Impact of diabetes on clinical outcomes after revascularization with the dual therapy CD34 antibody-covered sirolimus-eluting Combo stent and the sirolimus-eluting Orsiro stent

Selection Criteria in the Era of Perfect Competition for Drug-Eluting Stents in Association With Operator Volumes: An Operator-Volume Analysis of the Selection DES Study

Background

This study aimed to explore the factors influencing the drug-eluting stent (DES) selection criteria of cardiologists in association with percutaneous coronary intervention (PCI) volumes and to determine whether they value further DES improvements and modifications.

Methods

The survey was conducted on a group of cardiologist operators from April 10 to 30, 2023.

Results

The analysis included 126 operators who answered the questions. Of these, low-, intermediate-, and high-volume operators accounted for 49 (38.9%), 47 (37.3%), and 30 (23.8%), respectively. Overall, Xience™ everolimus-eluting stent (CoCr-EES) was most frequently used, with > 70% of cardiologists using it in > 20% of their PCI practice. The percentage of selection by low-, intermediate-, and high-volume operators among the DESs used demonstrated no difference, except for dual-therapy sirolimus-eluting and CD34+ antibody-coated Combo® stent (DTS). Logistic regression analysis revealed that low-volume operators are less likely to be affected in terms of company/sales representative (odds ratio (OR): 0.402, P = 0.031) and bending lesions (OR: 0.339, P = 0.037) for selecting DES. Low-volume operators less frequently selected Resolute Onyx™ zotarolimus-eluting stents (OR: 0.689, P = 0.043) and DTS (Drug-Eluting Stents) (OR: 0.361, P = 0.006) for PCI.

Conclusions

The current study results indicate that patient background, DES performance, and product specifications were not criteria for DES selection in cardiologists with different PCI volumes in routine PCI.

Restenosis after Coronary Stent Implantation: Cellular Mechanisms and Potential of Endothelial Progenitor Cells (A Short Guide for the Interventional Cardiologist)

Coronary stents are among the most common therapies worldwide. Despite significant improvements in the biocompatibility of these devices throughout the last decades, they are prone, in as many as 10–20% of cases, to short- or long-term failure. In-stent restenosis is a multifactorial process with a complex and incompletely understood pathophysiology in which inflammatory reactions are of central importance. This review provides a short overview for the clinician on the cellular types responsible for restenosis with a focus on the role of endothelial progenitor cells. The mechanisms of restenosis are described, along with the cell-based attempts made to prevent it. While the focus of this review is principally clinical, experimental evidence provides some insight into the potential implications for prevention and therapy of coronary stent restenosis.