Coronary Stent - Part A - Overview


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Coronary Stent - Part A - Overview

  1. 1. Stent design aspects Part A – Overview Dr. Amir KraitzerThe contents of materials available on this presentation are reserved. Content may not be reproduced,published, or transferred except with the prior written permission of Dr. Amir Kraitzer
  2. 2. Coronary Artery Disease Coronary artery disease (CAD) is leading cause of death world-wide CAD deaths estimated 1 in 5 annually Costs $151.6 billion in 2007 1995 – 2005: 34% decline in CAD death Initial Stenosis * Statistics were taken from American Heart Association
  3. 3. Historical background Andreas Jacques Puel Julio Palmaz Cypher, Abbott Gruentzig Ulrich Sigwart Richard Schatz J&J1960 1977 1977 1986 1994 2003 2011 2012CABG Angioplasty Stent First FDA First FDA First CE Research FIM Approved Approved approved Pro-healing Stent DES DEBDS
  4. 4. Restenosis Re-narrowing of a blood vessel causing a reduction of the luminal size Driver of restenosis recoil 40%revascularization mechanical stabilization of Need for acute result neointima formation 20% local delivery of anti-proliferative agents 5% implantation technique PTCA BMS DES
  5. 5. ISR Biology
  6. 6. ISR prevention Atherectomy Mechanical techniques  High-pressure stent deployment  Stent sandwich  Atherectomy Systemic drugs  Antiplatelets  Anticoagulants Temporary Local Delivery Edge Effect Brachytherapy Stents  Bare metal  Coated Stents  Passive coating  Active coating
  7. 7. Bare Metal Stent
  8. 8. Drug eluting stent (FDA approved)First generation DES Cypher, J&J (2003) – Sirolimus DES Taxus, Boston Scientific (2004) - Paclitaxel 2006 US coronary stent market estimated $5 billion, 90% is attributed to DESSecond generation DES Endeavor, Medtronic (2008)- Zotarolimus Xience, Abbott (2008)- Everolimus
  9. 9. Biodegradable drug eluting stent Third generation DES The first commercially approve drug-eluting biodegradable stent, ABSORB ABSORB, Abbott (2011) - Everolimus
  10. 10. Current and Future Research Biodegradable Stents Pro-healing approach
  11. 11. Clinical restenosis measurement definitions Measurement Definition Target Lesion Revascularization (TLR) The rate of reported re-intervention procedures inside the target lesion Target Vessel Revascularization (TVR) The rate of re-intervention procedures inside any lesion located in the same coronary vessel of treatment Late lumen loss The resulting luminal length reduction during follow-up In-stent restenosis (ISR) Angiographic measurement during follow-up as stenosis in the treated segment >50% of the treated patients In-segment restenosis Angiographic measurement during follow-up as stenosis in the treated segment including the 5mm segment distal and proximal to the stent edges >50% of the treated patientsMajor Adverse Cardiac Events (MACEs) Complications in cardiac trials such as death, Q-wave and non-Q-wave infarction, and target lesion/vessel revascularizations Stent Thrombosis Basically defined by the presence of angiographic thrombus in a stent during follow-up. However, it has variable definitions, such as probable or definite stent thrombosis. Recently, a set of definitions were developed by an academic research consortium (ARC) which included all unexplained deaths occurring early (<30 days), late (31 to 360 days), or very late (>360 days) after the procedure