Date post: | 18-Jan-2016 |
Category: |
Documents |
Upload: | elmer-jenkins |
View: | 224 times |
Download: | 4 times |
Consensus of ICAD treatment Consensus of ICAD treatment after SAMMPRIS in Chinaafter SAMMPRIS in China
Zhujiang Hospital Zhujiang Hospital Nanfang Medical UniversityNanfang Medical University
Liu Yajie, MDLiu Yajie, MD
Pros &Cons of PTAS in ICAD Pros &Cons of PTAS in ICAD
Zhujiang Hospital Zhujiang Hospital Nanfang Medical UniversityNanfang Medical University
Liu Yajie, MDLiu Yajie, MD
Kasner SE, et al. Circulation. 2006;113:555-563
HR=2.03,P=0.0025
We will Continue with Clinical Trials
AMT superior to PTAS by 30-day rates of Stroke and Death
Chimowitz MI et al. N Engl J Med .365(11):993-1003
SAMMPRIS Results
• Whacan we learn from SAMMPRIS?
• Should we stop PTAS after SAMMPRIS?
• Should we consider future clinical trials?
Does PTAS do more harm ?
Operator
• 20 most recent consecutive cases of intracranial stenting or angioplasty.
1. Wingspan™ Stent System 2. Balloon-mounted coronary stent 3. Self-expanding stent for aneurysm 4. Angioplasty alone• A minimum of 3 Wingspan™ Stent System cases
was required to be considered for credentialing.• Average 3-4 procedures / enrolled doctor, when
SAMMPRIS was halted.
Chimowitz MI et al.J Stroke Cerebrovasc Dis 20(4):357-68
.
Chimowitz NEJM 2011
CAS Learning Curve – 72 CASES for Matured Operator
William A. Gray,et al.J Am Coll Cardiol Intv 2011;4:235– 46
Facilitate More Complex PTAS
23
14.3
17.2
26.9
9
3.2
6.8
9.5
0
5
10
15
20
25
30
low volume center( 1-8cases)
High volume center (14-19 cases)
Zaidat OO, et al. Neurology. 2008;70:1518–1524
Primary end point : 30d Stroke or death/ ipsilateral stroke after 3 months
Primary end point(%
)
总体 24 小时 30 天 6 个月
• NIH Wingspan™ Stent System had lower event rate in low volume centers vs. high volume centers, operator skill is key factor in PTAS
P=0.022
Learning Curve for PTAS?
S GAO, et al .Front Neurol. 2011 Feb 15;2:6.
Pathogenesis and PTASPatient
PTAS not suitable for PA occluded patients
Hemodynamic impaired more suitable for PTAS
Pathogenesis and PTAS
Predictors of ischemic stroke in the territory of a symptomatic intracranial arterial stenosis. Kasner SE, Chimowitz MI, Lynn NJ, et al.: Circulation 2006, 113:555-563.
Timing
Chimowitz MI et al. N Engl J Med .365(11):993-1003
F. Nahab et al.Neurology. 2009 Jun 9;72(23):2014-9
Wingspan™ Stent System- Time Selection and Complication Rate
Patients enrolled Follow up
Clopidogrel™ 75mg day 1-5
AMT
PTAS
Clopidogrel™ 75mg day 1-5, with option of loading dose between 6 and 24 hours prior to PTAS
Clopidogrel™ 75mg daily
DAY 90
Randomized
Chimowitz Journal of Stroke and Cerebrovascular Diseases, Vol. 20, No. 4 (July - August), 2011: pp 357-368
Different Antiplatelet Therapy in 2 Groups
*Not all patients received the 600mg loading dose.
Medicine
Chimowitz MI, Lynn MJ, Derdeyn CP, et al. Stenting versusaggressive medical therapy for intracranial arterial stenosis.N Engl J Med 2011;365:993-1003.
DOI:10.3760/cma.j.issn.0578-1426.2013.03.00
Interventional therapy is one of the therapies to treat symptomatic ICAD patients. As inadequate evidence based, it should be a supplemental therapy for medical treatment, it can be conducted in selective patents.
Interventional therapy could be a supplemental therapy for ICAD patients whose vessels have ≥70% stenosis, and who are refractory to standard medical therapy with non/low collateral circulation.
Chinese Experts’ Consensus of Symptomatic ICAD PTAS Treatment
Summary
• PTAS performed by an experienced Operator in a hemodynamic impaired Patient at the right Timing with with adequate Medicine benefit all.
• Otherwise, it may harms everyone.