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Novel Coating Technologies of Drug Eluting Stents. ACTIVE IMPLANTS AND SCAFFOLDS FOR TISSUE REGENERATION 2011. [DOI: 10.1007/8415_2010_54] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
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The representative porcine model for human cardiovascular disease. J Biomed Biotechnol 2010; 2011:195483. [PMID: 21253493 PMCID: PMC3022214 DOI: 10.1155/2011/195483] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2010] [Accepted: 12/13/2010] [Indexed: 11/18/2022] Open
Abstract
To improve human health, scientific discoveries must be translated into practical applications. Inherent in the development of these technologies is the role of preclinical testing using animal models. Although significant insight into the molecular and cellular basis has come from small animal models, significant differences exist with regard to cardiovascular characteristics between these models and humans. Therefore, large animal models are essential to develop the discoveries from murine models into clinical therapies and interventions.
This paper will provide an overview of the more frequently used large animal models, especially porcine models for preclinical studies.
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A Numerical Methodology to Fully Elucidate the Altered Wall Shear Stress in a Stented Coronary Artery. Cardiovasc Eng Technol 2010. [DOI: 10.1007/s13239-010-0028-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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54
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The pre-clinical animal model in the translational research of interventional cardiology. JACC Cardiovasc Interv 2010; 2:373-83. [PMID: 19463458 DOI: 10.1016/j.jcin.2009.03.004] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2008] [Revised: 02/19/2009] [Accepted: 03/08/2009] [Indexed: 11/23/2022]
Abstract
Scientific discoveries for improvement of human health must be translated into practical applications. Such discoveries typically begin at "the bench" with basic research, then progress to the clinical level. In particular, in the field of interventional cardiology, percutaneous cardiovascular intervention has rapidly evolved from an experimental procedure to a therapeutic clinical setting. Pre-clinical studies using animal models play a very important role in the evaluation of efficacy and safety of new medical devices before their use in human clinical studies. This review provides an overview of the emerging role, results of pre-clinical studies and development, and evaluation of animal models for percutaneous cardiovascular intervention technologies for patients with symptomatic cardiovascular disease.
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Gonzalo N, Barlis P, Serruys PW, Garcia-Garcia HM, Onuma Y, Ligthart J, Regar E. Incomplete stent apposition and delayed tissue coverage are more frequent in drug-eluting stents implanted during primary percutaneous coronary intervention for ST-segment elevation myocardial infarction than in drug-eluting stents implanted for stable/unstable angina: insights from optical coherence tomography. JACC Cardiovasc Interv 2010; 2:445-52. [PMID: 19463469 DOI: 10.1016/j.jcin.2009.01.012] [Citation(s) in RCA: 160] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2009] [Accepted: 01/23/2009] [Indexed: 11/16/2022]
Abstract
OBJECTIVES The aim of this study was to compare the frequency of incomplete stent apposition (ISA) and struts not covered by tissue at long-term follow-up (as assessed by optical coherence tomography [OCT]) in drug-eluting stents (DES) implanted during primary percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI) versus DES implanted for unstable and stable angina. BACKGROUND Incomplete stent apposition and the absence of strut endothelialization might be linked to stent thrombosis. DES implanted for STEMI might have a higher risk of thrombosis. METHODS Consecutive patients in whom OCT was performed at least 6 months after DES implantation were included in the study. Stent struts were classified on the basis of the presence or absence of ISA and tissue coverage. RESULTS Forty-seven lesions in 43 patients (1,356 frames, 10,140 struts) were analyzed (49% stable angina, 17% unstable angina, 34% STEMI). Median follow-up time was 9 (range 7 to 72) months. Drug-eluting stents implanted during primary PCI presented ISA more often than DES implanted in stable/unstable angina patients (75% vs. 25.8%, p = 0.001). The frequency of uncovered struts was also higher in the STEMI group (93.8% vs. 67.7%, p = 0.048). On multivariate analysis, DES implantation in STEMI was the only independent predictor of ISA (odds ratio: 9.8, 95% confidence interval: 2.4 to 40.4, p = 0.002) and the presence of uncovered struts at follow-up (odds ratio: 9.5, 95% confidence interval: 1.0 to 90.3, p = 0.049). CONCLUSIONS DES implanted for STEMI had a higher frequency of incompletely apposed struts and uncovered struts as assessed by OCT at follow-up. DES implantation during primary PCI in STEMI was an independent predictor of ISA and the presence of uncovered struts at follow-up.
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Affiliation(s)
- Nieves Gonzalo
- Thoraxcenter, Erasmus Medical Center, Rotterdam, the Netherlands
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56
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Steinberg DH, Mintz GS, Mandinov L, Yu A, Ellis SG, Grube E, Dawkins KD, Ormiston J, Turco MA, Stone GW, Weissman NJ. Long-term impact of routinely detected early and late incomplete stent apposition: an integrated intravascular ultrasound analysis of the TAXUS IV, V, and VI and TAXUS ATLAS workhorse, long lesion, and direct stent studies. JACC Cardiovasc Interv 2010; 3:486-94. [PMID: 20488404 DOI: 10.1016/j.jcin.2010.03.007] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2009] [Revised: 02/01/2010] [Accepted: 03/12/2010] [Indexed: 11/27/2022]
Abstract
OBJECTIVES We sought to determine the 2-year impact of early and late-acquired incomplete stent apposition (ISA) on clinical events. BACKGROUND The late clinical impact of early or late-acquired ISA in bare-metal stents (BMS) and TAXUS stents (Boston Scientific, Natick, Massachusetts) is debatable. METHODS We evaluated 1,580 patients enrolled in the intravascular ultrasound (IVUS) substudies of TAXUS IV, V, VI and TAXUS-ATLAS WH, LL, and DS trials. RESULTS There were 96 cases of early ISA in 26 (7.2%) BMS patients, 35 (9.7%) TAXUS Express patients (p = 0.28 vs. BMS), and 35 (7.3%) TAXUS Liberté patients (p = 0.21 vs. TAXUS Express, and p = 1.00 vs. BMS). Major adverse cardiovascular events were similar at 9 months in patients with early ISA versus control subjects with no ISA for BMS (3.8% vs. 15.2%, p = 0.13) and for TAXUS (11.6% vs. 8.8%, p = 0.45). There was no impact of early ISA on stent thrombosis. At 9-month follow-up, there were 36 cases of late-acquired ISA in 7 (2.7%) BMS patients, 17 (3.1%) patients with TAXUS slow-release (TAXUS Express or TAXUS Liberté), and 12 (15.4%) patients receiving TAXUS moderate-release. Over 2 ensuing years, major adverse cardiovascular events were similar in patients with late-acquired ISA versus control subjects with no ISA for BMS (14.3% vs. 7.9%, p = 0.54), TAXUS (overall, 8.3% vs. 8.1% p = 0.87), or TAXUS slow-release formulation (0% vs. 7.9%, p = 0.28). There was no impact of late-acquired ISA on stent thrombosis. CONCLUSIONS Neither routinely detected acute ISA nor routinely detected late-acquired ISA in BMS or TAXUS patients was associated with adverse clinical events over long-term follow-up.
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Affiliation(s)
- Daniel H Steinberg
- Medical University of South Carolina, Charleston, South Carolina 29425, USA.
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57
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Abdel-Latif A, Moliterno DJ. Editorial: protein C and S deficiency as a risk factor for stent thrombosis--when a rare disorder can predispose to rare events. J Interv Cardiol 2010; 23:565-8. [PMID: 20796164 DOI: 10.1111/j.1540-8183.2010.00590.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Oikawa Y, Yajima J, Costa M, Matsuno S, Akabane M, Funada R, Inaba T, Nakagawa Y, Nakamura M, Nagashima K, Kirigaya H, Ogasawara K, Sawada H, Aizawa T. Intravascular ultrasound, angioscopic and histopathological characterisation of heterogeneous patterns of restenosis after sirolimus-eluting stent implantation: insights into potential “thromborestenosis” phenomenon. EUROINTERVENTION 2010; 6:380-7. [DOI: 10.4244/eijv6i3a63] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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59
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Impact of angiographic and intravascular ultrasound features on clinical outcome after sirolimus-eluting stent implantation for de-novo lesions in nondiabetic and type 2 diabetic patients. Coron Artery Dis 2010; 21:175-81. [DOI: 10.1097/mca.0b013e32833811fe] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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60
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Cardinal KO, Williams SK. Assessment of the intimal response to a protein-modified stent in a tissue-engineered blood vessel mimic. Tissue Eng Part A 2010; 15:3869-76. [PMID: 19563259 DOI: 10.1089/ten.tea.2009.0193] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Protein-coated intravascular stents have emerged as potential pro-healing modifications for or alternatives to anti-proliferative drug-eluting stents. To support the development of these devices, preclinical testing is required to evaluate the intimal response to new coatings and modifications. The purpose of this work was to implement a tissue-engineered blood vessel as an in vitro testing system to evaluate extracellular matrix-modified stents with regard to endothelialization of the stent surface. Stents were modified by submersion in a protein-enriched medium and were subsequently deployed within tissue-engineered blood vessels and cultivated in vitro under flow to assess the intimal response. Scanning electron microscopy, fluorescent nuclear staining with en face imaging, and histological assessments were performed 7 or 14 days postdeployment. Results illustrated accelerated cellular regeneration over protein-modified stent strut surfaces, with increased coverage and increased tissue thickness atop protein-modified stent struts. In addition, the intimal response to modified stents differed significantly from bare metal stents. Conclusions from this work support the use of a tissue-engineered blood vessel mimic system for evaluation of modified stent surfaces. These findings are important to stent researchers as well as laboratories developing tissue-engineered constructs.
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Bezerra HG, Costa MA, Guagliumi G, Rollins AM, Simon DI. Intracoronary optical coherence tomography: a comprehensive review clinical and research applications. JACC Cardiovasc Interv 2010; 2:1035-46. [PMID: 19926041 DOI: 10.1016/j.jcin.2009.06.019] [Citation(s) in RCA: 443] [Impact Index Per Article: 31.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2009] [Revised: 06/16/2009] [Accepted: 06/25/2009] [Indexed: 12/17/2022]
Abstract
Cardiovascular optical coherence tomography (OCT) is a catheter-based invasive imaging system. Using light rather than ultrasound, OCT produces high-resolution in vivo images of coronary arteries and deployed stents. This comprehensive review will assist practicing interventional cardiologists in understanding the technical aspects of OCT based upon the physics of light and will also highlight the emerging research and clinical applications of OCT. Semi-automated imaging analyses of OCT systems permit accurate measurements of luminal architecture and provide insights regarding stent apposition, overlap, neointimal thickening, and, in the case of bioabsorbable stents, information regarding the time course of stent dissolution. The advantages and limitations of this new imaging modality will be discussed with emphasis on key physical and technical aspects of intracoronary image acquisition, current applications, definitions, pitfalls, and future directions.
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Affiliation(s)
- Hiram G Bezerra
- Harrington-McLaughlin Heart & Vascular Institute, University Hospitals Case Medical Center, Cleveland, Ohio 44106-5038, USA
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62
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Sirolimus-eluting stent implantation in small coronary arteries: A three dimensional intravascular ultrasound study from the SIRIUS trial. Int J Cardiol 2010; 138:126-30. [DOI: 10.1016/j.ijcard.2008.08.006] [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: 01/07/2008] [Revised: 06/02/2008] [Accepted: 08/08/2008] [Indexed: 11/21/2022]
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63
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Meredith IT, Ormiston J, Whitbourn R, Kay IP, Muller D, Cutlip DE. Five-year clinical follow-up after implantation of the endeavor zotarolimus-eluting stent: ENDEAVOR I, first-in-human study. Catheter Cardiovasc Interv 2009; 74:989-95. [DOI: 10.1002/ccd.22206] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Barlis P, Regar E, Serruys PW, Dimopoulos K, van der Giessen WJ, van Geuns RJM, Ferrante G, Wandel S, Windecker S, van Es GA, Eerdmans P, Jüni P, di Mario C. An optical coherence tomography study of a biodegradable vs. durable polymer-coated limus-eluting stent: a LEADERS trial sub-study. Eur Heart J 2009; 31:165-76. [PMID: 19889649 DOI: 10.1093/eurheartj/ehp480] [Citation(s) in RCA: 196] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
AIMS Incomplete endothelialization has been found to be associated with late stent thrombosis, a rare but devastating phenomenon, more frequent after drug-eluting stent implantation. Optical coherence tomography (OCT) has 10 times greater resolution than intravascular ultrasound and thus appears to be a valuable modality for the assessment of stent strut coverage. The LEADERS trial was a multi-centre, randomized comparison of a biolimus-eluting stent (BES) with biodegradable polymer with a sirolimus-eluting stent (SES) using a durable polymer. This study sought to evaluate tissue coverage and apposition of stents using OCT in a group of patients from the randomized LEADERS trial. METHODS AND RESULTS Fifty-six consecutive patients underwent OCT during angiographic follow-up at 9 months. OCT images were acquired using a non-occlusive technique at a pullback speed of 3 mm/s. Data were analysed using a Bayesian hierarchical random-effects model, which accounted for the correlation of lesion characteristics within patients and implicitly assigned analytical weights to each lesion depending on the number of struts observed per lesion. Primary outcome was the difference in percentage of uncovered struts between BESs and SESs. Twenty patients were included in the analysis in the BES group (29 lesions with 4592 struts) and 26 patients in the SES group (35 lesions with 6476 struts). A total of 83 struts were uncovered in the BES group and 407 out of 6476 struts were uncovered in the SES group [weighted difference -1.4%, 95% confidence interval (CI) -3.7 to 0.0, P = 0.04]. Results were similar after adjustment for pre-procedure lesion length, reference vessel diameter, number of implanted study stents, and presence of stent overlap. There were three lesions in the BES group and 15 lesions in the SES group that had > or =5% of all struts uncovered (difference -33.1%, 95% CI -61.7 to -10.3, P < 0.01). CONCLUSION Strut coverage at an average follow-up of 9 months appears to be more complete in patients allocated to BESs when compared with SESs. The impact of this difference on clinical outcome and, in particular, on the risk of late stent thrombosis is yet to be determined.
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Affiliation(s)
- Peter Barlis
- Royal Brompton Hospital, Sydney Street, London, UK
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65
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Atary J, Bergheanu S, van der Hoeven B, Atsma D, Bootsma M, van der Kley F, Zeppenfeld K, Jukema JW, Schalij M. Impact of sirolimus-eluting stent implantation compared to bare-metal stent implantation for acute myocardial infarction on coronary plaque composition at nine months follow-up: a Virtual Histology intravascular ultrasound analysis. Results from the Leiden MISSION! intervention study. EUROINTERVENTION 2009; 5:565-72. [DOI: 10.4244/eijv5i5a92] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Suzuki Y, Oyane A, Ikeno F, Lyons JK, Yeung AC. Development of animal model for calcified chronic total occlusion. Catheter Cardiovasc Interv 2009; 74:468-75. [PMID: 19360862 DOI: 10.1002/ccd.22024] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Chronic total coronary occlusion (CTO) remains a major problem for percutaneous revascularization, with relatively low primary success rates and a high incidence of restenosis and reocclusion compared with those of subtotal stenoses. No reproducible animal model simulating human CTOs has previously been developed. We hypothesized that an apatite-coated bioabsorbable polymer sponge could be implanted to produce calcified CTO lesions in animal coronary arteries/peripheral arteries. A total of 10 swine and six rabbits were used for this study. The apatite-coated bioabsorbable polymer sponges were implanted into a preselected segment of coronary and peripheral arteries. Four weeks after implantation, both angiography and histopathology were performed to document the presence or absence of CTO lesions. We could reproducibly develop CTO lesions in animal coronary/peripheral arteries that mimic human CTO lesions. These lesions were found to have microvascular channels and microcalcification similar to those of human older CTO lesions and demonstrate the development of adventitial arterioles, a consistent finding in human CTO. This CTO model might provide a platform for evaluating future CTO technologies as well as contributing to a better understanding of CTOs in both educational and practical terms.
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Affiliation(s)
- Yoriyasu Suzuki
- Division of Cardiovascular Medicine, Stanford University, Stanford, California 94305-2200, USA
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67
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Kim SS, Jeong MH, Kim HK, Bae SY, Ryu KH, Cho KH, Kim MC, Park KH, Sim DS, Hong YJ, Kim JH, Ahn Y, Kang JC. Acute and subacute stent thrombosis in a patient with clopidogrel resistance: a case report. Korean Circ J 2009; 39:434-8. [PMID: 19949590 PMCID: PMC2771795 DOI: 10.4070/kcj.2009.39.10.434] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2009] [Accepted: 06/30/2009] [Indexed: 11/30/2022] Open
Abstract
Drug-eluting stents (DES) are considered the treatment of choice for most patients with obstructive coronary artery disease when percutaneous intervention (PCI) is feasible. However, stent thrombosis seems to occur more frequently with DES and occasionally is associated with resistance to anti-platelet drugs. We have experienced a case of recurrent stent thrombosis in a patient with clopidogrel resistance. A 63-year-old female patient suffered from acute myocardial infarction and underwent successful PCI of the left anterior descending coronary artery (LAD) with two DESs. She was found to be hyporesponsive to clopidogrel and was treated with triple anti-platelet therapy (aspirin 100 mg, clopidogrel 75 mg, and cilostazol 200 mg daily). Three days after discharge, she developed chest pain and was again taken to the cardiac catheterization laboratory, where coronary angiography (CAG) showed total occlusion of the mid-LAD where the stent had been placed. After intravenous administration of a glycoprotein IIb/IIIa inhibitor, balloon angioplasty was performed, resulting in Thrombolysis In Myocardial Infarction (TIMI) III antegrade flow. The next day, however, she complained of severe chest pain, and the electrocardiogram showed marked ST-segment elevation in V1-V6, I, and aVL with complete right bundle branch block. Emergent CAG revealed total occlusion of the proximal LAD due to stent thrombosis. She was successfully treated with balloon angioplasty and was discharged with triple anti-platelet therapy.
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Affiliation(s)
- Sung Soo Kim
- The Heart Research Center of Chonnam National University Hospital, Gwangju, Korea
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68
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Gerber RT, Latib A, Ielasi A, Cosgrave J, Qasim A, Airoldi F, Chieffo A, Montorfano M, Carlino M, Michev I, Tobis J, Colombo A. Defining a new standard for IVUS optimized drug eluting stent implantation: the PRAVIO study. Catheter Cardiovasc Interv 2009; 74:348-56. [PMID: 19213067 DOI: 10.1002/ccd.21973] [Citation(s) in RCA: 8] [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
OBJECTIVES Preliminary Investigation to the Angiographic Versus IVUS Optimization Trial is a single center prospective observational intravascular ultrasound (IVUS) guided stent implantation study assessing new criteria for optimal drug eluting stent (DES) deployment. BACKGROUND IVUS assessment of DES often reveals underexpansion and malapposition. Optimal stent deployment is currently poorly defined and previous criteria may not be suitable in long and complex lesions. METHODS Optimization was defined as achieving >/or 70% of the cross-sectional area (CSA) of the postdilation balloon. This criterion was applied in 113 complex lesions. The size of this balloon was calculated according to vessel media-to-media diameters at various sites inside the stented segment. The IVUS guided treated lesions were matched according to diabetes, vessel type, reference vessel diameter, minimum lumen diameter (MLD), and lesion length with a group of angiographic treated lesions to compare final MLD achieved. RESULTS Mean minimum stent CSA according to the postdilation balloon utilized was 4.62 mm(2), 6.26 mm(2), 7.87 mm(2), and 9.87 mm(2) for 2.5 mm, 3.0 mm, 3.5 mm, and 4 mm balloons, respectively. Final MLD (mm) was significantly larger in the IVUS compared to the angiographic-guided group (3.09 +/- 0.50 vs. 2.67 +/- 0.54; P < 0.0001). There were no procedural complications related to IVUS use. CONCLUSIONS We propose new IVUS criteria based on vessel remodeling that results in an increment in the final MLD, compared to angiographic guidance, which is much larger than any previously published study. This criterion seems to be safely achievable. A proposed randomized study (angiographic vs. IVUS optimization trial) has been launched to test these concepts.
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Affiliation(s)
- R T Gerber
- Catheterisation Laboratory, San Raffaele Hospital, Milan, Italy
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69
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Hur SH, Ako J, Honda Y, Sudhir K, Fitzgerald PJ. Late-acquired incomplete stent apposition: morphologic characterization. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2009; 10:236-46. [PMID: 19815171 DOI: 10.1016/j.carrev.2009.02.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2009] [Accepted: 02/04/2009] [Indexed: 11/24/2022]
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70
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Basalus M, van Houwelingen KG, Ankone M, de Man F, von Birgelen C. Scanning electron microscopic assessment of the biodegradable coating on expanded biolimus-eluting stents. EUROINTERVENTION 2009; 5:505-10. [DOI: 10.4244/eijv5i4a80] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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71
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Kaple RK, Tsujita K, Maehara A, Mintz GS. Accuracy of stent measurements using ECG-gated greyscale intravascular ultrasound images: a validation study. ULTRASOUND IN MEDICINE & BIOLOGY 2009; 35:1265-1270. [PMID: 19541405 DOI: 10.1016/j.ultrasmedbio.2009.02.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/26/2008] [Revised: 02/03/2009] [Accepted: 02/13/2009] [Indexed: 05/27/2023]
Abstract
Greyscale intravascular ultrasound (IVUS) is an accurate tool for measuring stent dimensions and residual disease at the stent edge. Electrocardiographically (ECG)-gated IVUS is used in evolving second-generation IVUS systems, but this modality provides fewer greyscale cross-sectional images, and its accuracy to measure stent dimensions has not been assessed. This study was designed to validate the use of ECG-gated greyscale IVUS in measuring minimum stent area (MSA), stent length and reference dimensions compared to standard greyscale IVUS data. IVUS imaging was performed after drug-eluting stent implantation in 53 target lesions in 48 patients with acute coronary syndrome. The IVUS catheter was mechanically withdrawn at 0.5 mm/s, standard greyscale images were collected at 10 frames/s, and ECG-gated greyscale images were constructed from R-wave gated images. The MSA measured 6.20 +/- 1.75 mm(2)vs. 5.98 +/- 1.55 mm(2) on standard greyscale and ECG-gated greyscale IVUS, respectively (R(2) = 0.91, p = 0.005). The MSA position (R(2) = 0.66, p = 0.179) and stent length (R(2) = 0.99, p = 0.435) measurements were similar between modalities. Proximal reference vessel area was larger by ECG-gated IVUS, but proximal reference lumen and distal reference measurements were similar. Bland-Altman plots demonstrated good agreement between modalities. In conclusion, ECG-gated greyscale IVUS provides accurate and reliable measurements of stent length, area and reference segment plaque burden after stent implantation and is not inferior to standard greyscale IVUS.
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Affiliation(s)
- Ryan K Kaple
- The Cardiovascular Research Foundation, Columbia University Medical Center, New York City, NY, USA
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72
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Claessen BE, Beijk MA, Legrand V, Ruzyllo W, Manari A, Varenne O, Suttorp MJ, Tijssen JG, Miquel-Hebert K, Veldhof S, Henriques JP, Serruys PW, Piek JJ. Two-Year Clinical, Angiographic, and Intravascular Ultrasound Follow-Up of the XIENCE V Everolimus-Eluting Stent in the Treatment of Patients With De Novo Native Coronary Artery Lesions. Circ Cardiovasc Interv 2009; 2:339-47. [DOI: 10.1161/circinterventions.108.831800.108.831800] [Citation(s) in RCA: 92] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Bimmer E. Claessen
- From the Department of Cardiology (B.E.C., M.A.B., J.G.P.T., J.P.S.H., J.J.P.), Academic Medical Center, University of Amsterdam, The Netherlands; C.H.U. de Liege Sart Tilman (V.L.), Liege, Belgium; National Institute of Cardiology in Warsaw (W.R.), Warsaw, Poland; Azienda Ospedaliera Santa Maria Nuova (A.M.), Reggio Emilia, Italy; Hopital Cochin (O.V.), Paris, France; St. Antonius Ziekenhuis (M.J.S.), Nieuwegein, The Netherlands; Abbott Vascular (K.M.-H., S.V.), Diegem, Belgium; and Thoraxcenter (P
| | - Marcel A. Beijk
- From the Department of Cardiology (B.E.C., M.A.B., J.G.P.T., J.P.S.H., J.J.P.), Academic Medical Center, University of Amsterdam, The Netherlands; C.H.U. de Liege Sart Tilman (V.L.), Liege, Belgium; National Institute of Cardiology in Warsaw (W.R.), Warsaw, Poland; Azienda Ospedaliera Santa Maria Nuova (A.M.), Reggio Emilia, Italy; Hopital Cochin (O.V.), Paris, France; St. Antonius Ziekenhuis (M.J.S.), Nieuwegein, The Netherlands; Abbott Vascular (K.M.-H., S.V.), Diegem, Belgium; and Thoraxcenter (P
| | - Victor Legrand
- From the Department of Cardiology (B.E.C., M.A.B., J.G.P.T., J.P.S.H., J.J.P.), Academic Medical Center, University of Amsterdam, The Netherlands; C.H.U. de Liege Sart Tilman (V.L.), Liege, Belgium; National Institute of Cardiology in Warsaw (W.R.), Warsaw, Poland; Azienda Ospedaliera Santa Maria Nuova (A.M.), Reggio Emilia, Italy; Hopital Cochin (O.V.), Paris, France; St. Antonius Ziekenhuis (M.J.S.), Nieuwegein, The Netherlands; Abbott Vascular (K.M.-H., S.V.), Diegem, Belgium; and Thoraxcenter (P
| | - Witold Ruzyllo
- From the Department of Cardiology (B.E.C., M.A.B., J.G.P.T., J.P.S.H., J.J.P.), Academic Medical Center, University of Amsterdam, The Netherlands; C.H.U. de Liege Sart Tilman (V.L.), Liege, Belgium; National Institute of Cardiology in Warsaw (W.R.), Warsaw, Poland; Azienda Ospedaliera Santa Maria Nuova (A.M.), Reggio Emilia, Italy; Hopital Cochin (O.V.), Paris, France; St. Antonius Ziekenhuis (M.J.S.), Nieuwegein, The Netherlands; Abbott Vascular (K.M.-H., S.V.), Diegem, Belgium; and Thoraxcenter (P
| | - Antonio Manari
- From the Department of Cardiology (B.E.C., M.A.B., J.G.P.T., J.P.S.H., J.J.P.), Academic Medical Center, University of Amsterdam, The Netherlands; C.H.U. de Liege Sart Tilman (V.L.), Liege, Belgium; National Institute of Cardiology in Warsaw (W.R.), Warsaw, Poland; Azienda Ospedaliera Santa Maria Nuova (A.M.), Reggio Emilia, Italy; Hopital Cochin (O.V.), Paris, France; St. Antonius Ziekenhuis (M.J.S.), Nieuwegein, The Netherlands; Abbott Vascular (K.M.-H., S.V.), Diegem, Belgium; and Thoraxcenter (P
| | - Olivier Varenne
- From the Department of Cardiology (B.E.C., M.A.B., J.G.P.T., J.P.S.H., J.J.P.), Academic Medical Center, University of Amsterdam, The Netherlands; C.H.U. de Liege Sart Tilman (V.L.), Liege, Belgium; National Institute of Cardiology in Warsaw (W.R.), Warsaw, Poland; Azienda Ospedaliera Santa Maria Nuova (A.M.), Reggio Emilia, Italy; Hopital Cochin (O.V.), Paris, France; St. Antonius Ziekenhuis (M.J.S.), Nieuwegein, The Netherlands; Abbott Vascular (K.M.-H., S.V.), Diegem, Belgium; and Thoraxcenter (P
| | - Maarten J. Suttorp
- From the Department of Cardiology (B.E.C., M.A.B., J.G.P.T., J.P.S.H., J.J.P.), Academic Medical Center, University of Amsterdam, The Netherlands; C.H.U. de Liege Sart Tilman (V.L.), Liege, Belgium; National Institute of Cardiology in Warsaw (W.R.), Warsaw, Poland; Azienda Ospedaliera Santa Maria Nuova (A.M.), Reggio Emilia, Italy; Hopital Cochin (O.V.), Paris, France; St. Antonius Ziekenhuis (M.J.S.), Nieuwegein, The Netherlands; Abbott Vascular (K.M.-H., S.V.), Diegem, Belgium; and Thoraxcenter (P
| | - Jan G.P. Tijssen
- From the Department of Cardiology (B.E.C., M.A.B., J.G.P.T., J.P.S.H., J.J.P.), Academic Medical Center, University of Amsterdam, The Netherlands; C.H.U. de Liege Sart Tilman (V.L.), Liege, Belgium; National Institute of Cardiology in Warsaw (W.R.), Warsaw, Poland; Azienda Ospedaliera Santa Maria Nuova (A.M.), Reggio Emilia, Italy; Hopital Cochin (O.V.), Paris, France; St. Antonius Ziekenhuis (M.J.S.), Nieuwegein, The Netherlands; Abbott Vascular (K.M.-H., S.V.), Diegem, Belgium; and Thoraxcenter (P
| | - Karine Miquel-Hebert
- From the Department of Cardiology (B.E.C., M.A.B., J.G.P.T., J.P.S.H., J.J.P.), Academic Medical Center, University of Amsterdam, The Netherlands; C.H.U. de Liege Sart Tilman (V.L.), Liege, Belgium; National Institute of Cardiology in Warsaw (W.R.), Warsaw, Poland; Azienda Ospedaliera Santa Maria Nuova (A.M.), Reggio Emilia, Italy; Hopital Cochin (O.V.), Paris, France; St. Antonius Ziekenhuis (M.J.S.), Nieuwegein, The Netherlands; Abbott Vascular (K.M.-H., S.V.), Diegem, Belgium; and Thoraxcenter (P
| | - Susan Veldhof
- From the Department of Cardiology (B.E.C., M.A.B., J.G.P.T., J.P.S.H., J.J.P.), Academic Medical Center, University of Amsterdam, The Netherlands; C.H.U. de Liege Sart Tilman (V.L.), Liege, Belgium; National Institute of Cardiology in Warsaw (W.R.), Warsaw, Poland; Azienda Ospedaliera Santa Maria Nuova (A.M.), Reggio Emilia, Italy; Hopital Cochin (O.V.), Paris, France; St. Antonius Ziekenhuis (M.J.S.), Nieuwegein, The Netherlands; Abbott Vascular (K.M.-H., S.V.), Diegem, Belgium; and Thoraxcenter (P
| | - Jose P.S. Henriques
- From the Department of Cardiology (B.E.C., M.A.B., J.G.P.T., J.P.S.H., J.J.P.), Academic Medical Center, University of Amsterdam, The Netherlands; C.H.U. de Liege Sart Tilman (V.L.), Liege, Belgium; National Institute of Cardiology in Warsaw (W.R.), Warsaw, Poland; Azienda Ospedaliera Santa Maria Nuova (A.M.), Reggio Emilia, Italy; Hopital Cochin (O.V.), Paris, France; St. Antonius Ziekenhuis (M.J.S.), Nieuwegein, The Netherlands; Abbott Vascular (K.M.-H., S.V.), Diegem, Belgium; and Thoraxcenter (P
| | - Patrick W. Serruys
- From the Department of Cardiology (B.E.C., M.A.B., J.G.P.T., J.P.S.H., J.J.P.), Academic Medical Center, University of Amsterdam, The Netherlands; C.H.U. de Liege Sart Tilman (V.L.), Liege, Belgium; National Institute of Cardiology in Warsaw (W.R.), Warsaw, Poland; Azienda Ospedaliera Santa Maria Nuova (A.M.), Reggio Emilia, Italy; Hopital Cochin (O.V.), Paris, France; St. Antonius Ziekenhuis (M.J.S.), Nieuwegein, The Netherlands; Abbott Vascular (K.M.-H., S.V.), Diegem, Belgium; and Thoraxcenter (P
| | - Jan J. Piek
- From the Department of Cardiology (B.E.C., M.A.B., J.G.P.T., J.P.S.H., J.J.P.), Academic Medical Center, University of Amsterdam, The Netherlands; C.H.U. de Liege Sart Tilman (V.L.), Liege, Belgium; National Institute of Cardiology in Warsaw (W.R.), Warsaw, Poland; Azienda Ospedaliera Santa Maria Nuova (A.M.), Reggio Emilia, Italy; Hopital Cochin (O.V.), Paris, France; St. Antonius Ziekenhuis (M.J.S.), Nieuwegein, The Netherlands; Abbott Vascular (K.M.-H., S.V.), Diegem, Belgium; and Thoraxcenter (P
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Late stent malapposition with marked positive vascular remodeling observed only at the site of drug-eluting stents after multivessel coronary stenting. Heart Vessels 2009; 24:308-12. [DOI: 10.1007/s00380-008-1124-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2008] [Accepted: 10/17/2008] [Indexed: 11/26/2022]
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Serruys PW, Hoye A, Grollier G, Colombo A, Symons J, Mudra H. A European multi‐center trial investigating the anti‐restenotic effect of intravascular sonotherapy after stenting of de novo lesions (EUROSPAH: EUROpean Sonotherapy Prevention of Arterial Hyperplasia). ACTA ACUST UNITED AC 2009; 6:53-60. [PMID: 15385204 DOI: 10.1080/14628840410030405] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND Intravascular sonotherapy (IST) reduces neointimal hyperplasia post-stenting in animal studies. Euro-SPAH is a multi-center, double blind, randomized trial investigating the efficacy of IST to reduce in-stent late loss. METHODS Patients with angina or silent ischaemia with stented de novo lesions were randomised to sham or IST. The sample size had a 90% power to detect a late loss difference of 0.21 mm at 6 months. The secondary endpoints were MACE at 1, 6, 12 months and neo-intimal hyperplasia on IVUS at 6 months. RESULTS At 23 sites in Europe, 403 patients were randomized, with successful treatment with sham or IST in 95.6%. There were no significant differences between the groups in terms of baseline demographics or lesion characteristics. Angiographic follow-up was obtained in 89%. In-stent late loss was not significantly different. The restenosis rate at 6 months was 23% in the IST group versus 25% in the sham group. The IVUS measurements confirm the absence of effect of IST on neointimal hyperplasia. At one year, the event-free survival did not significantly differ between the two groups. CONCLUSION The use of sonotherapy following stent implantation in de novo lesions does not reduce intra-stent neointimal hyperplasia, or effect the angiographic restenosis rate compared to sham treatment.
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Serruys PW, Heyndrickx GR, Patel J, Cummins PA, Kleijne JA, Clowes AW. Effect of an anti‐PDGF‐β‐receptor‐blocking antibody on restenosis in patients undergoing elective stent placement. ACTA ACUST UNITED AC 2009; 5:214-22. [PMID: 14630567 DOI: 10.1080/14628840310017177] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
AIM The aim of the study was to determine whether a single intravenous infusion of 25 mg/kg CDP860, a humanized di-Fab' fragment against PDGF-beta receptor, leads to a reduction of in-stent restenosis. METHODS In this phase II, double-blind, placebo-controlled, multicentre study 145 patients presenting with stable or unstable angina were randomized to a single infusion of placebo or active drug (CDP860) before undergoing stenting. Quantitative angiography and 3D intravascular ultrasound (IVUS) were obtained at baseline and follow-up. Primary endpoint was the IVUS assessment of percentage in-stent volume obstruction. RESULTS At six-month follow-up, the placebo group and CDP860 group did not differ significantly regarding minimal luminal diameter (1.75 +/- 0.68 versus 1.82 +/--0.66 mm), restenosis rate (16.2 versus 14.1%), minimal lumen area (4.71 +/- 1.85 versus 4.41 +/- 1.77 mm(2) ), in-stent neointimal volume (30 +/- 23 versus 31 +/- 31 mm(3)) and in-stent obstruction volume (23.8 +/- 14.4 versus 22.1 +/- 15.3%). Major adverse cardiac events at 210 days were similar in both groups: death 1.5 versus 1.4%, myocardial infarction 5.9 versus 8.1% and target vessel revascularization 16.4 versus 17.6%. CONCLUSION A single intravenous administration of monoclonal antibody against PDGF-beta receptor failed to reduce the amount of neointimal hyperplasia after stent implantation.
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Suzuki Y, Ikeno F, Koizumi T, Tio F, Yeung AC, Yock PG, Fitzgerald PJ, Fearon WF. In vivo comparison between optical coherence tomography and intravascular ultrasound for detecting small degrees of in-stent neointima after stent implantation. JACC Cardiovasc Interv 2009; 1:168-73. [PMID: 19463295 DOI: 10.1016/j.jcin.2007.12.007] [Citation(s) in RCA: 114] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2007] [Revised: 12/18/2007] [Accepted: 12/20/2007] [Indexed: 11/30/2022]
Abstract
OBJECTIVES The purpose of this study was to evaluate optical coherence tomography (OCT) for detecting small degrees of in-stent neointima (ISN) after stent implantation compared with intravascular ultrasound (IVUS). BACKGROUND The importance of detecting neointimal coverage of stent struts has grown with the appreciation of the increased risk for late stent thrombosis after drug-eluting stent (DES) implantation. Intravascular ultrasound, the current standard for evaluating the status of DES, lacks the resolution to detect the initial neointimal coverage. Optical coherence tomography has greater resolution but has not yet been compared with IVUS in vivo with histological correlation for validation. METHODS Intravascular ultrasound and OCT were performed with motorized pullback imaging in 6 pigs across 33 stents, 1 month after implantation. Each pig was euthanized, and histological measurements of vessel, stent, and lumen dimensions were performed in 3 sections of each stent. A small degree of ISN was defined as occupying <30% of the stent area measured with histology. The IVUS, OCT, and histological assessment of ISN were compared in matched cross-sections of the stents with a small degree of ISN. RESULTS Eleven stents had a small degree of ISN (average ISN area: 1.26 +/- 0.46 mm(2), and percent area obstruction: 21.4 +/- 5.2%). Compared with histology, the diagnostic accuracy of OCT (area under the receiver operating characteristic curve [AUC] = 0.967, 95% confidence interval [CI] 0.914 to 1.019) was higher than that of IVUS (AUC = 0.781, 95% CI 0.621 to 0.838). CONCLUSIONS Optical coherence tomography detects smaller degrees of ISN more accurately than IVUS and might be a useful method for identifying neointimal coverage of stent struts after DES implantation.
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Affiliation(s)
- Yoriyasu Suzuki
- Division of Cardiovascular Medicine, Stanford University, Stanford, California, USA
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CHECHI TANIA, VECCHIO SABINE, LILLI ALESSIO, GIULIANI GABRIELE, SPAZIANI GAIA, BALDERESCHI GIORGIO, MONTEREGGI ALESSIO, RUBBOLI ANDREA, MARGHERI MASSIMO. Mechanisms of Late Stent Malapposition After Primary Stenting in ST-Elevation Myocardial Infarction: A Subanalysis of the Selection Trial. J Interv Cardiol 2009; 22:201-6. [DOI: 10.1111/j.1540-8183.2009.00461.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Fukuda D, Enomoto S, Shirakawa I, Nagai R, Sata M. Fluvastatin accelerates re-endothelialization impaired by local sirolimus treatment. Eur J Pharmacol 2009; 612:87-92. [DOI: 10.1016/j.ejphar.2009.04.006] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2008] [Revised: 03/21/2009] [Accepted: 04/01/2009] [Indexed: 01/23/2023]
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Kim SS, Jeong MH, Sim DS, Hong YJ, Kim JH, Ahn YK, Kang JC. Very late thrombosis of a drug-eluting stent after discontinuation of dual antiplatelet therapy in a patient treated with both drug-eluting and bare-metal stents. Korean Circ J 2009; 39:205-8. [PMID: 19949580 PMCID: PMC2771789 DOI: 10.4070/kcj.2009.39.5.205] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2008] [Revised: 08/13/2008] [Accepted: 09/18/2008] [Indexed: 11/12/2022] Open
Abstract
Drug-eluting stents (DESs) are the treatment of choice for obstructive coronary artery disease when percutaneous intervention is feasible. However, late stent thrombosis seems to occur more frequently with DESs and is closely associated with the discontinuation of dual antiplatelet therapy. We report a case of very late stent thrombosis after discontinuation of dual antiplatelet therapy. The patient suffered from acute myocardial infarction (MI) and underwent bare metal stent (BMS) implantation in the left anterior descending artery (LAD) five years prior to presentation. Three years after BMS implantation, he presented again with acute MI and had a DES implanted in the right coronary artery (RCA). He ran out of his medication, but failed to refill his prescription. Sixteen days after discontinuing medication, he experienced an episode of chest pain and was taken to the cardiac catheterization laboratory, where he was found to have thrombosis in the DES, but no thrombosis in the BMS. It is possible that DESs are more vulnerable to late thrombosis than are BMSs, supporting the use of prolonged dual antiplatelet therapy in patients treated with DESs. The patient was successfully treated with balloon angioplasty and thrombus aspiration without complications.
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Affiliation(s)
- Sung Soo Kim
- The Heart Center of Chonnam National University Hospital, Gwangju, Korea
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Jensen LO, Maeng M, Mintz GS, Christiansen EH, Hansen KN, Galloe A, Kelbaek H, Lassen JF, Thuesen L, Thayssen P. Serial intravascular ultrasound analysis of peri-stent remodeling and proximal and distal edge effects after sirolimus-eluting or paclitaxel-eluting stent implantation in patients with diabetes mellitus. Am J Cardiol 2009; 103:1083-8. [PMID: 19361594 DOI: 10.1016/j.amjcard.2008.12.035] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2008] [Revised: 12/21/2008] [Accepted: 12/21/2008] [Indexed: 11/16/2022]
Abstract
Patients with diabetes have an increased risk of in-stent restenosis after coronary stent implantation. Serial intravascular ultrasound was used to study chronic arterial responses and edge effects after implantation of Cypher (Cordis, Johnson & Johnson, Miami Lakes, Florida) or Taxus (Boston Scientific, Maple Grove, Minnesota) stents in diabetic patients. Seventy-four diabetic patients were randomly assigned to Cypher or Taxus stent implantation. Intravascular ultrasound of 5-mm long segments immediately proximal and distal to the stent was performed after the procedure and at the 8-month follow-up. The increase in peri-stent external elastic membrane (EEM) volume was more pronounced in the Taxus group (292.4 +/- 132.6 to 309.5 +/- 146.8 mm(3)) than in the Cypher group (274.4 +/- 137.2 to 275.4 +/- 140.1 mm(3); p = 0.005). Peri-stent plaque volume increased in the Taxus group (152.5 +/- 73.7 to 166.1 +/- 85.1 mm(3)), but was unchanged in the Cypher group (153.5 +/- 75.5 to 151.5 +/- 75.8 mm(3); p = 0.002). In proximal and distal reference segments, mean lumen area decreased within the entire 5-mm edge segment (proximal and distal) because of plaque progression (distal, 5.5 +/- 3.6 to 5.8 +/- 3.7 mm(2); p = 0.097; proximal, 8.1 +/- 2.7 to 8.7 +/- 2.9 mm(2); p = 0.006) without remodeling (change in EEM) in the Taxus group. Conversely, there were no significant changes in reference-segment EEM or plaque areas in the Cypher group. In conclusion, in diabetic patients, Taxus stent implantation was associated with increased (1) peri-stent EEM volume and peri-stent plaque, and (2) stent edge plaque progression accompanied by lumen reduction without remodeling. These findings were not seen in Cypher stents.
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A novel approach to define risk of stent thrombosis after percutaneous coronary intervention with drug-eluting stents: the DERIVATION score. Clin Res Cardiol 2009; 98:240-8. [DOI: 10.1007/s00392-009-0753-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2008] [Accepted: 01/08/2009] [Indexed: 11/26/2022]
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Abstract
Drug-eluting stents (DES) in percutaneous coronary interventions significantly reduce rates of restenosis and the need for new revascularizations compared with bare metal stents. However, as the use of DES has increased dramatically, questions have been raised about their long-term safety. Concerns about an increased risk of late stent thrombosis, particularly beyond the first year of treatment, have arisen and have been exacerbated by sparse and conflicting information, and boosted an intense debate between cardiologists. In this article, we reviewed the most recent information to clarify the conundrum of late stent thrombosis and the long-term safety of DES.
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Affiliation(s)
- Francesco Saia
- Institute of Cardiology - University of Bologna, Policlinico S.Orsola-Malpighi (Pad 21), Via Massarenti, 9, 40138 Bologna Italy.
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LEE CHIHANG, ZHANG JUNJIE, KAILASAM ANAND, TAI BEECHOO, YE FEI, LOW ADRIANF, HOU XUMIN, HAY EDOURDOTIN, TEO SWEEGUAN, LIM YEANTENG, CHEN SHAOLIANG, TAN HUAYCHEEM. An Intravascular Ultrasound Study of Cypher, Taxus, and Endeavor Stents on Relation between Neointimal Proliferation and Residual Plaque Burden. J Interv Cardiol 2008; 21:519-27. [DOI: 10.1111/j.1540-8183.2008.00397.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Acute coronary syndrome is an independent risk factor for late incomplete stent apposition after sirolimus-eluting stent implantation. Chin Med J (Engl) 2008. [DOI: 10.1097/00029330-200812020-00007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Gurvitch R, Yan BP, Warren R, Marasco S, Black AJ, Ajani AE. Spontaneous resolution of multiple coronary aneurysms complicating drug eluting stent implantation. Int J Cardiol 2008; 130:e7-10. [PMID: 17897738 DOI: 10.1016/j.ijcard.2007.07.039] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2007] [Accepted: 07/01/2007] [Indexed: 11/26/2022]
Abstract
Recent reports of coronary aneurysm formation after drug eluting stent implantation have emerged. Although various treatment modalities have been proposed, minimal data is available relating to their natural history and optimal management. We present a case of aneurysm formation in the left anterior descending and right coronary arteries after stenting with paclitaxel-eluting stents. Coronary bypass grafting of the left anterior descending and circumflex coronary arteries was subsequently required. Repeat angiography (16 months later) showed complete resolution of both coronary aneurysms. Spontaneous resolution of potentially drug eluting stent-related coronary aneurysms is documented. This phenomenon may have therapeutic implications.
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Fitzgerald PJ, Otake H. Evaluación de la respuesta vascular al intervencionismo coronario. Rev Esp Cardiol 2008. [DOI: 10.1157/13126038] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Xie Y, Takano M, Murakami D, Yamamoto M, Okamatsu K, Inami S, Seimiya K, Ohba T, Seino Y, Mizuno K. Comparison of neointimal coverage by optical coherence tomography of a sirolimus-eluting stent versus a bare-metal stent three months after implantation. Am J Cardiol 2008; 102:27-31. [PMID: 18572031 DOI: 10.1016/j.amjcard.2008.02.091] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2007] [Revised: 02/26/2008] [Accepted: 02/26/2008] [Indexed: 11/30/2022]
Abstract
No detailed data regarding neointimal coverage of bare-metal stents (BMSs) at 3 months after implantation was reported to date. This investigation was designed to evaluate the neointimal coverage of BMSs compared with sirolimus-eluting stents (SESs) using optical coherence tomography. A prospective optical coherence tomographic follow-up examination was performed 3 months after stent implantation for patients who underwent BMS (n = 16) or SES implantation (n = 24). Neointimal hyperplasia (NIH) thickness on each stent strut and percentage of NIH area in each cross section were measured. Malapposition of stent struts to the vessel wall and the existence of in-stent thrombi were also evaluated. There were 5,076 struts of SESs and 2,875 struts of BMSs identified. NIH thickness and percentage of NIH area in the BMS group were higher than in the SES group (351 +/- 248 vs 31 +/- 39 mum; p <0.0001; 45.0 +/- 14% vs 10.0 +/- 4%; p <0.0001, respectively). The frequency of uncovered struts was higher in the SES group than the BMS group (15% vs 0.1%; p <0.0001). Malapposed struts were observed more frequently in the SES group than the BMS group (15% vs 1.1%; p <0.0001). In conclusion, there was no difference in incidence of in-stent thrombus between the 2 groups (14% vs 0%; p = 0.23). The present study showed almost all BMS struts to be well covered at a 3-month follow-up, suggesting that patients receiving BMS stents may not require dual-antiplatelet therapy >3 months after implantation.
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Affiliation(s)
- Yong Xie
- Division of Cardiology, Nippon Medical School, Tokyo, Japan
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88
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Jensen LO, Maeng M, Thayssen P, Christiansen EH, Hansen KN, Galloe A, Kelbaek H, Lassen JF, Thuesen L. Neointimal hyperplasia after sirolimus-eluting and paclitaxel-eluting stent implantation in diabetic patients: The Randomized Diabetes and Drug-Eluting Stent (DiabeDES) Intravascular Ultrasound Trial. Eur Heart J 2008; 29:2733-41. [PMID: 18832385 DOI: 10.1093/eurheartj/ehn434] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Abstract
Despite the success of coronary stent implantations in the last decade, in-stent restenosis due to neointimal hyperplasia remains a problem to overcome. Neointimal hyperplasia is a vascular response to stent injury and mainly consists of proliferation of smooth muscle cells and deposition of extracellular matrix. Recently, local drug delivery has been advocated as a potential strategy to prevent in-stent restenosis. Unprecedented results have been obtained in early clinical studies on sirolimus-eluting and paclitaxel-eluting stents. Trials using various pharmaceutical coatings on different coronary stents are ongoing. More types of drug-eluting stents are expected on the market in the near future. Meanwhile, the evaluation of drug-eluting stents is entering the second phase in which the safety and efficacy in more complex lesion subsets and different clinical presentations are being investigated. Results including cost-benefit analyses are expected to have a tremendous impact on the practice of interventional cardiology in the next decade.
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Affiliation(s)
- Chi-Hang Lee
- Cardiac Department, National University Hospital, Singapore
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Gerber R, Colombo A. Does IVUS guidance of coronary interventions affect outcome? a prime example of the failure of randomized clinical trials. Catheter Cardiovasc Interv 2008; 71:646-54. [PMID: 18360858 DOI: 10.1002/ccd.21489] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
There has been a decline in the role of intravascular ultrasound (IVUS) guiding stenting. IVUS has lost favor with interventional cardiologists largely due to the emergence of drug eluting stents (DES). The advent of DES has lowered the need to maximize the final result due to the known low late-loss. This phenomenon has contributed to reduced interest in optimizing results with IVUS guidance. However, current concerns regarding stent thrombosis in relation to DES and its associated significant morbidity and mortality has once more focused attention on optimal stent deployment. Prior to DES, the evidence base was rather ambiguous, as some randomized and observational studies supported IVUS guided bare metal stent insertion in terms of reducing rates of restenosis and clinically driven target lesion revascularisation whereas others demonstrated no such benefit. As there is an additional cost and learning curve with IVUS, it has become difficult to justify its routine use. We present here a contemporary argument for the resurgence of IVUS optimized stent insertion. We also highlight deficiencies in previously adopted IVUS optimization criteria, which were based on distal and proximal lumen sizes. The new criteria proposed are based on vessel size at different segments of the stented area and therefore take advantage of vessel remodeling. The availability of high pressure, non-compliant balloons have made attainment of these new optimization targets possible without increasing the risk of complications. We hope to demonstrate this statement with the completion of the angiographically versus IVUS optimization (AVIO) study that soon will be initiated.
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Affiliation(s)
- Robert Gerber
- EMO Centro Cuore Columbus and San Raffaele Hospitals, Milan, Italy
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91
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Abstract
The Van Nes rotationplasty is a useful limb-preserving procedure for skeletally immature patients with distal femoral or proximal tibial malignancy. The vascular supply to the lower limb either must be maintained and rotated or transected and reanastomosed. We asked whether there would be any difference in the ankle brachial index or complication rate for the two methods of vascular management. Vessels were resected with the tumor in seven patients and preserved and rotated in nine patients. One amputation occurred in the group in which the vessels were preserved. Four patients died secondary to metastatic disease diagnosed preoperatively. The most recent ankle brachial indices were 0.96 and 0.82 for the posterior tibial and dorsalis pedis arteries, respectively, in the reconstructed group. The ankle brachial indices were 0.98 and 0.96 for the posterior tibial and dorsalis pedis arteries, respectively, in the rotated group. Outcomes appear similar using both methods of vascular management and one should not hesitate to perform an en bloc resection when there is a question of vascular involvement.
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92
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Zhang ZY, Yin XH. Impact of Adenovirus-mediated Local Expression of Human Tissue Factor Pathway Inhibitor on Vascular Smooth Muscular Cell Proliferation and Apoptosis in the Stent-implanted Femoral Artery of the Rabbit. J Int Med Res 2008; 36:567-71. [PMID: 18534140 DOI: 10.1177/147323000803600323] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
This study examined the effect of gene transfer of local tissue factor pathway inhibitor (TFPI) on vascular smooth muscle cells (VSMCs) in stent-implanted arteries. Rabbit femoral arteries were balloon-injured, stent-implanted and infected with the replication-defective recombinant adenovirus-mediated TFPI gene (Ad-TFPI) or the β-galactosidase gene (Ad- LacZ), or treated with saline solution. Expression of TFPI at the site of the stent was confirmed after 3 days using reverse transcription-polymerase chain reaction (RT-PCR). After 7 days, proliferating cells were visualized by immunostaining with antibodies to proliferating cell nuclear antigen (PCNA) and apoptotic cells were detected using the terminal deoxynucleotidyl mediated nick end labelling (TUNEL) technique. Cell proliferation was significantly decreased and apoptosis significantly increased in the media in the Ad-TFPI group compared with the other two groups. In conclusion, Ad-TFPI gene transfer can significantly suppress VSMC proliferation and induce its apoptosis in the media at the site of an implanted stent and may have potential for the treatment of instent re-stenosis.
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Affiliation(s)
- Z-Y Zhang
- Cardiovascular Department, Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - X-H Yin
- Cardiovascular Department, Second Affiliated Hospital of Harbin Medical University, Harbin, China
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93
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Chronic Arterial Responses to Overlapping Paclitaxel-Eluting Stents. JACC Cardiovasc Interv 2008; 1:161-7. [DOI: 10.1016/j.jcin.2007.12.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2007] [Revised: 12/03/2007] [Accepted: 12/10/2007] [Indexed: 11/20/2022]
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94
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Sirolimus-eluting stents versus bare-metal stents in patients with ST-segment elevation myocardial infarction: 9-month angiographic and intravascular ultrasound results and 12-month clinical outcome results from the MISSION! Intervention Study. J Am Coll Cardiol 2008; 51:618-26. [PMID: 18261680 DOI: 10.1016/j.jacc.2007.09.056] [Citation(s) in RCA: 126] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2007] [Revised: 09/13/2007] [Accepted: 09/17/2007] [Indexed: 01/27/2023]
Abstract
OBJECTIVES Our purpose was to evaluate the efficacy and safety of drug-eluting stents in the setting of primary percutaneous coronary intervention for ST-segment elevation myocardial infarction (STEMI). BACKGROUND There is inconsistent and limited evidence about the efficacy and safety of drug-eluting stents in STEMI patients. METHODS A single-blind, single-center, randomized study was performed to compare bare-metal stents (BMS) with sirolimus-eluting stents (SES) in 310 STEMI patients. The primary end point was in-segment late luminal loss (LLL) at 9 months. Secondary end points included late stent malapposition (LSM) at 9 months as determined by intravascular ultrasound imaging and clinical events at 12 months. RESULTS In-segment LLL was 0.68 +/- 0.57 mm in the BMS group and 0.12 +/- 0.43 mm in the SES group with a mean difference of 0.56 mm, 95% confidence interval 0.43 to 0.68 mm (p < 0.001). Late stent malapposition at 9 months was present in 12.5% BMS patients and in 37.5% SES patients (p < 0.001). Event-free survival at 12 months was 73.6% in BMS patients and 86.0% in SES patients (p = 0.01). The target-vessel-failure-free survival was 84.7% in the BMS group and 93.0% in the SES group (p = 0.02), mainly because of a higher target lesion revascularization rate in BMS patients (11.3% vs. 3.2%; p = 0.006). Rates of death, myocardial infarction, and stent thrombosis were not different. CONCLUSIONS Sirolimus-eluting stent implantation in STEMI patients is associated with a favorable midterm clinical and angiographic outcome compared with treatment with BMS. However, LSM raises concern about the long-term safety of SES in STEMI patients.
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95
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A more than 2-year follow-up of incomplete apposition after drug-eluting stent implantation. Chin Med J (Engl) 2008. [DOI: 10.1097/00029330-200803020-00004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
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96
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Jabara R, Chronos N, Conway D, Molema W, Robinson K. Evaluation of a Novel Slow-Release Paclitaxel-Eluting Stent With a Bioabsorbable Polymeric Surface Coating. JACC Cardiovasc Interv 2008; 1:81-7. [DOI: 10.1016/j.jcin.2007.11.009] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2007] [Revised: 11/26/2007] [Accepted: 11/29/2007] [Indexed: 11/30/2022]
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97
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Romano M, Buffoli F, Tomasi L, Corrado L, Ferrari MR, Zanini R. Safety and effectiveness of drug eluting stent in patients with ST elevation myocardial infarction undergoing primary angioplasty. Catheter Cardiovasc Interv 2008; 71:759-63. [DOI: 10.1002/ccd.21529] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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98
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Hong YJ, Jeong MH, Hwang SH, Yun NS, Lim SY, Lee SR, Hong SN, Kim KH, Park HW, Kim JH, Kim W, Ahn YK, Cho JG, Park JC, Kang JC. Impact of postprocedure minimum stent area on long-term results following abciximab-coated stent implantation: an intravascular ultrasound analysis. Int J Cardiol 2007; 123:23-8. [PMID: 17289173 DOI: 10.1016/j.ijcard.2006.11.101] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2006] [Revised: 10/17/2006] [Accepted: 11/09/2006] [Indexed: 11/24/2022]
Abstract
BACKGROUND Smaller postprocedural minimum stent areas (MSA) measured by intravascular ultrasound (IVUS) have been associated with higher restenosis rates. METHODS This was a single-center, prospective, randomized trial and we assessed the predictive value of MSA for long-term patency and the incidence and extent of incomplete stent apposition (ISA) following abciximab-coated stent (n=69) compared to bare metal stent (BMS) implantation (n=69). All patients underwent IVUS follow-up at 6 months. RESULTS At follow-up coronary angiogram, the restenosis rate and late loss were 12%, 0.30+/-0.24 mm in abciximab-coated stent group and 29%, 0.68+/-0.36 mm in BMS group (p=0.011, 0.010, respectively). At follow-up IVUS, intrastent lumen area was significantly larger and intrastent neointimal hyperplasia area was significantly smaller in abciximab-coated stent group than those in BMS group (5.9+/-1.6 mm(2) vs. 4.5+/-1.7 mm(2), p=0.001, and 1.9+/-1.5 mm(2) vs. 3.3+/-1.9 mm(2), p<0.001, respectively). Target lesion revascularization occurred in 9%, 0%, and 0% in abciximab-coated stent group and 19%, 4%, and 1% in BMS group in lesions with a MSA <6.0 mm(2), from 6 to 7.5 mm(2), and >7.5 mm(2), respectively. Late-acquired ISA at follow-up was observed in 7 patients and there was no difference in the incidence of ISA between both groups [abciximab-coated stent: n=3 (4%) vs. BMS: n=4 (6%), p=0.698]. CONCLUSION Abciximab-coated stent reduced restenosis and had a considerably lower optimal MSA threshold compared to BMS and showed lower incidence of late-acquired ISA.
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Affiliation(s)
- Young Joon Hong
- The Heart Center of Chonnam National University Hospital, Chonnam National, University Research Institute of Medical Sciences, Gwangju, Republic of Korea
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POPMA JEFFREYJ, WEINER BONNIE, COWLEY MICHAELJ, SIMONTON CHARLES, McCORMICK DAN, FELDMAN TED. FDA Advisory Panel on the Safety and Efficacy of Drug-Eluting Stents: Summary of Findings and Recommendations. J Interv Cardiol 2007; 20:425-46. [DOI: 10.1111/j.1540-8183.2007.00312.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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100
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Lasave LI, Abizaid AAC, Paiva e Maia J, de Ribamar Costa J, Feres F, Mattos LA, Abizaid AS, Siqueira DA, Tanajura LF, Staico R, Beraldo de Andrade P, Braga SN, Sousa AGMR, Sousa JE. [Relationship between plasma C-reactive protein level and neointimal hyperplasia volume in patients with zotarolimus-eluting stents. Volumetric analysis by three-dimensional intracoronary ultrasound]. Rev Esp Cardiol 2007; 60:923-31. [PMID: 17915148 DOI: 10.1157/13109645] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
INTRODUCTION AND OBJECTIVES C-reactive protein (CRP) is an inflammatory marker that predicts cardiac events in patients with coronary syndromes. However, data on the relationship between the CRP level and in-stent restenosis are contradictory. The objective of this study was to investigate the relationship between the basal CRP level and the neointimal hyperplasia volume measured by intracoronary ultrasound 4 months after implantation of a zotarolimus-eluting stent. METHODS The study included 40 consecutive patients who underwent zotarolimus-eluting stent implantation. Patients were divided into quartiles according to their preprocedural CRP level. Intracoronary ultrasound was performed after stent implantation and at 4 months, and the neointimal hyperplasia volume was determined using Simpson's rule. Correlation and linear regression analyses were used to evaluate the relationships between variables. Multivariate analysis was used to identify variables that were independently related to neointimal hyperplasia volume. RESULTS The patients' mean age was 58 (8) years, 55% were male, and 40% had diabetes mellitus. There was no difference in baseline characteristics between the quartiles. The hyperplasia volumes were 4.8 (4.2) microl and 15.8 (10.0) microl in the first and fourth quartiles, respectively (P< .001). There was a significant positive correlation between the CRP level and neointimal hyperplasia volume (r = 0.64, P=.0001). The CRP level, the postimplantation lumen volume, and the final deployment pressure were all independent predictors of neointimal hyperplasia. CONCLUSIONS In this study, an independent correlation was observed between the CRP level before zotarolimus-eluting stent implantation and the neointimal hyperplasia volume at 4-month follow-up.
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Affiliation(s)
- Leandro I Lasave
- Servicio de Hemodinámica y Cardiología Intervencionista, Instituto Dante Pazzanese de Cardiología, São Paulo, Brasil
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