Procedural Results and Long-Term Outcomes of Percutaneous Coronary Intervention for in-Stent Restenosis Chronic Total Occlusion Compared with de novo Chronic Total Occlusion

Tang, Guodong; Zheng, Na; Yang, Guang; Li, Hui; Ai, Hu; Zhao, Ying; Sun, Fucheng; Zhang, Huiping

doi:10.2147/ijgm.s328332

Cited by 5 publications

(6 citation statements)

References 27 publications

(41 reference statements)

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“…As all the lesions in this study are CTOs, the patients may exhibit atypical clinical symptoms after target lesion thrombosis, making the diagnosis difficult. We observed two cases of NSTEMI (1.3%) and one cardiac death (1.9%) during the longterm follow up, which were similar to those reported in retrospective study and RCT [10,16]. The long-term follow up results in DCB only group in our study showed acceptable TLR which is comparable to DCB only strategy by other centers and slightly higher than that of DES treatment, and low rates of clinical endpoints, indicating the effect and safety of DCB only strategy in selected patients is comparable to DES implantation in native CTO lesion during long-term follow up.…”

Section: Discussionsupporting

confidence: 90%

“…In this study, we defined acceptable recanalization as TIMI flow grade 3 and residual stenosis ≤70%, and 82.5% of patients met this standard after DCB treatment. The long-term follow up showed similar results as previous CTO studies using DES [ 10 , 16 ], implying this standard might be feasible in de novo CTO lesion treated by DCB.…”

Section: Discussionsupporting

confidence: 80%

“…So far, none of the studies compared the clinical outcomes of DES and DCB treatment in de novo CTO lesions. In comparison with studies published previously in DES era, the incidence of TVR (11.3%) in our study seemed higher than that demonstrated in a retrospective study including 350 patients with 2-year follow up by Tang G, et al (7.6%), in which 79.4% of de novo CTO lesions were treated by DES [ 16 ]. Recently, another retrospective study including 1308 patients with de novo CTO lesion in which 73.9% of patients had stent implantation showed 6.3% TLR and 7.1% TVR in reasonable recanalization subgroup during 5-year follow up [ 17 ], which is similar to the 4-year follow up results in the DECISION-CTO trial, the randomized controlled trial (RCT) in CTO PCI [ 10 ].…”

Section: Discussioncontrasting

confidence: 77%

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Long-term clinical outcomes of drug-coated balloon for the management of chronic total occlusions

Qin,

Chen,

et al. 2023

Coronary Artery Disease

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Objectives This study aims to compare the clinical outcomes of patients with de novo chronic total occlusion (CTO) lesions treated by hybrid strategy and drug-coated balloons (DCB)-only strategy. Backgrounds DCBs have been used as an alternative to or in combination with drug-eluting stents in CTO lesions. However, the clinical impact of DCB treatment on CTO lesion remains uncertain. Methods We retrospectively enrolled 154 patients with de novo CTO lesions treated by DCB, including 57 cases in hybrid group and 97 cases in DCB-only group. Results The lesions in hybrid group were more complicated than those in DCB-only group as shown by higher J-CTO score, and therefore higher percentage of retrograde approach, more IVUS guidance, more CTO guidewires, and longer procedural time were demonstrated. Although the percentage of non-flow-limiting dissection and residual stenosis of more than 30% were lower in hybrid group, TIMI flow grade, satisfactory and acceptable recanalization rate were not significantly different between two groups. During a median follow-up was 470 days, the incidence of target lesion revascularization (TLR), myocardial infarction and cardiac death was 11.0%, 1.3% and 1.9%, respectively. The long-term TLR-free survival was comparable between hybrid and DCB-only groups. By multivariate analysis, DCB length and age were predictors of TLR. Conclusion DCB treatment appears effective and safe in selected de novo CTO lesions during long-term follow up. The recanalization results and long-term outcomes are comparable between hybrid and DCB-only group despite more complicated lesions in hybrid group.

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Section: Discussionsupporting

confidence: 90%

Section: Discussionsupporting

confidence: 80%

Section: Discussioncontrasting

confidence: 77%

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Long-term clinical outcomes of drug-coated balloon for the management of chronic total occlusions

Qin,

Chen,

et al. 2023

Coronary Artery Disease

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“…The final analysis included 12 studies published between 2011 to 2021, with a total of 708 391 patients: 71 353 patients underwent PCI for ISR, and 637 038 patients underwent PCI for de novo lesions. 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 There was good interrater agreement between the 2 researchers performing study selection (κ=0.79; standard error=0.09) and data extraction (κ=0.81; standard error=0.06). The weighted follow‐up duration was 29.8 months.…”

Section: Resultsmentioning

confidence: 92%

Outcomes of Percutaneous Coronary Intervention for In‐Stent Restenosis Versus De Novo Lesions: A Meta‐Analysis

Elbadawi

Dang

Mahana

et al. 2023

JAHA

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Background In‐stent restenosis (ISR) is commonly encountered even in the era of contemporary percutaneous coronary intervention (PCI). There is a paucity of data on the comparative outcomes of PCI for ISR lesions versus de novo lesions. Methods and Results An electronic search was conducted for MEDLINE, Cochrane, and Embase through August 2022 for studies comparing the clinical outcomes after PCI for ISR versus de novo lesions. The primary outcome was major adverse cardiac events. Data were pooled using a random‐effects model. The final analysis included 12 studies, with a total of 708 391 patients, of whom 71 353 (10.3%) underwent PCI for ISR. The weighted follow‐up duration was 29.1 months. Compared with de novo lesions, PCI for ISR was associated with a higher incidence of major adverse cardiac events (odds ratio [OR], 1.31 [95% CI, 1.18–1.46]). There was no difference on a subgroup analysis of chronic total occlusion lesions versus none ( P interaction =0.69). PCI for ISR was associated with a higher incidence of all‐cause mortality (OR, 1.03 [95% CI, 1.02–1.04]), myocardial infarction (OR, 1.20 [95% CI, 1.11–1.29]), target vessel revascularization (OR, 1.42 [95% CI, 1.29–1.55]), and stent thrombosis (OR, 1.44 [95% CI, 1.11–1.87]), but no difference in cardiovascular mortality (OR, 1.04 [95% CI, 0.90–1.20]). Conclusions PCI for ISR is associated with higher incidence of adverse cardiac events compared with PCI for de novo lesions. Future efforts should be directed toward prevention of ISR and exploring novel treatment strategies for ISR lesions.

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“…The in-stent CTO is characterized in high lesion stenosis rate, high complexity, high di culty of opening, and special population [14,15] . The research of K. Miura et al it as the result of DES-ISR after DCB angioplasty, and the independent risk factors for RISR [7] .…”

Section: Discussionmentioning

confidence: 99%

Incidence and predictors of recurrent in-stent restenosis after drug-coated balloon angioplasty from central China

Liu

Meng

Sun

et al. 2023

Preprint

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Background: The efficacy and safety of DCB in treating ISR lesions has been widely validated, and the recurrence of ISR (RISR) emerges as one of the primary causes of recurrence of acute coronary syndrome that results in the requirement for multiple revascularizations. Methods: This retrospective study enrolled patients with ISR lesions who were successfully treated by DCB in the First Affiliated Hospital of Zhengzhou University from September 2018 to September 2021. All patients during rehospitalization received the coronary angiography. According to whether there was RISR, the enrolled patients were divided into recurrent in-stent restenosis group (RISR group) and non-recurrent in-stent restenosis group (non-RISR group). The comparison of the basic data, laboratory parameters and the quantitative coronary angiography data at operation and follow-up between the two groups was caried out. According to RISR, multivariate logistic regression analysis was performed on the statistically significant baseline variables for further analysis. Results: A total of 136 patients (147 ISR lesions) were enrolled in the study, 35.4% (52 lesions) developed RISR at follow-up, which lasted 13.6±8.5 months in average.Multivariate analysis revealed the independent association of high RDW, high % DS before procedure and the use of cutting balloon with RISR after DCB angioplasty(P<0.05). Conclusion: At least 1/3 of patients with ISR lesions develop RISR after DCB dilation. High baseline RDW, high %DS before procedure, and the use of cutting balloon were identified as independent predictors of RISR.

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Procedural Results and Long-Term Outcomes of Percutaneous Coronary Intervention for in-Stent Restenosis Chronic Total Occlusion Compared with de novo Chronic Total Occlusion

Cited by 5 publications

References 27 publications

Long-term clinical outcomes of drug-coated balloon for the management of chronic total occlusions

Long-term clinical outcomes of drug-coated balloon for the management of chronic total occlusions

Outcomes of Percutaneous Coronary Intervention for In‐Stent Restenosis Versus De Novo Lesions: A Meta‐Analysis

Incidence and predictors of recurrent in-stent restenosis after drug-coated balloon angioplasty from central China

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