Stent di ultima generazionee durata della terapia

antiaggregante piastrinica: a che punto siamo?Alessandria, 7 Dicembre 2019

Gioel Gabrio Secco, MD, PhDInterventional CardiologySS Antonio e Biagio e Cesare ArrigoAlessandria, Italy

i-LAB Berlin 8.-9. November 2018

2

PRESENTER’S CONFLICT OF INTERESTS

I have the following potentially relevant conflict of interests:

Consulting, research grants, travel reimbursement, speaker honorarium:

• St Jude Medical – Abbott Vascular

• Biotronik

• Boston Scientific

• SIS Medical

• Philips Volcano corp

• Stentys

• Teleflex

• Terumo

PLAIN OLD BALLOON ANGIOPLASTY

Andreas R. Gruentzig(1939–1985)

PLAIN OLD BALLOON ANGIOPLASTY

BARE METAL STENT

Julio Palmatz

BARE METAL STENT

The BENESTENT trial

Serruys PW et al. NEJM; 1994; 331:489-95

INCIDENCE of RESTENOSIS

The STRESS I-II trial

CLINICAL EVENTS

Fischman DL, et al. N Engl J Med 1994;331:496-501

BARE METAL STENT

DRUG ELUTING STENT

DRUG ELUTING STENT

DRUG ELUTING STENT

2nd Generation DRUG ELUTING STENT

DRUG TYPE & CONCENTRATION

Awata M et al. J Am Coll Cardiol. 2008;52:789-90.

2nd Generation DRUG ELUTING STENT

POLYMER

Byrne RA, Kastrati A et al. Eur Heart J 2009;30:923–31.Lupi A, Secco GG et al Cath Cardiovasc Interv 2014

2nd Generation DRUG ELUTING STENT

STENT DESIGN & STRUT THICKENESS

Turco MA, Ormiston JA, Popma JJ, et al. J Am Coll Cardiol 2007.

DEVELOPMENTS IN DRUG-ELUTING STENT TECHNOLOGY

OVERVIEW OF SELECTED AVAILABLE METALLIC DRUG-ELUTING STENTS DESIGNS

IMPROVE TISSUE BIOCOMPATIBILITY, ENHANCE ARTERIAL HEALINGAND REDUCE LONG-TERM ADVERSE ISCHEMIC AND THROMBOTIC EVENTS

Is “ISR” always the same?

Secco GG, Di Mario C. Int J Cardiol 2015

2nd Generation DES: ISR

QUANLITATIVE OCT ANALYSIS

2nd Generation DRUG ELUTING STENT

DAPT: quale e per quanto tempo?

DAPT: quale e per quanto tempo?

DAPT: quale e per quanto tempo?

DAPT: quale e per quanto tempo?

DAPT: quale e per quanto tempo?

DAPT: quale e per quanto tempo?

OCT T 0

OCT

T1 7 d

OCT T2 30 d

OCTT 3

45 d

OCT

T4 90gg

OCTT5 180 d

RCA

7 days FU

RCA

90 days FU

ORSIRO HEALING PROPERTIES

RCA

3 months FU

LCX

3 months FU

ORSIRO HEALING PROPERTIES

“ The more I see, the less I knowfor sure”