learnings from the locomotive study: subgroup analyses ... · locomotive subgroup analysis: lesion...
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Learnings from the LOCOMOTIVE study:
Subgroup analyses: Spot stenting with DCB in high risk
patients
Gunnar Tepe, MD
Disclosure
Speaker name:
Gunnar Tepe............................................I have the following potential conflicts of interest to report:
Study support by: Biotronic, BBraun, BD, BSC, Gore, Medtronic, Verian, Shockwave, Terumo
026
Stents in long lesionsViastarLammer et al., CVIR 2015 38(1): 25-32
Everflex, Life, SMART
- Mean lesion length: 19 cm vs. 17.3 cm
Result: all lesions
result: >20cm
12-mo DUS
Conclusion:
with increased lesion length: less patency
Viabahn:
Contured Edge,
Heparin Coating,
keine Oversizing
SFA stent performance related to lesion length
Note: Results from clinical trials are not directly comparable.
This chart is for educational purposes only.1. Weinstock B et al. Vascular Disease Management 2014;11(4):E76-E86
With standard stenting strategies, the patency rates decrease with stent length.
LOCOMOTIVE subgroup analysis:Spot Stenting in long vs. short lesions
89.4 % 87.9%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
fTLR @ 12 months
fTLR @ 12 months: Spot Stenting in short and long lesions
≤ 10 cm > 10 cm
(93/104) (175/199)p=0.701
≤ 10 cm > 10 cm
Spot stenting is able to overcome the negative correlation between long lesions and reduced patency
Spot Stenting in comparison to other stenting strategies
Note: Results from clinical trials are not directly comparable.
This chart is for educational purposes only.Weinstock B et al. Vascular Disease Management 2014;11(4):E76-E86
LOCOMOTIVE Extended
Drug effect on patency: DCB needed to optimize the stentresult in standard therapy
Liistro et al. JACC 2013;6(12):1295-1302
DEBATE SFA: fTLR @ 12 months
Drug effect?!
LOCOMOTIVE subgroup analysis:POBA vs. DCB with Spot Stenting
86.7%90.5%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
fTLR @ 12 months
fTLR @ 12 months: POBA / DCB with Spot Stenting
POBA DCB
p=0.308(144/166)
(124/137)
POBA DCB
Spot stenting works well with POBA as well as with DCBin long & complex fempop lesions
LOCOMOTIVE subgroup analysis:Spot Stenting in long lesions with DCB
84.6%
91.6%
0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
60.0%
70.0%
80.0%
90.0%
100.0%
fTLR @ 12 months
fTLR @ 12 months: Subgroup long lesions (> 10 cm)
POBA long DCB long
p=0.132(88/104)
(87/95)
POBAlong
DCBlong
Relevant drug effect comes with DCB & spot stentingin long & complex fempop lesions
94.3%90.5%
86.5%84.0%
0.00%
10.00%
20.00%
30.00%
40.00%
50.00%
60.00%
70.00%
80.00%
90.00%
100.00%
fTLR @ 12 months
fTLR @ 12 months: Spot Stenting in different locations
DCB in SFA only SFA only Fempop Popliteal only
LOCOMOTIVE subgroup analysis:Lesion Location
(172/191)(75/87) (21/25)
(83/88)
Spot Stenting& DCB in
SFA
AllSFA only
ALLFempop
ALLPop 1-3
The best result is achieved with DCB + spot stenting in long SFA lesions.
Conclusions
Spot stenting overcomes the negative correlation between lesion length andreduced patency
DCBs + spot stenting = ideal partners in long lesions
Comparison of drug-eluting and bare metal stents
for extracranial vertebral artery stenting
Jagiellonian University Institute of Cardiology,
John Paul II Hospital Krakow, Poland
Prof. Piotr Pieniazek MD, PhD