Monday, January 17, 2011


I spend Thursday - Saturday last week in Singapore attending the Asia PCR 2011 ( formerly SingLive ). Looks like my Singapore colleagues have signed an agreement with EuroPCR ( the big live demo course held in Paris annually, run by the French Interventionist and their Dutch / Belgium colleagues ). I am not sure of the terms and conditions, but it looks like the Europeans are running the show. I felt a bit sad that something so Asian and Asean, has now taken a European outlook. The SingLive ( I still prefer this name ), has been in existent for the last 20 years ( if I am not mistaken ). I started attending ( invited faculty ), with them since we started stenting, and that was in 1992. At that time, it was held in Singapore General Hospital ( SGH ), at their auditorium. It was a much smaller affair. The course was organised by the SGH Heart Center team led by Prof Arthur Tan and assisted by Prof Koh Tian Hai. I was then staying in Apollo Hotel. Things were smaller and simpler then.
We were then discussing balloon angioplasty, and all the other niche devices, many of which have fallen by the wayside. The coronary stents remained and stood the test of time. Today, they are easily the most popular coronary device that works and that help us to treat our patients better. I remember when stents first appeared, we had a thick handbook to study, and we only had a few choices. The front runners then was the slotted tube Palmaz Schatz ( PS ) stent and the coiled Giantarco Rubin stent. I still remember that Gary Rubin ( the inventor of the GR stent ) came to conduct a half day stent course on the use of the Rubin stent. After the half day stent course on the Rubin stent, the attendees were certified as licensed to use the GR stent. I never attended because I felt, even then that the GR stent was too weak and open, and would easily re-stenosed. At that time, the GR was FDA approved and indicated for use in treating acute closures ( for which it was quite good, as it was easy to deploy ). It was not indicated for De Novo lesions as it carried a high re-stenosis rate, but some interventionist then used it ( off label ) on De Novo lesions. As time will tell, I was proven right. I also felt that the PS was better longterm, although it was much, much more difficult to implant. The PS stent delivery system was 5F in size and needed an 8F guiding catheter. Remember, in my last blog on the stent program, I mentioned that I had to be proctered in Japan. I could deliver it to treat acute closures as well as De Novo CAD. We were getting good at it and it serve us well when we had the newer bare metal stents thereafter. It was so easy to deliver all the other stents when you can deliver a PS-153 stent. When we got good with the PS 153, I remember cutting the stent, hand- crimp them on the balloon and delivering them without the Stent Delivery System. Of course, we lost some stents ( I lost 4 of them ) without any significant consequences.
Anyway, that was a bit of rumination, and nostalgia. Time flies.
Asia PCR 2011 was obviously of a much smaller scale. The main arena was smaller. The number of attendees ( I guess ) must be around 1,000. The exhibition halls was smaller too with less exhibitors. I hear that the registration fees was high ( and in Euros ). The discussion side rooms were fewer. All in all, things were scaled down, perhaps reflecting the times.
It was a good time to catch up with all my interventional cardiology friends from the ASEAN region and those from abroad. We saw a few live cases from Singapore, KL, Dubai. Nothing unusual, just the same, bifurcation cases, left main stem stenting, CTOs, calcified lesions, vein grafts. Nowadays, they are showing fewere live cases but trying to spend more time in discussion.
Perhaps what I remembered most out of Asia PCR 2011, was this rather provoking, controversial faculty member from Washington, USA. Dr Aggusto Prichard, propounds a view of planting fully deployed, fully expanded, but undersize stents in vein grafts, a very controversial concept. His reason was that, with a fully expanded stent, he will get full blood flow, and have less plaque prolapse into the stent and so less debris will go downstream ( that makes sense ). But when you implant a 3.0 mm stent into a 5.0 mm vein graft, the stent will be floating in the vein graft. It will be poorly anchored and it may float and get dislodged either by the balloon or the other devices that we pass down sometimes after stenting. I hate to thing of what will happen when less experience operators try this on their patients. There is certainly no good data ( to my knowledge ), proving his hypothesis or concept. I can only surmise from the worldwide literature, that there will be more stent thrombosis ( under deployed stents are a reason for stent thrombosis ) and also re-stenosis ( under deployed stents are a reason for stent re-stenosis, drug or no drug coated).
Probably the best session is the opening talk on the bioabsorbable scaffolding, the ABSORB, by Abbott Vascular. He showed some new data and also some OCT pictures, on the outcomes of the ABSORB after 3 years. Looks good.
So an era has pass away, a new are is beginning. SingLive has given over to Asia PCR. Let us all hope that this is for the better.

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