Abstract 13597: The Association Between Tissue Morphology Assessed With Optical Coherence Tomography and Mid-term Results After Paclitaxel-coated Balloon Dilatation

Abstract

Introduction: It was reported that mid-term results after paclitaxel-coated balloon (PCB) dilatation for in-stent restenosis (ISR) lesions might differ depending on the tissue morphology of ISR lesions assessed with optical coherence tomography (OCT). It was also reported that ISR lesions after drug-eluting stent (DES) implantation was associated with poorer mid-term outcomes compared with those after bare-metal stent (BMS) implantation after PCB dilatation. The aim of this study was to define the impact of OCT findings on recurrence of ISR after PCB dilatation. Methods: Between October 2008 and December 2013, we performed percutaneous coronary intervention for 210 ISR lesions in 180 patients using PCB (143 men, mean age 68.8±9.4 years). The restenotic tissue structure at the minimum lumen area site (homogeneous, heterogeneous, or layered type) was assessed with OCT. We examined the association between tissue structure and acute/mid-term (6-8 months) results including acute gain, late loss, ISR and target lesion revascularization rates. Furthermore, we also examined the distribution of tissue structure types in each previous procedure type including BMS/DES implantation and PCB dilatation. Results: The mean follow-up period was 194±36 days. The association of tissue structure with mid-term results is shown in the figure. The late loss was significantly larger in lesions with heterogeneous structure than in those with homogeneous and layered structures. The prevalence of heterogeneous structure in each previous procedure type is also shown in the figure. The prevalence of heterogeneous structure was significantly lower in lesions after BMS implantation than in those after PCB dilatation. Conclusions: The tissue morphology of ISR lesion assessed with OCT may have an impact on the mid-term efficacy of PCB. The difference in distribution of tissue structure types may also be related to the difference between efficacies of PCB with each previous procedure type.