Cutting balloon angioplasty for treatment of coronary in-stent restenosis: immediate results and 6-month outcomes

Objective To determine the mid-term effects of cutting balloon angioplasty (CBA) on in-stent restenosis.Methods A total of 69 patients with in-stent restenosis were divided into 2 groups randomly: cutting balloon angioplasty and plain old balloon angioplasty. The mechanisms of restenosis and dialation results were determined by quantitative coronary angiography and intravascular ultrasound. Follow-up was performed.Results The procedural success rate was 100% without death and acute closure. One patient experienced dissection at the distal end of the stent and needed another stent. The mean follow-up period was 6.7±2.3 months. The final re-restenosis rate was 15% and 18% at 3 months and 6 months respectively, markedly lower than after plain old balloon angioplasty (38% and 43%). Acute gain by intravascular ultrasound (IVUS) was 1.72±0.52mm after cutting balloon angioplasty, higher than 1.15±0.54mm after plain old balloon angioplasty. The lumen diameter late loss in the cutting balloon group was 0.26±0.05mm and 0.38±0.06mm at 3 months and 6 months respectively, significantly lower than for those in conventional balloon group (0.78±0.19mm and 0.89±0.16mm, respectivelly, P <0.001). As shown by IVUS, the main mechanism of cutting balloon angioplasty was marked reduction of plaque area without significant increase of vessel area (less vessel trauma).Conclusion Cutting balloon angioplasty is feasible and effective for the treatment of in-stent restenosis with less vessel trauma.