scholarly journals Safety and Long-Term Efficacy of Drug-Coated Balloon Angioplasty following Rotational Atherectomy for Severely Calcified Coronary Lesions Compared with New Generation Drug-Eluting Stents

2019 ◽  
Vol 2019 ◽  
pp. 1-10 ◽  
Author(s):  
Katsumi Ueno ◽  
Norihiko Morita ◽  
Yoshinobu Kojima ◽  
Hiroshi Takahashi ◽  
Masanori Kawasaki ◽  
...  
Keyword(s):  
De Novo ◽  
Propensity Score Analysis ◽  
Rotational Atherectomy ◽  
Drug Eluting Stents ◽  
Lesion Length ◽  
Term Efficacy ◽  
Drug Eluting ◽  
New Generation

Objectives. This study sought to assess the safety and long-term efficacy of drug-coated balloons (DCB) following aggressive intracoronary image-guided rotational atherectomy (iRA) for severe coronary artery calcification (CAC), and to compare this strategy with new generation drug-eluting stents (nDES) following iRA. Background. Ischemic events following the treatment of CAC is still relatively high. Thus, more innovative strategies are required. Methods. We evaluated 123 consecutive patients (166 lesions) with de novo CAC undergoing an iRA (burr size; 0.7 of the mean reference diameter by intracoronary imaging) followed by DCB (DCB-iRA; 54 patients, 68 lesions) or nDES (nDES-iRA; 69 patients, 98 lesions). Follow-up angiography was obtained at > 6 months. Results. The target vessels (right coronary and circumflex), bifurcation (67.6% versus 47.9%), reference diameter (2.28mm versus 2.49mm), and lesion length (11.89mm versus 18.78mm) were significantly different between the two groups. The median follow-up was 732 days. TLR and TVR in DCB-iRA and nDES-iRA at 3 years were similar: 15.6% versus 16.3% (P=0.99) and 15.6% versus 23.3% (P=0.38). In 41 well-matched lesion pairs after propensity score analysis, the cumulative incidence of TLR and TVR in DCB-iRA and nDES-iRA at 3 years was 12.9% versus 16.3% (P=0.70) and 12.9% versus 26.1% (P=0.17), respectively. On QCA analysis, although the acute gain was smaller in DCB-iRA (0.85 mm versus 1.53 mm, P<0.001), the minimum lumen diameter at follow-up was similar (1.69 mm versus 1.87 mm, P=0.29). The late lumen loss was lower (0.09 mm versus 0.52 mm, P=0.009) in DCB-iRA. Conclusions. DCB-iRA is feasible for CAC.

Long-term efficacy of drug coated balloons compared with new generation drug-eluting stents for the treatment of de novo coronary artery lesions

2018 ◽  
Vol 92 (5) ◽  
pp. E317-E326 ◽  
Author(s):  
Dimitrios Venetsanos ◽  
Sofia Sederholm Lawesson ◽  
Georgios Panayi ◽  
Tim Tödt ◽  
Ulf Berglund ◽  
...  
Keyword(s):  
Coronary Artery ◽  
De Novo ◽  
Drug Eluting Stents ◽  
Coronary Artery Lesions ◽  
Term Efficacy ◽  
Drug Eluting ◽  
New Generation

Long-term follow-up of first generation versus new-generation drug-eluting stents in three-vessel coronary artery disease

2017 ◽  
Vol 18 (7) ◽  
pp. 492-496 ◽  
Author(s):  
Toru Yoshizaki ◽  
Toru Naganuma ◽  
Tsuyoshi Kobayashi ◽  
Takeo Horikoshi ◽  
Hirokazu Onishi ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
First Generation ◽  
Drug Eluting Stents ◽  
Long Term Follow Up ◽  
Drug Eluting ◽  
Artery Disease ◽  
New Generation ◽  
Vessel Coronary Artery

Long-term efficacy and safety of newer generation ultrathin strut drug-eluting stents: a systematic review and meta-analysis

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
B Lattuca ◽  
X Odorico ◽  
B.V Occean ◽  
L Cornillet ◽  
L Schmutz ◽  
...  
Keyword(s):  
Meta Analysis ◽  
Target Lesion ◽  
Drug Eluting Stents ◽  
Target Vessel ◽  
Efficacy And Safety ◽  
Short Term ◽  
Term Efficacy ◽  
Drug Eluting

Abstract Background Recent trials have demonstrated that short-term efficacy and safety of ultrathin strut drug-eluting stents (DES) were non-inferior to contemporary stents but long-term benefit remains uncertain. Purpose The main objective of this meta-analysis was to evaluate efficacy and safety of ultrathin strut DES with an extended follow-up in comparison to 2nd and 3rd generations DES. Methods A double-blind review of randomized controlled trials (RCT) comparing ultrathin strut DES to contemporary DES was performed from MEDLINE and CENTRAL databases and from cardiological congresses. The primary efficacy endpoint was target vessel failure (TLF) defined as a composite of cardiac death, target vessel myocardial infarction (TV-MI) and target lesion revascularization (TLR) and the primary safety endpoint was occurrence of stent thrombosis (ST). Short (1 year) and long term (≥2 years) effects were estimated separately. This analysis was pre-specified in PROSPERO (CRD42019142206). Results The meta-analysis included 13 RCT including 19,490 patients. In short term, we found TLF decrease with ultrathin strut DES (RR 0.85, CI [0.75–0.97], p=0.01), driven by lower TV-MI (RR 0.83, CI [0.66–1.03], p=0.1) and TLR (RR 0.77, CI [0.58–1.01], p=0.1) rates, and a non-significant downward trend in ST (RR 0.85 CI [0.64–1.14]). In long term, from the 5 trials with extended follow-up, there was no significant difference between ultrathin strut DES and thicker strut stents in rate of TLF at the longest available follow-up (RR 0.90, CI [0.76–1.06], p=0.2), despite a numerically reduction of TV-MI (RR 0.81, CI [0.61–1.08], p=0.05) and TLR (RR 0.85, CI [0.69–1.04], p=0.1) in favor of ultrathin strut stents. However, we observed a persistent numerically reduction in ST (RR 0.79, CI [0.61–1.02], p=0.01). Conclusion Ultrathin strut DES was associated with a lower target lesion failure rate at one year but not beyond 2-years follow-up. Nevertheless, the safety of the ultrathin strut stents was sustained over time with a numerically reduction of ST. Funding Acknowledgement Type of funding source: None

Abstract 11963: Randomized Ivus Comparison Between a Durable and a Biodegradable-Polymer Second Generation Drug-Eluting Stents: The Bioactive Trial

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Jose de Ribamar Costa ◽  
Breno Almeida ◽  
Ricardo Costa ◽  
Daniel Chamie ◽  
Marco Perin ◽  
...  
Keyword(s):  
Second Generation ◽  
De Novo ◽  
Vessel Diameter ◽  
Drug Eluting Stents ◽  
Lesion Length ◽  
Stent Restenosis ◽  
Vessel Volume ◽  
Late Loss ◽  
Drug Eluting

Background: New generation drug-eluting stents (DES), biolimus-eluting stents (BES) and everolimus-eluting stents (EES) were conceived to minimize local coronary inflammation allowing better endothelial healing. The aim of this study is to compare the IVUS patterns observed with both stents at midterm follow-up. Methods: The Bioactive trial is a multicentre, randomized trial (1:1) comparing BES and EES based on surrogate safety and efficacy endpoints. Inclusion criteria was single, de novo lesions in native coronary arteries of 3.0 to 3.5mm and maximum lesion length of 20 mm. Patients with in-stent restenosis, lesion in grafts and treated in the setting of STEMI were excluded. The present analysis aims to compare the main IVUS findings for both DES at 9-month invasive follow-up. IVUS analyses were performed in an independent corelab blinded to the type of DES used. Results: A total of 40 patients were enrolled in the trial and 35 had IVUS performed. Procedure success was achieved in all cases. Baseline clinical characteristics as well as reference vessel diameter and lesion length did not significantly differ between the 2 cohorts. At 9 month, QCA measured in stent late loss was also comparable (0.15±0.18mm for BES vs. 0.20±0.47mm for EES, p=0.7). By IVUS, vessel volume (349±158mm3 for BES vs. 326±127mm3 for EES, p=0.6) and stent volume (178±78 for BESmm3 vs. 154±54mm3 for EES, p=0.4) did not significantly differ between the groups as well as neointimal tissue volume (3.6±2.8mm3 for BES vs 4.3±6.1mm3 for EES, p=0.4) and the % of stent obstruction (2.3±2.1% for BES vs. 2.5±2.8% for EES. OF note, the pattern of neointimal distribution was very similar between the two DES (figure). Conclusions: In this head-to-head to comparison, both second-generation DES were shown to be effective and safety in the treatment of coronary artery disease with no significant differences in terms of IVUS findings.

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