Provisional T stenting in the treatment of coronary

Provisional T stenting in the treatment of coronary bifurcation lesions with the new generation of paclitaxel eluting stents: Pilot phase results of the Liberty One Study Philippe BRUNEL, NANTES FRANCE ESC 02/09/2008

Dr. Paul Dupont Azertyuiop qsdfghjkllm Wxccvbn?

Welcome to the 4 th LOGOS DES SPONSORS European Bifurcation Club 26 -27 September 2008 PRAGUE

perfect ostial stent positionning is difficult (impossible? ? . . . ) Medina Type 001 coronary bifurcation lesions are very challenging, (specially in Y shape) ü perfect ostial stent positionning is difficult (impossible? ? . . . ) ü stent protrusion or ü poor ostial coverage ü high risk of plaque or carina shift (in the main branch)

conclusion ü Provisional T stenting in the treatment of coronary bifurcation lesions with the new generation of paclitaxel eluting stents (one stent in 88. 4% of CBL) provided sustained benefit at 8 -month follow-up. ü The stent thrombosis rate of 0. 9% and the TLR rate of 6. 6% were particularly low for this complex lesion subset. ü Results of the Liberty One study pilot phase are very promising, therefore leading to perform larger controled studies.

The SURF registry 21 ST Annual Interventional Cardiology 2006 P. Brunel One stent for two branches P. Brunel

‘INVERTED Provisional T’ for TYPE 001 LESIONS Different strategies to achieve the best treatment with ‘perfect’ ostial coverage and no main vessel dammage ü ‘Angulated’ and or funnel-shaped of the proximal stent part : pb is positionning ü Correction of the plaque or carina shift ü Delivery systems : to date no friendly-user, not available

‘INVERTED Provisional T’ for TYPE 001 LESIONS Provisional T stenting ü Demonstrated safety and efficacy ü Best results in the litterature ü Better results with DES ü ‘our strategy for all CBL

‘INVERTED Provisional T’ for TYPE 001 LESIONS Inverted T stenting : ü Two 0. 014 wires ü Predilate or not ü Implant a stent from main vessel to side-branch ü Cross the mesh from the main vessel proximal part to the main vessel distal part ü Kissing balloon ü Second stent on main vessel distal part if necessary

‘INVERTED Provisional T’ for TYPE 001 LESIONS Bench demonstration of Inverted T stenting : üa

Population

Résultats cliniques

Données angiographiques

Données de la procédure Actifs 92%

‘INVERTED Provisional T’ for TYPE 001 LESIONS other strategies such ü debulking or cutting balloon may be considered. ü Medical treatment, CABG should also be discussed.

‘INVERTED Provisional T’ for TYPE 001 LESIONS

‘INVERTED Provisional T’ for TYPE 001 LESIONS

brunel-philippe@wanadoo. fr