Clinical and Angiographic Outcomes With Sirolimus-Eluting Stents in Total Coronary Occlusions

Kandzari, David E.; Rao, Sunil V.; Moses, Jeffrey W.; Džavík, Vladimir; Strauss, Bradley H.; Kutryk, Michael J.B.; Simonton, Charles A.; Garg, Jyotsna; Lokhnygina, Yuliya; Mancini, G.B. John; Yeoh, Eunice; Buller, Christopher E.; Across,; Investigators, Tosca

doi:10.1016/j.jcin.2008.10.013

Cited by 74 publications

(16 citation statements)

References 14 publications

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“…6,[8][9][10]21 In the present study, ostial stent location and lesions with hinge motion, tortuosity, or calcification were independent predictors of SF after EES implantation. Among these, hinge motion and tortuosity contributed most greatly to the incidence of SF.…”

Section: Discussionsupporting

confidence: 50%

“…3,4 Stent fracture (SF) after DES implantation has recently become an important concern because of its potential association with ISR, TLR, and ST. 5 SF after sirolimus-eluting stent (SES) implantation has been reported to be associated with an increased risk of ISR, ranging from 15% to 60%, and with higher cardiac event rates within a 1-year observation period. [6][7][8][9][10][11] A recently published pathological study of 144 autopsy cases with DES implantation detected SF in 29% of lesions, and SFs with gaps within the stent body were associated with histological events, such as ST or restenosis, in 67% of cases. 12 The everolimus-eluting stent (EES) is a new-generation DES, based on a thin-strut, cobalt-chromium alloy platform and releases everolimus, a semisynthetic sirolimus analog, from an acrylic and fluoropolymer mixture.…”

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confidence: 99%

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Incidence and Clinical Impact of Stent Fracture After Everolimus-Eluting Stent Implantation

Kuramitsu

Iwabuchi

Haraguchi

et al. 2012

Circ: Cardiovascular Interventions

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Background-Stent fracture (SF) after drug-eluting stent implantation has recently become an important concern because of its potential association with in-stent restenosis and stent thrombosis. However, the incidence and clinical impact of SF after everolimus-eluting stent implantation remain unclear. Methods and Results-A total of 1035 patients with 1339 lesions undergoing everolimus-eluting stent implantation and follow-up angiography 6 to 9 months after index procedure were analyzed. SF was defined as complete or partial separation of the stent, as assessed by plain fluoroscopy or intravascular ultrasound during follow-up. We assessed the rates of SF and major adverse cardiac events, defined as cardiac death, myocardial infarction, stent thrombosis, and clinically driven target lesion revascularization within 9 months. SF was observed in 39 of 1339 lesions (2.9%) and in 39 of 1035 patients (3.8%). Ostial stent location and lesions with hinge motion, tortuosity, or calcification were independent predictors of SF. The rate of myocardial infarction and target lesion revascularization were significantly higher in the SF group than in the non-SF group (5.1% versus 0.4%; P=0.018 and 25.6% versus 2.0%; P<0.001, respectively). Stent thrombosis was more frequently observed in the SF group than in the non-SF group (5.1% versus 0.4%; P=0.018). Major adverse cardiac events within 9 months were significantly higher in the SF group than in the non-SF group (25.6% versus 2.3%; P<0.001). Conclusions-SF after everolimus-eluting stent implantation occurs in 2.9% of lesions and is associated with higher rate of major adverse cardiac events, driven by higher target lesion revascularization and stent thrombosis. (Circ Cardiovasc Interv. 2012;5:663-671.)

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Section: Discussionsupporting

confidence: 50%

mentioning

confidence: 99%

Incidence and Clinical Impact of Stent Fracture After Everolimus-Eluting Stent Implantation

Kuramitsu

Iwabuchi

Haraguchi

et al. 2012

Circ: Cardiovascular Interventions

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“…15 In the current era, however, a 1.9% to 16.0% incidence of SF after SES implantation has been recognized as one of the clinically relevant contributors to focal in-stent restenosis. [5][6][7][8][9][10][11][12] In the current study, SF patients had a significantly higher rate of in-stent restenosis at 6 to 9 months, as compared with non-SF patients. An increase in mechanical stimulation of the vessel wall, the loss of mechanical scaffolding of the stent, and a decrease in local drug delivery may have predominantly contributed to the higher rates of in-stent restenosis.…”

Section: Discussionmentioning

confidence: 83%

“…On the other hand, the presence of stent fracture (SF) after SES implantation has been reported to be associated with an increased risk of in-stent restenosis, ranging from 15% to 60%, [5][6][7][8][9][10][11][12] with higher cardiac event rates within a 1-year observation period. [5][6][7][8]10,12 A recently published pathological study in 144 autopsy cases of patients who had received drug-eluting stents (DES) demonstrated that SF was detected in 29% of lesions, and the presence of SF with gap within the stent body was associated with a histological event, such as stent thrombosis or restenosis, in 67% of cases. 13 Because the duration and severity of arterial responses at the site of SF, which may have an adverse effect on outcomes, as well as the time point at which the SF occurs after SES implantation remain uncertain, the clinical impact of SF on long-term outcomes should be evaluated.…”

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confidence: 99%

Impact of Sirolimus-Eluting Stent Fracture on 4-Year Clinical Outcomes

Umeda

Kawai

Misumida

et al. 2011

Circ: Cardiovascular Interventions

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Background-Although stent fracture (SF) after sirolimus-eluting stent (SES) implantation has been recognized as one of the predisposing factors of in-stent restenosis, it remains uncertain whether SF can increase the risk of major adverse cardiac events (MACE), especially beyond 1 year after SES implantation. The aim of this study was to assess the impact of SF relative to non-SF on 4-year clinical outcomes after treatment with SES of comparable unselected lesions. Methods and Results-A total of 874 lesions in 793 patients undergoing SES implantation and subsequent angiography 6 to 9 months after index procedure were analyzed. At 6-to 9-month angiographic follow-up, SF was identified in 70 of 874 lesions (8.0%

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“…Successful recanalization of CTO in patients with viable myocardium may decrease the need for bypass surgery, reduce angina symptoms and improve long-term survival [1][2][3][4]. PCI instruments and the techniques for CTO lesions had improved over time [5], and excellent outcomes have been achieved in multiple pilot studies, especially with the combined use of drug-eluting stents [4,[6][7][8].…”

Section: Introductionmentioning

confidence: 99%

In-hospital and 3-year clinical outcomes following ad hoc versus staged percutaneous coronary interventions in chronic total occlusion — A real world practice

Fang

Lee

Hussein

et al. 2014

IJC Heart & Vessels

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Background: Ad hoc percutaneous coronary intervention (PCI) which was performed immediately after diagnostic catheterization has become the most common way of coronary intervention. However, limited data is available on in-hospital and long-term outcome comparing ad hoc and staged chronic total occlusion (CTO) PCI. The aim of our study was to figure the short-term and long-term outcomes after ad hoc or staged CTO PCI. Methods: This retrospective analysis included 512 consecutive patients that underwent 561 CTO PCI procedures between January 2002 and December 2009. Patient basic demographics, lesion characteristics, interventional procedure, devices used and in-hospital outcomes were compared between ad hoc and staged CTO PCI groups. 3-Year clinical outcomes that included all-cause mortality, cardiac mortality, myocardial infarction (MI), the need for coronary artery bypass graft surgery (CABG), major adverse cardiac events (MACE) and target vessel revascularization (TVR) were compared. Time-to-event analyses were performed using Kaplan-Meier statistics. Results: Four hundred fifty-one patients (80.4%) were enrolled in ad hoc CTO PCI group. Final successful revascularization was higher in ad hoc CTO PCI group compared with staged CTO PCI group (82.9 vs. 77.3%, p = 0.17) without statistical significance. There was no significant difference between ad hoc CTO PCI and staged CTO PCI groups in in-hospital outcomes such as all-cause mortality, cardiac death, myocardial infarction, urgent bypass surgery, urgent PCI or complications. Patients with ad hoc CTO PCI had lower rate of all-cause mortality (6.2% vs. 6.5%, p = 0.89), the need for CABG (1.9% vs. 2.1%, p = 0.89) but higher rate of cardiac mortality (1.7% vs. 0.0%, p = 0.21), MI (1.0% vs. 0.0%, p = 0.34), MACE (24.1% vs. 17.5%, p = 0.19) and TVR (17.8% vs. 10.0%, p = 0.069) without statistical significance in 3-year clinical outcomes. Conclusion: 3-Year clinical outcomes compared with ad hoc CTO PCI and staged CTO PCI had insignificant differences between: all-cause mortality, cardiac mortality, MI, the need for CABG, MACE and TVR.

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Clinical and Angiographic Outcomes With Sirolimus-Eluting Stents in Total Coronary Occlusions

Cited by 74 publications

References 14 publications

Incidence and Clinical Impact of Stent Fracture After Everolimus-Eluting Stent Implantation

Incidence and Clinical Impact of Stent Fracture After Everolimus-Eluting Stent Implantation

Impact of Sirolimus-Eluting Stent Fracture on 4-Year Clinical Outcomes

In-hospital and 3-year clinical outcomes following ad hoc versus staged percutaneous coronary interventions in chronic total occlusion — A real world practice

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