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C ONTENTS 1 s 1 2 2 3 s 3 4 s 4 s 5 s 6 6 s LMT 7 s Bifurcation 7 s Calcified Lesion 8 CTO 8 9 s s s s Peripheral s Imaging 11 11 12 12 Renal Failure 13 13
9/21 Dr. Suzuki's Comment Complications with drug-eluting stents s % (n=2,386-99% of eligible patients) 16. 14. 12.. 8. 13.4% Dissections (n=67) No dissections (n=2,351) 11.% 6. 6.% 6.% 4.6% 4.5% 4. 3.% 3.% 2..9%.1%. MACE Death MI CABG TVR 9/21 Dr. Suzuki's Comment Drug- Eluting Stent for hemodialysis patients from HIJC- registry 1
9/21 Dr. Suzuki's Comment Restenosis after implantation-analysis of mid-term results 9/21 Dr. Suzuki's Comment Impact of black hole an echo-lucent tissue on the restenosis after Cypher implantation 2
9/22 Dr. Suzuki's Comment TAXUS VI trial: Three-year outcomes in high-risk subgroups (small, long, overlap) s 9/22 Dr. Suzuki's Comment The SISR trial: Sirolimus-eluting stents for the treatment of in-stent restenosis Brachytherapy Sirolimus-eluting stent Total occlusion 7% Total occlusion 7% Diffuse proliferation 9% Diffuse proliferation 19% Diffuse 26% Focal 48% Diffuse 13% N=31 N=45 (%)3 2 Brachytherapy Sirolimus p=.4 Focal 71% p=.23 p=.18 p=1. Death Q-MI NQ-MI TLR TVF Primary endpoint 3
9/22 Dr. Suzuki's Comment Treatment of diabetic patients: and anti- thrombotic therapy s Hs-CRP(mg/L) 14 12 8 6 4 2 7.6 7.2 Baseline 11.8 Cypher (n=57) Bare stent (n=59) 7.2 6.8 5.6 24 hours 1 mo. 9 mo. 9/23 Dr. Suzuki's Comment New for preventing thrombosis and restenosis s 4
9/23 Dr. Suzuki's Comment Late stent thrombosis: SES vs BMS in randomized clinical trials s % of patients 6 5 4 3 2 1 Composite of cardiac death or nonfatal MI(%) p=.63 8.4% 7.5% BMS % 8 CYPHER (n=878) CONTROL(n=87) p<.1348 8. p<.44 6 4 6. p<.1347 4.3 3.9 p<.3 6.1 2.3 2.5 2 p<.1786.8.2 1.4 3 36 72 1,8 1.44 Time after Initial Procedure(days) rate of death or Q-MI (%). 9. 8. 7. 6. 5. 4. 3. 2. 1.. % All randomized studies up to latest available follow-up 8 6 4 2 2.4% p=.3.. Control(BMS) 3.9 6.3 n=87 n=878 n=1,675 n=1,685 SES CYPHER (n=878) CONTROL(n=87) p<.511 p<.3424 1.8.8.7.3 3 36 72 1,8 1.44 Time after Initial Procedure(days).3% p=.68 2.6 2.3 PES p<.4737 p<.1589 3.2 2.4 2.5 1.4 5
9/23 Dr. Suzuki's Comment Insights from Japan Patients 14, 12,, 8, 6, 4, 2, 12,989 patients 81% of eligible 12,33 patients 69% of eligible 2,465,524 Available June 26, 26 3,684 8,349 FU at 3 days On going data collection Eligible F/U pending Data available 8,946 patients 56% of eligible 3,918 5,28 FU at 18 days 5,144 patients 51% of eligible 2,533 2,611 FU at 1 year 9/23 Dr. Suzuki's Comment Plaque modification is helpful in small vessel disease (coronary and peripheral) s 6
LMT Bifurcation 9/22 Dr. Suzuki's Comment Treatment of unprotected left main stenosis: stenting is an acceptable strategy s (%) 2 15 5 6% 2% De Lenzo (n=52) Restenosis Rivascularization Death % 7% 2% Park (n=2) % n.a. 6% 14% Valgimigli (n=95) 19% 14% Chieffo (n=85) 3.5% 4.2% 1.6% 1.5% Lefevre (n=146) 9/21 Dr. Suzuki's Comment Do technical strategies influence the outcome of coronary bifurcation stenting in the era? s 7
Calcified Lesion CTO 9/22 Dr. Suzuki's Comment PCI for severely calcified lesion in patients with end- stage renal disease % 5 45 4 35 3 25 2 15 5 41.7% p=ns Restenosis p=ns TLR BMS (n=24) (n=26) 26.9% 29.2% 23.% 9/21 Dr. Suzuki's Comment CTOs 28 cases of successful CTO-PCIs using both retro-approach 8
CTO 9/22 Dr. Suzuki's Comment CTO club (Part 1) s s s s Complex Catheter Therapeutics 28 9
Peripheral 9/21 Dr. Suzuki's Comment Long-term result of nitinol stenting in the superficial femoral artery % 9 8 7 6 73%@12mo 5 4 3 2 1 71%@24mo 2 month 3 4 9/21 Dr. Suzuki's Comment Stenting of the superficial femoral artery - a clinical update s
Imaging 9/23 Dr. Suzuki's Comment stent thrombosis (mm).8.7.6.5.4.3 IVUS (max Thickness).2.3.4.3.2.1.2.1 NA 1 2 3 Grade 9/23 Dr. Suzuki's Comment Impact of plaque characterization using 64-slice MDCT on PCI outcomes In-Segment Lumen Loss 2.5 2. 1.5 1..5. -.5-1. Ca Score n=16 lesions Pearson r=.5718 p value=.26 2 3 4 5 6 7 8 9 11
Imaging 9/23 Dr. Suzuki's Comment Clinical impacts of multislice CT 9/23 Dr. Suzuki's Comment Cardiac CT -Clinical impact for coronary intervention 12
Renal Failure 9/21 Dr. Suzuki's Comment Prevention and management for contrast-induced nephropathy 39 Trials-5,146 patients Relative risk CIN 7% of all patients CIN 3% of CRI patients 1.9.8.7.6.5.4.3.2.1 Low osmolar is better 1 High osm.61 Low osm 1. Avoid dehydration.45-.9% Saline DIV 12-24hrs before procedure Limit dose <3cc for diagnostic studies <cc for PCI,Use Biplane angiography recommended 2. If PCI is complex, staged PCI at least 48 hours after diagnostic procedure 3. Administer iso-osmolar contact(visipaque) 4. Discontinue NSAIDs and ACEI 5. Discontinue Metformin 6. Routine use Acetylcysteine 7. Sodium bicarbonate is used depending on the renal dysfunction 8. Above standard should be used for a diabetic Pt.with creatinine level>1.2 9/21 Dr. Suzuki's Comment Minimum contrast PCI Engaging guide catheter : using guidewire Wire cross : using prior image Balloon positioning : using IVUS Stent positioning Final result assessment : using IVUS 13