Ep. 407 The Evolving Role of Drug Eluting Stents in PAD with Dr. Eric Secemsky

BackTable Vascular & Interventional

In this episode of the BackTable Podcast, host Dr. Sabeen Dhand interviews Dr. Eric Secemsky about the efficacy of drug eluting technologies in vascular interventions, with Dr. Secemsky offering insight into his own practice. Dr. Secemsky is an interventional cardiologist practicing at Beth Israel Deaconess Medical Center in Boston.

Dr. Secemsky believes that drug coated technology is a game-changer in the endovascular space since it improves patient outcomes by reducing the risk of needing additional procedures. Dr. Secemsky highlights the importance of various trials such as IMPERIAL and EMINENT, which compare the effectiveness of different stents. He also speaks about the significance of the Cook Medical prediction model to calculate intervention success rates and the role of disease site-specific interventions. Dr. Secemsky ends the podcast by sharing his thoughts about advancements in the near future, including the use of bioabsorbable stents and sirolimus drug-coated balloons.

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Cook Medical Zilver PTX

https://www.cookmedical.com/zilverptxbacktable

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SHOW NOTES

00:00 - Introduction

09:31 - Understanding Drug Coated Balloons and Stents

14:29 - The Paclitaxel Controversy

19:30 - Stenting Algorithm for Fem-Pop Disease

23:55 - Impact of Lithotripsy on Drug Delivery

26:02 - Predictability Models for Revascularization

29:14 - Economic Considerations in Drug Eluting Stent Usage

31:33 - Highlighting Trials on Drug Coated Technology and Drug Eluting Stents

37:08 - Future Technologies: Drug on Stent Grafts and Spot Stenting

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RESOURCES

Zilver PTX Cook Prediction Model:

https://cooksfa.z13.web.core.windows.net/

Risk of Death Following Application of Paclitaxel‐Coated Balloons and Stents in the Femoropopliteal Artery of the Leg: A Systematic Review and Meta‐Analysis of Randomized Controlled Trials:

https://www.ahajournals.org/doi/full/10.1161/JAHA.118.011245

Durable Clinical Effectiveness With Paclitaxel-Eluting Stents in the Femoropopliteal Artery: 5-Year Results of the Zilver PTX Randomized Trial:

https://pubmed.ncbi.nlm.nih.gov/26969758/

Mortality in randomized controlled trials using paclitaxel-coated devices for femoropopliteal interventional procedures: an updated patient-level meta-analysis:

https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(23)02189-X/fulltext

Outcomes of Stented vs Nonstented Femoropopliteal Lesions Treated With Drug-Coated Balloon Angioplasty:

https://pubmed.ncbi.nlm.nih.gov/35179065/

Drug coated balloon improves outcomes of sub-optimal Supera deployment in the intermediate term:

https://pubmed.ncbi.nlm.nih.gov/36494491/

Directional Atherectomy Followed by a Paclitaxel-Coated Balloon to Inhibit Restenosis and Maintain Vessel Patency: Twelve-Month Results of the DEFINITIVE AR Study:

https://pubmed.ncbi.nlm.nih.gov/28916599/

Intravascular Lithotripsy for Peripheral Artery Calcification: 30-Day Outcomes From the Randomized Disrupt PAD III Trial:

https://pubmed.ncbi.nlm.nih.gov/34167675/

Efficacy of a Drug-Eluting Stent Versus Bare Metal Stents for Symptomatic Femoropopliteal Peripheral Artery Disease: Primary Results of the EMINENT Randomized Trial:

https://pubmed.ncbi.nlm.nih.gov/36254728/

A polymer-coated, paclitaxel-eluting stent (Eluvia) versus a polymer-free, paclitaxel-coated stent (Zilver PTX) for endovascular femoropopliteal intervention (IMPERIAL): a randomized, non-inferiority trial:

https://doi.org/10.1016/S0140-6736(18)32262-1

SPORTS Clinical Trial Results Boston Scientific:

https://www.bostonscientific.com/en-EU/medical-specialties/vascular-surgery/drug-eluting-stent-drug-coated-balloon/eluvia/sports-rct.html