First Stent failure Management and Long-Term Outcomes- Retrospective Insights from A single Center Cohort.

Background: Coronary stents has dramatically changed the revascularization paradigm. Yet, Stent failure (SF) is a major limitation. Understanding the pathogenesis behind SF, primarily by applying intravascular imaging is recommended.

Objectives: We aimed to assess real-life management, and outcomes of first event of SF.

Methods: Patients with 1st event of SF assigned to angioplasty between January 2008 and March 2023 were included. Management and long-term outcomes of SF were tested.

Results: 257 patients were allocated: 161 stent restenosis (ISR) and 96 thrombosis (ST). SF was managed by re-stenting (64% vs. 57%), DCB (17% vs. 4%), PB (7% vs. 37%), and CABG in (12% vs. 2%), in the ISR and ST groups, respectively. No intravascular imaging was applied. At follow-up repeat SF angioplasty (RSFA) was required in 10% of the ISR group (100% presenting as ISR): 10.7%, 16.7%, 12.4% and 0% in the DCB, PB, DES, and CABG arms, respectively, at median of 21.4 months. RSFA was achieved by stenting 75%, DCB 13%, PB 13%, and CABG 6%. Notably, recurrent SF occurred earlier than 1st SF in 63% of cases. In the ST group RSFA was required in 14% (67% ISR and 33% ST) at median follow up of 7.7 years: 0% post DCB, 2.9% post PB, and 23.4% post stenting. RSFA was achieved by stenting 60%, DCB 20%, or PB 20%. Recurrent SF occurred earlier than 1st SF in 33% of cases. Intravascular imaging was absent in both groups.

Conclusions: Unraveling the mechanism of SF using meticulous intracoronary tools is perceived as essential for optimal outcomes. DES and DCB strategies nonsignificantly reduced the risk for recurrent SF post ISR, while PB significantly reduced the risk for recurrent SF post ST. The high percentage of earlier recurrent SF together with stent inferiority in RSFA emphasize the importance of intracoronary investigation for optimal RSFA outcomes.