CLINICAL STUDY: INTERVENTIONAL CARDIOLOGY
Cutting balloon angioplasty for the treatment of in-stent restenosis: a matched comparison with rotational atherectomy, additional stent implantation and balloon angioplasty
Milena Adamian, MD, PhD ,
Antonio Colombo, MD, FACC*,
Carlo Briguori, MD, PhD*,
Takahiro Nishida, MD*,
Federica Marsico, MD*,
Carlo Di Mario, MD, PhD, FACC*,
Remo Albiero, MD*,
Issam Moussa, MD and
Jeffrey W. Moses, MD, FACC
* EMO Centro Cuore Columbus, Milan, Italy
Lenox Hill Heart and Vascular Institute, New York, New York, USA
Manuscript received January 23, 2001;
revised manuscript received April 27, 2001,
accepted June 8, 2001.
Reprint requests and correspondence: Dr. Antonio Colombo, EMO Centro Cuore Columbus, Via M. Buonarroti 48, 20145 Milan, Italy
columbus{at}micronet.it
OBJECTIVES
The purpose of the study was to determine whether cutting balloon angioplasty (CBA) has advantages over other modalities in treatment of in-stent restenosis (ISR).
BACKGROUND
Controversies exist regarding optimal treatment for ISR. Recently, CBA emerged as a tool in management of ISR.
METHODS
A total of 648 lesions treated for ISR were divided into four groups according to the treatment strategy: CBA, rotational atherectomy (ROTA), additional stenting (STENT), and percutaneous transluminal coronary angioplasty (PTCA). Following the matching process, 258 lesions were entered into the analysis.
RESULTS
Baseline clinical and angiographic characteristics were similar among the groups (p = NS). Acute lumen gain was significantly higher in the STENT group (2.12 ± 0.7 mm), whereas in the CBA group the gain was similar to one achieved following ROTA and following PTCA (1.70 ± 0.6 vs. 1.79 ± 0.5 mm and 1.56 ± 0.7 mm, respectively; p = NS). The lumen loss at follow-up was lower for the CBA versus ROTA and versus STENT (0.63 ± 0.6 vs. 1.30 ± 0.8 mm and 1.36 ± 0.8 mm, respectively; p < 0.0001), yielding a lower recurrent restenosis rate (20% vs. 35.9% and 41.4%, respectively; p < 0.05). By multivariate analysis, CBA (odds ratio [OR] = 0.17; confidence interval [CI], 0.06 to 0.51; p = 0.001) and diffuse restenosis type at baseline (OR = 2.07; CI, 1.15 to 3.71; p = 0.02) were identified as predictors of target lesion revascularization.
CONCLUSIONS
We conclude that CBA is a safe and efficient technique for treatment of ISR, with immediate results similar to atheroablation and better clinical and angiographic outcomes at follow-up. This approach might be implemented as a viable option in management of focal ISR and to prepare diffuse ISR for brachytherapy treatment.
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Abbreviations and Acronyms
| | CABG | = coronary artery bypass graft surgery | | CBA | = cutting balloon angioplasty | | CI | = confidence interval | | CK | = creatine kinase | | CK-MB | = creatine kinase-myocardial band | | ISR | = in-stent restenosis | | IVUS | = intravascular ultrasound | | MACE | = major adverse cardiac events | | MI | = myocardial infarction | | MLD | = minimal lumen diameter | | NQMI | = non–Q-wave myocardial infarction | | OR | = odds ratio | | PTCA | = percutaneous transluminal coronary angioplasty | | QCA | = quantitative coronary angiography | | QMI | = Q-wave myocardial infarction | | ROTA | = rotational atherectomy | | STENT | = additional stenting | | TLR | = target lesion revascularization |
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