Technical Mastery: Guidance on Proper Imaging, Lesion Preparation, and Deployment for Coronary Drug-Coated Balloons. Part 1: In-Stent Restenosis, Step-by-Step How to Treat-Case: Using DCBs to Treat In-Stent Restenosis, Dr. Kate Kearney

Video Transcription

Video Summary

The discussion centers on treating in-stent restenosis (ISR), emphasizing a shift from always aiming for perfect stenting to considering alternatives like drug-coated balloons (DCBs) and advanced imaging techniques. ISR remains a significant issue, accounting for about 10% of cases, largely due to cumulative incidence and challenges with drug-eluting stents. The speaker advocates for a methodical approach using imaging (OCT, IVL, laser) to assess and address underlying issues such as calcification, mechanical problems, or neo-intimal hyperplasia. They caution against repeated stenting, especially multiple layers, which often worsen outcomes. Instead, careful predilation, balloon sizing, and use of DCBs can help manage lesions while preserving vessel integrity and reducing restenosis risk. The importance of avoiding geographic miss—treating only areas covered by drug—is stressed. The conversation also highlights evolving comfort with leaving certain dissections untreated and managing them conservatively, reflecting a move away from automatic stenting towards a nuanced, individualized approach.

Keywords

in-stent restenosis

drug-coated balloons

advanced imaging

predilation and balloon sizing

conservative management