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Comparison of drug eluting stent implantation with coronary artery bypass surgery in the treatment of patients with chronic total occlusion and multiple vessel disease

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Chinese Medical Journal 2011年第8期124卷 1169-1174页

作者： LIU Wei MA Chang-sheng KANG Jun-ping DU Xin CHEN Fang ZHOU Yu-jie Lu Shu-zheng HUANG Fang-jiong GU Cheng-xiong ZHU Xiao-Ling Department of Carcliology Beiiing Anzllen Hospital Capital Medical University Beijing 100029 China Department of Cardiac Surgery Beijing Anzllen Hospital Capital MedicalUniversity Beijing 100029 China

Background In patients with chronic total occlusion （CTO） and multivessel coronary artery disease, the comparison of surgical and the percutaneous revascularization strategies has rarely been conducted. The aim of this study was to compare long term clinical outcomes of drug eluting stent （DES） implantation with coronary artery bypass surgery （CABG）in the patients with CTO and multivessel *** From a prospective registry of 6000 patients in our institution, we included patients with CTO and multivessel coronary artery disease who underwent either CABG （n=679） or DES （n=267） treatment. Their propensity risk score was used for adjusting baseline *** At a median follow-up of three years, propensity score adjusted Cox regression analysis showed that the rate of major adverse cardiac cerebrovascular events （MACCE） was lower in CABG group （12.7% vs. 24.3%, hazard ratio （HR） 1.969, 95% Cl 1.219-3.179, P=0.006） mainly due to lower rate of target vessel revascularization in CABG group than in DES group （3.1% vs. 17.2%, HR 16.14, 95% CI 5.739-45.391, P ＜0.001）. The incidence of cardiac death or myocardial infarction （composite end point） was not significantly different between these two groups. On multivariate analysis, the significant predictors of MACCE were only the type of revascularization. Age, left ventricular ejection fraction （LVEF）, and complete revascularization were identified as significant predictors of composite end *** Our study shows that in patients with CTO and multivessel coronary disease, DES can offer comparable long term outcomes in cardiac death and myocardial infraction free survival in comparison with CABG. However, there is an increased rate of MACCE which results from more repeat revascularizations. Obtaining a complete revascularization is crucial for decreasing adverse cardiac events.

关键词： chronic total occlusion drug eluting stent cardiopulmonary bypass complete revascularization

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Therapeutic effect of rotational atherectomy with implantation of drug eluting stent in heavily coronary calcified patients

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Journal of Geriatric Cardiology 2016年第3期13卷 233-238页

作者： Zhong-Hai WEI Jun XIE Lian WANG Wei HUANG Kun WANG Li-Na KANG Jing-Mei ZHANG Jie SONG Biao XU Department of Cardiology Drum Tower Hospital Medical School of Nanjing University Nanjing China

Background Rotational atherectomy （RA） could facilitate the percutaneous coronary intervention （PCI） in heavily coronary calcified patients. The effectiveness and safety of this technique needs to be further evaluated. Methods ＆ Results Eighty patients who underwent RA in our center from September 2011 to June 2014 were enrolled. The mean age was 72.4 ± 10.4 years. The left ventricular ejection frac- tion （LVEF） was average 52.3% ± 8.48% and the estimated glomerular filtration rate was 73.2 ± 3.20 mL/min per 1.73 m2. The coronary lesions were complex, with Syntax score 29.5 ± 9.86. The diameter of reference vessel was 3.4 ± 0.45 mm and the average diameter stenosis of target vessels was 80% ~ 10%. All the patients were deployed with drug eluting stents （DES） successfully aiter RA. The patients were followed up for 12-18 months. Kaplan-Meier plots estimated the survival rate was 93.4% and the cumulative incidence of major adverse cardiac and cerebral events （MACCE） was 25.4%. Bleeding and procedural-related complications were quite low. COX proportional hazards model for multivariate analysis demonstrated that diabetes, LVEF and maximum pressure of postdilatation were the predictors of MACCE. Conclusions RA followed by implantation of DES was effective and safe for heavily coronary calcified patients. Diabetes, LVEF and maximum pressure ofpostdilatation were predictive for MACCE.

关键词： Calcification drug eluting stent Percutaneous coronary intervention Rotational atherectomy

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Safety and efficacy of coronary drug eluting stent for atherosclerotic stenosis of the small renal artery

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Chinese Medical Journal 2009年第10期122卷 1223-1226页

作者： LI Chun-jie WU Zheng YAN Hong-bing WANG Jian ZHAO Han-jun The 28th Division Beijing Anzhen Hospital Capital Medical University Beijing 100029 China

Small diameter renal artery refers to the renal artery with the cross-section diameter less than 5 mm, the incidence of which is approximately 8%＇ Small diameter renal artery is common in patients with congenital multi-branch renal arteries, diabetes and multi-coronary artery lesions. Renal artery bare-mental stent （BMS） implantation is the standard treatment for ostial renal

关键词： drug eluting stent atherosclerotic stenosis small renal artery

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Superficial femoral artery pseudoaneurysm at implantation site of drug eluting stent discovered due to bacteremia:A case report

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World Journal of Clinical Cases 2024年第17期12卷 3194-3199页

作者： Takafumi Akai Shintarou Ninomiya Takanori Kaneko Department of Vascular Surgery Asahi General HospitalChibaAsahi 289-2511Japan

BACKGROUND drug-eluting stents(DES)are used to treat lower extremity arterial *** DES treatment,aneurysmal degeneration occasionally occurs,especially with fluoropolymer-based ***,the incidence of pseudoaneurysms after DES placement is rarely reported in the lower extremity region,although there have been several reports on pseudoaneurysm formation after DES placement in the coronary artery *** SUMMARY We report the case of a 64-year-old man who presented with fever and pain in his left hand after *** was diagnosed by blood culture,and after admission,he developed pain on the medial side of the right thigh.A pseudoaneurysm was observed in the right superficial femoral artery(SFA)at the proximal end of a previously placed *** bacteremia was thought to have been caused by a pseudoaneurysm of the left superficial brachial artery,and the pseudoaneurysm of the left superficial brachial artery was removed after antibiotic *** pseudoaneurysm of the right SFA rapidly expanded after admission,but the expansion rate was reduced after infection *** months after the first admission,the pseudoaneurysm of the left SFA was re-moved and in situ revascularization performed using a rifampicin-soaked Dacron *** Although pseudoaneurysm after DES placement in the lower extremity region is rare,it must be considered in patients with bacteremia.

关键词： Pseudoaneurysm drug eluting stent Superficial femoral artery Bacteremia Revascularization Case report

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Meta-analysis of stent thrombosis after drug-eluting stent implantation： 4-year follow-up

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Chinese Medical Journal 2010年第24期123卷 3689-3696页

作者： Natasa M Milic Biljana J Parapid Miodrag C Ostojic Milan A Nedeljkovic Jelena M Marinkovic Institute for Medical Statistics and Informatics BelgradeUniversity School of Medicine Serbia Institute for Cardiovascular Diseases Clinical Centre of Serbia Belgrade Serbia

Background drug-eluting stents （DES） are the most common device used in percutaneous treatment of coronary artery disease. Recently, there has been an increased concern regarding their safety profile, in particular the late and very late stent thrombosis rate compared to bare metal stents （BMS）. The aim of the study was to compare the reported incidence of late and very late stent thrombosis of DES and BMS in patients from published clinical studies with an extended follow-up period to four *** A search strategy was developed to identify publications reporting on late or very late thrombosis of BMS and DES available through MEDLINE and Cochrane Library databases. Two independent reviewers appraised eligible studies and extracted data. Odds ratios （OR） were calculated for each outcome and presented with 95% confidence intervals （CI）.Results Fourteen randomized controlled trials, which were at least single blinded, were identified. There was no difference in the incidence of late and very late stent thrombosis in patients treated with DES compared with patients treated with BMS （late OR 0.55, 95%Cl 0.23-1.31 and late/very late OR=1.08, 95%CI 0.61-1.91）.Conclusions The safety profile of DES was similar to BMS in terms of stent thrombosis. We found no evidence of increased risk of late and very late thrombosis for DES.

关键词： bare metal stent drug eluting stent thrombosis safety meta-analysis systematic review

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Long-term outcomes of drug-eluting versus bare-metal stent implantation in patients with chronic total coronary artery occlusions

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Chinese Medical Journal 2009年第6期122卷 643-647页

作者： HAN Ya-ling ZHANG Jian LI Yi WANG Shou-li JING Quan-min YI Xian-hua MA Ying-yan LUAN Bo WANG Geng WANG Bin Department of Cardiology Shenyang Northern Hospital Shenyang Liaoning 110016 China

Background There are limited data on the efficacy of drug-eluting stents （DES） for treatment of chronic total occlusions （CTO）. The aim of the study was to evaluate the long-term clinical outcomes of DES implantation for CTO compared with bare-metal stent （BMS） implantation.Methods Between June 1995 and December 2006, a total of 1184 patients with successful recanalization of at least one de novo CTO lesion were consecutively registered, including 660 （55.7%） who underwent DES and 524 （44.3%） who underwent BMS implantation. All patients were followed up for up to 5 years for occurrence of major adverse cardiac events （MACE）. Long-term survival rates were estimated with the Kaplan-Meier method.Results Baseline clinical and angiographic characteristics were comparable between the two groups except that patients in the DES group received longer dual antiplatelet therapy （（7.4±2.5） months vs （1.7±0.8） months, P 〈0.001）. Average follow-up periods were （4.7±0.89） and （3.2±1.3） years for the BMS and DES groups, respectively. There was no significant difference in 5-year survival rates between the two groups （90.3% for DES group vs 89.6% for BMS group, Log-rank P=0.38）, but the 5-year target vessel revascularization （TVR）-free survival rate in the DES group was significantly higher than that in the BMS group （81.6% vs 73.5%, Log-rank P 〈0.001）. The cumulative MACE-free survival in the DES group was also significantly higher than that in the BMS group （80.6% vs 71.5%, Log-rank P〈0.001）. The rates of readmission caused by cardiovascular disease （27.0% vs 37.8%, P 〈0.001） and the need for bypass surgery were significantly lower in the DES group （1.5% vs 3.4%, P 〈0.05）. By multivariable analysis, DES implantation could significantly lower the long-term MACE risk of PCI for CTO patients （HR： 0.492; 95% Cl 0.396-0.656, P 〈0.001）. Left ventricular ejection fraction 〈50% and elderly （〉65 years） were identified as independent predictors of long-term MACE during follow-up.Concl

关键词： chronic disease coronary artery disease percutaneous transluminal coronary angioplasty drug eluting stent

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Comparison of drug eluting stents with bare metal stents in daily practice for bifurcation lesions in Chinese patients

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Chinese Medical Journal 2006年第14期119卷 1157-1164页

作者： KANG Sheng YANG Yue-jin XU Bo CHEN Ji-lin QIAO Shu-bin YAO Min CHEN Jue WU Yong-jian LIU Hai-bo DAI Jun YUAN Jin-qing LI Jian-jun GAO Run-lin Department of Cardiology Cardiovascular Institute ＆ Fuwai Hospital Chinese Academy of Medical Sciences ＆ Peking Union Medical College Beijing 100037 China

Background Recently, numerous randomized and controlled trials have demonstrated great advantages of drug eluting stents （DES） with respect to significant reduction of restenosis and recurrence of symptoms and improvement of clinical outcomes after percutaneous coronary intervention （PCI）. Little is known about the comparative effects between DES and bare metal stents （BMS） for bifurcation angioplasty in the Chinese population. We compared the inpatient and 7-month follow-up outcomes between DES and BMS for the treatment of bifurcation lesions. Methods From April 2004 to October 2005, 291 Chinese patients [85.9% male, mean age （57.8± 10.4） years] underwent DES （387 lesions） and/or BMS （297 lesions） implantation for bifurcation lesions. Clinical and angiographic follow-up was performed at 7 months. Results Compared with BMS group, patients in DES group had significantly lower rates of restenosis at main branch （9.5% vs 28.7%, P 〈 0.001） or side branch （14.5% vs 37.0%, P 〈 0.001） and major adverse cardiac events （MACE）（14.0% vs 26.3%, P = 0.000）. The occurrence rate of late in-stent thrombosis did not differ between the two groups in both main （0.8% vs 0, P = 0.224） and side branches （1.4% vs 0, P =0.198）. Target lesion revascularization （TLR） was less frequent in DES group for main branch （8.3% vs 21.3%, P 〈 0.001） and for side branch （7.6% vs 23.5%, P 〈 0.001）. Multivariate regression analysis revealed that total stent length （OR = 1.029, P = 0.01）, postprocedural in-stent minimum lumen diameter （OR = 0.476, P = 0.03） and stent type （OR = 3.988, P = 0.0001） were independent predictors of TLR for main branch. Prior history of coronary intervention （OR = 2.424, P =0.041）, angulated lesion （OR = 2.337, P = 0.033）, postdilation （OR = 0.267, P = 0.035） and stent type （DES vs BMS, OR = 5.459, P = 0.000） were independent predictors of TLR for side branch. Conclusion The implantation of DES may be associated with greater reduction of restenosis and TLR than BMS in bi

关键词： percutaneous coronary intervention drug eluting stent bare metal stent bifurcation

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Short and long-term outcomes of two drug eluting stents in bifurcation lesions

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Chinese Medical Journal 2007年第3期120卷 183-186页

作者： CHEN Ji-lin GAO Run-lin YANGYue-jin QIAO Shu-bin QIN Xue-wen YAO Min XU Bo LIU Hai-bo WU Yong-jian YUAN Jin-qing CHEN Jue WU Yuan DAI Jun Cardiovascular Institute and Fuwai Hospital Chinese Academy ofMedical Sciences and Peking Union Medical College Beijing100037 China

Background Because no large prospective studies are available, this study evaluated the clinical outcomes of two drug eluting stents in bifurcation lesions. Methods Lesions with diameter of side branch ≥2.5 mm were selected. From October 2003 to June 2005, 112 patients with 113 bifurcation lesions were treated by two drug eluting stents （DESs）, technique. The location of bifurcation lesions were left anterior descending coronary artery/diagonal in 62 patients, left main distal bifurcation in 32, left circumflex coronary artery/obtute marginal branch in 18 and right coronary artery distal bifurcation in 1. Procedures for bifurcation lesions were crush or modified crush technique in 64, ＂T＂ stenting technique in 27, modified ＂Y＂ stenting, kiss stenting, ＂V＂ stenting as well as culotte stenting technique in 11, 5, 3 and 3, respectively. Among 226 lesions, 91 Cypher or Cypher select stents, 74 TAXUS and 67 Firebird were used. Final kiss balloon dilation was performed in 60 （93.7%） with crush technique after stenting. Results Success rate of percutaneous coronary intervention for the bifurcation lesions was 100%. One patient, who developed inhospital acute myocardial infarction due to subacute thrombosis, was successfully treated by a second intervention. Major adverse cardiac events rate in-hospital was 0.89% （1/112） and during followup was 7.14% （8/112）, No death occurred during the followup of all patients. Angiographic followup was effected for 46 patients, restenosis for eight, coronary artery bypass grafting for 1 and a repeat intervention for 5. Restenosis involving TAXUS, Cypher and Firebird was 5 （5/18, 27.8%）, 2 （2/17, 11.8%） and 1 （1/11, 9.1%）, respectively （P〉0.05）. Total restenotic rate was 17.4% （8/46）. Conclusions When ostium of side branch has severe stenosis and 〉12.5 mm in diameter, two-stent strategy in this bifurcation lesion is safe and effective, and the outcomes are satisfactory. Restenotic rates were not different between TAXUS, Cypher and F

关键词： bifurcation lesion drug eluting stent treatment outcome

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Intracoronary brachytherapy for the treatment of recurrent drugeluting stent in-stent restenosis:A systematic review and metaanalysis

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World Journal of Cardiology 2021年第4期13卷 95-102页

作者： Irtqa Ilyas Ashish Kumar Devina Adalja Mariam Shariff Rupak Desai Yasar Sattar Saraschandra Vallabhajosyula Nageshwara Gullapalli Rajkumar Doshi Department ofInternal Medicine University of Nevada Reno School of MedicineRenoNV 89509United States Department of Critical Care Medicine Saint John's Medical College HospitalBangalore 560034KarnatakaIndia Department of Internal Medicine GMERS Gotri Medical CollegeVadodara 380021GujaratIndia Department of Cardiology Atlanta VA Medical CenterDecaturGA 30033United States Department of Internal Medicine Icahn School of Medicine at Mount Sinai ElmhurstNew YorkNY 11373United States Interventional Cardiology Emory UniversityAtlantaGA 30322United States

BACKGROUND We performed a meta-analysis on observational studies since randomized control trials are not *** studied intracoronary brachytherapy(ICBT)and recurrent drug eluting stent in-stent restenosis(DES-ISR)to evaluate the procedural success,target lesion revascularization(TLR),incidence of myocardial infarction(MI)and all-cause mortality at 2 years *** To perform meta-analysis for patients undergoing ICBT for recurrent *** We performed a systematic search of the PubMed/MEDLINE,Cochrane and DARE databases to identify relevant *** were excluded if intracoronary brachytherapy was used as a treatment modality for initial ISR and studies with bare metal *** used a random-effect model with DerSimonian&Laird method to calculate summary *** was assessed using I2 *** A total of 6 observational studies were included in the final *** angiographic success following intra-coronary brachytherapy was 99.8%.Incidence of MI at 1-year was 2%and 4.1%at 2-years,*** incidence of TLR 14.1%at 1-year and 22.7%at 2-years,***-cause mortality at 1-and 2-year follow-up was 3%and 7.5%,*** Given the observational nature of the studies included in the analysis,heterogeneity was significantly higher for *** there are no randomized controlled trials or definitive guidelines available for recurrent ISR associated with DES,this analysis suggests that brachytherapy might be the alternative approach for recurrent *** controlled trials are required to confirm results from this study.

关键词： Intracoronary brachytherapy In-stent restenosis Meta-analysis drug eluting stent Systematic review Brachytherapy

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Polymer-free versus permanent polymer drug eluting stents in coronary artery disease: A meta-analysis of 10 RCTs with 6575 patients

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Chronic Diseases and Translational Medicine 2015年第4期1卷 -页

作者： De-Wei Wu Meng-Yue Yu Hai-Yang Gao Li Zhang Fei Song Xin-Yue Zhang Yong-Jian Wu Coronary Heart Disease Center National Center for Cardiovascular Diseases and Fuwai Hospital Chinese Academy of Medical Sciences and Peking Union Medical College 167 Beilishi Road Xicheng District Beijing 100037 China

Background:Permanent polymer drug eluting stents (PP-DES) may induce inflammation of the vessel wall due to the existence of the polymer,which may delay intimal ***-free DES (PF-DES) that eliminate the polymeric carrier may potentially lead to safer ***,the safety and efficacy of PF-DES remains ***:Randomized controlled trials comparing PF-DES with PP-DES were searched in online database including MEDLINE,Excerpta Medica Database (EMBASE) and Cochrane *** reporting late lumen loss (LLL),all-cause death,myocardial infarction (MI),target lesion revascularization (TLR) and late stent thrombosis (LST) were enrolled and quantitatively ***:Ten studies enrolling 6575 patients were included in this *** PF-DES showed a benefit in reducing all-cause death (OR =0.77,95％ CI:0.61 to 0.98,P =0.03) and long-term LLL (weighted mean difference (WMD)-0.16 mm,95％ CI:-0.22 to -0.11 mm,P ＜ 0.001),while no superiority was found in reducing short-term LLL (WMD 0.03 mm,95％ CI:-0.07-0.13 mm,P =0.57),MI (OR =1.12,95％ CI:0.19 to 23.18,P=0.39),TLR (OR =1.19,95％ CI:0.42 to 3.38,P=0.83)and LST (OR =0.92,95％CI:0.05 to 5.71,P =0.74).Conclusion:PF-DES showed benefits in reducing long-term LLL and mortality compared with PP-DES,but no superiority was found in short-term LLL,MI,TLR and *** findings provide a sound basis for the wide application of PF-DES in the future.

关键词： drug eluting stent Polymer-free DES Meta-analysis

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