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VICTORIA MARTIN - LONG TERM FOLLOW-UP WITH BVS IN CTO
- 1. LONG TERM FOLLOW- UP WITH BVS IN CTO VICTORIA MARTIN MD, PHD H CLINIC. BARCELONA. SPAIN
- 3. 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
- 4. 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
- 5. • 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.
- 6. • USE OF NON INVASIVE IMAGIN (CCT) FOR FOLLOW-UP • MAKE MORE FEASIBLE FUTURE SURGICAL REVASCULARIZATIONS
- 7. (J Am Coll Cardiol Intv 2013;6:999–1009
- 8. POTENCIAL LIMITATIONS • CROSSABILITY: crossing profile 1.4 mm • VESSEL SIZE • MALAPOSITION • RECOIL: • LENGTH OF DEVICES • PRIZE Circ Cardiovasc Intervent. 2009;2:255-260.
- 9. WHAT DO WE REALLY KNOW FROM BVS IN CTO LESIONS?
- 10. 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
- 11. 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%
- 12. 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
- 13. 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
- 14. (Am J Cardiol 2016;117:906e917
- 15. 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
- 16. 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
- 17. THANK YOU!!!
- 18. THANK YOU!!!