The impact of cutting balloon angioplasty for the treatment of diffuse in-stent restenosis.
To determine the comparable safety and efficacy of cutting balloon angioplasty (CBA) and balloon angioplasty (BA) for diffuse in-stent restenosis (ISR). Previous studies have found that diffuse-type ISR predicts recurrence of ISR. The efficacy of CBA in this clinical setting is incompletely documented. One-hundred and seven consecutive diffuse ISR lesions (length > 10 mm) in 104 patients treated by CBA or BA were retrospectively analyzed. CBA was used in 61 lesions and BA in 46 lesions. Initial success (residual restenosis 30% with no major complications) was achieved in 99% of cases in each group. Follow-up angiography was performed in all patients at 131 93 days. Although the percent diameter stenosis after CBA was lower than after BA (19 12% versus 27 12%; p = 0.001), intravascular ultrasound (IVUS) or other QCA data were similar in the 2 groups. In follow-up angiography, recurrent restenosis rate was not statistically different between CBA (34%) and BA (52%); however, recurrent diffuse ISR was lower in the CBA group (20%) than the BA group (48%; p = 0.01). Lesion length at follow-up in the CBA group was smaller compared to the BA group (15.9 7.3 mm versus 24.2 14.4 mm; p < 0.05), while lesion length before procedure was similar. CBA for ISR is safe and effective with favorable long-term outcomes. This effect is mainly due to shortening lesion length.