1. Long-Term Survival Benefit of DCB Versus DES for ISR Despite Angiographic Disadvantage of DCB
Bruno Scheller
Klinische und Experimentelle Interventionelle Kardiologie,
Universität des Saarlandes, Campus Homburg
Klinik für Innere Medizin III, Universitätsklinikum des Saarlandes
Homburg / Saar, Germany

2. Bruno Scheller, MD Disclosure:
I have the following relevant financial relationships
Lecture fees and travel support:
B.Braun Melsungen AG, Germany
Shareholder of a healthcare company:
InnoRa GmbH, Berlin, Germany
Named as coinventor on patent applications:
Charite university hospital, Berlin, Germany

3. Lee et al., JACC Cardiovasc Interv. 2015; 8: 382-94

4. Lancet, 2015; 386:

5. Lancet. 2013; 381: 461-7

6. ≈ 25 % ≈ 75 % EES SQP Binary restenosis 4 8 TLR 1 6 TLR/restenosis
Alfonso, J Am Coll Cardiol 2014; 63:

7. TLR/restenosis
≈ 83 %
≈ 85 %
Circ Cardiovasc Interv. 2016;9:e DOI: /CIRCINTERVENTIONS

8. EES
DCB
Binary restenosis
11 %
19 %
TLR
4 %
13 %
TLR/restenosis
≈ 47 %
≈ 74 %
“There is a possibility, however, that the indication for re-interventions at follow-up would have been influenced by their perceived risk benefit. Treating recurrent ISR in patients with a double metal layer […] might be considered as less attractive than treating ISR after BA failure”.
Alfonso F. J Am Coll Cardiol 2015; 66: 23-33
Alfonso F, Cuesta J. JACC Cardiovascular interventions 2015; 8:

9. Catheter Cardiovasc Interv. 2014; 83: 881-7

10. Heart Vessels. 2015 Sep 4. [Epub ahead of print]

11. Adequate: TIMI 3 flow, residual stenosis 30%, and no major dissections
Inadequate: at least 1 of the parameters used to define the adequate group absent (major dissections = types C to F)
Am J Cardiol Aug 24. pii: S (16)

12. JACC Cardiovasc Int 2013; 6: 905-13.

13. Stent thrombosis after treatment of ISR
Study
(pts per group)
Type of ISR
treatment
Follow-up
stent thrombosis
Reference
Richardt et al.
(n=281)
BMS- and
DES-ISR
ZES
1 year
2 years
2.1%
2.5%
JACC Cardiovasc Int 2013;6:905-13
PACCOCATH ISR (n=54)
BMS-ISR
DCB (paclitaxel iopromide)
6 years
JACC Cardiovasc Int 2012;5:323-30
PEPCAD II (n=66)
3 years
In press
Habara et al. (n=25)
6 months
JACC Cardiovasc Int 2011;4:149-54
PEPCAD DES
(n=72)
1.4%
(1 case, possible)
J Am Coll Cardiol 2012;59:
ISAR DESIRE III (n=131)
0.7%
(1 case)
Lancet 2013;381:461-7
PEPCAD Japan (n=136)
Am Heart J 2013; 166:
SQP Word Wide Registry
(n=1,523)
9 months
0.1%
(2 cases)
J Am Coll Cardiol 2012;60:1733-8
DCB overall
(n=2,007)
0.2 %
(4 cases)
JACC Cardiovasc Int 2013; 6: Comment on TCTMD.com August 14th 2013.

14. Catheterization and Cardiovascular Interventions 87:624–629 (2016)

15. JACC: Cardiovasc Int 2015

16. JACC CI 2015; 8:

17. DCB Versus DES for ISR No additional layers of metal
Decreases risk for late ST
Reduced need for prolonged dual antiplatelet therapy
Repeatability of the procedure
Positive influence on hard clinical endpoints
Secondary endpoint, however seen in several trials at longer FU
RCT with primary clinical endpoint required
Disadvantage in angiographic outcomes (in some trials)
quality of index procedure
careful lesion preparation assuring sufficient initial lumen gain