Objective: To assess the effectiveness of routine sirolimus eluting stent (SES) implantation for unselected patients with instent restenosis and to provide preliminary information about the angiographic outcome for lesion subgroups and for different in-stent restenosis patterns. Design: Prospective, single centre registry. Setting: Tertiary referral centre. Patients: 44 consecutive patients(53 lesions) without previous brachytherapy who were treated with SES for in-stent restenosis were evaluated. Routine angiographic follow up was obtained at six months and the incidence of major adverse cardiovascular events was evaluated. Results: At baseline, 42%of the lesions were focal, 21%diffuse, 26%proliferative, and 11%total occlusions. Small vessel size (reference diameter ≤2.5 mm) was present in 49%, long lesions( > 20 mm) in 30%, treatment of bypass grafts in 13%, and bifurcation stenting in 18%. At follow up, post-SES restenosis was observed in 14.6%. No restenosis was observed in focal lesions. For more complex lesions, restenosis rates ranged from 20-25%. At the one year follow up, the incidence of death was 0, myocardial infarction 4.7%(n=2), and target lesion revascularisation 16.3%(n=7). The target lesion was revascularised because of restenosis in 11.6%(n=5). Conclusions: Routine SES implantation is highly effective for focal in-stent restenosis and appears to be a promising strategy for more complex patterns of restenosis.
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