Randomized Trial of Optimal Treatment Strategies for In-Stent Restenosis After Drug-Eluting Stent Implantation

Song, Hae-Geun; Park, Duk‐Woo; Kim, Young‐Hak; Ahn, Jung‐Min; Kim, Won‐Jang; Lee, Jong‐Young; Kang, Soo–Jin; Lee, Seung-Whan; Lee, Cheol Whan; Park, Seong-Wook; Han, Seungbong; Seong, In‐Whan; Lee, Nae–Hee; Lee, Bong Ki; Lee, Keun; Lee, Seung-Wook; Nah, Deuk-Young; Park, Seung‐Jung

doi:10.1016/j.jacc.2011.11.047

Cited by 43 publications

(26 citation statements)

References 29 publications

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“…Another reason for the limited success is the presence of feedback loop between mTORC1 and AKT in certain tumor cells. It seems that mTORC1 inhibition by rapalogs fails to suppress a negative feedback loop that results in phosphorylation and activation of AKT [48,[53][54][55]. These limitations have led to the development of the second generation of mTOR inhibitors known as ATP-competitive mTOR kinase inhibitors [55].…”

Section: Clinical Indications Of M-tor I In Nontransplant Patients Anmentioning

confidence: 99%

m-TOR Inhibitors in the Current Practice

Alalawi¹,

Sharma²,

Halawa³

2017

J Clin Exp Nephrol

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Abstractfor long time, calcineurin-inhibitors (CNIs) was the best broadly used immunosuppressant in organ transplantation; since it had proven its efficacy in the reduction of acute rejection episodes and early graft loss, though their use in the long-term, are associated with chronic allograft nephropathy (CAN), besides it increases the cardiovascular risks such as diabetes, hypertension, and dyslipidemias. Moreover, CNIs in combination with other immunosuppressant's increases the risk of fatal infections and malignancy. Ultimately the introduction of the mammalian focus of rapamycin (mTOR) inhibitors, such as sirolimus and everolimus in 1990s, had changed the face of transplantation and conveyed a great hope to transplant physicians as an innovative class of effective immunosuppressants with a unique mechanism and less nephrotoxic effects (1-6).In this review article we will try briefly to elicit the clinical indications, advantage and disadvantage of m-TOR inhibitors over other immunosuppressant's medications and their clinical indications inside and outside the transplant field.

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Section: Clinical Indications Of M-tor I In Nontransplant Patients Anmentioning

confidence: 99%

m-TOR Inhibitors in the Current Practice

Alalawi¹,

Sharma²,

Halawa³

2017

J Clin Exp Nephrol

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“…Eight studies [19][20][21][22][23][24][25][26] with 326 TVR over 1718 patient-years follow-up contributed to the network for DES-ISR and compared 5 different treatments ( Figure 7A). As shown in Figure 7B, BA was inferior to all 4 drug-eluting treatments.…”

Section: Drug-eluting Stent Isrmentioning

confidence: 99%

“…Studies with at least 80% angiographic and 90% clinical follow-up were considered at low risk for attrition bias. On the basis of these criteria, the study by Scheller et al 29 and 3 other studies 21,25,30 were not considered low risk for attrition bias for clinical and angiographic end points, respectively. The risk of bias summary of the included studies is shown in Figure IV …”

Section: Study Quality Assessmentmentioning

confidence: 99%

Efficacy of Various Percutaneous Interventions for In-Stent Restenosis

Sethi

Malhotra

Singh

et al. 2015

Circ: Cardiovascular Interventions

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Background— In-stent restenosis (ISR) remains a difficult problem in interventional cardiology. The relative efficacy and safety of available interventions is not clear. We aimed to perform a network meta-analysis using both direct evidence and indirect evidence to compare all available interventions. Methods and Results— We systematically searched electronic databases for randomized trials comparing ≥2 treatments for ISR. A network meta-analysis was performed using a Bayesian approach. Eleven treatments were compared in 31 studies with 8157 patient-years follow-up. Compared with balloon angioplasty, everolimus-eluting stent (hazard ratio [95% credibility interval], 0.13 [0.048–0.35]), paclitaxel-eluting balloon (0.32 [0.20–0.49]), paclitaxel-eluting cutting balloon (0.054 [0.0017–0.5]), paclitaxel-eluting stent (0.39 [0.24–0.62]), and sirolimus-eluting stent (0.32 [0.18–0.50]) are associated with lower target vessel revascularization. Balloon angioplasty is not different from cutting balloon (0.73 [0.31–1.5]), excimer laser (0.89 [0.29–2.7]), rotational atherectomy (0.96 [0.53–1.7]), and vascular brachytherapy (0.60 [0.35–1.0]). In drug-eluting stent ISR, balloon angioplasty was inferior to everolimus-eluting stent (0.19 [0.049–0.76]), paclitaxel-eluting balloon (0.43 [0.18–0.80]), paclitaxel-eluting stent (0.35 [0.13–0.76]), and sirolimus-eluting stent (0.36 [0.11–0.86]) for target vessel revascularization. There was no difference between treatments in probable or definitive stent thrombosis. The results of binary restenosis and target lesion revascularization were similar. Paclitaxel-eluting cutting balloon, everolimus-eluting stent, and paclitaxel-eluting balloon have the highest probability of being in the top 3 treatments based on low target lesion revascularization, but there was no statistical significant difference between them. Conclusions— Balloon angioplasty is inferior to all drug-eluting treatments for ISR, including drug-eluting stent ISR. Drug-eluting stent, particularly everolimus-eluting stent, or paclitaxel-eluting cutting balloon and paclitaxel-eluting balloon should be preferred for treating ISR.

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“…Although residual stent struts are reported to cause inflammation around the struts and work as trigger of neoatherosclerosis by histological studies, particular medical treatment for this phenomenon is not realistic right now. Instead, recent investigations focus on the development and improvement of bioresorbable vascular scaffolds [24][25][26][27] which resolve completely. Interventional strategy for ISR is still controversial.…”

Section: Prevention and Management Of Very Late In-stent Restenosismentioning

confidence: 99%

“…Paclitaxel-coated balloon angioplasty is not inferior to paclitaxel-eluting stents for BMS restenosis [29]. In ISR after DES implantation, a couple of studies have been conducted [24,30,31]. It should be determined whether same or the other DES is more beneficial in preventing recurrence of ISR.…”

Section: Prevention and Management Of Very Late In-stent Restenosismentioning

confidence: 99%

Intracoronary Imaging and Histopathology of Late Phase In-Stent Restenosis after Coronary Stent Implantation

Ito

Nakasuka

Sekimoto

et al. 2012

ISRN Vascular Medicine

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In the field of coronary artery stenting, restenosis issue has been almost resolved after development of drug-eluting stents (DESs). In-stent restenosis (ISR) is generally considered to be a stable process, with an early peak in intimal hyperplasia followed by a quiescent period beginning 1 year after stent implantation. However, recently, extended-term problem (over 1 year) in both baremetal stents (BMSs) and DES has been reported. This phenomenon seems to be different from early ISR within one year in terms of its mechanism, prevention, and treatment. In this paper, we discuss this topic from the standpoint of intracoronary imagings and histopathology, referencing several interesting cases we experienced.

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Randomized Trial of Optimal Treatment Strategies for In-Stent Restenosis After Drug-Eluting Stent Implantation

Cited by 43 publications

References 29 publications

m-TOR Inhibitors in the Current Practice

m-TOR Inhibitors in the Current Practice

Efficacy of Various Percutaneous Interventions for In-Stent Restenosis

Intracoronary Imaging and Histopathology of Late Phase In-Stent Restenosis after Coronary Stent Implantation

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