scholarly journals Ticagrelor as an Alternative for Clopidogrel-Associated Acute Arthritis

2018 ◽  
Vol 2018 ◽  
pp. 1-3
Author(s):  
Starr-Mar’ee C. Bedy ◽  
Jacob P. Kesterson ◽  
Greg Flaker
Keyword(s):  
Symptomatic Improvement ◽  
Drug Event ◽  
Drug Eluting Stent ◽  
Temporal Association ◽  
Cardiac Events ◽  
Cardiology Clinic ◽  
History Of ◽  
Drug Eluting ◽  
St Elevation

A 65-year-old Caucasian man was hospitalized for a non-ST-elevation myocardial infarction. On discharge, the patient was started on multiple new medications, including clopidogrel and atorvastatin. Twenty-six days after discharge, he presented to the Emergency Department (ED) with polyarthralgias. He was instructed to stop atorvastatin and to follow up with rheumatology and cardiology clinic. At cardiology clinic follow-up 43 days after ED discharge, clopidogrel was discontinued and patient was switched to ticagrelor. On follow-up one month later, his symptoms had completely resolved. During the next 4 months, patient had routine follow-up due to participation in Cardiopulmonary Rehab and he had no cardiac events or recurrence of joint symptoms. Our patient had no history of arthritis. Because he initially presented with 2 medication classes associated with arthritis, each was withdrawn separately. The temporal association of patient’s symptomatic improvement strongly suggests that the arthritis was caused by clopidogrel. Our patient was able to tolerate ticagrelor with complete resolution of his arthritis and no cardiac events. Clopidogrel-induced arthritis is a rare adverse drug event. For patients with a recent drug-eluting stent, alternative antiplatelet therapy with ticagrelor may provide positive cardiac outcomes without similar adverse effects.

P974Efficacy of plaque debulking for bifurcated or ostial lesion by directional coronary atherectomy before 2nd generation drug eluting stent (PERFECT2)

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
M Habara ◽  
E Tsuchikane ◽  
K Nasu ◽  
Y Kinoshita ◽  
M Terashima ◽  
...  
Keyword(s):  
Artery Bypass ◽  
Coronary Intervention ◽  
Drug Eluting Stent ◽  
Target Vessel ◽  
Cardiac Events ◽  
Term Outcome ◽  
2Nd Generation ◽  
Drug Eluting ◽  
Directional Coronary Atherectomy

Abstract Objectives We sought to evaluate the efficacy of plaque debulking by directional coronary atherectomy (DCA) before 2nd generation drug-eluting stent (DES) implantation for bifurcated coronary lesions. Background Percutaneous coronary intervention (PCI) for bifurcated lesions still remains complex and challenging in terms of restenosis or stent thrombosis regardless of whether simple or complex stenting used. Methods Patients with bifurcated lesions were enrolled in this prospective multicenter registry. Pre-2nd generation DES plaque debulking with a novel DCA was conducted. All patients were scheduled to perform a follow up (9–12 months) angiography (coronary angiography or coronary computed tomography). The primary end point was the target vessel failure (TVF) at follow-up. Secondary end points were procedure-related events and major adverse cardiac events at 1 year. Results A total of 77 patients with bifurcated lesions were enrolled. PCI with DCA was performed successfully in all without any major procedure-related event and only 1 case needed complex stenting. TVF rate at 9–12 months follow up was 3.9% (3 of 77) and those were all associated with revascularization of the target vessel. Restenosis was only observed at ostial of main-branch in 3cases. No death, no coronary artery bypass grafting, and no myocardial infarction were reported in the patients within the first year. Figure1 Conclusion DCA before 2nd generation DES implantation can possibly avoid complex stenting and provide a good mid-term outcome in patients with bifurcated lesions. Acknowledgement/Funding None

Abstract 2526: Comparison of 4 Years Efficacy and Durability of Drug-Eluting Stent Implantation in Non-Bifurcation and Bifurcation Lesion of Unprotected Left Main Coronary Arteries: Multicenter Registry in Asia

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Sunao Nakamura ◽  
Hisao Ogawa ◽  
Jang-Ho Bae ◽  
Yeo Hans Cahyadi ◽  
Wasan Udayachalerm ◽  
...  
Keyword(s):  
Coronary Arteries ◽  
Stent Implantation ◽  
Clinical Success ◽  
Major Complication ◽  
Drug Eluting Stent ◽  
Left Main ◽  
Cardiac Events ◽  
Bifurcation Lesion ◽  
Drug Eluting

Aim : The aim of this study is to compare the 4 years safety and durability of drug-eluting stent implantation in non-bifurcation (ostium and/or mid shaft) (N-Bifur) and bifurcation (Bifur) lesion of unprotected left main coronary arteries (LMT). Methods : A prospective analysis of 448 patients with LMT stenosis (324 Bifur and 124 N-Bifur) in five high volume Asian centers after successful stenting in LMT was performed. LMT was treated with 5 strategies (single stenting 195 cases, T-stenting 47 cases, crush stenting 38 cases, Mini-crush stenting 93 cases, culotte stenting 54 cases, kissing stenting 21 cases). Complete clinical follow-up to 4 years is being analyzed for all 448 patients. Results : The baseline clinical characteristics between 2 groups were similar. Angiographic and clinical success were achieved in all patients without any major complication. At 4 years overall cardiac events of N-Bifur (14.5%) were significantly lower than Bifur (28.0%) (p=0.011). See figure for clinical results. Conclusion : The use of drug-eluting stent in patients with LMT was safe and feasible with low acute complication and low incidence of restenosis. Drug-eluting stent implantation in non-bifurcation lesion of LMT showed lesser incidence of cardiac events (death, myocardial infarction, CABG and PCI) compared with those of bifurcation lesion at 4 years clinical follow-up.

Long-Term Follow-Up After Treatment of Drug-Eluting Stent Restenosis and De Novo Lesions Using SeQuent Please Paclitaxel-Coated Balloons

Angiology ◽  
2018 ◽  
Vol 70 (5) ◽  
pp. 414-422
Author(s):  
Dai Zhang ◽  
Yan Sun ◽  
Xiaoli Liu ◽  
Fang Liu ◽  
Yujing Cheng ◽  
...  
Keyword(s):  
De Novo ◽  
Coronary Vessels ◽  
Target Lesion ◽  
Drug Eluting Stent ◽  
Cardiac Events ◽  
Stent Restenosis ◽  
Significant Difference ◽  
Drug Eluting

Managing patients with in-stent restenosis (ISR) remains an important clinical challenge. In particular, large, randomized trials assessing the effect of drug-eluting balloons (DEB) in patients with de novo lesions are warranted. We investigated the effect of DEB on procedural complications, target lesion revascularization (TLR), and major adverse cardiac and cerebrovascular events in patients with drug-eluting stent ISR and de novo lesions. The clinical profiles of 238 consecutive patients treated for coronary ISR (n = 174) and de novo lesions (n = 64) using SeQuent Please paclitaxel-coated balloon were analyzed. Study end points were major adverse cardiac events (MACEs). At 1-year follow-up, TLR and MACEs occurred with acceptably low rates (5.0% and 6.3%, respectively). At 2.00 (0.74) years of follow-up, there was a significant difference in the rates of TLR between the ISR and the de novo lesions groups (14.4% [ISR] vs 3.1% [de novo], P = .028), and the occurrence of MACEs distinctly increased in the ISR group compared to the de novo lesions group (21.8% vs 6.2%, P = .009). The long-term outcomes of the ISR group were inferior to those of the de novo group (TLR, log-rank P = .019; MACEs, log-rank P = .010). Drug-eluting balloon for ISR and de novo lesions of small coronary vessels is effective and safe.

BioMime – A Sirolimus-eluting Coronary Stent System for the Treatment of Patients with De Novo Coronary Lesions – meriT-1 Report

2011 ◽  
Vol 6 (1) ◽  
pp. 39
Author(s):  
Keyword(s):  
Stent Thrombosis ◽  
Time Course ◽  
De Novo ◽  
Drug Eluting Stent ◽  
Cobalt Chromium ◽  
Cardiac Events ◽  
End Points ◽  
Safety And Efficacy ◽  
Binary Restenosis

Background:Since the first reported use of percutaneous transluminal coronary angioplasty, advances in the interventional cardiology arena have been fast paced. Developers and clinicians are adapting from the learning curve awarded by the time-course of drug-eluting stent (DES) evolution. BioMime™ sirolimus-eluting stent (SES) is a step towards biomimicry. The stent is built on a strut of ultra-low thickness (65μm), a cobalt–chromium platform using an intelligent hybrid of closed and open cells allowing for morphology-mediated expansion. It employs a well-known antiproliferative – sirolimus – that elutes from a known biodegradable copolymer formulation within 30 days. The resultant stent demonstrates almost 100% endothelialisation at 30 days in preclinical models.Methods:The meriT-1 was a prospective, single-arm, single-centre trial to evaluate the safety and efficacy of BioMime SES in 30 patients with a single de novo lesion in native coronary arteries. The primary safety and efficacy end-points were major adverse cardiac events (MACE) at 30 days and in-stent late lumen loss at eight months, as measured using quantitative coronary angiographic (QCA) method. Secondary safety and efficacy end-points included MACE at one and two years and angiographic binary restenosis at eight-month angiographic follow-up. Other end-points included the occurrence of stent thrombosis at acute, subacute, late and very late periods and the percentage of diameter stenosis by QCA.Results:No MACE were observed and the median in-stent late luminal loss in 20 (67%) subjects studied by QCA was 0.15mm, with 0% binary restenosis at eight-month follow-up. No stent thrombosis was observed up to one-year follow-up.Conclusions:In comparison to currently available DES, BioMime SES appears to have a considerable scientific basis for prevention of neointimal proliferation, restenosis and associated clinical events.

Ischemic Complications of Pregnancy: Who is at Risk?

2016 ◽  
Vol 10 (1) ◽  
pp. 14
Author(s):  
Sara C Martinez ◽  
◽  
Sharonne N Hayes ◽  
Keyword(s):  
Artery Dissection ◽  
Cardiac Events ◽  
Coronary Artery Dissection ◽  
Reduction Strategies ◽  
Ischemic Complications ◽  
Substantial Risk ◽  
History Of ◽  
Invasive Management ◽  
In Pregnancy

The physiologic demands of pregnancy may either trigger or uncover ischemic heart disease (IHD) via largely unknown mechanisms, leading to an increased mortality compared with nonpregnant individuals. Risk factors for IHD in pregnancy are age, smoking, multiparity, and prior cardiac events. A multidisciplinary team at a referral center is key to coordinating medical or invasive management and inpatient observation. Etiologies may be revealed by experienced angiographers, and are predominantly spontaneous coronary artery dissection, followed by atherosclerotic disease and thrombus, while a significant percentage of women are found to have normal coronary arteries by angiogram. The management of these conditions is varied and, in general, conservative management is preferred with adequate coronary flow and stable hemodynamics. A woman with a history of IHD in pregnancy is at a substantial risk for further complications in future pregnancies and beyond; therefore, aggressive risk factor-reduction strategies and regular cardiology follow-up are imperative to decrease adverse events.

Impact of hinge motion on stent edge restenosis after new generation drug-eluting-stent implantation in RCA

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
T Jimba ◽  
M Ikutomi ◽  
D Nishijyo ◽  
M Yamasaki ◽  
A Shindou ◽  
...  
Keyword(s):  
Stent Implantation ◽  
Biomechanical Properties ◽  
Plaque Burden ◽  
Drug Eluting Stent ◽  
Landing Zone ◽  
Binary Restenosis ◽  
Drug Eluting ◽  
New Generation ◽  
Hinge Angle

Abstract Background Edge restenosis still occurs after stent implantation, even by using new generation drug-eluting stents (DES) considered to have favorable biomechanical properties. Mechanical stress imposed on the stent edge are thought to be aggravated by hinge motion at a point between the stented and unstented segments, inducing chronic local inflammation and neointimal overgrowth. Purpose The aim of this study was to investigate the association between the development of edge restenosis and hinge motion in right coronary artery (RCA) where the excessive vessel movement is commonly observed. Methods Among consecutive 650 lesions in RCA where new generation DESs were implanted between 2009 and 2019, 427 serial lesions with sets of angiographies at baseline and follow-up (6–18 month) were included. In addition to conventional quantitative angiography analysis, hinge angle at stent edges was measured (Fig. 1). All the appropriate data for intravascular imaging were analyzed for both stent edges and reference segments. Results Binary restenosis occurred in 43 lesions, and 39 of them were referred to re-intervention. Fifty five percent of them were related to stent edges (15 at proximal and 9 at distal edges). Classical risk factors including diabetes and hemodialysis were more prevalent in the restenosis group (p<0.05). Hinge angle was statistically larger in edge restenosis group than body restenosis or no restenosis group (17.3° vs 11.6° vs 10.6°, p<0.001, Fig. 2). In per-edge analysis, hinge angle, dissection and residual plaque ratio were the independent predictors for binary restenosis (Table 1) with the optimal cut-off value of hinge angle 11.5°. The coexistence of excessive hinge angle and residual plaque burden had an amplified effect on the angiographic stenotic progression at stent edge (p for interaction <0.001) and the incidents of binary restenosis (16.7% vs 1.7% p<0.01, Figs. 3,4). Conclusion Substantial stress determined by angulation at the stent edge and its interaction with residual plaque can be considered as one of the plausible mechanisms for edge restenosis. For tortuous RCA lesions, it would be important to decide the stent-landing zone for minimizing hinge motion and optimize the future stent design. Funding Acknowledgement Type of funding source: None

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