docThe Role of Atherectomy Devices in the Real DES Era
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The Role of Atherectomy Devices in the Real DES Era
Atherectomy in DES era Toyohashi Heart Center The Role of Atherectomy Devices in the Real DES Era Etsuo Tsuchikane, MD, PhD, FSCAI Toyohashi Heart Center, Japan Angioplasty Summit 2005 – TCT Asia Pacific Atherectomy in DES era Toyohashi Heart Center Atherectomy Devices in DES Era ¾ Rotablator ¾ DCA (Flexi-Cut) ¾ Fox Hollow atherectomy Angioplasty Summit 2005 – TCT Asia Pacific Atherectomy in DES era Toyohashi Heart Center Atherectomy Devices in DES Era ¾ Rotablator ¾ DCA (Flexi-Cut) ¾ Fox Hollow atherectomy Angioplasty Summit 2005 – TCT Asia Pacific Toyohashi Heart Center Atherectomy in DES era RCA-CTO Miracle 12g Angioplasty Summit 2005 – TCT Asia Pacific Toyohashi Heart Center Atherectomy in DES era Rotablator 1.25mm Angioplasty Summit 2005 – TCT Asia Pacific Toyohashi Heart Center Atherectomy in DES era Rotablator 1.75mm Angioplasty Summit 2005 – TCT Asia Pacific Toyohashi Heart Center Atherectomy in DES era Cypher Angioplasty Summit 2005 – TCT Asia Pacific Toyohashi Heart Center Atherectomy in DES era Cypher Angioplasty Summit 2005 – TCT Asia Pacific Toyohashi Heart Center Atherectomy in DES era Cypher Angioplasty Summit 2005 – TCT Asia Pacific Toyohashi Heart Center Atherectomy in DES era Final Angiogram Angioplasty Summit 2005 – TCT Asia Pacific Atherectomy in DES era Toyohashi Heart Center Atherectomy Devices in DES Era ¾ Rotablator is still required in severe calcified lesions for successful DES delivery and full DES expansion. ¾ DCA (Flexi-Cut) ¾ Fox Hollow atherectomy Angioplasty Summit 2005 – TCT Asia Pacific Atherectomy in DES era Toyohashi Heart Center Atherectomy Devices in DES Era ¾ Rotablator is still required in severe calcified lesions for successful DES delivery and full DES expansion. ¾ DCA (Flexi-Cut) ¾ Fox Hollow atherectomy Angioplasty Summit 2005 – TCT Asia Pacific Atherectomy in DES era LAD-Dx Bifurcation Angioplasty Summit 2005 – TCT Asia Pacific Toyohashi Heart Center Toyohashi Heart Center Atherectomy in DES era FlexiCut for LAD Angioplasty Summit 2005 – TCT Asia Pacific Toyohashi Heart Center Atherectomy in DES era FlexiCut for Dx Angioplasty Summit 2005 – TCT Asia Pacific Toyohashi Heart Center Atherectomy in DES era Final Angiogram Angioplasty Summit 2005 – TCT Asia Pacific Toyohashi Heart Center Atherectomy in DES era 12Mo Follow-up Angioplasty Summit 2005 – TCT Asia Pacific Toyohashi Heart Center Atherectomy in DES era LMT Bifurcation DCA Post Pre DCA Fu 68 y.o. male EF=49% DCA Angioplasty Summit 2005 – TCT Asia Pacific Toyohashi Heart Center Atherectomy in DES era Long-term Regression after DCA (mm) (N=98) 4 3.23 3.11 3.04 3 Reference 2.72 * 2 2.68 2.03 MLD * P<0.0001 1 15.7% 34.7% 12.2% post 6Mo 5Yr Percent DS 0 (Nasu K, Tsuchikane E, et al. Am J Cariol 2004;93:543-8) Angioplasty Summit 2005 – TCT Asia Pacific Toyohashi Heart Center Atherectomy in DES era Ostial LCx Stenosis Angioplasty Summit 2005 – TCT Asia Pacific Atherectomy in DES era Rotablator 2.0mm Angioplasty Summit 2005 – TCT Asia Pacific Toyohashi Heart Center FlexiCut Toyohashi Heart Center Atherectomy in DES era Final Angiogram Angioplasty Summit 2005 – TCT Asia Pacific Atherectomy in DES era Ostial LAD Stenosis Angioplasty Summit 2005 – TCT Asia Pacific Toyohashi Heart Center Atherectomy in DES era Toyohashi Heart Center FlexiCut Angioplasty Summit 2005 – TCT Asia Pacific Atherectomy in DES era Toyohashi Heart Center Final Angiogram Angioplasty Summit 2005 – TCT Asia Pacific Atherectomy in DES era Focal LMT Stenosis Angioplasty Summit 2005 – TCT Asia Pacific Toyohashi Heart Center Atherectomy in DES era Toyohashi Heart Center FlexiCut Angioplasty Summit 2005 – TCT Asia Pacific Atherectomy in DES era Toyohashi Heart Center Final Angiogram Angioplasty Summit 2005 – TCT Asia Pacific Toyohashi Heart Center Atherectomy in DES era LMT Bifurcation Angioplasty Summit 2005 – TCT Asia Pacific Toyohashi Heart Center Atherectomy in DES era Crush Stenting Main br stent Crushed side-br stent OrmistonSummit 2003 2005 – TCT Asia Pacific Angioplasty Atherectomy in DES era Toyohashi Heart Center “Culotte” Stent Technique (Y-stenting) Angioplasty Summit 2005 – TCT Asia Pacific Toyohashi Heart Center Atherectomy in DES era Cypher for Bifurcated Lesion Restenosis rate TLR rate MACE RESEARCH Registry (n=58) Main Branch = 9.1% Side Branch = 13.6% Total 23.7% 6mo = 8.6% T Stent = 18% Crush Stent = 8% Kissing Stent = 0% Culotte Stent = 11% 10.3% Milan Registry (n=164) N/A 11.8% 16.3% SIRIUS Bifurcation Registry (n=55) Main Branch = 6.0% Side Branch = 24.0% Total 25.7% N/A N/A Angioplasty Summit 2005 – TCT Asia Pacific Toyohashi Heart Center Atherectomy in DES era Restenosis after Cypher® for Bifurcation 30 24 restenosis (%) 25 25.7 23.7 20 13.6 15 10 9.1 6 5 0 main vessel side branch RESEARCH Angioplasty Summit 2005 – TCT Asia Pacific total SIRIUS bifurcations Toyohashi Heart Center Atherectomy in DES era LMT – Cypher: Stent Thrombosis Overall stent thrombosis at 6 months: LMT 1.82% (5/274) other locations 0.89% (97/108859) p=NS (%) 2 other location LMT 1.5 1 0.62 0.73 0.73 0.36 0.5 0.14 0.14 0 acute (<24h) sub-acute (day 2-30) Angioplasty Summit 2005 – TCT Asia Pacific late (31-180 days) Toyohashi Heart Center Atherectomy in DES era LMT Bifurcation Angioplasty Summit 2005 – TCT Asia Pacific Atherectomy in DES era FlexiCut for Ostial LAD Angioplasty Summit 2005 – TCT Asia Pacific Toyohashi Heart Center Atherectomy in DES era FlexiCut for Ostial LCx Angioplasty Summit 2005 – TCT Asia Pacific Toyohashi Heart Center Toyohashi Heart Center Atherectomy in DES era Cypher Angioplasty Summit 2005 – TCT Asia Pacific Toyohashi Heart Center Atherectomy in DES era Cypher Angioplasty Summit 2005 – TCT Asia Pacific Toyohashi Heart Center Atherectomy in DES era High Pressure KBT Angioplasty Summit 2005 – TCT Asia Pacific Toyohashi Heart Center Atherectomy in DES era Final Angiogram Angioplasty Summit 2005 – TCT Asia Pacific Toyohashi Heart Center Atherectomy in DES era 8Mo Follow-up Angioplasty Summit 2005 – TCT Asia Pacific Atherectomy in DES era Toyohashi Heart Center Atherectomy Devices in DES Era ¾ Rotablator is still required in severe calcified lesions for successful DES delivery and full DES expansion. ¾ DCA (Flexi-Cut) Stand alone DCA is still efficacious for ostial/bifurcated lesion if an optimal result can be obtained. Pre DES DCA enables simple stenting for bifurcated lesion, and may reduce restenosis. ¾ Fox Hollow atherectomy Angioplasty Summit 2005 – TCT Asia Pacific Atherectomy in DES era Toyohashi Heart Center PrE Rapamycin Eluting Stent Flexi-Cut Registry (PERFECT Registry) Angioplasty Summit 2005 – TCT Asia Pacific Atherectomy in DES era Toyohashi Heart Center Atherectomy Devices in DES Era ¾ Rotablator is still required in severe calcified lesions for successful DES delivery and full DES expansion. ¾ DCA (Flexi-Cut) Stand alone DCA is still efficacious for ostial/bifurcated lesion if an optimal result can be obtained. Pre DES DCA enables simple stenting for bifurcated lesion, and may reduce restenosis. ¾ Fox Hollow atherectomy Angioplasty Summit 2005 – TCT Asia Pacific Atherectomy in DES era Angioplasty Summit 2005 – TCT Asia Pacific Toyohashi Heart Center Atherectomy in DES era Angioplasty Summit 2005 – TCT Asia Pacific Toyohashi Heart Center Atherectomy in DES era Angioplasty Summit 2005 – TCT Asia Pacific Toyohashi Heart Center Atherectomy in DES era Angioplasty Summit 2005 – TCT Asia Pacific Toyohashi Heart Center Atherectomy in DES era Toyohashi Heart Center Atherectomy Devices in DES Era ¾ Rotablator is still required in severe calcified lesions for successful DES delivery and full DES expansion. ¾ DCA (Flexi-Cut) Stand alone DCA is still efficacious for ostial/bifurcated lesion if an optimal result can be obtained. Pre DES DCA enables simple stenting for bifurcated lesion, and may reduce restenosis. ¾ Fox Hollow atherectomy may be useful for diffuse lesions to ensure DES expansion. Angioplasty Summit 2005 – TCT Asia Pacific
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