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Uncoating new strategies: drug-coated balloons as a promising choice
Session:
SESSÃO DE POSTERS 32 - DOENÇAS CARDIOVASCULARES - EAM COM SUPRADESNIVELAMENTO DO SEGMENTO ST
Speaker:
Fábio Viveiros
Congress:
CPC 2025
Topic:
E. Coronary Artery Disease, Acute Coronary Syndromes, Acute Cardiac Care
Theme:
13. Acute Coronary Syndromes
Subtheme:
13.4 Acute Coronary Syndromes – Treatment
Session Type:
Cartazes
FP Number:
---
Authors:
Fabio Viveiros; Miguel Azaredo Raposo; Catarina Gregório; Ana Abrantes; Marta Vilela; Diogo Rosa Ferreira; João Mendes Cravo; João Fernandes Pedro; Ana Rita Francisco; João Silva Marques; Fausto J. Pinto; Pedro Pinto Cardoso
Abstract
<p><strong>Introduction:</strong> Drug-eluting stents (DES) are still the default treatment of coronary artery disease. However, drug-coated balloons (DCB) represent a new alternative in certain anatomic conditions. Although their use is established for in-stent restenosis of both bare-metal and DES, there are other emerging indications.</p> <p><br /> <strong>Purpose:</strong> To evaluate DCB angioplasty outcomes.</p> <p><br /> <strong>Methods:</strong> Single-center observational study of patients (pts) submited to DCB percutaneous intervention (PCI). Clinical characteristics and procedure-related data were collected at baseline and primary endpoint, defined as same vessel stenosis, was evaluated at follow-up (FUP).</p> <p><strong>Results: </strong>Two hundred and one pts (75.6% male; mean age 68 ± 11.5 years) were submited to PCI, with a mean FUP of 31 months. In terms of comorbidities: 87.1% had arterial hypertension, 81.6% hypercholesterolemia and 40.3% smoking habits. Clinical reasons to perform PCI included stable angina in 55.8% of pts, unstable angina in 13.7%, NSTEMI in 25.4% and STEMI in 5.1%. DCB were most frequently applied in the left anterior descending artery (40.3%, p<0.001), followed by the right coronary artery (18.4%), circumflex (14.9%) and marginal artery (10.4%). Two arteries angioplasty was performed in 6 pts and 58 pts treated a second vessel with DES. Regarding the indications for a DCB PCI, most pts had stent restenosis (58.2%), 23.4% small caliber vessel disease and 8.5% a bifurcation lesion.<br /> From a technical point of view, pre-dilation was performed in 83% of pts, 80% of which with non compliant balloons. InPact Falcon was the most frequently used DCB (63.7%) followed by Pantera Lux (33.3%), Sequent Please (2%) and Pantera Leo (1%).<br /> DES implantation after DCB PCI was performed in 14.5% of pts due to residual lesion (42.9%) or stenosis (14.3%), 14.3% due to dissection and for optimal final result in 7.1%. TIMI III pos-procedure flow was obtained in the vast majority of pts (97%).<br /> During FUP, 38 pts were submited to a new PCI, mainly due to stable angina. Primary outcome was observed in 7.5% of pts: 9 of them with a conservative approach (mild stenosis), 1 submited to balloon PCI and 5 underwent DES PCI. 64% of pts underwent a new vessel PCI.<br /> Regarding pts previously submited to DES implantation after DCB angioplasty, 5 repeated coronarography at FUP and a good angiographic result of the former procedure was verified, with statistically significant association between DES implantation at baseline and good angiographic results at FUP (p=0.047). At baseline, 4 of these pts were submited to angioplasty of the same lesion treated with DCB and 1 to proximal PCI. Stenosis didn’t correlate with the treated vessel (p=0.177) nor with balloon diameter or length.</p> <p><br /> <strong>Conclusions:</strong> Although DCBs are mainly used in restenosis, new indications and clinical benefits are emerging. Final result optimization, as with DES implantation, was associated with good angiographic results at FUP.</p>
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