Does a Carbon Ion-Implanted Surface Reduce the Restenosis Rate of Coronary Stents?

Abstract

Background: Neointimal hyperplasia and resulting restenosis limit the long-term success of coronary stenting. Heavy metal ions induce an inflammatory and allergic reaction, and result in in-stent restenosis. However, a carbon ion-implanted surface might prevent heavy metal ions from diffusing into surrounding tissue. Methods: 140 lesions in 140 patients with coronary lesions underwent implantation of carbon-implanted surface stents (Arthos^inert stent group, n = 70) or control stents (Arthos stent group, n = 70). The primary end point was the in-stent restenosis and the secondary end point was the value of hs-CRP at 48 h and 6 months after coronary stenting. Clinical and angiographic follow-ups were performed at 6 months. Results: The rate of in-stent restenosis was lower in the Arthos^inert stent group (15.9%, 10/63) than in the Arthos stent group (20.9%, 13/62), but there were no significant differences between both groups (p = 0.56). The value of hs-CRP at 48 h was lower in the Arthos^inert stent group (13.9 ± 13.4 mg/dl) than in the Arthos stent group (24.5 ± 26.0 mg/dl) with significant differences (p = 0.04). However, the differences between two groups were not statistically significant at 6 months (p = 0.76). Conclusions: As compared with a standard coronary stent, a carbon ion-implanted stent shows no considerable benefit for the prevention of in-stent restenosis within the range of this study. Despite all the limitations of this study, a positive effect of a carbon ion-implanted stent in reducing inflammatory reaction after coronary revascularization seems likely.

Prognostic Value of High-Sensitivity C-Reactive Protein in In-Stent Restenosis: A Meta-Analysis of Clinical Trials

“…The studies included in this systematic review were published in nine articles between 2005 and 2020. Seven articles were randomised controlled trials [ 21 , 22 , 23 , 24 , 25 , 26 , 27 ], and two were prospective study designs [ 28 , 29 ]. A total of 1049 patients who had undergone PCI and who were stented were included.…”

“…In patients presenting systemic evidence of inflammation as measured by an elevated hs-CRP level at baseline and follow-up, the administration of oral anti-inflammatory therapy post-stenting dramatically reduces the rate of restenosis, as reported by Gaztanaga J [ 21 ], Rosa W C [ 22 ], and Yao W [ 23 ]. Meanwhile, Jung J H [ 24 ], Kochiadakis G E [ 25 ], and Wang J [ 26 ] reported that the profound impact of DES on restenosis prevention reflects both its properties as an anti-proliferative as well as an anti-inflammatory agent. Such studies underscore the important role of anti-inflammation in the attendant risks of restenosis or thrombosis.…”

“… Meta-analysis of ORs in studies evaluating the prognostic value of hs-CRP to restenosis in higher vs lower hs-CRP group as sub-grouped by hs-CRP detecting timepoint. OR: odds ratio, hs-CRP: high-sensitive C-reactive protein, ISR: in-stent restenosis, 0: <6 (months), 1: ≥6 (months) [ 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 ]. …”

“…Gaztanaga J [ 21 ], Rosa W C [ 22 ], and Yao W [ 23 ] revealed the anti-inflammation effects of oral medications on ISR outcomes. Jung J H [ 24 ], Kochiadakis G E [ 25 ], and Wang J [ 26 ] evaluated the effects of modified stents on variations in ISR outcomes and plasma hs-CRP levels. Hs-CRP screening has become a cost/effectiveness indicator of clinical trials [ 19 ].…”