title: Association between tissue characteristics evaluated with optical coherence tomography and mid-term results after paclitaxel-coated balloon dilatation for in-stent restenosis lesions: a comparison with plain old balloon angioplasty.
abstract: OBJECTIVE
  Morphological assessment of neointimal tissue using optical coherence tomography (OCT) is important for clarifying the pathophysiology of in-stent restenosis (ISR) lesions. The aim of this study was to determine the impact of OCT findings on recurrence of ISR after paclitaxel-coated balloon (PCB) dilatation compared with plain old balloon angioplasty (POBA).
  
  
  RESULTS
  Between July 2008 and May 2012, we performed percutaneous coronary intervention for 214 ISR lesions using POBA + PCB (146 lesions, PCB group) or POBA only (68 lesions, POBA group). Morphological assessment of neointimal tissue using OCT, including assessment of restenotic tissue structure and restenotic tissue backscatter, was performed. We examined the association between lesion morphologies and mid-term (6-8 months) results including ISR and target lesion revascularization (TLR) rates. Both ISR and TLR rates of lesions with a homogeneous structure were significantly lower in the PCB group than those in the POBA group (ISR: 20.0 vs. 55.6%, P = 0.002, TLR: 12.7 vs. 37.0%, P = 0.019), but there was no difference between the two groups in ISR and TLR rates of lesions with a heterogeneous or layered structure. Both ISR and TLR rates of lesions with high backscatter were significantly lower in the PCB group than those in the POBA group (ISR: 19.8 vs. 52.5%, P < 0.001, TLR: 13.6 vs. 42.5%, P = 0.001), but there was no difference between the two groups in ISR and TLR rates of lesions with low backscatter.
  
  
  CONCLUSIONS
  Morphological assessment of ISR tissue using OCT might be useful for identifying ISR lesions favourable for PCB dilatation.
authors.affiliation: Department of Cardiovascular Medicine, Kurashiki Central Hospital, 1-1-1 Miwa, Kurashiki 710-8602, Japan.
authors.forename: Takeshi
authors.initials: T
authors.lastname: Tada
authors.forename: Kazushige
authors.initials: K
authors.lastname: Kadota
authors.forename: Shingo
authors.initials: S
authors.lastname: Hosogi
authors.forename: Koshi
authors.initials: K
authors.lastname: Miyake
authors.forename: Hideo
authors.initials: H
authors.lastname: Amano
authors.forename: Michitaka
authors.initials: M
authors.lastname: Nakamura
authors.forename: Yu
authors.initials: Y
authors.lastname: Izawa
authors.forename: Shunsuke
authors.initials: S
authors.lastname: Kubo
authors.forename: Tahei
authors.initials: T
authors.lastname: Ichinohe
authors.forename: Yusuke
authors.initials: Y
authors.lastname: Hyoudou
authors.forename: Haruki
authors.initials: H
authors.lastname: Eguchi
authors.forename: Yuki
authors.initials: Y
authors.lastname: Hayakawa
authors.forename: Suguru
authors.initials: S
authors.lastname: Otsuru
authors.forename: Daiji
authors.initials: D
authors.lastname: Hasegawa
authors.forename: Yoshikazu
authors.initials: Y
authors.lastname: Shigemoto
authors.forename: Seiji
authors.initials: S
authors.lastname: Habara
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Tanaka
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Fuku
authors.forename: Harumi
authors.initials: H
authors.lastname: Kato
authors.forename: Tsuyoshi
authors.initials: T
authors.lastname: Goto
authors.forename: Kazuaki
authors.initials: K
authors.lastname: Mitsudo
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000295:instrumentation* / Q000379:methods; D015331:Cohort Studies; D017023:Coronary Angiography / Q000379:methods; D003327:Coronary Disease / Q000000981:diagnostic imaging / Q000628:therapy*; D023903:Coronary Restenosis / Q000473:pathology* / Q000628:therapy*; D003331:Coronary Vessels / Q000473:pathology; D054855:Drug-Eluting Stents; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D017239:Paclitaxel / Q000494:pharmacology; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013997:Time Factors; D041623:Tomography, Optical Coherence / Q000379:methods*; D016896:Treatment Outcome
chemical_list: D017239:Paclitaxel
keywords: in-stent restenosis lesion; optical coherence tomography; paclitaxel-coated balloon