Rotablator versus cutting balloon for the treatment of long in-stent restenoses

Conventional balloon angioplasty of in-stent-restenoses (ISR) will result in 50 70% re-restenoses. In addition to intracoronary brachytherapy, several ablative and non-ablative interventional technologies have been proposed to manage diffuse ISR. This study was designed to retrospectively assess rotational coronary atherectomy (Rotablator , or RA) and the Cutting Balloon (CB) with respect to the rate of restenoses after 6 months, the need for any additional revascularization at the target lesion (TLR), and the frequency of major cardiac events.

To compare both techniques, we used the RA to treat 51 consecutive patients with long (> 10 mm) ISR. Subsequently, 76 patients with identical indications were treated with the CB. Both groups were comparable with respect to their coronary morphologies, demographic and clinical data.

Re-angiography was performed in 86% of patients in the RA group and in 72% of patients in the CB group. On quantitative coronary angiography (QCA), the rate of restenoses was 63.9% in the RA and 27.3% in the CB group; the difference was statistically significant (p < 0.01). The rate of re-TLR was also significantly lower (18.7%) in the CB than in the RA group (43.2%). The rate of major cardiac events (not requiring TLR) was not different between both groups (CD = 7.3%; RA = 9.1%).

Even when the methodological constraints of retrospective studies are taken into account, the study data indicate that treating diffuse ISR with the CB results in an acceptable long-term outcome and a low complication rate, results which make this method appear superior to RA.