Αγγειοπλαστική με απλό μπαλόνι και με μπαλόνια που αποδεσμέουν φαρμακευτική ουσία.

Transcription

1 7 ο Συνέδριο Επεμβατικής Καρδιολογίας και Ηλεκτροφυσιολογίας, Καρδιολογική Εταιρεία Βορείου Ελλάδος, 9-11/10/2014, Θεσσαλονίκη Αγγειοπλαστική με απλό μπαλόνι και με μπαλόνια που αποδεσμέουν φαρμακευτική ουσία. Αντώνιος Στ. Ντάτσιος MSc, MRCP Επεμβατικός Καρδιολόγος

2 Current indications for Balloon Angioplasty Small vessel disease Tx of sidebranch in bifurcations - Ostial stenosis Tx of culprit lesion in ACS pts with multivessel disease requiring surgical intervention Inability to deliver stent Contraindication to DAPT

3 Potential complications of POBA Dissection Abrupt closure Distal embolisation, no reflow Perforation Restenosis

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5 Available DEBs

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7 Excipient on DEB

8 Paclitaxel Drug

9 Drug Delivery

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11 Drug-Coated Balloons In-stent restenosis Small vessel disease Bifurcation sidebranches Long, diffuse disease?ami

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13 BMS-ISR: DCB vs Angioplasty PACCOCATH ISR

14 PACCOCATH ISR: 5 year results

15 DES-ISR: DCB v Angioplasty PEPCAD-DES

16 PEPCAD-II ISR

17 DEB Late Lumen Loss ISR Studies

18 DEB Target Lesion Revascularisation ISR Studies

19 RIBS V

20 RIBS V

21 RIBS V

22 DES-ISR: DCB v DES v Angioplasty

23 RIBS IV

24 RIBS IV InSegment Analysis (QCA)

25 RIBS IV Clinical Follow up

26 RIBS IV Clinical Follow up

27 RIBS IV - Conclusions In patients with DES-ISR EES provide superior late angiographic results than DEB (MLD 1ryend-point) In these patients EES also provide better late clinical results, driven by a significant reduction in the rate of TLR Treatment of DES-ISR remains challenging and associated with poorer clinical and angiographic results than treatment of BMS-ISR. Further studies (more patients & longer follow-up) are still warranted in this adverse setting.

28 ISR: DCB vs DES Both angioplasty with DCB and repeat stenting with DES are safe and effective treatments for the management of BMS-ISR and DES-ISR By obviating the need for additional stent implantation, DCB therapy may be the preferred treatment option Future studies should explore the role of OCT tissue characterization to guide treatment decision between DCB and DES

29 How to use the drug-eluting balloon: recommendations by the German consensus group Treatment recommendations for instent restenosis.

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33 Paclitaxel Coated Balloon in Small Vessel Disease

34 How to use the drug-eluting balloon: recommendations by the German consensus group Treatment recommendations for small vessel disease

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36 In bifurcation lesions everolimus-des present as a superior strategy over BMS+pDEB in the main branch (MB). This is of interest as most clinical events are due to restenosis of the MB. There are no angiographic differences on LLL of the ostium of the side branch (SB) after dilatation with plain balloon or pdeb, whereas there is a positive remodelling at follow-up, independent of the strategy used. So, at the present time, in daily practice, and with the strategy described in our study, there is no advantage of using pdeb in the SB. Future studies with dedicated DES respecting the ostium of the SB (without displacing the carina of the bifurcation) might show an advantage of using pdeb in the SB.

37 DEBUIT: DEB in bifurcations

38 001 DIOR Multicenter Registry

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47 Babilon Angiographic Results: - Main Branch: In-segment late luminal loss was almost double in drug eluting ballon (DEB) group (0.31±0.48) vs in DES group (0.16±0.38) although without reaching statistical significance (0,15). - Side Branch: No differences were found between groups Clinical Results: - No significant differences were reached in major adverse cardiac events (17.3% in DEB group vs 7.1% in DES group), although target lesion revascularization and target vessel revascularization were significantly higher in DEB group (15.4% vs 3.6% p= and 17.3% vs 3.6% p= respectively) - These differences were due only to higher restenosis of the main branch (13.5% vs 1.8% p= 0.027)

48 BMS-ISR: DES vs Angioplasty

49 DES-ISR:DES v DES ISAR DESIRE 2

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