Quantitative Assessment of Angiographic Restenosis After Sirolimus-Eluting Stent Implantation in Native Coronary Arteries

Popma, Jeffrey J.; Leon, Martin B.; Moses, Jeffrey W.; Holmes, David R.; Cox, Nicholas; Fitzpatrick, Michelle; Douglas, John S.; Lambert, Charles; Mooney, Michael; Yakubov, Steven; Kuntz, Richard E.

doi:10.1161/01.cir.0000150331.14687.4b

Cited by 137 publications

(84 citation statements)

References 41 publications

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“…The first RCT with DES 19 showed excellent results and even editorials were written 20 stating that the dream had come true because the first results of this study reported zero percent restenosis! Unfortunately, this phenomenon was soon demonstrated to keep occurring, but now at a quite lower and unprecedented incidence when compared with that obtained with bare-metal stents (3.2% versus 35.4%; p <0.001) 3 .…”

Section: Discussionmentioning

confidence: 94%

“…With the introduction of a new generation of drugeluting stents (DES), late angiographic restenosis rates have consistently shown to be clearly lower than those observed with bare-metal stent implantation 3,4 . In recent RCT, the use of DES with Sirolimus and Paclitaxel in the treatment of PAD resulted in low rates of TVR, of 6.0% and 7.9%, respectively 5,6 , at the end of one year, which leads to the hypothesis that DES will likely reduce or even outweigh the only advantage offered by the surgical treatment of PAD coronary artery disease.…”

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confidence: 99%

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Revascularização da descendente anterior proximal com stents revestidos por fármacos

Guardado¹,

Moreno²,

Costa³

et al. 2007

Arq. Bras. Cardiol.

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SummaryObjective: To assess the clinical prognosis of patients with coronary artery diseases undergoing percutaneous revascularization with drug-eluting stent implantation in the proximal left anterior descending coronary artery.Methods: One hundred and seventy consecutive patients with mean age of 65 years, 49 of them females (29%), undergoing implantation of at least one drug-eluting stent in our medical center. The total number of drug-eluting stents implanted was 189, of which 115 (61%) were sirolimus-eluting (CYPHER™) and 74 (39%) were paclitaxel-eluting stents (TAXUS™). In 100 (60%) of the cases, multivessel coronary artery disease was present. In 61 (36%) patients another coronary artery segment was treated in addition to the proximal left anterior descending coronary artery. The mean clinical follow-up period was 11 ± 5 months, and angiographic controls were performed between 6 and 9 months. The final endpoint was a composite of death, acute myocardial infarction and need for reintervention on the anterior descending. The secondary endpoint included the occurrence of restenosis, need for reintervention on the proximal segment of the left anterior descending and stent thrombosis.Results: The procedure achieved immediate angiographic success in all patients. Two deaths, two acute myocardial infarctions, and two percutaneous coronary reinterventions due to stent thrombosis were recorded during in-hospital stay. At the sixth month of follow-up, an additional cardiac death and three myocardial infarctions were observed; three repeat revascularization procedures were required. Up to the end of the followup, three additional deaths, three myocardial infarctions and eight revascularization procedures of the anterior descending, two of them surgical, were verified. Survival free from major adverse cardiac events was 91%. Cardiac mortality was 3%. Binary restenosis in the proximal segment of the left anterior descending coronary artery was 4.1%. Target vessel revascularization-free survival was 94%. No cases of late stent thrombosis were observed.Conclusion: Percutaneous revascularization of the proximal left anterior descending coronary artery with implantation of drug-eluting stents is a safe and very efficient therapeutic strategy in the short and long terms.

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Section: Discussionmentioning

confidence: 94%

mentioning

confidence: 99%

Revascularização da descendente anterior proximal com stents revestidos por fármacos

Guardado¹,

Moreno²,

Costa³

et al. 2007

Arq. Bras. Cardiol.

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“…In this analysis, the incidence of coronary aneurysms was similar with DES compared with BMS. 1.1% with DES and 0.8% with BMS 5,6,[27][28][29] .Three different types of aneurysms after DES or BMS implantation have been described. Type I aneurysm is a type of aneurysm that demonstrates rapid early growth with pseudoaneurysm formation detected within 4 weeks 30,31 .…”

Section: Discussionmentioning

confidence: 99%

“…Residual dissection and deep arterial wall injury (rupture or resection of the vessel media) caused by oversized balloons or stents, high pressure balloon inflations, atherectomy, and laser angioplasty have all been associated with coronary artery aneurysms after coronary intervention 1-3 . Drug-eluting stents (DES), which locally elute antiproliferative drugs, can dramatically inhibit neointimal growth, thereby suppressing restenosis 5,6 , but at the same time potentially causing coronary aneurysms due to other mechanisms, such as delayed reendothelialization, inflammatory changes of the medial wall, and hypersensitivity reactions [7][8][9][10] . These findings may be due to delayed healing secondary to the antiproliferative action of the eluted drug, cell necrosis and/or apoptosis from the antimetabolite effect of the drug, and hypersensitivity reactions to the drug/polymer mixture on the DES 7-9 .…”

Section: Introductionmentioning

confidence: 99%

Drug-Eluting Stent (DES) Induced Coronary Artery Aneurysm - A Rare Case Report

et al. 2017

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Introduction:Coronary artery aneurysms after coronary intervention are rare, the incidence of coronary artery aneurysms after DES implantation is low within the first 9 months, with a reported incidence of 0.2% to 2.3%, a rate similar to that reported after bare-metal stent (BMS) implantation (0.3% to 3.9%) in the DES versus BMS randomized trials. Most "aneurysms" are in fact pseudoaneurysms rather than true aneurysms [1][2][3][4] . Residual dissection and deep arterial wall injury (rupture or resection of the vessel media) caused by oversized balloons or stents, high pressure balloon inflations, atherectomy, and laser angioplasty have all been associated with coronary artery aneurysms after coronary intervention 1-3 . Drug-eluting stents (DES), which locally elute antiproliferative drugs, can dramatically inhibit neointimal growth, thereby suppressing restenosis 5,6 , but at the same time potentially causing coronary aneurysms due to other mechanisms, such as delayed reendothelialization, inflammatory changes of the medial wall, and hypersensitivity reactions [7][8][9][10] . These findings may be due to delayed healing secondary to the antiproliferative action of the eluted drug, cell necrosis and/or apoptosis from the antimetabolite effect of the drug, and hypersensitivity reactions to the drug/polymer mixture on the DES 7-9 . Systemic administration of antiinflammatory agents (glucocorticoids and colchicine) after stent implantation may be associated with a greater risk of aneurysm formation. 11 However, the true incidence, clinical course, and treatment of coronary artery aneurysms after DES implantation remain largely unknown.Case Report: Mr. X, 60 years old non smoker, non alcoholic, diabetic, hypertensive businessman got admitted in NICVD with complaint of ischaemic chest pain on minimal exertion for 3 months. ECG was within in normal limit, ETT was positive and Echocardiogram showed Anterior wall hypokinesia with EF-65%. CAG showed Significant long lesion in LAD. Direct stenting to LAD was done at the same setting with Promus Element ( 2.75×38mm, at 18 ATM).Whole procedure was uneventful and patient was discharged from hospital with double antiplatelet coverage. After 10 days of PCI patient got readmitted in hospital with complaints of chest discomfort with high grade fever for 2 days. ECG showed AMI ( Extensive Anterior) indicating involvement of LAD territory with strong suspicion of Sub Acute Stent Thrombosis (SAST). Streptokinase could not be given due to delayed arrival. Patient was treated conservatively with LMWH. Blood and urine culture was negative. Check CAG was done 7 days after readmission showing Patent stent in LAD with aneurysmal dilatation at the distal end of stent in LAD. Drug-Eluting Stent (DES) Induced Coronary

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“…Logo se constatou que esse acontecimento, a reestenose, mantinha-se presente 22,23 , embora com incidência significativamente inferior, num plano sem precedentes comparativamente à obtida pelos stents convencionais 24 .…”

Section: Discussionunclassified

Lesão no segmento proximal da artéria coronária descendente anterior: resultados entre o tratamento cirúrgico (mamária) e o percutâneo (stent com fármaco)

Filho

Correia

Bocchi

et al. 2007

Rev. Bras. Cardiol. Invasiva

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Objectives: To correlate the permeability and clinical evolution of single and multilateral patients, bearers of obstructive atherosclerosis heart disease in the proximal third of the anterior descending coronary artery (DA), who were submitted to myocardial revascularization using the left internal mammary or underwent a drug eluting stent procedure. Method: This a case history cohort study in which two centers participated. Three hundred patients were retrospectively analyzed, whose lesions were treated at the proximal one third of the DA: in the G-1 group, 150 patients, underwent myocardial revascularization surgery and, the G-2 group, 150 patients, received drug eluting stents, 95 of them received paclitaxel and 55 received sirolimus. All major adverse cardiovascular events were registered during the period (MACE) during the period between the two procedures and the angiographic restudy. Deaths were not included in these MACE, since all patients were restudied through coronariography. There were clinical and angiographic demographic differences between the two groups: the G-1 patients showed a higher incidence of diabetes (29.3% versus 20.0%, p<0.05) and three artery atherosclerosis disease 50% versus 30.6%, p<0.05) with a lower incidence of one artery (13.3% versus 30.6%, p<0.001). Results: The permeability of the two procedures was quite high in both groups. Those patients free of MACE in G-1 RESUMOObjetivo: Correlacionar a permeabilidade e a evolução clínica de pacientes uni ou multiarteriais, portadores de doença coronária aterosclerótica obstrutiva no terço proximal da artéria coronária descendente anterior (DA), que foram submetidos a cirurgia de revascularização miocárdica utilizando a mamária interna esquerda (MIE) ou que receberam stent com eluição de fármaco (SEF). Método: Este é um estudo de coorte histórico, com a participação de dois centros. Foram analisados, retrospectivamente, 300 pacientes, nos quais foi tratada lesão no terço proximal da DA: no Grupo 1 (G-1), 150 pacientes foram submetidos a cirurgia de revascularização miocárdica e no G-2, 150 receberam SEF, 95 desses stents de paclitaxel e 55 de sirolimo. Os principais eventos cardiovasculares adversos maiores (ECAM) foram registrados no período entre ambos os procedimentos e o reestudo angiográfico. O óbito não foi incluído nesses ECAM, já que todos os pacientes foram reestudados pela coronariografia. Ocorreram diferenças demográficas clínicas e angiográficas entre os dois grupos: os pacientes do G-1 apresentavam maior incidência de diabetes (29,3% vs. 20,0%; p < 0,05) e de doença aterosclerótica triarterial (50,0% vs. 30,6%; p < 0,05), com menor incidência de uniarteriais (13,3% vs. 30,6%; p < 0,001). Resultados: A permeabilidade da DA foi bastante alta, em ambos os grupos. Os pacientes livres de ECAM no G-1 e no G-2 ficaram assim distribuídos: em 12 meses, 98% vs. 97% (NS); em 24 meses, 93% vs. 94% (NS); e em 32 meses, 89% vs. 91% (NS). Conclusão: Ambas as técnicas de revascularização miocárdica para tratar a DA apresen-

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Quantitative Assessment of Angiographic Restenosis After Sirolimus-Eluting Stent Implantation in Native Coronary Arteries

Cited by 137 publications

References 41 publications

Revascularização da descendente anterior proximal com stents revestidos por fármacos

Revascularização da descendente anterior proximal com stents revestidos por fármacos

Drug-Eluting Stent (DES) Induced Coronary Artery Aneurysm - A Rare Case Report

Lesão no segmento proximal da artéria coronária descendente anterior: resultados entre o tratamento cirúrgico (mamária) e o percutâneo (stent com fármaco)

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