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type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/advagg_css\/css__ce2QY63WIanKyr8eSq7eavr1XQRRmFD6ZSmwpyJi8lM__zXwFqpqmxrZOXXcd_TpBQpjuELbmIP9wBR5UuTDWAO4__YJWWMMdfCJuAFm5cUEp88OsodhO3ZA-2lzRfoBsSlk4.css\u0022 media=\u0022all\u0022 \/\u003E\n\u003Clink rel=\u0027stylesheet\u0027 type=\u0027text\/css\u0027 href=\u0027\/sites\/all\/modules\/contrib\/panels\/plugins\/layouts\/onecol\/onecol.css\u0027 \/\u003E\u003C\/head\u003E\u003Cbody\u003E\u003Cdiv class=\u0022panels-ajax-tab-panel panels-ajax-tab-panel-sageoa-tab-art\u0022\u003E\u003Cdiv class=\u0022panel-display panel-1col clearfix\u0022 \u003E\n  \u003Cdiv class=\u0022panel-panel panel-col\u0022\u003E\n    \u003Cdiv\u003E\u003Cdiv class=\u0022panel-pane pane-highwire-markup\u0022 \u003E\n  \n      \n  \n  \u003Cdiv class=\u0022pane-content\u0022\u003E\n    \u003Cdiv class=\u0022highwire-markup\u0022\u003E\u003Cdiv xmlns=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 id=\u0022content-block-markup\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cdiv class=\u0022article fulltext-view \u0022\u003E\u003Cspan class=\u0022highwire-journal-article-marker-start\u0022\u003E\u003C\/span\u003E\u003Cdiv class=\u0022section abstract\u0022 id=\u0022abstract-1\u0022\u003E\u003Ch2\u003ESummary\u003C\/h2\u003E\n            \u003Cp id=\u0022p-1\u0022\u003EAngioplasty with a paclitaxel-eluting balloon was as effective as implantation of another drug-eluting stent for patients who have in-stent restenosis in the presence of a \u201climus\u201d-eluting stent. Both procedures were significantly better than plain old balloon angioplasty, according to the results of the Intracoronary Stenting and Angiographic Results: Drug Eluting Stents for In-Stent Restenosis: 3 Treatment Approaches [ISAR-DESIRE 3; \u003Ca class=\u0022external-ref external-ref-type-clintrialgov\u0022 href=\u0022\/lookup\/external-ref?link_type=CLINTRIALGOV\u0026amp;access_num=NCT00987324\u0026amp;atom=%2Fspmdc%2F12%2F17%2F18.atom\u0022\u003ENCT00987324\u003C\/a\u003E] trial.\u003C\/p\u003E\n         \u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003EInterventional Techniques \u0026amp; Devices\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EValvular Disease\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003ECardiology Clinical Trials\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EInterventional Radiology\u003C\/li\u003E\u003C\/ul\u003E\u003Cp id=\u0022p-2\u0022\u003EAngioplasty with a paclitaxel-eluting balloon (PEB) was as effective as implantation of another drug-eluting stent (DES) for patients who have in-stent restenosis (ISR) in the presence of a \u201climus\u201d-eluting stent. Both procedures were significantly better than plain old balloon angioplasty (POBA), according to the results of the Intracoronary Stenting and Angiographic Results: Drug Eluting Stents for In-Stent Restenosis: 3 Treatment Approaches [ISAR-DESIRE 3; \u003Ca class=\u0022external-ref external-ref-type-clintrialgov\u0022 href=\u0022\/lookup\/external-ref?link_type=CLINTRIALGOV\u0026amp;access_num=NCT00987324\u0026amp;atom=%2Fspmdc%2F12%2F17%2F18.atom\u0022\u003ENCT00987324\u003C\/a\u003E] trial.\u003C\/p\u003E\u003Cp id=\u0022p-3\u0022\u003EDES have been used for more than a decade, but the optimal treatment for ISR is unknown, said Robert A. Byrne, MBBCh, PhD, Deutsches Herzzentrum, Technische Universit\u00e4t, Munich, Germany, who reported on the study. He said that drug-eluting balloon (DEB) angioplasty has the advantage of avoiding additional stent layers, and small studies have shown promise for the treatment in patients who have ISR with a bare-metal stent. However, the role of this therapy for ISR in the presence of a DES is poorly defined. ISAR-DESIRE 3 was designed to compare the antirestenotic efficacy of 3 treatments of limus-eluting ISR: angioplasty with a PEB, implantation of a paclitaxel-eluting stent (PES), and traditional balloon angioplasty.\u003C\/p\u003E\u003Cp id=\u0022p-4\u0022\u003EThe trial enrolled 402 patients at 3 centers in Germany. All patients had ISR of more than 50% in a limus-eluting stent in the presence of symptoms\/signs of ischemia. Patients with left main stem disease, acute ST-elevation myocardial infarction (MI), or cardiogenic shock were excluded. The patterns of restenosis at baseline were well balanced across the groups, with a focal pattern in two-thirds of patients and a nonfocal pattern in one-third.\u003C\/p\u003E\u003Cp id=\u0022p-5\u0022\u003EThe patients were randomly assigned in a 1:1:1 manner to the 3 treatment groups. The primary endpoint was percentage diameter restenosis on follow-up angiography at 6 to 8 months. Secondary efficacy endpoints were binary restenosis and target lesion revascularization (TLR). Safety endpoints were target lesion thrombosis and a composite of death and MI.\u003C\/p\u003E\u003Cp id=\u0022p-6\u0022\u003EOn follow-up angiography, the percentage restenosis was noninferior between the PEB and PES groups (38.0% vs 37.4%, respectively (p for noninferiority=0.007; \u003Ca id=\u0022xref-fig-1-1\u0022 class=\u0022xref-fig\u0022 href=\u0022#F1\u0022\u003EFigure 1\u003C\/a\u003E). Both the PEB and PES groups had significantly lower percentage of restenosis when compared with the POBA group (54.1%; p\u0026lt;0.001). The results for the secondary efficacy endpoints followed a similar pattern. Binary restenosis (percentage of patients with restenosis \u0026gt;50%) was found in 26.5% of the patients in the PEB group and 24.0% of the patients in the PES group (p=0.61) compared with 56.7% of the patients in the POBA group (p\u0026lt;0.001). The rates (TLR) were 22.1% for the PEB group, 13.5% for the PES group (p=0.09), and 43.5% for the POBA group (p\u0026lt;0.001).\u003C\/p\u003E\u003Cdiv id=\u0022F1\u0022 class=\u0022fig pos-float  odd\u0022\u003E\u003Cdiv class=\u0022highwire-figure\u0022\u003E\u003Cdiv class=\u0022fig-inline-img-wrapper\u0022\u003E\u003Cdiv class=\u0022fig-inline-img\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/12\/17\/18\/F1.large.jpg?width=800\u0026amp;height=600\u0026amp;carousel=1\u0022 title=\u0022Primary Endpoint.\u0022 class=\u0022fragment-images colorbox-load\u0022 rel=\u0022gallery-fragment-images-1963979381\u0022 data-figure-caption=\u0022Primary Endpoint.\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003E\u003Cimg class=\u0022fragment-image\u0022 alt=\u0022Figure 1.\u0022 src=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/12\/17\/18\/F1.medium.gif\u0022\/\u003E\u003C\/a\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cul class=\u0022highwire-figure-links inline\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/12\/17\/18\/F1.large.jpg?download=true\u0022 class=\u0022highwire-figure-link highwire-figure-link-download\u0022 title=\u0022Download Figure 1.\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload figure\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/12\/17\/18\/F1.large.jpg\u0022 class=\u0022highwire-figure-link highwire-figure-link-newtab\u0022 target=\u0022_blank\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EOpen in new tab\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/14271\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003Cdiv class=\u0022fig-caption attrib\u0022\u003E\u003Cspan class=\u0022fig-label\u0022\u003EFigure 1.\u003C\/span\u003E \n            \u003Cp id=\u0022p-7\u0022 class=\u0022first-child\u0022\u003EPrimary Endpoint.\u003C\/p\u003E\n         \u003Cq class=\u0022attrib\u0022 id=\u0022attrib-1\u0022\u003EReproduced with permission from RA Byrne, MBBCh, PhD.\u003C\/q\u003E\u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cp id=\u0022p-8\u0022\u003EIn the safety analysis, the rates of death\/MI and target lesion thrombosis were low and similar among all 3 groups.\u003C\/p\u003E\u003Cp id=\u0022p-9\u0022\u003EProf. Byrne noted that the results of the study are limited to limus-eluting stent ISR and cannot be extrapolated to PES ISR. However, he added that there is no compelling reason to believe that the findings would differ substantially.\u003C\/p\u003E\u003Cp id=\u0022p-10\u0022\u003EThe researchers concluded that because DEB angioplasty obviates the need for additional stent implantation, this new treatment should be the default strategy for patients who have limus-eluting stent ISR. The European guidelines currently recommend DEB therapy for use only with bare-metal stents.\u003C\/p\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2012 MD Conference Express\u00ae\u003C\/li\u003E\u003C\/ul\u003E\u003Cspan class=\u0022highwire-journal-article-marker-end\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Cspan id=\u0022related-urls\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Ca href=\u0022http:\/\/mdc.sagepub.com\/content\/12\/17\/18.abstract\u0022 class=\u0022hw-link hw-link-article-abstract\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView Summary\u003C\/a\u003E\u003C\/div\u003E  \u003C\/div\u003E\n\n  \n  \u003C\/div\u003E\n\u003C\/div\u003E\n  \u003C\/div\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_figures.js?nzn73q\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_openurl.js?nzn73q\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}