Mesh covered stent in ST-segment elevation myocardial infarction

Dudek, Dariusz; Dziewierz, Artur; Rzeszutko, Łukasz; Legutko, Jacek; Dobrowolski, Wojciech; Rakowski, Tomasz; Bartuś, Stanisław; Dragan, Jacek; Klecha, Artur; Lansky, Alexandra-J; Siudak, Zbigniew; Żmudka, Krzysztof

doi:10.4244/eijv6i5a98

Cited by 39 publications

(41 citation statements)

References 27 publications

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“…Moreover, when a LTB is present, the use of special mesh-covered stents can be useful in managing thrombi and preventing distal embolization. There are some small studies reporting on the use of the MGuard stent in STEMI setting, documented promising surrogate results, such as a better ST-resolution and a higher post-procedural TIMI 3 flow rate, when compared to standard types of stents [95][96][97][98] .…”

Section: Embolic Protection Devicesmentioning

confidence: 99%

Coronary thrombus in patients undergoing primary PCI for STEMI: Prognostic significance and management

Vecchio¹

2014

WJC

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Acute ST-elevation myocardial infarction (STEMI) usually results from coronary atherosclerotic plaque disruption with superimposed thrombus formation. Detection of coronary thrombi is a poor prognostic indicator, which is mostly proportional to their size and composition. Particularly, intracoronary thrombi impair both epicardial blood flow and myocardial perfusion, by occluding major coronary arteries and causing distal embolization, respectively. Thus, although primary percutaneous coronary intervention is the preferred treatement strategy in STEMI setting, the associated use of adjunctive antithrombotic drugs and/or percutaneous thrombectomy is crucial to optimize therapy of STEMI patients, by improving either angiographical and clinical outcomes. This review article will focus on the prognostic significance of intracoronary thrombi and on current antithrombotic pharmacological and interventional strategies used in the setting of STEMI to manage thrombotic lesions.© 2014 Baishideng Publishing Group Inc. All rights reserved. Key words: ST-elevation myocardial infarction; Intracoronary thrombosis; Primary percutaneous coronary intervention; Antithrombotic therapies; Coronary thrombectomyCore tip: Intracoronary thrombosis, is the basic pathophysiologic event in acute ST-elevation myocardial infarction (STEMI), and thrombi are very frequently detected in STEMI patients undergoing primary percutaneous coronary intervention (PPCI). Thrombus burden and components are important determinants of prognosis in STEMI, being well-known risk factors for longterm adverse cardiovascular events, distal embolization and stent thrombosis. As a result, percutaneous management of lesions with a consistent thrombotic burden is still challenging in the setting of PPCI for STEMI. Therefore, several pharmacological and interventional strategies, such as thrombectomy have been developed in order to improve PPCI's safety and efficacy, by reducing thrombus burden.

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Section: Embolic Protection Devicesmentioning

confidence: 99%

Coronary thrombus in patients undergoing primary PCI for STEMI: Prognostic significance and management

Vecchio¹

2014

WJC

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“…28 Similarly, among 57 patients treated with the MGuard stent during primary PCI for STEMI, cardiac mortality at mean follow-up of 38.7±3.1 months was 7.0%, with a major adverse cardiovascular and cerebral event rate of 8.8%. 20 As expected, the 12-month rates of ischemic TLR and TVR in the MGuard group were higher than in the control stent group, as the control group consisted of patients treated with DES as well as with BMS. The 8.6% and 11.0% 1-year TLR and TVR rates with the MGuard in the present study are similar to those observed with this device in the firstin-human study (11.1% TVR), 15 20 likely because of inclusion of longer and more complex lesions in the present trial.…”

Section: Discussionmentioning

confidence: 62%

“…However, longer term clinical and angiographic follow-up is needed to characterize late vascular responses to the MGuard stent, especially as the only prior study with late follow-up after MGuard stent implantation was nonrandomized. 20 We herein report the 1-year clinical and 13-month angiographic outcomes from the MASTER study.…”

Section: Mesh-covered Stent In Stemimentioning

confidence: 99%

“…Feasibility and short-term efficacy of MGuard stent implantation during primary PCI for STEMI was confirmed in early studies. 17,18 Recently, the multicenter, prospective, randomized MGUARD for Acute ST Elevation Reperfusion (MASTER) trial 19 reported that among patients with STEMI, the MGuard resulted in superior rates of epicardial coronary flow and complete ST-segment resolution compared with conventional metallic stents, thus meeting its primary end point. A trend toward lower 30-day cardiac mortality was noted for patients treated with the MGuard stent.…”

Section: Mesh-covered Stent In Stemimentioning

confidence: 99%

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Mesh-Covered Embolic Protection Stent Implantation in ST-Segment–Elevation Myocardial Infarction

Dudek

Dziewierz

Brener

et al. 2015

Circ: Cardiovascular Interventions

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P rimary percutaneous coronary intervention (PCI), with stent implantation when feasible, is the recommended method of reperfusion in patients with ST-segment-elevation myocardial infarction (STEMI).1,2 Although stent implantation frequently restores normal epicardial coronary flow in patients with STEMI, myocardial reperfusion is often suboptimal and results in increased infarct size and mortality.3-5 Numerous strategies have been proposed to improve microvascular perfusion, including pharmacological agents (eg, glycoprotein IIb/IIIa inhibitors, adenosine) and mechanical approaches (eg, thrombus aspiration, distal protection devices).6-10 Meta-analyses of underpowered randomized trials suggested that manual aspiration thrombectomy might be associated with reduced 30-day mortality, with underlying improvements in epicardial and myocardial perfusion.11,12 However, in the large-scale, randomized Thrombus Aspiration in ST-Elevation Myocardial Infarction in Scandinavia (TASTE) trial, a survival benefit of routine manual aspiration thrombectomy during primary PCI was not observed. Background-The MGuard, a bare metal stent covered with a polymer mesh, was designed to reduce distal embolization during percutaneous coronary intervention in ST-segment-elevation myocardial infarction. In the MGUARD for Acute ST Elevation Reperfusion trial, the primary end point of complete ST-segment resolution was significantly improved with the MGuard compared with control. We evaluated 1-year clinical and angiographic results. Methods and Results-Patients with ST-segment-elevation myocardial infarction ≤12 hours undergoing primary percutaneous coronary intervention of a single de novo native lesion were randomized to the MGuard versus any commercially available metallic stent (39.8% drug-eluting). Clinical follow-up was performed through 1 year, and angiography at 13 months was planned in 50 MGuard patients. There was no difference in major adverse cardiac events (1.8% versus 2.3%; P=0.75) at 30 days between the groups. Major adverse cardiac events at 1 year were higher with the MGuard, driven by greater ischemia-driven target lesion revascularization (8.6% versus 0.9%; P=0.0003). Conversely, mortality tended to be lower with the MGuard at 30 days (0% versus 1.9%; P=0.04) and at 1 year (1.0% versus 3.3%; P=0.09). Late lumen loss at 13 months in the MGuard was 0.99±0.80 mm, and binary restenosis was 31.6%. Conclusions-In patients with ST-segment-elevation myocardial infarction undergoing primary percutaneous coronary intervention, a trend toward reduced 1-year mortality was present in patients treated with the MGuard stent. Target lesion revascularization and major adverse cardiac events rates during follow-up were higher in the MGuard group than in the control stent group, and angiographic late loss of the MGuard was consistent with that expected from bare metal stents. Clinical Trial Registration-URL: http://www.clinicaltrials.gov. Unique identifier: NCT01368471.(Circ Cardiovasc Interv. 2015;8:e001484.

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“…Future studies should evaluate the impact of multiple stent implantations in patients treated with new stents designs (i.e. mesh covered stents, self-expandable stents), specifically for lesions with a large thrombus burden [21]. Due to growing interest in bioresorbable vascular scaffold implantation in patients with ACS, it is also necessary to assess the impact of multiple bioresorbable vascular scaffolds implantation during primary PCI on long-term clinical outcomes of patients with STEMI [22,23].…”

Section: Discussionmentioning

confidence: 99%

The impact of multiple stent implantation in the infarct-related artery on one-year clinical outcomes of patients with ST-elevation myocardial infarction undergoing primary percutaneous coronary intervention. Data from the Polish NRDES Registry

et al. 2016

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A b s t r a c t Background and aim:We sought to evaluate the impact of multiple stent implantation in the infarct-related artery (IRA) on one-year clinical outcomes of patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI). Methods and results:Data on 1741 consecutive patients with STEMI, who underwent immediate PCI with implantation of ≥ 1 stent, enrolled the National Registry of Drug Eluting Stents (NRDES) were assessed. Patients were stratified based on the number of implanted stents in IRA: 1 vs. ≥ 2 stents. At the discretion of operators, ≥ 2 stents in IRA were implanted in 247 (14.2%) patients. The remaining 1494 patients were treated with a single stent. Patients treated with multiple stents were less likely to achieve Thrombolysis In Myocardial Infarction (TIMI) grade 3 flow after primary PCI. Overall mortality at one year was 8.3% in the single stent group and 10.3% in the ≥ 2 stents group (p = 0.37; adjusted for propensity score p = 0.13). After propensity score matching, patients treated with ≥ 2 stents were at higher risk of definite or probable stent thrombosis and urgent revascularisation at one year. Conclusions:In patients with STEMI undergoing primary PCI, a need for implantation of ≥ 2 stents in IRA carries an increased risk of stent thrombosis and urgent revascularisation at one year.

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Mesh covered stent in ST-segment elevation myocardial infarction

Abstract: Based on this experience, the MGuard stent implantation in STEMI patients is safe and highly effective. A larger randomised trial is warranted to confirm the clinical endpoints.

Cited by 39 publications

References 27 publications

Coronary thrombus in patients undergoing primary PCI for STEMI: Prognostic significance and management

Coronary thrombus in patients undergoing primary PCI for STEMI: Prognostic significance and management

Mesh-Covered Embolic Protection Stent Implantation in ST-Segment–Elevation Myocardial Infarction

The impact of multiple stent implantation in the infarct-related artery on one-year clinical outcomes of patients with ST-elevation myocardial infarction undergoing primary percutaneous coronary intervention. Data from the Polish NRDES Registry

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