Key result
ELCA before drug-coated balloon treatment for in-stent restenosis yielded comparable 1-year target lesion revascularization rates to scoring balloon alone (11.1% vs 11.4%, p=0.85).
Why the study?
ELCA for ISR typically provides superior acute gain via neointima debulking, but the efficacy of combining ELCA with DCB remains unknown.
Does excimer laser coronary atherectomy plus scoring balloon predilation prior to drug-coated balloon treatment improve OCT, angiographic, and clinical outcomes compared to scoring balloon alone in patients with in-stent restenosis?
Cohort (n=42)
Does excimer laser coronary atherectomy plus scoring balloon predilation prior to drug-coated balloon treatment improve OCT, angiographic, and clinical outcomes compared to scoring balloon alone in patients with in-stent restenosis?
Absolute Event Rate: 11.1% vs 11.4%
p-value: p=0.85
Excimer laser coronary atherectomy before drug-coated balloon treatment for in-stent restenosis yields comparable late angiographic and clinical outcomes to scoring balloon predilation alone.
ELCA plus scoring balloon before DCB for ISR warrants prospective trials; leaves open whether combination improves outcomes over scoring balloon alone.
Objectives . We aimed to compare the results of neointimal modification before drug-coated balloon (DCB) treatment with excimer laser coronary atherectomy (ELCA) plus scoring balloon predilation versus scoring balloon alone in patients presenting with in-stent restenosis (ISR). Background . Treatment of ISR with ELCA typically results in superior acute gain by neointima debulking. However, the efficacy of combination therapy of ELCA and DCB remains unknown. Methods . A total of 42 patients (44 ISR lesions) undergoing DCB treatment with ELCA plus scoring balloon (ELCA group, n = 18) or scoring balloon alone (non-ELCA group, n = 24) were evaluated via serial assessment by optical coherence tomography (OCT) performed before, after intervention, and at 6 months. Results . Although there was significantly greater frequency of diffuse restenosis and percent diameter stenosis (%DS) after intervention in the ELCA group, comparable result was shown in %DS, late lumen loss, and binary angiographic restenosis at follow-up. On OCT analysis, a decreased tendency in the minimum lumen area and a significant decrease in the minimum stent area were observed in the ELCA group between 6-month follow-up and after intervention (-0.89 ± 1.36 mm 2 vs. -0.09 ± 1.25 mm 2 , p = 0.05, -0.49 ± 1.48 mm 2 vs. 0.28 ± 0.78 mm 2 , p = 0.03, respectively). The changes in the neointimal area were similar between the groups, and target lesion revascularization showed comparable rates at 1 year (11.1% vs. 11.4%, p = 0.85). Conclusions . Despite greater %DS after intervention, ELCA before DCB had possible benefit for late angiographic and clinical outcome.
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Miyazaki et al. (2019) conducted a cohort in In-stent restenosis (ISR) (n=42). Excimer laser coronary atherectomy (ELCA) plus scoring balloon predilation vs. Scoring balloon alone was evaluated on Target lesion revascularization at 1 year (p=0.85). ELCA before drug-coated balloon treatment for in-stent restenosis yielded comparable 1-year target lesion revascularization rates to scoring balloon alone (11.1% vs 11.4%, p=0.85).
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