Abstract 4154: Is Cutting Balloon Angioplasty More Useful Than Plain Balloon Angioplasty for the Treatment of Drug-Eluting Stent Restenosis?
Background: The efficacy of plain or cutting balloon angioplasty (PBA or CBA) for instent restenosis (ISR) has not been analyzed in drug-eluting stent (DES) versus bare metal one (BMS). We compared the efficacy of PBA and CBA in the treatment of DES-ISR versus BMS-ISR.
Methods: We analyzed 252 ISR lesions in 211 consecutive patients treated by CBA (167 lesions) or PBA (85 lesions) among ISR cohorts between March 1998 to December 2008. The efficacy of both treatment modalities were analyzed in terms of angiographic repeated ISR, late loss, and major adverse cardiac events (MACE), which were defined as cardiac death, myocardial infarction, and target lesion revascularization (TLR).
Results: PBA and CBA group showed no difference in baseline clinical and lesions characteristics. In 9 month angiographic follow-up (85.6% vs. 85.9%, p=0.56), PBA and CBA showed similar efficacies; repeated ISR (37.8% vs. 37.0%, p=0.90), late loss (0.61 vs. 0.62mm, p=0.92), TLR (29.4% vs. 23.0%, p=0.27) and MACE (30.6% vs. 24.1%, p=0.27). These comparable efficacies between PBA and CBA were still maintained in BMS-ISR and DES-ISR. However, adverse outcomes were more frequently associated with CBA than PBA; myocardial infarction (9/167 vs. 0/85, p=0.031) and stent thrombosis (5/167 vs. 0/85, p=0.125). Moreover, these trends were still observed irrespective of initial type of stent (BMS-ISR or DES-ISR). Univariate analysis showed that smoking, renal insufficiency, left ventricular dysfunction, diffuse-ISR and lower pre-minimal lumen diameter (MLD) were independent predictor of repeated ISR. In multivariate analysis, however, diffuse-ISR and lower pre-MLD alone maintained significant correlation with repeated-ISR.
Conclusion: Plain balloon angioplasty might be safer modality than cutting balloon angioplasty for the treatment of ISR, although both of which seems to be comparable to each other in the angiographic or clinical outcomes that were not affected by the type of initial stent (DES-ISR versus BMS-ISR) but by the type of ISR (diffuse versus focal).