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.