Lesion Preparation Before Coronary Intravascular Brachytherapy: A Comparison of Plain Balloon Versus Cutting/Scoring Balloon Angioplasty

Background: Coronary intravascular brachytherapy (IVBT) has remained as an effective treatment for recurrent in-stent restenosis (ISR). However, optimal lesion preparation techniques prior to radiation delivery remain undefined. This study evaluated the clinical outcomes of IVBT after lesion preparation with either plain balloon angioplasty or cutting/scoring balloon angioplasty. Methods: We conducted a retrospective analysis of 219 patients who underwent vascular brachytherapy for coronary ISR between June 2016 and January 2024 at the Houston Methodist Hospital. Patients were stratified based on the type of balloon used for lesion preparation: plain balloon (n = 140) or cutting/scoring balloon (n = 79). The primary end point was target lesion revascularization (TLR) at 1 year. Secondary end points included major adverse cardiovascular events, stent thrombosis, and bleeding complications. Results: Baseline demographic characteristics were similar between groups, except for older age in the cutting/scoring balloon group (67.0 ± 11.0 vs 64.0 ± 10.3 years; P = .047). Lesion length was comparable (28.01 ± 18.62 vs 26.49 ± 17.16 mm; P = .55). At 1-year follow-up, TLR rates were similar (26.6% vs 17.9%; P = .17), as were major adverse cardiovascular event rates (32.9% vs 35.0%; P = .86). Conclusions: We observed no significant difference in 1-year and 3-year clinical outcomes compared to conventional plain balloon angioplasty. The trend toward higher TLR rates in the cutting/scoring balloon group warrants further investigation in larger, prospective studies. These findings suggest that lesion-specific factors, rather than balloon type alone, may be more important determinants of outcomes after IVBT for ISR.