Prior bare metal stent restenosis as a predictor for subsequent restenosis: the lightning often strikes twice.

摘要

The long-term success of stent implantation in coronary arteries is limited by in-stent restenosis (ISR). Drug-eluting stents (DES) substantially reduced the occurrence of ISR but raised concerns for in-stent thrombosis and its grim consequences. The need for prolonged therapy with dual anti-platelet therapy as well as the financial burden that is associated with widespread use of DES limit their penetration in large areas over the globe. From recent European surveys it was estimated that DES penetration is less than 50%.The decision whether to implant a DES or a bare metal stent (BMS) is often based on the predicted risk for ISR. The clinically and angiographically known risk factors for such restenosis include diabetes mellitus and renal failure as well as small-diameter arteries and long lesions. Any additional predictors for ISR occurrence are important to help the interventional cardiologist in reaching an intelligent and evidence-based decision as to the type of stent implanted. In the current issue of Cardiology, Ferguson et al. [1] report that previous restenosis following BMS implantation is a strong and independent predictor of further BMS restenosis.