1 / 33

Nick Curzen Wessex Cardiac Unit Southampton University Hospital

DES Promise Fulfilled: VEIN GRAFTS?. Nick Curzen Wessex Cardiac Unit Southampton University Hospital. DES Promise Fulfilled: VEIN GRAFTS?. NO!! There are tap all data. Real Complaints to the Council. “My bush is really overgrown round the front &

odette
Download Presentation

Nick Curzen Wessex Cardiac Unit Southampton University Hospital

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. DES Promise Fulfilled: VEIN GRAFTS? Nick Curzen Wessex Cardiac Unit Southampton University Hospital

  2. DES Promise Fulfilled: VEIN GRAFTS? NO!! There aretap alldata

  3. Real Complaints to the Council “My bush is really overgrown round the front & my back passage has fungus growing in it” “It’s the dogs’ mess that I find hard to swallow” “Their 18yr old son is continually banging his balls against our fence” “The man next door has a large erection in the back garden, which is unsightly & dangerous”

  4. > 1yr: 15% occlusion rate • 1-6yrs: 1-2% attrition rate/yr • 6-10 yrs: 4% attrition/yr • 60% patent at 10 yrs • Only 50% of patent VGs are free of disease

  5. What is the outcome of real life VG PCI? What about non-DES intervention? Is the restenosis rate as high as we think??

  6. TLR & Event free survival (death, QMI & revasc) in 290 diabetic & 618 non-diabetic vein graft cases at 1 year * * * JACC 2000;36:1186-93

  7. TLR & mortality at 1 year in 1199 consecutive vein graft stent cases NS NS Am J Cardiol 2001;87:401-5

  8. Dogging for the interventionalist………………………….

  9. Stent to intermediate via jump graft

  10. “Y” stent in vein graft

  11. “Symbiot and bare metal outcomes were comparable” But: Sig greater in-segment restenosis due to sig proximal edge restenosis + trend towards in-stent restenosis, leading to sig greater TVR by PCI

  12. What are the important considerations for DES? • Diameter of DES • Length of DES • GP IIb/IIIa • Clot burden in acute occlusions • Diffuse disease… reconstruct whole graft? • Stent thrombosis risk

  13. What are the data for DES in VG?

  14. Evaluation of a Tacrolimus-Eluting Coronary Stent Graft for Treatment of SVG Lesions: Procedural & 6 month Follow Up Results of the EVIDENT Trial • Non-randomised • 32 pts • Stent graft 16mm coated with tacrolimus • MACE 50.0% • Binary Restenosis 37.5% TCT 2003

  15. Effectiveness of the sirolimus-eluting stent in the treatment of saphenous vein graft disease. Journal of Invasive Cardiology. 16(5):230-3, 2004 May. • 19 consecutive patients who underwent de novo SVG intervention treated solely with SES. • Mean graft age was 10 years. • Clinical presentation: ACS 68%. • In total, 22 de novo lesions were treated with 35 SESs • (mean=1.6 stents per lesion). • Glycoprotein IIb/IIIa inhibitor therapy – 42% • Distal embolization protection device - 32% • In-hospital MACE was 11%………..2 patients CK rise • Mean 12.5+/-2.6 month follow-up: • one patient died from a non-cardiac cause • TLR 1 patient (5%) • Survival free of MACE was 84%.

  16. Data on its way for SVG DES • eCYPHER • Registries (Rotterdam;Milan;Lennox Hill) • Multicentre Studies (ADEST;Wisdom;DEScover; • Milestone II; US PMS) No RCTs are currently ongoing

  17. This is not what you want to see the morning after your wife comes home in the early hours after a night out ………..

More Related