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Treatment of drug‐eluting stent restenosis: Comparison between drug‐eluting balloon versus second‐generation drug‐eluting stents from a retrospective observational study 下载免费PDF全文
Sandeep Basavarajaiah MD MRCP Toru Naganuma MD Azeem Latib MD Alessandro Sticchi MD Giuseppe Ciconte MD Vasilis Panoulas MD Alaide Chieffo MD Matteo Montorfano MD Mauro Carlino MD Antonio Colombo MD 《Catheterization and cardiovascular interventions》2016,88(4):522-528
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Vijay S. Ramanath MD Jeremiah R. Brown PhD David J. Malenka MD James T. DeVries MD Mandeep S. Sidhu MD MBA John F. Robb MD John E. Jayne MD Bruce D. Hettleman MD Bruce J. Friedman MD Nathaniel W. Niles II MD Aaron V. Kaplan MD Craig A. Thompson MD MMSc 《Catheterization and cardiovascular interventions》2010,76(4):473-481
Objectives : We sought to determine if differences existed in in‐hospital outcomes, long‐term rates of target vessel revascularization (TVR), and/or long‐term mortality trends between patients with diabetes mellitus undergoing percutaneous coronary intervention (PCI) with either a drug‐eluting stent(s) (DES) or a bare metal stent(s) (BMS). Background : Short‐ and long‐term clinical outcomes of patients with diabetes mellitus undergoing PCI with DES versus BMS remain inconsistent between randomized‐controlled trials (RCTs) and observational studies. Methods : Data were collected prospectively on diabetics undergoing PCI with either DES or BMS from January 2000 to June 2008. Demographic information, medical histories, in‐hospital outcomes, and long‐term TVR and mortality trends were obtained for all patients. Results : A total of 1,319 patients were included in the study. Diabetics receiving DES had a significant reduction in index admission MACE compared to diabetics receiving BMS. Using multivariable adjustment, after a mean follow‐up of 2.5 years (maximum 5 years), diabetics who received DES had a 38% decreased risk of TVR compared to diabetics with BMS [HR 0.62 (95% CI: 0.43–0.90)]; diabetics with DES had an insignificant adjusted improvement in long‐term survival compared to diabetics with BMS [HR 0.72 (95% CI: 0.52–1.00)]. These long‐term survival and TVR rates were confirmed using propensity scoring. Conclusions : The use of DES when compared with BMS among diabetics undergoing PCI is associated with significant improvement in long‐term TVR, with an insignificant similar trend in all‐cause mortality. The long‐term results of this observational study are consistent with prior RCTs after adjusting for confounding variables. © 2010 Wiley‐Liss, Inc. 相似文献
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Moritz Baquet MD David Jochheim MD Julinda Mehilli MD 《Journal of interventional cardiology》2018,31(3):330-337
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Dobrin Vassilev MD PhD Maxim Hazan MD Larry Dean MD 《Catheterization and cardiovascular interventions》2012,80(7):1223-1226
A 55‐year‐old male underwent paclitaxel‐eluting stent implantation in a bifurcation lesion of his left anterior descending artery (LAD) during an episode of unstable angina in 2008. A late in‐stent restenosis developed 15 months after implantation of the drug‐eluting stent (DES) and was treated with paclitaxel eluting balloon. Two months later, during angiography for functional assessment of the significance of lesions in the circumflex artery, an aneurysm at the place of drug‐eluting balloon (DEB) inflation was observed. The patient was left on double antiplatelet therapy and scheduled for clinical observation after 3 months and control coronary angiography after 6 months for aneurysm progression follow‐up. © 2012 Wiley Periodicals, Inc. 相似文献
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Anna Plitt Bimmer E. Claessen Samantha Sartori Usman Baber Jaya Chandrasekhar Melissa Aquino Pooja Vijay Sherif Elsayed Jason C. Kovacic Joseph Sweeny Nitin Barman Pedro Moreno Prakash Krishnan Antonia Demopoulos George Dangas Annapoorna S. Kini Roxana Mehran Samin K. Sharma 《Catheterization and cardiovascular interventions》2020,96(3):558-564
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Michael S. Lee MD Daniel Jurewitz BA Joseph Aragon MD James Forrester MD Raj R. Makkar MD Saibal Kar MD 《Catheterization and cardiovascular interventions》2007,69(3):387-394
Objective : To evaluate the clinical characteristics and implications of stent fracture in drug‐eluting stents. Background : Approximately 2.5 million drug‐eluting stents are implanted every year worldwide. In 10 randomized controlled trials involving 2,602 patients, no incidence of stent fracture was recognized or reported. Methods : From April 2003 to December 2005, 2,728 patients underwent drug‐eluting stenting. The angiograms of all 530 patients who underwent repeat angiography were analyzed to identify the presence of stent fracture. We then documented the incidence of adverse events associated with drug‐eluting stent fracture and systematically analyzed the clinical, procedural, and structural factors, which might predispose to stent fracture. Results : Stent fracture was identified in 10 patients. None of these fractures were detectable at the time of stent placement. The median time interval from stent implantation to detection of fracture at repeat angiography was 226 days (range, 7–620 days). Adverse clinical outcomes associated with stent fracture occurred in 7 patients (6 patients had binary restenosis and 1 patient had stent thrombosis), all necessitating repeat intervention. Analysis of potential predisposing clinical, procedural, and structural factors revealed that 4 patients had excessive tortuosity in the proximal segment, and overlapping stents were used in 5 cases. All fractures occurred in sirolimus‐eluting stents. Conclusions : Stent fracture may represent a new potential mechanism of restenosis and stent thrombosis in drug‐eluting stents. Predisposing clinical and procedural factors may be vessel tortuosity and use of overlapping stents. The most important predisposing factor, however, may be stent structure, since all fractures occurred in sirolimus‐eluting stents. © 2006 Wiley‐Liss, Inc. 相似文献
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Sa'ar Minha MD Tamir Bental MD Abid Assali MD Hana Vaknin‐Assa MD Eli I. Lev MD Eldad Rechavia MD Alexander Battler MD FACC FESC Ran Kornowski MD FACC FESC 《Catheterization and cardiovascular interventions》2011,78(5):710-717
Objectives: We aim to explore the clinical outcome of drug‐eluting stents (DES) versus bare‐metal stents (BMS) implantation in diabetics versus nondiabetic patients. Background: Diabetic patients sustain worse long‐term clinical outcomes after percutaneous coronary interventions (PCI) when compared with nondiabetics. The use of DES decreases the rate of repeat revascularization in this population but data concerning long‐term clinical benefits, such as myocardial infarction (MI) or mortality is scant. Methods: We analyzed data from a comprehensive registry of 6,583 consecutive patients undergoing PCI at our center. A propensity score was used for analysis of outcomes and for matching (DES vs. BMS). Outcome parameters were total mortality, MI, repeat target vessel revascularization (TVR) rates, and risk‐adjusted event‐free survival. Within this cohort, we identified 2,571 nondiabetic patients and these were compared with 1,826 diabetic coronary patients. Results: Mean and median follow up time was 3 and 3.25 years, respectively. Overall, diabetics had higher rates of major‐adverse cardiovascular events (MACE) at 4 years compared with nondiabetics (23.03 vs. 31.96 P > 0.001). DES use was associated with lower rates of TVR in both groups [diabetics hazard ratio (HR) = 0.56, 95% confidence interval (CI): 0.42–0.76, P < 0.001, nondiabetics HR = 0.73, 95% CI: 0.55–0.97, P = 0.03] while sustained decreased rates of both mortality and MI were evident solely among diabetics (HR = 0.71, 95% CI: 0.56–0.89, P = 0.004 in diabetic vs. HR = 0.88, 95% CI: 0.69–1.13, P = 0.3). Conclusions: In a “real‐world,” unselected population and extended clinical use, DES in diabetics was associated with sustained decreased rates of MI, death, TVR, and MACE while this benefit was attenuated in the nondiabetic population. © 2011 Wiley‐Liss, Inc. 相似文献
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Yogesh Raja MRCP Sagar N. Doshi MD FRCP Jonathan N. Townend MD FRCP FESC 《Catheterization and cardiovascular interventions》2012,79(3):392-396
The management of in‐stent restenosis (ISR) complicating bifurcation lesions is technically challenging and implant of further stents may not be feasible. The use of drug‐eluting balloons provides an attractive option for treatment of such lesions allowing a technically simple procedure without the need for further complex stenting. The SeQuent Please paclitaxel‐eluting balloon (B. Braun, Berlin, Germany) has been shown to be superior to a paclitaxel eluting stent or balloon angioplasty for ISR complicating a bare‐metal stent. However, there is no data on the efficacy of the SeQuent Please in ISR complicating drug‐eluting stents or bifurcation lesions. We report two cases where the SeQuent Please was used in this setting with angiographic success and freedom from target vessel failure and angina at 24 months. In both cases the Sheathless Eau Cath guide (Asahi Intecc, Japan) was employed to perform a kissing‐balloon dilatation with the SeQuent Please, so allowing treatment via radial access. © 2012 Wiley Periodicals, Inc. 相似文献
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Meta‐analysis of bioabsorbable versus durable polymer drug‐eluting stents in 20,005 patients with coronary artery disease: An update 下载免费PDF全文
Alessandro Lupi MD Gioel Gabrio Secco MD Andrea Rognoni MD Maurizio Lazzero MD Rossella Fattori MD PhD Imad Sheiban MD Angelo Sante Bongo MD Leonardo Bolognese MD Pierfrancesco Agostoni MD PhD Italo Porto MD PhD 《Catheterization and cardiovascular interventions》2014,83(6):E193-E206
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Vascular brachytherapy versus drug‐eluting stents in the treatment of in‐stent restenosis: A meta‐analysis of long‐term outcomes 下载免费PDF全文
Tyrone Collins MD FACC FSCAI Daniel Garcia MD Francisco Y. Macedo MD Georges El‐Hayek MD Girish Nadkarni MD Emad Aziz DO FACC J. Stephen Jenkins MD FACC FSCAI 《Catheterization and cardiovascular interventions》2016,87(2):200-208
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Xavier Freixa MD Ali S. Almasood MD Sohail Q. Khan MD Rodrigo Wainstein MD Azriel Osherov MD Karen Mackie RN Peter H. Seidelin MD FSCAI Vladimír Džavík MD FSCAI 《Catheterization and cardiovascular interventions》2012,79(4):559-565
Objective: To compare the outcomes between paclitaxel‐eluting stents (PES) and sirolimus‐eluting stents (SES) for the treatment of drug‐eluting stent (DES) fracture. Background: DES fracture is considered as an important predictor of in‐stent restenosis (ISR). However, little data are available evaluating the optimal treatment for this complication of coronary stenting. Methods: From January 1, 2004 to December 31, 2008, patients with DES ISR treated with a second DES were identified and evaluated for stent fracture. Stent fracture was defined by the presence of strut separation in multiple angiographic projections, assessed by two independent reviewers. Target lesion revascularization (TLR) at 6 and 12 months were the primary end points. Results: Of 131 lesions with DES ISR treated with a second DES, we found 24 patients (24 lesions, 18.2%) with angiographically confirmed stent fracture. Of these, 20 patients (20 lesions) treated with either PES (n = 11/55%) or SES (n = 9/45%) were included in the study. TLR at 6 months occurred in 9% of patients treated with PES and 22% of those treated with SES (P = 0.41). After 12 months, TLR was 9% and 55.5%, respectively (P = 0.024). Conclusions: This study demonstrates a high incidence of stent fracture in patients presenting with DES ISR in need of further treatment with another DES. The suggested association between treatment of stent fracture‐associated DES ISR with PES as compared with SES, and better long‐term outcomes, is in need of confirmation by larger prospective registries and randomized trials. © 2011 Wiley Periodicals, Inc. 相似文献
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Michael S. Lee MD Raymond Zimmer MD Antonio Pessegueiro MD Daniel Jurewitz MD Jonathan Tobis MD 《Catheterization and cardiovascular interventions》2008,71(4):526-530
Background : Age is an important predictor of mortality after percutaneous coronary intervention (PCI). The safety and efficacy of PCI with drug‐eluting stents (DES) in nonagenarians have not been extensively studied. Methods : A retrospective analysis of 889 consecutive patients identified 28 (3.1%) nonagenarians who underwent PCI with DES from May 2003 to December 2005 at our institution. Results : The mean age was 92 ± 2 years, 39% were male, and 4% were diabetic. Sirolimus‐eluting stents were used in 79%. A mean of 1.5 ± 0.9 stents/patient were implanted with a total stent length of 31 ± 20 mm. Twenty‐nine percent presented with unstable angina and 39% with myocardial infarction. The angiographic success rate obtained was 100%. The 30‐day mortality rate was 21%. The 6 patients who died within 30 days included 3 patients who had cardiogenic shock and one patient with critical aortic stenosis who died due to complications during percutaneous aortic valvuloplasty. The cumulative survival rate for all nonagenarians at 1 year and 3 years was (68 ± 9)% and (61 ± 9)%. When the four patients who were in extremis on presentation were excluded, there were no in‐hospital deaths, the 30‐day mortality was 8%, and the 1 year and 3 year survival rate was (79 ± 8)% and (71 ± 9)% for the nonagenarians. No patient had definite stent thrombosis. Conclusions : The majority of the nonagenarians who underwent PCI with DES presented with acute coronary syndrome. Percutaneous coronary intervention with DES was safe in nonagenarians as there were no in‐hospital deaths and acceptable 3‐year survival rates when patients who were in extremis on presentation were excluded. The high‐risk profile of these patients and the expected attrition of nonagenarians may contribute to their mortality rates. © 2008 Wiley‐Liss, Inc. 相似文献
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Tamir Bental MD Abid Assali MD Hana Vaknin‐Assa MD Eli I. Lev MD David Brosh MD Shmuel Fuchs MD Alexander Battler MD Ran Kornowski MD 《Catheterization and cardiovascular interventions》2010,76(3):374-380
Objectives : To ascertain the long‐term safety, efficacy, and pattern of use of drug‐eluting stents (DES) in routine clinical practice. Methods : We analyzed a registry of 6,583 consecutive patients undergoing percutaneous coronary intervention (PCI), of whom 2,633 were treated using DES (DES group) and 3,950 were treated using bare‐metal stents (BMS group). Propensity score was used for stratified analysis of outcomes and for matching. Outcomes were total mortality, myocardial infarction (MI), repeat target vessel revascularization (TVR) rates, and risk‐adjusted event‐free survival. Results : Follow‐up time was 6 months to 5.18 years (mean: 3 years). Patients in the DES group were more likely to be diabetic and had use of longer or more stents, treatment of more lesions and of more proximal main vessels. After propensity score matching, the cumulative mortality was 12.85% in the DES group versus 14.14% in the BMS group (P = 0.001). Use of DES reduced the occurrence of MI (5.17% vs.5.83%, P = 0.046), of clinically driven TVR (9.76% vs. 12.28%, P < 0.001) and of the composite endpoint of death/MI/TVR (23.38% vs. 26.07%; P < 0.001). Conclusions : Our risk‐adjusted event‐free survival analysis indicates a prognostic benefit for DES utilization that sustains up to 5 years following PCI. © 2010 Wiley‐Liss, Inc. 相似文献
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John Cosgrave Asif Qasim Azeem Latib Tiziana C. Aranzulla Antonio Colombo 《Catheterization and cardiovascular interventions》2008,71(7):913-914
The treatment of hemorrhagic complications of percutaneous interventions with protamine is an accepted practice. Concerns exist about the increased thrombo‐genicity of drugeluting stents. We report two cases of acute stent thrombosis following drug‐eluting stent implantation related to Protamine administration. © 2008 Wiley‐Liss, Inc. 相似文献
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Comparison of abluminal biodegradable polymer biolimus‐eluting stents and durable polymer everolimus‐eluting stents in the treatment of coronary bifurcations 下载免费PDF全文
Charis Costopoulos MD Azeem Latib MD Toru Naganuma MD Alessandro Sticchi MD Santo Ferrarello MD Damiano Regazzoli MD Alaide Chieffo MD Filippo Figini MD Mauro Carlino MD Matteo Montorfano MD Charbel Naim MD Masanori Kawaguchi MD Argyrios Gerasimou MD Francesco Giannini MD Cosmo Godino MD Antonio Colombo MD 《Catheterization and cardiovascular interventions》2014,83(6):889-895
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Angiographic predictors of 2‐year stent thrombosis in patients receiving drug‐eluting stents: Insights from the ADAPT‐DES study 下载免费PDF全文
Philippe Généreux MD Björn Redfors MD PhD Bernhard Witzenbichler MD Akiko Maehara MD Mayank Yadav MD Giora Weisz MD Dominic P. Francese MPH Rupa Parvataneni MS Sorin J. Brener MD Roxana Mehran MD Ajay J. Kirtane MD SM Gregg W. Stone MD 《Catheterization and cardiovascular interventions》2017,89(1):26-35