新一代DES的抗血小板治疗 PPT.pptxVIP

Anti-platelet therapy for new generation DES disclosureI have nothing to disclosure regarding this lecture 1st degeneration DES has demonstrated its’ superior efficacy But safety is always a dark cloud ……BASKET LATE Trial: 6-18 Mo MACE N=743 (pts with early events excluded) Rationales for prolonged antiplatelet therapy post DES implantation48 months40 mosBMSDESIncompleteappositionLate stentthrombosisAngioscopyBMSDESEosGiant cellsIVUSAbn Vasomotion*P0.001 vs. controlSirolimus Control ** Rationales for prolonged antiplatelet therapy post DES implantationCYPHER?TAXUS? Cypher Stent? Launch2003AHA/ACC Guidelines 2001(9-12 months post PCI)(TAXUS stent 6 months post PCI)(Cypher stent 3 months post PCI)AHA/ACC/SCAIUpdated Guidelines 2005ESC PCIUpdated Guidelines 2005(6-12 months post PCI)Optimal Duration of Anti-platelet Therapy Post DES Still UnclearBMS EraDES EraCURE (PCI-CURE)200111 yearTAXUS? Express2TM Stent Launch2004Latest FDA, ACC/AHA/SCAI Recommendations 2006(1 year post PCI in pts at low risk of bleeding Clinical scenarios need early cessation of anti-platelet therapy What’s new in new generation DES ?Stent platform Everolimus-Eluting StentsXIENCE V / PROMUS (CoCr-EES)PROMUS Element (PtCr-EES)PBMA=poly (n?butyl methacrylate) (primer layer); PVDF-HFP=poly vinylidene fluoride?co?hexafluoropropylene) (drug matrix layer) 33% Platinum37% Iron18%Chromium9% Nickel0.05%Manganese2.6% Molybdenum20%Chromium52% Cobalt15%Tungsten10%Nickel1.5%Manganese3% Iron XIENCE V / PROMUSEverolimus-eluting Stent ML VISION? Stent PlatformDurable Fluorinated CopolymerML VISION? Stent Delivery SystemEverolimus Endeavor DES SystemPC TechnologyDrug: ZotarolimusStent Delivery SystemDriver Cobalt Alloy Stent DES strut and polymerStrut Thickness:81 mmPolymer Thickness:7.8 mmTotal:96.6 umStrut Thickness:91 mmPolymer Thickness:5.3 mmTotal:101.6 umStrut Thickness:132 mmPolymer Thickness:16 mmTotal:164 umStrut Thickness:140 mmPolymer Thickness:12.6 mmTotal:165.2 umXIENCE? VCYPHER?TAXUS?EN