I Like the Candy, I Hate the Wrapper

Serruys, Patrick W.; Kay, Ian

doi:10.1161/01.cir.101.1.3

Cited by 95 publications

(39 citation statements)

References 19 publications

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“…6,7 However, initial enthusiasm in the use of radioactive stents has been limited by the occurrence of stenosis in the segments adjacent to the proximal and distal edge of the stent (so-called edge stenosis). 8,9 Recently, stent-based local drug delivery with a number of pharmacological agents has been demonstrated to reduce in-stent neointimal hyperplasia. Randomized clinical safety and feasibility trials with sirolimus-and paclitaxel-eluting stents have shown very promising results, with prevention of in-stent restenosis in de novo coronary and in-stent restenosis lesions.…”

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confidence: 99%

Vascular Responses at Proximal and Distal Edges of Paclitaxel-Eluting Stents

et al. 2004

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MD; for the TAXUS II Study GroupBackground-On the basis of brachytherapy experience, edge stenosis has been raised as a potential limitation for drug-eluting stents. We used serial intravascular ultrasound (IVUS) to prospectively analyze vessel responses in adjacent reference segments after implantation of polymer-controlled paclitaxel-eluting stents. Methods and Results-TAXUS II was a randomized, double-blind trial with 2 consecutive patient cohorts that compared slow-release (SR) and moderate-release (MR) paclitaxel-eluting stents with control bare metal stents (BMS). By protocol, all patients had postprocedure and 6-month follow-up IVUS. Quantitative IVUS analysis was performed by an independent core laboratory, blinded to treatment allocation, in 5-mm vessel segments immediately proximal and distal to the stent. Serial IVUS was available for 106 SR, 107 MR, and 214 BMS patients. For all 3 groups, a significant decrease in proximal-edge lumen area was observed at 6 months. The decrease was comparable (by ANOVA, Pϭ0.194) for patients in the SR (Ϫ0.54Ϯ2.1 mm 2 ) and MR (Ϫ0.88Ϯ1.9 mm 2 ) groups compared with the BMS (Ϫ1.02Ϯ1.9 mm 2 ) group. For the distal edge, a significant decrease in lumen area was only observed with BMS (Ϫ0.91Ϯ2.0 mm 2 , PϽ0.0001); this decrease was significantly attenuated with SR (0.08Ϯ2.0 mm 2 ) and MR (Ϫ0.19Ϯ1.7 mm 2 ) stents (PϽ0.0001 by ANOVA). Negative vessel remodeling was observed at the proximal (Ϫ0.48Ϯ2.2 mm 2 , Pϭ0.011) but not the distal edges of BMS and at neither edge of SR or MR stents. Conclusions-The marked reduction in in-stent restenosis with SR or MR stents is not associated with increased edge stenosis at 6-month follow-up IVUS. In fact, compared with BMS, there is instead a significant reduction in late lumen loss at the distal edge with TAXUS stents.

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confidence: 99%

Vascular Responses at Proximal and Distal Edges of Paclitaxel-Eluting Stents

et al. 2004

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“…This so-called "edge effect" was most pronounced in studies using the 32 P radioactive stent. 20,21 Edge effect is believed to be due to endovascular injury incurred by the angioplasty procedure that extends outside of the irradiated region. Common recent practice, therefore, is to provide an adequate margin of radiation at either end of the treated (ie, injured) vessel segment.…”

Section: See P 2694mentioning

confidence: 99%

Fulfilling the Promise of Percutaneous Angioplasty

Teirstein

2000

Circulation

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“…Figure 2-5 shows the tight stenosis at the stent edges, which are marked by arrows. This phenomenon has generally been observed 2 to 3 mm distal and proximal to the stent (Albeiro et al, 2000b;Serruys and Kay, 2000;van der Giessen et al, 2001). …”

Section: Edge Restenosis or "Candy Wrapper Effect"mentioning

confidence: 87%

“…Intravascular brachytherapy has emerged as an attractive candidate therapy for the treatment of restenosis and is considered a promising anti-restenosis technology (Kuntz and Baim, 2000;Serruys and Kay, 2000;Fox, 2002). It involves treating restenosis with a radioactive source within the arterial lumen.…”

Section: Radiation To Treat Restenosismentioning

confidence: 99%

“…Finally, edge restenosis can also be a result of the basic physics of a radioactive stent. At the ends of the stent, the dose will be very close to 50% of its value at the center due to steep dose gradients, especially in the case of beta emitters (Amols, 19 9 9a; Serruys and Kay, 2000;van der Giessen et al, 2001). …”

Section: Edge Restenosis or "Candy Wrapper Effect"mentioning

confidence: 99%

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A dosimetry and radiobiological model for intravascular brachytherapy treatment planning with radioisotope emitting stents

Caceres¹

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I Like the Candy, I Hate the Wrapper

Cited by 95 publications

References 19 publications

Vascular Responses at Proximal and Distal Edges of Paclitaxel-Eluting Stents

Vascular Responses at Proximal and Distal Edges of Paclitaxel-Eluting Stents

Fulfilling the Promise of Percutaneous Angioplasty

A dosimetry and radiobiological model for intravascular brachytherapy treatment planning with radioisotope emitting stents

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