IVUS Findings of Drug Eluting Balloon Failure in the Treatment of In-Stent Restenosis

Abstract

Background and objective: The objective of this study is to investigate pre-intervention IVUS characteristics of instent restenosis (ISR) lesion correlated with PEB failure. Materials and methods: We performed pre-intervention IVUS for 58 patients with ISR and treated with PEB angioplasty. The PEB failure was defined as death, myocardial infarction and symptom driven revascularization. IVUS images were analyzed at 6 locations: Proximal and distal vessel segment within 3 mm from stent edge, proximal and distal stent edge, lesion site at minimal lumen area and minimal stent area. Results: Among 58 patients treated with 58 PEB (3.0 ± 0.4 mm by 21.9 ± 4.8 mm), PEB failure were developed at 8 patients (13.8%) during 0.81 years of follow-up. ISR of drug eluting stent comprised large proportion (86.2%) among index procedure. There was no significant difference in clinical presentation and used stents at index procedure between PEB failure and non-failure group. In PEB failure group, neointimal area (4.0 ± 0.7 vs. 2.9 ± 0.8 mm2, p = 0.05) and neointimal hyperplasia (%) (59.4 ± 12.0 vs. 46.0 ± 24.9%, p = 0.05) were significant greater than non-failure group. Stent under-expansion was found in 24 ISR lesions (48.0%) of non-failure group, whereas none was detected in PEB failure group. Conclusion: PEB failure for ISR lesion could be associated with prominent neointimal hyperplasia on normally extended stent. Future studies are warranted to investigate another RESEaRcH aRticLE