Drug-Eluting Stents Versus Bare-Metal Stents in Saphenous Vein Graft Interventions

Wiisanen, Matthew; Abdel‐Latif, Ahmed; Mukherjee, Debabrata; Ziada, Khaled M.

doi:10.1016/j.jcin.2010.08.019

Cited by 62 publications

(32 citation statements)

References 55 publications

(41 reference statements)

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“…Similar results have been obtained with next-generation DES (21). Clinical studies also have provided direction for selection of patients for either BMS or DES according to criteria aimed at obtaining good outcomes with either BMS or DES (22)(23)(24).…”

Section: Houston Texassupporting

confidence: 56%

Vascular Responses to Percutaneous Coronary Intervention With Bare-Metal Stents and Drug-Eluting Stents

Buja

2011

Journal of the American College of Cardiology

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The era of percutaneous coronary intervention (PCI) has led to substantial changes in the management of patients with acute coronary syndromes and stable coronary heart disease, with an associated range of impacts on the course and outcomes of subsets of patients with these conditions. Interventional cardiology has moved from percutaneous transluminal coronary angioplasty (PTCA), with or without administration of tissue plasminogen activator or other thrombolytic agent, to the combined use of PTCA and implantation of a bare-metal stent (BMS) or multiple stents, to PTCA and implantation of 1 or more drugeluting stents (DES) (1-3). As first-generation DES, See page 1314 paclitaxel-eluting stents (PES) and sirolimus-eluting stents (SES) have had extensive clinical application. The evolution in treatment has been associated with a progressive decrease in short-term complications, including early thrombosis, and a decrease in short-term and long-term restenosis (2,3). Optimal results with PTCA and stent placement requires concomitant antithrombotic drug therapy to avoid shortterm thrombotic occlusion (4). Although the implementation of first-generation DES has resulted in a marked decrease in the incidence of restenosis, the DES are affected by a certain incidence of late and very late coronary thrombosis (2-4). The first-generation DES are now being followed by second-generation and newer DES (3).The number of patients receiving PCI and stent implants now numbers in the millions (2-4). Follow-up of these patients with clinical evaluation and imaging studies has yielded abundant data regarding clinical outcomes based on these parameters. Clinical features and imaging results also serve as the basis for assessment in randomized clinical trials. Conversely, relatively few published studies have provided information derived from direct pathological evaluation of stented coronary arteries, and these observations are necessarily limited to autopsy series of a relatively limited number of patients. The relative paucity of pathological observations is related to a constellation of factors, including the relatively low autopsy rates in most countries and the technical challenges of adequately examining coronary arteries with implanted stents. Nevertheless, direct pathological examination has an important role in providing observations and insights not available by any other approach.Insights from pathology studies have served as a basis for evolution in approaches to PCI. Pathology studies showed that PTCA results in arterial injury of variable degree, including endothelial damage, plaque fractures, variable damage and dissection of the media, and mural platelet and fibrin thrombus deposition (5-7). The vascular responses to PTCA were identified as: 1) recoil and negative remodeling or contraction of the coronary artery segment after dilation; 2) endothelial damage, often with associated thrombosis; and 3) concomitant progressive fibrocellular intimal thickening involving perturbation of vascular smooth muscle cells leading t...

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Section: Houston Texassupporting

confidence: 56%

Vascular Responses to Percutaneous Coronary Intervention With Bare-Metal Stents and Drug-Eluting Stents

Buja

2011

Journal of the American College of Cardiology

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“…One of the limitations of bare metal stent implantation is the restenosis secondary to intimal hyperplasia within or adjacent to the stent [19,20]. Cilostazol has been found to reduce neointimal formation in balloon-injured rat carotid arteries and inhibits restenosis after percutaneous transluminal coronary angioplasty [21,22].…”

Section: Discussionmentioning

confidence: 99%

Open-Label Phase I Clinical Study to Assess the Safety and Efficacy of Cilostazol in Patients Undergoing Internal Carotid Artery Stent Placement

et al. 2016

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Background: One-month dual antiplatelet treatment, with aspirin and clopidogrel, following internal carotid artery stent placement is the current standard of care to prevent in-stent thrombosis. Cilostazol, an antiplatelet drug, has been demonstrated to have a safety profile comparable to aspirin and clopidogrel. Objective: To evaluate the safety and clinical efficacy of cilostazol and aspirin therapy following internal carotid artery stent placement up to 1 month postprocedure. Methods: A phase I open-label, nonrandomized two-center prospective study was conducted. All subjects received aspirin (325 mg/day) and cilostazol (200 mg/day) 3 days before extracranial stent placement. Two antiplatelet agents were continued for 1 month postprocedure followed by aspirin daily monotherapy. The primary efficacy end point was the 30-day composite occurrence of death, cerebral infarction, transient ischemic attack, and in-stent thrombosis. The primary safety end point was bleeding. Results: Twelve subjects (mean age ± SD, 66 ± 12 years; 9 males) were enrolled and underwent internal carotid artery angioplasty and stent placement. None of the subjects who successfully followed the study protocol experienced any complications at the 1- and 3-month follow-ups. One patient had a protocol deviation due to concurrent use of enoxaparin (1 mg/kg twice daily) in addition to aspirin and cilostazol, resulting in a fatal symptomatic intracerebral hemorrhage following successful stent placement on postprocedure day 1. One patient discontinued cilostazol after the first dose secondary to dizziness. Conclusion: The use of cilostazol and aspirin for internal carotid artery stent placement appears to be safe, but protocol compliance needs to be emphasized.

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“…[153] Consistent results of improved efficacy with DES and no significant safety hazard were reported in different metaanalyses which also included non randomized trails. [154][155][156][157] The RRISC, SOS and ISAR CABG all compared first-generation DES to BMS. The SOS-Xience V (Stenting of Saphenous Grafts-Xience V) prospectively examined the frequency of angiographic in-stent restenosis in SVG lesions 12 months after implantation of everolimus-eluting stent (EES), a second generation DES.…”

Section: Percutaneous Coronary Interventionmentioning

confidence: 99%

Treatment of Coronary Artery Bypass Graft Failure

Beijk¹,

Harskamp²

2013

Artery Bypass

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Drug-Eluting Stents Versus Bare-Metal Stents in Saphenous Vein Graft Interventions

Abstract: In this meta-analysis comparing DES with BMS use in PCI of SVG lesions, DES use was associated with improved mortality, MACE, TLR, and TVR. There was no evidence of increased risk of myocardial infarction or stent thrombosis.

Cited by 62 publications

References 55 publications

Vascular Responses to Percutaneous Coronary Intervention With Bare-Metal Stents and Drug-Eluting Stents

Vascular Responses to Percutaneous Coronary Intervention With Bare-Metal Stents and Drug-Eluting Stents

Open-Label Phase I Clinical Study to Assess the Safety and Efficacy of Cilostazol in Patients Undergoing Internal Carotid Artery Stent Placement

Treatment of Coronary Artery Bypass Graft Failure

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