1
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Mansour HM, Mohamed AM, Ibrahim SG, Ibrahim AM, Mohamed RG. Value of stent boost imaging in decision making after coronary stenting. Int J Cardiovasc Imaging 2023; 39:2557-2566. [PMID: 37845408 PMCID: PMC10692007 DOI: 10.1007/s10554-023-02961-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 09/16/2023] [Indexed: 10/18/2023]
Abstract
BACKGROUND Several studies reported the comparability of digital stent enhancement techniques (including stent boost imaging) in detecting suboptimal results of coronary stenting with Intra Vascular Ultrasound and optical coherence tomography. AIMS to assess results of stent deployment and determine the incidence of suboptimal results requiring changing final decision using stent boost imaging. METHODS This cross-sectional study included 120 patients eligible for PCI were recruited during a period of one year (January 2021 to 2022) using DES. RESULTS Suboptimal results were found in 38% of the PCI cases with stents (angiography guided). Importantly it was found that improper lesion preparation in our practice could not help improving stent optimization. Also, angiography guided PCI has significant incidence of suboptimal results. Digital stent enhancement techniques like stent boost have significant and important value in better decision making. After adjusting for age and sex, six factors were identified as independent predictors for final decision change (stent length, LAD/RCA affection, proximal segment affection, calcification, and optical coherence tomography. CONCLUSION This study has confirmed the utility of stent boost for the optimization of PCI in daily practice. Stent Boost is a simple and costless technique that provides an accurate assessment of a deployed stent without extending the procedure time and without more risk. It appears to be useful for the immediate evaluation of stent expansion and optimization of PCI by additional post-dilatation, when appropriate. Future studies are needed to determine whether Stent Boost data will correlate with adverse long-term clinical outcomes in patients undergoing PCI.
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Affiliation(s)
- Hossam M Mansour
- Department of Cardiology, Faculty of Medicine, Aswan University, Aswan, 81528, Egypt
| | - Ahmed M Mohamed
- Department of Cardiology, Faculty of Medicine, Aswan University, Aswan, 81528, Egypt.
| | - Soliman G Ibrahim
- Department of Cardiology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Ayman M Ibrahim
- Department of Cardiology, Faculty of Medicine, Aswan University, Aswan, 81528, Egypt
| | - Ramadan G Mohamed
- Department of Cardiology, Faculty of Medicine, Aswan University, Aswan, 81528, Egypt
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2
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Mechanisms of Stent Failure: Lessons from IVUS and OCT. CURRENT CARDIOVASCULAR IMAGING REPORTS 2019. [DOI: 10.1007/s12410-019-9513-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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3
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Kuramitsu S, Ohya M, Shinozaki T, Otake H, Horie K, Kawamoto H, Yamanaka F, Natsuaki M, Shiomi H, Nakazawa G, Ando K, Kadota K, Saito S, Kimura T. Risk Factors and Long-Term Clinical Outcomes of Second-Generation Drug-Eluting Stent Thrombosis. Circ Cardiovasc Interv 2019; 12:e007822. [DOI: 10.1161/circinterventions.119.007822] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Background:
The risk factors and long-term clinical outcomes of patients with definite stent thrombosis (ST) after second-generation drug-eluting stent (DES) implantation have not yet been adequately assessed.
Methods and Results:
The REAL-ST (Retrospective Multicenter Registry of ST After First- and Second-Generation DES Implantation) included 313 definite ST of second-generation DES (early ST, n=179; late ST, n=66; very late ST, n=68). Four patients without definite ST of second-generation DES were identified as control patients for each ST case. Risk factors of definite ST were mostly different according to the timing of ST: ST-segment–elevation myocardial infarction, non–ST-segment–elevation myocardial infarction, and unstable angina at presentation, current smoking, left ventricular ejection fraction <40%, prior percutaneous coronary intervention, stent overlap, severely calcified lesion, left main coronary artery lesion, proximal left anterior descending lesion, postdiameter stenosis ≥20%, for early ST; age <70 years, ST-segment–elevation myocardial infarction at presentation, hemodialysis, left ventricular ejection fraction <40%, in-stent restenosis, and severely calcified lesion for late ST; and proximal left anterior descending lesion and in-stent restenosis for very late ST. Cumulative 4-year incidence of death after the index ST events was significantly higher in the ST patients than control patients (33.0% versus 12.3%,
P
<0.001 for early ST versus control; 30.6% versus 14.2%,
P
<0.001 for late ST versus control; and 28.0% versus 13.0%,
P
<0.001 for very late ST versus control, respectively).
Conclusions:
Risk factors of definite ST after second-generation DES implantation were mostly different according to the timing of ST. Definite ST patients showed unfavorable long-term clinical outcomes compared with those without definite ST.
Clinical Trial Registration:
URL:
https://www.umin.ac.jp
. Unique identifier: UMIN000025181.
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Affiliation(s)
- Shoichi Kuramitsu
- Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan (S.K., K.A.)
| | - Masanobu Ohya
- Department of Cardiology, Kurashiki Central Hospital, Japan (M.O., K.K.)
| | - Tomohiro Shinozaki
- Department of Biostatistics, School of Public Health, the University of Tokyo, Japan (T.S.)
| | - Hiromasa Otake
- Division of Cardiology, Department of Internal Medicine, Kobe University Graduates School of Medicine, Japan (H.O.)
| | - Kazunori Horie
- Department of Cardiovascular Medicine, Sendai Kousei Hospital, Japan (K.H.)
| | | | - Futoshi Yamanaka
- Division of Cardiology and Catheterization Laboratories, Shonan Kamakura General Hospital, Kanagawa, Japan (F.Y., S.S.)
| | - Masahiro Natsuaki
- Department of Cardiology, Saiseikai Fukuoka General Hospital, Japan (M.N)
| | - Hiroki Shiomi
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Japan (H.S., T.K.)
| | - Gaku Nakazawa
- Division of Cardiology, Tokai University School of Medicine, Isehara, Japan (G.K.)
| | - Kenji Ando
- Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan (S.K., K.A.)
| | - Kazushige Kadota
- Department of Cardiology, Kurashiki Central Hospital, Japan (M.O., K.K.)
| | - Shigeru Saito
- Division of Cardiology and Catheterization Laboratories, Shonan Kamakura General Hospital, Kanagawa, Japan (F.Y., S.S.)
| | - Takeshi Kimura
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Japan (H.S., T.K.)
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4
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Mehrotra S, Mishra S, Paramasivam G. Imaging during percutaneous coronary intervention for optimizing outcomes. Indian Heart J 2018; 70 Suppl 3:S456-S465. [PMID: 30595307 PMCID: PMC6309719 DOI: 10.1016/j.ihj.2018.08.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2017] [Revised: 08/02/2018] [Accepted: 08/09/2018] [Indexed: 01/29/2023] Open
Abstract
Angiography is the current gold standard for imaging during percutaneous coronary interventions but has significant limitations. Catheter-based intravascular imaging techniques such as intravascular ultrasound and the more recent optical coherence tomography have the potential to overcome these limitations and thus optimize clinical outcomes. In this update, we discussed the current applications of the available imaging techniques, existing evidence, continuing unmet needs, and potential areas for further research.
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Affiliation(s)
| | | | - Ganesh Paramasivam
- Kasturba Medical College, Manipal Academy of Higher Education, Manipal, India
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5
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Räber L, Mintz GS, Koskinas KC, Johnson TW, Holm NR, Onuma Y, Radu MD, Joner M, Yu B, Jia H, Meneveau N, de la Torre Hernandez JM, Escaned J, Hill J, Prati F, Colombo A, Di Mario C, Regar E, Capodanno D, Wijns W, Byrne RA, Guagliumi G. Clinical use of intracoronary imaging. Part 1: guidance and optimization of coronary interventions. An expert consensus document of the European Association of Percutaneous Cardiovascular Interventions. EUROINTERVENTION 2018; 14:656-677. [DOI: 10.4244/eijy18m06_01] [Citation(s) in RCA: 62] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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6
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Räber L, Mintz GS, Koskinas KC, Johnson TW, Holm NR, Onuma Y, Radu MD, Joner M, Yu B, Jia H, Meneveau N, de la Torre Hernandez JM, Escaned J, Hill J, Prati F, Colombo A, di Mario C, Regar E, Capodanno D, Wijns W, Byrne RA, Guagliumi G, Alfonso F, Bhindi R, Ali Z, Carter R. Clinical use of intracoronary imaging. Part 1: guidance and optimization of coronary interventions. An expert consensus document of the European Association of Percutaneous Cardiovascular Interventions. Eur Heart J 2018; 39:3281-3300. [DOI: 10.1093/eurheartj/ehy285] [Citation(s) in RCA: 271] [Impact Index Per Article: 45.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Accepted: 05/16/2018] [Indexed: 12/22/2022] Open
Affiliation(s)
- Lorenz Räber
- Department of Cardiology, Bern University Hospital, Bern, Switzerland
| | - Gary S Mintz
- Cardiovascular Research Foundation, New York, NY, USA
| | | | - Thomas W Johnson
- Bristol Heart Institute, University Hospitals Bristol NHSFT, Bristol, UK
| | - Niels R Holm
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Yoshinubo Onuma
- Department of Interventional Cardiology, Cardialysis, Thoraxcenter, Erasmus MC, Rotterdam, The Netherlands
| | - Maria D Radu
- The Heart Center, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Michael Joner
- Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
- DZHK (German Center for Cardiovascular Research), partner site Munich Heart Alliance, Munich, Germany
| | - Bo Yu
- Department of Cardiology, 2nd Affiliated Hospital of Harbin Medical University, The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, Harbin, China
| | - Haibo Jia
- Department of Cardiology, 2nd Affiliated Hospital of Harbin Medical University, The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, Harbin, China
| | - Nicolas Meneveau
- Department of Cardiology, University Hospital Jean Minjoz, Besancon, France
- EA3920, University of Burgundy Franche-Comté, Besancon, France
| | | | - Javier Escaned
- Hospital Clinico San Carlos IDISSC and Universidad Complutense, Madrid, Spain
| | - Jonathan Hill
- Department of Cardiology, King’s College Hospital, London, UK
| | - Francesco Prati
- Department of Cardiology, San Giovanni Hospital, Rome, Italy & CLI Foundation, Rome, Italy
| | - Antonio Colombo
- Interventional Cardiology Unit, Cardio-Thoracic-Vascular Department, San Raffaele, Scientific Institute, Milan, Italy
| | - Carlo di Mario
- Structural Interventional Cardiology, Careggi University Hospital, Florence, Italy
| | - Evelyn Regar
- Department of Cardiovacular Surgery, Zürich University Hospita, Zürich, Switzerland
| | - Davide Capodanno
- Division of Cardiology, Cardio-Thoraco-Vascular and Transplant Department, CAST, Rodolico Hospital, AOU “Policlinico-Vittorio Emanuele”, University of Catania, Catania, Italy
| | - William Wijns
- The Lambe Institute for Translational Medicine and Curam, National University of Ireland Galway, Saolta University Healthcare Group, Galway, Ireland
| | - Robert A Byrne
- Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
| | - Giulio Guagliumi
- Cardiovascular Department, Ospedale Papa Giovanni XXIII, Bergamo, Italy
| | - Fernando Alfonso
- Department of Cardiology Hospital Universitario de la Princesa, Madrid, Spain
| | - Ravinay Bhindi
- Royal North Shore Hospital, The University of Sydney, Sydney, Australia
| | - Ziad Ali
- Columbia University Medical Center, New York, USA
| | - Rickey Carter
- Department of Health Sciences Research, Mayo Clinic, Rochester, USA
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7
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Šalinger - Martinović S, Apostolović S, Pavlović MP, Damjanović M, Kostić T, Božinović N, Perišić Z, Živković M, Mitić V, Stojanović V, Eraković V, Djindjić B, Stanojević D, Dimitrijević Z, Cvetković P, Krstić M. A SUCCESSFULLY TREAT EDIATROGENIC LEFT MAIN AND CIRCUMFLEX CORONARY ARTERY DISSECTION DU RING A PRIMARY PERCUTANEO US CORONARY INTERVEN TION DUE TO A STENT THROMBOSIS: A CASE REPORT. ACTA MEDICA MEDIANAE 2018. [DOI: 10.5633/amm.2018.0114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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8
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Ng J, Bourantas CV, Torii R, Ang HY, Tenekecioglu E, Serruys PW, Foin N. Local Hemodynamic Forces After Stenting: Implications on Restenosis and Thrombosis. Arterioscler Thromb Vasc Biol 2017; 37:2231-2242. [PMID: 29122816 DOI: 10.1161/atvbaha.117.309728] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Accepted: 10/13/2017] [Indexed: 12/19/2022]
Abstract
Local hemodynamic forces are well-known to modulate atherosclerotic evolution, which remains one of the largest cause of death worldwide. Percutaneous coronary interventions with stent implantation restores blood flow to the downstream myocardium and is only limited by stent failure caused by restenosis, stent thrombosis, or neoatherosclerosis. Cumulative evidence has shown that local hemodynamic forces affect restenosis and the platelet activation process, modulating the pathophysiological mechanisms that lead to stent failure. This article first covers the pathophysiological mechanisms through which wall shear stress regulates arterial disease formation/neointima proliferation and the role of shear rate on stent thrombosis. Subsequently, the article reviews the current evidence on (1) the implications of stent design on the local hemodynamic forces, and (2) how stent/scaffold expansion can influence local flow, thereby affecting the risk of adverse events.
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Affiliation(s)
- Jaryl Ng
- From the National Heart Centre Singapore (J.N., H.Y.A., N.F.); Department of Biomedical Engineering, National University of Singapore, Singapore (J.N.); Departments of Cardiovascular Sciences (C.V.B.) and Mechanical Engineering (R.T.), University College London, United Kingdom; Department of Cardiology, Barts Health NHS Trust, London, United Kingdom (C.V.B.); Thoraxcenter, Erasmus MC, Rotterdam Erasmus University, The Netherlands (E.T., P.W.S.); National Heart & Lung Institute, Imperial College London, United Kingdom (P.W.S.); and Duke-NUS Medical School, National University of Singapore (N.F.)
| | - Christos V Bourantas
- From the National Heart Centre Singapore (J.N., H.Y.A., N.F.); Department of Biomedical Engineering, National University of Singapore, Singapore (J.N.); Departments of Cardiovascular Sciences (C.V.B.) and Mechanical Engineering (R.T.), University College London, United Kingdom; Department of Cardiology, Barts Health NHS Trust, London, United Kingdom (C.V.B.); Thoraxcenter, Erasmus MC, Rotterdam Erasmus University, The Netherlands (E.T., P.W.S.); National Heart & Lung Institute, Imperial College London, United Kingdom (P.W.S.); and Duke-NUS Medical School, National University of Singapore (N.F.)
| | - Ryo Torii
- From the National Heart Centre Singapore (J.N., H.Y.A., N.F.); Department of Biomedical Engineering, National University of Singapore, Singapore (J.N.); Departments of Cardiovascular Sciences (C.V.B.) and Mechanical Engineering (R.T.), University College London, United Kingdom; Department of Cardiology, Barts Health NHS Trust, London, United Kingdom (C.V.B.); Thoraxcenter, Erasmus MC, Rotterdam Erasmus University, The Netherlands (E.T., P.W.S.); National Heart & Lung Institute, Imperial College London, United Kingdom (P.W.S.); and Duke-NUS Medical School, National University of Singapore (N.F.)
| | - Hui Ying Ang
- From the National Heart Centre Singapore (J.N., H.Y.A., N.F.); Department of Biomedical Engineering, National University of Singapore, Singapore (J.N.); Departments of Cardiovascular Sciences (C.V.B.) and Mechanical Engineering (R.T.), University College London, United Kingdom; Department of Cardiology, Barts Health NHS Trust, London, United Kingdom (C.V.B.); Thoraxcenter, Erasmus MC, Rotterdam Erasmus University, The Netherlands (E.T., P.W.S.); National Heart & Lung Institute, Imperial College London, United Kingdom (P.W.S.); and Duke-NUS Medical School, National University of Singapore (N.F.)
| | - Erhan Tenekecioglu
- From the National Heart Centre Singapore (J.N., H.Y.A., N.F.); Department of Biomedical Engineering, National University of Singapore, Singapore (J.N.); Departments of Cardiovascular Sciences (C.V.B.) and Mechanical Engineering (R.T.), University College London, United Kingdom; Department of Cardiology, Barts Health NHS Trust, London, United Kingdom (C.V.B.); Thoraxcenter, Erasmus MC, Rotterdam Erasmus University, The Netherlands (E.T., P.W.S.); National Heart & Lung Institute, Imperial College London, United Kingdom (P.W.S.); and Duke-NUS Medical School, National University of Singapore (N.F.)
| | - Patrick W Serruys
- From the National Heart Centre Singapore (J.N., H.Y.A., N.F.); Department of Biomedical Engineering, National University of Singapore, Singapore (J.N.); Departments of Cardiovascular Sciences (C.V.B.) and Mechanical Engineering (R.T.), University College London, United Kingdom; Department of Cardiology, Barts Health NHS Trust, London, United Kingdom (C.V.B.); Thoraxcenter, Erasmus MC, Rotterdam Erasmus University, The Netherlands (E.T., P.W.S.); National Heart & Lung Institute, Imperial College London, United Kingdom (P.W.S.); and Duke-NUS Medical School, National University of Singapore (N.F.)
| | - Nicolas Foin
- From the National Heart Centre Singapore (J.N., H.Y.A., N.F.); Department of Biomedical Engineering, National University of Singapore, Singapore (J.N.); Departments of Cardiovascular Sciences (C.V.B.) and Mechanical Engineering (R.T.), University College London, United Kingdom; Department of Cardiology, Barts Health NHS Trust, London, United Kingdom (C.V.B.); Thoraxcenter, Erasmus MC, Rotterdam Erasmus University, The Netherlands (E.T., P.W.S.); National Heart & Lung Institute, Imperial College London, United Kingdom (P.W.S.); and Duke-NUS Medical School, National University of Singapore (N.F.).
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9
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Oktaviono YH. Case Report: INTRAPROCEDURAL STENT THROMBOSIS IN PERCUTANEOUS CORONARY ANGIOPLASTY. FOLIA MEDICA INDONESIANA 2017. [DOI: 10.20473/fmi.v52i1.5213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Stent thrombosis is a rare complication of PCI but associated with STEMI and sudden cardiac death. Intra procedural stent thrombosis (IPST) was defined new or increasing (compared with baseline) thrombus within or adjacent to a deployed stent occurring the index PCI procedure whether occlusive or nonocclusive. We describe a case with double vessel disease who has complication cardiac arrest and intra procedural stent thrombosis in LAD and Left Main coronary artery after deployed stent in bifurcation LAD-D1. Thrombectomy and rescucitation were performed, and the patient completed her hospital course without complications.
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10
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Bioresorbable vascular scaffolds in coronary chronic total occlusions revascularization: safety assessment related to struts coverage and apposition in 6-month OCT follow-up. Heart Vessels 2017; 32:1077-1084. [PMID: 28432385 DOI: 10.1007/s00380-017-0980-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2017] [Accepted: 04/14/2017] [Indexed: 10/19/2022]
Abstract
Beneficial properties of bioresorbable vascular scaffolds (BVS) regarding to vasomotility restoration and no caging of the vessel make them attractive devices in chronic total occlusions (CTO) revascularization. However, more evidence is needed attending to their use in this specific setting. We aim to determine feasibility and safety of BVS use in CTO revascularization attending to struts coverage and apposition, as well as re-stenosis and stent thrombosis (ST) rates. 29 BVS were deployed in 9 CTO lesions revascularization (mean J-CTO score ≥3) with an acute procedural success rate of 100%. Clinical and angiographic follow-up was performed 6 months later, including intracoronary analyses from optical coherence tomography (OCT) images. 44,723 struts were analyzed within the total 636 mm of scaffolded vessel. Mean length scaffolded per lesion was 70.66 ± 31.01 mm with a mean number of 3.22 BVS. 2051 struts (4.59%) were identified as uncovered, being most of them (98.4%) neither malapposed nor disrupted. Mean thickness of struts' coverage was 0.13 ± 0.05 mm. Incomplete strut apposition (ISA) percentage was 0% as no malapposed struts were detected and 134 struts were identified as disrupted, which represents a 0.29% from the total. Mean vessel, scaffold, and lumen diameters were 3.87 ± 0.51, 2.97 ± 0.49, and 2.68 ± 0.50 mm, respectively. Neither in-stent re-stenosis nor ST was detected. During follow-up, none of our patients died, suffered from stroke or needed target lesion revascularization. Clinical and angiographic 6-month follow-up (including OCT analyses) of BVS in CTO revascularization suggests their effectiveness and safety, even in very complex chronic occluded lesions. Nevertheless, more evidence is needed.
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11
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Wang B, Mintz GS, Witzenbichler B, Souza CF, Metzger DC, Rinaldi MJ, Duffy PL, Weisz G, Stuckey TD, Brodie BR, Matsumura M, Yamamoto MH, Parvataneni R, Kirtane AJ, Stone GW, Maehara A. Predictors and Long-Term Clinical Impact of Acute Stent Malapposition: An Assessment of Dual Antiplatelet Therapy With Drug-Eluting Stents (ADAPT-DES) Intravascular Ultrasound Substudy. J Am Heart Assoc 2016; 5:e004438. [PMID: 28007741 PMCID: PMC5210413 DOI: 10.1161/jaha.116.004438] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Accepted: 11/21/2016] [Indexed: 11/26/2022]
Abstract
BACKGROUND The impact of acute stent malapposition (ASM) on long-term clinical outcomes in patients undergoing percutaneous coronary intervention is still controversial. We sought to evaluate predictors and long-term clinical outcomes of ASM. METHODS AND RESULTS ADAPT-DES (Assessment of Dual Antiplatelet Therapy With Drug-Eluting Stents) was a prospective multicenter study of 8663 patients undergoing percutaneous coronary intervention using drug-eluting stents. In a prespecified intravascular ultrasound-guided substudy, 2072 patients with 2446 culprit lesions had post-percutaneous coronary intervention intravascular ultrasound and were classified according to the presence or absence of ASM. After intravascular ultrasound-guided percutaneous coronary intervention, the overall prevalence of ASM after successful drug-eluting stents implantation was 14.4% per patient and 12.6% per lesion. Compared to lesions without ASM, lesions with ASM had larger in-stent lumen areas, larger stent areas, and larger in-stent vessel areas. A larger mean plaque area along with more attenuated plaque was observed in lesions with ASM versus lesions without ASM. Lesions with ASM had greater proximal and distal reference lumen areas and more distal, but not proximal, reference calcium compared to lesions without ASM. At 2-year follow-up, there was no significant difference in the incidence of cardiac death; myocardial infarction; early, late, or very late stent thrombosis; or clinically driven target lesion revascularization in patients with ASM versus those without ASM. Furthermore, ASM was not an independent predictor of 2-year major adverse cardiac events or target lesion revascularization even when forced into the multivariate model. CONCLUSIONS In patients treated with intravascular ultrasound-guided drug-eluting stents implantation, ASM was not associated with adverse clinical events during long-term follow-up including, but not limited to, stent thrombosis. CLINICAL TRIAL REGISTRATION URL: https://www.clinicaltrials.gov. Unique identifier: NCT00638794.
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Affiliation(s)
- Bin Wang
- Cardiovascular Research Foundation, New York, NY
- Columbia University Medical Center/NewYork-Presbyterian Hospital, New York, NY
- Shenyang Northern Hospital, Shenyang, China
| | - Gary S Mintz
- Cardiovascular Research Foundation, New York, NY
| | | | | | | | - Michael J Rinaldi
- Sanger Heart & Vascular Institute/Carolinas HealthCare System, Charlotte, NC
| | - Peter L Duffy
- Reid Heart Center, FirstHealth of the Carolinas, Pinehurst, NC
| | - Giora Weisz
- Cardiovascular Research Foundation, New York, NY
- Columbia University Medical Center/NewYork-Presbyterian Hospital, New York, NY
- Shaare Zedek Medical Center, Jerusalem, Israel
| | - Thomas D Stuckey
- LeBauer Cardiovascular Research Foundation/Cone Health, Greensboro, NC
| | - Bruce R Brodie
- LeBauer Cardiovascular Research Foundation/Cone Health, Greensboro, NC
| | | | - Myong-Hwa Yamamoto
- Cardiovascular Research Foundation, New York, NY
- Columbia University Medical Center/NewYork-Presbyterian Hospital, New York, NY
| | | | - Ajay J Kirtane
- Cardiovascular Research Foundation, New York, NY
- Columbia University Medical Center/NewYork-Presbyterian Hospital, New York, NY
| | - Gregg W Stone
- Cardiovascular Research Foundation, New York, NY
- Columbia University Medical Center/NewYork-Presbyterian Hospital, New York, NY
| | - Akiko Maehara
- Cardiovascular Research Foundation, New York, NY
- Columbia University Medical Center/NewYork-Presbyterian Hospital, New York, NY
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12
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Radu MD, Engstrøm T. Casting light on coronary evaginations: different mechanisms in different coronary devices? Eur Heart J 2016; 37:2050-4. [PMID: 26612580 DOI: 10.1093/eurheartj/ehv623] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Affiliation(s)
- Maria D Radu
- Department of Cardiology, Herlev Hospital, Copenhagen University Hospital, Herlev, Denmark Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Thomas Engstrøm
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
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13
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Antonsen L, Thayssen P, Maehara A, Hansen HS, Junker A, Veien KT, Hansen KN, Hougaard M, Mintz GS, Jensen LO. Optical Coherence Tomography Guided Percutaneous Coronary Intervention With Nobori Stent Implantation in Patients With Non-ST-Segment-Elevation Myocardial Infarction (OCTACS) Trial: Difference in Strut Coverage and Dynamic Malapposition Patterns at 6 Months. Circ Cardiovasc Interv 2016; 8:e002446. [PMID: 26253735 DOI: 10.1161/circinterventions.114.002446] [Citation(s) in RCA: 64] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
BACKGROUND Incomplete strut coverage has been documented an important histopathologic morphometric predictor for later thrombotic events. This study sought to investigate whether optical coherence tomography (OCT)-guided percutaneous coronary intervention with Nobori biolimus-eluting stent implantation in patients with non-ST-segment-elevation myocardial infarction would provide improved strut coverage at 6 months in comparison with angiographic guidance only. METHODS AND RESULTS One hundred patients were randomized 1:1 to either OCT-guided or angio-guided Nobori biolimus-eluting stent implantation. Postprocedure OCT was performed in all patients. In the OCT-guided group, prespecified criteria indicating additional intervention were related to (1) stent underexpansion, (2) strut malapposition, (3) edge dissection(s), and (4) residual stenosis at the distal or proximal reference segment(s). A final OCT was performed in case of reintervention. Six-month OCT follow-up was available in 85 patients. Twenty-three (46%) OCT-guided patients had additional postdilation or stenting. The percentage of acutely malapposed struts was substantially lower in the OCT-guided group (3.4% [interquartile range, 0.3-7.6] versus 7.8% [interquartile range, 2.3-19.4]; P<0.01). At 6-month follow-up, the OCT-guided group had a significantly lower proportion of uncovered struts; 4.3% [interquartile range, 1.2-9.8] versus 9.0% [interquartile range, 5.5-14.5], P<0.01. Furthermore, OCT-guided patients had significantly more completely covered stents: 17.5% versus 2.2%, P=0.02. The percentages of malapposed struts and struts being both uncovered and malapposed at follow-up were comparable between groups. CONCLUSIONS OCT-guided optimization of Nobori biolimus-eluting stent implantation improves strut coverage at 6-month follow-up in comparison with angiographic guidance alone. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT02272283.
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Affiliation(s)
- Lisbeth Antonsen
- From the Department of Cardiology, Odense University Hospital, Odense, Denmark (L.A., P.T., H.S.H., A.J., K.T.V., K.N.H., M.H., L.O.J.); and Departments of Cardiology, Columbia University Medical Center and Cardiovascular Research Foundation, New York, NY (A.M., G.S.M.).
| | - Per Thayssen
- From the Department of Cardiology, Odense University Hospital, Odense, Denmark (L.A., P.T., H.S.H., A.J., K.T.V., K.N.H., M.H., L.O.J.); and Departments of Cardiology, Columbia University Medical Center and Cardiovascular Research Foundation, New York, NY (A.M., G.S.M.)
| | - Akiko Maehara
- From the Department of Cardiology, Odense University Hospital, Odense, Denmark (L.A., P.T., H.S.H., A.J., K.T.V., K.N.H., M.H., L.O.J.); and Departments of Cardiology, Columbia University Medical Center and Cardiovascular Research Foundation, New York, NY (A.M., G.S.M.)
| | - Henrik Steen Hansen
- From the Department of Cardiology, Odense University Hospital, Odense, Denmark (L.A., P.T., H.S.H., A.J., K.T.V., K.N.H., M.H., L.O.J.); and Departments of Cardiology, Columbia University Medical Center and Cardiovascular Research Foundation, New York, NY (A.M., G.S.M.)
| | - Anders Junker
- From the Department of Cardiology, Odense University Hospital, Odense, Denmark (L.A., P.T., H.S.H., A.J., K.T.V., K.N.H., M.H., L.O.J.); and Departments of Cardiology, Columbia University Medical Center and Cardiovascular Research Foundation, New York, NY (A.M., G.S.M.)
| | - Karsten Tange Veien
- From the Department of Cardiology, Odense University Hospital, Odense, Denmark (L.A., P.T., H.S.H., A.J., K.T.V., K.N.H., M.H., L.O.J.); and Departments of Cardiology, Columbia University Medical Center and Cardiovascular Research Foundation, New York, NY (A.M., G.S.M.)
| | - Knud Nørregaard Hansen
- From the Department of Cardiology, Odense University Hospital, Odense, Denmark (L.A., P.T., H.S.H., A.J., K.T.V., K.N.H., M.H., L.O.J.); and Departments of Cardiology, Columbia University Medical Center and Cardiovascular Research Foundation, New York, NY (A.M., G.S.M.)
| | - Mikkel Hougaard
- From the Department of Cardiology, Odense University Hospital, Odense, Denmark (L.A., P.T., H.S.H., A.J., K.T.V., K.N.H., M.H., L.O.J.); and Departments of Cardiology, Columbia University Medical Center and Cardiovascular Research Foundation, New York, NY (A.M., G.S.M.)
| | - Gary S Mintz
- From the Department of Cardiology, Odense University Hospital, Odense, Denmark (L.A., P.T., H.S.H., A.J., K.T.V., K.N.H., M.H., L.O.J.); and Departments of Cardiology, Columbia University Medical Center and Cardiovascular Research Foundation, New York, NY (A.M., G.S.M.)
| | - Lisette Okkels Jensen
- From the Department of Cardiology, Odense University Hospital, Odense, Denmark (L.A., P.T., H.S.H., A.J., K.T.V., K.N.H., M.H., L.O.J.); and Departments of Cardiology, Columbia University Medical Center and Cardiovascular Research Foundation, New York, NY (A.M., G.S.M.)
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Abstract
Implantation of drug-eluting stents (DESs) via percutaneous coronary intervention is the most popular treatment option to restore blood flow to occluded vasculature. The many devices currently used in clinic and under examination in research laboratories are manufactured using a variety of coating techniques to create the incorporated drug release platforms. These coating techniques offer various benefits including ease of use, expense of equipment, and design variability. This review paper discusses recent novel DES designs utilizing individual or a combination of these coating techniques and their resulting drug release profiles.
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Affiliation(s)
- Megan Livingston
- Department of Regenerative Medicine and Orthopaedics, Houston Methodist Research Institute, Houston, USA
| | - Aaron Tan
- Centre for Nanotechnology & Regenerative Medicine, UCL Division of Surgery & Interventional Science, UCL Medical School, University College London (UCL), London, UK
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15
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Otsuka F, Cheng Q, Yahagi K, Acampado E, Sheehy A, Yazdani SK, Sakakura K, Euller K, Perkins LE, Kolodgie FD, Virmani R, Joner M. Acute Thrombogenicity of a Durable Polymer Everolimus-Eluting Stent Relative to Contemporary Drug-Eluting Stents With Biodegradable Polymer Coatings Assessed Ex Vivo in a Swine Shunt Model. JACC Cardiovasc Interv 2015; 8:1248-1260. [DOI: 10.1016/j.jcin.2015.03.029] [Citation(s) in RCA: 93] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2015] [Accepted: 03/01/2015] [Indexed: 12/01/2022]
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16
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Yeo KK, Armstrong EJ, Soni K, Waldo SW, Patel M, Reeves R, MacGregor JS, Low RI, Shunk KA, Mahmud E, Rogers JH. Long-term outcomes of angiographically confirmed coronary stent thrombosis: results from a multicentre California registry. EUROINTERVENTION 2015; 11:188-95. [PMID: 26093838 DOI: 10.4244/eijv11i2a33] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS Limited data exist on long-term outcomes of patients with stent thrombosis (ST). Our aim was to describe the long-term outcomes after angiographically confirmed ST. METHODS AND RESULTS In this multicentre registry, consecutive cases of definite ST were identified between 2005 and 2013. Clinical and procedural characteristics, in-hospital outcomes and long-term survival up to five years were compared between those with and those without adverse cardiovascular and cerebrovascular events (MACCE), defined as all-cause mortality, myocardial infarction and stroke. Two hundred and twenty-one patients with 239 stent thrombosis events were identified. Patients who developed MACCE were older, less likely to be men, and less likely to have hypertension. Angiographic characteristics were similar. Patients who had a MACCE event showed a trend towards a lower likelihood of procedural success (86% vs. 91%, p=0.05). MACCE rates were 22% at one year and 41% at five years. All-cause mortality was 13% at one year and 24% at five years. On multivariable analysis, age, diabetes mellitus, active smoking and ST at a bifurcation were independently associated with the occurrence of MACCE up to five years. CONCLUSIONS Age, active smoking, diabetes mellitus and bifurcation disease are independently associated with long-term MACCE over a five-year follow-up period.
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Affiliation(s)
- Khung Keong Yeo
- Department of Medicine, Division of Cardiovascular Medicine, University of California, Davis Medical Center, Sacramento, CA, USA
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Sommer P, Armstrong EJ. Stent Thrombosis: Current Management and Outcomes. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2015; 17:365. [DOI: 10.1007/s11936-015-0365-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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18
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Abstract
Stent thrombosis is an uncommon but serious complication which carries with it significant mortality and morbidity. This review analyzes the entity of stent thrombosis from a historical and clinical perspective, and chronicles the evolution of this condition through the various generations of stent development, from bare metal to first-generation, second-generation, and third-generation drug-eluting stents. It also delineates the specific risk factors associated with stent thrombosis and comprehensively examines the literature related to each of these risks. Finally, it highlights the preventative strategies that can be garnered from the existing data, and concludes that a multifactorial approach is necessary to combat the occurrence of stent thrombosis, with higher risk groups, such as patients with ST segment elevation myocardial infarction, meriting further research.
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Affiliation(s)
| | - Amir S Lotfi
- Division of Cardiology, Baystate Medical Center, Springfield, MA, USA
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19
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Cortese B, Piraino D, La Franca E, Buccheri D, Silva Orrego P, Andolina G, Seregni R. Coronary Stent Thrombosis in 2015: A Comprehensive and Uptodated Review. AIMS MEDICAL SCIENCE 2015. [DOI: 10.3934/medsci.2015.3.131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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20
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Tyczyński P, Karcz MA, Kalińczuk Ł, Fronczak A, Witkowski A. Early stent thrombosis. Aetiology, treatment, and prognosis. ADVANCES IN INTERVENTIONAL CARDIOLOGY 2014; 10:221-5. [PMID: 25489313 PMCID: PMC4252318 DOI: 10.5114/pwki.2014.46761] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2014] [Revised: 10/24/2014] [Accepted: 11/04/2014] [Indexed: 11/17/2022] Open
Affiliation(s)
- Paweł Tyczyński
- Department of Interventional Cardiology and Angiology, Institute of Cardiology, Warsaw, Poland
| | - Maciej A. Karcz
- Department of Interventional Cardiology and Angiology, Institute of Cardiology, Warsaw, Poland
| | - Łukasz Kalińczuk
- Department of Coronary Artery Disease and Structural Heart Diseases, Institute of Cardiology, Warsaw, Poland
| | - Aneta Fronczak
- Department of Interventional Cardiology and Angiology, Institute of Cardiology, Warsaw, Poland
| | - Adam Witkowski
- Department of Interventional Cardiology and Angiology, Institute of Cardiology, Warsaw, Poland
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21
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22
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Intracoronary Optical Coherence Tomography: Insights from Clinical Research—What Do We Need to Learn? CURRENT CARDIOVASCULAR IMAGING REPORTS 2014. [DOI: 10.1007/s12410-014-9286-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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23
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Blicq E, Georges JL, Elbeainy E, Gibault-Genty G, Benjemaa K, Jerbi B, Livarek B. Detection of Stent Underdeployment by StentBoost Imaging. J Interv Cardiol 2014; 26:444-53. [PMID: 24106743 DOI: 10.1111/joic.12062] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVE To evaluate the additional value of StentBoost® (SB), a motion-corrected X-ray technique that enhances stent visualization, for the assessment of stent deployment and procedure optimization during routine percutaneous coronary interventions (PCI). BACKGROUND Underdeployment and malapposition of stents during PCI may lead to in-stent thrombosis and restenosis. Coronary angiography (CA) is of limited value for the assessment of stent deployment. Intravascular ultrasound and optical imaging techniques are the gold standard, but are used in <10% of routine PCIs. METHODS We retrospectively analyzed 260 coronary lesions treated by stent implantation and assessed by SB during 168 consecutive PCI procedures. The immediate results of SB analysis and CA were assessed by 2 independent interventional cardiologists and compared. RESULTS A total of 275 stents were implanted; 45% were drug-eluting stents (DES). Direct stenting was performed in 78%. Results of SB and angiography were concordant for 210 lesions: 194 stents were correctly deployed (75%) and 16 were underdeployed (6%), shown by both techniques. In 47 patients (18%), SB detected an underdeployment of the stent whereas the angiographic result was good. Postdilatation was performed on the basis of SB in 89% of these cases. The additional contribution of SB was higher for left main lesions and for DES, and was not affected by coronary calcifications. CONCLUSIONS This study confirmed the usefulness of the stent visualization enhancement technique StentBoost® in current PCI practice. SB revealed about 20% underdeployed stents not detected by CA, and allowed for optimizing PCI by ad hoc effective postdilatation.
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Affiliation(s)
- Elodie Blicq
- Service de Cardiologie, Centre Hospitalier de Versailles, Hôpital André Mignot, Le Chesnay, France
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24
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Windecker S, O'Sullivan CJ. Mitigating the risk of early stent thrombosis. J Am Coll Cardiol 2014; 63:2521-2524. [PMID: 24768885 DOI: 10.1016/j.jacc.2014.03.035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2014] [Accepted: 03/25/2014] [Indexed: 10/25/2022]
Affiliation(s)
- Stephan Windecker
- Department of Cardiology, Bern University Hospital, Bern, Switzerland.
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25
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Yadav M, Généreux P, Palmerini T, Caixeta A, Madhavan MV, Xu K, Brener SJ, Mehran R, Stone GW. SYNTAX score and the risk of stent thrombosis after percutaneous coronary intervention in patients with non-ST-segment elevation acute coronary syndromes: An ACUITY trial substudy. Catheter Cardiovasc Interv 2014; 85:1-10. [DOI: 10.1002/ccd.25396] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2013] [Accepted: 12/22/2013] [Indexed: 12/11/2022]
Affiliation(s)
- Mayank Yadav
- Cardiovascular Research Foundation; New York New York
- New York-Presbyterian Hospital/ Columbia University Medical Center; New York New York
| | - Philippe Généreux
- Cardiovascular Research Foundation; New York New York
- New York-Presbyterian Hospital/ Columbia University Medical Center; New York New York
- Hôpital du Sacré-Coeur de Montréal; Université de Montréal; Montréal Québec Canada
| | | | - Adriano Caixeta
- Hospital Israelita Albert Einstein and Escola Paulista de Medicina; Universidade Federal de Sao Paulo; Brazil
| | - Mahesh V. Madhavan
- New York-Presbyterian Hospital/ Columbia University Medical Center; New York New York
| | - Ke Xu
- Cardiovascular Research Foundation; New York New York
| | | | | | - Gregg W. Stone
- Cardiovascular Research Foundation; New York New York
- New York-Presbyterian Hospital/ Columbia University Medical Center; New York New York
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26
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Nakano M, Yahagi K, Otsuka F, Sakakura K, Finn AV, Kutys R, Ladich E, Fowler DR, Joner M, Virmani R. Causes of Early Stent Thrombosis in Patients Presenting With Acute Coronary Syndrome. J Am Coll Cardiol 2014; 63:2510-2520. [DOI: 10.1016/j.jacc.2014.02.607] [Citation(s) in RCA: 89] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2014] [Revised: 02/18/2014] [Accepted: 02/24/2014] [Indexed: 12/01/2022]
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27
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ANN SOEHEE, CHUNG JAEWOOK, DE JIN CAI, LEE JUNHO, KIM JONGMIN, GARG SCOT, SHIN EUNSEOK. Better Inflation Time of Stent Balloon for Second-Generation Drug-Eluting Stent Expansion and Apposition: An Optical Coherence Tomography Study. J Interv Cardiol 2014; 27:171-6. [DOI: 10.1111/joic.12096] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- SOE HEE ANN
- Ulsan University Hospital; University of Ulsan College of Medicine; Ulsan South Korea
| | - JAE-WOOK CHUNG
- College of Medicine; Yeungnam University; Daegu South Korea
| | - CAI DE JIN
- Ulsan University Hospital; University of Ulsan College of Medicine; Ulsan South Korea
| | - JUN HO LEE
- Ulsan University Hospital; University of Ulsan College of Medicine; Ulsan South Korea
| | - JONG MIN KIM
- Ulsan University Hospital; University of Ulsan College of Medicine; Ulsan South Korea
| | - SCOT GARG
- East Lancashire Hospitals NHS Trust; Blackburn Lancashire UK
| | - EUN-SEOK SHIN
- Ulsan University Hospital; University of Ulsan College of Medicine; Ulsan South Korea
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28
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Attizzani GF, Capodanno D, Ohno Y, Tamburino C. Mechanisms, pathophysiology, and clinical aspects of incomplete stent apposition. J Am Coll Cardiol 2014; 63:1355-67. [PMID: 24530675 DOI: 10.1016/j.jacc.2014.01.019] [Citation(s) in RCA: 93] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2013] [Revised: 12/12/2013] [Accepted: 01/07/2014] [Indexed: 11/25/2022]
Abstract
Incomplete stent apposition (ISA) is characterized by the lack of contact of at least 1 stent strut with the vessel wall in a segment not overlying a side branch; it is more commonly found in drug-eluting stents than bare-metal stents. The accurate diagnosis of ISA, initially only possible with intravascular ultrasound, can currently be performed with higher accuracy by optical coherence tomography, which also enables strut-level assessment due to its higher axial resolution. Different circumstances related both to the index procedure and to vascular healing might influence ISA occurrence. Although several histopathology and clinical studies linked ISA to stent thrombosis, potential selection bias precluded definitive conclusions. Initial studies usually performed single time point assessments comparing overall ISA percentage and magnitude in different groups (i.e., stent type), thus hampering a comprehensive understanding of its relationship with vascular healing. Serial intravascular imaging studies that evaluated vascular response heterogeneity recently helped fill this gap. Some particular clinical scenarios such as acute coronary syndromes, bifurcations, tapered vessels, overlapping stents, and chronic total occlusions might predispose to ISA. Interventional cardiologists should be committed to optimal stent choices and techniques of implantation and use intravascular imaging guidance when appropriate to aim at minimizing acute ISA. In addition, the active search for new stent platforms that could accommodate vessel remodeling over time (i.e., self-expandable stents) and for new polymers and/or eluting drugs that could induce less inflammation (hence, less positive remodeling) could ultimately reduce the occurrence of ISA and its potentially harmful consequences.
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Affiliation(s)
- Guilherme F Attizzani
- Division of Cardiology, Ferrarotto Hospital, University of Catania, Catania, Italy; Division of Interventional Cardiology, Pitangueiras Hospital, Jundiaí, SP, Brazil; Harrington Heart and Vascular Institute, University Hospitals, Case Medical Center, Cleveland, Ohio
| | - Davide Capodanno
- Division of Cardiology, Ferrarotto Hospital, University of Catania, Catania, Italy; Excellence Through Newest Advances (ETNA) Foundation, Catania, Italy.
| | - Yohei Ohno
- Division of Cardiology, Ferrarotto Hospital, University of Catania, Catania, Italy
| | - Corrado Tamburino
- Division of Cardiology, Ferrarotto Hospital, University of Catania, Catania, Italy; Excellence Through Newest Advances (ETNA) Foundation, Catania, Italy
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Rath PC, Reddy K, Agarwal MK, Purohit BV, Deb T, Reddy AM. Optical coherence tomography guided PCI - initial experience at Apollo Health City, Jubilee Hills, Hyderabad. Indian Heart J 2014; 66:31-7. [PMID: 24581093 PMCID: PMC4054838 DOI: 10.1016/j.ihj.2013.12.048] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2013] [Accepted: 12/15/2013] [Indexed: 01/27/2023] Open
Abstract
Background The capability of OCT to examine the structure of the arterial wall before or after PCI is superior to those of other imaging modalities. Therefore the application of OCT during PCI seems logical and has the potential to enhance our performance during the PCI procedures. Methods OCT was performed in fifty-two patients out of which, 45 patients underwent PCI. Out of these 45 patients, in 25 patients both pre and post PCI OCT assessment was done. In 20 patients only post PCI OCT assessment was done. In seven patients PCI was not done due to nonsignificant obstruction, these seven patients were not included in final analysis. Results Over all OCT leads to management changes in 65% of the time it was used. Alteration of stent length was done in 56% of the cases when evaluated pre PCI. Alteration of stent diameter was done in 36% cases when evaluated pre PCI. Treatment of malapposition was done in 24% of total cases. Further balloon dilatation for vessel expansion was done in 15% of total cases. In one case left main stenting was done after proximal edge dissection. Conclusion OCT makes better visualization of plaque, thrombus, stent malapposition, dissection, plaque prolapse and helps in optimization of PCI results. More extensive, long-term studies will be needed to assess the prognostic implications of these findings.
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Affiliation(s)
- Pratap Chandra Rath
- Director, Cath Lab, Senior Interventional Cardiologist, Apollo Health City, Jubilee Hills, Hyderabad, India.
| | - Krupal Reddy
- Consultant Interventional Cardiologist, Apollo Health City, Jubilee Hills, Hyderabad, India
| | - Manoj K Agarwal
- Senior Interventional Cardiologist, Apollo Health City, Jubilee Hills, Hyderabad, India
| | - Bharat V Purohit
- Senior Interventional Cardiologist, Apollo Health City, Jubilee Hills, Hyderabad, India
| | - Tripti Deb
- Senior Interventional Cardiologist, Apollo Health City, Jubilee Hills, Hyderabad, India
| | - Aleti Mallikarjun Reddy
- Registrar and Research Officer, Dept. of Cardiology, Apollo Health City, Jubilee Hills, Hyderabad, India
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Radu MD, Räber L, Heo J, Gogas BD, Jørgensen E, Kelbæk H, Muramatsu T, Farooq V, Helqvist S, Garcia-Garcia HM, Windecker S, Saunamäki K, Serruys PW. Natural history of optical coherence tomography-detected non-flow-limiting edge dissections following drug-eluting stent implantation. EUROINTERVENTION 2014; 9:1085-94. [DOI: 10.4244/eijv9i9a183] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Mogabgab O, Wiviott SD, Cannon CP, Sloan S, Sabatine MS, Antman EM, Braunwald E, Giugliano RP. Circadian variation of stent thrombosis and the effect of more robust platelet inhibition: a post hoc analysis of the TRITON-TIMI 38 trial. J Cardiovasc Pharmacol Ther 2013; 18:555-9. [PMID: 24064010 DOI: 10.1177/1074248413497534] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND The well-described morning peak in the onset of acute coronary syndromes has been partly attributed to increased platelet activity upon arising. It has been suggested that stent thrombosis (ST) exhibits a similar pattern. We assessed whether a diurnal variation in ST occurs, and whether more robust antiplatelet therapy with prasugrel (vs clopidogrel) can attenuate a morning excess. METHODS AND MATERIALS Patients from the Trial to Assess Improvement in Therapeutic Outcomes by Optimizing Platelet Inhibition with Prasugrel-Thrombolysis in Myocardial Infarction (TRITON-TIMI) 38 trial (N = 13 608) with adjudicated ST classified per the Academic Research Consortium definitions of definite (N = 135) and probable (N = 27) were grouped into prespecified 8-hour intervals by time of onset: early (6 am-2 pm), late-day (2 pm-10 pm), and overnight (10 pm-6 am). We compared the rates per 1000 patients of ST across time intervals and stratified by treatment and stent type. RESULTS A diurnal variation in definite/probable ST was observed with rates of 6.5, 3.7, and 2.1 for early, late-day, and overnight intervals, respectively (P < .001), per 1000 patients treated. A sensitivity analysis excluding periprocedural acute-ST (<24 hours after index percutaneous coronary intervention [PCI]) resulted in similar findings (5.2, 2.5, and 1.8 per 1000, P < .001). The circadian variation in ST was observed in patients on clopidogrel (9.7, 4.8, and 3.1 per 1000, P < .001) with the highest rate of ST early in the day. Patients on prasugrel also demonstrated a circadian variation with particularly low rates of overnight ST (3.4, 3.0, and 1.1 per 1000, P = .020). CONCLUSIONS In TRITON-TIMI 38 trial, the timing of ST exhibited a significant diurnal variation similar to that seen with onset of other acute coronary syndromes. ST occurred less frequently among patients randomized to prasugrel compared to clopidogrel with the greatest absolute reduction (6.2 per 1000 patients) in events earlier in the day when platelet activity is known to be highest.
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Affiliation(s)
- Owen Mogabgab
- 1Cardiology Division, University of Texas Southwestern Medical School, Dallas, TX, USA
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D'Ascenzo F, Bollati M, Clementi F, Castagno D, Lagerqvist B, de la Torre Hernandez JM, ten Berg JM, Brodie BR, Urban P, Jensen LO, Sardi G, Waksman R, Lasala JM, Schulz S, Stone GW, Airoldi F, Colombo A, Lemesle G, Applegate RJ, Buonamici P, Kirtane AJ, Undas A, Sheiban I, Gaita F, Sangiorgi G, Modena MG, Frati G, Biondi-Zoccai G. Incidence and predictors of coronary stent thrombosis: Evidence from an international collaborative meta-analysis including 30 studies, 221,066 patients, and 4276 thromboses. Int J Cardiol 2013; 167:575-84. [PMID: 22360945 DOI: 10.1016/j.ijcard.2012.01.080] [Citation(s) in RCA: 139] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2011] [Revised: 01/24/2012] [Accepted: 01/26/2012] [Indexed: 02/08/2023]
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D'Ascenzo F, Bollati M, Clementi F, Castagno D, Lagerqvist B, de la Torre Hernandez JM, ten Berg JM, Brodie BR, Urban P, Jensen LO, Sardi G, Waksman R, Lasala JM, Schulz S, Stone GW, Airoldi F, Colombo A, Lemesle G, Applegate RJ, Buonamici P, Kirtane AJ, Undas A, Sheiban I, Gaita F, Sangiorgi G, Modena MG, Frati G, Biondi-Zoccai G. Incidence and predictors of coronary stent thrombosis: Evidence from an international collaborative meta-analysis including 30 studies, 221,066 patients, and 4276 thromboses. Int J Cardiol 2013. [DOI: 10.10.1016/j.ijcard.2012.01.080] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Madan V, Coppola J, Sedlis SP. Avoiding stent thrombosis: advances in technique, antiplatelet pharmacotherapy and stent design. Interv Cardiol 2013. [DOI: 10.2217/ica.13.10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Cook JR, Mhatre A, Wang FW, Uretsky BF. Prolonged high-pressure is required for optimal stent deployment as assessed by optical coherence tomography. Catheter Cardiovasc Interv 2013; 83:521-7. [PMID: 23436559 DOI: 10.1002/ccd.24724] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2012] [Accepted: 10/12/2012] [Indexed: 12/21/2022]
Abstract
AIMS Optimizing stent deployment is important for both acute- and long-term outcomes. High-pressure balloon inflation is the standard for coronary stent implantation. However, there is no standardized inflation protocol. We hypothesized that prolonged high-pressure balloon inflation until stabilization of inflation pressure is superior to a rapid inflation/deflation sequence for both stent expansion and strut apposition. METHODS AND RESULTS A high-pressure rapid inflation/deflation sequence was deployed followed by angiography to assure no residual stenosis. Optical coherence tomography (OCT) was then performed followed by prolonged inflation until balloon pressure was stabilized for 30 sec using the same balloon at the same pressure as the rapid sequence. A second OCT run was then done. Thirteen thousand nine hundred thirteen stent struts were evaluated by OCT in 12 patients undergoing successful stenting. Stent expansion improved with prolonged (206 ± 115 sec) vs. rapid (28 ± 17 sec) inflation for both minimal stent diameter (3.0 ± 0.5 vs. 2.75 ± 0.44 mm, P < 0.0001) and area (7.83 ± 2.45 vs. 6.63 ± 1.85 mm(2) , P = 0.0003). The number of malapposed struts decreased (45 ± 41 vs. 88 ± 75, P = 0.005) as did the maximal malapposed strut distance (0.31 ± 0.2 vs. 0.43 ± 0.2 mm, P = 0.0001). Factors related to strut malapposition after rapid inflation included localized asymmetry in 67%, stent underexpansion in 75%, and stent undersizing in 67%. CONCLUSIONS These data demonstrate that prolonged inflation is superior to a rapid inflation/deflation technique for both stent expansion and strut apposition. We recommend for routine stent deployment a prolonged inflation protocol as described above to optimize stent deployment.
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Affiliation(s)
- Jeffrey R Cook
- Central Arkansas Veterans Health System, Division of Cardiology, University of Arkansas for Medical Sciences, Little Rock, Arkansas
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Gonzalo N, Alfonso F, Escaned J. Combined use of optical coherence tomography and intravascular ultrasound imaging for the evaluation of stent thrombosis. Expert Rev Cardiovasc Ther 2012; 11:5-7. [PMID: 23259439 DOI: 10.1586/erc.12.163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Räber L, Radu M. Optimising cardiovascular outcomes using optical coherence tomography-guided percutaneous coronary interventions. EUROINTERVENTION 2012; 8:765-71. [DOI: 10.4244/eijv8i7a118] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Alfonso F, Gonzalo N, Sandoval J. Late drug-eluting stent thrombosis: optical coherence tomography and intravascular ultrasound insights. Circ Cardiovasc Interv 2012; 5:615-6. [PMID: 22896577 DOI: 10.1161/circinterventions.112.970525] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Fernando Alfonso
- Interventional Cardiology Unit, Cardiovascular Institute, San Carlos University Hospital, Plaza Cristo Rey, Madrid, Spain.
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Alfonso F, Sandoval J. New Insights on Stent Thrombosis. JACC Cardiovasc Interv 2012; 5:141-4. [DOI: 10.1016/j.jcin.2011.12.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2011] [Accepted: 12/21/2011] [Indexed: 10/28/2022]
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Gutiérrez-Chico JL, García-García HM, Ligthart J, Bol-Raap G, Garg S, Bekkers JA, Serruys PW. How should I treat impaired systolic function and clinical deterioration after surgery of type A aortic dissection? EUROINTERVENTION 2012; 7:638-46. [PMID: 21930470 DOI: 10.4244/eijv7i5a102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND A 50-year-old male with diagnosis of acute type A aortic dissection underwent surgical repair. Immediately after surgery the patient had transient ECG changes, a raise in serum cardiac markers and physical signs of heart failure. INVESTIGATION Physical examination, electrocardiography, echocardiography (transthoracic and transoesophageal), coronary angiography, intravascular ultrasound. DIAGNOSIS Type A aortic dissection. MANAGEMENT Surgical repair, coronary angiography, percutaneous coronary intervention.
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Marchini JF, Manica A, Croce K. Stent Thrombosis: Understanding and Managing a Critical Problem. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2011; 14:91-107. [DOI: 10.1007/s11936-011-0155-4] [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: 02/06/2023]
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Alfonso F, Gonzalo N, Hernández R. A Rare Cause of Late Drug-Eluting Stent Thrombosis Unraveled by Optical Coherence Tomography. Circ Cardiovasc Interv 2011; 4:399-400. [DOI: 10.1161/circinterventions.111.963082] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Fernando Alfonso
- From Interventional Cardiology, the Cardiovascular Institute, San Carlos University Hospital, Madrid, Spain
| | - Nieves Gonzalo
- From Interventional Cardiology, the Cardiovascular Institute, San Carlos University Hospital, Madrid, Spain
| | - Rosana Hernández
- From Interventional Cardiology, the Cardiovascular Institute, San Carlos University Hospital, Madrid, Spain
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Rogacka R, Latib A, Colombo A. IVUS-Guided Stent Implantation to Improve Outcome: A Promise Waiting to be Fulfilled. Curr Cardiol Rev 2011; 5:78-86. [PMID: 20436848 PMCID: PMC2805818 DOI: 10.2174/157340309788166697] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2008] [Revised: 11/10/2008] [Accepted: 11/10/2008] [Indexed: 02/04/2023] Open
Abstract
The use of intravascular ultrasound (IVUS) to improve acute angiographic results was already shown in the prestent era. Various studies demonstrated the efficacy of IVUS in balloon sizing and estimating the extent of positive remodeling. With the introduction of drug-eluting stents (DES) the rate of restenosis has been significantly reduced but a new concern, the risk of stent thrombosis, has emerged. The association of stent underexpansion with stent thrombosis was observed for bare metal stents (BMS) and DES. Until now, the criteria for IVUS optimization used in different studies have relied on distal reference or on mean reference vessel for stent or postdilatation balloon sizing. Furthermore, an important recent innovation not available in previous studies is the use of noncompliant balloons to perform high pressure post-dilatation. Universal and easily applicable IVUS criteria for optimization of stent implantation as well as randomized studies on IVUS-guided DES implantation are necessary to minimize stent malapposition and underexpansion, which in turn can positively influence the rates of stent restenosis and thrombosis.
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Affiliation(s)
- Renata Rogacka
- Interventional Cardiology Unit, Desio Hospital, Milan, Italy
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Alfonso F, Canales E, Dutary J, Cruz A. Coronary dissection healing patterns: from complete resolution to restenosis, insights from optical coherence tomography. EUROINTERVENTION 2011; 7:270-3. [DOI: 10.4244/eijv7i2a43] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Choi SY, Witzenbichler B, Maehara A, Lansky AJ, Guagliumi G, Brodie B, Kellett MA, Dressler O, Parise H, Mehran R, Dangas GD, Mintz GS, Stone GW. Intravascular ultrasound findings of early stent thrombosis after primary percutaneous intervention in acute myocardial infarction: a Harmonizing Outcomes with Revascularization and Stents in Acute Myocardial Infarction (HORIZONS-AMI) substudy. Circ Cardiovasc Interv 2011; 4:239-47. [PMID: 21586693 DOI: 10.1161/circinterventions.110.959791] [Citation(s) in RCA: 160] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Small stent area and residual inflow/outflow disease have been reported as the strongest intravascular ultrasound (IVUS) predictors of early stent thrombosis (ST) in patients with stable angina. IVUS predictors of early ST in patients with acute myocardial infarction have not been studied. METHODS AND RESULTS In the Harmonizing Outcomes with Revascularization and Stents in Acute Myocardial Infarction (HORIZONS-AMI) study, a formal substudy included poststent and 13-month follow-up IVUS at 36 centers. Twelve patients with baseline IVUS who had definite/probable early ST ≤30 days after enrollment were compared with 389 patients without early ST. Significant residual stenosis was a lumen area <4.0 mm(2) with ≥70% plaque burden ≤10 mm from each stent edge. Significant edge dissection was more than medial dissection with lumen area <4 mm(2) or dissection angle ≥60°. Randomization to bivalirudin (P=0.29) or paclitaxel-eluting stent (P=0.74) was not related to early ST. Minimum lumen area was smaller in patients with versus without early ST (4.4 mm(2) [3.6, 6.9] versus 6.7 mm(2) [5.3, 8.0], respectively, P=0.014). Minimum lumen area <5 mm(2), significant residual stenosis, significant stent edge dissection, and significant tissue (plaque/thrombus) protrusion (more than the median that narrowed the lumen to <4 mm(2)) were more prevalent in patients with early ST, but significant acute malapposition (more than the median) was not. Overall, 100% of patients with early ST had at least 1 of these significant features: minimum lumen area <5 mm(2), edge dissection, residual stenosis, or tissue protrusion versus 23% in patients without early ST (P<0.01). CONCLUSIONS Smaller final lumen area and inflow/outflow disease (residual stenosis or dissection) but not acute malapposition were related to early ST after acute myocardial infarction intervention. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT00433966.
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Affiliation(s)
- So-Yeon Choi
- Columbia University Medical Center, New York, NY, USA
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Brugaletta S, Gomez-Lara J, Diletti R, Farooq V, van Geuns RJ, de Bruyne B, Dudek D, Garcia-Garcia HM, Ormiston JA, Serruys PW. Comparison of in vivo eccentricity and symmetry indices between metallic stents and bioresorbable vascular scaffolds: insights from the ABSORB and SPIRIT trials. Catheter Cardiovasc Interv 2011; 79:219-28. [PMID: 21563288 DOI: 10.1002/ccd.22996] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2011] [Accepted: 01/16/2011] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To compare the geometrical parameters of a bioresorbable vascular scaffold (BVS) with a standard metallic stent. BACKGROUND The introduction of polymeric bioresorbable materials in the design of novel coronary scaffolds may affect some geometrical parameters, such as eccentricity and symmetry indices, previously introduced as IVUS criteria for optimal metallic stent deployment. METHODS From ABSORB Cohort A, ABSORB Cohort B, SPIRIT I, and SPIRIT II, all patients implanted with BVS 1.0, BVS 1.1, or XIENCE V, respectively and intravascular ultrasound analyses post-implantation were selected. The eccentricity index was calculated frame by frame and expressed as an average per device (minimum diameter/maximum diameter). The symmetry index of the device was reported as ([maximum diameter - minimum diameter]/maximum diameter). Six months major adverse cardiac events (MACE) were analyzed. RESULTS A total of 242 patients were selected (BVS 1.0: n = 28, BVS 1.1: n = 94, XIENCE V: n = 120). The BVS exhibited a significantly lower eccentricity index (BVS 1.0: 0.83 ± 0.09; BVS 1.1: 0.85 ± 0.08; XIENCE V: 0.90 ± 0.06; P < 0.01) and a significantly higher symmetry index (BVS 1.0: 0.30 ± 0.07; BVS 1.1: 0.31 ± 0.06, XIENCE V 0.26 ± 0.07; P < 0.01) as compared to the XIENCE V. An inverse correlation was found between the symmetry and eccentricity indices for both (BVS r = -0.69, P < 0.01; XIENCE V r = -0.61, P < 0.01). No differences in MACE were detected between the groups according to their geometrical parameters. CONCLUSIONS The introduction of a new polymeric material in the design of BVS resulted in a lower eccentricity index and a higher symmetry index as compared to metallic stents, without detectable impact in MACE, at 6 months.
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Yeo KK, Mahmud E, Armstrong EJ, Bennett WE, Shunk KA, MacGregor JS, Li Z, Low RI, Rogers JH. Contemporary clinical characteristics, treatment, and outcomes of angiographically confirmed coronary stent thrombosis: Results from a multicenter California registry. Catheter Cardiovasc Interv 2011; 79:550-6. [DOI: 10.1002/ccd.23011] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2011] [Accepted: 01/20/2011] [Indexed: 11/06/2022]
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Affiliation(s)
- Zuzana Motovska
- Third Medical Faculty, Charles University and University Hospital, Kralovske Vinohrady, Prague, Czech Republic.
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