Drug coated balloon angioplasty in elderly patients with small vessel coronary disease

Sinaga, Dasdo Antonius; Ho, Hee Hwa; Zeymer, Uwe; Waliszewski, Matthias; Jafary, Fahim H.; Ooi, Yau Wei; Loh, Jason Kwok Kong; Tan, Julian; Ong, Paul Jau Lueng

doi:10.1177/1753944715598714

Cited by 14 publications

(12 citation statements)

References 21 publications

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“…Compared to the SeQuent Please World Wide Registry [39], the slightly higher clinical event rates seen in the SeQuent Please Small Vessel “PCB Only” Registry are probably explained by the smaller reference vessel diameter in this study, as also suggested by the authors [35]. From the SeQuent Please Small Vessel “PCB Only” Registry, three substudies have been reported focusing on the DEB-only strategy for elderly patients (≥75 years) [43], patients with acute coronary syndrome [44], and Asian vs. Western patients [45]. These studies are presented in Table 3.…”

Section: Drug-eluting Balloonsmentioning

confidence: 59%

“…The authors noticed that the results are comparable with the everolimus-eluting stent from the SPIRIT Small Vessel trial that reported a clinically indicated TLR of 5.1% after 1 year [78]. The recommendation for DAPT treatment was 1 month, and most of the patients received DAPT for this period with a small proportion exceeding it [43]. As older people in general are more at risk of complications with prolonged DAPT treatment, this study showed a low 6.1% MACE after 9 months despite the shortened DAPT duration, highlighting the tempting aspects of DEB treatment and thereby avoidance of prolonged DAPT treatment in the elderly patients.…”

Section: Drug-eluting Balloonsmentioning

confidence: 94%

“…As part of a substudy from the SeQuent Please Small Vessel “PCB Only” Registry [35], Sinaga et al were the first to investigate the use of DEBs in elderly patients [43]. In spite of an excess of comorbidities in the elderly (hypertension, renal impairment, atrial fibrillation, previous PCI) and more calcified lesions than in the younger age group, similar bailout rate (7.3%, age <75; 6.7%, age ≥75) and clinical outcome were observed in the two groups.…”

Section: Drug-eluting Balloonsmentioning

confidence: 99%

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Drug-Eluting Balloons in the Treatment of Coronary De Novo Lesions: A Comprehensive Review

2016

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Drug-eluting balloons (DEBs) have emerged as a new application in percutaneous coronary intervention. DEBs have proven successful in the treatment of in-stent restenosis, but their role in de novo lesions is less clear. This paper provides a review of the current studies where DEBs have been used in coronary de novo lesions, either as part of a DEB-only strategy or in combination with another device, mainly a bare metal stent (BMS). By searching Pubmed and Embase we were able to identify 52 relevant studies, differing in design, intervention, and clinical setting, including patients with small vessel disease, bifurcation lesions, complex long lesions, acute myocardial infarction, diabetes mellitus, and elderly. In 23 studies, a DEB was combined with a BMS, 25 studies used a DEB-only strategy with only provisional BMS implantation, and four studies combined a DEB with a drug-eluting stent (DES). In the vast majority of studies, DEB in combination with BMS does not seem to improve clinical or angiographic outcome compared with DES, whereas a DEB-only strategy seems promising, especially when predilatation and geographical mismatch are taken into account. A lower risk of recurrent thrombosis with DEB compared with DES is not evident from the current studies. In conclusion, the main indication for DEB seems to be small vessel disease, especially in clinical scenarios in which a contraindication to dual antiplatelet therapy exists. The main approach should be a DEB-only strategy with only provisional bailout stenting, which has shown interesting results in different clinical scenarios. In general, larger randomized controlled studies with prolonged follow-up comparing DEB with best in class DES are warranted. Technical developments of DEBs including the use of different drugs might potentially improve the efficacy of such treatment.Electronic supplementary materialThe online version of this article (doi:10.1007/s40119-016-0064-4) contains supplementary material, which is available to authorized users.

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Section: Drug-eluting Balloonsmentioning

confidence: 59%

Section: Drug-eluting Balloonsmentioning

confidence: 94%

Section: Drug-eluting Balloonsmentioning

confidence: 99%

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Drug-Eluting Balloons in the Treatment of Coronary De Novo Lesions: A Comprehensive Review

2016

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“…Drug‐coated balloons (DCB) have recently emerged as a potential therapeutic strategy for patients with small vessel de novo coronary artery disease, even in the setting of primary angioplasty . DCB allow rapid and uniform tissue delivery of paclitaxel to the lesion of interest and is an established treatment modality for in‐stent restenosis .…”

Section: Introductionmentioning

confidence: 99%

“…3,4 However, small coronary arteries (<2.5 mm) remain a particular challenge with high rates of stent failure due to late lumen loss (LLL) and may predict both repeat revascularization and subsequent adverse events. 5 Drug-coated balloons (DCB) have recently emerged as a potential therapeutic strategy for patients with small vessel de novo coronary artery disease, 6,7 even in the setting of primary angioplasty. 8 DCB allow rapid and uniform tissue delivery of paclitaxel to the lesion of interest and is an established treatment modality for in-stent restenosis.…”

Section: Introductionmentioning

confidence: 99%

Drug‐Coated Balloons: A Safe and Effective Alternative to Drug‐Eluting Stents in Small Vessel Coronary Artery Disease

Sinaga

Watson

et al. 2016

J Interven Cardiology

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Application of Drug‐Coated Balloons in Complex High Risk and Indicated Percutaneous Coronary Interventions

Somsen,

Rissanen,

Hoek

et al. 2024

Cathet Cardio Intervent

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There is a growing trend of patients with significant comorbidities among those referred for percutaneous coronary intervention (PCI). Consequently, the number of patients undergoing complex high risk indicated PCI (CHIP) is rising. CHIP patients frequently present with factors predisposing to extensive drug‐eluting stent (DES) implantation, such as bifurcation and/or heavily calcified coronary lesions, which exposes them to the risks associated with an increased stent burden. The drug‐coated balloon (DCB) may overcome some of the limitations of DES, either through a hybrid strategy (DCB and DES combined) or as a leave‐nothing‐behind strategy (DCB‐only). As such, there is a growing interest in extending the application of DCB to the CHIP population. The present review provides an outline of the available evidence on DCB use in CHIP patients, which comprise the elderly, comorbid, and patients with complex coronary anatomy. Although the majority of available data are observational, most studies support a lower threshold for the use of DCBs, particularly when multiple CHIP factors coexist within a single patient. In patients with comorbidities which predispose to bleeding events (such as increasing age, diabetes mellitus, and hemodialysis) DCBs may encourage shorter dual antiplatelet therapy duration—although randomized trials are currently lacking. Further, DCBs may simplify PCI in bifurcation lesions and chronic total coronary occlusions by reducing total stent length, and allow for late lumen enlargement when used in a hybrid fashion. In conclusion, DCBs pose a viable therapeutic option in CHIP patients, either as a complement to DES or as stand‐alone therapy in selected cases.

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Drug coated balloon angioplasty in elderly patients with small vessel coronary disease

Abstract: DBCA in the elderly with SVCD is as safe and effective compared with younger patients despite more complex anatomy and comorbidities.

Cited by 14 publications

References 21 publications

Drug-Eluting Balloons in the Treatment of Coronary De Novo Lesions: A Comprehensive Review

Drug-Eluting Balloons in the Treatment of Coronary De Novo Lesions: A Comprehensive Review

Drug‐Coated Balloons: A Safe and Effective Alternative to Drug‐Eluting Stents in Small Vessel Coronary Artery Disease

Application of Drug‐Coated Balloons in Complex High Risk and Indicated Percutaneous Coronary Interventions

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