Author + information
- Katsuya Miura1,
- Hiroyuki Tanaka2,
- Akimune Kuwayama3,
- Masanobu Ohya2,
- Takenobu Shimada4,
- Hidewo Amano5,
- Shunsuke Kubo2,
- Seiji Habara6 and
- Yasushi Fuku2
In-stent chronic total occlusion (IS-CTO) is reported to be associated with poor clinical outcomes compared with de-novo CTO; however, the optimal treatment strategy and risk factors of restenosis after percutaneous coronary intervention (PCI) for IS-CTO have not been fully elucidated.We aimed to investigate a impact of treatment strategy on angiographic outcomes and risk factors for restenosis after PCI for IS-CTO.
Between 2010 and 2015, 153 lesions underwent PCI for IS-CTO using drug-eluting stents (DES), drug-coated balloons (DCB), or both. Of these, 123 lesions that were successfully treated and undergoing follow-up angiography within 1 year were examined. The 123 lesions were divided into 3 groups based on the treatment strategy (DES: 78, DCB: 27, and hybrid: 18). Baseline/lesion characteristics and angiographic outcomes at 1 year were compared between the 3 groups. Risk factors for restenosis at 1 year were also analyzed.
The success rate of PCI for IS-CTO was 96.1%. Between the DES, DCB, and hybrid groups, the DES group had the highest proportion of stent-in-stent restenosis (32.1% vs. 3.7% vs. 11.1%, p=0.01) and the hybrid group had the significantly longest occluded length (25.1±23.0 mm vs. 26.6±19.0 mm vs. 41.0±31.6 mm, p= 0.04). After the procedure, the DES group had the significantly smallest percentage diameter stenosis (19.4±10.1% vs. 29.4±14.4% vs. 23.1±9.1%, p=0.0004) and the significantly largest minimal lumen diameter (2.67±0.53 mm vs. 2.05±0.69 mm vs. 2.58±0.51, p=0.0001). At 1-year follow-up, the hybrid group had the highest rate of binary restenosis, but the differences were not significant between the 3 groups (34.6% vs. 33.3% vs. 61.1%, p=0.10). Multivariate analysis revealed insulin-dependent diabetes mellitus, occluded length, and post procedural percentage diameter stenosis were independent risk factor of binary restenosis within 1 year.
In treating IS-CTO, the results of DES implantation and DCB angioplasty were comparable. Treatment strategies should be selected based on the lesion characteristics.
CORONARY: Complex and Higher Risk Procedures for Indicated Patients (CHIP)