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Blessing R, Ahoopai M, Geyer M, Brandt M, Zeiher AM, Münzel T, Wenzel P, Gori T, Dimitriadis Z. The Bioengineered Combo Dual-Therapy CD34 Antibody-Covered Sirolimus-Eluting Coronary Stent in Patients with Chronic Total Occlusion Evaluated by Clinical Outcome and Optical Coherence Tomography Imaging Analysis. J Clin Med 2020; 10:jcm10010080. [PMID: 33379321 PMCID: PMC7794972 DOI: 10.3390/jcm10010080] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Revised: 12/20/2020] [Accepted: 12/21/2020] [Indexed: 01/25/2023] Open
Abstract
We sought to determine the effects of the use of a Bioengineered Combo Dual-Therapy CD34 Antibody-Covered Sirolimus-Eluting Coronary Stent (Combo® DTS) in patients with chronic total occlusion (CTO) by evaluating clinical outcomes and by performing an optical coherence tomography (OCT) analysis. We retrospectively analyzed data from 39 patients who had successfully undergone OCT-guided revascularization of a CTO being treated with a Combo® DTS. Clinical assessment, angiography (with quantitative coronary angiography analysis) and OCT examination were performed at baseline and at follow-up. The median follow-up period was 189 days, ranging from 157 to 615 days. At follow-up, revascularization was required due to angiographic restenosis in 40% (14 of 35) of patients. OCT analysis detected neointima proliferation in 23 (76.6%) patients. Neointima formation was often associated with microvessels in 18 patients (60%). Neoatheroslcerosis was observed in 2 (6.6%) patients. Malapposition was found in 4 patients (13.3%), and stent fractures were found in 11 patients (36.6%). Rate of strut coverage was 96.3% at follow-up. In conclusion, the implantation of a Combo® DTS after successful CTO recanalization was associated with a restenosis rate of 40% despite good stent implantation at baseline, proven by OCT. Neointima formation was found as a main contributor to restenosis. Nevertheless, we observed a low rate of major cardiovascular events in our follow-up.
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Affiliation(s)
- Recha Blessing
- Department of Cardiology, Cardiology I, University Medical Center of the Johannes Gutenberg University, 55131 Mainz, Germany; (R.B.); (M.A.); (M.G.); (M.B.); (T.M.); (P.W.); (T.G.)
| | - Majid Ahoopai
- Department of Cardiology, Cardiology I, University Medical Center of the Johannes Gutenberg University, 55131 Mainz, Germany; (R.B.); (M.A.); (M.G.); (M.B.); (T.M.); (P.W.); (T.G.)
| | - Martin Geyer
- Department of Cardiology, Cardiology I, University Medical Center of the Johannes Gutenberg University, 55131 Mainz, Germany; (R.B.); (M.A.); (M.G.); (M.B.); (T.M.); (P.W.); (T.G.)
| | - Moritz Brandt
- Department of Cardiology, Cardiology I, University Medical Center of the Johannes Gutenberg University, 55131 Mainz, Germany; (R.B.); (M.A.); (M.G.); (M.B.); (T.M.); (P.W.); (T.G.)
- Center for Thrombosis and Hemostasis (CTH), Johannes Gutenberg University, 55131 Mainz, Germany
| | - Andreas M. Zeiher
- Department of Cardiology, Center of Internal Medicine, Goethe University Frankfurt, 60590 Frankfurt, Germany;
| | - Thomas Münzel
- Department of Cardiology, Cardiology I, University Medical Center of the Johannes Gutenberg University, 55131 Mainz, Germany; (R.B.); (M.A.); (M.G.); (M.B.); (T.M.); (P.W.); (T.G.)
- German Center for Cardiovascular Research (DZHK), Partner Site Rhine-Main, 55131 Mainz, Germany
| | - Philip Wenzel
- Department of Cardiology, Cardiology I, University Medical Center of the Johannes Gutenberg University, 55131 Mainz, Germany; (R.B.); (M.A.); (M.G.); (M.B.); (T.M.); (P.W.); (T.G.)
- Center for Thrombosis and Hemostasis (CTH), Johannes Gutenberg University, 55131 Mainz, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Rhine-Main, 55131 Mainz, Germany
| | - Tommaso Gori
- Department of Cardiology, Cardiology I, University Medical Center of the Johannes Gutenberg University, 55131 Mainz, Germany; (R.B.); (M.A.); (M.G.); (M.B.); (T.M.); (P.W.); (T.G.)
- German Center for Cardiovascular Research (DZHK), Partner Site Rhine-Main, 55131 Mainz, Germany
| | - Zisis Dimitriadis
- Department of Cardiology, Center of Internal Medicine, Goethe University Frankfurt, 60590 Frankfurt, Germany;
- Correspondence: ; Tel.: +49-69-6301-7387; Fax: +49-69-6301
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Pavlidis AN, Jones DA, Sirker A, Mathur A, Smith EJ. Prevention of contrast-induced acute kidney injury after percutaneous coronary intervention for chronic total coronary occlusions. Am J Cardiol 2015; 115:844-51. [PMID: 25638517 DOI: 10.1016/j.amjcard.2014.12.047] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2014] [Revised: 12/13/2014] [Accepted: 12/13/2014] [Indexed: 10/24/2022]
Abstract
Chronic total occlusions (CTOs) represent a major challenge in percutaneous coronary revascularization. The recent advances in strategies and techniques and the development of dedicated equipment, such as microcatheters and wires, have resulted in considerably higher success rates. Although successful CTO recanalization is associated with significant clinical benefits, including improvement of angina, quality of life, reduced need for surgical revascularization, and improvement of left ventricular function, CTO procedures may require prolonged x-ray exposure and use of larger volumes of contrast compared with non-CTO procedures. Large volumes of contrast medium have been associated with increased rates of contrast-induced acute kidney injury (CI-AKI) and adverse short- and long-term outcomes. Application of specific measures and algorithms should be considered by all CTO operators to prevent CI-AKI.
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