Plaque scoring in calcified lesions

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Plaque scoring in calcified lesions Advancing DCB therapy in complex SFA lesions Erwin Blessing, MD, FESC SRH Klinikum Karlsbad- Langensteinbach, Germany

Disclosure Speaker name: Erwin Blessing I have the following potential conflicts of interest to report: Consulting Employment in industry Stockholder of a healthcare company Owner of a healthcare company X Other(s): speakers honoraria (Spectranetics, Medtronic, Abbott) I do not have any potential conflict of interest

Restenosis following interventions Predictiors: Lesion length 1 Diabetes 2 Occlusions 3 Calcification 1. Norgren et al. Eur J Vas Endovasc Surg 33, S1-S75: 2007 2. DeRubertis et al. J Vasc Surg 2008;47:101-108 3. Lida et al Cath and Cardiovasc Interven 2011 Oct 1;78(4):611-7

DCB use in calcified lesions Fanelli, Cardiovasc Intervent Radiol 2014

Scoring balloons in calcified lesions Inadequate penetration of the drug into the media/adventitia and therefore poorer outcome? Does a lesion preparation prior DCB improve penetration of the drug and therefore patency?

Scoring balloons in calcified lesions Inadequate penetration of the drug into the media/adventitia and therefore poorer outcome? Does a lesion preparation prior DCB improve penetration of the drug and therefore patency?

VascuTrak (Bard) Scoring Balloon Catheter

Scoring Balloon Catheter Flextome Cutting Balloon (Boston Scientific)

Chocolate (TriReme Medical) Scoring Balloon Catheter

AngioSculpt (Spectranetics) Scoring Balloon Catheter Semi-compliant nylon balloon with an external nitinol shape memory helical scoring edge

Angiosculpt plus DCB 90 year old female patient Claudicant (walking capacity 50 m) CVRF: Art. HTN, HLP

Real world registry PANTHER Evaluation of treatment of femoro Popliteal lesions with ANgiosculpT PTA Scoring Balloons HEidelberg Registry Angiosculpt PTA in calcified femoropopliteal lesions 101 patients JEVT, submitted

Real world registry PANTHER Evaluation of treatment of femoro Popliteal lesions with ANgiosculpT PTA Scoring Balloons HEidelberg Registry Angiosculpt PTA in calcified femoropopliteal lesions 124 lesions JEVT, submitted

Real world registry PANTHER Evaluation of treatment of femoro Popliteal lesions with ANgiosculpT PTA Scoring Balloons HEidelberg Registry Angiosculpt PTA in calcified femoropopliteal lesions Treatment strategy 124 lesions JEVT, submitted

Real world registry PANTHER Evaluation of treatment of femoro Popliteal lesions with ANgiosculpT PTA Scoring Balloons HEidelberg Registry Angiosculpt PTA in calcified femoropopliteal lesions Overall cohort 124 lesions Primary Patency Secondary Patency 91.8% 81.2% JEVT, submitted

Real world registry PANTHER Evaluation of treatment of femoro Popliteal lesions with ANgiosculpT PTA Scoring Balloons HEidelberg Registry Angiosculpt PTA in calcified femoropopliteal lesions Lesion length 124 lesions 86.5% 85.7% 53.8% JEVT, submitted

Primary Patency (%) PANTHER Evaluation of treatment of femoro Popliteal lesions with ANgiosculpT PTA Scoring Balloons HEidelberg Registry Real world registry Angiosculpt PTA in calcified femoropopliteal lesions Treatment strategy 124 lesions Angiosculpt Angiosculpt Angiosculpt + DCB + Supera Stent Lesion length (cm) 6.1 5.9 10.1 Occlusions (%) 2.2 17.5 31.6 83.9% 81.5% 77.8% JEVT, submitted Months

Real world registry PANTHER Evaluation of treatment of femoro Popliteal lesions with ANgiosculpT PTA Scoring Balloons HEidelberg Registry Angiosculpt PTA in calcified femoropopliteal lesions Calcification 124 lesions 81.8% 81.3% 78.9% JEVT, submitted

Real world registry PANTHER Evaluation of treatment of femoro Popliteal lesions with ANgiosculpT PTA Scoring Balloons HEidelberg Registry Angiosculpt PTA in calcified femoropopliteal lesions Calcification 124 lesions JEVT, submitted

Real world registry PANTHER Evaluation of treatment of femoro Popliteal lesions with ANgiosculpT PTA Scoring Balloons HEidelberg Registry Angiosculpt PTA in calcified femoropopliteal lesions Calcification 124 lesions JEVT, submitted

Real world registry PANTHER Evaluation of treatment of femoro Popliteal lesions with ANgiosculpT PTA Scoring Balloons HEidelberg Registry Angiosculpt PTA in calcified femoropopliteal lesions Clinical outcome p<0.0001 101 patients 6 Months 12 Months p<0.01 p<0.0001 JEVT, submitted 6 Months 12 Months

PANTHER Evaluation of treatment of femoro Popliteal lesions with ANgiosculpT PTA Scoring Balloons HEidelberg Registry

Scoring balloons in long lesions? pre 2 atm 4 atm 8 atm

Scoring balloons in long lesions? post Stellarex 5x120 Stellarex 5x120 final

Scoring balloons in ISR?

Scoring balloons in ISR? Angiosculpt 5x200 mm 4 atm 6 atm 12 atm

Scoring balloons in ISR? Post Angiosculpt 5x200 mm

Scoring balloons in ISR? Final result after DCB

Conclusions DCBs work less well in heavily calcified lesions Improved penetration of drug after lesion preparation? Encouraging register data for scoring balloons in short and moderate long calcified femoropopliteal lesions (hypothesis generating) Calcificiation was no predictor for loss of 12-month patency as long as lesion preparation was performed Scoring balloons might be a (less expensive) alternative to debulking devices in calcified lesions

Plaque scoring in calcified lesions Advancing DCB therapy in complex SFA lesions Erwin Blessing, MD, FESC SRH Klinikum Karlsbad- Langensteinbach, Germany

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