Use of Drug-Eluting Stents in Patients With Coronary Artery Disease and Renal Insufficiency

El‐Menyar, Ayman; Suwaidi, Jassim Al; Holmes, David R.

doi:10.4065/mcp.2009.0314

Cited by 18 publications

(12 citation statements)

References 62 publications

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“…Consequently, the most important factor to predict TLR was the presence of HD, but not DM or usage of insulin. Stent restenosis in HD patients is still a major issue (12). Our study results indicated that they still had a higher restenosis rate even when using PES.…”

Section: Des In High-risk Patientsmentioning

confidence: 53%

“…Therefore, technical factors such as poor dilation of the vessels were not the causes of the high TLR rate in HD patients. The incidence of restenosis in HD patients is high and stent restenosis is still a major issue (12). The reason for this might be that the mechanism of restenosis in HD patients is highly related to vessel shrinkage and neointimal hyperplasia (22).…”

Section: Hemodialysis Patientsmentioning

confidence: 99%

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Hemodialysis is an Independent Predictor of Coronary In-stent Restenosis after Paclitaxel Eluting Stent Implantation

et al. 2010

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Objective A drug eluting stent is often used for high-risk patients with complications such as diabetes mellitus (DM) and hemodialysis (HD), however the factors to predict restenosis after paclitaxel-eluting stent (PES) placement have not been reported to date. Methods Between May 2007 and August 2009, 165 consecutive patients (231 stents) received PES in our hospital. Stent diameter and length were determined by the use of intravascular ultrasound (IVUS). All patients continued to take 2 types of anti-platelet agents (aspirin and Clopidogrel or Ticlopidine). Ninety percent of the subjects received a follow-up coronary angiogram 6 months later. Results Underlying diseases were hypertension in 75%, hyperlipidemia in 78% and DM in 60% (15% on insulin), and 14% of the subjects received HD. Eighty-three percent of the patients had orally taken Statin, 85% ACE/ARB and 68% had beta blockers. Mean length and diameter of PES were 21.6 ± 7.2 mm and 2.9 ± 0.3 mm, respectively. Target lesion revascularization (TLR) rate 6 months after PES placement was 14.6% overall. In HD patients TLR was 43%, hypertension 15.0%, hyperlipemia 12.4%, DM with oral medication 12.5%, DM with insulin 12.0%, respectively. In multivariate analysis, HD was an independent risk factor for TLR (p=0.0001, OR: 6.61, 95% C.I.: 2.34-18.6). Conclusion HD had the greatest influence on TLR after PES even though risk factors were well controlled. It is necessary to develop new PCI techniques and stents that are useful for HD patients.

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Section: Des In High-risk Patientsmentioning

confidence: 53%

Section: Hemodialysis Patientsmentioning

confidence: 99%

Hemodialysis is an Independent Predictor of Coronary In-stent Restenosis after Paclitaxel Eluting Stent Implantation

et al. 2010

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“…Chronic kidney disease (CKD): CKD has been recognized as a risk factor for coronary artery disease, 10) restenosis (in hemodialysis patients), 11,12) adverse clinical outcomes after both BMS and DES implantation, 13) and procedural failure. [14][15][16] It is also well known that there is a strong relationship between calcifi cation of plaque and renal function. [5][6][7] In this study, we report another new fi nding related to CKD, including those with end-stage renal disease on dialysis replacement therapy.…”

Section: Discussionmentioning

confidence: 99%

Neointimal Calcification After Stenting and Chronic Kidney Disease

et al. 2013

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SummaryThe timing and incidence of neointimal calcifi cation after stenting (NIC) is largely unknown. The purpose of our study was to elucidate the characteristics of NIC. The presence of NIC in patients who underwent intravascular ultrasound between June 30, 2009 and June 30, 2012 was analyzed. The patients were divided into two groups based on the follow-up period: < 365 days or ≥ 365 days. A total of 181 images were analyzed. Those with NIC had a lower estimated glomerular fi ltration rate [51 (6-60) versus 61 (52-72) mL/minute/1.73 m 2 ; P < 0.01] and longer time after stenting [3198 (1710-3684) versus 211 (180-516) days; P < 0.01] compared to those without NIC. NIC during short-term follow-up was observed only in patients who were on hemodialysis. On the other hand, NIC in the long-term follow-up was observed only in patients with bare metal stents. The development of NIC was related to renal function and time after stenting. NIC in the short-term and the long-term follow-up was observed only in patients who were on hemodialysis and who were implanted with a bare metal stent, respectively. ( These studies showed homogeneous neointima in the early phase (< 6 months) that transformed into atherosclerotic tissue in the late phase (> 5 years). Typical neoatherosclerotic characteristics include calcifi cation (10%), cholesterol crystals (14%), lipid-laden intima (67%), disruption (38%), and thrombus (52%).Calcifi cation in the native coronary arteries is regarded as a surrogate for total plaque burden and may predict future coronary events.3,4) The strong relationship between calcifi cation of plaque and renal function is also well known.5-7) However, the characteristics of neointimal calcification after stenting (NIC) are largely unknown. Identifying patients who are prone to develop NIC may help us to understand the pathophysiology of NIC and to develop a strategy for the prevention and treatment of this particular type of in-stent restenosis (ISR).The aim of this study was to evaluate the characteristics of NIC using intravascular ultrasound (IVUS). MethodsPatients: Patients with ISR who underwent IVUS for percutaneous coronary intervention between June 30, 2009 and June 30, 2012 were evaluated retrospectively. Inclusion criteria were: (1) patients with ISR with a known stent type (BMS or drug-eluting stent (DES)) and duration after stenting, and (2) acceptable IVUS image quality for analysis. Exclusion criteria included: (1) ISR at the stent edge to exclude possible misinterpretation of calcifi cation of the coronary artery adjacent to the implanted stent as NIC due to an oblique cross-sectional slice; (2) restenosis of previously treated ISR without a new stent implantation; (3) stent fracture which was confi rmed by coronary angiography; and (4) recoil or underexpansion of the initial stent.A total of 181 IVUS pullbacks from 164 patients were analyzed (133 men, 31 women). Target lesion locations were: left main trunk in 3 (2%), left anterior descending artery in 78 (43%), left circumfl ex artery in 42 (2...

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“…31 However, among patients with CKD, in general, DES is deemed safer than BMS and associated with improved survival, [32][33][34][35] although not all studies are concordant in this regard. 36 In a large cohort of 121,446 patients with CKD, Tsai et al 37 reported that, at all stages of CKD, DES was associated with improved survival compared with BMS.…”

Section: Des Versus Bms: Mortality and In-stent Restenosismentioning

confidence: 99%

Coronary Revascularization in Patients with CKD Stage 5D: Pragmatic Considerations

Shroff

Herzog

2016

JASN

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Coronary revascularization decisions for patients with CKD stage 5D present a dilemma for clinicians because of high baseline risks of mortality and future cardiovascular events. This population differs from the general population regarding characteristics of coronary plaque composition and behavior, accuracy of noninvasive testing, and response to surgical and percutaneous revascularization, such that findings from the general population cannot be automatically extrapolated. However, this high-risk population has been excluded from all randomized trials evaluating outcomes of revascularization. Observational studies have attempted to address long-term outcomes after surgical versus percutaneous revascularization strategies, but inherent selection bias may limit accuracy. Compared with percutaneous strategies, surgical revascularization seems to have long-term survival benefit on the basis of observational data but associates with substantially higher short-term mortality rates. Percutaneous revascularization with drug-eluting and bare metal stents associates with a high risk of in-stent restenosis and need for future revascularization, perhaps contributing to the higher long-term mortality hazard. Off-pump coronary bypass surgery and the newest generation of drugeluting stent platforms offer no definitive benefits. In this review, we address the nuances, complexities, and tradeoffs that clinicians face in determining the optimal method of coronary revascularization for this high-risk population.

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Use of Drug-Eluting Stents in Patients With Coronary Artery Disease and Renal Insufficiency

Cited by 18 publications

References 62 publications

Hemodialysis is an Independent Predictor of Coronary In-stent Restenosis after Paclitaxel Eluting Stent Implantation

Hemodialysis is an Independent Predictor of Coronary In-stent Restenosis after Paclitaxel Eluting Stent Implantation

Neointimal Calcification After Stenting and Chronic Kidney Disease

Coronary Revascularization in Patients with CKD Stage 5D: Pragmatic Considerations

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