Paclitaxel Balloons on Par With Repeat Stenting for In-Stent CTO

The study covered in this summary was published on as a preprint and has not yet been peer reviewed.

Key Takeaway

  • Paclitaxel-coated balloon (PCB) angioplasty had similar long-term outcomes as repeat stenting with a drug-eluting stent (DES) in patients with DES in-stent chronic total occlusion (IS-CTO).

  • Both treatments were associated with high rates of major adverse cardiac events (MACE).

Why This Matters

  • The two main treatments for in-stent restenosis are angioplasty with PCBs and repeat stenting with DESs. However, current data are insufficient for comparisons of effectiveness between the two strategies.

  • IS-CTO accounts for approximately 10%-25% of percutaneous coronary interventions performed for CTO.

Study Design

  • The study retrospectively enrolled 214 patients who underwent successful percutaneous coronary intervention for DES IS-CTO from January 2016 to December 2019, of whom 78 were treated with PCB angioplasty and 136 with DESs.

  • CTO was defined as a coronary obstruction with a Thrombolysis In Myocardial Infarction (TIMI) flow grade 0 for at least 3 months.

  • Cox proportional hazards modeling was performed to compare the risk for MACE between PCB angioplasty and DES repeat stenting. The Student t-test or the Wilcoxon rank-sum test was used to compare differences in continuous variables between groups. Propensity score–based inverse probability of treatment weighting was also performed to reduce possible selection bias.

Key Results

  • During a median follow-up of 3 years, the primary outcome of MACE occurred in approximately one fourth of PCB and DES patients (28.2% vs 26.5%, respectively; P = .784) and was mostly due to target lesion revascularization (21.8% vs. 19.9%; respectively; P =.735).

  • No significant differences were observed in long-term clinical events between the two treatments in multivariable-adjusted or propensity-weighted analyses.

  • PCB angioplasty increased with an increase in the number of previous stent layers.

  • Chronic kidney disease (hazard ratio [HR], 2.82) and 3 or more stent layers (HR, 4.50) were independent predictors of MACE, whereas switching to another antiproliferative drug decreased risk by 55% (HR, 0.45).


  • This was a single-center, retrospective study of a small cohort.

  • Possible bias existed because the final choices of implants were determined by operators or interventional treatment groups.

  • The use of intracoronary imaging was much lower than in other large IS-CTOs, thus precluding detailed evaluation of pathologic features and potential mechanisms of DES IS-CTO.

  • Medication use after discharge was not evaluated.

  • Patients with unknown data on previous interventional procedures were excluded, so the conclusions of this study may not extend to all patients with DES IS-CTO.


  • The study was supported by the National Natural Science Foundation of China.

  • The authors declared they have no competing interests.

This is a summary of a preprint research study, “Clinical Outcome of Paclitaxel-Coated Balloon Angioplasty Versus Drug-Eluting Stent Implantation for the Treatment of Coronary Drug-Eluting Stent In-stent Chronic Total Occlusion,” written by Yuchao Zhang, Beijing Institute of Heart Lung and Blood Vessel Diseases: Capital Medical University Affiliated Anzhen Hospital, and colleagues, on ResearchSquare provided to you by Medscape. This study has not yet been peer reviewed. The full text of the study can be found on

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