Long-term clinical and angiographic outcomes after sirolimus- and paclitaxel-eluting stent placement following rotablation for severely calcified lesions: a retrospective nonrandomized study

Abstract

We conducted a retrospective comparison of the long-term clinical and angiographic outcomes of 281 consecutive nonrandomized severely calcified lesions in 221 patients treated with a sirolimus-eluting stent (SES; CYPHER Bx VELOCITY) or a paclitaxel-eluting stent (PES; TAXUS Express) placed after rotablation between August 2004 and February 2009. The clinical safety endpoint, comprising the incidence of cardiac death, nonfatal recurrent myocardial infarction, and definite stent thrombosis, in 164 patients after exclusive SES placement (4.9 % with a mean clinical follow-up period of 1396 ± 763 days) was not significantly different from that after exclusive PES placement in 51 patients (2.0 %, 1011 ± 605 days; p = 0.364 and p < 0.001, respectively). The cumulative clinical safety endpoint-free ratio after exclusive SES placement was not significantly different from that after PES placement (p = 0.61, by log-rank test). The angiographic efficacy endpoint (binary restenosis: diameter stenosis >50 % at follow-up angiography) in the 169 lesions placed using SES (20.1 % with a mean angiographic follow-up period of 669 ± 605 days) was not significantly different from that in the 40 lesions using PES (17.5 %; 498 ± 320 days) (p = 0.707). In univariate analysis, SES use did not relate to the efficacy endpoint (p = 0.707). Thus, our small single-center study showed that the long-term clinical and angiographic outcomes after SES placements for severely calcified lesions after rotablation were not significantly different from those after PES placement.

Very long-term clinical and angiographic outcomes after sirolimus- and paclitaxel-eluting stent placement for ST-elevation myocardial infarction: a propensity score-matched comparison

“…Therefore, PES exerted the similar degree of the anti-restenotic effects against the various baselines including the culprit of STEMI. However, the mean late luminal loss of SES (approximately 0.16 mm, Table 2) represented that SES exerted the potent antirestenotic effects in the culprit of STEMI compared to the elective stable cases in a clinical setting (approximately or more than 0.30 mm) [20][21][22][23]. Therefore, although the present study did not precisely examine the details of late TLR [9] during the long-term observational interval, SES exerted the advantage for the culprit of STEMI.…”

“…As the background about the angiographic outcomes between SES and PES, the superiority of SES to PES in terms of cumulative incidence of TLR was inconsistent based on the baselines, such as allcomer [20], diabetes, small vessel, and long lesion [21], severe calcified lesion using a rotablator [22], and the complex lesions evaluated for consistent predictors of cardiac events, binary restenosis and TLR of the SES [23]. The present mean late luminal loss (approximately 0.45-0.50 mm), and the frequencies of binary in-stent restenosis and TLR (15-20 %) after PES placement (Table 5) were similar to the several settings as previously reported [20][21][22][23]. Therefore, PES exerted the similar degree of the anti-restenotic effects against the various baselines including the culprit of STEMI.…”

Effects of tripterygium glycosides on restenosis following endovascular treatment

“…However, a recent comparison of an atorvastatin-eluting stent vs. a paclitaxel-eluting stent in a rabbit iliac artery overstretch restenosis model did not demonstrate significant differences in neointimal hyperplasia, but did demonstrate more effective arterial healing within arteries of rabbits receiving atorvastatin ( 22 ). In another study comparing long-term clinical and angiographic outcomes of patients with severe calcified lesions following administration of one of two widely used drug-eluting stents, the paclitaxel-eluting stent or the sirolimus-eluting stent, no significant differences were demonstrated between the two therapeutic agents (restenosis rates were 21.1% for sirolimus and 17.5% for paclitaxel) ( 23 ). Direct drug-eluting stenting without pre-dilation also did not reduce restenosis compared with conventional or provisional stenting in patients with percutaneous coronary intervention ( 24 ).…”

Very Long-Term Follow-Up After Coronary Rotational Atherectomy: A Single-Center Experience

“…Intravascular ultrasound showed an increase in lumen size, smooth interface between residual atherosclerotic plaques and the lumen, and dissections were uncommon. Tsutsumi et al 32 retrospectively compared the long-term clinical and angiographic outcomes of 281 severely calcified lesions in 221 patients treated with a sirolimus-eluting stent or a paclitaxel-eluting stent placed after RA. Failure of IVUS catheter passage was an indicator for RA.…”