title: Association between tissue characteristics assessed with optical coherence tomography and mid-term results after percutaneous coronary intervention for in-stent restenosis lesions: a comparison between balloon angioplasty, paclitaxel-coated balloon dilatation, and drug-eluting stent implantation.
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 various types of percutaneous coronary intervention (PCI) including plain old balloon angioplasty (POBA), paclitaxel-coated balloon (PCB) dilatation, and drug-eluting stent (DES) implantation.
  
  
  RESULTS
  Between June 2008 and August 2013, we performed PCI for 428 ISR lesions in 379 patients using POBA (78 lesions, POBA group), PCB dilatation (202 lesions, PCB group), and DES implantation (148 lesions, DES group). Morphological assessment of neointimal tissue at the minimum lumen area site to determine restenotic tissue structure (homogeneous, heterogeneous, or layered type) using OCT was performed. We examined the association between tissue structure and midterm results including ISR and target lesion revascularization (TLR) rates. The patients were 308 men and 71 women with a mean age of 68.9 ± 9.4 years. The mean follow-up period was 211 ± 40 days. ISR and TLR rates of lesions with a homogeneous structure were significantly higher in the POBA group than in the PCB group (ISR: 54.8 vs. 19.1%, P < 0.001; TLR: 38.7 vs. 10.6%, P < 0.001) and DES group (ISR: 54.8 vs. 19.6%, P = 0.002; TLR: 38.7 vs. 10.7%, P = 0.005), whereas there were no differences in ISR and TLR rates between the three groups in lesions with a heterogeneous structure.
  
  
  CONCLUSIONS
  Morphological assessment of ISR tissue using OCT might suggest favourable types of PCI for ISR lesions.
authors.affiliation: Department of Cardiovascular Medicine, Kurashiki Central Hospital, 1-1-1 Miwa, Kurashiki 710-8602, Japan tadatakecirc@yahoo.co.jp.
authors.forename: Takeshi
authors.initials: T
authors.lastname: Tada
authors.affiliation: Department of Cardiovascular Medicine, Kurashiki Central Hospital, 1-1-1 Miwa, Kurashiki 710-8602, Japan.
authors.forename: Kazushige
authors.initials: K
authors.lastname: Kadota
authors.affiliation: Department of Cardiovascular Medicine, Kochi Health Sciences Center, Kochi, Japan.
authors.forename: Shingo
authors.initials: S
authors.lastname: Hosogi
authors.affiliation: Department of Cardiovascular Medicine, Kurashiki Central Hospital, 1-1-1 Miwa, Kurashiki 710-8602, Japan.
authors.forename: Koshi
authors.initials: K
authors.lastname: Miyake
authors.affiliation: Department of Cardiovascular Medicine, Kurashiki Central Hospital, 1-1-1 Miwa, Kurashiki 710-8602, Japan.
authors.forename: Masanobu
authors.initials: M
authors.lastname: Ohya
authors.affiliation: Department of Cardiovascular Medicine, Kurashiki Central Hospital, 1-1-1 Miwa, Kurashiki 710-8602, Japan.
authors.forename: Hideo
authors.initials: H
authors.lastname: Amano
authors.affiliation: Department of Cardiovascular Medicine, Kurashiki Central Hospital, 1-1-1 Miwa, Kurashiki 710-8602, Japan.
authors.forename: Yu
authors.initials: Y
authors.lastname: Izawa
authors.affiliation: Department of Cardiovascular Medicine, Kurashiki Central Hospital, 1-1-1 Miwa, Kurashiki 710-8602, Japan.
authors.forename: Takenori
authors.initials: T
authors.lastname: Kanazawa
authors.affiliation: Department of Cardiovascular Medicine, Kurashiki Central Hospital, 1-1-1 Miwa, Kurashiki 710-8602, Japan.
authors.forename: Shunsuke
authors.initials: S
authors.lastname: Kubo
authors.affiliation: Department of Cardiovascular Medicine, Kurashiki Central Hospital, 1-1-1 Miwa, Kurashiki 710-8602, Japan.
authors.forename: Tahei
authors.initials: T
authors.lastname: Ichinohe
authors.affiliation: Department of Cardiovascular Medicine, Kurashiki Central Hospital, 1-1-1 Miwa, Kurashiki 710-8602, Japan.
authors.forename: Yusuke
authors.initials: Y
authors.lastname: Hyoudou
authors.affiliation: Department of Cardiovascular Medicine, Kurashiki Central Hospital, 1-1-1 Miwa, Kurashiki 710-8602, Japan.
authors.forename: Yuki
authors.initials: Y
authors.lastname: Hayakawa
authors.affiliation: Department of Cardiology, Suez Canal University, Ismailia, Egypt.
authors.forename: Mahmoud Mohamed Hassan
authors.initials: MM
authors.lastname: Sabbah
authors.affiliation: Department of Cardiovascular Medicine, Kurashiki Central Hospital, 1-1-1 Miwa, Kurashiki 710-8602, Japan.
authors.forename: Suguru
authors.initials: S
authors.lastname: Otsuru
authors.affiliation: Department of Cardiovascular Medicine, Kurashiki Central Hospital, 1-1-1 Miwa, Kurashiki 710-8602, Japan.
authors.forename: Daiji
authors.initials: D
authors.lastname: Hasegawa
authors.affiliation: Department of Cardiovascular Medicine, Kurashiki Central Hospital, 1-1-1 Miwa, Kurashiki 710-8602, Japan.
authors.forename: Seiji
authors.initials: S
authors.lastname: Habara
authors.affiliation: Department of Cardiovascular Medicine, Kurashiki Central Hospital, 1-1-1 Miwa, Kurashiki 710-8602, Japan.
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Tanaka
authors.affiliation: Department of Cardiovascular Medicine, Kurashiki Central Hospital, 1-1-1 Miwa, Kurashiki 710-8602, Japan.
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Fuku
authors.affiliation: Department of Cardiovascular Medicine, Kurashiki Central Hospital, 1-1-1 Miwa, Kurashiki 710-8602, Japan.
authors.forename: Harumi
authors.initials: H
authors.lastname: Katoh
authors.affiliation: Department of Cardiovascular Medicine, Kurashiki Central Hospital, 1-1-1 Miwa, Kurashiki 710-8602, Japan.
authors.forename: Tsuyoshi
authors.initials: T
authors.lastname: Goto
authors.affiliation: Department of Cardiovascular Medicine, Kurashiki Central Hospital, 1-1-1 Miwa, Kurashiki 710-8602, Japan.
authors.forename: Kazuaki
authors.initials: K
authors.lastname: Mitsudo
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000295:instrumentation*; D017023:Coronary Angiography; D023903:Coronary Restenosis / Q000473:pathology* / Q000628:therapy*; D003331:Coronary Vessels / Q000473:pathology; D054855:Drug-Eluting Stents; D005260:Female; D006801:Humans; D008297:Male; D017239:Paclitaxel / Q000008:administration & dosage*; D062645:Percutaneous Coronary Intervention; D012008:Recurrence; D015203:Reproducibility of Results; D012720:Severity of Illness Index; D015607:Stents / Q000009:adverse effects; D041623:Tomography, Optical Coherence; D016896:Treatment Outcome
chemical_list: D017239:Paclitaxel
keywords: in-stent restenosis lesion; optical coherence tomography; paclitaxel-coated balloon