Safety of bailout stenting after paclitaxel-coated balloon angioplasty

Mok, Kwang How; Wickramarachchi, Upul; Watson, Timothy; Ho, Hee Hwa; Eccleshall, Simon; Ong, Paul Jau Lueng

doi:10.1007/s00059-016-4502-9

Cited by 4 publications

(3 citation statements)

References 27 publications

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“…14,15 Therefore, current guidelines on DCB therapy advocate the use of DES in case of unplanned stent implantation, 10 and current generation "limus"-DES should be preferred. 31 However, the combination of DCB with stents in the same lesion should be avoided whenever possible. Second, the MACE rates of DES patients receiving paclitaxeleluting stents were numerically higher than of patients receiving everolimus-eluting stents.…”

Section: Discussionmentioning

confidence: 99%

Drug-coated balloons for small coronary artery disease (BASKET-SMALL 2): an open-label randomised non-inferiority trial

et al. 2018

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Section: Discussionmentioning

confidence: 99%

Drug-coated balloons for small coronary artery disease (BASKET-SMALL 2): an open-label randomised non-inferiority trial

et al. 2018

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“…Exceptionally, if the DCB-only approach shows a suboptimal result such as flow-limiting dissection or acute recoil, bail-out BMS implantation should be considered to avoid geographical mismatch. However, recent data has shown that bail-out stenting with DES for suboptimal DCB results is a feasible and safe strategy and is comparable to bail-out BMS [34,35]. For this issue, further large-scaled, randomized controlled trials are needed.…”

Section: De Novo Lesionmentioning

confidence: 99%

Drug-coated balloon treatment in coronary artery disease: Recommendations from an Asia-Pacific Consensus Group

Her

Shin²,

Bang

et al. 2021

Cardiol J.

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Coronary artery disease (CAD) is currently the leading cause of death globally, and the prevalence of this disease is growing more rapidly in the Asia-Pacific region than in Western countries. Although the use of metal coronary stents has rapidly increased thanks to the advancement of safety and efficacy of newer generation drug eluting stent (DES), patients are still negatively affected by some the inherent limitations of this type of treatment, such as stent thrombosis or restenosis, including neoatherosclerosis, and the obligatory use of dual antiplatelet therapy (DAPT) with unknown optimal duration. Drug-coated balloon (DCB) treatment is based on a leave-nothing-behind concept and therefore it is not limited by stent thrombosis and long-term DAPT; it directly delivers an anti-proliferative drug which is coated on a balloon after improving coronary blood flow. At present, DCB treatment is recommended as the first-line treatment option in metal stent-related restenosis linked to DES and bare metal stent. For de novo coronary lesions, the application of DCB treatment is extended further, for conditions such as small vessel disease, bifurcation lesions, and chronic total occlusion lesions, and others. Recently, several reports have suggested that fractional flow reserve guided DCB application was safe for larger coronary artery lesions and showed good long-term outcomes. Therefore, the aim of these recommendations of the consensus group was to provide adequate guidelines for patients with CAD based on objective evidence, and to extend the application of DCB to a wider variety of coronary diseases and guide their most effective and correct use in actual clinical practice.

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“…This will include maximum transit time to the lesion and balloon inflation times. In the case of a coronary dissection of type C or above after DCB use, we recommend bailout stenting with a second-generation DES rather than a BMS [24]. 1 Proposed protocol for optimal use of DCB The lesion should be aspirated if there is presence of intracoronary thrombus.…”

Section: Drug Deliverymentioning

confidence: 99%

Drug-Coated Balloons in STEMI

Wickramarachchi

Eccleshall

2018

Primary Angioplasty

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The management of ST-elevation myocardial infarction (STEMI) has evolved significantly with the introduction of new pharmacological therapies as well as interventional procedures and devices. The GISSI and ISIS-2 studies showed a mortality benefit of streptokinase over standard therapy (heparin ± oral anticoagulation)/placebo which lead to the widespread use of streptokinase in the late 1980s [1,2]. The use of recombinant tissue plasminogen activator (rt-PA) was shown to be more beneficial than streptokinase in the TIMI and GUSTO trials [3,4]. Results of other studies such as CLARITY and COMMIT paved the way for addition of clopidogrel to the drug regime which further reduced mortality [5,6].Primary percutaneous coronary intervention (PPCI) became the preferred choice of treatment for acute STEMI, with balloon angioplasty (BA) showing an improvement in mortality (or the combined endpoint of mortality and MI) over thrombolysis in a number of studies [7,8]. Subsequently, bare-metal stent (BMS) implantation in STEMI showed a reduction in target vessel revascularizations (TVR) in comparison with BA but without a reduction in death or MI in the Stent PAMI and CADILLAC trials [9,10]. The percentage of vessels with TIMI III flow was numerically higher in the BA group as compared to the BMS group, while mortality and MI rates were numerically but not statistically lower [9]. When stenting (BMS) was compared with thrombolysis as in the STAT study, the results were similar with stenting showing a reduction in TVR but no reduction in death or MI [11]. When both first-and second-generation drug-eluting stents (DES) were compared to BMS in the setting

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Safety of bailout stenting after paclitaxel-coated balloon angioplasty

Abstract: Our initial experience using DES instead of BMS as a bailout after suboptimal PCB results shows that the procedure is safe and effective at 1 year.

Cited by 4 publications

References 27 publications

Drug-coated balloons for small coronary artery disease (BASKET-SMALL 2): an open-label randomised non-inferiority trial

Drug-coated balloons for small coronary artery disease (BASKET-SMALL 2): an open-label randomised non-inferiority trial

Drug-coated balloon treatment in coronary artery disease: Recommendations from an Asia-Pacific Consensus Group

Drug-Coated Balloons in STEMI

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