Excimer laser coronary angioplasty combined with drug-coated balloon in the treatment of in-stent restenosis

IF 2.2 3区医学 Q2 DERMATOLOGY

Lasers in Surgery and Medicine Pub Date : 2024-05-13 DOI:10.1002/lsm.23794

Pan He, Haiwei Chen, Junjie Yang, Lei Gao, Jun Guo, Yundai Chen, Qi Wang

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Abstract

Objectives

The aim of this study is to investigate the safety and efficacy of excimer laser coronary angioplasty (ELCA) combined with drug-coated balloons (DCBs) in the treatment of in-stent restenosis (ISR), and to explore whether the contrast injection technique would improve the neointimal tissue ablation of ELCA.

Methods

We studied patients diagnosed with ISR between January 2019 and October 2022 at two medical centers. These patients underwent DCB angioplasty guided by optical coherence tomography (OCT). Based on whether ELCA was performed before DCB treatment, patients were categorized into two groups: the ELCA + DCB group and the DCB group. All patients underwent clinical follow-up 1 year after the procedure. The primary endpoint was the 1-year rate of target lesion revascularization (TLR), which was defined as any repeat percutaneous intervention or bypass surgery on the target vessel conducted to address restenosis or other complications related to the target lesion. The secondary endpoints including immediate luminal gain (ΔMLA, defined as the difference in minimum lumen area before and after the intervention).

Results

A total of 85 lesions in 75 patients were included. The mean age of the study population was 64.2 ± 12.0 years, with 81.3% male. Baseline clinical characteristics were well-balanced, and procedural success was 100% in both groups. The ELCA + DCB group (n = 24) exhibited a greater ΔMLA compared to the DCB group (n = 61) (3.57 ± 0.79 mm² vs. 2.50 ± 1.06 mm², [95% confidence interval, CI: 0.57–1.69], p < 0.001), The reduction in 1-year TLR was more frequently observed in patients from the ELCA + DCB group compared to the DCB group (hazard ratio 0.33 [95% CI: 0.11–0.99]; log-rank p = 0.048). The exploratory analysis showed that ELCA with contrast infusion is associated with greater acute lumen gain compared to ELCA with saline infusion (p < 0.001).

Conclusions

The combination of ELCA and DCB is a safe and effective treatment strategy for in-stent stenosis. Additionally, compared with saline injection, ELCA with contrast injection is associated with greater acute lumen gain. However, the optimal contrast agent concentration and long-term outcome of the contrast injection technique need confirmation through larger sample sizes and prospective studies.

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准分子激光冠状动脉血管成形术联合药物涂层球囊治疗支架内再狭窄。

研究目的本研究旨在探讨准分子激光冠状动脉成形术（ELCA）联合药物涂层球囊（DCB）治疗支架内再狭窄（ISR）的安全性和有效性，并探讨造影剂注射技术是否能改善ELCA的新生内膜组织消融：我们对两家医疗中心在2019年1月至2022年10月期间诊断为ISR的患者进行了研究。这些患者在光学相干断层扫描（OCT）的引导下接受了 DCB 血管成形术。根据 DCB 治疗前是否进行了 ELCA，患者被分为两组：ELCA + DCB 组和 DCB 组。所有患者都在术后一年接受了临床随访。主要终点是靶病变血运重建（TLR）的1年率，TLR的定义是为解决再狭窄或与靶病变相关的其他并发症而对靶血管进行的任何重复经皮介入治疗或搭桥手术。次要终点包括即时管腔增大（ΔMLA，定义为介入治疗前后最小管腔面积的差异）：结果：共纳入了 75 名患者的 85 个病灶。研究对象的平均年龄为（64.2 ± 12.0）岁，81.3%为男性。两组患者的基线临床特征均衡，手术成功率均为100%。与 DCB 组（n = 61）相比，ELCA + DCB 组（n = 24）的ΔMLA 更大（3.57 ± 0.79 mm² vs. 2.50 ± 1.06 mm²，[95% 置信区间，CI：0.57-1.69]，p 结论：ELCA + DCB 组的ΔMLA 更小：ELCA和DCB联合治疗支架内狭窄是一种安全有效的治疗策略。此外，与生理盐水注射相比，注射造影剂的 ELCA 与急性管腔增大相关。然而，造影剂的最佳浓度和造影剂注射技术的长期效果还需要通过更大样本量的前瞻性研究来证实。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Lasers in Surgery and Medicine 医学-外科

CiteScore

5.40

自引率

12.50%

发文量

119

审稿时长

1 months

期刊介绍： Lasers in Surgery and Medicine publishes the highest quality research and clinical manuscripts in areas relating to the use of lasers in medicine and biology. The journal publishes basic and clinical studies on the therapeutic and diagnostic use of lasers in all the surgical and medical specialties. Contributions regarding clinical trials, new therapeutic techniques or instrumentation, laser biophysics and bioengineering, photobiology and photochemistry, outcomes research, cost-effectiveness, and other aspects of biomedicine are welcome. Using a process of rigorous yet rapid review of submitted manuscripts, findings of high scientific and medical interest are published with a minimum delay.