Abstract 17797: Paclitaxel-coated Drug Eluting Balloon Less Effective for Treatment of in-stent Restenosis in Drug Eluting Stent as Compared to Bare Metal Stent
The paclitaxel-coated drug eluting balloon (DEB) is effective for treatment of native coronary bare metal stent (BMS) in-stent restenosis. In addition, treatment of drug eluting stent (DES) and coronary artery bypass graft (CABG) in-stent restenosis by DEB is occasionally performed on a compassionate basis. The current retrospective analysis compares the efficacy of DEB for treatment of DES and CABG in-stent restenosis to established treatment for native BMS in-stent restenosis.
Between April 2009 and March 2013, we enrolled 83 patients of whom N=51 sustained in-stent restenosis (>50% lumen diameter reduction) after previous implantation of a BMS and N=32 after previous implantation of a DES (81% everolimus eluting stents, EES). These two groups were further subdivided according to localization of the in-stent restenosis in native vessels (N=46 BMS-lesions and N=20 DES-lesions) or CABG grafts (N=5 BMS-lesions and N=12 DES-lesions). The primary endpoint was recurrent restenosis (>50% lumen diameter reduction) at scheduled follow-up angiography after an average of 8 months.
Follow-up angiography was available for all 83 patients. In native vessel in-stent restenosis, application of DEB was associated with recurrent restenosis in 34.8% of patients with BMS and 60.0% of patients with DES (p < 0.05). In CABG graft in-stent restenosis, application of DEB was associated with recurrent restenosis in 20.0% of patients with BMS and 83.3% of patients with DES (p < 0.05).
In conclusion, treatment of in-stent restenosis with paclitaxel-coated DEB is effective for treatment of BMS in-stent restenosis, both in native coronaries and CABG grafts. In contrast, application of the DEB is significantly less effective for treatment of DES in-stent restenosis, both in native vessels and CABG grafts. More potent and effective treatment options need to be developed for treatment of in-stent restenosis of DES.
- © 2013 by American Heart Association, Inc.