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Naguib AM, Sobhi MA, Zaki A, El Amrawy AM. Very long versus overlapping drug eluting stents for the management of long coronary artery lesions. Acta Cardiol 2024; 79:187-193. [PMID: 38085257 DOI: 10.1080/00015385.2023.2289722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 11/26/2023] [Indexed: 04/18/2024]
Abstract
BACKGROUND The prevalence of long diffuse coronary artery disease (CAD) is increasing nowadays due to increase prevalence of multiple risk factors and population ageing. We aimed in our study to show the differences clinically or angiographically (guided by IVUS) between the use of single long stent versus overlapping stents in very long coronary lesions (≥40 mm) in patients presented with chronic coronary syndromes. METHODS 550 patients presenting with chronic coronary syndromes were included: 320 treated with a single long stent (≥40 mm) and 230 patients with two or more overlapping stents. Angiographic follow-up (guided by IVUS) 6 months after PCI was performed only in 50 patients. We assessed the procedural characteristics and the occurrence of major adverse cardiovascular events (MACE) after a median follow-up of 24 months. RESULTS Total stent length was 56.16 ± 14.85 mm and mean diameter was 3.05 ± 0.36 mm. At the end of follow-up, MACE rate in the single long stent group was 4.1% vs. 7.8% in the overlapping stents group, with higher incidence in overlapping stents group but non-statistically significant (p value = 0.059). PCI using overlapping stents consumed more contrast volume (248 ± 85.36 vs 164.5 ± 70.43 ml, p < 0.001), and higher fluoroscopy time (23.65 ± 9.19 vs 19.72 ± 9.19 min, p < 0.001). Regarding IVUS subgroup follow-up, there was no significant difference between both groups regarding in-stent restenosis and MACE. CONCLUSIONS We can conclude that long or overlapping stents are both acceptable therapeutic choices for patients with long CAD. There was no difference between both strategies regarding angiographic follow-up guided by IVUS after 6 months.
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Affiliation(s)
| | | | - Amr Zaki
- Department of Cardiology, Alexandria University, Alexandria, Egypt
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Goel R, Spirito A, Gao M, Vogel B, N Kalkman D, Mehran R. Second-generation everolimus-eluting intracoronary stents: a comprehensive review of the clinical evidence. Future Cardiol 2024; 20:103-116. [PMID: 38294774 PMCID: PMC11216266 DOI: 10.2217/fca-2023-0092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 01/08/2024] [Indexed: 02/01/2024] Open
Abstract
Percutaneous coronary intervention with implantation of second-generation drug-eluting stents (DES) has emerged as a mainstay for the treatment of obstructive coronary artery disease given its beneficial impact on clinical outcomes in these patients. Everolimus-eluting stents (EES) are one of the most frequently implanted second-generation DES; their use for the treatment of a wide range of patients including those with complex coronary lesions is supported by compelling evidence. Although newer stent platforms such as biodegradable polymer DES may lower local vessel inflammation, their efficacy and safety have not yet surpassed that of Xience stents. This article summarizes the properties of the Xience family of EES and the evidence supporting their use across diverse patient demographics and coronary lesion morphologies.
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Affiliation(s)
- Ridhima Goel
- Center for Interventional Cardiovascular Research & Clinical Trials, Icahn School Medicine at Mount Sinai, New York, NY 10029, USA
- Department of Internal Medicine, SUNY Downstate Health Sciences University, Brooklyn, NY 11203, USA
| | - Alessandro Spirito
- Center for Interventional Cardiovascular Research & Clinical Trials, Icahn School Medicine at Mount Sinai, New York, NY 10029, USA
| | - Michael Gao
- Center for Interventional Cardiovascular Research & Clinical Trials, Icahn School Medicine at Mount Sinai, New York, NY 10029, USA
| | - Birgit Vogel
- Center for Interventional Cardiovascular Research & Clinical Trials, Icahn School Medicine at Mount Sinai, New York, NY 10029, USA
| | - Deborah N Kalkman
- Center for Interventional Cardiovascular Research & Clinical Trials, Icahn School Medicine at Mount Sinai, New York, NY 10029, USA
- Department of Clinical & Experimental Cardiology, Heart Center, Amsterdam Cardiovascular Sciences, Amsterdam UMC – University of Amsterdam, Amsterdam, 1105, The Netherlands
| | - Roxana Mehran
- Center for Interventional Cardiovascular Research & Clinical Trials, Icahn School Medicine at Mount Sinai, New York, NY 10029, USA
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Babu Pothineni R, Ajmera P, Chawla KK, Mantravadi SS, Pathak A, Inamdar MK, Jariwala PV, Vijan V, Vijan V, Potdar A. Ultrathin Strut Biodegradable Polymer-Coated Sirolimus-Eluting Coronary Stents: Patient-Level Pooled Analysis From Two Indian Registries. Cureus 2023; 15:e41743. [PMID: 37575772 PMCID: PMC10415628 DOI: 10.7759/cureus.41743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/07/2023] [Indexed: 08/15/2023] Open
Abstract
Background Despite significant evolution in stent technology, female gender, and patients with diabetes mellitus, multivessel disease, total occlusions, long lesions, and small vessels represent the "Achilles' heel" of contemporary percutaneous coronary intervention (PCI). We performed a pooled analysis of high-risk subgroup on patient-level data from the T-Flex registry (1,203 patients) and a real-world Indian registry (1,269 patients), with the aim of assessing one-year safety and clinical performance of ultrathin strut biodegradable polymer-coated Supra family of sirolimus-eluting stents (SES) (Sahajanand Medical Technologies Limited, Surat, India) in the real-world, all-comer population. Method We pooled the following high-risk subgroups data from two all-comer registries: female gender (n=678), diabetes mellitus (n=852), multivessel disease (n=406), total occlusions (n=420), long lesions (≥28 mm) (n=1241), and small vessels (≤2.5 mm) (n=726). Both the registries included patients with coronary artery disease who underwent implantation of at least one SES belonging to the Supra family of stents from May 2016 until March 2018, irrespective of lesion complexity and comorbidities. The primary endpoint was the inci-dence of target lesion failure (TLF), a composite of cardiac death, target vessel myocardial infarction, and clinically indicated target lesion revas-cularization by percutaneous or surgical methods up to one year. The safety endpoint was stent thrombosis. Results According to prespecified high-risk subgroups, one-year rates of TLF and overall stent thrombosis, respectively, were as follows: female gender (4.9% and 0.6%), diabetes mellitus (6.9% and 1.0%), multivessel disease (6.4% and 0.8%), total occlusions (5.2% and 0.5%), long lesions (≥28 mm) (6.6% and 0.8%), and small vessels (≤2.5 mm) (6.1% and 1.3%). Conclusion This present pooled analysis demonstrated the one-year safety and clinical performance of ultrathin strut biodegradable polymer-coated Supra family of SES in a real-world, all-comer population, with considerably low rates of TLF and stent thrombosis.
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Affiliation(s)
| | - Prakash Ajmera
- Cardiology, Malla Reddy Narayana Multispeciality Hospital, Hyderabad, IND
| | - Kamal Kumar Chawla
- Cardiology, Malla Reddy Narayana Multispeciality Hospital, Hyderabad, IND
| | | | - Abhijit Pathak
- Cardiology, Swasthya Hospital and Medical Research Centre, Ahmednagar, IND
| | | | | | - Vikrant Vijan
- Cardiology, Vijan Cardiac and Critical Care Centre, Nashik, IND
| | - Vinod Vijan
- Cardiology, Vijan Cardiac and Critical Care Centre, Nashik, IND
| | - Anil Potdar
- Cardiology, Parisoha Foundation Pvt. Ltd, Mumbai, IND
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Gautier A, Hovasse T, Arroyo D, Unterseeh T, Garot P, Champagne S, Neylon A, Sanguineti F, Benamer H, Chevalier B, Lefèvre T. Safety and efficacy of 48 mm Xience Xpedition everolimus-eluting stent for the treatment of long coronary lesions. Catheter Cardiovasc Interv 2022; 100:179-187. [PMID: 35621281 DOI: 10.1002/ccd.30249] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Accepted: 05/14/2022] [Indexed: 11/10/2022]
Abstract
INTRODUCTION Long drug-eluting stents may limit the issue of overlapping multiple stents when treating long coronary lesions. AIM The aim of the study was to assess the safety and efficacy of the 48 mm Xience Xpedition everolimus-eluting stent (48mm-EES) for the treatment of long coronary lesions, in an all-comer population. METHODS Patients receiving at least one 48mm-EES were prospectively included from March 2014 to December 2018. The primary endpoint was target lesion failure (TLF), defined as a composite of cardiac death, target vessel myocardial infarction, and clinically driven target lesion revascularization (TLR) at 1 year. The main secondary endpoint was the patient-oriented composite endpoint (POCE) defined as a composite of death, stroke, myocardial infarction, and reintervention. RESULTS A total of 268 patients with 276 long coronary lesions, including 94 chronic total occlusions (CTO), were successfully treated using at least one 48mm-EES. The total stent length per lesion was 66 ± 22 mm. A single 48mm-EES was suitable to successfully treat the target lesion in 48% of cases (60% for non-CTO lesions). One-year follow-up rate was 96.3%. TLF occurred in 13 patients (5.3%), mainly driven by TLR (4.1%). Two cardiac death occurred (0.7%). POCE occurred in 30 patients (11.6%) mainly driven by repeat revascularization (9.7%). Definite stent thrombosis was observed in two patients (0.7%). No difference was observed in one-year outcomes between single 48mm-EES and multiple stents implantation as well as between CTO and non-CTO lesions. CONCLUSION The 48mm-EES is safe and effective to treat long coronary lesions, including CTOs, and provides attractive cost-effectiveness by limiting multiple stenting.
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Affiliation(s)
- Alexandre Gautier
- Institut Cardiovasculaire Paris Sud, Hôpital Privé Jacques Cartier, Massy, France
| | - Thomas Hovasse
- Institut Cardiovasculaire Paris Sud, Hôpital Privé Jacques Cartier, Massy, France
| | - Diego Arroyo
- Hôpital Fribourgeois, Service de Cardiologie, Fribourg, Suisse, Switzerland
| | - Thierry Unterseeh
- Institut Cardiovasculaire Paris Sud, Hôpital Privé Jacques Cartier, Massy, France
| | - Philippe Garot
- Institut Cardiovasculaire Paris Sud, Hôpital Privé Jacques Cartier, Massy, France
| | - Stéphane Champagne
- Institut Cardiovasculaire Paris Sud, Hôpital Privé Jacques Cartier, Massy, France
| | - Antoinette Neylon
- Institut Cardiovasculaire Paris Sud, Hôpital Privé Jacques Cartier, Massy, France
| | - Francesca Sanguineti
- Institut Cardiovasculaire Paris Sud, Hôpital Privé Jacques Cartier, Massy, France
| | - Hakim Benamer
- Institut Cardiovasculaire Paris Sud, Hôpital Privé Jacques Cartier, Massy, France
| | - Bernard Chevalier
- Institut Cardiovasculaire Paris Sud, Hôpital Privé Jacques Cartier, Massy, France
| | - Thierry Lefèvre
- Institut Cardiovasculaire Paris Sud, Hôpital Privé Jacques Cartier, Massy, France
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Kong M, Han JK, Kang HJ, Koo BK, Chae IH, Kim HS, Kang HJ, Koo BK, Chae IH, Kim HS. Clinical outcomes of long stenting in the drug-eluting stent era: patient-level pooled analysis from the GRAND-DES registry. EUROINTERVENTION 2021; 16:1318-1325. [PMID: 31543496 PMCID: PMC9724862 DOI: 10.4244/eij-d-19-00296] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS We aimed to understand the association between stent length and clinical outcomes after percutaneous coronary intervention (PCI) using newer-generation drug-eluting stents (DES). METHODS AND RESULTS We analysed 9,217 patients who underwent stenting for a single lesion from the GRAND-DES registry, a patient-level pooled registry including five Korean multicentre DES registries. The median follow-up duration was 730 days (interquartile range 708 to 752 days). A total of 8,035 patients were classified into the short stenting group (≤40 mm), and 1,182 into the long stenting group (>40 mm). The primary endpoint was target lesion failure (TLF). Long stenting (>40 mm) was significantly associated with higher TLF (IPTW adjusted HR 1.88, 95% CI: 1.67-2.13; p<0.001), and definite or probable stent thrombosis (IPTW adjusted HR 2.20, 95% CI: 1.51-3.20; p<0.001). In the landmark analysis, the incidence of TLF was significantly higher with long stenting during the first 30 days after PCI (log-rank p=0.001) and also after 30 days (log-rank p<0.001). Long stenting was associated with a higher risk of early stent thrombosis (log-rank p=0.001), but not with that of late stent thrombosis (log-rank p=0.887). CONCLUSIONS In the contemporary second-generation DES era, stenting longer than 40 mm continues to be associated with less favourable clinical outcomes such as TLF and stent thrombosis.
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Affiliation(s)
- Min Kong
- Cardiovascular Center, Seoul National University Hospital, Seoul, Republic of Korea
| | - Jung-Kyu Han
- Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
| | - Hyun-Jae Kang
- Cardiovascular Center, Seoul National University Hospital, Seoul, Republic of Korea
| | - Bon-Kwon Koo
- Cardiovascular Center, Seoul National University Hospital, Seoul, Republic of Korea
| | - In-Ho Chae
- Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam-si, Republic of Korea
| | - Hyo-Soo Kim
- Cardiovascular Center, Seoul National University Hospital, Seoul, Republic of Korea
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Affiliation(s)
- Upendra Kaul
- Batra Hospital and Medical Research Centre, 1, Mehrauli - Badarpur Rd, Tughlakabad Institutional Area, Vayusenabad, New Delhi, Delhi 110062, India
| | - Vineet Bhatia
- Department of Cardiology, Fortis Hospital, Noida, India
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Sim HW, Thong EH, Loh PH, Lee CH, Chan MY, Low AF, Tay EL, Chan KH, Tan HC, Loh JP. Treating Very Long Coronary Artery Lesions in the Contemporary Drug-Eluting-Stent Era: Single Long 48 mm Stent Versus Two Overlapping Stents Showed Comparable Clinical Outcomes. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2020; 21:1115-1118. [DOI: 10.1016/j.carrev.2020.02.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Revised: 02/06/2020] [Accepted: 02/10/2020] [Indexed: 01/23/2023]
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Ragosta M. Stenting Long Coronary Lesions: Can One Stent Do the Job of Two? CARDIOVASCULAR REVASCULARIZATION MEDICINE 2020; 21:1119-1120. [PMID: 32741588 DOI: 10.1016/j.carrev.2020.06.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 06/29/2020] [Indexed: 10/23/2022]
Affiliation(s)
- Michael Ragosta
- Cardiac Catheterization Laboratory, University of Virginia Health System, Charlottesville, VA, United States of America.
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Evaluation of Mechanical Performances of Stents with 38 mm Length in Long Lesion. BIOMED RESEARCH INTERNATIONAL 2020; 2020:2594161. [PMID: 32190656 PMCID: PMC7064835 DOI: 10.1155/2020/2594161] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Accepted: 10/15/2019] [Indexed: 11/17/2022]
Abstract
Objective Single stent with 38 mm length has emerged as a potential solution for long lesion treatment using PCI. However, long stents need to come over a longer lesion length combined with a higher incidence of tortuous calcification, requiring a stent to provide superior transport and compliance and reduce elastic retraction. Here, we evaluated the mechanical performances of the existing four types of drug eluting stents with 38 mm length, which could provide guidance for clinicians to choose the proper stents for the patients. Methods The stents with 38 mm length from XIENCE Xpedition (Abbott, US), SYNERGY (Boston Scientific, US), FIREHAWK (Microport, China), and HELIOS (HELIOS, China) were collected. Mechanical parameters of stents including crossing ability, compliance, elastic recoil, and longitudinal strength were performed. Results The resistance force of stents from XIENCE Xpedition was smaller than FIREHAWK (p < 0.05), which indicates that the stent from XIENCE Xpedition has better crossing ability. The ratio of stent diameter reduction from both XIENCE Xpedition and SYNERGY was less than 3% with no statistical difference. In addition, the elastic recoil percentage of stents from SYNERGY, XIENCE Xpedition, FIREHAWK, and HELIOS was 1.16%, 2.62%, 3.66%, and 4.19%, respectively, indicating that SYNERGY had better elastic recoil compared to FIREHAWK and HELIOS (p < 0.05), which indicates that the stent from XIENCE Xpedition has better crossing ability. The ratio of stent diameter reduction from both XIENCE Xpedition and SYNERGY was less than 3% with no statistical difference. In addition, the elastic recoil percentage of stents from SYNERGY, XIENCE Xpedition, FIREHAWK, and HELIOS was 1.16%, 2.62%, 3.66%, and 4.19%, respectively, indicating that SYNERGY had better elastic recoil compared to FIREHAWK and HELIOS (p < 0.05), which indicates that the stent from XIENCE Xpedition has better crossing ability. The ratio of stent diameter reduction from both XIENCE Xpedition and SYNERGY was less than 3% with no statistical difference. In addition, the elastic recoil percentage of stents from SYNERGY, XIENCE Xpedition, FIREHAWK, and HELIOS was 1.16%, 2.62%, 3.66%, and 4.19%, respectively, indicating that SYNERGY had better elastic recoil compared to FIREHAWK and HELIOS ( Conclusion The evaluation of mechanical properties for the stent with 38 mm length including crossing ability, compliance, elastic recoil, and longitudinal strength could provide reference index for more accurately clinical application for long lesion treatment.
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Orbital Atherectomy for the Treatment of Long (≥25–40 mm) Severely Calcified Coronary Lesions: ORBIT II Sub-Analysis. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2020; 21:164-170. [DOI: 10.1016/j.carrev.2019.12.027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Revised: 12/17/2019] [Accepted: 12/23/2019] [Indexed: 12/27/2022]
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Ultrathin (60 μm), ultralong (≥40 mm) sirolimus-eluting stent: study of clinical and safety profiles among real-world patients. Anatol J Cardiol 2020; 25:111-119. [PMID: 33583818 DOI: 10.14744/anatoljcardiol.2020.40909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE Although thin-strut drug-eluting stents (DES) with a more flexible design are easily obtainable, data regarding using ultralong DES (≥40 mm) for long coronary lesions are limited in the literature. Therefore, the current study assessed the safety and efficacy of an ultralong (≥40 mm) and ultrathin (60 μm) biodegradable polymer-coated sirolimus-eluting stent (SES), Supralimus Grace, with a unique Long Dual Z-link (LDZ-link) design (Sahajanand Medical Technologies Pvt. Ltd., Surat, India) in real-world patients with long coronary lesions. METHODS The assigned stents were implanted in 684 patients. The primary endpoint was target lesion failure (TLF), which is a composite of cardiovascular death, target vessel myocardial infarction (MI), and target lesion revascularization (TLR), whereas periprocedural secondary endpoints included device failure (failure of stent delivery, change of stent, and stent fracture) and patient-oriented composite endpoint (POCE), which is a composite of all deaths, any MI, and any revascularization, and stent thrombosis (ST). These outcomes were analyzed at one-year follow-up and during the procedure. RESULTS The patients' mean age was 52.7±15.9 years; 537 (78.5%) were males. 626 (91.5%) patients suffered from acute coronary syndrome and 58 (8.5%) patients from chronic coronary syndrome (CSS). 989 lesions were removed. The mean numbers of lesions and stents implanted per patient were 1.3±0.2 mm and 1.4±0.3 mm, respectively. TLF occurred in 42 (6.1%) as a result of cardiac death, target vessel MI, and TLR in 9 (1.3%), 20 (2.9%), and 13 (1.9%) patients, respectively. POCE was observed in 131 patients (19.1%) at one-year follow-up, mainly in 63 (9.2%) patients because of any revascularization. Stent failure was seen in 21 patients (3.1%) as a result of delivery failure (2.2%), edge dissection (0.8%), and fracture (0.1%). Definite and probable ST were observed in 8 (1.1%) and 9 (1.3%) patients, respectively. CONCLUSION Ultralong (≥40 mm), ultrathin (60 μm) Supralimus Grace stent can be safely implanted in vessels having long and multiple lesions.
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Jurado-Román A, Abellán-Huerta J, Requena JA, Sánchez-Pérez I, López-Lluva MT, Maseda-Uriza R, Piqueras-Flores J, Pérez-Díaz P, Frías-García R, Lozano-Ruíz-Poveda F. Comparison of Clinical Outcomes Between Very Long Stents and Overlapping Stents for the Treatment of Diffuse Coronary Disease in Real Clinical Practice. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2019; 20:681-686. [DOI: 10.1016/j.carrev.2018.09.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Revised: 09/09/2018] [Accepted: 09/10/2018] [Indexed: 11/25/2022]
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Genuardi L, Burzotta F, Russo G, Shoeib O, Verdirosi D, Aurigemma C, Niccoli G, Porto I, Leone AM, Trani C. Novel ultra-long (48 mm) everolimus-eluting stent for diffusely coronary vessels disease. Minerva Cardioangiol 2019; 67:87-93. [PMID: 30895769 DOI: 10.23736/s0026-4725.19.04879-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Long drug-eluting stents may limit the need of stent overlaps in patients with diffusely diseased coronary arteries. We evaluated the clinical results of percutaneous-coronary-intervention (PCI) using a novel ultra-long (48 mm) everolimus-eluting stent (EES) in a real-word population. METHODS Patients who underwent PCI with 48 mm EES between June 2015 and April 2017 in our Center were enrolled. The only exclusion criteria was cardiogenic shock established before PCI. Target vessels were divided in "very long lesion" (>38 mm) and "multiple focal disease" (multiple stenoses separated by healthy coronary segments >10 mm). Clinical follow-up was obtained to evaluate the occurrence of device-oriented composite endpoint (DOCE) (primary end-point). RESULTS A total of 216 patients were identified (70.6±11 years, 48.1% acute coronary syndrome) who were treated on 230 vessels. The target vessel appearance was "very long lesion" in 44.8% of cases and "multiple focal disease" in 55.2%. A single 48-mm EES was implanted in 129 (56.1%), while additional overlapping stents were needed in 101 cases (43.9%). Total stent length was 64.9±24.0 mm. The median follow-up time was of 474 (411-614) days, DOCE occurred in 7% of patients. No stent thrombosis was noticed. At multivariate analysis, diabetes was associated with DOCE increase (P=0.02), while "multiple focal disease" predicted lower DOCE (P=0.02). CONCLUSIONS The present real-world experience shows promising clinical results with the use of ultra-long stents in order to limit the need of stents overlaps in patients with diffuse coronary disease undergoing PCI.
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Affiliation(s)
- Lorenzo Genuardi
- Institute of Cardiology, A. Gemelli IRCCS University Policlinic Foundation, Sacred Heart Catholic University, Rome, Italy
| | - Francesco Burzotta
- Institute of Cardiology, A. Gemelli IRCCS University Policlinic Foundation, Sacred Heart Catholic University, Rome, Italy -
| | - Giulio Russo
- Institute of Cardiology, A. Gemelli IRCCS University Policlinic Foundation, Sacred Heart Catholic University, Rome, Italy
| | - Osama Shoeib
- Institute of Cardiology, A. Gemelli IRCCS University Policlinic Foundation, Sacred Heart Catholic University, Rome, Italy
| | - Diana Verdirosi
- Institute of Cardiology, A. Gemelli IRCCS University Policlinic Foundation, Sacred Heart Catholic University, Rome, Italy
| | - Cristina Aurigemma
- Institute of Cardiology, A. Gemelli IRCCS University Policlinic Foundation, Sacred Heart Catholic University, Rome, Italy
| | - Giampaolo Niccoli
- Institute of Cardiology, A. Gemelli IRCCS University Policlinic Foundation, Sacred Heart Catholic University, Rome, Italy
| | - Italo Porto
- Institute of Cardiology, A. Gemelli IRCCS University Policlinic Foundation, Sacred Heart Catholic University, Rome, Italy
| | - Antonio M Leone
- Institute of Cardiology, A. Gemelli IRCCS University Policlinic Foundation, Sacred Heart Catholic University, Rome, Italy
| | - Carlo Trani
- Institute of Cardiology, A. Gemelli IRCCS University Policlinic Foundation, Sacred Heart Catholic University, Rome, Italy
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Tan CK, Tin ZL, Arshad MKM, Loh JKK, Jafary FH, Ho HH, Ong PJL, Watson T. Treatment with 48-mm everolimus-eluting stents. Herz 2018; 44:419-424. [DOI: 10.1007/s00059-017-4670-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Revised: 11/11/2017] [Accepted: 12/04/2017] [Indexed: 10/18/2022]
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Beale CE, Dawn Abbott J. Drug Eluting Stents for Very Long Lesions: Go Long, But Know the Risks. Catheter Cardiovasc Interv 2017; 89:992-993. [PMID: 28488403 DOI: 10.1002/ccd.27073] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Accepted: 03/29/2017] [Indexed: 11/10/2022]
Abstract
Long coronary artery lesions are increasingly treated with new technologies including current generation drug eluting stents (DES) despite a lack of robust data on outcomes. In the current study, patients receiving Xience V DES for very long lesions (>35 mm) compared to lesions 25-35 mm had similar outcomes. Future research should address late outcomes, stent thrombosis rates, as well as investigation of lesions greater than 60 mm.
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Affiliation(s)
- Charles E Beale
- Division of Cardiology, Rhode Island Hospital, Brown Medical School, Providence, Rhode Island
| | - J Dawn Abbott
- Division of Cardiology, Rhode Island Hospital, Brown Medical School, Providence, Rhode Island
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