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Nick Curzen Wessex Cardiac Unit Southampton University Hospital - PowerPoint PPT Presentation


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DES Promise Fulfilled: VEIN GRAFTS?. Nick Curzen Wessex Cardiac Unit Southampton University Hospital. DES Promise Fulfilled: VEIN GRAFTS?. NO!! There are tap all data. Real Complaints to the Council. “My bush is really overgrown round the front &

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Presentation Transcript
slide1

DES Promise Fulfilled:

VEIN GRAFTS?

Nick Curzen

Wessex Cardiac Unit

Southampton University Hospital

slide4

DES Promise Fulfilled:

VEIN GRAFTS?

NO!!

There aretap alldata

slide5

Real Complaints to the Council

“My bush is really overgrown round the front &

my back passage has fungus growing in it”

“It’s the dogs’ mess that I find hard to swallow”

“Their 18yr old son is continually banging his balls

against our fence”

“The man next door has a large erection in the back

garden, which is unsightly & dangerous”

slide6

> 1yr: 15% occlusion rate

  • 1-6yrs: 1-2% attrition rate/yr
  • 6-10 yrs: 4% attrition/yr
  • 60% patent at 10 yrs
  • Only 50% of patent VGs are free of disease
slide7

What is the outcome of real life VG PCI?

What about non-DES intervention?

Is the restenosis rate as high

as we think??

slide9

TLR & Event free survival (death, QMI & revasc) in

290 diabetic & 618 non-diabetic vein graft cases at

1 year

*

*

*

JACC 2000;36:1186-93

slide10

TLR & mortality at 1 year in 1199 consecutive

vein graft stent cases

NS

NS

Am J Cardiol 2001;87:401-5

slide16

Dogging for the interventionalist………………………….

slide18

Stent to intermediate

via jump graft

slide22

“Symbiot and bare metal outcomes were comparable”

But:

Sig greater in-segment restenosis due to sig proximal edge restenosis + trend towards in-stent restenosis, leading to sig greater TVR by PCI

slide23

What are the important considerations for DES?

  • Diameter of DES
  • Length of DES
  • GP IIb/IIIa
  • Clot burden in acute occlusions
  • Diffuse disease… reconstruct whole graft?
  • Stent thrombosis risk
slide26

Evaluation of a Tacrolimus-Eluting Coronary Stent Graft for

Treatment of SVG Lesions: Procedural & 6 month Follow Up Results

of the EVIDENT Trial

  • Non-randomised
  • 32 pts
  • Stent graft 16mm coated with tacrolimus
  • MACE 50.0%
  • Binary Restenosis 37.5%

TCT 2003

slide29

Effectiveness of the sirolimus-eluting stent in the treatment of saphenous vein graft disease.

Journal of Invasive Cardiology. 16(5):230-3, 2004 May.

  • 19 consecutive patients who underwent de novo SVG intervention treated solely with SES.
  • Mean graft age was 10 years.
  • Clinical presentation: ACS 68%.
  • In total, 22 de novo lesions were treated with 35 SESs
  • (mean=1.6 stents per lesion).
  • Glycoprotein IIb/IIIa inhibitor therapy – 42%
  • Distal embolization protection device - 32%
  • In-hospital MACE was 11%………..2 patients CK rise
  • Mean 12.5+/-2.6 month follow-up:
  • one patient died from a non-cardiac cause
  • TLR 1 patient (5%)
  • Survival free of MACE was 84%.
slide30

Data on its way for SVG DES

  • eCYPHER
  • Registries (Rotterdam;Milan;Lennox Hill)
  • Multicentre Studies (ADEST;Wisdom;DEScover;
  • Milestone II; US PMS)

No RCTs are currently ongoing

slide33

This is not what you want to see the morning after your wife

comes home in the early hours after a night out ………..