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Effect of drug-coated balloon angioplasty on in-stent restenotic coronary lesions analyzed with optical coherence tomography and serial coronary artery angioscopy

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Abstract

Drug-coated balloon angioplasty (DCBA) has been recognized for its utility in preventing in-stent re-restenosis (ISR); however, imaging of the neointima immediately after treatment and during follow-up has only been described in a few case reports. This study aimed to determine the efficacy and mechanism of the DCBA using imaging studies both immediately after the DCBA and during the follow-up period. We enrolled 15 consecutive patients who underwent DCBA for in-stent restenosis (ISR). The in-stent neointimal volume was evaluated using optical coherence tomography (OCT), and the in-stent yellow grade was assessed using coronary angioscopy (CAS) immediately after DCBA and during the median follow-up period of 9 (8–15) months. The neointimal volume was significantly reduced from 77.1 ± 36.2 mm3 at baseline to 60.2 ± 23.9 mm3 immediately after DCBA (p = 0.0012 vs. baseline) and to 46.7 ± 21.9 mm3 during the follow-up (p = 0.0002 vs. post DCBA). The yellow grade of the residual plaques at the ISR lesion, which indicated plaque vulnerability, was significantly decreased in the follow-up CAG (from baseline: 1.79 ± 1.03, during the follow-up: 0.76 ± 0.82; p < 0.0001). These data suggest that DCBA may inhibit neointimal formation and provide angioscopic intimal stabilization for ISR lesions.

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Acknowledgements

The authors would like to extend their sincere appreciation to Professor Atsushi Hirayama for guidance and valuable suggestions during the research, to Professor Yasuo Okumura and Professor Tadateru Takayama for their direct guidance during the research. Furthermore, we would like to express our gratitude to the catheter room of Nihon University Itabashi Hospital, who always cooperated at the clinical site of the research.

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Authors and Affiliations

  1. Division of Cardiology, Department of Medicine, Nihon University School of Medicine, 30-1, Oyaguchi Kami-chou, Itabashi-ku, Tokyo, 173-8610, Japan

    Naotaka Akutsu, Akihito Ogaku, Yutaka Koyama, Hidesato Fujito, Yasunari Ebuchi, Suguru Migita, Tomoyuki Morikawa, Takehiro Tamaki, Takashi Mineki, Takaaki Kougo, Keisuke Kojima, Korehito Iida, Nobuhiro Murata, Toshihiko Nishida, Toru Oshima, Mitsumasa Sudo, Daisuke Kitano, Hironori Haruta, Daisuke Fukamachi, Takafumi Hiro, Atsushi Hirayama & Yasuo Okumura

  2. Division of Advanced Cardiovascular Imaging, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan

    Mitsumasa Sudo, Daisuke Kitano & Takafumi Hiro

  3. Department of General Medicine, Nihon University School of Medicine, Tokyo, Japan

    Tadateru Takayama

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  1. Naotaka Akutsu
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  2. Akihito Ogaku
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Corresponding author

Correspondence to Yasuo Okumura.

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Conflict of interest

Dr. Hirayama A and Hiro T are employed by the Department of Advanced Cardiovascular Imaging, Nihon University School of Medicine; which is endowed by Boston Scientific Corporation Japan, Abbott Medical Japan Co., Ltd and St. Jude Medical Japan Co., Ltd.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. The study and its protocols were approved by the Institutional Review Board of Nihon University Itabashi Hospital. This article does not contain any studies with animals performed by any of the authors.

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Akutsu, N., Ogaku, A., Koyama, Y. et al. Effect of drug-coated balloon angioplasty on in-stent restenotic coronary lesions analyzed with optical coherence tomography and serial coronary artery angioscopy. Heart Vessels 34, 1925–1935 (2019). https://doi.org/10.1007/s00380-019-01447-5

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