Comparison of 2 Different Paclitaxel-Coated Balloons in CoronaryIn-Stent Restenosis: A Randomized Controlled Trial.

Abstract

Drug-coated balloons (DCBs) offer an effective treatment for in-stent restenosis (ISR). The Genoss DCB is a novel paclitaxel-coated balloon with a shellac plus vitamin E excipient that enhances drug delivery to the target lesion, minimizing restenosis. This study aimed to investigate the angiographic efficacy, clinical safety, and effectiveness of the novel shellac plus vitamin E-based DCB in a randomized controlled trial designed to enable regulatory approval of this new device in South Korea. This noninferiority trial randomized patients experiencing their first ISR to the novel shellac plus vitamin E-based DCB or the reference SeQuent Please iopromide-based DCB in a 1:1 ratio. All patients underwent planned angiographic and clinical follow-up at 6months. The study was powered for the primary endpoint of 6months in-segment late lumen loss (LLL). A total of 82 patients from 7 centers were randomized to either the novel shellac plus vitamin E-based DCB group (n=41) or the reference iopromide-based DCB group (n=41). The 6-month in-segment LLL was 0.15 ± 0.43mm with the novel DCB compared with 0.24 ± 0.39mm with the reference device. The 1-sided 97.5% upper confidence limit of the difference was 0.13mm, lower than the noninferiority limit of 0.29mm, achieving noninferiority (P for noninferiority=0.001). Major cardiovascular events were comparable between 2 groups at 6months (7.7% for the novel DCB vs 10.3% for the reference DCB; P = 0.692). In this multicenter, head-to-head comparison randomized trial, the novel shellac plus vitamin E-based DCB showed a comparable result to the reference iopromide-based device for the primary endpoint of 6-month in-segment LLL for the treatment of coronary ISR. (Compare the Safety and Efficacy of Genoss® DCB and SeQuent® Please in Korean Patient With Coronary In-stent Restenosis; NCT04405063).