Long-term Outcome following Percutaneous Intervention of Intra-stent Coronary Occlusion and Evaluating the Different Treatment Modalities

Sandeep Basavarajaiah; Satoru Mitomo; Sunao Nakamura; Vinoda Sharma; Ishaq Mohammed; Yusuke Watanabe; Toru Ouchi; Gurbir Bhatia; Jerome Ment; Sampath Athukorala; Michael Pitt; George Pulikal; Bethan Freestone; Hannah Rides; Nitin Kumar; Richard Watkin; Kaeng Lee

doi:10.1016/j.ijcha.2021.100803

Long-term Outcome following Percutaneous Intervention of Intra-stent Coronary Occlusion and Evaluating the Different Treatment Modalities

Int J Cardiol Heart Vasc. 2021 May 31:34:100803. doi: 10.1016/j.ijcha.2021.100803. eCollection 2021 Jun.

Authors

Sandeep Basavarajaiah¹, Satoru Mitomo², Sunao Nakamura², Vinoda Sharma³, Ishaq Mohammed¹, Yusuke Watanabe¹, Toru Ouchi², Gurbir Bhatia¹, Jerome Ment¹, Sampath Athukorala¹, Michael Pitt¹, George Pulikal¹, Bethan Freestone¹, Hannah Rides¹, Nitin Kumar¹, Richard Watkin¹, Kaeng Lee¹

Affiliations

¹ Heartlands Hospital, University Hospitals Birmingham, United Kingdom.
² New Tokyo Hospital, Chiba, Japan.
³ Birmingham City Hospital, United Kingdom.

Abstract

Background: Angioplasty for ISR remains a challenge with relatively high rates of recurrence. Although there is a plethora of data on ISR, there is relatively less data on intra-stent-CTO. In this study, we explore the long-term clinical outcomes following angioplasty to intra-stent CTO and study the differences in clinical outcomes between three treatment-arms: POBA vs. DES vs. DCB.

Methods and results: We evaluated all patients who underwent PCI to intra-stent CTO between 2011 and 2017. The endpoints used were: cardiac-death, TVMI, TLR, TVR, and MACE.During the study period, 403-patients with a mean age of 69.2 years had successful PCI to intra-stent CTO. 50% were diabetic, 38% had CKD and 32% had left ventricular dysfunction. 93% of cases were stable angina. 22% (n = 88) received only POBA, 28% (n = 113) received DCB and 50% (n = 202) received DES. During the median follow-up of 48-months, cardiac-death occurred in 5.8% (n = 23), TVMI in 4% (n = 16), TLR in 45.6% (n = 182), TVR in 48.7% (n = 194) and MACE of 46%. There were no differences in the hard endpoints between the 3treatment arms. However, the TLR and overall MACE were better in DCB and DES-groups as compared to POBA (TLR: 33%vs.42%vs.49%; p = 0.06); MACE (34% vs. 45% vs. 52%; p = 0.05).

Conclusion: This is the first study that has focussed on the outcomes following angioplasty to intra-stent CTOs with a very long-term follow-up. The hard endpoints were low, although the TLR rates were high. In regards to treatment strategy, the DCB and DES provide relatively better outcomes than POBA.

Keywords: CKD, Chronic kidney disease; CTO, Chronic total occlusion; Chronic total occlusion; DCB, Drug coated balloon; DES, Drug eluting stent; Drug coated balloon; Drug eluting stent; ISR, In-stent restenosis; In-stent restenosis; LVSD, Left ventricular dysfunction; MACE, Major adverse cardiac events; POBA, Plain old balloon angioplasty; TLR, Target lesion revascularisation; TVMI, Target vessel myocardial infarction; TVR, Target vessel revascularisation.