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Local delivery of glycoprotein IIb/IIIa receptor inhibitors using drug eluting stents. 使用药物洗脱支架局部递送糖蛋白IIb/IIIa受体抑制剂。
Seminars in interventional cardiology : SIIC Pub Date : 1998-09-01
A H Gershlick
{"title":"Local delivery of glycoprotein IIb/IIIa receptor inhibitors using drug eluting stents.","authors":"A H Gershlick","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":79534,"journal":{"name":"Seminars in interventional cardiology : SIIC","volume":"3 3-4","pages":"185-90"},"PeriodicalIF":0.0,"publicationDate":"1998-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21274155","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Anti-inflammatory stent coatings: dexamethasone and related compounds. 抗炎支架涂层:地塞米松及相关化合物。
Seminars in interventional cardiology : SIIC Pub Date : 1998-09-01
S H Park, A M Lincoff
{"title":"Anti-inflammatory stent coatings: dexamethasone and related compounds.","authors":"S H Park,&nbsp;A M Lincoff","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>The dexamethasone-eluting stent was a well-tolerated and effective means of providing sustained site-specific drug delivery to the porcine coronary artery wall for 28 days, although longer-term biocompatibility of the polymer coating was not assessed. Dexamethasone did not reduce the neointimal hyperplastic response to injury, despite sustained tissue levels of drug.</p>","PeriodicalId":79534,"journal":{"name":"Seminars in interventional cardiology : SIIC","volume":"3 3-4","pages":"191-5"},"PeriodicalIF":0.0,"publicationDate":"1998-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21274160","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Plaque removal prior to stent implantation in native coronary arteries: why? When? And how? 原生冠状动脉支架植入前的斑块清除:为什么?什么时候?以及如何?
Seminars in interventional cardiology : SIIC Pub Date : 1998-06-01
I Moussa, C Di Mario, A Colombo
{"title":"Plaque removal prior to stent implantation in native coronary arteries: why? When? And how?","authors":"I Moussa,&nbsp;C Di Mario,&nbsp;A Colombo","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Coronary stenting has significantly reduced restenosis in focal de novo coronary lesions, but its impact in complex lesions has been less pronounced. Recent data suggest a possible role for pre-intervention plaque burden in exacerbating neo-intimal hyperplasia after stent implantation. These observations formed the basis for the hypothesis that plaque removal prior to stent implantation, using directional atherectomy in non-calcified lesions and rotational atherectomy in calcified lesions, may reduce restenosis. The currently available non-randomized experience that used this approach has shown its feasibility and favourable long-term outcome when applied in selected patients. However, the incidence of non-Q-wave myocardial infarction is increased with both rotational and directional atherectomy compared to PTCA or stent alone. The utilization of potent antiplatelet agents and/or the development of new atherectomy devices that produce lower embolization rate may decrease the incidence of these ischaemic complications. In addition, considering the increased procedural time and cost, this approach will have to be applied in selected patient subsets where debulking or stenting as a stand-alone strategy is associated with a high restenosis rate. Randomized clinical trials testing the usefulness of this approach, with both rotational and directional atherectomy, are currently in progress.</p>","PeriodicalId":79534,"journal":{"name":"Seminars in interventional cardiology : SIIC","volume":"3 2","pages":"57-63"},"PeriodicalIF":0.0,"publicationDate":"1998-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21083476","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Bifurcational stenting. 分歧支架。
Seminars in interventional cardiology : SIIC Pub Date : 1998-06-01
C Di Mario, F Airoldi, B Reimers, A Anzuini, A Vilas Dharmadhikari, A Colombo
{"title":"Bifurcational stenting.","authors":"C Di Mario,&nbsp;F Airoldi,&nbsp;B Reimers,&nbsp;A Anzuini,&nbsp;A Vilas Dharmadhikari,&nbsp;A Colombo","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Treatment of bifurcation lesions is a complex issue, and there is no single panacea to the variety of lesions that form this cohort. The contribution of side-branch compromise to the adverse clinical events occurring after stent implantation need not be stressed and requires an aggressive approach including balloon dilatation before and after stent deployment. Various new techniques of kissing stent placement, such as the 'T', 'V', 'Y', and the culottes technique, have been proposed in recent years to treat different anatomical situations. The angle formed by the side-branches, the severity of involvement of the ostia and the vessel size are the main factors which influence selection of the strategy. Newer generations of stents, such as the bifurcate stents, tailor-made for bifurcation lesions, are evolving, and are expected to make a positive impact on the procedural outcomes and long-term results after bifurcation stenting. The development of new strategies and stent designs has greatly improved safety and immediate outcome of bifurcational stenting, but the procedural success still needs to be matched by an equal improvement in long-term patency.</p>","PeriodicalId":79534,"journal":{"name":"Seminars in interventional cardiology : SIIC","volume":"3 2","pages":"65-76"},"PeriodicalIF":0.0,"publicationDate":"1998-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21083477","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Prevention of in-stent restenosis. 预防支架内再狭窄。
Seminars in interventional cardiology : SIIC Pub Date : 1998-06-01
C R Narins, S G Ellis
{"title":"Prevention of in-stent restenosis.","authors":"C R Narins,&nbsp;S G Ellis","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Despite the favourable impact of stent implantation on restenosis rates for selected lesion types, in-stent restenosis remains a commonly encountered and difficult to manage entity. Histologically, in-stent restenosis appears to derive almost exclusively from neointimal hyperplasia, which appears to be more abundant following stent implantation than balloon angioplasty. The most powerful predictors of in-stent restenosis include the presence of diabetes, greater lesion length, small vessel caliber, and inadequate stent expansion. Several strategies have been proposed as a means to reduce the incidence of in-stent restenosis. Perhaps the most important among these relates to a strategy of provisional stent use, whereby stenting is undertaken only if suboptimal results are achieved following balloon angioplasty. Recent data from the EPILOG and EPILOG-stent trials suggest that the use of IIb/IIIa receptor antagonists may enhance the strategy of provisional stenting. When stents are used, adequate deployment is essential. The ability of adjunct IVUS imaging to guide proper balloon sizing during stent implantation and consequently reduce the risk of restenosis is currently the subject of randomized trials. Based on preliminary study results, intravascular radiation appears to hold great potential as a means to inhibit neointimal hyperplasia and consequently reduce the occurrence of in-stent restenosis, and large scale safety and efficacy trials are in progress. Other pharmacologic- and device-oriented strategies are likewise undergoing evaluation. In conclusion, while the availability of coronary stents has without question improved the safety and efficacy of coronary angioplasty, it remains critical that we continue to determine in an objective manner how and when best to use these devices.</p>","PeriodicalId":79534,"journal":{"name":"Seminars in interventional cardiology : SIIC","volume":"3 2","pages":"91-103"},"PeriodicalIF":0.0,"publicationDate":"1998-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21083480","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Stenting in acute myocardial infarction. 急性心肌梗死支架植入术。
Seminars in interventional cardiology : SIIC Pub Date : 1998-06-01
M C Morice, T Lefèvre, Y Louvard, P Dumas, C Loubeyre
{"title":"Stenting in acute myocardial infarction.","authors":"M C Morice,&nbsp;T Lefèvre,&nbsp;Y Louvard,&nbsp;P Dumas,&nbsp;C Loubeyre","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>The limitations (recurrent ischaemia, restenosis, reocclusion) of percutaneous transluminal coronary angioplasty (PTCA) in acute myocardial infarction (MI) can be addressed by stenting. The preliminary results of stenting are favourable (Stent PAMI, STENTIM, ZWOLLE trials). We report the results of the ICPS registry including 519 patients directly treated with angioplasty and stenting at the acute phase of myocardial infarction, with a repeat MI rate of 1% and a mortality of 3.7% in the non-shock group.</p>","PeriodicalId":79534,"journal":{"name":"Seminars in interventional cardiology : SIIC","volume":"3 2","pages":"77-80"},"PeriodicalIF":0.0,"publicationDate":"1998-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21083478","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Radioactive stents. 放射性支架。
Seminars in interventional cardiology : SIIC Pub Date : 1998-06-01
T A Fischell
{"title":"Radioactive stents.","authors":"T A Fischell","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Intracoronary stenting has improved catheter-based revascularization of obstructive coronary artery disease. Despite the improved outcomes with stenting, restenosis still occurs at an unacceptable rate, particularly in smaller vessels and in longer lesions. In this article, we review the concept of using a stent implanted with low activities of radioisotope as a means to inhibit the proliferative process that is believed to initiate in-stent restenosis. This approach has been shown to be effective in certain animal models of restenosis. The initial clinical results with the phase-1 safety trials are summarized. The early clinical results with more than 200 implants of low activity 32P Palmaz-Schatz and BX radioactive stents have demonstrated excellent procedural and 30-day event-free survival. Further dose-finding safety trials are anticipated in 1998 and 1999. A large scale randomized clinical trial will commence if and when early safety and efficacy data suggest a therapeutic effect from this technology.</p>","PeriodicalId":79534,"journal":{"name":"Seminars in interventional cardiology : SIIC","volume":"3 2","pages":"51-6"},"PeriodicalIF":0.0,"publicationDate":"1998-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21083475","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Glycoprotein IIb/IIIa receptor blockade with coronary stent placement. 糖蛋白IIb/IIIa受体阻断与冠状动脉支架置入。
Seminars in interventional cardiology : SIIC Pub Date : 1998-06-01
F J Neumann, A Schömig
{"title":"Glycoprotein IIb/IIIa receptor blockade with coronary stent placement.","authors":"F J Neumann,&nbsp;A Schömig","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>GP IIb/IIIa blockade for stenting offers almost complete inhibition of platelet aggregation and can bridge the delayed onset of action of ticlopidine. In the EPISTENT trial, GP IIb/IIIa blockade with abciximab reduced the 30-day cardiac event rate after stenting by more than 50% compared to placebo. Economic constraints may demand to restrict the use of GP IIb/IIIa blockade to subgroups that benefit most. Bail-out stenting constitutes one of these subgroups. Another group are patients with acute myocardial infarction. Moreover, the exquisitely high risk of residual dissection after stenting suggests to always employ GP IIb/IIIa blockade in this instance.</p>","PeriodicalId":79534,"journal":{"name":"Seminars in interventional cardiology : SIIC","volume":"3 2","pages":"81-90"},"PeriodicalIF":0.0,"publicationDate":"1998-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21083479","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Cervical carotid artery stent placement. 颈动脉支架置入术。
Seminars in interventional cardiology : SIIC Pub Date : 1998-06-01
M H Wholey, M H Wholey, G Eles
{"title":"Cervical carotid artery stent placement.","authors":"M H Wholey,&nbsp;M H Wholey,&nbsp;G Eles","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>This article reviews the clinical application and early results of cervical carotid artery stent placement. Patient preparation, techniques in stent delivery and post care treatment performed at Pittsburgh Vascular Institute are discussed. Experiences of a multicentre study obtained from an international survey is revealed. A total of 3129 carotid stent procedures have been performed worldwide to date, with a technical success rate of 98.8%. Complications during placement or within a 30-day period of placement included 74 (2.4%) transient ischemic insults, 78 (2.49%) minor strokes, 43 (1.37%) major strokes and 30 (0.96%) procedure-related deaths. Restenosis rates at 6 months was 2.3%. Post-procedure neurologic sequelae occurred in 14 (0.79%) of cases. Carotid artery stent placement is growing as an alternative for endarterectomy, especially for patients with high surgical risk. The periprocedural risks for death and minor and major stroke are generally acceptable at this early stage of development.</p>","PeriodicalId":79534,"journal":{"name":"Seminars in interventional cardiology : SIIC","volume":"3 2","pages":"105-15"},"PeriodicalIF":0.0,"publicationDate":"1998-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21083481","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Treatment of in-stent restenosis. 支架内再狭窄的治疗。
Seminars in interventional cardiology : SIIC Pub Date : 1998-06-01
G S Mintz, R Mehran, R Waksman, A D Pichard, K M Kent, L F Satler, M B Leon
{"title":"Treatment of in-stent restenosis.","authors":"G S Mintz,&nbsp;R Mehran,&nbsp;R Waksman,&nbsp;A D Pichard,&nbsp;K M Kent,&nbsp;L F Satler,&nbsp;M B Leon","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Although in-stent restenosis is the result of neointimal hyperplasia, mechanical problems (e.g. stent underexpansion) that occurred during implantation may result in restenosis at follow-up. The treatment of in-stent restenosis, begins with identification of these occult mechanical problems. Thereafter, in-stent restenosis can be treated with PTCA, atheroablation, or additional stent implantation; it is nuclear which technique is superior. Not all in-stent restenosis lesions have a similar risk of recurrence. Recurrence appears to depend on several markers of biologic activity: focal vs diffuse in-stent restenosis, the first episode vs recurrent in-stent restenosis, and early vs late recurrence. Vascular brachytherapy has emerged as the most promising way to treat high-risk lesion subsets.</p>","PeriodicalId":79534,"journal":{"name":"Seminars in interventional cardiology : SIIC","volume":"3 2","pages":"117-21"},"PeriodicalIF":0.0,"publicationDate":"1998-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21083482","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
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