Endothelial Progenitor Cell Capture Research Articles

Comparison between endothelial progenitor cell capture and bare metal stents in coronary artery disease patients at high risk for instent restenosis and thrombosis

Backgroud Since EPCs represent a pool of cells which contribute to the endothelial repair after vascular injury, the increased homing and retention of these cells at the site of stent implantation may increase and speed up the process of endothelialization. The new bioengineered stent with the immobilized antibody against CD34 antigen bound to the surface of the struts is thought to enable the stent to capture circulating EPCs from the blood stream to establish a functional endothelial lining preventing platelet adhesion and activation, and thus thrombus formation, with modulation of the foreign body inflammatory response through acceleration of the natural healing process, thus preventing ISR. This may minimize the need for long term dual anti-platelet therapy. Objectives The purpose of this study was to compare the efficacy of the new endothelial progenitor cell (EPC) capture stents with that of bare metal stents in coronary artery disease patients at high risk for instent restenosis and thrombosis. Methods We randomly assigned 38 patients with lesions carrying a high risk of restenosis to have the Genous stent or a bare metal stent implanted. Lesions were considered high risk of restenosis if one of the following applied: a chronic coronary artery occlusion; a coronary artery stenosis with a length of more than 20 mm; a lesion in a coronary artery with a diameter of less than 2.8 mm by QCA; or any lesion in a diabetic patient or renal failure. Results At 6 months, the rate of the primary end point, composite of ISR and IST, was 26% in the Genous stent group when compared with 58% in the bare metal stent group [ p = 0.049]. Also, no stent thrombosis was observed in the Genous stent group compared to 1 probable stent thromboses in the bare metal stent group ( p = 0.3). The cumulative rate of MACE (cardiac death, MI and clinically driven TLR) at 6 months was 26% in the Genous stent group (all due to clinically driven TLR) when compared with 52% in the bare metal stent group, a difference due to clinically driven target lesion revascularization ( p -value = 0.1). Conclusions In patients with lesions carrying a high risk of restenosis, the Genous stent resulted in a non-significant trend towards lower rate of ISR and MACE compared with bare metal stents mainly due to more repeat revascularizations in the bare metal stent group.

Enhanced Endothelialization of a New Stent Polymer Through Surface Enhancement and Incorporation of Growth Factor-Delivering Microparticles

In this study, we sought to develop strategies for improved endothelialization of a new polymer coating for vascular stents. Surface enhancement of the new poly-1,8-octanediol-co-citric acid (POC) polymer was achieved through conjugation of anti-CD34 antibody and incorporation of vascular endothelial growth factor and basic fibroblast growth factor-containing poly-lactic-co-glycolic acid microparticles to improve capture and proliferation of endothelial progenitor cells (EPC) and compared to untreated POC and poly-L-lactic acid (PLLA) polymer. Our results indicate that compared to PLLA, POC coating was more hemocompatible, with less platelet activation (p = 0.01), thrombogenicity (p < 0.05 for 20 and 30 min clot formation), and inflammatory response (IL-1β release, p = 0.0009; TNF-α release, p = 0.004). EPC adhesion and proliferation on POC were significantly improved with surface enhancement and microparticle incorporation compared to untreated POC (p = 0.006) and PLLA (p = 0.003). These results suggest a new strategy for enhancing endothelialization of polymeric coatings of vascular prostheses.

Endothelial Progenitor Cell Capture Stent: Safety and Effectiveness

The endothelial progenitor cell (EPC) capture stent is an innovative device that makes use of the ability of bone marrow-derived EPCs to migrate to injured arterial segments to facilitate healing. The EPC antibody surface, consisting of a covalently coupled polysaccharide intermediate coating with anti-human CD34 antibodies, is attached to a stainless steel stent. Upon stent placement, the anti-human CD34 antibodies will attract circulating EPCs, which are expected to develop into mature functional endothelium. This accelerated healing strategy aims to lower the risk of restenosis and stent thrombosis, as well as obviate prolonged dual antiplatelet therapy. Since the first-in-man study in 2003, a number of small-to-medium size registry and postmarketing studies that confirmed the good safety profile of the EPC capture stent have been published. However, due to lack of large-scale randomized trials, its effectiveness, compared with bare metal stents and drug-eluting stents, cannot be ascertained. Based on restudy angiographic data, instent late loss was approximately 0.7-0.9 mm, which compares unfavorably with that of drug-eluting stents. In order to improve the effectiveness of the EPC capture stent in reducing restenosis--while maintaining its pro-healing property--a bioengineered sirolimus-eluting stent known as the Combo stent was recently designed to combine the EPC capture technology with the abluminal elution of sirolimus. Data from animal studies have been encouraging. The first-in-man study of the Combo stent has been completed and results were presented.

Twelve-month clinical outcomes after coronary stenting with the Genous Bio-engineered R Stent in patients with a bifurcation lesion

The e-Healthy Endothelial Accelerated Lining Inhibits Neointimal Growth (e-HEALING) registry was designed to capture clinical data on the use of the endothelial progenitor cell capture stent (ECS) in routine clinical practice. In this analysis, we investigated the 12-month clinical outcomes in patients treated with an ECS for a bifurcation lesion. The worldwide, prospective, nonrandomized e-HEALING registry aimed to enroll 5000 patients treated for coronary artery disease with one or more ECS between October 2005 and October 2007. Clinical follow-up was obtained at 1, 6, and 12 months. The primary endpoint was target vessel failure (TVF), defined as the composite of cardiac death, myocardial infarction, and target vessel revascularization at 12 months. A total of 573 patients were treated for at least one bifurcation lesion and were assessed in the current analysis. Baseline characteristics showed a median age of 65 years; 21% were diabetic patients and 36% had unstable angina. A total of 63% of the bifurcation lesions were located in the left artery descending and the mean stent length was 20.7±12.6 mm. At 12 months, TVF was 12.7% and target lesion revascularization was 7.5%. Definite or probable stent thrombosis occurred in 1.7% of the patients. Moreover, one or more stents per lesion [hazard ratio (HR): 2.79, 95% confidence interval (CI): 1.60-4.86, P<0.001], predilatation (HR: 0.39, 95% CI: 0.17-0.87, P=0.023), and lesions located in the right coronary artery (HR: 4.56, 95% CI: 1.07-19.5, P=0.041) were independent predictors of TVF. In the e-HEALING registry, coronary bifurcation stenting with the ECS results in favorable clinical outcomes and low incidences of repeat revascularization and stent thrombosis.

070 Coronary stenting and surgery, a complex situation to manage. Usefulness of endothelial progenitor cells capture

070 Coronary stenting and surgery, a complex situation to manage. Usefulness of endothelial progenitor cells capture

Very late stent thrombosis due to DES fracture: Description of a case and review of potential causes

Stent fracture and subsequent stent thrombosis are known complications after stent implantation, especially in stents with closed cell design like the first generation sirolimus drug eluting stents (DES). Late stent thrombosis is very rarely encountered in our patient population, majority Chinese. We report a case of non-ST elevation myocardial infarction as a result of very late stent thrombosis (three years after implantation) due to stent fracture at the site of overlap of two first generation sirolimus DES. There were initial difficulties in restoring coronary flow by conventional reperfusion therapies but a successful outcome after implantation of an endothelial progenitor cell capture stent, with no further recurrence of ischemic event after 12 months. An attempt was made to analyze all existing factors present and contributing to the stent fracture and stent thrombosis in this case, as reported in the literature.

Metallic taste after coronary artery stent implantation

Percutaneous coronary intervention (PCI) with stent implantation has become the first choice of treatment for acute myocardial infarction [1]. The most often used metals and metallic alloys for manufacturing stents have a net positive electrical charge on their surface [2]. Dental procedures that use amalgam are the most frequent restoration techniques worldwide. In contrast with the alloys used for stent manufacturing, most alloys used in dental fillings tend to be electronegative. Oral galvanic currents and the elucidated metallic vapor release have long been recognized as a potential source of oral discomfort [3]. The phenomenon of oral galvanism results from the difference in electrical potential between dissimilar restorative metals located in the mouth. Whether electrical potential difference between coronary stents and metals located in the mouth has any clinical implication is uncertain. A 54-year-old male, with 2-hour chest pain and ST elevation in anterior ECG leads has been admitted to our invasive cardiology center for primary percutaneous coronary intervention (PCI). A diagnosis of anterior ST-elevation myocardial infarction (STEMI) was made and the subsequent coronary angiography described an occlusion of a left anterior descendent coronary artery. A successful revascularization was performed with implantation of an endothelial progenitor cell capture 3.0×23 mm stent (Genous Bio-engineered R stentTM, OrbusNeich Medical Technologies, Fort Lauderdale, FL, USA). Three days after the PCI, the patient was discharged without symptoms. One month after the PCI a progressive severe disturbance in sense of taste with metallic taste and inability to distinguish between

The genous™ endothelial progenitor cell capture stent accelerates stent re‐endothelialization but does not affect intimal hyperplasia in porcine coronary arteries

To study the effect of endothelial progenitor cell (EPC) capture on the vascular response to coronary stenting. The introduction of drug-eluting stents has reduced the need for target lesion revascularization, but their effect on delayed healing, inflammation, and vascular dysfunction has emphasized the need to design strategies that improve current DES. One such strategy is to improve endothelialization by capturing CD34-positive cells (EPC) by the stent surface. The first human clinical trial using coronary EPC capture stents showed stent safety but neointimal thickness (NIT) was not reduced compared to bare metal stents (BMS). To understand these responses we studied the coronary response to the EPC capture stent in swine. The stent, coated with murine antihuman monoclonal CD34 antibodies, was assessed with QCA guided stent implantation in normal swine coronary arteries for early endothelialization at 2 and 5 days, and NIT at 28 and 90 days in comparison to control stents carrying a non-specific murine antibody or to BMS. The main finding was that while the EPC capture stent significantly improved early endothelialization it did not reduce NIT at 28 and 90 days. The EPC capture stent improves early endothelialization in swine but this does not affect neointimal thickness as compared to control stents at 28 and 90 days.

Design and validation of an endothelial progenitor cell capture chip and its application in patients with pulmonary arterial hypertension

The number of circulating endothelial progenitor cells (EPCs) inversely correlates with cardiovascular risk and clinical outcome, and thus has been proposed as a valuable biomarker for risk assessment, disease progression, and response to therapy. However, current strategies for isolation of these rare cells are limited to complex, laborious approaches. The goal of this study was the design and validation of a disposable microfluidic platform capable of selectively capturing and enumerating EPCs directly from human whole blood in healthy and diseased subjects, eliminating sample preprocessing. We then applied the "EPC capture chip" clinically and determined EPC numbers in blood from patients with pulmonary arterial hypertension (PAH). Blood was collected in tubes and injected into polymeric microfluidic chips containing microcolumns pre-coated with anti-CD34 antibody. Captured cells were immunofluorescently stained for the expression of stem and endothelial antigens, identified and counted. The EPC capture chip was validated with conventional flow cytometry counts (r = 0.83). The inter- and intra-day reliability of the microfluidic devices was confirmed at different time points in triplicates over 1-5months. In a cohort of 43 patients with three forms of PAH (idiopathic/heritable, drug-induced, and connective tissue disease), EPC numbers are ≈50% lower in PAH subjects vs. matched controls and inversely related to two potential disease modifiers: body mass index and postmenopausal status. The EPC capture chip (5 × 30 × 0.05mm(3)) requires only 200μL of human blood and has the strong potential to serve as a rapid bedside test for the screening and monitoring of patients with PAH and other proliferative cardiovascular, pulmonary, malignant, and neurodegenerative diseases.

Capture of circulatory endothelial progenitor cells and accelerated re-endothelialization of a bio-engineered stent in human ex vivo shunt and rabbit denudation model

AimsThe Genous™ Bio-engineered R™ stent (GS) aims to promote vascular healing by capture of circulatory endothelial progenitor cells (EPCs) to the surface of the stent struts, resulting in accelerated re-endothelialization. Here, we assessed the function of the GS in comparison to bare-metal stent (BMS), when exposed to the human and animal circulation.Methods and resultsFirst, 15 patients undergoing coronary angiography received an extracorporeal femoral arteriovenous (AV) shunt containing BMS and GS. Macroscopical mural thrombi were observed in BMS, whereas GS remained visibly clean. Confocal and scanning electron microscopic (SEM) analysis of GS showed an increase in strut coverage. Quantitative polymerase chain reaction (qPCR) analysis of captured cells on the GS demonstrated increased expression of endothelial markers KDR/VEGFR2 and E-selectin, and a decrease in pro-thrombogenic markers tissue factor pathway inhibitor and plasminogen activator inhibitor-1 compared with BMS. Secondly, a similar primate AV shunt model was used to validate these findings and occlusion of BMS was observed, while GS remained patent, as demonstrated by live imaging of indium-labelled platelets. Thirdly, in an in vitro cell-capture assay, GS struts showed increased coverage by EPCs, whereas monocyte coverage remained similar to BMS. Finally, the assessment of re-endothelialization was studied in a rabbit denudation model. Twenty animals received BMS and GS in the aorta and iliac arteries for 7 days. Scanning electron microscopic analysis showed a trend towards increased strut coverage, confirmed by qPCR analysis revealing increased levels of endothelial markers (Tie2, CD34, PCD31, and P-selectin) in GS.ConclusionIn this proof-of-concept study, we have demonstrated that the bio-engineered EPC-capture stent, Genous™ R™ stent, is effective in EPC capture, resulting in accelerated re-endothelialization and reduced thrombogenicity.

Final results of the HEALING IIB trial to evaluate a bio-engineered CD34 antibody coated stent (Genous™Stent) designed to promote vascular healing by capture of circulating endothelial progenitor cells in CAD patients

ObjectiveTo assess the safety and efficacy of the Genous™ endothelial progenitor cell (EPC) capturing stent in conjunction with HmG-CoA-reductase inhibitors (statins) to stimulate EPC recruitment, in the treatment of patients with de novo coronary artery lesions. Methods and resultsThe HEALING IIB study was a multi-center, prospective trial, including 100 patients. The primary efficacy endpoint was late luminal loss by QCA at 6-month follow-up (FU). Although statin therapy increased relative EPC levels by 5.6-fold, the angiographic outcome at 6 month FU was not improved in patients with an overall in-stent late luminal loss of 0.76±0.50mm. The composite major adverse cardiac events (MACE) rate was 9.4%, whereas 6.3% clinically justified target lesion revascularizations (TLRs) were observed. 2 Patients died within the first 30 days after stent implantation due to angiographically verified in-stent thrombosis. At 12 month FU, MACE and TLR increased to 15.6% and 11.5% respectively and stabilized until 24 month FU. 18 Month angiographic FU showed a significant decrease in late luminal loss (0.67±0.54, 11.8% reduction or 10% by matched serial analysis, P=0.001). ConclusionThe HEALING IIB study suggests that statin therapy in combination with the EPC capture stent does not contribute to a reduction of in-stent restenosis formation for the treatment of de novo coronary artery disease. Although concomitant statin therapy was able to stimulate EPC recruitment, it did not improve the angiographic outcome of the bio-engineered EPC capture stent. Remarkably, angiographic late loss was significantly reduced between 6 and 18 months.

Prospective randomised trial evaluating a paclitaxel-coated balloon in patients treated with endothelial progenitor cell capturing stents for de novo coronary artery disease

BackgroundPercutaneous coronary intervention with stent implantation is limited by the occurrence of re-stenosis and the risk of stent thromboses.ObjectiveTo define the impact of paclitaxel-coated balloon angioplasty plus endothelial progenitor cell...

Effectiveness and Safety of the Genous Endothelial Progenitor Cell-Capture Stent in Acute ST-Elevation Myocardial Infarction

The endothelial progenitor cell (EPC)-capture stent promotes endothelialization and preliminary studies have suggested its safety and feasibility in ST-elevation myocardial infarction (STEMI). Detailed late clinical follow-up and angiographic analyses are, however, limited. We sought to determine late angiographic and clinical outcomes of the Genous EPC-capture stent in primary angioplasty. EPC-capture stents were implanted during primary angioplasty in 489 consecutive patients presenting with STEMI from 2004 through 2008. The first 100 consenting patients undergoing successful stent implantation scheduled to undergo relook coronary angiography at 6 to 12 months were enrolled. Ninety-five patients with 96 lesions were analyzed independently. Mean duration of follow-up coronary angiography was 245 days. In-stent late luminal loss measured 0.87 ± 0.67 mm. Binary restenosis (defined as >50% diameter stenosis) was 28%, with diffuse in-stent restenosis (Mehran class II) as the predominant pattern. Of 27 patients with binary restenosis, 14 (52%) were symptomatic, with 10 patients undergoing target lesion revascularization. Asymptomatic patients had significantly larger reference vessel and in-stent minimal luminal diameters (2.77 ± 0.39 vs 2.54 ± 0.44 mm, p = 0.040; 2.74 ± 0.34 vs 2.31 ± 0.72 mm, p = 0.004, respectively). Follow-up late loss and diameter stenoses were also in favor of the asymptomatic group. Major adverse cardiac event rate was 16% at a mean follow-up of 34 months. There were no cases of Academic Research Consortium-defined stent thrombosis. In conclusion, implantation of the EPC-capture stent during primary angioplasty is associated with a favorable late clinical outcome but with higher than anticipated angiographic late loss.

Engineered alginate hydrogels for effective microfluidic capture and release of endothelial progenitor cells from whole blood.

Microfluidic adhesion-based cell separation systems are of interest in clinical and biological applications where small sample volumes must be processed efficiently and rapidly. While the ability to capture rare cells from complex suspensions such as blood using microfluidic systems has been demonstrated, few methods exist for rapid and nondestructive release of the bound cells. Such detachment is critical for applications in tissue engineering and cell-based therapeutics in contrast with diagnostics wherein immunohistochemical, proteomic, and genomic analyses can be carried out by simply lysing captured cells. This paper demonstrates how the incorporation of four-arm amine-terminated poly(ethylene glycol) (PEG) molecules along with antibodies within alginate hydrogels can enhance the ability of the hydrogels to capture endothelial progenitor cells (EPCs) from whole human blood. The hydrogel coatings are applied conformally onto pillar structures within microfluidic channels and their dissolution with a chelator allows for effective recovery of EPCs following capture.

Coronary revascularisation with Genous stent helps reduce the waiting time for lung resection

Patients suitable for lung resection for primary lung cancer and with myocardial ischaemia due to significant coronary artery stenosis, despite optimal medical therapy, are considered for either percutaneous or surgical revascularisation prior to thoracic surgery. Percutaneous coronary intervention (PCI) with bare metal stent (BMS) requires patients to initially receive dual anti-platelet therapy of clopidogrel and aspirin for at least 6 weeks, which delays the waiting time for curative lung resection. We report the successful use of the Genous endothelial progenitor cell (EPC) capture stent in two patients requiring PCI for significant coronary artery disease prior to lung resection. Following PCI with Genous stent implantation, both patients received dual anti-platelet therapy for 1 week. Clopidogrel was then discontinued and a week later both safely underwent curative lung resection receiving aspirin alone. At 6 months' follow-up, neither patient had symptoms or electrocardiograph changes suggestive of angina. Our report suggests that in patients requiring PCI prior to lung resection the Genous EPC capture stent is suitable and reduces their waiting time for surgical resection to 2 weeks instead of 6.

Percutaneous coronary interventions with an endothelial progenitor cell capture stent (EPC) for high risk patients with no option for drug eluting stents: long term clinical outcomes of a single centre registry

Drug eluting stents (DES) are currently considered the gold standard for reducing restenosis of coronary artery lesions. Owing to their effect on the healing process, DES use requires mandatory prolonged dual antiplatelet therapy (DAT). The endothelial progenitor cell (EPC) capture stent, attracting circulating EPCs, promotes vascular healing and allows a short post-procedural period of DAT. The aim of the present study was to evaluate the short and long term clinical outcomes of the use of the Genos R stent™ in a selected high risk population with "no option" for DES. From December 2005 to October 2008, 61 high risk patients with clear contraindications to a prolonged period of DAT who underwent PCI with EPC capture stent implantation in our institution were prospectively selected and analysed. Technical success rate was 100%. Procedural success rate was 95.1%. After two years, major adverse cardiovascular events (MACE) free survival was 80.6%. According to the Academic Research Consortium definitions, cardiac death occurred in 1.6% of patients, and re-infarction, target lesion revascularisation (TLR), and target vessel revascularisation (TVR) occurred in 6.6%, 9.8%, and 11.5% of patients, respectively. Definite stent thrombosis occurred in one patient (specifically at 0 days). In patients who underwent surgery, no post-procedural MACE and no stent thrombosis were recorded. EPC capture stent implantation in high-risk patients with no option for DES seems encouraging, with satisfactory clinical outcomes both at short and at long term follow-up.

Autologous cell therapy for enhanced endovascular repair after coronary stent implantation

A little history Michael Kutryk is the name of the interventional cardiologist and scientist who had this dream. As early as the late 90s, Michael had the vision that it could be most desirable to heal strut coverage specifically with functional endothelial cells in order to improve the biocompatibility of metallic stents. The concept of designing a “prohealing” device with accelerated restoration of endothelial continuity was born at least at first in the mind of its inventor, but was quickly supported by bench and preclinical experiments. By this time, Kutryk had left Canada to join the group at the Thoraxcenter in Rotterdam as a post-doctoral fellow (Figure 1). During this period, Patrick Serruys was experimenting with local drug delivery with sweating balloons and, needless to say, he was immediately taken with Kutryk’s idea. Perhaps somewhat naively, they hypothesised that endothelial progenitor cell capture could prevent at one and the same time both thrombosis and restenosis. It should be remembered that in those early days of stenting, the issues were immediate stent thrombosis and early restenosis, at rates of 20% each! Nobody at that time was anticipating that late thrombotic events would plague the future anti-restenosis solutions, initially vascular brachytherapy and now drug-elution. The Genous technology invented by Kutryk and embraced by Serruys was developed and supported by Orbus Medical Technologies, and later acquired by Neich, an Asian-based company to form Orbus-Neich. Major research and development efforts eventually led to the First-In-Man trial that was published in 2005. The illustration (Figure 2) depicting the principles of the therapy was indeed very convincing, to the point that it was eventually included in the patient informed consent document for further studies. It shows how the stent is covered with a biocompatible matrix to which murine, monoclonal, anti-human CD34+ antibodies are covalently attached. The antibody is specific to the surface antigens, present on circulating endothelial progenitor cells creating an immuno-affinity surface for preferentially capturing these circulating cells. CE mark approval was obtained on August 11, 2005. The HEALING clinical trial program was designed and indeed completed, and publications appeared at an increasing pace. The device also underwent a number of technical iterations including the use of a cobaltchromium stent platform, to replace the bio-engineered R-stent.

Endothelial progenitor cell capturing stent and short dual antiplatelet therapy in patients on chronic anti-vitamin k regimen undergoing percutaneous coronary interventions: long-term outcomes of a single centre registry

To evaluate outcomes of the endothelial progenitor cell (EPC) capture stent in patients on chronic anti-vitamin K (AVK) regimen, requiring percutaneous coronary intervention (PCI). Between February 2007 and February 2008, 78 consecutive patients under chronic AVK treatment undergoing PCI were enrolled in the registry and received an EPC capture stent. The incidence of comorbid conditions was analysed by the Charlson index. Dual antiplatelet therapy (DAT, aspirin and clopidogrel) was prescribed for one month only together with the AVK treatment, after PCI. Major adverse clinical events (MACE) rate, included death, acute myocardial infarction (MI) or target lesion revascularisation (TLR), incidence of stent thrombosis and rate of haemorrhagic events were collected. A?Charlson index >3 was present in 89% of patients. At 14±8 months the cumulative rate of MACE was 22%: 10 deaths (six cardiac deaths), and six TLR. No MI or definitive/probable stent thromboses occurred during follow-up. Four major haemorrhagic episodes occurred during follow-up, all of them after the first month. Patients on AVK treatment represent a highly comorbid population with a high event rate after PCI. The strategy of PCI with an EPC capture stent and short duration of DAT may be used in patients who need a short-term DAT.

Effects of shear stress on the number and function of endothelial progenitor cells adhered to specific matrices

The aim of this study was to screen specific adherent matrix for endothelial progenitor cells (EPCs), which can be used for antibody capturing stents. In this study, the adhesion of EPCs on different matrices containing three different antibodies, VEGFR-2, CD34, CD133, was observed under shear stress in a flow chamber. Nitric oxide (NO) release, cell proliferation and the retention rate of EPCs, were measured separately. The results demonstrated that shear stress within a certain range can promote proliferation and NO secretion of EPCs. Under the same shear stress, the EPCs showed stronger adhesion on matrix-containing CD133 antibody than on the other matrices. CD133 antibody has the potential application for EPCs capture.

Replay to the article by Wendel HP et al.: Endothelial progenitor cell capture stents — Hype or hope?

We are grateful to Wendel et al. for their article elucidating mechanisms and problems about cell capturing stents. This interesting paper give rise to some remarks regarding the beneficial impact of new devices and drug on reducing the incidence of the most important complication associated with stent implantation during percutaneous coronary intervention (PCI).