{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,10]],"date-time":"2026-02-10T17:45:58Z","timestamp":1770745558448,"version":"3.49.0"},"reference-count":15,"publisher":"Oxford University Press (OUP)","issue":"7","license":[{"start":{"date-parts":[[2022,6,28]],"date-time":"2022-06-28T00:00:00Z","timestamp":1656374400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2022,7,6]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Drug-coated balloon angioplasty after directional coronary atherectomy (DCA) allows for a stentless strategy providing good short-term outcomes; however, late-phase restenosis and its mechanism remain unclear. Moreover, histopathological evaluation for late-phase restenosis post-drug-coated balloon angioplasty after DCA has never been reported.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Case summary<\/jats:title>\n                  <jats:p>We report the first case of late-phase restenosis post-drug-coated balloon angioplasty after DCA, wherein tissue analysis using intravascular coronary imaging and histopathology suggested neovascularization in newly developed neointimal proliferation. A 52-year-old man with a history of dyslipidaemia presented with exertional angina pectoris. He underwent percutaneous coronary intervention (PCI) with drug-coated balloon angioplasty after DCA for the proximal left anterior descending artery. Although coronary angiography after nine months revealed no restenosis, he experienced recurrent chest discomfort after 25 months. Coronary angiography confirmed late-phase restenosis, and intravascular ultrasound showed progressively developed neointima above the underlying residual plaque. Optical coherence tomography suggested developing neovascularization within the neointima. Stentless PCI with drug-coated balloon angioplasty after DCA was re-performed, and collected restenotic sample. The histopathological evaluation confirmed less-cellular neointimal proliferation with rich neovascularization and concomitant diffuse vascular endothelial growth factor (VEGF) expression.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Discussion<\/jats:title>\n                  <jats:p>Late-phase restenosis post-drug-coated balloon angioplasty after DCA comprised less-cellular neointima, suggesting inhibition of cell proliferation by drug-coated balloon efficacy. However, diffuse VEGF expression and concomitant rich neovascularization with haemorrhage and inflammation might indicate neointimal proliferation. Further large-scale investigations of the restenotic mechanism should be performed to avoid long-term target vascular failure after drug-coated balloon angioplasty post-DCA.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/ehjcr\/ytac259","type":"journal-article","created":{"date-parts":[[2022,6,28]],"date-time":"2022-06-28T05:11:15Z","timestamp":1656393075000},"source":"Crossref","is-referenced-by-count":2,"title":["Histopathological findings of late-phase restenosis after directional coronary atherectomy with drug-coated balloon angioplasty: a case report"],"prefix":"10.1093","volume":"6","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5268-4606","authenticated-orcid":false,"given":"Hiroyuki","family":"Yamamoto","sequence":"first","affiliation":[{"name":"Division of Cardiovascular Medicine, Hyogo Brain and Heart Centre , 520, Saisho-Kou, 670-0981 Himeji , Japan"},{"name":"Division of Cardiovascular Medicine, Department of Internal Medicine, Hyogo Prefectural Harima-Himeji General medical Center3-264 Kamiya-cho , 670-8560 Himeji , Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7425-4087","authenticated-orcid":false,"given":"Takuo","family":"Emoto","sequence":"additional","affiliation":[{"name":"Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine , 7-5-1 Kusunoki-cho, Chuo-ku, Kobe 6500017 , Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shintaro","family":"Takeda","sequence":"additional","affiliation":[{"name":"Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine , 7-5-1 Kusunoki-cho, Chuo-ku, Kobe 6500017 , Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5775-8072","authenticated-orcid":false,"given":"Tomofumi","family":"Takaya","sequence":"additional","affiliation":[{"name":"Division of Cardiovascular Medicine, Hyogo Brain and Heart Centre , 520, Saisho-Kou, 670-0981 Himeji , Japan"},{"name":"Division of Cardiovascular Medicine, Department of Internal Medicine, Hyogo Prefectural Harima-Himeji General medical Center3-264 Kamiya-cho , 670-8560 Himeji , Japan"},{"name":"Division of Exploratory and Advanced Search in Cardiology, Kobe University Graduate School of Medicine , 7-5-1 Kusunoki-cho, Chuo-ku, Kobe 6500017 , Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2022,6,28]]},"reference":[{"key":"2022070805170571700_ytac259-B1","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1093\/ehjcr\/ytaa001","article-title":"Repetitive restenosis in a biodegradable polymer sirolimus-eluting stent with hypersensitivity reaction: a case report","volume":"4","author":"Jimba","year":"2020","journal-title":"Eur Heart J Case Rep"},{"key":"2022070805170571700_ytac259-B2","doi-asserted-by":"crossref","first-page":"ytab370","DOI":"10.1093\/ehjcr\/ytab370","article-title":"In-stent restenosis due to delayed healing of abluminal bioresorbable polymer everolimus-eluting stent: insight from histopathological evaluation with directional coronary atherectomy","volume":"5","author":"Yamamoto","year":"2021","journal-title":"Eur Heart J Case Rep"},{"key":"2022070805170571700_ytac259-B3","doi-asserted-by":"crossref","first-page":"62","DOI":"10.1016\/j.carrev.2021.06.004","article-title":"Waksman in-stent restenosis classification: a mechanism-based approach to the treatment of restenosis","volume":"33","author":"Shlofmitz","year":"2021","journal-title":"Cardiovasc Revasc Med"},{"key":"2022070805170571700_ytac259-B4","doi-asserted-by":"crossref","first-page":"1061","DOI":"10.1016\/j.jacc.2019.12.046","article-title":"Drug-coated balloon for de novo coronary artery disease: JACC state-of-the-art review","volume":"75","author":"Yerasi","year":"2020","journal-title":"J Am Coll Cardiol"},{"key":"2022070805170571700_ytac259-B5","doi-asserted-by":"crossref","first-page":"1941","DOI":"10.1016\/j.jacc.2007.07.066","article-title":"Pre-drug-eluting stent debulking of bifurcated coronary lesions","volume":"50","author":"Tsuchikane","year":"2007","journal-title":"J Am Coll Cardiol"},{"key":"2022070805170571700_ytac259-B6","doi-asserted-by":"crossref","first-page":"E614","DOI":"10.1002\/ccd.29185","article-title":"Efficacy of drug-coated balloon angioplasty after directional coronary atherectomy for coronary bifurcation lesions (DCA\/DCB registry)","volume":"97","author":"Kitani","year":"2021","journal-title":"Catheter Cardiovasc Interv"},{"key":"2022070805170571700_ytac259-B7","doi-asserted-by":"crossref","first-page":"831","DOI":"10.1253\/circj.CJ-19-1109","article-title":"JCS 2020 guideline focused update on antithrombotic therapy in patients with coronary artery disease","volume":"84","author":"Nakamura","year":"2020","journal-title":"Circ J"},{"key":"2022070805170571700_ytac259-B8","doi-asserted-by":"crossref","first-page":"1391","DOI":"10.1016\/j.jcin.2020.02.043","article-title":"Drug-coated balloons for coronary artery disease: third report of the international DCB Consensus Group","volume":"13","author":"Jeger","year":"2020","journal-title":"JACC Cardiovasc Interv"},{"key":"2022070805170571700_ytac259-B9","doi-asserted-by":"crossref","first-page":"207","DOI":"10.1007\/s12928-019-00587-9","article-title":"Cell proliferation does occur following directional coronary atherectomy","volume":"35","author":"Nakamura","year":"2020","journal-title":"Cardiovasc Interv Ther"},{"key":"2022070805170571700_ytac259-B10","doi-asserted-by":"crossref","first-page":"3304","DOI":"10.1093\/eurheartj\/eht241","article-title":"Human autopsy study of drug-eluting stents restenosis: histomorphological predictors and neointimal characteristics","volume":"34","author":"Nakano","year":"2013","journal-title":"Eur Heart J"},{"key":"2022070805170571700_ytac259-B11","doi-asserted-by":"crossref","first-page":"706","DOI":"10.3389\/fimmu.2018.00706","article-title":"Vasa vasorum angiogenesis: key player in the initiation and progression of atherosclerosis and potential target for the treatment of cardiovascular disease","volume":"9","author":"Sedding","year":"2018","journal-title":"Front Immunol"},{"key":"2022070805170571700_ytac259-B12","doi-asserted-by":"crossref","first-page":"884","DOI":"10.1016\/j.ahj.2014.03.013","article-title":"Spatial heterogeneity of neoatherosclerosis and its relationship with neovascularization and adjacent plaque characteristics: optical coherence tomography study","volume":"167","author":"Tian","year":"2014","journal-title":"Am Heart J"},{"key":"2022070805170571700_ytac259-B13","doi-asserted-by":"crossref","first-page":"1882","DOI":"10.1016\/j.jacc.2018.02.051","article-title":"Neoatherosclerosis 5 years after bioresorbable vascular scaffold implantation","volume":"71","author":"Moriyama","year":"2018","journal-title":"J Am Coll Cardiol"},{"key":"2022070805170571700_ytac259-B14","doi-asserted-by":"crossref","first-page":"931","DOI":"10.3390\/ijms23020931","article-title":"The role of the VEGF family in atherosclerosis development and its potential as treatment targets","volume":"23","author":"Dabravolski","year":"2022","journal-title":"Int J Mol Sci"},{"key":"2022070805170571700_ytac259-B15","doi-asserted-by":"crossref","first-page":"145","DOI":"10.1016\/j.yjmcc.2018.07.007","article-title":"Local adventitial anti-angiogenic gene therapy reduces growth of vasa-vasorum and in-stent restenosis in WHHL rabbits","volume":"121","author":"Hyt\u00f6nen","year":"2018","journal-title":"J Mol Cell Cardiol"}],"container-title":["European Heart Journal - Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/ehjcr\/advance-article-pdf\/doi\/10.1093\/ehjcr\/ytac259\/44268024\/ytac259.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ehjcr\/article-pdf\/6\/7\/ytac259\/44615221\/ytac259.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ehjcr\/article-pdf\/6\/7\/ytac259\/44615221\/ytac259.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,7,8]],"date-time":"2022-07-08T05:17:43Z","timestamp":1657257463000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/ehjcr\/article\/doi\/10.1093\/ehjcr\/ytac259\/6618827"}},"subtitle":[],"editor":[{"given":"Dimitrios A","family":"Vrachatis","sequence":"additional","affiliation":[],"role":[{"role":"editor","vocabulary":"crossref"}]},{"given":"Devika","family":"Kir","sequence":"additional","affiliation":[],"role":[{"role":"editor","vocabulary":"crossref"}]},{"given":"Denizhan","family":"Ozdemir","sequence":"additional","affiliation":[],"role":[{"role":"editor","vocabulary":"crossref"}]},{"given":"Alexandru","family":"Achim","sequence":"additional","affiliation":[],"role":[{"role":"editor","vocabulary":"crossref"}]},{"given":"Oliver","family":"Ian Brown","sequence":"additional","affiliation":[],"role":[{"role":"editor","vocabulary":"crossref"}]},{"given":"Michael","family":"Waight","sequence":"additional","affiliation":[],"role":[{"role":"editor","vocabulary":"crossref"}]}],"short-title":[],"issued":{"date-parts":[[2022,6,28]]},"references-count":15,"journal-issue":{"issue":"7","published-print":{"date-parts":[[2022,7,6]]}},"URL":"https:\/\/doi.org\/10.1093\/ehjcr\/ytac259","relation":{},"ISSN":["2514-2119"],"issn-type":[{"value":"2514-2119","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2022,7,1]]},"published":{"date-parts":[[2022,6,28]]},"article-number":"ytac259"}}