Routine debulking rotational atherectomy preparation before drug eluting balloons for the management of in-stent restenosis (original) (raw)
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Journal of Interventional Cardiology
Objectives. To determine the one-year and five-year occurrence and prognosticators of major adverse cardiac events (MACE: composition of all-cause death, myocardial infarction, target vessel revascularization, and vessel thrombosis), mortality, and target lesion revascularization (TLR) in patients with in-stent restenosis (ISR) treated with drug-eluting balloons (DEBs). Background. DEBs have become an emerging therapeutic option for ISR. We report the results of a single-center retrospective study on the treatment of ISR with DEB. Methods. 94 consecutive patients with ISR treated with the paclitaxel-eluting balloon were retrospectively studied between August 2011 and December 2019. Results. The one-year MACE rate was 11.8%, and the five-year MACE rate was 39.8%. The one-year mortality was 5.3%, and the five-year mortality rate was 21.5%. The one-year TLR rate was 4.3%, and the five-year rate was 18.7%. The univariable-Cox proportional hazard models for TLR showed lesion length, and ...
The Journal of invasive cardiology, 2012
BACKGROUND The advent of drug-eluting balloons (DEBs) is a promising development for coronary revascularization procedures, especially for in-stent restenosis (ISR). This study aims to highlight our experience with DEBs in the treatment of drug-eluting ISR at a tertiary care hospital in Pakistan. METHODS All patients presenting to our institution from August 2008 to February 2011 with significant drug-eluting in-stent restenosis (DES-ISR) who were eligible to receive treatment via DEB were included in the analysis. Patient baseline characteristics and angiographic data about the lesion characteristics were obtained. Postprocedural and follow-up endpoints, including cardiac death, myocardial infarction, and repeat revascularization, ie, major adverse cardiovascular events (MACE), were included in the analysis. RESULTS A total of 26 patients received treatment with DEB in the study period, with a significant number having major predisposing factors for the development of ischemic hear...
Circulation, 2002
Background-Aim of this trial was to compare rotational atherectomy followed by balloon angioplasty (rotablation [ROTA] group) with balloon angioplasty (percutaneous transluminal coronary angioplasty [PTCA] group) alone in patients with diffuse in-stent restenosis. Methods and Results-The ARTIST study is a multicenter, randomized, prospective European trial with 298 patients with in-stent restenosisϾ70% (mean lesion length, 14Ϯ8 mm) in stents, implanted in coronary arteries for Ն3 months. In the PTCA group, angioplasty was performed at the discretion of the local investigator, and rotablation was performed by using a stepped-burr approach followed by adjunctive PTCA with low (Յ6 atm) inflation pressure. Intravascular ultrasound during the intervention and at follow-up was used in a substudy in 86 patients (45 PTCA, 41 ROTA). Angiography demonstrated no difference regarding the short-term outcome, with equivalent procedural success rates defined as remaining stenosis Ͻ30% (89% PTCA, 88% ROTA). However, the results showed that, in the long term, PTCA was a significantly better strategy than ROTA. Mean net gain in minimal lumen diameter was 0.67 mm and 0.45 mm for PTCA and ROTA, respectively (Pϭ0.0019). Mean gain in diameter stenosis was 25% and 17% (Pϭ0.002), resulting in restenosis (Ն50%) rates of 51% (PTCA) and 65% (ROTA) (Pϭ0.039). By intravascular ultrasound, the major difference was the missing stent over-expansion during PTCA after ROTA. Six-month event-free survival was significantly higher after PTCA (91.3%) compared with ROTA (79.6%, Pϭ0.0052). Conclusions-In terms of the primary objective of the study, PTCA produced a significantly better long-term outcome than ROTA followed by adjunctive low-pressure PTCA. (Circulation. 2002;105:583-588.)
Drug-eluting balloon: Initial experience in patients with in-stent restenosis (ISR)
Medical Journal Armed Forces India, 2014
Background: In-stent restenosis is the most important limitation of modern coronary angioplasty. Drug-eluting stents solve this problem but at the cost of late stent thrombosis and longer duration of dual-antiplatelet therapy. Drug-eluting balloon (DEB) technology is now available and offers an attractive option for treatment of restenosis. Methods: A cohort of 20 patients with in-stent restenosis after stenting were treated with a drug-eluting balloon and were followed up clinically and angiographically for 6 months. Results and conclusion: Procedural success was achieved in all patients. 6 month clinical follow-up was available for all and 6 month angiographic follow up for 17 patients. On 6 month follow-up, 5 of the 20 patients had recurrence of angina and 4 patients had angiographic restenosis (2 focal, 2 diffuse). The mean Canadian Cardiovascular Society angina score improved significantly from 3.1 to 1.1. DEB offers a novel method of treatment for patients with in-stent restenosis with a good safety and efficacy profile.
Journal of Endovascular Therapy, 2012
urpose: To evaluate the safety and efficacy of drug-eluting balloons (DEB) for the treatment of in-stent restenosis (ISR) after carotid artery stenting (CAS). Methods: Among 830 consecutive patients undergoing CAS between November 2001 and June 2012, significant ISR (.80% stenosis) occurred in 10 (1.2%) asymptomatic patients. Angioplasty with DEB treatment was performed in 7 patients (6 internal and 1 common carotid arteries) at a mean of 20.9619.4 months (median 12.1) after CAS. Intravascular ultrasound (IVUS)-guided predilation with distal cerebral protection was carried out with a cutting balloon followed by inflation of a DEB with a 1:1 stent-to-balloon size ratio. Results: Technical/procedural success was achieved in all cases. Angiographic stenosis decreased from 83%65% to 18%66%. At IVUS evaluation, minimal lumen area increased from 3.1961.73 to 12.7861.97 mm 2 (p¼0.0001), stent area was unchanged (from 17.3664.36 to 17.5264.34 mm 2 , p¼0.70), and the restenosis area decreased from 13.5865.27 to 4.7163.06 mm 2 (p¼0.0005). At a mean follow-up of 13.761.5 months (median 13.7), 1 patient had a minor stroke ipsilateral to the ISR vessel 2 months after DEB treatment; the stent was widely patent on duplex ultrasound and angiographic images. Overall, the average PSV decreased from 4.061.0 to 0.960.1 m/s (p¼0.0001). At 6 and 12 months, PSVs after DEB treatment were significantly lower compared to those assessed at comparable intervals after CAS. Conclusion: The use of DEBs to treat ISR after CAS shows promising acute and midterm results.
International Heart Journal
Drug-coated balloon (DCB) has emerged as an alternative therapeutic choice for in-stent restenosis (ISR) lesions. Cutting balloon angioplasty (CBA) is also a strategy utilized to treat tight stenotic lesions or ISR lesions. Few studies have focused on whether CBA plus DCB could achieve a better result in lowering the incidence of recurrent ISR. This study aimed to evaluate the efficacy of CBA plus DCB for ISR lesions. Between August 2011 and December 2017, 681 patients (937 lesions) were diagnosed with ISR and treated with DCBs in our hospital. The CBA plus DCB group comprised 90 patients who underwent PCI with further CBA plus DCB, and the DCB alone group comprised 591 patients who underwent percutaneous coronary intervention (PCI) with DCB alone. Baseline characteristics, the types of previous stents, lesion type, prevalence of ostial lesion and left main lesion, and pre-PCI and post-PCI stenotic percentage showed no significant difference between the two groups. Only post-PCI reference luminal diameter and size of DCB were larger in the CBA plus DCB group. During the one-year follow-up period, late loss and clinical outcomes did not differ between the two groups before and after propensity score matching. The incidence of subtotal/total occlusion with delay flow was lower in the CBA plus DCB group after propensity score matching (4.1% versus 10.9%; P = 0.030). In these patients with ISR lesions, the clinical outcomes and the incidence of repeat target lesion revascularization were similar after treatment with CBA plus DCB versus DCB alone. Further study is warranted, including prospective, randomized comparisons.