Presentation is loading. Please wait.

Presentation is loading. Please wait.

Drug-Eluting Stents in Challenging Lesions: Randomized Trials and Registries.

Published byTyler Sutton Modified over 8 years ago

Similar presentations

Presentation on theme: "Drug-Eluting Stents in Challenging Lesions: Randomized Trials and Registries."— Presentation transcript:

1 Drug-Eluting Stents in Challenging Lesions: Randomized Trials and Registries

2 Outline Definition of challenging lesion Aorto-ostial lesions Bifurcation lesions Unprotected left main Thrombotic lesions Total occlusions Safenous vein grafts Long lesions and small vessels Diabetics TRUE Study

3 Outline Definition of challenging lesion Aorto-ostial lesions Bifurcation lesions Unprotected left main Thrombotic lesions Total occlusions Safenous vein grafts Long lesions and small vessels Diabetics TRUE Study

4 Definition of challenging lesion Any lesion with features associated with a higher risk of procedural failure or peri-procedural adverse events

5 Outline Definition of challenging lesion Aorto-ostial lesions Bifurcation lesions Unprotected left main Thrombotic lesions Total occlusions Safenous vein grafts Long lesions and small vessels Diabetics TRUE Study

6

7 Iakovou et al, JACC 2004

8 Outline Definition of challenging lesion Aorto-ostial lesions Bifurcation lesions Unprotected left main Thrombotic lesions Total occlusions Safenous vein grafts Long lesions and small vessels Diabetics TRUE Study

9

10 Steigen et al, Circulation 2006

11 Di Mario et al, CCI 2006

12

13 Outline Definition of challenging lesion Aorto-ostial lesions Bifurcation lesions Unprotected left main Thrombotic lesions Total occlusions Safenous vein grafts Long lesions and small vessels Diabetics TRUE Study

14

15

16 Outline Definition of challenging lesion Aorto-ostial lesions Bifurcation lesions Unprotected left main Thrombotic lesions Total occlusions Safenous vein grafts Long lesions and small vessels Diabetics TRUE Study

17

18 Pasceri et al, AHJ 2005

19 Outline Definition of challenging lesion Aorto-ostial lesions Bifurcation lesions Unprotected left main Thrombotic lesions Total occlusions Safenous vein grafts Long lesions and small vessels Diabetics TRUE Study

20

21 Suttorp et al, Circ 2006

22 Werner et al, CCI 2005

23

24 Outline Definition of challenging lesion Aorto-ostial lesions Bifurcation lesions Unprotected left main Thrombotic lesions Total occlusions Safenous vein grafts Long lesions and small vessels Diabetics TRUE Study

25

26 Vermeersch et al, JACC 2007

27 Outline Definition of challenging lesion Aorto-ostial lesions Bifurcation lesions Unprotected left main Thrombotic lesions Total occlusions Safenous vein grafts Long lesions and small vessels Diabetics TRUE Study

28

29 Ardissino et al, JAMA 2004

30

31

32 Stone et al, JAMA 2005

33

34 Dawkins et al, Circulation 2005

35 Outline Definition of challenging lesion Aorto-ostial lesions Bifurcation lesions Unprotected left main Thrombotic lesions Total occlusions Safenous vein grafts Long lesions and small vessels Diabetics TRUE Study

36 Spaulding et al, NEJM 2007

37 TAXUS diabetics meta-analysis (N=715) Baim, FDA Panel 2006 BMS PES

38 Outline Definition of challenging lesion Aorto-ostial lesions Bifurcation lesions Unprotected left main Thrombotic lesions Total occlusions Safenous vein grafts Long lesions and small vessels Diabetics TRUE Study

39 TRUE Taxus™ Multicenter Registry European ( Taxus in Real-life Usage Evaluation) ( Taxus in Real-life Usage Evaluation)

40 DELIVER II TAXUS II ASPECT Mean lesion length (mm) FUTURE II E-SIRIUS SIRIUS TAXUS IV DELIVER I C-SIRIUS FUTURE I 810121416182022 Lesion Complexity (% C Type) RAVEL ELUTES 0% 60% 50% 40% 30% 20% 10% ACTION TAXUS I ENDEAVOR I Complex Lesions Long Lesions TAXUS VI The complexity of lesions in TRUE 70% TRUE

41 Patient distribution (n=1065) by intentional treatment Diabetes n=322 (30%) Unprotected Left Main n=115 (11%) Bifurcations Trifurcations n=229 (22%) Long lesions n=289 (27%) CTO n=191 (18%) Small vessels n=430 (40%)

42 Incidence % Overall 7-month follow-up (N=1065)

43 Incidence % Overall 12-month follow-up (N=1065)

44 Incidence % Overall ARC-probable stent thrombosis (n=1065)

45 Kaplan-Meier curve for event-free survival,9,8,7,6,5 Time (months) 12 10 8 6 4 2 0 Survival free from MACE 1,0

46 Kaplan-Meier curve for stent thrombosis- free survival Time (months) 12 10 8 6 4 2 0 Survival free from thrombosis-related events,9,8,7,6,5 1,0

47 Incidence % Unprotected left main 7-month follow-up (N=115)

48 N=25N=2 Incidence % N=24N=18 N=4N=2 Chronic total occlusions 7-month follow-up (N=191)

49 Incidence % Diabetes mellitus 7-month follow-up (N=322)

50 Take home messages

51 DES usage in challenging lesions is associated with favorable early and mid- term results in most cases Notable exceptions may be safenous vein grafts and diabetic patients (the latter applies to sirolimus-eluting stents only) Lesion preparation and accurate choice of the most appropriate platform-drug combination for each individual lesion are also pivotal to maximize success and long- term efficacy

52 For further slides on these topics please feel free to visit the metcardio.org website: http://www.metcardio.org/slides.html http://www.metcardio.org/slides.html

Download ppt "Drug-Eluting Stents in Challenging Lesions: Randomized Trials and Registries."

Similar presentations

SPIRIT IV A Prospective, Randomized Trial Comparing an Everolimus-Eluting Stent and a Paclitaxel-Eluting Stent in Patients with Coronary Artery Disease.

SPIRIT IV A Prospective, Randomized Trial Comparing an Everolimus-Eluting Stent and a Paclitaxel-Eluting Stent in Patients with Coronary Artery Disease.
Complex Lesion Subsets: Indications for DES Andreas Baumbach, MD, FRCP, FESC Bristol Heart Institute.

Complex Lesion Subsets: Indications for DES Andreas Baumbach, MD, FRCP, FESC Bristol Heart Institute.
Is this the “spioenkop” for CABG?

Is this the “spioenkop” for CABG?
Late Drug-Eluting Stent Thrombosis: Should we be worried?

Late Drug-Eluting Stent Thrombosis: Should we be worried?
STENT THROMBOSIS: WHICH IMPACT IN REAL CLINICAL PRACTICE? Giuseppe Biondi Zoccai Divisione di Cardiologia, Università di Torino Ospedale S. Giovanni Battista.

STENT THROMBOSIS: WHICH IMPACT IN REAL CLINICAL PRACTICE? Giuseppe Biondi Zoccai Divisione di Cardiologia, Università di Torino Ospedale S. Giovanni Battista.
Www. Clinical trial results.org  Major Endpoints: Death, MI, stent thrombosis, TLR, TVR, MACE, and CKMB >3x nl  Major Endpoints: Death, MI, stent thrombosis,

Www. Clinical trial results.org  Major Endpoints: Death, MI, stent thrombosis, TLR, TVR, MACE, and CKMB >3x nl  Major Endpoints: Death, MI, stent thrombosis,
Gerald S. Werner, MD, FESC, FACC Klinikum Darmstadt, Germany BSIC, Manchester, September 15, 2006.

Gerald S. Werner, MD, FESC, FACC Klinikum Darmstadt, Germany BSIC, Manchester, September 15, 2006.
J. Mehilli, MD, G. Richard, F-J. Neumann, S. Massberg, K-L. Laugwitz, J. Pache, J. Hausleiter, I. Ott, M. Fusaro, T. Ibrahim, A. Schömig, A. Kastrati Deutsches.

J. Mehilli, MD, G. Richard, F-J. Neumann, S. Massberg, K-L. Laugwitz, J. Pache, J. Hausleiter, I. Ott, M. Fusaro, T. Ibrahim, A. Schömig, A. Kastrati Deutsches.
Five-Year Follow-up of Safety and Efficacy of the Resolute Zotarolimus-Eluting Stent: Insights from the RESOLUTE Global Clinical Trial Program in Approximately.

Five-Year Follow-up of Safety and Efficacy of the Resolute Zotarolimus-Eluting Stent: Insights from the RESOLUTE Global Clinical Trial Program in Approximately.
ISAR-LEFT MAIN 2 Randomized Trial Zotarolimus- vs. Everolimus-Eluting Stents for Treatment of Unprotected Left Main Coronary Artery Lesions Julinda Mehilli,

ISAR-LEFT MAIN 2 Randomized Trial Zotarolimus- vs. Everolimus-Eluting Stents for Treatment of Unprotected Left Main Coronary Artery Lesions Julinda Mehilli,
29th ANNUAL SCIENTIFIC SESSIONS – SCA&I

29th ANNUAL SCIENTIFIC SESSIONS – SCA&I
Basel Stent Cost-effectiveness Trial-Late Thrombotic Events (BASKET LATE) Trial Basel Stent Cost-effectiveness Trial-Late Thrombotic Events (BASKET LATE)

Basel Stent Cost-effectiveness Trial-Late Thrombotic Events (BASKET LATE) Trial Basel Stent Cost-effectiveness Trial-Late Thrombotic Events (BASKET LATE)
Drug-Eluting Stent Mortality Meta-Analysis Presented at European Society of Cardiology Scientific Congress, September 2006 Presented by Dr. Alain J. Nordmann.

Drug-Eluting Stent Mortality Meta-Analysis Presented at European Society of Cardiology Scientific Congress, September 2006 Presented by Dr. Alain J. Nordmann.
New-generation drug-eluting stents and dual antiplatelet therapy: overview Giuseppe Biondi Zoccai, MD Department of Medico-Surgical Sciences and Biotechnologies.

New-generation drug-eluting stents and dual antiplatelet therapy: overview Giuseppe Biondi Zoccai, MD Department of Medico-Surgical Sciences and Biotechnologies.
BURZOTTA F. 1, PAN M. 2 (CO-FIRST AUTHOR), TRANI C. 1, MEDINA A. 3, SUÀREZ DE LEZO J. 2, NICCOLI G. 1, ROMERO M. 2, PORTO I. 1, MAZUELOS F. 2, LEONE A.M.

BURZOTTA F. 1, PAN M. 2 (CO-FIRST AUTHOR), TRANI C. 1, MEDINA A. 3, SUÀREZ DE LEZO J. 2, NICCOLI G. 1, ROMERO M. 2, PORTO I. 1, MAZUELOS F. 2, LEONE A.M.
Elective Stenting versus Balloon Angioplasty with Bail-out Stenting for Small Vessel Coronary Artery Disease: Evidence from a Meta-analysis of Randomized.

Elective Stenting versus Balloon Angioplasty with Bail-out Stenting for Small Vessel Coronary Artery Disease: Evidence from a Meta-analysis of Randomized.
A Pooled Analysis of the REAL-LATE and the ZEST-LATE Trial A Pooled Analysis of the REAL-LATE and the ZEST-LATE Trial Seung-Jung Park, MD, PhD, University.

A Pooled Analysis of the REAL-LATE and the ZEST-LATE Trial A Pooled Analysis of the REAL-LATE and the ZEST-LATE Trial Seung-Jung Park, MD, PhD, University.
1 Contemporary PCI with the CYPHER ® Stent: The Standard of Care and Comparison David E. Kandzari, MD, FACC, FSCAI Chief Medical Officer Cordis Corporation.

1 Contemporary PCI with the CYPHER ® Stent: The Standard of Care and Comparison David E. Kandzari, MD, FACC, FSCAI Chief Medical Officer Cordis Corporation.
1 SIROLIMUS-ELUTING STENTS FOR IN-STENT RESTENOSIS TREATMENT IN 278 UNSELECTED PATIENTS: INSIGHTS ON LONG-TERM OUTCOMES FROM A LARGE TWO-CENTER REGISTRY.

1 SIROLIMUS-ELUTING STENTS FOR IN-STENT RESTENOSIS TREATMENT IN 278 UNSELECTED PATIENTS: INSIGHTS ON LONG-TERM OUTCOMES FROM A LARGE TWO-CENTER REGISTRY.
Richard Melsheimer Director, Medical Affairs Europe Centocor Eli Lilly and Company Coordinated Use of ReoPro and Drug Eluting Stents: Rationale and Evidence.

Richard Melsheimer Director, Medical Affairs Europe Centocor Eli Lilly and Company Coordinated Use of ReoPro and Drug Eluting Stents: Rationale and Evidence.

Similar presentations

Ads by Google