Bare Metal Stents Research Articles

A Revolutionary Device for Endovascular Aortic Repair of Abdominal Aortic Aneurysm: A Pilot Study

Background Endovascular repair for abdominal aortic aneurysms (AAA) has been the gold standard since it was established in 1991. Various graft configurations have been developed to overcome the limitations of endovascular aortic repair (EVAR), including contralateral gate cannulation (CGC). We propose a new device and technique intended to simplify endovascular AAA repair, along with reports of its application in six patients. Intervention The Taofan and Kang (T&K) bidirectional endovascular aortic repair (B-EVAR (B-EVAR) device uses a main-body stent graft, two-limb extensions, and bare metal stent. The procedure involved accessing the right and left femoral arteries, followed by standard aortography evaluation using a pigtail catheter through the contralateral femoral access. The main body stent graft is deployed through ipsilateral femoral access using a balloon catheter, while the contralateral gate is cannulated with a hydrophilic coated wire. Both balloons were inflated simultaneously to ensure that the wires were in different lumens. Contralateral and ipsilateral extensions were deployed using a limb extension stent graft. Standard aortography evaluation was repeated. Result T&K B-EVAR pilot procedures proved successful in various cases, from simple to complex anatomy, and even with varied graft stent deployment strategies. None of the patients had complications or prolonged length of stay (LOS). Follow-up CT did not reveal any high-pressure endoleaks. Conclusion T&K B-EVAR has been proven to simplify endovascular AAA repair in six patients with excellent results. It is also reproducible, potentially universally applicable, and can offer operators ease of use, faster procedure times, reduced fluoroscopy times, and reduced contrast usage.

Efficacy and safety of drug-eluting stents versus bare-metal stents in symptomatic intracranial and vertebral artery stenosis: a meta-analysis

ObjectivesThis study aims to present the first comprehensive meta-analysis assessing the effectiveness and safety of drug-eluting stents (DES) versus bare-metal stents (BMS) in treating intracranial and vertebral artery stenosis.MethodsA comprehensive examination was undertaken to compare the effectiveness and safety of DES and BMS in individuals experiencing symptomatic stenosis in the intracranial and vertebral arteries through an in-depth analysis of clinical research. We conducted an extensive search across multiple databases including PubMed, Embase, Web of Science, and the Cochrane Library up to September 2024. The emphasis of our investigation was on various outcomes including rates of in-stent restenosis, symptomatic occurrences of in-stent restenosis, incidence of stroke, procedural success, mortality rates, complications associated with the procedure, and any adverse events.ResultsOur analysis included 12 studies with a total of 1,243 patients (562 in the DES group and 681 in the BMS group). The findings demonstrated a significantly lower rate of in-stent restenosis in the DES group for both intracranial [odds ratio (OR): 0.23; 95% confidence interval (CI): 0.13 to 0.41; p < 0.00001] and vertebral artery stenosis (OR: 0.38; 95% CI: 0.20 to 0.72; p = 0.003) compared to the BMS group. Additionally, the DES group showed a significantly reduced rate of postoperative strokes in vertebral artery stenosis cases (OR: 0.38; 95% CI: 0.16 to 0.90; p = 0.03), with no significant differences noted in the intracranial artery stenosis comparison (OR: 0.63; 95% CI: 0.20 to 1.95; p = 0.42). The study also revealed no significant disparities in symptomatic in-stent restenosis, procedural success, mortality, adverse effects, and perioperative complications between the two groups across the conditions studied.ConclusionThe comparison indicates that DES significantly reduces the risk of in-stent restenosis and postoperative strokes in patients with vertebral artery stenosis, compared to BMS. For both intracranial and vertebral artery stenosis, DES and BMS exhibit comparable safety profiles.Systematic review registrationhttps://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=439967.

Primary Aortic Coarctation Repair in Adolescents and Adults

ObjectiveOptimal management of primary aortic coarctation in adolescents and adults remains controversial. We assess early and late mortality of repair, longitudinal anti-hypertensive regimens, and freedom from reintervention for repair-related complications. MethodsFrom 01/01/1999–07/01/2023, 110 adolescents or adults, mean age 39±16 years, underwent primary aortic coarctation repair at Cleveland Clinic. Patients were grouped by repair strategy: stented (60, 55%), grafted (interposition graft or extra-anatomic bypass; 36, 33%), or other (14, 13%). Longitudinal anti-hypertensive regimens were assessed parametrically. Freedom from reintervention and survival were assessed by the Kaplan-Meier method. Median follow-up for survival was 9.2 years. ResultsOne patient (0.91%) died in-hospital. Major morbidity included stroke (2/107, 1.9%), tracheostomy (2/107, 1.9%), acute renal failure requiring dialysis (1/108, 0.93%), iatrogenic aortic dissection (1/107, 0.93%) and vascular access complication (1/56, 1.8%). Prevalence of patients requiring zero anti-hypertensive medications postoperatively peaked within two years. Twelve-year freedom from reintervention was 69% in the stented group and 97% in the grafted group (P log-rank = .003). Most reinterventions were for in-stent restenosis of bare metal stents. Overall freedom from reintervention at one, five, and 12 years was 91%, 80%, and 76%. Overall survival was 98%, 95%, and 80% at five, 10, and 14 years. ConclusionsA tailored approach to coarctation repair in adolescents and adults utilizing stented repair when anatomically feasible yields excellent short-term outcomes, but patients require persistent hypertension monitoring and have lower than expected long-term survival. Covered stents or stent grafts are preferred to bare metal stents which are subject to in-stent restenosis.

Characteristics and outcomes of patients with stent implantation for coronary artery lesions caused by Kawasaki disease - insights from second-generation stent implantation.

Adult Kawasaki patients may require intervention for occlusive coronary artery disease. Some adverse effects of first-generation drug-eluting stent implantation with sirolimus have been reported in this population. A total of nine lesions in eight (seven males, one female) patients who underwent stent implantations in this population between 2000 and 2021 were reviewed. The age at stent implantation ranged from 31 to 47 years, with a median of 37 years. There were six lesions treated by primary percutaneous transluminal coronary interventions, and three by elective procedures. A coronary aneurysm was found in two lesions, and coronary artery calcification was found in all culprit lesions. The numbers of everolimus-eluting stents, sirolimus-eluting stents and bare metal stents were six, two, and one, respectively. As anti- thrombotic therapy, aspirin, clopidogrel, and prasugrel were given to four, three, and one, respectively. Warfarin was given to five patients. The follow-up ranged from 2 to 12 years, with a median of 4 years. Follow-up angiograms were performed for eight lesions, at 2 to 38 months, with a median of 11 months. The patency of the target vessel was confirmed in all eight vessels. Slight malapposition, and peri-stent contrast staining were found in two lesions each. Acute coronary syndrome due to coronary artery lesions caused by Kawasaki disease occurred, even in lesions without any apparent coronary artery aneurysms. In our study, we show safe and efficacious placement of second-generation stent without adverse effects during the short-term follow-up, but long-term follow-up is needed to determine the efficacy and complication.

Influence of hospital ownership on patient outcomes in STEMI-induced cardiogenic shock undergoing revascularization: a retrospective cohort study

Abstract Background Investor-owned hospitals constitute an expanding segment of healthcare enterprises that frequently eschew the provision of non-profitable services. The implications of this disparity in costs on the mortality rates of patients experiencing cardiogenic shock (CS) subsequent to ST-Elevation Myocardial Infarction (STEMI) undergoing percutaneous coronary intervention (PCI) with drug-eluting stents (DES) or bare-metal stents (BMS) remain unknown. Methods In this retrospective analysis, data from the National Inpatient Sample (NIS) were examined, including acute care admissions for patients aged 18 years and above admitted due to cardiogenic shock secondary to ST-Elevation Myocardial Infarction (STEMI) who underwent percutaneous coronary intervention (PCI) with the placement of either drug-eluting stents (DES) or bare-metal stents (BMS) between 2016 and 2020. Multivariable logistic regression, multilinear regression, chi-square tests, and t-tests were used to compare mortality rates, length of stay (LOS), and healthcare costs, adjusting for potential confounders. The total charges were adjusted for inflation using the Consumer Price Index (CPI) from the Bureau of Labor Statistics to ensure consistency in financial evaluations. Results We analyzed 66,180 patients and divided them into two cohorts: admitted to investor-owned vs nonprofit institutions. The findings revealed no significant difference in mortality rates, with an adjusted odds ratio (aOR) of 1.03 (P=0.60; 95% CI: 0.91-1.16). However, treatment in investor-owned hospitals was associated with significantly higher healthcare costs, with a coefficient of 120,921 (P<0.001; 95% CI: 106,658.6–135,184.7), but without a significant difference in length of stay (LOS) (coefficient 0.04; P=0.81; 95% CI: -0.33 to 0.41). Key predictors of mortality included age, with each additional year increasing the odds of mortality by 3% (P<0.001; 95% CI: 1.02-1.03), and uninsured status, which was linked to a higher mortality risk (aOR 1.40; P<0.001; 95% CI: 1.16-1.70). Disparities in healthcare costs were observed across different races and insurance types, notably affecting Hispanic patients and those covered by Medicaid. A significant difference was noted in the average adjusted hospital charges between non-profit and investor-owned hospitals; the average charge at investor-owned hospitals was $314,633, compared to $220,227 at non-profit hospitals (P<0.01), marking a net difference of $94,406. Conclusion This retrospective cohort analysis demonstrated that investor-owned hospitals incurred, on average, over $94,406 more in healthcare costs than nonprofit hospitals, with no significant difference in mortality rates and only a marginal difference in length of stay (LOS). Higher expenses at investor-owned hospitals did not translate into improved patient outcomes, challenging the notion that increased healthcare spending necessarily results in better healthcare delivery.

Patient and procedural characteristics of successful endovascular procedures in the BEST-CLI Trial and their relationship to major adverse limb events

Abstract Background The Best Endovascular versus Best Surgical Therapy in Patients with Chronic Limb Threatening Ischemia (CLTI) (BEST-CLI) trial randomized 1830 subjects with chronic limb threatening ischemia (CLTI) to endovascular or surgical bypass revascularization. Major adverse limb events (MALE) were higher after endovascular revascularization compared to bypass in the cohort with bypass using adequate single segment great saphenous vein. However, 15% of endovascular procedures had a major endpoint due to lack of technical success of the index procedure. Purpose To assess the factors related to a MALE in subjects in the BEST-CLI trial with an initial endovascular procedure that was technically successful. Methods All patients with a technically successful endovascular procedure (defined as a residual stenosis < 50% in the superficial femoral, popliteal, and/ or tibial arteries with in-line flow to the foot) were included. MALE was defined as above ankle amputation of the index limb or a major index-limb reintervention (new bypass, interposition graft revision, thrombectomy, or thrombolysis). Patient, procedure, and limb characteristics at the time of the index procedure were compared to the risk of MALE over an average 2.7 years follow-up. Characteristics were compared with the Kruskal-Wallis or Chi-square tests as appropriate. Results Of 923 patients having endovascular therapy as the index revascularization, 773 (84%) had a technically successful procedure. The cause of failure in 122 (82%) of unsuccessful procedures was the inability to cross the lesion with a wire. Significant patient factors associated with MALE included younger age (64 vs 68 years, p<0.0001), current smoking (44% vs 33%, p=0.004), and end-stage renal disease (17% vs 10%, p=0.013). Diabetes mellitus was not associated with MALE (74% vs 68%, p=0.08). Significant limb characteristics associated with MALE included lesions treated in the superficial femoral (SFA) or above knee popliteal artery (87% vs 81%, p=0.042), length of lesion in the SFA or above knee popliteal artery (201 cm vs 172 cm, p=0.02), use of atherectomy and bare-metal stent (10% vs 5%, p=0.01), and total procedure time (172 vs 155 min, p=0.002). Lesions treated in the below-knee popliteal artery or tibial arteries (62% vs 62%, p=0.93) or lesion length in this region (134 vs 144 cm, p=0.70) were not related to the risk of MALE. Conclusions The risk of MALE after successful endovascular revascularization for CLTI was increased with younger age, current smoking, end-stage renal disease, longer lesion length, treatment of the SFA to above knee popliteal arteries, and treatment with atherectomy with bare-metal stenting. Treatment of below knee lesions were not associated with MALE. These results indicate the importance of both modifiable and non-modifiable patient factors as well as the anatomic location of disease in determining limb outcomes in CLTI.

The prognosis of acute myocardial infarction due to stent thrombosis after 2nd generation drug eluting stents era (comparative study with acute myocardial infarction due to plaque rupture or erosion)

Abstract Backgrounds Stent thrombosis (ST) is a rare complication after percutaneous coronary intervention (PCI), and more than 70% of ST cases result in acute myocardial infarction (AMI). Although a new generation of drug-eluting stents (DES) and newer antiplatelet therapies have been shown to reduce the incidence of ST, ST-related AMI continues to be observed in contemporary practice. The prevalence and prognosis of ST results in AMI have not been well evaluated after the 2nd generation DES (G2-DES) era. Purpose The purpose of this study was to evaluate the prevalence and prognosis of AMI due to ST after the G2-DES era compared with AMI due to plaque rupture or erosion. Methods Among 6601 AMI patients enrolled in the Mie ACS registry from January 2013 to November 2022, 6273 AMI patients with AMI due to ST(ST) and AMI due to plaque rupture and erosion (AMI:P) were included for this analysis after excluding other types of AMI. ST was confirmed by angiography. The primary endpoint was defined as all-cause mortality, and revascularization after PCI for AMI was also evaluated. Results Seventy-eight patients, or 1.2% of all AMI in this study, had AMI due to ST, including early ST n=13 (16.7%), late ST n=4 (5.1%), and very late ST n=61 (78.2%). Stent types were G2-DES n=35 (44%), G1-DES n=18 (23.1%), bare metal stent (BMS) n=12 (15.4%), and unknown n=13 (16.7%). According to the KM survival curve, the 30-day mortality rate of ST was 2.6%, while the AMI:P rate was 6.7%, which was not statistically significant, but the ST was half the mortality rate. Furthermore, in the landmark analysis, the 2-year mortality rates were 6.2% for ST and 7.0% for AMI:P (P=0.66, Figure 1). ST was not an independent predictor of poor prognosis by multivariate Cox regression analysis. Even after the propensity score matching analysis as a sensitivity analysis, ST was not an independent predictor of poor prognosis in AMI patients. Among ST patients, 82.2% were treated with balloon angioplasty (without additional stenting) at the time of AMI, whereas 9.7% of AMI:P patients were treated with balloon angioplasty (P<0.001). Compared to patients with AMI:P, patients with ST had a higher incidence of revascularization after PCI for AMI within 2 years (21.8% vs. 11.2%; P=0.02, Figure 2A). Multivariate Cox regression analysis also showed that ST was an independent predictor of revascularization after PCI for AMI with a hazard ratio of 2.00 (P<0.01, Figure 2B). Conclusion The prognosis of ST patients tended to be better than that of AMI:P patients. The proportion of ST in AMI has decreased in the G2-DES era, and the higher proportion of VLST in ST suggests that its prognosis may be better than that of AMI:P . However, the rate of revascularization is higher in ST patients because stenting was not performed in the acute phase of PCI for AMI, and the appropriate use of stents depending on the type of ST may lead to a reduction in revascularization.Figure1Figure2

A baculoviral gene and drug-eluting (GDES) stent to promote re-endothelialization and prevent restenosis caused by atherosclerosis

Abstract Background Coronary artery disease (CAD) is a prevalent condition affecting approximately one in every 20 individuals over the age of 20, resulting in significant health and economic burdens worldwide. Atherosclerosis, characterized by plaque buildup in the arteries, is a leading cause of CAD, involving endothelial dysfunction, inflammation, and smooth muscle cell hyperproliferation. The standard interventions for CAD, namely bare-metal stents (BMS) or drug-eluting stents (DES), often lead to complications such as blood clotting, inflammation, and arterial re-narrowing, necessitating further interventions and potentially leading to severe outcomes like heart failure, stroke, or death. Additionally, the TGFβ1 gene regulates SMC proliferation and ECM secretion, promoting endothelial cell proliferation, inhibiting smooth muscle cell hyperproliferation, reducing reactive oxygen species production. Purpose This innovative stent aims to mitigate complications associated with conventional stents by promoting endothelial health and preventing inflammation and hyperproliferation downstream. The purpose of this study is to design a new gene and drug eluting stent and evaluate their preclinical efficacy and safety in addressing some of the key limitations of currently available coronary stents. Methods The TGFβ1 expressing baculoviruses loaded PLGA nanoparticles are prepared by double emulsion solvent evaporation method. The formulated nanoparticles were characterized by their surface morphology, particle size, zeta potential, and in vitro release. Moreover, the designed nanoparticles undergo a further investigation for their therapeutic efficiency using cell lines. The GDES is synthesized by dip-coating a BMS into a solution containing Everolimus and genipin carrying baculoviruses expressing TGFβ1 in nanoparticles. The stent elutes the gene and drug over specific durations pertaining to a sustained release profile. The study assesses the functionality and safety of the GDES through in vitro and in vivo experiments, including cell culture studies and animal models. Results The PLGA nanoparticles at 115.3±1.4 nm with a polydipersity (pdi) index of 0.152 have a sustained release profile for the TGFβ1 expressing baculovirus. The findings demonstrate that the GDES effectively promotes endothelial health and prevents inflammation and hyperproliferation downstream. The expression of TGFβ1 facilitates the formation of a fully reconstituted endothelial lining, reducing the risk of complications. Additionally, the prolonged release of Everolimus prevents inflammation and the progression of neointimal hyperplasia. The stent coating and system exhibit non-cytotoxicity and hemocompatibility, ensuring safety during expansion and degradation over time. Overall, the combined action of gene and drug elution in the GDES shows promising results in addressing current complications associated with cardiovascular stents.

Comparative outcomes of drug-coated balloon angioplasty versus second-generation drug-eluting stent for in-stent restenosis: a real-world data analysis

Abstract Background Coronary in-stent restenosis (ISR) poses a significant challenge in interventional cardiology, with optimal treatment strategies being the subject of ongoing debate. Current clinical guidelines offer a choice between drug-coated balloon angioplasty (DCB) and repeat stenting with second-generation drug-eluting stents (DES), each with distinct implications for long-term patient outcomes. Purpose The aim of this study is to compare 1-year outcomes between DCB angioplasty and second-generation DES in the treatment of ISR. Longitudinal real-world data are used from the OBSERVABLE database, which comprises German health claims data between 2012 and 2021. Methods A total of 10,440 ISR individuals undergoing DCB or DES intervention were identified. After exclusion of bare-metal stents, first generation stents and non-DCBs, 3,810 propensity score-matched individuals remained. The primary outcome was the composite of all-cause mortality and myocardial infraction (MI). Secondary outcomes included all-cause death, MI, and bleeding as a safety outcome. Results At 1-year follow-up, the primary outcome of all-cause mortality and MI was observed in 246 individuals (12.9%) in the DES group, compared with 201 individuals (10.6%) in the DCB group (HR, 1.27; 95% CI, 1.06-1.53). Sensitivity analysis confirmed the robustness of these findings. Secondary outcomes revealed higher all-cause mortality in the DES group (7.9%) compared to the DCB group (6.3%) (HR, 1.31; 95% CI, 1.03-1.66), with no difference in MI. Bleeding events were comparable between the two treatments, with 244 individuals (12.8%) in the DES group and 206 individuals (10.8%) in the DCB group (HR, 1.17; 95% CI, 0.89-1.53). Conclusion This real-world data analysis demonstrated a higher incidence of the primary composite endpoint of all-cause mortality and MI within one year, after treatment with DES compared to DCB. Our results support prior findings about the safety profile of repeated DES implantation and strengthen DCB as a potential superior alternative to DES in ISR management.

Synthetic Flavonoid 3,7-Dihydroxy-Isoflav-3-Ene (DHIF) Reduces In-Stent Restenosis in an Atherosclerotic Watanabe Heritable Hyperlipidemic Rabbit Stent Model

Inflammation is a major component of the pathogenesis of atherosclerosis and the formation of in-stent restenosis (ISR). A novel flavonoid, DHIF, attenuates reactive oxygen species and nf-κB signaling and has potential to limit ISR via antioxidant action. While current drug eluting stents (DESs) perform well in clinical practice, new therapies to prevent ISR without dependance on cytotoxic drugs are warranted. Our objective was to test whether DHIF reduces ISR in a hyperlipidemic rabbit aorta model of ISR via attenuated inflammatory responses. WHHL rabbit aortas (n = 24) were denuded. Six weeks after injury, stents were implanted into the denuded aortas. DHIF was dissolved in carboxymethyl cellulose (CMC) and administered orally with two doses. CMC served as a control. The animals were sacrificed six weeks after stenting. ISR was evaluated from stent histomorphometry and immunohistology was used to assess the inflammatory and antiproliferative effects of the treatment. ISR was reduced from 20.9 ± 3.0% in controls to 15.2 ± 2.4% (p = 0.0009) and 16.4 ± 2.1% (p = 0.004) in the low- and high-dose groups, respectively. The neointimal area covered by macrophages was 32 ± 9.3% in the controls, 17.2 ± 5.9% (p = 0.005) in the low-dose group and 19.4 ± 7.9% (p = 0.008) in the high-dose group. DHIF significantly reduces ISR and local inflammation in stented arterial regions and could be used to reduce ISR when bare metal stents are used. Targeting local inflammation in the arterial wall may provide a way to reduce ISR in a clinical setting and further studies are warranted.

A Snapshot on Clinical Trials on Zotarolimus DES: A Repurposing Drug against Myocardial Infarction

AbstractMyocardial infarction is the permanent death (necrosis) of heart muscle caused by a lack of oxygen for an extended period of time (ischemia). Since the very first percutaneous transluminal coronary angioplasty was done 40 years ago, the science of interventional cardiology has advanced dramatically. The above progression began with a balloon catheter attached to a fixed wire, advancing to bare-metal stents, first-generation drug-eluting stents (DES), second- and third-generation biodegradable polymer-based DES. Ultimately, bioabsorbable stents are still in development. Zotarolimus is a new pharmacologic therapy with a similar reprint address; for example, the antirestenosis agent sirolimus has recently been investigated as part of a stent platform combined with a biomimetic phosphorylcholine and BioLINX polymer for its biological activity, as well as its usefulness as an antiproliferative agent. Several clinical trials have been conducted to assess the safety and efficacy of the zotarolimus drug-eluting stent (Z-DES). Medtronic Medical Devices, a global leader in medical technology (United States), and Abbot Global Health Care and Research began clinical trials on the Z-DES in 2002 and will continue through 2021 (INDIA). Endeavor (E-Zes), Resolute (R-Zes), Resolute Integrity (I-Zes), and Resolute Onyx are the different forms of Z-DES that Medtronic has tested in clinical trials. In comparison to other DES, Z-DES was found to be safe in these clinical trials done across multiple nations and in a diverse demographic. This review helps understand the overall clinical trial of Z-DES.

The Effect of Stenting on Post-Stenotic Dilatation in Coarctation of The Aorta.

The effect of stenting of native aortic coarctation (CoA) on post-stenotic dilatation (PSD) has not been previously described. We hypothesized that CoA stenting may lead to positive remodeling of PSD. Retrospective analysis of patients who underwent stent implantation for native CoA from 1999 to 2021 was performed. Primary outcome was incremental change PSD diameter and the PSD/DescAo (Descending Aorta) following stent implantation and comparison between covered and bare-metal stents. 90 consecutive patients, (26 female, average age at first intervention 12.0years) were included. 35 patients (38.9%) underwent dilatation with bare-metal stents and 55 patients (61.1%) with covered stents. The covered stent subgroup was older (14.0 vs. 9.2years old, p < 0.001) and PSD was larger (17.0 vs 14.0mm, p < 0.001). Over a mean of 3.2years, mean inter-catheterization growth of the PSD was blunted [- 0.05 mm, 95% CI (- 1.5 to 1.4)]. The covered stent subgroup demonstrated a negative inter-catheterization growth compared to the bare-metal stent subgroup (- 0.7 vs 1.6mm, p < 0.001). When controlled for somatic growth, the PDS/DescAo decreased more significantly among those with covered stent vs bare metal (- 0.12 vs - 0.058, p = 0.004). Stenting of native CoA blunts the growth of PSD; covered stents were significantly associated with regression of the diameter of the PSD over time compared to bare-metal stents.

Dual antiplatelet therapy duration and stent type in patients with high bleeding risk: A systematic review and network meta-analysis

BackgroundIt is uncertain whether the efficacy and safety of dual antiplatelet therapy (DAPT) in patients with high bleeding risk (HBR) vary according to DAPT duration and stent type (e.g., durable polymer drug-eluting stents (DP-DESs), biodegradable polymer DESs (BP-DESs), or polymer-free drug-coated stents (PF-DCSs)). We aimed to study the stent type and DAPT duration appropriate for patients with HBR. MethodsPubMed and EMBASE were searched until October 2023. Randomized controlled trials (RCTs) involving patients with HBR that compared standard DAPT (6-12 months) with DP- or BP-DES versus short DAPT (≤3 months) with DP- or BP-DES or PF-DCS or bare-metal stent (BMS) were identified. The primary efficacy outcome was major adverse cardiovascular events (MACEs), defined as cardiovascular death, myocardial infarction (MI), and stroke. The primary safety outcome was major bleeding. Secondary outcomes included MI and stent thrombosis (ST). We performed a network meta-analysis using a random effects model. ResultsThirteen RCTs with a total of 19,418 patients with HBR were included. Compared to standard DAPT with DP-DES, short DAPT with BMS was associated with a higher risk of MACE and MI. For major bleeding, short DAPT strategies were associated with a lower risk than standard DAPT strategies (e.g. short DAPT with DP-DES versus standard DAPT with DP-DES; HR[95% CI]: 0.48[0.28-0.82]). Interestingly, the use of BP-DES was associated with a higher risk of ST than DP-DES (e.g. standard DAPT with BP-DES versus short DAPT with DP-DES; HR[95% CI]: 2.65[1.03-6.79]). ConclusionsIn patients with HBR who underwent percutaneous coronary intervention, a short DAPT strategy with DP-DES should be used since it offers the best combination of efficacy and safety.

Advancements in Endovascular Treatment of Extracranial Carotid Artery Aneurysms

Traditionally, extracranial carotid artery aneurysms or pseudoaneurysms (ECCAs) have been managed through open surgical repair. Recent literature highlights the increasing success of endovascular techniques in treating ECCAs. Our study explores our center's experience with endovascular management of ECCAs, including the innovative use of Transcarotid Artery Revascularization (TCAR) at a tertiary care center. We performed a retrospective analysis of patients with ECCAs who underwent endovascular intervention at a single institution. We examined our database from the period of 2010 to 2024. Our treatment modalities have expanded to include covered stenting, stent-assisted coil embolization, braided stents, overlapping closed-cell stents, and most recently Transcarotid Artery Revascularization (TCAR). There were 29 extracranial carotid artery aneurysms in 27 patients treated with various endovascular modalities. The average age was 67.6 years, with 17 (63.0%) males and 10 (37.0%) females. 8 (29.6%) patients had prior ipsilateral carotid intervention. 9 (31.0%) aneurysms were symptomatic. The most common etiology was idiopathic, with 16 (55.2%) aneurysms being spontaneous. Treatment modalities included: 2 (6.9%) treated with covered stents, 2 (6.9%) with stent-assisted embolization, 3 (10.3%) with flow-diverting braided stents, 3 (10.3%) with embolization or ligation alone, 17 (58.6%) with overlapping bare metal stents via femoral or radial access, and 2 (6.9%) with overlapping bare metal stents via TCAR. Technical success was achieved in all patients. The mean follow-up duration was 236 days (range: 2 to 3039 days). No perioperative or post-operative complications occurred, including no neurological deficits or embolic events. All patients were discharged on post-operative day 1 or 2. All 29 (100%) stents maintained vessel patency on follow-up imaging, and exclusion of ECCAs was confirmed on post-procedure surveillance imaging. Our study highlights that endovascular therapy is effective in managing ECCAs, with high patency rates and a favorable procedural safety profile.

Successful Factors for Improving Aortic Remodeling with Thoracic Endovascular Repair and Bare Stent Extension

ObjectiveProximal ExTension to Induce COmplete ATtachment (PETTICOAT), which utilizes downstream bare metal stents for structural support, demonstrates potential, yet its adoption is limited by variable outcomes. This study elucidates the potential of PETTICOAT in aortic dissection, emphasizing the determinants that guide patient selection. MethodsA retrospective analysis of 60 patients who underwent full PETTICOAT for aortic dissections was conducted. A multivariate logistic regression model identified predictors of favorable aortic remodeling. Patients underwent standardized follow-up with CT scans to assess size, volumetric changes, and anatomical conditions. Selection criteria included full PETTICOAT application and a minimum three-month follow-up. Demographics, preoperative conditions, and procedural details were collected and analyzed. ResultsThe analysis identified predictors of favorable aortic remodeling, including age over 60, a larger downstream aorta stent graft, a smaller abdominal aorta (<450mm2), and oral angiotensin II receptor blocker (ARB) administration. Over a median 47.5-month follow-up, survival rates in the favorable remodeling (97.3%) and unfavorable groups (100%) were similar. Downstream aortic event-free survival rates did not significantly differ (89.2% vs. 73.9%), although the unfavorable group had a relatively higher incidence of distal stent-induced new entries (26.1% vs. 8.1%). ConclusionsThe PETTICOAT concept effectively enhances aortic remodeling in complex aortic dissections. Predictors for favorable remodeling, including age, stent graft sizing, aortic diameter, and ARB therapy, offer insights for optimizing patient selection. This approach improves survival outcomes, mitigates risks associated with untreated aortic segments, and provides a minimally invasive solution for aortic dissections. Despite some outcome variations, the technique holds promise for addressing the challenges of aortic dissections, with the potential for further refinement in patient selection and technique application.

COMPARISON OF DRUG-ELUTING STENTS VERSUS BARE-METAL STENTS FOR THE TREATMENT OF CORONARY ARTERY DISEASE

Coronary artery disease is a condition that affects millions of people worldwide and can lead to serious complications such as heart attack or stroke. Objectives: The study compares drug-eluting stents to bare-metal stents for treating coronary artery disease. Methods: The present study aimed to compare the efficacy and safety of drug-eluting stents (1) versus bare metal stents (BMS) for the treatment of coronary artery disease (CAD). The study was conducted at Cardiology Department Hayat Abad Medical Complex Peshawar Pakistan, from 01 January 2022 till 30 June 2022. The study included a total of 384 patients with CAD who underwent percutaneous coronary intervention (PCI) with either DES or BMS. Results: The study included a total of 384 patients with CAD who underwent PCI with either DES or BMS. The mean age of the study participants was 58.2 ± 9.4 years, and 75.8% were male. The baseline characteristics, including demographic data, clinical presentation, cardiovascular risk factors, and angiographic findings, were comparable between the two groups. Conclusion: In conclusion, our study contrasting medication-eluting stents versus exposed metal stents for the treatment of coronary supply route sickness found that drug-eluting stents were related to a lower chance of unfriendly heart occasions, including objective vessel revascularization, myocardial dead tissue, and cardiovascular demise, contrasted with uncovered metal stents.

Optimization stages of transjugular intrahepatic portosystemic shunt technique as a treatment method for portal hypertension complications

Aim. To describe the milestones to optimize of the technique of transjugular intrahepatic portosystemic shunt.Materials and methods. The PubMed and Embase databases, the Web of Science platform, the Google Scholar retrieval system, the Cochrane Database of Systematic Reviews, the eLIBRARY.RU scientific electronic library, and the reference lists were used to search for articles. Articles corresponding to the aim of the review were selected for 1969-2023. The inclusion criteria were limited to technical solutions related to optimize of the technique of transjugular intrahepatic portosystemic shunt.Results. Innovative ideas, subsequent experimental studies and preliminary experience in liver cirrhosis patients contributed to the introduction of transjugular intrahepatic portosystemic shunt into clinical practice. At the moment, the main achievement to optimize of the technique of transjugular intrahepatic portosystemic shunt is progress in the qualitative characteristics of stents. The transition from bare metal stents to expandable polytetrafluoroethylene-covered stent graft made it possible to largely prevent shunt dysfunction. However, the issue of its optimal diameter, contributing to an effective reduction of portal pressure without the risk of developing hepatic encephalopathy, which is one of the most common complications of transjugular intrahepatic portosystemic shunt, remains relevant.Conclusion. Further to optimize of the technique of transjugular intrahepatic portosystemic shunt, as well as careful selection of patients based on cognitive indicators, nutritional status and assessment of liver function will reduce the incidence of hepatic encephalopathy and improve treatment results.

CLINICAL OUTCOMES OF PRIMARY PERCUTANEOUS CORONARY INTERVENTION USING DES VS BMS In ACUTE CORONARY SYNDROME PATIENTS WITH LEFT ANTERIOR DESCENDING ARTERY INVOLVEMENT: A COMPARATIVE STUDY

Acute coronary syndrome (ACS) with left anterior descending (LAD) artery involvement often leads to more extensive myocardial infarction. Choosing between drug-eluting stents (DES) and bare-metal stents (BMS) for revascularisation in these patients is a topic of clinical relevance. While drug-eluting stents are the gold standard, bare-metal stents remain an essential option for patients with specific considerations such as an inability to complete the recommended duration of DAPT, advanced age, concomitant oral anticoagulation, cancer, affordability issues, increased bleeding risk, and planned noncardiac surgery within the next year. Objective: This study aimed to compare the clinical outcomes of ACS patients with LAD involvement treated with either DES or BMS during primary PCI.Methods: A retrospective cohort study was conducted between January 1, 2021, and December 31, 2023, at a tertiary care center. A total of 200 ACS patients with LAD involvement who underwent primary PCI were included. Patients were grouped based on the type of stent used (DES or BMS). Data on patient demographics, comorbidities, procedural details, and outcomes were collected. Major adverse cardiovascular events (MACE), including all-cause mortality, myocardial infarction (MI), and target lesion revascularisation (TLR), were assessed. Kaplan-Meier survival analysis and Cox proportional hazards models were used to analyse outcomes. Results: MACE occurred in 48 patients (24%) during the one-year follow-up. Patients treated with DES experienced significantly fewer events (p &lt; 0.001) compared to those receiving BMS. Diabetes mellitus and chronic kidney disease were independent predictors of adverse outcomes (p = 0.006 and p &lt; 0.001, respectively).Conclusion: Primary PCI using DES in ACS patients with LAD involvement is associated with better clinical outcomes compared to BMS, particularly in high-risk populations. These findings suggest that DES should be the preferred stent type for this patient group to reduce adverse events and improve long-term survival.

Drug-eluting stent and drug-coated balloon for in-stent restenosis: A meta-analysis

&lt;p&gt;The optimal strategy for patients with in-stent restenosis (ISR) is controversial. We aimed to compare the effects of a drug-coating balloon (DCB) and drug-eluting stent (DES) in ISR treatment.&lt;strong&gt; &lt;/strong&gt;Clinical trials were extensively collected, and retrieved items were screened for inclusion. Both clinical (major adverse cardiac event (MACE); myocardial infarction (MI); and target lesion revascularization (TLR) and angiographic (minimal lumen diameter (MLD), and stenosis relative to reference lumen diameter (SRLD) endpoints were extracted and compared. MACE and MI were not significantly different between the groups. Pooled results of TLR showed a marginal effect that DES was superior to DCB (13.50% for DCB vs&lt;em&gt;.&lt;/em&gt; 11.17% for DES, RR = 1.256, 95% CI: 0.997 to 1.583, &lt;em&gt;P&lt;/em&gt; = 0.053), with heterogeneity across studies (&lt;em&gt;I&lt;/em&gt;&lt;sup&gt;2&lt;/sup&gt; = 42.0%, Cochrane &lt;em&gt;Q&lt;/em&gt;-test = 0.069). Meta-regression identified bare metal stent (BMS) or drug eluting stents (DES) implanted in the previous intervention and proportions of diabetes in the DCB group as sources of heterogeneity. DES implantation also significantly improved angiographic outcomes (WMD for MLD: −0.318, 95% CI: −0.424 to −0.213, &lt;em&gt;P&lt;/em&gt;&lt;em&gt; &lt;/em&gt;&amp;lt; 0.001; WMD for SRLD: 6.164%, 95% CI: 4.915% to 7.412%, &lt;em&gt;P&lt;/em&gt;&lt;em&gt; &lt;/em&gt;&amp;lt; 0.001). All DES, including everolimus-eluting ones, did not benefit BMS-ISR patients compared with DCB treatment.&lt;strong&gt; &lt;/strong&gt;DES implantation, which is superior to DCB angioplasty only in DES-ISR patients, should be preferred in the DES-ISR population to reduce TLR. DCB may be preferred in BMS-ISR to avoid increasing stent layers.&lt;/p&gt;

Recent Advancements in Drug-Eluting Stents: A Comprehensive Review

Drug-eluting stents (DES) have revolutionized the field of interventional cardiology by significantly reducing restenosis rates compared to bare-metal stents (BMS). Over the past two decades, there have been remarkable advancements in DES technology aimed at improving efficacy, safety, and long-term outcomes. This comprehensive review provides an overview of recent developments in DES design, drug formulations, coatings, and delivery systems. It discusses the clinical evidence supporting the efficacy and safety of next-generation DES and explores emerging strategies to address remaining challenges, such as late stent thrombosis and neo atherosclerosis. Additionally, the paper examines future directions in DES research, including bioresorbable stents, drug-free coatings, and personalized approaches to stent selection.