Effect of drug-coated balloon angioplasty on in-stent restenotic coronary lesions analyzed with optical coherence tomography and serial coronary artery angioscopy
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Drug-coated balloon angioplasty (DCBA) has been recognized for its utility in preventing in-stent re-restenosis (ISR); however, imaging of the neointima immediately after treatment and during follow-up has only been described in a few case reports. This study aimed to determine the efficacy and mechanism of the DCBA using imaging studies both immediately after the DCBA and during the follow-up period. We enrolled 15 consecutive patients who underwent DCBA for in-stent restenosis (ISR). The in-stent neointimal volume was evaluated using optical coherence tomography (OCT), and the in-stent yellow grade was assessed using coronary angioscopy (CAS) immediately after DCBA and during the median follow-up period of 9 (8–15) months. The neointimal volume was significantly reduced from 77.1 ± 36.2 mm3 at baseline to 60.2 ± 23.9 mm3 immediately after DCBA (p = 0.0012 vs. baseline) and to 46.7 ± 21.9 mm3 during the follow-up (p = 0.0002 vs. post DCBA). The yellow grade of the residual plaques at the ISR lesion, which indicated plaque vulnerability, was significantly decreased in the follow-up CAG (from baseline: 1.79 ± 1.03, during the follow-up: 0.76 ± 0.82; p < 0.0001). These data suggest that DCBA may inhibit neointimal formation and provide angioscopic intimal stabilization for ISR lesions.
KeywordsDrug-coated balloon In-stent restenosis Optical coherence tomography Coronary angioscopy
The authors would like to extend their sincere appreciation to Professor Atsushi Hirayama for guidance and valuable suggestions during the research, to Professor Yasuo Okumura and Professor Tadateru Takayama for their direct guidance during the research. Furthermore, we would like to express our gratitude to the catheter room of Nihon University Itabashi Hospital, who always cooperated at the clinical site of the research.
Compliance with ethical standards
Conflict of interest
Dr. Hirayama A and Hiro T are employed by the Department of Advanced Cardiovascular Imaging, Nihon University School of Medicine; which is endowed by Boston Scientific Corporation Japan, Abbott Medical Japan Co., Ltd and St. Jude Medical Japan Co., Ltd.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. The study and its protocols were approved by the Institutional Review Board of Nihon University Itabashi Hospital. This article does not contain any studies with animals performed by any of the authors.
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