Author + information
- Received September 27, 2017
- Revision received February 5, 2018
- Accepted February 7, 2018
- Published online May 21, 2018.
- Tae-Min Rhee, MDa,∗,
- Joo Myung Lee, MD, MPH, PhDb,∗,
- Eun-Seok Shin, MD, PhDc,
- Doyeon Hwang, MDa,
- Jonghanne Park, MD, PhDa,
- Ki-Hyun Jeon, MDd,
- Hack-Lyoung Kim, MD, PhDe,
- Han-Mo Yang, MD, PhDa,
- Jung-Kyu Han, MD, PhDa,
- Kyung Woo Park, MD, PhDa,
- Joo-Yong Hahn, MD, PhDb,
- Bon-Kwon Koo, MD, PhDa,
- Sang-Hyun Kim, MD, PhDe and
- Hyo-Soo Kim, MD, PhDa,∗ ()
- aDepartment of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, Korea
- bDivision of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- cDepartment of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
- dSejong General Hospital, Sejong Heart Institute, Bucheon, Korea
- eCardiovascular Center, Seoul National University Boramae Medical Center, Seoul, Korea
- ↵∗Address for correspondence:
Dr. Hyo-Soo Kim, Department of Internal Medicine, Cardiovascular Center, Seoul National University Hospital, 101 Daehak-ro, Jongro-gu, Seoul 03080, Korea.
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.
- drug-eluting balloon
- in-stent restenosis
- paclitaxel-coated balloon
- percutaneous coronary intervention
- target lesion failure
↵∗ Drs. Rhee and Lee contributed equally to this work.
This study was supported by a grant of the Korea Health Technology R&D Project “Korea Research-Driven Hospital” through the Korea Health Industry Development Institute, funded by the Ministry of Health & Welfare, Korea (grant HI14C1277). This study was also supported by an unrestricted research grant from Endocor Korea. The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received September 27, 2017.
- Revision received February 5, 2018.
- Accepted February 7, 2018.
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