Abstract
Background
Modified balloon angioplasty (MB) using a cutting-/scoring balloon or intravascular lithotripsy (IVL) is used in patients with in-stent restenosis (ISR). However, IVL is an off-label use in this setting. The aim of this subgroup analysis of an all-comers registry was to compare IVL to MB angioplasty in patients with ISR.
Methods
The subgroup (n = 117) included all patients with an ISR treated by MB or IVL between 2019 and 2021. Primary endpoint was strategy success (< 20% residual stenosis). The secondary endpoint was cardiac death, acute myocardial infarction (AMI) and target lesion failure/revascularization (TVR). Quantitative coronary angiography was performed in all patients.
Results
A total of n = 36 patients were treated by IVL and n = 81 patients by MB. No significant differences in baseline characteristics were observed between the groups. The primary endpoint was reached in 99 patients (84.6%). Patients in the IVL group had less residual stenosis (2.8% vs. 21.0%; p = 0.012). Multivariate regression analysis revealed that IVL had a significant positive effect on reaching the primary end point (Estimate 2.857; standard error (SE) 1.166; p = 0.014).
During the follow-up period (450 days) there were no significant differences in rates of cardiac death (IVL n = 2 (1.7%) vs. MB n = 3 (2.6%); p = 0.643), AMI (IVL n = 2 (1.7%) vs. MB n = 4 (3.4%); p = 0.999) and TVR (IVL n = 5 (4.3%) vs. MB n = 14 (12%); p = 0.851).
Conclusion
IVL results in a significantly lower rate of residual stenosis than MB in patients with ISR. During the long-term follow-up, no differences in rates of cardiac death, AMI or TVR were observed.
Graphical abstract
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The raw data supporting the conclusions of this article will be made available by the authors, without undue reservation.
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Acknowledgements
We thank Sebastian Runge, of the Runge Statistik GmbH for statistical analysis and advice.
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JL: Speaker honorarium AstraZeneca, Boston Scientific, Shockwave Medical, Abiomed. NW: speaker honorarium, travel grants, and adviser Abiomed, Boston Scientific, Shockwave Medical. TR: lecture fees SIS Medical AG and AstraZeneca, not related to the current work. Other authors have no relevant disclosures.
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Leick, J., Rheude, T., Denne, M. et al. Comparison of long-term outcome in patients with in-stent restenosis treated with intravascular lithotripsy or with modified balloon angioplasty. Clin Res Cardiol (2023). https://doi.org/10.1007/s00392-023-02357-3
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DOI: https://doi.org/10.1007/s00392-023-02357-3