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Pradhan A, Roy S, Chaudhary G, Vishwakarma P, Chandra S, Hasibuzzaman MA. A tale of two in stent restenosis in same patient: Surprising findings from optical coherence tomography. Clin Case Rep 2023; 11:e8222. [PMID: 38028098 PMCID: PMC10654474 DOI: 10.1002/ccr3.8222] [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: 10/04/2023] [Revised: 11/02/2023] [Accepted: 11/04/2023] [Indexed: 12/01/2023] Open
Abstract
Key Clinical Message The morphology of in-stent restenosis (ISR) in drug eluting stents varies greatly from that of bare metal stents. Optical coherence tomography (OCT) is a useful aid for identifying the nature of ISR and planning the treatment accordingly, which may be by intravascular lithotripsy, cutting balloon or Rotablator, which can be used upfront if OCT shows calcified neoatherosclerosis. Abstract Restenosis is the decrease in the diameter of the vessel lumen after the performance of percutaneous intervention (PCI), which may or may not involve the implantation of a stent. The morphology of in-stent restenosis (ISR) in drug eluting stents (DES) vary greatly from that of bare metal stents (BMS). We present the case of a 60-years-old lady, who was a follow up case of PCI of the left anterior descending artery with DES and left circumflex artery using BMS 16 years ago. Optical coherence tomography (OCT) revealed both neoatherosclerosis and neointimal hyperplasia in both DES as well as BMS. The morphology of ISR in DES differed from that of BMS. PCI and pharmacological strategies form the main stream of management in case of neointimal hyperplasia. Detection of pattern of ISR on OCT can direct the management of a particular patient, which may be by the use of adjunct devices like intravascular lithotripsy, cutting balloon and Rotablator, which can be used upfront if OCT shows calcified neoatherosclerosis.
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Affiliation(s)
- Akshyaya Pradhan
- Department of CardiologyKing George's Medical UniversityLucknowIndia
| | - Shubhajeet Roy
- Faculty of Medical SciencesKing George's Medical UniversityLucknowIndia
| | - Gaurav Chaudhary
- Department of CardiologyKing George's Medical UniversityLucknowIndia
| | | | - Sharad Chandra
- Department of CardiologyKing George's Medical UniversityLucknowIndia
| | - Md. Al Hasibuzzaman
- The First Affiliated hospital of Ningbo UniversityNingboChina
- Institute of Nutrition and Food ScienceUniversity of DhakaDhakaBangladesh
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Cao Z, Li J, Fang Z, Feierkaiti Y, Zheng X, Jiang X. The factors influencing the efficiency of drug-coated balloons. Front Cardiovasc Med 2022; 9:947776. [PMCID: PMC9602405 DOI: 10.3389/fcvm.2022.947776] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Accepted: 08/26/2022] [Indexed: 11/13/2022] Open
Abstract
The drug-coated balloon (DCB) is an emerging percutaneous coronary intervention (PCI) device that delivers drugs to diseased vessels to decrease the rate of vascular stenosis. Recent clinical studies have demonstrated that DCBs tend to have both good safety and efficacy profiles, leading to extended application indications in the clinic, including in-stent restenosis (ISR) for metal stents such as drug-eluting stents (DESs), small vascular disease, bifurcation disease, large vascular disease, acute coronary syndrome (ACS), and high bleeding risk. However, some previous clinical data have suggested that DCBs performed less effectively than DESs. No studies or reviews have systematically discussed the improvement strategies for better DCB performance until now. Drug loss during the process of delivery to the target lesion and inefficient delivery of the coating drug to the diseased vascular wall are two key mechanisms that weaken the efficiency of DCBs. This review is the first to summarize the key influencing factors of DCB efficiency in terms of balloon structure and principles, and then it analyzes how these factors cause outcomes in practice based on current clinical trial studies of DCBs in the treatment of different types of lesions. We also provide some recommendations for improving DCBs to contribute to better DCB performance by improving the design of DCBs and combining other factors in clinical practice.
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Affiliation(s)
- Zheng Cao
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, Hubei, China,Cardiovascular Research Institute, Wuhan University, Wuhan, Hubei, China,Hubei Key Laboratory of Cardiology, Wuhan, Hubei, China
| | - Jun Li
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, Hubei, China,Cardiovascular Research Institute, Wuhan University, Wuhan, Hubei, China,Hubei Key Laboratory of Cardiology, Wuhan, Hubei, China
| | - Zhao Fang
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, Hubei, China,Cardiovascular Research Institute, Wuhan University, Wuhan, Hubei, China,Hubei Key Laboratory of Cardiology, Wuhan, Hubei, China
| | - Yushanjiang Feierkaiti
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, Hubei, China,Cardiovascular Research Institute, Wuhan University, Wuhan, Hubei, China,Hubei Key Laboratory of Cardiology, Wuhan, Hubei, China
| | - Xiaoxin Zheng
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, Hubei, China,Cardiovascular Research Institute, Wuhan University, Wuhan, Hubei, China,Hubei Key Laboratory of Cardiology, Wuhan, Hubei, China,*Correspondence: Xiaoxin Zheng,
| | - Xuejun Jiang
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, Hubei, China,Cardiovascular Research Institute, Wuhan University, Wuhan, Hubei, China,Hubei Key Laboratory of Cardiology, Wuhan, Hubei, China,Xuejun Jiang,
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3
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Zhu Y, Liu K, Kong X, Nan J, Gao A, Liu Y, Han H, Li H, Zhu H, Zhang J, Zhao Y. Comparison of Drug-Coated Balloon Angioplasty vs. Drug-Eluting Stent Implantation for Drug-Eluting Stent Restenosis in the Routine Clinical Practice: A Meta-Analysis of Randomized Controlled Trials. Front Cardiovasc Med 2021; 8:766088. [PMID: 34926617 PMCID: PMC8671700 DOI: 10.3389/fcvm.2021.766088] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2021] [Accepted: 10/31/2021] [Indexed: 11/13/2022] Open
Abstract
Introduction: In-stent restenosis (ISR) remains a challenging issue despite the great advance of drug-eluting stents (DES). In addition, the consensus was lacking regarding the optimal strategy for DES-ISR. Therefore, we aimed to evaluate angiographic and clinical outcomes of the two most effective treatments DES vs. drug-eluting balloon (DCB) for patients with DES-ISR. Methods: This meta-analysis used the data from the randomized controlled trials (RCTs), which were identified by a systematic search in the databases of PubMed, Embase, and Cochrane Library. Target lesion revascularization (TLR) was regarded as the primary endpoint. In addition, the late angiographic outcomes and other clinical outcomes, namely, cardiac death, myocardial infarction (MI), target vessel revascularization, stent thrombosis, and major adverse cardiac events, were also included for analysis. Results: Five RCTs with about 1,193 patients were included in this meta-analysis for the analysis. For the primary endpoint, the overall pooled outcomes suggested repeat DES implantation was associated with a significant reduction in the term of TLR compared with DCB angioplasty (risk ratio = 1.53, 95% CI 1.15-2.04, p = 0.003). But no significant difference in angiographic outcomes and other clinical endpoints were observed between DES and DCB. In the subgroup analysis, DCB was inferior to new-generation DES (NG-DES)/everolimus-eluting stent (EES) in the term of TLR. In addition, this non-significant trend was also noted in the subgroup of the paclitaxel-eluting stent (PES) vs. DCB. For the angiographic endpoints, EES, not PES, was associated with larger minimum lumen diameter [mean difference (MD) = -0.25, 95% CI -0.38 to -0.11, p = 0.0003], lower percent diameter stenosis (MD = 7.29%, 95% CI 2.86-11.71%, p = 0.001), and less binary restenosis (OR = 2.20, 95% CI 1.18-4.11, p = 0.01). But NG-DES/EES was comparable to DCB in cardiac death, MI, and stent thrombosis. Conclusions: For the patients with DES-ISR, treatment with DES, especially NG-DES/EES could reduce the risk of TLR significantly compared to DCB at long-term follow-up.
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Affiliation(s)
- Yong Zhu
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Kesen Liu
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Xiangyun Kong
- Department of Cardiology, Beijing Luhe Hospital, Capital Medical University, Beijing, China
| | - Jing Nan
- Department of Cardiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Ang Gao
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Yan Liu
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Hongya Han
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Hong Li
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Huagang Zhu
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Jianwei Zhang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Yingxin Zhao
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
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4
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Wiebe J, Rai H, Kuna C, Cassese S, Kessler T, Rheude T, Colleran R, Schunkert H, Koch T, Kufner S, Joner M, Kastrati A, Byrne RA. Angiographic performance of everolimus-eluting stents for the treatment of coronary in-stent restenosis in daily practice. Catheter Cardiovasc Interv 2021; 98:857-862. [PMID: 32845090 DOI: 10.1002/ccd.29225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 07/27/2020] [Accepted: 08/10/2020] [Indexed: 11/10/2022]
Abstract
OBJECTIVES The present study aims to analyze the angiographic anti-restenotic performance of durable polymer everolimus-eluting stents (EES) for the treatment of in-stent restenosis (ISR) in daily practice. BACKGROUND Randomized data is available supporting the use of drug-coated balloons and drug-eluting stents for the treatment of ISR; however, additional real-world data including angiographic follow-up is needed. METHODS Patients who underwent EES-implantation for the treatment of drug-eluting stent ISR and attended for a 6-8 months angiographic surveillance were analyzed. Off-line assessment of the angiograms was conducted at a central quantitative coronary angiographic core laboratory. RESULTS A total of 426 patients with ISR were treated with EES and had undergone angiographic follow-up. The mean age was 66.8 ± 9.9 years and 27.5% suffered from diabetes. A total of 459 lesions were treated. The diameter stenosis decreased from 64.3 ± 19.1% (preprocedural) to 12.0 ± 6.4% (postprocedural). At 6-8 months angiographic follow-up, the in-segment diameter stenosis was 38.3 ± 21.7% and the in-stent late luminal loss was 0.54 ± 0.74 mm in the treated area analysis. The rate of recurrent binary restenosis was 25.7%. CONCLUSIONS In the setting of ISR, the angiographic anti-restenotic efficacy of stenting with EES is comparable to that observed in randomized clinical trials and less favorable than its performance in patients undergoing stenting for de novo disease.
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Affiliation(s)
- Jens Wiebe
- Deutsches Herzzentrum München, Technische Universität München, München, Germany.,School of Pharmacy and Biomolecular Sciences, DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance, Berlin, Germany
| | - Himanshu Rai
- Deutsches Herzzentrum München, Technische Universität München, München, Germany
| | - Constantin Kuna
- Deutsches Herzzentrum München, Technische Universität München, München, Germany
| | - Salvatore Cassese
- Deutsches Herzzentrum München, Technische Universität München, München, Germany
| | - Thorsten Kessler
- Deutsches Herzzentrum München, Technische Universität München, München, Germany.,School of Pharmacy and Biomolecular Sciences, DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance, Berlin, Germany
| | - Tobias Rheude
- Deutsches Herzzentrum München, Technische Universität München, München, Germany
| | - Roisin Colleran
- Deutsches Herzzentrum München, Technische Universität München, München, Germany
| | - Heribert Schunkert
- Deutsches Herzzentrum München, Technische Universität München, München, Germany.,School of Pharmacy and Biomolecular Sciences, DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance, Berlin, Germany
| | - Tobias Koch
- Deutsches Herzzentrum München, Technische Universität München, München, Germany
| | - Sebastian Kufner
- Deutsches Herzzentrum München, Technische Universität München, München, Germany
| | - Michael Joner
- Deutsches Herzzentrum München, Technische Universität München, München, Germany.,School of Pharmacy and Biomolecular Sciences, DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance, Berlin, Germany
| | - Adnan Kastrati
- Deutsches Herzzentrum München, Technische Universität München, München, Germany.,School of Pharmacy and Biomolecular Sciences, DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance, Berlin, Germany
| | - Robert A Byrne
- Mater Private Hospital, Department of Cardiology, Dublin, Ireland.,Royal College of Surgeons, Dublin, Ireland
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5
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Affiliation(s)
- Giuseppe Esposito
- Cardiovascular Center Aalst, OLV Hospital, Belgium (G.E., E.B., J.B.).,Department of Advanced Biomedical Sciences, University of Naples Federico II, Italy (G.E., E.B.)
| | - Emanuele Barbato
- Cardiovascular Center Aalst, OLV Hospital, Belgium (G.E., E.B., J.B.).,Department of Advanced Biomedical Sciences, University of Naples Federico II, Italy (G.E., E.B.)
| | - Jozef Bartunek
- Cardiovascular Center Aalst, OLV Hospital, Belgium (G.E., E.B., J.B.)
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6
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Wang P, Qiao H, Wang R, Hou R, Guo J. The characteristics and risk factors of in-stent restenosis in patients with percutaneous coronary intervention: what can we do. BMC Cardiovasc Disord 2020; 20:510. [PMID: 33276720 PMCID: PMC7716487 DOI: 10.1186/s12872-020-01798-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 11/24/2020] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Percutaneous coronary intervention (PCI) is a common treatment for patients with coronary heart disease, and intra-stent restenosis (ISR) is a serious complication after PCI. It's necessary to identify the potential risk factors to provide evidence for the prevention of ISR. METHODS The patients who underwent coronary angiography 1 year after PCI in our hospital from January 2017 to May 2019 were selected. The characteristics and results of clinical examination of ISR and no-ISR patients were compared, Multivariate logistic regression analyses were performed to identify the risk factors. RESULTS A total of 209 patients were included, the incidence of ISR after PCI was 30.62%. There were significant differences on the hypertension, diabetes, number of coronary artery lesions, reasons for stent implantation, the diameter of stent, the length of stent and stent position between ISR group and no-ISR patients (all p < 0.05). The LDL-C in ISR groups was significantly higher than that of no-ISR group (p = 0.048), there were no significant differences between two groups in FPG, TG, TC, HDL-C, Apo A1, Apo B, LP-a and glycated haemoglobin (all p > 0.05). The hypertension (OR 4.30, 95% CI 1.12-9.34), diabetes (OR 5.29, 95% CI 1.25-9.01), number of coronary artery lesions ≥ 2 (OR 4.84, 95% CI 1.21-9.55), LDL-C ≥ 1.9 mmol/L (OR 5.93, 95% CI 2.29-10.01), unstable angina (OR 2.92, 95% CI 1.20-4.55), left anterior descending artery (OR 4.01, 95% CI 1.73-7.58), diameter of stent ≥ 3 mm (OR 5.42, 95% CI 1.24-10.84), the length of stent > 20 mm (OR 3.06, 95% CI 1.19-5.22) were the independent risk factor for ISR (all p < 0.05). CONCLUSION It is necessary to take preventive measures against these risk factors to reduce ISR, and studies with larger sample size and longer follow-up on this issue are needed in the future.
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Affiliation(s)
- Pengfei Wang
- Department of Cardiology, Affiliated Hospital of Chengde Medical College, No. 36 Nanyingzi Street, Chengde, 067000, Hebei Province, People's Republic of China.
| | - Haixia Qiao
- Department of Cardiology, Chengde Central Hospital, Chengde, People's Republic of China
| | - RuiJuan Wang
- Department of Cardiology, Affiliated Hospital of Chengde Medical College, No. 36 Nanyingzi Street, Chengde, 067000, Hebei Province, People's Republic of China
| | - Ruitian Hou
- Department of Cardiology, Affiliated Hospital of Chengde Medical College, No. 36 Nanyingzi Street, Chengde, 067000, Hebei Province, People's Republic of China
| | - Jingtao Guo
- Department of Cardiology, Chengde Central Hospital, Chengde, People's Republic of China
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Clinical Outcomes of Drug-Eluting versus Bare-Metal In-Stent Restenosis after the Treatment of Drug-Eluting Stent or Drug-Eluting Balloon: A Systematic Review and Meta-Analysis. J Interv Cardiol 2020; 2020:8179849. [PMID: 32684867 PMCID: PMC7336236 DOI: 10.1155/2020/8179849] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Accepted: 06/02/2020] [Indexed: 11/17/2022] Open
Abstract
Background Although drug-eluting stents (DES) have reduced the rates of in-stent restenosis (ISR) compared with bare-metal stents (BMS), DES related ISR (DES-ISR) still occurs and outcomes of DES-ISR remain unclear. The objective of this meta-analysis was to investigate the long-term clinical outcomes of patients with DES-ISR compared with patients with BMS related ISR (BMS-ISR) after the treatment of DES or drug-eluting balloon (DEB). Methods and results. We searched the literature in the main electronic databases including PUBMED, EMBASE, Cochrane Library, and Web of Science. The primary endpoints were target lesion revascularization (TLR) and target vessel revascularization (TVR). The secondary endpoints included all cause death (ACD), cardiac death (CD), myocardial infarction (MI), stent thrombosis or re-in-stent restenosis (ST/RE-ISR), and major adverse cardiovascular events (MACEs). A total of 19 studies with 6256 participants were finally included in this meta-analysis. Results showed that the rates of TLR (P < 0.00001), TVR (P < 0.00001), CD (P=0.02), ST/RE-ISR (P < 0.00001), and MACEs (P < 0.00001) were significantly higher in the DES-ISR group than in the BMS-ISR group. No significant differences were found between the two groups in the rates of MI (P=0.05) and ACD (P=0.21). Conclusions Our study demonstrated that patients with DES-ISR had worse clinical outcomes at the long-term follow-up than patients with BMS-ISR after the treatment of DES or DEB, suggesting that DES and DEB may be more effective for BMS-ISR than that for DES-ISR. Positive prevention of DES-ISR is indispensable and further studies concentrating on detecting the predictors of outcomes of DES-ISR are required.
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Giacoppo D, Alfonso F, Xu B, Claessen BE, Adriaenssens T, Jensen C, Pérez-Vizcayno MJ, Kang DY, Degenhardt R, Pleva L, Baan J, Cuesta J, Park DW, Kukla P, Jiménez-Quevedo P, Unverdorben M, Gao R, Naber CK, Park SJ, Henriques JP, Kastrati A, Byrne RA. Drug-Coated Balloon Angioplasty Versus Drug-Eluting Stent Implantation in Patients With Coronary Stent Restenosis. J Am Coll Cardiol 2020; 75:2664-2678. [DOI: 10.1016/j.jacc.2020.04.006] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Revised: 03/10/2020] [Accepted: 04/02/2020] [Indexed: 12/18/2022]
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Harada Y, Schneider S, Colleran R, Rai H, Bohner J, Kuna C, Kufner S, Giacoppo D, Schüpke S, Joner M, Ibrahim T, Laugwitz KL, Kastrati A, Byrne RA. Resultado del tratamiento percutáneo de la reestenosis de stents farmacoactivos: ¿depende de si el stent tenía o no recubrimiento polimérico? Rev Esp Cardiol (Engl Ed) 2020. [DOI: 10.1016/j.recesp.2019.01.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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10
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Mintz GS. Intravascular ultrasound guidance improves patient survival (mortality) after drug-eluting stent implantation: review and updated bibliography. Cardiovasc Interv Ther 2019; 35:37-43. [PMID: 31482290 DOI: 10.1007/s12928-019-00616-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Accepted: 08/26/2019] [Indexed: 12/11/2022]
Abstract
Individual studies IVUS vs angiography-guided DES implantation studies, whether randomized clinical trials or registries are underpowered, to show a reduction in mortality, especially at 1 year of follow-up. However, either meta-analyses or the few studies with long-term (> 5 year) follow-up showed that IVUS guidance reduced mortality and improved patient survival, even with second-generation DES.
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Affiliation(s)
- Gary S Mintz
- Cardiovascular Research Foundation, 1700 Broadway, 9th floor, New York, NY, 10019, USA.
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11
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Harada Y, Schneider S, Colleran R, Rai H, Bohner J, Kuna C, Kufner S, Giacoppo D, Schüpke S, Joner M, Ibrahim T, Laugwitz KL, Kastrati A, Byrne RA. Do outcomes following intervention for drug-eluting stent restenosis depend on whether the restenosed stent was polymer-free or polymer-coated? ACTA ACUST UNITED AC 2019; 73:225-231. [PMID: 30878234 DOI: 10.1016/j.rec.2019.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Accepted: 01/14/2019] [Indexed: 11/28/2022]
Abstract
INTRODUCTION AND OBJECTIVES Outcomes of patients undergoing percutaneous intervention for drug-eluting stent (DES) restenosis are poorer than those in patients with bare-metal stent restenosis. It is unknown if this is related to the presence of polymer coating. We sought to compare outcomes after interventions for in-stent restenosis (ISR) of polymer-free DES vs durable polymer DES. METHODS Patients enrolled in the ISAR-TEST 5 randomized trial who underwent repeat percutaneous intervention for ISR during follow-up were included. Angiographic outcomes at 6 to 8 months and clinical outcomes at 2 years were analyzed and compared between 2 groups according to whether the restenosed stent was a polymer-free or a durable polymer DES. Multivariate analysis was used to adjust for differences between groups. RESULTS A total of 326 patients with ISR were included: 220 with ISR in polymer-free DES and 106 with ISR in durable polymer DES. Angiographic follow-up was available for 83.4% of patients. No difference was observed in recurrent binary restenosis between the 2 groups (31.7% vs 27.0%; P=.38; Padjusted=.29). At 2 years, the composite of death, myocardial infarction, or repeat target lesion revascularization were similar between the 2 groups (35.7% vs 34.0%; HR=1.04, 95%CI, 0.70-1.55; P=.83; Padjusted=.79). The rate of repeat target lesion revascularization was also similar in the 2 groups (29.8% vs 31.5%; HR=0.91, 95%CI, 0.60-1.39; P=.68; Padjusted=.62). CONCLUSIONS In patients undergoing reintervention for DES-ISR, we found no evidence of differences in outcomes according to whether the restenosed stent was a polymer-free or durable polymer DES.
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Affiliation(s)
- Yukinori Harada
- Deutsches Herzzentrum München, Technische Universität München, München, Germany
| | - Simon Schneider
- I. Medizinische Klinik, Klinikum rechts der Isar, Technische Universität München, München, Germany
| | - Roisin Colleran
- Deutsches Herzzentrum München, Technische Universität München, München, Germany
| | - Himanshu Rai
- Deutsches Herzzentrum München, Technische Universität München, München, Germany
| | - Janika Bohner
- Deutsches Herzzentrum München, Technische Universität München, München, Germany
| | - Constantin Kuna
- Deutsches Herzzentrum München, Technische Universität München, München, Germany
| | - Sebastian Kufner
- Deutsches Herzzentrum München, Technische Universität München, München, Germany
| | - Daniele Giacoppo
- Deutsches Herzzentrum München, Technische Universität München, München, Germany
| | - Stefanie Schüpke
- Deutsches Herzzentrum München, Technische Universität München, München, Germany; DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, München, Germany
| | - Michael Joner
- Deutsches Herzzentrum München, Technische Universität München, München, Germany; DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, München, Germany
| | - Tareq Ibrahim
- I. Medizinische Klinik, Klinikum rechts der Isar, Technische Universität München, München, Germany
| | - Karl-Ludwig Laugwitz
- I. Medizinische Klinik, Klinikum rechts der Isar, Technische Universität München, München, Germany; DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, München, Germany
| | - Adnan Kastrati
- Deutsches Herzzentrum München, Technische Universität München, München, Germany; DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, München, Germany
| | - Robert A Byrne
- Deutsches Herzzentrum München, Technische Universität München, München, Germany; DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, München, Germany.
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13
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Cassese S, Xu B, Habara S, Rittger H, Byrne RA, Waliszewski M, Pérez-Vizcayno MJ, Gao R, Kastrati A, Alfonso F. Incidencia y predictores de la reestenosis recurrente tras angioplastia con balón farmacoactivo en reestenosis de stents farmacoactivos: proyecto cooperativo ICARUS. Rev Esp Cardiol 2018. [DOI: 10.1016/j.recesp.2017.07.034] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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14
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Cortese B, D’Ascenzo F, Fetiveau R, Balian V, Blengino S, Fineschi M, Rogacka R, Lettieri C, Pavei A, D’Amico M, Poli A, Di Palma G, Latini RA, Orrego PS, Seregni R. Treatment of coronary artery disease with a new-generation drug-coated balloon. J Cardiovasc Med (Hagerstown) 2018; 19:247-252. [DOI: 10.2459/jcm.0000000000000632] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Palmerini T, Della Riva D, Biondi-Zoccai G, Leon MB, Serruys PW, Smits PC, von Birgelen C, Ben-Yehuda O, Généreux P, Bruno AG, Jenkins P, Stone GW. Mortality Following Nonemergent, Uncomplicated Target Lesion Revascularization After Percutaneous Coronary Intervention: An Individual Patient Data Pooled Analysis of 21 Randomized Trials and 32,524 Patients. JACC Cardiovasc Interv 2018; 11:892-902. [PMID: 29680221 DOI: 10.1016/j.jcin.2018.01.277] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2018] [Revised: 01/25/2018] [Accepted: 01/31/2018] [Indexed: 02/08/2023]
Abstract
OBJECTIVES This study sought to investigate the impact of nonemergent, uncomplicated target lesion revascularization (TLR) on the risk of long-term mortality after percutaneous coronary intervention (PCI). BACKGROUND Restenosis requiring TLR after PCI is generally considered a benign event. METHODS The study pooled patient-level data from 21 randomized trials. Subjects dying the same day as or the day after the TLR procedure as well as those with myocardial infarction (MI) the day before, the same day as or the day after TLR were excluded. The primary endpoint of the study was all-cause mortality. RESULTS The dataset included 32,524 patients who were stratified according to whether repeat TLR was performed during follow-up. During a median follow-up of 37 months, 2,330 (7.2%) patients underwent a nonemergent, uncomplicated TLR procedure. After adjusting for potential confounders, TLR was an independent predictor of mortality (hazard ratio: 1.23, 95% confidence interval: 1.04 to 1.45; p = 0.02). Patients undergoing nonemergent, uncomplicated TLR had significantly higher rates of non-procedure-related MI compared with those without TVR. Among patients undergoing elective TLR, MI occurring after TLR was an independent predictor of mortality (hazard ratio: 3.82; 95% confidence interval: 2.44 to 5.99; p < 0.0001). CONCLUSIONS Nonemergent, uncomplicated TLR after PCI is an independent predictor of long-term mortality, an association in part explained by higher rates of MI occurring after TLR. Efforts aimed at reducing TLR risk may translate into prognostic benefits including reduced rates of MI and survival.
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Affiliation(s)
- Tullio Palmerini
- Polo Cardio-Toraco-Vascolare, Policlinico S. Orsola, Bologna, Italy
| | - Diego Della Riva
- Polo Cardio-Toraco-Vascolare, Policlinico S. Orsola, Bologna, Italy
| | - Giuseppe Biondi-Zoccai
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy; Department of AngioCardioNeurology, IRCCS Neuromed, Pozzilli, Italy
| | - Martin B Leon
- NewYork-Presbyterian Hospital/Columbia University Medical Center, New York, New York; Clinical Trials Center, Cardiovascular Research Foundation, New York, New York
| | - Patrick W Serruys
- International Centre for Circulatory Health, NHLI, Imperial College London, London, United Kingdom
| | - Pieter C Smits
- Department of Cardiology, Maasstad Ziekenhuis, Rotterdam, the Netherlands
| | - Clemens von Birgelen
- Department of Cardiology, Thoraxcentrum Twente, Medisch Spectrum Twente, University of Twente, Enschede, the Netherlands
| | - Ori Ben-Yehuda
- NewYork-Presbyterian Hospital/Columbia University Medical Center, New York, New York; Clinical Trials Center, Cardiovascular Research Foundation, New York, New York
| | - Philippe Généreux
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York; Gagnon Cardiovascular Institute, Morristown Medical Center, Morristown, New Jersey; Hôpital du Sacré-Coeur de Montréal, Montréal, Québec, Canada
| | - Antonio G Bruno
- Polo Cardio-Toraco-Vascolare, Policlinico S. Orsola, Bologna, Italy
| | - Paul Jenkins
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York
| | - Gregg W Stone
- NewYork-Presbyterian Hospital/Columbia University Medical Center, New York, New York; Clinical Trials Center, Cardiovascular Research Foundation, New York, New York.
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Affiliation(s)
- Ron Waksman
- From the Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC.
| | - Arie Steinvil
- From the Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC
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Wang F, Su X, Liu C, Wu M, Li B. Prognostic Value of Plasma Long Noncoding RNA ANRIL for In-Stent Restenosis. Med Sci Monit 2017; 23:4733-4739. [PMID: 28970468 PMCID: PMC5635947 DOI: 10.12659/msm.904352] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Background In-stent restenosis (ISR) remains a major cause of failure of contemporary percutaneous revascularization therapies. Invasive biomarkers to improve the prognosis of ISR should be considered. This study aimed to investigate the association between plasma ANRIL expression and ISR. Material/Methods A total of 444 patients were included in this research. Serial coronary angiography was performed at baseline (before and after intervention) and within 36 months’ follow-up. ISR was defined as >50% diameter stenosis at follow-up. ANRIL expression was quantified using reverse transcription-PCR. An area under the ROC curve (auROC) was generated to assess the diagnostic values of ANRIL. Logistic regression models were used to assess the independent risk factors for ISR. Results Plasma ANRIL expression was significantly increased in patients with ISR, as compared with that in patients without ISR (1.6 [1.1–2.5] vs. 0.9 [0.6–1.3], P<0.001). The auROC (95% confidence interval [CI]) of plasma ANRIL in diagnosing ISR was 0.745 (0.687–0.811). Multiple logistic regression models indicated that drinking (odds ratio [OR]=2.09, 95% CI: 1.08–4.04, P=0.028), hypertension (OR=2.01, 95% CI: 1.14–3.57, P=0.017), diabetes (OR=3.15, 95% CI: 1.63–3.57, P<0.001), low-density lipoprotein (OR=3.14, 95% CI: 1.57–6.31, P=0.001), and ANRIL (OR=2.21, 95% CI: 1.68–2.92, P<0.001) were the independent risk factors for ISR. Conclusions We found that higher ANRIL expression is associated with ISR, indicating that ANRIL may be an optimal prognostic factor for ISR.
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Affiliation(s)
- Fang Wang
- Department of Cardiology, Wuhan Asia Heart Hospital, Wuhan, Hubei, China (mainland)
| | - Xi Su
- Department of Cardiology, Wuhan Asia Heart Hospital, Wuhan, Hubei, China (mainland)
| | - Chengwei Liu
- Department of Cardiology, Wuhan Asia Heart Hospital, Wuhan, Hubei, China (mainland)
| | - Mingxiang Wu
- Department of Cardiology, Wuhan Asia Heart Hospital, Wuhan, Hubei, China (mainland)
| | - Bei Li
- Department of Cardiology, Wuhan Asia Heart Hospital, Wuhan, Hubei, China (mainland)
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18
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Piccolo R. The Debut of Sirolimus-Eluting Balloons. JACC Cardiovasc Interv 2017; 10:2038-2039. [DOI: 10.1016/j.jcin.2017.07.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Accepted: 07/18/2017] [Indexed: 11/30/2022]
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19
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Incidence and predictors of reCurrent restenosis after drug-coated balloon Angioplasty for Restenosis of a drUg-eluting Stent: The ICARUS Cooperation. ACTA ACUST UNITED AC 2017; 71:620-627. [PMID: 28916429 DOI: 10.1016/j.rec.2017.08.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Accepted: 07/25/2017] [Indexed: 11/22/2022]
Abstract
INTRODUCTION AND OBJECTIVES The incidence and predictors of recurrent restenosis after drug-coated balloon (DCB) angioplasty for drug-eluting stent (DES) restenosis remain poorly studied. We sought to evaluate the incidence and predictors of recurrent restenosis among participants in randomized controlled trials receiving DCB angioplasty for DES restenosis. METHODS The clinical and lesion data of individuals enrolled in 6 randomized controlled trials of DCB angioplasty for DES restenosis were pooled. All patients included in this report were assigned to receive paclitaxel-coated balloon angioplasty with the SeQuent Please DCB (B Braun, Melsungen, Germany). The current analysis focused on participants with available follow-up angiography at 6 to 9 months. The incidence of recurrent restenosis, defined as diameter restenosis ≥ 50% in the in-segment area at follow-up angiography, and its clinical and angiographic predictors were evaluated. RESULTS A total of 546 patients were combined in a single dataset. Angiographic follow-up at 6 to 9 months was available for 484 patients (88.6%) with 518 treated lesions. Recurrent restenosis was detected in 101 (20.8%) patients. On multivariable analysis, lesion length (OR, 1.58; 95%CI, 1.10-2.26; P=.012 for 5mm increase) and vessel size (OR, 1.42; 95%, 1.12-1.79; P=.003 for 0.5mm reduction) were independently associated with recurrent restenosis. CONCLUSIONS In the largest cohort to date of individuals with angiographic surveillance after DCB angioplasty for DES restenosis, we demonstrated that recurrent restenosis occurs in approximately 1 out of 5 patients. Predictors of recurrent restenosis are increased lesion length and small vessel size.
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Alraies MC, Darmoch F, Tummala R, Waksman R. Diagnosis and management challenges of in-stent restenosis in coronary arteries. World J Cardiol 2017; 9:640-651. [PMID: 28932353 PMCID: PMC5583537 DOI: 10.4330/wjc.v9.i8.640] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2016] [Revised: 05/27/2017] [Accepted: 07/17/2017] [Indexed: 02/06/2023] Open
Abstract
Over the course of the 3 decades, percutaneous coronary intervention (PCI) with stent implantation transformed the practice of cardiology. PCI with stenting is currently the most widely performed procedure for the treatment of symptomatic coronary disease. In large trials, drug-eluting stents (DES) have led to a significant reduction in in-stent restenosis (ISR) rates, one of the major limitations of bare-metal stents. Due to these favorable findings, DES was rapidly and widely adopted enabling more complex coronary interventions. Nevertheless, ISR remains a serious concern as late stent complications. ISR mainly results from aggressive neointimal proliferation and neoatherosclerosis. DES-ISR treatment continues to be challenging complications for interventional cardiologists.
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Affiliation(s)
- M Chadi Alraies
- Heart and Vascular Institute, Department of Interventional Cardiology, Georgetown University/MedStar Washington Hospital Center, Washington, DC 20010, United States
| | - Fahed Darmoch
- Internal Medicine Department, St Vincent Charity Medical Center/Case Western Reserve University, Cleveland, OH 44115, United States
| | - Ramyashree Tummala
- Internal Medicine Department, St Vincent Charity Medical Center/Case Western Reserve University, Cleveland, OH 44115, United States
| | - Ron Waksman
- Heart and Vascular Institute, Department of Interventional Cardiology, Georgetown University/MedStar Washington Hospital Center, Washington, DC 20010, United States
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Waldo SW, O'Donnell CI, Prouse A, Plomondon ME, Rao SV, Maddox TM, Ho PM, Armstrong EJ. Incidence, procedural management, and clinical outcomes of coronary in-stent restenosis: Insights from the National VA CART Program. Catheter Cardiovasc Interv 2017; 91:425-433. [DOI: 10.1002/ccd.27161] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Accepted: 05/13/2017] [Indexed: 11/12/2022]
Affiliation(s)
- Stephen W. Waldo
- Department of Medicine; VA Eastern Colorado Health Care System; Denver Colorado
| | - Colin I. O'Donnell
- Department of Medicine; VA Eastern Colorado Health Care System; Denver Colorado
| | - Andrew Prouse
- Department of Medicine; VA Eastern Colorado Health Care System; Denver Colorado
| | - Mary E. Plomondon
- Department of Medicine; VA Eastern Colorado Health Care System; Denver Colorado
| | - Sunil V. Rao
- Department of Medicine; Durham VA Medical Center; Durham North Carolina
| | - Thomas M. Maddox
- Department of Medicine; VA Eastern Colorado Health Care System; Denver Colorado
| | - P. Michael Ho
- Department of Medicine; VA Eastern Colorado Health Care System; Denver Colorado
| | - Ehrin J. Armstrong
- Department of Medicine; VA Eastern Colorado Health Care System; Denver Colorado
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Alfonso F, Pérez-Vizcayno MJ, García del Blanco B, García-Touchard A, López-Mínguez JR, Sabaté M, Zueco J, Melgares R, Hernández R, Moreno R, Domínguez A, Sanchís J, Moris C, Moreu J, Cequier A, Romaguera R, Rivero F, Cuesta J, Gonzalo N, Jiménez-Quevedo P, Cárdenas A, Fernández C. Usefulness of Drug-Eluting Balloons for Bare-Metal and Drug-Eluting In-Stent Restenosis (from the RIBS IV and V Randomized Trials). Am J Cardiol 2017; 119:983-990. [PMID: 28139220 DOI: 10.1016/j.amjcard.2016.12.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2016] [Revised: 12/19/2016] [Accepted: 12/19/2016] [Indexed: 11/26/2022]
Abstract
Treatment of patients with drug-eluting stent (DES) in-stent restenosis (ISR) is particularly challenging. We sought to compare results of drug-eluting balloons in patients with DES-ISR with those in patients with bare-metal stent (BMS) ISR. A pooled analysis of the Restenosis Intra-Stent: Drug-Eluting Balloon versus Everolimus-Eluting Stent IV and V randomized trials was performed. Both trials had identical inclusion and exclusion criteria. Results of drug-eluting balloons in 95 patients with BMS-ISR and 154 patients with DES-ISR were compared. Patients with DES-ISR were more frequently diabetics, presented more often as an acute coronary syndrome and had more severe lesions and more frequently a focal pattern, including edge-ISR. Late angiographic findings (92% of eligible patients), including minimal lumen diameter (1.80 ± 0.6 vs 2.01 ± 0.6 mm, p = 0.001; absolute mean difference 0.21 mm; 95% confidence interval 0.04 to 0.38; p = 0.014) and restenosis rate (19% vs 9.5%, p <0.05) were poorer in DES-ISR. Results were consistent across 10 prespecified subgroups. Moreover, on multiple linear regression analysis, minimal lumen diameter at follow-up remained significantly smaller in patients with DES-ISR after adjusting for potential confounders (adjusted absolute mean difference 0.17 mm; 95% confidence interval 0.04 to 0.41; p = 0.019). Finally, at 1-year clinical follow-up (100% of patients), rates of target vessel revascularization (16% vs 6%, p = 0.02) and of the main combined clinical end point (18% vs 8%, p = 0.03) were significantly higher in patients treated for DES-ISR. In conclusion, this study confirms the efficacy of DEB for patients with ISR. However, the long-term clinical and angiographic results of DEB are poorer in patients with DES-ISR than in those with BMS-ISR. (ClinicalTrials.govIdentifier:NCT01239953&NCT01239940).
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