Background—The presence of chronic total occlusion of the right coronary artery (CTO-RCA) in patients undergoing percutaneous interventions for unprotected left main (ULM) disease may affect the prognosis. In this study, we evaluated the immediate results and follow-up of patients with ULM-percutaneous interventions and with or without associated CTO-RCA.
Background: Biolimus-eluting stents (BESs) with a biodegradable polymer in abluminal coating achieve more complete coverage at 9 months compared with sirolimus-eluting stents (SESs) with a durable polymer, as assessed by optical coherence tomography (OCT). Whether this advantage persists or augments after complete resorption of the polymer (>12 months) is unknown.
Background: The options for secondary prevention of cryptogenic embolism in patients with patent foramen ovale are administration of antithrombotic medications or percutaneous closure of the patent foramen ovale. We investigated whether closure is superior to medical therapy.
Background—Conduction disturbances are relatively common after transcatheter aortic valve implantation. Previous data demonstrated an adverse impact of persistent left bundle-branch block (LBBB) after surgical aortic valve replacement. It is unclear whether new-onset LBBB may also impact the prognosis of patients after transcatheter aortic valve implantation.
Background: Whether closure of a patent foramen ovale is effective in the prevention of recurrent ischemic stroke in patients who have had a cryptogenic stroke is unknown. We conducted a trial to evaluate whether closure is superior to medical therapy alone in preventing recurrent ischemic stroke or early death in patients 18 to 60 years of age.
Background: Limited information is available regarding genetic contributions to valvular calcification, which is an important precursor of clinical valve disease.
Objectives: To evaluate the effect of a polymer-free Biolimus A9-eluting stent [BioFreedom™ (BF)], compared with that of a biodegradable polymer-based Biolimus A9-eluting stent [BioMatrix Flex™ (BMF)] and a bare metal stent (BMS) in balloon denuded and radiated hypercholesterolemic rabbit iliac arteries. Methods: Rabbits were fed with 1% cholesterol diet (n = 14) for 14 days, both iliac arteries were balloon denuded and radiated, and then rabbits were switched to 0.15% cholesterol diet. After 4 weeks, BF (n = 8), BMF (n = 8), and BMS (n = 8) were deployed in denuded and radiated areas. Four weeks later animals were euthanized, arterial segments were processed for morphometry. Results: The neointimal area in vessels implanted with BF stents was significantly less than that seen in vessels implanted with BMS (0.90 mm2 ± 0.14 vs. 1.29 mm2 ± 0.23, P <0.01). Percent fibrin and fibrin score were higher with BMF stents compared to BMS (P <0.03 and <0.04) and giant cell number was significantly higher with both BMF and BF stents (P < 0.01 for both). Percent endothelialization was significantly higher and % uncovered struts were lower with BMS compared to either BMF or BF stents (P < 0.05 for both). Conclusion: This study demonstrates that compared to BMS, BF stents significantly decreased neointimal hyperplasia. © 2011 Wiley Periodicals, Inc.
Objectives: Mechanical properties of drug eluting stents (DES) will be measured to provide comparable numerical data to assess deliverability, and thus clinical performance.
The aim of this analysis was to assess the effect of body mass index (BMI) on 1-year outcomes in patients enrolled in a contemporary percutaneous coronary intervention trial comparing a sirolimus-eluting stent with a durable polymer to a biolimus-eluting stent with a biodegradable polymer. A total of 1,707 patients who underwent percutaneous coronary intervention were randomized to treatment with either biolimus-eluting stents (n = 857) or sirolimus-eluting stents (n = 850). Patients were assigned to 1 of 3 groups according to BMI: normal (<25 kg/m2), overweight (25 to 30 kg/m2), or obese (>30 kg/m2). At 1 year, the incidence of the composite of cardiac death, myocardial infarction, and clinically justified target vessel revascularization was assessed. In addition, rates of clinically justified target lesion revascularization and stent thrombosis were assessed. Cox proportional-hazards analysis, adjusted for clinical differences, was used to develop models for 1-year mortality. Forty-five percent of the patients (n = 770) were overweight, 26% (n = 434) were obese, and 29% (n = 497) had normal BMIs. At 1-year follow-up, the cumulative rate of cardiac death, myocardial infarction, and clinically justified target vessel revascularization was significantly higher in the obese group (8.7% in normal-weight, 11.3% in overweight, and 14.5% in obese patients, p = 0.01). BMI (hazard ratio 1.47, 95% confidence interval 1.02 to 2.14, p = 0.04) was an independent predictor of stent thrombosis. Stent type had no impact on the composite of cardiac death, myocardial infarction, and clinically justified target vessel revascularization at 1 year in the 3 BMI groups (hazard ratio 1.08, 95% confidence interval 0.63 to 1.83, p = 0.73). In conclusion, BMI was an independent predictor of major adverse cardiac events at 1-year clinical follow-up. The higher incidence of stent thrombosis in the obese group may suggest the need for a weight-adjusted dose of clopidogrel.
Aims: We evaluated the efficacy and safety of a biolimus- eluting biodegradable polymer-coated stent (BES) in patients with ST-segment elevation and non ST-segment elevation acute myocardial infarction (AMI).
Background: Patients with diabetes mellitus (DM) undergoing percutaneous cardiovascular intervention (PCI) represent a challenging population with higher risk of adverse events compared to non-diabetic patients. We investigated the impact of DM on long-term clinical outcomes of biolimus-eluting stents (BES) with biodegradable polymer versus sirolimus-eluting stents (SES) with durable polymer within the randomized multi-center all-comers LEADERS trial through 5 years.
Background: Second-generation drug eluting stents (DES) have shown a high efficacy in terms of restenosis prevention, like first-generation DES, with reduced rates of stent thrombosis, especially late stent thrombosis. The suggested mechanism for this superiority is a better morphological and functional healing response. The objective of this study is to compare the efficacy and safety results of 2 different, first and second-generation, DES in a swine model of normal coronary arteries
Background: Patients with diabetes show higher rates of restenosis and stent thrombosis following PCI. Optimal for treatment of patients with diabetes is not known and no stent has demonstrated superior efficacy or safety. Late stent thrombosis is associated with impaired endothelial coverage and adverse vessel remodeling- both features of delayed arterial healing caused by permanent polymer drug-eluting stents (DES). Biodegradable polymer DES offer improved biocompatibility and may improved long-term outcomes.
Background: The aim of this study is to compare the safety and efficacy of Sirolimus (SES), Paclitaxel (PES), Zotarolimus (ZES-R/ Endeavor Resolute), BiolimusA9 (BES), EPC capture (ECS) and Everolimus-eluting stent (EES) on the outcome of stenting in patients with diabetic very long coronary lesion (VLL) (lesion length ≥40 mm).
Background: The aim of this study is to compare the safety and efficacy of Sirolimus (SES), Paclitaxel (PES), Zotarolimus (ZES-R/ Endeavor Resolute), BiolimusA9 (BES), EPC capture (ECS) and Everolimus-eluting stent (EES) on the outcome of treatment of small coronary artery disease with diabetes mellitus (DM).
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