DRUG-ELUTING BALLOON COMPARED TO DRUG-ELUTING STENT TREATMENT IN DES RESTENOSIS

Introduction:
One of the possible complications after drug eluting stent (DES) implantation is in-stent restenosis (ISR). There are two main recommended treatment methods - using a drug-eluting balloon (DEB) or implantation of another DES. Our aim was to compare long-term outcome of the patients with ISR according to the method used.

Sample and methodology:
Monocentric retrospective data analysis. Between 2013 and 2018, there were 116 consecutive patients with ISR in previously implanted DES. One of two recommended treatment methods was used – either another DES implantation or a drug-eluting balloon dilatation (DEB). The first group of 71 patients was treated with an implantation of another DES (DES+) and the second group of 45 patients was treated with DEB (DEB+). The primary endpoint was composite of cardiovascular (CV) mortality, rehospitalization for CV related diagnosis and target lesion revascularization (TLR) in more than 3 years follow up period.

Results:
In a follow up period, no significant difference was found between DES+ a DEB+ group in composite endpoint [27 (38 % of DES+ group) vs. 18 (40 % of DEB+ group); p-value = 0,885], nor in a relative frequency of and individual events .

Conclusion:
Only few randomised trials have focused on DES-ISR. We present real-life data with long follow-up of events. Despite the follow up period length, statistical significance of events difference wasn’t found. Hypothetically, using intravascular imaging (IVI) to get more information about ISR (its nature, plaque burden, tissue characteristics, possible mechanical problem in original stent) might be helpful for . treatment and decision making. However, routine use of IVI in ISR therapy needs to be verified by larger randomized trial.