Frequency, Etiology, Treatment, and Outcomes of Drug-Eluting Stent Thrombosis During One Year of Follow-Up

Sandhu, Gurpreet S.; Doyle, Brendan; Singh, Rajesh Kumar; Bell, Malcolm R.; Bresnahan, John F.; Holmes, David R.; Lerman, Amir; Rihal, Charanjit S.

doi:10.1016/j.amjcard.2006.08.058

Cited by 24 publications

(11 citation statements)

References 28 publications

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“…However, our study demonstrates that it is feasible to combine antiproliferative therapies with technologies designed to increase stent endothelialization, particularly EPC-capturing, with the objective of promoting vascular healing (20,21). Furthermore, anti-CD34 antibody surface modification did enhance stent endothelialization when applied on SES.…”

Section: Discussionmentioning

confidence: 77%

Anti-CD34 Antibodies Immobilized on the Surface of Sirolimus-Eluting Stents Enhance Stent Endothelialization

Nakazawa

Granada

Alviar

et al. 2010

JACC: Cardiovascular Interventions

143

107

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Section: Discussionmentioning

confidence: 77%

Anti-CD34 Antibodies Immobilized on the Surface of Sirolimus-Eluting Stents Enhance Stent Endothelialization

Nakazawa

Granada

Alviar

et al. 2010

JACC: Cardiovascular Interventions

143

107

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“…In drug-eluting stents for coronary artery intervention, subacute thrombosis was reported to be higher compared with bare metal stents (0.9% to 3.1%) but still did not reach the frequency that we observed in our study for intracranial stents. 3 This should be considered in the current ongoing discussion on using drugeluting stents in the intracranial circulation. 30 As in our study, there is a high level of uncertainty about the reasons for instent thrombosis in the interventional cardiology literature.…”

Section: Discussionmentioning

confidence: 99%

“…1 In contrast, stent thrombosis after coronary artery angioplasty is an important issue that has been reported on a regular basis for Ͼ10 years. [2][3][4] Furthermore, researchers in interventional cardiology have analyzed the underlying pathophysiology of stent thrombosis in depth [5][6][7][8][9] and have presented treatment options to lower the overall risk for this complication. 10 -12 Apart from that, effective treatment procedures have been reported for cases of subacute stent thrombosis after coronary angioplasty.…”

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confidence: 99%

Subacute Stent Thrombosis in Intracranial Stenting

Riedel

Tietke

Alfke

et al. 2009

Stroke

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Background and Purpose— We sought to determine the safety of intracranial stenting with respect to subacute stent thrombosis in patients being treated with standardized antiplatelet therapy. Methods— We retrospectively evaluated the outcome of primary intracranial stenting of atherosclerotic stenoses and of stenting in coil embolization procedures in 67 patients. We focused on those cases that led to subacute stent thrombosis even though the patients had been treated with standardized antiplatelet therapy before, during, and after stent placement. Patient age ranged from 19 to 78 years. In 33 patients, stents were placed for treatment of atherosclerotic stenoses; in the remaining 34 patients, stents were placed to assist coiling of aneurysms. The patients in this study were treated between January 2003 and August 2007. Results— Of the total 67 patients initially treated successfully by intracranial stenting, 7 patients developed subacute stent thrombosis. Of these 7 patients, 3 received stent placement into the basilar artery because of an underlying stenosis; in 1 patient, a stenosis of the M1 segment of the middle cerebral artery was treated. In 3 patients, aneurysms of the anterior cerebral artery, the posterior inferior cerebellar artery, and the basilar artery were treated by stent-assisted coil embolization. In 4 of the 7 patients with subacute thrombosis, recanalization of stents by local application of recombinant tissue-type plasminogen activator was successful. Conclusions— Intracranial stenting can lead to subacute stent thrombosis, even in patients who are treated with standardized antiplatelet therapy. Such complications have been described for patients after coronary artery stenting, but to our knowledge, no one has reported on a comparable number of cases of intracranial stenting procedures. In certain clinical scenarios, local thrombolysis with recombinant tissue-type plasminogen activator is an important treatment option to deal with subacute stent thrombosis.

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“…1 However, the beneficial effects seen with most of the antiproliferative medications are found to be hampered by the potential of late thrombotic events that seem to be related to delayed vascular healing. [2][3][4] Stent endothelialization after acute vascular injury results from either the local recruitment of adjacent endothelial cells 5 or blood-derived endothelial progenitor cells (EPC) that adhere, differentiate, and populate the surface of the device. 2 Although the predominant mechanism of stent endothelialization is still unclear, the phenomenon of vascular healing occurring after bare-metal stent implantation is linear and predictable.…”

mentioning

confidence: 99%

Development of a Novel Prohealing Stent Designed to Deliver Sirolimus From a Biodegradable Abluminal Matrix

Granada

Inami

Aboodi

et al. 2010

Circ: Cardiovascular Interventions

113

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Background-We aimed to demonstrate that, by separating endothelial progenitor cell capture from sirolimus delivery through the application of drug to the abluminal surface of the stent, the degree of endothelialization can be enhanced. Methods and Results-Stainless steel R Stents, with biodegradable SynBiosys polymer coating with sirolimus abluminally applied and surface modified with anti-CD34 antibody were prepared at 2 dosages (low-dose sirolimus [LD-Combo, 2.5 g sirolimus/mm] and full-dose sirolimus [Combo, 5 g sirolimus/mm). These Combo stents and the Cypher stent (10 g sirolimus/mm) were deployed in 98 normal porcine arteries and harvested for pharmacokinetic analysis at 0.25, 1, 3, 7, 14, 28, and 35 days. The LD-Combo stents showed faster early release (50% total dose in 72 hours) than the Combo and Cypher. At 30 days, drug release was near complete with both Combo stents, whereas 20% of drug remained on the Cypher stents. To assess efficacy, a total of 50 stents (Xience Vϭ8, Cypherϭ8, Genous bioengineered R stentϭ6, LD-Comboϭ14, and Comboϭ14) were implanted in 18 pigs for 14 and 28 days. Optical coherence tomography was performed, and stents were harvested for histology. At 28 days, there was less neointimal thickness with Combo (0.173Ϯ0.088 mm) compared with Cypher (0.358Ϯ0.225 mm), LD-Combo (0.316Ϯ0.228 mm), and Xience V (0.305Ϯ0.252 mm; PϽ0.00001). Immunohistochemical analysis of endothelialization showed that Genous bioengineered R stent had the highest degree of platelet endothelial cell adhesion molecule expression (87%) followed by the Combo (75%), LD-Combo (65%), and Cypher (58%). Conclusions-Both optical coherence tomography and histology demonstrate that anti-CD34 sirolimus-eluting stents promote endothelialization while reducing neointimal formation and inflammation. (Circ Cardiovasc Interv. 2010;3:257-266.)

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Frequency, Etiology, Treatment, and Outcomes of Drug-Eluting Stent Thrombosis During One Year of Follow-Up

Cited by 24 publications

References 28 publications

Anti-CD34 Antibodies Immobilized on the Surface of Sirolimus-Eluting Stents Enhance Stent Endothelialization

Anti-CD34 Antibodies Immobilized on the Surface of Sirolimus-Eluting Stents Enhance Stent Endothelialization

Subacute Stent Thrombosis in Intracranial Stenting

Development of a Novel Prohealing Stent Designed to Deliver Sirolimus From a Biodegradable Abluminal Matrix

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