Comparison of 12-month angiographic outcomes between repeat drug-eluting stent implantation and drug-coated balloon treatment for restenotic lesion caused by stent fracture.

We aimed to compare the angiographic outcomes between repeat drug-eluting stent (DES) implantation and drug-coated balloon (DCB) treatment for restenotic lesion caused by stent fracture (SF). The treatment of restenotic lesion caused by SF after DES implantation has not been well evaluated. From April 2007 to April 2015, 9320 lesions were implanted with a DES during percutaneous coronary intervention in our hospital; of those, 815 lesions (8.7%) showed restenosis on the follow-up angiogram. The study subjects were 47 consecutive patients with 69 restenotic lesions caused by SF and treated by target lesion revascularization (TLR); of those, 27 patients with 45 lesions were treated with repeat DES during TLR (either a cobalt-chromium or platinum-chromium everolimus-eluting stent or zotarolimus-eluting stent; DES group), and 20 patients with 24 lesions were treated with DCB (DCB group) during TLR. The 12-month cumulative incidence of repeat TLR and predictors of repeat TLR was evaluated. Restenosis and re-restenosis were defined as % diameter stenosis > 50% on the follow-up angiogram. SF was defined as complete or partial separation of the stent strut as assessed by plain fluoroscopy. Baseline characteristics were similar between the groups. The 12-month binary re-restenosis rate and cumulative incidence of repeat TLR between the DES group and DCB group were 44.4% and 37.5% (p = 0.58) and 43.9% and 31.9% (p = 0.31), respectively. On multivariate analysis, a lesion with vessel hinge movement was an independent predictor of repeat TLR (p = 0.02, hazard ratio: 6.54, 95% confidence interval 1.30-32.8). The 12-month repeat TLR rate was high in both groups. After treating restenosis lesions caused by SF after DES implantation, mechanical stress leads to further interventional treatment, regardless of the type of device used.