Sirolimus- versus Paclitaxel-Eluting Stent Implantation for Unprotected Left Main Coronary Artery Stenosis

Lee, Sang Hak; Ko, Young Guk; Jang, Yangsoo; Kwon, Hyuck Moon; Lee, Seung Hwan; Yoon, Jung Han; Park, Si Hoon; Kim, Byung Ok; Jeon, Dong Woon; Yang, Joo Young; Ryu, Seungki

doi:10.1159/000088106

Cited by 34 publications

(10 citation statements)

References 27 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The widespread use of drug-eluting stents has resulted in a large reduction in the restenosis rate and the need for target lesion revascularization after percutaneous coronary intervention (PCI) in patients with renal insufficiency (RI) [1, 2]. However, an elevated occurrence rate of stent thrombosis (ST) after implantation of drug-eluting stentsraises a genuine safety concern [3,4,5,6].…”

Section: Introductionmentioning

confidence: 99%

Moderate-Severe Renal Insufficiency Is a Risk Factor for Sirolimus-Eluting Stent Thrombosis

Zhu¹,

Zhang²,

Zhang³

et al. 2008

Cardiology

View full text Add to dashboard Cite

Objective: The RIFT study aimed to observe the impact of renal insufficiency (RI) on the incidence of stent thrombosis (ST) after percutaneous coronary intervention. Methods: The RIFT study enrolled 1,174 patients undergoing revascularization exclusively with sirolimus-eluting stents. The occurrence of ST and major adverse cardiac events were compared between patients with (n = 309) and without (n = 865) RI, and independent predictors of ST were also identified. Results: During follow-up (mean 18.9 ± 9.2 months), the rate of ST was significantly higher in patients with than without RI [5.5% (n = 17) vs. 1.7% (n = 15), p < 0.001], and the presence of severe RI (estimated glomerular filtration rate <30 ml/min·1.73 m²) was an independent predictor of ST (odds ratio = 4.5, 95% confidence interval 1.4–15, p = 0.011). In patients with RI and diabetes or left ventricular ejection fraction (LVEF) <50%, the incidence of ST was significantly increased [13.0% (n = 10) vs. 3.6% (n = 7), p = 0.010; 11.6% (n = 8) vs. 1.9% (n = 3), p = 0.004, respectively] compared to those with diabetes or LVEF <50% alone. The influence of RI on ST was not significant in patients with multivessel disease, calcified or bifurcation lesions, and target lesion revascularization. Conclusions: These findings substantiate the importance of long-term antiplatelet therapy for patients with RI after drug-eluting stent implantation.

show abstract

Section: Introductionmentioning

confidence: 99%

Moderate-Severe Renal Insufficiency Is a Risk Factor for Sirolimus-Eluting Stent Thrombosis

Zhu¹,

Zhang²,

Zhang³

et al. 2008

Cardiology

View full text Add to dashboard Cite

show abstract

“…This standard is being challenged by DES. Table 2 summarizes eight registry reports that have evaluated DES in the treatment of unprotected LMCA stenosis [48][49][50][51][52][53][54][55]. Procedural success was high in all reported series (90% to 100%), with low rates of in-hospital death ( 1.0%), confirming the technical feasibility of treating unprotected LMCA with DES.…”

Section: Unprotected Lmca Diseasementioning

confidence: 84%

Utility of drug-eluting stents in complex lesions and high-risk patients

Nikolsky

Stone

2007

Curr Treat Options Cardio Med

View full text Add to dashboard Cite

Drug-eluting stents represent a breakthrough technology designed to deliver high concentrations of a bioactive agent locally to an atherosclerotic lesion, thereby minimizing systemic side effects of the drug. The safety and efficacy of drug-eluting stents have clearly been demonstrated in noncomplex lesions. This article presents an evidence-based analysis of the current experience with CYPHER sirolimus-eluting stents (Cordis Corp., Miami Lakes, FL) and TAXUS paclitaxel-eluting stents (Boston Scientific, Natick, MA) in a broad spectrum of high-risk and/or complex subsets of patients and lesions, including those with diabetes mellitus, multivessel disease, diffuse disease, very small vessels, lesions in saphenous vein grafts, chronic total occlusions, in-stent restenosis, ostial and bifurcation lesions, unprotected left main disease, and acute myocardial infarction. Emerging data in several of these subsets suggest that drug-eluting stents are safe and effective, and their use may currently be recommended, whereas in other groups of patients and lesions the efficacy and/or safety of drug-eluting stents remains to be determined, thus warranting caution. It is anticipated that penetration of drug-eluting stents will continue to increase, and fewer patients will require surgical revascularization to achieve sustained event-free survival.

show abstract

“…30 On the other hand, recent observational studies and randomized trials comparing PTCA with stenting to CABG in the management of LMCA lesion are more encouraging. 24,27,31-38 Lee et al 26 and Chieffo et al 31 found better short-term outcomes in terms of death, myocardial infarction (MI) and target-vessel revascularization in PTCA with DES group. Death and MI after 6-12 months' observation were also less in DES implantation group, whereas restenosis rates were higher than that in CABG group.…”

Section: Pci Versus Cabg In Lmca Stenosismentioning

confidence: 99%

Percutaneous Coronary Intervention in Left Main Coronary Artery Disease - A Case Report

Chowdhury¹,

Uddin

Khalequzzaman

et al. 2012

Univ. Heart J.

View full text Add to dashboard Cite

Left main coronary artery (LMCA) atherosclerosis bears extra importance because of the large territory of myocardium supplied by the vessel. By convention, significant LMCA stenosis is treated by coronary artery bypass graft (CABG) surgery, and this type of lesion has long been regarded as a contraindication for percutaneous coronary intervention (PCI). However, with the advancement in interventional tools, operators' expertise, pharmaceuticals and supportive measures, outlook regarding left main PCI is changing. Recent clinical trials tell about the feasibility of LMCA PCI. The three cases of significant left main lesion presented here, were treated successfully by percutaneous transluminal coronary angioplasty (PTCA) with stenting in National Institute of Cardiovascular Diseases (NICVD), Dhaka. In near future, PCI may be an equally effective alternative to surgical revascularization in judiciously selected cases of LMCA stenosis even in Bangladesh. Case 1:Mr. AB, a 43-year-old smoker, who was hypertensive but non-diabetic, was admitted into NICVD, Dhaka. Two weeks back, he was treated as a case of unstable angina in Chittagong Medical College Hospital (CMCH). Coronary angiography (CAG) done in Chittagong Medical College Hospital (CMCH) revealed severe left main coronary artery (LMCA) disease with 70-80% stenosis at its mid part, for which he was referred to NICVD for further management. His resting ECG showed ST depression in lead II, III, AVF, V 5 and V 6 ; echocardiography disclosed septal and inferior left ventricular wall hypokinesia with left ventricular ejection fraction (LVEF) 54%. Blood counts and biochemistry including sugar, creatinine and lipid profile were normal. Serological tests i.e. HBsAg, Anti-HCV, Anti-HIV, VDRL were negative. PTCA and stenting to LMCA was done uneventfully. The LMCA lesion was negotiated with floppy PTCA guidewire, and a 3.0x10 mm cobultchromium stent was deployed at the lesion at 14 atm pressure, preceded by dilatation with a 1.5x6 mm balloon at 8 atm. TIMI III flow was established (Fig. 1). Postprocedural period was uneventful. An anesthesiologist was constantly present in the cath lab and a full coronary artery bypass graft (CABG) team was kept ready for emergency revascularization surgery, if needed. Case 2:Mr. AK, a 38-year-old normotensive, nondiabetic but dyslipidaemic man, with a strong family history of coronary artery disease, presented to NICVD with compressive chest pain. He was haemodynamically stable with pulse 80 beats per minute, blood pressure 120/75 mm Hg, lung bases were clear and heart sounds were

show abstract

Sirolimus- versus Paclitaxel-Eluting Stent Implantation for Unprotected Left Main Coronary Artery Stenosis

Cited by 34 publications

References 27 publications

Moderate-Severe Renal Insufficiency Is a Risk Factor for Sirolimus-Eluting Stent Thrombosis

Moderate-Severe Renal Insufficiency Is a Risk Factor for Sirolimus-Eluting Stent Thrombosis

Utility of drug-eluting stents in complex lesions and high-risk patients

Percutaneous Coronary Intervention in Left Main Coronary Artery Disease - A Case Report

Contact Info

Product

Resources

About