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Leick J, Rheude T, Denne M, Tobias K, Cassese S, Kastrati A, Afzal S, Hug KP, Saad L, Lauterbach M, Werner N. Comparison of long-term outcome in patients with in-stent restenosis treated with intravascular lithotripsy or with modified balloon angioplasty. Clin Res Cardiol 2023:10.1007/s00392-023-02357-3. [PMID: 38112745 DOI: 10.1007/s00392-023-02357-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 12/04/2023] [Indexed: 12/21/2023]
Abstract
BACKGROUND Modified balloon angioplasty (MB) using a cutting-/scoring balloon or intravascular lithotripsy (IVL) is used in patients with in-stent restenosis (ISR). However, IVL is an off-label use in this setting. The aim of this subgroup analysis of an all-comers registry was to compare IVL to MB angioplasty in patients with ISR. METHODS The subgroup (n = 117) included all patients with an ISR treated by MB or IVL between 2019 and 2021. Primary endpoint was strategy success (< 20% residual stenosis). The secondary endpoint was cardiac death, acute myocardial infarction (AMI) and target lesion failure/revascularization (TVR). Quantitative coronary angiography was performed in all patients. RESULTS A total of n = 36 patients were treated by IVL and n = 81 patients by MB. No significant differences in baseline characteristics were observed between the groups. The primary endpoint was reached in 99 patients (84.6%). Patients in the IVL group had less residual stenosis (2.8% vs. 21.0%; p = 0.012). Multivariate regression analysis revealed that IVL had a significant positive effect on reaching the primary end point (Estimate 2.857; standard error (SE) 1.166; p = 0.014). During the follow-up period (450 days) there were no significant differences in rates of cardiac death (IVL n = 2 (1.7%) vs. MB n = 3 (2.6%); p = 0.643), AMI (IVL n = 2 (1.7%) vs. MB n = 4 (3.4%); p = 0.999) and TVR (IVL n = 5 (4.3%) vs. MB n = 14 (12%); p = 0.851). CONCLUSION IVL results in a significantly lower rate of residual stenosis than MB in patients with ISR. During the long-term follow-up, no differences in rates of cardiac death, AMI or TVR were observed.
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Affiliation(s)
- Jürgen Leick
- Department of Cardiology, Heart Centre Trier, Barmherzige Brueder Hospital, Nordallee 1, 54296, Trier, Germany.
| | - Tobias Rheude
- Department of Cardiovascular Diseases, German Heart Centre, , Technical University Munich, Lazarettstraße 36, 80636, Munich, Germany
| | - Michael Denne
- Department of Cardiology, Heart Centre Trier, Barmherzige Brueder Hospital, Nordallee 1, 54296, Trier, Germany
| | - Krause Tobias
- Department of Cardiology, Heart Centre Trier, Barmherzige Brueder Hospital, Nordallee 1, 54296, Trier, Germany
| | - Salvatore Cassese
- Department of Cardiovascular Diseases, German Heart Centre, , Technical University Munich, Lazarettstraße 36, 80636, Munich, Germany
| | - Adnan Kastrati
- Department of Cardiovascular Diseases, German Heart Centre, , Technical University Munich, Lazarettstraße 36, 80636, Munich, Germany
| | - Shazia Afzal
- Department of Cardiology, Heart Centre Trier, Barmherzige Brueder Hospital, Nordallee 1, 54296, Trier, Germany
| | - Karsten P Hug
- Department of Cardiovascular Diseases, German Heart Centre, , Technical University Munich, Lazarettstraße 36, 80636, Munich, Germany
| | - Louai Saad
- Department of Cardiology, Heart Centre Trier, Barmherzige Brueder Hospital, Nordallee 1, 54296, Trier, Germany
| | - Michael Lauterbach
- Department of Cardiology, Heart Centre Trier, Barmherzige Brueder Hospital, Nordallee 1, 54296, Trier, Germany
| | - Nikos Werner
- Department of Cardiology, Heart Centre Trier, Barmherzige Brueder Hospital, Nordallee 1, 54296, Trier, Germany
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