Outcome After Acute Incomplete Sirolimus-Eluting Stent Apposition as Assessed by Serial Intravascular Ultrasound

Kimura, Masashi; Mintz, Gary S.; Carlier, Stéphane; Takebayashi, Hideo; Fujii, Kenichi; Sano, Koichi; Yasuda, Takenori; Costa, Ricardo; Costa, J. Ribamar; Quen, Jie; Tanaka, Kaoru; Lui, Joanna; Weisz, Giora; Moussa, Issam; Dangas, George; Mehran, Roxana; Lansky, Alexandra J.; Kreps, Edward M.; Collins, Michael B.; Stone, Gregg W.; Moses, Jeffrey W.; Leon, Martin B.

doi:10.1016/j.amjcard.2006.02.050

Cited by 70 publications

(44 citation statements)

References 18 publications

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“…Interestingly, the authors noted that acute malapposition by IVUS in the left main was not related to either restenosis or 2-year adverse events, findings that are in line with other IVUS studies from nonleft main lesions. 8 The results from the present study are noteworthy as they reinforce the important influence of smaller stent areas by IVUS after PCI on adverse outcomes. Smaller MSA at any 1 of 4 sites in left main lesions were associated with greater angiographic restenosis at 9 months.…”

Section: Article See P 562supporting

confidence: 61%

Stent Area by Intravascular Ultrasound and Outcomes in Left Main Intervention With Drug-Eluting Stents

McDaniel

Douglas

2011

Circ: Cardiovascular Interventions

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W hile the standard revascularization for left main lesions traditionally has been surgical coronary artery bypass grafting, increasingly studies suggest that percutaneous coronary intervention (PCI) with drug-eluting stents (DES) may be an acceptable alternative to surgery for selected patients. In total, the current evidence suggests that rates of death, myocardial infarction, and stroke may be similar between patients managed with PCI and coronary artery bypass grafting, but revascularization occurs less frequently in patients undergoing surgery. This was illustrated in the recently published randomized PRECOMBAT (Premier of Randomized Comparison of Bypass Surgery versus Angioplasty Using Sirolimus-Eluting Stent in Patients with Left Main Coronary Artery Disease) trial, where the 2-year risk of death, myocardial infarction, or stroke was similar (hazard ratio: 0.92; 95% confidence interval (CI), 0.43 to 1.96; Pϭ0.83) in patients with unprotected left main disease managed with PCI using DES (Nϭ300) and coronary artery bypass grafting (Nϭ300), but revascularizations were more common in patients undergoing PCI (hazard ratio: 2.18; 95% CI, 1.10 -4.32; Pϭ0.02). 1 A recent meta-analyses of 1611patients from 4 randomized trials comparing PCI with coronary artery bypass grafting for unprotected left main lesions found similar results. 2 Article see p 562Given the significant consequences associated with stent thrombosis and restenosis in the left main, intravascular ultrasound (IVUS) guidance has been advocated to optimize stent deployment in this important lesion subset. Increasing evidence suggests that IVUS-guidance reduces adverse events in PCI with DES in various clinical settings. 3,4 This likely relates to the preintervention assessment of appropriate stent size and interventional strategy, as well as the postintervention detection and correction of suboptimal stent deployment, such as dissections, underexpansion, geographic miss, plaque/tissue prolapse, and incomplete stent apposition. Of these, stent underexpansion most consistently has been associated with adverse events in nonleft main PCI with DES. 5,6 However, the optimal cut-off values to define "adequate stent expansion" in left main lesions are unknown.In the current issue of Circulation: Cardiovascular Interventions, Kang et al investigated the relationship between underexpansion in left main PCI with DES and adverse events. 7 Specifically, the authors evaluated the relationship between poststent area by IVUS on 9-month angiographic restenosis, and 2-year clinical outcomes in 403 consecutive patients undergoing left main PCI with DES from a single center. In the study, IVUS measurements were made at 4 locations: proximal left main, at the polygon of confluence, ostial left anterior descending, and ostial left circumflex in order to determine the stent area cut-off values associated with optimal outcomes. Of the patients undergoing PCI in this study, 13% were ostial/midshaft and 87% were bifurcation lesions. Two thirds of the bifurcation lesions were ...

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Section: Article See P 562supporting

confidence: 61%

Stent Area by Intravascular Ultrasound and Outcomes in Left Main Intervention With Drug-Eluting Stents

McDaniel

Douglas

2011

Circ: Cardiovascular Interventions

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“…Conversely, other investigators have reported that ISA imediately after stent implantation was not related to adverse clinical events. 4-8, 25 In contrast, IVUS studies have demonstrated that late acquired ISA could be observed following BMS with or without brachytherapy or following DES implantation, and could possibly be related to very late stent thrombosis. 26-29…”

Section: Discussionmentioning

confidence: 97%

Natural History of Stent Edge Dissection, Tissue Protrusion and Incomplete Stent Apposition Detectable Only on Optical Coherence Tomography After Stent Implantation

Kume

Okura

Miyamoto

et al. 2012

Circ J

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“…It can be observed that the highest tensile stresses are located at the inner curvatures and at the stent ends. while other studies conclude that stent malapposition is a pure IVUS finding without significant impact on the incidence of major adverse cardiac events [4,10-11, [14][15][16]. The main limitation of all these studies is their inadequate statistical power.…”

Section: Stent-induced Vessel Wall Stressesmentioning

confidence: 98%

Virtual bench testing of new generation coronary stents

Mortier¹,

Beule²,

Segers³

et al. 2011

EuroIntervention

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Financial support / Conflict of interestMedtronic has provided financial support for this study and has delivered all stent samples.Peter Mortier, Matthieu De Beule and Benedict Verhegghe are shareholder of FEops, an engineering consultancy spin-off from Ghent University, and have served as a consultant for several medical device companies. Address for correspondencePeter Mortier Conclusions: The mechanical behaviour of the investigated stents differs considerably in terms of stent strut apposition and stent induced vessel wall stresses. These differences in mechanical behaviour might influence clinical performance. KeywordsStent strut apposition, stent induced wall stresses, finite element analysis 2 Condensed abstract (100 words, max 500 char)Incomplete strut apposition has been associated with higher levels of thrombus deposition. A better understanding of how stent design influences strut apposition is therefore essential.We studied the strut apposition of six stent designs using computer simulations. The percentage of malapposed struts ranged between 9% (Integrity) and 43% (Promus Element).The largest strut-artery distances were observed at the plaque shoulders. In conclusion, the mechanical behaviour of the investigated stents differs considerably and these differences might influence clinical performance.

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Outcome After Acute Incomplete Sirolimus-Eluting Stent Apposition as Assessed by Serial Intravascular Ultrasound

Cited by 70 publications

References 18 publications

Stent Area by Intravascular Ultrasound and Outcomes in Left Main Intervention With Drug-Eluting Stents

Stent Area by Intravascular Ultrasound and Outcomes in Left Main Intervention With Drug-Eluting Stents

Natural History of Stent Edge Dissection, Tissue Protrusion and Incomplete Stent Apposition Detectable Only on Optical Coherence Tomography After Stent Implantation

Virtual bench testing of new generation coronary stents

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