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Long-term outcomes of titanium-nitride-oxide coated stents and drug-eluting stents in acute coronary syndrome:A systematic review and meta-analysis

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World Journal of Cardiology 2024年第5期16卷 293-305页

作者： Muhammad Ahmed Ali Fahim Afia Salman Hira Anas Khan Syed Muhammad Hasan Muskan FatimaBhojani Sarah Aslam Amna Zia Ul Haq Vishal Reddy Bejugam Beena Muntaha Nasir Wajiha Gul Abdul Moeed Abdelrahman S Abdalla Muhammad Majid Muhammad Sohaib Asghar Md Al Hasibuzzaman Department of Internal Medicine Dow University of Health SciencesKarachi 74200Pakistan Department of Internal Medicine North Central Bronx HospitalBronxNY 10467United States Department of Urology Center for Academic MedicineStanford University School of MedicinePalo AltoCA 33872United States Department of Cardiovascular Imaging Cleveland ClinicClevelandOH 44195United States Division of Nephrology and Hypertension Mayo Clinic RochesterRochesterMN 55905United States Institute of Nutrition and Food Science University of DhakaDhaka 1000Bangladesh

BACKGROUND In severe cases of coronary artery disease,percutaneous coronary intervention provide promising results.The stent used could be a drug-eluting stent(DES)or a titanium-nitride-oxide coated stent(TiNOS).AIM To compare the 5-year effectiveness and safety of the two stent types.METHODS The following systematic review and meta-analysis was conducted in accordance with the preferred reporting items for systematic reviews and meta-analysis guidelines,and PubMed/MEDLINE,Scopus,and Cochrane Central were searched from inception till August 2023.Primary outcomes were major adverse cardiac events(MACE),cardiac death,myocardial infarction(MI),cardiac death or MI,and ischemia-driven total lesion revascularization(ID-TLR).RESULTS Four randomized controlled trials(RCT),which analyzed a sum total of 3045 patients with acute coronary syndrome(ACS)after a median follow-up time of 5 years were included.Though statistically insignificant,an increase in the ID-TLR was observed in patients receiving TiNOSs vs DESs.In addition,MI,cardiac death and MI,and definite stent thrombosis(DST)were significantly decreased in the TiNOS arm.Baseline analysis revealed no significant results with meta-regression presenting non-ST elevated MI(NSTEMI)as a statistically significant covariate in the outcome of MACE.CONCLUSION TiNOS was found to be superior to DES in terms of MI,cardiac death or MI,and DST outcomes,however,the effect of the two stent types on ID-TLR and MACE was not significant.A greater number of studies are required to establish an accurate comparison of patient outcomes in TiNOS and DES.

关键词： Stents drug-eluting Major adverse cardiac events All-cause death Meta-analysis

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Comparison of the Efficacy of drug-eluting Stents Versus Bare-metal Stents for the Treatment of Left Main Coronary Artery Disease

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Chinese Medical Journal 2015年第6期128卷 721-726页

作者： Xiao-ZengWang Kai Xu Yi Li Quan-Min Jing Hai-Wei Liu Xin Zhao Geng Wang Bin Wang Ying-Yan Ma Shao-Liang Chen Ya-Ling Han Department of Cardiology General Hospital of Shenyang Military Region Shenyang Liaoning 110840 China Department of Cardiorogy Nanjing First Hospital Affiliated to Nanjing Medical University Nanjing Jiangsu 210006 China

treatment of left main coronary artery （LMCA） disease in select patients. However, it is unclear whether drug-eluting stents （DESs） have better outcomes in patients with LMCA disease compared with bare-metal stent （BMS） during long-term follow-up in Chinese populations. Methods： From a perspective multicenter registry, 1136 consecutive patients, who underwent BMS or DES implantation for unprotected LMCA stenosis, were divided into two groups： 1007 underwent DES implantation, and 129 underwent BMS implantation. The primary outcome was the rate of major adverse cardiac events （MACEs）, including cardiovascular （CV） death, myocardial infarction （MI）, and target lesion revascularization （TLR） at 5 years postimplantation. Results： Patients in the DES group were older and more likely to have hyperlipidemia and bifurcation lesions. They had smaller vessels and longer lesions than patients in the BMS group. In the adjusted cohort of patients, the DES group had significantly lower 5 years rates of MACE （19.4% vs. 31.8%, P = 0.022）, CV death （7.0% vs. 14.7%, P = 0.045）, and MI （5.4% vs. 12.4%, P = 0.049） than the BMS group. There were no significant differences in the rate of TLR （10.9% vs. 17.8%, P = 0.110） and stent thrombosis （4.7% vs. 3.9%, P = 0.758）. The rates of MACE （80.6% vs. 68.2%, P = 0.023）, CV death （93.0% vs. 85.3%, P - 0.045）, TLR （84.5% vs. 72.1%, P = 0.014）, and MI （89.9% vs. 80.6%, P = 0.029） free survival were significantly higher in the DES group than in the BMS group. When the propensity score was included as a covariate in the Cox model, the adjusted hazard ratios for the risk of CV death and M1 were 0.41 （95% confidence interval [C/l： 0.21-0.63, P = 0.029） and 0.29 （95% CI： 0.08-0.92, P = 0.037）, respectively. Conelusions： DES implantation was associated with more favorable clinical outcomes than BMS implantation for the treatment of LMCA disease even though there was no significant difference in the rate of TLR between the two groups.

关键词： Bare-metal Stent drug-eluting Stent Left Main Coronary Artery Disease Percutaneous Coronary Intervention

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drug-eluting balloons versus new generation drug-eluting stents for the management of in-stent restenosis: an updated meta-analysis of randomized studies

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Journal of Geriatric Cardiology 2019年第6期16卷 448-457页

作者： Lei GAO Ya-Bin WANG Jing JING Ming ZHANG Yun-Dai CHEN Department of Cardiology Chinese PLA General Hospital

Background New-generation drug-eluting stents (DES) was more effective in the treatment of in-stent restenosis (ISR) compared with the first-generation DES. drug-eluting balloons (DEB) and new-generation DES had been available strategies in treatment of bare-metal stents/DES ISR (BMS/DES-ISR). Six new randomized trials have recently examined the angiographic outcomes and one-year clinical outcomes of DEB and new generation DES in BMS/DES-ISR. However, the optimal management for BMS/DES-ISR lesions remains controversial. Methods We searched the randomized clinical trials evaluating the angiographic outcomes and one-year clinical outcomes of DEB and new-generation DES in patients with BMS/DES-ISR. The primary endpoints were the angiographic outcomes, including the minimal luminal diameter (MLD), diameter stenosis %(DS%), late lumen loss (LLL), and binary restenosis (BR). Results A total of six randomized clinical trials with 1177 BMS/DES-ISR patients were included in our meta-analysis. For angiographic outcomes, there were significantly less MLD and more DS% with DEB compared to new-generation DES (MLD: MD =?0.18, 95% CI:?0.31– ?0.04, P < 0.001;DS%: MD = 5.68, 95% CI: 1.00–10.37, P < 0.001). Moreover, for one-year clinical outcomes, DEB was associated with a significant increase risk in target lesion revascularization (TLR)(RR = 2.93, 95% CI: 1.50–5.72, P = 0.002). However, DEB was associated with higher risks of major adverse cardiac event, target vessel revascularization, TLR, BR, and more DS% only in DES-ISR group. Conclusions DEB and new-generation DES have the similar clinical efficacy for the treatment of BMS-ISR. However, DES showed more MLD, less DS%, and a decreased risk of TLR for the treatment of DES-ISR.

关键词： drug-eluting balloons drug-eluting stents In-stent restenosis Meta-analysis

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Five-year clinical outcomes of first-generation versus second-generation drug-eluting stents following coronary chronic total occlusion intervention

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Journal of Geriatric Cardiology 2019年第8期16卷 639-647页

作者： Yong Hoon Kim Ae-Young Her Seung-Woon Rha Byoung Geol Choi Se Yeon Choi Jae Kyeong Byun Yoonjee Park Dong Oh Kang Won Young Jang Woohyeun Kim Ju Yeol Baek Woong Gil Choi Tae Soo Kang Jihun Ahn Sang-Ho Park Ji Young Park Min-Ho Lee Cheol Ung Choi Chang Gyu Park Hong Seog Seo Division of Cardiology Department of Internal MedicineKangwon National University School of MedicineChuncheonSouth Korea Department of Cardiology Soonchunhyang University College of MedicineSeoulSouth Korea Cardiovascular Center Korea University Guro HospitalSeoulSouth Korea Department of Medicine Korea University Graduate SchoolSeoulSouth Korea Cardiovascular Center Seoul St. Mary’s Hospitalthe Catholic University of KoreaSeoulSouth Korea Cardiology Department Konkuk University Chungju HospitalChungjuSouth Korea Department of Internal Medicine Cardiovascular DivisionDankook University HospitalCheonanSouth Korea Department of Cardiology Soonchunhyang University Gumi HospitalGumiSouth Korea Cardiology Department Soonchunhyang University Cheonan HospitalCheonanSouth Korea Division of Cardiology Department of Internal MedicineCardiovascular CenterNowon Eulji Medical CenterEulji UniversitySeoulSouth Korea

Background There are limited data comparing long-term clinical outcomes between first-generation (1G) and second-generation (2G) drug-eluting stents (DESs) in patients who underwent successful percutaneous coronary intervention (PCI) for coronary chronic total occlusion (CTO) lesion. Methods A total of 840 consecutive patients who underwent PCI with DESs for CTO lesion from January 2004 to November 2015 were enrolled. Finally, a total of 324 eligible CTO patients received 1G-DES (Paclitaxel-eluting stent or Sirolimus-eluting stent, n = 157) or 2G-DES (Zotarolimus-eluting stent or Everolimus-eluting stent, n = 167) were enrolled. The clinical endpoint was the occurrence of major adverse cardiac events (MACE) defined as all-cause death, recurrent myocardial infarction (re-MI), total repeat revascularization [target lesion revascularization (TLR), target vessel revascularization (TVR), and non-TVR]. We investigated the 5-year major clinical outcomes between 1G-DES and 2G-DES in patient who underwent successful CTO PCI. Results After propensity score matched (PSM) analysis, two well-balanced groups (111 pairs, n = 222, C-statistic = 0.718) were generated. Up to the 5-year follow-up period, the cumulative incidence of all-cause death, re-MI, TLR, TVR and non-TVR were not significantly different between the two groups. Finally, MACE was also similar between the two groups (HR = 1.557, 95% CI: 0.820–2.959, P = 0.176) after PSM. Conclusions In this study, 2G-DES was not associated with reduced long-term MACE compared with 1G-DES following successful CTO revascularization up to five years.

关键词： Chronic total occlusion drug-eluting stent Outcomes

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drug-eluting fully covered self-expanding metal stent for dissolution of bile duct stones in vitro

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World Journal of Gastroenterology 2019年第26期25卷 3370-3379页

作者： Chao Huang Xiao-Bo Cai Li-Li Guo Xiao-Sheng Qi Qiang Gao Xin-Jian Wan Department of Gastroenterology Shanghai General HospitalShanghai Jiaotong University School of MedicineShanghai 201620China Shanghai Key Laboratory for Pancreatic Diseases Shanghai General HospitalShanghai Jiaotong University School of MedicineShanghai 201620China Department of General Surgery Shanghai General HospitalShanghai Jiaotong University School of MedicineShanghai 201620China State Key Laboratory for Modification of Chemical Fibers and Polymer Materials College of ChemistryChemical Engineering and BiotechnologyDonghua UniversityShanghai 201620China

BACKGROUND The treatment of difficult common bile duct stones(CBDS)remains a big challenge around the world.Biliary stenting is a widely accepted rescue method in patients with failed stone extraction under endoscopic retrograde cholangiopancreatography.Fully covered self-expanding metal stent(FCSEMS)has gained increasing attention in the management of difficult CBDS.AIM To manufacture a drug-eluting FCSEMS,which can achieve controlled release of stone-dissolving agents and speed up the dissolution of CBDS.METHODS Customized covered nitinol stents were adopted.Sodium cholate(SC)and disodium ethylene diamine tetraacetic acid(EDTA disodium,EDTA for short)were used as stone-dissolving agents.Three different types of drug-eluting stents were manufactured by dip coating(Stent I),coaxial electrospinning(Stent II),and dip coating combined with electrospinning(Stent III),respectively.The drugrelease behavior and stone-dissolving efficacy of these stents were evaluated in vitro to sort out the best manufacturing method.And the selected stonedissolving stents were further put into porcine CBD to evaluate their biosecurity.RESULTS Stent I and Stent II had obvious burst release of drugs in the first 5 d while Stent III presented controlled and sustainable drug release for 30 d.In still buffer,the final stone mass-loss rate of each group was 5.19%±0.69%for naked FCSEMS,20.37%±2.13%for Stent I,24.57%±1.45%for Stent II,and 33.72%±0.67%for Stent III.In flowing bile,the final stone mass-loss rate of each group was 5.87%±0.25%for naked FCSEMS,6.36%±0.48%for Stent I,6.38%±0.37%for Stent II,and 8.15%±0.27%for Stent III.Stent III caused the most stone mass-loss no matter in still buffer or in flowing bile,which was significantly higher than those of other groups(P0.05)and histopathological examination(P>0.05).CONCLUSION The novel SC and EDTA-eluting FCSEMS is efficient in diminishing CBDS in vitro.When conventional endoscopic techniques fail to re

关键词： Common bile duct stone drug-eluting stent Fully covered self-expanding metal stent Electrospinning Nanofiber film

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Efficacy of intra-arterial contrast-enhanced ultrasonography during transarterial chemoembolization with drug-eluting beads for hepatocellular carcinoma

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World Journal of Hepatology 2018年第1期10卷 95-104页

作者： Kazue Shiozawa Manabu Watanabe Takashi Ikehara Shuhei Yamamoto Takashi Matsui Yoshinori Saigusa Yoshinori Igarashi Iruru Maetani Division of Gastroenterology and Hepatology Department of Internal Medicine Toho University Medical Center Ohashi Hospital Division of Gastroenterology and Hepatology Department of Internal Medicine Toho University Medical Center Omori Hospital

AIM To assess the usefulness of intra-arterial contrastenhanced ultrasonography(IAUS) during transarterial chemoembolization(TACE) with drug-eluting beads(DEB) for hepatocellular carcinoma(HCC).METHODS Thirty two patients with 39 HCC underwent DEB-TACE guided with IAUS, and examined by contrast-enhanced ultrasonography(CEUS) or dynamic CT after DEB-TACE were enrolled in this study. CEUS findings before DEBTACE and IAUS findings were compared. Treatments judged to be complete and incomplete for lesions were appropriate and insufficient, respectively. Findings on CEUS and/or dynamic CT performed 1, 3 and 6 mo after DEB-TACE were evaluated using m RECIST(CR/PR/SD/PD).RESULTS The treatments were complete and incomplete in 26 and 13 lesions, respectively. On imaging evaluation using CEUS and/or dynamic CT one month after treatment, 25 and 1 lesions were judged to be CR and PR, respectively, and at 6 mo after treatment, the results were CR, PR, SD and PD for 24, 1, 0 and 1 of these lesions, respectively, in the 26 completely treated lesions. Of the 13 lesions in which treatment was incomplete, the results on imaging at one month after treatment were CR, PR, SD and PD for 0, 6, 4 and 3 lesions, respectively. The overall CR rate at 6 mo after treatment was 61.5%(24/39).CONCLUSION A combination of DEB-TACE with IAUS can improve the therapeutic effects in patients with HCC.

关键词： Hepatocellular carcinoma Contrast-enhanced ultrasonography drug-eluting beads Transarterial chemoembolization Intra-arterial contrast-enhanced ultrasonography

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Optimizing the Duration of Dual Antiplatelet Therapy After Implantation of drug-eluting Coronary Stents

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Chinese Medical Journal 2015年第6期128卷 711-713页

作者： Ying Shen Wei-Feng Shen Department of Cardiology Ruijin Hospital Shanghai Jiaotong University School of Medicine Shanghai 200025 China

Percutaneous coronary intervention （PCI） with implantation of drug-eluting stents （DESs） has become the standard of care for coronary artery disease and gives a great impetus to device industry. In 2013, approximately half million patients with coronary artery disease underwent PCI in China with a penetration rate of DES reaching beyond 95%.131 The use of DES including domestic ones is highly effective in preventing coronary restenosis, but there is a collateral cost to be borne in terms of delayed healing or re-endothelialization of the stented arterial segment and risk of stent thrombosisJ41 Therefore.

关键词： Dual Antiplatelet Therapy Percutaneous Coronary Intervention drug-eluting Coronary Stents

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Efficacy of Short-term Dual Antiplatelet Therapy after Implantation of Second-generation drug-eluting Stents:A Meta-analysis and Systematic Review

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Chinese Medical Sciences Journal 2017年第1期32卷 1-12页

作者： Peisen Huang Yuan Yu Xikun Han Yuejin Yang State Key Laboratory of Cardiovascular Disease Fuwai HospitalNational Center for Cardiovascular Diseases Chinese Academy of Medical Sciences & Peking Union Medical College Beijing 100037 China National Clinical Research Center of Cardiovascular Diseases Fuwai HospitalNational Center for Cardiovascular Diseases Chinese Academy of Medical Sciences & Peking Union Medical College Beijing 100037 China

Objective The benefit of short-term dual antiplatelet therapy(DAPT) following second-generation drug-eluting stents implantation has not been systematically evaluated. To bridge the knowledge gap,we did a meta-analysis to assess the efficacy of ≤6 months versus ≥12 months DAPT among patients with second-generation drug-eluting stents. Methods We searched online databases and identified randomized controlled trials that assess the clinical impact of short-term DAPT(≤6 months) published before March 3,2016. The efficacy endpoints included the incidence of all-cause death,myocardial infarction,cerebrovascular accidents,and definite or probable stent thrombosis. Safety endpoint defined as major bleeding was also evaluated and discussed. Results We included 5 trials that randomized 9473 participants(49.8%,short-term DAPT duration vs. 50.2%,standard duration). A total of 9445(99.7%) patients reported the efficacy endpoints,and the safety endpoint was available from 4 studies(n=8457). There was no significant difference in efficacy endpoints between short-term and standard DAPT duration(≥12 months) [risk ratio(RR) 0.96; 95% confidence intervals(CI),0.80-1.15]. Short-term DAPT duration did not significantly increase the individual risk of all-cause death,myocardial infarction,cerebrovascular accidents,or definite or probable stent thrombosis. Although short-term DAPT obviously reduced risk of major bleeding compared with standard DAPT(RR 0.53; 95% CI,0.29-0.96),significant publication bias was found when accessing the safety endpoint of the 4 studies(Egger's test,P=0.009). Conclusions The efficacy of short-term DAPT was comparable with that of standard duration DAPT.DAPT less than 6 months may be appropriate for patients receiving second-generation drug-eluting stents implantation.

关键词： meta-analysis drug-eluting stents dual antiplatelet therapy percutaneous coronary intervention efficacy

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Extravascular use of drug-eluting beads: A promising approach in compartment-based tumor therapy

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World Journal of Gastroenterology 2013年第43期19卷 7586-7593页

作者： Simon Binder Andrew L Lewis J-Matthias Lhr Michael Keese Faculty of Medicine Mannheim University of Heidelberg68167 MannheimGermany Biocompatibles UK Ltd. Department for Research and DevelopmentFarnham GU98QL SurreyUnited Kingdom Karolinska Institute Department of Clinical ScienceIntervention and Technology17177 StockholmSweden Clinic for Vascular and Endovascular Surgery University Hospital Frankfurt60590 Frankfurt am MainGermany

Intraperitoneal carcinomatosis(PC)may occur with several tumor entities.The prognosis of patients suffering from PC is usually poor.Present treatment depends on the cancer entity and includes systemic chemotherapy,radiation therapy,hormonal therapy and surgical resection.Only few patients may also benefit from hyperthermic intraperitoneal chemotherapy with a complete tumor remission.These therapies are often accompanied by severe systemic side-effects.One approach to reduce side effects is to target chemotherapeutic agents to the tumor with carrier devices.Promising experimental results have been achieved using drug-eluting beads(DEBs).A series of in vitro and in vitro experiments has been conducted to determine the suitability of their extravascular use.These encapsulation devices were able to harbor CYP2B1producing cells and to shield them from the hosts immune system when injected intratumorally.In this way ifosfamide-which is transformed into its active metabolites by CYP2B1-could be successfully targeted into pancreatic tumor growths.Furthermore DEBs can be used to target chemotherapeutics into the abdominal cavity for treatment of PC.If CYP2B1 producing cells are proven to be save for usage in man and if local toxic effects of chemotherapeutics can be controlled,DEBs will become promising tools in compartmentbased anticancer treatment.

关键词： Compartment based therapy Intraperitoneal drug-eluting beads Carcinomatosis Hyperthermic intraperitoneal chemotherapy Glioblastoma Pancreatic cancer CYP2B1 Ifosfamide

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Role of Second-Generation drug-eluting Stents and Bypass Grafting in Coronary Artery Disease:A Systematic Review and Meta-analysis

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Cardiovascular Innovations and Applications 2017年第B2期2卷 183-191页

作者： Linjuan Guo Ying Ding Fuwei Liu Wengen Zhu Xinghua Jiang Department of Cardiovascular Medicine the Second Affi liated Hospital of Nanchang UniversityNanchang of Jiangxi330006China

Background:The safety and efficacy of coronary artery bypass grafting(CABG)and second-generation drug-eluting stents(DESs)in patients with coronary artery disease(CAD)remain controversial.Therefore we aimed to compare the outcomes of CAD patients treated with CABG and second-generation DESs.Methods:We systematically searched the PubMed,Cochrane Library,Ovid,and Elsevier databases.Studies comparing second-generation DESs with CABG in CAD patients were included.RevMan 5.3 was used to extract and pool the data from the applicable studies.Results:Six trials(N=6604 participants)were included in this meta-analysis.Among all of the CAD patients,second-generation DESs were associated with no differences in the risks of all-cause death[risk ratio(RR)1.18,95% confi dence interval(CI)0.98–1.43,P=0.09],cardiovascular death(RR 1.14,95% CI 0.81–1.59,P=0.45),myocardial infarction(RR 1.22,95% CI 0.98–1.54,P=0.08),and stroke(RR 0.83,95% CI 0.59–1.17,P=0.29),but increased the risks of revascularization(RR 1.95,95% CI 1.66–2.30,P<0.001)and major adverse cardiac and cerebrovascular events(RR 1.72,95% CI:1.31–2.26,P<0.001)when compared with CABG.Conclusions:In the treatment of CAD patients,second-generation DESs was not associated with increased risks of all-cause death,cardiovascular death,myocardial infarction,and stroke,but increased the risks of revascularization and major adverse cardiac and cerebrovascular events when compared with CABG.

关键词： coronary artery bypass grafting second-generation drug-eluting stents coronary artery disease everolimus-eluting stents zotarolimus-eluting stents

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