FormalPara Reply

This is a reply to the letter by F. Krackhardt, M. Noutsias, C. Tschöpe, B. Kherad (2016) DCB meets DES. Herz. doi: 10.1007/s00059-016-4529-y

Original article: Mok KH, Wickramarachchi U, Watson T et al. (2016) Safety of bailout stenting after paclitaxel-coated balloon angioplasty. Herz. doi: 10.1007/s00059-016-4502-9

We thank Krackhardt and colleagues for their astute comments regarding our manuscript. While we agree that lesion preparation is vital to the success of drug-coated balloon (DCB) angioplasty, we would like to emphasize that when a DCB approach is selected, the best stent policy remains to avoid stent insertion unless absolutely required. This is important as a DCB strategy offers a potential opportunity for positive re-modeling and therefore allowing some early recoil (<30%) or minor dissections is very reasonable [1, 2]. Stenting is therefore largely reserved for cases where dissection is extensive or flow-limiting or where lesion expansion has failed [3].

It is thus of paramount importance to employ a meticulous technique during both lesion preparation as well as during DCB deployment, in particular with slow balloon inflation and deflation such that the lesion is dilated gently and is progressively expanded. Naturally this means that there is a learning curve in DCB angioplasty and thus the need for bailout stenting can be expected to drop as operators gain experience. Retrospective analysis of our DCB registry showed that even during emergency PCI for STEMI, the need for bailout stenting when employing a DCB approach can be as low as 4% [4]. Importantly, however, DCB operators can be assured that should bailout stenting be required following DCB, available evidence indicates that a drug-eluting stent appears to be a safe choice.