1632_Nakama.pdf

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1、DCB or DES in ISR:Is There Data to Suggest One Over the Other?Tatsuya NakamaTokyo Bay Medical Center,Urayasu,JapanNeointimal hyperplasia is Achilles heal of STENTING22.7%72.5%65.6%1Y patencyISR typeTosaka et al.JACC 2012:59;16-23 We needs barrierHow can we overcome ISRHD-DCB Showed significant clini

2、cal benefit through the 5-yearHorie K et al.CVIR Endovascular 2021.Nakama T et al.JACC Cardiovasc Intev.2025Several comparison data about the DES vs DCBNakama T et al.JACC Cardiovasc Intev.2025No restenosis risk difference between DES&DCB for ISRChallenging Tosaka III ISOAspiration+2days CDTOnly2WFa

3、ilureof DCB angioplasty for ISRHow can we overcome challenging ISRs?OFDI(OPTICAL FREQUENCY DOMAIN IMAGING)OFDI(LUNAWAVE,Terumo),were developed as high-resolution imaging devices to evaluate blood vessel lumens and use near-infrared radiation to measure the intensity of reflected light waves.OFDI has

4、 about 10 x higher resolution than IVUS,with a resolution range of 10-20m.Based on the results of a regulatory approval trial for its use in EVT.,OFDI became commercially available for clinical use in 2021.OFDI findings:Late acquired stent malpositionOFDI findings of PB-PES Afterlate stent thrombosi

5、sCaused by late stent mal-appositionOnly2WWhat cause this acute EVT failure?bcdeafabcdefOFDI findings disclosed Nodular calc ISR Neointimal pattern of the ISR lesionThe homogeneous type has a homogeneous pattern and highly luminous neointima.The non-homogeneous type has a non-homogeneous and non-hig

6、hly luminous neointima that contains both heterogeneous and layered patterns.All cohort(n=22)IWS(n=7)PES(n=15)P valueOFDI Neointima patternHomogenous,%21.06.656.2 12.04.6 2.40.0024Non-Homogenous,%36.56.714.06.546.88.80.0044Intra-luminal protruding masses,%16.75.91.2 0.823.8 8.00.0137Late stent mal-a