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BackTable / VI / Podcast / Episode #407
The Evolving Role of Drug Eluting Stents in PAD
with Dr. Eric Secemsky
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.
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BackTable, LLC (Producer). (2024, January 22). Ep. 407 – The Evolving Role of Drug Eluting Stents in PAD [Audio podcast]. Retrieved from https://www.backtable.com
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Podcast Contributors
Dr. Eric Secemsky
Dr. Eric A. Secemsky, MD, MSc, RPVI, FACC, FSCAI, FSVM is the Director of Vascular Intervention and an Interventional Cardiologist within the CardioVascular Institute at Beth Israel Deaconess Medical Center (BIDMC).
Dr. Sabeen Dhand
Dr. Sabeen Dhand is a practicing interventional radiologist with PIH Health in Los Angeles.
Synopsis
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.
Timestamps
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
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
Transcript Preview
[Dr. Eric Secemsky]
Drug is the right way to get the longest benefit for our patients, to really reduce the risk of needing another procedure, coming back to the hospital, taking time off work, being bedbound, whatever it might be. So I typically put a drug-coated balloon down in a lot of cases, even if I know I'm probably going to scaffold some of it. I still usually start with a DCB, because I see no downside. Then from there, I can also focally stent or rely on the whole thing if I need to. I almost always use drug-coated technology and that same algorithm that I presented to you, long fem pop outside of a distal SFA pop, I'm going to put in drug-coated or drug-eluting stent. If it's a pop, I'm going to put in a Supera, but I don't have many procedures where there's not some drug touching the patient. I don't think there's any downside for double treating. Again, I think that the drug-coated balloon and the drug stents might have different properties and when that paclitaxel might be most effective. I'm looking for a long-term benefit. I think that the dual technology could have an impact, but at minimum, it's not going to hurt the patient.
Please see Essential Prescribing Information for Zilver PTX here: https://www.cookmedical.com/patient-resources/peripheral-arterial-disease/cook-offers-solutions-for-peripheral-arterial-disease-pad/
Use of the Zilver PTX drug-eluting peripheral stent carries the risks associated with peripheral artery stenting, including vascular complications and/or bleeding events. Refer to the Instructions for Use (IFU) for full prescribing information including information on potential adverse events, contraindications, warnings, and precautions.
Disclaimer: The Materials available on BackTable.com are for informational and educational purposes only and are not a substitute for the professional judgment of a healthcare professional in diagnosing and treating patients. The opinions expressed by participants of the BackTable Podcast belong solely to the participants, and do not necessarily reflect the views of BackTable.
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