Long-term outcomes of percutaneous coronary intervention for in-stent chronic total occlusion

Gong, Minglian; Mao, Yi; Liu, Jinghua

doi:10.1097/cm9.0000000000001289

Cited by 6 publications

(3 citation statements)

References 16 publications

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“…As the other choice of the two main treatment options, DES stenting seems to be the more common and widely accepted treatment for CTO. However, repeated stenting in IS-CTO may again trigger previous stent restenosis factors, such as local abnormal inflammation, adverse reactions to the stent polymer, resistance to antiplatelet agents, stent malapposition or underexpansion, and even immune diseases [29,35]. Therefore, in the intervention of DES IS-CTO, especially in the treatment of complex lesions with multiple stent layers, there is a dilemma that every operator must face.…”

Section: Discussionmentioning

confidence: 99%

Clinical Outcome of Paclitaxel-Coated Balloon Angioplasty Versus Drug-Eluting Stent Implantation for the Treatment of Coronary Drug-Eluting Stent In-Stent Chronic Total Occlusion

Zhang

Wang

et al. 2022

Cardiovasc Drugs Ther

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Aims In-stent chronic total occlusion (IS-CTO) represents a unique challenge for percutaneous coronary intervention. Whether the optimal treatment for IS-CTO is angioplasty with paclitaxel-coated balloons (PCBs) or repeat stenting with drug-eluting stents (DESs) is unclear. We aimed to evaluate the long-term clinical outcome of PCB angioplasty and DES repeat stenting for DES IS-CTO. Methods We retrospectively included patients with DES IS-CTO who underwent successful PCB angioplasty or DES repeat stenting from January 2016 to December 2019. The primary endpoints were major adverse cardiac events (MACEs), including cardiac death, myocardial infarction, and target lesion revascularization (TLR). Cox proportional hazards model was performed to compare the risk of MACEs between PCB angioplasty and DES repeat stenting, and to further explore the prognostic factors of patients with DES IS-CTO. Results A total of 214 patients with DES IS-CTO were enrolled: 78 patients (36.4%) treated with PCB and 136 patients (63.6%) treated with DES respectively. The median follow-up was 1160 days, and MACEs were observed in 28.2% of patients with PCB angioplasty versus 26.5% of patients with DES repeat stenting (P = 0.784), mainly driven by TLR (21.8% vs. 19.9%, P = 0.735). There was no significant difference in the risk of MACEs between the PCB group and the DES group (hazard ratio [HR] 1.25, 95% confidence interval [CI] 0.64–2.46, P = 0.512). Multivariate Cox analysis revealed that chronic kidney disease and ≥ 3 stent layers in the lesion were independent predictors of MACEs, while switching to another antiproliferative drug was an independent protective factor (all P < 0.05). Conclusions PCB angioplasty was an effective alternative treatment strategy for DES IS-CTO, which had similar long-term outcomes to DES repeat stenting in contemporary practice, but both were accompanied by a high rate of long-term MACEs. Improving the poor prognosis of patients with DES IS-CTO remains a challenge.

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Section: Discussionmentioning

confidence: 99%

Clinical Outcome of Paclitaxel-Coated Balloon Angioplasty Versus Drug-Eluting Stent Implantation for the Treatment of Coronary Drug-Eluting Stent In-Stent Chronic Total Occlusion

Zhang

Wang

et al. 2022

Cardiovasc Drugs Ther

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“…As the other of the two main treatment options, DES stenting seems to be the more common and widely accepted treatment for CTO. However, repeated stenting in IS-CTO may again trigger previous stent restenosis factors, such as local abnormal in ammation, adverse reactions to the stent polymer, resistance to antiplatelet agents, stent malapposition or underexpansion, and even immune diseases [29,35]. Therefore, in the intervention of DES IS-CTO, especially in the treatment of complex lesions with multiple stent layers, there was a dilemma that every operator must face.…”

Section: Discussionmentioning

confidence: 99%

Clinical Outcome of Paclitaxel-Coated Balloon Angioplasty Versus Drug-Eluting Stent Implantation for the Treatment of Coronary Drug-Eluting Stent In-Stent Chronic Total Occlusion

Zhang

Wang

et al. 2022

Preprint

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AIMS In-stent chronic total occlusion (IS-CTO) represents a unique challenge for percutaneous coronary intervention (PCI). Whether the optimal treatment for IS-CTO is angioplasty with paclitaxel-coated balloons (PCBs) or repeat stenting with drug-eluting stents (DESs) is unclear. We aimed to evaluate the long-term clinical outcome of PCB angioplasty and DES repeat stenting for DES IS-CTO. METHODS We retrospectively included patients with DES IS-CTO who underwent successful PCB angioplasty or DES repeat stenting from January 2016 to December 2019. The primary endpoints were major adverse cardiac events (MACEs), including cardiac death, myocardial infarction (MI) and target lesion revascularization (TLR). Cox proportional hazards model was performed to compare the risk of MACEs between PCB angioplasty and DES repeat stenting, and to further explore the prognostic factors of patients with DES IS-CTO. RESULTS A total of 214 patients with DES IS-CTO were enrolled: 78 patients (36.4%) treated with PCB and 136 patients (63.6%) treated with DES respectively. The median follow-up was 1160 days, and MACEs were observed in 28.2% of patients with PCB angioplasty versus 26.5% of patients with DES repeat stenting (P = 0.784), mainly driven by TLR (21.8% vs. 19.9%, P = 0.735). There was no significant difference in the risk of MACEs between PCB group and DES group (hazard ratio [HR] 1.25, 95% confidence interval [CI] 0.64–2.46, P = 0.512). Multivariate Cox analysis revealed that chronic kidney disease (CKD) and ≥ 3 stent layers in the lesion were independent predictors of MACEs, while switching to another antiproliferative drug was an independent protective factor (all P < 0.05). CONCLUSIONS PCB angioplasty was an effective alternative treatment strategy for DES IS-CTO, which had similar long-term outcomes to DES repeat stenting in contemporary practice, but both were accompanied by a high rate of long-term MACEs. Improving the poor prognosis of patients with DES IS-CTO remains a challenge.

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“…ISR continues to pose a therapeutic challenge and can be classified as focal, diffuse (with or without involvement of the stent edge), and chronic total occlusion (CTO) based on the results of angiography [ 3 ]. Due to the diffuse neointimal proliferation or neoatherosclerosis that may occur in the stents, the most severe ISR CTOs are more challenging to treat, and the outcomes of conventional treatments such as plain old balloon angioplasty (POBA), drug-coated balloon (DCB) angioplasty, and new stent implantations are usually unsatisfactory [ 4 – 6 ].…”

Section: Introductionmentioning

confidence: 99%

The therapeutic effects of excimer laser coronary atherectomy therapy for in-stent restenosis chronic total occlusions

et al. 2021

BMC Cardiovasc Disord

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Objectives To evaluate the safety and efficacy of excimer laser coronary atherectomy (ELCA) in patients with in-stent restenosis chronic total occlusions (ISR CTOs). Background ISR CTOs are a challenge in percutaneous coronary intervention (PCI). Although they can be treated by ELCA, limited data are available on the effects of ELCA treatment in these patients. Methods Fifty-nine consecutive patients underwent PCI for ISR CTOs at Beijing Hospital between December 2017 and September 2020. According to whether or not ELCA was performed, they were divided into two groups. Quantitative coronary angiography (QCA) analyses were performed routinely, including measurement of the minimal lumen diameter and calculation of the percentage diameter stenosis. The procedural success rate, the frequency of peri-procedural complications, and the incidence rates of major adverse cardiac events (MACEs) over nine months were assessed. The primary endpoint in the study was the percentage diameter stenosis. Results Procedure success was achieved in most patients in both groups (75.9%). Patients in the ELCA group exhibited a lower percentage diameter stenosis (24.5 ± 9.09 vs. 35.1 ± 18.6, p = 0.048) and a larger minimal lumen diameter (2.36 ± 0.29 mm vs. 1.78 ± 0.64 mm, p < 0.001) than those in the control group and the 9-month incidence rates of MACEs did not differ (9.5% vs 15.8%, p = 0.699). Conclusions This study demonstrated that ELCA may be a safe and effective technique in the treatment of ISR CTOs, and the use of ELCA can achieve good immediate angiographic results, as measured by QCA, without increasing peri-procedural complications or the incidence rates of 9-month MACEs.

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Long-term outcomes of percutaneous coronary intervention for in-stent chronic total occlusion

Cited by 6 publications

References 16 publications

Clinical Outcome of Paclitaxel-Coated Balloon Angioplasty Versus Drug-Eluting Stent Implantation for the Treatment of Coronary Drug-Eluting Stent In-Stent Chronic Total Occlusion

Clinical Outcome of Paclitaxel-Coated Balloon Angioplasty Versus Drug-Eluting Stent Implantation for the Treatment of Coronary Drug-Eluting Stent In-Stent Chronic Total Occlusion

Clinical Outcome of Paclitaxel-Coated Balloon Angioplasty Versus Drug-Eluting Stent Implantation for the Treatment of Coronary Drug-Eluting Stent In-Stent Chronic Total Occlusion

The therapeutic effects of excimer laser coronary atherectomy therapy for in-stent restenosis chronic total occlusions

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