Cutting balloon versus conventional balloon angioplasty for the treatment of in-stent restenosis

Albiero, Remo; Silber, Sigmund; Mario, Carlo Di; Cernigliaro, C; Battaglia, Salvatore; Reimers, Bernhard; Frasheri, Arian; Klauß, Volker; Auge, Joseph M.; Rubartelli, Paolo; Morice, Marie‐Claude; Cremonesi, Alberto; Schofer, Joachim; Bortone, Alessandro Santo; Colombo, Antonio; Investigators, Rescut

doi:10.1016/j.jacc.2003.09.054

Cited by 182 publications

(53 citation statements)

References 21 publications

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“…CB has been shown to facilitate dilation of fibrotic and restenotic lesions with less dissection and less bailout stenting. 13,14 Also, cryoplasty reduces elastic recoil of the arterial segment by altering elastin fibers in the vessel wall. 15 This potentially reduces recoil and need for stenting.…”

mentioning

confidence: 99%

An Overview of Optimal Endovascular Strategy in Treating the Femoropopliteal Artery: Mechanical, Biological, and Procedural Factors

Shammas¹

2013

Int J Angiol

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ReviewPeripheral arterial disease is highly prevalent in the general population affecting 12 to 14% of people and leading to claudication or threatened limb ischemia. 1 Endovascular lower extremity arterial interventions have increased exponentially over the past decade. 2 The femoropopliteal (FP) segment represents 40% of vessels treated and its treatment continues to be a challenge to the endovascular specialist. Despite a high rate of acute procedural success, target lesion revascularization (TLR) and target vessel revascularization remain elevated. 3,4 We have previously proposed a triad of optimal peripheral vascular revascularization strategy (►Fig. 1) 5 with an emphasis on three key principles: (1) Mechanical, improve vessel compliance to allow dilatation of a stenotic segment at low balloon inflation pressure and reduce dissection and recoil. Low balloon inflation pressure would theoretically preserve vessel integrity by minimizing barotrauma and bailout stenting. (2) Biological, inhibit smooth muscle cell (SMC) proliferation to improve patency rates and reduce repeat revascularization. (3) Procedural, preserve the outflow vessels by minimizing distal embolization (DE) and reduce procedural time and radiation exposure to both operator and patient.In this overview, we examine these principles to determine whether current data support their validity. We recognize the lack of uniform performance criteria and reporting standards in clinical trials in peripheral arterial disease. This unfortunately makes comparisons across studies difficult. Mechanical FactorsThe concept of improving vessel compliance as a prerequisite to a more definitive treatment of the FP artery has gained more attention over the past few years. Measurement of vessel compliance in vivo is difficult to obtain. One surrogate endpoint is the minimum balloon pressure (MBP) needed to fully stretch the artery to a lumen diameter equal to a normal reference segment with the use of a noncompliant balloon sized 1:1 to the reference vessel. The balloon is typically inflated to two atmospheres then the inflation pressure is increased by increment of one atmosphere at a time until full balloon expansion is achieved. 6,7 According to Laplace's law, tension (T) in the vessel wall is equal to (pressure (P) gradient across the arterial wall * radius (R) of artery)/wall thickening (M), or (T¼ [P * R]/M). In order for MBP change to reflect on compliance, the segments under comparison need to have similar radius and lesion Keywords AbstractTreatment of the femoropopliteal (FP) artery remains a challenge to the endovascular specialist. Long-term patency is low with a high rate of target lesion revascularization. The true patency rate varies considerably between studies partly because there is a lack of uniform performance criteria and reporting standards in peripheral arterial interventions. Literature review supports three principles that emerge as important components of an optimal strategy in treating the FP artery: (1) improving vessel compliance and sub...

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confidence: 99%

An Overview of Optimal Endovascular Strategy in Treating the Femoropopliteal Artery: Mechanical, Biological, and Procedural Factors

Shammas¹

2013

Int J Angiol

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“…It is of note that the CB has been reported to be safer for the reason that it does not slip out the stent and because the incisions made the dilatation of the elastic neointimal mass easier. Altogether, the use of CB in in-stent restenosis is associated with some procedural advantages [9]. Furthermore, CB still has its role besides other alternatives in treating fibrocalcific lesions, some bifurcational lesions, and ostial stenoses.…”

Section: Discussionmentioning

confidence: 99%

Comminution of a prolapsed thrombus after coronary stent implantation using cutting balloon

Komócsi¹,

Költő²,

Horváth³

et al. 2012

Interventional Medicine and Applied Science

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Coronary thrombosis and secondary embolization remain two of the major challenges of intervention in myocardial infarction. Pharmacological dissolution as well as instruments to evacuate the thrombotic mass with or without distal protection have been applied in the acute interventions with variable degrees of success. With time, cross-linking of the fibrin strands results in a resilient, partially organizing coagulate that is more or less attached to the wall of the artery. The currently used devices designed to cope with recently formed thrombus may fail to disrupt these flexible structures, and pharmacological dissolution is also usually ineffective. Here, we report a case with a subacute occlusion; after failure of thrombus extraction, mechanical comminution of a clot with cutting balloons was successfully performed.

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“…After a careful matching process, late lumen loss, loss index and restenosis rates were significantly lower after CBA. These favorable results, however, could not be confirmed in the RESCUT trial, 8 in which 428 patients with BMS-ISR were randomized to PBA or CBA. After CBA, the occurrence of balloon slippage was significantly reduced (6.5% vs 25%) and there was a trend for a lower requirement of stenting.…”

Section: Previous Studiesmentioning

confidence: 93%

“…A similar problem might have afflicted RESCUT. 8 Fifth, subgroups analyses, specially limited by sample size constraints, are of interest as hypothesis generating. Indeed, the possibility that CBA may be particularly advantageous in patients with DES-ISR and in focal lesions would require confirmation in larger studies.…”

Section: Present Studymentioning

confidence: 99%

Interventions for Drug-Eluting Stent Restenosis

Alfonso¹

2010

Circ J

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Circulation Journal Official Journal of the Japanese Circulation Society http://www. j-circ.or.jp reatment of patients with in-stent restenosis (ISR) remains a clinical and technical challenge. Bare-metal stents (BMS), still widely used during coronary interventions, suffer from relatively high rates of ISR recurrence. Drug-eluting stents (DES) have drastically reduced the incidence of ISR, but the problem has not been completely eliminated. Indeed, treatment of DES-ISR appears to confer poorer results than those seen in BMS-ISR. 1,2 Currently, the standard of care for patients suffering from BMS-ISR remains DES implantation. 3,4 Several randomized studies have demonstrated the benefit of DES over alternative strategies in this setting. 3,4 Although DES are widely used in the management of DES-ISR results of such an intervention appear less favorable. 1,2 Further, whether a switch strategy is superior to re-intervention with the same DES remains controversial. 1,2 Finally, the drug-eluting balloon has raised great expectations, 5 but its value in DES-ISR needs to be established. Article p 1837ISR is caused by severe neointimal proliferation obstructing the stent lumen. Therefore, the use of debulking strategies to tackle this resistant, elastic, tissue was considered an attractive option. However, ablative techniques failed to meet initial expectations and were complicated by high recurrence rates. 6 Another strategy to "modify/prepare" the underlying proliferative tissue is cutting balloon angioplasty (CBA). Initial studies suggested the safety and efficacy of CBA in this scenario; 7 however, a large randomized study failed to demonstrate the superiority of CBA over plain balloon angioplasty (PBA), although CBA prevented balloon-slippage related-problems. 8,9 With the advent of DES the caveat of edge DES-ISR was re-emphasized. 1 In this setting, CBA might also offer an attractive strategy.In this issue of the Journal, Park et al 10 report on the use of CBA in a large cohort of patients with ISR. Notably, a significant number of patients were treated for DES-ISR. This is relevant considering the scarce information currently available on the management of DES-ISR with CBA. Previous StudiesISR constitutes an adverse anatomic substrate. CBA microblades are capable of longitudinally incising neointimal obstructive tissue, thus potentially facilitating its extrusion/ redistribution. Precise control of the injured segment boundaries, avoiding undesirable forward/backward balloon movements, is also very important when dealing with the slippery tissue causing ISR. Our group previously analyzed the implications of the "watermelon seeding" phenomenon. 11 This problem (detected in 9% of 450 patients with BMS-ISR) was frequently found in long and severe lesions and was associated with complex and prolonged procedures, suboptimal results, residual dissections and unplanned stent requirement. Importantly, balloon slippage was associated with poorer long-term angiographic results. 11 Many initial studies suggested the value of...

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Cutting balloon versus conventional balloon angioplasty for the treatment of in-stent restenosis

Cited by 182 publications

References 21 publications

An Overview of Optimal Endovascular Strategy in Treating the Femoropopliteal Artery: Mechanical, Biological, and Procedural Factors

An Overview of Optimal Endovascular Strategy in Treating the Femoropopliteal Artery: Mechanical, Biological, and Procedural Factors

Comminution of a prolapsed thrombus after coronary stent implantation using cutting balloon

Interventions for Drug-Eluting Stent Restenosis

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