marc sirvent, md, febvs angiology and vascular surgery department germans … · germans trias i...
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Marc Sirvent, MD, FEBVS
Angiology and Vascular Surgery Department
Germans Trias i Pujol University Hospital
Badalona
Disclosure
Marc Sirvent, MD, FEBVS
I have the following potential conflicts of interest toreport: consulting, speaking, training, proctoring.
• Biotronik
• Cardiva/Ivascular
• Cook
• Cordis/Cardinal Health
• Medtronic
• Terumo
• W.L. Gore & Associates
Technical challenge
Fem-Pop segment
Implants reduce vessel compliance and their ability to absorbdeformations
Smouse HB. Changes in major peripheral arteries during joint movement before and after stent placement in the cadaver model. TCT 2004
Stent’s related challenges
Courtesy Dr. Roberto Ferraresi
Popliteal artery
Courtesy Dr. Roberto Ferraresi
Popliteal artery
fractured
stents
non-fractured
stents
1. Scheinert D et al.Prevalence and clinical impact of stent fractures after femoropopliteal stenting. J Am Coll Cardiol. 2005 Jan 18;45(2):312-5
2. Iida O et al. Effect of exercise on frequency of stent fracture in the superficial femoral artery. Am J Cardiol. 2006;98:272-274
3. Nikanorov A et al.Fracture of self-expanding nitinol stents stressed in vitro under simulated intravascular conditions. J Vasc Surg. 2008 Aug;48(2):435-40
Fractures may trigger restenosis
Fractures associated with longer stents,overlapping movement, calcification, stent’sfeatures, location…
Implants are subject to fatigue stress and fractures
Stent’s related challenges
Key requisites of stents
• Flexibility and high fracture resistance: to withstand fatigue and stress due
to biomechanic forces of this territory.
• Adequate radial force: to achieve correct stent expantion.
• Low Chronic Outward Force (COF): less neointimal hiperplasia.
• Precise deployment: for correct positioning without geographic miss.
• Stent mechanical features are essential.
Fem-Pop segment
Tigris®
Tigris®
Dual component stent design
Designed to:
• Maximize flexibility while minimizing risk of stent fracture.
• Allow axial compression while resisting stent elongation.
• Naturally conforms and allows vessel movement.
Tigris®
Very flexible. Adaptable. Mimics.
No kinking, no spicules.
No fractures.
No elongation. No shortening.
Easy and precise deployment.
>100 mm length not available.
<5 mm diameter not available.
No radiopaque markers on the stent.
Further trials are needed.
Case: 30.10.2015
• Male 47 y.o. Rutherford Class 5 RLL.
• Former smoker.
• Hypertension, Hyperlipidemia.
• COPD.
• Grade III obesity.
• April 2014: bypass P1-P3 GSV right lower limb.
• Vascular physical examination:
– RLL: F+, P-, pedals -.
– LLL: F+, P-, pedals -.
• Duplex RLL: bypass occlusion.
Case: 30.10.2015
Tigris 5X100
Case: 30.10.2015
Knee flexion
Proximal anastomosis previous bypass
Case: 30.10.2015
Knee flexion
Proximal anastomosis previous bypass
Overlapping
Overlapping Tigris 5X100 + 5X40
Case: 30.10.2015
Overlapping
Proximalanastomosisprevious bypass
Follow-Up: 1 year
Flexibility
Overlapping
Overlapping
Flexibility
Flexibility
The Tigris® stent design provides the unique combination of:
• Superb flexibility.
• Minimal stent elongation.
• Low straightening force.
• The ability to absorb longitudinal and axial compression.
• It mimics vessel movement and minimizes stent fractures.
Conclusions
Marc Sirvent, MD, FEBVS
Angiology and Vascular Surgery Department
Germans Trias i Pujol University Hospital
Badalona