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Impact of Optimized Procedure-Related Factors in Drug-Eluting Balloon Angioplasty for Treatment of In-Stent Restenosis
- Authors
- Rhee, T.-M.[Rhee, T.-M.]; Lee, J.M.[Lee, J.M.]; Shin, E.-S.[Shin, E.-S.]; Hwang, D.[Hwang, D.]; Park, J.[Park, J.]; Jeon, K.-H.[Jeon, K.-H.]; Kim, H.-L.[Kim, H.-L.]; Yang, H.-M.[Yang, H.-M.]; Han, J.-K.[Han, J.-K.]; Park, K.W.[Park, K.W.]; Hahn, J.-Y.[Hahn, J.-Y.]; Koo, B.-K.[Koo, B.-K.]; Kim, S.-H.[Kim, S.-H.]; Kim, H.-S.[Kim, H.-S.]
- Issue Date
- 28-May-2018
- Publisher
- Elsevier Inc.
- Keywords
- drug-eluting balloon; in-stent restenosis; paclitaxel-coated balloon; percutaneous coronary intervention; target lesion failure
- Citation
- JACC: Cardiovascular Interventions, v.11, no.10, pp.969 - 978
- Indexed
- SCIE
SCOPUS
- Journal Title
- JACC: Cardiovascular Interventions
- Volume
- 11
- Number
- 10
- Start Page
- 969
- End Page
- 978
- ISSN
- 1936-8798
- Abstract
- Objectives: The aim of this study was to investigate the impact of optimizing procedure-related factors during drug-eluting balloon (DEB) angioplasty on clinical outcomes of drug-eluting stent in-stent restenosis (ISR). Background: Although DEB angioplasty is recommended as a reasonable option for ISR, recurrent target lesion failure (TLF) still occurs in many patients after DEB angioplasty. Methods: Consecutive patients with drug-eluting stent ISR treated with DEB (SeQuent Please) were collected from 4 centers in Korea. The primary outcome was 2-year TLF. Procedure-related modifiable independent predictors for TLF and their best cutoff values were determined. Results: In a total of 256 patients (309 lesions), TLF occurred in 52 patients (20.3%). Modifiable independent predictors of TLF among procedure-related factors were residual diameter stenosis after lesion preparation (residual percentage diameter stenosis [%DS]), DEB-to-stent ratio (BSR), and DEB inflation time (Tinflation), whose best cutoff values were 20%, 0.91, and 60 s, respectively. TLF rates were significantly higher in groups with residual %DS ≥20% (34.7% vs. 12.5%; adjusted hazard ratio: 2.15; 95% confidence interval: 1.86 to 2.48; p < 0.001), BSR ≤0.91 (46.4% vs. 21.9%; adjusted hazard ratio: 2.02; 95% confidence interval: 1.75 to 2.34; p < 0.001), and Tinflation ≤60 s (26.2% vs. 14.0%; adjusted hazard ratio: 1.82; 95% confidence interval: 1.36 to 2.45; p < 0.001). When classifying ISR lesions by combination of procedure-related factors, TLF occurred in 8.3% in the fully optimized procedure group (residual %DS <20%, BSR >0.91, and Tinflation >60 s) and 66.7% in the nonoptimized group (residual %DS ≥20%, BSR ≤0.91, and Tinflation ≤60 s) (p < 0.001). Conclusions: Residual %DS after lesion preparation, BSR, and Tinflation were the only modifiable procedure-related factors in DEB angioplasty. Fully optimized DEB angioplasty with optimal lesion preparation, prolonged inflation, and sufficient dilation may play an important role in reducing TLF after DEB angioplasty. © 2018
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