Real‐life experience of a stent‐less revascularization strategy using a combination of excimer laser and drug‐coated balloon for patients with acute coronary syndrome

• Published in: Journal of interventional cardiology Vol. 31; no. 3; pp. 284 - 292
• Main Authors: Harima, Ayako, Sairaku, Akinori, Inoue, Ichiro, Nishioka, Kenji, Oka, Toshiharu, Nakama, Yasuharu, Dai, Kazuoki, Ohi, Kuniomi, Hashimoto, Haruki, Kihara, Yasuki
• Format: Journal Article
• Language: English
• Published: United States Hindawi Limited 01.06.2018
• Subjects: acute coronary syndrome; Acute coronary syndromes; Angioplasty; Antiplatelet therapy; Balloon treatment; Drug delivery; drug‐coated balloon; excimer laser coronary angioplasty; Heart; Heart diseases; Implants; Patients; Restenosis; Stenosis; Stents; stent‐less strategy; Thrombosis; acute coronary syndrome; excimer laser coronary angioplasty; stent-less strategy; drug-coated balloon
• ISSN: 0896-4327; 1540-8183
• DOI: 10.1111/joic.12495

Objectives We aimed to test a novel stent‐less revascularization strategy using a combination of excimer laser coronary angioplasty (ELCA) and drug‐coated balloon (DCB) for patients with acute coronary syndrome (ACS). Background Percutaneous coronary intervention with drug eluting stents is a standard invasive treatment for ACS. Some unsolved issues however remain, such as stent thrombosis and bleeding risks associated with dual antiplatelet therapy. Methods Consecutive ACS patients were planned to receive either a DCB application following ELCA without a stent implantation or conventional revascularization with a coronary stent. The endpoints were (i) major cardiac adverse events (MACEs), defined as the composite of cardiac death, myocardial infarctions, and target lesion revascularization; (ii) target vessel revascularization (TVR); and (iii) angiographic outcome. Results Since a greater than expected number of patients allocated to the stent‐less treatment arm eventually received a bailout stenting, the following 3 as‐treated groups were compared; DCB with ELCA group (N = 60), Stent with ELCA group (N = 23), and Stent without ELCA group (N = 85). During a mean follow‐up period of 420 ± 137 days, and with angiographic 6‐ and 12‐month‐follow‐up rates of 96.7%, 87%, and 81.2%, and 50%, 65.2%, and 45.9%, respectively, the MACE rate did not differ across the groups (10%, 4.3%, and 3.5%; P = 0.22) while an incidence of TVR was more common (15%, 0, and 4.7%; P = 0.02) and the diameter stenosis at 6‐months of follow‐up was greater (25.7 ± 18.2, 14.9 ± 13.1 and 16.2 ± 15.4%; P = 0.002) in the DCB with ELCA group. Conclusions The stent‐less revascularization strategy with DCB and ELCA was associated with a higher occurrence of restenosis in ACS patients.