Intraplaque wiring enables drug‐coated balloons to be utilized for percutaneous recanalization of chronically occluded coronary arteries

Abstract

Objectives This study aimed to determine whether drug‐coated balloon (DCB) angioplasty following intraplaque wiring and the use of modified balloons is safe and effective in the percutaneous treatment of coronary chronic total occlusions (CTOs). Background DCB is an alternative therapeutic option without the limitations of permanent vascular implants. However, its efficacy in CTOs has yet to be confirmed. The combination of modified balloons and DCB can be effectively applied when the intraplaque passage of the guidewire is achieved in CTOs. Methods Data from 124 consecutive CTO lesions (105 patients) treated at our hospital between February 2016 and December 2020 were screened for inclusion and retrospectively analyzed. Among the 118 lesions successfully recanalized, intraplaque wiring was achieved in 108, and 85 were treated by the DCB‐only approach following cutting/scoring balloon dilatation. Results Follow‐up data were available for 82 lesions (71 patients). The median occlusion length was 18.5 mm, and the J‐CTO score was 1.7 ± 0.9. No in‐hospital major adverse cardiac events occurred, including abrupt vessel closure. During the median 29‐month follow‐up period, target lesion revascularization was performed for 10 lesions. Follow‐up coronary angiography (8.7 ± 3.9 months after the index procedure) was performed for 64 lesions, demonstrating late lumen loss of −0.15 mm (interquartile range −0.4 to 0.23 mm), binary restenosis (diameter stenosis ≥50%) in 12 lesions (18.8%), and late lumen enlargement in 37 (57.8%). Conclusion The DCB‐only approach following the use of modified balloons is a promising strategy for coronary CTOs when intraplaque wiring is achieved.

Efficacy and safety of drug-coated balloons in chronic total coronary occlusion recanalization: a systematic review and meta-analysis

“…Post-recanalization, the previously occluded segment undergoes extravascular remodeling due to long-term hypoperfusion. Over time, the restoration of anterograde blood flow and perfusion pressure helps to return the segment to its original size [ 13 ]. In addition, considering that most CTO segments contain organized thrombi rich in fibrin or proteoglycans in their occluded segments, the recovery of blood flow may promote the dissolution of organized thrombi, thereby further increasing the lumen [ 32 ].…”

“…Studies were then excluded for one of the following reasons: (a) they did not report de novo CTO lesions; (b) they were not original articles; and (c) they were review articles or case reports. Finally, a total of 5 studies were available for the meta-analysis, including 511 patients [11][12][13][14][15]. Figure 1 shows the flowchart of the study selection procedure.…”

“…Considering the high risk of restenosis or thrombosis and the prevalence of CTO, it seems reasonable to study whether the DCB-only method is a feasible option for treating such lesions. However, only a few small sample sizes and short follow-up studies have evaluated the effectiveness of DCB in treating de novo CTO lesions [11][12][13][14][15]. To shed further light on this issue, we conducted a systematic literature review and meta-analysis to assess the clinical outcomes of DCB treatment for patients with CTO lesions.…”

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

“…Two patients who intended to receive DCB only strategy had bailout stenting in the target lesion during the same procedure and were excluded from the study. Previous results showed the incidence of target lesion revascularization (TLR) after DCB only strategy in CTO lesions is 7.1–12.2% during 8–12 month follow up [ 8 , 9 ], which is higher than the incidence of TLR (6.3%) after DES implantation in CTO PCIs in randomized studies [ 10 ]. Considering the fact that inclusion of patients with bailout stenting in DCB-only group might favor the outcomes of DCB treatment, we excluded them from the study.…”

What is the role of drug‐coated balloons in chronic total occlusion percutaneous coronary intervention?

“…There is limited observational data on DCB utilization in CTO PCI. In this issue of the journal, Terashita et al 2 retrospectively analyzed clinical and angiographic outcomes of DCB use in 124 consecutive CTO PCIs attempted at a single center. Crossing was achieved in 118 CTO lesions (success rate 95.1%) with 108 lesions crossed with intraplaque wire tracking (antegrade or retrograde) as detected by intravascular ultrasound.…”