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Updated: Oct 30, 2025
A Murine Model of Stent Implantation in the Carotid Artery for the Study of Restenosis
Published on: May 14, 2013
Long-term Outcome following Percutaneous Intervention of Intra-stent Coronary Occlusion and Evaluating the Different
Sandeep Basavarajaiah1, Satoru Mitomo2, Sunao Nakamura2
1Heartlands Hospital, University Hospitals Birmingham, United Kingdom.
Insights
This study investigated long-term outcomes of angioplasty for intra-stent chronic total occlusions (CTO). Drug-eluting stents (DES) and drug-coated balloons (DCB) showed better results than plain old balloon angioplasty (POBA) for target lesion revascularization and major adverse cardiac events.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Vascular Biology
Background:
- In-stent restenosis (ISR) angioplasty presents challenges with high recurrence rates.
- Intra-stent chronic total occlusions (CTO) have limited data regarding treatment outcomes.
- This study focuses on long-term clinical outcomes of angioplasty for intra-stent CTO.
Purpose of the Study:
- To explore long-term clinical outcomes after angioplasty for intra-stent CTO.
- To compare outcomes between percutaneous coronary intervention (PCI) with plain old balloon angioplasty (POBA), drug-eluting stents (DES), and drug-coated balloons (DCB).
Main Methods:
- A retrospective evaluation of 403 patients undergoing PCI for intra-stent CTO between 2011 and 2017.
- Patients were treated with POBA, DES, or DCB.
- Endpoints included cardiac death, TVMI, TLR, TVR, and MACE, with a median follow-up of 48 months.
Main Results:
- The study included 403 patients with a mean age of 69.2 years; 50% were diabetic, 38% had CKD.
- Overall MACE was 46%, with no significant differences in hard endpoints between POBA, DES, and DCB groups.
- Target lesion revascularization (TLR) and MACE were notably better in DCB and DES groups compared to POBA (TLR: 33% vs. 42% vs. 49%; MACE: 34% vs. 45% vs. 52%).
Conclusions:
- This is the first study to report very long-term outcomes following angioplasty for intra-stent CTOs.
- While hard endpoints were low, target lesion revascularization (TLR) rates remained high.
- Drug-eluting stents (DES) and drug-coated balloons (DCB) demonstrated superior outcomes compared to plain old balloon angioplasty (POBA).
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.
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