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Balón con fármaco, ¿hay que cambiar la técnica de angioplastia?

Balón con fármaco, ¿hay que cambiar la técnica de angioplastia?. Esther Gálvez González Hospital Severo Ochoa. Mechanism of action. Reestenosis cascade. Mitosis inhibition. Mechanism of action. Elements of an effective DEB Must deliver large quantities of the drug within seconds

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Balón con fármaco, ¿hay que cambiar la técnica de angioplastia?

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  1. Balón con fármaco, ¿hay que cambiar la técnica de angioplastia? Esther Gálvez González Hospital Severo Ochoa

  2. Mechanism of action Reestenosis cascade Mitosis inhibition

  3. Mechanism of action Elements of an effective DEB • Must deliver large quantities of the drug within seconds • Distribute within the media in the first days • Therapeutic drug levels must be maintained several weeks

  4. Effectiveness BIOLUX P-III IN-PACT LEVANT 2 65,2% 52,6%

  5. Indications • New femoropopliteal lesions • Restenosis after POBA • Intrastent stenosis • BTK • FAV TASC Type A TASC Type B TASC Type C

  6. Technique 1. Vessel preparation ATP ballon diameter 1 mm smaller than the vessel Problems - Flow-limiting dissection Fanelli study Effectiveness and flow-limiting dissection depend on the distribution of Ca² Grade 3 and 4 Atherectomy

  7. Technique 2. ATP with DEB Diameter = vessel Length = Lession + ≥ 5 mm proximal and distal Don´t touch the balloon Transit time less than 3 min Minimum angioplasty time 30 seg (at least 3 min) 5 mm 5 mm

  8. Lesion min. 5mm Pre - Dilatation/Injury Segment min. 5mm Variable Overlap as needed Technique Long lessions Minimum overlap 1 cm

  9. Technique 3. Complications - Flow-limiting dissection ATP Stent - Residual estenosis >50% Stent

  10. Technique Femoropopliteal lession POBA <1 mm vessel diameter Atherectomy DEB Flow-limiting dissection Residual estenosis >50% ATP Stent Stent

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