Open Access
Stent Thrombogenicity Early in High Risk Interventional Settings is Driven by Stent Design and Deployment, and Protected by Polymer-Drug Coatings
Kumaran Kolandaivelu,Rajesh V. Swaminathan,William J. Gibson,Vijaya B. Kolachalama,Kim-Lien Nguyen-Ehrenreich,Virginia L. Giddings,Leslie Coleman,Gee K. Wong,Elazer R. Edelman +8 more
TLDR
Optimal stent geometries and surfaces, as demonstrated with thin stent struts, help reduce the potential for thrombosis despite complex stent configurations and variability in deployment.Abstract:
Background—Stent thrombosis is a lethal complication of endovascular intervention. Concern has been raised about the inherent risk associated with specific stent designs and drug-eluting coatings, yet clinical and animal support is equivocal. Methods and Results—We examined whether drug-eluting coatings are inherently thrombogenic and if the response to these materials was determined to a greater degree by stent design and deployment with custom-built stents. Drug/polymer coatings uniformly reduce rather than increase thrombogenicity relative to matched bare metal counterparts (0.65-fold; P=0.011). Thick-strutted (162 μm) stents were 1.5-fold more thrombogenic than otherwise identical thin-strutted (81 μm) devices in ex vivo flow loops (P<0.001), commensurate with 1.6-fold greater thrombus coverage 3 days after implantation in porcine coronary arteries (P=0.004). When bare metal stents were deployed in malapposed or overlapping configurations, thrombogenicity increased compared with apposed, length-matche...read more
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Journal ArticleDOI
Stent thrombosis with drug-eluting and bare-metal stents: evidence from a comprehensive network meta-analysis
Tullio Palmerini,Giuseppe Biondi-Zoccai,Diego Della Riva,Christoph Stettler,Diego Sangiorgi,Fabrizio D'Ascenzo,Takeshi Kimura,Carlo Briguori,Manel Sabaté,Hyo-Soo Kim,Antoinette de Waha,Elvin Kedhi,Pieter C. Smits,Christoph Kaiser,Gennaro Sardella,Antonino G.M. Marullo,Ajay J. Kirtane,Martin B. Leon,Gregg W. Stone +18 more
TL;DR: In randomised studies completed to date, CoCr-EES has the lowest rate of stent thrombosis within 2 years of implantation and if confirmed in future randomised trials, represents a paradigm shift.
Journal ArticleDOI
Drug-eluting coronary-artery stents.
TL;DR: This review provides an overview of currently available devices, summarizes randomized evidence, and outlines clinical indications for use ofercutaneous coronary intervention.
Journal ArticleDOI
Percutaneous coronary intervention with everolimus-eluting bioresorbable vascular scaffolds in routine clinical practice: early and midterm outcomes from the European multicentre GHOST-EU registry
Davide Capodanno,Tommaso Gori,Holger Nef,Azeem Latib,Julinda Mehilli,Maciej Lesiak,Giuseppe Caramanno,Christoph Naber,Carlo Di Mario,Antonio Colombo,Piera Capranzano,Jens Wiebe,Aleksander Araszkiewicz,Salvatore Geraci,Stelios Pyxaras,Alessio Mattesini,Toru Naganuma,Thomas Münzel,Corrado Tamburino +18 more
TL;DR: "Real-world" outcomes of BVS showed acceptable rates of TLF at six months, although the rates of early and midterm scaffold thrombosis, mostly clustered within 30 days, were not negligible.
Journal ArticleDOI
Everolimus-eluting stent versus bare-metal stent in ST-segment elevation myocardial infarction (EXAMINATION): 1 year results of a randomised controlled trial
Manel Sabaté,Angel Cequier,Andrés Iñiguez,Antonio Serra,Rosana Hernández-Antolín,Vicente Mainar,Marco Valgimigli,Maurizio Tespili,Pieter den Heijer,Armando Bethencourt,Nicolás Vázquez,Joan Antoni Gómez-Hospital,José Antonio Baz,Victoria Martin-Yuste,Robert-Jan van Geuns,Fernando Alfonso,Pascual Bordes,Matteo Tebaldi,Mónica Masotti,Antonio Silvestro,Bianca Backx,Salvatore Brugaletta,Gerrit Anne van Es,Patrick W. Serruys +23 more
TL;DR: The 1-year result of the EXAMINATION (clinical Evaluation of the Xience-V stent in Acute Myocardial INfArcTION) trial, comparing EES with bare-metal stents (BMS) in patients with STEMI, is reported, which shows device success rate was similar between groups, but procedure success rates were significantly higher in the EES group.
Journal ArticleDOI
Stent thrombosis and restenosis: what have we learned and where are we going? The Andreas Grüntzig Lecture ESC 2014.
TL;DR: Although recent developments focus on strategies which circumvent the need for chronically indwelling stents—such as drug-coated balloons or fully bioresorbable stents.—more data are needed before the wider use of these therapies can be advocated.
References
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Journal ArticleDOI
Incidence, predictors, and outcome of thrombosis after successful implantation of drug-eluting stents.
Ioannis Iakovou,Thomas Schmidt,Erminio Bonizzoni,Lei Ge,Giuseppe Sangiorgi,Goran Stankovic,Flavio Airoldi,Alaide Chieffo,Matteo Montorfano,Mauro Carlino,Iassen Michev,Nicola Corvaja,Carlo Briguori,Ulrich Gerckens,Eberhard Grube,Antonio Colombo +15 more
TL;DR: The cumulative incidence of stent thrombosis 9 months after successful drug-eluting stent implantation in consecutive "real-world" patients was substantially higher than the rate reported in clinical trials.
Journal ArticleDOI
On the mechanisms of biocompatibility.
TL;DR: It is shown that, in the vast majority of circumstances, the sole requirement for biocompatibility in a medical device intended for long-term contact with the tissues of the human body is that the material shall do no harm to those tissues, achieved through chemical and biological inertness.
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
Stent thrombosis with drug-eluting and bare-metal stents: evidence from a comprehensive network meta-analysis
Tullio Palmerini,Giuseppe Biondi-Zoccai,Diego Della Riva,Christoph Stettler,Diego Sangiorgi,Fabrizio D'Ascenzo,Takeshi Kimura,Carlo Briguori,Manel Sabaté,Hyo-Soo Kim,Antoinette de Waha,Elvin Kedhi,Pieter C. Smits,Christoph Kaiser,Gennaro Sardella,Antonino G.M. Marullo,Ajay J. Kirtane,Martin B. Leon,Gregg W. Stone +18 more
TL;DR: In randomised studies completed to date, CoCr-EES has the lowest rate of stent thrombosis within 2 years of implantation and if confirmed in future randomised trials, represents a paradigm shift.
Journal ArticleDOI
Everolimus-Eluting versus Paclitaxel-Eluting Stents in Coronary Artery Disease
Gregg W. Stone,Ali Rizvi,William G. Newman,Kourosh Mastali,John C. Wang,Ronald P. Caputo,Julie Doostzadeh,Sherry Cao,Charles A. Simonton,Krishnankutty Sudhir,Alexandra J. Lansky,Donald E. Cutlip,Dean J. Kereiakes +12 more
TL;DR: Everolimus-eluting stents resulted in reduced rates of target-lesion failure at 1 year, results that were consistent in all patients except those with diabetes, in whom the results were nonsignificantly different.