Use of multiple overlapping sirolimus-eluting stents for treatment of long coronary artery lesions: Results from a single-center registry in 318 consecutive patients

Ahn

Cathet Cardio Intervent

et al. 2014

Objectives: We examined long-term outcomes and predictors of major adverse cardiac events after the full metal jacket (FMJ) stent implantation. Background: The FMJ procedure has been used to treat diffuse coronary artery disease (CAD), but long-term outcomes remain unknown. Methods: The study population consisted of 347 consecutive patients (352 lesions) who had been treated for de novo diffuse CAD with FMJ stents (stent length 60 mm). Results: The mean age was 61.0 6 10.1 years, and the stent length was 71.9 6 13.7 mm. The procedural success rate was 97.7%. Major in-hospital complications (one death and two acute stent thromboses) occurred in three patients (0.7%). The median follow-up was 101 months (interquartile range, 95-108 months). During follow-up, there were 60 deaths (33 cardiac), 20 myocardial infarctions, and 94 revascularizations. Definite stent thrombosis occurred in 12 patients. The eventfree survival rate for cardiac death, cardiac death/myocardial infarction, or cardiac death/ myocardial infarction/target lesion revascularization was 90.5 6 1.6, 85.8 6 1.9, and 71.6 6 2.5% at 8 years, respectively. Left ventricular dysfunction (ejection fraction < 45%) was an independent predictor of cardiac death (OR: 4.88; 95% CI: 1.81-13.13; P 5 0.002). Left ventricular dysfunction and a stent length > 80 mm were significantly related to cardiac death/myocardial infarction. Likewise, a stent length > 80 mm was an independent predictor of cardiac death/myocardial infarction/target lesion revascularization (OR: 2.45; 95% CI: 1.16-5.19; P 5 0.019). Conclusion: Long-term outcomes appear favorable after FMJ procedures, and left ventricular dysfunction and a stent length > 80 mm are major predictors of major adverse cardiac events. These findings might be useful in identifying the most suitable treatments for patients with very diffuse CAD. V C 2013 Wiley Periodicals, Inc.

Section: Introductionmentioning

confidence: 99%

Long‐term (8 year) outcomes and predictors of major adverse cardiac events after full metal jacket drug‐eluting stent implantation

Ahn

Cathet Cardio Intervent

et al. 2014

“…One study reported a 9-month late stent thrombosis rate of 1.25% (4/318) for a mean stent length ≥ 55 mm (14). In the present study, 4 stent thrombosis (one acute, two sub-acute and one late) events developed in the PES group (3.4%), while only one subacute stent thrombosis occurred in the SES group (0.5%, P = 0.033).…”

Section: Discussionmentioning

confidence: 99%

Two-year Clinical Outcomes of Patients with Long Segments Drug-Eluting Stents: Comparison of Sirolimus-Eluting Stent with Paclitaxel-Eluting Stent

et al. 2011

Limited data are available on the long-term clinical efficacy of drug-eluting stent (DES) in diffuse long lesions. From May 2006 to May 2007, a total of 335 consecutive patients (374 lesions) were underwent percutaneous coronary intervention with implantation of long DES (≥ 30 mm) in real world practice. Eight-month angiographic outcomes and 2-yr clinical outcomes were compared between SES (n = 218) and PES (n = 117). Study endpoints were major adverse cardiac events including cardiac death, myocardial infarction, target-lesion revascularization, target-vessel revascularization and stent thrombosis. Baseline characteristics were similar in the two groups as were mean stent length (44.9 ± 15.2 mm in SES and 47.4 ± 15.9 in PES, P = 0.121). Late loss at 8 months follow-up was significantly lower in SES than in PES group (0.4 ± 0.6 mm in SES vs 0.7 ± 0.8 mm in PES, P = 0.007). Mean follow-up duration was 849 ± 256 days, and 2-yr cumulative major adverse cardiac events were significantly lower in the SES than in the PES group (5.5% in SES vs 15.4% in PES, P = 0.003). In conclusion, long-term DES use in diffuse long coronary lesions is associated with favorable results, with SES being more effective and safer than PES in this real-world clinical experience.

“…Stents are most often placed in vessels with angulated geometries and remain in bent positions throughout their lifetime (Fournier, et al 2005;Smith, et al 2001). Long lesions can require two overlapping stents (Ruchin, et al 2008) and bifurcation lesions often require two stents at varying angles or the use of a novel stent specifically designed for a bifurcation (Sukhija, Mehta and Sachdeva 2008;Ikeno, Buchbinder and Yeung 2007).…”

Section: Published In Computer Methods and Programs In Biomedicine Bymentioning

confidence: 99%

“…Coronary lesions are often extremely long in length and treatment can require multiple overlapping stents (Ruchin, et al 2008). Therefore, new interlocking stent designs, such as the Custom NX(R) DES System manufactured by XTENT, Inc., are exploring the possibility of deploying stents up to 60 mm in total length (Stella, et al 2008).…”

Section: Complex Lesionsmentioning

confidence: 99%

“…However, single coronary lesions are often longer than 38 mm, sometimes greater than 60 mm in length, and treatment requires multiple overlapping stents (Ruchin, et al 2008). Using the BVM system for preclinical testing of overlapping stents could allow for better understanding of the cellular response at the overlapping junctions as well as the effect of the potentially double local drug does when using drug-eluting stents ).…”

Section: Design Of Next Generation Bvmsmentioning

confidence: 99%

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Design and Optimization of a Blood Vessel Mimic Bioreactor System for the Evaluation of Intravascular Devices in Simple and Complex Vessel Geometries

Leifer¹

Coronary artery disease affects millions of people and the ability to detect and treat the disease is advancing at a rapid rate. As a result, the development of intravascular technologies is the focus of many medical device manufacturers. Specifically, coronary stent implantation is being performed in an increasing number of patients and a number of new stent designs have been introduced to the market, resulting in the need for improved preclinical testing methods. An in vitro tissue engineered "blood vessel mimic" (BVM) system has previously been established and its feasibility for the initial testing of newly emerging intravascular technology has been demonstrated. There are limitations that exist with this original design, however, and the focus of this thesis was to both improve and expand upon the original model. Therefore, research was conducted based on two specific aims. The first aim was to develop a more ideal BVM system to accommodate a wider range of stent lengths and diameters, while allowing for easy graft insertion and seal-ability. The second aim was to develop next generation BVM systems, v focused on future needs and technology, such as long, angulated and bifurcated geometries.The work described in this thesis demonstrates that a BVM chamber can be created which has the advantages of easy graft insertion and seal-ability, as well as the ability to accommodate varying sizes of vessel scaffolds, all while maintaining the needs of a tissue engineering bioreactor system. The next generation BVM systems presented demonstrate that the BVM concept can be expanded to meet the needs of long, angulated and bifurcated geometries. Overall, the work in this thesis describes the design and optimization of an in vitro blood vessel mimic bioreactor system for the evaluation of intravascular devices, specifically coronary stents, in simple and complex vessel geometries.vi ACKNOWLEDGEMENTS First, I would like to acknowledge and thank the members of my thesis committee: Dr. Kristen O'Halloran Cardinal, Dr. Trevor Cardinal and Dr. Lily Laiho. Thanks for all your guidance and input and for providing assistance and ideas throughout the project.