Comparison of drug-eluting stents vs. drug-coated balloon after rotational atherectomy for severely calcified lesions of
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ORIGINAL ARTICLE
Comparison of drug‑eluting stents vs. drug‑coated balloon after rotational atherectomy for severely calcified lesions of nonsmall vessels Yoshihiro Iwasaki1 · Jumpei Koike1 · Toshinori Ko1 · Atsushi Funatsu1 · Tomoko Kobayashi1 · Takanori Ikeda2 · Shigeru Nakamura1 Received: 10 April 2020 / Accepted: 14 August 2020 © Springer Japan KK, part of Springer Nature 2020
Abstract Calcified lesion is a risk factor for adverse events, even in the drug-eluting stent (DES) era. Recently, drug-coated balloon (DCB) has been shown to have favourable results for in-stent restenosis and small vessels, but its results for calcified lesions are unknown. This study aimed to clarify the rotational atherectomy (RA) and DCB results for calcified lesions of nonsmall vessels. A total of 194 consecutive de novo lesions from 165 cases underwent RA for calcified lesions of nonsmall vessels between January 2016 and August 2018 in a single centre. Overall, 8 cases/10 lesions were excluded because of RA followed plain old balloon angioplasty (POBA). Remaining lesions were grouped into the DES (88 cases/104 lesions) and DCB (69 cases/80 lesions) groups and then compared retrospectively. The primary endpoint was post-discharge major adverse cardiovascular events (MACE) at 1 year, and it was defined as cardiac death, noncardiac death, target-vessel-related myocardial infarction, target lesion revascularization (TLR), and major bleeding (BARC ≥ type 3). There was no difference in the clinical follow-up rate between RA + DES (96/104 lesions) and RA + DCB (78/80 lesions). The post-discharge MACE values after 1 year of RA + DES and RA + DCB were 8% and 11% (P = 0.30), respectively, in terms of cardiac death (0% vs. 0%, respectively), noncardiac death (4% vs. 3%, respectively, P = 0.36), target-vessel-related myocardial infarction (0% vs. 0%, respectively), TLR (4% vs. 8%, respectively, P = 0.30), and major bleeding (1% vs. 0%, respectively). For calcified lesions of nonsmall vessels, RA + DCB showed good results as well as RA + DES. RA + DCB is a potential new strategy for these lesions. Keywords Rotablator · Calcified lesion · Drug-coated balloon · Drug-eluting stent
Introduction Drug-eluting stents (DES) have improved the clinical and procedural outcomes of patients with coronary artery disease. At present, most percutaneous coronary intervention (PCI) procedures have been accomplished with the use of DES. However, a calcified lesion is a risk factor for adverse events, even in the era of DES [1]. In fact, the rates * Yoshihiro Iwasaki [email protected] 1
Cardiovascular Center, Kyoto Katsura Hospital, 1‑8,10:17‑banchi, Yamada Hirao‑cho, Nishikyo‑ku, Kyoto‑shi, Kyoto 615‑8256, Japan
Department of Cardiovascular Medicine, Toho University Graduate School of Medicine, 9:11‑banchi, omorinishi 6 Choume, Ota‑ku, Tokyo 143‑8541, Japan
2
of restenosis and stent thrombosis were higher for calcified lesions than for noncalcified lesions [2]. Rotational atherectomy (RA) beneficial for severely calcified lesions, because it a
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