P2211 Treatment of thin cap fibroatheroma with drug eluting stents: importance of fibrous cap injury, neointimal formation and vascular healing after ?-oestradiol and everolimus coated stents

2003 ◽  
Vol 24 (5) ◽  
pp. 419
Author(s):  
D ECHEVERRI
Keyword(s):  
Drug Eluting Stents ◽  
Neointimal Formation ◽  
Fibrous Cap ◽  
Drug Eluting

scholarly journals Optical coherent tomography in patients with unstable angina

2019 ◽  
Vol 26 (1) ◽  
pp. 79-88
Author(s):  
M. Yu. Sokolov ◽  
O. O. Lazarenko
Keyword(s):  
Vulnerable Plaque ◽  
Clinical Case ◽  
Vascular Wall ◽  
Drug Eluting Stents ◽  
Atherosclerotic Plaques ◽  
Additional Method ◽  
Optical Coherent Tomography ◽  
Fibrous Cap ◽  
Before And After ◽  
Drug Eluting

The article describes modern approaches to the study of atherosclerotic plaques characteristics using invasive imaging methods of the coronary arteries. We briefly highlighted the features of the so-called «vulnerable» atheroma. The features of the method of optical coherent tomography (OCT) in determining the thickness of the fibrous cap of a vulnerable plaque are considered. Factors limiting the possibilities of OCT and advantages over intravascular ultrasound before and after stenting are described. The clinical case is presented as a complex and uncertain one for the further tactics of treating a patient with non-Q myocardial infarction and a destroyed plaque in the LAD. The objective of this clinical case was to show the advantages of OCT as an additional method for assessing the structure of the vascular wall at the site of the destroyed plaque, the extent of the affected area, to assess the adequacy of stent implantation and the degree of pressure of stent branches, the possible dissection with an angio-graphically adequate result, which made it possible to identify malposition earlier. Also, the OCT method can be used in the remote period to visualize the degree of stent endothelization and determine the duration of double antiplatelet therapy in patients after stenting with drug-eluting stents.

The association of diabetes mellitus with neointimal formation following deployment of second-generation drug-eluting stents

2020 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Jin-Zan Cai ◽  
Wen-Qi Lu ◽  
Chen Xu ◽  
Jue Gu ◽  
Wei You ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Second Generation ◽  
Drug Eluting Stents ◽  
Neointimal Formation ◽  
Drug Eluting

Abstract 3442: Pattern and Time Path of Neonintimal Healing in Drug Eluting versus Bare Metal Stents in the Rat Aortic Stent Model

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Hendrik C Groenewegen ◽  
Anton J Roks ◽  
Maaike Goris ◽  
Felix Zijlstra ◽  
Wiek H van Gilst ◽  
...  
Keyword(s):  
Cell Density ◽  
Bare Metal Stents ◽  
Drug Eluting Stents ◽  
Metal Stents ◽  
Bare Metal ◽  
Neointimal Formation ◽  
Neointimal Thickness ◽  
Incomplete Healing ◽  
Drug Eluting ◽  
Inflammation Score

Purpose:to determine if the neointima of drug-eluting stents is histological different from their bare metal controls. Neointimal formation in stented aortas was evaluated quantatively and qualitatively at two time points. Methods:male Wistar rats were randomized to one of four groups: Express 2 stent , Taxus Express 2 stent , Bx Velocity stent and Cypher stent. Stents were implanted in the abdominal aorta. Histological analyses were performed after 1 and 4 weeks. After 1 week the inflammation score and neointimal cell density was measured. Stented aortas were also examined for acellularity of neointima and /or the presence of a hemorrhage in the neointima. After 4 weeks the same measurements were performed plus the neointimal area and neointimal thickness. Results:no differences were observed after 1 week between bare metal stents and drug-eluting stents. At 4 weeks neointimal cell density was lower and inflammation-score was higher in the drug eluting stents. Furthermore in less than 10% of the bare metal stents acellularity of neointima and/or hemorrhage was found. On the contrary, in more than 90% of the drug eluting stents acellularity of neointima and/or hemorrhage was seen. Neointima area and neointimal thickness was reduced in the drug-eluting stents. No histological differences were found between the paclitaxel and the sirolimus eluting stent. Conclusions:Both drug eluting stents are effective in reducing neointimal formation however in both drug eluting stents acellular areas were observed in the neointima of almost every single stent. This is likely to be a reflection of incomplete healing which persists after neointimal formation has peaked. Table 1. Histological measurements: results in the 4 week groups.

Abstract 2558: Vascular Healing Following Comparator Drug-Eluting Stents Implantation in an Atherosclerotic Rabbit Iliac Model - A Model of More Predictive in Human Responses to Drug-Eluting Stents

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Gaku Nakazawa ◽  
Josiah N Wilcox ◽  
Robert Melder ◽  
Sean Pruitt ◽  
Frank D Kolodgie ◽  
...  
Keyword(s):  
Stent Implantation ◽  
Rabbit Model ◽  
Inflammatory Cells ◽  
Bare Metal Stent ◽  
Macrophage Infiltration ◽  
Blood Cholesterol ◽  
Drug Eluting Stents ◽  
Cholesterol Diet ◽  
Neointimal Formation ◽  
Drug Eluting

Drug eluting stents (DES) induce delayed arterial healing in man, however, the ideal animal model for predicting the vascular response to DES placement in man is lacking. Hypercholesterolemic (1% cholesterol diet for 5 weeks followed by 0.025% for 4 weeks before stent implantation) New Zealand White rabbits (n=21) received bilateral stents implanted in iliac arteries. Animals were randomized to bare metal stent (Driver), zotarolimus- (Endeavor), sirolimus- (Cypher), and everolimus- (Xience V) eluting stents. Stents were harvested 4 weeks after stent implantation. Morphometric/pathologic analysis was performed. Macrophage infiltration was assessed by RAM-11 immunostaining. Blood cholesterol levels peaked at 5 weeks after initiation of the cholesterol diet which ranged from 1400 –2000mg/dL, followed by ideal range of 500 to 800mg/dL at 9 weeks (stent implantation), and were similar among groups. While EEL, and stent area were comparable in all groups, neointimal formation was significantly more suppressed in Xience and Cypher followed by Endeavor. All DES showed significantly less neointimal formation versus Driver by suppressing cell proliferation (reduced BrdU positive cells, in intima and media). Fibrin deposition, the prevalence of uncovered struts, and the number of adherent luminal inflammatory cells were greater in Xience and Cypher as compared to Driver and Endeavor. All DES showed significantly less macrophage infiltration as compared to BMS. An atherosclerotic rabbit model mimics neointimal formation in various DES and BMS similar to man with greater number of uncovered stent struts and luminal inflammation seen in Cypher and Xience as compared to Endeavor and Driver. Therefore, the atherosclerotic model is a more appropriate model for the assessment of DES efficacy as well as safety. Morphometric Analysis

scholarly journals Very Late Stent Thrombosis 11 Years after Implantation of a Drug-Eluting Stent

2015 ◽  
Vol 42 (5) ◽  
pp. 487-490 ◽  
Author(s):  
Kevin Liou ◽  
Nigel Jepson
Keyword(s):  
Antiplatelet Therapy ◽  
Stent Thrombosis ◽  
Drug Eluting Stents ◽  
Drug Eluting Stent ◽  
Stent Insertion ◽  
Late Stent Thrombosis ◽  
Neointimal Formation ◽  
Very Late Stent Thrombosis ◽  
St Segment Elevation ◽  
Drug Eluting

Very late stent thrombosis is an infrequent yet potentially fatal complication associated with drug-eluting stents. We report the case of an 88-year-old man who sustained an ST-segment-elevation myocardial infarction 11 years after initial sirolimus-eluting stent implantation. Optical coherence tomograms of the lesion showed that the focal incomplete endothelialization of the stent struts was the likely cause; neointimal formation, neoatherosclerosis, and late stent malapposition might also have contributed. To our knowledge, this is the longest reported intervening period between stent insertion and the development of an acute coronary event secondary to very late stent thrombosis. The associated prognostic and therapeutic implications are considerable, because they illuminate the uncertainties surrounding the optimal duration of antiplatelet therapy in patients who have drug-eluting stents. Clinicians face challenges in treating these patients, particularly when competing medical demands necessitate the discontinuation of antiplatelet therapy. In addition to the patient's case, we discuss factors that can contribute to very late stent thrombosis.

Drug-Eluting Stents Equal on Thrombosis

2012 ◽  
Vol 45 (14) ◽  
pp. 8
Author(s):  
MICHELE G. SULLIVAN
Keyword(s):  
Drug Eluting Stents ◽  
Drug Eluting

Drug-eluting stents for treatment of focal infrapopliteal lesions

VASA ◽  
2012 ◽  
Vol 41 (2) ◽  
pp. 90-95 ◽  
Author(s):  
Rastan ◽  
Noory ◽  
Zeller
Keyword(s):  
Limb Salvage ◽  
Bare Metal Stents ◽  
Target Lesion ◽  
Drug Eluting Stents ◽  
Metal Stents ◽  
Target Lesion Revascularisation ◽  
Randomized Studies ◽  
Drug Eluting ◽  
The Mean

We have investigated the role of drug-eluting stents on patency rates after treatment of focal infrapopliteal lesions in patients with intermittent claudication and critical limb ischemia. Reports indicate that drug-eluting stents reduce the risk of restenosis after percutaneous infrapopliteal artery revascularization. A Pub Med, EMBASE, Cochrane database review search of non-randomized studies investigating patency rates, target lesion revascularisation rates, limb salvage rates and mortality rates in an up to 3-year follow-up period after drug-eluting stent placement was conducted. In addition, preliminary results of randomized studies comparing drug-eluting stents with bare-metal stents and plain balloon angioplasty in treatment of focal infrapopliteal lesions were included in this review. A total of 1039 patients from 10 non-randomized and randomized studies were included. Most commonly used drug-eluting stents were sirolimus-eluting. The mean follow-up period was 12.6 (range 8 - 24). The mean 1-year primary patency rate was 86 ± 5 %. The mean target lesion revascularization rate and limb salvage rate was 9.9 ± 5 % and 96.6 %±4 %, respectively. Results from non-randomized and preliminary results from prospective, randomized trials show a significant advantage for drug-eluting stents in comparison to plain balloon angioplasty and bare-metal stents concerning target lesion patency and in parts target lesion revascularisation. No trial reveals an advantage for drug-eluting stents with regard to limb salvage and mortality.

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