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Nick Curzen Wessex Cardiac Unit Southampton University Hospital

DES Promise Fulfilled: VEIN GRAFTS?. Nick Curzen Wessex Cardiac Unit Southampton University Hospital. DES Promise Fulfilled: VEIN GRAFTS?. NO!! There are tap all data. Real Complaints to the Council. “My bush is really overgrown round the front &

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Nick Curzen Wessex Cardiac Unit Southampton University Hospital

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  1. DES Promise Fulfilled: VEIN GRAFTS? Nick Curzen Wessex Cardiac Unit Southampton University Hospital

  2. DES Promise Fulfilled: VEIN GRAFTS? NO!! There aretap alldata

  3. Real Complaints to the Council “My bush is really overgrown round the front & my back passage has fungus growing in it” “It’s the dogs’ mess that I find hard to swallow” “Their 18yr old son is continually banging his balls against our fence” “The man next door has a large erection in the back garden, which is unsightly & dangerous”

  4. > 1yr: 15% occlusion rate • 1-6yrs: 1-2% attrition rate/yr • 6-10 yrs: 4% attrition/yr • 60% patent at 10 yrs • Only 50% of patent VGs are free of disease

  5. What is the outcome of real life VG PCI? What about non-DES intervention? Is the restenosis rate as high as we think??

  6. TLR & Event free survival (death, QMI & revasc) in 290 diabetic & 618 non-diabetic vein graft cases at 1 year * * * JACC 2000;36:1186-93

  7. TLR & mortality at 1 year in 1199 consecutive vein graft stent cases NS NS Am J Cardiol 2001;87:401-5

  8. Dogging for the interventionalist………………………….

  9. Stent to intermediate via jump graft

  10. “Y” stent in vein graft

  11. “Symbiot and bare metal outcomes were comparable” But: Sig greater in-segment restenosis due to sig proximal edge restenosis + trend towards in-stent restenosis, leading to sig greater TVR by PCI

  12. What are the important considerations for DES? • Diameter of DES • Length of DES • GP IIb/IIIa • Clot burden in acute occlusions • Diffuse disease… reconstruct whole graft? • Stent thrombosis risk

  13. What are the data for DES in VG?

  14. Evaluation of a Tacrolimus-Eluting Coronary Stent Graft for Treatment of SVG Lesions: Procedural & 6 month Follow Up Results of the EVIDENT Trial • Non-randomised • 32 pts • Stent graft 16mm coated with tacrolimus • MACE 50.0% • Binary Restenosis 37.5% TCT 2003

  15. Effectiveness of the sirolimus-eluting stent in the treatment of saphenous vein graft disease. Journal of Invasive Cardiology. 16(5):230-3, 2004 May. • 19 consecutive patients who underwent de novo SVG intervention treated solely with SES. • Mean graft age was 10 years. • Clinical presentation: ACS 68%. • In total, 22 de novo lesions were treated with 35 SESs • (mean=1.6 stents per lesion). • Glycoprotein IIb/IIIa inhibitor therapy – 42% • Distal embolization protection device - 32% • In-hospital MACE was 11%………..2 patients CK rise • Mean 12.5+/-2.6 month follow-up: • one patient died from a non-cardiac cause • TLR 1 patient (5%) • Survival free of MACE was 84%.

  16. Data on its way for SVG DES • eCYPHER • Registries (Rotterdam;Milan;Lennox Hill) • Multicentre Studies (ADEST;Wisdom;DEScover; • Milestone II; US PMS) No RCTs are currently ongoing

  17. This is not what you want to see the morning after your wife comes home in the early hours after a night out ………..

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