Impact of Stent Deployment Procedural Factors on Long-Term Effectiveness and Safety of Sirolimus-Eluting Stents (Final Results of the Multicenter Prospective STLLR Trial)

Costa, Marco A.; Angiolillo, Dominick J.; Tannenbaum, Mark; Driesman, Mitchell; Chu, Alan; Patterson, John B.; Kuehl, W. D.; Battaglia, Joseph; Dabbons, Samir; Shamoon, Fayez; Flieshman, Bruce; Niederman, Alan; Bass, Theodore A.

doi:10.1016/j.amjcard.2008.02.053

Cited by 215 publications

(135 citation statements)

References 15 publications

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“…Little is known about the development mechanism of edge restenosis, however, the residual uncovered atherosclerotic plaques or exposed margins of the stent that did not cover the entire region of the balloon injury could be the primary sites of edge restenosis. [13][14][15] Therefore, it seems that careful DES positioning and meticulous attention to decrease balloon injury outside the stent are still valid technical recommendations even with 2nd generation DES implantation. The optimal treatment for DES restenosis remains undefined.…”

Section: Lee Et Almentioning

confidence: 99%

Angiographic Patterns of Restenosis With 2nd Generation Drug-Eluting Stent

Lee

Yoon

et al. 2015

Int. Heart J.

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SummaryThe angiographic features of restenosis contain prognostic information. However, restenosis patterns of the new generation drug-eluting stents (DES), everolimus-(EES) and resolute zotarolimus-eluting stent (ZES) have not been described.A total of 210 consecutive patients with DES restenosis were enrolled from 2003 to 2012. We analyzed 217 restenotic lesions after DES implantation, and compared the morphologic characteristics of the 2nd generation DES restenosis to those of restenosis with 2 first generation DES, sirolimus-(SES) and paclitaxel-eluting stent (PES).Baseline characteristics were comparable between the different stent groups. The incidence of focal restenosis was significantly lower for PES than the other stents (49.5% versus 87.0%, 76.2%, and 82.1% for PES versus SES, EES, and ZES, respectively, P < 0.001). When considering the pattern of restenosis solely within the stent margins, a further clear distinction between PES and other stents was observed (40.0% versus 92.9%, 88.9%, and 81.2% in PES versus SES, EES, and ZES, respectively, P < 0.001). There were no significant differences in restenosis patterns among SES, EES, and ZES. In multivariate analysis, PES implantation, hypertension, and age were associated with non-focal type of restenosis after DES implantation. After the introduction of EES and ZES into routine clinical practice in 2008, focal restenosis significantly increased from 63.9% to 76.7% and diffuse restenosis significantly decreased from 26.4% to 11.0% (P = 0.045).Focal restenosis was the most common pattern of restenosis in the new generation DES and the incidence of diffuse restenosis significantly decreased with the introduction of the 2nd generation DES. (Int Heart J 2015; 56: 6-12) Key words: Coronary, Intervention, Angioplasty, Angiography I n the stent era, in-stent restenosis (ISR) has been one of the major issues of percutaneous coronary intervention (PCI). 1) Even if drug-eluting stents (DES) dramatically reduce the rates of restenosis and target lesion revascularization (TLR) after PCI, 2) DES restenosis is still clinically important with the expansion of the indications for PCI to high-risk patients and complex lesions. The angiographic presentation of ISR may have important prognostic information on subsequent TLR not only after bare-metal stent (BMS) implantation 3) but also after DES implantation. 4,5) Moreover, the morphologic classification of DES ISR remains an important predictor of clinical outcomes after ISR treatment. [4][5][6] The newer DES, such as everolimus-eluting stents (EES) and Resolute zotarolimus-eluting stents (ZES), are characterized by improvements in stent platform, polymer, and drug, with the aim of minimizing the incidence of DES ISR and improving safety.7-10) However, the angiographic patterns of the new generation DES ISR have not been fully described yet. Thus, we analyzed the angiographic patterns of restenosis that occurred after DES implantation in our institution, and compared the morphologic patterns of the new generation DES ISR ...

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Section: Lee Et Almentioning

confidence: 99%

Angiographic Patterns of Restenosis With 2nd Generation Drug-Eluting Stent

Lee

Yoon

et al. 2015

Int. Heart J.

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“…12,13,21,22 Thus, proximal edge restenosis may occur particularly when there is diffuse atherosclerosis in the angiographic reference segment. 22,23 In contrast, distal edge restenosis is infrequent. An experimental study showed a higher drug concentration at the distal edge, 24 which may be associated with less restenosis.…”

Section: Ses Edge Restenosismentioning

confidence: 99%

Angiographic Patterns of Restenosis After Sirolimus-Eluting Stent Implantation

Kitahara

Kobayashi

Takebayashi

et al. 2009

Circ J

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Circ J 2009; 73: 508 -511 lthough drug-eluting stents (DES) have significantly decreased the incidence of restenosis and the need for repeat revascularization, restenosis still occurs. 1-10 Large-scale randomized trials 1-3 have demonstrated a high proportion of focal restenosis after DES implantation, but on the other hand, recent real-world registries have shown that a significant proportion of restenosis is non-focal when DES are used in unselected lesions. [4][5][6][7][8] The present study evaluated angiographic patterns of restenosis after sirolimuseluting stent (SES) implantation in real-world practice in Japan. Methods PatientsA total of 1,693 lesions underwent SES implantation in 3 Japanese hospitals (Chiba University Hospital, Fukuyama Cardiovascular Hospital, and Chiba Cardiovascular Center) between August 2004 and April 2007. PCI was performed after written informed consent was given by the patients. All lesions underwent SES implantation according to current guidelines. 10 Angiographic follow-up was performed in 1,312 lesions (78%) at 6-9 months or earlier if noninvasive evaluation or clinical presentation suggested ischemia. Restenosis occurred in 124 lesions (9.5%) in 122 patients.Using a validated edge detection system (CMS, MEDIS, The Netherlands), quantitative coronary angiography was performed by an experienced cardiologist (H.K.). Standard qualitative and quantitative definitions and measurements were used. The outer diameter of the contrast-filled catheter was used as the calibration and the minimal lumen diameter was obtained from the single "worst" view. Angiographic restenosis was defined as diameter stenosis >50% within a previously stented segment (stent and 5 mm proximal and distal) on follow-up angiography. Cases of stent thrombosis were not considered as restenosis. The angiographic pattern of restenosis was classified as focal (≤10 mm in length), diffuse (restenosis >10 mm within the stent), proliferative (restenosis >10 mm in length extending outside the stent) or occlusive. 11 Focal restenosis was further categorized according to its position as proximal edge, intrastent, distal edge, or multi-focal. This study was approved by the local council on human research. Statistical AnalysisStatistical analysis was performed using StatView 5.0 (SAS Institute, Cary, NC, USA). Continuous variables are expressed as mean ± SD and categorical variables as frequency (%). Continuous variables were compared using Student's t-test. Categorical variables were compared with chi-square statistics; P<0.05 was considered significant.Multivariate logistic regression was used to identify independent predictors of non-focal restenosis. At this stage, the diffuse, proliferative, and occlusive restenosis patterns were combined into a single non-focal group in order to simplify and strengthen subsequent analysis. This was done (Received July 23, 2008; revised manuscript received September 30, 2008; accepted October 20, 2008; released online January 16, 2009 Angiographic Patterns of Restenosis After Sirol...

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“…A detailed description of the protocol has been previously reported. 5 In summary, within 72 h after implantation of SES, cineangiograms were transmitted to an independent angiographic core laboratory, which analyzed all the steps of the percutaneous coronary intervention proce-TAHARA S et al…”

Section: Methodsmentioning

confidence: 99%

“…1- 4 The impact of stent deployment techniques on clinical outcomes of patients treated with sirolimus-eluting stents (SES) was recently investigated in the Stent deployment Techniques on cLinicaL outcomes of patients treated with the cypheR TM stent (STLLR) trial. 5 Geographical miss (GM) was associated with a higher incidence of target vessel revascularization (TVR) and myocardial infarction 1 year after the deployment of SES. The term GM was first introduced in interventional cardiology when describing the failure to fully treat the diseased coronary artery segment and was also recognized as an important predictor of restenosis after brachytherapy.…”

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confidence: 99%

Impact of Acute Gain on Clinical Outcomes of Patients Treated With Sirolimus-Eluting Stent - A Sub-Analysis Study From the STLLR Trial -

Tahara

Bezerra

Kyono

et al. 2011

Circ J

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Background: Geographical miss (GM), representing suboptimal drug-eluting stent deployment, is associated with an increased risk of target lesion revascularization (TLR) and myocardial infarction. The impact of suboptimal stenting techniques on clinical outcomes in diabetics remains unknown. Methods and Results:Stent deployment Techniques on cLinicaL outcomes of patients treated with the cypheR TM stent (STLLR) is the first multicenter, large trial to prospectively evaluate outcomes associated with sirolimus-eluting stent (SES) deployment techniques. Axial GM and longitudinal GM (LGM), defined as a balloon injured segment or a diseased segment not covered by a SES, were assessed by an independent core laboratory. One-year outcomes between diabetics and non-diabetics and their relationship with GM were assessed. This substudy included 1,336 patients, 28.8% with diabetes. In non-LGM patients, TLR was similarly low in both diabetics and non-diabetics (2.0% vs. 2.0%, P=NS). However, TLR increased 4.1 times in diabetics (8.0%) and 1.9 times in non-diabetics (3.8%) in the presence of LGM (P=0.03). Axial GM had no impact on outcomes. By univariate analysis, stent length, acute gain, and LGM were the predictors of TLR in the total cohort. However, by multivariate analysis, acute gain was the only predictor of TLR (P=0.03), independently of LGM or diabetes.Conclusions: Acute gain is the exclusive predictor of TLR after SES implantation. Particularly in diabetics, the negative impact of LGM on TLR seems to be amplified. Diligent SES deployment for larger acute gain is critical to improve clinical outcomes. (Circ J 2011; 75: 2113 - 2119

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Impact of Stent Deployment Procedural Factors on Long-Term Effectiveness and Safety of Sirolimus-Eluting Stents (Final Results of the Multicenter Prospective STLLR Trial)

Cited by 215 publications

References 15 publications

Angiographic Patterns of Restenosis With 2nd Generation Drug-Eluting Stent

Angiographic Patterns of Restenosis With 2nd Generation Drug-Eluting Stent

Angiographic Patterns of Restenosis After Sirolimus-Eluting Stent Implantation

Impact of Acute Gain on Clinical Outcomes of Patients Treated With Sirolimus-Eluting Stent - A Sub-Analysis Study From the STLLR Trial -

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