Comparison of 12-month angiographic outcomes between repeat drug-eluting stent implantation and drug-coated balloon treatment for restenotic lesion caused by stent fracture
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We aimed to compare the angiographic outcomes between repeat drug-eluting stent (DES) implantation and drug-coated balloon (DCB) treatment for restenotic lesion caused by stent fracture (SF). The treatment of restenotic lesion caused by SF after DES implantation has not been well evaluated. From April 2007 to April 2015, 9320 lesions were implanted with a DES during percutaneous coronary intervention in our hospital; of those, 815 lesions (8.7%) showed restenosis on the follow-up angiogram. The study subjects were 47 consecutive patients with 69 restenotic lesions caused by SF and treated by target lesion revascularization (TLR); of those, 27 patients with 45 lesions were treated with repeat DES during TLR (either a cobalt–chromium or platinum–chromium everolimus-eluting stent or zotarolimus-eluting stent; DES group), and 20 patients with 24 lesions were treated with DCB (DCB group) during TLR. The 12-month cumulative incidence of repeat TLR and predictors of repeat TLR was evaluated. Restenosis and re-restenosis were defined as % diameter stenosis > 50% on the follow-up angiogram. SF was defined as complete or partial separation of the stent strut as assessed by plain fluoroscopy. Baseline characteristics were similar between the groups. The 12-month binary re-restenosis rate and cumulative incidence of repeat TLR between the DES group and DCB group were 44.4% and 37.5% (p = 0.58) and 43.9% and 31.9% (p = 0.31), respectively. On multivariate analysis, a lesion with vessel hinge movement was an independent predictor of repeat TLR (p = 0.02, hazard ratio: 6.54, 95% confidence interval 1.30–32.8). The 12-month repeat TLR rate was high in both groups. After treating restenosis lesions caused by SF after DES implantation, mechanical stress leads to further interventional treatment, regardless of the type of device used.
KeywordsPercutaneous coronary intervention Drug-eluting stent Drug-coated balloon Stent fracture
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Conflict of interest
The authors declare that they have no financial relationships or other conflicts of interest relevant to the contents of this paper.
- 3.Habara S, Kadota K, Kuwayama A, Shimada T, Ohya M, Miura K, Amano H, Kubo S, Hyodo Y, Otsuru S, Tada T, Tanaka H, Fuku Y, Goto T (2016) Late restenosis after both first-generation and second-generation drug-eluting stent implantations occurs in patients with drug-eluting stent restenosis. Circ Cardiovasc Interv 9:e004449CrossRefGoogle Scholar
- 4.Otsuka F, Vorpahl M, Nakano M, Foerst J, Newell JB, Sakakura K, Kutys R, Ladich E, Finn AV, Kolodgie FD, Virmani R (2014) Pathology of second-generation everolimus-eluting stents versus first-generation sirolimus- and paclitaxel-eluting stents in humans. Circulation 129(2):211–223CrossRefGoogle Scholar
- 6.Sianos G, Morel MA, Kappetein AP, Morice MC, Colombo A, Dawkins K, van den Brand M, Van Dyck N, Russell ME, Mohr FW, Serruys PW (2005) The SYNTAX Score: an angiographic tool grading the complexity of coronary artery disease. EuroIntervention 1(2):219–227Google Scholar
- 7.Ino Y, Kubo T, Kitabata H, Shimamura K, Shiono Y, Orii M, Okochi K, Sougawa H, Tanimoto T, Komukai K, Ishibashi K, Takarada S, Nakanishi H, Tanaka A, Kimura K, Hirata K, Mizukoshi M, Imanishi T, Akasaka T (2011) Impact of hinge motion on in-stent restenosis after sirolimus-eluting stent implantation. Circ J 75(8):1878–1884CrossRefGoogle Scholar
- 10.Kufner S, Cassese S, Valeskini M, Neumann FJ, Schulz-Schupke S, Hoppmann P, Fusaro M, Schunkert H, Laugwitz KL, Kastrati A, Byrne RA, Investigators I-D (2015) Long-term efficacy and safety of paclitaxel-eluting balloon for the treatment of drug-eluting stent restenosis: 3-year results of a randomized controlled trial. JACC Cardiovasc Interv 8(7):877–884CrossRefGoogle Scholar
- 11.Alfonso F, Perez-Vizcayno MJ, Cardenas A, Garcia del Blanco B, Garcia-Touchard A, Lopez-Minguez JR, Benedicto A, Masotti M, Zueco J, Iniguez A, Velazquez M, Moreno R, Mainar V, Dominguez A, Pomar F, Melgares R, Rivero F, Jimenez-Quevedo P, Gonzalo N, Fernandez C, Macaya C, Investigators RIS (2015) A prospective randomized trial of drug-eluting balloons versus everolimus-eluting stents in patients with in-stent restenosis of drug-eluting stents: The RIBS IV randomized clinical trial. J Am Coll Cardiol 66(1):23–33CrossRefGoogle Scholar
- 15.Kashiwagi M, Tanaka A, Kitabata H, Ino Y, Tsujioka H, Komukai K, Ozaki Y, Ishibashi K, Tanimoto T, Takarada S, Kubo T, Hirata K, Mizukoshi M, Imanishi T, Akasaka T (2012) OCT-verified neointimal hyperplasia is increased at fracture site in drug-eluting stents. JACC Cardiovasc Imaging 5(2):232–233CrossRefGoogle Scholar