finet influence bif angle repot · 2016. 11. 7. · gérard finet, md phd françois derimay, md....
TRANSCRIPT
TheinfluenceofbifurcationangleontherePOTsequence
DepartmentofCardiologyandInterventionalCardiologyCardiovascularHospital- HospicesCivilsdeLyonINSERMResearchUnit1060CarMeNClaudeBernardUniversityLyon1Lyon- France
XIIEuropeanBifurcationClubmeeting– Rotterdam– October2015
GérardFINET,MDPhDFrançoisDERIMAY,MD
carena- plaque-freesegment- thin- potentialymovable- oppositetoplaquegrowth
carena
carenashifting
Radialstrainmapduringstentimplantation
bifangle
Bifurcationangleandcarenashifting
FinetGetOhayonJ(EBC2012)
Courtesy:DrR.Virmani
30°-bifangle 60°-bifangle 90°-bifangle
LinearfractalratioDmother-vessel =0.678(Ddaughter-vessel1 +Ddaughter-vessel2)
b =a1+a2a1
a1
DMoV =4.25mmDMB =3.25mm
DSB =2.9mm
a1 a1 b
BenchA 20° 10° 30°
BenchB 20° 40° 60°
BenchC 20° 70° 90°
Newfractalbifurcationbenchmodelswithdifferentbifurcationangle
Fractalbifurcationbenchmodel90° bifurcationangle
rePOT POT+KBcomplete
balloonjuxtaposition
POT+KBminimal
balloonjuxtaposition
DrefMoV/DstentedMoV /SARMoV 4.29/4.28mm/1.0 4.21/4.38mm/1.01 4.23/4.30mm/1.01
Ellipticalratio 1.03 1.19 1.04
DrefMB /DMB/SARMB 3.26/3.40mm/1.04 3.28/3.53mm/1.07 3.25/ 3.45mm/1.06
DMBostium 3.83mm 3.46mm 3.60mm
DdistalMOV /ellipticratio 4.13mm/1.04 4.36mm/1.21 4.23mm/1.18
DstentedMoVSARMoVEllipticalratio
SBobstruction
DMBostium
DMBSARMB
D distalMoVEllipticalratio
DrefMoV
DrefMB
Fractalbifurcationbenchmodel60° bifurcationangle
rePOT POT+KBcomplete
balloonjuxtaposition
POT+KBminimal
balloonjuxtaposition
DrefMoV/DstentedMoV/SARMoV 4.07/4.23mm/1.03 4.07/4.40mm/1.04 4.27/4.45mm/1.01
Ellipticratio 1.03 1.19 1.01
DrefMB /DMB/SARMB 3.18/3.44mm/1.08 3.27/3.46mm/1.10 3.24/3.49mm/1.07
mean DMB ostium 3.93mm 3.60mm 3.52mm
DdistalMOV /ellipticratio 4.17mm/1.05 4.37 mm/1.20 4.28mm/1.09
DstentedMoVSARMoVEllipticalratio
SBobstruction
DMBostium
DMBSARMB
D distalMoVEllipticalratio
DrefMoV
DrefMB
Fractalbifurcationbenchmodel30° bifurcationangle
rePOT POT+KBcomplete
balloonjuxtaposition
POT+KBminimal
balloonjuxtaposition
DrefMoV/DstentedMoV/SARMoV 4.30/4.30mm/1.0 4.24/4.41mm/1.03 4.33/4.39mm/1.01
Ellipticratio 1.04 1.28 1.05
Dref /DMB/SARMB 3.35/3.55mm/1.05 3.24/3.52mm/1.07 3.18/3.42mm/1.07
mean DMB ostium 3.92mm 3.50mm 3.50mm
DdistalMOV /ellipticratio 4.28mm/1.09 4.43mm/ 1.26 4.32/1.12
DstentedMoVSARMoVEllipticalratio
SBobstruction
DMBostium
DMBSARMB
D distalMoVEllipticalratio
DrefMoV
DrefMB
ImmediateinvivoassessmentofrePOTsequenceinprovisionalcoronarystentingSerialOCTanalysis
InfluenceofMedinaclassification100bifurcations 1-0-0
n=13(13%)010– 110– 010n=42(42%)
001– 101– 011n=18(18%)
111n=27(27%)
Afterstent implantation
a° bif angle 70± 26° 67±18° 66±23° 74±18°
MeanDMoV 3.76± 0.78mm 3.76±0.69mm 3.6±0.6 mm 3.65±0.51mm
Meanstent D 3.08± 0.58mm 3.10±0.55mm 3.02±0.51mm 2.98±0.35mm
∆D(proximalunderexpansion)
0.67± 0.57mm 0.60±0.44 mm 0.58±0.39mm 0.67±0.41mm
SBOobstruction 37.63± 18.55% 34.54±22.91% 29.1±25.9% 38.31±25.15 %
AfterrePOTsequence
meanDMoV /SARMoV 3.73±0.61mm0.94±0.38
3.94±0.701.04±0.08
3.80±0.641.08±0.07
3.77±0.52mm1.03±0.1
meanDMB/SARMB 3.16±0.58mm0.95±0.39
3.08±0.551.09±0.19
2.86±0.511.04±0.08
2.97±0.51mm1.05±0.1
SBOobtruction% 17.0±18.7 % 11.73±16.57% 12.28±21.24% 10.44±12.6%
Finalglobalstrutmalapposition(%)
6.4±5.4% 2.8±3.08% 2.91±3.3% 2.77±4.2
100bifurcations a° :20° - 40°n=17(17%)
a° :45° - 70°n=35(35%)
a° :80° - 110°n=48(48%)
Afterstent implantation
MeanDMoV 3.73± 0.65mm 3.38±0.52mm 4.13±0.67mm
Meanstent D 3.08± 0.51mm 2.95±0.49mm 3.14±0.57mm
∆D(proximalunderexpansion)
0.59± 0.34mm 0.43±0.37mm 0.84±0.39mm
SBOobstruction 38.9± 21.3% 34.2±22.3 % 33.3±24.8
AfterrePOTsequence
SARMoV 1.03± 0.06 1.02± 0.24 1.01± 0.13
SARMB 1.0± 0.12 1.07± 0.28 1.05± 0.11
SBO% 13.2± 15.0% 23.1± 22.1% 9.84± 12.5%
Globalstrutmalpposition(%)
2.71±2.76% 2.52± 2.37% 4.05± 4.88%
ImmediateinvivoassessmentofrePOTsequenceinprovisionalcoronarystentingSerialOCTanalysis
Influenceofbifurcationanglebetweentwodaughtervessels
Summary
Theoretically bifurcation angle plays a negative role in the treatment ofbifurcation with provisional stenting
This negative role increases as the cosinus of the bifurcation angle, thisrelationship is curvilinear and becomes major for small angles close to 30 °
However:1) in fractal bifurcation bench models, rePOT sequence produces rather
constant results if the precise positioning of the POT balloon is welldone,
1) in clinical study with OCT analysis, bifurcation angles do not influencethe final morphological results after rePOT sequence