Late Stent Thrombosis After Drug-Coated Balloon Coronary Angioplasty for In-Stent Restenosis

Wang, Wenjun; Wang, Bailu; Chen, Yuguo; Wei, Shujian

doi:10.1536/ihj.20-309

“…ISR is a major clinical problem after interventional therapy, which is mainly caused by coronary intimal hyperplasia, and oral administration alone to reduce the incidence of ISR is ineffective and has side effects [ 12 ]. Relevant studies have pointed out that DCB treatment for DES-ISR patients can improve the degree of in-stent stenosis [ 13 , 14 ]. It has also been reported that CBA can reduce the incidence of repeated ISR and have less lumen loss than ordinary high-pressure balloon preconditioning [ 15 , 16 ].…”

Section: Discussionmentioning

confidence: 99%

Efficacy and Prediction Model Construction of Drug-Coated Balloon Combined with Cutting Balloon Angioplasty in the Treatment of Drug-Eluting Stent In-Stent Restenosis

Wu

¹

,

Yu

²

,

Tang

³

et al. 2022

Computational and Mathematical Methods in Medicine

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Objective. To investigate the efficacy of drug-coated balloon (DCB) combined with cutting balloon angioplasty (CBA) in the treatment of drug-eluting stent in-stent restenosis (DES-ISR) and to construct a predictive model for the occurrence of DES-ISR. Methods.According to the criteria of diagnosis, inclusion, and exclusion, DES-ISR patients who were treated in the outpatient and inpatient departments of cardiovascular medicine of Second People’s Hospital of Guangdong Province from July 2021 to December 2021 were included. A total of 72 cases were planned to be enrolled, including 36 cases in the control group and 36 cases in the experimental group. The control group was treated with DCB, and the experimental group was combined with CBA. The treatment success rate, coronary angiography results before and after surgery, and the incidence of major adverse cardiovascular events during the follow-up period were compared between the two groups. Seventy-two DES-ISR patients were divided into ISR group and 59 non-ISR patients were divided into non-ISR group. The clinical data of the two groups were compared to analyze the risk factors affecting the occurrence of DES-ISR, and the prediction model was established. Results. The surgical success rate of the experimental group was 94.44% (34/36), which was higher than the 77.78% (28/36) of the control group ( P < 0.05 ). The minimum lumen diameter (MLD) of the experimental group 6 months after operation was greater than that of the control group, the late lumen loss (LL) and lumen stenosis rate were higher than those in the control group, and the incidence of major adverse cardiovascular events was lower than that in the control group ( P < 0.05 ). In the ISR group, the proportion of patients with abnormal BMI, smoking, hypertension, diabetes, and family history of coronary heart disease and multivessel coronary artery disease was higher than that in the non-ISR group, the degree of stenosis target lesion was higher than that in the non-ISR group, the diameter of target lesion and stent diameter were smaller than those in the non-ISR group, and the length of target lesion and stent length were longer than those in the non-ISR group; the number of stents was more than that in the non-ISR group ( P < 0.05 ). Combined hypertension, multiple coronary artery lesions, stenosis target lesion degree ≥85.05%, and target lesion length ≥36.88 mm were risk factors for DES-ISR, and target lesion diameter ≥3.15 mm and stent diameter ≥3.15 mm were protective factors ( P < 0.05 ). The prediction model of DES-ISR was obtained by multiple logistic regression analysis, P = 1 1 + e 2.281 + 3.321 X hypertension + 3.427 X umber of arterial lesions + 3.359 X stenosis target lesion degree − 3.143 X target lesion diameter + 0.650 X target lesion length − 10.159 X stent diameter . The Hosmer-Lemeshow test showed that Hosmer-Lemeshow χ 2 = 0.925, P =0.413; the ROC curve analysis showed that the AUC of the prediction model for the occurrence of DES-ISR was 0.924, the SE value was 0.022, and the 95% CI was 0.880-0.967. Conclusion. DCB combined with CBA has good clinical efficacy in the treatment of DES-ISR, which can reduce the rate of lumen stenosis and the incidence of adverse cardiovascular events. The prediction model established according to risk factors has high predictive value for the occurrence of DES-ISR.

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“…A loading dose of 180 mg followed by a maintenance dose of 90 mg twice daily are recommended for patients with ACS, while a dose of 60 mg twice daily is recommended for long-term antiplatelet prophylaxis in high-ischemic-risk CAD patients [ 5 , 39 , 40 ]. Although a recent randomized study suggested better efficacy (with similar safety profile) of prasugrel compared to ticagrelor in ACS patients undergoing PCI [ 2 ], ticagrelor therapy had been repeatedly described as an effective approach for overcoming clopidogrel resistance [ 5 , 41 , 42 ] and is still preferred in those ACS patients who could not receive prasugrel.…”

Section: Novel-generation Adprbmentioning

confidence: 99%

Resistance on the Latest Oral and Intravenous P2Y12 ADP Receptor Blockers in Patients with Acute Coronary Syndromes: Fact or Myth?

Blaško

¹

,

Samoš

²

,

Bolek

³

et al. 2022

JCM

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Novel P2Y12 ADP receptor blockers (ADPRB) should be preferred in dual-antiplatelet therapy in patients with acute coronary syndrome. Nevertheless, there are still patients who do not respond optimally to novel ADP receptor blocker therapy, and this nonoptimal response (so-called “high on-treatment platelet reactivity” or “resistance”) could be connected with increased risk of adverse ischemic events, such as myocardial re-infarction, target lesion failure and stent thrombosis. In addition, several risk factors have been proposed as factors associated with the phenomenon of inadequate response on novel ADPRB. These include obesity, multivessel coronary artery disease, high pre-treatment platelet reactivity and impaired metabolic status for prasugrel, as well as elderly, concomitant therapy with beta-blockers, morphine and platelet count for ticagrelor. There is no literature report describing nonoptimal therapeutic response on cangrelor, and cangrelor therapy seems to be a possible approach for overcoming HTPR on prasugrel and ticagrelor. However, the optimal therapeutic management of “resistance” on novel ADPRB is not clear and this issue requires further research. This narrative review article discusses the phenomenon of high on-treatment platelet reactivity on novel ADPRB, its importance in clinical practice and approaches for its therapeutic overcoming.

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“…The findings of two major randomized trials [9,10] establish that elective stent insertion is better for new pathological changes in balloon angioplasty for large coronary arteries (.3 mm). Though, nearly one-third of lesions in current practice are situated in narrow (3 mm) coronary arteries, [11,12] a status associated with poor prognosis after balloon angioplasty [13].…”

Section: Introductionmentioning

confidence: 99%

Efficacy of Coronary Stenting Versus Ballon Angioplasty in Small Coronary Arteries

Khan¹,

Khalil²,

Latif³

et al. 2022

PJMHS

0

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Background and aim: The most common approach of percutaneous myocardial revascularization is stent placement. In de novo focal lesions found in big native arteries, balloon angioplasty had lower efficacy than coronary stenting. However, the usefulness of stenting in small arteries remains debatable. The purpose study aimed to compare the efficacy of coronary stenting vs. balloon angioplasty in small coronary arteries. Patients and Method: This comparative study was carried out on 132 patients with lesion in small coronary arteries (reference diameter <3mm) in the department of Interventional Cardiology, MTI- Hayat Abad Medical Complex, Peshawar from 16th January 2021 to 15th July 2022. Patients were arbitrarily assigned to stent implantation and standard balloon angioplasty. Study protocol was approved by research and ethical committee. Each individual provided written informed consent. The rates of clinical event were evaluated within 1 year. Descriptive statistics was carried out in SPSS version 26. Results: Of the total patients, there were 80 (60.6%) male and 52 (39.4%) were females. Both groups were assigned 66 patients and had similar baseline characteristics and angiography data. Based on treatment analysis, the major adverse cardiac events (MACEs) and angiographic success rate were similar: 5.2% and 96.8% in coronary stenting versus 5.9% and 92.4% in balloon angioplasty group respectively. About 4.2% patients underwent abrupt closure changes within 30 days. Stenting convened the substantially larger lumen (1.52 mm vs. 1.32 mm, p<0.001) at 6 months and larger post-procedural lumen diameter (2.31 vs. 1.82 mm, p<0.001) as compared to balloon angioplasty. The incidence of restenosis was found 36% and 56% in coronary stenting and balloon angioplasty respectively. The survival rate (event-free) was achieved in 79% and 69% (p=0.021) in coronary stenting and angioplasty respectively. Conclusion: The present study found that optimum balloon angioplasty with preliminary stenting may be a viable therapeutic option for small coronary arteries lesions. Restenosis was found to be 36% and 56% in coronary stenting and balloon angioplasty, respectively. Keywords: Restenosis, Small coronary arteries, Balloon angioplasty, Coronary stenting

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Late Stent Thrombosis After Drug-Coated Balloon Coronary Angioplasty for In-Stent Restenosis

Cited by 5 publications

References 10 publications

Efficacy and Prediction Model Construction of Drug-Coated Balloon Combined with Cutting Balloon Angioplasty in the Treatment of Drug-Eluting Stent In-Stent Restenosis

Efficacy and Prediction Model Construction of Drug-Coated Balloon Combined with Cutting Balloon Angioplasty in the Treatment of Drug-Eluting Stent In-Stent Restenosis

Resistance on the Latest Oral and Intravenous P2Y12 ADP Receptor Blockers in Patients with Acute Coronary Syndromes: Fact or Myth?

Efficacy of Coronary Stenting Versus Ballon Angioplasty in Small Coronary Arteries

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