16

16. Indications for Stenting 1996-2001

TCTMD Slide Sets

New Horizons in Coronary Stents, by M.B. Leon
Breakthroughs in Interventional Cardiology: Revascularization Strategies in Chronic Coronary Artery Disease by M.B. Leon

TCTMD - The Great Debate Slide Sets

Surgical Coronary Revascularization Strategies: Treatment of Single Vessel Disease, by M. Connolly
Treatment of Single Vessel Disease: The Interventional Approach, by D.R. Holmes, Jr.

Education in Heart
Role of stenting in coronary revascularisation
Gershlick AH.
Heart 2001;86:104-12
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=11410576

Underuse of coronary revascularization procedures in patients considered appropriate candidates for revascularization
Hemingway H, et al.
N Engl J Med 2001;344:645-54
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=11228280 http://www.tctmd.com/ct/enewsletter-20010409/6122/?send_to=http://www.tctmd.com/journal-synopses/one.html?synopsis_id=2042
The underuse of coronary revascularization procedures is common. Medical treatment for patients with indications for revascularization is associated with higher mortality and a higher prevalence of angina over 2.5 years of follow-up, as compared with patients who underwent coronary revascularization. Finally, the integration of explicit measures of appropriateness into routine clinical practice may improve long-term outcomes in these patients.

Coronary stenting beyond standard indications. Immediate and follow-up results
Finci L || Colombo A
Ital Heart J 2000;1:739-48
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=0011110516
Click here to view the full article in PDF
Coronary stenting in left main, calcified lesions, small vessels, diffuse disease, and bifurcations is associated with acceptable primary success and complication rates. However, the overall MACE rates were relatively high (34-62%), particularly in bifurcation lesions treated with stents in both branches.

Results of Coronary Stenting with Different Indications
Finci L || Colombo A
Cardiovascular Interventions CVI 2000;5:8-13
Click here to view the full article in PDF

Coronary artery stents
Al Suwaidi J || Holmes DR Jr
Jama 2000;284:1828-36
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=0011025836
Intracoronary stents have become an essential component of the catheter-based treatment of coronary artery disease. The evidence indicates that elective stenting, rather than provisional stenting or balloon angioplasty alone, improves clinical outcomes in the months following percutaneous coronary revascularization in a wide variety of clinical settings and lesion types

Guidelines
Coronary artery stents in the treatment of ischaemic heart disease
National Institute for Clinical Excellence
http://www.nice.org.uk
Click here to view the full article
Conclusions: 1) In sub-acute ischaemic heart disease IHD, especially stable angina and unstable angina, there is evidence for the effectiveness of a strategy of using stents as opposed to PTCA plus recourse to bailout stenting when acute closure occurs. 2) The main impact is on reduced need for repeat PTCA. 3) Although based on randomised trials, the available research is open to bias and hence there is not complete certainty. 4) Our tentative view is that used in these conditions and this way, stents are likely to represent an efficient use of resources. 5) The evidence on the relative effectiveness and efficiency of stents used provisionally is inconclusive. 6) Outside use of stents in sub-acute IHD, the effectiveness and/or efficiency of stents use is not known.

Medical therapy versus coronary angioplasty in stable coronary artery disease: a critical review of the literature
Blumenthal RS || Schulman SP
J Am Coll Cardiol 2000;36:668-73
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=0010987582
For now, aggressive medical therapy and revascularization should be viewed as complementary rather than opposing strategies. All patients with coronary heart disease should receive proven medical and lifestyle prescriptions to favorably alter the atherosclerotic process. Percutaneous revascularization without comprehensive risk factor modification is a suboptimal therapeutic strategy.
Click here to view the comments from TCTMD.

CME - Treatment Update November 22, 2000 Medscape

Medical vs. Interventional Approaches to the Management of Coronary Artery Disease: The Clinical Application of Current Knowledge
by Peter Libby MD and Steven Nissen MD
Click here to view the full article

Balloon optimization versus stent study (BOSS): provisional stenting and early recoil after balloon angioplasty
Dangas G, et al.
Am J Cardiol 2000;85:957-61.
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=10760334

Stent implantation neutralizes the impact of preintervention arterial remodeling on subsequent target lesion revascularization
Dangas G, et al.
Am J Cardiol 2000;86:452-5.
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=10946042

Long-term follow-up study of coronary reconstruction with multiple stents
Liu MW, et al.
Am Heart J 1999;137:292-7.
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=9924163

Procedural results and late clinical outcomes following multivessel coronary stenting
Kornowski R, et al.
J Am Coll Cardiol 1999;33:420-6.
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=9973022

Indications for intracoronary stent placement: the european view. Working Group on Coronary Circulation of the European Society of Cardiology
Eeckhout E, et al.
Eur Heart J 1999;20:1014-9.
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=10381853

Procedural results and late clinical outcomes after placement of three or more stents in single coronary lesions
Kornowski R, et al.
Circulation 1998;97:1355-61.
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=9577946

One-year follow-up of the Stent Restenosis (STRESS I) Study
George CJ, et al.
Am J Cardiol 1998;81:860-5.
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=9555775

The state of the stent: current practices, controversies, and future trends
Serruys PW, et al.
Am J Cardiol 1996;78:4-7.
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=8751839

Contemporary stent designs: technical considerations, complications, role of intravascular ultrasound, and anticoagulation therapy
Popma JJ, et al.
Prog Cardiovasc Dis 1996;39:111-28.
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=8841006

Coronary artery stents. American College of Cardiology
Pepine CJ, et al.
J Am Coll Cardiol 1996;28:782-94.
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=8772772

Reduction in angioplasty complications after the introduction of coronary stents: results from a consecutive series of 2242 patients
Altmann DB, et al.
Am Heart J 1996;132:503-7.
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=8800018