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Mirhosseini N, Li L, Liu Z, Mamas M, Fraser D, Wang T. A comparison of endothelial cell growth on commercial coronary stents with and without laser surface texturing. Heliyon 2024; 10:e26425. [PMID: 38434339 PMCID: PMC10906303 DOI: 10.1016/j.heliyon.2024.e26425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 02/12/2024] [Accepted: 02/13/2024] [Indexed: 03/05/2024] Open
Abstract
Complete endothelialisation of coronary stents is an important determinant of future thrombotic complications following coronary stenting. Stent surface texture is an important factor that influences endothelial cell growth. With the emergence of second and third generation coronary stents, is limited comparative data describing endothelial cell growth in contemporary stent platforms, and limited data available on approaches used to rapidly modify the surfaces of commercial coronary stents to improve endothelialisation. In this study we have determined the in vitro proliferation of the primary human coronary artery endothelial cells on the commonly used 4 types of commercial coronary stents and found that the inner surface of BioMatrix drug-eluting stents (DES), after eliminating of the polymer and drug coating, had significantly higher endothelial cell proliferation compared to that of other bare metal stents (BMS): Multi-Link8, Integrity and Omega. The surfaces of the 3 types of BMS which are smooth, displayed similar endothelial cell proliferation, suggesting the importance of surface features in manipulating endothelial cell growth. Laser surface texturing was used to create micro/nano patterns on the stents. The laser treatment has significantly increased endothelial proliferation on the inner surfaces of all 4 types of stents, and Multi-Link8 stents displayed the highest (>100%) improvement. The laser textured BioMatrix stents had the highest absolute number of endothelial cells growth. Our results provided useful information in the endothelialisation potential for the commonly used commercial coronary stents and suggested a potential future application of laser surface bioengineering to coronary stents for better biocompatibility of the device.
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Affiliation(s)
- Nazanin Mirhosseini
- Engineering Building A, 4th Floor Core 1, Department of Engineering for Sustainability, School of Engineering, Faculty of Science and Engineering, The University of Manchester, Manchester, M13 9PL, UK
| | - Lin Li
- Department of Engineering for Sustainability, School of Engineering, The University of Manchester, Manchester, M13 9PL, UK
| | - Zhu Liu
- Research Centre for Laser Extreme Manufacturing, Ningbo Institute of Materials Engineering and Technology, Chinese Academy of Science, Ningbo, China
| | - Mamas Mamas
- Cardiovascular Research Group, Institute of Science and Technology in Medicine, University of Keele, Stoke-on-Trent, and Royal Stoke Hospital, Stoke-on-Trent, UK
| | - Douglas Fraser
- Manchester Heart Centre, Manchester Royal Infirmary, Oxford Road, Manchester, M13 9WL, UK
| | - Tao Wang
- AV Hill Building, Faculty of Biology, Medicine and Health, The University of Manchester, Upper Brook Street, Manchester, M13 9PT, UK
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2
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Razzi F, Dijkstra J, Hoogendoorn A, Witberg K, Ligthart J, Duncker DJ, van Esch J, Wentzel JJ, van Steijn V, van Soest G, Regar E, van Beusekom HMM. Plaque burden is associated with minimal intimal coverage following drug-eluting stent implantation in an adult familial hypercholesterolemia swine model. Sci Rep 2023; 13:10683. [PMID: 37393320 PMCID: PMC10314904 DOI: 10.1038/s41598-023-37690-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 06/26/2023] [Indexed: 07/03/2023] Open
Abstract
Safety and efficacy of coronary drug-eluting stents (DES) are often preclinically tested using healthy or minimally diseased swine. These generally show significant fibrotic neointima at follow-up, while in patients, incomplete healing is often observed. The aim of this study was to investigate neointima responses to DES in swine with significant coronary atherosclerosis. Adult familial hypercholesterolemic swine (n = 6) received a high fat diet to develop atherosclerosis. Serial OCT was performed before, directly after, and 28 days after DES implantation (n = 14 stents). Lumen, stent and plaque area, uncovered struts, neointima thickness and neointima type were analyzed for each frame and averaged per stent. Histology was performed to show differences in coronary atherosclerosis. A range of plaque size and severity was found, from healthy segments to lipid-rich plaques. Accordingly, neointima responses ranged from uncovered struts, to minimal neointima, to fibrotic neointima. Lower plaque burden resulted in a fibrotic neointima at follow-up, reminiscent of minimally diseased swine coronary models. In contrast, higher plaque burden resulted in minimal neointima and more uncovered struts at follow-up, similarly to patients' responses. The presence of lipid-rich plaques resulted in more uncovered struts, which underscores the importance of advanced disease when performing safety and efficacy testing of DES.
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Affiliation(s)
- Francesca Razzi
- Department of Cardiology, Erasmus MC, Dr. Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands
| | - Jouke Dijkstra
- Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
| | - Ayla Hoogendoorn
- Department of Cardiology, Erasmus MC, Dr. Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands
| | - Karen Witberg
- Department of Cardiology, Erasmus MC, Dr. Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands
| | - Jurgen Ligthart
- Department of Cardiology, Erasmus MC, Dr. Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands
| | - Dirk J Duncker
- Department of Cardiology, Erasmus MC, Dr. Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands
| | - Jan van Esch
- Department of Chemical Engineering, Delft University of Technology, Van der Maasweg 9, 2629 HZ, Delft, The Netherlands
| | - Jolanda J Wentzel
- Department of Cardiology, Erasmus MC, Dr. Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands
| | - Volkert van Steijn
- Department of Chemical Engineering, Delft University of Technology, Van der Maasweg 9, 2629 HZ, Delft, The Netherlands
| | - Gijs van Soest
- Department of Cardiology, Erasmus MC, Dr. Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands
| | - Evelyn Regar
- University Hospital Ludwig-Maximilians University, Marchioninistrasse 15, 81377, Munich, Germany
| | - Heleen M M van Beusekom
- Department of Cardiology, Erasmus MC, Dr. Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands.
- Department of Cardiology, Erasmus MC, University Medical Center, Room Ee2393A, Dr. Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands.
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3
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Liu JD, Gong R, Zhang SY, Zhou ZP, Wu YQ. Beneficial effects of high-density lipoprotein (HDL) on stent biocompatibility and the potential value of HDL infusion therapy following percutaneous coronary intervention. Medicine (Baltimore) 2022; 101:e31724. [PMID: 36397406 PMCID: PMC9666103 DOI: 10.1097/md.0000000000031724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Several epidemiological studies have shown a clear inverse relationship between serum levels of high-density lipoprotein cholesterol (HDL-C) and the risk of atherosclerotic cardiovascular disease (ASCVD), even at low-density lipoprotein cholesterol levels below 70 mg/dL. There is much evidence from basic and clinical studies that higher HDL-C levels are beneficial, whereas lower HDL-C levels are detrimental. Thus, HDL is widely recognized as an essential anti-atherogenic factor that plays a protective role against the development of ASCVD. Percutaneous coronary intervention is an increasingly common treatment choice to improve myocardial perfusion in patients with ASCVD. Although drug-eluting stents have substantially overcome the limitations of conventional bare-metal stents, there are still problems with stent biocompatibility, including delayed re-endothelialization and neoatherosclerosis, which cause stent thrombosis and in-stent restenosis. According to numerous studies, HDL not only protects against the development of atherosclerosis, but also has many anti-inflammatory and vasoprotective properties. Therefore, the use of HDL as a therapeutic target has been met with great interest. Although oral medications have not shown promise, the developed HDL infusions have been tested in clinical trials and have demonstrated viability and reproducibility in increasing the cholesterol efflux capacity and decreasing plasma markers of inflammation. The aim of the present study was to review the effect of HDL on stent biocompatibility in ASCVD patients following implantation and discuss a novel therapeutic direction of HDL infusion therapy that may be a promising candidate as an adjunctive therapy to improve stent biocompatibility following percutaneous coronary intervention.
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Affiliation(s)
- Jian-Di Liu
- Department of Cardiology, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Ren Gong
- Department of Cardiology, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Shi-Yuan Zhang
- Department of Cardiology, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Zhi-Peng Zhou
- Department of Cardiology, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Yan-Qing Wu
- Department of Cardiology, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
- * Correspondence: Yan-Qing Wu, Department of Cardiology, The Second Affiliated Hospital of Nanchang University, Minde Road No. 1, Nanchang, Jiangxi 330006, China (e-mail: )
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Stevens JR, Zamani A, Osborne JIA, Zamani R, Akrami M. Critical evaluation of stents in coronary angioplasty: a systematic review. Biomed Eng Online 2021; 20:46. [PMID: 33964954 PMCID: PMC8105986 DOI: 10.1186/s12938-021-00883-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Accepted: 04/26/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Coronary stents are routinely placed in the treatment and prophylaxis of coronary artery disease (CAD). Current coronary stent designs are prone to developing blockages: in-stent thrombosis (IST) and in-stent re-stenosis (ISR). This is a systematic review of the design of current coronary stent models, their structural properties and their modes of application, with a focus on their associated risks of IST and ISR. The primary aim of this review is to identify the best stent design features for reducing the risk of IST and ISR. To review the three major types of stents used in clinical settings today, determining best and relevant clinical practice by exploring which types and features of offer improved patient outcomes regarding coronary angioplasty. This information can potentially be used to increase the success rate of coronary angioplasty and stent technology in the future taking into account costs and benefits. METHODS Scientific databases were searched to find studies concerning stents. After the exclusion criteria were applied, 19 of the 3192 searched literature were included in this review. Studies investigating three major types of stent design were found: bare-metal stents (BMS), drug-eluting stents (DES) and bioresorbable stents (BRS). The number of participants varied between 14 and 1264. On average 77.4% were male, with a mean age of 64 years. RESULTS From the findings of these studies, it is clear that DES are superior in reducing the risk of ISR when compared to BMS. Conflicting results do not clarify whether BRS are superior to DES at reducing IST occurrence, although studies into newer BRS technologies show reducing events of IST to 0, creating a promising future for BRS showing them to be non-inferior. Thinner stents were shown to reduce IST rates, due to better re-endothelialisation. Scaffold material has also been shown to play a role with cobalt alloy stents reducing the risk of IST. This study found that thinner stents that release drugs were better at preventing re-blockages. Some dissolvable stents might be better at stopping blood clots blocking the arteries when compared to metal stents. The method and procedure of implanting the stent during coronary angioplasty influences success rate of these stents, meaning stent design is not the only significant factor to consider. CONCLUSIONS Positive developments in coronary angioplasty could be made by designing new stents that encompass all the most desirable properties of existing stent technology. Further work is needed to investigate the benefits of BRS in reducing the risk of IST compared to DES, as well as to investigate the effects of different scaffold materials on IST and ISR outcomes.
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Affiliation(s)
| | - Ava Zamani
- Medical School, University College London (UCL), London, UK
| | | | - Reza Zamani
- Medical School, College of Medicine and Health, Exeter, UK
| | - Mohammad Akrami
- Department of Mechanical Engineering, College of Engineering, Mathematics, and Physical Sciences, University of Exeter, Exeter, UK.
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5
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Verheye S, Vrolix M, Montorfano M, Zivelonghi C, Giannini F, Bedogni F, Dubois C, De Bruyne B, Costa RA, Chamié D, de Ribamar Costa J, Kereiakes DJ, Abizaid AA, Colombo A. Twelve-month clinical and imaging outcomes of the uncaging coronary DynamX bioadaptor system. EUROINTERVENTION 2020; 16:e974-e981. [PMID: 32894231 DOI: 10.4244/eij-d-20-00763] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS We aimed to assess the safety and efficacy of the DynamX Novolimus-Eluting Coronary Bioadaptor System, a novel device that initially acts as a second-generation drug-eluting stent, but after six months frees the vessel through uncaging elements. METHODS AND RESULTS This multicentre study enrolled 50 patients with single de novo lesions. In-device acute lumen gain was 1.61±0.34 mm, and device and procedure success was 100%. Up to 12 months, two target lesion failures occurred: both were cardiac deaths (day 255 and day 267 post procedure). No definite or probable device thrombosis was observed. Mean late lumen loss was 0.12±0.18 mm in-device and 0.11±0.16 mm in-segment. Per intravascular ultrasound, the mean device area and mean vessel area increased significantly by 5% and 3%, respectively, while the mean lumen area was maintained. Stationary optical coherence tomography in seven patients demonstrated restoration of cyclic pulsatility, with an approximate lumen area variance of 11% between systole and diastole. CONCLUSIONS The DynamX bioadaptor showed drug-eluting stent-like acute performance and safety and efficacy up to one year. Positive remodelling with an increase of vessel and device area while maintaining the mean lumen area was demonstrated. Long-term follow-up and randomised trials are required to assess the benefit of this device on events beyond one year.
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Affiliation(s)
- Stefan Verheye
- Interventional Cardiology, ZNA Cardiovascular Center Middelheim, Antwerp, Belgium
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6
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Iannaccone M, D'Ascenzo F, Templin C, Omedè P, Montefusco A, Guagliumi G, Serruys PW, Di Mario C, Kochman J, Quadri G, Biondi-Zoccai G, Lüscher TF, Moretti C, D'amico M, Gaita F, Stone GW. Optical coherence tomography evaluation of intermediate-term healing of different stent types: systemic review and meta-analysis. Eur Heart J Cardiovasc Imaging 2017; 18:159-166. [PMID: 27099274 DOI: 10.1093/ehjci/jew070] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Accepted: 03/09/2016] [Indexed: 02/05/2023] Open
Abstract
AIMS The intermediate-term incidence of strut malapposition (SM) and uncovered struts (US), and the degree of neointimal thickness (NIT) according to stent type have not been characterized. METHODS AND RESULTS All studies of >50 patients in which optical coherence tomography was performed between 6 and 12 months after stent implantation were included. The incidences of SM and US were the co-primary end points, while NIT was the secondary end point. A total of 458 citations were initially appraised at the abstract level, and 11 full-text studies (280 652 analysed struts, 921 patients) were assessed. The 6-12 months incidences of SM and US were 5.0 and 7.8%, respectively, and the mean NIT was 206 μm. Biolimus-eluting stents (BES) and bioresorbable vascular scaffolds (BVS) had the highest SM rates (2.7 and 3.8%, respectively), while everolimus-eluting stents (EES) and fast-release zotarolimus-eluting stents (ZES) had the lowest SM rates (0.9 and 0.1%, respectively). BES and sirolimus-eluting stents (SES) had the highest US rates (7.7 and 8.8%, respectively), while bare metal stents (BMS) and ZES had the lowest US rates (0.3 and 0.3%, respectively). BMS had the greatest NIT (340 μm), while SES, EES, and BES had the least NIT. CONCLUSION Second-generation drug-eluting stents (DES) have better intermediate-term strut apposition and coverage than first-generation DES, BVS, and BMS. EES demonstrate the overall best combination of healing with suppression of neointimal hyperplasia at 6-12 months. Further studies with clinical correlation are warranted to determine the implications of these findings.
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Affiliation(s)
- Mario Iannaccone
- Division of Cardiology, Città Della Salute e Della Scienza, Turin, Italy
| | - Fabrizio D'Ascenzo
- Division of Cardiology, Città Della Salute e Della Scienza, Turin, Italy
| | - Christian Templin
- University Heart Center, Cardiology, University Hospital, Zurich, Switzerland
| | - Pierluigi Omedè
- Division of Cardiology, Città Della Salute e Della Scienza, Turin, Italy
| | - Antonio Montefusco
- Division of Cardiology, Città Della Salute e Della Scienza, Turin, Italy
| | - Giulio Guagliumi
- Cardiovascular Department, Ospedali Riuniti di Bergamo, Bergamo, Italy
| | - Patrick W Serruys
- Department of Interventional Cardiology, Erasmus University Medical Centre, Thoraxcenter, Rotterdam, The Netherlands
| | - Carlo Di Mario
- National Institute of Health Research Cardiovascular Biomedical Research Unit, Royal Brompton & Harefield NHS Foundation Trust, London, UK
| | - Janusz Kochman
- Department of Cardiology, Warsaw Medical University, Warszawa, Poland
| | - Giorgio Quadri
- Division of Cardiology, Città Della Salute e Della Scienza, Turin, Italy
| | - Giuseppe Biondi-Zoccai
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy
| | - Thomas F Lüscher
- University Heart Center, Cardiology, University Hospital, Zurich, Switzerland
| | - Claudio Moretti
- Division of Cardiology, Città Della Salute e Della Scienza, Turin, Italy
| | - Maurizio D'amico
- Division of Cardiology, Città Della Salute e Della Scienza, Turin, Italy
| | - Fiorenzo Gaita
- Division of Cardiology, Città Della Salute e Della Scienza, Turin, Italy
| | - Gregg W Stone
- Division of Cardiology, Columbia University Medical Center, New York, NY, USA
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7
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Akinapelli A, Chen JP, Roy K, Donnelly J, Dawkins K, Huibregtse B, Hou D. Current State of Bioabsorbable Polymer-Coated Drug-Eluting Stents. Curr Cardiol Rev 2017; 13:139-154. [PMID: 28017123 PMCID: PMC5452149 DOI: 10.2174/1573403x12666161222155230] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2016] [Revised: 10/06/2016] [Accepted: 10/18/2016] [Indexed: 12/22/2022] Open
Abstract
Drug-eluting stents (DES) have been shown to significantly reduce clinical and angiographic restenosis compared to bare metal stents (BMS). The polymer coatings on DES elute antiproliferative drugs to inhibit intimal proliferation and prevent restenosis after stent implantation. Permanent polymers which do not degrade in vivo may increase the likelihood of stent-related delayed arterial healing or polymer hypersensitivity. In turn, these limitations may contribute to an increased risk of late clinical events. Intuitively, a polymer which degrades after completion of drug release, leaving an inert metal scaffold in place, may improve arterial healing by removing a chronic source of inflammation, neoatherosclerosis, and/or late thrombosis. In this way, a biodegradable polymer may reduce late ischemic events. Additionally, improved healing after stent implantation could reduce the requirement for long-term dual antiplatelet therapy and the associated risk of bleeding and cost. This review will focus on bioabsorbable polymer-coated DES currently being evaluated in clinical trials.
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8
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Intravascular imaging comparison of two metallic limus-eluting stents abluminally coated with biodegradable polymers: IVUS and OCT results of the DESTINY trial. Int J Cardiovasc Imaging 2016; 33:161-168. [DOI: 10.1007/s10554-016-0992-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Accepted: 10/01/2016] [Indexed: 11/26/2022]
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9
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Saito N, Mori Y, Uchiyama S. Drug diffusion and biological responses of arteries using a drug-eluting stent with nonuniform coating. MEDICAL DEVICES-EVIDENCE AND RESEARCH 2016; 9:33-43. [PMID: 27051322 PMCID: PMC4803265 DOI: 10.2147/mder.s102094] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
The purpose of this study was to determine the effect of a nonuniform coating, abluminal-gradient coating (AGC), which leaves the abluminal surface of the curves and links parts of the stent free from the drug coating, on the diffusion direction of the drug and the biological responses of the artery to drug-eluting stent (DES) by comparing the AGC-sirolimus stent and the conventional full-surface coating (CFC) sirolimus stent. The study aimed to verify whether the AGC approach was appropriate for the development of a safer DES, minimizing the risks of stent thrombosis due to delayed endothelialization by the drug and distal embolization due to cracking of the coating layer on the hinge parts of the DES on stent expansion. In the in vitro local drug diffusion study, we used rhodamine B as a model drug, and rhodamine B released from the AGC stent diffused predominantly into the abluminal side of the alginate artery model. Conversely, rhodamine B released from the CFC stent quickly spread to the luminal side of the artery model, where endothelial cell regeneration is required. In the biological responses study, the luminal surface of the iliac artery implanted with the AGC-sirolimus stent in a rabbit iliac artery for 2 weeks was completely covered with endothelial-like cells. On the other hand, the luminal surface of the iliac artery implanted with the CFC-sirolimus stent for 2 weeks only showed partial coverage with endothelial-like cells. While thrombosis was observed in two of the three CFC-sirolimus stents, it was observed in only one of the three AGC-sirolimus stents. Taken together, these findings indicate that the designed nonuniform coating (AGC) is an appropriate approach to ensure a safer DES. However, the number of studies is limited and a larger study should be conducted to reach a statistically significant conclusion.
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Affiliation(s)
- Noboru Saito
- Terumo Corporation R&D Center, Inokuchi, Nakai-machi, Ashigarakami-gun, Kanagawa, Japan
| | - Yuhei Mori
- Terumo Corporation R&D Center, Inokuchi, Nakai-machi, Ashigarakami-gun, Kanagawa, Japan
| | - Sayaka Uchiyama
- Terumo Corporation R&D Center, Inokuchi, Nakai-machi, Ashigarakami-gun, Kanagawa, Japan
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10
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Yu Y, Wise SG, Celermajer DS, Bilek MMM, Ng MKC. Bioengineering stents with proactive biocompatibility. Interv Cardiol 2015. [DOI: 10.2217/ica.15.46] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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11
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O’Brien B, Zafar H, Ibrahim A, Zafar J, Sharif F. Coronary Stent Materials and Coatings: A Technology and Performance Update. Ann Biomed Eng 2015; 44:523-35. [DOI: 10.1007/s10439-015-1380-x] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2015] [Accepted: 06/27/2015] [Indexed: 12/15/2022]
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12
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Gargesha M, Shalev R, Prabhu D, Tanaka K, Rollins AM, Costa M, Bezerra HG, Wilson DL. Parameter estimation of atherosclerotic tissue optical properties from three-dimensional intravascular optical coherence tomography. J Med Imaging (Bellingham) 2015; 2:016001. [PMID: 26158087 DOI: 10.1117/1.jmi.2.1.016001] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2014] [Accepted: 11/25/2014] [Indexed: 01/17/2023] Open
Abstract
We developed robust, three-dimensional methods, as opposed to traditional A-line analysis, for estimating the optical properties of calcified, fibrotic, and lipid atherosclerotic plaques from in vivo coronary artery intravascular optical coherence tomography clinical pullbacks. We estimated attenuation [Formula: see text] and backscattered intensity [Formula: see text] from small volumes of interest annotated by experts in 35 pullbacks. Some results were as follows: noise reduction filtering was desirable, parallel line (PL) methods outperformed individual line methods, root mean square error was the best goodness-of-fit, and [Formula: see text]-trimmed PL ([Formula: see text]-T-PL) was the best overall method. Estimates of [Formula: see text] were calcified ([Formula: see text]), fibrotic ([Formula: see text]), and lipid ([Formula: see text]), similar to those in the literature, and tissue classification from optical properties alone was promising.
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Affiliation(s)
- Madhusudhana Gargesha
- Case Western Reserve University , Department of Biomedical Engineering, 10900 Euclid Avenue, Cleveland, Ohio 44106, United States
| | - Ronny Shalev
- Case Western Reserve University , Department of Electrical Engineering and Computer Science, 10900 Euclid Avenue, Cleveland, Ohio 44106, United States
| | - David Prabhu
- Case Western Reserve University , Department of Biomedical Engineering, 10900 Euclid Avenue, Cleveland, Ohio 44106, United States
| | - Kentaro Tanaka
- University Hospitals Case Medical Center , Harrington Heart and Vascular Institute, Cardiovascular Imaging Core Laboratory, 11100 Euclid Avenue, Cleveland, Ohio 44106, United States
| | - Andrew M Rollins
- Case Western Reserve University , Department of Biomedical Engineering, 10900 Euclid Avenue, Cleveland, Ohio 44106, United States
| | - Marco Costa
- University Hospitals Case Medical Center , Harrington Heart and Vascular Institute, Cardiovascular Imaging Core Laboratory, 11100 Euclid Avenue, Cleveland, Ohio 44106, United States
| | - Hiram G Bezerra
- University Hospitals Case Medical Center , Harrington Heart and Vascular Institute, Cardiovascular Imaging Core Laboratory, 11100 Euclid Avenue, Cleveland, Ohio 44106, United States
| | - David L Wilson
- Case Western Reserve University , Department of Biomedical Engineering, 10900 Euclid Avenue, Cleveland, Ohio 44106, United States ; Case Western Reserve University , Department of Radiology, 11100 Euclid Avenue, Cleveland, Ohio 44106, United States
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13
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Vignali L, Solinas E, Emanuele E. Research and clinical applications of optical coherence tomography in invasive cardiology: a review. Curr Cardiol Rev 2014; 10:369-76. [PMID: 24893934 PMCID: PMC4101202 DOI: 10.2174/1573403x10666140604120753] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2014] [Revised: 05/29/2014] [Accepted: 06/01/2014] [Indexed: 11/22/2022] Open
Abstract
In cardiology, optical coherence tomography (OCT) is an invasive imaging technique based on the principle of light coherence. This system was developed to obtain three-dimensional high resolution images to examine coronary artery normal and/or pathological structure. This technique replaces the ultrasound used by its main alternative procedure, intravascular ultrasound, by a near-infrared light source. Acute coronary syndromes due to atherosclerotic vascular disease are the leading cause of mortality in developed and developing countries. As a consequence, intravascular imaging systems became an important area of research and 1991 marks the first use of OCT in coronary artery observations. Since its first appearance in invasive cardiology, OCT maintains a strong presence in the research environments for the identification of vulnerable plaques, as it is able to overcome difficulties presented by other techniques such as virtual intravascular ultrasound, near-infrared spectroscopy, and histology. Moreover, OCT is increasingly being used in the clinical practice as a guide during coronary interventions and in the assessment of vascular response after coronary stent implantation. This review focuses on the relevance of OCT in research and clinical applications in the field of invasive cardiology and discusses the future directions of the field.
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Affiliation(s)
| | | | - Enzo Emanuele
- Living Research s.a.s., Via Monte Grappa, 13, I-27038, Robbio (PV), Italy.
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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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15
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Zhang J. Stent thrombosis in patients with coronary artery disease treated with biodegradable polymer drug-eluting stents: an update meta-analysis. Int Heart J 2014; 55:213-8. [PMID: 24806382 DOI: 10.1536/ihj.13-322] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Delayed re-endothelialization may be the pathophysiological cause of stent thrombosis (ST). Biodegradable polymer drug-eluting stents (BP-DES) may reduce the risk of ST. The aim of this study was to evaluate the risk of ST in patients treated with BP-DES. Studies were retrieved from the PubMed, Cochrane Library, and EMBASE online databases. Twelve studies (15,155 patients) with long-term follow-up (≥ 12 months) were included. Compared with durable polymer drug-eluting stents (DP-DES), BP-DES did not significantly decrease the risk of definite and probable ST (RR, 0.89; 95% CI, 0.68 to 1.18; P = 0.425) and definite ST (RR, 0.92; 95% CI, 0.66 to 1.30; P = 0.648). Furthermore, there was no difference in the risk of late ST (RR, 1.17; 95% CI, 0.39 to 3.53; P = 0.780). However, the rate of early ST was slightly higher in the BP-DES group (RR, 1.60; 95% CI, 0.94 to 2.73; P = 0.084) than in the DP-DES group. A significant reduction in very late ST (> 12 months) was evident with the BP-DES group (RR, 0.27; 95% CI, 0.10 to 0.68; P = 0.006). Subgroup analysis showed that there was no difference in the rate of definite and probable ST between the BP-DES and first- or second-generation DES groups.Biodegradable polymer stents were associated with a significantly lower risk of very late ST. However, there was no difference in the risk of definite and probable ST between the two groups.
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Affiliation(s)
- Jing Zhang
- Department of Cardiology, Fifth People' Hospital of Dalian
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Kwong JSW, Yu CM. Clinical outcomes of biodegradable polymer drug-eluting stents for percutaneous coronary intervention: an updated meta-analysis of randomized controlled trials. Clin Cardiol 2014; 37:440-53. [PMID: 24723467 DOI: 10.1002/clc.22285] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2014] [Revised: 03/11/2014] [Indexed: 01/25/2023] Open
Abstract
Biodegradable polymer drug-eluting stents (DES) are innovative concepts in the era of percutaneous coronary intervention. We systematically reviewed the latest randomized evidence on the efficacy and safety of biodegradable polymer DES as compared to durable polymer DES. MEDLINE, Embase, and the Cochrane database were searched in August 2013 for eligible randomized controlled trials (RCTs) comparing biodegradable polymer DES with durable polymer DES. Clinical outcomes of interest were mortality, myocardial infarction (MI), target lesion revascularization (TLR), target vessel revascularization (TVR), and stent thrombosis. A total of 20 RCTs randomizing 20 021 participants were included, of whom 11 045 were allocated to biodegradable polymer DES and 8976 to durable polymer DES. Treatment of biodegradable polymer DES was not associated with a significant reduction of any of the clinical outcomes (all-cause mortality, odds ratio [OR]: 0.94, 95% confidence interval [CI]: 0.80 to 1.10, P = 0.42; cardiovascular mortality, OR: 0.97, 95% CI: 0.79 to 1.19, P = 0.74; MI, OR: 1.07, 95% CI: 0.91 to 1.26, P = 0.41; TLR, OR: 0.87, 95% CI: 0.69 to 1.08, P = 0.20; TVR, OR: 1.05, 95% CI: 0.85 to 1.28, P = 0.67; definite/probable stent thrombosis, OR: 0.80, 95% CI: 0.59 to 1.07, P = 0.14). Current randomized data indicate that clinical efficacy and safety profiles of biodegradable polymer DES are comparable to those of durable polymer DES. Findings from large-scale studies with rigorous methodology and long follow-up duration are needed.
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Affiliation(s)
- Joey S W Kwong
- Institute of Vascular Medicine, Li Ka Shing Institute of Health Sciences, S.H. Ho Cardiovascular Disease and Stroke Centre, Heart Education And Research Training (HEART) Centre, and Division of Cardiology, Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong
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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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Nammas W, Ligthart JMR, Karanasos A, Witberg KT, Regar E. Optical coherence tomography for evaluation of coronary stentsin vivo. Expert Rev Cardiovasc Ther 2014; 11:577-88. [DOI: 10.1586/erc.13.37] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Attizzani GF, Bezerra HG, Ormiston J, Wang W, Donohoe D, Wijns W, Costa MA. Serial assessment by optical coherence tomography of early and late vascular responses after implantation of an absorbable-coating Sirolimus-Eluting stent (from the first-in-human DESSOLVE I trial). Am J Cardiol 2013; 112:1557-64. [PMID: 23992957 DOI: 10.1016/j.amjcard.2013.07.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2013] [Revised: 07/12/2013] [Accepted: 07/12/2013] [Indexed: 10/26/2022]
Abstract
The initial enthusiasm caused by the potent antirestenotic effect of early generation drug-eluting stents was recently plagued by concerns regarding their safety profile. Investigators worldwide were stimulated, therefore, to seek for improvement in drug-eluting stent technology, such as eliminating their permanent polymer blamed for vascular inflammation and delayed healing. Optical coherence tomography (OCT) assessments of stent-vessel interactions are used as a surrogate for vessel healing after DES implantation. Herewith, we report serial OCT assessments of vascular reactions to the implantation of a novel absorbable polymer sirolimus-eluting stent (MiStent). In total, 30 patients were included. At 4-, 6-, and 8-month follow-up, different groups of 10 patients underwent OCT imaging, whereas all the patients had OCT assessments scheduled at 18-month follow-up. A total of 13,569 stent struts were analyzed. Low rates of uncovered (14.34 ± 15.35%, 6.62 ± 10.93%, 3.51 ± 2.87%, and 0.84 ± 1.15%, respectively, p <0.05 for 8- vs 18-month follow-up) and malapposed (3.74 ± 7.35%, 3.15 ± 6.13%, 0.48 ± 0.56%, and 0.09 ± 0.28%, respectively, p = NS) stent struts coupled with thin and increasingly homogenous neointimal proliferation were demonstrated. Neointimal area increased from 4- to 8-month follow-up (0.46 ± 0.29 and 1.12 ± 0.73 mm(2), respectively, p <0.05), whereas no "late catch up" was demonstrated at 18-month follow-up (1.28 ± 0.66 mm(2), p = NS vs 8-month follow-up). Early tissue maturation and reduction of low signal intensity tissue covering stent struts (8.8%, 3.1%, 0.3%, and 0%, respectively, p <0.05 for 4- vs 8-month follow-up comparison) were revealed by optical density analysis. In addition, high rates of strut coverage overlying the ostia of side branches without proliferative pattern were demonstrated. In conclusion, this comprehensive OCT analysis depicted favorable absorbable polymer sirolimus-eluting stent-vessel interactions up to 18-month follow-up.
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Karjalainen P. Neointimal coverage and vasodilator response to titanium-nitride-oxide-coated bioactive stents and everolimus-eluting stents in patients with acute coronary syndrome: insights from the BASE-ACS trial. Int J Cardiovasc Imaging 2013; 29:1693-703. [DOI: 10.1007/s10554-013-0285-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2013] [Accepted: 08/24/2013] [Indexed: 10/26/2022]
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Asrar Ul Haq M, Layland J, Mutha V, Barlis P. The invasive assessment of coronary atherosclerosis and stents using optical coherence tomography: a clinical update. HEART ASIA 2013; 5:154-161. [PMID: 24563666 PMCID: PMC3898547 DOI: 10.1136/heartasia-2013-010328] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/01/2013] [Revised: 06/21/2013] [Accepted: 06/30/2013] [Indexed: 01/12/2023]
Abstract
Ischaemic heart disease (IHD) remains one of the leading causes of death. Atherosclerosis has been intensely researched given the IHD prevalence and the financial impacts on healthcare systems. More recently, in vivo characterisation of coronary atherosclerotic plaque and tissue responses following stent implantation in a coronary artery has been made possible by a novel technology called optical coherence tomography (OCT). OCT is a light-based, invasive, intracoronary imaging modality long applied to the field of ophthalmology and now in clinical use worldwide. It gives a unique view of within the coronary artery using near-infrared light with a resolution of 15 microns, 10 times higher than other invasive coronary imaging techniques like intravascular ultrasound. The technology is being adopted to comprehensively detect features that make plaques 'vulnerable' (eg, large lipid pool, thin, fibrous-cap atheroma), whether stents are implanted optimally within the artery, and visualise the small layers of tissue that form over stent metal surfaces over time, which in turn may provide surrogate markers for long-term stent safety and help guide the optimal duration of dual antiplatelet therapy, a topic of big discussion at the current point of time.
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Affiliation(s)
- Muhammad Asrar Ul Haq
- Department of Medicine , University of Melbourne , Melbourne , Australia ; Department of Cardiology , The Northern Hospital , Melbourne , Australia
| | - Jamie Layland
- Department of Cardiology , St Vincent's Hospital , Melbourne , Australia
| | - Vivek Mutha
- Department of Medicine , University of Melbourne , Melbourne , Australia ; Department of Cardiology , The Northern Hospital , Melbourne , Australia
| | - Peter Barlis
- Department of Medicine , University of Melbourne , Melbourne , Australia ; Department of Cardiology , The Northern Hospital , Melbourne , Australia ; Department of Cardiology , St Vincent's Hospital , Melbourne , Australia
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Tan A, Farhatnia Y, de Mel A, Rajadas J, Alavijeh MS, Seifalian AM. Inception to actualization: Next generation coronary stent coatings incorporating nanotechnology. J Biotechnol 2013; 164:151-70. [DOI: 10.1016/j.jbiotec.2013.01.020] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2012] [Revised: 01/09/2013] [Accepted: 01/11/2013] [Indexed: 02/07/2023]
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TIAN FENG, CHEN YUNDAI, LIU CHANGFU, JIN QINHUA, CHEN LIAN, SUN ZHIJUN, LIU HONGBIN, GUO JUN, GAI LUYUE. A randomized, open-label clinical trial using optical coherence tomography to compare two sirolimus-eluting stents, one with a biodegradable polymer and the other with a permanent polymer. Mol Med Rep 2013; 7:1191-6. [DOI: 10.3892/mmr.2013.1313] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2012] [Accepted: 01/15/2013] [Indexed: 11/05/2022] Open
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Early vascular healing with rapid breakdown biodegradable polymer sirolimus-eluting versus durable polymer everolimus-eluting stents assessed by optical coherence tomography. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2013; 14:84-9. [PMID: 23352095 DOI: 10.1016/j.carrev.2012.12.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2012] [Revised: 12/03/2012] [Accepted: 12/10/2012] [Indexed: 11/23/2022]
Abstract
BACKGROUND Differences in early arterial healing patterns after stent implantation between biodegradable and durable polymer based new generation drug-eluting stents are not well understood. The aim of this study was to compare the healing patterns of a novel rapid breakdown (≤8 weeks) biodegradable polymer sirolimus-eluting stent (BP-SES) with a durable polymer everolimus-eluting stent (EES) using intravascular optical coherence tomography (OCT) at 4 months. METHODS A total of 20 patients were randomly assigned to stenting with BP-SES (n=11) or EES (n=9). Overall intravascular imaging was available for 15 (75%) patients. The primary endpoint was the difference in rate of uncovered struts between BP-SES and EES. To account for strut-level clustering, the results in both treatment groups were compared using a generalized linear mixed model approach. RESULTS Regarding the primary endpoint, BP-SES as compared to EES showed similar rates of uncovered struts (37 [6.8%] versus 167 [17.5%], odds ratio (OR) 0.45 (95% CI 0.09-2.24), p=0.33). There were no malapposed struts in BP-SES group and 14 malapposed struts in EES group (p=0.97). No difference in percent neointimal volume (14.1±8.2% vs. 11.4±6.4%, p=0.56) was observed. CONCLUSIONS Although rapid-breakdown BP-SES as compared to EES showed signs of improved early tissue coverage, after adjustment for strut-level clustering these differences were not statistically significant. No differences in ability to suppress neointimal hyperplasia after stent implantation between 2 stents were observed.
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Bege N, Renette T, Endres T, Beck-Broichsitter M, Hänggi D, Kissel T. In situ forming nimodipine depot system based on microparticles for the treatment of posthemorrhagic cerebral vasospasm. Eur J Pharm Biopharm 2013; 84:99-105. [PMID: 23298622 DOI: 10.1016/j.ejpb.2012.12.016] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2011] [Revised: 11/29/2012] [Accepted: 12/21/2012] [Indexed: 10/27/2022]
Abstract
The present study was conducted to examine the feasibility of nimodipine-loaded PLGA microparticles suspended in Tisseel fibrin sealant as an in situ forming depot system. This device locally placed can be used for the treatment of vasospasm after a subarachnoid hemorrhage. Microparticles were prepared via spray-drying by using the vibration mesh spray technology of Nano Spray Dryer B-90. Spherically shaped microparticles with different loadings and high encapsulation efficiencies of 93.3-97.8% were obtained. Depending on nimodipine loading (10-40%), the particle diameter ranged from 1.9 ± 1.2 μm to 2.4 ± 1.3 μm. Thermal analyses using DSC revealed that nimodipine is dissolved in the PLGA matrix. Also, fluorescent dye loaded microparticles were encapsulated in Tisseel to examine the homogeneity of particles. 3D-pictures of the in situ forming devices displayed uniform particle homogeneity in the sealant matrix. Drug release was examined by fluorescence spectrophotometry which demonstrated a drug release proportional to the square root of time. A prolonged drug release of 19.5h was demonstrated under in vitro conditions. Overall, the nimodipine in situ forming device could be a promising candidate for the local treatment of vasospasm after a subarachnoid hemorrhage.
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Affiliation(s)
- Nadja Bege
- Department of Pharmaceutics and Biopharmacy, Philipps-Universität, Marburg, Germany
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Lu H, Gargesha M, Wang Z, Chamie D, Attizzani GF, Kanaya T, Ray S, Costa MA, Rollins AM, Bezerra HG, Wilson DL. Automatic stent detection in intravascular OCT images using bagged decision trees. BIOMEDICAL OPTICS EXPRESS 2012; 3:2809-24. [PMID: 23162720 PMCID: PMC3493217 DOI: 10.1364/boe.3.002809] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/09/2012] [Revised: 09/27/2012] [Accepted: 10/05/2012] [Indexed: 05/19/2023]
Abstract
Intravascular optical coherence tomography (iOCT) is being used to assess viability of new coronary artery stent designs. We developed a highly automated method for detecting stent struts and measuring tissue coverage. We trained a bagged decision trees classifier to classify candidate struts using features extracted from the images. With 12 best features identified by forward selection, recall (precision) were 90%-94% (85%-90%). Including struts deemed insufficiently bright for manual analysis, precision improved to 94%. Strut detection statistics approached variability of manual analysis. Differences between manual and automatic area measurements were 0.12 ± 0.20 mm(2) and 0.11 ± 0.20 mm(2) for stent and tissue areas, respectively. With proposed algorithms, analyst time per stent should significantly reduce from the 6-16 hours now required.
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Affiliation(s)
- Hong Lu
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, 44106, USA
| | - Madhusudhana Gargesha
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, 44106, USA
| | - Zhao Wang
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, 44106, USA
| | - Daniel Chamie
- Cardiovascular Imaging Core Laboratory, Harrington Heart & Vascular Institute, University Hospitals Case Medical Center, Cleveland, OH, 44106, USA
| | - Guilherme F. Attizzani
- Cardiovascular Imaging Core Laboratory, Harrington Heart & Vascular Institute, University Hospitals Case Medical Center, Cleveland, OH, 44106, USA
| | - Tomoaki Kanaya
- Cardiovascular Imaging Core Laboratory, Harrington Heart & Vascular Institute, University Hospitals Case Medical Center, Cleveland, OH, 44106, USA
| | - Soumya Ray
- Department of Electrical Engineering & Computer Science, Case Western Reserve University Cleveland, OH, 44106, USA
| | - Marco A. Costa
- Cardiovascular Imaging Core Laboratory, Harrington Heart & Vascular Institute, University Hospitals Case Medical Center, Cleveland, OH, 44106, USA
| | - Andrew M. Rollins
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, 44106, USA
| | - Hiram G. Bezerra
- Cardiovascular Imaging Core Laboratory, Harrington Heart & Vascular Institute, University Hospitals Case Medical Center, Cleveland, OH, 44106, USA
| | - David L. Wilson
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, 44106, USA
- Department of Radiology, Case Western Reserve University, Cleveland, OH, 44106, USA
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Karanasos A, Ligthart J, Witberg K, van Soest G, Bruining N, Regar E. Optical Coherence Tomography: Potential Clinical Applications. CURRENT CARDIOVASCULAR IMAGING REPORTS 2012; 5:206-220. [PMID: 22798978 PMCID: PMC3389242 DOI: 10.1007/s12410-012-9140-x] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Optical coherence tomography (OCT) is a novel intravascular imaging modality using near-infrared light. By OCT it is possible to obtain high-resolution cross-sectional images of the vascular wall structure and assess the acute and long-term effects of percutaneous coronary intervention. For the time being OCT has been mainly used in research providing new insights into the pathophysiology of the atheromatic plaque and of the vascular response to stenting, however, it seems that there is potential for clinical application of OCT in various fields, such as pre-interventional evaluation of coronary arteries, procedural guidance in coronary interventions, and follow-up assessment of vascular healing after stent implantation. This review will focus on the potential and advantages of OCT in the clinical practice of a catheterization laboratory.
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Affiliation(s)
- Antonios Karanasos
- Department of Cardiology, Erasmus University Medical Center, Thoraxcenter, BA-585, ‘s Gravendijkwal 230, 3015 CE Rotterdam, The Netherlands
| | - Jurgen Ligthart
- Department of Cardiology, Erasmus University Medical Center, Thoraxcenter, BA-585, ‘s Gravendijkwal 230, 3015 CE Rotterdam, The Netherlands
| | - Karen Witberg
- Department of Cardiology, Erasmus University Medical Center, Thoraxcenter, BA-585, ‘s Gravendijkwal 230, 3015 CE Rotterdam, The Netherlands
| | - Gijs van Soest
- Department of Cardiology, Erasmus University Medical Center, Thoraxcenter, BA-585, ‘s Gravendijkwal 230, 3015 CE Rotterdam, The Netherlands
| | - Nico Bruining
- Department of Cardiology, Erasmus University Medical Center, Thoraxcenter, BA-585, ‘s Gravendijkwal 230, 3015 CE Rotterdam, The Netherlands
| | - Evelyn Regar
- Department of Cardiology, Erasmus University Medical Center, Thoraxcenter, BA-585, ‘s Gravendijkwal 230, 3015 CE Rotterdam, The Netherlands
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Abstract
The following are highlights from the series,
Circulation: Cardiovascular Interventions
Topic Review. This series summarizes the most important articles, as selected by the editors, that have published in the
Circulation
portfolio. The studies included in this article represent the most noteworthy research in the area of new drug-eluting stents.
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Khan W, Farah S, Domb AJ. Drug eluting stents: Developments and current status. J Control Release 2012; 161:703-12. [PMID: 22366546 DOI: 10.1016/j.jconrel.2012.02.010] [Citation(s) in RCA: 121] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2011] [Revised: 02/07/2012] [Accepted: 02/11/2012] [Indexed: 11/27/2022]
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Shen L, Wu Y, Zhang F, Wu L, Dong C, Gao Y, Sun A, Zou Y, Qian J, Sun J, Zhong W, Ge J. Assessment of an asymmetrical coating stent with sirolimus released from ablumial matrix in porcine model. Clin Res Cardiol 2012; 101:917-27. [PMID: 22627890 DOI: 10.1007/s00392-012-0476-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2012] [Accepted: 05/10/2012] [Indexed: 11/25/2022]
Abstract
BACKGROUND Delayed endothelialization contributes to stent thrombosis of current drug-eluting stents. The asymmetrical coating technique provides an anti-proliferative effect abluminally without affecting luminal endothelialization. Layer-by-layer self-assembled chitosan/heparin (C/H LBL) has been proved to promote re-endothelialization. A novel stent system, C/H LBL coated luminally and sirolimus released abluminally (C/H LBL-SES), was fabricated. METHODS Bare metal stents (BMS), traditionally circumferential sirolimus-eluting stents (SES), and C/H LBL-SES were implanted into porcine coronary arteries. At the 7, 14 and 28 days follow-up (FU), angiography, intravascular ultrasound (IVUS), vasomotor function induced by acetylcholine (Ach), scanning-electron microscopy and histopathology were performed. Remodeling index (RI) was based on IVUS and defined as cross-sectional area (CSA) of vessel at in-stent segment divided by CSA of reference vessel and expressed as a percentage with a normal range from 0.95 to 1.05. RESULTS Thirty-eight mini pigs were enrolled and 74 stents (BMS = 23, C/H LBL = 28, SES = 23) were implanted in this study. At 28 days after implantation, the diameter stenosis of C/H LBL-SES by quantitative coronary angiography was 18.8 ± 2.5 %, the area stenosis by histomorphometry was 24.2 ± 2.9 %, which were comparable to that of SES and superior to BMS. At 14 days, re-endothelialization of C/H LBL-SES was almost completed, while only about 50 % of surface of SES was covered by endothelium. At 7, 14 and 28 days FU, although C/H LBL-SES suffered a greater vasoconstriction induced by Ach infusion than BMS (P < 0.05), it behaved better than SES (P < 0.01). No sign of stent malapposition was detected, while RI was within the normal range by IVUS. No acute or subacute thrombotic events occurred in all three groups. CONCLUSIONS The asymmetrically designed C/H LBL-SES successfully inhibited neointima hyperplasia, while diminishing vasoconstriction after Ach-stress. Endothelialization of C/H LBL-SES was less affected compared with traditionally circumferentially coated SES.
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Affiliation(s)
- Li Shen
- Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai 200032, China
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Ex vivo assessment of vascular response to coronary stents by optical frequency domain imaging. JACC Cardiovasc Imaging 2012; 5:71-82. [PMID: 22239896 DOI: 10.1016/j.jcmg.2011.09.015] [Citation(s) in RCA: 100] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2011] [Revised: 08/08/2011] [Accepted: 09/22/2011] [Indexed: 02/08/2023]
Abstract
OBJECTIVES This study sought to examine the capability of optical frequency domain imaging (OFDI) to characterize various morphological and histological responses to stents implanted in human coronary arteries. BACKGROUND A precise assessment of vascular responses to stents may help stratify the risk of future adverse events in patients who have been treated with coronary stents. METHODS Fourteen human stented coronary segments with implant duration ≥ 1 month from 10 hearts acquired at autopsy were interrogated ex vivo by OFDI and intravascular ultrasound (IVUS). Comparison with histology was assessed in 134 pairs of images where the endpoints were to investigate: 1) accuracy of morphological measurements; 2) detection of uncovered struts; and 3) characterization of neointima. RESULTS Although both OFDI and IVUS provided a good correlation of neointimal area with histology, the correlation of minimum neointimal thickness was inferior in IVUS (R(2) = 0.39) as compared with OFDI (R(2) = 0.67). Similarly, IVUS showed a weak correlation of the ratio of uncovered to total stent struts per section (RUTSS) (R(2) = 0.24), whereas OFDI maintained superiority (R(2) = 0.66). In a more detailed analysis by OFDI, identification of individual uncovered struts demonstrated a sensitivity of 77.9% and specificity of 96.4%. Other important morphological features such as fibrin accumulation, excessive inflammation (hypersensitivity), and in-stent atherosclerosis were characterized by OFDI; however, the similarly dark appearance of these tissues did not allow for direct visual discrimination. The quantitative analysis of OFDI signal reflections from various in-stent tissues demonstrated distinct features of organized thrombus and accumulation of foamy macrophages. CONCLUSIONS The results of the present study reinforce the potential of OFDI to detect vascular responses that may be important for the understanding of long-term stent performance, and indicate the capability of this technology to serve as a diagnostic indicator of clinical success.
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Jaguszewski M, Landmesser U. Optical Coherence Tomography Imaging: Novel Insights into the Vascular Response After Coronary Stent Implantation. CURRENT CARDIOVASCULAR IMAGING REPORTS 2012; 5:231-238. [PMID: 22798979 PMCID: PMC3389253 DOI: 10.1007/s12410-012-9138-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Optical coherence tomography (OCT) is a high-resolution imaging technique that is increasingly used for intracoronary imaging to characterize coronary atherosclerotic plaques and vascular responses after coronary stent implantation. Introduction of optical frequency-domain imaging (OFDI; second generation OCT) has simplified practical use of this novel imaging modality resulting in a more widespread availability in interventional cardiology. Here we highlight recent insights into the acute and chronic vascular response after coronary stent implantation by OCT imaging. OCT provides cross-sectional images with approximately 10-fold higher resolution as compared to intravascular-ultrasound (IVUS), allowing for precise evaluation of tissue coverage and malapposition of coronary stent struts. More than 30 studies using OCT to compare vascular responses to different stents have now been reported. Recent studies have examined the relation between OCT-image characteristics and tissue composition around stent struts. OCT is used for evaluation of novel stent concepts, such as bioengineered stents and bioabsorbable stents, where it provides more accurate information than IVUS. While intracoronary OCT imaging is further developed, including faster 3D-OCT-image-reconstruction, larger OCT studies/registries with standardized analysis will provide more insights into clinical implications of observations from OCT-imaging after coronary stent implantation.
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Affiliation(s)
- Milosz Jaguszewski
- Cardiology, Cardiovascular Center, University Hospital of Zurich, Raemistrassse 100, 8091 Zurich, Switzerland
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Guagliumi G, Capodanno D, Ikejima H, Bezerra HG, Sirbu V, Musumeci G, Fiocca L, Lortkipanidze N, Vassileva A, Tahara S, Valsecchi O, Costa MA. Impact of different stent alloys on human vascular response to everolimus-eluting stent: An optical coherence tomography study: The OCTEVEREST. Catheter Cardiovasc Interv 2012; 81:510-8. [DOI: 10.1002/ccd.24374] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2012] [Accepted: 02/12/2012] [Indexed: 02/03/2023]
Affiliation(s)
| | - Davide Capodanno
- Cardiology Department; Ferrarotto Hospital, Catania, and University of Catania; Catania; Italy
| | | | - Hiram G. Bezerra
- University Hospitals Case Medical Center; Case Western Reserve University; Cleveland; Ohio
| | - Vasile Sirbu
- Cardiovascular Department; Ospedali Riuniti; Bergamo; Italy
| | | | - Luigi Fiocca
- Cardiovascular Department; Ospedali Riuniti; Bergamo; Italy
| | | | | | - Satoko Tahara
- University Hospitals Case Medical Center; Case Western Reserve University; Cleveland; Ohio
| | | | - Marco A. Costa
- University Hospitals Case Medical Center; Case Western Reserve University; Cleveland; Ohio
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Kaňovský J, Boček O, Červinka P, Ondrúš T, Kala P. Optical coherence tomography in interventional cardiology - research field or future daily routine? COR ET VASA 2012. [DOI: 10.1016/j.crvasa.2012.05.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Attizzani GF, Bezerra HG. Contemporary assessment of stent strut coverage by OCT. Int J Cardiovasc Imaging 2012; 29:23-7. [DOI: 10.1007/s10554-012-0046-0] [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] [Received: 03/20/2012] [Accepted: 03/26/2012] [Indexed: 10/28/2022]
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Papayannis AC, Cipher D, Banerjee S, Brilakis ES. Optical coherence tomography evaluation of drug-eluting stents: a systematic review. Catheter Cardiovasc Interv 2012; 81:481-7. [PMID: 22488730 DOI: 10.1002/ccd.24327] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2011] [Accepted: 01/03/2012] [Indexed: 11/08/2022]
Abstract
AIMS We performed a systematic review of studies reporting stent strut coverage and malapposition post implantation of different drug-eluting stent (DES), as assessed by optical coherence tomography (OCT). METHODS A review of publications and online databases in May 2011 retrieved 33 published studies reporting stent strut coverage and malapposition post-DES implantation using OCT: 24 for sirolimus-eluting stents (SES), 13 for paclitaxel-eluting stents (PES), 10 for zotarolimus-eluting stents (ZES), and two for everolimus-eluting stents (EES). The follow-up duration ranged from 3 months to 4 years. Stent strut coverage and malapposition were compared between DES at various time intervals post implantation. RESULTS Significant differences in stent strut coverage and malapposition exist between various DES. The SES had the highest frequency of uncovered struts at 3, 6, 9, and 12 months (13.1%, 10.9%, 8.1%, and 7.5%, respectively), followed by PES (5.5%, 4.4%, and 5.7% at 6, 9, and 12 months, respectively) and ZES (0.7%, 0%, and 0.5% at 3, 6, and 9 months, respectively) (P < 0.001 for all comparisons between stents). Only two studies reported 3.1% uncovered struts at 9 months with the EES. Stent strut malapposition at 6, 9, and 12 months was highest with SES (3.2%, 2.2%, and 1.2%, respectively) followed by PES (1.6%, 1.3%, and 0.9%, respectively), EES (0.46% at 9 months), and ZES (0.7% and 0.1% at 6 and 9 months, respectively). CONCLUSIONS SES had the highest rates of uncovered struts and malapposition, followed by PES and ZES. Such differences may explain the different clinical outcomes between various DES. © 2012 Wiley Periodicals, Inc.
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Drug eluting stents based on Poly(ethylene carbonate): Optimization of the stent coating process. Eur J Pharm Biopharm 2012; 80:562-70. [DOI: 10.1016/j.ejpb.2011.12.006] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2011] [Revised: 12/11/2011] [Accepted: 12/13/2011] [Indexed: 11/22/2022]
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Most Important Papers in Intravascular Imaging. Circ Cardiovasc Interv 2012. [DOI: 10.1161/circinterventions.112.970186] [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: 11/16/2022]
Abstract
The following are highlights from the series
Circulation: Cardiovascular Interventions
Topic Review. This series summarizes the most important manuscripts, as selected by the editors, that have published in the
Circulation
portfolio. The studies included in this article represent the most noteworthy research in the area of intravascular imaging.
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Differences in Neointimal Thickness Between the Adluminal and the Abluminal Sides of Malapposed and Side-Branch Struts in a Polylactide Bioresorbable Scaffold. JACC Cardiovasc Interv 2012; 5:428-35. [DOI: 10.1016/j.jcin.2011.12.015] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2011] [Revised: 11/30/2011] [Accepted: 12/01/2011] [Indexed: 11/23/2022]
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Kandzari DE. Biodegradable polymer and permanent polymer drug-eluting stents: at the crossroads of evidence and expectation. Interv Cardiol 2012. [DOI: 10.2217/ica.12.7] [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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Gutiérrez-Chico JL, Alegría-Barrero E, Teijeiro-Mestre R, Chan PH, Tsujioka H, de Silva R, Viceconte N, Lindsay A, Patterson T, Foin N, Akasaka T, di Mario C. Optical coherence tomography: from research to practice. Eur Heart J Cardiovasc Imaging 2012; 13:370-84. [PMID: 22330231 PMCID: PMC3342852 DOI: 10.1093/ehjci/jes025] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Optical coherence tomography (OCT) is a high-resolution imaging technique with great versatility of applications. In cardiology, OCT has remained hitherto as a research tool for characterization of vulnerable plaques and evaluation of neointimal healing after stenting. However, OCT is now successfully applied in different clinical scenarios, and the introduction of frequency domain analysis simplified its application to the point it can be considered a potential alternative to intravascular ultrasound for clinical decision-making in some cases. This article reviews the use of OCT for assessment of lesion severity, characterization of acute coronary syndromes, guidance of intracoronary stenting, and evaluation of long-term results.
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Gutiérrez-Chico JL, Wykrzykowska J, Nüesch E, van Geuns RJ, Koch KT, Koolen JJ, di Mario C, Windecker S, van Es GA, Gobbens P, Jüni P, Regar E, Serruys PW. Vascular Tissue Reaction to Acute Malapposition in Human Coronary Arteries. Circ Cardiovasc Interv 2012; 5:20-9, S1-8. [DOI: 10.1161/circinterventions.111.965301] [Citation(s) in RCA: 95] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- Juan Luis Gutiérrez-Chico
- From the Erasmus Medical Centre–Thoraxcentre, Rotterdam, The Netherlands (J.L.G.-C., J.W., E.R., P.W.S., R.J.v.G.); Institute for Social and Preventive Medicine, University of Bern, Bern, Switzerland (E.N., P.J.); CTU Bern, Bern University Hospital, Bern, Switzerland (E.N., P.J.); Academisch Medisch Centrum, Amsterdam, The Netherlands (K.T.K.); Catharina Ziekenhuis, Eindhoven, The Netherlands (J.J.K.); Cardiovascular Biomedical Research Unit, Royal Brompton and Harefield NHS Trust, London, United
| | - Joanna Wykrzykowska
- From the Erasmus Medical Centre–Thoraxcentre, Rotterdam, The Netherlands (J.L.G.-C., J.W., E.R., P.W.S., R.J.v.G.); Institute for Social and Preventive Medicine, University of Bern, Bern, Switzerland (E.N., P.J.); CTU Bern, Bern University Hospital, Bern, Switzerland (E.N., P.J.); Academisch Medisch Centrum, Amsterdam, The Netherlands (K.T.K.); Catharina Ziekenhuis, Eindhoven, The Netherlands (J.J.K.); Cardiovascular Biomedical Research Unit, Royal Brompton and Harefield NHS Trust, London, United
| | - Eveline Nüesch
- From the Erasmus Medical Centre–Thoraxcentre, Rotterdam, The Netherlands (J.L.G.-C., J.W., E.R., P.W.S., R.J.v.G.); Institute for Social and Preventive Medicine, University of Bern, Bern, Switzerland (E.N., P.J.); CTU Bern, Bern University Hospital, Bern, Switzerland (E.N., P.J.); Academisch Medisch Centrum, Amsterdam, The Netherlands (K.T.K.); Catharina Ziekenhuis, Eindhoven, The Netherlands (J.J.K.); Cardiovascular Biomedical Research Unit, Royal Brompton and Harefield NHS Trust, London, United
| | - Robert Jan van Geuns
- From the Erasmus Medical Centre–Thoraxcentre, Rotterdam, The Netherlands (J.L.G.-C., J.W., E.R., P.W.S., R.J.v.G.); Institute for Social and Preventive Medicine, University of Bern, Bern, Switzerland (E.N., P.J.); CTU Bern, Bern University Hospital, Bern, Switzerland (E.N., P.J.); Academisch Medisch Centrum, Amsterdam, The Netherlands (K.T.K.); Catharina Ziekenhuis, Eindhoven, The Netherlands (J.J.K.); Cardiovascular Biomedical Research Unit, Royal Brompton and Harefield NHS Trust, London, United
| | - Karel T. Koch
- From the Erasmus Medical Centre–Thoraxcentre, Rotterdam, The Netherlands (J.L.G.-C., J.W., E.R., P.W.S., R.J.v.G.); Institute for Social and Preventive Medicine, University of Bern, Bern, Switzerland (E.N., P.J.); CTU Bern, Bern University Hospital, Bern, Switzerland (E.N., P.J.); Academisch Medisch Centrum, Amsterdam, The Netherlands (K.T.K.); Catharina Ziekenhuis, Eindhoven, The Netherlands (J.J.K.); Cardiovascular Biomedical Research Unit, Royal Brompton and Harefield NHS Trust, London, United
| | - Jacques J. Koolen
- From the Erasmus Medical Centre–Thoraxcentre, Rotterdam, The Netherlands (J.L.G.-C., J.W., E.R., P.W.S., R.J.v.G.); Institute for Social and Preventive Medicine, University of Bern, Bern, Switzerland (E.N., P.J.); CTU Bern, Bern University Hospital, Bern, Switzerland (E.N., P.J.); Academisch Medisch Centrum, Amsterdam, The Netherlands (K.T.K.); Catharina Ziekenhuis, Eindhoven, The Netherlands (J.J.K.); Cardiovascular Biomedical Research Unit, Royal Brompton and Harefield NHS Trust, London, United
| | - Carlo di Mario
- From the Erasmus Medical Centre–Thoraxcentre, Rotterdam, The Netherlands (J.L.G.-C., J.W., E.R., P.W.S., R.J.v.G.); Institute for Social and Preventive Medicine, University of Bern, Bern, Switzerland (E.N., P.J.); CTU Bern, Bern University Hospital, Bern, Switzerland (E.N., P.J.); Academisch Medisch Centrum, Amsterdam, The Netherlands (K.T.K.); Catharina Ziekenhuis, Eindhoven, The Netherlands (J.J.K.); Cardiovascular Biomedical Research Unit, Royal Brompton and Harefield NHS Trust, London, United
| | - Stephan Windecker
- From the Erasmus Medical Centre–Thoraxcentre, Rotterdam, The Netherlands (J.L.G.-C., J.W., E.R., P.W.S., R.J.v.G.); Institute for Social and Preventive Medicine, University of Bern, Bern, Switzerland (E.N., P.J.); CTU Bern, Bern University Hospital, Bern, Switzerland (E.N., P.J.); Academisch Medisch Centrum, Amsterdam, The Netherlands (K.T.K.); Catharina Ziekenhuis, Eindhoven, The Netherlands (J.J.K.); Cardiovascular Biomedical Research Unit, Royal Brompton and Harefield NHS Trust, London, United
| | - Gerrit-Anne van Es
- From the Erasmus Medical Centre–Thoraxcentre, Rotterdam, The Netherlands (J.L.G.-C., J.W., E.R., P.W.S., R.J.v.G.); Institute for Social and Preventive Medicine, University of Bern, Bern, Switzerland (E.N., P.J.); CTU Bern, Bern University Hospital, Bern, Switzerland (E.N., P.J.); Academisch Medisch Centrum, Amsterdam, The Netherlands (K.T.K.); Catharina Ziekenhuis, Eindhoven, The Netherlands (J.J.K.); Cardiovascular Biomedical Research Unit, Royal Brompton and Harefield NHS Trust, London, United
| | - Pierre Gobbens
- From the Erasmus Medical Centre–Thoraxcentre, Rotterdam, The Netherlands (J.L.G.-C., J.W., E.R., P.W.S., R.J.v.G.); Institute for Social and Preventive Medicine, University of Bern, Bern, Switzerland (E.N., P.J.); CTU Bern, Bern University Hospital, Bern, Switzerland (E.N., P.J.); Academisch Medisch Centrum, Amsterdam, The Netherlands (K.T.K.); Catharina Ziekenhuis, Eindhoven, The Netherlands (J.J.K.); Cardiovascular Biomedical Research Unit, Royal Brompton and Harefield NHS Trust, London, United
| | - Peter Jüni
- From the Erasmus Medical Centre–Thoraxcentre, Rotterdam, The Netherlands (J.L.G.-C., J.W., E.R., P.W.S., R.J.v.G.); Institute for Social and Preventive Medicine, University of Bern, Bern, Switzerland (E.N., P.J.); CTU Bern, Bern University Hospital, Bern, Switzerland (E.N., P.J.); Academisch Medisch Centrum, Amsterdam, The Netherlands (K.T.K.); Catharina Ziekenhuis, Eindhoven, The Netherlands (J.J.K.); Cardiovascular Biomedical Research Unit, Royal Brompton and Harefield NHS Trust, London, United
| | - Evelyn Regar
- From the Erasmus Medical Centre–Thoraxcentre, Rotterdam, The Netherlands (J.L.G.-C., J.W., E.R., P.W.S., R.J.v.G.); Institute for Social and Preventive Medicine, University of Bern, Bern, Switzerland (E.N., P.J.); CTU Bern, Bern University Hospital, Bern, Switzerland (E.N., P.J.); Academisch Medisch Centrum, Amsterdam, The Netherlands (K.T.K.); Catharina Ziekenhuis, Eindhoven, The Netherlands (J.J.K.); Cardiovascular Biomedical Research Unit, Royal Brompton and Harefield NHS Trust, London, United
| | - Patrick W. Serruys
- From the Erasmus Medical Centre–Thoraxcentre, Rotterdam, The Netherlands (J.L.G.-C., J.W., E.R., P.W.S., R.J.v.G.); Institute for Social and Preventive Medicine, University of Bern, Bern, Switzerland (E.N., P.J.); CTU Bern, Bern University Hospital, Bern, Switzerland (E.N., P.J.); Academisch Medisch Centrum, Amsterdam, The Netherlands (K.T.K.); Catharina Ziekenhuis, Eindhoven, The Netherlands (J.J.K.); Cardiovascular Biomedical Research Unit, Royal Brompton and Harefield NHS Trust, London, United
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Guagliumi G, Bezerra HG, Sirbu V, Ikejima H, Musumeci G, Biondi-Zoccai G, Lortkipanidze N, Fiocca L, Capodanno D, Wang W, Tahara S, Vassileva A, Matiashvili A, Valsecchi O, Costa MA. Serial Assessment of Coronary Artery Response to Paclitaxel-Eluting Stents Using Optical Coherence Tomography. Circ Cardiovasc Interv 2012; 5:30-8. [PMID: 22298797 DOI: 10.1161/circinterventions.111.965582] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- Giulio Guagliumi
- From the Cardiovascular Department, Ospedali Riuniti, Bergamo, Italy (G.G., V.S., H.I., G.M., N.L., L.F., A.V., A.M., O.V.); University Hospitals Case Medical Center, Case Western Reserve University, Cleveland, Ohio (H.G.B., W.W., S.T., M.A.C.); Division of Cardiology, University of Modena and Reggio Emilia, Modena, Italy (G.B.-Z.); Cardiology Department, Ferrarotto Hospital, Catania, and University of Catania, Catania, Italy (D.C.)
| | - Hiram G. Bezerra
- From the Cardiovascular Department, Ospedali Riuniti, Bergamo, Italy (G.G., V.S., H.I., G.M., N.L., L.F., A.V., A.M., O.V.); University Hospitals Case Medical Center, Case Western Reserve University, Cleveland, Ohio (H.G.B., W.W., S.T., M.A.C.); Division of Cardiology, University of Modena and Reggio Emilia, Modena, Italy (G.B.-Z.); Cardiology Department, Ferrarotto Hospital, Catania, and University of Catania, Catania, Italy (D.C.)
| | - Vasile Sirbu
- From the Cardiovascular Department, Ospedali Riuniti, Bergamo, Italy (G.G., V.S., H.I., G.M., N.L., L.F., A.V., A.M., O.V.); University Hospitals Case Medical Center, Case Western Reserve University, Cleveland, Ohio (H.G.B., W.W., S.T., M.A.C.); Division of Cardiology, University of Modena and Reggio Emilia, Modena, Italy (G.B.-Z.); Cardiology Department, Ferrarotto Hospital, Catania, and University of Catania, Catania, Italy (D.C.)
| | - Hideyuki Ikejima
- From the Cardiovascular Department, Ospedali Riuniti, Bergamo, Italy (G.G., V.S., H.I., G.M., N.L., L.F., A.V., A.M., O.V.); University Hospitals Case Medical Center, Case Western Reserve University, Cleveland, Ohio (H.G.B., W.W., S.T., M.A.C.); Division of Cardiology, University of Modena and Reggio Emilia, Modena, Italy (G.B.-Z.); Cardiology Department, Ferrarotto Hospital, Catania, and University of Catania, Catania, Italy (D.C.)
| | - Giuseppe Musumeci
- From the Cardiovascular Department, Ospedali Riuniti, Bergamo, Italy (G.G., V.S., H.I., G.M., N.L., L.F., A.V., A.M., O.V.); University Hospitals Case Medical Center, Case Western Reserve University, Cleveland, Ohio (H.G.B., W.W., S.T., M.A.C.); Division of Cardiology, University of Modena and Reggio Emilia, Modena, Italy (G.B.-Z.); Cardiology Department, Ferrarotto Hospital, Catania, and University of Catania, Catania, Italy (D.C.)
| | - Giuseppe Biondi-Zoccai
- From the Cardiovascular Department, Ospedali Riuniti, Bergamo, Italy (G.G., V.S., H.I., G.M., N.L., L.F., A.V., A.M., O.V.); University Hospitals Case Medical Center, Case Western Reserve University, Cleveland, Ohio (H.G.B., W.W., S.T., M.A.C.); Division of Cardiology, University of Modena and Reggio Emilia, Modena, Italy (G.B.-Z.); Cardiology Department, Ferrarotto Hospital, Catania, and University of Catania, Catania, Italy (D.C.)
| | - Nikoloz Lortkipanidze
- From the Cardiovascular Department, Ospedali Riuniti, Bergamo, Italy (G.G., V.S., H.I., G.M., N.L., L.F., A.V., A.M., O.V.); University Hospitals Case Medical Center, Case Western Reserve University, Cleveland, Ohio (H.G.B., W.W., S.T., M.A.C.); Division of Cardiology, University of Modena and Reggio Emilia, Modena, Italy (G.B.-Z.); Cardiology Department, Ferrarotto Hospital, Catania, and University of Catania, Catania, Italy (D.C.)
| | - Luigi Fiocca
- From the Cardiovascular Department, Ospedali Riuniti, Bergamo, Italy (G.G., V.S., H.I., G.M., N.L., L.F., A.V., A.M., O.V.); University Hospitals Case Medical Center, Case Western Reserve University, Cleveland, Ohio (H.G.B., W.W., S.T., M.A.C.); Division of Cardiology, University of Modena and Reggio Emilia, Modena, Italy (G.B.-Z.); Cardiology Department, Ferrarotto Hospital, Catania, and University of Catania, Catania, Italy (D.C.)
| | - Davide Capodanno
- From the Cardiovascular Department, Ospedali Riuniti, Bergamo, Italy (G.G., V.S., H.I., G.M., N.L., L.F., A.V., A.M., O.V.); University Hospitals Case Medical Center, Case Western Reserve University, Cleveland, Ohio (H.G.B., W.W., S.T., M.A.C.); Division of Cardiology, University of Modena and Reggio Emilia, Modena, Italy (G.B.-Z.); Cardiology Department, Ferrarotto Hospital, Catania, and University of Catania, Catania, Italy (D.C.)
| | - Wei Wang
- From the Cardiovascular Department, Ospedali Riuniti, Bergamo, Italy (G.G., V.S., H.I., G.M., N.L., L.F., A.V., A.M., O.V.); University Hospitals Case Medical Center, Case Western Reserve University, Cleveland, Ohio (H.G.B., W.W., S.T., M.A.C.); Division of Cardiology, University of Modena and Reggio Emilia, Modena, Italy (G.B.-Z.); Cardiology Department, Ferrarotto Hospital, Catania, and University of Catania, Catania, Italy (D.C.)
| | - Satoko Tahara
- From the Cardiovascular Department, Ospedali Riuniti, Bergamo, Italy (G.G., V.S., H.I., G.M., N.L., L.F., A.V., A.M., O.V.); University Hospitals Case Medical Center, Case Western Reserve University, Cleveland, Ohio (H.G.B., W.W., S.T., M.A.C.); Division of Cardiology, University of Modena and Reggio Emilia, Modena, Italy (G.B.-Z.); Cardiology Department, Ferrarotto Hospital, Catania, and University of Catania, Catania, Italy (D.C.)
| | - Angelina Vassileva
- From the Cardiovascular Department, Ospedali Riuniti, Bergamo, Italy (G.G., V.S., H.I., G.M., N.L., L.F., A.V., A.M., O.V.); University Hospitals Case Medical Center, Case Western Reserve University, Cleveland, Ohio (H.G.B., W.W., S.T., M.A.C.); Division of Cardiology, University of Modena and Reggio Emilia, Modena, Italy (G.B.-Z.); Cardiology Department, Ferrarotto Hospital, Catania, and University of Catania, Catania, Italy (D.C.)
| | - Aleksandre Matiashvili
- From the Cardiovascular Department, Ospedali Riuniti, Bergamo, Italy (G.G., V.S., H.I., G.M., N.L., L.F., A.V., A.M., O.V.); University Hospitals Case Medical Center, Case Western Reserve University, Cleveland, Ohio (H.G.B., W.W., S.T., M.A.C.); Division of Cardiology, University of Modena and Reggio Emilia, Modena, Italy (G.B.-Z.); Cardiology Department, Ferrarotto Hospital, Catania, and University of Catania, Catania, Italy (D.C.)
| | - Orazio Valsecchi
- From the Cardiovascular Department, Ospedali Riuniti, Bergamo, Italy (G.G., V.S., H.I., G.M., N.L., L.F., A.V., A.M., O.V.); University Hospitals Case Medical Center, Case Western Reserve University, Cleveland, Ohio (H.G.B., W.W., S.T., M.A.C.); Division of Cardiology, University of Modena and Reggio Emilia, Modena, Italy (G.B.-Z.); Cardiology Department, Ferrarotto Hospital, Catania, and University of Catania, Catania, Italy (D.C.)
| | - Marco A. Costa
- From the Cardiovascular Department, Ospedali Riuniti, Bergamo, Italy (G.G., V.S., H.I., G.M., N.L., L.F., A.V., A.M., O.V.); University Hospitals Case Medical Center, Case Western Reserve University, Cleveland, Ohio (H.G.B., W.W., S.T., M.A.C.); Division of Cardiology, University of Modena and Reggio Emilia, Modena, Italy (G.B.-Z.); Cardiology Department, Ferrarotto Hospital, Catania, and University of Catania, Catania, Italy (D.C.)
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Papafaklis MI, Chatzizisis YS, Naka KK, Giannoglou GD, Michalis LK. Drug-eluting stent restenosis: effect of drug type, release kinetics, hemodynamics and coating strategy. Pharmacol Ther 2011; 134:43-53. [PMID: 22212618 DOI: 10.1016/j.pharmthera.2011.12.006] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2011] [Accepted: 12/07/2011] [Indexed: 11/26/2022]
Abstract
Restenosis following stent implantation diminishes the procedure's efficacy influencing long-term clinical outcomes. Stent-based drug delivery emerged a decade ago as an effective means of reducing neointimal hyperplasia by providing localized pharmacotherapy during the acute phase of the stent-induced injury and the ensuing pathobiological mechanisms. However, drug-eluting stent (DES) restenosis may still occur especially when stents are used in complex anatomical and clinical scenarios. A DES consists of an intravascular metallic frame and carriers which allow controlled release of active pharmaceutical agents; all these components are critical in determining drug distribution locally and thus anti-restenotic efficacy. Furthermore, dynamic flow phenomena characterizing the vascular environment, and shear stress distribution, are greatly influenced by stent implantation and play a significant role in drug deposition and bioavailability within local vascular tissue. In this review, we discuss the performance of DES and the interaction of the different DES components with the hemodynamic milieu emphasizing on the inhibition of clinical restenosis.
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Affiliation(s)
- Michail I Papafaklis
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02120, USA.
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Possibilities of optical coherence tomography in assessment of stent healing. COR ET VASA 2011. [DOI: 10.33678/cor.2011.154] [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]
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Gutiérrez-Chico JL, van Geuns RJ, Koch K, Koolen J, Duckers H, Regar E, Serruys P. Paclitaxel-coated balloon in combination with bare metal stent for treatment of de novo coronary lesions: an optical coherence tomography first-in-human randomised trial, balloon first vs. stent first. EUROINTERVENTION 2011; 7:711-22. [DOI: 10.4244/eijv7i6a114] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Abstract
Drug-eluting stents (DES) have revolutionized the treatment of coronary artery disease by reducing the rate of in-stent restenosis from 20-40% with bare-metal stent (BMS) to 6-8% with DES. However, with widespread use of DES, safety concerns have risen due to the observation of late stent thrombosis. With this in mind and better understanding of mechanism and pathophysiology of stent thrombosis, the technological platform, especially innovative anti-restenotic agents, polymeric coatings, and stent platforms, improved with newer DES. Two second-generation DES, the Endeavor zotarolimus-eluting stent (ZES) and the Xience-V everolimus-eluting stent (EES), have provided promising results in both randomized controlled trials (SPIRIT and ENDEAVOR) and registries (E-Five, COMPARE) compared with bare-metal stents (BMS) and first-generation DES. Newer third-generation stent technology, especially biodegradable polymers, polymer-free stents, and biodegradable stents on the basis of poly-L-lactide (PLLA) or magnesium, has been evaluated in preclinical and initial clinical trials. However, despite encouraging initial results, long-term data of large-scale randomized trials as well as registries comparing them to currently approved first- and second-generation DES are still lacking.
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Gutiérrez-Chico JL, Regar E, Nüesch E, Okamura T, Wykrzykowska J, di Mario C, Windecker S, van Es GA, Gobbens P, Jüni P, Serruys PW. Delayed Coverage in Malapposed and Side-Branch Struts With Respect to Well-Apposed Struts in Drug-Eluting Stents. Circulation 2011; 124:612-23. [PMID: 21768536 DOI: 10.1161/circulationaha.110.014514] [Citation(s) in RCA: 102] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Background—
Pathology studies on fatal cases of very late stent thrombosis have described incomplete neointimal coverage as common substrate, in some cases appearing at side-branch struts. Intravascular ultrasound studies have described the association between incomplete stent apposition (ISA) and stent thrombosis, but the mechanism explaining this association remains unclear. Whether the neointimal coverage of nonapposed side-branch and ISA struts is delayed with respect to well-apposed struts is unknown.
Methods and Results—
Optical coherence tomography studies from 178 stents implanted in 99 patients from 2 randomized trials were analyzed at 9 to 13 months of follow-up. The sample included 38 sirolimus-eluting, 33 biolimus-eluting, 57 everolimus-eluting, and 50 zotarolimus-eluting stents. Optical coherence tomography coverage of nonapposed side-branch and ISA struts was compared with well-apposed struts of the same stent by statistical pooled analysis with a random-effects model. A total of 34 120 struts were analyzed. The risk ratio of delayed coverage was 9.00 (95% confidence interval, 6.58 to 12.32) for nonapposed side-branch versus well-apposed struts, 9.10 (95% confidence interval, 7.34 to 11.28) for ISA versus well-apposed struts, and 1.73 (95% confidence interval, 1.34 to 2.23) for ISA versus nonapposed side-branch struts. Heterogeneity of the effect was observed in the comparison of ISA versus well-apposed struts (H=1.27; I
2
=38.40) but not in the other comparisons.
Conclusions—
Coverage of ISA and nonapposed side-branch struts is delayed with respect to well-apposed struts in drug-eluting stents, as assessed by optical coherence tomography.
Clinical Trial Registration—
http://www.clinicaltrials.gov
. Unique identifier: NCT00389220, NCT00617084.
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Abstract
The following are highlights from the new series,
Circulation: Cardiovascular Interventions
Topic Review. This series will summarize the most important manuscripts, as selected by the editors, that have published in the
Circulation
portfolio. The objective of this new series is to provide a concise review of significant papers that are relevant to interventional cardiology. The studies included in this article represent the most noteworthy research in the area of coronary stent placement.
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Gutiérrez-Chico JL, van Geuns RJ, Regar E, van der Giessen WJ, Kelbæk H, Saunamäki K, Escaned J, Gonzalo N, di Mario C, Borgia F, Nüesch E, García-García HM, Silber S, Windecker S, Serruys PW. Tissue coverage of a hydrophilic polymer-coated zotarolimus-eluting stent vs. a fluoropolymer-coated everolimus-eluting stent at 13-month follow-up: an optical coherence tomography substudy from the RESOLUTE All Comers trial. Eur Heart J 2011; 32:2454-63. [PMID: 21659439 PMCID: PMC3184229 DOI: 10.1093/eurheartj/ehr182] [Citation(s) in RCA: 114] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Aims To compare the tissue coverage of a hydrophilic polymer-coated zotarolimus-eluting stent (ZES) vs. a fluoropolymer-coated everolimus-eluting stent (EES) at 13 months, using optical coherence tomography (OCT) in an ‘all-comers' population of patients, in order to clarify the mechanism of eventual differences in the biocompatibility and thrombogenicity of the devices. Methods and results Patients randomized to angiographic follow-up in the RESOLUTE All Comers trial (NCT00617084) at pre-specified OCT sites underwent OCT follow-up at 13 months. Tissue coverage and apposition were assessed strut by strut, and the results in both treatment groups were compared using multilevel logistic or linear regression, as appropriate, with clustering at three different levels: patient, lesion, and stent. Fifty-eight patients (30 ZES and 28 EES), 72 lesions, 107 stents, and 23 197 struts were analysed. Eight hundred and eighty-seven and 654 uncovered struts (7.4 and 5.8%, P= 0.378), and 216 and 161 malapposed struts (1.8 and 1.4%, P= 0.569) were found in the ZES and EES groups, respectively. The mean thickness of coverage was 116 ± 99 µm in ZES and 142 ± 113 µm in EES (P= 0.466). No differences in per cent neointimal volume obstruction (12.5 ± 7.9 vs. 15.0 ± 10.7%) or other areas–volumetric parameters were found between ZES and EES, respectively. Conclusion No significant differences in tissue coverage, malapposition, or lumen/stent areas and volumes were detected by OCT between the hydrophilic polymer-coated ZES and the fluoropolymer-coated EES at 13-month follow-up.
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Affiliation(s)
- Juan Luis Gutiérrez-Chico
- Erasmus Medical Centre, Thoraxcenter, Ba583a, 's-Gravendijkwal 230, 3015 CE Rotterdam, The Netherlands.
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