Very late thrombosis induced by neoatherosclerosis in bioresorbable stent

Coronary angioplasty has vastly improved both in technique and devices since the first angioplasty in 1977. Currently, stent implantation is used almost ubiquitously, despite being developed originally to treat vessel threatening dissections. Newer concepts including absorbable polymers or fully bioabsorbable scaffolds are constantly being developed. However, we find the concept of no permanent implant whilst still delivering a chemotherapeutic drug to reduce restenosis very attractive given the long term implications of a metallic stent, which include restenosis, late thrombosis and neo-atheroma formation. The use of a drug-coated balloon-only approach to de novo angioplasty will avoid the late thrombotic problems whilst also reducing early restenosis, simplifying the procedure and reducing the dual antiplatelet duration to 1 month. We review the current literature and highlight our practice with regard to use of drug-coated balloons in treatment of de novo coronary artery disease.

Download Full-text

Late thrombosis of coronary bare-metal stent: Case report

Srpski arhiv za celokupno lekarstvo ◽

10.2298/sarh0604155a ◽

2006 ◽

Vol 134 (3-4) ◽

pp. 155-158 ◽

Cited By ~ 1

Author(s):

Svetlana Apostolovic ◽

Zoran Perisic ◽

Miloje Tomasevic ◽

Goran Stankovic ◽

Milan Pavlovic ◽

...

Keyword(s):

Stent Thrombosis ◽

Bare Metal Stent ◽

Drug Eluting Stent ◽

Bare Metal ◽

Metal Stent ◽

Coronary Syndrome ◽

Percutaneous Coronary ◽

Drug Eluting ◽

Late Thrombosis ◽

And Control

Stent thrombosis remains the primary cause of death after percutaneous coronary interventions (PCI). Despite modern concepts of PCI, stent thrombosis occurs in 0.5% -2% of elective procedures and even 6% of patients with the acute coronary syndrome (ACS). Stent thrombosis most often develops within the first 48 hours after the PCI, and rarely after a week of stent implantation. Angiographically documented late (>6 months) thrombosis of coronary bare-metal stent (BMS) is rare, because the stent endothelialization is considered to be completed after four weeks of the intervention. Our patient is a 41 year old male and he had BMS thrombosis 345 days after the implantation, which was clinically manifested as an acute myocardial infarction in the inferoposterolateral localization. Stent Clinical Centre of Serbia, Belgrade thrombosis occurred despite a long term dual antiplatelet therapy and control of known risk factors. Thrombolytic therapy (Streptokinase in a dose of 1 500 000 IU) was not successful in reopening the occluded vessel, so the flow through the coronary artery was achieved by rescue balloon angioplasty, followed by implantation of drug eluting stent in order to prevent restenosis.

Download Full-text

Late thrombosis of a drug-eluting stent during combined anti-platelet therapy in a clopidogrel nonresponsive diabetic patient: Shall we routinely test platelet function ?

Thrombosis and Haemostasis ◽

10.1160/th07-01-0032 ◽

2007 ◽

Vol 97 (05) ◽

pp. 862-865 ◽

Cited By ~ 4

Author(s):

Andreas Bonz ◽

Martin Eigenthaler ◽

Johann Bauersachs ◽

Andreas Schäfer

Keyword(s):

Diabetic Patient ◽

Platelet Function ◽

Drug Eluting Stent ◽

Anti Platelet Therapy ◽

Drug Eluting ◽

Late Thrombosis

Download Full-text

Testing bioresorbable stent feasibility in a rat aneurysm model

Journal of NeuroInterventional Surgery ◽

10.1136/neurintsurg-2018-014697 ◽

2019 ◽

Vol 11 (10) ◽

pp. 1050-1054 ◽

Cited By ~ 3

Author(s):

Basil Erwin Grüter ◽

Dominik Täschler ◽

Fabio Strange ◽

Jeannine Rey ◽

Michael von Gunten ◽

...

Keyword(s):

Inflammatory Responses ◽

Treatment Options ◽

Cerebral Aneurysms ◽

Parent Artery ◽

Cobalt Chromium ◽

Inflammatory Reactions ◽

Male Wistar Rats ◽

Bioresorbable Stent ◽

Cobalt Chromium Stent ◽

Aneurysm Model

BackgroundAdvances in stent-assisted coiling have incrementally expanded endovascular treatment options for complex cerebral aneurysms. After successful coil consolidation and aneurysm occlusion, endovascular scaffolds are no longer needed. Thus, bioresorbable stents that disappear after aneurysm healing could avoid future risks of in-stent thrombosis and the need for lifelong antiplatelet therapy.ObjectiveTo assess the applicability and compatibility of a bioresorbable magnesium- alloy stent (brMAS) for assisted coiling.MethodsSaccular sidewall aneurysms were created in 84 male Wistar rats and treated with brMAS alone, brMAS + aspirin, or brMAS + coils + aspirin. Control groups included no treatment (natural course), solely aspirin treatment, or conventional cobalt–chromium stent + coils + aspirin treatment. After 1 and 4 weeks, aneurysm specimens were harvested and macroscopically, histologically, and molecularly examined for healing, parent artery perfusion status, and inflammatory reactions. Stent degradation was monitored for up to 6 months with micro-computed and optical coherence tomography.ResultsAneurysms treated with brMAS showed advanced healing, neointima formation, and subsequent stent degradation. Additional administration of aspirin sustained aneurysm healing while reducing stent-induced intraluminal and periadventitial inflammatory responses. No negative interaction was detected between platinum coils and brMAS. Progressive brMAS degradation was confirmed.ConclusionsbrMAS induced appropriate healing in this sidewall aneurysm model. The concept of using bioresorbable materials to promote complete aneurysm healing and subsequent stent degradation seems promising. These results should encourage further device refinements and clinical evaluation of this treatment strategy for cerebrovascular aneurysms.

Download Full-text