scholarly journals The Development of Magnesium-Based Resorbable and Iron-Based Biocorrodible Metal Scaffold Technology and Biomedical Applications in Coronary Artery Disease Patients

2019 ◽  
Vol 9 (17) ◽  
pp. 3527 ◽  
Author(s):  
Alexandre Hideo-Kajita ◽  
Samuel Wopperer ◽  
Vinícius Bocchino Seleme ◽  
Marcelo Harada Ribeiro ◽  
Carlos M. Campos
Keyword(s):  
Bare Metal Stents ◽  
Interventional Cardiology ◽  
Coronary Intervention ◽  
Metal Stents ◽  
Stent Restenosis ◽  
The Status ◽  
Drug Eluting ◽  
Iron Based ◽  
Artery Disease ◽  
Acute Stent Thrombosis

In the treatment of atherosclerotic disease patients, the adoption of second-generation drug-eluting stents (DES) in percutaneous coronary intervention reduced the occurrence of in-stent restenosis (ISR) and acute stent thrombosis (ST) when compared to bare metal stents and 1st generation DES. However, the permanent encaging of the vessel wall by any of the metallic stents perpetuates the inflammation process and prevents vasomotion in the treated segment. Aiming to overcome this issue, the bioresorbable scaffold (BRS) concept was developed by providing transient vascular radial support to the target segment during the necessary time to heal and disappearing after a period of time. Close to 20 years since BRS technology was first reported, the interventional cardiology field saw the rise and fall of several BRS devices. Although iron-based BRS is an emerging technology, currently, magnesium-alloy resorbable scaffolds devices are supported with the most robust data. This manuscript aims to review the concept of magnesium-based BRS devices, as well as their bioresorption mechanisms and the status of this technology, and the clinical outcomes of patients treated with magnesium BRS and to review the available evidence on iron-based BRS technology.

In-stent restenosis in the drug-eluting stent era

2018 ◽  
pp. 453-472
Author(s):  
Jaya Chandrasekhar ◽  
Adriano Caixeta ◽  
Philippe Généreux ◽  
George Dangas ◽  
Roxana Mehran
Keyword(s):  
Low Frequency ◽  
Bare Metal Stents ◽  
Coronary Intervention ◽  
Drug Eluting Stent ◽  
Metal Stents ◽  
Pharmacological Agents ◽  
Stent Restenosis ◽  
Drug Eluting ◽  
In Stent Restenosis

Since the inception of percutaneous coronary intervention, restenosis has been considered a significant problem. Although drug-eluting stents (DES) have reduced rates of in-stent restenosis (ISR) compared with bare metal stents across all lesion subsets, ISR has not been abolished. DES efficacy has been limited by suboptimal polymer biocompatibility, efficacy of pharmacological agents, in vivo pharmacokinetic properties, and local drug resistance and toxicity. While the first two DES to be manufactured (sirolimus- and paclitaxel-eluting stents) have the longest clinical follow-up, extensive data are now also available on zotarolimus- and everolimus-eluting stents. The uptake of biolimus-eluting stents has recently increased in clinical practice. Although the low frequency of DES ISR makes it difficult to investigate this condition fully, many studies have examined the mechanism, incidence, predictors, and optimal treatment of DES restenosis. This review discusses the data relevant to DES restenosis and the perspective on the current treatment of this condition.

scholarly journals Bioabsorbable Vascular Scaffold: A Revolution in Coronary Intervention

2014 ◽  
Vol 6 (2) ◽  
pp. 149-163 ◽  
Author(s):  
M Ullah ◽  
AKMM Islam ◽  
AAS Majumer
Keyword(s):  
Bare Metal Stents ◽  
Coronary Intervention ◽  
Drug Eluting Stents ◽  
Metal Stents ◽  
Percutaneous Coronary Angioplasty ◽  
Vascular Stents ◽  
Percutaneous Coronary ◽  
Vascular Scaffold ◽  
Drug Eluting ◽  
Artery Disease

Since the advent of percutaneous coronary angioplasty in 1977, immense experiment has been done to improve the outcome of the patients with coronary artery disease. Lot of trials have been done with angioplasty, bare metal stents, drug eluting stents, drug eluting balloons and other devices. Bioabsorbable vascular stents are relatively newcomers in this field with a lot of hope. We tried to update the latest status of Bioabsorbable vascular stents in this review, specially the short and midterm safety and efficacy and some of their limitations. DOI: http://dx.doi.org/10.3329/cardio.v6i2.18359 Cardiovasc. j. 2014; 6(2): 149-163

Second- versus First-generation Drug-eluting Stents

2010 ◽  
Vol 5 (1) ◽  
pp. 23 ◽  
Author(s):  
Kamal Chitkara ◽  
Anthony Gershlick ◽  
◽  
Keyword(s):  
First Generation ◽  
Second Generation ◽  
Bare Metal Stents ◽  
Coronary Intervention ◽  
Drug Eluting Stents ◽  
Metal Stents ◽  
Stent Restenosis ◽  
Early Results ◽  
Number Of Patients ◽  
Drug Eluting

Drug-eluting stents (DES) have demonstrated their superiority over bare-metal stents (BMS) with respect to in-stent restenosis and the need for repeat revascularisation. BMS and first-generation DES, such as sirolimus-eluting (Cypher®) and paclitaxel-eluting stents (Taxus®), have further improved the results of percutaneous coronary intervention (PCI) by improving early results and reducing the risk of restenosis. However, there is currently a debate as to the safety of these first-generation DES given the potential for late stent thrombosis, especially after discontinuation of dual-antiplatelet therapy. Second-generation DES, such as zotarolimus-eluting (Endeavor®) and everolimus-eluting stents (Xience V®), have recently become available in the US and Europe. The available data already suggest the superiority of the Xience V stent in comparison with the Taxus stent in terms of prevention of restenosis, without significant untoward events. Nonetheless, the number of patients studied and the follow-up duration are still too limited to enable definitive conclusions. This systematic review aims to provide a concise and critical appraisal of the available data to compare first- and second-generation stents.

scholarly journals Drug-coated Balloons for Small Coronary Disease—A Literature Review

2021 ◽  
Vol 23 (11) ◽  
Author(s):  
Ketina Arslani ◽  
Raban Jeger
Keyword(s):  
De Novo ◽  
Small Vessel Disease ◽  
Bare Metal Stents ◽  
Metal Stents ◽  
Interventional Treatment ◽  
Efficacy And Safety ◽  
Stent Restenosis ◽  
Drug Eluting ◽  
Artery Disease ◽  
New Generation

Abstract Purpose of Review In the interventional treatment of coronary artery disease, new-generation drug-eluting stents (DES) currently are the standard treatment. In addition, drug-coated balloons (DCB) are a well-established option for the treatment of in-stent restenosis in both bare-metal stents (BMS) and DES, where DCBs deliver an antiproliferative drug without the necessity of re-implanting a stent. Since the field of use for DCB has increasingly been extended to other indications such as de novo lesions in small vessel disease (SVD), a review of literature may be useful. Recent Findings Recent randomized trial data show good efficacy and safety for DCB in de novo lesions, especially in small coronary arteries, and confirm long-term clinical efficacy and safety up to three years. Summary DCB are an attractive and safe option in the treatment of de novo lesions in SVD.

scholarly journals Stent Selection for Primary Angioplasty and Outcomes in the Era of Potent Antiplatelets. Data from the Multicenter Randomized Prague-18 Trial

2021 ◽  
Vol 10 (21) ◽  
pp. 5103
Author(s):  
Ota Hlinomaz ◽  
Zuzana Motovska ◽  
Jiri Knot ◽  
Roman Miklik ◽  
Mahmoud Sabbah ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Bare Metal Stents ◽  
Coronary Intervention ◽  
Primary Angioplasty ◽  
Metal Stents ◽  
Risk Of Death ◽  
Percutaneous Coronary ◽  
Drug Eluting ◽  
Artery Disease ◽  
One Year

Drug-eluting stents (DES) are the recommended stents for primary percutaneous coronary intervention (PCI). This study aimed to determine why interventional cardiologists used non-DES and how it influenced patient prognoses. The efficacy and safety outcomes of the different stents were also compared in patients treated with either prasugrel or ticagrelor. Of the PRAGUE-18 study patients, 749 (67.4%) were treated with DES, 296 (26.6%) with bare-metal stents (BMS), and 66 (5.9%) with bioabsorbable vascular scaffold/stents (BVS) between 2013 and 2016. Cardiogenic shock at presentation, left main coronary artery disease, especially as the culprit lesion, and right coronary artery stenosis were the reasons for selecting a BMS. The incidence of the primary composite net-clinical endpoint (EP) (death, nonfatal myocardial infarction, stroke, serious bleeding, or revascularization) at seven days was 2.5% vs. 6.3% and 3.0% in the DES, vs. with BMS and BVS, respectively (HR 2.7; 95% CI 1.419–5.15, p = 0.002 for BMS vs. DES and 1.25 (0.29–5.39) p = 0.76 for BVS vs. DES). Patients with BMS were at higher risk of death at 30 days (HR 2.20; 95% CI 1.01–4.76; for BMS vs. DES, p = 0.045) and at one year (HR 2.1; 95% CI 1.19–3.69; p = 0.01); they also had a higher composite of cardiac death, reinfarction, and stroke (HR 1.66; 95% CI 1.0–2.74; p = 0.047) at one year. BMS were associated with a significantly higher rate of primary EP whether treated with prasugrel or ticagrelor. In conclusion, patients with the highest initial risk profile were preferably treated with BMS over BVS. BMS were associated with a significantly higher rate of cardiovascular events whether treated with prasugrel or ticagrelor.

In-stent restenosis in the drug-eluting stent era

2010 ◽  
pp. 486-503
Author(s):  
Adriano Caixeta ◽  
Philippe Généreux ◽  
George Dangas ◽  
Roxana Mehran
Keyword(s):  
Bare Metal Stents ◽  
Interventional Cardiology ◽  
Daily Practice ◽  
Drug Eluting Stent ◽  
Metal Stents ◽  
Pharmacological Agents ◽  
Stent Restenosis ◽  
Drug Eluting ◽  
In Stent Restenosis

For the last two decades, restenosis has been considered the most significant problem in interventional cardiology. Drug-eluting stents (DES) have reduced rates of restenosis and target lesion revascularization (TLR) by 50–90% compared with bare-metal stents (BMS) across all lesion and patient subsets. However, a small number of patients have in-stent restenosis (ISR) after DES treatment. DES efficacy has been limited by suboptimal polymer biocompatibility, suitability of pharmacological agents, suboptimal in vivo pharmacokinetic properties, and local drug resistance and toxicity. The first two DES (sirolimus-eluting stents [SES] and paclitaxel- eluting stents [PES]) have the longest clinical follow- up, whereas the zotarolimus-eluting stents [ZES], everolimus-eluting stents [EES], and biolimus-eluting stents [BES] have only recently been introduced in daily practice. Although the low frequency of ISR events with DES makes it difficult to fully investigate this syndrome, many studies have been conducted or are ongoing to find the mechanism, incidence, predictors, and optimal treatment of DES restenosis. This review discusses the data relevant to DES restenosis and the perspective on the current treatment of this condition.

scholarly journals A Case of Very Early Stent Restenosis Following DES Implantation

2019 ◽  
Vol 04 (04) ◽  
pp. 200-203 ◽  
Author(s):  
Shravan Kumar Ch ◽  
Naveen Kumar M. ◽  
Sudhakar Kanumuri
Keyword(s):  
Bare Metal Stents ◽  
Coronary Intervention ◽  
Drug Eluting Stents ◽  
Metal Stents ◽  
Bare Metal ◽  
Stent Restenosis ◽  
Percutaneous Coronary ◽  
Drug Eluting ◽  
In Stent Restenosis ◽  
Stent Stenosis

AbstractIntracoronary in-stent restenosis (ISR) is more common with bare metal stents. With the introduction of drug-eluting stents (DESs), the incidence of ISR has markedly decreased. Here, we report a case of unusual very early stent restenosis in a patient who presented with unstable angina 15 days after percutaneous coronary intervention with sirolimus-eluting DES. Optical coherence tomography (OCT) was done to know the pathophysiology of the very early stent stenosis and the possibilities of the rare findings of this OCT are discussed.

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