-
Gill Louise Buchanan,
Alaide Chieffo,
Julinda Mehilli,
Ghada W Mikhail,
Fina Mauri,
Patrizia Presbitero,
Liliana Grinfeld,
Anna Sonia Petronio,
Kimberly A Skelding, Angela Hoye,
Roxana Mehran,
Marie-Claude Morice
[show abstract]
[hide abstract]
ABSTRACT: Aims: Interventional cardiologists are amongst the most intensive radiation users within medicine. To assess the implications of this usage, the "Women In Innovation" Group (WIN) created a web-based survey called "WIN for Safety" distributed through the European Association of Percutaneous Coronary Intervention (EAPCI) to all catheterisation laboratory healthcare professionals, enquiring about radiation protection measures, compliance with monitoring, health (orthopaedic issues), radiation-associated problems (cataracts and cancer) and restrictions imposed upon the pregnant female. Methods and results: In total, there were 615 participants: 72.8% were interventional cardiologists. Most (73.5%) of them were male and 63.3% were aged 31-50 years. A radiation collar badge was used by the majority (64.4%) and the most frequently utilised protective measure was the thyroid shield (87.2%). Potential illnesses related to radiation exposure included 19.5% orthopaedic problems (back/neck/hip pain), 5.5% varicose veins, 2.4% blood count problems and 2.0% cataracts. Notably, an association between orthopaedic problems and years of exposure was found (p=0.001). Overall, only 2.2% had ever been diagnosed with a cancer, with a trend for more females to be affected (4.4% vs. 1.8%; p=0.067). Finally, 62.1% have restrictions imposed upon the pregnant female in the working environment. Conclusions: Awareness of radiation in the field of interventional cardiology is essential. The main risk is orthopaedic problems and measures should be taken for prevention. Cancer has not been demonstrated to be a direct consequence; however, we should remain vigilant and monitor individuals.
EuroIntervention: journal of EuroPCR in collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology 10/2012; 8(6):658-63. · 3.29 Impact Factor
-
Alaide Chieffo, Angela Hoye,
Fina Mauri,
Ghada Mikhail,
Michelle Ammerer,
Cindy Grines,
Liliana Grinfeld,
Mina Madan,
Patrizia Presbitero,
Kimberly A Skelding,
Bonnie H Weiner,
Roxana Mehran
[show abstract]
[hide abstract]
ABSTRACT: Cardiovascular disease is the leading cause of mortality in women yet studies have suggested it is often under-recognized. Of particular concern is the apparent suboptimal treatment of women in comparison to men, with less revascularization and use of evidence-based medications. The Women in Innovations group of cardiologists, aims to highlight these issues and change perceptions to optimize the treatment of female patients with cardiovascular disease, support future research, and encourage and guide the training of female interventional cardiologists.
Revista Espa de Cardiologia 02/2010; 63(2):200-8. · 2.53 Impact Factor
-
Alaide Chieffo, Angela Hoye,
Fina Mauri,
Ghada W Mikhail,
Michelle Ammerer,
Cindy Grines,
Liliana Grinfeld,
Mina Madan,
Patrizia Presbitero,
Kimberly A Skelding,
Bonnie H Weiner,
Roxana Mehran
[show abstract]
[hide abstract]
ABSTRACT: Cardiovascular disease (CVD) is the leading cause of mortality in women, yet studies have suggested that it is often under-recognized. Of particular concern is the apparent suboptimal treatment of women in comparison to men, with less revascularisation and use of evidence-based medications. The Women in Innovations group of cardiologists aims to highlight these issues and change perceptions to optimize the treatment of female patients with CVD, to support future research, and to encourage and guide training of female interventional cardiologists.
EuroIntervention: journal of EuroPCR in collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology 02/2010; 5(7):773-9. · 3.29 Impact Factor
-
Jiro Aoki,
Gaku Nakazawa,
Kengo Tanabe, Angela Hoye,
Hirosada Yamamoto,
Tomohiro Nakayama,
Yoshinobu Onuma,
Yasutomi Higashikuni,
Syuji Otsuki,
Atsuhiko Yagishita,
Sen Yachi,
Hiroyoshi Nakajima,
Kazuhiro Hara
[show abstract]
[hide abstract]
ABSTRACT: Stent fracture is one of the possible causes of restenosis after sirolimus-eluting stents (SES) implantation. The aim of our study was to evaluate the prevalence and clinical impact of coronary stent fracture after SES implantation.
From our prospective institutional database, 280 patients were treated solely with SES from August 2004 to June 2005. Among the 280 patients, 256 patients with a total of 307 lesions underwent follow-up angiography on an average of 240 days after the procedure.
Stent fractures were observed in eight (2.6%) lesions. Of the eight lesions with stent fracture, five were located in the right coronary artery (RCA), two in the saphenous vein (SV) graft, and one in the left anterior descending coronary artery. The stent fractures were all in the locations that served as hinges during vessel movement in the cardiac contraction cycle. Seven of the eight stent fractures were adjacent to the edge of previously implanted or overlapped stent. Significant multivariate predictors of stent fracture were SV graft location (Odds ratio 35.88; 95% confidence interval 2.73-471.6, P = 0.006), implanted stent length (Odds ratio 1.04; 95% confidence interval 1.01-1.07, P = 0.02), and RCA location (Odds ratio 10.00; 95% confidence interval 1.11-89.67, P = 0.04). In-stent binary restenosis rate was 37.5% and target lesion repeat revascularization rate was 50.0% in patients with stent fracture.
Stent fracture was likely to be affected by mechanical stress provoked by rigid structures and hinge points. Stent fracture might be associated with the high incidence of target lesion revascularization.
Catheterization and Cardiovascular Interventions 03/2007; 69(3):380-6. · 2.29 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: A number of percutaneous stenting techniques have been proposed for optimal treatment of bifurcation lesions. However, to date the most favorable interventional approach still remains controversial, since bifurcation lesions are associated with high procedural complication and restenosis rates. In the era of drug-eluting stents, crush stenting technique simplified the procedure, concurrently allowing full lesion coverage. The purpose of the present report is to review three cases treated with crush stenting and to describe in detail the technique and its variations.
Catheterization and Cardiovascular Interventions 07/2006; 67(6):839-45. · 2.29 Impact Factor
-
Angela Hoye,
Ioannis Iakovou,
Lei Ge,
Carlos A G van Mieghem,
Andrew T L Ong,
John Cosgrave,
Giuseppe M Sangiorgi,
Flavio Airoldi,
Matteo Montorfano,
Iassen Michev, [......],
Nicola Corvaja,
Jiro Aoki,
Gaston A Rodriguez Granillo,
Marco Valgimigli,
Georgios Sianos,
Willem J van der Giessen,
Pim J de Feyter,
Ron T van Domburg,
Patrick W Serruys,
Antonio Colombo
[show abstract]
[hide abstract]
ABSTRACT: The purpose of this study was to evaluate predictors of an adverse outcome after "crush" bifurcation stenting.
The "crush" technique is a recently introduced strategy with limited data regarding long-term outcomes.
We identified 231 consecutive patients treated with drug-eluting stent implantation with the "crush" technique for 241 de novo bifurcation lesions. Clinical follow-up was obtained in 99.6%.
The in-hospital major adverse cardiac event (MACE) rate was 5.2%. At 9 months, 10 (4.3%) patients had an event consistent with possible post-procedural stent thrombosis. Survival free of target lesion revascularization (TLR) was 90.3%; the only independent predictor of TLR was left main stem (LMS) therapy (odds ratio [OR] 4.97; 95% confidence interval [CI] 2.00 to 12.37, p = 0.001). Survival free of MACE was 83.5% and independent predictors of MACE were LMS therapy (OR 3.79; 95% CI 1.76 to 8.14, p = 0.001) and treatment of patients with multivessel disease (OR 4.21; 95% CI 0.95 to 18.56, p = 0.058). Angiographic follow-up was obtained in 77% of lesions at 8.3 +/- 3.7 months. The mean late loss of the main vessel and side branch were 0.30 +/- 0.64 mm and 0.41 +/- 0.67 mm, respectively, with binary restenosis rates of 9.1% and 25.3%. Kissing balloon post-dilation significantly reduced the side branch late lumen loss (0.24 +/- 0.50 mm vs. 0.58 +/- 0.77 mm, p < 0.001).
The crush technique of bifurcation stenting with drug-eluting stents is associated with favorable outcomes for most lesions; however, efficacy appears significantly reduced in LMS bifurcations, and further research is needed before the technique can be routinely recommended in this group. Furthermore, the incidence of possible stent thrombosis is of concern and requires further investigation. Kissing balloon post-dilatation is mandatory to reduce side branch restenosis.
Journal of the American College of Cardiology 05/2006; 47(10):1949-58. · 14.16 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Chronic total occlusions (CTOs) are commonly found on diagnostic angiography, and there is some evidence from one study that successful percutaneous revascularization leads to an improvement in long-term survival rates. However, this study included patients treated for unstable angina with short-duration occlusion, and stent implantation was utilized in only 7%. We re-evaluated the long-term outcomes of a large consecutive series of patients with a CTO of >1-month duration treated at our centre, with stent implantation utilized in the majority.
All patients treated with percutaneous coronary intervention (PCI) between 1992 and 2002 were retrospectively identified from a dedicated database. A total of 874 consecutive patients were treated for 885 CTO lesions. Mean follow-up time was 4.47 +/- 2.69 years (median 4.10 years). Patients were evaluated for the occurrence of major adverse cardiac events (MACE) comprising death, acute myocardial infarction, and need for repeat revascularization with either coronary artery bypass surgery or PCI. Successful revascularization was achieved in 576 lesions (65.1%), in which stent implantation was used in 81.0%. At 30 days, the overall MACE rate was significantly lower in those patients with a successful recanalization (5.5 vs. 14.8%, P < 0.00001). At 5 years, survival was significantly higher in those patients with a successful revascularization (93.5 vs. 88.0%, P = 0.02). In addition, there was a significantly higher survival free of MACE (63.7 vs. 41.7%, P < 0.0001), with the majority of events reflecting the need for repeat intervention. Independent predictors for survival were successful revascularization, lower age, and the absence of diabetes mellitus and multivessel disease.
Successful percutaneous revascularization of a CTO leads to a significantly improved survival rate and a reduction in major adverse events at 5 years. Most events relate to the need for repeat reintervention, and the introduction of drug-eluting stents, with low-restenosis rates, encourages the development of technologies to improve recanalization success rates. However, failed recanalization may be associated acutely with an adverse event, and new technologies must focus on a safe approach to successful recanalization.
European Heart Journal 12/2005; 26(24):2630-6. · 10.48 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Chronic total occlusion (CTO) is one of the most challenging coronary lesions to be faced in the catheterization laboratory. This report of a patient with stable angina and a CTO illustrates the potential problems that may arise and must be overcome, and demonstrates the utilization of technologies including the Intraluminal wire.
The Journal of invasive cardiology 11/2005; 17(10):E7-10. · 1.84 Impact Factor
-
Gregg W Stone,
Antonio Colombo,
Paul S Teirstein,
Jeffrey W Moses,
Martin B Leon,
Nicolaus J Reifart,
Gary S Mintz, Angela Hoye,
David A Cox,
Donald S Baim, [......],
Eberhard Grube,
Louis A Cannon,
David E Kandzari,
Mark Reisman,
Robert S Schwartz,
Steven Bailey,
George Dangas,
Roxana Mehran,
Alexander Abizaid,
Patrick W Serruys
Catheterization and Cardiovascular Interventions 11/2005; 66(2):217-36. · 2.29 Impact Factor
-
Gregg W Stone,
David E Kandzari,
Roxana Mehran,
Antonio Colombo,
Robert S Schwartz,
Steven Bailey,
Issam Moussa,
Paul S Teirstein,
George Dangas,
Donald S Baim, [......], Angela Hoye,
Gary S Mintz,
Eberhard Grube,
Louis A Cannon,
Nicolaus J Reifart,
Mark Reisman,
Alexander Abizaid,
Jeffrey W Moses,
Martin B Leon,
Patrick W Serruys
Circulation 11/2005; 112(15):2364-72. · 14.74 Impact Factor
-
Gregg W Stone,
Nicolaus J Reifart,
Issam Moussa, Angela Hoye,
David A Cox,
Antonio Colombo,
Donald S Baim,
Paul S Teirstein,
Bradley H Strauss,
Matthew Selmon, [......],
David E Kandzari,
Mark Reisman,
Robert S Schwartz,
Steven Bailey,
George Dangas,
Roxana Mehran,
Alexander Abizaid,
Jeffrey W Moses,
Martin B Leon,
Patrick W Serruys
Circulation 11/2005; 112(16):2530-7. · 14.74 Impact Factor
-
Jiro Aoki,
Andrew T L Ong, Angela Hoye,
Lex A van Herwerden,
J Eduardo Sousa,
Adib Jatene,
Johannes J R M Bonnier,
Jacques P M A Schönberger,
Nigel Buller,
Robert Bonser,
Wietze Lindeboom,
Felix Unger,
Patrick W Serruys
[show abstract]
[hide abstract]
ABSTRACT: To compare coronary stent implantation and bypass surgery for multivessel coronary disease in patients with renal insufficiency.
In the ARTS trial, 142 moderate renal insufficient patients (Ccr<60 mL/min) with multivessel coronary disease were randomly assigned to stent implantation (n=69) or CABG (n=73). At 5 years, there was no significant difference between the two groups in terms of mortality (14.5% in the stent group vs. 12.3% in the CABG group, P=0.81), or combined endpoint of death, cerebrovascular accident (CVA), or myocardial infarction (MI) (30.4% in the stent group vs. 23.3% in the CABG group, P=0.35). Among patients who survived without CVA or MI, 18.8% in the stent group underwent a second revascularization procedure when compared with 8.2% in the surgery group (P=0.08). The event-free survival at 5 years was 50.7% in the stent group and 68.5% in the surgery group (P=0.04).
At 5 years, the differences in mortality and combined incidence of death, CVA, and MI between coronary stenting and surgery did not reach statistically significant level. However, the occurrence of MACCE in the stent group was higher than in the CABG group, mainly driven by the higher incidence of repeat revascularization in the stent group.
European Heart Journal 08/2005; 26(15):1488-93. · 10.48 Impact Factor
-
Angela Hoye,
Andrew T L Ong,
Jiro Aoki,
Carlos A G van Mieghem,
Gaston A Rodriguez Granillo,
Marco Valgimigli,
Georgios Sianos,
Eugene McFadden,
Willem J van der Giessen,
Pim J de Feyter,
Ron T van Domburg,
Patrick W Serruys
[show abstract]
[hide abstract]
ABSTRACT: Aims: Long-term results following percutaneous coronary intervention (PCI) with bare metal stents in the treatment of chronic total occlusions (CTOs) is hindered by a significant rate of restenosis and re-occlusion. Drug-eluting stents have shown dramatically reduced restenosis rates for the treatment of relatively simple non-occlusive lesions, though there is only limited data as to the efficacy in CTO's. We evaluated the long-term results of the sirolimus-eluting stent (SES) and paclitaxel-eluting stent (PES) for the treatment of CTOs. Methods and results: From April 2002, all patients at our institution were treated with SES as the device of choice during PCI. During the first quarter of 2003 the default strategy changed to the use of PES. Drug-eluting stent implantation was carried out in CTOs (defined as >3 months' duration) in 9% of de novo PCI procedures. A total of 76 consecutive patients were treated with SES implantation, followed by a consecutive series of 57 patients treated with PES implantation. These patients were compared with a similar group of patients (n=26) treated with BMS in the 6-month period preceding April 2002. At 400 days, the cumulative survival-free of target vessel revascularization was 80.8% in the BMS group versus 97.4% and 96.4% in the SES and PES groups respectively (p=0.01). Conclusions: The use of both the SES and PES in the treatment of chronic total coronary occlusions reduces the need for target vessel revascularization compared to bare metal stents.
EuroIntervention: journal of EuroPCR in collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology 08/2005; 1(2):193-7. · 3.29 Impact Factor
-
The Journal of invasive cardiology 06/2005; 17(5):277-9. · 1.84 Impact Factor
-
Andrew T L Ong,
Patrick W Serruys,
Jiro Aoki, Angela Hoye,
Carlos A G van Mieghem,
Gaston A Rodriguez-Granillo,
Marco Valgimigli,
Karel Sonnenschein,
Evelyn Regar,
Martin van der Ent,
Peter P T de Jaegere,
Eugene P McFadden,
Georgios Sianos,
Willem J van der Giessen,
Pim J de Feyter,
Ron T van Domburg
[show abstract]
[hide abstract]
ABSTRACT: We investigated the efficacy of paclitaxel-eluting stents (PES) compared to sirolimus-eluting stents (SES) when used without restriction in unselected patients.
Both SES and PES have been separately shown to be efficacious when compared to bare stents. In unselected patients, no direct comparison between the two devices has been performed.
Paclitaxel-eluting stents have been used as the stent of choice for all percutaneous coronary interventions in the prospective Taxus-Stent Evaluated At Rotterdam Cardiology Hospital (T-SEARCH) registry. A total of 576 consecutive patients with de novo coronary artery disease exclusively treated with PES were compared with 508 patients treated with SES from the Rapamycin-Eluting Stent Evaluated At Rotterdam Cardiology Hospital (RESEARCH) registry.
The PES patients were more frequently male, more frequently treated for acute myocardial infarction, had longer total stent lengths, and more frequently received glycoprotein IIb/IIIa inhibitors. At one year, the raw cumulative incidence of major adverse cardiac events was 13.9% in the PES group and 10.5% in the SES group (unadjusted hazard ratio [HR] 1.33, 95% confidence interval [CI] 0.95 to 1.88, p = 0.1). Correction for differences in the two groups resulted in an adjusted HR of 1.16 (95% CI 0.81 to 1.64, p = 0.4, using significant univariate variables) and an adjusted HR of 1.20 (95% CI 0.85 to 1.70, p = 0.3, using independent predictors). The one-year cumulative incidence of clinically driven target vessel revascularization was 5.4% versus 3.7%, respectively (HR 1.38, 95% CI 0.79 to 2.43, p = 0.3).
The universal use of PES in an unrestricted setting is safe and is associated with a similar adjusted outcome compared to SES. The inferior trend in crude outcome seen in PES was due to its higher-risk population. A larger, randomized study enrolling an unselected population may assist in determining the relative superiority of either device.
Journal of the American College of Cardiology 05/2005; 45(7):1135-41. · 14.16 Impact Factor
-
Angela Hoye,
Carlos A G van Mieghem,
Andrew T L Ong,
Jiro Aoki,
Gaston A Rodriguez Granillo,
Marco Valgimigli,
Keiichi Tsuchida,
Georgios Sianos,
Eugene McFadden,
Willem J van der Giessen,
Pim J de Feyter,
Ron T van Domburg,
Patrick W Serruys
[show abstract]
[hide abstract]
ABSTRACT: Objective: Both the sirolimus-(SES) and paclitaxel-eluting (PES) stents have been shown to reduce restenosis rates when used in relatively simple lesions. This study aimed to evaluate the results of a consecutive series of patients treated with drug-eluting stent implantation for de novo bifurcation lesions, and compared outcomes with respect to stenting strategy and stent type.Patients: From April 2002 to September 2003, all patients at our institution were treated with drug-eluting stent implantation. A consecutive series of 144 patients were treated for 167 de novo bifurcation lesions with SES, followed by 104 patients treated with PES for 113 lesions. Results: Clinical follow-up at 6 months was obtained in 99% patients with survival-free of major adverse cardiac events (MACE) of 93.7% for SES versus 85.8% for PES, p=0.05. By multivariate analysis, factors predictive for MACE were age, diabetes mellitus, previous CABG, multivessel disease, treatment for acute myocardial infarction, and treatment with PES. Survival-free of target lesion revascularization (TLR) was 95.7% for SES versus 86.8% for PES, p=0.01, with stent type being the only independent predictor. Technique of stenting was not a predictor of either MACE or TLR. Conclusions: MACE rates for both the SES and PES are low compared with historical data of bare metal stents. The most effective techniques for bifurcation stenting remain undefined. Our data suggests a higher need for TLR for the PES compared with the SES, however further randomized studies are needed to fully evaluate both stenting strategy, and any difference between the stents.
EuroIntervention: journal of EuroPCR in collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology 05/2005; 1(1):24-30. · 3.29 Impact Factor
-
Andrew T L Ong, Angela Hoye,
Jiro Aoki,
Carlos A G van Mieghem,
Gaston A Rodriguez Granillo,
Karel Sonnenschein,
Evelyn Regar,
Eugene P McFadden,
Georgios Sianos,
Willem J van der Giessen,
Peter P T de Jaegere,
Pim de Feyter,
Ron T van Domburg,
Patrick W Serruys
[show abstract]
[hide abstract]
ABSTRACT: We sought to determine the real-world incidence of angiographically confirmed and possible stent thrombosis (ST) in an unrestricted population during the first 30 days after bare-metal stent (BMS), sirolimus-eluting stent (SES), and paclitaxel-eluting stent (PES) implantation.
Current data on ST in drug-eluting stents (DES) have come from randomized trials with strict entry criteria, which limits their generalizability to daily practice.
The study population comprised three sequential cohorts of 506 consecutive patients with BMS, 1,017 consecutive patients with SES, and 989 consecutive patients treated with PES.
In the first 30 days after stent implantation, 6 BMS (1.2%, 95% confidence interval [CI] 0.5% to 2.6%; p = 0.9), 10 SES (1.0%, 95% CI 0.5% to 1.8%), and 10 PES (1.0%, 95% CI 0.6% to 1.9%) patients developed angiographically proven ST. Multiple potential risk factors were identified in most patients with ST. Bifurcation stenting in the setting of acute myocardial infarction was an independent risk factor for angiographic ST in the entire population (odds ratio [OR] 12.9, 95% CI 4.7 to 35.8, p < 0.001). In patients with DES who had angiographic ST, 30-day mortality was 15%, whereas another 60% suffered a nonfatal myocardial infarction; no further deaths occurred during six months of follow-up. Including possible cases, 7 BMS (1.4%, 95% CI 0.7% to 2.8%), 15 SES (1.5%, 95% CI 0.9% to 2.4%), and 16 PES (1.6%, 95% CI 1.0% to 2.6%) patients had ST.
The unrestricted use of SES or PES is associated with ST rates in the range expected for BMS. Stent thrombosis was associated with a high morbidity and mortality. Bifurcation stenting, when performed in patients with acute myocardial infarction, was associated with an increased risk of ST.
Journal of the American College of Cardiology 04/2005; 45(6):947-53. · 14.16 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Chronic total occlusion of the left main coronary artery (LMCA) is rare. Recently, percutaneous coronary intervention has been increasingly applied to unprotected LMCA lesions. We describe a patient with chronic total occlusion of the LMCA who was successfully treated with bifurcation stenting with sirolimus-eluting stents.
Journal of Interventional Cardiology 03/2005; 18(1):65-9; discussion 69. · 1.18 Impact Factor
-
Kengo Tanabe,
Patrick W Serruys,
Muzaffer Degertekin,
Eberhard Grube,
Giulio Guagliumi,
Wilhelm Urbaszek,
Johannes Bonnier,
Jean-Michel Lablanche,
Tomasz Siminiak,
Jan Nordrehaug, [......],
Karl Hauptmann,
Dariusz Dudek,
Nico Bruining,
Ronald Hamers, Angela Hoye,
Jurgen M R Ligthart,
Clemens Disco,
Jörg Koglin,
Mary E Russell,
Antonio Colombo
[show abstract]
[hide abstract]
ABSTRACT: The clinical impact of late incomplete stent apposition (ISA) for drug-eluting stents is unknown. We sought to prospectively investigate the incidence and extent of ISA after the procedure and at 6-month follow-up of paclitaxel-eluting stents in comparison with bare metal stents (BMS) and survey the clinical significance of ISA over a period of 12 months.
TAXUS II was a randomized, double-blind study with 536 patients in 2 consecutive cohorts comparing slow-release (SR; 131 patients) and moderate-release (MR; 135 patients) paclitaxel-eluting stents with BMS (270 patients). This intravascular ultrasound (IVUS) substudy included patients who underwent serial IVUS examination after the procedure and at 6 months (BMS, 240 patients; SR, 113; MR, 116). The qualitative and quantitative analyses of ISA were performed by an independent, blinded core laboratory. More than half of the instances of ISA observed after the procedure resolved at 6 months in all groups. No difference in the incidence of late-acquired ISA was observed among the 3 groups (BMS, 5.4%; SR, 8.0%; MR, 9.5%; P=0.306), with a similar ISA volume (BMS, 11.4 mm3; SR, 21.7 mm3; MR, 8.5 mm3; P=0.18). Late-acquired ISA was the result of an increase of vessel area without change in plaque behind the stent. Predictive factors of late-acquired ISA were lesion length, unstable angina, and absence of diabetes. No stent thrombosis occurred in the patients diagnosed with ISA over a period of 12 months.
The incidence and extent of late-acquired ISA are comparable in paclitaxel-eluting stents and BMS. ISA is a pure IVUS finding without clinical repercussions.
Circulation 03/2005; 111(7):900-5. · 14.74 Impact Factor
-
Angela Hoye,
Carlos A G van Mieghem,
Andrew T L Ong,
Jiro Aoki,
Gaston A Rodriguez Granillo,
Marco Valgimigli,
Keiichi Tsuchida,
Georgios Sianos,
Eugene P McFadden,
Willem J van der Giessen,
Pim J de Feyter,
Ron T van Domburg,
Patrick W Serruys
[show abstract]
[hide abstract]
ABSTRACT: The most effective strategy for bifurcation stenting is currently undefined. The Culotte technique was developed as a method that ensures complete bifurcation lesion coverage. However, it went out of favour due to a high rate of restenosis when utilizing bare metal stents. Drug-eluting stents reduce the rate of restenosis and need for repeat lesion revascularization compared with bare metal stents; we re-evaluated this technique with drug-eluting stent implantation.
Between April 2002 and October 2003, 207 patients were treated for at least one bifurcation lesion with drug-eluting stent implantation to both the main vessel and side branch. Of these, 23 were treated with the Culotte technique (11.1%) for 24 lesions. Sirolimus-eluting stents were used in 8.3%, and paclitaxel-eluting stents in the remaining 92.7%.
Clinical follow-up was obtained in 100%. One patient had a myocardial infarction at 14 days (maximum rise in creatine kinase 872 IU/L) related to thrombosis occurring in another lesion, and underwent repeat revascularization. There were no episodes of stent thrombosis in the Culotte lesions. At eight months follow-up, there were no deaths and no further myocardial infarction. One patient required target lesion revascularization (TLR), and a second underwent target vessel revascularization. The cumulative rates of survival-free of TLR and major adverse cardiac events were 94.7% and 84.6% respectively. Angiographic follow-up was obtained in 16 patients (69.6%) at a mean period of 8.3+/-4.3 months. The late lumen loss for the main vessel and side branch were 0.48+/-0.56 mm and 0.53+/-0.33 mm respectively, with binary restenosis rates of 18.8% and 12.5%.
In this small study of bifurcation stenting utilizing the Culotte technique with drug-eluting stent implantation, there was a low rate of major adverse events and need for target lesion revascularization at eight months, when compared with historical data of bifurcation stenting with bare metal stents. Further re-evaluation of this technique utilizing drug-eluting stents, is warranted in the setting of larger randomized studies.
International Journal of Cardiovascular Interventions 02/2005; 7(1):36-40.
