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Hybrid (DES + DCB) strategy for chronic total occlusions: Development of the GLOW risk stratification score
Ehab Cherif1, Husam Abdulaziz Noor1
1Mohammed Bin Khalifa Cardiac Centre (MKCC), Royal Medical Services (RMS), Bahrain.
Insights
Hybrid drug-eluting stent/drug-coated balloon percutaneous coronary intervention (DES-DCB PCI) for chronic total occlusions (CTOs) showed feasibility with low late lumen loss. Optimal lesion preparation and sizing are key to successful outcomes.
Area of Science:
- Interventional Cardiology
- Vascular Devices
- Biomedical Engineering
Background:
- Hybrid drug-eluting stent/drug-coated balloon percutaneous coronary intervention (DES-DCB PCI) is explored to reduce stent burden in chronic total occlusion (CTO) lesions.
- Maintaining vessel patency is crucial in CTO interventions.
Purpose of the Study:
- To evaluate the feasibility and outcomes of a hybrid DES-DCB PCI strategy for CTO lesions.
- To identify predictors of late lumen loss (LLL) and clinical outcomes.
Main Methods:
- Prospective study of 19 consecutive CTO patients treated with hybrid DES-DCB PCI.
- Primary endpoint: LLL at 3-4 months.
- Secondary endpoints: Clinical outcomes at 6 months.
Main Results:
- Technical success rate was 89.5%.
- Mean LLL was 0.10 ± 0.83 mm; 53% achieved late lumen gain.
- Residual stenosis predicted LLL; optimal DCB sizing and inflation ≥180s were protective. IVUS guidance showed 0% restenosis.
Conclusions:
- Hybrid DES-DCB PCI is a feasible strategy for CTOs, demonstrating low LLL.
- Lesion preparation, sizing, and inflation duration significantly impact outcomes.
- The GLOW score offers intra-procedural risk stratification for CTO interventions.
Background:
Hybrid drug-eluting stent/drug-coated balloon percutaneous coronary intervention (DES-DCB PCI) aims to minimize stent burden while maintaining patency in chronic total occlusion lesions.
Methods:
We prospectively studied 19 consecutive CTO patients treated with a hybrid DES-DCB strategy; primary endpoint was late lumen loss (LLL) at 3-4 months, with secondary clinical outcomes at six months.
Results:
Technical success was 89.5 %; mean LLL was 0.10 ± 0.83 mm; late lumen gain occurred in ~53 % of patients completing angiographic follow-up; binary restenosis was 10.5 %. Residual stenosis strongly predicted LLL, while optimal DCB sizing and inflation ≥180 s were protective; residual stenosis remained the independent predictor in multivariable regression. IVUS guidance was associated with 0 % restenosis.
Conclusions:
Hybrid DES-DCB PCI for CTOs was feasible with low LLL. Outcomes hinged on lesion preparation, sizing, and inflation duration. The six-component GLOW score provides intra-procedural risk stratification and warrants multicenter validation.
