Post on 28-Jul-2020
AUSTRALIAN EXPERIENCE WITH
Associate Professor Ramon L. Varcoe FRACS, PhD
Sydney, Australia
Disclosure
Speaker name:
.........Ramon Varcoe........................................................
I have the following potential conflicts of interest to report:
Consulting Abbott, Boston, Gore, Medtronic
Employment in industry
Stockholder of a healthcare company
Owner of a healthcare company
Other(s)
I do not have any potential conflict of interest
Charles Dotter: 1920-1985
A Number of UNMET needs in the Femoro-popliteal Segment
IT’S A HOSTILE ENVIRONMENT…
1. Considerable mechanical strain
2. Often heavily Calcified
3. Elastic recoil and dissection are common
4. Metallic devices are prone to fracture
Options for the SFA…
POBA
Options for the SFA…
BMS POBA
Options for the SFA…
DCB POBA BMS
Options for the SFA…
DES POBA BMS
DCB
Options for the SFA… MIMETIC STENTS
POBA BMS
DCB DES
Options for the SFA… STENT-GRAFT
POBA BMS
DCB DES
MIMETIC STENTS
Other Devices (Less frequently used in Aust)
ATHERECTOMY TACKS
SHORT MULTI-STENTS
CRYOPLASTY
HYBRID STENTS
It’s a Minefield!
0
10
20
30
40
50
60
70
80
90
100
0 50 100 150 200 250 300
%
Lesion Length (mm)
12-month Primary Patency – All Multi-CTs and Registries
POW. Myint M. 2016 JEVT (in press)
DURABILITY 200. BosiersM. JVS. 2011;54:1042-50
STELLA. Davaine JM. EJVES 2012;44:332-41
VIABAHN TASC C&D. Schneider JR. VES 2011;45(5):391-7
SUPERA 500. Werner M. Euroint 2014;10:861-868
BRESCIA etal-
SUPERA
ZILVER PTX. Bosiers M. JCS 2013; 54:115-22
STELLA PTX Davaine JM. EJVES 2015;50:631-7
Brescia AA. Etal 2015;61:1472-8
VIPER. Saxon RR. JVIR 2013;24:165-173
VIBRANT. Geraghty PJ. JVS 2013;58(2):395
SUPERA 500-SUPERA
DURABILITY 200-BMS STELLA-BMS
ZILVER PTX-DES
VIABAHN TASC C&D-SG
STELLA PTX-DES
VIPER-SG
POW-SUPERA
VIBRANT-SG
VIBRANT-BMS
Combination of All Publications
0
10
20
30
40
50
60
70
80
90
100
0 50 100 150 200 250 300
%
Lesion Length (mm)
12-month Primary Patency – All Multi-CTs and Registries
BMS
POW. Myint M. 2016 JEVT (in press)
DURABILITY 200. BosiersM. JVS. 2011;54:1042-50
STELLA. Davaine JM. EJVES 2012;44:332-41
VIABAHN TASC C&D. Schneider JR. VES 2011;45(5):391-7
SUPERA 500. Werner M. Euroint 2014;10:861-868
ZILVER PTX. Bosiers M. JCS 2013; 54:115-22
STELLA PTX Davaine JM. EJVES 2015;50:631-7
Brescia AA. Etal 2015;61:1472-8
VIPER. Saxon RR. JVIR 2013;24:165-173
VIBRANT. Geraghty PJ. JVS 2013;58(2):395
BRESCIA etal-
SUPERA SUPERA 500-SUPERA
ZILVER PTX-DES
VIABAHN TASC C&D-SG
STELLA PTX-DES
VIPER-SG
POW-SUPERA
VIBRANT-SG
Combination of All Publications
0
10
20
30
40
50
60
70
80
90
100
0 50 100 150 200 250 300
%
Lesion Length (mm)
12-month Primary Patency – All Multi-CTs and Registries
BMS
POW. Myint M. 2016 JEVT (in press)
DURABILITY 200. BosiersM. JVS. 2011;54:1042-50
STELLA. Davaine JM. EJVES 2012;44:332-41
VIABAHN TASC C&D. Schneider JR. VES 2011;45(5):391-7
SUPERA 500. Werner M. Euroint 2014;10:861-868
ZILVER PTX. Bosiers M. JCS 2013; 54:115-22
STELLA PTX Davaine JM. EJVES 2015;50:631-7
Brescia AA. Etal 2015;61:1472-8
VIPER. Saxon RR. JVIR 2013;24:165-173
VIBRANT. Geraghty PJ. JVS 2013;58(2):395
DES
BRESCIA etal-
SUPERA SUPERA 500-SUPERA
VIABAHN TASC C&D-SG
VIPER-SG
POW-SUPERA
VIBRANT-SG
Combination of All Publications
0
10
20
30
40
50
60
70
80
90
100
0 50 100 150 200 250 300
%
Lesion Length (mm)
12-month Primary Patency – All Multi-CTs and Registries
BMS
POW. Myint M. 2016 JEVT (in press)
DURABILITY 200. BosiersM. JVS. 2011;54:1042-50
STELLA. Davaine JM. EJVES 2012;44:332-41
VIABAHN TASC C&D. Schneider JR. VES 2011;45(5):391-7
SUPERA 500. Werner M. Euroint 2014;10:861-868
ZILVER PTX. Bosiers M. JCS 2013; 54:115-22
STELLA PTX Davaine JM. EJVES 2015;50:631-7
Brescia AA. Etal 2015;61:1472-8
VIPER. Saxon RR. JVIR 2013;24:165-173
VIBRANT. Geraghty PJ. JVS 2013;58(2):395
DES
SG
BRESCIA etal-
SUPERA SUPERA 500-SUPERA POW-SUPERA
Combination of All Publications
0
10
20
30
40
50
60
70
80
90
100
0 50 100 150 200 250 300
%
Lesion Length (mm)
12-month Primary Patency – All Multi-CTs and Registries
BMS
POW. Myint M. 2016 JEVT (in press)
DURABILITY 200. BosiersM. JVS. 2011;54:1042-50
STELLA. Davaine JM. EJVES 2012;44:332-41
VIABAHN TASC C&D. Schneider JR. VES 2011;45(5):391-7
SUPERA 500. Werner M. Euroint 2014;10:861-868
Combination of All Publications
ZILVER PTX. Bosiers M. JCS 2013; 54:115-22
STELLA PTX Davaine JM. EJVES 2015;50:631-7
Brescia AA. Etal 2015;61:1472-8
VIPER. Saxon RR. JVIR 2013;24:165-173
VIBRANT. Geraghty PJ. JVS 2013;58(2):395
DES
SG
SUPERA
Tepe G. LINC 2016
40.4% Had Bailout
Stent
Long Complex Disease: Lesion lengths 126-199mm; ISR 13-27%; Retro access 3-11%; Prov stent(DCB) 21%
“The Algorithm” (lesions >15cm) Pre-Dilate
Good Result (VERY RARE)
(DCB)
“The Algorithm” (lesions >12cm) Pre-Dilate
Good Result (VERY RARE)
Dissection or Recoil (MOST COMMON)
(DCB) STENT
“The Algorithm” (lesions >12cm) Pre-Dilate
Good Result (VERY RARE)
Dissection or Recoil (MOST COMMON)
(DCB) STENT
Heavy Ca/Severe Recoil/Pop involved
SUPERA
1o
“The Algorithm” (lesions >12cm) Pre-Dilate
Good Result (VERY RARE)
Dissection or Recoil (MOST COMMON)
(DCB) STENT
Heavy Ca/Severe Recoil/Pop involved
SUPERA DCB with Provisional (SPOT) Stent
BMS
1o 2o
Tepe G. LINC 2016
“The Algorithm” (lesions >12cm) Pre-Dilate
Good Result (VERY RARE)
Dissection or Recoil (MOST COMMON)
(DCB) STENT
Heavy Ca/Severe Recoil/Pop involved
SUPERA DES or
SG
DCB with Provisional (SPOT) Stent
BMS
1o 2o
Specialised applications
eg Fresh thrombus or SFA ostium 3o
POW Supera Experience 2012-2014 (n=146 Supera stents; n=111 Limbs; mean length 151mm)
Myint M. 2016 JEVT (in press)
12-month
Primary
Patency
78.4%
POW Supera Experience 2012-2014 (n=146 Supera stents; n=111 Limbs; mean length 151mm)
Myint M. 2016 JEVT (in press)
12-month
FF
CD-TLR
86.3%
CONCLUSIONS
• Little DATA for Long, Complex Fem-Pop Lesions
• Almost none is comparative
• Most complex disease requires scaffolding
• What data exists suggests Interwoven Nitinol Stents have excellent patency
• Alternatives such as DCB with spot stenting may have particular utility in small arteries
AUSTRALIAN EXPERIENCE WITH
Associate Professor Ramon L. Varcoe FRACS, PhD
Sydney, Australia