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Athrectomie Lithotripsie B.Honton Clinique Pasteur Toulouse - - PowerPoint PPT Presentation
Athrectomie Lithotripsie B.Honton Clinique Pasteur Toulouse - - PowerPoint PPT Presentation
Lsions Rsistantes : Les Traiter Athrectomie Lithotripsie B.Honton Clinique Pasteur Toulouse Disclosure None Calcifications coronaires 1-Year Ischemic Outcomes by Calcification* p = 0.003 19.9 20 NONE/MILD MODERATE SEVERE
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1Genereux et al. J Am Coll Cardiol 2014 2ESC Guidelines on myocardial revasculrization
Majoration TLR – Thrombose de stent DC cardiaque et toute cause
2.8 1.8 7.3 6.0 1.7 12.9 4.2 2.8 7.6 8.2 3.4 15.3 6.3 4.0 9.4 8.7 2.4 19.9
10 20
Death Cardiac death MI TLR ARC Definite ST MACE NONE/MILD MODERATE SEVERE
p = 0.01 p = 0.003 p = 0.0001 p = 0.22 p = 0.002 p = 0.002
6,855 ACS pts pooled from HORIZONS-AMI and ACUITY trials
1-Year Ischemic Outcomes by Calcification*
Calcifications coronaires
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Atherectomie Rotative
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Atherectomie Rotative : ROTAPROTM
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Pas de changement
Bouton de libération du frein
Bouton d’activation temporaire du Dynaglide Bouton ON / OFF du mode Dynaglide Bouton d’activation du fraisage sur le curseur de l’Advancer
Fraise – KT guide : identiques
Atherectomie Rotative : ROTAPROTM Advancer
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Atherectomie Rotative : Console
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De Waha S et al. Catheter Cardiovasc Interv. 2016
p = 1 p = 0,8 p = 0,62 p = 0,58 p = 0,47
Atherectomie Rotative : Preuves scientifiques ROTAXUS
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Abdel Wahab et al. Circ Cardiovasc Interv. 2018
Atherectomie Rotative : Preuves scientifiques PREPARE-CALC Trial
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Carrie D et al. EuroPCR 2019
Atherectomie Rotative : Preuves scientifiques Euro4C
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Atherectomie Orbitale
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Atherectomie Orbitale : Diamondback 360°
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Atherectomie Orbitale : Diamondback 360°
No Yes Yes No
Differential Sanding Pulsatile Forces
Plaque Calcium OAS Crown
High Low
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Lee et al. Cardiovasc Revasc Med. 2017
Prospective – Single Arm N= 443 49 US Site 49 US Site
Atherectomie Orbitale : Preuves scientifiques ORBIT II Trial
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Co-Primary Endpoints
* 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) 150 US Site 150 US Site
Environ 700 inclusions USA Ouverture en EUROPE… AMM …..
Atherectomie Orbitale : Preuves scientifiques ECLIPSE Trial
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Projection USA
Penetration Atherectomie USA 2009 – 2017 1.7% (n=65033)
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Lithotripsie intravasculaire
SLIDE 19 A picture co ntaining sitting, table Description generated with high confidence
Générateur
Rechargeable / secteur
Connecteur
Plug magnétique
Cathéter
Usage unique
Emetteur
Pulse 1/s – Max 80 pulses
Lithotripsie intracoronaire : Shockwave
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Lithotripsie intracoronaire : Preuve scientifique
Registre POST MARKET N=120
Ali et al. Circ Cardiovasc Interv. 2019
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French Shock Initiative – 7 centres Français
99 patients were included - 107 procedures
Angio Post IVL N = 107 TIMI 1 ( 0.9%) 3 106 (99.1%) Dissection 0 (0%) Perforation 0 (0%) No Reflow 1 ( 0.9%) Residual stenosis 17.1 (14.8%) Device Success 104 (97.2%) Complementary Atherectomy 2 ( 1.9%) Procedure N = 107 Target Lesion Left Main 10 (9,3%) LAD 40 (37,8%) LCX 8 (7%) RCA 35 ( 32,7%) Bissectrice 1 ( 0,9%) Venous Graft 1 (0,9%) In stent Restenosis 17 (15,2%) Lesion mean Length (mm) 19.4 (7.7) 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
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Event 30 days FU n = 71 6 month FU n = 45 12 month FU n=20 Death All cause 1 (1.4%) 0 (0%) 0 (0%) Cardiac Death 1 (1.4%) 0 (0%) 0 (0%) MACE 7 (9.9%) 3 (6.7%) 1 (5.0%) NSTEMI 0 (0%) 0 (0%) 1 (5.0%) STEMI 0 (0%) 0 (0%) 0 (0%) CD-TLR 0 (0%) 0 (0%) 1 (5.0%) CD-TVR 1 (1.4%) 0 (0%) 1 (5.0%) TVNTLR 0 (0%) 1 (2.2%) 0 (0%) Stent Thrombosis 1 ( 1.0%) 0 (0%) 1 (5.0%) 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%) Event In Hospital N = 99 Cardiac Death 0 (0%) MACE 9 (9.1%) Periprocedural MI 8 (8.1%) NSTEMI 2 (2.0%) STEMI 0 (0%) Stroke 0 (0%) Acute Stent Thrombosis 1 ( 1.0%) Target Lesion Failure 1 (1.0%) Target Vessel Failure 1 (1.0%) Repeat Revascularisation 1 (1.0%)
French Shock Initiative – Outcome
Submited EuroPCR 2020
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De Maria and al. JACC Interv 2019
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CONCLUSION Nouveautés
- Futur code LPP pour RotaPRO
- Probable AMM proche pour l’athérectomie Orbitale
- Intégration IVL dans nos Cath-Lab