Abstract
Treatment of in-stent restenosis (ISR) is associated with a high incidence of recurrence. This study evaluated the clinical safety and 6-month efficacy of excimer laser coronary angioplasty (ELCA) before scoring balloon dilatation for the treatment of ISR. Twenty-three patients with ISR were included and treatment strategy of ISR was dependent on each operator. Twelve patients among those were treated with ELCA before scoring balloon dilatation (ELCA group) and 11 patients were treated with scoring balloon alone (non-ELCA group). Acute procedural results were evaluated by quantitative coronary angiography (QCA) and frequency domain optical coherence tomography (FD-OCT). Follow-up angiography was performed in all patients and the incidence of recurrent ISR and target lesion revascularization (TLR) was determined at 6 months after initial ISR treatment. Procedural success was achieved in all patients. Baseline clinical and angiographic characteristics were similar between groups. Maximum dilatation pressure of scoring balloon was significantly lower in the ELCA group than in the non-ELCA group (9.0 ± 3.1 vs. 14.9 ± 4.3 atm, p = 0.001). In follow-up angiography, the occurrence of TLR was similar between groups (16.7 vs. 45.5 %, p = 0.09), but the late luminal loss was significantly lower in the ELCA group (0.7 ± 0.6 vs. 1.3 ± 0.7 mm, p = 0.03). ELCA is a safe and feasible technique for the treatment of ISR and associated with a relatively low recurrent restenosis in comparison with scoring balloon dilatation alone.
Similar content being viewed by others
References
Moulias A, Alexopoulos D (2011) Long-term outcome of percutaneous coronary intervention: the significance of native coronary artery disease progression. Clin Cardiol 34(10):588–592. doi:10.1002/clc.20929
Alfonso F, Perez-Vizcayno MJ, Hernandez R, Bethencourt A, Marti V, Lopez-Minguez JR, Angel J, Iniguez A, Moris C, Cequier A, Sabate M, Escaned J, Jimenez-Quevedo P, Banuelos C, Suarez A, Macaya C (2008) Long-term clinical benefit of sirolimus-eluting stents in patients with in-stent restenosis results of the RIBS-II (Restenosis Intra-stent: Balloon angioplasty vs. elective sirolimus-eluting Stenting) study. J Am Coll Cardiol 52(20):1621–1627. doi:10.1016/j.jacc.2008.08.025
Liistro F, Fineschi M, Grotti S, Angioli P, Carrera A, Ducci K, Gori T, Falsini G, Pierli C, Bolognese L (2010) Long-term effectiveness and safety of sirolimus stent implantation for coronary in-stent restenosis results of the TRUE (Tuscany Registry of sirolimus for unselected in-stent restenosis) registry at 4 years. J Am Coll Cardiol 55(7):613–616. doi:10.1016/j.jacc.2009.08.075
Steinberg DH, Gaglia MA Jr, Pinto Slottow TL, Roy P, Bonello L, De Labriolle A, Lemesle G, Torguson R, Kineshige K, Xue Z, Suddath WO, Kent KM, Satler LF, Pichard AD, Lindsay J, Waksman R (2009) Outcome differences with the use of drug-eluting stents for the treatment of in-stent restenosis of bare-metal stents versus drug-eluting stents. Am J Cardiol 103(4):491–495. doi:10.1016/j.amjcard.2008.09.107
Alfonso F, Perez-Vizcayno MJ, Hernandez R, Bethencourt A, Marti V, Lopez-Minguez JR, Angel J, Mantilla R, Moris C, Cequier A, Sabate M, Escaned J, Moreno R, Banuelos C, Suarez A, Macaya C, Investigators R-I (2006) A randomized comparison of sirolimus-eluting stent with balloon angioplasty in patients with in-stent restenosis: results of the Restenosis Intrastent: Balloon Angioplasty Versus Elective Sirolimus-Eluting Stenting (RIBS-II) trial. J Am Coll Cardiol 47(11):2152–2160. doi:10.1016/j.jacc.2005.10.078
Holmes DR Jr, Teirstein P, Satler L, Sketch M, O’Malley J, Popma JJ, Kuntz RE, Fitzgerald PJ, Wang H, Caramanica E, Cohen SA (2006) Sirolimus-eluting stents vs vascular brachytherapy for in-stent restenosis within bare-metal stents: the SISR randomized trial. JAMA 295(11):1264–1273. doi:10.1001/jama.295.11.1264
Miyamoto T, Araki T, Hiroe M, Marumo F, Niwa A, Yokoyama K (2001) Standalone cutting balloon angioplasty for the treatment of stent-related restenosis: acute results and 3- to 6-month angiographic recurrent restenosis rates. Catheter Cardiovasc Interv 54(3):301–308
Albiero R, Silber S, Di Mario C, Cernigliaro C, Battaglia S, Reimers B, Frasheri A, Klauss V, Auge JM, Rubartelli P, Morice MC, Cremonesi A, Schofer J, Bortone A, Colombo A, Investigators R (2004) Cutting balloon versus conventional balloon angioplasty for the treatment of in-stent restenosis: results of the restenosis cutting balloon evaluation trial (RESCUT). J Am Coll Cardiol 43(6):943–949. doi:10.1016/j.jacc.2003.09.054
Mehran R, Dangas G, Abizaid AS, Mintz GS, Lansky AJ, Satler LF, Pichard AD, Kent KM, Stone GW, Leon MB (1999) Angiographic patterns of in-stent restenosis: classification and implications for long-term outcome. Circulation 100(18):1872–1878
Takeda Y, Tsuchikane E, Kobayashi T, Terai K, Kobayashi Y, Nakagawa T, Sakurai M, Awata N, Kobayashi T (2003) Effect of plaque debulking before stent implantation on in-stent neointimal proliferation: a serial 3-dimensional intravascular ultrasound study. Am Heart J 146(1):175–182. doi:10.1016/S0002-8703(03)00114-5
Cutlip DE, Windecker S, Mehran R, Boam A, Cohen DJ, van Es GA, Steg PG, Morel MA, Mauri L, Vranckx P, McFadden E, Lansky A, Hamon M, Krucoff MW, Serruys PW, Academic Research C (2007) Clinical end points in coronary stent trials: a case for standardized definitions. Circulation 115(17):2344–2351. doi:10.1161/CIRCULATIONAHA.106.685313
Nishino M, Lee Y, Nakamura D, Yoshimura T, Taniike M, Makino N, Kato H, Egami Y, Shutta R, Tanouchi J, Yamada Y (2012) Differences in optical coherence tomographic findings and clinical outcomes between excimer laser and cutting balloon angioplasty for focal in-stent restenosis lesions. J Invasive Cardiol 24(10):478–483
Ashida K, Hayase T, Shinmura T (2013) Efficacy of lacrosse NSE using the “leopard-crawl” technique on severely calcified lesions. J Invasive Cardiol 25(10):555–564
Taguchi I, Kageyama M, Kanaya T, Abe S, Node K, Inoue T (2014) Clinical significance of non-slip element balloon angioplasty for patients of coronary artery disease: a preliminary report. J Cardiol 63(1):19–23. doi:10.1016/j.jjcc.2013.06.009
Frobert O, Sarno G, James SK, Saleh N, Lagerqvist B (2013) Effect of stent inflation pressure and post-dilatation on the outcome of coronary artery intervention. A report of more than 90,000 stent implantations. PLoS One 8(2):e56348. doi:10.1371/journal.pone.0056348
Ashikaga T, Yoshikawa S, Isobe M (2014) The efficacy of excimer laser pretreatment for calcified nodule in acute coronary syndrome. Cardiovasc Revasc Med. doi:10.1016/j.carrev.2014.09.006
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Hirose, S., Ashikaga, T., Hatano, Y. et al. Treatment of in-stent restenosis with excimer laser coronary angioplasty: benefits over scoring balloon angioplasty alone. Lasers Med Sci 31, 1691–1696 (2016). https://doi.org/10.1007/s10103-016-2039-z
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10103-016-2039-z