Comparison of angiographic patterns of in-stent restenosis between sirolimus- and paclitaxel-eluting stent

Background Angiographic pattern of in-stent restenosis (ISR) after drug-eluting stent (DES) implantation was known to be different to that after bare metal stent (BMS) implantation. But the different angiographic patterns of ISR and its prognosis between sirolimus-eluting stent (SES) and paclitaxel-eluting stent (PES) has not been properly addressed in large scale studies. Objectives and methods We evaluated the angiographic pattern of ISR and their subsequent clinical outcomes in 177 ISR lesions of 163 consecutive patients previously treated with SES (n = 97) or PES (n = 80) from February 2003 to April 2005. Results In angiographic ISR pattern, diffuse ISR was more common in PES implantation (SES vs PES; 23.7% vs 48.7%, p = 0.001) mainly because of higher incidence of diffuse intrastent ISR (8.2% vs 33.8%, p < 0.001, respectively) whereas focal ISR was more common in SES implantation (76.3% vs 51.3%, p = 0.001, respectively) mainly because of higher incidence of focal margin ISR (27.8% vs 2.5%, p < 0.001, respectively). Among 177 ISR lesions, clinically driven target lesion revascularization (TLR) was performed in 53.6% in SES implantation and 56.3% in PES implantation (p = 0.725). Conclusion Angiographic pattern of ISR differed after SES and PES implantation, but their subsequent TLR rate was similar to both types of DES.