In-stent restenosis of drug-eluting stents in patients with diabetes mellitus: Clinical presentation, angiographic features and outcomes

Paramasivam, Ganesh; Devasia, Tom; Jayaram, Ashwal Adamane; K, Abdul Razak U; Rao, M. Sudhakar; Vijayvergiya, Rajesh; Nayak, Krishnananda

doi:10.14744/anatoljcardiol.2019.72916

Cited by 26 publications

(21 citation statements)

References 29 publications

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“…Perhaps the observation period here was too short, and therefore, no effect of DM on the frequency of ISR was found. In a one-year follow-up study performed by Paramasivam et al, it was shown that, in subjects with DM, the incidence of stent-edge restenosis after PCI with DES implantation is higher than in individuals without DM (20.3% vs. 9.2%, p = 0.019) [167].…”

Section: Clinical Significance Of Restenosismentioning

confidence: 96%

Pathogenesis and Clinical Significance of In-Stent Restenosis in Patients with Diabetes

Jakubiak

Pawlas

Cieślar

et al. 2021

IJERPH

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Diabetes mellitus (DM) is a strong risk factor for the development of cardiovascular diseases such as coronary heart disease, cerebrovascular disease, and peripheral arterial disease (PAD). In the population of people living with DM, PAD is characterised by multi-level atherosclerotic lesions as well as greater involvement of the arteries below the knee. DM is also a factor that significantly increases the risk of lower limb amputation. Percutaneous balloon angioplasty with or without stent implantation is an important method of the treatment for atherosclerotic cardiovascular diseases, but restenosis is a factor limiting its long-term effectiveness. The pathogenesis of atherosclerosis in the course of DM differs slightly from that in the general population. In the population of people living with DM, more attention is drawn to such factors as inflammation, endothelial dysfunction, platelet dysfunction, blood rheological properties, hypercoagulability, and additional factors stimulating vascular smooth muscle cell proliferation. DM is a risk factor for restenosis. The purpose of this paper is to provide a review of the literature and to present the most important information on the current state of knowledge on mechanisms and the clinical significance of restenosis and in-stent restenosis in patients with DM, especially in association with the endovascular treatment of PAD. The role of such processes as inflammation, neointimal hyperplasia and neoatherosclerosis, allergy, resistance to antimitotic drugs used for coating stents and balloons, genetic factors, and technical and mechanical factors are discussed. The information on restenosis collected in this publication may be helpful in planning further research in this field, which may contribute to the formulation of more and more precise recommendations for the clinical practice.

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Section: Clinical Significance Of Restenosismentioning

confidence: 96%

Pathogenesis and Clinical Significance of In-Stent Restenosis in Patients with Diabetes

Jakubiak

Pawlas

Cieślar

et al. 2021

IJERPH

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“…On the basis of the results, we verified older age as a predictor of ISR by logistic regression analysis and ROC curve analysis (AUC = 0.604, P = 0.032). Older age can independently predict the risk for ISR after stent implantation [ 25 , 26 ]. Elderly patients with frequent and numerous comorbidities consistently exhibit decreased anticoagulant ability and thicker arterial walls, which makes them fragile with different phenotypes.…”

Section: Discussionmentioning

confidence: 99%

Risk factors for revascularization and in-stent restenosis in patients with triple-vessel disease after second-generation drug-eluting stent implantation: a retrospective analysis

Zeng

Yan

2021

BMC Cardiovasc Disord

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Objectives Coronary artery disease (CAD) is a common cardiac disease with high morbidity and mortality, and triple-vessel disease (TVD) is a severe type of CAD. This study investigated risk factors for revascularization and in-stent restenosis (ISR) in TVD patients who underwent second-generation drug-eluting stent implantation. Methods A retrospective clinical study was conducted, and 246 triple-vessel disease (TVD) patients with 373 vessels after second-generation drug-eluting stent (DES) implantation who received follow-up coronary angiography (CAG) were consequently enrolled. According to the follow-up angiography, patients were categorized into the revascularization group and nonrevascularization group as well as the in-stent restenosis (ISR) group and non-ISR group. Univariate and multivariate logistic regression analyses were used to identify risk factors for revascularization and ISR. Receiver operating characteristic (ROC) curve with area under the curve (AUC) analysis was performed to assess the predictive power of these risk factors. Results In the median follow-up period of 28.0 (14.0, 56.0) months, 142 TVD patients (57.7%) with 168 vessels underwent revascularization, and ISR occurred in 43 TVD patients (17.5%) with 47 vessels after second-generation DES implantation. Compared to the nonrevascularization group, the revascularization group presented with an increased rate of current smoking and higher levels of TC, LDL-C, HDL-C, non-HDL-c, ApoB, neutrophils, and Hs-CRP as well as a longer follow-up of months but with a lower level of HDL-C. In addition, patients in the ISR group had an older age, longer follow-up (months) and elevated rates of current smoking and stage 4–5 chronic kidney disease (CKD4-5). In multivariate analysis, current smoking and higher non-HDL-c were independent risk factors for revascularization. In addition, older age, current smoking and CKD4-5 were considered independent risk factors for ISR. Importantly, the receiver operating characteristic curve showed that non-HDL-C and age displayed predictive power for revascularization and ISR, respectively. Conclusion Current smoking is an independent risk factor for both revascularization and in-stent restenosis. Higher non-HDL-c is independently related to revascularization; moreover, increased age and CKD4-5 are potential risk factors for ISR in TVD patients after second-generation drug-eluting stent implantation.

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“…However, some studies have proven that diabetes in fact increases the risk of restenosis at the edges of the stents. 21 The efficiency and efficacy of REJUVENATE ® can be estimated by the fact that around 80% patients were either diabetic or hypertensive or both and still it performed efficiently; and did not give rise to any major cardiac event. In Driver Registry, there were 68% hypertensive patients and 27% diabetic patients and Driver BMS [Medtronic, U.S.A] exhibited 3.4% of TLR and 5% TVF.…”

Section: Discussionmentioning

confidence: 99%

Clinical Evaluation of the Indigenously Manufactured Rejuvenate® Bare Metal Stent System in Pakistani Patients With Coronary Artery Disease

Kayani¹,

Rizvi

Niazi³

et al. 2021

Pak Heart J

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Objectives: The aim of this pilot study was the ﬁrst-in-man evaluation of the safety, feasibility, deliverability, and efficiency of the newly developed REJUVENATE® bare metal stent system in coronary artery disease. Methodology: Current study was a pilot non-randomized, multi-centric and prospective study which was intended to study the safety of the REJUVENATE® bare metal stent in Pakistani population over 10 months. Study endpoints included target vessel related myocardial infarction, stent thrombosis, in-stent restenosis, stroke and death. The diameter of the target lesions selected was between 3-4mm with length no more than 22mm. Only one BMS was implanted per patient. These patients had well defined regular clinical follow-ups and CT scan coronary angiography at the end of 10 months. Results: 20 patients suffering from coronary artery disease (CAD) including15 male subjects and 5 female subjects were enrolled in this study and were treated with REJUVENATE® BMS. 65% patients were hypertensive, 25% diabetics and 25% were active smokers. Out of the 20 stents implanted, 14 stents were implanted in the right coronary artery and 6 were implanted in the left circumflex artery. During this 10-month study period there was 10.65% of cases in which late lumen loss (lumen stenosis <70%) was observed, however no cases of in stent restenosis and stent thrombosis were observed. There was no target vessel related myocardial infarction or stroke as well. One patient died of pneumonia during the follow up period. Conclusion: The current study demonstrated the deliverability and clinical safety of REJUVENATE® bare metal stent over a period of 10 months.

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In-stent restenosis of drug-eluting stents in patients with diabetes mellitus: Clinical presentation, angiographic features and outcomes

Cited by 26 publications

References 29 publications

Pathogenesis and Clinical Significance of In-Stent Restenosis in Patients with Diabetes

Pathogenesis and Clinical Significance of In-Stent Restenosis in Patients with Diabetes

Risk factors for revascularization and in-stent restenosis in patients with triple-vessel disease after second-generation drug-eluting stent implantation: a retrospective analysis

Clinical Evaluation of the Indigenously Manufactured Rejuvenate® Bare Metal Stent System in Pakistani Patients With Coronary Artery Disease

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