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Torsello GF, Stavroulakis K, Chlouverakis G, Torsello GB. Cobalt Chromium or Stainless Steel Balloon-Expandable Bare Metal Stents for Iliac Occlusive Disease? J Endovasc Ther 2024:15266028241306068. [PMID: 39711490 DOI: 10.1177/15266028241306068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2024]
Abstract
BACKGROUND To compare the performance of a new-generation cobalt-chromium balloon-expandable bare metal stent with a stainless steel platform for the treatment of iliac occlusive disease. METHODS Consecutive patients treated for symptomatic iliac occlusive disease between 2014 and 2021 with the cobalt-chromium Dynetic-35 or the stainless steel Dynamic platform were retrospectively evaluated. Outcome measures included technical success, device- or procedure-related death, clinically-driven target lesion revascularization (CD-TLR), primary patency, and major index limb amputation up to 12 months. RESULTS In total, 222 Cobalt chromium (CC) stents were used in 159 patients (34.6% female; mean age 66.9 ± 9.5 years) for the treatment of 216 lesions, while 234 iliac lesions of 182 patients (34.6% female; mean age 66.3 ± 9.9 years) were treated with 252 stainless steel (SS) stents. The mean lesion length (30.2 ± 12.8 mm vs 28.7 ± 22.5 mm, p=0.36) and the mean calcification grade (2.0 vs 1.9, p=0.07) did not differ significantly between the 2 groups. Patients treated by the CC platform were more frequently on statins (p<0.001), whereas more active smokers and subjects with higher Rutherford class underwent a SS deployment (p<0.001). Technical success was significantly higher in the SS group (100% vs 97.3%; p=0.01). This was due to longitudinal deformation or stent dislocation after passing the Dynetic-35 with endovascular material. After 1 year, no difference was found following CC and SS stent deployment in terms of device- or procedure-related deaths (0.6% vs 1.1%, p=0.99), target limb amputations (1.9% vs 1.6%, p=0.99), primary patency (91.3% vs 93.5%), and CD-TLR (6.5% vs 2.8% p=0.07). CONCLUSIONS Through 1 year, cobalt-chromium and stainless steel balloon-expandable stents are safe and effective in the treatment of iliac occlusive disease. Enhanced attention should be given passing the cobalt-chromium stent with endovascular devices to avoid procedural complications. CLINICAL IMPACT Stents with a thin-strut structure improve the flexibility and deliverability. The lower profile also increases the applicability lowering the risk of vascular access complications. In this study newer-generation cobalt chromium balloon-expandable stent did not confer advantages over stainless steel bare metal stent. On contrary, the technical success was inferior to stainless steel stents as longitudinal deformation or dislocation of the Dynetic-35 occurred. Therefore, enhanced attention should be given passing a Cobalt chromium stent with wires, catheters or sheaths to avoid stent deformation.
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Affiliation(s)
| | - Konstantinos Stavroulakis
- Department of Vascular and Endovascular Surgery, Ludwig-Maximilians-University Hospital, Munich, Germany
| | - Gregory Chlouverakis
- Biostatistics Laboratory, Department of Social Medicine, School of Medicine, University of Crete, Rethymno, Greece
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McGarvey M, Lam LT, Razak MA, Barraclough J, O'Gallagher K, Webb I, Melikian N, Kalra S, MacCarthy P, Shah AM, Hill JM, Johnson TW, Byrne J, Dworakowski R, Pareek N. Impact of lesion morphology on stent elongation during bifurcation PCI: an in vivo OCT study. EUROINTERVENTION 2024; 20:e1184-e1194. [PMID: 39279513 PMCID: PMC11384226 DOI: 10.4244/eij-d-23-00663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/18/2024]
Abstract
BACKGROUND Recent observations in silico and in vivo reported that, during proximal optimisation technique, drug-eluting stents (DES) elongate, challenging conventional wisdom. The interaction between plaque morphology and radial expansion is well established, but little is known about the impact of plaque morphology on elongation. AIMS We aimed to assess the longitudinal mechanical behaviour of contemporary DES in vivo and evaluate the relationship between post-percutaneous coronary intervention (PCI) stent elongation and lesion morphology, as assessed with optical coherence tomography (OCT). METHODS Patients treated with OCT-guided PCI to left main or left anterior descending artery bifurcations, between July 2017 and March 2022, from the King's Optical coherence Database Analysis Compendium were included. Patients were excluded if there were overlapping stents, if they had undergone prior PCI, or if there was inadequate image quality. Lesions were characterised as fibrocalcific, fibrous or lipid-rich by pre-PCI OCT. Following stent post-dilatation, stent expansion and final stent length were assessed. The primary outcome was the percentage change in stent length from baseline. RESULTS Of 501 eligible consecutive patients from this period, 116 were included. The median age was 66 years (interquartile range [IQR] 57-76), 31% were female, and 53.4% were treated for an acute coronary syndrome. A total of 50.0% of lesions were classified as fibrocalcific, 6.9% were fibrous, and 43.1% were lipid-rich. The change in relative stent length was 4.4% (IQR 1.0-8.9), with an increase of 3.1% (IQR 0.5-6.3) in fibrocalcific lesions, 3.3% (IQR 0.5-5.9) in fibrous lesions, and 6.4% (IQR 3.1-11.1) in lipid-rich plaque (p=0.006). In multivariate regression modelling, lipid-rich plaque was an independent predictor of stent elongation (odds ratio 3.689, 95% confidence interval: 1.604-8.484). CONCLUSIONS Contemporary DES elongate following implantation and post-dilatation, and this is significantly mediated by plaque morphology. This is an important consideration when planning a strategy for DES implantation.
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Affiliation(s)
- Michael McGarvey
- Department of Cardiology, King's College Hospital NHS Foundation Trust, London, United Kingdom
- School of Cardiovascular and Metabolic Medicine & Sciences, BHF Centre of Excellence, King's College London, London, United Kingdom
| | - Lap-Tin Lam
- Department of Cardiology, King's College Hospital NHS Foundation Trust, London, United Kingdom
| | - Muhamad Abd Razak
- Department of Cardiology, King's College Hospital NHS Foundation Trust, London, United Kingdom
- School of Cardiovascular and Metabolic Medicine & Sciences, BHF Centre of Excellence, King's College London, London, United Kingdom
| | - Jennifer Barraclough
- Bristol Heart Institute, University Hospitals Bristol NHSFT & University of Bristol, Bristol, United Kingdom
| | - Kevin O'Gallagher
- Department of Cardiology, King's College Hospital NHS Foundation Trust, London, United Kingdom
- School of Cardiovascular and Metabolic Medicine & Sciences, BHF Centre of Excellence, King's College London, London, United Kingdom
| | - Ian Webb
- Department of Cardiology, King's College Hospital NHS Foundation Trust, London, United Kingdom
| | - Narbeh Melikian
- Department of Cardiology, King's College Hospital NHS Foundation Trust, London, United Kingdom
- School of Cardiovascular and Metabolic Medicine & Sciences, BHF Centre of Excellence, King's College London, London, United Kingdom
| | - Sundeep Kalra
- Royal Free NHS Foundation Trust, London, United Kingdom
| | - Philip MacCarthy
- Department of Cardiology, King's College Hospital NHS Foundation Trust, London, United Kingdom
- School of Cardiovascular and Metabolic Medicine & Sciences, BHF Centre of Excellence, King's College London, London, United Kingdom
| | - Ajay M Shah
- Department of Cardiology, King's College Hospital NHS Foundation Trust, London, United Kingdom
- School of Cardiovascular and Metabolic Medicine & Sciences, BHF Centre of Excellence, King's College London, London, United Kingdom
| | - Jonathan M Hill
- Department of Cardiology, Royal Brompton & Harefield Hospitals, Guy's & St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Thomas W Johnson
- Bristol Heart Institute, University Hospitals Bristol NHSFT & University of Bristol, Bristol, United Kingdom
| | - Jonathan Byrne
- Department of Cardiology, King's College Hospital NHS Foundation Trust, London, United Kingdom
- School of Cardiovascular and Metabolic Medicine & Sciences, BHF Centre of Excellence, King's College London, London, United Kingdom
| | - Rafal Dworakowski
- Department of Cardiology, King's College Hospital NHS Foundation Trust, London, United Kingdom
- School of Cardiovascular and Metabolic Medicine & Sciences, BHF Centre of Excellence, King's College London, London, United Kingdom
| | - Nilesh Pareek
- Department of Cardiology, King's College Hospital NHS Foundation Trust, London, United Kingdom
- School of Cardiovascular and Metabolic Medicine & Sciences, BHF Centre of Excellence, King's College London, London, United Kingdom
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Baz RO, Gherghescu G, Mustafa A, Enyedi M, Scheau C, Baz RA. The Role of CT Imaging in a Fractured Coronary Stent with Pseudoaneurysm Formation. Diagnostics (Basel) 2024; 14:840. [PMID: 38667485 PMCID: PMC11049618 DOI: 10.3390/diagnostics14080840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Revised: 04/11/2024] [Accepted: 04/16/2024] [Indexed: 04/28/2024] Open
Abstract
We report a case of a 63-year-old male patient with multiple cardiovascular risk factors and previous myocardial infarction who was referred to the emergency department on September 2023 with symptoms and clinical and biological data consistent with an acute coronary event. A coronary angiography revealed severe ostial stenosis of the left anterior descending artery (LAD) and intrastent thrombotic occlusion in the first two segments of the LAD. Two drug-eluting stents were implanted and the patient was discharged when hemodynamically stable; however, three weeks later, he returned to the emergency department complaining of fever, anterior chest pain, dyspnea at rest, and high blood pressure values at home. High levels of troponin T, C-reactive protein, and NT-proBNP were detected and blood cultures showed methicillin-resistant Staphylococcus aureus. The computed tomography (CT) examination showed a saccular dilatation had developed between two fragments of a stent mounted at the level of the LAD, surrounded by a hematic pericardial accumulation. LAD pseudoaneurysm ablation and a double aortocoronary bypass with inverted saphenous vein autograft were performed and the patient showed a favorable postoperative evolution. In this case, surgical revascularization was proven to be the appropriate treatment strategy, demonstrating the need to choose an individualized therapeutic option depending on case-specific factors.
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Affiliation(s)
- Radu Octavian Baz
- Clinical Laboratory of Radiology and Medical Imaging, “Sf. Apostol Andrei” County Emergency Hospital, 900591 Constanta, Romania; (R.O.B.); (G.G.)
- Department of Radiology and Medical Imaging, Faculty of Medicine, “Ovidius” University, 900527 Constanta, Romania
| | - George Gherghescu
- Clinical Laboratory of Radiology and Medical Imaging, “Sf. Apostol Andrei” County Emergency Hospital, 900591 Constanta, Romania; (R.O.B.); (G.G.)
| | - Adnan Mustafa
- Department of Cardiology, “Sf. Apostol Andrei” County Emergency Hospital, 900591 Constanta, Romania;
| | - Mihaly Enyedi
- Department of Anatomy, The “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania;
- Department of Radiology, “Victor Babes” Center for Diagnosis and Treatment, 030303 Bucharest, Romania
| | - Cristian Scheau
- Department of Physiology, The “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania
- Department of Radiology and Medical Imaging, “Foisor” Clinical Hospital of Orthopaedics, Traumatology and Osteoarticular TB, 030167 Bucharest, Romania
| | - Radu Andrei Baz
- Clinical Laboratory of Radiology and Medical Imaging, “Sf. Apostol Andrei” County Emergency Hospital, 900591 Constanta, Romania; (R.O.B.); (G.G.)
- Department of Radiology and Medical Imaging, Faculty of Medicine, “Ovidius” University, 900527 Constanta, Romania
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Nakao F. Novel planned two-stent technique for bifurcation lesions: Inverted compression T-stenting. Cardiol J 2023; 30:1049-1052. [PMID: 37987560 PMCID: PMC10713204 DOI: 10.5603/cj.97345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Revised: 10/16/2023] [Accepted: 11/08/2023] [Indexed: 11/22/2023] Open
Affiliation(s)
- Fumiaki Nakao
- Department of Cardiology, Yamaguchi Grand Medical Center, Hofu, Japan.
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Investigation of the small-balloon technique as a method for retrieving dislodged stents. Cardiovasc Interv Ther 2023:10.1007/s12928-023-00917-y. [PMID: 36800064 DOI: 10.1007/s12928-023-00917-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 02/06/2023] [Indexed: 02/18/2023]
Abstract
The small-balloon technique used to retrieve a dislodged coronary stent is less studied. We investigated the small-balloon technique to study the capture force and retrieval rate of dislodged proximal or distal stents. We developed a retrieval model for stent dislodgement and performed bench tests to compare proximal and distal capture. We evaluated capture force by capture site in a fixed stent dislodgement model and capture force and retrieval rate by capture site using a retrieval model of stent dislodgement. Three-dimensional (3D)-micro-computed tomography (CT) was used to scan the captured conditions of the distal (DC) and proximal (PC) groups. Stent, balloon shaft, and guiding catheter (GC) diameters were measured. Retrieval areas within GC were calculated and compared. The force was significantly lower in the PC group than in the DC group (p < 0.01). Successful retrieval was achieved in 100% and 84.8% in the PC and DC groups, respectively. The force required to retrieve the dislodged stent was significantly lower in the PC group than that in the DC group (p < 0.01). The force was significantly lower in the successful cases in the DC group than in the unsuccessful cases (p < 0.01). The retrievable areas in the PC and DC groups were 67.5% and 32.7%, respectively, as calculated from the values measured from the 3D-CT images. The success rate of PC was higher than that of DC using the small-balloon technique. The smaller proximal stent gap in the PC method facilitated the retrieval of the dislodgement stent.
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Jo WI, Youn JH, Kang SY, Byeon DH, Lee HI, Yang HM, Park JK. Performance evaluation of biodegradable polymer sirolimus and ascorbic acid eluting stent systems. JOURNAL OF MATERIALS SCIENCE. MATERIALS IN MEDICINE 2022; 33:77. [PMID: 36308635 PMCID: PMC9617831 DOI: 10.1007/s10856-022-06699-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 09/27/2022] [Indexed: 06/16/2023]
Abstract
The purpose of this study was to evaluate the performance of biodegradable polymer sirolimus and ascorbic acid eluting stent systems with four commercially available drug-eluting stents (DES). We investigated the characterization of mechanical properties by dimension, foreshortening, recoil, radial force, crossing profile, folding shape, trackability, and dislodgement force. Additionally, we identify the safety and efficacy evaluation through registry experiments. Each foreshortening and recoil of D + Storm® DES is 1.3 and 3.70%, which has better performance than other products. A post-marketing clinical study to evaluate the performance and safety of D + Storm® DES is ongoing in real-world clinical settings. Two hundred one patients were enrolled in this study and have now completed follow-up for up to 1 month. No major adverse cardiovascular event (MACE) occurred in any subjects, confirming the safety of D + Storm® DES in the clinical setting. An additional approximately 100 subjects will be enrolled in the study and the final safety profile will be assessed in 300 patients. In conclusion, this study reported the objective evaluation of DES performance and compared the mechanical responses of four types of DES available in the market. There is little difference between the four cardiovascular stents in terms of mechanical features, and it can help choose the most suitable stent in a specific clinical situation if those features are understood. Graphical abstract.
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Affiliation(s)
| | | | | | | | | | - Hyoung-Mo Yang
- Department of Cardiology, Ajou University School of Medicine, Suwon, Korea.
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Nicolas J, Pivato CA, Chiarito M, Beerkens F, Cao D, Mehran R. Evolution of drug-eluting coronary stents: a back-and-forth journey from the bench-to-bedside. Cardiovasc Res 2022; 119:631-646. [PMID: 35788828 DOI: 10.1093/cvr/cvac105] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Revised: 05/06/2022] [Accepted: 05/11/2022] [Indexed: 11/13/2022] Open
Abstract
Coronary stents have revolutionized the treatment of coronary artery disease. Compared with balloon angioplasty, bare-metal stents effectively prevented abrupt vessel closure but were limited by in-stent restenosis due to smooth muscle cell proliferation and neointimal hyperplasia. The first-generation drug-eluting stent (DES), with its antiproliferative drug coating, offered substantial advantages over bare-metal stents as it mitigated the risk of in-stent restenosis. Nonetheless, they had several design limitations that increased the risk of late stent thrombosis. Significant advances in stent design, including thinner struts, enhanced polymers' formulation, and more potent antiproliferative agents, have led to the introduction of new-generation DES with a superior safety profile. Cardiologists have over 20 different DES types to choose from, each with its unique features and characteristics. This review highlights the evolution of stent design and summarizes the clinical data on the different stent types. We conclude by discussing the clinical implications of stent design in high-risk subsets of patients.
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Affiliation(s)
- Johny Nicolas
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Carlo Andrea Pivato
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Department of Biomedical Sciences, Humanitas University, Pieve Emanuele-Milan, Italy.,IRCCS Humanitas Research Hospital, via Manzoni 56, 20089 Rozzano, Milan, Italy
| | - Mauro Chiarito
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Department of Biomedical Sciences, Humanitas University, Pieve Emanuele-Milan, Italy.,IRCCS Humanitas Research Hospital, via Manzoni 56, 20089 Rozzano, Milan, Italy
| | - Frans Beerkens
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Davide Cao
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Cardiovascular Department, Humanitas Gavazzeni, Bergamo, Italy
| | - Roxana Mehran
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Thondapu V, Sutherland N, Ford T, Claessen B, Dangas GD, Barlis P. Bioresorbable‐polymer Everolimus‐eluting Stents. Interv Cardiol 2022. [DOI: 10.1002/9781119697367.ch32] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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Seo KW, Yang HM, Lim HS, Yoon MH. Stent dislodgement force of drug-eluting coronary stents: a bench test. Cardiovasc Diagn Ther 2022; 12:370-377. [PMID: 35800358 PMCID: PMC9253166 DOI: 10.21037/cdt-22-49] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 05/25/2022] [Indexed: 01/07/2025]
Abstract
BACKGROUND Coronary stent dislodgement can cause critical complications. The dislodgement force of coronary drug-eluting stents (DES) remains unknown. This study aimed to compare the dislodgement force and pattern of contemporary DES. METHODS Five DES designs which commonly used in clinical practice were tested. The force at which the stent dislodges relative to the balloon was measured. For the shim test, peak displacement force, defined as the first peak force that occurs during stent displacement and peak dislodgement force, defined as the peak force required to completely dislodge the stent from the delivery system, were measured. Three examples of each of the stents were tested using the shim test. RESULTS The peak displacement force of Orsiro (3.1±0.8 N) was lower than that of Xience Sierra (5.8±0.5 N) [Firehawk 3.8±0.2 N, Resolute Onyx 4.5±1.5 N, Synergy 4.8±0.5 N (P=0.024)]. The peak dislodgement force was lowest in Orsiro (3.2±0.8 N) when compared to the other stents (Firehawk 6.6±0.6 N, Resolute Onyx 7.4±0.3 N, Synergy 11.8±0.4 N, Xience Sierra 11.1±1.6 N) (P<0.001); this remained significant in the multiple comparison analysis. During pullback of the stents, most stents buckled without removal. However, the whole Orsiro stent was completely removed from the delivery system. CONCLUSIONS The dislodgement force of DESs differed between stent designs. The Orsiro stent was lower than that of other DES; additionally, it easily removed the whole stent from the delivery system. During the coronary intervention, operators should consider stent design and be cautious when pulling DES back in lesions with calcifications or a previously implanted stent, which are at high risk for stent dislodgement.
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Toth GG, Achim A, Kafka M, Wu X, Lunardi M, Biswas S, Shahzad A, Thury A, Ruzsa Z, Johnson TW, Wijns W. Bench test and in vivo evaluation of longitudinal stent deformation during proximal optimisation. EUROINTERVENTION 2022; 18:83-90. [PMID: 34930716 PMCID: PMC9904376 DOI: 10.4244/eij-d-21-00824] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND While radial stent deformation has been thoroughly investigated, data on longitudinal deformation are scarce. AIMS The aim of the study was to describe longitudinal stent deformation associated with the proximal optimisation technique (POT). METHODS Longitudinal stent deformation was assessed by bench testing and by clinical evaluation. Bench testing was performed in silicone models using 3.00 (n=15) and 3.50 mm (n=14) stent platforms. After deployment, stents were sequentially post-dilated in the proximal main branch up to 5.50 mm, in increments of 0.50 mm, in order to simulate a spectrum of overexpansion. Stent length was redefined by optical coherence tomography (OCT) after each step. Clinical data were collected retrospectively from OCT-guided bifurcation percutaneous coronary intervention cases. RESULTS In bench tests, POT has led to significant stent elongation in all cases. The magnitude of elongation was comparable between the 3.00 and the 3.50 mm stent platforms, with 0.86±0.74 mm vs 0.86±0.73 mm, respectively (p=0.71), per 0.5 mm overexpansion. For 3.00 mm stent platforms, maximal elongation was 4.31±1.47 mm after up to 5.5 mm overexpansion. For 3.50 mm platforms, maximal elongation was 2.87±0.94 mm after up to 5.5 mm overexpansion. Thirty-six clinical cases were analysed, of which 22 (61%) were performed in the distal left main. Post-dilation was performed with 0.98±0.36 mm absolute overexpansion, resulting in 2.22±1.35 mm elongation, as compared to nominal stent length. CONCLUSIONS Overexpansion by POT results in proximal stent elongation. This has to be considered once the stent length is selected and the stent is positioned, especially in the left main stem, where proximal overexpansion is marked and accurate ostial landing is critical.
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Affiliation(s)
- Gabor G. Toth
- University Heart Center Graz, Department of Cardiology, Medical University of Graz, Auenbruggerplatz 15, 8036 Graz, Austria
| | - Alexandru Achim
- University Heart Center Graz, Department of Cardiology, Medical University of Graz, Graz, Austria,Second Department of Internal Medicine, Division of Invasive Cardiology, University of Szeged, Szeged, Hungary
| | - Marcel Kafka
- University Heart Center Graz, Department of Cardiology, Medical University of Graz, Graz, Austria
| | - Xinlei Wu
- The Lambe Institute for Translational Medicine, Smart Sensors Lab and Curam, Saolta University Healthcare Group, Galway, Ireland
| | - Mattia Lunardi
- The Lambe Institute for Translational Medicine, Smart Sensors Lab and Curam, Saolta University Healthcare Group, Galway, Ireland
| | - Sinjini Biswas
- Bristol Heart Institute, University of Bristol, Bristol, United Kingdom
| | - Atif Shahzad
- The Lambe Institute for Translational Medicine, Smart Sensors Lab and Curam, Saolta University Healthcare Group, Galway, Ireland,Centre for Systems Modelling and Quantitative Biomedicine, University of Birmingham, Birmingham, United Kingdom
| | - Attila Thury
- Second Department of Internal Medicine, Division of Invasive Cardiology, University of Szeged, Szeged, Hungary
| | - Zoltan Ruzsa
- Second Department of Internal Medicine, Division of Invasive Cardiology, University of Szeged, Szeged, Hungary
| | - Thomas W. Johnson
- Bristol Heart Institute, University of Bristol, Bristol, United Kingdom
| | - William Wijns
- The Lambe Institute for Translational Medicine, Smart Sensors Lab and Curam, Saolta University Healthcare Group, Galway, Ireland
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Herbert R, Lim HR, Rigo B, Yeo WH. Fully implantable wireless batteryless vascular electronics with printed soft sensors for multiplex sensing of hemodynamics. SCIENCE ADVANCES 2022; 8:eabm1175. [PMID: 35544557 PMCID: PMC9094660 DOI: 10.1126/sciadv.abm1175] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 03/29/2022] [Indexed: 05/13/2023]
Abstract
The continuous monitoring of hemodynamics attainable with wireless implantable devices would improve the treatment of vascular diseases. However, demanding requirements of size, wireless operation, and compatibility with endovascular procedures have limited the development of vascular electronics. Here, we report an implantable, wireless vascular electronic system, consisting of a multimaterial inductive stent and printed soft sensors capable of real-time monitoring of arterial pressure, pulse rate, and flow without batteries or circuits. Developments in stent design achieve an enhanced wireless platform while matching conventional stent mechanics. The fully printed pressure sensors demonstrate fast response times, high durability, and sensing at small bending radii. The device is monitored via inductive coupling at communication distances notably larger than prior vascular sensors. The wireless electronic system is validated in artery models, while minimally invasive catheter implantation is demonstrated in an in vivo rabbit study. Overall, the vascular system offers an adaptable framework for comprehensive monitoring of hemodynamics.
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Affiliation(s)
- Robert Herbert
- George W. Woodruff School of Mechanical Engineering, Georgia Institute of Technology, Atlanta, GA 30332, USA
- IEN Center for Human-Centric Interfaces and Engineering at the Institute for Electronics and Nanotechnology, Georgia Institute of Technology, Atlanta, GA 30332, USA
| | - Hyo-Ryoung Lim
- Major of Human Biocovergence, Division of Smart Healthcare, College of Information Technology and Convergence, Pukyong National University, Busan, 48513, Republic of Korea
| | - Bruno Rigo
- IEN Center for Human-Centric Interfaces and Engineering at the Institute for Electronics and Nanotechnology, Georgia Institute of Technology, Atlanta, GA 30332, USA
- School of Electrical and Computer Engineering, Georgia Institute of Technology, Atlanta, GA 30332, USA
| | - Woon-Hong Yeo
- George W. Woodruff School of Mechanical Engineering, Georgia Institute of Technology, Atlanta, GA 30332, USA
- IEN Center for Human-Centric Interfaces and Engineering at the Institute for Electronics and Nanotechnology, Georgia Institute of Technology, Atlanta, GA 30332, USA
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA 30332, USA
- Parker H. Petit Institute for Bioengineering and Biosciences, Neural Engineering Center, Institute for Materials, Institute for Robotics and Intelligent Machines, Georgia Institute of Technology, Atlanta, GA 30332, USA
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Thondapu V, Dayawansa NH, Claessen B, Dangas GD, Barlis P. Durable Polymer Everolimus Eluting Stents. Interv Cardiol 2022. [DOI: 10.1002/9781119697367.ch31] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
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13
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Zhang J, Li G, Qu Y, Guo Z, Zhang S, Li D. Fabrication and Hemocompatibility Evaluation of a Robust Honeycomb Nanostructure on Medical Pure Titanium Surface. ACS APPLIED MATERIALS & INTERFACES 2022; 14:9807-9823. [PMID: 35084192 DOI: 10.1021/acsami.1c22818] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Thrombosis induced by blood-contacting medical devices is still a major clinical problem, resulting in some serious complications such as infarction, irreversible tissue damage, and even death. Therefore, seeking an effective and safe surface modification approach to improve the hemocompatibility of the material is still urgent. In this research, a novel and facile approach was proposed to fabricate a robust honeycomb nanostructure on medical pure titanium surface by two-step anodic oxidation, which effectively enhanced the physicochemical performance and hemocompatibility of the material. Especially, the honeycomb nanostructure that underwent annealing treatment at 500 °C (HN-Ti-500 °C) presented significant performance to suppress the coagulation cascade in the in vitro tests, the reason mainly ascribed to an overall repulsive interaction between the protein molecule related to thrombosis and material surface based on an extended Derjaguin-Landau-Verwey-Overbeek (XDLVO) theory analysis. Furthermore, a vessel stent fabricated by HN-Ti-500 °C was implanted into the left carotid artery of rabbits for 1 month. The antithrombotic mechanism and biocompatibility of the modified surface were further verified. The results presented that no thrombus generated and adhered onto the inner surface of the modified stent, and no obvious disorder hyperplasia and inflammation were observed in the intima tissue of the vessel at the implantation site, which indicated that the modified surface could effectively decrease the risk of in-stent restenosis and thrombosis. This work offers a promising strategy for surface modification of blood-contacting medical titanium material to address the clinical complications associated with restenosis and thrombosis.
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Affiliation(s)
- Jing Zhang
- Key Laboratory of High Efficiency and Clean Mechanical Manufacture of Ministry of Education, School of Mechanical Engineering, Shandong University, Jinan 250061, P. R. China
- Key National Demonstration Center for Experimental Mechanical Engineering Education, Shandong University, Jinan 250061, P. R. China
| | - Guiling Li
- Advanced Medical Research Institute, Shandong University, Jinan 250012, P. R. China
| | - Yifei Qu
- Key Laboratory of High Efficiency and Clean Mechanical Manufacture of Ministry of Education, School of Mechanical Engineering, Shandong University, Jinan 250061, P. R. China
- Key National Demonstration Center for Experimental Mechanical Engineering Education, Shandong University, Jinan 250061, P. R. China
| | - Ziyu Guo
- Key Laboratory of High Efficiency and Clean Mechanical Manufacture of Ministry of Education, School of Mechanical Engineering, Shandong University, Jinan 250061, P. R. China
- Key National Demonstration Center for Experimental Mechanical Engineering Education, Shandong University, Jinan 250061, P. R. China
| | - Song Zhang
- Key Laboratory of High Efficiency and Clean Mechanical Manufacture of Ministry of Education, School of Mechanical Engineering, Shandong University, Jinan 250061, P. R. China
- Key National Demonstration Center for Experimental Mechanical Engineering Education, Shandong University, Jinan 250061, P. R. China
| | - Donghai Li
- Advanced Medical Research Institute, Shandong University, Jinan 250012, P. R. China
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14
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Öner A, Rosam P, Borowski F, Grabow N, Siewert S, Schmidt W, Schmitz KP, Stiehm M. Side-branch expansion capacity of contemporary DES platforms. Eur J Med Res 2021; 26:121. [PMID: 34641963 PMCID: PMC8507243 DOI: 10.1186/s40001-021-00595-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 09/27/2021] [Indexed: 11/24/2022] Open
Abstract
Background Percutaneous coronary interventions (PCI) of bifurcation stenoses are both complex and challenging. Stenting strategies share that the stents’ side cells must be carefully explored and appropriately prepared using balloons or stents. So far, stent manufacturers have not provided any information regarding side-branch expansion capacity of their stent platforms. Aims Given that drug-eluting stent (DES) information regarding their mechanical capacity of side-branch expansion is not available, we aimed to evaluate contemporary DES (Orsiro, BIOTRONIK AG; Xience Sierra, Abbott Vascular; Resolute Integrity, Medtronic; Promus Premier Select, Boston Scientific; Supraflex Cruz, Sahajan and Medical Technologies) by their side-branch expansion behavior using in vitro bench testing. Methods In this in vitro study, we analyzed five commercially available DES (diameter 3.0 mm), measuring their side-branch expansion following inflation of different high-pressure non-compliant (NC) balloons (balloon diameter: 2.00–4.00 mm), thereby revealing the morphological characteristics of their side-branch expansion capacities. Results We demonstrated that all tested contemporary DES platforms could withstand large single-cell deformations, up to 4.0 mm. As seen in our side-branch experiments, DES designs consisting of only two connectors between strut rings did not only result in huge cell areas, but also in larger cell diameters following side-branch expansion compared with DES designs using three or more connectors. Furthermore, the stent cell diameter attained was below the balloon diameter at normal pressure. Conclusions We recommend that the expansion capacity of side-branches should be considered in stent selection for bifurcation interventions.
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Affiliation(s)
- Alper Öner
- Department for Cardiology, Center for Internal Medicine, University Medical Center Rostock, Ernst-Heydemann-Straße 6, 18057, Rostock, Germany. .,Institute for Implant Technology and Biomaterials-IIB E.V, Associated Institute of the University of Rostock, Warnemuende, Rostock, Germany.
| | - Paula Rosam
- Institute for Implant Technology and Biomaterials-IIB E.V, Associated Institute of the University of Rostock, Warnemuende, Rostock, Germany
| | - Finja Borowski
- Institute for Implant Technology and Biomaterials-IIB E.V, Associated Institute of the University of Rostock, Warnemuende, Rostock, Germany
| | - Niels Grabow
- Institute for Biomedical Engineering, University Medical Center Rostock, Warnemuende, Rostock, Germany
| | - Stefan Siewert
- Institute for Implant Technology and Biomaterials-IIB E.V, Associated Institute of the University of Rostock, Warnemuende, Rostock, Germany
| | - Wolfram Schmidt
- Institute for Biomedical Engineering, University Medical Center Rostock, Warnemuende, Rostock, Germany
| | - Klaus-Peter Schmitz
- Institute for Implant Technology and Biomaterials-IIB E.V, Associated Institute of the University of Rostock, Warnemuende, Rostock, Germany
| | - Michael Stiehm
- Institute for Implant Technology and Biomaterials-IIB E.V, Associated Institute of the University of Rostock, Warnemuende, Rostock, Germany
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15
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Barone-Rochette G. The hyperdeliverability of the latest evolution of drug-eluting stents should not cause any steps to be omitted during percutaneous coronary intervention. Arch Cardiovasc Dis 2021; 114:609-611. [PMID: 34548265 DOI: 10.1016/j.acvd.2021.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 08/23/2021] [Accepted: 08/24/2021] [Indexed: 11/18/2022]
Affiliation(s)
- Gilles Barone-Rochette
- Université Grenoble Alpes, Inserm, CHU Grenoble Alpes, LRB, 38000 Grenoble, France; Department of Cardiology, CHU Grenoble Alpes, 38000 Grenoble, France; French Alliance Clinical Trial, French Clinical Research Infrastructure Network, 75018 Paris, France.
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16
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Algowhary M, Abdelmegid MAKF. Longitudinal stent elongation or shortening after deployment in the coronary arteries: which is dominant? Egypt Heart J 2021; 73:46. [PMID: 34002293 PMCID: PMC8128949 DOI: 10.1186/s43044-021-00170-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 05/06/2021] [Indexed: 11/18/2022] Open
Abstract
Background Stent manufacturers always record stent shortening data while they do not record stent elongation data. The aim of this study is to identify both stent shortening and elongation occurring after deployment in the coronary arteries and know their percentage. Results The length of coronary stents was measured by intravascular ultrasound (IVUS) by (1) edge-to-edge (E-E) length, measured from the appearance of the first distal strut to the last proximal strut, and (2) area-to-area (A-A) length, measured from the first distal struts seen at more than one IVUS quadrant to the last proximal struts seen at more than one IVUS quadrant. Stent shortening was defined as both E-E and A-A lengths were shorter than the manufacturer box-stated length (shortened group). Stent elongation was defined as both E-E and A-A lengths were longer than the manufacturer box-stated length (elongated group), otherwise unchanged group. Consecutive 102 stents deployed in ischemic patients were included. Stent elongation was detected in 67.6% (69 stents), and shortening was detected in 15.7% (16 stents), while unchanged stents were detected in 16.7% (17 stents). Although the 3 groups had similar box-stated length and predicted foreshortened length, they had significantly different measurements by IVUS, p<0.001 for each comparison. Differences from box-stated length were 1.9±1.4mm, −1.4±0.4mm, and 0.4±0.3mm, respectively, p<0.001. The elongated group had significantly longer differences from the corresponding box-stated and predicted foreshortened lengths, while the shortened group had significantly shorter differences from the corresponding box-stated length and similar foreshortened length. By multinomial regression analysis, the plaque-media area and stent deployment pressure were the independent predictors of the stent length groups, p=0.015 and p=0.026, respectively. Conclusions Change in stent length is not only shortening—as mentioned in the manufacturer documents—but also stent elongation. Stent elongation is dominant, and the most important predictors of longitudinal stent changes are plaque-media area and stent deployment pressure.
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Affiliation(s)
- Magdy Algowhary
- Department of Cardiovascular Medicine, Assiut University Heart Hospital, Faculty of Medicine, Assiut University, Asyut, 71515, Egypt.
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Mahadevan K, Cosgrove C, Strange JW. Factors Influencing Stent Failure in Chronic Total Occlusion Coronary Intervention. Interv Cardiol 2021; 16:e27. [PMID: 34721666 PMCID: PMC8532005 DOI: 10.15420/icr.2021.03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 06/07/2021] [Indexed: 11/04/2022] Open
Abstract
Stent failure remains one of the greatest challenges for interventional cardiologists. Despite the evolution to superior second- and third-generation drug-eluting stent designs, increasing use of intracoronary imaging and the adoption of more potent antiplatelet regimens, registries continue to demonstrate a prevalence of stent failure or target lesion revascularisation of 15-20%. Predisposition to stent failure is consistent across both chronic total occlusion (CTO) and non-CTO populations and includes patient-, lesion- and procedure-related factors. However, histological and pathophysiological properties specific to CTOs, alongside complex strategies to treat these lesions, may potentially render percutaneous coronary interventions in this cohort more vulnerable to failure. Prevention requires recognition and mitigation of the precipitants of stent failure, optimisation of interventional techniques, including image-guided precision percutaneous coronary intervention, and aggressive modification of a patient's cardiovascular risk factors. Management of stent failure in the CTO population is technically challenging and itself begets recurrence. We aim to provide a comprehensive review of factors influencing stent failure in the CTO population and strategies to attenuate these.
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Affiliation(s)
- Kalaivani Mahadevan
- Department of Cardiology, University Hospitals Bristol and Weston NHS Foundation TrustBristol, UK
| | - Claudia Cosgrove
- Department of Cardiology, St George’s University NHS TrustLondon, UK
| | - Julian W Strange
- Department of Cardiology, University Hospitals Bristol and Weston NHS Foundation TrustBristol, UK
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18
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Iwakami T, Fujii N, Son J. Comparison of the Physical Characteristics of Support Stents for Cerebral Aneurysm Embolization. JOURNAL OF NEUROENDOVASCULAR THERAPY 2021; 15:778-786. [PMID: 37501998 PMCID: PMC10370937 DOI: 10.5797/jnet.oa.2020-0167] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 02/12/2021] [Indexed: 07/29/2023]
Abstract
Objective There is a limited understanding of the characteristics of individual intracranial stents used for aneurysm treatment. We used an experimental model to evaluate the physical characteristics of support stents for aneurysm embolization. Methods Enterprise 2 VRD 4.0 × 39 mm, Neuroform Atlas 4.5 × 21 mm, and LVIS 4.5 × 32 mm stents were: 1) observed under light microscopy and subjected to measurements of 2) circumferential radial force, 3) strut tension, 4) stent compression, and 5) conformability upon bending. Results 1) Light microscopy showed a large structural difference between laser-cut (Enterprise 2 VRD, Neuroform Atlas) and braided (LVIS) stents. 2) Within the range of indicated blood vessel diameters, the radial force of Enterprise 2 VRD was higher than that of Neuroform Atlas. An extremely large force was required to decrease the LVIS diameter. 3) Neuroform Atlas easily deformed compared to Enterprise 2 VRD, while LVIS was extended with a smaller traction force than that required for Neuroform Atlas. 4) The compression strength was in the order of Enterprise 2 VRD >Neuroform Atlas >LVIS. 5) Enterprise 2 VRD showed a decreased cell area on the concave side, and Neuroform Atlas showed deformation with overlapping struts on the concave side. LVIS naturally adhered to the wall of the blood vessel model. Conclusion Laser-cut and braided stents showed different physical characteristics that were visualized and shown as numerical data. These findings improve the understanding of the proper use of these stents in clinical applications.
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Affiliation(s)
- Takayuki Iwakami
- Department of Neurosurgery, Tomishiro Central Hospital, Tomigusuku, Okinawa, Japan
| | - Norio Fujii
- Department of Neurosurgery, Tomishiro Central Hospital, Tomigusuku, Okinawa, Japan
| | - Jaehyun Son
- Department of Neurosurgery, Tomishiro Central Hospital, Tomigusuku, Okinawa, Japan
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19
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Cockerill I, See CW, Young ML, Wang Y, Zhu D. Designing Better Cardiovascular Stent Materials - A Learning Curve. ADVANCED FUNCTIONAL MATERIALS 2021; 31:2005361. [PMID: 33708033 PMCID: PMC7942182 DOI: 10.1002/adfm.202005361] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Indexed: 05/07/2023]
Abstract
Cardiovascular stents are life-saving devices and one of the top 10 medical breakthroughs of the 21st century. Decades of research and clinical trials have taught us about the effects of material (metal or polymer), design (geometry, strut thickness, and the number of connectors), and drug-elution on vasculature mechanics, hemocompatibility, biocompatibility, and patient health. Recently developed novel bioresorbable stents are intended to overcome common issues of chronic inflammation, in-stent restenosis, and stent thrombosis associated with permanent stents, but there is still much to learn. Increased knowledge and advanced methods in material processing have led to new stent formulations aimed at improving the performance of their predecessors but often comes with potential tradeoffs. This review aims to discuss the advantages and disadvantages of stent material interactions with the host within five areas of contrasting characteristics, such as 1) metal or polymer, 2) bioresorbable or permanent, 3) drug elution or no drug elution, 4) bare or surface-modified, and 5) self-expanding or balloon-expanding perspectives, as they relate to pre-clinical and clinical outcomes and concludes with directions for future studies.
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Affiliation(s)
- Irsalan Cockerill
- Department of Biomedical Engineering, University of North Texas, Denton, TX 76207, USA
- Department of Materials Science and Engineering, University of North Texas, Denton, TX 76207, USA
| | - Carmine Wang See
- Department of Biomedical Engineering, Stony Brook University, Stony Brook, NY 11794, USA
| | - Marcus L. Young
- Department of Materials Science and Engineering, University of North Texas, Denton, TX 76207, USA
| | - Yadong Wang
- Meinig School of Biomedical Engineering, Cornell University, Ithaca, NY, USA
| | - Donghui Zhu
- Department of Biomedical Engineering, Stony Brook University, Stony Brook, NY 11794, USA
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20
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Cosgrove C, Marciniak M, Spratt JC. Reverse longitudinal stent deformation during percutaneous intervention via the retrograde approach to a chronic total occlusion of the right coronary artery: a case report. Eur Heart J Case Rep 2021; 5:ytaa571. [PMID: 33521515 PMCID: PMC7819831 DOI: 10.1093/ehjcr/ytaa571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 07/28/2020] [Accepted: 12/18/2020] [Indexed: 06/12/2023]
Abstract
BACKGROUND Longitudinal stent deformation (LSD) is an uncommon but recognized mechanical complication of coronary stent implantation, usually occurring at the proximal stent edge due to compression by guide catheter or catheter extensions. Retrograde techniques for chronic total occlusion (CTO) percutaneous coronary intervention expose the distal stent edge to potential interaction with retrograde equipment under a tensioned system. CASE SUMMARY We describe a case of distal stent edge LSD, occurring during a retrograde approach to a right coronary artery CTO via septal collateral channels. While removing the externalized wire, interaction with the retrograde microcatheter caused compression of the distal end of the newly implanted stents. DISCUSSION This unusual complication highlights the reduced longitudinal strength of newer generation stent platforms and the risks of interaction between retrograde equipment and stents on an externalized wire.
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Affiliation(s)
- Claudia Cosgrove
- Cardiology Department, St George’s University Hospitals NHS Trust, Blackshaw Road, London SW17 0QT, UK
| | - Marciej Marciniak
- Cardiology Department, East Surrey Hospital, Canada Ave, London RH1 5RH, UK
| | - James C Spratt
- Cardiology Department, St George’s University Hospitals NHS Trust, Blackshaw Road, London SW17 0QT, UK
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21
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Amemiya K, Maehara A, Yamamoto MH, Oyama Y, Igawa W, Ono M, Kido T, Ebara S, Okabe T, Yamashita K, Isomura N, Mintz GS, Ochiai M. Chronic stent recoil in severely calcified coronary artery lesions. A serial optical coherence tomography study. Int J Cardiovasc Imaging 2020; 36:1617-1626. [PMID: 32462449 DOI: 10.1007/s10554-020-01876-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Accepted: 05/02/2020] [Indexed: 10/24/2022]
Abstract
Chronic second-generation drug-eluting stent recoil in severely calcified coronary lesions has not been studied. We aimed to evaluate chronic stent recoil by optical coherence tomography (OCT) in severely calcified lesions treated with thin strut stents after rotational atherectomy. In 28 lesions (26 patients with 23% on hemodialysis) treated with everolimus-eluting stents after rotational atherectomy, baseline and 8-month follow-up OCT were compared. Stent recoil was defined as >10% decrease in stent area from baseline to follow-up. Overall, there was no change in minimal stent area (6.0 mm2 [5.0, 8.1] to 6.0 mm2 [4.8, 8.6], p = 0.51) from baseline to follow-up, although neointimal hyperplasia measured 16.3 ± 15.8%. Thirty-six percent of lesions showed stent recoil associated with 6 non-nodular calcifications, 1 calcified nodule, and 3 stent deformations. The overall mean calcium angle with attenuation decreased (54° [29-76] to 31° [19-48], p < 0.0001), and calcium without attenuation increased (28° [21-67] to 64° [34-93], p < 0.0001), but primarily at the location of stent recoil. Furthermore, in the stent recoil segments in 10 recoil lesions, the stent circumference decreased primarily at non-calcium segments rather than at calcium with or without attenuation. One lesion with stent recoil and 2 lesions without stent recoil required repeat revascularization. Thin strut stents can chronically recoil in severely calcified lesions, but this rarely causes restenosis.
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Affiliation(s)
- Kisaki Amemiya
- Showa University Northern Yokohama Hospital, Yokohama, Japan
| | - Akiko Maehara
- Clinical Trials Center, Cardiovascular Research Foundation, New York, NY, USA. .,NewYork-Presbyterian Hospital, Columbia University Irving Medical Center, New York, NY, USA.
| | | | - Yuji Oyama
- Showa University Northern Yokohama Hospital, Yokohama, Japan
| | - Wataru Igawa
- Showa University Northern Yokohama Hospital, Yokohama, Japan
| | - Morio Ono
- Showa University Northern Yokohama Hospital, Yokohama, Japan
| | - Takehiko Kido
- Showa University Northern Yokohama Hospital, Yokohama, Japan
| | - Seitarou Ebara
- Showa University Northern Yokohama Hospital, Yokohama, Japan
| | - Toshitaka Okabe
- Showa University Northern Yokohama Hospital, Yokohama, Japan
| | | | - Naoei Isomura
- Showa University Northern Yokohama Hospital, Yokohama, Japan
| | - Gary S Mintz
- Clinical Trials Center, Cardiovascular Research Foundation, New York, NY, USA
| | - Masahiko Ochiai
- Showa University Northern Yokohama Hospital, Yokohama, Japan
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22
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Blum M, Cao D, Mehran R. Device profile of the Resolute Onyx Zotarolimus eluting coronary stent system for the treatment of coronary artery disease: overview of its safety and efficacy. Expert Rev Med Devices 2020; 17:257-265. [PMID: 32154750 DOI: 10.1080/17434440.2020.1736037] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Introduction: The increasing complexity of patients undergoing percutaneous coronary intervention (PCI) regarding both coronary anatomy and comorbidities requires dedicated devices. The Resolute Onyx (R-Onyx, Medtronic, CA, USA) stent is a novel durable polymer zotarolimus-eluting stent (ZES) promising better deliverability, increased radiopacity and lower thrombogenicity.Areas covered: In this review, we discuss device features, preclinical evidence, and clinical studies including patients treated with R-Onyx. The BIONYX and Onyx ONE studies were two major landmark trials demonstrating non-inferiority of R-Onyx as compared to other latest generation devices. We also elaborate on alternative innovations in drug-eluting stent (DES) technology and how R-Onyx fits into this field.Expert opinion: R-Onyx is designed to address the challenges of contemporary PCI, but evidence on its clinical performance is largely derived from studies on older generation devices from the ZES family. Nonetheless, all clinical studies on R-Onyx consistently show excellent outcomes, with particularly low rates of stent thrombosis, making it a promising candidate for short dual antiplatelet regimens. In addition, R-Onyx is available with a wide range of stent diameters allowing accurate sizing for both very small and very large coronary vessels.
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Affiliation(s)
- Moritz Blum
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Department of Internal Medicine/Cardiology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Davide Cao
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Department of Biomedical Sciences, Humanitas University, Pieve Emanuele-Milan, Italy
| | - Roxana Mehran
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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23
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Si D, Tong Y, Yu B, He Y, Liu G. In-stent restenosis and longitudinal stent deformation: a case report. BMC Cardiovasc Disord 2020; 20:24. [PMID: 31952504 PMCID: PMC6969443 DOI: 10.1186/s12872-020-01335-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Accepted: 01/09/2020] [Indexed: 01/18/2023] Open
Abstract
Background Longitudinal stent deformation (LSD) is an infrequent complication of percutaneous coronary intervention (PCI), and it may lead to catastrophic clinical outcomes. However, reports of cardiac adverse events associated with LSD are rare. Case presentation A 55-year-old man with chest pain was treated for a severe left anterior descending branch (LAD)-diagonal 1 (D1) bifurcation lesion by PCI with two stents in the proximal LAD. LSD occurred during the withdrawal of the trapped D1 wire. High-pressure balloon dilatation was performed in the deformed stent, and the end-angiographic appearance was acceptable, but no additional corrective measures were implemented. Ten months later, the patient represented with acute coronary syndrome. Severe in-stent restenosis (ISR) had suboccluded the proximal LAD, and optical coherence tomography (OCT) visualized multilayered stent struts protruding into the lumen at the compressed segment of the stent. Following complete apposition with balloon dilation, a drug-coated balloon (DCB) was used to avoid an additional permanent metallic layer. He remained angina free, and the angiographic result demonstrated no residual stenosis at the six-month follow-up. To our knowledge, this case demonstrates the first report of ISR triggered by LSD in patients treated with DCBs under the guidance of OCT. Conclusions The current report underscores the importance of awareness of LSD, and OCT seems to be the preferred modality to confirm complete apposition. If left without performing additional corrective measures, LSD may be associated with a risk of ISR. Complete apposition with balloon dilation followed by a DCB is a feasible treatment option.
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Affiliation(s)
- Daoyuan Si
- Department of Cardiology, China-Japan Union Hospital of Jilin University, Changchun, Jilin, China.,Jilin Provincial Engineering Laboratory for Endothelial Function and Genetic Diagnosis of Cardiovascular Disease, Changchun, Jilin, China.,Jilin Provincial Cardiovascular Research Institute, Xiantai Street NO.126, Changchun, 130033, Jilin, China
| | - Yaliang Tong
- Department of Cardiology, China-Japan Union Hospital of Jilin University, Changchun, Jilin, China.,Jilin Provincial Engineering Laboratory for Endothelial Function and Genetic Diagnosis of Cardiovascular Disease, Changchun, Jilin, China.,Jilin Provincial Cardiovascular Research Institute, Xiantai Street NO.126, Changchun, 130033, Jilin, China
| | - Bo Yu
- Department of Cardiology, China-Japan Union Hospital of Jilin University, Changchun, Jilin, China.,Jilin Provincial Engineering Laboratory for Endothelial Function and Genetic Diagnosis of Cardiovascular Disease, Changchun, Jilin, China.,Jilin Provincial Cardiovascular Research Institute, Xiantai Street NO.126, Changchun, 130033, Jilin, China
| | - Yuquan He
- Department of Cardiology, China-Japan Union Hospital of Jilin University, Changchun, Jilin, China.,Jilin Provincial Engineering Laboratory for Endothelial Function and Genetic Diagnosis of Cardiovascular Disease, Changchun, Jilin, China.,Jilin Provincial Cardiovascular Research Institute, Xiantai Street NO.126, Changchun, 130033, Jilin, China
| | - Guohui Liu
- Department of Cardiology, China-Japan Union Hospital of Jilin University, Changchun, Jilin, China. .,Jilin Provincial Engineering Laboratory for Endothelial Function and Genetic Diagnosis of Cardiovascular Disease, Changchun, Jilin, China. .,Jilin Provincial Cardiovascular Research Institute, Xiantai Street NO.126, Changchun, 130033, Jilin, China.
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24
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Iannaccone M, D'Ascenzo F, Gallone G, Mitomo S, Parma R, Trabattoni D, Ryan N, Muscoli S, Venuti G, Montabone A, De Lio F, Zaccaro L, Quadri G, De Filippo O, Wojakowski W, Rognoni A, Helft G, Gallo D, De Luca L, Figini F, Imori Y, Conrotto F, Boccuzzi G, Mattesini A, Wańha W, Smolka G, Huczek Z, Rolfo C, Pennone M, Cortese B, Capodanno D, Chieffo A, Nuñez-Gil I, Morbiducci U, D'Amico M, Varbella F, Romeo F, Sheiban I, Escaned J, Garbo R, Moretti C, di Mario C, De Ferrari GM. Impact of structural features of very thin stents implanted in unprotected left main or coronary bifurcations on clinical outcomes. Catheter Cardiovasc Interv 2019; 96:1-9. [PMID: 31860158 DOI: 10.1002/ccd.28667] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Revised: 10/24/2019] [Accepted: 12/08/2019] [Indexed: 11/12/2022]
Abstract
OBJECTIVES To evaluate the independent clinical impact of stent structural features in a large cohort of patients undergoing unprotected left main (ULM) or coronary bifurcation percutaneous coronary intervention (PCI) with a range of very thin strut stents. BACKGROUND Clinical impact of structural features of contemporary stents remains to be defined. METHODS All consecutive patients enrolled in the veRy thin stents for patients with left mAIn or bifurcatioN in real life (RAIN) registry were included. The following stent structural features were studied: antiproliferative drugs (everolimus vs. sirolimus vs. zotarolimus), strut material (platinum-chromium vs. cobalt-chromium), polymer (bioresorbable vs. durable), number of crowns (<8 vs. ≥8) and number of connectors (<3 vs. ≥3). For small diameter stents (≤2.5 mm), struct thickness (74 vs. 80/81 μm) was also tested. Target lesion failure (TLF), a composite of target lesion revascularization and stent thrombosis, was the primary endpoint. Multivariate analysis was performed with Cox regression models. RESULTS Out of 2,707 patients, 110 (4.1%) experienced a TLF event after 16 months (12-18). After adjustment for confounders, an increased number of connectors (adjusted hazard ratio [adj-HR] 0.62, 95% confidence interval (CI) 0.39-0.99, p = .04) reduced risk of TLF, driven by stents with ≥2.5 mm diameter (HR 0.54, 95% CI 0.32-0.93, p = .02). This independent relationship was lost for stents with diameter <2.5 mm, where only strut thickness appeared to impact. Conversely, no independent relationship of polymer type, number of crowns, and the specific limus-family eluted drug with outcomes was observed. CONCLUSIONS Among a range of contemporary very thin stent models, an increased number of connectors improved device-related outcomes in this investigated high-risk procedural setting.
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Affiliation(s)
- Mario Iannaccone
- Division of Cardiology, SS. Annunziata Hospital, Savigliano, Italy
| | - Fabrizio D'Ascenzo
- Division of Cardiology, Department of Internal Medicine, Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Guglielmo Gallone
- Division of Cardiology, Department of Internal Medicine, Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Satoru Mitomo
- Unit of Cardiovascular Interventions, IRCCS San Raffaele Hospital, Milan, Italy
| | - Radosław Parma
- Division of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland
| | - Daniela Trabattoni
- Department of Cardiovascular Sciences, Centro Cardiologico Monzino, IRCCS, Milan, Italy
| | - Nicola Ryan
- Hospital Clínico San Carlos, IDISSC, and Universidad Complutense de Madrid, Madrid, Spain
| | - Saverio Muscoli
- Department of Cardiovascular Disease, Tor Vergata University of Rome, Rome, Italy
| | - Giuseppe Venuti
- Division of Cardiology, Ferrarotto Hospital, University of Catania, Catania, Italy
| | | | - Francesca De Lio
- Division of Cardiology, Department of Internal Medicine, Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Lorenzo Zaccaro
- Division of Cardiology, Department of Internal Medicine, Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Giorgio Quadri
- Department of Cardiology, Infermi Hospital, Rivoli, Italy
| | - Ovidio De Filippo
- Division of Cardiology, Department of Internal Medicine, Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Wojciech Wojakowski
- Division of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland
| | - Andrea Rognoni
- Coronary Care Unit and Catheterization Laboratory, A.O.U. Maggiore della Carità, Novara, Italy
| | - Gerard Helft
- Pierre and Marie Curie University, Paris, France
| | - Diego Gallo
- PolitoBIOMed Lab, Department of Mechanical and Aerospace Engineering, Politecnico di Torino, Turin, Italy
| | - Leonardo De Luca
- Division of Cardiology, S. Giovanni Evangelista Hospital, Tivoli, Italy
| | | | - Yoichi Imori
- Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan
| | - Federico Conrotto
- Division of Cardiology, Department of Internal Medicine, Città della Salute e della Scienza, University of Turin, Turin, Italy
| | | | - Alessio Mattesini
- Division of Structural Interventional Cardiology, Careggi University Hospital, Florence, Italy
| | - Wojciech Wańha
- Division of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland
| | - Grzegorz Smolka
- Division of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland
| | | | - Cristina Rolfo
- Department of Cardiology, Infermi Hospital, Rivoli, Italy
| | - Mauro Pennone
- Division of Cardiology, Department of Internal Medicine, Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Bernardo Cortese
- Interventional Cardiology Unit, ASST Fatebenefratelli-Sacco, Milan, Italy
| | - Davide Capodanno
- Division of Cardiology, Ferrarotto Hospital, University of Catania, Catania, Italy
| | - Alaide Chieffo
- Unit of Cardiovascular Interventions, IRCCS San Raffaele Hospital, Milan, Italy
| | - Ivan Nuñez-Gil
- Hospital Clínico San Carlos, IDISSC, and Universidad Complutense de Madrid, Madrid, Spain
| | - Umberto Morbiducci
- PolitoBIOMed Lab, Department of Mechanical and Aerospace Engineering, Politecnico di Torino, Turin, Italy
| | - Maurizio D'Amico
- Division of Cardiology, Department of Internal Medicine, Città della Salute e della Scienza, University of Turin, Turin, Italy
| | | | - Francesco Romeo
- Department of Medicine, Università degli Studi di Roma 'Tor Vergata', Rome, Italy
| | | | - Javier Escaned
- Hospital Clínico San Carlos, IDISSC, and Universidad Complutense de Madrid, Madrid, Spain
| | - Roberto Garbo
- Department of Cardiology, S.G. Bosco Hospital, Torino, Italy
| | - Claudio Moretti
- Division of Cardiology, Department of Internal Medicine, Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Carlo di Mario
- Division of Structural Interventional Cardiology, Careggi University Hospital, Florence, Italy
| | - Gaetano M De Ferrari
- Division of Cardiology, Department of Internal Medicine, Città della Salute e della Scienza, University of Turin, Turin, Italy
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Algowhary M, Taha S, Hasan-Ali H, Matsumura A. In vivo measurement of stent length by using intravascular ultrasound. Egypt Heart J 2019; 71:32. [PMID: 31858288 PMCID: PMC6923296 DOI: 10.1186/s43044-019-0036-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Accepted: 12/04/2019] [Indexed: 11/25/2022] Open
Abstract
Background What happens to stent length when deployed in a coronary artery? It is the aim of this study. Results Consecutive 95 balloon-expandable stents (BES) were studied by intravascular ultrasound (IVUS) imaging. The stent length was measured from the longitudinal view in two ways: (1) edge-to-edge length (E-E) measured between distal and proximal stent frames located at one IVUS quadrant and (2) area-to-area length (A-A) measured between distal and proximal stent frames located at two or more IVUS quadrants. IVUS measurements were compared with the manufacturer-stated length (M-L). The median E-E length was significantly longer than M-L, 18.76 mm [interquartile range (IQR) 15.65–23.60] versus 18.00 mm (IQR 15.00–23.00), respectively, p < 0.0001. Also, the median A-A length was significantly longer, 18.36 mm (IQR 15.19–23.47), p < 0.0001, than M-L. Moreover, the E-E length was significantly different from A-A length, p < 0.0001. Among the stent groups, the differences were significantly present in all drug-eluting stent and bare metal stent (BMS) comparisons, p < 0.0001, except the A-A length versus M-L in BMS only. By multivariate analysis, the predictors of difference in stent length were as follows: lesion length, p = 0.01; pre-intervention minimal diameter of the external elastic membrane (EEM), p = 0.03; lesions present in the left anterior descending branch, p = 0.03; and M-L, p = 0.04. Conclusions In the present study, the length of BES measured by IVUS was significantly different from the manufacturer-stated length. In addition to the manufacturer length, other important factors such as lesion length, pre-intervention diameter of EEM, and affected vessel determine the stent length.
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Affiliation(s)
- Magdy Algowhary
- Department of Cardiovascular Medicine, Faculty of Medicine, Assiut University, Asyut, 71516, Egypt.
| | - Salma Taha
- Department of Cardiovascular Medicine, Faculty of Medicine, Assiut University, Asyut, 71516, Egypt
| | - Hosam Hasan-Ali
- Department of Cardiovascular Medicine, Faculty of Medicine, Assiut University, Asyut, 71516, Egypt
| | - Akihiko Matsumura
- Department of Cardiology, Kameda Medical Center, Higashi-cho 929, Kamogawa, Chiba, 296-8602, Japan
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Warisawa T, Nour D, Seligman H, Doi S, Kuwata S, Howard JP, Rajkumar C, Cook CM, Nakayama Y, Kasahara M, Suzuki N, Matsuda H, Mizuno K, Akashi YJ. Interference Between Pressure-Wire and Deployed Coronary Stents: Insights from a Bench Test. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2019; 21:765-770. [PMID: 31784356 DOI: 10.1016/j.carrev.2019.10.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Revised: 10/03/2019] [Accepted: 10/23/2019] [Indexed: 01/10/2023]
Abstract
BACKGROUND While several complications related to pressure-wire (PW) have been reported, mechanistic justification has not always been offered. Furthermore, interference between a PW and a protruding side-branch stent has not been previously reported. The purpose of this study was to evaluate interference between PW-pullback from a main-branch with a protruded ostial stent deployed in a side-branch. METHODS In a polyurethane bifurcation vessel model, PW-pullback was performed in a main-branch following protruded ostial stenting in a side-branch. Tested PWs included PressureWire X, Comet, OptoWire, and Verrata. For each PW, pullback was performed through the same proximal cell of the protruded stent 20 times. Interference during PW-pullback was objectively analyzed with a fiberscope placed at the distal main-branch and classified into 3 grades according to the interaction with stent strut. RESULTS There were significant differences in the rate of interference between the PWs. No-interference, interference without strut traction, and interference with strut traction (i.e. stent deformation) were observed as follows: 17/20, 3/20, and 0/20 in PressureWire X; 19/20, 1/20, and 0/20 in Comet; 8/20, 10/20, and 2/20 in OptoWire; and 13/20, 2/20, and 5/20 in Verrata, respectively (p for any differences: <0.001). Visually identifiable major stent deformation was observed once in OptoWire due to the deep concave sensor window and twice in Verrata due to the proximal gap between the sensor and coiled-wire. CONCLUSIONS PW-pullback in the main-branch after side-branch ostial stenting should be carefully performed to avoid stent deformation. Consideration on the specific mechanical features of the PW is also essential.
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Affiliation(s)
- Takayuki Warisawa
- National Heart and Lung Institute, Imperial College London, London, UK; Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan.
| | - Daniel Nour
- National Heart and Lung Institute, Imperial College London, London, UK; James Cook University, Queensland, Australia
| | - Henry Seligman
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Shunichi Doi
- Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Shingo Kuwata
- Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
| | - James P Howard
- National Heart and Lung Institute, Imperial College London, London, UK
| | | | | | - Yui Nakayama
- Department of Cardiovascular Medicine, St. Marianna University School of Medicine Yokohama City Seibu Hospital, Yokohama, Japan
| | - Mizuho Kasahara
- Department of Cardiovascular Medicine, St. Marianna University School of Medicine Yokohama City Seibu Hospital, Yokohama, Japan
| | - Norio Suzuki
- Department of Cardiovascular Medicine, St. Marianna University School of Medicine Yokohama City Seibu Hospital, Yokohama, Japan
| | - Hisao Matsuda
- Department of Cardiovascular Medicine, St. Marianna University School of Medicine Yokohama City Seibu Hospital, Yokohama, Japan
| | - Koichi Mizuno
- Department of Cardiovascular Medicine, St. Marianna University School of Medicine Yokohama City Seibu Hospital, Yokohama, Japan
| | - Yoshihiro J Akashi
- Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
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Giannini F, Candilio L, Mitomo S, Ruparelia N, Chieffo A, Baldetti L, Ponticelli F, Latib A, Colombo A. A Practical Approach to the Management of Complications During Percutaneous Coronary Intervention. JACC Cardiovasc Interv 2019; 11:1797-1810. [PMID: 30236352 DOI: 10.1016/j.jcin.2018.05.052] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2018] [Revised: 05/07/2018] [Accepted: 05/29/2018] [Indexed: 12/13/2022]
Abstract
Percutaneous coronary intervention relieves symptoms in patients with chronic ischemic heart disease resistant to optimal medical therapy and alters the natural history of acute coronary syndromes. However, adverse procedural outcomes may occur during the intervention. Knowledge of possible complications and their timely management are essential for the practicing cardiologist and can be life-saving for the patient. In this review, the authors summarize potential complications of percutaneous coronary intervention focusing on their practical management.
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Affiliation(s)
- Francesco Giannini
- Unit of Cardiovascular Interventions, IRCCS San Raffaele Scientific Institute, Milan, Italy.
| | - Luciano Candilio
- Unit of Cardiovascular Interventions, IRCCS San Raffaele Scientific Institute, Milan, Italy; Cardiovascular Department, Hammersmith Hospital, Imperial College, London, United Kingdom
| | - Satoru Mitomo
- Unit of Cardiovascular Interventions, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Neil Ruparelia
- Unit of Cardiovascular Interventions, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Alaide Chieffo
- Unit of Cardiovascular Interventions, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Luca Baldetti
- Unit of Cardiovascular Interventions, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Francesco Ponticelli
- Unit of Cardiovascular Interventions, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Azeem Latib
- Unit of Cardiovascular Interventions, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Antonio Colombo
- Unit of Cardiovascular Interventions, IRCCS San Raffaele Scientific Institute, Milan, Italy
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28
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Bink N, Mohan VB, Fakirov S. Recent advances in plastic stents: a comprehensive review. INT J POLYM MATER PO 2019. [DOI: 10.1080/00914037.2019.1685519] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Nienke Bink
- Plastics Centre of Excellence, Department of Mechanical Engineering, The University of Auckland, Auckland, New Zealand
- Centre for Advanced Composite Materials, Department of Mechanical Engineering, The University of Auckland, Auckland, New Zealand
- Department of Mechanics of Solids, Surfaces and Systems, Faculty of Engineering Technology, The University of Twente, Enschede, The Netherlands
| | - Velram Balaji Mohan
- Plastics Centre of Excellence, Department of Mechanical Engineering, The University of Auckland, Auckland, New Zealand
- Centre for Advanced Composite Materials, Department of Mechanical Engineering, The University of Auckland, Auckland, New Zealand
| | - Stoyko Fakirov
- Plastics Centre of Excellence, Department of Mechanical Engineering, The University of Auckland, Auckland, New Zealand
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29
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Drug-eluting coronary stents: insights from preclinical and pathology studies. Nat Rev Cardiol 2019; 17:37-51. [PMID: 31346257 DOI: 10.1038/s41569-019-0234-x] [Citation(s) in RCA: 148] [Impact Index Per Article: 24.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/25/2019] [Indexed: 01/02/2023]
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Iannaccone M, Gatti P, Barbero U, Bassignana A, Gallo D, Benedictis M, Helft G, Morbiducci U, Doronzo B, D'Ascenzo F. Impact of strut thickness and number of crown and connectors on clinical outcomes on patients treated with second‐generation drug eluting stent. Catheter Cardiovasc Interv 2019; 96:1417-1422. [DOI: 10.1002/ccd.28228] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Revised: 01/31/2019] [Accepted: 03/23/2019] [Indexed: 01/25/2023]
Affiliation(s)
| | - Paolo Gatti
- Division of Cardiology Città Della Salute e della Scienza Hospital Turin Italy
| | - Umberto Barbero
- Division of Cardiology SS. Annunziata Hospital Savigliano Italy
| | | | - Diego Gallo
- PolitoBIOMed Lab, Department of Mechanical and Aerospace Engineering Politecnico di Torino Turin Italy
| | | | - Gerard Helft
- Division of Cardiology Cardiology Institute, Pitié‐Salpêtrière Hospital, UPMC, APHP Paris France
| | - Umberto Morbiducci
- PolitoBIOMed Lab, Department of Mechanical and Aerospace Engineering Politecnico di Torino Turin Italy
| | | | - Fabrizio D'Ascenzo
- Division of Cardiology Città Della Salute e della Scienza Hospital Turin Italy
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31
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Chichareon P, Katagiri Y, Asano T, Takahashi K, Kogame N, Modolo R, Tenekecioglu E, Chang CC, Tomaniak M, Kukreja N, Wykrzykowska JJ, Piek JJ, Serruys PW, Onuma Y. Mechanical properties and performances of contemporary drug-eluting stent: focus on the metallic backbone. Expert Rev Med Devices 2019; 16:211-228. [DOI: 10.1080/17434440.2019.1573142] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
- Ply Chichareon
- Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
- Division of Cardiovascular Medicine, Department of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Hatyai, Songkhla, Thailand
| | - Yuki Katagiri
- Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Taku Asano
- Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Kuniaki Takahashi
- Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Norihiro Kogame
- Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Rodrigo Modolo
- Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
- Department of Internal Medicine, Cardiology Division, University of Campinas (UNICAMP). Campinas, Sao Paulo, Brazil
| | | | - Chun-Chin Chang
- ThoraxCenter, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Mariusz Tomaniak
- ThoraxCenter, Erasmus Medical Center, Rotterdam, the Netherlands
- First Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Neville Kukreja
- Department of Cardiology, East and North Hertfordshire NHS Trust, Hertfordshire, UK
| | | | - Jan J. Piek
- Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Patrick W. Serruys
- International Centre for Circulatory Health, NHLI, Imperial College London, London, UK
| | - Yoshinobu Onuma
- ThoraxCenter, Erasmus Medical Center, Rotterdam, the Netherlands
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Multi-Objective Optimization Design of Balloon-Expandable Coronary Stent. Cardiovasc Eng Technol 2019; 10:10-21. [PMID: 30673977 DOI: 10.1007/s13239-019-00401-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Accepted: 01/11/2019] [Indexed: 01/10/2023]
Abstract
PURPOSE Recent studies suggested that suboptimal delivery and longitudinal stent deformation can result in in-stent restenosis. Therefore, the purpose of this paper was to study the effect of stent geometry on stent flexibility and longitudinal stiffness (LS) and optimize the two metrics simultaneously. Then, the reliable and accurate relationships between metrics and design variables were established. METHODS A multi-objective optimization method based on finite element analysis was proposed for the investigation and improvement of stent flexibility and LS. The relative influences of design variables on the two metrics were evaluated on the basis of the main effects. Three surrogate models, namely, the response surface model (RSM), radial basis function neural network (RBF), and Kriging were employed and compared. RESULTS The accuracies of the three models in fitting flexibility were nearly similar, although Kriging made more accurate prediction in LS. The link width played important roles in flexibility and LS. Although the flexibility of the optimal stent decreased by 13%, the LS increased by 48.3%. CONCLUSIONS The obtained results showed that the multi-objective optimization method is efficient in predicting an optimal stent design. The method presented in this paper can be useful in optimizing stent design and improving the comprehensive mechanical properties of stents.
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Barkholt TØ, Ormiston JA, Ding P, Webber B, Ubod B, Waite S, Webster MW. Coronary balloon catheter tip damage. A bench study of a clinical problem. Catheter Cardiovasc Interv 2018; 92:883-889. [PMID: 29219238 PMCID: PMC6282566 DOI: 10.1002/ccd.27441] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Accepted: 11/11/2017] [Indexed: 11/09/2022]
Abstract
Objectives To confirm clinically that coronary balloon catheter tips may be damaged during bifurcation treatment with side‐branch access through the side of a stent. On the bench, we aimed to assess the susceptibility of different balloon designs to damage. We compared catheter tip widths. We tested whether balloon tip flaring can cause stent distortion. Background We had observed that balloon catheters that failed to cross to a side‐branch frequently exhibited tip damage. Methods and Results We examined microscopically for damage 82 balloon tips after clinical side‐branch access. In a bench study, the forces required to compress catheter tips 0.5 mm were compared to assess susceptibility to damage. We compared tip widths of balloons of different nominal inflation diameters. We examined stents after side‐branch access for distortion. In 42 of 48 (88%) of balloon tips from patients with resistance to or failure to cross through the side of a stent there was tip damage. Even when the balloon crossed without perceptible resistance, tip damage occurred in over half of balloons 18/34 (53%). Some balloon designs were more resistant to damage than others. Tips from balloons of different nominal diameters from the same manufacturer had the same width. Stent distortion caused by damaged balloon tips is improved by kissing balloon post‐dilatation. Conclusions Balloon tip damage is common with crossing between stent struts. This is one cause of failure of a balloon to access a side‐branch and a new balloon should be used. If stent distortion is suspected, it should be corrected with kissing balloon post‐dilatation.
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Affiliation(s)
- Trine Ø Barkholt
- Department of Cardiology, Aarhus University Hospital Skejby, Aarhus, Denmark
| | - John A Ormiston
- Mercy Angiography, Auckland, New Zealand.,Auckland City Hospital, Auckland, New Zealand.,University of Auckland School of Medicine, Auckland, New Zealand
| | - Patricia Ding
- Whangarei Hospital, 2 Hospital Road, Private Bag 9742, Whangarei, 0148, New Zealand
| | | | - Ben Ubod
- Mercy Angiography, Auckland, New Zealand
| | - Stephen Waite
- Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand
| | - Mark Wi Webster
- Mercy Angiography, Auckland, New Zealand.,Auckland City Hospital, Auckland, New Zealand.,University of Auckland School of Medicine, Auckland, New Zealand
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Ribeiro NS, Folgado J, Rodrigues HC. Surrogate-based visualization and sensitivity analysis of coronary stent performance: A study on the influence of geometric design. INTERNATIONAL JOURNAL FOR NUMERICAL METHODS IN BIOMEDICAL ENGINEERING 2018; 34:e3125. [PMID: 29956892 DOI: 10.1002/cnm.3125] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Revised: 06/21/2018] [Accepted: 06/21/2018] [Indexed: 06/08/2023]
Abstract
The main goal of this numerical study is to assess the impact of geometric design perturbations on the performance of a representative coronary stent platform. In this context, first, a design parameterization model was defined for the stent under study. After, a set of metrics characterizing stent performance, namely, vessel injury, radial recoil, bending resistance, longitudinal resistance, radial strength, the risk of fracture, prolapse index, and dogboning were evaluated within the context of a finite element analysis. Afterwards, accurate surrogate models were developed, using the efficient global optimization algorithm, as predictive tools in the execution of tasks that normally require a high number of model evaluations, such as global sensitivity analysis and visualization. In the end, the dependence of the output response surfaces on the geometric parameters was mechanically interpreted, which allowed us to understand the complex interplay that exists between the considered design variables and the defined performance metrics.
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Affiliation(s)
- Nelson S Ribeiro
- IDMEC, Instituto Superior Técnico, Universidade de Lisboa, Lisbon, Portugal
| | - João Folgado
- IDMEC, Instituto Superior Técnico, Universidade de Lisboa, Lisbon, Portugal
| | - Hélder C Rodrigues
- IDMEC, Instituto Superior Técnico, Universidade de Lisboa, Lisbon, Portugal
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35
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Shreenivas SS, Kereiakes DJ. Evolution of the SYNERGY bioresorbable polymer metallic coronary stent. Future Cardiol 2018; 14:307-317. [DOI: 10.2217/fca-2018-0040] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
The SYNERGY stent is composed of thin, platinum-chromium metal alloy struts and an ultrathin, bioabsorbable poly-DL-lactide-co-glycolide polymer limited to the abluminal strut surface which elutes everolimus prior to complete resorption within 3–4 months. SYNERGY was designed to reduce inflammation and facilitate stent healing compared with permanent polymer drug eluting stents. This review summarizes the preclinical and clinical development of SYNERGY, its integration into clinical practice and future directions.
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Affiliation(s)
- Satya S Shreenivas
- The Christ Hospital Heart & Vascular Center/The Carl & Edyth Lindner Center for Research & Education at The Christ Hospital, 2123 Auburn Avenue, Suite 424, Cincinnati 45219, OH, USA
| | - Dean J Kereiakes
- The Christ Hospital Heart & Vascular Center/The Carl & Edyth Lindner Center for Research & Education at The Christ Hospital, 2123 Auburn Avenue, Suite 424, Cincinnati 45219, OH, USA
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36
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The potential hazard of a non-slip element balloon causing distal longitudinal stent deformation: the first clinical experience and in vitro assessment. Cardiol J 2018; 26:645-652. [PMID: 29924377 DOI: 10.5603/cj.a2018.0065] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Revised: 06/14/2018] [Accepted: 06/10/2018] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND A new complication, longitudinal stent deformation (LSD), is increasingly reported with recent intracoronary stent designs. There have been experiences of unusual cases of distal LSD caused by entrapment of a Lacrosse® non-slip element (NSE) balloon (Goodman Co., Ltd., Nagoya, Japan), which has three flexible nylon elements to prevent slippage. Accordingly, the aim of this study is to report the clinical experience of distal LSD caused by the NSE in the documented center and to investigate the incidence and mechanisms involved. METHODS Coronary intervention cases were retrospectively reviewed using the NSE balloon in hospital between May 2014 and June 2017. In bench testing, distal LSD was reproduced in a silicon tube model to identify its mechanism. RESULTS A total of 95 patients with 107 lesions underwent coronary interventions with NSE. Of these, 72 lesions (12 de-novo lesions and 60 in-stent restenosis) were treated using in-stent dilatation. Two distal LSD cases occurred, representing an incidence of 2.78% (2/72) among all procedures; 16.7% (2/12) of the de-novo lesions developed LSD. In vitro experimentation allowed indentification of the mechanisms involved and bailout strategies. CONCLUSIONS This is the first study to evaluate NSE balloon catheter entrapment complicated by distal LSD in which reconstruction of the deformed stent and retrieval of the NSE could be achieved successfully. There is a potential hazard for distal LSD during post-dilatation using the NSE balloon due to its structural characteristics. Careful assessment is needed to prevent this complication.
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Yang JX, Yeh RW. Safety and effectiveness of zotarolimus-eluting stents for percutaneous coronary intervention: a systematic review. Future Cardiol 2018; 14:251-267. [DOI: 10.2217/fca-2017-0091] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Drug-eluting stents revolutionized the treatment of coronary artery disease with vastly improved outcomes compared with bare metal stents. As stent technology has evolved, a wide variety of antiproliferative drugs have been developed to prevent stent restenosis and stent thrombosis. The Resolute stent system (Medtronic, CA, USA) elutes zotarolimus from a multipolymer blend to prevent early and late stent-related complications. The Resolute stents have evolved from the initial Resolute stent, to the Resolute Integrity™ and most recently, the Resolute Onyx™. These stents have been studied across a wide range of patients and coronary syndromes. They compare similarly in performance to their contemporary second generation stents. We present a review of the major trials involving these zotarolimus-eluting stents.
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Affiliation(s)
- Jesse X Yang
- Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA
| | - Robert W Yeh
- Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA
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38
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Mylotte D. The humble case report: bottom of the evidence-based medical pyramid or the foundation of clinical research? EUROINTERVENTION 2018; 13:e2097-e2098. [PMID: 29624171 DOI: 10.4244/eijv13i18a343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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39
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5-Year Outcome Following Randomized Treatment of All-Comers With Zotarolimus-Eluting Resolute Integrity and Everolimus-Eluting PROMUS Element Coronary Stents. JACC Cardiovasc Interv 2018. [DOI: 10.1016/j.jcin.2017.11.031] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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40
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Ormiston JA, Kassab G, Finet G, Chatzizisis YS, Foin N, Mickley TJ, Chiastra C, Murasato Y, Hikichi Y, Wentzel JJ, Darremont O, Iwasaki K, Lefèvre T, Louvard Y, Beier S, Hojeibane H, Netravali A, Wooton J, Cowan B, Webster MW, Medrano-Gracia P, Stankovic G. Bench testing and coronary artery bifurcations: a consensus document from the European Bifurcation Club. EUROINTERVENTION 2018; 13:e1794-e1803. [PMID: 29131803 DOI: 10.4244/eij-d-17-00270] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
This is a consensus document from the European Bifurcation Club concerning bench testing in coronary artery bifurcations. It is intended to provide guidelines for bench assessment of stents and other strategies in coronary bifurcation treatment where the United States Food and Drug Administration (FDA) or International Organization for Standardization (ISO) guidelines are limited or absent. These recommendations provide guidelines rather than a step-by-step manual. We provide data on the anatomy of bifurcations and elastic response of coronary arteries to aid model construction. We discuss testing apparatus, bench testing endpoints and bifurcation nomenclature.
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41
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Cuenza LR, Yeo KK. Stent accordion phenomenon visualized with optical coherence tomography. Cardiovasc Diagn Ther 2018; 7:640-642. [PMID: 29302469 DOI: 10.21037/cdt.2017.09.04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Lucky R Cuenza
- Philippine Heart Centre, Manila, Philippines.,National Heart Centre Singapore, Singapore
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42
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Sumi T, Ishii H, Tanaka A, Suzuki S, Kojima H, Iwakawa N, Aoki T, Hirayama K, Mitsuda T, Harada K, Negishi Y, Ota T, Kada K, Murohara T. Impact of post-dilatation on longitudinal stent elongation: An in vitro study. J Cardiol 2017; 71:464-470. [PMID: 29198920 DOI: 10.1016/j.jjcc.2017.11.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Revised: 10/18/2017] [Accepted: 11/02/2017] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To evaluate whether balloon inflation for post-dilatation causes longitudinal stent deformation (LSD). METHODS AND RESULTS Two stents, sized 2.5mm×28mm and 3.5mm×28mm (Nobori®, biodegradable polymer biolimus-eluting stent; Ultimaster®, biodegradable polymer sirolimus-eluting stent; Terumo Co., Tokyo, Japan), were deployed at nominal pressure in straight and tapered silicon vessel models. Then, post-dilatation was performed in two ways: dilatation from the distal (D-P group) or proximal (P-D group) side of the stent. Microscopic findings showed that the stents were elongated during every step of the procedure regardless of the post-dilatation method and type of vessel model. The D-P group showed linear elongation during each step of post-dilatation (straight model: 28.7±0.3mm vs. 29.9±0.3mm, p=0.002; tapered model: 28.0±0.1mm vs. 29.9±0.1mm, p<0.001). In contrast, in the P-D group, the most significant change was observed in the first step of post-dilatation and only slight changes were observed thereafter (straight model: 28.6±0.1mm vs. 29.5±0.1mm, p<0.001; tapered model: 28.2±0.1mm vs. 29.5±0.1mm, p<0.001). Optical frequency domain imaging analysis showed that the frequency of stent strut malapposition was positively correlated with the percentage change in stent length (r=0.74, p<0.0001). CONCLUSION LSD was observed during every step of post-dilatation in both the straight and tapered vessel models. However, some differences were observed between the D-P and P-D groups. Minimizing stent strut malapposition may reduce the risk of LSD.
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Affiliation(s)
- Takuya Sumi
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya University, Nagoya, Japan
| | - Hideki Ishii
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya University, Nagoya, Japan.
| | - Akihito Tanaka
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya University, Nagoya, Japan
| | - Susumu Suzuki
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya University, Nagoya, Japan
| | - Hiroki Kojima
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya University, Nagoya, Japan
| | - Naoki Iwakawa
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya University, Nagoya, Japan
| | - Toshijiro Aoki
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya University, Nagoya, Japan
| | - Kenshi Hirayama
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya University, Nagoya, Japan
| | - Takayuki Mitsuda
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya University, Nagoya, Japan
| | - Kazuhiro Harada
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya University, Nagoya, Japan
| | - Yosuke Negishi
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya University, Nagoya, Japan
| | - Tomoyuki Ota
- Department of Cardiology, Nagoya Central Hospital, Nagoya, Japan
| | - Kenji Kada
- Department of Cardiology, Japan Community Health Care Organization Chukyo Hospital, Nagoya, Japan
| | - Toyoaki Murohara
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya University, Nagoya, Japan
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Si D, Yang H, Liu G, Tong Y, He Y. Treatment of longitudinal stent compression under intravenous ultrasound guidance: A case report. Medicine (Baltimore) 2017; 96:e9405. [PMID: 29390556 PMCID: PMC5758258 DOI: 10.1097/md.0000000000009405] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
RATIONALE Longitudinal stent compression is a rare phenomenon, which has been increasingly reported in recent years. PATIENT CONCERNS Following 2 stents implanted into the middle and proximal segments of the left anterior descending (LAD) artery, longitudinal stent compression occurred when a post-dilation balloon was introduced into the proximal stent opening. DIAGNOSE The intravenous ultrasound (IVUS) examination revealed overlapping at the opening of the proximal stent and poor stent adherence. INTERVENTIONS Another balloon was carefully inserted into the opening for post-dilation, followed by angiography and IVUS examination. OUTCOMES The IVUS examination indicated that the overlapping at the opening of the proximal stent was improved and the stents were well adhered. LESSONS Such compression may be prevented by gentle and careful balloon maneuverability and improved with the use of additional balloon angioplasty or stent implantation.
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44
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Homorodean C, Ober MC, Iancu AC, Olinic M, Tataru D, Spinu M, Olinic DM, Burzotta F, Trani C, Erglis A. How should I treat this mini-crush stenting complication? EUROINTERVENTION 2017; 13:1248-1252. [PMID: 29151440 DOI: 10.4244/eij-d-16-00689] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Calin Homorodean
- University of Medicine and Pharmacy "Iuliu Hatieganu", Cluj-Napoca, Romania
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45
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Edelman ER, Wang PJ. Needles in Our Technology Haystacks: Defining Efficacy Is Easy, Characterizing Complications Is the Challenge. Circ Cardiovasc Interv 2017; 10:CIRCINTERVENTIONS.117.006059. [PMID: 29146674 DOI: 10.1161/circinterventions.117.006059] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
| | - Pei-Jiang Wang
- From the Massachusetts Institute of Technology, Cambridge
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46
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Choudhury TR, Al-Saigh S, Burley S, Li L, Shakhshir N, Mirhosseini N, Wang T, Arnous S, Khan MA, Mamas MA, Fraser DGW. Longitudinal deformation bench testing using a coronary artery model: a new standard? Open Heart 2017; 4:e000537. [PMID: 29226914 PMCID: PMC5708317 DOI: 10.1136/openhrt-2016-000537] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Revised: 05/15/2017] [Accepted: 06/13/2017] [Indexed: 11/03/2022] Open
Abstract
Objectives To compare susceptibility of five different stent platforms with longitudinal stent deformation (LSD) using a clinically relevant bench testing model simulating both short and long malapposed lengths. Background Recent data suggest that design modifications to the Promus Element stent which led to the Promus Premier stent has reduced susceptibility to LSD. However, susceptibility to LSD at long malapposed lengths has not been tested. Furthermore, the mechanisms behind susceptibility to LSD are as yet unclear. Methods The Omega, Integrity, Multilink 8, Biomatrixand Promus Premier stent platforms were tested. The Omega, Integrity and Multilink 8 platforms were used in place of their drug-eluting equivalents. 3.5 mm stents were deployed in a stepped tube with the distal portion fixed and the proximal test section exposed. The force required to compress stents by a fixed distance at different exposed lengths was compared. Symmetrical and point loading were used. Results The Promus Premier was longitudinally as strong as Multilink and Integrity at a short exposed length (4 mm) but weaker, in between Omega and the other platforms, at longer exposed lengths (12 mm). As previously noted, the Omega (Promus Element) platform was significantly weaker than the other stents and Biomatrix was the strongest stent. Conclusion Susceptibility to LSD varies depending on length of malapposed segment when tested using a clinically relevant model as in this study. The mechanisms behind the susceptibility are likely multifactorial, including connector number, strut thickness, connector alignment and ring orientation but remain to be elucidated.
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Affiliation(s)
| | - Salwan Al-Saigh
- School of Mechanical, Aerospace and Civil Engineering, The University of Manchester, Manchester, UK.,College of Engineering, University of Mosul, Mosul, Iraq
| | - Steve Burley
- School of Mechanical, Aerospace and Civil Engineering, The University of Manchester, Manchester, UK
| | - Lin Li
- School of Mechanical, Aerospace and Civil Engineering, The University of Manchester, Manchester, UK
| | - Nizar Shakhshir
- Manchester Heart Centre, Manchester Royal Infirmary, Manchester, UK
| | - Nazanin Mirhosseini
- Faculty of Medical and Human sciences, University of Manchester, Manchester, UK
| | - Tao Wang
- Institute of Human Development, University of Manchester, Manchester, UK
| | - Samer Arnous
- Manchester Heart Centre, Manchester Royal Infirmary, Manchester, UK
| | - Muhammad A Khan
- Manchester Heart Centre, Manchester Royal Infirmary, Manchester, UK
| | - Mamas A Mamas
- Keele Cardiovascular Research Group, Keele University, Stoke-on-Trent, UK
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47
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Watson T, Webster MWI, Ormiston JA, Ruygrok PN, Stewart JT. Long and short of optimal stent design. Open Heart 2017; 4:e000680. [PMID: 29118997 PMCID: PMC5663262 DOI: 10.1136/openhrt-2017-000680] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2017] [Accepted: 09/26/2017] [Indexed: 01/25/2023] Open
Abstract
The ideal stent must fulfil a broad range of technical requirements. Stents must be securely crimped onto the delivery balloon and, in this form, must have a low profile and be sufficiently flexible to facilitate deliverability to the lesion site without distortion or displacement. Following expansion, stents must exert sufficient radial force on the vessel wall to overcome lesion resistance and elastic recoil. To achieve an optimal lumen diameter, the lesion must be uniformly and adequately scaffolded, with minimal tissue prolapse between struts but without compromising side-branch access. Furthermore, the deployed stent must conform to the vessel curvature to minimise vessel distortion, particularly at the stent edges. Radio-opacity is also important to guide safe positioning, adequate deployment and postdilataion and to permit assessment of optimal stent expansion. Equally though, the stent lumen must also be sufficiently visible to allow radiographic assessment of flow dynamics and restenosis. Efforts to optimise one characteristic of stent design may have detrimental effects on another. Thus, currently available stents all reflect a compromise between competing desirable features and have subtle differences in their performance characteristics. Striving to achieve stents with optimal deliverability, conformability and radial strength led to a reduction in longitudinal strength. The importance of this parameter was highlighted by complications occurring in the real-world setting where percutaneous coronary intervention is often undertaken in challenging anatomy. This review focuses on aspects of stent design relevant to longitudinal strength.
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Affiliation(s)
- Timothy Watson
- Department of Cardiology, Tan Tock Seng Hospital, Singapore, Singapore.,Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Mark W I Webster
- Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand.,Green Lane Cardiovascular Service, Auckland City Hospital, Auckland, New Zealand
| | - John A Ormiston
- Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand.,Green Lane Cardiovascular Service, Auckland City Hospital, Auckland, New Zealand
| | - Peter N Ruygrok
- Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand.,Green Lane Cardiovascular Service, Auckland City Hospital, Auckland, New Zealand
| | - James T Stewart
- Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand.,Green Lane Cardiovascular Service, Auckland City Hospital, Auckland, New Zealand
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48
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Sabbah M, Kadota K, Kubo S, Hyodo Y, Otsuru S, Hasegawa D, Tada T, Habara S, Tanaka H, Fuku Y, Goto T. Clinical and angiographic outcomes of axial stent deformations in unrestricted real world patient population. J Interv Cardiol 2017; 30:550-557. [DOI: 10.1111/joic.12445] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2017] [Revised: 08/24/2017] [Accepted: 08/24/2017] [Indexed: 11/26/2022] Open
Affiliation(s)
- Mahmoud Sabbah
- Faculty of Medicine; Department of Cardiology; Suez Canal University; Ismailia Egypt
- Department of Cardiology; Kurashiki Central Hospital; Kurashiki Japan
| | - Kazushige Kadota
- Department of Cardiology; Kurashiki Central Hospital; Kurashiki Japan
| | - Shunsuke Kubo
- Department of Cardiology; Kurashiki Central Hospital; Kurashiki Japan
| | - Yusuke Hyodo
- Department of Cardiology; Kurashiki Central Hospital; Kurashiki Japan
| | - Suguru Otsuru
- Department of Cardiology; Kurashiki Central Hospital; Kurashiki Japan
| | - Daiji Hasegawa
- Department of Cardiology; Kurashiki Central Hospital; Kurashiki Japan
| | - Takeshi Tada
- Department of Cardiology; Kurashiki Central Hospital; Kurashiki Japan
| | - Seiji Habara
- Department of Cardiology; Kurashiki Central Hospital; Kurashiki Japan
| | - Hiroyuki Tanaka
- Department of Cardiology; Kurashiki Central Hospital; Kurashiki Japan
| | - Yasushi Fuku
- Department of Cardiology; Kurashiki Central Hospital; Kurashiki Japan
| | - Tsuyoshi Goto
- Department of Cardiology; Kurashiki Central Hospital; Kurashiki Japan
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49
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Piccolo R, Franzone A, Windecker S. From bare metal to barely anything: an update on coronary stenting. Heart 2017; 104:533-540. [DOI: 10.1136/heartjnl-2016-310877] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
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50
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Shah BR. Longitudinal Stent Deformation at Aneurysm Site: Flexibility at the Expense of Longitudinal Integrity. J Clin Diagn Res 2017; 11:OD15-OD16. [PMID: 28892966 DOI: 10.7860/jcdr/2017/30006.10297] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Accepted: 06/27/2017] [Indexed: 11/24/2022]
Abstract
Longitudinal stent deformation is a recently described complication of percutaneous coronary intervention. Novel stents with thin struts and reduced number of fixed links between cells improve flexibility and deliverability but in certain cases it may reduce longitudinal strength and thereby increase the risk of longitudinal deformation. Although longitudinal deformation of coronary stents is an infrequent finding, it requires clinical attention as it may lead to catastrophic clinical outcomes. We report a case of longitudinal deformation of coronary stent observed at our institution while treating ostial lesion and aneurysm of left anterior descending artery. Longitudinal deformation was identified during the procedure and treated with the deployment of another stent. Three-month follow-up of the patient was found satisfactory without any incidence of stent thrombosis.
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Affiliation(s)
- Bhupesh R Shah
- Associate Professor, Department of Cardiology, NHL Municipal Medical College, Ahmedabad, Gujarat, India
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