Recurrent Revascularization at 10 Years After Percutaneous Treatment of Drug-Eluting Stent Restenosis

To investigate long-term incidence of recurrent revascularization events after percutaneous treatment of drug-eluting in-stent restenosis (DES-ISR). Treatment of patients with recurrence of ISR remains particularly challenging with data and guideline recommendations for repeat PCI being scant. In this post-hoc analysis, 402 patients (500 lesions) being assigned to plain balloon (PB), drug-coated balloon (DCB) or drug-eluting stent (DES) in the randomized ISAR-DESIRE 3 trial were followed-up over a median of 10.3 years. Primary endpoint was total repeat target lesion revascularization (R-TLR) including all, first and recurrent events. At the end of follow-up, first R-TLR was required in 204 lesions, 82 in PB, 70 in DCB and 52 in DES group. Total number of R-TLR was 373: 162 in PB, 124 in DCB and 87 in DES. During the first year of follow-up, the risk of total R-TLR was reduced by DCB (hazard ratio [HR] = 0.36 [95% confidence interval: 0.24-0.54]) and by DES (HR = 0.23 [0.14-0.38]) as compared with PB. After 1 year, the risk of total R-TLR was non-significantly reduced by DCB (HR = 0.77 [0.51-1.16]) and significantly reduced by DES (HR = 0.61 [0.39-0.95]) as compared with PB. Risk in DCB- versus DES-group was similar during (HR = 1.54 [0.89-2.69]) and after 1year (HR = 1.26 [0.82 - 1.92]). The total number of R-TLR over 10 years after treatment of DES-ISR is high. DCB and, particularly DES, are able to reduce the need of both first and recurrent revascularizations as compared with PB.