10:35 Role of DEB in CTO-PCI Gregor Leibundgut (Basel - CH) ___________________________________________ PARALLEL SESSION Challenges And Opportunities In Cto Recanalization Auditorium Zubin Mehta - Saturday 10:00 - 11:10 Chairperson: Jonathan Hill (London - UK) Discussants: Lesnek Bryniarski (Krakow - PL), Ugo Fabrizio (Vercelli), Paul Knaapen (Amsterdam - NL), Eugenio La Scala (Ollioiouls - F) ___________________________________________ 15th Experts Live CTO, EUROCTO Club meeting in partnership with the GISE CTO meeting. September 8th - 9th, 2023 Florence, Italy

1. The Role of DCB in CTO-PCI
Leibundgut - Gregor
CHALLENGES AND OPPORTUNITIES
IN CTO RECANALIZATION - 7 min
09.09.2023 | 08:30 - 10:00
Gregor Leibundgut, MD
Head of Interventional Cardiology
Director of CHIP and CTO Program
University Hospital Basel, Switzerland
gregor.leibundgut@usb.ch
09.09.2023 | 10:35

2. Which is result is the best ?
CTO-PCI/DES of LAD CTO-PCI/DCB of LAD

3. The early phase of PTCA with balloons only (POBA)
Ballooning (POBA)
Wait and see
Perfusion Balloon
No flow limiting
dissection or recoil
Flow limiting dissection
or recoil
Good result
Emergency CABG

4. Benefits of BMS
Ballooning (POBA)
Wait and see
Perfusion Balloon
No flow limiting
dissection or recoil
Flow limiting dissection
or recoil
Good result
Less Emergency CABG
BMS

5. Downside of BMS
Ballooning (POBA)
Wait and see
Perfusion Balloon
No flow limiting
dissection or recoil
Flow limiting dissection
or recoil
Good result BMS
Acute and late stent
thrombosis
Restenosis (ISR)

6. 1st Generation DES
Ballooning (POBA)
Wait and see
Perfusion Balloon
No flow limiting
dissection or recoil
Flow limiting dissection
or recoil
Good result 1st Generation DES
Acute and late stent
thrombosis
Low Restenosis (ISR)

7. Next Generation DES
Ballooning (POBA)
Wait and see
Perfusion Balloon
No flow limiting
dissection or recoil
Flow limiting dissection
or recoil
Good result Next Generation DES
Low rate of stent
thrombosis
Low Restenosis (ISR)

8. Disadvantages of metal based stents
Delayed healing → Stent thrombosis?
Neo-intima hyperplasia (NIH)
→ In-Stent Restenosis (ISR)
Late Acquired Malapposition → Stent Thrombosis?
Benign neo-intima
Neo-Atheroma
→ Stent Thrombosis?
* uncovered struts

9. Predictors of ISR
Cassese S et al. Heart 2014;100:153–159 | Byrne et al. Eur Heart J 2015; 36: 3320–31

10. No mortality hazard with coronary use of PCB
POBA, BMS, DES
Scheller et al, J Am Coll Cardiol 2020; 75: 1017–28

11. Jeger R et al. JACC Interv 2020 3:1391–402
DCB in Small Vessels (Metanalysis)

12. Jeger R et al. JACC Interv 2020 3:1391–402
Low TLR in large vessels
DCB in de novo lesions (Metaanalysis)

13. DCB - the game changer?
Mitsuru Abe et al. 2010;122:42-51
DCB
BA = Balloon Angioplasty
SES = Sirolimus eluting stent

14. E. Sanchez-Jimenez. Rev. Cardiovasc. Med. 2022; 23(2): 42
DCB for CTO-PCI: the rationale

15. DCB for CTO-PCI
Jun et al. Frontiers in Cardiovascular Medicine 2022 Vol 9 April

16. Complex CTO PCI of the RCA

17. 6 month FU

18. CTO of the proximal LAD

19. CTO of the LCX

20. Thank you!
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