Interaction Between Guiding-Extension Catheter and Drug-Eluting Stents: Always Safe or Sometimes Harmful?

Salvatore Colangelo, Riccardo Mangione, Mario Iannaccone, Francesco Colombo, Giacomo Giovanni Boccuzzi
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Abstract

Background: Guiding-extension catheters (GECs) provide enhanced support to guiding catheter (GC) during complex percutaneous coronary intervention (PCI). However, by reducing the inner cross-sectional diameter, they can create high friction between the GEC and the drug-eluting stents (DES), potentially causing abrasion and damage to the abluminal struts.

Aim: This study aims to compare the performances of the Amphilimus Cre8 EVO polymer-free DES with all the other surface-coated DES. The abluminal grooves of this polymer-free DES, which contain the drug and avoid any risk of its abrasion and detachment (abluminal reservoir technology), may offer a protective effect during stent advancement within the GEC.

Methods: Between January 2019 and April 2024, 218 patients who underwent complex PCI procedures with the insertion of a DES and the use of GEC were enrolled in the study. They were divided into Group A (39 patients) received the Amphilimus polymer-free DES, while Group B (179 patients) received other types of DES. To evaluate the efficacy and safety of the DES used, a device-oriented composite endpoint (DoCE) was assessed at one year of follow-up. This composite endpoint included Cardiovascular Death, Target Vessel Myocardial Infarction, and Clinically and Physiologically indicated Target Lesion Revascularization.

Results: At the one-year follow-up, the primary endpoint demonstrated a statistically significant difference between the two groups. Event-free survival from DoCE was 97.4% in Group A compared to 85.5% in Group B (Log rank = 0.027). Additionally, there was a significant difference in mean stent length between the groups: Group A had a longer mean stent length of 52.4 ± 38.6 mm, while Group B had a mean length of 40.4 ± 22.6 mm, with a p-value of 0.01. All other clinical and procedural variables were similar between the two groups.

Conclusion: Our findings suggest that the polymer-free DES tested in this study appears to be the most effective option when using GECs, as it may help prevent negative interactions between the inner surface of GEC and the abluminal struts of the DES.

引导延伸导管与药物洗脱支架的相互作用:总是安全的还是有时有害的?
背景:在复杂的经皮冠状动脉介入治疗(PCI)中,引导延伸导管(GECs)为引导导管(GC)提供了增强的支持。然而,通过减小内部横截面直径,它们可以在GEC和药物洗脱支架(DES)之间产生高摩擦,可能导致腔柱的磨损和损坏。目的:本研究旨在比较Amphilimus Cre8 EVO无聚合物DES与所有其他表面包被DES的性能。这种无聚合物DES的腔槽含有药物,避免了任何磨损和脱离的风险(腔槽技术),可能在支架在GEC内推进过程中提供保护作用。方法:在2019年1月至2024年4月期间,218名患者接受了复杂的PCI手术,并插入DES和使用GEC。他们被分为A组(39例患者)接受无Amphilimus聚合物DES,而B组(179例患者)接受其他类型DES。为了评估所使用DES的有效性和安全性,在一年的随访中评估了器械导向的复合终点(DoCE)。该复合终点包括心血管死亡、靶血管心肌梗死以及临床和生理学指示的靶病变血运重建术。结果:在一年的随访中,两组的主要终点显示有统计学意义的差异。A组的DoCE无事件生存率为97.4%,B组为85.5% (Log rank = 0.027)。此外,两组平均支架长度差异有统计学意义:a组平均支架长度为52.4±38.6 mm, B组平均支架长度为40.4±22.6 mm, p值为0.01。所有其他临床和程序变量在两组之间相似。结论:我们的研究结果表明,本研究中测试的无聚合物DES似乎是使用GEC时最有效的选择,因为它可能有助于防止GEC内表面与DES的腔柱之间的负相互作用。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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