Session 2: Histopathology and Imaging in CAD - Imaging with Angiography – Franz Kleber

Understanding Drug-Coated Balloons in PCI

Overview of DCB Efficacy

• The speaker discusses the success rates of drug-coated balloons (DCB), citing an 80% success rate with a low incidence of myocardial infarction (4.5%) and emergency surgery (2.5%) over 50 years.

Dissection Classification

• Reference to Andreasik's paper highlights that dissection is not inherently negative; in some cases, it may have a lower restenosis rate compared to non-dissected cases.

• The classification system for angiography by Huba categorizes dissections into benign (A and B) and problematic (C), emphasizing the need for understanding these classifications among cardiologists.

Clinical Implications of Dissections

• A significant drop in clinical success rates is noted when moving from B to C dissections, indicating the importance of careful assessment during procedures.

• Techniques like cutting or scoring balloons can convert C dissections into more manageable B dissections, improving outcomes.

Case Study Insights

• An example case illustrates successful DCB application on a long lesion without persistent staining, resulting in excellent four-month follow-up results with minimal risk of thrombosis or restenosis.

Recoil vs. Incomplete Expansion

• Distinction made between recoil and incomplete balloon expansion; achieving complete expansion is crucial for effective treatment with DCB.

Positive Remodeling Observations

Positive Remodeling Evidence

• Early experiences with positive remodeling after using DCB are discussed, highlighting its significance in patient outcomes.

Comparative Analysis of Results

• Comparison between historical data on plain old balloon angioplasty (POBA) and current DCB results shows improved outcomes with DCB regarding lumen preservation and positive remodeling.

Importance of Non-target Vessel Assessment

• Emphasizes the necessity to evaluate non-target vessels during angiography to rule out vascular tone effects, enhancing the reliability of findings related to treated vessels.

Addressing Complications: Aneurysms and Calcifications

Aneurysm Formation Rates

• Data indicates low aneurysm formation rates associated with drug-coated balloons, comparable to traditional methods like stenting or regular balloon angioplasty.

Handling Calcified Lesions

Understanding the Role of Angiography in PCI and DCB Applications

Key Insights on OCT and Dissection

• The use of Optical Coherence Tomography (OCT) reveals that dissection is a common occurrence during procedures, indicating that every Percutaneous Coronary Intervention (PCI) involves some level of dissection.

• It is emphasized that while dissection is prevalent, it does not necessitate an angiogram for every patient; rather, practitioners must learn to manage these occurrences effectively.

Learnings from Angiography

• Angiography provides critical insights into various vascular conditions such as vessel size narrowing, dissections, persistent staining (important for identifying dissections), and residual stenosis.

• It aids in differentiating between recoil and incomplete opening of vessels, which are crucial for understanding the outcomes of interventions.

Importance of Angiographic Follow-Up

• Most knowledge regarding Drug-Coated Balloons (DCB) in both chronic and acute coronary syndromes stems from clinical studies and angiographic follow-ups.

• Angiography remains a fundamental tool in assessing the effectiveness of PCI procedures, particularly concerning DCB applications.

Current Consensus on Physiological Assessment

• There is no established consensus on how physiological assessments or OCT Integrated with Intravascular Ultrasound (IBOS) should influence procedural modifications during DCB applications.