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SECOND GENERATION OF DES AND CTO PCI
FULL METAL JACKET
AUGMENTED RISK OF RESTENOSIS
PERMANENT IMPAIRMENT OF VASOMOTION
IMPAIRMENT OF POSITIVE REMODELING
ARTIFACTS AT NON-INVASIVE CARDIAC IMAGING TECHNIQUES
INABILITY FOR PLACEMENTS OF BYPASS
CTO & ANY OTHER KIND OF LESIONS
POTENCIAL BENEFICES OF BVS IN CTO
• RESTORATION OF VASOMOTION
12 months
24 months
Eur Heart J. 2012 Jun;33(11):1325-33. doi: 10.1093/eurheartj/ehr466.
Baseline post acetylcholine
• ENLARGMENT OF SCAFFOLD AND LUMEN AREA
J Am Coll Cardiol. 2014 Dec 9;64(22):2343-56. doi: 10.1016/j.jacc.2014.09.029.
• USE OF NON INVASIVE IMAGIN (CCT) FOR FOLLOW-UP
• MAKE MORE FEASIBLE FUTURE SURGICAL REVASCULARIZATIONS
POTENCIAL LIMITATIONS
• CROSSABILITY: crossing profile 1.4 mm
• VESSEL SIZE
• MALAPOSITION
• RECOIL:
• LENGTH OF DEVICES
• PRIZE
Circ Cardiovasc Intervent. 2009;2:255-260.
CTO AGE
(years)
SEX DM HTA DLP TOBACC
O
Ozel et al 41 61.9±9.7 85.4% 51.2% 80.5% 46.3% 34.1%
Lesiak et al 40 59.9±8.3 77.5% 30% 80% 35%
Ojeda et al 46 58±9 98% 33% 57% 64% 19%
Vaquerizo
et al
35 61±10 80% 20%
Wiebe et al 23 60.4±9 80% 34.8% 91% 65.2% 47.8%
BASELINE CHARACTERISTICS
PROCEDURAL CHARACTERISTICS
CTO
Vessel
JCTO
score
Diameter
BVS (mm)
Length (mm) Post
dilatation
Ozel et al 48.7%
RCA
70%<2 2.8 ± 0.29 25.6 ± 4.2 97.5%
Lesiak et
al
57.5%
LAD
45%<2 2.9 ± 0.32 42 ± 21.5 ?
Ojeda et al 48% LAD 54%<2 3.03 ± 0.38 43 ± 21 100%
Vaquerizo
et al
46% RCA 75%<2 2.74 ± 0.4 52.5 ± 22.98 63%
Wiebe et
al
47.8%
RCA
77.5%<
2
3.1 ± 0.2 64.8 ± 24.2 69.6%
Antegrade
approach
Final MINIMAL
BVS diameter
(mm)
IVUS/OCT
Ozel et al 86.7% 2.5 ± 0.25 No
Lesiak et al 85% 2.52 ± 0.8 25%
Ojeda et al 74% 2.7 ± 0.4 8%
Vaquerizo et al 86% 2.18 ± 0.39 100%
Wiebe et al 95.7% 2.13 ± 0.31 60.9%
PROCEDURAL CHARACTERISTICS
FOLLOW - UP
Follow-up
(days)
Resteno
sis
Device
thrombos
is
AMI ANGIO
follow-up
CT
Scan
Ozel et al 365 12.2% 2.4% 2.4% No No
Lesiak et
al
365
(92.5%)
7.5% 5% 5% 68% 12 m No
Ojeda et al 390±150 8% 0% 0% No 6m
Vaquerizo
et al
365 6% 0% 0% 100% 12
m
6 m
Wiebe et
al
108
(79.5/214.5)
4.3% 4.3% 0% 59% No
CONCLUSIONS
• WE CAN'T GENERALIZE THIS RESULTS
• PROBABLY WE NEED TO WAIT 3-5 YEARS TO HAVE THE
LONG TERM FOLLOW UP FOCCUSING IN LATE
THROMBOSIS/RESTENOSIS OF BVS IN CTO
CONCLUSIONS
•ACCORDING TO THESE STUDYS TO GUARANTEE LONG TERM
RESULTS AVOIDING DEVICE THROMBOSIS
• PREPARE THE LESION WITH AGRESSIVE PREDILATATION
• IF THE LESION IS CALCIFIEF USE LASER OR ROTABLATION
• DON'T USE BVS IN SMALL VESSELS
• USE HIGHT PRESSURE POSTDIATATION WITH A NON COMPLIANT
BALLOON
• IF WE ARE NO SURE ABOUT SIZE AND IMPLANTATION RESULT
USE IMAGIN (OCT
• PAY ATTENTION TO ANTIPLATELET THERAPY