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Observational Study
. 2020 Apr 1;95(5):954-958.
doi: 10.1002/ccd.28645. Epub 2019 Dec 19.

Recurrent pulmonary vein stenosis after successful intervention: Prognosis and management of restenosis

Erin A Fender  1 , R Jay Widmer  2 , Madeline K Mahowald  1 , David O Hodge  3 , Douglas L Packer  1 , David R Holmes Jr  1
Affiliations
Observational Study

Recurrent pulmonary vein stenosis after successful intervention: Prognosis and management of restenosis

Erin A Fender et al. Catheter Cardiovasc Interv. .

Abstract

Objectives: The aim of this study was to describe management of recurrent pulmonary vein stenosis (PVS) and determine if stenting is superior to balloon angioplasty (BA) in preventing subsequent restenosis.

Background: PVS is a serious complication of atrial fibrillation ablation. BA and stenting are effective therapies; however, restenosis frequently occurs. Here we report management of recurrent stenosis.

Methods: This was a prospective observational study performed from 2000 to 2014.

Results: One hundred and thirteen patients with severe PVS underwent intervention in 88 veins treated with BA and 81 treated with stenting. Forty-two patients experienced restenosis. Restenosis was more common in veins treated with BA (RRR 53% [95% CI 32-70%, p = .008]). A second intervention was performed in 41 patients. In the 34 vessels treated with initial BA, 24 were treated for restenosis with a stent and 10 were treated with a second BA. The recurrence rate was 46% in those treated with BA followed by stenting and 50% in those treated with two BA procedures. In the 22 veins treated with initial stenting, 9 were treated with another stent and 13 were treated with BA. The recurrence rate was 44% in those treated with a second stent and 46% for those treated with a stent followed by BA. The risk of a third stenosis was the same among all groups (Analysis of variance [ANOVA] p = .99). Limited sample size precluded analysis of outcome by stent size.

Conclusions: Restenosis occurred in 44% of patients overall. Management is challenging; stenting does not appear to be superior to BA.

Keywords: balloon angioplasty; catheter ablation; pulmonary vein stenosis; stents; vascular patency.

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References

REFERENCES

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