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WE NEED A DEDICATED STENT

WE NEED A DEDICATED STENT. PHILIPPE GUYON. An Evidence Based Medicine:. Surgery is the unique validated option to treat a left main coronary disease. Left Main PTCA Validation. Battling: Restenosis Stent Thrombosis Widely reproductive. Do we meet this goal?.

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WE NEED A DEDICATED STENT

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  1. WE NEED A DEDICATED STENT PHILIPPE GUYON

  2. An Evidence Based Medicine: Surgery is the unique validated option to treat a left main coronary disease.

  3. Left Main PTCA Validation • Battling: • Restenosis • Stent Thrombosis • Widely reproductive Do we meet this goal?

  4. e-CYPHER Registry (15 389 pts) MACE at 6-months (Follow up rate : 92.6%) Mean 3,2% MACE (%)

  5. LM RESTENOSIS A Chieffo et als, Circ, 2005, 111, 791-795

  6. STENT THROMBOSIS IN BIFURCATION Ge et als, JACC, 46, 4, 2005, 613-620

  7. Technical approaches are not widely reproductives (aleatory)

  8. Acute Coronary Syndrom ST elevation with cardiogenic shock

  9. Result after one stent implantation and a kissing balloon

  10. Acute Coronary Syndrom no ST elevation with cardiogenic shock

  11. J. Ormiston TCT 2003 (Crush) Crush technic and kissing balloon

  12. Stable angina with a positive stress test (60W)

  13. Result after a « culotte technique » and a kissing balloon

  14. Stent thrombosis (H12) Bail-out procedure (Death at J1)

  15. Are dedicated better than standard stents for left main disease?

  16. Bard XT Carinatm(investigational only) Good crossability / Guide wire twist 20 patients (single experience center) 90% (18/20) device success rate 15 LAD/Diagonal 2 NQ MI at 30 days TLR at 6 month 15% Binary restenosis 45% (15% for the main Branch ; 40% for the side branch) 1 acute stent thrombosis (day 9) ; no late stent thrombosis B Chevalier, AHA 1999 and ACC 2000

  17. THE DBS STENTtm (investigational only) Complete bifurcation coverage / Guide wire twist and bad profile 34 patients in 4 French centers 94% (32/34) device success rate 19 LAD/Diagonal, and 7 distal LM 1 death at 6 month TLR at 6 month 19% Binary restenosis 34% (22% for the main Branch ; 27% for the side branch) No acute stent thrombosis A Dibie, AHA Asia-pacific 2003

  18. THE FRONTIERtm (CE mark) No guide wire twist / false kissing balloon 105 patients in 11 centers (world wide) 91% (96/105) device success rate 2 Q and 2 NQ MI at 6 month TLR at 6 month 13.3% Binary restenosis 44% (29.9% for the main Branch ; 29.1% for the side branch) No acute stent thrombosis T Lefevre et als, JACC 46, 4, 2005, 592-598

  19. THE NILEtm (CE mark) Dedicated delivery system / not a dedicaded stent

  20. (CE mark)

  21. Biolimus A9 DES (investigational only)

  22. (investigational only)

  23. A MESSAGE? • Distal left main disease is a specific bifurcation site, requiring, in most cases, two stents to be treated. • With standard and old design stents, Genius and creativity have been unbelievable in this setting, permitting to treat with a PTCA approach and to date, these complex lesions. • However, to be more effective, standardized and a validated therapeutic alternative to surgery, this angioplasty needs specific dedicated DES. First name Surname PS: please note that the photo is optional.

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