The impact of cutting balloon angioplasty for the treatment of diffuse in-stent restenosis.
OBJECTIVE
To determine the comparable safety and efficacy of cutting balloon angioplasty (CBA) and balloon angioplasty (BA) for diffuse in-stent restenosis (ISR).


BACKGROUND
Previous studies have found that diffuse-type ISR predicts recurrence of ISR. The efficacy of CBA in this clinical setting is incompletely documented.


RESULTS
One-hundred and seven consecutive diffuse ISR lesions (length > 10 mm) in 104 patients treated by CBA or BA were retrospectively analyzed. CBA was used in 61 lesions and BA in 46 lesions. Initial success (residual restenosis   30% with no major complications) was achieved in 99% of cases in each group. Follow-up angiography was performed in all patients at 131   93 days. Although the percent diameter stenosis after CBA was lower than after BA (19   12% versus 27   12%; p = 0.001), intravascular ultrasound (IVUS) or other QCA data were similar in the 2 groups. In follow-up angiography, recurrent restenosis rate was not statistically different between CBA (34%) and BA (52%); however, recurrent diffuse ISR was lower in the CBA group (20%) than the BA group (48%; p = 0.01). Lesion length at follow-up in the CBA group was smaller compared to the BA group (15.9   7.3 mm versus 24.2   14.4 mm; p < 0.05), while lesion length before procedure was similar.


CONCLUSIONS
CBA for ISR is safe and effective with favorable long-term outcomes. This effect is mainly due to shortening lesion length.
Iijima
Raisuke
R
Division of Cardiology, Mitsui Memorial Hospital, 1 Kanda-Izumicho Chiyoda-ku, Tokyo, 101-8643, Japan. Raisuke329@aol.com
Ikari
Yuji
Y
Anzai
Hitoshi
H
Nishida
Takahiro
T
Tsunoda
Taro
T
Nakamura
Masato
M
Hara
Kazuhiro
K
Yamaguchi
Tetsu
T
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015906:Angioplasty, Balloon, Coronary; D019917:Blood Vessel Prosthesis Implantation; D017023:Coronary Angiography; D023903:Coronary Restenosis / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000628:therapy*; D003331:Coronary Vessels / Q000000981:diagnostic imaging / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007564:Japan / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D015607:Stents; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional