Bifurcation stenting with BVS
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1 Bifurcation stenting with BVS Breaking the limits or just breaking the struts? Maciej Lesiak Department of Cardiology University Hospital in Poznan, Poland
2 Disclosure Speaker s name: Maciej Lesiak I have the following potential conflicts of interest to this presentation: Research contracts Consulting: Abbott Vascular Employment in industry Stockholder of a healthcare company Owner of a healthcare company Other(s)
3 Background BVS is a promising technology (vessel reparative therapy) Scaffolds have not been tested in bifurcation lesions so far Is coronary artery bifurcation an important limitation in the use of BVS?
4 Strut crossing BVS 3.0x18 mm, test in the air connector 2.0 mm balloon 8 ATM 2.5 mm balloon 8 ATM
5 The importance of the crossing point location
6 Test in the air BVS 3.0 x 18 mm mm Kissing with two NC balloons 3.0 & 8 ATM
7 BVS 3.0x18 mm Silicone tube, lumen 3.0 mm No ruptured links NC 3.0 BVS 3.0 x 18 mm BVS 3.0 x 18 mm NC mm 3.0 Kissing with two NC balloons (3.0 & ATM
8 Poznan Bifurcation BVS Registry Prospective, single-centre clinical registry Inclusion / exclusion criteria Consecutive bifurcation cases treated with BVS Informed consent Any indication to PCI (stable or ACS) Any Medina type No excessive calcium & tortuosity
9 Total population Baseline characteristics N = 43 Age (years) 62± 11 Male gender 33 (77%) Diabetes mellitus 14 (32.6%) Hypertension 33 (76.7%) Smoking 20 (46.5%) Previous MI 22 (52.4%) LV Ejection Fraction (%) 51 ± 11 Previous revascularization 24 (55,8%) Peripheral vascular disease 4 (9.3%) Chronic Kidney Disease (egfr<60) 6 (14.0%) Indication for PCI Stable angina 33 (76.7%) Unstable angina / NSTEMI 7 (16.5%) STEMI 3 (7.0%)
10 Vessel / lesion Vessel / Lesion characteristics N = 43 Bifurcation location LM/LAD, LM/LCx 7 (16.3%) LAD/DIA 25 (58.1%) LCX/OM 9 (20.9%) RCA (PL/PDA) 2 (4.7%) True bifurcation lesion: 1,1,1 / 1,0,1 / 0,1,1 20 (46.5%) Ostial SB only (0,0,1) 8 (18.6%) Type B2+C 36 (83.7%) Calcification (moderate/heavy) 10 (27%) Thrombus (angio) 4 (9.3%) CTO 7 (16.3%)
11 Results Procedure characteristics N = 43 Radial approach 30 (70%) 6 F Guiding catheter 43 (100%) Simple technique (one stent) 37 (86%) Provisional T stenting 30 (70%) Systematic T stenting 4 (9%) TAP technique 1 (3%) SB ostial stenting 8 (19%) Pre dilatation 42(98%) Strut opening 13 (35%) Final Kissing / snuggle 13 (30%) FK MB balloon diameter 3.0 ± 0.2 mm FK SB balloon diameter 2.4 ± 0.2 mm
12 Results Vessel / Lesion characteristics N = 43 Main Vessel Reference vessel diameter prox. 3.2 ± 0.7 mm Reference vessel diameter dist. 2.7 ± 1.0 mm Lesion length (mm) 11.8 ± 8.8 mm Diameter stenosis (%) 72 ± 27 % Side Branch Reference vessel diameter 2.4 ± 0.5 mm Lesion length 5.1 ± 5.4 mm Diameter stenosis 39.6 ± 31.4 % Angles Proximal bifurcation angle (angle A) 140 ± 40 degrees Distal bifurcation angle (angle B) 54± 30 degrees Bifurcation angle < 50 degrees 26 (60.5%)
13 Results Procedure characteristics N = 43 MB Stent diameter 3.1 ± 0.2 mm MB Stent length 21 ± 4.6 mm SB Stent diameter 2.8 ± 0.4 mm SB Stent length 21 ± 4.4 mm Additional stenting MB / SB 3 / 0 Scaffold/procedure success 43 / 42* Fluoroscopy time 10.9 ± 6.7 min Contrast use 145 ± 57 ml IVUS / OCT 13 (30%) *One case of SB dissection during wire re-cross, slow flow, CKMB
14 Clinical outcomes In hospital Discharge-30 days Death 0 1 (fatal stroke) Cardiac death 0 0 Myocardial infarction 2 0 Q MI 0 0 Non-Q MI 2* 0 Stroke 0 1 Stent thrombosis (any as of ARC) 0 0 Target vessel failure 0 0 *One case of SB dissection during wire re-cross, slow flow, CKMB One case of septal branch closure with CKMB
15 Follow-up Median observation time 134 days (3 366) Mean observation time 140 ± 98 days n=43 Discharge end of FU All cause death 1 Cardiac death 0 Myocardial infarction 0 Target lesion revascularization 0 Target vessel revascularization 0 Stent thrombosis (any as of ARC) 0 Target vessel failure 0
16 Baseline characteristics and angiography 49YO man, stable angina class 3. Anterior MI & PCI of LAD in F Guide, femoral approach Target vessel
17 Wired vessel
18 Pre-dilatation, NC 2.5x15 mm 12 ATM BVS 2.5x18 mm, 16 ATM
19 After BVS implantation
20 Kissing 8 ATM SB 2.5x15 mm / MB 2.75x15 Proximal BVS implant. 3.0x18, 16 ATM
21 Final result
22 OCT SB ostium
23 OCT
24 OCT
25 Baseline characteristics and angiography 60 YO woman, stable angina class 2 6 F Guide, femoral approach Target vessel
26 Direct BVS 3.0x18 mm, 16 ATM After implantation
27 POT, NC 3.25x12 mm 18 ATM
28 Rewiring distal strut
29 Strut crossing NC 2.5x12, 10 ATM SB wire
30 BVS 2.5x18 through BVS 3.0 struts
31 SB BVS positioning TAP
32 BVS TAP SB BVS position Implantation: SB BVS 2.5x18 mm, 14 ATM
33 BVS implantation
34 MB balloon 3.25x12 inflation, 4 ATM Kissing: SB BVS 2.5x18 mm, 8 ATM / MB 3.25x12, 8 ATM
35 II nd POT: NC 3.25x12 mm, 18 ATM
36 Final result
37 Final result
38 OCT Pullback from diagonal branch Pullback from LAD
39 OCT LAD DIA LAD Pullback from diagonal branch Pullback from LAD Neo-carina
40 Breaking the limits or breaking the struts?
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