Intravascular ultrasound studies were performed at angiographic follow-up on 121 native coronary lesions treated with 1 bare metal stent(n=50), high-dose dexamethasone-eluting stents(n=18), non-polymer-based paclitaxe...Intravascular ultrasound studies were performed at angiographic follow-up on 121 native coronary lesions treated with 1 bare metal stent(n=50), high-dose dexamethasone-eluting stents(n=18), non-polymer-based paclitaxel-eluting stents(n=18), or sirolimus-eluting stents(n=35). Paclitaxel-and sirolimus-eluting stents reduced mean intimal hyperplasia thickness compared with bare metal stents by 49%and 90%(p=0.048 and p< 0.001), respectively, whereas mean intimal hyperplasia thickness treated with dexamethasone-eluting stents was similar to those lesions treated with bare metal stents.展开更多
duce the frequency of neointimal hyperplasia and restenosis compared with bare metal stents. However, the clinical implication of overlapping stents with regard to the pattern of restenosis is unclear. All patients wh...duce the frequency of neointimal hyperplasia and restenosis compared with bare metal stents. However, the clinical implication of overlapping stents with regard to the pattern of restenosis is unclear. All patients who underwent angiography at our institution from May 2003 to March 2005 who had previously received 2 overlapping Cypher stents in native coronary lesions and had binary restenosis were included in our study. Quantitative coronary analysis was performed to determine the degree and location of the restenotic lesion with respect to the overlapping stented segment. The primary end point was to determine how often restenotic lesions occurred at the overlapped segment versus the nonoverlapped stented segments. During the study, 11 patients fit the inclusion criteria for our study; 91% were men and 55% had diabetes mellitus. The mean total stent length was 33.7± 8.2 mm. The mean length of the overlapped segment was 5.9± 3.8 mm, equating to 19± 16% of the total stented area. The average time to follow- up angiography was 277± 126 days. All 11 lesions exhibited type 1(focal) restenosis. Of these 11 lesions, 10 had focal restenosis at the overlapped segment(p=0.01, binomial test). The single case involving in- stent restenosis in the nonoverlapped segment occurred at the proximal stent edge. In conclusion, the pattern of restenosis observed in our study suggests a higher relative incidence of binary restenosis in the overlapped stented segment in patients who receive 2 overlapping Cypher stents.展开更多
Objective:To evaluate neointimal coverage after Drug Eluting Stent implantation without no restenosis during angiographic follow up by using optical coherence tomography(OCT).Methods:18 case enrolled into this project...Objective:To evaluate neointimal coverage after Drug Eluting Stent implantation without no restenosis during angiographic follow up by using optical coherence tomography(OCT).Methods:18 case enrolled into this project who received angiography follow up and OCT checkout.Results:1.Totally,4709 struts were analyzed and 88.6% were completely covered with neointimal,and 0.7% were partly covered and 8.1% were uncovered.The rate of late malapposition of struts was 2.6%.The average neointimal hyperplasia thickness was 0.099 mm.2.The rates of uncovered struts,late strut malapposition were different among different types of DES,and so did the average neointimal hyperplasia thickness.3.Compared with DES implantation less than 12 months,the average neointimal hyperplasia thickness increased in the group of DES implantation more than 12 months(0.1183 mm vs 0.0875 mm ;P=0.001),and uncovered struts rate were 1.7% and 6.8%respectively(P<0.05),and late struts malapposition rate were 2.1% and 0.5% respectively(P<0.001).Conclusion:Rate of neointimal coverage over DES at about 16-months follow-up was 90.1%,as the rate of uncoverage was 9.9%.Out study suggests that dual antiplatelet therapy might be continued>16 months after DES implantation.展开更多
We sought to demonstrate the safety and performance of the actinomycin D-coated Multilink-Tetra stent(Guidant Corp., Santa Clara, California) in the treatment of patients with single de novo native coronary esions. Dr...We sought to demonstrate the safety and performance of the actinomycin D-coated Multilink-Tetra stent(Guidant Corp., Santa Clara, California) in the treatment of patients with single de novo native coronary esions. Drug-eluting stents (DES) releasing sirolimus or paclitaxel dramatically reduce restenosis. The anti-proliferative drug, actinomycinD,which is highly effective in reducing neointimal proliferation in preclinical studies, was selected for clinical evaluation. The multi-center, single-blind, three-arm ACT inomycin-eluting stent Improves Outcomes by reducing Neointimal hyperplasia(ACTION) trial randomized 360 patients to receive a DES(2.5 or 10 μg/cm2 of actinomycin D) or metallic stent(MS). The primary end points were major adverse cardiac events(MACE) at 30 days, diameter stenosis by angiography, tissue effects, and neointimal volume by intravascular ultrasound(IVUS) at six months. When early monitoring revealed an increased rate of repeat revascularization, the protocol was amended to allow for additional follow-up for DES patients. Angiographic control of MS patients was no longer mandatory. The biased selection of DES patients undergoing IVUS follow-up invalidated the interpretation of the IVUS findings. The in-stent late lumen loss and that at the proximal and distal edges were higher in both DES groups than in the MS group and resulted in higher six-month and one-year MACE (34.8%and 43.1%vs. 13.5%), driven exclusively by target vessel revascularization without excess death or myocardial infarction. The results of the ACTION trial indicate that all anti-proliferative drugs will not uniformly show a drug class effect in the prevention of restenosis.展开更多
文摘Intravascular ultrasound studies were performed at angiographic follow-up on 121 native coronary lesions treated with 1 bare metal stent(n=50), high-dose dexamethasone-eluting stents(n=18), non-polymer-based paclitaxel-eluting stents(n=18), or sirolimus-eluting stents(n=35). Paclitaxel-and sirolimus-eluting stents reduced mean intimal hyperplasia thickness compared with bare metal stents by 49%and 90%(p=0.048 and p< 0.001), respectively, whereas mean intimal hyperplasia thickness treated with dexamethasone-eluting stents was similar to those lesions treated with bare metal stents.
文摘duce the frequency of neointimal hyperplasia and restenosis compared with bare metal stents. However, the clinical implication of overlapping stents with regard to the pattern of restenosis is unclear. All patients who underwent angiography at our institution from May 2003 to March 2005 who had previously received 2 overlapping Cypher stents in native coronary lesions and had binary restenosis were included in our study. Quantitative coronary analysis was performed to determine the degree and location of the restenotic lesion with respect to the overlapping stented segment. The primary end point was to determine how often restenotic lesions occurred at the overlapped segment versus the nonoverlapped stented segments. During the study, 11 patients fit the inclusion criteria for our study; 91% were men and 55% had diabetes mellitus. The mean total stent length was 33.7± 8.2 mm. The mean length of the overlapped segment was 5.9± 3.8 mm, equating to 19± 16% of the total stented area. The average time to follow- up angiography was 277± 126 days. All 11 lesions exhibited type 1(focal) restenosis. Of these 11 lesions, 10 had focal restenosis at the overlapped segment(p=0.01, binomial test). The single case involving in- stent restenosis in the nonoverlapped segment occurred at the proximal stent edge. In conclusion, the pattern of restenosis observed in our study suggests a higher relative incidence of binary restenosis in the overlapped stented segment in patients who receive 2 overlapping Cypher stents.
文摘Objective:To evaluate neointimal coverage after Drug Eluting Stent implantation without no restenosis during angiographic follow up by using optical coherence tomography(OCT).Methods:18 case enrolled into this project who received angiography follow up and OCT checkout.Results:1.Totally,4709 struts were analyzed and 88.6% were completely covered with neointimal,and 0.7% were partly covered and 8.1% were uncovered.The rate of late malapposition of struts was 2.6%.The average neointimal hyperplasia thickness was 0.099 mm.2.The rates of uncovered struts,late strut malapposition were different among different types of DES,and so did the average neointimal hyperplasia thickness.3.Compared with DES implantation less than 12 months,the average neointimal hyperplasia thickness increased in the group of DES implantation more than 12 months(0.1183 mm vs 0.0875 mm ;P=0.001),and uncovered struts rate were 1.7% and 6.8%respectively(P<0.05),and late struts malapposition rate were 2.1% and 0.5% respectively(P<0.001).Conclusion:Rate of neointimal coverage over DES at about 16-months follow-up was 90.1%,as the rate of uncoverage was 9.9%.Out study suggests that dual antiplatelet therapy might be continued>16 months after DES implantation.
文摘We sought to demonstrate the safety and performance of the actinomycin D-coated Multilink-Tetra stent(Guidant Corp., Santa Clara, California) in the treatment of patients with single de novo native coronary esions. Drug-eluting stents (DES) releasing sirolimus or paclitaxel dramatically reduce restenosis. The anti-proliferative drug, actinomycinD,which is highly effective in reducing neointimal proliferation in preclinical studies, was selected for clinical evaluation. The multi-center, single-blind, three-arm ACT inomycin-eluting stent Improves Outcomes by reducing Neointimal hyperplasia(ACTION) trial randomized 360 patients to receive a DES(2.5 or 10 μg/cm2 of actinomycin D) or metallic stent(MS). The primary end points were major adverse cardiac events(MACE) at 30 days, diameter stenosis by angiography, tissue effects, and neointimal volume by intravascular ultrasound(IVUS) at six months. When early monitoring revealed an increased rate of repeat revascularization, the protocol was amended to allow for additional follow-up for DES patients. Angiographic control of MS patients was no longer mandatory. The biased selection of DES patients undergoing IVUS follow-up invalidated the interpretation of the IVUS findings. The in-stent late lumen loss and that at the proximal and distal edges were higher in both DES groups than in the MS group and resulted in higher six-month and one-year MACE (34.8%and 43.1%vs. 13.5%), driven exclusively by target vessel revascularization without excess death or myocardial infarction. The results of the ACTION trial indicate that all anti-proliferative drugs will not uniformly show a drug class effect in the prevention of restenosis.
