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

2. 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.

3. 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?

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

5. 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 -

6. 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 % +/- 1.7
12 months % +/- 3.7
24 months % +/- 3.7
36 months % +/- 4.8
60 months % +/- 4.8
Werner M et al. JEVT 2012

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

8. DESTINY-Study : DES Have Higher Patency Rate than BMS

9. YUKON Study: DES Have Higher Patency Rate than BMS

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

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

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

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

14. 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

15. 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

16. Focal BTK Lesions: DES is the treatment of first choice

17. Limitation: Max. Stent Length so far 3 to 4 cm
DES 6 months FU
Limitation: Max. Stent Length so far 3 to 4 cm

18. 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