scholarly journals Peri-Contrast Staining as a Marker of Stent Failure: Restenosis, Thrombosis, and Fracture

2021 ◽  
Vol 2021 ◽  
pp. 1-4
Author(s):  
Fakilahyel S. Mshelbwala ◽  
Mir B. Basir ◽  
Brittany Fuller ◽  
Khaldoon Alaswad
Keyword(s):  
Stent Thrombosis ◽  
First Generation ◽  
Coronary Aneurysm ◽  
Target Lesion ◽  
Stent Fracture ◽  
Coronary Angiogram ◽  
Stent Restenosis ◽  
Artery Disease ◽  
In Stent Restenosis

The introduction of stents has led to significant improvement in the management of coronary artery disease. In-stent thrombosis, target lesion revascularization, and stent fracture (SF) have been identified as causes of in-stent restenosis. Peri-contrast staining (PSS) has been associated with in-stent restenosis, stent thrombosis, stent fracture, and the development of coronary aneurysm. As the frequency of patients with first generation sirolimus-eluting coronary stents becomes infrequent; PSS may go unrecognized. Herein, we present a patient with a decade of longitudinal follow-up, who developed PSS identified on coronary angiogram with recurrent stent failure.

Abstract 12022: Long-Term Clinical Outcomes of Everolimus-Eluting Stents versus Sirolimus-Eluting Stents: Systematic Review and a Meta-Analysis of 14 Randomized Control Trials, Focused on Stent Thrombosis

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
TOSHIAKI TOYOTA ◽  
Hiroki Shiomi ◽  
Takeshi Morimoto ◽  
Takeshi Kimura
Keyword(s):  
Clinical Outcomes ◽  
Stent Thrombosis ◽  
Controlled Trial ◽  
Meta Analysis ◽  
Target Lesion ◽  
Pooled Analysis ◽  
Significant Difference ◽  
Artery Disease

Background: We sought to compare the long-term clinical outcomes between everolimus-eluting stent (EES) and sirolimus-eluting stents (SES) with a meta-analysis method. The long-term clinical outcomes, especially stent thrombosis (ST), after EES versus SES implantation has not been clearly defined among trials directly comparing the 2 types of stents. Methods: We searched PubMed, Cochrane database, and ClinicalTrials.gov. for trials comparing outcomes between EES (Xience V/Promus) and SES (Cypher select/Cypher select plus) in patients with native coronary artery disease using randomized controlled trial (RCT) design. We selected the article reporting the longest follow-up outcomes from each RCT. The outcome measure was all-cause death, myocardial infarction (MI), definite ST, and target-lesion revascularization (TLR). ST was further classified as those occurring early (<=30 days), late (30-365 days), or very late (<365 days). Results: We identified 14 RCT comparing EES and SES including 2 trials reporting the longest follow-up outcomes as a pooled analysis. We analyzed 13,434 randomly assigned patients with the weighted follow-up period of 2.1 years (Follow-up <=1-year: 7 trials, and 3191 patients; >1-year: 7 trials, and 10243 patients). EES as compared to SES was associated with significantly lower risks for overall ST, and early ST (pooled odds ratio (OR) 0.49, 95% confidence interval (CI) 0.30-0.81, P=0.01, and OR 0.42, 95% CI 0.18-0.99, P=0.046, respectively), while there was no significant difference in the risk for late ST and very late ST (OR 0.49, 95% CI 0.17-1.43, P=0.19, and OR 0.66, 95% CI 0.23-1.85, P=0.43, respectively). EES as compared to SES was also associated with significantly lower risks for TLR (OR 0.84, 95% CI 0.71-0.99, P=0.04). There was no significant difference in the risk for all-cause death, and MI between EES and SES. (OR 0.91, 95% CI 0.78-1.07, P=0.11, and OR 0.92, 95% CI 0.75-1.13, P=0.44, respectively). Conclusions: In the current meta-analysis of 14 RCT directly comparing EES with SES, implantation of EES as compared to SES implantation was associated with significantly lower risk for definite ST and TLR.

Abstract 12908: Effects of Metabolic Syndrome on In-Stent Restenosis After PCI: Obesity Paradox and Sex-Associated Differences

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Kenji Sakamoto ◽  
Naohiro Komura ◽  
Kenichi Tsujita ◽  
Kenshi Yamanaga ◽  
Noriaki Tabata ◽  
...  
Keyword(s):  
Metabolic Syndrome ◽  
Waist Circumference ◽  
Obesity Paradox ◽  
Target Lesion ◽  
Positive Influence ◽  
Female Patients ◽  
Stent Restenosis ◽  
The Impact ◽  
In Stent Restenosis

Background: The impact of metabolic syndrome (MetS) on the efficacy of PCI remains controversial. Hypothesis: This controversy may be due in part to a positive influence of obesity (the “obesity paradox”) among the factors included in the definition of MetS. Fat distribution also varies by sex, possibly confounding the impact of obesity. Methods: To elucidate the possible effects of obesity in MetS patients on in-stent restenosis (ISR) or target lesion revascularization (TLR), 546 patients treated with coronary stents (BMS or DES) were stratified according to the presence of MetS with or without obesity, using NCEP-ATP III guidelines. Waist circumference or BMI (in patients without waist circumference data) was used for diagnosis of obesity. Follow-up angiography was scheduled 8 to 9 months after PCI to obtain ISR, which was defined as %diameter stenosis (%DS)>50%. Results: Mean age of the subjects was 70.5±9.8 years, and 32.1% were female. By standard criteria, 286 patients (52.4%) were diagnosed as MetS, and 320 patients (58.6%) met criteria for obesity. Among MetS patients, 61 patients (21.3% of MetS patients) were categorized as non-obesity. At 8 to 9 months follow-up, % DS, ISR rates, and TLR rates had trends to be higher in MetS than no-MetS (ISR; 26.6% in MetS, 20.0% in non-MetS, p=0.085). These parameters showed no difference between obesity and non-obesity (ISR; 23.8% in obesity, 23.0% in non- obesity, p=0.918, TLR; 14.1% in obesity, 15.0% in non-obesity, p=0.805). In patients with MetS (Figure), however, the ratio of %DS and ISR were significantly greater in the absence of obesity in female patients, whereas no difference was observed in male patients. In multivariate analysis, non-obesity was an independent predictor for ISR or TLR in female patients with MetS. Conclusions: Overall, obesity was not related to ISR or TLR after PCI. In female MetS patients, however, comorbidity of obesity appeared to be paradoxically protective.

Stent fracture and restenosis after placement of a drug-eluting device in the vertebral artery origin and treatment with the stent-in-stent technique

2007 ◽  
Vol 106 (5) ◽  
pp. 907-911 ◽  
Author(s):  
Seong-Rim Kim ◽  
Min-Woo Baik ◽  
Seung-Hoon Yoo ◽  
Ik-Seong Park ◽  
Sang-Don Kim ◽  
...  
Keyword(s):  
Vertebral Artery ◽  
Stent Placement ◽  
Coronary Stents ◽  
Drug Eluting Stent ◽  
Stent Fracture ◽  
Stent Restenosis ◽  
Stent Strut ◽  
Drug Eluting ◽  
In Stent Restenosis

✓ The authors report two cases of stent fracture and restenosis after placement of a drug-eluting device in the vertebral artery (VA) origin, and describe management of restenosis with the stent-in-stent technique. Two women, one 62 and the other 67 years of age, underwent stent placement in the VA origin to treat symptomatic and angiographically significant stenosis in this vessel. Sirolimus-eluting coronary stents (Cypher) were used in both cases. Four months after placement of the devices, the symptoms recurred. Follow-up angiography performed 5 months after insertion of the devices revealed a transverse stent fracture with separation of the fragments and severe in-stent restenosis in both cases. The restenoses were treated with reinsertion of coronary stents (Cypher and Jostent FlexMaster) by using the stent-in-stent technique. After stent reinsertion, the patients exhibited relief of symptoms. This paper is the first report of fracture in a drug-eluting stent and restenosis after stent placement in the VA origin. Restenosis caused by such a fracture can be managed successfully by performing the stent-in-stent maneuver. The physical properties of metallic devices, stent strut geometry, and anatomical peculiarities of the subclavian artery may be associated with stent fractures. Earlier follow-up angiography studies (within 6 months) are warranted.

scholarly journals The in vivo comparison of first versus second generation bioresorbable technologies early after implantation in the porcine coronary in stent restenosis model

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
M Kachel ◽  
A Janas ◽  
M Jelonek ◽  
P Kazmierczak ◽  
P.E Buszman ◽  
...  
Keyword(s):  
First Generation ◽  
Second Generation ◽  
Neointimal Hyperplasia ◽  
Funding Source ◽  
Metallic Stent ◽  
Vascular Response ◽  
Stent Restenosis ◽  
In Stent Restenosis

Abstract Background Second generation bioresorbable scaffold (BRS) technologies with thinner struts were developed to overcome thrombotic and restenotic events when compared to first generation Purpose Herein we compare vascular response and scaffold recoil of first generation BRS (Absorb, BVS, 150 micron) with second generation (Meres 100, MRS, 100 micron) in the porcine model of coronary in stent restenosis model Methods In total 11 BRS and 13 MRS similar scaffolds were implanted in 12 domestic swine, with 110% overstretch under Optical coherence tomography guidance. Animals were followed up for 2, 7 and 28 days (8 scaffolds for each period). At terminal follow up comprehensive evaluation with OCT was performed and tissues harvested for pathology Results Arterial injury expressed as overstretch was similar among groups. There were no differences at 2 and 7 days with regards to lumen area (LA), neointimal area (NA) stent areas (SA) and %AS. At 28 days SA and NA were lower in the MRS group when compared to BRS (SA: 5,1 vs. 8,8 mm2, p=0,01; NA: 1,94 vs. 3.36 mm2; p=0,01). Arterial healing was similar at 28 days between MRS and BRS as expressed by embedded and covered struts (100 vs 100%, p=1,0), however at 7 days there were more uncovered struts in the MRS (43% vs 12%, p=0,01). Conclusions Second generation MRS have proven improved vascular response in porcine coronary model with regard to lesser neointimal hyperplasia. Thinner struts however caused recoil when compared to thicker ones at early follow-up point. Further BRS material and design improvements are necessary to achieve metallic stent - like properties. Funding Acknowledgement Type of funding source: Public grant(s) – National budget only. Main funding source(s): National Center for Research and Development

Abstract 2156: In-Stent Restenosis after Sirolimus-Eluting Stent Implantation is Related to Coronary Stent Fracture

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
SY Lee ◽  
MH Kim ◽  
CM Ahn ◽  
JS Kim ◽  
DH Choi ◽  
...  
Keyword(s):  
Coronary Angiography ◽  
Stent Implantation ◽  
Time Interval ◽  
Stent Fracture ◽  
Fracture Group ◽  
Stent Restenosis ◽  
Sirolimus Eluting Stent ◽  
Stent Diameter ◽  
In Stent Restenosis

Background and objectives : It has been reported in few studies about relationship between sirolimus-eluting stent (SES) fracture and in-stent restenosis (ISR). Therefore, authors investigated clinical characteristics of the SES fracture and the association with ISR. Subjects and Methods : From December 2003 to February 2006, implantation and follow-up coronary angiography(CAG) for 796 sirolimus-eluting stents were carried out in Severance hospital. We reviewed clinical, procedural and structural factors which might affect SES fracture and ISR. Results : Twenty four fractures after 796 SES implantation were identified by follow-up coronary angiography, sixteen cases in the left anterior descending artery and eight in the right coronary artery. The median time interval from stent implantation to follow up CAG was 9.0 months [range: 2 ~ 30 months]. No statistical difference was found in stent diameter (fracture group 3.06 ± 0.32 mm vs non-fracture group 3.08 ± 0.31 mm, P=0.778). Length of fractured stents was longer than non-fractured stents (30.29 ± 4.16 mm vs 24.51 ± 6.18 mm, P<0.001). The binary ISR rate in the stent fracture group was higher compared to non-fracture group (50% vs 4.4%, p < 0.001). Predictors for ISR estimated by multivariate analysis were stent fracture (OR=33.6, p < 0.001), stent diameter less than 3.0 mm (OR=2.84, p =0.015) and stent length over 28 mm (OR = 3.10, p = 0.023). Among twelve cases which had both binary restenosis and stent fracture, eight cases were treated by balloon angioplasty or additional stent implantation considering the condition of patients. Conclusion : Stent fracture may be one of the crucial mechanisms of ISR after implantation of SES. However, further studies in larger scale are required to define the incidence, predisposing factors, and clinical outcomes of SES fracture.

Late Outcomes of Carotid Artery Stenting for Radiation Therapy-Induced Carotid Stenosis

2022 ◽  
pp. 152660282110687
Author(s):  
Bahaa Nasr ◽  
Valentin Crespy ◽  
Edouard Penasse ◽  
Marine Gaudry ◽  
Eugenio Rosset ◽  
...  
Keyword(s):  
Radiation Therapy ◽  
Mortality Rate ◽  
Carotid Artery ◽  
Carotid Stenosis ◽  
Target Lesion ◽  
Long Term Outcomes ◽  
Stent Restenosis ◽  
In Stent Restenosis

Purpose: Carotid artery stenting (CAS) appears as a promising alternative treatment to carotid endarterectomy for radiation therapy (RT)-induced carotid stenosis. However, this is based on a poor level of evidence studies (small sample size, primarily single institution reports, few long-term data). The purpose of this study was to report the long-term outcomes of a multicentric series of CAS for RT-induced stenosis. Methods: All CAS for RT-induced stenosis performed in 11 French academic institutions from 2005 to 2017 were collected in this retrospective study. Patient demographics, clinical risk factors, elapsed time from RT, clinical presentation and imaging parameters of carotid stenosis were preoperatively gathered. Long-term outcomes were determined by clinical follow-up and duplex ultrasound. The primary endpoint was the occurrence of cerebrovascular events during follow-up. Secondary endpoints included perioperative morbidity and mortality rate, long-term mortality rate, primary patency, and target lesion revascularization. Results: One hundred and twenty-one CAS procedures were performed in 112 patients. The mean interval between irradiation and CAS was 15 ± 12 years. In 31.4% of cases, the lesion was symptomatic. Mean follow-up was 42.5 ± 32.6 months (range 1–141 months). The mortality rate at 5 years was 23%. The neurologic event-free survival and the in-stent restenosis rates at 5 years were 87.8% and 38.9%, respectively. Diabetes mellitus (p=0.02) and single postoperative antiplatelet therapy (p=0.001) were found to be significant predictors of in-stent restenosis. Freedom from target lesion revascularization was 91.9% at 5 years. Conclusion: This study showed that CAS is an effective option for RT-induced stenosis in patients not favorable to carotid endarterectomy. The CAS was associated with a low rate of neurological events and reinterventions at long-term follow-up.

scholarly journals The Predictors of Target Lesion Revascularization and Rate of In-Stent Restenosis in the Second-Generation Drug-Eluting Stent Era

2019 ◽  
Vol 2019 ◽  
pp. 1-13
Author(s):  
Chengbin Zheng ◽  
Jeehoon Kang ◽  
Kyung Woo Park ◽  
Jung-Kyu Han ◽  
Han-Mo Yang ◽  
...  
Keyword(s):  
Target Lesion ◽  
University Hospital ◽  
Target Lesion Revascularization ◽  
Drug Eluting Stent ◽  
2Nd Generation ◽  
Stent Restenosis ◽  
Significant Difference ◽  
Drug Eluting ◽  
In Stent Restenosis

Objectives. The aim of our study was to investigate the predictors of target lesion revascularization (TLR) and to compare the in-stent restenosis (ISR) progression rates of different 2nd-generation drug-eluting stents (DES). Background. The predictors of early and late TLR after 2nd-generation DES implantation have not been fully evaluated. Methods. We analyzed 944 stented lesions from 394 patients who had at least two serial follow-up angiograms, using quantitative coronary angiography (QCA) analysis. The study endpoints were TLR and the velocity of diameter stenosis (DS) progression. Results. TLR occurred in 58 lesions (6.1%) during the first angiographic follow-up period and 23 de novo lesions (2.4%) during the following second interval. Independent predictors for early TLR were diabetes mellitus (DM) (HR 2.58, 95% CI 1.29–5.15, p=0.007), previous percutaneous coronary intervention (PCI) (HR 2.41, 95% CI 1.03–5.65, p=0.043), and postprocedure DS% (HR 1.08, 95% CI 1.05–1.11, p<0.001, per 1%), while predictors of late TLR were previous PCI (HR 9.43, 95% CI 2.58-34.52, p=0.001) and serum C-reactive protein (CRP) (HR 1.60, 95% CI 1.28-2.00, p<0.001). The ISR progression velocity (by DS%) was 12.1 ±21.0%/year and 3.7 ±10.1%/year during the first and second follow-up periods, respectively, which had no significant difference (p>0.05) between the four types of DESs. Conclusions. Our data showed that predictors for TLR may be different at different time intervals. DM, pervious PCI, and postprocedure DS could predict early TLR, while previous PCI and CRP level could predict late TLR. Contemporary DESs had similar rates of ISR progression rates. Trial Registration. This study was retrospectively registered and approved by the institutional review board of Seoul National University Hospital (no. 1801–138-918).

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