Why the study?
Angioplasty for in-stent restenosis remains challenging, and there are relatively few data on long-term outcomes after intervention for intra-stent chronic total occlusion.
Does treatment with a drug-coated balloon or drug-eluting stent improve clinical outcomes compared to plain old balloon angioplasty in patients with intra-stent chronic total occlusion?
Does treatment with a drug-coated balloon or drug-eluting stent improve clinical outcomes compared to plain old balloon angioplasty in patients with intra-stent chronic total occlusion?
In patients undergoing PCI for intra-stent CTO, the use of drug-coated balloons or drug-eluting stents is associated with lower rates of MACE and TLR compared to plain balloon angioplasty at long-term follow-up.
Answers are grounded in this paper and cite their sources.
May favor DCB over POBA/DES for intra-stent CTO; leaves open optimal strategy pending randomized data.
BACKGROUND: Angioplasty for ISR remains a challenge with relatively high rates of recurrence. Although there is a plethora of data on ISR, there is relatively less data on intra-stent-CTO. In this study, we explore the long-term clinical outcomes following angioplasty to intra-stent CTO and study the differences in clinical outcomes between three treatment-arms: POBA vs. DES vs. DCB. METHODS AND RESULTS: We evaluated all patients who underwent PCI to intra-stent CTO between 2011 and 2017. The endpoints used were: cardiac-death, TVMI, TLR, TVR, and MACE.During the study period, 403-patients with a mean age of 69.2 years had successful PCI to intra-stent CTO. 50% were diabetic, 38% had CKD and 32% had left ventricular dysfunction. 93% of cases were stable angina. 22% (n = 88) received only POBA, 28% (n = 113) received DCB and 50% (n = 202) received DES. During the median follow-up of 48-months, cardiac-death occurred in 5.8% (n = 23), TVMI in 4% (n = 16), TLR in 45.6% (n = 182), TVR in 48.7% (n = 194) and MACE of 46%. There were no differences in the hard endpoints between the 3treatment arms. However, the TLR and overall MACE were better in DCB and DES-groups as compared to POBA (TLR: 33%vs.42%vs.49%; p = 0.06); MACE (34% vs. 45% vs. 52%; p = 0.05). CONCLUSION: This is the first study that has focussed on the outcomes following angioplasty to intra-stent CTOs with a very long-term follow-up. The hard endpoints were low, although the TLR rates were high. In regards to treatment strategy, the DCB and DES provide relatively better outcomes than POBA.
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Basavarajaiah et al. (2021) studied this question.
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