1) The document discusses revascularization options for patients with small vessel coronary artery disease less than 2.5mm in diameter. 2) It finds that drug-eluting stents (DES) and bio-active stents significantly reduce long-term restenosis rates compared to bare metal stents (BMS) in small vessels. 3) The bio-active stent (Titan) performed similarly to DES with low restenosis and target-lesion revascularization rates, suggesting it may be an alternative option for patients who cannot tolerate long-term anti-platelet therapy required by DES.

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. True small vessel disease < 2.5mm DEFINITION (Vessel Diameter)

3. In-Stent Restenosis Small vessels, [ long lesions] ARE THE MAJOR ANTOMICAL DETERMINANTS OF STENT RESTENOSIS !

4. Relationship : Between Restenosis Rate and Post P.C.I M.L.D CONSTANT LATE LOSS

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. No. of patients [by stent groups] B.M.S C.S D.E.S B.A.S

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. 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. RVD Distal (mm) B.M.S C.S D.E.S B.A.S

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. Mean Lesion Length B.M.S C.S D.E.S B.A.S

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. Successful Acute Results B.M.S C.S D.E.S B.A.S

16. MLD: Pre – Post Stenting B.M.S C.S D.E.S B.A.S

17. FOLLOW UP RESULTS

18. % of Patients F.U. at 1 year B.M.S C.S D.E.S B.A.S

19. Re. Cath due to Symptoms B.M.S C.S D.E.S B.A.S

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. Binary Restenosis B.M.S C.S D.E.S B.A.S

22. TLR > 12m B.M.S C.S D.E.S B.A.S