Impact of strut thickness and number of crown and connectors on clinical outcomes on patients treated with second-generation drug eluting stent.
Aged
Aged, 80 and over
Coronary Artery Disease
/ diagnostic imaging
Coronary Thrombosis
/ diagnostic imaging
Drug-Eluting Stents
Female
Humans
Male
Middle Aged
Percutaneous Coronary Intervention
/ adverse effects
Prosthesis Design
Randomized Controlled Trials as Topic
Recurrence
Risk Assessment
Risk Factors
Time Factors
Treatment Outcome
connector
crowns
stent thrombosis
strut thickness
target lesion revascularization
Journal
Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions
ISSN: 1522-726X
Titre abrégé: Catheter Cardiovasc Interv
Pays: United States
ID NLM: 100884139
Informations de publication
Date de publication:
12 2020
12 2020
Historique:
received:
20
11
2018
revised:
31
01
2019
accepted:
23
03
2019
pubmed:
14
4
2019
medline:
10
8
2021
entrez:
14
4
2019
Statut:
ppublish
Résumé
In new generation drug eluting stents (DESs) era, the impact of stent geometry on freedom from recurrent events has been poorly explored. Impact of struts thickness and the number of crowns and connectors on clinical outcomes were evaluated in the present study. Randomized controlled trials comparing last generation DESs were selected. The primary endpoint was the rate of target lesion revascularization (TLR), while secondary was definite stent thrombosis (ST). Fifty-three studies with 52,006 patients were included. A struts thickness ≤81 nm was associated with a lower incidence of TLR (2.9%: 2.4-3.4 vs. 3.6%: 3.0-4.3) and ST (0.8%: 0.6-1.1 vs. 1.3%: 0.9-1.8). A mean number of connectors >2.5 was also associated with a lower incidence of TLR (3.2%: 2.8-3.6 vs. 3.5%: 2.9-4.2) and ST (1.0%:0.8-1.3 vs. 1.3%: 0.9-1.7 vs. for ST). On the other hand, stents with average number of crowns <7.5 did not perform better than stents with higher average number of crowns. The findings of the study support that lower struts thickness and higher numbers of connectors have a positive clinical outcome reducing stent thrombosis and target lesion revascularizations, while the average number of stent crowns plays a secondary role.
Types de publication
Journal Article
Meta-Analysis
Review
Langues
eng
Sous-ensembles de citation
IM
Pagination
1417-1422Informations de copyright
© 2019 Wiley Periodicals, Inc.
Références
Rymer JA, Patel MR. Mature technology for mature patients: The increasing complexities of patients treated with coronary angiography and interventions. JACC Cardiovasc Interv. 2018;11(9):889-891.
D'Ascenzo F, Iannaccone M, De Filippo O, et al. Optical coherence tomography compared with fractional flow reserve guided approach in acute coronary syndromes: a propensity matched analysis. Int J Cardiol. 2017;244:54-58.
Iannaccone M, D'Ascenzo F, Templin C, et al. Optical coherence tomography evaluation of intermediate-term healing of different stent types: systemic review and meta-analysis. Eur Heart J Cardiovasc Imaging. 2017;18(2):159-166.
Buccheri S, Franchina G, Romano S, et al. Clinical outcomes following intravascular imaging-guided versus coronary angiography-guided percutaneous coronary intervention with stent implantation: a systematic review and Bayesian network meta-analysis of 31 studies and 17,882 patients. JACC Cardiovasc Interv. 2017;10(24):2488-2498.
Bangalore S, Toklu B, Patel N, Feit F, Stone GW. Newer-generation ultrathin strut drug-eluting stents versus older second-generation thicker strut drug-eluting stents for coronary artery disease. Circulation. 2018;138(20):2216-2226. https://doi.org/10.1161/CIRCULATIONAHA.118.034456.
D'Ascenzo F, Iannaccone M, Saint-Hilary G, et al. Impact of design of coronary stents and length of dual antiplatelet therapies on ischaemic and bleeding events: a network meta-analysis of 64 randomized controlled trials and 102 735 patients. Eur Heart J. 2017;38(42):3160-3172.
Moher D, Liberati A, Tetzlaff J, et al. PRISMA group. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. BMJ. 2009;339:b2535.
Moher D, Cook DJ, Eastwood S, et al. Improving the quality of reports of meta-analyses of randomised controlled trials: the QUOROM statement. Quality of reporting of meta-analyses. Lancet. 1999;354:1896-1900.
Stroup DF, Berlin JA, Morton SC, et al. Meta-analysis of observational studies in epidemiology: a proposal for reporting. Meta-analysis of observational studies in epidemiology (MOOSE) group. JAMA. 2000;283:2008-2012.
Higgins JP, Altman DG, Gøtzsche PC, et al. Cochrane bias methods group; Cochrane statistical methods group. The Cochrane Collaboration's tool for assessing risk of bias in randomised trials. BMJ. 2011;343:d5928. https://doi.org/10.1136/bmj.d5928.
Stettler C, Wandel S, Allemann S, et al. Outcomes associated with drug-eluting and bare-metal stents: a collaborative network meta-analysis. Lancet. 2007;370:937-948.
Chiastra C, Morlacchi S, Gallo D, et al. Computational fluid dynamic simulations of patient-specific stented coronary bifurcations. J R Soc Interface. 2013;10(4):20130193.
Piccolo R, Stefanini GG, Franzone A, et al. Safety and efficacy of resolute zotarolimus-eluting stents compared with everolimus-eluting stents: a meta-analysis. Circ Cardiovasc Interv. 2015;8:27-3427.
Bangalore S, Kumar S, Fusaro M, et al. Short- and long-term outcomes with drug-eluting and bare-metal coronary stents: a mixed-treatment comparison analysis of 117 762 patient-years of follow-up from randomized trials. Circulation. 2012;125(23):2873-2891.
Wenaweser P, Daemen J, Zwahlen M, et al. Incidence and correlates of drug-eluting stent thrombosis in routine clinical practice. 4-year results from a large 2-institutional cohort study. J Am Coll Cardiol. 2008;52:1134-1140.
Billinger M, Buddeberg F, Hubbell JA, et al. Polymer stent coating for prevention of neointimal hyperplasia. J Invasive Cardiol. 2006;18(9):423-426. discussion 427.
Zivelonghi C, Teeuwen K, Agostoni P, et al. Impact of ultra-thin struts on restenosis after chronic total occlusion recanalization: insights from the randomized PRISON IV trial. J Interv Cardiol. 2018;31:580-587.
Cutlip DE, Chauhan MS, Baim DS, et al. Clinical restenosis after coronary stenting: perspectives from multicenter clinical trials. J Am Coll Cardiol. 2002;40(12):2082-2089.
Kolandaivelu K, Swaminathan R, Gibson WJ, et al. Stent thrombogenicity early in high-risk interventional settings is driven by stent design and deployment and protected by polymer-drug coatings. Circulation. 2011;123:1400-1409.
Soucy NV, Feygin JM, Tunstall R, et al. Strut tissue coverage and endothelial cell coverage: a comparison between bare metal stent platforms and platinum chromium stents with and without everolimus-eluting coating. EuroIntervention. 2010;6:630-637.
Koskinas KC, Chatzizisis YS, Antoniadis AP, Giannoglou GD. Role of endothelial shear stress in stent restenosis and thrombosis: pathophysiologic mechanisms and implications for clinical translation. J Am Coll Cardiol. 2012;59(15):1337-1349.
Kastrati A, Mehilli J, Dirschinger J, et al. Intracoronary stenting and angiographic results: strut thickness effect on restenosis outcome (ISAR-STEREO) trial. Circulation. 2001;103(23):2816-2821.
Pache J, Kastrati A, Mehilli J, et al. Intracoronary stenting and angiographic results: strut thickness effect on restenosis outcome (Isar-stereo-2) trial. J Am Coll Cardiol. 2003;41:1283-1288.
Ng J, Bourantas CV, Torii R, et al. Local hemodynamic forces after StentingHighlights: implications on restenosis and thrombosis. Arterioscler Thromb Vasc Biol. 2017;37(12):2231-2242.
Watson T, Webster MWI, Ormiston JA, Ruygrok PN, Stewart JT. Long and short of optimal stent design. Open Heart. 2017;4(2):e000680.
Ormiston JA, Webber B, Webster MWI. Stent longitudinal integrity. Bench insights into a clinical problem. JACC Cardiovasc Interv. 2011;4(12):1310-1317.
Nakazawa G, Finn AV, Kolodgie FD, et al. A review of current devices and a look at new technology: drug-eluting stents. Expert Rev Med Devices. 2009;6:33-42.
Joner M, Finn AV, Farb A, et al. Pathology of drug-eluting stents in humans: delayed healing and late thrombotic risk. J Am Coll Cardiol. 2006;48:193-202.
Finn AV, Nakazawa G, Joner M, et al. Vascular responses to drug eluting stents: importance of delayed healing. Arterioscler Thromb Vasc Biol. 2007;27:1500-1510.
Fontaine AB, Spigos DG, Eaton G, et al. Stent-induced intimal hyperplasia: are there fundamental differences between flexible and rigid stent designs? J Vasc Interv Radiol. 1994;5:739-744.
Garasic JM, Edelman ER, Squire JC, Seifert P, Williams MS, Rogers C. Stent and artery geometry determine intimal thickening independent of arterial injury. Circulation. 2000;101:812-818.
Gunn J, Arnold N, Chan KH, Shepherd L, Cumberland DC, Crossman DC. Coronary artery stretch versus deep injury in the development of in-stent neointima. Heart. 2002;88:401-405.
Pant S, Bressloff NW, Forrester AI, Curzen N. The influence of strut-connectors in stented vessels: a comparison of pulsatile flow through five coronary stents. Ann Biomed Eng. 2010 May;38(5):1893-1907. https://doi.org/10.1007/s10439-010-9962-0.
von Birgelen C, Kok MM, van der Heijden LC, Danse PW, Schotborgh CE, Scholte M, Gin RMTJ, Somi S, van Houwelingen KG, Stoel MG, de Man FHAF, Louwerenburg JHW, Hartmann M, Zocca P, Linssen GCM, van der Palen J, Doggen CJM, Löwik MM. Very thin strut biodegradable polymer everolimus-eluting and sirolimus-eluting stents versus durable polymer zotarolimus-eluting stents in allcomers with coronary artery disease (BIO-RESORT): a three-arm, randomised, non-inferiority trial.