Abstract 2555: Vascular Brachytherapy an Effective Therapy for Patients with Drug-Eluting Stent Restenosis

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Laurent Bonello ◽  
Kimberley Kaneshige ◽  
Axel de Labriolle ◽  
Probal Roy ◽  
Daniel H Steinberg ◽  
...  
Keyword(s):  
Artery Bypass ◽  
Bare Metal Stent ◽  
Beta Radiation ◽  
Drug Eluting Stent ◽  
Stent Restenosis ◽  
Vascular Brachytherapy ◽  
Drug Eluting ◽  
Procedural Success ◽  
Multiple Recurrences

The rates of drug-eluting stent (DES) in-stent restenosis (ISR) exceeds 10% in difficult subsets of patients and lesions. The optimal management of DES ISR remains unclear. Vascular brachytherapy (VBT) was proven to be effective for the treatment of bare metal stent (BMS) ISR but its outcome for DES ISR has not established. We aimed to investigate the safety and efficacy of VBT for DES ISR lesions. Ninety-nine consecutive patients who presented with ISR following DES implantation in 122 lesions were subjected to conventional PCI with adjunct VBT using either a beta radiation system [Beta Rail in 74 patients (82.2%) and the Galileo system in 13 patients 14.4%] or gamma radiation [Checkmate system in 3 patients (3.3%)]. Patients were followed clinically for MACE during 1-year follow-up. More than half of the patients had a previous coronary artery bypass surgery. A high proportion of patients (55%) had complex ISR with diffuse or proliferate pattern and 31.1% had recurrences of ISR to the same site. Procedural success was documented in all patients post-VBT with uneventful course during hospitalization. At 12 months’ follow-up the TLR rate was 11.1% and the overall MACE rate was 24.4%. Patients with multiple episodes of ISR to the same site had a MACE rate of 32%. There were no reports of stent thrombosis in any of the patients. VBT for the treatment of DES ISR was found to be effective and safe and should be considered a viable tool for the treatment of DES ISR, in particular in complex patients with multiple recurrences.

scholarly journals A Different Way of Coronary Lesion Preparation: Stentablation and Rotastenting

2012 ◽  
Vol 6 ◽  
pp. CMC.S8959 ◽  
Author(s):  
Ibrahim Akin ◽  
Steffen Pohlmann ◽  
Christoph A. Nienaber ◽  
Hüseyin Ince
Keyword(s):  
Case Reports ◽  
Balloon Dilation ◽  
Target Lesion ◽  
Bare Metal Stent ◽  
Drug Eluting Stent ◽  
Stent Restenosis ◽  
Direct Stenting ◽  
Drug Eluting ◽  
Calcified Coronary Lesions

Calcified coronary lesions are challenging to deal with, as they require optimal lesion preparation. Direct stenting in this scenario is associated with risk of stent-underexpansion, which is related to in-stent restenosis, target lesion revascularization and stent-thrombosis. We report on the interventional management of an underexpanded bare-metal stent not amenable to high-pressure balloon dilation and cutting-balloon. By using rotablation we could abrade the underexpanded stent struts and the calcification with subsequent implantation of a drug-eluting stent. Follow-up of 6 months revealed good results without evidence of significant restenosis. Our clinical experience and case reports in the literature suggest that this strategy might be an option for underexpanded stents not amenable to conventional techniques.

The effect of REDV/TiO2 coating coronary stents on in-stent restenosis and re-endothelialization

2016 ◽  
Vol 31 (6) ◽  
pp. 911-922 ◽  
Author(s):  
Xiangshan Xu ◽  
Lijie Wang ◽  
Guofeng Wang ◽  
Yuanzhe Jin
Keyword(s):  
Metal Ion ◽  
316L Stainless Steel ◽  
Ceramic Coating ◽  
Bare Metal Stent ◽  
Drug Eluting Stent ◽  
Bare Metal ◽  
Metal Stent ◽  
Stent Restenosis ◽  
Drug Eluting ◽  
In Stent Restenosis

The coronary artery stent has been widely used in clinic. In-stent restenosis was mainly caused by the excessive proliferation of smooth muscle cell and the inflammation due to the metal ion released from stent scaffold of the drug-eluting stent. Thus, to reduce the in-stent restenosis and promote the vascular endothelialization have become a hot research point in this area. In this paper, a nano-TiO2 ceramic coating was deposited on 316L stainless steel to reduce the metal ion release and to inhibit the inflammation reaction. An endothelia cell selective adhesion peptide Arg-Glu-Asp-Val (REDV) coating was prepared on the ceramic coating by a polydopamine technology to promote the endothelialization. The corrosion test indicated that nano-TiO2 ceramic film could effectively decrease the nickel ion released from 316L stainless steel. REDV/TiO2 coating could promote the endothelial cell adhesion and proliferation, meanwhile REDV/TiO2 coating could also increase the nitric oxide concentration. Bare metal stent, TiO2-coated stent and REDV/TiO2-coated stent were implanted in the iliac arteries of rabbit model. In-stent restenosis and re-endothelialization were evaluated at 28 days post-implantation of the stents. The results showed that REDV/TiO2-coated stents could effectively reduce in-stent restenosis and promote re-endothelialization in comparison with TiO2-coated drug-eluting stent and bare metal stent. These results suggest that REDV/TiO2-coated drug-eluting stent maybe a good choice of the application for coronary artery disease.

Stent fracture and restenosis after placement of a drug-eluting device in the vertebral artery origin and treatment with the stent-in-stent technique

2007 ◽  
Vol 106 (5) ◽  
pp. 907-911 ◽  
Author(s):  
Seong-Rim Kim ◽  
Min-Woo Baik ◽  
Seung-Hoon Yoo ◽  
Ik-Seong Park ◽  
Sang-Don Kim ◽  
...  
Keyword(s):  
Vertebral Artery ◽  
Stent Placement ◽  
Coronary Stents ◽  
Drug Eluting Stent ◽  
Stent Fracture ◽  
Stent Restenosis ◽  
Stent Strut ◽  
Drug Eluting ◽  
In Stent Restenosis

✓ The authors report two cases of stent fracture and restenosis after placement of a drug-eluting device in the vertebral artery (VA) origin, and describe management of restenosis with the stent-in-stent technique. Two women, one 62 and the other 67 years of age, underwent stent placement in the VA origin to treat symptomatic and angiographically significant stenosis in this vessel. Sirolimus-eluting coronary stents (Cypher) were used in both cases. Four months after placement of the devices, the symptoms recurred. Follow-up angiography performed 5 months after insertion of the devices revealed a transverse stent fracture with separation of the fragments and severe in-stent restenosis in both cases. The restenoses were treated with reinsertion of coronary stents (Cypher and Jostent FlexMaster) by using the stent-in-stent technique. After stent reinsertion, the patients exhibited relief of symptoms. This paper is the first report of fracture in a drug-eluting stent and restenosis after stent placement in the VA origin. Restenosis caused by such a fracture can be managed successfully by performing the stent-in-stent maneuver. The physical properties of metallic devices, stent strut geometry, and anatomical peculiarities of the subclavian artery may be associated with stent fractures. Earlier follow-up angiography studies (within 6 months) are warranted.

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