Longitudinal stent compression of everolimus-eluting stent: A report of 2 cases

Second generation drug eluting stents(DES) have shown better safety and efficacy in comparison to first generation DES,because of thinner struts,nondurable polymers and coating with better anti-proliferative drugs.The newer DES with cobalt alloy base have demonstrated a greater trackability,deliverability,conformability,flexibility and radio-opacity.However,these thin strut stents have a downside of poor longitudinal axial strength,and therefore get easily deformed/ compressed at their end with a slight trauma during exchange of various catheters.We hereby report two cases of "longitudinal stent compression(LSC)" of everolimus-eluting stent,which happened during percutaneous coronary intervention of right coronary artery.Both the cases were successfully managed with non-compliant balloon dilatation.Various reasons for LSC and its management are discussed in the article.

Safety and Efficacy of a Novel Everolimus-Eluting Stent System in “Real-World” Patients with Coronary Artery Disease: A Report of Preliminary Outcomes

Introduction: Tetrilimus (Sahajanand Medical Technologies Pvt. Ltd., Surat, India) is a recently-introduced biodegradable-polymer coated everolimus-eluting cobalt-chromium coronary stent system with an ultra-thin strut thickness. We aimed to evaluate the clinical outcomes with Tetrilimus coronary stents in “real-world” patients with coronary artery disease. Methods: In this retrospective, single-arm, open-label, multi-center registry, all consecutive patients who received Tetrilimus stents between July-2015 and April-2016 at two tertiary-care centers in India were analyzed. Primary endpoint was 30-day incidence of major adverse cardiac events (MACE), defined as a composite of cardiac death, myocardial infarction, target lesion revascularization, and target vessel revascularization. The Academic Research Consortium (ARC)-defined stent thrombosis was assessed as additional safety endpoint. Results: During the study period, 280 Tetrilimus stents (1.4 ± 0.5 stent/patient) were implanted to treat 252 coronary lesions (1.1 ± 0.3 stent/lesion) in 208 patients (age: 57.5 ± 11.9 years). Of study population, 65.9% were males, 46.6% were hypertensives, 25% were diabetics, 36.5% were alcoholics, 29.3% were smokers, 13.9% were tobacco chewers, 5.3% had previous revascularization, and 45.2% displayed multi-vessel disease. Of treated lesions, 67.5% were complex and 18.7% had total occlusion. Average length and diameter of implanted stents were 25.5 ± 8.8 mm and 2.9 ± 0.3 mm respectively. Subsequently, 30-day MACE were reported in 2 (0.96%) patients;both cases owing to in-hospital cardiac deaths. Events of stent thrombosis or noncardiac death were not reported in any patient. Conclusion: Low MACE rates and absence of stent thrombosis at early 30-day follow-up indicates that Tetrilimus everolimus-eluting stents may have encouraging safety and efficacy in unselected “real-world” patients with coronary artery disease.

Clinical Impact of Dual Antiplatelet Therapy Use in Patients Following Everolimus-eluting Stent Implantation： Insights from the SEEDS Study

Background:Studies have suggested that use of prolonged dual antiplatelet therapy (DAPT) following new generation drug-eluting stent implantation may increase costs and potential bleeding events.This study aimed to investigate the association of DAPT status with clinical safety in patients undergoing everolimus-eluting stent (EES) implantation in the SEEDS study (A Registry to Evaluate Safety and Effectiveness of Everolimus Drug-eluting Stent for Coronary Revascularization) at 2-year follow-up.Methods:The SEEDS study is a prospective,multicenter study,where patients (n =1900) with small vessel,long lesion,or multi-vessel diseases underwent EES implantation.Detailed DAPT status was collected at baseline,6-month,1-and 2-year.DAPT interruption was defined as any interruption of aspirin and/or clopidogrel more than 14 days.The net adverse clinical events (NACE,a composite endpoint of all-cause death,all myocardial infarction (MI),stroke,definite/probable stent thrombosis (ST),and major bleeding (Bleeding Academic Research Consortium Ⅱ-Ⅴ)) were investigated according to the DAPT status at 2-year follow-up.Results:DAPT was used in 97.8％ of patients at 6 months,69.5％ at 12 months and 35.4％ at 2 years.It was observed that the incidence of NACE was low (8.1％) at 2 years follow-up,especially its components of all-cause death (0.9％),stroke (1.1％),and definite/probable ST (0.7％).DAPT was not an independent predictor of composite endpoint of all-cause death/MI/stroke (hazard ratio [HR]:0.693,95％confidence interval [CI]:0.096-4.980,P =0.715) and NACE (HR:1.041,95％ CI:0.145-7.454,P =0.968).Of 73 patients who had DAPT interruption,no patient had ST at 12-month,and only 1 patient experienced ST between 1-and 2-year (1.4％).There was a high frequency of major bleeding events (53/65,82.5％) occurred in patients receiving DAPT treatment.Conclusions:Prolonged DAPT use was not associated with improved clinical safety.The study emphasized that duration of DAPT needs to be shortened in Chinese patients following EES implantation (ClinicalTrials.gov identifier:NCT 01 157455).

Role of Second-Generation Drug-Eluting Stents and Bypass Grafting in Coronary Artery Disease:A Systematic Review and Meta-analysis

Background:The safety and efficacy of coronary artery bypass grafting(CABG)and second-generation drug-eluting stents(DESs)in patients with coronary artery disease(CAD)remain controversial.Therefore we aimed to compare the outcomes of CAD patients treated with CABG and second-generation DESs.Methods:We systematically searched the PubMed,Cochrane Library,Ovid,and Elsevier databases.Studies comparing second-generation DESs with CABG in CAD patients were included.RevMan 5.3 was used to extract and pool the data from the applicable studies.Results:Six trials(N=6604 participants)were included in this meta-analysis.Among all of the CAD patients,second-generation DESs were associated with no differences in the risks of all-cause death[risk ratio(RR)1.18,95% confi dence interval(CI)0.98–1.43,P=0.09],cardiovascular death(RR 1.14,95% CI 0.81–1.59,P=0.45),myocardial infarction(RR 1.22,95% CI 0.98–1.54,P=0.08),and stroke(RR 0.83,95% CI 0.59–1.17,P=0.29),but increased the risks of revascularization(RR 1.95,95% CI 1.66–2.30,P<0.001)and major adverse cardiac and cerebrovascular events(RR 1.72,95% CI:1.31–2.26,P<0.001)when compared with CABG.Conclusions:In the treatment of CAD patients,second-generation DESs was not associated with increased risks of all-cause death,cardiovascular death,myocardial infarction,and stroke,but increased the risks of revascularization and major adverse cardiac and cerebrovascular events when compared with CABG.