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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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Kelbæk H, Yeh RW, Engstrøm T, Neumann FJ, Serruys PW, Windecker S, Belardi J, Qiao S, Xu B, Liu M, Silber S. Five-year clinical outcomes of zotarolimus-eluting stents in coronary total occlusions. EUROINTERVENTION 2021; 16:1326-1332. [PMID: 31746760 PMCID: PMC9725065 DOI: 10.4244/eij-d-19-00866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS Reports of long-term outcomes of patients treated with drug-eluting stents in total coronary occlusions are limited. We analysed clinical outcomes of patients treated with the zotarolimus-eluting Resolute stent (R-ZES) implanted in coronary total occlusions versus non-occluded lesions. METHODS AND RESULTS Patients treated with R-ZES and included in four trials (RESOLUTE All Comers, RESOLUTE International, RESOLUTE China RCT, and RESOLUTE China Registry) were pooled and divided into three groups - patients with chronic total occlusions (CTO), patients with total occlusions that had occurred recently (rec-TO), and patients without total occlusions (non-TO). Clinical outcomes at five years were analysed. Of 5,487 patients treated with R-ZES in these trials, 8.0% had CTOs, 8.5% rec-TOs and 83.5% non-TOs. Patients had a mean age of 62.8 years, approximately 25% were female and 30% were diabetics. TLF was similar in the three groups at five years (TLF was 13.2%, 12.5% and 13.3% in the CTO, rec-TO and non-TO groups, respectively, p=0.96). Stent thrombosis tended to occur more frequently for rec-TO compared to CTO and non-TO patients (2.6% vs 1.2% and 1.3%, respectively, p=0.11). CONCLUSIONS In this large population of patients who had R-ZES implanted, five-year clinical outcomes were similar whether or not the stents were implanted in total occlusions.
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Affiliation(s)
- Henning Kelbæk
- Department of Cardiology, Zealand University Hospital, Roskilde, Denmark
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Ybarra LF, Buller CE, Rinfret S. The Canadian Contribution to Science, Techniques, Technology, and Education in Chronic Total Occlusion Percutaneous Coronary Intervention. CJC Open 2021; 3:22-27. [PMID: 33458629 PMCID: PMC7801209 DOI: 10.1016/j.cjco.2020.09.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Accepted: 09/02/2020] [Indexed: 12/29/2022] Open
Abstract
Chronic total occlusions are considered the most complex coronary lesions in interventional cardiology. This article reviews the Canadian clinical and academic contributions to this field, including innovative procedural techniques, teaching and proctoring, clinical research, and the development of novel tools and therapies.
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Affiliation(s)
- Luiz F Ybarra
- London Health Sciences Centre, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
| | | | - Stéphane Rinfret
- Division of Cardiology, Department of Medicine, McGill University Health Centre, McGill University, Montreal, Quebec, Canada
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Guo L, Wang J, Ding H, Meng S, Zhang X, Lv H, Zhong L, Wu J, Xu J, Zhou X, Huang R. Long-term outcomes of medical therapy versus successful recanalisation for coronary chronic total occlusions in patients with and without type 2 diabetes mellitus. Cardiovasc Diabetol 2020; 19:100. [PMID: 32622353 PMCID: PMC7335447 DOI: 10.1186/s12933-020-01087-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 07/02/2020] [Indexed: 12/11/2022] Open
Abstract
Background In this study, we compared the outcomes of medical therapy (MT) with successful percutaneous coronary intervention (PCI) in chronic total occlusions (CTO) patients with and without type 2 diabetes mellitus. Methods A total of 2015 patients with CTOs were stratified. Diabetic patients (n = 755, 37.5%) and non-diabetic patients (n = 1260, 62.5%) were subjected to medical therapy or successful CTO-PCI. We performed a propensity score matching (PSM) to balance the baseline characteristics. A comparison of the major adverse cardiac events (MACE) was done to evaluate long-term outcomes. Results The median follow-up duration was 2.6 years. Through multivariate analysis, the incidence of MACE was significantly higher among diabetic patients compared to the non-diabetic patients (adjusted hazard ratio [HR] 1.32, 95% confidence interval [CI] 1.09–1.61, p = 0.005). Among the diabetic group, the rate of MACE (adjusted HR 0.61, 95% CI 0.42–0.87, p = 0.006) was significantly lower in the successful CTO-PCI group than in the MT group. Besides, in the non-diabetic group, the prevalence of MACE (adjusted HR 0.85, 95% CI 0.64–1.15, p = 0.294) and cardiac death (adjusted HR 0.94, 95% CI 0.51–1.70, p = 0.825) were comparable between the two groups. Similar results as with the early detection were obtained in propensity-matched diabetic and non-diabetic patients. Notably, there was a significant interaction between diabetic or non-diabetic with the therapeutic strategy on MACE (p for interaction = 0.036). Conclusions For treatment of CTO, successful CTO-PCI highly reduces the risk of MACE in diabetic patients when compared with medical therapy. However, this does not apply to non-diabetic patients.
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Affiliation(s)
- Lei Guo
- Department of Cardiology, The First Affiliated Hospital of Dalian Medical University, Dalian, People's Republic of China.
| | - Junjie Wang
- Department of Cardiology, The First Affiliated Hospital of Dalian Medical University, Dalian, People's Republic of China
| | - Huaiyu Ding
- Department of Cardiology, The First Affiliated Hospital of Dalian Medical University, Dalian, People's Republic of China
| | - Shaoke Meng
- Department of Cardiology, The First Affiliated Hospital of Dalian Medical University, Dalian, People's Republic of China
| | - Xiaoyan Zhang
- Department of Radiology, Fuyang Hospital of Anhui Medical University, Fuyang, People's Republic of China
| | - Haichen Lv
- Department of Cardiology, The First Affiliated Hospital of Dalian Medical University, Dalian, People's Republic of China
| | - Lei Zhong
- Department of Cardiology, The First Affiliated Hospital of Dalian Medical University, Dalian, People's Republic of China
| | - Jian Wu
- Department of Cardiology, The First Affiliated Hospital of Dalian Medical University, Dalian, People's Republic of China
| | - Jiaying Xu
- Department of Cardiology, The First Affiliated Hospital of Dalian Medical University, Dalian, People's Republic of China
| | - Xuchen Zhou
- Department of Cardiology, The First Affiliated Hospital of Dalian Medical University, Dalian, People's Republic of China
| | - Rongchong Huang
- Department of Cardiology, The First Affiliated Hospital of Dalian Medical University, Dalian, People's Republic of China.,Department of Cardiology, Capital Medical University Affiliated Beijing Friendship Hospital, Beijing, People's Republic of China
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Kandzari DE, Karmpaliotis D, Kini AS, Moses JW, Tummala PE, Grantham JA, Orr C, Lombardi W, Nicholson WJ, Lembo NJ, Popma JJ, Wang J, Zhao W, McGreevy R. Late-term safety and effectiveness of everolimus-eluting stents in chronic total coronary occlusion revascularization: Final 4-year results from the evaluation of the XIENCE coronary stent, Performance, and Technique in Chronic Total Occlusions (EXPERT CTO) multicenter trial. Catheter Cardiovasc Interv 2019; 94:509-515. [PMID: 31444897 DOI: 10.1002/ccd.28436] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Revised: 07/10/2019] [Accepted: 07/27/2019] [Indexed: 01/16/2023]
Abstract
BACKGROUND Limited study has detailed the late-term safety and efficacy of chronic total coronary occlusion (CTO) revascularization among multiple centers applying modern techniques and with newer-generation drug-eluting stents. METHODS Among 20 centers, 222 patients enrolled in the XIENCE coronary stent, performance, and technique (EXPERT) CTO trial underwent CTO percutaneous coronary intervention (PCI) with everolimus-eluting stents (EES). Through planned 4-year follow-up, the primary composite endpoint of major adverse cardiac events (MACE; death, myocardial infarction [MI] and target lesion revascularization) and rates of individual component endpoints and stent thrombosis were determined. RESULTS Demographic, lesion, and procedural characteristics included prior bypass surgery, 9.9%; diabetes, 40.1%; lesion length, 36.1 ± 18.5 mm; and stent length, 51.7 ± 27.2 mm. By 4 years, MACE rates were 31.6 and 22.4% by the pre-specified ARC and per-protocol definitions, respectively. Clinically-indicated target lesion revascularization at 4 years was 11.3%. In landmark analyses of events beyond the first year of revascularization, the annualized rates of target vessel-related MI and clinically-indicated target lesion revascularization were 0.53 and 1.3%, respectively. Through 4 years, the cumulative definite/probable stent thrombosis rate was 1.7% with no events occurring beyond the initial year of index revascularization. CONCLUSIONS In a multicenter registration trial representing contemporary technique and EES, these results demonstrate sustained long-term safety and effectiveness of EES in CTO percutaneous revascularization and can be used to inform shared decision making with patients being considered for CTO PCI relative to late safety and vessel patency.
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Affiliation(s)
| | - Dimitri Karmpaliotis
- Columbia University Medical Center and the Cardiovascular Research Foundation, New York, New York
| | | | - Jeffrey W Moses
- Columbia University Medical Center and the Cardiovascular Research Foundation, New York, New York
| | | | | | - Charles Orr
- St. Vincent's Heart Center, Indianapolis, Indiana
| | - William Lombardi
- PeaceHealth St. Joseph Medical Center, Cardiovascular Center, North Cascade Cardiology, Bellingham, WA
| | | | - Nicholas J Lembo
- Columbia University Medical Center and the Cardiovascular Research Foundation, New York, New York
| | | | - Jin Wang
- Abbott Vascular, Inc., Santa Clara, California
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Yaginuma K, Moehlis H, Koch M, Tischer K, Werner J, Werner GS. Bioresorbable vascular scaffolds for complex chronic total occlusions. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2019; 20:220-227. [DOI: 10.1016/j.carrev.2018.06.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Revised: 05/26/2018] [Accepted: 06/18/2018] [Indexed: 10/28/2022]
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Bioresorbable vascular scaffolds in coronary chronic total occlusions revascularization: safety assessment related to struts coverage and apposition in 6-month OCT follow-up. Heart Vessels 2017; 32:1077-1084. [PMID: 28432385 DOI: 10.1007/s00380-017-0980-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2017] [Accepted: 04/14/2017] [Indexed: 10/19/2022]
Abstract
Beneficial properties of bioresorbable vascular scaffolds (BVS) regarding to vasomotility restoration and no caging of the vessel make them attractive devices in chronic total occlusions (CTO) revascularization. However, more evidence is needed attending to their use in this specific setting. We aim to determine feasibility and safety of BVS use in CTO revascularization attending to struts coverage and apposition, as well as re-stenosis and stent thrombosis (ST) rates. 29 BVS were deployed in 9 CTO lesions revascularization (mean J-CTO score ≥3) with an acute procedural success rate of 100%. Clinical and angiographic follow-up was performed 6 months later, including intracoronary analyses from optical coherence tomography (OCT) images. 44,723 struts were analyzed within the total 636 mm of scaffolded vessel. Mean length scaffolded per lesion was 70.66 ± 31.01 mm with a mean number of 3.22 BVS. 2051 struts (4.59%) were identified as uncovered, being most of them (98.4%) neither malapposed nor disrupted. Mean thickness of struts' coverage was 0.13 ± 0.05 mm. Incomplete strut apposition (ISA) percentage was 0% as no malapposed struts were detected and 134 struts were identified as disrupted, which represents a 0.29% from the total. Mean vessel, scaffold, and lumen diameters were 3.87 ± 0.51, 2.97 ± 0.49, and 2.68 ± 0.50 mm, respectively. Neither in-stent re-stenosis nor ST was detected. During follow-up, none of our patients died, suffered from stroke or needed target lesion revascularization. Clinical and angiographic 6-month follow-up (including OCT analyses) of BVS in CTO revascularization suggests their effectiveness and safety, even in very complex chronic occluded lesions. Nevertheless, more evidence is needed.
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8
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Fang HY, Wu CJ, Fang CY, Lee WC. Influence about the flow of distal branch after intervention of the right coronary artery chronic total occlusion. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2017; 18:411-417. [PMID: 28366607 DOI: 10.1016/j.carrev.2017.03.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2017] [Accepted: 03/16/2017] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Limited data are available for the clinical outcomes after the recanalization of right coronary artery (RCA) chronic total occlusion (CTO). The study aims to assess the clinical outcomes in the antegrade flow of the distal branch after successful RCA CTO percutaneous coronary intervention (PCI). METHODS Between January 2002 and December 2012, 538 patients who underwent RCA CTO PCI were enrolled. The clinical outcomes as myocardial infarction (MI), target vessel revascularization, cardiac death, major adverse cardiac events, and all-cause mortality, were compared to the antegrade flow of distal branch after successful RCA CTO PCI. RESULTS The CTOs were located in proximal segments (57.6%), mid segments (27.5%) and distal segments (14.9%). The average Syntax score was 18.4±9.6 and 47.8% patients had a Syntax score greater than 27.5. A total of 62.8% patients had final thrombolysis of myocardial infarction (TIMI)-3 flow of distal branch, 16.9% patients had final TIMI-3 flow of only one major branch, 11.3% patients had TIMI-1-2 flow, and 8.9% patients had no antegrade flow. The incidence of periprocedural MI was lower in both side branches were preserved (13.9% vs. 23.0% and 18.8%, p=0.01). The clinical outcomes were similar between the groups with and without good antegrade flow of distal side branch. End stage renal disease (ESRD) and left ventricular ejection fraction (LVEF) <40% predicted three-year cardiac death. CONCLUSIONS There is no significant difference of clinical outcomes when distal side branches of RCA are recanalized successfully. ESRD and LVEF <40% were the predictors for three-year cardiac death.
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Affiliation(s)
- Hsiu-Yu Fang
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Chiung-Jen Wu
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Chih-Yuan Fang
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Wei-Chieh Lee
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.
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Kokkinidis DG, Waldo SW, Armstrong EJ. Treatment of coronary artery in-stent restenosis. Expert Rev Cardiovasc Ther 2017; 15:191-202. [DOI: 10.1080/14779072.2017.1284588] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
- Damianos G. Kokkinidis
- Section of Cardiology, Denver VA Medical Center and University of Colorado School of Medicine, Aurora, CO, USA
| | - Stephen W. Waldo
- Section of Cardiology, Denver VA Medical Center and University of Colorado School of Medicine, Aurora, CO, USA
| | - Ehrin J. Armstrong
- Section of Cardiology, Denver VA Medical Center and University of Colorado School of Medicine, Aurora, CO, USA
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10
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Fang HY, Lee WC, Fang CY, Wu CJ. Application of a snare technique in retrograde chronic total occlusion percutaneous coronary intervention - a step by step practical approach and an observational study. Medicine (Baltimore) 2016; 95:e5129. [PMID: 27741138 PMCID: PMC5072965 DOI: 10.1097/md.0000000000005129] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [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
Percutaneous coronary intervention (PCI) for chronic total occlusion (CTO) has recently become popular among interventional cardiologists. CTO originating from the ostium has been one of the most difficult CTO lesions to treat with PCI for a number of reasons. Our aim was to illustrate a specific technique during retrograde CTO PCI referred to as the "snare technique."We retrospectively examined the use of "snare technique" among 371 consecutive retrograde CTO PCIs performed at our institution between 2006 and 2015."Snare technique" was used in 10 patients among the 371 retrograde CTO PCIs. The baseline clinical and angiographic characteristics of patients with or without "snare technique" were similar. The "snare technique" group had significantly fewer side branches at occlusion (30.0% vs 71.2%, P = 0.01) and a higher incidence of externalization (90% vs 25.5%, P < 0.001). The contrast volume was significantly lower in the "snare technique" group (285.0 ± 68.5 vs 379.2 ± 144.0, P = 0.04). The incidence of major complications, retrograde success, or final success did not differ between the groups.The "snare technique" is safe and feasible in retrograde CTO PCI, especially in cases of difficult coronary engagement in cases such as ostial occlusion, challenging coronary anatomy, or retrograde guidewire cannot get in antegrade guiding catheter.
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Affiliation(s)
- Hsiu-Yu Fang
- Division of Cardiology, Department of Internal Medicine; Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
- Correspondence: Hsiu-Yu Fang, Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Kaohsiung 123, Ta Pei Road, Niao Sung District, Kaohsiung City 80144, Taiwan, R.O.C. (e-mail: )
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Real-time fusion of coronary CT angiography with x-ray fluoroscopy during chronic total occlusion PCI. Eur Radiol 2016; 27:2464-2473. [DOI: 10.1007/s00330-016-4599-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Revised: 08/29/2016] [Accepted: 09/07/2016] [Indexed: 10/21/2022]
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12
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Comparison of 12-month clinical outcomes in diabetic and nondiabetic patients with chronic total occlusion lesions: a multicenter study. Coron Artery Dis 2016; 26:699-705. [PMID: 26407238 PMCID: PMC4635872 DOI: 10.1097/mca.0000000000000304] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Supplemental Digital Content is available in the text. This study aimed to compare 1-year clinical outcomes in diabetic and nondiabetic patients with chronic total occlusion (CTO) lesions.
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13
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Fractura de los stents: una etiología diferente. REVISTA COLOMBIANA DE CARDIOLOGÍA 2016. [DOI: 10.1016/j.rccar.2015.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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14
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Kan J, Ge Z, Zhang JJ, Liu ZZ, Tian NL, Ye F, Li SJ, Qian XS, Yang S, Chen MX, Rab T, Chen SL. Incidence and Clinical Outcomes of Stent Fractures on the Basis of 6,555 Patients and 16,482 Drug-Eluting Stents From 4 Centers. JACC Cardiovasc Interv 2016; 9:1115-23. [DOI: 10.1016/j.jcin.2016.02.025] [Citation(s) in RCA: 61] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2015] [Revised: 02/03/2016] [Accepted: 02/18/2016] [Indexed: 10/22/2022]
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15
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Wolff R, Fefer P, Knudtson ML, Cheema AN, Galbraith PD, Sparkes JD, Wright GA, Wijeysundera HC, Strauss BH. Gender differences in the prevalence and treatment of coronary chronic total occlusions. Catheter Cardiovasc Interv 2015; 87:1063-70. [DOI: 10.1002/ccd.26330] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2014] [Accepted: 10/24/2015] [Indexed: 11/09/2022]
Affiliation(s)
- Rafael Wolff
- Division of Cardiology; Schulich Heart Program, Sunnybrook Health Sciences Centre; Toronto, Ontario Canada
| | - Paul Fefer
- Division of Cardiology; Schulich Heart Program, Sunnybrook Health Sciences Centre; Toronto, Ontario Canada
- Department of Cardiology; Sheba Medical Center, Tel Aviv University; Tel Aviv Israel
| | - Merril L. Knudtson
- Division of Cardiology; Libin Cardiovascular Institute of Alberta; Calgary Alberta Canada
| | - Asim N. Cheema
- Division of Cardiology; St. Michael's Hospital; Toronto Ontario Canada
- Department of Medicine; University of Toronto, Division of Cardiology; Toronto Ontario Canada
| | - P. Diane Galbraith
- Division of Cardiology; Libin Cardiovascular Institute of Alberta; Calgary Alberta Canada
| | - John D. Sparkes
- Division of Cardiology; Schulich Heart Program, Sunnybrook Health Sciences Centre; Toronto, Ontario Canada
| | - Graham A. Wright
- Division of Cardiology; Schulich Heart Program, Sunnybrook Health Sciences Centre; Toronto, Ontario Canada
| | - Harindra C. Wijeysundera
- Division of Cardiology; Schulich Heart Program, Sunnybrook Health Sciences Centre; Toronto, Ontario Canada
- Department of Medicine; University of Toronto, Division of Cardiology; Toronto Ontario Canada
- Management and Evaluation (IHPME); University of Toronto, Institute of Health Policy; Toronto, Ontario Canada
- Institute for Clinical Evaluative Sciences (ICES); Toronto Ontario Canada
| | - Bradley H. Strauss
- Division of Cardiology; Schulich Heart Program, Sunnybrook Health Sciences Centre; Toronto, Ontario Canada
- Department of Medicine; University of Toronto, Division of Cardiology; Toronto Ontario Canada
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16
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Kandzari DE, Kini AS, Karmpaliotis D, Moses JW, Tummala PE, Grantham JA, Orr C, Lombardi W, Nicholson WJ, Lembo NJ, Popma JJ, Wang J, Larracas C, Rutledge DR. Safety and Effectiveness of Everolimus-Eluting Stents in Chronic Total Coronary Occlusion Revascularization. JACC Cardiovasc Interv 2015; 8:761-769. [DOI: 10.1016/j.jcin.2014.12.238] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2014] [Revised: 11/24/2014] [Accepted: 12/04/2014] [Indexed: 10/23/2022]
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Shuvy M, Strauss BH. The mini-STAR technique in chronic total occlusions: maximizing the interventional toolbox. Can J Cardiol 2014; 30:1253-5. [PMID: 25442427 DOI: 10.1016/j.cjca.2014.09.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2014] [Accepted: 09/05/2014] [Indexed: 11/12/2022] Open
Affiliation(s)
- Mony Shuvy
- Schulich Heart Center, Sunnybrook Health Sciences Center, University of Toronto, Toronto, Ontario, Canada
| | - Bradley H Strauss
- Schulich Heart Center, Sunnybrook Health Sciences Center, University of Toronto, Toronto, Ontario, Canada.
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Galassi A, Grantham A, Kandzari D, Lombardi W, Moussa I, Thompson C, Werner G, Chambers C, Brilakis E. Percutaneous Treatment of Coronary Chronic Total Occlusions Part 1: Rationale and Outcomes. Interv Cardiol 2014; 9:195-200. [PMID: 29588802 DOI: 10.15420/icr.2014.9.3.195] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
Coronary chronic total occlusions (CTOs) are commonly encountered in patients with coronary artery disease. Compared to patients without coronary CTOs, those with CTO have worse clinical outcomes and lower likelihood of complete coronary revascularisation. Successful CTO percutaneous coronary intervention (PCI) can significantly improve angina and improve left ventricular function. Although currently unproven, successful CTO PCI might also reduce the risk for arrhythmic events in patients with ischaemic cardiomyopathy, provide better tolerance of future acute coronary syndrome, and possibly improve survival. Evaluation by a heart team comprised of both interventional and non-interventional cardiologists and cardiac surgeons is important for determining the optimal revascularisation strategy in patients with coronary artery disease and CTOs. Ad hoc CTO PCI is generally not recommended, so as to allow sufficient time for (a) discussion with the patient about the indications, goals, risks, and alternatives to PCI; (b) careful procedural planning; and (c) contrast and radiation exposure minimisation. Use of drug-eluting stents is recommended for CTO PCI, given the lower rates of angiographic restenosis compared to bare metal stents.
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Affiliation(s)
| | - Aaron Grantham
- Saint Luke's Mid America Heart Institute and University of Missouri Kansas City, Missouri, US
| | | | | | | | | | | | - Charles Chambers
- Penn State University College of Medicine, Hershey, Pennsylvania, US
| | - Emmanouil Brilakis
- VA North Texas Healthcare System and University of Texas Southwestern Medical Center at Dallas, Dallas, Texas, US
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19
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Fang HY, Lu SY, Lee WC, Lin YS, Cheng CI, Chen CJ, Yang CH, Yip HK, Hang CL, Fang CY, Wu CJ. The predictors of successful percutaneous coronary intervention in ostial left anterior descending artery chronic total occlusion. Catheter Cardiovasc Interv 2014; 84:E30-7. [DOI: 10.1002/ccd.25514] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2013] [Accepted: 04/06/2014] [Indexed: 02/01/2023]
Affiliation(s)
- Hsiu-Yu Fang
- Division of Cardiology; Department of Internal Medicine; Kaohsiung Chang Gung Memorial Hospital; Chang Gung University College of Medicine; Kaohsiung Taiwan
| | - Shang-Yeh Lu
- Division of Cardiology; Department of Internal Medicine; Kaohsiung Chang Gung Memorial Hospital; Chang Gung University College of Medicine; Kaohsiung Taiwan
| | - Wei-Chieh Lee
- Division of Cardiology; Department of Internal Medicine; Kaohsiung Chang Gung Memorial Hospital; Chang Gung University College of Medicine; Kaohsiung Taiwan
| | - Yu-Sheng Lin
- Division of Cardiology; Chang Gung Memorial Hospital; Chiayi; Chang Gung Institute of Technology; Chiayi Taiwan
| | - Cheng-I Cheng
- Division of Cardiology; Department of Internal Medicine; Kaohsiung Chang Gung Memorial Hospital; Chang Gung University College of Medicine; Kaohsiung Taiwan
| | - Chien-Jen Chen
- Division of Cardiology; Department of Internal Medicine; Kaohsiung Chang Gung Memorial Hospital; Chang Gung University College of Medicine; Kaohsiung Taiwan
| | - Cheng-Hsu Yang
- Division of Cardiology; Department of Internal Medicine; Kaohsiung Chang Gung Memorial Hospital; Chang Gung University College of Medicine; Kaohsiung Taiwan
| | - Hon-Kan Yip
- Division of Cardiology; Department of Internal Medicine; Kaohsiung Chang Gung Memorial Hospital; Chang Gung University College of Medicine; Kaohsiung Taiwan
| | - Chi-Ling Hang
- Division of Cardiology; Department of Internal Medicine; Kaohsiung Chang Gung Memorial Hospital; Chang Gung University College of Medicine; Kaohsiung Taiwan
| | - Chih-Yuan Fang
- Division of Cardiology; Department of Internal Medicine; Kaohsiung Chang Gung Memorial Hospital; Chang Gung University College of Medicine; Kaohsiung Taiwan
| | - Chiung-Jen Wu
- Division of Cardiology; Department of Internal Medicine; Kaohsiung Chang Gung Memorial Hospital; Chang Gung University College of Medicine; Kaohsiung Taiwan
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20
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Teeuwen K, Van den Branden BJL, Rahel BM, Laarman GJ, Tijssen JGP, Kelder JC, Slagboom T, Ten Berg JM, Suttorp MJ. Late catch-up in lumen diameter at five-year angiography in MACE-free patients treated with sirolimus-eluting stents in the Primary Stenting of Totally Occluded Native Coronary Arteries: a randomised comparison of bare metal stent implantation with sirolimus-eluting stent implantation for the treatment of total coronary occlusions (PRISON II). EUROINTERVENTION 2014; 9:212-9. [PMID: 23392450 DOI: 10.4244/eijv9i2a36] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS The present study was designed to examine the five-year angiographic follow-up of MACE-free patients enrolled in the PRISON II study. METHODS AND RESULTS In the PRISON II study a total of 200 patients were randomised to either bare metal stents (BMS) or sirolimus-eluting stents (SES) after successful recanalisation of total coronary occlusions (TCO). Patients free of MACE with available angiography at six months were approached for repeated angiography at five years. The primary endpoint was in-stent very late luminal loss (VLLL) at five years. The secondary endpoint was additional late luminal loss (ALLL) between six months and five years. At five years, repeated angiography was performed in 72 patients, 50/82 (61%) in the SES group and 22/58 (38%) in the BMS group. In-stent VLLL was lower in the SES group (0.19 mm ± 0.72 vs. 0.51 mm ± 0.71, p=0.09) compared to the BMS group and in-segment VLLL was comparable in both groups (0.01 mm±0.58 vs. 0.03 mm ± 0.73, p=0.89). Late catch-up in lumen diameter was observed in the SES group with a trend towards increased ALLL compared to the BMS group (in-stent, 0.35 mm ± 0.88 vs. 0.04 mm ± 0.81, p=0.16; in-segment, 0.20 mm ± 0.74 vs. -0.05 mm ± 0.73, p=0.19). CONCLUSIONS At five-year angiographic follow-up, late catch-up was observed after successful recanalisation of TCOs treated with SES. Despite a late catch-up, the angiographic results of SES were superior in-stent and similar in-segment compared to BMS.
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Affiliation(s)
- Koen Teeuwen
- Department of Interventional Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands
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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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Brilakis ES, Kotsia A, Luna M, Garcia S, Abdullah SM, Banerjee S. The role of drug-eluting stents for the treatment of coronary chronic total occlusions. Expert Rev Cardiovasc Ther 2014; 11:1349-58. [DOI: 10.1586/14779072.2013.838142] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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23
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Design considerations for studies of the biomechanical environment of the femoropopliteal arteries. J Vasc Surg 2013; 58:804-13. [DOI: 10.1016/j.jvs.2013.03.052] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2012] [Revised: 01/14/2013] [Accepted: 03/24/2013] [Indexed: 11/18/2022]
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24
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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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25
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Qiao Y, Bian Y, Yan X, Liu Z, Chen Y. Efficacy and safety of sirolimus-eluting stents versus bare-metal stents in coronary artery disease patients with diabetes: a meta-analysis. Cardiovasc J Afr 2013; 24:274-9. [PMID: 24217305 PMCID: PMC3807685 DOI: 10.5830/cvja-2013-062] [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] [Subscribe] [Scholar Register] [Received: 05/22/2013] [Accepted: 08/14/2013] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVE To compare by meta-analysis the efficacy and safety of sirolimus-eluting and bare-metal stents in coronary artery disease (CAD) patients with diabetes. METHOD PubMed, MEDLINE and EMBASE were searched from 1971 to 2012. Data on the efficacy and safety of sirolimus-eluting and bare-metal stents in patients with diabetes were collected. A meta-analysis was then performed on a total of 1 259 CAD patients with diabetes from six studies. The odds ratio (OR) was used for comparison. Subgroup analysis was performed according to the sample size, year of study, subjects' geographic area and study method. RESULTS Compared with those in the bare-metal stent group (BMS), the subjects in the sirolimus-eluting stent (SES) group had a reduced risk for major cardiac events [OR 0.42, 95% confidence interval (CI): 024-0.74, p < 0.01] and target-lesion revascularisation (OR 0.26, 95% CI: 0.11 - 0.59, p < 0.01). There was no difference for myocardial infarction (OR 0.92, 95% CI: 0.61-1.40, p > 0.05) or mortality (OR 1.19, 95% CI: 0.74-1.92, p > 0.05). Subgroup analysis showed a significant difference for overall risk of major cardiac events between SES and BMS when the sample size was ≤ 90 (OR 0.28, 95% CI: 0.16-0.48, p < 0.01), when it was a randomised control trial (RCT) (OR 0.28, 95% CI: 0.19-0.42, p < 0.01), or when it was performed on European subjects (OR 0.45, 95% CI: 0.27-0.77, p < 0.01). The sensitivity was not different when one study was removed at a time. CONCLUSION Our study confirmed that SES are safer and more effective than BMS in CAD patients with diabetes, as far as major cardiac events are concerned.
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Affiliation(s)
- Yanxiang Qiao
- Department of Emergency Medicine, Qilu Hospital, Shandong Univeristy, Shandong, China
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26
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Valenti R, Vergara R, Migliorini A, Parodi G, Carrabba N, Cerisano G, Dovellini EV, Antoniucci D. Predictors of Reocclusion After Successful Drug-Eluting Stent–Supported Percutaneous Coronary Intervention of Chronic Total Occlusion. J Am Coll Cardiol 2013; 61:545-50. [PMID: 23273395 DOI: 10.1016/j.jacc.2012.10.036] [Citation(s) in RCA: 100] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2012] [Revised: 09/28/2012] [Accepted: 10/23/2012] [Indexed: 01/16/2023]
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27
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28
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Venero CV, Aligeti VR, Wortham DC. A completely fractured zotarolimus-eluting stent in an aortocoronary saphenous vein bypass graft. Catheter Cardiovasc Interv 2013; 81:62-5. [PMID: 22553171 DOI: 10.1002/ccd.24312] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2011] [Accepted: 12/27/2011] [Indexed: 11/08/2022]
Abstract
Drug-eluting stents (DES) have significantly improved the rate of target vessel revascularization in comparison with bare metal stents. DES fracture was not reported in multicenter randomized clinical trials, but several case reports of DES fracture have been published, mostly with sirolimus-eluting stents. DES fracture is associated with stent restenosis and thrombosis. We report a zotarolimus-eluting stent fracture in an aortocoronary saphenous vein graft (SVG) bypass. The patient presented with chest pain and a non-ST-elevation myocardial infarction. He underwent cardiac catheterization that showed a complete fracture of a zotarolimus-eluting stent in the ostium of a sequential SVG to the diagonal and obtuse coronary arteries. His management included coronary angioplasty and retrieval of the proximal fractured segment. We discuss the potential causes for this stent fracture and suggest caution when using a DES in an ostial location of a SVG bypass, especially in a highly mobile vessel.
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Affiliation(s)
- Carmelo V Venero
- Section of Interventional Cardiology, Division of Cardiology, University of Alabama at Birmingham, Birmingham, Alabama, USA
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29
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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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30
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Lee SP, Shin DH, Park KW, Kang HJ, Koo BK, Cho YS, Yeon TJ, Chae IH, Choi DJ, Kim HS. Angiographic patterns of restenosis after percutaneous intervention of chronic total occlusive lesions with drug-eluting stents. Int J Cardiol 2012; 156:180-5. [DOI: 10.1016/j.ijcard.2010.10.138] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2010] [Revised: 08/23/2010] [Accepted: 10/31/2010] [Indexed: 11/27/2022]
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31
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Suh SY, Kang WC, Ahn T. Recurrent episode of very late stent thrombosis in a patient who underwent percutaneous coronary intervention with sirolimus-eluting stent: Same or different mechanism? J Cardiol Cases 2012; 5:e8-e11. [DOI: 10.1016/j.jccase.2011.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2011] [Accepted: 10/25/2011] [Indexed: 11/15/2022] Open
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32
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Strauss BH, Osherov AB, Radhakrishnan S, Mancini GBJ, Manners A, Sparkes JD, Chisholm RJ. Collagenase Total Occlusion-1 (CTO-1) trial: a phase I, dose-escalation, safety study. Circulation 2011; 125:522-8. [PMID: 22179536 DOI: 10.1161/circulationaha.111.063198] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Percutaneous interventions for chronic total occlusions have low success rates, primarily because of failure of guide wire crossing. Collagen-rich matrix constitutes the main barrier to chronic total occlusion crossing. In preclinical studies, local delivery of a bacterial collagenase formulation improved guide wire crossing. The Collagenase Total Occlusion-1 (CTO-1) Trial is a phase I, dose-escalation trial to assess the safety and efficacy of collagenase therapy to facilitate guide wire crossing in coronary artery chronic occlusions. METHODS AND RESULTS Twenty subjects with ≥1 previous failure of chronic total occlusion guide wire crossing were enrolled at 2 sites. Subjects were treated in 4 distinct cohorts of 5 patients, with escalation of collagenase dose in each cohort from 300 to 1200 μg. Collagenase was locally delivered into the occlusions with either an over-the-wire balloon system (n=8) or a fine-cross microcatheter (n=12) for a period of 30 minutes. Subjects were brought back to the catheterization laboratory for guide wire crossing and angioplasty the next day. Guide wire crossing was successfully achieved in 15 subjects (75%). A soft-tip guide wire (Whisper, Pilot-50, Fielder XT) was either the sole or predominant guide wire used in 75% of successful crossings. Non-ST-segment-elevation myocardial infarctions occurred in 3 patients as a result of side-branch ischemia during stenting. Computed tomographic angiography at 3 months showed no late complications and patent stents in successfully treated chronic total occlusion. Anginal improvement occurred with a reduction in Canadian Cardiovascular Society class from baseline to 3 months (2.5±0.6 versus 0.9±0.9; P<0.001). CONCLUSION Local delivery of collagenase into coronary chronic total occlusion is feasible and safe with encouraging guide wire crossing results in previously failed cases. Larger clinical trials are required to determine efficacy. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT01271335.
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Affiliation(s)
- Bradley H Strauss
- Sunnybrook Health Sciences Center, 2075 Bayview Ave, D4-06, Toronto, Ontario, Canada.
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33
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Scheller B, Levenson B, Joner M, Zahn R, Klauss V, Naber C, Schächinger V, Elsässer A. Medikamente freisetzende Koronarstents und mit Medikamenten beschichtete Ballonkatheter. DER KARDIOLOGE 2011. [DOI: 10.1007/s12181-011-0375-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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34
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35
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Galassi AR, Tomasello SD, Costanzo L, Campisano MB, Barrano G, Tamburino C. Long-Term Clinical and Angiographic Results of Sirolimus-Eluting Stent in Complex Coronary Chronic Total Occlusion Revascularization: The SECTOR Registry. J Interv Cardiol 2011; 24:426-36. [PMID: 22004600 DOI: 10.1111/j.1540-8183.2011.00648.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- Alfredo R Galassi
- Clinical Division of Cardiology, Department of Internal Medicine and Systemic Disease, Ferrarotto Hospital, ETNA Foundation, University of Catania, Via Antonello da Messina 75, Catania, Italy.
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36
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Umeda H, Kawai T, Misumida N, Ota T, Hayashi K, Iwase M, Izawa H, Sugino S, Shimizu T, Takeichi Y, Ishiki R, Inagaki H, Ozaki Y, Murohara T. Impact of Sirolimus-Eluting Stent Fracture on 4-Year Clinical Outcomes. Circ Cardiovasc Interv 2011; 4:349-54. [DOI: 10.1161/circinterventions.110.958306] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background—
Although stent fracture (SF) after sirolimus-eluting stent (SES) implantation has been recognized as one of the predisposing factors of in-stent restenosis, it remains uncertain whether SF can increase the risk of major adverse cardiac events (MACE), especially beyond 1 year after SES implantation. The aim of this study was to assess the impact of SF relative to non-SF on 4-year clinical outcomes after treatment with SES of comparable unselected lesions.
Methods and Results—
A total of 874 lesions in 793 patients undergoing SES implantation and subsequent angiography 6 to 9 months after index procedure were analyzed. At 6- to 9-month angiographic follow-up, SF was identified in 70 of 874 lesions (8.0%). In-stent late loss was significantly higher in SF lesions versus non-SF lesions (0.42±0.59 mm versus 0.13±0.49 mm,
P
<0.001), resulting in a significantly higher in-stent restenosis rate (21.4% versus 4.1%,
P
<0.001). At 4 years, SF versus non-SF was associated with a significantly higher MACE rate (23.2% versus 12.6%,
P
=0.014), mainly driven by significantly higher target-lesion revascularization (18.8% versus 10.2%,
P
=0.029) rate. Adverse effects of SF on clinical outcomes occurred mostly within the first year (17.4% versus 6.6%,
P
=0.001), with similar MACE rate between 1 and 4 years (5.8% versus 5.9%,
P
=0.611). No significant differences between SF versus non-SF patients were observed in the cumulative frequency of very late stent thrombosis (2.9% versus 1.4%,
P
=0.281), death (0% versus 2.1%,
P
=0.252), or myocardial infarction (5.8% versus 2.9%,
P
=0.165).
Conclusions—
SF of SES was associated with higher MACE rate up to 1 year, mainly driven by higher target-lesion revascularization, whereas no significant association was evident between years 1 and 4.
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Affiliation(s)
- Hisashi Umeda
- From the Division of Cardiology, Toyota Memorial Hospital, Toyota, Japan (H.U., N.M., T.O., K.H., S.S., R.I., H.I.); the Department of Cardiology, Fujita Health University, Toyoake, Japan (T.K., Y.O.); the Division of Integrated Medicine, Toyota Memorial Hospital, Toyota, Japan (M.I., Y.T.); the Department of Cardiology, Bantane Hospital, Fujita Health University, Nagoya, Japan (H.I.); the Division of Cardiology, Aichi Prefectural Cardiovascular and Respiratory Center, Ichinomiya, Japan (T.S.); and
| | - Tomoko Kawai
- From the Division of Cardiology, Toyota Memorial Hospital, Toyota, Japan (H.U., N.M., T.O., K.H., S.S., R.I., H.I.); the Department of Cardiology, Fujita Health University, Toyoake, Japan (T.K., Y.O.); the Division of Integrated Medicine, Toyota Memorial Hospital, Toyota, Japan (M.I., Y.T.); the Department of Cardiology, Bantane Hospital, Fujita Health University, Nagoya, Japan (H.I.); the Division of Cardiology, Aichi Prefectural Cardiovascular and Respiratory Center, Ichinomiya, Japan (T.S.); and
| | - Naoki Misumida
- From the Division of Cardiology, Toyota Memorial Hospital, Toyota, Japan (H.U., N.M., T.O., K.H., S.S., R.I., H.I.); the Department of Cardiology, Fujita Health University, Toyoake, Japan (T.K., Y.O.); the Division of Integrated Medicine, Toyota Memorial Hospital, Toyota, Japan (M.I., Y.T.); the Department of Cardiology, Bantane Hospital, Fujita Health University, Nagoya, Japan (H.I.); the Division of Cardiology, Aichi Prefectural Cardiovascular and Respiratory Center, Ichinomiya, Japan (T.S.); and
| | - Tomoyuki Ota
- From the Division of Cardiology, Toyota Memorial Hospital, Toyota, Japan (H.U., N.M., T.O., K.H., S.S., R.I., H.I.); the Department of Cardiology, Fujita Health University, Toyoake, Japan (T.K., Y.O.); the Division of Integrated Medicine, Toyota Memorial Hospital, Toyota, Japan (M.I., Y.T.); the Department of Cardiology, Bantane Hospital, Fujita Health University, Nagoya, Japan (H.I.); the Division of Cardiology, Aichi Prefectural Cardiovascular and Respiratory Center, Ichinomiya, Japan (T.S.); and
| | - Kazutaka Hayashi
- From the Division of Cardiology, Toyota Memorial Hospital, Toyota, Japan (H.U., N.M., T.O., K.H., S.S., R.I., H.I.); the Department of Cardiology, Fujita Health University, Toyoake, Japan (T.K., Y.O.); the Division of Integrated Medicine, Toyota Memorial Hospital, Toyota, Japan (M.I., Y.T.); the Department of Cardiology, Bantane Hospital, Fujita Health University, Nagoya, Japan (H.I.); the Division of Cardiology, Aichi Prefectural Cardiovascular and Respiratory Center, Ichinomiya, Japan (T.S.); and
| | - Mitsunori Iwase
- From the Division of Cardiology, Toyota Memorial Hospital, Toyota, Japan (H.U., N.M., T.O., K.H., S.S., R.I., H.I.); the Department of Cardiology, Fujita Health University, Toyoake, Japan (T.K., Y.O.); the Division of Integrated Medicine, Toyota Memorial Hospital, Toyota, Japan (M.I., Y.T.); the Department of Cardiology, Bantane Hospital, Fujita Health University, Nagoya, Japan (H.I.); the Division of Cardiology, Aichi Prefectural Cardiovascular and Respiratory Center, Ichinomiya, Japan (T.S.); and
| | - Hideo Izawa
- From the Division of Cardiology, Toyota Memorial Hospital, Toyota, Japan (H.U., N.M., T.O., K.H., S.S., R.I., H.I.); the Department of Cardiology, Fujita Health University, Toyoake, Japan (T.K., Y.O.); the Division of Integrated Medicine, Toyota Memorial Hospital, Toyota, Japan (M.I., Y.T.); the Department of Cardiology, Bantane Hospital, Fujita Health University, Nagoya, Japan (H.I.); the Division of Cardiology, Aichi Prefectural Cardiovascular and Respiratory Center, Ichinomiya, Japan (T.S.); and
| | - Shigeo Sugino
- From the Division of Cardiology, Toyota Memorial Hospital, Toyota, Japan (H.U., N.M., T.O., K.H., S.S., R.I., H.I.); the Department of Cardiology, Fujita Health University, Toyoake, Japan (T.K., Y.O.); the Division of Integrated Medicine, Toyota Memorial Hospital, Toyota, Japan (M.I., Y.T.); the Department of Cardiology, Bantane Hospital, Fujita Health University, Nagoya, Japan (H.I.); the Division of Cardiology, Aichi Prefectural Cardiovascular and Respiratory Center, Ichinomiya, Japan (T.S.); and
| | - Takeshi Shimizu
- From the Division of Cardiology, Toyota Memorial Hospital, Toyota, Japan (H.U., N.M., T.O., K.H., S.S., R.I., H.I.); the Department of Cardiology, Fujita Health University, Toyoake, Japan (T.K., Y.O.); the Division of Integrated Medicine, Toyota Memorial Hospital, Toyota, Japan (M.I., Y.T.); the Department of Cardiology, Bantane Hospital, Fujita Health University, Nagoya, Japan (H.I.); the Division of Cardiology, Aichi Prefectural Cardiovascular and Respiratory Center, Ichinomiya, Japan (T.S.); and
| | - Yasushi Takeichi
- From the Division of Cardiology, Toyota Memorial Hospital, Toyota, Japan (H.U., N.M., T.O., K.H., S.S., R.I., H.I.); the Department of Cardiology, Fujita Health University, Toyoake, Japan (T.K., Y.O.); the Division of Integrated Medicine, Toyota Memorial Hospital, Toyota, Japan (M.I., Y.T.); the Department of Cardiology, Bantane Hospital, Fujita Health University, Nagoya, Japan (H.I.); the Division of Cardiology, Aichi Prefectural Cardiovascular and Respiratory Center, Ichinomiya, Japan (T.S.); and
| | - Ryoji Ishiki
- From the Division of Cardiology, Toyota Memorial Hospital, Toyota, Japan (H.U., N.M., T.O., K.H., S.S., R.I., H.I.); the Department of Cardiology, Fujita Health University, Toyoake, Japan (T.K., Y.O.); the Division of Integrated Medicine, Toyota Memorial Hospital, Toyota, Japan (M.I., Y.T.); the Department of Cardiology, Bantane Hospital, Fujita Health University, Nagoya, Japan (H.I.); the Division of Cardiology, Aichi Prefectural Cardiovascular and Respiratory Center, Ichinomiya, Japan (T.S.); and
| | - Haruo Inagaki
- From the Division of Cardiology, Toyota Memorial Hospital, Toyota, Japan (H.U., N.M., T.O., K.H., S.S., R.I., H.I.); the Department of Cardiology, Fujita Health University, Toyoake, Japan (T.K., Y.O.); the Division of Integrated Medicine, Toyota Memorial Hospital, Toyota, Japan (M.I., Y.T.); the Department of Cardiology, Bantane Hospital, Fujita Health University, Nagoya, Japan (H.I.); the Division of Cardiology, Aichi Prefectural Cardiovascular and Respiratory Center, Ichinomiya, Japan (T.S.); and
| | - Yukio Ozaki
- From the Division of Cardiology, Toyota Memorial Hospital, Toyota, Japan (H.U., N.M., T.O., K.H., S.S., R.I., H.I.); the Department of Cardiology, Fujita Health University, Toyoake, Japan (T.K., Y.O.); the Division of Integrated Medicine, Toyota Memorial Hospital, Toyota, Japan (M.I., Y.T.); the Department of Cardiology, Bantane Hospital, Fujita Health University, Nagoya, Japan (H.I.); the Division of Cardiology, Aichi Prefectural Cardiovascular and Respiratory Center, Ichinomiya, Japan (T.S.); and
| | - Toyoaki Murohara
- From the Division of Cardiology, Toyota Memorial Hospital, Toyota, Japan (H.U., N.M., T.O., K.H., S.S., R.I., H.I.); the Department of Cardiology, Fujita Health University, Toyoake, Japan (T.K., Y.O.); the Division of Integrated Medicine, Toyota Memorial Hospital, Toyota, Japan (M.I., Y.T.); the Department of Cardiology, Bantane Hospital, Fujita Health University, Nagoya, Japan (H.I.); the Division of Cardiology, Aichi Prefectural Cardiovascular and Respiratory Center, Ichinomiya, Japan (T.S.); and
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Morino Y, Abe M, Morimoto T, Kimura T, Hayashi Y, Muramatsu T, Ochiai M, Noguchi Y, Kato K, Shibata Y, Hiasa Y, Doi O, Yamashita T, Hinohara T, Tanaka H, Mitsudo K. Predicting successful guidewire crossing through chronic total occlusion of native coronary lesions within 30 minutes: the J-CTO (Multicenter CTO Registry in Japan) score as a difficulty grading and time assessment tool. JACC Cardiovasc Interv 2011; 4:213-21. [PMID: 21349461 DOI: 10.1016/j.jcin.2010.09.024] [Citation(s) in RCA: 614] [Impact Index Per Article: 47.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2010] [Accepted: 09/03/2010] [Indexed: 12/18/2022]
Abstract
OBJECTIVES This study sought to establish a model for grading lesion difficulty in interventional chronic total occlusion (CTO) treatment. BACKGROUND Owing to uncertainty of success of the procedure and difficulties in selecting suitable cases for treatment, performance of interventional CTO remains infrequent. METHODS Data from 494 native CTO lesions were analyzed. To eliminate operator bias, the objective parameter of successful guidewire crossing within 30 min was set as an end point, instead of actual procedural success. All observations were randomly assigned to a derivation set and a validation set at a 2:1 ratio. The J-CTO (Multicenter CTO Registry of Japan) score was determined by assigning 1 point for each independent predictor of this end point and summing all points accrued. This value was then used to develop a model stratifying all lesions into 4 difficulty groups: easy (J-CTO score of 0), intermediate (score of 1), difficult (score of 2), and very difficult (score of ≥ 3). RESULTS The set end point was achieved in 48.2% of lesions. Independent predictors included calcification, bending, blunt stump, occlusion length >20 mm, and previously failed lesion. Easy, intermediate, difficult, and very difficult groups, stratified by J-CTO score, demonstrated stepwise, proportioned, and highly reproducible differences in probability of successful guidewire crossing within 30 min (87.7%, 67.1%, 42.4%, and 10.0% in the derivation set and 92.3%, 58.3%, 34.8%, and 22.2% in the validation set, respectively). Areas under receiver-operator characteristic curves were comparable (derivation: 0.82 vs. validation: 0.76). CONCLUSIONS This model predicted the probability of successful guidewire crossing within 30 min very well and can be applied for difficulty grading.
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Affiliation(s)
- Yoshihiro Morino
- Division of Cardiology, Tokai University School of Medicine, Isehara, Japan.
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Drug-eluting stents for coronary artery disease: a review. Med Eng Phys 2011; 33:148-63. [PMID: 21075668 DOI: 10.1016/j.medengphy.2010.10.009] [Citation(s) in RCA: 74] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2010] [Revised: 09/01/2010] [Accepted: 10/10/2010] [Indexed: 11/21/2022]
Abstract
Over the past decade the introduction of drug-eluting stents (DESs) has revolutionised the treatment of coronary artery disease. However, in recent years concern has arisen over the long-term safety and efficacy of DESs due to the occurrence of late adverse clinical events such as stent thrombosis. With this concern in mind, research and development is currently centred on increasing the long-term safety and efficacy of DESs. The aim of this paper is to provide a thorough review of currently approved and promising investigational DESs. With dozens of companies involved in the development of new and innovative anti-restenotic agents, polymeric coatings and stent platforms, it is intended that this review paper will provide a clear indication of how DESs are currently evolving and prove a valuable reference tool for future research in this area.
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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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40
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Barison A, de Carlo M, Bellini F, Capozza PFG, Lunardini A, Petronio AS. Recurrent episodes of very late stent thrombosis in a patient with aspirin hypersensitivity, stent fracture and malapposition. ACTA ACUST UNITED AC 2011; 13:52-4. [PMID: 21323408 DOI: 10.3109/17482941.2011.553288] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Late stent thrombosis represents a life-threatening event, usually triggered by inadequate antiplatelet therapy and promoted by multiple risk factors, such as stenting of a chronic total occlusion, overlapping stenting, an abnormal vascular response to the eluted drug, stent malapposition and stent fracture. A 57-year-old man with aspirin hypersensitivity underwent successful percutaneous revascularization of a chronic total occlusion of the left anterior descending artery (LAD). He received two sirolimus-eluting stents overlapping for 2 mm and was discharged on clopidogrel and picotamide. Two years later, 15 days after clopidogrel discontinuation, he experienced an anterior ST-segment elevation myocardial infarction and underwent rescue percutaneous LAD thrombectomy after unsuccessful fibrinolysis. Coronary angiography showed fracture of the distal stent, with a 5 mm gap between the two portions, as well as severe late stent malapposition, confirmed by optical coherence tomography. Despite treatment with clopidogrel and picotamide, in the following days the patient experienced two new episodes of stent thrombosis, treated with thrombectomy and deployment of bioengineered stents. The patient underwent successful oral aspirin desensitization, with a complete in vitro inhibition of platelet function, and was discharged on aspirin, clopidogrel and warfarin, without experiencing other events at 6-month follow-up.
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41
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Saeed B, Kandzari DE, Agostoni P, Lombardi WL, Rangan BV, Banerjee S, Brilakis ES. Use of drug-eluting stents for chronic total occlusions: A systematic review and meta-analysis. Catheter Cardiovasc Interv 2011; 77:315-32. [DOI: 10.1002/ccd.22690] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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42
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HUANG PEIHSIU, YEUNG MICHAEL, LASALA JOHNM, COX DAVIDA, BOWMAN THOMASS, STARZYK RUTHM, DAWKINS KEITHD. Two-Year Clinical Outcomes with Paclitaxel-Eluting Coronary Stents in Patients with Chronic Total Occlusions: Analysis from the TAXUS ARRIVE Program. J Interv Cardiol 2011; 24:232-40. [DOI: 10.1111/j.1540-8183.2010.00622.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Choi JH, Song YB, Hahn JY, Choi SH, Gwon HC, Cho JR, Jang Y, Choe Y. Three-Dimensional Quantitative Volumetry of Chronic Total Occlusion Plaque Using Coronary Multidetector Computed Tomography. Circ J 2011; 75:366-375. [DOI: 10.1253/circj.cj-09-0940] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
Affiliation(s)
- Jin-Ho Choi
- Department of Emergency Medicine, Cardiac and Vascular Center, Cardiovascular Imaging Center, Samsung Medical Center, Sungkyunkwan University School of Medicine
- Department of Medicine, Cardiac and Vascular Center, Cardiovascular Imaging Center, Samsung Medical Center, Sungkyunkwan University School of Medicine
| | - Young Bin Song
- Department of Medicine, Cardiac and Vascular Center, Cardiovascular Imaging Center, Samsung Medical Center, Sungkyunkwan University School of Medicine
| | - Joo-Yong Hahn
- Department of Medicine, Cardiac and Vascular Center, Cardiovascular Imaging Center, Samsung Medical Center, Sungkyunkwan University School of Medicine
| | - Seung Hyuk Choi
- Department of Medicine, Cardiac and Vascular Center, Cardiovascular Imaging Center, Samsung Medical Center, Sungkyunkwan University School of Medicine
| | - Hyeon-Cheol Gwon
- Department of Medicine, Cardiac and Vascular Center, Cardiovascular Imaging Center, Samsung Medical Center, Sungkyunkwan University School of Medicine
| | - Jung Rae Cho
- Department of Internal Medicine, Gangnam Sacred Hospital, Hallyum University School of Medicine
| | - Yangsoo Jang
- Department of Internal Medicine, Severance Hospital, Yeunsei University School of Medicine
| | - YeonHyeon Choe
- Department of Radiology, Cardiac and Vascular Center, Cardiovascular Imaging Center, Samsung Medical Center, Sungkyunkwan University School of Medicine
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Wu CJ, Fang HY, Cheng CI, Hussein H, Abdou SM, Youssef AA, Bhasin A, Yang CH, Chen CJ, Hsieh YK, Yip HK, Fang CY. The Safety and Feasibility of Bilateral Radial Approach in Chronic Total Occlusion Percutaneous Coronary Intervention. Int Heart J 2011; 52:131-8. [PMID: 21646733 DOI: 10.1536/ihj.52.131] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Chiung-Jen Wu
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital- Kaohsiung Medical Center, Chang Gung University College of Medicine
| | - Hsiu-Yu Fang
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital- Kaohsiung Medical Center, Chang Gung University College of Medicine
| | - Cheng-I Cheng
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital- Kaohsiung Medical Center, Chang Gung University College of Medicine
| | - Hesham Hussein
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital- Kaohsiung Medical Center, Chang Gung University College of Medicine
- National Heart Institute
| | - Sayed M Abdou
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital- Kaohsiung Medical Center, Chang Gung University College of Medicine
- National Heart Institute
| | - Ali A Youssef
- Department of Cardiology, Suez Canal University Hospital
| | - Anuj Bhasin
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital- Kaohsiung Medical Center, Chang Gung University College of Medicine
| | - Cheng-Hsu Yang
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital- Kaohsiung Medical Center, Chang Gung University College of Medicine
| | - Chien-Jen Chen
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital- Kaohsiung Medical Center, Chang Gung University College of Medicine
| | - Yuan-Kai Hsieh
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital- Kaohsiung Medical Center, Chang Gung University College of Medicine
| | - Hon-Kan Yip
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital- Kaohsiung Medical Center, Chang Gung University College of Medicine
| | - Chih-Yuan Fang
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital- Kaohsiung Medical Center, Chang Gung University College of Medicine
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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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46
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Sianos G. CTO PCI at the crossroads. EUROINTERVENTION 2010; 6:303-7. [PMID: 20884406 DOI: 10.4244/eijv6i3a51] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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47
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Reifart N, Hauptmann KE, Rabe A, Enayat D, Giokoglu K. Short and long term comparison (24 months) of an alternative sirolimus-coated stent with bioabsorbable polymer and a bare metal stent of similar design in chronic coronary occlusions: the CORACTO trial. EUROINTERVENTION 2010; 6:356-60. [DOI: 10.4244/eijv6i3a59] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Rubartelli P, Petronio AS, Guiducci V, Sganzerla P, Bolognese L, Galli M, Sheiban I, Chirillo F, Ramondo A, Bellotti S. Comparison of sirolimus-eluting and bare metal stent for treatment of patients with total coronary occlusions: results of the GISSOC II-GISE multicentre randomized trial. Eur Heart J 2010; 31:2014-20. [DOI: 10.1093/eurheartj/ehq199] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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50
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Leo A, Giubilato S, Bacà M, Montone RA, Niccoli G. Stent for chronic total coronary occlusions: benefits and drawbacks after the introduction of drug-eluting stents. Interv Cardiol 2010. [DOI: 10.2217/ica.10.25] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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