The Relationship and Threshold of Stent Length With Regard to Risk of Stent Thrombosis After Drug-Eluting Stent Implantation

Suh, Jon; Park, Duk‐Woo; Lee, Jong‐Young; Jung, In Mok; Lee, Seung-Whan; Kim, Young‐Hak; Lee, Cheol Whan; Cheong, Sang-Sig; Kim, Jae‐Joong; Park, Seong-Wook; Park, Seung‐Jung

doi:10.1016/j.jcin.2009.10.033

Cited by 120 publications

(83 citation statements)

References 26 publications

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“…Stent length has been considered as an important predictor of adverse clinical outcomes after PCI [36,37]. Our data also demonstrated that stent length was one of the predictors of TLR in HD patients after the implantation of DES.…”

Section: Discussionsupporting

confidence: 72%

Influence of hemodialysis duration on mid-term clinical outcomes in hemodialysis patients with coronary artery disease after drug-eluting stent implantation

et al. 2014

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Accelerated atherosclerosis in prolonged maintenance hemodialysis (HD) has been recognized; however, whether HD duration is associated with poor clinical outcome in HD patients with coronary artery disease (CAD) after drug-eluting stent (DES) implantation is unknown. We evaluated the impact of HD duration on clinical outcomes in HD patients with CAD after DES implantation. Between April 2007 and December 2012, 168 angina pectoris patients (320 de novo lesions) on HD were treated with DES. Major adverse cardiovascular events (MACE) and target lesion revascularization (TLR) were investigated at 3 years according to the HD duration (≤ 3 years, 83 patients; >3 years, 85 patients). The incidence of MACE was significantly higher in the long HD duration group (25.3 vs. 50.6 %; P = 0.001). Especially, sudden cardiac death (SCD) was significantly higher in the long HD duration group (3.6 vs. 16.5 %; P = 0.006). On the other hand, the rates of TLR were similar between the two groups (12.0 vs. 14.1 %; P = 0.69). Cox's proportional hazard analysis revealed that HD duration (HR 1.08 per year, 95 % CI 1.03-1.13, P = 0.002), β-blocker use (0.28, 0.17-0.46, P < 0.001), and diabetes mellitus (2.10, 1.23-3.56, P = 0.007) were independent predictors of MACE. Longer HD duration did not affect TLR; however, SCD was significantly higher in the long HD duration group.

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Section: Discussionsupporting

confidence: 72%

Influence of hemodialysis duration on mid-term clinical outcomes in hemodialysis patients with coronary artery disease after drug-eluting stent implantation

et al. 2014

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“…In addition, although a complete coverage of diffuse disease is one of the strategies for prevention of SER, multiple long stent implantation may lead to a high incidence of periprocedural myocardial infarction and late stent thrombosis. 14,15 In the present study, we proposed new OCT criteria for stent landing zone to minimize SER. Even in cases with diffuse disease, there might be some segments with an OCT-measured lipid arc of <185°, which could be used for a stent landing zone.…”

Section: Discussionmentioning

confidence: 99%

Optical Coherence Tomography Predictors for Edge Restenosis After Everolimus-Eluting Stent Implantation

Ino

Kubo

Matsuo

et al. 2016

Circ: Cardiovascular Interventions

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P ercutaneous coronary intervention (PCI) is a common and established therapy for coronary artery disease. Drugeluting stents have been shown to reduce neointimal hyperplasia and restenosis in stent segments. However, restenosis in reference segments adjacent to the proximal and distal border of the stent (so-called stent edge restenosis [SER]) remains a potential limitation of drug-eluting stents. 1Stenting from normal to normal is effective to minimize SER. However, the reference segments are rarely normal. Especially in diffuse disease, it is difficult to determine appropriate plaque-free reference segments for stent landing. Previous intravascular ultrasound studies have disclosed that greater residual plaque burden and stent overexpansion are associated with SER. 2,3 Optical coherence tomography (OCT) is a high-resolution (10-20 μm) intravascular imaging technique that uses near-infrared light to create images. An excellent contrast between lumen and vessel wall in OCT allows accurate lumen measurements. 4 Tissue characterization by OCT enables us to identify 3 types of coronary plaques such as lipid, fibrous, and fibrocalcific. 5 In addition, OCT has a high sensitivity for detection of suboptimal stent findings such as intrastent tissue protrusion, incomplete stent apposition, stent edge dissection, and intrastent thrombus. 4 Recently, OCT is becoming increasingly widespread as a clinical tool to guide PCI. The aim of this study was to determine OCT predictors for angiographic SER after everolimus-eluting stent implantation.Background-Stent edge restenosis (SER) remains a potential limitation of drug-eluting stents. The aim of this study was to determine optical coherence tomography (OCT) predictors for angiographic late SER after everolimus-eluting stent implantation. Methods and Results-We retrospectively analyzed 319 patients who underwent OCT immediately after everolimus-eluting stent implantation and scheduled 9-to 12-month follow-up angiography. The binary angiographic SER rate was 10% (32/319) in the patients, 8.4% (32/382) in lesions, and 4.4% (33/744) in stent edge segments. In the stent edge segments at post stenting, OCT-derived lipidic plaque (61% versus 20%; P<0.001) was more often observed in the SER group, and OCT-measured minimum lumen area (4.13±2.61 versus 5.58±2.46 mm 2 ; P=0.001) was significantly smaller in the SER group compared with the non-SER group. Multivariate analysis identified lipidic plaque (odds ratio: 5.99; 95% confidence interval: 2.89-12.81; P<0.001) and minimum lumen area (odds ratio: 0.64; 95% confidence interval: 0.42-0.96; P=0.029) as independent predictors of binary SER. Receiver-operating characteristic analysis demonstrated that lipid arc of 185° (sensitivity: 71%; specificity: 72%; area under the curve: 0.761) and minimum lumen area of 4.10 mm 2 (sensitivity: 67%; specificity: 77%; area under the curve: 0.787) were optimal cutoff values for predicting ischemiadriven SER. Conclusions-The present OCT study demonstrated that lipidic plaque and minimum lumen area in t...

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“…1 Furthermore, first-generation DESs are associated with delayed arterial healing and potential inflammation, as well as a propensity for late thrombosis, especially in high-risk lesions such as long coronary segments. 2 Therefore, the development of newer-generation DESs that ensure both safety and efficacy has become a matter of intensive investigation. These newergeneration DESs use innovative stent platforms, polymers, and a variety of drugs.…”

mentioning

confidence: 99%

“…3,4 Recently, several trials revealed that the outcomes of a newly developed biodegradable polymer-coated biolimus A9-eluting stent (BES) and a platinum chromium everolimuseluting stent (PtCr-EES) were favorable. [1][2][3][4][5] To date, no investigations have compared the benefits of the biodegradable polymer-based BES with the durable polymer PtCr-EES for the treatment of long coronary artery disease. Because of their severity, long coronary artery lesions may be a practical target to assess the anticipated high antirestenotic efficacy and safety of these newer devices.…”

mentioning

confidence: 99%

Comparison of Biolimus A9–Eluting (Nobori) and Everolimus-Eluting (Promus Element) Stents in Patients With De Novo Native Long Coronary Artery Lesions

Lee

Park

Kim

et al. 2014

Circ: Cardiovascular Interventions

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Background-Procedural and clinical outcomes still remain unfavorable for patients with long coronary lesions who undergo percutaneous coronary intervention. The current study, therefore, evaluated 2 innovative drug-eluting stents for the management of long-lesion coronary artery disease. Methods and Results-This randomized, multicenter, prospective trial, called the Long Drug-Eluting Stent (LONG-DES) V trial, compared the biodegradable polymer-based biolimus A9-eluting stent (BES) and the durable polymer-based platinum chromium everolimus-eluting stent (PtCr-EES) in 500 patients with long (≥25 mm) coronary lesions. The primary end point of the trial was in-segment late luminal loss at the 9-month angiographic follow-up.

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The Relationship and Threshold of Stent Length With Regard to Risk of Stent Thrombosis After Drug-Eluting Stent Implantation

Abstract: Length of the stented segment was independently associated with the incidence of ST and death or myocardial infarction after DES implantation. The value of stent length >or=31.5 mm is a threshold for the prediction of ST.

Cited by 120 publications

References 26 publications

Influence of hemodialysis duration on mid-term clinical outcomes in hemodialysis patients with coronary artery disease after drug-eluting stent implantation

Influence of hemodialysis duration on mid-term clinical outcomes in hemodialysis patients with coronary artery disease after drug-eluting stent implantation

Optical Coherence Tomography Predictors for Edge Restenosis After Everolimus-Eluting Stent Implantation

Comparison of Biolimus A9–Eluting (Nobori) and Everolimus-Eluting (Promus Element) Stents in Patients With De Novo Native Long Coronary Artery Lesions

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