Clinical outcomes in real-world patients with small vessel disease treated with XIENCE V®everolimus-eluting stents: One year results from the XIENCE V®USA condition of approval post-market study

Stroke and dementia are the most common neurological disorders worldwide. Cerebrovascular disease, particularly cerebral small vessel disease (CSVD) is implicated in both, and the two main types of CSVD (hypertensive vasculopathy and cerebral amyloid angiopathy) account for the majority of cerebrovascular contributions to stroke and dementia. Current knowledge of CSVD may influence treatment decisions and preventive efforts. Although the causes of CSVD are not entirely elucidated, ongoing research of the pathophysiology of CSVD, such as the role of inflammation, is helping identify potential treatment targets, evaluate prediction models and develop preventive strategies. Given the detectability of CSVD in preclinical stages using brain MRI, a long window of opportunity is presented to implement existent preventive measures. This review considers CSVD including its subclinical manifestations detected using brain MRI, clinical manifestations, use of markers of CSVD as predictors of clinical outcomes such as dementia and stroke, and presents potential management strategies when seeing patients with cerebral small vessel disease to reduce its disease burden and clinical consequences. Clinical trials have evaluated some aspects of CSVD treatment and are beginning to recognize CSVD as endpoint in subclinical stages. Future studies will clarify if this approach is able to delay onset of dementia and prevent stroke occurrence, meanwhile implementation of existent recommendations for the prevention and treatment of stroke and dementia may reduce disability and clinical outcomes related to CSVD.

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One-year clinical outcomes of patients implanted with a Resolute Onyx™ zotarolimus-eluting stent

Journal of International Medical Research ◽

10.1177/0300060517717826 ◽

2017 ◽

Vol 46 (1) ◽

pp. 457-463 ◽

Cited By ~ 2

Author(s):

Chor Cheung Tam ◽

Kelvin Chan ◽

Simon Lam ◽

Arthur Yung ◽

Yui Ming Lam ◽

...

Keyword(s):

Clinical Outcomes ◽

Small Vessel Disease ◽

Clinical Performance ◽

Cardiovascular Death ◽

Target Lesion ◽

World Population ◽

Vessel Disease ◽

One Year ◽

Target Lesion Failure

Objective To evaluate the 1-year clinical outcomes of patients who received the Resolute Onyx™ stent. Methods This was a single-centre, retrospective registry analysis that reviewed the clinical data from all patients who were implanted with a Resolute Onyx™ stent between March 2015 and February 2016. Clinical follow-up was performed at 1 year post-implantation. Results A total of 252 patients received a Resolute Onyx™ stent and two patients were lost to follow-up. The mean age of the cohort was 66.9 years and 113 (45.2%) had diabetes mellitus. Thirty-eight patients (15.2%) had left main disease and 73 (29.2%) had three-vessel disease. A total of 175 patients (70.0%) had small vessel disease (<2.75 mm) and 210 (84.0%) had long lesions (>20 mm). The 1-year target lesion failure was 4.4% (11 of 250), cardiovascular death occurred in eight patients (3.2%), ischaemia-driven target lesion revascularization was undertaken in five patients (2.0%) and stent thrombosis occurred in one patient (0.4%). Conclusion The Resolute Onyx™ stent showed a favourable 1-year clinical performance in a real-world population.

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Small vessel disease in patients with subarachnoid hemorrhage: Prevalence and associations with vasospasm occurrence, severity and clinical outcomes

The Neuroradiology Journal ◽

10.1177/1971400919877470 ◽

2019 ◽

Vol 32 (6) ◽

pp. 438-444

Author(s):

Adrien Villain ◽

Grégoire Boulouis ◽

Wagih Ben Hassen ◽

Christine Rodriguez-Regent ◽

Denis Trystram ◽

...

Keyword(s):

Subarachnoid Hemorrhage ◽

White Matter ◽

Clinical Outcome ◽

Clinical Outcomes ◽

White Matter Hyperintensities ◽

Small Vessel Disease ◽

Brain Magnetic Resonance Imaging ◽

Favorable Outcome ◽

Small Vessel ◽

Vessel Disease

Purpose Investigating the associations between cerebral small vessel disease (cSVD) burden and cerebral vasospasm (CVS), delayed cerebral ischemia (DCI) and clinical outcomes in patients with aneurysmal subarachnoid hemorrhage (aSAH). Methods Consecutive aSAH patients with initial (<7 days after onset) and 3-month follow-up brain magnetic resonance imaging (MRI) and clinical evaluation at 6 months were included. The cSVD burden score was built using MRI criteria. CVS was defined according to transcranial Doppler examination and computed tomography (CT) or digital subtraction angiography. DCI was defined by the appearance of hyperintense fluid-attenuated inversion recovery lesions, with territorial or cortico-subcortical distribution, between initial MRI and 3-month MRI. The modified Rankin scale of ≤2 at 6 months was considered a favorable outcome. Using univariate and multivariable analyses, we investigated the associations between cSVD and CVS, DCI and clinical outcome. Results A total of 113 patients were included in the study sample (median age 49.1 years (IQR 42.1–60.8), 70/113 females). The burden of cSVD was mild with a median of 0 (IQR 0–1). When comparing patients with no/mild versus those with moderate/severe cSVD burden, we did not find a univariable difference regarding vasospasm occurrence (60% versus 46.1%, p = 0.54), DCI (20.2% versus 23%, p = 0.66) or favorable outcome at 3 months (94% versus 83.3%, p = 0.20). There was a univariable trend towards more frequent favorable outcome in patients with no/milde white matter hyperintensities versus those with moderate/severe white matter hyperintensities (92% versus 85%, p = 0.09). In multivariable models, cSVD markers were not associated with CVS occurrence and severity, DCI or clinical outcome. Conclusions In patients with mild aSAH, the burden of cSVD as assessed by MRI is minimal and is not associated with CVS, DCI or clinical outcome.

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