1
|
Zhang X, Li L, Deng Z. Liquid Metal-Based Flexible Bioelectrodes for Management of In-Stent-Restenosis: Potential Application. BIOSENSORS 2023; 13:795. [PMID: 37622881 PMCID: PMC10452354 DOI: 10.3390/bios13080795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 07/28/2023] [Accepted: 07/30/2023] [Indexed: 08/26/2023]
Abstract
Although vascular stents have been widely used in clinical practice, there is still a risk of in-stent restenosis after their implantation. Combining conventional vascular stents with liquid metal-based electrodes with impedance detection, irreversible electroporation, and blood pressure detection provides a new direction to completely solve the restenosis problem. Compared with conventional rigid electrodes, liquid metal-based electrodes combine high conductivity and stretchability, and are more compliant with the implantation process of vascular stents and remain in the vasculature for a long period of time. This perspective reviews the types and development of conventional vascular stents and proposes a novel stent that integrates liquid metal-based electrodes on conventional vascular stents. This vascular stent has three major functions of prediction, detection and treatment, and is expected to be a new generation of cardiovascular implant with intelligent sensing and real-time monitoring.
Collapse
Affiliation(s)
- Xilong Zhang
- Key Laboratory of Cryogenics, Technical Institute of Physics and Chemistry, Chinese Academy of Sciences, Beijing 100190, China;
- School of Future Technology, University of Chinese Academy of Sciences, Beijing 100049, China
| | - Lei Li
- Key Laboratory of Cryogenics, Technical Institute of Physics and Chemistry, Chinese Academy of Sciences, Beijing 100190, China;
- Plastic Surgery Hospital, Chinese Academy of Medical Sciences, Beijing 100144, China
| | - Zhongshan Deng
- Key Laboratory of Cryogenics, Technical Institute of Physics and Chemistry, Chinese Academy of Sciences, Beijing 100190, China;
- School of Future Technology, University of Chinese Academy of Sciences, Beijing 100049, China
| |
Collapse
|
2
|
Song J, Vikulina AS, Parakhonskiy BV, Skirtach AG. Hierarchy of hybrid materials. Part-II: The place of organics- on-inorganics in it, their composition and applications. Front Chem 2023; 11:1078840. [PMID: 36762189 PMCID: PMC9905839 DOI: 10.3389/fchem.2023.1078840] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 01/05/2023] [Indexed: 01/26/2023] Open
Abstract
Hybrid materials or hybrids incorporating organic and inorganic constituents are emerging as a very potent and promising class of materials due to the diverse but complementary nature of their properties. This complementarity leads to a perfect synergy of properties of the desired materials and products as well as to an extensive range of their application areas. Recently, we have overviewed and classified hybrid materials describing inorganics-in-organics in Part-I (Saveleva, et al., Front. Chem., 2019, 7, 179). Here, we extend that work in Part-II describing organics-on-inorganics, i.e., inorganic materials modified by organic moieties, their structure and functionalities. Inorganic constituents comprise of colloids/nanoparticles and flat surfaces/matrices comprise of metallic (noble metal, metal oxide, metal-organic framework, magnetic nanoparticles, alloy) and non-metallic (minerals, clays, carbons, and ceramics) materials; while organic additives can include molecules (polymers, fluorescence dyes, surfactants), biomolecules (proteins, carbohydtrates, antibodies and nucleic acids) and even higher-level organisms such as cells, bacteria, and microorganisms. Similarly to what was described in Part-I, we look at similar and dissimilar properties of organic-inorganic materials summarizing those bringing complementarity and composition. A broad range of applications of these hybrid materials is also presented whose development is spurred by engaging different scientific research communities.
Collapse
Affiliation(s)
- Junnan Song
- Nano-BioTechnology Group, Department of Biotechnology, Faculty of Bioscience Engineering, Ghent University, Ghent, Belgium,*Correspondence: Junnan Song, ; Bogdan V. Parakhonskiy, ; Andre G. Skirtach,
| | - Anna S. Vikulina
- Bavarian Polymer Institute, Friedrich-Alexander-Universität Erlangen-Nürnberg, Bayreuth, Germany
| | - Bogdan V. Parakhonskiy
- Nano-BioTechnology Group, Department of Biotechnology, Faculty of Bioscience Engineering, Ghent University, Ghent, Belgium,*Correspondence: Junnan Song, ; Bogdan V. Parakhonskiy, ; Andre G. Skirtach,
| | - Andre G. Skirtach
- Nano-BioTechnology Group, Department of Biotechnology, Faculty of Bioscience Engineering, Ghent University, Ghent, Belgium,*Correspondence: Junnan Song, ; Bogdan V. Parakhonskiy, ; Andre G. Skirtach,
| |
Collapse
|
3
|
Weiss AJ, Lorente-Ros M, Correa A, Barman N, Tamis-Holland JE. Recent Advances in Stent Technology: Do They Reduce Cardiovascular Events? Curr Atheroscler Rep 2022; 24:731-744. [PMID: 35821187 DOI: 10.1007/s11883-022-01049-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/03/2022] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW Drug-eluting stents are used in nearly all cases of percutaneous coronary revascularization and have been shown to be superior to balloon angioplasty or bare metal stents. The designs of these stents are continually evolving to maximize efficacy and safety. RECENT FINDINGS This review outlines the important components of a drug-eluting stent and highlights the changes in stent design that have led to the optimization of clinical outcomes. Most stents used in contemporary times are thin strut, durable polymer drug-eluting stents (DES) that elute either everolimus or zotarolimus. Newer DES designs incorporating bioresorbable polymers or ultrathin struts have shown encouraging safety and efficacy profiles. DES are essential for the management of patients with obstructive coronary artery disease and are used in most coronary interventions. Changes in stent designs over the past 30 years reflect the ongoing need to address the limitations of earlier stents aimed to improve patient outcomes.
Collapse
Affiliation(s)
- Allen J Weiss
- Divison of Cardiology, Bronxcare Health System, Division of Cardiology, Mount Sinai Morningside Hospital and the Ichan School of Medicine at Mount Sinai, New York, NY, USA
| | - Marta Lorente-Ros
- Department of Medicine, Mount Sinai Morningside and Mount Sinai West Hospitals and the Ichan School of Medicine at Mount Sinai, New York, NY, USA
| | - Ashish Correa
- Division of Cardiology, Mount Sinai Morningside Hospital and the Ichan School of Medicine at Mount Sinai, New York, NY, USA
| | - Nitin Barman
- Division of Cardiology, Mount Sinai Morningside Hospital and the Ichan School of Medicine at Mount Sinai, New York, NY, USA
| | - Jacqueline E Tamis-Holland
- Division of Cardiology, Mount Sinai Morningside Hospital and the Ichan School of Medicine at Mount Sinai, New York, NY, USA.
| |
Collapse
|
4
|
Longitudinal Neointimal Distribution Pattern After Everolimus-Eluting Stent Implantation: Insights From Optical Coherence Tomography Study. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2020; 26:17-23. [PMID: 33160894 DOI: 10.1016/j.carrev.2020.10.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 10/28/2020] [Accepted: 10/28/2020] [Indexed: 11/20/2022]
Abstract
BACKGROUND/PURPOSE Everolimus-eluting stents (EES) are established as latest generation drug eluting stents. However, optical coherence tomography (OCT) assessment of neointimal distribution after EES implantation is lacking. We aimed to assess the longitudinal neointimal distribution pattern after EES implantation using OCT. METHODS Data from 3 prospective studies (HEAL-EES, REVER and RESERVOIR), including patients with EES implantation and OCT follow-up study, were merged. Analyzed stents were divided into 3 segments of equal length (distal, medial, proximal). Longitudinal neointimal distribution patterns were compared between the 3 segments using generalized estimating equation. Neointimal thickness (NIT), neointimal area obstruction, and uncovered or malapposed struts were analyzed. RESULTS In total, 86 patients (92 lesions) were analyzed. Time of OCT follow-up was 9.0 ± 1.5 months. NIT was 101.7 ± 65.4 μm and neointimal obstruction area was 12.2 ± 7.6%. The number of assessed struts was the same in all three segments. NIT tended to be higher at the medial segment (108.8 ± 71.1 μm) compared to distal (103.0 ± 63.4 μm) and proximal (93.3 ± 61.1 μm) (p = 0.076). Neointimal area obstruction was significantly different between the 3 segments (12.4 ± 7.5% [distal], 13.1 ± 7.7% [medial], 11.1 ± 7.5% [proximal]; p = 0.037). In the proximal segment, there was a significantly higher frequency of uncovered struts compared to medial and distal segments (3.9% vs. 2.1% vs. 2.5%, p = 0.009). The distribution of malapposed struts was not significantly different. CONCLUSIONS Distribution of neointimal hyperplasia seems to be different between stent segments, being higher in the medial segment as compared to proximal and distal. Whether this may reflect a response to local pre-interventional plaque burden centrally covered by the stent should be confirmed in a future study. MANUSCRIPT SUMMARY As optical coherence tomography based assessment of neointimal distribution after everolimus-eluting stent implantation is lacking, we analyzed data of 86 patients (92 lesions) from 3 prospective trials to evaluate neointimal distribution in distal, medial and proximal stent segments. Neointimal hyperplasia seemed to be different between the three segments, with a higher burden in the medial stent segment. Whether this reflects a response to local pre-interventional plaque burden centrally covered by the stent should be confirmed in a future study.
Collapse
|
5
|
Hamshere S, Byrne A, Choudhury T, Gallagher SM, Rathod KS, Lungley J, Knight CJ, Kapur A, Jones DA, Mathur A. Randomised trial of the comparison of drug-eluting stents in patients with diabetes: OCT DES trial. Open Heart 2018; 5:e000705. [PMID: 29632674 PMCID: PMC5888447 DOI: 10.1136/openhrt-2017-000705] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Revised: 01/10/2018] [Accepted: 01/18/2018] [Indexed: 12/13/2022] Open
Abstract
Background To date, there have been limited comparisons performed between everolimus-eluting stents (EES) and zotarolimus-eluting stents (ZES) in patients with diabetes mellitus (DM). The objectives of this study was to assess the use of second-generation drug-eluting stents in patients with DM, using optical coherence tomography (OCT) to compare the level of stent coverage of Boston Scientific Promus Element EES compared with Medtronic Resolute Integrity ZES.(Clinicaltrials.gov number NCT02060357). Methods This is a single-centre randomised blinded trials assessing two commercially available stents in 60 patients with diabetes (ZES: n=30, EES: n=30). Patients underwent intracoronary assessment at 6 months with OCT assessing stent coverage, malapposition, neointimal thickness and percentage of in-stent restenosis (ISR). Results Of the 60 patients randomised, 46 patients underwent OCT analysis. There was no difference in baseline characteristics between the two groups. Both Promus Element and Resolute Integrity had low rates of uncovered struts at 6 months with no significant difference between the two groups (2.44% vs 1.24%, respectively; P=0.17). Rates of malapposition struts (3.9% vs 2.5%, P=0.25) and percentage of luminal loss did not differ between stent types. In addition, there was no significant difference in major adverse cardiovascular events (P=0.24) between the stent types. Conclusions This study is the first randomised trial to evaluate OCT at 6 months for ZES and EES in patients with diabetes. Both stents showed comparable strut coverage at 6 months, with no difference in ISR rates at 6 months.
Collapse
Affiliation(s)
- Stephen Hamshere
- Department of Cardiology, Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK
| | - Alex Byrne
- Department of Cardiology, Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK
| | - Tawfiq Choudhury
- Department of Cardiology, Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK
| | - Sean M Gallagher
- Department of Cardiology, Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK
| | - Krishnaraj S Rathod
- Department of Cardiology, Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK
| | - Julia Lungley
- Department of Cardiology, Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK
| | - Charles J Knight
- Department of Cardiology, Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK
| | - Akhil Kapur
- Department of Cardiology, Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK
| | - Daniel A Jones
- Department of Cardiology, Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK
| | - Anthony Mathur
- Department of Cardiology, Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK
| |
Collapse
|
6
|
Kitahara H, Okada K, Kimura T, Yock PG, Lansky AJ, Popma JJ, Yeung AC, Fitzgerald PJ, Honda Y. Impact of Stent Size Selection on Acute and Long-Term Outcomes After Drug-Eluting Stent Implantation in De Novo Coronary Lesions. Circ Cardiovasc Interv 2017; 10:CIRCINTERVENTIONS.116.004795. [DOI: 10.1161/circinterventions.116.004795] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Accepted: 08/22/2017] [Indexed: 11/16/2022]
Affiliation(s)
- Hideki Kitahara
- From the Stanford University School of Medicine, CA (H.K., K.O., T.K., P.G.Y., A.C.Y., P.J.F., Y.H.); Yale University School of Medicine, New Haven, CT (A.J.L.); and Beth Israel Deaconess Medical Center, Boston, MA (J.J.P.)
| | - Kozo Okada
- From the Stanford University School of Medicine, CA (H.K., K.O., T.K., P.G.Y., A.C.Y., P.J.F., Y.H.); Yale University School of Medicine, New Haven, CT (A.J.L.); and Beth Israel Deaconess Medical Center, Boston, MA (J.J.P.)
| | - Takumi Kimura
- From the Stanford University School of Medicine, CA (H.K., K.O., T.K., P.G.Y., A.C.Y., P.J.F., Y.H.); Yale University School of Medicine, New Haven, CT (A.J.L.); and Beth Israel Deaconess Medical Center, Boston, MA (J.J.P.)
| | - Paul G. Yock
- From the Stanford University School of Medicine, CA (H.K., K.O., T.K., P.G.Y., A.C.Y., P.J.F., Y.H.); Yale University School of Medicine, New Haven, CT (A.J.L.); and Beth Israel Deaconess Medical Center, Boston, MA (J.J.P.)
| | - Alexandra J. Lansky
- From the Stanford University School of Medicine, CA (H.K., K.O., T.K., P.G.Y., A.C.Y., P.J.F., Y.H.); Yale University School of Medicine, New Haven, CT (A.J.L.); and Beth Israel Deaconess Medical Center, Boston, MA (J.J.P.)
| | - Jeffrey J. Popma
- From the Stanford University School of Medicine, CA (H.K., K.O., T.K., P.G.Y., A.C.Y., P.J.F., Y.H.); Yale University School of Medicine, New Haven, CT (A.J.L.); and Beth Israel Deaconess Medical Center, Boston, MA (J.J.P.)
| | - Alan C. Yeung
- From the Stanford University School of Medicine, CA (H.K., K.O., T.K., P.G.Y., A.C.Y., P.J.F., Y.H.); Yale University School of Medicine, New Haven, CT (A.J.L.); and Beth Israel Deaconess Medical Center, Boston, MA (J.J.P.)
| | - Peter J. Fitzgerald
- From the Stanford University School of Medicine, CA (H.K., K.O., T.K., P.G.Y., A.C.Y., P.J.F., Y.H.); Yale University School of Medicine, New Haven, CT (A.J.L.); and Beth Israel Deaconess Medical Center, Boston, MA (J.J.P.)
| | - Yasuhiro Honda
- From the Stanford University School of Medicine, CA (H.K., K.O., T.K., P.G.Y., A.C.Y., P.J.F., Y.H.); Yale University School of Medicine, New Haven, CT (A.J.L.); and Beth Israel Deaconess Medical Center, Boston, MA (J.J.P.)
| |
Collapse
|
7
|
Van den Branden BJL, Teeuwen K, Koolen JJ, van der Schaaf RJ, Henriques JPS, Tijssen JGP, Kelder JC, Vermeersch PHMJ, Rensing BJWM, Suttorp MJ. Primary Stenting of Totally Occluded Native Coronary Arteries III (PRISON III): a randomised comparison of sirolimus-eluting stent implantation with zotarolimus-eluting stent implantation for the treatment of total coronary occlusions. EUROINTERVENTION 2016; 9:841-53. [PMID: 23628457 DOI: 10.4244/eijv9i7a138] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS We investigated whether sirolimus-eluting stents (SES) are superior to next-generation zotarolimus-eluting stents (ZES) in treating patients with total coronary occlusions (TCO). METHODS AND RESULTS In a prospective, randomised trial we compared the SES with the zotarolimus-eluting stent (ZES; Endeavor or Resolute) after successful recanalisation of TCO. During the first phase of the trial, 51 patients were assigned to receive the SES and 46 patients to receive the Endeavor ZES. In the second phase we randomised 103 patients to the SES group and 104 patients to the Resolute ZES group. The primary endpoint was in-segment late lumen loss at eight-month follow-up. At eight months, patients in the SES group had less in-segment and in-stent late loss as compared to the Endeavor group: -0.13±0.3 mm vs. 0.27±0.6 mm (p=0.0002) and -0.13±0.5 mm vs. 0.54±0.5 mm (p<0.0001), respectively. In contrast, the SES and the Resolute ZES showed comparable amounts of in-segment (-0.03±0.7 mm vs. -0.10±0.7 mm, p=0.6) and in-stent (0.03±0.8 mm vs. 0.05±0.8 mm, p=0.9) late loss. CONCLUSIONS In the treatment of TCOs, the SES was associated with superior angiographic outcomes compared to the Endeavor ZES. On the other hand, the SES and the Resolute ZES showed comparable angiographic outcomes.
Collapse
|
8
|
Stenting for ST-segment elevation myocardial infarction is associated with less neointimal hyperplasia in the pooled IVUS analysis from HORIZONS-AMI and the TAXUS IV and V and ATLAS workhorse, long lesion, and direct stent studies. Coron Artery Dis 2016; 25:575-81. [PMID: 24911615 DOI: 10.1097/mca.0000000000000131] [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] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To investigate the difference in neointimal hyperplasia (NIH) between ST-segment elevation myocardial infarction (STEMI), stable angina pectoris (SAP), and unstable angina pectoris (UAP). PATIENTS AND METHODS From formal core laboratory intravascular ultrasound substudies, we compared NIH after paclitaxel-eluting stents (PES) or bare metal stents (BMS) in STEMI lesions from HORIZONS-AMI trial with SAP and UAP lesions from TAXUS IV, V, and ATLAS studies. RESULTS At follow-up, %NIH at the minimum lumen area (MLA) site was less in STEMI (n=212) than in UAP (n=233) and SAP (n=440) lesions treated with PES (19.6 vs. 26.2 vs. 25.0%, P=0.002; all intravascular ultrasound data shown as least-square means in abstract) and less in STEMI (n=66) than in UAP (n=72) and SAP (n=143) lesions treated with BMS (34.0 vs. 26.7 vs. 45.5%, P=0.0003). As a result, MLA at follow-up was larger in STEMI than in UAP and SAP lesions treated with PES (5.9 vs. 5.2 vs. 5.0 mm, P<0.0001) or treated with BMS (5.1 vs. 4.3 vs. 4.0 mm, P=0.002). Net volume obstruction ([NIH/stent volume]×100) at follow-up was significantly less in STEMI than in UAP and SAP lesions treated with PES (7.8 vs. 13.4 vs. 13.4%, P<0.0001) or BMS (20.6 vs. 28.5 vs. 32.1%, P<0.0001). Multivariate linear regression analysis showed that STEMI was correlated independently and inversely with net volume obstruction compared with SAP (regression coefficient -6.99, P<0.0001) or UAP (regression coefficient -6.29, P<0.0001). CONCLUSION Implantation of PES or BMS in STEMI compared with UAP and SAP was associated with less NIH.
Collapse
|
9
|
Kitahara H, Waseda K, Yamada R, Sakamoto K, Yock PG, Fitzgerald PJ, Honda Y. Relative dose and vascular response after drug-eluting stent implantation: A dosimetric 3D-intravascular ultrasound study. Int J Cardiol 2016; 204:211-7. [PMID: 26681540 DOI: 10.1016/j.ijcard.2015.11.130] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2015] [Revised: 11/19/2015] [Accepted: 11/22/2015] [Indexed: 11/20/2022]
Abstract
BACKGROUND In drug-eluting stents (DESs), the theoretical drug dose exposed to the vessel wall per stent surface area may vary due to the fixed loading dose and differences in the stent surface area once expanded in varying vessel sizes. The aim of this study was to evaluate the potential effects of different dose intensities, as estimated by 3D-IVUS dosimetry, on vascular response after DES implantation. METHODS Follow-up (6-9 months) 3D-IVUS was performed in 840 coronary lesions treated with a single DES of the following types: sirolimus (SES, n=148), paclitaxel (PES, n=162), Endeavor zotarolimus (E-ZES, n=233), Resolute zotarolimus (R-ZES, n=147), and everolimus (EES, n=150). Volume index (volume/length, mm(3)/mm) was obtained for vessel, lumen, plaque, stent, and neointima. In each lesion, exposed dose intensity was calculated as known loading dose divided by measured luminal surface area of the stented segment. Lesions were divided into tertiles based on the exposed dose intensity: high, medium, and low dose groups. RESULTS The exposed dose intensity ranged 0.74-1.76 μg/mm(2) for SES, 0.41-1.18 μg/mm(2) for PES, 0.71-1.57 μg/mm(2) for E-ZES, 0.72-1.63 μg/mm(2) for R-ZES, and 0.40-0.99 μg/mm(2) for EES. All types of DES showed no significant difference in neointimal hyperplasia among the 3 groups, except that E-ZES showed significantly less neointimal hyperplasia in the high dose group. CONCLUSIONS Detailed 3D-IVUS revealed significant lesion-to-lesion variability in dose intensity exposed to the vessel wall following DES implantation. However, the major types of DES appear to yield equally effective neointimal suppression, despite the varying dose intensity, except for E-ZES.
Collapse
Affiliation(s)
- Hideki Kitahara
- Division of Cardiovascular Medicine, Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA, United States
| | - Katsuhisa Waseda
- Division of Cardiovascular Medicine, Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA, United States
| | - Ryotaro Yamada
- Division of Cardiovascular Medicine, Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA, United States
| | - Kenji Sakamoto
- Division of Cardiovascular Medicine, Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA, United States
| | - Paul G Yock
- Division of Cardiovascular Medicine, Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA, United States
| | - Peter J Fitzgerald
- Division of Cardiovascular Medicine, Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA, United States
| | - Yasuhiro Honda
- Division of Cardiovascular Medicine, Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA, United States.
| |
Collapse
|
10
|
Huang Y, Ng HCA, Ng XW, Subbu V. Drug-eluting biostable and erodible stents. J Control Release 2014; 193:188-201. [DOI: 10.1016/j.jconrel.2014.05.011] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2014] [Revised: 04/29/2014] [Accepted: 05/07/2014] [Indexed: 12/30/2022]
|
11
|
Maeng M, Tilsted HH, Jensen LO, Krusell LR, Kaltoft A, Kelbæk H, Villadsen AB, Ravkilde J, Hansen KN, Christiansen EH, Aarøe J, Jensen JS, Kristensen SD, Bøtker HE, Thuesen L, Madsen M, Thayssen P, Sørensen HT, Lassen JF. Differential clinical outcomes after 1 year versus 5 years in a randomised comparison of zotarolimus-eluting and sirolimus-eluting coronary stents (the SORT OUT III study): a multicentre, open-label, randomised superiority trial. Lancet 2014; 383:2047-2056. [PMID: 24631162 DOI: 10.1016/s0140-6736(14)60405-0] [Citation(s) in RCA: 86] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
BACKGROUND In head-to-head comparisons of coronary drug-eluting stents, the primary endpoint is traditionally assessed after 9-12 months. However, the optimum timepoint for this assessment remains unclear. In this study, we assessed clinical outcomes at up to 5 years' follow-up in patients who received two different types of drug-eluting stents. METHODS We undertook this multicentre, open-label, randomised superiority trial at five percutaneous coronary intervention centres in Denmark. We randomly allocated 2332 eligible adult patients (≥18 years of age) with an indication for drug-eluting stent implantation to the zotarolimus-eluting Endeavor Sprint stent (Medtronic, Santa Rosa, CA, USA) or the sirolimus-eluting Cypher Select Plus stent (Cordis, Johnson & Johnson, Warren, NJ, USA). Randomisation of participants was achieved by computer-generated block randomisation and a telephone allocation service. The primary endpoint of the SORT OUT III study was a composite of major adverse cardiac events-cardiac death, myocardial infarction, and target vessel revascularisation-at 9 months' follow-up. In this study, endpoints included the occurrence of major adverse cardiac events and definite stent thrombosis at follow-up times of up to 5 years. Analysis was by intention to treat. The trial is registered with ClinicalTrials.gov, number NCT00660478. FINDINGS We randomly allocated 1162 patients to receive the zotarolimus-eluting stent and 1170 to the sirolimus-eluting stent. At 5-year follow-up, rates of major adverse cardiac events were similar in patients treated with both types of stents (zotarolimus-eluting stents 197/1162 [17.0%] vs sirolimus-eluting stents 182/1170 [15.6%]; odds ratio [OR] 1.10, 95% CI 0.88-1.37; p=0.40). This finding was indicative of the directly contrasting results for rates of major adverse cardiac events at 1-year follow up (zotarolimus 93/1162 [8.0%] vs sirolimus 46/1170 [3.9%]; OR 2.13, 95% CI 1.48-3.07; p<0.0001) compared with those at follow-up between 1 and 5 years (104 [9.0%] vs 136 [11.6%]; OR 0.78, 95% CI 0.59-1.02; p=0.071). At 1-year follow-up, definite stent thrombosis was more frequent after implantation of the zotarolimus-eluting stent (13/1162 [1.1%]) than the sirolimus-eluting stent (4/1170 [0.3%]; OR 3.34, 95% CI 1.08-10.3; p=0.036), whereas the opposite finding was recorded for between 1 and 5 years' follow-up (zotarolimus-eluting stent 1/1162 [0.1%] vs sirolimus-eluting stent 21/1170 [1.8%], OR 0.05, 95% CI 0.01-0.36; p=0.003). 26 of 88 (30%) target lesion revascularisations in the zotarolimus-eluting stent group occurred between 1 and 5 years' follow-up, whereas 54 of 70 (77%) of those in the sirolimus-eluting stent group occurred during this follow-up period. INTERPRETATION The superiority of sirolimus-eluting stents compared with zotarolimus-eluting stents at 1-year follow-up was lost after 5 years. The traditional 1-year primary endpoint assessment therefore might be insufficient to predict 5-year clinical outcomes in patients treated with coronary drug-eluting stent implantation. FUNDING Cordis and Medtronic.
Collapse
Affiliation(s)
- Michael Maeng
- Department of Cardiology, Aarhus University Hospital, Skejby, Aarhus, Denmark.
| | - Hans Henrik Tilsted
- Department of Cardiology, Aarhus University Hospital, Aalborg Hospital, Aalborg, Denmark
| | | | - Lars Romer Krusell
- Department of Cardiology, Aarhus University Hospital, Skejby, Aarhus, Denmark
| | - Anne Kaltoft
- Department of Cardiology, Aarhus University Hospital, Skejby, Aarhus, Denmark
| | - Henning Kelbæk
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Anton B Villadsen
- Department of Cardiology, Aarhus University Hospital, Aalborg Hospital, Aalborg, Denmark
| | - Jan Ravkilde
- Department of Cardiology, Aarhus University Hospital, Aalborg Hospital, Aalborg, Denmark
| | | | | | - Jens Aarøe
- Department of Cardiology, Aarhus University Hospital, Aalborg Hospital, Aalborg, Denmark
| | - Jan Skov Jensen
- Department of Cardiology, Gentofte University Hospital, Hellerup, Denmark
| | | | - Hans Erik Bøtker
- Department of Cardiology, Aarhus University Hospital, Skejby, Aarhus, Denmark
| | - Leif Thuesen
- Department of Cardiology, Aarhus University Hospital, Skejby, Aarhus, Denmark
| | - Morten Madsen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - Per Thayssen
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | - Henrik Toft Sørensen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | | |
Collapse
|
12
|
Interventional cardiology: Outcomes in coronary stent trials--1 year is not enough. Nat Rev Cardiol 2014; 11:318-20. [PMID: 24797576 DOI: 10.1038/nrcardio.2014.63] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|
13
|
Niccoli G, Sgueglia GA, Montone RA, Roberto M, Banning AP, Crea F. Evolving management of patients treated by drug-eluting stent: prevention of late events. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2014; 15:100-8. [PMID: 24603193 DOI: 10.1016/j.carrev.2014.01.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2013] [Revised: 01/19/2014] [Accepted: 01/23/2014] [Indexed: 01/21/2023]
Abstract
SUMMARY Drug eluting stents (DES) were introduced in clinical practice to overcome the problem of in-stent restenosis (ISR) that limited the overall efficacy of percutaneous coronary revascularization with bare metal stent (BMS). Long-term outcome data confirm a sustained benefit of DES as compared with BMS. However, this benefit is mainly evident in the first year of follow-up. Indeed, DES-related events may extend over this time, due to late events (late ISR and/or very late stent thrombosis). Prevention of late failure of DES may become a specific therapeutic target.
Collapse
Affiliation(s)
- Giampaolo Niccoli
- Institute of Cardiology, Catholic University of the Sacred Heart, Rome, Italy.
| | | | - Rocco A Montone
- Institute of Cardiology, Catholic University of the Sacred Heart, Rome, Italy
| | - Marco Roberto
- Institute of Cardiology, Catholic University of the Sacred Heart, Rome, Italy
| | - Adrian P Banning
- Oxford Heart Centre, The John Radcliffe Hospital, Oxford, United Kingdom
| | - Filippo Crea
- Institute of Cardiology, Catholic University of the Sacred Heart, Rome, Italy
| |
Collapse
|
14
|
Kandzari DE. Development and performance of the zotarolimus-eluting Endeavor®coronary stent. Expert Rev Med Devices 2014; 7:449-59. [DOI: 10.1586/erd.10.31] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|
15
|
Liatsikos E, Kallidonis P, Stolzenburg JU, Karnabatidis D. Ureteral stents: past, present and future. Expert Rev Med Devices 2014; 6:313-24. [DOI: 10.1586/erd.09.5] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|
16
|
Petersen S, Hussner J, Reske T, Grabow N, Senz V, Begunk R, Arbeiter D, Kroemer HK, Schmitz KP, Meyer zu Schwabedissen HE, Sternberg K. In vitro study of dual drug-eluting stents with locally focused sirolimus and atorvastatin release. JOURNAL OF MATERIALS SCIENCE. MATERIALS IN MEDICINE 2013; 24:2589-2600. [PMID: 23846839 DOI: 10.1007/s10856-013-5001-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/07/2013] [Accepted: 07/01/2013] [Indexed: 06/02/2023]
Abstract
Within the context of novel stent designs we developed a dual drug-eluting stent (DDES) with an abluminally focussed release of the potent anti-proliferative drug sirolimus and a luminally focussed release of atorvastatin with stabilizing effect on atherosclerotic deposits and stimulating impact on endothelial function, both from biodegradable poly(L-lactide)-based stent coatings. With this concept we aim at simultaneous inhibition of in-stent restenosis as a result of disproportionally increased smooth muscle cell proliferation and migration as well as thrombosis due to failed or incomplete endothelialisation. The especially adapted spray-coating processes allowed the formation of smooth form-fit polymer coatings at the abluminal and luminal side with 70% respectively 90% of the drug/polymer solution being deposited at the intended stent surface. The impacts of tempering, sterilization, and layer composition on drug release are thoroughly discussed making use of a semi-empirical model. While tempering at 80 °C seems to be necessary for the achievement of adequate and sustained drug release, the coating sequence for DDES should be rather abluminal-luminal than luminal-abluminal, as reduction of the amount of sirolimus eluted luminally could then potentially minimize the provocation of endothelial dysfunction. In vitro proliferation and viability assays with smooth muscle and endothelial cells underline the high potential of the developed DDES.
Collapse
Affiliation(s)
- Svea Petersen
- Institute for Biomedical Engineering, University of Rostock, Friedrich-Barnewitz-Straße 4, 18119, Rostock, Germany,
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
17
|
New coronary aneurysm formation and malapposition after zotarolimus-eluting stent implantation in Kawasaki disease. J Cardiol Cases 2013; 8:118-120. [PMID: 30546760 DOI: 10.1016/j.jccase.2013.06.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2012] [Revised: 04/22/2013] [Accepted: 06/24/2013] [Indexed: 11/20/2022] Open
Abstract
Coronary artery involvement is the most important complication of Kawasaki disease. Coronary artery bypass surgery has been performed for ischemic heart disease caused by Kawasaki disease, however, long-term coronary graft patency is not satisfactory. Therefore, percutaneous coronary intervention (PCI) has its role in Kawasaki disease-related coronary artery disease. The incidence of new aneurysm is lower following stent implantation than balloon dilatation alone, even if a higher balloon pressure is applied. However, there are few reports about the efficacy of drug-eluting stent implantation for Kawasaki disease with coronary artery disease. Here, we describe a case of new coronary aneurysm formation and malapposition after zotarolimus-eluting stent implantation in Kawasaki disease. <Learning objective: New aneurysm formation after balloon angioplasty for coronary artery lesions in Kawasaki disease is a relatively well-known phenomenon, however there have been no reports about the influence of drug-eluting stents for coronary artery disease with Kawasaki disease. This report is useful when we consider strategies of revascularization for coronary artery disease with Kawasaki disease.>.
Collapse
|
18
|
The “Final” 5-Year Follow-Up From the ENDEAVOR IV Trial Comparing a Zotarolimus-Eluting Stent With a Paclitaxel-Eluting Stent. JACC Cardiovasc Interv 2013; 6:325-33. [DOI: 10.1016/j.jcin.2012.12.123] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2012] [Revised: 12/11/2012] [Accepted: 12/21/2012] [Indexed: 11/18/2022]
|
19
|
Comparison of neointimal hyperplasia and peri-stent vascular remodeling after implantation of everolimus-eluting versus sirolimus-eluting stents: intravascular ultrasound results from the EXCELLENT study. Int J Cardiovasc Imaging 2013; 29:1229-36. [DOI: 10.1007/s10554-013-0199-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2012] [Accepted: 02/19/2013] [Indexed: 11/24/2022]
|
20
|
Maeng M, Tilsted HH, Jensen LO, Kaltoft A, Kelbæk H, Abildgaard U, Villadsen AB, Krusell LR, Ravkilde J, Hansen KN, Christiansen EH, Aarøe J, Jensen JS, Kristensen SD, Bøtker HE, Madsen M, Thayssen P, Sørensen HT, Thuesen L, Lassen JF. 3-Year clinical outcomes in the randomized SORT OUT III superiority trial comparing zotarolimus- and sirolimus-eluting coronary stents. JACC Cardiovasc Interv 2013; 5:812-8. [PMID: 22917452 DOI: 10.1016/j.jcin.2012.04.008] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2012] [Accepted: 04/27/2012] [Indexed: 10/28/2022]
Abstract
OBJECTIVES This study sought to examine the 3-year clinical outcomes in patients treated with the Endeavor (Medtronic, Santa Rosa, California) zotarolimus-eluting stent (ZES) or the Cypher (Cordis, Johnson & Johnson, Warren, New Jersey) sirolimus-eluting stent (SES) in routine clinical practice. BACKGROUND The long-term clinical outcome in patients treated with ZES in comparison with SES is unclear. METHODS The authors randomized 2,332 patients to ZES (n = 1,162) or SES (n = 1,170) implantation. Endpoints included major adverse cardiac events (MACE), a composite of cardiac death, myocardial infarction, or target vessel revascularization; the individual endpoints of MACE; and definite stent thrombosis. RESULTS At 3-year follow-up, the MACE rate was higher in patients treated with ZES than in patients treated with SES (148 [12.9%] vs. 116 [10.1%]; hazard ratio [HR]: 1.33, 95% confidence interval [CI]: 1.04 to 1.69; p = 0.022). Target vessel revascularization was more frequent in the ZES group compared with the SES group (103 [9.1%] vs. 76 [6.7%]; HR: 1.40, 95% CI: 1.04 to 1.89; p = 0.025), whereas the occurrence of myocardial infarction (3.8% vs. 3.3%) and cardiac death (2.8% vs. 2.8%) did not differ significantly. Although the rate of definite stent thrombosis was similar at 3-year follow-up (1.1% vs. 1.4%), very late (12 to 36 months) definite stent thrombosis occurred in 0 (0%) patients in the ZES group versus 12 (1.1%) patients in the SES group (p = 0.0005). CONCLUSIONS Although the 3-year MACE rate is higher in patients treated with ZES versus SES, our data highlight a late safety problem concerning definite stent thrombosis with the use of SES. This finding underscores the importance of long-term follow-up in head-to-head comparisons of drug-eluting stents. (Randomized Clinical Comparison of the Endeavor and the Cypher Coronary Stents in Non-selected Angina Pectoris Patients [SORT OUT III]; NCT00660478).
Collapse
Affiliation(s)
- Michael Maeng
- Department of Cardiology, Aarhus University Hospital, Skejby, Aarhus, Denmark.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
21
|
Feres F, Costa RA, Bhatt DL, Leon MB, Botelho RV, King SB, de Paula JET, Mangione JA, Salvadori D, Gusmão MO, Castello H, Nicolela E, Perin MA, Devito FS, Marin-Neto JA, Abizaid A. Optimized duration of clopidogrel therapy following treatment with the Endeavor zotarolimus-eluting stent in real-world clinical practice (OPTIMIZE) trial: rationale and design of a large-scale, randomized, multicenter study. Am Heart J 2012. [PMID: 23194480 DOI: 10.1016/j.ahj.2012.09.009] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
BACKGROUND Current recommendations for antithrombotic therapy after drug-eluting stent (DES) implantation include prolonged dual antiplatelet therapy (DAPT) with aspirin and clopidogrel ≥12 months. However, the impact of such a regimen for all patients receiving any DES system remains unclear based on scientific evidence available to date. Also, several other shortcomings have been identified with prolonged DAPT, including bleeding complications, compliance, and cost. The second-generation Endeavor zotarolimus-eluting stent (E-ZES) has demonstrated efficacy and safety, despite short duration DAPT (3 months) in the majority of studies. Still, the safety and clinical impact of short-term DAPT with E-ZES in the real world is yet to be determined. METHODS The OPTIMIZE trial is a large, prospective, multicenter, randomized (1:1) non-inferiority clinical evaluation of short-term (3 months) vs long-term (12-months) DAPT in patients undergoing E-ZES implantation in daily clinical practice. Overall, 3,120 patients were enrolled at 33 clinical sites in Brazil. The primary composite endpoint is death (any cause), myocardial infarction, cerebral vascular accident, and major bleeding at 12-month clinical follow-up post-index procedure. CONCLUSIONS The OPTIMIZE clinical trial will determine the clinical implications of DAPT duration with the second generation E-ZES in real-world patients undergoing percutaneous coronary intervention.
Collapse
Affiliation(s)
- Fausto Feres
- Instituto Dante Pazzanese de Cardiologia, São Paulo, Brazil
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
22
|
Kim SJ, Kim TH, Choi JW, Kwon IK. Current perspectives of biodegradable drug-eluting stents for improved safety. BIOTECHNOL BIOPROC E 2012. [DOI: 10.1007/s12257-011-0571-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
|
23
|
Abstract
Stent thrombosis is a challenging problem following percutaneous coronary intervention that can lead to serious clinical consequences, such as death and acute myocardial infarction. Its pathophysiology is not yet completely known, and there are several causes suggested, such as incomplete stent endothelization, presence of polymers and late incomplete stent apposition. One of the main predictors is the early discontinuation of dual antiplatelet therapy. Stent improvements related to their design, with more friendly metallic platforms, thinner biocompatible or biodegradable polymers, absence of polymers, and even stents manufactured with bioabsorbable materials, could make the percutaneous procedure much safer and effective, allowing its application in increasingly complex anatomic and clinical scenarios, with low thrombosis rates.
Collapse
|
24
|
Maeng M, Jensen LO, Kaltoft A, Tilsted HH, Christiansen EH, Thayssen P, Madsen M, Sørensen HT, Lassen JF, Thuesen L. Comparison of zotarolimus-eluting and sirolimus-eluting coronary stents: a study from the Western Denmark Heart Registry. BMC Cardiovasc Disord 2012; 12:84. [PMID: 23031197 PMCID: PMC3518209 DOI: 10.1186/1471-2261-12-84] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2012] [Accepted: 09/20/2012] [Indexed: 11/30/2022] Open
Abstract
Background We evaluated the effectiveness and safety of a zotarolimus-eluting (ZES) versus a sirolimus-eluting (SES) coronary stent in a large cohort of patients treated with one of these stents in Western Denmark. Methods A total of 6,122 patients treated with ZES (n=2,282) or SES (n=3,840) were followed for up to 27 months. We ascertained clinical outcomes based on national medical databases. Results Incidence of target lesion revascularization (no. per 100 person-years) was 5.3 in the ZES group compared to 1.9 in the SES group (adjusted hazard ratio (HR)=2.19, 95% confidence intervals (CI): 1.39-3.47; p=0.001). All-cause mortality was also higher in the ZES group (ZES: 6.3; SES: 3.3; adjusted HR=1.34, 95% CI: 1.05-1.72; p=0.02), while stent thrombosis (ZES: 1.2; SES: 0.5; adjusted HR=1.98, 95% CI: 0.75-5.23; p=0.14) did not differ significantly. Conclusions In agreement with previously published randomised data, this observational study indicated that the ZES was associated with an increased risk of death and TLR in a large cohort of consecutive patients.
Collapse
Affiliation(s)
- Michael Maeng
- Department of Cardiology, Aarhus University Hospital, Skejby, Brendstrupgaardsvej 100, 8200 Aarhus N, Denmark.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
25
|
Li S, Gai L, Yang T, Zhang L, Xu X, Bai Q, Xu H, Wang Y. Evaluation of long-term follow-up with neointimal coverage and stent apposition after sirolimus-eluting stent implantation by optical coherence tomography. Catheter Cardiovasc Interv 2012; 81:768-75. [PMID: 22639418 DOI: 10.1002/ccd.24497] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2011] [Accepted: 05/20/2012] [Indexed: 01/23/2023]
Abstract
BACKGROUND Late stent thrombosis related to delayed endothelialization is a major concern after drug-eluting stent (DES) implantation. The long-term vascular response towards DES implantation remains unclear. Optical coherence tomography (OCT) is a high-resolution imaging modality which provides new opportunities for evaluating neointimal coverage and stent strut apposition after stent implantation. METHODS Fifty two patients who accepted 64 sirolimus-eluting stents (SESs, Cypher Select) were enrolled in the study. The OCT procedure was performed in 20 patients at 12 months (group 1), 17 patients at 24 months (group 2), and 15 patients at 48 months (group 3) after SESs implantation, respectively. The neointimal hyperplasia (NIH) thickness and stent strut apposition were assessed at 1-mm interval, and the presence of thrombus was observed in each stent. RESULTS The NIH thickness was significantly higher at 48 months than that of 12 months (0.1694 ± 0.1455 mm in G3 vs. 0.1455 ± 0.1373 mm in G1, P < 0.01) and 24 months (0.1514 ± 0.1296 mm in G2, P <0.01) after SESs implantation, but no significant difference existed between that of 12 months and 24 months (P > 0.05). Longer follow-up time was associated with significant decrease in the prevalence of uncovered struts (17.3% in group 1 vs. 8.8% in group 2 vs. 2.6% in group 3, P < 0.01) and malapposed struts (14.2% in group 1 vs. 10.3% in group 2 vs. 4.7% in group 3, P < 0.01). The incidence of intracoronary thrombus steadily decreased from 3.6% at 12 months to 2.4% at 24 months, and to 0.8% at 48 months (P < 0.01). CONCLUSION Neointimal growth continued for as long as 48 months after SES implantation. NIH thickness increased insignificantly from 12 to 24 months, but markedly increased at 48 months after stent implantation. Late neointimal growth was accompanied by a higher rate of covered struts and lower rate of malapposed stent struts.
Collapse
Affiliation(s)
- Shan Li
- First Division of Geriatric Cardiology, Chinese PLA General Hospital, Peking, China
| | | | | | | | | | | | | | | |
Collapse
|
26
|
Nakatani S, Nishino M, Taniike M, Makino N, Kato H, Egami Y, Shutta R, Tanouchi J, Yamada Y. Initial findings of impact of strut width on stent coverage and apposition of sirolimus-eluting stents assessed by optical coherence tomography. Catheter Cardiovasc Interv 2012; 81:776-81. [PMID: 22517601 DOI: 10.1002/ccd.24401] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2011] [Accepted: 03/02/2012] [Indexed: 11/12/2022]
Abstract
OBJECTIVES We investigate the influence of stent design on stent coverage at 6-9 months after sirolimus eluting stent (SES) implantation using optical coherence tomography (OCT). BACKGROUND Although some reports suggest that stent design may correlate with stent coverage of stent struts, there were few detailed data whether stent design impact on stent coverage in the same drug-eluting stent. METHODS A total of 21 SESs (15 patients), who had implanted 2.5, 2.75, and 3.0 mm stents, underwent OCT at 6-9 months after stent implantation. SES is constructed by two different strut width-components; narrow strut width parts (59 μm) and wide strut width parts (115 μm). Thus, we divided stent struts of SESs into two groups: narrow strut width parts (narrow group) and wide ones (wide group). We compared the incidence of incomplete apposed struts, uncovered struts, and neointimal hyperplasia (NIH) thickness between the two groups. RESULTS We could detect 2,948 struts (narrow group consisted of 1,132 struts and wide group consisted of 1,816 struts). Incidence of uncovered struts in the narrow group was significantly lower than in the wide group (30.2% vs. 40.8%, P < 0.001), and NIH thickness in the narrow group was significantly greater than in the wide group (127.5 ± 93.4 μm vs. 118.6 ± 81.4 μm, P = 0.03). CONCLUSIONS Stent design, especially strut width, affects stent coverage of SES. The narrow strut may avoid the absence of stent coverage in SES, which correlates with stent thrombosis.
Collapse
|
27
|
Wakabayashi K, Waksman R, Weissman NJ. Edge Effect From Drug-Eluting Stents as Assessed With Serial Intravascular Ultrasound. Circ Cardiovasc Interv 2012; 5:305-11. [DOI: 10.1161/circinterventions.111.966259] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Kohei Wakabayashi
- From the MedStar Health Research Institute at Washington Hospital Center, Washington, DC
| | - Ron Waksman
- From the MedStar Health Research Institute at Washington Hospital Center, Washington, DC
| | - Neil J. Weissman
- From the MedStar Health Research Institute at Washington Hospital Center, Washington, DC
| |
Collapse
|
28
|
Kang KW, Ko YG, Shin DH, Kim JS, Kim BK, Choi D, Hong MK, Kang WC, Ahn T, Jeon DW, Yang JY, Jang Y. Impact of positive peri-stent vascular remodeling after sirolimus-eluting and paclitaxel-eluting stent implantation on 5-year clinical outcomes: intravascular ultrasound analysis from the Poststent Optimal Stent Expansion Trial multicenter randomized trial. Circ J 2012; 76:1102-8. [PMID: 22382382 DOI: 10.1253/circj.cj-11-1313] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Positive peri-stent vascular remodeling (PPVR) after drug-eluting stent (DES) implantation is an important mechanism of late-acquired stent malapposition (LASM). METHODS AND RESULTS A total of 226 patients (sirolimus-eluting stent [SES], n=105; paclitaxel-eluting stent [PES], n=121) from the Poststent Optimal Stent Expansion Trial who underwent a post-intervention and 9-month follow-up intravascular ultrasound were followed clinically for 5 years. PPVR was arbitrarily defined as a >10% increase in the external elastic membrane volume index at follow-up. PPVR and LASM occurred more frequently with SESs than with PESs. The 5-year rate of major adverse cardiac events was lower with SES than with PES (10.7% vs. 23.2%, P=0.002). The late and very late stent thrombosis (ST) rate was similar between the 2 DES types, but it was higher in patients with PPVR than in those without PPVR (8.8% vs. 1.3%, P=0.009) regardless of the DES type. Early discontinuation (<1 year) of dual antiplatelet therapy (DAPT; hazard ratio [HR], 24.14; 95% confidence interval [CI]: 4.90-118.87; P<0.001), PPVR (HR, 14.94; 95%CI: 1.85-120.46; P=0.011), LASM (HR, 8.01; 95%CI: 1.93-33.16; P=0.004), and stent length (HR, 1.14; 95%CI: 0.98-1.32 per mm; P=0.078) were associated with increased risk of late and very late ST. CONCLUSIONS PPVR and LASM development after DES implantation, along with early discontinuation of DAPT and longer stent length, are important risk factors of late and very late ST.
Collapse
Affiliation(s)
- Ki-Woon Kang
- Division of Cardiology, Eulji University Hospital, Daejeon, Korea
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
29
|
Park HJ, Kim HY, Lee JM, Choi YS, Park CS, Kim DB, Her SH, Koh YS, Park MW, Kwon BJ, Kim PJ, Chang K, Chung WS, Seung KB. Randomized Comparison of the Efficacy and Safety of Zotarolimus-Eluting Stents vs. Sirolimus-Eluting Stents for Percutaneous Coronary Intervention in Chronic Total Occlusion. Circ J 2012; 76:868-75. [DOI: 10.1253/circj.cj-11-1021] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Hun-Jun Park
- Division of Cardiology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea
| | - Hee-Yeol Kim
- Division of Cardiology, Department of Internal Medicine, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea
| | - Jong-Min Lee
- Division of Cardiology, Department of Internal Medicine, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea
| | - Yoon Seok Choi
- Division of Cardiology, Department of Internal Medicine, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea
| | - Chul-Soo Park
- Division of Cardiology, Department of Internal Medicine, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea
| | - Dong-Bin Kim
- Division of Cardiology, Department of Internal Medicine, St. Paul's Hospital, College of Medicine, The Catholic University of Korea, Seoul
| | - Sung Ho Her
- Division of Cardiology, Department of Internal Medicine, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea
| | - Yoon Seok Koh
- Division of Cardiology, Department of Internal Medicine, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea
| | - Mahn Won Park
- Division of Cardiology, Department of Internal Medicine, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea
| | - Beom-June Kwon
- Division of Cardiology, Department of Internal Medicine, St. Paul's Hospital, College of Medicine, The Catholic University of Korea, Seoul
| | - Pum Joon Kim
- Division of Cardiology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea
| | - Kiyuk Chang
- Division of Cardiology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea
| | - Wook Sung Chung
- Division of Cardiology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea
| | - Ki-Bae Seung
- Division of Cardiology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea
| |
Collapse
|
30
|
Kang KW, Ko YG, Shin DH, Kim JS, Kim BK, Choi D, Jang Y, Hong MK. Comparison of vascular remodeling in patients treated with sirolimus-versus zotarolimus-eluting stent following acute myocardial infarction. Clin Cardiol 2011; 35:49-54. [PMID: 22161864 DOI: 10.1002/clc.20988] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2011] [Revised: 09/11/2011] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The differences in the vascular response to stent implantation or in the incidence of late acquired stent malapposition among different types of drug-eluting stents are not well known in patients with acute myocardial infarction (MI). HYPOTHESIS The pattern of vascular remodeling and degree of neointimal proliferation were different depending on the different types of drug-eluting stents. METHODS This study used intravascular ultrasound (IVUS) to investigate vascular remodeling in patients treated with implantation of sirolimus-eluting stents (SESs) vs zotarolimus-eluting stents (ZESs) following acute MI. The study population consisted of 100 patients with acute MI who were treated either with SES (n = 41) or ZES (n = 59) and underwent both poststenting and 9-month follow-up IVUS examination. Serial vascular changes surrounding stented segments were compared between SES- and ZES-treated lesions. RESULTS Percentage of neointimal volume obstruction at follow-up was significantly smaller in SES-treated compared to ZES-treated lesions (2.8 ± 7.1% vs 18.1 ± 15.7%, respectively; P < 0.001). However, positive vascular remodeling, which was defined as greater than 10% increase in external elastic membrane volume index (31.7% vs 10.2%, respectively, P = 0.007), and late acquired stent malapposition (12.0% vs 0%, respectively, P = 0.006 ) occurred more frequently in SES-treated than in ZES-treated lesions. CONCLUSIONS The pattern of vascular remodeling, including positive remodeling, late acquired stent malapposition, and degree of neointimal proliferation might be different depending on the different types of drug-eluting stents in patients with acute MI.
Collapse
Affiliation(s)
- Ki-Woon Kang
- Severance Cardiovascular Hospital, Seoul, South Korea
| | | | | | | | | | | | | | | |
Collapse
|
31
|
Nakatani D, Ako J, Tremmel JA, Waseda K, Otake H, Koo BK, Miyazawa A, Hongo Y, Hur SH, Sakurai R, Yock PG, Honda Y, Fitzgerald PJ. Sex differences in neointimal hyperplasia following endeavor zotarolimus-eluting stent implantation. Am J Cardiol 2011; 108:912-7. [PMID: 21784390 DOI: 10.1016/j.amjcard.2011.05.019] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2011] [Revised: 05/12/2011] [Accepted: 05/12/2011] [Indexed: 11/28/2022]
Abstract
Inconsistent results in outcomes have been observed between the genders after drug-eluting stent implantation. The aim of this study was to investigate gender differences in neointimal proliferation for the Endeavor zotarolimus-eluting stent (ZES) and the Driver bare-metal stent (BMS). A total of 476 (n = 391 ZES, n = 85 BMS) patients whose volumetric intravascular ultrasound analyses were available at 8-month follow-up were studied. At 8 months, neointimal obstruction and maximum cross-sectional narrowing (CSN) were significantly lower in women than in men receiving ZES (neointimal obstruction 15.5 ± 9.5% vs 18.2 ± 10.9%, p = 0.025; maximum CSN 30.3 ± 13.2% vs 34.8 ± 15.0%, p = 0.007). Conversely, these parameters tended to be higher in women than in men receiving BMS (neointimal obstruction 36.3 ± 15.9% vs 27.5 ± 17.2%, p = 0.053; maximum CSN 54.3 ± 18.6% vs 45.6 ± 18.3%, p = 0.080). There was a significant interaction between stent type and gender regarding neointimal obstruction (p = 0.001) and maximum CSN (p = 0.003). Multivariate linear regression analysis revealed that female gender was independently associated with lower neointimal obstruction (p = 0.027) and maximum CSN (p = 0.004) for ZES but not for BMS. Compared to BMS, ZES were independently associated with a reduced risk for binary restenosis in both genders (odds ratio for women 0.003, p = 0.001; odds ratio for men 0.191, p <0.001), but the magnitude of this risk reduction with ZES was significantly greater in women than men (p = 0.015). In conclusion, female gender is independently associated with decreased neointimal hyperplasia in patients treated with ZES. The magnitude of risk reduction for binary restenosis with ZES is significantly greater in women than in men.
Collapse
Affiliation(s)
- Daisaku Nakatani
- Center for Cardiovascular Technology, Stanford University, California, USA
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
32
|
Gomez-Lara J, Radu M, Brugaletta S, Farooq V, Diletti R, Onuma Y, Windecker S, Thuesen L, McClean D, Koolen J, Whitbourn R, Dudek D, Smits PC, Regar E, Veldhof S, Rapoza R, Ormiston JA, Garcia-Garcia HM, Serruys PW. Serial Analysis of the Malapposed and Uncovered Struts of the New Generation of Everolimus-Eluting Bioresorbable Scaffold With Optical Coherence Tomography. JACC Cardiovasc Interv 2011; 4:992-1001. [DOI: 10.1016/j.jcin.2011.03.020] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2010] [Revised: 03/18/2011] [Accepted: 03/28/2011] [Indexed: 10/17/2022]
|
33
|
Shelton RJ, Chitkara K, Singh R, Dorsch MF, Somers K, McLenachan JM, Blaxill JM, Wheatcroft SB, Blackman DJ, Greenwood JP. Three-year clinical outcome with the Endeavor™ zotarolimus-eluting stent in primary percutaneous coronary intervention for ST elevation myocardial infarction: the Endeavor™ primary PCI study (E-PPCI). J Interv Cardiol 2011; 24:542-8. [PMID: 21883474 DOI: 10.1111/j.1540-8183.2011.00674.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Primary percutaneous coronary intervention (PPCI) is superior to thrombolysis in STEMI (ST segment elevation myocardial infarction) patients. Data on late stent thrombosis (ST) have raised concerns regarding the use of drug-eluting stents during PPCI. We report the first 3-year clinical evaluation of the zotarolimus-eluting stent (ZES) in patients undergoing PPCI for STEMI, a single-center, prospective cohort study of consecutive patients admitted with STEMI. All underwent PPCI within 12 hours of symptoms; each received one or more ZES in one or more target lesions. All patients received aspirin 300 mg, clopidogrel 600 mg, abciximab, and unfractionated heparin. A total of 102 STEMI patients (76 male, mean 62 years) received 162 ZES (mean 1.6 stents/patient). Median call-to-balloon time was 123 (102-152) minutes. Thirty-day combined major adverse cardiovascular event (MACE) rate was 3.9% (n = 4). Subacute ST occurred in 2 patients (1.96%). Combined MACE rates at 12 months and 3 years were 7.8% (n = 8) and 13.7% (n = 14). Late ST occurred in 1 patient (1%) with no occurrence of very late ST. This is the first 3-year report of the use of the ZES in an unselected, consecutive PPCI population. Overall 3-year incidence of MACE and target lesion revascularization (5.9%) was low, and was comparable to that seen with sirolimus- and paclitaxel-eluting stents in randomized controlled trials. At 3 years there was no occurrence of very late ST.
Collapse
Affiliation(s)
- Rhidian J Shelton
- Department of Cardiology, Leeds General Infirmary, Leeds, United Kingdom
| | | | | | | | | | | | | | | | | | | |
Collapse
|
34
|
Kim JS, Kim JS, Shin DH, Kim BK, Ko YG, Choi D, Jang Y, Hong MK. Optical coherence tomographic comparison of neointimal coverage between sirolimus- and resolute zotarolimus-eluting stents at 9 months after stent implantation. Int J Cardiovasc Imaging 2011; 28:1281-7. [PMID: 21858655 DOI: 10.1007/s10554-011-9943-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2011] [Accepted: 08/13/2011] [Indexed: 01/04/2023]
Abstract
The Resolute zotarolimus-eluting stent (ZES-R) has a thinner stent strut with biocompatible polymer than first generation drug-eluting stents. However, minimal optical coherence tomography (OCT) data exists about vascular responses after ZES-R implantation. This study investigated OCT findings in ZES-R implantation and compared them to those in sirolimus-eluting stent (SES) implantation. A total of 123 lesions (43 ZES-R and 80 SES) in 111 patients were evaluated with OCT at 9 months after stent implantation. Strut apposition, neointimal hyperplasia (NIH) thickness, and stent coverage on each stent strut were evaluated. Mean NIH thickness was significantly greater in ZES-R-treated lesions than in SES-treated lesions (166 ± 73 μm vs. 96 ± 63 μm, respectively, P < 0.001). The percentage of uncovered strut was significantly lower in ZES-R-treated lesions than in SES-treated lesions (4.4 ± 4.8% vs. 10.3 ± 13.2%, respectively, P = 0.05). The percentage of malapposed struts was also significantly lower in ZES-R-treated than in SES-treated lesions (0.1 ± 0.4% vs. 1.5 ± 4.2%, respectively, P = 0.002). Intracoronary thrombus was less frequently detected in ZES-R-treated lesions (4.7% vs. 30.0%, respectively, P = 0.001). ZES-R showed a lower incidence of uncovered or malapposed stent struts and intracoronary thrombus than SES at 9-month follow-up OCT examination. Compared with SES, ZES-R may elicit more favorable vascular responses at the expense of an increased neointimal proliferation.
Collapse
Affiliation(s)
- Jung-Sun Kim
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, 250 Seongsanno, Seodaemun-gu, Seoul 120-752, Korea
| | | | | | | | | | | | | | | |
Collapse
|
35
|
Jensen L, Maeng M, Thayssen P, Villadsen A, Krusell L, Botker HE, Pedersen KE, Aaroe J, Christiansen E, Vesterlund T, Hansen K, Ravkilde J, Tilsted H, Lassen J, Thuesen L. Late lumen loss and intima hyperplasia after sirolimus-eluting and zotarolimus-eluting stent implantation in diabetic patients: the diabetes and drug-eluting stent (DiabeDES III) angiography and intravascular ultrasound trial. EUROINTERVENTION 2011; 7:323-31. [DOI: 10.4244/eijv7i3a56] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
|
36
|
Waseda K, Ako J, Yamasaki M, Koizumi T, Sakurai R, Hongo Y, Koo BK, Ormiston J, Worthley SG, Whitbourn RJ, Walters DL, Meredith IT, Fitzgerald PJ, Honda Y. Impact of Polymer Formulations on Neointimal Proliferation After Zotarolimus-Eluting Stent With Different Polymers. Circ Cardiovasc Interv 2011; 4:248-55. [DOI: 10.1161/circinterventions.110.957548] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background—
Polymer formulation may affect the efficacy of drug-eluting stents. Resolute, Endeavor, and ZoMaxx are zotarolimus-eluting stents with different stent platforms and different polymer coatings and have been tested in clinical trials. The aim of this analysis was to compare the efficacy of zotarolimus-eluting stents with different polymers.
Methods and Results—
Data were obtained from the first-in man trial or first randomized trials of each stent, The Clinical RESpOnse EvaLUation of the MedTronic Endeavor CR ABT-578 Eluting Coronary Stent System in De Novo Native Coronary Artery Lesions (RESOLUTE), Randomized Controlled Trial to Evaluate the Safety and Efficacy of the Medtronic AVE ABT-578 Eluting Driver Coronary Stent in De Novo Native Coronary Artery Lesions (ENDEAVOR II), and ZoMaxx I trials. Follow-up intravascular ultrasound analyses (8 to 9 months of follow-up) were possible in 353 patients (Resolute: 88, Endeavor: 98, ZoMaxx: 82, Driver: 85). Volume index (volume/stent length) was obtained for vessel, stent, lumen, peristent plaque, and neointima. Cross-sectional narrowing was defined as neointimal area divided by stent area (%). Neointima-free frame ratio was calculated as the number of frames without intravascular ultrasound–detectable neointima divided by the total number of frames within the stent. At baseline, vessel, lumen, and peristent plaque volume index were not significantly different among the 4 stent groups. At follow-up, percent neointimal obstruction was significantly lower in Resolute compared with Endeavor, ZoMaxx, and Driver (Resolute: 3.7±4.0, Endeavor: 17.5±10.1, ZoMaxx: 14.6±8.1, Driver: 29.4±17.2%;
P
<0.001). Greater maximum cross-sectional narrowing and higher neointima-free frame ratio, suggesting less neointimal coverage, were observed in Resolute compared with other stent groups. Multiple regression analysis confirmed that the biodurable polymer used in Resolute independently correlated with neointimal suppression among 3 zotarolimus-eluting stents.
Conclusions—
The different polymer formulations significantly affect the relative amount of neointima for zotarolimus-eluting stents.
Clinical Trial Registration—
URL:
http://www.clinicaltrials.gov
. Unique identifier: NCT00248079.
Collapse
Affiliation(s)
- Katsuhisa Waseda
- From Stanford University, Stanford, CA (K.W., J.A., M.Y., T.K., R.S., Y. Hongo, B.-K.K., P.J.F., Y. Honda); Auckland City Hospital, Auckland, New Zealand (J.O.); Royal Adelaide Hospital, Adelaide, Australia (S.G.W.); St Vincent's Hospital, Melbourne, Australia (R.J.W.); Prince Charles Hospital, Brisbane, Australia (D.L.W.); and Monash Heart and Medical Centre, Clayton, Australia (I.T.M.)
| | - Junya Ako
- From Stanford University, Stanford, CA (K.W., J.A., M.Y., T.K., R.S., Y. Hongo, B.-K.K., P.J.F., Y. Honda); Auckland City Hospital, Auckland, New Zealand (J.O.); Royal Adelaide Hospital, Adelaide, Australia (S.G.W.); St Vincent's Hospital, Melbourne, Australia (R.J.W.); Prince Charles Hospital, Brisbane, Australia (D.L.W.); and Monash Heart and Medical Centre, Clayton, Australia (I.T.M.)
| | - Masao Yamasaki
- From Stanford University, Stanford, CA (K.W., J.A., M.Y., T.K., R.S., Y. Hongo, B.-K.K., P.J.F., Y. Honda); Auckland City Hospital, Auckland, New Zealand (J.O.); Royal Adelaide Hospital, Adelaide, Australia (S.G.W.); St Vincent's Hospital, Melbourne, Australia (R.J.W.); Prince Charles Hospital, Brisbane, Australia (D.L.W.); and Monash Heart and Medical Centre, Clayton, Australia (I.T.M.)
| | - Tomomi Koizumi
- From Stanford University, Stanford, CA (K.W., J.A., M.Y., T.K., R.S., Y. Hongo, B.-K.K., P.J.F., Y. Honda); Auckland City Hospital, Auckland, New Zealand (J.O.); Royal Adelaide Hospital, Adelaide, Australia (S.G.W.); St Vincent's Hospital, Melbourne, Australia (R.J.W.); Prince Charles Hospital, Brisbane, Australia (D.L.W.); and Monash Heart and Medical Centre, Clayton, Australia (I.T.M.)
| | - Ryota Sakurai
- From Stanford University, Stanford, CA (K.W., J.A., M.Y., T.K., R.S., Y. Hongo, B.-K.K., P.J.F., Y. Honda); Auckland City Hospital, Auckland, New Zealand (J.O.); Royal Adelaide Hospital, Adelaide, Australia (S.G.W.); St Vincent's Hospital, Melbourne, Australia (R.J.W.); Prince Charles Hospital, Brisbane, Australia (D.L.W.); and Monash Heart and Medical Centre, Clayton, Australia (I.T.M.)
| | - Yoichiro Hongo
- From Stanford University, Stanford, CA (K.W., J.A., M.Y., T.K., R.S., Y. Hongo, B.-K.K., P.J.F., Y. Honda); Auckland City Hospital, Auckland, New Zealand (J.O.); Royal Adelaide Hospital, Adelaide, Australia (S.G.W.); St Vincent's Hospital, Melbourne, Australia (R.J.W.); Prince Charles Hospital, Brisbane, Australia (D.L.W.); and Monash Heart and Medical Centre, Clayton, Australia (I.T.M.)
| | - Bon-Kwon Koo
- From Stanford University, Stanford, CA (K.W., J.A., M.Y., T.K., R.S., Y. Hongo, B.-K.K., P.J.F., Y. Honda); Auckland City Hospital, Auckland, New Zealand (J.O.); Royal Adelaide Hospital, Adelaide, Australia (S.G.W.); St Vincent's Hospital, Melbourne, Australia (R.J.W.); Prince Charles Hospital, Brisbane, Australia (D.L.W.); and Monash Heart and Medical Centre, Clayton, Australia (I.T.M.)
| | - John Ormiston
- From Stanford University, Stanford, CA (K.W., J.A., M.Y., T.K., R.S., Y. Hongo, B.-K.K., P.J.F., Y. Honda); Auckland City Hospital, Auckland, New Zealand (J.O.); Royal Adelaide Hospital, Adelaide, Australia (S.G.W.); St Vincent's Hospital, Melbourne, Australia (R.J.W.); Prince Charles Hospital, Brisbane, Australia (D.L.W.); and Monash Heart and Medical Centre, Clayton, Australia (I.T.M.)
| | - Stephen G. Worthley
- From Stanford University, Stanford, CA (K.W., J.A., M.Y., T.K., R.S., Y. Hongo, B.-K.K., P.J.F., Y. Honda); Auckland City Hospital, Auckland, New Zealand (J.O.); Royal Adelaide Hospital, Adelaide, Australia (S.G.W.); St Vincent's Hospital, Melbourne, Australia (R.J.W.); Prince Charles Hospital, Brisbane, Australia (D.L.W.); and Monash Heart and Medical Centre, Clayton, Australia (I.T.M.)
| | - Robert J. Whitbourn
- From Stanford University, Stanford, CA (K.W., J.A., M.Y., T.K., R.S., Y. Hongo, B.-K.K., P.J.F., Y. Honda); Auckland City Hospital, Auckland, New Zealand (J.O.); Royal Adelaide Hospital, Adelaide, Australia (S.G.W.); St Vincent's Hospital, Melbourne, Australia (R.J.W.); Prince Charles Hospital, Brisbane, Australia (D.L.W.); and Monash Heart and Medical Centre, Clayton, Australia (I.T.M.)
| | - Darren L. Walters
- From Stanford University, Stanford, CA (K.W., J.A., M.Y., T.K., R.S., Y. Hongo, B.-K.K., P.J.F., Y. Honda); Auckland City Hospital, Auckland, New Zealand (J.O.); Royal Adelaide Hospital, Adelaide, Australia (S.G.W.); St Vincent's Hospital, Melbourne, Australia (R.J.W.); Prince Charles Hospital, Brisbane, Australia (D.L.W.); and Monash Heart and Medical Centre, Clayton, Australia (I.T.M.)
| | - Ian T. Meredith
- From Stanford University, Stanford, CA (K.W., J.A., M.Y., T.K., R.S., Y. Hongo, B.-K.K., P.J.F., Y. Honda); Auckland City Hospital, Auckland, New Zealand (J.O.); Royal Adelaide Hospital, Adelaide, Australia (S.G.W.); St Vincent's Hospital, Melbourne, Australia (R.J.W.); Prince Charles Hospital, Brisbane, Australia (D.L.W.); and Monash Heart and Medical Centre, Clayton, Australia (I.T.M.)
| | - Peter J. Fitzgerald
- From Stanford University, Stanford, CA (K.W., J.A., M.Y., T.K., R.S., Y. Hongo, B.-K.K., P.J.F., Y. Honda); Auckland City Hospital, Auckland, New Zealand (J.O.); Royal Adelaide Hospital, Adelaide, Australia (S.G.W.); St Vincent's Hospital, Melbourne, Australia (R.J.W.); Prince Charles Hospital, Brisbane, Australia (D.L.W.); and Monash Heart and Medical Centre, Clayton, Australia (I.T.M.)
| | - Yasuhiro Honda
- From Stanford University, Stanford, CA (K.W., J.A., M.Y., T.K., R.S., Y. Hongo, B.-K.K., P.J.F., Y. Honda); Auckland City Hospital, Auckland, New Zealand (J.O.); Royal Adelaide Hospital, Adelaide, Australia (S.G.W.); St Vincent's Hospital, Melbourne, Australia (R.J.W.); Prince Charles Hospital, Brisbane, Australia (D.L.W.); and Monash Heart and Medical Centre, Clayton, Australia (I.T.M.)
| |
Collapse
|
37
|
Caixeta A, Maehara A, Mintz GS. Intravascular Ultrasound: Principles, Image Interpretation, and Clinical Applications. Interv Cardiol 2011. [DOI: 10.1002/9781444319446.ch10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
|
38
|
Otake H, Honda Y, Courtney BK, Shimohama T, Ako J, Waseda K, Macours N, Rogers C, Popma JJ, Abizaid A, Ormiston JA, Spaulding C, Cohen SA, Fitzgerald PJ. Intravascular Ultrasound Results From the NEVO ResElution-I Trial. Circ Cardiovasc Interv 2011; 4:146-54. [PMID: 21386089 DOI: 10.1161/circinterventions.110.957175] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background—
The NEVO sirolimus-eluting stent (NEVO SES) is a novel cobalt-chromium stent combining sirolimus release from reservoirs with bioabsorbable polymer to reduce spatial and temporal polymer exposure. The aim of this study was to assess the arterial response to the NEVO SES in a randomized, blinded comparison versus the surface-coated TAXUS Liberte paclitaxel-eluting stent (TAXUS Liberté PES) in human native coronary lesions using intravascular ultrasound (IVUS).
Methods and Results—
The NEVO ResElution-I IVUS substudy enrolled 100 patients (1:1 randomization). In addition to standard IVUS variables, uniformity of neointimal distribution within stents was evaluated in 3 dimensions by computing mean neointimal thickness within 12 equally spaced radial sectors on every 1-mm cross section along the stented segment. The NEVO SES showed significantly less neointimal proliferation (neointimal obstruction: 5.5±11.0% versus 11.5±9.7%,
P
=0.02), resulting in less late lumen area loss and smaller maximum cross-sectional narrowing at 6 months. The absolute variability of neointima distribution, assessed by the standard deviation of neointimal thickness within each stent, was significantly reduced with the NEVO SES compared with the TAXUS Liberté PES(0.04±0.04 mm versus 0.10±0.07 mm,
P
<0.0001). TAXUS Liberté PES showed significantly greater positive vessel remodeling than the NEVO SES (Δvessel volume index: 1.30±1.36 mm
3
/mm versus 0.36±0.63 mm
3
/mm, respectively,
P
=0.003).
Conclusions—
The NEVO SES with focal release of sirolimus from reservoirs achieved significantly greater and more consistent suppression of neointimal hyperplasia than the surface-coated TAXUS Liberté PES. This was associated with less positive remodeling and no increased morphological or morphometric abnormalities surrounding the stent or at the stent margins.
Clinical Trial Registration—
URL:
http://www.clinicaltrials.gov
. Unique identifier: NCT00714883.
Collapse
Affiliation(s)
- Hiromasa Otake
- From the Center for Cardiovascular Technology (H.O., Y.H., T.S., J.A., K.W., P.J.F.), Stanford University, Stanford, CA; Sunnybrook Health Sciences Centre (B.K.C.), University of Toronto, Toronto, Canada; Cordis Clinical Research (N.M., C.R., S.A.C.), Waterloo, Belgium, and Bridgewater, NJ; Beth Israel Deaconess Medical Center (J.J.P.), Harvard Medical School, Boston, MA; Instituto Dante Pazzanese de Cardiologia (A.A.), São Paulo, Brazil; North Shore Hospital (J.A.O.), Auckland, New Zealand; Cochin
| | - Yasuhiro Honda
- From the Center for Cardiovascular Technology (H.O., Y.H., T.S., J.A., K.W., P.J.F.), Stanford University, Stanford, CA; Sunnybrook Health Sciences Centre (B.K.C.), University of Toronto, Toronto, Canada; Cordis Clinical Research (N.M., C.R., S.A.C.), Waterloo, Belgium, and Bridgewater, NJ; Beth Israel Deaconess Medical Center (J.J.P.), Harvard Medical School, Boston, MA; Instituto Dante Pazzanese de Cardiologia (A.A.), São Paulo, Brazil; North Shore Hospital (J.A.O.), Auckland, New Zealand; Cochin
| | - Brian K. Courtney
- From the Center for Cardiovascular Technology (H.O., Y.H., T.S., J.A., K.W., P.J.F.), Stanford University, Stanford, CA; Sunnybrook Health Sciences Centre (B.K.C.), University of Toronto, Toronto, Canada; Cordis Clinical Research (N.M., C.R., S.A.C.), Waterloo, Belgium, and Bridgewater, NJ; Beth Israel Deaconess Medical Center (J.J.P.), Harvard Medical School, Boston, MA; Instituto Dante Pazzanese de Cardiologia (A.A.), São Paulo, Brazil; North Shore Hospital (J.A.O.), Auckland, New Zealand; Cochin
| | - Takao Shimohama
- From the Center for Cardiovascular Technology (H.O., Y.H., T.S., J.A., K.W., P.J.F.), Stanford University, Stanford, CA; Sunnybrook Health Sciences Centre (B.K.C.), University of Toronto, Toronto, Canada; Cordis Clinical Research (N.M., C.R., S.A.C.), Waterloo, Belgium, and Bridgewater, NJ; Beth Israel Deaconess Medical Center (J.J.P.), Harvard Medical School, Boston, MA; Instituto Dante Pazzanese de Cardiologia (A.A.), São Paulo, Brazil; North Shore Hospital (J.A.O.), Auckland, New Zealand; Cochin
| | - Junya Ako
- From the Center for Cardiovascular Technology (H.O., Y.H., T.S., J.A., K.W., P.J.F.), Stanford University, Stanford, CA; Sunnybrook Health Sciences Centre (B.K.C.), University of Toronto, Toronto, Canada; Cordis Clinical Research (N.M., C.R., S.A.C.), Waterloo, Belgium, and Bridgewater, NJ; Beth Israel Deaconess Medical Center (J.J.P.), Harvard Medical School, Boston, MA; Instituto Dante Pazzanese de Cardiologia (A.A.), São Paulo, Brazil; North Shore Hospital (J.A.O.), Auckland, New Zealand; Cochin
| | - Katsuhisa Waseda
- From the Center for Cardiovascular Technology (H.O., Y.H., T.S., J.A., K.W., P.J.F.), Stanford University, Stanford, CA; Sunnybrook Health Sciences Centre (B.K.C.), University of Toronto, Toronto, Canada; Cordis Clinical Research (N.M., C.R., S.A.C.), Waterloo, Belgium, and Bridgewater, NJ; Beth Israel Deaconess Medical Center (J.J.P.), Harvard Medical School, Boston, MA; Instituto Dante Pazzanese de Cardiologia (A.A.), São Paulo, Brazil; North Shore Hospital (J.A.O.), Auckland, New Zealand; Cochin
| | - Nathalie Macours
- From the Center for Cardiovascular Technology (H.O., Y.H., T.S., J.A., K.W., P.J.F.), Stanford University, Stanford, CA; Sunnybrook Health Sciences Centre (B.K.C.), University of Toronto, Toronto, Canada; Cordis Clinical Research (N.M., C.R., S.A.C.), Waterloo, Belgium, and Bridgewater, NJ; Beth Israel Deaconess Medical Center (J.J.P.), Harvard Medical School, Boston, MA; Instituto Dante Pazzanese de Cardiologia (A.A.), São Paulo, Brazil; North Shore Hospital (J.A.O.), Auckland, New Zealand; Cochin
| | - Campbell Rogers
- From the Center for Cardiovascular Technology (H.O., Y.H., T.S., J.A., K.W., P.J.F.), Stanford University, Stanford, CA; Sunnybrook Health Sciences Centre (B.K.C.), University of Toronto, Toronto, Canada; Cordis Clinical Research (N.M., C.R., S.A.C.), Waterloo, Belgium, and Bridgewater, NJ; Beth Israel Deaconess Medical Center (J.J.P.), Harvard Medical School, Boston, MA; Instituto Dante Pazzanese de Cardiologia (A.A.), São Paulo, Brazil; North Shore Hospital (J.A.O.), Auckland, New Zealand; Cochin
| | - Jeffrey J. Popma
- From the Center for Cardiovascular Technology (H.O., Y.H., T.S., J.A., K.W., P.J.F.), Stanford University, Stanford, CA; Sunnybrook Health Sciences Centre (B.K.C.), University of Toronto, Toronto, Canada; Cordis Clinical Research (N.M., C.R., S.A.C.), Waterloo, Belgium, and Bridgewater, NJ; Beth Israel Deaconess Medical Center (J.J.P.), Harvard Medical School, Boston, MA; Instituto Dante Pazzanese de Cardiologia (A.A.), São Paulo, Brazil; North Shore Hospital (J.A.O.), Auckland, New Zealand; Cochin
| | - Alexandre Abizaid
- From the Center for Cardiovascular Technology (H.O., Y.H., T.S., J.A., K.W., P.J.F.), Stanford University, Stanford, CA; Sunnybrook Health Sciences Centre (B.K.C.), University of Toronto, Toronto, Canada; Cordis Clinical Research (N.M., C.R., S.A.C.), Waterloo, Belgium, and Bridgewater, NJ; Beth Israel Deaconess Medical Center (J.J.P.), Harvard Medical School, Boston, MA; Instituto Dante Pazzanese de Cardiologia (A.A.), São Paulo, Brazil; North Shore Hospital (J.A.O.), Auckland, New Zealand; Cochin
| | - John A. Ormiston
- From the Center for Cardiovascular Technology (H.O., Y.H., T.S., J.A., K.W., P.J.F.), Stanford University, Stanford, CA; Sunnybrook Health Sciences Centre (B.K.C.), University of Toronto, Toronto, Canada; Cordis Clinical Research (N.M., C.R., S.A.C.), Waterloo, Belgium, and Bridgewater, NJ; Beth Israel Deaconess Medical Center (J.J.P.), Harvard Medical School, Boston, MA; Instituto Dante Pazzanese de Cardiologia (A.A.), São Paulo, Brazil; North Shore Hospital (J.A.O.), Auckland, New Zealand; Cochin
| | - Christian Spaulding
- From the Center for Cardiovascular Technology (H.O., Y.H., T.S., J.A., K.W., P.J.F.), Stanford University, Stanford, CA; Sunnybrook Health Sciences Centre (B.K.C.), University of Toronto, Toronto, Canada; Cordis Clinical Research (N.M., C.R., S.A.C.), Waterloo, Belgium, and Bridgewater, NJ; Beth Israel Deaconess Medical Center (J.J.P.), Harvard Medical School, Boston, MA; Instituto Dante Pazzanese de Cardiologia (A.A.), São Paulo, Brazil; North Shore Hospital (J.A.O.), Auckland, New Zealand; Cochin
| | - Sidney A. Cohen
- From the Center for Cardiovascular Technology (H.O., Y.H., T.S., J.A., K.W., P.J.F.), Stanford University, Stanford, CA; Sunnybrook Health Sciences Centre (B.K.C.), University of Toronto, Toronto, Canada; Cordis Clinical Research (N.M., C.R., S.A.C.), Waterloo, Belgium, and Bridgewater, NJ; Beth Israel Deaconess Medical Center (J.J.P.), Harvard Medical School, Boston, MA; Instituto Dante Pazzanese de Cardiologia (A.A.), São Paulo, Brazil; North Shore Hospital (J.A.O.), Auckland, New Zealand; Cochin
| | - Peter J. Fitzgerald
- From the Center for Cardiovascular Technology (H.O., Y.H., T.S., J.A., K.W., P.J.F.), Stanford University, Stanford, CA; Sunnybrook Health Sciences Centre (B.K.C.), University of Toronto, Toronto, Canada; Cordis Clinical Research (N.M., C.R., S.A.C.), Waterloo, Belgium, and Bridgewater, NJ; Beth Israel Deaconess Medical Center (J.J.P.), Harvard Medical School, Boston, MA; Instituto Dante Pazzanese de Cardiologia (A.A.), São Paulo, Brazil; North Shore Hospital (J.A.O.), Auckland, New Zealand; Cochin
| |
Collapse
|
39
|
Kang SJ, Mintz GS, Park DW, Lee SW, Kim YH, Lee CW, Han KH, Kim JJ, Park SW, Park SJ. Comparison of Zotarolimus-Eluting Stents With Sirolimus-Eluting and Paclitaxel-Eluting Stents. Circ Cardiovasc Interv 2011; 4:139-45. [DOI: 10.1161/circinterventions.110.957936] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Soo-Jin Kang
- From the Department of Cardiology (S.-J.K., D.-W.P., S.-W.L., Y.-H.K., C.W.L., K.-H.H., J.-J.K., S.-W.P., S.-J.P.), University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea; and the Cardiovascular Research Foundation (G.S.M.), New York, NY
| | - Gary S. Mintz
- From the Department of Cardiology (S.-J.K., D.-W.P., S.-W.L., Y.-H.K., C.W.L., K.-H.H., J.-J.K., S.-W.P., S.-J.P.), University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea; and the Cardiovascular Research Foundation (G.S.M.), New York, NY
| | - Duk-Woo Park
- From the Department of Cardiology (S.-J.K., D.-W.P., S.-W.L., Y.-H.K., C.W.L., K.-H.H., J.-J.K., S.-W.P., S.-J.P.), University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea; and the Cardiovascular Research Foundation (G.S.M.), New York, NY
| | - Seung-Whan Lee
- From the Department of Cardiology (S.-J.K., D.-W.P., S.-W.L., Y.-H.K., C.W.L., K.-H.H., J.-J.K., S.-W.P., S.-J.P.), University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea; and the Cardiovascular Research Foundation (G.S.M.), New York, NY
| | - Young-Hak Kim
- From the Department of Cardiology (S.-J.K., D.-W.P., S.-W.L., Y.-H.K., C.W.L., K.-H.H., J.-J.K., S.-W.P., S.-J.P.), University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea; and the Cardiovascular Research Foundation (G.S.M.), New York, NY
| | - Cheol Whan Lee
- From the Department of Cardiology (S.-J.K., D.-W.P., S.-W.L., Y.-H.K., C.W.L., K.-H.H., J.-J.K., S.-W.P., S.-J.P.), University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea; and the Cardiovascular Research Foundation (G.S.M.), New York, NY
| | - Ki-Hoon Han
- From the Department of Cardiology (S.-J.K., D.-W.P., S.-W.L., Y.-H.K., C.W.L., K.-H.H., J.-J.K., S.-W.P., S.-J.P.), University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea; and the Cardiovascular Research Foundation (G.S.M.), New York, NY
| | - Jae-Joong Kim
- From the Department of Cardiology (S.-J.K., D.-W.P., S.-W.L., Y.-H.K., C.W.L., K.-H.H., J.-J.K., S.-W.P., S.-J.P.), University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea; and the Cardiovascular Research Foundation (G.S.M.), New York, NY
| | - Seong-Wook Park
- From the Department of Cardiology (S.-J.K., D.-W.P., S.-W.L., Y.-H.K., C.W.L., K.-H.H., J.-J.K., S.-W.P., S.-J.P.), University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea; and the Cardiovascular Research Foundation (G.S.M.), New York, NY
| | - Seung-Jung Park
- From the Department of Cardiology (S.-J.K., D.-W.P., S.-W.L., Y.-H.K., C.W.L., K.-H.H., J.-J.K., S.-W.P., S.-J.P.), University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea; and the Cardiovascular Research Foundation (G.S.M.), New York, NY
| |
Collapse
|
40
|
Leon MB, Nikolsky E, Cutlip DE, Mauri L, Liberman H, Wilson H, Patterson J, Moses J, Kandzari DE. Improved late clinical safety with zotarolimus-eluting stents compared with paclitaxel-eluting stents in patients with de novo coronary lesions: 3-year follow-up from the ENDEAVOR IV (Randomized Comparison of Zotarolimus- and Paclitaxel-Eluting Stents in Patients With Coronary Artery Disease) trial. JACC Cardiovasc Interv 2011; 3:1043-50. [PMID: 20965463 DOI: 10.1016/j.jcin.2010.07.008] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2010] [Revised: 07/01/2010] [Accepted: 07/10/2010] [Indexed: 12/28/2022]
Abstract
OBJECTIVES The increased frequency of very late (>1 year) stent thrombosis (VLST) has raised concerns with regard to the safety of sirolimus-eluting stents and paclitaxel-eluting stents (PES). BACKGROUND Experimental and preliminary clinical findings with the zotarolimus-eluting stent (ZES) have suggested a favorable safety profile. METHODS The ENDEAVOR IV (Randomized Comparison of Zotarolimus- and Paclitaxel-Eluting Stents in Patients With Coronary Artery Disease) trial is a single-blind randomized ZES versus PES clinical trial in 1,548 patients with de novo native coronary lesions; the primary end point-9-month target vessel failure-was previously reported, annual clinical follow-up is planned for 5 years, and this report describes the 3-year outcomes. RESULTS The ZES compared with PES reduced target vessel failure (12.3% vs. 15.9%, hazard ratio [HR]: 0.76, 95% confidence interval [CI]: 0.58 to 1.00, p = 0.049), myocardial infarctions (MI) (2.1% vs. 4.9%, HR: 0.44, 95% CI: 0.25 to 0.80, p = 0.005), and cardiac death plus MI (3.6% vs. 7.1%, HR: 0.52, 95% CI 0.32 to 0.82, p = 0.004). Although the overall 3-year rate of Academic Research Consortium definite/probable stent thrombosis did not differ significantly (1.1% vs. 1.7%, HR: 0.67, 95% CI 0.28 to 1.64, p = 0.380), VLST (between 1 and 3 years) was significantly reduced in ZES patients (1 event vs. 11 events; 0.1% vs. 1.6%, HR: 0.09, 95% CI: 0.01 to 0.71, p = 0.004). Ischemia-driven target lesion revascularization at 3 years was similar with ZES versus PES (6.5% vs. 6.1%, HR: 1.10, 95% CI: 0.73 to 1.65, p = 0.662). CONCLUSIONS Three-year follow-up results from the ENDEAVOR IV trial indicate similar antirestenosis efficacy but improved clinical safety associated with ZES compared with PES, due to significantly fewer peri-procedural and remote MIs associated with fewer VLST events. (A Randomized, Controlled Trial of the Medtronic Endeavor Drug [ABT-578] Eluting Coronary Stent System Versus the Taxus Paclitaxel-Eluting Coronary Stent System in De Novo Native Coronary Artery Lesions; NCT00217269).
Collapse
Affiliation(s)
- Martin B Leon
- Columbia University Medical Center, New York, New York 10032, USA.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
41
|
Maeng M, Holm NR, Kaltoft A, Jensen LO, Tilsted HH, Thuesen L, Lassen JF. Zotarolimus-eluting versus sirolimus-eluting coronary stent implantation. Interv Cardiol 2010. [DOI: 10.2217/ica.10.72] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
|
42
|
Waseda K, Hasegawa T, Ako J, Honda Y, Grube E, Whitbourn R, Ormiston J, O'Shaughnessy CD, Henry TD, Overlie P, Schwartz LB, Sudhir K, Chevalier B, Gray WA, Yeung AC, Fitzgerald PJ. Comparison of vascular response to zotarolimus-eluting stent vs paclitaxel-eluting stent implantation: pooled IVUS results from the ZoMaxx I and II trials. Circ J 2010; 74:2334-9. [PMID: 20890052 DOI: 10.1253/circj.cj-09-0850] [Citation(s) in RCA: 11] [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 The ZoMaxx I and II trials were randomized controlled studies of the zotarolimus-eluting, phosphorylcholine-coated, TriMaxx stent for the treatment of de novo coronary lesions. The aim of this study was to compare the vessel response between zotarolimus- (ZES) and paclitaxel-eluting stents (PES) using intravascular ultrasound (IVUS). METHODS AND RESULTS Data were obtained from the ZoMaxx I and II trials, in which a standard IVUS parameter was available in 263 cases (baseline and 9-months follow up). Neointima-free frame ratio was calculated as the number of frames without IVUS-detectable neointima divided by the total number of frames within the stent. While an increase in vessel and plaque was observed in PES from baseline to follow up, there was no significant change in ZES. At follow up, % neointimal obstruction was significantly higher (15.4 ± 8.8% vs 11.3 ± 9.7%), and minimum lumen area at follow up was significantly smaller in ZES compared to PES. However, the incidence of IVUS-defined restenosis (maximum cross-sectional narrowing >60%) was similar in the 2 groups (3.2% vs 6.7%). Neointima-free frame ratio was significantly lower in ZES. There were 5 cases of late incomplete stent apposition in PES and none in ZES. CONCLUSIONS These IVUS results demonstrate a similar incidence of severe narrowing between these 2 DES. There was a moderate increase in neointimal hyperplasia that was associated with a greater extent of neointimal coverage in ZES compared with PES.
Collapse
|
43
|
Shimohama T, Ako J, Yamasaki M, Otake H, Tsujino I, Hasegawa T, Nakatani D, Sakurai R, Chang H, Kusano H, Waseda K, Honda Y, Stone GW, Saito S, Fitzgerald PJ, Sudhir K. SPIRIT III JAPAN versus SPIRIT III USA: a comparative intravascular ultrasound analysis of the everolimus-eluting stent. Am J Cardiol 2010; 106:13-7. [PMID: 20609640 DOI: 10.1016/j.amjcard.2010.02.008] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2009] [Revised: 02/21/2010] [Accepted: 02/21/2010] [Indexed: 11/26/2022]
Abstract
The aim of this study was to evaluate the vascular response after everolimus-eluting stent (EES) implantation in the SPIRIT III Japan Registry (JAPAN) compared to EES implantation in the SPIRIT III United States (USA) trial using serial intravascular ultrasound (IVUS) analysis. Data were obtained from the JAPAN and the randomized EES arm of the USA trial. Serial (postprocedure and 8-month follow-up) IVUS analysis was available in 199 lesions (JAPAN 82, USA 117) of 183 patients (JAPAN 73, USA 110). Although no difference was observed in vessel size in the reference segment between the 2 groups, postprocedure minimum lumen area and stent volume index were significantly greater in the JAPAN arm (minimum lumen area 5.8 +/- 2.2 vs 5.1 +/- 1.5 mm(2), p = 0.03; stent volume index 7.0 +/- 2.4 vs 6.3 +/- 1.7 mm(3)/mm, p = 0.03). Postprocedure incomplete stent apposition (ISA) was less frequently observed in the JAPAN arm (15.9% vs 33.3%, p = 0.006), possibly related to higher maximum balloon pressure and/or more postdilatation without excess tissue prolapse or edge dissection. In the JAPAN arm, percent neointimal obstruction and maximum percent cross-sectional narrowing were significantly lower at 8-month follow-up (percent neointimal obstruction 3.5 +/- 4.2% vs 6.8 +/- 6.4%, p = 0.0004). Late acquired ISA was infrequent in the 2 arms. In conclusion, comparative IVUS analysis between the JAPAN and USA arms showed more optimal stent deployment in the JAPAN arm as evidenced by the lower incidence of postprocedure ISA and larger minimum lumen area after the procedure. Moreover, there was less neointimal hyperplasia in patients with EES implants from the JAPAN arm compared to the USA arm.
Collapse
|
44
|
Kim U, Kim JS, Kim JS, Lee JM, Son JW, Kim J, Ko YG, Choi D, Jang Y. The initial extent of malapposition in ST-elevation myocardial infarction treated with drug-eluting stent: the usefulness of optical coherence tomography. Yonsei Med J 2010; 51:332-8. [PMID: 20376884 PMCID: PMC2852787 DOI: 10.3349/ymj.2010.51.3.332] [Citation(s) in RCA: 22] [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] [Indexed: 11/29/2022] Open
Abstract
PURPOSE The aim of this study is to identify the extent of initial malapposition using optical coherence tomography (OCT) in ST-elevation myocardial infarctions (STEMI) treated with different types of drug-eluting stents (DES). MATERIALS AND METHODS Twenty four STEMI patients that underwent primary percutaneous coronary intervention (PCI) were enrolled. The OCT and intravascular ultrasound (IVUS) were performed within 72 hours after the primary PCI. Distances between the endo-luminal surface of the strut reflection and the vessel wall and the extent of malapposition were measured and analyzed. RESULTS Sirolimus-eluting stents (SES), paclitaxel-eluting stents (PES) and zotarolimus-eluting stents (ZES) were deployed in 7 patients (29%), 7 patients (29%) and 10 patients (42%). In total, 4951 struts in 620 mm single-stent segments were analyzed (1463 struts in SES, 1522 in PES, and 1966 in ZES). In strut analysis by OCT, the incidence of malapposition was 17 % (860/4951) and in stent analysis by IVUS, malapposition rate was 21% (5/24). The malapposition rate of strut level using OCT in 5 patients who had malapposition in IVUS was significantly higher than the 19 of those who had not (32 +/- 5% vs. 12 +/- 6%, p = 0.001). In addition, the frequency of malapposition was also significantly different (28% in SES, 11% in PES, 10% in ZES, p = 0.001). The use of SES was an independent predictor of malapposed struts. CONCLUSION The incidence of malapposition using OCT was quite prevalent in STEMI after primary PCI with DES implantation and SES has especially higher rates of malapposition compared to other DESs.
Collapse
Affiliation(s)
- Ung Kim
- Division of Cardiology, Inje University College of Medicine, Pusan Paik Hospital, Busan, Korea
| | - Jung-Sun Kim
- Division of Cardiology, Yonsei Cardiovascular Center, Yonsei University College of Medicine, Seoul, Korea
| | - Jin-Sun Kim
- Division of Cardiology, Yonsei Cardiovascular Center, Yonsei University College of Medicine, Seoul, Korea
| | - Jung-Myung Lee
- Division of Cardiology, Yonsei Cardiovascular Center, Yonsei University College of Medicine, Seoul, Korea
| | - Jung-Woo Son
- Division of Cardiology, Yonsei Cardiovascular Center, Yonsei University College of Medicine, Seoul, Korea
| | - Jaedeok Kim
- Division of Cardiology, Yonsei Cardiovascular Center, Yonsei University College of Medicine, Seoul, Korea
| | - Young-Guk Ko
- Division of Cardiology, Yonsei Cardiovascular Center, Yonsei University College of Medicine, Seoul, Korea
| | - Donghoon Choi
- Division of Cardiology, Yonsei Cardiovascular Center, Yonsei University College of Medicine, Seoul, Korea
| | - Yangsoo Jang
- Division of Cardiology, Yonsei Cardiovascular Center, Yonsei University College of Medicine, Seoul, Korea
| |
Collapse
|
45
|
FERNÁNDEZ-GUERRERO JUANCARLOS, HERRADOR-FUENTES JUAN, SÁNCHEZ-GILA JOAQUIN, GUZMÁN-HERRERA MANUEL, LOZANO CRISTÓBAL. In-Hospital and 12-Month Postprocedural Clinical Outcome of Coronary Bifurcational Lesion Treatment with the Endeavor Stent. J Interv Cardiol 2010; 23:188-94. [DOI: 10.1111/j.1540-8183.2010.00538.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
|
46
|
Rasmussen K, Maeng M, Kaltoft A, Thayssen P, Kelbaek H, Tilsted HH, Abildgaard U, Christiansen EH, Engstrøm T, Krusell LR, Ravkilde J, Hansen PR, Hansen KN, Abildstrøm SZ, Aarøe J, Jensen JS, Kristensen SD, Bøtker HE, Madsen M, Johnsen SP, Jensen LO, Sørensen HT, Thuesen L, Lassen JF. Efficacy and safety of zotarolimus-eluting and sirolimus-eluting coronary stents in routine clinical care (SORT OUT III): a randomised controlled superiority trial. Lancet 2010; 375:1090-9. [PMID: 20231034 DOI: 10.1016/s0140-6736(10)60208-5] [Citation(s) in RCA: 177] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND In low-risk patients, the zotarolimus-eluting stent has been shown to reduce rates of restenosis without increasing the risk of stent thrombosis. We compared the efficacy and safety of the zotarolimus-eluting stent versus the sirolimus-eluting stent in patients with coronary artery disease who were receiving routine clinical care with no direct follow-up. METHODS We did a single-blind, all-comer superiority trial in adult patients with chronic stable coronary artery disease or acute coronary syndromes, and at least one target lesion. Patients were treated at one of five percutaneous coronary intervention centres between January, 2006, and August, 2007. Computer-generated block randomisation and a telephone allocation service were used to randomly assign patients to receive the zotarolimus-eluting or the sirolimus-eluting stent. Data for follow-up were obtained from national Danish administrative and health-care registries. The primary endpoint was a composite of major adverse cardiac events within 9 months: cardiac death, myocardial infarction, and target vessel revascularisation. Intention-to-treat analyses were done at 9-month and 18-month follow-up. This trial is registered with ClinicalTrials.gov, number NCT00660478. FINDINGS 1162 patients (1619 lesions) were assigned to receive the zotarolimus-eluting stent, and 1170 patients (1611 lesions) to receive the sirolimus-eluting stent. 67 patients (72 lesions) had stent failure, and six patients were lost to follow-up. All randomly assigned patients were included in analyses at 9-month follow-up; 2200 patients (94%) had completed 18-month follow-up by the time of our assessment. At 9 months, the primary endpoint had occurred in a higher proportion of patients treated with the zotarolimus-eluting stent than in those treated with the sirolimus-eluting stent (72 [6%] vs 34 [3%]; HR 2.15, 95% CI 1.43-3.23; p=0.0002). At 18-month follow-up, this difference was sustained (113 [10%] vs 53 [5%]; 2.19, 1.58-3.04; p<0.0001). For patients receiving the zotarolimus-eluting stent and those receiving the sirolimus-eluting stent, all cause-mortality was similar at 9-month follow-up (25 [2%] vs 18 [2%]; 1.40, 0.76-2.56; p=0.28), but was significantly different at 18-month follow-up (51 [4%] vs 32 [3%]; 1.61, 1.03-2.50; p=0.035). INTERPRETATION The sirolimus-eluting stent is superior to the zotarolimus-eluting stent for patients receiving routine clinical care. FUNDING Cordis and Medtronic.
Collapse
Affiliation(s)
- Klaus Rasmussen
- Department of Cardiology, Aarhus University Hospital, Aalborg Hospital, Aalborg, Denmark
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
47
|
Cilingiroglu M, Bailey SR. Effect of drug-eluting stents on endothelial dysfunction. Interv Cardiol 2010. [DOI: 10.2217/ica.09.37] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
|
48
|
Kim JS, Kim JS, Kim TH, Fan C, Lee JM, Kim W, Ko YG, Choi D, Hong MK, Jang Y. Comparison of Neointimal Coverage of Sirolimus-Eluting Stents and Paclitaxel-Eluting Stents Using Optical Coherence Tomography at 9 Months After Implantation. Circ J 2010; 74:320-6. [DOI: 10.1253/circj.cj-09-0546] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Jin-Sun Kim
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine
| | - Jung-Sun Kim
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine
| | - Tae Hoon Kim
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine
| | - Chunyu Fan
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine
| | - Jung Myung Lee
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine
| | - Woong Kim
- Division of Cardiology, Inje University Busan Paik Hospital
| | - Young-Guk Ko
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine
| | - Donghoon Choi
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine
| | - Myeong-Ki Hong
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine
| | - Yangsoo Jang
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine
| |
Collapse
|
49
|
|
50
|
Waseda K, Ako J, Yamasaki M, Koizumi T, Ormiston J, Worthley SG, Whitbourn RJ, Walters DL, Honda Y, Meredith IT, Fitzgerald PJ, The RESOLUTE Trial Investigators. Short- and Mid-Term Intravascular Ultrasound Analysis of the New Zotarolimus-Eluting Stent With Durable Polymer - Results From the RESOLUTE Trial -. Circ J 2010; 74:2097-102. [DOI: 10.1253/circj.cj-10-0063] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
|