A Different Way of Coronary Lesion Preparation: Stentablation and Rotastenting

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.

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

Circulation ◽

10.1161/circ.118.suppl_18.s_745-c ◽

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.

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The Predictors of Target Lesion Revascularization and Rate of In-Stent Restenosis in the Second-Generation Drug-Eluting Stent Era

Journal of Interventional Cardiology ◽

10.1155/2019/3270132 ◽

2019 ◽

Vol 2019 ◽

pp. 1-13

Author(s):

Chengbin Zheng ◽

Jeehoon Kang ◽

Kyung Woo Park ◽

Jung-Kyu Han ◽

Han-Mo Yang ◽

...

Keyword(s):

Target Lesion ◽

University Hospital ◽

Target Lesion Revascularization ◽

Drug Eluting Stent ◽

2Nd Generation ◽

Stent Restenosis ◽

Significant Difference ◽

Drug Eluting ◽

In Stent Restenosis

Objectives. The aim of our study was to investigate the predictors of target lesion revascularization (TLR) and to compare the in-stent restenosis (ISR) progression rates of different 2nd-generation drug-eluting stents (DES). Background. The predictors of early and late TLR after 2nd-generation DES implantation have not been fully evaluated. Methods. We analyzed 944 stented lesions from 394 patients who had at least two serial follow-up angiograms, using quantitative coronary angiography (QCA) analysis. The study endpoints were TLR and the velocity of diameter stenosis (DS) progression. Results. TLR occurred in 58 lesions (6.1%) during the first angiographic follow-up period and 23 de novo lesions (2.4%) during the following second interval. Independent predictors for early TLR were diabetes mellitus (DM) (HR 2.58, 95% CI 1.29–5.15, p=0.007), previous percutaneous coronary intervention (PCI) (HR 2.41, 95% CI 1.03–5.65, p=0.043), and postprocedure DS% (HR 1.08, 95% CI 1.05–1.11, p<0.001, per 1%), while predictors of late TLR were previous PCI (HR 9.43, 95% CI 2.58-34.52, p=0.001) and serum C-reactive protein (CRP) (HR 1.60, 95% CI 1.28-2.00, p<0.001). The ISR progression velocity (by DS%) was 12.1 ±21.0%/year and 3.7 ±10.1%/year during the first and second follow-up periods, respectively, which had no significant difference (p>0.05) between the four types of DESs. Conclusions. Our data showed that predictors for TLR may be different at different time intervals. DM, pervious PCI, and postprocedure DS could predict early TLR, while previous PCI and CRP level could predict late TLR. Contemporary DESs had similar rates of ISR progression rates. Trial Registration. This study was retrospectively registered and approved by the institutional review board of Seoul National University Hospital (no. 1801–138-918).

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Long-Term Follow-Up After Treatment of Drug-Eluting Stent Restenosis and De Novo Lesions Using SeQuent Please Paclitaxel-Coated Balloons

Angiology ◽

10.1177/0003319718809423 ◽

2018 ◽

Vol 70 (5) ◽

pp. 414-422

Author(s):

Dai Zhang ◽

Yan Sun ◽

Xiaoli Liu ◽

Fang Liu ◽

Yujing Cheng ◽

...

Keyword(s):

De Novo ◽

Coronary Vessels ◽

Target Lesion ◽

Drug Eluting Stent ◽

Cardiac Events ◽

Stent Restenosis ◽

Significant Difference ◽

Drug Eluting

Managing patients with in-stent restenosis (ISR) remains an important clinical challenge. In particular, large, randomized trials assessing the effect of drug-eluting balloons (DEB) in patients with de novo lesions are warranted. We investigated the effect of DEB on procedural complications, target lesion revascularization (TLR), and major adverse cardiac and cerebrovascular events in patients with drug-eluting stent ISR and de novo lesions. The clinical profiles of 238 consecutive patients treated for coronary ISR (n = 174) and de novo lesions (n = 64) using SeQuent Please paclitaxel-coated balloon were analyzed. Study end points were major adverse cardiac events (MACEs). At 1-year follow-up, TLR and MACEs occurred with acceptably low rates (5.0% and 6.3%, respectively). At 2.00 (0.74) years of follow-up, there was a significant difference in the rates of TLR between the ISR and the de novo lesions groups (14.4% [ISR] vs 3.1% [de novo], P = .028), and the occurrence of MACEs distinctly increased in the ISR group compared to the de novo lesions group (21.8% vs 6.2%, P = .009). The long-term outcomes of the ISR group were inferior to those of the de novo group (TLR, log-rank P = .019; MACEs, log-rank P = .010). Drug-eluting balloon for ISR and de novo lesions of small coronary vessels is effective and safe.

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Paclitaxel-coated balloon angioplasty vs. drug-eluting stenting for the treatment of coronary in-stent restenosis: a comprehensive, collaborative, individual patient data meta-analysis of 10 randomized clinical trials (DAEDALUS study)

European Heart Journal ◽

10.1093/eurheartj/ehz594 ◽

2019 ◽

Vol 41 (38) ◽

pp. 3715-3728 ◽

Cited By ~ 25

Author(s):

Daniele Giacoppo ◽

Fernando Alfonso ◽

Bo Xu ◽

Bimmer E P M Claessen ◽

Tom Adriaenssens ◽

...

Keyword(s):

Myocardial Infarction ◽

Randomized Clinical Trials ◽

Meta Analysis ◽

Target Lesion ◽

Drug Eluting Stent ◽

Stent Restenosis ◽

All Cause Mortality ◽

Drug Eluting ◽

In Stent Restenosis

Abstract Aims Consensus is lacking regarding the best treatment for coronary in-stent restenosis (ISR). The two most effective treatments are angioplasty with paclitaxel-coated balloon (PCB) and repeat stenting with drug-eluting stent (DES) but individual trials were not statistically powered for clinical endpoints, results were heterogeneous, and evidence about comparative efficacy and safety in relevant subsets was limited. Methods and results The Difference in Anti-restenotic Effectiveness of Drug-eluting stent and drug-coated balloon AngiopLasty for the occUrrence of coronary in-Stent restenosis (DAEDALUS) study was a comprehensive, investigator-initiated, collaborative, individual patient data meta-analysis comparing angioplasty with PCB alone vs. repeat stenting with DES alone for the treatment of coronary ISR. The protocol was registered with PROSPERO (CRD42017075007). All 10 available randomized clinical trials were included with 1976 patients enrolled, 1033 assigned to PCB and 943 to DES. At 3-year follow-up, PCB was associated with a significant increase in the risk of target lesion revascularization (TLR) compared with DES [hazard ratio (HR) 1.32, 95% CI 1.02–1.70, P = 0.035; number-needed-to-harm 28.5]. There was a significant interaction between treatment effect and type of restenosed stent (P = 0.029) with a more marked difference in patients with DES-ISR and comparable effects in patients with bare-metal stent-ISR. At 3-year follow-up, the primary safety endpoint of all-cause death, myocardial infarction, or target lesion thrombosis was comparable between treatments (HR 0.80, 95% CI 0.58–1.09, P = 0.152). A pre-specified subgroup analysis indicated a significant interaction between treatment effect and type of DES used to treat ISR (P = 0.033), with a lower incidence of events associated with PCB compared with first-generation DES and similar effect between PCB and second-generation DES (HR 1.06, 95% CI 0.71–1.60, P = 0.764). Long-term all-cause mortality was similar between PCB and DES (HR 0.81, 95% CI 0.53–1.22, P = 0.310); results were consistent comparing PCB and non-paclitaxel-based DES (HR 1.42, 95% CI 0.80–2.54, P = 0.235). Myocardial infarction and target lesion thrombosis were comparable between treatments. Conclusions In patients with coronary ISR, repeat stenting with DES is moderately more effective than angioplasty with PCB at reducing the need for TLR at 3 years. The incidence of a composite of all-cause death, myocardial infarction, or target lesion thrombosis was similar between groups. The rates of individual endpoints, including all-cause mortality, were not significantly different between groups.

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

Journal of Biomaterials Applications ◽

10.1177/0885328216675829 ◽

2016 ◽

Vol 31 (6) ◽

pp. 911-922 ◽

Cited By ~ 7

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.

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