Dedicated Bifurcation Stent Technology:

Dedicated Bifurcation Stent Technology: Dedicated Bifurcation Stent Technology: - Start

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Implications for Everyday Practice. Jens Flensted Lassen MD, PH.D., FESC. The . Heart Centre, Rigshospitalet . University of . Copenhagen. . Denmark. Disclosure Statement of Financial Interest. I, (Jens Flensted Lassen) DO NOT have a financial interest/arrangement or affiliation with one or more .... ID: 571788 Download Presentation

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Presentations text content in Dedicated Bifurcation Stent Technology:

Slide1

Dedicated Bifurcation Stent Technology:Implications for Everyday Practice

Jens Flensted Lassen MD, PH.D., FESC

The

Heart Centre, Rigshospitalet

University of

Copenhagen

Denmark

Slide2

Disclosure Statement of Financial Interest

I, (Jens Flensted Lassen) DO NOT have a financial interest/arrangement or affiliation with one or more organizations that could be perceived as a real or apparent conflict of interest in the context of the subject of this presentation.

Slide3

Disclosure Statement of Financial Interest

……. BUT !!!

I, (Jens Flensted Lassen)

a

m a Board member and one of the Directors of the European Bifurcation Club (EBC) and my view on bifurcation stenting is heavily influenced by the thoughts and consensus statements of EBC.

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Treating coronary bifurcationsWhy is it difficult?

True versus non-true

bifurcations

Small

and Large SB

Diameter difference between MB and SB

MB tapering

Angels between MB and

SB

4-D movements

Extension of disease in SB

Slide7

Slide8

© 2015 EuroIntervention. All rights reserved.

Slide9

4-D movements

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Slide11

Treating Bifurcation Lesions

Why is it difficult?

Anatomic Variation

Side Branch : Main Branch Diameter

Angle of Bifurcation

Disease Burden: Wide Variation Difficult to Assess

Slide12

Workhorse DES: Optimized for Straight LesionsPoorly Suited to of Bifurcation Lesions

Wide Variety of Techniques Required

Poorly Characterized/Inconsistently Performed:

crush,

culotte

,

reverse

culotte

,

internal crush, reverse crush, T, provisional T, Y, extended Y, V, SKS, shotgun,

Helqvist

, sleeve, modified crush,

Buchbinder

,

minicrush

,

mini crush, short back and

sides,

DK

crush, flower

Slide13

Predilate side branch and/or main branchSafety wireP.O.T.Kiss/No KissPost DilateNon vs Semi CompliantSizing

Many Techniques: Many Questions

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Slide14

EuroIntervention

2015;11:V96-V98

Slide15

Patient level meta analysis of BBC1 & NORDIC 1

Circ Cardiovasc interv. 2011;4:57-64

Slide16

Slide17

"Life can only be understood backwards; but it must be lived forwards.“Søren Kirkegaard(1813-1855 Danish philosopher)

The dilemma in the provisional side branch stenting in Bifurcation lesions

Slide18

EBC

Consensus:

Side branch diameter and length can both be used visually as surrogates for volume of muscle at risk.

Large side branches with

ostial

disease extending >5mm from the carina are likely to require two stents.

Side branches whose access is particularly challenging should be secured by stenting once accessed.

Slide19

Bifurcation Lesions: Defining The Need

Coverage

Radial Strength

Addresses AllAngulationSB-MB Diameter DifferencesDisease Burden

Ease-of-UseTracking (Single Wire) Equipment (Operator’s Choice) Guide Catheters (5 or 6 Fr) GuidewiresCompatibility: Workhorse stent (DES or BMS)

USER ISSUES

CLINICAL REQUIREMENTS

Slide20

Dedicated Bifurcation Stents:

Difficult Design Problem: Many Failures

Slide21

Historical Dedicated Devices

Failed Clinically

Not ‘easy to use’

Larger profile than workhorse stents

Rotational orientation required

Two wire tracking

Poor Clinical Outcomes

Lower Procedural Success than standard stenting

Higher Event Rates than standard stenting

Slide22

The Ideal Dedicated Device

Easy to use and safe

Simplify the procedure

- Shorten procedural time, reduce X-ray exposure

- reduce contrast media

Allow continuously SB access (wire)

Predictable successful

ostial

SB-stenting

High rate of procedural success

Optimal long terms results (restenosis & ST-rates, low)

Abel

to treat all kinds of

bifurcations.

Abel to be flexible during cardiac cycles

Slide23

Slide24

Tryton

Tryton Pivotal Trials (RCT and Confirmatory):

Landmark studies

I

mprovement

in clinical outcomes in large

branches. Long-term results required.

Simplified 2-stent technique

New guidelines include incorporation of dedicated stents (Tryton).

Slide25

Complex (1.1.1) Bifurcation Lesion Involving a Large Side Branch (LAD-D1)

Baseline

Tryton

Slide26

- Dedicated devices should focus on:Easy, safe and quick, treatment of the Left MainProtection of a side branch the operator don´t want to loose

ESC & EBC 2014 (15) Consensus

Slide27

Conclusion – the way forward

Evaluate dedicated devices in “significant” SB

Dedicated devices

already challenge

2-stent techniques

Ease of use (simplified technique)

Designed, tested, and approved for

bifurcation

Indications for dedicated

devices

Large Side branches

Complex Disease

Left

Main

Dedicated devices may challenge provisional stenting

-

Ease of use (simplified technique)

Slide28

Thank you for your attention

"Life can only be understood backwards; but it must be lived forwards.“Søren Kirkegaard(1813-1855 Danish philosopher)


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