Balloon-Expandable Intraarterial Stents: Effect of Antithrombotic Medication on Thrombus Formation

Palmaz, Julio C.; Garcia, O.; Kopp, David T.; Tio, Fermin O.; Ciaravino, Victor; Schatz, Richard; Rees, Chet R.; Alvarado, Ricardo; Lancaster, Jeffrey; Borchert, R. D.

doi:10.1007/978-3-642-73736-7_21

Cited by 16 publications

(10 citation statements)

References 17 publications

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“…The mechanical properties and biocompatibility profile of this stent have been previously described in multiple animal models. [18][19][20]21,29 The second stent used in this study was developed by Schatz et a125 as a modification of the Palmaz design to improve flexibility (Figure lb). This stent is composed of two shorter (7 mm) segments of slotted tubes connected by a small (1 mm) bridging strut, a design that permits longitudinal flexibility while preserving the radial noncompliance of each component segment upon expansion.…”

Section: Patient Selectionmentioning

confidence: 99%

“…Furthermore, perioperative occlusion after PTCA is an ominous predictor of both in-hospital and late ischemic complications,9-11 prompting investigators to explore permanent vascular implants as an alternative method to maintain vessel patency after angioplasty.12-29 One such device is a balloon-expandable intracoronary stent developed by Palmaz and colleagues. [18][19][20][21][22][23]25 The focus of this report is to describe the procedural results and short-term follow-up obtained during a multicenter investigation of this device.…”

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confidence: 99%

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Clinical experience with the Palmaz-Schatz coronary stent. Initial results of a multicenter study.

et al. 1991

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Stenting of native coronary arteries with a balloon-expandable stent was attempted in 226 patients after elective angioplasty. Delivery of the device was successful in 213 (94%) of the patients. Of these, 39 received aspirin and dipyridamole only (group 1) and 174 received aspirin, dipyridamole, and warfarin for 1-3 months (group 2). There was no abrupt closure (c1 day) or perioperative death in either group. In-hospital or perioperative complications in group 1 compared with group 2 were as follows: subacute closure (1-14 days), seven (18%) patients versus one (0.6%) patient, respectively, p<0.0001; myocardial infarction, five (13%) patients versus one (0.6%) patient, respectively; condition requiring urgent bypass surgery, one (2.5%) patient versus no patients, respectively. Thus, the incidence of major complications such as death, myocardial infarction, or a condition requiring urgent bypass surgery was 15% in group 1 and 0.6% in group 2. Clinical follow-up revealed that 92% of the patients were asymptomatic at 3 months after stenting compared with 6% before stenting (p<0.0001). Of the 13 patients who were symptomatic, nine underwent cardiac catheterization and, ultimately, successful elective coronary angioplasty or bypass surgery. We conclude that a high delivery success rate can be expected with this device and that clinical thrombosis is less frequent in anticoagulated patients than in nonanticoagulated patients. Furthermore, in this selected patient population, coronary stenting results in a low incidence of in-hospital and perioperative complications. Clinical success, defined by absence of symptoms, appears to be sustained at 3 months. (Circulation 1991;83:148- From the Cardiology Division of the Arizona Heart Institute Foundation (R.A.S, R.P., I.M.P., S

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Section: Patient Selectionmentioning

confidence: 99%

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confidence: 99%

Clinical experience with the Palmaz-Schatz coronary stent. Initial results of a multicenter study.

et al. 1991

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“…Durante a experiência inicial com stent, a inadequação dos esquemas de anticoagulação foi considerada como principal responsável pela incidência de TSA. Este conceito baseava-se em um estudo experimental de Palmaz e col, que mostrava que a deposição plaquetária sobre stents era menor se houvesse administração de heparina, ácido acetil-salicílico, dipiridamol e dextran se comparado apenas com heparina ou heparina + ácido acetilsalicílico 102 . Da mesma forma, um ensaio inicial com o stent de Palmaz-Schatz registrou incidência de TSA da prótese abaixo de 1% com anticoagulantes orais, frente a 18% de TSA com tratamento antiplaquetário 103 .…”

Section: A Trombose Subagudaunclassified

Stents. Uma revisão da literatura

Guérios

Bueno

Andrade

et al. 1998

Arq. Bras. Cardiol.

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Revisão Aspectos históricosCharles Stent foi um dentista inglês que há mais de um século idealizou um material dentário para moldagem. Mais tarde, este material foi utilizado como suporte para tecidos vivos em cicatrização 1 . Em 1964, Dotter e Judkins descreveram o procedimento original de angioplastia com o uso de cateter de dilatação em circulação periférica, antevendo sua aplicabilidade em circulação coronária 2 . Para combater o alto índice de reestenose que se seguia à angioplastia, foi proposto também por Dotter, em 1969, o implante de uma prótese endovascular que promovesse sustentação da parede do vaso após a intervenção. Por semelhança, esta prótese recebeu o nome de stent. Em sua experiência inicial usando enxertos tubulares plásticos, houve trombose de todos eles em 24h. Contudo, os resultados melhoraram quando se usaram molas de aço inoxidável 3 . Apesar do entusiasmo de Dotter, a técnica de dilatação transluminal percutânea de obstruções vasculares não obteve repercussão nos Estados Unidos. Foi, entretanto, empregada e modificada em vários centros europeus. Andreas Grüntzig, na Suíça, desenvolveu um cateter de dilatação com dupla luz e um balão não-elástico, usando-os com sucesso em artérias femorais e poplíteas. Estendeu então o seu uso para artérias coronárias, em 1977 4 , o que impulsionou a cardiologia invasiva diagnóstica para a era do intervencionismo. A partir de então, tem se observado rápi-do crescimento tecnológico e constante aperfeiçoamento neste campo. Atualmente, mais de 400 mil norte-americanos e quase 900 mil pacientes em todo o mundo são submetidos à angioplastia transluminal coronária (ATC) a cada ano 5,6 . Foram desenvolvidos métodos alternativos e/ou complementares à técnica tradicional, como a aterectomia (direcional, rotacional e por laser) e a abordagem farmacológica (antagonistas da serotonina, inibidores da enzima de conversão da angiotensina, estimuladores da liberação de óxi-do nítrico, anticorpos anti-glicoproteína IIB/IIIA, entre outros) 7 . Avançou-se no entendimento da doença aterosclerótica e dos efeitos da ATC sobre ela com o advento da angioscopia e do ultra-som intravascular.

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“…Antiplatelet therapy, particularly with dextran, has been important in limiting acute throm bosis of Palmaz stents in dogs [14], In animals, complete endothelialization of this stent occurs in 30-60 days resulting ultimately in a smooth luminal surface at which time anticoagulation can be discontinued [15]. However, we still recommend an aggressive anticoagulation regi men with warfarin, aspirin and dipyridamole for 90 days.…”

Section: Case Reportsmentioning

confidence: 99%

“…However, the central veins are relatively stationary. The placement of stents provides a foreign body stimulus to thrombosis [14], The propensity to thrombosis seems to be related to the size of the vessel and rate of blood flow.…”

Section: Case Reportsmentioning

confidence: 99%

Balloon Expandable Stents to Treat Central Venous Stenoses in Hemodialysis Patients

et al. 1992

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Vascular access failure in hemodialysis patients remains a significant problem. The use of thrombolytic agents and balloon angioplasty instead of or in conjunction with surgical revision, has been helpful in increasing the life span of vascular access in these patients. The application of newer endovascular therapies, such as vascular stents, may further improve the salvage rate of hemodialysis access sites. These stents may be particularly valuable in treating stenoses in large central veins. We present 2 cases in which a balloon-expandable Palmaz® stent was used to treat a central venous stenosis causing signs of vascular access failure.

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Balloon-Expandable Intraarterial Stents: Effect of Antithrombotic Medication on Thrombus Formation

Cited by 16 publications

References 17 publications

Clinical experience with the Palmaz-Schatz coronary stent. Initial results of a multicenter study.

Clinical experience with the Palmaz-Schatz coronary stent. Initial results of a multicenter study.

Stents. Uma revisão da literatura

Balloon Expandable Stents to Treat Central Venous Stenoses in Hemodialysis Patients

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