SYNERGY™

Everolimus-Eluting Platinum Chromium Coronary Stent System

Technical Considerations for Left Main PCI1

Patients undergoing PCI are becoming more complex and that includes treating left main vessels which can be technically challenging. There are important considerations when treating these types of vessels including:

  • overexpansion
  • radial strength
  • early healing
The SYNERGY stent is optimally designed to meet these types of requirements. Also for elderly patients, who may be at High Bleed Risk, SYNERGY is an excellent choice for SHORT 1 month DAPT*.

Explore


 

CASE STUDY: Left Main Bifurcation in Elderly Patient at High Risk of Bleeding

Imaging & Culotte Stenting Technique

Dr. Stuart Watkins, Interventional Cardiologist - Golden Jubilee National Hospital, Glasgow

WHAT YOU WILL LEARN:

  • Challenges with and impact stent design has on treating Left Main bifurcations
  • Step by step instruction on use of Culotte Technique
  • Advantages of using IVUS for the treatment of the Left Main
Left Main Bifurcation - Dr. Watkins - Video


Culotte Technique

Learn how to do Culotte Technique in astep guide and aided by bench deployment images as shown.

Culotte Technique Step 1
STEP 1: Pre-dilaion of main and side brances
Culotte Technique Step 2
STEP 2: Side branch stent deployment and pot
Culotte Technique Step 3
STEP 3: Re-cross into the main branch and dilate
Culotte Technique Step 4
STEP 4: Main branch stent positioning and deployment
Culotte Technique Step 5
STEP 5: Re-cross into the side stent, final kiss and pot

Re-Cross into the Main Branch and Dilate

A View From Bench


IVUS 

Discover why you need to use and the benefits of IVUS in the Left Main.

IVUS - LAD BACK INTO LMS

BENEFITS OF IVUS IN THE LM:

Tissue penetration between 4-8 mm
Insight into the vessel wall characteristics
Qualitative characterization
True vessel dimensions
Evaluation of landing zones
3D evaluation of the extent of disease
No need for blood clearance
Stent optimization if necessary


Overexpansion

Left Main Vessels are Large (>5.5mm on average2) Making Stent Overexpansion Capabilities Critical1

When choosing the correct size stent, it is important to keep Finet’s Law in mind. It is very important that it sized according to the distal main vessel reference diameter and then over-expanded, if required, in the proximal vessel using an appropriate sized balloon.

The SYNERGY Stent is indicated for treatment of patients presenting unprotected left main coronary artery lesions and has a labeled overexpansion indication of up to 5.75mm allowing the physician to customize the stent to the appropriate vessel size.

SYNERGY Stent Overexpansion Capabilities

SYNERGY Stent System DFU
 

Radial Strength 

Left Main Vessels Require Stents with Significant Radial Strength1

The SYNERGY 4.00mm diameter stent utilizes a customized architecture for strength and a 9% thicker (81µm) PtCr strut design3 which offers excellent radial strength. In addition, radial strength increases as diameter increases based on bench test measurements.

SYNERGY 4.0mm Diameter Stent's Radial Strength Increases as the Diameter
is Overexpanded

Radial Strength Bench Test

Adapted from a presentation by Jiang Ming Fam, MD at AsiaPCR 2015. 4.0mm diameter x 16mm length stent shown; n = 10. Data pending publication. Bench test results not necessarily indicative of clinical performance.

 

SYNERGY Stent's PtCr Stent Design Combine for Greater Radial Strength

Radial Strength Bench Test

Stent Radial Strength

Bench testing performed by Boston Scientific Corporation. Data on file at Boston Scientific. All stents 2.5mm. SYNERGY Stent n = 5, all other stents are n = 3. Bench test results not necessarily indicative of clinicial performance.

 

Early Healing

Left Main PCI and Vessel Healing1

The SYNERGY Stent’s bioabsorbable polymer and abluminal coating are designed for early healing as the polymer is gone when no longer needed, shortly after completion of drug elution at 3 months.

Clinical Study Outcomes 

IDEAL Left Main – An Investigator Sponsored Clinical Study Evaluating Stenting in this Complex Vessel Type4

Boston Scientific is committed to supporting studies evaluating the SYNERGY Stent in patient populations that interventional cardiologists see in their everyday practice; including left main stenting.
 
IDEAL Left Main Clinical Study
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