Treatment of chronic total occlusions in native coronary arteries by drug-coated balloons without stenting - A feasibility and safety study

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• 作者：Philine J. Kö ; ln^a ; ¹ ; Bruno Scheller^b ; ¹ ; Houng Bang Liew^c ; ¹ ; Tuomas T. Rissanen^d ; ¹ ; Wan Azman Wan Ahmad^e ; ¹ ; Ralf Weser^f ; ¹ ; Telse Hauschild^g ; ¹ ; Amin Ariff Nuruddin^h ; ¹ ; Yvonne P. Clever^b ; ¹ ; Hee Hwa Hoⁱ ; ¹ ; Franz X. Kleber^j ; ¹ ; ^{post@fxkleber.de" class="auth_mail" title="E-mail the corresponding author}
• 关键词：Drug-coated balloon (DCB) ; Chronic coronary total occlusion (CTO) ; Percutaneous coronary intervention (PCI) ; Paclitaxel ; Drug-eluting stent (DES) ; Balloon angioplasty
• 刊名：International Journal of Cardiology
• 出版年：2016
• 出版时间：15 December 2016
• 年：2016
• 卷：225
• 期：Complete
• 页码：262-267
• 全文大小：665 K

文摘

Chronic total occlusions remain one of the biggest challenges for interventional cardiologists and the high risk of restenosis and stent thrombosis is still a major problem. Drug-coated balloons showed favorable results for the treatment of in-stent restenosis and other lesion types. The aim of this study was to evaluate the feasibility and outcome of a drug-coated balloon only approach for chronic total occlusion.

Methods

We included 34 patients with a native chronic total occlusion treated only by drug-coated balloons. A visual residual stenosis of 30% or less without major dissection was considered a satisfactory percutaneous intervention result according to the German Consensus Group recommendations for drug-coated balloon use. We collected clinical and procedural data. Angiograms were conducted during the procedure and at follow-up. Quantitative coronary analysis was performed and mean and minimal lumen diameter and late luminal changes were assessed.

Results

The recanalization was considered satisfactory in 79.4% (n = 27). Restenosis occurred in 11.8% (n = 4) and reocclusion in 5.9% (n = 2). Out of the 27 patients with a satisfactory initial result, 3.7% (n = 1) had reocclusion and 3.7% (n = 1) had restenosis. In the subgroup without satisfactory result (n = 7), restenosis occurred in 3 patients (42.9%) and reocclusion in 1 patient (14.3%). A luminal increase was found in 67.6% (n = 23) and mean late luminal gain was 0.11 ± 0.49 mm. Angina class improved significantly (p < 0.001). There was no death or myocardial infarction.

Conclusions

Drug-coated balloon angioplasty without stenting is a feasible and well-tolerated treatment method for chronic total occlusions if the predilatation result is good.