title: Intimal disruption affects drug-eluting cobalt-chromium stent expansion: A randomized trial comparing scoring and conventional balloon predilation.
abstract: BACKGROUND
  Stent expansion remains one of the most important predictors of restenosis and subacute thrombosis, even with the use of drug-eluting stents. This study was designed to clarify the impact of lesion preparation on final stent expansion.
  
  
  METHODS
  Sixty-six consecutive patients were included in this trial, and ultimately 52 enrolled non-calcified de novo lesions were randomly assigned to undergo single predilation with either a semi-compliant scoring balloon or a semi-compliant conventional balloon. Lesions were treated with a single 2.5- to 3.0-mm cobalt-chromium everolimus-eluting stent under optical coherence tomography (OCT) guidance without post-stenting dilation. Stent expansion was defined as the ratio of OCT-measured minimum stent area to the predicted stent area.
  
  
  RESULTS
  Stent expansion was significantly higher after predilation by a scoring balloon (68.0% vs. 62.1%, p=0.017) with similar stent lumen eccentricity (0.84 vs. 0.80, p=0.18). Intimal disruption was induced significantly more frequently (68.0% vs. 38.4%, p=0.035) and was more extensive in the scoring group (122° vs. 65°, p=0.038). Lesions with intimal disruption after predilation achieved significantly higher stent expansion than that without it (67.7% vs. 61.6%, p=0.023). One case in the conventional group required target lesion revascularization; however, any other adverse clinical events including death, myocardial infarction, and stent thrombosis were not observed up to 9months after PCI in both groups.
  
  
  CONCLUSIONS
  In this randomized study, pretreatment with a scoring balloon enhanced stent expansion partly through induction of intimal disruption.
  
  
  BACKGROUND
  URL: http://www.umin.ac.jp/ctr/index.htm. Unique identifier: UMIN000014176.
authors.affiliation: Department of Cardiology, Tokyo Women's Medical University, Tokyo, Japan; Department of Cardiology, Nishiarai Heart Center Hospital, Tokyo, Japan. Electronic address: juken1123@mac.com.
authors.forename: Kentaro
authors.initials: K
authors.lastname: Jujo
authors.affiliation: Department of Cardiology, Nishiarai Heart Center Hospital, Tokyo, Japan.
authors.forename: Katsumi
authors.initials: K
authors.lastname: Saito
authors.affiliation: Department of Cardiology, Nishiarai Heart Center Hospital, Tokyo, Japan.
authors.forename: Issei
authors.initials: I
authors.lastname: Ishida
authors.affiliation: Department of Cardiology, Nishiarai Heart Center Hospital, Tokyo, Japan.
authors.forename: Ahsung
authors.initials: A
authors.lastname: Kim
authors.affiliation: Department of Cardiology, Nishiarai Heart Center Hospital, Tokyo, Japan.
authors.forename: Yuki
authors.initials: Y
authors.lastname: Suzuki
authors.affiliation: Department of Cardiology, Nishiarai Heart Center Hospital, Tokyo, Japan.
authors.forename: Yuho
authors.initials: Y
authors.lastname: Furuki
authors.affiliation: Department of Cardiology, Nishiarai Heart Center Hospital, Tokyo, Japan.
authors.forename: Taisuke
authors.initials: T
authors.lastname: Ouchi
authors.affiliation: Department of Cardiology, Cardiovascular Center, Ogikubo Hospital, Tokyo, Japan.
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Ishii
authors.affiliation: Department of Cardiology, Tokyo Women's Medical University, Tokyo, Japan.
authors.forename: Haruki
authors.initials: H
authors.lastname: Sekiguchi
authors.affiliation: Department of Cardiology, Tokyo Women's Medical University, Tokyo, Japan.
authors.forename: Junichi
authors.initials: J
authors.lastname: Yamaguchi
authors.affiliation: Department of Cardiology, Tokyo Women's Medical University, Tokyo, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Ogawa
authors.affiliation: Department of Cardiology, Tokyo Women's Medical University, Tokyo, Japan.
authors.forename: Nobuhisa
authors.initials: N
authors.lastname: Hagiwara
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000800:Angioplasty, Balloon / Q000009:adverse effects / Q000379:methods; D017023:Coronary Angiography / Q000379:methods; D003324:Coronary Artery Disease / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy; D023903:Coronary Restenosis / Q000209:etiology / Q000473:pathology / Q000503:physiopathology / Q000517:prevention & control; D054855:Drug-Eluting Stents / Q000009:adverse effects*; D000068338:Everolimus / Q000494:pharmacology; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000494:pharmacology; D008297:Male; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care; D013927:Thrombosis / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control; D041623:Tomography, Optical Coherence / Q000379:methods; D017539:Tunica Intima / Q000000981:diagnostic imaging / Q000293:injuries / Q000473:pathology
chemical_list: D007166:Immunosuppressive Agents; D000068338:Everolimus
keywords: Intimal disruption; Optical coherence tomography; Scoring balloon; Stent expansion; Stent recoil