Stent thrombosis

2010 ◽  
pp. 503-524 ◽  
Author(s):  
Mariuca Vasa-Nicotera ◽  
Tony Gershlick
Keyword(s):  
Coronary Artery ◽  
Stent Thrombosis ◽  
Artery Bypass ◽  
Bare Metal Stents ◽  
Metal Stents ◽  
Stent Restenosis ◽  
Repeat Procedure ◽  
The Difference ◽  
Artery Disease

Over the past three decades, new strategies have rapidly evolved to achieve coronary reperfusion of ischaemic myocardium in patients with coronary artery disease (CAD). Studies comparing percutaneous coronary intervention (PCI) with coronary artery bypass grafting (CABG) have shown that the long-term rates of death and/or myocardial infarction (MI) are substantially the same, justifying the increasing and widespread use of PCI. PCI is the dominant reperfusion therapy for such patients with the ratio of numbers of PCIs undertaken to CABG performed being 4:1 in the United Kingdom and up to 8:1 in other parts of Europe. A recurrent issue during the evolution of PCI has been the difference between PCI and CABG in the percentage of patients requiring a repeat procedure (reintervention). To date, the need of reintervention has been less with CABG and this is due to the development of in-stent restenosis that occurs after PCI. Restenosis is the re-narrowing of the vessel, which requires a repeat procedure. The rate of restenosis with early balloon angioplasty has been high. The implantation of bare metal stents (BMS) and then drug-eluting stents (DES) has reduced significantly the incidence of restenosis. While such improved overall clinical outcomes with DES has supported the use of these in preference to BMS, another long-term complication has somewhat tempered the enthusiasm for their use: the possibility that implantation of DES would result in an excess of occlusive stent thrombosis (ST). This chapter will analyse the data on the incidence, causes, and clinical consequences of ST, and will outline the ongoing and future preventive and therapeutic initiatives. Finally, the risk/benefit of DES will be addressed.

scholarly journals Long-term outcome of patients with very small coronary artery disease: A comparison of drug-eluting and bare metal stents

2016 ◽  
Vol 79 (12) ◽  
pp. 642-648 ◽  
Author(s):  
Wei-Ting Wang ◽  
Shih-Hsien Sung ◽  
Cheng-Hsueh Wu ◽  
Shao-Sung Huang ◽  
Wan-Leong Chen ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Bare Metal Stents ◽  
Metal Stents ◽  
Bare Metal ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Drug Eluting ◽  
Artery Disease

scholarly journals Impact of 6-Month Angiographic Restenosis Inside Bare-Metal Stents on Long-Term Clinical Outcome in Patients With Coronary Artery Disease

2007 ◽  
Vol 48 (4) ◽  
pp. 443-454 ◽  
Author(s):  
Yung-Lung Chen ◽  
Mien-Cheng Chen ◽  
Chiung-Jen Wu ◽  
Hon-Kan Yip ◽  
Chih-Yuan Fang ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Clinical Outcome ◽  
Bare Metal Stents ◽  
Metal Stents ◽  
Bare Metal ◽  
Angiographic Restenosis ◽  
Artery Disease

scholarly journals From Stenosis to Restenosis - The New Coronary Artery Disease Continuum in the PCI Era

2020 ◽  
Vol 17 (4) ◽  
pp. 61-68
Author(s):  
Alice Elena Munteanu ◽  
Liviu Chiriac ◽  
Filip Romi Bolohan ◽  
Daniel Niţă ◽  
Corina Diaconescu ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Current Knowledge ◽  
Bare Metal Stents ◽  
Myocardial Infarctions ◽  
Metal Stents ◽  
Complex Issue ◽  
Stent Restenosis ◽  
Percutaneous Coronary ◽  
Artery Disease ◽  
Made In

AbstractMortality rates from acute myocardial infarctions have been declining in the past 4 decades since percutaneous coronary interventions (PCIs) became a valid therapeutical option. PCI is a non-surgical revascularization procedure in which blood flow in an occluded or narrowed epicardial coronary artery is re-established by inflating an angioplasty balloon in order to remove the blockage, followed by the insertion of a stent in order to maintain the patency of the artery. Since the late ‘70s when the first bare metal stents (BMS) became available, progress has been made in developing new types of stents in order to lower the incidence of two important and feared complications: and thrombosis restenosis.While thrombosis is manageable and preventable with antithrombotic therapy, restenosis is a more complex issue of which many clinicians may not be aware or underestimate. The review would like to summarize the current knowledge from the literature on stent restenosis and present to clinicians some tools for recognizing, or at least suspecting, restenosis in their patients.

scholarly journals Results of surgical treatment of moderate ischemic mitral regurgitation: A propensity analysis

2020 ◽  
Author(s):  
Jiyoung Lee ◽  
Kan Kajimoto ◽  
Taira Yamamoto ◽  
Kenji Kuwaki ◽  
Yuki Kamikawa ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Surgical Treatment ◽  
Mitral Valve ◽  
Propensity Score ◽  
Artery Bypass ◽  
Long Term Outcomes ◽  
Artery Disease ◽  
The Impact

Background and Aim of the Study: Ischemic mitral valve regurgitation (IMR) in patients undergoing coronary artery bypass grafting (CABG) is associated with worse long-term outcomes. The aim of this study was to assess the impact of mitral valve repair with CABG in patients with moderate IMR. Method: This observational study enrolled 3,215 consecutive patients from the Juntendo CABG registry with moderate IMR and multivessel coronary artery disease who underwent CABG between 2002 and 2017. The CABG alone and CABG with mitral valve surgery (MVs) groups were compared. The propensity score was calculated for each patient. Long-term all-cause death, cardiac death, and major adverse cardiac and cerebrovascular events (MACCEs) were compared between the two groups. Results: A total of 101 patients who underwent CABG had moderate IMR in our database. Propensity score matching selected 40 pairs for final analysis. MVs was associated with increased risks of postoperative atrial fibrillation, blood transfusion, and longer hospitalization. There were no differences between the two groups in long-term outcomes, including all-cause mortality, cardiac mortality, and the incidence of MACCEs. Conclusions: Surgical treatment of moderate IMR combined with CABG was as safe as CABG alone, with no differences in long-term outcomes. Further studies are needed to determine the effects of MVs in patients with moderate IMR and severe coronary artery disease.

Long-term prognosis after percutaneous or surgical revascularization in patients with diabetes mellitus and complex coronary artery disease- a systematic review and meta analysis

2021 ◽  
Vol 28 (Supplement_1) ◽  
Author(s):  
A Abdul Razzack ◽  
S Mandava ◽  
S Pothuru ◽  
S Adeel Hassan ◽  
D Missael Rocha Castellanos ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Artery Bypass ◽  
Left Main ◽  
All Cause Mortality ◽  
Patients With Diabetes ◽  
Artery Disease

Abstract Funding Acknowledgements Type of funding sources: None. Background-Whether Coronary artery bypass grafting (CABG) confers a survival benefit in patients with diabetes mellitus(DM) and complex coronary artery disease (CAD), including left main CAD and multivessel coronary disease (MVD) after a follow up period ≥ 5 years remains unknown. Methods- Electronic databases (PubMed, Embase, Scopus, Cochrane) were searched from inception to December 12th 2020. Using a generic invariance weighted random effects model, Hazard ratios (HRs) and their 95% confidence intervals (CIs) from individual studies were converted to Log HRs and corresponding standard errors, which were then pooled. The primary outcome of interest was all-cause mortality and major adverse cardiac and cerebrovascular events (MACCE) which was defined as a composite of death, myocardial reinfarction and stroke at ≥ 5 years. Results-A total of 8 studies with 13336 participants(PCI = 6783, CABG = 6553)were included in our analysis. Mean age was 54.6 and 55.3 in the PCI-DES and CABG groups respectively. The 5-yr follow-up outcomes including all-cause mortality (HR 1.37; 95%CI 1.15-1.65; p = 0.0006, I2 = 0)and MACCE (HR 1.48; 95%CI 1.29-1.69; p < 0.00001, I2 = 0) were significantly higher with PCI as compared to CABG. Furthermore, at >5 year follow-up, all-cause mortality (HR 1.35; 95%CI 1.10-1.66; p = 0.004, I2 = 37) and MACCE (HR 1.98; 95%CI 1.85-2.12; p < 0.00001, I2 = 0) had similar outcomes. Conclusion-Amongst patients with DM and Complex CAD ( left main/MVD), CABG was associated with improved long-term mortality and freedom from MACCEs as opposed to PCI-DES. CABG is the preferred revascularization strategy in patients with complex anatomic disease and concurrent diabetes. Abstract Figure.

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