Hachinohe Daisuke, Kashima Yoshifumi, Hirata Kazuya, Kanno Daitaro, Kobayashi Ken, Kaneko Umihiko, Sugie Takuro, Tadano Yutaka, Watanabe Tomohiko, Shitan Hidemasa, Haraguchi Takuya, Enomoto Morio, Sato Katsuhiko, Fujita Tsutomu
The Sapporo Heart Center, Sapporo Cardio Vascular Clinic, Sapporo, Japan.
J Interv Cardiol. 2018 Dec;31(6):747-754. doi: 10.1111/joic.12558. Epub 2018 Sep 2.
This study aimed to evaluate the outcomes of patients with in-stent restenosis (ISR) who underwent rotablation (RA) followed by balloon angioplasty (BA), drug-eluting stent (DES) implantation, or drug-coated balloon (DCB) angioplasty.
Interventional treatment of ISR is occasionally challenging. Despite the availability of various percutaneous treatments, the optimal solution remains unclear.
A total of 200 patients with ISR who underwent RA were retrospectively identified from our institutional database. Clinical outcomes at 12 months and independent predictors of target lesion revascularization (TLR) were assessed. Of patients, 90, 55, and 55 underwent BA, DES implantation, and DCB angioplasty, respectively. The incidence of all-cause death, cardiac death, and hospitalization due to heart failure was low in all groups. Moreover, no definite stent thrombosis was observed in the three groups. The TLR rate of BA, DES implantation, and DCB angioplasty following RA for ISR were 40.7%, 35.0%, and 27.3%, respectively. The adjusted outcomes for TLR using the inverse probability of treatment weighting method based on propensity scores indicated that DCB angioplasty following RA was superior to BA after RA. Intraprocedural complications, which could be successfully managed with interventional treatment, were identified in only three cases.
TLR at 12 months is dismal. RA is not effective for ISR requiring RA. In unfavorable settings, DCB angioplasty following RA is the most effective treatment option in patients with ISR requiring debulking strategy.
本研究旨在评估接受旋磨术（RA）后再行球囊血管成形术（BA）、药物洗脱支架（DES）植入术或药物涂层球囊（DCB）血管成形术的支架内再狭窄（ISR）患者的治疗结果。
ISR的介入治疗有时具有挑战性。尽管有多种经皮治疗方法，但最佳解决方案仍不明确。
从我们机构的数据库中回顾性识别出总共200例接受RA的ISR患者。评估了12个月时的临床结果以及靶病变血运重建（TLR）的独立预测因素。其中，分别有90例、55例和55例患者接受了BA、DES植入术和DCB血管成形术。所有组中全因死亡、心源性死亡和因心力衰竭住院的发生率均较低。此外，三组均未观察到明确的支架血栓形成。RA后ISR行BA、DES植入术和DCB血管成形术的TLR率分别为40.7%、35.0%和27.3%。使用基于倾向评分的治疗权重逆概率方法对TLR进行调整后的结果表明，RA后DCB血管成形术优于RA后BA。仅3例患者出现术中并发症，经介入治疗可成功处理。
12个月时的TLR情况不佳。RA对需要RA的ISR无效。在不利情况下，RA后DCB血管成形术是需要减容策略的ISR患者最有效的治疗选择。
