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Although the effectiveness of Paclitaxel-Coated Balloon (PCB) for the patients with in-stent-restenosis (ISR) has been reported, treatment strategy of “recurrent restenosis” cases after PCB still remains challenging. Previous reports suggested that final percent diameter stenosis after the PCI procedure was a predictor of recurrent restenosis for ISR lesions. Excimer Laser Coronary Angioplasty (ELCA) is a debulking device with vaporizing effect, and may potentially achieve larger final lumen when using ISR cases. The purpose of the study was to assess the effectiveness of ELCA pre-dilation procedure for the ISR cases.
We retrospectively analyzed 75 patients with 75 lesions treated with PCB from January 2014 to June 2015. Fifteen patients were treated with 1.4 to 2.0 mm ELCA catheter prior to final PCB dilatation (ELCA group), and 60 patients were treated with PCB after conventional balloon dilation (PCB group). The primary endpoint was the rate of TLR during 12 months. The secondary endpoint was quantitative angiographic indices: Acute gain and percent diameter stenosis after procedure assessed by quantitative coronary angiography (QCA).
Procedure success was achieved in all the patients. The incidence of Target Lesion Revascularization (TLR) was not significantly different between two groups (20% vs. 15% P=0.69). However, acute gain (1.49 ± 0.37 vs. 1.09 ± 0.45 mm, P=0.001), and percent diameter stenosis after procedure (9.53 ± 7.43% vs. 15.82 ± 10.37%, p=0.031) was significantly larger in ELCA group than PCB group.
Excimer laser coronary angioplasty before PCB strategy seems to be safe and effective as conventional PCB strategy. ELCA was effective to achieve larger final lumen size; however, ELCA therapy did not reach the chronic benefit possibly due to small sample size.