Ultrasound assessment of intimal hyperplasia after plain balloon angioplasty and drug-coated balloon angioplasty of AV access stenosis.

PURPOSE: To determine whether there is a significant decrease in intimal hyperplasia post percutaneous transluminal angioplasty (PTA) of AV access stenosis. Comparing drug-coated balloon (DCB) angioplasty with plain uncoated balloon (PUB) angioplasty by examining B-mode ultrasound measurements of percentage intimal medial thickening (%IMT) in stenotic lesions pre and post PTA. METHODS: One hundred ninety-one consecutive PTA procedures for AV access dysfunction were screened retrospectively for inclusion. Those procedures where there was an ultrasound prior to and following PTA with measurements of IMT were included. RESULTS: Ninety-nine stenotic lesions were included in a total of 87 patients. A total of 26/99, 26%, were treated by DCB angioplasty, and a total of 73/99, 74%, were treated by PUB angioplasty. The difference between the pre-PTA and post-PTA %IMT was calculated and defined as the delta-%IMT for each group. There was a greater reduction in %IMT in the DCB group (mean delta-%IMT =  - 22.35%) when compared with the PUB group (mean delta-%IMT =  - 5.94%), p = 0.0005. Delta-%IMT for those lesions where there was a baseline pre-PTA %IMT of greater than 25% was examined. The mean delta-%IMT reduced in the PUB group from - 5.94% to - 2.20% and remained similar in the DCB group at - 20.05%, p = 0.0003. A Kaplan-Meir survival analysis examining primary patency over 24 months did not demonstrate any significant difference between the 2 groups. CONCLUSION: The statistically significant decrease in %IMT post PTA using a DCB compared with PUB angioplasty appears to demonstrate an anti-proliferative drug effect on lesion intimal hyperplasia. However, this did not translate into a sustained difference in target lesion primary patency.