We've got about two minutes left. We're just going to let John Lisker talk about the Emory setup. They've actually been so in on this problem to help patients. They've started a brachytherapy program over the past year, which has gotten very busy very quickly, John. So tell us a little bit about your stent failure practice, the clinic you have, and your efforts to help these patients. Yeah. Thanks so much to everybody for the invitation, and thanks, Kevin. He's been a huge mentor in this whole process. So as everyone has already alluded to on the panel, stent failure is such a large problem, especially in our part of the country in the Southeast, and there's not a lot of comprehensive stent failure management programs. So Prathik Sandesara really led the effort, and then I joined him when I started on faculty. So we have a dedicated stent failure program with two MDs, Prathik and myself, a dedicated coordinator that really assists us getting these patients in, getting the films, and all the almost unbelievable amount of back work it takes to get them approved. We've had a significant amount of education with our APP staff, especially with the pharmacotherapy and doing things like getting these people on uninterrupted dapton, colchicine, and then really have tried to offer more so than the brachyclinic, a comprehensive stent failure management clinic. Be it either brachytherapy, drug-coated balloon therapy, or we have a surgeon here, John Puskis, who in very extreme cases will actually do stentectomy and cut out the stents and reconstruct the artery. We've made a big effort to standardize our practices. So it's almost kind of akin to the CTO world, the way we do things with 100% of intravascular imaging than the algorithmic approach that you and Evan were so instrumental in developing. We then have long-term follow-up on all these patients. We put them in an in-house registry with the hope of being able to generate some meaningful data going forward about imaging and the approach and long-term outcomes. We started back in July, Kevin, I think is when you came down for the first time, and we've done about 129 cases to date. So we're very grateful for all your help and certainly look forward to keep going. Great. Yeah. And for people that are looking to grow their practice, I mean, it really is an underserved area for which there's a lot of camaraderie and shared approaches and algorithms. And I credit Ron to helping teach all of us the importance of this field and the various ways to treat it over years. He's been at this a long time, and it is a little bit of a Sisyphean task, Ron. For some of these patients, you feel like you're internally rolling the rock up the hill, but they definitely need our services, and they may be back every couple of years, but we keep them going to the best of our ability. There was one last question about the medical therapy that Evan spoke further about. How long do you leave people on colchicine and silostazole? There's not a lot of clarity. I took coaching from our cardio room clinic, where they put their patients that are highly inflamed on colchicine for life. It's the Colcott dosing. I had the reference on that slide. We give people 0.6 milligrams Q-Day. I think Lodoco is 0.5. It's more expensive, so we just give them generic colchicine as long as they can tolerate it. In the Q-Day dosing, it tends to be well-tolerated. I put people on silostazole for 18 months, not knowing any better. I don't know, John or Pradek or Evan, if you do anything differently for these chronic incident re-stenosis patients. In the past, we used to give oral sirolimus, but it was associated with a lot of side effects, so we stopped doing that. I would not give colchicine if you don't have high CRP. The inflammatory process, if it's very local, it's going to be very hard to believe that colchicine will do anything to the local inflammation, which could be resulted from the polymer or from something else. You need to have more systematic CRP levels or something that would be—because there are side effects with colchicine. It's not that innocent. Not everybody can take it also. I really think that brachytherapy for me is like the sledgehammer for everything. It's not a permanent solution, but at least it gives you some relief. As we said, you can do it two or three times. Surgery is also an option. Sometimes that's the only option, so we're just trying to avoid it, but we have to admit that if this is an LAD like this patient that you showed, Kevin, you can easily graft this and the patient probably would live longer and good quality of life. Right. Yeah. I wish our surgeon would have taken her up front because it would have saved us these complicated procedures. Well, Tanvir, thank you very much for organizing this tonight. I want to thank our co-moderator, Juan Waxman, Khaled, Evan, John, product presenters, and panelists. This has really been wonderful. I think it nicely highlights an extension of interest in bifurcation. Bifurcation PCI is interesting because it's complicated, there's ways to do it well, and they're more TLR failure prone. When they fail, I think it's an added benefit to have a systematic approach to treat them. Thanks everyone. I hope you have a good night.

brachytherapy

stent failure management

drug-coated balloon therapy

algorithmic approach

patient outcomes