Long-term Outcome following Percutaneous Intervention of Intra-stent Coronary Occlusion and Evaluating the Different Treatment Modalities

• Main Authors: Sandeep Basavarajaiah, Satoru Mitomo, Sunao Nakamura, Vinoda Sharma, Ishaq Mohammed, Yusuke Watanabe, Toru Ouchi, Gurbir Bhatia, Jerome Ment, Sampath Athukorala, Michael Pitt, George Pulikal, Bethan Freestone, Hannah Rides, Nitin Kumar, Richard Watkin, Kaeng Lee
• Format: Article
• Language: English
• Published: Elsevier 2021-06-01
• Series: International Journal of Cardiology: Heart & Vasculature
• Subjects: In-stent restenosis; Chronic total occlusion; Drug eluting stent; Drug coated balloon
• Online Access: http://www.sciencedirect.com/science/article/pii/S2352906721000919

Background: Angioplasty for ISR remains a challenge with relatively high rates of recurrence. Although there is a plethora of data on ISR, there is relatively less data on intra-stent-CTO. In this study, we explore the long-term clinical outcomes following angioplasty to intra-stent CTO and study the differences in clinical outcomes between three treatment-arms: POBA vs. DES vs. DCB. Methods and results: We evaluated all patients who underwent PCI to intra-stent CTO between 2011 and 2017. The endpoints used were: cardiac-death, TVMI, TLR, TVR, and MACE.During the study period, 403-patients with a mean age of 69.2 years had successful PCI to intra-stent CTO. 50% were diabetic, 38% had CKD and 32% had left ventricular dysfunction. 93% of cases were stable angina. 22% (n = 88) received only POBA, 28% (n = 113) received DCB and 50% (n = 202) received DES. During the median follow-up of 48-months, cardiac-death occurred in 5.8% (n = 23), TVMI in 4% (n = 16), TLR in 45.6% (n = 182), TVR in 48.7% (n = 194) and MACE of 46%. There were no differences in the hard endpoints between the 3treatment arms. However, the TLR and overall MACE were better in DCB and DES-groups as compared to POBA (TLR: 33%vs.42%vs.49%; p = 0.06); MACE (34% vs. 45% vs. 52%; p = 0.05). Conclusion: This is the first study that has focussed on the outcomes following angioplasty to intra-stent CTOs with a very long-term follow-up. The hard endpoints were low, although the TLR rates were high. In regards to treatment strategy, the DCB and DES provide relatively better outcomes than POBA.