Late stent malapposition risk is higher after drug-eluting stent compared with bare-metal stent implantation and associates with late stent thrombosis

Abolghasemi, Hassan; Bergheanu, Sandrin C.; Stijnen, Theo; Hoeven, Bas L. van der; Snoep, Jaapjan D.; Plevier, Josepha W.M.; Schalij, Martin J.; Jukema, J. Wouter

doi:10.1093/eurheartj/ehn553

Cited by 264 publications

(170 citation statements)

References 45 publications

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“…Several studies have reported LSM was common after DES than after bare metal stent implantation (2). Currently, the various postulated mechanisms of LSM have been reported.…”

Section: Discussionmentioning

confidence: 99%

Late stent malapposition combined by thrombus resolution after primary stenting in acute myocardial infarction: Optical coherence tomography findings

Her¹,

Kim²,

Kim³

et al. 2013

Anadolu Kardiyol Derg

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“…Several studies have reported LSM was common after DES than after bare metal stent implantation (2). Currently, the various postulated mechanisms of LSM have been reported.…”

Section: Discussionmentioning

confidence: 99%

Late stent malapposition combined by thrombus resolution after primary stenting in acute myocardial infarction: Optical coherence tomography findings

Her¹,

Kim²,

Kim³

et al. 2013

Anadolu Kardiyol Derg

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“…Ainsi, lors d'un infarctus du myocarde, la présence de thrombus et la survenue d'une vasoconstriction sont des phénomènes transitoires qui peuvent exposer à l'existence d'une mal-apposition tardive une fois que le thrombus a été résorbé et que l'artère a récupéré son calibre originel. Ce phénomène de mal-apposition est considéré comme un facteur de thrombose de stent [7] ( Figure 4C). …”

Section: Limites Des Stents De Première Générationunclassified

Stentscoronaires

et al. 2014

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> Les révolutions successives ont marqué l'histoire de la cardiologie interventionnelle. La première fut l'introduction de l'angioplastie percutanée par ballonnet, utilisée en alternative à la chirurgie pour la revascularisation coronaire, suivie de l'invention des premiers stents métalliques nus (bare metal stent ou BMS) et leur amélioration en stents dits actifs à élution de médicaments (drug-eluting stent ou DES), réduisant drastiquement le taux de re-sténoses observé avec les BMS. L'amélioration des plates-formes et des polymères des stents (biocompatibles ou résorbables) a permis de réduire le taux de thromboses tardives de stent à des niveaux extrêmement bas. Le développement de stents auto-expansibles est actuellement proposé pour lutter contre le problème de mauvaise apposition tardive aux parois du vaisseau dans l'infarctus du myocarde. Enfin, les nouveaux stents intégralement biorésorbables, pouvant être combinés à des molécules actives antiprolifératives, deviendront très probablement les stents de choix pour la revascularisation coronaire dans un futur proche. < été reconnue par le magazine anglais Intellectual property international magazine comme l'une des dix inventions qui ont changé le monde lors du siècle dernier. La troisième révolution a été l'arrivée, en 2002, du stent dit actif ou à élution de médicaments (DES ou drug-eluting stent), développé avec succès par les laboratoires Johnson & Johnson, pour réduire le risque de re-sténose observé avec les BMS. Ce risque obligeait a une ré-intervention dans 10 à 20 % des cas et, parfois, conduisait à proposer une revascularisation chirurgicale en cas de re-sténose diffuse ou itérative. Le principe du stent actif à élution de médicament antiprolifératif incorporé au sein d'un polymère le recouvrant a entraîné, de manière parallèle, une augmentation des thromboses tardives de stent, observées avec la première génération de DES, et attribuées à un retard ou à un défaut d'endothélisation du stent. L'amélioration des plates-formes des DES de nouvelle génération a permis de réduire ce taux de thrombose de stent au même niveau que celui du BMS. La diminution de la taille des mailles, et le caractère biocompatible ou résorbable des polymères les recouvrant ont permis de réduire le taux de thromboses tardives de stent à moins de 1 %. L'utilisation de stents auto-expansibles est actuellement proposée pour éviter la mal-apposition tardive dans l'infarctus du myocarde 2 . La dernière révolution est le stent biorésorbable, qui peut être combiné à des molécules antiprolifératives. Ce concept, encore au stade de validation chez l'homme, va possiblement devenir un standard pour la revascularisation coronaire. Ces stents ont le potentiel théorique de permettre la réduction de la durée de la bithérapie anti-agrégante plaquettaire 3 et, donc, des complications hémorragiques potentielles 2 On appelle mal-apposition le fait que le stent n'est pas parfaitement apposé aux parois du vaisseau, laissant un espace. 3 Association de 2 antiagrégants plaquettaires : acide acétyl...

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“…Overall, a recent meta-analysis of 7 randomized trials reported that the risk of late-acquired ISA in patients with DES was 4 times higher compared to those with BMS (odds ratio 4.36, 95%CI 1.74-10.94, P= 0.002). 53 In contrast to baseline ISA as a mechanical problem, lateacquired ISA primarily results from structural vessel wall changes that occur during the follow-up period (so-called biological ISA). The most commonly reported mechanisms are (1) dissolution of thrombus present at baseline, and (2) regional positive vessel remodeling disproportional to peristent plaque area change.…”

Section: Incomplete Stent Apposition (Isa)mentioning

confidence: 99%

“…53 However, careful interpretation is still required, considering the inherent limitations of literature-based analysis of heterogeneous studies.…”

Section: Incomplete Stent Apposition (Isa)mentioning

confidence: 99%

“…[59][60][61] Some investigator groups have also suggested baseline or late ISA as another possible risk factor. 53,[59][60][61] However, there is significant overlap in each risk factor between thrombosis and non-thrombosis cases, undoubtedly representing a multifactorial process of this phenomenon. Nevertheless, the importance of procedural optimization cannot be overemphasized because these risk factors are the only variables that operators could alter in the cardiac catheterization laboratory.…”

Section: Insights Into Optimal Deployment Techniquementioning

confidence: 99%

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Drug-Eluting Stents Insights From Invasive Imaging Technologies

Honda

2009

Circ J

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n the history of percutaneous coronary intervention, drug-eluting stents (DES) are recognized as revolutionary technologies with their unique ability to provide both mechanical and biological solutions simultaneously to the target lesion. While the clinical success of DES depends on these 2 properties, the ability of the operator to properly deploy the device is also of utmost importance. Although contrast angiography remains the clinical standard for coronary imaging, this conventional method provides very little information about in vivo device properties and their effects on the arterial wall. In contrast, catheter-based imaging tools, such as intravascular ultrasound (IVUS), optical coherence tomography (OCT), and intracoronary angioscopy can offer unique insights into novel interventional technologies through direct assessment of the device and the treated vessel. This article will review our multimodality insights into current DES, focusing on performance, safety, and an optimal deployment technique. Performance Characteristics Neointimal HyperplasiaSpatial Distribution IVUS observations from clinical experience with antiproliferative DES have shown a striking inhibition of in-stent neointimal hyperplasia. In addition to the absolute amount of neointimal hyperplasia, significant differences can be observed in its spatial distribution within conventional bare metal stents (BMS) vs current DES.In BMS, several IVUS studies reported an association between the native plaque burden and subsequent neointimal hyperplasia in terms of both circumferential and longitudinal distributions within the stent. 1 On average, across most patients, a wide individual variation in native disease along the target segment generally results in a relatively even neointimal distribution throughout the stent. Drug-Eluting Stents Insights From Invasive Imaging TechnologiesYasuhiro Honda, MD Drug-eluting stents (DES) represent a revolutionary technology in their unique ability to provide both mechanical and biological solutions simultaneously to the target lesion. As a result of biological effects from the pharmacological agents and interaction of DES components with the arterial wall, considerable differences exist between DES and conventional bare metal stents (BMS), yet some of the old lessons learned in the BMS era remain clinically significant. In this context, contrast angiography provides very little information about in vivo device properties and their biomechanical effects on the arterial wall. In contrast, current catheter-based imaging tools, such as intravascular ultrasound, optical coherence tomography, and intracoronary angioscopy can offer unique insights into DES through direct assessment of the device and treated vessel in the clinical setting. This article reviews these insights from current DES with particular focus on performance and safety characteristics as well as discussing an optimal deployment technique, based upon findings obtained through the use of the invasive imaging technologies. On the contrary, if the...

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Late stent malapposition risk is higher after drug-eluting stent compared with bare-metal stent implantation and associates with late stent thrombosis

Abstract: In our meta-analysis, the risk of LASM is strongly increased after DES implantation compared with BMS. Furthermore, LSM seems to be associated with late and very late ST.

Cited by 264 publications

References 45 publications

Late stent malapposition combined by thrombus resolution after primary stenting in acute myocardial infarction: Optical coherence tomography findings

Late stent malapposition combined by thrombus resolution after primary stenting in acute myocardial infarction: Optical coherence tomography findings

Stentscoronaires

Drug-Eluting Stents Insights From Invasive Imaging Technologies

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