Drug Eluting Stents: Update
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1 Drug Eluting Stents: Update B. Berekoven Research Coordinator Department of Vascular Surgery St. Franziskus Hospital Münster Head: Univ.- Prof. Dr. G. Torsello
2 Disclosure Speaker name:... 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 Why Drug Eluting Stents (DES)? prevent restenosis due to intimal hyperplasia
4 Why Drug Eluting Stents (DES)? DEB better than POBA
5 Why Drug Eluting Stents (DES)? DEB better than POBA Leaving nothing behind not always possible
6 Why Drug Eluting Stents (DES)? DEB better than POBA Leaving nothing behind not always possible Stent-indication Recoil, Dissection
7 Why Drug Eluting Stents (DES)? DEB better than POBA Leaving nothing behind not always possible Stent-indication Recoil, Dissection Transfer the effect from DEB to DES
8 Process of Intimal Hyperplasia Trauma
9 Process of Intimal Hyperplasia Trauma Proliferation of smooth muscle cells
10 Process of Intimal Hyperplasia Trauma Proliferation of smooth muscle cells migration into the intima
11 Migration of Platelets to the place of injury
12 Migration of Platelets to the place of injury Platelets release PDGF (platelet derived groth factor)
13 Massive production of extra cellular matrix (Collagen / Elastin)
14 Massive production of extra cellular matrix (Collagen / Elastin) Restenosis
15 What s the effect of the applicated drugs? Prevent the growing of smooth muscle cells in the intima
16 What s the effect of the applicated drugs? Prevent the growing of smooth muscle cells in the intima Paclitaxel blockes the Mitosis
17 What s the effect of the applicated drugs? Prevent the growing of smooth muscle cells in the intima Paclitaxel blockes the Mitosis Sirolimus and everolimus Immunosuppressants, anti-proliferative
18 Drug Eluting Stents DES SFA BTK Zilver PTX Eluvia x x Xience Prime BTK Cre8 BTK BioMatrix Flex BTK Promus Premier Angiolite BTK x x x x x All other BTK stents have no CE mark for this indication
19 Femoro-popliteal region Zilver PTX Eluvia Paclitaxel x x Polymer x Release of drug 72 hours Up to 360 days CE-mark
20 BTK Drug Polymere Material Randomized trials Xience Prime BTK Everolimus x Cobalt chromium x Cre8 BTK Sirolimus + organic acid Cobalt chromium BioMatrix Flex BTK Promus Premier Biolimus A9 x Stainless steel Everolimus x Platinium chromium Angiolite BTK Sirolimus x Cobalt chromium
21 Randomised Trials SFA
22 Randomised Trials SFA Eminent Eluvia vs BMS still enrolling
23 Randomised Trials SFA Imperial-Trial 2:1 randomized (ELUVIA vs Zilver PTX) Enrolment complete 1 year results in 2018
24 Randomized Trials BTK ACHILLES POBA vs CYPHER (DES) A. Schmidt
25 Randomized Trials BTK DESTINY DES vs BMS
26 Randomized Trials BTK YUKON DES vs BMS The one-year primary patency rate for the drugeluting stent was 80.6% versus 55.6% for the bare metal stent.
27 Conclusions drug is better than no drug
28 Conclusions drug is better than no drug DES are better than BMS
29 Conclusions drug is better than no drug DES are better than BMS
30 open questions (SFA) Is Zilver PTX better than BMS and DEB? Cost effectiveness?
31 open questions (SFA) Is Zilver PTX better than BMS and DEB? Cost effectiveness? No equivalent therapie for Eluvia But what happens to the vessel wall due to long time exposure of paclitaxel?
32 open questions (SFA) Is Zilver PTX better than BMS and DEB? Cost effectiveness? No equivalent therapie for Eluvia But what happens to the vessel wall due to long time exposure of paclitaxel? Eluvia better than Zilver PTX?
33 open questions (BTK) What drug is the best for BTK (BTK vessels are not coronarys)
34 open questions (BTK) What drug is the best for BTK (BTK vessels are not coronarys) Ballonexpanding or selfsexpanding
35 we have to wait for further randomized trials
36 Drug Eluting Stents: Update B. Berekoven Research Coordinator Department of Vascular Surgery St. Franziskus Hospital Münster Head: Univ.- Prof. Dr. G. Torsello
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