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Raikar AS, Priya S, Bhilegaonkar SP, Somnache SN, Kalaskar DM. Surface Engineering of Bioactive Coatings for Improved Stent Hemocompatibility: A Comprehensive Review. MATERIALS (BASEL, SWITZERLAND) 2023; 16:6940. [PMID: 37959540 PMCID: PMC10650382 DOI: 10.3390/ma16216940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Revised: 10/21/2023] [Accepted: 10/26/2023] [Indexed: 11/15/2023]
Abstract
Cardiovascular diseases continue to be a major contributor to illness and death on a global scale, and the implementation of stents has given rise to a revolutionary transformation in the field of interventional cardiology. The thrombotic and restenosis complications associated with stent implantation pose ongoing challenges. In recent years, bioactive coatings have emerged as a promising strategy to enhance stent hemocompatibility and reduce thrombogenicity. This review article provides an overview of the surface engineering techniques employed to improve the hemocompatibility of stents and reduce thrombus formation. It explores the mechanisms underlying thrombosis and discusses the factors influencing platelet activation and fibrin formation on stent surfaces. Various bioactive coatings, including anticoagulant agents, antiplatelet agents, and surface modifications, are discussed in detail, highlighting their potential in reducing thrombogenicity. This article also highlights a multitude of surface modification techniques which can be harnessed to enhance stent hemocompatibility including plasma treatment, physical vapor deposition (PVD), chemical vapor deposition (CVD), and electrodeposition. These techniques offer precise control over surface properties such as roughness, charge, and composition. The ultimate goal is to reduce platelet adhesion, tailor wettability, or facilitate the controlled release of bioactive agents. Evaluation methods for assessing hemocompatibility and thrombogenicity are also reviewed, ranging from in vitro assays to animal models. Recent advances in the field, such as nanotechnology-based coatings and bioactive coatings with controlled drug release systems, are highlighted. Surface engineering of bioactive coatings holds great promise for enhancing the long-term outcomes of stent implantation by enhancing hemocompatibility and reducing thrombogenicity. Future research directions and potential clinical applications are discussed, underscoring the need for continued advancements in this field.
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Affiliation(s)
- Amisha S. Raikar
- Department of Pharmaceutics, PES Rajaram and Tarabai Bandekar College of Pharmacy, Ponda 403401, India;
| | - Sushma Priya
- University College of London, Division of Surgery and Interventional Science, Royal National Orthopaedic Hospital, Rowland Hill Street, London NW3 2PF, UK;
- Department of Biomedical Engineering, Regenerative Medicine and Stem Cell (RMS) Labs, Indian Institute of Technology, Hyderabad 502285, India
| | - Shilpa P. Bhilegaonkar
- Department of Pharmaceutics, PES Rajaram and Tarabai Bandekar College of Pharmacy, Ponda 403401, India;
| | - Sandesh N. Somnache
- Department of Pharmaceutics, SSPM’s VP College of Pharmacy, Madkhol 416510, India;
| | - Deepak M. Kalaskar
- University College of London, Division of Surgery and Interventional Science, Royal National Orthopaedic Hospital, Rowland Hill Street, London NW3 2PF, UK;
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Chen Y, Li D, Liao Y, Yao X, Ruan Y, Zou K, Liao H, Ding J, Qin H, Yu Z, Zhao Y, Hu L, Yang R. Incidence of coronary drug-eluting stent fracture: A systematic review and meta-analysis. Front Cardiovasc Med 2022; 9:925912. [PMID: 36082117 PMCID: PMC9445981 DOI: 10.3389/fcvm.2022.925912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Accepted: 08/04/2022] [Indexed: 11/24/2022] Open
Abstract
Background Reported evidence of coronary stent fracture (CSF) has increased in recent years. The purpose of this study was to determine reliable estimates of the overall incidence of CSF. Methods and results The MEDLINE, Embase and Cochrane databases were searched until March 18, 2022. Pooled estimates were acquired using random effects models. Meta-regression and subgroup analysis were used to explore sources of heterogeneity, and publication bias was evaluated by visual assessment of funnel plots and Egger’s test. Overall, 46 articles were included in this study. Estimates of CSF incidence were 5.5% [95% confidence interval (CI): 3.7–7.7%] among 39,953 patients based on 36 studies, 4.8% (95% CI: 3.1–6.8%) among 39,945 lesions based on 29 studies and 4.9% (95% CI: 2.5–9.4%) among 19,252 stents based on 8 studies. There has been an obvious increase in the incidence of CSF over the past two decades, and it seems that the duration of stent placement after stent implantation has no impact on incidence estimation. Conclusion The incidence of CSF was 5.5% among patients, 4.8% for lesions and 4.9% for stents and increased over the past 20 years. The duration of stent placement after stent implantation was found to have no impact on the incidence of CSF, but drug-eluting stent (DES) types and right coronary artery (RCA) lesions influenced the pooled incidence. Systematic review registration [https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022311995], identifier [CRD42022311995].
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Affiliation(s)
- Yang Chen
- Department of Cardiovascular Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Dandan Li
- Department of Neurology, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Yanhui Liao
- Department of Cardiovascular Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Xiongda Yao
- Department of Cardiovascular Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Yuehua Ruan
- Department of Cardiovascular Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Kai Zou
- Department of Cardiovascular Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Hanhui Liao
- Department of Cardiovascular Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Jingwen Ding
- Department of Cardiovascular Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Hao Qin
- Department of Cardiovascular Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Zuozhong Yu
- Department of Cardiovascular Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Yuanbin Zhao
- Department of Cardiovascular Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Longlong Hu
- Department of Cardiovascular Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Renqiang Yang
- Department of Cardiovascular Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang, China
- *Correspondence: Renqiang Yang,
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Coronary Artery Radial Deformation and Velocity in Native and Stented Arteries. J Interv Cardiol 2022; 2022:5981027. [PMID: 35401063 PMCID: PMC8976594 DOI: 10.1155/2022/5981027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 03/12/2022] [Indexed: 11/30/2022] Open
Abstract
Introduction Coronary arteries are exposed to a variety of complex biomechanical forces during a normal cardiac cycle. These forces have the potential to contribute to coronary stent failure. Recent advances in stent design allow for the transmission of native pulsatile biomechanical forces in the stented vessel. However, there is a significant lack of evidence in a human model to measure vessel motion in native coronary arteries and stent conformability. Thus, we aimed to characterize and define coronary artery radial deformation and the effect of stent implantation on arterial deformation. Materials and Methods Intravascular ultrasound (IVUS) pullback DICOM images were obtained from human coronary arteries using a coronary ultrasound catheter. Using two-dimensional speckle tracking, coronary artery radial deformation was defined as the inward and outward displacement (mm) and velocity (cm/s) of the arterial wall during the cardiac cycle. These deformation values were obtained in native and third-generation drug-eluting stented artery segments. Results A total of 20 coronary artery segments were independently analyzed pre and poststent implantation for a total of 40 IVUS runs. Stent implantation impacted the degree of radial deformation and velocity. Mean radial deformation in native coronary arteries was 0.1230 mm ± 0.0522 mm compared to 0.0775 mm ± 0.0376 mm in stented vessels (p=0.0031). Mean radial velocity in native coronary arteries was 0.1194 cm/s ± 0.0535 cm/s compared to 0.0840 cm/s ± 0.0399 cm/s in stented vessels (p=0.0228). Conclusion In this in vivo analysis of third-generation stents, stent implantation attenuates normal human coronary deformation during the cardiac cycle. The implications of these findings on stent failure and improved clinical outcomes require further investigation.
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Coronary stent fracture in an octogenarian patient: from bad to worse. J Geriatr Cardiol 2021; 18:968-972. [PMID: 34908931 PMCID: PMC8648541 DOI: 10.11909/j.issn.1671-5411.2021.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Peri-Contrast Staining as a Marker of Stent Failure: Restenosis, Thrombosis, and Fracture. Case Rep Cardiol 2021; 2021:4688228. [PMID: 34721905 PMCID: PMC8556128 DOI: 10.1155/2021/4688228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 08/18/2021] [Indexed: 11/17/2022] Open
Abstract
Peri-stent contrast staining (PSS), defined as contrast staining around the stent struts, has been identified as an indicator of future stent failure in first generation, sirolimus-eluting coronary stents. 1 PSS has been associated with in-stent restenosis, stent thrombosis, stent fracture, and the development of coronary aneurysm. As the frequency of patients with first generation sirolimus-eluting coronary stents becomes infrequent; PSS may go unrecognized. Herein, we present a patient with a decade of longitudinal follow-up, who developed PSS identified on coronary angiogram with recurrent stent failure.
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Jimba T, Ikutomi M, Tsukamoto A, Matsushita M, Yamasaki M. Effect of Hinge Motion on Stent Edge-Related Restenosis After Right Coronary Artery Treatment in the Current Drug-Eluting Stent Era. Circ J 2021; 85:1959-1968. [PMID: 34234051 DOI: 10.1253/circj.cj-21-0196] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Stent edge-related restenosis (SER) remains a potential limitation of drug-eluting stent (DES). Hinge motion at the stent edge could lead to mechanical stress and contribute to incidents of SER. We investigated the effect of hinge motion on SER after implantation of current-generation DES in the right coronary artery (RCA), where excessive vessel movement is commonly observed.Methods and Results:Of 647 consecutive lesions in the RCA treated with second-generation or later DESs, 426 with follow-up angiography were included in this study. Intravascular imaging analysis was performed for 584 stent edges and reference segments. Binary restenosis occurred in 42 lesions (9.9%), and 55% were SERs. The hinge angle was significantly larger in the SER group than in the other restenosis or the no-restenosis group (17.9° vs. 11.6° and 10.6°, respectively; P<0.001). Lesions with an excessive hinge angle (>11.5°) had an increased rate of target lesion revascularization (19.1% vs. 7.2%; P<0.001) during the median follow-up period of 1,578 days. In per-edge analysis, hinge angle and residual plaque burden were independent predictors of SER. The coexistence of excessive hinge motion and residual plaque burden had a synergistic effect on stenotic progression in quantitative angiographic analysis (Pinteraction<0.001) at follow-up angiography. CONCLUSIONS Substantial stress determined by angulation at a stent edge and its interaction with residual plaque can be considered as one plausible mechanism for SER.
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Affiliation(s)
- Takahiro Jimba
- Department of Cardiovascular Medicine, NTT Medical Center Tokyo
| | | | | | | | - Masao Yamasaki
- Department of Cardiovascular Medicine, NTT Medical Center Tokyo
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Schochlow K, Weissner M, Blachutzik F, Boeder NF, Tröbs M, Lorenz L, Dijkstra J, Münzel T, Achenbach S, Nef H, Gori T. Coronary Stent Strut Fractures: Classification, Prevalence and Clinical Associations. J Clin Med 2021; 10:jcm10081765. [PMID: 33921606 PMCID: PMC8072680 DOI: 10.3390/jcm10081765] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 04/11/2021] [Accepted: 04/12/2021] [Indexed: 12/11/2022] Open
Abstract
Introduction. The frequency, characteristics and clinical implications of Strut fractures (SFs) remain incompletely understood. Methods and results. A total of 185 (160 patients) newer-generation drug-eluting stents (DES) were imaged. SFs were found in 21 DES (11.4%) and were classified in four patterns: one single stacked strut (41%); two or more stacked struts (23%); deformation without gap (27%); transection (9%). In multivariable analysis, calcific and bifurcation lesions were associated with SF in DES (OR: 3.5 [1.1–11] and 4.0 [2.2–7.2], p < 0.05). Device eccentricity and asymmetry as well as optical coherence tomography (OCT) features of impaired strut healing were also associated with SF. The prevalence of fractures was similar in a set of 289 bioresorbable scaffolds (BRS). In a separate series of 20 device thromboses and 36 device restenoses, the prevalence of SF was higher (61.2% of DES and 66.7% of BRS, p < 0.001 for both), with a higher frequency of complex SF patterns (p < 0.0001). In logistic regression analysis, fractures were a correlate of device complications (p < 0.0001, OR = 24.9 [5.6–111] for DES and OR = 6.0 [1.8–20] for BRS). Discussion. The prevalence of OCT-diagnosed SF was unexpectedly high in the setting of elective controls and it increased by about three-fold in the setting of device failure. Fractures were associated with increased lesion complexity and device asymmetry/eccentricity and were more frequent in the setting of device failure such as restenosis and thrombosis.
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Affiliation(s)
- Katharina Schochlow
- Kardiologie 1, Zentrum für Kardiologie, Universitätsmedizin der Johannes Gutenberg-Universität Mainz, Langenbeckstraße 1, 55131 Mainz, Germany; (K.S.); (M.W.); (L.L.); (T.M.)
| | - Melissa Weissner
- Kardiologie 1, Zentrum für Kardiologie, Universitätsmedizin der Johannes Gutenberg-Universität Mainz, Langenbeckstraße 1, 55131 Mainz, Germany; (K.S.); (M.W.); (L.L.); (T.M.)
| | - Florian Blachutzik
- Med. Klinik 2, Universitätsklinikum Erlangen, Ulmenweg 18, 91054 Erlangen, Germany; (F.B.); (M.T.); (S.A.)
| | - Niklas F. Boeder
- Med. Klinik I, Universitätsklinikum Gießen und Marburg GmbH, Klinikstr. 33, 35392 Gießen, Germany; (N.F.B.); (H.N.)
| | - Monique Tröbs
- Med. Klinik 2, Universitätsklinikum Erlangen, Ulmenweg 18, 91054 Erlangen, Germany; (F.B.); (M.T.); (S.A.)
| | - Liv Lorenz
- Kardiologie 1, Zentrum für Kardiologie, Universitätsmedizin der Johannes Gutenberg-Universität Mainz, Langenbeckstraße 1, 55131 Mainz, Germany; (K.S.); (M.W.); (L.L.); (T.M.)
| | - Jouke Dijkstra
- Division of Image Processing, Department of Radiology, Leiden University Medical Center, 2300 RC Leiden, The Netherlands;
| | - Thomas Münzel
- Kardiologie 1, Zentrum für Kardiologie, Universitätsmedizin der Johannes Gutenberg-Universität Mainz, Langenbeckstraße 1, 55131 Mainz, Germany; (K.S.); (M.W.); (L.L.); (T.M.)
| | - Stephan Achenbach
- Med. Klinik 2, Universitätsklinikum Erlangen, Ulmenweg 18, 91054 Erlangen, Germany; (F.B.); (M.T.); (S.A.)
| | - Holger Nef
- Med. Klinik I, Universitätsklinikum Gießen und Marburg GmbH, Klinikstr. 33, 35392 Gießen, Germany; (N.F.B.); (H.N.)
| | - Tommaso Gori
- Kardiologie 1, Zentrum für Kardiologie, Universitätsmedizin der Johannes Gutenberg-Universität Mainz, Langenbeckstraße 1, 55131 Mainz, Germany; (K.S.); (M.W.); (L.L.); (T.M.)
- Correspondence: ; Tel.: +49-6131-17-2829
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Canan A, Ranganath P, Goerne H, Abbara S, Landeras L, Rajiah P. CAD-RADS: Pushing the Limits. Radiographics 2020; 40:629-652. [PMID: 32281902 DOI: 10.1148/rg.2020190164] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Coronary CT angiography is now established as the first-line diagnostic imaging test to exclude coronary artery disease (CAD) in the population at low to intermediate risk. Wide variability exists in both the reporting of coronary CT angiography and the interpretation of these reports by referring physicians. The CAD Reporting and Data System (CAD-RADS) is sponsored by multiple societies and is a collaborative effort to provide standard classification of CAD, which is then integrated into patient clinical care. The main goals of the CAD-RADS are to decrease variability among readers; enhance communication between interpreting and referring clinicians, allowing collaborative determination of the best course of patient care; and generate consistent data for auditing, data mining, quality improvement, research, and education. There are several scenarios in which the CAD-RADS guidelines are ambiguous or do not provide definite recommendations for further management of CAD. The authors discuss the CAD-RADS categories and modifiers, highlight a variety of complex or ambiguous scenarios, and provide recommendations for managing these scenarios. Online supplemental material is available for this article. ©RSNA, 2020 See discussion on this article by Aviram and Wolak.
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Affiliation(s)
- Arzu Canan
- From the Department of Radiology, Division of Cardiothoracic Imaging, UT Southwestern Medical Center, Dallas, Tex (A.C., P. Ranganath, H.G., S.A., P. Rajiah); Imaging and Diagnosis Center, Guadalajara, Mexico (H.G.); and Department of Radiology, University of Chicago Medical Center, Chicago, Ill (L.L.)
| | - Praveen Ranganath
- From the Department of Radiology, Division of Cardiothoracic Imaging, UT Southwestern Medical Center, Dallas, Tex (A.C., P. Ranganath, H.G., S.A., P. Rajiah); Imaging and Diagnosis Center, Guadalajara, Mexico (H.G.); and Department of Radiology, University of Chicago Medical Center, Chicago, Ill (L.L.)
| | - Harold Goerne
- From the Department of Radiology, Division of Cardiothoracic Imaging, UT Southwestern Medical Center, Dallas, Tex (A.C., P. Ranganath, H.G., S.A., P. Rajiah); Imaging and Diagnosis Center, Guadalajara, Mexico (H.G.); and Department of Radiology, University of Chicago Medical Center, Chicago, Ill (L.L.)
| | - Suhny Abbara
- From the Department of Radiology, Division of Cardiothoracic Imaging, UT Southwestern Medical Center, Dallas, Tex (A.C., P. Ranganath, H.G., S.A., P. Rajiah); Imaging and Diagnosis Center, Guadalajara, Mexico (H.G.); and Department of Radiology, University of Chicago Medical Center, Chicago, Ill (L.L.)
| | - Luis Landeras
- From the Department of Radiology, Division of Cardiothoracic Imaging, UT Southwestern Medical Center, Dallas, Tex (A.C., P. Ranganath, H.G., S.A., P. Rajiah); Imaging and Diagnosis Center, Guadalajara, Mexico (H.G.); and Department of Radiology, University of Chicago Medical Center, Chicago, Ill (L.L.)
| | - Prabhakar Rajiah
- From the Department of Radiology, Division of Cardiothoracic Imaging, UT Southwestern Medical Center, Dallas, Tex (A.C., P. Ranganath, H.G., S.A., P. Rajiah); Imaging and Diagnosis Center, Guadalajara, Mexico (H.G.); and Department of Radiology, University of Chicago Medical Center, Chicago, Ill (L.L.)
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Hiraya D, Sato A, Hoshi T, Sakai S, Watabe H, Ieda M. Incidence, retrieval methods, and outcomes of intravascular ultrasound catheter stuck within an implanted stent: Systematic literature review. J Cardiol 2019; 75:164-170. [PMID: 31416780 DOI: 10.1016/j.jjcc.2019.07.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Revised: 06/26/2019] [Accepted: 07/09/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND There have been no reviews regarding intravascular ultrasound (IVUS) catheter entrapment during percutaneous coronary intervention (PCI). This study investigated the incidence, retrieval methods, and outcomes of IVUS catheter stuck within implanted stents. METHODS Between January 2015 and July 2018, a total of 794 consecutive patients underwent PCI for coronary artery disease. Among them, 705 patients underwent stent implantation using IVUS. The patients with IVUS catheter entrapment in an implanted stent were investigated. RESULTS Ten patients (1.4%) suffered from an IVUS catheter stuck in an implanted stent. Among them, 7 patients had very tortuous lesions while 5 patients had severely calcified lesions. Seven patients (70%) underwent placement of the 3rd generation drug-eluting stent (DES), and the stent diameters were ≤2.5mm among 8 patients (80%). Retrieval methods were the buddy wire technique, the double guide catheter technique, covering the exit port of IVUS catheter with a balloon catheter, and covering with GuideLiner® catheter (Vascular Solutions Inc., Minneapolis, MN, USA). On multivariable analysis, the predictors of IVUS catheter entrapment were tortuous lesion [odds ratio (OR), 8.21; 95% confidence interval (CI), 2.19-30.7; p=0.002], 3rd generation DES (OR, 5.31; 95% CI, 1.08-26.1; p=0.021), and stent diameter ≤2.5mm (OR, 6.31; 95% CI, 1.29-30.8; p=0.010). Furthermore, we identified 6 cases of IVUS catheter entrapment through a systematic literature review. CONCLUSIONS The IVUS catheter was almost stuck in tortuous lesions and the 3rd generation DES with a small diameter. We could successfully retrieve it in all cases using various retrieval techniques.
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Affiliation(s)
- Daigo Hiraya
- Department of Cardiology, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Akira Sato
- Department of Cardiology, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan.
| | - Tomoya Hoshi
- Department of Cardiology, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Shunsuke Sakai
- Department of Cardiology, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Hiroaki Watabe
- Department of Cardiology, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Masaki Ieda
- Department of Cardiology, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
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Shen X, Zhu H, Ji S, Jiang J, Deng Y. Fatigue behavior of stent in tapered arteries: The role of arterial tapering and stent material. Proc Inst Mech Eng H 2019; 233:989-998. [PMID: 31277553 DOI: 10.1177/0954411919862400] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Stenting has achieved great success in treating cardiovascular diseases due to its high efficiency and minimal invasiveness. However, fatigue of stents severely limits its long-term outcome. In this article, finite element method was adopted to study the effects of arterial tapering and stent material on the fatigue performance of stents. A series of tapered vessels with different taper levels and two sets of stents with different materials were modeled. The Goodman diagram was used to evaluate the fatigue resistance of stents. Results showed that the fatigue resistance of stents can be extremely improved by simply changing stent material. In addition, the taper of the arteries had an important influence on the fatigue resistance of the stent. The fatigue life of the stent will be shortened with the increase of the arterial taper. The method that predicted stent fatigue life in tapered vessels can help clinicians select stents that are more suitable for tapered vessels and help stent engineers design stents that are more resistant to fatigue.
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Affiliation(s)
- Xiang Shen
- School of Mechanical Engineering, Jiangsu University, Zhenjiang, China
| | - Hongfei Zhu
- School of Mechanical Engineering, Jiangsu University, Zhenjiang, China
| | - Song Ji
- School of Mechanical Engineering, Jiangsu University, Zhenjiang, China
| | - Jiabao Jiang
- School of Mechanical Engineering, Jiangsu University, Zhenjiang, China
| | - Yongquan Deng
- School of Mechanical Engineering, Jiangsu University, Zhenjiang, China
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Wang PJ, Nezami FR, Gorji MB, Berti F, Petrini L, Wierzbicki T, Migliavacca F, Edelman ER. Effect of working environment and procedural strategies on mechanical performance of bioresorbable vascular scaffolds. Acta Biomater 2018; 82:34-43. [PMID: 30342288 DOI: 10.1016/j.actbio.2018.10.020] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Revised: 09/14/2018] [Accepted: 10/15/2018] [Indexed: 01/28/2023]
Abstract
Polymeric bioresorbable scaffolds (BRS), at their early stages of invention, were considered as a promising revolution in interventional cardiology. However, they failed dramatically compared to metal stents showing substantially higher incidence of device failure and clinical events, especially thrombosis. One problem is that use of paradigms inherited from metal stents ignores dependency of polymer material properties on working environment and manufacturing/deployment steps. Unlike metals, polymeric material characterization experiments cannot be considered identical under dry and submerged conditions at varying rates of operation. We demonstrated different material behaviors associated with variable testing environment and parameters. We, then, have employed extracted material models, which are verified by computational methods, to assess the performance of a full-scale BRS in different working condition and under varying procedural strategies. Our results confirm the accepted notion that slower rate of crimping and inflation can potentially reduce stress concentrations and thus reduce localized damages. However, we reveal that using a universal set of material properties derived from a benchtop experiment conducted regardless of working environment and procedural variability may lead to a significant error in estimation of stress-induced damages and overestimation of benefits procedural updates might offer. We conclude that, for polymeric devices, microstructural damages and localized loss of structural integrity should complement former macroscopic performance-assessment measures (fracture and recoil). Though, to precisely capture localized stress concentration and microstructural damages, context-related testing environment and clinically-relevant procedural scenarios should be devised in preliminary experiments of polymeric resorbable devices to enhance their efficacy and avoid unpredicted clinical events. STATEMENT OF SIGNIFICANCE: Bioresorbable scaffolds (BRS) with the hope to become the next cardiovascular interventional revolution failed in comparison to metal stents. When BRS were characterized using methods for metal stents, designers were misled to seek problem sources at erroneous timeframe and use inefficient indicators, and thus no signal of concern emerged. We demonstrated fundamental flaws associated with applying a universal set of material properties to study device performances in different phases of manufacturing/implantation, and these may be responsible for failure in predicting performance in first-generation BRS. We introduced new criterion for the assessment of structural integrity and device efficacy in next-generation BRS, and indeed all devices using polymeric materials which evolve with the environment they reside in.
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Mollazadeh-Moghaddam K, Rezaei Nejad H, Chen AZ, Ju J, Tamayol A, Liu X, Zhang YS, Oklu R, Khademhosseini A. Fracture-Resistant and Bioresorbable Drug-Eluting Poly(glycerol Sebacate) Coils. ADVANCED THERAPEUTICS 2018. [DOI: 10.1002/adtp.201800109] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Kamyar Mollazadeh-Moghaddam
- Division of Engineering in Medicine, Department of Medicine; Brigham and Women's Hospital, Harvard Medical School; Cambridge MA 02139 USA
- Harvard-MIT Division of Health Sciences and Technology; Massachusetts Institute of Technology; Cambridge MA 02139 USA
| | - Hojatollah Rezaei Nejad
- Division of Engineering in Medicine, Department of Medicine; Brigham and Women's Hospital, Harvard Medical School; Cambridge MA 02139 USA
- Harvard-MIT Division of Health Sciences and Technology; Massachusetts Institute of Technology; Cambridge MA 02139 USA
| | - Ai-Zheng Chen
- Division of Engineering in Medicine, Department of Medicine; Brigham and Women's Hospital, Harvard Medical School; Cambridge MA 02139 USA
- Harvard-MIT Division of Health Sciences and Technology; Massachusetts Institute of Technology; Cambridge MA 02139 USA
- Institute of Biomaterials and Tissue Engineering; Huaqiao University; Xiamen Fujian 362021 P. R. China
| | - Jie Ju
- Division of Engineering in Medicine, Department of Medicine; Brigham and Women's Hospital, Harvard Medical School; Cambridge MA 02139 USA
- Harvard-MIT Division of Health Sciences and Technology; Massachusetts Institute of Technology; Cambridge MA 02139 USA
| | - Ali Tamayol
- Division of Engineering in Medicine, Department of Medicine; Brigham and Women's Hospital, Harvard Medical School; Cambridge MA 02139 USA
- Harvard-MIT Division of Health Sciences and Technology; Massachusetts Institute of Technology; Cambridge MA 02139 USA
- Department of Mechanical and Materials Engineering; University of Nebraska-Lincoln; Lincoln NE 68508 USA
| | - Xiao Liu
- Division of Engineering in Medicine, Department of Medicine; Brigham and Women's Hospital, Harvard Medical School; Cambridge MA 02139 USA
- Harvard-MIT Division of Health Sciences and Technology; Massachusetts Institute of Technology; Cambridge MA 02139 USA
- Beijing Advanced Innovation Center for Biomedical Engineering; Key Laboratory for Biomechanics and Mechanobiology of the Ministry of Education; School of Biological Science and Medical Engineering; Beihang University; Beijing 100083 P. R. China
| | - Yu Shrike Zhang
- Division of Engineering in Medicine, Department of Medicine; Brigham and Women's Hospital, Harvard Medical School; Cambridge MA 02139 USA
- Harvard-MIT Division of Health Sciences and Technology; Massachusetts Institute of Technology; Cambridge MA 02139 USA
| | - Rahmi Oklu
- Division of Vascular & Interventional Radiology; Minimally Invasive Therapeutics Laboratory; Mayo Clinic, 5777 E. Mayo Blvd Phoenix AZ 85054 USA
| | - Ali Khademhosseini
- Division of Engineering in Medicine, Department of Medicine; Brigham and Women's Hospital, Harvard Medical School; Cambridge MA 02139 USA
- Harvard-MIT Division of Health Sciences and Technology; Massachusetts Institute of Technology; Cambridge MA 02139 USA
- Center for Minimally Invasive Therapeutics; University of California-Los Angeles; Los Angeles CA 90095 USA
- Department of Radiology, David Geffen School of Medicine; University of California-Los Angeles; Los Angeles CA 90095 USA
- Department of Bioengineering, Department of Chemical and Biomolecular Engineering, Henry Samueli School of Engineering and Applied Sciences; University of California-Los Angeles; Los Angeles CA 90095 USA. California NanoSystems Institute; University of California-Los Angeles; Los Angeles 90095 CA USA. Department of Bioindustrial Technologies; Konkuk University; Seoul 143-701 Republic of Korea
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13
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Conway C. Coronary Stent Fracture: Clinical Evidence Vs. the Testing Paradigm. Cardiovasc Eng Technol 2018; 9:752-760. [DOI: 10.1007/s13239-018-00384-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Accepted: 10/03/2018] [Indexed: 12/23/2022]
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14
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Strain-induced accelerated asymmetric spatial degradation of polymeric vascular scaffolds. Proc Natl Acad Sci U S A 2018; 115:2640-2645. [PMID: 29483243 DOI: 10.1073/pnas.1716420115] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Polymer-based bioresorbable scaffolds (BRS) seek to eliminate long-term complications of metal stents. However, current BRS designs bear substantially higher incidence of clinical failures, especially thrombosis, compared with metal stents. Research strategies inherited from metal stents fail to consider polymer microstructures and dynamics--issues critical to BRS. Using Raman spectroscopy, we demonstrate microstructural heterogeneities within polymeric scaffolds arising from integrated strain during fabrication and implantation. Stress generated from crimping and inflation causes loss of structural integrity even before chemical degradation, and the induced differences in crystallinity and polymer alignment across scaffolds lead to faster degradation in scaffold cores than on the surface, which further enlarge localized deformation. We postulate that these structural irregularities and asymmetric material degradation present a response to strain and thereby clinical performance different from metal stents. Unlike metal stents which stay patent and intact until catastrophic fracture, BRS exhibit loss of structural integrity almost immediately upon crimping and expansion. Irregularities in microstructure amplify these effects and can have profound clinical implications. Therefore, polymer microstructure should be considered in earliest design stages of resorbable devices, and fabrication processes must be well-designed with microscopic perspective.
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15
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Zhang BC, Tu SX, Karanasos A, van Geuns RJ, de Jaegere P, Zijlstra F, Regar E. Association of stent-induced changes in coronary geometry with late stent failure: Insights from three-dimensional quantitative coronary angiographic analysis. Catheter Cardiovasc Interv 2018; 92:1040-1048. [PMID: 29399998 DOI: 10.1002/ccd.27520] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2017] [Revised: 12/31/2017] [Accepted: 01/06/2018] [Indexed: 11/12/2022]
Abstract
BACKGROUND The relationship between vessel angulation and large changes in vessel geometry after stent implantation and the occurrence of stent failure still remains unclear. We sought to investigate the association of the change in the coronary bending angle after stenting and the risk for late stent failure by three-dimensional quantitative coronary angiography (3D QCA). METHODS The bending angle in coronary lesions that presented with late stent failure and those without stent failure was computed during the cardiac cycle, before and after stenting using a recently developed 3D QCA software. RESULTS A total of 40 lesions with stent failure (cases) were successfully matched to 47 lesions without stent failure (controls).The mean duration to follow-up coronary angiography was 1,011 days in cases and 1,109 days in the control group (P = 0.14). In stent failure, the systolic bending angle after stenting was smaller (14.45° [12.18, 17.68] versus 18.20° [14.00, 20.30], P = 0.01), while the stent-induced change in systolic bending angle was significantly larger (4.15° [1.13, 7.20] versus 1.80° [-1.90, 4.40], P = 0.004). Multivariable logistic regression analysis suggested that systolic bending angle after stenting (odds ratio: 0.88; 95% CI: 0.79-0.99; P = 0.03), and decrease in systolic bending angle after stenting (odds ratio: 1.13; 95% CI: 1.02-1.26; P = 0.03) were predictors of stent failure. CONCLUSIONS Our study suggests that a change in the natural tortuous course of the coronaries by stent implantation with the decrease in coronary bending angle is a potentially major contributor in stent failure.
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Affiliation(s)
- Bu Chun Zhang
- Department of Cardiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, People's Republic of China.,Department of Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Sheng Xian Tu
- Med-X Research Institute, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Antonios Karanasos
- Department of Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands.,Department of Cardiology, Hippokration Hospital, Athens, Greece
| | - Robert-Jan van Geuns
- Department of Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Peter de Jaegere
- Department of Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Felix Zijlstra
- Department of Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Evelyn Regar
- Department of Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands.,University Hospital of Zurich, Heart Center, Zurich, Switzerland
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16
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Deformation mechanisms of prototype composite braided stent-grafts in bending fatigue for peripheral artery application. J Mech Behav Biomed Mater 2018; 78:74-81. [DOI: 10.1016/j.jmbbm.2017.10.037] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Revised: 10/29/2017] [Accepted: 10/30/2017] [Indexed: 12/31/2022]
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17
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SHEN XIANG, DENG YONGQUAN, JI SONG, XIE ZHONGMIN, ZHU HONGFEI. FLEXIBILITY BEHAVIOR OF CORONARY STENTS: THE ROLE OF LINKER INVESTIGATED WITH NUMERICAL SIMULATION. J MECH MED BIOL 2018. [DOI: 10.1142/s0219519417501123] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Flexibility is a vital property of stents and different stent structures lead to different flexibility behaviors. In this study, the finite element analysis was adopted and a virtual bending deformation was imposed to quantify the effects of linker pattern, linker number, bending direction and linker location on flexibility. Stent performance indicators, including stress distribution, deformation patterns and bending stiffness, were examined. Results indicate that higher levels of stresses are found on the linker struts, associated with much larger deformation. The linker number plays the most significant role in flexibility, and simply decreasing linker number could result in a sharp increase in flexibility and a decrease in stress. The linker pattern has great impact on stent flexibility, especially on the behavior of self-contact. Stents with different linker patterns could respond differently in the course of bending, and the stent with an offset peak-to-peak linker pattern is the best choice. It is also found that stent flexibility can be improved when fewer linkers lie in the compression area and the linker directions between two adjacent rows are consistent. The results obtained could provide useful information for the improvement of stent design and clinical choice.
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Affiliation(s)
- XIANG SHEN
- School of Mechanical Engineering, Jiangsu University, Zhenjiang 212013, P. R. China
| | - YONG-QUAN DENG
- School of Mechanical Engineering, Jiangsu University, Zhenjiang 212013, P. R. China
| | - SONG JI
- School of Mechanical Engineering, Jiangsu University, Zhenjiang 212013, P. R. China
| | - ZHONG-MIN XIE
- School of Mechanical Engineering, Jiangsu University, Zhenjiang 212013, P. R. China
| | - HONG-FEI ZHU
- School of Mechanical Engineering, Jiangsu University, Zhenjiang 212013, P. R. China
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18
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Alraies MC, Darmoch F, Tummala R, Waksman R. Diagnosis and management challenges of in-stent restenosis in coronary arteries. World J Cardiol 2017; 9:640-651. [PMID: 28932353 PMCID: PMC5583537 DOI: 10.4330/wjc.v9.i8.640] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2016] [Revised: 05/27/2017] [Accepted: 07/17/2017] [Indexed: 02/06/2023] Open
Abstract
Over the course of the 3 decades, percutaneous coronary intervention (PCI) with stent implantation transformed the practice of cardiology. PCI with stenting is currently the most widely performed procedure for the treatment of symptomatic coronary disease. In large trials, drug-eluting stents (DES) have led to a significant reduction in in-stent restenosis (ISR) rates, one of the major limitations of bare-metal stents. Due to these favorable findings, DES was rapidly and widely adopted enabling more complex coronary interventions. Nevertheless, ISR remains a serious concern as late stent complications. ISR mainly results from aggressive neointimal proliferation and neoatherosclerosis. DES-ISR treatment continues to be challenging complications for interventional cardiologists.
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Affiliation(s)
- M Chadi Alraies
- Heart and Vascular Institute, Department of Interventional Cardiology, Georgetown University/MedStar Washington Hospital Center, Washington, DC 20010, United States
| | - Fahed Darmoch
- Internal Medicine Department, St Vincent Charity Medical Center/Case Western Reserve University, Cleveland, OH 44115, United States
| | - Ramyashree Tummala
- Internal Medicine Department, St Vincent Charity Medical Center/Case Western Reserve University, Cleveland, OH 44115, United States
| | - Ron Waksman
- Heart and Vascular Institute, Department of Interventional Cardiology, Georgetown University/MedStar Washington Hospital Center, Washington, DC 20010, United States
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19
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Independent predictors of in-stent restenosis after drug-eluting stent implantation for ostial right coronary artery lesions. Int J Cardiol 2017; 240:108-113. [PMID: 28476515 DOI: 10.1016/j.ijcard.2017.04.083] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Revised: 03/27/2017] [Accepted: 04/24/2017] [Indexed: 11/21/2022]
Abstract
OBJECTIVES We evaluated the angiographic patterns and predictors of in-stent restenosis (ISR) for ostial lesions of the right coronary artery (RCA) to clarify the mechanism of insoluble restenosis. BACKGROUND Although ISR of the RCA still occurs, limited data is available regarding the associated angiographic findings. METHODS Between January 2005 and September 2013, we recruited consecutive patients undergoing routine angiography 6-18months after implantation of a drug-eluting stent (DES). Multiple logistic regression analysis was used to determine the independent predictors of ISR, and the adjusted odds ratios (aOR) and 95% confidence intervals (95% CI) were calculated. RESULTS Routine angiography revealed that 45 of 131 patients (34.3%) had RCA-ISR, which were classifiable by occlusion type into ostial (24 cases), proximal (17 cases), diffuse (3 cases), and total (1 case). By multivariable analysis, early generation DES was the only independent predictor of overall ISR (aOR, 3.54; 95% CI, 1.59-7.87; p=0.002). In a subgroup analysis of each focal ISR pattern, early generation DES (aOR, 7.76; 95% CI, 2.15-28.0; p=0.002) was associated with increased risk of ostial ISR. On the contrary, larger stent (aOR, 0.21; 95% CI, 0.05-0.84; p=0.027) was associated with decreased risk of ostial ISR. Furthermore, a ratio of the stent to post-balloon size >1.10 (aOR, 3.93; 95% CI, 1.30-11.8; p=0.002) and good left ventricular contractility (ejection fraction >60%) (aOR, 8.27; 95% CI, 1.76-39.0; p=0.008) were associated with increased risk of proximal ISR when stent fracture was observed. CONCLUSION The focal pattern of RCA-ISR was mostly observed after DES implantation, and the mechanisms of proximal and ostial ISR differed.
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20
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Liu R, Gao Z, Chen J, Gao L, Song L, Qiao S, Yang Y, Gao R, Xu B, Yuan J. Comparison between imported versus domestic drug-eluting stents in China: A large single-center data. J Interv Cardiol 2017; 30:338-346. [PMID: 28670789 DOI: 10.1111/joic.12402] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Revised: 06/03/2017] [Accepted: 06/07/2017] [Indexed: 11/30/2022] Open
Affiliation(s)
- Ru Liu
- Department of Cardiology; Fuwai Hospital; National Center for Cardiovascular Diseases; Chinese Academy of Medical Science and Peking Union Medical College; Beijing China
| | - Zhan Gao
- Department of Cardiology; Fuwai Hospital; National Center for Cardiovascular Diseases; Chinese Academy of Medical Science and Peking Union Medical College; Beijing China
| | - Jue Chen
- Department of Cardiology; Fuwai Hospital; National Center for Cardiovascular Diseases; Chinese Academy of Medical Science and Peking Union Medical College; Beijing China
| | - Lijian Gao
- Department of Cardiology; Fuwai Hospital; National Center for Cardiovascular Diseases; Chinese Academy of Medical Science and Peking Union Medical College; Beijing China
| | - Lei Song
- Department of Cardiology; Fuwai Hospital; National Center for Cardiovascular Diseases; Chinese Academy of Medical Science and Peking Union Medical College; Beijing China
| | - Shubin Qiao
- Department of Cardiology; Fuwai Hospital; National Center for Cardiovascular Diseases; Chinese Academy of Medical Science and Peking Union Medical College; Beijing China
| | - Yuejin Yang
- Department of Cardiology; Fuwai Hospital; National Center for Cardiovascular Diseases; Chinese Academy of Medical Science and Peking Union Medical College; Beijing China
| | - Runlin Gao
- Department of Cardiology; Fuwai Hospital; National Center for Cardiovascular Diseases; Chinese Academy of Medical Science and Peking Union Medical College; Beijing China
| | - Bo Xu
- Department of Cardiology; Fuwai Hospital; National Center for Cardiovascular Diseases; Chinese Academy of Medical Science and Peking Union Medical College; Beijing China
| | - Jinqing Yuan
- Department of Cardiology; Fuwai Hospital; National Center for Cardiovascular Diseases; Chinese Academy of Medical Science and Peking Union Medical College; Beijing China
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21
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Wiktor DM, Waldo SW, Armstrong EJ. Coronary Stent Failure: Fracture, Compression, Recoil, and Prolapse. Interv Cardiol Clin 2017; 5:405-414. [PMID: 28582037 DOI: 10.1016/j.iccl.2016.03.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Current-generation coronary drug-eluting stents are associated with low rates of restenosis and target lesion revascularization. However, several mechanisms of stent failure remain clinically important. Stent fracture may occur in areas of excessive torsion or angulation. Longitudinal stent deformation is related to axial stent compression owing to extrinsic forces or secondary devices that disrupt stent architecture. Stent recoil occurs when a stent does not deploy at its optimal cross-sectional area. Tissue prolapse between stent struts may also predispose patients to adverse outcomes. Prevention, recognition, and treatment of these stent failures are necessary to optimize patient outcomes after percutaneous coronary interventions.
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Affiliation(s)
- Dominik M Wiktor
- Division of Cardiology, VA Eastern Colorado Healthcare System, University of Colorado, Denver, CO, USA
| | - Stephen W Waldo
- Division of Cardiology, VA Eastern Colorado Healthcare System, University of Colorado, Denver, CO, USA
| | - Ehrin J Armstrong
- Division of Cardiology, VA Eastern Colorado Healthcare System, University of Colorado, Denver, CO, USA.
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22
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Biscaglia S, Tebaldi M, Tumscitz C, Pavasini R, Marchesini J, Gallo F, Spitaleri G, Zaraket F, Serenelli M, Cimaglia P, Bugani G, Campo G. Prospective Identification of Stent Fracture by Enhanced Stent Visualization System During Percutaneous Coronary Intervention. Circ J 2016; 81:82-89. [PMID: 27853098 DOI: 10.1253/circj.cj-16-0785] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND No study has evaluated the clinical consequences of stent fracture (SF) detected during the index percutaneous coronary intervention (PCI). Thus, we sought to investigate the relationship between SF detected during PCI and clinical outcome.Methods and Results:We consecutively enrolled 832 patients with SF-predisposing factors undergoing 2nd-generation drug-eluting stent implantation and enhanced stent visualization (ESV) system evaluation to detect SF at index PCI. The primary endpoint was a 9-month device-oriented endpoint (DOCE, including cardiac death, target vessel myocardial infarction, and target lesion revascularization). We observed 136 SF in 115 patients (14% of study population). SF I-II was present in 78 patients (68% of patients with SF), and SF III-IV occurred in 37 patients (32%). DOCE at 9 months occurred in 135 patients (16% of the overall population). There was a significant difference in DOCE occurrence between the 3 groups (P=0.006 at log-rank), driven by the SF III-IV group (P=0.001 vs. no SF group, and P=0.01 vs. SF I-II group). In 23 cases of SF III-IV (62%) a further stent was implanted. DOCE occurrence was significantly higher in patients with "untreated" type III-IV SF as compared with the "treated" ones (9% vs. 79%, P<0.01). CONCLUSIONS The ESV system is helpful in detecting SF during the index PCI. Type III-IV SFs are associated with a higher incidence of DOCE.
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Affiliation(s)
- Simone Biscaglia
- Cardiovascular Institute, Medical Sciences Department, Azienda Ospedaliero-Universitaria S.Anna
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23
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Review: Stent fracture in the drug-eluting stent era. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2016; 17:404-11. [DOI: 10.1016/j.carrev.2016.06.002] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Accepted: 06/23/2016] [Indexed: 11/23/2022]
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24
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Arat Ozkan A, Sinan UY, Gurmen AT. Zotarolimus-eluting stent fracture at initial implantation diagnosed with StentBoost. SAGE Open Med Case Rep 2016; 4:2050313X16645754. [PMID: 27489714 PMCID: PMC4927216 DOI: 10.1177/2050313x16645754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2015] [Accepted: 03/30/2016] [Indexed: 11/15/2022] Open
Abstract
Stent fracture is a rare complication of drug-eluting stent implantation with a reported rate of 0.84%–3.2% in various clinical studies with first-generation drug-eluting stents and 29% in autopsy studies. Sirolimus-eluting stents with their closed cell design were reported to be more prone to fracture compared to paclitaxel-eluting stents. Other risk factors for stent fracture are multiple stenting, longer stent length, chronic renal failure, right coronary artery intervention, and a higher maximal inflation pressure. The role of angiography in diagnosing stent fracture is limited, a fact also questioning the reliability of angiographic data. Image enhancement techniques like StentBoost are widely available in new-generation angiography systems and are used to assess stent expansion, overlap size, or to localize the postdilation balloon. Here, we report a case of zotarolimus-eluting stent fracture at initial implantation diagnosed with StentBoost.
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Affiliation(s)
- Alev Arat Ozkan
- Department of Cardiology, Istanbul University Institute of Cardiology, Istanbul, Turkey
| | - Umit Yasar Sinan
- Department of Cardiology, Istanbul University Institute of Cardiology, Istanbul, Turkey
| | - Aziz T Gurmen
- Department of Cardiology, Istanbul University Institute of Cardiology, Istanbul, Turkey
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25
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The role of angiographic follow-up after percutaneous coronary intervention. Int J Cardiol 2016; 222:911-920. [PMID: 27526358 DOI: 10.1016/j.ijcard.2016.08.031] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Revised: 08/02/2016] [Accepted: 08/02/2016] [Indexed: 01/22/2023]
Abstract
In the early days of coronary angioplasty, follow-up coronary angiography was often performed to assess restenosis. Angiographic restenosis has been shown to be associated with worse clinical outcomes, though the exact causality has yet to be determined. Numerous studies have repeatedly demonstrated that routine follow-up coronary angiography increases the incidence of target lesion revascularization without a clear reduction in mortality or myocardial infarction. Despite the lack of proven benefit of angiographic follow-up, routine follow-up coronary angiography is still being performed in certain countries and facilities. There are several factors that might explain the lack of benefit of angiographic follow-up: 1) lower incidence of stent failure in the current drug-eluting stent era has attenuated the net clinical benefit of follow-up angiography. 2) Angiographic restenosis might not lead to myocardial ischemia. 3) Patients that do have functionally significant restenosis are often referred for coronary angiography due to clinical indications such as intractable angina. 4) Absence of restenosis at the time of follow-up angiography does not exclude future restenosis. The absence of proven benefit in unselected populations does not necessarily preclude the presence of benefit in selected population, and there may be a subgroup of patients who can benefit from angiographic follow-up such as those with a large myocardial ischemic territory or those at very high risk of restenosis. Until there is more clinical evidence with respect to follow-up angiography, the decision of whether or not to perform it routinely in selected high-risk population should entail an in-depth discussion with the patient.
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Fractura de los stents: una etiología diferente. REVISTA COLOMBIANA DE CARDIOLOGÍA 2016. [DOI: 10.1016/j.rccar.2015.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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27
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Abstract
Coronary optical coherence tomography (OCT) is now an established imaging technique in many catheterization laboratories worldwide. With its near-histological view of the vessel wall and lumen interface, it offers unprecedented imaging quality to improve our understanding of the pathophysiology of atherosclerosis, plaque vulnerability, and vascular biology. Not only is OCT used to accurately detect atherosclerotic plaque and optimize stent position, but it can further characterize plaque composition, quantify stent apposition, and assess stent tissue coverage. Given that its resolution of 15 μm is well above that of angiography and intravascular ultrasound, OCT has become the invasive imaging method of choice to examine the interaction between stents and the vessel wall. This review focuses on the application of OCT to examine coronary stents, the mechanisms of stent complications, and future directions of OCT-guided intervention.
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Abstract
In-stent restenosis (ISR) is the narrowing of a stented coronary artery lesion. The mean time from percutaneous coronary intervention (PCI) to ISR was 12 months with drug-eluting stents (DES) and 6 months with bare metal stents (BMS). ISR typically presents as recurrent angina. The use of DES has significantly reduced the rate of ISR compared with BMS. Predictors of ISR include patient, lesion, and procedural characteristics. Intravascular ultrasound, optical coherence tomography, and fractional flow reserve are important tools for the anatomic and hemodynamic assessment of ISR. Treatment options for ISR include percutaneous coronary intervention with DES.
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Affiliation(s)
- Michael S Lee
- Cardiology Division, Department of Medicine, UCLA Medical Center, 100 Medical Plaza Suite 630, Los Angeles, CA 90095, USA.
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29
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Xu J, Yang J, Huang N, Uhl C, Zhou Y, Liu Y. Mechanical response of cardiovascular stents under vascular dynamic bending. Biomed Eng Online 2016; 15:21. [PMID: 26897123 PMCID: PMC4761418 DOI: 10.1186/s12938-016-0135-8] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Accepted: 02/02/2016] [Indexed: 11/27/2022] Open
Abstract
Backround Currently, the effect of vascular dynamic bending (VDB) has not been fully considered when studying cardiovascular stents’ long-term mechanical properties, as the previous studies about stent’s mechanical properties mostly focus on the effect of vascular pulsation (VP). More and more clinical reports suggested that the effect of VDB have a significant impact on stent. Methods In this paper, an explicit-implicit coupling simulation method was applied to analyze the mechanical responses of cardiovascular stents considering the effect of VDB. The effect of VP on stent mechanical properties was also studied and compared to the effect of VDB. Results The results showed that the dynamic bending deformation occurred in stents due to the effect of VDB. The effects of VDB and VP resulted in alternating stress states of the stent, while the VDB alternate stresses effective on the stent were almost three times larger than that of the VP. The stress concentration under VDB mainly occurred in bridge struts and the maximal stress was located in the middle loops of the stent. However, the stress distributed uniformly in the stents under the effect of VP. Stent fracture occurred more frequently as a result of VDB with the predicted fracture position located in the bridging struts of the stent. These results are consistent with the reported data in clinical literatures. The stress of the vessel under VDB was higher, than that caused by VP. Conclusions The results showed that the effect of VDB has a significant impact on the stent’s stress distribution, fatigue performance and overall stress on the vessel, thus it is necessary to be considered when analyzing stent’s long-term mechanical properties. Meanwhile, the results showed that the explicit-implicit coupling simulation can be applied to analyze stent mechanical properties.
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Affiliation(s)
- Jiang Xu
- School of Mechanics and Engineering, Southwest Jiaotong University, 610031, Chengdu, People's Republic of China.
| | - Jie Yang
- School of Mechanics and Engineering, Southwest Jiaotong University, 610031, Chengdu, People's Republic of China.
| | - Nan Huang
- School of Material Engineering and Science, Southwest Jiaotong University, 610031, Chengdu, People's Republic of China.
| | - Christopher Uhl
- Bioengineering Program, Lehigh University, Bethlehem, PA, 18015, USA.
| | - Yihua Zhou
- Department of Mechanical Engineering and Mechanics, Lehigh University, Bethlehem, PA, 18015, USA.
| | - Yaling Liu
- School of Mechanics and Engineering, Southwest Jiaotong University, 610031, Chengdu, People's Republic of China. .,Bioengineering Program, Lehigh University, Bethlehem, PA, 18015, USA. .,Department of Mechanical Engineering and Mechanics, Lehigh University, Bethlehem, PA, 18015, USA.
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30
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A Computational Framework to Model Degradation of Biocorrodible Metal Stents Using an Implicit Finite Element Solver. Ann Biomed Eng 2015; 44:382-90. [DOI: 10.1007/s10439-015-1530-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2015] [Accepted: 12/03/2015] [Indexed: 11/26/2022]
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Granata F, Attizzani GF, Tartaglione D, Cappelli Bigazzi M, Bianchi R, Varricchio A, Russo MG, Calabrò P. Atypical "vacuum" inside of neoatherosclerosis long term after DES implantation: insights from optical coherence tomography. Int J Cardiol 2015. [PMID: 26209822 DOI: 10.1016/j.ijcard.2015.06.064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Francesco Granata
- Chair of Cardiology, Cardio-thoracic and Respiratory Sciences Department, Second University of Naples, Monaldi Hospital, A.O.R.N. dei Colli, Via L. Bianchi n.1, Naples, Italy.
| | | | - Donato Tartaglione
- Chair of Cardiology, Cardio-thoracic and Respiratory Sciences Department, Second University of Naples, Monaldi Hospital, A.O.R.N. dei Colli, Via L. Bianchi n.1, Naples, Italy
| | - Maurizio Cappelli Bigazzi
- Chair of Cardiology, Cardio-thoracic and Respiratory Sciences Department, Second University of Naples, Monaldi Hospital, A.O.R.N. dei Colli, Via L. Bianchi n.1, Naples, Italy
| | - Renatomaria Bianchi
- Chair of Cardiology, Cardio-thoracic and Respiratory Sciences Department, Second University of Naples, Monaldi Hospital, A.O.R.N. dei Colli, Via L. Bianchi n.1, Naples, Italy
| | - Attilio Varricchio
- Laboratory of Interventional Cardiology, Department of Cardiology, Santa Maria della Pietà Hospital, Nola, Italy
| | - Maria Giovanna Russo
- Chair of Cardiology, Cardio-thoracic and Respiratory Sciences Department, Second University of Naples, Monaldi Hospital, A.O.R.N. dei Colli, Via L. Bianchi n.1, Naples, Italy
| | - Paolo Calabrò
- Chair of Cardiology, Cardio-thoracic and Respiratory Sciences Department, Second University of Naples, Monaldi Hospital, A.O.R.N. dei Colli, Via L. Bianchi n.1, Naples, Italy
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[Very late drug-eluting stent thrombosis by stent fracture]. Ann Cardiol Angeiol (Paris) 2015; 64:487-91. [PMID: 26542320 DOI: 10.1016/j.ancard.2015.09.060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
The superiority of drug-eluting stents in reducing the risk of in-stent restenosis compared to bare-metal stents is no longer challenged. Nevertheless, the drug-eluting stents may carry long-term risk of late and very late stent thrombosis. The promoting factors of this complication are usually divided into three chapters depending on the patient, the procedure and the stent. Indeed, the literature has reported several parameters related to the stent itself, such as its length, the malapposition, its diameter, but also more rarely the occurrence of stent fracture. We present the case of a patient admitted for myocardial infarction after a very late thrombosis of Cypher drug-eluting stent four years after its implantation and related to stent fracture.
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Stent fracture and longitudinal compression detected on coronary CT angiography in the first- and new-generation drug-eluting stents. Int J Cardiovasc Imaging 2015; 32:637-46. [PMID: 26498655 DOI: 10.1007/s10554-015-0798-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Accepted: 10/22/2015] [Indexed: 01/18/2023]
Abstract
To evaluated prevalence and clinical implication of stent fracture and longitudinal compression in first- and new-generation drug-eluting stents (DES) using coronary computed tomography angiography (CCTA). The incidence of stent fracture and longitudinal compression were compared between first- and new-generation DES in 374 patients who underwent coronary stenting using DES and follow-up CCTA due to recurrent angina. 235 and 139 patients received 322 first- and 213 new-generation DES, respectively. The crude per-stent incidence of longitudinal compression (6.1 vs. 0.3 %, p < 0.001) was higher after new- than first-generation DES implantation using CCTA and the incidence of stent fracture (11.3 vs. 8.1 %, p = 0.23) was comparable. On follow-up coronary angiography for 347 stents, stent fracture (3.2 %) and longitudinal compression (0.9 %) were less detected than those on CCTA. Ostial stenting was a risk factor of longitudinal compression (p < 0.001). Stent fracture was associated with younger patients (p = 0.03), longer stent (p = 0.010), and excessively tortuous lesions (p = 0.001). The presence of stent fracture or longitudinal compression was not associated with poor clinical outcomes. The longitudinal compression more frequently occurred after new-generation DES implantation. The stent fracture was comparable between two DES. However, the occurrence of such mechanical deformities did not translate into a poor clinical outcome.
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Kobayashi N, Ito Y, Nakano M, Araki M, Hirano K, Yamawaki M, Takimura H, Sakamoto Y, Tsukahara R, Muramatsu T. Incidence and Characteristics of Late Catch-Up Phenomenon Between Sirolimus-Eluting Stent and Everolimus-Eluting Stent: A Propensity Matched Study. J Interv Cardiol 2015; 28:551-62. [DOI: 10.1111/joic.12247] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Affiliation(s)
- Norihiro Kobayashi
- Department of Cardiology; Saiseikai Yokohama-City Eastern Hospital; Yokohama Kanagawa Japan
| | - Yoshiaki Ito
- Department of Cardiology; Saiseikai Yokohama-City Eastern Hospital; Yokohama Kanagawa Japan
| | | | - Motoharu Araki
- Department of Cardiology; Saiseikai Yokohama-City Eastern Hospital; Yokohama Kanagawa Japan
| | - Keisuke Hirano
- Department of Cardiology; Saiseikai Yokohama-City Eastern Hospital; Yokohama Kanagawa Japan
| | - Masahiro Yamawaki
- Department of Cardiology; Saiseikai Yokohama-City Eastern Hospital; Yokohama Kanagawa Japan
| | - Hideyuki Takimura
- Department of Cardiology; Saiseikai Yokohama-City Eastern Hospital; Yokohama Kanagawa Japan
| | - Yasunari Sakamoto
- Department of Cardiology; Saiseikai Yokohama-City Eastern Hospital; Yokohama Kanagawa Japan
| | - Reiko Tsukahara
- Department of Cardiology; General Tokyo Hospital; Tokyo Japan
| | - Toshiya Muramatsu
- Department of Cardiology; Saiseikai Yokohama-City Eastern Hospital; Yokohama Kanagawa Japan
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35
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Ormiston JA, Webber B, Ubod B, White J, Webster MW. Coronary stent durability and fracture: an independent bench comparison of six contemporary designs using a repetitive bend test. EUROINTERVENTION 2015; 10:1449-55. [DOI: 10.4244/eijy14m11_08] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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36
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Lee PH, Lee SW, Lee JY, Kim YH, Lee CW, Park DW, Park SW, Park SJ. Two cases of immediate stent fracture after zotarolimus-eluting stent implantation. Korean Circ J 2015; 45:67-70. [PMID: 25653706 PMCID: PMC4310982 DOI: 10.4070/kcj.2015.45.1.67] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2014] [Revised: 05/17/2014] [Accepted: 06/09/2014] [Indexed: 11/11/2022] Open
Abstract
Drug-eluting stent (DES) implantation is currently the standard treatment for various types of coronary artery disease. However, previous reports indicate that stent fractures, which usually occur after a period of time from the initial DES implantation, have increased during the DES era; stent fractures can contribute to unfavorable events such as in-stent restenosis and stent thrombosis. In our present report, we describe two cases of zotarolimus-eluting stent fracture: one that was detected six hours after implementation, and the other case that was detected immediately after deployment. Both anatomical and technical risk factors contributed to these unusual cases of immediate stent fracture.
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Affiliation(s)
- Pil Hyung Lee
- Department of Cardiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Seung-Whan Lee
- Department of Cardiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Jong-Young Lee
- Department of Cardiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Young-Hak Kim
- Department of Cardiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Cheol Whan Lee
- Department of Cardiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Duk-Woo Park
- Department of Cardiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Seong-Wook Park
- Department of Cardiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Seung-Jung Park
- Department of Cardiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
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Inaba S, Mintz GS, Yun KH, Yakushiji T, Shimizu T, Kang SJ, Généreux P, Weisz G, Rabbani LE, Moses JW, Stone GW, Maehara A. Mechanical complications of everolimus-eluting stents associated with adverse events: an intravascular ultrasound study. EUROINTERVENTION 2014; 9:1301-8. [PMID: 24650772 DOI: 10.4244/eijv9i11a220] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS Mechanical complications contribute to bare metal and first-generation drug-eluting stent (DES) failure. However, the importance of the mechanical complications of second-generation DES remains unclear. We report mechanical complications associated with everolimus-eluting stent (EES) failures. METHODS AND RESULTS We retrospectively analysed 177 consecutive EES-treated lesions in 136 patients who underwent intravascular ultrasound (IVUS) at follow-up. Mechanical complications were identified in 17 patients (five stable angina, 10 unstable angina, two non-ST-elevation myocardial infarction [NSTEMI] without angiographic thrombus). Fifteen (88.2%) were treated with repeat revascularisation. By IVUS, there were 16 focal (94.1%) and one diffuse (5.9%) in-stent restenoses. Complete stent fracture with separation was seen in only one, partial stent fracture with separation was seen in three, and in 13 there was longitudinal deformation (n=2) or stent strut fracture (n=11) with overlapping of the proximal and distal stent fragments. In 13 EES with evidence of overlapping in the setting of either fracture or deformation, there was a 35.5±12.2% smaller stent area compared to the adjacent proximal and distal stent fragments, and >50% neointimal hyperplasia in 12 (92.3%). CONCLUSIONS We found EES mechanical complications, often followed by longitudinal deformation or fracture leading to excessive neointimal hyperplasia, in-stent restenosis, and repeat revascularisation.
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Affiliation(s)
- Shinji Inaba
- Cardiovascular Research Foundation, New York, NY, USA
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Chinikar M, Sadeghipour P. Coronary stent fracture: a recently appreciated phenomenon with clinical relevance. Curr Cardiol Rev 2014; 10:349-54. [PMID: 24720422 PMCID: PMC4101199 DOI: 10.2174/1573403x10666140404105923] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2013] [Revised: 12/05/2013] [Accepted: 02/04/2014] [Indexed: 11/28/2022] Open
Abstract
In the stent era, in addition to restenosis, there are many important consequences deserving more attention. Firstly described in peripheral vascular interventions, it took several years for stent fracture to be known as an appreciable complication of coronary intervention. Especially with the introduction of drug eluting stents and the use of coronary stents in more complex cases, its prevalence has raised and new data have been published concerning its mechanism, predictors, diagnosis, clinical course and treatments. This review will discuss the available literature about stent fracture.
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Affiliation(s)
| | - Parham Sadeghipour
- Department of Cardiac Catheterization and Interventional Cardiology, Heshmat Cardiovascular Medical Center, Guilan University of Medical Sciences. Kooye Bayani, Mossalla square, Rasht, P.O. Box: 4193955588, Iran.
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39
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Kuramitsu S, Iwabuchi M, Yokoi H, Domei T, Sonoda S, Hiromasa T, Morinaga T, Kobayashi Y, Ohe K, Goya K, Yamaji K, Hyodo M, Soga Y, Kondo K, Shirai S, Ando K, Sakai K, Nobuyoshi M. Incidence and clinical impact of stent fracture after the Nobori biolimus-eluting stent implantation. J Am Heart Assoc 2014; 3:e000703. [PMID: 24650925 PMCID: PMC4187487 DOI: 10.1161/jaha.113.000703] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background Stent fracture (SF) after drug‐eluting stent implantation has become an important concern. The aim of this study was to assess the incidence, predictors, and clinical impact of SF after biolimus‐eluting stent. Methods and Results A total of 1026 patients with 1407 lesions undergoing the Nobori biolimus‐eluting stent implantation and follow‐up angiography within 9 months after index procedure were analyzed. SF was defined as complete or partial separation of the stent, as assessed by using plain fluoroscopy, intravascular ultrasound, or optical coherence tomography during the follow‐up. We assessed the rate of SF and the cumulative incidence of clinically driven target lesion revascularization and definite stent thrombosis within 9 months. SF was observed in 58 (4.1%) of 1407 lesions and 57 (5.5%) of 1026 patients. Lesions with hinge motion (OR 8.90, 95% CI 3.84 to 20.6, P<0.001), tortuosity (OR 4.16, 95% CI 1.75 to 9.88, P=0.001), and overlapping stents (OR 2.41, 95% CI 0.95 to 6.10, P=0.06) were predictors of SF. Cumulative incidence of clinically driven target lesion revascularization within 9 months was numerically higher in the SF group than that in the non‐SF group (12.0% versus 1.0%). Cumulative incidence of definite stent thrombosis within 9 months tended to be higher in the SF group than that in the non‐SF group (1.7% versus 0.5%). Conclusions SF after biolimus‐eluting stent occurs in 4.1% of lesions and appears to be associated with clinically driven target lesion revascularization.
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Affiliation(s)
- Shoichi Kuramitsu
- Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan
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40
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Mamas MA, Foin N, Abunassar C, Khan MA, Di Mario C, Fraser DG. Stent fracture: Insights on mechanisms, treatments, and outcomes from the food and drug administration manufacturer and user facility device experience database. Catheter Cardiovasc Interv 2014; 83:E251-9. [DOI: 10.1002/ccd.25423] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2013] [Revised: 01/08/2014] [Accepted: 02/05/2014] [Indexed: 11/10/2022]
Affiliation(s)
- Mamas A. Mamas
- Cardiovascular Institute; University of Manchester; Manchester United Kingdom
- Manchester Heart Centre; Manchester Royal Infirmary; United Kingdom
| | | | | | - Muhammad A. Khan
- Cardiovascular Institute; University of Manchester; Manchester United Kingdom
- Manchester Heart Centre; Manchester Royal Infirmary; United Kingdom
| | - Carlo Di Mario
- Cardiovascular Biomedical Research Unit Royal Brompton Hospital; London United Kingdom
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Shand JA, Sharma D, Hanratty C, McClelland A, Menown IB, Spence MS, Richardson G, Herity NA, Walsh SJ. A prospective intravascular ultrasound investigation of the necessity for and efficacy of postdilation beyond nominal diameter of 3 current generation DES platforms for the percutaneous treatment of the left main coronary artery. Catheter Cardiovasc Interv 2013; 84:351-8. [DOI: 10.1002/ccd.25265] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2013] [Accepted: 10/17/2013] [Indexed: 12/29/2022]
Affiliation(s)
- James A. Shand
- St James's Hospital; Dublin Ireland
- Department of Cardiology, Belfast City Hospital; Belfast Northern Ireland United Kingdom
| | - Divyesh Sharma
- Department of Cardiology, Belfast City Hospital; Belfast Northern Ireland United Kingdom
| | - Colm Hanratty
- Department of Cardiology, Belfast City Hospital; Belfast Northern Ireland United Kingdom
| | - Anthony McClelland
- Department of Cardiology, Craigavon Area Hospital; Portadown Northern Ireland United Kingdom
| | - Ian B.A. Menown
- Department of Cardiology, Craigavon Area Hospital; Portadown Northern Ireland United Kingdom
| | - Mark S. Spence
- Department of Cardiology, Royal Victoria Hospital; Belfast Northern Ireland United Kingdom
| | - Geoffrey Richardson
- Department of Cardiology, Belfast City Hospital; Belfast Northern Ireland United Kingdom
| | - Niall A. Herity
- Department of Cardiology, Belfast City Hospital; Belfast Northern Ireland United Kingdom
| | - Simon J. Walsh
- Department of Cardiology, Belfast City Hospital; Belfast Northern Ireland United Kingdom
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42
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Are we aware of stent fracture? Herz 2013; 40:417-22. [DOI: 10.1007/s00059-013-3947-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2013] [Revised: 07/25/2013] [Accepted: 08/07/2013] [Indexed: 10/26/2022]
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43
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Hernández Hernández F, Jurado Román A, García Tejada J, Velázquez Martín M, Albarrán González-Trevilla A, Tascón Pérez JC. Intravascular diagnosis of stent fractures: beyond X-ray imaging. REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2013; 66:751-753. [PMID: 24773688 DOI: 10.1016/j.rec.2013.04.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/10/2013] [Accepted: 04/13/2013] [Indexed: 06/03/2023]
Affiliation(s)
| | - Alfonso Jurado Román
- Unidad de Hemodinámica y Cardiología Intervencionista, Hospital 12 de Octubre, Madrid, Spain
| | - Julio García Tejada
- Unidad de Hemodinámica y Cardiología Intervencionista, Hospital 12 de Octubre, Madrid, Spain
| | - Maite Velázquez Martín
- Unidad de Hemodinámica y Cardiología Intervencionista, Hospital 12 de Octubre, Madrid, Spain
| | | | - Juan C Tascón Pérez
- Unidad de Hemodinámica y Cardiología Intervencionista, Hospital 12 de Octubre, Madrid, Spain
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Hernández Hernández F, Jurado Román A, García Tejada J, Velázquez Martín M, Albarrán González-Trevilla A, Tascón Pérez JC. Diagnóstico intravascular de fracturas de stents: más allá de la imagen radiológica. Rev Esp Cardiol 2013. [DOI: 10.1016/j.recesp.2013.04.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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45
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Kosonen P, Vikman S, Jensen LO, Lassen JF, Harnek J, Olivecrona GK, Erglis A, Fossum E, Niemelä M, Kervinen K, Ylitalo A, Pietilä M, Aaroe J, Kellerth T, Saunamäki K, Thayssen P, Hellsten L, Thuesen L, Niemelä K. Intravascular ultrasound assessed incomplete stent apposition and stent fracture in stent thrombosis after bare metal versus drug-eluting stent treatment the Nordic Intravascular Ultrasound Study (NIVUS). Int J Cardiol 2013; 168:1010-6. [DOI: 10.1016/j.ijcard.2012.10.033] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2012] [Revised: 10/02/2012] [Accepted: 10/28/2012] [Indexed: 12/13/2022]
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Abstract
In spite of there being several case reports, coronary stent fracture is not a well-recognized entity and incidence rates are likely to be underestimated. In this article, we review different aspects of stent fracture, including incidence, classification, predictors, outcome, diagnosis, and management.
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47
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Sun D, Zheng Y, Yin T, Tang C, Yu Q, Wang G. Coronary drug-eluting stents: From design optimization to newer strategies. J Biomed Mater Res A 2013; 102:1625-40. [DOI: 10.1002/jbm.a.34806] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2013] [Revised: 04/25/2013] [Accepted: 05/11/2013] [Indexed: 01/25/2023]
Affiliation(s)
- Daming Sun
- Key Laboratory of Biorheological Science and Technology (Chongqing University), Ministry of Education, Chongqing Engineering Laboratory in Vascular Implants, Bioengineering College of Chongqing University; Chongqing 400044 People's Republic of China
| | - Yiming Zheng
- Key Laboratory of Biorheological Science and Technology (Chongqing University), Ministry of Education, Chongqing Engineering Laboratory in Vascular Implants, Bioengineering College of Chongqing University; Chongqing 400044 People's Republic of China
| | - Tieying Yin
- Key Laboratory of Biorheological Science and Technology (Chongqing University), Ministry of Education, Chongqing Engineering Laboratory in Vascular Implants, Bioengineering College of Chongqing University; Chongqing 400044 People's Republic of China
| | - Chaojun Tang
- Key Laboratory of Biorheological Science and Technology (Chongqing University), Ministry of Education, Chongqing Engineering Laboratory in Vascular Implants, Bioengineering College of Chongqing University; Chongqing 400044 People's Republic of China
| | - Qingsong Yu
- Department of Mechanical and Aerospace Engineering; University of Missouri; Columbia Missouri 65211
| | - Guixue Wang
- Key Laboratory of Biorheological Science and Technology (Chongqing University), Ministry of Education, Chongqing Engineering Laboratory in Vascular Implants, Bioengineering College of Chongqing University; Chongqing 400044 People's Republic of China
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48
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Douglas CJ, Applegate RJ. Minimizing complications following stent implantation: outcomes and follow-up. Interv Cardiol 2013. [DOI: 10.2217/ica.13.24] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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49
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Ruzsa Z, Szabó G, Jambrik Z, Berta B, Molnár L, Édes I, Merkely B. Stent thrombosis due to stent fracture in heavily calcified right coronary artery. COR ET VASA 2013. [DOI: 10.1016/j.crvasa.2012.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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50
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Nazif TM, Weisz G, Moses JW. Clinical applications of a new Enhanced Stent Imaging technology. Catheter Cardiovasc Interv 2013; 82:1115-22. [PMID: 23404958 DOI: 10.1002/ccd.24849] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2012] [Revised: 12/11/2012] [Accepted: 01/27/2013] [Indexed: 12/17/2022]
Abstract
Enhanced Stent Imaging (ESI) refers to a rapidly evolving class of imaging tools that seek to provide enhanced visualization of coronary stent architecture with minimal disruption to the catheterization laboratory workflow. Various ESI stent platforms are available, all of which utilize a brief cine acquisition of a deflated balloon within a stent to generate a motion-corrected, enhanced image of the stent. The enhanced image permits detailed assessment of stent architecture, integrity, and positioning relative to other stents. We present two illustrative cases of percutaneous coronary intervention utilizing a new ESI platform. The relevant literature is briefly reviewed.
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Affiliation(s)
- Tamim M Nazif
- Center for Interventional Vascular Therapy, New York Presbyterian Hospital, Columbia University Medical Center, New York, New York
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