Impact of strut thickness and number of crown and connectors on clinical outcomes on patients treated with second‐generation drug eluting stent

Iannaccone, Mario; Gatti, Philip J.; Barbero, Umberto; Bassignana, Antonia; Gallo, Diego; Benedictis, Michele De; Helft, Gérard; Morbiducci, Umberto; Doronzo, Baldassare; D’Ascenzo, Fabrizio

doi:10.1002/ccd.28228

Cited by 15 publications

(9 citation statements)

References 38 publications

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“…DP-DES are equally heterogeneous groups. Innaccone et al observed that lower strut thickness would have a positive clinical outcome, thereby reducing ST and TLRs 37. We were unable to match the stents with regards to the strut thickness.…”

Section: Discussionmentioning

confidence: 89%

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Comparison of biodegradable and durable polymer drug-eluting stents in acute coronary syndrome: a meta-analysis

Yuan

et al. 2022

BMJ Open

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ObjectiveTo compare the safety and effectiveness between biodegradable polymer drug-eluting stents (BP-DES) and durable polymer drug-eluting stents (DP-DES) in patients with acute coronary syndrome (ACS).DesignMeta-analysis of randomised controlled trials (RCTs).Primary and secondary outcome measuresMajor adverse cardiovascular events (MACEs) were considered the primary endpoint. Efficacy endpoints included target vessel revascularisation (TVR) and target lesion revascularisation (TLR). Safety endpoints included all-cause death, cardiac death, target vessel myocardial infarction and stent thrombosis (ST).MethodsWe searched PubMed, Medline, Embase and the Cochrane Controlled Register of Trials for comparative studies of BP-DES and DP-DES in patients with ACS from January 2000 to July 2021. Statistical pooling was performed to estimate incidence using a random-effects model with generic inverse-variance weighting. Risk estimates were computed with 95% CIs.ResultsEight articles with seven RCTs that compared BP-DES and DP-DES in patients with ACS were identified and included in the qualitative and quantitative analyses. There was no difference in the baseline characteristics, except for the number of smoking patients (OR: 1.13, 95% CI 1.03 to 1.24; p=0.008, I2=29%), which was significantly lower in the BP-DES group. The meta-analysis demonstrated that MACEs, efficacy endpoints and safety endpoints were similar between the groups at 1 year. However, the incidence of total ST was signiﬁcantly different between the BP-DES and DP-DES groups in the follow-up period (p=0.0001). Further analysis showed a statistically significant difference in MACEs (OR: 0.71, 95% CI 0.57 to 0.88; p=0.002, I2=0 %), TLR (OR: 0.71, 95% CI 0.51 to 1.01; p=0.05, I2=0%), TVR (OR: 0.70, 95% CI 0.52 to 0.94; p=0.002, I2=15%), total ST incidence (OR: 0.59, 95% CI 0.46 to 0.77; p=0.0001, I2=48%) and ST incidence (OR: 0.63, 95% CI 0.47 to 0.85; p=0.002, I2=0%) over 2 years.ConclusionThis meta-analysis revealed that both stent types demonstrated excellent safety and efficacy profiles at 12 months. However, a slight increase in MACEs, TLR, TVR and ST incidence was observed in the DP-DES group over the 2-year follow-up period, suggesting that BP-DES may be more favourable when treating patients with ACS.Trial registration numberNCT00389220.

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Section: Discussionmentioning

confidence: 89%

“…Innaccone et al observed that lower strut thickness would have a positive clinical outcome, thereby reducing ST and TLRs. 37 We were unable to match the stents with regards to the strut thickness. Consequently, the reported results may not be generalisable to all stents from the respective group.…”

Section: Discussionmentioning

confidence: 99%

Comparison of biodegradable and durable polymer drug-eluting stents in acute coronary syndrome: a meta-analysis

Yuan

et al. 2022

BMJ Open

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“…The impact of strut thickness on subsequent repeat revascularization remains inconclusive in the literature. A recent meta‐analysis of RCTs focusing on new DESs reported that the incidence of 1‐year TLR favored DESs with strut thickness ≤ 81 μm when compared with those > 81 μm 14 . Conversely, a network meta‐analysis investigating both early and new DESs reported that TLR incidence was comparable among DESs with struts of 60–80, 81–100, 101–120, and > 120 μm 6 .…”

Section: Discussionmentioning

confidence: 99%

“…Strut thickness and TLRThe impact of strut thickness on subsequent repeat revascularization remains inconclusive in the literature. A recent meta-analysis of RCTs focusing on new DESs reported that the incidence of 1-year TLR favored DESs with strut thickness ≤ 81 μm when compared with those > 81 μm 14. Conversely, a network meta-analysis investigatingF I G U R E 2Scatterplots of event incidence against stent strut thickness at study-arm level along with meta-regression lines, regarding early stent thrombosis (EST; A), late stent thrombosis (LST; B), and 5-year very late stent thrombosis (VLST; C).…”

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confidence: 99%

The relationship between coronary stent strut thickness and the incidences of clinical outcomes after drug‐eluting stent implantation: A systematic review and meta‐regression analysis

Saito

Dai

Ono

et al. 2021

Cathet Cardio Intervent

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Background: Drug-eluting stents (DESs) have been developed with thinner stent struts, and more biocompatible polymers and anti-proliferative drugs to improve the clinical performance. However, it remains unclear whether thinner struts are associated with favorable short-and long-term clinical outcomes such as target lesion revascularization (TLR), periprocedural myocardial infarction (PMI), and stent thrombosis (ST).Methods: We searched MEDLINE, Embase and other online sources for randomized controlled trials (RCTs) comparing clinical outcomes between a DES and other stent(s), with independent clinical event adjudication. We investigated stent-related events (TLR, PMI, and ST) in 5 years. Each outcome was analyzed with randomeffects meta-regression model against strut thickness, then adjusted for DES generation and patient and lesion characteristics.Results: We identified 49 RCTs enrolling 97,465 patients, of which strut thickness ranged from 60 to 140 μm. Incidences of 1-year TLR, PMI, and early ST were reduced with thinner stent struts, when adjusted for stent generation (adjusted relative risk[RR] per 10 μm increase 1.12 [95% CI 1.04-1.21], 1.15 [95% CI 1.05-1.26], and 1.15 [95% CI 1.06-1.25], respectively). Strut thickness was not independently associated with incidences of 5-year TLR, late and very late ST. In addition, early DESs contributed to a higher incidence of very late ).Conclusions: In this meta-regression analysis, a thinner strut thickness was associated with reduced incidences of early stent-related adverse events (1-year TLR, PMI, and early ST), but not with later events (5-year TLR, late ST, and very late ST).

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“…Joner et al (2006) reported this delayed arterial healing with drug‐eluting stents as part of a study to investigate the long‐term effects of stents on coronary arterial healing. The current standard of care in revascularization, the second‐generation drug‐eluting stent was introduced with ultrathin struts (80–90 µm), reduced drug loading and more biocompatible or biodegradable polymers (Bangalore, Toklu, Patel, Feit, & Stone, 2018; Beijk & Piek, 2007; Iannaccone et al, 2019; Palmerini et al, 2013). Nevertheless, the presence of antiproliferative drug and polymers can adversely elicit delayed or incomplete endothelialization obviating the need for a prolonged dual antiplatelet therapy (DAPT) (Bønaa et al, 2016; McFadyen, Schaff, & Peter, 2018).…”

Section: Introductionmentioning

confidence: 99%

Perspectives on smart stents with sensors: From conventional permanent to novel bioabsorbable smart stent technologies

Vishnu

Manivasagam

2020

Med Devices & Sens

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Percutaneous coronary intervention with the aid of cardiovascular stents is the widely used therapeutic procedure for treating occlusive vascular diseases associated with the plaque deposition inside blood vessels. In spite of the momentous evolution and innovations in the field of medical technologies as well as biomaterial science, cardiovascular stents are still associated with several limitations. The introduction of bare metal stents, which revolutionized the field of interventional cardiology, was later hampered by the occurrence of restenosis (recurrence of arterial narrowing after surgery) and target lesion revascularization (repeated percutaneous intervention or revascularization within a stent) (Nordrehaug, Wiseth, & Bønaa, 2016; Piccolo et al., 2019). Repeated attempts to correct stenotic regions can often result in rupture of vessel that can elicit blood clot formation (thrombosis) or even lead to life-threatening haemorrhage (Farooq and Gogas Bill, 2011). Restenosis occurrence originating from proliferative neointimal tissue growth in response to strut-related injury and inflammation can be clinically evident typically within 6-9 months after stent placement (Alfonso, Byrne, Rivero, & Kastrati, 2014; Moliterno, 2005). In order to specifically address the restenosis problem, the first-generation drug-eluting stents with a drug-loaded (paclitaxel) polymer coating on a metallic platform (316L stainless steel) were de

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Impact of strut thickness and number of crown and connectors on clinical outcomes on patients treated with second‐generation drug eluting stent

Cited by 15 publications

References 38 publications

Comparison of biodegradable and durable polymer drug-eluting stents in acute coronary syndrome: a meta-analysis

Comparison of biodegradable and durable polymer drug-eluting stents in acute coronary syndrome: a meta-analysis

The relationship between coronary stent strut thickness and the incidences of clinical outcomes after drug‐eluting stent implantation: A systematic review and meta‐regression analysis

Perspectives on smart stents with sensors: From conventional permanent to novel bioabsorbable smart stent technologies

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