Intravascular imaging analysis of a drug-eluting balloon followed by a bare metal stent compared to a drug-eluting stent for treatment of de novo lesions.

Abstract

BACKGROUND/AIMS:

After a study comparing drug-eluting stents (DESs) to sequential treatment with drug-eluting balloons (DEBs) and bare metal stents (BMSs), we retrospectively analysed strut malapposition and neointimal hyperplasia in de novo coronary lesions using optical coherence tomography (OCT) or intravascular ultrasonography (IVUS).

METHODS:

We obtained OCT data from 16 patients (eight per group) and IVUS data from 40 patients (20 per group). OCT or IVUS was performed after the index procedure and after 9 months. Parameters including obstruction volume due to neointimal hyperplasia (neointimal hyperplasia volume/stent volume, %), strut malapposition (% of malapposed struts), and intra-individual inhomogeneity of in-stent restenosis were compared.

RESULTS:

Although obstruction volume due to neointimal hyperplasia was significantly higher in the DEB-BMS group (14.90 ± 15.36 vs. DES 7.03 ± 11.39, p = 0.025), there was no difference in strut malapposition between the two groups (DEB-BMS 1.99 ± 5.37 vs. DES 0.88 ± 2.22, p = 0.856). The DEB-BMS group showed greater intra-individual inhomogeneity of in-stent restenosis pattern than the DES group.

CONCLUSION:

Treatment with DEB followed by BMS failed to improve strut malapposition despite higher in-stent neointimal growth, probably because of the inhomogeneous inhibition of in-stent neointimal hyperplasia by DEB. DEB technology should be improved to obtain even drug delivery to the vessel wall and homogeneous prevention of neointimal growth comparable to contemporary DES.

• Authors: Wonsuk Choi, In-Ho Chae, Jin Joo Park, Sun-Hwa Kim, Si-Hyuck Kang, Il-Young Oh, Chang-Hwan Yoon, Young-Seok Cho, Tae-Jin Youn, Dong-Ju Choi
• Journal: The Korean journal of internal medicine (Korean J Intern Med) Vol. 34 Issue 4 Pg. 819-829 (Jul 2019) ISSN: 2005-6648 [Electronic] Korea (South)
• PMID: 29961306 (Publication Type: Comparative Study, Journal Article)

Chemical References

• Coated Materials, Biocompatible
• Metals

Topics

• Aged
• Angioplasty, Balloon, Coronary (adverse effects, instrumentation)
• Cardiac Catheters
• Coated Materials, Biocompatible
• Coronary Angiography
• Coronary Artery Disease (diagnostic imaging, therapy)
• Coronary Vessels (diagnostic imaging)
• Drug-Eluting Stents
• Female
• Humans
• Hyperplasia
• Male
• Metals
• Middle Aged
• Neointima
• Predictive Value of Tests
• Prosthesis Design
• Randomized Controlled Trials as Topic
• Retrospective Studies
• Stents
• Time Factors
• Tomography, Optical Coherence
• Treatment Outcome
• Ultrasonography, Interventional