Restenosis rates following bifurcation stenting with sirolimus-eluting stents for de novo narrowings

Tanabe, Kengo; Hoye, Angela; Lemos, Pedro A.; Aoki, Jiro; Arampatzis, Chourmouzios A.; Saia, Francesco; Lee, Chi‐Hang; Degertekin, M; Hofma, Sjoerd H.; Sianos, Georgios; McFadden, Eugène; Smits, Pieter C.; Giessen, Willem J. van der; Feyter, Pim de; Domburg, Ron T. van; Serruys, Patrick W.

doi:10.1016/j.amjcard.2004.03.040

Cited by 130 publications

(74 citation statements)

References 12 publications

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“…Long-term (24.4 ± 15.1 months) MACE occurred in about 16% of the total study population, with rates of death and stent thrombosis respectively of 4.7% and 2.7%. Rates of adverse cardiac events are quite variable across literature, reflecting continuous improvement over time, in stenting techniques and devices [1,15,18,[24][25][26][27]. Overall, we experienced a relatively low rate of MACE, and our results are in line with previous studies.…”

Section: Discussionsupporting

confidence: 82%

“…Coronary bifurcation lesions account for up to 15%-20% of all current percutaneous revascularizations, and represent challenging subsets, with lower rates of angiographic and procedural success [14][15][16]. Given the relative frequency and the overall complexity of coronary bifurcation lesions, many works have addressed this topic, focusing mainly on stenting techniques, and BMS vs. DES use [17][18][19].…”

Section: Discussionmentioning

confidence: 99%

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Early and long-term outlook of percutaneous coronary intervention for bifurcation lesions in young patients

Roversi

Biondi‐Zoccai

Romagnoli

et al. 2013

International Journal of Cardiology

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Background: Coronary artery disease is most common in older patients, but may occur in younger subjects. The outlook of young patients after percutaneous coronary intervention (PCI) of challenging lesion subsets such as coronary bifurcations, is not established. We thus aimed to appraise the early and long-term results of PCI for bifurcations in young patients. Methods: A multicenter, retrospective study was conducted enrolling consecutive patients undergoing bifurcation PCI between 2002 and 2006 in 22 Italian centers. Patients were divided in 2 groups: age ≤45 years, and age >45 years. The primary end-point was long-term rate of major adverse cardiac events (MACE). Results: 4,314 patients were included: 195 (4.5%) in the younger group, and 4119 (95.5%) in the older group. 30-day outcomes did not show significant differences in MACE rates, with 1.0% in the ≤45 years group and 2.1% in the >45 years group (p=0.439), with death in 0.5% and 1.2% (p=0.388). At long-term follow-up (24.4± 15.1 months), younger patients showed similar rates of MACE, (12.8% vs. 16.6%, p=0.161), myocardial infarction (3.1% vs. 3.7%, p=0.633), target lesion revascularization (11.3% vs. 12.5%, p =0.627), or stent International Journal of Cardiology xxx (2012) xxx-xxx ☆ All authors take responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation.

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Section: Discussionsupporting

confidence: 82%

Section: Discussionmentioning

confidence: 99%

Early and long-term outlook of percutaneous coronary intervention for bifurcation lesions in young patients

Roversi

Biondi‐Zoccai

Romagnoli

et al. 2013

International Journal of Cardiology

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“…4 In one study of bifurcation lesions, the overall restenosis rate was 23%, with the majority of side branch restenoses occurring at the ostium after use of the T-stenting technique. 5 Side branch restenosis occurred in 16.7% after T-stenting, compared with 7.1% after other stenting techniques. The crush technique of bifurcation stenting with DESs is associated with favorable clinical outcomes when compared with BMSs, but the incidence of post-procedural stent thrombosis (ST) is of concern and is higher than after stenting of more simple lesions.…”

Section: Discussionmentioning

confidence: 99%

“…Previous DES data have suggested a higher restenosis rate after Tstenting, with the hypothesis that this might relate to incomplete coverage of the side branch ostium. 5 Preliminary data have indicated acceptable short-term results, suggesting that the crush technique might be more effective for bifurcation lesions than the T-stenting technique. 6 The crush technique was not used in these 2 cases; the kissing balloon technique was used in Case 1, and the kissing and T-stenting techniques were used in Case 2.…”

Section: Discussionmentioning

confidence: 99%

Coronary Artery Bypass Grafting Following In-Stent Restenosis of Drug-Eluting Stents Deployed in the Left Main Coronary Artery

Kanemitsu

Tanaka

et al. 2008

Circ J

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drug-eluting stent (DES) has been heralded as the next breakthrough technology in the fight against coronary artery disease. A DES reduces the incidence of restenosis after percutaneous coronary intervention (PCI) compared with a bare metal stent. 1 This may prove to significantly improve percutaneous treatment results and is likely to influence the surgical treatment of coronary artery disease. The number of PCIs with DESs has been increasing in Japan, and DESs have been deployed in lesions of the left main coronary artery and its bifurcation with good results. Patients are now rarely referred for surgery for either the occurrence or threat of stent restenosis. Case Reports Case 1A 71-year-old woman was admitted with unstable angina pectoris. She had previously undergone PCI using a DES (Cypher; Cordis, Miami Lakes, FL, USA) for left main coronary artery disease (LMCAD). A Cypher 3.5/18-mm stent was deployed at the proximal end and a Cypher 3.5/ 23-mm stent was deployed at the distal end of the LMCA using the kissing ballooning technique. Coronary angiography 4 months after PCI showed in-stent restenosis (Fig 1). She had been taking anti-platelet drugs (ticlopidine 200 mg daily and aspirin 100 mg daily). As her condition was unstable, emergent off-pump coronary artery bypass (OPCAB) grafting was performed. Anti-platelet drugs were not stopped before the operation, resulting in intra-and postoperative bleeding. She was transfused 6 units of blood, 10 units of fresh frozen plasma and 10 units of platelets. Rethoracotomy was not required. The postoperative course was otherwise uneventful, and postoperative coronary angiography revealed that all grafts were patent. Case 2A 74-year-old man was admitted with angina pectoris on effort. He had previously undergone PCI using a DES for LMCAD. A Cypher 3.0/33-mm stent was deployed in the LMCA using the kissing ballooning technique, and a Cypher 3.0/13-mm stent was deployed at the ostium of the left circumflex coronary artery using the T-stenting technique. Coronary angiography 6 months after PCI showed in-stent restenosis (Fig 2). He had been taking the same anti-platelet drugs as the patient in Case 1 (ie, ticlopidine 200 mg daily and aspirin 100 mg daily). As his condition was stable, antiplatelet drugs were stopped 5 days before surgery. Elective OPCAB grafting was performed without blood transfusion. The postoperative course was uneventful, and postoperative coronary angiography revealed that all grafts were patent. DiscussionTechnological advancements in PCI have resulted in a reduced restenosis rate and a broader range of lesions that can be treated successfully, thereby shifting the focus of coronary artery intervention from coronary artery bypass grafting (CABG) to PCI. In-stent restenosis of a DES occurs with a frequency of 2.3%, 1 and is more frequent among patients with diabetes mellitus, multivessel disease, complex lesions, and small vessels. 2 The expanding indications for angioplasty have already had an unquestionable impact on the practice of coronary reva...

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“…A major limitation to the use of those stents is the risk of unsuccessful protection against side branch occlusion in the early postprocedural phase and later on against restenosis. Initial studies reported that the frequency of in-segment restenosis may reach 20% [10,11]. Stents dedicated to the treatment of coronary artery bifurcations gave hope for safe and effective management of this type of lesion.…”

Section: Introductionmentioning

confidence: 99%

Coronary bifurcation stenting with dedicated Tryton side-branch stent. Early and 6-month results of 40 patients

Lesiak¹,

Stanisławska²,

Drewnicki³

et al. 2011

pwki

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A b s t r a c tBackground: Coronary artery bifurcation stenting using standard stents is associated with increased risk of complications and poor long-term prognosis. Bifurcation-dedicated stents raise a hope of improving the acute and late results of such procedures.Aim: To assess the early and mid-term results of bifurcation stenting with the specially designed bifurcation-dedicated Tryton side-branch stent.Methods and results: We evaluated 40 consecutive procedures of coronary artery bifurcation stenting using a Tryton stent in patients with stable angina or acute coronary syndrome without ST elevation. The stent was successfully implanted in 39 patients. The main vessel was treated with drug-eluting stents in 38 cases, whereas bare metal stents were used in the remaining two. In one case the procedure was complicated by non-Q wave myocardial infarction. During 30-day and 6-month observation no additional major adverse cardiac events were observed.Conclusion: Coronary bifurcation stenting with the Tryton side-branch stent is highly effective, with a low rate of acute and midterm complications.Key words: coronary bifurcation lesion, percutaneous coronary intervention, bifurcation dedicated stents S t r e s z c z e n i e Wstęp: Stentowanie bifurkacji tętnic wieńcowych przy użyciu standardowych stentów obarczone jest zwiększonym ryzykiem powikłań i gorszym rokowaniem odległym. Stenty specjalnie przeznaczone do bifurkacji mogą się przyczynić do poprawy wyników bezpośrednich i odległych zabiegów.Cel: Ocena wczesnych i średnioterminowych wyników stentowania zwężeń bifurkacji tętnic wieńcowych za pomocą implantacji stentu przeznaczonego do protekcji bocznicy Tryton.Metody i wyniki: Ocenie poddano kolejnych 40 zabiegów stentowania bifurkacji tętnic wieńcowych z zastosowaniem stentu Tryton u pacjentów z dławicą piersiową stabilną lub ostrym zespołem wieńcowym bez uniesienia odcinka ST. Stent skutecznie implantowano do bocznicy u 39 pacjentów. Naczynie główne leczono implantacją stentu uwalniającego lek w 38 przypadkach, w dwóch implantowano stent metalowy. W jednym przypadku zabieg był powikłany zawałem serca bez wytworzenia załamków Q. W obserwacji 30-dniowej oraz 6-miesięcznej nie stwierdzono żadnych dodatkowych niekorzystnych zdarzeń sercowych.Wnioski: Leczenie zwężeń bifurkacji tętnic wieńcowych z zastosowaniem stentu Tryton przeznaczonego do protekcji bocznicy cechuje się wysoką skutecznością bezpośrednią i niskim ryzykiem powikłań w obserwacji 30-dniowej i 6-miesięcznej.Słowa kluczowe: zwężenie bifurkacji tętnic wieńcowych, przezskórne interwencje wieńcowe, stenty przeznaczone do bifurkacji

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Restenosis rates following bifurcation stenting with sirolimus-eluting stents for de novo narrowings

Cited by 130 publications

References 12 publications

Early and long-term outlook of percutaneous coronary intervention for bifurcation lesions in young patients

Early and long-term outlook of percutaneous coronary intervention for bifurcation lesions in young patients

Coronary Artery Bypass Grafting Following In-Stent Restenosis of Drug-Eluting Stents Deployed in the Left Main Coronary Artery

Coronary bifurcation stenting with dedicated Tryton side-branch stent. Early and 6-month results of 40 patients

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