Randomized Comparison of GR-II Stent and Palmaz-Schatz Stent for Elective Treatment of Coronary Stenoses

Lansky, Alexandra J.; Roubin, Gary S.; O’Shaughnessy, Charles; Moore, Paul Β.; Dean, Larry S.; Raizner, Albert E.; Safian, Robert D.; Zidar, James P.; Kerr, Jennifer L.; Popma, Jeffrey J.; Mehran, Roxana; Kuntz, Richard E.; Leon, Martin B.

doi:10.1161/01.cir.102.12.1364

Cited by 87 publications

(49 citation statements)

References 15 publications

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“…Our data showed a 4.5-fold risk of complication (CI: 2.2-9.1) greater with filamentary stents, and a 2.4-fold risk of complication (CI: 1.2-4.6) greater with first-generation tubular stents. These findings are in accordance with those of previous studies showing a weaker radial strength of filamentary stents and the possibility of a greater prolapse of the plate between their rods, allowing greater residual stenoses and a greater thrombogenic substrate 22 . Although these models of prostheses are no longer being used clinically, these results emphasize the importance of the design and shape of the stent in the outcome of the procedure and may be important in the future, when the availability of stent coating This study was initiated in 1996, including filamentary and first-generation stents.…”

Section: Discussionsupporting

confidence: 93%

Predictive factors of complications after coronary stent implantation

Quadros¹,

Gottschall²,

Sarmento‐Leite³

et al. 2003

Arq. Bras. Cardiol.

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Percutaneous coronary interventions are currently the main technique for myocardial revascularization, and stents have been used in more than 70% of these procedures, reducing restenosis and in-hospital mortality [1][2][3] . Based on the last studies on coated stents and the perspective that restenosis should be drastically reduced 4 , the occurrence or not of complications and the clinical success of the procedure should become the major limitation of this technique. Although many randomized clinical assays have suggested the almost nonexistence of complications, data illustrating the so-called "real world" of clinical practice are not so encouraging. In the recently published dynamic NHLBI registry, the incidence of acute myocardial infarction remained around 3%, of urgent surgery around 1.5%, of death around 2%, and overall success of the procedure around 92% 1 . However, few studies have analyzed the predictive factors of complications after percutaneous procedures using only stents [5][6][7][8][9][10][11][12] . Predictive models of complications based on angioplasty studies may overestimate events when applied to a series of patients treated only with stents 5 . Variations in the populations studied and in the criteria of the definition of success and complications reduce the external validity of the studies available 13,14 . Aiming at analyzing predictive factors of complications in patients undergoing stent implantation, we carried out a consecutive cohort study with 1,018 patients undergoing 1,070 stent implantations at a referral hospital for interventional cardiology. MethodsIn the period from April 1996 to December 2000, 1,092 coronary stents were implanted in 1,030 patients. The patients were prospectively included in an Access database, and clinical and angiographic characteristics were analyzed, as were aspects related to stent implantation and inhospital evolution. filamentary stent, multiple stents,); complexity of the lesion, thrombus,). Conclusion

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Section: Discussionsupporting

confidence: 93%

Predictive factors of complications after coronary stent implantation

Quadros¹,

Gottschall²,

Sarmento‐Leite³

et al. 2003

Arq. Bras. Cardiol.

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“…WSSG, in practice stent oversizing to ensure maximum patency is more common [39]. Seo et al created models to investigate flow disturbances in 2D straight and curved vessels with Newtonian and non-Newtonian flow [35].…”

Section: Effect-based Researchmentioning

confidence: 99%

Predicting neointimal hyperplasia in stented arteries using time-dependant computational fluid dynamics: A review

Murphy¹,

Boyle²

2010

Computers in Biology and Medicine

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a b s t r a c tThis paper reviews the recent literature regarding the time-dependant computational fluid dynamics (CFD) analyses of blood flow through implanted coronary stents. The in vivo processes which result in arterial restenosis are identified. The definition and range of the computationally predicted variables which are believed to stimulate the restenosis processes are evaluated. The reviewed literature is subdivided into effect-based in which the effects of altering the flow model are investigated and designbased in which different geometric stent configurations are compared. Finally, conclusions are made regarding the body of work reviewed and recommendations are provided for future work in this field.

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“…1,31 Bare metal stent trials and registries have demonstrated mean late losses varying from 0.6 to 1.2 mm. 5,6,26,27,[32][33][34][35] The RAVEL trial of the sirolimus-eluting Bx Velocity stent was the first randomized trial to report a stent with an average late loss well below the expected historical range, as well as its own control arm (in-stent late loss Ϫ0.01 mm active versus 0.80 mm control), which corresponded to a BAR rate of 0% for the active arm versus 26% in the control arm. 36 As the positive mean of any normal distribution is reduced enough so that its spread becomes significantly bounded by zero, it becomes right-skewed.…”

Section: Late Loss and Its Skewed Distribution For Dessmentioning

confidence: 99%

Relationship of Late Loss in Lumen Diameter to Coronary Restenosis in Sirolimus-Eluting Stents

et al. 2005

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Background-Observed rates of restenosis after drug-eluting stenting are low (Ͻ10%). Identification of a reliable and powerful angiographic end point will be useful in future trials. Methods and Results-Late loss (postprocedural minimum lumen diameter minus 8-month minimum lumen diameter) was measured in the angiographic cohorts of the SIRIUS (nϭ703) and E-SIRIUS (nϭ308) trials. Two techniques, the standard normal approximation and an optimized power transformation, were used to predict binary angiographic restenosis rates and compare them with observed restenosis rates. The mean in-stent late loss observed in the SIRIUS trial was 0.17Ϯ0.45 mm (sirolimus) versus 1.00Ϯ0.70 mm (control). If a normal distribution was assumed, late loss accurately estimated in-stent binary angiographic restenosis for the control arm (predicted 35.4% versus observed 35.4%) but underestimated it in the sirolimus arm (predicted 0.6% versus observed 3.2%). Power transformation improved the reliability of the estimate in the sirolimus arm (predicted 3.2% [CI 1.0% to 6.7%]) with similar improvements in the E-SIRIUS trial (predicted 4.0% [CI 1.2% to 7.0%] versus observed 3.9%). In the sirolimus-eluting stent arm, in-stent late loss correlated better with target-lesion revascularization than in-segment late loss (c-statisticϭ0.915 versus 0.665). Conclusions-Because distributions of late loss with a low mean are right-skewed, the use of a transformation improves the accuracy of predicting low binary restenosis rates. Late loss is monotonically correlated with the probability of restenosis and yields a more efficient estimate of the restenosis process in the era of lower binary restenosis rates.

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Randomized Comparison of GR-II Stent and Palmaz-Schatz Stent for Elective Treatment of Coronary Stenoses

Cited by 87 publications

References 15 publications

Predictive factors of complications after coronary stent implantation

Predictive factors of complications after coronary stent implantation

Predicting neointimal hyperplasia in stented arteries using time-dependant computational fluid dynamics: A review

Relationship of Late Loss in Lumen Diameter to Coronary Restenosis in Sirolimus-Eluting Stents

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