Category Archives: Drug-Eluting Stents

Post-Dilatation Stent Sizes

2018 stent expansion chart

click for hi-res PDF of chart

For the interventionalist, proper sizing of coronary stents is critical. While imaging via angiography has been the standard for years, newer intravascular imaging technologies, such as IVUS and OCT, are becoming more widely used, as evidence accrues that these modalities make a difference in outcomes. For example, IVUS (Intravascular Ultrasound) not only allows the measurement of the exact open diameter of the vessel, as seen on angiography, but it shows the “invisible to angiography” layer of plaque. plaque that will be compressed, so that a more accurate post-PCI diameter can be determined. Under-expanded stents have been associated with increased stent thrombosis and restenosis. Continue reading

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Filed under Angiograms, Drug-Eluting Stents, Imaging, IVUS, OCT, Stent, Stent Thrombosis

NORSTENT: Drug-Eluting Stents – Doing What They’re Supposed To

Coronary StentsAt this week’s annual European Society of Cardiology Congress in Rome, an important randomized clinical trial on stents was presented by Professor Kaare H. Bønaa, MD, PhD of the Clinic for Heart Disease, St. Olav’s University Hospital in Trondheim, Norway. Called NORSTENT, short for the “Norwegian Coronary Stent Trial,” this was the largest stent trial ever conducted, with 9,013 patients followed for six years. That’s serious! Continue reading

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Filed under Antiplatelet Medications, Back to the Future, Bare Metal Stents, Clinical Trials / Studies, Cost Effectiveness, Diabetes, Drug-Eluting Stents, Europe, Global Trends, Media Coverage, Meetings & Conferences, Patient Experience, Patients, Stent, Stent Thrombosis

COURAGE: Does 15-Year Data Have Any Clinical Relevance?

pills_vs_stent_140sqThis past week saw publication of an update to the 2007 COURAGE trial which compared optimal medical therapy (OMT) to stenting (PCI) as the initial management strategy for stable coronary artery disease. (Please note the phrase “initial management strategy.” This will not be the last time you see it in this post.)

Appearing in the New England Journal of Medicine and titled “Effect of PCI on Long-Term Survival in Patients with Stable Ischemic Heart Disease,” this study, performed by Dr. Steven P. Sedlis and other COURAGE trial investigators, is described as “an extended survival analysis to examine the potential long-term survival benefit from initial PCI among the patients with stable ischemic heart disease who were followed for up to 15 years after initial enrollment in the COURAGE trial.”

This new analysis concluded: “…we did not find a difference in survival between an initial strategy of PCI plus medical therapy and medical therapy alone in patients with stable ischemic heart disease.” This also was the finding of the original COURAGE trial at five years. Continue reading

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Filed under Appropriate Use Criteria (AUC), Bare Metal Stents, Clinical Trials / Studies, COURAGE, Drug-Eluting Stents, FAME I / FAME II, FFR, Intravascular Guidance, IVUS, OCT, Optimal Medical Therapy, Stent

Plavix and Aspirin After Stent: 8 Years Later – Is Longer Better?

plavix_and_stentNo one thought it would take quite so long to get this information, but in just a couple hours results from the Dual Antiplatelet Therapy (DAPT) Study will be presented at the American Heart Association Scientific Sessions 2014. The question to be answered: Is there a benefit to extending dual antiplatelet therapy (aspirin plus a thienopyridine, such as clopidogrel/Plavix, prasugrel/Effient, etc.) beyond one year after stenting?

This is a question asked back in 2006, during a special two-day FDA hearing, convened to discuss all known issues with drug-eluting stents and prompted by the “ESC firestorm” over the problems of increased incidence of late stent thrombosis in drug-eluting stents. (See “Problems Resurface with Drug-Eluting Stents” – September 9, 2006.) Continue reading

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Filed under Antiplatelet Medications, Bare Metal Stents, Clinical Trials / Studies, Drug-Eluting Stents, Global Trends, Meetings & Conferences, Optimal Medical Therapy, Stent Thrombosis

George W. Bush Gets Angioplasty and Stent – Was It Necessary?

George W BushFormer President George W. Bush received an angioplasty and stent this morning at Texas Health Presbyterian Hospital Dallas. The stent was recommended by Bush’s doctors to open a blockage in one of his coronary arteries, found yesterday during what was described by Bush spokesman Freddy Ford as his annual physical exam at the Cooper Clinic in Dallas. Continue reading

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Filed under Angiograms, Appropriate Use Criteria (AUC), Cardiac CT, Celebrity Patients, COURAGE, Drug-Eluting Stents, FFR, Imaging, Media Coverage, Non-Invasive Testing, Optimal Medical Therapy, Stent

Stent Wars, the Prequel: PROMUS Element “Beats” Xience

Jar Jar Binks and StentSorry Jar-Jar. We all know that Episodes 1-3 of “Star Wars” just didn’t cut it when compared with the original trilogy. Although these prequels were technically more sophisticated, and the digital rendering was way more advanced, the stories were just…boring.

I started the wordplay about “Stent Wars” over a decade ago, a time when the competitive juices of the two device-makers, Boston Scientific and J&J/Cordis, were at an all time peak — each company was heavily marketing their first generation drug-eluting stent and every interventional cardiology meeting was saturated with “Cypher vs. Taxus” messaging. Continue reading

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Filed under Drug-Eluting Stents, Stent, Stent Wars

Meta-Analysis Shows Benefit of Drug-Eluting Stents vs BMS Below the Knee

Frank J. Criado, MD

Frank J. Criado, MD

Guest Post by Frank J. Criado, MD, FACS, FSVM, editor in chief of Vascular Disease Management.

(Editor’s note: this article is the first in a series of guest posts, a new collaboration between Angioplasty.Org and Vascular Disease Management.)

In the introductory remarks of “Meta-Analysis of Outcomes of Endovascular Treatment of Infrapopliteal Occlusive Disease With Drug-Eluting Stents,” lead author George A. Antoniou and his colleagues, from the Manchester Royal Infirmary in the UK, state that:

“Emerging evidence suggests that the combination of stenting and targeted delivery of drugs with antiproliferative properties, aiming to inhibit smooth muscle cell proliferation and intimal hyperplasia, improves the outcomes of endoluminal treatments of distal vessel disease. A small number of series have demonstrated satisfactory performance of drug-eluting stents, as expressed by increased patency and freedom from revascularisation to maintain good clinical results. Controversy exists, however, with regard to the superiority of drug-eluting stents over bare metal stents in terms of the clinical benefit in critical limb ischaemia patients.” Continue reading

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Filed under Bare Metal Stents, Drug-Eluting Stents, Guest Post, Peripheral Artery Disease (PAD), Stent