The concept offocal stenting-Lessons learned and future perspectives ^Di«koniekr<nkcnhiu> Center of Vascular Medicine „Oberrhein“ (Mannheim - Speyer) Clinic for Internal Medicine I: Angiology, Cardiology and Subsequent Complications of Diabetes mellitus Diakonissenkrankenhaus Mannheim Germany Academic Teaching Hospital Clinical Medicine Mannheim University Heidelberg [email protected]

6.-%,&-42#$ I have the following potential conflicts of interest to report: Advisory Board and Consultant: BAYER AG Boehringer Ingelheim UCB Pharma

The concept offocal stenting-Lessons learned and future perspectives NCBI Resources 0 How To 0 US NaDonai Library of Meflicine National l«sttutes of Health Show additional filters Display Settings: 0 Summary, Sorted by Recently Added Article types Review More ... See sfa cold shock gene in the Gene database sfa in Escherichia coli CFTQ73 | Escherichia coli Q157:H7 sir. EDL933 | Escherichia coli UTI891 All 52 Gene records Text availability Abstract available Full text available Publication dates 10 years Custom range. □ Contemporary endovascular treatment for disease of the superficial femoral...

Lesion length Spectrum of arteries It is good to be less invasive - but not enough: we must become superior to open vascular surgery Patency @ 5a: 80% AK Patency @ 5a: ?? Fem.-pop: Balloon < 45% Stent: ?? Open vascular surgery

F+'+/#9#')$&*$(2&=,#9-$ Primary Patency In long lesions (> 40-50mm) fem.-pop medication training Progress of disease Recoil Flap Dissektion Early Intimal hyperplasia Ongoing vessel wall trauma conformability Late Remodeling Long lasting Trauma

F+'+/#9#')$&*$(2&=,#9-$ Primary Patency In long lesions (> 40-50mm) fem.-pop medication training Progress of disease Recoil Flap Dissection Early Intimal hyperplasia Ongoing vessel wall trauma conformability stent covered stent Viabahn Late Remodeling Long lasting Trauma

F+'+/#9#')$&*$(2&=,#9-$ Primary Patency In long lesions (> 40-50mm) fem.-pop Drug elution DEB-DES medication training Progress of disease Recoil Flap Dissection Early Intimal hyperplasia Ongoing vessel wall trauma conformability stent covered stent Viabahn Late Remodeling Long lasting Trauma

Primary Patency In long lesions (> 40-50mm) fem.-pop Tack BVS D-BVS Spot-stenting Management of problems Progress of disease Recoil Flap Dissection Early Intimal hyperplasia Ongoing vessel wall trauma („conformability“) ▼ \ \ Late Remodeling Long lasting Trauma Achille's heel: foreign body The longer the lesion- the longer the stent ^ ongoing trauma

POBA 1 ° Stents LUMINEXX SMART Protege LifeStent Astron 18 Absolute Zilver Supera DES Zilver PTX DEB Thunder Viabahn

Studies 2007-2013 Nitinol Stents no drug POBA 1° Stents LUMINEXX SMART Protege LifeStent Astron 18 Absolute Zilver Supera Studies 2007-2013 Nitinol Stents no drug randomized

Recoil Flap Dissektion Intimal hyperplasia (✓) Remodeling Ongoing stent trauma

Focus on Stents accepted ind. lesions > 4-5 cm elastic recoil fl-dissection/flap calcification enlarge and stabilize vessel-lumen t = scaffold foreign body • intimal hyperpl. fracture/ong. trauma • bending • pulsatile Do not cure atheroscleros.

Different ways from long lesion to patency PATENCY and winding road -hightech- Initial therapy of long fem.-pop. lesion K. Amendt 2014

DEB alone won't do the job! DEB + spot stenting is the answer?

5 x 80mm | Multi- tent- elivery- ystem: 5x 15 mm x5 angiographic control 27d after implantation Made In OsiriX ssition; FFS

103 mm (78)* * total lenght of the stens with no distance in between

The concept offocal stenting-Lessons learned and future perspectives ^Di«koniekr<nkcnhiu> Center of Vascular Medicine „Oberrhein“ (Mannheim - Speyer) Clinic for Internal Medicine I: Angiology, Cardiology and Subsequent Complications of Diabetes mellitus Diakonissenkrankenhaus Mannheim Germany Academic Teaching Hospital Clinical Medicine Mannheim University Heidelberg [email protected]