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.
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 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>
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
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
<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