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1st or 2nd generation?
Patient population:742/7765 CTO PCI (2006-2011)
Single center retrospective analysis
MACEfreesurvival
MACEfreesurvivalafter PA
TLRfreesurvival
TLRfreesurvivalafter PA
TWENTE: CTO PCI with 2nd Gen DES
van Houwelingen et al, CCI 2015
Analysis of 59 CTO pts treated with ZES (Resolute) or EES 56% with J-CTO scores ≥2; mean lesion length 31.3 mm Similar rates of ST (1.7% CTO vs. 1.5% for non-CTO)
Resolute ZES in Coronary Occlusions2 year outcomes: 256 CTO lesions, 292 non-chronic TO lesions
Kelbaek et al, Eurointervention 2015
EuroIntervention 2014;10
We found a significantly higher rate of uncovered and malapposed stent struts in DES implanted afterinterventional revascularisation of CTO lesions, suggesting these patients to be at higher risk for STcompared to the control group. Furthermore, the OCT analyses found uncovered and malapposedstent struts even beyond 12-month follow-up. While antegrade wiring as well as dissection and re-entrytechniques are leading to similar coverage and apposition, the healing of DES implanted into CTO lesionsseems to be independent of the applied revascularisation approach.We suggest regular use of OCT-based follow-up examinations in patients after successful PCI of CTOlesions to assess the duration of DAPT and improve the patient’s outcome.
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Conclusions
BMS or DES? DES
1st or 2nd generation? 2nd generation
Does it matter which drugis on the stent? No evidence
CTO is the same lesion thannon-CTO for the long-term result? No
Careful implantation strategy and follow-up are necessary forthe good long term result
DES in CTO RevascularizationQuantifying the Relative Benefit of DES: ≥3 Year Follow-up
Saeed, Kandzari, Brilakis et al. CCI 2010
64% RR
62% RR
DES in CTO RevascularizationQuantifying the Relative Benefit of DES: ≥3 Year Follow-up
Saeed, Kandzari, Brilakis et al. CCI 2010
Questions on the use of DES for CTO PCI
• Is there DES use indispensible for CTO recanalization?
• Are there significant differences between te results of each specificDES design?
• Are there any patient- or procedure-related factors influecing thelong-term DES outcome?
• Does BVS better than new generation metallic DES?