Goal: Optimal Stent Deployment

Transcription

1 Ground breaking, Life changing Goal: Optimal Stent Deployment

2 Ground breaking, Life changing Cordis Corporation has no independent knowledge concerning the information contained in these presentations. The opinions an conclusions were reached independently by the authors. This educational activity was provided by Cordis to the Alliance of Cardiovascular Professionals. ACVP is a provider of continuing education through Cardiovascular & Pulmonary Continuing Education and the CA BRN.

3 Stent Length Selection Choose your stent length FIRST based on the diseased area to be treated Stent disease-free to disease-free or normal reference vessel (NRV) to NRV If unsure and the landing zone is the exact length of the stent e.g. 13 mm, choose a longer stent length

4 Balloon Length Selection Predilate the lesion with a PTCA catheter. Limit the longitudinal length of predilatation by the PTCA balloon to avoid creating a region of vessel injury that is outside the boundaries of the stent The stent may be further expanded using a low profile, high pressure, and noncompliant balloon catheter. The balloon should be centered within the stent and should not extend outside of the stented region

5 Limit Balloon Vessel Injury 5mm 5mm Delivery Balloon Delivery Balloon Delivery Balloon Longer Pre or Post Balloon Limit balloon inflations to within boundaries of the stent

6 What Is the Importance of Proper Technique on Final Outcomes? Predilatation compliant balloon 20atm Stent Deployment 16atm Postdilatation i semi compliant balloon 20atm The third party trademarks used herein are trademarks of their respective owners. Final Result Cordis Corporation /09

7 Stent Under-Expansion Can Lead to Stent Thrombosis and Stent Restenosis Stent Thrombosis Under-expansion Fujii et al. J Am Coll Cardiol 2005; 45:995-8 Torre-Hernandez et al. J Am Coll Cardiol 2008;51: Cook et al. Circulation 2007;115: Cheneau et al. Circulation 2003;108:43-47 Stent Restenosis Sonoda et al. J Am Coll Cardiol 2004;43: Hong et al. Eur Heart J 2006; 27L Fujii et al. Circulation 2004; 109: Takebayashi et al. Am J Cardiol 2005;95:

8 IVUS Predictors of Early (<30 days) BMS Thrombosis % 80 Stent thrombosis (n=23) Mthd t l 60 p< p= p=0.047 p= p= p< p= p< Calcified <50% <60% <70% <80% Dissection 1 Abnomality* >1 Abnormality* Expansion (MSA=6.4 vs 7.7mm 2, p=0.047) *Expansion defined as <90% of reference lumen or <80% if MLA>9.0mm 2 Cheneau et al. Circulation 2003;108:

9 Why Optimal Stent Deployment is Important Objective TLR Clinical evidence supporting importance of complete stent apposition 44% TLR reduction with complete stent apposition Fitzgerald et al. Circulation 2000; 102: SATs 78% of SATs involved incomplete stent apposition Cheneau et al. Circulation 2003;108:43-47 Restenosis DES restenosis with incomplete stent strut apposition Takebayashi et al. Circulation 2004; 110: Drug Delivery Complete stent apposition facilitates uniform drug delivery Hwang et al. Circulation 2001; 104:

10 IS DES Technique Associated with Late Stent Thrombosis: NewInsightsfromTheSTLLR S.T.L.L.R. Trial Stent t deployment Techniques on clinical i L outcomes of patients t treated t with the CYPHER Sirolimus Eluting Stent Costa et al. American Journal of Cardiology 2008; 101: