title: Everolimus-eluting stent implantation versus repeat paclitaxel-coated balloon angioplasty for recurrent in-stent restenosis lesion caused by paclitaxel-coated balloon failure.
abstract: OBJECTIVE
  Although paclitaxel-coated balloon (PCB) angioplasty has been reported to be effective for in-stent restenosis (ISR) lesions, the optimal treatment for recurrent ISR lesions caused by PCB failure remains unclear. This study compared clinical and angiographic outcomes after everolimus-eluting stent (EES) implantation and repeat PCB angioplasty for PCB failure.
  
  
  RESULTS
  From November 2008 to October 2011, we performed PCB angioplasty for 599 ISR lesions, of which 93 recurrent ISR lesions underwent EES implantation (53 lesions, 52 patients) or repeat PCB angioplasty (40 lesions, 37 patients). The choice of treatment strategy was decided at the operatorÕs discretion. Angiographic outcomes were evaluated by follow-up angiography at six to eight months after procedure. The baseline characteristics were similar between the two groups. At follow-up angiography (93.5% of all lesions), minimum lumen diameter was significantly larger and the binary restenosis rate was significantly lower after EES implantation than after repeat PCB angioplasty (2.08±0.79 mm vs. 1.45±0.68 mm, p<0.001; 20.0% vs. 54.1%, p=0.001; respectively), whereas late lumen loss was not different between the two groups (0.49±0.62 mm vs. 0.59±0.74 mm, p=0.47). At two years, the incidences of both target lesion revascularisation (TLR) and clinically driven TLR were significantly lower after EES implantation than after repeat PCB angioplasty (17.9% vs. 57.5%, p=0.001; 5.9% vs. 18.1%, p=0.01; respectively).
  
  
  CONCLUSIONS
  EES implantation was more effective for PCB failure in preventing subsequent TLR than repeat PCB angioplasty because of better angiographic results.
authors.affiliation: Department of Cardiology, Kurashiki Central Hospital, Kurashiki, Japan.
authors.forename: Shunsuke
authors.initials: S
authors.lastname: Kubo
authors.forename: Kazushige
authors.initials: K
authors.lastname: Kadota
authors.forename: Suguru
authors.initials: S
authors.lastname: Otsuru
authors.forename: Daiji
authors.initials: D
authors.lastname: Hasegawa
authors.forename: Seiji
authors.initials: S
authors.lastname: Habara
authors.forename: Takeshi
authors.initials: T
authors.lastname: Tada
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: Katoh
authors.forename: Tsuyoshi
authors.initials: T
authors.lastname: Goto
authors.forename: Kazuaki
authors.initials: K
authors.lastname: Mitsudo
mesh_terms: D000800:Angioplasty, Balloon / Q000379:methods; D015906:Angioplasty, Balloon, Coronary / Q000379:methods; D017023:Coronary Angiography / Q000379:methods; D023903:Coronary Restenosis / Q000209:etiology* / Q000601:surgery; D054855:Drug-Eluting Stents / Q000009:adverse effects*; D000068338:Everolimus; D005260:Female; D006801:Humans; D008297:Male; D017239:Paclitaxel / Q000627:therapeutic use*; D011474:Prosthesis Design; D012008:Recurrence; D020123:Sirolimus / Q000009:adverse effects / Q000031:analogs & derivatives*; D016896:Treatment Outcome
chemical_list: D000068338:Everolimus; D017239:Paclitaxel; D020123:Sirolimus