Impact of cutting balloon angioplasty (CBA) prior to bare metal stenting on restenosis a prospective randomized multicenter trial comparing CBA with balloon angioplasty (BA) before stenting (REDUCE III)

Yukio Ozaki, Tetsu Yamaguchi, Takahiko Suzuki, Masato Nakamura, Michihiko Kitayama, Hideo Nishikawa, Teruo Inoue, Kazuhiro Kara, Fumihiko Usuba, Masami Sakurada, Kojiro Awano, Hitoshi Matsuo, Sugao Ishiwata, Tatsuya Yasukawa, Tevfik F. Ismail, Hitoshi Hishida, Osamu Kato

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Abstract

Background: While stent restenosis and late thrombosis still occur even with drug-eluting-stents (DES), there remains a need to explore other strategies for preventing restenosis. Methods and Results: Five hundred and twenty-one patients were randomized: 260 to cutting-balloon angioplasty (CBA) before bare-metal stent (CBA-BMS) and 261 to balloon-angioplasty (BA) before BMS (BA-BMS). Intravascular ultrasound (IVUS)-guided procedures were performed in 279 (54%) patients and angiographic guidance was used in the remainder. Minimal lumen diameter was significantly greater in CBA-BMS than BA-BMS (2.65±0.40 mm vs 2.52±0.4 mm, p<0.01) and % diameter stenosis (%DS)-post was less in CBA-BMS than BA-BMS (14.0±5.9% vs 16.3±6.8%, p<0.01). %DS-follow-up was subsequently less in CBA-BMS than BABMS (32.4±15.1% vs 35.4±15.3%, p<0.05) associated with lower rates of restenosis in CBA-BMS than BA-BMS (11.8% vs 19.6%, p<0.05) and less target lesion revascularization (TLR) in CBA-BMS than BA-BMS (9.6% vs 15.3%, p<0.05). Patients were divided into 4 groups based on the device used before stenting and IVUS use (IVUS-CBA-BMS: 137 patients; Angio-CBA-BMS; 123; IVUS-BA-BMS: 142; and Angio-BA-BMS: 119). At follow-up IVUS-CBA-BMS had a significantly lower restenosis rate (6.6%) than Angio-CBA-BMS (17.9%), IVUS-BA-BMS (19.8%) and Angio-BA-BMS (18.2%, p<0.05). Conclusions: Restenosis and TLR were significantly lower in CBA-BMS than BA-BMS. This favorable outcome was achieved because of the lower restenosis rate conferred by the IVUS-guided-CBA-BMS strategy (6.6%). The restenosis rates obtained with this strategy were comparable to those achieved with DES.

Original languageEnglish
Pages (from-to)1-8
Number of pages8
JournalCirculation Journal
Volume71
Issue number1
DOIs
Publication statusPublished - 2007

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine

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    Ozaki, Y., Yamaguchi, T., Suzuki, T., Nakamura, M., Kitayama, M., Nishikawa, H., Inoue, T., Kara, K., Usuba, F., Sakurada, M., Awano, K., Matsuo, H., Ishiwata, S., Yasukawa, T., Ismail, T. F., Hishida, H., & Kato, O. (2007). Impact of cutting balloon angioplasty (CBA) prior to bare metal stenting on restenosis a prospective randomized multicenter trial comparing CBA with balloon angioplasty (BA) before stenting (REDUCE III). Circulation Journal, 71(1), 1-8. https://doi.org/10.1253/circj.71.1