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Drug-Coated Balloon for Instent Restenosis in Patients at High Risk: Another Brick in the Wall of the Challenging Settings for Interventionists

      Recently, Miglionico et al
      • Miglionico M.
      • Mangiacapra F.
      • Nusca A.
      • Scordino D.
      • Gallo P.
      • Campanale M.
      • Melfi R.
      • Di Sciascio G.
      Efficacy and safety of paclitaxel-coated balloon for the treatment of in-stent restenosis in high-risk patients.
      published in this journal an interesting prospective observational study regarding 82 patients at high-risk with instent restenosis of bare-metal stent, n = 48 (59%) or drug-eluting stent (DES), n = 34 (41%). All patients had at least one of the following high-risk features: a history of hemorrhagic stroke or gastrointestinal bleeding, ischemic stroke not longer of 3 months before, need for oral anticoagulation or noncardiac surgery or recent surgery, chronic inflammatory disease, or neoplasm. Patients presenting with ST-segment elevation myocardial infarction and with paclitaxel hypersensivity
      • Miglionico M.
      • Mangiacapra F.
      • Nusca A.
      • Scordino D.
      • Gallo P.
      • Campanale M.
      • Melfi R.
      • Di Sciascio G.
      Efficacy and safety of paclitaxel-coated balloon for the treatment of in-stent restenosis in high-risk patients.
      were excluded. In.Pact Falcon (Medtronic Inc., Minneapolis, Minnesota), Pantera Lux (Biotronik, Bulach, Switzerland), and Restore (Cardionovum GmbH, Bonn, Germany) were the 3 drug-coated balloons (DCBs) available for percutaneous coronary interventions. In all cases the lesion was predilatated with a semicompliant or noncompliant balloon.
      • Miglionico M.
      • Mangiacapra F.
      • Nusca A.
      • Scordino D.
      • Gallo P.
      • Campanale M.
      • Melfi R.
      • Di Sciascio G.
      Efficacy and safety of paclitaxel-coated balloon for the treatment of in-stent restenosis in high-risk patients.
      Double antiplatelet therapy (DAPT) with aspirin and clopidogrel was maintained for 4 weeks after the procedure.
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      Linked Article

      • Efficacy and Safety of Paclitaxel-Coated Balloon for the Treatment of In-Stent Restenosis in High-Risk Patients
        American Journal of CardiologyVol. 116Issue 11
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          In-stent restenosis (ISR) is a major cause of failure of percutaneous coronary intervention. The efficacy and safety of drug-coated balloon (DCB) in patients with high-risk clinical features are largely unknown. We enrolled 82 consecutive patients at high risk of bleeding with angiographically significant (diameter stenosis ≥50%) ISR of bare metal stent (BMS) or drug-eluting stent (DES), treated with paclitaxel-coated balloon. All patients presented at least one of the following criteria: high bleeding risk, neoplasm, chronic inflammatory disease, and need for noncardiac surgery.
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