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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.

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



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).


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


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

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