Key result
Cutting or scoring balloon angioplasty shows no TLR benefit over plain balloon before intravascular brachytherapy.
Why the study?
Optimal lesion preparation techniques prior to coronary intravascular brachytherapy for recurrent in-stent restenosis remain undefined.
Does lesion preparation with cutting/scoring balloon angioplasty reduce target lesion revascularization compared to plain balloon angioplasty in patients undergoing intravascular brachytherapy for coronary in-stent restenosis?
Cohort (n=219)
No
Does lesion preparation with cutting/scoring balloon angioplasty reduce target lesion revascularization compared to plain balloon angioplasty in patients undergoing intravascular brachytherapy for coronary in-stent restenosis?
Absolute Event Rate: 26.6% vs 17.9%
p-value: p=0.17
Lesion preparation with cutting/scoring balloons prior to intravascular brachytherapy for in-stent restenosis does not significantly improve 1-year clinical outcomes compared to conventional plain balloon angioplasty.
Similar 1-year TLR rates with either preparation; leaves open optimal lesion prep before IVBT for ISR pending prospective trials.
Background Coronary intravascular brachytherapy (IVBT) has remained as an effective treatment for recurrent in-stent restenosis (ISR). However, optimal lesion preparation techniques prior to radiation delivery remain undefined. This study evaluated the clinical outcomes of IVBT after lesion preparation with either plain balloon angioplasty or cutting/scoring balloon angioplasty. Methods We conducted a retrospective analysis of 219 patients who underwent vascular brachytherapy for coronary ISR between June 2016 and January 2024 at the Houston Methodist Hospital. Patients were stratified based on the type of balloon used for lesion preparation: plain balloon (n = 140) or cutting/scoring balloon (n = 79). The primary end point was target lesion revascularization (TLR) at 1 year. Secondary end points included major adverse cardiovascular events, stent thrombosis, and bleeding complications. Results Baseline demographic characteristics were similar between groups, except for older age in the cutting/scoring balloon group (67.0 ± 11.0 vs 64.0 ± 10.3 years; P = .047). Lesion length was comparable (28.01 ± 18.62 vs 26.49 ± 17.16 mm; P = .55). At 1-year follow-up, TLR rates were similar (26.6% vs 17.9%; P = .17), as were major adverse cardiovascular event rates (32.9% vs 35.0%; P = .86). Conclusions We observed no significant difference in 1-year and 3-year clinical outcomes compared to conventional plain balloon angioplasty. The trend toward higher TLR rates in the cutting/scoring balloon group warrants further investigation in larger, prospective studies. These findings suggest that lesion-specific factors, rather than balloon type alone, may be more important determinants of outcomes after IVBT for ISR.
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Sella et al. (2025) conducted a cohort in Coronary in-stent restenosis (n=219). Cutting/scoring balloon angioplasty vs. Plain balloon angioplasty was evaluated on Target lesion revascularization (TLR) at 1 year (p=0.17). Cutting/scoring balloon angioplasty before intravascular brachytherapy yielded similar 1-year target lesion revascularization rates to plain balloon (26.6% vs 17.9%; P=0.17).
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