[Treatment of drug-eluting stent restenosis with another drug-eluting stent: do not fail the second time!].

Drug-eluting stents (DES) have dramatically diminished but not eradicated in-stent restenosis (ISR) and even though they have resulted in single digit rates in simple lesions, it is not unusual to see double figure rates of ISR in more complex lesions and real world studies. Despite this problem little attention has been given to evaluate the pathogenesis of DES restenosis and the optimal treatment of this condition. Thus, the study by Byrne et al1 published in this issue of Revista Española de Cardiología is welcomed and provides a foundation for the discussion of DES restenosis. First we would like to briefly highlight what we have learnt over the last few years about DES failure. We have seen a developing consensus regarding the predictors of DES restenosis which include: diabetes, treatment of ISR, ostial lesions, lesion length, stent length, reference vessel diameter, post-intervention minimal lumen diameter, final diameter stenosis, non-left anterior descending coronary artery lesions, and complex lesions.24 While the treatment of bifurcation lesions and chronic total occlusions were not shown to be predictors of restenosis in some studies, there is no doubt that both are associated with increased risk. In bifurcations the ostium of the side branch is the major offender while the increased risk with long stents frequently utilized in chronic total occlusions is the corresponding risk factor. Bryne et al1 found that in 43 restenotic lesions, the predominant pattern of paclitaxel-eluting stent (PES) restenosis was focal (77%) with a non-focal pattern in the remainder (Table 1).5-11 Recent data from our centre examining the largest cohort of restenotic lesions found a similar spread of restenosis patterns.12 In a cohort of Treatment of Drug-Eluting Stent Restenosis With Another Drug-Eluting Stent: Do Not Fail the Second Time! Antonio Colombo,a,b and Azeem Latiba