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Koltowski L, Tomaniak M, Ochijewicz D, Opolski G, Kochman J. Third-Generation Sirolimus-Eluting Bioresorbable Tyrocore Scaffold Implantation in Patients with ST-Segment Elevation Myocardial Infarction: Baseline and 6-Month OCT and Clinical Outcomes-a FANTOM STEMI Pilot Study. Cardiovasc Drugs Ther 2024; 38:719-729. [PMID: 36640215 PMCID: PMC11266382 DOI: 10.1007/s10557-023-07429-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/04/2022] [Indexed: 01/15/2023]
Abstract
PURPOSE The aim of this study was to evaluate the safety and efficacy of the Fantom BRS 6 months after implantation using the optical coherence tomography (OCT) imaging. METHODS Twenty STEMI patients treated with a sirolimus-eluting Fantom BRS were enrolled into a prospective, single-arm, serial observational study. The scaffold sizing, positioning and optimisation were guided by OCT imaging. The primary endpoint was device-orientated composite endpoints (DOCE), comprised of cardiac death, target-vessel-related myocardial infarction and target lesion failure. To evaluate the device performance at the scaffold level, we performed a quantitative coronary angiography (QCA) and OCT imaging at 6 months. RESULTS The primary endpoint did not occur in any patient within the 6-month follow-up. There were no major adverse cardiac events (MACEs) or DOCEs, no cases of scaffold thrombosis, target lesion revascularization and no deaths. In QCA, we observed a decrease in the minimum and mean lumen diameter in the in-scaffold region and in the proximal and distal peri-scaffold region. Similarly, the minimum lumen area and reference vessel diameter had decreased in both QCA and OCT. The OCT imaging showed improvement in the expansion index and malposition rate. CONCLUSION A serial 6-month OCT imaging after implantation of a third-generation Tyrocore-based bioresorbable coronary scaffold indicated good coverage of the struts with excellent healing of the scaffold, low neointima growth and no signs of neoatherosclerosis.
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Affiliation(s)
- Lukasz Koltowski
- 1st Department of Cardiology, Medical University of Warsaw, Banacha 1a, 02-097, Warsaw, Poland.
| | - Mariusz Tomaniak
- 1st Department of Cardiology, Medical University of Warsaw, Banacha 1a, 02-097, Warsaw, Poland
| | - Dorota Ochijewicz
- 1st Department of Cardiology, Medical University of Warsaw, Banacha 1a, 02-097, Warsaw, Poland
| | - Grzegorz Opolski
- 1st Department of Cardiology, Medical University of Warsaw, Banacha 1a, 02-097, Warsaw, Poland
| | - Janusz Kochman
- 1st Department of Cardiology, Medical University of Warsaw, Banacha 1a, 02-097, Warsaw, Poland
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Wei L, Wang J, Chen Q, Li Z. Impact of stent malapposition on intracoronary flow dynamics: An optical coherence tomography-based patient-specific study. Med Eng Phys 2021; 94:26-32. [PMID: 34303498 DOI: 10.1016/j.medengphy.2021.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 05/10/2021] [Accepted: 06/04/2021] [Indexed: 10/21/2022]
Abstract
Percutaneous coronary intervention with stent implantation has emerged as a popular approach to treat coronary artery stenosis. Stent malapposition (SM), also referred as incomplete stent apposition, could reduce stent tissue coverage and hence increase the risk of late stent thrombosis. The objective of this study was to investigate the impact of SM on intracoronary flow dynamics by combining optical coherence tomography (OCT) image-based model reconstruction and computational analysis. Firstly, a stenosed coronary artery model was reconstructed from OCT and angiography imaging data of a patient. Two structural analyses were carried out to simulate two types of coronary artery stent implantations: a fully-apposed (FA) case and a SM case. Then, based on the two deformed coronary geometries, two computational fluid dynamics (CFD) analyses were performed to evaluate the differences of hemodynamic metrics between the FA and the SM cases, including wall shear stress (WSS), time-averaged WSS (TWSS), oscillatory shear index (OSI), WSS gradient (WSSG), time-averaged WSSG (TWSSG), and relative residence time (RRT). The results indicated that maximum flow velocity was higher in the SM case than that of the FA case, due to the incomplete expansion of the stent and artery. Moreover, the SM case had a lower percentage of areas of adverse WSS (< 0.5 Pa) and RRT (> 10/Pa) but a higher percentage of areas of adverse OSI (> 0.1) and WSSG (> 5000 Pa/m). Specifically, the differences of OSI, WSSG, and RRT between the two cases were relatively small. It was suggested that SM might not be responsible for negative hemodynamic metrics which would further result in stent thrombosis on the basis of the present specific model.
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Affiliation(s)
- Lingling Wei
- Biomechanics Laboratory, School of Biological Science & Medical Engineering, Southeast University, Nanjing 210096, PR China
| | - Jiaqiu Wang
- School of Mechanical, Medical and Process Engineering, Queensland University of Technology, Brisbane QLD 4001, Australia
| | - Qiang Chen
- Biomechanics Laboratory, School of Biological Science & Medical Engineering, Southeast University, Nanjing 210096, PR China.
| | - Zhiyong Li
- Biomechanics Laboratory, School of Biological Science & Medical Engineering, Southeast University, Nanjing 210096, PR China; School of Mechanical, Medical and Process Engineering, Queensland University of Technology, Brisbane QLD 4001, Australia.
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Lee SY, Mintz GS, Kim JS, Kim BK, Jang Y, Hong MK. Long-term Clinical Outcomes of Drug-Eluting Stent Malapposition. Korean Circ J 2020; 50:880-889. [PMID: 32812407 PMCID: PMC7515765 DOI: 10.4070/kcj.2020.0198] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 06/12/2020] [Accepted: 07/14/2020] [Indexed: 11/11/2022] Open
Abstract
Previous pathologic, intravascular imaging, and clinical studies have investigated the association between adverse cardiac events and stent malapposition, including acute stent malapposition (ASM, that is detected at index procedure) and late stent malapposition (LSM, that is detected during follow-up) that can be further classified into late-persistent stent malapposition (LPSM, ASM that remains at follow-up) or late-acquired stent malapposition (LASM, newly developed stent malapposition at follow-up that was not present immediately after index stent implantation). ASM has not been associated with adverse cardiac events compared with non-ASM, even in lesions with large-sized malapposition. The clinical outcomes of LSM may depend on its subtype. The recent intravascular ultrasound studies with long-term follow-up have consistently demonstrated that LASM steadily increased the risk of thrombotic events in patients with first-generation drug-eluting stents (DESs). This association has not yet been identified in LPSM. Accordingly, it is reasonable that approaches to stent malapposition should be based on its relationship with clinical outcomes. ASM may be tolerable after successful stent implantation, whereas prolonged anti-thrombotic medications and/or percutaneous interventions to modify LASM may be considered in selected patients with first-generation DESs. However, these treatments are still questionable due to lack of firm evidences.
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Affiliation(s)
- Seung Yul Lee
- Regional Cardiocerebrovascular Center, Wonkwang University Hospital, Iksan, Korea
| | - Gary S Mintz
- Cardiovascular Research Foundation, New York, NY, USA
| | - Jung Sun Kim
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University Health System, Seoul, Korea
| | - Byeong Keuk Kim
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University Health System, Seoul, Korea
| | - Yangsoo Jang
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University Health System, Seoul, Korea
| | - Myeong Ki Hong
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University Health System, Seoul, Korea.
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4
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Fedewa R, Puri R, Fleischman E, Lee J, Prabhu D, Wilson DL, Vince DG, Fleischman A. Artificial Intelligence in Intracoronary Imaging. Curr Cardiol Rep 2020; 22:46. [DOI: 10.1007/s11886-020-01299-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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Lee SY, Ahn JM, Mintz GS, Hong SJ, Ahn CM, Park DW, Kim JS, Kim BK, Ko YG, Choi D, Jang Y, Park SJ, Hong MK. Ten-Year Clinical Outcomes of Late-Acquired Stent Malapposition After Coronary Stent Implantation. Arterioscler Thromb Vasc Biol 2020; 40:288-295. [DOI: 10.1161/atvbaha.119.313602] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective:
The goal of this study was to determine the impact of late-acquired stent malapposition (LASM) on long-term clinical outcomes in patients treated with coronary stent implantation.
Approach and Results:
We investigated major adverse cardiac event during 10 years after 6-month intravascular ultrasound examination using our previous studies database. A total of 732 patients treated with bare-metal stent (54 LASM versus 678 non-LASM) and 529 patients treated with first-generation drug-eluting stent (82 LASM versus 447 non-LASM), who did not have clinical event or censoring at the time of follow-up intravascular ultrasound, were included for the present analysis. major adverse cardiac event was defined as the composite of cardiac death, target vessel–related myocardial infarction, target lesion revascularization and stent thrombosis. Multivariable adjustment and inverse probability weight were performed to consider baseline differences. After multivariable adjustment, LASM was related to a greater risk of major adverse cardiac event (hazard ratio, 1.666 [95% CI, 1.041–2.665];
P
=0.0333) and very-late stent thrombosis (hazard ratio, 3.529 [95% CI, 1.153–10.798];
P
=0.0271) than non-LASM in patients treated with first-generation drug-eluting stent, but not in those treated with bare-metal stent. Results were consistent after inverse probability weight. Among patients with LASM of first-generation drug-eluting stent, no late stent thrombosis occurred in patients who continued to receive dual antiplatelet therapy.
Conclusions:
The relationship between LASM and major adverse cardiac event might depend on the type of implanted stents during the long-term follow-up, highlighting the clinical significance of polymers and drugs in drug-eluting stent system.
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Affiliation(s)
- Seung-Yul Lee
- From the Department of Cardiovascular Medicine, Regional Cardiocerebrovascular Center, Wonkwang University Hospital, Iksan, Korea (S.-Y.L.)
| | - Jung-Min Ahn
- Department of Cardiology, Heart Institute, Asan Medical Center, University of Ulsan, Seoul, Korea (J.-M.A., D.-W.P., S.-J.P.)
| | - Gary S. Mintz
- Cardiovascular Research Foundation, New York (G.S.M.)
| | - Sung-Jin Hong
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University Health System, Seoul, Korea (S.-J.H., C.-M.A., J.-S.K., B.-K.K., Y.-G.K., D.C., Y.J., M.-K.H.)
| | - Chul-Min Ahn
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University Health System, Seoul, Korea (S.-J.H., C.-M.A., J.-S.K., B.-K.K., Y.-G.K., D.C., Y.J., M.-K.H.)
| | - Duk-Woo Park
- Department of Cardiology, Heart Institute, Asan Medical Center, University of Ulsan, Seoul, Korea (J.-M.A., D.-W.P., S.-J.P.)
| | - Jung-Sun Kim
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University Health System, Seoul, Korea (S.-J.H., C.-M.A., J.-S.K., B.-K.K., Y.-G.K., D.C., Y.J., M.-K.H.)
| | - Byeong-Keuk Kim
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University Health System, Seoul, Korea (S.-J.H., C.-M.A., J.-S.K., B.-K.K., Y.-G.K., D.C., Y.J., M.-K.H.)
| | - Young-Guk Ko
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University Health System, Seoul, Korea (S.-J.H., C.-M.A., J.-S.K., B.-K.K., Y.-G.K., D.C., Y.J., M.-K.H.)
| | - Donghoon Choi
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University Health System, Seoul, Korea (S.-J.H., C.-M.A., J.-S.K., B.-K.K., Y.-G.K., D.C., Y.J., M.-K.H.)
| | - Yangsoo Jang
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University Health System, Seoul, Korea (S.-J.H., C.-M.A., J.-S.K., B.-K.K., Y.-G.K., D.C., Y.J., M.-K.H.)
| | - Seung-Jung Park
- Department of Cardiology, Heart Institute, Asan Medical Center, University of Ulsan, Seoul, Korea (J.-M.A., D.-W.P., S.-J.P.)
| | - Myeong-Ki Hong
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University Health System, Seoul, Korea (S.-J.H., C.-M.A., J.-S.K., B.-K.K., Y.-G.K., D.C., Y.J., M.-K.H.)
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Roth C, Gangl C, Dalos D, Delle-Karth G, Neunteufl T, Berger R. Incidence of late-acquired stent malapposition of drug eluting stents with second generation permanent and biodegradable polymer coatings-A prospective, randomized comparison using optical coherence tomography. J Interv Cardiol 2018; 31:780-791. [PMID: 30479028 DOI: 10.1111/joic.12572] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Revised: 10/13/2018] [Accepted: 10/22/2018] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES AND BACKGROUND Polymer coatings of drug-eluting stents (DES) may induce allergic reactions and inflammation, resulting in late-acquired stent malapposition (LASM) with the risk of stent thrombosis. This study evaluated, if biodegradable polymer (BP) reduces the incidence of LASM compared to permanent polymer (PP) after treatment with newer generation DES. METHODS AND RESULTS Fifty patients with 59 lesions were randomized (2:1) to elective treatment with second generation PP-DES (n = 32, 39 stents), either Everolimus-eluting or Zotarolimus-eluting stents, or with BP-DES (Biolimus-eluting stents [BES]; n = 18, 20 stents) and underwent optical coherence tomography directly after implantation and after 1 year. After implantation acute stent malappositions (ASM) were documented in 30 stents (51%) distributed to 22 stents treated with PP-DES (56%) and 8 with BP-DES (40%; n.s.). After 1 year, late stent malappositions (LSM) were detected in 14 stents (24 %); ASM persisted (APSM) in 9 stents after one year (7 PP-DES-18%, 2 BES-10%), whereas ASM resolved in 21 stents. In addition, LASM was documented in nine stents including five stents without and four stents with additional APSM. All LASM were located in PP-DES (n = 9; 23%), none in BP-DES (P = 0.022). Compared to the reference lumen area, in-stent lumen area of stents without LASM was smaller due to neointimal hyperplasia (P = 0.021), whereas in-stent lumen area at maximum LASM of stents with LASM was larger due to positive remodeling (P = 0.002). CONCLUSIONS In conclusion the use of BP-DES reduced the occurrence of LASM due to positive remodeling compared to second generation PP-DES.
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Affiliation(s)
- Christian Roth
- Department of Internal Medicine II, Cardiology, Medical University of Vienna, Vienna, Austria
| | - Clemens Gangl
- Department of Internal Medicine II, Cardiology, Medical University of Vienna, Vienna, Austria
| | - Daniel Dalos
- Department of Internal Medicine II, Cardiology, Medical University of Vienna, Vienna, Austria
| | - Georg Delle-Karth
- Department of Internal Medicine IV, Cardiology, Hospital of Hietzing, Vienna, Austria
| | - Thomas Neunteufl
- Department of Internal Medicine I, Cardiology, University Hospital of Krems, Krems an der Donau, Austria.,Karl Landsteiner Private University for Health Sciences, Krems an der Donau, Austria
| | - Rudolf Berger
- Department of Internal Medicine II, Cardiology, Medical University of Vienna, Vienna, Austria.,Department of Internal Medicine I, Cardiology and Nephrology, Hospital of St. John of God, Eisenstadt, Austria
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7
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Blumenstein J, Kriechbaum SD, Leick J, Meyer A, Kim WK, Wolter JS, Abu-Samra M, Weipert K, Bayer M, Dörr O, Walther C, Hamm CW, Nef H, Liebetrau C, Möllmann H. Outcome of thrombus aspiration in STEMI patients: a propensity score-adjusted study. J Thromb Thrombolysis 2018; 45:240-249. [PMID: 29274046 DOI: 10.1007/s11239-017-1601-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
The use of thrombus aspiration (TA) prior to primary percutaneous coronary intervention (PPCI) has undergone a radical change in intervention guidelines. The clinical implications, however, are still under scrutiny. This study investigated the clinical effects and outcome of TA before PPCI in patients with ST-segment elevation myocardial infarction (STEMI). Overall 1027 patients with STEMI were analyzed in this retrospective, propensity score-adjusted, multicenter study. The primary endpoints were in-hospital and long-term mortality. There were 418 patients in the TA group and 609 in the conventional PPCI group. The in-hospital mortality rate was significantly higher in the TA group (8.7 vs. 5.0%; P = 0.03). During long-term follow-up [median follow-up duration 689 days (IQR 405-959)] the mortality rates were similar (TA 14.3%, conventional PPCI 15.0%; P = 0.85). Survival analysis for the complete observation period revealed no significant benefit of TA [hazard ratio (HR) 1.12; 97.5% CI 0.90-0.71; P = 0.63]. There were also no significant differences between the groups in the following secondary endpoints: composite of cardiovascular death and non-fatal reinfarction at discharge (P = 0.39), post-PPCI thrombolysis in myocardial infarction flow-grade-3 (P = 0.14), left ventricular ejection fraction (P = 0.47), and non-fatal reinfarction during follow-up (P = 0.17). Rehospitalization rate (1.82 vs. 10.3%; P < 0.0001) and Canadian Cardiovascular Society (CCS) grading (P = 0.02) during follow-up were significantly lower in the TA group. In our cohort the in-hospital mortality rate was significantly higher for TA patients, but during long-term follow-up the mortality rates did not differ. The incidence of rehospitalization and CCS grading were lower in the TA-treated patients.
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Affiliation(s)
- Johannes Blumenstein
- Department of Cardiology, Kerckhoff Heart and Thorax Center, German Center for Cardiovascular Research (DZHK), Partner Site Rhine-Main, Benekestrasse 2-8, 61231, Bad Nauheim, Germany
| | - Steffen Daniel Kriechbaum
- Department of Cardiology, Kerckhoff Heart and Thorax Center, German Center for Cardiovascular Research (DZHK), Partner Site Rhine-Main, Benekestrasse 2-8, 61231, Bad Nauheim, Germany.
| | - Jürgen Leick
- Department of Cardiology, Kerckhoff Heart and Thorax Center, German Center for Cardiovascular Research (DZHK), Partner Site Rhine-Main, Benekestrasse 2-8, 61231, Bad Nauheim, Germany
| | - Alexander Meyer
- Department of Cardiac Surgery, Kerckhoff Heart and Thorax Center, Benekestraße 2-8, 61231, Bad Nauheim, Germany
| | - Won-Keun Kim
- Department of Cardiology, Kerckhoff Heart and Thorax Center, German Center for Cardiovascular Research (DZHK), Partner Site Rhine-Main, Benekestrasse 2-8, 61231, Bad Nauheim, Germany
- Division of Cardiology and Angiology, Department of Internal Medicine I, Justus Liebig University of Giessen, Klinikstraße 33, 35392, Giessen, Germany
| | - Jan Sebastian Wolter
- Department of Cardiology, Kerckhoff Heart and Thorax Center, German Center for Cardiovascular Research (DZHK), Partner Site Rhine-Main, Benekestrasse 2-8, 61231, Bad Nauheim, Germany
| | - Maisun Abu-Samra
- Division of Cardiology and Angiology, Department of Internal Medicine I, Justus Liebig University of Giessen, Klinikstraße 33, 35392, Giessen, Germany
| | - Kay Weipert
- Division of Cardiology and Angiology, Department of Internal Medicine I, Justus Liebig University of Giessen, Klinikstraße 33, 35392, Giessen, Germany
| | - Matthias Bayer
- Division of Cardiology and Angiology, Department of Internal Medicine I, Justus Liebig University of Giessen, Klinikstraße 33, 35392, Giessen, Germany
| | - Oliver Dörr
- Division of Cardiology and Angiology, Department of Internal Medicine I, Justus Liebig University of Giessen, Klinikstraße 33, 35392, Giessen, Germany
| | - Claudia Walther
- Department of Cardiology, Kerckhoff Heart and Thorax Center, German Center for Cardiovascular Research (DZHK), Partner Site Rhine-Main, Benekestrasse 2-8, 61231, Bad Nauheim, Germany
| | - Christian W Hamm
- Department of Cardiology, Kerckhoff Heart and Thorax Center, German Center for Cardiovascular Research (DZHK), Partner Site Rhine-Main, Benekestrasse 2-8, 61231, Bad Nauheim, Germany
- Division of Cardiology and Angiology, Department of Internal Medicine I, Justus Liebig University of Giessen, Klinikstraße 33, 35392, Giessen, Germany
| | - Holger Nef
- Department of Cardiology, Kerckhoff Heart and Thorax Center, German Center for Cardiovascular Research (DZHK), Partner Site Rhine-Main, Benekestrasse 2-8, 61231, Bad Nauheim, Germany
- Division of Cardiology and Angiology, Department of Internal Medicine I, Justus Liebig University of Giessen, Klinikstraße 33, 35392, Giessen, Germany
| | - Christoph Liebetrau
- Department of Cardiology, Kerckhoff Heart and Thorax Center, German Center for Cardiovascular Research (DZHK), Partner Site Rhine-Main, Benekestrasse 2-8, 61231, Bad Nauheim, Germany
- Division of Cardiology and Angiology, Department of Internal Medicine I, Justus Liebig University of Giessen, Klinikstraße 33, 35392, Giessen, Germany
| | - Helge Möllmann
- Department of Cardiology, Kerckhoff Heart and Thorax Center, German Center for Cardiovascular Research (DZHK), Partner Site Rhine-Main, Benekestrasse 2-8, 61231, Bad Nauheim, Germany
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Abdel-Karim ARR, Uretsky BF. The importance of malapposition in angiographically optimized stenting in contemporaneous interventions. Expert Rev Cardiovasc Ther 2018; 16:599-605. [DOI: 10.1080/14779072.2018.1493377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
| | - Barry F. Uretsky
- Division of Cardiology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
- Division of Cardiology, Central Arkansas Veterans Healthcare System and the University of Arkansas for Medical Sciences, Little Rock, AR, USA
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9
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Mutzenbach SJ, Millesi K, Roesler C, Broussalis E, Pikija S, Sellner J, Machegger L, Griessenauer CJ, Killer-Oberpfalzer M. The Casper Stent System for carotid artery stenosis. J Neurointerv Surg 2018; 10:869-873. [DOI: 10.1136/neurintsurg-2017-013583] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Revised: 12/19/2017] [Accepted: 12/24/2017] [Indexed: 01/31/2023]
Abstract
PurposeTo report the results of a retrospective analysis of prospectively collected data evaluating the safety and efficacy of a double layer stent engineered for carotid artery occlusive disease.MethodsBetween January 2014 and February 2017, 138 patients (25.4% women; median age 71 years) underwent Casper stent implantation for carotid artery stenosis. Eligibility criteria included stenosis >70% of vessel diameter (or >50% diameter with ulceration) in symptomatic patients or asymptomatic patients with >80% stenosis at the carotid bifurcation or in the proximal internal carotid artery. For all procedures, a distal embolic protection device was used. The primary endpoint was the rate of 90 day major adverse neurological events, defined as minor stroke, major stroke, or death by independent neurological assessment.ResultsStent deployment was completed successfully in all cases without documented technical failure. There were no adverse neurological events or mortalities within 90 days. One thromboembolic occlusion of a small distal branch of the anterior cerebral artery occurred during the procedure and resolved with systemic recombinant tissue plasminogen activator administration. New ischemic lesions, all clinically silent, were seen in 6.5% of patients on post-procedure cerebral MRI.ConclusionThe Casper carotid stent demonstrated safety and efficacy in the treatment of carotid stenosis, with no technical failures and no adverse neurological events seen throughout the 90 day follow-up period. Its double layer structure seems to combine adequate plaque scaffolding with high vessel adaptability.
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10
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A Review of the Clinical Utility of Intravascular Ultrasound and Optical Coherence Tomography in the Assessment and Treatment of Coronary Artery Disease. Cardiol Rev 2017; 25:68-76. [DOI: 10.1097/crd.0000000000000128] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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11
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Yadlapati A, Gajjar M, Schimmel DR, Ricciardi MJ, Flaherty JD. Contemporary management of ST-segment elevation myocardial infarction. Intern Emerg Med 2016; 11:1107-1113. [PMID: 27714584 DOI: 10.1007/s11739-016-1550-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Accepted: 09/22/2016] [Indexed: 01/22/2023]
Abstract
ST-elevation myocardial infarction (STEMI), which constitutes nearly 25-40 % of current acute myocardial infarction (AMI) cases, is a medical emergency that requires prompt recognition and treatment. Since the 2013 STEMI practice guidelines, a wealth of additional data that may further advance optimal STEMI practices has emerged. These data highlight the importance of improving patient treatment and transport algorithms for STEMI from non-primary percutaneous coronary intervention (PCI) centers. In addition, a focus on the reduction of total pain-to-balloon (P2B) times rather than simply door-to-balloon (D2B) times may further improve outcomes after primary PCI for STEMI. The early administration of newer oral P2Y12 inhibitors, including crushed forms of these agents for faster absorption, represents another treatment advancement. Recent data also suggest avoiding concurrent morphine use due to interactions with P2Y12 inhibitors. Furthermore, new technological advancements and investigational therapies, including Bioresorbable Vascular Scaffolds and the use of pre-intervention intravenous microbubbles with transthoracic ultrasound, hold promise to play a useful role in future STEMI care. Despite these advancements, the prompt recognition of STEMI, at both the patient and health care system level, remains the cornerstone of optimal treatment.
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Affiliation(s)
- Ajay Yadlapati
- Division of Cardiology, Bluhm Cardiovascular Institute, Feinberg School of Medicine, Northwestern University, 676 N. St. Clair Street, Suite 600, Chicago, IL, 60611-2996, USA
| | - Mark Gajjar
- Division of Cardiology, Bluhm Cardiovascular Institute, Feinberg School of Medicine, Northwestern University, 676 N. St. Clair Street, Suite 600, Chicago, IL, 60611-2996, USA
| | - Daniel R Schimmel
- Division of Cardiology, Bluhm Cardiovascular Institute, Feinberg School of Medicine, Northwestern University, 676 N. St. Clair Street, Suite 600, Chicago, IL, 60611-2996, USA
| | - Mark J Ricciardi
- Division of Cardiology, Bluhm Cardiovascular Institute, Feinberg School of Medicine, Northwestern University, 676 N. St. Clair Street, Suite 600, Chicago, IL, 60611-2996, USA
| | - James D Flaherty
- Division of Cardiology, Bluhm Cardiovascular Institute, Feinberg School of Medicine, Northwestern University, 676 N. St. Clair Street, Suite 600, Chicago, IL, 60611-2996, USA.
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12
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Caixeta A, Maehara A, Mintz GS. Intravascular Ultrasound and Virtual Histology. Interv Cardiol 2016. [DOI: 10.1002/9781118983652.ch7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Affiliation(s)
- Adriano Caixeta
- Hospital Israelita Albert Einstein; Universidade Federal de São Paulo; São Paulo Brazil
| | - Akiko Maehara
- Columbia University Medical Center and the Cardiovascular Research Foundation; New York NY USA
| | - Gary S. Mintz
- Columbia University Medical Center and the Cardiovascular Research Foundation; New York NY USA
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Bosiers M, Deloose K, Torsello G, Scheinert D, Maene L, Peeters P, Müller-Hülsbeck S, Sievert H, Langhoff R, Bosiers M, Setacci C. The CLEAR-ROAD study: evaluation of a new dual layer micromesh stent system for the carotid artery. EUROINTERVENTION 2016; 12:e671-6. [PMID: 27180304 DOI: 10.4244/eijy16m05_04] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Marc Bosiers
- Department of Vascular Surgery, A.Z. Sint-Blasius, Dendermonde, Belgium
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14
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Bioresorbable vascular scaffold implantation in acute coronary syndromes: clinical evidence, tips and tricks. ADVANCES IN INTERVENTIONAL CARDIOLOGY 2015; 11:161-9. [PMID: 26677353 PMCID: PMC4631727 DOI: 10.5114/pwki.2015.54006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2015] [Revised: 06/18/2015] [Accepted: 07/08/2015] [Indexed: 11/18/2022] Open
Abstract
Percutaneous coronary intervention (PCI) with a drug-eluting stent (DES) is routine treatment for patients with acute coronary syndromes (ACS). However, permanent metallic caging of the vessel has several shortcomings, such as side branch jailing and impossibility of late lumen enlargement. Moreover, DES PCI is affected by vasomotion impairment. In ACS a high thrombus burden and vasospasm lead to a higher risk of acute and late acquired stent malapposition than in stable patients. This increases the risk of acute, late and very late stent thrombosis. In this challenging clinical setting, the implantation of bioresorbable vascular scaffolds (BVS) could represent an appealing therapeutic option. Temporary vessel scaffolding has proved to have several advantages over metallic stent delivery, such as framework reabsorption, late lumen enlargement, side branch patency, and recovery of physiological reactivity to vasoactive stimuli. In the thrombotic environment of ACS, BVS implantation has the benefit of capping the thrombus and the vulnerable plaque. Bioresorbable vascular scaffolds also seems to reduce the incidence of angina during follow-up. Acute coronary syndromes patients may therefore benefit more from temporary polymeric caging than from permanent stent platform implantation. The aim of this review is to update the available knowledge concerning the use of BVS in ACS patients, by analyzing the potential pitfalls in this challenging clinical setting and presenting tricks to overcome these limitations.
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15
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Vos NS, Dirksen MT, Vink MA, van Nooijen FC, Amoroso G, Herrman JPR, Kiemeneij F, Patterson MS, Slagboom T, van der Schaaf RJ. Safety and feasibility of a PAclitaxel-eluting balloon angioplasty in Primary Percutaneous coronary intervention in Amsterdam (PAPPA): one-year clinical outcome of a pilot study. EUROINTERVENTION 2015; 10:584-90. [PMID: 25256200 DOI: 10.4244/eijv10i5a101] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS In primary percutaneous coronary intervention (PPCI), stenting has been shown to reduce the need for repeat target lesion revascularisation (TLR) compared to balloon angioplasty alone, but did not result in a reduction of recurrent myocardial infarction (MI) or cardiac death. Meanwhile, stent-related adverse events such as stent thrombosis continue to be of concern. Our aim was to evaluate the safety and feasibility of drug- coated balloon (DCB) angioplasty without stenting in PPCI. METHODS AND RESULTS One hundred patients presenting with ST-elevation MI were prospectively enrolled in this pilot study. They underwent PPCI with DCB angioplasty; additional stenting was allowed only in case of type C to F coronary dissection or residual stenosis >50%. All patients were treated with i.v. bivalirudin. The primary endpoint was the composite of cardiac death, recurrent MI and TLR. A total of 59 patients received treatment with DCB angioplasty alone, whereas additional stenting was required in 41 patients. One-year clinical follow-up was completed in 98 patients. A total of five major adverse cardiac events were reported (5%). Cardiac death was seen in two patients, while three patients underwent TLR. CONCLUSIONS This first study of a DCB angioplasty-only strategy in the setting of PPCI showed good one-year clinical results.
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Affiliation(s)
- Nicola S Vos
- Department of Cardiology, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands
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16
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Ielasi A, Cortese B, Varricchio A, Tespili M, Sesana M, Pisano F, Loi B, Granata F, Moscarella E, Silva Orrego P, La Vecchia L, Steffenino G. Immediate and midterm outcomes following primary PCI with bioresorbable vascular scaffold implantation in patients with ST-segment myocardial infarction: insights from the multicentre “Registro ABSORB Italiano” (RAI registry). EUROINTERVENTION 2015; 11:157-62. [DOI: 10.4244/eijy14m10_11] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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17
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Yetgin T, Nakatani S, Onuma Y, van Geuns RJM. Alternative stents in ST-segment elevation myocardial infarction: improving the efficacy of primary percutaneous coronary intervention. Future Cardiol 2015; 11:347-57. [PMID: 26021640 DOI: 10.2217/fca.15.26] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Despite the efficacy of primary percutaneous coronary intervention in achieving epicardial reperfusion in ST-segment elevation myocardial infarction, it is often limited by impaired microvascular perfusion attributable to distal embolization of plaque and thrombus, and stent malappostion due to vessel constriction and thrombus apposition, attenuating the full benefits of myocardial reperfusion and resulting in unfavorable clinical outcomes. In the long run implantation of permanent metallic implants have negative effect the biological behavior of the target vessel with a continuous low device failure over the years. Recently, however, efforts have been realized to tackle these shortcomings and optimize mechanical reperfusion by improvements to stent design, as substantiated by the self-expanding stent, the mesh-covered stent and the bioresorbable vascular scaffold. In this article, we provide an overview of the role of these novel, innovatively designed, alternative devices in patients undergoing primary percutaneous coronary intervention for ST-segment elevation myocardial infarction.
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Affiliation(s)
- Tuncay Yetgin
- 1Department of Cardiology, Thoraxcenter, Erasmus University Medical Center, 's-Gravendijkwal 230, 3015 GE Rotterdam, The Netherlands
| | - Shimpei Nakatani
- 1Department of Cardiology, Thoraxcenter, Erasmus University Medical Center, 's-Gravendijkwal 230, 3015 GE Rotterdam, The Netherlands
| | - Yoshinobu Onuma
- 1Department of Cardiology, Thoraxcenter, Erasmus University Medical Center, 's-Gravendijkwal 230, 3015 GE Rotterdam, The Netherlands
| | - Robert-Jan M van Geuns
- 1Department of Cardiology, Thoraxcenter, Erasmus University Medical Center, 's-Gravendijkwal 230, 3015 GE Rotterdam, The Netherlands
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18
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19
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Scalone G, Brugaletta S, Gómez-Monterrosas O, Otsuki S, Sabate M. ST-segment elevation myocardial infarction – ideal scenario for bioresorbable vascular scaffold implantation? Circ J 2015; 79:263-70. [PMID: 25744740 DOI: 10.1253/circj.cj-14-1398] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Bioresorbable vascular scaffolds (BVS) represent a breakthrough technology for percutaneous coronary intervention (PCI). In this context, because of the unique properties of bioresorbable devices, ST-segment elevation myocardial infarction (STEMI) may represent the ideal scenario for BVS implantation. Consistently, 57% of physicians declare they currently use BVS in this group of patients. However, continuous and growing evidence on the good performance of these devices has been actually shown only in small studies with short- and mid-term follow-up. For these reasons, we need data from sufficiently large observational studies, with long-term follow-up, to confirm that BVS can deliver the same results as 2nd-generation drug-eluting stents when using an appropriate implantation technique. In this review, we discuss the potential advantages of BVS implantation in STEMI patients, together with the most recent evidence from clinical studies, highlighting safety and procedural concerns.
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Affiliation(s)
- Giancarla Scalone
- Department of Cardiology, Thorax Institute, Hospital Clinic, Biomedical Investigation Institute, IDIBAPS, University of Barcelona, Spain
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20
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Morr S, Lin N, Siddiqui AH. Carotid artery stenting: current and emerging options. MEDICAL DEVICES-EVIDENCE AND RESEARCH 2014; 7:343-55. [PMID: 25349483 PMCID: PMC4208632 DOI: 10.2147/mder.s46044] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Carotid artery stenting technologies are rapidly evolving. Options for endovascular surgeons and interventionists who treat occlusive carotid disease continue to expand. We here present an update and overview of carotid stenting devices. Evidence supporting carotid stenting includes randomized controlled trials that compare endovascular stenting to open surgical endarterectomy. Carotid technologies addressed include the carotid stents themselves as well as adjunct neuroprotective devices. Aspects of stent technology include bare-metal versus covered stents, stent tapering, and free-cell area. Drug-eluting and cutting balloon indications are described. Embolization protection options and new direct carotid access strategies are reviewed. Adjunct technologies, such as intravascular ultrasound imaging and risk stratification algorithms, are discussed. Bare-metal and covered stents provide unique advantages and disadvantages. Stent tapering may allow for a more fitted contour to the caliber decrement between the common carotid and internal carotid arteries but also introduces new technical challenges. Studies regarding free-cell area are conflicting with respect to benefits and associated risk; clinical relevance of associated adverse effects associated with either type is unclear. Embolization protection strategies include distal filter protection and flow reversal. Though flow reversal was initially met with some skepticism, it has gained wider acceptance and may provide the advantage of not crossing the carotid lesion before protection is established. New direct carotid access techniques address difficult anatomy and incorporate sophisticated flow-reversal embolization protection techniques. Carotid stenting is a new and exciting field with rapidly advancing technologies. Embolization protection, low-risk deployment, and lesion assessment and stratification are active areas of research. Ample room remains for further innovations and developments.
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Affiliation(s)
- Simon Morr
- Department of Neurosurgery, School of Medicine and Biomedical Sciences, Buffalo, NY, USA ; Department of Neurosurgery, Gates Vascular Institute, Kaleida Health, Buffalo, NY, USA
| | - Ning Lin
- Department of Neurosurgery, School of Medicine and Biomedical Sciences, Buffalo, NY, USA ; Department of Neurosurgery, Gates Vascular Institute, Kaleida Health, Buffalo, NY, USA
| | - Adnan H Siddiqui
- Department of Neurosurgery, School of Medicine and Biomedical Sciences, Buffalo, NY, USA ; Department of Radiology, School of Medicine and Biomedical Sciences, Buffalo, NY, USA ; Toshiba Stroke and Vascular Research Center, University at Buffalo, State University of New York, Buffalo, NY, USA ; Department of Neurosurgery, Gates Vascular Institute, Kaleida Health, Buffalo, NY, USA ; Jacobs Institute, Buffalo, NY, USA
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21
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Galassi A, Grantham A, Kandzari D, Lombardi W, Moussa I, Thompson C, Werner G, Chambers C, Brilakis E. Percutaneous Treatment of Coronary Chronic Total Occlusions Part 1: Rationale and Outcomes. Interv Cardiol 2014; 9:195-200. [PMID: 29588802 DOI: 10.15420/icr.2014.9.3.195] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
Coronary chronic total occlusions (CTOs) are commonly encountered in patients with coronary artery disease. Compared to patients without coronary CTOs, those with CTO have worse clinical outcomes and lower likelihood of complete coronary revascularisation. Successful CTO percutaneous coronary intervention (PCI) can significantly improve angina and improve left ventricular function. Although currently unproven, successful CTO PCI might also reduce the risk for arrhythmic events in patients with ischaemic cardiomyopathy, provide better tolerance of future acute coronary syndrome, and possibly improve survival. Evaluation by a heart team comprised of both interventional and non-interventional cardiologists and cardiac surgeons is important for determining the optimal revascularisation strategy in patients with coronary artery disease and CTOs. Ad hoc CTO PCI is generally not recommended, so as to allow sufficient time for (a) discussion with the patient about the indications, goals, risks, and alternatives to PCI; (b) careful procedural planning; and (c) contrast and radiation exposure minimisation. Use of drug-eluting stents is recommended for CTO PCI, given the lower rates of angiographic restenosis compared to bare metal stents.
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Affiliation(s)
| | - Aaron Grantham
- Saint Luke's Mid America Heart Institute and University of Missouri Kansas City, Missouri, US
| | | | | | | | | | | | - Charles Chambers
- Penn State University College of Medicine, Hershey, Pennsylvania, US
| | - Emmanouil Brilakis
- VA North Texas Healthcare System and University of Texas Southwestern Medical Center at Dallas, Dallas, Texas, US
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22
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Yamawaki M, Onuma Y, Nakano M, Muramatsu T, Nakatani S, Ishibashi Y, Ishimori H, Hirano K, Ito Y, Tsukahara R, Muramatsu T. Simultaneous occlusion of left anterior descending and left circumflex arteries by very late stent thrombosis: vascular response to drug-eluting stents assessed by intravascular ultrasound. Heart Vessels 2014; 30:824-9. [PMID: 25031154 DOI: 10.1007/s00380-014-0545-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2014] [Accepted: 06/27/2014] [Indexed: 11/25/2022]
Abstract
Very late stent thrombosis (VLST) is a catastrophic complication after implantation of a drug-eluting stent (DES). It has been reported that VLST is associated with pathological changes, which often include late acquired incomplete stent apposition (LAISA) with thrombus formation. In addition, the vascular response to the stent (evaginations, neointimal growth, and thrombosis) and the incidence of LAISA are reported to vary among the different types of DES. We experienced a patient with cardiogenic shock induced by simultaneous VLST of both the left anterior descending artery (LAD) and the left circumflex artery (LCX) at 3 years after implantation of two sirolimus-eluting stents. Intravascular ultrasound (IVUS) showed LAISA of both arteries. A paclitaxel-eluting stent, which had been implanted in the right coronary artery 3 years earlier, did not show such a finding. IVUS revealed "different vascular reactions" to "different types of DES" in this patient.
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Affiliation(s)
- Masahiro Yamawaki
- Department of Cardiology, Saiseikai Yokohama City Eastern Hospital, 3-6-1 Shimosueyoshi, Tsurumi-ku, Yokohama, Japan.
| | - Yoshinobu Onuma
- Department of Interventional Cardiology, Thoraxcenter, Erasmus MC, Rotterdam, The Netherlands
| | - Masatsugu Nakano
- Department of Cardiology, Saiseikai Yokohama City Eastern Hospital, 3-6-1 Shimosueyoshi, Tsurumi-ku, Yokohama, Japan
| | - Takashi Muramatsu
- Department of Interventional Cardiology, Thoraxcenter, Erasmus MC, Rotterdam, The Netherlands
| | - Shimpei Nakatani
- Department of Interventional Cardiology, Thoraxcenter, Erasmus MC, Rotterdam, The Netherlands
| | - Yuki Ishibashi
- Department of Interventional Cardiology, Thoraxcenter, Erasmus MC, Rotterdam, The Netherlands
| | - Hiroshi Ishimori
- Department of Cardiology, Saiseikai Yokohama City Eastern Hospital, 3-6-1 Shimosueyoshi, Tsurumi-ku, Yokohama, Japan
| | - Keisuke Hirano
- Department of Cardiology, Saiseikai Yokohama City Eastern Hospital, 3-6-1 Shimosueyoshi, Tsurumi-ku, Yokohama, Japan
| | - Yoshiaki Ito
- Department of Cardiology, Saiseikai Yokohama City Eastern Hospital, 3-6-1 Shimosueyoshi, Tsurumi-ku, Yokohama, Japan
| | - Reiko Tsukahara
- Department of Cardiology, Saiseikai Yokohama City Eastern Hospital, 3-6-1 Shimosueyoshi, Tsurumi-ku, Yokohama, Japan
| | - Toshiya Muramatsu
- Department of Cardiology, Saiseikai Yokohama City Eastern Hospital, 3-6-1 Shimosueyoshi, Tsurumi-ku, Yokohama, Japan
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23
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Antonsen L, Thayssen P, Jensen LO. Peri-stent contrast staining, major evaginations and severe malapposition after biolimus-eluting stent implantation: a case report based on coronary optical frequency domain imaging. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2014; 15:424-7. [PMID: 24880913 DOI: 10.1016/j.carrev.2014.04.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2014] [Revised: 04/17/2014] [Accepted: 04/22/2014] [Indexed: 11/30/2022]
Abstract
Peri-stent contrast staining and late acquired malapposition represent pathological vessel wall healing patterns following percutaneous coronary intervention with stent implantation. Earlier studies have described these abnormal vessel wall responses commonly present after implantation of first-generation drug-eluting stents. These coronary vascular changes can cause flow disturbance and thereby dispose for later thrombotic events. This case report, based on coronary optical frequency domain imaging, describes peri-stent contrast staining, major evaginations and severe malapposition occurring 18months after third-generation biolimus-eluting stent implantation.
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Affiliation(s)
- Lisbeth Antonsen
- Department of Cardiology, Odense University Hospital, Odense, Denmark.
| | - Per Thayssen
- Department of Cardiology, Odense University Hospital, Odense, Denmark
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24
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Attizzani GF, Capodanno D, Ohno Y, Tamburino C. Mechanisms, pathophysiology, and clinical aspects of incomplete stent apposition. J Am Coll Cardiol 2014; 63:1355-67. [PMID: 24530675 DOI: 10.1016/j.jacc.2014.01.019] [Citation(s) in RCA: 93] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2013] [Revised: 12/12/2013] [Accepted: 01/07/2014] [Indexed: 11/25/2022]
Abstract
Incomplete stent apposition (ISA) is characterized by the lack of contact of at least 1 stent strut with the vessel wall in a segment not overlying a side branch; it is more commonly found in drug-eluting stents than bare-metal stents. The accurate diagnosis of ISA, initially only possible with intravascular ultrasound, can currently be performed with higher accuracy by optical coherence tomography, which also enables strut-level assessment due to its higher axial resolution. Different circumstances related both to the index procedure and to vascular healing might influence ISA occurrence. Although several histopathology and clinical studies linked ISA to stent thrombosis, potential selection bias precluded definitive conclusions. Initial studies usually performed single time point assessments comparing overall ISA percentage and magnitude in different groups (i.e., stent type), thus hampering a comprehensive understanding of its relationship with vascular healing. Serial intravascular imaging studies that evaluated vascular response heterogeneity recently helped fill this gap. Some particular clinical scenarios such as acute coronary syndromes, bifurcations, tapered vessels, overlapping stents, and chronic total occlusions might predispose to ISA. Interventional cardiologists should be committed to optimal stent choices and techniques of implantation and use intravascular imaging guidance when appropriate to aim at minimizing acute ISA. In addition, the active search for new stent platforms that could accommodate vessel remodeling over time (i.e., self-expandable stents) and for new polymers and/or eluting drugs that could induce less inflammation (hence, less positive remodeling) could ultimately reduce the occurrence of ISA and its potentially harmful consequences.
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Affiliation(s)
- Guilherme F Attizzani
- Division of Cardiology, Ferrarotto Hospital, University of Catania, Catania, Italy; Division of Interventional Cardiology, Pitangueiras Hospital, Jundiaí, SP, Brazil; Harrington Heart and Vascular Institute, University Hospitals, Case Medical Center, Cleveland, Ohio
| | - Davide Capodanno
- Division of Cardiology, Ferrarotto Hospital, University of Catania, Catania, Italy; Excellence Through Newest Advances (ETNA) Foundation, Catania, Italy.
| | - Yohei Ohno
- Division of Cardiology, Ferrarotto Hospital, University of Catania, Catania, Italy
| | - Corrado Tamburino
- Division of Cardiology, Ferrarotto Hospital, University of Catania, Catania, Italy; Excellence Through Newest Advances (ETNA) Foundation, Catania, Italy
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25
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Kurosawa T, Kotani JI, Matsuyama TA, Ishibashi-Ueda H. A case of active peri-stent inflammation after sirolimus-eluting stent implantation. Heart Vessels 2014; 30:270-3. [DOI: 10.1007/s00380-013-0465-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2013] [Accepted: 12/27/2013] [Indexed: 11/30/2022]
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26
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Diletti R, Karanasos A, Muramatsu T, Nakatani S, Van Mieghem NM, Onuma Y, Nauta ST, Ishibashi Y, Lenzen MJ, Ligthart J, Schultz C, Regar E, de Jaegere PP, Serruys PW, Zijlstra F, van Geuns RJ. Everolimus-eluting bioresorbable vascular scaffolds for treatment of patients presenting with ST-segment elevation myocardial infarction: BVS STEMI first study. Eur Heart J 2014; 35:777-86. [DOI: 10.1093/eurheartj/eht546] [Citation(s) in RCA: 92] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
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Abstract
Stent implantation in coronary stenosis has revolutionized the treatment of coronary artery disease. The introduction of antirestenotic drug coatings further improved their efficacy in reducing target vessel revascularizations. With increasing use of drug-eluting stents (DES), stent thrombosis (ST) rose as potentially fatal major complication. Initially, the incidence of ST late after stent implantation seemed to be similar for DES and bare metal stents until several studies proved otherwise in first-generation DES. Since then, the design and components of DES have been changed and new polymers, drugs and different combinations of platelet inhibitors have been introduced to further improve the safety of DES. In this review, the authors focus on the relationship between DES, lesion anatomy, implantation technique and pharmacology to avoid the occurrence of ST. Furthermore, the relationship between dual antiplatelet therapy, bleeding rate and its significant impact on patient outcome is discussed. Finally, some promising future concepts are highlighted.
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Affiliation(s)
- Florian N Riede
- Division of Cardiology, University Hospital, Basel, Switzerland
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28
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Higuma T, Abe N, Hanada K, Yokoyama H, Tomita H, Okumura K. Stent malapposition, as a potential mechanism of very late stent thrombosis after bare-metal stent implantation: a case report. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2013; 15:178-81. [PMID: 24139450 DOI: 10.1016/j.carrev.2013.09.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2013] [Revised: 09/17/2013] [Accepted: 09/17/2013] [Indexed: 10/26/2022]
Abstract
A 90-year-old man was admitted to our hospital with acute ST-segment elevation myocardial infarction. He had a history of post-infarction angina pectoris 79months ago and had a bare-metal stent (BMS) implanted in the proximal left anterior descending artery at our hospital. Emergent coronary angiography demonstrated thrombotic occlusion in the previously stented segment. After catheter thrombectomy, antegrade flow was restored, but 90% stenosis with haziness persisted in the proximal and distal portions of the previously stented segment. Intravascular ultrasound imaging showed interstrut cavities or stent malapposition at the proximal and distal sites of stented segment. In close proximity to the sites, residual thrombi were also observed. Optical coherence tomography (OCT) demonstrated neither lipid-laden neointimal tissue nor rupture but clearly demonstrated residual thrombus adjacent to the malapposed region in addition to the stent malapposition. PCI with balloon was successfully performed and stent apposition was confirmed by OCT. Stent malapposition is an unusual mechanism of very late stent thrombosis after BMS implantation. OCT can clearly reveal the etiology of stent thrombosis.
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Affiliation(s)
- Takumi Higuma
- Department of Cardiology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan.
| | - Naoki Abe
- Department of Cardiology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Kenji Hanada
- Department of Cardiology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Hiroaki Yokoyama
- Department of Cardiology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Hirofumi Tomita
- Department of Cardiology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Ken Okumura
- Department of Cardiology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
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29
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Feng T, Yundai C, Hongbin L, Lian C, Zhijun S, Jun G, Qinhua J, Tao Z. Evaluation neointimal coverage in patients with coronary artery aneurysm formation after drug-eluting stent implantation by optical coherence tomography. Int J Cardiovasc Imaging 2013; 29:1677-83. [PMID: 24030292 PMCID: PMC3835944 DOI: 10.1007/s10554-013-0282-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2013] [Accepted: 08/24/2013] [Indexed: 12/14/2022]
Abstract
The neointimal coverage in patients with coronary artery aneurysms (CAA) formation after drug eluting stent (DES) implantation is not clear. Total of 175 patients who had been implanted DES were identified. Patients were divided into the CAA group (n = 31) and non-CAA group (n = 144) based on the results of the coronary angiography. The cardiac events including angina and acute myocardial infarction were noted, in addition, the neointimal thickness and the frequence of strut malapposition and strut uncoverage were noted. A greater proportion of incomplete neointimal coverage (17.17 vs. 1.9 %, P < 0.001) and malapposition struts (18.2 vs. 1.38%, P < 0.001) were observed in the CAA group. 8 patients in CAA group underwent OCT examination twice in the period of follow-up. The proportion of incomplete neointimal coverage increased significantly as compared the second OCT results with the first examination (18.45 vs. 2.66 %, P < 0.001). Hyperplasia neointimal desquamated from struts and acquired struts incomplete neointimal coverage were detected. Patients with CAA had a higher frequency of cardiac events including angina pectoris (25.81 vs. 6.25 %, P = 0.001) and acute myocardial infarction (9.68 vs. 0.13 %, P = 0.002) and thrombosis (16.13 vs. 0.69 %, P < 0.001). The longitudinal length of CAA in cardiac event group was significantly longer than no cardiac event group (20.0 ± 9.07 vs. 12.05 ± 5.38 mm, P = 0.005). CAA formation after DES implantation frequently associated with cardiac events as a result of stent malapposition and incomplete neointimal coverage. Acquired incomplete neointimal coverage associated with CAA formation.
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Affiliation(s)
- Tian Feng
- Department of Cardiology, Chinese PLA General Hospital, Beijing, 100853, China
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30
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Relation between poststenting peristent plaque components and late stent malapposition after drug-eluting stent implantation: Virtual histology-intravascular ultrasound analysis. Int J Cardiol 2013; 167:1882-7. [DOI: 10.1016/j.ijcard.2012.04.152] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2012] [Revised: 04/02/2012] [Accepted: 04/28/2012] [Indexed: 11/22/2022]
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Relation between coronary plaque calcium deposits as described by computed tomography coronary angiography and acute results of stent deployment as assessed by intravascular ultrasound. ADVANCES IN INTERVENTIONAL CARDIOLOGY 2013; 9:115-20. [PMID: 24570702 PMCID: PMC3915965 DOI: 10.5114/pwki.2013.35444] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2013] [Revised: 03/25/2013] [Accepted: 05/09/2013] [Indexed: 01/09/2023] Open
Abstract
Introduction The findings from intravascular ultrasound studies on the impact of calcium deposits on the results of stent implantation are conflicting. Aim To evaluate whether calcium deposits as assessed by (CTCA) influence results of stent deployment. Material and methods The study population comprised 60 patients (43 male; age 64.2 ±8.6 years) who underwent CTCA before stent implantation. Lesion calcium score, total calcium length, and maximal area and maximal thickness of calcium deposits within the lesion segment were assessed. Plaques were divided into those with calcium score ≥ median (group 1), calcium score < median (group 2), and without calcium (group 3). Intravascular ultrasound (IVUS) was performed after attainment of optimal angiographic results of the stent procedure. Focal and diffuse stent expansion was defined as either minimum stent area (MSA) or mean stent area over the length of the stent divided by reference lumen area. Results The proximal reference segments of lesions with higher calcium score contained a larger plaque burden (47 ±12% vs. 41 ±9% vs. 34 ±18%, p = 0.02) – respectively for groups 1, 2, and 3. Positive correlation was observed between lesion calcium score and frequency of post-dilation (R = 0.28, p = 0.03). There was no difference in focal stent expansion (71 ±14% vs. 65 ±15% vs.71 ±15%, p = 0.3) or diffuse stent expansion (92 ±30% vs. 85 ±30% vs. 93 ±38%, p = 0.7) comparing groups 1, 2, and 3. Lesion calcium score, total length of calcium, and maximum area and thickness of calcium deposits did not correlate with focal or diffuse stent expansion. Conclusions Lesions with a higher CTCA calcium score had larger reference plaque burden after stent implantation and more likely required post-dilation, but final stent expansion as assessed by IVUS was not affected by the amount of CTCA calcium provided an angiographically optimal result was achieved.
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Comparison of neointimal hyperplasia and peri-stent vascular remodeling after implantation of everolimus-eluting versus sirolimus-eluting stents: intravascular ultrasound results from the EXCELLENT study. Int J Cardiovasc Imaging 2013; 29:1229-36. [DOI: 10.1007/s10554-013-0199-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2012] [Accepted: 02/19/2013] [Indexed: 11/24/2022]
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Adjunctive balloon dilatation after stent deployment: Beneficial or deleterious? Int J Cardiol 2012; 157:3-7. [DOI: 10.1016/j.ijcard.2011.06.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2011] [Revised: 05/25/2011] [Accepted: 06/04/2011] [Indexed: 11/23/2022]
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Kim BK, Hong MK, Shin DH, Kim JS, Ko YG, Choi D, Jang Y. Relationship between stent malapposition and incomplete neointimal coverage after drug-eluting stent implantation. J Interv Cardiol 2012; 25:270-7. [PMID: 22372890 DOI: 10.1111/j.1540-8183.2011.00706.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Using optical coherence tomography (OCT), we evaluated the relationship between malapposed and uncovered struts following implantation of drug-eluting stents (DESs). METHODS A total of 271 patients with 306 lesions who underwent DES implantation and follow-up OCT were included in the study. The lesions were grouped based on the presence of malapposition and then by the median value of the percentage of malapposed struts (1.3%) to produce 3 groups: lesions without malapposition (group I, n = 232) and those with percentage of malapposed struts <1.3% (group II, n = 37) or ≥1.3% (group III, n = 37). Percentages of malapposed and uncovered struts were calculated as percent ratio of malapposed or uncovered to total struts in the defined cross-sections, respectively. We compared percentage of uncovered struts in all analyzable struts and in the residual struts without malapposed segments among the 3 groups. RESULTS Group III showed a significantly larger percentage of uncovered struts among all the struts (group I, 3.7 ± 6.4 vs. II, 5.5 ± 5.6 vs. III, 17.6 ± 15.9%, P < 0.001) and among residual struts without malapposed segments (3.7 ± 6.4 vs. 5.2 ± 5.7 vs. 15.0 ± 14.4%, respectively, P < 0.001). There was a significant correlation between malapposed and uncovered struts in group III (r = 0.393, P = 0.016), but not in group II (r =-0.007, P = 0.965) among residual struts without malapposed segments. CONCLUSION The percentage of uncovered DES struts was quite different depending on the presence and extent of malapposed struts.
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Cassese S, Tada T, Kastrati A. Lost contact with vessel wall, signed contract with stent thrombosis? Eur Heart J 2012; 33:1305-8. [DOI: 10.1093/eurheartj/ehs039] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
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Cook S, Eshtehardi P, Kalesan B, Raber L, Wenaweser P, Togni M, Moschovitis A, Vogel R, Seiler C, Eberli FR, Luscher T, Meier B, Juni P, Windecker S. Impact of incomplete stent apposition on long-term clinical outcome after drug-eluting stent implantation. Eur Heart J 2012; 33:1334-43. [DOI: 10.1093/eurheartj/ehr484] [Citation(s) in RCA: 82] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
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Kume T, Okura H, Miyamoto Y, Yamada R, Saito K, Tamada T, Koyama T, Neishi Y, Hayashida A, Kawamoto T, Yoshida K. Natural history of stent edge dissection, tissue protrusion and incomplete stent apposition detectable only on optical coherence tomography after stent implantation – preliminary observation – . Circ J 2012; 76:698-703. [PMID: 22251751 DOI: 10.1253/circj.cj-11-0845] [Citation(s) in RCA: 68] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND The clinical impact of stent edge dissection, tissue protrusion, and incomplete stent apposition (ISA) after stent implantation, detectable only on optical coherence tomography (OCT), is still unknown because the natural course has not been investigated. METHODS AND RESULTS All consecutive patients with angina pectoris in whom both intravascular ultrasound (IVUS) and OCT were performed immediately after stenting and at follow-up were included in the present study. The natural history of OCT-detected stent edge dissection, tissue protrusion, and ISA during follow-up was investigated. A total of 36 patients with 39 lesions was analyzed. At baseline, OCT showed 12 stent edge dissections, 25 tissue protrusions, and 8 ISAs, whereas IVUS demonstrated 6 stent edge dissections, 5 tissue protrusions, and 3 ISAs. All IVUS findings were clearly visualized on OCT. The maximum length of dissection flap and depth of ISA visualized on OCT were significantly shorter than those visualized on IVUS. Maximum length of tissue protrusion tended to be smaller on OCT than on IVUS. At follow-up (median 188 days), all findings noted on OCT were healed or resolved without any restenosis or thrombus formation. CONCLUSIONS Acute findings after stenting, such as edge dissection, tissue protrusion, and ISA, detectable only on OCT, tended to be smaller than those seen on both OCT and IVUS. The majority of OCT-detected acute findings resolved completely at follow-up.
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Affiliation(s)
- Teruyoshi Kume
- Department of Cardiology, Kawasaki Medical School, Kurashiki, Japan.
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Zghal FM, Amri A, Mourali MS, Farhati A, Larbi N, Mechmèche R. Bare Metal Stent Thrombosis in Patients With Acute Coronary Syndrome. Circ J 2012; 76:634-40. [DOI: 10.1253/circj.cj-11-1041] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
| | - Aymen Amri
- Cardiology Department, Rabta Hospital of Tunis
| | | | | | - Noureddine Larbi
- Cardiology Department, Rabta Hospital of Tunis
- University of Tunis El Manar
| | - Rachid Mechmèche
- Cardiology Department, Rabta Hospital of Tunis
- University of Tunis El Manar
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Pregowski J, Kepka C, Kruk M, Mintz GS, Kalinczuk L, Ciszewski M, Ciszewski A, Wolny R, Szubielski M, Chmielak Z, Demkow M, Norwa-Otto B, Opolski M, Tyczynski P, Ruzyllo W, Witkowski A. Comparison of usefulness of percutaneous coronary intervention guided by angiography plus computed tomography versus angiography alone using intravascular ultrasound end points. Am J Cardiol 2011; 108:1728-34. [PMID: 21906708 DOI: 10.1016/j.amjcard.2011.07.043] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2011] [Revised: 07/20/2011] [Accepted: 07/20/2011] [Indexed: 11/17/2022]
Abstract
The aim of our study was to assess the impact of coronary computed tomographic angiographic (CTCA) guidance on outcomes of percutaneous coronary intervention (PCI). The study was a randomized single-center trial. Consecutive eligible patients with CTCA-detected significant coronary lesions who were scheduled for PCI were randomized to an angiographically guided versus an angiographically plus computed tomographically guided (ACTG) group. In the ACTG group the operator preliminarily planned PCI based on computed tomographic angiogram. The coprimary end points were minimal stent area and minimal reference lumen area assessed in all patients with intravascular ultrasound performed after achieving optimal angiographic results. Seventy-one patients (50 men, mean age 65 ± 8 years) were randomized. After invasive angiography, PCI of 32 lesions (30 patients) in the ACTG and in 32 lesions (30 patients) in the angiographically guided group was performed. A stented segment length was longer and nominal stent diameter tended to be larger in the ACTG group (23.8 ± 6.7 vs 19.5 ± 6.5 mm, p = 0.01; 3.27 ± 0.44 vs 3.09 ± 0.41 mm(2), p = 0.110). Minimal stent area tended to be larger (6.62 ± 2.01 vs 5.80 ± 2.02 mm(2), p = 0.100) and the smallest peri-stent reference lumen area was significantly larger in the ACTG group (6.76 ± 3.01 vs 5.0 ± 1.62 mm(2), p = 0.006) with a smaller plaque burden (50 ± 16% vs 58 ± 13%, p = 0.025). In conclusion, CTCA analysis before PCI significantly influences treatment strategy and results in better lesion coverage as defined by intravascular criteria.
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Kang KW, Ko YG, Shin DH, Kim JS, Kim BK, Choi D, Jang Y, Hong MK. Comparison of vascular remodeling in patients treated with sirolimus-versus zotarolimus-eluting stent following acute myocardial infarction. Clin Cardiol 2011; 35:49-54. [PMID: 22161864 DOI: 10.1002/clc.20988] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2011] [Revised: 09/11/2011] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The differences in the vascular response to stent implantation or in the incidence of late acquired stent malapposition among different types of drug-eluting stents are not well known in patients with acute myocardial infarction (MI). HYPOTHESIS The pattern of vascular remodeling and degree of neointimal proliferation were different depending on the different types of drug-eluting stents. METHODS This study used intravascular ultrasound (IVUS) to investigate vascular remodeling in patients treated with implantation of sirolimus-eluting stents (SESs) vs zotarolimus-eluting stents (ZESs) following acute MI. The study population consisted of 100 patients with acute MI who were treated either with SES (n = 41) or ZES (n = 59) and underwent both poststenting and 9-month follow-up IVUS examination. Serial vascular changes surrounding stented segments were compared between SES- and ZES-treated lesions. RESULTS Percentage of neointimal volume obstruction at follow-up was significantly smaller in SES-treated compared to ZES-treated lesions (2.8 ± 7.1% vs 18.1 ± 15.7%, respectively; P < 0.001). However, positive vascular remodeling, which was defined as greater than 10% increase in external elastic membrane volume index (31.7% vs 10.2%, respectively, P = 0.007), and late acquired stent malapposition (12.0% vs 0%, respectively, P = 0.006 ) occurred more frequently in SES-treated than in ZES-treated lesions. CONCLUSIONS The pattern of vascular remodeling, including positive remodeling, late acquired stent malapposition, and degree of neointimal proliferation might be different depending on the different types of drug-eluting stents in patients with acute MI.
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Affiliation(s)
- Ki-Woon Kang
- Severance Cardiovascular Hospital, Seoul, South Korea
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Ejiri K, Ishihara M, Dai K, Miki T, Inoue I, Kawagoe T, Shimatani Y, Miura F, Nakama Y, Otani T, Ikenaga H, Oda N, Nakamura M. Three-year follow-up of sirolimus-eluting stents vs. bare metal stents for acute myocardial infarction. Circ J 2011; 76:65-70. [PMID: 22040936 DOI: 10.1253/circj.cj-11-0300] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND The long-term safety and efficacy of drug-eluting stents for patients with acute myocardial infarction (AMI) remain controversial. METHODS AND RESULTS A total of 143 consecutive patients who presented between August 2004 and July 2006 with AMI and who underwent primary percutaneous coronary intervention (PCI) using sirolimus-eluting stents (SES), were compared with a historical control cohort of 129 consecutive patients who presented between August 2002 and July 2004 and who underwent primary PCI using bare metal stents (BMS). The rate of major adverse cardiovascular events at 3 years was significantly lower in the SES group than in the BMS group (20.3% vs. 33.1%, respectively; P=0.01). This reduction was mainly driven by a decrease in the rate of target vessel revascularization (12.3% vs. 22.4%, respectively; P=0.02). There was no significant difference in the rate of cardiovascular death (4.5% vs. 5.7%, respectively; P=0.67), non-fatal myocardial infarction (4.5% vs. 9.2%, respectively; P=0.16), coronary artery bypass grafting (2.3% vs. 2.5%, respectively; P=0.93), stroke (2.4% vs. 0.8%, respectively; P=0.35), and stent thrombosis (2.9% vs. 2.3%, respectively; P=0.80) between the 2 groups. CONCLUSIONS SES can be used safely and effectively in patients with AMI.
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Affiliation(s)
- Kentaro Ejiri
- Department of Cardiology, Hiroshima City Hospital, Hiroshima, Japan
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Radu M, Jørgensen E, Kelbæk H, Helqvist S, Skovgaard L, Saunamäki K. Optical coherence tomography at follow-up after percutaneous coronary intervention: relationship between procedural dissections, stent strut malapposition and stent healing. EUROINTERVENTION 2011; 7:353-61. [DOI: 10.4244/eijv7i3a60] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Goto K, Lansky AJ, Nikolsky E, Fahy M, Feit F, Ohman EM, White HD, Mehran R, Bertrand ME, Desmet W, Hamon M, Stone GW. Prognostic Significance of Coronary Thrombus in Patients Undergoing Percutaneous Coronary Intervention for Acute Coronary Syndromes. JACC Cardiovasc Interv 2011; 4:769-77. [DOI: 10.1016/j.jcin.2011.02.019] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2010] [Revised: 01/10/2011] [Accepted: 02/04/2011] [Indexed: 10/18/2022]
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Yumoto K, Anzai T, Aoki H, Inoue A, Funada S, Nishiyama H, Tanaka S, Kowase S, Shirai Y, Kurosaki K, Nogami A, Daida H, Kato K. Calcified plaque rupture and very late stent thrombosis after bare-metal stent implantation. Cardiovasc Interv Ther 2011; 26:252-9. [DOI: 10.1007/s12928-011-0070-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2010] [Accepted: 05/10/2011] [Indexed: 11/24/2022]
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Räber L, Wohlwend L, Wigger M, Togni M, Wandel S, Wenaweser P, Cook S, Moschovitis A, Vogel R, Kalesan B, Seiler C, Eberli F, Lüscher TF, Meier B, Jüni P, Windecker S. Five-year clinical and angiographic outcomes of a randomized comparison of sirolimus-eluting and paclitaxel-eluting stents: results of the Sirolimus-Eluting Versus Paclitaxel-Eluting Stents for Coronary Revascularization LATE trial. Circulation 2011; 123:2819-28, 6 p following 2828. [PMID: 21646500 DOI: 10.1161/circulationaha.110.004762] [Citation(s) in RCA: 146] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Long-term comparative data of first-generation drug-eluting stents are scarce. We investigated clinical and angiographic outcomes of sirolimus-eluting (SES) and paclitaxel-eluting stents (PES) at 5 years as part of the Sirolimus-Eluting Versus Paclitaxel-Eluting Stents for Coronary Revascularization (SIRTAX) LATE study. METHODS AND RESULTS A total of 1012 patients were randomly assigned to SES or PES. Repeat angiography was completed in 444 of 1012 patients (43.8%) at 5 years. Major adverse cardiac events occurred in 19.7% of SES- and 21.4% of PES-treated patients (hazard ratio, 0.89; 95% confidence interval, 0.68 to 1.17; P=0.39) at 5 years. There were no differences between SES and PES in terms of cardiac death (5.8% versus 5.7%; P=0.35), myocardial infarction (6.6% versus 6.9%; P=0.51), and target lesion revascularization (13.1% versus 15.1%; P=0.29). Between 1 and 5 years, the annual rate of target lesion revascularization was 2.0% (95% confidence interval, 1.4% to 2.6%) for SES and 1.4% (95% confidence interval, 0.9% to 2.0%) for PES. Among patients undergoing paired angiography at 8 months and 5 years, delayed lumen loss amounted to 0.37 ± 0.73 mm for SES and 0.29 ± 0.59 mm for PES (P=0.32). The overall rate of definite stent thrombosis was 4.6% for SES and 4.1% for PES (P=0.74), and very late definite stent thrombosis occurred at an annual rate of 0.65% (95% confidence interval, 0.40% to 0.90%). CONCLUSIONS Long-term follow-up of first-generation drug-eluting stents shows no significant differences in clinical and angiographic outcomes between SES and PES. The continuous increase in late lumen loss in conjunction with the ongoing risk of very late stent thrombosis suggests that vascular healing remains incomplete up to 5 years after implantation of first-generation drug-eluting stents.
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Affiliation(s)
- Lorenz Räber
- Department of Cardiology, Bern University Hospital, 3010 Bern, Switzerland
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Nakata T, Fujii K, Fukunaga M, Ohyanagi M, Masuyama T. Coronary artery aneurysm formation 7 months after bare-metal stent implantation: Intravascular ultrasound and optical coherence tomography observation. J Cardiol Cases 2011; 3:e115-e118. [PMID: 30532852 PMCID: PMC6265208 DOI: 10.1016/j.jccase.2011.01.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2011] [Accepted: 01/26/2011] [Indexed: 11/22/2022] Open
Abstract
Late-acquired angiographic coronary aneurysm formation after drug-eluting stent implantation is a rare phenomenon but potentially life-threatening event that has become a major cause of concern. Optical coherence tomography (OCT) is a high-resolution imaging method that allows detailed evaluation of stent strut coverage and characterization of neointimal tissue. This case report describes the possible mechanism of late-acquired angiographic coronary aneurysm formation after bare-metal stent implantation using OCT and intravascular ultrasound.
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Affiliation(s)
- Tsuyoshi Nakata
- Cardiovascular Division, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo, 6638501, Japan
| | - Kenichi Fujii
- Cardiovascular Division, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo, 6638501, Japan
| | - Masashi Fukunaga
- Cardiovascular Division, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo, 6638501, Japan
| | - Mitsumasa Ohyanagi
- Division of Coronary Heart Disease, Hyogo College of Medicine, Nishinomiya, Japan
| | - Tohru Masuyama
- Cardiovascular Division, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo, 6638501, Japan
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LEE CHIHANG. Intravascular Ultrasound Guided Percutaneous Coronary Intervention: A Practical Approach. J Interv Cardiol 2011; 25:86-94. [DOI: 10.1111/j.1540-8183.2011.00651.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Sakamoto N, Nakazato K, Misaka T, Mizukami H, Kunii H, Suzuki H, Saitoh SI, Takeishi Y. Very late stent thrombosis and neointimal plaque rupture after implantation of sirolimus-eluting stents: observations with angiography, IVUS and OCT. Cardiovasc Interv Ther 2011; 26:263-8. [DOI: 10.1007/s12928-011-0064-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2010] [Accepted: 03/23/2011] [Indexed: 11/28/2022]
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Caixeta A, Maehara A, Mintz GS. Intravascular Ultrasound: Principles, Image Interpretation, and Clinical Applications. Interv Cardiol 2011. [DOI: 10.1002/9781444319446.ch10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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50
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Automatic segmentation of in-vivo intra-coronary optical coherence tomography images to assess stent strut apposition and coverage. Int J Cardiovasc Imaging 2011; 28:229-41. [DOI: 10.1007/s10554-011-9824-3] [Citation(s) in RCA: 82] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2010] [Accepted: 01/25/2011] [Indexed: 11/26/2022]
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