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SKS in LM stenting

SKS in LM stenting. Sheffield experience in 100 consecutive ULMCA bifurcation stenoses. Dr. Julian Gunn. Senior Lecturer/ Hon. Consultant Cardiologist, University of Sheffield, Sheffield Teaching Hospitals, UK. SKS: technique/ tips. 8F catheter Predilatation Taxus stents Cover all disease

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SKS in LM stenting

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  1. SKS in LM stenting Sheffield experience in 100 consecutive ULMCA bifurcation stenoses

  2. Dr. Julian Gunn Senior Lecturer/ Hon. Consultant Cardiologist, University of Sheffield, Sheffield Teaching Hospitals, UK

  3. SKS: technique/ tips • 8F catheter • Predilatation • Taxus stents • Cover all disease • 1:1 diameter LAD/ Cx • Balloon for length • Back beyond ostium • Spider and LAO Cranial • IVUS/ abciximab/ IABP if necessary 60y M Elective *Cathet Cardiovasc Interv 2007; 69:209-15

  4. SKS for ULMCA bifurcation: aftercare • Dual antiplatelet therapy for life • Clinical followup 3,12 months • 1st 30: 6/12 angiography • 2nd 70: no routine angio • ETT when possible: 4/12 and 8/12

  5. SKS for UMLCA bifurcation: Sheffield results • N= 100 • All-comers (shock/ AMI/ v elderly/ frail) • 1 PCI turndown • 35 % unsuitable for CABG • Mean age 66 (45-88) • 76% male • 8% emergency, 23% acute, 69% elective • 2.0 vessel disease (+ULMCA) • 1.8 vessels treated

  6. SKS for UMLCA bifurcation: Sheffield results • 100% SKS technical success • 96% DES, 4% BMS • 3% IVUS • 17% IABP • Followup: median 20m • Death in hospital 4 (3 emerg, 1 urgent, 0 routine) • Death long term 6 (0 emerg, 2 urgent, 4 routine)

  7. SKS for UMLCA bifurcation: SheffieldThe deaths 3 emergency cases. All cardiogenic shocks; had successful PCI but died subsequently. 3 urgent cases. 1 death following LMS rupture. 1 had renal failure at time of PCI and died 7m later. 1 died after 4m. 4 routines. Died at 2, 4, 7 and 10m.

  8. SKS for UMLCA bifurcation: Risk scores

  9. SKS for UMLCA bifurcation: survival Elective and urgent patients (n=92) (p=0.03) Emergency patients (n=8) No deaths beyond 10 m

  10. SKS for ULMCA bifurcation: TVR • 6% • Symptom-driven • 5 re-PCI (3 repeat SKS; 2 SKB/S) • 1 CABG

  11. SKS: Restenosis, Thrombosis, Re-PCI SKS 8/12 ago 3.5/3.5 Taxus STEMI at DGH Lysis Successful Immediate transfer HP 3.0/ 3.0 Kissing Balloons Pre-dil Repeat SKS: Taxus 3.5x24 3.5x24

  12. SKS: IVUS pre 77y F, Elective

  13. SKS: IVUS post

  14. SKS: re-endothelialisation Septum 6/12, M

  15. SKS: Animal studies 3/12, pig *Cathet Cardiovasc Interv 2007; 69:209-15

  16. SKS: in emergency 79y M Cardiogenic shock

  17. SKS for ULMCA bifurcation: Conclusions • Easy • Quick • Effective • Excellent in extremis • Mortality 4% in hospital (incl shocks/ turndowns) • Mortality 10 % at 20m (incl shocks/ turndowns) • Electives (69%) 8% (incl turndowns) • Urgents (23%) 14% (incl turndowns) • Emergencies (8%) 38% (incl shocks and turndowns) • [CABG 3% in hospital (no shocks/ turndowns) 7% at 20m (all LMSs]] • TVR 6%

  18. Acknowledgments • Dr Anjan Siotia • Dr Allison Morton • Dr Jiun Tuan • Dr Nadine Arnold • Dr Peter Korgul • Jim Heppenstall • John Bowles

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