Peripheral Stents: R2P Misago

Question 1

What is the difference between Balloon Expandable (BX) and Self-Expandable (SX) stents?

Answer 1

BX: BMS or DES mounted on balloon. Scaffolding locks permanently after balloon expansions. + radial strenght / - flexibility

SX: collapsed BMS or DES that expands once exposed to heat/moisture within vessel. It is permanent via friction. + flexibility.

Question 2

What has a higher risk of ISR - a BMS or a DES?

Answer 2

BMS because it depends on endothelial growth to hold it in place, and does not have drugs attached that discourage tissue growth.

Question 3

What are some of the benefits of RX platform stents?

Answer 3

Single operator
Reduced radiation exposure
Shorter guidewires
Faster device exchange

Question 4

What are some of the perceived draw backs of a RX stent platform?

Answer 4

Decreased pushability
Increased susceptibility to kinking

Question 5

What types of stents are most commonly seen in the SFA?

Answer 5

Nitinol, self-expanding

Question 6

What is the difference between an “open cell” vs. “closed cell” stent design?

Answer 6

Open cells do not have connecting links between the struts so they are more flexible. Close cells have those connecting links and are more rigid.

Question 7

What are some of the potential issues that operators need to consider when placing a stent?

Answer 7

Foreshortening (shrinking)
Elongation (stretching)
Jumping
Apposition/Expansion

Question 8

True or False: the Misago stent was originally brought to market as a femoral stent

Answer 8

True

Question 9

R2P Misago is IFU in the ____________ areas, in ______mm diameter vessels and in lesions ______.

Answer 9

SFA to Proximal Popliteal
4 - 7mm
up to 150cm in length

Question 10

True or False: Misago can be used from the femoral, pedal or radial access approach.

Answer 10

True

Question 11

Misago is a BX or SX stent?

Answer 11

SX

Question 12

Misago is a BMS, DES or Covered stent?

Answer 12

BMS

Question 13

Misago comes on a Nitinol or Stainless Steel system?

Answer 13

Nitinol

Question 14

Misago is a OTW or RX system and comes in _____ size?

Answer 14

RX
035

Question 15

What is the working length of the Misago stent?

Answer 15

200cm

Question 16

R2P Misago stents come in _____mm diameters and ______mm lenghts.

Answer 16

6-8mm diameters
40-150mm lengths

Question 17

R2P Misago stents have _____ coating and are ___Fr comptible.

Answer 17

Hydrophilic
6Fr

Question 18

There are ____ markers on each end of the proximal and distal portion of the stent.

Answer 18

3

Question 19

What are some contraindications for R2P Misago?

Answer 19

1) Tall patients with radial-iliac artery distance greater than 150cm
2) known UE PVD, severe subclavian disease
3) Extreme tortuosity, known anatomical abnormalities
4) Presence of AVF, aortic aneurysm/dissection
5) anomalous radial take off
6) Buerger’s Disease, Raynaud’s Phenomenon

Question 20

How many depth markers are on R2P Misago and at what lengths?

Answer 20

2
120 + 150cm from distal tip

Question 21

What is the general rule of thumb for stent sizing a Misago stent?

Answer 21

The vessel should be 1-2mm smaller than the stent diameter

OR

The stent should be 1-2mm larger than the vessel diameter

Ex: 5mm vessel should have a 6 or 7mm stent

Question 22

What are the 3 primary F&B’s of Misago?

Answer 22

1) FELXIBILITY - open cell design
2) CONFORMABILITY - high crush resistance
3) DEPLOYMENT - thumbwheel, single-op

Question 23

What was FF MAE @ 30 days in the OSPREY trial?

Answer 23

99.2%

Question 24

What was FF TLR @ 12mos in the OSPREY trial?

Answer 24

88.6%

Question 25

What was Primary Patency @ 12mos in the OSPREY trial?

Answer 25

82.9%

Question 26

What was FF Stent Fracture x/stent in the OSPREY trial?

Answer 26

99.1%