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Merinopoulos I, Corballis N, Gunawardena T, Bhalraam U, Natarajan R, Reinhold J, Wickramarachchi U, Maart C, Sawh C, Sulfi S, Gilbert T, Wistow T, Ryding A, Vassiliou VS, Eccleshall SC. Assessment of Scoring Balloons in STEMI Patients Treated With DCB-Only Angioplasty: A Single Center Study. Health Sci Rep 2025; 8:e70839. [PMID: 40406647 PMCID: PMC12095844 DOI: 10.1002/hsr2.70839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2024] [Revised: 04/11/2025] [Accepted: 04/17/2025] [Indexed: 05/26/2025] Open
Abstract
Background and Aims A randomized trial has previously demonstrated that neointimal modification with a scoring balloon improves the anti-restenotic effect of drug-coated balloon (DCB) in patients with drug-eluting stent restenosis. There are very limited data about the safety and efficacy of using scoring balloons as part of lesion preparation in patients with STEMI, especially in patients with de novo disease treated with DCB-only angioplasty. Methods We undertook an analysis of the SPARTAN Norwich Registry to address this question. We compared the composite endpoint of cardiovascular mortality or unplanned target lesion revascularization in the DCB-only cohort stratified based on the use or not of scoring balloon as part of the lesion preparation. Furthermore, we undertook a propensity score-matched analysis of the DCB-only cohort. Results A total of 452 consecutive patients were treated with DCB-only angioplasty and scoring balloon was used in 121 patients as part of the lesion preparation. Scoring balloon was not a significant predictor of the composite endpoint even after propensity score-matched analysis. Chronic obstructive pulmonary disease was the only significant predictor of the composite endpoint after propensity score-matched analysis. Conclusion This is the first study demonstrating the safety and efficacy of scoring balloon as part of lesion preparation in patients with STEMI due to de novo disease treated with DCB-only angioplasty. Trial Registration https://clinicaltrials.gov/ct2/show/NCT04482972; Unique identifier: NCT04482972.
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Affiliation(s)
- Ioannis Merinopoulos
- Department of CardiologyNorfolk and Norwich University HospitalNorwichNorfolkUK
- Norwich Medical SchoolUniversity of East AngliaNorwichUK
| | - Natasha Corballis
- Department of CardiologyNorfolk and Norwich University HospitalNorwichNorfolkUK
- Norwich Medical SchoolUniversity of East AngliaNorwichUK
| | - Tharusha Gunawardena
- Department of CardiologyNorfolk and Norwich University HospitalNorwichNorfolkUK
- Norwich Medical SchoolUniversity of East AngliaNorwichUK
| | - U. Bhalraam
- Department of CardiologyNorfolk and Norwich University HospitalNorwichNorfolkUK
- Norwich Medical SchoolUniversity of East AngliaNorwichUK
| | - Rajkumar Natarajan
- Department of CardiologyNorfolk and Norwich University HospitalNorwichNorfolkUK
- Norwich Medical SchoolUniversity of East AngliaNorwichUK
| | - Johannes Reinhold
- Department of CardiologyNorfolk and Norwich University HospitalNorwichNorfolkUK
- Norwich Medical SchoolUniversity of East AngliaNorwichUK
| | - Upul Wickramarachchi
- Department of CardiologyNorfolk and Norwich University HospitalNorwichNorfolkUK
- Norwich Medical SchoolUniversity of East AngliaNorwichUK
| | - Clint Maart
- Department of CardiologyNorfolk and Norwich University HospitalNorwichNorfolkUK
| | - Chris Sawh
- Department of CardiologyNorfolk and Norwich University HospitalNorwichNorfolkUK
| | - Sreekumar Sulfi
- Department of CardiologyNorfolk and Norwich University HospitalNorwichNorfolkUK
| | - Tim Gilbert
- Department of CardiologyNorfolk and Norwich University HospitalNorwichNorfolkUK
| | - Trevor Wistow
- Department of CardiologyNorfolk and Norwich University HospitalNorwichNorfolkUK
| | - Alisdair Ryding
- Department of CardiologyNorfolk and Norwich University HospitalNorwichNorfolkUK
| | - Vassilios S. Vassiliou
- Department of CardiologyNorfolk and Norwich University HospitalNorwichNorfolkUK
- Norwich Medical SchoolUniversity of East AngliaNorwichUK
| | - Simon C. Eccleshall
- Department of CardiologyNorfolk and Norwich University HospitalNorwichNorfolkUK
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2
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Giacoppo D. Paclitaxel- or sirolimus-coated balloons for coronary bifurcations: is the side branch SPACIOUS enough for both? EUROINTERVENTION 2025; 21:e290-e292. [PMID: 40091876 PMCID: PMC11891917 DOI: 10.4244/eij-e-25-00004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/19/2025]
Affiliation(s)
- Daniele Giacoppo
- Department of General Surgery and Medical-Surgical Specialties, University of Catania, Catania, Italy
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3
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Somsen YBO, Rissanen TT, Hoek R, Ris TH, Stuijfzand WJ, Nap A, Kleijn SA, Henriques JP, de Winter RW, Knaapen P. Application of Drug-Coated Balloons in Complex High Risk and Indicated Percutaneous Coronary Interventions. Catheter Cardiovasc Interv 2025; 105:494-516. [PMID: 39660933 PMCID: PMC11788978 DOI: 10.1002/ccd.31316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2024] [Revised: 11/21/2024] [Accepted: 11/22/2024] [Indexed: 12/12/2024]
Abstract
There is a growing trend of patients with significant comorbidities among those referred for percutaneous coronary intervention (PCI). Consequently, the number of patients undergoing complex high risk indicated PCI (CHIP) is rising. CHIP patients frequently present with factors predisposing to extensive drug-eluting stent (DES) implantation, such as bifurcation and/or heavily calcified coronary lesions, which exposes them to the risks associated with an increased stent burden. The drug-coated balloon (DCB) may overcome some of the limitations of DES, either through a hybrid strategy (DCB and DES combined) or as a leave-nothing-behind strategy (DCB-only). As such, there is a growing interest in extending the application of DCB to the CHIP population. The present review provides an outline of the available evidence on DCB use in CHIP patients, which comprise the elderly, comorbid, and patients with complex coronary anatomy. Although the majority of available data are observational, most studies support a lower threshold for the use of DCBs, particularly when multiple CHIP factors coexist within a single patient. In patients with comorbidities which predispose to bleeding events (such as increasing age, diabetes mellitus, and hemodialysis) DCBs may encourage shorter dual antiplatelet therapy duration-although randomized trials are currently lacking. Further, DCBs may simplify PCI in bifurcation lesions and chronic total coronary occlusions by reducing total stent length, and allow for late lumen enlargement when used in a hybrid fashion. In conclusion, DCBs pose a viable therapeutic option in CHIP patients, either as a complement to DES or as stand-alone therapy in selected cases.
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Affiliation(s)
- Yvemarie B. O. Somsen
- Department of Cardiology, Amsterdam UMCVrije Universiteit AmsterdamAmsterdamthe Netherlands
| | - Tuomas T. Rissanen
- Department of Cardiology, Heart CenterNorth Karelia Central HospitalJoensuuFinland
| | - Roel Hoek
- Department of Cardiology, Amsterdam UMCVrije Universiteit AmsterdamAmsterdamthe Netherlands
| | - Tijmen H. Ris
- Department of Cardiology, Amsterdam UMCVrije Universiteit AmsterdamAmsterdamthe Netherlands
| | - Wynand J. Stuijfzand
- Department of Cardiology, Amsterdam UMCVrije Universiteit AmsterdamAmsterdamthe Netherlands
| | - Alexander Nap
- Department of Cardiology, Amsterdam UMCVrije Universiteit AmsterdamAmsterdamthe Netherlands
| | - Sebastiaan A. Kleijn
- Department of Cardiology, Amsterdam UMCVrije Universiteit AmsterdamAmsterdamthe Netherlands
| | - José P. Henriques
- Department of Cardiology Amsterdam UMCAmsterdam Medical CenterAmsterdamthe Netherlands
| | - Ruben W. de Winter
- Department of Cardiology, Amsterdam UMCVrije Universiteit AmsterdamAmsterdamthe Netherlands
| | - Paul Knaapen
- Department of Cardiology, Amsterdam UMCVrije Universiteit AmsterdamAmsterdamthe Netherlands
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Shaikh S, Hamza M, Upreti P, Akkawi M, Rajak K, Haider MZ, Kumar N, Turkmani M, Kathawa F, Basit SA, Bahar Y, Fakhra S, Sattar Y, Alraies MC. Meta-Analysis Comparing Drug-Coated Balloon Versus Plain Old Balloon Angioplasty for In-Stent Restenosis of Coronary Arteries. Am J Cardiol 2024; 229:22-27. [PMID: 39029724 DOI: 10.1016/j.amjcard.2024.07.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2024] [Revised: 07/07/2024] [Accepted: 07/11/2024] [Indexed: 07/21/2024]
Abstract
Despite the advent of newer stents, in-stent restenosis has been a persistent and formidable challenge. Trials have demonstrated the superiority of drug-coated balloons over plain old balloon angioplasty. A recent AGENT IDE PRESTO (Prevention of REStenosis with Tranilast and its Outcomes) trial highlighted the need for a more comprehensive understanding; therefore, we conducted a meta-analysis to elucidate their respective clinical outcomes. A literature search was conducted by 2 investigators (SS and MH) using MEDLINE (EMBASE and PubMed) using a systematic search strategy by Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) until November 1, 2023. CRAN-R software was used for statistical analysis. The quality assessment was performed using the Cochrane Risk of Bias tool (Supplementary Table 5). We included 6 studies with a total of 1,171 patients. Our analysis showed decreased odds of multiple outcomes with statistically significant results, including target vessel revascularization (odds ratio [OR] 0.33, confidence interval [CI] 0.19 to 0.57), target vessel failure (OR 0.30, CI 0.09 to 0.99), target lesion revascularization (OR 0.22, CI 0.10 to 0.46), restenosis (OR 0.1343, CI 0.06 to 0.27), and major adverse cardiac events (OR 0.2 CI 0.12 to 0.37). Although myocardial infraction and all-cause mortality showed decreased odds with all-cause mortality at 0.8 (95% CI 0.363 to 2.09), and myocardial infarction at 0.6 (95% CI 0.0349 to 1.07), the reductions did not reach statistical significance. Our analysis by scrutinizing 6 randomized controlled trials favored drug-coated balloons over plain old balloon angioplasty. However, extensive research for deeper understanding cannot be overemphasized.
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Affiliation(s)
- Safia Shaikh
- Division of Hospital Medicine, Washington University in St. Louis, St Louis, Missouri
| | - Mohammad Hamza
- Department of Internal Medicine, Guthrie Medical Group, Cortland, New York
| | - Prakash Upreti
- Sands Constellation Heart Institute, Rochester Regional Health, Rochester, New York
| | - Mohammad Akkawi
- Department of Internal Medicine, Detroit Medical Center/Sinai Grace, Wayne State University, Detroit, Michigan
| | - Kripa Rajak
- Department of Internal Medicine, University of Pittsburgh Medical Center, Harrisburg, Pennsylvania
| | - Mobeen Zaka Haider
- Department of Internal Medicine, Carle Foundation Hospital, Carle Illinois College of Medicine, Urbana, Illinois
| | - Nomesh Kumar
- Department of Internal Medicine, Wayne State University School of Medicine, Detroit, Michigan
| | - Mustafa Turkmani
- Department of Internal Medicine, McLaren Healthcare Oakland, Pontiac, Michigan
| | - Fadi Kathawa
- Department of Internal Medicine, Detroit Medical Center/Wayne State University, Detroit, Michigan
| | | | | | - Sadaf Fakhra
- University of Nevada, Las Vegas-Kirk Kerkorian School of Medicine, Las Vegas, Nevada
| | - Yasar Sattar
- Department of Cardiology, West Virginia University, Morgantown, West Virginia
| | - M Chadi Alraies
- Cardiovascular Institute, Detroit Medical Center, Detroit, Michigan.
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Saito Y, Kobayashi Y. Advances in Technology and Technique in Percutaneous Coronary Intervention: A Clinical Review. Intern Med 2024:4505-24. [PMID: 39343561 DOI: 10.2169/internalmedicine.4505-24] [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] [Indexed: 10/01/2024] Open
Abstract
Percutaneous coronary intervention (PCI) has become the standard procedure for patients with angina and acute coronary syndrome. From the perspective of technology and technique, PCI has advanced over the last four decades, resulting in considerably improved clinical outcomes in patients with coronary artery disease in the current era. In this review article, we summarize recent advances, promising technologies, and areas for research in the field of PCI.
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Affiliation(s)
- Yuichi Saito
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Japan
| | - Yoshio Kobayashi
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Japan
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Padilla L, Liberman F, Tello J, Rosas P, Spaletra P, Pedernera G, Mascolo P, Ordoñez S, Santilli P, Candiello A, Cura F, Belardi J, Lamelas P. [Safety and efficacy of the Essential Pro paclitaxel drug-eluting balloon for the treatment of coronary in-stent restenosis]. REC: INTERVENTIONAL CARDIOLOGY 2024; 6:166-171. [PMID: 40415784 PMCID: PMC12097305 DOI: 10.24875/recic.m24000462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Accepted: 04/15/2024] [Indexed: 05/27/2025] Open
Abstract
Introduction and objectives Drug-eluting balloons (DEB) are an established treatment option for in-stent restenosis (ISR). This study aimed to assess the safety and efficacy of a novel DEB in patients with ISR. Methods This prospective, single-center study enrolled a consecutive cohort of patients diagnosed with ISR who underwent coronary angioplasty with a new second-generation paclitaxel-eluting balloon. The 3 main endpoints were myocardial infarction, target lesion revascularization, and target vessel revascularization. Baseline variables were collected, including patient and procedure characteristics. Follow-up data were collected through medical records or telephone contact. Results The study included 160 consecutive patients with 206 treated lesions (mean age, 71.4 ± 14.9 years, 15.5% women) undergoing percutaneous coronary intervention with DEB for ISR. A total of 53.3% of patients had acute coronary syndrome. The average diameter of the treated vessel was 3.10 ± 0.7 mm. The DEB used had a mean diameter of 3.1 ± 0.6 mm and a mean length of 23.1 ± 6.8 mm. Predilatation was performed in 98% of the lesions, and a noncompliant balloon was used in 80%. Intracoronary imaging was used in 24% of cases. At the end of the procedure, 98.5% of patients had Thrombolysis in Myocardial Infarction flow grade 3, residual stenosis was > 30% in 3.4%, and dissection occurred in 1.4%. Bail-out stenting was required in 4.8% of patients. Mortality was nil during follow-up (maximum 768 days). The incidence of myocardial infarction, target lesion revascularization, and target vessel revascularization were 5.4% (95%CI, 0.69-10.1), 8.4% (95%CI, 0-17.8), and 14.2% (95%CI, 3.61-24.78), respectively. Conclusions In this cohort of patients with ISR treated with DEB, we observed a low rate of adverse events in both the short- and mid-term. These results support the safety and efficacy of this new generation of DEB for treating ISR.
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Affiliation(s)
- Lucio Padilla
- Servicio de Cardiología Intervencionista, Instituto Cardiovascular de Buenos Aires, Buenos Aires, ArgentinaServicio de Cardiología IntervencionistaInstituto Cardiovascular de Buenos AiresBuenos AiresArgentina
| | - Federico Liberman
- Servicio de Cardiología Intervencionista, Instituto Cardiovascular de Buenos Aires, Buenos Aires, ArgentinaServicio de Cardiología IntervencionistaInstituto Cardiovascular de Buenos AiresBuenos AiresArgentina
| | - Jorge Tello
- Servicio de Cardiología Intervencionista, Instituto Cardiovascular de Buenos Aires, Buenos Aires, ArgentinaServicio de Cardiología IntervencionistaInstituto Cardiovascular de Buenos AiresBuenos AiresArgentina
| | - Pablo Rosas
- Servicio de Cardiología Intervencionista, Instituto Cardiovascular de Buenos Aires, Buenos Aires, ArgentinaServicio de Cardiología IntervencionistaInstituto Cardiovascular de Buenos AiresBuenos AiresArgentina
| | - Pablo Spaletra
- Servicio de Cardiología Intervencionista, Instituto Cardiovascular de Buenos Aires, Buenos Aires, ArgentinaServicio de Cardiología IntervencionistaInstituto Cardiovascular de Buenos AiresBuenos AiresArgentina
| | - Gustavo Pedernera
- Servicio de Cardiología Intervencionista, Instituto Cardiovascular de Buenos Aires, Buenos Aires, ArgentinaServicio de Cardiología IntervencionistaInstituto Cardiovascular de Buenos AiresBuenos AiresArgentina
| | - Pablo Mascolo
- Servicio de Cardiología Intervencionista, Instituto Cardiovascular de Buenos Aires, Buenos Aires, ArgentinaServicio de Cardiología IntervencionistaInstituto Cardiovascular de Buenos AiresBuenos AiresArgentina
| | - Santiago Ordoñez
- Servicio de Cardiología Intervencionista, Instituto Cardiovascular de Buenos Aires, Buenos Aires, ArgentinaServicio de Cardiología IntervencionistaInstituto Cardiovascular de Buenos AiresBuenos AiresArgentina
| | - Pablo Santilli
- Servicio de Cardiología Intervencionista, Instituto Cardiovascular de Buenos Aires, Buenos Aires, ArgentinaServicio de Cardiología IntervencionistaInstituto Cardiovascular de Buenos AiresBuenos AiresArgentina
| | - Alfonsina Candiello
- Servicio de Cardiología Intervencionista, Instituto Cardiovascular de Buenos Aires, Buenos Aires, ArgentinaServicio de Cardiología IntervencionistaInstituto Cardiovascular de Buenos AiresBuenos AiresArgentina
| | - Fernando Cura
- Servicio de Cardiología Intervencionista, Instituto Cardiovascular de Buenos Aires, Buenos Aires, ArgentinaServicio de Cardiología IntervencionistaInstituto Cardiovascular de Buenos AiresBuenos AiresArgentina
| | - Jorge Belardi
- Servicio de Cardiología Intervencionista, Instituto Cardiovascular de Buenos Aires, Buenos Aires, ArgentinaServicio de Cardiología IntervencionistaInstituto Cardiovascular de Buenos AiresBuenos AiresArgentina
| | - Pablo Lamelas
- Servicio de Cardiología Intervencionista, Instituto Cardiovascular de Buenos Aires, Buenos Aires, ArgentinaServicio de Cardiología IntervencionistaInstituto Cardiovascular de Buenos AiresBuenos AiresArgentina
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, CanadáDepartment of Health Research Methods, Evidence, and ImpactMcMaster UniversityHamiltonCanadá
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Undarsa AC, Saboe A, Tiksnadi BB, Akbar MR, Yahya AF. Factors influencing coronary artery target lesion revascularization after drug-coated balloon angioplasty. Front Cardiovasc Med 2024; 11:1387074. [PMID: 38818212 PMCID: PMC11137689 DOI: 10.3389/fcvm.2024.1387074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Accepted: 04/29/2024] [Indexed: 06/01/2024] Open
Abstract
Background Concerns regarding restenosis after treatment with drug-coated balloons (DCB) remain. We aimed to identify the incidence of target lesion revascularization (TLR) and explore clinical, procedural, and other factors influencing it. Methods Single-center retrospective analysis of a prospective cohort PCI registry study included 80 patients (100 lesions) who underwent successful DCB angioplasty between January 2020 and October 2023 and follow-up angiography within 2 years of either planned or unplanned reason. Incidence and factors associated with TLR were analyzed. Results Angiographic evaluation was conducted within a median of 151 days (interquartile range: 109 days). During index procedure, 54% were complex lesions. Intravascular imaging (IVI) was performed in 80% of lesions. TLR occurred in 11% of the lesions and was less frequent in the IVI group compared to the angiography-alone group [6.3 vs. 54.5%; odds ratio: 0.156, 95% confidence interval (CI): 0.042-0.580; p = 0.002]. No association was found between baseline and lesion characteristics, lesion complexity, plaque morphology, pre-dilatation procedure balloon type, maximal inflation pressure, or length of DCB between the groups (p > 0.05). Multivariate analysis revealed that IVI utilization was independently associated with a lower TLR rate (adjusted odds ratio: 0.116, 95% CI: 0.020-0.669; p = 0.016). Conclusion In DCB angioplasty, only IVI use exhibited a significant difference in the TLR rate among baseline lesion characteristics and lesion preparation and was independently associated with a lower TLR rate.
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Affiliation(s)
| | | | | | | | - Achmad Fauzi Yahya
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Padjadjaran—Dr. Hasan Sadikin General Hospital, Bandung, Indonesia
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