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Zhang Y, Wu Z, Wang S, Liu T, Liu J. Clinical Outcome of Paclitaxel-Coated Balloon Angioplasty Versus Drug-Eluting Stent Implantation for the Treatment of Coronary Drug-Eluting Stent In-Stent Chronic Total Occlusion. Cardiovasc Drugs Ther 2023; 37:1155-1166. [PMID: 35930211 PMCID: PMC10721670 DOI: 10.1007/s10557-022-07363-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/26/2022] [Indexed: 11/25/2022]
Abstract
AIMS In-stent chronic total occlusion (IS-CTO) represents a unique challenge for percutaneous coronary intervention. Whether the optimal treatment for IS-CTO is angioplasty with paclitaxel-coated balloons (PCBs) or repeat stenting with drug-eluting stents (DESs) is unclear. We aimed to evaluate the long-term clinical outcome of PCB angioplasty and DES repeat stenting for DES IS-CTO. METHODS We retrospectively included patients with DES IS-CTO who underwent successful PCB angioplasty or DES repeat stenting from January 2016 to December 2019. The primary endpoints were major adverse cardiac events (MACEs), including cardiac death, myocardial infarction, and target lesion revascularization (TLR). Cox proportional hazards model was performed to compare the risk of MACEs between PCB angioplasty and DES repeat stenting, and to further explore the prognostic factors of patients with DES IS-CTO. RESULTS A total of 214 patients with DES IS-CTO were enrolled: 78 patients (36.4%) treated with PCB and 136 patients (63.6%) treated with DES respectively. The median follow-up was 1160 days, and MACEs were observed in 28.2% of patients with PCB angioplasty versus 26.5% of patients with DES repeat stenting (P = 0.784), mainly driven by TLR (21.8% vs. 19.9%, P = 0.735). There was no significant difference in the risk of MACEs between the PCB group and the DES group (hazard ratio [HR] 1.25, 95% confidence interval [CI] 0.64-2.46, P = 0.512). Multivariate Cox analysis revealed that chronic kidney disease and ≥ 3 stent layers in the lesion were independent predictors of MACEs, while switching to another antiproliferative drug was an independent protective factor (all P < 0.05). CONCLUSIONS PCB angioplasty was an effective alternative treatment strategy for DES IS-CTO, which had similar long-term outcomes to DES repeat stenting in contemporary practice, but both were accompanied by a high rate of long-term MACEs. Improving the poor prognosis of patients with DES IS-CTO remains a challenge.
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Affiliation(s)
- Yuchao Zhang
- Center for Coronary Artery Disease, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Diseases, No. 2 Anzhen Road, Chaoyang District, Beijing, 100029, China
| | - Zheng Wu
- Center for Coronary Artery Disease, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Diseases, No. 2 Anzhen Road, Chaoyang District, Beijing, 100029, China
| | - Shaoping Wang
- Center for Coronary Artery Disease, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Diseases, No. 2 Anzhen Road, Chaoyang District, Beijing, 100029, China
| | - Tong Liu
- Center for Coronary Artery Disease, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Diseases, No. 2 Anzhen Road, Chaoyang District, Beijing, 100029, China
| | - Jinghua Liu
- Center for Coronary Artery Disease, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Diseases, No. 2 Anzhen Road, Chaoyang District, Beijing, 100029, China.
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2
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Wang X, Zhang M, Cheng J, Zhou H. Association of serum apoA-I with in-stent restenosis in coronary heart disease. BMC Cardiovasc Disord 2022; 22:355. [PMID: 35927634 PMCID: PMC9354313 DOI: 10.1186/s12872-022-02762-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 07/11/2022] [Indexed: 11/10/2022] Open
Abstract
Background Despite use of drug-eluting stents (DES), in-stent restenosis (ISR) continues adversely affecting clinical outcomes of patients undergoing percutaneous coronary intervention (PCI). Apolipoprotein A-I (apoA-I) has athero-protective effects. However, there is a paucity of clinical data regarding the association between apoA-I and ISR. We sought to investigate whether serum apoA-I is related to ISR after DES-based PCI. Methods In this retrospective case control study, 604 consecutive patients who underwent DES implantation before were enrolled. Patients who underwent repeat angiography within 12 months were included in the early ISR study (n = 205), while those beyond 12 months were included in the late ISR study (n = 399). ISR was defined as the presence of > 50% diameter stenosis at the stent site or at its edges. Clinical characteristics were compared between ISR and non-ISR patients in the early and late ISR study, respectively, after adjusting for confounding factors by multivariate logistic regression, stratified analysis, and propensity score matching. The predictive value was assessed by univariate and multivariate logistic regression analysis, receiver operating characteristic (ROC) curve analysis, and quartile analysis. Results In the early ISR study, 8.8% (18 of 205) patients developed ISR. Serum apoA-I in the ISR group was lower than that in the non-ISR group (1.1 ± 0.26 vs. 1.24 ± 0.23, P < 0.05). On multivariate logistic regression analysis, apoA-I was an independent risk factor for early ISR. Incidence of early ISR showed negative correlation with apoA-I and could be predicted by the combined use of apoA-I and glycosylated hemoglobin (HbA1c) level. In the late ISR study, 21.8% (87 of 399) patients developed ISR. On subgroup analysis, late ISR showed negative correlation with apoA-I irrespective of intensive lipid lowering; on multivariate logistic regression analysis, apoA-I was also an independent risk factor for late ISR. In patients with intensive lipid lowering, combined use of apoA-I, stenting time, and diabetes predicted the incidence of late ISR. Conclusions ApoA-I was an independent risk factor for ISR, and showed a negative correlation with ISR after DES-based PCI. Combined use of apoA-I and clinical indicators may better predict the incidence of ISR under certain circumstances.
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Affiliation(s)
- Xin Wang
- Department of Cardiology, School of Medicine, East Hospital, Tongji University, Shanghai, China
| | - Min Zhang
- Department of Cardiology, School of Medicine, Ren Ji Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Jie Cheng
- Center for Reproductive Medicine, School of Medicine, Ren Ji Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Hua Zhou
- Department of Cardiology, School of Medicine, East Hospital, Tongji University, Shanghai, China.
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3
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Abstract
In-stent restenosis (ISR) remains the most common cause of stent failure after percutaneous coronary intervention (PCI). Recent data suggest that ISR-PCI accounts for 5-10% of all PCI procedures performed in current clinical practice. This State-of-the-Art review will primarily focus on the management of ISR but will begin by briefly discussing diagnosis and classification. We then move on to detail the evidence base underpinning the various therapeutic strategies for ISR before finishing with a proposed ISR management algorithm based on current scientific data.
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Affiliation(s)
- Fernando Alfonso
- Department of Cardiology, Hospital Universitario de La Princesa, Universidad Autónoma de Madrid, IIS-IP, CIBER-CV, Calle de Diego de León 62, 28006 Madrid, Spain
| | - J. J. Coughlan
- Deutsches Herzzentrum München und Technische Universität München, Munich, Germany,Department of Cardiology, ISAResearch, German Heart Center, Munich, Germany,Cardiovascular Research Institute, Mater Private Network, Dublin, Ireland,School of Pharmacy and Biomolecular Sciences, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Daniele Giacoppo
- Department of Cardiology, ISAResearch, German Heart Center, Munich, Germany,Cardiovascular Research Institute, Mater Private Network, Dublin, Ireland,School of Pharmacy and Biomolecular Sciences, RCSI University of Medicine and Health Sciences, Dublin, Ireland,Department of Cardiology, Alto Vicentino Hospital, Santorso, Italy
| | - Adnan Kastrati
- Deutsches Herzzentrum München und Technische Universität München, Munich, Germany,Department of Cardiology, ISAResearch, German Heart Center, Munich, Germany,German Center for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Munich, Germany
| | - Robert A. Byrne
- Cardiovascular Research Institute, Mater Private Network, Dublin, Ireland,School of Pharmacy and Biomolecular Sciences, RCSI University of Medicine and Health Sciences, Dublin, Ireland
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4
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Zheng YC, Lee WC, Fang HY, Chen CJ, Yang CH, Wu CJ, Fang CY. Cutting Balloon Combined with Drug-Coated Balloon Angioplasty for the Treatment of In-Stent Restenosis. Int Heart J 2021; 62:1213-1220. [PMID: 34744147 DOI: 10.1536/ihj.21-207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Drug-coated balloon (DCB) has emerged as an alternative therapeutic choice for in-stent restenosis (ISR) lesions. Cutting balloon angioplasty (CBA) is also a strategy utilized to treat tight stenotic lesions or ISR lesions. Few studies have focused on whether CBA plus DCB could achieve a better result in lowering the incidence of recurrent ISR. This study aimed to evaluate the efficacy of CBA plus DCB for ISR lesions.Between August 2011 and December 2017, 681 patients (937 lesions) were diagnosed with ISR and treated with DCBs in our hospital. The CBA plus DCB group comprised 90 patients who underwent PCI with further CBA plus DCB, and the DCB alone group comprised 591 patients who underwent percutaneous coronary intervention (PCI) with DCB alone.Baseline characteristics, the types of previous stents, lesion type, prevalence of ostial lesion and left main lesion, and pre-PCI and post-PCI stenotic percentage showed no significant difference between the two groups. Only post-PCI reference luminal diameter and size of DCB were larger in the CBA plus DCB group. During the one-year follow-up period, late loss and clinical outcomes did not differ between the two groups before and after propensity score matching. The incidence of subtotal/total occlusion with delay flow was lower in the CBA plus DCB group after propensity score matching (4.1% versus 10.9%; P = 0.030).In these patients with ISR lesions, the clinical outcomes and the incidence of repeat target lesion revascularization were similar after treatment with CBA plus DCB versus DCB alone. Further study is warranted, including prospective, randomized comparisons.
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Affiliation(s)
- You-Cheng Zheng
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine
| | - Wei-Chieh Lee
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine.,Institute of Clinical Medicine, College of Medicine, National Cheng Kung University
| | - Hsiu-Yu Fang
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine
| | - Chien-Jen Chen
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine
| | - Cheng-Hsu Yang
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine
| | - Chiung-Jen Wu
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine
| | - Chih-Yuan Fang
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine
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5
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Wiebe J, Rai H, Kuna C, Cassese S, Kessler T, Rheude T, Colleran R, Schunkert H, Koch T, Kufner S, Joner M, Kastrati A, Byrne RA. Angiographic performance of everolimus-eluting stents for the treatment of coronary in-stent restenosis in daily practice. Catheter Cardiovasc Interv 2021; 98:857-862. [PMID: 32845090 DOI: 10.1002/ccd.29225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 07/27/2020] [Accepted: 08/10/2020] [Indexed: 11/10/2022]
Abstract
OBJECTIVES The present study aims to analyze the angiographic anti-restenotic performance of durable polymer everolimus-eluting stents (EES) for the treatment of in-stent restenosis (ISR) in daily practice. BACKGROUND Randomized data is available supporting the use of drug-coated balloons and drug-eluting stents for the treatment of ISR; however, additional real-world data including angiographic follow-up is needed. METHODS Patients who underwent EES-implantation for the treatment of drug-eluting stent ISR and attended for a 6-8 months angiographic surveillance were analyzed. Off-line assessment of the angiograms was conducted at a central quantitative coronary angiographic core laboratory. RESULTS A total of 426 patients with ISR were treated with EES and had undergone angiographic follow-up. The mean age was 66.8 ± 9.9 years and 27.5% suffered from diabetes. A total of 459 lesions were treated. The diameter stenosis decreased from 64.3 ± 19.1% (preprocedural) to 12.0 ± 6.4% (postprocedural). At 6-8 months angiographic follow-up, the in-segment diameter stenosis was 38.3 ± 21.7% and the in-stent late luminal loss was 0.54 ± 0.74 mm in the treated area analysis. The rate of recurrent binary restenosis was 25.7%. CONCLUSIONS In the setting of ISR, the angiographic anti-restenotic efficacy of stenting with EES is comparable to that observed in randomized clinical trials and less favorable than its performance in patients undergoing stenting for de novo disease.
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Affiliation(s)
- Jens Wiebe
- Deutsches Herzzentrum München, Technische Universität München, München, Germany.,School of Pharmacy and Biomolecular Sciences, DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance, Berlin, Germany
| | - Himanshu Rai
- Deutsches Herzzentrum München, Technische Universität München, München, Germany
| | - Constantin Kuna
- Deutsches Herzzentrum München, Technische Universität München, München, Germany
| | - Salvatore Cassese
- Deutsches Herzzentrum München, Technische Universität München, München, Germany
| | - Thorsten Kessler
- Deutsches Herzzentrum München, Technische Universität München, München, Germany.,School of Pharmacy and Biomolecular Sciences, DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance, Berlin, Germany
| | - Tobias Rheude
- Deutsches Herzzentrum München, Technische Universität München, München, Germany
| | - Roisin Colleran
- Deutsches Herzzentrum München, Technische Universität München, München, Germany
| | - Heribert Schunkert
- Deutsches Herzzentrum München, Technische Universität München, München, Germany.,School of Pharmacy and Biomolecular Sciences, DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance, Berlin, Germany
| | - Tobias Koch
- Deutsches Herzzentrum München, Technische Universität München, München, Germany
| | - Sebastian Kufner
- Deutsches Herzzentrum München, Technische Universität München, München, Germany
| | - Michael Joner
- Deutsches Herzzentrum München, Technische Universität München, München, Germany.,School of Pharmacy and Biomolecular Sciences, DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance, Berlin, Germany
| | - Adnan Kastrati
- Deutsches Herzzentrum München, Technische Universität München, München, Germany.,School of Pharmacy and Biomolecular Sciences, DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance, Berlin, Germany
| | - Robert A Byrne
- Mater Private Hospital, Department of Cardiology, Dublin, Ireland.,Royal College of Surgeons, Dublin, Ireland
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Abstract
PURPOSE OF REVIEW In the interventional treatment of coronary artery disease, new-generation drug-eluting stents (DES) currently are the standard treatment. In addition, drug-coated balloons (DCB) are a well-established option for the treatment of in-stent restenosis in both bare-metal stents (BMS) and DES, where DCBs deliver an antiproliferative drug without the necessity of re-implanting a stent. Since the field of use for DCB has increasingly been extended to other indications such as de novo lesions in small vessel disease (SVD), a review of literature may be useful. RECENT FINDINGS Recent randomized trial data show good efficacy and safety for DCB in de novo lesions, especially in small coronary arteries, and confirm long-term clinical efficacy and safety up to three years. DCB are an attractive and safe option in the treatment of de novo lesions in SVD.
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Affiliation(s)
- Ketina Arslani
- Department of Cardiology, University Hospital Basel, University of Basel, Petersgraben 4, CH-4031 Basel, Switzerland
| | - Raban Jeger
- Department of Cardiology, University Hospital Basel, University of Basel, Petersgraben 4, CH-4031 Basel, Switzerland
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7
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Kyaw H, Johal G, Gedela M, Barman N, Kini A, Sharma SK. Is Coronary Brachytherapy Staging a Comeback for the Treatment of In-Stent Restenosis? Curr Cardiol Rep 2021; 23:156. [PMID: 34599432 DOI: 10.1007/s11886-021-01582-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/06/2021] [Indexed: 11/24/2022]
Abstract
PURPOSE OF REVIEW The catheter-based coronary intervention has become a well-established therapeutic modality for obstructive coronary artery disease. However, in-stent restenosis remains a significant limitation of coronary intervention despite the use of newer devices. Intravascular brachytherapy was introduced to treat recurrent in-stent restenosis but only modestly adopted. This review will discuss the mechanism of intracoronary brachytherapy, available clinical evidence of brachytherapy in recurrent in-stent restenosis treatment, and the future of coronary brachytherapy in coronary intervention. RECENT FINDINGS Drug-eluting stents have an inherent limitation as they leave a permanent metal layer inside an artery when deployed. Recently, drug-coated balloon technology has emerged to treat coronary artery disease as a combination of balloon angioplasty and local drug delivery without leaving a metal layer behind. Recent European guidelines recommended using drug-coated balloons when treating in-stent restenosis treatment, while the US guidelines have not yet addressed the use of drug-coated balloons in such cases. Coronary brachytherapy is a valuable addition to treat these challenging diseases despite several logistic issues. If there are newer technologies with easier setup, such as drug-coated balloons, coronary brachytherapy resurgence is improbable in the contemporary era, although it may not become obsolete.
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Affiliation(s)
- Htoo Kyaw
- Department of Cardiology, The Zena and Michael A. Wiener Cardiovascular Institute, Mount Sinai Hospital, One Gustave L. Levy Place, Box 1030, New York, NY, 10029-6574, USA
| | - Gurpreet Johal
- Department of Cardiology, The Zena and Michael A. Wiener Cardiovascular Institute, Mount Sinai Hospital, One Gustave L. Levy Place, Box 1030, New York, NY, 10029-6574, USA
| | - Maheedhar Gedela
- Department of Cardiology, The Zena and Michael A. Wiener Cardiovascular Institute, Mount Sinai Hospital, One Gustave L. Levy Place, Box 1030, New York, NY, 10029-6574, USA
| | - Nitin Barman
- Department of Cardiology, The Zena and Michael A. Wiener Cardiovascular Institute, Mount Sinai Hospital, One Gustave L. Levy Place, Box 1030, New York, NY, 10029-6574, USA
| | - Annapoorna Kini
- Department of Cardiology, The Zena and Michael A. Wiener Cardiovascular Institute, Mount Sinai Hospital, One Gustave L. Levy Place, Box 1030, New York, NY, 10029-6574, USA
| | - Samin K Sharma
- Department of Cardiology, The Zena and Michael A. Wiener Cardiovascular Institute, Mount Sinai Hospital, One Gustave L. Levy Place, Box 1030, New York, NY, 10029-6574, USA.
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8
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Influences of Stent Design on In-Stent Restenosis and Major Cardiac Outcomes: A Scoping Review and Meta-Analysis. Cardiovasc Eng Technol 2021; 13:147-169. [PMID: 34409580 DOI: 10.1007/s13239-021-00569-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 07/21/2021] [Indexed: 10/20/2022]
Abstract
Thanks to the developments in implantable biomaterial technologies, invasive operating procedures, and widespread applications especially in vascular disease treatment, a milestone for interventional surgery was achieved with the introduction of vascular stents. Despite vascular stents providing a solution for embolisms, this technology includes various challenges, such as mechanical, electro-chemical complications, or in-stent restenosis (ISR) risks with long-term usage. Therefore, further development of biomaterial technologies is vital to overcome such risks and problems. For this purpose, recent research has focused mainly on the applications of surface modification techniques on biomaterials and vascular stents to increase their hemocompatibility. ISR risk has been reduced with the development and prevalent usage of the art technology stent designs of drug-eluting and biodegradable stents. Nevertheless, their problems have not been overcome completely. Furthermore, patients using drug-eluting stents are faced with further clinical challenges. Therefore, the bare metal stent, which is the first form of the vascular stent technology and includes the highest ISR risk, is still in common usage for vascular treatment applications. For this reason, further research is necessary to solve the remaining vital problems. In this scoping review, stent-based major cardiac events including ISR are analyzed depending on different designs and material selection in stent manufacturing. Recent and novel approaches to overcome such challenges are stated in detail.
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9
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Giacoppo D, Alfonso F, Xu B, Claessen BEPM, Adriaenssens T, Jensen C, Pérez-Vizcayno MJ, Kang DY, Degenhardt R, Pleva L, Baan J, Cuesta J, Park DW, Schunkert H, Colleran R, Kukla P, Jiménez-Quevedo P, Unverdorben M, Gao R, Naber CK, Park SJ, Henriques JPS, Kastrati A, Byrne RA. Paclitaxel-coated balloon angioplasty vs. drug-eluting stenting for the treatment of coronary in-stent restenosis: a comprehensive, collaborative, individual patient data meta-analysis of 10 randomized clinical trials (DAEDALUS study). Eur Heart J 2021; 41:3715-3728. [PMID: 31511862 PMCID: PMC7706792 DOI: 10.1093/eurheartj/ehz594] [Citation(s) in RCA: 100] [Impact Index Per Article: 33.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Revised: 06/26/2019] [Accepted: 08/08/2019] [Indexed: 01/10/2023] Open
Abstract
Abstract
Aims
Consensus is lacking regarding the best treatment for coronary in-stent restenosis (ISR). The two most effective treatments are angioplasty with paclitaxel-coated balloon (PCB) and repeat stenting with drug-eluting stent (DES) but individual trials were not statistically powered for clinical endpoints, results were heterogeneous, and evidence about comparative efficacy and safety in relevant subsets was limited.
Methods and results
The Difference in Anti-restenotic Effectiveness of Drug-eluting stent and drug-coated balloon AngiopLasty for the occUrrence of coronary in-Stent restenosis (DAEDALUS) study was a comprehensive, investigator-initiated, collaborative, individual patient data meta-analysis comparing angioplasty with PCB alone vs. repeat stenting with DES alone for the treatment of coronary ISR. The protocol was registered with PROSPERO (CRD42017075007). All 10 available randomized clinical trials were included with 1976 patients enrolled, 1033 assigned to PCB and 943 to DES. At 3-year follow-up, PCB was associated with a significant increase in the risk of target lesion revascularization (TLR) compared with DES [hazard ratio (HR) 1.32, 95% CI 1.02–1.70, P = 0.035; number-needed-to-harm 28.5]. There was a significant interaction between treatment effect and type of restenosed stent (P = 0.029) with a more marked difference in patients with DES-ISR and comparable effects in patients with bare-metal stent-ISR. At 3-year follow-up, the primary safety endpoint of all-cause death, myocardial infarction, or target lesion thrombosis was comparable between treatments (HR 0.80, 95% CI 0.58–1.09, P = 0.152). A pre-specified subgroup analysis indicated a significant interaction between treatment effect and type of DES used to treat ISR (P = 0.033), with a lower incidence of events associated with PCB compared with first-generation DES and similar effect between PCB and second-generation DES (HR 1.06, 95% CI 0.71–1.60, P = 0.764). Long-term all-cause mortality was similar between PCB and DES (HR 0.81, 95% CI 0.53–1.22, P = 0.310); results were consistent comparing PCB and non-paclitaxel-based DES (HR 1.42, 95% CI 0.80–2.54, P = 0.235). Myocardial infarction and target lesion thrombosis were comparable between treatments.
Conclusions
In patients with coronary ISR, repeat stenting with DES is moderately more effective than angioplasty with PCB at reducing the need for TLR at 3 years. The incidence of a composite of all-cause death, myocardial infarction, or target lesion thrombosis was similar between groups. The rates of individual endpoints, including all-cause mortality, were not significantly different between groups.
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Affiliation(s)
- Daniele Giacoppo
- Department of Cardiovascular Diseases, Deutsches Herzzentrum München, Technische Universität München, Lazarettstrasse 36, 80636 Munich, Germany
| | - Fernando Alfonso
- Department of Cardiology, Hospital Universitario de La Princesa Madrid, Calle Diego de León 62, Madrid 28006, Spain
| | - Bo Xu
- Department of Cardiology, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, 167 Beilishi Road, Xicheng, 100037 Beijing, China
| | - Bimmer E P M Claessen
- Mount Sinai Heart, the Zena and Michael Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, 1428 Madison Avenue, 10029 New York, NY, USA
| | - Tom Adriaenssens
- Department of Cardiovascular Diseases, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium
| | - Christoph Jensen
- Department of Cardiology, Contilia Heart and Vascular Center, Elisabeth Krankenhaus, Klara-Kopp-Weg 1, 45138 Essen, Germany
| | - María J Pérez-Vizcayno
- Department of Cardiology, Hospital Clinico San Carlos, Calle Profesor Martin Lagos, 28040 Madrid, Spain
| | - Do-Yoon Kang
- Department of Cardiology, Asan Medical Center, University of Ulsan, 388-1 Poongnapdong, Seoul 138-736, South Korea
| | - Ralf Degenhardt
- Department of Cardiology, Herz-Kreislauf-Zentrum, Heinz-Meise-Strasse 100, 36199 Rotenburg an der Fulda, Germany
| | - Leos Pleva
- Department of Cardiology, University Hospital Ostrava, tr. 17 listopadu 1790, 70852 Ostrava, Czech Republic
| | - Jan Baan
- Department of Cardiology, Academic Medical Centre, University of Amsterdam, Meibergdreef 9, 1105 Amsterdam, the Netherlands
| | - Javier Cuesta
- Department of Cardiology, Hospital Universitario de La Princesa Madrid, Calle Diego de León 62, Madrid 28006, Spain
| | - Duk-Woo Park
- Department of Cardiology, Asan Medical Center, University of Ulsan, 388-1 Poongnapdong, Seoul 138-736, South Korea
| | - Heribert Schunkert
- Department of Cardiovascular Diseases, Deutsches Herzzentrum München, Technische Universität München, Lazarettstrasse 36, 80636 Munich, Germany.,DZHK (German Centre for Cardiovascular Research), Munich Heart Alliance, Marchioninistrasse 15, 81377 Munich, Germany
| | - Roisin Colleran
- Department of Cardiovascular Diseases, Deutsches Herzzentrum München, Technische Universität München, Lazarettstrasse 36, 80636 Munich, Germany
| | - Pavel Kukla
- Department of Cardiology, University Hospital Ostrava, tr. 17 listopadu 1790, 70852 Ostrava, Czech Republic
| | - Pilar Jiménez-Quevedo
- Department of Cardiology, Hospital Clinico San Carlos, Calle Profesor Martin Lagos, 28040 Madrid, Spain
| | - Martin Unverdorben
- Department of Cardiology, Herz-Kreislauf-Zentrum, Heinz-Meise-Strasse 100, 36199 Rotenburg an der Fulda, Germany.,Daiichi Sankyo, 211 Mt. Airy Road, 07920 Basking Ridge, NJ, USA
| | - Runlin Gao
- Department of Cardiology, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, 167 Beilishi Road, Xicheng, 100037 Beijing, China
| | - Christoph K Naber
- Department of Cardiology, Contilia Heart and Vascular Center, Elisabeth Krankenhaus, Klara-Kopp-Weg 1, 45138 Essen, Germany
| | - Seung-Jung Park
- Department of Cardiology, Asan Medical Center, University of Ulsan, 388-1 Poongnapdong, Seoul 138-736, South Korea
| | - José P S Henriques
- Department of Cardiology, Academic Medical Centre, University of Amsterdam, Meibergdreef 9, 1105 Amsterdam, the Netherlands
| | - Adnan Kastrati
- Department of Cardiovascular Diseases, Deutsches Herzzentrum München, Technische Universität München, Lazarettstrasse 36, 80636 Munich, Germany.,DZHK (German Centre for Cardiovascular Research), Munich Heart Alliance, Marchioninistrasse 15, 81377 Munich, Germany
| | - Robert A Byrne
- Department of Cardiovascular Diseases, Deutsches Herzzentrum München, Technische Universität München, Lazarettstrasse 36, 80636 Munich, Germany.,DZHK (German Centre for Cardiovascular Research), Munich Heart Alliance, Marchioninistrasse 15, 81377 Munich, Germany
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Neumann FJ, Sousa-Uva M, Ahlsson A, Alfonso F, Banning AP, Benedetto U, Byrne RA, Collet JP, Falk V, Head SJ, Jüni P, Kastrati A, Koller A, Kristensen SD, Niebauer J, Richter DJ, Seferovic PM, Sibbing D, Stefanini GG, Windecker S, Yadav R, Zembala MO. 2018 ESC/EACTS Guidelines on myocardial revascularization. Eur Heart J 2020; 40:87-165. [PMID: 30165437 DOI: 10.1093/eurheartj/ehy394] [Citation(s) in RCA: 3886] [Impact Index Per Article: 971.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
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11
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Clinical Outcomes of Drug-Eluting versus Bare-Metal In-Stent Restenosis after the Treatment of Drug-Eluting Stent or Drug-Eluting Balloon: A Systematic Review and Meta-Analysis. J Interv Cardiol 2020; 2020:8179849. [PMID: 32684867 PMCID: PMC7336236 DOI: 10.1155/2020/8179849] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Accepted: 06/02/2020] [Indexed: 11/17/2022] Open
Abstract
Background Although drug-eluting stents (DES) have reduced the rates of in-stent restenosis (ISR) compared with bare-metal stents (BMS), DES related ISR (DES-ISR) still occurs and outcomes of DES-ISR remain unclear. The objective of this meta-analysis was to investigate the long-term clinical outcomes of patients with DES-ISR compared with patients with BMS related ISR (BMS-ISR) after the treatment of DES or drug-eluting balloon (DEB). Methods and results. We searched the literature in the main electronic databases including PUBMED, EMBASE, Cochrane Library, and Web of Science. The primary endpoints were target lesion revascularization (TLR) and target vessel revascularization (TVR). The secondary endpoints included all cause death (ACD), cardiac death (CD), myocardial infarction (MI), stent thrombosis or re-in-stent restenosis (ST/RE-ISR), and major adverse cardiovascular events (MACEs). A total of 19 studies with 6256 participants were finally included in this meta-analysis. Results showed that the rates of TLR (P < 0.00001), TVR (P < 0.00001), CD (P=0.02), ST/RE-ISR (P < 0.00001), and MACEs (P < 0.00001) were significantly higher in the DES-ISR group than in the BMS-ISR group. No significant differences were found between the two groups in the rates of MI (P=0.05) and ACD (P=0.21). Conclusions Our study demonstrated that patients with DES-ISR had worse clinical outcomes at the long-term follow-up than patients with BMS-ISR after the treatment of DES or DEB, suggesting that DES and DEB may be more effective for BMS-ISR than that for DES-ISR. Positive prevention of DES-ISR is indispensable and further studies concentrating on detecting the predictors of outcomes of DES-ISR are required.
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Giacoppo D, Alfonso F, Xu B, Claessen BE, Adriaenssens T, Jensen C, Pérez-Vizcayno MJ, Kang DY, Degenhardt R, Pleva L, Baan J, Cuesta J, Park DW, Kukla P, Jiménez-Quevedo P, Unverdorben M, Gao R, Naber CK, Park SJ, Henriques JP, Kastrati A, Byrne RA. Drug-Coated Balloon Angioplasty Versus Drug-Eluting Stent Implantation in Patients With Coronary Stent Restenosis. J Am Coll Cardiol 2020; 75:2664-2678. [DOI: 10.1016/j.jacc.2020.04.006] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Revised: 03/10/2020] [Accepted: 04/02/2020] [Indexed: 12/18/2022]
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Jeger RV, Eccleshall S, Wan Ahmad WA, Ge J, Poerner TC, Shin ES, Alfonso F, Latib A, Ong PJ, Rissanen TT, Saucedo J, Scheller B, Kleber FX. Drug-Coated Balloons for Coronary Artery Disease. JACC Cardiovasc Interv 2020; 13:1391-1402. [DOI: 10.1016/j.jcin.2020.02.043] [Citation(s) in RCA: 60] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Revised: 02/26/2020] [Accepted: 02/27/2020] [Indexed: 12/19/2022]
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14
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Konishi A, Mitsutake Y, Ho M, Handa N, Koike K, Mochizuki S, Ishii K. Patient and lesion characteristics in late/very late stent thrombosis with everolimus-eluting stents from real-world adverse event reporting. J Cardiol 2020; 75:255-260. [DOI: 10.1016/j.jjcc.2019.07.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2019] [Revised: 07/11/2019] [Accepted: 07/28/2019] [Indexed: 11/16/2022]
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15
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Harada Y, Schneider S, Colleran R, Rai H, Bohner J, Kuna C, Kufner S, Giacoppo D, Schüpke S, Joner M, Ibrahim T, Laugwitz KL, Kastrati A, Byrne RA. Resultado del tratamiento percutáneo de la reestenosis de stents farmacoactivos: ¿depende de si el stent tenía o no recubrimiento polimérico? Rev Esp Cardiol (Engl Ed) 2020. [DOI: 10.1016/j.recesp.2019.01.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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16
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Megaly M, Glogoza M, Xenogiannis I, Vemmou E, Nikolakopoulos I, Willson L, Monyak DJ, Sullivan P, Stanberry L, Sorajja P, Chavez I, Mooney M, Traverse J, Wang Y, Garcia S, Poulose A, Burke MN, Brilakis ES. Outcomes of intravascular brachytherapy for recurrent drug-eluting in-stent restenosis. Catheter Cardiovasc Interv 2020; 97:32-38. [PMID: 31943747 DOI: 10.1002/ccd.28716] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 12/25/2019] [Accepted: 12/29/2019] [Indexed: 12/27/2022]
Abstract
OBJECTIVES To examine the outcomes of vascular brachytherapy (VBT) for recurrent drug-eluting stents (DES) in-stent restenosis (ISR). BACKGROUND Recurrent DES-ISR can be challenging to treat. VBT has been used with encouraging results. METHODS We report the long-term outcomes of patients with recurrent DES-ISR treated with VBT between January 2014 and September 2018 at a tertiary care institution. The main outcome was target lesion failure (TLF), defined as the composite of clinically driven target lesion revascularization (TLR), target lesion myocardial infarction (MI), and target lesion-related cardiac death. Cox proportional hazards analysis was performed to identify variables associated with recurrent TLF. RESULTS During the study period, 116 patients (143 lesions) underwent VBT. Median follow-up was 24.7 (14.5-35.4) months. The incidence of TLR, target-lesion MI, and TLF was 18.9%, 5.6%,and 20.1% at 1 year, and 29.4%, 10.5%, and 32.9% at 2 years.Initial presentation with acute coronary syndrome (ACS) was independently associated with TLF (hazard ratio = 1.975, 95% CI [1.120, 3.485], p = .019). Lesions treated with intravascular ultrasound (IVUS) guidance had a lower incidence of TLR (14.3% vs. 39.6%, log-rank p = .038), and a trend toward lower incidence of TLF (19% vs. 42.6%, log-rank p = .086). CONCLUSIONS VBT can improve the treatment of recurrent DES-ISR, but TLF occurs in approximately one in three patients at 2 years. Initial presentation with ACS was associated with higher TLF and the use of IVUS with a trend for lower incidence of TLF.
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Affiliation(s)
- Michael Megaly
- Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, Minnesota.,Department of Cardiovascular Medicine, Hennepin Healthcare, Minneapolis, Minnesota
| | - Matthew Glogoza
- Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - Iosif Xenogiannis
- Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - Evangelia Vemmou
- Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - Ilias Nikolakopoulos
- Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - Laura Willson
- Department of Radiation Oncology, Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - David J Monyak
- Department of Radiation Oncology, Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - Patsa Sullivan
- Department of Radiation Oncology, Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - Larissa Stanberry
- Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - Paul Sorajja
- Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - Ivan Chavez
- Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - Michael Mooney
- Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - Jay Traverse
- Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - Yale Wang
- Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - Santiago Garcia
- Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - Anil Poulose
- Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, Minnesota
| | | | - Emmanouil S Brilakis
- Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, Minnesota
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17
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Paramasivam G, Devasia T, Jayaram A, Razak A, Rao MS, Vijayvergiya R, Nayak K. In-stent restenosis of drug-eluting stents in patients with diabetes mellitus: Clinical presentation, angiographic features, and outcomes. Anatol J Cardiol 2020; 23:28-34. [PMID: 31911567 PMCID: PMC7141436 DOI: 10.14744/anatoljcardiol.2019.72916] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/03/2019] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE Diabetes mellitus (DM) is a risk factor for developing in-stent restenosis (ISR) following percutaneous coronary intervention (PCI). This study aimed to examine the presentation and outcomes of drug-eluting stent (DES) ISR in diabetics. METHODS This retrospective study included consecutive patients with clinical DES-ISR, who were hospitalized between January 2013 and December 2017 and who were grouped based on the presence or absence of DM. Clinical, angiographic features and 1-year outcomes [composite of death, myocardial infarction (MI), and repeat-target lesion revascularization] were compared. RESULTS Baseline characteristics of the DM group (n=109) were comparable to the non-DM group (n=82), except for the higher prevalence of hypertension and dyslipidemia in the former (60.6% vs. 46.3%, p=0.050; 74.4% vs. 57.8%, p=0.034, respectively). Clinical presentation was similar in both groups [acute coronary syndrome (ACS): 62.4% vs. 61%, p=0.843; MI: 34.9% vs. 34.1%, p=0.918). Diabetics had a higher prevalence of stent-edge restenosis (20.3% vs. 9.2%, p=0.019). The treatment strategy was similar in both groups with 52.3% in the DM group and 57.3% in the non-DM group undergoing PCI (p=0.513). One-year outcomes of the DM group were not different from those of the non-DM group (14.7% vs. 17.1%, p=0.683). Age [hazard ratio (HR), 1.05; 95% confidence interval (CI), 1.01-1.10; p=0.017], MI presentation (HR, 2.34; 95% CI, 1.14-4.80; p=0.020), and chronic kidney disease (CKD: HR, 2.82; 95% CI, 1.21-6.58; p=0.016) were predictors of poor outcomes. CONCLUSION Stent-edge restenosis is more common in diabetics. Clinical presentation and 1-year outcomes following DES-ISR are similar in diabetics and non-diabetics. Age, MI presentation, CKD, and not DM were predictors of poor outcomes following DES-ISR.
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Affiliation(s)
- Ganesh Paramasivam
- Department of Cardiology, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal; Karnataka-India
| | - Tom Devasia
- Department of Cardiology, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal; Karnataka-India
| | - Ashwal Jayaram
- Department of Cardiology, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal; Karnataka-India
| | | | - M. Sudhakar Rao
- Department of Cardiology, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal; Karnataka-India
| | - Rajesh Vijayvergiya
- Department of Cardiology, Postgraduate Institute of Medical Education and Research (PGIMER); Chandigarh-India
| | - Krishnananda Nayak
- Department of Cardiovascular Technology, School of Allied Health Sciences, Manipal Academy of Higher Education, Manipal; Karnataka-India
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3-Year Clinical Follow-Up of the RIBS IV Clinical Trial: A Prospective Randomized Study of Drug-Eluting Balloons Versus Everolimus-Eluting Stents in Patients With In-Stent Restenosis in Coronary Arteries Previously Treated With Drug-Eluting Stents. JACC Cardiovasc Interv 2019; 11:981-991. [PMID: 29798776 DOI: 10.1016/j.jcin.2018.02.037] [Citation(s) in RCA: 53] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Revised: 02/20/2018] [Accepted: 02/28/2018] [Indexed: 01/21/2023]
Abstract
OBJECTIVES This study sought to compare the long-term safety and efficacy of drug-eluting balloons (DEB) and everolimus-eluting stents (EES) in patients with in-stent restenosis (ISR) of drug-eluting stents (DES). BACKGROUND Treatment of patients with DES-ISR remains a challenge. METHODS The RIBS IV (Restenosis Intra-Stent of Drug-Eluting Stents: Drug-Eluting Balloons vs Everolimus-Eluting Stents) trial is a prospective multicenter randomized clinical trial comparing DEB and EES in patients with DES-ISR. The pre-specified comparison of the 3-year clinical outcomes obtained with these interventions is the main objective of the present study. RESULTS A total of 309 patients with DES-ISR were randomized to DEB (n = 154) or EES (n = 155). At angiographic follow-up, the in-segment minimal lumen diameter was larger in the EES arm (2.03 ± 0.7 mm vs. 1.80 ± 0.6 mm; p < 0.01). Three-year clinical follow-up was obtained in all enrolled patients (100%). The combined clinical outcome measure of cardiac death, myocardial infarction and target lesion revascularization was significantly reduced in the EES arm (19 [12.3%] vs. 31 [20.1%]; p = 0.04; hazard ratio: 0.57 [95% confidence interval: 0.34 to 0.96]), driven by a lower need for target lesion revascularization (11 [7.1%] vs. 24 [15.6%]; p = 0.015; hazard ratio: 0.43 [95% confidence interval: 0.21 to 0.87]). The need for "late" (>1 year) target lesion revascularization (2.6% vs. 4%) and target vessel revascularization (4% vs. 6.6%) was similar in the 2 arms. Rates of cardiac death (3.9% vs. 3.2%), myocardial infarction (2.6% vs. 4.5%), and stent thrombosis (1.3% vs. 2.6%) at 3 years were also similar in both arms. CONCLUSIONS The 3-year clinical follow-up of this randomized clinical trial demonstrates that in patients with DES-ISR, EES reduce the need for repeat interventions compared with DEB. (Restenosis Intra-Stent of Drug-Eluting Stents: Drug-Eluting Balloons vs Everolimus-Eluting Stents [RIBS IV]; NCT01239940).
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Rhee TM, Lee JM, Shin ES, Hwang D, Park J, Jeon KH, Kim HL, Yang HM, Han JK, Park KW, Hahn JY, Koo BK, Kim SH, Kim HS. Impact of Optimized Procedure-Related Factors in Drug-Eluting Balloon Angioplasty for Treatment of In-Stent Restenosis. JACC Cardiovasc Interv 2019; 11:969-978. [PMID: 29798774 DOI: 10.1016/j.jcin.2018.02.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Revised: 02/05/2018] [Accepted: 02/07/2018] [Indexed: 10/16/2022]
Abstract
OBJECTIVES The aim of this study was to investigate the impact of optimizing procedure-related factors during drug-eluting balloon (DEB) angioplasty on clinical outcomes of drug-eluting stent in-stent restenosis (ISR). BACKGROUND Although DEB angioplasty is recommended as a reasonable option for ISR, recurrent target lesion failure (TLF) still occurs in many patients after DEB angioplasty. METHODS Consecutive patients with drug-eluting stent ISR treated with DEB (SeQuent Please) were collected from 4 centers in Korea. The primary outcome was 2-year TLF. Procedure-related modifiable independent predictors for TLF and their best cutoff values were determined. RESULTS In a total of 256 patients (309 lesions), TLF occurred in 52 patients (20.3%). Modifiable independent predictors of TLF among procedure-related factors were residual diameter stenosis after lesion preparation (residual percentage diameter stenosis [%DS]), DEB-to-stent ratio (BSR), and DEB inflation time (Tinflation), whose best cutoff values were 20%, 0.91, and 60 s, respectively. TLF rates were significantly higher in groups with residual %DS ≥20% (34.7% vs. 12.5%; adjusted hazard ratio: 2.15; 95% confidence interval: 1.86 to 2.48; p < 0.001), BSR ≤0.91 (46.4% vs. 21.9%; adjusted hazard ratio: 2.02; 95% confidence interval: 1.75 to 2.34; p < 0.001), and Tinflation ≤60 s (26.2% vs. 14.0%; adjusted hazard ratio: 1.82; 95% confidence interval: 1.36 to 2.45; p < 0.001). When classifying ISR lesions by combination of procedure-related factors, TLF occurred in 8.3% in the fully optimized procedure group (residual %DS <20%, BSR >0.91, and Tinflation >60 s) and 66.7% in the nonoptimized group (residual %DS ≥20%, BSR ≤0.91, and Tinflation ≤60 s) (p < 0.001). CONCLUSIONS Residual %DS after lesion preparation, BSR, and Tinflation were the only modifiable procedure-related factors in DEB angioplasty. Fully optimized DEB angioplasty with optimal lesion preparation, prolonged inflation, and sufficient dilation may play an important role in reducing TLF after DEB angioplasty.
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Affiliation(s)
- Tae-Min Rhee
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, Korea
| | - Joo Myung Lee
- Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Eun-Seok Shin
- Department of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Doyeon Hwang
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, Korea
| | - Jonghanne Park
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, Korea
| | - Ki-Hyun Jeon
- Sejong General Hospital, Sejong Heart Institute, Bucheon, Korea
| | - Hack-Lyoung Kim
- Cardiovascular Center, Seoul National University Boramae Medical Center, Seoul, Korea
| | - Han-Mo Yang
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, Korea
| | - Jung-Kyu Han
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, Korea
| | - Kyung Woo Park
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, Korea
| | - Joo-Yong Hahn
- Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Bon-Kwon Koo
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, Korea
| | - Sang-Hyun Kim
- Cardiovascular Center, Seoul National University Boramae Medical Center, Seoul, Korea
| | - Hyo-Soo Kim
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, Korea.
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20
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Harada Y, Schneider S, Colleran R, Rai H, Bohner J, Kuna C, Kufner S, Giacoppo D, Schüpke S, Joner M, Ibrahim T, Laugwitz KL, Kastrati A, Byrne RA. Do outcomes following intervention for drug-eluting stent restenosis depend on whether the restenosed stent was polymer-free or polymer-coated? ACTA ACUST UNITED AC 2019; 73:225-231. [PMID: 30878234 DOI: 10.1016/j.rec.2019.01.005] [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: 08/30/2018] [Accepted: 01/14/2019] [Indexed: 11/28/2022]
Abstract
INTRODUCTION AND OBJECTIVES Outcomes of patients undergoing percutaneous intervention for drug-eluting stent (DES) restenosis are poorer than those in patients with bare-metal stent restenosis. It is unknown if this is related to the presence of polymer coating. We sought to compare outcomes after interventions for in-stent restenosis (ISR) of polymer-free DES vs durable polymer DES. METHODS Patients enrolled in the ISAR-TEST 5 randomized trial who underwent repeat percutaneous intervention for ISR during follow-up were included. Angiographic outcomes at 6 to 8 months and clinical outcomes at 2 years were analyzed and compared between 2 groups according to whether the restenosed stent was a polymer-free or a durable polymer DES. Multivariate analysis was used to adjust for differences between groups. RESULTS A total of 326 patients with ISR were included: 220 with ISR in polymer-free DES and 106 with ISR in durable polymer DES. Angiographic follow-up was available for 83.4% of patients. No difference was observed in recurrent binary restenosis between the 2 groups (31.7% vs 27.0%; P=.38; Padjusted=.29). At 2 years, the composite of death, myocardial infarction, or repeat target lesion revascularization were similar between the 2 groups (35.7% vs 34.0%; HR=1.04, 95%CI, 0.70-1.55; P=.83; Padjusted=.79). The rate of repeat target lesion revascularization was also similar in the 2 groups (29.8% vs 31.5%; HR=0.91, 95%CI, 0.60-1.39; P=.68; Padjusted=.62). CONCLUSIONS In patients undergoing reintervention for DES-ISR, we found no evidence of differences in outcomes according to whether the restenosed stent was a polymer-free or durable polymer DES.
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Affiliation(s)
- Yukinori Harada
- Deutsches Herzzentrum München, Technische Universität München, München, Germany
| | - Simon Schneider
- I. Medizinische Klinik, Klinikum rechts der Isar, Technische Universität München, München, Germany
| | - Roisin Colleran
- Deutsches Herzzentrum München, Technische Universität München, München, Germany
| | - Himanshu Rai
- Deutsches Herzzentrum München, Technische Universität München, München, Germany
| | - Janika Bohner
- Deutsches Herzzentrum München, Technische Universität München, München, Germany
| | - Constantin Kuna
- Deutsches Herzzentrum München, Technische Universität München, München, Germany
| | - Sebastian Kufner
- Deutsches Herzzentrum München, Technische Universität München, München, Germany
| | - Daniele Giacoppo
- Deutsches Herzzentrum München, Technische Universität München, München, Germany
| | - Stefanie Schüpke
- Deutsches Herzzentrum München, Technische Universität München, München, Germany; DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, München, Germany
| | - Michael Joner
- Deutsches Herzzentrum München, Technische Universität München, München, Germany; DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, München, Germany
| | - Tareq Ibrahim
- I. Medizinische Klinik, Klinikum rechts der Isar, Technische Universität München, München, Germany
| | - Karl-Ludwig Laugwitz
- I. Medizinische Klinik, Klinikum rechts der Isar, Technische Universität München, München, Germany; DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, München, Germany
| | - Adnan Kastrati
- Deutsches Herzzentrum München, Technische Universität München, München, Germany; DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, München, Germany
| | - Robert A Byrne
- Deutsches Herzzentrum München, Technische Universität München, München, Germany; DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, München, Germany.
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Neumann FJ, Sousa-Uva M, Ahlsson A, Alfonso F, Banning AP, Benedetto U, Byrne RA, Collet JP, Falk V, Head SJ, Jüni P, Kastrati A, Koller A, Kristensen SD, Niebauer J, Richter DJ, Seferović PM, Sibbing D, Stefanini GG, Windecker S, Yadav R, Zembala MO. 2018 ESC/EACTS Guidelines on myocardial revascularization. EUROINTERVENTION 2019; 14:1435-1534. [PMID: 30667361 DOI: 10.4244/eijy19m01_01] [Citation(s) in RCA: 310] [Impact Index Per Article: 62.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Affiliation(s)
- Franz-Josef Neumann
- Department of Cardiology & Angiology II, University Heart Center Freiburg-Bad Krozingen, Bad Krozingen, Germany
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Sousa-Uva M, Neumann FJ, Ahlsson A, Alfonso F, Banning AP, Benedetto U, Byrne RA, Collet JP, Falk V, Head SJ, Jüni P, Kastrati A, Koller A, Kristensen SD, Niebauer J, Richter DJ, Seferovic PM, Sibbing D, Stefanini GG, Windecker S, Yadav R, Zembala MO. 2018 ESC/EACTS Guidelines on myocardial revascularization. Eur J Cardiothorac Surg 2018; 55:4-90. [PMID: 30165632 DOI: 10.1093/ejcts/ezy289] [Citation(s) in RCA: 347] [Impact Index Per Article: 57.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
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25
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Kufner S, Joner M, Schneider S, Tölg R, Zrenner B, Repp J, Starkmann A, Xhepa E, Ibrahim T, Cassese S, Fusaro M, Ott I, Hengstenberg C, Schunkert H, Abdel-Wahab M, Laugwitz KL, Kastrati A, Byrne RA. Neointimal Modification With Scoring Balloon and Efficacy of Drug-Coated Balloon Therapy in Patients With Restenosis in Drug-Eluting Coronary Stents: A Randomized Controlled Trial. JACC Cardiovasc Interv 2018; 10:1332-1340. [PMID: 28683939 DOI: 10.1016/j.jcin.2017.04.024] [Citation(s) in RCA: 81] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2017] [Revised: 04/07/2017] [Accepted: 04/08/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVES The aim of this study was to compare neointimal modification with scoring balloon pre-dilation before drug-coated balloon (DCB) versus DCB standard therapy in patients presenting with drug-eluting stent (DES) restenosis. BACKGROUND DCB angioplasty for the treatment of coronary drug-eluting stent restenosis has demonstrated encouraging results. The efficacy of DCB treatment relies on rapid initial drug transfer and tissue retention of the antiproliferative drug. Neointimal modification with scoring balloon pre-dilation may enhance the efficacy of DCB therapy. METHODS In this randomized, open-label, active-controlled trial, 252 patients with clinically significant DES restenosis were enrolled at 4 centers in Germany. Patients undergoing DCB angioplasty were randomly assigned to treatment with scoring balloon pre-dilation or standard therapy. The primary endpoint of the study was in-segment percentage diameter stenosis on 6- to 8-month follow-up angiography. The secondary endpoints included binary angiographic restenosis and late lumen loss on follow-up angiography, the combined incidence of death or myocardial infarction, target lesion revascularization, and target lesion thrombosis at 1 year. RESULTS Follow-up angiographic data at 6 to 8 months were available for 203 patients (80.6%). Scoring balloon pre-dilation compared with standard therapy showed significantly lower rates with respect to the primary endpoint (35.0 ± 16.8% vs. 40.4 ± 21.4%; p = 0.047) and binary angiographic restenosis (18.5% vs. 32.0%; p = 0.026). Late lumen loss was numerically lower after scoring balloon pre-dilation compared with standard therapy (0.31 ± 59 mm vs. 0.41 ± 0.74 mm; p = 0.27). There was no difference between the groups in the incidence of death or myocardial infarction (4.0% vs. 3.4%; p = 0.73). Scoring balloon versus standard therapy showed comparable rates of target lesion revascularization (16.2% vs. 21.8%; p = 0.26). No target lesion thrombosis occurred out to 1 year. CONCLUSIONS In patients presenting with drug-eluting stent restenosis, neointimal modification with scoring balloon improves the antirestenotic efficacy of DCB therapy. (Intracoronary Stenting and Angiographic Results: Optimizing Treatment of Drug Eluting Stent In-Stent Restenosis 4 [ISAR-DESIRE 4]; NCT01632371).
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Affiliation(s)
- Sebastian Kufner
- Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
| | - Michael Joner
- Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
| | - Simon Schneider
- I. Medizinische Klinik, Klinikum Rechts der Isar, Technische Universität München, Munich, Germany
| | - Ralph Tölg
- Herzzentrum der Segeberger Kliniken, Bad Segeberg, Germany
| | - Bernhard Zrenner
- Krankenhaus Landshut-Achdorf, Medizinische Klinik I, Landshut, Germany
| | - Janika Repp
- Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
| | - Alissa Starkmann
- Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
| | - Erion Xhepa
- Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
| | - Tareq Ibrahim
- I. Medizinische Klinik, Klinikum Rechts der Isar, Technische Universität München, Munich, Germany
| | - Salvatore Cassese
- Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
| | - Massimiliano Fusaro
- Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
| | - Ilka Ott
- Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
| | - Christian Hengstenberg
- Deutsches Herzzentrum München, Technische Universität München, Munich, Germany; DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, Munich, Germany
| | - Heribert Schunkert
- Deutsches Herzzentrum München, Technische Universität München, Munich, Germany; DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, Munich, Germany
| | | | - Karl-Ludwig Laugwitz
- I. Medizinische Klinik, Klinikum Rechts der Isar, Technische Universität München, Munich, Germany; DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, Munich, Germany
| | - Adnan Kastrati
- Deutsches Herzzentrum München, Technische Universität München, Munich, Germany; DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, Munich, Germany
| | - Robert A Byrne
- Deutsches Herzzentrum München, Technische Universität München, Munich, Germany; DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, Munich, Germany.
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Redfors B, Généreux P, Witzenbichler B, Maehara A, Weisz G, McAndrew T, Mehran R, Kirtane AJ, Stone GW. Percutaneous coronary intervention of lesions with in-stent restenosis: A report from the ADAPT-DES study. Am Heart J 2018; 197:142-149. [PMID: 29447774 DOI: 10.1016/j.ahj.2017.11.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2017] [Accepted: 11/28/2017] [Indexed: 12/31/2022]
Abstract
BACKGROUND There is a paucity of data from large contemporary cohorts of patients with in-stent restenosis (ISR) treated with drug-eluting stents (DESs), and no studies have examined the impact of high platelet reactivity (HPR) on the occurrence of ischemic events after ISR percutaneous coronary intervention (PCI) with DESs. We sought to report outcomes after PCI of ISR lesions and its association with HPR. METHODS Patients in the prospective, multicenter ADAPT-DES study were stratified according to whether they had ISR versus non-ISR PCI. Two-year outcomes were compared between the groups using Cox proportional hazards models. HPR was defined as on-clopidogrel P2Y12 platelet reaction units >208 as measured by the VerifyNow assay; target vessel failure (TVF) was defined as the composite of all-cause death, myocardial infarction, or ischemia-driven target vessel revascularization. RESULTS Among the 8,582 patients included in the ADAPT-DES study, 840 (9.8%) patients underwent successful ISR PCI. ISR PCI was independently associated with a higher 2-year risk of TVF (adjusted hazard ratio [HR] 1.95; 95% CI 1.68-2.27; P<.001) and stent thrombosis (adjusted HR 1.95; 95% CI 1.08-3.51; P=.027) but not bleeding (adjusted HR 0.94; 95% CI 0.73-1.21; P=.64). There was no statistical interaction between HPR and ISR versus non-ISR PCI in regard to TVF (adjusted Pinteraction=.81). CONCLUSIONS ISR PCI is associated with a considerably higher risk of 2-year adverse ischemic events, with HPR conferring similar risk in ISR and non-ISR PCI. More effective therapeutic strategies for managing ISR lesions are necessary.
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Affiliation(s)
- Björn Redfors
- Clinical Trials Center, Cardiovascular Research Foundation, New York, NY
| | - Philippe Généreux
- Clinical Trials Center, Cardiovascular Research Foundation, New York, NY; Gagnon Cardiovascular Institute, Morristown Medical Center, Morristown, NJ; Hôpital du Sacré-Coeur de Montréal, Université de Montréal, Montréal, Quebec, Canada.
| | | | - Akiko Maehara
- Clinical Trials Center, Cardiovascular Research Foundation, New York, NY; NewYork-Presbyterian Hospital/Columbia University Medical Center, New York, NY
| | - Giora Weisz
- Clinical Trials Center, Cardiovascular Research Foundation, New York, NY; Montefiore Medical Center, Bronx, NY
| | - Thomas McAndrew
- Clinical Trials Center, Cardiovascular Research Foundation, New York, NY
| | - Roxana Mehran
- Clinical Trials Center, Cardiovascular Research Foundation, New York, NY; Icahn School of Medicine at Mount Sinai, New York, NY
| | - Ajay J Kirtane
- Clinical Trials Center, Cardiovascular Research Foundation, New York, NY; Icahn School of Medicine at Mount Sinai, New York, NY
| | - Gregg W Stone
- Clinical Trials Center, Cardiovascular Research Foundation, New York, NY; Icahn School of Medicine at Mount Sinai, New York, NY
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27
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Abstract
PURPOSE OF REVIEW In-stent restenosis (ISR) is a complex disease process that became apparent shortly after the introduction of stents into clinical practice. This review seeks to define in-stent restenosis (ISR) as well as to summarize the major treatment options that have been developed and studied over the past two decades. RECENT FINDINGS Recent developments in drug-coated balloons and bioresorbable vascular scaffolds have added new potential treatments for ISR. Two recent network meta-analyses performed a head-to-head comparison of all the various treatment modalities in order to identify the best approach to management of ISR. Current data suggests that repeat stenting with second-generation drug-eluting stents is most likely to lead to the best angiographic and clinical outcomes. In situations where repeat stenting is not preferable, drug-coated balloon therapy seems to be a reasonably effective alternative.
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28
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Moscarella E, Tanaka A, Ielasi A, Cortese B, Coscarelli S, De Angelis MC, Piraino D, Latib A, Grigis G, Bianchi R, Buccheri D, Calabrò P, Tespili M, Silva Orrego P, Colombo A, Varricchio A. Bioresorbable vascular scaffold versus everolimus-eluting stents or drug eluting balloon for the treatment of coronary in-stent restenosis: 1-Year follow-up of a propensity score matching comparison (the BIORESOLVE-ISR Study). Catheter Cardiovasc Interv 2018; 92:668-677. [DOI: 10.1002/ccd.27473] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Revised: 11/13/2017] [Accepted: 11/25/2017] [Indexed: 12/18/2022]
Affiliation(s)
- Elisabetta Moscarella
- Department of Cardio-Thoracic Science; Second University of Naples, Presidio Ospedaliero “Monaldi,” Azienda Ospedaliera Dei Colli; Napoli Italy
| | - Akihito Tanaka
- Department of Interventional Cardiology, EMO-GVM Centro Cuore Columbus ed Ospedale San Raffaele; Milano Italy
| | - Alfonso Ielasi
- Cardiology Division, Ospedale Bolognini Seriate, ASST Bergamo Est; Italy
| | - Bernardo Cortese
- Department of Interventional Cardiology, ASST Fatebenefratelli-Sacco; Milano Italy
- Fondazione Monasterio CNR-Regione Toscana; Italy
| | | | | | - Davide Piraino
- Interventional Cardiology Unit, University of Palermo; Palermo Italy
| | - Azeem Latib
- Department of Interventional Cardiology, EMO-GVM Centro Cuore Columbus ed Ospedale San Raffaele; Milano Italy
| | - Giulietta Grigis
- Cardiology Division, Ospedale Bolognini Seriate, ASST Bergamo Est; Italy
| | - Renatomaria Bianchi
- Department of Cardio-Thoracic Science; Second University of Naples, Presidio Ospedaliero “Monaldi,” Azienda Ospedaliera Dei Colli; Napoli Italy
| | - Dario Buccheri
- Interventional Cardiology Unit, University of Palermo; Palermo Italy
| | - Paolo Calabrò
- Department of Cardio-Thoracic Science; Second University of Naples, Presidio Ospedaliero “Monaldi,” Azienda Ospedaliera Dei Colli; Napoli Italy
| | - Maurizio Tespili
- Cardiology Division, Ospedale Bolognini Seriate, ASST Bergamo Est; Italy
| | - Pedro Silva Orrego
- Department of Interventional Cardiology, ASST Fatebenefratelli-Sacco; Milano Italy
| | - Antonio Colombo
- Department of Interventional Cardiology, EMO-GVM Centro Cuore Columbus ed Ospedale San Raffaele; Milano Italy
| | - Attilio Varricchio
- Department of Invasive Cardiology; Santa Maria della Pietà Hospital; Nola Napoli Italy
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29
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Her AY, Shin ES. Current Management of In-Stent Restenosis. Korean Circ J 2018; 48:337-349. [PMID: 29737639 PMCID: PMC5940640 DOI: 10.4070/kcj.2018.0103] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Accepted: 04/10/2018] [Indexed: 12/31/2022] Open
Abstract
Despite the advent of the drug-eluting stents (DES) and improved stent design, in-stent restenosis (ISR) remains a challenging problem. The currently available options for treatment of ISR include angioplasty alone, repeat stenting with DES or drug-coated balloons. Several recent studies have compared the available options for treating ISR in an attempt to identify the preferred therapeutic strategy. In this review, we will discuss the currently available therapeutic strategies for the management of patients with ISR and the evidence supporting their use.
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Affiliation(s)
- Ae Young Her
- Division of Cardiology, Department of Internal Medicine, Kangwon National University School of Medicine, Chuncheon, Korea
| | - Eun Seok Shin
- Division of Cardiology, Department of Internal Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea.
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30
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Alfonso F, Pérez-Vizcayno MJ, García Del Blanco B, García-Touchard A, López-Mínguez JR, Masotti M, Zueco J, Melgares R, Mainar V, Moreno R, Domínguez A, Sanchís J, Bethencourt A, Moreu J, Cequier A, Martí V, Otaegui I, Bastante T, Gonzalo N, Jiménez-Quevedo P, Cárdenas A, Fernández C. Everolimus-Eluting Stents in Patients With Bare-Metal and Drug-Eluting In-Stent Restenosis: Results From a Patient-Level Pooled Analysis of the RIBS IV and V Trials. Circ Cardiovasc Interv 2017; 9:CIRCINTERVENTIONS.115.003479. [PMID: 27412868 DOI: 10.1161/circinterventions.115.003479] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2015] [Accepted: 05/31/2016] [Indexed: 12/12/2022]
Abstract
BACKGROUND Treatment of patients with drug-eluting stent (DES) in-stent restenosis (ISR) is more challenging than that of patients with bare-metal stent ISR. However, the results of everolimus-eluting stents (EES) in these distinct scenarios remain unsettled. METHODS AND RESULTS A pooled analysis of the RIBS IV (Restenosis Intra-Stent of Drug-Eluting Stents: Paclitaxel-Eluting Balloon vs Everolimus-Eluting Stent) and RIBS V (Restenosis Intra-Stent of Bare Metal Stents: Paclitaxel-Eluting Balloon vs Everolimus-Eluting Stent) randomized trials was performed using patient-level data to compare the efficacy of EES in bare-metal stent ISR and DES-ISR. Inclusion and exclusion criteria were identical in both trials. Results of 94 patients treated with EES for bare-metal stent ISR were compared with those of 155 patients treated with EES for DES-ISR. Baseline characteristics were more adverse in patients with DES-ISR, although they presented later and more frequently with a focal pattern. After intervention, minimal lumen diameter (2.22±0.5 versus 2.38±0.5 mm, P=0.01) was smaller in the DES-ISR group. Late angiographic findings (89.3% of eligible patients), including minimal lumen diameter (2.03±0.7 versus 2.36±0.6 mm, P<0.001) and diameter stenosis (23±22 versus 13±17%, P<0.001) were poorer in patients with DES-ISR. Results were consistent in the in-segment and in-lesion analyses. On multiple linear regression analysis, minimal lumen diameter at follow-up remained significantly smaller in patients with DES-ISR. Finally, at 1-year clinical follow-up (100% of patients), mortality (2.6 versus 0%, P<0.01) and need for target vessel revascularization (8 versus 2%, P=0.03) were higher in the DES-ISR group. CONCLUSIONS This patient-level pooled analysis of the RIBS IV and RIBS V randomized clinical trials suggests that EES provide favorable outcomes in patients with ISR. However, the results of EES are less satisfactory in patients with DES-ISR than in those with bare-metal stent ISR. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifiers: NCT01239953 and NCT01239940.
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Affiliation(s)
- Fernando Alfonso
- From the Hospital Universitario de La Princesa, Madrid, Spain (F.A., T.B.); Hospital Universitario Clínico San Carlos, Madrid, Spain (M.J.P.-V., N.G., P.J.-Q., A. Cárdenas, C.F.); Fundación Interhospitalaria Investigación Cardiovascular, Madrid, Spain (M.J.P.-V.); Hospital Universitario Vall d'Hebron, Barcelona, Spain (B.G.d.B., I.O.); Hospital Universitario Puerta de Hierro-Majadahonda, Madrid, Spain (A.G.-T.); Hospital Universitario Infanta Cristina, Badajoz, Spain (J.-R.L.-M.); Hospital Universitario Clinic de Barcelona, Spain (M.M.); Hospital Universitario Marqués de Valdecilla, Santander, Spain (J.Z.); Hospital Universitario Virgen de las Nieves, Granada, Spain (R. Melgares); Hospital Universitario de Alicante, Spain (V. Mainar); Hospital Universitario La Paz, Madrid, Spain (R. Moreno); Hospital Universitario Virgen de la Victoria, Málaga, Spain (A.D.); Hospital Universitario Clínico de Valencia, Spain (J.S.); Hospital Universitario Son Espases, Palma de Mallorca, Spain (A.B.); Hospital Universitario Virgen de la Salud Toledo, Spain (J.M.); Hospital Universitario de Bellvitge, Barcelona, Spain (A. Cequier); and Hospital Universitario de San Pau, Barcelona, Spain (V. Martí).
| | - María José Pérez-Vizcayno
- From the Hospital Universitario de La Princesa, Madrid, Spain (F.A., T.B.); Hospital Universitario Clínico San Carlos, Madrid, Spain (M.J.P.-V., N.G., P.J.-Q., A. Cárdenas, C.F.); Fundación Interhospitalaria Investigación Cardiovascular, Madrid, Spain (M.J.P.-V.); Hospital Universitario Vall d'Hebron, Barcelona, Spain (B.G.d.B., I.O.); Hospital Universitario Puerta de Hierro-Majadahonda, Madrid, Spain (A.G.-T.); Hospital Universitario Infanta Cristina, Badajoz, Spain (J.-R.L.-M.); Hospital Universitario Clinic de Barcelona, Spain (M.M.); Hospital Universitario Marqués de Valdecilla, Santander, Spain (J.Z.); Hospital Universitario Virgen de las Nieves, Granada, Spain (R. Melgares); Hospital Universitario de Alicante, Spain (V. Mainar); Hospital Universitario La Paz, Madrid, Spain (R. Moreno); Hospital Universitario Virgen de la Victoria, Málaga, Spain (A.D.); Hospital Universitario Clínico de Valencia, Spain (J.S.); Hospital Universitario Son Espases, Palma de Mallorca, Spain (A.B.); Hospital Universitario Virgen de la Salud Toledo, Spain (J.M.); Hospital Universitario de Bellvitge, Barcelona, Spain (A. Cequier); and Hospital Universitario de San Pau, Barcelona, Spain (V. Martí)
| | - Bruno García Del Blanco
- From the Hospital Universitario de La Princesa, Madrid, Spain (F.A., T.B.); Hospital Universitario Clínico San Carlos, Madrid, Spain (M.J.P.-V., N.G., P.J.-Q., A. Cárdenas, C.F.); Fundación Interhospitalaria Investigación Cardiovascular, Madrid, Spain (M.J.P.-V.); Hospital Universitario Vall d'Hebron, Barcelona, Spain (B.G.d.B., I.O.); Hospital Universitario Puerta de Hierro-Majadahonda, Madrid, Spain (A.G.-T.); Hospital Universitario Infanta Cristina, Badajoz, Spain (J.-R.L.-M.); Hospital Universitario Clinic de Barcelona, Spain (M.M.); Hospital Universitario Marqués de Valdecilla, Santander, Spain (J.Z.); Hospital Universitario Virgen de las Nieves, Granada, Spain (R. Melgares); Hospital Universitario de Alicante, Spain (V. Mainar); Hospital Universitario La Paz, Madrid, Spain (R. Moreno); Hospital Universitario Virgen de la Victoria, Málaga, Spain (A.D.); Hospital Universitario Clínico de Valencia, Spain (J.S.); Hospital Universitario Son Espases, Palma de Mallorca, Spain (A.B.); Hospital Universitario Virgen de la Salud Toledo, Spain (J.M.); Hospital Universitario de Bellvitge, Barcelona, Spain (A. Cequier); and Hospital Universitario de San Pau, Barcelona, Spain (V. Martí)
| | - Arturo García-Touchard
- From the Hospital Universitario de La Princesa, Madrid, Spain (F.A., T.B.); Hospital Universitario Clínico San Carlos, Madrid, Spain (M.J.P.-V., N.G., P.J.-Q., A. Cárdenas, C.F.); Fundación Interhospitalaria Investigación Cardiovascular, Madrid, Spain (M.J.P.-V.); Hospital Universitario Vall d'Hebron, Barcelona, Spain (B.G.d.B., I.O.); Hospital Universitario Puerta de Hierro-Majadahonda, Madrid, Spain (A.G.-T.); Hospital Universitario Infanta Cristina, Badajoz, Spain (J.-R.L.-M.); Hospital Universitario Clinic de Barcelona, Spain (M.M.); Hospital Universitario Marqués de Valdecilla, Santander, Spain (J.Z.); Hospital Universitario Virgen de las Nieves, Granada, Spain (R. Melgares); Hospital Universitario de Alicante, Spain (V. Mainar); Hospital Universitario La Paz, Madrid, Spain (R. Moreno); Hospital Universitario Virgen de la Victoria, Málaga, Spain (A.D.); Hospital Universitario Clínico de Valencia, Spain (J.S.); Hospital Universitario Son Espases, Palma de Mallorca, Spain (A.B.); Hospital Universitario Virgen de la Salud Toledo, Spain (J.M.); Hospital Universitario de Bellvitge, Barcelona, Spain (A. Cequier); and Hospital Universitario de San Pau, Barcelona, Spain (V. Martí)
| | - José-Ramón López-Mínguez
- From the Hospital Universitario de La Princesa, Madrid, Spain (F.A., T.B.); Hospital Universitario Clínico San Carlos, Madrid, Spain (M.J.P.-V., N.G., P.J.-Q., A. Cárdenas, C.F.); Fundación Interhospitalaria Investigación Cardiovascular, Madrid, Spain (M.J.P.-V.); Hospital Universitario Vall d'Hebron, Barcelona, Spain (B.G.d.B., I.O.); Hospital Universitario Puerta de Hierro-Majadahonda, Madrid, Spain (A.G.-T.); Hospital Universitario Infanta Cristina, Badajoz, Spain (J.-R.L.-M.); Hospital Universitario Clinic de Barcelona, Spain (M.M.); Hospital Universitario Marqués de Valdecilla, Santander, Spain (J.Z.); Hospital Universitario Virgen de las Nieves, Granada, Spain (R. Melgares); Hospital Universitario de Alicante, Spain (V. Mainar); Hospital Universitario La Paz, Madrid, Spain (R. Moreno); Hospital Universitario Virgen de la Victoria, Málaga, Spain (A.D.); Hospital Universitario Clínico de Valencia, Spain (J.S.); Hospital Universitario Son Espases, Palma de Mallorca, Spain (A.B.); Hospital Universitario Virgen de la Salud Toledo, Spain (J.M.); Hospital Universitario de Bellvitge, Barcelona, Spain (A. Cequier); and Hospital Universitario de San Pau, Barcelona, Spain (V. Martí)
| | - Mónica Masotti
- From the Hospital Universitario de La Princesa, Madrid, Spain (F.A., T.B.); Hospital Universitario Clínico San Carlos, Madrid, Spain (M.J.P.-V., N.G., P.J.-Q., A. Cárdenas, C.F.); Fundación Interhospitalaria Investigación Cardiovascular, Madrid, Spain (M.J.P.-V.); Hospital Universitario Vall d'Hebron, Barcelona, Spain (B.G.d.B., I.O.); Hospital Universitario Puerta de Hierro-Majadahonda, Madrid, Spain (A.G.-T.); Hospital Universitario Infanta Cristina, Badajoz, Spain (J.-R.L.-M.); Hospital Universitario Clinic de Barcelona, Spain (M.M.); Hospital Universitario Marqués de Valdecilla, Santander, Spain (J.Z.); Hospital Universitario Virgen de las Nieves, Granada, Spain (R. Melgares); Hospital Universitario de Alicante, Spain (V. Mainar); Hospital Universitario La Paz, Madrid, Spain (R. Moreno); Hospital Universitario Virgen de la Victoria, Málaga, Spain (A.D.); Hospital Universitario Clínico de Valencia, Spain (J.S.); Hospital Universitario Son Espases, Palma de Mallorca, Spain (A.B.); Hospital Universitario Virgen de la Salud Toledo, Spain (J.M.); Hospital Universitario de Bellvitge, Barcelona, Spain (A. Cequier); and Hospital Universitario de San Pau, Barcelona, Spain (V. Martí)
| | - Javier Zueco
- From the Hospital Universitario de La Princesa, Madrid, Spain (F.A., T.B.); Hospital Universitario Clínico San Carlos, Madrid, Spain (M.J.P.-V., N.G., P.J.-Q., A. Cárdenas, C.F.); Fundación Interhospitalaria Investigación Cardiovascular, Madrid, Spain (M.J.P.-V.); Hospital Universitario Vall d'Hebron, Barcelona, Spain (B.G.d.B., I.O.); Hospital Universitario Puerta de Hierro-Majadahonda, Madrid, Spain (A.G.-T.); Hospital Universitario Infanta Cristina, Badajoz, Spain (J.-R.L.-M.); Hospital Universitario Clinic de Barcelona, Spain (M.M.); Hospital Universitario Marqués de Valdecilla, Santander, Spain (J.Z.); Hospital Universitario Virgen de las Nieves, Granada, Spain (R. Melgares); Hospital Universitario de Alicante, Spain (V. Mainar); Hospital Universitario La Paz, Madrid, Spain (R. Moreno); Hospital Universitario Virgen de la Victoria, Málaga, Spain (A.D.); Hospital Universitario Clínico de Valencia, Spain (J.S.); Hospital Universitario Son Espases, Palma de Mallorca, Spain (A.B.); Hospital Universitario Virgen de la Salud Toledo, Spain (J.M.); Hospital Universitario de Bellvitge, Barcelona, Spain (A. Cequier); and Hospital Universitario de San Pau, Barcelona, Spain (V. Martí)
| | - Rafael Melgares
- From the Hospital Universitario de La Princesa, Madrid, Spain (F.A., T.B.); Hospital Universitario Clínico San Carlos, Madrid, Spain (M.J.P.-V., N.G., P.J.-Q., A. Cárdenas, C.F.); Fundación Interhospitalaria Investigación Cardiovascular, Madrid, Spain (M.J.P.-V.); Hospital Universitario Vall d'Hebron, Barcelona, Spain (B.G.d.B., I.O.); Hospital Universitario Puerta de Hierro-Majadahonda, Madrid, Spain (A.G.-T.); Hospital Universitario Infanta Cristina, Badajoz, Spain (J.-R.L.-M.); Hospital Universitario Clinic de Barcelona, Spain (M.M.); Hospital Universitario Marqués de Valdecilla, Santander, Spain (J.Z.); Hospital Universitario Virgen de las Nieves, Granada, Spain (R. Melgares); Hospital Universitario de Alicante, Spain (V. Mainar); Hospital Universitario La Paz, Madrid, Spain (R. Moreno); Hospital Universitario Virgen de la Victoria, Málaga, Spain (A.D.); Hospital Universitario Clínico de Valencia, Spain (J.S.); Hospital Universitario Son Espases, Palma de Mallorca, Spain (A.B.); Hospital Universitario Virgen de la Salud Toledo, Spain (J.M.); Hospital Universitario de Bellvitge, Barcelona, Spain (A. Cequier); and Hospital Universitario de San Pau, Barcelona, Spain (V. Martí)
| | - Vicente Mainar
- From the Hospital Universitario de La Princesa, Madrid, Spain (F.A., T.B.); Hospital Universitario Clínico San Carlos, Madrid, Spain (M.J.P.-V., N.G., P.J.-Q., A. Cárdenas, C.F.); Fundación Interhospitalaria Investigación Cardiovascular, Madrid, Spain (M.J.P.-V.); Hospital Universitario Vall d'Hebron, Barcelona, Spain (B.G.d.B., I.O.); Hospital Universitario Puerta de Hierro-Majadahonda, Madrid, Spain (A.G.-T.); Hospital Universitario Infanta Cristina, Badajoz, Spain (J.-R.L.-M.); Hospital Universitario Clinic de Barcelona, Spain (M.M.); Hospital Universitario Marqués de Valdecilla, Santander, Spain (J.Z.); Hospital Universitario Virgen de las Nieves, Granada, Spain (R. Melgares); Hospital Universitario de Alicante, Spain (V. Mainar); Hospital Universitario La Paz, Madrid, Spain (R. Moreno); Hospital Universitario Virgen de la Victoria, Málaga, Spain (A.D.); Hospital Universitario Clínico de Valencia, Spain (J.S.); Hospital Universitario Son Espases, Palma de Mallorca, Spain (A.B.); Hospital Universitario Virgen de la Salud Toledo, Spain (J.M.); Hospital Universitario de Bellvitge, Barcelona, Spain (A. Cequier); and Hospital Universitario de San Pau, Barcelona, Spain (V. Martí)
| | - Raul Moreno
- From the Hospital Universitario de La Princesa, Madrid, Spain (F.A., T.B.); Hospital Universitario Clínico San Carlos, Madrid, Spain (M.J.P.-V., N.G., P.J.-Q., A. Cárdenas, C.F.); Fundación Interhospitalaria Investigación Cardiovascular, Madrid, Spain (M.J.P.-V.); Hospital Universitario Vall d'Hebron, Barcelona, Spain (B.G.d.B., I.O.); Hospital Universitario Puerta de Hierro-Majadahonda, Madrid, Spain (A.G.-T.); Hospital Universitario Infanta Cristina, Badajoz, Spain (J.-R.L.-M.); Hospital Universitario Clinic de Barcelona, Spain (M.M.); Hospital Universitario Marqués de Valdecilla, Santander, Spain (J.Z.); Hospital Universitario Virgen de las Nieves, Granada, Spain (R. Melgares); Hospital Universitario de Alicante, Spain (V. Mainar); Hospital Universitario La Paz, Madrid, Spain (R. Moreno); Hospital Universitario Virgen de la Victoria, Málaga, Spain (A.D.); Hospital Universitario Clínico de Valencia, Spain (J.S.); Hospital Universitario Son Espases, Palma de Mallorca, Spain (A.B.); Hospital Universitario Virgen de la Salud Toledo, Spain (J.M.); Hospital Universitario de Bellvitge, Barcelona, Spain (A. Cequier); and Hospital Universitario de San Pau, Barcelona, Spain (V. Martí)
| | - Antonio Domínguez
- From the Hospital Universitario de La Princesa, Madrid, Spain (F.A., T.B.); Hospital Universitario Clínico San Carlos, Madrid, Spain (M.J.P.-V., N.G., P.J.-Q., A. Cárdenas, C.F.); Fundación Interhospitalaria Investigación Cardiovascular, Madrid, Spain (M.J.P.-V.); Hospital Universitario Vall d'Hebron, Barcelona, Spain (B.G.d.B., I.O.); Hospital Universitario Puerta de Hierro-Majadahonda, Madrid, Spain (A.G.-T.); Hospital Universitario Infanta Cristina, Badajoz, Spain (J.-R.L.-M.); Hospital Universitario Clinic de Barcelona, Spain (M.M.); Hospital Universitario Marqués de Valdecilla, Santander, Spain (J.Z.); Hospital Universitario Virgen de las Nieves, Granada, Spain (R. Melgares); Hospital Universitario de Alicante, Spain (V. Mainar); Hospital Universitario La Paz, Madrid, Spain (R. Moreno); Hospital Universitario Virgen de la Victoria, Málaga, Spain (A.D.); Hospital Universitario Clínico de Valencia, Spain (J.S.); Hospital Universitario Son Espases, Palma de Mallorca, Spain (A.B.); Hospital Universitario Virgen de la Salud Toledo, Spain (J.M.); Hospital Universitario de Bellvitge, Barcelona, Spain (A. Cequier); and Hospital Universitario de San Pau, Barcelona, Spain (V. Martí)
| | - Juan Sanchís
- From the Hospital Universitario de La Princesa, Madrid, Spain (F.A., T.B.); Hospital Universitario Clínico San Carlos, Madrid, Spain (M.J.P.-V., N.G., P.J.-Q., A. Cárdenas, C.F.); Fundación Interhospitalaria Investigación Cardiovascular, Madrid, Spain (M.J.P.-V.); Hospital Universitario Vall d'Hebron, Barcelona, Spain (B.G.d.B., I.O.); Hospital Universitario Puerta de Hierro-Majadahonda, Madrid, Spain (A.G.-T.); Hospital Universitario Infanta Cristina, Badajoz, Spain (J.-R.L.-M.); Hospital Universitario Clinic de Barcelona, Spain (M.M.); Hospital Universitario Marqués de Valdecilla, Santander, Spain (J.Z.); Hospital Universitario Virgen de las Nieves, Granada, Spain (R. Melgares); Hospital Universitario de Alicante, Spain (V. Mainar); Hospital Universitario La Paz, Madrid, Spain (R. Moreno); Hospital Universitario Virgen de la Victoria, Málaga, Spain (A.D.); Hospital Universitario Clínico de Valencia, Spain (J.S.); Hospital Universitario Son Espases, Palma de Mallorca, Spain (A.B.); Hospital Universitario Virgen de la Salud Toledo, Spain (J.M.); Hospital Universitario de Bellvitge, Barcelona, Spain (A. Cequier); and Hospital Universitario de San Pau, Barcelona, Spain (V. Martí)
| | - Armando Bethencourt
- From the Hospital Universitario de La Princesa, Madrid, Spain (F.A., T.B.); Hospital Universitario Clínico San Carlos, Madrid, Spain (M.J.P.-V., N.G., P.J.-Q., A. Cárdenas, C.F.); Fundación Interhospitalaria Investigación Cardiovascular, Madrid, Spain (M.J.P.-V.); Hospital Universitario Vall d'Hebron, Barcelona, Spain (B.G.d.B., I.O.); Hospital Universitario Puerta de Hierro-Majadahonda, Madrid, Spain (A.G.-T.); Hospital Universitario Infanta Cristina, Badajoz, Spain (J.-R.L.-M.); Hospital Universitario Clinic de Barcelona, Spain (M.M.); Hospital Universitario Marqués de Valdecilla, Santander, Spain (J.Z.); Hospital Universitario Virgen de las Nieves, Granada, Spain (R. Melgares); Hospital Universitario de Alicante, Spain (V. Mainar); Hospital Universitario La Paz, Madrid, Spain (R. Moreno); Hospital Universitario Virgen de la Victoria, Málaga, Spain (A.D.); Hospital Universitario Clínico de Valencia, Spain (J.S.); Hospital Universitario Son Espases, Palma de Mallorca, Spain (A.B.); Hospital Universitario Virgen de la Salud Toledo, Spain (J.M.); Hospital Universitario de Bellvitge, Barcelona, Spain (A. Cequier); and Hospital Universitario de San Pau, Barcelona, Spain (V. Martí)
| | - José Moreu
- From the Hospital Universitario de La Princesa, Madrid, Spain (F.A., T.B.); Hospital Universitario Clínico San Carlos, Madrid, Spain (M.J.P.-V., N.G., P.J.-Q., A. Cárdenas, C.F.); Fundación Interhospitalaria Investigación Cardiovascular, Madrid, Spain (M.J.P.-V.); Hospital Universitario Vall d'Hebron, Barcelona, Spain (B.G.d.B., I.O.); Hospital Universitario Puerta de Hierro-Majadahonda, Madrid, Spain (A.G.-T.); Hospital Universitario Infanta Cristina, Badajoz, Spain (J.-R.L.-M.); Hospital Universitario Clinic de Barcelona, Spain (M.M.); Hospital Universitario Marqués de Valdecilla, Santander, Spain (J.Z.); Hospital Universitario Virgen de las Nieves, Granada, Spain (R. Melgares); Hospital Universitario de Alicante, Spain (V. Mainar); Hospital Universitario La Paz, Madrid, Spain (R. Moreno); Hospital Universitario Virgen de la Victoria, Málaga, Spain (A.D.); Hospital Universitario Clínico de Valencia, Spain (J.S.); Hospital Universitario Son Espases, Palma de Mallorca, Spain (A.B.); Hospital Universitario Virgen de la Salud Toledo, Spain (J.M.); Hospital Universitario de Bellvitge, Barcelona, Spain (A. Cequier); and Hospital Universitario de San Pau, Barcelona, Spain (V. Martí)
| | - Angel Cequier
- From the Hospital Universitario de La Princesa, Madrid, Spain (F.A., T.B.); Hospital Universitario Clínico San Carlos, Madrid, Spain (M.J.P.-V., N.G., P.J.-Q., A. Cárdenas, C.F.); Fundación Interhospitalaria Investigación Cardiovascular, Madrid, Spain (M.J.P.-V.); Hospital Universitario Vall d'Hebron, Barcelona, Spain (B.G.d.B., I.O.); Hospital Universitario Puerta de Hierro-Majadahonda, Madrid, Spain (A.G.-T.); Hospital Universitario Infanta Cristina, Badajoz, Spain (J.-R.L.-M.); Hospital Universitario Clinic de Barcelona, Spain (M.M.); Hospital Universitario Marqués de Valdecilla, Santander, Spain (J.Z.); Hospital Universitario Virgen de las Nieves, Granada, Spain (R. Melgares); Hospital Universitario de Alicante, Spain (V. Mainar); Hospital Universitario La Paz, Madrid, Spain (R. Moreno); Hospital Universitario Virgen de la Victoria, Málaga, Spain (A.D.); Hospital Universitario Clínico de Valencia, Spain (J.S.); Hospital Universitario Son Espases, Palma de Mallorca, Spain (A.B.); Hospital Universitario Virgen de la Salud Toledo, Spain (J.M.); Hospital Universitario de Bellvitge, Barcelona, Spain (A. Cequier); and Hospital Universitario de San Pau, Barcelona, Spain (V. Martí)
| | - Vicens Martí
- From the Hospital Universitario de La Princesa, Madrid, Spain (F.A., T.B.); Hospital Universitario Clínico San Carlos, Madrid, Spain (M.J.P.-V., N.G., P.J.-Q., A. Cárdenas, C.F.); Fundación Interhospitalaria Investigación Cardiovascular, Madrid, Spain (M.J.P.-V.); Hospital Universitario Vall d'Hebron, Barcelona, Spain (B.G.d.B., I.O.); Hospital Universitario Puerta de Hierro-Majadahonda, Madrid, Spain (A.G.-T.); Hospital Universitario Infanta Cristina, Badajoz, Spain (J.-R.L.-M.); Hospital Universitario Clinic de Barcelona, Spain (M.M.); Hospital Universitario Marqués de Valdecilla, Santander, Spain (J.Z.); Hospital Universitario Virgen de las Nieves, Granada, Spain (R. Melgares); Hospital Universitario de Alicante, Spain (V. Mainar); Hospital Universitario La Paz, Madrid, Spain (R. Moreno); Hospital Universitario Virgen de la Victoria, Málaga, Spain (A.D.); Hospital Universitario Clínico de Valencia, Spain (J.S.); Hospital Universitario Son Espases, Palma de Mallorca, Spain (A.B.); Hospital Universitario Virgen de la Salud Toledo, Spain (J.M.); Hospital Universitario de Bellvitge, Barcelona, Spain (A. Cequier); and Hospital Universitario de San Pau, Barcelona, Spain (V. Martí)
| | - Imanol Otaegui
- From the Hospital Universitario de La Princesa, Madrid, Spain (F.A., T.B.); Hospital Universitario Clínico San Carlos, Madrid, Spain (M.J.P.-V., N.G., P.J.-Q., A. Cárdenas, C.F.); Fundación Interhospitalaria Investigación Cardiovascular, Madrid, Spain (M.J.P.-V.); Hospital Universitario Vall d'Hebron, Barcelona, Spain (B.G.d.B., I.O.); Hospital Universitario Puerta de Hierro-Majadahonda, Madrid, Spain (A.G.-T.); Hospital Universitario Infanta Cristina, Badajoz, Spain (J.-R.L.-M.); Hospital Universitario Clinic de Barcelona, Spain (M.M.); Hospital Universitario Marqués de Valdecilla, Santander, Spain (J.Z.); Hospital Universitario Virgen de las Nieves, Granada, Spain (R. Melgares); Hospital Universitario de Alicante, Spain (V. Mainar); Hospital Universitario La Paz, Madrid, Spain (R. Moreno); Hospital Universitario Virgen de la Victoria, Málaga, Spain (A.D.); Hospital Universitario Clínico de Valencia, Spain (J.S.); Hospital Universitario Son Espases, Palma de Mallorca, Spain (A.B.); Hospital Universitario Virgen de la Salud Toledo, Spain (J.M.); Hospital Universitario de Bellvitge, Barcelona, Spain (A. Cequier); and Hospital Universitario de San Pau, Barcelona, Spain (V. Martí)
| | - Teresa Bastante
- From the Hospital Universitario de La Princesa, Madrid, Spain (F.A., T.B.); Hospital Universitario Clínico San Carlos, Madrid, Spain (M.J.P.-V., N.G., P.J.-Q., A. Cárdenas, C.F.); Fundación Interhospitalaria Investigación Cardiovascular, Madrid, Spain (M.J.P.-V.); Hospital Universitario Vall d'Hebron, Barcelona, Spain (B.G.d.B., I.O.); Hospital Universitario Puerta de Hierro-Majadahonda, Madrid, Spain (A.G.-T.); Hospital Universitario Infanta Cristina, Badajoz, Spain (J.-R.L.-M.); Hospital Universitario Clinic de Barcelona, Spain (M.M.); Hospital Universitario Marqués de Valdecilla, Santander, Spain (J.Z.); Hospital Universitario Virgen de las Nieves, Granada, Spain (R. Melgares); Hospital Universitario de Alicante, Spain (V. Mainar); Hospital Universitario La Paz, Madrid, Spain (R. Moreno); Hospital Universitario Virgen de la Victoria, Málaga, Spain (A.D.); Hospital Universitario Clínico de Valencia, Spain (J.S.); Hospital Universitario Son Espases, Palma de Mallorca, Spain (A.B.); Hospital Universitario Virgen de la Salud Toledo, Spain (J.M.); Hospital Universitario de Bellvitge, Barcelona, Spain (A. Cequier); and Hospital Universitario de San Pau, Barcelona, Spain (V. Martí)
| | - Nieves Gonzalo
- From the Hospital Universitario de La Princesa, Madrid, Spain (F.A., T.B.); Hospital Universitario Clínico San Carlos, Madrid, Spain (M.J.P.-V., N.G., P.J.-Q., A. Cárdenas, C.F.); Fundación Interhospitalaria Investigación Cardiovascular, Madrid, Spain (M.J.P.-V.); Hospital Universitario Vall d'Hebron, Barcelona, Spain (B.G.d.B., I.O.); Hospital Universitario Puerta de Hierro-Majadahonda, Madrid, Spain (A.G.-T.); Hospital Universitario Infanta Cristina, Badajoz, Spain (J.-R.L.-M.); Hospital Universitario Clinic de Barcelona, Spain (M.M.); Hospital Universitario Marqués de Valdecilla, Santander, Spain (J.Z.); Hospital Universitario Virgen de las Nieves, Granada, Spain (R. Melgares); Hospital Universitario de Alicante, Spain (V. Mainar); Hospital Universitario La Paz, Madrid, Spain (R. Moreno); Hospital Universitario Virgen de la Victoria, Málaga, Spain (A.D.); Hospital Universitario Clínico de Valencia, Spain (J.S.); Hospital Universitario Son Espases, Palma de Mallorca, Spain (A.B.); Hospital Universitario Virgen de la Salud Toledo, Spain (J.M.); Hospital Universitario de Bellvitge, Barcelona, Spain (A. Cequier); and Hospital Universitario de San Pau, Barcelona, Spain (V. Martí)
| | - Pilar Jiménez-Quevedo
- From the Hospital Universitario de La Princesa, Madrid, Spain (F.A., T.B.); Hospital Universitario Clínico San Carlos, Madrid, Spain (M.J.P.-V., N.G., P.J.-Q., A. Cárdenas, C.F.); Fundación Interhospitalaria Investigación Cardiovascular, Madrid, Spain (M.J.P.-V.); Hospital Universitario Vall d'Hebron, Barcelona, Spain (B.G.d.B., I.O.); Hospital Universitario Puerta de Hierro-Majadahonda, Madrid, Spain (A.G.-T.); Hospital Universitario Infanta Cristina, Badajoz, Spain (J.-R.L.-M.); Hospital Universitario Clinic de Barcelona, Spain (M.M.); Hospital Universitario Marqués de Valdecilla, Santander, Spain (J.Z.); Hospital Universitario Virgen de las Nieves, Granada, Spain (R. Melgares); Hospital Universitario de Alicante, Spain (V. Mainar); Hospital Universitario La Paz, Madrid, Spain (R. Moreno); Hospital Universitario Virgen de la Victoria, Málaga, Spain (A.D.); Hospital Universitario Clínico de Valencia, Spain (J.S.); Hospital Universitario Son Espases, Palma de Mallorca, Spain (A.B.); Hospital Universitario Virgen de la Salud Toledo, Spain (J.M.); Hospital Universitario de Bellvitge, Barcelona, Spain (A. Cequier); and Hospital Universitario de San Pau, Barcelona, Spain (V. Martí)
| | - Alberto Cárdenas
- From the Hospital Universitario de La Princesa, Madrid, Spain (F.A., T.B.); Hospital Universitario Clínico San Carlos, Madrid, Spain (M.J.P.-V., N.G., P.J.-Q., A. Cárdenas, C.F.); Fundación Interhospitalaria Investigación Cardiovascular, Madrid, Spain (M.J.P.-V.); Hospital Universitario Vall d'Hebron, Barcelona, Spain (B.G.d.B., I.O.); Hospital Universitario Puerta de Hierro-Majadahonda, Madrid, Spain (A.G.-T.); Hospital Universitario Infanta Cristina, Badajoz, Spain (J.-R.L.-M.); Hospital Universitario Clinic de Barcelona, Spain (M.M.); Hospital Universitario Marqués de Valdecilla, Santander, Spain (J.Z.); Hospital Universitario Virgen de las Nieves, Granada, Spain (R. Melgares); Hospital Universitario de Alicante, Spain (V. Mainar); Hospital Universitario La Paz, Madrid, Spain (R. Moreno); Hospital Universitario Virgen de la Victoria, Málaga, Spain (A.D.); Hospital Universitario Clínico de Valencia, Spain (J.S.); Hospital Universitario Son Espases, Palma de Mallorca, Spain (A.B.); Hospital Universitario Virgen de la Salud Toledo, Spain (J.M.); Hospital Universitario de Bellvitge, Barcelona, Spain (A. Cequier); and Hospital Universitario de San Pau, Barcelona, Spain (V. Martí)
| | - Cristina Fernández
- From the Hospital Universitario de La Princesa, Madrid, Spain (F.A., T.B.); Hospital Universitario Clínico San Carlos, Madrid, Spain (M.J.P.-V., N.G., P.J.-Q., A. Cárdenas, C.F.); Fundación Interhospitalaria Investigación Cardiovascular, Madrid, Spain (M.J.P.-V.); Hospital Universitario Vall d'Hebron, Barcelona, Spain (B.G.d.B., I.O.); Hospital Universitario Puerta de Hierro-Majadahonda, Madrid, Spain (A.G.-T.); Hospital Universitario Infanta Cristina, Badajoz, Spain (J.-R.L.-M.); Hospital Universitario Clinic de Barcelona, Spain (M.M.); Hospital Universitario Marqués de Valdecilla, Santander, Spain (J.Z.); Hospital Universitario Virgen de las Nieves, Granada, Spain (R. Melgares); Hospital Universitario de Alicante, Spain (V. Mainar); Hospital Universitario La Paz, Madrid, Spain (R. Moreno); Hospital Universitario Virgen de la Victoria, Málaga, Spain (A.D.); Hospital Universitario Clínico de Valencia, Spain (J.S.); Hospital Universitario Son Espases, Palma de Mallorca, Spain (A.B.); Hospital Universitario Virgen de la Salud Toledo, Spain (J.M.); Hospital Universitario de Bellvitge, Barcelona, Spain (A. Cequier); and Hospital Universitario de San Pau, Barcelona, Spain (V. Martí)
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Verheye S, Vrolix M, Kumsars I, Erglis A, Sondore D, Agostoni P, Cornelis K, Janssens L, Maeng M, Slagboom T, Amoroso G, Jensen LO, Granada JF, Stella P. The SABRE Trial (Sirolimus Angioplasty Balloon for Coronary In-Stent Restenosis): Angiographic Results and 1-Year Clinical Outcomes. JACC Cardiovasc Interv 2017; 10:2029-2037. [PMID: 28964764 DOI: 10.1016/j.jcin.2017.06.021] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2017] [Revised: 06/06/2017] [Accepted: 06/15/2017] [Indexed: 10/18/2022]
Abstract
OBJECTIVES The aim of this first-in-human study was to assess the safety and effectiveness of the Virtue sirolimus-eluting balloon in a cohort of patients with in-stent restenosis (ISR). BACKGROUND Angioplasty balloons coated with the cytotoxic drug paclitaxel have been widely used for ISR treatment. The Virtue angioplasty balloon (Caliber Therapeutics, New Hope, Pennsylvania) delivers sirolimus in a nanoencapsulated liquid formulation. This clinical trial is the first to examine a sirolimus-eluting balloon for ISR. METHODS In this prospective, single-arm feasibility study at 9 European centers, 50 ISR patients were treated with the Virtue balloon. Angiographic measurements at 6 months are reported, along with 12-month clinical follow-up. RESULTS Procedural success in the intention-to-treat population was 100%. The primary safety endpoint was target lesion failure (TLF) (cardiac death, target vessel myocardial infarction, and clinically driven target lesion revascularization) assessed at 30 days (0%, n = 50). The primary performance endpoint was in-segment late lumen loss (LLL) at 6 months (0.31 ± 0.52 mm; n = 47). Secondary 6-month endpoints include binary restenosis (19.1%), diameter stenosis (30.3 ± 19.9%), and major adverse cardiac events (MACE) (10.2%, n = 49). In the 36-patient per-protocol population (excluding major protocol violations and previously stented ISR), LLL was 0.12 ± 0.33 mm at 6 months. Clinical outcomes at 1 year for the intention-to-treat group were 12.2% TLF and 14.3% MACE and for the per-protocol population were 2.8% TLF and 2.8% MACE. CONCLUSIONS This first-in-human study showed excellent procedural success for the Virtue sirolimus-eluting angioplasty balloon, 6-month LLL rates in line with current stent-free ISR treatment options, and clinical outcomes that warrant further evaluation in dedicated randomized studies.
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Affiliation(s)
- Stefan Verheye
- Antwerp Cardiovascular Center, ZNA Middelheim, Antwerp, Belgium.
| | - Mathias Vrolix
- Department of Cardiology, Ziekenhuis Oost Limburg, Genk, Belgium
| | - Indulis Kumsars
- Latvian Center of Cardiology, Paul Stradins Clinical University Hospital, Riga, Latvia
| | - Andrejs Erglis
- Latvian Center of Cardiology, Paul Stradins Clinical University Hospital, Riga, Latvia
| | - Dace Sondore
- Latvian Center of Cardiology, Paul Stradins Clinical University Hospital, Riga, Latvia
| | | | | | - Luc Janssens
- Department of Cardiology, Imeldaziekenhuis Bonheiden, Bonheiden, Belgium
| | - Michael Maeng
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Ton Slagboom
- Department of Cardiology, OLVG Amsterdam, Amsterdam, the Netherlands
| | - Giovanni Amoroso
- Department of Cardiology, OLVG Amsterdam, Amsterdam, the Netherlands
| | | | - Juan F Granada
- Skirball Center for Innovation, Cardiovascular Research Foundation, Orangeburg, New York
| | - Pieter Stella
- Department of Cardiology, University Medical Center Utrecht, Utrecht, the Netherlands
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Zhu X, Xie H, Liang X, Li X, Duan J, Chen Y, Yang Z, Liu C, Wang C, Zhang H, Fang Q, Sun H, Li C, Li Y, Wang C, Song C, Zeng Y, Yang J. Bilayered Nanoparticles with Sequential Release of VEGF Gene and Paclitaxel for Restenosis Inhibition in Atherosclerosis. ACS APPLIED MATERIALS & INTERFACES 2017; 9:27522-27532. [PMID: 28748694 DOI: 10.1021/acsami.7b08312] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Complete reendothelialization followed by inhibition of smooth muscle cell (SMC) proliferation is considered as an effective therapeutic option to prevent restenosis. We have designed poly(lactide-co-glycolide)-loaded bilayered nanoparticles (NPs) with the ability to sequentially release vascular endothelial growth factor (VEGF)-encoding plasmids from the outer layer and paclitaxel (PTX) from the core to promote endothelial regeneration as well as prevent restenosis. Comparing with conventional NPs, which release VEGF plasmid and PTX simultaneously, we expect that the bilayered NPs could release the VEGF plasmid more rapidly, followed by a delayed release of PTX, resulting in an efficient VEGF gene transfection, which ideally could promote reendothelialization and inhibit excessive SMC growth. Indeed, in the present study, we have observed efficient gene transfection using a model plasmid as well as cell growth attenuation in vitro using Chinese hamster ovary cells. Therapeutic efficacy of the bilayered NPs on restenosis was further evaluated in vivo using a rabbit model of atherosclerosis. The bilayered NPs were administered locally via balloon angioplasty to the injured aortic wall through perfusion. Twenty-eight days after the NP administration, rabbits treated with the bilayered NPs exhibited rapid reendothelialization and inhibition of restenosis, as demonstrated by histological analysis. Increased level of VEGF and decreased level of C-reactive protein, a biological marker that is closely related to atherosclerosis, were also observed from animals treated with the bilayered NPs, implicating ameliorated atherosclerosis. Our results suggest that the VEGF plasmid-/PTX-loaded bilayered NPs exert a beneficial impact on atherosclerotic restenosis by sequentially releasing VEGF and PTX in vivo.
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Affiliation(s)
- Xiaowei Zhu
- Tianjin Key Laboratory of Biomaterial Research, Institute of Biomedical Engineering, Chinese Academy of Medical Science , Tianjin 300192, China
| | - Hongzhi Xie
- Peking Union Medical College Hospital , Beijing 100730, China
| | - Xiaoyu Liang
- Tianjin Key Laboratory of Biomaterial Research, Institute of Biomedical Engineering, Chinese Academy of Medical Science , Tianjin 300192, China
| | - Xuanling Li
- Tianjin Key Laboratory of Biomaterial Research, Institute of Biomedical Engineering, Chinese Academy of Medical Science , Tianjin 300192, China
| | - Jianwei Duan
- Tianjin Key Laboratory of Biomaterial Research, Institute of Biomedical Engineering, Chinese Academy of Medical Science , Tianjin 300192, China
| | - Yongxia Chen
- Tianjin Key Laboratory of Biomaterial Research, Institute of Biomedical Engineering, Chinese Academy of Medical Science , Tianjin 300192, China
| | - Ziying Yang
- Tianjin Key Laboratory of Biomaterial Research, Institute of Biomedical Engineering, Chinese Academy of Medical Science , Tianjin 300192, China
| | - Chao Liu
- Tianjin Key Laboratory of Biomaterial Research, Institute of Biomedical Engineering, Chinese Academy of Medical Science , Tianjin 300192, China
| | - Cuiwei Wang
- Tianjin Key Laboratory of Biomaterial Research, Institute of Biomedical Engineering, Chinese Academy of Medical Science , Tianjin 300192, China
| | - Hailing Zhang
- Tianjin Key Laboratory of Biomaterial Research, Institute of Biomedical Engineering, Chinese Academy of Medical Science , Tianjin 300192, China
| | - Quan Fang
- Peking Union Medical College Hospital , Beijing 100730, China
| | - Hongfan Sun
- Tianjin Key Laboratory of Biomaterial Research, Institute of Biomedical Engineering, Chinese Academy of Medical Science , Tianjin 300192, China
| | - Chen Li
- Tianjin Key Laboratory of Biomaterial Research, Institute of Biomedical Engineering, Chinese Academy of Medical Science , Tianjin 300192, China
| | - Yongjun Li
- Department of Vascular Surgery, Beijing Hospital , Beijing 100730, China
| | - Chun Wang
- Tianjin Key Laboratory of Biomaterial Research, Institute of Biomedical Engineering, Chinese Academy of Medical Science , Tianjin 300192, China
- Department of Biomedical Engineering, University of Minnesota , Minneapolis, Minnesota 55455, United States
| | - Cunxian Song
- Tianjin Key Laboratory of Biomaterial Research, Institute of Biomedical Engineering, Chinese Academy of Medical Science , Tianjin 300192, China
| | - Yong Zeng
- Peking Union Medical College Hospital , Beijing 100730, China
| | - Jing Yang
- Tianjin Key Laboratory of Biomaterial Research, Institute of Biomedical Engineering, Chinese Academy of Medical Science , Tianjin 300192, China
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Minacapelli A, Piraino D, Buccheri D, Cortese B. Drug-coated balloons for the treatment of in-stent restenosis in diabetic patients: A review of currently available scientific data. Catheter Cardiovasc Interv 2017; 92:E20-E27. [PMID: 28544361 DOI: 10.1002/ccd.26957] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Revised: 11/23/2016] [Accepted: 12/30/2016] [Indexed: 11/09/2022]
Abstract
After the introduction of drug eluting stent (DES) the rate of in-stent restenosis (ISR) has decreased if compared to the BMS era; however, treatment of patients with ISR remained a major issue for the interventional cardiologist. DES has been largely used with good results also as second layer for the treatment of ISR, but the overall percentage of patients suffering from restenosis still remains high, especially in some subgroups of patients as ones with diabetes mellitus (DM). In this clinical scenario, drug coated balloon (DCB) has been gaining an important role for the treatment of ISR. In fact, it allows to release an antiproliferative drug, namely paclitaxel, without the addition of a second metallic strut, which can lead to a persistent inflammatory stimulus and further narrow the vessel. This could be an advantage in patients with an already increased systemic inflammatory burden and stiffer vessels as those with DM. Despite differences in terms of efficacy and safety between DES and DCB have already been evaluated in different clinical trials, just few of these focused on diabetic patients. The aim of this paper is to review the available data for treatment of ISR both with DES, DCB, and a comparison between these two devices, in patients affected by DM. © 2017 Wiley Periodicals, Inc.
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Affiliation(s)
| | - Davide Piraino
- Interventional cardiology, Paolo Giaccone Hospital, Palermo, Italy.,Interventional cardiology, Fatebenefratelli Hospital, Milano, Italy
| | - Dario Buccheri
- Interventional cardiology, Paolo Giaccone Hospital, Palermo, Italy.,Interventional cardiology, Fatebenefratelli Hospital, Milano, Italy.,Department of Cardiology, San Giacomo D'Altopasso Hospital, Licata (Agrigento), Italy
| | - Bernardo Cortese
- Interventional cardiology, Fatebenefratelli Hospital, Milano, Italy
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Alfonso F, Pérez-Vizcayno MJ, García del Blanco B, García-Touchard A, López-Mínguez JR, Sabaté M, Zueco J, Melgares R, Hernández R, Moreno R, Domínguez A, Sanchís J, Moris C, Moreu J, Cequier A, Romaguera R, Rivero F, Cuesta J, Gonzalo N, Jiménez-Quevedo P, Cárdenas A, Fernández C. Usefulness of Drug-Eluting Balloons for Bare-Metal and Drug-Eluting In-Stent Restenosis (from the RIBS IV and V Randomized Trials). Am J Cardiol 2017; 119:983-990. [PMID: 28139220 DOI: 10.1016/j.amjcard.2016.12.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2016] [Revised: 12/19/2016] [Accepted: 12/19/2016] [Indexed: 11/26/2022]
Abstract
Treatment of patients with drug-eluting stent (DES) in-stent restenosis (ISR) is particularly challenging. We sought to compare results of drug-eluting balloons in patients with DES-ISR with those in patients with bare-metal stent (BMS) ISR. A pooled analysis of the Restenosis Intra-Stent: Drug-Eluting Balloon versus Everolimus-Eluting Stent IV and V randomized trials was performed. Both trials had identical inclusion and exclusion criteria. Results of drug-eluting balloons in 95 patients with BMS-ISR and 154 patients with DES-ISR were compared. Patients with DES-ISR were more frequently diabetics, presented more often as an acute coronary syndrome and had more severe lesions and more frequently a focal pattern, including edge-ISR. Late angiographic findings (92% of eligible patients), including minimal lumen diameter (1.80 ± 0.6 vs 2.01 ± 0.6 mm, p = 0.001; absolute mean difference 0.21 mm; 95% confidence interval 0.04 to 0.38; p = 0.014) and restenosis rate (19% vs 9.5%, p <0.05) were poorer in DES-ISR. Results were consistent across 10 prespecified subgroups. Moreover, on multiple linear regression analysis, minimal lumen diameter at follow-up remained significantly smaller in patients with DES-ISR after adjusting for potential confounders (adjusted absolute mean difference 0.17 mm; 95% confidence interval 0.04 to 0.41; p = 0.019). Finally, at 1-year clinical follow-up (100% of patients), rates of target vessel revascularization (16% vs 6%, p = 0.02) and of the main combined clinical end point (18% vs 8%, p = 0.03) were significantly higher in patients treated for DES-ISR. In conclusion, this study confirms the efficacy of DEB for patients with ISR. However, the long-term clinical and angiographic results of DEB are poorer in patients with DES-ISR than in those with BMS-ISR. (ClinicalTrials.govIdentifier:NCT01239953&NCT01239940).
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Moscarella E, Ielasi A, Granata F, Coscarelli S, Stabile E, Latib A, Cortese B, Tespili M, Tanaka A, Capozzolo C, Caliendo L, Colombo A, Varricchio A. Long-Term Clinical Outcomes After Bioresorbable Vascular Scaffold Implantation for the Treatment of Coronary In-Stent Restenosis: A Multicenter Italian Experience. Circ Cardiovasc Interv 2016; 9:e003148. [PMID: 27059683 DOI: 10.1161/circinterventions.115.003148] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2015] [Accepted: 03/06/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND Treatment of in-stent restenosis (ISR) is still challenging. In this setting, the use of bioresorbable vascular scaffold (BVS) seems attractive because it allows drug delivery combined with transient vessel scaffolding. We aimed to investigate the long-term results after BVS use in ISR lesions. METHODS AND RESULTS A prospective analysis was performed on all patients who underwent percutaneous coronary intervention with BVS implantation for ISR at 7 Italian Centers. Primary end point was the device-oriented composite end point (cardiac death, target vessel myocardial infarction, and ischemia-driven target lesion revascularization) at the longest follow-up available. From April 2012 to June 2014, 116 patients (127 lesions) underwent percutaneous coronary intervention for ISR with BVS implantation. Among the ISR lesions, the majority were drug-eluting stent ISR (78, 61.6%), de novo ISR (92, 72.4%), and diffuse ISR (81, 63.8%). Procedural success was achieved for all (100%) patients. No in-hospital death, myocardial infarction, or revascularization occurred. At 15 months of follow-up, the incidence of the device-oriented composite end point estimated with the Kaplan-Meier method was 9.1%. No significant differences were reported between drug-eluting stent and bare-metal stent ISR groups in terms of device-oriented composite end point (10.9% versus 6.4%; hazard ratio, 1.7; 95% confidence interval, 0.5-6.5; P=0.425) and its singular components (cardiac death: 2.8% versus 2.0%, hazard ratio, 1.3; 95% confidence interval, 0.1-14.1, P=0.843; target vessel myocardial infarction: 1.5% versus 0%, P=0.421; ischemia-driven target lesion revascularization: 9.6% versus 4.4%, hazard ratio, 2.3; 95% confidence interval, 0.5-10.8, P=0.309). CONCLUSIONS Our registry suggests that the use of BVS implantation for the treatment of complex drug-eluting stent and bare-metal stent ISR lesions might be associated with acceptable long-term clinical outcomes.
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Affiliation(s)
- Elisabetta Moscarella
- From the Department of Cardio-Thoracic Science, Second University of Naples, Presidio Ospedaliero "Monaldi", Azienda Ospedaliera Dei Colli, Napoli, Italy (E.M.); Cardiology Division, Azienda Ospedaliera Bolognini Seriate, Bergamo, Italy (A.I., M.T.); Laboratory of Invasive Cardiology, Santa Maria della Pietà Hospital, Nola, Napoli, Italy (F.G., L.C., A.V.); Cardiovascular Intervention Unit, San Martino Hospital, Belluno, Italy (S.C.); Laboratory of Invasive Cardiology, Dipartimento di Scienze Biomediche Avanzate, Università degli Studi "Federico II", Napoli, Italy (E.S.); Interventional Cardiology Unit, EMO-GVM Centro Cuore Columbus ed Ospedale San Raffaele, Milano, Italy (A.L., A.T., A.C.); Laboratory of Invasive Cardiology, Azienda Ospedaliera Fatebenefratelli, Milano, Italy (B.C.); and Laboratory of Invasive Cardiology, Department of Cardiology, Presidio Ospedaliero "Monaldi", Azienda Ospedaliera Dei Colli, Napoli, Italy (C.C.).
| | - Alfonso Ielasi
- From the Department of Cardio-Thoracic Science, Second University of Naples, Presidio Ospedaliero "Monaldi", Azienda Ospedaliera Dei Colli, Napoli, Italy (E.M.); Cardiology Division, Azienda Ospedaliera Bolognini Seriate, Bergamo, Italy (A.I., M.T.); Laboratory of Invasive Cardiology, Santa Maria della Pietà Hospital, Nola, Napoli, Italy (F.G., L.C., A.V.); Cardiovascular Intervention Unit, San Martino Hospital, Belluno, Italy (S.C.); Laboratory of Invasive Cardiology, Dipartimento di Scienze Biomediche Avanzate, Università degli Studi "Federico II", Napoli, Italy (E.S.); Interventional Cardiology Unit, EMO-GVM Centro Cuore Columbus ed Ospedale San Raffaele, Milano, Italy (A.L., A.T., A.C.); Laboratory of Invasive Cardiology, Azienda Ospedaliera Fatebenefratelli, Milano, Italy (B.C.); and Laboratory of Invasive Cardiology, Department of Cardiology, Presidio Ospedaliero "Monaldi", Azienda Ospedaliera Dei Colli, Napoli, Italy (C.C.)
| | - Francesco Granata
- From the Department of Cardio-Thoracic Science, Second University of Naples, Presidio Ospedaliero "Monaldi", Azienda Ospedaliera Dei Colli, Napoli, Italy (E.M.); Cardiology Division, Azienda Ospedaliera Bolognini Seriate, Bergamo, Italy (A.I., M.T.); Laboratory of Invasive Cardiology, Santa Maria della Pietà Hospital, Nola, Napoli, Italy (F.G., L.C., A.V.); Cardiovascular Intervention Unit, San Martino Hospital, Belluno, Italy (S.C.); Laboratory of Invasive Cardiology, Dipartimento di Scienze Biomediche Avanzate, Università degli Studi "Federico II", Napoli, Italy (E.S.); Interventional Cardiology Unit, EMO-GVM Centro Cuore Columbus ed Ospedale San Raffaele, Milano, Italy (A.L., A.T., A.C.); Laboratory of Invasive Cardiology, Azienda Ospedaliera Fatebenefratelli, Milano, Italy (B.C.); and Laboratory of Invasive Cardiology, Department of Cardiology, Presidio Ospedaliero "Monaldi", Azienda Ospedaliera Dei Colli, Napoli, Italy (C.C.)
| | - Sebastian Coscarelli
- From the Department of Cardio-Thoracic Science, Second University of Naples, Presidio Ospedaliero "Monaldi", Azienda Ospedaliera Dei Colli, Napoli, Italy (E.M.); Cardiology Division, Azienda Ospedaliera Bolognini Seriate, Bergamo, Italy (A.I., M.T.); Laboratory of Invasive Cardiology, Santa Maria della Pietà Hospital, Nola, Napoli, Italy (F.G., L.C., A.V.); Cardiovascular Intervention Unit, San Martino Hospital, Belluno, Italy (S.C.); Laboratory of Invasive Cardiology, Dipartimento di Scienze Biomediche Avanzate, Università degli Studi "Federico II", Napoli, Italy (E.S.); Interventional Cardiology Unit, EMO-GVM Centro Cuore Columbus ed Ospedale San Raffaele, Milano, Italy (A.L., A.T., A.C.); Laboratory of Invasive Cardiology, Azienda Ospedaliera Fatebenefratelli, Milano, Italy (B.C.); and Laboratory of Invasive Cardiology, Department of Cardiology, Presidio Ospedaliero "Monaldi", Azienda Ospedaliera Dei Colli, Napoli, Italy (C.C.)
| | - Eugenio Stabile
- From the Department of Cardio-Thoracic Science, Second University of Naples, Presidio Ospedaliero "Monaldi", Azienda Ospedaliera Dei Colli, Napoli, Italy (E.M.); Cardiology Division, Azienda Ospedaliera Bolognini Seriate, Bergamo, Italy (A.I., M.T.); Laboratory of Invasive Cardiology, Santa Maria della Pietà Hospital, Nola, Napoli, Italy (F.G., L.C., A.V.); Cardiovascular Intervention Unit, San Martino Hospital, Belluno, Italy (S.C.); Laboratory of Invasive Cardiology, Dipartimento di Scienze Biomediche Avanzate, Università degli Studi "Federico II", Napoli, Italy (E.S.); Interventional Cardiology Unit, EMO-GVM Centro Cuore Columbus ed Ospedale San Raffaele, Milano, Italy (A.L., A.T., A.C.); Laboratory of Invasive Cardiology, Azienda Ospedaliera Fatebenefratelli, Milano, Italy (B.C.); and Laboratory of Invasive Cardiology, Department of Cardiology, Presidio Ospedaliero "Monaldi", Azienda Ospedaliera Dei Colli, Napoli, Italy (C.C.)
| | - Azeem Latib
- From the Department of Cardio-Thoracic Science, Second University of Naples, Presidio Ospedaliero "Monaldi", Azienda Ospedaliera Dei Colli, Napoli, Italy (E.M.); Cardiology Division, Azienda Ospedaliera Bolognini Seriate, Bergamo, Italy (A.I., M.T.); Laboratory of Invasive Cardiology, Santa Maria della Pietà Hospital, Nola, Napoli, Italy (F.G., L.C., A.V.); Cardiovascular Intervention Unit, San Martino Hospital, Belluno, Italy (S.C.); Laboratory of Invasive Cardiology, Dipartimento di Scienze Biomediche Avanzate, Università degli Studi "Federico II", Napoli, Italy (E.S.); Interventional Cardiology Unit, EMO-GVM Centro Cuore Columbus ed Ospedale San Raffaele, Milano, Italy (A.L., A.T., A.C.); Laboratory of Invasive Cardiology, Azienda Ospedaliera Fatebenefratelli, Milano, Italy (B.C.); and Laboratory of Invasive Cardiology, Department of Cardiology, Presidio Ospedaliero "Monaldi", Azienda Ospedaliera Dei Colli, Napoli, Italy (C.C.)
| | - Bernardo Cortese
- From the Department of Cardio-Thoracic Science, Second University of Naples, Presidio Ospedaliero "Monaldi", Azienda Ospedaliera Dei Colli, Napoli, Italy (E.M.); Cardiology Division, Azienda Ospedaliera Bolognini Seriate, Bergamo, Italy (A.I., M.T.); Laboratory of Invasive Cardiology, Santa Maria della Pietà Hospital, Nola, Napoli, Italy (F.G., L.C., A.V.); Cardiovascular Intervention Unit, San Martino Hospital, Belluno, Italy (S.C.); Laboratory of Invasive Cardiology, Dipartimento di Scienze Biomediche Avanzate, Università degli Studi "Federico II", Napoli, Italy (E.S.); Interventional Cardiology Unit, EMO-GVM Centro Cuore Columbus ed Ospedale San Raffaele, Milano, Italy (A.L., A.T., A.C.); Laboratory of Invasive Cardiology, Azienda Ospedaliera Fatebenefratelli, Milano, Italy (B.C.); and Laboratory of Invasive Cardiology, Department of Cardiology, Presidio Ospedaliero "Monaldi", Azienda Ospedaliera Dei Colli, Napoli, Italy (C.C.)
| | - Maurizio Tespili
- From the Department of Cardio-Thoracic Science, Second University of Naples, Presidio Ospedaliero "Monaldi", Azienda Ospedaliera Dei Colli, Napoli, Italy (E.M.); Cardiology Division, Azienda Ospedaliera Bolognini Seriate, Bergamo, Italy (A.I., M.T.); Laboratory of Invasive Cardiology, Santa Maria della Pietà Hospital, Nola, Napoli, Italy (F.G., L.C., A.V.); Cardiovascular Intervention Unit, San Martino Hospital, Belluno, Italy (S.C.); Laboratory of Invasive Cardiology, Dipartimento di Scienze Biomediche Avanzate, Università degli Studi "Federico II", Napoli, Italy (E.S.); Interventional Cardiology Unit, EMO-GVM Centro Cuore Columbus ed Ospedale San Raffaele, Milano, Italy (A.L., A.T., A.C.); Laboratory of Invasive Cardiology, Azienda Ospedaliera Fatebenefratelli, Milano, Italy (B.C.); and Laboratory of Invasive Cardiology, Department of Cardiology, Presidio Ospedaliero "Monaldi", Azienda Ospedaliera Dei Colli, Napoli, Italy (C.C.)
| | - Akihito Tanaka
- From the Department of Cardio-Thoracic Science, Second University of Naples, Presidio Ospedaliero "Monaldi", Azienda Ospedaliera Dei Colli, Napoli, Italy (E.M.); Cardiology Division, Azienda Ospedaliera Bolognini Seriate, Bergamo, Italy (A.I., M.T.); Laboratory of Invasive Cardiology, Santa Maria della Pietà Hospital, Nola, Napoli, Italy (F.G., L.C., A.V.); Cardiovascular Intervention Unit, San Martino Hospital, Belluno, Italy (S.C.); Laboratory of Invasive Cardiology, Dipartimento di Scienze Biomediche Avanzate, Università degli Studi "Federico II", Napoli, Italy (E.S.); Interventional Cardiology Unit, EMO-GVM Centro Cuore Columbus ed Ospedale San Raffaele, Milano, Italy (A.L., A.T., A.C.); Laboratory of Invasive Cardiology, Azienda Ospedaliera Fatebenefratelli, Milano, Italy (B.C.); and Laboratory of Invasive Cardiology, Department of Cardiology, Presidio Ospedaliero "Monaldi", Azienda Ospedaliera Dei Colli, Napoli, Italy (C.C.)
| | - Claudia Capozzolo
- From the Department of Cardio-Thoracic Science, Second University of Naples, Presidio Ospedaliero "Monaldi", Azienda Ospedaliera Dei Colli, Napoli, Italy (E.M.); Cardiology Division, Azienda Ospedaliera Bolognini Seriate, Bergamo, Italy (A.I., M.T.); Laboratory of Invasive Cardiology, Santa Maria della Pietà Hospital, Nola, Napoli, Italy (F.G., L.C., A.V.); Cardiovascular Intervention Unit, San Martino Hospital, Belluno, Italy (S.C.); Laboratory of Invasive Cardiology, Dipartimento di Scienze Biomediche Avanzate, Università degli Studi "Federico II", Napoli, Italy (E.S.); Interventional Cardiology Unit, EMO-GVM Centro Cuore Columbus ed Ospedale San Raffaele, Milano, Italy (A.L., A.T., A.C.); Laboratory of Invasive Cardiology, Azienda Ospedaliera Fatebenefratelli, Milano, Italy (B.C.); and Laboratory of Invasive Cardiology, Department of Cardiology, Presidio Ospedaliero "Monaldi", Azienda Ospedaliera Dei Colli, Napoli, Italy (C.C.)
| | - Luigi Caliendo
- From the Department of Cardio-Thoracic Science, Second University of Naples, Presidio Ospedaliero "Monaldi", Azienda Ospedaliera Dei Colli, Napoli, Italy (E.M.); Cardiology Division, Azienda Ospedaliera Bolognini Seriate, Bergamo, Italy (A.I., M.T.); Laboratory of Invasive Cardiology, Santa Maria della Pietà Hospital, Nola, Napoli, Italy (F.G., L.C., A.V.); Cardiovascular Intervention Unit, San Martino Hospital, Belluno, Italy (S.C.); Laboratory of Invasive Cardiology, Dipartimento di Scienze Biomediche Avanzate, Università degli Studi "Federico II", Napoli, Italy (E.S.); Interventional Cardiology Unit, EMO-GVM Centro Cuore Columbus ed Ospedale San Raffaele, Milano, Italy (A.L., A.T., A.C.); Laboratory of Invasive Cardiology, Azienda Ospedaliera Fatebenefratelli, Milano, Italy (B.C.); and Laboratory of Invasive Cardiology, Department of Cardiology, Presidio Ospedaliero "Monaldi", Azienda Ospedaliera Dei Colli, Napoli, Italy (C.C.)
| | - Antonio Colombo
- From the Department of Cardio-Thoracic Science, Second University of Naples, Presidio Ospedaliero "Monaldi", Azienda Ospedaliera Dei Colli, Napoli, Italy (E.M.); Cardiology Division, Azienda Ospedaliera Bolognini Seriate, Bergamo, Italy (A.I., M.T.); Laboratory of Invasive Cardiology, Santa Maria della Pietà Hospital, Nola, Napoli, Italy (F.G., L.C., A.V.); Cardiovascular Intervention Unit, San Martino Hospital, Belluno, Italy (S.C.); Laboratory of Invasive Cardiology, Dipartimento di Scienze Biomediche Avanzate, Università degli Studi "Federico II", Napoli, Italy (E.S.); Interventional Cardiology Unit, EMO-GVM Centro Cuore Columbus ed Ospedale San Raffaele, Milano, Italy (A.L., A.T., A.C.); Laboratory of Invasive Cardiology, Azienda Ospedaliera Fatebenefratelli, Milano, Italy (B.C.); and Laboratory of Invasive Cardiology, Department of Cardiology, Presidio Ospedaliero "Monaldi", Azienda Ospedaliera Dei Colli, Napoli, Italy (C.C.)
| | - Attilio Varricchio
- From the Department of Cardio-Thoracic Science, Second University of Naples, Presidio Ospedaliero "Monaldi", Azienda Ospedaliera Dei Colli, Napoli, Italy (E.M.); Cardiology Division, Azienda Ospedaliera Bolognini Seriate, Bergamo, Italy (A.I., M.T.); Laboratory of Invasive Cardiology, Santa Maria della Pietà Hospital, Nola, Napoli, Italy (F.G., L.C., A.V.); Cardiovascular Intervention Unit, San Martino Hospital, Belluno, Italy (S.C.); Laboratory of Invasive Cardiology, Dipartimento di Scienze Biomediche Avanzate, Università degli Studi "Federico II", Napoli, Italy (E.S.); Interventional Cardiology Unit, EMO-GVM Centro Cuore Columbus ed Ospedale San Raffaele, Milano, Italy (A.L., A.T., A.C.); Laboratory of Invasive Cardiology, Azienda Ospedaliera Fatebenefratelli, Milano, Italy (B.C.); and Laboratory of Invasive Cardiology, Department of Cardiology, Presidio Ospedaliero "Monaldi", Azienda Ospedaliera Dei Colli, Napoli, Italy (C.C.)
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Drug-eluting Balloon Versus Second Generation Drug Eluting Stents in the Treatment of In-stent Restenosis: A Systematic Review and Meta-analysis. Heart Lung Circ 2016; 25:1184-1194. [DOI: 10.1016/j.hlc.2016.04.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2015] [Revised: 02/15/2016] [Accepted: 04/02/2016] [Indexed: 11/21/2022]
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Buccheri D, Piraino D, Andolina G, Cortese B. Understanding and managing in-stent restenosis: a review of clinical data, from pathogenesis to treatment. J Thorac Dis 2016; 8:E1150-E1162. [PMID: 27867580 DOI: 10.21037/jtd.2016.10.93] [Citation(s) in RCA: 209] [Impact Index Per Article: 26.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
The lumen diameter reduction after percutaneous coronary intervention (PCI) is well known as "restenosis". This phenomenon is due to vessel remodeling/recoil in case of no-stent strategy or, in case of stent employ, "neointimal proliferation" that consists in an excessive tissue proliferation in the luminal surface of the stent otherwise by a further new-occurring atherosclerotic process called "neoatherosclerosis". The exact incidence of in-stent restenosis (ISR) is not easy to determine caused by different clinical, angiographic and operative factors. In the pre-stent era the occurrence of restenosis ranged between 32-55% of all angioplasties, and drop to successively 17-41% in the bare metal stents (BMS) era. The advent of drug-eluting stent (DES), especially 2nd generation, and drug-coated balloon (DCB) further reduce restenosis rate until <10%. We here review the main characteristics of this common complication of coronary interventions, from its pathogenesis to the most appropriate treatment strategy.
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Affiliation(s)
- Dario Buccheri
- Interventional Cardiology, "Paolo Giaccone" Hospital, Palermo, Italy; ; Interventional Cardiology, Fatebenefratelli Hospital, Milano, Italy; ; Cardiology Department, San Giacomo D'Altopasso Hospital, Licata (Agrigento), Italy
| | - Davide Piraino
- Interventional Cardiology, "Paolo Giaccone" Hospital, Palermo, Italy; ; Interventional Cardiology, Fatebenefratelli Hospital, Milano, Italy
| | - Giuseppe Andolina
- Interventional Cardiology, "Paolo Giaccone" Hospital, Palermo, Italy
| | - Bernardo Cortese
- Interventional Cardiology, Fatebenefratelli Hospital, Milano, Italy; ; Fondazione G. Monasterio CNR-Regione Toscana, Pisa, Massa, Italy
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Alfonso F, Pérez-Vizcayno MJ, García del Blanco B, García-Touchard A, Masotti M, López-Minguez JR, Iñiguez A, Zueco J, Velazquez M, Cequier A, Lázaro-García R, Martí V, Moris C, Urbano-Carrillo C, Bastante T, Rivero F, Cárdenas A, Gonzalo N, Jiménez-Quevedo P, Fernández C. Comparison of the Efficacy of Everolimus-Eluting Stents Versus Drug-Eluting Balloons in Patients With In-Stent Restenosis (from the RIBS IV and V Randomized Clinical Trials). Am J Cardiol 2016; 117:546-554. [PMID: 26725102 DOI: 10.1016/j.amjcard.2015.11.042] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2015] [Revised: 11/18/2015] [Accepted: 11/18/2015] [Indexed: 10/22/2022]
Abstract
Treatment of patients with in-stent restenosis (ISR) remains a challenge. This study sought to compare the efficacy of everolimus-eluting stents (EESs) and drug-eluting balloons (DEBs) with paclitaxel in patients with ISR. A pooled analysis of the Restenosis Intra-Stent of Drug-Eluting Stents: Drug-Eluting Balloon vs Everolimus-Eluting Stent (RIBS IV) and Restenosis Intra-Stent of Bare-Metal Stents: Drug-Eluting Balloon vs Everolimus-Eluting Stent (RIBS V) randomized trials was performed using patient-level data. In both trials, EESs were compared with DEBs in patients with ISR (RIBS V included 189 patients with bare-metal ISR; RIBS IV included 309 patients with drug-eluting ISR). Inclusion and exclusion criteria were identical in both trials. A total of 249 patients were allocated to EES and 249 to DEB. Clinical follow-up at 1 year was obtained in all (100%) patients and late angiography (median 249 days) in 91% of eligible patients. Compared with patients treated with DEBs, patients treated with EESs obtained better short-term results (postprocedural minimal lumen diameter 2.28 ± 0.5 vs 2.12 ± 0.4 mm, p <0.0001). At follow-up, patients treated with EESs had larger in-segment minimal lumen diameter (primary end point 2.16 ± 0.7 vs 1.88 ± 0.6 mm, p <0.0001; absolute mean difference 0.28 mm; 95% confidence interval [CI] 0.16 to 0.40) and net lumen gain (1.33 ± 0.6 vs 1.00 ± 0.7 mm, p <0.0001) and had lower %diameter stenosis (19 ± 21% vs 28 ± 22%, p <0.0001) and binary restenosis rate (8.7% vs 15.7%, p = 0.02). Consistent results were observed in the in-lesion analysis. No interactions were found between the underlying stent type and treatment effects. At 1-year clinical follow-up, the composite of cardiac death, myocardial infarction, and target vessel revascularization was significantly reduced in the EES arm (8.8% vs 14.5%, p = 0.03; hazard ratio 0.59, 95% CI 0.31 to 0.94) mainly driven by a lower need for target vessel revascularization (6% vs 12.4%, p = 0.01, hazard ratio 0.46, 95% CI 0.25 to 0.86). This pooled analysis of the RIBS IV and RIBS V randomized trials demonstrates the superiority of EES over DEB in the treatment of patients with ISR.
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Li J, Liu WL, Yi X, Feng GK, Lu Z, Jiang XJ, Li XY. Paclitaxel-coated balloons for the treatment of patients with in-stent restenosis: A meta-analysis of angiographic and clinical data. Exp Ther Med 2015; 9:2285-2292. [PMID: 26136975 DOI: 10.3892/etm.2015.2431] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2014] [Accepted: 03/17/2015] [Indexed: 11/06/2022] Open
Abstract
Paclitaxel-coated balloons (PCBs) have become attractive alternative treatment options for patients with in-stent restenosis (ISR); however, the safety and efficacy of PCBs in comparison with those of conventional therapies are less well defined. The aim of this meta-analysis was to systematically review the efficacy and safety of PCBs for patients with ISR using comparisons with control groups. Electronic databases, such as MEDLINE, Embase and the Cochrane Central Register of Controlled Trials, were searched, and eligible studies that compared PCBs with uncoated balloons (UCBs) or drug-eluting stents (DESs) in patients with ISR were considered. Subgroup analyses were performed with different control groups. Nine studies (1,488 patients, 1,608 lesions) were included in the meta-analysis. Compared with patients who underwent UCB angioplasty, those who underwent PCB angioplasty exhibited a clear superiority in late lumen loss (LLL) [weighted mean difference (WMD), -0.46; 95% confidence interval (CI), (-0.59)-(-0.34); P<0.00001] and major adverse cardiac events (MACEs) [odds ratio (OR), 0.21; 95% CI, 0.13-0.33; P<0.00001]. The OR for myocardial infarction (MI) (OR, 0.46; 95% CI, 0.15-1.47; P=0.19) did not reach statistical significance. PCBs were associated with similar outcomes when compared with DESs with regard to LLL (WMD, -0.04; 95% CI, -0.18-0.10; P=0.57), MACEs (OR, 0.74; 95% CI, 0.36-1.53; P=0.42) and the ORs for all endpoints, including total mortality, target lesion revascularization, MI, stent thrombosis and binary restenosis, and no statistically significant differences were found. This meta-analysis showed that PCBs are associated with superior outcomes when compared with UCBs in the management of ISR, and are at least as efficacious and as well tolerated as DESs.
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Affiliation(s)
- Jun Li
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, Hubei 430060, P.R. China
| | - Wan-Li Liu
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, Hubei 430060, P.R. China
| | - Xin Yi
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, Hubei 430060, P.R. China
| | - Gao-Ke Feng
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, Hubei 430060, P.R. China
| | - Zhao Lu
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, Hubei 430060, P.R. China
| | - Xue-Jun Jiang
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, Hubei 430060, P.R. China
| | - Xiao-Yan Li
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, Hubei 430060, P.R. China
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Alfonso F, Pérez-Vizcayno MJ, Cárdenas A, García del Blanco B, García-Touchard A, López-Minguéz JR, Benedicto A, Masotti M, Zueco J, Iñiguez A, Velázquez M, Moreno R, Mainar V, Domínguez A, Pomar F, Melgares R, Rivero F, Jiménez-Quevedo P, Gonzalo N, Fernández C, Macaya C. A Prospective Randomized Trial of Drug-Eluting Balloons Versus Everolimus-Eluting Stents in Patients With In-Stent Restenosis of Drug-Eluting Stents. J Am Coll Cardiol 2015; 66:23-33. [DOI: 10.1016/j.jacc.2015.04.063] [Citation(s) in RCA: 212] [Impact Index Per Article: 23.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2015] [Revised: 04/17/2015] [Accepted: 04/20/2015] [Indexed: 12/15/2022]
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41
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Kufner S, Cassese S, Valeskini M, Neumann FJ, Schulz-Schüpke S, Hoppmann P, Fusaro M, Schunkert H, Laugwitz KL, Kastrati A, Byrne RA. Long-Term Efficacy and Safety of Paclitaxel-Eluting Balloon for the Treatment of Drug-Eluting Stent Restenosis. JACC Cardiovasc Interv 2015; 8:877-84. [DOI: 10.1016/j.jcin.2015.01.031] [Citation(s) in RCA: 72] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2014] [Revised: 12/22/2014] [Accepted: 01/15/2015] [Indexed: 11/28/2022]
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42
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Drug-eluting stents for drug-eluting stent restenosis: stick with the old or switch to a new one? Coron Artery Dis 2014; 25:633-5. [PMID: 25365642 DOI: 10.1097/mca.0000000000000171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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43
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Current treatment of in-stent restenosis. J Am Coll Cardiol 2014; 63:2659-73. [PMID: 24632282 DOI: 10.1016/j.jacc.2014.02.545] [Citation(s) in RCA: 370] [Impact Index Per Article: 37.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2013] [Revised: 01/31/2014] [Accepted: 02/11/2014] [Indexed: 01/04/2023]
Abstract
Management of patients with in-stent restenosis (ISR) remains an important clinical problem. Although drug-eluting stents (DES) have drastically reduced the incidence of ISR, treatment of DES-ISR is particularly challenging. ISR mainly results from aggressive neointimal proliferation, but recent data also suggest that neoatherosclerosis may play an important pathophysiological role. Intracoronary imaging provides unique insights to unravel the underlying substrate of ISR and may be used to guide repeated interventions. In this paper, we systematically reviewed clinical trial data with currently available therapeutic modalities, including DES and drug-coated balloons, in patients presenting with ISR within bare-metal stents or DES.
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Sirolimus-eluting versus paclitaxel-eluting stents in diabetic and non-diabetic patients within sirolimus-eluting stent restenosis: Results from the ISAR-DESIRE 2 trial. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2014; 15:69-75. [DOI: 10.1016/j.carrev.2014.02.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2013] [Revised: 02/09/2014] [Accepted: 02/10/2014] [Indexed: 01/22/2023]
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