Abstract
Background: The morphological assessment of neointimal tissue using optical coherence tomography (OCT) is highly significant to clarify the pathophysiology of in-stent restenosis (ISR) lesions. These OCT findings may be related to recurrence of ISR. Meanwhile, the effectiveness of paclitaxel-eluting balloon (PEB) dilatation for ISR lesions was reported recently. The aim of this study was to define the impact of OCT findings on recurrence of ISR after PEB dilatation compared with plain old balloon angioplasty (POBA). Methods: Between July 2008 and November 2011, we performed percutaneous coronary intervention for 165 ISR lesions in 141 patients using PEB (109 lesions, PEB group) or POBA (56 lesions, POBA group). The morphological assessment of neointimal tissue at the minimum lumen area site using OCT, including restenotic tissue structure (homogeneous, heterogeneous, or layered type), restenotic tissue backscatter (high or low), visible microvessels, lumen shape, red or white thrombus, lipid-rich plaque (lipid arc more than 90 degrees) was performed. We examined the association between lesion morphologies and mid-term (6-8 months) results including ISR and target lesion revascularization (TLR) rates. Results: The patients were 114 men and 27 women, and the mean age was 68.9 ± 9.6 years. The association of tissue structure with ISR and TLR in both PEB and POBA groups are shown in the figure. The ISR rate of lesions with high backscatter was significantly lower in the PEB group than in the POBA group (17.2% vs. 40.0%, p<0.05). Both ISR and TLR rates of lesions without lipid-rich plaque were significantly lower in the PEB group than in the POBA group (ISR: 22.7% vs. 58.3%, p<0.01; TLR: 15.9% vs. 41.6%, p<0.05). There was no significant difference in other factors between two groups. Conclusions: The morphological assessment of ISR tissue using OCT might be useful to identify ISR lesions favorable for PEB dilatation.
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