Mẹp nong bóng trước và sau khi đặt stent kinh nghiệm từ stent phủ thuốc đến stent tự tiêu

Tips and Tricks From DES to BRS Khôi Minh Lê, MD, FACC, FSCAI Co-Director Cardiac Cath Lab Eisenhower Medical Center Rancho Mirage, CA Absorb GT1 Only BRS currently available in the US Absorb: What’s Different? Absorb polymer ≠ Cobalt alloy Strut size a Thickness 157 (vs 89 μm for Xience) b Width 190.5 – 215.9 μm (vs 90 μm for Xience) Crossing profile A-BVS 1.42 mm (vs Xience 1.07 mm) Does not score the vessel like a metallic stent and therefore requires more thorough lesion preparation Absorb’s maximum expansion range (≤0.5 mm) is less than that of current metallic stents Radiolucent, cannot be visualized with x-ray equipment Lesion Selection • • • • • • De novo native lesion 24 mm or less 2.5 to 3.75 mm reference vessel diameter Non-ostial Avoid jailing side branches ≥2.0 mm Avoid heavily calcified, eccentric lesions Recognize the Differences Between CoCr and PLLA • The Absorb polymer is viscoelastic which means it is temperature and rate sensitive The Absorb scaffold needs to expand slowly to optimally realign the polymer chains • After reaching the desired atmosphere it is important to hold for 30 seconds in order for the polymer to reset its memory from being in the crimped state If the “hold time” is too short the scaffold may experience slight recoil Deployment Procedure • Deploy the scaffold slowly, in 2-atm increments, over seconds, until scaffold is completely expanded – Use a constant, slow inflation – Count (“1, 2, 3, 4, 5” while going up atm) and repeat – [Not cutting balloon technique of quickly going up to atms] • Nominal pressures: – atm for 2.5 and 3.5 mm – atm for 3.0 mm • Deployment pressures should range from 10 – 16 atm • Hold maximum pressure for 30 seconds (if tolerated) Early Experience and Absorb-Specific Protocol Oversized scaffolds* Incomplete deployment *