Balloon Angioplasty For In-stent Restenosis Research Articles

Balloon Blocking Technique to Overcome Watermelon Seeding Phenomenon during Balloon Angioplasty for Instent Restenosis.

Balloon Blocking Technique to Overcome Watermelon Seeding Phenomenon during Balloon Angioplasty for Instent Restenosis.

Endovascular bypass as a strategy for long femoropopliteal lesions.

Endovascular treatment has become the predominant treatment modality for femoropopliteal lesions. In longer and more complex lesions advanced technology is often required to improve results, with the endovascular bypass being one of them. A systematic review of the literature was performed to determine the clinical and technical outcomes of the latest generation endoprosthesis, with heparin bioactive surface and contoured proximal edge. 13 articles were enrolled: 3 randomized controlled trials, 4 prospective multicenter trials and 6 retrospective studies. The VIASTAR trial showed that the endoprosthesis has a better two-year primary patency compared to bare metal stenting, especially in long lesions (62% vs. 27%, P=0.004). The SUPERB trial showed that the endoprosthesis had similar results compared to bypass surgery, albeit with less complications (31% vs. 55%, P=0.048). The RELINE study showed that treatment with an endoprosthesis had a better one-year primary patency compared to balloon angioplasty for in-stent restenosis (75% vs. 28%, P<0.001). In the cohort studies one-year patency rates ranged from 61% to 86% for primary patency, from 65% to 92% for primary assisted patency, and from 83% to 95% for secondary patency. For long femoropopliteal lesions, the heparin-bonded endoprosthesis is related to better outcomes compared to bare nitinol stents, and comparable outcomes as with the femoropopliteal bypass, but with less complications. There is a wide range in primary patency rates, with consistent high secondary patency rates. The endovascular bypass can be considered an appropriate strategy in these patients.

Open-Label Multicenter Registry on the Outcomes of In-Stent Restenosis Treated by Balloon Angioplasty with Optical Frequency Domain Imaging in the Superficial Femoral Artery (ISLAND-SFA Study).

Objectives: Balloon angioplasty for in-stent restenosis (ISR) in the superficial femoral artery (SFA) has a high recurrent restenosis rate; however, its mechanism has not been fully and precisely evaluated using high-resolution intravascular imaging. Thus, we aimed to evaluate the relationship between vascular features obtained by optical frequency domain imaging (OFDI) and recurrent restenosis at 6 months.Methods: This was a prospective multicenter single-arm study. OFDI was performed before and after balloon angioplasty, and vascular features were assessed. A multi-layered ISR pattern detected by OFDI was defined as several signal-poor appearances with a high-signal band adjacent to the luminal surface. The primary outcome was defined as recurrent restenosis 6 months after balloon angioplasty.Results: Given that this study was terminated early, only 18 patients completed the 6-month follow-up; of these, 8 developed restenosis. Recurrent restenosis at 6 months tended to be related to a multi-layered ISR pattern (odds ratio (OR), 6.67; 95% confidence interval (CI), 0.81–54.96; p=0.078) and the minimum lumen area (MLA) after balloon angioplasty (OR, 0.71; 95%CI, 0.48–1.04; p=0.077).Conclusion: A multi-layered ISR pattern and MLA after balloon angioplasty detected by OFDI might be risk factors for recurrent ISR in the SFA.

Drug-coated balloon angioplasty for in-stent restenosis - a question of the right device or the right patient selection and technique?

Drug-coated balloon angioplasty for in-stent restenosis - a question of the right device or the right patient selection and technique?

Coronary aneurysm formation after paclitaxel-coated balloon angioplasty for in-stent restenosis of first-generation sirolimus-eluting stent implanted 9years ago.

Coronary aneurysm formation after paclitaxel-coated balloon angioplasty for in-stent restenosis of first-generation sirolimus-eluting stent implanted 9years ago.

Endovascular Reconstruction of Subclavian Artery Aneurysms in Patients with Arterial Thoracic Outlet Syndrome

Subclavian artery aneurysms associated with thoracic outlet syndrome (TOS) have traditionally been managed by open surgical reconstruction. Endovascular subclavian artery reconstruction is novel in the setting of arterial TOS (aTOS). Our objective is to report our results with endovascular subclavian artery reconstruction in aTOS patients over a 10-year period with attention to surgical approach and late results. Patients who underwent stent-graft reconstruction of subclavian artery aneurysms associated with aTOS between 2006 and 2016 were identified in a prospective database. Data collected included age, gender, presentation, surgical details, and outcomes. Over the study period, 869 TOS procedures were performed. Of these, 7 (0.8%) were aTOS related subclavian artery aneurysms managed with stent-graft repair. All presented with upper extremity pain (7) and a majority with limb-threatening ischemia (6). Other significant findings included subclavian artery aneurysm (7), cervical rib (4), and clavicular fracture (3). TOS decompression was accomplished via transaxillary cervical and first rib resection. Stent-graft deployment was performed concurrently with TOS decompression via brachial artery approach. The mean follow-up period was 24.9months (range 1-60). Two patients required reintervention for stent thrombosis (1.5months, 36months) and 1 required balloon angioplasty for in-stent restenosis (24months). Limb salvage was achieved in all patients with no major amputations, no minor amputations, and restoration of normal function in all. Our experience indicates that stent-graft reconstruction of subclavian artery aneurysms associated with aTOS is successful. This procedure was characterized by short surgical times, low blood loss, and no complications. It may be subject to late graft thrombosis or stenosis and requires life-long surveillance.

Abstract 16601: Evaluation of Vascular Response After Balloon Angioplasty for In-Stent Restenosis Assessed by Optical Frequency Domain Imaging

Background and aim: The optimal balloon angioplasty (BA) procedure for in-stent restenosis (ISR) was not established. The aim of this study was to investigate vascular response after BA in ISR lesions using optimal frequency domain imaging (OFDI). Methods and results: This study consisted of 22 ISR lesions that were treated with BA. OFDI analysis were performed for 10mm longitudinal ISR segment including minimum lumen area before and after BA, furthermore morphology of ISR neointimal tissue and volumetric measurements were assessed. We analyzed at 1mm interval cross-sectional OFDI images of lesions before BA, and at every slices per each lesion, the neointimal tissue was divided into 2 morphologic patterns: homogeneous pattern and non-homogeneous pattern. Then, the neointimal tissue morphological characteristics of each lesion was expressed according to “homogeneous ratio”, defined as the number of homogeneous pattern slices divide by a total of slices. In volumetric OFDI measurements, lumen gain rate was calculated as (lumen volume (LV) after BA - LV before BA) / LV before BA, stent expansion rate as (stent volume (SV) after BA - SV before BA) / SV before BA and neointimal volume (NV) reduction rate as (NV before BA -NV after BA) / NV before BA. There was no correlation between homogeneous ratio and lumen gain ratio. There was positive correlation between homogeneous ratio and stent expansion ratio, and there was negative correlation between homogeneous ratio and neointimal volume reduction ratio (figure). Conclusions: OFDI assessment is useful to understand the vascular response by BA for ISR lesions. The mechanism of lumen gain in BA procedure for ISR lesions with homogeneous tissue is mainly obtained by stent expansion, whereas for lesions with non-homogeneous tissue is by neointimal tissue compression.

The impact of tissue characterization for in-stent restenosis with optical coherence tomography during excimer laser coronary angioplasty

We aimed to evaluate the impact of tissue characterization for in-stent restenosis (ISR) with optical computed tomography (OCT) during excimer laser coronary angioplasty (ELCA) in the drug-eluting stent (DES) era. The effect of ELCA for ISR according to differences in tissue characteristics is unclear. Fifty-three ISR lesions (7 bare metal stents and 46 drug-eluting stents) were treated with an ELCA catheter. After ELCA, balloon dilatation with either the scoring or non-compliant balloons was conducted. The procedure was completed by applying a drug-coated balloon. Tissue characterization and lumen measurement with OCT were performed thrice: (1) before percutaneous coronary intervention (PCI), (2) after ELCA, and (3) and after the procedure. Lesions were categorized into the homogenous, layered, and mixed groups. Follow-up angiograms were conducted 6–12 months after PCI. No significant differences in minimal lumen area (MLA) were observed before PCI. A significant difference was observed in MLA after ELCA among the three groups (homogeneous group: 1.75 ± 0.84 mm2, layered group: 1.72 ± 0.45 mm2, mixed group: 2.24 ± 0.70 mm2, P = 0.048). Final MLA was larger in the mixed group than in the homogeneous group (P = 0.028). No significant difference was observed in binary restenosis in the follow-up angiogram (homogeneous group 55.5%, layered group 33.3%, mixed group 33.3%; P = 0.311) and the target lesion revascularization rate (homogeneous 30.0%, layered 23.8%, mixed 25.0%; P = 0.923). Tissue characterization by OCT may predict the efficacy of ELCA and balloon angioplasty for ISR during the acute phase.

TCTAP A-071 Sirolimus Coated Balloon Angioplasty for In-stent Restenosis in Small Coronary Arteries

TCTAP A-071 Sirolimus Coated Balloon Angioplasty for In-stent Restenosis in Small Coronary Arteries

Cutting balloon angioplasty for in-stent restenosis in Takayasu's arteritis

Cutting balloon angioplasty for in-stent restenosis in Takayasu's arteritis

TCT-560 Paclitaxel-Eluting Balloon versus conventional Balloon Angioplasty for In-Stent Restenosis of Superficial Femoral Artery. The ISAR-PEBIS randomized trial

TCT-560 Paclitaxel-Eluting Balloon versus conventional Balloon Angioplasty for In-Stent Restenosis of Superficial Femoral Artery. The ISAR-PEBIS randomized trial

P2072Independent predictors of the recurrent restenosis after paclitaxel-coated balloon angioplasty for in-stent restenosis

P2072Independent predictors of the recurrent restenosis after paclitaxel-coated balloon angioplasty for in-stent restenosis

Drug-coated balloon angioplasty for in-stent restenosis of femoropopliteal arteries: a meta-analysis.

Our aim was to perform a meta-analysis to investigate the outcomes of patients undergoing percutaneous revascularisation with drug-coated balloon (DCB) angioplasty because of femoropopliteal in-stent restenosis (ISR). We searched scientific databases for studies of DCB angioplasty for femoropopliteal ISR. The primary outcome was target lesion revascularisation (TLR). The main secondary outcome was recurrent ISR. Other outcomes of interest were Rutherford class (RC) improvement, ankle-brachial index (ABI) and death. A total of 367 patients enrolled in four studies received DCB (n=188) or plain balloon angioplasty (n=179). Median follow-up was 12 months. Patients treated with DCB angioplasty displayed a lower risk for TLR (odds ratio [OR] 0.20, 95% confidence interval [CI]: 0.07-0.55, p=0.002) and recurrent ISR (OR 0.24, 95% CI: 0.09-0.61, p=0.003), and a sustained RC improvement (OR 2.57, 95% CI: 1.40-4.72, p=0.002) with similar ABI and mortality as compared to those patients treated with plain balloon angioplasty. In comparison to plain balloon angioplasty, DCB therapy for femoropopliteal ISR is associated with superior clinical and antirestenotic efficacy. Further randomised trials comparing DCB with therapies alternative to plain balloon, in a larger number of patients, and with extended follow-up are needed to address definitively the role of DCB for femoropopliteal ISR.

Angiographic and clinical outcomes of patients treated with drug-coated balloon angioplasty for in-stent restenosis after coronary bifurcation stenting with a two-stent technique.

We conducted this study to evaluate the efficacy of drug-coated balloon therapy for in-stent restenosis after coronary bifurcation stenting. Patients who underwent angioplasty with at least one paclitaxel-coated balloon for in-stent restenosis after bifurcation intervention using a two-stent approach were included. Two types of paclitaxel-coated balloon were used, with either an iopromide (iopromide-PCB) or a butyryl tri-n-hexyl citrate (BTHC-PCB) excipient. Angiographic surveillance was planned at six to eight months. Quantitative coronary angiography analysis was carried out with dedicated bifurcation analysis software. Clinical follow-up was performed to one year. In total, 177 patients were included in this study. Information on the type of stent technique used at the time of the index intervention was available for 145 (81.9%) patients: the culotte technique was used in 123 (69.5%) and T-stenting in 22 (12.4%) patients. Iopromide-PCB and BTHC-PCB were used in 124 (70%) and 53 (30%) patients, respectively. Of 125 patients who underwent angiographic follow-up, 30 cases (24%) of binary restenosis were observed. At one year, the composite endpoint of death, myocardial infarction or target lesion revascularisation was observed in 35 patients (24%). There was no significant difference in the incidence of angiographic and clinical outcomes between iopromide-PCB versus BTHC-PCB. In the setting of in-stent restenosis after coronary bifurcation stenting, drug-coated balloons demonstrated good clinical efficacy without the requirement for further stent implantation. There were similar outcomes between iopromide-PCB and BTHC-PCB.

TCT-393 Long-term Outcomes of Repeated Paclitaxel-coated Balloon Angioplasty for Recurrent Restenosis Lesions after Paclitaxel-coated Balloon Angioplasty for In-stent Restenosis

Paclitaxel-coated balloon (PCB) angioplasty is reported to be effective for in-stent restenosis (ISR) lesions; however, PCB failure has emerged as reccurent ISR after PCB angioplasty for ISR lesions. The long-term outcomes of repeated PCB angioplasty for PCB failure remain unclear. Between November

A Prospective, Randomized Study of an Expanded Polytetrafluoroethylene Stent Graft versus Balloon Angioplasty for In-Stent Restenosis in Arteriovenous Grafts and Fistulae: Two-Year Results of the RESCUE Study

PurposeTo assess the safety and efficacy of an expanded polytetrafluoroethylene stent graft versus balloon angioplasty for the treatment of in-stent restenosis in the venous outflow of hemodialysis access grafts and fistulae. Materials and MethodsTwo hundred seventy-five patients were randomized at 23 US sites to stent-graft placement or percutaneous transluminal angioplasty (PTA). Primary study endpoints were access circuit primary patency (ACPP) at 6 months and safety through 30 days; secondary endpoints were evaluated through 24 months. ResultsACPP at 6 months was significantly higher in the stent-graft group (18.6%) versus the PTA group (4.5%; P < .001), and freedom from safety events (30 days) was comparable (stent graft, 96.9%; PTA, 96.4%; P = .003 for noninferiority). The separation in ACPP survival curves remained through 12 months (stent graft, 6.2%; PTA, 1.5%). Treatment area primary patency (TAPP) was superior for the stent-graft group (66.4%) versus the PTA group (12.3%) at 6 months (P < .001), with a survivorship difference in favor of stent-graft placement maintained through 24 months (stent graft, 15.6%; PTA, 2.2%). ACPP and TAPP for the stent-graft group were better than those for the PTA group when compared within central and peripheral vein subgroups (P < .001). In central veins, TAPP was 13.6% in the stent-graft group versus 4.3% in the PTA group at 24 months (P < .001). ConclusionsStent-graft use provided better ACPP and TAPP than PTA when treating in-stent restenosis in patients receiving dialysis with arteriovenous grafts and fistulae.

Incidence and distribution of thin-high signals detected by coronary optical coherence tomography in patients treated with paclitaxel-coated balloon angioplasty for in-stent restenosis

Incidence and distribution of thin-high signals detected by coronary optical coherence tomography in patients treated with paclitaxel-coated balloon angioplasty for in-stent restenosis

Coronary angioscopy and optical coherence tomography for confirmation of drug-coated neointimal plaque after paclitaxel-coated balloon angioplasty for in-stent restenosis

Coronary angioscopy and optical coherence tomography for confirmation of drug-coated neointimal plaque after paclitaxel-coated balloon angioplasty for in-stent restenosis

Cutting balloon angioplasty for in-stent restenosis of the aortic coarctation in a young boy presenting with systemic hypertension of the upper extremities

An 8.25-year-old boy was incidentally found to have systemic hypertension of the upper extremities. Blood pressures of the upper extremities were 142-150/86-98 mmHg, and those of the lower extremities 110-116/60-66 mmHg. Doppler echocardiography showed in-stent restenosis of the aortic coarctation. Traditional high-pressure balloon angioplasty failed to dilate this inveterate in-stent restenosis. Instead, a cutting balloon angioplasty was performed. The lumen was dilated from 4.80 mm to 7.89 mm. The pressure gradient dropped from 32 mmHg to 9 mmHg. Blood pressures of the upper extremities were 112-116/76-78 mmHg, and those of the lower extremities 100-104/70-72 mmHg.This paper highlights that a cutting balloon angioplasty can serve as a juste milieu to relieve in-stent restenosis of the aortic coarctation when traditional high-pressure balloon angioplasty is debatable.

In-stent tissue characteristics detected by optical coherence tomography may affect re-restenosis after cutting balloon angioplasty for in-stent restenosis

Purpose: Cutting balloon angioplasty (CBA) is one of proposed treatments for in-stent restenosis (ISR) but re-restenosis rate after CBA is relatively high. In this study, we investigated whether optical coherence tomography (OCT) detected tissue characteristics can affect re-restenosis after CBA for ISR. Methods: Seventy consecutive patients with ISR who received OCT-guided CBA were enrolled. We divided our patients into TLR group in whom we performed target lesion revascuralization (TLR) for re-restenosis over 3 months after CBA for ISR and non-TLR group in whom we didn't perform TLR. We compared the incidence of drug-eluting stent, phase of ISR, ISR pattern, balloon size, maximal inflation pressure and the OCT parameters of ISR before CBA including restenotic tissue structure/backscatter, microvessels, thrombus and minimum lumen area between the two groups. Results: The rate of TLR was 21.4%. The incidence of microvessels, thrombus and heterogeneous or layered pattern in TLR group (n=15) was significantly higher than non-TLR group (n=55) while the other parameters showed non-significant differences (table). View this table: Table 1 Conclusions: The incidence of microvessels, thrombus and heterogeneous or layered pattern in ISR tissue detected by OCT may affect re-restenosis after CBA for ISR.