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Seungjung Park - One of the best experts on this subject based on the ideXlab platform.
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optical coherence tomographic analysis of in Stent neoatherosclerosis after drug eluting Stent implantation
Circulation, 2011Co-Authors: Soojin Kang, Takashi Akasaka, Seungjung ParkAbstract:Background—We report findings from optical coherence tomography (OCT) of in-Stent neoatherosclerosis as a cause of Drug-Eluting Stent (DES) failure. Methods and Results—Optical coherence tomography and grayscale and virtual histology intravascular ultrasound were performed in 50 patients (30 stable, 20 unstable angina) with 50 DES in-Stent restenosis lesions and intimal hyperplasia >50% of Stent area. Median follow-up time was 32.2 months. Overall, 26 lesions (52%) had at least 1 OCT-defined in-Stent thin-cap fibroatheroma (TCFA)–containing neointima and 29 (58%) had at least 1 in-Stent neointimal rupture. Patients presenting with unstable angina showed a thinner fibrous cap (55 μm [interquartile range 42 to 105 μm] versus 100 μm [interquartile range 60 to 205 μm], P=0.006) and higher incidence of OCT-defined TCFA-containing neointima (75% versus 37%, P=0.008), intimal rupture (75% versus 47%, P=0.044), thrombi (80% versus 43%, P=0.010), and red thrombi (30% versus 3%, P=0.012) than stable patients. Fibro...
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impact of angiographic complete revascularization after drug eluting Stent implantation or coronary artery bypass graft surgery for multivessel coronary artery disease
Circulation, 2011Co-Authors: Hae Geun Song, Junhyok Oh, Soojin Kang, Jong-seon Park, Seungjung ParkAbstract:Background—This study sought to evaluate the clinical impact of angiographic complete revascularization (CR) after Drug-Eluting Stent implantation or coronary artery bypass graft surgery for multivessel coronary disease. Methods and Results—A total of 1914 consecutive patients with multivessel coronary disease undergoing Drug-Eluting Stent implantation (1400 patients) or coronary artery bypass graft surgery (514 patients) were enrolled. Angiographic CR was defined as revascularization in all diseased segments according to the Synergy Between PCI With Taxus and Cardiac Surgery classification. The outcomes of patients undergoing CR were compared with those undergoing incomplete revascularization (IR) after adjustments with the inverse-probability-of-treatment weighting method. Angiographic CR was performed in 917 patients (47.9%) including 573 percutaneous coronary intervention (40.9%) and 344 coronary artery bypass graft (66.9%) patients. CR patients were younger and had more extensive coronary disease tha...
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mechanisms of in Stent restenosis after drug eluting Stent implantation intravascular ultrasound analysis
Circulation-cardiovascular Interventions, 2011Co-Authors: Soojin Kang, Cheol Whan Lee, Seungwhan Lee, Younghak Kim, Kihoon Han, Jaejoong Kim, Gary S Mintz, Dukwoo Park, Seongwook Park, Seungjung ParkAbstract:Background —We used intravascular ultrasound (IVUS) to (1) clarify the mechanisms of luminal loss after Drug-Eluting Stent (DES) implantation and (2) classify morphological patterns of in-Stent restenosis (ISR). Methods and Results —On the basis of IVUS-identified luminal narrowing (in-Stent minimum lumen area 10 mm in length) with or without Stent edge involvement. Significant intimal hyperplasia (IH) was defined as IH area >50% of Stent. Overall, 76 lesions had IVUS-defined ISR; 32 (42%) had Stent underexpansion (minimal Stent area 50% of Stent. Total Stent length negatively correlated with minimal Stent area ( r =−0.613, P 28 mm, even though there was significant IH in 34 (79%) lesions; conversely, in 32 of 33 (97%) lesions with Stent length ≤28 mm, the minimum lumen site was not associated with Stent underexpansion but significant IH. IVUS-defined focal ISR was most common (47%). Compared with focal ISR, normalized vessel, Stent, lumen, and plaque volumes were smaller in diffuse and multifocal than focal ISR, with no difference in IH extent. Conclusions —In most DES restenosis, IH was the dominant mechanism of ISR. Nevertheless, underexpansion associated with longer Stent length remained an important preventable mechanism of ISR.
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late and very late drug eluting Stent malapposition
Circulation-cardiovascular Interventions, 2010Co-Authors: Soojin Kang, Cheol Whan Lee, Seungwhan Lee, Younghak Kim, Kihoon Han, Jaejoong Kim, Seungjung ParkAbstract:Background—The long-term natural history of acquired malapposition continues to be the subject of debate. Methods and Results—Using volumetric intravascular ultrasound analyses, we evaluated serial (postStenting, 6-month, and 2-year follow-up) changes in Drug-Eluting Stent–treated vascular segments with acquired malapposition. External elastic membrane, Stent, lumen, malapposition, and periStent plaque+media (P+M=external elastic membrane −Stent− malapposition) areas were measured; and volumes were calculated and divided by Stent length (normalized volume). Among 250 lesions in which complete serial intravascular ultrasound data were available, Stent malapposition was identified in 19 lesions (7.6%) at 6 months, and an additional 13 malapposition lesions were newly detected at 2 years (5.2%). Because no malapposition sites resolved, the malapposition rate at 2 years was 12.8%. Malapposition areas and volumes were correlated to the increases in external elastic membrane (positive remodeling) throughout the...
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late and very late drug eluting Stent malapposition serial 2 year quantitative ivus analysis
Circulation-cardiovascular Interventions, 2010Co-Authors: Soojin Kang, Cheol Whan Lee, Seungwhan Lee, Younghak Kim, Kihoon Han, Jaejoong Kim, Seungjung ParkAbstract:Background —The long-term natural history of acquired malapposition continues to be the subject of debate. Method and Results —Using volumetric intravascular ultrasound analyses, we evaluated serial (postStenting, 6-month, and 2-year follow-up) changes in Drug-Eluting Stent–treated vascular segments with acquired malapposition. External elastic membrane, Stent, lumen, malapposition, and periStent plaque+media (P+M=external elastic membrane –Stent–malapposition) areas were measured; and volumes were calculated and divided by Stent length (normalized volume). Among 250 lesions in which complete serial intravascular ultrasound data were available, Stent malapposition was identified in 19 lesions (7.6%) at 6 months, and an additional 13 malapposition lesions were newly detected at 2 years (5.2%). Because no malapposition sites resolved, the malapposition rate at 2 years was 12.8%. Malapposition areas and volumes were correlated to the increases in external elastic membrane (positive remodeling) throughout the study period, from immediately after Stenting to 6 months and from 6 months to 2 years, both in the group that developed malapposition at 6 months and in the group that developed malapposition at 2 years. Clinical follow-up beyond the 2 year intravascular ultrasound study was done in all patients. Overall, there were 2 cardiac deaths and 1 noncardiac death. Two patients presented with acute myocardial infarction associated with very late Stent thrombosis (1 definite Stent thrombosis, 1 probable Stent thrombosis). Three patients underwent repeat revascularization owing to in-Stent restenosis developed after the 2-year follow-up. Conclusions —Expansive vascular remodeling may play a role in the development and dynamic progression of acquired Drug-Eluting Stent malapposition, not only during the first 6 months after implantation but thereafter.
Soojin Kang - One of the best experts on this subject based on the ideXlab platform.
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optical coherence tomographic analysis of in Stent neoatherosclerosis after drug eluting Stent implantation
Circulation, 2011Co-Authors: Soojin Kang, Takashi Akasaka, Seungjung ParkAbstract:Background—We report findings from optical coherence tomography (OCT) of in-Stent neoatherosclerosis as a cause of Drug-Eluting Stent (DES) failure. Methods and Results—Optical coherence tomography and grayscale and virtual histology intravascular ultrasound were performed in 50 patients (30 stable, 20 unstable angina) with 50 DES in-Stent restenosis lesions and intimal hyperplasia >50% of Stent area. Median follow-up time was 32.2 months. Overall, 26 lesions (52%) had at least 1 OCT-defined in-Stent thin-cap fibroatheroma (TCFA)–containing neointima and 29 (58%) had at least 1 in-Stent neointimal rupture. Patients presenting with unstable angina showed a thinner fibrous cap (55 μm [interquartile range 42 to 105 μm] versus 100 μm [interquartile range 60 to 205 μm], P=0.006) and higher incidence of OCT-defined TCFA-containing neointima (75% versus 37%, P=0.008), intimal rupture (75% versus 47%, P=0.044), thrombi (80% versus 43%, P=0.010), and red thrombi (30% versus 3%, P=0.012) than stable patients. Fibro...
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impact of angiographic complete revascularization after drug eluting Stent implantation or coronary artery bypass graft surgery for multivessel coronary artery disease
Circulation, 2011Co-Authors: Hae Geun Song, Junhyok Oh, Soojin Kang, Jong-seon Park, Seungjung ParkAbstract:Background—This study sought to evaluate the clinical impact of angiographic complete revascularization (CR) after Drug-Eluting Stent implantation or coronary artery bypass graft surgery for multivessel coronary disease. Methods and Results—A total of 1914 consecutive patients with multivessel coronary disease undergoing Drug-Eluting Stent implantation (1400 patients) or coronary artery bypass graft surgery (514 patients) were enrolled. Angiographic CR was defined as revascularization in all diseased segments according to the Synergy Between PCI With Taxus and Cardiac Surgery classification. The outcomes of patients undergoing CR were compared with those undergoing incomplete revascularization (IR) after adjustments with the inverse-probability-of-treatment weighting method. Angiographic CR was performed in 917 patients (47.9%) including 573 percutaneous coronary intervention (40.9%) and 344 coronary artery bypass graft (66.9%) patients. CR patients were younger and had more extensive coronary disease tha...
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mechanisms of in Stent restenosis after drug eluting Stent implantation intravascular ultrasound analysis
Circulation-cardiovascular Interventions, 2011Co-Authors: Soojin Kang, Cheol Whan Lee, Seungwhan Lee, Younghak Kim, Kihoon Han, Jaejoong Kim, Gary S Mintz, Dukwoo Park, Seongwook Park, Seungjung ParkAbstract:Background —We used intravascular ultrasound (IVUS) to (1) clarify the mechanisms of luminal loss after Drug-Eluting Stent (DES) implantation and (2) classify morphological patterns of in-Stent restenosis (ISR). Methods and Results —On the basis of IVUS-identified luminal narrowing (in-Stent minimum lumen area 10 mm in length) with or without Stent edge involvement. Significant intimal hyperplasia (IH) was defined as IH area >50% of Stent. Overall, 76 lesions had IVUS-defined ISR; 32 (42%) had Stent underexpansion (minimal Stent area 50% of Stent. Total Stent length negatively correlated with minimal Stent area ( r =−0.613, P 28 mm, even though there was significant IH in 34 (79%) lesions; conversely, in 32 of 33 (97%) lesions with Stent length ≤28 mm, the minimum lumen site was not associated with Stent underexpansion but significant IH. IVUS-defined focal ISR was most common (47%). Compared with focal ISR, normalized vessel, Stent, lumen, and plaque volumes were smaller in diffuse and multifocal than focal ISR, with no difference in IH extent. Conclusions —In most DES restenosis, IH was the dominant mechanism of ISR. Nevertheless, underexpansion associated with longer Stent length remained an important preventable mechanism of ISR.
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late and very late drug eluting Stent malapposition
Circulation-cardiovascular Interventions, 2010Co-Authors: Soojin Kang, Cheol Whan Lee, Seungwhan Lee, Younghak Kim, Kihoon Han, Jaejoong Kim, Seungjung ParkAbstract:Background—The long-term natural history of acquired malapposition continues to be the subject of debate. Methods and Results—Using volumetric intravascular ultrasound analyses, we evaluated serial (postStenting, 6-month, and 2-year follow-up) changes in Drug-Eluting Stent–treated vascular segments with acquired malapposition. External elastic membrane, Stent, lumen, malapposition, and periStent plaque+media (P+M=external elastic membrane −Stent− malapposition) areas were measured; and volumes were calculated and divided by Stent length (normalized volume). Among 250 lesions in which complete serial intravascular ultrasound data were available, Stent malapposition was identified in 19 lesions (7.6%) at 6 months, and an additional 13 malapposition lesions were newly detected at 2 years (5.2%). Because no malapposition sites resolved, the malapposition rate at 2 years was 12.8%. Malapposition areas and volumes were correlated to the increases in external elastic membrane (positive remodeling) throughout the...
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late and very late drug eluting Stent malapposition serial 2 year quantitative ivus analysis
Circulation-cardiovascular Interventions, 2010Co-Authors: Soojin Kang, Cheol Whan Lee, Seungwhan Lee, Younghak Kim, Kihoon Han, Jaejoong Kim, Seungjung ParkAbstract:Background —The long-term natural history of acquired malapposition continues to be the subject of debate. Method and Results —Using volumetric intravascular ultrasound analyses, we evaluated serial (postStenting, 6-month, and 2-year follow-up) changes in Drug-Eluting Stent–treated vascular segments with acquired malapposition. External elastic membrane, Stent, lumen, malapposition, and periStent plaque+media (P+M=external elastic membrane –Stent–malapposition) areas were measured; and volumes were calculated and divided by Stent length (normalized volume). Among 250 lesions in which complete serial intravascular ultrasound data were available, Stent malapposition was identified in 19 lesions (7.6%) at 6 months, and an additional 13 malapposition lesions were newly detected at 2 years (5.2%). Because no malapposition sites resolved, the malapposition rate at 2 years was 12.8%. Malapposition areas and volumes were correlated to the increases in external elastic membrane (positive remodeling) throughout the study period, from immediately after Stenting to 6 months and from 6 months to 2 years, both in the group that developed malapposition at 6 months and in the group that developed malapposition at 2 years. Clinical follow-up beyond the 2 year intravascular ultrasound study was done in all patients. Overall, there were 2 cardiac deaths and 1 noncardiac death. Two patients presented with acute myocardial infarction associated with very late Stent thrombosis (1 definite Stent thrombosis, 1 probable Stent thrombosis). Three patients underwent repeat revascularization owing to in-Stent restenosis developed after the 2-year follow-up. Conclusions —Expansive vascular remodeling may play a role in the development and dynamic progression of acquired Drug-Eluting Stent malapposition, not only during the first 6 months after implantation but thereafter.
Rosana Hernandezantolin - One of the best experts on this subject based on the ideXlab platform.
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characterization of plaque prolapse after drug eluting Stent implantation in diabetic patients a three dimensional volumetric intravascular ultrasound outcome study
Journal of the American College of Cardiology, 2006Co-Authors: Hideki Futamatsu, Fernando Alfonso, Manel Sabate, Dominick J Angiolillo, Pilar Jimenezquevedo, Cecilia Corros, Kino Morikawafutamatsu, Julie Jiang, Pavel Cervinka, Rosana HernandezantolinAbstract:Characterization of Plaque Prolapse After Drug-Eluting Stent Implantation in Diabetic Patients: A Three-Dimensional Volumetric Intravascular Ultrasound Outcome StudyHideki Futamatsu, Manel Sabate, ...
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characterization of plaque prolapse after drug eluting Stent implantation in diabetic patients a three dimensional volumetric intravascular ultrasound outcome study
Journal of the American College of Cardiology, 2006Co-Authors: Hideki Futamatsu, Fernando Alfonso, Manel Sabate, Dominick J Angiolillo, Pilar Jimenezquevedo, Cecilia Corros, Kino Morikawafutamatsu, Julie Jiang, Pavel Cervinka, Rosana HernandezantolinAbstract:Objectives The aim of this research was to evaluate the plaque prolapse (PP) phenomenon after bare-metal (BMS) and Drug-Eluting Stent (DES) implantation in patients with diabetes mellitus using 3-dimensional volumetric intravascular ultrasound (IVUS). Background Plaque prolapse has been observed in up to 22% of patients treated with BMS. Diabetic patients have a larger atherothrombotic burden and may be more prone to have PP. However, the incidence of PP and its clinical impact after DES implantation is unknown. Methods Three-dimensional IVUS was performed after intervention and at 9-month follow-up in 168 patients with diabetes (205 lesions) treated with bare BX Velocity Stents ((BX Velocity/Sonic, Cordis, Johnson & Johnson) (BMS, n = 65), sirolimus-eluting Stents (Cypher, Cordis) (SES, n = 69), and paclitaxel-eluting Stents (Taxus, Boston Scientific, Natick, Massachusetts) (PES, n = 71). Intravascular ultrasound data at the sites of PP were compared with Stented segments without PP in each lesion. Outcomes were evaluated at 9- and 12-month follow-up. Results There were 42 sites of PP (BMS = 11, SES = 11, PES = 20, p = NS) in 34 Stented segments of 205 (16.6%) lesions. Plaque prolapse was more frequent in the right coronary artery and in chronic total occlusion lesions. Post-procedure PP volume was 1.95 mm 3 in BMS, 2.96 mm 3 in SES, and 4.53 mm 3 in PES. At follow-up, tissue volume increased at PP sites in both BMS and PES, but not after SES. Neointimal proliferation was similar between PP and non-PP sites. Stent thrombosis and restenosis rates were similar between PP and non-PP lesions. Conclusions The incidence of PP after implantation of new generation tubular Stents in patients with diabetes remains high. Drug-Eluting Stent implantation was not associated with increased risk of PP. Plaque prolapse was not associated with Stent thrombosis or increased neointimal proliferation.
Fernando Alfonso - One of the best experts on this subject based on the ideXlab platform.
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tct 343 variations in efficacy and safety over time between drug coated balloon and drug eluting Stent for the treatment of coronary in Stent restenosis results from the daedalus study
Journal of the American College of Cardiology, 2018Co-Authors: Daniele Giacoppo, Bimmer E. Claessen, Fernando Alfonso, Maria Jose Perezvizcayno, Tom Adriaenssens, Christoph Naber, Doyoon Kang, Ralf Degenhardt, Leos Pleva, Jan BaanAbstract:Drug-coated balloon (DCB) and Drug-Eluting Stent (DES) are the most effective strategies for coronary in-Stent restenosis (ISR). In the main analysis of the DAEDALUS study, DES resulted more effective than DCB at long-term follow-up, but variations over time were not explored. The DAEDALUS is a
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implantation of a drug eluting Stent with a different drug switch strategy in patients with drug eluting Stent restenosis results from a prospective multicenter study ribs iii restenosis intra Stent balloon angioplasty versus drug eluting Stent
Jacc-cardiovascular Interventions, 2012Co-Authors: Fernando Alfonso, Javier Zueco, Angel Cequier, Juan Angel, Maria Jose Perezvizcayno, Jaime Dutary, Arturo Garciatouchard, Vicens Marti, Inigo Lozano, Jose M De La Torre HernandezAbstract:Objectives This study sought to assess the effectiveness of a strategy of using Drug-Eluting Stents (DES) with a different drug (switch) in patients with DES in-Stent restenosis (ISR). Background Treatment of patients with DES ISR remains a challenge. Methods The RIBS-III (Restenosis Intra-Stent: Balloon Angioplasty Versus Drug-Eluting Stent) study was a prospective, multicenter study that aimed to assess results of coronary interventions in patients with DES ISR. The use of a different DES was the recommended strategy. The main angiographic endpoint was minimal lumen diameter at 9-month follow-up. The main clinical outcome measure was a composite of cardiac death, myocardial infarction, and target lesion revascularization. Results This study included 363 consecutive patients with DES ISR from 12 Spanish sites. The different-DES strategy was used in 274 patients (75%) and alternative therapeutic modalities (no switch) in 89 patients (25%). Baseline characteristics were similar in the 2 groups, although lesion length was longer in the switch group. At late angiographic follow-up (77% of eligible patients, median: 278 days) minimal lumen diameter was larger (1.86 ± 0.7 mm vs. 1.40 ± 0.8 mm, p = 0.003) and recurrent restenosis rate lower (22% vs. 40%, p = 0.008) in the different-DES group. At the last clinical follow-up (99% of patients, median: 771 days), the combined clinical endpoint occurred less frequently (23% vs. 35%, p = 0.039) in the different-DES group. After adjustment using propensity score analyses, restenosis rate (relative risk: 0.41, 95% confidence interval [CI]: 0.21 to 0.80, p = 0.01), minimal lumen diameter (difference: 0.41 mm, 95% CI: 0.19 to 0.62, p = 0.001), and the event-free survival (hazard ratio: 0.56, 95% CI: 0.33 to 0.96, p = 0.038) remained significantly improved in the switch group. Conclusions In patients with DES ISR, the implantation of a different DES provides superior late clinical and angiographic results than do alternative interventional modalities.
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characterization of plaque prolapse after drug eluting Stent implantation in diabetic patients a three dimensional volumetric intravascular ultrasound outcome study
Journal of the American College of Cardiology, 2006Co-Authors: Hideki Futamatsu, Fernando Alfonso, Manel Sabate, Dominick J Angiolillo, Pilar Jimenezquevedo, Cecilia Corros, Kino Morikawafutamatsu, Julie Jiang, Pavel Cervinka, Rosana HernandezantolinAbstract:Characterization of Plaque Prolapse After Drug-Eluting Stent Implantation in Diabetic Patients: A Three-Dimensional Volumetric Intravascular Ultrasound Outcome StudyHideki Futamatsu, Manel Sabate, ...
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characterization of plaque prolapse after drug eluting Stent implantation in diabetic patients a three dimensional volumetric intravascular ultrasound outcome study
Journal of the American College of Cardiology, 2006Co-Authors: Hideki Futamatsu, Fernando Alfonso, Manel Sabate, Dominick J Angiolillo, Pilar Jimenezquevedo, Cecilia Corros, Kino Morikawafutamatsu, Julie Jiang, Pavel Cervinka, Rosana HernandezantolinAbstract:Objectives The aim of this research was to evaluate the plaque prolapse (PP) phenomenon after bare-metal (BMS) and Drug-Eluting Stent (DES) implantation in patients with diabetes mellitus using 3-dimensional volumetric intravascular ultrasound (IVUS). Background Plaque prolapse has been observed in up to 22% of patients treated with BMS. Diabetic patients have a larger atherothrombotic burden and may be more prone to have PP. However, the incidence of PP and its clinical impact after DES implantation is unknown. Methods Three-dimensional IVUS was performed after intervention and at 9-month follow-up in 168 patients with diabetes (205 lesions) treated with bare BX Velocity Stents ((BX Velocity/Sonic, Cordis, Johnson & Johnson) (BMS, n = 65), sirolimus-eluting Stents (Cypher, Cordis) (SES, n = 69), and paclitaxel-eluting Stents (Taxus, Boston Scientific, Natick, Massachusetts) (PES, n = 71). Intravascular ultrasound data at the sites of PP were compared with Stented segments without PP in each lesion. Outcomes were evaluated at 9- and 12-month follow-up. Results There were 42 sites of PP (BMS = 11, SES = 11, PES = 20, p = NS) in 34 Stented segments of 205 (16.6%) lesions. Plaque prolapse was more frequent in the right coronary artery and in chronic total occlusion lesions. Post-procedure PP volume was 1.95 mm 3 in BMS, 2.96 mm 3 in SES, and 4.53 mm 3 in PES. At follow-up, tissue volume increased at PP sites in both BMS and PES, but not after SES. Neointimal proliferation was similar between PP and non-PP sites. Stent thrombosis and restenosis rates were similar between PP and non-PP lesions. Conclusions The incidence of PP after implantation of new generation tubular Stents in patients with diabetes remains high. Drug-Eluting Stent implantation was not associated with increased risk of PP. Plaque prolapse was not associated with Stent thrombosis or increased neointimal proliferation.
Yangsoo Jang - One of the best experts on this subject based on the ideXlab platform.
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coronary artery aneurysm after second generation drug eluting Stent implantation
Yonsei Medical Journal, 2019Co-Authors: Sung Jin Hong, Donghoon Choi, Yangsoo Jang, Jung-sun Kim, Byeong-keuk Kim, Hyoeun Kim, Chul Min Ahn, Bumkee HongAbstract:PURPOSE We evaluated the incidence, predictors, and prognosis of coronary artery aneurysm (CAA) after second-generation Drug-Eluting Stent (DES) implantation. MATERIALS AND METHODS A total of 976 consecutive patients (1245 lesions) who underwent follow-up angiography after second-generation DES implantation were analyzed. Incidence and predictors of CAA were assessed, and clinical prognosis was compared with 34 cases of CAA after first-generation DES implantation using previous CAA registry data. RESULTS All 10 cases of CAA (0.80% per lesion) in 10 patients (1.02% per patient) were detected at follow up. Compared to lesions without CAA, those with CAA had greater involvement of the proximal segment (90% vs. 51%, p=0.014), a higher proportion of pre-intervention, a Thrombolysis in Myocardial Infarction score of 0 or 1 flow (80% vs. 16%, p<0.001), more chronic total occlusions (40% vs. 10%, p<0.001), and longer implanted Stents (41.9±23.2 mm vs. 28.8±14.8 mm, p=0.006). As for CAA morphology, instances of CAA after second-generation DES were predominantly the single fusiform type (90%), whereas instances of CAA after first-generation DES were multiple saccular (47%) and single saccular (35%) types (p<0.001). Myocardial infarction with Stent thrombosis occurred in 5 patients with CAA after first-generation DES (15%), and no adverse events were observed in patients with CAA after second-generation DES over a median follow-up duration of 4.3 years (p=0.047, log-rank). CONCLUSION Although CAAs after second-generation DES implantation were detected at a similar incidence to that for CAAs after first-generation DES implantation, second-generation DES-related CAAs had different morphologies and more benign clinical outcomes versus first-generation DES-related CAAs.
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ethnic differences in ischemia bleeding risk trade off during antiplatelet therapy post drug eluting Stent implantation individual patient level meta analysis from seven randomized clinical trials
Journal of the American College of Cardiology, 2018Co-Authors: Jeehoon Kang, Tullio Palmerini, Kyung Woo Park, Alexandre Abizaid, Antonio Colombo, Alaide Chieffo, Deepak L. Bhatt, Gregg Stone, Myeongki Hong, Yangsoo JangAbstract:Prolonged dual antiplatelet therapy (DAPT) is intended to reduce risk of ischemic events at the cost of increased risk of bleeding in patients undergoing Drug-Eluting Stent implantation. The optimal DAPT duration will be determined by the tradeoff between ischemia and bleeding risk. However, it
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mortality in patients treated with extended duration dual antiplatelet therapy after drug eluting Stent implantation a pairwise and bayesian network meta analysis of randomised trials
The Lancet, 2015Co-Authors: Tullio Palmerini, Letizia Bacchireggiani, Fausto Feres, Diego Della Riva, Umberto Benedetto, Alexandre Abizaid, Giuseppe Biondizoccai, Yangsoo Jang, Kyung Woo ParkAbstract:Summary Background Despite recent studies, the optimum duration of dual antiplatelet therapy (DAPT) after coronary Drug-Eluting Stent placement remains uncertain. We performed a meta-analysis with several analytical approaches to investigate mortality and other clinical outcomes with different DAPT strategies. Methods We searched Medline, Embase, Cochrane databases, and proceedings of international meetings on Nov 20, 2014, for randomised controlled trials comparing different DAPT durations after Drug-Eluting Stent implantation. We extracted study design, inclusion and exclusion criteria, sample characteristics, and clinical outcomes. DAPT duration was categorised in each study as shorter versus longer, and as 6 months or shorter versus 1 year versus longer than 1 year. Analyses were done by both frequentist and Bayesian approaches. Findings We identified ten trials published between Dec 16, 2011, and Nov 16, 2014, including 31 666 randomly assigned patients. By frequentist pairwise meta-analysis, shorter DAPT was associated with significantly lower all-cause mortality compared with longer DAPT (HR 0·82, 95% CI 0·69–0·98; p=0·02; number needed to treat [NNT]=325), with no significant heterogeneity apparent across trials. The reduced mortality with shorter compared with longer DAPT was attributable to lower non-cardiac mortality (0·67, 0·51–0·89; p=0·006; NNT=347), with similar cardiac mortality (0·93, 0·73–1·17; p=0.52). Shorter DAPT was also associated with a lower risk of major bleeding, but a higher risk of myocardial infarction and Stent thrombosis. We noted similar results in a Bayesian framework with non-informative priors. By network meta-analysis, patients treated with 6-month or shorter DAPT and 1-year DAPT had higher risk of myocardial infarction and Stent thrombosis but lower risk of mortality compared with patients treated with DAPT for longer than 1 year. Patients treated with DAPT for 6 months or shorter had similar rates of mortality, myocardial infarction, and Stent thrombosis, but lower rates of major bleeding than did patients treated with 1-year DAPT. Interpretation Although treatment with DAPT beyond 1 year after Drug-Eluting Stent implantation reduces myocardial infarction and Stent thrombosis, it is associated with increased mortality because of an increased risk of non-cardiovascular mortality not offset by a reduction in cardiac mortality. Funding None.
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Incidences, Predictors, and Clinical Outcomes of Acute and Late Stent Malapposition Detected by Optical Coherence Tomography After Drug-Eluting Stent Implantation
Circulation: Cardiovascular Interventions, 2014Co-Authors: Byeong-keuk Kim, Dong-ho Shin, Donghoon Choi, Jung-sun Kim, Yangsoo JangAbstract:Background—We investigated the incidences, predictors, and clinical outcomes of acute and late Stent malapposition detected by optical coherence tomography (OCT) after Drug-Eluting Stent implantation. Methods and Results—We analyzed the OCT images from 351 patients with 356 lesions who received postStent and follow-up OCT examinations. Acute Stent malapposition was observed in 62% of lesions. Approximately half of the acute Stent malappositions were located within the edges of the Stents. Severe diameter stenosis, calcified lesions, and long Stents were independent predictors of acute Stent malapposition. Follow-up OCT examinations were performed 175±60 days after Drug-Eluting Stent implantation. Thirty-one percent of lesions with acute Stent malapposition remained malapposed (late-persiStent Stent malapposition) and were typically (72%) located within the edges of the Stent. The location within the Stent edges and the volume of acute Stent malapposition were independent predictors of late-persiStent sten...
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randomized comparison of clinical outcomes between intravascular ultrasound and angiography guided drug eluting Stent implantation for long coronary artery stenoses
Jacc-cardiovascular Interventions, 2013Co-Authors: Jung-sun Kim, Dong-ho Shin, Donghoon Choi, Byeong-keuk Kim, Tae Soo Kang, Byoung Eun Park, Yangsoo JangAbstract:Objectives This study sought to assess the impact of intravascular ultrasound (IVUS) guidance on clinical outcomes following Drug-Eluting Stent implantation when treating long lesions. Background The role of IVUS guidance when treating long lesions has been tested during bare-metal Stent, but not during Drug-Eluting Stent, implantation. Methods A total of 543 patients treated with Stents ≥28 mm in length were randomly assigned to IVUS guidance (n = 269) versus angiography guidance (n = 274). The primary endpoint was a composite of major adverse cardiac events (MACE), including cardiovascular death, myocardial infarction, target vessel revascularization, or Stent thrombosis at 1 year following intervention. Results In the intention-to-treat analysis, total Stent length was 32.4 mm in the IVUS-guided arm versus 32.3 mm in angiography-guided arm (p = 0.84). Adjunct post-dilation was more frequently performed in the IVUS-guided arm (54.6% vs. 44.5%, p = 0.03); post-intervention minimal lumen diameters were similar (2.55 vs. 2.55 mm, respectively, p = 0.50); and MACE occurred in 12 (4.5%) patients in IVUS-guided arm and in 20 (7.3%) patients in the angiography-guided arm (p = 0.16). However, among the 269 patients assigned to IVUS guidance, IVUS was not used in 13 patients (4.8%); conversely, in 274 patients assigned to angiography alone, 41 patients (15.0%) were treated with IVUS guidance. Therefore, in a per-protocol analysis according to actual IVUS usage, minimum lumen diameter was larger (2.58 vs. 2.51 mm, p = 0.04), and MACE rates were lower: 4.0% in the IVUS-guided arm versus 8.1% in the angiography-guided arm (p = 0.048). Conclusions A strategy of routine IVUS for Drug-Eluting Stent implantation in long lesions did not improve the 1-year MACE rates. The IVUS use per operator decision was associated with improved results. (A New Strategy Regarding Discontinuation of Dual Antiplatelet; NCT01145079 )
