1. Morris Mosseri, MD Director of Interventional Cardiology Hadassah-Hebrew University Medical Center The Israeli Working Group of Interventional Cardiology The Titan Stent in Real Life Results from a Multi-Center Registry

2. Stainless steel and Cobalt-Chromium stents contain considerable amounts of Nickel , Chromium and Molybdenum : Nickel Chromium Molybdenum 316L SS 12-15% 17-19% 2-3% Co-CR Vision 9-11% 19-21% ___ Co-Cr Driver 33-37% 19-21% 9-10% Background

3. Allergy 5-15 % of the population are allergic to Nickel. Nickel allergy Background

5. The Inflammatory Equilibrium Inflammatory factors Systemic (vulnerable patient) Local (vulnerable plaque) Procedural (trauma) Stent (“foreign” material) Anti-inflammatory therapy DES Systemic therapy

6. TiNOX The Titan stent (Hexacath, France) is a balloon expandable stent made of stainless steel and coated with Titanium-Nitride-Oxide (TiNOX) which completely prevents discharge of nickel, chromium and molybdenum . Background

8. The Titan Israeli Registry (296 patients) List of centers and investigators: Hadassah - Mosseri M. Ichilov - Miller H. Barzilai - Jefferey J. Hillel-Jaffe - Friemerman A. Naharia - Brizines M, Poriah - Hasin Y. Shiba - Guetta V Wolfson - Tamari I. Ziv - Plich M, ISRAEL

14. Risk factors %

15. Cardiac history prior to PCI %

16. Indications for PCI %

17. Distribution of patients per number of narrowed coronary arteries

18. Blood vessels treated

19. Lesion location

20. Lesion type

21. Lesion characteristics Length <15 mm Length 15-20 mm Length >20 mm

22. Indications for stenting % Acute MI Prevention of restenosis >30% Residual stenosis In-stent restenosis Dissection

23. Stent diameter (mm)

24. Stent Length (mm) Number of stents

25. Delivery Data % %

26. Delivery data 0 0 No Flow 0 0 Distal dissection 0 0 Proximal dissection 0.6 2/296 Balloon rupture 0.3 1/296 Unsuccessful delivery % No Type

27. Early Complications 0 0 Death 0 0 CABG 0 0 Side branch acute occlusion 0.6 2/296 Sub-acute stent thrombosis 0 0 Acute occlusion / Q wave MI % No Type

28. Adverse Events at 12 months Another 39 patients who underwent coronary angiography during follow up had patent Titan stent. 10.9% (32) Total pts with TVF 10.9% (32) Total pts with MACE 12.1% (36) TVF - Target Vessel Failure (Cardiac death, MI, TVR) 12.5% (37) MACE (Death, MI, TLR) 0.3% (1) NQWMI 0.3% (1) QWMI 9.6% (28) / 1% (3) PCI / CABG 10.6% (31) TVR 9.6% (28) / 0.6% (2) PCI / CABG 10.1% (30) TLR 1.7% (5) 1% (3) 0.7% (2) Death Cardiac Non-cardiac 12 months - % (no) Type

29. MACE at 30 days and 6 months follow up * Another 24 patients who underwent coronary angiography during follow up had patent Titan stent. 6.3 (19) 1.0 (3) Total Patients with MACE 7.0 (21) 1.2 (5) Total MACE 0.3 (1) 0.3 (1) NQWMI 0.3 (1) 0.3 (1) QWMI 0.6 (2) 0 CABG 5.1 (15) 0.6 (2) PCI 5.7 (17) 0.6 (2) TVR (=TLR)* 0.7 (2) 0.3 (1) Death 6 months - % (no) 30 days - % (no) Type

30. MACE at 30 days and 6 months follow up See notes page for report on the 2 patients who died

31. Functional class at 6 months 1 Class IV 1 Class III 15 Class II 83 Class I 6 months (%) Type

32. Results of 17 stent registries in Israel 6 months follow-up %

39. Thank you !