Skip to main content
SpringerLink
Log in

Plaque modification and stabilization after paclitaxel-coated balloon treatment for de novo coronary lesions

  • Original Article
  • Published:
Heart and Vessels Aims and scope Submit manuscript

Abstract

This study aimed to assess the healing response, as evidenced through temporal morphological and functional changes, following paclitaxel-coated balloon (PCB) treatment of de novo coronary lesions. This retrospective, observational study, included patients with significant de novo coronary lesions who were treated with PCB and had serial angiographic, intravascular ultrasound virtual histology (IVUS-VH), fractional flow reserve (FFR) measurements, and optical coherence tomography (OCT) performed before balloon angioplasty (BA), after BA, and at 9-month follow-up. A total of 20 patients (21 lesions) were included in this study. After PCB treatment, IVUS showed significant increases in the mean vessel area (12.0 ± 2.2 mm2 to 13.8 ± 2.5 mm2, p = 0.023), and mean lumen area (5.6 ± 1.2 mm2 to 7.0 ± 1.5 mm2, p = 0.003). Coronary flow was restored after BA with an FFR value of 0.87 ± 0.04 which was sustained at 9-month follow-up with no significant decrease (0.83 ± 0.08, p = 0.329). Serial OCT analysis showed that at 9-month follow-up dissections after BA sealed in 14 lesions (67%), whilst the macrophages decreased from 10 (50%) to 7 (35%) lesions, and the cap thickness of plaque increased from 0.12 ± 0.06 mm to 0.17 ± 0.09 mm (p = 0.007). PCB treatment for de novo coronary lesions showed persistent anatomical and functional patency at mid-term follow-up. Plaque modification, vascular remodeling, and plaque stabilization were also observed during follow-up.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Latib A, Colombo A, Castriota F, Micari A, Cremonesi A, De Felice F, Marchese A, Tespili M, Presbitero P, Sgueglia GA, Buffoli F, Tamburino C, Varbella F, Menozzi A (2012) A randomized multicenter study comparing a paclitaxel drug-eluting balloon with a paclitaxel-eluting stent in small coronary vessels: the BELLO (Balloon Elution and Late Loss Optimization) study. J Am Coll Cardiol 60(24):2473–2480

    Article  CAS  PubMed  Google Scholar 

  2. Wohrle J, Werner GS (2013) Paclitaxel-coated balloon with bare-metal stenting in patients with chronic total occlusions in native coronary arteries. Catheter Cardiovasc Interv 81(5):793–799

    Article  PubMed  Google Scholar 

  3. Her AY, Ann SH, Singh GB, Kim YH, Yoo SY, Garg S, Koo BK, Shin ES (2016) Comparison of paclitaxel-coated balloon treatment and plain old balloon angioplasty for de novo coronary lesions. Yonsei Med J 57(2):337–341

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  4. Shin ES, Ann SH, Balbir Singh G, Lim KH, Kleber FX, Koo BK (2016) Fractional flow reserve-guided paclitaxel-coated balloon treatment for de novo coronary lesions. Catheter Cardiovasc Interv 88(2):193–200

    Article  PubMed  Google Scholar 

  5. Ann SH, Balbir Singh G, Lim KH, Koo BK, Shin ES (2016) Anatomical and physiological changes after paclitaxel-coated balloon for atherosclerotic de novo coronary lesions: serial IVUS-VH and FFR Study. PLoS ONE 11(1):e0147057

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  6. Ann SH, Her AY, Singh GB, Okamura T, Koo BK, Shin ES (2016) Serial morphological and functional assessment of the paclitaxel-coated balloon for de novo lesions. Rev Esp Cardiol (Engl Ed) 69(11):1026–1032

    Article  Google Scholar 

  7. Shin ES, Lee JH, Yoo SY, Park Y, Hong YJ, Kim MH, Lee JY, Nam CW, Tahk SJ, Kim JS, Jeong YH, Lee CW, Shin HK, Kim JH (2014) A randomised, multicentre, double blind, placebo controlled trial to evaluate the efficacy and safety of cilostazol in patients with vasospastic angina. Heart 100(19):1531–1536

    Article  CAS  PubMed  Google Scholar 

  8. Mintz GS, Nissen SE, Anderson WD, Bailey SR, Erbel R, Fitzgerald PJ, Pinto FJ, Rosenfield K, Siegel RJ, Tuzcu EM, Yock PG (2001) American College of Cardiology Clinical Expert Consensus Document on Standards for Acquisition, Measurement and Reporting of Intravascular Ultrasound Studies (IVUS). A report of the American College of Cardiology Task Force on Clinical Expert Consensus Documents. J Am Coll Cardiol 37(5):1478–1492

    Article  CAS  PubMed  Google Scholar 

  9. Nair A, Kuban BD, Tuzcu EM, Schoenhagen P, Nissen SE, Vince DG (2002) Coronary plaque classification with intravascular ultrasound radiofrequency data analysis. Circulation 106(17):2200–2206

    Article  PubMed  Google Scholar 

  10. Rodriguez-Granillo GA, Garcia-Garcia HM, Mc Fadden EP, Valgimigli M, Aoki J, De Feyter P, Serruys PW (2005) In vivo intravascular ultrasound-derived thin-cap fibroatheroma detection using ultrasound radiofrequency data analysis. J Am Coll Cardiol 46(11):2038–2042

    Article  PubMed  Google Scholar 

  11. Kubo T, Maehara A, Mintz GS, Doi H, Tsujita K, Choi SY, Katoh O, Nasu K, Koenig A, Pieper M, Rogers JH, Wijins W, Bose D, Margolis MP, Moses JW, Stone GW, Leon MB (2010) The dynamic nature of coronary artery lesion morphology assessed by serial virtual histology intravascular ultrasound tissue characterization. J Am Coll Cardiol 55(15):1590–1597

    Article  CAS  PubMed  Google Scholar 

  12. Tian J, Ren X, Vergallo R, Xing L, Yu H, Jia H, Soeda T, McNulty I, Hu S, Lee H, Yu B, Jang IK (2014) Distinct morphological features of ruptured culprit plaque for acute coronary events compared to those with silent rupture and thin-cap fibroatheroma: a combined optical coherence tomography and intravascular ultrasound study. J Am Coll Cardiol 63(21):2209–2216

    Article  PubMed  Google Scholar 

  13. Tearney GJ, Yabushita H, Houser SL, Aretz HT, Jang IK, Schlendorf KH, Kauffman CR, Shishkov M, Halpern EF, Bouma BE (2003) Quantification of macrophage content in atherosclerotic plaques by optical coherence tomography. Circulation 107(1):113–119

    Article  PubMed  Google Scholar 

  14. Tearney GJ, Regar E, Akasaka T, Adriaenssens T, Barlis P, Bezerra HG, Bouma B, Bruining N, Cho JM, Chowdhary S, Costa MA, de Silva R, Dijkstra J, Di Mario C, Dudek D, Falk E, Feldman MD, Fitzgerald P, Garcia-Garcia HM, Gonzalo N, Granada JF, Guagliumi G, Holm NR, Honda Y, Ikeno F, Kawasaki M, Kochman J, Koltowski L, Kubo T, Kume T, Kyono H, Lam CC, Lamouche G, Lee DP, Leon MB, Maehara A, Manfrini O, Mintz GS, Mizuno K, Morel MA, Nadkarni S, Okura H, Otake H, Pietrasik A, Prati F, Raber L, Radu MD, Rieber J, Riga M, Rollins A, Rosenberg M, Sirbu V, Serruys PW, Shimada K, Shinke T, Shite J, Siegel E, Sonoda S, Suter M, Takarada S, Tanaka A, Terashima M, Thim T, Uemura S, Ughi GJ, van Beusekom HM, van der Steen AF, van Es GA, van Soest G, Virmani R, Waxman S, Weissman NJ, Weisz G (2012) Consensus standards for acquisition, measurement, and reporting of intravascular optical coherence tomography studies: a report from the International Working Group for intravascular optical coherence tomography standardization and validation. J Am Coll Cardiol 59(12):1058–1072

    Article  PubMed  Google Scholar 

  15. Cutlip DE, Windecker S, Mehran R, Boam A, Cogen DJ, van Es GA, Steg PG, Morel MA, Mauri L, Vranckx P, McFadden E, Lansky A, Hamon M, Krucoff MW, Serruys PW (2007) Clinical end points in coronary stent trials: a case for standardized definitions. Circulation 115(17):2344–2351

    Article  Google Scholar 

  16. Talley JD, Hurst JW, King SB 3rd, Douglas JS Jr, Roubin GS, Gruentzig AR, Anderson HV, Weintraub WS (1988) Clinical outcome 5 years after attempted percutaneous transluminal coronary angioplasty in 427 patients. Circulation 77(4):820–829

    Article  CAS  PubMed  Google Scholar 

  17. Mintz GS (2000) Remodeling and restenosis: observations from serial intravascular ultrasound studies. Curr Interv Cardiol Rep 2(4):316–325

    CAS  PubMed  Google Scholar 

  18. Kleber FX, Rittger H, Bonaventura K, Zeymer U, Wohrler J, Jeger R, Levenson B, Mobius-Winkler S, Bruch L, Fischer D, Hengstenberg C, Porner T, Mathey D, Scheller B (2013) Drug-coated balloons for treatment of coronary artery disease: updated recommendations from a consensus group. Clin Res Cardiol 102(11):785–797

    Article  CAS  PubMed  Google Scholar 

  19. Scheller B, Speck U, Abramjuk C, Bernhardt U, Bohm M, Nickenig G (2004) Paclitaxel balloon coating, a novel method for prevention and therapy of restenosis. Circulation 110(7):810–814

    Article  CAS  PubMed  Google Scholar 

  20. Gray WA, Granada JF (2010) Drug-coated balloons for the prevention of vascular restenosis. Circulation 121(24):2672–2680

    Article  PubMed  Google Scholar 

  21. Axel DI, Kunert W, Goggelmann C, Oberhoff M, Herdeg C, Kuttner A, Wild DH, Brehm BR, Riessen R, Koveker G, Karsch KR (1997) Paclitaxel inhibits arterial smooth muscle cell proliferation and migration in vitro and in vivo using local drug delivery. Circulation 96(2):636–645

    Article  CAS  Google Scholar 

  22. Mintz GS, Popma JJ, Pichard AD, Kent KM, Satler LF, Wong C, Hong MK, Kovach JA, Leon MB (1996) Arterial remodeling after coronary angioplasty: a serial intravascular ultrasound study. Circulation 94(1):35–43

    Article  CAS  PubMed  Google Scholar 

  23. Scheller B, Fischer D, Clever YP, Koeber FX, Speck U, Bohm M, Cremers B (2013) Treatment of a coronary bifurcation lesion with drug-coated balloons: lumen enlargement and plaque modification after 6 months. Clin Res Cardiol 102(6):469–472

    Article  PubMed  Google Scholar 

  24. Scheller B, Speck U, Schmitt A, Bohm M, Nickenig G (2003) Addition of paclitaxel to contrast media prevents restenosis after coronary stent implantation. J Am Coll Cardiol 42(8):1415–1420

    Article  CAS  PubMed  Google Scholar 

  25. Vogt F, Stein A, Rettemeier G, Krott N, Hoffmann R, vom Dahl J, Bosserhoff AK, Michaeli W, Hanrath P, Weber C, Blindt R (2004) Long-term assessment of a novel biodegradable paclitaxel-eluting coronary polylactide stent. Eur Heart J 25(15):1330–1340

    Article  CAS  PubMed  Google Scholar 

  26. Weissman NJ, Koglin J, Cox DA, Hermiller J, O'Shaughnessy C, Mann JT, Turco M, Caputo R, Bergin P, Greenberg J, Kutcher M, Wong SC, Strickland W, Mooney M, Russel ME, Ellis SH, Stone GW (2005) Polymer-based paclitaxel-eluting stents reduce in-stent neointimal tissue proliferation: a serial volumetric intravascular ultrasound analysis from the TAXUS-IV trial. J Am Coll Cardiol 45(8):1201–1205

    Article  CAS  PubMed  Google Scholar 

  27. Serruys PW, Degertekin M, Tanabe K, Russel ME, Guagliumi G, Webb J, Hamburger J, Rutsch W, Kaiser C, Whitbourn R, Camenzind E, Meredith I, Reeves F, Nienaber C, Benit E, Disco C, Koglin J, Colombo A (2004) Vascular responses at proximal and distal edges of paclitaxel-eluting stents: serial intravascular ultrasound analysis from the TAXUS II trial. Circulation 109(5):627–633

    Article  PubMed  Google Scholar 

  28. Morton AC, Arnold ND, Crossman DC, Gunn J (2004) Response of very small (2 mm) porcine coronary arteries to balloon angioplasty and stent implantation. Heart 90(3):324–327

    Article  CAS  PubMed  PubMed Central  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Division of Cardiology, Department of Internal Medicine, Kangwon National University School of Medicine, Chuncheon, South Korea

    Ae-Young Her & Yong Hoon Kim

  2. Division of Cardiology, Ulsan Medical Center, Ulsan Hospital, 13, Wolpyeong-ro, 171beon-gil, Nam-gu, Ulsan, 44033, South Korea

    Eun-Seok Shin & Ju-Hyun Chung

  3. East Lancashire Hospitals NHS Trust, Blackburn, Lancashire, UK

    Scot Garg

  4. Department of Internal Medicine and Cardiovascular Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea

    Joo Myung Lee

  5. Department of Cardiology, Inje University Ilsan Paik Hospital, Goyang, South Korea

    Joon-Hyung Doh

  6. Department of Internal Medicine, Keimyung University Dongsan Medical Center, Daegu, South Korea

    Chang-Wook Nam

  7. Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, South Korea

    Bon-Kwon Koo

Authors
  1. Ae-Young Her
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Eun-Seok Shin
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Ju-Hyun Chung
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Yong Hoon Kim
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Scot Garg
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Joo Myung Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Joon-Hyung Doh
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Chang-Wook Nam
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Bon-Kwon Koo
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Eun-Seok Shin.

Ethics declarations

Conflict of interest

Authors have approved the final manuscript, which has not been published and is not under consideration for publication elsewhere. We declare that there is no conflict of interest for any author.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Her, AY., Shin, ES., Chung, JH. et al. Plaque modification and stabilization after paclitaxel-coated balloon treatment for de novo coronary lesions. Heart Vessels 34, 1113–1121 (2019). https://doi.org/10.1007/s00380-019-01346-9

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00380-019-01346-9

Keywords

Search

Navigation