| 박승정, 곽재진, 박경우, 이해영, 박진식, 강현재, 구본권, 김효수, 오병희, 박영배, 최윤식 |
Background: In-stent restenosis (ISR) is one of the major problems after stent implantation. However, treatment of ISR has not been established definitely. Therefore we evaluated the efficacy of cutting and conventional balloon angioplasty in the treatment of ISR of BMS and DES.
Methods: Consecutive 123 patients with ISR were treated successfully by cutting balloon (82 patients) or conventional balloon angioplasty (41 patients). Angiographic and clinical follow-up was scheduled within 12 month. Treatment with another stenting was excluded and treatment modality was decided by operators’ discretion. Successful angioplasty was defined as residual stenosis < 50%. Major adverse cardiac events (MACE) were defined as death, myocardial infarction and target vessel revascularization (TVR).
Results: Cutting balloon-treated group (88 lesions) and conventional balloon-treated group (43 lesions) showed no difference in baseline clinical characteristics before percutaneous coronary intervention (PCI), including stent length (24.4±7.2mm vs. 22.5±7.8mm, p=0.19), stent diameter (3.05±0.48mm vs. 3.04±0.44mm, p=0.94) and post-PCI residual stenosis. Cutting balloon was more frequently used in the treatment of diffuse-ISR versus focal-ISR (40.9% vs. 18.6%, p=0.01). In 12 month angiographic follow-up, binary re-ISR occurred more commonly in diffuse-ISR compared to focal-ISR (67.9% vs. 32.1%, p=0.003), irrespective of type of stent (BMS vs. DES) or treatment (cutting vs. conventional). And, diffuse re-ISR showed more close correlation to diffuse-ISR rather than focal-ISR (p<0.01). However, binary re-ISR (47.1% vs. 40.0%, p=0.65), TVR rate (20.5% vs. 20.9%, p=NS) and MACE (22.7.0% vs. 20.9%, p=NS) were not significantly different between both balloon groups. In a multivariate analysis, type of stent (BMS vs. DES), type of lesion (focal vs. diffuse), and type of treatment (cutting vs. conventional) were not an independent predictor for TVR after ISR treatment.
Conclusion: The efficacy of cutting or conventional balloon angioplasty was not different in the treatment of ISR of DES and BMS.
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