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WE NEED A DEDICATED STENT

Evidence-based information on surgery as a validated option for treating left main coronary disease, discussing restenosis, stent thrombosis, and technical approaches. Explore dedicated stents such as Bard XT Carinatm, DBS Stenttm, FRONTIERtm, and NILEtm for better outcomes in complex lesions.

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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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