Cutting balloon angioplasty vs. conventional balloon angioplasty in patients receiving intracoronary brachytherapy for the treatment of in‐stent restenosis
Panayotis FasseasJames L. OrfordRyan J. LennonJessica O’NeillAli E. DenktasCarmelo PanettaPeter B. BergerDavid R. Holmes
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Abstract The objective of this study was to evaluate the safety and efficacy of cutting balloon angioplasty (CBA) for the treatment of in‐stent restenosis prior to intracoronary brachytherapy (ICB). Cutting balloon angioplasty may reduce the incidence of uncontrolled dissection requiring adjunctive stenting and may limit “melon seeding” and geographic miss in patients with in‐stent restenosis who are subsequently treated with ICB. We performed a retrospective case‐control analysis of 134 consecutive patients with in‐stent restenosis who were treated with ICB preceded by either CBA or conventional balloon angioplasty. We identified 44 patients who underwent CBA and ICB, and 90 control patients who underwent conventional percutaneous transluminal coronary angioplasty (PTCA) and ICB for the treatment of in‐stent restenosis. Adjunctive coronary stenting was performed in 13 patients (29.5%) in the CBA/ICB group and 41 patients (45.6%; P < 0.001) in the PTCA/ICB group. There was no difference in the injury length or active treatment (ICB) length. The procedural and angiographic success rates were similar in both groups. There were no statistically significant differences in the incidence of death, myocardial infarction, recurrent angina pectoris, subsequent target lumen revascularization, or the composite endpoint of all four clinical outcomes ( P > 0.05). Despite sound theoretical reasons why CBA may be better than conventional balloon angioplasty for treatment of in‐stent restenosis with ICB, and despite a reduction in the need for adjunctive coronary stenting, we were unable to identify differences in clinical outcome. Catheter Cardiovasc Interv 2004;63:152–157. © 2004 Wiley‐Liss, Inc.Keywords:
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To determine the mid-term effects of cutting balloon angioplasty (CBA) on in-stent restenosis.A total of 69 patients with in-stent restenosis were divided into 2 groups randomly: cutting balloon angioplasty and plain old balloon angioplasty. The mechanisms of restenosis and dilation results were determined by quantitative coronary angiography and intravascular ultrasound. Follow-up was performed.The procedural success rate was 100% without death and acute closure. One patient experienced dissection at the distal end of the stent and needed another stent. The mean follow-up period was 6.7 +/- 2.3 months. The final re-restenosis rate was 15% and 18% at 3 months and 6 months respectively, markedly lower than after plain old balloon angioplasty (38% and 43%). Acute gain by intravascular ultrasound (IVUS) was 1.72 +/- 0.52 mm after cutting balloon angioplasty, higher than 1.15 +/- 0.54 mm after plain old balloon angioplasty. The lumen diameter late loss in the cutting balloon group was 0.26 +/- 0.05 mm and 0.38 +/- 0.06 mm at 3 months and 6 months respectively, significantly lower than for those in conventional balloon group (0.78 +/- 0.19 mm and 0.89 +/- 0.16 mm, respectively, P < 0.001). As shown by IVUS, the main mechanism of cutting balloon angioplasty was marked reduction of plaque area without significant increase of vessel area (less vessel trauma).Cutting balloon angioplasty is feasible and effective for the treatment of in-stent restenosis with less vessel trauma.
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We evaluated the effectiveness of Cutting Balloon angioplasty for ostial lesions of the left anterior descending artery compared with conventional balloon angioplasty. Cutting Balloon angioplasty (n = 7) produced larger acute gain (1.70 ± 0.37 vs 0.48 ± 0.25 mm, P < 0.001) and smaller late loss index (0.54 ± 0.55 vs 1.32 ± 0.81, P < 0.05) than conventional balloon angioplasty (n = 7). As a result, late restenosis was seen in only two patients undergoing Cutting Balloon angioplasty, but in all seven patients undergoing conventional balloon angioplasty. Ostial lesions of the left anterior descending artery may be one of the suitable targets of Cutting Balloon angioplasty . (J Interven Cardiol 2000;13:7–14)
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Restenosis after successful balloon angioplasty remains problematic. Early elastic response after angioplasty is significant when considering the possible development of restenosis. The purpose of this study was to compare early elastic recoil within 10 minutes after successful percutaneous transluminal coronary angioplasty and early lumen loss at 24 hours after angioplasty in a cutting balloon group and a conventional balloon group.Extent of early elastic recoil was quantitatively measured as the difference of mean balloon diameter at maximal inflation pressure and minimal luminal diameter after angioplasty in 82 cutting balloon-treated lesions and 51 conventional balloon-treated lesions.Reference diameter and balloon/artery ratio were similar between the cutting balloon and conventional balloon groups (2.89 0.47 mm vs. 2.88 0.60 mm; 1.19 0.11 vs. 1.19 0.13, respectively). Early elastic recoil after angioplasty was significantly smaller in the cutting balloon than the conventional balloon group (0.96 0.40 mm vs. 1.12 0.37 mm, respectively; p = 0.04). Also, the mean amount of lumen loss from 10 minutes after angioplasty to 24 hours after was significantly smaller in the cutting balloon than the conventional balloon group (0.08 0.28 mm vs. 0.20 0.33 mm, respectively; p = 0.02).There is significantly less early elastic recoil in the cutting balloon angioplasty than in the conventional balloon angioplasty group. The efficacy of cutting balloon continues 24 hours after angioplasty.
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Objective To determine if the cutting balloon angioplasty has advantages over conventional balloon percutaneous transluminal coronary angioplasty (PTCA) in treatment of in-stent restenosis (ISR). Methods A total of 266 lesions treated for ISR were divided into two groups according to the treatment strategy: conventional balloon PTCA and cutting balloon angioplasty. Angiogram obtained during the procedure and 6 month after the two interventions, and quantitative angiograpic analysis was performed. Results ①Immediately after intervention, the maxium luminal diameter(MLD) in cutting balloon angioplasty group was similar to the one achieved of conventional balloon angioplasty[(2.51±0.65) vs (2.53±0.65) mm, P0.05]. ②At six-month follow-up, the MLD has no significant change between the conventional balloon PTCA group and the cutting balloon angioplasty group [(1.75±0.83) vs (1.96±0.74) mm, P0.05]. ③The cutting balloon angioplasty group has a lower late lumen loss(P0.05). Conclusion We conclude that cutting balloon angioplasty did not increase the MLD immediately after intervention and at 6-month follow-up as compared with conventional balloon angioplasty in the treatment of in-stent restenosis, but with a less late lumen loss.
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