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Circ J. 2018 Oct 25;82(11):2745-2752. doi: 10.1253/circj.CJ-18-0619. Epub 2018 Sep 7.

Different Neointimal Pattern in Early vs. Late In-Stent Restenosis and Clinical Outcomes After Drug-Coated Balloon Angioplasty - An Optical Coherence Tomography Study.

Lee JH1, Jung HW2, Kim JS3,4, Hong SJ3,4, Ahn CM3,4, Kim BK3,4, Ko YG3,4, Choi D3,4, Hong MK3,4,5, Jang Y3,4,5.

Author information

1
Division of Cardiology, Yeungnam University Medical Center, Yeungnam University College of Medicine.
2
Department of Cardiology, Daegu Catholic University Medical Center.
3
Severance Cardiovascular Hospital, Yonsei University College of Medicine.
4
Cardiovascular Institute, Yonsei University College of Medicine.
5
Severance Biomedical Science Institute, Yonsei University College of Medicine.

Abstract

BACKGROUND:

There are few data of clinical outcomes after drug-coated balloon (DCB) angioplasty according to neointimal characteristics. This study investigated long-term clinical outcomes according to timing of in-stent restenosis (ISR) and neointimal characteristics in patients with drug-eluting stent (DES) ISR after DCB angioplasty. Methods and Results: In all, 122 patients (122 ISR lesions), treated with DCB under optical coherence tomography (OCT) examination before and after DCB, were categorized as early ISR (<12 months; E-ISR; n=21) and late ISR (≥12 months; L-ISR; n=101). Associations between OCT-based neointima characteristics and period of ISR, as well as clinical outcomes after DCB were evaluated. Major adverse cardiac events (MACE) were a composite of cardiac death, non-fatal myocardial infarction, or target lesion revascularization (TLR). Quantitative parameters of the neointima were similar, but qualitative characteristics showed significant differences between the E-ISR and L-ISR groups. The incidence of MACE (33.3% vs. 20.8%; P=0.069) and TLR (33.3% vs. 18.5%; P=0.040) was higher in the E-ISR group. In addition, the incidence of MACE was significantly higher for heterogeneous than non-heterogeneous neointima (43.7% vs. 19.6%; P=0.018), but was not significantly associated with neoatherosclerosis (33.4% vs. 18.4%; P=0.168).

CONCLUSIONS:

DCB angioplasty is less effective for heterogeneous neointima in DES ISR. OCT-based neointimal evaluation may be helpful in guiding treatment of DES ISR.

KEYWORDS:

Drug-eluting balloon; In-stent restenosis; Optical coherence tomography

PMID:
30197402
DOI:
10.1253/circj.CJ-18-0619
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