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Drug-eluting or absorbable stents versus bare-metal stents in peripheral artery disease

Drug-eluting or absorbable stents versus bare-metal stents in peripheral artery disease. Giuseppe Biondi Zoccai Divisione di Cardiologia, Università di Torino gbiondizoccai@gmail.com. Scope of the problem. Biondi Zoccai et al, G Ital Cardiol 2009. Scope of the problem - II.

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Drug-eluting or absorbable stents versus bare-metal stents in peripheral artery disease

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  1. Drug-eluting or absorbable stents versus bare-metal stents in peripheral artery disease Giuseppe Biondi Zoccai Divisione di Cardiologia, Università di Torino gbiondizoccai@gmail.com

  2. Scope of the problem Biondi Zoccai et al, G ItalCardiol 2009

  3. Scope of the problem - II

  4. Scope of the problem - III

  5. TASC II 2007 vs. TASC 2000

  6. Why stents? • Balloon-only angioplasty is fraught with: • Elastic recoil • Flow-limiting dissection • Constrictive remodeling • Neointimal hyperplasia • Biocompatibility • Stents may address these issues

  7. Why stents? • Balloon-only angioplasty is fraught with: • Elastic recoil • Flow-limiting dissection • Constrictive remodeling • Neointimal hyperplasia • Biocompatibility • Stents may address these issues BMS

  8. Why stents? • Balloon-only angioplasty is fraught with: • Elastic recoil • Flow-limiting dissection • Constrictive remodeling • Neointimal hyperplasia • Biocompatibility • Stents may address these issues DES

  9. Why stents? • Balloon-only angioplasty is fraught with: • Elastic recoil • Flow-limiting dissection • Constrictive remodeling • Neointimal hyperplasia • Biocompatibility • Stents may address these issues ABS

  10. Explosion of data on stents for PAD PubMed queried on 7 December 2009: stent* AND (femoral OR popliteal OR femoropopliteal OR "femoro-popliteal" OR tibial OR "infra-popliteal" OR infrapopliteal OR (critical AND limb AND ischemia)) NOT (vein OR venous)

  11. Iliac stenting: just in bail-out? DutchIliacStent Trial: randomized trial of stenting vs balloon-only PTA (withstentifcomplications or meangradient >10 mm Hg)* *stentingfinallyperformed in 40% ofptsrandomizedto PTA Routine stenting PTA with selective stenting Klein et al, Radiology 2006

  12. The FAST trial: Luminexx stent

  13. The ABSOLUTE trial: Absolute stent Schillinger et al, Circulation 2007

  14. The RESILIENT II trial: LifeStent12-month results

  15. Can you beat new bare-metal stents?

  16. The SIROCCO I trial: Sirolimus-eluting Smart stent Duda et al, Circulation 2002

  17. The SIROCCO II trial: Sirolimus-eluting Smart stentFreedom from restenosis 71.8% 67.2% Duda et al, J VascIntervRadiol 2005

  18. Zilver paclitaxel eluting stent

  19. Repeat PTA after BTK stenting Biondi-Zoccai et al, J EndovascTher 2009

  20. What about absorbable stents? BASELINE 6 MONTHS POST-AMS Bosiers et al, CardiovascInterventRadiol 2009

  21. What about absorbable stents? 6-month angiographic patency rate: 31.8% for AMS vs. 58.0% for PTA (p=0.013) Bosiers et al, CardiovascInterventRadiol 2009

  22. Take home messages • Primary stenting with self-expandable bare-metal stents is considered by many the standard of care for iliac and superficial femoral arteries • Bail-out drug-eluting stenting is beneficial for infra-popliteal lesions • Conversely, stents (any) should be avoided in common femoral or popliteal arteries • Further clinical evidence is needed before deciding on the role of absorbable stents and femoral drug-eluting stents

  23. Thank you for your attentionFor any correspondence: gbiondizoccai@gmail.comFor these and further slides on these topics feel free to visit the metcardio.org website:http://www.metcardio.org/slides.html

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