Incidence, predictors, and outcomes of coronary dissections left untreated after drug-eluting stent implantation†

Biondi‐Zoccai, Giuseppe; Agostoni, Pierfrancesco; Sangiorgi, Giuseppe; Airoldi, Flavio; Cosgrave, John; Chieffo, Alaide; Barbagallo, Rossella; Tamburino, Corrado; Vittori, Guido; Falchetti, Elena; Margheri, Massimo; Briguori, Carlo; Remigi, Enrico; Iakovou, Ioannis; Colombo, Antonio

doi:10.1093/eurheartj/ehi618

Cited by 84 publications

(70 citation statements)

References 26 publications

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“…2,[10][11][12][13][14][15][16] In the stent era, one large angiographic study of 4630 lesions treated with DES reported a prevalence of 1.7%. 17 IVUS data showed that the prevalence of coronary artery dissection in lesions treated with balloon angioplasty was >60% 16,18 compared with 11% to 20% in lesions treated with bare metal stents [19][20][21] and 7.8% in lesions treated with DES. 22 In addition, the detection rates for coronary dissection varied among imaging modalities.…”

Section: Prevalence Of Coronary Artery Dissectionmentioning

confidence: 99%

Prevalence, Features, and Prognostic Importance of Edge Dissection After Drug-Eluting Stent Implantation

Kobayashi

Mintz

Witzenbichler

et al. 2016

Circ: Cardiovascular Interventions

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Background-Intravascular ultrasound detects stent edge dissections after percutaneous coronary intervention that are not seen angiographically. This study investigated the association between stent edge dissections and clinical outcomes. Methods and Results-ADAPT-DES (Assessment of Dual Antiplatelet Therapy With Drug-Eluting Stents) was a largescale, prospective, multicenter study of patients undergoing drug-eluting stent implantation. In this prospective substudy, 2062 patients (2433 lesions) were evaluated with intravascular ultrasound to characterize the morphological features and clinical outcomes of stent edge dissection after percutaneous coronary intervention. The prevalence of post-percutaneous coronary intervention stent edge dissection was 6.6% per lesion (161 of 2433 ; P=0.05). Conclusions-Greater stent expansion and the presence of large, calcified, and/or attenuated plaques were independent predictors of stent edge dissection. Residual stent edge dissection, especially with a smaller effective lumen area, was associated with target lesion revascularization during 1-year follow-up after drug-eluting stent implantation. Clinical Trial Registration-URL: http://www.clinicaltrials.gov. Unique identifier: NCT00638794.(Circ Cardiovasc Interv. 2016;9:e003553.

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Section: Prevalence Of Coronary Artery Dissectionmentioning

confidence: 99%

Prevalence, Features, and Prognostic Importance of Edge Dissection After Drug-Eluting Stent Implantation

Kobayashi

Mintz

Witzenbichler

et al. 2016

Circ: Cardiovascular Interventions

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“…The importance of residual dissections in the DES era has been reiterated when observing an increased risk of ST (6.3% versus 1.3%; Pϭ0.01) and major adverse cardiac events (18.5% versus 11.2%; Pϭ0.07) at 6 months in patients with or without residual dissections. 48 ST is mediated predominantly by platelet-rich thrombi and hence platelet aggregation. ADP-induced (65Ϯ3% versus 51Ϯ2%; PϽ0.001) and shear-induced (40.9Ϯ12.2% versus 18.2Ϯ18%; Pϭ0.013) platelet aggregation has been found to be increased in patients with ST compared with control subjects, suggesting increased intrinsic platelet reactivity.…”

Section: Risk Factors Of Stmentioning

confidence: 99%

Late Coronary Stent Thrombosis

2007

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Introduced Ͼ20 years ago, 1 coronary artery stents have improved the safety and particularly the efficacy of percutaneous coronary interventions (PCIs). 2 Abrupt vessel closure, complicating 6% to 8% of balloon angioplasty procedures, was associated with a 5% mortality, 40% rate of myocardial infarction (MI), and 40% rate of emergency coronary artery bypass grafting. 3 Stents significantly reduced these adverse events (Figure 1). 4,5 The reduction of restenosis afforded by bare metal stents (BMS) was modest (30% to 40%). Repeat revascularization still occurred in 15% to 20% of cases. 6 Drug-eluting stents (DES) with antiproliferative drugs attached via polymers on the stent surface to minimize smooth muscle proliferation have reduced restenosis and rates of target lesion revascularization by 50% to 70% compared with BMS across nearly all lesion and patient subsets. 7 Initially 8 and again more recently, 9 -16 safety concerns were raised about DES, particularly about late stent thrombosis (ST). Historical PerspectiveST was a bane of stent implantation from the beginning. The initial experience with Wallstents in the late 1980s was overshadowed by ST rates approaching 24%. 17 Subsequent series with Palmaz-Schatz and Gianturco-Roubin stents (still predominantly bailout stenting) observed ST in 6% to 12% of cases. 4,18 The postprocedural antithrombotic regimen at the time consisted of aspirin, often in conjunction with oral anticoagulation. Dual antiplatelet therapy of aspirin and the thienopyridine ticlopidine in conjunction with a shift from bailout to elective stenting resulted in a significant reduction of ST to Ͻ2%. 5,19 Earlier oral antiplatelet drug loading and glycoprotein IIb/IIIa antagonists further diminished ST. Table 1 provides an overview of ST reported in contemporary trials of BMS and DES, ranging from 0.1% to 3.1%. 11,20 -38 The wide range in the incidence of ST across trials with both BMS and DES is explained by differences in definitions, length of follow-up, antithrombotic drug regimens, and complexity of patients and lesions.

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“…The greatest risk of antiplatelet therapy hyporesponsiveness occurs following PCI and stenting where HPR in the setting of ASA and ADP-receptor antagonist dual antiplatelet therapy (DAPT) is associated with a 2-fold increase in the risk of stent thrombosis 3,10 . Stent thrombosis is an infrequent but serious complication, which results in myocardial infarction rates exceeding 60%, case fatality rates ranging from 10 to 45% [11][12][13][14] , and increased long term MACE 15 . Several clinical factors including ACS presentation, body mass index (BMI) > 30 kg/m 2 , diabetes, and congestive heart failure (CHF) are associated with hyporesponsiveness to antiplatelet therapies 16 .…”

Section: Discussionmentioning

confidence: 99%

Prevalência de alta reatividade plaquetária em pacientes tratados com aspirina encaminhados para angiografia coronária

Manica¹,

Sarmento‐Leite²,

Manfroi³

et al. 2013

Arq. Bras. Cardiol.

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Incidence, predictors, and outcomes of coronary dissections left untreated after drug-eluting stent implantation†

Abstract: This study, reporting for the first time on incidence, predictors, and outcomes of residual dissections in DES-treated coronary lesions, demonstrates their adverse clinical impact and supports the pursuit of a strategy of sealing dissection flaps with other DES.

Cited by 84 publications

References 26 publications

Prevalence, Features, and Prognostic Importance of Edge Dissection After Drug-Eluting Stent Implantation

Prevalence, Features, and Prognostic Importance of Edge Dissection After Drug-Eluting Stent Implantation

Late Coronary Stent Thrombosis

Prevalência de alta reatividade plaquetária em pacientes tratados com aspirina encaminhados para angiografia coronária

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