Morris Mosseri, MD Director of Interventional Cardiology Hadassah-Hebrew University Medical Center The Israeli Working Group of Interventional Cardiology The Titan Stent in Real Life Results from a Multi-Center Registry
Stainless steel and Cobalt-Chromium stents contain considerable amounts of Nickel , Chromium and Molybdenum : Nickel Chromium Molybdenum 316L SS 12-15% 17-19% 2-3% Co-CR Vision 9-11% 19-21% ___ Co-Cr Driver 33-37% 19-21% 9-10% Background
Allergy 5-15 % of the population are allergic to Nickel. Nickel allergy Background
All patients with positive allergic patch-test reactions had a restenosis at 6 months post stenting.
Koster R et al Lancet 2000:356; 1895-7. Nickel and Molybdenum contact allergies in patients with coronary in-stent restenosis. P=0.03 131 42 89 121 42 79 Negative patch test 10 0 10 Positive patch test Restenosis (-) Restenosis (+)
The Inflammatory Equilibrium Inflammatory factors Systemic (vulnerable patient) Local (vulnerable plaque) Procedural (trauma) Stent (“foreign” material) Anti-inflammatory therapy DES Systemic therapy
TiNOX The Titan stent (Hexacath, France) is a balloon expandable stent made of stainless steel and coated with Titanium-Nitride-Oxide (TiNOX) which completely prevents discharge of nickel, chromium and molybdenum . Background
To assess the short and long term characteristics of the Titan stent in a multi-center registry.
The Titan Israeli Registry (296 patients) List of centers and investigators: Hadassah - Mosseri M. Ichilov - Miller H. Barzilai - Jefferey J. Hillel-Jaffe - Friemerman A. Naharia - Brizines M, Poriah - Hasin Y. Shiba - Guetta V Wolfson - Tamari I. Ziv - Plich M, ISRAEL
TLR rate in randomized trials tends to be higher than registries because patients may undergo follow-up angiographic driven revascularization. Therefore, comparison of studies of the same kind (registries, randomized studies) is preferable.