In-stent restenosis in small coronary arteries

Briguori, Carlo; Sarais, Cristiano; Pagnotta, Paolo; Liïstro, Francesco; Montorfano, Matteo; Chieffo, Alaide; Sgura, Fabio; Corvaja, Nicola; Albiero, Remo; Stanković, Goran; Toutoutzas, Costantinos; Bonizzoni, Erminio; Mario, Carlo Di; Colombo, Antonio

doi:10.1016/s0735-1097(02)01989-7

Cited by 233 publications

(135 citation statements)

References 19 publications

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“…This may be incorrect as there is evidence that newer stent designs with thinner struts may have lower restenosis rates than older stents. 95,96 In one retrospective study, the stent design was the second most important factor in predicting restenosis after lesion type, and different stents had restenosis rates of between 20 and 50%. 97 There are also other ways in which technology differed or has changed -in particular the adjuvant drug therapies may differ substantially between those early studies that used aspirin, heparin, ticlopidine or clopidogrel, or the much more recent studies which have used the glycoprotein IIb/IIIa receptor antagonists.…”

Section: Comparability Of Interventionsmentioning

confidence: 99%

Coronary artery stents: a rapid systematic review and economic evaluation

Hill¹,

Bagust²,

Bakhai³

et al. 2004

Health Technol Assess

144

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Section: Comparability Of Interventionsmentioning

confidence: 99%

Coronary artery stents: a rapid systematic review and economic evaluation

Hill¹,

Bagust²,

Bakhai³

et al. 2004

Health Technol Assess

144

View full text Add to dashboard Cite

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“…In recent years, several clinical trials have identified stent strut thickness as an independent predictor of restenosis [2,12,23]. A clear conclusion from the many clinical studies on stent strut thickness is that stents with thinner struts have a lower restenosis rate, consequently, most of the current generation of stents are produced with thinner struts using high strength materials such as cobalt-chromium alloys [20].…”

Section: Introductionmentioning

confidence: 99%

Determination of the influence of stent strut thickness using the finite element method: implications for vascular injury and in-stent restenosis

Zahedmanesh

Lally

2009

Med Biol Eng Comput

120

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Many clinical studies, including the ISAR-STEREO trial, have identified stent strut thickness as an independent predictor of in-stent restenosis where thinner struts result in lower restenosis than thicker struts. The aim of this study was to more conclusively identify the mechanical stimulus for in-stent restenosis using results from such clinical trials as the ISAR-STEREO trial. The mechanical environment in arteries stented with thin and thicker strut stents was investigated using numerical modelling techniques. Finite element models of the stents used in the ISAR-STEREO clinical trial were developed and the stents were deployed in idealised stenosed vessel geometries in order to compare the mechanical environment of the vessel for each stent. The stresses induced within the stented vessels by these stents were compared to determine the level of vascular injury caused to the artery by the stents with different strut thickness. The study found that when both stents were expanded to achieve the same initial maximum stent diameter that the thinner strut stent recoiled to a greater extent resulting in lower luminal gain but also lower stresses in the vessel wall, which is hypothesised to be responsible for the lower restenosis outcome. This study supports the hypothesis that arteries develop restenosis in response to injury, where high vessel stresses are a good measure of that injury. This study points to a critical stress level in arteries, above which an aggressive healing response leads to in-stent restenosis in stented vessels. Stents can be designed to reduce stresses in this range in arteries using preclinical tools such as numerical modelling.

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“…The strut thickness has been shown to be an important determinant of the long-term restenosis rate. [1][2][3][4] This prospective, nonrandomized, multicenter study was designed to assess the safety and efficacy of the Medtronic Driver stent.• • • Patients with clinical evidence of stable or unstable angina pectoris, or positive functional study findings, with a planned percutaneous transluminal coronary angioplasty procedure of a single de novo lesion in a native coronary artery were considered for inclusion. Lesions (Յ13 mm) situated in a major coronary artery or major branch with estimated stenosis of 50% to 100% and a diameter suitable for implantation of a single stent with a diameter of 3.0 to 4.0 mm were considered eligible for enrollment.…”

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confidence: 99%

mentioning

confidence: 99%

Clinical and Angiographic Analysis With a Cobalt Alloy Coronary Stent (Driver) in Stable and Unstable Angina Pectoris

Legrand

Kelbæk

Hauptmann

et al. 2006

The American Journal of Cardiology

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The Clinical and Angiographic analysis with a Cobalt Alloy Coronary Stent (Driver) (CLASS) study was a prospective, nonrandomized, multicenter study designed to assess the safety and efficacy of a cobalt-chromium alloy-based stent in patients with stable or unstable angina pectoris. A total of 203 lesions were treated in 202 enrolled patients. The percentage of major adverse cardiac event-free patients was 87.6% (177 of 202) at 6 months (primary safety end point; major adverse cardiac events were defined as death, myocardial infarction, emergency bypass surgery, or target lesion revascularization [percutaneous transluminal coronary angioplasty or coronary artery bypass grafting]). The angiographic success rate (primary efficacy end point) was 100%, and the procedural success rate was 98%. The binary in-stent restenosis rate at 6 months was 12.6%. Our results have demonstrated that the Driver cobalt-chromium alloy stent can be used with a low 6-month incidence of major adverse cardiac events, a low 6-month binary restenosis rate, and high angiographic and procedural success rates. The Medtronic Driver stent (Medtronic Vascular, Santa Rosa, California) is composed of a cobalt-chromium alloy and is similar in design to the Medtronic S7 stent. The design is based on elements 1.0 mm in length with an elliptical-rectangular strut cross section and a strut thickness of 0.0036 in. (91 m). The cobalt-chromium alloy has superior mechanical properties compared with traditional 316L stainless steel, including greater strength and increased density. These properties have allowed the development of stents with thinner struts, offering increased flexibility and ease of delivery, without compromising radial strength or radiopacity. The strut thickness has been shown to be an important determinant of the long-term restenosis rate. [1][2][3][4] This prospective, nonrandomized, multicenter study was designed to assess the safety and efficacy of the Medtronic Driver stent.• • • Patients with clinical evidence of stable or unstable angina pectoris, or positive functional study findings, with a planned percutaneous transluminal coronary angioplasty procedure of a single de novo lesion in a native coronary artery were considered for inclusion. Lesions (Յ13 mm) situated in a major coronary artery or major branch with estimated stenosis of 50% to 100% and a diameter suitable for implantation of a single stent with a diameter of 3.0 to 4.0 mm were considered eligible for enrollment.Preprocedural antiplatelet therapy was administered according to local routine with the following recommendations: aspirin (minimum 75 mg/day) and ticlopidine (500 mg loading dose followed by 250 mg twice daily) or aspirin and clopidogrel (300 mg loading dose followed by 75 mg/ day). It was initiated Ն24 hours before the procedure or before the conclusion of the catheterization. Ticlopidine or clopidogrel were discontinued after 14 to 28 days, and aspirin (Ն75 mg/day) was maintained indefinitely (Ն6 months after implantation).After introduction of the arterial...

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In-stent restenosis in small coronary arteries

Abstract: This study supports that strut thickness is an independent predictor of restenosis in coronary arteries with a reference diameter of 2.75 to 2.99 mm.

Cited by 233 publications

References 19 publications

Coronary artery stents: a rapid systematic review and economic evaluation

Coronary artery stents: a rapid systematic review and economic evaluation

Determination of the influence of stent strut thickness using the finite element method: implications for vascular injury and in-stent restenosis

Clinical and Angiographic Analysis With a Cobalt Alloy Coronary Stent (Driver) in Stable and Unstable Angina Pectoris

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