Selection of coronary stents
Colombo A, et al.
J Am Coll Cardiol 2002;40:1021-33
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=12354423
In clinical practice, the operator must decide which stent is most appropriate
for the patient. This article focuses on the features of stent design that make
a specific stent more or less suitable for a particular type of lesion or
anatomy: the "average" coronary lesion, the lesion situated on a
curve, the ostial lesion, the bifurcational lesion, the lesion located at the
left main stem, the calcified lesion, the chronic total occlusion, the small
vessel, the saphenous vein graft, acute or threatened vessel closure, and
special situations such as coronary aneurysms and perforations.
Full Text PDF
No-reflow
phenomenon and lesion morphology in patients with acute myocardial infarction
Tanaka A, et al.
Circulation
2002;105:2148-52.
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=11994247
http://www.circulationaha.org/cgi/content/full/105/18/2148
http://www.circulationaha.org/cgi/content/abstract/105/18/2148
Large vessels with lipid pool-like image are at high risk for no reflow
after primary intervention for AMI. Also, plaque content may play a role in
damage to the microcirculation after primary intervention for AMI.
Revisiting
the culprit lesion in non-Q-wave myocardial infarction. Results from the
VANQWISH trial angiographic core laboratory
Kerensky RA, et al.
J Am Coll Cardiol
2002;39:1456-63.
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=11985907
Coronary angiography early after NQWMI frequently identifies severe obstructive
CAD, but a single identifiable culprit lesion was identified in <50% of
patients. Multiple culprit lesions were seen in 14% of patients. An angiographic
culprit lesion could not be identified in more than one-third of patients
undergoing coronary angiography as part of an invasive strategy.
A
randomized comparison of
the value of additional stenting
after optimal balloon angioplasty
for long coronary lesions:
final results of the additional
value of NIR stents for
treatment of long coronary lesions
(ADVANCE) study
Serruys PW, et
al.
J Am Coll Cardiol
2002;39:393-9.
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=11823075
A strategy of provisional stenting for long coronary lesions led to bailout
stenting in one-third of patients, with a threefold increase in peri-procedural
infarction. Additional stenting yielded a lower angiographic restenosis rate,
but no reduction in MACE at nine months
ACC 2002 Meeting Coverage
| Does Heparin Coating Help In Small Vessel Stenting? Results of the COAST Trial | M. Haude |
Comparative analysis of stent placement
versus balloon angioplasty in small coronary arteries with long narrowings (the
Intracoronary Stenting or Angioplasty for Restenosis Reduction in Small Arteries
[ISAR-SMART] Trial)
Hausleiter J, et al.
Am J Cardiol 2002;89:58-60
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=11779524
Stenting
very small coronary narrowings (< 2 mm) using the biocompatible
phosphorylcholine-coated coronary stent
Grenadier E, et al.
Catheter Cardiovasc Interv
2002;55:303-8.
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=11870932
This initial clinical experience indicates that the implantation of 2.0 mm
stents coated with phosphorylcholine appears to be safe and efficacious in the
treatment of complex coronary lesions and is associated with low target vessel
revascularization rate in spite of the very small vessel diameter
Stenting
vs. balloon angioplasty with provisional stenting for the treatment of vessels
with small reference diameter
Lemos PA, et al.
Catheter Cardiovasc Interv
2002;55:309-14.
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=11870933
Treatment of small vessels with balloon dilatation and provisional stenting
or with primary stenting yielded similar late outcomes. Operators' choice of
treatment strategy was based on particular angiographic characteristics
Comparison
of stenting with balloon angioplasty for lesions of small coronary vessels in
patients with diabetes mellitus
Mehilli J, et al.
Am J Med 2002;112:13-8.
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=11812401
Patients with diabetes who undergo percutaneous coronary interventions for
lesions in small vessels have an especially high risk of restenosis that does
not appear to be attenuated by stenting.
Moer R, et al.
Scand Cardiovasc J
2002;36:86-90.
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=12028870
At 6 months the clinical outcome was significantly better in the stent group
as compared with the PTCA group, with an event-free survival in 90.5 and 76.1%
(p = 0.016), respectively. Angioplasty in small coronary arteries is associated
with a favorable clinical outcome after 1 year. The clinical benefit of elective
stenting using the HepamedŽ-coated beStent is maintained beyond 6 months,
without any tendency towards late events. Thus, elective stenting should be
considered as an option when treating small coronary arteries
(Free Full text available)
Natural
history of small and medium-sized side branches after coronary stent
implantation
Poerner TC, et al.
Am Heart J 2002;143:627-35.
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=11923799
http://www.mosby.com/scripts/om.dll/serve?action=searchDB&searchDBfor=art&artType=abs&id=a120411&target=
Acute SBO after stenting occurred in 21.2% of cases and had a benign course.
Most acutely occluded side branches underwent late spontaneous reperfusion. A
baseline side branch diameter >1.4 mm predicted a preserved antegrade flow
immediately after stent implantation, as well as during follow-up.
TCT 2002 Meeting Coverage
The
Role of Drug-Eluting Stents in Bifurcation Lesions
Two small clinical studies show that the use of a sirolimus-eluting stent
for the treatment of bifurcation lesions is safe and yields relatively low rates
of restenosis; however, incomplete ostial coverage has been identified with
higher rates of side branch restenosis.
A
stepwise strategy for the stent treatment of bifurcated coronary lesions
Pan M, et al.
Catheter Cardiovasc Interv 2002;55:50-7.
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=11793495
Patients with coronary stenosis at major bifurcations may be treated
following an unitary stepwise approach. In the first step, balloon angioplasty
of the side branch followed by stenting of the parent vessel; in the second,
balloon redilation of the side-branch origin across the metallic structure of
the stent; in the third, stenting of the side-branch origin. Progression through
each phase was triggered by the failure of one procedure to achieve a <50%
residual stenosis at the side branch: this attitude may avoid side-branch stent
implantation in most patients, providing good immediate and long-term results.
Stenting
of bifurcation lesions using the Bestent: a prospective dual- center study
Gobeil F, et al.
Catheter Cardiovasc Interv 2002;55:427-33.
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=11948886
This study shows that using a simple strategy of provisional T-stenting of
the side branch in the majority of cases, the Bestent can be used for treating
bifurcation lesions with a high rate of success and an acceptable rate of TVR at
6-month follow-up
Sequential
vs. kissing balloon angioplasty for stenting of bifurcation coronary lesions
Brueck M, et al.
Catheter Cardiovasc Interv 2002;55:461-6.
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=11948892
Using sequential balloon angioplasty, permanent or transient side-branch
compromise rate (TIMI flow < 3) was significantly higher than after kissing
balloon technique (33% vs. 0%, respectively; P = 0.003). Major clinical events
in-hospital or at 6-month follow-up, however, showed no significant differences.
Kissing balloon angioplasty reduces the rate of transient side-branch occlusion
compared to sequential PTCA but does not improve immediate or long-term outcome
compared to sequential PTCA for stenting of bifurcation lesions
Outcome
of treatment of aorto-ostial lesions involving the right coronary artery or a
saphenous vein graft with a polytetrafluoroethylene- covered stent
Toutouzas K, et al.
Am J Cardiol 2002;90:63-6.
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=12088784
Selection of coronary stents
Colombo A, et al.
J Am Coll Cardiol 2002;40:1021-33
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=12354423
In clinical practice, the operator must decide which stent is most appropriate
for the patient. This article focuses on the features of stent design that make
a specific stent more or less suitable for a particular type of lesion or
anatomy: the "average" coronary lesion, the lesion situated on a
curve, the ostial lesion, the bifurcational lesion, the lesion located at the
left main stem, the calcified lesion, the chronic total occlusion, the small
vessel, the saphenous vein graft, acute or threatened vessel closure, and
special situations such as coronary aneurysms and perforations.
Full
Text PDF
Cutting
and stenting in a heavily calcified left anterior descending artery lesion
Meerkin D, et al.
J Invasive Cardiol 2002;14:547-51
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=12205357
The significance of heavily calcified proximal left anterior descending coronary
artery stenosis in a 57-year-old man was assessed physiologically using a
Doppler flow wire. Intravascular ultrasound guidance allowed for adequate
dilatation with a cutting balloon and optimization of stent deployment. The
cutting balloon offers an effective alternative in this challenging scenario.
TCT 2002 Meeting Coverage
Chronic
Total Occlusions -- New Approaches, New Hopes
Typically referred for CABG surgery, patients with CTOs may now be able to
undergo transcatheter treatment with new devices designed to enhance operator
skill in crossing these complex lesions.
Fate
of collateral circulation after successful coronary angioplasty of total
occlusion assessed by coronary angiography and myocardial contrast
echocardiography
Ha JW, et al.
J Am Soc Echocardiogr 2002;15:389-95.
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=12019421
http://www.mosby.com/scripts/om.dll/serve?action=searchDB&searchDBfor=art&artType=abs&id=a115185&target=
Successful PTCA with stenting of a totally occluded coronary artery leads to
a disappearance of collateral vessels by coronary angiography in most of the
patients. However, although angiographically not visible, coronary collateral
circulation may persist even 24 hours after successful PTCA of a totally
occluded artery demonstrated by MCE.
Long-term (three-year)
outcomes after stenting of unprotected left main coronary artery stenosis in
patients with normal left ventricular function
Park SJ, et al.
Am J Cardiol 2003;91:12-6
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=12505564
The cumulative probabilities free from major adverse cardiac events were
81.9 +/- 2.4%, 78.4 +/- 2.6%, and 77.7 +/- 2.7%, respectively, at 1, 2, and 3
years. Combined coronary artery disease and postprocedural minimal luminal
diameter were the significant predictors of major adverse cardiac events. Thus,
the long-term prognosis of patients after stenting of unprotected LMCA stenosis
was favorable in selected patients with normal left ventricular function.
Editorial
Safety
and efficacy of unprotected left main coronary artery stenting
Nageh T, et al.
Circulation 2002;105:e85.
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=11940562
http://www.circulationaha.org/cgi/content/full/105/14/e85
Acute stent recoil in the left main coronary
artery treated with additional stenting
Battikh K, et al.
J Invasive Cardiol 2003;15:39-42
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=12499528
Case report on acute stent recoil occurring after
stenting of an ostial left main coronary artery lesion. The marked recoil after
high-pressure balloon inflation confirmed that the radial force of the first
stent was unable to ensure vessel patency. The addition of a second stent
provided the necessary support to achieve a good final result.
Percutaneous
reperfusion of left main coronary disease complicated by acute myocardial
infarction
Neri R, et al.
Catheter Cardiovasc Interv
2002;56:31-4.
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=11979530
A percutaneous mechanical intervention strategy in patients with left main
disease complicated by AMI is feasible and effective, and patients discharged
alive have a good mid-term prognosis.
Images in cardiovascular
medicine
Left main rapamycin-coated stent: invasive versus
noninvasive angiographic follow-up
Nieman K, et al.
Circulation 2002;105:e130-1.
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=11994262
http://www.circulationaha.org/cgi/content/full/105/18/e130
Emergency
stenting of the unprotected left main coronary artery
Ramondo A, et al.
Ital Heart J 2002;3:72-4.
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=11899596
Report of a case of successful stenting of the unprotected left main
coronary artery as a salvage procedure in a patient with tight ostial left main
coronary artery stenosis who had cardiac arrest following diagnostic coronary
angiography
Obliteration
of a left main coronary artery aneurysm with a PTFE-coated stent
Strozzi M, et al.
J Invasive Cardiol
2002;14:280-1.
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=11983953
The successful percutaneous obliteration of a left main coronary artery
aneurysm using a covered stent (JOMED) is described. The immediate angiographic
result was excellent and the early post-procedural period was uneventful.
Six-month follow-up angiography revealed no changes.
AHA 2002 Meeting Coverage
X-TRACT:
Thrombus extraction device cuts incidence of large MI
with slides / A device to remove thrombus
during percutaneous coronary intervention in saphenous vein grafts and native
coronary arteries with thrombus appears to reduce the incidence of large MI and
the composite of death and large MI at 30 days.
TCT 2002 Meeting Coverage
| X-TRACT: X-Sizer Cuts and Vacuums Thrombus | G. W. Stone |
X-TRACT:
X-Sizer for Treatment of Thrombus and Atherosclerosis in Coronary Interventions
Trial
The use of a device that combines cutting and vacuum capabilities is safe as
an adjunct to percutaneous intervention and reduces the incidence of large MI at
30 days.
TCT 2002 Expert Presentations
| XTRACT Trial | G. W. Stone |
Full text journal article Aug
2002
Removal of Thrombus by
Catheter Aspiration Prior to Stenting
Experts in the field review a case and share their opinion on how to manage
the patient.
Intracoronary
thrombectomy with the X-sizer catheter system improves epicardial flow and
accelerates ST-segment resolution in patients with acute coronary syndrome: a
prospective, randomized, controlled study
Beran G, et al.
Circulation
2002;105:2355-60.
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=12021220
http://www.circulationaha.org/cgi/content/full/105/20/2355
http://www.circulationaha.org/cgi/content/abstract/105/20/2355
In ACS with suspected thrombus, pretreatment with the X-sizer catheter system
improves epicardial flow and accelerates ST-segment resolution compared with
conventional PCI alone.
Thrombectomy with rescue percutaneous
thrombectomy catheter: our initial experience
Bahuleyan CG, et al.
J Invasive Cardiol 2003;15:36-8
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=12499527
Rescue Percutaneous Thrombectomy Catheter has been successfully used in the
setting of acute myocardial infarction. The present case illustrates that the
Rescue Percutaneous Thrombectomy Catheter can be used for removing thrombus even
one month after acute myocardial infarction.
Percutaneous
transluminal therapeutic ultrasound for high-risk thrombus- containing lesions
in native coronary arteries
Brosh D, et al.
Catheter Cardiovasc Interv
2002;55:43-49.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=11793494
Ultrasound thrombolysis is a feasible procedure that offers a safe and probably
effective adjuvant device solution for the treatment of high-risk,
thrombus-containing lesions in the native coronary arteries
Angiographic
outcome after intracoronary X-Sizer helical atherectomy and thrombectomy: first
use in humans
Kwok OH, et al.
Catheter Cardiovasc Interv
2002;55:133-9.
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=11835634
The angiographic analysis of the first cohort of human subjects suggests
that X-Sizer helical atherectomy is a feasible method of removing occlusive
tissue or thrombus in coronary artery disease with a low angiographic
complication rate. A large-scale randomized phase II clinical trial is underway
to determine the ultimate safety and efficacy of this device in
thrombo-occlusive native coronary arteries and saphenous vein grafts.
Editorial
Thrombo-atherectomy:
hope for pesky thrombus-containing lesions?
Carter AJ, et al.
Catheter Cardiovasc Interv
2002;55:140-1.
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=11835635
Direct
Use of the X-SIZER Catheter System in the Treatment of Acute Thrombotic Coronary
Occlusion
Palmer ND, et al.
J Invasive Cardiol
2002;14:420-2.
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=12082198
This case report suggests that the X-SIZER device has potential as an
adjunct to PTCA and stenting in reducing the risk associated with thrombotic
occlusion. In addition, its limited ability to cross severe stenoses or reduce
lesion severity suggests that the X-SIZER should not be regarded as an
atherectomy device.
Rheolytic
thrombectomy with Angiojet in thrombus-containing lesions
Singh M, et al.
Catheter Cardiovasc Interv
2002;56:1-7.
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=11979522
High procedural success can be achieved with the AngioJet thrombectomy
device in lesions containing thrombus. It is effective in both native coronary
arteries and vein graft interventions. However, the long-term outcome of
patients with vein graft intervention was worse.
TCT 2002 Expert
Presentations
DEBATE: Does
SAFER Establish Distal Protection as the Standard of Care?
PCR 2002 Meeting Coverage
| Preliminary Results of RECOVERS Trial | A. Colombo |
Summaries of important articles from major peer-reviewed journals
| Distal Protection During PCI of Saphenous Vein Aorto-Coronary Bypass Grafts | D. S. Baim | Circulation. 2002;105:1285 |
Randomized
trial of a distal embolic protection device during percutaneous intervention of
saphenous vein aorto-coronary bypass grafts (SAFER
Trial)
Baim DS, et al.
Circulation 2002;105:1285-90.
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=11901037
http://www.circulationaha.org/cgi/content/full/105/11/1285
http://www.circulationaha.org/cgi/content/abstract/105/11/1285
Use of this distal protection device during stenting of stenotic venous
grafts was associated with a highly significant reduction in major adverse
events compared with stenting over a conventional angioplasty guidewire. This
demonstrates the importance of distal embolization in causing major adverse
cardiac events and the value of embolic protection devices in preventing such
complications
Lack of Benefit From
Intravenous Platelet Glycoprotein IIb/IIIa Receptor Inhibition as Adjunctive
Treatment for Percutaneous Interventions of Aortocoronary Bypass Grafts: A
Pooled Analysis of Five Randomized Clinical Trials
Marco Roffi et al
Circulation 2002;106 3063-3067
http://circ.ahajournals.org/cgi/content/abstract/106/24/3063?etoc
Intravenous platelet GP IIb/IIIa receptor inhibition does not improve
outcomes after PCI of bypass grafts. In the absence of mechanical emboli
protection, this procedure is associated with high incidence of death and
nonfatal ischemic events.
Evaluation
of a balloon occlusion and aspiration system for protection from distal
embolization during stenting in saphenous vein grafts
Grube E, et al.
Am J Cardiol 2002;89:941-5.
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=11950432
GuardWire distal balloon occlusion and aspiration system is an effective and
safe method for protecting distal microcirculation from the adverse consequences
of embolization during mechanical intervention of degenerated SVGs.
Transient
occlusion of an Angioguard protection system by massive embolization during
angioplasty of a degenerated aortocoronary saphenous vein graft
Kindel M, et al.
Catheter Cardiovasc Interv 2002;55:501-4.
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=11948899
Distal embolization is the most important complication of balloon dilatation
of degenerated saphenous vein grafts. This report describes a case of massive
embolization associated with transient occlusion in which larger distal
embolization and myocardial infarction were avoided despite transient but
complete occlusion of a filter protection system (Angioguard).
Percutaneous
intervention for atherosclerotic disease in saphenous vein grafts
Mulvihill NT, et al.
Int J Cardiol 2002;83:103-10.
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=12007681
The immediate and long term results of percutaneous intervention for SVGs is
reviewed. Therapeutic considerations as well as novel technical advances are
overviewed
Coronary
angiographic morphology in unstable angina: comparative observations of culprit
lesions in saphenous vein grafts versus native coronary arteries
Preston LM, et al.
J Invasive Cardiol 2002;14:81-6.
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=11818643
In UA, culprit lesions of SVGs assessed angiographically demonstrate
morphology consistent with ulcerated plaque and thrombus more frequently than
lesions in NCAs, but total occlusions are more common in NCAs.
Angiographically-evident active thrombotic and ulcerated lesions underlie acute
ischemic syndromes more frequently in SVGs than in native vessels
Intravascular
gamma radiation for in-stent restenosis in saphenous-vein bypass grafts
Waksman R, et al.
N Engl J Med 2002;346:1194-9.
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=11961147
http://content.nejm.org/cgi/content/full/346/16/1194
http://content.nejm.org/cgi/content/abstract/346/16/1194
The results of our study support the use of gamma-radiation therapy for the
treatment of in-stent restenosis in patients with bypass grafts.
An
unusual case of left internal mammary artery ostial disease: clarifying role of
intravascular ultrasound
Tantibhedhyangkul
W, et al.
Catheter Cardiovasc Interv
2002;55:369-72.
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=11870944
Case report of a suspected stenosis involving the origin of the left internal
mammary artery that conventional angiography failed to demonstrate convincingly.
Intravascular ultrasound illustrated a severe stenosis and the patient underwent
successful stenting of the left internal mammary artery origin. The
intravascular ultrasound finding of a dissection flap, just distal to the left
internal mammary artery origin, suggests that local trauma to the vessel from
prior catheterization procedures may have been responsible for the progressive
narrowing at the left internal mammary artery ostium