title: Simple balloon dilation for drug-eluting in-stent restenosis: an optical coherent tomography analysis.
abstract: BACKGROUND
  Although drug-eluting stent (DES) has significantly reduced restenosis, the treatment of DES-in-stent restenosis (ISR) remains a challenge with high restenosis rate.
  
  
  METHODS
  We examined whether morphologic appearance of restenosis tissue by optical coherent tomography (OCT) had an impact on outcomes after balloon angioplasty for DES-ISR. The morphologic appearance of restenosis tissue was qualitatively assessed for tissue structures such as homogeneous, layered, and heterogeneous patterns.
  
  
  RESULTS
  Using OCT, 50 patients with DES-ISR were divided into 2 groups: 25 lesions with homogeneous or layered patterns (homo/layered group) and 25 lesions with heterogeneous patterns (hetero group). Acute gain was larger in the hetero group (1.33 ± 0.41 mm vs. 1.06 ± 0.32 mm in the homo/layered group, P = 0.03). On intravascular ultrasound analysis, post-procedural percent neointimal area was smaller in the hetero group (27.4 ± 9.2% vs. 34.0 ± 11.2% in the homo/layered group, P = 0.05). Angiographic follow-up was performed in 37 lesions (74%). Follow-up minimal lumen diameter was larger in the hetero group (1.75 ± 0.89 mm vs. 1.01 ± 0.81 mm in the homo/layered group, P = 0.04). Target lesion revascularization rates tended to be lower in the hetero group (20% vs. 43% in the homo/layered group, P = 0.12).
  
  
  CONCLUSIONS
  Balloon angioplasty was more effective for DES-ISR with heterogeneous tissue appearance than DES-ISR with homogeneous/layered tissue appearance. OCT assessment of DES-ISR morphology may be a useful adjunct in determining clinical strategies. Simple balloon dilatation is a possible treatment strategy for DES-ISR lesions with a heterogeneous appearance on OCT images.
authors.affiliation: Division of Cardiology, Tenyoukai Central Hospital, Izumi-cho, Kagoshima City, Kagoshima, Japan.
authors.forename: Ryo
authors.initials: R
authors.lastname: Arikawa
authors.affiliation: Division of Cardiology, Tenyoukai Central Hospital, Izumi-cho, Kagoshima City, Kagoshima, Japan. Electronic address: hyamaguchi@tsm.bbiq.jp.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Yamaguchi
authors.affiliation: Division of Cardiology, Tenyoukai Central Hospital, Izumi-cho, Kagoshima City, Kagoshima, Japan.
authors.forename: Junichiro
authors.initials: J
authors.lastname: Takaoka
authors.affiliation: Division of Cardiology, Tenyoukai Central Hospital, Izumi-cho, Kagoshima City, Kagoshima, Japan.
authors.forename: Akihiro
authors.initials: A
authors.lastname: Miyamura
authors.affiliation: Division of Cardiology, Tenyoukai Central Hospital, Izumi-cho, Kagoshima City, Kagoshima, Japan.
authors.forename: Nobuhiko
authors.initials: N
authors.lastname: Atsuchi
authors.affiliation: Division of Cardiology, Tenyoukai Central Hospital, Izumi-cho, Kagoshima City, Kagoshima, Japan.
authors.forename: Toshiko
authors.initials: T
authors.lastname: Ninomiya
authors.affiliation: Division of Cardiology, Tenyoukai Central Hospital, Izumi-cho, Kagoshima City, Kagoshima, Japan.
authors.forename: Yoshihiko
authors.initials: Y
authors.lastname: Atsuchi
authors.affiliation: Department of Cardiovascular Medicine and Hypertension, Graduate School of Medical and Dental Science, Kagoshima University, Kagoshima, Japan.
authors.forename: Mitsuru
authors.initials: M
authors.lastname: Ohishi
authors.affiliation: Department of Cardiology, Toyohashi Heart Center, Toyohashi, Japan.
authors.forename: Mitsuyasu
authors.initials: M
authors.lastname: Terashima
authors.affiliation: Okinaka Memorial Institute for Medical Research, Tokyo, Japan.
authors.forename: Hideaki
authors.initials: H
authors.lastname: Kaneda
mesh_terms: D015906:Angioplasty, Balloon, Coronary; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000175:diagnosis / Q000628:therapy*; D023903:Coronary Restenosis / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D003331:Coronary Vessels / Q000000981:diagnostic imaging / Q000473:pathology*; D054855:Drug-Eluting Stents; D006801:Humans; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000295:instrumentation*; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D013997:Time Factors; D041623:Tomography, Optical Coherence; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional
keywords: Angiography; Angioplasty; Atherosclerosis