IVUS Findings of Drug Eluting Balloon Failure in the Treatment of In-Stent Restenosis

Abstract

Background and objective: The objective of this study is to investigate pre-intervention IVUS characteristics of in-stent restenosis (ISR) lesion correlated with PEB failure.Materials and methods: We performed pre-intervention IVUS for 58 patients with ISR and treated with PEB angioplasty. The PEB failure was defined as death, myocardial infarction and symptom driven revascularization. IVUS images were analyzed at 6 locations: Proximal and distal vessel segment within 3 mm from stent edge, proximal and distal stent edge, lesion site at minimal lumen area and minimal stent area.Results: Among 58 patients treated with 58 PEB (3.0 ± 0.4 mm by 21.9 ± 4.8 mm), PEB failure were developed at 8 patients (13.8%) during 0.81 years of follow-up. ISR of drug eluting stent comprised large proportion (86.2%) among index procedure. There was no significant difference in clinical presentation and used stents at index procedure between PEB failure and non-failure group. In PEB failure group, neointimal area (4.0 ± 0.7 vs. 2.9 ± 0.8 mm2, p = 0.05) and neointimal hyperplasia (%) (59.4 ± 12.0 vs. 46.0 ± 24.9%, p = 0.05) were significant greater than non-failure group. Stent under-expansion was found in 24 ISR lesions (48.0%) of non-failure group, whereas none was detected in PEB failure group.Conclusion: PEB failure for ISR lesion could be associated with prominent neointimal hyperplasia on normally extended stent. Future studies are warranted to investigate another treatment modality that might substitute PEB in the treatment of ISR lesions with those characteristics.