title: Cutting balloon combined with paclitaxel-eluting balloon for treatment of in-stent restenosis.
abstract: BACKGROUND
  The optimal therapy for in-stent restenosis (ISR) is controversial. We evaluated three different strategies for the treatment of in-stent restenosis: cutting balloon angioplasty (CBA), paclitaxel-eluting balloon angioplasty (PEBA) and cutting balloon followed by paclitaxel-eluting balloon angioplasty (CB+PEBA).
  
  
  METHODS
  Forty-five coronary arteries in 45 mini-pigs underwent oversized bare-metal stent (stent-to-artery ratio, 1.2:1) implantation to induce in-stent restenosis. After 28 days, vessels with in-stent restenosis (≥50% diameter stenosis) were randomly divided into three groups: CBA, PEBA and CB+PEBA. In vivo angiography was performed before intervention, immediately after intervention and at 28-day follow-up. Stented arteries were harvested for pathological analyses. The proliferation and apoptosis of vascular smooth muscle cells were evaluated by immunohistochemical staining and the terminal deoxynucleotidyl transferase dUTP nick end labelling (TUNEL) assay, respectively.
  
  
  RESULTS
  Acute lumen gain was not different between the three groups. Late lumen loss and neointimal area at follow-up were lower for CB+PEBA compared with CBA but similar for CB+PEBA compared with PEBA. There were no significant differences in proliferating cell nuclear antigen-positive vascular smooth muscle cells and TUNEL-positive vascular smooth muscle cells between the CB+PEBA and PEBA groups.
  
  
  CONCLUSIONS
  PEBA with or without cutting balloon was superior to CBA alone for in-stent restenosis. The underlying mechanism was probably related to inhibition of smooth muscle cell proliferation and increased apoptosis. In this porcine coronary artery restenosis model, PEBA with or without cutting balloon was superior.
authors.affiliation: Department of Cardiology, Second Affiliated Hospital of Harbin Medical University, Key Laboratories of Education, Ministry for Myocardial Ischaemia Mechanism and Treatment, 150086 Harbin, Heilongjiang, China.
authors.forename: Junying
authors.initials: J
authors.lastname: Kong
authors.forename: Jingbo
authors.initials: J
authors.lastname: Hou
authors.forename: Lijia
authors.initials: L
authors.lastname: Ma
authors.forename: Lei
authors.initials: L
authors.lastname: Xing
authors.forename: Haibo
authors.initials: H
authors.lastname: Jia
authors.forename: Huimin
authors.initials: H
authors.lastname: Liu
authors.forename: Shaosong
authors.initials: S
authors.lastname: Zhang
authors.forename: Bo
authors.initials: B
authors.lastname: Yu
authors.forename: Ik-Kyung
authors.initials: IK
authors.lastname: Jang
mesh_terms: D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods*; D000818:Animals; D017209:Apoptosis / Q000187:drug effects; D062906:Cardiac Catheters; D002317:Cardiovascular Agents / Q000008:administration & dosage*; D049109:Cell Proliferation / Q000187:drug effects; D020099:Coated Materials, Biocompatible; D017023:Coronary Angiography; D023903:Coronary Restenosis / Q000000981:diagnostic imaging / Q000209:etiology / Q000473:pathology / Q000628:therapy*; D003331:Coronary Vessels / Q000000981:diagnostic imaging / Q000187:drug effects* / Q000473:pathology; D004195:Disease Models, Animal; D004867:Equipment Design; D007150:Immunohistochemistry; D020287:In Situ Nick-End Labeling; D008670:Metals; D009131:Muscle, Smooth, Vascular / Q000000981:diagnostic imaging / Q000187:drug effects* / Q000473:pathology; D058426:Neointima; D017239:Paclitaxel / Q000008:administration & dosage*; D011474:Prosthesis Design; D015607:Stents; D013552:Swine; D013556:Swine, Miniature; D013997:Time Factors
chemical_list: D002317:Cardiovascular Agents; D020099:Coated Materials, Biocompatible; D008670:Metals; D017239:Paclitaxel