Bifurcation stenting with BVS

Transcription

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?