Technical Mastery: Guidance on Proper Imaging, Lesion Preparation, and Deployment for Coronary Drug-Coated Balloons. Part 2: Coronary DCBs in De Novo Lesions, Small Vessel, and Bifurcation: The European Experience-Case: De Novo Lesion, Dr. Antonio Colombo

Video Transcription

Video Summary

Antonio presented a pragmatic approach integrating drug-coated balloons (DCB) with drug-eluting stents (DES) to simplify complex coronary interventions, particularly in cases of long, diffuse lesions and bifurcations. He emphasized minimizing stent length to avoid complications like carina shift and full metal jacket, especially beneficial for high bleeding risk patients. Essential to DCB success is thorough lesion preparation using non-compliant balloons sized one-to-one, high-pressure inflation, and sometimes cutting balloons to achieve optimal dilation with minimal dissection. Residual lumens should be adequate, with dye clearing swiftly in angiography, guided by imaging like IVUS when possible. The risk of acute vessel closure after leaving some dissections untreated is low, supported by clinical data due to drug healing effects and anticoagulation. Post-DCB imaging is discouraged as it may dislodge the drug. The panel underlined that final lumen area after lesion preparation is the critical factor for successful DCB treatment of de novo lesions.

Keywords

drug-coated balloons

drug-eluting stents

coronary interventions

lesion preparation

high bleeding risk

angiographic imaging