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-Getting It Right: Using IVUS, Lesion Preparation and DCB’s to Treat Stent Failure, Dr. Evan Shlofmitz

Getting It Right: Using IVUS, Lesion Preparation and DCB’s to Treat Stent Failure, Dr. Evan Shlofmitz

Video Transcription

Video Summary

The discussion highlights the critical role of intracoronary imaging alongside lesion preparation when treating instant restenosis using drug-coated balloons (DCB), especially in cases of stent failure. Instant restenosis is common, occurring in over 10% of PCIs in the U.S., and is associated with poor patient outcomes, including high mortality rates. U.S. guidelines recommend using intracoronary imaging like IVUS or OCT to determine the specific mechanism behind stent failure, which varies widely (e.g., neoendothelial hyperplasia, neoatherosclerosis, or stent under-expansion). Accurate diagnosis informs tailored lesion preparation strategies essential for effective DCB treatment. Evidence shows that optimal lesion preparation—achieving low residual stenosis and adequate stent expansion—significantly reduces adverse events. Inflation time and balloon sizing also impact success rates. The session emphasized that individualized imaging-guided strategies improve outcomes and minimize revascularization risks, underscoring that instant restenosis is a heterogeneous condition requiring precise, mechanism-driven interventions.

Keywords

intracoronary imaging

drug-coated balloons

instant restenosis

stent failure

lesion preparation