Q&A
Q.
Why does Elixir DynamX make physiological sense?
A.
Elixir DynamX bioadaptor has a unique design which other bioabsorbable scaffolds (BVS) lacked; to provide the tensile strength at the time of deployment and avoid vessel recoil.
The unique design of bioadaptor allows interlock of the struts to unlock after resorption of the biodegradable polymer in 4-6 months, and making the tensile strength weak so that it can conform to vessel movement and pulsetality. As compared to BVS, struts remain and there are no thrombosis reported upto 3 years of follow up. Elixir has CE mark approval and is undergoing trials in USA; likely to be commercially available by 2027 end.
Q.
In what types of lesions will you use it for?
A.
Elixir DynamX now is being used in all types of simple and complex lesions, avoiding only the bifurcation lesions.
Q.
Does it present any downside?
A.
Downside of Elixir is lack of 5 year data at present, otherwise it has very low profile and easily crossable and comparable to current generation DES. Bioadaptor RCT has shown lower TLR and MACE compared to Resolute Onyx DES upto 3-4 years follow up.
Q.
Were you surprised by the STEMI-DTU trial results?
A.
I was not at all surprised by the STEMI-DTU trial results because the pilot trial of 50 pts did not even had the hint of better efficacy, yet company and investigators went for a large RCT. I predicted 2 years ago that major RCT will be futile; now results showed exactly that.
Q.
Would there be any STEMI subset where you would initially place an Impella?
A.
I will use Impella in STEMI pts with hemodynamic compromise or instability, and then will proceed to PCI right away and not waiting for 30 minutes which was done in the RCT.
Q.
What was the key step in today’s case?
A.
Key step in today’s case was successful initial Rota ablation and based on the IVUS, then IVL for still high calcium burden for better final stent expansion.
Q.
Are you using any 2.0 burrs?
A.
Currently our different Rota burr size usage in 700 cases annually is; 1.25mm in 20%, 1.5mm in 40%, 1.75mm in 38%, 2mm in 2% and almost none above 2mm. We have used only three 2.25mm burr and one 2.38mm burr in last 5 yrs (in almost 3000 Rota cases).
Q.
How specifically did IVUS help today?
A.
IVUS after RA helped in identifying the calcium arc at LAD ostium but no nodules, which then responded to IVL very well.
Q.
Could a similar result have been without additional use of IVL?
A.
In this case, IVL because of still high residual calcium burden, helped a lot in addition to rotablation; true “RotaTripsy”. Perhaps Wolverine cutting ballon might also have gotten the similar results (as shown in Short Cut Trial).
Q.
Or using only IVL, without using Rotational Atherectomy?
A.
IVL alone after predilating the lesion with 2.5mm NC balloon could have been ok with similar results as shown by 2 RCTs comparing RA vs IVL (R3, OFDI) with similar procedural efficacy and similar MSA post but with lower perforation by IVL.
