AUSTRALIAN EXPERIENCE WITH · Pre-Dilate Good Result (VERY RARE) Dissection or Recoil (MOST COMMON)...

AUSTRALIAN EXPERIENCE WITH

Associate Professor Ramon L. Varcoe FRACS, PhD

Sydney, Australia

Disclosure

Speaker name:

.........Ramon Varcoe........................................................

I have the following potential conflicts of interest to report:

Consulting Abbott, Boston, Gore, Medtronic

Employment in industry

Stockholder of a healthcare company

Owner of a healthcare company

Other(s)

I do not have any potential conflict of interest

Charles Dotter: 1920-1985

A Number of UNMET needs in the Femoro-popliteal Segment

IT’S A HOSTILE ENVIRONMENT…

1. Considerable mechanical strain

2. Often heavily Calcified

3. Elastic recoil and dissection are common

4. Metallic devices are prone to fracture

Options for the SFA…

POBA


BMS POBA


DCB POBA BMS


DES POBA BMS

DCB

Options for the SFA… MIMETIC STENTS

POBA BMS

DCB DES

Options for the SFA… STENT-GRAFT

POBA BMS

DCB DES

MIMETIC STENTS

Other Devices (Less frequently used in Aust)

ATHERECTOMY TACKS

SHORT MULTI-STENTS

CRYOPLASTY

HYBRID STENTS

It’s a Minefield!

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%

Lesion Length (mm)

12-month Primary Patency – All Multi-CTs and Registries

POW. Myint M. 2016 JEVT (in press)

DURABILITY 200. BosiersM. JVS. 2011;54:1042-50

STELLA. Davaine JM. EJVES 2012;44:332-41

VIABAHN TASC C&D. Schneider JR. VES 2011;45(5):391-7

SUPERA 500. Werner M. Euroint 2014;10:861-868

BRESCIA etal-

SUPERA

ZILVER PTX. Bosiers M. JCS 2013; 54:115-22

STELLA PTX Davaine JM. EJVES 2015;50:631-7

Brescia AA. Etal 2015;61:1472-8

VIPER. Saxon RR. JVIR 2013;24:165-173

VIBRANT. Geraghty PJ. JVS 2013;58(2):395

SUPERA 500-SUPERA

DURABILITY 200-BMS STELLA-BMS

ZILVER PTX-DES

VIABAHN TASC C&D-SG

STELLA PTX-DES

VIPER-SG

POW-SUPERA

VIBRANT-SG

VIBRANT-BMS

Combination of All Publications

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%

Lesion Length (mm)


BMS











BRESCIA etal-

SUPERA SUPERA 500-SUPERA

ZILVER PTX-DES

VIABAHN TASC C&D-SG

STELLA PTX-DES

VIPER-SG

POW-SUPERA

VIBRANT-SG


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Lesion Length (mm)


BMS











DES

BRESCIA etal-

SUPERA SUPERA 500-SUPERA

VIABAHN TASC C&D-SG

VIPER-SG

POW-SUPERA

VIBRANT-SG


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Lesion Length (mm)


BMS











DES

SG

BRESCIA etal-

SUPERA SUPERA 500-SUPERA POW-SUPERA


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Lesion Length (mm)


BMS












DES

SG

SUPERA

Tepe G. LINC 2016

40.4% Had Bailout

Stent

Long Complex Disease: Lesion lengths 126-199mm; ISR 13-27%; Retro access 3-11%; Prov stent(DCB) 21%

“The Algorithm” (lesions >15cm) Pre-Dilate

Good Result (VERY RARE)

(DCB)



Dissection or Recoil (MOST COMMON)

(DCB) STENT




(DCB) STENT

Heavy Ca/Severe Recoil/Pop involved

SUPERA

1o




(DCB) STENT


SUPERA DCB with Provisional (SPOT) Stent

BMS

1o 2o

Tepe G. LINC 2016




(DCB) STENT


SUPERA DES or

SG

DCB with Provisional (SPOT) Stent

BMS

1o 2o

Specialised applications

eg Fresh thrombus or SFA ostium 3o

POW Supera Experience 2012-2014 (n=146 Supera stents; n=111 Limbs; mean length 151mm)

Myint M. 2016 JEVT (in press)

12-month

Primary

Patency

78.4%

POW Supera Experience 2012-2014 (n=146 Supera stents; n=111 Limbs; mean length 151mm)

Myint M. 2016 JEVT (in press)

12-month

FF

CD-TLR

86.3%

CONCLUSIONS

• Little DATA for Long, Complex Fem-Pop Lesions

• Almost none is comparative

• Most complex disease requires scaffolding

• What data exists suggests Interwoven Nitinol Stents have excellent patency

• Alternatives such as DCB with spot stenting may have particular utility in small arteries

AUSTRALIAN EXPERIENCE WITH

Associate Professor Ramon L. Varcoe FRACS, PhD

Sydney, Australia

AUSTRALIAN EXPERIENCE WITH · Pre-Dilate Good Result (VERY RARE) Dissection or Recoil (MOST COMMON)...

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