AUSTRALIAN EXPERIENCE WITH · Pre-Dilate Good Result (VERY RARE) Dissection or Recoil (MOST COMMON)...
Transcript of AUSTRALIAN EXPERIENCE WITH · Pre-Dilate Good Result (VERY RARE) Dissection or Recoil (MOST COMMON)...
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AUSTRALIAN EXPERIENCE WITH
Associate Professor Ramon L. Varcoe FRACS, PhD
Sydney, Australia
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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
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Charles Dotter: 1920-1985
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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
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Options for the SFA…
POBA
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Options for the SFA…
BMS POBA
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Options for the SFA…
DCB POBA BMS
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Options for the SFA…
DES POBA BMS
DCB
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Options for the SFA… MIMETIC STENTS
POBA BMS
DCB DES
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Options for the SFA… STENT-GRAFT
POBA BMS
DCB DES
MIMETIC STENTS
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Other Devices (Less frequently used in Aust)
ATHERECTOMY TACKS
SHORT MULTI-STENTS
CRYOPLASTY
HYBRID STENTS
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It’s a Minefield!
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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
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%
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
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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
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0
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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
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0
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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
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Tepe G. LINC 2016
40.4% Had Bailout
Stent
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Long Complex Disease: Lesion lengths 126-199mm; ISR 13-27%; Retro access 3-11%; Prov stent(DCB) 21%
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“The Algorithm” (lesions >15cm) Pre-Dilate
Good Result (VERY RARE)
(DCB)
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“The Algorithm” (lesions >12cm) Pre-Dilate
Good Result (VERY RARE)
Dissection or Recoil (MOST COMMON)
(DCB) STENT
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“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
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“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
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Tepe G. LINC 2016
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“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
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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%
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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%
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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
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AUSTRALIAN EXPERIENCE WITH
Associate Professor Ramon L. Varcoe FRACS, PhD
Sydney, Australia