Open AccessDrug Coated Balloon Is Less Effective for Treatment of DES In‐Stent Restenosis Both in Native Coronary Arteries and Saphenous Vein Grafts: Results From a Bicenter Registry
Author(s) -
Resch Markus,
Ostheim Patrick,
Endemann Dierk H.,
Debl Kurt,
Buchner Stefan,
Birner Christoph,
Maier Lars S.,
Kerber Sebastian,
Luchner Andreas,
Griese Daniel P.
Publication year - 2016
Publication title -
journal of interventional cardiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.764
H-Index - 51
eISSN - 1540-8183
pISSN - 0896-4327
DOI - 10.1111/joic.12324
Subject(s) - medicine , restenosis , coronary arteries , cardiology , drug eluting stent , bare metal stent , stent , target lesion , balloon , percutaneous coronary intervention , artery , myocardial infarction
Background The paclitaxel drug coated balloon (DCB) is an established treatment for bare metal stent (BMS) in‐stent restenosis (ISR) in native coronary arteries. The evidence of DCB‐application for drug eluting stent (DES) ISR both in native coronaries and saphenous vein grafts (SVG) is limited. Aim of our study was to compare the differential efficacy of DCB for treatment of BMS‐ and DES‐ISR in native coronary vessels and SVGs. Methods and Results N = 135 DCB‐treated patients with available follow up (FU) angiography were included in this retrospective study. Patients received treatment between April 2009 and March 2013 at 2 tertiary care hospitals in Germany. DCB was applied in BMS‐ISR (n = 65; 48%) and DES‐ISR (n = 70; 52%). DCB‐treated lesions were located in native coronary arteries (n = 110; 81%; BMS‐ISR: n = 58; 53%; DES‐ISR: n = 52; 47%) and SVGs (n = 25; 19%; BMS‐ISR: n = 7, 28%; DES‐ISR: n = 18, 72%). Median FU was 12 months. Endpoints were binary restenosis and target lesion revascularization (TLR). Binary restenosis (29% vs. 57%; P < 0.01) and TLR (18% vs. 46%; P < 0.01) were significantly more frequent in DES‐ISR versus BMS‐ISR. In SVGs, TLR was required in 72% (DES‐ISR) versus 14% (BMS‐ISR); P = 0.02. In the Kaplan–Meier‐analysis freedom from both endpoints was significantly decreased in the DES‐lesions both in the total population (binary restenosis P < 0.01; TLR P < 0.01) and native coronaries (binary restenosis P = 0.02; TLR P = 0.04). Conclusions DCB treatment is less effective in DES‐ISR than in BMS‐ISR. The diminished efficacy of DCB treatment is even more pronounced in DES‐ISR located within degenerated SVGs.