Long-Term Results of Drug-Coated Balloons for Drug-Eluting In-Stent Restenosis

Drug-eluting balloons currently constitute a therapeutic tool used in percutaneous coronary interventions (PCI). Long-term results remain unknown. We evaluated the prognosis of PCI using a second generation paclitaxel-eluting balloon (PEB) in real-world patients. We included all PCI with PEB in de novo or in-stent restenosis coronary lesions performed in our unit from March 2009 to March 2019. We assessed the composite of major adverse cardiovascular events (MACE) rate after a median follow-up of 42 months. Consecutive patients (n = 320) with 386 lesions were included; 46.9% presented with stable angina and 53.1% acute coronary syndromes; 52.6% of the lesions were in-stent restenosis and 47.3% de novo lesions with a mean diameter of 2.4 ± 0.5 mm. A bare metal stent was implanted in 6.7% and a drug-eluting stent in 8.5% of patients. The MACE rate was 8%: 10 (2.6%) cardiovascular deaths, 13 (3.4%) myocardial infarctions, and 16 (4.1%) target lesion revascularization. The all-cause death rate was 5.2%. No cases of thrombosis were recorded. In conclusion, PEB was a safe and effective tool to treat in-stent restenosis and de novo coronary lesions, especially small vessel disease, during long-term follow-up.

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Long Term Results of Laser Angioplasty for In-stent Restenosis

Journal of the American College of Cardiology ◽

10.1016/s0735-1097(97)84314-8 ◽

1998 ◽

Vol 31 (2) ◽

pp. 141A ◽

Cited By ~ 4

Author(s):

R Köster

Keyword(s):

Laser Angioplasty ◽

Long Term Results ◽

Stent Restenosis ◽

In Stent Restenosis

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Predictive value of the CHA2DS2-VASc Score in detecting in-stent restenosis among patients who underwent previous revascularization due to stable angina or acute coronary syndromes

QJM ◽

10.1093/qjmed/hcaa041.013 ◽

2020 ◽

Vol 113 (Supplement_1) ◽

Author(s):

R Ayman ◽

H Shehata ◽

E AL-Fikki ◽

Y Gomaa

Keyword(s):

Significant Relationship ◽

Stable Angina ◽

Predictive Value ◽

Long Term Results ◽

Drug Eluting Stents ◽

P Value ◽

Stent Restenosis ◽

Stent Length ◽

Drug Eluting ◽

In Stent Restenosis

Abstract Background Introduction of coronary stents in the field of interventional cardiology has significantly improved short- and long-term results of the percutaneous coronary interventions but in the same time they became responsible for development of a new entity called neo-intimal hyperplasia (NIH). If overexpressed, NIH can lead to so-called in-stent restenosis (ISR). Objective To assess the predictive value of the CHA2DS2-VASc Score in detecting in-stent restenosis among patients who underwent previous revascularization in Proximal Left Anterior Descending(LAD) Artery using Drug Eluting Stents (DES) due to stable angina and acute coronary syndrome. Material and Methods This study was conducted over 113 pateints to assess the predictive value of the CHA2DS2-VASc Score in detecting in-stent restenosis among patients who underwent previous revascularization in Proximal Left Anterior Descending (LAD) Artery using Drug Eluting Stents (DES). Results From the study population collected(n = 113), 18.4% of which were females (n = 21), statistically significant relation was found between DES-ISR and CHADSVasc score (p value =0.033). A significant relationship existed between ISR and CHADVasc score 3 or more, and each of: Age(p value= 0.022), DM(p value=0.029), SBP during the procedure(p value = 0.036), time since the PCI was done(p value =0.001), stent length(p value=0.028), pattern of the lesion and management of the lesions as individual variables (p value less than0.001). However, non-significant relationship could be concluded between ISR and each of gender(p value= 0.987), CHF(p value=0.163), HTN(p value=0.446), vascular diseases (p value=0.662), CAD type (SCAD or ACS)(p value=0.616), DBP during the procedure(p value=0.167), creatinine clearance (p value=0.69), HBA1c(p value=0.091), use of DAPT(p value=0.198), the duration of DAPT use(p value=0.873), type of P2Y12 inhibitor used(p value=0.083), use of statins(p value=0.402), beta blockers or nitrates (p values= 1 & 0.836, respectively) and stent diameter used (p value=0.615) Conclusion This study was able to show a significant relationship between ISR and each of CHADVasc score, Age, DM, SBP during the procedure, time since the PCI was done, stent length used, pattern of the lesion and management of the lesions

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TCT-800 Long-term Target Lesion Revascularization After Treatment With Excimer Laser Coronary Atherectomy for In-Stent Restenosis of Drug-Eluting Stent

Journal of the American College of Cardiology ◽

10.1016/j.jacc.2017.09.1010 ◽

2017 ◽

Vol 70 (18) ◽

pp. B325 ◽

Cited By ~ 1

Author(s):

Eiji Ichimoto ◽

Tadayuki Kadohira ◽

Takashi Nakayama ◽

Joseph De Gregorio

Keyword(s):

Excimer Laser ◽

Target Lesion ◽

Target Lesion Revascularization ◽

Drug Eluting Stent ◽

Stent Restenosis ◽

Drug Eluting ◽

In Stent Restenosis

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Clinical Outcomes of Drug-Eluting versus Bare-Metal In-Stent Restenosis after the Treatment of Drug-Eluting Stent or Drug-Eluting Balloon: A Systematic Review and Meta-Analysis

Journal of Interventional Cardiology ◽

10.1155/2020/8179849 ◽

2020 ◽

Vol 2020 ◽

pp. 1-11

Author(s):

Yi-Xing Yang ◽

Yin Liu ◽

Chang-Ping Li ◽

Peng-Ju Lu ◽

Jiao Wang ◽

...

Keyword(s):

Clinical Outcomes ◽

Meta Analysis ◽

Cochrane Library ◽

Bare Metal ◽

Stent Restenosis ◽

Positive Prevention ◽

Drug Eluting ◽

Drug Eluting Balloon ◽

In Stent Restenosis

Background. Although drug-eluting stents (DES) have reduced the rates of in-stent restenosis (ISR) compared with bare-metal stents (BMS), DES related ISR (DES-ISR) still occurs and outcomes of DES-ISR remain unclear. The objective of this meta-analysis was to investigate the long-term clinical outcomes of patients with DES-ISR compared with patients with BMS related ISR (BMS-ISR) after the treatment of DES or drug-eluting balloon (DEB). Methods and results. We searched the literature in the main electronic databases including PUBMED, EMBASE, Cochrane Library, and Web of Science. The primary endpoints were target lesion revascularization (TLR) and target vessel revascularization (TVR). The secondary endpoints included all cause death (ACD), cardiac death (CD), myocardial infarction (MI), stent thrombosis or re-in-stent restenosis (ST/RE-ISR), and major adverse cardiovascular events (MACEs). A total of 19 studies with 6256 participants were finally included in this meta-analysis. Results showed that the rates of TLR (P<0.00001), TVR (P<0.00001), CD (P=0.02), ST/RE-ISR (P<0.00001), and MACEs (P<0.00001) were significantly higher in the DES-ISR group than in the BMS-ISR group. No significant differences were found between the two groups in the rates of MI (P=0.05) and ACD (P=0.21). Conclusions. Our study demonstrated that patients with DES-ISR had worse clinical outcomes at the long-term follow-up than patients with BMS-ISR after the treatment of DES or DEB, suggesting that DES and DEB may be more effective for BMS-ISR than that for DES-ISR. Positive prevention of DES-ISR is indispensable and further studies concentrating on detecting the predictors of outcomes of DES-ISR are required.

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Vascular brachytherapy versus drug-eluting stents in the treatment of in-stent restenosis: A meta-analysis of long-term outcomes

Catheterization and Cardiovascular Interventions ◽

10.1002/ccd.25998 ◽

2015 ◽

Vol 87 (2) ◽

pp. 200-208 ◽

Cited By ~ 2

Author(s):

Alexandre Benjo ◽

Rhanderson N. Cardoso ◽

Tyrone Collins ◽

Daniel Garcia ◽

Francisco Y. Macedo ◽

...

Keyword(s):

Meta Analysis ◽

Drug Eluting Stents ◽

Long Term Outcomes ◽

Stent Restenosis ◽

Vascular Brachytherapy ◽

Drug Eluting ◽

In Stent Restenosis

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Excimer Laser Coronary Angioplasty (ELCA) for Diffuse In-stent Restenosis: Beneficial Long-term Results after Sufficient Debulking with a Lesion-specific Approach using various Laser Catheters

Lasers in Medical Science ◽

10.1007/pl00011347 ◽

2001 ◽

Vol 16 (2) ◽

pp. 84-89 ◽

Cited By ~ 11

Author(s):

J.B. Dahm

Keyword(s):

Excimer Laser ◽

Coronary Angioplasty ◽

Long Term Results ◽

Specific Approach ◽

Stent Restenosis ◽

In Stent Restenosis ◽

Excimer Laser Coronary Angioplasty

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Femtosecond Laser Nanotexturing of Drug-Eluting Stents

Journal of Manufacturing Science and Engineering ◽

10.1115/1.4007713 ◽

2012 ◽

Vol 134 (6) ◽

Cited By ~ 5

Author(s):

Rajeev Nair ◽

Vaelan Molian ◽

Pal Molian

Keyword(s):

Femtosecond Laser ◽

Cost Effective ◽

Interventional Cardiology ◽

Drug Eluting Stents ◽

Potential Cost ◽

Polymer Carrier ◽

Stent Restenosis ◽

Drug Eluting ◽

In Stent Restenosis

Drug-eluting stents (DES) have profoundly affected the field of interventional cardiology by dramatically reducing the problem of in-stent restenosis. However, the adverse, long-term, thrombosis raises the questions on the safety profile of DES. Femtosecond pulsed laser nanotexturing of metallic stents was performed to minimize thrombosis by improving three fundamental characteristics of DES: (1) increase the availability of drug for elution; (2) enhance the adhesion between stent and drug; and (3) minimize and, if possible, eliminate the polymer carrier. Results of laser-induced nanoprotrusion/drug interactions confirmed these benefits and indicated that femtosecond laser nanotexturing is a potential cost-effective solution for improving the performance and safety of DES while eliminating the need for postfinishing operations.

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