Thursday, May 31, 2007


Seeing that there were about 20 Malaysians at the Euro PCR 2007, I can only conclude that devices companies in Malaysia are doing well. That is good. I attended most of the sessions in the main arena and some of the sessions in Room 4. Room 4 is the room where Dr Jean Marco (course director) runs his very popular basic PCI course, dealing with strategies, planning and doing a case.

From the main arena, these are my take home messages. I learnt that device companies have got to professionals and cardiologist, asking them to give a clear message that dangers of DES has been over exaggerated. There is a problem, but that we can contain it with better DESs, more diligent supervision of dual anti-platelet therapy especially in the high risk groups for LST (late stent thrombosis) and VLST (very late stent thrombosis), paying closer attention to DES choices and DES lengths and also DES over-laps.The current DESs are good.

The so-call second generation DESs has proven difficult to define. Some seem to go with when they come on (any DES after cypher and taxus are second generation), some seem to talk about polymerless DES as second generation, while others seem to talk of EPC capture stents as cellular DESs.

Two DES which I learnt should feature as second generation DES are the Xtent, and the biomatrix (biolimus A9) absorbable polymer DES. Both these DES are in the early stages of clinical trials, but it looks promising (at least to me). The Xtent is appealing to me because it is coated with the biolimus A9 drug (developed by our Singaporean stent company, the Biosensors International), and it can be use for multiple lesions and with multiple length. Imagine, if the clinical trials should prove its safety and efficacy, then we could use one DES for many lesions and at various lengths. There will obviously be some cost savings. The other DES that should be watched carefully is the biomatrix DES which is also coated with the biolimus A9 drug and has biodegradeable polymer. Once again we are awaiting the results of their large RCT, the LEADERS trial. This " -limus " looks superior to the other "-limuses " and with the biodegradeable polymer, should have less late stent thrombosis. But this remains to be proven.

The EPC capture stent, the Genous stent, (they say that it is a cellular stent, and not a true DES), are still with small numbers, and eHealing registry data. Looks like Orbus Niche (the makers of Genous) are trying to position this stent as being superior for heart attack arteries or thrombus rich lesions. I must say that although my friend, Dr H Suprayannatta seem to have good results with this stent in Zwolle, Netherlands, the grapevine tells me that my colleagues in Singapore had rather bad experience with it. Well, as usual, we would like to see more data with Genous.

One technology that I saw there, that I am very keen to bring into Malaysia, is the Philips " stent-boost " technology. This technology allows us to almost supercharge my angiogram machine for a few seconds so that I get a gamma-radiation boost, and with good computer software, to allow us to see stent edges and make up our mind as to whether the stent is well deployed and the stent struts fully apposed to the vessel wall. This will save us getting intra vascular ultrasound. The "stent-boost" technology could be an alternative to IVUS, in helping with stent deployment.

Of course throughout the convention, we see cases of  80year olds having procedures done, usually with some renal dysfunction. There was always the European favourite of bifurcation stenting, much fewer left-main stem stenting and also much fewer CTO-PCI when compared to Asian (read  Korean or Japanese) courses. The French has this liking for bifurcation stenting. There may have been somethings that I may have missed, but these to me are the main messages that I took back. The next posting, we shall talk about some of the areas for improvement.

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