L'apport des mailles fines dans le stenting moderne - Marc SILVESTRI GCS Axium-Rambot - High ...
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L’apport des mailles fines dans le
stenting moderne
Marc SILVESTRI
GCS Axium-Rambot
Aix en Provence
Disclosure statement of financial interest Pas de conflit d’interet pour cette lecture
Pourquoi l’épaisseur des mailles est-ce
important ?
Pourquoi l’épaisseur des mailles est-ce
important ?
Mailles épaisses = plus de thrombogenicité
Thrombus formation assessed by
immunofluorescence staining for platelet
marker CD61 after 1 hour
in ex-vivo pig AV shunt model
Thick strut DES
Thin strut DES
Ultra-thin strut DES
Adapted from J Am Coll Cardiol 2012; 59: 1337-49.
Avantages des mailles fines Court terme: Moins de traumatisme,d’inflammamtion et de formation de thrombus1 Moyen terme: Endothelialisation rapide et cicatrisation précoce2 Long terme: Moins de risque de mailles non recouvertes et malapposées 1Kolandaivelu. Circulation 2011; Soucy. EuroIntervention 2010; Kastrati. Circulation 2001; Pache. JACC 2003 2Cassese S et al. Eur Heart J Cardiovasc Imaging. 2018 Jan 2.
Classification des DES Adapted from Bangalore et al. Circulation 2018 Jun 26.
Mailles ultrafines(
Mailles fines versus épaisses: impact clinique ? Metaanalyse M.Lantorno Am J Cardiol 2018
10 RCTs, 11,658 pts, 3 ultrathin DES: Orsiro(60µm), Mistent(65µm) and BioMime(65µm) vs.
2nd generation DES: Xience (7 trials), Resolute (1 trial) and Nobori (1 trial)
TLF @ 1 yearMetaanalyse 9 études ( 2017-2020),11000 patients,
Orsiro vs 6 Xience + 3 Resolute
Suivi 2.8 ans
Monjur MR et al. Open Heart 2020;7:e001394
1.3% Absolute Risk Reduction in Target Lesion FailureMailles fines et petits vaisseaux
BIO-RESORT
RA Buiten et al JAMA cardio 2019 Iglesias JF et al Circ Cardiovasc Interv 2019Supraflex CRUZ SES
Platform Stent material CoCr (L605) with
highly flexible ‘S–link’ interconnector
Strut 60 µm across all stent diameters (2.0 to
thickness 4.5mm)
Carrier Biodegradable - Top layer
polymer matrix • 0% drug
• Protective layer (PVP: poly-vinylpyrrolidone)
PVP
- Base layer
PLLA/PLGA
with Sirolimus • 100% drug (Sirolimus)
• PLLA and PLGA
Coating Circumferential
The average thickness: 4-5 µm
Drug Sirolimus 1.4 µg/mm2
Release profile 1. Initial burst
- 70% released within 7 days
- Aiming to prevent excessive cell
growth
2. Sustained release up to 48 days 14TALENT TRIAL: Per-protocol analysis at 2 years Zaman A, et al. Lancet. 2019
Supraflex Xience
Percentage difference p
n=660 n=685
(95% CI) value
DOCE 5.5% (36) 7.2% (49) -1.7% (-4.3 to 1.0%) 0.223
Cardiac death 1.4% (9) 1.6% (11) -0.2% (-1.6 to 1.1%) 0.736
TV-MI 2.6% (17) 3.8% (26) -1.2% (-3.1 to 0.7%) 0.216
CI-TLR 3.3% (21) 4.5% (30) -1.2% (-3.3 to 0.9%) 0.267
DOCE CI-TLR
-1.7% (95%CI: -4.3 to 1.0) -1.2% (95%CI: -3.3 to 0.9)
Log-Rank p=0.223 7.2% Log-Rank p=0.267
4.5%
5.5%
3.3%
18TAKE HOME MESSAGE
STENTS MAILLES FINES
- Probablement moins d’infarctus et de thrombose de stent
- Possiblement moins de TLR dans les petits vaisseaux
- Difficile de départager entre 60 et 80 microns
- Succès TLF plurifactoriel
- Importance du soin à apporter à l’apposition
- A utiliser préférentiellement dans le stenting moderne pour
essayer de faire un petit plus (1 à 2% ?)
- En attendant l’étude Multitalent…Multi-TALENT study design
De novo 3VD patients
Screening with SYNTAX Scores (SS) I & II
R 775
775
Supraflex Cruz Everolimus-eluting stent
Primary endpoint: POCE at 1 year
(non-inferiority) Powered Secondary
Endpoint: VOCE at 2 year (superiority)
Chair/Co-Chair: Patrick W. Serruys, William Wijns, Corelab/Deputy Chair: Yoshi OnumaBACK UP SLIDES
Concerns with thinner struts
strut design
Radial strength Xience 81µm Ring
Resolute Onyx 81µm Helix
Synergy 79µm Ring
Orsiro 60µm* Double Helix
Acute Recoil 0 1 2 3
81µm Ring
Xience
81µm Helix
Resolute Onyx
79µm Ring
Synergy
Advances in stent design
Orsiro helps overcome potential
60µm* Double Helix
disadvantages of0 ultra 5thin struts
10
*For 2.25 mm to 3.0 mm Ø stents, 80 µm for > 3.0 mm Ø stents
** Bench test performed by independent laboratory - IIB // BIOTRONIK data on file
Source: S James, Evaluating the broad clinical utility of ultrathin bioabsorbable polymer DES; Oral presentation; Presented at: EuroPCR 2018; MAY 24You can also read
