Five-Year Outcomes After Paclitaxel-Coated Balloon Angioplasty for Drug-Eluting Stent Restenosis

The long-term outcomes of patients who underwent paclitaxel-coated balloon (PCB) angioplasty for drug-eluting stent restenosis (DES-ISR) remain unclear. We investigated the 5-year safety and efficacy outcomes of PCB angioplasty for DES-ISR. The study included 185 patients with 216 DES-ISR lesions who underwent PCB angioplasty from September 2008 to December 2010. Two serial angiographic follow-ups were routinely scheduled at 6 and 18 months after the index procedure. Five-year clinical outcomes were investigated. The mean duration of follow-up was 2,052 ± 352.5 days, and 94.1% of the patients completed the 5-year follow-up. Recurrent restenosis was observed in 48 lesions (22.2%) at the 6-month follow-up and late restenosis was observed in 22 lesions (14.3%) at the 18-month follow-up. Very late restenosis was observed in 6 lesions (6.8%), and target lesion revascularization (TLR) was performed for 8 lesions (13.6%) beyond 24 months after the procedure. The cumulative rates of TLR at 1, 2, and 5 years were 16.4%, 28.9%, and 34.1%, respectively. In patients who underwent TLR, 87% (52 of 60 patients) underwent TLR within the first 2 years after the index procedure. Multivariable analysis revealed that in-stent occlusion lesion (odds ratio [OR] 2.21; 95% confidence interval [CI] 1.09 to 4.47; p = 0.03), postprocedural percent diameter stenosis >35% (OR 3.19; 95% CI 1.54 to 6.68; p = 0.001), and right coronary artery ostial lesions (OR 5.56; 95% CI 1.40 to 24.9; p = 0.01) were independent predictors of recurrent restenosis. In conclusion, our results suggest that long-term outcomes after PCB angioplasty are acceptable; however, close follow-up during the first 2 years following this procedure may be necessary.