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Comparison of drug-eluting stents vs. drug-coated balloon after rotational atherectomy for severely calcified lesions of nonsmall vessels

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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.

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References

  1. Huang BT, Huang FY, Zuo ZL, Liu W, Huang KS, Liao YB, Wang PJ, Peng Y, Zhang C, Zhao ZG, Huang DJ, Chen M (2015) Target lesion calcification and risk of adverse outcomes in patients with drug-eluting stents. A meta-analysis. Herz 40:1097–1106

    Article  CAS  Google Scholar 

  2. Madhavan MV, Tarigopula M, Mintz GS, Maehara A, Stone GW, Genereux P (2014) Coronary artery calcification: pathogenesis and prognostic implications. J Am Coll Cardiol 63:1703–1714

    Article  CAS  Google Scholar 

  3. Cortese B, Aranzulla TC, Godino C, Chizzola G, Zavalloni D, Tavasci E, De Benedictis M, Ettori F, Presbitero P, Colombo A (2016) Drug-eluting stent use after coronary atherectomy: results from a multicentre experience—The ROTALINK I study. J Cardiovasc Med 17:665–672

    Article  CAS  Google Scholar 

  4. Jinnouchi H, Kuramitsu S, Shinozaki T, Hiromasa T, Kobayashi Y, Takeji Y, Miura M, Masuda H, Matsumura Y, Yamaji Y, Sakakura K (2018) Five-year clinical outcomes after drug-eluting stent implantation following rotational atherectomy for heavily calcified lesions. Circ J 82:983–991

    Article  Google Scholar 

  5. Jeger RV, Farah A, Ohlow MA, Mangner N, Möbius-Winkler S, Leibundgut G, Weilenmann D, Wöhrle J, Richter S, Matthias Schreiber M, Mahfoud F, Linke A, Stephan FP, Mueller C, Rickenbacher P, Coslovsky M, Gilgen N, Osswald S, Kaiser C, Scheller B (2018) Drug-coated balloons for small coronary artery disease (BASKET-SMALL 2). Lancet 392:849–856

    Article  CAS  Google Scholar 

  6. Rissanen TT, Uskela S, Eränen J, Mäntylä P, Olli A, Romppanen H, Antti Siljander A, Pietilä M, Minkkinen MJ, Tervo J, Kärkkäinen JM (2019) Drug-coated balloon for treatment of de-novo coronary artery lesions in patients with high bleeding risk (DEBUT): a single-blind, randomised, non-inferiority trials. Lancet 394:230–239

    Article  Google Scholar 

  7. Buccheri D, Lombardo RM, Cortese B (2019) Drug-coated balloons for coronary artery disease: current concepts and controversies. Future Cardiol 15:437–454

    Article  CAS  Google Scholar 

  8. Cortese B, Piraino D, Buccheri D, Alfonso F (2016) Treatment of bifurcation lesions with drug-coated balloons: a review of currently available scientific data. Int J Cardiol 220:589–594

    Article  Google Scholar 

  9. Jeger RV, Eccleshall S, Ahmad WAW, Ge J, Poerner TC, Shin ES, Alfonso F, Latib A, Ong PJ, Rissanen TT, Saucedo J, Scheller B, Kleber FX (2020) Drug-coated balloons for coronary artery disease: third report of the International DCB Consensus Group. JACC Cardiovasc Interv 13:1391–1402

    Article  Google Scholar 

  10. Scheller B, Vukadinovic D, Jeger R, Rissanen TT, Scholz SS, Byrne R, Kleber FX, Latib A, Clever YP, Ewen S, Böhm M, Yang Y, Lansky A, Mahfoud F (2020) Survival after coronary revascularization with paclitaxel-coated balloons. J Am Coll Cardiol 75:1017–1028

    Article  CAS  Google Scholar 

  11. Cortese B, D’Ascenzo F, Fetiveau R, Balian V, Blengino S, Fineschi M, Rogacka R, Lettieri C, Pavei A, D’Amico M, Poli A (2018) Treatment of coronary artery disease with a new-generation drug-coated balloon: final results of the Italian Elutax SV rEgistry-DCB-RISE. J Cardiovasc Med (Hagerstown) 19:247–252

    Article  CAS  Google Scholar 

  12. Moussa ID, Klein LW, Shah B, Mehran R, Mack MJ, Brilakis ES, Reilly JP, Zoghbi G, Holper E, Stone GW (2013) Consideration of a new definition of clinically relevant myocardial infarction after coronary revasculrarization. An expert consensus document from the Society for Cardiovascular Angiography and Intervention (SCAI). J Am Coll Cardiol 62:1563–1570

    Article  Google Scholar 

  13. Mehran R, Rao SV, Bhatt DL, Gibson CM, Caixeta A, Eikelboom J, Kaul S, Wiviott SD, Menon V, Nikolsky E, Serebruany V (2011) Standardized bleeding definitions for cardiovascular clinical trials: a consensus report from the Bleeding Academic Research Consortium. Circulation 123:2736–2747

    Article  Google Scholar 

  14. Nagai T, Mizobuchi M, Funatsu A, Kobayashi T, Nakamura S (2019) Acute and mid-term outcomes of drug-coated balloon following rotational atherectomy. Cardiovasc Interv Ther. https://doi.org/10.1007/s12928-019-00611-y

    Article  PubMed  PubMed Central  Google Scholar 

  15. Abdel-Wahab M, Baev R, Dieker P, Kassner G, Khattab AA, Toelg R, Sulimov D, Geist V, Richardt G (2013) Long-term clinical outcome of rotational atherectomy followed by drug-eluting stent implantation in complex calcified coronary lesions. Catheter Cardiovasc Interv 81:285–291

    Article  Google Scholar 

  16. Furuichi S, Sangiorgi GM, Godino C, Airoldi F, Montorfano M, Chieffo A, Michev I, Carlino M, Colombo A (2009) Rotational atherectomy followed by drug-eluting stent implantation in calcified coronary lesions. EuroIntervention 5:370–374

    Article  Google Scholar 

  17. Abdel-Wahab M, Richardt G, Joachim Büttner H, Toelg R, Geist V, Meinertz T, Schofer J, King L, Neumann FJ, Khattab AA (2013) High-speed rotational atherectomy before paclitaxel-eluting stent implantation in complex calcified coronary lesions: the randomized ROTAXUS (Rotational Atherectomy Prior to Taxus Stent Treatment for Complex Native Coronary Artery Disease) trial. JACC Cardiovasc Interv 6:10–19

    Article  Google Scholar 

  18. Tian W, Mahmoudi M, Lhermusier T, Pendyala LK, Kiramijyan S, Saar M, Ota H, Chen F, Torguson R, Suddath WO, Satler LF (2015) Clinical outcomes of first- and second-generation drug-eluting stents in patients undergoing rotational atherectomy for heavily calcified coronary lesions. Cardiovasc Revasc Med 16:147–150

    Article  Google Scholar 

  19. Rissanen TT, Uskela S, Siljander A, Kärkkäinen JM, Mäntylä P, Eränen J (2017) Percutaneous coronary intervention of complex calcified lesions with drug-coated balloon after rotational atherectomy. J Interv Cardiol 30:139–146

    Article  Google Scholar 

  20. Shiraishi J, Kataoka E, Ozawa T, Shiraga A, Ikemura N, Matsubara Y, Nishimura T, Ito D, Kojima A, Kimura M, Kishita E, Nakagawa Y, Hyogo M, Sawada T (2019) Angiographic and clinical outcomes after stent-less coronary intervention using rotational atherectomy and drug-coated balloon in patients with de novo lesions. Cardiovasc Revasc MED 21:647–653

    Article  Google Scholar 

  21. Ueno K, Morita N, Kojima Y, Takahashi H, Kawasaki M, Ito R, Kondo H, Motoguchi S, Yoshida T, Hashimoto Y, Tatsumi T, Kitamura T (2019) Safety and long-term efficacy of drug-coated balloon angioplasty following rotational atherectomy for severely calcified coronary lesions compared with new generation drug-eluting stents. J Interv Cardiol 2019:9094178

    Article  Google Scholar 

  22. Ito R, Ueno K, Yoshida T, Takahashi H, Tatsumi T, Hashimoto Y, Kojima Y, Kitamura T, Morita N (2018) Outcomes after drug-coated balloon treatment for patients with calcified coronary lesions. J Interv Cardiol 31:436–441

    Article  Google Scholar 

  23. Natsuaki M, Morimoto T, Yamaji K, Watanabe H, Yoshikawa Y, Shiomi H, Nakagawa Y, Furukawa Y, Kadota K, Ando K, Akasaka T (2018) Prediction of thrombotic and bleeding events after percutaneous coronary intervention: CREDO-Kyoto thrombotic and bleeding risk scores. J Am Heart Assoc 7:e008708

    Article  Google Scholar 

  24. Faza NN, Mentias A, Parashar A, Chaudhury P, Barakat AF, Agarwal S, Wayangankar S, Ellis SG, Murat Tuzcu E, Kapadia SR (2017) Bleeding complications of triple antithrombotic therapy after percutaneous coronary interventions. Catheter Cardiovasc Interv 89:E64–E74

    Article  Google Scholar 

  25. Généreux P, Giustino G, Witzenbichler B, Weisz G, Stuckey TD, Rinaldi MJ, Neumann FJ, Metzger DC, Henry TD, Cox DA, Duffy PL (2015) Incidence, predictors, and impact of post-discharge bleeding after percutaneous coronary intervention. J Am Coll Cardiol 66:1036–1045

    Article  Google Scholar 

  26. Holmes DR Jr, Kereiakes DJ, Garg S, Serruys PW, Dehmer GJ, Ellis SG, Williams DO, Kimura T, Moliterno DJ (2010) Stent thrombosis. J Am Coll Cardiol 56:1357–1365

    Article  Google Scholar 

  27. Cheneau E, Leborgne L, Mintz GS, Kotani JI, Pichard AD, Satler LF, Canos D, Castagna M, Weissman NJ, Waksman R (2003) Predictors of subacute stent thrombosis:results of a systematic intravascular ultrasound study. Circulation 108:43–47

    Article  Google Scholar 

  28. Cui Y, Liu Y, Zhao F, Shi D, Chen K (2016) Neoatherosclerosis after drug-eluting stent implantation: roles and mechanisms. Oxid Med Cell Longev 2016:5924234

    Article  Google Scholar 

  29. Otsuka F, Byrne RA, Yahagi K, Mori H, Ladich E, Fowler DR, Kutys R, Xhepa E, Kastrati A, Virmani R, Joner M (2015) Neoatherosclerosis: overview of histopathologic findings and implications for intravascular imaging assessment. Eur Heart J 36:2147–2159

    Article  Google Scholar 

  30. Nakamura D, Attizzani GF, Toma C, Sheth T, Wang W, Soud M, Aoun R, Tummala R, Leygerman M, Fares A, Mehanna E (2016) Failure mechanisms and neoatherosclerosis patterns in very late drug-eluting and bare-metal stent thrombosis. Circ Cardiovasc Interv 9:e003785

    Article  CAS  Google Scholar 

  31. Mauri L, Kereiakes DJ, Yeh RW, Driscoll-Shempp P, Cutlip DE, Steg PG, Normand SL, Braunwald E, Wiviott SD, Cohen DJ, Holmes DR Jr (2014) Twelve or 30 months of dual antiplatelet therapy after drug-eluting stents. N Engl J Med 371:2155–2166

    Article  Google Scholar 

  32. Cortese B, Silva Orrego P, Agostoni P, Buccheri D, Piraino D, Andolina G, Seregni RG (2015) Effect of drug-coated balloons in native coronary artery disease left with a dissection. JACC Cardiovasc Interv 8:2003–2009

    Article  Google Scholar 

  33. Funatsu A, Nakamura S, Inoue N, Nanto S, Nakamura M, Iwabuchi M, Ando K, Asano R, Habara S, Saito S, Mitsudo K (2017) A multicenter randomized comparison of paclitaxel-coated balloon with plain balloon angioplasty in patients with small vessel disease. Clin Res Cardiol 106:824–832

    Article  CAS  Google Scholar 

  34. Kaplan BM, Safian RD, Mojares JJ, Reddy VM, Gangadharan V, Schreiber TL, Grines CL, O’Neill WW (1996) Optimal burr and adjunctive balloon sizing reduces the need for target artery revascularization after coronary mechanical rotational atherectomy. Am J Cardiol 78:1224–1229

    Article  CAS  Google Scholar 

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Authors and Affiliations

  1. Cardiovascular Center, Kyoto Katsura Hospital, 1-8,10:17-banchi, Yamada Hirao-cho, Nishikyo-ku, Kyoto-shi, Kyoto, 615-8256, Japan

    Yoshihiro Iwasaki, Jumpei Koike, Toshinori Ko, Atsushi Funatsu, Tomoko Kobayashi & Shigeru Nakamura

  2. Department of Cardiovascular Medicine, Toho University Graduate School of Medicine, 9:11-banchi, omorinishi 6 Choume, Ota-ku, Tokyo, 143-8541, Japan

    Takanori Ikeda

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  1. Yoshihiro Iwasaki
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  2. Jumpei Koike
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Iwasaki, Y., Koike, J., Ko, T. et al. Comparison of drug-eluting stents vs. drug-coated balloon after rotational atherectomy for severely calcified lesions of nonsmall vessels. Heart Vessels 36, 189–199 (2021). https://doi.org/10.1007/s00380-020-01684-z

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