Drug-Eluting Stents Ameliorate Pulmonary Vein Stenotic Changes in Pigs In Vivo

Furukawa, T.; Kishiro, Masahiko; Fukunaga, Hideo; Ohtsuki, Masahiro; Takahashi, Ken; Akimoto, Katsumi; Shimizu, Toshiaki; Kawasaki, Shiori; Kumasaka, Takashi

doi:10.1007/s00246-010-9695-8

Cited by 14 publications

(9 citation statements)

References 30 publications

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“…In an animal model with small pulmonary veins, DES were shown to develop less initial proliferation than BMS. 28 Balasubramanian et al 3 found that acute relief of PVS was possible with BMS implantation, however long-term vessel patency and patient survival were poor. Larger stent diameters were associated with longer freedom from restenosis and reintervention in that study.…”

Section: Discussionmentioning

confidence: 99%

Comparison of drug eluting versus bare metal stents for pulmonary vein stenosis in childhood

Khan

Qureshi

Justino

2019

Cathet Cardio Intervent

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Objective Comparison of outcomes using bare metal (BMS) and drug‐eluting (DES) stents in pulmonary vein stenosis (PVS). Background PVS is a serious condition with frequent restenosis after surgical and percutaneous interventions. After experiencing encouraging results with DES, we sought to compare outcomes of BMS and DES in native and post‐surgical PVS. Methods and Results A retrospective review of all patients who underwent stent implantation between 08/93 and 11/17 for PVS at Texas Children's Hospital was performed. BMS were used to treat 58 lesions in 37 patients and 105 DES used to treat 105 lesions in 41 patients. Mean age at first stent implant was 2.9 ± 3.5 years in BMS and 16.2 ± 18.8 months in DES group. Of those with follow‐up catheterization, mean lumen loss rate from stent implant to first follow‐up catheterization was 0.85 ± 1.47 mm/month over 6.4 ± 6.4 months in the BMS group (n = 44 lesions) compared to 0.16 ± 0.31 mm/month over 6.8 ± 7.4 months in the DES group (n = 86 lesions), p < .01. Follow‐up for the BMS group was 14 months (6 days–22.3 years), with 13 mortalities, eight lesions were re‐stented and six complete occlusions were noted. Follow‐up for DES group (including four cross‐overs) was 17.5 months (3 days‐9 years), with 10 mortalities, seven lesions were re‐stented, 11 had complete occlusion, 20 new adjacent lesions in the same vessel underwent stenting and 12 stents were intentionally fractured. Conclusion DES have significantly lowered lumen loss rate when compared to BMS at medium term follow‐up and can be fractured to enable larger diameters. Availability of larger diameter DES would be ideal.

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Section: Discussionmentioning

confidence: 99%

Comparison of drug eluting versus bare metal stents for pulmonary vein stenosis in childhood

Khan

Qureshi

Justino

2019

Cathet Cardio Intervent

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“…Pulmonary vein stenosis is defined as the reduction in the total diameter of pulmonary veins more than 50% from the diameter present before the ablation [7]. It results from the radiofrequency energy delivered at the ostia or within the lumen of pulmonary veins [8][9][10]. Ernest et al reported thickening of venous walls from myoblast proliferation and luminal sclerosis of veins characteristic of venous occlusive syndrome secondary to radiofrequency [11].…”

Section: The Lungmentioning

confidence: 99%

“…The rate of restenosis was found to be 47 to 61% in the case of balloon dilation alone whereas in the case of stent deployment, it has shown a significant decrease ranging from 0 to 47% [8,35]. Drug eluting stents are an option but more studies are needed to determine the efficacy and safety of the stents for treating PVS/PVO [9,36]. There is no role for stents in the treatment of PH when PVS is absent.…”

Section: Treatmentmentioning

confidence: 99%

Pulmonary Hypertension due to Radiofrequency Catheter Ablation (RFCA) for Atrial Fibrillation: The Lungs, the Atrium or the Ventricle?

Verma

Tripathi

Sikachi

2016

Heart, Lung and Circulation

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Atrial fibrillation is the most common heart rhythm disorder in United States, characterised by rapid and irregular beating of both the atria resulting in the similar ventricular response. While rate and rhythm control using pharmacological regimens remain the primary management strategies in these patients, radiofrequency catheter ablation (RFCA) is rapidly rising as an alternative modality of treatment. Increase in the incidence of RFCA has shed light on complications associated with this procedure. Pulmonary hypertension (PH) is one of the long-term complications that has been observed postcatheter ablation. There have been multiple mechanisms which have been proposed to explain these elevated pulmonary pressures. These include the involvement of the lungs due to pulmonary vein stenosis, pulmonary vein occlusion and, rarely, pulmonary embolism. Radiofrequency catheter ablation can also lead to scarring of the atrium which can cause left atrial diastolic dysfunction leading to elevated pulmonary pressures. Recently, it was also proposed that elevated pulmonary pressure was related to the unmasking of left ventricular diastolic dysfunction occurring after this procedure. In this article, we review all the mechanisms that are associated with the development of pulmonary hypertension in patients undergoing RCFA for atrial fibrillation and the approach to diagnosis and management of such patients.

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“…According to a previous report by Furukawa et al on the use and effectiveness of drug-eluting stent for PVS, comparison of similar sized drug-eluting stent and bare-metal stent in pigs indicated that bare-metal stent was associated with more severe internal proliferation and stent stenosis and a significantly larger amount of granuloma formation than drug-eluting stent. 21 Drug-eluting stents used in our study were all of the size 3.5 mm. A drug-eluting stent has an advantage of pharmacological benefits; however, we selected a bare-metal stent because the larger stent is believed to be more important for good outcomes.…”

mentioning

confidence: 99%

Clinical outcomes after the endovascular treatments of pulmonary vein stenosis in patients with congenital heart disease

et al. 2019

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Background:Pulmonary vein stenosis (PVS) is a condition with challenging treatment and leads to severe cardiac failure and pulmonary hypertension. Despite aggressive surgical or catheter-based intervention, the prognosis of PVS is unsatisfactory. This study aimed to assess the prognosis and to establish appropriate treatment strategies.Methods:We retrospectively reviewed endovascular treatments for PVS (2001–2017) from the clinical database at the Okayama University Hospital.Results:A total of 24 patients underwent PVS associated with total anomalous pulmonary venous connection and 7 patients underwent isolated congenital PVS. In total, 53 stenotic pulmonary veins were subjected to endovascular treatments; 40 of them were stented by hybrid (29) and percutaneous procedures (11) (bare-metal stent, n = 34; drug-eluting stent, n = 9). Stent size of hybrid stenting was larger than percutaneous stenting. Median follow-up duration from the onset of PVS was 24 months (4–134 months). Survival rate was 71 and 49% at 1 and 5 years, respectively. There was no statistically significant difference between stent placement and survival; however, patients who underwent bare-metal stent implantation had statistically better survival than those who underwent drug-eluting stent implantation or balloon angioplasty. Early onset of stenosis, timing of stenting, and small vessel diameter of pulmonary vein before stenting were considered as risk factors for in-stent restenosis. Freedom from re-intervention was 50 and 26% at 1 and 2 years.Conclusions:To improve survival and stent patency, implantation of large stent is important. However, re-intervention after stenting is also significant to obtain good outcome.

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Drug-Eluting Stents Ameliorate Pulmonary Vein Stenotic Changes in Pigs In Vivo

Cited by 14 publications

References 30 publications

Comparison of drug eluting versus bare metal stents for pulmonary vein stenosis in childhood

Comparison of drug eluting versus bare metal stents for pulmonary vein stenosis in childhood

Pulmonary Hypertension due to Radiofrequency Catheter Ablation (RFCA) for Atrial Fibrillation: The Lungs, the Atrium or the Ventricle?

Clinical outcomes after the endovascular treatments of pulmonary vein stenosis in patients with congenital heart disease

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