Coronary stent failure: role of a blended approach with drug-coated balloons for complex lesions

Cortese, Bernardo; Sanchez-Jimenez, Erick; Lazar, Florin-Leontin

doi:10.23736/s2724-5683.22.06172-5

Cited by 5 publications

(2 citation statements)

References 95 publications

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“…What is more, this approach is currently being used as a routine strategy for small coronary vessels and for high-bleeding risk patients that cannot tolerate long-term antiplatelet therapy as well. 3 DCB share the peculiarity of delivering an antirestenotic drug without the need for prosthesis implantation. 4,5 As it is well recognized from the early era of interventional cardiology, one of the direct consequences of balloon dilatation of a vessel could be the occurrence of an angiographically visible coronary dissection.…”

Section: Introductionmentioning

confidence: 99%

The fate of coronary dissections left after sirolimus‐coated balloon angioplasty: A prespecified subanalysis of the EASTBOURNE study

El Khoury,

Lazar,

Cortese

2023

Cathet Cardio Intervent

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ObjectivesWe sought to understand the clinical outcomes of dissections left untreated after sirolimus drug‐coated balloon (DCB) angioplasty.BackgroundDCB may be a valuable alternative to stents for the treatment of native coronary lesions, but the risk of having a dissection after DCB‐angioplasty is not negligible. While type A and B dissections can be safely treated conservatively, some debate exists regarding type C dissections. We previously showed the safety of dissections left untreated after second‐generation paclitaxel‐DCB. However, the fate of dissections after sirolimus‐DCB angioplasty has not been investigated so far.MethodsEASTBOURNE is a prospective, multicenter, international, investigator‐driven study aiming to explore the safety and efficacy of a novel sirolimus‐DCB. This study enrolled a consecutive, all‐comer population of coronary artery disease patients and is the largest prospective study on DCB so far. Primary endpoints of the study, target‐lesion revascularization (TLR), and other clinical endpoints at 12 months, have been presented elsewhere. This is a prespecified subgroup analysis of the patients left with not‐flow limiting dissection after DCB angioplasty, with complete 12 months follow‐up and comparison between patients left with a dissection versus patients with DCB used for de novo lesions.ResultsBetween September 2016 and November 2020, a total of 2123 patients were enrolled at 38 study centers. Seventy‐three patients were left with nonflow limiting dissections (43 type A, 27 type B, 3 type C) and underwent complete 1‐year clinical follow‐up. In the nondissection group, 1110 patients had de‐novo coronary artery disease while 900 had in‐stent restenosis. Baseline characteristics were similar between the groups, while the dissection group was associated with longer lesions (23.8 vs. 18.4 mm, p < 0.001) and more frequent use of predilation (100 vs. 91.4%, p = 0.016). At 12‐month follow‐up, no significant differences among the groups were found, with a total of 1.25% TLR in the dissection cohort versus 5.6% in the de‐novo cohort (p = 0.13), and an overall rate of major adverse cardiovascular events of 4.4% versus 10.1% (p = 0.18). Total death (1.5 vs. 2.6, p = 0.87), cardiac death, myocardial infarction (0% vs. 2.5%, p = 0.35), and bleedings did not differ significantly among the groups as well.ConclusionsIn this subgroup analysis of the EASTBOURNE study of consecutive patients treated with new‐generation sirolimus DCB, dissections left untreated after angioplasty did not lead to an increase in adverse events.

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Section: Introductionmentioning

confidence: 99%

The fate of coronary dissections left after sirolimus‐coated balloon angioplasty: A prespecified subanalysis of the EASTBOURNE study

El Khoury,

Lazar,

Cortese

2023

Cathet Cardio Intervent

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“…And again, we would like to know if the important information provided by this study will automatically translate into the coronary field. Newer approaches with blended therapies of stents and DCB, 4 and newer prospective studies, including the ongoing TRANSFORM II, 5 will, fortunately, give more fuel to the topic and let us understand the best way to treat the last frontier of interventional cardiology.…”

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Calcific lesions are the last frontier of endovascular therapies

Cortese

2023

Cathet Cardio Intervent

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Key Points This study brings new important insights on the role of drug‐coated balloons for calcific lesions management in peripheral interventions, being this therapeutic option less performant in longer calcifications, as assessed by PACSS methodology. The role of intravascular imaging and atherectomy devices, and if these rules can be applied also to coronary arteries is still not understood. Calcified arteries are the last frontier of endovascular interventions, and ongoing adequately powered studies will hopefully shed light on the best treatment for this complex scenario.

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Magic Touch sirolimus-coated balloon: animal and clinical evidence of a coronary sirolimus drug-coated balloon

Cortese,

Malakouti,

Khater

et al. 2024

Future Cardiology

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Coronary stent failure: role of a blended approach with drug-coated balloons for complex lesions

Cited by 5 publications

References 95 publications

The fate of coronary dissections left after sirolimus‐coated balloon angioplasty: A prespecified subanalysis of the EASTBOURNE study

The fate of coronary dissections left after sirolimus‐coated balloon angioplasty: A prespecified subanalysis of the EASTBOURNE study

Calcific lesions are the last frontier of endovascular therapies

Magic Touch sirolimus-coated balloon: animal and clinical evidence of a coronary sirolimus drug-coated balloon

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