Fast track — Research LettersLate thrombosis in drug-eluting coronary stents after discontinuation of antiplatelet therapy
Summary
Although the safety profiles of coronary stents eluting sirolimus or paclitaxel do not seem to differ from those of bare metal stents in the short-to-medium term, concern has arisen about the potential for late stent thromboses related to delayed endothelialisation of the stent struts. We report four cases of angiographically-confirmed stent thrombosis that occurred late after elective implantation of polymer-based paxlitaxel-eluting (343 and 442 days) or sirolimus-eluting (335 and 375 days) stents, and resulted in myocardial infarction. All cases arose soon after antiplatelet therapy was interrupted. If confirmed in systematic long-term follow-up studies, our findings have potentially serious clinical implications.
References (7)
- MN Babapulle et al.
A hierarchical Bayesian meta-analysis of randomised clinical trials of drug-eluting stents
Lancet
(2004) - RS Schwartz et al.
Preclinical restenosis models and drug-eluting stents: still important, still much to learn
J Am Coll Cardiol
(2004) - GL Kaluza et al.
Catastrophic outcomes of noncardiac surgery soon after coronary stenting
J Am Coll Cardiol
(2000)
Cited by (1373)
Optimizing Dual Antiplatelet Therapy in the Perioperative Period for Spine Surgery After Recent Percutaneous Coronary Intervention: A Comprehensive Review, Synthesis, and Catalyst for Protocol Formulation
2024, World NeurosurgeryThe increased incidence of spine surgery within the past decade has highlighted the importance of robust perioperative management to improve patient outcomes overall. Coronary artery disease is a common medical comorbidity present in the population of individuals who receive surgery for spinal pathology that is often treated with dual antiplatelet therapy (DAPT) after percutaneous coronary intervention. Discontinuation of DAPT before surgical intervention is typically indicated; however, contradictory evidence exists in the literature regarding the timing of DAPT use and discontinuation in the perioperative period. We review the most recent cardiac and spine literature on the intricacies of percutaneous coronary intervention and its associated risks in the postoperative period. We further propose protocols for DAPT use after both elective and urgent spine surgery to optimize perioperative care.
Sirolimus-coated balloon in acute and chronic coronary syndromes: subanalysis of the EASTBOURNE registry
2024, Revista Espanola de CardiologiaEl estudio PEACE (Performance of a sirolimus-eluting balloon strategy in acute and chronic coronary syndromes) investiga por primera vez si un balón recubierto de sirolimus (BRS) (Magic Touch, Concept Medical, India) deriva en resultados diferentes según se utilice en síndromes coronarios agudos (SCA) o crónicos (SCC).
Este es un análisis post-hoc del registro EASTBOURNE (NCT03085823). De los 2.083 pacientes inscritos, se utilizó un BRS para tratar a 968 (46,5%) pacientes con SCA y a 1.115 (53,5%) con SCC. El objetivo primario es la revascularización de la lesión diana a los 12 meses; las variables secundarias son el éxito angiográfico y los eventos cardiovasculares adversos mayores.
Las características demográficas iniciales, el diámetro medio del vaso de referencia y la longitud media de la lesión son similares en ambos grupos. Es importante destacar que la predilatación se realiza con mayor frecuencia en SCA que en SCC (p = 0,007). Los BRS se inflan a una presión estándar en ambos grupos, con una ligera tendencia hacia un tiempo de inflado más largo en SCA. El éxito angiográfico es alto en ambos grupos (el 97,4% en SCA frente al 97,7% en SCC; p = 0,820) con un limitado uso de stents de rescate, y a los 12 meses la incidencia acumulada de revascularización de la lesión diana es similar en SCA y SCC (el 6,6% en SCA frente al 5,2% en SCC; p = 0,258). Por el contrario, los eventos cardiovasculares adversos mayores son más frecuentes en SCA (el 10,4% frente al 8,3% en SCC; p = 0,009) debido a su mayor número de recaídas. La reestenosis intrastent muestra una mayor proporción de revascularización de la lesión diana y eventos cardiovasculares adversos mayores que las lesiones nuevas, independientemente del tipo de presentación en el procedimiento inicial.
Este BRS muestra buenos resultados agudos y a un año, independientemente de la presentación clínica.
The PEACE study (Performance of a sirolimus-eluting balloon strategy in acute and chronic coronary syndromes) investigated for the first time whether a sirolimus-coated balloon (SCB) (Magic Touch, Concept Medical, India) is associated with different outcomes depending on whether it is used in acute coronary syndromes (ACS) or chronic coronary syndromes (CCS).
This was a post-hoc analysis from the all-comers EASTBOURNE Registry (NCT03085823). Out of 2083 patients enrolled, an SCB was used to treat 968 (46.5%) ACS and 1115 (53.5%) CCS patients. The primary endpoint was target lesion revascularization at 12 months, while secondary endpoints were angiographic success and major adverse cardiovascular events.
Baseline demographics, mean reference vessel diameter and mean lesion length were comparable between ACS and CCS. Predilatation was more commonly performed in ACS (P = .007). SCB was inflated at a standard pressure in both groups with a slight trend toward longer inflation time in ACS. Angiographic success was high in both groups (ACS 97.4% vs CCS 97.7%, P = .820) with limited bailout stenting. Similarly, at 12 months the cumulative incidence of target lesion revascularization (ACS 6.6% vs CCS 5.2%, P = .258) was comparable between ACS and CCS. Conversely, a higher rate of major adverse cardiovascular events in acute presenters was mainly driven by myocardial infarction recurrencies (ACS 10.4% vs CCS 8.3%, P = .009). In-stent restenosis showed a higher proportion of target lesion revascularization and major adverse cardiovascular events than de novo lesions, independently of the type of presentation at the index procedure.
This SCB shows good performance in terms of acute and 1-year outcomes independently of the clinical presentation.
Methods for improving the properties of zinc for the application of biodegradable vascular stents
2024, Biomaterials AdvancesBiodegradable stents can support vessels for an extended period, maintain vascular patency, and progressively degrade once vascular remodeling is completed, thereby reducing the constraints of traditional metal stents. An ideal degradable stent must have good mechanical properties, degradation behavior, and biocompatibility. Zinc has become a new type of biodegradable metal after magnesium and iron, owing to its suitable degradation rate and good biocompatibility. However, zinc's poor strength and ductility make it unsuitable as a vascular stent material. Therefore, this paper reviewed the primary methods for improving the overall properties of zinc. By discussing the mechanical properties, degradation behavior, and biocompatibility of various improvement strategies, we found that alloying is the most common, simple, and effective method to improve mechanical properties. Deformation processing can further improve the mechanical properties by changing the microstructures of zinc alloys. Surface modification is an important means to improve the biological activity, blood compatibility and corrosion resistance of zinc alloys. Meanwhile, structural design can not only improve the mechanical properties of the vascular stents, but also endow the stents with special properties such as negative Poisson ‘s ratio. Manufacturing zinc alloys with excellent degradation properties, improved mechanical properties and strong biocompatibility and exploring their mechanism of interaction with the human body remain areas for future research.
Bleeding and Ischemic Risks of Ticagrelor Monotherapy After Coronary Interventions
2023, Journal of the American College of CardiologyIn TWILIGHT (Ticagrelor With Aspirin or Alone in High-Risk Patients After Coronary Intervention), among high-risk patients undergoing percutaneous coronary intervention (PCI), ticagrelor monotherapy vs continuation of dual antiplatelet therapy (DAPT) with aspirin and ticagrelor after completing a 3-month course of DAPT was associated with reduced bleeding, without an increase in ischemic events.
This investigation sought to study the clinical benefit of ticagrelor monotherapy vs DAPT by simultaneously modeling its associated potential bleeding benefits and ischemic harms on an individual patient basis.
Multivariable Cox regression models for: 1) Bleeding Academic Research Consortium type 2, 3, or 5 (BARC-2/3/5); and 2) cardiovascular death, nonfatal myocardial infarction, and nonfatal ischemic stroke (major adverse cardiac and cerebrovascular event [MACCE]) were developed using stepwise forward variable selection. The coefficients in the BARC-2/3/5 and MACCE models were used to calculate bleeding and ischemic risk scores, respectively, for each patient (excluding the coefficient for randomized treatment).
In the total study group (N = 7,119), BARC-2/3/5 occurred in 391 (5.5%) patients, and MACCE occurred in 258 (3.6%). There was a consistent reduction in bleeding events associated with ticagrelor monotherapy compared with DAPT across both bleeding and ischemic risk strata (P interaction = 0.54 and 0.11, respectively). Importantly, this benefit associated with ticagrelor monotherapy was not offset by an increase in MACCE at any level of bleeding or ischemic risk.
Three months after PCI, discontinuing aspirin and maintaining ticagrelor monotherapy reduces bleeding in both higher–bleeding risk and lower–bleeding risk patients compared with continued DAPT. This benefit does not appear to be offset by greater ischemic risk. (Ticagrelor With Aspirin or Alone in High-Risk Patients After Coronary Intervention [TWILIGHT]; NCT02270242)
Structural and temporal dynamics analysis on drug-eluting stents: History, research hotspots and emerging trends
2023, Bioactive MaterialsThis review aims to explore the history, research hotspots, and emerging trends of drug-eluting stents(DES)in the last two decades from the perspective of structural and temporal dynamics.
Publications on DES were retrieved from WoSCC. The bibliometric tools including CiteSpace and HistCite were used to identify the historical features, the evolution of active topics, and emerging trends on the DES field.
In the last 20 years, the field of DES is still in the hot phase and there is a wide range of extensive scientific collaborations. In addition, active topics emerge in different periods, as evidenced by a total of 41 disciplines, 511 keywords, and 1377 papers with citation bursts. Keyword clustering anchored five emerging research subfields, namely #0 dual antiplatelet therapy, #3 drug-coated balloon, #4 bifurcation, 5# rotational atherectomy, and 6# quantitative flow ratio. The keyword alluvial map shows that the most persistent research concepts in this field are thrombosis, restenosis, etc., and the emerging keywords are paclitaxel eluting balloon, coated balloon, drug-eluting balloon, etc. There are 7 recent research subfields anchored by reference clustering, namely #2 dual antiplatelet therapy, #4 drug-coated balloon, #5 peripheral artery disease, #8 fractional flow reserve, #10 bioresorbable vascular scaffold, # 13 intravascular ultrasound, #14 biodegradable polymer.
The findings based on the bibliometric studies provide the current status and trends in DES research and may help researchers to identify hot topics and explore new research directions in this field.
Looking into the future of ACS patients through the small OCT window
2023, Revista Espanola de Cardiologia
The first two authors contributed equally.