scholarly journals Coronary Stent Strut Fractures: Classification, Prevalence and Clinical Associations

2021 ◽  
Vol 10 (8) ◽  
pp. 1765
Author(s):  
Katharina Schochlow ◽  
Melissa Weissner ◽  
Florian Blachutzik ◽  
Niklas F. Boeder ◽  
Monique Tröbs ◽  
...  
Keyword(s):  
Optical Coherence Tomography ◽  
Multivariable Analysis ◽  
Drug Eluting Stents ◽  
Clinical Implications ◽  
Device Failure ◽  
Stent Strut ◽  
Drug Eluting ◽  
Bifurcation Lesions ◽  
Clinical Associations ◽  
Device Complications

Introduction. The frequency, characteristics and clinical implications of Strut fractures (SFs) remain incompletely understood. Methods and results. A total of 185 (160 patients) newer-generation drug-eluting stents (DES) were imaged. SFs were found in 21 DES (11.4%) and were classified in four patterns: one single stacked strut (41%); two or more stacked struts (23%); deformation without gap (27%); transection (9%). In multivariable analysis, calcific and bifurcation lesions were associated with SF in DES (OR: 3.5 [1.1–11] and 4.0 [2.2–7.2], p < 0.05). Device eccentricity and asymmetry as well as optical coherence tomography (OCT) features of impaired strut healing were also associated with SF. The prevalence of fractures was similar in a set of 289 bioresorbable scaffolds (BRS). In a separate series of 20 device thromboses and 36 device restenoses, the prevalence of SF was higher (61.2% of DES and 66.7% of BRS, p < 0.001 for both), with a higher frequency of complex SF patterns (p < 0.0001). In logistic regression analysis, fractures were a correlate of device complications (p < 0.0001, OR = 24.9 [5.6–111] for DES and OR = 6.0 [1.8–20] for BRS). Discussion. The prevalence of OCT-diagnosed SF was unexpectedly high in the setting of elective controls and it increased by about three-fold in the setting of device failure. Fractures were associated with increased lesion complexity and device asymmetry/eccentricity and were more frequent in the setting of device failure such as restenosis and thrombosis.

Percutaneous Coronary Intervention for Complex Bifurcation Lesions

2010 ◽  
Vol 5 (1) ◽  
pp. 58
Author(s):  
Yves Louvard ◽  
Morice Marie-Claude ◽  
Thomas Hovasse ◽  
Thierry Lefèvre ◽  
◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Coronary Intervention ◽  
Side Branch ◽  
Drug Eluting Stents ◽  
Open Angle ◽  
Balloon Inflation ◽  
Percutaneous Coronary ◽  
Drug Eluting ◽  
Bifurcation Lesions ◽  
Stent Diameter

Coronary bifurcations are prone to the development of atherosclerosis. They pose technical difficulties for angioplasty treatment and are a predictor of stent thrombosis and restenosis. Treatment of coronary bifurcations is still subject to debate, especially when the side branch (SB) is large, not easily accessible and narrowed by a long lesion. There is currently no indexed treatment for this type of lesion (Medina classification), as the strategy of provisional SB stenting with drug-eluting stents (DES) has proved to be equally efficient as the dualstent technique. Complex techniques are associated with poor outcome in certain lesion types, such as T-stenting when the angle between the two distal branches is small or the crush and culotte technique in the presence of an open angle. Provisional SB stenting may be used when primary dual stenting is required, with a low risk of failure provided that the following guidelines are implemented: stenting of the main branch through the protected SB with a stent diameter adapted to the distal main branch, immediate optimisation of the proximal stent segment (Finet’s law), guidewire exchange, kissing balloon inflation with non-compliant balloons selected according to the diameter of the distal branches and T-stenting of the SB before final kissing inflation.

scholarly journals The role of optical coherence tomography guidance in scaffold versus stent optimization

2020 ◽  
Vol 72 (1) ◽  
Author(s):  
Arif A. Al Nooryani ◽  
Nagwa A. Abdelrahman ◽  
Hatem A. Helmy ◽  
Yehia T. Kishk ◽  
Ayman K. M. Hassan
Keyword(s):  
Decision Making ◽  
Optical Coherence Tomography ◽  
Coronary Intervention ◽  
Drug Eluting Stents ◽  
Optical Coherence ◽  
Total Rate ◽  
Great Ability ◽  
Bioresorbable Scaffolds ◽  
Drug Eluting ◽  
The Impact

Abstract Background Optical coherence tomography showed a great ability to identify adverse features during percutaneous coronary intervention with drug-eluting stents and resulted in better clinical outcomes. The study aimed to assess the impact of optical coherence tomography on intraoperative decision-making during implantation of Absorb bioresorbable scaffolds versus everolimus drug-eluting stents. Results We performed an observational study that included 223 consecutive patients post optical coherence tomography-guided implantation of either Absorb bioresorbable scaffolds (162 patients) or everolimus drug-eluting stents (61 patients). We studied the influence of optical coherence tomography on intraoperative decision-making during implantation of bioresorbable scaffolds versus drug-eluting stents by analyzing the total rate of optical coherence tomography-dependent modifications in each device. After satisfactory angiographic results, the total rate of required intervention for optical coherence tomography detected complications was significantly higher in the bioresorbable scaffolds arm compared to drug-eluting stents arm (47.8% versus 32.9%, respectively; p = 0.019). The additional modifications encompassed further optimization in the case of device underexpansion or struts malapposition, and even stenting in the case of strut fractures, or significant edge dissection. Conclusions Compared to drug-eluting stents, Absord scaffold was associated with a significantly higher rate of optical coherence tomography-identified intraprocedural complications necessitating further modifications. The study provides some hints on the reasons of scaffolds failure in current PCI practice; it offers a new insight for the enhancement of BRS safety and presents and adds to the growing literature for successful BRS utilization.

scholarly journals The comparison of the chronic-phase vascular healing between bioabsorbable and durable polymer drug eluting stent by using optical coherence tomography

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
Y Yamakami ◽  
S Kimura ◽  
K Hara ◽  
M Ohmori ◽  
R Tateishi ◽  
...  
Keyword(s):  
Optical Coherence Tomography ◽  
Acute Coronary Syndrome ◽  
Clinical Presentation ◽  
Neointimal Hyperplasia ◽  
Chronic Phase ◽  
Drug Eluting Stents ◽  
Coronary Syndrome ◽  
Durable Polymer ◽  
Drug Eluting

Abstract Background Bioabsorbable polymer drug eluting stents (BP-DESs) were designed to reduce a vascular inflammatory reaction compared to durable polymer drug eluting stents (DP-DESs). However, few studies have compared vascular responses to BP-DESs and DP-DESs. Methods We enrolled 88 consecutive patients with single culprit coronary artery lesions (31 lesions with acute coronary syndrome) undergoing a single stent-implantation. BP-DESs and DP-DESs were implanted in 50 (57%) and 38 patients (43%), respectively. All lesions underwent optical coherence tomography examination at chronic phase and intrastent OCT findings at the follow-up were evaluated in every 1-mm cross-sections (CSs). Results A total of 1887 CSs (BP-DES: 1096, DP-DES: 791) were analyzed. The median period of follow-up OCT was 293 (250–374) days. There were no differences in the patient, lesion, and initial clinical presentation of acute coronary syndrome (ACS). BP-DESs had significantly higher percent neointimal hyperplasia area, defined as neointimal hyperplasia area divided by stent area x 100 (18.4±9.0% vs. 16.1±9.9%, p&lt;0.001), fewer malapposed struts (1.7% vs. 3.9%, p=0.005), fewer uncovered struts (3.6% vs. 5.8%, p=0.02) but higher frequency of superficial low intensity neointima (LIN) (7.7% vs. 3.4%, p&lt;0.001). Multivariate logistic analysis showed that BP-DES (OR: 2.5, 95% CI: 1.49–4.08, p&lt;0.001) and the initial clinical presentation of ACS (OR: 2.31, 95% CI: 1.47–3.62, p&lt;0.001) are independent predictive factors for LIN. Conclusion BP-DESs showed homogenous neointimal growth and complete stent coverage quantitatively. Meanwhile, the significant relationships of BP-DES with LIN may suggest that the neointimal quality remains immature in BP-DESs in this period. Funding Acknowledgement Type of funding source: None

scholarly journals Μεταλλικές ενδοπροθέσεις που απελευθερώνουν φαρμακευτικές ουσίες στο ενδαγγειακό μοντέλο φλεβών κονίκλου

2013 ◽  
Author(s):  
Παναγιώτης Κίτρου
Keyword(s):  
Optical Coherence Tomography ◽  
Frequency Domain ◽  
Drug Eluting Stents ◽  
Optical Coherence ◽  
Drug Eluting

ΣκοπόςΤο παρόν πρωτόκολλο σχεδιάστηκε προκειμένου να εκτιμήσει την ασφάλεια και τηνfeasibility των μεταλλικών ενδοπροθέσεων που απελευθερώνουν φαρμακευτικές ουσίες(Drug-Eluting Stents, DES) έναντι των απλών μεταλλικών ενδοπροθέσεων (Bare-MetalStents, BMS) στο φλεβικό μοντέλο κονίκλου, χρησιμοποιώντας Οπτική ΣυνεκτικήΤομογραφία (Frequency Domain – Optical Coherence Tomography, FD-OCT).ΜέθοδοιΔεκατρείς λευκοί κόνικλοι Νέας Ζηλανδίας υποβλήθηκαν σε τοποθέτηση μεταλλικώνενδοπροθέσεων που απελευθερώνουν Zotarolimus (Group DES) στη μία κοινή λαγόνιο φλέβακαι απλών μεταλλικών ενδοπροθέσεων (Group BMS) στην απέναντι κοινή λαγόνιο. Ταπρωτογενή καταληκτικά σημεία περιελάμβαναν την τεχνική επιτυχία της τοποθέτησης τωνμεταλλικών ενδοπροθέσεων καθώς και την σύγκριση της νεοενδοθηλιακής υπερπλασίαςανάμεσα στα δύο υπό μελέτη σύνολα με την βοήθεια την οπτικής συνεκτικής τομογραφίας.ΑποτελέσματαΗ τεχνική επιτυχία της τοποθέτησης 13 μεταλλικών ενδοπροθέσεων που απελευθερώνουνφαρμακευτικές ουσίες και 13 απλών μεταλλικών ενδοπροθέσεων ήταν 100% (26/26μεταλλικές ενδοπροθέσεις). Τρεις κόνικλοι πέθαναν (3/13, 23%) μέσα στις πρώτες 45 μέρες.Τα υπόλοιπα 10/13 ζώα (77%) θανατώθηκαν την 90η μέρα από την ημέρα τοποθέτησης τωνμεταλλικών ενδοπροθέσεων. Οι 20 μεταλλικές ενδοπροθέσεις (stents) αφαιρέθηκαν μεεπιτυχία. Επιτυχής FD-OCT πραγματοποιήθηκε σε όλα τα τμήματα των κοινών λαγόνιωνφλεβών που αφαιρέθηκαν, 10 στο Group DES και 10 στο Group BMS. Δεν υπήρξε στατιστικάσημαντική διαφορά στην μέση νεοενδοθηλιακή υπερπλασία ανάμεσα στα δύο σύνολα(3.02±1.19mm2 στο Group DES, έναντι 2.76±1.17mm2 στο Group BMS).ΣυμπέρασμαΣε αυτό το πειραματικό πρωτόκολλο, η τοποθέτηση DES στο φλεβικό αγγειακό σύστημα ήταν δυνατή. Η νεοενδοθηλιακή υπερπλασία ήταν παρόμοια και στα δύο σύνολα μετά από περίοδοελέγχου τριών μηνών.

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