LES STENTS BIORESORBABLES: UN AVENIR ? Ren Koning St Hilaire, Rouen - PowerPoint PPT Presentation

LES STENTS BIORESORBABLES: UN AVENIR ? René Koning – St Hilaire, Rouen

(Circ Res. 2017;120:1341-1352. DOI: 10.1161/CIRCRESAHA.117.310275.)

Septembre 2017

POURQUOI RK Y CROIS ENCORE?

Baseline 6 Months 2 Years 5 Years Cohort B OCT images - courtesy of RJ van Geuns, Erasmus Medical Center, Netherlands De Bruyne, B. TCT 2014

On a voulu aller trop vite !

EuroIntervention 2019;15:28-30

S. ELLIS

FIN DU CONCEPT BIORESORBABLE ?

Mammaire Interne Gauche – IVA implantée il y a 35 ans …

(?) LIMITES DES

EXAMINATION: 5-year results of a randomised trial (STEMI) Lancet 2016; 387: 357 – 66, M Sabate.

NEOATHEROME 15 ANS PLUS TARD! 11/09/2001

NEO-ATHEROME A Lipid-laden neointima. B Neointima with calcification S.Y. Lee, Circ Cardiovasc Interv. 2015;

S.Y. Lee, Circ Cardiovasc Interv. 2015 ;

“And we know that metallic DES from years 3 to 10, and probably for the life of the patient, have about a 2-3% per year rate of TLF. So if Absorb or a bioresorbable scaffold can capture back a 1% or a half percent of those events on a per year benefit, then it won’t be many years at all before it makes up that early difference.” G. STONE,2017 “The reason to persevere is not because of any expectation that scaffolds can beat metal stents in the intermediate term, but the concern that metal stents will begin to produce significant adverse events many years after implantation. That will have to become a demonstrated reality rather than a hypothetical speculation for bioresorbable scaffolds to replace metal stents.”

ESPOIR !

SUIVI A 1 AN (N = 135) Circulation Journal doi: 10.1253/circj.CJ-19-0636 PRE DILATATION 100% OPTIMAL SIZNG OCT 100% POST DILATATION 100%

Pas de différence de mortalité

Pas de Thrombose entre 3 et 4 ans ! ABSORB II à 4 ans

FRANCE ABSORB 3 ANS MACE and BVS THROMBOSIS INCIDENCE RATES MACE incidence rate (for 1000 patient-years) Definite or probable BVS thrombosis incidence rate (for 1000 patient-years) EUROPCR 2019

Time-Varying Outcomes With the Absorb Bioresorbable Vascular Scaffold During 5-Year Follow-up A Systematic Meta-analysis and Individual Patient Data Pooled Study (JAMA 2019) G. Stone…. .P. Serruys

(Circ Res. 2017;120:1341-1352. DOI: 10.1161/CIRCRESAHA.117.310275.)

(Circ Res. 2017;120:1341-1352. DOI: 10.1161/CIRCRESAHA.117.310275.)

M HAUDE

M HAUDE

Three-year clinical and two-year multimodality imaging outcomes of a thin-strut sirolimus-eluting bioresorbable vascular scaffold: MeRes-1 trial, Ashok Seth,…. EuroIntervention 2019;15:607-614.