Drug-eluting Stents Research Articles

Cover to Make a Covered Stent: An Unusual Method of treating a Coronary Perforation

Coronary artery perforation is an infrequent yet serious complication of Percutaneous Coronary Intervention (PCI). Management includes conservative methods like prolonged balloon tamponade, emergency pericardiocentesis, in addition to implantation of covered stents, coil embolization of small vessels, as well as, Coronary Artery Bypass Graft (CABG) Surgery. Here we describe a unique case of coronary perforation management by using a man-made covered stent and an un-inflated semi-compliant balloon over a standard Drug Eluting Stent (DES).

Cost-effectiveness of intravascular ultrasound-guided percutaneous intervention in patients with acute coronary syndromes: A UK perspective.

Use of intravascular ultrasound (IVUS) during percutaneous coronary intervention (PCI) is associated with improved clinical outcomes over angiography alone. Despite this, the adoption of IVUS in clinical practice remains low. To examine the cost-effectiveness of IVUS-guided PCI compared to angiography alone in patients with acute coronary syndromes (ACS). A one-year decision tree and lifetime Markov model were constructed to compare the cost-effectiveness of IVUS-guided PCI to angiography alone for two hypothetical adult populations consisting of 1,000 individuals: ST-elevation myocardial infarction (STEMI) and unstable angina/ non-ST-elevation myocardial infarction (UA/NSTEMI) patients undergoing drug-eluting stent (DES) implantation. The UK healthcare system perspective was applied using 2019/20 costs. All-cause death, myocardial infarction (MI), repeat PCI, lifetime costs, life expectancy and quality-adjusted life-years (QALYs) were assessed. Over a lifetime horizon, IVUS-guided PCI was cost-effective compared to angiography alone in both populations, yielding an incremental cost-effectiveness ratio of £3,649 and £5,706 per-patient in STEMI and UA/NSTEMI patients, respectively. In the one-year time horizon, the model suggested that IVUS was associated with reductions in mortality, MI and repeat PCI by 51%, 33% and 52% in STEMI and by 50%, 29% and 57% in UA/NSTEMI patients, respectively. Sensitivity analyses demonstrated the robustness of the model with IVUS being 100% cost-effective at a willingness-to-pay (WTP) threshold of £20,000 per QALY-gained. From a UK healthcare perspective, an IVUS-guided PCI strategy was highly cost-effective over angiography alone amongst ACS patients undergoing DES implantation due to the medium- and long-term reduction in repeat PCI, death, and MI.

RIGHT CORONARY ARTERY PERCUTANEOUS CORONARY INTERVENTION IN A PATIENT WITH ANOMALOUS ORIGIN OF LEFT MAIN FROM RIGHT CORONARY SINUS – CASE REPORT”

A 63-year-old male is hospitalized during an episode of NSTEMI and therefore he underwent Coronary Angiography which revealed Two-Vessel coronary artery disease and anomalous origin of Left Main Artery. Left Main Artery and Right Coronary Artery did both originate from right coronary sinus, but with separate ostia. The patient underwent revascularization of Right Coronary Artery with balloon angioplasty and drug eluting stents. The case report is made at the University Hospital Center “Mother Tereza”, Tirana Albania.

Safety and Outcomes of Same-Day Discharge Versus Overnight Observation After Transradial Percutaneous Coronary Intervention: A Retrospective Cohort Study in a Tertiary Hospital in Philippines

INTRODUCTION: Since earlier days of percutaneous coronary intervention (PCI), there has been improvement in several aspects of PCI including use of transradial approach and third-generation drug-eluting stents. Despite data showing its safety, same-day discharge (SDD) PCI has not been widely practiced in our institution and country. At present, there are no published studies from the Philippines showing the safety and outcome of SDD PCI. OBJECTIVES: The primary objective of this study is to determine and compare the safety and outcomes of SDD versus overnight observation after PCI in The Medical City from 2018 to 2021. METHODS: This was a retrospective cohort study. The primary endpoint was to describe and compare the clinical profile of patients who underwent same-day versus overnight observation after PCI such as age, sex, comorbidities, indication for coronary angiogram, procedure time, total dye used, stent, and drug-eluting stent used. Incidence of major adverse cardiovascular event, mortality, readmission, and access site complications were also determined at 48 hours and 30 days after PCI. RESULTS: Ninety-three patients were included in the analysis. Reasons for undergoing PCI were a positive noninvasive stress test (45%), stable angina (40%), coronary artery disease (26%), and heart failure (20%). More single-vessel (60%) than multivessel (40%) PCIs were performed. The most frequently affected coronary artery was the LAD (82%), followed by right coronary artery (32%) and left circumflex artery (30%). Compared with patients who stayed longer after PCI, the SDD group had lower mean (±SD) body mass index (25.10 ± 3.12 vs 28.55 ± 4.95 kg/m2), less due to a positive noninvasive test (26% vs 51%), more who underwent a single-vessel PCI (78% vs 54%), lower median amount of injected dye (130 vs 188 mL), shorter median procedural time (74 vs 101.5 minutes), and greater use of sirolimus-eluting stent (22% vs 3%). No adverse outcome of interest was noted in any patient up to 30 days after hospital discharge. CONCLUSION: No adverse outcome was noted with SDD PCI. Larger, prospective, randomized comparative studies are needed to ascertain its safety before recommending SDD PCI routinely. KEYWORDS: left anterior descending artery, left circumflex artery, percutaneous coronary intervention, right coronary artery, same-day discharge

Circulating intermediate monocytes CD14++CD16+ are increased after elective percutaneous coronary intervention

Aim Inflammation plays a central role in the pathogenesis of atherosclerosis and in the sequelae of percutaneous coronary intervention (PCI). Previous work demonstrated that intermediate monocytes (CD14++CD16+) are associated with adverse cardiovascular events, yet monocyte subset response following elective PCI has not been described. This article explores the changes in monocyte subset and humoral response after elective PCI. Methods This prospective study included 30 patients without inflammatory diseases being referred for elective PCI. We included patients treated with drug coated balloons or 2nd generation drug eluting stents. Patients underwent blood tests at baseline (prior to PCI), four hours, two weeks and two months later. Analyses were performed in terms of monocyte subsets (classical CD14++CD16-, intermediate CD14++CD16+ and non-classical CD14+CD16++), gene expression of CD14+ leucocytes and humoral biomarkers. Results Intermediate monocytes decreased significantly four hours after PCI, were recovered at two weeks, and increased significantly at two months post elective, uncomplicated PCI. They remain significantly elevated in the DES group but not in the DCB group. Gene expression analysis of CD14+ leucocytes showed IL18 had decreased expression at two weeks, CXCR4 and IL1β decreased at two months, while pentraxin 3 increased at two weeks and two months. In terms of humoral biomarkers, hsTnI remains elevated up to two weeks post PCI while IL6 and TNFα remain elevated till two months post PCI. Conclusion Intermediate monocytes increase significantly two months following elective, uncomplicated PCI. They remain significantly elevated in the DES group but not in the DCB group suggesting that the PCI strategy could be one of the ways to modulate the inflammatory response post PCI.

Percutaneous coronary intervention in patients admitted with acute coronary syndrome within 6 months after COVID-19 (retrospective single-center study)

BACKGROUND: Assessing clinical manifestations in patients during the period of destabilization of the course of coronary artery disease after COVID-19 coronavirus infection remains a clinical problem. Identifying features of coronary artery lesions in such patients will help to prevent the development of complications and may influence the tactics of active dynamic monitoring.
 AIM: To evaluate the structure of coronary artery lesions and clinical manifestations in patients with acute coronary syndrome that developed within 6 months after COVID-19 new coronavirus infection.
 MATERIALS AND METHODS: A comparative analysis of the results of coronary artery stenting in 157 patients admitted with acute coronary syndrome has been carried out. The 1st group included 69 patients who had COVID-19 (vaccinated — 24.6%) during the 6 months preceding acute coronary syndrome; in the 2nd — 88 patients without a history of COVID-19 (vaccinated — 42%). All the patients had drug-eluting stents implanted in the infarct-related artery. Long-term results have been observed in 151 (96.2%) patients.
 RESULTS: Before the development of acute coronary syndrome, dispnoe was more often observed in patients of the 1st group (36; 52%) than in patients of the 2nd group (13; 14.8%). There were no focal neurological symptoms in the patients of both groups. Dizziness more often preceded acute coronary syndrome in the patients of the 1st group (26; 38.2%) compared to the control group (5; 5.7%). Decreased motivation and fatigue were detected in 27 (67.5%) patients in the 1st group, which was more common than in the 2nd group (13; 32.5%). Acute coronary syndrome with ST elevation was treated in 47 % and 38.6% of the patients in the 1st groups and the 2nd, respectively. The development of acute coronary syndrome with ST segment elevation with previous clinical manifestations of post-covid syndrome in the 1st group was observed in 95.8%, whereas in the absence of post-covid syndrome in 53.3%. The mean value of LVEF in patients who had COVID-19 was 55.9 ± 14%, which was significantly lower than in the patients in the control group (63.2 ± 5.5%; р 0.001). During the course of coronavirus infection in the patients in the first group, lung damage of degrees I–II according to CT scan data was observed in 76.8% of the patients and in 23.2% of degrees III–IV. The frequency of lesions of the circumflex branch in the 1st group was 15.9%, in the 2nd — 11.4% (р = 0.403); of the right coronary artery — 33.3%, and 22.7% (р = 0.41); of the diagonal branch — 5.8%, and 3.4% (р = 0.47); of the left main coronary artery — 5.8%, and 6.8% (р = 0.79), of the left anterior descending branch — 52.2%, and 35.2% (р = 0.033), respectively. The incidence of vasospastic angina in the 1st group was 53.6%, in the 2nd — 15.9% (р 0.0001). ST segment elevation in lead AVR as a manifestation of subendocardial ischemia was registered in the 1st group — 40.6%, the 2nd — 11.4% (р 0.0001). All the patients had drug-eluting stents implanted in the infarct-related artery. Overall survival (in-hospital and long-term) was 100% for the first group and 100 % for the second one.
 CONCLUSIONS: In the structure of coronary arteries lesions after COVID-19 new coronavirus infection in patients with acute coronary syndrome, damage to the anterior interventricular artery dominates (52.2%). The likelihood of having a left anterior descending lesion during the development of acute coronary syndrome with ST segment elevation in patients who have had COVID-19 is 1.5 times higher. The structure of clinical manifestations after COVID-19 in patients before the development of acute coronary syndrome is dominated by shortness of breath (52 %) and decreased motivation and fatigue (67.5 %).

Ácido acetilsalicílico versus inibidores dos receptores P2Y12 para prevenção secundária em pacientes tratados por meio de intervenção coronária percutânea

Currently, percutaneous coronary intervention with a drug-eluting stent implantation is the main method of myocardial revascularization in tertiary care hospitals, regardless of the clinical presentation of coronary artery disease. It is well known that to be effective, it requires the use of a dual antiplatelet therapy, which is a combination of acetylsalicylic acid and a P2Y12 platelet receptor inhibitor, which plays a key role in preventing thromboses after endoprosthesis implantation and is also indicated to prevent atherothrombotic events in the late clinical course, regardless of the stent model used. After a variable period of time, depending on some factors, such as the clinical presentation of coronary artery disease and the type of stent implanted, this therapy is discontinued, and the main current guidelines recommend interrupting the P2Y12 receptor inhibitor and maintaining acetylsalicylic acid in the long term, as one of the main pharmacological measures for secondary prevention of atherosclerosis. However, recently, due to their greater antiplatelet potency and probable lower potential for significant bleeding, especially in the digestive tract, P2Y12 inhibitors have been considered a valid and attractive option as an antiplatelet agent for long-term use; but this alternative has not been endorsed by guidelines yet. This review discusses the details related to this important decision that must be made by cardiologists when discontinuing the different antithrombotic therapies initially used after percutaneous coronary intervention. In principle, the scarcity of conclusive and normative clinical studies, especially in the population treated by percutaneous intervention, means that acetylsalicylic acid is the only antiplatelet agent with class I indication for secondary prevention of atherosclerosis.

Percutaneous Coronary Intervention For Treatment of Unusual Origin of the Left Main Artery: A Case Report

The left main coronary artery originating from the right sinus of Valsalva is a rare congenital anomaly. A 62-year-old male came in with recurring exertional chest discomfort, as observed by the authors. He was referred to the catheterisation laboratory for coronary angiography, which revealed the presence of a left main coronary artery coming from the right coronary sinus. In the proximal portion of the left anterior ascending coronary artery, a critical stenotic lesion was identified. The cardiac CT angiography demonstrated a benign retroaortic course. The lesion was effectively treated utilising three drug-eluting stents.

Very long versus overlapping drug eluting stents for the management of long coronary artery lesions

Background The prevalence of long diffuse coronary artery disease (CAD) is increasing nowadays due to increase prevalence of multiple risk factors and population ageing. We aimed in our study to show the differences clinically or angiographically (guided by IVUS) between the use of single long stent versus overlapping stents in very long coronary lesions (≥40 mm) in patients presented with chronic coronary syndromes. Methods 550 patients presenting with chronic coronary syndromes were included: 320 treated with a single long stent (≥40 mm) and 230 patients with two or more overlapping stents. Angiographic follow-up (guided by IVUS) 6 months after PCI was performed only in 50 patients. We assessed the procedural characteristics and the occurrence of major adverse cardiovascular events (MACE) after a median follow-up of 24 months. Results Total stent length was 56.16 ± 14.85 mm and mean diameter was 3.05 ± 0.36 mm. At the end of follow-up, MACE rate in the single long stent group was 4.1% vs. 7.8% in the overlapping stents group, with higher incidence in overlapping stents group but non-statistically significant (p value = 0.059). PCI using overlapping stents consumed more contrast volume (248 ± 85.36 vs 164.5 ± 70.43 ml, p < 0.001), and higher fluoroscopy time (23.65 ± 9.19 vs 19.72 ± 9.19 min, p < 0.001). Regarding IVUS subgroup follow-up, there was no significant difference between both groups regarding in-stent restenosis and MACE. Conclusions We can conclude that long or overlapping stents are both acceptable therapeutic choices for patients with long CAD. There was no difference between both strategies regarding angiographic follow-up guided by IVUS after 6 months.

Shortened Duration of Dual Antiplatelet Therapy Following Percutaneous Coronary Intervention: A Contemporary Clinical Review

Percutaneous coronary intervention with stent implantation is an integral aspect of minimally interventional cardiac procedures. The technology and techniques behind stent design and implantation have evolved rapidly over several decades. However, continued discourse remains around optimal peri- and post-interventional management with dual antiplatelet therapy to minimise both major cardiovascular or cerebrovascular events and iatrogenic bleeding risk. Standard guidelines around dual antiplatelet therapy historically recommended long-term dual antiplatelet therapy for 12 months (with consideration for &gt;12 months in certain patients); however, emerging data and generational improvements in the safety of drug-eluting stents have ushered in a new era of short-term therapy to reduce the incidence of major bleeding events. This case review will provide an overview of the current state of guidelines around duration of dual antiplatelet therapy and examine recent updates and continued gaps in existing research.

High Inflammation and Coronary Calcification in an Acute Coronary Syndrome Successfully Treated with Cutting Balloon

Abstract Complex coronary atherosclerosis may exhibit different phenotypes of coronary plaques, from non-calcified highly vulnerable atheroma to heavily calcified ones. Computed coronary tomography angiography (CCTA) may identify these different phenotypes and the recently introduced CCTA-based techniques for mapping coronary inflammation along the coronary arteries may provide useful additional information on cardiovascular risk. Here we present the case of a 68-year-old male patient with acute coronary syndrome in whom invasive coronary angiography and CCTA revealed a severe three-vessel disease with a heavily calcified lesion. Mapping of the CT fat attenuation index along the coronary arteries identified a high level of coronary inflammation, especially associated with the non-calcified lesions. All lesions were successfully revascularized by implantation of drug-eluting stents. A cutting balloon was used for the lesion identified by CCTA as heavily calcified, followed by stent implantation, with good results. In conclusion, CCTA, in association with novel techniques for mapping coronary inflammation, may represent an extremely useful tool for preparing complex interventions in multivessel diseases, helping preprocedural planning in high-risk patients.

Drug-coated balloons versus drug-eluting stents in patients with acute myocardial infarction undergoing percutaneous coronary intervention: an updated meta-analysis with trial sequential analysis

BackgroundDrug-coated balloons (DCBs) are an established strategy for coronary artery disease. However, the new generation drug-eluting stent (DES) is recommended for patients with Acute myocardial infarction (AMI) for coronary artery revascularization. Our aim is to provide a comprehensive appraisal of the efficacy of DCBs in patients with AMI undergoing PCI.MethodsWe searched the WOS, PubMed, Scopus, and Cochrane CENTRAL till March 2023, for studies that compared DCBs versus DES in patients with AMI undergoing PCI. We used a random-effects model to compare major adverse cardiac events (MACE), cardiac death, all-cause death, myocardial infarction, target lesion revascularization (TLR), stent thrombosis, Late lumen Loss (LLL), and minimum lumen diameter (MLD) between the two groups.ResultsThirteen studies comprising 2644 patients were included. The pooled OR showed non-inferiority of DCB over DES in terms of MACE (OR = 0.89, 95% CI [0.57 to 1.40], p = 0.63). When we defined MACE as a composite of cardiac death, MI, and TLR; the pooled OR favored DCB over DES (OR = 0.50, 95% CI [0.28 to 0.9], p = 0.02). Moreover, DCB was not inferior to DES in terms of all-cause mortality (OR = 0.88, 95% CI: 0.43 to 1.8, p = 0.73), cardiac mortality, (OR = 0.59, 95% CI: 0.22 to 1.56, p = 0.29), MI (OR = 0.88, 95% CI: 0.34 to 2.29, p = 0.79), stent thrombosis (OR = 1.21, 95% CI: 0.35 to 4.23, p = 0.76), TLR (OR = 0.9, 95% CI: 0.43 to 1.93, p = 0.8), LLL (MD = -0.6, 95% CI: -0.3 to 0.19, p = 0.64), or MLD (MD = -0.4, 95% CI: -0.33 to 0.25, p = 0.76).ConclusionOur meta-analysis indicated that DCB intervention was not inferior to DES in the PCI setting in patients with AMI, and can be recommended as a feasible strategy in AMI.PROSPERO registrationCRD42023412757.

Effects of exenatide on coronary stent’s endothelialization in subjects with type 2 diabetes: a randomized controlled trial. The Rebuild study

BackgroundSubjects with type 2 diabetes (T2D) have a higher risk of in-stent restenosis and stent thrombosis. The activation of the glucagon-like peptide-1 receptor (GLP-1R) has been suggested to induce several effects on the vasculature that may reduce the risk of stent failure following an angioplasty. The aim of this study is to evaluate the effect of the GLP-1R agonist exenatide on endothelialization of a modern drug-eluting stent (DES) in subjects with T2D.Methods38 subjects with T2D who were eligible for revascularization with implantation of DES were randomized to treatment with exenatide (once weekly) plus standard treatment, or to standard treatment alone. After 12 weeks, a new coronary angiography was performed to evaluate the percentage of strut coverage (primary endpoint) and the presence of neo-atherosclerosis by optical coherence tomography. This study was approved by the Stockholm’s Ethical Review Board.ResultsThe two groups were well balanced regarding baseline clinical characteristics. Strut coverage was 95% (88.7–98.5%) in the exenatide group and 91.4% (88.8–98.5%) in the control group (p = 0.692). There were no significant differences between groups neither in the thickness of neo-intima (0.2 mm in both groups, p = 0.471), nor the maximal in-stent obstruction by neo-intima (15.5% in exenatide group vs 14.7% in control group, p = 0.801). No significant differences were detected in the rate of target lesion revascularization between groups (p = 0.224).ConclusionTwelve weeks treatment with exenatide did not lead to a significantly better stent coverage in people with T2D. No significant differences in the occurrence of neo-atherosclerosis were detected between groups.Trial registration: The study was registered at www.clinicaltrials.gov (Rebuild Study, NCT02621489).

Sex-differences in 5 year Survival with Percutaneous Coronary Intervention Compared to Coronary Artery Bypass Graft surgery in patients with Diabetes and Multivessel Disease

BackgroundCoronary artery bypass graft (CABG) surgery is preferred over percutaneous coronary intervention (PCI) in patients with diabetes (DM) and multivessel disease (MVD). However, differences in survival are equivocal and outcomes according to sex remain unknown. MethodsPatients with DM and MVD undergoing either PCI (with drug-eluting stents) or CABG within 90-days of cardiac catheterization between 01/05/2009-03/29/2019 in Alberta, Canada were included. We examined death and death or myocardia infraction (MI) at 5-years. Cox proportional hazards model was used to examine the sex difference stratified by revascularization. ResultsAmong 4803 patients, 2941 underwent PCI (805 females [27%]; 2136 males [73%]) and 1862 underwent CABG (391 females [21%] and 1471 males [79%]). Regardless of type of revascularization females were older, had higher body mass index and comorbidity burden. Females versus males had higher rates of death and death/MI (PCI: F 4.2, M 3.0; CABG: F 4.8, M: 3.7 deaths per 100 person-year and PCI: F 6.2, M 4.7; CABG: F 5.9, M: 4.7 deaths per 100 person-year, p<0.01). However, no sex-difference was observed in adjusted survival (PCI: HR 1.15, 95% CI 0.90-1.46; CABG: HR 1.26, 95% CI 0.93-1.70) or death/MI outcomes (PCI: HR 1.14, 95% CI 0.94-1.40; CABG: HR 1.23, 95% CI 0.94-1.61). ConclusionOur study revealed that females versus male had higher risk of death or death/MI. However, these differences in outcomes were explained by differences in demographic and clinical characteristics. Our results could be considered when contemplating revascularization strategy based on survival.

5 Year Survival with Percutaneous Coronary Intervention Compared to Coronary Artery Bypass Graft Surgery in Patients with Diabetes and Multivessel Disease

BackgroundCoronary artery bypass graft (CABG) surgery is preferred over percutaneous coronary intervention (PCI) in patients with diabetes (DM) and multivessel disease (MVD). However, it is unclear whether CABG confers a survival advantage. MethodsPatients with DM and MVD undergoing either PCI (with drug-eluting stents) or CABG within 90-days of cardiac catheterization between 01/05/2009-03/29/2019 in Alberta, Canada were included. The study excluded patients with previous revascularization or other cardiac interventions. We examined death and death or myocardial infarction (MI) 5-years post revascularization via linkage with vital statistics death registry and hospitalization data. Inverse probability of treatment weighting was used to balance baseline characteristics between PCI and CABG groups and then compared the survival difference with Cox proportional hazards model. ResultsAmong 4803 patients, 2941 (61.2%) had PCI and 1862 (38.8%) had CABG. PCI recipients were more likely to be female, younger, to have higher body mass index, present with ST-elevation MI or lesser extent of MVD than CABG patients. At 5-years there was no significant difference in the death rate or the death/MI rate between two groups (Death, PCI: 3.2, CABG 3.6 events per 100 person-year, p=0.16) and (Death/MI PCI: 5.1, CABG 4.7 events per 100 person-year, p=0.35). Adjusting for confounding factors did not change the associations of PCI vs CABG (Death HR: 0.96, 95% CI 0.73, 1.24) and (Death/MI HR: 1.16 95% CI 0.92, 1.45). ConclusionNo significant difference in all-cause death or death/MI was found between revascularization strategies, providing guidance on selection for patients with DM and MVD.

Comprehensive review of materials, applications, and future innovations in biodegradable esophageal stents.

Esophageal stricture (ES) results from benign and malignant conditions, such as uncontrolled gastroesophageal reflux disease (GERD) and esophageal neoplasms. Upper gastrointestinal endoscopy is the preferred diagnostic approach for ES and its underlying causes. Stent insertion using an endoscope is a prevalent method for alleviating or treating ES. Nevertheless, the widely used self-expandable metal stents (SEMS) and self-expandable plastic stents (SEPS) can result in complications such as migration and restenosis. Furthermore, they necessitate secondary extraction in cases of benign esophageal stricture (BES), rendering them unsatisfactory for clinical requirements. Over the past 3decades, significant attention has been devoted to biodegradable materials, including synthetic polyester polymers and magnesium-based alloys, owing to their exceptional biocompatibility and biodegradability while addressing the challenges associated with recurring procedures after BES resolves. Novel esophageal stents have been developed and are undergoing experimental and clinical trials. Drug-eluting stents (DES) with drug-loading and drug-releasing capabilities are currently a research focal point, offering more efficient and precise ES treatments. Functional innovations have been investigated to optimize stent performance, including unidirectional drug-release and anti-migration features. Emerging manufacturing technologies such as three-dimensional (3D) printing and new biodegradable materials such as hydrogels have also contributed to the innovation of esophageal stents. The ultimate objective of the research and development of these materials is their clinical application in the treatment of ES and other benign conditions and the palliative treatment of malignant esophageal stricture (MES). This review aimed to offer a comprehensive overview of current biodegradable esophageal stent materials and their applications, highlight current research limitations and innovations, and offer insights into future development priorities and directions.

Percutaneous Coronary Intervention With a Drug-Eluting Stent Versus Coronary Artery Bypass Grafting in Patients Receiving Dialysis: A National Study From Taiwan

Rationale & ObjectiveTo study the comparative effectiveness of percutaneous coronary intervention with drug-eluting stent and coronary artery bypass grafting in dialysis patients. Study DesignRetrospective observational cohort study. Setting & ParticipantsThis population-based study identified dialysis patients hospitalized for coronary revascularization between January 1, 2009 and December 31, 2015 in Taiwan National Health Insurance Research Database. ExposuresPercutaneous coronary intervention with drug-eluting stent versus coronary artery bypass grafting. OutcomesAll-cause mortality, in-hospital mortality, and repeat revascularization. Analytical ApproachPropensity scores were used to match patients. Cox proportional hazards models and logistic regression models were constructed to examine associations between revascularization strategies and mortality. Interval Cox models were fit to estimate time-varying hazards during different periods. ResultsA total of 1,840 propensity score-matched dialysis patients were analyzed. Coronary artery bypass grafting was associated with higher in-hospital mortality (coronary artery bypass grafting vs. percutaneous coronary intervention with drug-eluting stent, crude mortality rate 12.5% vs. 3.3%; adjusted odds ratio 5.22; 95% confidence interval [CI] 3.42-7.97; p < 0.001), and longer hospitalization duration (median [interquartile range], 20 [14-30] days vs. 3 [2-8] days, p < 0.001). After discharge, repeat revascularization, acute coronary syndrome, and repeat hospitalization all occurred more frequently in the percutaneous coronary intervention with drug-eluting stent group. Importantly, with a median follow-up of 2.8 years, coronary artery bypass grafting was significantly associated with a higher risk of all-cause overall mortality (adjusted hazard ratio 1.19, 95% CI 1.05-1.35, p = 0.006) in the multivariable Cox proportional hazard model. Sensitivity and subgroup analyses yielded consistent results. LimitationsObservational study with mainly Asian ethnicity. ConclusionsPercutaneous coronary intervention with drug-eluting stent may be associated with better survival than coronary artery bypass grafting in dialysis patients. Future studies are warranted to confirm this finding. Plain Language SummaryAlthough in the general population coronary artery bypass grafting offers better long-term survival than percutaneous coronary intervention with drug-eluting stent, dialysis patients may be too frail to tolerate the increased perioperative mortality risk of coronary artery bypass grafting. In this retrospective study in a national cohort of Taiwan dialysis patients, percutaneous coronary intervention with drug-eluting stent is associated with lower in-hospital mortality and better long-term survival when compared with coronary artery bypass grafting. Subsequent acute coronary syndrome, repeat revascularization, and re-hospitalization developed more frequently in the percutaneous coronary intervention with drug-eluting stent group. These findings may suggest percutaneous coronary intervention with drug-eluting stent as a safe revascularization strategy for dialysis patients.

Electrosprayed zein nanoparticles as antibacterial and anti-thrombotic coatings for ureteral stents

Ureteral stents are among the most frequently used human implants, with urothelium trauma, blood clots, and bacterial colonization being their main reasons for failure. In this study, berberine-loaded zein (ZB) nanoparticles with high drug encapsulation efficiency (>90 %) were fabricated via electrospray on flat and 3D stainless steel structures. Physico-chemical characterization revealed that the ZB nanoparticles created a highly hydrophilic, antioxidant, and scratch-resistant continuous coating over the metal structure. Results showed that the drug release rate was faster at neutral pH (i.e., PBS pH 7.4) than in an artificial urine medium (pH 5.3) due to the different swelling behavior of the zein polymeric matrix. In vitro evaluation of ZB particles onto human dermal fibroblasts and blood cells demonstrated good cell proliferation and enhanced anti-thrombotic properties compared to bare stainless steel. The ability of the electrosprayed zein particles to resist bacterial adherence and proliferation was evaluated with Gram-negative (Escherichia coli) bacteria, showing high inhibition rates (−29 % and −46 % for empty and berberine-loaded particles, respectively) compared to the medical-grade metal substrates. Overall, the proposed composite coating fulfilled the requirements for ureteral applications, and can advance the development of innovative biocompatible, biodegradable, and antibacterial coatings for drug-eluting stents.

Long-term benefits of drug-coated balloons for coronary artery revascularization.

Percutaneous coronary intervention (PCI) with drug-eluting stents (DES) represents the treatment of choice for the majority of patients with coronary artery disease. While currently available DES, in addition to physiological support, has failed to show the non-inferiority to coronary artery bypass grafting (CABG) in terms of cumulative incidence of clinical events over the short-term follow-up. Studies have also shown that DES is associated with an increased risk of target vessel revascularization compared to CABG after long-term follow-up. Drug-coated balloons (DCB) have been shown to provide clinically significant benefits in the management of in-stent restenosis and diffuse coronary artery disease, as well as small coronary artery lesions. The aim of this review was to describe the inherent technical limitations of DES and highlight the potential advantages of PCI with DCB for long-term outcomes and potentially demonstrate its non-inferiority to CABG. Currently, ongoing studies will provide more information and help to understand if a blended therapy of DCB+DES can match the performance of CABG in the need for revascularization in more complex patients.

Association of Endothelial Nitric Oxide Synthase and Angiotensin-Converting Enzyme Genes Polymorphism With In-Sent Restenosis of Bare Metal Stents vs Drug-Eluting Stents in Egyptians.

Despite its unequivocal superiority compared with balloon angioplasty, coronary stenting did not abolish restenosis. We aimed to evaluate the associations between a common single nucleotide polymorphism occurring in endothelial nitric oxide synthase (eNOS) and angiotensin-converting enzyme (ACE) genes and the risk of in-stent restenosis (ISR) of bare metal stents vs drug-eluting stents (BMS vs DES) implanted in Egyptian patients. Two hundred patients who had coronary stenting were divided into group I (n = 98) who received a BMS and group II (n = 102) who received a DES. eNOS and ACE genes polymorphism were analyzed by polymerase chain reaction (PCR). We found that the GA and AA genotypes of the eNOS gene were associated with the ISR with both BMS and DES. However, the ACE gene was not associated with ISR. We concluded that eNOS gene polymorphism is associated with ISR. Hypertension, stent length, and AA genotype of the eNOS gene were found to be independent predictors of the occurrence of ISR after both BMS and DES use.