Miniaturized Self-Expanding Drug-Eluting Stent in Small Coronary Arteries: Late Effectiveness

Abstract

BackgroundSmall vessels represent a risk factor for restenosis in percutaneous coronary angioplasty (PCA). The Sparrow® self-expanding drug-eluting stent, which has a lower profile than the current systems, has never been tested in this scenario. ObjectivesTo evaluate the late effectiveness of the Sparrow® drug-eluting stent, regarding in-stent late lumen loss (LLL). MethodsPatients with ischemia, symptomatic or documented, were submitted to PCA in vessels with reference diameter < 2.75 mm, divided into two groups regarding Sparrow® stent type: group 1: Sparrow® drug-eluting stent (DES), group 2: Sparrow® bare metal stent (BMS). Clinical follow-up duration was 12 months. Evaluation using quantitative coronary angiography (QCA) was performed immediately and at 8 months. A decrease of over 65% of in-stent LLL with DES was estimated to calculate sample size. IBM® SPSS software, release 19 (Chicago, Illinois, USA) was used for the statistical analysis. ResultsA total of 24 patients were randomized, 12 in each group. The DES and BMS groups were similar in age (63.25 ± 10.01 vs. 64.58 ± 11.54, p = 0.765), male gender (58.3% vs. 33.3%, p = 0.412), risk factors and all angiographs aspects. Immediate results were satisfactory in both groups. At 8 months in-stent late lumen loss was significantly lower in DES than in BMS group (DES vs. BMS 0.25 ± 0.16 0.97 ± 0.76, p = 0.008). ConclusionIn small-vessel PCA, the Sparrow® DES determined significant reduction in in-stent LLL, when compared to Sparrow® BMS.

Smart materials in cardiovascular implants: Shape memory alloys and shape memory polymers

“…45,46 The 12 months follow-up of the DESolve stent reported luminal patency of the stent, no stent thrombosis, and a low late lumen loss that was comparable to other metallic drug eluting stents and much lower than that described in the Igaki-Tamai stents. 25,39 This trial was rather small and was repeated with a larger sample size demonstrating fairly similar results. 47 Moreover, a disadvantage of the SMP stents are that they are generally manufactured with a larger strut size, around 150 μm, as compared to metallic stents, where some of the Nitinol stents have strut sizes as small as 67 μm.…”

“…No difference was observed between the two different types of stents, however, the STENTYS self‐expanding stent was noted to be safe and effective 38 . In contrast, the sirolimus eluting SPARROW stent has been shown to significantly decrease late lumen loss in small coronary arteries when compared to the bare metal SPARROW stent at 8 months indicating a potential for a lower rate of restenosis 39 …”

“…47 Moreover, a disadvantage of the SMP stents are that they are generally manufactured with a larger strut size, around 150 μm, as compared to metallic stents, where some of the Nitinol stents have strut sizes as small as 67 μm. 39,48 Larger strut sizes tend to interfere with vessel healing and can increase the rate of restenosis. 48 Thinner strut sizes can affect the radial strength of the stent, which is the force the stent exerts on the vessel wall in order to prevent collapse, and thus, failure of the device.…”

Long-term Clinical and Angiographic Results of Recanalization of Small Diameter Coronary Arteries in Patients with Ischemic Heart Disease

“…Так, за даними багатьох авторів від 30% до 50% КА, які потребують стентування, мають діа-метр менше 3 мм [9,10].…”

Фактори Ризику Розвитку Відстрочених Рестенозів У Пацієнтів З Малим Діаметром Коронарних Артерій Після Проведених Рентген-Ангіографічних Процедур

“…рою зумовлений тим, що пацієнти з такими артеріями становлять значну частину популяції. Так, за даними багатьох авторів, від 30% до 50% КА, які потребують стентування, мають діаметр менше 3 мм [7][8][9]. До того ж при ендоваскулярній реваскуляризації коронарних артерій малого діаметра у великому відсотку випадків спостерігаються рестенози стентованого сегмента і «великі» кардіальні ускладнення [8,10,11].…”