Comparison of Plain Balloon and Cutting Balloon Angioplasty for the Treatment of Restenosis With Drug-Eluting Stents vs Bare Metal Stents

Background: The efficacy of cutting or plain balloon angioplasty (CBA or PBA) has not been analyzed for the treatment of drug-eluting stent (DES) restenosis vs bare metal stent (BMS) restenosis Methods and Results: The 252 in-stent restenosis (ISR) lesions in 224 consecutive patients treated by CBA (n=167) or PBA (n=85) between July 2002 and December 2007 were analyzed At 6-month angiographic and 12-month clinical follow-up, CBA and PBA showed similar efficacies repeat-ISR (37 0% vs 37.8%, P=0 90), late loss (0 62 +/- 0 60 vs 0 61 +/- 0 47 mm, P=0 92), and target lesion revascularization (18 3% vs 22 4%, P=0 50) This comparable efficacy was maintained for treatment in the DES-ISR and BMS-ISR subgroups However, target lesion-related myocardial infarction (n=9) occurred more frequently in the CBA than in the PBA arm (6 2% vs 0%, P=0 03), most of which developed early after ISR treatment (n=7, 54 +/- 26 days) Independent predictors of repeatISR were diffuse ISR and smaller pretreatment minimal lumen diameter, both of which might imply heavier plaque burden in the ISR group Conclusions: Plain or cutting balloon angioplasty for ISR seems to be comparable, as the angiographic or clinical endpoints were not affected by initial stent type but by parameters related to the plaque burden of the ISR lesion However, CBA might be associated with higher risk of myocardial infarction than PBA, suggesting more attention to dual-antiplatelet therapy after its use for ISR (Circ J 2010, 74: 1837-1845)