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Bioresorbable Vascular Scaffolds in Complex Lesions ... · BVS at Cardioteam 03. 2013- 06. 2016:...
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Dr. Ștefan Moț 1, 2 Bioresorbable Vascular Scaffolds in Complex Lesions: Experience in an Outpatient Clinic Dr. Ștefan Moț 1, 2 1. Heart Institute “Niculae Stăncioiu” Cluj-Napoca 2. CARDIOTEAM Cluj-Napoca, http://www.cardio-team.ro/
Transcript of Bioresorbable Vascular Scaffolds in Complex Lesions ... · BVS at Cardioteam 03. 2013- 06. 2016:...
Dr. Ștefan Moț 1, 2
Bioresorbable Vascular Scaffolds in Complex Lesions:Experience in an Outpatient ClinicDr. Ștefan Moț 1, 2
1. Heart Institute “Niculae Stăncioiu” Cluj-Napoca2. CARDIOTEAM Cluj-Napoca, http://www.cardio-team.ro/
The BVS
The BVS
+ REPARAGABI-RTROFI IITROFI IIESTROFA-BVSGHOST EUASURE
The Outpatient Clinic
The Outpatient Clinic
Siemens Artis U 80
The Outpatient Clinic
The Cath lab team:
- 1 Primary operator: interventional cardiologist, MD- 2 secondary operators: trained interventional cardiologists- 4 registered scrub nurses
The Cath lab Outpatient Protocol:The Cath lab Outpatient Protocol:
1. Patient check-in2. Cardiac exam prior to cath lab admission3. Cath lab admission and preparation (informed consent, entry site preparation, premedication)3. Cath lab admission and preparation (informed consent, entry site preparation, premedication)4. Procedure (diagnostic/therapeutic): 90% of cases using radial access5. Patient monitoring (symptoms, ecg, BP, puncture site): 4-6h after procedure6. +/- Patient recovery: up to 24h after procedure7. Patient discharge7. Patient discharge
The Outpatient Clinic
90% of procedures done using radial approach90% of procedures done using radial approach
The Outpatient Clinic
Factors influencing a safe early discharge:
1. Patient and family (social)1. Patient and family (social)2. Severity of disease (SCAD)3. No procedural complications4. Follow-up, patient feedback and contact after the procedure
The Outpatient Clinic
The Outpatient Clinic
The Outpatient Clinic
Evidence: observational studies
J Am Coll Cardiol. 2013;62(4):275-285. doi:10.1016/j.jacc.2013.03.051
The Outpatient Clinic
Evidence: observational studies-results
J Am Coll Cardiol. 2013;62(4):275-285. doi:10.1016/j.jacc.2013.03.051
The Outpatient Clinic
Evidence: RCT
J Am Coll Cardiol. 2013;62(4):275-285. doi:10.1016/j.jacc.2013.03.051
The Outpatient Clinic
Evidence: RCT-results
J Am Coll Cardiol. 2013;62(4):275-285. doi:10.1016/j.jacc.2013.03.051
The Outpatient Clinic
Evidence: RCT-results: efficiency
J Am Coll Cardiol. 2013;62(4):275-285. doi:10.1016/j.jacc.2013.03.051
The Outpatient Clinic
Evidence: RCT-results: safety
J Am Coll Cardiol. 2013;62(4):275-285. doi:10.1016/j.jacc.2013.03.051
The Outpatient Clinic
SCAI recommendation for same day discharge
J Am Coll Cardiol. 2013;62(4):275-285. doi:10.1016/j.jacc.2013.03.051
Sample Protocol for a Same-Day Percutaneous Coronary Intervention Program
CTO = chronic total occlusion; EF = ejection fraction; GFR = glomerular filtration rate; PCI = percutaneous coronary intervention.
BVS at Cardioteam
03. 2013- 06. 2016:
174 PCI cases using BVS (1400 total cases, 864 PCI)
Symptoms No. of patientsSymptoms No. of patients
SCAD:
1. CCS I 0
2. CCS II 422. CCS II 42
3. CCS III 20
UA 104
NSTEMI/STEMI 2 (recent NSTEMI)NSTEMI/STEMI 2 (recent NSTEMI)
Silent ischemia with + stress test 6
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Angio No. of patients
1 vessel disease
LAD 74LAD 74
LCX 10
RCA 12
2 vessel disease2 vessel disease
LAD+ Diag. 4
LAD+ LCX 18
LAD+ RCA 26LAD+ RCA 26
LCX+RCA 4
3 vessel disease, no CABG 20
3 vessel disease+ CABG 6
BVS at Cardioteam
PCI on vessel BVS BVS+DES BVS+DEB
1 vessel disease:1 vessel disease:
LAD 68 6
LCX 10
RCA 12RCA 12
2 vessel disease:
LAD+ Diag. 4
LAD+ LCx 6 10LAD+ LCx 6 10
LAD+RCA 10 18
LCX+RCA 4
3 vessel disease, no CABG:3 vessel disease, no CABG:
Functional PCI 6
Complete revascularization 10 2
3 vessel disease+ CABG:3 vessel disease+ CABG:
Functional PCI 8
BVS at Cardioteam
Complication Type Resolved? How?
Intraprocedural 1 VFib Yes Converted to SR using 1 EES (200 J)
Early postprocedural (<24 h) 2 Paroxistic Afib Yes Converted to SR after iv BB
Late postprocedural (>24 h) 0
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6 months clinical follow-up:
Symptoms No. of patients pre-PCI No. of patients post-PCI
No Symptoms 142
SCAD:
1. CCS I 0 24
2. CCS II 42 8
3. CCS III 20 0
UA 104 0
NSTEMI/STEMI 2 (recent NSTEMI) 0
Silent ischemia with + stress test 6 NA
BVS at Cardioteam
Examples:
Sympt.: UAAngio:- Severe proximal LAD
- 0.014” BMW II- Pre-dilatation with 3.5x20mm- BVS: 3.5x28 mm
- Post-dilatation with 4x20mm NC (20 atm.)
- End-result- Follow-up: No AP
- Severe proximal LAD- CTO of proximal RCA
- BVS: 3.5x28 mm
BVS at Cardioteam
Examples: stent thrombosis
- 0.014” Cross-it 200- Predilatation: 1.5 and 3.5x20mm- BVS Absorb 3.5x28 mm
- LAD end-result
- BVS Absorb 3.5x28 mm
Sympt: recent NSTEMI in previous PCI patientAngio:- LAD stent thrombosis- Severe RCA I and III - 0.014” BMW II
- Pre-dilatation with 2.5x20mm (distal) and3x20 mm (proximal)
- Distal: BVS 2.5x28mm- Proximal: BVS 3x28 mm
BVS at Cardioteam
Examples: bifurcation
- 0.014” BMW II on LAD and D1- Predilatation: 3x20mm (LAD and D1)
- BVS 3x18 mm positioning (cross-over D1)
- LAD end-result
Sympt: UAAngio:- LAD II 70%, D1 90%- OM1 80%
- 0.014” BMW II (both braches)- Pre-dilatation with 2.5x20mm
- BVS 2.5x28 mm (post-dilated with3x15 mm NC) cross-over side-branch
BVS at Cardioteam
Examples: Calcified lesion
RCA: BVS at crux 3x18 mm- ncessity for “buddy wire” andvigurous predilatation
RCA: severely calcific lesion at crux
BVS at Cardioteam
Examples: Overlapping stents
- 0.014” BMW II on LAD- Predilatation: 2.5x20mm ; 3.0/20 mm- BVS 2.5/28 mm (LAD II), 3x28 mm (LAD I)
Sympt: UAAngio:- LAD I 80%, LAD II 80%- 95% Proximal LCx
- 0.014” BMW II on LCx- Predilatation: 2.5 x20mm- BVS 2.5/18 mm
- Postdilatation: 3x15 mm (20 atm.) - LCx final result
BVS at Cardioteam
Examples: Overlapping
Sympt: UAAngio:- LAD I 90%, LAD II 90%- 0.014” BMW II on LAD and D1
- Predilatation LAD: 2.5x15 mm- LAD II: BVS 2.5x28 mm- LAD I: BVS 3x13 mm
- Postdilatation: 3x15 mm NC - LAD final result
BVS at Cardioteam
Examples: bifurcation 2 x BVS
“T” STENTING 2X BVS ON LAD+ DIAG 1“T” STENTING 2X BVS ON LAD+ DIAG 1
LAD 1 +1st DIAGONALAND LAD 2AND LAD 2
BVS ON LAD 2
BVS at Cardioteam
Examples: bifurcation BVS + DES
D1: XIENCE 3x18 mmLAD: BVS 3x23 mm (post dil with 3.5x20 NC)
Conclusion
1. Early discharge can lead to better patient care (improving comfort and satisfaction) withoutcompromising treatment safety.
2. PCI with BVS is feasible in selected early discharge cases.2. PCI with BVS is feasible in selected early discharge cases.
