Author + information
- Katsuya Miura1,
- Akimune Kuwayama1,
- Masanobu Ohya1,
- Takenobu Shimada1,
- Hidewo Amano1,
- Shunsuke Kubo1,
- Habara Seiji1,
- Hiroyuki Tanaka1 and
- Yasushi Fuku1
Residual stenosis and the heterogeneous tissue pattern are reported to be the risk factors of recurrent restenosis after paclitaxel-coated balloon (PCB) angioplasty for drug-eluting stent (DES) in-stent restenosis (ISR). Optimal coherence tomography (OCT) can assess the mechanism of restenosis. We aimed to investigate the relationship between OCT findings and angiographic outcomes after PCB for DES-ISR.
A total of 222 DES-ISR lesions undergoing OCT-guided PCB angioplasty and follow-up angiography within 1 year were examined. Pre-procedural morphological assessment of neointimal tissue at the minimum lumen area (MLA) site was performed. The MLA, intimal area (IA), and stent area (SA) before and after procedure were measured. OCT findings were compared between lesions with and without restenosis at follow-up angiography.
Recurrent restenosis occurred in 49 lesions (22.1%). Between lesions with and without restenosis, pre-procedural MLA, IA, and SA were not significantly different between 2 groups (1.39±0.61mm2 vs 1.22±0.65mm2, p=0.09, 4.77±2.01mm2 vs 4.58±2.45 mm2, p=0.56, 6.21±2.14mm2 vs 5.80±2.49 mm2, p=0.26), but proportion of heterogeneous restenotic tissue pattern was significantly higher in the restenosis-group (11.0% vs 22.5%, P = 0.03). After the procedure, the MLA and SA were significantly smaller in lesion with restenosis (4.90±1.76mm2 vs 4.14±1.66 mm2, P=0.008, 8.00±2.51mm2 vs 7.14±2.74 mm2, P=0.04), but the IA was similar between the 2 groups (3.01±1.62mm2 vs 2.98±1.76mm2, p=0.79). The proportion of stent underexpansion, defined as a ratio of a post-procedural stent diameter divided by a previous deployed stent size <1.0, was significantly higher in restenosis-group (18.1% vs 33.3%, p = 0.02)
A smaller post-procedural MLA, mainly caused by persistent stent underexpansion, and the heterogeneous restenotic tissue pattern were associated with restenosis after PCB angioplasty for DES-ISR.
IMAGING: Imaging: Intravascular