Mechanisms of Postintervention and Nine-Month Luminal Enlargement After Treatment of Drug-Eluting In-Stent Restenosis With a Drug-Eluting Balloon

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• 作者：Seung-Yul Lee ; MD^a ; Myeong-Ki Hong ; MD ; PhD^a ; ^b ; ^{mkhong61@yuhs.ac" class="auth_mail} ; Dong-Ho Shin ; MD ; MPH^a ; Jung-Sun Kim ; MD^a ; Byeong-Keuk Kim ; MD^a ; Young-Guk Ko ; MD^a ; Donghoon Choi ; MD^a ; Yangsoo Jang ; MD^a ; ^b
• 刊名：The American Journal of Cardiology
• 出版年：1 May, 2014
• 年：2014
• 卷：113
• 期：9
• 页码：1468-1473
• 全文大小：730 K

文摘

Using optical coherence tomography (OCT), the mechanisms of postintervention and 9-month luminal enlargement in drug-eluting stent in-stent restenosis (ISR) lesions treated with a drug-eluting balloon (DEB) were evaluated. A total of 42 patients with DEB-treated drug-eluting stent ISR lesions underwent serial OCT examination before intervention, after intervention, and at 9-month follow-up. Preintervention OCT-derived neointima was classified as either a homogeneous or nonhomogeneous pattern. Ten ISR lesions with homogeneous neointima were identified and compared with 32 ISR lesions with nonhomogeneous neointima. When comparing pre- and postintervention evaluations, changes in luminal cross-sectional area (CSA) were 3.4聽mm² in ISR lesions with homogeneous neointima and 3.7聽mm² in those with nonhomogeneous neointima, respectively (p聽= 0.529); changes in stent CSA were 2.5聽mm² and 1.4聽mm², respectively, p聽= 0.004; and changes in neointimal CSA were聽鈭?.9聽mm² and聽鈭?.3聽mm², respectively, p聽= 0.001. At 9-month follow-up, changes in luminal CSA were聽鈭?.0聽mm² and聽鈭?.9聽mm² in ISR lesions with homogeneous and nonhomogeneous neointima, respectively (p聽= 0.021); in stent CSA changed by聽鈭?.2聽mm² in both groups (p聽= 0.851) and changes in neointimal CSA was 1.8聽mm² and 0.7聽mm², respectively (p聽= 0.003). At the 9-month follow-up, >50% neointimal CSA stenosis was observed in 60% and 19% of the ISR lesions with homogeneous and nonhomogeneous neointima, respectively (p聽= 0.020). In conclusion, the mechanism of postintervention luminal enlargement by DEB varied with the preintervention OCT-based neointimal characteristics. ISR lesions with homogeneous neointima determined by OCT were associated with greater subsequent regrowth of neointima after DEB treatment.