title: Differences in optical coherence tomographic findings and clinical outcomes between excimer laser and cutting balloon angioplasty for focal in-stent restenosis lesions.
abstract: OBJECTIVE
  In-stent restenosis (ISR), especially focal ISR, after percutaneous coronary intervention (PCI) remains one of the major clinical problems in the drug-eluting stent (DES) era. Several reports have revealed that excimer laser coronary angioplasty (ELCA) is useful for ISR; however, detailed findings after ELCA are unknown. Therefore, we investigated the condition of the neointima after ELCA for ISR with optical coherence tomography (OCT) and compared the OCT findings and clinical outcome between ELCA and cutting-balloon angioplasty (CBA).
  
  
  METHODS
  Twenty-one consecutive patients with focal ISR who underwent ELCA or CBA were enrolled. All patients underwent 12- to 15-month follow-up coronary angiography. OCT was performed immediately after successful PCI to evaluate the neointimal condition in the ISR lesion. We compared the following OCT parameters between ELCA and CBA groups: maximal thickness of remaining in-stent neointima (MTN), number of tears, minimum lumen dimension (MLD), and minimum lumen area (MLA). We also evaluated clinical outcomes, including target vessel revascularization, acute myocardial infarction, death, and stent thrombosis.
  
  
  RESULTS
  MLA in the ELCA group (n = 10) was significantly larger than in the CBA group, and number of tears in the ELCA group was significantly lower than in the CBA group. A trend was shown toward lower TLR with ELCA versus CBA (10.0% vs 45.5%).
  
  
  CONCLUSIONS
  OCT immediately after ELCA for ISR lesions revealed larger lumen area and smaller number of tears compared with CBA, which may support favorable effects of ELCA for focal ISR.
authors.affiliation: Division of Cardiology, Osaka Rosai Hospital, 1179-3 Nagasone-cho, Sakai-city, Osaka 591-8025, Japan. mnishino@orh.go.jp
authors.forename: Masami
authors.initials: M
authors.lastname: Nishino
authors.forename: Yasuharu
authors.initials: Y
authors.lastname: Lee
authors.forename: Daisuke
authors.initials: D
authors.lastname: Nakamura
authors.forename: Takahiro
authors.initials: T
authors.lastname: Yoshimura
authors.forename: Masayuki
authors.initials: M
authors.lastname: Taniike
authors.forename: Nobuhiko
authors.initials: N
authors.lastname: Makino
authors.forename: Hiroyasu
authors.initials: H
authors.lastname: Kato
authors.forename: Yasuyuki
authors.initials: Y
authors.lastname: Egami
authors.forename: Ryu
authors.initials: R
authors.lastname: Shutta
authors.forename: Jun
authors.initials: J
authors.lastname: Tanouchi
authors.forename: Yoshio
authors.initials: Y
authors.lastname: Yamada
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000379:methods*; D017023:Coronary Angiography; D023903:Coronary Restenosis / Q000453:epidemiology / Q000473:pathology* / Q000628:therapy*; D003331:Coronary Vessels / Q000000981:diagnostic imaging / Q000473:pathology; D054855:Drug-Eluting Stents; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D054018:Lasers, Excimer / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D058426:Neointima / Q000000981:diagnostic imaging / Q000473:pathology; D017239:Paclitaxel; D012189:Retrospective Studies; D020123:Sirolimus; D041623:Tomography, Optical Coherence / Q000379:methods*; D016896:Treatment Outcome
chemical_list: D017239:Paclitaxel; D020123:Sirolimus