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Funayama N, Kayanuma K, Sunaga D, Furugen M. Angiographic patterns after drug-coated balloon angioplasty for de novo coronary lesions. ASIAINTERVENTION 2024; 10:119-125. [PMID: 39070971 PMCID: PMC11261657 DOI: 10.4244/aij-d-23-00064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Accepted: 03/12/2024] [Indexed: 07/30/2024]
Abstract
Background Drug-coated balloon (DCB) angioplasty has emerged as an effective treatment option for de novo coronary artery lesions; however, the chronic-phase angiographic patterns after DCB angioplasty for de novo lesions have not yet been described. Aims The aim of the present study was to evaluate chronic-phase angiographic classification after DCB angioplasty. Methods This was a single-centre, retrospective, observational study. From June 2016 to August 2022, 708 lesions (670 patients) underwent DCB angioplasty for de novo coronary lesions. Successful DCB angioplasty was defined as a non-flow-limiting dissection, with residual stenosis ≤30% and absence of a bailout stent. A total of 337 lesions (318 patients) were enrolled in this study. Results Of the 337 lesions analysed, 91.1% (n=307) were in the non-restenosis group, and 8.9% (n=30) were in the restenosis group. The non-restenosis group was classified into non-restenosis (45.1%; n=152) and lumen enlargement (46.0%; n=155). The restenosis group was classified into focal restenosis (5.0%; n=17), diffuse restenosis (3.6%; n=12), and occlusive restenosis (0.3%; n=1). There were no aneurysms, and plaque cavities were often observed (8.0%). During the chronic phase, residual dissection was seen in only one case (0.3%). Conclusions This report demonstrates for the first time the angiographic classification after DCB angioplasty for de novo coronary lesions. Restenosis patterns were seen in 8.9% of lesions, and half of the restenosis patterns presented a focal restenosis pattern. Late lumen enlargement was observed in 46% of the treated lesions.
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Affiliation(s)
- Naohiro Funayama
- Division of Cardiovascular Medicine, Hokkaido Cardiovascular Hospital, Sapporo, Japan
| | - Keigo Kayanuma
- Division of Cardiovascular Medicine, Hokkaido Cardiovascular Hospital, Sapporo, Japan
| | - Daisuke Sunaga
- Division of Cardiovascular Medicine, Hokkaido Cardiovascular Hospital, Sapporo, Japan
| | - Makoto Furugen
- Division of Cardiovascular Medicine, Hokkaido Cardiovascular Hospital, Sapporo, Japan
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Kondo Y, Ishikawa T, Shimura M, Yamada K, Ukaji T, Tamura Y, Arai M, Mori K, Takeyama T, Hori Y, Hisauchi I, Nakahara S, Itabashi Y, Kobayashi S, Taguchi I. Cardiovascular Outcomes after Paclitaxel-Coated Balloon Angioplasty versus Drug-Eluting Stent Placement for Acute Coronary Syndrome: A Systematic Review and Meta-Analysis. J Clin Med 2024; 13:1481. [PMID: 38592314 PMCID: PMC10934935 DOI: 10.3390/jcm13051481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2024] [Revised: 02/26/2024] [Accepted: 02/28/2024] [Indexed: 04/10/2024] Open
Abstract
Background: We conducted a systematic review and meta-analysis to examine the feasibility of paclitaxel-coated balloon (PCB) angioplasty for de novo lesions in patients with acute coronary syndrome (ACS) by comparing with drug-eluting stent (DES) placement. Methods: By a systematic literature search, nine (five randomized controlled, two retrospective propensity-score matched, and two retrospective baseline-balanced) studies comparing the midterm clinical and angiographic outcomes after PCB angioplasty and DES placement were included, yielding 974 and 1130 ACS cases in PCB and DES groups, respectively. Major adverse cardiac event (MACE) was defined as a composite of cardiac mortality (CM), all-cause mortality (ACM), myocardial infarction (MI), target vessel revascularization (TVR), and target lesion revascularization (TLR). Late luminal loss (LLL) and bleeding events (BLD) were also estimated. Results: The frequencies of MACE in PCB and DES groups were 8.42% and 10.62%, respectively. PCB angioplasty had no significant impacts on all of MACE (risk ratio: 0.90, 95%CI: 0.68-1.18, p = 0.44), CM, ACM, MI, TVR, TLR, BLD, and LLL, compared to DES placement in random-effects model. Conclusions: The present systematic review and meta-analysis showed the feasibility of PCB angioplasty for the de novo lesions in patients with ACS in comparison with DES placement by the emergent procedures.
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Affiliation(s)
| | - Tetsuya Ishikawa
- Department of Cardiology, Dokkyo Medical University Saitama Medical Center, 2-1-50 Minamikoshigaya, Koshigaya 343-8555, Saitama, Japan; (Y.K.); (M.S.); (K.Y.); (T.U.); (Y.T.); (M.A.); (K.M.); (T.T.); (Y.H.); (I.H.); (S.N.); (Y.I.); (S.K.); (I.T.)
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Guo Q, Peng L, Rao L, Ma C, Zhao K, Zhao Z, Tang H, Li M. The " L-Sandwich" Strategy for True Coronary Bifurcation Lesions: A Randomized Clinical Trial. J Interv Cardiol 2023; 2023:6889836. [PMID: 36998672 PMCID: PMC10049845 DOI: 10.1155/2023/6889836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Revised: 12/31/2022] [Accepted: 01/09/2023] [Indexed: 04/01/2023] Open
Abstract
Background This study explored the efficacy of the "L-sandwich" strategy, which involves the implantation of stents in the main vessel (MV) and shaft of the side branch (SB) with a drug-coated balloon (DCB) applied to the SB ostium, for coronary true bifurcation lesions. Methods and Results Of 99 patients with true bifurcation lesions, 38 patients underwent the "L-sandwich" strategy (group A), 32 patients underwent a two-stent strategy (group B), and 29 patients underwent a single-stent + DCB strategy (group C). Angiography outcomes (late lumen loss [LLL], minimum lumen diameter [MLD]), and clinical outcomes (major adverse cardiac events [MACEs]) were analyzed. At 6 months, the MLD of the SB ostium in groups A and B were similar (P > 0.05) and group A larger than group C (P < 0.05). The LLL of group B was the largest among the three groups (P < 0.05). The MLD of the SB shaft in groups A and B were larger than in group C (P < 0.05). The LLL of the SB shaft in group C was the lowest (P < 0.05). Two patients in group B received target vessel revascularization at the 6-month followup (P > 0.05), and patients in the other groups had no MACEs. Conclusions The "L-sandwich" strategy was feasible for the treatment of true coronary bifurcation lesions. It is a simpler procedure with similar acute lumen gain than the two-stent strategy, results in a larger SB lumen than the single-stent + DCB strategy, and it can also be used as a remedy for dissection following the single-stent + DCB strategy.
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Affiliation(s)
- Quan Guo
- 1Department of Cardiology, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Zhengzhou, Henan, China
- 2Department of Coronary Heart Disease of Central China Fuwai Hospital, Henan Key Laboratory for Coronary Heart Disease, Central China Fuwai of Zhengzhou University, Zhengzhou, Henan, China
| | - Liang Peng
- 2Department of Coronary Heart Disease of Central China Fuwai Hospital, Henan Key Laboratory for Coronary Heart Disease, Central China Fuwai of Zhengzhou University, Zhengzhou, Henan, China
| | - Lixin Rao
- 2Department of Coronary Heart Disease of Central China Fuwai Hospital, Henan Key Laboratory for Coronary Heart Disease, Central China Fuwai of Zhengzhou University, Zhengzhou, Henan, China
| | - Cao Ma
- 2Department of Coronary Heart Disease of Central China Fuwai Hospital, Henan Key Laboratory for Coronary Heart Disease, Central China Fuwai of Zhengzhou University, Zhengzhou, Henan, China
| | - Kang Zhao
- 2Department of Coronary Heart Disease of Central China Fuwai Hospital, Henan Key Laboratory for Coronary Heart Disease, Central China Fuwai of Zhengzhou University, Zhengzhou, Henan, China
| | - Zhenzhou Zhao
- 2Department of Coronary Heart Disease of Central China Fuwai Hospital, Henan Key Laboratory for Coronary Heart Disease, Central China Fuwai of Zhengzhou University, Zhengzhou, Henan, China
| | - Haiyu Tang
- 2Department of Coronary Heart Disease of Central China Fuwai Hospital, Henan Key Laboratory for Coronary Heart Disease, Central China Fuwai of Zhengzhou University, Zhengzhou, Henan, China
| | - Muwei Li
- 1Department of Cardiology, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Zhengzhou, Henan, China
- 2Department of Coronary Heart Disease of Central China Fuwai Hospital, Henan Key Laboratory for Coronary Heart Disease, Central China Fuwai of Zhengzhou University, Zhengzhou, Henan, China
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Funayama N, Muratsubaki S, Ito R, Tobisawa T, Konishi T. Drug-coated balloons versus drug-eluting stents for coronary de novo lesions in dialysis patients. Heart Vessels 2023; 38:300-308. [PMID: 36045267 PMCID: PMC9898424 DOI: 10.1007/s00380-022-02169-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Accepted: 08/24/2022] [Indexed: 02/06/2023]
Abstract
BACKGROUND The aim of this study was to compare the efficacy of drug-coated balloon (DCB) angioplasty with drug-eluting stent (DES) angioplasty in the treatment of de novo coronary artery lesions in dialysis patients. METHOD We retrospectively enrolled 400 consecutive dialysis patients with 464 coronary de novo lesions treated by DCB or DES from five participating institutions in Japan. The primary endpoint was target lesion revascularization (TLR) at 12 months. We performed serial coronary angiographic analysis. RESULTS There were no significant differences in the rate of TLR between the groups in either crude or propensity score-matched analysis (DES 14.1% vs. DCB 14.7%, P = 0.864, DES 12.1% vs. 12.1%, P = 1.00). Target lesion thrombosis was not observed in the DCB group; however, stent thrombosis was observed in 7 patients (2.2%) in the DES group. The rate of binary restenosis was similar in both groups (DES, 20.9% vs. DCB, 22.8%; P = 0.749). The late lumen loss at follow-up was significantly greater in the DES group than in the DCB group (0.61 ± 0.76 mm vs 0.22 ± 0.48 mm; P < 0.001). Late lumen enlargement was observed in 38.6% of patients in the DCB group. CONCLUSION The efficacy of DCB angioplasty for de novo coronary artery lesions in dialysis patients was similar to that of DES angioplasty in the real world. Drug-coated balloon angioplasty can be an acceptable treatment for de novo coronary artery lesions in dialysis patients.
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Affiliation(s)
- Naohiro Funayama
- Division of Cardiovascular Medicine, Hokkaido Cardiovascular Hospital, West 13, South 27, Chuou-ku, Sapporo, Hokkaido, 064-8622, Japan.
| | - Shingo Muratsubaki
- Division of Cardiovascular Medicine, Hakodate Goryoukaku Hospital, 38-3, Goryoukaku-cho, Hakodate, Hokkaido, 040-8611, Japan
| | - Ryuta Ito
- Division of Cardiovascular Medicine, Nagoya Kyoritsu Hospital, 1-172, Hokke, Nakagawa-ku, Nagoya, Aichi, 454-0933, Japan
| | - Toshiyuki Tobisawa
- Division of Cardiovascular Medicine, Asahikawa Red Cross Hospital, 1-1, Akebono, Asahikawa, Hokkaido, 070-8530, Japan
| | - Takao Konishi
- Division of Cardiovascular Medicine, Hokkaido University Hospital, West 5, North 14, Kita-ku, Sapporo, Hokkaido, 060-8648, Japan
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Clinical Utility of Intravascular Imaging. JACC: CARDIOVASCULAR IMAGING 2022; 15:1799-1820. [DOI: 10.1016/j.jcmg.2022.04.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 04/01/2022] [Indexed: 12/28/2022]
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Favorable Vasomotor Function after Drug-Coated Balloon-Only Angioplasty of De Novo Native Coronary Artery Lesions. J Clin Med 2022; 11:jcm11020299. [PMID: 35053994 PMCID: PMC8779419 DOI: 10.3390/jcm11020299] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 01/05/2022] [Accepted: 01/05/2022] [Indexed: 02/05/2023] Open
Abstract
Balloon-injured coronary segments are known to harbor abnormal vasomotion. We evaluated whether de novo coronary lesions treated using drug-coated balloon (DCB) are prone to vasospasm and how they respond to ergonovine and nitrate. Among 132 DCB angioplasty recipients followed, 89 patients underwent ergonovine provocation test at 6–9 months follow-up. Within-subject ergonovine- and nitrate-induced diameter changes were compared among three different sites: DCB-treated vs. angiographically normal vs. segment showing prominent vasoreactivity (spastic). No patient experienced clinically refractory vasospastic angina or symptom-driven revascularization during follow-up. Ergonovine induced vasospasm in seven patients; all were multifocal spasm either involving (n = 2) or rather sparing DCB-treated segments (n = 5). None showed focal spasm that exclusively involved DCB-treated lesions. Among 27 patients with vasospastic features, DCB-treated segments showed less vasoconstriction than spastic counterparts (p < 0.001). A total of 110 DCB-treated lesions were analyzed to assess vasomotor function. Vasomotor function, defined as a combined constrictor and dilator response, was comparable between DCB-treated and angiographically normal segments (p = 0.173), while significant differences were observed against spastic counterparts (p < 0.001). In our study, DCB-treated lesions were not particularly vulnerable to vasospasm and were found to have vasomotor function similar to angiographically normal segments, supporting safety of DCB-only strategy in treating de novo native coronary lesions.
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