Clinical Restenosis Rate Research Articles

Diabetes Mellitus and Clinical Outcomes in Carotid Artery Revascularization Using Second-Generation, MicroNet-Covered Stents: Analysis from the PARADIGM Study.

Introduction Carotid artery stenting (CAS) using conventional (single-layer) stents is associated with worse clinical outcomes in diabetes mellitus (DM) vs. non-DM patients: an effect driven largely by lesion-related adverse events. CAS outcomes with MicroNet-covered stents (MCS) in diabetic patients have not been evaluated. Aim To compare short- and long-term clinical outcomes and restenosis rate in DM vs. non-DM patients with carotid stenosis treated using MCS. Materials and Methods In a prospective study in all-comer symptomatic and increased-stroke-risk asymptomatic carotid stenosis, 101 consecutive patients (age 51-86 years, 41% diabetics) underwent 106 MCS-CAS. Clinical outcomes and duplex ultrasound velocities were assessed periprocedurally and at 30 days/12 months. Results Baseline characteristics of DM vs. non-DM patients were similar except for a higher prevalence of recent cerebral symptoms in DM. Type 1 and type 1+2 plaques were more prevalent in DM patients (26.7% vs. 9.8%, p = 0.02; 62.2% vs. 37.7%, p = 0.01). Proximal embolic protection was more prevalent in DM (60% vs. 36%; p = 0.015). 30-day clinical complications were limited to a single periprocedural minor stroke in DM (2.4% vs. 0%, p = 0.22). 12-month in-stent velocities and clinical outcomes were not different (death rate 4.8% vs. 3.3%; p = 0.69; no new strokes). Restenosis rate was not different (0% vs. 1.7%, p = 0.22). Conclusions MCS may offset the adverse impact of DM on periprocedural, 30-day, and 12-month clinical complications of CAS and minimize the risk of in-stent restenosis. In this increased-stroke-risk cohort, adverse event rate was low both in DM and non-DM. Further larger-scale clinical datasets including extended follow-ups are warranted.

Estimated Glomerular Filtration Rate as a Predictor of Restenosis After Carotid Stenting Using First-Generation Stents.

This study evaluated the impact of the baseline estimated glomerular filtration rate (eGFR) on clinical and angiographic outcomes and long-term in-stent restenosis (ISR) rates in patients undergoing elective carotid artery stenting (CAS) procedures. Consecutive patients who underwent CAS were retrospectively enrolled (n = 456). At the end of 3 years of follow-up, patients who had died or were lost follow-up were excluded from the study and a final analysis was performed using data from the remaining 405 patients. The study population (n = 405) was divided into 3 tertiles based on the tertile values of the eGFR level (T1, T2, and T3); then, clinical and procedural characteristics and 3-year ISR rates were compared between the groups. An ISR of 50% was detected in 49 (12%) surviving patients. The 3-year ISR was higher among patients with the lowest eGFR values (T1) by 3.7 times (95% CI: 2.01-11.38) than that among patients with the highest eGFR values (T3). These significant relationships persisted following adjustment for confounders. A lower baseline eGFR level was significantly associated with an increased ISR rate. Decreased renal function may be a predictor of ISR after CAS using first-generation stents.

IVUS and OCT: Current State-of-the-Art in Intravascular Coronary Imaging

To summarize the current state-of-the-art of intracoronary imaging with a focus on clinical outcomes, novel approaches, and anticipated future developments. Multiple randomized trials have demonstrated that intravascular ultrasound (IVUS) guidance of percutaneous coronary intervention (PCI) significantly reduces major cardiac adverse events (MACE), and in particular, rates of target lesion failure or clinical restenosis. High-definition IVUS enhances the ability to visualize stent struts and plaque components. Optical coherence tomography (OCT) offers a greater resolution and can image many plaque morphology and stent characteristics that are not visualized with IVUS. Image guidance should be considered strongly in complex PCI lesions and potentially in all-comers. Multimodality imaging using near-infrared spectroscopy or fluorescence, combined with IVUS or OCT, is an exciting new approache to image plaque lipid, intraplaque hemorrhage, inflammation, and fibrin deposition. Intravascular imaging guidance of PCI utilizing IVUS or OCT definitively improves outcomes in many patient subsets but remains heavily underutilized. Emerging intravascular imaging modalities, such as near-infrared spectroscopy and near-infrared fluorescence imaging, will allow for improved plaque and stent characterization. As cath lab integration, automated image segmentation, and x-ray co-registration evolve further, we envision that intravascular imaging will become a routine for the vast majority of PCI patients, with resultant benefits in clinical outcomes.

Carotid Endarterectomy and Carotid Artery Stenting in a Predominantly Symptomatic Real-World Patient Population

Carotid endarterectomy (CEA) and carotid artery stenting (CAS) are well-established treatments that have been shown to decrease stroke recurrence in patients with underlying carotid artery disease. We assessed clinical outcome, safety, and restenosis rates for patients who underwent standardized CEA or CAS at our tertiary care center using patient selection criteria based on available scientific evidence. Retrospective chart review of patients who underwent CEA or CAS between 2009 and2016. In total, 314 cases (204 with CEA and 110 with CAS) were analyzed. Patients were predominantly white (84.4%), men (61.1%) with hypertension (86.9%) and hyperlipidemia (81.8%). Most patients (84.5%) had symptomatic carotid disease. No significant differences were observed in median postoperative National Institutes of Health Stroke Scale and modified Rankin scale (mRS) scores based on pretreatment symptomatic status or treatment modality (CEA vs. CAS). Most patients (85.9%) had favorable outcomes (mRS score 0-2) at a median follow-up of 11.7 months (interquartile range, 1.8-28.8). The perioperative complication rate was low (3.2%), and permanent neurologic deficit was seen in only 3 patients (1%). Restenosis was found in 7.3%, without significant difference between CEA and CAS at last follow-up. Restenosis was asymptomatic in most patients. Our findings in a real-world predominantly symptomatic cohort demonstrate that favorable patient outcomes and low restenosis and complication rates can be achieved with both CEA and CAS by the utilization of a consistent institutional patient selection and treatment process.

Bioresorbable vascular scaffolds for percutaneous treatment of chronic total coronary occlusions: a meta-analysis

BackgroundBRS represent a new approach to treating coronary artery disease. Beneficial properties of BRS regarding the restoration of vasomotility after resorption make them attractive devices in CTO revascularization. However, experience in this setting is limited.MethodsWe systematically searched Medline, Scholar, and Scopus for reports of at least 9 patients with CTO undergoing BRS implantation. Patients’ and procedural characteristics were summarized. The primary outcome of interest was target lesion revascularization (TLR). Pooled estimates were calculated using a random-effects meta-analysis. The study protocol was registered in PROSPERO (CRD42017069322).ResultsThirteen reports for a total of 843 lesions with a median follow-up of 12 months (IQR 6–12) were included in the analysis. At short-term, the summary estimate rate of TLR was 2.6% (95% CI: 1 to 4%, I2 = 0%, P = 0.887) while at mid to long-term it was 3.8% (95% CI: 2 to 6%, I2 = 0%, P = 0.803). At long-term follow-up (≥12 months), the summary estimate rate of cardiac death was 1.1% (95% CI: 0 to 2%, I2 = 0%, P = 0.887). The summary estimate rates of scaffold thrombosis and clinical restenosis were respectively 0.9% (95% CI: 0 to 2%, I2 = 0%, P = 0.919) and 1.8% (95% CI: 0 to 4%, I2 = 0%, P = 0.448). Finally, the summary estimate rate of target vessel revascularization was 6.6% (95% CI: 0 to 11%, I2 = 0%, P = 0.04).ConclusionsImplantation of BRS in a population with CTO is feasible, although further longer-term outcome studies are necessary.

Clinical characteristics and treatment of renal artery fibromuscular dysplasia with percutaneous transluminal angioplasty: a long-term follow-up study.

Renal artery fibromuscular dysplasia (RAFMD) is a non-atherosclerotic cause of renal artery stenosis often affecting the young. Percutaneous transluminal renal angioplasty (PTRA) is the treatment of choice but there are few studies of the outcome of the procedure. This retrospective analysis included 64 patients (56.2% female; mean age at diagnosis, 28.0years) with RAFMD who underwent PTRA between November 2003 and August 2015. Technical and clinical success rates and restenosis rates were evaluated. Seventy-six procedures were performed on 64 RAFMD patients. Technical success was 96.9%, as defined by<30% residual stenosis, with stent placement required in 11 patients (17.2%). In the short term (1month), the majority (79.7%) had an immediate clinical benefit, with cure of hypertension in 35.9%, and improvement in hypertension and a lower requirement for antihypertensive medications in 43.8%. In the long term (mean, 47.5months; range, 5-141months), the survival rate was 96.9%, freedom from restenosis was 84.4%, and 76.6% of patients showed a sustained clinical benefit (cure rate 40.6%, improvement rate 35.9%). Eight patients were treated with a second procedure and two had a third procedure, with half of these patients showing an improvement in hypertension. PTRA for symptomatic RAFMD is safe and clinically successful. More than half of patients experience an immediate clinical benefit with sustained long-term effects. For patients with restenosis, there was a good response to a second PTRA.

New developments in the clinical use of drug-coated balloon catheters in peripheral arterial disease.

Peripheral arterial disease (PAD) involving the lower extremity is a major source of morbidity and mortality. Clinical manifestations of PAD span the spectrum from lifestyle limiting claudication to ulceration and gangrene leading to amputation. Advancements including balloon angioplasty, self-expanding stents, drug-eluting stents, and atherectomy have resulted in high technical success rates for endovascular therapy in patients with PAD. However, these advances have been limited by somewhat high rates of clinical restenosis and clinically driven target lesion revascularization. The recent introduction of drug-coated balloon technology shows promise in limiting neointimal hyperplasia induced by vascular injury after endovascular therapies. This review summarizes the contemporary clinical data in the emerging area of drug-coated balloons.

Application of finite element method to comparing the NIR stent with the multi-link stent for narrowings in coronary arteries

‘Stent versus stent’ studies are a kind of randomized trials which are designed to show the superiority of the new stent designs compared with the previously approved ones. These studies are usually used by regulatory agencies, such as the U.S. Food and Drug Administration (FDA), to give an approval to new stent designs. The problem with these clinical trials is their high cost and difficulty. In this paper, a numerical alternative for ‘stent versus stent’ complicated clinical studies is presented. A finite element model is developed to investigate the influence of stent design on the outcome after coronary stent placement. Two commercially available stents (the NIR and Multi-Link stents) are modeled and their behavior during the deployment is compared in terms of stress distribution, radial gain, outer diameter changes and foreshortening. Moreover, the effect of stent design on the restenosis rate is investigated by comparing the stress distribution within the arteries. An analysis of the arterial wall stresses in the stented arteries indicates that the Multi-Link stent design causes lower stress to an atherosclerotic vessel with a localized stenotic lesion compared to the slotted tube NIR design. The findings correlate with the observed clinical restenosis rates, which have reported higher restenosis rates in the NIR compared with the Multi-Link stent design.

A prospective intravascular ultrasound investigation of the necessity for and efficacy of postdilation beyond nominal diameter of 3 current generation DES platforms for the percutaneous treatment of the left main coronary artery

To define the size of the left mainstem coronary artery (LMS) in the Northern Irish population and investigate the clinical feasibility, safety, and efficacy of post dilation beyond nominal diameter of current generation Drug eluting stent (DES) when treating the LMS. There is no prospective data examining the need, feasibility, and safety of over-expansion of current generation DES beyond nominal diameter. Patients with flow-limiting coronary atheroma requiring IVUS assessment of the LMS were recruited. Standardized measurements of the distal LMS were made. Subsequently, patients requiring post dilation of current generation DES within the LMS were entered into a PCI registry. Overall, 125 patients were recruited into the initial study. Mean cross-sectional area (CSA) of the distal LMS was 22.6 mm(2) (SD ± 5.4 mm(2) ). Mean maximal vessel diameter was 5.7 mm (SD ± 0.7 mm). Increasing plaque burden was associated with reduced CSA (P < 0.001). In 31 consecutive patients undergoing IVUS guided PCI of the LMS with 5.5 and 6.0 mm balloon catheters, mean maximal stent diameters were >5.0 mm with the Biomatrix Flex 9 crown and Promus Element Large vessel platforms. No intraprocedural complications occurred. Mean follow up was 13.4 months. Clinical restenosis rate was 3.2%, with 2 deaths unrelated to index procedure. The majority of patients with angiographic coronary atheroma have a mean LMS diameter of >4 mm indicating the requirement for post dilation beyond nominal diameter all of current generation DES in almost all patients when treating the LMS. This is achievable with current DES platforms with no intraprocedural complication. Clinical follow up indicates excellent short-term efficacy.

Final 5-Year Outcomes From the Endeavor Zotarolimus-Eluting Stent Clinical Trial Program: Comparison of Safety and Efficacy With First-Generation Drug-Eluting and Bare-Metal Stents

The aim of this study was to evaluate late safety and efficacy outcomes among patients enrolled in clinical trials comparing Endeavor zotarolimus-eluting stents (E-ZES) (Medtronic, Inc., Santa Rosa, California) with first-generation drug-eluting stents (DES) and bare-metal stents (BMS). Despite demonstration of higher angiographic luminal loss and restenosis with E-ZES compared with alternative DES, whether differences in these early angiographic measures translate into more disparate late clinical events is uncertain. Among 3,616 patients undergoing percutaneous coronary revascularization in 5 registration trials, late safety and efficacy events were compared between E-ZES (n = 2,132) versus sirolimus- or paclitaxel-eluting stents (n = 888) or BMS (n = 596). Compared with a parallel cohort of patients treated with first-generation DES and BMS, 5-year rates of cardiac death/myocardial infarction (MI) (5.8% vs. 8.8% DES, p = 0.003; vs. 8.4% BMS, p = 0.02) and major adverse cardiac events (16.1% vs. 20.6% DES, p = 0.009; vs. 24.6% BMS, p < 0.001) were significantly lower with E-ZES. The E-ZES was associated with significantly lower target lesion revascularization (TLR) compared with BMS (7.4% vs. 16.3%, p < 0.001) but similar to comparator DES (7.4% vs. 8.1%, p = 0.63). Despite higher TLR in the first year with E-ZES compared with DES, between 1- and 5-year follow-up, rates of cardiac death/MI, TLR, and definite/probable stent thrombosis were significantly lower with E-ZES. Over 5 years, significant differences in cardiac death/MI and composite endpoints favored treatment with E-ZES over comparator BMS and DES. Rates of clinical restenosis and safety events, including stent thrombosis beyond the first year of revascularization, remain stable with E-ZES, leading to significant differences compared with first-generation DES.

Comparison of Clinical Outcomes After PCI With DES in Diabetic Patient with and Without Microvascular Disease

Aim Higher rates of clinical and angiographic restenosis have been reported after percutaneous coronary intervention (PCI) with stenting drug eluting stent (DES) in diabetic patient. Improved blood-glucose control decreases the progression of diabetic microvascular disease, but the effect on macrovascular complications after PCI with DES is unknown. We compared the good control of blood-glucose group; diabetic patient without microvascular disease (non M group: 63 patients 112 lesions) and uncontrolled blood-glucose group; diabetic patient with microvascular disease (M group: 30 patients 51 lesions).

046: Use of drug eluting stents: impact of french recommendations on the rate of clinical restenosis at two years

The drug-eluting stents reduce restenosis rate compared to bare metal stents. The clinical efficacy is greater in some subgroups of patients at high risk of restenosis. The aim of this study is to evaluate the use of drug-eluting stent based on the recommendations of the French Society of Cardiology and his impact on the restenosis rate at 2 years. We included all patients who had coronary angioplasty with stenting in 2008. We evaluated the percentage of drug-eluting stent, the proportion of patients for which the French recommendations have been followed, and the rate of clinical restenosis at 2 years. Four hundred and seventy-nine angioplasties were performed in 2008. The percentage of drug-eluting stents was 21.8%. Acute coronary syndrome with or without elevation of the ST segment were the main indications of angioplasty (67.9%). For the 115 drug-eluting stents implanted in 2008, French recommendations were followed in 93% of cases (107 stents). For 89 patients who received DES, these recommendations were followed in 91% of cases (81 patients). The clinical restenosis rate at two years evaluated in 89% of patients was 5.6%. The rate of in-stent restenosis in bare metal and drug-eluting stents were 5.9% and 3.7%. The use of DES in our center is characterized by a small rate and a good compliance of the recommendations of the French Society of Cardiology. This strategy is associated with a low rate of restenosis at 2 years of follow-up.

Zotarolimus-eluting stent-induced hypersensitivity pneumonitis

Zotarolimus-eluting stent-induced hypersensitivity pneumonitis

Repeat Revascularization After PCI

In the modern era of percutaneous coronary interventions (PCI), drug-eluting stents are commonly used to reduce the risk of restenosis.1 With the development of second-generation drug-eluting stents, there has been a significant reduction in the incidence of restenosis with rates ranging from 6% to 10% in most clinical trials,2 with emerging evidence for a reduction in late myocardial infarction (MI). Numerically, the rate of clinical restenosis is now close to the rate of MI, 1 to 2 years after a PCI.1 However, among patients with multivessel coronary artery disease (CAD) there remains uncertainty regarding the risk of restenosis, stent thrombosis (ST), and possible late MI.3 Interventional cardiologists are, therefore, faced with a dilemma in trading off the various risks of adverse events (such as the need for repeat revascularization and periprocedural MI) during decision-making for the most appropriate use of PCI. Article see p 772 In this issue of Circulation: Cardiovascular Interventions , Stolker and colleagues4 report on the use and need for repeat revascularization in a large contemporary registry. The EVENT Registry was a prospective observational registry designed to study PCI in clinical practice in 55 US centers. A total of 10,144 patients were included; ≈5%, ST-segment–elevation myocardial infarction (STEMI); 40% other acute coronary syndromes; and 49% with stable CAD. Analysis of 4 main outcomes was undertaken; ST, target lesion revascularization (TLR), target vessel revascularization, or other vessel revascularization. TLR was defined as repeat PCI or bypass graft placement for restenosis at the lesion treated during index PCI, or occurring within 5 mm of the PCI site (edge effect) as determined clinically by the investigator at each site. Target vessel revascularization …

Left main stenting, a short and intermediate follow-up

Background Significant left main coronary artery disease occurs in about 5–7% of patients undergoing coronary angiography. Coronary artery bypass graft (CABG) surgery was the standard acceptable way in treating these lesions. The introduction of drug eluting stents (DES) in mid 2003 has pushed the rate of clinical restenosis below 5% for most lesion types. This encourged the cardiologists to treat the LMCA with DES. Methods and results We implanted DES in 30 patients with denovo LMCA-Stenosis (middle age 69.9 ± 12.5 83% men). 25 patients (83%) had hypertension, 5 diabetes mellitus (17%), 22 hyperlipidemia (73.3%) and 16 were smokers (53.3%). We implanted Paclitaxel-Stents in 26 (87%) and 4 Sirolimus-Stents (13%). 11 patients (37%) with Stents Conclusion LMCA intervention is in the hands of experienced interventionalist technically possible and sure (without MACE), connected with an accepted rate of re-intervention.

A prospective randomized control clinical trial about clopidogrel combined with warfarin versus clopidogrel alone in the prevention of restenosis after femoral-popliteal artery angioplasty

Using two antithrombotic treatment (clopidogrel vs. clopidogrel combined warfarin) strategies after femoral-popliteal artery angioplasty prospectively, to evaluate which strategy is more effective for the restenosis prevention. Totally 50 patients referred for endovascular treatment (including the percutaneous transluminal angioplasty (PTA) and stent implantation) of the superficial femoral artery and popliteal artery from January 2008 to May 2009 were randomly divided into clopidogrel group (group A, 25 cases, 30 limbs) and clopidogrel plus warfarin group (group B, 25 cases, 33 limbs) before operation. Clinical outcomes and restenosis rate of the target lesions were evaluated at 3, 6 and 12 months after operation. Totally 88 patients were screened for participation in the study, 56 patients were included after the follow-up of 12 months. At 3 months, the rates of restenosis were 16.7% in group A and 18.2% in group B (χ² = 0.025, P = 0.874). At 6 months, the accumulated restenosis rates were 36.7% in group A and 36.4% in group B (χ² = 0.001, P = 0.98). At 12 months, the accumulated restenosis rates were 53.3% in group A and 42.4% in group B (χ² = 0.75, P = 0.387). Analysis for the critical limb ischemia sub-group showed that follow-up of 12 months, the accumulated restenosis rate was 8/10 in group A and 6/12 in group B (χ² = 1.023, P = 0.312). The clopidogrel alone treatment for PTA or PTA plus stent implantation of femoral popliteal artery has no statistically significant difference in comparison with the clopidogrel combined warfarin treatment in terms of the cumulative vascular restenosis rate at 3, 6, 12 months postoperatively.

Ultrasound-guided percutaneous delivery of tissue-engineered endothelial cells to the adventitia of stented arteries controls the response to vascular injury in a porcine model

High restenosis rates are a limitation of peripheral vascular interventions. Previous studies have shown that surgical implantation of a tissue-engineered endothelium onto the adventitia surface of injured vessels regulates vascular repair. In the present study, we developed a particulate formulation of tissue-engineered endothelium and a method to deliver the formulation perivascular to injured blood vessels using a percutaneous, minimally invasive technique. Stainless steel stents were implanted in 18 balloon-injured femoral arteries of nine domestic swine, followed by ultrasound-guided percutaneous perivascular injection of gelatin particles containing cultured allogeneic porcine aortic endothelial cells (PAE). Controls received injections of empty particles (matrix) or no perivascular injection (sham) after stent deployment. Animals were sacrificed after 90 days. Angiographic analysis revealed a significantly greater lumen diameter in the stented segments of arteries treated with PAE/matrix (4.72 ± 0.12 mm) compared with matrix (4.01 ± 0.20 mm) or sham (4.03 ± 0.16 mm) controls (P < .05). Similarly, histologic analysis revealed that PAE/matrix-treated arteries had the greatest lumen area (20.4 ± 0.7 mm(2); P < .05) compared with controls (16.1 ± 0.9 mm(2) and 17.1 ± 1.0 mm(2) for sham and matrix controls, respectively) and the smallest intimal area (3.3 ± 0.4 mm(2); P < .05) compared with controls (6.2 ± 0.5 mm(2) and 4.4 ± 0.5 mm(2) for sham and matrix controls, respectively). Overall, PAE-treated arteries had a 33% to 50% decrease in percent occlusion (P < .05) compared with controls. Histopathological analysis revealed fewer leukocytes present in the intima in the PAE/matrix group compared with control groups, suggesting that the biological effects were in part due to inhibition of the inflammatory phase of the vascular response to injury. Minimally invasive, perivascular delivery of PAE/matrix to stented arteries was performed safely using ultrasound-guided percutaneous injections and significantly decreased stenosis. Application at the time of or subsequent to peripheral interventions may decrease clinical restenosis rates.

ARTERIAL WALL MECHANICS AND CLINICAL IMPLICATIONS AFTER CORONARY STENTING: COMPARISONS OF THREE STENT DESIGNS

The goal of this work is to quantitatively assess the relationship between the reported restenosis rates and stent induced arterial stress or strain parameters through finite element method. The impact of three stent designs (Palmaz–Schatz stent, Express stent, and Multilink Vision stent) on the arterial stress distributions were characterized. The influences of initial stent deployment location, stent-tissue friction, and plaque properties on the arterial stresses were also investigated. Higher arterial stresses were observed at the proximal end of the plaque. The Multilink–Vision stent induced lesser stress concentrations due to the high stiffness of the Cobalt Chromium material and thinner strut thickness. The stent-induced arterial stress concentrations were positively correlated with the reported in-stent restenosis rates, with a correlation coefficient of 0.992. Stent deployment initiated at the center of the lumen led to less arterial stress variation, while deployment closer to the thinner edge of the plaque causes higher arterial stresses. The friction between the stent and tissue was found to contribute to larger stress alternations for the plaque only. Increased plaque stiffness resulted in a reduced arterial stress concentration and clinical restenosis rate. Results presented herein suggested that arterial stresses serve as a comprehensive index factor to predict the occurrence of in-stent restenosis, which will facilitate the new stent design and surgical planning.

Resultados clínicos de um ano do registro POLAR (Promus eluting stent registry in Latin America)

INTRODUÇÃO: Desde 2002, os stents farmacológicos são utilizados em diversas populações de pacientes objetivando alcançar elevados índices de sucesso, com baixas taxas de reestenose angiográfica e clínica. Com os resultados adversos em relação à trombose tardia associados aos stents farmacológicos de primeira geração eluidores de sirolimus e paclitaxel, surgiram recentemente os stents farmacológicos de segunda geração eluidores de zotarolimus e everolimus. MÉTODOS: O registro POLAR é um registro prospectivo, não-randomizado, multicêntrico, que incluiu 988 pacientes totalizando 1.362 lesões tratadas com o stent Promus®. Objetivando representar a prática clínica, praticamente todos os subtipos de pacientes e lesões foram incluídos neste registro. O seguimento clínico foi planejado para ser realizado 1 mês, 6 meses, 12 meses e 24 meses após o procedimento. RESULTADOS: A maioria dos pacientes era do sexo masculino (69,8%), com média de idade de 64,9 ± 9,4 anos, 35,2% eram diabéticos e 55% tinham sido tratados na vigência de síndrome coronária aguda. O diâmetro do vaso foi de 2,95 ± 0,43 mm e a extensão da lesão, de 20,5 ± 5,6 mm. Foi implantado 1,14 ± 0,38 stent/paciente e o sucesso do procedimento foi alcançado em 96,6% dos casos. Eventos cardíacos adversos maiores ocorreram em 4,1% dos pacientes, e trombose de stent esteve presente em 5 pacientes (0,5%) após o seguimento clínico de 12 meses. CONCLUSÕES: O presente registro sugere que os stents farmacológicos eluidores de everolimus são seguros e eficazes em pacientes da prática clínica diária, com baixas taxas de eventos cardíacos adversos maiores ao término do primeiro ano de seguimento.

Utilisation des stents actifs : impact des recommandations françaises sur le taux de resténose clinique à deux ans

AimsThe drug-eluting stents (DES) reduce restenosis rate compared to bare metal stents. The clinical efficacy is greater in some subgroups of patients at high risk of restenosis. The aim of this study is to evaluate the use of drug-eluting stent based on the recommendations of the French Society of Cardiology and its impact on the restenosis rate at 2years. MethodsWe included all patients who had coronary angioplasty with stenting in 2008. We evaluated the percentage of drug-eluting stent, the proportion of patients for which the French recommendations have been followed, and the rate of clinical restenosis at 2years. ResultsFour hundred and seventy-nine angioplasties were performed in 2008. The percentage of drug-eluting stents was 21.8%. Acute coronary syndrome with or without elevation of the ST segment were the main indications of angioplasty (67.9%). For the 115 drug-eluting stents implanted in 2008, French recommendations were followed in 93% of cases (107 stents). For 89 patients who received DES, these recommendations were followed in 91% of cases (81 patients). The clinical restenosis rate at 2years evaluated in 89% of patients was 5.6%. The rate of in-stent restenosis in bare metal and drug-eluting stents were 5.9 and 3.7%. ConclusionThe use of DES in our center is characterized by a small rate and a good compliance of the recommendations of the French Society of Cardiology. This strategy is associated with a low rate of restenosis at 2years of follow-up.