Is it possible to think of a hybrid solution?
Yes, it is possible In some cases, it is possible to opt for a hybrid solution, i.e. the implantation of a drug-eluting metal stent and a drug-coated balloon.
When do we need a hybrid solution?
The use of a hybrid solution can be implemented:
When treating stenosis particularly resistant to optimal dilation or stenosis localized at the aortic origin of the coronary artery (defined aorto-ostial stenosis), for which it is necessary to use a metal stent instead of the bioabsorbable stent;
For patients for whom short-term antiplatelet therapy is appropriate.
What are the potential benefits of a hybrid solution?
The hybrid solution allows to obtain the following benefits in addition to the advantages of the best drug eluting metal stents:
Limitation of the length of the metal stent to be implanted thanks to the combined use of a drug-eluting balloon.
Positive remodeling can take place in the areas with a drug-coated balloon.
The reduction of the amount of foreign body implanted, may lower the time duration for dual antiplatelet therapy.
The use of a hybrid approach is illustrated here
The image 1 shows a left coronary artery with narrowing present on the common trunk and in different areas of the artery highlighted by arrows. In the areas marked with (A) and with (B) the narrowing is limited and can treated with a short metal drug-eluting stent, while the area highlighted in (C) treatment is performed with a drug-coated balloon, avoiding implantation of a long stent.
Image 2 shows the result after the implantation of two metal drug-eluting stents in (A) and in (B) and after treatment with a drug-coated balloon in (C).
Thanks to the absence of a foreign bodies, the usage of drug-coated balloons require treatment with dual antiplatelet therapy (aspirin and another medication) for a shorter time duration compared to the needs following implantation of a drug-eluting stent or a bioresorbable scaffold.