Improved Late Clinical Safety With Zotarolimus-Eluting Stents Compared With Paclitaxel-Eluting Stents in Patients With De Novo Coronary Lesions

Leon, Martin B.; Nikolsky, Eugenia; Cutlip, Donald E.; Mauri, Laura; Liberman, Henry; Wilson, Hadley; Patterson, John B.; Moses, Jeffrey W.; Kandzari, David E.; Investigators, Endeavor Iv

doi:10.1016/j.jcin.2010.07.008

Cited by 96 publications

(22 citation statements)

References 24 publications

(14 reference statements)

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“…After the first ENDEAVOR trials, the subsequent ENDEAVOR III trial compared ZESs with SESs, with ZES showing greater late lumen loss and ISR but less major adverse cardiovascular events (MACE) than SESs 30. The ENDEAVOR IV trial compared ZESs with PESs and again found higher rates of ISR but fewer AMIs, ostensibly from very late ST in the ZES group 31. However, the PROTECT trial failed to demonstrate a difference in ST rates between Endeavor and Cypher stent 32…”

Section: Coronary Stentsmentioning

confidence: 99%

Coronary stents and vascular response to implantation: literature review

Brancati¹,

Burzotta²,

Trani³

et al. 2017

POR

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Drug-eluting stents (DESs) have minimized the limitations of bare-metal stents (BMSs) after percutaneous coronary interventions. Nevertheless, serious concerns remain about possible late complications of stenting, such as stent thrombosis (ST) and in-stent restenosis (ISR), although the introduction of second-generation DESs seems to have softened the phenomenon, compared to the first-generation ones. ST is a potentially catastrophic event, which has been markedly reduced by optimization of stent implantation, novel stent designs, and dual antiplatelet therapy. The exact mechanism to explain its occurrence is under investigation, and, realistically, multiple factors are responsible. ISR of BMSs has been previously considered as a stable condition with an early peak (at 6 months) of intimal hyperplasia, followed by a regression period beyond 1 year. On the contrary, both clinical and histologic studies of DESs have demonstrated evidence of continuous neointimal growth during long-term follow-up, named “late catch-up” phenomenon. The acknowledgment that ISR is a relatively benign clinical condition has been recently challenged by evidences which reported that patients with ISR can experience acute coronary syndromes. Intracoronary imaging is an invasive technology that allows identifying features of atherosclerotic plaque of stent implanted and of vascular healing after stenting; it is often used to complete diagnostic coronary angiography and to drive interventional procedures. Intracoronary optical coherence tomography is currently considered a state-of-the-art imaging technique; it provides, compared to intravascular ultrasound, better resolution (at least >10 times), allowing the detailed characterization of the superficial structure of the vessel wall. Imaging studies “in vivo,” in agreement with histological findings, suggest that chronic inflammation and/or endothelial dysfunction may induce late de novo “neoatherosclerosis” inside both BMSs and DESs. So, neoatherosclerosis has become the prime suspect in the pathogenesis of late stent failure.

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Section: Coronary Stentsmentioning

confidence: 99%

Coronary stents and vascular response to implantation: literature review

Brancati¹,

Burzotta²,

Trani³

et al. 2017

POR

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“…Recent studies have shown that second-generation DESs (Everolimus-eluting or Zotarolimuseluting stent) lead to more favorable healing profiles18) and are associated with lower rates of ST compared with first-generation DESs 19)20)…”

Section: Discussionmentioning

confidence: 99%

Kounis Syndrome Presenting as Very Late Stent Thrombosis in an Everolimus-Eluting Stent Following Wasp Stings

Min

Kang

2013

Korean Circ J

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Kounis syndrome is the concurrence of acute coronary syndromes with conditions associated with mast cell activation following an allergic insult. We report a 56-year-old man who experienced a ST-segment elevation myocardial infarction after wasp stings. The patient presented without signs of anaphylaxis or shock. Coronary angiography showed an everolimus-eluting stent thrombosis (ST) of the left anterior descending artery occluding the vessel completely which was deployed for stable angina 3 years ago. The patient had been compliant with anti-platelet therapy, and no relevant cardiovascular events occurred until the day of admission. We interpreted our patient's condition as a manifestation of Kounis syndrome. To our knowledge, this is the first case of Kounis syndrome showing very late ST in a second-generation drug-eluting stent caused by wasp stings.

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“…ENDEAVOR IV (Randomized Comparison of Zotarolimus and Paclitaxel-Eluting Stents in Patient with Coronary Artery Disease) showed noninferiority of the ZES to the paclitaxel-eluting stent (PES) for target vessel failure (cardiac death, MI, target vessel revascularization) at 9-month follow-up 43. Long-term follow-up found similar rates of target lesion revascularization (6.5% versus 6.1%, P =0.662) with an improvement in rates of cardiac death, MI, and very late stent thrombosis, (0.1% versus 1.6%, P =0.004), favoring the Endeavor 44. However, when the ZES was compared with the sirolimus-eluting stent (SES) in ENDEAVOR III (Comparison of Zotarolimus-Eluting and Sirolimus-Eluting stents in Patients With Native Coronary Artery Disease), the results were not as convincing regarding its improvement over first-generation DES 45.…”

Section: Stent Evolution In Clinical Trialsmentioning

confidence: 99%

Advances in stent technologies and their effect on clinical efficacy and safety

Nikam¹,

Steinberg²,

Steinberg³

2014

MDER

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The introduction of intracoronary stents represented a major advance in interventional cardiology. While bare metal stents set the benchmark for improved safety over angioplasty, intimal hyperplasia and subsequent restenosis were important limitations. First-generation drug-eluting stents demonstrated significant improvements in efficacy, but not necessarily safety, and further technologic developments have focused on optimizing both. Current advances and understanding in stent design continue to improve on these concepts. This review summarizes past and present technology with particular emphasis on the principles underlying the efficacy and safety of drug-eluting stents, and offers a glimpse into the next generations of stents aimed at treating symptomatic coronary artery disease.

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Improved Late Clinical Safety With Zotarolimus-Eluting Stents Compared With Paclitaxel-Eluting Stents in Patients With De Novo Coronary Lesions

Cited by 96 publications

References 24 publications

Coronary stents and vascular response to implantation: literature review

Coronary stents and vascular response to implantation: literature review

Kounis Syndrome Presenting as Very Late Stent Thrombosis in an Everolimus-Eluting Stent Following Wasp Stings

Advances in stent technologies and their effect on clinical efficacy and safety

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