Downstream coronary effects of drug-eluting stents

Krasuski, Richard A.; Cater, George; Devendra, Ganesh; Wolski, Kathy; Shishehbor, Mehdi H.; Nissen, Steven E.; Oberti, Carlos; Ellis, Stephen G.

doi:10.1016/j.ahj.2011.08.001

Cited by 5 publications

(6 citation statements)

References 39 publications

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“…However, interpretation of endothelial function is very difficult, because many factors, including existing arteriosclerotic disease, medicinal therapies with direct or indirect effects on endothelial function, and local hemodynamics, affect endothelial function in vivo. Several studies suggested the idea that sirolimus could have an atheroprotective effect . In this study, QCA and IVUS analyses showed significant less luminal LL, greater MLA and less NIH volume index in the distal microstent of the SES‐BMS group compared with the Single BMS group.…”

Section: Discussionsupporting

confidence: 49%

“…In this study, QCA and IVUS analyses showed significant less luminal LL, greater MLA and less NIH volume index in the distal microstent of the SES‐BMS group compared with the Single BMS group. Therefore, downstream antiproliferative effects could be expected in the SES‐BMS group . A greater amount of sirolimus may accumulate near the proximal SES site in the distal BMS of the SES‐BMS group.…”

Section: Discussionmentioning

confidence: 99%

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In‐stent restenosis is inhibited in a bare metal stent implanted distal to a sirolimus‐eluting stent to treat a long de novo coronary lesion with small distal vessel diameter

Obata

Nakamura

Kitta

et al. 2013

Cathet Cardio Intervent

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Section: Discussionsupporting

confidence: 49%

Section: Discussionmentioning

confidence: 99%

In‐stent restenosis is inhibited in a bare metal stent implanted distal to a sirolimus‐eluting stent to treat a long de novo coronary lesion with small distal vessel diameter

Obata

Nakamura

Kitta

et al. 2013

Cathet Cardio Intervent

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“…Although previous studies have investigated the impact of type of stent on downstream coronary disease progression, the conclusions from these studies are conflicting. 27,28 Of note, in our study, the number of vessels revascularized by DES was relatively small compared with BMS and LIMA. This may have influenced the results, and therefore further research involving larger number of patients is warranted in order to confirm our findings.…”

Section: Discussionmentioning

confidence: 53%

Left Internal Mammary Artery Versus Coronary Stents: Impact on Downstream Coronary Stenoses and Conduit Patency

Zhang

Guddeti

Matsuzawa

et al. 2016

JAHA

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BackgroundThe study compared downstream coronary and conduit disease progression in the left anterior descending coronary artery treated with coronary artery bypass grafting using the left internal mammary artery (LIMA) versus percutaneous coronary intervention with bare metal stent (BMS) or drug eluting stent (DES).Methods and ResultsA total of 12 301 consecutive patients underwent isolated primary coronary revascularization, of which 2386 met our inclusion criteria (Percutaneous coronary intervention, n=1450; coronary artery bypass grafting, n=936). Propensity score analysis matched 628 patients, of which 468 were treated to the left anterior descending with coronary artery bypass grafting with LIMA (n=314), percutaneous coronary intervention with BMS (n=94), and DES (n=60). Coronary angiograms were analyzed by quantitative coronary angiography (QCA; n=433). Cumulative downstream coronary and conduit disease progression were estimated by Kaplan–Meier method and effect of treatment type by Cox proportional hazard models. Patients treated with LIMA had significantly lower risk of downstream coronary disease progression at follow‐up angiogram compared with BMS and DES (hazard ratio [HR] [95% CI], 0.34; [0.20–0.59]; P=0.0002; and HR [95% CI], 0.39; [0.20–0.79]; P=0.01, respectively). LIMA was associated with a lower risk of conduit disease progression compared to BMS and DES (HR [95% CI], 0.18; [0.12–0.28]; P<0.001; and HR [95% CI], 0.27; [0.16–0.46]; P<0.001, respectively). BMS was associated with higher HR for downstream coronary and conduit disease progression compared with DES, but the difference did not reach statistical significance (HR [95% CI], 1.13; [0.57–2.36]; P=0.73; and HR [95% CI], 1.46; [0.88–2.50]; P=0.14, respectively).Conclusions LIMA grafting to left anterior descending is associated with significantly lower risk of downstream coronary and conduit disease progression compared to percutaneous coronary intervention with BMS and DES.

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“…Although the small number of the distal bifurcations studied does not allow us to draw firm conclusions and potentially detect significant changes between baseline and follow-up the effect of the downstream drug delivery from the BVS on vessel wall physiology and on the distal bifurcation cannot also be excluded. Several studies have demonstrated that implantation of a drug eluting stent can affect plaque development [26,27]. Krasouski et al demonstrated that patients treated with a drug eluting were less likely to develop stenoses at the downstream vessel and events compared to patients receiving bare-metal stents fact that was attributed to a beneficial effect of the downstream drug delivery [26].…”

Section: Discussionmentioning

confidence: 99%

“…Several studies have demonstrated that implantation of a drug eluting stent can affect plaque development [26,27]. Krasouski et al demonstrated that patients treated with a drug eluting were less likely to develop stenoses at the downstream vessel and events compared to patients receiving bare-metal stents fact that was attributed to a beneficial effect of the downstream drug delivery [26]. On the other hand, Wakabayashi et al showed that in patients treated with a paclitaxel eluting stent there is an increase in the plaque burden up to 15 mm distally to the implanted stent.…”

Section: Discussionmentioning

confidence: 99%

Assessment of plaque evolution in coronary bifurcations located beyond everolimus eluting scaffolds: serial intravascular ultrasound virtual histology study

Lee

Bourantas

Muramatsu

et al. 2013

Cardiovasc Ultrasound

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PurposeTo evaluate the atherosclerotic evolution in coronary bifurcations located proximally and distally to a bioresorbable scaffold.MethodsThirty bifurcations located >5 mm beyond the scaffolded segment, being investigated with serial intravascular ultrasound virtual histology (IVUS-VH) examinations, at baseline and 2-years, in patients enrolled in the ABSORB cohort B1 study were included in this analysis. In each bifurcation, the frames portraying the proximal rim, in-bifurcation, and distal rim of the ostium of the side branch were analyzed. The geometric parameters and plaque types were evaluated at baseline and 2-years follow-up.ResultsThere were no significant differences in the geometrical parameters such as lumen, vessel and plaque areas as well as in the composition of the atheroma between baseline and 2-years follow-up.When we separately examined the bifurcations located proximally and distally to the scaffolded segment, no changes were found at the distal bifurcations, while at the proximal bifurcations there was a statistical significant decrease in the plaque burden (36.67 ± 13.33% at baseline vs. 35.06 ± 13.20% at 2 years follow-up, p = 0.04).Ten necrotic core rich plaques were found at baseline, of which 2 regressed to either fibrotic plaque or to intimal thickening at 2 years follow-up. The other 8 did not change. Disease progression was noted in 3 plaques (1 adaptive intimal thickening, 1 fibrotic and 1 fibrocalcific plaque) that evolved to necrotic rich plaques.ConclusionsPlaque regression was noted at the bifurcations located proximally to the bioresorbable scaffold but not at these located distally. Additional studies are required to confirm this finding and examine further the effect of drug elution on atherosclerotic evolution.

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Downstream coronary effects of drug-eluting stents

Cited by 5 publications

References 39 publications

In‐stent restenosis is inhibited in a bare metal stent implanted distal to a sirolimus‐eluting stent to treat a long de novo coronary lesion with small distal vessel diameter

In‐stent restenosis is inhibited in a bare metal stent implanted distal to a sirolimus‐eluting stent to treat a long de novo coronary lesion with small distal vessel diameter

Left Internal Mammary Artery Versus Coronary Stents: Impact on Downstream Coronary Stenoses and Conduit Patency

Assessment of plaque evolution in coronary bifurcations located beyond everolimus eluting scaffolds: serial intravascular ultrasound virtual histology study

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