Long-Term Clinical and Angiographic Follow-Up After Coronary Stent Placement in Native Coronary Arteries

SummaryThe efficacy of drug-eluting stents (DES) has been proven, but concerns about late complications after DES have been raised. Polymers that do not increase inflammatory or hypersensitivity reactions which may contribute to late complications are needed for new generation DES. To evaluate the safety and efficacy of phosphorylcholine-polymer coating, we investigated serial clinical and angiographic outcomes after phosphorylcholine-coated stent placement. Seventyfive consecutive patients treated with a BiodivYsio phosphorylcholine-coated stent for de novo lesions at our institute between October 2001 and August 2002 were enrolled. Six-month follow-up angiography was performed in 71 lesions (94.7%), and angiographic restenosis was found in 19 lesions (26.8%). Target lesion revascularization (TLR) was performed in 10 lesions (14.1%). Eighteen-month follow-up angiography was performed in 58 (95.1%) of the remaining 61 lesions (excluding TLR lesions), and angiographic restenosis was found in only 3 lesions. The cumulative MACE-free survival rate was 86.3%, 83.6%, and 78.6% at 6-month, 18-month, and 8-year follow-up, respectively. There were no episodes of stent thrombosis. Late loss decreased significantly from 0.74 ± 0.40 mm (6-months) to 0.51 ± 0.46 mm (18-months) (P < 0.0001). Phosphorylcholine-coated stent implantation was associated with acceptable clinical and angiographic results. Phosphorylcholine-coating may be an ideal polymer for new generation DESs. (Int Heart J 2011; 52: 88-91)

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“…16,17) This regression is accompanied mainly by a reduction in proteoglycan, with no change in smooth muscle cell density or collagen content.…”

Section: Discussionmentioning

confidence: 99%

Serial Clinical and Angiographic Follow-Up After Phosphorylcholine-Coated Stent Implantation

et al. 2011

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“…Meanwhile, there is a report of late in-stent luminal renarrowing which occurred more than 4 years after BMS deployment. 1) Hasegawa, et al demonstrated that 43% of new in-stent restenosis (ISR) lesions that develop beyond 5 years are clinically represented as ACS.…”

Section: Discussionmentioning

confidence: 99%

Disruption of Atherosclerotic Neointima Seven Years After Bare Metal Stent Deployment

et al. 2012

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SummaryA 58-year-old male with a history of prior myocardial infarction, hypertension, and dyslipidemia was admitted due to deteriorating exertional angina. A bare metal stent (Multilink plus TM , GUIDANT Corporation, Santa Clara, CA, USA) had been implanted into the proximal left anterior descending artery because of ST-elevation myocardial infarction 7 years earlier. Optical coherence tomography (OCT) showed a disruption of the atherosclerotic neointima overlying the stent. Intravascular imaging studies and pathological studies have shown that neointima within a bare-metal stent often transform into atherosclerotic tissue during an extended period of time. In the current report, OCT demonstrated that a disruption of the atherosclerotic neointima has the potential to cause the development of unstable clinical features. OCT examinations therefore help to understand the pathogenesis of acute coronary syndrome after stent implantation. ( imaging technology that provides cross-sectional tomographic imaging, which yields detailed structural information superior to any other currently available modality. The image is formed with a 15-20 μm axial resolution, which is about 10 times that of intravascular ultrasound (IVUS). Moreover, atherosclerotic lesions can be identified by their distinctive borderlines and the intensity, uniformity, and attenuation of the associated signal. Lipid plaques are diffusely bordered, and exhibit lower signal intensity with high attenuation. OCT examinations help to clarify the course of vascular healing and the cause of stent failure after stent implantation. This report presents a case of deteriorating exertional angina in which OCT showed a rupture of the atherosclerotic neointima 7 years after bare-metal stent (BMS) implantation. Case ReportA 58-year-old male with a history of prior myocardial infarction, hypertension, and dyslipidemia was admitted for deteriorating exertional angina. A bare metal stent (Multilink plus TM , 3.5/15 mm; GUIDANT Corporation, Santa Clara, CA, USA) had been implanted into the proximal left anterior descending artery (LAD) 7 years earlier because of ST-elevation myocardial infarction. Aspirin, statin, and ACE inhibitory therapy were continued after stent deployment and he had an uneventful course for 7 years. Since he developed worsening exer-

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“…However, this is merely a hypothesis because angiographic ISR with neointimal growth at the second study does not induce late complication. 9) Abnormal platelet aggregation also plays a role in stent thrombosis. The WRIST PLUS study 10) demonstrated the efficacy of prolonged intentional antiplatelet therapy against LST with prior brachytherapy.…”

Section: Discussionmentioning

confidence: 99%

A Case Report of Late Coronary Stent Thrombosis Manifested as Acute Myocardial Infarction 19 Months After Stenting

et al. 2004

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SUMMARYA 63-year-old Japanese man was readmitted to our hospital due to acute broad-anterior myocardial infarction (AMI). The proximal left anterior descending artery (LAD) at the prior stent, which was implanted 19 months earlier and in which no angiographic restenosis was recognized 13 months before the second study, was totally occluded. After crossing a guide wire and balloon angioplasty, angiographic radiolucency was observed at the prior stent, suggesting that AMI was induced by late coronary stent thrombosis. Intravascular ultrasound performed 19 days after the onset of AMI revealed superficial calcification without significant stenosis and an atherosclerotic plaque distal to the stent that was not significantly changed compared to 19 months previously, consistent with the culprit lesion being an intrastent site. AMI may thus be induced by late coronary stent thrombosis during long-term clinical follow-up without clinical symptoms or angiographic restenosis at the second study. (Jpn Heart J 2004; 45: 147-152)

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Long-Term Clinical and Angiographic Follow-Up After Coronary Stent Placement in Native Coronary Arteries

Cited by 180 publications

References 22 publications

Serial Clinical and Angiographic Follow-Up After Phosphorylcholine-Coated Stent Implantation

Serial Clinical and Angiographic Follow-Up After Phosphorylcholine-Coated Stent Implantation

Disruption of Atherosclerotic Neointima Seven Years After Bare Metal Stent Deployment

A Case Report of Late Coronary Stent Thrombosis Manifested as Acute Myocardial Infarction 19 Months After Stenting

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