Comparison of the clinical effect of cutting balloon angioplasty and drug-eluting stent for treating the focal type of in-stent restenosis

Background and Objectives: Treating coronary in-stent restenosis (ISR) has become one of the major challenges for interventional cardiologists. The aim of this study was to compare the clinical effect of performing cutting balloon angioplasty (CBA) with implanting drug eluting stent (DES) for treating the focal type of instent restenosis (ISR). Subjects and Methods: We retrospectively analyzed 56 patients who were treated by CBA (Group I: 59.6±9.6 years, male: female=46: 10) and 20 patients who were treated by DES (Group II: 61.0±8.5 year, male: female=15: 5) between January 2002 and December 2004. All the patients had the focal type of ISR (Group I - type IB: IC: ID=23: 9: 26, Group II - type IB: IC: ID=10: 3: 7). The 6-month angiographically determined late loss and the major adverse cardiac events (MACE) were compared between the two groups. Results: The baseline clinical characteristics were similar between the two groups except for the high proportion of old myocardial infarction [4 (7.1%) and 3 (15%); respectively, p=0.02] and low left ventricular ejection fraction (62.6±8.8% vs. 55.2±13.8%, respectively, p=0.02) in group II. The acute gain after the procedure was higher in group II (1.86±0.53 mm vs. 2.54±0.20 mm, respectively, p<0.01). Follow-up angiography at 6 months was achieved in 40 of 56 (71.4%) patients in group I and in 15 of 20 patients (75%) in group II. The late loss was lower in group II than in group I (0.49±0.35 mm vs. 0.14±0.24 mm respectively, p<0.01). MACE during the 6-month follow-up developed in 8 patients (14.3%) of group I and in 1 patient (5.0%) of group II (p=0.04). Conclusion: DES is associated with a better clinical outcome than CBA for the treatment of the focal type of ISR.