Micromesh technology in carotid artery treatment what is next? Max Amor MD Clinique Louis Pasteur, Essey-Les-Nancy France
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1 Micromesh technology in carotid artery treatment what is next? Max Amor MD Clinique Louis Pasteur, Essey-Les-Nancy France
2 Disclosure Speaker name: Max Amor, MD.... I have the following potential conflicts of interest to report: Consulting Employment in industry Stockholder of a healthcare company Owner of a healthcare company Other(s) X I do not have any potential conflict of interest
3 Endovascular Carotid artery treatment requires Prevention of embolisation Peri-procedural/ Temporary embolic protection Several protecting devices to block distal embolisation of ditached debris (Access, Poststenting dilatation ) Post-procedural/ Sustained embolic protection
4 Roadsaver dual layer micromesh Carotid stent Braided Nitinol carotid stent with a built-in Nitinol micromesh for sustained embolic protection Cell surface area (mm²)
5 First clinical cases 33 Patients with high risk carotid artery lesions treated with Roadsaver dual layer stent Midterm results Single center experience Clinique Louis Pasteur Essey Les Nancy France
6 Details of procedure DAPT before : All 24Men, 9 Women. From 49 y to 88 y (Mean 72±10y) 8 Symptomatic 25 Asymptomatic Sedation : Midazolam: All Femoral Approach : All Protection : 32 : Filters 28, MOMA 4 Atropine before inflation :All Direct Stenting : 8 Post-Dilatation: All
7 Complications after 48 h before discharge and 30 th day No significant local complications requiring surgery No clinical neurological events No new silent defects or anomalies at the 24h CT scan
8 Roadsaver Carotid Stent. Mid-term Results ( 33 Pts) (23 to 6 months, 16,7±6,6 months ) Events 30 th days 6 months 1 year Clinical Delayed embolisation no Neurological events no no No Anatomical Stent Geometry External Carotid Occlusion no no No Restenosis no no Migration no no no Compression no no no Deformation no no no Fracture no no no Page 8 Clinique Louis Pasteur, Essey Les Nancy, M.Amor 1/2016
9 Long LICA Lesion Central Dual Layer segment
10 Harmonious deployment OCT IMAGES OF ROADSAVER
11 Nitinol Micromesh Technology for temporary Embolic Protection Novel, Concentric, Nitinol Micromesh Embolic Protection Device
12 Nanoparasol Filter (Terumo) Design and technical specifications Concentric filter design Wire independent Construction: Braided Hybrid Micromesh Material: all Nitinol with Tantalum markers Average Pore Size < 170µ Large size for mm vessels Small size for mm vessels Delivery System: 3.5Fr. RX Retrieval Catheter: 4.5Fr. RX All Niti Braid Wire Compatible Markers * Atraumatic Tip EPD Filter RX Exit Port EPD Wire
13 Nanoparasol: Current Status CE Mark Early clinical testing ongoing in EU Ongoing study in the US (N=300) (Roadsaver + Nanoparasol) (FDA requirement)
14 P.D 76 y.o male Risk factors: HBP,dyslipidemia,Diabetes mellitus Medical History: ischemic heart disease Severe stenosis of the Right internal carotid artery by Ultrasound assessment
15 Angiographic assesement
16 Procedure Wiring the Right Internal Carotid Artery with guidewire of choice
17 Procedure Advancement of Nanoparasol, monorail
18 Procedure Nanoparasol wire retrieving, Nanoparasol wire in place
19 Procedure Nanoparasol deployment, peel away
20 Procedure Nanoparasol - position in RICA
21 Procedure Predilatation Predilatation ULTRASOFT 4.5X20mm
22 Procedure Roadsaver deployment, ideally 2.5 cm between proximal end of the nanoparasol and distal end of the stent Roadsaver 8x25mm deployment
23 Procedure Filter and stent postion
24 Procedure Nanoparasol - retriving
25 Final result
26
27 Conclusion Nitinol Micromesh Technology provides unmatched flexibility for versatile embolic protection purposes The use of a dual layer micromesh in carotid stents demonstrated promising safety and efficiency results The pre-clinical and early clinical testing of the novel concentric Nitinol micromesh filter appears to be an interesting development, which requires further clinical evaluation
28 Micromesh technology in carotid artery treatment what is next? Max Amor MD Clinique Louis Pasteur, Essey-Les-Nancy France
Nitinol micromesh technology for Carotid artery treatment. Max Amor Julien Lemoine Clinique Louis Pasteur, Essey-lès-Nancy
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