Document Detail

Impact of cutting balloon angioplasty (CBA) prior to bare metal stenting on restenosis.
MedLine Citation:
PMID:  17186970     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: While stent restenosis and late thrombosis still occur even with drug-eluting-stents (DES), there remains a need to explore other strategies for preventing restenosis. METHODS AND RESULTS: Five hundred and twenty-one patients were randomized: 260 to cutting-balloon angioplasty (CBA) before bare-metal stent (CBA-BMS) and 261 to balloon-angioplasty (BA) before BMS (BA-BMS). Intravascular ultrasound (IVUS)-guided procedures were performed in 279 (54%) patients and angiographic guidance was used in the remainder. Minimal lumen diameter was significantly greater in CBA-BMS than BA-BMS (2.65+/-0.40 mm vs 2.52+/-0.4 mm, p<0.01) and % diameter stenosis (%DS)-post was less in CBA-BMS than BA-BMS (14.0+/-5.9% vs 16.3+/-6.8%, p<0.01). %DS-follow-up was subsequently less in CBA-BMS than BA-BMS (32.4+/-15.1% vs 35.4+/-15.3%, p<0.05) associated with lower rates of restenosis in CBA-BMS than BA-BMS (11.8% vs 19.6%, p<0.05) and less target lesion revascularization (TLR) in CBA-BMS than BA-BMS (9.6% vs 15.3%, p<0.05). Patients were divided into 4 groups based on the device used before stenting and IVUS use (IVUS-CBA-BMS: 137 patients; Angio-CBA-BMS: 123; IVUS-BA-BMS: 142; and Angio-BA-BMS: 119). At follow-up IVUS-CBA-BMS had a significantly lower restenosis rate (6.6%) than Angio-CBA-BMS (17.9%), IVUS-BA-BMS (19.8%) and Angio-BA-BMS (18.2%, p<0.05). CONCLUSIONS: Restenosis and TLR were significantly lower in CBA-BMS than BA-BMS. This favorable outcome was achieved because of the lower restenosis rate conferred by the IVUS-guided-CBA-BMS strategy (6.6%). The restenosis rates obtained with this strategy were comparable to those achieved with DES.
Yukio Ozaki; Tetsu Yamaguchi; Takahiko Suzuki; Masato Nakamura; Michihiko Kitayama; Hideo Nishikawa; Teruo Inoue; Kazuhiro Hara; Fumihiko Usuba; Masami Sakurada; Kojiro Awano; Hitoshi Matsuo; Sugao Ishiwata; Tatsuya Yasukawa; Tevfik F Ismail; Hitoshi Hishida; Osamu Kato
Publication Detail:
Type:  Comparative Study; Journal Article; Multicenter Study; Randomized Controlled Trial    
Journal Detail:
Title:  Circulation journal : official journal of the Japanese Circulation Society     Volume:  71     ISSN:  1346-9843     ISO Abbreviation:  Circ. J.     Publication Date:  2007 Jan 
Date Detail:
Created Date:  2006-12-25     Completed Date:  2007-02-13     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101137683     Medline TA:  Circ J     Country:  Japan    
Other Details:
Languages:  eng     Pagination:  1-8     Citation Subset:  IM    
Division of Cardiology, Fujita Health University Hospital, Toyoake, Japan.
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MeSH Terms
Angioplasty, Transluminal, Percutaneous Coronary / methods*
Coronary Restenosis / pathology,  prevention & control*
Coronary Stenosis / pathology,  therapy*
Disease-Free Survival
Drug Delivery Systems / methods
Middle Aged
Multivariate Analysis
Prospective Studies
Regression Analysis
Treatment Outcome
Ultrasonography, Interventional

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