Author + information
- Sung Yun Lee,
- Sang–Wook Kim,
- Jin Bae Lee,
- Eun–Seok Shin,
- Joon Hyung Doh,
- Hyunmin Choi and
- Young Joon Hong
Paclitaxel eluting balloon (PEB) angioplasty has been shown to superior to plain old balloon angioplasty (POBA) for treatment of in–stent restenosis (ISR), but 10% of target lesion revascularization rate at 12 or 24 months. There is no report which IVUS characteristics are associated with PEB angioplasty outcomes.
We performed pre–PCI IVUS for 58 patients with ISR (8 BMS, 50 DES) treated with PEB angioplasty. Plaque modification was done with POBA before using PEB. ISR lesions treated with stent implantation, and follow duration less than 6 months were excluded. The DEB failure was defined as death, myocardial infarction and symptom driven revascularization. IVUS images were analysed at 6 locations: proximal and distal vessel segment within 3mm from stent edge, proximal and distal stent edge, lesion site at minimal lumen area and minimal stent area. The following measurements were obtained: lumen area (LA), stent area (SA), external elastic membrane, neointima area calculated as (SA–LA), % neointimal area calculated as (SA-LA/SA) × 100, and stent under–expansion if SA<5 mm2.
Among 58 patients treated with 58 PEB (3.0 ± 0.4 mm by 21.9 ± 4.8 mm), PEB failure were developed at 8 patients (13.8%) during 0.81 years of follow–up. There was no significant difference in clinical presentation and used stents at index procedure between PEB failure and non–failure group. In PEB failure group, neointima area (4.0 ± 0.7 vs. 2.9 ± 0.8 mm2, p=0.05) and % neointimal area (59.4 ± 12.0 vs. 46.0 ± 24.9 %, p=0.05) were significant greater than non–failure group. Minimal stent area was tend to larger (6.7 ± 0.3 vs. 5.5 ± 2.7 mm2, p=0.06) and no stent under–expansion was found in failure group. Stent under–expansion was found in 24 ISR lesions (48.0%) of non–failure group.
PEB failure was more frequently occured in ISR lesions with prominent neo–intimal hyperplasia on normally expanded stent, whereas PEB angioplasty was successful in ISR lesions with stent under–expansion and modest neo–intimal hyperplasia. These suggest that we need differentiate treatment modality according to pre–PCI IVUS findings in patients with ISR lesion.
Poster Sessions, Expo North
Sunday, March 10, 2013, 9:45 a.m.–10:30 a.m.
Session Title: Intravascular Imaging: IVUS and OCT
Abstract Category: 38. TCT@ACC–i2: Intravascular Imaging and Physiology
Presentation Number: 2108–250
- 2013 American College of Cardiology Foundation