Late Coronary Occlusion After Intracoronary Brachytherapy

Costa, Marco A.; Sabaté, Manel; Giessen, Wim J. van der; Kay, Ian; Červinka, Pavel; Ligthart, Jürgen; Serrano, Pedro; Coen, V.; Levendag, Peter C.; Serruys, Patrick W.

doi:10.1161/01.cir.100.8.789

Cited by 349 publications

(163 citation statements)

References 20 publications

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“…This is also consistent with the observations in the RAVEL study, where patients have been off dual antiplatelet agents for at least 10 months without thrombotic events. 6 This should be compared with the Ն6% late thrombosis rate observed after intracoronary radiation therapy, 3 which resulted in the recommendation for prolonged antiplatelet therapy (6 to 12 months) after brachytherapy, especially when a new stent is implanted at the time of the procedure. The outcomes of patients with ISR treated with stents covered with a polymer containing a paclitaxel derivative have been reported recently.…”

Section: Discussionmentioning

confidence: 99%

“…2 Unfortunately, this complex therapy carries with it the risks associated with ionizing radiation, including delayed endothelialization and potential late vascular thrombosis. 3 The first-in-man (FIM) study has recently demonstrated the safety and effectiveness of sirolimus-eluting Bx VELOC-ITY stents for the treatment of single, de novo coronary lesions. 4,5 In this somewhat benign population, no major clinical events (thrombosis, repeat revascularization, myocardial infarction, or death) occurred within 1-year of follow-up.…”

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confidence: 99%

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Sirolimus-Eluting Stent for the Treatment of In-Stent Restenosis

Sousa¹,

Costa²,

Abizaid³

et al. 2003

Circulation

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189

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Background-We have previously reported the safety and effectiveness of sirolimus-eluting stents for the treatment of de novo coronary lesions. The present investigation explored the potential of this technology to treat in-stent restenosis. Methods and Results-Twenty-five patients with in-stent restenosis were successfully treated with the implantation of 1 or 2 sirolimus-eluting Bx VELOCITY stents in São Paulo, Brazil. Nine patients received 2 stents (1.4 stents per lesion). Angiographic and volumetric intravascular ultrasound (IVUS) images were obtained after the procedure and at 4 and 12 months. All vessels were patent at the time of 12-month angiography. Angiographic late loss averaged 0.07Ϯ0.2 mm in-stent and Ϫ0.05Ϯ0.3 mm in-lesion at 4 months, and 0.36Ϯ0.46 mm in-stent and 0.16Ϯ0.42 mm in-lesion after 12 months. No patient had in-stent or stent margin restenosis at 4 months, and only one patient developed in-stent restenosis at 1-year follow-up. Intimal hyperplasia by 3-dimensional IVUS was 0.92Ϯ1.9 mm 3 at 4 months and 2.55Ϯ4.9 mm

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Sirolimus-Eluting Stent for the Treatment of In-Stent Restenosis

Sousa¹,

Costa²,

Abizaid³

et al. 2003

Circulation

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189

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“…4,5 Late thrombosis and edge stenosis (the "candy wrapper effect") are potential complications that may limit the effectiveness of this approach. 5,6 Pharmacological inhibitors of neointimal hyperplasia, like paclitaxel, represent an alternative to radiation therapy. 7,8 Paclitaxel (Taxol) is a derivatized diterpenoid that exerts an antineoplastic effect by interfering with cell microtubule function.…”

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confidence: 99%

Paclitaxel Stent Coating Inhibits Neointimal Hyperplasia at 4 Weeks in a Porcine Model of Coronary Restenosis

et al. 2001

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Background-Despite limiting elastic recoil and late vascular remodeling after angioplasty, coronary stents remain vulnerable to restenosis, caused primarily by neointimal hyperplasia. Paclitaxel, a microtubule-stabilizing drug, has been shown to inhibit vascular smooth muscle cell migration and proliferation contributing to neointimal hyperplasia. We tested whether paclitaxel-coated coronary stents are effective at preventing neointimal proliferation in a porcine model of restenosis. Methods and Results-Palmaz-Schatz stents were dip-coated with paclitaxel (0, 0.2, 15, or 187 g/stent) by immersion in ethanolic paclitaxel and evaporation of the solvent. Stents were deployed with mild oversizing in the left anterior descending coronary artery (LAD) of 41 minipigs. The treatment effect was assessed 4 weeks after stent implantation.

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“…21 In addition, delayed reendothelialization has been associated with late side effects of potent antiproliferative therapies, such as with radiation therapy. 22,23 Immediate restoration of endothelial function might abort the initiation of restenosis. Endothelial cell seeding has been proposed as the ultimate method to assure immediate stent endothelialization, 24 but cell viability has been a limitation.…”

Section: (4) Stents Eluting Prohealing Agentsmentioning

confidence: 99%