Coronary Interventions - Mini Focus on Stent Restenosis

Clinical outcomes by optical characteristics of neointima and treatment modality in patients with coronary in-stent restenosis

EuroIntervention 2021;17:388-395. DOI: 10.4244/EIJ-D-20-00662

Erion Xhepa
Erion Xhepa1, MD, PhD; Jola Bresha1, MD; Michael Joner1,2, MD; Alexander Hapfelmeier3,4, MSc; Fernando Rivero5, MD; Gjin Ndrepepa1, MD; Nejva Nano1, MD; Javier Cuesta5, MD; Sebastian Kufner1, MD; Salvatore Cassese1, MD, PhD; Teresa Bastante5, MD; Alp Aytekin1, MD; Andi Rroku1, MD; Marcos García-Guimaraes5, MD; Anna Lena Lahmann1, MD; Susanne Pinieck1, RN; Himanshu Rai1, MSc, PhD; Massimiliano Fusaro1, MD; Heribert Schunkert1,2, MD; Maria José Pérez-Vizcayno6, MD; Nieves Gonzalo6, MD, PhD; Fernando Alfonso5, MD, PhD; Adnan Kastrati1,2, MD
1. Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Technical University of Munich, Munich, Germany; 2. DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, Munich, Germany; 3. Institute of General Practice and Health Services Research, Technical University of Munich, Munich, Germany; 4. Institute of Medical Informatics, Statistics and Epidemiology, Technical University of Munich, Munich, Germany; 5. Hospital Universitario de La Princesa, IIS-IP, CIBER-CV, Universidad Autónoma de Madrid, Madrid, Spain; 6. Hospital Clínico San Carlos, IdISSC, Universidad Complutense Madrid, Madrid, Spain

Background: Drug-coated balloons (DCB) and drug-eluting stents (DES) represent the currently recommended treatments for in-stent restenosis (ISR). Optical coherence tomography (OCT) allows detailed neointimal characterisation which can guide treatment strategies.

Aims: The aims of this study were first, to assess the relation between neointimal pattern and clinical outcomes following in-stent restenosis (ISR) treatment, and second, to explore a potential interaction between neointimal pattern and treatment modality relative to clinical outcomes.

Methods: Patients undergoing OCT-guided treatment (DCB or DES) of ISR in three European centres were included. Based on the median of distribution of non-homogeneous neointima quadrants, patients were categorised into low and high inhomogeneity groups.

Results: A total of 197 patients (low inhomogeneity=100 and high inhomogeneity=97) were included. There were no significant differences in terms of major adverse cardiac events (MACE) (p=0.939) or target lesion revascularisation (TLR) (p=0.732) between the two groups. The exploratory analysis showed a significant interaction between neointimal pattern and treatment modality regarding MACE (pint=0.006) and TLR (pint=0.022). DES showed a significant advantage over DCB in the high (MACE: HR 0.26 [0.10-0.65], p=0.004; TLR: HR 0.28 [0.11-0.69], p=0.006), but not in the low inhomogeneity group (MACE: p=0.917; TLR: p=0.797).

Conclusions: In patients with ISR treated with DCB or DES, there were no significant differences in terms of MACE or TLR between the low and high inhomogeneity groups. A significant interaction was observed between treatment modality and neointimal pattern with an advantage of DES over DCB in the high and no difference in the low inhomogeneity group. This warrants confirmation from prospective dedicated studies.

Sign in to read and download the full article

Forgot your password?

No account yet?
Sign up for free!

Create my pcr account

Join us for free and access thousands of articles from EuroIntervention, as well as presentations, videos, cases from

drug-eluting stentoptical coherence tomographyin-stent restenosisdrug-eluting balloon
Coronary interventionsStents and scaffolds
Read next article
Quantitative flow ratio for functional evaluation of in-stent restenosis

Latest news