WHAT IS THE BEST OPTION FOR A PATIENT WHO NEED REVASCULARIZATION IN A SMALL CORONARY VESSEL Deps. of Cardiology - Interven...
True small vessel disease  <  2.5mm DEFINITION (Vessel Diameter)
In-Stent Restenosis Small vessels,  [ long lesions] ARE THE MAJOR ANTOMICAL DETERMINANTS OF STENT   RESTENOSIS !
Relationship :  Between  Restenosis Rate and Post  P.C.I  M.L.D CONSTANT LATE LOSS
<ul><li>Long term results post various  S.V bare   metal stents insertion  are  accompanied with a relatively  high  rate ...
Disadvantages of Small Vessels P.C.I F.U <ul><li>Higher restenosis rate  </li></ul><ul><li>Higher subacute closure  </li><...
Aim of the study Comparative, prospective, non randomized- Study of the Bio-active stent :  ‘Titan’   versus :  Bare metal...
No. of patients  [by stent groups] B.M.S C.S D.E.S B.A.S
Patients Demographics & Risk  factors NS 163 (32) 84 (39) 172 (42) Hypercholesterolemia NS 173 (34) 73 (35) 106 (26) Syste...
Lesion Characteristics   TNOS indicates titanium-nitride-oxide stent; LAD, left anterior descending coronary artery; LCx, ...
RVD Distal (mm) B.M.S C.S D.E.S B.A.S
[Distal ] R.V.D  [mm] Minivision  Lekton  Driver  Clear  R stent  Yukon  Bio  Tecnic  Titan  Taxus  Cypher  Endeavor petit...
Mean Lesion Length B.M.S C.S D.E.S B.A.S
CAD - S.V Disease Pre stent plaque preparation P.O.B.A    S.V stent:  Bio-Active.  > 2.0 PRE STENT PREPARATION ! DIRECT ST...
Successful Acute Results B.M.S C.S D.E.S B.A.S
MLD: Pre – Post Stenting B.M.S C.S D.E.S B.A.S
FOLLOW  UP  RESULTS
% of Patients F.U. at 1 year B.M.S C.S D.E.S B.A.S
Re. Cath due to Symptoms B.M.S C.S D.E.S B.A.S
Major Adverse Cardiac Events.  <12  months   follow up TNOS indicates titanium-nitride-oxide stent; MACE, major adverse ca...
Binary Restenosis B.M.S C.S D.E.S B.A.S
TLR  >  12m B.M.S C.S D.E.S B.A.S
<ul><li>Various sv BMS stents have different rates of restenosis . </li></ul><ul><li>Coated stents have similar rates of r...
 
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Titan S.V Final Ici

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Transcript of "Titan S.V Final Ici"

  1. 1. WHAT IS THE BEST OPTION FOR A PATIENT WHO NEED REVASCULARIZATION IN A SMALL CORONARY VESSEL Deps. of Cardiology - Interventional Cardiology Unit Rambam Medical Center & Technion Israel Institute of Technology, H.M.C, Hertzelia, Haifa - Israel Ehud Grenadier,Arthur Kerner, Nabeel Makhoul, Ariel Roguin.
  2. 2. True small vessel disease < 2.5mm DEFINITION (Vessel Diameter)
  3. 3. In-Stent Restenosis Small vessels, [ long lesions] ARE THE MAJOR ANTOMICAL DETERMINANTS OF STENT RESTENOSIS !
  4. 4. Relationship : Between Restenosis Rate and Post P.C.I M.L.D CONSTANT LATE LOSS
  5. 5. <ul><li>Long term results post various S.V bare metal stents insertion are accompanied with a relatively high rate of restenosis. </li></ul><ul><li>Recent data from S.V: Bio Active Stents or D.E.S studies revealed a significant reduction of long term angiographic and clinical restenosis rates. </li></ul><ul><li>The indispensable addiction to unti-platelets therapy after DES insertion is of concern and of less beneficial in small vessel CAD. </li></ul>
  6. 6. Disadvantages of Small Vessels P.C.I F.U <ul><li>Higher restenosis rate </li></ul><ul><li>Higher subacute closure </li></ul>Co morbid states association <ul><li>Higher percentage of diabetes patients </li></ul><ul><li>High incidence of undetected dissections </li></ul><ul><li>Dissections are more of occlusive types </li></ul><ul><li>More frequent need of bail-out stenting </li></ul>Procedural complications <ul><li>Deep wedging of the guiding catheter </li></ul><ul><li>Difficulty in distal negotiating with the guide wire </li></ul><ul><li>Difficulty in crossing with the balloon/stent </li></ul><ul><li>Frequent need of Focused Force Angioplasty. </li></ul><ul><li>and N.C Balloon postdilation </li></ul>Technical Less visualization Significant Challenge Cost/ Benefit
  7. 7. Aim of the study Comparative, prospective, non randomized- Study of the Bio-active stent : ‘Titan’ versus : Bare metal , Coated and Drug eluted stents in pts. with true small coronary artery disease undergoing P.C.I
  8. 8. No. of patients [by stent groups] B.M.S C.S D.E.S B.A.S
  9. 9. Patients Demographics & Risk factors NS 163 (32) 84 (39) 172 (42) Hypercholesterolemia NS 173 (34) 73 (35) 106 (26) Systemic hypertension NS 76 (15) 38 (18) 94 (23) Family history of CAD NS 142 (28) 57 (27) 127 (31) Diabetes mellitus NS 107 (21) 36 (17) 90 (22) Smoking Cardiovascular risk factors, n (%) NS 18 (38) 19 (42) 127 (31) Previous myocardial infarction, n (%) NS 346 (68) 160 (76) 286 (65) Male gender, n (%) NS 62 + 14 65 + 10 68 + ±17 Age, y 509 211 409 Patients (n) P BMS TNOS DES
  10. 10. Lesion Characteristics TNOS indicates titanium-nitride-oxide stent; LAD, left anterior descending coronary artery; LCx, left circumflex coronary artery; RCA, right coronary artery; and ACC/AHA, American College of Cardiology/American Heart Association. 66 (13) 33 (16) 78 (19)      Type C 148 (29) 69 (32) 123 (30)      Type B2 168 (33) 58 (28) 139 (34)      Type B1 0.27 127 (25) 51 (24) 69 (17)      Type A ACC/AHA class, n (%) 198 (39) 44 (21) 57 (14)      LCx 107 (21) 55 (26) 78 (19)      RCA 0.13 204 (40) 112 (53) 274 (67)      LAD Target vessel, n (%) 718 337 554 No. of lesions 509 211 409 Patients P BMS TNOS DES
  11. 11. RVD Distal (mm) B.M.S C.S D.E.S B.A.S
  12. 12. [Distal ] R.V.D [mm] Minivision Lekton Driver Clear R stent Yukon Bio Tecnic Titan Taxus Cypher Endeavor petite flex divysio N.S mm
  13. 13. Mean Lesion Length B.M.S C.S D.E.S B.A.S
  14. 14. CAD - S.V Disease Pre stent plaque preparation P.O.B.A S.V stent: Bio-Active. > 2.0 PRE STENT PREPARATION ! DIRECT STENTING ??? 2.0 - 2.5 mm Diameter Coronary Artery ± [D.E.S > 2.25mm] Focused force P.C.I (Angiosculpt,C.B.A,Flex ;rx- Minirail; Safe-Cut) Rotational Ablation
  15. 15. Successful Acute Results B.M.S C.S D.E.S B.A.S
  16. 16. MLD: Pre – Post Stenting B.M.S C.S D.E.S B.A.S
  17. 17. FOLLOW UP RESULTS
  18. 18. % of Patients F.U. at 1 year B.M.S C.S D.E.S B.A.S
  19. 19. Re. Cath due to Symptoms B.M.S C.S D.E.S B.A.S
  20. 20. Major Adverse Cardiac Events. <12 months follow up TNOS indicates titanium-nitride-oxide stent; MACE, major adverse cardiac events; TLR, target-lesion revascularization; and PCI, percutaneous coronary intervention. NS 1 (0.2%) 0 (0) 5 (1.2%) Stent thrombosis NS 35 (7%) 1 (2%) 9 (2.2%) CABG 0.03 109 (21.4) 18 (8.5%) 31 (7.5%) TLR NS 12 (2.3%) 2 (0.9%) 8 (2.0%) Non–Q-wave NS 7 (1.4%) 1 (0.5%) 4 (0.9%) Q-wave NS 8 (1.6%) 3 (1.4%) 12 (2.9%) Myocardial infarction NS 6 (1.2%) 0 (0) 5 (1.2%) Death 0.02 139(27.3) 20 (9.5%) 47 (11.5%) Overall, n (%) 6-Month MACE 509 211 409 No. of patients P BMS TNOS DES
  21. 21. Binary Restenosis B.M.S C.S D.E.S B.A.S
  22. 22. TLR > 12m B.M.S C.S D.E.S B.A.S
  23. 23. <ul><li>Various sv BMS stents have different rates of restenosis . </li></ul><ul><li>Coated stents have similar rates of restenosis compared to the B.M.S. group . </li></ul><ul><li>Bio-Active stents [Titan ] have a low of restenosis/TLR rates which is within the detected rate of the D.E.S group. </li></ul><ul><li>Similar comparative rates of M.A.C.E were obtained in the D.E.S and the B.A.S groups compared to the B.M.S group. </li></ul>CONCLUSIONS : SV STENTS

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