title: Drug Coated Balloon Is Less Effective for Treatment of DES In-Stent Restenosis Both in Native Coronary Arteries and Saphenous Vein Grafts: Results From a Bicenter Registry.
abstract: BACKGROUND
  The paclitaxel drug coated balloon (DCB) is an established treatment for bare metal stent (BMS) in-stent restenosis (ISR) in native coronary arteries. The evidence of DCB-application for drug eluting stent (DES) ISR both in native coronaries and saphenous vein grafts (SVG) is limited. Aim of our study was to compare the differential efficacy of DCB for treatment of BMS- and DES-ISR in native coronary vessels and SVGs.
  
  
  RESULTS
  N = 135 DCB-treated patients with available follow up (FU) angiography were included in this retrospective study. Patients received treatment between April 2009 and March 2013 at 2 tertiary care hospitals in Germany. DCB was applied in BMS-ISR (n = 65; 48%) and DES-ISR (n = 70; 52%). DCB-treated lesions were located in native coronary arteries (n = 110; 81%; BMS-ISR: n = 58; 53%; DES-ISR: n = 52; 47%) and SVGs (n = 25; 19%; BMS-ISR: n = 7, 28%; DES-ISR: n = 18, 72%). Median FU was 12 months. Endpoints were binary restenosis and target lesion revascularization (TLR). Binary restenosis (29% vs. 57%; P < 0.01) and TLR (18% vs. 46%; P < 0.01) were significantly more frequent in DES-ISR versus BMS-ISR. In SVGs, TLR was required in 72% (DES-ISR) versus 14% (BMS-ISR); P = 0.02. In the Kaplan-Meier-analysis freedom from both endpoints was significantly decreased in the DES-lesions both in the total population (binary restenosis P < 0.01; TLR P < 0.01) and native coronaries (binary restenosis P = 0.02; TLR P = 0.04).
  
  
  CONCLUSIONS
  DCB treatment is less effective in DES-ISR than in BMS-ISR. The diminished efficacy of DCB treatment is even more pronounced in DES-ISR located within degenerated SVGs.
authors.affiliation: Department of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany. markus.resch@ukr.de.
authors.forename: Markus
authors.initials: M
authors.lastname: Resch
authors.affiliation: Department of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany.
authors.forename: Patrick
authors.initials: P
authors.lastname: Ostheim
authors.affiliation: Department of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany.
authors.forename: Dierk H
authors.initials: DH
authors.lastname: Endemann
authors.affiliation: Department of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany.
authors.forename: Kurt
authors.initials: K
authors.lastname: Debl
authors.affiliation: Department of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany.
authors.forename: Stefan
authors.initials: S
authors.lastname: Buchner
authors.affiliation: Department of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany.
authors.forename: Christoph
authors.initials: C
authors.lastname: Birner
authors.affiliation: Department of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany.
authors.forename: Lars S
authors.initials: LS
authors.lastname: Maier
authors.affiliation: Department of Cardiology, Cardiovascular Center Bad Neustadt, Bad Neustadt, Germany.
authors.forename: Sebastian
authors.initials: S
authors.lastname: Kerber
authors.affiliation: Department of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany.|Department of Internal Medicine I, Klinikum St. Marien, Amberg, Germany.
authors.forename: Andreas
authors.initials: A
authors.lastname: Luchner
authors.affiliation: Department of Cardiology, Cardiovascular Center Bad Neustadt, Bad Neustadt, Germany.
authors.forename: Daniel P
authors.initials: DP
authors.lastname: Griese
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods; D000972:Antineoplastic Agents, Phytogenic / Q000627:therapeutic use; D017023:Coronary Angiography / Q000379:methods; D023903:Coronary Restenosis / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control / Q000628:therapy; D003331:Coronary Vessels / Q000000981:diagnostic imaging / Q000473:pathology; D054855:Drug-Eluting Stents / Q000009:adverse effects*; D005260:Female; D005858:Germany; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care; D017239:Paclitaxel / Q000627:therapeutic use; D011474:Prosthesis Design; D012042:Registries; D012189:Retrospective Studies; D012501:Saphenous Vein / Q000473:pathology / Q000637:transplantation; D013997:Time Factors
chemical_list: D000972:Antineoplastic Agents, Phytogenic; D017239:Paclitaxel