JACC Cardiovasc Interv. 2018;11(10):969-978.
Impact of Optimized Procedure-Related Factors in Drug-Eluting Balloon Angioplasty for Treatment of In-Stent Restenosis.
제1저자 이태민, 이주명 · 교신저자 김효수
소속 (6)
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, Korea.
- Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
- Department of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea.
- Sejong General Hospital, Sejong Heart Institute, Bucheon, Korea.
- Cardiovascular Center, Seoul National University Boramae Medical Center, Seoul, Korea.
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, Korea. Electronic address: usahyosoo@gmail.com.
Abstract
OBJECTIVES The aim of this study was to investigate the impact of optimizing procedure-related factors during drug-eluting balloon (DEB) angioplasty on clinical outcomes of drug-eluting stent in-stent restenosis (ISR).
BACKGROUND Although DEB angioplasty is recommended as a reasonable option for ISR, recurrent target lesion failure (TLF) still occurs in many patients after DEB angioplasty.
METHODS Consecutive patients with drug-eluting stent ISR treated with DEB (SeQuent Please) were collected from 4 centers in Korea. The primary outcome was 2-year TLF. Procedure-related modifiable independent predictors for TLF and their best cutoff values were determined.
RESULTS In a total of 256 patients (309 lesions), TLF occurred in 52 patients (20.3%). Modifiable independent predictors of TLF among procedure-related factors were residual diameter stenosis after lesion preparation (residual percentage diameter stenosis [%DS]), DEB-to-stent ratio (BSR), and DEB inflation time (Tinflation), whose best cutoff values were 20%, 0.91, and 60 s, respectively. TLF rates were significantly higher in groups with residual %DS ≥20% (34.7% vs. 12.5%; adjusted hazard ratio: 2.15; 95% confidence interval: 1.86 to 2.48; p < 0.001), BSR ≤0.91 (46.4% vs. 21.9%; adjusted hazard ratio: 2.02; 95% confidence interval: 1.75 to 2.34; p < 0.001), and Tinflation ≤60 s (26.2% vs. 14.0%; adjusted hazard ratio: 1.82; 95% confidence interval: 1.36 to 2.45; p < 0.001). When classifying ISR lesions by combination of procedure-related factors, TLF occurred in 8.3% in the fully optimized procedure group (residual %DS <20%, BSR >0.91, and Tinflation >60 s) and 66.7% in the nonoptimized group (residual %DS ≥20%, BSR ≤0.91, and Tinflation ≤60 s) (p < 0.001).
CONCLUSIONS Residual %DS after lesion preparation, BSR, and Tinflation were the only modifiable procedure-related factors in DEB angioplasty. Fully optimized DEB angioplasty with optimal lesion preparation, prolonged inflation, and sufficient dilation may play an important role in reducing TLF after DEB angioplasty.
Copyright © 2018. Published by Elsevier Inc.
Keywords
drug-eluting balloonin-stent restenosispaclitaxel-coated balloonpercutaneous coronary interventiontarget lesion failure
Comment · 정정
그 밖의 정보
- 출판 형태
- Journal Article, Multicenter Study, Research Support, Non-U.S. Gov't
- 저널
- JACC. Cardiovascular interventions · eISSN 1876-7605
- MeSH
- Aged · Angioplasty, Balloon, Coronary / adverse effects / instrumentation · Cardiac Catheters* · Cardiovascular Agents / administration & dosage / adverse effects · Coated Materials, Biocompatible* · Coronary Artery Disease / diagnostic imaging / therapy · Coronary Restenosis / diagnostic imaging / etiology / therapy · Drug-Eluting Stents* · Female · Humans · Male · Middle Aged · Paclitaxel / administration & dosage / adverse effects · Percutaneous Coronary Intervention / adverse effects / instrumentation · Registries · Republic of Korea · Retreatment · Risk Factors · Time Factors · Treatment Outcome
- Substances
- Cardiovascular Agents · Coated Materials, Biocompatible · Paclitaxel