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Qi J, Zhang H, Chen S, Du T, Zhang Y, Qiao A. Numerical Simulation of Dynamic Degradation and Fatigue Damage of Degradable Zinc Alloy Stents. J Funct Biomater 2023; 14:547. [PMID: 37998116 PMCID: PMC10672128 DOI: 10.3390/jfb14110547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 11/09/2023] [Accepted: 11/09/2023] [Indexed: 11/25/2023] Open
Abstract
Current research on the fatigue properties of degradable zinc alloy stents has not yet considered the issue of the fatigue life changing with material properties during the dynamic degradation process. Therefore, in this paper, we established a fatigue damage algorithm to study the fatigue problem affected by the changing of material properties during the dynamic degradation process of the stent under the action of pulsating cyclic loading. Three models: the dynamic degradation model, the dynamic degradation model under pulsating cyclic loading, and the coupled model of fatigue damage and dynamic degradation, were developed to verify the effect of fatigue damage on stent life. The results show that fatigue damage leads to a deeper degree of inhomogeneous degradation of the stent, which affects the service life of the stent. Fatigue damage is a factor that cannot be ignored. Therefore, when studying the mechanical properties and lifetime of degradable stents, incorporating fatigue damage into the study can help more accurately assess the lifetime of the stents.
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Affiliation(s)
| | | | | | | | | | - Aike Qiao
- Faculty of Environment and Life, Beijing University of Technology, Beijing 100124, China
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2
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Donisan T, Madanat L, Balanescu DV, Mertens A, Dixon S. Drug-Eluting Stent Restenosis: Modern Approach to a Classic Challenge. Curr Cardiol Rev 2023; 19:e030123212355. [PMID: 36597603 PMCID: PMC10280993 DOI: 10.2174/1573403x19666230103154638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 11/19/2022] [Accepted: 11/21/2022] [Indexed: 01/05/2023] Open
Abstract
In-stent restenosis (ISR) is a recognized complication following percutaneous coronary intervention in which the luminal diameter is narrowed through neointimal hyperplasia and vessel remodeling. Although rates of ISR have decreased in most recent years owing to newer generation drug-eluting stents, thinner struts, and better intravascular imaging modalities, ISR remains a prevalent dilemma that proves to be challenging to manage. Several factors have been proposed to contribute to ISR formation, including mechanical stent characteristics, technical factors during the coronary intervention, and biological aspects of drug-eluting stents. Presentation of ISR can range from asymptomatic to late myocardial infarction and could be difficult to differentiate from acute thrombus formation. No definite guidelines are present on the management of ISR. In this review, we will discuss the mechanisms underlying ISR and provide insight into patient-related and procedural risk factors contributing to ISR, in addition to highlighting common treatment approaches utilized in the management of ISR.
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Affiliation(s)
- Teodora Donisan
- Department of Internal Medicine, Beaumont Hospital, Royal Oak, MI, 48073, USA
| | - Luai Madanat
- Department of Internal Medicine, Beaumont Hospital, Royal Oak, MI, 48073, USA
| | - Dinu V. Balanescu
- Department of Internal Medicine, Beaumont Hospital, Royal Oak, MI, 48073, USA
| | - Amy Mertens
- Department of Cardiovascular Medicine, Beaumont Hospital, Royal Oak, MI, 48073, USA
| | - Simon Dixon
- Department of Cardiovascular Medicine, Beaumont Hospital, Royal Oak, MI, 48073, USA
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3
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Chen Y, Li D, Liao Y, Yao X, Ruan Y, Zou K, Liao H, Ding J, Qin H, Yu Z, Zhao Y, Hu L, Yang R. Incidence of coronary drug-eluting stent fracture: A systematic review and meta-analysis. Front Cardiovasc Med 2022; 9:925912. [PMID: 36082117 PMCID: PMC9445981 DOI: 10.3389/fcvm.2022.925912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Accepted: 08/04/2022] [Indexed: 11/24/2022] Open
Abstract
Background Reported evidence of coronary stent fracture (CSF) has increased in recent years. The purpose of this study was to determine reliable estimates of the overall incidence of CSF. Methods and results The MEDLINE, Embase and Cochrane databases were searched until March 18, 2022. Pooled estimates were acquired using random effects models. Meta-regression and subgroup analysis were used to explore sources of heterogeneity, and publication bias was evaluated by visual assessment of funnel plots and Egger’s test. Overall, 46 articles were included in this study. Estimates of CSF incidence were 5.5% [95% confidence interval (CI): 3.7–7.7%] among 39,953 patients based on 36 studies, 4.8% (95% CI: 3.1–6.8%) among 39,945 lesions based on 29 studies and 4.9% (95% CI: 2.5–9.4%) among 19,252 stents based on 8 studies. There has been an obvious increase in the incidence of CSF over the past two decades, and it seems that the duration of stent placement after stent implantation has no impact on incidence estimation. Conclusion The incidence of CSF was 5.5% among patients, 4.8% for lesions and 4.9% for stents and increased over the past 20 years. The duration of stent placement after stent implantation was found to have no impact on the incidence of CSF, but drug-eluting stent (DES) types and right coronary artery (RCA) lesions influenced the pooled incidence. Systematic review registration [https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022311995], identifier [CRD42022311995].
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Affiliation(s)
- Yang Chen
- Department of Cardiovascular Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Dandan Li
- Department of Neurology, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Yanhui Liao
- Department of Cardiovascular Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Xiongda Yao
- Department of Cardiovascular Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Yuehua Ruan
- Department of Cardiovascular Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Kai Zou
- Department of Cardiovascular Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Hanhui Liao
- Department of Cardiovascular Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Jingwen Ding
- Department of Cardiovascular Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Hao Qin
- Department of Cardiovascular Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Zuozhong Yu
- Department of Cardiovascular Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Yuanbin Zhao
- Department of Cardiovascular Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Longlong Hu
- Department of Cardiovascular Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Renqiang Yang
- Department of Cardiovascular Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang, China
- *Correspondence: Renqiang Yang,
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4
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Coronary stent fracture in an octogenarian patient: from bad to worse. J Geriatr Cardiol 2021; 18:968-972. [PMID: 34908931 PMCID: PMC8648541 DOI: 10.11909/j.issn.1671-5411.2021.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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5
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Levent F, Senoz O, Emren SV, Emren ZY, Gediz RB. Is coronary artery tortuosity a predisposing factor for drug-eluting stent restenosis? Herz 2021; 47:73-78. [PMID: 33895890 DOI: 10.1007/s00059-021-05036-z] [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: 01/08/2021] [Revised: 03/15/2021] [Accepted: 03/25/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Coronary artery tortuosity (CAT) is a relatively common finding on coronary angiography and may be associated with impaired left ventricular relaxation and coronary ischemia However, the significance of CAT remains unknown. This study aimed to investigate whether the severity of tortuosity in the targeted coronary segment is a predictor of stent restenosis. METHODS The study included a total of 637 patients undergoing drug-eluting stent implantation due to stable or unstable angina and who had no native coronary artery stenosis on their last coronary angiogram. The patients were separated into two groups: 312 patients with in-stent restenosis and 325 patients without in-stent restenosis. All patients underwent computed tomography (CT) coronary angiography after invasive angiography and CAT was calculated using the computer software. RESULTS Patients with in-stent restenosis had higher CAT than those without restenosis (1.25 ± 0.11 vs. 1.11 + 0.07, p < 0.001). Multivariate Cox regression analysis showed that the tortuosity index (hazard ratio [HR]: 1.246 95% confidence interval [CI]: 1.127-1.376 p < 0.001) and the circumflex lesion (HR: 1.437 95% CI: 1.062-1.942 p = 0.019) were independently associated with in-stent restenosis. With the threshold value of severe tortuosity set at 1.15, the prediction of could be made with 81% sensitivity and 80% specificity. CONCLUSION The severity of tortuosity is proportional to coronary in-stent stenosis in patients with stable and unstable angina pectoris undergoing drug-eluting stent implantation for a severe single coronary artery.
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Affiliation(s)
- Fatih Levent
- Bursa Yüksek İhtisas Training and Research Hospital, Bursa, Turkey. .,, Cumhuriyet Mah, Ozan Sok, Bina no. 10, 5. Kat, D. 9, Nilüfer, 16140, Bursa, Turkey.
| | - Oktay Senoz
- Çiğli Regional Education Hospital, Bakırçay University, Izmir, Turkey
| | - Sadık Volkan Emren
- Ataturk Training and Research Hospital, Izmir Katip Celebi University, Izmir, Turkey
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6
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Mostaed E, Sikora-Jasinska M, Ardakani MS, Mostaed A, Reaney IM, Goldman J, Drelich JW. Towards revealing key factors in mechanical instability of bioabsorbable Zn-based alloys for intended vascular stenting. Acta Biomater 2020; 105:319-335. [PMID: 31982587 PMCID: PMC7294534 DOI: 10.1016/j.actbio.2020.01.028] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 01/20/2020] [Accepted: 01/21/2020] [Indexed: 12/22/2022]
Abstract
Zn-based alloys are recognized as promising bioabsorbable materials for cardiovascular stents, due to their biocompatibility and favorable degradability as compared to Mg. However, both low strength and intrinsic mechanical instability arising from a strong strain rate sensitivity and strain softening behavior make development of Zn alloys challenging for stent applications. In this study, we developed binary Zn-4.0Ag and ternary Zn-4.0Ag-xMn (where x = 0.2-0.6wt%) alloys. An experimental methodology was designed by cold working followed by a thermal treatment on extruded alloys, through which the effects of the grain size and precipitates could be thoroughly investigated. Microstructural observations revealed a significant grain refinement during wire drawing, leading to an ultrafine-grained (UFG) structure with a size of 700 nm and 200 nm for the Zn-4.0Ag and Zn-4.0Ag-0.6Mn, respectively. Mn showed a powerful grain refining effect, as it promoted the dynamic recrystallization. Furthermore, cold working resulted in dynamic precipitation of AgZn3 particles, distributing throughout the Zn matrix. Such precipitates triggered mechanical degradation through an activation of Zn/AgZn3 boundary sliding, reducing the tensile strength by 74% and 57% for Zn-4.0Ag and Zn-4.0Ag-0.6Mn, respectively. The observed precipitation softening caused a strong strain rate sensitivity in cold drawn alloys. Short-time annealing significantly mitigated the mechanical instability by reducing the AgZn3 fraction. The ternary alloy wire showed superior microstructural stability relative to its Mn-free counterpart due to the pinning effect of Mn-rich particles on the grain boundaries. Eventually, a shift of the corrosion regime from localized to more uniform was observed after the heat treatment, mainly due to the dissolution of AgZn3 precipitates. STATEMENT OF SIGNIFICANCE: Owing to its promising biodegradability, zinc has been recognized as a potential biodegradable material for stenting applications. However, Zn's poor strength alongside intrinsic mechanical instability have propelled researchers to search for Zn alloys with improved mechanical properties. Although extensive researches have been conducted to satisfy the mentioned concerns, no Zn-based alloys with stabilized mechanical properties have yet been reported. In this work, the mechanical properties and stability of the Zn-Ag-based alloys were systematically evaluated as a function of microstructural features. We found that the microstructure design in Zn alloys can be used to find an effective strategy to not only improve the strength and suppress the mechanical instability but also to minimize any damage by augmenting the corrosion uniformity.
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Affiliation(s)
- Ehsan Mostaed
- Department of Materials Science and Engineering, Michigan Technological University, Houghton, MI 49931, USA.
| | - Malgorzata Sikora-Jasinska
- Department of Materials Science and Engineering, Michigan Technological University, Houghton, MI 49931, USA
| | - Morteza Shaker Ardakani
- Department of Materials Science and Engineering, Michigan Technological University, Houghton, MI 49931, USA
| | - Ali Mostaed
- Department of Engineering Materials, University of Sheffield, Sheffield S1 3JD, UK; Department of Materials, University of Oxford, 16 Parks Road, Oxford OX1 3PH, UK
| | - Ian M Reaney
- Department of Engineering Materials, University of Sheffield, Sheffield S1 3JD, UK
| | - Jeremy Goldman
- Department of Biomedical Engineering, Michigan Technological University, Houghton, MI 49931, USA
| | - Jaroslaw W Drelich
- Department of Materials Science and Engineering, Michigan Technological University, Houghton, MI 49931, USA
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7
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Lin S, Ran X, Yan X, Wang Q, Zhou JG, Hu T, Wang G. Systematical evolution on a Zn-Mg alloy potentially developed for biodegradable cardiovascular stents. JOURNAL OF MATERIALS SCIENCE. MATERIALS IN MEDICINE 2019; 30:122. [PMID: 31677119 DOI: 10.1007/s10856-019-6324-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Accepted: 10/17/2019] [Indexed: 05/14/2023]
Abstract
To reduce the long-term side effects of permanent metallic stents, a new generation of cardiovascular stents called "biodegradable stents" is being extensively developed. Zinc has been considered as a promising candidate material for biodegradable cardiovascular stents due to its excellent biocompatibility and appropriate biodegradability. However, weak mechanical properties limit its further clinic application. In this study, hot extruded pure Zn and Zn-0.02 Mg alloy were prepared. Compared with pure Zn, Zn-0.02 Mg alloy showed more homogeneous microstructure, much smaller grain size and higher mechanical strength. Zn-0.02 Mg alloy presented uniform corrosion morphologies during the immersion process, and its corrosion rates was higher than that of pure Zn. Hemocompatibility results showed that the Zn-based alloy had extremely low hemolysis rate (0.74 ± 0.15%) and strong inhibitory effect on blood coagulation, platelet adhesion and aggregation. Zn-0.02 Mg alloy also exhibited excellent cytocompatibility. Its extracts could significantly promote the proliferation of endothelial cells. Moreover, the antibacterial activities of the Zn-based alloy were demonstrated by spread plate assay, live/dead viability assay and bacterial morphology observation. These results indicate that the extruded Zn-0.02 Mg alloy has a potential in biodegradable cardiovascular stents.
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Affiliation(s)
- Song Lin
- Key Laboratory for Biorheological Science and Technology of Ministry of Education, State and Local Joint Engineering Laboratory for Vascular Implants, Bioengineering College of Chongqing University, Chongqing, 400030, China
| | - Xiaolin Ran
- Key Laboratory for Biorheological Science and Technology of Ministry of Education, State and Local Joint Engineering Laboratory for Vascular Implants, Bioengineering College of Chongqing University, Chongqing, 400030, China
| | - Xinhao Yan
- Xi'an Advanced Medical Technology Co., Ltd, Xi'an, 710000, China
| | - Qilong Wang
- Key Laboratory for Biorheological Science and Technology of Ministry of Education, State and Local Joint Engineering Laboratory for Vascular Implants, Bioengineering College of Chongqing University, Chongqing, 400030, China
| | - Jack G Zhou
- Xi'an Advanced Medical Technology Co., Ltd, Xi'an, 710000, China
| | - Tingzhang Hu
- Key Laboratory for Biorheological Science and Technology of Ministry of Education, State and Local Joint Engineering Laboratory for Vascular Implants, Bioengineering College of Chongqing University, Chongqing, 400030, China.
| | - Guixue Wang
- Key Laboratory for Biorheological Science and Technology of Ministry of Education, State and Local Joint Engineering Laboratory for Vascular Implants, Bioengineering College of Chongqing University, Chongqing, 400030, China.
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8
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Abstract
Despite on-going evolution and iteration of drug-eluting stent (DES) technology, the prevalence of in-stent restenosis (ISR) remains relatively unchanged, encompassing ≈10% of percutaneous coronary interventions. The mechanism of ISR is multifactorial, including biological, mechanical, patient, and operator-related factors. The main mechanical contributors are stent underexpansion or fracture, while biological factors include local inflammation leading to aggressive neointimal proliferation and late neoatherosclerosis. Intracoronary imaging is critical to identify the mechanism of ISR and tailor therapy accordingly. The presentation of DES-ISR is not benign and is challenging for optimal treatment. Among the proposed treatment modalities are scoring and high-pressure balloons, percutaneous coronary intervention with additional DES, atheroablative therapies by laser or mechanical atherectomy, drug-coated balloons, vascular brachytherapy, and surgical revascularization. We propose a new classification for ISR that differentiates among mechanical, biological, and mixed etiologies. Stratifying ISR by mechanism guides individualized treatment of DES-ISR to improve clinical outcomes. An algorithmic approach, guided by intracoronary imaging, for the treatment of DES-ISR, is recommended based on the specific cause of restenosis.
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Affiliation(s)
- Evan Shlofmitz
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC
| | - Micaela Iantorno
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC
| | - Ron Waksman
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC
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9
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Conway C. Coronary Stent Fracture: Clinical Evidence Vs. the Testing Paradigm. Cardiovasc Eng Technol 2018; 9:752-760. [DOI: 10.1007/s13239-018-00384-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Accepted: 10/03/2018] [Indexed: 12/23/2022]
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10
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Iijima R, Kougame N, Hara H, Moroi M, Nakamura M. Clinical Outcomes of Drug-Coated Balloons in Coronary Artery Disease Unsuitable for Drug-Eluting Stent Implantation. Circ J 2018; 82:2025-2031. [DOI: 10.1253/circj.cj-18-0121] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Raisuke Iijima
- Toho University School of Medicine, Ohashi Medical Center
| | | | - Hidehiko Hara
- Toho University School of Medicine, Ohashi Medical Center
| | - Masao Moroi
- Toho University School of Medicine, Ohashi Medical Center
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11
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Novel high-strength, low-alloys Zn-Mg (<0.1wt% Mg) and their arterial biodegradation. MATERIALS SCIENCE & ENGINEERING. C, MATERIALS FOR BIOLOGICAL APPLICATIONS 2017. [PMID: 29519445 DOI: 10.1016/j.msec.2017.11.021] [Citation(s) in RCA: 71] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
It is still an open challenge to find a biodegradable metallic material exhibiting sufficient mechanical properties and degradation behavior to serve as an arterial stent. In this study, Zn-Mg alloys of 0.002 (Zn-002Mg), 0.005 (Zn-005Mg) and 0.08wt% Mg (Zn-08Mg) content were cast, extruded and drawn to 0.25mm diameter, and evaluated as potential biodegradable stent materials. Structural analysis confirmed formation of Mg2Zn11 intermetallic in all three alloys with the average grain size decreasing with increasing Mg content. Tensile testing, fractography analysis and micro hardness measurements showed the best integration of strength, ductility and hardness for the Zn-08Mg alloy. Yield strength, tensile strength, and elongation to failure values of >200-300MPa, >300-400MPa, and >30% respectively, were recorded for Zn-08Mg. This metal appears to be the first formulated biodegradable material that satisfies benchmark values desirable for endovascular stenting. Unfortunately, the alloy reveals signs of age hardening and strain rate sensitivity, which need to be addressed before using this metal for stenting. The explants of Zn-08Mg alloy residing in the abdominal aorta of adult male Sprague-Dawley rats for 1.5, 3, 4.5, 6 and 11months demonstrated similar, yet slightly elevated inflammation and neointimal activation for the alloy relative to what was recently reported for pure zinc.
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12
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Miura K, Tada T, Kuwayama A, Shimada T, Ohya M, Amano H, Kubo S, Hyodo Y, Otsuru S, Habara S, Tanaka H, Fuku Y, Goto T, Kadota K. Stent Fracture and Peri-Stent Contrast Staining After Everolimus-Eluting Stent Implantation - 5-Year Outcomes. Circ J 2017. [PMID: 28626202 DOI: 10.1253/circj.cj-17-0236] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Stent fracture (SF) and peri-stent contrast staining (PSS) after sirolimus-eluting stent implantation are reported to be risk factors of adverse events. However, the effect of these after everolimus-eluting stent (EES) implantation on long-term outcomes remains unclear.Methods and Results:The study sample comprised 636 patients (1,081 lesions) undergoing EES implantation in 2010 and follow-up angiography within 1 year. The 5-year cumulative rates of target lesion revascularization (TLR) and major adverse cardiac events (MACE: a combination of all-cause death, myocardial infarction, and TLR) were compared between patients with and without SF or PSS. SF was observed in 2.7%, and PSS in 3.0%. The cumulative rates of MACE and TLR were significantly higher in the SF group than in the non-SF group (51.7% vs. 27.5% and 48.3% vs. 13.4%, respectively), but showed no significant differences between the PSS and non-PSS groups. In a landmark analysis, the rate of TLR within 1 year was significantly higher in the SF group than in the non-SF group (44.8% vs. 7.2%), but beyond 1 year showed no significant difference (6.3% vs 6.7%). CONCLUSIONS The 5-year clinical outcomes suggested that SF after EES implantation is related to increased risk of MACE and TLR, especially within 1 year after the procedure, but PSS after EES implantation is unrelated.
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Affiliation(s)
- Katsuya Miura
- Department of Cardiology, Kurashiki Central Hospital
| | - Takeshi Tada
- Department of Cardiology, Kurashiki Central Hospital
| | | | | | - Masanobu Ohya
- Department of Cardiology, Kurashiki Central Hospital
| | - Hidewo Amano
- Department of Cardiology, Kurashiki Central Hospital
| | - Shunsuke Kubo
- Department of Cardiology, Kurashiki Central Hospital
| | - Yusuke Hyodo
- Department of Cardiology, Kurashiki Central Hospital
| | - Suguru Otsuru
- Department of Cardiology, Kurashiki Central Hospital
| | - Seiji Habara
- Department of Cardiology, Kurashiki Central Hospital
| | | | - Yasushi Fuku
- Department of Cardiology, Kurashiki Central Hospital
| | - Tsuyoshi Goto
- Department of Cardiology, Kurashiki Central Hospital
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13
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Drelich AJ, Zhao S, Guillory RJ, Drelich JW, Goldman J. Long-term surveillance of zinc implant in murine artery: Surprisingly steady biocorrosion rate. Acta Biomater 2017; 58:539-549. [PMID: 28532901 PMCID: PMC5553077 DOI: 10.1016/j.actbio.2017.05.045] [Citation(s) in RCA: 81] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Revised: 05/03/2017] [Accepted: 05/18/2017] [Indexed: 10/19/2022]
Abstract
Metallic zinc implanted into the abdominal aorta of rats out to 6months has been demonstrated to degrade while avoiding responses commonly associated with the restenosis of vascular implants. However, major questions remain regarding whether a zinc implant would ultimately passivate through the production of stable corrosion products or via a cell mediated fibrous encapsulation process that prevents the diffusion of critical reactants and products at the metal surface. Here, we have conducted clinically relevant long term in vivo studies in order to characterize late stage zinc implant biocorrosion behavior and products to address these critical questions. We found that zinc wires implanted in the murine artery exhibit steady corrosion without local toxicity for up to at least 20months post-implantation, despite a steady buildup of passivating corrosion products and intense fibrous encapsulation of the wire. Although fibrous encapsulation was not able to prevent continued implant corrosion, it may be related to the reduced chronic inflammation observed between 10 and 20months post-implantation. X-ray elemental and infrared spectroscopy analyses confirmed zinc oxide, zinc carbonate, and zinc phosphate as the main components of corrosion products surrounding the Zn implant. These products coincide with stable phases concluded from Pourbaix diagrams of a physiological solution and in vitro electrochemical impedance tests. The results support earlier predictions that zinc stents could become successfully bio-integrated into the arterial environment and safely degrade within a time frame of approximately 1-2years. STAEMENT OF SIGNIFICANCE Previous studies have shown zinc to be a promising candidate material for bioresorbable endovascular stenting applications. An outstanding question, however, is whether a zinc implant would ultimately passivate through the production of stable corrosion products or via a cell mediated tissue encapsulation process that prevented the diffusion of critical reactants and products at the metal surface. We found that zinc wires implanted in the murine artery exhibit steady corrosion for up to at least 20months post-implantation. The results confirm earlier predictions that zinc stents could safely degrade within a time frame of approximately 1-2years.
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Affiliation(s)
- Adam J Drelich
- Department of Biomedical Engineering, Michigan Technological University, Houghton, MI 49931, USA
| | - Shan Zhao
- Department of Material Science and Engineering, Michigan Technological University, Houghton, MI 49931, USA
| | - Roger J Guillory
- Department of Biomedical Engineering, Michigan Technological University, Houghton, MI 49931, USA
| | - Jaroslaw W Drelich
- Department of Material Science and Engineering, Michigan Technological University, Houghton, MI 49931, USA
| | - Jeremy Goldman
- Department of Biomedical Engineering, Michigan Technological University, Houghton, MI 49931, USA.
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14
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Yang F, Zhang L, Huang D, Shen D, Ma Y, Xiong M, Zhang C, Tian M. Detection of very delayed coronary stent fracture using a novel fluoroscopic stent visualization technique against intravascular ultrasound: A case series. Medicine (Baltimore) 2017; 96:e6804. [PMID: 28538372 PMCID: PMC5457852 DOI: 10.1097/md.0000000000006804] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
RATIONALE Stent fracture has received increased concern as it may be an important risk factor for late stent failure, intravascular ultrasound (IVUS) is always recommended to confirm the diagnosis of stent fracture. StentBoost can detect stent fractures more easily due to the enhanced stent strut visibility, compared with coronary angiography (CAG). Few cases were reported to compare the advantages of StentBoost vis-à-vis IVUS in detecting stent fracture. PATIENT CONCERNS We reported 3 cases that were confirmed the diagnosis of stent fracture by StentBoost, which were preliminarily suspected by angiography, including one case that lacked the IVUS evidence of stent fracture. DIAGNOSES 3 cases of stent fracture presented with asymptomatic, angina and acute myocardial infarction, respectively. INTERVENTION Stents were implanted in the patients of case 2 and case 3, but the patient of case 1 was not given any intervention. OUTCOMES No recurrent angina or myocardial infarction during outpatient follow-up. LESSONS StentBoost may distinguish partial, complete, or multiple stent fracture, even which sometimes is not obvious in IVUS, StentBoost is a useful and handy tool for identifying the stent struts.
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15
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Bowen PK, Seitz JM, Guillory RJ, Braykovich JP, Zhao S, Goldman J, Drelich JW. Evaluation of wrought Zn-Al alloys (1, 3, and 5 wt % Al) through mechanical and in vivo testing for stent applications. J Biomed Mater Res B Appl Biomater 2017; 106:245-258. [PMID: 28130871 DOI: 10.1002/jbm.b.33850] [Citation(s) in RCA: 72] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Revised: 12/26/2016] [Accepted: 01/01/2017] [Indexed: 11/09/2022]
Abstract
Special high grade zinc and wrought zinc-aluminum (Zn-Al) alloys containing up to 5.5 wt % Al were processed, characterized, and implanted in rats in search of a new family of alloys with possible applications as bioabsorbable endovascular stents. These materials retained roll-induced texture with an anisotropic distribution of the second-phase Al precipitates following hot-rolling, and changes in lattice parameters were observed with respect to Al content. Mechanical properties for the alloys fell roughly in line with strength (190-240 MPa yield strength; 220-300 MPa ultimate tensile strength) and elongation (15-30%) benchmarks, and favorable elastic ranges (0.19-0.27%) were observed. Intergranular corrosion was observed during residence of Zn-Al alloys in the murine aorta, suggesting a different corrosion mechanism than that of pure zinc. This mode of failure needs to be avoided for stent applications because the intergranular corrosion caused cracking and fragmentation of the implants, although the composition of corrosion products was roughly identical between non- and Al-containing materials. In spite of differences in corrosion mechanisms, the cross-sectional reduction of metals in murine aorta was nearly identical at 30-40% and 40-50% after 4.5 and 6 months, respectively, for pure Zn and Zn-Al alloys. Histopathological analysis and evaluation of arterial tissue compatibility around Zn-Al alloys failed to identify areas of necrosis, though both chronic and acute inflammatory indications were present. © 2017 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 106B: 245-258, 2018.
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Affiliation(s)
- Patrick K Bowen
- Department of Materials Science and Engineering, Michigan Technological University, Houghton, Michigan, 49931
| | - Jan-Marten Seitz
- Department of Materials Science and Engineering, Michigan Technological University, Houghton, Michigan, 49931
| | - Roger J Guillory
- Department of Biomedical Engineering, Michigan Technological University, Houghton, Michigan, 49931
| | - Jacob P Braykovich
- Department of Materials Science and Engineering, Michigan Technological University, Houghton, Michigan, 49931
| | - Shan Zhao
- Department of Materials Science and Engineering, Michigan Technological University, Houghton, Michigan, 49931
| | - Jeremy Goldman
- Department of Biomedical Engineering, Michigan Technological University, Houghton, Michigan, 49931
| | - Jaroslaw W Drelich
- Department of Materials Science and Engineering, Michigan Technological University, Houghton, Michigan, 49931
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16
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Review: Stent fracture in the drug-eluting stent era. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2016; 17:404-11. [DOI: 10.1016/j.carrev.2016.06.002] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Accepted: 06/23/2016] [Indexed: 11/23/2022]
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17
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Abstract
Coronary optical coherence tomography (OCT) is now an established imaging technique in many catheterization laboratories worldwide. With its near-histological view of the vessel wall and lumen interface, it offers unprecedented imaging quality to improve our understanding of the pathophysiology of atherosclerosis, plaque vulnerability, and vascular biology. Not only is OCT used to accurately detect atherosclerotic plaque and optimize stent position, but it can further characterize plaque composition, quantify stent apposition, and assess stent tissue coverage. Given that its resolution of 15 μm is well above that of angiography and intravascular ultrasound, OCT has become the invasive imaging method of choice to examine the interaction between stents and the vessel wall. This review focuses on the application of OCT to examine coronary stents, the mechanisms of stent complications, and future directions of OCT-guided intervention.
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18
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Ohya M, Kadota K, Kubo S, Tada T, Habara S, Shimada T, Amano H, Izawa Y, Hyodo Y, Otsuru S, Hasegawa D, Tanaka H, Fuku Y, Goto T, Mitsudo K. Incidence, predictive factors, and clinical impact of stent recoil in stent fracture lesion after drug-eluting stent implantation. Int J Cardiol 2016; 214:123-9. [PMID: 27060271 DOI: 10.1016/j.ijcard.2016.03.013] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2015] [Revised: 10/21/2015] [Accepted: 03/12/2016] [Indexed: 11/18/2022]
Abstract
BACKGROUND Stent fracture (SF) after drug-eluting stent (DES) implantation was reported to be associated with target lesion revascularization (TLR). We have noted abnormal late acquired stent axial deformation in lesions after DES implantation, especially in SF lesions, and defined it as stent recoil (SR). We evaluated the incidence, predictive factors, and clinical impact of SR in SF lesions. METHODS Between 2003 and 2012, 5456 patients (11,712 lesions) underwent DES implantations and follow-up angiography within one year after the index procedure. SR was defined as an axial recoil deformation less than 80% of the stent diameter and SF was defined as the separation of stent segments or stent struts. SF and SR were confirmed by follow-up angiography. The primary endpoint was defined as clinically driven TLR. RESULTS SF was observed in 494 lesions (4.2%) and SR in 138 of SF lesions (27.9%). According to multinomial logistic regression analyses, severe calcification and ostial lesion in the right coronary artery were stronger predictive factors of SF with SR lesions. The cumulative incidences of any and clinically driven TLR at 5years were both significantly higher in the SF with SR group than in the SF without SR group (51.7% versus 35.0%, P<0.001; 22.2% versus 12.8%, P=0.019; respectively). CONCLUSIONS SR in SF lesions after DES implantation could be related to the lesion characteristics. SF with SR was highly associated with subsequent TLR compared with SF without SR.
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Affiliation(s)
- Masanobu Ohya
- Department of Cardiology, Kurashiki Central Hospital, 1-1-1 Miwa, Kurashiki, Okayama 710-8602, Japan
| | - Kazushige Kadota
- Department of Cardiology, Kurashiki Central Hospital, 1-1-1 Miwa, Kurashiki, Okayama 710-8602, Japan..
| | - Shunsuke Kubo
- Department of Cardiology, Kurashiki Central Hospital, 1-1-1 Miwa, Kurashiki, Okayama 710-8602, Japan
| | - Takeshi Tada
- Department of Cardiology, Kurashiki Central Hospital, 1-1-1 Miwa, Kurashiki, Okayama 710-8602, Japan
| | - Seiji Habara
- Department of Cardiology, Kurashiki Central Hospital, 1-1-1 Miwa, Kurashiki, Okayama 710-8602, Japan
| | - Takenobu Shimada
- Department of Cardiology, Kurashiki Central Hospital, 1-1-1 Miwa, Kurashiki, Okayama 710-8602, Japan
| | - Hidewo Amano
- Department of Cardiology, Kurashiki Central Hospital, 1-1-1 Miwa, Kurashiki, Okayama 710-8602, Japan
| | - Yu Izawa
- Department of Cardiology, Kurashiki Central Hospital, 1-1-1 Miwa, Kurashiki, Okayama 710-8602, Japan
| | - Yusuke Hyodo
- Department of Cardiology, Kurashiki Central Hospital, 1-1-1 Miwa, Kurashiki, Okayama 710-8602, Japan
| | - Suguru Otsuru
- Department of Cardiology, Kurashiki Central Hospital, 1-1-1 Miwa, Kurashiki, Okayama 710-8602, Japan
| | - Daiji Hasegawa
- Department of Cardiology, Kurashiki Central Hospital, 1-1-1 Miwa, Kurashiki, Okayama 710-8602, Japan
| | - Hiroyuki Tanaka
- Department of Cardiology, Kurashiki Central Hospital, 1-1-1 Miwa, Kurashiki, Okayama 710-8602, Japan
| | - Yasushi Fuku
- Department of Cardiology, Kurashiki Central Hospital, 1-1-1 Miwa, Kurashiki, Okayama 710-8602, Japan
| | - Tsuyoshi Goto
- Department of Cardiology, Kurashiki Central Hospital, 1-1-1 Miwa, Kurashiki, Okayama 710-8602, Japan
| | - Kazuaki Mitsudo
- Department of Cardiology, Kurashiki Central Hospital, 1-1-1 Miwa, Kurashiki, Okayama 710-8602, Japan
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19
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Ji EY, Park GM, Kim DW, Kim TS, Kim CJ, Cho JS, Park MW, Her SH. Multiple Stent Fractures After Everolimus-Eluting Stent Implantation Causing Acute Myocardial Infarction: A Case Report. Medicine (Baltimore) 2016; 95:e2704. [PMID: 26871806 PMCID: PMC4753902 DOI: 10.1097/md.0000000000002704] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Stent fracture is an uncommon complication of drug-eluting stent implantation, but it has a clinical significance because of its potential association with adverse cardiac events such as in-stent restenosis, target lesion revascularization, and stent thrombosis. Multiple stent fractures account for a small proportion, but they may lead to more serious complications. Newer generation drug-eluting stents are designed for improved safety and efficacy compared with early generation drug-eluting stents. Multiple stent fractures after newer generation drug-eluting stent implantation are a rare case.We report a case of 25-year-old male who presented with acute myocardial infarction caused by multiple stent fractures after everolimus-eluting stents implantation and was treated by balloon angioplasty.Physicians should be aware of the possibility of multiple stent fractures even after newer generation drug-eluting stent implantation.
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Affiliation(s)
- Eun Young Ji
- From the Department of Cardiology, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
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20
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[Very late drug-eluting stent thrombosis by stent fracture]. Ann Cardiol Angeiol (Paris) 2015; 64:487-91. [PMID: 26542320 DOI: 10.1016/j.ancard.2015.09.060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
The superiority of drug-eluting stents in reducing the risk of in-stent restenosis compared to bare-metal stents is no longer challenged. Nevertheless, the drug-eluting stents may carry long-term risk of late and very late stent thrombosis. The promoting factors of this complication are usually divided into three chapters depending on the patient, the procedure and the stent. Indeed, the literature has reported several parameters related to the stent itself, such as its length, the malapposition, its diameter, but also more rarely the occurrence of stent fracture. We present the case of a patient admitted for myocardial infarction after a very late thrombosis of Cypher drug-eluting stent four years after its implantation and related to stent fracture.
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21
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Structural Mechanics Predictions Relating to Clinical Coronary Stent Fracture in a 5 Year Period in FDA MAUDE Database. Ann Biomed Eng 2015; 44:391-403. [PMID: 26467552 DOI: 10.1007/s10439-015-1476-3] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2015] [Accepted: 09/25/2015] [Indexed: 10/22/2022]
Abstract
Endovascular stents are the mainstay of interventional cardiovascular medicine. Technological advances have reduced biological and clinical complications but not mechanical failure. Stent strut fracture is increasingly recognized as of paramount clinical importance. Though consensus reigns that fractures can result from material fatigue, how fracture is induced and the mechanisms underlying its clinical sequelae remain ill-defined. In this study, strut fractures were identified in the prospectively maintained Food and Drug Administration's (FDA) Manufacturer and User Facility Device Experience Database (MAUDE), covering years 2006-2011, and differentiated based on specific coronary artery implantation site and device configuration. These data, and knowledge of the extent of dynamic arterial deformations obtained from patient CT images and published data, were used to define boundary conditions for 3D finite element models incorporating multimodal, multi-cycle deformation. The structural response for a range of stent designs and configurations was predicted by computational models and included estimation of maximum principal, minimum principal and equivalent plastic strains. Fatigue assessment was performed with Goodman diagrams and safe/unsafe regions defined for different stent designs. Von Mises stress and maximum principal strain increased with multimodal, fully reversed deformation. Spatial maps of unsafe locations corresponded to the identified locations of fracture in different coronary arteries in the clinical database. These findings, for the first time, provide insight into a potential link between patient adverse events and computational modeling of stent deformation. Understanding of the mechanical forces imposed under different implantation conditions may assist in rational design and optimal placement of these devices.
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22
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Soares JS, Moore JE. Biomechanical Challenges to Polymeric Biodegradable Stents. Ann Biomed Eng 2015; 44:560-79. [DOI: 10.1007/s10439-015-1477-2] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2015] [Accepted: 09/26/2015] [Indexed: 10/23/2022]
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23
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Fatigue of Metallic Stents: From Clinical Evidence to Computational Analysis. Ann Biomed Eng 2015; 44:287-301. [PMID: 26438450 DOI: 10.1007/s10439-015-1447-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2015] [Accepted: 09/02/2015] [Indexed: 10/23/2022]
Abstract
The great success of stents in treating cardiovascular disease is actually undermined by their long-term fatigue failure. The high variability of stent failure incidence suggests that it is due to several correlated aspects, such as loading conditions, material properties, component design, surgical procedure, and patient functional anatomy. Numerical and experimental non-clinical assessments are included in the recommendations and requirements of several regulatory bodies and they are thus exploited in the analysis of stent fatigue performance. Optimization-based simulation methodologies have been developed as well, to improve the fatigue endurance of novel designs. This paper presents a review on the fatigue issue in metallic stents, starting from a description of clinical evidence about stent fracture up to the analysis of computational approaches available from the literature. The reported discussion on both the experimental and numerical framework aims at providing a general insight into stent lifetime prediction as well as at understanding the factors which affect stent fatigue performance for the design of novel components.
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24
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Ohya M, Kadota K, Tada T, Habara S, Shimada T, Amano H, Izawa Y, Hyodo Y, Miyake K, Otsuru S, Hasegawa D, Tanaka H, Maruo T, Katoh H, Fuku Y, Goto T, Mitsudo K. Stent Fracture After Sirolimus-Eluting Stent Implantation. Circ Cardiovasc Interv 2015; 8:e002664. [DOI: 10.1161/circinterventions.115.002664] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background—
Stent fracture (SF) after sirolimus-eluting stent implantation is reported to be associated with target lesion revascularization (TLR) and stent thrombosis. We aimed to assess the clinical impact of SF at 8 years.
Methods and Results—
Between 2002 and 2005, 972 patients (1795 lesions) underwent sirolimus-eluting stent implantation and follow-up angiography within 1 year after index procedure. SF, defined as the complete separation of stent segments or stent struts at follow-up angiography, was observed in 105 lesions (5.8%). The study sample comprised 954 patients (1630 lesions), excluding 147 lesions undergoing TLR and 18 patients (18 lesions) who died or in whom stent thrombosis developed within 1 year after sirolimus-eluting stent implantation. The median follow-up duration was 9.1 years (the first and third quarters, 8.7 and 9.4 years). The primary end point was defined as any TLR. The 8-year cumulative rates of adverse events were estimated by Kaplan–Meier methods with
P
values from log-rank tests. Between patients with and without SF, there were no significant differences in the cumulative rates of all-cause death (23.5% versus 27.6%,
P
=0.35) and cardiac death (4.7% versus 9.1%,
P
=0.14), whereas patients with SF had significantly higher cumulative rates in myocardial infarction (10.1% versus 3.3%,
P
=0.001), very late stent thrombosis (6.8% versus 0.7%,
P
<0.001), any TLR (38.1% versus 10.8%,
P
<0.001), and clinically driven TLR (26.2% versus 6.6%,
P
<0.001).
Conclusions—
SF after sirolimus-eluting stent implantation was consistently associated with higher rates of adverse cardiac events during the 8-year follow-up.
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Affiliation(s)
- Masanobu Ohya
- From the Department of Cardiology, Kurashiki Central Hospital, Kurashiki, Japan
| | - Kazushige Kadota
- From the Department of Cardiology, Kurashiki Central Hospital, Kurashiki, Japan
| | - Takeshi Tada
- From the Department of Cardiology, Kurashiki Central Hospital, Kurashiki, Japan
| | - Seiji Habara
- From the Department of Cardiology, Kurashiki Central Hospital, Kurashiki, Japan
| | - Takenobu Shimada
- From the Department of Cardiology, Kurashiki Central Hospital, Kurashiki, Japan
| | - Hidewo Amano
- From the Department of Cardiology, Kurashiki Central Hospital, Kurashiki, Japan
| | - Yu Izawa
- From the Department of Cardiology, Kurashiki Central Hospital, Kurashiki, Japan
| | - Yusuke Hyodo
- From the Department of Cardiology, Kurashiki Central Hospital, Kurashiki, Japan
| | - Koshi Miyake
- From the Department of Cardiology, Kurashiki Central Hospital, Kurashiki, Japan
| | - Suguru Otsuru
- From the Department of Cardiology, Kurashiki Central Hospital, Kurashiki, Japan
| | - Daiji Hasegawa
- From the Department of Cardiology, Kurashiki Central Hospital, Kurashiki, Japan
| | - Hiroyuki Tanaka
- From the Department of Cardiology, Kurashiki Central Hospital, Kurashiki, Japan
| | - Takeshi Maruo
- From the Department of Cardiology, Kurashiki Central Hospital, Kurashiki, Japan
| | - Harumi Katoh
- From the Department of Cardiology, Kurashiki Central Hospital, Kurashiki, Japan
| | - Yasushi Fuku
- From the Department of Cardiology, Kurashiki Central Hospital, Kurashiki, Japan
| | - Tsuyoshi Goto
- From the Department of Cardiology, Kurashiki Central Hospital, Kurashiki, Japan
| | - Kazuaki Mitsudo
- From the Department of Cardiology, Kurashiki Central Hospital, Kurashiki, Japan
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25
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Kuramitsu S, Hiromasa T, Enomoto S, Shinozaki T, Iwabuchi M, Mazaki T, Domei T, Yamaji K, Soga Y, Hyodo M, Shirai S, Ando K. Incidence and Clinical Impact of Stent Fracture After PROMUS Element Platinum Chromium Everolimus-Eluting Stent Implantation. JACC Cardiovasc Interv 2015. [PMID: 26210803 DOI: 10.1016/j.jcin.2015.02.029] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
OBJECTIVES This study sought to assess the incidence and clinical impact of stent fracture (SF) after the PROMUS Element platinum-chromium everolimus-eluting stent (PtCr-EES). BACKGROUND SF remains an unresolved, clinically relevant issue, even in the newer-generation drug-eluting stent era. METHODS From March 2012 to August 2013, 816 patients with 1,094 lesions were treated only with PtCr-EES and 700 patients (85.7%) with 898 lesions undergoing follow-up angiography within 9 months after the index procedure were analyzed. SF was defined as complete or partial separation of the stent, as assessed by plain fluoroscopy, intravascular ultrasound, or optical coherence tomography during the follow-up. We assessed the rate of SF and the cumulative incidence of clinically driven target lesion revascularization and definite stent thrombosis within 9 months after the index procedure. RESULTS SF was observed in 16 of 898 lesions (1.7%) and 16 of 700 patients (2.2%). Lesions with in-stent restenosis at baseline (odds ratio [OR]: 14.2, 95% confidence intervals [CI]: 5.09 to 39.7; p < 0.001) or hinge motion (OR: 4.31, 95% CI: 1.12 to 16.5; p = 0.03), and total stent length (per 10-mm increase; OR: 1.32, 95% CI: 1.12 to 1.57; p = 0.001) were predictors of SF. Cumulative incidence of clinically driven target lesion revascularization within 9-months was numerically higher in the SF group than that in the non-SF group (18.7% vs. 2.3%). Cumulative incidence of definite stent thrombosis within 9 months after the index procedure was similar between the SF and non-SF groups (0.0% vs. 0.23%). CONCLUSIONS SF after PtCr-EES occurs in 1.7% of lesions and appears to be associated with clinically driven target lesion revascularization.
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Affiliation(s)
- Shoichi Kuramitsu
- Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan.
| | - Takashi Hiromasa
- Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan
| | | | - Tomohiro Shinozaki
- Department of Biostatistics, School of Public Health, the University of Tokyo, Tokyo, Japan
| | - Masashi Iwabuchi
- Department of Cardiovascular Medicine, Nephrology and Neurology, University of the Ryukyus School of Medicine, Okinawa, Japan
| | - Toru Mazaki
- Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Takenori Domei
- Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Kyohei Yamaji
- Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Yoshimitsu Soga
- Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Makoto Hyodo
- Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Shinichi Shirai
- Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Kenji Ando
- Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan
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26
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Inaba S, Mintz GS, Yun KH, Yakushiji T, Shimizu T, Kang SJ, Généreux P, Weisz G, Rabbani LE, Moses JW, Stone GW, Maehara A. Mechanical complications of everolimus-eluting stents associated with adverse events: an intravascular ultrasound study. EUROINTERVENTION 2014; 9:1301-8. [PMID: 24650772 DOI: 10.4244/eijv9i11a220] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS Mechanical complications contribute to bare metal and first-generation drug-eluting stent (DES) failure. However, the importance of the mechanical complications of second-generation DES remains unclear. We report mechanical complications associated with everolimus-eluting stent (EES) failures. METHODS AND RESULTS We retrospectively analysed 177 consecutive EES-treated lesions in 136 patients who underwent intravascular ultrasound (IVUS) at follow-up. Mechanical complications were identified in 17 patients (five stable angina, 10 unstable angina, two non-ST-elevation myocardial infarction [NSTEMI] without angiographic thrombus). Fifteen (88.2%) were treated with repeat revascularisation. By IVUS, there were 16 focal (94.1%) and one diffuse (5.9%) in-stent restenoses. Complete stent fracture with separation was seen in only one, partial stent fracture with separation was seen in three, and in 13 there was longitudinal deformation (n=2) or stent strut fracture (n=11) with overlapping of the proximal and distal stent fragments. In 13 EES with evidence of overlapping in the setting of either fracture or deformation, there was a 35.5±12.2% smaller stent area compared to the adjacent proximal and distal stent fragments, and >50% neointimal hyperplasia in 12 (92.3%). CONCLUSIONS We found EES mechanical complications, often followed by longitudinal deformation or fracture leading to excessive neointimal hyperplasia, in-stent restenosis, and repeat revascularisation.
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Affiliation(s)
- Shinji Inaba
- Cardiovascular Research Foundation, New York, NY, USA
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27
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Arauz-Garofalo G, López-Domínguez V, Hernàndez JM, Rodríguez-Leor O, Bayés-Genís A, O'Callaghan JM, García-Santiago A, Tejada J. Microwave spectrometry for the evaluation of the structural integrity of metallic stents. Med Phys 2014; 41:041902. [PMID: 24694133 DOI: 10.1118/1.4866881] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
PURPOSE To assess the feasibility of a method based on microwave spectrometry to detect structural distortions of metallic stents in open air conditions and envisage the prospects of this approach toward possible medical applicability for the evaluation of implanted stents. METHODS Microwave absorbance spectra between 2.0 and 18.0 GHz were acquired in open air for the characterization of a set of commercial stents using a specifically design setup. Rotating each sample over 360°, 2D absorbance diagrams were generated as a function of frequency and rotation angle. To check our approach for detecting changes in stent length (fracture) and diameter (recoil), two specific tests were performed in open air. Finally, with a few adjustments, this same system provides 2D absorbance diagrams of stents immersed in a water-based phantom, this time over a bandwidth ranging from 0.2 to 1.8 GHz. RESULTS The authors show that metallic stents exhibit characteristic resonant frequencies in their microwave absorbance spectra in open air which depend on their length and, as a result, may reflect the occurrence of structural distortions. These resonances can be understood considering that such devices behave like dipole antennas in terms of microwave scattering. From fracture tests, the authors infer that microwave spectrometry provides signs of presence of Type I to Type IV stent fractures and allows in particular a quantitative evaluation of Type III and Type IV fractures. Recoil tests show that microwave spectrometry seems able to provide some quantitative assessment of diametrical shrinkage, but only if it involves longitudinal shortening. Finally, the authors observe that the resonant frequencies of stents placed inside the phantom shift down with respect to the corresponding open air frequencies, as it should be expected considering the increase of dielectric permittivity from air to water. CONCLUSIONS The evaluation of stent resonant frequencies provided by microwave spectrometry allows detection and some quantitative assessment of stent fracture and recoil in open air conditions. Resonances of stents immersed in water can be also detected and their characteristic frequencies are in good agreement with theoretical estimates. Although these are promising results, further verification in a more relevant phantom is required in order to foresee the real potential of this approach.
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Affiliation(s)
- Gianluca Arauz-Garofalo
- Grup de Magnetisme, Departament de Física Fonamental, Facultat de Física, Universitat de Barcelona, Martí i Franquès 1, planta 4, edifici nou, ES-08028 Barcelona, Spain
| | - Víctor López-Domínguez
- Grup de Magnetisme, Departament de Física Fonamental, Facultat de Física, Universitat de Barcelona, Martí i Franquès 1, planta 4, edifici nou, ES-08028 Barcelona, Spain
| | - Joan Manel Hernàndez
- Grup de Magnetisme, Departament de Física Fonamental, Facultat de Física, Universitat de Barcelona, Martí i Franquès 1, planta 4, edifici nou, ES-08028 Barcelona, Spain and Institut de Nanociència i Nanotecnologia IN2UB, Universitat de Barcelona, Martí i Franquès 1, planta 3, edifici nou, ES-08028 Barcelona, Spain
| | - Oriol Rodríguez-Leor
- Servei de Cardiologia, Hospital Universitari Germans Trias i Pujol, Carretera del Canyet s/n, ES-08916 Badalona, Spain
| | - Antoni Bayés-Genís
- Servei de Cardiologia, Hospital Universitari Germans Trias i Pujol, Carretera del Canyet s/n, ES-08916 Badalona, Spain
| | - Juan M O'Callaghan
- Department of Signal Theory and Communications, Universitat Politècnica de Catalunya, Jordi Girona 1, ES-08034 Barcelona, Spain
| | - Antoni García-Santiago
- Grup de Magnetisme, Departament de Física Fonamental, Facultat de Física, Universitat de Barcelona, Martí i Franquès 1, planta 4, edifici nou, ES-08028 Barcelona, Spain and Institut de Nanociència i Nanotecnologia IN2UB, Universitat de Barcelona, Martí i Franquès 1, planta 3, edifici nou, ES-08028 Barcelona, Spain
| | - Javier Tejada
- Grup de Magnetisme, Departament de Física Fonamental, Facultat de Física, Universitat de Barcelona, Martí i Franquès 1, planta 4, edifici nou, ES-08028 Barcelona, Spain and Institut de Nanociència i Nanotecnologia IN2UB, Universitat de Barcelona, Martí i Franquès 1, planta 3, edifici nou, ES-08028 Barcelona, Spain
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28
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Bennett J, De Cock D, Hiltrop N, Adriaenssens T. Unusual stent fracture: diagnosis with optical coherence tomography. J Cardiovasc Med (Hagerstown) 2014; 17 Suppl 2:e231-e232. [PMID: 25226340 DOI: 10.2459/jcm.0000000000000200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
: We report an unusual case of new-generation drug-eluting stent fracture, diagnosed and managed with aid of optical coherence tomography.
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Affiliation(s)
- Johan Bennett
- Department of Cardiovascular Medicine, University Hospitals Leuven, Leuven, Belgium
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Kuramitsu S, Iwabuchi M, Yokoi H, Domei T, Sonoda S, Hiromasa T, Morinaga T, Kobayashi Y, Ohe K, Goya K, Yamaji K, Hyodo M, Soga Y, Kondo K, Shirai S, Ando K, Sakai K, Nobuyoshi M. Incidence and clinical impact of stent fracture after the Nobori biolimus-eluting stent implantation. J Am Heart Assoc 2014; 3:e000703. [PMID: 24650925 PMCID: PMC4187487 DOI: 10.1161/jaha.113.000703] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background Stent fracture (SF) after drug‐eluting stent implantation has become an important concern. The aim of this study was to assess the incidence, predictors, and clinical impact of SF after biolimus‐eluting stent. Methods and Results A total of 1026 patients with 1407 lesions undergoing the Nobori biolimus‐eluting stent implantation and follow‐up angiography within 9 months after index procedure were analyzed. SF was defined as complete or partial separation of the stent, as assessed by using plain fluoroscopy, intravascular ultrasound, or optical coherence tomography during the follow‐up. We assessed the rate of SF and the cumulative incidence of clinically driven target lesion revascularization and definite stent thrombosis within 9 months. SF was observed in 58 (4.1%) of 1407 lesions and 57 (5.5%) of 1026 patients. Lesions with hinge motion (OR 8.90, 95% CI 3.84 to 20.6, P<0.001), tortuosity (OR 4.16, 95% CI 1.75 to 9.88, P=0.001), and overlapping stents (OR 2.41, 95% CI 0.95 to 6.10, P=0.06) were predictors of SF. Cumulative incidence of clinically driven target lesion revascularization within 9 months was numerically higher in the SF group than that in the non‐SF group (12.0% versus 1.0%). Cumulative incidence of definite stent thrombosis within 9 months tended to be higher in the SF group than that in the non‐SF group (1.7% versus 0.5%). Conclusions SF after biolimus‐eluting stent occurs in 4.1% of lesions and appears to be associated with clinically driven target lesion revascularization.
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Affiliation(s)
- Shoichi Kuramitsu
- Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan
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Impact of sirolimus-eluting stent fractures without early cardiac events on long-term clinical outcomes: A multislice computed tomography study. Eur Radiol 2014; 24:1006-12. [DOI: 10.1007/s00330-014-3118-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2013] [Revised: 01/14/2014] [Accepted: 02/05/2014] [Indexed: 10/25/2022]
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31
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Lambert ND, Applegate RJ. The comparative safety of bare-metal and drug-eluting intracoronary stents. Expert Rev Med Devices 2014; 7:611-24. [DOI: 10.1586/erd.10.39] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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32
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Impact of 3-Dimensional Bifurcation Angle on 5-Year Outcome of Patients After Percutaneous Coronary Intervention for Left Main Coronary Artery Disease. JACC Cardiovasc Interv 2013; 6:1250-60. [DOI: 10.1016/j.jcin.2013.08.009] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2013] [Accepted: 08/14/2013] [Indexed: 11/17/2022]
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33
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Are we aware of stent fracture? Herz 2013; 40:417-22. [DOI: 10.1007/s00059-013-3947-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2013] [Revised: 07/25/2013] [Accepted: 08/07/2013] [Indexed: 10/26/2022]
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34
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Abstract
In spite of there being several case reports, coronary stent fracture is not a well-recognized entity and incidence rates are likely to be underestimated. In this article, we review different aspects of stent fracture, including incidence, classification, predictors, outcome, diagnosis, and management.
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35
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Bowen PK, Drelich J, Goldman J. Zinc exhibits ideal physiological corrosion behavior for bioabsorbable stents. ADVANCED MATERIALS (DEERFIELD BEACH, FLA.) 2013; 25:2577-82. [PMID: 23495090 DOI: 10.1002/adma.201300226] [Citation(s) in RCA: 300] [Impact Index Per Article: 27.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/15/2013] [Revised: 02/14/2013] [Indexed: 05/06/2023]
Abstract
Zinc is proposed as an exciting new biomaterial for use in bioabsorbable cardiac stents. Not only is zinc a physiologically relevant metal with behavior that promotes healthy vessels, but it combines the best behaviors of both current bioabsorbable stent materials: iron and magnesium. Shown here is a composite image of zinc degradation in a murine (rat) artery.
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Affiliation(s)
- Patrick K Bowen
- Department of Materials Science and Engineering, Michigan Technological University, 1400 Townsend Drive, 512 Minerals and Materials Building, Houghton, MI 49931, USA
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36
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Kuramitsu S, Iwabuchi M, Haraguchi T, Domei T, Nagae A, Hyodo M, Yamaji K, Soga Y, Arita T, Shirai S, Kondo K, Ando K, Sakai K, Goya M, Takabatake Y, Sonoda S, Yokoi H, Toyota F, Nosaka H, Nobuyoshi M. Incidence and clinical impact of stent fracture after everolimus-eluting stent implantation. Circ Cardiovasc Interv 2012; 5:663-71. [PMID: 23011266 DOI: 10.1161/circinterventions.112.969238] [Citation(s) in RCA: 75] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Stent fracture (SF) after drug-eluting stent implantation has recently become an important concern because of its potential association with in-stent restenosis and stent thrombosis. However, the incidence and clinical impact of SF after everolimus-eluting stent implantation remain unclear. METHODS AND RESULTS A total of 1035 patients with 1339 lesions undergoing everolimus-eluting stent implantation and follow-up angiography 6 to 9 months after index procedure were analyzed. SF was defined as complete or partial separation of the stent, as assessed by plain fluoroscopy or intravascular ultrasound during follow-up. We assessed the rates of SF and major adverse cardiac events, defined as cardiac death, myocardial infarction, stent thrombosis, and clinically driven target lesion revascularization within 9 months. SF was observed in 39 of 1339 lesions (2.9%) and in 39 of 1035 patients (3.8%). Ostial stent location and lesions with hinge motion, tortuosity, or calcification were independent predictors of SF. The rate of myocardial infarction and target lesion revascularization were significantly higher in the SF group than in the non-SF group (5.1% versus 0.4%; P=0.018 and 25.6% versus 2.0%; P<0.001, respectively). Stent thrombosis was more frequently observed in the SF group than in the non-SF group (5.1% versus 0.4%; P=0.018). Major adverse cardiac events within 9 months were significantly higher in the SF group than in the non-SF group (25.6% versus 2.3%; P<0.001). CONCLUSIONS SF after everolimus-eluting stent implantation occurs in 2.9% of lesions and is associated with higher rate of major adverse cardiac events, driven by higher target lesion revascularization and stent thrombosis.
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Park MW, Chang K, Her SH, Lee JM, Choi YS, Kim DB, Kim PJ, Cho JS, Choi MS, Baek JY, Park CS, Yoon SG, Chung WS, Seung KB. Incidence and clinical impact of fracture of drug-eluting stents widely used in current clinical practice: Comparison with initial platform of sirolimus-eluting stent. J Cardiol 2012; 60:215-21. [DOI: 10.1016/j.jjcc.2012.07.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2012] [Revised: 06/01/2012] [Accepted: 06/28/2012] [Indexed: 11/29/2022]
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38
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Long-term clinical and angiographic outcomes of patients with sirolimus-eluting stent fracture. Int J Cardiol 2012; 158:83-7. [DOI: 10.1016/j.ijcard.2011.01.013] [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: 07/21/2010] [Revised: 10/30/2010] [Accepted: 01/04/2011] [Indexed: 01/02/2023]
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39
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Guagliumi G, Capodanno D, Ikejima H, Bezerra HG, Sirbu V, Musumeci G, Fiocca L, Lortkipanidze N, Vassileva A, Tahara S, Valsecchi O, Costa MA. Impact of different stent alloys on human vascular response to everolimus-eluting stent: An optical coherence tomography study: The OCTEVEREST. Catheter Cardiovasc Interv 2012; 81:510-8. [DOI: 10.1002/ccd.24374] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2012] [Accepted: 02/12/2012] [Indexed: 02/03/2023]
Affiliation(s)
| | - Davide Capodanno
- Cardiology Department; Ferrarotto Hospital, Catania, and University of Catania; Catania; Italy
| | | | - Hiram G. Bezerra
- University Hospitals Case Medical Center; Case Western Reserve University; Cleveland; Ohio
| | - Vasile Sirbu
- Cardiovascular Department; Ospedali Riuniti; Bergamo; Italy
| | | | - Luigi Fiocca
- Cardiovascular Department; Ospedali Riuniti; Bergamo; Italy
| | | | | | - Satoko Tahara
- University Hospitals Case Medical Center; Case Western Reserve University; Cleveland; Ohio
| | | | - Marco A. Costa
- University Hospitals Case Medical Center; Case Western Reserve University; Cleveland; Ohio
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40
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Amico F, Geraci S, Tamburino C. Acute coronary syndrome due to early multiple and complete fractures in sirolimus-eluting stent: A case report and brief literature review. Catheter Cardiovasc Interv 2012; 81:52-6. [DOI: 10.1002/ccd.24414] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2011] [Accepted: 03/14/2012] [Indexed: 02/02/2023]
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41
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Kohli SK, Wong A, Khurana R. How should I treat a mural perforation due to acute stent fracture in a calcified proximal LAD? EUROINTERVENTION 2012; 7:1350-60. [PMID: 22433198 DOI: 10.4244/eijv7i11a212] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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42
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Ben Salem H, Kamoun M, Khaldi H, Ghannem K, Majadla S, Ghannem M, Godard S. [Sirolimus-eluting stent displaced fracture: case report and review of the literature]. Ann Cardiol Angeiol (Paris) 2012; 61:64-68. [PMID: 21658673 DOI: 10.1016/j.ancard.2011.04.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2010] [Accepted: 04/18/2011] [Indexed: 05/30/2023]
Abstract
Drug-eluting stents have greatly reduced the risk of in-stent restenosis compared to bare metal stents by inhibiting neointimal growth. However, they may carry some long-term risks, especially the risk of late stent thrombosis. Recently, several cases of drug-eluting stent fracture have been also reported. The mechanisms, the diagnosis, the clinical implications and the management of this new complication are not well-known. We report the observation of a new case of displaced, sirolimus drug-eluting stent fracture. To our knowledge, this is the first reported case in France.
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Affiliation(s)
- H Ben Salem
- Service de cardiologie, centre hospitalier de Gonesse, 25 rue Bernard-Février, Gonesse, France.
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43
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Ong SH, Mueller R, Boekstegers P. A ticking time bomb?: a case report of very late stent thrombosis more than 2 years after fracture of a Cypher stent. Clin Res Cardiol 2011; 100:951-3. [PMID: 21725857 DOI: 10.1007/s00392-011-0339-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2011] [Accepted: 06/20/2011] [Indexed: 11/30/2022]
Affiliation(s)
- Sea Hing Ong
- Department of Cardiology/Angiology, HELIOS Klinikum Siegburg, Medizinische Klinik-Kardiologie, Germany.
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Freixa X, Almasood AS, Khan SQ, Wainstein R, Osherov A, Mackie K, Seidelin PH, Džavík V. Decreased risk of stent fracture-related restenosis between paclitaxel-eluting stents and sirolimus eluting stents: Results of long-term follow-up. Catheter Cardiovasc Interv 2011; 79:559-65. [DOI: 10.1002/ccd.23031] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2010] [Accepted: 01/29/2011] [Indexed: 11/12/2022]
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45
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Almasood AS, Freixa X, Khan SQ, Seidelin PH, Džavík V. Stent fracture after everolimus-eluting stent implantation. Cardiol Res Pract 2011; 2011:320983. [PMID: 21559260 PMCID: PMC3087897 DOI: 10.4061/2011/320983] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2010] [Accepted: 02/06/2011] [Indexed: 11/20/2022] Open
Abstract
Compared with bare-metal stents, drug-eluting stents (DES) have greatly reduced the risk of in-stent restenosis (ISR) by inhibiting neointimal growth. Nevertheless, DES are still prone to device failure, which may lead to cardiac events. Recently, stent fracture (SF) has emerged as a potential mechanism of DES failure that is associated with ISR. Stent fracture is strongly related to stent type, and prior reports suggest that deployment of sirolimus eluting stents (SES) may be associated with a higher risk of SF compared to other DES. Everolimus eluting stents (EESs) represent a new generation of DES with promising results. The occurrence of SF with EES has not been well established. The present paper describes two cases of EES fracture associated with ISR.
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Affiliation(s)
- Ali S Almasood
- Interventional Cardiology Program, Division of Cardiology, Peter Munk Cardiac Centre, University Health Network, University of Toronto, 6-246 EN, Toronto General Hospital, 200 Elizabeth Street, Toronto, ON, Canada M5G 2C4
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46
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Abstract
Coronary stent fracture is a relatively uncommon and rare complication of stent implantation. The reported incidence of stent fracture among drug-eluting stents ranges from 1% to 8%. Since 2003, when the use of drug-eluding stents was approved by the FDA for the treatment of coronary atherosclerosis, a number of retrospective and prospective studies and case reports have been published. We reviewed these publications to determine the incidence, predictors, clinical implications, and different management strategies for drug-eluding stent fracture in the coronary arteries. A review of the literature showed that the risk for stent fracture was higher with right coronary artery location, increased vessel tortuosity and angulation prior to stenting, use of overlapping stents, and use of longer stents. A higher risk of bare metal stent fracture was reported in saphenous vein bypass grafts. The authors also report in this issue in the Department “Case Study” a symptomatic fracture of a sirolimus-eluding Cypher® stent in the mid-left anterior descending artery.
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Affiliation(s)
- Ravi N. Nair
- Ravi N. Nair, MD, Sones Cardiac Catheterization Laboratories, Cleveland Clinic, Cleveland, OH, USA
- Mumbai University, India. Lerner College of Medicine, Case Western Reserve University, Cleveland, OH. Kenneth Quadros, MBBS
| | - Kenneth Quadros
- Ravi N. Nair, MD, Sones Cardiac Catheterization Laboratories, Cleveland Clinic, Cleveland, OH, USA
- Mumbai University, India. Lerner College of Medicine, Case Western Reserve University, Cleveland, OH. Kenneth Quadros, MBBS
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Park KW, Park JJ, Chae IH, Seo JB, Yang HM, Lee HY, Kang HJ, Cho YS, Yeon TJ, Chung WY, Koo BK, Choi DJ, Oh BH, Park YB, Kim HS. Clinical characteristics of coronary drug-eluting stent fracture: insights from a two-center des registry. J Korean Med Sci 2011; 26:53-8. [PMID: 21218030 PMCID: PMC3012850 DOI: 10.3346/jkms.2011.26.1.53] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2010] [Accepted: 09/20/2010] [Indexed: 11/21/2022] Open
Abstract
Stent fracture (SF) has been implicated as a risk factor for in-stent restenosis, but its incidence and clinical characteristics are not well established. Therefore we investigated the conditions associated with stent fracture and its clinical presentation and outcome. Between 2004 and 2007, consecutive cases of SF were collected from the Seoul National University Hospital. Clinical characteristics and outcome of patients with fractured stents were compared with a ten-fold cohort of age and gender matched controls (n = 236). A total of 4,845 patients received percutaneous coronary intervention and 3,315 patients (68.4%) underwent angiographic follow-up. Twenty-eight fractured stents were observed in 24 patients. The incidence of SF was 0.89% for sirolimus-eluting stents (SES) and 0.09% for paclitaxel-eluting stents. Chronic kidney disease, stent implantation in the right coronary artery (RCA), and SES use were independent predictors of drug-eluting stent fracture by multivariate analysis. SF was significantly associated with binary restenosis (11.4% vs 41.7%, P < 0.001) and increased risk of target lesion revascularization (8.1% vs 33.3%, P = 0.001). Patients with SF but without significant restenosis showed excellent outcome despite only medical treatment. In conclusion, SF is associated with increased rates of restenosis and repeat revascularization. Significant risk factors include chronic kidney disease, RCA intervention, and SES use.
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Affiliation(s)
- Kyung Woo Park
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, Korea
| | - Jin Joo Park
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, Korea
| | - In-Ho Chae
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Jae-Bin Seo
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, Korea
| | - Han-Mo Yang
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, Korea
| | - Hae-Young Lee
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, Korea
| | - Hyun-Jae Kang
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, Korea
| | - Young-Seok Cho
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Tae-Jin Yeon
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Woo-Young Chung
- Department of Internal Medicine, Boramae Medical Center, Seoul, Korea
| | - Bon-Kwon Koo
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, Korea
| | - Dong-Ju Choi
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Byung-Hee Oh
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, Korea
| | - Young-Bae Park
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, Korea
| | - Hyo-Soo Kim
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, Korea
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Serikawa T, Kawasaki T, Koga H, Orita Y, Ikeda S, Goto Y, Shintani Y, Kajiwara M, Tanaka H, Fukuyama T, Koga N. Late catch-up phenomenon associated with stent fracture after sirolimus-eluting stent implantation: incidence and outcome. J Interv Cardiol 2010; 24:165-71. [PMID: 21198850 DOI: 10.1111/j.1540-8183.2010.00614.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To examine the long-term outcome of the stent fracture (SF) and the potential predictive factors contributing to in-stent restenosis (ISR) in the fractured stent. BACKGROUND The SF is thought to be a higher risk of ISR in drug-eluting stent, although SF does not always develop ISR. METHODS The consecutive 1,228 de novo lesions in 1,079 patients who underwent sirolimus-eluting stents implantation and assessed by 8 months follow-up coronary angiography were retrospectively analyzed. RESULTS One hundred and seventeen SFs (9.5%) were identified in 100 patients and 22 (18.8%) SFs revealed ISR at the first follow-up. In addition, 16 (13.7%) developed new ISRs from 95 residual SFs without ISR prior to the second follow-up. Overall, 38 (32.5%) of all 117 SFs developed ISR, and 16 (42.1%) of 38 SFs occurred in a late phase beyond the first 8 months follow-up. A higher risk of ISR in the SF site was associated with the chronic total occlusion (ISR vs. no ISR: 34.2% vs. 16.5%, P = 0.0304), calcified lesions (55.3% vs. 34.2%, P = 0.0299), and correspondence 89.5% versus 43.0%, P < 0.0001 (SF site occurring at the original target lesion site) in the univariate analysis. The correspondence was identified as the only strong predictive factor for ISR at the SF site according to a multivariate logistic regression analysis (odds ratio 12.6, 95% confidence interval 3.82-53.5, P < 0.0001). CONCLUSIONS SF occurring at the site of the original target lesion was a strong independent predictor of ISR. This indicates the need for a careful, long-term follow-up in those situations, even when no significant ISR is initially detected.
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Chakravarty T, White AJ, Buch M, Naik H, Doctor N, Schapira J, Kar S, Forrester JS, Weiss RE, Makkar R. Meta-analysis of incidence, clinical characteristics and implications of stent fracture. Am J Cardiol 2010; 106:1075-80. [PMID: 20920641 DOI: 10.1016/j.amjcard.2010.06.010] [Citation(s) in RCA: 86] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2010] [Revised: 06/05/2010] [Accepted: 06/05/2010] [Indexed: 11/25/2022]
Abstract
A meta-analysis of published studies was conducted to evaluate the incidence, predictors, and clinical outcomes of stent fractures. Eight studies with 108 stent fractures in 5,321 patients were analyzed using the Bayesian method. Study end points included in-stent restenosis (ISR) and target lesion revascularization (TLR). The mean incidence of stent fracture per patient was 4.0% (95% confidence interval 0.4% to 16.3%). All cases, except 1, were reported with sirolimus-eluting stents. The incidence of stent fracture was 30.4% in the left anterior descending coronary artery, 10.9% in the left circumflex coronary artery, 56.4% in the right coronary artery, < 0.01% in the left main coronary artery, and 1.7% in saphenous vein grafts. The probability of stent fracture was significantly higher in the right coronary artery than in the left anterior descending and left circumflex lesions (p < 0.01). Left main stents were less likely to fracture compared to those in all other vessels (p < 0.01). The probability of stent fracture was significantly increased in overlapping stents (7.5% vs 2.1%, p = 0.01) and long stents (46 vs 32.5 mm, p < 0.01). Lesions with stent fractures had higher rates of ISR (38% vs 8.2%, p < 0.01) and TLR (17% vs 5.6%, p < 0.01). Conversely, the probability of stent fractures was higher in patients with ISR (12.8% vs 2.1%, p < 0.01) and TLR (8.8% vs 2.7%, p < 0.01). In conclusion, although not always associated with clinical sequelae, the probability of ISR and TLR is increased with stent fracture. Conversely, the probability of stent fractures is increased in lesions with ISR or TLR, thus raising the need for surveillance and management guidelines for at-risk patients.
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