Simon eccleshall

@jonnywatt @evandrofilhobr Ok so you have to trade off a slightly higher 1 year repeat revasc rate for SEB against a slightly higher cardiac death rate in DES Death is undoubtedly the ultimate endpoint. A repeat revasc is a choice… Time to start making choices

@evandrofilhobr Promising data but we've been here before with scaffolds. Target vessel failure after DCB was 1% higher than DES at 1 year and DCBs are more expensive and have less evidence for long-term efficacy or safety. I don't think DCB are the way to go yet.

SELUTION DeNovo 🇪🇺 | #TCT2025 Large, pragmatic strategy trial: sirolimus DCB-first vs contemporary DES for de novo lesions. Unique strategy: patients randomized before lesion preparation — unlike prior DCB studies. ✅ Non-inferior for 1-year TVF (5.3% vs 4.4%) 💀 Death, MI, thrombosis all similar 🧠 80% of DCB patients avoided a stent ⚠️ Slightly higher TVR (3.3% vs 2.1%) 🔍 Low intravascular imaging use (~16%) outcomes could be even stronger with optimized prep & imaging guidance. A real step toward “leave nothing behind.” #DCB #InterventionalCardiology #TCT2025

@djc795 @sbrugaletta Mine too. See you in another 4 years! Or hopefully sooner with a beer!

@Simoneccles66 @sbrugaletta My only concern is the long term results.

everyone is excited about DCB after Selution trial. but no inferiority margin was set at 50%. this means that even with 2.5% of events in DES group, DCB would have been still no inferior. in which other scenario we accept that a new treatment can be up to 50% less effective than the standard, and we still consider it acceptable? probably the trial is underpowered because a good margin would have been 10 or 20%. anyhow let's wait for the final publication to know the details and to understand which is the assumption of superiority for the 5-year. #TCT #TCT2025 @crfheart @TCTMD @PCRonline

@MarqPatton @sbrugaletta That’s not the point. A strategy of DCB first and DES when needed is being tested. The result is 80% fewer patients need a DES and the outcome in non-inferior Why leave them with a DES if not needed. We all hate ISR and DES-induced ACS - poor PCI outcomes

@Simoneccles66 @sbrugaletta I think we are talking apples and oranges here. We have a questionable “non-inferiority” endpoint with ~1:5 patients crossing over in dcb arm. So to tease out that stand alone dcb is actually non-inferior to current generation DES is premature at best

@djc795 @sbrugaletta We have published cost effectiveness already showing even with higher price on DCB that overall procedural cost v similar in a UK setting . And not longer procedural time and not more contrast

@Simoneccles66 @sbrugaletta We accept an NI margin as the price to pay for some advantage of the newcomer. And, IMHO, that advantage should be something that is perceptible to the pt (ie, sx or clinical events). In most of the world, DCBs cost more than DES, so the bar is even higher for that benefit.

@djc795 @sbrugaletta How many layers of metal are good? One? Two?? Three??? If you want to avoid ISR and worse (stent thrombosis) then you only need the DES for failed lesion prep. If your concern is restenosis just deliver the drug don’t leave metal behind

@sbrugaletta I think we have to wait for the 3-5 year outcomes to properly interpret this study. If they are superior to DES, it’s a useful approach for de novo lesions. If not, avoiding a stent (except in the LIMA touchdown zone) is a purely hypothetical benefit without real value.

@MarqPatton @sbrugaletta But that means 80% of your cases can leave the lab stent-free and avoid those documented stent attrition rates seen out to at least 10 years. Why wait 10 years - it is safe and non-inferior at one. GAME CHANGER😎 Mic drop….

@sbrugaletta I believe in the DCB arm ~20% had bailout stenting for dissection too. So very cautious here.

@ihtanboga Obviously! It’s a game changer

If the SELUTION DeNovo trial yields positive results, could it represent a paradigm shift in interventional cardiology practice? #TCT2025

@cordis DEBonly anyone???? 😎

🚨 Breakthrough SELUTION™ SLR DEB Trial Data Unveiled at #TCT 2025 Cordis proudly announces groundbreaking results from the SELUTION DeNovo and SELUTION4ISR randomized trials, presented during the Late-Breaking Clinical Science sessions at TCT 2025. SELUTION DeNovo Trial, the largest randomized Drug Eluting Balloon trial, demonstrates a SELUTION SLR™ DEB strategy is non-inferior to a Drug Eluting Stent treatment strategy in de novo lesions. SELUTION4ISR, a randomized controlled trial, proves SELUTION SLR™ DEB is an alternative to current standard of care for In-Stent Restenosis (ISR) treatment. Read the full announcement: cordis.com/na/news/cordis… #CordisGoBeyond #Cordis #InterventionalCardiology #LateBreakingClinicalData #SELUTIONSLR #DEB

@DrPascalMeier I will try but don’t use many anyway !😀 Only required for failed lesion prep and a vessel threatening dissection. So good prep and avoiding or modifying those nasty dissections gives you lots of options for a stent free result

@realarainmd Absolutely. Do your best lesion prep then choose the right destination device. We have the choice of DCB, scaffold or DES PCI is changing (again)

Drugs On The Mind As my #TCT2025 comes to an end, here are 3 🔑 takeaways: - DCBs are the future - Or, perhaps it is BVS - Eitherway, vessel prep and physiology matter! Here is the last case I did before I came to #TCT2025. As they say, the future is now. 38 y/o w CAD + DM1!

@angioplastyorg I have just watched it WOW WOW WOW he is (still) so far ahead of the game Amazing Thank you

Drug-coated BALLOONS, cutting BALLOONS, high-pressure non-compliant BALLOONS -- it seems that it's BALLOON Sunday at #TCT2025 #SELUTION #ShortCUT #VICTORY

@angioplastyorg BALLOON SUNDAY - love it! BALLOON EVERYDAY 🤩

SELUTION DENOVO strategy with sirolimus #DCB has met noninferiority margin. ⁦@crfheart⁩ ⁦@TCTConference⁩ #TCT2025

My @TCTMD with @Simoneccles66 and christian spaulding around #SelutionDeNovo trial @crfheart @jgranadacrf

@drrajnatarajan @vass_vassiliou @CorballisTash @justvick Great work Raj! Well done DCBonly just keeps expanding

CTO PCI with DCB! Our systematic review/meta-analysis supports DCB as a safe, effective option for both de novo and in-stent CTOs. Similar outcomes, promising late lumen gain! @Simoneccles66 @vass_vassiliou @CorballisTash @justvick Read here: link.springer.com/article/10.100…

@upulwick @bit @SanjogKalra @aayshacader Awesome job as always Upul!!

Great times @BIT 25 with colleagues from SLCC, talking on DCBs for the fourth time in Dhaka, very happy to see the interest growing. Thank you Prof Afzalur Rahman. Meeting friends and legends from all around the world. @SanjogKalra @aayshacader (missed you)

@Atul_SharmaMD @mmamas1973 @vass_vassiliou Best treatment for residual thrombus is good DAPT etc plus TIMI 3 FLOW IMHO

@mmamas1973 @vass_vassiliou @Simoneccles66 Seems like there might be residual thrombus. Might consider stenting. Megatron and Onyx stents can expand to 6mm and even though would not have proximal apposition, at that size I don’t think there would be significant risk given expansion.

1. Interesting STEMI PCI case (shared with pt consent) Male type 2 DM, anterior STEMI mid 50s, prox lad lesion, thrombus visualised. How would you treat? What size stents would you use? @Hragy @mirvatalasnag @KardiologieHH @alaide_chief @SVRaoMD @djc795 @DrPascalMeier @ShrillaB @ncurzen @jdrwilcox @SimoneBiscaglia @GoranEBC @mathur_a @AntoniousAttall @RodrigoBagur @Simoneccles66

@Hragy @amrelhadidyy And thanks again for the invitation

@Hragy @amrelhadidyy Thank you! I hope it was useful educational and entertaining! So much to talk about in DCB land !

At Egypt’s Critical care and PCI meeting organized yearly for the last 12 years by my friend @amrelhadidyy attending a brilliant online presentation from UK on DCB by @Simoneccles66