1
|
The Clinical and Angiographic Outcomes of Postdilation after Percutaneous Coronary Intervention in Patients with Acute Coronary Syndrome: A Systematic Review and Meta-Analysis. J Interv Cardiol 2021; 2021:6699812. [PMID: 33935601 PMCID: PMC8055432 DOI: 10.1155/2021/6699812] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 03/01/2021] [Accepted: 03/23/2021] [Indexed: 12/18/2022] Open
Abstract
Objective The effect of postdilation in patients with acute coronary syndrome is still controversial. This meta-analysis aims to analyze the clinical and angiographic outcomes of postdilation after percutaneous coronary intervention in patients with acute coronary syndrome. Methods PubMed, Embase, the Cochrane Library, Web of Science, CNKI, and Wangfang databases were searched from inception to August 30, 2020. Eligible studies from acute coronary syndrome patients treated with postdilation were included. The primary clinical outcome was major adverse cardiovascular events (MACE), the secondary clinical outcomes comprised all-cause death, stent thrombosis, myocardial infarction, and target vessel revascularization, and the angiographic outcomes were no reflow and slow reflow. Results 11 studies met inclusion criteria. In clinical outcomes, our pooled analysis demonstrated that the postdilation had a tendency of decreasing MACE (OR = 0.67, 95% CI 0.45–1.00; P = 0.05) but significantly increased all-cause death (OR = 1.49, 95% CI 1.05–2.12; P = 0.03). No significant difference existed in stent thrombosis (OR = 0.71, 95% CI 0.40–1.26; P = 0.24), myocardial infarction (OR = 1.40, 95% CI 0.51–3.83; P = 0.51), and target vessel revascularization (OR = 0.61, 95% CI 0.21–1.80; P = 0.37) between postdilation and non-postdilation groups. In angiographic outcomes, there were no significant differences in no reflow (OR = 1.19, 95% CI 0.54–2.65; P = 0.66) and slow reflow (OR = 1.12, 95% CI 0.93–1.35; P = 0.24) between two groups. Conclusions The postdilation tends to reduce the risk of MACE but significantly increases all-cause death, without significantly affecting stent thrombosis, myocardial infarction, target vessel revascularization, and coronary TIMI flow grade. However, more randomized controlled trials are required for investigating the effect of postdilation for patients with acute coronary syndrome (registered by PROSPERO, CRD42020160748).
Collapse
|
2
|
Kozuma K, Shinozaki T, Kozuma K, Kashiwabara K, Oba K, Aoki J, Awata M, Nanasato M, Shiode N, Tanabe K, Yamaguchi J, Kimura T, Matsuyama Y. Impact of Residual Stenosis on the Angiographic Edge Restenosis of a Second-Generation Drug-Eluting Stent. Int Heart J 2019; 60:1050-1060. [DOI: 10.1536/ihj.18-717] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Kayoko Kozuma
- Department of Biostatistics, Division of Health Sciences and Nursing, Graduate School of Medicine, The University of Tokyo
| | - Tomohiro Shinozaki
- Department of Biostatistics, Division of Health Sciences and Nursing, Graduate School of Medicine, The University of Tokyo
| | - Ken Kozuma
- Division of Cardiology, Teikyo University School of Medicine
| | - Kosuke Kashiwabara
- Department of Biostatistics, Division of Health Sciences and Nursing, Graduate School of Medicine, The University of Tokyo
| | - Koji Oba
- Department of Biostatistics, Division of Health Sciences and Nursing, Graduate School of Medicine, The University of Tokyo
| | - Jiro Aoki
- Division of Cardiology, Mitsui Memorial Hospital
| | - Masaki Awata
- Division of Cardiology, National Hospital Organization Osaka National Hospital
| | | | - Nobuo Shiode
- Division of Cardiology, Hiroshima City Hiroshima Citizens Hospital
| | - Kengo Tanabe
- Division of Cardiology, Mitsui Memorial Hospital
| | | | - Takeshi Kimura
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine
| | - Yutaka Matsuyama
- Department of Biostatistics, Division of Health Sciences and Nursing, Graduate School of Medicine, The University of Tokyo
| |
Collapse
|
3
|
Song HG, Kang SJ, Mintz GS. Value of intravascular ultrasound in guiding coronary interventions. Echocardiography 2018; 35:520-533. [DOI: 10.1111/echo.13837] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Affiliation(s)
- Hae Geun Song
- Department of Cardiology; DeltaHealth Hospital; Shanghai China
| | - Soo-Jin Kang
- Department of Cardiology; Asan Medical Center; University of Ulsan College of Medicine; Seoul South Korea
| | | |
Collapse
|
4
|
Optical Frequency Domain Imaging Versus Intravascular Ultrasound in Percutaneous Coronary Intervention (OPINION Trial): Results From the OPINION Imaging Study. JACC Cardiovasc Imaging 2017; 11:111-123. [PMID: 28917678 DOI: 10.1016/j.jcmg.2017.06.021] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Revised: 06/02/2017] [Accepted: 06/08/2017] [Indexed: 12/19/2022]
Abstract
OBJECTIVES The authors sought to clarify how intravascular ultrasound (IVUS) and optical coherence tomography affect percutaneous coronary intervention (PCI) with current-generation drug-eluting stents in a pre-specified substudy of the OPINION (OPtical frequency domain imaging versus INtravascular ultrasound in percutaneous coronary interventiON) trial, a multicenter, prospective, randomized, noninferiority trial comparing optical frequency domain imaging (OFDI)-guided PCI with IVUS-guided PCI. BACKGROUND The impact of these 2 imaging modalities in guiding PCI remains unknown. METHODS Of 829 patients enrolled in the OPINION trial, 106 were included in the present imaging substudy. Their PCI was guided by either IVUS or OFDI, but all patients were imaged by both modalities after PCI and by OFDI at 8 months. Angiographic, OFDI, and IVUS images were analyzed by independent core laboratories, and statistical analysis was done independently by a dedicated institution. RESULTS A total of 103 patients underwent either OFDI-guided (n = 54) or IVUS-guided (n = 49) PCI. Immediately after PCI, OFDI-guided PCI was associated with a smaller trend of minimum stent area (5.28 ± 1.65 mm2 vs. 6.12 ± 2.34 mm2; p = 0.088), fewer proximal stent-edge hematomas (p = 0.04), and fewer irregular protrusions (p = 0.014) than IVUS-guided PCI. At 8 months, the neointima area tended to be smaller in the OFDI-guided PCI group than in the IVUS-guided PCI group (0.56 ± 0.30 mm2 vs. 0.80 ± 0.65 mm2; p = 0.057), although the percentage of uncovered struts was significantly higher in the OFDI-guided PCI group than in the IVUS-guided PCI group (6.97 ± 7.03% vs. 4.67 ± 6.43%; p = 0.039). The minimum lumen area was comparable in both groups (p = 0.18). CONCLUSIONS There were several differences in local findings between OFDI- and IVUS-guided PCI as expected given the different protocols for stent sizing in the 2 groups. The minimum lumen area at the 8-month follow-up was comparable, suggesting that OFDI- and IVUS-guided PCI are similarly feasible using the current-generation drug-eluting stents. (OPtical frequency domain imaging versus INtravascular ultrasound in percutaneous coronary interventiON; NCT01873222).
Collapse
|
5
|
Hong SJ, Ahn CM, Shin DH, Kim JS, Kim BK, Ko YG, Choi D, Her AY, Kim YH, Jang Y, Hong MK. Effect of Adjunct Balloon Dilation after Long Everolimus-eluting Stent Deployment on Major Adverse Cardiac Events. Korean Circ J 2017; 47:694-704. [PMID: 28955388 PMCID: PMC5614946 DOI: 10.4070/kcj.2017.0016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Revised: 04/12/2017] [Accepted: 04/28/2017] [Indexed: 11/11/2022] Open
Abstract
Background and Objectives The effectiveness of adjunct balloon dilation after drug-eluting stent (DES) deployment has not been sufficiently evaluated. We evaluated whether adjunct balloon dilation was associated with a reduction in major adverse cardiac events (MACEs) after long everolimus-eluting stents (EESs) implantation. Subjects and Methods Drawing from 2 randomized trials, a total of 1,672 patients treated with long EES were analyzed. Of 1,672 patients, 1,061 patients (64%) received post-stent adjunct balloon dilation. MACE, defined as a composite of cardiac death, myocardial infarction, and target-lesion revascularization (TLR), was compared between patients who received post-stent adjunct balloon dilation and patients who did not in 595 propensity score-matched pairs. Results For the matched population, MACE occurred in 29 patients (4.9%) who received adjunct balloon dilation and in 29 patients (4.9%) who did not (hazard ratio [HR], 1.01; 95% confidence interval [CI], 0.60–1.69; p=0.972). However, significant interactions were observed among the subgroups for clinical presentation and vessel size. Adjunct balloon dilation was more favored within the subset of patients with stable angina vs. the subset of patients with acute coronary syndrome (p for interaction=0.037), and within the subset of lesions with small vessel diameter (reference vessel diameter [RVD] <3 mm) vs. the subset of lesions with larger vessel diameter (RVD ≥3 mm; p for interaction=0.027). Conclusion Adjunct balloon dilation was not associated with MACE reduction at 1 year among patients requiring long EES implantation. However, post-stent adjunct balloon dilation may be necessary for patients requiring long EES implantation who present with stable angina or for lesions with small vessel diameters.
Collapse
Affiliation(s)
- Sung-Jin Hong
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University Health System, Seoul, Korea
| | - Chul-Min Ahn
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University Health System, Seoul, Korea
| | - Dong-Ho Shin
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University Health System, Seoul, Korea
| | - 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
| | - Young-Guk Ko
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University Health System, Seoul, Korea
| | - Donghoon Choi
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University Health System, Seoul, Korea
| | - Ae-Young Her
- Department of Internal Medicine, Kangwon National University School of Medicine, Chuncheon, Korea
| | - Yong Hoon Kim
- Department of Internal Medicine, Kangwon National University School of Medicine, Chuncheon, Korea
| | - Yangsoo Jang
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University Health System, Seoul, Korea.,Severance Biomedical Science Institute, Yonsei University College of Medicine, Seoul, Korea.,Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Myeong-Ki Hong
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University Health System, Seoul, Korea.,Severance Biomedical Science Institute, Yonsei University College of Medicine, Seoul, Korea.,Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul, Korea
| |
Collapse
|
6
|
Song HG, Kang SJ. Current Clinical Applications of Intravascular Ultrasound in Coronary Artery Disease. CURRENT CARDIOVASCULAR IMAGING REPORTS 2017. [DOI: 10.1007/s12410-017-9424-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
7
|
Seth A, Gupta S, Pratap Singh V, Kumar V. Expert Opinion: Optimising Stent Deployment in Contemporary Practice: The Role of Intracoronary Imaging and Non-compliant Balloons. Interv Cardiol 2017; 12:81-84. [PMID: 29588734 DOI: 10.15420/icr.2017:12:1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Final stent dimensions remain an important predictor of restenosis, target vessel revascularisation (TVR) and subacute stent thrombosis (ST), even in the drug-eluting stent (DES) era. Stent balloons are usually semi-compliant and thus even high-pressure inflation may not achieve uniform or optimal stent expansion. Post-dilatation with non-compliant (NC) balloons after stent deployment has been shown to enhance stent expansion and could reduce TVR and ST. Based on supporting evidence and in the absence of large prospective randomised outcome-based trials, post-dilatation with an NC balloon to achieve optimal stent expansion and maximal luminal area is a logical technical recommendation, particularly in complex lesion subsets.
Collapse
Affiliation(s)
- Ashok Seth
- Fortis Escorts Heart Institute, New Delhi, India
| | - Sajal Gupta
- Fortis Escorts Heart Institute, New Delhi, India
| | | | - Vijay Kumar
- Fortis Escorts Heart Institute, New Delhi, India
| |
Collapse
|
8
|
Wang B, Mintz GS, Witzenbichler B, Souza CF, Metzger DC, Rinaldi MJ, Duffy PL, Weisz G, Stuckey TD, Brodie BR, Matsumura M, Yamamoto MH, Parvataneni R, Kirtane AJ, Stone GW, Maehara A. Predictors and Long-Term Clinical Impact of Acute Stent Malapposition: An Assessment of Dual Antiplatelet Therapy With Drug-Eluting Stents (ADAPT-DES) Intravascular Ultrasound Substudy. J Am Heart Assoc 2016; 5:e004438. [PMID: 28007741 PMCID: PMC5210413 DOI: 10.1161/jaha.116.004438] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Accepted: 11/21/2016] [Indexed: 11/26/2022]
Abstract
BACKGROUND The impact of acute stent malapposition (ASM) on long-term clinical outcomes in patients undergoing percutaneous coronary intervention is still controversial. We sought to evaluate predictors and long-term clinical outcomes of ASM. METHODS AND RESULTS ADAPT-DES (Assessment of Dual Antiplatelet Therapy With Drug-Eluting Stents) was a prospective multicenter study of 8663 patients undergoing percutaneous coronary intervention using drug-eluting stents. In a prespecified intravascular ultrasound-guided substudy, 2072 patients with 2446 culprit lesions had post-percutaneous coronary intervention intravascular ultrasound and were classified according to the presence or absence of ASM. After intravascular ultrasound-guided percutaneous coronary intervention, the overall prevalence of ASM after successful drug-eluting stents implantation was 14.4% per patient and 12.6% per lesion. Compared to lesions without ASM, lesions with ASM had larger in-stent lumen areas, larger stent areas, and larger in-stent vessel areas. A larger mean plaque area along with more attenuated plaque was observed in lesions with ASM versus lesions without ASM. Lesions with ASM had greater proximal and distal reference lumen areas and more distal, but not proximal, reference calcium compared to lesions without ASM. At 2-year follow-up, there was no significant difference in the incidence of cardiac death; myocardial infarction; early, late, or very late stent thrombosis; or clinically driven target lesion revascularization in patients with ASM versus those without ASM. Furthermore, ASM was not an independent predictor of 2-year major adverse cardiac events or target lesion revascularization even when forced into the multivariate model. CONCLUSIONS In patients treated with intravascular ultrasound-guided drug-eluting stents implantation, ASM was not associated with adverse clinical events during long-term follow-up including, but not limited to, stent thrombosis. CLINICAL TRIAL REGISTRATION URL: https://www.clinicaltrials.gov. Unique identifier: NCT00638794.
Collapse
Affiliation(s)
- Bin Wang
- Cardiovascular Research Foundation, New York, NY
- Columbia University Medical Center/NewYork-Presbyterian Hospital, New York, NY
- Shenyang Northern Hospital, Shenyang, China
| | - Gary S Mintz
- Cardiovascular Research Foundation, New York, NY
| | | | | | | | - Michael J Rinaldi
- Sanger Heart & Vascular Institute/Carolinas HealthCare System, Charlotte, NC
| | - Peter L Duffy
- Reid Heart Center, FirstHealth of the Carolinas, Pinehurst, NC
| | - Giora Weisz
- Cardiovascular Research Foundation, New York, NY
- Columbia University Medical Center/NewYork-Presbyterian Hospital, New York, NY
- Shaare Zedek Medical Center, Jerusalem, Israel
| | - Thomas D Stuckey
- LeBauer Cardiovascular Research Foundation/Cone Health, Greensboro, NC
| | - Bruce R Brodie
- LeBauer Cardiovascular Research Foundation/Cone Health, Greensboro, NC
| | | | - Myong-Hwa Yamamoto
- Cardiovascular Research Foundation, New York, NY
- Columbia University Medical Center/NewYork-Presbyterian Hospital, New York, NY
| | | | - Ajay J Kirtane
- Cardiovascular Research Foundation, New York, NY
- Columbia University Medical Center/NewYork-Presbyterian Hospital, New York, NY
| | - Gregg W Stone
- Cardiovascular Research Foundation, New York, NY
- Columbia University Medical Center/NewYork-Presbyterian Hospital, New York, NY
| | - Akiko Maehara
- Cardiovascular Research Foundation, New York, NY
- Columbia University Medical Center/NewYork-Presbyterian Hospital, New York, NY
| |
Collapse
|
9
|
Gogas BD, Bourantas CV, Garcia-Garcia HM, Onuma Y, Muramatsu T, Farooq V, Diletti R, van Geuns RJM, De Bruyne B, Chevalier B, Thuesen L, Smits PC, Dudek D, Koolen J, Windecker S, Whitbourn R, McClean D, Dorange C, Miquel-Hebert K, Veldhof S, Rapoza R, Ormiston JA, Serruys PW. The edge vascular response following implantation of the Absorb everolimus-eluting bioresorbable vascular scaffold and the XIENCE V metallic everolimus-eluting stent. First serial follow-up assessment at six months and two years: insights from the first-in-man ABSORB Cohort B and SPIRIT II trials. EUROINTERVENTION 2016; 9:709-20. [PMID: 23628499 DOI: 10.4244/eijv9i6a115] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
AIMS To assess serially the edge vascular response (EVR) of a bioresorbable vascular scaffold (BVS) compared to a metallic everolimus-eluting stent (EES). METHODS AND RESULTS Non-serial evaluations of the Absorb BVS at one year have previously demonstrated proximal edge constrictive remodelling and distal edge changes in plaque composition with increase of the percent fibro-fatty (FF) tissue component. The 5 mm proximal and distal segments adjacent to the implanted devices were investigated serially with intravascular ultrasound (IVUS), post procedure, at six months and at two years, from the ABSORB Cohort B1 (n=45) and the SPIRIT II (n=113) trials. Twenty-two proximal and twenty-four distal edge segments were available for analysis in the ABSORB Cohort B1 trial. In the SPIRIT II trial, thirty-three proximal and forty-six distal edge segments were analysed. At the 5-mm proximal edge, the vessels treated with an Absorb BVS from post procedure to two years demonstrated a lumen loss (LL) of 6.68% (-17.33; 2.08) (p=0.027) with a trend toward plaque area increase of 7.55% (-4.68; 27.11) (p=0.06). At the 5-mm distal edge no major changes were evident at either time point. At the 5-mm proximal edge the vessels treated with a XIENCE V EES from post procedure to two years did not show any signs of LL, only plaque area decrease of 6.90% (-17.86; 4.23) (p=0.035). At the distal edge no major changes were evident with regard to either lumen area or vessel remodelling at the same time point. CONCLUSIONS The IVUS-based serial evaluation of the EVR up to two years following implantation of a bioresorbable everolimus-eluting scaffold shows a statistically significant proximal edge LL; however, this finding did not seem to have any clinical implications in the serial assessment. The upcoming imaging follow-up of the Absorb BVS at three years is anticipated to provide further information regarding the vessel wall behaviour at the edges.
Collapse
Affiliation(s)
- Bill D Gogas
- Thoraxcenter, Erasmus University Medical Center, Rotterdam, The Netherlands
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
10
|
Tanaka A. Bioresorbable Scaffold – Taking the Edge Off? –. Circ J 2016; 80:1100-1101. [DOI: 10.1253/circj.cj-16-0277] [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: 08/30/2023]
Affiliation(s)
- Atsushi Tanaka
- Department of Cardiovascular Medicine, Wakayama Medical University
| |
Collapse
|
11
|
Longo G, Granata F, Capodanno D, Ohno Y, Tamburino CI, Capranzano P, La Manna A, Francaviglia B, Gargiulo G, Tamburino C. Anatomical features and management of bioresorbable vascular scaffolds failure: A case series from the GHOST registry. Catheter Cardiovasc Interv 2015; 85:1150-61. [PMID: 25573598 DOI: 10.1002/ccd.25819] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2014] [Revised: 12/06/2014] [Accepted: 01/03/2015] [Indexed: 11/09/2022]
Abstract
The Absorb bioresorbable vascular scaffold (Absorb BVS, Abbott Vascular, Santa Clara, California) promises to address some of the residual shortcomings of existing metallic stents, such as late events induced by permanent caging of the coronary vessel. Scaffold restenosis (ScR) of BVS has been poorly described so far and treatment strategies for this event remain to be codified. We report on a case series of 14 lesions in 12 patients presenting with ScR and discuss their anatomical features and management strategies. © 2015 Wiley Periodicals, Inc.
Collapse
Affiliation(s)
- Giovanni Longo
- Cardio-Thorax-Vascular Department, Ferrarotto Hospital, University of Catania, Catania, Italy
| | - Francesco Granata
- Cardio-Thorax-Vascular Department, Ferrarotto Hospital, University of Catania, Catania, Italy
| | - Davide Capodanno
- Cardio-Thorax-Vascular Department, Ferrarotto Hospital, University of Catania, Catania, Italy
| | - Yohei Ohno
- Cardio-Thorax-Vascular Department, Ferrarotto Hospital, University of Catania, Catania, Italy
| | - Claudia Ina Tamburino
- Cardio-Thorax-Vascular Department, Ferrarotto Hospital, University of Catania, Catania, Italy
| | - Piera Capranzano
- Cardio-Thorax-Vascular Department, Ferrarotto Hospital, University of Catania, Catania, Italy
| | - Alessio La Manna
- Cardio-Thorax-Vascular Department, Ferrarotto Hospital, University of Catania, Catania, Italy
| | - Bruno Francaviglia
- Cardio-Thorax-Vascular Department, Ferrarotto Hospital, University of Catania, Catania, Italy
| | - Giuseppe Gargiulo
- Cardio-Thorax-Vascular Department, Ferrarotto Hospital, University of Catania, Catania, Italy
| | - Corrado Tamburino
- Cardio-Thorax-Vascular Department, Ferrarotto Hospital, University of Catania, Catania, Italy
| |
Collapse
|
12
|
Gogas BD, Garcia-Garcia HM, Onuma Y, Muramatsu T, Farooq V, Bourantas CV, Serruys PW. Edge Vascular Response After Percutaneous Coronary Intervention. JACC Cardiovasc Interv 2013; 6:211-21. [DOI: 10.1016/j.jcin.2013.01.132] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2012] [Revised: 01/24/2013] [Accepted: 01/30/2013] [Indexed: 11/30/2022]
|
13
|
Fröbert O, Sarno G, James SK, Saleh N, Lagerqvist B. Effect of stent inflation pressure and post-dilatation on the outcome of coronary artery intervention. A report of more than 90,000 stent implantations. PLoS One 2013; 8:e56348. [PMID: 23418560 PMCID: PMC3571959 DOI: 10.1371/journal.pone.0056348] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2012] [Accepted: 01/08/2013] [Indexed: 11/23/2022] Open
Abstract
Background Percutaneous coronary intervention (PCI) stent inflation pressure correlates to angiographic lumen improvement and stent expansion but the relation to outcome is not clarified. Using comprehensive registry data our aim was to evaluate how stent inflation pressure influences restenosis, stent thrombosis and death following PCI. Methods We evaluated all consecutive coronary stent implantations in Sweden during 46 months from 2008 using data from the Swedish Coronary Angiography and Angioplasty Registry (SCAAR). We used logistic regression and Cox proportional hazard modeling to estimate risk of outcomes with different balloon pressures. Results In total, 93 697 stents were eligible for analysis and divided into five different pressure interval groups: ≤15 atm, 16–17 atm, 18–19 atm, 20–21 atm and ≥22 atm. The risks of stent thrombosis and restenosis were significantly higher in the ≤15 atm, 18–19 atm and ≥22 atm groups (but not in the 16–17 atm group) compared to the 20–21 atm group. There were no differences in mortality. Post-dilatation was associated with a higher restenosis risk ratio (RR) of 1.22 (95% confidence interval (CI) 1.14–1.32, P<0.001) but stent thrombosis did not differ statistically between procedures with or without post-dilatation. The risk of death was lower following post-dilatation (RR 0.81 (CI 0.71–0.93) P = 0.003) and the difference compared to no post-dilatation was seen immediately after PCI. Conclusion Our retrospective study of stent inflation pressure identified a possible biological pattern—the risks of stent thrombosis and of restenosis appeared to be higher with low and very high pressures. Post-dilatation might increase restenosis risk.
Collapse
Affiliation(s)
- Ole Fröbert
- Department of Cardiology, Örebro University Hospital, Örebro, Sweden.
| | | | | | | | | |
Collapse
|
14
|
Sadamatsu K, Yoshida K, Yoshidomi Y, Koga Y, Amari K, Tokunou T. Comparison of pre-dilation with a non-compliant balloon versus a dual wire scoring balloon for coronary stenting. ACTA ACUST UNITED AC 2013. [DOI: 10.4236/wjcd.2013.36061] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
|
15
|
The edge vascular response following implantation of a fully bioresorbable device. Int J Cardiol 2012; 158:455-7. [DOI: 10.1016/j.ijcard.2012.05.023] [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: 04/07/2012] [Accepted: 05/04/2012] [Indexed: 11/17/2022]
|
16
|
Gogas BD, Serruys PW, Diletti R, Farooq V, Brugaletta S, Radu MD, Heo JH, Onuma Y, van Geuns RJM, Regar E, De Bruyne B, Chevalier B, Thuesen L, Smits PC, Dudek D, Koolen J, Windecker S, Whitbourn R, Miquel-Hebert K, Dorange C, Rapoza R, Garcia-Garcia HM, McClean D, Ormiston JA. Vascular Response of the Segments Adjacent to the Proximal and Distal Edges of the ABSORB Everolimus-Eluting Bioresorbable Vascular Scaffold: 6-Month and 1-Year Follow-Up Assessment. JACC Cardiovasc Interv 2012; 5:656-65. [DOI: 10.1016/j.jcin.2012.02.017] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2011] [Revised: 01/09/2012] [Accepted: 02/14/2012] [Indexed: 11/26/2022]
|
17
|
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]
|
18
|
Wakabayashi K, Mintz GS, Weissman NJ, Stone GW, Ellis SG, Grube E, Ormiston JA, Turco MA, Pakala R, Xue Z, Desale S, Laynez-Carnicero A, Romaguera R, Sardi G, Pichard AD, Waksman R. Impact of Drug-Eluting Stents on Distal Vessels. Circ Cardiovasc Interv 2012; 5:211-9. [DOI: 10.1161/circinterventions.111.965780] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Kohei Wakabayashi
- From the Washington Hospital Center (K.W., N.J.W., R.P., Z.X., S.D., A.L.-C., R.R., G.S., A.D.P., R.W.), Washington, DC; Cardiovascular Research Foundation and Columbia University Medical Center (G.S.M., G.W.S.), New York, NY; Cleveland Clinic (S.G.E.), Cleveland, OH; University Hospital Bonn (S.G.), Bonn, Germany; North Shore Hospital (J.A.O.), Auckland, New Zealand; and Washington Adventist Hospital (M.A.T.), Takoma Park, MD
| | - Gary S. Mintz
- From the Washington Hospital Center (K.W., N.J.W., R.P., Z.X., S.D., A.L.-C., R.R., G.S., A.D.P., R.W.), Washington, DC; Cardiovascular Research Foundation and Columbia University Medical Center (G.S.M., G.W.S.), New York, NY; Cleveland Clinic (S.G.E.), Cleveland, OH; University Hospital Bonn (S.G.), Bonn, Germany; North Shore Hospital (J.A.O.), Auckland, New Zealand; and Washington Adventist Hospital (M.A.T.), Takoma Park, MD
| | - Neil J. Weissman
- From the Washington Hospital Center (K.W., N.J.W., R.P., Z.X., S.D., A.L.-C., R.R., G.S., A.D.P., R.W.), Washington, DC; Cardiovascular Research Foundation and Columbia University Medical Center (G.S.M., G.W.S.), New York, NY; Cleveland Clinic (S.G.E.), Cleveland, OH; University Hospital Bonn (S.G.), Bonn, Germany; North Shore Hospital (J.A.O.), Auckland, New Zealand; and Washington Adventist Hospital (M.A.T.), Takoma Park, MD
| | - Gregg W. Stone
- From the Washington Hospital Center (K.W., N.J.W., R.P., Z.X., S.D., A.L.-C., R.R., G.S., A.D.P., R.W.), Washington, DC; Cardiovascular Research Foundation and Columbia University Medical Center (G.S.M., G.W.S.), New York, NY; Cleveland Clinic (S.G.E.), Cleveland, OH; University Hospital Bonn (S.G.), Bonn, Germany; North Shore Hospital (J.A.O.), Auckland, New Zealand; and Washington Adventist Hospital (M.A.T.), Takoma Park, MD
| | - Stephen G. Ellis
- From the Washington Hospital Center (K.W., N.J.W., R.P., Z.X., S.D., A.L.-C., R.R., G.S., A.D.P., R.W.), Washington, DC; Cardiovascular Research Foundation and Columbia University Medical Center (G.S.M., G.W.S.), New York, NY; Cleveland Clinic (S.G.E.), Cleveland, OH; University Hospital Bonn (S.G.), Bonn, Germany; North Shore Hospital (J.A.O.), Auckland, New Zealand; and Washington Adventist Hospital (M.A.T.), Takoma Park, MD
| | - Eberhard Grube
- From the Washington Hospital Center (K.W., N.J.W., R.P., Z.X., S.D., A.L.-C., R.R., G.S., A.D.P., R.W.), Washington, DC; Cardiovascular Research Foundation and Columbia University Medical Center (G.S.M., G.W.S.), New York, NY; Cleveland Clinic (S.G.E.), Cleveland, OH; University Hospital Bonn (S.G.), Bonn, Germany; North Shore Hospital (J.A.O.), Auckland, New Zealand; and Washington Adventist Hospital (M.A.T.), Takoma Park, MD
| | - John A. Ormiston
- From the Washington Hospital Center (K.W., N.J.W., R.P., Z.X., S.D., A.L.-C., R.R., G.S., A.D.P., R.W.), Washington, DC; Cardiovascular Research Foundation and Columbia University Medical Center (G.S.M., G.W.S.), New York, NY; Cleveland Clinic (S.G.E.), Cleveland, OH; University Hospital Bonn (S.G.), Bonn, Germany; North Shore Hospital (J.A.O.), Auckland, New Zealand; and Washington Adventist Hospital (M.A.T.), Takoma Park, MD
| | - Mark A. Turco
- From the Washington Hospital Center (K.W., N.J.W., R.P., Z.X., S.D., A.L.-C., R.R., G.S., A.D.P., R.W.), Washington, DC; Cardiovascular Research Foundation and Columbia University Medical Center (G.S.M., G.W.S.), New York, NY; Cleveland Clinic (S.G.E.), Cleveland, OH; University Hospital Bonn (S.G.), Bonn, Germany; North Shore Hospital (J.A.O.), Auckland, New Zealand; and Washington Adventist Hospital (M.A.T.), Takoma Park, MD
| | - Rajbabu Pakala
- From the Washington Hospital Center (K.W., N.J.W., R.P., Z.X., S.D., A.L.-C., R.R., G.S., A.D.P., R.W.), Washington, DC; Cardiovascular Research Foundation and Columbia University Medical Center (G.S.M., G.W.S.), New York, NY; Cleveland Clinic (S.G.E.), Cleveland, OH; University Hospital Bonn (S.G.), Bonn, Germany; North Shore Hospital (J.A.O.), Auckland, New Zealand; and Washington Adventist Hospital (M.A.T.), Takoma Park, MD
| | - Zhenyi Xue
- From the Washington Hospital Center (K.W., N.J.W., R.P., Z.X., S.D., A.L.-C., R.R., G.S., A.D.P., R.W.), Washington, DC; Cardiovascular Research Foundation and Columbia University Medical Center (G.S.M., G.W.S.), New York, NY; Cleveland Clinic (S.G.E.), Cleveland, OH; University Hospital Bonn (S.G.), Bonn, Germany; North Shore Hospital (J.A.O.), Auckland, New Zealand; and Washington Adventist Hospital (M.A.T.), Takoma Park, MD
| | - Sameer Desale
- From the Washington Hospital Center (K.W., N.J.W., R.P., Z.X., S.D., A.L.-C., R.R., G.S., A.D.P., R.W.), Washington, DC; Cardiovascular Research Foundation and Columbia University Medical Center (G.S.M., G.W.S.), New York, NY; Cleveland Clinic (S.G.E.), Cleveland, OH; University Hospital Bonn (S.G.), Bonn, Germany; North Shore Hospital (J.A.O.), Auckland, New Zealand; and Washington Adventist Hospital (M.A.T.), Takoma Park, MD
| | - Ana Laynez-Carnicero
- From the Washington Hospital Center (K.W., N.J.W., R.P., Z.X., S.D., A.L.-C., R.R., G.S., A.D.P., R.W.), Washington, DC; Cardiovascular Research Foundation and Columbia University Medical Center (G.S.M., G.W.S.), New York, NY; Cleveland Clinic (S.G.E.), Cleveland, OH; University Hospital Bonn (S.G.), Bonn, Germany; North Shore Hospital (J.A.O.), Auckland, New Zealand; and Washington Adventist Hospital (M.A.T.), Takoma Park, MD
| | - Rafael Romaguera
- From the Washington Hospital Center (K.W., N.J.W., R.P., Z.X., S.D., A.L.-C., R.R., G.S., A.D.P., R.W.), Washington, DC; Cardiovascular Research Foundation and Columbia University Medical Center (G.S.M., G.W.S.), New York, NY; Cleveland Clinic (S.G.E.), Cleveland, OH; University Hospital Bonn (S.G.), Bonn, Germany; North Shore Hospital (J.A.O.), Auckland, New Zealand; and Washington Adventist Hospital (M.A.T.), Takoma Park, MD
| | - Gabriel Sardi
- From the Washington Hospital Center (K.W., N.J.W., R.P., Z.X., S.D., A.L.-C., R.R., G.S., A.D.P., R.W.), Washington, DC; Cardiovascular Research Foundation and Columbia University Medical Center (G.S.M., G.W.S.), New York, NY; Cleveland Clinic (S.G.E.), Cleveland, OH; University Hospital Bonn (S.G.), Bonn, Germany; North Shore Hospital (J.A.O.), Auckland, New Zealand; and Washington Adventist Hospital (M.A.T.), Takoma Park, MD
| | - Augusto D. Pichard
- From the Washington Hospital Center (K.W., N.J.W., R.P., Z.X., S.D., A.L.-C., R.R., G.S., A.D.P., R.W.), Washington, DC; Cardiovascular Research Foundation and Columbia University Medical Center (G.S.M., G.W.S.), New York, NY; Cleveland Clinic (S.G.E.), Cleveland, OH; University Hospital Bonn (S.G.), Bonn, Germany; North Shore Hospital (J.A.O.), Auckland, New Zealand; and Washington Adventist Hospital (M.A.T.), Takoma Park, MD
| | - Ron Waksman
- From the Washington Hospital Center (K.W., N.J.W., R.P., Z.X., S.D., A.L.-C., R.R., G.S., A.D.P., R.W.), Washington, DC; Cardiovascular Research Foundation and Columbia University Medical Center (G.S.M., G.W.S.), New York, NY; Cleveland Clinic (S.G.E.), Cleveland, OH; University Hospital Bonn (S.G.), Bonn, Germany; North Shore Hospital (J.A.O.), Auckland, New Zealand; and Washington Adventist Hospital (M.A.T.), Takoma Park, MD
| |
Collapse
|
19
|
Wakabayashi K, Waksman R, Weissman NJ. Edge Effect From Drug-Eluting Stents as Assessed With Serial Intravascular Ultrasound. Circ Cardiovasc Interv 2012; 5:305-11. [DOI: 10.1161/circinterventions.111.966259] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Kohei Wakabayashi
- From the MedStar Health Research Institute at Washington Hospital Center, Washington, DC
| | - Ron Waksman
- From the MedStar Health Research Institute at Washington Hospital Center, Washington, DC
| | - Neil J. Weissman
- From the MedStar Health Research Institute at Washington Hospital Center, Washington, DC
| |
Collapse
|
20
|
Three-year prognosis of Japanese patients with ST-elevation myocardial infarction treated with sirolimus-eluting stents. Coron Artery Dis 2009; 20:422-7. [DOI: 10.1097/mca.0b013e32832fa92c] [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] [Indexed: 11/25/2022]
|
21
|
Safety and efficacy of 2.5-mm sirolimus-eluting stent implantation at lower deployment pressures in very small vessels (<2.5 mm). Coron Artery Dis 2009; 20:163-8. [DOI: 10.1097/mca.0b013e328329dc20] [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: 11/25/2022]
|
22
|
Ikari Y, Kotani J, Kozuma K, Kyo E, Nakamura M, Yokoi H, The J-PMS study group. Assessment of Sirolimus-Eluting Coronary Stent Implantation With Aspirin Plus Low Dose Ticlopidine Administration One Year Results From CYPHER Stent Japan Post-Marketing Surveillance Registry (J-PMS). Circ J 2009; 73:1038-44. [DOI: 10.1253/circj.cj-08-0732] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
|
23
|
van der Hoeven BL, Liem SS, Dijkstra J, Bergheanu SC, Putter H, Antoni ML, Atsma DE, Bootsma M, Zeppenfeld K, Jukema JW, Schalij MJ. Stent Malapposition After Sirolimus-Eluting and Bare-Metal Stent Implantation in Patients with ST-Segment Elevation Myocardial Infarction. JACC Cardiovasc Interv 2008; 1:192-201. [PMID: 19463300 DOI: 10.1016/j.jcin.2008.02.003] [Citation(s) in RCA: 71] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2007] [Revised: 01/31/2008] [Accepted: 02/07/2008] [Indexed: 01/21/2023]
Affiliation(s)
- Bas L van der Hoeven
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
24
|
Romagnoli E, Sangiorgi GM, Cosgrave J, Guillet E, Colombo A. Drug-Eluting Stenting. JACC Cardiovasc Interv 2008; 1:22-31. [DOI: 10.1016/j.jcin.2007.10.005] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2007] [Revised: 10/16/2007] [Accepted: 10/25/2007] [Indexed: 02/02/2023]
|
25
|
Sakurai R, Bonneau HN, Honda Y, Fitzgerald PJ. Intravascular ultrasound findings in ENDEAVOR II and ENDEAVOR III. Am J Cardiol 2007; 100:71M-76M. [PMID: 17950835 DOI: 10.1016/j.amjcard.2007.08.025] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
The results of 2 randomized controlled trials of the Endeavor zotarolimus-eluting stent (ZES; Medtronic Vascular, Santa Rosa, CA) were recently reported: ENDEAVOR II, in which the Endeavor stent was compared with the Driver bare metal stent (BMS; Medtronic Vascular), and ENDEAVOR III, in which the Endeavor stent was compared with the first-generation Cypher sirolimus-eluting stent (SES; Cordis Corporation, Miami Lakes, FL). To examine in detail the vascular responses to the Endeavor stent, serial intravascular ultrasound (IVUS) analyses were performed in subsets of patients in the 2 trials at baseline and 8-month follow-up. The investigators report results for various IVUS parameters and compare those with published results for the first-generation SES and paclitaxel-eluting stent (PES). The ZES demonstrated significantly improved effectiveness and equivalent safety compared with the BMS in ENDEAVOR II. Although the ZES seems to be slightly less effective at inhibiting intimal hyperplasia than the SES and PES, early results are indicative of an acceptable safety profile. This finding may be due in part to the relatively complete and uniform neointimal coverage associated with the ZES.
Collapse
|
26
|
Abstract
The sirolimus-eluting coronary stent received CE Mark approval in Europe in April 2002. In the US, FDA approval followed in April 2003. Since the preliminary results from the First-in-Man feasibility study were presented, several randomized, controlled trials have documented the profound antiproliferative effects of sirolimus, a macrolide antibiotic and potent cytostatic inhibitor of smooth muscle cell proliferation. Subsequently, the body of clinical evidence was increased by the second wave of evidence from trials in more complex lesions (such as in-stent restenosis, small vessels, chronic total occlusions) and "high-risk" patients such as those with diabetes. More recently we have had the opportunity to compare the two commercially available drug-eluting stents following the presentation of data from six head-to-head trials. As a result of numerous single and multi-center, national and international studies in which the safety and efficacy of sirolimus-eluting coronary stents have been subjected to close scrutiny, the global interventional cardiology community now has a wealth of evidence in support of the use of this technology resulting in dramatically improved patient outcomes after percutaneous intervention.
Collapse
|
27
|
Petronio AS, De Carlo M, Branchitta G, Papini B, Ciabatti N, Gistri R, Cortese B, Gherarducci G, Barsotti A. Randomized Comparison of Sirolimus and Paclitaxel Drug-Eluting Stents for Long Lesions in the Left Anterior Descending Artery. J Am Coll Cardiol 2007; 49:539-46. [PMID: 17276176 DOI: 10.1016/j.jacc.2006.09.042] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2006] [Revised: 09/22/2006] [Accepted: 09/27/2006] [Indexed: 10/23/2022]
Abstract
OBJECTIVES The goal of this work was to verify whether the superiority of the sirolimus-eluting stent (SES) in inhibiting neointimal hyperplasia could be demonstrated in complex coronary lesions. BACKGROUND Both the SES (Cypher, Cordis, Miami Lakes, Florida) and the paclitaxel-eluting stent (PES) (Taxus, Boston Scientific, Natick, Massachusetts) have shown a marked reduction in neointimal hyperplasia compared with bare-metal stents. Intravascular ultrasound (IVUS) is the best method to assess arterial response to stent deployment, but few IVUS data are available comparing complex lesions treated with SES or PES. METHODS We prospectively randomized patients with complex lesions to SES or PES implantation. Intravascular ultrasound and quantitative angiography were performed post-procedure and at 9 months. Mean neointimal hyperplasia area (NIHA), percent of NIHA (NIHA%), mean peristent plaque area (PSPA), and percent of PSPA (PSPA%) were calculated. The primary end point was NIHA% at follow-up. Secondary end points included change in PSPA% and angiographic late luminal loss at follow-up. RESULTS Of the 100 patients enrolled, 42 receiving the SES and 43 receiving the PES had adequate IVUS assessment. Vessel, plaque, and lumen areas were comparable at follow-up, but NIHA% was significantly lower with SES than PES (7.4 +/- 4.2% vs. 15.4 +/- 8.1%; p < 0.001). A significant reduction in PSPA% was observed with SES (-4 +/- 10% vs. 0 +/- 8%; p = 0.01). Late loss was significantly lower with SES (0.16 +/- 0.19 mm vs. 0.32 +/- 0.33 mm; p = 0.003). CONCLUSIONS The SES shows a significantly higher inhibition of neointimal hyperplasia compared with PES in complex lesions. However, both stents have excellent IVUS and angiographic results at 9 months. A significant reduction in peri-stent plaque is observed only with SES.
Collapse
Affiliation(s)
- Anna Sonia Petronio
- Cardiology Unit, Cardiothoracic Department, University of Pisa, Pisa, Italy.
| | | | | | | | | | | | | | | | | |
Collapse
|
28
|
Hirohata A, Morino Y, Ako J, Sakurai R, Buchbinder M, Caputo RP, Karas SP, Mishkel GJ, Mooney MR, O'shaughnessy CD, Raizner AE, Wilensky RL, Williams DO, Wong SC, Yock PG, Honda Y, Moses JW, Fitzgerald PJ. Comparison of the efficacy of direct coronary stenting with sirolimus-eluting stents versus stenting with predilation by intravascular ultrasound imaging (from the DIRECT trial). Am J Cardiol 2006; 98:1464-7. [PMID: 17126651 DOI: 10.1016/j.amjcard.2006.06.046] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2006] [Revised: 06/20/2006] [Accepted: 06/20/2006] [Indexed: 11/28/2022]
Abstract
A direct coronary stenting technique using drug-eluting stents may decrease drug-eluting stent efficacy due to possible damage to the surface coating of the stent. The DIRECT is a multicenter, prospective, nonrandomized trial designed to evaluate the direct stenting strategy for the sirolimus-eluting Bx-Velocity stent compared with the historical control (SIRIUS trial, stenting with predilation). Volumetric and cross-sectional intravascular ultrasound analyses at 8-month follow-up were performed in 115 patients (DIRECT n= 64, control n = 51). Patient and lesion characteristics were comparable between groups. The DIRECT group achieved an equivalent uniform expansion index, defined as minimum stent area/maximum stent area x 100, compared with the control group (65.9 +/- 11.7 vs 63.1 +/- 12.7, p = NS). At 8-month follow-up, vessel, stent, lumen, and neointimal volume index (volume in cubic millimeters/length in millimeters) and percent neointimal volume were similar between the DIRECT and control groups (vessel volume index 13.9 +/- 4.40 vs 15.0 +/- 3.83; stent volume index 6.83 +/- 2.02 vs 6.94 +/- 2.04; lumen volume index 6.71 +/- 2.04 vs 6.81 +/- 2.07; neointimal volume index 0.14 +/- 0.24 vs 0.16 +/- 0.23; percent neointimal volume 3.73 +/- 6.97 vs 3.14 +/- 5.32, p = NS for all). In addition, in-stent neointimal hyperplasia distribution was significantly smaller near the distal stent edge (0.22 vs 0.098 mm(3)/mm, p = 0.01 for an average neointimal volume index within 3 mm from the distal stent edge). In conclusion, direct coronary stenting with the sirolimus-eluting Bx-Velocity stent is equally effective in terms of uniform stent expansion and long-term quantitative intravascular ultrasound results compared with conventional stenting using predilation. This strategy appears to be associated with less neointimal hyperplasia near the distal stent edge.
Collapse
Affiliation(s)
- Atsushi Hirohata
- Center for Research in Cardiovascular Intervention, Stanford University, Stanford, California, USA
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|