Does stent design affect probability of restenosis? A randomized trial comparing Multilink stents with GFX stents

Yoshitomi, Yuji; Kojima, Sunao; Yano, Masayuki; Sugi, Toshihiko; Matsumoto, Yuji; Saotome, Masao; Tanaka, Kyoe; Endo, Michiko; Kuramochi, Morio

doi:10.1067/mhj.2001.117321

Cited by 53 publications

(28 citation statements)

References 22 publications

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“…Topograficamente, essa resposta ocorre principalmente na túnica íntima e é caracterizada por proliferação celular e espessamento intimal que pode resultar em significativa redução da luz vascular 1,2,3 . A hiperplasia intimal é uma complicação relativamente freqüente após procedimentos endovasculares e pode ser considerada a principal causa de reestenose no seguimento de pacientes submetidos ao implante de "stents", uma vez que outro importante componente, o remodelamento geomé- trico, é minimizado pelo dispositivo intravascular 4,5,6,7,8 . Os "stents" recobertos com material proté-tico estão sendo utilizados no tratamento da doença aterosclerótica oclusiva com o objetivo de limitar o espessamento intimal e, conseqüentemente a taxa de reestenose, melhorando a perviedade arterial a médio e longo prazo 9,10,11 .…”

Section: Introductionunclassified

Efeitos a curto prazo de "stents" não recobertos e recobertos com politetrafluoroetileno em aorta de suínos: um modelo experimental

et al. 2004

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curto prazo de "stents" não recobertos e recobertos com politetrafluoroetileno em aorta de suínos: um modelo experimental. Acta Cir Bras [serial online] 2004 Mar-Abr;19(2). Disponível em URL: http://www.scielo.br/acb. RESUMO -Objetivo: Descrever um estudo experimental avaliando através da morfometria digital o espessamento intimal na parede arterial após o implante de "stents" metálicos auto-expansíveis recobertos ou não com politetrafluoroetileno (PTFE) na aorta de suínos. Métodos: Em três grupos de suínos jovens uma bainha introdutora de 12 F foi inserida na aorta abdominal distal. Os animais do grupo I (n=5) foram considerados controle. Os animais do grupo II (n=10) receberam o implante de um stent metálico auto-expansível não recoberto. No grupo III (n=10) um stent auto-expansível recoberto com PTFE foi inserido. Após quatro semanas os animais foram sacrificados e os espécimes arteriais foram retirados, sendo o espessamento intimal quantificado pela análise morfométrica. Resultados: Na comparação entre os grupos I, II e III quanto às áreas da íntima, média e índice intimal, não foi observada variação estatisticamente significativa. Diferenças foram observadas entre os grupos em relação às áreas luminais proximais (p=0,0036) e distais (p=0,044). Através dos testes de comparação múltipla para Kruskal-Wallis foi identificada uma diferença entre os grupos I e II. Entretanto, quando essas variáveis foram controladas pelo fator peso (relação área luminal/peso), a diferença não foi mais observada. Conclusões: Nesse estudo a curto prazo, o revestimento de PTFE não esteve associado a adicional espessamento intimal além daquele promovido pelo dispositivo metálico em artérias de grande calibre e condições de alto fluxo.

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Section: Introductionunclassified

Efeitos a curto prazo de "stents" não recobertos e recobertos com politetrafluoroetileno em aorta de suínos: um modelo experimental

et al. 2004

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“…Aside from small vessel size, stent design again remained the strongest predictor of restenosis during long-term follow-up [90]. Moreover, the impact of stent design received further support from a recent trial demonstrating a significantly higher restenosis rate with the GFX stent (Applied Vascular Engineering, Santa Rosa, CA) compared with the Multi-Link (4% with the Multi-Link vs. 26% with the GFX; P ϭ 0.003) [91]. Although exactly which stent features influence outcomes requires further study, two recent comparisons of two similar stent designs associated thinner struts (50 m for thin struts vs. 140 m for thick struts) with a lower rate of angiographic and clinical restenosis [92,93].…”

Section: Does Stent Design Influence Clinical Outcomes?mentioning

confidence: 90%

Coronary artery stents: Evaluating new designs for contemporary percutaneous intervention

Kandzari

Tcheng

Zidar

2002

Cathet Cardio Intervent

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Intracoronary stents have markedly improved the short- and long-term safety and efficacy of percutaneous coronary intervention by improving acute gains in luminal dimensions, decreasing abrupt vessel occlusion, and reducing restenosis. At present, nearly 90% of all coronary interventions involve stenting. A variety of advances in stent technology and design have expanded the clinical application of stenting to include complex coronary lesions, multivessel disease, and small-diameter vessels. In addition, the development of stents as drug delivery systems for antithrombotic or antiproliferative agents has the potential to expand the role of coronary stenting, and early clinical experience appears promising. The purpose of this review is to describe recent developments in stent design, examine the results of clinical trials of contemporary stents, and present future directions for investigation of new stent technologies.

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“…14,36,37 Our results also show that ex vivo chamber systems demonstrate antithrombotic effects similar to those of antiplatelet agents used in vivo, ie, similar to the superior effects of the combination of aspirin and ticlopidine rather Those results (along with the finding that the inhibiting effects of abciximab on platelet accumulation around a stent in an ex vivo flow chamber system were achieved at a dose previously shown to be effective for preventing vascular complications after stent implantation in vivo) 5,16 also suggest that the in vivo antithrombotic effects may be predicted by an ex vivo perfusion system. Nevertheless, there are limitations to the methodology used in our experiments, particularly regarding the application of our ex vivo results to the understanding of events occurring in clinical situations.…”

Section: Discussionmentioning

confidence: 99%

Application of Ex Vivo Flow Chamber System for Assessment of Stent Thrombosis

Sakakibara

Goto

Eto

et al. 2002

ATVB

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Objective-Factors influencing platelet accumulation around stents were to be investigated by an ex vivo flow chamber system. Methods and Results-Platelet accumulations on collagen surfaces under flow conditions were augmented in the presence of stents, especially at sites downstream from coil stents. Densitometric analysis revealed that 4.9Ϯ0.8 times more platelets accumulated downstream from coil stents than were formed downstream from tube stents (PϽ0.01), suggesting that stent morphology is an important determinant factor of its thrombogenicity. Platelet accumulations around stents were significantly inhibited by a combination of ticlopidine and aspirin, whereas aspirin alone produced only modest inhibition. Anti-glycoprotein IIb/IIIa (abciximab) inhibited platelet accumulation around stents in a dose-dependent manner, whereas the antibody blocking von Willebrand factor binding to glycoprotein Ib␣, which had been shown to inhibit platelet thrombus formation under high shear rates, did not inhibit the accumulation downstream from the coil stents. Our results suggest that the important characteristics of in vivo stent thrombosis, ie, augmented platelet accumulation with coil stents and the strong antithrombotic effect of the combination antiplatelet agents and an anti-glycoprotein IIb/IIIa, can be reproduced in ex vivo perfusion model. Conclusions-We conclude that an ex vivo perfusion system is useful in the assessment of the thrombogenicity of various stents and in the screening of effective antiplatelet agents. Key Words: stent thrombosis Ⅲ platelets Ⅲ glycoproteins Ⅲ flow chamber Ⅲ von Willebrand factor C oronary stent implantation is now an established procedure for the prevention of abrupt occlusion after unsuccessful coronary interventions. 1 However, thrombotic occlusion of the coronary arteries 2-4 (even though the incidence has been greatly reduced by high-pressure inflation and appropriate antithrombotic therapy) 5 and restenosis occurring later in Ϸ15% of patients 6 are unresolved issues regarding the use of stents. The results of clinical trials have clearly demonstrated that therapy with antiplatelet drugs, a combination of aspirin and ticlopidine, was more effective than persistent powerful anticoagulation with an oral anticoagulant, [3][4][5]7 suggesting an important role of platelets in the onset of stent thrombosis. Platelet accumulation around the stent is also believed to play a role in the later event of restenosis via local release of bioactive materials, such as platelet-derived growth factor 8,9 or recruitment of leukocytes, 10 although there are, as yet, no convincing clinical data showing the effects of antiplatelet agents on restenosis. 11 Nevertheless, it is reasonable to speculate that inhibition of the platelet accumulation around stents would facilitate reducing not only acute vascular events but also the subsequent event, restenosis. Indeed, clinical experiences and animal experiments have suggested that patient factors, 12 vascular factors (such as small vessel diameter), 13 and ...

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Does stent design affect probability of restenosis? A randomized trial comparing Multilink stents with GFX stents

Cited by 53 publications

References 22 publications

Efeitos a curto prazo de "stents" não recobertos e recobertos com politetrafluoroetileno em aorta de suínos: um modelo experimental

Efeitos a curto prazo de "stents" não recobertos e recobertos com politetrafluoroetileno em aorta de suínos: um modelo experimental

Coronary artery stents: Evaluating new designs for contemporary percutaneous intervention

Application of Ex Vivo Flow Chamber System for Assessment of Stent Thrombosis

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