1
|
Niezgoda P, Kasprzak M, Kubica J, Kuźma Ł, Januszek R, Iwańczyk S, Tomasiewicz B, Bil J, Kowalewski M, Jaguszewski M, Wybraniec M, Reczuch K, Dobrzycki S, Bartuś S, Lesiak M, Gąsior M, Wolny R, Witkowski A, Gil R, Cortese B, D’Ascenzo F, Wojakowski W, Wańha W. Drug-Eluting Balloons and Drug-Eluting Stents in Diabetic Patients Undergoing Percutaneous Coronary Intervention Due to Restenosis-DM-Dragon Registry. J Clin Med 2024; 13:4464. [PMID: 39124731 PMCID: PMC11313611 DOI: 10.3390/jcm13154464] [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: 06/24/2024] [Revised: 07/24/2024] [Accepted: 07/28/2024] [Indexed: 08/12/2024] Open
Abstract
Background: The rate of in-stent restenosis (ISR) is decreasing; however, it is still a challenge for contemporary invasive cardiologists. Therapeutic methods, including drug-eluting balloons (DEBs), intravascular lithotripsy, excimer laser coronary atherectomy, and imaging-guided percutaneous coronary intervention (PCI) with drug-eluting stents (DES), have been implemented. Patients with diabetes mellitus (DM) are burdened with a higher risk of ISR than the general population. Aims: DM-Dragon is aimed at evaluating the clinical outcomes of ISR treatment with DEBs vs. DES, focusing on patients with co-existing diabetes mellitus. Methods: The DM-Dragon registry is a retrospective study comprising data from nine high-volume PCI centers in Poland. A total of 1117 patients, of whom 473 individuals had DM and were treated with PCI due to ISR, were included. After propensity-score matching (PSM), 198 pairs were created for further analysis. The primary outcome of the study was target lesion revascularization (TLR). Results: In DM patients after PSM, TLR occurred in 21 (10.61%) vs. 20 (10.1%) in non-diabetic patients, p = 0.8690. Rates of target vessel revascularization (TVR), target vessel myocardial infarction, device-oriented composite endpoint (DOCE), and cardiac death did not differ significantly. Among diabetic patients, the risk of all-cause mortality was significantly lower in the DEB group (2.78% vs. 11.11%, HR 3.67 (95% confidence interval, CI) [1.01-13.3), p = 0.0483). Conclusions: PCI with DEBs is almost as effective as DES implantation in DM patients treated for ISR. In DM-Dragon, the rate of all-cause death was significantly lower in patients treated with DEBs. Further large-scale, randomized clinical trials would be needed to support these findings.
Collapse
Affiliation(s)
- Piotr Niezgoda
- Department of Cardiology and Internal Medicine, Nicolaus Copernicus University in Toruń, L. Rydygier Collegium Medicum in Bydgoszcz, 85-094 Bydgoszcz, Poland
| | - Michał Kasprzak
- Department of Cardiology and Internal Medicine, Nicolaus Copernicus University in Toruń, L. Rydygier Collegium Medicum in Bydgoszcz, 85-094 Bydgoszcz, Poland
| | - Jacek Kubica
- Department of Cardiology and Internal Medicine, Nicolaus Copernicus University in Toruń, L. Rydygier Collegium Medicum in Bydgoszcz, 85-094 Bydgoszcz, Poland
| | - Łukasz Kuźma
- Department of Invasive Cardiology, Medical University of Bialystok, 15-276 Bialystok, Poland
| | - Rafał Januszek
- Faculty of Medicine and Health Sciences, Andrzej Frycz Modrzewski Cracow University, 30-705 Kraków, Poland
| | - Sylwia Iwańczyk
- 1st Department of Cardiology, Poznan University of Medical Sciences, 61-701 Poznan, Poland
| | - Brunon Tomasiewicz
- Centre for Heart Disease, Department of Heart Disease, University Hospital Wroclaw, Wroclaw Medical University, 50-556 Wroclaw, Poland
| | - Jacek Bil
- Department of Cardiology, National Medical Institute of the Ministry of Interior and Administration, Wołoska 137 Str., 02-507 Warsaw, Poland
| | - Mariusz Kowalewski
- Thoracic Research Centre, Collegium Medicum Nicolaus Copernicus University, Innovative Medical Forum, 85-094 Bydgoszcz, Poland
- Department of Cardiac Surgery and Transplantology, National Medical Institute of the Ministry of Interior and Administration, Wołoska 137 Str., 02-507 Warsaw, Poland
- Cardio-Thoracic Surgery Department, Heart and Vascular Centre, Maastricht University Medical Centre, Cardiovascular Research Institute Maastricht (CARIM), 6229 HX Maastricht, The Netherlands
| | - Miłosz Jaguszewski
- First Department of Cardiology, Medical University of Gdansk, 80-210 Gdansk, Poland
| | - Maciej Wybraniec
- First Department of Cardiology, School of Medicine in Katowice, Medical University of Silesia, 40-287 Katowice, Poland
| | - Krzysztof Reczuch
- Centre for Heart Disease, Department of Heart Disease, University Hospital Wroclaw, Wroclaw Medical University, 50-556 Wroclaw, Poland
| | - Sławomir Dobrzycki
- Department of Invasive Cardiology, Medical University of Bialystok, 15-276 Bialystok, Poland
| | - Stanisław Bartuś
- Department of Cardiology, Jagiellonian University Medical College, 30-688 Krakow, Poland
| | - Maciej Lesiak
- 1st Department of Cardiology, Poznan University of Medical Sciences, 61-701 Poznan, Poland
| | - Mariusz Gąsior
- Third Department of Cardiology, Medical University of Silesia, 41-800 Zabrze, Poland
| | - Rafał Wolny
- Department of Interventional Cardiology and Angiology, National Institute of Cardiology, 04-628 Warsaw, Poland
| | - Adam Witkowski
- Department of Interventional Cardiology and Angiology, National Institute of Cardiology, 04-628 Warsaw, Poland
| | - Robert Gil
- Department of Cardiology, National Medical Institute of the Ministry of Interior and Administration, Wołoska 137 Str., 02-507 Warsaw, Poland
| | - Bernardo Cortese
- Fondazione Ricerca e Innovazione Cardiovascolare, 20143 Milano, Italy
- DCB Academy, 20136 Milano, Italy
| | - Fabrizio D’Ascenzo
- Division of Cardiology, Department of Internal Medicine, Cittàdella Salute e della Scienza, University of Turin, 10126 Turin, Italy
| | - Wojciech Wojakowski
- Department of Cardiology and Structural Heart Diseases, Medical University of Silesia, 40-055 Katowice, Poland
| | - Wojciech Wańha
- Department of Cardiology and Structural Heart Diseases, Medical University of Silesia, 40-055 Katowice, Poland
| |
Collapse
|
2
|
Kheifets M, Rahat O, Bental T, Levi A, Vaknin-Assa H, Greenberg G, Codner P, Witberg G, Kornowski R, Perl L. Outcomes of Drug-Eluting Balloons for In-Stent Restenosis: Large Cohort Analysis and Single-Center Clinical Experience. Can J Cardiol 2024; 40:1250-1257. [PMID: 38211886 DOI: 10.1016/j.cjca.2023.12.033] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 12/17/2023] [Accepted: 12/29/2023] [Indexed: 01/13/2024] Open
Abstract
BACKGROUND The use of drug-eluting balloons (DEBs) remains clinically relevant in the contemporary era of drug-eluting stent percutaneous coronary interventions (DES-PCI), especially in the setting of in-stent restenosis (ISR). Our goal was to assess the outcomes of ISR patients in a large prospective registry. METHODS A total of 2329 consecutive patients with ISR-PCI (675 using DEB and 1654 with DES) were treated in our medical centre from 2010 to 2021. Clinical end points included mortality and major adverse cardiac events (MACE) at 1 year. Clinical outcomes were adjusted for multiple confounders. RESULTS Mean ages (65.9 ± 11.0 vs 66.1 ± 10.5; P = 0.73) and percentages of female patients (16.6% vs 18.2%; P = 0.353) were similar between both ISR groups. Patients treated with DEB for ISR suffered more from diabetes, hypertension, and previous myocardial infarction (P < 0.01 for all) and presented more frequently with acute coronary syndrome (40.0% vs 34.4%; P = 0.01) compared with patients treated with DES for ISR. One-year MACE was significantly higher in the DEB ISR-PCI group (23.4% vs 19.6%; P = 0.002) compared to the DES ISR-PCI group, but no significant differences in mortality were observed at 1 year between the groups. After adjustment for multiple confounders, DEB ISR-PCI was not associated with increased MACE at 1 year (P = 0.55). CONCLUSIONS In our large experience, patients treated with DEB for ISR-PCI have higher baseline risk and sustained increased MACE rates compared with DES ISR-PCI patients. After adjustment for confounding variables, clinical outcomes are similar between the groups at 1 year after PCI.
Collapse
Affiliation(s)
- Mark Kheifets
- Department of Cardiology, Rabin Medical Center, Petach Tikva, Israel; Beilinson and Hasharon Hospitals, The Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Ori Rahat
- Department of Cardiology, Rabin Medical Center, Petach Tikva, Israel; Beilinson and Hasharon Hospitals, The Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Tamir Bental
- Department of Cardiology, Rabin Medical Center, Petach Tikva, Israel; Beilinson and Hasharon Hospitals, The Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Amos Levi
- Department of Cardiology, Rabin Medical Center, Petach Tikva, Israel; Beilinson and Hasharon Hospitals, The Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Hana Vaknin-Assa
- Department of Cardiology, Rabin Medical Center, Petach Tikva, Israel; Beilinson and Hasharon Hospitals, The Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Gabriel Greenberg
- Department of Cardiology, Rabin Medical Center, Petach Tikva, Israel; Beilinson and Hasharon Hospitals, The Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Pablo Codner
- Department of Cardiology, Rabin Medical Center, Petach Tikva, Israel; Beilinson and Hasharon Hospitals, The Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Guy Witberg
- Department of Cardiology, Rabin Medical Center, Petach Tikva, Israel; Beilinson and Hasharon Hospitals, The Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ran Kornowski
- Department of Cardiology, Rabin Medical Center, Petach Tikva, Israel; Beilinson and Hasharon Hospitals, The Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Leor Perl
- Department of Cardiology, Rabin Medical Center, Petach Tikva, Israel; Beilinson and Hasharon Hospitals, The Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| |
Collapse
|
3
|
Alqam B, Blankenship JC. When Less is More: Drug-Coated Balloons Threaten a Paradigm Revolution. Cardiovasc Drugs Ther 2024; 38:397-399. [PMID: 38112931 DOI: 10.1007/s10557-023-07542-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/14/2023] [Indexed: 12/21/2023]
Affiliation(s)
- Bilal Alqam
- Department of Cardiology, University of New Mexico Health Sciences Center, MSC10-5550, 1 University of New Mexico, Albuquerque, NM, 87131, USA
| | - James C Blankenship
- Department of Cardiology, University of New Mexico Health Sciences Center, MSC10-5550, 1 University of New Mexico, Albuquerque, NM, 87131, USA.
| |
Collapse
|
4
|
Lu K, Ye X, Chen Y, Wang P, Gong M, Xuan B, Tang Z, Li M, Hou J, Peng K, Pei H. Research progress of drug eluting balloon in arterial circulatory system. Front Cardiovasc Med 2024; 11:1287852. [PMID: 38601040 PMCID: PMC11005962 DOI: 10.3389/fcvm.2024.1287852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2023] [Accepted: 03/04/2024] [Indexed: 04/12/2024] Open
Abstract
The arterial circulatory system diseases are common in clinical practice, and their treatment options have been of great interest due to their high morbidity and mortality. Drug-eluting balloons, as a new type of endovascular interventional treatment option, can avoid the long-term implantation of metal stents and is a new type of angioplasty without stents, so drug-eluting balloons have better therapeutic effects in some arterial circulatory diseases and have been initially used in clinical practice. In this review, we first describe the development, process, and mechanism of drug-eluting balloons. Then we summarize the current studies on the application of drug-eluting balloons in coronary artery lesions, in-stent restenosis, and peripheral vascular disease. As well as the technical difficulties and complications in the application of drug-eluting balloons and possible management options, in order to provide ideas and help for future in-depth studies and provide new strategies for the treatment of more arterial system diseases.
Collapse
Affiliation(s)
- Keji Lu
- Department of Cardiology, The Affiliated Hospital, Southwest Medical University, Luzhou, China
- School of Medical and Life Sciences, Chengdu University of TCM, Chengdu, China
| | - Xianglin Ye
- Department of Cardiology, The Affiliated Hospital, Southwest Medical University, Luzhou, China
- Department of Cardiology, The General Hospital of Western Theater Command, Chengdu, China
| | - Yaoxuan Chen
- School of Medical and Life Sciences, Chengdu University of TCM, Chengdu, China
| | - Peng Wang
- Department of Cardiology, The General Hospital of Western Theater Command, Chengdu, China
| | - Meiting Gong
- Department of Cardiology, The General Hospital of Western Theater Command, Chengdu, China
| | - Bing Xuan
- Department of Cardiology, The General Hospital of Western Theater Command, Chengdu, China
| | - Zhaobing Tang
- Department of Rehabilitation, The General Hospital of Western Theater Command, Chengdu, China
| | - Meiling Li
- Department of Cardiology, The General Hospital of Western Theater Command, Chengdu, China
| | - Jun Hou
- Department of Cardiology, Chengdu Third People's Hospital, Chengdu, China
| | - Ke Peng
- Department of Cardiology, The General Hospital of Western Theater Command, Chengdu, China
| | - Haifeng Pei
- Department of Cardiology, The Affiliated Hospital, Southwest Medical University, Luzhou, China
- Department of Cardiology, The General Hospital of Western Theater Command, Chengdu, China
| |
Collapse
|
5
|
Koch T, Lenz T, Rheude T, Cassese S, Kazazi M, Xhepa E, Kessler T, Wiebe J, Ferenc M, Laugwitz KL, Joner M, Schunkert H, Kastrati A, Kufner S. Recurrent Revascularization at 10 Years After Percutaneous Treatment of Drug-Eluting Stent Restenosis. JACC Cardiovasc Interv 2024; 17:1-13. [PMID: 37902151 DOI: 10.1016/j.jcin.2023.10.031] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 10/03/2023] [Accepted: 10/13/2023] [Indexed: 10/31/2023]
Abstract
BACKGROUND Treatment of patients with recurrence of in-stent restenosis (ISR) remains particularly challenging, with data and guideline recommendations for repeat percutaneous coronary intervention being scant. OBJECTIVES The aim of this study was to investigate the long-term incidence of recurrent revascularization events after percutaneous treatment of drug-eluting stent (DES) ISR. METHODS In this post hoc analysis, 402 patients (500 lesions) assigned to plain balloon (PB), drug-coated balloon (DCB), or DES treatment in the randomized ISAR-DESIRE 3 (Efficacy Study of Paclitaxel-Eluting Balloon, -Stent vs. Plain Angioplasty for Drug-Eluting Stent Restenosis) trial were followed up over a median of 10.3 years. The primary endpoint was total repeat target lesion revascularization (R-TLR) including all, first and recurrent, events. RESULTS At the end of follow-up, first R-TLR was required in 204 lesions, 82 in the PB group, 70 in the DCB group, and 52 in the DES group. The total number of R-TLRs was 373: 162 in the PB group, 124 in the DCB group, and 87 in the DES group. During the first year of follow-up, the risk for total R-TLR was reduced by DCB (HR: 0.36; 95% CI: 0.24-0.54) and DES (HR: 0.23; 95% CI: 0.14-0.38) treatment compared with PB treatment. After 1 year, the risk for total R-TLR was nonsignificantly reduced by DCB treatment (HR: 0.77; 95% CI: 0.51-1.16) and significantly reduced by DES treatment (HR: 0.61; 95% CI: 0.39-0.95) compared with PB treatment. Risk in the DCB and DES groups was similar during (HR: 1.54; 95% CI: 0.89-2.69) and after (HR: 1.26; 95% CI: 0.82-1.92) 1 year. CONCLUSIONS The total number of R-TLRs over 10 years after treatment of patients with DES ISR was high. DCBs and particularly DES were able to reduce the need for both first and recurrent revascularization compared with PB treatment.
Collapse
Affiliation(s)
- Tobias Koch
- ISAResearch Zentrum, Deutsches Herzzentrum München, an der Technische Universität München, Munich, Germany
| | - Tobias Lenz
- ISAResearch Zentrum, Deutsches Herzzentrum München, an der Technische Universität München, Munich, Germany
| | - Tobias Rheude
- ISAResearch Zentrum, Deutsches Herzzentrum München, an der Technische Universität München, Munich, Germany
| | - Salvatore Cassese
- ISAResearch Zentrum, Deutsches Herzzentrum München, an der Technische Universität München, Munich, Germany
| | - Mej Kazazi
- ISAResearch Zentrum, Deutsches Herzzentrum München, an der Technische Universität München, Munich, Germany
| | - Erion Xhepa
- ISAResearch Zentrum, Deutsches Herzzentrum München, an der Technische Universität München, Munich, Germany
| | - Thorsten Kessler
- ISAResearch Zentrum, Deutsches Herzzentrum München, an der Technische Universität München, Munich, Germany; Deutsches Zentrum für Herz-Kreislauf-Forschung, Partner Site Munich, Munich, Germany
| | - Jens Wiebe
- ISAResearch Zentrum, Deutsches Herzzentrum München, an der Technische Universität München, Munich, Germany; Deutsches Zentrum für Herz-Kreislauf-Forschung, Partner Site Munich, Munich, Germany
| | - Miroslaw Ferenc
- Department of Cardiology, Universitätsherzzentrum Freiburg Bad Krotzingen, Bad Krotzingen, Germany
| | - Karl-Ludwig Laugwitz
- Deutsches Zentrum für Herz-Kreislauf-Forschung, Partner Site Munich, Munich, Germany; Erste Medizinische Klinik, Klinikum Rechts der Isar der Technischen Universität München, Munich, Germany
| | - Michael Joner
- ISAResearch Zentrum, Deutsches Herzzentrum München, an der Technische Universität München, Munich, Germany; Deutsches Zentrum für Herz-Kreislauf-Forschung, Partner Site Munich, Munich, Germany
| | - Heribert Schunkert
- ISAResearch Zentrum, Deutsches Herzzentrum München, an der Technische Universität München, Munich, Germany; Deutsches Zentrum für Herz-Kreislauf-Forschung, Partner Site Munich, Munich, Germany
| | - Adnan Kastrati
- ISAResearch Zentrum, Deutsches Herzzentrum München, an der Technische Universität München, Munich, Germany; Deutsches Zentrum für Herz-Kreislauf-Forschung, Partner Site Munich, Munich, Germany
| | - Sebastian Kufner
- ISAResearch Zentrum, Deutsches Herzzentrum München, an der Technische Universität München, Munich, Germany; Deutsches Zentrum für Herz-Kreislauf-Forschung, Partner Site Munich, Munich, Germany.
| |
Collapse
|
6
|
Kamolov IH, Asadov DA, Sandodze TS, Chernysheva IE. Microporous surface as a new solution for stent surface modification: A review. CONSILIUM MEDICUM 2022. [DOI: 10.26442/20751753.2022.10.201955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
The introduction of coronary stents into clinical practice has reduced repeated patient visits compared with balloon angioplasty alone. Also, drug-eluting stents substantially reduced the restenosis incidence. Therefore, later complications related to the implantation of a stent coated with a cytostatic-containing polymer became more relevant. The mechanism of late stent complications is multifactorial. It is mainly due to the body's response to the prolonged indwelling of the drug carrier polymer on the coronary stent's surface. There is a trend towards the return of polymer-free drug coating technologies, which are implemented through certain modifications of stent surfaces for better drug retention and proper drug distribution. It is mainly achieved using drug depots in various reservoirs: grooves, nanoparticles in the matrix compound, micropores, through and blind micro reservoirs, etc. New promising technologies for crystallizing cytostatic drugs or depositing them in specially designed reservoirs show good preclinical and clinical results, comparable or even superior to approved coronary stents. Micropores as carriers for antiproliferative agents on the stent surface are a promising direction to rejecting the use of polymers in stents.
Collapse
|
7
|
Zhu Y, Liu K, Kong X, Nan J, Gao A, Liu Y, Han H, Li H, Zhu H, Zhang J, Zhao Y. Comparison of Drug-Coated Balloon Angioplasty vs. Drug-Eluting Stent Implantation for Drug-Eluting Stent Restenosis in the Routine Clinical Practice: A Meta-Analysis of Randomized Controlled Trials. Front Cardiovasc Med 2021; 8:766088. [PMID: 34926617 PMCID: PMC8671700 DOI: 10.3389/fcvm.2021.766088] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2021] [Accepted: 10/31/2021] [Indexed: 11/13/2022] Open
Abstract
Introduction: In-stent restenosis (ISR) remains a challenging issue despite the great advance of drug-eluting stents (DES). In addition, the consensus was lacking regarding the optimal strategy for DES-ISR. Therefore, we aimed to evaluate angiographic and clinical outcomes of the two most effective treatments DES vs. drug-eluting balloon (DCB) for patients with DES-ISR. Methods: This meta-analysis used the data from the randomized controlled trials (RCTs), which were identified by a systematic search in the databases of PubMed, Embase, and Cochrane Library. Target lesion revascularization (TLR) was regarded as the primary endpoint. In addition, the late angiographic outcomes and other clinical outcomes, namely, cardiac death, myocardial infarction (MI), target vessel revascularization, stent thrombosis, and major adverse cardiac events, were also included for analysis. Results: Five RCTs with about 1,193 patients were included in this meta-analysis for the analysis. For the primary endpoint, the overall pooled outcomes suggested repeat DES implantation was associated with a significant reduction in the term of TLR compared with DCB angioplasty (risk ratio = 1.53, 95% CI 1.15-2.04, p = 0.003). But no significant difference in angiographic outcomes and other clinical endpoints were observed between DES and DCB. In the subgroup analysis, DCB was inferior to new-generation DES (NG-DES)/everolimus-eluting stent (EES) in the term of TLR. In addition, this non-significant trend was also noted in the subgroup of the paclitaxel-eluting stent (PES) vs. DCB. For the angiographic endpoints, EES, not PES, was associated with larger minimum lumen diameter [mean difference (MD) = -0.25, 95% CI -0.38 to -0.11, p = 0.0003], lower percent diameter stenosis (MD = 7.29%, 95% CI 2.86-11.71%, p = 0.001), and less binary restenosis (OR = 2.20, 95% CI 1.18-4.11, p = 0.01). But NG-DES/EES was comparable to DCB in cardiac death, MI, and stent thrombosis. Conclusions: For the patients with DES-ISR, treatment with DES, especially NG-DES/EES could reduce the risk of TLR significantly compared to DCB at long-term follow-up.
Collapse
Affiliation(s)
- Yong Zhu
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Kesen Liu
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Xiangyun Kong
- Department of Cardiology, Beijing Luhe Hospital, Capital Medical University, Beijing, China
| | - Jing Nan
- Department of Cardiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Ang Gao
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Yan Liu
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Hongya Han
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Hong Li
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Huagang Zhu
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Jianwei Zhang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Yingxin Zhao
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| |
Collapse
|
8
|
Influences of Stent Design on In-Stent Restenosis and Major Cardiac Outcomes: A Scoping Review and Meta-Analysis. Cardiovasc Eng Technol 2021; 13:147-169. [PMID: 34409580 DOI: 10.1007/s13239-021-00569-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 07/21/2021] [Indexed: 10/20/2022]
Abstract
Thanks to the developments in implantable biomaterial technologies, invasive operating procedures, and widespread applications especially in vascular disease treatment, a milestone for interventional surgery was achieved with the introduction of vascular stents. Despite vascular stents providing a solution for embolisms, this technology includes various challenges, such as mechanical, electro-chemical complications, or in-stent restenosis (ISR) risks with long-term usage. Therefore, further development of biomaterial technologies is vital to overcome such risks and problems. For this purpose, recent research has focused mainly on the applications of surface modification techniques on biomaterials and vascular stents to increase their hemocompatibility. ISR risk has been reduced with the development and prevalent usage of the art technology stent designs of drug-eluting and biodegradable stents. Nevertheless, their problems have not been overcome completely. Furthermore, patients using drug-eluting stents are faced with further clinical challenges. Therefore, the bare metal stent, which is the first form of the vascular stent technology and includes the highest ISR risk, is still in common usage for vascular treatment applications. For this reason, further research is necessary to solve the remaining vital problems. In this scoping review, stent-based major cardiac events including ISR are analyzed depending on different designs and material selection in stent manufacturing. Recent and novel approaches to overcome such challenges are stated in detail.
Collapse
|
9
|
Wang T, Guan H, Tian T, Guan C, Bai Y, Hu Y, Yuan J, Qiao S, Xu B, Yang W. Thirty-day and 5-year results of percutaneous coronary intervention for in-stent restenotic chronic total occlusion lesions: Data from 2,659 consecutive patients. Catheter Cardiovasc Interv 2021; 97 Suppl 2:1016-1024. [PMID: 33666337 DOI: 10.1002/ccd.29585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 02/15/2021] [Indexed: 11/10/2022]
Abstract
OBJECTIVES To investigate the procedure success rate and clinical outcomes of in-stent restenotic chronic total occlusion (ISR-CTO) percutaneous coronary intervention (PCI). BACKGROUND Few studies have reported the short- and long-term clinical outcomes of ISR-CTO PCI. METHOD Patients who underwent ISR-CTO (n = 212) or de-novo CTO (n = 2,447) PCI at Fuwai Hospital from 2010 to 2013 were enrolled. Thirty-day and 5-year clinical outcomes were analyzed. The primary outcome was the incidence of all-cause death, myocardial infarction (MI), and heart failure at follow-up. The secondary outcome was the recanalization result (reasonable, suboptimal, or failed recanalization). RESULTS ISR-CTO PCI had a higher rate of suboptimal recanalization than de-novo CTO PCI (p < .01). The syntax score before PCI (odds ratio (OR): 1.06; 95% confidence interval (CI): 1.02-1.10; p = .002) and occlusion length ≥ 20 mm (OR: 2.70:95% CI: 1.46-4.98; p = .001) were predictors of suboptimal recanalization in ISR-CTO PCI. Cardiac death (p = .03) and 30-day all-cause mortality (p = .05) were higher among patients who underwent ISR-CTO PCI. The ISR-CTO group had a higher rate of MI (p = .07) at 5 years. Suboptimal recanalization (hazard ratio: 2.56; 95% CI: 1.13-5.83; p = .025) was an independent predictor of long-term major adverse events in ISR-CTO. CONCLUSIONS Suboptimal recanalization, 30-day cardiac death, and long-term MI rates are higher for ISR-CTO PCI than de-novo CTO PCI. Suboptimal recanalization is an independent predictor of long-term major adverse events after ISR-CTO PCI.
Collapse
Affiliation(s)
- Tianjie Wang
- Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Hao Guan
- Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Tao Tian
- Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Changdong Guan
- Department of Catheterization Laboratory, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yinxiao Bai
- Medical Research and Biometrics Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yang Hu
- Medical Research and Biometrics Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jiansong Yuan
- Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Shubin Qiao
- Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Bo Xu
- Department of Catheterization Laboratory, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Weixian Yang
- Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| |
Collapse
|
10
|
Song JB, Shen J, Fan J, Zhang Z, Yi ZJ, Bai S, Mu XL, Xiao L. Effects of a Matrix Metalloproteinase Inhibitor-Eluting Stent on In-Stent Restenosis. Med Sci Monit 2020; 26:e922556. [PMID: 32214058 PMCID: PMC7119448 DOI: 10.12659/msm.922556] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Background The aim of this study was to compare changes in the extracellular matrix after implantation of a stent that elutes a matrix metalloproteinase (MMP) inhibitor (GM6001); and to determine the effects of the GM6001-eluting stent upon prevention of in-stent restenosis (ISR). Material/Methods We included 48 Guangxi Bama mini-pigs in this study. A GM6001-eluting stent was placed in one iliac artery and a stent that did not elute GM6001 was placed in the contralateral iliac artery. The iliac arteries were removed at 6 hours as well as 1, 7, 14, 56, 84, and 336 days after stent placement. Arteries were analyzed for morphometry, gelatinase content, different phenotypes of vascular smooth muscle cells (VSMCs), collagen content, apoptotic rate, and cell density. Results The vascular lumen areas of the GM6001 group were significantly increased and the neointimal areas were significantly reduced compared with the control group from the 7 days to the 336 days. In the 2 groups, expression of MMP-2 and MMP-9 peaked simultaneously, but GM6001-eluting stents inhibited expression of MMP-2 and MMP-9 in the vascular media and neointima (especially around the struts) significantly. In the GM6001 group, expression of tissue inhibitor of matrix metalloproteinase (TIMP)-1, TIMP-2, myosin heavy chain 10 (MYH-10, marker of the proliferative phenotype of VSMCs), collagen content, percentage of apoptotic cells, and cell density were also decreased significantly compared with those in the control group. Conclusion Use of GM6001-eluting stents resulted in persistent and potent inhibition of intimal hyperplasia, an increase in luminal area, and no obvious thrombosis in the arteries of the mini-pigs.
Collapse
Affiliation(s)
- Jian-Bo Song
- Department of Intervention, The Fourth Affiliated Hospital of China Medical University, Shenyang, Liaoning, China (mainland)
| | - Jing Shen
- Department of Intervention, The Fourth Affiliated Hospital of China Medical University, Shenyang, Liaoning, China (mainland).,Department of Intervention, Shanxi Provincial People's Hospital, Taiyuan, Shanxi, China (mainland)
| | - Jun Fan
- Department of Tissue Engineering, China Medical University, Shenyang, Liaoning, China (mainland)
| | - Zhe Zhang
- Department of Intervention, The Fourth Affiliated Hospital of China Medical University, Shenyang, Liaoning, China (mainland)
| | - Zheng-Jia Yi
- Department of Intervention, The Fourth Affiliated Hospital of China Medical University, Shenyang, Liaoning, China (mainland)
| | - Shuo Bai
- Department of Intervention, The Fourth Affiliated Hospital of China Medical University, Shenyang, Liaoning, China (mainland)
| | - Xiao-Lin Mu
- Department of Intervention, The Fourth Affiliated Hospital of China Medical University, Shenyang, Liaoning, China (mainland)
| | - Liang Xiao
- Department of Intervention, The Fourth Affiliated Hospital of China Medical University, Shenyang, Liaoning, China (mainland)
| |
Collapse
|