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Bare Metal or Drug- Eluting Coronary Stents

Pankaj Aggarwal, Pravin Saxena, Anil Bhan
Coronary artery stent infection has been reported with both bare metal stent and drug eluting stent and can present as mycotic coronary artery aneurysm, pseudoaneurysm, myocardial abscess, pericarditis or exudative effusion. Infection at the site of coronary stent implantation is rare and is believed to result typically from either direct stent contamination at the time of delivery or transient bacteraemia from access site. Introduction of drug-eluting stent (DES) has led to a marked reduction in the problem of in-stent restenosis across all patient subsets and lesions complexities...
September 2016: Indian Heart Journal
Vivian W Y Lee, Franco W Cheng, Adrian Y Choi, Sam T Fong, Cheuk Man Yu, Bryan P Yan
BACKGROUND: Percutaneous coronary intervention (PCI) is one of the most performed interventions for ischemic heart diseases. In Hong Kong, the total number of patient discharges and deaths for ischemic heart diseases in 2009 was 33,363, including 4,360 deaths. There are over 5,000 cases of PCI yearly. This study aimed to compare clinical, economic and humanistic outcomes among patients receiving drug-eluting stent (DES) or bare metal stent (BMS) in Hong Kong. METHODS: Patients who received stent implantation between 15(th) September, 2009 and 11(th) October, 2010 in Prince of Wales Hospital, Hong Kong, were recruited and followed for 18 months...
October 14, 2016: Journal of Medical Economics
Jong Shiuan Yeh, Seung Jin Oh, Chun Mei Hsueh
BACKGROUND: We aimed to describe the frequency of vascular inflammatory reactions with second generation drug eluting stents (DES) compared to first generation DES, and analyze the impact on inflammation and neointimal proliferation in a porcine coronary model. METHODS: A total of 26 stents (7 multi-link VISION, 6 CYPHER, 6 TAXUS and 7 XIENCE V) were deployed in the coronary arteries of 10 domestic swine for 28 days, after which each stent was harvested and processed (divided into 8 or 9 segments) for histomorphometric analysis...
September 2016: Acta Cardiol Sin
Josep Gomez-Lara, Salvatore Brugaletta, Francisco Jacobi, Luis Ortega-Paz, Marcos Ñato, Gerard Roura, Rafael Romaguera, Jose-Luis Ferreiro, Luis Teruel, Montserrat Gracida, Victoria Martin-Yuste, Xavier Freixa, Monica Masotti, Joan-Antoni Gomez-Hospital, Manel Sabate, Angel Cequier
BACKGROUND: The main causes of late (>1 month) stent thrombosis (ST) are stent uncoverage, malapposition, and neoatherosclerosis. First-generation drug-eluting stents were associated with higher rate of late ST compared with bare-metal stents (BMS), especially in patients with ST-segment-elevation myocardial infarction. Second-generation everolimus-eluting stents (EES) have shown similar rate of late ST than BMS. The aims of the study are to compare the ratio of uncovered to total struts per cross-section ≥30% and other optical coherence tomographic findings associated with ST between EES and BMS in patients with ST-segment-elevation myocardial infarction at 5 years...
October 2016: Circulation. Cardiovascular Interventions
Wei-Ting Wang, Shih-Hsien Sung, Cheng-Hsueh Wu, Shao-Sung Huang, Wan-Leong Chen, Shing-Jong Lin, Tse-Min Lu
BACKGROUND: Among patients with very small vessel disease and chronic kidney disease (CKD), the comparative efficacy of bare metal stents (BMSs) versus drug-eluting stents (DESs) is not frequently addressed. This study aimed to evaluate the long-term outcomes of patients with very small vessel disease managed with percutaneous coronary intervention. METHODS: Our study included 158 consecutive patients undergoing percutaneous coronary intervention from January 2003 to December 2013...
September 28, 2016: Journal of the Chinese Medical Association: JCMA
Vjekoslav Tomulić, David Gobić, Davorka Lulić, David Židan, Luka Zaputović
Adhesion molecules play an important role in inflammation, atherosclerosis and coronary artery disease (CAD). These molecules are expressed on the surface of dysfunctional endothelial cells, causing inflammatory cells from the circulation to adhere and migrate through the endothelium. Their expression is upregulated in acute coronary syndrome (ACS) and after percutaneous coronary intervention (PCI). The contact between stent struts and endothelium upregulates endothelial cell gene expression, endothelial cell activation and inflammation...
October 2016: Medical Hypotheses
Pasi P Karjalainen, Wail Nammas
Coating of stent surface with a biocompatible material is suggested to improve stent safety profile. A proprietary process was developed to coat titanium-nitride-oxide on the stent surface, based on plasma technology that uses the nano-synthesis of gas and metal. Preclinical in vitro and in vivo investigation confirmed blood compatibility of titanium (nitride-) oxide films. Titanium-nitride-oxide-coated stents demonstrated a better angiographic outcome, compared with bare-metal stents at mid-term follow-up; however, they failed to achieve non-inferiority for angiographic outcome versus second-generation drug-eluting stents...
October 3, 2016: Annals of Medicine
Ciro Indolfi, Salvatore De Rosa, Antonio Colombo
The introduction of percutaneous treatment of coronary artery stenosis with balloon angioplasty was the first revolution in interventional cardiology; the advent of metallic coronary stents (bare and drug-eluting) marked the second and third revolutions. However, the latest generation of drug-eluting stents is limited by several factors. Permanent vessel caging impairs arterial physiology, and the incidence of very late stent thrombosis - although lower with the second generation than with the first generation of drug-eluting stents - remains a major concern...
September 29, 2016: Nature Reviews. Cardiology
Sebastian Kufner, Erion Xhepa, Christoph Lutter, Salvatore Cassese, Michael Joner
Despite the high anti-restenotic efficacy of contemporary percutaneous interventional techniques, a substantial number of patients who undergo percutaneous coronary intervention (PCI) still present with restenosis. Despite iterations of devices- from plain balloon angioplasty to bare metal stenting (BMS) to drug-eluting stent (DES) therapy - have granted a progressive decline in the rate of this complication, in-stent restenosis remains a critical issue encountered in clinical practice. Owing to the overall increase in the use of DES, the number of patients presenting with DES restenosis is not insignificant in absolute terms...
September 27, 2016: Minerva Cardioangiologica
Ming-Lung Tsai, Chun-Chi Chen, Dong-Yi Chen, Chia-Hung Yang, Ming-Jer Hsieh, Cheng-Hung Lee, Chao-Yung Wang, Shang-Hung Chang, I-Chang Hsieh
Compared to bare metal stent (BMS) implantation, drug-eluting stents (DES) is significantly better in attenuating intimal hyperplasia and reducing the rate of revascularization. However, the requirement of prolonged dual antiplatelet therapy (DAPT) and the economic cost have been the major disadvantages of DES. Studies have shown that the use of DES in small vessels decrease revascularization rate, but the results in large vessels vary. Previous studies have shown that the extent of late loss is unrelated to vessel diameter, and that late loss is easily accommodated in large vessels, thus resulting in decreased clinical benefit of DES in this setting...
September 17, 2016: International Journal of Cardiology
Vikas Singh, Alex P Rodriguez, Badal Thakkar, Nileshkumar J Patel, Abhijit Ghatak, Apurva O Badheka, Carlos E Alfonso, Eduardo de Marchena, Rahul Sakhuja, Ignacio Inglessis-Azuaje, Igor Palacios, Mauricio G Cohen, Sammy Elmariah, William W O'Neill
Transcatheter aortic valve replacement (TAVR) with percutaneous coronary intervention (PCI) has emerged as a less-invasive therapeutic option for high surgical risk patients with aortic stenosis and coronary artery disease. The aim of this study was to determine the outcomes of TAVR when performed with PCI during the same hospitalization. We identified patients using the International Classification of Diseases, Ninth Revision, Clinical Modification procedure codes from the Nationwide Inpatient Sample between the years 2011 and 2013...
August 30, 2016: American Journal of Cardiology
Ming Zhang, Raviteja R Guddeti, Yasushi Matsuzawa, Jaskanwal D S Sara, Taek-Geun Kwon, Zhi Liu, Tao Sun, Seung-Jin Lee, Ryan J Lennon, Malcolm R Bell, Hartzell V Schaff, Richard C Daly, Lilach O Lerman, Amir Lerman, Chaim Locker
BACKGROUND: The study compared downstream coronary and conduit disease progression in the left anterior descending coronary artery treated with coronary artery bypass grafting using the left internal mammary artery (LIMA) versus percutaneous coronary intervention with bare metal stent (BMS) or drug eluting stent (DES). METHODS AND RESULTS: A total of 12 301 consecutive patients underwent isolated primary coronary revascularization, of which 2386 met our inclusion criteria (Percutaneous coronary intervention, n=1450; coronary artery bypass grafting, n=936)...
2016: Journal of the American Heart Association
Koki Shishido, Antonios P Antoniadis, Saeko Takahashi, Masaya Tsuda, Shingo Mizuno, Ioannis Andreou, Michail I Papafaklis, Ahmet U Coskun, Caroline O'Brien, Charles L Feldman, Shigeru Saito, Elazer R Edelman, Peter H Stone
BACKGROUND: In-stent hyperplasia (ISH) may develop in regions of low endothelial shear stress (ESS), but the relationship between the magnitude of low ESS, the extent of ISH, and subsequent clinical events has not been investigated. METHODS AND RESULTS: We assessed the association of poststent ESS with neointimal ISH and clinical outcomes in patients treated with percutaneous coronary interventions (PCI). Three-dimensional coronary reconstruction was performed in 374 post-PCI patients at baseline and 6 to 10 months follow-up as part of the PREDICTION Study...
September 2016: Journal of the American Heart Association
Krzysztof Milewski, Paweł Gąsior, Stefan Samborski, Piotr P Buszman, Aleksandra Błachut, Adam Wojtaszczyk, Adam Młodziankowski, Artur Mendyk, Marek Król, Wojciech Wojakowski, Paweł E Buszman
INTRODUCTION: Despite the dominance of drug-eluting stents in modern interventional cardiology, there is still a niche for bare metal stents. AIM: The aim of the Polish NexGen registry was to evaluate the safety and efficacy of a new generation cobalt-chromium NexGen stent in a real life patient population. MATERIAL AND METHODS: A prospective multi-center registry was conducted in five clinical sites of American Heart of Poland. Three hundred and eighty-three patients who underwent percutaneous coronary intervention (PCI) with NexGen stent implantation were included...
2016: Postępy W Kardiologii Interwencyjnej, Advances in Interventional Cardiology
Louise Baschet, Sandrine Bourguignon, Sébastien Marque, Isabelle Durand-Zaleski, Emmanuel Teiger, Fanny Wilquin, Karine Levesque
OBJECTIVE: To determine the cost-effectiveness of drug-eluting stents (DES) compared with bare-metal stents (BMS) in patients requiring a percutaneous coronary intervention in France, using a recent meta-analysis including second-generation DES. METHODS: A cost-effectiveness analysis was performed in the French National Health Insurance setting. Effectiveness settings were taken from a meta-analysis of 117 762 patient-years with 76 randomised trials. The main effectiveness criterion was major cardiac event-free survival...
2016: Open Heart
Erin A Woods, Margaret L Ackman, Michelle M Graham, Sheri L Koshman, Rosaleen M Boswell, Arden R Barry
BACKGROUND: Current guidelines recommend triple antithrombotic therapy (TAT), defined as acetylsalicylic acid (ASA), clopidogrel, and warfarin, for patients with nonvalvular atrial fibrillation who have undergone percutaneous coronary intervention with stent implantation. The choice of anticoagulant/antiplatelet therapy in this population is ambiguous and complex, and prescribing patterns are not well documented. OBJECTIVE: To characterize local prescribing patterns for anticoagulant/antiplatelet therapy after percutaneous coronary intervention in patients with nonvalvular atrial fibrillation...
July 2016: Canadian Journal of Hospital Pharmacy
So-Youn Lee, In-Ho Bae, Dae Sung Park, Eun-Jae Jang, Jae-Won Shim, Kyung Seob Lim, Jun-Kyu Park, Doo Sun Sim, Myung Ho Jeong
The aim of this study was to compare dextran and Poly(L-lactide) (PLLA) polymer stent coatings as mediators for sirolimus (SRL) drug elution in a porcine coronary model. The bare metal stent (BMS) surface was first coated with a layer of SRL and then either dextran (DSS, a natural polymer) or PLA (PSS, a synthetic polymer). The release velocity of SRL was slightly faster in DSS than PSS over the first 7 days (78.5% and 62.3%, respectively, n=10, p<0.05) and continued to 28 days in both groups. The contact angle was dramatically decreased in DSS (38...
September 12, 2016: Journal of Biomedical Materials Research. Part A
Jennifer A Rymer, Robert W Harrison, David Dai, Matthew T Roe, John C Messenger, H Vernon Anderson, Eric D Peterson, Tracy Y Wang
In 2006, the United States (US) Food and Drug Administration published advisory highlighting concerns for late drug-eluting stent thrombosis; its impact on US bare-metal stent (BMS) utilization is unknown. We examined rates of BMS use among Medicare patients at 946 US hospitals in the CathPCI Registry who underwent percutaneous coronary intervention (PCI) during 3 periods: (1) 2004 to 2006 preadvisory (n = 166,458); (2) 2007 to 2008 postadvisory (n = 216,318); and (3) 2012 to 2014 contemporary (n = 827,948)...
October 1, 2016: American Journal of Cardiology
Kyohei Yamaji, Lorenz Räber, Thomas Zanchin, Ernest Spitzer, Christian Zanchin, Thomas Pilgrim, Stefan Stortecky, Aris Moschovitis, Michael Billinger, Christa Schönenberger, Franz Eberli, Peter Jüni, Thomas F Lüscher, Dik Heg, Stephan Windecker
AIMS: Compared with bare metal stents, first-generation drug-eluting stents (DES) are associated with an increased risk of late restenosis and stent thrombosis (ST). Whether this risk continues or attenuates during long-term follow-up remains unknown. METHODS AND RESULTS: We extended the follow-up of 1012 patients [sirolimus-eluting stent (SES): N = 503 and paclitaxel-eluting stent (PES): N = 509] included in the all-comers, randomized Sirolimus-Eluting vs...
August 30, 2016: European Heart Journal
Kaare H Bønaa, Jan Mannsverk, Rune Wiseth, Lars Aaberge, Yngvar Myreng, Ottar Nygård, Dennis W Nilsen, Nils-Einar Kløw, Michael Uchto, Thor Trovik, Bjørn Bendz, Sindre Stavnes, Reidar Bjørnerheim, Alf-Inge Larsen, Morten Slette, Terje Steigen, Ole J Jakobsen, Øyvind Bleie, Eigil Fossum, Tove A Hanssen, Øystein Dahl-Eriksen, Inger Njølstad, Knut Rasmussen, Tom Wilsgaard, Jan E Nordrehaug
Background Limited data are available on the long-term effects of contemporary drug-eluting stents versus contemporary bare-metal stents on rates of death, myocardial infarction, repeat revascularization, and stent thrombosis and on quality of life. Methods We randomly assigned 9013 patients who had stable or unstable coronary artery disease to undergo percutaneous coronary intervention (PCI) with the implantation of either contemporary drug-eluting stents or bare-metal stents. In the group receiving drug-eluting stents, 96% of the patients received either everolimus- or zotarolimus-eluting stents...
September 29, 2016: New England Journal of Medicine
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