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A Murine Model of Stent Implantation in the Carotid Artery for the Study of Restenosis
Published on: May 14, 2013
Late outcomes after drug-eluting stent implantation in "real-world" clinical practice
David R Ramsdale1, Archana Rao, Omar Asghar
1The Cardiothoracic Centre, Thomas Drive, Liverpool, L14 3PE, United Kingdom. David.Ramsdale@ctc.nhs.uk
Insights
Drug-eluting stents (DES) show a low incidence of late complications in high-risk patients, with in-stent restenosis (ISR) being the most common issue. Late stent thrombosis (LST) is rare but serious, sometimes occurring with ISR.
Area of Science:
- Cardiology
- Interventional Cardiology
- Biomedical Engineering
Background:
- Drug-eluting stent (DES) implantation is a common procedure for coronary artery disease.
- Late outcomes of DES implantation in a real-world patient cohort are important for understanding long-term safety and efficacy.
Purpose of the Study:
- To report the late outcomes of drug-eluting stent (DES) implantation in 411 consecutive patients.
- To evaluate the incidence of late complications, including in-stent restenosis (ISR) and late stent thrombosis (LST).
Main Methods:
- Prospective registry with continuous follow-up of 411 patients undergoing DES implantation.
- Patients included those with stable angina or acute coronary syndrome, treated for various complex lesion types and conditions.
Main Results:
- The study included patients with a high prevalence of risk factors like hypercholesterolemia and diabetes.
- Twenty-five patients experienced late complications, with in-stent restenosis (ISR) in 23 cases (3.5-38 months post-DES).
- Three patients suffered late stent thrombosis (LST), with one-third also having ISR; 9 patients died during 1-5 year follow-up.
Conclusions:
- Off-label DES implantation in high-risk patients demonstrates a low incidence of late complications.
- In-stent restenosis (ISR) is the most frequent late complication, presenting later than after bare-metal stenting (BMS).
- Late stent thrombosis (LST) is uncommon but serious, potentially associated with ISR.
Background:
We report the late outcomes in 411 consecutive patients undergoing drug-eluting stent (DES) implantation by a single operator between 2003-2006.
Methods:
Prospective registry with continuous follow up. Patients with stable angina (SA) or acute coronary syndrome (ACS) received DES for long lesions, small vessels, chronic total occlusion, bifurcation, aorto-ostial, left main, post atherectomy or saphenous vein graft lesions, multivessel/multilesion single-vessel (V) disease, in-stent restenosis (ISR) or diabetes.
Results:
Age range: 34-86 years. One hundred sixty-six (40.3%) had ACS, 98.3% hypercholesterolemia and 14.6% diabetes. Two hundred sixty-one (63.5%) had percutaneous coronary intervention (PCI) to 1V and 150 (36.5%) to >1V. Six hundred seven V were treated. Two hundred fifty-nine patients (63%) had multilesion PCI, and 109 (26.5%) 1V multilesion PCI. Two hundred ninety-three (71.3%) patients had long lesions and 224 had Vs < 2.75 mm diameter. 75.5% of lesions were Type B2/C. 1-8 stents were implanted/patient. Eight hundred twenty-two of 883 stents were DES. One hundred eight patients received > or = 1 stent of < or = 2.5 mm diameter and 246 patients received stents greater than or equal to 20 mm long. Twenty-five patients developed late complications. ISR occurred in 23, 3.5-38 months after DES implantation. Three had sudden late DES thrombosis (LST). One-third also had ISR. Twenty of twenty-five required PCI, 1 CABG and 4 medical treatment. Subsequently, 3 of the 20 required further PCI for recurrent ISR and 1 CABG. 9 patients died during 1-5-year follow up.
Conclusions:
In "real-world" patients at increased risk of ISR after bare-metal stenting (BMS), "off-label" DES implantation has a low incidence of late complications. The most common is ISR which presents later than after BMS. Acute LST is serious but unusual and may be accompanied by ISR.