1534_Fanelli.pdf

1、DCB with Spot Stenting is the Right Way to TreatLong Segment SFA DiseaseFabrizio Fanelli,MD,EBIRProfessor of Interventional RadiologyDirector Vascular and Interventional Radiology DepartmentCareggi University HospitalFlorence-ItalyDisclosures Consultant/Speaker/Proctor/Advisory Board Abbott BD Bard

2、Boston Scientific Cook iVascular Medtronic Merit Penumbra Philips Volcano W.L.Gore&Associates Zylox Tonbridge DCB and DES have become the preferred treatment modality for PAD DCBs are a cornerstone for the treatment of femoropopliteal disease They provide effective inhibition of restenosis without l

3、eaving a permanent implant However,additional treatment may be required in cases of vessel recoil,flow-limiting dissection or acutecomplications,especially in complex lesions such as heavily calcified or long CTO.In these cases,selective spotstenting can provide mechanical support exactly where need

4、ed The combined strategyDCB plus spot stentingaims to:-maximize drug delivery benefits-minimize metal burden-preserve vessel integrity and future treatment optionsBackgroundDisadvantagesLong metallic strutsFracture rate/metallic fatigueNo-stent zoneDESDCB+BMSAdvantagesDESDCB+BMSProlonged drug releas

5、eLimit stent coverageStent only in more critical areaMedicine(2025)104:12Meta-analysis to compare the efficacy between DES and DCB for Fem-pop lesionsPubMed,Embase,and Cochrane Library were systematically searched until January 202525 trials encompassed 2806 pts.22/25 studies were multicenter trials

6、Pooled risk for TLR DCB=13.6%(95%CI:10.2%17.0%;P .001)DES=10.9%(95%CI:7.1%14.8%;P .001)Subgroup analysis founded DCB associated with an increased risk of TLR compared with DES when diabetesproportion was 40.0%Pooled risk for restenosis DCB=17.2%(95%CI:14.0%20.4%;P .001)DES=17.0%(95%CI:10.5%23.6%;P .