Comparison of plain balloon and cutting balloon angioplasty for the treatment of restenosis with drug-eluting stents vs bare metal stents.
BACKGROUND
The efficacy of cutting or plain balloon angioplasty (CBA or PBA) has not been analyzed for the treatment of drug-eluting stent (DES) restenosis vs bare metal stent (BMS) restenosis.


RESULTS
The 252 in-stent restenosis (ISR) lesions in 224 consecutive patients treated by CBA (n=167) or PBA (n=85) between July 2002 and December 2007 were analyzed. At 6-month angiographic and 12-month clinical follow-up, CBA and PBA showed similar efficacies: repeat-ISR (37.0% vs 37.8%, P=0.90), late loss (0.62+/-0.60 vs 0.61+/-0.47 mm, P=0.92), and target lesion revascularization (18.3% vs 22.4%, P=0.50). This comparable efficacy was maintained for treatment in the DES-ISR and BMS-ISR subgroups. However, target lesion-related myocardial infarction (n=9) occurred more frequently in the CBA than in the PBA arm (6.2% vs 0%, P=0.03), most of which developed early after ISR treatment (n=7; 54+/-26 days). Independent predictors of repeat-ISR were diffuse ISR and smaller pretreatment minimal lumen diameter, both of which might imply heavier plaque burden in the ISR group.


CONCLUSIONS
Plain or cutting balloon angioplasty for ISR seems to be comparable, as the angiographic or clinical endpoints were not affected by initial stent type but by parameters related to the plaque burden of the ISR lesion. However, CBA might be associated with higher risk of myocardial infarction than PBA, suggesting more attention to dual-antiplatelet therapy after its use for ISR.
Park
Seung-Jung
SJ
Cardiovascular Center and Department of Internal Medicine, Seoul National University Hospital, Seoul, South Korea.
Kim
Kyung-Hee
KH
Oh
Il-Young
IY
Shin
Dong-Ho
DH
Park
Kyung-Il
KI
Seo
Myung-Ki
MK
Chung
Jin-Wook
JW
Park
Kyung Woo
KW
Lee
Hae-Young
HY
Kang
Hyun-Jae
HJ
Koo
Bon-Kwon
BK
Youn
Tae-Jin
TJ
Kim
Hyo-Soo
HS
D000368:Aged; D000800:Angioplasty, Balloon / Q000009:adverse effects / Q000379:methods* / Q000592:standards; D023903:Coronary Restenosis / Q000628:therapy*; D054855:Drug-Eluting Stents / Q000009:adverse effects / Q000592:standards*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000209:etiology; D058226:Plaque, Atherosclerotic / Q000209:etiology; D015607:Stents / Q000009:adverse effects / Q000592:standards*