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Recurrent revascularization at 10 years after percutaneous treatment of drug-eluting stent restenosis

https://doi.org/10.1007/s00392-025-02625-4

Tobias Koch (München)1, T. Lenz (München)1, T. Rheude (München)1, S. Cassese (München)1, M. Kazazi (München)1, E. Xhepa (München)1, T. Keßler (München)1, J. Wiebe (München)2, M. Ferenc (Bad Krozingen)3, K.-L. Laugwitz (München)4, M. Joner (München)1, H. Schunkert (München)1, A. Kastrati (München)1, S. Kufner (München)1

1Deutsches Herzzentrum München Klinik für Herz- und Kreislauferkrankungen München, Deutschland; 2Herz-Gefäss-Zentrum Nymphenburg München, Deutschland; 3Universitäts-Herzzentrum Freiburg / Bad Krozingen Klinik für Kardiologie und Angiologie II Bad Krozingen, Deutschland; 4Klinikum rechts der Isar der Technischen Universität München Klinik und Poliklinik für Innere Medizin I München, Deutschland

 

Objectives:
To investigate long-term (10 years) incidence of recurrent revascularization events after percutaneous treatment of drug-eluting in-stent restenosis (DES-ISR).

Background:
Treatment decisions in patients presenting with recurrence of ISR remain particularly challenging with data and guideline recommendations for repeat percutaneous coronary intervention (PCI) being scant.

Methods:
This analysis includes 500 lesions (402 patients) randomized to treatment with plain balloon (PB), drug-coated balloon (DCB) or drug-eluting stent (DES) in the randomized ISAR-DESIRE 3 trial with 10 years follow-up. Primary endpoint of this total event analysis was repeat target lesion revascularization (R-TLR) including all, first and subsequent, events.

Results:
At 10 years, a first R-TLR was required in 204 lesions, 82 in PB, 70 in DCB and 52 in DES group. Of these 204 lesions, 76 lesions required subsequently one or more R-TLR. The total number of R-TLR events was 373, 162 in PB, 124 in DCB and 87 in DES.
Treatment with DCB versus PB resulted in reduction of first R-TLR hazard ratio [HR] = 0.59, 95% confidence interval [CI]: 0.41-0.83; and total R-TLR; HR=0.68, 95% CI: 0.49-0.95.
Treatment with DES versus PB resulted in reduction of first R-TLR hazard ratio HR= 0.46, 95% CI: 0.31-0.68); and total R-TLR; HR=0.52, 95% CI: 0.36-0.75). Treatment with DCB versus DES showed comparable results.

Conclusions:
In lesions treated for DES-ISR the absolute number of recurrent revascularization events remains considerable throughout 10 years after index PCI. DES and DCB showed favorable results as compared to PB concerning prevention of first but also subsequent repeat revascularizations.
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