EXPRESS PUBLICATION
Late Angiographic Stent Thrombosis (LAST) Events With Drug-Eluting Stents
Andrew T.L. Ong, MBBS, FRACP,
Eugène P. McFadden, MD, FRCPI, FACC,
Evelyn Regar, MD, PhD,
Peter P.T. de Jaegere, MD, PhD,
Ron T. van Domburg, PhD and
Patrick W. Serruys, MD, PhD, FACC*
Thoraxcenter, Erasmus Medical Center, Rotterdam, the Netherlands
Manuscript received January 25, 2005;
revised manuscript received February 25, 2005,
accepted February 28, 2005.
* Reprint requests and correspondence: Prof. Patrick W. Serruys, Thoraxcenter, Ba-583, Dr. Molewaterplein 40, 3015-GD Rotterdam, the Netherlands (Email: p.w.j.c.serruys{at}erasmusmc.nl).
 |
Abstract
|
|---|
OBJECTIVES: We sought to describe the incidence of late angiographic stent thrombosis (LAST) events in an unselected drug-eluting stent (DES) population.
BACKGROUND: Concerns have been raised that LAST may be a potential limitation of DES.
METHODS: We have previously reported the angiographic incidence of early stent thrombosis (1.0%) in this prospective cohort of 2,006 patients treated with either sirolimus-eluting stents (SES) (n = 1,017) or paclitaxel-eluting stents (PES) (n = 989). We continued long-term follow-up to determine the incidence of LAST events, defined as angiographically proven stent thrombosis associated with acute symptoms more than 30 days after DES implantation. All patients had at least 1 year of follow-up, mean duration 1.5 years.
RESULTS: There were eight angiographically confirmed LAST events in seven patients: three with SES (at 2, 25, and 26 months) and five with PES (at 6, 7, 8, 11, and 14.5 months). Three cases were related to complete cessation of antiplatelet therapy, two cases occurred while patients were on aspirin therapy within one month of cessation of clopidogrel, and three cases occurred at a time when patients were apparently clinically stable on aspirin monotherapy. We observed no cases of LAST in patients who were on dual antiplatelet therapy. Two deaths occurred directly as a result of LAST.
CONCLUSIONS: Angiographically proven late stent thrombosis occurs with an incidence of at least 0.35% (95% confidence limits 0.17% to 0.72%) in patients treated with DES. Importantly, it may also occur when patients are stable on antiplatelet monotherapy.
|
Abbreviations and Acronyms
| | DES = drug-eluting stents | | IVUS = intravascular ultrasound | | LAST = late angiographic stent thrombosis | | MI = myocardial infarction | | PES = paclitaxel-eluting stents | | SES = sirolimus-eluting stents | | TIMI = Thrombolysis In Myocardial Infarction |
|
Drug-eluting stents (DES) have revolutionized the practice of interventional cardiology with their proven efficacy in reducing restenosis rates. In the U.S., up to 80% of stent implantations currently are with DES. A meta-analysis of 11 randomized trials confirmed the efficacy and safety profile of these stents, but these trials were not powered to detect or exclude an effect of DES on rare events such as stent thrombosis (1). Since April 2002, we have adopted a policy of universal DES implantation for all patients irrespective of clinical presentation or angiographic features, the "all-comers" approach. Based on this approach, we were able to define the incidence of early stent thrombosis (<30 days) in a DES population of 2,006 patients (2).
Our institution has been confronted with patients presenting with late angiographic stent thrombosis (LAST) events, an unexpected occurrence given the long period of dual antiplatelet therapy prescribed in comparison to bare stents (3). Late angiographic stent thrombosis events were uncommon with bare stents except after brachytherapy (4), and subsequent to that report, dual antiplatelet therapy was prolonged for that population. Furthermore, in animal models, DES may delay or cause incomplete healing to a greater degree than with bare-metal stents (5). Therefore, we sought to investigate the incidence of LAST events in the DES population.
|
Methods
|
|---|
Study design and patient population.
Briefly, since April 2002, we have adopted a policy of universal DES implantation for all patients irrespective of clinical presentation or angiographic characteristics, known as an "all-comers population." We have previously reported on the incidence of early stent thrombosis (defined as stent thrombosis occurring within the first 30 days following stent implantation) in 2,006 consecutive patients after DES implantation (2). This study population thus comprises 1,017 patients treated with sirolimus-eluting stents (SES) from April 2002 to February 2003, and 989 patients treated with paclitaxel-eluting stents (PES) from February 2003 to December 2003. We continued a long-term (minimum one year) follow-up on this cohort of patients to determine the incidence of LAST.
Follow-up.
Post-discharge survival status was obtained from the Municipal Civil Registries. A health questionnaire was sent to all living patients with specific questions on re-hospitalization and adverse events. As the principal referral center within the region, repeat procedures are normally performed at our institution and recorded prospectively in our database. For patients who suffered an adverse event at another center, medical records or discharge summaries from the other institutions were systematically reviewed. General practitioners, referring cardiologists, and patients were contacted as necessary for additional information.
Procedure and antiplatelet management.
All interventions were performed according to current standard guidelines, with the interventional strategy including periprocedural glycoprotein IIb/IIIa inhibitor and intravascular ultrasound (IVUS) use left to the discretion of the operator. Patients were pretreated with aspirin and a loading dose of 300 mg clopidogrel.
Duration of clopidogrel therapy.
Upon completion of the index procedure, patients are advised to maintain lifelong aspirin therapy. Patients who received SES were prescribed clopidogrel for three or six months depending on the complexity of the procedure, whereas patients treated with PES were given a six-month prescription. In the Netherlands, clopidogrel after stenting is not reimbursed by medical insurance companies and our department has covered the cost for patients treated here. As a tertiary referral center, most of our patients are referred from other institutions and after discharge from our institution, are managed by referring physicians at peripheral centers. Late decisions regarding antiplatelet therapy are at their discretion.
Definition of LAST.
Late angiographic stent thrombosis is defined as late—occurring at least one month after DES implantation with acute symptoms; angiographic—stent thrombosis confirmed angiographically; stent thrombosis—defined as Thrombolysis In Myocardial Infarction (TIMI) flow 0 or 1 or the presence of flow-limiting thrombus (TIMI flow 1 or 2).
|
Results
|
|---|
Baseline and procedural characteristics.
The average age of our patients was 62 years, with 72% being male (Table 1). Over half had multivessel disease on angiography, one-third presented with unstable angina, and 22% with an acute myocardial infarction (MI) as the indication for treatment. Stent type was approximately equally distributed as was the enrolment period. On average, 1.9 lesions in 1.4 vessels were treated with 2.3 stents implanted, totaling 43 mm/patient.
Findings.
Follow-up was complete for 98% of the population. Mean follow-up was 1.5 ± 0.5 years. There were eight LAST events in seven patients, three with SES and five with PES (Tables 2 and 3), with an overall incidence of 0.35% (95% confidence limits 0.17% to 0.72%). All patients were male, and all presented at the time of LAST with an acute ST-segment elevation MI. Figure 1 is a representative example of LAST. No differences in patient characteristics (Table 1) were noted between patients with and without LAST. None of the 20 patients described in the previous report with early stent thrombosis (2) developed LAST.
View larger version (45K):
[in this window]
[in a new window]
|
Figure 1 Representative film of late angiographic stent thrombosis (LAST). (A) Index procedure, post-stent implantation, right coronary artery. (B) Late angiographic stent thrombosis with ST-segment elevation. (C) After wire passage, LAST demonstrating large thrombus burden.
|
|
There were two deaths in the seven patients with LAST. One death (Patient #6) occurred in a patient who received a SES to the left anterior descending coronary artery (LAD). Late angiographic stent thrombosis 25 months later resulted in a large anterior MI with cardiogenic shock and the patient died from refractory left ventricular failure two days later. The second death occurred in a patient (Patient #7) who had a pre-existing occlusion of the right coronary artery that received collaterals from the LAD. A single SES was implanted at a proximal LAD lesion. Late angiographic stent thrombosis 26 months later resulted in a large acute anterior MI with cardiogenic shock and the patient died on the catheterization table. Of note, in both these patients, initial attempts to pass a wire through the previous stent were unsuccessful because the wires, on each occasion, appeared to pass between the outside of the stent and the vessel wall. This is highly suggestive of acquired aneurysm formation at the stented site because on review, the initial procedural result was optimal. Due to hemodynamic instability, IVUS was not attempted. Autopsy was refused in both cases.
One patient (Patient #3) treated with a PES to the LAD developed two LAST events. The first occurred 11 months after the index procedure and re-presented with an anterior ST-segment elevation MI. He was treated with a new PES inside the original PES stent and lifelong clopidogrel was recommended; before discharge he was given his first prescription of six months worth of clopidogrel. He completed the prescribed six-month course of dual antiplatelet therapy and did not renew the prescription of clopidogrel. Twenty-one days later, he re-presented with lateral ST-segment elevation. Three new PES were used to re-canalize a diagonal branch occluded with thrombus. Intravascular ultrasound study did not reveal a specific contributory factor, in particular, there was no evidence of incomplete stent apposition.
With regard to antiplatelet therapy, three events occurred when patients had stopped all antiplatelet therapy (two were for non-cardiac surgery, and one due to non-compliance). Five events occurred in patients on aspirin monotherapy who had completed their prescribed course of clopidogrel. Two of these events occurred soon after (21 and 28 days) clopidogrel was stopped.
Treatment.
Balloon angioplasty was performed in all patients, followed by new DES implantation in seven of eight (Table 3). Glycoprotein IIb/IIIa inhibitors were used in five cases. Intravascular ultrasound was performed in two patients with no evidence of incomplete stent apposition noted. A thrombectomy device was used in two cases. After an episode of late stent thrombosis, prolonged clopidogrel therapy was empirically recommended.
|
Discussion
|
|---|
The purpose of this report is to highlight that LAST occurs with an incidence of at least 0.35% and possibly up to 0.72% after DES implantation. Furthermore, we have now observed that LAST may also occur not only in temporal relation to complete cessation of antiplatelet therapy (3), but may also occur shortly after clopidogrel is stopped but aspirin continued, and unexpectedly remote from clopidogrel cessation when patients were clinically stable on long-term aspirin therapy. We observed no episodes of LAST while patients were on dual antiplatelet therapy.
In the randomized trials of DES, late stent thrombosis has been reported. Two presumed late stent thromboses related to clopidogrel discontinuation were reported in the TAXUS-II trial (6). With SES, there has been one published report of LAST from the European multicenter, randomized, double-blind study of the SIRolImUS-coated Bx velocity balloon-expandable stent in the treatment of patients with de novo coronary artery lesions (E-SIRIUS) trial, with accompanying histological findings showing acquired aneurysm formation with eosinophilic infiltrates; the investigators concluded that LAST was due to a hypersensitive reaction to the polymer coating of the stent (7). Two of the LAST events we report occurred more than two years after SES implantation and both patients died. The timing of the events and the intraprocedural difficulty in wiring the lesion in both patients are potentially compatible with a similar etiology of LAST.
Late stent thrombosis was a major problem with the now discontinued QP2 stent program (8). The ongoing occurrence of stent thrombosis (3.2%, 7.1%, and 10.3% at 1, 6, and 12 months) in the Study to COmpare REstenosis Rate between QueST and QuaDDS-QP2 (SCORE) trial was attributed to the long duration of high-dose drug release and proinflammatory nature of the polymer sleeves.
Several mechanisms of LAST have been postulated: a local drug effect delaying endothelialization or results in the formation of a dysfunctional endothelium, a hypersensitivity, or inflammatory reaction to the polymer, or the development of neointimal hyperplasia with occlusive thrombus formation as the acute event. Furthermore, it is known that previous treatment with brachytherapy is associated with an increased risk of late stent thrombosis when on mono-antiplatelet therapy (4); however, no patient in this report had previous brachytherapy in the stented segment. The use of IVUS, if clinically feasible at the time of stent thrombosis, may help facilitate the elucidation of its etiology. However, their clinical condition often precludes a pre-intervention IVUS.
In patients with documented LAST, we empirically prescribe long-term dual antiplatelet therapy in an attempt to reduce recurrence. The use of long-term dual antiplatelet therapy for the primary prevention of LAST is more problematic. Although it would seem intuitive to do so, there is debate in published literature. There are data from the pre-DES era to suggest that in selected patients, prolonged dual antiplatelet therapy is associated with a reduction in major adverse cardiac events (9,10); however, such potent inhibition of platelet function is associated with an increased risk of major bleeding complications (11,12).
It is difficult to compare the incidence we have reported with that from the bare stent era due to the paucity of reports; a single center registry reported a late stent thrombosis incidence (defined as >30 days) of 0.76%, a figure not dissimilar to this report (13).
The results of this preliminary report expand our previous observations that LAST occurs with DES, demonstrate that it may occur when patients are receiving antiplatelet monotherapy, and provide an estimate of the expected rate in an unselected DES population. Its incidence is low, but potentially problematic given the rapid uptake of such stents. It is imperative that cardiologists and other doctors who treat these patients are aware of this potential late complication, and any decision to stop antiplatelet therapy for whatever reason must take this into account.
Study limitations.
This report is confined to patients who presented with acute symptoms and angiographically proven late stent thrombosis. The low frequency of postmortem studies performed in the Netherlands, which would have accurately determined the cause of death, precluded an accurate assessment of the overall rate of late stent thrombosis.
|
Footnotes
|
|---|
This study was supported by the Erasmus Medical Center, Rotterdam, and by unrestricted institutional grants from Boston Scientific Corporation and Cordis, a Johnson & Johnson company.
|
References
|
|---|
1. Babapulle MN, Joseph L, Belisle P, Brophy JM, Eisenberg MJ. A hierarchical Bayesian meta-analysis of randomised clinical trials of drug-eluting stents Lancet 2004;364:583-591.[CrossRef][Web of Science][Medline]
2. Ong AT, Hoye A, Aoki J, et al. Thirty-day incidence and six-month clinical outcome of thrombotic stent occlusion following bare metal, sirolimus, or paclitaxel stent implantation J Am Coll Cardiol 2005;45:947-953.[Abstract/Free Full Text]
3. McFadden EP, Stabile E, Regar E, et al. Late thrombosis in drug-eluting coronary stents after discontinuation of antiplatelet therapy Lancet 2004;364:1519-1521.[CrossRef][Web of Science][Medline]
4. Costa MA, Sabate M, van der Giessen WJ, et al. Late coronary occlusion after intracoronary brachytherapy Circulation 1999;100:789-792.[Abstract/Free Full Text]
5. Schwartz RS, Chronos NA, Virmani R. Preclinical restenosis models and drug-eluting stentsstill important, still much to learn. J Am Coll Cardiol 2004;44:1373-1385.[Abstract/Free Full Text]
6. Colombo A, Drzewiecki J, Banning A, et al. Randomized study to assess the effectiveness of slow- and moderate-release polymer-based paclitaxel-eluting stents for coronary artery lesions Circulation 2003;108:788-794.[Abstract/Free Full Text]
7. Virmani R, Guagliumi G, Farb A, et al. Localized hypersensitivity and late coronary thrombosis secondary to a sirolimus-eluting stentshould we be cautious?. Circulation 2004;109:701-705.[Abstract/Free Full Text]
8. Grube E, Lansky A, Hauptmann KE, et al. High-dose 7-hexanoyltaxol-eluting stent with polymer sleeves for coronary revascularizationone-year results from the SCORE randomized trial. J Am Coll Cardiol 2004;44:1368-1372.[Abstract/Free Full Text]
9. Mehta SR, Yusuf S, Peters RJ, et al. Effects of pretreatment with clopidogrel and aspirin followed by long-term therapy in patients undergoing percutaneous coronary interventionthe PCI-CURE study. Lancet 2001;358:527-533.[CrossRef][Web of Science][Medline]
10. Steinhubl SR, Berger PB, Mann 3rd JT, et al. Early and sustained dual oral antiplatelet therapy following percutaneous coronary interventiona randomized controlled trial. JAMA 2002;288:2411-2420.[Abstract/Free Full Text]
11. Eriksson P. Long-term clopidogrel therapy after percutaneous coronary intervention in PCI-CURE and CREDOthe "Emperor’s New Clothes" revisited. Eur Heart J 2004;25:720-722.[Free Full Text]
12. Diener HC, Bogousslavsky J, Brass LM, et al. Aspirin and clopidogrel compared with clopidogrel alone after recent ischaemic stroke or transient ischaemic attack in high-risk patients (MATCH)randomised, double-blind, placebo-controlled trial. Lancet 2004;364:331-337.[CrossRef][Web of Science][Medline]
13. Wang F, Stouffer GA, Waxman S, Uretsky BF. Late coronary stent thrombosis: early vs. late stent thrombosis in the stent era Catheter Cardiovasc Interventions 2002;55:142-147.
This article has been cited by other articles:
|
|
|
|
 
N. Kukreja, Y. Onuma, H. M. Garcia-Garcia, J. Daemen, R. van Domburg, P. W. Serruys, and on behalf of the Interventional cardiologists of t
The Risk of Stent Thrombosis in Patients With Acute Coronary Syndromes Treated With Bare-Metal and Drug-Eluting Stents
J. Am. Coll. Cardiol. Intv.,
June 1, 2009;
2(6):
534 - 541.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
S. Anwaruddin, A. T. Askari, H. Saudye, L. Batizy, P. L. Houghtaling, M. Alamoudi, M. Militello, K. Muhammad, S. Kapadia, and S. G. Ellis
Characterization of Post-Operative Risk Associated With Prior Drug-Eluting Stent Use
J. Am. Coll. Cardiol. Intv.,
June 1, 2009;
2(6):
542 - 549.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
B. Chevalier, S. Silber, S.-J. Park, E. Garcia, G. Schuler, H. Suryapranata, J. Koolen, K. E. Hauptmann, W. Wijns, M.-C. Morice, et al.
Randomized Comparison of the Nobori Biolimus A9-Eluting Coronary Stent With the Taxus Liberte Paclitaxel-Eluting Coronary Stent in Patients With Stenosis in Native Coronary Arteries: The NOBORI 1 Trial--Phase 2
Circ Cardiovasc Intervent,
June 1, 2009;
2(3):
188 - 195.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
G. Weisz, M. B. Leon, D. R. Holmes Jr, D. J. Kereiakes, J. J. Popma, P. S. Teirstein, S. A. Cohen, H. Wang, D. E. Cutlip, and J. W. Moses
Five-year follow-up after sirolimus-eluting stent implantation results of the SIRIUS (Sirolimus-Eluting Stent in De-Novo Native Coronary Lesions) Trial.
J. Am. Coll. Cardiol.,
April 28, 2009;
53(17):
1488 - 1497.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
Y. Han, Q. Jing, B. Xu, L. Yang, H. Liu, X. Shang, T. Jiang, Z. Li, H. Zhang, H. Li, et al.
Safety and Efficacy of Biodegradable Polymer-Coated Sirolimus-Eluting Stents in "Real-World" Practice: 18-Month Clinical and 9-Month Angiographic Outcomes
J. Am. Coll. Cardiol. Intv.,
April 1, 2009;
2(4):
303 - 309.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. H. Shishehbor, S. J. Filby, A. K. Chhatriwalla, R. D. Christofferson, A. Jain, S. R. Kapadia, A. M. Lincoff, D. L. Bhatt, and S. G. Ellis
Impact of Drug-Eluting Versus Bare-Metal Stents on Mortality in Patients With Anemia
J. Am. Coll. Cardiol. Intv.,
April 1, 2009;
2(4):
329 - 336.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
A. C. Philpott MD, D. A. Southern MSc, F. M. Clement PhD, P. D. Galbraith BN MSc, M. Traboulsi MD, M. L. Knudtson MD, W. A. Ghali MD, and for the APPROACH Investigators
Long-term outcomes of patients receiving drug-eluting stents
Can. Med. Assoc. J.,
January 20, 2009;
180(2):
167 - 174.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
J. P. Chen, L. V. Crisco, R. Jabara, and S. B. King III
Late Angiographic Stent Thrombosis: The LAST Straw for Drug-Eluting Stents?
Angiology,
January 1, 2009;
59(6):
667 - 675.
[Abstract]
[PDF]
|
|
|
|
|
|
|
S.-J. Park and Y.-H. Kim
Current Status of Percutaneous Coronary Intervention With Drug-Eluting Stents in Asia
Circulation,
December 16, 2008;
118(25):
2730 - 2737.
[Full Text]
[PDF]
|
|
|
|
|
|
|
B. Shoulders-Odom
Management of Patients After Percutaneous Coronary Interventions
Crit. Care Nurse,
October 1, 2008;
28(5):
26 - 40.
[Full Text]
[PDF]
|
|
|
|
|
|
|
L. T. Newsome, M. A. Kutcher, and R. L. Royster
Coronary Artery Stents: Part I. Evolution of Percutaneous Coronary Intervention
Anesth. Analg.,
August 1, 2008;
107(2):
552 - 569.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
S. G. Ellis, C. D. O'Shaughnessy, S. L. Martin, K. Kent, T. McGarry, M. A. Turco, D. J. Kereiakes, J. J. Popma, M. Friedman, J. Koglin, et al.
Two-year clinical outcomes after paclitaxel-eluting stent or brachytherapy treatment for bare metal stent restenosis: the TAXUS V ISR trial
Eur. Heart J.,
July 1, 2008;
29(13):
1625 - 1634.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
E. Meliga, H. M. Garcia-Garcia, M. Valgimigli, A. Chieffo, G. Biondi-Zoccai, A. O. Maree, S. Cook, L. Reardon, C. Moretti, S. De Servi, et al.
Longest available clinical outcomes after drug-eluting stent implantation for unprotected left main coronary artery disease: the DELFT (Drug Eluting stent for LeFT main) Registry.
J. Am. Coll. Cardiol.,
June 10, 2008;
51(23):
2212 - 2219.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
P. Foley, S. Foley, T. Kinnaird, and R.A. Anderson
Clinical review: gastrointestinal bleeding after percutaneous coronary intervention: a deadly combination
QJM,
June 1, 2008;
101(6):
425 - 433.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
P. Garg, D. J. Cohen, T. Gaziano, and L. Mauri
Balancing the Risks of Restenosis and Stent Thrombosis in Bare-Metal Versus Drug-Eluting Stents: Results of a Decision Analytic Model
J. Am. Coll. Cardiol.,
May 13, 2008;
51(19):
1844 - 1853.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
C. L. Grines, J. A. Goldstein, and R. D. Safian
Should We Routinely Use Drug-Eluting Stents for Acute Myocardial Infarction?: Let's Wait and See
J. Am. Coll. Cardiol. Intv.,
April 1, 2008;
1(2):
136 - 138.
[Full Text]
[PDF]
|
|
|
|
|
|
|
J. M. de la Torre-Hernandez, F. Alfonso, F. Hernandez, J. Elizaga, M. Sanmartin, E. Pinar, I. Lozano, J. M. Vazquez, J. Botas, A. Perez de Prado, et al.
Drug-eluting stent thrombosis: results from the multicenter Spanish registry ESTROFA (Estudio ESpanol sobre TROmbosis de stents FArmacoactivos).
J. Am. Coll. Cardiol.,
March 11, 2008;
51(10):
986 - 990.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
R. J. Applegate, M. T. Sacrinty, M. A. Kutcher, R. M. Santos, S. K. Gandhi, T. T. Baki, and W. C. Little
"Off-label" stent therapy 2-year comparison of drug-eluting versus bare-metal stents.
J. Am. Coll. Cardiol.,
February 12, 2008;
51(6):
607 - 614.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
F Prati, M Zimarino, E Stabile, G Pizzicannella, T Fouad, R Rabozzi, A Filippini, J Pizzicannella, M Cera, and R De Caterina
Does optical coherence tomography identify arterial healing after stenting? An in vivo comparison with histology, in a rabbit carotid model
Heart,
February 1, 2008;
94(2):
217 - 221.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
J. M. Wilson and J. T. Willerson
Myocardial Revascularization with Percutaneous Devices
Card. Surg. Adult,
January 1, 2008;
3(2008):
573 - 598.
[Full Text]
|
|
|
|
|
|
|
E. Grube, K. D. Dawkins, G. Guagliumi, A. P. Banning, K. Zmudka, A. Colombo, L. Thuesen, K. Hauptman, J. Marco, W. Wijns, et al.
TAXUS VI 2-year follow-up: randomized comparison of polymer-based paclitaxel-eluting with bare metal stents for treatment of long, complex lesions
Eur. Heart J.,
November 1, 2007;
28(21):
2578 - 2582.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
L. A. Fleisher, J. A. Beckman, K. A. Brown, H. Calkins, E. L. Chaikof, K. E. Fleischmann, W. K. Freeman, J. B. Froehlich, E. K. Kasper, J. R. Kersten, et al.
ACC/AHA 2007 Guidelines on Perioperative Cardiovascular Evaluation and Care for Noncardiac Surgery: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 2002 Guidelines on Perioperative Cardiovascular Evaluation for Noncardiac Surgery) Developed in Collaboration With the American Society of Echocardiography, American Society of Nuclear Cardiology, Heart Rhythm Society, Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, Society for Vascular Medicine and Biology, and Society for Vascular Surgery
J. Am. Coll. Cardiol.,
October 23, 2007;
50(17):
e159 - e242.
[Full Text]
[PDF]
|
|
|
|
|
|
|
L. A. Fleisher, J. A. Beckman, K. A. Brown, H. Calkins, E. L. Chaikof, K. E. Fleischmann, W. K. Freeman, J. B. Froehlich, E. K. Kasper, J. R. Kersten, et al.
ACC/AHA 2007 Guidelines on Perioperative Cardiovascular Evaluation and Care for Noncardiac Surgery: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 2002 Guidelines on Perioperative Cardiovascular Evaluation for Noncardiac Surgery)
Circulation,
October 23, 2007;
116(17):
e418 - e500.
[Full Text]
[PDF]
|
|
|
|
|
|
|
A. E. Rodriguez, A. O. Maree, J. Mieres, D. Berrocal, L. Grinfeld, C. Fernandez-Pereira, V. Curotto, A. Rodriguez-Granillo, W. O'Neill, and I. F. Palacios
Late loss of early benefit from drug-eluting stents when compared with bare-metal stents and coronary artery bypass surgery: 3 years follow-up of the ERACI III registry
Eur. Heart J.,
September 1, 2007;
28(17):
2118 - 2125.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
P.-G. Chassot, A. Delabays, and D. R. Spahn
Perioperative antiplatelet therapy: the case for continuing therapy in patients at risk of myocardial infarction
Br. J. Anaesth.,
September 1, 2007;
99(3):
316 - 328.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
J. Daemen and P. W. Serruys
Drug-Eluting Stent Update 2007: Part II: Unsettled Issues
Circulation,
August 21, 2007;
116(8):
961 - 968.
[Full Text]
[PDF]
|
|
|
|
|
|
|
F. Airoldi, A. Colombo, N. Morici, A. Latib, J. Cosgrave, L. Buellesfeld, E. Bonizzoni, M. Carlino, U. Gerckens, C. Godino, et al.
Incidence and Predictors of Drug-Eluting Stent Thrombosis During and After Discontinuation of Thienopyridine Treatment
Circulation,
August 14, 2007;
116(7):
745 - 754.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
J. Machecourt, N. Danchin, J. M. Lablanche, J. M. Fauvel, J. L. Bonnet, S. Marliere, A. Foote, J. L. Quesada, H. Eltchaninoff, G. Vanzetto, et al.
Risk Factors for Stent Thrombosis After Implantation of Sirolimus-Eluting Stents in Diabetic and Nondiabetic Patients: The EVASTENT Matched-Cohort Registry
J. Am. Coll. Cardiol.,
August 7, 2007;
50(6):
501 - 508.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. Valgimigli, G. Campo, C. Arcozzi, P. Malagutti, R. Carletti, F. Ferrari, D. Barbieri, G. Parrinello, G. Percoco, and R. Ferrari
Two-Year Clinical Follow-Up After Sirolimus-Eluting Versus Bare-Metal Stent Implantation Assisted by Systematic Glycoprotein IIb/IIIa Inhibitor Infusion in Patients With Myocardial Infarction: Results From the STRATEGY Study
J. Am. Coll. Cardiol.,
July 10, 2007;
50(2):
138 - 145.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
S. Kaul, P. K. Shah, and G. A. Diamond
As Time Goes By: Current Status and Future Directions in the Controversy Over Stenting
J. Am. Coll. Cardiol.,
July 10, 2007;
50(2):
128 - 137.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
R. Jaffe and B. H. Strauss
Late and Very Late Thrombosis of Drug-Eluting Stents: Evolving Concepts and Perspectives
J. Am. Coll. Cardiol.,
July 10, 2007;
50(2):
119 - 127.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
D. R. Holmes Jr, D. J. Kereiakes, W. K. Laskey, A. Colombo, S. G. Ellis, T. D. Henry, J. J. Popma, P. W.J.C. Serruys, T. Kimura, D. O. Williams, et al.
Thrombosis and Drug-Eluting Stents: An Objective Appraisal
J. Am. Coll. Cardiol.,
July 10, 2007;
50(2):
109 - 118.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
E. S. Brilakis, S. Banerjee, and P. B. Berger
Perioperative Management of Patients With Coronary Stents
J. Am. Coll. Cardiol.,
June 5, 2007;
49(22):
2145 - 2150.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
D. F. Kallmes and H. M. Do
Wherefore Wingspan?
AJNR Am. J. Neuroradiol.,
June 1, 2007;
28(6):
997 - 998.
[Full Text]
[PDF]
|
|
|
|
|
|
|
S. Cook, P. Wenaweser, M. Togni, M. Billinger, C. Morger, C. Seiler, R. Vogel, O. Hess, B. Meier, and S. Windecker
Incomplete Stent Apposition and Very Late Stent Thrombosis After Drug-Eluting Stent Implantation
Circulation,
May 8, 2007;
115(18):
2426 - 2434.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
C. L. Grines, R. O. Bonow, D. E. Casey Jr, T. J. Gardner, P. B. Lockhart, D. J. Moliterno, P. O'Gara, and P. Whitlow
Prevention of premature discontinuation of dual antiplatelet therapy in patients with coronary artery stents: A science advisory from the American Heart Association, American College of Cardiology, Society for Cardiovascular Angiography and Interventions, American College of Surgeons, and American Dental Association, with representation from the American College of Physicians
J Am Dent Assoc,
May 1, 2007;
138(5):
652 - 655.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
A. Abbate, G. G.L. Biondi-Zoccai, P. Agostoni, M. J. Lipinski, and G. W. Vetrovec
Recurrent angina after coronary revascularization: a clinical challenge
Eur. Heart J.,
May 1, 2007;
28(9):
1057 - 1065.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
D. E. Cutlip, S. Windecker, R. Mehran, A. Boam, D. J. Cohen, G.-A. van Es, P. Gabriel Steg, M.-a. Morel, L. Mauri, P. Vranckx, et al.
Clinical End Points in Coronary Stent Trials: A Case for Standardized Definitions
Circulation,
May 1, 2007;
115(17):
2344 - 2351.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
E. Camenzind, P. G. Steg, and W. Wijns
A Cause for Concern
Circulation,
March 20, 2007;
115(11):
1440 - 1455.
[Full Text]
[PDF]
|
|
|
|
|
|
|
P. W. Serruys and J. Daemen
Late Stent Thrombosis: A Nuisance in Both Bare Metal and Drug-Eluting Stents
Circulation,
March 20, 2007;
115(11):
1433 - 1439.
[Full Text]
[PDF]
|
|
|
|
|
|
|
S. G. Ellis, A. Colombo, E. Grube, J. Popma, J. Koglin, K. D. Dawkins, and G. W. Stone
Incidence, Timing, and Correlates of Stent Thrombosis With the Polymeric Paclitaxel Drug-Eluting Stent: A TAXUS II, IV, V, and VI Meta-Analysis of 3,445 Patients Followed for Up to 3 Years
J. Am. Coll. Cardiol.,
March 13, 2007;
49(10):
1043 - 1051.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
C. Spaulding, J. Daemen, E. Boersma, D. E. Cutlip, and P. W. Serruys
A Pooled Analysis of Data Comparing Sirolimus-Eluting Stents with Bare-Metal Stents
N. Engl. J. Med.,
March 8, 2007;
356(10):
989 - 997.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
G. W. Stone, J. W. Moses, S. G. Ellis, J. Schofer, K. D. Dawkins, M.-C. Morice, A. Colombo, E. Schampaert, E. Grube, A. J. Kirtane, et al.
Safety and Efficacy of Sirolimus- and Paclitaxel-Eluting Coronary Stents
N. Engl. J. Med.,
March 8, 2007;
356(10):
998 - 1008.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
L. Mauri, W.-h. Hsieh, J. M. Massaro, K. K.L. Ho, R. D'Agostino, and D. E. Cutlip
Stent Thrombosis in Randomized Clinical Trials of Drug-Eluting Stents
N. Engl. J. Med.,
March 8, 2007;
356(10):
1020 - 1029.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
H.-P. B.-L. Rocca, C. Kaiser, M. Pfisterer, and on behalf of the BASKET Investigators
Targeted stent use in clinical practice based on evidence from the BAsel Stent Cost Effectiveness Trial (BASKET)
Eur. Heart J.,
March 2, 2007;
28(6):
719 - 725.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
T. F. Luscher, J. Steffel, F. R. Eberli, M. Joner, G. Nakazawa, F. C. Tanner, and R. Virmani
Drug-Eluting Stent and Coronary Thrombosis: Biological Mechanisms and Clinical Implications
Circulation,
February 27, 2007;
115(8):
1051 - 1058.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
C. L. Grines, R. O. Bonow, D. E. Casey Jr, T. J. Gardner, P. B. Lockhart, D. J. Moliterno, P. O'Gara, and P. Whitlow
Prevention of Premature Discontinuation of Dual Antiplatelet Therapy in Patients With Coronary Artery Stents: A Science Advisory From the American Heart Association, American College of Cardiology, Society for Cardiovascular Angiography and Interventions, American College of Surgeons, and American Dental Association, With Representation From the American College of Physicians
J. Am. Coll. Cardiol.,
February 13, 2007;
49(6):
734 - 739.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
C. L. Grines, R. O. Bonow, D. E. Casey Jr, T. J. Gardner, P. B. Lockhart, D. J. Moliterno, P. O'Gara, and P. Whitlow
Prevention of Premature Discontinuation of Dual Antiplatelet Therapy in Patients With Coronary Artery Stents: A Science Advisory From the American Heart Association, American College of Cardiology, Society for Cardiovascular Angiography and Interventions, American College of Surgeons, and American Dental Association, With Representation From the American College of Physicians
Circulation,
February 13, 2007;
115(6):
813 - 818.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
G. J. Mishkel, A. L. Moore, S. Markwell, M. C. Shelton, and M. E. Shelton
Long-Term Outcomes After Management of Restenosis or Thrombosis of Drug-Eluting Stents
J. Am. Coll. Cardiol.,
January 16, 2007;
49(2):
181 - 184.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. J. Kern
Attenuated Coronary Collateral Function After Drug-Eluting Stent Implantation: A New Downside of Drug-Eluting Stents?
J. Am. Coll. Cardiol.,
January 2, 2007;
49(1):
21 - 22.
[Full Text]
[PDF]
|
|
|
|
|
|
|
P. Meier, R. Zbinden, M. Togni, P. Wenaweser, S. Windecker, B. Meier, and C. Seiler
Coronary Collateral Function Long After Drug-Eluting Stent Implantation
J. Am. Coll. Cardiol.,
January 2, 2007;
49(1):
15 - 20.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
J. Daemen, H. M. Garcia-Garcia, N. Kukreja, F. Imani, P. P.T. de Jaegere, G. Sianos, R. T. van Domburg, and P. W. Serruys
The long-term value of sirolimus- and paclitaxel-eluting stents over bare metal stents in patients with diabetes mellitus
Eur. Heart J.,
January 1, 2007;
28(1):
26 - 32.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. Pfisterer, H. P. Brunner-La Rocca, P. T. Buser, P. Rickenbacher, P. Hunziker, C. Mueller, R. Jeger, F. Bader, S. Osswald, C. Kaiser, et al.
Late Clinical Events After Clopidogrel Discontinuation May Limit the Benefit of Drug-Eluting Stents: An Observational Study of Drug-Eluting Versus Bare-Metal Stents
J. Am. Coll. Cardiol.,
December 19, 2006;
48(12):
2584 - 2591.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
P. Vermeersch, P. Agostoni, S. Verheye, P. Van den Heuvel, C. Convens, N. Bruining, F. Van den Branden, and G. Van Langenhove
Randomized Double-Blind Comparison of Sirolimus-Eluting Stent Versus Bare-Metal Stent Implantation in Diseased Saphenous Vein Grafts: Six-Month Angiographic, Intravascular Ultrasound, and Clinical Follow-Up of the RRISC Trial
J. Am. Coll. Cardiol.,
December 19, 2006;
48(12):
2423 - 2431.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
D. R. Holmes Jr, J. W. Moses, J. Schofer, M.-C. Morice, E. Schampaert, and M. B. Leon
Cause of death with bare metal and sirolimus-eluting stents
Eur. Heart J.,
December 1, 2006;
27(23):
2815 - 2822.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
G. G.L. Biondi-Zoccai, M. Lotrionte, P. Agostoni, A. Abbate, M. Fusaro, F. Burzotta, L. Testa, I. Sheiban, and G. Sangiorgi
A systematic review and meta-analysis on the hazards of discontinuing or not adhering to aspirin among 50 279 patients at risk for coronary artery disease
Eur. Heart J.,
November 2, 2006;
27(22):
2667 - 2674.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
W. Desmet
Delayed neointimal healing after drug-eluting stent implantation: seeing is believing
Eur. Heart J.,
September 2, 2006;
27(18):
2147 - 2149.
[Full Text]
[PDF]
|
|
|
|
|
|
|
H. B. Barner
Status of percutaneous coronary intervention and coronary artery bypass.
Eur. J. Cardiothorac. Surg.,
September 1, 2006;
30(3):
419 - 424.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
B. E. Stahli, G. G. Camici, J. Steffel, A. Akhmedov, K. Shojaati, M. Graber, T. F. Luscher, and F. C. Tanner
Paclitaxel Enhances Thrombin-Induced Endothelial Tissue Factor Expression via c-Jun Terminal NH2 Kinase Activation
Circ. Res.,
July 21, 2006;
99(2):
149 - 155.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. Joner, A. V. Finn, A. Farb, E. K. Mont, F. D. Kolodgie, E. Ladich, R. Kutys, K. Skorija, H. K. Gold, and R. Virmani
Pathology of Drug-Eluting Stents in Humans: Delayed Healing and Late Thrombotic Risk
J. Am. Coll. Cardiol.,
July 4, 2006;
48(1):
193 - 202.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
K. N. Charbucinska, G. Godet, O. Itani, M.-H. Fleron, M. Bertrand, M. Rienzo, and P. Coriat
Anticoagulation management for patients with drug-eluting stents undergoing vascular surgery.
Anesth. Analg.,
July 1, 2006;
103(1):
261 - 263.
[Full Text]
[PDF]
|
|
|
|
|
|
|
R. Tung, S. Kaul, G. A. Diamond, and P. K. Shah
Narrative review: drug-eluting stents for the management of restenosis: a critical appraisal of the evidence.
Ann Intern Med,
June 20, 2006;
144(12):
913 - 919.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
P. Jimenez-Quevedo, M. Sabate, D. J. Angiolillo, M. A. Costa, F. Alfonso, J. A. Gomez-Hospital, R. Hernandez-Antolin, C. Banuelos, J. Goicolea, F. Fernandez-Aviles, et al.
Vascular Effects of Sirolimus-Eluting Versus Bare-Metal Stents in Diabetic Patients: Three-Dimensional Ultrasound Results of the Diabetes and Sirolimus-Eluting Stent (DIABETES) Trial
J. Am. Coll. Cardiol.,
June 6, 2006;
47(11):
2172 - 2179.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
D. J. Kereiakes and D. P. Faxon
Left Main Coronary Revascularization at the Crossroads
Circulation,
May 30, 2006;
113(21):
2480 - 2484.
[Full Text]
[PDF]
|
|
|
|
|
|
|
J.-H. Buhk, A. Wellmer, and M. Knauth
Late in-stent thrombosis following carotid angioplasty and stenting
Neurology,
May 23, 2006;
66(10):
1594 - 1596.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
S. Tsimikas
Drug-Eluting Stents and Late Adverse Clinical Outcomes: Lessons Learned, Lessons Awaited
J. Am. Coll. Cardiol.,
May 16, 2006;
47(10):
2112 - 2115.
[Full Text]
[PDF]
|
|
|
|
|
|
|
J.-i. Kotani, M. Awata, S. Nanto, M. Uematsu, F. Oshima, H. Minamiguchi, G. S. Mintz, and S. Nagata
Incomplete Neointimal Coverage of Sirolimus-Eluting Stents: Angioscopic Findings
J. Am. Coll. Cardiol.,
May 16, 2006;
47(10):
2108 - 2111.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
F. Pugliese, F. Cademartiri, C. van Mieghem, W. B. Meijboom, P. Malagutti, N. R. A. Mollet, C. Martinoli, P. J. de Feyter, and G. P. Krestin
Multidetector CT for visualization of coronary stents.
RadioGraphics,
May 1, 2006;
26(3):
887 - 904.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
S. R. Dixon, C. L. Grines, and W. W. O'Neill
The Year in Interventional Cardiology
J. Am. Coll. Cardiol.,
April 18, 2006;
47(8):
1689 - 1706.
[Full Text]
[PDF]
|
|
|
|
|
|
|
A. T.L. Ong, R. T. van Domburg, J. Aoki, K. Sonnenschein, P. A. Lemos, and P. W. Serruys
Sirolimus-Eluting Stents Remain Superior to Bare-Metal Stents at Two Years: Medium-Term Results From the Rapamycin-Eluting Stent Evaluated at Rotterdam Cardiology Hospital (RESEARCH) Registry
J. Am. Coll. Cardiol.,
April 4, 2006;
47(7):
1356 - 1360.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
C H Lee, J Lim, A Low, H C Tan, and Y T Lim
Late angiographic stent thrombosis of polymer based paclitaxel eluting stent.
Heart,
April 1, 2006;
92(4):
551 - 553.
[Full Text]
[PDF]
|
|
|
|
|
|
|
P. K. Kuchulakanti, W. W. Chu, R. Torguson, P. Ohlmann, S.-W. Rha, L. C. Clavijo, S.-W. Kim, A. Bui, N. Gevorkian, Z. Xue, et al.
Correlates and Long-Term Outcomes of Angiographically Proven Stent Thrombosis With Sirolimus- and Paclitaxel-Eluting Stents
Circulation,
February 28, 2006;
113(8):
1108 - 1113.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
R. Wessely, A. Schomig, and A. Kastrati
Sirolimus and Paclitaxel on Polymer-Based Drug-Eluting Stents: Similar But Different
J. Am. Coll. Cardiol.,
February 21, 2006;
47(4):
708 - 714.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
P. W. Serruys, M. J.B. Kutryk, and A. T.L. Ong
Coronary-Artery Stents
N. Engl. J. Med.,
February 2, 2006;
354(5):
483 - 495.
[Full Text]
[PDF]
|
|
|
|
Top
Abstract
Methods