CLINICAL RESEARCH: INTERVENTIONAL CARDIOLOGY
Cutting balloon versus conventional balloon angioplasty for the treatment of in-stent restenosis
Results of the restenosis cutting balloon evaluation trial (RESCUT)
Remo Albiero, MD*,*,
Sigmund Silber, MD ,
Carlo Di Mario, MD ,
Carmelo Cernigliaro, MD ,
Salvatore Battaglia, MD||,
Bernhard Reimers, MD¶,
Arian Frasheri, MD#,
Volker Klauss, MD**,
Joseph M. Auge, MD,
Paolo Rubartelli, MD,
Marie-Claude Morice, MD,
Alberto Cremonesi, MD||||,
Joachim Schofer, MD¶¶,
Alessandro Bortone, MD##,
Antonio Colombo, MD* RESCUT Investigators
* Columbus Hospital, Milan, Italy
Müller Hospital, Munich, Germany
San Raffaele Hospital, Milan, Italy
Ospedale Maggiore della Carità, Novara, Italy
|| Clinica Montevergine, Mercogliano (AV), Italy
¶ Ospedale Civile, Mirano, Italy
# Casa di Cura Villa Maria Eleonora, Palermo, Italy
** Klinikum Innenstadt Abteilung Cardiologie, Munich, Germany
Hospital Santa Creu I Sant Pau, Barcelona, Spain
Ospedale San Martino, Genova, Italy
Institut Cardiovasculaire Paris Sud, Massy, France
|||| Casa di Cura Villa Maria Cecilia, Cotignola (RA), Italy
¶¶ Kardiologische Klinik Andreas-Grünzig-Haus, Hamburg, Germany
## Policlinico, Bari, Italy
Manuscript received July 23, 2003;
revised manuscript received September 5, 2003,
accepted September 9, 2003.
* Reprint requests and correspondence: Dr. Remo Albiero, Laboratorio di Emodinamica, Clinica San Rocco di Franciacorta; Via dei Sabbioni 24, 25050 Ome (BS), Italy.
remo.albiero{at}email.it
OBJECTIVES: The aim of this trial was to compare cutting balloon angioplasty (CBA) with conventional balloon angioplasty (i.e., percutaneous transluminal coronary angioplasty [PTCA]) for the treatment of patients with coronary in-stent restenosis (ISR).
BACKGROUND: Retrospective studies suggest CBA might be superior to conventional PTCA in the treatment of ISR.
METHODS: The Restenosis Cutting Balloon Evaluation Trial (RESCUT) is a multicenter, randomized, prospective European trial including 428 patients with all types of ISR (e.g., focal, multifocal, diffuse, proliferative).
RESULTS: In both groups, the majority of ISR lesions were shorter than 20 mm. The length of restenotic stents was similar (CBA: 18.6 ± 9.7 mm; PTCA: 18.3 ± 8.7 mm). The number of balloons used to treat ISR was lower in the CBA group: only one balloon was used in 82.3% of CBA cases, compared with 75% of PTCA procedures (p = 0.03). Balloon slippage was less frequent in the CBA group (CBA 6.5%, PTCA 25%; p < 0.01). There was a trend toward a lower need for additional stenting in the CBA group (CBA 3.9%, PTCA 8.0%; p = 0.07). At seven-month angiographic follow-up, the binary restenosis rate was not different between the groups (CBA 29.8%, PTCA 31.4%; p = 0.82), with a similar pattern of recurrent restenosis. Clinical events at seven months were also similar.
CONCLUSIONS: Cutting balloon angioplasty did not reduce recurrent ISR and major adverse cardiac events, as compared with conventional PTCA. However, CBA was associated with some procedural advantages, such as use of fewer balloons, less requirement for additional stenting, and a lower incidence of balloon slippage.
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Abbreviations and Acronyms
| | CABG | = coronary artery bypass graft surgery | | CBA | = cutting balloon angioplasty | | CK | = creatine kinase | | %DS | = percent diameter stenosis | | ISR | = in-stent restenosis | | IVUS | = intravascular ultrasound | | MACE | = major adverse cardiac events | | MLD | = minimum lumen diameter | | PTCA | = percutaneous transluminal coronary angioplasty | | QCA | = quantitative coronary angiography | | RESCUT | = Restenosis Cutting Balloon Evaluation Trial |
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