Cath Lab Digest - September 2007 - (Page 13)

13 There is the issue of control over the timing of absorption of the stent, not too fast but not too slow. There will be recoil and particularly in the calcified vessels, I would not put in a (current generation) bioabsorbable stent. However, I expect over time, new technology will provide us with bioabsorbable stents with better mechanical properties. What are the future plans for Genous stent data presentation? We have done a pilot study here at Academic Medical Center (AMC), randomizing patients between a Genous stent and Taxus, and we are doing follow-up angiograms on these patients. I am not sure that the full dataset will be available at the time of TCT this October, but hopefully it will be. We will also show results from e-HEALING at TCT. About three years ago, I predicted that there was going to be a serious concern about late stent thrombosis, based on seeing just our own cases of late stent thrombosis at AMC. With the adoption of DES by the interventional community, what is happening now could be foreseen a couple of years ago. At our center, we have been cautious with the use of DES. In the beginning, the use of DES in our lab was just in patients that otherwise would have gone on to bypass surgery and treatment of in-stent restenosis. We are still using a maximum 20–25% of DES in our patient population. In particular, the patients who are treated for acute myocardial infarction and undergo primary PCI are treated with BMS. Now, increasingly, we are treating some of these patients with DES, but we are also turning to the Genous stent for longer segments and chronic total occlusions. I think that at the present time, Genous is one of the candidates that will likely replace the first generation of DES, because the performance is good and there is no risk of late stent thrombosis.■ Genous Case #2 (Figures 5-6) • • • • Male 66 years old Angina NYHA 3/4 Statin, beta-blocker, nitrate, ASA • Occlusion dominant RCA • Scheduled for hemicolectomy for colon cancer within next weeks. stent, which we were using in our cath lab before the bio-engineered version. We are particularly fond of the design, which is perfectly suited for treating bifurcated lesions. I think the deliverability of the Genous is better than the Cypher, and comparable but a little better than a Taxus stent. We have Cypher and Taxus and we now have the Xience V stent available in our cath lab, and I think that the Genous is comparable to Xience V in terms of the profile and trackability. Considering your experience with the Genous stent, how do you feel another type of stent under development, the bioabsorbable stent, will fit into patient treatment options? It’s an interesting concept. If you think of having a metal scaffolding in the proximal part of your coronary artery, when the vessel is healed and the vessel is patent, then stented segments usually stay stable. It may very well be that having a metal scaffolding in the proximal part of your coronary artery is not a bad thing. You may think that it is unnatural to have metal in your coronary artery, so if you have a bioabsorbable stent which performs as well as a metal stent, it could be an advantage. I think bioabsorbable stents may prove useful in cath labs where they have the tendency to stent long segments of the coronary arteries. If you give a patient a “full metal jacket” in the right coronary artery, and he subsequently is eligible for coronary artery bypass surgery, then all the stented segments provide the surgeon with a problem — where to put his bypass graft? That may be an application for bioabsorbable stents. From the data I have seen at this particular time, I think bioabsorbable stents do not have the scaffolding properties of metal stents. Figure 5. RCA occlusion pre procedure Figure 6. RCA post procedure, 3.0 x 33 mm Genous would do spot stenting and leave the aneurysms alone, but now with the Genous stent we can just treat the whole segment. If I look at the practice in our cath lab, of course, we have become more and more aware of the fact that you don’t want to have patients on dual anti-platelets for 6 months or 12 months or even longer. Thus there are many patients that we now treat with the Genous stent because we want to put them on dual anti-platelets for a shorter period of time, as we did with bare metal stents. Can you tell us about the stent from an operator perspective? The Genous stent became commercially available to our center in September 2005, and prior to that we participated in the HEALING II study, so our center had some experience with Genous prior to it becoming commercially available. Of course, the stent platform is the bare-metal R Reference 1. Virmani R, Farb A, Kolodgie FD. Histopathologic alterations after endovascular radiation and antiproliferative stents: similarities and differences. Herz 2002 Feb;27(1):1-6. Dr. de Winter can be contacted at: Academic Medical Center Amsterdam Dept of Cardiology, B2-137 Meibergdreef 9 1105 AZ Amsterdam, The Netherlands Email: r.j.dewinter@amc.uva.nl

Table of Contents Feed for the Digital Edition of Cath Lab Digest - September 2007

St. Dominic Hospital The Genous Bio-engineered R Stent Percutaneous Treatment of Peripheral Arterial Chronic Total Occlusions: Device Options and Clinical Outcomes Contents Clinical Editor’s Corner Percutaneous Revascularization of Peripheral Chronic Total Occlusion — Which Patients, Why, and How? Myocardial Infarction and Syncope: A Manifestation of the “Raynaud-Prinzmetal Syndrome”? Essential Technical Components of the Transradial Approach If You Build It, Will They Come? Evidence-Based Medicine with Drug-Eluting Stents Back to School: The Value of Education in Cardiovascular Services The ACVP Standards and Competencies: Are You Using Them Effectively? What Do You Think? My Experience with Fibromuscular Dysplasia and Stroke A Brief Review of Fibromuscular Dysplasia Letter to the Editor A Look at On-the-Job Training: Perceptions, Reality and Our Profession Doing the Wave: Inventory Management with RFID The Ten-Minute Interview with… Paul Pinsker, RCIS CLD’s Annual Salary Survey Harrisburg Area Community College Volunteer Survey CEU Education Center SICP* Section Ask the Clinical Instructor: A Q&A Column for Those New to the Cath Lab Clinical & Industry News

Cath Lab Digest - September 2007

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