scholarly journals Negative impact of ultra-thin strut on neointimal coverage condition within one year after implantation as compared to thin sturt in biogradable-polymer sirorimus eluting stents

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
R Shutta ◽  
M Nishino ◽  
A Kawamura ◽  
K Ukita ◽  
H Nakamura ◽  
...  
Keyword(s):  
Stent Thrombosis ◽  
Stent Implantation ◽  
Negative Impact ◽  
Neointimal Hyperplasia ◽  
Coronary Syndrome ◽  
Durable Polymer ◽  
Stent Length ◽  
Neointimal Coverage ◽  
Device Use ◽  
One Year

Abstract Background BIOSCIENCE randomized trial which compared biodegradable-polymer sirolimus-eluting stents with ultra-thin (60μm) strut (ultra-thin BP-SES) and durable-polymer everolimus-eluting stents with thin (81μm) strut (thin DP-EES) have reported that definite stent thrombosis within 1 year had more frequently occurred in ultra-thin BP-SES (0.9%) than in thin DP-EES group (0.4%) although it was not statistically significant. It suggests that neointimal coverage after stent implantation within 1 year might be different between ultra-thin BP-SES and thin DP-EES. Recently, two types of biogradable-polymer sirorimus eluting stents, thin (80μm) strut type (thin BP-SES) and ultra-thin (60μm) strut type (ultra-thin BP-SES), can be available in clinical settings. Purpose We compared neointimal coverage conditions between ultra-thin BP-SES and thin BP-SES by optical coherence tomography (OCT). Methods Consecutive Forty-six patients who underwent 21 ultra-thin BP-SESs or 25 thin BP-SESs implantation were enrolled. We compared incidences of acute coronary syndrome, type B2/C lesion, atherectomy device use, stent size, stent length, maximum inflation pressure, and 8-month follow-up OCT parameters including proportions of uncovered struts (%Uncovered), malapposed struts, (%Mallaposed) and mean neointimal hyperplasia thickness (mean NHT) between the two groups. Results %Uncovered and %malapposed were significantly higher and mean NHT was significantly lower in ultra-thin BP-SES than in thin BP-SES (Table). The other parameters were similar between the two groups. Conclusion Ultra-thin BP-SES showed worse neointimal coverage as compared to thin BP-SES within 1 year after stent implantation, which may increase stent thrombosis. Funding Acknowledgement Type of funding source: None

scholarly journals The comparison of the chronic-phase vascular healing between bioabsorbable and durable polymer drug eluting stent by using optical coherence tomography

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
Y Yamakami ◽  
S Kimura ◽  
K Hara ◽  
M Ohmori ◽  
R Tateishi ◽  
...  
Keyword(s):  
Optical Coherence Tomography ◽  
Acute Coronary Syndrome ◽  
Clinical Presentation ◽  
Neointimal Hyperplasia ◽  
Chronic Phase ◽  
Drug Eluting Stents ◽  
Coronary Syndrome ◽  
Durable Polymer ◽  
Drug Eluting

Abstract Background Bioabsorbable polymer drug eluting stents (BP-DESs) were designed to reduce a vascular inflammatory reaction compared to durable polymer drug eluting stents (DP-DESs). However, few studies have compared vascular responses to BP-DESs and DP-DESs. Methods We enrolled 88 consecutive patients with single culprit coronary artery lesions (31 lesions with acute coronary syndrome) undergoing a single stent-implantation. BP-DESs and DP-DESs were implanted in 50 (57%) and 38 patients (43%), respectively. All lesions underwent optical coherence tomography examination at chronic phase and intrastent OCT findings at the follow-up were evaluated in every 1-mm cross-sections (CSs). Results A total of 1887 CSs (BP-DES: 1096, DP-DES: 791) were analyzed. The median period of follow-up OCT was 293 (250–374) days. There were no differences in the patient, lesion, and initial clinical presentation of acute coronary syndrome (ACS). BP-DESs had significantly higher percent neointimal hyperplasia area, defined as neointimal hyperplasia area divided by stent area x 100 (18.4±9.0% vs. 16.1±9.9%, p<0.001), fewer malapposed struts (1.7% vs. 3.9%, p=0.005), fewer uncovered struts (3.6% vs. 5.8%, p=0.02) but higher frequency of superficial low intensity neointima (LIN) (7.7% vs. 3.4%, p<0.001). Multivariate logistic analysis showed that BP-DES (OR: 2.5, 95% CI: 1.49–4.08, p<0.001) and the initial clinical presentation of ACS (OR: 2.31, 95% CI: 1.47–3.62, p<0.001) are independent predictive factors for LIN. Conclusion BP-DESs showed homogenous neointimal growth and complete stent coverage quantitatively. Meanwhile, the significant relationships of BP-DES with LIN may suggest that the neointimal quality remains immature in BP-DESs in this period. Funding Acknowledgement Type of funding source: None

Stent thrombosis after drug-eluting stent implantation in acute coronary syndrome versus stable patients

2010 ◽  
Vol 11 (3) ◽  
pp. 204
Author(s):  
Asmir I. Syed ◽  
Itsik Ben-Dor ◽  
Yanlin Li ◽  
Manuel A. Gonzalez ◽  
Sara D. Collins ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Stent Thrombosis ◽  
Stent Implantation ◽  
Drug Eluting Stent ◽  
Coronary Syndrome ◽  
Drug Eluting

scholarly journals 736 Hazy spots: through the eye of optical coherence tomography

2021 ◽  
Vol 23 (Supplement_G) ◽  
Author(s):  
Emiliano Bianchini ◽  
Rocco Vergallo ◽  
Angela Buonpane ◽  
Marco Lombardi ◽  
Alfredo Ricchiuto ◽  
...  
Keyword(s):  
Optical Coherence Tomography ◽  
Coronary Artery ◽  
Coronary Angiography ◽  
Stent Thrombosis ◽  
Anticoagulant Therapy ◽  
Stent Implantation ◽  
Optimization Technique ◽  
Optical Coherence ◽  
Coronary Syndrome ◽  
Acute Stent Thrombosis

Abstract Aims Acute stent thrombosis after coronary artery stent placement is a rare but serious complication in percutaneous coronary intervention (PCI). Stenting culprit lesions in acute coronary syndrome (ACS) has higher risk of acute stent thrombosis than stable coronary artery disease, and many local and systemic factors may contribute to increase this risk. Tissue protrusion (TP), and in particular, plaque prolapse after PCI can play a role in acute stent thrombosis, and intra-vessel imaging is the principal instrument to identify such underlying lumen alteration after stent implantation, and guide intervention. Methods and results We report the case of a 54-year-old man with a history of hypertension, dyslipidemia, type 2 diabetes mellitus, obesity and no other relevant comorbidities in remote history, who underwent a coronary angiography for an unstable angina. A long, calcific sub-occlusion of the left anterior descending artery (LAD), which involved LAD-first diagonal branch (D1) bifurcation (Medina 1.1.1) and LAD-D2 bifurcation (Medina 1.1.0) was found. After deployment of two overlapping drug-eluting stents (DES), (ULTIMASTER TANSEI 3.0 × 38 mm and 3.0 × 21 mm) and struts apposition optimization with sequence of proximal optimization technique (POT) on D1 and D2, and a kissing balloon technique (KS) on LAD-D2 bifurcation, a ‘hazy’ in-stent image was detected right after the LAD-D2 bifurcation, suggesting an acute in-stent thrombosis, in absence of flow alteration (TIMI 3), symptoms or ECG modifications. Multiple thrombus-aspiration were made and resulted in abundant thrombus removal and improvement in the angiographic image, with persistent valid flow on every three vessels (TIMI 3). After 5 days of triple anticoagulant therapy with ticagrelor, cardioaspirin and UFH infusion, he underwent a new coronary angiography control. A similar ‘hazy’ image was detected right after LAD-D2 bifurcation within the LAD. An optical coherence tomography (OCT) pullback was made to assess the nature of the angiographic finding. OCT showed good struts apposition in almost every cross-sectional images, but an evident TP was detected right on the angiographic hazy spot. OCT allowed to evaluate the lipid-richness of the stented plaque and the nature of the TP, which was mixed with evident both white and red thrombus apposition (minimum luminal area measured 4.5 mm2). OCT guided a new PCI, with a stent-in-stent implantation on LAD. TP was absent on the post-PCI OCT run. Conclusions In this report, we showed the usefulness of OCT in revealing a potential high risk thrombogenic source. OCT not only characterized something that angiography alone couldn’t, but suggested the etiology of the amount of thrombus removed by the vessel during the first PCI. Indeed, despite an optimized cycle of anticoagulant therapy, OCT still revealed several mixed thrombus apposition on the TP, and this suggested its role in the acute stent thrombosis. OCT guided the choice to appose a new stent-in-stent to solve a potential thrombogenic source.

scholarly journals Coronary Stent Healing in Cancer Patients—An Optical Coherence Tomography Perspective

2021 ◽  
Vol 8 ◽  
Author(s):  
Moez Karim Aziz ◽  
Joerg Herrmann ◽  
Konstantinos Marmagkiolis ◽  
Dinu Valentin Balanescu ◽  
Teodora Donisan ◽  
...  
Keyword(s):  
Optical Coherence Tomography ◽  
Cancer Patients ◽  
Stent Thrombosis ◽  
Neointimal Hyperplasia ◽  
Drug Eluting Stent ◽  
Primary Study ◽  
Optical Coherence ◽  
Oncological Treatment ◽  
Coronary Syndrome ◽  
Risk Of Cancer

Objective: This study assessed stent healing patterns and cardiovascular outcomes by optical coherence tomography (OCT) in cancer patients after drug-eluting stent (DES) placement.Background: Cancer treatment, owing to its cytotoxic and antiproliferative effects, could delay stent healing and increase stent thrombosis risk, especially when dual antiplatelet therapy (DAPT) is discontinued early for oncological treatment. OCT can assess stent endothelialization and other healing parameters, which may provide clinical guidance in these challenging scenarios.Methods: This single-center retrospective study enrolled all cancer patients who underwent OCT for assessment of vascular healing patterns after prior DES placement from November 2009 to November 2018. Primary study endpoints were stent healing parameters, including stent coverage, apposition, degree of expansion, neointimal hyperplasia heterogeneity, in-stent restenosis, stent thrombosis, and overall survival (OS).Results: A total of 67 patients were included in this study. Mean time between DES placement and OCT evaluation was 154 ± 82 days. Stent healing matched published values for DES in non-cancer patients (P ≥ 0.063). At 1 year, the OS was 86% (95% confidence interval [CI]: 78–96%) with 0% incidence of acute coronary syndrome. Advanced cancers and active chemotherapies were associated with inferior OS (P = 0.024, hazard ratio [HR]: 3.50, 95% CI: 1.18–10.42 and P = 0.026, HR: 2.65, 95% CI: 1.13–6.22, respectively), while stent healing parameters were unassociated with OS. Forty-one patients (61%) had DAPT duration ≤6 months.Conclusions: Stent healing of contemporary DES appears similar in cancer and non-cancer patients. Cardiovascular risk of cancer patients after DES placement can be managed to facilitate timely cancer therapies, as the underlying malignancy and active chemotherapy ultimately determine survival.

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.

Abstract 2777: Optimal Expansion of the Stent is a Major Contributor to the Neointimal Coverage Following Sirolimus-eluting Stent Implantation: A Combined Study of Angioscopy and Intravascular Ultrasound

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Fusako Sera ◽  
Jun-ichi Kotani ◽  
Masaki Awata ◽  
Shinsuke Nanto ◽  
Masaaki Uematsu ◽  
...  
Keyword(s):  
Intravascular Ultrasound ◽  
Stent Implantation ◽  
Neointimal Hyperplasia ◽  
Multivariate Logistic Regression Analysis ◽  
Plaque Burden ◽  
Elastic Membrane ◽  
Major Contributor ◽  
Stent Expansion ◽  
Neointimal Coverage ◽  
Sirolimus Eluting Stent

Background: Although sirolimus-eluting stent (SES) has significantly reduced in-stent restenosis by inhibiting neointimal hyperplasia, insufficient neointimal coverage after stenting may result in adverse outcomes. Determinants of neointimal coverage following SES, however, are poorly understood. Methods: We evaluated 28 SES lesions using both angioscopy and intravascular ultrasound (IVUS). Degree of neointimal coverage was judged by angioscopy at follow-up (11 ± 6 months): complete/incomplete coverage, based on whether the stent struts were embedded by the neointima. Minimal stent area (MSA), external elastic membrane (EEM), lumen cross-sectional area (CSA) and plaque burden (EEM minus lumen/EEM CSA) were measured by IVUS at stent implantation. Both proximal and distal references were used. Stent expansion was assessed by stent expansion index (SEI) as MSA/reference EEM CSA. Under-expansion was defined as SEI < 0.4. Incomplete apposition was defined as the lack of contact between any strut and the underlying vessel wall. Results: Complete coverage was identified in 10 (36%), and incomplete coverage in 18 (64%). Time from the stenting to angioscopy (10 ± 5 versus 11 ± 7 months, p=0.8) as well as the lesion and procedural characteristics was similar between the complete/incomplete coverage groups. IVUS parameters were also similar, except for the final MSA (7.0±1.8mm 2 in complete versus 5.3±1.9mm 2 in incomplete , p=0.02) and lumen CSA at the distal reference site (6.1±1.4mm 2 in complete versus 4.9 ±1.2mm 2 in incomplete , p= 0.02). The frequency of incomplete apposition was similar between the groups (20% in complete versus 39% in incomplete , P= 0.4); however, SEI was significantly larger in the complete coverage than in the incomplete coverage group (0.52 ± 0.11 versus 0.39 ± 0.09, p=0.002). Stent under-expansion was identified only in 2 (20%) of the complete coverage, as compared to 67% of the incomplete coverage group (P=0.046). By multivariate logistic regression analysis, large SEI was strongly associated with complete neointimal coverage (P=0.04). Conclusion: Optimal expansion of the stent is a major contributor to the complete neointimal coverage following sirolimus-eluting stent implantation.

P2698Is stent thrombosis caused by patient-related factors or by operator-related factors?

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
M Kamenik ◽  
P Widimsky
Keyword(s):  
Risk Factors ◽  
Stent Thrombosis ◽  
Stent Implantation ◽  
Clinical Laboratory ◽  
Laboratory Data ◽  
Coronary Intervention ◽  
Related Factors ◽  
Coronary Syndrome ◽  
Related Risk ◽  
Tertiary Center

Abstract Background/Introduction Stent thrombosis (ST) is the most feared complication of percutaneous coronary intervention (PCI). Purpose To analyze the patient-, lesion- and operator-related risk factors of ST. Methods Coronary angiograms of 1764 consecutive patients admitted between 2014–16 with an acute coronary syndrome (ACS) to a large tertiary center have been analyzed retrospectively for the presence of ST. ST was found in 29 of them (1,6% of all ACS patients). Paired angiograms (initial PCI from the time of stent implantation and second angiography done at the time of ST) from these 29 ST patients were analyzed by two independent observers with focus on lesion characteristics and procedure techniques. Clinical and laboratory data were included in the analysis. Results The following risk factors for ST were found: renal insufficiency (OR 4,30; p<0,001), type 2. diabetes (OR 2.24, p=0,03), stent implantation for STEMI (OR 1,75; p=0,009), left main or left anterior descending artery as culprit lesion (OR 2,80; p<0,001), absolute platelet count (p=0,005) and absence of antiplatelet therapy prior to ST (OR 1,87; p=0,01). The rates of lesion-/operator-related factors among ST patients were: bifurcation lesion (n=7; 24%), heavy coronary calcifications (n=13; 44%), wrong stent size selection (diameter undersizing or incomplete lesion coverage) (n=6, 20%). A combination of at least one clinical/laboratory and one lesion/operator risk factor was identified in 28 patients out of 29 with confirmed ST (96%). Conclusion Stent thrombosis usually occurs when clinical, laboratory, lesion and/or operator-related risk factors combine together. While clinical, laboratory and lesion-related factors are well described in the literature, operator-related factors need more detailed research.

scholarly journals Mobilization of progenitor cells and vessel healing after implantation of SYNERGY in acute coronary syndrome

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Masashi Sakuma ◽  
Setsu Nishino ◽  
Takahisa Nasuno ◽  
Michiya Kageyama ◽  
Michiaki Tokura ◽  
...  
Keyword(s):  
Optical Coherence Tomography ◽  
Acute Coronary Syndrome ◽  
Progenitor Cells ◽  
Stent Implantation ◽  
Healing Process ◽  
Coronary Syndrome ◽  
Neointimal Thickness ◽  
Coronary Stent Implantation ◽  
Coronary Angioscopy ◽  
Neointimal Coverage

AbstractThis study was aimed to compare the vascular healing process of a SYNERGY stent with that of a PROMUS PREMIER stent in patients with acute coronary syndrome (ACS). In 71 patients with ACS, undergoing coronary stent implantation using the SYNERGY stent (n = 52) or PROMUS PREMIER stent (n = 19), we measured circulating CD34+/CD133+/CD45null cells and CD34+/KDR+ cells and observed vascular healing at the stented sites using optical coherence tomography (OCT) and coronary angioscopy. On the day 7, circulating CD34+/CD133+/CD45null cells increased in SYNERGY group (P < 0.0001), while it did not change in PROMUS group. The CD34+/KDR+ cells also increased in SYNERGY group (P < 0.0001) but less significantly in the PROMUS group (P < 0.05). The OCT-based neointimal thickness (P < 0.0005) and neointimal coverage rate (P < 0.05) at 12 months were greater in SYNERGY group, compared with PROMUS group. The coronary angioscopy-based neointimal coverage grade at 12 months was also greater in SYNERGY group (P < 0.001). In overall patients, the change in CD34+/KDR+ cells on the day 7 correlated with the OCT-based neointimal thickness at 12 months (R = 0.288, P < 0.05). SYNERGY stent seems to have potential advantages over PROMUS PREMIER stent for ACS patients in terms of vascular healing process at the stented sites.

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