Andrew Wiper

Incidence and mechanisms of longitudinal stent deformation associated with Biomatrix, Resolute, Element, and Xience stents: Angiographic and case-by-case review of 1,800 PCIs.

There is conflicting evidence regarding the incidence of longitudinal stent deformation (LSD) in contemporary practice.

A Comparison of Drug-Eluting Stents versus Bare Metal Stents in Saphenous Vein Graft PCI Outcomes: A Meta-Analysis

AIMS Studies demonstrate that percutaneous coronary intervention (PCI) with drug-eluting stents (DES) is associated with reduced revascularization and major adverse cardiac events (MACE) rates compared to bare metal stents (BMS) in native coronary vessels. Optimal PCI treatment of saphenous vein graft (SVG) lesions remains unclear despite SVG procedures representing up to 10% of PCI cases. We therefore performed a meta-analysis to compare outcomes between BMS and DES in SVG PCI. METHODS AND RESULTS A search (2004-2009) of MEDLINE and conference proceedings for all relevant studies comparing mortality and MACE outcomes in DES versus BMS in SVG PCI and meta-analysis of the data was performed. Twenty studies were identified from 2005 to 2009 enrolling a total of 5,296 patients. Meta-analysis revealed a decrease in mortality associated with DES use, odds ratio (OR) 0.68; 95% confidence interval (CI) 0.53-0.88; P = 0.004. Similarly, MACE (OR 0.64; 95% CI 0.51-0.82; P < 0.001), total lesion revascularization (OR 0.60; 95% CI 0.43-0.83; P = 0.002), and total vessel revascularization (OR 0.57; 95% CI 0.41-0.80; P = 0.001) were significantly decreased in the patients in which DES were used compared to BMS. This reduction in mortality and MACE events associated with DES use appears to be limited to registry studies and not randomized controlled studies. CONCLUSIONS Our meta-analysis suggests DES use to be safe in SVG PCI and associated with reduced mortality and MACE rates with reductions in revascularization also observed.

Use of the Sideguard (Cappella) stent in bifurcation lesions: a real-world experience.

AIMS The Sideguard® stent (Cappella Medical Devices Ltd, Galway, Ireland), is a novel nitinol self-expanding dedicated bifurcation stent that flares proximally at the ostium of the side branch (SB) into a trumpet shape thereby achieving full ostial coverage. The aim of this study is to report the utility and limitations of this stent in patients undergoing treatment to bifurcation coronary lesions in a real-world setting. METHODS AND RESULTS We prospectively identified 20 successive patients admitted over a 6-month period in whom there was significant SB disease and who were suitable for a bifurcation procedure. The Sideguard® stent was successfully used in all 20 cases including several that would have been technically difficult using conventional bifurcation techniques. We highlight use of this system using five illustrative cases that illustrate its utility and limitations in the treatment of bifurcation lesions. CONCLUSIONS The Sideguard® stent can be used to treat complex bifurcation lesions in a straight forward manner and is not subject to the limitations associated with conventional bifurcation PCI techniques including jailing of the SB ostium and inability to fully cover/scaffold the ostium of the SB.

Balloon assisted retraction of a migrated CoreValve Evolut R bioprosthesis during cardiac arrest

We describe a case of balloon assisted retraction of a migrated CoreValve Evolut R bioprosthesis during trans-femoral TAVI.

37 Decrease in mace rates associated with drug eluting stent use in patients with diabetes undergoing PCI in large diameter coronary arteries

Introduction Both large multi centre trials and registry studies have demonstrated that PCI with drug eluting stents (DES) is associated with reduced MACE and restenosis rates compared to bare metal stents (BMS) in native coronary vessels, although this benefit is less evident in those patients with a larger coronary vessel diameter and MACE rates may actually paradoxically increase in this cohort as observed in the BASKET trial. In diabetic patients, a similar or even greater absolute reduction in MACE rates / restenosis risk is seen associated with DES use, although it is unclear as to whether any benefit persists in those with larger diameter native coronary vessels. Previous data derived from diabetic patients in large diameter native coronary vessels has come from registry studies in which numbers were either small (<200 patients) or were from highly selected patient sub groups excluding high-risk individuals (SCAAR registry). Methods We therefore retrospectively studied 1165 consecutive diabetic patients with target vessel diameter ≥3 mm admitted to our centre for PCI from 2003 to 2009, the largest series of its kind to date. Primary endpoint was defined as total mortality and secondary endpoint was major adverse cardiac event (MACE) defined as composite endpoint of Death, Stroke, MI, Stent Thrombosis and Target Lesion / Vessel Re-Vascularisation. Results Of the 1165 patients studied, 170 had BMS and 995 had DES. Mean follow-up period was 43.3±21.8 months (median 41.8 months). 73.5% were male in the BMS cohort vs 73.1% in the DES cohort (p>0.05). Mean age was 62.8±11.2 in BMS and 62.3± 10.4 years old in DES (p=0.55). Other demographic parameters were similar in both groups. There were a total of 23/170 deaths in BMS cohort (13.5%) and 91/995 in DES cohort (9.1%), (HR 1.38; 95% CI 0.83 to 2.27, p=0.21). A total of 42/170 (24.7%) and 163/995 (16.3%) MACE events were observed in the BMS and DES cohort respectively (HR 1.49; 1.02 to 2.19, p=0.04). Multivariate analysis illustrated that use of BMS was independently associated with increased risk of MACE (HR 1.54; 95% CI 1.05 to 2.25, p=0.03), driven through an increase in revascularisation. Conclusion In conclusion, in one of the largest analyses of its kind, use of DES in patients with diabetes in a real world setting undergoing PCI in large diameter coronary vessels (≥3 mm) is safe and is independently associated with a reduction in MACE events. This is in contrast to that of non-diabetic patients where the benefits of DES in large diameter coronary vessels are less evident.