<b>Comparison of Initial Efficacy and Long-term Follow-up of Heparin-coated Jostent With Conventional NIR Stent</b>

Abstract

SUMMARYThe implantation of heparin-coated stents was reported to be well tolerated, but there are conflicting results about acute in-hospital complications, (sub)acute thrombosis rates, and long-term follow-up compared to uncoated stents. We compared the angiographic and clinical results after coronary placement of two stent models: the heparin-coated premounted Jostent and the uncoated premounted NIR stent. Of 710 patients revascularized, a total of 426 patients received Jostent (n = 230) or NIR stent (n = 196) implantation. The primary end points were acute or subacute thrombosis, urgent CABG, AMI or death, while the secondary end points were the comparison of the restenosis rates of the stents at the 6 th month and of the functional angina classification of the stent groups at the 1 st , 6 th and 12 th months. There were no significant differences between the Jostent and NIR stent groups regarding angiographic and procedural success. Acute thrombosis rates in the Jostent and NIR stent groups were similar while no subacute thrombosis was observed in either group. The major adverse cardiac event rates of the groups also did not differ. Angiographic restenosis occurred in 17% of the Jostent group and 16% of the NIR stent group (NS). The combined clinical and angiographic restenosis rate was also similar between the Jo and NIR groups (19% and 18%, respectively). Comparison of functional angina classes at the 1 st , 6 th and 12 th months revealed no significant difference between the study groups.In conclusion, when compared with implantation of an uncoated premounted NIR stent, implantation of a heparin-coated premounted Jostent does not provide any more benefit with respect to initial efficacy, sub(acute) thrombosis and 6-month restenosis rates and 12-month clinical outcomes. (Jpn Heart J 2003; 44: 889-898)

Differences of platelet adhesion and thrombus activation on amorphous silicon carbide, magnesium alloy, stainless steel, and cobalt chromium stent surfaces

“…In addition, platelet adhesion to a vascular or foreign body surface and not platelet aggregation plays a central role in the development of stent thrombosis [11]. Possible strategies to prevent stent thrombosis are stent coatings that actively prevent platelet adhesion or thrombosis by either being coated or eluting antithrombogenic substances 12,13 formerly. It is known that thrombogenicity and neointimal formation is determined by the electron charge of a stent [14].…”

5-Year Follow-Up of Polytetrafluoroethylene-Covered Stents Compared With Bare-Metal Stents in Aortocoronary Saphenous Vein Grafts

“…Lower pressure inflations or less aggressive implantation technique might have prevented complications from the "toothpaste" effect but would likely have negatively affected late outcomes. Freedom from early thrombosis or late occlusion was not enhanced in a prior study by adding a heparin coat to the JOSTENT (22). A different, totally encapsulated PTFE stent-graft has similarly failed to prevent periprocedural complications or late restenosis after SVG intervention (23).…”

Preventing restenosis in early drug-eluting stent era: recent developments and future perspectives

“…Although heparin per-se has shown strong anti-proliferative and anti-migratory action on SMC (Au et al 1993;Chajara & Capron 1993;Yang et al 1999) and despite initial encouraging results (Schmid et al 1993), multicentre clinical trials did not corroborate the anti-restenotic efficacy of systemically administered heparin (Brack et al 1995). Further studies showed that heparin-coated Jostent stents were not superior to uncoated premounted NIR stents (Medinol, Tel Aviv, Israel) with respect to initial efficacy, (sub)acute thrombosis, 6-month restenosis rates or 12-month clinical outcomes (Semiz et al 2003).…”