Send to

Choose Destination
See comment in PubMed Commons below
Ital Heart J. 2004 Apr;5(4):271-9.

Randomized trial of conventional balloon angioplasty versus cutting balloon for in-stent restenosis. Acute and 24-hour angiographic and intravascular ultrasound changes and long-term follow-up.

Author information

Institute of Cardiology, University of Milan, Centro Cardiologico Monzino, IRCCS, Italy.



The aim of this study was to investigate the angiographic and intravascular ultrasound (IVUS) changes following cutting balloon (CB) and percutaneous transluminal coronary angioplasty (PTCA) treatment in in-stent restenosis.


Fifty consecutive patients with in-stent restenosis were randomized to treatment with CB (n = 25) or PTCA (n = 25). The size of the device was selected using IVUS according to a 1:1 device-to-stent ratio and balloons were inflated to a maximal pressure of 8 atm. Quantitative coronary angiography (QCA) and IVUS (both planar and volumetric) evaluations were carried out before and after treatment and 24 hours later. In case of suboptimal results at 24 hours (> or = 50% diameter stenosis at QCA and/or < or = 4.7 mm2 minimal lumen area [MLA] at IVUS), the patients were re-randomized to receive additional treatment (CB for PTCA and vice versa) or to follow-up. Measurements included the minimal lumen diameter and diameter stenosis for QCA and the external elastic membrane area (EEMA), stent area (SA), MLA, restenosis area (RA = SA - MLA) and plaque + media area (PMA = EEMA - SA) for IVUS.


A similar minimal lumen diameter increase (1.19 +/- 0.44 vs 1.37 +/- 0.55 mm) and diameter stenosis decrease (-37 +/- 14 vs -45 +/- 13%) was found after PTCA and CB. No significant difference was found in MLA increase (4.81 +/- 1.9 vs 5.45 +/- 2.0 mm2) and RA decrease (-3.8 +/- 1.3 vs -4.2 +/- 1.7 mm2) in PTCA and CB. SA, EEMA and PMA did not significantly change after treatment in either group. Of the total mean lumen enlargement after PTCA and CB, 20% was due to additional stent expansion and 80% was due to RA decrease. At 24 hours, a greater minimal lumen diameter increase (-0.23 +/- 0.34 vs -0.06 +/- 0.23 mm, p = 0.03) and MLA loss (-1.9 +/- 1.4 vs 0.37 +/- 0.8 mm2, p = 0.000) and RA increase (1.74 +/- 1.3 vs 0.37 +/- 0.52 mm2, p = 0.000) were detected in PTCA vs CB. Volumetric changes paralleled planar IVUS variations. A suboptimal result was more frequently found in PTCA as compared to CB (36 vs 4%, p < 0.01). At follow-up, PTCA had a higher target lesion revascularization as compared to CB (40 vs 12.5%, p < 0.05).


In in-stent restenosis, PTCA and CB share similar effects and mechanisms of lumen enlargement. In-stent tissue is mainly redistributed along a larger stent rather than being extruded out of the stent struts. At 24 hours, a significant lumen loss (instant restenosis) occurred more frequently in PTCA as compared to CB and may account for a higher target lesion revascularization in this group.

[Indexed for MEDLINE]
PubMed Commons home

PubMed Commons

How to join PubMed Commons

    Supplemental Content

    Loading ...
    Support Center