Coronary-Artery Stents

Serruys, Patrick W.; Kutryk, Michael J.B.; Ong, Andrew T.L.

doi:10.1056/nejmra051091

Cited by 642 publications

(363 citation statements)

References 82 publications

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“…1,2 The advent of DES has also raised safety concerns regarding stent thrombosis (ST), which is a catastrophic, albeit infrequent, complication that results in myocardial infarction (MI) or sudden cardiac death. 3,4 However, little is known about the long-term clinical outcomes after very late stent thrombosis (VLST) detection and this study is aimed at assessing longterm clinical outcomes after angiographically documented VLST of DES.…”

Section: Introductionmentioning

confidence: 99%

Long‐Term Clinical Outcomes After Angiographically Defined Very Late Stent Thrombosis of Drug‐Eluting Stent

Kim

et al. 2009

Clinical Cardiology

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BackgroundThe advent of drug‐eluting stent (DES) use has raised concerns regarding later occurring stent thrombosis, especially very late stent thrombosis (VLST), and little is known about long‐term clinical outcomes after VLST occurrence.HypothesisLong‐term clinical outcomes after detection of VLST may be poor.MethodWe evaluated 3572 consecutive patients who received DES implantation from May 2004 to July 2007 at 3 hospitals. The primary outcomes were a composite of major adverse cardiac events (MACE) including cardiac death, myocardial infarction (MI), target‐lesion revascularization (TLR), and target‐vessel revascularization (TVR) after VLST occurrence.ResultsWe identified 19 patients (0.53%) with angiographically documented stent thrombosis developing over 1 year after DES implantation. The mean time to VLST occurrence was 899 days (899 ± 353). Discontinuation of antiplatelet drugs was noted in 4 (21%) patients and the average duration of discontinuation was 4 days. Clinical presentations of VLST were mainly MI (17 patients, 89%). Balloon angioplasty was only performed in 12 patients (63%) and stent implantation in 7 patients (37%). Mean follow‐up duration from VLST occurrence was 620 days (620±256). During clinical follow‐up after VLST occurrence, no cardiac deaths or MIs were detected. Target‐vessel revascularization was done in 2 (11%) patients and TLR in 1 patient (6%). Major adverse cardiac events occurred in 3 (16%) patients during long‐term clinical follow‐up.ConclusionsClinical presentation of VLST after DES implantation is associated with serious adverse events, such as MI. Long‐term follow‐up outcomes after VLST occurrence appear unfavorable and more data from larger studies are warranted. Copyright © 2009 Wiley Periodicals, Inc.

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Section: Introductionmentioning

confidence: 99%

Long‐Term Clinical Outcomes After Angiographically Defined Very Late Stent Thrombosis of Drug‐Eluting Stent

Kim

et al. 2009

Clinical Cardiology

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“…The combination of improved tolerability, sustained release, and vascular targeting could potentially provide a safe and efficacious option in the management of CAD. P ercutaneous coronary interventions (PCIs) using drug-eluting stents (DESs) are credited with significant reductions in vessel restenosis, due to the effective combination of a drug delivery system and mechanical scaffold (1). Despite the extensive clinical use of DESs to maintain vascular patency, not all coronary lesions are amenable to DES placement (2).…”

mentioning

confidence: 99%

In vivo prevention of arterial restenosis with paclitaxel-encapsulated targeted lipid–polymeric nanoparticles

Chan

Rhee

Drum

et al. 2011

Proc. Natl. Acad. Sci. U.S.A.

125

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Following recent successes with percutaneous coronary intervention (PCI) for treating coronary artery disease (CAD), many challenges remain. In particular, mechanical injury from the procedure results in extensive endothelial denudation, exposing the underlying collagen IV-rich basal lamina, which promotes both intravascular thrombosis and smooth muscle proliferation. Previously, we reported the engineering of collagen IV-targeting nanoparticles (NPs) and demonstrated their preferential localization to sites of arterial injury. Here, we develop a systemically administered, targeted NP system to deliver an antiproliferative agent to injured vasculature. Approximately 60-nm lipid-polymeric NPs were surface functionalized with collagen IV-targeting peptides and loaded with paclitaxel. In safety studies, the targeted NPs showed no signs of toxicity and a ≥3.5-fold improved maximum tolerated dose versus paclitaxel. In efficacy studies using a rat carotid injury model, paclitaxel (0.3 mg/kg or 1 mg/kg) was i.v. administered postprocedure on days 0 and 5. The targeted NP group resulted in lower neointima-to-media (N/M) scores at 2 wk versus control groups of saline, paclitaxel, or nontargeted NPs. Compared with sham-injury groups, an ∼50% reduction in arterial stenosis was observed with targeted NP treatment. The combination of improved tolerability, sustained release, and vascular targeting could potentially provide a safe and efficacious option in the management of CAD. P ercutaneous coronary interventions (PCIs) using drug-eluting stents (DESs) are credited with significant reductions in vessel restenosis, due to the effective combination of a drug delivery system and mechanical scaffold (1). Despite the extensive clinical use of DESs to maintain vascular patency, not all coronary lesions are amenable to DES placement (2). In addition, DESs are associated with delayed endothelialization (3) and increased thrombogenicity (4, 5) that require extended antiplatelet treatment (6). In some cases, only bare metal stents (BMSs) may be applied, which lack the benefit of antirestenotic therapy and instead stimulate neointimal smooth muscle cell (SMC) proliferation (7,8).Nanomedicines may offer improvements to existing clinical treatments, including those for cardiovascular disorders (9, 10). Sub-100-nm organic nanoparticles (NPs) combine useful features of ultrasmall size (11, 12), surface modification (13), controlled drug release, biodegradability, and biocompatibility (14). Liposomal, polymeric, and albumin-based NPs have been formulated to improve drug solubility and deliver paclitaxel at doses higher than otherwise possible in circulation (15-17). Temporal control of drug delivery may facilitate endothelial healing after injury, as NPs may be used to deliver antiproliferative agents to the vascular wall when neointimal proliferation is most active, followed by complete degradation and clearance (18). Targeted NPs that bind to exposed antigens in injured arteries may help to achieve therapeutic doses at sites of injury, b...

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“…Both drugs interfere with mitosis. The DES has been consistently shown superior to the BMS [255][256][257].…”

Section: Intra-arterial Stentsmentioning

confidence: 99%

A Discussion of the Role of Complex Evolved Systems in the Development of Invasive Cardiovascular Interventions as Illustrated by the Blalock- Taussig Shunt and Intra-Arterial Stents

Greek¹

2014

Biol Syst Open Access

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Scientific disciplines normally thought of as outside the sphere of medical science have experienced advances over the past twenty years that currently have profound implications for medical care and medical research. Evolutionary and developmental biology, complexity and chaos science, along with the Human Genome Project and spinoff projects, have dramatically altered our understanding of how the human body functions and what can be expected from research methods like animal modeling. In this article, I summarize these advances and examine one historical medical development, the Blalock-Taussig shunt, in order to ascertain whether historically accepted representations of this development are consistent with current knowledge. I also examine an ongoing technology-intra-arterial stent development-to compare human data to the known animal data and place this comparison in the context of the aforementioned advances.

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Coronary-Artery Stents

Abstract: T h e ne w e ngl a nd jou r na l o f m e dic i ne n engl j med 354;5 www.nejm.

Cited by 642 publications

References 82 publications

Long‐Term Clinical Outcomes After Angiographically Defined Very Late Stent Thrombosis of Drug‐Eluting Stent

Long‐Term Clinical Outcomes After Angiographically Defined Very Late Stent Thrombosis of Drug‐Eluting Stent

In vivo prevention of arterial restenosis with paclitaxel-encapsulated targeted lipid–polymeric nanoparticles

A Discussion of the Role of Complex Evolved Systems in the Development of Invasive Cardiovascular Interventions as Illustrated by the Blalock- Taussig Shunt and Intra-Arterial Stents

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