Ứng dụng của stent tự tiêu trong can thiệp mạch vành cấp

9-11th Oct 2016, Hanoi 15th VNCC

Bioabsorbable Vascular
Scaffolds in Primary PCI
Koh Tian Hai
National Heart Centre, Singapore


Conflicts of Interest

► Nil

with regards to this presentation


HORIZONS Trial: PES vs BMS at 30 days
TLR, all cause mortality & Stent Thrombosis:
Ischaemic TLR

Ischaemic TLR

& angio follow-up

No angio follow-up

All cause
mortality

Stent
Thrombosis

GW Stone et al. Lancet2011; 377:; 2193-204


Absorb III Trial

2008 pt
Randomised 2:1 BRS vs EES
1 end pt: TLF at 1 yr for
non-inferiority
and superiority

SG Ellis et al. NEJM 2015; 373: 1905-15


ABSORB III – Target Lesion Failure at 1 yr
Non Inferior

TLF: Card Death, TV-MI, ID-TLR

SG Ellis et al. NEJM 2015; 373: 1905-15


Safety &
Efficacy
Outcomes
at 1yr

SG Ellis et al. NEJM 2015; 373: 1905-15

Safety &
Efficacy
Outcomes
at 1yr

SG Ellis et al. NEJM 2015; 373: 1905-15


Why BRS in STEMI?
► Young

patient: benefit from long term freedom
from permanent stent caging.

► Vasomotion

recovery.

► Favourable

long term remodelling.

► Potential

plaque sealing.


Young Man, smoker, with sudden
chest pain

Case courtesy of Dr Jack Tan, NHCS


BRS in STEMI


Post aspiration

Desolve BRS

NC inflation

Post NC inflation

BRS Inflation

OCT evaluation


final


ECG in CCU later
the same day
OCT LCX


Randomised BRS Trials in STEMI

M Sabate et al. EHJ 2016; 37: 229-240


1 end pt: healing score at 6mths

M Sabate et al. EHJ 2016; 37: 229-240


PRAGUE -19

P Tousek et al. IJC 2016


PRAGUE-19 2yr Results

P Tousek et al. IJC 2016


Potential Risks of BRS implants in STEMI
► Thrombogenic

► Large

milieu promotes Stent Thrombosis

profile device promotes abnormal sheer stress->

ST
► Potential

for acute malapposition due to thrombus
resorption.

► Scaffold

underexpansion due to undersizing with
vasoconstricted vessel.


ABSORB II at 1yr: Stent Thrombosis
(Define or Probable)
Absorb
N=335

EES
N=166

P=0.55

PW Serruys et al. Lancet; online 14 Sept 2014


Ghost Multicentre Registry-1189 patients
Def/Prob Scaffold Thrombosis to 6 mths
ST= 1.5% at 30 days, 2.1% at 6 mths

D Capodanno et al. EuroIntv 2014 July online


VLST-OCT & Histology

L Raber et al. JACC 2015: 66:1901-14


Mechanisms of Very Late Stent Thrombosis

Scaffold discontinuity
Uncovered struts
with thrombus
Restenosis

L Raber et al. JACC 2015: 66:1901-14


Safety of BVS in randomised Trials
patient level meta-analysis

GW Stone et al. Lancet 2016; 387: 1277-89


Results

GW Stone et al. Lancet 2016; 387: 1277-89