Outcomes of paclitaxel‐coated balloon angioplasty for in‐stent calcified nodule: An optical coherence tomography study. Issue 6 (13th October 2022)

• Record Type: Journal Article
• Authors: Masuda, Hisaki; Kuramitsu, Shoichi; Ito, Tomoaki; Morofuji, Toru; Domei, Takenori; Hyodo, Makoto; Shirai, Shinichi; Ando, Kenji
• Is Part Of: Catheterization and cardiovascular interventions. Volume 100:Issue 6(2022)
• Page Start: 990
• Page End: 999
• Publication Date: 2022-10-13
• Subjects: drug‐coated balloon -- drug‐eluting stent -- in‐stent calcified nodule -- percutaneous coronary intervention; Heart -- Diseases -- Diagnosis -- Periodicals; Cardiac catheterization -- Periodicals; 616.1207572
• DOI: 10.1002/ccd.30418
• Languages: English
• ISSNs: 1522-1946

Abstract

Abstract: Background: Paclitaxel‐coated balloon (PCB) angioplasty emerges as an effective therapeutic option for in‐stent restenosis (ISR). However, whether PCB angioplasty would be effective for in‐stent calcified nodule (ISCN) lesions remain fully understood. This study aimed to evaluate the frequency and outcomes of ISCN in patients undergoing PCB angioplasty for ISR after second‐generation drug‐eluting stents (G2‐DES) implantation. Methods: This study enrolled 179 lesions (160 patients) undergoing PCB angioplasty for G2‐DES restenosis with optical coherence tomography guidance. According to the presence of ISCN at the minimum lumen area, the lesions were divided into two groups: the ISCN ( n = 16) and the non‐ISCN groups ( n = 163). The primary study endpoint was the cumulative 3‐year incidence of target lesion failure (TLF; a composite of cardiac death, clinically driven target vessel revascularization, and definite stent thrombosis) on a lesion basis. Results: ISCN was observed in 16 of 179 lesions (8.9%). Cumulative 3‐year incidence of TLF was significantly higher in the ISCN group than in the non‐CN group (85.3% vs. 16.9%, inverse probability weighted hazard ratio [HR] 4.46, 95% confidence intervals [CIs]: 2.42–8.22, p < 0.001). Risk factors associated with TLF were ISCN (HR 4.55, 95% CI: 1.56–13.3, p = 0.005), recurrent ISR (HR 2.82, 95% CI: 1.50–3.30, p = 0.001), and early ISR (HR 2.18, 95% CI: 1.21–3.92, p = 0.009). Conclusion: ISCN was observed in 8.3% of G2‐DES restenosis. PCB angioplasty had little effect on ISCN lesions compared with non‐ISCN lesions, suggesting the need for careful clinical follow‐up of patients with ISCN lesions after PCB angioplasty.