1
|
Aleem S, Parikh P, Bhasin V, Pyo RT. Interventional Approach in Small Vessel, Diffuse, and Tortuous Coronary Artery Disease. Interv Cardiol 2022. [DOI: 10.1002/9781119697367.ch20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
|
2
|
Affiliation(s)
- Upendra Kaul
- Batra Hospital and Medical Research Centre, 1, Mehrauli - Badarpur Rd, Tughlakabad Institutional Area, Vayusenabad, New Delhi, Delhi 110062, India
| | - Vineet Bhatia
- Department of Cardiology, Fortis Hospital, Noida, India
| |
Collapse
|
3
|
Tanaka A. Is stent Overlap Still an Achilles' Heel of Drug-Eluting Stents? CARDIOVASCULAR REVASCULARIZATION MEDICINE 2020; 21:1113-1114. [PMID: 32646717 DOI: 10.1016/j.carrev.2020.06.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 06/24/2020] [Indexed: 11/26/2022]
Affiliation(s)
- Atsushi Tanaka
- Department of Cardiovascular Medicine, Wakayama Medical University, Japan.
| |
Collapse
|
4
|
Sakamoto A, Torii S, Jinnouchi H, Virmani R, Finn AV. Histopathologic and physiologic effect of overlapping vs single coronary stents: impact of stent evolution. Expert Rev Med Devices 2018; 15:665-682. [DOI: 10.1080/17434440.2018.1515012] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
| | - Sho Torii
- CVPath Institute, Gaithersburg, MD, USA
| | | | | | - Aloke V. Finn
- CVPath Institute, Gaithersburg, MD, USA
- School of Medicine, University of Maryland, Baltimore, MD, USA
| |
Collapse
|
5
|
Fogarty TJ, Arko FR, Zarins CK. Ten Years of Advancements in Interventional Cardiology. J Endovasc Ther 2016; 11 Suppl 2:II192-9. [PMID: 15760266 DOI: 10.1177/15266028040110s604] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The past decade has seen the evolution of an exciting technology that has changed forever the treatment of aortic aneurysmal disease. From rather crude homemade stent-grafts constructed in the surgical suite to elegant commercially manufactured devices in a variety of configurations and sizes, the aortic endograft has experienced a meteoric rise in popularity to become a beneficial, minimally invasive therapy that can obviate the risk of rupture and death. There are now 3 approved endovascular devices on the market for infrarenal abdominal aortic aneurysm repair, and it is likely that additional and improved devices will become available in the future. This review revisits the developmental history of the aortic endograft, noting the ongoing refinements that have arisen from our experiences with the growing population of stent-graft patients. Although research continues to search for solutions to the problems of endoleak and migration, long-term results even with the earlier second and third-generation devices are better than has been achieved with open surgical repair.
Collapse
Affiliation(s)
- Thomas J Fogarty
- Division of Vascular Surgery, Stanford University Medical Center, Stanford, California 94305, USA
| | | | | |
Collapse
|
6
|
Pyo R. Interventional Approach in Small Vessel, Diffuse, and Tortuous Coronary Artery Disease. Interv Cardiol 2016. [DOI: 10.1002/9781118983652.ch20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Affiliation(s)
- Robert Pyo
- Montefiore Medical Center; Albert Einstein College of Medicine; New York NY USA
| |
Collapse
|
7
|
Ino Y, Kubo T, Matsuo Y, Yamaguchi T, Shiono Y, Shimamura K, Katayama Y, Nakamura T, Aoki H, Taruya A, Nishiguchi T, Satogami K, Yamano T, Kameyama T, Orii M, Ota S, Kuroi A, Kitabata H, Tanaka A, Hozumi T, Akasaka T. Optical Coherence Tomography Predictors for Edge Restenosis After Everolimus-Eluting Stent Implantation. Circ Cardiovasc Interv 2016; 9:CIRCINTERVENTIONS.116.004231. [PMID: 27688261 DOI: 10.1161/circinterventions.116.004231] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Accepted: 08/19/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND Stent edge restenosis (SER) remains a potential limitation of drug-eluting stents. The aim of this study was to determine optical coherence tomography (OCT) predictors for angiographic late SER after everolimus-eluting stent implantation. METHODS AND RESULTS We retrospectively analyzed 319 patients who underwent OCT immediately after everolimus-eluting stent implantation and scheduled 9- to 12-month follow-up angiography. The binary angiographic SER rate was 10% (32/319) in the patients, 8.4% (32/382) in lesions, and 4.4% (33/744) in stent edge segments. In the stent edge segments at post stenting, OCT-derived lipidic plaque (61% versus 20%; P<0.001) was more often observed in the SER group, and OCT-measured minimum lumen area (4.13±2.61 versus 5.58±2.46 mm2; P=0.001) was significantly smaller in the SER group compared with the non-SER group. Multivariate analysis identified lipidic plaque (odds ratio: 5.99; 95% confidence interval: 2.89-12.81; P<0.001) and minimum lumen area (odds ratio: 0.64; 95% confidence interval: 0.42-0.96; P=0.029) as independent predictors of binary SER. Receiver-operating characteristic analysis demonstrated that lipid arc of 185° (sensitivity: 71%; specificity: 72%; area under the curve: 0.761) and minimum lumen area of 4.10 mm2 (sensitivity: 67%; specificity: 77%; area under the curve: 0.787) were optimal cutoff values for predicting ischemia-driven SER. CONCLUSIONS The present OCT study demonstrated that lipidic plaque and minimum lumen area in the stent edge segments at post stenting were associated with late SER after everolimus-eluting stent implantation. OCT provides valuable information to determine an appropriate landing zone for stent implantation.
Collapse
Affiliation(s)
- Yasushi Ino
- From the Department of Cardiovascular Medicine, Wakayama Medical University, Japan
| | - Takashi Kubo
- From the Department of Cardiovascular Medicine, Wakayama Medical University, Japan.
| | - Yoshiki Matsuo
- From the Department of Cardiovascular Medicine, Wakayama Medical University, Japan
| | - Tomoyuki Yamaguchi
- From the Department of Cardiovascular Medicine, Wakayama Medical University, Japan
| | - Yasutsugu Shiono
- From the Department of Cardiovascular Medicine, Wakayama Medical University, Japan
| | - Kunihiro Shimamura
- From the Department of Cardiovascular Medicine, Wakayama Medical University, Japan
| | - Yosuke Katayama
- From the Department of Cardiovascular Medicine, Wakayama Medical University, Japan
| | - Tomoko Nakamura
- From the Department of Cardiovascular Medicine, Wakayama Medical University, Japan
| | - Hiroshi Aoki
- From the Department of Cardiovascular Medicine, Wakayama Medical University, Japan
| | - Akira Taruya
- From the Department of Cardiovascular Medicine, Wakayama Medical University, Japan
| | - Tsuyoshi Nishiguchi
- From the Department of Cardiovascular Medicine, Wakayama Medical University, Japan
| | - Keisuke Satogami
- From the Department of Cardiovascular Medicine, Wakayama Medical University, Japan
| | - Takashi Yamano
- From the Department of Cardiovascular Medicine, Wakayama Medical University, Japan
| | - Takeyoshi Kameyama
- From the Department of Cardiovascular Medicine, Wakayama Medical University, Japan
| | - Makoto Orii
- From the Department of Cardiovascular Medicine, Wakayama Medical University, Japan
| | - Shingo Ota
- From the Department of Cardiovascular Medicine, Wakayama Medical University, Japan
| | - Akio Kuroi
- From the Department of Cardiovascular Medicine, Wakayama Medical University, Japan
| | - Hironori Kitabata
- From the Department of Cardiovascular Medicine, Wakayama Medical University, Japan
| | - Atsushi Tanaka
- From the Department of Cardiovascular Medicine, Wakayama Medical University, Japan
| | - Takeshi Hozumi
- From the Department of Cardiovascular Medicine, Wakayama Medical University, Japan
| | - Takashi Akasaka
- From the Department of Cardiovascular Medicine, Wakayama Medical University, Japan
| |
Collapse
|
8
|
Ortega-Paz L, Capodanno D, Giacchi G, Gori T, Nef H, Latib A, Caramanno G, Di Mario C, Naber C, Lesiak M, Capranzano P, Wiebe J, Mehilli J, Araszkiewicz A, Pyxaras S, Mattesini A, Geraci S, Naganuma T, Colombo A, Münzel T, Sabaté M, Tamburino C, Brugaletta S. Impact of overlapping on 1-year clinical outcomes in patients undergoing everolimus-eluting bioresorbable scaffolds implantation in routine clinical practice: Insights from the European multicenter GHOST-EU registry. Catheter Cardiovasc Interv 2016; 89:812-818. [PMID: 27515568 DOI: 10.1002/ccd.26674] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2016] [Revised: 06/05/2016] [Accepted: 07/02/2016] [Indexed: 11/08/2022]
Abstract
BACKGROUND Overlapping implantation of bioresorbable scaffolds (BRSs) are frequent in long coronary lesions. Its impact on clinical outcomes is unknown. OBJECTIVE To compare the clinical outcomes of patients treated with overlapping BRS with those patients treated with no-overlap BRS. METHODS We analyzed the 1-year clinical outcomes of 1,477 patients treated with BRS in the GHOST-EU registry, according to the implantation of overlapping BRS. Primary endpoint was patient oriented composite endpoint (PoCE) of: all-cause death, any myocardial infarction (MI) and any repeated revascularization. Scaffold thrombosis, according to Academic Research Consortium definition, was also analyzed. RESULTS A total of 320 (21.7%) patients were treated with overlapping BRS (overlap group), whereas the remaining 1,157 (78.3%) received no-overlap BRS (no-overlap group). The overlap group had significantly higher frequency of male sex, diabetes mellitus, stable angina, B2/C lesion type, SYNTAX score ≥22, lesion length >34 mm, use of intracoronary imaging guidance, pre- and postdilatation. At 1-year, there were no differences in PoCE between the overlap versus no-overlap group (18.4% vs. 18.2%; HR 1.07, [0.80-1.44]; P = 0.636), even after adjustment (HR 1.05, [0.48-2.20]; P = 0.904). Scaffold thrombosis rate did not differ either at one-month (1.3% vs. 1.5%, P = 0.769) or at 1-year (1.9% vs. 2.1%, P = 0.823). CONCLUSIONS In "Real-world" clinical practice, overlapping BRS does not appear to have an impact on clinical outcomes as compared to no-overlapping BRS. These preliminary data should be confirmed. © 2016 Wiley Periodicals, Inc.
Collapse
Affiliation(s)
- Luis Ortega-Paz
- Cardiovascular Clinic Institute, Hospital Clinic, University of Barcelona, IDIBAPS, Barcelona, Spain
| | | | - Giuseppe Giacchi
- Cardiovascular Clinic Institute, Hospital Clinic, University of Barcelona, IDIBAPS, Barcelona, Spain
| | - Tommaso Gori
- Medizinische Klinik und Poliklinik, Universitätsmedizin Mainz, University Medical Center, Mainz, Germany
| | - Holger Nef
- Department of Cardiology, University of Giessen, Giessen, Germany
| | - Azeem Latib
- EMOGVM Centro Cuore and San Raffaele Hospitals, Milan, Italy
| | | | - Carlo Di Mario
- Royal Brompton Hospital & Imperial College, London, United Kingdom
| | - Christoph Naber
- Klinik für Kardiologie und Angiologie, Elisabeth-Krankenhaus, Essen, Germany
| | - Maciej Lesiak
- Department of Cardiology, University of Medical Sciences, Poznan, Poland
| | | | - Jens Wiebe
- Department of Cardiology, University of Giessen, Giessen, Germany
| | - Julinda Mehilli
- Department of Cardiology, Klinikum Großhadern, Ludwig-Maximilian Universität, Munich, Germany
| | | | - Stelios Pyxaras
- Klinik für Kardiologie und Angiologie, Elisabeth-Krankenhaus, Essen, Germany
| | | | | | - Toru Naganuma
- EMOGVM Centro Cuore and San Raffaele Hospitals, Milan, Italy
| | - Antonio Colombo
- EMOGVM Centro Cuore and San Raffaele Hospitals, Milan, Italy
| | - Thomas Münzel
- Medizinische Klinik und Poliklinik, Universitätsmedizin Mainz, University Medical Center, Mainz, Germany
| | - Manel Sabaté
- Cardiovascular Clinic Institute, Hospital Clinic, University of Barcelona, IDIBAPS, Barcelona, Spain
| | | | - Salvatore Brugaletta
- Cardiovascular Clinic Institute, Hospital Clinic, University of Barcelona, IDIBAPS, Barcelona, Spain
| |
Collapse
|
9
|
Durante A, Foglia Manzillo G, Burzotta F, Trani C, Aurigemma C, Summaria F, Patrizi R, Talarico GP, Latib A, Figini F, Romagnoli E, De Vita M, Fantoni C, My L, Larosa C, Manzoli A, Turturo M, Berni A, Corrado G. Long term follow-up of "full metal jacket" of de novo coronary lesions with new generation Zotarolimus-eluting stents. Int J Cardiol 2016; 221:1008-12. [PMID: 27441483 DOI: 10.1016/j.ijcard.2016.07.050] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Revised: 06/24/2016] [Accepted: 07/04/2016] [Indexed: 11/29/2022]
Abstract
BACKGROUND Diffuse coronary artery disease treatment still remains a challenge for interventional cardiologists and cardiac surgeons. There are few data on full metal jacket (FMJ) stenting, especially with new-generation drug-eluting stents. We aimed to assess the efficacy and safety of FMJ with new-generation Zotarolimus-eluting stents (n-ZES). METHODS AND RESULTS All patients who underwent FMJ with n-ZES (≥60mm stent length) in eleven Italian interventional centers participating in the Clinical Service® project were included in this analysis. The project population consisted of 120 patients and 122 lesions. Mean age was 67±10years and 95 (79.2%) patients were male. A chronic total occlusion was present in 34 lesions (27.9%). The number of stents implanted per lesion was 2.9±0.8, and the diameter of the stents was 3.0±0.5mm. Predilation and post-dilatation were performed in 107 (87.7%) and 92 (75.4%) patients, respectively. At 41±21month follow-up there were 2 patients with subacute definite stent thrombosis, 6 patients (5.0%) had cardiac death and 5 patients (4.2%) had non-fatal myocardial infarction. Seven patients (5.8%) underwent clinically-driven target lesion revascularization. Fourteen patients (11.7%) had at least one major adverse cardiac event. CONCLUSION The treatment of diffuse coronary artery disease with FMJ stenting with n-ZES appears to be effective and safe. Late and very-late ST does not seem to be an issue and the rate of restenosis and of major cardiac adverse events after more than 3-year follow-up is rather low.
Collapse
Affiliation(s)
- Alessandro Durante
- Unità Operativa Complessa di Cardiologia, Ospedale Valduce, Como, Italy.
| | | | - Francesco Burzotta
- Dipartimento Cardiovascolare, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Carlo Trani
- Dipartimento Cardiovascolare, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Cristina Aurigemma
- Dipartimento Cardiovascolare, Università Cattolica del Sacro Cuore, Roma, Italy
| | | | | | | | - Azeem Latib
- Unità Di Emodinamica e Cardiologia Interventistica, Ospedale San Raffaele, Milan, Italy
| | - Filippo Figini
- Unità Di Emodinamica e Cardiologia Interventistica, Ospedale San Raffaele, Milan, Italy
| | - Enrico Romagnoli
- Unità di Emodinamica e Cardiologia Interventistica - Ospedale di Belcolle, Viterbo, Italy
| | - Mariarosaria De Vita
- Unità Operativa Di Cardiologia, Azienda Ospedaliera Morgagni Pierantoni, Forlì, Italy
| | - Cecilia Fantoni
- Unità Operativa Di Cardiologia, Istituto Clinico Humanitas Mater Domini, Castellanza, Italy
| | - Luigi My
- Unità di Cardiologia, Casa di Cura Villa Verde, Taranto, Italy
| | - Claudio Larosa
- Unità Di Cardiologia, Ospedale Lorenzo Bonomo, Andria, Italy
| | - Alessandro Manzoli
- Unità di Emodinamica e Cardiologia Interventistica, Azienda Ospedaliera San Giovanni Addolorata, Rome, Italy
| | - Maurizio Turturo
- UOC Cardiologia, Presidio Ospedaliero Di Venere, Bari Carbonara, Italy
| | - Andrea Berni
- UOC Cardiologia, Azienda Ospedaliera Sant'Andrea, Roma, Italy
| | - Giovanni Corrado
- Unità Operativa Complessa di Cardiologia, Ospedale Valduce, Como, Italy
| |
Collapse
|
10
|
High-definition computed tomography for coronary artery stents imaging: Initial evaluation of the optimal reconstruction algorithm. Eur J Radiol 2015; 84:834-9. [DOI: 10.1016/j.ejrad.2015.02.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2014] [Revised: 12/04/2014] [Accepted: 02/02/2015] [Indexed: 11/23/2022]
|
11
|
Impact of the distance from the stent edge to the residual plaque on edge restenosis following everolimus-eluting stent implantation. PLoS One 2015; 10:e0121079. [PMID: 25775115 PMCID: PMC4361545 DOI: 10.1371/journal.pone.0121079] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2014] [Accepted: 01/28/2015] [Indexed: 11/22/2022] Open
Abstract
Objectives This study aimed to assess the relation between stent edge restenosis (SER) and the distance from the stent edge to the residual plaque using quantitative intravascular ultrasound. Background Although percutaneous coronary intervention with drug-eluting stents has improved SER rates, determining an appropriate stent edge landing zone can be challenging in cases of diffuse plaque lesions. It is known that edge vascular response can occur within 2 mm from the edge of a bare metal stent, but the distance to the adjacent plaque has not been evaluated for drug-eluting stents. Methods A total of 97 proximal residual plaque lesions (plaque burden [PB] >40%) treated with everolimus-eluting stents were retrospectively evaluated to determine the distance from the stent edge to the residual plaque. Results The SER group had significantly higher PB (59.1 ± 6.1% vs. 51.9 ± 9.1% for non-SER; P = 0.04). Higher PB was associated with SER, with the cutoff value of 54.74% determined using receiver operating characteristic (ROC) curve analysis. At this cutoff value of PB, the distance from the stent edge to the lesion was significantly associated with SER (odds ratio = 2.05, P = 0.035). The corresponding area under the ROC curve was 0.725, and the cutoff distance value for predicting SER was 1.0 mm. Conclusion An interval less than 1 mm from the proximal stent edge to the nearest point with the determined PB cutoff value of 54.74% was significantly associated with SER in patients with residual plaque lesions.
Collapse
|
12
|
Poerner TC, Otto S, Gassdorf J, Nitsche K, Janiak F, Scheller B, Goebel B, Jung C, Figulla HR. Stent coverage and neointimal proliferation in bare metal stents postdilated with a Paclitaxel-eluting balloon versus everolimus-eluting stents: prospective randomized study using optical coherence tomography at 6-month follow-up. Circ Cardiovasc Interv 2014; 7:760-7. [PMID: 25371536 DOI: 10.1161/circinterventions.113.001146] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND In this randomized trial, strut coverage and neointimal proliferation of a therapy of bare metal stents (BMSs) postdilated with the paclitaxel drug-eluting balloon (DEB) was compared with everolimus drug-eluting stents (DESs) at 6-month follow-up using optical coherence tomography. We hypothesized sufficient stent coverage at follow-up. METHODS AND RESULTS A total of 105 lesions in 90 patients were treated with either XIENCE V DES (n=51) or BMS postdilated with the SeQuent Please DEB (n=54). At follow-up, comparable results on the primary optical coherence tomography end point (percentage uncovered struts 5.64±9.65% in BMS+DEB versus 4.93±9.29% in DES; P=0.366) were found. Thus, BMS+DEB achieved the prespecified noninferiority margin of 5% uncovered struts versus DES (difference between treatment means, 0.71%; one-sided upper 95% confidence interval, 4.14%; noninferiority P=0.04). Optical coherence tomography analysis showed significantly more global neointimal proliferation in the BMS+DEB group (15.7±7.8 versus 11.0±5.2 mm(3) proliferation volume/cm stent length; P=0.002). No significant focal in-stent stenosis analyzed with angiography (percentage diameter stenosis at follow-up, 22.8±11.9 versus 16.9±10.4; P=0.014) and optical coherence tomography (peak local area stenosis, 39.5±13.8% versus 36.8±15.6%; P=0.409) was found. CONCLUSIONS Good stent strut coverage of >94% was found in both therapy groups. Despite greater suppression of global neointimal growth in DES, both DES and BMS+DEB effectively prevented clinically relevant focal restenosis at 6-month follow-up. CLINICAL TRIAL REGISTRATION URL http://www.clinicaltrials.gov. Unique identifier: NCT01056744.
Collapse
Affiliation(s)
- Tudor C Poerner
- From the 1st Department of Medicine, Division of Cardiology, University Hospital of Jena, Jena, Germany (T.C.P., S.O., J.G., K.N., F.J., B.G., C.J., H.R.F.); and Clinical and Experimental Interventional Cardiology, Internal Medicine III, University of Saarland, Saarbrücken, Germany (B.S.)
| | - Sylvia Otto
- From the 1st Department of Medicine, Division of Cardiology, University Hospital of Jena, Jena, Germany (T.C.P., S.O., J.G., K.N., F.J., B.G., C.J., H.R.F.); and Clinical and Experimental Interventional Cardiology, Internal Medicine III, University of Saarland, Saarbrücken, Germany (B.S.).
| | - Johannes Gassdorf
- From the 1st Department of Medicine, Division of Cardiology, University Hospital of Jena, Jena, Germany (T.C.P., S.O., J.G., K.N., F.J., B.G., C.J., H.R.F.); and Clinical and Experimental Interventional Cardiology, Internal Medicine III, University of Saarland, Saarbrücken, Germany (B.S.)
| | - Kristina Nitsche
- From the 1st Department of Medicine, Division of Cardiology, University Hospital of Jena, Jena, Germany (T.C.P., S.O., J.G., K.N., F.J., B.G., C.J., H.R.F.); and Clinical and Experimental Interventional Cardiology, Internal Medicine III, University of Saarland, Saarbrücken, Germany (B.S.)
| | - Florian Janiak
- From the 1st Department of Medicine, Division of Cardiology, University Hospital of Jena, Jena, Germany (T.C.P., S.O., J.G., K.N., F.J., B.G., C.J., H.R.F.); and Clinical and Experimental Interventional Cardiology, Internal Medicine III, University of Saarland, Saarbrücken, Germany (B.S.)
| | - Bruno Scheller
- From the 1st Department of Medicine, Division of Cardiology, University Hospital of Jena, Jena, Germany (T.C.P., S.O., J.G., K.N., F.J., B.G., C.J., H.R.F.); and Clinical and Experimental Interventional Cardiology, Internal Medicine III, University of Saarland, Saarbrücken, Germany (B.S.)
| | - Björn Goebel
- From the 1st Department of Medicine, Division of Cardiology, University Hospital of Jena, Jena, Germany (T.C.P., S.O., J.G., K.N., F.J., B.G., C.J., H.R.F.); and Clinical and Experimental Interventional Cardiology, Internal Medicine III, University of Saarland, Saarbrücken, Germany (B.S.)
| | - Christian Jung
- From the 1st Department of Medicine, Division of Cardiology, University Hospital of Jena, Jena, Germany (T.C.P., S.O., J.G., K.N., F.J., B.G., C.J., H.R.F.); and Clinical and Experimental Interventional Cardiology, Internal Medicine III, University of Saarland, Saarbrücken, Germany (B.S.)
| | - Hans R Figulla
- From the 1st Department of Medicine, Division of Cardiology, University Hospital of Jena, Jena, Germany (T.C.P., S.O., J.G., K.N., F.J., B.G., C.J., H.R.F.); and Clinical and Experimental Interventional Cardiology, Internal Medicine III, University of Saarland, Saarbrücken, Germany (B.S.)
| |
Collapse
|
13
|
Abstract
The introduction of drug-eluting stents (DES) to interventional cardiology practice has resulted in a significant improvement in the long-term efficacy of percutaneous coronary interventions. DES successfully combine mechanical benefits of bare-metal stents and stabilizing the lumen, with direct delivery and the controlled elution of a pharmacologic agent to the injured vessel wall to suppress further neointimal proliferation. The dramatic reduction in restenosis has resulted in the implementation of DES in clinical practice, and has rapidly expanded the whole spectrum of successfully treatable coronary conditions, particularly in high-risk patients and complex lesions. In this review the authors present current data on DES. Currently, two types of DES are available in the USA: sirolimus-eluting stents (SES) CYPHER (Cordis Corp., FL, USA) and paclitaxel-eluting stents (PES) TAXUS (Boston Scientific, MA, USA), and many more are on the way to approval. In addition to sirolimus and paclitaxel, several other drugs have been successfully used in DES. Everolimus and ABT-578 are both analogs of sirolimus that also have immunosuppressive and antiproliferative properties. Another approach in the development of DES is to use drugs that can accelerate re-endothelialization and restore normal endothelial function following vascular injury. Recent advances in vascular gene transfer have also demonstrated potential new treatment modalities for cardiovascular disease, particularly in the treatment of vascular restenosis.
Collapse
Affiliation(s)
- Nicholas N Kipshidze
- Department of Interventional Cardiac and Vascular Services, Lenox Hill Hospital, New York, NY 10021, USA.
| | | | | | | | | |
Collapse
|
14
|
Rikhtegar F, Wyss C, Stok KS, Poulikakos D, Müller R, Kurtcuoglu V. Hemodynamics in coronary arteries with overlapping stents. J Biomech 2014; 47:505-11. [DOI: 10.1016/j.jbiomech.2013.10.048] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2013] [Revised: 09/17/2013] [Accepted: 10/26/2013] [Indexed: 01/20/2023]
|
15
|
The impact of triple anti-platelet therapy for endothelialization and inflammatory response at overlapping bioabsorbable polymer coated drug-eluting stents in a porcine coronary model. Int J Cardiol 2013; 168:1853-8. [DOI: 10.1016/j.ijcard.2012.12.070] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2012] [Accepted: 12/25/2012] [Indexed: 10/27/2022]
|
16
|
Calé R, Teles RC, Almeida M, do Rosário I, Sousa PJ, Brito J, Raposo L, Gonçalves PDA, Gabriel HM, Mendes M. Percutaneous coronary intervention using a full metal jacket with drug-eluting stents: major adverse cardiac events at one year. Arq Bras Cardiol 2013; 101:117-26. [PMID: 23821408 PMCID: PMC3998154 DOI: 10.5935/abc.20130139] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2012] [Accepted: 12/14/2013] [Indexed: 11/20/2022] Open
Abstract
Background The clinical benefit of percutaneous coronary intervention (PCI) for long coronary
lesions is unclear; furthermore, concerns have been raised about its safety. Objectives To evaluate the predictors of major adverse cardiac events (MACE) associated with
PCI using a full metal jacket (FMJ), defined as overlapping drug-eluting stents
(DES) measuring > 60 mm in length, for very long lesions. Methods We enrolled 136 consecutive patients with long coronary lesions requiring FMJ in
our single-center registry. The primary endpoint included the combined occurrence
of all-cause death, myocardial infarction (MI), and target vessel
revascularization (TVR). Demographic, clinical, angiographic, and procedural
variables were evaluated using stepwise Cox regression analysis to determine
independent predictors of outcome. Results The mean length of stent per lesion was 73.2 ± 12.3 mm and the mean reference
vessel diameter was 2.9 ± 0.6 mm. Angiographic success was 96.3%. Freedom from
MACE was 94.9% at 30 days and 85.3% at one year. At the one-year follow-up, the
all-cause mortality rate was 3.7% (1.5% cardiac deaths), the MI rate was 3.7%, and
the incidence of definite or probable stent thrombosis (ST) was 2.9%. Female
gender [hazard ratio (HR), 4.40; 95% confidence interval (CI), 1.81-10.66; p =
0.001) and non-right coronary artery PCI (HR, 3.49; 95%CI, 1.42-8.59; p = 0,006)
were independent predictors of MACE at one year. Freedom from adverse events at
one year was higher in patients with stable angina who underwent PCI (HR, 0.33;
95%CI, 0.13-0.80; p = 0.014). Conclusions PCI using FMJ with DES for very long lesions was efficacious but associated with a
high rate of ST at the one-year follow-up. However, the rate of cardiac mortality,
nonprocedure-related MI, and MACE was relatively low. Target coronary vessel PCI,
clinical presentation, and female gender are new contemporary clinical factors
that appear to have adverse effects on the outcome of PCI using FMJ for long
lesions.
Collapse
Affiliation(s)
- Rita Calé
- Mailing Address: Rita Calé, Rua João Chagas Urbanização Alto dos
Moinhos, nº4, nucleo Z 6ºEsq. Postal Code 1500-493, Lisboa, Portugal, E-mail:
| | | | | | | | | | | | | | | | | | | |
Collapse
|
17
|
Steudel W, Dingmann C, Zhang YL, Bendrick-Peart J, Clavijo C, Shulze J, Betts R, Christians U. Randomized, Double-Blind, Placebo-Controlled, Single Intravenous Dose-Escalation Study to Evaluate the Safety, Tolerability, and Pharmacokinetics of the Novel Coronary Smooth Muscle Cell Proliferation Inhibitor Biolimus A9 in Healthy Individuals. J Clin Pharmacol 2013; 51:29-39. [DOI: 10.1177/0091270010361255] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
|
18
|
JIM MANHONG, YIU KAIHANG, HO HEEHWA, CHAN WAILING, NG ANDREWKEIYAN, SIU CHUNGWAH, CHOW WINGHING. Angiographic and Clinical Outcomes of Everolimus-Eluting Stent in the Treatment of Extra Long Stenoses (AEETES). J Interv Cardiol 2012; 26:22-8. [DOI: 10.1111/joic.12006] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Affiliation(s)
- MAN-HONG JIM
- From the Cardiac Medical Unit; Grantham Hospital; Hong Kong
| | - KAI-HANG YIU
- Division of Cardiology; Queen Mary Hospital; Hong Kong
| | - HEE-HWA HO
- Department of Cardiology; Teng Tock Seng Hospital; Singapore
| | - WAI-LING CHAN
- From the Cardiac Medical Unit; Grantham Hospital; Hong Kong
| | | | - CHUNG-WAH SIU
- From the Cardiac Medical Unit; Grantham Hospital; Hong Kong
| | - WING-HING CHOW
- From the Cardiac Medical Unit; Grantham Hospital; Hong Kong
| |
Collapse
|
19
|
Rha SW, Chen KY, Oh DJ, Li YJ, Jin Z, Poddar KL, Ramasamy S, Minami Y, Elnagar A, Choi BG, Hong SP, Cheon BW, Moon SK, Im SI, Kim SW, Na JO, Choi CU, Lim HE, Kim JW, Kim EJ, Han SW, Park CG, Seo HS, Kim JH, Hong YJ, Jeong MH. Impact of heterogeneous overlapping drug-eluting stents on the arterial responses of rabbit iliac arteries: a comparison with overlapping bare metal stents. Korean Circ J 2012; 42:397-405. [PMID: 22787470 PMCID: PMC3390425 DOI: 10.4070/kcj.2012.42.6.397] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2011] [Revised: 10/31/2011] [Accepted: 12/12/2011] [Indexed: 12/02/2022] Open
Abstract
Background and Objectives Although the use of heterogeneous overlapping drug-eluting stents (DES) is not uncommon in clinical practice, whether the implantation sequences of heterogeneous DES will influence the endothelialization or arterial responses differently remains unclear. Materials and Methods Twenty-one rabbits were randomized to receive overlapping stents in the iliac artery for 3 months {distal sirolimus-eluting stent (SES, Cypher™)+proximal paclitaxel-eluting stent (PES, Taxus™) (C+T, n=7), distal Taxus+proximal Cypher (T+C, n=7) and bare metal stent (BMS)+BMS (B+B, n=7)}. Endothelial function was evaluated by the acetylcholine provocation test during follow-up angiography. Histopathological changes in proximal, overlapped, and distal stented segments were evaluated. Results Although the overall angiographic outcomes were comparable, late loss (mm) in the distal stented segment was higher in the B+B (0.39±0.07) and C+T (0.40±0.20) than that in the T+C (0.06±0.02) group (p<0.001). The incidence of acetylcholine-induced spasm was higher in the DES groups compared with BMS, regardless of the implantation sequences (85.7% in C+T vs. 14.3% in B+B vs. 71.4% in T+C, p=0.017). Notably, only the distal Cypher implantation group (C+T) had three cases of stent fracture. A histopathological analysis showed that despite similar arterial injury scores, Taxus and Cypher stents had higher inflammatory reactions at the overlapped and distal segments compared with those of BMS. Conclusion Despite similar arterial injury, higher inflammatory reactions were observed in overlapping DES segments regardless of the implantation sequence compared with that of BMS. Moreover, DES was associated with impaired endothelial function on the adjacent non-stented segments.
Collapse
Affiliation(s)
- Seung-Woon Rha
- Cardiovascular Center, Korea University Guro Hospital, Seoul, Korea
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
20
|
Vranckx P, Boersma E, Garg S, Valgimigli M, Van Es GA, Goedhart D, Serruys P. Cardiovascular risk profile of patients included in stent trials; a pooled analysis of individual patient data from randomised clinical trials: insights from 33 prospective stent trials in Europe. EUROINTERVENTION 2011; 7:859-71. [DOI: 10.4244/eijv7i7a134] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
|
21
|
Extensive reconstruction of the left anterior descending coronary artery with an internal thoracic artery graft. Ann Thorac Surg 2011; 91:445-51. [PMID: 21256288 DOI: 10.1016/j.athoracsur.2010.10.002] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2010] [Revised: 09/29/2010] [Accepted: 10/01/2010] [Indexed: 11/22/2022]
Abstract
BACKGROUND Revascularization of the diffusely diseased coronary artery is a big challenge for both cardiologists and cardiac surgeons. Long reconstruction of the diffusely diseased vessel may be a useful surgical option. The aim of this study is to assess clinical and angiographic outcomes of extensive reconstruction (≥4 cm) of the left anterior descending coronary artery (LAD) using an internal thoracic artery (ITA) graft with or without endarterectomy. METHODS We retrospectively reviewed 213 patients who underwent extensive reconstruction of the LAD using an ITA graft between September 2004 and July 2009. The diffusely diseased LAD was extensively incised, additional endarterectomy was performed if necessary, and then the LAD was reconstructed with an ITA graft in a long on-lay fashion. Early and 1-year postoperative angiography was performed in 188 patients (88.3%) and 152 patients (71.4%), respectively. RESULTS The mean length of the reconstructed LAD was 5.4 ± 1.2 cm. Endarterectomy was performed in 46.0% of the patients. The operative mortality was 1.4%. Low cardiac output and perioperative myocardial infarction were observed in 3.3 and 5.2% of the patients, respectively. Freedom from death and other cardiac or cerebrovascular events was 91.5 ± 2.2% at 3 years. The early and 1-year patency rates of the ITA to LAD grafting were 95.7% and 93.4%, respectively. CONCLUSIONS Extensive reconstruction of the diffusely diseased LAD using an ITA graft could be performed safely. Early and 1-year angiographic outcome were excellent. This surgical revascularization is an useful option for revascularization of the diffuse coronary artery disease.
Collapse
|
22
|
Sarno G, Garg S, Gomez-Lara J, Garcia Garcia HM, Ligthart J, Bruining N, Onuma Y, Witberg K, van Geuns RJ, de Boer S, Wykrzykowska J, Schultz C, Duckers H, Regar E, de Jaegere P, de Feyter P, van Es GA, Boersma E, van der Giessen W, Serruys PW. Intravascular ultrasound radiofrequency analysis after optimal coronary stenting with initial quantitative coronary angiography guidance: an ATHEROREMO sub-study. EUROINTERVENTION 2011; 6:977-84. [DOI: 10.4244/eijv6i8a169] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
|
23
|
Zhu D, Jin X, Leng X, Wang H, Bao J, Liu W, Yao K, Song C. Local gene delivery via endovascular stents coated with dodecylated chitosan-plasmid DNA nanoparticles. Int J Nanomedicine 2010; 5:1095-102. [PMID: 21270960 PMCID: PMC3023238 DOI: 10.2147/ijn.s14358] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Development of efficacious therapeutic strategies to prevent and inhibit the occurrences of restenosis after percutaneous transluminal coronary angioplasty is critical for the treatment of cardiovascular diseases. In this study, the feasibility and efficiency of stents coated with dodecylated chitosan-plasmid DNA nanoparticles (DCDNPs) were evaluated as scaffolds for localized and prolonged delivery of reporter genes into the diseased blood vessel wall. Dodecylated chitosan-plasmid DNA complexes formed stable positive charged nanospheres with mean diameter of approximately 90-180 nm and zeta potential of +28 ± 3 mV. As prepared DCDNPs were spray-coated on stents, a thin layer of dense DCDNPs was successfully distributed onto the metal struts of the endovascular stents as demonstrated by scanning electron microscopy. The DCDNP stents were characterized for the release kinetics of plasmid DNA, and further evaluated for gene delivery and expression both in vitro and in vivo. In cell culture, DCDNP stents containing plasmid EGFP-C1 exhibited high level of GFP expression in cells grown on the stent surface and along the adjacent area. In animal studies, reporter gene activity was observed in the region of the artery in contact with the DCDNP stents, but not in adjacent arterial segments or distal organs. The DCDNP stent provides a very promising strategy for cardiovascular gene therapy.
Collapse
Affiliation(s)
- Dunwan Zhu
- Tianjin Key Laboratory of Biomedical Materials, Institute of Biomedical Engineering, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin, China
| | | | | | | | | | | | | | | |
Collapse
|
24
|
Koizumi T, Fitzgerald PJ, Honda Y, Ellis SG, Kent K, Martin SL, Brown CL, Masud AZ, Patterson JB, Greenberg J, Friedman M, Uchida T, Stone GW. Vascular responses to the multiple overlapped paclitaxel-eluting stents for the treatment of bare-metal in-stent restenotic lesions: angiographic and intravascular ultrasound analysis from the TAXUS-V ISR Trial. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2010; 11:140-8. [DOI: 10.1016/j.carrev.2009.07.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2009] [Accepted: 07/08/2009] [Indexed: 12/01/2022]
|
25
|
Suh J, Park DW, Lee JY, Jung IH, Lee SW, Kim YH, Lee CW, Cheong SS, Kim JJ, Park SW, Park SJ. The Relationship and Threshold of Stent Length With Regard to Risk of Stent Thrombosis After Drug-Eluting Stent Implantation. JACC Cardiovasc Interv 2010; 3:383-9. [DOI: 10.1016/j.jcin.2009.10.033] [Citation(s) in RCA: 80] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2009] [Accepted: 10/29/2009] [Indexed: 01/22/2023]
|
26
|
Räber L, Jüni P, Löffel L, Wandel S, Cook S, Wenaweser P, Togni M, Vogel R, Seiler C, Eberli F, Lüscher T, Meier B, Windecker S. Impact of Stent Overlap on Angiographic and Long-Term Clinical Outcome in Patients Undergoing Drug-Eluting Stent Implantation. J Am Coll Cardiol 2010; 55:1178-1188. [DOI: 10.1016/j.jacc.2009.11.052] [Citation(s) in RCA: 125] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2009] [Revised: 10/28/2009] [Accepted: 11/02/2009] [Indexed: 11/28/2022]
|
27
|
Assessment of in-stent restenosis using 64-MDCT: analysis of the CORE-64 Multicenter International Trial. AJR Am J Roentgenol 2010; 194:85-92. [PMID: 20028909 DOI: 10.2214/ajr.09.2652] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
OBJECTIVE Evaluations of stents by MDCT from studies performed at single centers have yielded variable results with a high proportion of unassessable stents. The purpose of this study was to evaluate the accuracy of 64-MDCT angiography (MDCTA) in identifying in-stent restenosis in a multicenter trial. MATERIALS AND METHODS The Coronary Evaluation Using Multidetector Spiral Computed Tomography Angiography Using 64 Detectors (CORE-64) Multicenter Trial and Registry evaluated the accuracy of 64-MDCTA in assessing 405 patients referred for coronary angiography. A total of 75 stents in 52 patients were assessed: 48 of 75 stents (64%) in 36 of 52 patients (69%) could be evaluated. The prevalence of in-stent restenosis by quantitative coronary angiography (QCA) in this subgroup was 23% (17/75). Eighty percent of the stents were <or=3.0 mm in diameter. RESULTS The overall sensitivity, specificity, positive predictive value, and negative predictive value to detect 50% in-stent stenosis visually using MDCT compared with QCA was 33.3%, 91.7%, 57.1%, and 80.5%, respectively, with an overall accuracy of 77.1% for the 48 assessable stents. The ability to evaluate stents on MDCTA varied by stent type: Thick-strut stents such as Bx Velocity were assessable in 50% of the cases; Cypher, 62.5% of the cases; and thinner-strut stents such as Taxus, 75% of the cases. We performed quantitative assessment of in-stent contrast attenuation in Hounsfield units and correlated that value with the quantitative percentage of stenosis by QCA. The correlation coefficient between the average attenuation decrease and >or=50% stenosis by QCA was 0.25 (p=0.073). Quantitative assessment failed to improve the accuracy of MDCT over qualitative assessment. CONCLUSION The results of our study showed that 64-MDCT has poor ability to detect in-stent restenosis in small-diameter stents. Evaluability and negative predictive value were better in large-diameter stents. Thus, 64-MDCT may be appropriate for stent assessment in only selected patients.
Collapse
|
28
|
Wykrzykowska JJ, Räber L, de Vries T, Bressers M, Buszman P, Linke A, Ischinger T, Klauss V, Eberli F, Corti R, Wijns W, Morice MC, di Mario C, Regar E, Jüni P, Windecker S, Serruys PW. Biolimus-eluting biodegradable polymer versus sirolimus-eluting permanent polymer stent performance in long lesions: results from the LEADERS multicentre trial substudy. EUROINTERVENTION 2009; 5:310-7. [PMID: 19736154 DOI: 10.4244/v5i3a49] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS Lesion length remains a predictor of target lesion revascularisation and results of long lesion stenting remain poor. Sirolimus-eluting stents have been shown to perform better than paclitaxel eluting stents in long lesions. In this substudy of the LEADERS trial, we compared the performance of biolimus biodegradable polymer (BES) and sirolimus permanent polymer stents (SES) in long lesions. METHODS AND RESULTS A total of 1,707 'all-comer' patients were randomly allocated to treatment with BES and SES. A stratified analysis of angiographic and clinical outcomes at nine months and one year, respectively was performed for vessels with lesion length <20 mm versus >20 mm (as measured by quantitative angiography).Of 1,707 patients, 592 BES patients with 831 lesions and 619 SES patients with 876 lesions had only short lesions treated. One hundred and fifty-three BES patients with 166 lesions and 151 SES patients with 162 lesions had long lesions. There were no significant differences in baseline clinical characteristics, except for higher number of patients with long lesions presenting with acute myocardial infarction in both stent groups. Long lesions tended to have lower MLD and greater percent diameter stenosis at baseline than short lesions. Late loss was greater for long lesions than short lesions. There was no statistically significant difference in late loss between BES and SES stents (0.32+/-0.69 vs 0.24+/-0.57, p=0.59). Binary in-segment restenosis was present in 23.2% versus 13.1% of long lesions treated with BES and SES, respectively (p=0.042). In patients with long lesions, the overall MACE rate was similar for BES and SES (17% vs 14.6%; p=0.62). There was a trend towards higher overall TLR rate with BES (12.4 % vs 6.0%; HR=2.06; p=0.07) and clinically driven TLR (10.5% vs 5.3%: HR 1.94; p=0.13). Rates of definite stent thrombosis were 3.3% in the long lesion group and 1.3-1.7 % in the short lesion group. CONCLUSIONS BES and SES appear similar with respect to MACE in long lesions in this "all-comer" patient population. However, long lesions tended to have a higher rate of binary in-segment restenosis and TLR following BES than SES treatment.
Collapse
Affiliation(s)
- Joanna J Wykrzykowska
- The Department of Interventional Cardiology Thoraxcenter, Erasmus MC, Rotterdam, The Netherlands
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
29
|
Kent DM, Trikalinos TA. Are "treatment" bare metal stents superior to "control" bare metal stents? A meta-analytic approach. Am Heart J 2008; 155:624-9, 629.e1-2. [PMID: 18371468 DOI: 10.1016/j.ahj.2007.11.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2007] [Accepted: 11/02/2007] [Indexed: 11/27/2022]
Abstract
BACKGROUND It has been suggested that the benefits of drug-eluting stents compared to bare metal stents (BMS) have been overestimated in part because target lesion/vessel revascularization (TLR/TVR) rates in the BMS control group of these trials were spuriously high. METHODS We used meta-analytic techniques to systematically compare clinical event rates among patients treated with BMS in trials where BMS were the experimental (BMS(experimental)) rather than the control (BMS(control)) intervention. MEDLINE searches were performed to identify eligible randomized trials comparing either drug-eluting stents with BMS(control) or BMS(experimental) with balloon angioplasty in patients with nonacute coronary artery disease. Trial characteristics and 6- to 12-month rates for death, myocardial infarction, TLR/TVR, and major adverse cardiac events were extracted and assessed. RESULTS Eligible trials yielded 50 BMS cohorts: 19 in the BMS(control) group (4046 patients) and 31 in the BMS(experimental) group (5068 patients). Summary death and infarction rates did not differ between groups. The summary TLR/TVR rates were 16.2% (95% CI 13.5-19.3) versus 13.8% (95% CI 12.0-15.7) in BMS(control) versus BMS(experimental) groups, respectively (P = .15). Among 39 BMS cohorts with < or = 250 patients, TLR/TVR rates were significantly higher in BMS(control) versus BMS(experimental) groups (18.9% [95% CI 16.0-22.2] vs 13.7% [95% CI 11.5-16.3], P = .01). There were no between-group differences among larger BMS cohorts (P = .98). CONCLUSIONS Although overall clinical event rates did not differ in the BMS(control) and the BMS(experimental) groups, a higher rate of TVR/TLR was seen in the BMS(control) group among smaller trials.
Collapse
|
30
|
Lee SH, Chae JK, Lee KH, Lee SR, Rhee KS, Kim WH, Ko JK. Full Metal Jackets (≥60 mm) of Drug-Eluting Stents: Short- and Long-term Clinical and Angiographic Outcomes. Korean Circ J 2008. [DOI: 10.4070/kcj.2008.38.2.87] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Affiliation(s)
- Sun Hwa Lee
- Division of Cardiology, Department of Internal Medicine, Chonbuk National University Medical School, Jeonju, Korea
| | - Jei-Keon Chae
- Division of Cardiology, Department of Internal Medicine, Chonbuk National University Medical School, Jeonju, Korea
| | - Kang-Hyu Lee
- Division of Cardiology, Department of Internal Medicine, Chonbuk National University Medical School, Jeonju, Korea
| | - Sang-Rok Lee
- Division of Cardiology, Department of Internal Medicine, Chonbuk National University Medical School, Jeonju, Korea
| | - Kyoung-Suk Rhee
- Division of Cardiology, Department of Internal Medicine, Chonbuk National University Medical School, Jeonju, Korea
| | - Won-Ho Kim
- Division of Cardiology, Department of Internal Medicine, Chonbuk National University Medical School, Jeonju, Korea
| | - Jae-Ki Ko
- Division of Cardiology, Department of Internal Medicine, Chonbuk National University Medical School, Jeonju, Korea
| |
Collapse
|
31
|
Lee HG, Chun KJ, Cho KI, Lee DW, Oh JH, Ahn BJ, Kim SH, Lee JS, Kim MY, Bae WH, Ko WS, Jeong JH, Kim TI, Lee HC, Kim J, Kim JH, Hong TJ, Shin YW. Impact of Drug-Eluting Stents on Clinical Outcomes in Patients With Diffuse Coronary Lesions. Korean Circ J 2008. [DOI: 10.4070/kcj.2008.38.11.612] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Affiliation(s)
- Hyeon Gook Lee
- Division of Cardiology, Department of Internal Medicine, Maryknoll Medical Center, Busan, Korea
| | - Kook Jin Chun
- Division of Cardiology, Department of Internal Medicine, College of Medicine, Pusan National University, Busan, Korea
| | - Kyoung Im Cho
- Division of Cardiology, Department of Internal Medicine, Maryknoll Medical Center, Busan, Korea
| | - Dong Won Lee
- Division of Cardiology, Department of Internal Medicine, Maryknoll Medical Center, Busan, Korea
| | - Jun Hyuk Oh
- Division of Cardiology, Department of Internal Medicine, College of Medicine, Pusan National University, Busan, Korea
| | - Byung Jae Ahn
- Division of Cardiology, Department of Internal Medicine, College of Medicine, Pusan National University, Busan, Korea
| | - Seong Ho Kim
- Division of Cardiology, Department of Internal Medicine, College of Medicine, Pusan National University, Busan, Korea
| | - Joon Sang Lee
- Division of Cardiology, Department of Internal Medicine, College of Medicine, Pusan National University, Busan, Korea
| | - Moo Young Kim
- Division of Cardiology, Department of Internal Medicine, College of Medicine, Pusan National University, Busan, Korea
| | - Woo Hyung Bae
- Division of Cardiology, Department of Internal Medicine, College of Medicine, Pusan National University, Busan, Korea
| | - Woo Seog Ko
- Division of Cardiology, Department of Internal Medicine, College of Medicine, Pusan National University, Busan, Korea
| | - Joon Hoon Jeong
- Division of Cardiology, Department of Internal Medicine, College of Medicine, Pusan National University, Busan, Korea
| | - Tae Ik Kim
- Division of Cardiology, Department of Internal Medicine, Maryknoll Medical Center, Busan, Korea
| | - Han Cheol Lee
- Division of Cardiology, Department of Internal Medicine, College of Medicine, Pusan National University, Busan, Korea
| | - Jun Kim
- Division of Cardiology, Department of Internal Medicine, College of Medicine, Pusan National University, Busan, Korea
| | - June Hong Kim
- Division of Cardiology, Department of Internal Medicine, College of Medicine, Pusan National University, Busan, Korea
| | - Taek Jong Hong
- Division of Cardiology, Department of Internal Medicine, College of Medicine, Pusan National University, Busan, Korea
| | - Yung Woo Shin
- Division of Cardiology, Department of Internal Medicine, College of Medicine, Pusan National University, Busan, Korea
| |
Collapse
|
32
|
Lim SY, Jeong MH, Hong SJ, Lim DS, Moon JY, Hong YJ, Kim JH, Ahn Y, Kang JC. Inflammation and Delayed Endothelization With Overlapping Drug-Eluting Stents in a Porcine Model of In-Stent Restenosis. Circ J 2008; 72:463-8. [PMID: 18296847 DOI: 10.1253/circj.72.463] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Sang Yup Lim
- The Cardiovascular Center of Korea University Anam Hospital
| | - Myung Ho Jeong
- The Heart Center of Chonnam National University Hospital, Cardiovascular Research Institute of Chonnam National University
| | - Soon Jun Hong
- The Cardiovascular Center of Korea University Anam Hospital
| | - Do Sun Lim
- The Cardiovascular Center of Korea University Anam Hospital
| | - Jae Youn Moon
- The Heart Center of Chonnam National University Hospital, Cardiovascular Research Institute of Chonnam National University
| | - Young Joon Hong
- The Heart Center of Chonnam National University Hospital, Cardiovascular Research Institute of Chonnam National University
| | - Ju Han Kim
- The Heart Center of Chonnam National University Hospital, Cardiovascular Research Institute of Chonnam National University
| | - Youngkeun Ahn
- The Heart Center of Chonnam National University Hospital, Cardiovascular Research Institute of Chonnam National University
| | - Jung Chaee Kang
- The Heart Center of Chonnam National University Hospital, Cardiovascular Research Institute of Chonnam National University
| |
Collapse
|
33
|
Kang WC, Oh KJ, Han SH, Ahn TH, Chung WJ, Shin MS, Koh KK, Choi IS, Shin EK. Angiographic and intravascular ultrasound study of the effects of overlapping sirolimus- and paclitaxel-eluting stents: Comparison with same drug-eluting overlapping stents. Int J Cardiol 2007; 123:12-7. [PMID: 17289176 DOI: 10.1016/j.ijcard.2006.11.104] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2006] [Revised: 10/20/2006] [Accepted: 11/09/2006] [Indexed: 11/24/2022]
Abstract
BACKGROUND Although complete coverage of diffuse long coronary lesions has warranted the use of overlapping drug-eluting stents (DESs), the effect of stent overlap with different DESs on the neointimal hyperplasia and whether it would result in dose-related side effects are unknown. METHODS AND RESULTS Forty-seven consecutive patients, from June 2003 to August 2004, underwent percutaneous coronary intervention (PCI) with 2 of the same or different overlapping DESs for diffuse long lesions. Out of the total of 47 patients, a nine-month angiographic examination and IVUS were performed in 40 (85.1%) patients. Of the 47 overlapping DESs utilized, 14 were overlapped using sirolimus- and paclitaxel-eluting stents (S-P group), 13 using two sirolimus-eluting stents (S-S group) and 20 using two paclitaxel-eluting stents (P-P group). In the follow-up, there was no difference between the three groups in the late loss or area of neointimal hyperplasia. All restenoses were noted at non-overlapping sites (2 at the proximal edge of the proximal stent, and 3 at the distal in-stent). There were no stent thromboses documented or aneurysmal formations at the overlapping site in any of the three groups. One late stent malapposition was observed not at an overlapping site, but in the distal single stent area. CONCLUSIONS In conclusion, compared with using the same overlapping DESs, PCI with different overlapping DESs exhibited similar effects on the suppression of neointimal hyperplasia and did not increase the side effects of the DES.
Collapse
Affiliation(s)
- Woong Chol Kang
- Division of Cardiology, Gil Medical Center, Gachon University of Medicine and Science, Incheon, Republic of Korea
| | | | | | | | | | | | | | | | | |
Collapse
|
34
|
Lim SY, Jeong MH, Kim JH, Lee SR, Moon JY, Hong YJ, Kim JH, Ahn Y, Cho JG, Park JC, Kim KS, Joo SJ, Kang JC. Re-endothelization and Inflammatory Reaction at Site of Overlapping Drug-Eluting Stents in a Porcine Coronary In-Stent Restenosis Model. Korean Circ J 2007. [DOI: 10.4070/kcj.2007.37.1.33] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Affiliation(s)
- Sang Yup Lim
- Department of Internal Medicine, Cheju National University, Jeju, Korea
| | - Myung Ho Jeong
- The Heart Center of Chonnam National University Hospital, Chonnam National University Research Institute of Medical Sciences, Gwangju, Korea
| | - Jeong Ha Kim
- The Heart Center of Chonnam National University Hospital, Chonnam National University Research Institute of Medical Sciences, Gwangju, Korea
| | - Sang Rok Lee
- The Heart Center of Chonnam National University Hospital, Chonnam National University Research Institute of Medical Sciences, Gwangju, Korea
| | - Jae Youn Moon
- The Heart Center of Chonnam National University Hospital, Chonnam National University Research Institute of Medical Sciences, Gwangju, Korea
| | - Young Joon Hong
- The Heart Center of Chonnam National University Hospital, Chonnam National University Research Institute of Medical Sciences, Gwangju, Korea
| | - Ju Han Kim
- The Heart Center of Chonnam National University Hospital, Chonnam National University Research Institute of Medical Sciences, Gwangju, Korea
| | - Youngkeun Ahn
- The Heart Center of Chonnam National University Hospital, Chonnam National University Research Institute of Medical Sciences, Gwangju, Korea
| | - Jeong Gwan Cho
- The Heart Center of Chonnam National University Hospital, Chonnam National University Research Institute of Medical Sciences, Gwangju, Korea
| | - Jong Chun Park
- The Heart Center of Chonnam National University Hospital, Chonnam National University Research Institute of Medical Sciences, Gwangju, Korea
| | - Ki-Seok Kim
- Department of Internal Medicine, Cheju National University, Jeju, Korea
| | - Seung-Jae Joo
- Department of Internal Medicine, Cheju National University, Jeju, Korea
| | - Jung Chaee Kang
- The Heart Center of Chonnam National University Hospital, Chonnam National University Research Institute of Medical Sciences, Gwangju, Korea
| |
Collapse
|
35
|
Affiliation(s)
- Patrick W Serruys
- Department of Interventional Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands
| | | | | |
Collapse
|
36
|
Abstract
The introduction and widespread use of coronary stents have been the most important advancement in the percutaneous treatment of coronary artery disease since the introduction of balloon angioplasty. Coronary artery stents reduce the rate of angiographic and clinical restenosis compared to balloon angioplasty. This angiographic restenosis was further reduced with the introduction of drug-eluting stents and hence further reduction in the frequency of major adverse cardiac events. Herein we present a comprehensive and up-to-date review about the use of drug-eluting stents in the treatment of coronary artery disease.
Collapse
|
37
|
Koizumi T, Wilson AM, Clark DA, Fitzgerald PJ. Latent plaque rupture in a patient undergoing stenting for acute coronary syndrome and diffuse coronary disease: A case report and review of literature. Catheter Cardiovasc Interv 2006; 67:241-5. [PMID: 16400671 DOI: 10.1002/ccd.20596] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Secondary prevention of plaque rupture following percutaneous coronary intervention in patients with acute coronary syndrome is not well studied. This case report describes a 53-year-old man who experienced plaque rupture between two previously successfully implanted stents in the right coronary artery, as documented during the 3rd intervention using intravascular ultrasound.
Collapse
Affiliation(s)
- Tomomi Koizumi
- Division of Cardiovascular Medicine, Stanford University, Stanford, California, USA
| | | | | | | |
Collapse
|
38
|
Aoki J, Ong ATL, Rodriguez Granillo GA, McFadden EP, van Mieghem CAG, Valgimigli M, Tsuchida K, Sianos G, Regar E, de Jaegere PPT, van der Giessen WJ, de Feyter PJ, van Domburg RT, Serruys PW. "Full metal jacket" (stented length > or =64 mm) using drug-eluting stents for de novo coronary artery lesions. Am Heart J 2005; 150:994-9. [PMID: 16290984 DOI: 10.1016/j.ahj.2005.01.050] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2004] [Accepted: 01/26/2005] [Indexed: 10/25/2022]
Abstract
BACKGROUND Stented segment length was a predictive factor for restenosis in the bare metal stent era. The objective of the study was to evaluate the medium-term clinical outcome and the potential for adverse effects when very long segments (ie, > or =64 mm of stented length) are treated by drug-eluting stent (DES) implantation, an approach colloquially referred to as a "full metal jacket." METHODS Since April 2002, we have used DES as the default stent for all percutaneous coronary interventions. From our prospective institutional database we identified 122 consecutive patients, with de novo coronary lesions, in whom a coronary artery was treated with at least 64 mm of overlapping DES: 81 patients were treated with sirolimus-eluting stents and 41 with paclitaxel-eluting stents. RESULTS The mean number of stents per lesion was 3.3 +/- 1.1, and the median stented length was 79 mm (range 64-168 mm). Periprocedural Q-wave myocardial infarction (MI) occurred in 2 patients (1.6%) and subacute stent thrombosis in 1 patient (0.8%). During 1-year follow-up, 5 patients (4.1%), including 3 patients treated for acute MI with cardiogenic shock, died and 10 patients (8.2%) had nonfatal MI (creatine kinase-MB >3 times). The 1-year target vessel revascularization rate was 7.5% and the overall incidence of major adverse cardiac events was 18%. Outcomes in sirolimus-eluting stents and paclitaxel-eluting stents groups did not differ statistically. CONCLUSIONS The use of DES for the treatment of diffuse lesions was associated with a low rate of repeat revascularization, irrespective of stent type. No safety concerns were raised at medium-term follow-up.
Collapse
Affiliation(s)
- Jiro Aoki
- Erasmus Medical Center, Thoraxcenter, Rotterdam, The Netherlands
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
39
|
Han B, Aboud M, Nahir M, Noem F, Hasin Y. Cutting balloons versus conventional long balloons for PCI of long coronary lesions. INTERNATIONAL JOURNAL OF CARDIOVASCULAR INTERVENTIONS 2005; 7:29-35. [PMID: 16019612 DOI: 10.1080/14628840510011171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND PCI for long coronary lesions remains a challenge because of high incidence of early complications and late restenosis. Cutting balloon angioplasty may result in reduced procedural complications and late restenosis than angioplasty with conventional long balloons (LBA) due to minimized injury to the culprit arteries. OBJECTIVE To compare the immediate and one-year outcomes of CBA and LBA for long coronary lesions. METHODS 169 consecutive patients were retrospectively identified who underwent CBA or LBA for de novo lesions 20 mm in length and 2.5 mm in diameter. The primary endpoint was immediate procedural outcomes and angiographic restenosis at one year. RESULTS CBA was performed in 54 patients (56 lesions) and LBA in 115 patients (151 lesions). Baseline characteristics were similar in both groups with a mean lesion length of 34.89+/-11.19 mm, and vessel diameter of 3.03+/-0.54 mm. CBA resulted in reduced incidence of side branch loss (23.2% versus 41.7%, P=0.022) which was associated with less peri-procedural infarction (OR: 11.39 (95% CI: 1.34-96.53), P=0.026). It also caused less dissection (23.2% versus 38.4%, P=0.048) leading to a trend of less provisional focal stenting (32.1% versus 41.1%, P=0.264). The rate of angiographic restenosis and clinically driven target lesion revascularization at one year (follow-up 91.1%) was similar (25% versus 21.2%, and 20.4% versus 20%, for CBA versus LBA, both P=NS). The mean event-free survival was also similar (10.15+/-0.45 months for CBA versus 9.50+/-0.39 months for LBA, P=NS). CONCLUSION CBA demonstrated better immediate results and equivalent late results than LBA, and therefore, it may be considered a reasonable firstline approach for PCI of long coronary lesions.
Collapse
Affiliation(s)
- Bo Han
- Cardiology Department, Poria Medical Center, Tiberias, MP Hatachton, Israel
| | | | | | | | | |
Collapse
|
40
|
Tsagalou E, Chieffo A, Iakovou I, Ge L, Sangiorgi GM, Corvaja N, Airoldi F, Montorfano M, Michev I, Colombo A. Multiple Overlapping Drug-Eluting Stents to Treat Diffuse Disease of the Left Anterior Descending Coronary Artery. J Am Coll Cardiol 2005; 45:1570-3. [PMID: 15893168 DOI: 10.1016/j.jacc.2005.01.049] [Citation(s) in RCA: 83] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2004] [Revised: 01/18/2005] [Accepted: 01/25/2005] [Indexed: 10/25/2022]
Abstract
OBJECTIVES We sought to determine the safety and efficacy of using multiple overlapping drug-eluting stents (DES) in patients with diffuse left anterior descending coronary artery (LAD) disease. BACKGROUND Diffuse LAD disease represents a therapeutic challenge. Results after coronary artery bypass surgery are suboptimal, whereas the use of bare metal stents is limited by high rates of restenosis. The introduction of DES prompted treatment of long diffuse disease with multiple overlapping stents. METHODS All consecutive patients with de novo diffuse LAD disease treated with more than 60-mm long DES from April 2002 to March 2004 were analyzed. RESULTS The study population consisted of 66 patients. Thirty-nine patients were treated with sirolimus-eluting stents (SES), average length 84 +/- 22 mm, and 27 patients with paclitaxel-eluting stents (PES), average length 74 +/- 14 mm. The number of stents implanted per patient was 2.8 +/- 0.7, whereas the mean total stent length for the LAD treatment was 80 +/- 20 mm. Angiographic as well as procedural success was achieved in 95% of cases. Eleven (16.6%) patients had in-hospital non-Q-wave myocardial infarction (five SES and six PES), and one patient developed intraprocedural stent thrombosis. All patients had clinical follow-up, and 52 patients (79%) had an angiographic follow-up at six months. Hierarchical major adverse cardiac event rate was 15% (7.5% for SES and 7.5% for PES). No patients died, one patient had non-Q-wave myocardial infarction (non-index vessel), and 10 patients (15%) underwent target vessel revascularization. CONCLUSIONS The implantation of multiple overlapping DES in patients with a diffusely diseased LAD is relatively safe and associated with good midterm clinical outcomes.
Collapse
|
41
|
Huarte E, Tirapu I, Arina A, Vera M, Alfaro C, Murillo O, Palencia B, Busto V, Marín V, Mazzolini G, Melero I. Intratumoural administration of dendritic cells: hostile environment and help by gene therapy. Expert Opin Biol Ther 2005; 5:7-22. [PMID: 15709906 DOI: 10.1517/14712598.5.1.7] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Like paratroopers in special operations, dendritic cells (DCs) can be deployed behind the enemy borders of malignant tissue to ignite an antitumour immune response. 'Cross-priming T cell responses' is the code name for their mission, which consists of taking up antigen from transformed cells or their debris, migrating to lymphoid tissue ferrying the antigenic cargo, and meeting specific T cells. This must be accomplished in such an immunogenic manner that specific T lymphocytes would mount a robust enough response as to fully reject the malignancy. To improve their immunostimulating activity, local gene therapy can be very beneficial, either by transfecting DCs with genes enhancing their performance, or by preparing tumour tissue with pro-inflammatory mediators. In addition, endogenous DCs from the tumour host can be attracted into the malignant tissue following transfection of certain chemokine genes into tumour cells. On their side, tumour stroma and malignant cells set up a hostile immunosuppressive environment for artificially released or attracted DCs. This milieu is usually rich in transforming growth factor-beta, vascular endothelial growth factor, and IL-10, -6 and -8, among other substances that diminish DC performance. Several molecular strategies are being devised to interfere with the immunosuppressive actions of these substances and to further enhance the level of anticancer immunity achieved after artificial release of DCs intratumourally.
Collapse
Affiliation(s)
- Eduardo Huarte
- University of Navarra School of Medicine, Gene Therapy Unit, Centro Investigación Médica Aplicada (CIMA), Avda/Pio XII,55, 31080 Pamplona, Spain
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
42
|
Nordmann AJ, Bucher H, Hengstler P, Harr T, Young J. Primary stenting versus primary balloon angioplasty for treating acute myocardial infarction. Cochrane Database Syst Rev 2005:CD005313. [PMID: 15846752 DOI: 10.1002/14651858.cd005313] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Balloon angioplasty following myocardial infarction (MI) reduces death, non-fatal MI and stroke compared to thrombolytic reperfusion. However up to 50% of patients experience restenosis and 3% to 5% recurrent myocardial infarction. Therefore, primary stenting may offer additional benefits compared to balloon angioplasty in patients with acute myocardial infarction. OBJECTIVES To examine whether primary stenting compared to primary balloon angioplasty reduces clinical outcomes in patients with acute myocardial infarction. SEARCH STRATEGY We searched MEDLINE, EMBASE, Pascal, Index medicus and The Cochrane Controlled Trials Register (The Cochrane Library) from 1979 to March 2002. SELECTION CRITERIA Randomised controlled trials of primary stenting or balloon angioplasty prior to the invasive procedure; intervention in native coronary arteries within 24 hours after onset of symptoms of myocardial infarction; report of death or reinfarction; and follow-up of at least 1 month. Trials were excluded when randomisation occurred after an invasive procedure and if they exclusively included patients with cardiogenic shock. DATA COLLECTION AND ANALYSIS Two reviewers independently selected and extracted data from identified trials. Outcomes included mortality, reinfarction, coronary artery bypass grafting, target vessel revascularization, need for vascular repair or blood transfusion. Peto odds ratios were calculated. To explore the stability of the overall treatment effect various sensitivity analyses were performed. MAIN RESULTS We included nine trials of 4433 participants. Odds ratios for mortality after stenting compared to balloon angioplasty at 30 days, 6 and 12 months were 1.16 (95% CI 0.78 to 1.73), 1.27 (95% CI 0.89 to 1.83), and 1.06 (95% CI 0.77 to 1.45). At 30 days, 6 and 12 months odds ratios for reinfarction after stenting compared to balloon angioplasty were 0.52 (95% CI 0.31 to 0.87), 0.67 (95% CI 0.45 to 1.00), and 0.67 (95% CI 0.45-0.98) and odds ratio for target vessel revascularization after stenting compared to balloon angioplasty were 0.45 (95%CI 0.34 to 0.60), 0.42 (95% CI 0.35 to 0.51), and 0.47 (95% CI 0.38 to 0.57). The odds ratio for post-interventional bleeding complications after stenting compared to balloon angioplasty was 1.34 (95% CI 0.95 to 1.88; test of heterogeneity p > 0.1). AUTHORS' CONCLUSIONS There is no evidence to suggest that primary stenting reduces mortality when compared to balloon angioplasty. Stenting seems to be associated with a reduced risk of reinfarction and target vessel revascularization, but potential confounding due to unbalanced post-interventional antithrombotic/anticoagulant therapies can not be ruled out on basis of this review.
Collapse
Affiliation(s)
- A J Nordmann
- Basel Institute for Clinical Epidemiology, University Hospital Basel, Hebelstrasse 10, Basel, Switzerland, 4031.
| | | | | | | | | |
Collapse
|
43
|
|
44
|
Abstract
Since the era of balloon angioplasty, stents have been a revolutionary advance in the treatment of severe coronary artery disease. However, one of the major limitations is in-stent restenosis. Although brachytherapy was found to be an effective treatment, the goal remains to develop a kind of stent that will not restenose. The emergence of drug-eluting stents provided a novel solution for the reduction of restenosis. The currently approved indication for drug-eluting stents by the US Food and Drug Administration is for discrete, de novo lesions in native vessels with reference vessel diameters of 2.5 to 3.5 mm. However, in the worldwide daily practice, there have been numerous off-label uses of drug-eluting stents, and their long-term follow-up and experience in more complex lesions are accumulating. This article reviews the current off-label uses of drug-eluting stents. The majority of the supporting data are from registry and observational studies, yet many studies are limited by small sample sizes. Therefore, large, prospective, randomized, double-blind, and controlled trials are definitely warranted to further support current practice. Nevertheless, the "real world" unrestricted uses of drug-eluting stents seem to be the current trend in the interventional field.
Collapse
Affiliation(s)
- William W Chu
- Washington Hospital Center, 110 Irving Street, NW, Suite 4B-1, Washington, DC 20010-2975, USA.
| | | |
Collapse
|
45
|
Dündar Y, Hill RA, Bakhai A, Dickson R, Walley T. Angioplasty and stents in coronary artery disease: a systematic review and meta-analysis. SCAND CARDIOVASC J 2004; 38:200-10. [PMID: 15553930 DOI: 10.1080/14017430410032325] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVES To undertake a systematic review of the clinical effectiveness of routine percutaneous transluminal coronary angioplasty (PTCA) plus stenting vs PTCA alone. DATA SOURCES MEDLINE; EMBASE; Science Citation Index; The Cochrane Library; cardiovascular journals and conference proceedings; Internet resources (including industry supported web pages); and reference lists of included studies and relevant reviews. REVIEW METHODS Study selection included published and unpublished randomized controlled trials (RCTs) comparing the use of coronary stents to PTCA. Outcome measures assessed included death, acute myocardial infarction (AMI), event rate (such as major cardiac adverse events (MACE) or other composite measures), and binary restenosis (BR). Data extraction and quality assessment were conducted according to internationally recognized methods. Data synthesis included meta-analysis of assessed outcomes, reported as odds ratios (ORs). RESULTS Fifty RCTs involving 16,500 patients met the inclusion criteria (39 full articles, 11 abstracts). Of these, 23 studies compared stenting with PTCA in patients with non-specific coronary artery disease (CAD), 11 compared stents with PTCA following AMI, 8 included patients with small coronary arteries and 8 included patients whose vessels had chronic total occlusion. There were no differences in rates of death or AMI. There were reductions in the rates of MACE (death, AMI or revascularization) with stents compared to PTCA (at 6 months, for non-specific group OR: 1.64, 95% CI 1.44-1.87; for AMI group OR: 2.36, 95% CI 1.92-2.89; for small vessel group OR: 1.38, 95% CI 1.10-1.74; at 12 months, for non-specific group OR: 1.31, 95% CI 1.11-1.55; for AMI OR: 2.26, 95% CI 1.47-3.46). Reporting of combined major adverse cardiac events was inconsistent across studies. Most events were revascularizations that may have been partly driven by protocol-required angiograms. Stents reduced BR rates at angiogram at 6 months compared to PTCA in all groups. CONCLUSION We found no differences in mortality or AMI, but the studies were not powered to identify changes in these endpoints. Coronary stenting is associated with reduced restenosis and combined adverse cardiac events, primarily revascularizations. However, the frequency of revascularization may have been distorted by protocol-dictated angiography.
Collapse
Affiliation(s)
- Yenal Dündar
- The University of Liverpool, Faculty of Medicine, Liverpool Reviews & Implementation Group, Liverpool, UK.
| | | | | | | | | |
Collapse
|
46
|
Abstract
Long coronary lesions, comprising up to 20% of the interventional practice, pose a significant challenge to the interventionalist. Several approaches have been described to treat long coronary lesions with long-term suboptimal outcomes. Atherectomy and laser treatments with or without adjunctive balloon angioplasty have not been shown to be superior to conventional balloon angioplasty alone. Preliminary data with the use of drug-eluting stents in the treatment of long coronary lesions appears to be promising even in small vessels and may eventually become the mainstay treatment of long lesions.
Collapse
|
47
|
Kipshidze N, Dangas G, Tsapenko M, Moses J, Leon MB, Kutryk M, Serruys P. Role of the endothelium in modulating neointimal formation: vasculoprotective approaches to attenuate restenosis after percutaneous coronary interventions. J Am Coll Cardiol 2004; 44:733-9. [PMID: 15312851 DOI: 10.1016/j.jacc.2004.04.048] [Citation(s) in RCA: 110] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2004] [Revised: 04/10/2004] [Accepted: 04/27/2004] [Indexed: 10/26/2022]
Abstract
Restenosis at the site of an endoluminal procedure remains a significant problem in the practice of interventional cardiology. We present current data on intimal hyperplasia, which identify the major role of endothelial cells (ECs) in the development of restenosis. Considering endothelial denudation as one of the most important mechanisms contributing to restenosis, we focus more attention on methods of accelerating restoration of endothelial continuity. Prevention of restenosis may be achieved by promoting endothelial regeneration through the use of growth factors, EC seeding, vessel reconstruction with autologous EC/fibrin matrix, and the use of estrogen-loaded stents and stents designed to capture progenitor ECs.
Collapse
Affiliation(s)
- Nicholas Kipshidze
- Lenox Hill Heart and Vascular Institute and Cardiovascular Research Foundation, New York, New York 10021, USA.
| | | | | | | | | | | | | |
Collapse
|
48
|
Schukro C, Syeda B, Schmid R, Stemberger A, Lang I, Derntl M, Neunteufl T, Christ G, Kirisits C, Pokrajac B, Glogar D. Intracoronary brachytherapy with ??-radiation for the treatment of long diffuse in-stent restenosis. Coron Artery Dis 2004; 15:285-9. [PMID: 15238826 DOI: 10.1097/01.mca.0000135403.46579.ef] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To assess the efficacy of intracoronary brachytherapy with beta-radiation (Sr/Y) for the treatment of long diffuse in-stent restenosis (ISR). METHODS As recurrent ISR depends on intimal injury after coronary angioplasty, long in-stent restenotic lesions were defined as lesions with a treatment length >26 mm (lesion length >20 mm plus a treatment margin of 3 mm at each end). Seventy-eight patients with long ISR were treated at our institution with beta-brachytherapy after coronary angioplasty. Patients were irradiated with either an approximate dose of 12 Gy at 1 mm vessel wall depth or with 18 Gy at 1 mm vessel wall depth. Clinical follow-up was available for 69 patients and angiographic follow-up for 65 patients. Late lumen loss (LLL), binary restenosis (stenosis >50%), target lesion revascularization (TLR) and major adverse cardiac events (MACE) were assessed for a follow-up time of 6.6+/-2.2 months. RESULTS Mean interventional treatment length was 46+/-18 mm. TLR was performed in all 23 patients with binary restenosis (33%). Death of cardiac cause was reported for two patients, one of whom did not undergo TLR. Thus, overall MACE rate was 35%. Recurrent ISR was significantly more frequent in patients with geographic miss. Comparison of the different radiation dose regimens revealed significantly lower LLL in patients irradiated with the higher dose (0.20+/-0.68 mm compared with 0.65+/-0.96 mm, P=0.03). CONCLUSION Intracoronary brachytherapy with beta-radiation (Sr/Y) is a safe and effective therapeutic option for the reduction of recurrent ISR in long diffuse lesions. We recommend a high-dose irradiation with 18 Gy at 1 mm vessel wall depth.
Collapse
Affiliation(s)
- Christoph Schukro
- Department of Internal Medicine II, Medical School of Vienna, Austria.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
49
|
Abstract
Coronary stent implantation has become a well established therapy in the management of coronary artery disease (CAD). Although the Stent Restenosis Study (STRESS) and Belgium-Netherlands Stent (BENESTENT) trials demonstrated convincingly that stenting is superior to percutaneous transluminal coronary angioplasty with respect to restenosis in de novo lesions, there is, however, still a high incidence (10 to 50%) of restenosis following stent implantation. Improvements in stent design and implantation techniques resulted in an increase in the use of coronary stents and today, in most centers in the US and Europe, stenting has become the predominant form of nonsurgical revascularization accounting for about 80% of all percutaneous coronary intervention procedures. Coronary stents provide luminal scaffolding that virtually eliminates elastic recoil and remodelling. Stents, however, do not decrease neointimal hyperplasia and in fact lead to an increase in the proliferative comportment of restenosis. Agents that inhibit cell-cycle progression indirectly have also been tested as inhibitors of vascular proliferation. When coated onto stents, sirolimus, a macrolide antibiotic with immunosuppressive properties, and paclitaxel and dactinomycin, both chemotherapeutic agents, induced cell-cycle arrest in smooth muscle cells (SMC) and inhibited neointimal formation in animal models. Preliminary clinical studies with drug-eluting stents produced dramatic results eliminating restenosis in large and mid-size arteries. Quantitative coronary angiography and intravascular ultrasound demonstrated virtually complete inhibition of tissue growth at 6 and 12 months after sirolimus-eluting stent implantation. Results are also very encouraging with paclitaxel-coated stents. However, it needs to be proven that current drug-eluting stents will produce similar results in 'real life' interventional practice (long lesions, lesions in small vessels, in vein grafts, chronic total occlusions, and bifurcated and ostial lesions). The ongoing randomized, double-blind sirolimus-coated Bx Velocity trade mark balloon expandable stent in the treatment of patients with de novo coronary artery lesions (SIRIUS) trial may answer some of these concerns. With further improvements, including the expansion of drug-loading capacity, double coatings and coatings with programmable pharmacokinetic capacity using advances in nanotechnology (which may allow for more precise and controlled release of less toxic and improved molecules), we think that in the next few years the practice of interventional cardiology may undergo major changes. A new era of dramatic improvements in the treatment of CAD may have dawned. The prospect of approval of this technology should herald a host of clinical trials to revisit basic assumptions about the place of coronary stenting in the contemporary care of obstructive (and nonobstructive) CAD.
Collapse
Affiliation(s)
- Jeffrey W Moses
- Lenox Hill Heart and Vascular Institute of New York and Cardiovascular Research Foundation, New York, New York 10021, USA.
| | | | | |
Collapse
|
50
|
Degertekin M, Arampatzis CA, Lemos PA, Saia F, Hoye A, Daemen J, Tanabe K, Lee CH, Hofma SJ, Sianos G, McFadden E, van der Giessen W, Smits PC, de Feyter PJ, van Domburg RT, Serruys PW. Very long sirolimus-eluting stent implantation for de novo coronary lesions. Am J Cardiol 2004; 93:826-9. [PMID: 15050483 DOI: 10.1016/j.amjcard.2003.12.018] [Citation(s) in RCA: 71] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2003] [Revised: 12/04/2003] [Accepted: 12/04/2003] [Indexed: 11/18/2022]
Abstract
Long-length stenting has a poor outcome when bare metal stents are used. The safety and efficacy of the sirolimus-eluting stent (SES) in long lesions has not been evaluated. Therefore, the aim of the present study was to evaluate the clinical and angiographic outcomes of SES implantation over a very long coronary artery segment. Since April 2002, all patients treated percutaneously at our institution received a SES as the device of choice as part of the Rapamycin Eluting Stent Evaluated At Rotterdam Cardiology Hospital (RESEARCH) registry. During the RESEARCH registry, stents were available in lengths of 8, 18, and 33 mm. The present report includes a predefined study population consisting of patients treated with >36-mm-long stented segments. Patients had a combination of >or=2 overlapping stents at a minimum length of 41 mm (i.e., one 33-mm SES overlapping an 8-mm SES) to treat native de novo coronary lesions. The incidence of major cardiac adverse events (death, nonfatal myocardial infarction, and target lesion revascularization) was evaluated. The study group comprised 96 consecutive patients (102 lesions). Clinical follow-up was available for all patients at a mean of 320 days (range 265 to 442). In all, 20% of long-stented lesions were chronic total occlusions, and mean stented length per lesion was 61.2 +/- 21.4 mm (range 41 to 134). Angiographic follow-up at 6 months was obtained in 67 patients (71%). Binary restenosis rate was 11.9% and in-stent late loss was 0.13 +/- 0.47 mm. At long-term follow-up (mean 320 days), there were 2 deaths (2.1%), and the overall incidence of major cardiac events was 8.3%. Thus, SES implantation appears safe and effective for de novo coronary lesions requiring multiple stent placement over a very long vessel segment.
Collapse
Affiliation(s)
- Muzaffer Degertekin
- Department of Interventional Cardiology, Thoraxcentre, Erasmus MC, Rotterdam, The Netherlands
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|