Impact of in-stent tissue characteristics on excimer laser coronary angioplasty prior to drug-coated balloon treatment. (15th September 2021)

• Record Type: Journal Article
• Authors: Ishihara, Takayuki; Dohi, Tomoharu; Nakamura, Daisuke; Kikuchi, Atsushi; Okamoto, Naotaka; Mori, Naoki; Iida, Osamu; Tsujimura, Takuya; Mizote, Isamu; Higuchi, Yoshiharu; Yamada, Takahisa; Nishino, Masami; Mano, Toshiaki; Sakata, Yasushi
• Is Part Of: International journal of cardiology. Volume 339(2021)
• Page Start: 28
• Page End: 32
• Publication Date: 2021-09-15
• Subjects: Drug-coated balloon -- Excimer laser coronary angioplasty -- Optical coherence tomography; Cardiology -- Periodicals; Electronic journals; 616.12
• DOI: 10.1016/j.ijcard.2021.07.019
• Languages: English
• ISSNs: 0167-5273

Abstract

Abstract: Background: Percutaneous coronary intervention with drug-coated balloon (DCB) angioplasty is one of the standard treatments for lesions with in-stent restenosis (ISR). However, the efficacy of additional excimer laser coronary angioplasty (ELCA) for ISR lesions prior to DCB angioplasty has not been elucidated. The aims of this study were to elucidate the efficacy of ELCA prior to DCB treatment for ISR and the difference in effectiveness by lesion morphology. Methods: This was a multicenter, retrospective observational study. We enrolled 208 ISR lesions from 204 patients which were treated with DCB angioplasty under optical coherence tomography (OCT) guidance. We compared the acute gain evaluated by quantitative coronary angiography and clinically driven target lesion revascularization (CD-TLR) between the ELCA (+) (47 lesions) and ELCA (−) (161 lesions) groups. Results: The acute gain was significantly larger in the ELCA (+) group (1.51 ± 0.47 mm versus 1.29 ± 0.52 mm, P = 0.012). Even after adjustment for comorbidities, the ELCA had a significant impact on the acute gain (coefficient 0.24 [95% confidence interval 0.067–0.41]). In addition, the ELCA usage was significantly associated with larger acute gain in lesions with a homogeneous pattern, although there was no association between ELCA and either the heterogeneous pattern or neoatherosclerosis. The freedom from CD-TLR was not different between the ELCA (−) and ELCA (+) groups (hazard ratio 0.53 [0.24–1.18]). Conclusions: ELCA had a significant impact on the larger acute gain in ISR lesions, especially may did in those with a homogenous pattern, while it did not impact CD-TLR significantly. Highlights: ELCA was significantly associated with larger acute gain by PCI with DCB for ISR. ELCA had a significant impact on the acute gain for ISR with a homogeneous pattern. Active usage of ELCA prior to DCB is recommended for ISR with a homogeneous pattern.