Incidence of in-stent restenosis in pre-transcatheter aortic valve replacement percutaneous coronary intervention
Mawri S, Basir MB, Fuller B, Guerrero M, Alfonso C, O'Neill B, Heldman A, Cohen M, Greenbaum A, O'Neill W. Incidence of in-stent restenosis in pre-transcatheter aortic valve replacement percutaneous coronary intervention. Catheter Cardiovasc Interv. 2017;89:S57.
Catheter Cardiovasc Interv
Background: In-stent restenosis (ISR) continues to be a vexing problem of contemporary percutaneouscoronary intervention (PCI). A large proportion ofpatients with severe aortic stenosis concomitantly have significant coronary artery disease requiring PCI prior to transcatheter aortic valve replacement(TAVR). No data exists on the incidence of ISR in the TAVR population. Methods: We retrospectively reviewed 355 patients who underwent TAVR at two tertiary referral centers (Henry Ford Hospital and the University of Miami) from April, 2010 to March, 2013. All patients who underwent coronary stenting within 1 year prior to TAVR were included in the analysis. Results: Sixty-one (17%) patients met inclusion criteria. Baseline patient and procedure characteristics are listed in Table 1. A total of 86 stents were placed: 59% bare metal, 18% first generation drug eluting stents (DES) and 44% second generation DES. All patients received Edward Sapien valves (Edwards Lifescience, Irvine, CA). On average stents were placed 104 days prior to TAVR (Range 0-350 days). Patients were followed for an average period of 1.1 years. Patients were evaluated either angiographically at time of TAVR or clinically thereafter with subsequent angiographic surveillance based on clinical symptoms. ISR occurred in 2 (2.3%) cases - one with a first-generation DES and the second with a bare metal stent. Conclusion: Our findings suggest that the incidence of ISR in patients who undergo TAVR is below previously published rates, despite a high use of bare metal stents. The mechanism underlying this finding is unknown. It is plausible the restenosismay have a different mechanism in this population.