INFRATIBIAL INTERVENTIONS Current Results with DES

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Presentation transcript:

INFRATIBIAL INTERVENTIONS Current Results with DES Klaus Hertting Park-Hospital Leipzig Leipzig, Germany

I/we have no real or apparent conflicts of interest to report. Klaus Hertting, MD I/we have no real or apparent conflicts of interest to report.

Aim of Interventional Treatment in Critical Limb Ischemia Re-establishing straight-line pulsatile blood flow to the ischemic limb Long-term patency of the vessel not important?

CLI – Patient (LACI Study) 3 Months Prolonged patency is needed to achieve wound healing Before PTA 6 Months

First Clinical Reports: Non-randomized comparisons of DES vs First Clinical Reports: Non-randomized comparisons of DES vs. Bare-metal Stent in BTK Non-randomized comparison BMS vs. Cypher 6-months angiographic binary restenosis BMS DES Scheinert 2006 56 % 0 % Siablis 2006 55 % 4 % Bosiers 2006 -

Long-term Data: Cypher – BTK Registry - Angiographic Stent Patency - 150 pts with 158 treated limbs 26 death (21%), 3 amputations (2%) 100 pts available for angiographic FU (mean 22 months) FU-Time Primary Patency 6 months 96.9% +/- 1.7 12 months 87.0% +/- 3.7 24 months 87.0% +/- 3.7 36 months 83.8% +/- 4.8 60 months 83.8% +/- 4.8 Werner M et al. JEVT 2012

RCT Results: DES have superior patency compared to BMS or PTA in BTK

DESTINY-Study : DES Have Higher Patency Rate than BMS

YUKON Study: DES Have Higher Patency Rate than BMS

YUKON Study: DES Have Lower Amputation and TVR Rates than BMS at 2 years Zeller T LINC 2012

YUKON Study: DES Have Higher Event-Free Survival Rates than BMS at 2 years Zeller T LINC 2012

ACHILLES Study: DES Have Higher Patency Rate than PTA Scheinert D JACC under review

ACHILLES Study: DES Have Lower Clinical Event Rates than PTA Scheinert D JACC under review

DES in BTK - Bifurcations Single centre registy 11 patients with CLI Provisional DES-placement in infrapopliteal bifurcation lesions 6-months angiographic follow-up Werner M. et al, Cath Cardiovasc Intervent, accepted

DES in BTK – Bifurcations 6-Months results 2 vessel primary patency: 55% 1 vessel primary patency: 82% Werner M. et al, Cath Cardiovasc Intervent, accepted

Focal BTK Lesions: DES is the treatment of first choice

Limitation: Max. Stent Length so far 3 to 4 cm DES 3.5/33 @ 6 months FU Limitation: Max. Stent Length so far 3 to 4 cm

Conclusion Drug-eluting stents have proven benefits and are first choice for focal BTK lesions DES have better patency than BMS and PTA DES contribute to a better clinical outcome