1526_Secemsky.pdf

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1、Eric A.Secemsky,MD,MSc,RPVI,FACC,FAHA,FSCAI,FSVM Director|Vascular Intervention|Beth Israel Deaconess Medical CenterSection Head|Interventional Cardiology and Vascular Research|Richard A.and Susan F.Smith Center for Outcomes Research Associate Professor of Medicine|Harvard Medical SchoolNYEVS 2025DE

2、S IS SUPERIOR TO DCB IN LONG-SEGMENT DISEASE2Funding:NIH/NHLBI K23HL150290,Food&Drug Administration,SCAIGrants to Institution:Abbott/CSI,BD,Boston Scientific,Cook,Medtronic,PhilipsSpeaking/Consulting:Abbott/CSI,BD,BMS,Boston Scientific,Cagent,Conavi,Cook,Cordis,Endovascular Engineering,Gore,InfraRed

3、x,Medtronic,Philips,RapidAI,Rampart,Shockwave,Terumo,Thrombolex,VentureMedand ZollDisclosures3TASC A/B Lesions Representative of DCB clinical trial populationsEndovascular guidelines1,2In-Stent Restenosis SCAI consensus guidelines support DCB use over DES for ISR2No-stent zonesBehind the knee,ostial

4、 lesions,bifurcations1.Norgren L,et al.Int Angiol.2007;26(2):81-157.2.Feldman DN,et al.Catheter Cardiovasc Interv.2018;92(1):124-140.Drug-eluting Therapy SelectionDCBDCBs offer durable outcomes for several types of femoropopliteal lesions4DES DES is beneficial in cases requiring mechanical vessel su

5、pport Vessel prep with residual stenosis 30%Residual stenosis 30%is the#1 predictor of reintervention within 1 year1 Vessel prep with flow-limiting dissection Severe angiographic dissection is associated with future restenosis2Drug-eluting Therapy Selection5Procedural characteristics,lesion complexi

6、ty,&failure riskNoYesDoes my risk increase?DCBDES TASC A/B lesions In-stent restenosis No-stent zones Flow-limiting dissection 30%residual stenosisBailout stent/reintervention risk highlowFavor DCBFavor DES100 mmNoOcclusionYesLowCalcificationModerate to SevereDCB or DES?6DCB Trials13%24%46%100mm100m