Key Points 1,025 patients with de novo coronary artery disease (66.9%) or in‐stent restenosis (ISR) (33.1%) underwent treatment with paclitaxel drug‐coated balloons in a multinational single‐arm registry. Bail‐out stenting rate was only 4.8%. One‐year target lesion revascularization was 2.3% for de novo lesions, 2.9% for bare metal stent ISR, and 5.8% for drug‐eluting stent ISR. Short‐term results with coronary drug‐coated balloons are promising. Nonetheless, long‐term data, preferably from randomized trials are necessary to confirm their safety and efficacy.
Stent thrombosis (ST) is the most feared complication of coronary stent treatment because of its morbidity and mortality. Ongoing research is focusing on the frequency and the timing in various patient subsets as well as the factors associated with the occurrence of ST. The mechanism of ST is multifactorial, hence various procedure-, lesion- and patient-related factors have been associated with its occurrence. Beside these factors the role of adjunctive antithrombotic therapy remains unchallenged. Emerging data suggest that primary percutaneous coronary intervention for ST-elevation myocardial infarction (STEMI) can be a predictor of subsequent ST. As patients presenting with STEMI are at increased risk of ST, employment of the optimal pharmacological, procedure- and device-related prevention and treatment modalities are imperative.
To create awareness of, to summarise and to classify "Slender TRI": any technique associated with less trauma to the radial artery compared to traditional, established or recommended procedures, predominantly by reduction of French (Fr) size.A literature search was conducted to identify publications on Slender transradial coronary interventions. Based on this search the following techniques will be described: miniaturisation of materials, sheathless coronary intervention, guideless coronary intervention and back-up-improving techniques. The European perspectives will be discussed.Slender TRI is a new challenge to maximise patient value by improving outcome and reducing costs during TRI. Materials and techniques are continuously being refined and miniaturised to the highest standards. Whether outcome improves while reducing costs remains to be validated.
Patients with non-obstructive lipid-rich plaques (LRPs) on combined intravascular ultrasound (IVUS) and near-infrared spectroscopy (NIRS) are at high risk for future events. Local pre-emptive percutaneous treatment of LRPs with a paclitaxel-eluting drug-coated balloon (PE-DCB) may be a novel therapeutic strategy to prevent future adverse coronary events without leaving behind permanent coronary implants. In this pilot study, we aim to investigate the safety and feasibility of pre-emptive treatment with a PE-DCB of non-culprit non-obstructive LRPs by evaluating the change in maximum lipid core burden in a 4 mm segment (maxLCBImm4) after 9 months of follow up. Therefore, patients with non-ST-segment elevation acute coronary syndrome underwent 3-vessel IVUS-NIRS after treatment of the culprit lesion to identify additional non-obstructive non-culprit LRPs, which were subsequently treated with PE-DCB sized 1:1 to the lumen. We enrolled 45 patients of whom 20 patients (44%) with a non-culprit LRP were treated with PE-DCB. After 9 months, repeat coronary angiography with IVUS-NIRS will be performed. The primary endpoint at 9 months is the change in maxLCBImm4 in PE-DCB-treated LRPs. Secondary endpoints include clinical adverse events and IVUS-derived parameters such as plaque burden and luminal area. Clinical follow-up will continue until 1 year after enrollment. In conclusion, this first-in-human study will investigate the safety and feasibility of targeted pre-emptive PE-DCB treatment of LRPs to promote stabilization of vulnerable coronary plaque at risk for developing future adverse events.
Abstract Background In patients treated with bare metal stents and first‐generation drug‐eluting stents (DES) smaller stent diameter (SD) has been associated with worse long term outcomes after percutaneous coronary intervention (PCI). Data on the impact of small SD on outcomes after PCI with second‐generation DES is scarce. Methods Consecutive patients treated with second‐generation DES between 2010 and 2016 were included in a single tertiary center. Patients were grouped according to SD: ≤2.50 mm, 2.75 ≤ 3.00 mm, 3.25 ≤ 3.50 mm, and >3.50 mm. One‐year event rates were estimated using the Kaplan–Meier method and adjusted hazard ratios were generated using Cox regression analysis. The primary endpoint was major adverse cardiac events (MACE; death, myocardial infarction [MI], or target vessel revascularization [TVR]). Results Of the 17,607 patients who underwent PCI with second‐generation DES, 32.6% ( n = 5,741) had SD ≤2.5 mm, 39.1% ( n = 6,890) had SD 2.75 ≤ 3.0 mm, 22.2% ( n = 3,910) had SD 3.25 ≤ 3.5 mm, and 6.1% ( n = 1,066) had SD >3.5 mm. At 1 year, MACE rates were 10.5%, 9.5%, 8.0%, and 8.0%, respectively, with increasing SD ( p = .006). TVR rates decreased with increasing SD (7.2%, 5.8%, 4.7%, and 3.3%, respectively [ p < .0001]) whereas rates of MI across SD groups were comparable (1.7%, 1.9%, 2.0%, and 1.5%, respectively [ p = .60]). After multivariable adjustment, smaller SD remained associated with higher rates of MACE, TVR, and target lesion revascularization. Conclusion In a large cohort of patients undergoing PCI with second‐generation DES, smaller SD was associated with increased MACE, driven by higher rates of repeat revascularization. Further research into the optimal treatment of small coronary arteries is warranted.
