共查询到20条相似文献,搜索用时 31 毫秒
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Holmes DR Kereiakes DJ Laskey WK Colombo A Ellis SG Henry TD Popma JJ Serruys PW Kimura T Williams DO Windecker S Krucoff MW 《Journal of the American College of Cardiology》2007,50(2):109-118
Stent thrombosis (ST) after percutaneous coronary intervention has been the focus of intense interest because of its attendant morbidity and mortality. There is controversy about several facets of the problem. These include the frequency of ST with drug-eluting stents (DES) versus bare-metal stents (BMS), the timing of the event, clinical consequences, risk factors, adjunctive therapy, and new preventive approaches. Information has accrued rapidly from several sources, including randomized controlled clinical trials of DES versus BMS in carefully selected subsets of patients and registry experiences in larger patient groups, which provide a more universal real-world picture. The results from these different data sets are not completely concordant. However, several general conclusions can be made: 1) ST is an infrequent but very severe complication of both BMS and DES; 2) at the present time, during 4 years of follow-up from randomized controlled trials that compared DES and BMS, there is no apparent difference in overall ST frequency, although the time course for occurrence appears to differ, with a relative numeric excess of ST late after DES implant; 3) despite this relative imbalance, no differences in the end points of death or death and infarction between DES and BMS are observed; 4) longer-term follow-up of these patients as well as larger angiographic and clinical subsets of patients who receive this technology outside of randomized trials are required to fully study this issue; and 5) advances in stent platforms for drug elution as well as adjunctive pharmacologic therapy are being evaluated to enhance long-term safety. 相似文献
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Fernando Alfonso María José Pérez-Vizcayno Javier Cuesta Bruno García del Blanco Arturo García-Touchard José Ramón López-Mínguez Mónica Masotti Javier Zueco Angel Cequier Maite Velázquez Raúl Moreno Vicente Mainar Antonio Domínguez Cesar Moris Eduardo Molina Fernando Rivero Pilar Jiménez-Quevedo Nieves Gonzalo N. Vázquez 《JACC: Cardiovascular Interventions》2018,11(10):981-991
Objectives
This study sought to compare the long-term safety and efficacy of drug-eluting balloons (DEB) and everolimus-eluting stents (EES) in patients with in-stent restenosis (ISR) of drug-eluting stents (DES).Background
Treatment of patients with DES-ISR remains a challenge.Methods
The RIBS IV (Restenosis Intra-Stent of Drug-Eluting Stents: Drug-Eluting Balloons vs Everolimus-Eluting Stents) trial is a prospective multicenter randomized clinical trial comparing DEB and EES in patients with DES-ISR. The pre-specified comparison of the 3-year clinical outcomes obtained with these interventions is the main objective of the present study.Results
A total of 309 patients with DES-ISR were randomized to DEB (n = 154) or EES (n = 155). At angiographic follow-up, the in-segment minimal lumen diameter was larger in the EES arm (2.03 ± 0.7 mm vs. 1.80 ± 0.6 mm; p < 0.01). Three-year clinical follow-up was obtained in all enrolled patients (100%). The combined clinical outcome measure of cardiac death, myocardial infarction and target lesion revascularization was significantly reduced in the EES arm (19 [12.3%] vs. 31 [20.1%]; p = 0.04; hazard ratio: 0.57 [95% confidence interval: 0.34 to 0.96]), driven by a lower need for target lesion revascularization (11 [7.1%] vs. 24 [15.6%]; p = 0.015; hazard ratio: 0.43 [95% confidence interval: 0.21 to 0.87]). The need for “late” (>1 year) target lesion revascularization (2.6% vs. 4%) and target vessel revascularization (4% vs. 6.6%) was similar in the 2 arms. Rates of cardiac death (3.9% vs. 3.2%), myocardial infarction (2.6% vs. 4.5%), and stent thrombosis (1.3% vs. 2.6%) at 3 years were also similar in both arms.Conclusions
The 3-year clinical follow-up of this randomized clinical trial demonstrates that in patients with DES-ISR, EES reduce the need for repeat interventions compared with DEB. (Restenosis Intra-Stent of Drug-Eluting Stents: Drug-Eluting Balloons vs Everolimus-Eluting Stents [RIBS IV]; NCT01239940) 相似文献13.
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Coronary stents are the mainstay of percutaneous coronary revascularization procedures and have significantly decreased the rates of acute vessel closure and restenosis. Stent thrombosis (ST) after percutaneous coronary intervention is an uncommon and potentially catastrophic event that might manifest as myocardial infarction and sudden death. Optimization of stent implantation and dual antiplatelet therapy have markedly reduced the occurrence of this complication. Bare-metal stent (BMS) thrombosis occurs in <1% of the cases, usually within the first month after implantation. The advent of drug-eluting stents (DES) has raised concerns regarding later occurrence of ST, beyond the traditional 1-month timeframe, especially in complex lesion subsets that were excluded from randomized trials that compared BMS to DES. There is widespread controversy regarding the actual incremental risk associated with DES. Recent studies suggest a 0.5% increased long-term thrombosis risk with DES; however, the clinical significance of these events remains under debate. The degree of protection achieved by dual antiplatelet therapy and optimal duration of treatment are under investigation. Novel stent designs might potentially decrease the incidence of this event. In this review, we will describe the current knowledge of the pathophysiology of late DES thrombosis, although many aspects remain incompletely understood. 相似文献
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Absorb bioresorbable vascular scaffold vs. everolimus‐eluting metallic stent in small vessel disease: A propensity matched analysis of COMPARE II,RAI, and MAASSTAD‐ABSORB studies 下载免费PDF全文
Giuseppe Tarantini MD PhD Giulia Masiero MD Alberto Barioli MD Valeria Paradies MD Georgios Vlachojannis MD PhD Paola Tellaroli PhD Bernardo Cortese MD Gaetano di Palma MD Attilio Varricchio MD Alfonso Ielasi MD Bruno Loi MD Daisuke Ueshima MD Marco Mojoli MD Pieter Smits MD PhD 《Catheterization and cardiovascular interventions》2018,92(2):E115-E124
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Hiroki Shiomi Ken Kozuma Takeshi Morimoto Kazushige Kadota Kengo Tanabe Yoshihiro Morino Takashi Akasaka Mitsuru Abe Yasuaki Takeji Satoru Suwa Yoshiaki Ito Masakazu Kobayashi Kazuoki Dai Koichi Nakao Yasuhiro Tarutani Ryoji Taniguchi Hideo Nishikawa Yoshito Yamamoto Takeshi Kimura 《JACC: Cardiovascular Interventions》2019,12(7):637-647