Prognosis and Management of Recurrent Stenosis After Pulmonary Vein Stenting

Abstract

Background

Pulmonary vein stenting is effective for severe pulmonary vein stenosis, which is limited by restenosis. The assessment and management of in-stent restenosis (ISR) are inadequate, and follow-up outcomes after reintervention remain unknown.

Objectives

This study aimed to assess the prognosis and management of pulmonary vein ISR and determine whether the modified stent-in-stent strategy is superior to balloon angioplasty (BA) in treating ISR.

Methods

The authors conducted a prospective observational study on patients with severe pulmonary vein stenosis post radiofrequency ablation for atrial fibrillation.

Results

A total of 107 patients with 174 severely stenosed veins underwent successful stenting. Forty-three veins among 36 patients experienced ISR (24.7%, 43 of 174). Veins developing ISR had smaller diameter stents (7.8 ± 0.8 mm vs 9.2 ± 0.7 mm; P = 0.008). Restenosis veins were assigned to BA group or stent-in-stent group. Success rate was 95.7% for BA and 90.0% for stent-in-stent. Twelve veins experienced recurrent ISR, including 2 in stent-in-stent group (11.1%, 2 of 18) and 10 in BA group (45.5%, 10 of 22). The risk of recurrent stenosis was significantly lower in veins treated with the stent-in-stent method than with BA (HR: 0.21; 95% CI: 0.07-0.64; P = 0.02). Patients in the stent-in-stent group had greater exercise endurance and better World Health Organization cardiac functional class compared with BA group (F = 7.2; P < 0.05; and F = 4.4; P < 0.05, respectively) at 6- and 12-month follow-ups.

Conclusions

Our modified stent-in-stent implantation approach is superior to BA for treating pulmonary vein ISR, by reducing recurrent restenosis rate and improving exercise endurance.