Session 4: Technical Strategies - Impact of lesion characteristics on DCB success – Takashi Ashikaga

Impact of DCB Success in Japan

Overview of DCB Usage in Japan

• Dr. from Japan discusses the increasing adoption of Drug-Coated Balloons (DCB) in medical procedures, noting that 25% of cases are currently treated with DCB.

• The speaker highlights that image-guided PCI is utilized in 100% of cases, with 80% using IVUS and 20% using OCT guidance.

Challenges with Severely Calcified Lesions

• The long-term outcomes for severely calcified lesions are poor, even when treated with CABG, indicating a significant challenge in treatment efficacy.

• Data shows a high rate of restenosis (10% at one year and 30% at five years) particularly associated with severe calcification and hemodialysis patients.

Strategies to Overcome Calcification Issues

• The presentation categorizes treatable calcified regions into three types: non-elastic, elastic, and superficial; emphasizing the need for specialized devices to address these challenges.

• Japanese studies indicate that rotational atherectomy demonstrates no inferiority compared to DES (Drug-Eluting Stents), showing less late lumen loss than DCB.

Efficacy of Various Treatment Devices

• Long-term outcomes reveal similar event rates between DES and DCB after atherectomy; however, acute lumen gain is greater in DES while late lumen loss is more pronounced in DCB.

• The effectiveness of IBL followed by DCB strategy shows a target vessel failure rate below 10%, which is considered acceptable.

Techniques for Treating Calcified Lesions

• Different techniques such as guide wire bias plaque reduction and centrifugal force application via OA can effectively debulk calcium deposits.

• Elap crush nodules show promising results clinically despite previous reports indicating limited long-term outcomes post-stent expansion.

Case Studies Highlighting Treatment Outcomes

• A case study illustrates a patient who initially had good results from OS and cutting BCB but returned later with angina requiring further intervention.

• Another case involved a patient experiencing recurrent issues after initial successful treatments, ultimately leading to surgical referral due to persistent problems.

Patterns of Restenosis Post PCI

• Analysis reveals three patterns of restenosis: layered proliferation, suboptimal region enlargement, and protrusion from calcified nodules.

• A study indicates that approximately 20% experience restenosis within two years primarily linked to adaptive calcific nodules.

Importance of Guide Wire Positioning

• Emphasizes the critical nature of guide wire positioning during procedures involving eccentric lesions to prevent vessel injury post-OAS treatment.

Rotational Arctomy and Adaptive Culture Nodal Treatment

Overview of Techniques and Devices

• The discussion begins with the effectiveness of rotational arctomy or araserectomy, particularly when combined with a debarking device followed by drug-coated balloons (DCB).

• Emphasis is placed on the importance of guide wire positioning in adaptive culture nodal treatment, highlighting that the proximal site may be close to the eruptive caria nal while the distal site remains within normal vessel areas.

• The use of an additional scoring balloon is noted as crucial for achieving round shape expansion in cult regions, enhancing treatment efficacy.

• The speaker mentions using optical coherence tomography (OCT) alongside other devices like OS and IBL, although they note that this combination may not always yield effective results.