Relation of stent design and stent surface material to subsequent in-stent intimal hyperplasia in coronary arteries determined by intravascular ultrasound

Hoffmann, Rainer; Mintz, Gary S.; Haager, Philipp K.; Bozoglu, Togul; Grube, Eberhard; Groß, Michael; Beythien, C.; Mudra, Harald; Dahl, Jürgen vom; Hanrath, Peter

doi:10.1016/s0002-9149(02)02347-0

Cited by 54 publications

(40 citation statements)

References 21 publications

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“…11,12 However, two other studies concluded that these stents may increase neointimal hyperplasia compared with uncoated stents, although patients at a higher risk for restenosis were enrolled. 13,14 Follow-up angiography at 6 months demonstrated a relatively high lumen late loss (postintervention minimum luminal diameter minus the minimum luminal diameter at follow-up) and diameter stenosis in both studies (Table 1). Overall, there have been conflicting results in observational studies examining goldcoated stents, and the restenosis rates seem to be no better than those obtained with uncoated steel stents.…”

Section: Stents Coated With Biocompatible Materialsmentioning

confidence: 93%

Coated Stents for the Prevention of Restenosis: Part II

2002

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T his is the second part of a 2-part article that reviews the literature on coated stents and their effects on in-stent restenosis after percutaneous coronary intervention (PCI). Part I of this review discussed the pathophysiology of in-stent restenosis, specific stent coatings, and animal studies investigating coated stents. Part II discusses nonrandomized studies and clinical trials in humans. Studies in humans have examined stents coated with biocompatible materials and drug-eluting stents. Complications and controversies associated with this new technology are also addressed. Human StudiesThe risk of developing in-stent restenosis is related to a variety of factors, both clinical and procedural. [1][2][3][4][5][6][7] On the basis of these risk factors, patients enrolled in both nonrandomized studies and clinical trials have been classified as having a high, intermediate, or low risk of restenosis. Therefore, the binary restenosis rates (Ͼ50% diameter stenosis angiographically) and major adverse cardiac event (MACE) rates in human studies vary greatly depending on the overall risk profile of patients enrolled in these studies. Non-Randomized Studies Stents Coated with Biocompatible MaterialsThe biocompatibility of stents coated with several materials, including carbon, gold, silicon carbide, and phosphorylcholine, has been investigated in humans. The Carbostent (Sorin Biomedica Cardio) is a metal stent coated with a carbon film that is thought to be less thrombogenic than uncoated steel stents. 8 Antoniucci et al 9 investigated the long-term biocompatibility of the Carbostent in a group of 112 patients with an intermediate risk of developing restenosis. Six-month follow-up revealed low MACE and restenosis rates of 12% and 11%, respectively. A second study in another group of 112 patients at high risk for restenosis resulted in a MACE rate of 20% and a binary restenosis rate of 25% by 6 months. 10 These results suggest that the Carbostent is well tolerated in vivo and possibly inhibits neointimal hyperplasia, especially in high-risk patients (Table 1).Gold has been touted as a biocompatible material and has been thought to be ideal for coating coronary stents because of its radio-opaque properties. 1 Two studies evaluating the biocompatibility of gold-coated stents suggested equivalency with uncoated steel stents. 11,12 However, two other studies concluded that these stents may increase neointimal hyperplasia compared with uncoated stents, although patients at a higher risk for restenosis were enrolled. 13,14 Follow-up angiography at 6 months demonstrated a relatively high lumen late loss (postintervention minimum luminal diameter minus the minimum luminal diameter at follow-up) and diameter stenosis in both studies (Table 1). Overall, there have been conflicting results in observational studies examining goldcoated stents, and the restenosis rates seem to be no better than those obtained with uncoated steel stents.Silicon carbide is an inert semiconductor that can be coated onto prosthetic surfaces and has be...

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Section: Stents Coated With Biocompatible Materialsmentioning

confidence: 93%

Coated Stents for the Prevention of Restenosis: Part II

2002

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“…In these studies, diabetes mellitus, lesion length, lesion plaque burden, number of stents, stent design, acute lumen gain, and the final obtained lumen diameter were found to have a significant impact on in-stent restenosis rates. 15 …”

Section: In-stent Restenosismentioning

confidence: 99%

Approaches for prevention of restenosis

2007

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Coronary artery disease is characterized by a narrowing (stenosis) of the arteries that supply blood to the tissue of the heart. Continued restriction of blood flow manifests itself as angina and ultimately myocardial infarction (heart attack) for the patient. Heart bypass was once the only treatment for this condition, but over the years percutaneous coronary intervention (PCI) has become an increasingly attractive alternative to medical therapy and surgical revascularization for the treatment of coronary artery disease. A vascular stent is a medical device designed to serve as a temporary or permanent internal scaffold, to maintain or increase the lumen of a blood vessel. Metallic coronary stents were first introduced to prevent arterial dissections and to eliminate vessel recoil and intimal hyperplasia associated with PCI. Further advancement in the treatment of coronary artery disease is the development of drug-eluting stents that dramatically reduce the incidence of in-stent restenosis to less than 5%. Local drug delivery offers the advantages of allowing a relatively high local concentration of drug at the treatment site while minimizing systemic toxic effect. This review describes approaches for prevention of restenosis. It focuses on drugs for prevention of restenosis, bare metal stents, and drug-eluting stents. It also describes recent advances in bioresorbable stents. One of the chapters is dedicated to our novel composite bioresorbable drug-eluting fibers, designed to be used as basic elements in drug-eluting stents.

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“…28 Restenosis, however, limits the longterm success of percutaneous transluminal coronary angioplasty, necessitating second procedures or coronary bypass surgery. Intimal hyperplasia, because of smooth muscle cell proliferation and migration, is thought to be a major cause of restenosis 17 and may also play an important role in the progression of atherosclerotic plaques. 29,30 A variety of animal models of arterial injury have been developed to examine the molecular events underlying intimal hyperplasia and to test pharmacological and molecular biological approaches to inhibiting this process.…”

Section: Discussionmentioning

confidence: 99%

“…Intimal hyperplasia is thought to play a critical role in the development of restenosis after percutaneous transluminal coronary angioplasty and in the progression of atherosclerosis. 17 Induction of M3 resulted in a 67% reduction in intimal area and a 68% reduction in intimal/medial ratio (I/M ratio). These data demonstrate that the levels of M3 induced in this mouse model are sufficient to interfere with an important pathophysiological response and strengthen the hypothesis that chemokines play an important role in the response to arterial injury.…”

mentioning

confidence: 99%

Inhibition of Intimal Hyperplasia in Transgenic Mice Conditionally Expressing the Chemokine-Binding Protein M3

Pyo

Jensen

Wiekowski³

et al. 2004

The American Journal of Pathology

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Chemokines are small 8-to 11-kd secreted proteins that act as chemoattractants and activators of leukocytes through their interaction with G-protein-coupled receptors. More than 40 chemokines have been identified and grouped according to the relative positions of their cysteine residues. CC chemokines have the first two cysteine residues adjacent to each other, whereas CXC chemokines have one amino acid separating the first two cysteine residues. Two chemokines fit into neither category. CL1 (lymphotactin) contains only one cysteine residue and CX3CL1 (fractalkine) has three amino acids separating the first two cysteine residues.

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Relation of stent design and stent surface material to subsequent in-stent intimal hyperplasia in coronary arteries determined by intravascular ultrasound

Cited by 54 publications

References 21 publications

Coated Stents for the Prevention of Restenosis: Part II

Coated Stents for the Prevention of Restenosis: Part II

Approaches for prevention of restenosis

Inhibition of Intimal Hyperplasia in Transgenic Mice Conditionally Expressing the Chemokine-Binding Protein M3

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