Angiography and Optical Coherence Tomography Assessment of the Drug-Coated Balloon ESSENTIAL for the Treatment of In-Stent Restenosis

2020 ◽  
Vol 21 (4) ◽  
pp. 508-513
Author(s):  
Jose M. de la Torre Hernández ◽  
Tamara Garcia Camarero ◽  
Fernando Lozano Ruiz-Poveda ◽  
Cristóbal A. Urbano-Carrillo ◽  
Ignacio Sánchez Pérez ◽  
...  
Keyword(s):  
Optical Coherence Tomography ◽  
Optical Coherence ◽  
Stent Restenosis ◽  
Drug Coated Balloon ◽  
In Stent Restenosis

scholarly journals Treatment of In-Stent Restenosis by Excimer Laser Coronary Atherectomy and Drug-Coated Balloon: Serial Assessment with Optical Coherence Tomography

2019 ◽  
Vol 2019 ◽  
pp. 1-9 ◽  
Author(s):  
Toru Miyazaki ◽  
Takashi Ashikaga ◽  
Taku Fukushima ◽  
Yu Hatano ◽  
Taro Sasaoka ◽  
...  
Keyword(s):  
Optical Coherence Tomography ◽  
Excimer Laser ◽  
Target Lesion ◽  
Optical Coherence ◽  
Angiographic Restenosis ◽  
Stent Restenosis ◽  
Scoring Balloon ◽  
Drug Coated Balloon ◽  
In Stent Restenosis

Objectives. We aimed to compare the results of neointimal modification before drug-coated balloon (DCB) treatment with excimer laser coronary atherectomy (ELCA) plus scoring balloon predilation versus scoring balloon alone in patients presenting with in-stent restenosis (ISR).Background. Treatment of ISR with ELCA typically results in superior acute gain by neointima debulking. However, the efficacy of combination therapy of ELCA and DCB remains unknown.Methods. A total of 42 patients (44 ISR lesions) undergoing DCB treatment with ELCA plus scoring balloon (ELCA group, n = 18) or scoring balloon alone (non-ELCA group, n = 24) were evaluated via serial assessment by optical coherence tomography (OCT) performed before, after intervention, and at 6 months.Results. Although there was significantly greater frequency of diffuse restenosis and percent diameter stenosis (%DS) after intervention in the ELCA group, comparable result was shown in %DS, late lumen loss, and binary angiographic restenosis at follow-up. On OCT analysis, a decreased tendency in the minimum lumen area and a significant decrease in the minimum stent area were observed in the ELCA group between 6-month follow-up and after intervention (-0.89 ± 1.36 mm2vs. -0.09 ± 1.25 mm2, p = 0.05, -0.49 ± 1.48 mm2vs. 0.28 ± 0.78 mm2, p = 0.03, respectively). The changes in the neointimal area were similar between the groups, and target lesion revascularization showed comparable rates at 1 year (11.1% vs. 11.4%, p = 0.85).Conclusions. Despite greater %DS after intervention, ELCA before DCB had possible benefit for late angiographic and clinical outcome.

Abstract 16128: Vascular Healing Response After Everolimus Eluting Stent Implantation in Patients With or Without Diabetes Mellitus -Evaluation With Optical Coherence Tomography

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Yutaka Goryo ◽  
Shiro Uemura ◽  
Yoko Dote ◽  
Yu Sugawara ◽  
Tomoya Ueda ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Optical Coherence Tomography ◽  
Cross Sections ◽  
Healing Process ◽  
Drug Eluting Stent ◽  
Optical Coherence ◽  
Cross Sectional ◽  
Stent Restenosis ◽  
Neointimal Coverage ◽  
In Stent Restenosis

Introduction: Clinical introduction of percutaneous coronary intervention (PCI) with drug eluting stent has substantially decreased the rate of in-stent restenosis (ISR). However, it is reported that patients with diabetes mellitus (DM) still have higher incidence of restenosis and secondary cardiovascular events than patients without DM. Using intravascular optical coherence tomography (OCT), we evaluated the effect of DM on healing process of coronary artery after everolimus eluting stents (EES) implantation in the comparison with non-DM patients. Methods and Results: We studied 26 DM patients (65.1±11.9y/o) and 59 non-DM patients (68.1±9.4y/o) who received OCT-guided EES implantation. The second OCT examination was performed on 296±71.1 days after implantation (291±74.2days vs. 298±70.3days, p=0.51). OCT cross-sectional images of the second study were examined to determine the condition of neointimal coverage over every strut in 1mm interval (DM; 725 cross-sections and 5742 struts, non-DM; 1482 cross-sections and 12098 struts). In addition, neointimal thickness (NIT) over each strut measured and tissue characteristics were examined. One in-stent restenosis with clinical manifestation was observed in each group. Average NIT was significantly thicker in DM group than in non-DM group (107±99.2μm vs. 92±74.6μm, p<0.01). The incidence of malapposed struts without neointimal coverage were very low and similar in both groups (0.22±0.54 vs. 0.13±0.72%, p=0.43). The frequency of OCT-defined unstable neointimal characteristics was significantly higher rate in DM than non-DM group (14.5±18.9% vs. 6.67±14.5%, p=0.03). Conclusions: EES implanted in DM patients showed acceptable neointimal proliferation and uncovered stent struts similar to non-DM patients, suggesting the mid-term efficacy and safety of EES in DM patients. However, long-term follow-up should be necessary because of the high incidence of unstable neointimal characteristics which might be a substrate for the future development of neoatherosclerosis.

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