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J BERLAND, SAINT-HILAIRE, ROUEN

ST+: Stenting après pré- dilataion et ouverture de maille. J BERLAND, SAINT-HILAIRE, ROUEN. Mr L; 60 ans Infarcus ant H 4. Pre dilatation IVA et Diag ballon 2.5 x 15. IMPLANTATION du STENT 2.5/3 x 22 mm. OUVERTURE DES MAILLES et CONTROLE FINAL sans post-dilatation ni kissing.

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J BERLAND, SAINT-HILAIRE, ROUEN

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  1. ST+: Stenting après pré-dilataion et ouverture de maille J BERLAND, SAINT-HILAIRE, ROUEN

  2. Mr L; 60 ansInfarcus ant H 4

  3. Pre dilatation IVA et Diagballon 2.5 x 15

  4. IMPLANTATION du STENT2.5/3 x 22 mm

  5. OUVERTURE DES MAILLES et CONTROLE FINAL sans post-dilatation ni kissing

  6. CONTRÔLE à J30 avant Angioplastie CX

  7. ANGIOGRAPHIE QUANTITATIVE J O : Ref 2.96 Sténose: 2.56 mm J 30: Ref 3.25 Sténose 2,9 mm

  8. APPOSITION III trial 1000 patients • DESIGN • Prospective, non-randomized, single-arm, multi-center study of the STENTYS Coronary Stent • OBJECTIVE • Evaluate safety and performance of the STENTYS stent,in routine clinical practicein 1000 STEMI patients • PRIMARY ENDPOINT • MACE at 12 months • (MACE defined as cardiac death, target vessel re-MI, emergent CABG, or clinically-driven TVR by percutaneous or surgical methods at 12 months) • SECONDARY ENDPOINTS • MACE at 30 days and 24 months • Target vessel failure at 30 days and 24 months • Reperfusion measured by TIMI Flow, ST elevation resolution • Incidence of stroke at 30 days, 12 and 24 months • Stent thrombosis at 30 days, 12 and 24 months • Abrupt closure of Side Branch >2.25 mm (TIMI<3) 600 patients interim analysis Clinical follow-up at 1 month

  9. Stent characteristics 9

  10. Procedure guidelines Recommendation to perform thrombo-aspiration Pre-dilatation left to the discretion of the operator Overlapping stents allowed Treatment of other lesions in the target vessel is allowed Side Branch treatment left to the discretion of the operator; ‘disconnection’ of STENTYS stent to create SB-access Post-dilatation Cohort A (pt 1-390): recommended for residual stenosis >30% Cohort B(pt 391-600): generally recommended High pressures are generally not needed due to the self-expanding properties of the STENTYS stent Medication according to ESC and local guidelines

  11. MACE at 30 days (cohort analysis) Optimized pre/post dilatation results in a low rate of adverse events 1 MACE: cardiac death, target vessel based re-MI, emergent bypass surgery (CABG), or clinically driven TLR 12

  12. Result in post-dilatation cohorts 13

  13. COMMENTAIRES En cas de préparation efficace de la lésion , une post-dilatation ne semble pas toujours indispensable . Du fait des propriétés d’expansion du stentys ,le kissing final ne parait pas nécessaire dans toutes les lésions de bifurcation.

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