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Technical Mastery: Guidance on Proper Imaging, Les ...
Case: Treating Stent Failure with DCBs, Underinfla ...
Case: Treating Stent Failure with DCBs, Underinflation or Lack of Calcium Management, Dr. Emily Larnard
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Video Transcription
Video Summary
The discussion centers on treating stent failure, particularly in-stent restenosis (ISR), using drug-coated balloons (DCBs) with a focus on lesion preparation and imaging techniques. A 66-year-old patient with complex coronary disease and double-layer stenting underwent CTO PCI, extensive lesion prep including high-pressure angioplasty and cutting balloons, followed by DCB use. Imaging with IVUS and OCT was debated; OCT offers superior resolution for assessing restenosis, tissue characterization, and calcium depth, whereas IVUS is better for complex lesions like CTOs and left main disease. Proper lesion preparation—achieving less than 30% residual stenosis—is emphasized as critical for DCB success, potentially involving techniques like shockwave, rotational atherectomy, and laser ablation, though laser use is less common. Calcium depth matters significantly since superficial calcium is easier to modify than deep calcium beneath neointimal layers. The panel highlighted challenges with cost and reimbursement of multiple DCBs for diffuse ISR and noted evolving strategies acknowledging that DCB failures may produce different restenosis patterns requiring tailored reinterventions. Overall, the experts expressed cautious optimism for DCB technology, anticipating new data from ongoing trials and broader adoption as evidence grows, particularly for complex lesions and diffuse disease, marking a promising advance in coronary intervention.
Keywords
in-stent restenosis
drug-coated balloons
lesion preparation
intravascular imaging
coronary intervention
calcium modification
complex coronary disease
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