scholarly journals Heparin-Bonded Viabahn and Drug-Eluting Bare Metal Zilver (PTX) Sandwich Stents in Femoral Chronic Total Occlusion: A Retrospective Review of Mid-Term and Long-Term Outcomes

2015 ◽  
Vol 2015 ◽  
pp. 1-9
Author(s):  
Amir Awwad ◽  
Waleed Al-Obaydi ◽  
Yao Pey Yong ◽  
Said B. Habib
Keyword(s):  
Neointimal Hyperplasia ◽  
Total Duration ◽  
Total Occlusion ◽  
Sandwich Technique ◽  
Need To Evaluate ◽  
Type Ii Diabetics ◽  
Drug Eluting ◽  
Occlusive Peripheral Vascular Disease ◽  
Zilver Ptx

Articles describe a retrospective cohort study to assess the feasibility of reducing neointimal hyperplasia following interventions in chronic total occlusive peripheral vascular disease. The “sandwich” technique implemented is a novel modified angioplasty technique that combines heparin-bonded (Viabahn) stents with drug-eluting stents (Zilver PTX) deployed during arterial recanalisation. A review of 46 cases underwent this procedure at our institution as a limb saving procedure is conducted to determine mid-long-term patency outcomes and identify any subsequent interventions. Followup demonstrates favourable mid-long-term patency in 50% of TASC-C cases. No documented postprocedural complications were noted with unrelated observed mortality rates in either TASC-C or TASC-D subgroups. An observed advantage could be gained by using this new stenting technique via the subintimal recanalisation route. Albeit not statistically significant, type II diabetics and patients on aspiring had better sustained patency angioplasties. The sandwich technique has been shown to effectively offer symptoms relief and reduce total duration of hospital stay. Study findings support the need to evaluate the long-term efficacy through a larger longitudinal prospective study. However, to overcome the encountered study limitations, a well-structured methodology for comparison with conventional angioplasty techniques is essential to assess the synergetic potential of the sandwich technique.

Comparable 2-Year Restenosis Rates Following Subintimal and Intraluminal Drug-Eluting Stent Implantation for Femoropopliteal Chronic Total Occlusion

2016 ◽  
Vol 23 (6) ◽  
pp. 889-895 ◽  
Author(s):  
Takayuki Ishihara ◽  
Mitsuyoshi Takahara ◽  
Osamu Iida ◽  
Yoshimitsu Soga ◽  
Keisuke Hirano ◽  
...  
Keyword(s):  
Chronic Total Occlusion ◽  
Primary Outcome ◽  
De Novo ◽  
Drug Eluting Stent ◽  
Significant Interaction Effect ◽  
Total Occlusion ◽  
Subintimal Angioplasty ◽  
Drug Eluting ◽  
Baseline Characteristics ◽  
Zilver Ptx

Purpose: To report midterm outcomes after subintimal vs intraluminal drug-eluting stent (DES) implantation for femoropopliteal (FP) chronic total occlusion (CTO). Methods: This subanalysis of the prospective, multicenter ZEPHYR study (ZilvEr PTX for tHe Femoral ArterY and Proximal Popliteal ArteRy) included 176 patients (mean age 74±8 years; 130 men) with 192 de novo FP CTOs that were evaluated by intravascular ultrasound after successful guidewire crossing. The primary outcome was the 2-year restenosis rate after subintimal (n=73) or intraluminal (n=119) DES implantation. Propensity score matching extracted 61 matched pairs (mean age 75 years; 49 men) for patency analysis to minimize baseline intergroup differences. Restenosis rates are reported with the 95% confidence interval (CI). Results: The 1-year restenosis rates in the groups with subintimal and intraluminal DES implantation were 45% (95% CI 32% to 59%) and 35% (95% CI 22% to 49%), respectively (p=0.352), whereas the corresponding rates at 2 years were not significantly different (p=0.648) at 56% (95% CI 41% to 71%) and 51% (95% CI 34% to 68%). Baseline characteristics had no significant interaction effect on the association of subintimal angioplasty with restenosis risk. Conclusion: In FP CTO, 2-year restenosis rates were comparable after subintimal or intraluminal DES implantation.

scholarly journals Long-Term Outcomes of Neointimal Hyperplasia Without Neoatherosclerosis After Drug-Eluting Stent Implantation

2014 ◽  
Vol 7 (8) ◽  
pp. 788-795 ◽  
Author(s):  
Jung-Sun Kim ◽  
Jung-Hee Lee ◽  
Dong-Ho Shin ◽  
Byeong-Keuk Kim ◽  
Young-Guk Ko ◽  
...  
Keyword(s):  
Stent Implantation ◽  
Neointimal Hyperplasia ◽  
Drug Eluting Stent ◽  
Long Term Outcomes ◽  
Drug Eluting

scholarly journals The Return of the Vulnerable Plaque: Optical Coherence Tomography Imaging of a Case of a Late In-Stent Restenotic Chronic Total Occlusion

2016 ◽  
Vol 26 (03) ◽  
pp. 191-195
Author(s):  
Pranav Patel ◽  
Alisha Grewal ◽  
Prabhsimran Mohar ◽  
Morton Kern ◽  
Dilbahar Mohar
Keyword(s):  
Optical Coherence Tomography ◽  
Neointimal Hyperplasia ◽  
Optical Coherence ◽  
Vulnerable Atherosclerotic Plaque ◽  
Total Occlusion ◽  
Tomography Imaging ◽  
Stent Restenosis ◽  
Drug Eluting ◽  
Optical Coherence Tomography Imaging ◽  
Oct Imaging

Although the use of drug-eluting stents (DES) has dramatically decreased the incidence of in-stent restenosis (ISR), concerns regarding the late manifestations of ISR remain. Optical coherence tomography (OCT) imaging provides unique insights into characteristics and patterns of ISR. We report a case of late DES ISR with unusual heterogeneous intracoronary luminal characteristics suggestive of vulnerable atherosclerotic plaque activity by OCT imaging. This case demonstrates that late ISR after DES may involve more than mere neointimal hyperplasia with lesion-associated craters, septae, and neoatherosclerosis. The use of OCT provides novel insights into the mechanisms and potential biology of the late DES ISR.

Paclitaxel exposure and long-term mortality of patients treated with the Zilver PTX drug-eluting stent

Vascular ◽  
2020 ◽  
pp. 170853812096437
Author(s):  
Jordan R Stern ◽  
Kenneth Tran ◽  
Venita Chandra ◽  
E John Harris ◽  
Jason T Lee
Keyword(s):  
Real World ◽  
Drug Eluting Stent ◽  
Secondary Patency ◽  
Kaplan Meier ◽  
Drug Eluting ◽  
Lifetime Exposure ◽  
Zilver Ptx ◽  
Long Term Mortality

Objectives Paclitaxel-eluting stents have demonstrated improved patency over balloon angioplasty and bare metal stenting for endovascular interventions in the femoral-popliteal segment. Recently, concerns have arisen regarding the safety of paclitaxel use and its association with mortality. This study aims to examine real-world, long-term mortality, and patency of patients treated with the Zilver PTX drug-eluting stent. Methods Patients treated with the PTX stent after FDA approval between 2013 and 2015 were identified from an institutional database. Demographic, procedural, and device information was collected and initial- and lifetime-exposure dose of paclitaxel was calculated. The primary outcome was all-cause mortality and its association with paclitaxel exposure. Long-term patency was also evaluated. Results Seventy-nine procedures involving PTX placement were performed on 64 individual patients during the study period, with 15 (23.4%) having bilateral procedures. Average age was 70 years, and 71.9% were male. Forty-five patients (70.3%) were claudicants, and 19 (29.7%) had chronic, limb-threatening ischemia. An average of 2.3 PTX stents, totaling 203 mm in length, were placed per procedure. Paclitaxel exposure was 1.87 mg/procedure initially (range 0.38–4.03 mg), and average lifetime exposure was 4.65 mg/patient (range 0.38–27.91 mg). Average follow-up was 59.6 months. Kaplan–Meier estimated survival was 96.9%, 81.2% and 71.7% at one , three, and five years. On multivariate analysis, no specific factors were associated with overall morality including initial paclitaxel dose (HR 0.99, 95% CI 0.99–1.00) and lifetime paclitaxel exposure (HR 0.98, 95% CI 0.89–1.08). Kaplan–Meier primary patency was 76.2%, 60.1%, and 29.3% at one, two, and five years, respectively. Secondary patency was 92.2%, 85.4%, and 75.2% at the same intervals. Conclusions At a mean follow-up of five years, exposure to higher doses of paclitaxel from Zilver PTX does not appear to be associated with increased mortality compared to lower doses in real-world patients. Long-term patency rates confirm the efficacy of Zilver PTX, and further investigation may be warranted before abandoning paclitaxel use altogether.

Abstract 2770: Neointimal Hyperplasia Patterns Among 3 Drug-Eluting Stents: A Comparative Intravascular Ultrasound Analysis of Everolimus-, Sirolimus-, and Paclitaxel-Eluting Stents

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Ryota Sakurai ◽  
Brian K Courtney ◽  
Masao Yamasaki ◽  
Ichizo Tsujino ◽  
Katsuhisa Waseda ◽  
...  
Keyword(s):  
Intravascular Ultrasound ◽  
De Novo ◽  
Neointimal Hyperplasia ◽  
Drug Eluting Stents ◽  
Stent Coverage ◽  
Stent Length ◽  
Drug Eluting ◽  
Neointimal Coverage ◽  
Multicenter Clinical Trials

Background The amount of neointimal hyperplasia as well as the percentage of neointimal stent surface coverage may be different among various types of drug-eluting stents (DES). Methods From the Stanford University Intravascular Ultrasound (IVUS) Core Laboratory database, this study consisted of the patients enrolled in prospective, multicenter clinical trials with DES deployment for de novo coronary lesions and 3-D IVUS at 8- to 9-month follow-up as part of their study protocol. In these cases, 155 single DES: (1) an 18-mm everolimus-eluting (EES, 52 stents in 50 patients); (2) an 18-mm sirolimus-eluting (SES, 51 stents); or (3) a 16-mm paclitaxel-eluting (PES, 52 stents) stent in 153 patients were investigated. Using Simpson’s rule, %neointimal volume was defined as neointimal volume / stent volume × 100. Circumferential stent length covered with neointima (L N ) and stent perimeter (L S ) were also measured at every 1-mm cross section throughout the stent. Then, %neointimal coverage was defined as total L N / total L S × 100. Results EES had comparable %neointimal volume to SES, but less %neointimal volume than PES (5.2±5.3 vs 2.6±4.0 vs 9.2±8.7%, P< 0.0001), whereas EES had greater %neointimal coverage than SES, but comparable %neointimal coverage to PES (25.7±19.9 vs 9.1±14.6 vs 29.3±23.5%, P< 0.0001). Conclusions Compared to SES, EES had comparable neointimal hyperplasia, but greater neointimal stent coverage by IVUS. Compared to PES, EES had less neointimal hyperplasia, but comparable neointimal stent coverage by IVUS. This unique pattern of neointimal hyperplasia with these platforms may be important to the balance of the short-term efficacy and the long-term safety.

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