Simple balloon dilation for drug-eluting in-stent restenosis: An optical coherent tomography analysis




Abstract


Background


Although drug-eluting stent (DES) has significantly reduced restenosis, the treatment of DES-in-stent restenosis (ISR) remains a challenge with high restenosis rate.


Methods


We examined whether morphologic appearance of restenosis tissue by optical coherent tomography (OCT) had an impact on outcomes after balloon angioplasty for DES-ISR. The morphologic appearance of restenosis tissue was qualitatively assessed for tissue structures such as homogeneous, layered, and heterogeneous patterns.


Results


Using OCT, 50 patients with DES-ISR were divided into 2 groups: 25 lesions with homogeneous or layered patterns (homo/layered group) and 25 lesions with heterogeneous patterns (hetero group). Acute gain was larger in the hetero group (1.33 ± 0.41 mm vs. 1.06 ± 0.32 mm in the homo/layered group, P = 0.03). On intravascular ultrasound analysis, post-procedural percent neointimal area was smaller in the hetero group (27.4 ± 9.2% vs. 34.0 ± 11.2% in the homo/layered group, P = 0.05). Angiographic follow-up was performed in 37 lesions (74%). Follow-up minimal lumen diameter was larger in the hetero group (1.75 ± 0.89 mm vs. 1.01 ± 0.81 mm in the homo/layered group, P = 0.04). Target lesion revascularization rates tended to be lower in the hetero group (20% vs. 43% in the homo/layered group, P = 0.12).


Conclusions


Balloon angioplasty was more effective for DES-ISR with heterogeneous tissue appearance than DES-ISR with homogeneous/layered tissue appearance. OCT assessment of DES-ISR morphology may be a useful adjunct in determining clinical strategies. Simple balloon dilatation is a possible treatment strategy for DES-ISR lesions with a heterogeneous appearance on OCT images.


1


Introduction


Drug-eluting stents (DES) have significantly reduced the rates of in-stent restenosis (ISR) . However, DES-ISR still occurs, and its prevalence is not negligible because the population treated with DES is large. Although several treatment options (conventional balloon angioplasty, cutting or scoring balloon, drug-eluting balloon, bare metal stent, same DES, different DES, vascular brachytherapy, or bypass surgery) have been examined, optimal management for ISR of DES has not been definitely established .


Optical coherence tomography (OCT) is a high-resolution imaging modality that enables us to identify the morphologic pattern of ISR tissue . Based on several pathologic studies, neointimal tissue has various components, including proteoglycans, organized thrombi, smooth muscle cells, atheromas, inflammatory cells, and fibrinoids . Different OCT morphologic patterns may represent different tissue components and have a different response after treatment for DES-ISR. In the present study, we retrospectively examined the efficacy of conventional balloon angioplasty in the treatment of DES-ISR based on the morphologic pattern of OCT findings.

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Nov 14, 2017 | Posted by in CARDIOLOGY | Comments Off on Simple balloon dilation for drug-eluting in-stent restenosis: An optical coherent tomography analysis

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