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

Erin A. Fender, R. Jay Widmer, Madeline K. Mahowald, David O. Hodge, Douglas L. Packer, David R. Holmes

Research output: Contribution to journalArticle

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.

Original languageEnglish (US)
Pages (from-to)954-958
Number of pages5
JournalCatheterization and Cardiovascular Interventions
Volume95
Issue number5
DOIs
StatePublished - Apr 1 2020

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Keywords

  • balloon angioplasty
  • catheter ablation
  • pulmonary vein stenosis
  • stents
  • vascular patency

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

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