Stent design related neointimal tissue proliferation in human coronary arteries; an intravascular ultrasound study

Hoffmann, Rainer; Jansen, Christian; König, Andreas; Haager, Phillip; Kerckhoff, Gregor; Dahl, Jürgen vom; Klauss, V.; Hanrath, Peter; Mudra, Harald

doi:10.1053/euhj.2001.2606

Cited by 41 publications

(26 citation statements)

References 20 publications

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“…The simulation technique predicted the same ranking of stents based on average neointimal area as two clinical studies (Hoffmann et al, 2001;Kastrati et al, 2001) with the open-cell-type stent outperforming more rigid stents. Simulations predicted less of a difference between the PALMAZ and NIR stent than between the MULTILINK and PALMAZ stent, in terms of both tissue volume and cell numbers.…”

Section: Discussionmentioning

confidence: 98%

“…We applied the simulation technique in 3D to three stents similar in design to the ones analysed clinically by Hoffmann et al (2001) and Kastrati et al (2001). If the hypothesis is corroborated, then this methodology could be applied to future device design and treatment options.…”

Section: Introductionmentioning

confidence: 99%

“…In order to test the suitability of using such a mechanobiological model as an engineering design tool, the predictions of the model must be compared to in vivo, clinical data. Hoffmann et al (2001) performed a detailed study of the clinical performance of three different stent designs, which included information on the stent types, and detailed data on the outcomes of these stents in terms of the neointimal areas produced. Kastrati et al (2001) also analysed clinical data for the same stent types, and ranked their performance based on a multivariate analysis of restenosis predictors.…”

Section: Introductionmentioning

confidence: 99%

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Application of a mechanobiological simulation technique to stents used clinically

Boyle

Lennon

Prendergast

2013

Journal of Biomechanics

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Section: Discussionmentioning

confidence: 98%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Application of a mechanobiological simulation technique to stents used clinically

Boyle

Lennon

Prendergast

2013

Journal of Biomechanics

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“…[1][2][3][4][5][6][7] On the basis of these risk factors, patients enrolled in both nonrandomized studies and clinical trials have been classified as having a high, intermediate, or low risk of restenosis. Therefore, the binary restenosis rates (Ͼ50% diameter stenosis angiographically) and major adverse cardiac event (MACE) rates in human studies vary greatly depending on the overall risk profile of patients enrolled in these studies.…”

Section: Human Studiesmentioning

confidence: 99%

Coated Stents for the Prevention of Restenosis: Part II

2002

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T his is the second part of a 2-part article that reviews the literature on coated stents and their effects on in-stent restenosis after percutaneous coronary intervention (PCI). Part I of this review discussed the pathophysiology of in-stent restenosis, specific stent coatings, and animal studies investigating coated stents. Part II discusses nonrandomized studies and clinical trials in humans. Studies in humans have examined stents coated with biocompatible materials and drug-eluting stents. Complications and controversies associated with this new technology are also addressed. Human StudiesThe risk of developing in-stent restenosis is related to a variety of factors, both clinical and procedural. [1][2][3][4][5][6][7] On the basis of these risk factors, patients enrolled in both nonrandomized studies and clinical trials have been classified as having a high, intermediate, or low risk of restenosis. Therefore, the binary restenosis rates (Ͼ50% diameter stenosis angiographically) and major adverse cardiac event (MACE) rates in human studies vary greatly depending on the overall risk profile of patients enrolled in these studies. Non-Randomized Studies Stents Coated with Biocompatible MaterialsThe biocompatibility of stents coated with several materials, including carbon, gold, silicon carbide, and phosphorylcholine, has been investigated in humans. The Carbostent (Sorin Biomedica Cardio) is a metal stent coated with a carbon film that is thought to be less thrombogenic than uncoated steel stents. 8 Antoniucci et al 9 investigated the long-term biocompatibility of the Carbostent in a group of 112 patients with an intermediate risk of developing restenosis. Six-month follow-up revealed low MACE and restenosis rates of 12% and 11%, respectively. A second study in another group of 112 patients at high risk for restenosis resulted in a MACE rate of 20% and a binary restenosis rate of 25% by 6 months. 10 These results suggest that the Carbostent is well tolerated in vivo and possibly inhibits neointimal hyperplasia, especially in high-risk patients (Table 1).Gold has been touted as a biocompatible material and has been thought to be ideal for coating coronary stents because of its radio-opaque properties. 1 Two studies evaluating the biocompatibility of gold-coated stents suggested equivalency with uncoated steel stents. 11,12 However, two other studies concluded that these stents may increase neointimal hyperplasia compared with uncoated stents, although patients at a higher risk for restenosis were enrolled. 13,14 Follow-up angiography at 6 months demonstrated a relatively high lumen late loss (postintervention minimum luminal diameter minus the minimum luminal diameter at follow-up) and diameter stenosis in both studies (Table 1). Overall, there have been conflicting results in observational studies examining goldcoated stents, and the restenosis rates seem to be no better than those obtained with uncoated steel stents.Silicon carbide is an inert semiconductor that can be coated onto prosthetic surfaces and has be...

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“…23,24) Studies showed the significant impact of stent design on restenosis rates, [25][26][27][28] and patterns of neointimal hyperplasia. 29,30) One important observation is the lower rates of TLR and binary restenosis in both groups, including a much lower rate among CCS in comparison to the impression of the huge difference between DES and BMS in the randomized trials. This finding was reported by some studies, 6) still one study showed no significant clinical difference, even in revascularization between DES and CCS.…”

Section: Figurementioning

confidence: 99%

Cobalt Chromium Coronary Stents and Drug-Eluting Stents in Real Practice

Youssef

Hussein²,

Hsueh

et al. 2010

Int. Heart J.

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SummaryCobalt chromium stents (CCS) are seldom compared to drug-eluting stents (DES) for coronary intervention in published clinical trials. We evaluated the daily usage patterns of CCS in comparison to DES unconstrained by eligibility criteria. We compared consecutive patients (n = 303) with de novo lesions treated exclusively with a CCS to 432 patients treated exclusively with a DES. Patients in the CCS group were older, frequently had heart failure, renal failure, prior coronary balloon angioplasty, prior stroke, more comorbidities, and more multivessel disease than the DES group. The DES group had longer and more type C and left anterior descending (LAD) coronary artery lesions. The in-hospital major adverse cardiac events (MACE; death, myocardial infarction, stroke and target lesion revascularization (TLR)) were similar. At 6 months, the cumulative rate of MACE was 12.9% in the CCS group and 5.6% in the DES group (P < 0.001), and this was driven by TLR. The rates of stent thrombosis were similar in CCS (0.9%) and DES (1.0%) patients.In conclusion, the CCS were used in clinically higher risk patients, while DES were used in more severely diseased coronary arteries. Drug-eluting stent use resulted in lower rates of clinically driven repeat revascularization with similar rates of death, MI, stroke, and stent thrombosis. (Int Heart J 2010; 51: 231-237) Key words: Stents, Cobalt chromium, Drug-eluting, Restenosis T he rates of restenosis and major adverse cardiac events (MACE) have both been demonstrated to be significantly reduced with the use of drug-eluting stents (DES) compared with bare-metal stents (BMS) in a broad variety of studies and trials.1-6) The same trials could not demonstrate any differences in mortality or acute myocardial infarction (AMI) rates. Therefore, the reported clinical benefit of DES is entirely due to the highly significant reduction in the need for repeated interventions. However, concerns about late events associated with DES have come to light, suggesting that the indiscriminate use of DES is actually not advisable. [7][8][9] Moreover, there is controversy regarding the advantage of using DES over BMS in terms of clinical outcome for short lesions and relatively large vessels (≥ 3.0 mm). 6) Also, exploring how physicians decide which stent category to use for different uncontrolled clinical and angiographic varieties, and how this impacts clinical outcome in real practice represents is important. And finally, in the majority of the randomized DES trials, the BMS used were not the most up-to-date in terms of stent design and technology. A study involving last-generation BMS, essentially cobalt chromium stents (CCS), showed lower revascularization rates. This famous randomized trial showed that the use of DES compared to CCS in all patients has no clinical benefit, including no significant difference in restenosis related target vessel revascularization. 10) However, data regarding such comparisons and the usage patterns in clinical settings are limited in the literature. . Subjects...

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Stent design related neointimal tissue proliferation in human coronary arteries; an intravascular ultrasound study

Cited by 41 publications

References 20 publications

Application of a mechanobiological simulation technique to stents used clinically

Application of a mechanobiological simulation technique to stents used clinically

Coated Stents for the Prevention of Restenosis: Part II

Cobalt Chromium Coronary Stents and Drug-Eluting Stents in Real Practice

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