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Drug-Eluting Stents and In-Stent Restenosis—Reply
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In Reply: Regarding the logistics required to administer the 600 mg of clopidogrel 2 hours before intervention, it is important to note that according to our routine practice, all patients scheduled for coronary angiography due to suspected or established coronary artery disease are pretreated with a 600-mg loading dose of clopidogrel.1 This makes possible the performance of ad hoc interventions.
The protocol did not give recommendations about the use of direct stenting because no influence on restenosis has been described with this technique for both bare metal and drug-eluting stents.2-4 In the Intracoronary Stenting and Angiographic Results: Drug-Eluting Stents for In-Stent Restenosis (ISAR-DESIRE) trial, the operators used direct stenting only when they felt this technique would have been possible. Thus, it was only used in selected patients, which prevents any meaningful comparison with predilatation. Direct stenting was used in 18 patients (18.0%) of the sirolimus-eluting stent group and in 16 . . . [Full Text of this Article]
Adnan Kastrati, MD
kastrati@dhm.mhn.de
Albert Schömig, MD
Deutsches Herzzentrum
Technische Universität
Munich, Germany
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