title: Mechanisms of postintervention and nine-month luminal enlargement after treatment of drug-eluting in-stent restenosis with a drug-eluting balloon.
abstract: Using optical coherence tomography (OCT), the mechanisms of postintervention and 9-month luminal enlargement in drug-eluting stent in-stent restenosis (ISR) lesions treated with a drug-eluting balloon (DEB) were evaluated. A total of 42 patients with DEB-treated drug-eluting stent ISR lesions underwent serial OCT examination before intervention, after intervention, and at 9-month follow-up. Preintervention OCT-derived neointima was classified as either a homogeneous or nonhomogeneous pattern. Ten ISR lesions with homogeneous neointima were identified and compared with 32 ISR lesions with nonhomogeneous neointima. When comparing pre- and postintervention evaluations, changes in luminal cross-sectional area (CSA) were 3.4 mm(2) in ISR lesions with homogeneous neointima and 3.7 mm(2) in those with nonhomogeneous neointima, respectively (p = 0.529); changes in stent CSA were 2.5 mm(2) and 1.4 mm(2), respectively, p = 0.004; and changes in neointimal CSA were -0.9 mm(2) and -2.3 mm(2), respectively, p = 0.001. At 9-month follow-up, changes in luminal CSA were -2.0 mm(2) and -0.9 mm(2) in ISR lesions with homogeneous and nonhomogeneous neointima, respectively (p = 0.021); in stent CSA changed by -0.2 mm(2) in both groups (p = 0.851) and changes in neointimal CSA was 1.8 mm(2) and 0.7 mm(2), respectively (p = 0.003). At the 9-month follow-up, >50% neointimal CSA stenosis was observed in 60% and 19% of the ISR lesions with homogeneous and nonhomogeneous neointima, respectively (p = 0.020). In conclusion, the mechanism of postintervention luminal enlargement by DEB varied with the preintervention OCT-based neointimal characteristics. ISR lesions with homogeneous neointima determined by OCT were associated with greater subsequent regrowth of neointima after DEB treatment.
authors.affiliation: Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Seung-Yul
authors.initials: SY
authors.lastname: Lee
authors.affiliation: Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea; Severance Biomedical Science Institute, Yonsei University College of Medicine, Seoul, Korea. Electronic address: mkhong61@yuhs.ac.
authors.forename: Myeong-Ki
authors.initials: MK
authors.lastname: Hong
authors.affiliation: Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Dong-Ho
authors.initials: DH
authors.lastname: Shin
authors.affiliation: Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Jung-Sun
authors.initials: JS
authors.lastname: Kim
authors.affiliation: Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Byeong-Keuk
authors.initials: BK
authors.lastname: Kim
authors.affiliation: Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Young-Guk
authors.initials: YG
authors.lastname: Ko
authors.affiliation: Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Donghoon
authors.initials: D
authors.lastname: Choi
authors.affiliation: Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea; Severance Biomedical Science Institute, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Yangsoo
authors.initials: Y
authors.lastname: Jang
mesh_terms: D000368:Aged; D023903:Coronary Restenosis / Q000473:pathology / Q000628:therapy*; D054855:Drug-Eluting Stents; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D013997:Time Factors; D041623:Tomography, Optical Coherence; D017539:Tunica Intima / Q000473:pathology