Athrectomie Lithotripsie B.Honton Clinique Pasteur Toulouse - PowerPoint PPT Presentation

Lésions Résistantes : Les Traiter Athérectomie Lithotripsie B.Honton Clinique Pasteur Toulouse

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Calcifications coronaires 1-Year Ischemic Outcomes by Calcification* p = 0.003 19.9 20 NONE/MILD MODERATE SEVERE 15.3 12.9 p = 0.22 p = 0.002 9.4 10 8.7 8.2 7.6 p = 0.0001 7.3 6.3 6.0 p = 0.002 p = 0.01 4.2 4.0 3.4 2.8 2.8 2.4 1.8 1.7 0 Death Cardiac death MI TLR ARC Definite ST MACE 6,855 ACS pts pooled from HORIZONS-AMI and ACUITY trials Majoration TLR – Thrombose de stent DC cardiaque et toute cause 1 Genereux et al. J Am Coll Cardiol 2014 2 ESC Guidelines on myocardial revasculrization

Atherectomie Rotative

Atherectomie Rotative : ROTAPRO TM

Advancer Atherectomie Rotative : ROTAPRO TM Bouton d’activation temporaire du Dynaglide Bouton d’activation du fraisage sur le curseur de l’Advancer Bouton ON / OFF du mode Dynaglide Bouton de libération du frein Pas de changement Fraise – KT guide : identiques

Atherectomie Rotative : Console

ROTAXUS Atherectomie Rotative : Preuves scientifiques p = 1 p = 0,8 p = 0,62 p = 0,58 p = 0,47 De Waha S et al. Catheter Cardiovasc Inte rv. 2016

PREPARE-CALC Trial Atherectomie Rotative : Preuves scientifiques Abdel Wahab et al. Circ Cardiovasc Interv. 2018

scientifiques Atherectomie Rotative : Preuves Euro4C Carrie D et al. EuroPCR 2019

Atherectomie Orbitale

Atherectomie Orbitale : Diamondback 360°

Atherectomie Orbitale : Diamondback 360° Differential Sanding Yes No Calcium Plaque No Yes OAS Crown Pulsatile Forces Low High

ORBIT II Trial Atherectomie Orbitale : Preuves scientifiques 49 US Site 49 US Site Prospective – Single Arm N= 443 Lee et al. Cardiovasc Revasc Med. 2017

ECLIPSE Trial Atherectomie Orbitale : Preuves scientifiques 150 US 150 US Co-Primary Endpoints Site Site * MLA Stent / OCT lors de l’implantation * Target vessel failure (TVF) à 12 mois : Critère composite associant décès d’origine cardiaque, Revascularisation du vaisseaux cible (Myocardial infaction ou ischemia driven) Environ 700 inclusions USA Ouverture en EUROPE… AMM …..

Projection USA Penetration Atherectomie USA 2009 – 2017 1.7% (n=65033)

Lithotripsie intravasculaire

Lithotripsie intracoronaire : Shockwave A picture co ntaining sitting, table Description generated with high confidence Générateur Rechargeable / secteur Emetteur Pulse 1/s – Max 80 pulses Cathéter Connecteur Usage unique Plug magnétique

Lithotripsie intracoronaire : Preuve scientifique Registre POST MARKET N=120 Ali et al. Circ Cardiovasc Interv. 2019

French Shock Initiative – 7 centres Français 99 patients were included - 107 procedures Procedure N = 107 Angio Post IVL N = 107 Target Lesion TIMI Left Main 10 (9,3%) 0 1 ( 0.9%) LAD 40 (37,8%) 3 106 (99.1%) LCX 8 (7%) Dissection 0 (0%) RCA 35 ( 32,7%) Perforation 0 (0%) Bissectrice 1 ( 0,9%) No Reflow 1 ( 0.9%) Venous Graft 1 (0,9%) Residual stenosis 17.1 (14.8%) In stent Restenosis 17 (15,2%) Device Success 104 (97.2%) Lesion mean Length 19.4 (7.7) (mm) Complementary Atherectomy 2 ( 1.9%) Lesion mean stenosis (%) 78.1 (10.3) B2-C Type Lesion 72 (67,2%) Concentric Calcification 59 (57.8%) Eccentric Calcification 43 ( 42.2%) Bifurcation (SB>2mm) 25 ( 23.4%) Submited EuroPCR 2020

French Shock Initiative – Outcome In 6 month 12 month 30 days FU Event Hospital Event FU FU n = 71 N = 99 n = 45 n=20 Cardiac Death 0 (0%) Death All cause 1 (1.4%) 0 (0%) 0 (0%) MACE 9 (9.1%) Cardiac Death 1 (1.4%) 0 (0%) 0 (0%) Periprocedural MI 8 (8.1%) MACE 7 (9.9%) 3 (6.7%) 1 (5.0%) NSTEMI 2 (2.0%) NSTEMI 0 (0%) 0 (0%) 1 (5.0%) STEMI 0 (0%) STEMI 0 (0%) 0 (0%) 0 (0%) Stroke 0 (0%) CD-TLR 0 (0%) 0 (0%) 1 (5.0%) Acute Stent Thrombosis 1 ( 1.0%) CD-TVR 1 (1.4%) 0 (0%) 1 (5.0%) Target Lesion Failure 1 (1.0%) TVNTLR 0 (0%) 1 (2.2%) 0 (0%) Target Vessel Failure 1 (1.0%) Stent Thrombosis 1 ( 1.0%) 0 (0%) 1 (5.0%) Repeat Revascularisation 1 (1.0%) Target Lesion Failure 0 (1.0%) 0 (0%) 1 (5.0%) Target Vessel Failure 1 (1.4%) 0 (0%) 1 (5.0%) Repeat Revascularisation 6 (8.5%) 3 (6.7%) 1 (5.0%) Stroke 0 (0%) 0 (0%) 0 (0%) Submited EuroPCR 2020

De Maria and al. JACC Interv 2019

CONCLUSION Nouveautés - Futur code LPP pour RotaPRO -Probable AMM proche pour l’athérectomie Orbitale -Intégration IVL dans nos Cath-Lab Questions Dichotomie entre CROYANCE PREP LESION - PREUVES SCIENTIFIQUES Perspectives Recherche Clinique – Registre Prospectif France LILI