Predictors of Recurrent In-Stent Restenosis After Paclitaxel-Coated Balloon Angioplasty

• Published in: Circulation Journal Vol. 81; no. 9; pp. 1286 - 1292
• Main Authors: Koiwaya, Hiroshi, Watanabe, Nozomi, Kuriyama, Nehiro, Nishino, Shun, Ogata, Kenji, Kimura, Toshiyuki, Nakama, Tatsuya, Matsuura, Hirohide, Furugen, Makoto, Shibata, Yoshisato
• Format: Journal Article
• Language: English
• Published: Japan The Japanese Circulation Society 2017
• Subjects: Aged; Angioplasty, Balloon, Coronary; Atherectomy; Coronary Angiography; Databases, Factual; Female; Follow-Up Studies; Graft Occlusion, Vascular - diagnostic imaging; Graft Occlusion, Vascular - physiopathology; Graft Occlusion, Vascular - prevention & control; Humans; In-stent restenosis; Male; Middle Aged; Paclitaxel - administration & dosage; Paclitaxel-coated balloon angioplasty; Percutaneous coronary intervention; Predictive Value of Tests; Recurrent in-stent restenosis; Retrospective Studies; Stents; Paclitaxel-coated balloon angioplasty; In-stent restenosis; Recurrent in-stent restenosis; Percutaneous coronary intervention
• ISSN: 1346-9843; 1347-4820
• DOI: 10.1253/circj.CJ-17-0095

Background:Although paclitaxel-coated balloon (PCB) angioplasty is an effective procedure for in-stent restenosis (ISR) after coronary stenting, recurrent ISR after PCB angioplasty still occurs. The aim of this study was to evaluate the predictors of recurrent ISR after PCB angioplasty for ISR.Methods and Results:A total of 157 ISR lesions treated with PCB angioplasty from January 2014 to May 2015 were retrospectively examined. Recurrent ISR was judged on 6-month follow-up angiography. Clinical, angiographic and procedural parameters were evaluated as possible predictors of recurrent ISR. Recurrent ISR occurred in 13.9% of lesions after PCB angioplasty. On multivariate analysis the following independent predictors of recurrent ISR were identified: (1) smaller acute gain after initial ballooning (OR, 3.06; 95% CI: 1.08–8.71; P=0.04); (2) geographic mismatch between PCB position and initial ballooning (OR, 5.59; 95% CI: 1.64–19.1; P=0.006); and (3) use of percutaneous transluminal coronary rotational atherectomy (PTCRA) at primary percutaneous coronary intervention (PCI; OR, 5.53; 95% CI: 1.89–16.2; P=0.002).Conclusions:Optimal expansion at initial ballooning before PCB angioplasty and careful positioning of PCB are important technical tips to prevent recurrent ISR after PCB angioplasty. Recurrent ISR occurred more frequently in severely calcified lesions that required PTCRA at primary PCI.