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Is adjunctive balloon postdilatation necessary with drug-eluting stents? One center experience in Chinese patients
Zhan Gao1, Yue-jin Yang, Bo Xu
1Department of Cardiology, Cardiovascular Institute and Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China.
Insights
Adjunctive balloon postdilatation after drug-eluting stent (DES) implantation is safe and reduces restenosis rates, particularly in complex lesions. This strategy optimizes outcomes without increasing major adverse cardiac events.
Area of Science:
- Cardiovascular Interventions
- Interventional Cardiology
- Biomedical Engineering
Background:
- Drug-eluting stents (DES) have lowered target vessel revascularization (TVR) rates.
- The benefit of adjunctive balloon postdilatation following DES deployment remains unclear.
- This study compares outcomes with and without postdilatation after DES implantation.
Purpose of the Study:
- To evaluate the efficacy and safety of adjunctive balloon postdilatation after DES implantation.
- To compare clinical and angiographic outcomes between patients with and without postdilatation.
- To determine if postdilatation optimizes outcomes in patients undergoing DES procedures.
Main Methods:
- Analysis of 6479 consecutive Chinese patients undergoing DES implantation from April 2004 to September 2006.
- 1769 patients received postdilatation, while 4710 did not.
- Clinical and angiographic follow-up was performed at 7 months.
Main Results:
- The postdilatation group had more complex lesions and larger relevant vessel diameter.
- Postdilatation significantly improved in-stent residual restenosis immediately post-procedure.
- At 7-month follow-up, postdilatation significantly reduced in-stent and in-segment restenosis and late loss.
- No significant differences were observed in major adverse cardiac events, death, acute myocardial infarction, target lesion revascularization, or in-stent thrombosis rates between groups.
Conclusions:
- Adjunctive balloon postdilatation after DES deployment is a safe procedure.
- Postdilatation effectively reduces restenosis rates, especially in complex coronary lesions.
- This adjunctive technique can optimize angiographic outcomes following DES implantation.
Background:
With the advent of drug-eluting stents (DES) and much lower rates of target vessel revascularization (TVR), whether adjunctive balloon postdilatation can further optimize outcome is still unknown. The present study was to compare the outcomes of postdilatation with un-postdilatation following deployment of DES.
Methods:
From April 2004 to September 2006, 6479 consecutive Chinese patients who underwent DES implantation, including 1769 with postdilatation (1454 male, (57.9+/-10.8) years old) and 4710 without postdilatation (3819 male, (57.9+/-10.6) years old) were analyzed. Clinical and angiographic follow-up was performed at 7 months.
Results:
Compared with the un-postdilatation group, the postdilatation group had more complex lesions and larger relevant vessel diameter (RVD). In the postdilatation group, in-stent residual restenosis was significantly improved right after the procedure ((16.80+/-5.88)% vs (19.60+/-6.07)%; P=0.000). There was no statistical difference in the major adverse cardiac events (MACE) rate between the groups (2.9% vs 3.3%; P=0.420), and there were also no statistical differences in death, acute myocardial infarction (AMI) and target lesion revascularization (TLR) rates in the two groups (0.1% vs 0.4%, P=0.127; 1.7% vs 1.3%, P=0.229; and 1.5% vs 2.0%, P=0.206, respectively). The in-stent thrombosis rate was almost the same in both groups (0.5% vs 0.5%; P=1.000). Seven months angiographic follow-up results showed that both in-stent and in-segment restenosis rates were lower in the postdilatation group (8.8% vs 15.6%, P=0.000; and 10.5% vs 17.3%, P=0.000), and so were in-stent and in-segment late loss ((0.32+/-0.12) mm vs (0.49+/-0.13) mm, P=0.000; and (0.24+/-0.08) mm vs (0.36+/-0.09) mm, P=0.001).
Conclusion:
Postdilatation after DES deployment was safe and could reduce the restenosis rate, especially for more complex lesions.