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As presented by Patrick W. Serruys, MD, PhD, FACC Principal Investigator

PISCES P aclitaxel I n- S tent C ontrolled E lution S tudy. As presented by Patrick W. Serruys, MD, PhD, FACC Principal Investigator Thoraxcentre - Erasmus University Rotterdam, The Netherlands. 4 and 12-Month Results. Reservoirs. Ductile Hinges. Bridge Elements.

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As presented by Patrick W. Serruys, MD, PhD, FACC Principal Investigator

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  1. PISCESPaclitaxel In-Stent Controlled Elution Study As presented by Patrick W. Serruys, MD, PhD, FACC Principal Investigator Thoraxcentre - Erasmus University Rotterdam, The Netherlands 4 and 12-Month Results

  2. Reservoirs Ductile Hinges Bridge Elements CoStar™ Stent Design CoStar™ Paclitaxel-Eluting Coronary Stent System Clinical Trials A Stent Designed Specifically for Controlled and Targeted Drug Delivery

  3. Conor Stainless Steel and Cobalt Chromium Stents * MedStent was the study stent for the PISCES trial

  4. PISCES – Paclitaxel In-Stent Controlled Elution Study • Study Purpose: • To evaluate safety and performance of the Conor MedStent™ and determine optimal dosing of Paclitaxel in a prospective, multi-center, sequentially enrolled study involving 6 different release formulations. The proposed intended use of the MedStent is to improve and maintain arterial lumen diameter in patients with ischemic heart disease in native coronary arteries with de novo lesions.

  5. D 1 10 µg / 5 days Bi-Directional* Release N = 30 patients D 2 10 µg / 10 days Mural Release N = 30 patients D 3 10 µg / 10 days Bi-Directional* Release N = 29 patients Treatment Arms D 4 10 µg / 30 days Mural Release N = 39 patients D 5 30 µg / 30 days Mural Release N = 29 patients D 6 30 µg / 10 days Bi-Directional* Release N = 30 patients PISCES TrialStudy Design & Patient Follow-Up Baseline Angiography 1 Month Clinical 4 Month Clinical Dose Ranging Study 4 Month Angiographic with QCA & IVUS 1 Year Clinical 12 Month Angiographic with QCA & IVUS+ * Bi-Directional = direction of paclitaxel elution is both mural and luminal + 12 Month Angiography w/ QCA and IVUS was optional

  6. PISCES TrialStudy Endpoints • Safety Endpoint: • A composite of MACE at 4 months • Efficacy Endpoints: • Late Loss by QCA within the stent • % Stent Volume Obstruction by IVUS • Rate of Binary Restenosis • The data is presented as “intent to treat”.

  7. Investigator • Site Location • Patients Enrolled Participating Investigators & Centers • J. E. Sousa / A. Abizaid • Sao Paolo • 62 • P.W. Serruys • Rotterdam • 31 • P. den Heijer • Breda • 26 • H. Bonnier • Eindhoven • 23 • A. G. de Vries • Rotterdam Zuid • 12 • D. McClean • New Zealand • 11 • S. Verheye • Antwerp • 10 • J. Belardi • Buenos Aires • 8 • J. A. Condado • Caracas • 7 • M. Pieper • Kreuzlingen • 1 • 191 • Total

  8. Risk Factors per Dose D1 D2 D3 D4 D5 D6Total Dose/ Duration/ Direction10/5/b 10/10/m 10/10/b 10/30/m 30/30/m 30/10/b N=30 N=31 N=30 N=31 N=39 N=30N=191 DM, % 16 16 23 16 10 33 19 HT, % 40 65 63 55 36 63 53 Dyslip, % 67 65 73 65 62 67 66 Prior MI, % 40 42 33 29 41 43 38 Prior PCI, % 7 7 10 16 15 16 12 Release Direction: b = bi-directional, m = mural

  9. PISCES TrialProcedural Data

  10. PISCES TrialBaseline Patient Demographics

  11. PISCES TrialBaseline Lesion Demographics

  12. QCA Analysis - Methodology Distal Proximal 17 mm 5 mm 5 mm C D vessel Side Branch Side Branch In-Stent Peri-Stent Total Vessel

  13. 15 11.6 10.7 10.3 10 6.9 % 5 3.8 3.6 0 30/30/m 10/30/m Bare 10/5/b 10/10/b 10/10/m 30/10/b 0 D0 D1 D2 D3 D4 D5 D6 N=38 N=29 N=26 N=43 N=28 N=28 N=29 In-Stent Binary Restenosis at 4 Months

  14. 30/30/m 10/30/m In-Stent Binary Restenosis at 4 and 12 MonthsCumulative % 5.6 5.6 0 0 N=18 N=32

  15. 30/30/m 10/30/m Bare 10/5/b 10/10/b 10/10/m 30/10/b In-Stent Late Loss at 4 Months (mm) N=38 N=29 N=26 N=43 N=28 N=28 N=29

  16. 10/30/m 30/30/m In-Stent Late Loss at 4 and 12 MonthsSerial Analysis Late loss of patients undergoing TLR at 4 months (D5=0, D6=1) is imputed as the value of late loss at 12 months. p=0.01 p=0.53 0.52 (mm) 0.40 0.36 0.32 N=32 N=18

  17. 30/30/m 10/30/m Bare 10/5/b 10/10/b 10/10/m 30/10/b Neo-Intimal Volume at 4 Months (mm3) N=37 N=26 N=21 N=39 N=23 N=27 N=28

  18. 10/30/m 30/30/m Neo-Intimal Volume at 4 and 12 MonthsSerial Analysis (mm3) p=0.29 p=0.0004 18 14 11 9 N=30 N=15

  19. 10/30/m Bare 10/5/b 10/10/b 10/10/m 30/10/b 30/30/m In-Stent % Volume Obstruction at 4 Months % N=39 N=23 N=27 N=26 N=28 N=21 N=37

  20. 30/30/m 10/30/m In-Stent % Volume Obstruction at 4 and 12 MonthsSerial Analysis p=0.0004 p=0.31 12 % 8 7 6 N=15 N=30

  21. 30/30/m 10/30/m Bare 10/5/b 10/10/b 10/10/m 30/10/b MACE at 4 and 12 Months 20.7 17.2 16.7 13.3 % 10 8 6.7 6.9 6.7 5.1 3.4 2.6 N=29 N=39 N=30 N=50 N=29 N=30 N=30 Between 4 and 12 months, 1 non Q-wave MI occurred in D5 in a non-target vessel and 1 Q-wave MI (total occlusion of target lesion) in D6.

  22. TLR at 4 and 12 Months % 6.9 3.4 0 0 10/30/m 30/30/m N=50 N=30 N=30 N=29 N=30 N=39 N=29

  23. 1 0.8 0.6 0.4 0.27 0.22 0.2 0.11 0.10 0 proximal distal Proximal and Distal Edge Late Loss at 4 and 12 Months - Serial Analysis D5 p=0.44 p=0.97 D6 p=0.69 p=0.10

  24. Conclusions • This study represents one of the most comprehensive analyses of pharmacokinetic releases ever performed in a FIM Study. • The safety profile of this system - using an erodable polymer and delivering 100% of the drug is within the accepted standards. • Protocol called for 6 months Plavix therapy. There were no reported cases of delayed stent thrombosis in the interval period. • Although the doses used were substantially less than paclitaxel-coated stents, the inhibition of neo-intimal hyperplasia was similar.

  25. Conclusions • In the 2 long release (most effective) formulations the TLR and MACE rates remained low at 12 months. • In D5, there was 0% in stent restenosis at both 4 and 12 months and in D6 the restenosis rate remained 5.6%. • There was a modest but statistically significant increase in neo-intimal volume, % in-stent obstruction and late loss between 4 months and 12 months in D5 but not in D6. The TLR and restenosis rates in the D6 group were not as good as in D5. • These 2 pharmacokinetic profiles are currently under investigation in the Eurostar trial with a thin strut cobalt chromium stent and 33% less polymer volume.

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