Impact of cutting balloon angioplasty (CBA) prior to bare metal stenting on restenosis.
BACKGROUND
While stent restenosis and late thrombosis still occur even with drug-eluting-stents (DES), there remains a need to explore other strategies for preventing restenosis.


RESULTS
Five hundred and twenty-one patients were randomized: 260 to cutting-balloon angioplasty (CBA) before bare-metal stent (CBA-BMS) and 261 to balloon-angioplasty (BA) before BMS (BA-BMS). Intravascular ultrasound (IVUS)-guided procedures were performed in 279 (54%) patients and angiographic guidance was used in the remainder. Minimal lumen diameter was significantly greater in CBA-BMS than BA-BMS (2.65+/-0.40 mm vs 2.52+/-0.4 mm, p<0.01) and % diameter stenosis (%DS)-post was less in CBA-BMS than BA-BMS (14.0+/-5.9% vs 16.3+/-6.8%, p<0.01). %DS-follow-up was subsequently less in CBA-BMS than BA-BMS (32.4+/-15.1% vs 35.4+/-15.3%, p<0.05) associated with lower rates of restenosis in CBA-BMS than BA-BMS (11.8% vs 19.6%, p<0.05) and less target lesion revascularization (TLR) in CBA-BMS than BA-BMS (9.6% vs 15.3%, p<0.05). Patients were divided into 4 groups based on the device used before stenting and IVUS use (IVUS-CBA-BMS: 137 patients; Angio-CBA-BMS: 123; IVUS-BA-BMS: 142; and Angio-BA-BMS: 119). At follow-up IVUS-CBA-BMS had a significantly lower restenosis rate (6.6%) than Angio-CBA-BMS (17.9%), IVUS-BA-BMS (19.8%) and Angio-BA-BMS (18.2%, p<0.05).


CONCLUSIONS
Restenosis and TLR were significantly lower in CBA-BMS than BA-BMS. This favorable outcome was achieved because of the lower restenosis rate conferred by the IVUS-guided-CBA-BMS strategy (6.6%). The restenosis rates obtained with this strategy were comparable to those achieved with DES.
Ozaki
Yukio
Y
Division of Cardiology, Fujita Health University Hospital, Toyoake, Japan. ozakiyuk@fujita-hu.ac.jp
Yamaguchi
Tetsu
T
Suzuki
Takahiko
T
Nakamura
Masato
M
Kitayama
Michihiko
M
Nishikawa
Hideo
H
Inoue
Teruo
T
Hara
Kazuhiro
K
Usuba
Fumihiko
F
Sakurada
Masami
M
Awano
Kojiro
K
Matsuo
Hitoshi
H
Ishiwata
Sugao
S
Yasukawa
Tatsuya
T
Ismail
Tevfik F
TF
Hishida
Hitoshi
H
Kato
Osamu
O
D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000379:methods*; D023903:Coronary Restenosis / Q000473:pathology / Q000517:prevention & control*; D023921:Coronary Stenosis / Q000473:pathology / Q000628:therapy*; D018572:Disease-Free Survival; D016503:Drug Delivery Systems / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011446:Prospective Studies; D012044:Regression Analysis; D015607:Stents; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional