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Stent edge vascular response and in-stent geometry after aerobic exercise. Cardiovasc Interv Ther 2020; 36:111-120. [PMID: 32152930 PMCID: PMC7829229 DOI: 10.1007/s12928-020-00655-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Accepted: 02/24/2020] [Indexed: 11/29/2022]
Abstract
The purpose of the present study was to investigate the edge vascular response in patients treated with second-generation drug-eluting stents (DES) after 3 months of aerobic exercise intervention. Thirty-two patients with significant coronary artery disease underwent percutaneous coronary intervention with DES implantation prior to randomization to aerobic interval training (AIT, 14 patients) versus moderate continuous training (MCT, 18 patients). Plaque changes were assessed using grayscale and radiofrequency intravascular ultrasound at baseline and follow-up. The main endpoints were changes in plaque burden and necrotic core content in the 5-mm proximal and distal stent edges. Plaque burden in the distal stent edges decreased significantly in both groups (AIT: − 3.3%; MCT: − 0.4%, p = 0.01 for both), and more in the AIT group (p = 0.048). Necrotic core content decreased significantly in the distal stent edges in both groups (− 2.1 mm3 in AIT, − 0.3 mm3 in MCT, p = 0.01 for both), and more in the AIT group (p = 0.03). There were no significant changes in proximal stent edges or in in-stent geometry at follow-up. In this small study of patients treated with DES implantation, 3 months of aerobic exercise training demonstrated decreased plaque burden and necrotic core content in the distal stent edges, with larger reductions in the AIT group.
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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]
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3
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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]
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4
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Gogas BD, Garcia-Garcia HM, Onuma Y, Muramatsu T, Farooq V, Bourantas CV, Serruys PW. Edge Vascular Response After Percutaneous Coronary Intervention. JACC Cardiovasc Interv 2013; 6:211-21. [DOI: 10.1016/j.jcin.2013.01.132] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2012] [Revised: 01/24/2013] [Accepted: 01/30/2013] [Indexed: 11/30/2022]
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5
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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.
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Affiliation(s)
- Ki-Woon Kang
- Division of Cardiology, Eulji University Hospital, Daejeon, Korea
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6
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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.
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Affiliation(s)
- Ki-Woon Kang
- Severance Cardiovascular Hospital, Seoul, South Korea
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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.
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Affiliation(s)
- Rhidian J Shelton
- Department of Cardiology, Leeds General Infirmary, Leeds, United Kingdom
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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]
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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
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de la Torre Hernández JM, Alfonso F, Gimeno F, Diarte JA, Lopez-Palop R, Pérez de Prado A, Rivero F, Sanchis J, Larman M, Diaz JF, Elizaga J, Moreiras JM, Gomez Jaume A, Hernández JM, Mauri J, Recalde AS, Bullones JA, Rumoroso JR, del Blanco BG, Baz JA, Bosa F, Botas J, Hernández F. Thrombosis of Second-Generation Drug-Eluting Stents in Real Practice. JACC Cardiovasc Interv 2010; 3:911-9. [DOI: 10.1016/j.jcin.2010.06.010] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2010] [Accepted: 06/11/2010] [Indexed: 10/19/2022]
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Jia G, Mitra AK, Gangahar DM, Agrawal DK. Regulation of cell cycle entry by PTEN in smooth muscle cell proliferation of human coronary artery bypass conduits. J Cell Mol Med 2009; 13:547-54. [PMID: 18544045 PMCID: PMC2782893 DOI: 10.1111/j.1582-4934.2008.00384.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Proliferation of smooth muscle cells (SMCs) is the key event in the pathogenesis of intimal hyperplasia (IH) leading to coronary artery bypass graft (CABG) occlusion. The saphenous vein (SV) conduits are often affected by IH, while the internal mammary artery (IMA) conduits remain remarkably patent. SMC proliferation is mediated by the cell cycle, under the control of cyclin-dependent kinases (cdks), cdk-inhibitors and the retinoblastoma protein (Rb). Early passage of the SMCs through the cell cycle involves crossing the non-reversible G(1) checkpoint, the restriction (R) point. In this study, we investigated the effect of mitogenic insulin-like growth factor (IGF)-1 stimulation on the R-point and its relationship with the phosphorylation of Rb protein and the cdk inhibitors p21 and p27 in SV and IMA SMCs. We observed no change in the R-point following IGF-1 activation in either SV or IMA SMCs. However, Rb-phosphorylation occurred much earlier and was quantitatively greater in SV SMCs than IMA. Overexpression of phosphatase and tensin homologue deleted on chromosome 10 (PTEN) in SV SMCs followed by IGF-1 activation significantly decreased the expression of cyclin E and pRb and induced p27 expression in SV SMCs, while, pRb levels were markedly decreased and p27 levels were significantly increased in IMA SMCs. Silencing the PTEN gene by siRNA transfection of IMA SMCs significantly induced the expression of pRb and inhibited p27 expression, while, the expression levels of cyclin E, pRb, p21 and p27 were unaffected by the silencing of PTEN in SV SMCs. These results demonstrate that the PTEN plays a critical role in regulating cell cycle entry. Therefore, overexpression of PTEN possibly by means of gene therapy could be a viable option in regulating the cell cycle in SV SMCs in the treatment of vein graft disease.
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Affiliation(s)
- Guanghong Jia
- Department of Biomedical Sciences, Creighton University School of Medicine, Omaha, NE 68178, USA
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12
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Cirillo P, De Rosa S, Di Palma V, De Rosa R, Maietta P, Piscione F, Chiariello M. Different vascular response to concurrent implantation of sirolimus- and zotarolimus-eluting stents in the same vessel. Heart Vessels 2009; 24:313-6. [DOI: 10.1007/s00380-008-1134-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2008] [Accepted: 11/25/2008] [Indexed: 11/25/2022]
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13
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Wykrzykowska JJ, Onuma Y, Serruys PW. Advances in stent drug delivery: the future is in bioabsorbable stents. Expert Opin Drug Deliv 2009; 6:113-26. [PMID: 19239384 DOI: 10.1517/17425240802668495] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
This expert opinion review offers a perspective on the future developments in drug-eluting stent design. Initial efforts were focused on reduction of in-stent restenosis, which the drug-eluting stents addressed effectively. Current concerns are predominantly with regard to risk of stent thrombosis and delayed endothelialization. All three components of the stent have been modified to achieve the goal of endothelialization and vessel healing: drug, polymer and the platform. We review different approaches to reduce this risk from design of different drug combinations, through less traumatic metallic stent platforms, via biodegradable polymers and, finally, fully biodegradable stents. It seems at this time that fully biodegradable solutions to stenting hold the greatest promise, but larger long-term studies are needed to evaluate fully their safety and efficacy in 'all-comer' patient populations. At the time of this review, design of a safe drug-eluting stent still remains a challenge.
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Affiliation(s)
- Joanna J Wykrzykowska
- Department of Interventional Cardiology, Thoraxcentrum, Erasmus MC, 's Gravendijkwal 230, Ba583, 3015CE Rotterdam, The Netherlands
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Hudson PA, Kim MS, Carroll JD. Coronary ischemia and percutaneous intervention. Cardiovasc Pathol 2009; 19:12-21. [PMID: 19200756 DOI: 10.1016/j.carpath.2008.12.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2008] [Revised: 11/07/2008] [Accepted: 12/14/2008] [Indexed: 11/28/2022] Open
Abstract
The interventional treatment of ischemia is a complex issue grounded on an understanding of basic pathophysiology, but translated and implemented in practice by extensive clinical trial data representing patients with a spectrum of ischemia-causing clinical syndromes and anatomical variations of coronary artery disease (CAD). Percutaneous coronary intervention (PCI) has evolved to treat ischemia within this matrix of clinical and anatomical subsets using a wide array of techniques. Initial techniques using balloon angioplasty were promising, but demonstrated significant rates of restenosis due to negative arterial remodeling. The advent of stent technology prevented arterial recoil and provided a viable treatment for flow-limiting coronary dissections, thereby facilitating improved long-term patency of coronary vessels without the need for repeat revascularization. In-stent restenosis has been successfully addressed with drug elution, but late stent thrombosis has emerged as a complex issue involving dual antiplatelet therapy, patient compliance, and reexamination of the delicate balance between reducing restenosis and promoting endothelial proliferation. Finally, complex coronary lesions associated with heavy calcification or extensive plaque/thrombus burden that introduce unique challenges in obtaining ideal angiographic results have led to the development of new debulking devices aimed at optimizing procedural outcomes. This review will describe a variety of percutaneous coronary interventional techniques and technologies that are employed in the invasive treatment of ischemia under the guidance of clinical guidelines and evidence-based medicine.
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Affiliation(s)
- Paul A Hudson
- Division of Cardiology, University of Colorado-Denver, 12401 E. 17th Avenue, Aurora, CO 80045, USA
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Affiliation(s)
- Yasuhiro Honda
- Division of Cardiovascular Medicine, Stanford University Medical Center
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16
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Shin DI, Seung KB, Kim PJ, Chang K, Choi JK, Jeon DS, Kim MJ, Lee MY, Chung WS. Long-Term Coronary Endothelial Function After Zotarolimus-Eluting Stent Implantation A 9 Month Comparison Between Zotarolimus-Eluting and Sirolimus-Eluting Stents. Int Heart J 2008; 49:639-52. [DOI: 10.1536/ihj.49.639] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Dong Il Shin
- Division of Cardiology, Department of Internal Medicine, Kangnam St. Mary’s Hospital, The Catholic University of Korea
| | - Ki-Bae Seung
- Division of Cardiology, Department of Internal Medicine, Kangnam St. Mary’s Hospital, The Catholic University of Korea
| | - Pum Joon Kim
- Division of Cardiology, Department of Internal Medicine, Kangnam St. Mary’s Hospital, The Catholic University of Korea
| | - Kiyuk Chang
- Division of Cardiology, Department of Internal Medicine, Kangnam St. Mary’s Hospital, The Catholic University of Korea
| | - Jae Kee Choi
- Division of Cardiology, Department of Internal Medicine, Kangnam St. Mary’s Hospital, The Catholic University of Korea
| | - Doo Soo Jeon
- Division of Cardiology, Department of Internal Medicine, Kangnam St. Mary’s Hospital, The Catholic University of Korea
| | - Mi-Jeong Kim
- Division of Cardiology, Department of Internal Medicine, Kangnam St. Mary’s Hospital, The Catholic University of Korea
| | - Man Young Lee
- Division of Cardiology, Department of Internal Medicine, Kangnam St. Mary’s Hospital, The Catholic University of Korea
| | - Wook Sung Chung
- Division of Cardiology, Department of Internal Medicine, Kangnam St. Mary’s Hospital, The Catholic University of Korea
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