Développement d'une nouvelle technique séquentielle d'optimisation proximale des angioplasties de bifurcations coronaires avec implantation d'un seul stent nommée rePOT : concept, validations expérimentales et cliniques

Abstract : Coronary bifurcations are a preferential location for atherosclerosis development. Until now, no technic with balloons juxtaposition demonstrated a clinical benefit in percutaneous coronary bifurcation revascularization by provisional stenting (with 1 stent). Successive failures could be explained by the absence of respect of the bifurcations fractal geometry, which need to be systematically followed during all revascularization (correction of the malapposition and optimization of the side branch ostium). Thus, we imagined a new technique, simple and sequential, in 3 steps, named rePOT. It is combining initial Proximal Optimizing Technique (POT), side-branch opening and final POT. We proposed a demonstration in 4 steps : 1) concept, 2) experimental proofs of concept, 3) confirmation of the clinical benefits in vivo, and 4) clinical validation. In this work, we experimentally demonstrated the superiority of the final mechanical results of the rePOT compared to all non-sequential provisional stenting (manuscript # 1). Thus, rePOT decreased stent global malapposition, maintained the initial proximal circularity and optimized the final ostial side branch obstruction. These excellent results were confirmed independently of stent design or material (manuscripts # 2, 4). Moreover, we demonstrated the specific benefits of each steps of the rePOT : initial POT (manuscript # 1), SB opening, and final POT (manuscript # 3). Finally, we confirmed in vivo, with serial OCT analysis, these excellent mechanical results and the good clinical outcome at mid-term. (manuscript # 5). Thank to this step by step demonstration, from experimental to clinic, we confirmed all benefits of this new provisional stenting sequential technique "rePOT". Thereby, before the last step of the demonstration, rePOT became a reference in Europe for the percutaneous revascularization of coronary bifurcations
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François Derimay. Développement d'une nouvelle technique séquentielle d'optimisation proximale des angioplasties de bifurcations coronaires avec implantation d'un seul stent nommée rePOT : concept, validations expérimentales et cliniques. Biomécanique [physics.med-ph]. Université de Lyon, 2019. Français. ⟨NNT : 2019LYSE1004⟩. ⟨tel-02136218⟩

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