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

Oct 26, 2022 •412 likes •661 views

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

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

  2. Disclosure • None

  3. 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

  4. Atherectomie Rotative

  5. Atherectomie Rotative : ROTAPRO TM

  6. 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

  7. Atherectomie Rotative : Console

  8. 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

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

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

  12. Atherectomie Orbitale

  13. Atherectomie Orbitale : Diamondback 360°

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

  15. 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

  16. 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 …..

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

  18. Lithotripsie intravasculaire

  19. 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

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

  21. 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

  22. 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

  23. De Maria and al. JACC Interv 2019

  24. 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

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