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A Murine Model of Stent Implantation in the Carotid Artery for the Study of Restenosis
04:30

A Murine Model of Stent Implantation in the Carotid Artery for the Study of Restenosis

Published on: May 14, 2013

Clinical presentation and predictors of target vessel revascularization after drug-eluting stent implantation

Hazem Al Muradi1, Aditya Mehra, Joseph Okolo

  • 1Division of Cardiology, Rhode Island Hospital, Brown University, 593 Eddy St, Providence, RI 02903, USA.

Cardiovascular Revascularization Medicine : Including Molecular Interventions
|November 21, 2012
PubMed

Insights

Clinically driven target vessel revascularization (TVR) after drug-eluting stent (DES) implantation is uncommon. Disease progression, not in-stent restenosis, is the primary driver for TVR, often presenting as acute coronary syndrome.

Area of Science:

  • Cardiovascular Medicine
  • Interventional Cardiology
  • Biomedical Engineering

Background:

  • Drug-eluting stent (DES) failure can lead to target vessel revascularization (TVR).
  • Mechanisms of TVR in the DES era, including restenosis, stent thrombosis, and disease progression, require further elucidation.
  • Understanding predictors and presentations of TVR post-DES is crucial for patient management.

Purpose of the Study:

  • To examine the predictors and clinical presentations of patients undergoing clinically driven TVR after DES implantation.
  • To differentiate the contributions of restenosis, stent thrombosis, and disease progression to TVR events.

Main Methods:

  • Analysis of 2691 patients with 3401 lesions treated with DES from the Dynamic Registry (2004-2006).
  • Comparison of patients with and without TVR at 2 years based on clinical, procedural, and angiographic data.
  • Multivariate analysis to identify independent predictors of TVR and target lesion revascularization (TLR).

Main Results:

  • TVR occurred in 7.2% of patients by 2 years; TLR in 3.8%.
  • Disease progression accounted for 47% of TVR events; restenosis was the cause in 86.6% of TLR.
  • Independent predictors of TVR included younger age, diabetes, graft lesion, long lesion length, and prior intervention.

Conclusions:

  • The incidence of clinically driven TVR after DES is low.
  • Disease progression is a major contributor to TVR, explaining acute coronary syndrome presentations.
  • Low rates of in-stent restenosis and significant contribution of disease progression characterize TVR in the DES era.
Abstract

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