Tag Archives: stent thrombosis

Disease made worse? Dr Pitt O Lim When Grüntzig extended balloon angioplasty from the leg to the heart as a minimally invasive procedure for coronary atherosclerosis in 1977, there was a 10% rate of abrupt vessel closure (AVC), possibly causing a myocardial infarction (MI).1,2 At the time, cardiac surgeons stood by, rescuing these patients with emergency coronary artery bypass grafting (CABG). Bare-metal stent (BMS), a balloon-expandable metallic-mesh scaffold was introduced 10 years later to overcome this immediate complication. The drug-eluting stent (DES), marketed from 2003, overcomes BMS’s in-stent restenosis (ISR) due to healing tiss

Introduction Dr Pitt O Lim, Consultant Cardiologist The use of drug-coated balloon (DCB) in de novo coronary artery disease has seeped through into routine practice in recent years.1 Largely unnoticed by the mainstream community, ignored by multi-national device companies and rarely discussed at international meetings. Its development actually parallels that of first-generation drug-eluting stent (DES) from the early 2000s; pioneered, propagated and instructed by expert German operators.2,3 Its efficacy is proven for in-stent re-stenosis (ISR),4 small vessel disease,5,6 high-risk bleeder,7 and where stenting might be avoided, such as in Takay

Introduction Activated platelets play a pivotal role in the pathophysiology of acute coronary syndromes, and dual antiplatelet therapy with both aspirin and clopidogrel has become one of the cornerstones of their treatment.1 Similarly, dual antiplatelet therapy is mandated following percutaneous coronary intervention (PCI) with stent insertion to prevent stent thrombosis.2 Recently, there has been considerable interest in the phenomenon of inter-patient variability of clopidogrel response (sometimes termed ‘clopidogrel resistance’)3 and, to a lesser degree, the variability of aspirin response. This has led to interest in tailoring the dos

SAPIEN valve positive results Clinicians have achieved successful one-year outcomes in high-risk or inoperable patients undergoing transcatheter aortic valve replacement during the first two years since release of the valve (Sapien®, Edwards) commercially, according to results presented at the Euro PCR 2001 meeting in Paris, France. Despite high predicted mortality and multiple co-morbidities in many of these patients, survival at one year was 76% in the 1,038 patients treated as part of Cohort I (first year of commercialisation), and 77% in the 1,269 patients treated as part of Cohort II (second year of commercialisation).  Since November

Introduction Developments along the way have included better patient selection, improved peri-procedural management of patients and, with newer-generation drugs and devices, better results. Recent hurdles have been confronted, including left main stem disease, complex bifurcation lesions and total chronic occlusions. Similarly, primary percutaneous coronary intervention (PCI) has become the treatment of choice in acute myocardial infarction. Challenges remain, however, including restenosis. The fine balance between thrombosis and haemostasis demands that we provide more effective and predictable antiplatelet strategies to optimise risk reduct

Introduction While primary PCI, rather than thrombolysis, is now the reperfusion treatment of choice for STEMI, the majority of patients coming for revascularisation in the UK have stable coronary disease or NSTE-ACS. In the treatment of NSTE-ACS, first principles involve the selection of patients for diagnostic angiography followed by either PCI or coronary artery bypass grafting (CABG). Rates of PCI are increasing annually in the UK, which, in part, is a reflection of greater awareness of coronary artery disease, its earlier diagnosis and treatment in the ageing population. This section looks at coronary intervention in general, how PCI act

Introduction The discovery of the thienopyridines, or ADP receptor antagonists, led to the development of more effective oral antiplatelet agents. Trials assessed dual antiplatelet therapy in high-risk patients versus aspirin alone and the significant benefits observed have resulted in dual antiplatelet therapy becoming a mainstay of treatment. As expected with more potent dual therapy, there is always a fine balance between prevention of thrombosis and bleeding risk. There are still many challenges to overcome. Many patients, such as those with diabetes or with a previous stent thrombosis, are at high risk for further infarction, indicating

These results, from the TYCOON (Two-Year Clopidogrel Need) registry, were published online on September 28, 2009 in the American Journal of Cardiology. Current guidelines recommend at least 9-12 months of dual antiplatelet therapy (aspirin plus clopidogrel) following intervention with a drug-eluting stent to prevent thromboses, but authors of the TYCOON paper, wanted to investigate whether longer treatment would be better. The TYCOON database includes 897 consecutive patients who received a coronary stent in 2003 and 2004, about half of whom received a drug-eluting stent. Patients given a drug-eluting stent in 2003 were treated with clopidog

Introduction The use of drug-eluting stents (DES) has increased exponentially in recent years with a significant improvement in the rates of re-stenosis, target lesion and target vessel revascularisation.1-3 There appears to be little difference in short- to medium-term safety compared with bare metal stenting (BMS).4 Coronary thrombosis after stent implantation is well recognised, resulting in acute myocardial infarction and marked adverse outcome. Typically, it happens in the first 3–10 days after the procedure leading almost always to an acute myocardial infarction and not uncommonly to death. Late (>6 months) stent thrombosis is rare

Introduction Stent thrombosis (ST) is a potentially life-threatening complication of coronary artery stent placement (percutaneous coronary intervention [PCI]). Concern about the incidence of ST is greatest in patients treated with drug-eluting stents (DES), in whom some evidence suggests there is a higher incidence than for bare metal stents (BMS).1–3 Recently reported meta-analyses from collections of randomised studies comparing BMS with either Cypher® or Taxus® DES have been interpreted as confirming this increase in risk for these drug-eluting devices.4 It is likely that ST is multi-factorial in its aetiology since evidence demonstra