scholarly journals Structural Design of Vascular Stents: A Review

Micromachines ◽  
2021 ◽  
Vol 12 (7) ◽  
pp. 770
Author(s):  
Chen Pan ◽  
Yafeng Han ◽  
Jiping Lu
Keyword(s):  
Cardiovascular Diseases ◽  
Hot Spot ◽  
Coronary Intervention ◽  
Patient Specific ◽  
Vascular Stent ◽  
Vascular Stents ◽  
Stent Restenosis ◽  
Percutaneous Coronary ◽  
Representative Unit Cell ◽  
Volume Unit

Percutaneous Coronary Intervention (PCI) is currently the most conventional and effective method for clinically treating cardiovascular diseases such as atherosclerosis. Stent implantation, as one of the ways of PCI in the treatment of coronary artery diseases, has become a hot spot in scientific research with more and more patients suffering from cardiovascular diseases. However, vascular stent implanted into vessels of patients often causes complications such as In-Stent Restenosis (ISR). The vascular stent is one of the sophisticated medical devices, a reasonable structure of stent can effectively reduce the complications. In this paper, we introduce the evolution, performance evaluation standards, delivery and deployment, and manufacturing methods of vascular stents. Based on a large number of literature pieces, this paper focuses on designing structures of vascular stents in terms of “bridge (or link)” type, representative volume unit (RVE)/representative unit cell (RUC), and patient-specific stent. Finally, this paper gives an outlook on the future development of designing vascular stents.

Provisional and Complex Techniques for Bifurcation Treatment – Trading Apposition for Scaffolding?

2012 ◽  
Vol 7 (1) ◽  
pp. 44
Author(s):  
Nicolas Foin ◽  
Eduardo Alegria-Barrero ◽  
Ryo Torii ◽  
Pak H Chan ◽  
Ajay K Jain ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
New Technology ◽  
Coronary Intervention ◽  
Target Lesion ◽  
Side Branch ◽  
Simultaneous Increase ◽  
Stent Restenosis ◽  
Percutaneous Coronary ◽  
Stent Coverage ◽  
Bifurcation Lesions

Provisional T-stenting with stenting of the main branch and optional side branch (SB) stenting in the case of significant SB occlusion with thrombolysis in myocardial infarction (TIMI) flow <3 is the strategy chosen nowadays by most interventionalists for treating simple bifurcation lesions. Percutaneous coronary intervention (PCI) of complex true bifurcation lesions remains, however, the subject of debate: treatment of complex bifurcation lesions requires more time than treatment of simple bifurcations and can lead to significantly higher rates of restenosis, target lesion revascularisation and myocardial infarction. Current bifurcation techniques often fail to ensure continuous stent coverage of the SB ostium and of the two bifurcation branches without a simultaneous increase in the rate of malapposed struts. Stent struts left unapposed in the lumen disturb blood flow and are increasingly recognised as increasing the risk of stent thrombosis and focal in-stent restenosis, limiting the success of stent procedures in these lesions. New technology and dedicated designs may, in the near future, overcome such limitations of conventional two-stent bifurcation strategies.

In vivo and in vitro analyses of the effects of a novel high-nitrogen low-nickel coronary stent on reducing in-stent restenosis

2018 ◽  
Vol 33 (1) ◽  
pp. 64-71 ◽  
Author(s):  
Jinpeng Wang ◽  
Chunli Song ◽  
Yanlong Xiao ◽  
Bin Liu
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Coronary Arteries ◽  
Coronary Intervention ◽  
Coronary Stent ◽  
High Nitrogen ◽  
Stent Restenosis ◽  
Percutaneous Coronary ◽  
In Stent Restenosis

Currently, percutaneous coronary intervention is an important treatment for coronary heart disease. However, the in-stent restenosis rate is still approximately 10–30% after stenting. Nickel ions from the stent are considered to be associated with in-stent restenosis. Therefore, in the present study, we quantitatively evaluated in-stent restenosis after implanting the novel high-nitrogen low-nickel coronary stent (HNS) and studied the mechanism underlying the reduction in in-stent restenosis by using ELISA and Western blot. The in vivo results showed that the HNS could significantly reduce neointima formation and inflammation as compared to SUS316L stents (316L) at 180 days after implantation in porcine coronary arteries and that vascular endothelial growth factor-A expression in porcine coronary arteries after HNS implantation also decreased. The in vitro results showed that, in the case of the HNS, human umbilical vein endothelial cell (HUVEC) proliferation was lower and lesser IL-6 release was noted from HUVECs at one and three days after culture than in the 316L group. Furthermore, p-STAT3 expression in HUVECs on the HNS surface was downregulated after culture for seven days. Thus, we conclude that the HNS could be a promising alternative coronary stent for percutaneous coronary intervention.

Abstract 15440: Bleeding Complications May Outweigh the Risk of Thrombosis in Patients With End-stage Liver Disease Taking Dual Antiplatelet Therapy After Percutaneous Coronary Intervention

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Sami J Natour ◽  
May Myint Thanda Kyaw ◽  
Ronald W Busuttil ◽  
Jonathan M Tobis ◽  
Henry M Honda
Keyword(s):  
Antiplatelet Therapy ◽  
Dual Antiplatelet Therapy ◽  
Coronary Intervention ◽  
Bleeding Complications ◽  
Bleeding Events ◽  
Stent Restenosis ◽  
Percutaneous Coronary ◽  
Ischemic Complications ◽  
End Stage

Introduction: Randomized trials have demonstrated the safety and efficacy of one month of dual antiplatelet therapy (DAPT) after placement of drug-eluting stents in patients with high bleeding risk. Patients with end-stage liver disease (ESLD) are underrepresented in these trials. Patients who undergo percutaneous coronary intervention (PCI) in preparation for orthotopic liver transplantation (OLT) exhibit a high incidence of bleeding complications on DAPT. The rates of bleeding versus thrombotic complications in ESLD patients placed on DAPT following PCI are poorly described. Methods: We retrospectively collected data from 61 patients who were evaluated for OLT between 2016 and 2019 and underwent PCI prior to listing. Bleeding events were classified using the Bleeding Academic Research Consortium (BARC) definitions and included if the following criteria were met: events occurred in the setting of DAPT, were non-procedural in etiology, and occurred during the time following PCI and prior to OLT. Ischemic complications were evaluated by the incidence of myocardial infarction (MI), stent thrombosis, in-stent restenosis (>50%) and all-cause mortality at 1 year follow-up. Results: A total of 55/61 patients (90%) were placed on DAPT following PCI. Among them, 21/55 patients (38%) bled while taking DAPT, including 15 patients (27%) with BARC types 3-5 first-time bleeding events and 10 patients (18%) requiring early discontinuation of therapy. The median time to first bleeding event was 8 days (range 1 to 477 days, 85 th percentile 17 days). Among ischemic complications, MI occurred in 11/55 patients (20%) however only one patient had a type 1 MI with the remaining being type 2 in etiology. There were no episodes of stent thrombosis and 2 episodes of in-stent restenosis during the 1 year follow-up. A total of 12/55 patients (22%) went on to receive OLT and 18/55 (33%) passed away by 1 year post-PCI. Conclusions: Patients with ESLD exhibit a high rate of clinically significant bleeding on DAPT when compared to overall thrombotic events. The majority of bleeds occurred within the first month after PCI. These findings illustrate the need for larger studies to assess the safety of single instead of dual antiplatelet therapy in patients with ESLD who receive PCI.

scholarly journals Intracoronary lithotripsy for calcific neoatherosclerotic in-stent restenosis: a case report

2020 ◽  
Vol 4 (4) ◽  
pp. 1-4
Author(s):  
Helena Tizón-Marcos ◽  
Iris Rodríguez-Costoya ◽  
Cristina Tevar ◽  
Beatriz Vaquerizo
Keyword(s):  
Coronary Intervention ◽  
Percutaneous Treatment ◽  
Diabetic Woman ◽  
Intracoronary Imaging ◽  
Stent Restenosis ◽  
Promising Tool ◽  
Percutaneous Coronary ◽  
Calcific Plaque ◽  
St Elevation ◽  
In Stent Restenosis

Abstract Background In-stent restenosis is a difficult percutaneous scenario if calcific neoatherosclerosis is the underlying aetiology. Case summary A 69-year-old diabetic woman with a previous percutaneous coronary intervention on the left anterior descending coronary artery was readmitted for non-ST-elevation myocardial infarction. In-stent restenosis due to calcific neoatherosclerosis was observed by intracoronary imaging during the intervention. Intravascular lithotripsy was used successfully to fracture the underlying calcific plaque. However, the balloon ruptured during treatment although this did not damage the artery. Discussion Intravascular lithotripsy is a promising tool for the treatment of extremely calcified lesions including calcific neoatherosclerosis of in-stent restenosis. Balloon rupture is a complication of this new percutaneous treatment that has not previously been described.

Antithrombotic Therapy in Patients With Atrial Fibrillation Undergoing Percutaneous Coronary Intervention: Where Are We Now?

2018 ◽  
Vol 52 (9) ◽  
pp. 884-897 ◽  
Author(s):  
Ryan G. D’Angelo ◽  
Thaddeus McGiness ◽  
Laura H. Waite
Keyword(s):  
Atrial Fibrillation ◽  
Percutaneous Coronary Intervention ◽  
Triple Therapy ◽  
Bleeding Risk ◽  
Coronary Intervention ◽  
Low Risk ◽  
Current Evidence ◽  
Patient Specific ◽  
Coronary Syndrome ◽  
Percutaneous Coronary

Objective: To synthesize the literature and provide guidance to practitioners regarding double therapy (DT) and triple therapy (TT) in patients with atrial fibrillation (AF) requiring percutaneous coronary intervention (PCI). Data Sources: PubMed and MEDLINE (January 2000 to February 2018) were searched using the following terms: atrial fibrillation, myocardial infarction, acute coronary syndrome, percutaneous coronary intervention, anticoagulation, dual-antiplatelet therapy, clopidogrel, aspirin, ticagrelor, prasugrel, and triple therapy. Study Selection and Data Extraction: The results included randomized and nonrandomized clinical trials and meta-analyses. Each study was reported based on study design, population, intervention, comparator, and key cardiovascular (CV) and bleeding outcomes. Data Synthesis: A total of 15 studies were included in the review. The majority of studies evaluating DT and TT utilized clopidogrel and warfarin as components of the regimen, although there are emerging data with newer agents. Evidence purporting DT regimens to be equally effective in preventing CV events and improved safety profiles compared with TT regimens included populations with relatively low risk for recurrent CV events, and many of these studies were observational in nature. Overall, current evidence as well as American and European guidelines support the use of TT in patients with AF who require PCI for the least possible amount of time, depending on patient-specific factors involving bleeding and thrombosis. Conclusions: In the majority of patients with AF who require PCI, TT should be used for the shortest period of time possible. DT regimens may be used in patients requiring PCI who have low risk for thrombosis and/or high bleeding risk.

scholarly journals Percutaneous Coronary Intervention for High Takeoff Left Main Coronary Artery: A Case Report

2018 ◽  
Vol 03 (04) ◽  
pp. 237-239
Author(s):  
Seetharam Vankudoth ◽  
Madhurima Banoth
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Case Reports ◽  
Coronary Intervention ◽  
Anterior Wall ◽  
Left Main ◽  
Stent Restenosis ◽  
Percutaneous Coronary ◽  
The Right ◽  
Diagnostic Catheter ◽  
Guiding Catheter

AbstractPercutaneous coronary intervention (PCI) for high takeoff left main is challenging, as it poses difficulties with the engagement of the guiding catheter and establishment of backup support. This report examines the case of a 53-year-old woman with history of anterior wall myocardial infarction with a ventricular septal defect (VSD), who was treated with left anterior descending (LAD) angioplasty and VSD device closure done 4 years back, and now she presented with unstable angina. After successful engagement of 5F Tiger diagnostic catheter through a right radial artery, the angiography revealed an 80% stenosis of the proximal LAD and in-stent restenosis 70% of mid-LAD. The authors tried to engage the left coronary system through the right femoral artery with 6F Judkins left, 6F Amplatzer left, 6F EBU, and 6F XBU. They could not cannulate because of high takeoff left main, so they switched to right radial access. Then they engaged a 6F 3.5 EBU catheter. Due to the weak backup support of the guiding catheter, they used another wire to stabilize it and the stent was implanted successfully. This is one of the rare case reports of PCI for high takeoff left main.

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