Background: The efficacy of cutting or plain balloon angioplasty (CBA or PBA) for in-stent restenosis (ISR) has not been analyzed in drug-eluting stent (DES) versus bare metal one (BMS). We compared the efficacy of CBA and PBA in the treatment of DES-ISR versus BMS-ISR.

Methods: We analyzed 252 ISR lesions in 224 consecutive patients treated by CBA (157 lesions) or PBA (95 lesions) among 855 ISR cohorts between Jul. 2002 to Dec. 2008. The end point analyzed were angiographic repeated-ISR, late loss and major adverse cardiac events (MACE), which were defined as target lesion revascularization (TLR), myocardial infarction (MI) and cardiac death. Results: In 6 month angiographic and 12 month clinical follow-up, CBA and PBA showed similar efficacies; repeated-ISR (37.0% vs. 37.8%, p=0.90), late loss (0.62 짹 0.60mm vs. 0.61 짹 0.47mm, p=0.92), TLR (20.8% vs. 25.3%, p=0.50) and MACE (22.1% vs. 25.3%, p=0.59). These comparable efficacies between both treatments were still maintained in DES-ISR and BMS-ISR subgroups. However, target lesion-related MI (n=9) occurred more frequently in CBA arm than PBA arm (6.2% vs. 0%, p=0.03, Figure) with most cases early period after ISR treatment (n=7; 54 짹 26 days). Diffuse-ISR and smaller pre-treatment minimal lumen diameter, both of which imply heavier plaque burden of ISR, were identified as independent predictors of repeated-ISR at 6 month follow-up using multivariate analysis In post-hoc analysis, the prognosis of DES-ISR after balloon angioplasty was not significantly different from BMS-ISR even though DES-ISR group had more coronary risk factors and adverse lesion characteristics.

Conclusion: Plain or cutting balloon angioplasty for ISR seems to be comparable to each other in the angiographic or clinical endpoints that were not affected by the type of initial stent (DES-ISR versus BMS-ISR) but by the plaque burden of ISR lesion. However, PBA may be a safer choice in terms of risk of myocardial infarction.