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A scoring system to predict the occurrence of very late stent thrombosis following percutaneous coronary intervention for acute coronary syndrome. Sci Rep 2020; 10:6378. [PMID: 32286484 PMCID: PMC7156476 DOI: 10.1038/s41598-020-63455-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Accepted: 03/31/2020] [Indexed: 02/05/2023] Open
Abstract
We aimed to derive and validate an effective risk score to identify high-risk patients of very late stent thrombosis (VLST), following percutaneous coronary intervention (PCI) for acute coronary syndrome (ACS). Stepwise multivariable Cox regression was used to build the risk model using data from 5,185 consecutive ACS patients treated with PCI (derivation cohort) and 2,058 patients from the external validation cohort. Eight variables were independently associated with the development of VLST: history of diabetes mellitus, previous PCI, acute myocardial infarction as admitting diagnosis, estimated glomerular filtration rate <90 ml/min/1.73 m2, three-vessel disease, number of stents per lesion, sirolimus-eluting stent, and no post-dilation. Based on the derived score, patients were classified into low- (≤7), intermediate- (8-9), and high- (≥10) risk categories. Observed VLST rates were 0.5%, 2.2%, and 8.7% and 0.45%, 2.3%, and 9.3% across the 3 risk categories in the derivation and validation cohorts, respectively. High discrimination (c-statistic = 0.80 and 0.82 in the derivation and validation cohorts, respectively) and excellent calibration were observed in both cohorts. VLST risk score, a readily useable and efficient tool to identify high-risk patients of VLST after PCI for ACS, may aid in risk-stratification and pre-emptive decision-making.
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Ali ZA, Karimi Galougahi K, Shlofmitz RA, Mintz GS. The "Oculo-Appositional Reflex": Should Optical Coherence Tomography-Detected Stent Malapposition Be Corrected? J Am Heart Assoc 2019; 8:e012262. [PMID: 30907208 PMCID: PMC6509721 DOI: 10.1161/jaha.119.012262] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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
See Article by Im et al
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Affiliation(s)
- Ziad A Ali
- 1 Division of Cardiology Center for Interventional Vascular Therapy Presbyterian Hospital and Columbia University New York NY.,2 Cardiovascular Research Foundation New York NY
| | - Keyvan Karimi Galougahi
- 1 Division of Cardiology Center for Interventional Vascular Therapy Presbyterian Hospital and Columbia University New York NY.,2 Cardiovascular Research Foundation New York NY.,3 Department of Cardiovascular Medicine University of Sydney Australia
| | | | - Gary S Mintz
- 2 Cardiovascular Research Foundation New York NY
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Holm NR, Andreasen LN, Walsh S, Kajander OA, Witt N, Eek C, Knaapen P, Koltowski L, Gutiérrez-Chico JL, Burzotta F, Kockman J, Ormiston J, Santos-Pardo I, Laanmets P, Mylotte D, Madsen M, Hjort J, Kumsars I, Råmunddal T, Christiansen EH. Rational and design of the European randomized Optical Coherence Tomography Optimized Bifurcation Event Reduction Trial (OCTOBER). Am Heart J 2018; 205:97-109. [PMID: 30205242 DOI: 10.1016/j.ahj.2018.08.003] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Accepted: 08/09/2018] [Indexed: 12/16/2022]
Abstract
Background Percutaneous coronary intervention in complex bifurcation lesions is prone to suboptimal implantation results and is associated with increased risk of subsequent clinical events. Angiographic ambiguity is high during bifurcation stenting, but it is unknown if procedural guidance by intravascular optical coherence tomography (OCT) improves clinical outcome. Methods and Design OCTOBER is a randomized, investigator-initiated, multicenter trial aimed to show superiority of OCT-guided stent implantation compared to standard angiographic-guided implantation in bifurcation lesions. The primary outcome measure is a 2-year composite end point of cardiac death, target lesion myocardial infarction, and ischemia-driven target lesion revascularization. The calculated sample size is 1,200 patients in total, and allocation is 1:1. Eligible patients have stable or unstable angina pectoris or stabilized non–ST elevation myocardial infarction, and a coronary bifurcation lesion with significant main vessel stenosis and more than 50 % stenosis in a side branch with a reference diameter ≥2.5mm. Treatment is performed by the provisional side branch stenting technique or 2-stent techniques, and the systematic OCT guiding protocol is aimed to evaluate (1) plaque preparation, (2) lesion length, (3) segmental reference sizes, (4) lesion coverage, (5) stent expansion, (6) malapposition, (7) wire positions, and (8) ostial results. Implications A positive outcome of the OCTOBER trial may establish OCT as a routine tool for optimization of complex percutaneous coronary intervention, whereas a negative result would indicate that OCT remains a tool for ad hoc evaluation in selected cases.
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Differences between first-generation and second-generation drug-eluting stent regarding in-stent neoatherosclerosis characteristics: an optical coherence tomography analysis. Int J Cardiovasc Imaging 2018; 34:1521-1528. [DOI: 10.1007/s10554-018-1375-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Accepted: 05/16/2018] [Indexed: 10/16/2022]
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Fuentes L, Gómez-Lara J, Salvatella N, Gonzalo N, Hernández-Hernández F, Fernández-Nofrerias E, Sánchez-Recalde Á, Alfonso F, Romaguera R, Ferreiro JL, Roura G, Teruel L, Gracida M, Marcano AL, Gómez-Hospital JA, Cequier Á. Hallazgos por IVUS en trombosis de stent tardía y muy tardía. Comparación entre stents metálicos y farmacoactivos. Rev Esp Cardiol 2018. [DOI: 10.1016/j.recesp.2017.07.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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7
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Fuentes L, Gómez-Lara J, Salvatella N, Gonzalo N, Hernández-Hernández F, Fernández-Nofrerias E, Sánchez-Recalde Á, Alfonso F, Romaguera R, Ferreiro JL, Roura G, Teruel L, Gracida M, Marcano AL, Gómez-Hospital JA, Cequier Á. IVUS Findings in Late and Very Late Stent Thrombosis. A Comparison Between Bare-metal and Drug-eluting Stents. ACTA ACUST UNITED AC 2017; 71:335-343. [PMID: 28870640 DOI: 10.1016/j.rec.2017.08.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Accepted: 07/18/2017] [Indexed: 11/17/2022]
Abstract
INTRODUCTION AND OBJECTIVES Stent thrombosis (ST) is a life-threatening complication after stent implantation. Intravascular ultrasound is able to discern most causes of ST. The aim of this study was to compare intravascular ultrasound findings between bare-metal stents (BMS) and drug-eluting stents (DES) in patients with late (31 days to 1 year) or very late ST (> 1 year). METHODS Of 250 consecutive patients with late or very late ST in 7 Spanish institutions, 114 patients (45.5% BMS and 54.5% DES) were imaged with intravascular ultrasound. Off-line intravascular ultrasound analysis was performed to assess malapposition, underexpansion, and neoatherosclerosis. RESULTS The median time from stent implantation to ST was 4.0 years with BMS and 3.4 years with DES (P = .04). Isolated malapposition was similarly observed in both groups (36.5% vs 46.8%; P = .18) but was numerically lower with BMS (26.6% vs 48.0%; P = .07) in patients with very late ST. Isolated underexpansion was similarly observed in both groups (13.5% vs 11.3%; P = .47). Isolated neoatherosclerosis occurred only in patients with very late ST and was more prevalent with BMS (22.9%) than with DES (6.0%); P = .02. At 2.9 years' follow-up, there were 0% and 6.9% cardiac deaths, respectively (P = .06) and recurrent ST occurred in 4.0% and 5.2% of patients, respectively (P = .60). CONCLUSIONS Malapposition was the most common finding in patients with late and very late ST and is more prevalent with DES in very late ST. In contrast, neoatherosclerosis was exclusively observed in patients with very late ST and mainly with BMS.
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Affiliation(s)
- Lara Fuentes
- Departamento de Cardiología Intervencionista, Hospital Universitari de Bellvitge, Institut d' Investigació Biomèdica de Bellvitge (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain.
| | - Josep Gómez-Lara
- Departamento de Cardiología Intervencionista, Hospital Universitari de Bellvitge, Institut d' Investigació Biomèdica de Bellvitge (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain
| | - Neus Salvatella
- Departamento de Cardiología Intervencionista, Hospital del Mar, Barcelona, Spain
| | - Nieves Gonzalo
- Departamento de Cardiología Intervencionista, Hospital Clínico San Carlos, Madrid, Spain
| | | | - Eduard Fernández-Nofrerias
- Departamento de Cardiología Intervencionista, Hospital Germans Trias i Pujol, Badalona, Barcelona, Spain
| | | | - Fernando Alfonso
- Departamento de Cardiología Intervencionista, Hospital de La Princesa, Madrid, Spain
| | - Rafael Romaguera
- Departamento de Cardiología Intervencionista, Hospital Universitari de Bellvitge, Institut d' Investigació Biomèdica de Bellvitge (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain
| | - José Luis Ferreiro
- Departamento de Cardiología Intervencionista, Hospital Universitari de Bellvitge, Institut d' Investigació Biomèdica de Bellvitge (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain
| | - Gerard Roura
- Departamento de Cardiología Intervencionista, Hospital Universitari de Bellvitge, Institut d' Investigació Biomèdica de Bellvitge (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain
| | - Luis Teruel
- Departamento de Cardiología Intervencionista, Hospital Universitari de Bellvitge, Institut d' Investigació Biomèdica de Bellvitge (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain
| | - Montserrat Gracida
- Departamento de Cardiología Intervencionista, Hospital Universitari de Bellvitge, Institut d' Investigació Biomèdica de Bellvitge (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain
| | - Ana Lucrecia Marcano
- Departamento de Cardiología Intervencionista, Hospital Universitari de Bellvitge, Institut d' Investigació Biomèdica de Bellvitge (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain
| | - Joan-Antoni Gómez-Hospital
- Departamento de Cardiología Intervencionista, Hospital Universitari de Bellvitge, Institut d' Investigació Biomèdica de Bellvitge (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain
| | - Ángel Cequier
- Departamento de Cardiología Intervencionista, Hospital Universitari de Bellvitge, Institut d' Investigació Biomèdica de Bellvitge (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain
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Kikuchi T, Ishii A, Chihara H, Arai D, Ando M, Takenobu Y, Okada T, Takagi Y, Miyamoto S. Occlusion Status on Magnetic Resonance Angiography Is Associated with Risk of Delayed Ischemic Events in Cerebral Aneurysms Treated with Stent-Assisted Coiling. World Neurosurg 2017; 107:226-232. [PMID: 28826708 DOI: 10.1016/j.wneu.2017.07.161] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Revised: 07/25/2017] [Accepted: 07/27/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Management after stent-assisted coiling (SAC) for unruptured intracranial aneurysm is sometimes difficult because close monitoring for ischemic events for a long period of time after the procedure is necessary. The purpose of this study was to clarify the usefulness of magnetic resonance angiography (MRA) at follow-up after SAC. METHODS Sixty-six consecutive cases of SAC for unruptured intracranial aneurysm in our institute and affiliated hospitals were retrospectively reviewed for a delayed ischemic event. Occlusion status of the aneurysm and stent apposition on time-of-flight (TOF)-MRA, patient demographics, and characteristics of the aneurysms were analyzed for a possible relationship to delayed ischemic events. RESULTS Over a median follow-up of 755 days, 14 patients had delayed ischemic events after a median follow-up of 230.5 days. All of the ischemic events were transient or asymptomatic. Univariate analysis revealed that the history of hypertension (P = 0.042) and the occlusion status of the aneurysm (P = 0.006) were significantly associated with delayed ischemic events. Multivariate analysis indicated that dome filling had a hazard ratio of 4.96 (95% confidence interval [CI], 1.30-23.60) and 3.74 (95% CI, 1.10-13.34), compared with neck remnant and complete obliteration, respectively. Six of 7 patients who had persistent dome filling during follow-up developed a delayed ischemic event. CONCLUSIONS In this preliminary study, dome filling on follow-up TOF-MRA is a possible risk factor for delayed ischemic events. TOF-MRA could be a modality for tailored management after SAC.
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Affiliation(s)
- Takayuki Kikuchi
- Department of Neurosurgery, Kyoto University Graduate School of Medicine, Kyoto, Japan.
| | - Akira Ishii
- Department of Neurosurgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Hideo Chihara
- Department of Neurosurgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Daisuke Arai
- Department of Neurosurgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Mitsushige Ando
- Department of Neurosurgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Yohei Takenobu
- Department of Neurosurgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Tomohisa Okada
- Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Yasushi Takagi
- Department of Neurosurgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Susumu Miyamoto
- Department of Neurosurgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
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Iannaccone M, D'Ascenzo F, Templin C, Omedè P, Montefusco A, Guagliumi G, Serruys PW, Di Mario C, Kochman J, Quadri G, Biondi-Zoccai G, Lüscher TF, Moretti C, D'amico M, Gaita F, Stone GW. Optical coherence tomography evaluation of intermediate-term healing of different stent types: systemic review and meta-analysis. Eur Heart J Cardiovasc Imaging 2017; 18:159-166. [PMID: 27099274 DOI: 10.1093/ehjci/jew070] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Accepted: 03/09/2016] [Indexed: 02/05/2023] Open
Abstract
AIMS The intermediate-term incidence of strut malapposition (SM) and uncovered struts (US), and the degree of neointimal thickness (NIT) according to stent type have not been characterized. METHODS AND RESULTS All studies of >50 patients in which optical coherence tomography was performed between 6 and 12 months after stent implantation were included. The incidences of SM and US were the co-primary end points, while NIT was the secondary end point. A total of 458 citations were initially appraised at the abstract level, and 11 full-text studies (280 652 analysed struts, 921 patients) were assessed. The 6-12 months incidences of SM and US were 5.0 and 7.8%, respectively, and the mean NIT was 206 μm. Biolimus-eluting stents (BES) and bioresorbable vascular scaffolds (BVS) had the highest SM rates (2.7 and 3.8%, respectively), while everolimus-eluting stents (EES) and fast-release zotarolimus-eluting stents (ZES) had the lowest SM rates (0.9 and 0.1%, respectively). BES and sirolimus-eluting stents (SES) had the highest US rates (7.7 and 8.8%, respectively), while bare metal stents (BMS) and ZES had the lowest US rates (0.3 and 0.3%, respectively). BMS had the greatest NIT (340 μm), while SES, EES, and BES had the least NIT. CONCLUSION Second-generation drug-eluting stents (DES) have better intermediate-term strut apposition and coverage than first-generation DES, BVS, and BMS. EES demonstrate the overall best combination of healing with suppression of neointimal hyperplasia at 6-12 months. Further studies with clinical correlation are warranted to determine the implications of these findings.
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Affiliation(s)
- Mario Iannaccone
- Division of Cardiology, Città Della Salute e Della Scienza, Turin, Italy
| | - Fabrizio D'Ascenzo
- Division of Cardiology, Città Della Salute e Della Scienza, Turin, Italy
| | - Christian Templin
- University Heart Center, Cardiology, University Hospital, Zurich, Switzerland
| | - Pierluigi Omedè
- Division of Cardiology, Città Della Salute e Della Scienza, Turin, Italy
| | - Antonio Montefusco
- Division of Cardiology, Città Della Salute e Della Scienza, Turin, Italy
| | - Giulio Guagliumi
- Cardiovascular Department, Ospedali Riuniti di Bergamo, Bergamo, Italy
| | - Patrick W Serruys
- Department of Interventional Cardiology, Erasmus University Medical Centre, Thoraxcenter, Rotterdam, The Netherlands
| | - Carlo Di Mario
- National Institute of Health Research Cardiovascular Biomedical Research Unit, Royal Brompton & Harefield NHS Foundation Trust, London, UK
| | - Janusz Kochman
- Department of Cardiology, Warsaw Medical University, Warszawa, Poland
| | - Giorgio Quadri
- Division of Cardiology, Città Della Salute e Della Scienza, Turin, Italy
| | - Giuseppe Biondi-Zoccai
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy
| | - Thomas F Lüscher
- University Heart Center, Cardiology, University Hospital, Zurich, Switzerland
| | - Claudio Moretti
- Division of Cardiology, Città Della Salute e Della Scienza, Turin, Italy
| | - Maurizio D'amico
- Division of Cardiology, Città Della Salute e Della Scienza, Turin, Italy
| | - Fiorenzo Gaita
- Division of Cardiology, Città Della Salute e Della Scienza, Turin, Italy
| | - Gregg W Stone
- Division of Cardiology, Columbia University Medical Center, New York, NY, USA
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Mitomo S, Naganuma T, Fujino Y, Kawamoto H, Basavarajaiah S, Pitt M, Yin WH, Tresukosol D, Colombo A, Nakamura S. Bioresorbable Vascular Scaffolds for the Treatment of Chronic Total Occlusions: An International Multicenter Registry. Circ Cardiovasc Interv 2017; 10:CIRCINTERVENTIONS.116.004265. [PMID: 28069611 DOI: 10.1161/circinterventions.116.004265] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Accepted: 12/09/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND There are only limited studies reporting clinical outcomes after bioresorbable vascular scaffold (BVS; Absorb; Abbott Vascular, Santa Clara, CA) implantation for coronary chronic total occlusions (CTO). The aim of this study was to evaluate the real-world feasibility and safety of BVS implantation for the treatment of CTO. METHODS AND RESULTS We retrospectively evaluated CTO cases treated with BVS from a multicenter registry. The primary end point was target lesion failure defined as a composite of cardiac death, target vessel myocardial infarction, and clinically driven target lesion revascularization. From September 2012 to November 2015, 65 patients with CTO were successfully treated with BVS. The mean age of patients was 60.8±11.0 years; 89.2% were male and 40.0% diabetic. The mean ejection fraction was 57.7±10.8%. The mean reference vessel diameter and CTO lesion length were 3.0±0.4 and 20.2±3.0 mm, respectively. The mean number of BVS deployed per patient was 1.8±0.7, of which mean diameter and total length were 3.0±0.4 and 47.6±19.9 mm, respectively. Postdilatation with noncompliant balloons (mean diameter 3.3±0.3 mm) was performed at high pressures (18.6±5.3 atm) in all cases. Intravascular ultrasound (n=34) or optical coherence tomography (n=31) was performed in all cases. During the follow-up period (median: 453 days, 25th and 75th percentiles: 230 and 703), there were no occurrences of target lesion failure or scaffold thrombosis. CONCLUSIONS BVS implantation for the treatment of CTO seems feasible and safe. Appropriate lesion preparation, high-pressure postdilatation, and the use of intravascular imaging are recommended to obtain the best possible final result.
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Affiliation(s)
- Satoru Mitomo
- From the Department of Cardiology, New Tokyo Hospital, Chiba, Japan (S.M., T.N., Y.F., H.K., S.N.); Department of Interventional Cardiology, Heart of England NHS Trust, Birmingham, United Kingdom (S.B., M.P.); Division of Cardiology, Cheng Hsin Geneal Hospital, Taipei, Taiwan (W.-H.Y.); Division of Cardiology, Siriraj Hospital, Bangkok, Thailand (D.T.); Interventional Cardiology Unit, EMO-GVM Centro Cuore Columbus, Milan, Italy (H.K., A.C.); and Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy (H.K., A.C.)
| | - Toru Naganuma
- From the Department of Cardiology, New Tokyo Hospital, Chiba, Japan (S.M., T.N., Y.F., H.K., S.N.); Department of Interventional Cardiology, Heart of England NHS Trust, Birmingham, United Kingdom (S.B., M.P.); Division of Cardiology, Cheng Hsin Geneal Hospital, Taipei, Taiwan (W.-H.Y.); Division of Cardiology, Siriraj Hospital, Bangkok, Thailand (D.T.); Interventional Cardiology Unit, EMO-GVM Centro Cuore Columbus, Milan, Italy (H.K., A.C.); and Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy (H.K., A.C.)
| | - Yusuke Fujino
- From the Department of Cardiology, New Tokyo Hospital, Chiba, Japan (S.M., T.N., Y.F., H.K., S.N.); Department of Interventional Cardiology, Heart of England NHS Trust, Birmingham, United Kingdom (S.B., M.P.); Division of Cardiology, Cheng Hsin Geneal Hospital, Taipei, Taiwan (W.-H.Y.); Division of Cardiology, Siriraj Hospital, Bangkok, Thailand (D.T.); Interventional Cardiology Unit, EMO-GVM Centro Cuore Columbus, Milan, Italy (H.K., A.C.); and Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy (H.K., A.C.)
| | - Hiroyoshi Kawamoto
- From the Department of Cardiology, New Tokyo Hospital, Chiba, Japan (S.M., T.N., Y.F., H.K., S.N.); Department of Interventional Cardiology, Heart of England NHS Trust, Birmingham, United Kingdom (S.B., M.P.); Division of Cardiology, Cheng Hsin Geneal Hospital, Taipei, Taiwan (W.-H.Y.); Division of Cardiology, Siriraj Hospital, Bangkok, Thailand (D.T.); Interventional Cardiology Unit, EMO-GVM Centro Cuore Columbus, Milan, Italy (H.K., A.C.); and Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy (H.K., A.C.)
| | - Sandeep Basavarajaiah
- From the Department of Cardiology, New Tokyo Hospital, Chiba, Japan (S.M., T.N., Y.F., H.K., S.N.); Department of Interventional Cardiology, Heart of England NHS Trust, Birmingham, United Kingdom (S.B., M.P.); Division of Cardiology, Cheng Hsin Geneal Hospital, Taipei, Taiwan (W.-H.Y.); Division of Cardiology, Siriraj Hospital, Bangkok, Thailand (D.T.); Interventional Cardiology Unit, EMO-GVM Centro Cuore Columbus, Milan, Italy (H.K., A.C.); and Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy (H.K., A.C.)
| | - Michael Pitt
- From the Department of Cardiology, New Tokyo Hospital, Chiba, Japan (S.M., T.N., Y.F., H.K., S.N.); Department of Interventional Cardiology, Heart of England NHS Trust, Birmingham, United Kingdom (S.B., M.P.); Division of Cardiology, Cheng Hsin Geneal Hospital, Taipei, Taiwan (W.-H.Y.); Division of Cardiology, Siriraj Hospital, Bangkok, Thailand (D.T.); Interventional Cardiology Unit, EMO-GVM Centro Cuore Columbus, Milan, Italy (H.K., A.C.); and Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy (H.K., A.C.)
| | - Wei-Hsian Yin
- From the Department of Cardiology, New Tokyo Hospital, Chiba, Japan (S.M., T.N., Y.F., H.K., S.N.); Department of Interventional Cardiology, Heart of England NHS Trust, Birmingham, United Kingdom (S.B., M.P.); Division of Cardiology, Cheng Hsin Geneal Hospital, Taipei, Taiwan (W.-H.Y.); Division of Cardiology, Siriraj Hospital, Bangkok, Thailand (D.T.); Interventional Cardiology Unit, EMO-GVM Centro Cuore Columbus, Milan, Italy (H.K., A.C.); and Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy (H.K., A.C.)
| | - Damras Tresukosol
- From the Department of Cardiology, New Tokyo Hospital, Chiba, Japan (S.M., T.N., Y.F., H.K., S.N.); Department of Interventional Cardiology, Heart of England NHS Trust, Birmingham, United Kingdom (S.B., M.P.); Division of Cardiology, Cheng Hsin Geneal Hospital, Taipei, Taiwan (W.-H.Y.); Division of Cardiology, Siriraj Hospital, Bangkok, Thailand (D.T.); Interventional Cardiology Unit, EMO-GVM Centro Cuore Columbus, Milan, Italy (H.K., A.C.); and Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy (H.K., A.C.)
| | - Antonio Colombo
- From the Department of Cardiology, New Tokyo Hospital, Chiba, Japan (S.M., T.N., Y.F., H.K., S.N.); Department of Interventional Cardiology, Heart of England NHS Trust, Birmingham, United Kingdom (S.B., M.P.); Division of Cardiology, Cheng Hsin Geneal Hospital, Taipei, Taiwan (W.-H.Y.); Division of Cardiology, Siriraj Hospital, Bangkok, Thailand (D.T.); Interventional Cardiology Unit, EMO-GVM Centro Cuore Columbus, Milan, Italy (H.K., A.C.); and Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy (H.K., A.C.)
| | - Sunao Nakamura
- From the Department of Cardiology, New Tokyo Hospital, Chiba, Japan (S.M., T.N., Y.F., H.K., S.N.); Department of Interventional Cardiology, Heart of England NHS Trust, Birmingham, United Kingdom (S.B., M.P.); Division of Cardiology, Cheng Hsin Geneal Hospital, Taipei, Taiwan (W.-H.Y.); Division of Cardiology, Siriraj Hospital, Bangkok, Thailand (D.T.); Interventional Cardiology Unit, EMO-GVM Centro Cuore Columbus, Milan, Italy (H.K., A.C.); and Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy (H.K., A.C.).
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Morofuji T, Inaba S, Aisu H, Takahashi K, Saito M, Higashi H, Yoshii T, Sumimoto T. Heterogeneous Intravascular Ultrasound Findings of Stent Thrombosis. Intern Med 2017; 56:259-268. [PMID: 28154268 PMCID: PMC5348448 DOI: 10.2169/internalmedicine.56.7093] [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: 01/21/2023] Open
Abstract
Objective The underlying mechanisms of stent thrombosis are not completely understood. Methods We experienced 12 definite stent thrombosis cases (1 early, 1 late, and 10 very late) at our hospital from July 2011 to April 2016 and evaluated the possible causes of stent thrombosis by intravascular ultrasound (IVUS). Results Five different potential morphological causes of stent thrombosis (neoatherosclerosis, stent malapposition, stent fracture, edge dissection, and stent underexpansion) were detected by IVUS in 10 cases (83.3%); in 1 of the remaining 2 cases, the discontinuation of antithrombotic drugs resulted in early stent thrombosis without abnormal IVUS findings. Of the 12 stent thrombosis cases, 4 occurred at a bare-metal stent (average time from stent implantation, 106 months); in all 12, significant neointimal hyperplasia was observed on IVUS, and 2 had plaque ruptures at an in-stent or proximal reference. Malapposed stent struts were observed in three very-late stent thromboses, and all of these underwent sirolimus-eluting stent implantation. Stent thrombosis due to mechanical (stent fracture) or procedure-related complications (edge dissection and stent underexpansion) was observed in three cases. Conclusion In patients with stent thrombosis, heterogeneous findings were observed in IVUS. This IVUS case series illustrates the possible mechanisms of stent thrombosis.
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Affiliation(s)
- Toru Morofuji
- Department of Cardiology, Kitaishikai Hospital, Japan
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12
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Gomez-Lara J, Salvatella N, Gonzalo N, Hernández-Hernández F, Fernandez-Nofrerias E, Sánchez-Recalde A, Bastante T, Marcano A, Romaguera R, Ferreiro JL, Roura G, Teruel L, Ariza-Solé A, Miranda-Guardiola F, Rodríguez García-Abad V, Gomez-Hospital JA, Alfonso F, Cequier A. IVUS-guided treatment strategies for definite late and very late stent thrombosis. EUROINTERVENTION 2016; 12:e1355-e1365. [DOI: 10.4244/eijy15m12_08] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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13
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Grundeken MJ, Garcia-Garcia HM, Kumsars I, Lesiak M, Kayaert P, Dens J, Stella PR, de Winter RJ, Laak LL, Généreux P, Kaplan AV, Leon MB, Wykrzykowska JJ, Onuma Y, Serruys PW. Segmental comparison between a dedicated bifurcation stent and balloon angioplasty using intravascular ultrasound and three-dimensional quantitative coronary angiography: A subgroup analysis of the Tryton IDE randomized trial. Catheter Cardiovasc Interv 2016; 89:E53-E63. [DOI: 10.1002/ccd.26527] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Accepted: 02/27/2016] [Indexed: 11/11/2022]
Affiliation(s)
- Maik J. Grundeken
- The Heartcenter; Academic Medical Center - University of Amsterdam; Amsterdam The Netherlands
| | - Hector M. Garcia-Garcia
- Cardialysis B.V, Rotterdam; Rotterdam The Netherlands
- Thoraxcenter; Erasmus Medical Center; Rotterdam The Netherlands
| | | | - Maciej Lesiak
- Karol Marcinkowski University of Medical Sciences; Poznan Poland
| | | | - Jo Dens
- Department of Cardiology; ZOL Ziekenhuis Oost-Limburg; Genk Belgium
| | | | - Robbert J. de Winter
- The Heartcenter; Academic Medical Center - University of Amsterdam; Amsterdam The Netherlands
| | | | - Philippe Généreux
- Columbia University Medical Center/NewYork Presbyterian Hospital; New York New York
- Hôpital du Sacré-Coeur de Montréal; Montréal Québec Canada
| | - Aaron V. Kaplan
- Tryton Medical; Newton Massachusetts
- Dartmouth Medical School/Dartmouth-Hitchcock Medical Center; NH Lebanon
| | - Martin B. Leon
- Columbia University Medical Center/NewYork Presbyterian Hospital; New York New York
- Cardiovascular Research Foundation; New York New York
| | - Joanna J. Wykrzykowska
- The Heartcenter; Academic Medical Center - University of Amsterdam; Amsterdam The Netherlands
| | - Yoshinobu Onuma
- Thoraxcenter; Erasmus Medical Center; Rotterdam The Netherlands
- Cardialysis B.V, Rotterdam; Rotterdam The Netherlands
| | - Patrick W. Serruys
- International Centre for Circulatory Health, NHLI; Imperial College London; London United Kingdom
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14
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Mitomo S, Naganuma T, Takagi K, Costopoulos C, Nakamura S, Hozawa K, Kurita N, Tahara S, Ishiguro H, Nakamura S. Comparison between Plain Old Balloon Angioplasty and Drug-Eluting Stent Implantation for the Treatment of Stent Fracture. J Interv Cardiol 2015; 28:365-73. [DOI: 10.1111/joic.12215] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Affiliation(s)
- Satoru Mitomo
- Department of Cardiology; New Tokyo Hospital; Chiba Japan
| | - Toru Naganuma
- Department of Cardiology; New Tokyo Hospital; Chiba Japan
| | - Kensuke Takagi
- Department of Cardiology; New Tokyo Hospital; Chiba Japan
| | - Charis Costopoulos
- Division of Cardiovascular Medicine; University of Cambridge; Cambridge United Kingdom
| | | | - Koji Hozawa
- Department of Cardiology; New Tokyo Hospital; Chiba Japan
| | - Naoyuki Kurita
- Department of Cardiology; New Tokyo Hospital; Chiba Japan
| | - Satoko Tahara
- Department of Cardiology; New Tokyo Hospital; Chiba Japan
| | | | - Sunao Nakamura
- Department of Cardiology; New Tokyo Hospital; Chiba Japan
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15
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Honda Y, Muramatsu T, Ito Y, Sakai T, Hirano K, Yamawaki M, Araki M, Kobayashi N, Takimura H, Sakamoto Y, Mouri S, Tsutumi M, Takama T, Takafuji H, Tokuda T, Makino K. Impact of ultra-long second-generation drug-eluting stent implantation. Catheter Cardiovasc Interv 2015; 87:E44-53. [DOI: 10.1002/ccd.26010] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2014] [Revised: 04/08/2015] [Accepted: 04/11/2015] [Indexed: 11/06/2022]
Affiliation(s)
- Yohsuke Honda
- Saiseikai Yokohama City Eastern Hospital; Yokohama City Kanagawa Japan
| | - Toshiya Muramatsu
- Saiseikai Yokohama City Eastern Hospital; Yokohama City Kanagawa Japan
| | - Yoshiaki Ito
- Saiseikai Yokohama City Eastern Hospital; Yokohama City Kanagawa Japan
| | - Tsuyoshi Sakai
- Saiseikai Yokohama City Eastern Hospital; Yokohama City Kanagawa Japan
| | - Keisuke Hirano
- Saiseikai Yokohama City Eastern Hospital; Yokohama City Kanagawa Japan
| | - Masahiro Yamawaki
- Saiseikai Yokohama City Eastern Hospital; Yokohama City Kanagawa Japan
| | - Motoharu Araki
- Saiseikai Yokohama City Eastern Hospital; Yokohama City Kanagawa Japan
| | | | - Hideyuki Takimura
- Saiseikai Yokohama City Eastern Hospital; Yokohama City Kanagawa Japan
| | - Yasunari Sakamoto
- Saiseikai Yokohama City Eastern Hospital; Yokohama City Kanagawa Japan
| | - Shinsuke Mouri
- Saiseikai Yokohama City Eastern Hospital; Yokohama City Kanagawa Japan
| | - Masakazu Tsutumi
- Saiseikai Yokohama City Eastern Hospital; Yokohama City Kanagawa Japan
| | - Takuro Takama
- Saiseikai Yokohama City Eastern Hospital; Yokohama City Kanagawa Japan
| | - Hiroya Takafuji
- Saiseikai Yokohama City Eastern Hospital; Yokohama City Kanagawa Japan
| | - Takahiro Tokuda
- Saiseikai Yokohama City Eastern Hospital; Yokohama City Kanagawa Japan
| | - Kenji Makino
- Saiseikai Yokohama City Eastern Hospital; Yokohama City Kanagawa Japan
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16
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Lv J, Wu Y, Zhang X, Jing T, Zhang L, Tong S, Song Z, Wang M, Wang G, Chi L. Comparison of the safety and efficacy of biodegradable polymer drug-eluting stents versus durable polymer drug-eluting stents: a meta-analysis. Eur J Med Res 2015; 20:21. [PMID: 25889197 PMCID: PMC4403984 DOI: 10.1186/s40001-015-0110-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2014] [Accepted: 02/04/2015] [Indexed: 11/21/2022] Open
Abstract
Background A meta-analysis was conducted to assess the safety and efficacy of biodegradable polymer drug-eluting stents (BP-DESs). Methods PubMed, Science Direct, China National Knowledge Infrastructure, and Chongqing VIP databases were searched for randomized controlled trials comparing the safety and efficacy of BP-DESs versus durable polymer drug-eluting stents (DP-DESs). Efficacy included the prevalence of target lesion revascularization (TLR), target vessel revascularization (TVR), and late lumen loss (LLL), and safety of these stents at the end of follow-up for the selected research studies were compared. Results A total of 16 qualified original studies that addressed a total of 22,211 patients were included in this meta-analysis. In regard to efficacy, no statistically significant difference in TLR (odds ratio (OR) = 0.94, P = 0.30) or TVR (OR 1.01, P = 0.86) was observed between patients treated with BP-DESs and those with DP-DESs. However, there were significant differences in in-stent LLL (weighted mean difference [WMD] = −0.07, P = 0.005) and in-segment LLL (WMD = −0.03, P = 0.05) between patients treated with BP-DESs and with DP-DESs. In terms of safety, there was no significant difference in overall mortality (OR 0.97, P = 0.67), cardiac death (OR 0.99, P = 0.90), early stent thrombosis (ST) and late ST (OR 0.94, P = 0.76; OR 0.96, P = 0.73), or myocardial infarction (MI) (OR 0.99, P = 0.88) between patients treated with BP-DESs and with DP-DESs. However, there was a statistically significant difference in very late ST (OR 0.69, P = 0.007) between these two groups. In addition, the general trend of the rates of TVR and TLR of BP-DESs groups was lower than DP-DESs groups after a 1-year follow-up. Conclusion BP-DESs are safe, efficient, and exhibit superior performance to DP-DESs with respect to reducing the occurrence of very late ST and LLL. The general trend of the rates of TVR and TLR of BP-DESs groups was lower than DP-DESs groups after a 1-year follow-up.
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Affiliation(s)
- Jianfeng Lv
- Department of Cardiology, Southwest Hospital, Third Military Medical University, Gaotanyan Street, Shapingba District, Chongqing, 40038, China. .,Department of Cardiology, General Hospital of Ningxia Medical University, Shengli Street, Xingqing District, Yinchuan, 750004, China.
| | - Yazhou Wu
- Department of Health Statistics, Third Military Medical University, Gaotanyan Street, Shapingba District, Chongqing, 400038, China.
| | - Xingmei Zhang
- Department of Neurology, Fifth Hospital of the People's Liberation Army, Shengli Street, Xingqing District, Yinchuan, 750004, China.
| | - Tao Jing
- Department of Cardiology, Southwest Hospital, Third Military Medical University, Gaotanyan Street, Shapingba District, Chongqing, 40038, China.
| | - Li Zhang
- Department of Cardiology, General Hospital of Ningxia Medical University, Shengli Street, Xingqing District, Yinchuan, 750004, China.
| | - Shifei Tong
- Department of Cardiology, Southwest Hospital, Third Military Medical University, Gaotanyan Street, Shapingba District, Chongqing, 40038, China.
| | - Zhiyuan Song
- Department of Cardiology, Southwest Hospital, Third Military Medical University, Gaotanyan Street, Shapingba District, Chongqing, 40038, China.
| | - Mingli Wang
- Department of Cardiology, Southwest Hospital, Third Military Medical University, Gaotanyan Street, Shapingba District, Chongqing, 40038, China.
| | - Gang Wang
- Department of Cardiology, Southwest Hospital, Third Military Medical University, Gaotanyan Street, Shapingba District, Chongqing, 40038, China.
| | - Luxiang Chi
- Department of Cardiology, Southwest Hospital, Third Military Medical University, Gaotanyan Street, Shapingba District, Chongqing, 40038, China.
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17
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Kapnisis K, Constantinides G, Georgiou H, Cristea D, Gabor C, Munteanu D, Brott B, Anderson P, Lemons J, Anayiotos A. Multi-scale mechanical investigation of stainless steel and cobalt–chromium stents. J Mech Behav Biomed Mater 2014; 40:240-251. [DOI: 10.1016/j.jmbbm.2014.09.010] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2014] [Revised: 09/05/2014] [Accepted: 09/07/2014] [Indexed: 01/28/2023]
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18
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Yamaji K, Kubo S, Inoue K, Kadota K, Kuramitsu S, Shirai S, Ando K, Nobuyoshi M, Mitsudo K, Kimura T. Association of localized hypersensitivity and in-stent neoatherosclerosis with the very late drug-eluting stent thrombosis. PLoS One 2014; 9:e113870. [PMID: 25423451 PMCID: PMC4244219 DOI: 10.1371/journal.pone.0113870] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2014] [Accepted: 11/01/2014] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Localized hypersensitivity reaction, delayed arterial healing, and neoatherosclerosis inside the stent have been suggested as the underlying pathologic mechanisms of very late stent thrombosis (VLST) of drug-eluting stent (DES). The present study sought to explore the prevalence of inflammatory cell infiltrates and evidence for fragments of atherosclerotic plaques in the aspirated thrombi in patients with DES VLST. METHODS AND RESULTS From April 2004 to September 2012, 48 patients with stent thrombosis (ST) of DES underwent thrombus aspiration with retrieved material sufficient for the histopathologic analysis; early ST (EST, within 30 days): N = 17, late ST (LST, between 31 and 365 days): N = 7, and very late ST (VLST, >1 year): N = 24. Eosinophil fraction in the aspirated thrombi was significantly higher in patients with VLST (8.2±5.7%) as compared with those with EST (4.3±3.0%) and LST (5.5±3.8%) (P = 0.03). Eosinophil fraction in the aspirated thrombi was significantly higher in 12 VLST patients with angiographic peri-stent contrast staining (PSS) and/or incomplete stent apposition (ISA) by intravascular ultrasound than in 12 VLST patients without PSS or ISA (10.6±6.1% versus 5.8±4.1%, P = 0.03). Evidences for fragments of atherosclerotic plaques in the aspirated thrombi were observed only in 3 (13%) out of 24 patients with DES VLST. CONCLUSIONS Eosinophil fraction in the aspirated thrombi was significantly higher in patients with DES VLST as compared with those with EST and LST. Evidences for fragments of atherosclerotic plaques were relatively uncommon in patients with DES VLST.
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Affiliation(s)
- Kyohei Yamaji
- Division of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan
- * E-mail:
| | - Shunsuke Kubo
- Department of Cardiology, Kurashiki Central Hospital, Kurashiki, Japan
| | - Katsumi Inoue
- Division of Laboratory Medicine, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Kazushige Kadota
- Department of Cardiology, Kurashiki Central Hospital, Kurashiki, Japan
| | | | - Shinichi Shirai
- Division of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Kenji Ando
- Division of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan
| | | | - Kazuaki Mitsudo
- Department of Cardiology, Kurashiki Central Hospital, Kurashiki, Japan
| | - Takeshi Kimura
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
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19
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Mintz GS. Why are we so concerned with acute incomplete stent apposition? Eur Heart J Cardiovasc Imaging 2014; 16:110-1. [DOI: 10.1093/ehjci/jeu199] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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20
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Waksman R, Kirtane AJ, Torguson R, Cohen DJ, Ryan T, Räber L, Applegate R, Waxman S, Gordon P, Kaneshige K, Leon MB. Correlates and outcomes of late and very late drug-eluting stent thrombosis: results from DESERT (International Drug-Eluting Stent Event Registry of Thrombosis). JACC Cardiovasc Interv 2014; 7:1093-102. [PMID: 25240540 DOI: 10.1016/j.jcin.2014.04.017] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2014] [Accepted: 04/24/2014] [Indexed: 12/15/2022]
Abstract
OBJECTIVES The aim of this study was to identify clinical, procedural, and angiographic correlates of late/very late drug-eluting stent (DES) thrombosis as well as to determine the clinical outcomes of these events. BACKGROUND Late/very late DES thromboses are a poorly studied phenomenon, partly due to the relative infrequency of these events, even in large cohort studies. METHODS In the DESERT (International Drug-Eluting Stent Event Registry of Thrombosis), a retrospective, case-control registry, 492 cases of late/very late definite DES thrombosis from 21 international sites were matched in a 1:1 fashion with controls without stent thrombosis (ST). Controls were matched according to 2 criteria: same enrolling institution and date of initial DES implantation. Baseline and procedural variables were collected, and clinical follow-up was obtained for patients with ST as long as 1 year after the event. Offline quantitative coronary angiography was performed for a subset of 378 case-control pairs. RESULTS The majority of ST events occurred after 1 year (75%) and continued to occur for as long as 7.3 years. The clinical presentation of late/very late ST events was mainly myocardial infarction (66.7% ST-segment elevation myocardial infarction and 22.0% non-ST-segment elevation myocardial infarction); in-hospital mortality was 3.8%. A minority of patients (30%) with ST were receiving dual-antiplatelet therapy at the time of the event. Independent clinical correlates of late/very late ST were younger age, African-American race, current smoking, multivessel disease, longer stented length, overlapping stents, and percutaneous coronary intervention of vein graft lesions. Independent angiographic correlates for late/very late ST were lesions within the left anterior descending artery or a bypass graft, thrombus, and a larger residual diameter stenosis after the initial DES implantation. Despite the large sample of ST cases, all identified correlates of late/very late ST had weak associations with subsequent ST (all odds ratios <2.5). CONCLUSIONS Despite a large sample of ST cases and use of limited matching to maximize the identification of predictive factors associated with late/very late ST, the variables associated with the development of late/very late ST were only weakly predictive of subsequent events. Additionally, a relatively low observed mortality rate of ST in this series may reflect a different pathophysiology of these late/very late events compared with acute/subacute ST. (Drug Eluting Stent Registry of Thrombosis [DESERT]; NCT00812552).
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Affiliation(s)
- Ron Waksman
- MedStar Washington Hospital Center, Washington, DC.
| | - Ajay J Kirtane
- Columbia University Medical Center/New York-Presbyterian Hospital/Cardiovascular Research Foundation, New York, New York
| | | | - David J Cohen
- Saint Luke's Mid America Heart Institute, Kansas City, Kansas
| | | | - Lorenz Räber
- Swiss Cardiovascular Center, Bern University Hospital, Bern, Switzerland
| | | | - Sergio Waxman
- Lahey Clinic Medical Center, Burlington, Massachusetts
| | - Paul Gordon
- The Miriam Hospital, Providence, Rhode Island
| | | | - Martin B Leon
- Columbia University Medical Center/New York-Presbyterian Hospital/Cardiovascular Research Foundation, New York, New York
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21
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Mamas MA, Foin N, Abunassar C, Khan MA, Di Mario C, Fraser DG. Stent fracture: Insights on mechanisms, treatments, and outcomes from the food and drug administration manufacturer and user facility device experience database. Catheter Cardiovasc Interv 2014; 83:E251-9. [DOI: 10.1002/ccd.25423] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2013] [Revised: 01/08/2014] [Accepted: 02/05/2014] [Indexed: 11/10/2022]
Affiliation(s)
- Mamas A. Mamas
- Cardiovascular Institute; University of Manchester; Manchester United Kingdom
- Manchester Heart Centre; Manchester Royal Infirmary; United Kingdom
| | | | | | - Muhammad A. Khan
- Cardiovascular Institute; University of Manchester; Manchester United Kingdom
- Manchester Heart Centre; Manchester Royal Infirmary; United Kingdom
| | - Carlo Di Mario
- Cardiovascular Biomedical Research Unit Royal Brompton Hospital; London United Kingdom
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22
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Attizzani GF, Capodanno D, Ohno Y, Tamburino C. Mechanisms, pathophysiology, and clinical aspects of incomplete stent apposition. J Am Coll Cardiol 2014; 63:1355-67. [PMID: 24530675 DOI: 10.1016/j.jacc.2014.01.019] [Citation(s) in RCA: 93] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2013] [Revised: 12/12/2013] [Accepted: 01/07/2014] [Indexed: 11/25/2022]
Abstract
Incomplete stent apposition (ISA) is characterized by the lack of contact of at least 1 stent strut with the vessel wall in a segment not overlying a side branch; it is more commonly found in drug-eluting stents than bare-metal stents. The accurate diagnosis of ISA, initially only possible with intravascular ultrasound, can currently be performed with higher accuracy by optical coherence tomography, which also enables strut-level assessment due to its higher axial resolution. Different circumstances related both to the index procedure and to vascular healing might influence ISA occurrence. Although several histopathology and clinical studies linked ISA to stent thrombosis, potential selection bias precluded definitive conclusions. Initial studies usually performed single time point assessments comparing overall ISA percentage and magnitude in different groups (i.e., stent type), thus hampering a comprehensive understanding of its relationship with vascular healing. Serial intravascular imaging studies that evaluated vascular response heterogeneity recently helped fill this gap. Some particular clinical scenarios such as acute coronary syndromes, bifurcations, tapered vessels, overlapping stents, and chronic total occlusions might predispose to ISA. Interventional cardiologists should be committed to optimal stent choices and techniques of implantation and use intravascular imaging guidance when appropriate to aim at minimizing acute ISA. In addition, the active search for new stent platforms that could accommodate vessel remodeling over time (i.e., self-expandable stents) and for new polymers and/or eluting drugs that could induce less inflammation (hence, less positive remodeling) could ultimately reduce the occurrence of ISA and its potentially harmful consequences.
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Affiliation(s)
- Guilherme F Attizzani
- Division of Cardiology, Ferrarotto Hospital, University of Catania, Catania, Italy; Division of Interventional Cardiology, Pitangueiras Hospital, Jundiaí, SP, Brazil; Harrington Heart and Vascular Institute, University Hospitals, Case Medical Center, Cleveland, Ohio
| | - Davide Capodanno
- Division of Cardiology, Ferrarotto Hospital, University of Catania, Catania, Italy; Excellence Through Newest Advances (ETNA) Foundation, Catania, Italy.
| | - Yohei Ohno
- Division of Cardiology, Ferrarotto Hospital, University of Catania, Catania, Italy
| | - Corrado Tamburino
- Division of Cardiology, Ferrarotto Hospital, University of Catania, Catania, Italy; Excellence Through Newest Advances (ETNA) Foundation, Catania, Italy
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23
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StentBoost Visualization for the Evaluation of Coronary Stent Expansion During Percutaneous Coronary Interventions. Cardiol Ther 2013; 2:171-80. [PMID: 25135395 PMCID: PMC4107427 DOI: 10.1007/s40119-013-0023-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2013] [Indexed: 01/07/2023] Open
Abstract
Introduction Inadequate stent implantation is associated with stent thrombosis and restenosis. StentBoost can enhance stent visualization and evaluate stent expansion. Currently, there are limited comparison studies between StentBoost and intravascular ultrasound (IVUS). We aimed to test the correlation and agreement between IVUS and StentBoost measurements. Methods From December 2010 to December 2011, 38 patients (54 stents) were analyzed using IVUS and StentBoost. Minimal stent diameter and proximal and distal edge stent diameter were compared between imaging techniques using Pearson correlation and Bland–Altman scatter plot. Results There was good correlation between StentBoost and IVUS measurements regarding minimal stent diameter (p < 0.001 in all stent portions) and an optimal agreement between IVUS and StentBoost, while lesser agreement was found between IVUS and quantitative coronary angiography. Conclusion The assessment of stent implantation using StentBoost showed an adequate correlation and agreement with IVUS. This easily applicable angiographic technique can be used to guide stent implantation. Electronic supplementary material The online version of this article (doi:10.1007/s40119-013-0023-2) contains supplementary material, which is available to authorized users.
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