Rotational Atherectomy Combined With Super High‐Pressure Noncompliant Balloon in Severe or Recurrent In‐Stent Restenosis
Bibliographic record
Abstract
Background In‐stent restenosis (ISR) and recurrent ISR (Re‐ISR) remain significant challenges of percutaneous coronary intervention (PCI), especially in complex lesions where conventional therapies are less effective. Rotational atherectomy (RA) combined with super high‐pressure noncompliant (NC) balloons represents a potential strategy for addressing severe ISR or Re‐ISR. Objectives and Methods This study investigated the procedural success and safety as well as clinical outcomes of RA combined with super high‐pressure NC balloons in patients with severe or Re‐ISR. Consecutive patients treated for severe or Re‐ISR between January 2020 and September 2024 were retrospectively analyzed. The primary endpoint was major adverse cardiovascular events (MACEs) at follow‐up, including target vessel myocardial infarction (TV‐MI), target lesion revascularization (TLR), and target vessel revascularization (TVR). Periprocedural complications were also recorded. Results Out of 13 treated patients, 6 (46%) patients experienced periprocedural events, including 3 (23%) Type A dissections, 2 (15%) Type B dissections, and 1 (8%) Ellis Grade I perforation. 9 (70%) patients were treated with drug‐coated balloons (DCBs), 1 (8%) of which had crossover to stenting and 2 (15%) had hybrid strategy with DCB and stenting combined. At a median follow‐up of 13 months, 4 (31%) patients had MACE, comprising 1 (8%) TV‐MI by TLR, 2 (15%) clinically driven TLR, and 1 (8%) TVR. Secondary outcomes included 1 (8%) case of hospitalization for heart failure (HF) and 1 (8%) COVID‐19–related death. Conclusions RA combined with super high‐pressure NC balloons for the treatment of severe ISR or Re‐ISR is associated with a significant risk of periprocedural complications. However, the midterm outcomes suggest this strategy might be effective in managing severe or Re‐ISR. Trail Registration ClinicalTrials.gov identifier: NCT06075602
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".