Long-Term Survival Benefit of DCB Versus DES for ISR Despite Angiographic Disadvantage of DCB Bruno Scheller Klinische und Experimentelle Interventionelle.

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Presentation transcript:

Long-Term Survival Benefit of DCB Versus DES for ISR Despite Angiographic Disadvantage of DCB Bruno Scheller Klinische und Experimentelle Interventionelle Kardiologie, Universität des Saarlandes, Campus Homburg Klinik für Innere Medizin III, Universitätsklinikum des Saarlandes Homburg / Saar, Germany

Bruno Scheller, MD Disclosure: I have the following relevant financial relationships Lecture fees and travel support: B.Braun Melsungen AG, Germany Shareholder of a healthcare company: InnoRa GmbH, Berlin, Germany Named as coinventor on patent applications: Charite university hospital, Berlin, Germany

Lee et al., JACC Cardiovasc Interv. 2015; 8: 382-94

Lancet, 2015; 386: 655-64

Lancet. 2013; 381: 461-7

≈ 25 % ≈ 75 % EES SQP Binary restenosis 4 8 TLR 1 6 TLR/restenosis Alfonso, J Am Coll Cardiol 2014; 63: 1378-86

TLR/restenosis ≈ 83 % ≈ 85 % Circ Cardiovasc Interv. 2016;9:e003316. DOI: 10.1161/CIRCINTERVENTIONS.115.003316

EES DCB Binary restenosis 11 % 19 % TLR 4 % 13 % TLR/restenosis ≈ 47 % ≈ 74 % “There is a possibility, however, that the indication for re-interventions at follow-up would have been influenced by their perceived risk benefit. Treating recurrent ISR in patients with a double metal layer […] might be considered as less attractive than treating ISR after BA failure”. Alfonso F. J Am Coll Cardiol 2015; 66: 23-33 Alfonso F, Cuesta J. JACC Cardiovascular interventions 2015; 8: 885-8.

Catheter Cardiovasc Interv. 2014; 83: 881-7

Heart Vessels. 2015 Sep 4. [Epub ahead of print]

Adequate: TIMI 3 flow, residual stenosis 30%, and no major dissections Inadequate: at least 1 of the parameters used to define the adequate group absent (major dissections = types C to F) Am J Cardiol. 2016 Aug 24. pii: S0002-9149(16)31366-2

JACC Cardiovasc Int 2013; 6: 905-13.

Stent thrombosis after treatment of ISR Study (pts per group) Type of ISR treatment Follow-up stent thrombosis Reference Richardt et al. (n=281) BMS- and DES-ISR ZES 1 year 2 years 2.1% 2.5% JACC Cardiovasc Int 2013;6:905-13 PACCOCATH ISR (n=54) BMS-ISR DCB (paclitaxel iopromide) 6 years JACC Cardiovasc Int 2012;5:323-30 PEPCAD II (n=66) 3 years In press Habara et al. (n=25) 6 months JACC Cardiovasc Int 2011;4:149-54 PEPCAD DES (n=72) 1.4% (1 case, possible) J Am Coll Cardiol 2012;59:1377-82 ISAR DESIRE III (n=131) 0.7% (1 case) Lancet 2013;381:461-7 PEPCAD Japan (n=136) Am Heart J 2013; 166: 527-33 SQP Word Wide Registry (n=1,523) 9 months 0.1% (2 cases) J Am Coll Cardiol 2012;60:1733-8 DCB overall (n=2,007) 0.2 % (4 cases) JACC Cardiovasc Int 2013; 6: 905-13. Comment on TCTMD.com August 14th 2013.

Catheterization and Cardiovascular Interventions 87:624–629 (2016)

JACC: Cardiovasc Int 2015

JACC CI 2015; 8: 1132-4

DCB Versus DES for ISR No additional layers of metal Decreases risk for late ST Reduced need for prolonged dual antiplatelet therapy Repeatability of the procedure Positive influence on hard clinical endpoints Secondary endpoint, however seen in several trials at longer FU RCT with primary clinical endpoint required Disadvantage in angiographic outcomes (in some trials) quality of index procedure careful lesion preparation assuring sufficient initial lumen gain