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Author(s): Gaku Nakazawa , Aloke V Finn , Renu Virmani Added: 3 years ago
Polymer-based sirolimus (Cypher®) and paclitaxel (Taxus®) drug-eluting stents (DES) have reduced rates of restenosis and target lesion revascularization (TLR) compared with bare-metal stents (BMS) and have launched a revolution in the interventional treatment of symptomatic coronary artery disease.1,2 However, this overwhelming enthusiasm has recently been dampened by safety concerns regarding a… View more

Anticoagulation

Intervention
Author(s): Georgios J Vlachojannis , Bimmer E Claessen , George D Dangas Added: 3 years ago
Platelet adhesion, activation and aggregation play key roles in the initiation of intracoronary thrombosis that causes acute coronary syndromes (ACS) and ischaemic complications following coronary artery interventions, including recurrent myocardial infarction (MI) and stent thrombosis (ST). Indeed, the most feared complication related to coronary stent placement is ST. ST might occur after… View more

MI/ACS

Intervention
Author(s): Elved B Roberts , Nicholas D Palmer Added: 3 years ago
Late stent thrombosis has been a concern for interventional cardiologists since the early days of drug-eluting stent (DES) technology. Although the problem did not appear common, a series of angiographically documented late stent thromboses from the Thoraxcenter Rotterdam was published in 2004, sounding a cautionary, albeit non-alarmist, note.1 In 2005, a prospective observational cohort study of… View more

Intervention
Author(s): Paul A Gurbel , David Kandzari Added: 3 years ago
The rare but catastrophic occurrence of stent thrombosis, in particular 'late' stent thrombosis, in association with deployment of drug-eluting stents has focused attention on the adequacy of the current dual anti-platelet regimen of aspirin and clopidogrel. Stent thrombosis is due to multiple factors. These include, specific stent features (delayed healing or polymer hypersensitivity),… View more

Anticoagulation

MI/ACS
Author(s): Jacques Machecourt Added: 3 years ago
Drug-eluting stents (DES) have been recognised as a ‘breakthrough technology’ since 2003 due to their unique capacity to reduce clinical restenosis. The difference in restenosis rates, as assessed by angiography, was so large between DES and bare-metal stents (BMS) in the first trials – 0% versus 26% after six months in the first published trial (RAVEL) with the sirolimus-eluting stent (SES),1… View more

Anticoagulation

Intervention
Author(s): Giora Weisz Added: 3 years ago
Much has been written, but little is known, about the long-term outcomes after drug-eluting stent (DES). The introduction of DES has extended the use of stents from a passive platform for vessel wall scaffolding to an active biotechnology vehicle for local delivery of antiproliferative pharmacotherapy. Like any other therapy or medical technology, no treatment is perfect and free of potential… View more

Intervention
Author(s): Christian Spaulding Added: 3 years ago
Currently, the optimal treatment of acute myocardial infarction (AMI) in patients presenting with ST-segment-elevation MI (STEMI) is to perform a primary percutaneous coronary intervention (PCI) as quickly as possible after onset of symptoms.1,2 While this has become the standard of care for treating AMI, several factors, including limited availability of catheterisation laboratories in a… View more

MI/ACS

Intervention
Author(s): Walter Desmet Added: 3 years ago
Since its introduction in 1977, the long-term benefits of percutaneous coronary intervention have been limited by the phenomenon of restenosis, i.e. the recurrence of significant stenosis at the site of intervention. While in restenosis after plain balloon angioplasty roughly two-thirds of the late lumen loss is due to negative vessel wall remodelling, the late lumen loss after stent implantation… View more

Intervention
Author(s): Simon Kennon Added: 3 years ago
Reports of late stent thrombosis following percutaneous coronary intervention (PCI) with drug-eluting stents started to emerge in 2005 and 2006, causing widespread alarm and a substantial reduction in their use.1,2 Research-led advances in pharmacology and stent design have done much to allay this alarm, but nevertheless late stent thrombosis (LST) remains a concern for coronary interventionists… View more

Vascular Disease and Surgery

Intervention
Author(s): Donald E Cutlip Added: 3 years ago
Stent thrombosis has been recognized as a serious complication of coronary stent placement since the procedure was first reported in the 1980s.1 Subsequent aggressive peri-procedural anti-thrombotic strategies with inpatient transition to warfarin reduced the risk to about 3.5 % for subacute (30-day) stent thrombosis,2,3 a rate that would be unacceptable by current standards and did not account… View more

Prevention & Chronic Conditions

Intervention