Open AccessJournal Article
[Intracoronary Stenting and Angiographic Results Strut Thickness Effect on Restenosis Outcome (ISAR-STEREO) Trial].
Adnan Kastrati,Julinda Mehilli,Josef Dirschinger,Franz Dotzer,Helmut Schühlen,Franz-Josef Neumann,Martin Fleckenstein,Conrad Pfafferott,Melchior Seyfarth,Albert Schömig +9 more
Reads0
Chats0
TLDR
The use of a thinner-strut device is associated with a significant reduction of angiographic and clinical restenosis after coronary artery stenting, and may have relevant implications for the currently most widely used percutaneous coronary intervention.Abstract:
Background Increased thrombogenicity and smooth muscle cell proliferative response induced by the metal struts compromise the advantages of coronary stenting. The objective of this randomized, multicenter study was to ascertain whether a reduced strut thickness of a stent is associated with improved follow-up angiographic and clinical results. Methods and results The study covered 651 patients with stenosis in the native coronary arteries > 2.8 mm in diameter. They were randomly assigned to receive 1 of 2 commercially available stents of comparable design but different thickness: 326 patients to the thin-strut stent (strut thickness of 50 microm) and 325 patients to the thicker-strut stent (strut thickness of 140 microm). The primary end point was the angiographic restenosis (> or = 50% diameter luminal stenosis at follow-up angiography). The secondary end points were the incidence of reinterventions due to restenosis-induced ischemia and the total rate of death and myocardial infarctions at 1 year (a combined end point). The incidence of angiographic restenosis was 15.0% in the thin-strut group and 25.8% in the thick-strut group (relative risk, 0.58; 95% CI, 0.39 to 0.87; p = 0.003). Clinical restenosis was also significantly reduced. Reinterventions were made in 8.6% of the thin-strut patients and in 13.8% of the thick-strut patients (relative risk, 0.62; 95% CI, 0.39 to 0.99; p = 0.03). No difference was observed in the combined 1-year rate of death and myocardial infarction. Conclusions The use of a thin-strut device is associated with a significant reduction of angiographic and clinical restenosis after coronary artery stenting. These findings may have relevant implications for the currently most widely used percutaneous coronary intervention.read more
Citations
More filters
Journal ArticleDOI
2018 ESC/EACTS Guidelines on myocardial revascularization.
Miguel Sousa-Uva,Franz-Josef Neumann,Anders Ahlsson,Fernando Alfonso,Adrian P. Banning,Umberto Benedetto,Robert A. Byrne,Jean-Philippe Collet,Falk,Stuart J. Head,Peter Jüni,Adnan Kastrati,Akos Koller,Steen Dalby Kristensen,Josef Niebauer,Dimitrios J. Richter,Petar M. Seferovic,Dirk Sibbing,Giulio G. Stefanini,Stephan Windecker,Rashmi Yadav,Michael O. Zembala +21 more
TL;DR: Authors/Task Force Members: Franz-Josef Neumann* (ESC Chairperson) (Germany), Miguel Sousa-Uva* (EACTS Chair person) (Portugal), Anders Ahlsson (Sweden), Fernando Alfonso (Spain), Adrian P. Banning (UK), Umberto Benedetto (UK).
Journal ArticleDOI
Effects of Disturbed Flow on Vascular Endothelium: Pathophysiological Basis and Clinical Perspectives
Jeng Jiann Chiu,Shu Chien +1 more
TL;DR: Current knowledge on the role of disturbed flow in EC physiology and pathophysiology, as well as its clinical implications are summarized to contribute to the understanding of the etiology of lesion development in vascular niches with disturbed flow and help to generate new approaches for therapeutic interventions.
Journal ArticleDOI
Hemodynamic shear stress and the endothelium in cardiovascular pathophysiology
TL;DR: Endothelium lining the cardiovascular system is highly sensitive to hemodynamic shear stresses that act at the vessel luminal surface in the direction of blood flow, which contributes to regional and focal heterogeneity of endothelial gene expression, which is important in vascular pathology.
Journal ArticleDOI
Intracoronary stenting and angiographic results: strut thickness effect on restenosis outcome (ISAR-STEREO-2) trial
Adnan Kastrati,Julinda Mehilli,Josef Dirschinger,Franz Dotzer,Helmut Schühlen,Franz-Josef Neumann,Martin Fleckenstein,Conrad Pfafferott,Melchior Seyfarth,Albert Schömig +9 more
TL;DR: When two stents with different design are compared, the stent with thinner struts elicits less angiographic and clinical restenosis than the thicker-strut stent.
Journal ArticleDOI
Endothelial Cell Recovery Between Comparator Polymer-Based Drug-Eluting Stents
Michael Joner,Gaku Nakazawa,Aloke V. Finn,Shawn Chin Quee,Leslie Coleman,Eduardo Acampado,Patricia S. Wilson,Kristi Skorija,Qi Cheng,Xin Xu,Herman K. Gold,Frank D. Kolodgie,Renu Virmani +12 more
TL;DR: The present study marks the first comparator analysis of endothelial coverage in leading polymeric DES, supporting disparities in arterial healing based on endothelial regrowth and recovery, favoring newer designs over the current generation of FDA-approved stents.
References
More filters
Journal ArticleDOI
A Randomized Comparison of Coronary-Stent Placement and Balloon Angioplasty in the Treatment of Coronary Artery Disease
David L. Fischman,Martin B. Leon,Donald S. Baim,Richard A. Schatz,Michael P. Savage,Ian M. Penn,Katherine D. Detre,Lisa Veltri,Donald R. Ricci,Masakiyo Nobuyoshi,Michael W. Cleman,Richard R. Heuser,David Almond,Paul S. Teirstein,R. David Fish,Antonio Colombo,Jeffrey C. Brinker,Jeffrey Moses,Alex Shaknovich,John N. Hirshfeld,Stephen Bailey,Stephen E. Ellis,Randal Rake,Sheldon Goldberg +23 more
TL;DR: In selected patients, placement of an intracoronary stent, as compared with balloon angioplasty, results in an improved rate of procedural success, a lower rate of angiographically detected restenosis, a similar rate of clinical events after six months, and a less frequent need for revascularization of the original coronary lesion.
Journal ArticleDOI
Endovascular Stent Design Dictates Experimental Restenosis and Thrombosis
TL;DR: Surface material and geometric configuration of stents may be more important than postplacement diameter in determining neointimal hyperplasia and thrombosis and monocytes may be important modulators of stent-induced intimal thickening.
Journal ArticleDOI
Coronary Stenting plus Platelet Glycoprotein IIb/IIIa Blockade Compared with Tissue Plasminogen Activator in Acute Myocardial Infarction
Albert Schömig,Adnan Kastrati,Josef Dirschinger,Julinda Mehilli,Ullrich Schricke,Jürgen Pache,Stefan Martinoff,Franz-Josef Neumann,Markus Schwaiger +8 more
TL;DR: In patients with acute myocardial infarction, coronary stenting plus abciximab leads to a greater degree ofMyocardial salvage and a better clinical outcome than does fibrinolysis with a tissue plasminogen activator.
Journal ArticleDOI
Complementary Clinical Benefits of Coronary-Artery Stenting and Blockade of Platelet Glycoprotein IIb/IIIa Receptors
A.M. Lincoff,Robert M. Califf,David J. Moliterno,Stephen G. Ellis,John Ducas,Kramer Jh,Neal S. Kleiman,Eric A. Cohen,Joan E. Booth,Shelly Sapp,Catherine F. Cabot,Eric J. Topol +11 more
TL;DR: Among patients with diabetes, the combination of abciximab and stenting was associated with a lower rate of repeated target-vessel revascularization than was stenting and placebo or angioplasty and abcximab.
Journal ArticleDOI
Restenosis after coronary placement of various stent types
Adnan Kastrati,Julinda Mehilli,Josef Dirschinger,Jürgen Pache,Kurt Ulm,Helmut Schühlen,Melchior Seyfarth,Claus Schmitt,Rudolf Blasini,Franz-Josef Neumann,Albert Schömig +10 more
TL;DR: The predominant role of lesion and procedural factors in determining the occurrence of restenosis after coronary stent placement is demonstrated, and stent design appears to play a particularly important role in the hyperplastic response of the vessel wall.