The Experts below are selected from a list of 360 Experts worldwide ranked by ideXlab platform
Ikseong Park - One of the best experts on this subject based on the ideXlab platform.
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stent fracture and Restenosis after placement of a drug eluting device in the vertebral artery origin and treatment with the stent in stent technique
Journal of Neurosurgery, 2007Co-Authors: Minwoo Baik, Ikseong ParkAbstract:✓ The authors report two cases of stent fracture and Restenosis after placement of a drug-eluting device in the vertebral artery (VA) origin, and describe management of Restenosis with the stent-in-stent technique. Two women, one 62 and the other 67 years of age, underwent stent placement in the VA origin to treat symptomatic and angiographically significant stenosis in this vessel. Sirolimus-eluting coronary stents (Cypher) were used in both cases. Four months after placement of the devices, the symptoms recurred. Follow-up angiography performed 5 months after insertion of the devices revealed a transverse stent fracture with separation of the fragments and severe in-stent Restenosis in both cases. The restenoses were treated with reinsertion of coronary stents (Cypher and Jostent FlexMaster) by using the stent-in-stent technique. After stent reinsertion, the patients exhibited relief of symptoms. This paper is the first report of fracture in a drug-eluting stent and Restenosis after stent placement in t...
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stent fracture and Restenosis after placement of a drug eluting device in the vertebral artery origin and treatment with the stent in stent technique
Journal of Neurosurgery, 2007Co-Authors: Seongrim Kim, Minwoo Baik, Ikseong Park, Seunghoon Yoo, Sangdon Kim, M C KimAbstract:The authors report two cases of stent fracture and Restenosis after placement of a drug-eluting device in the vertebral artery (VA) origin, and describe management of Restenosis with the stent-in-stent technique. Two women, one 62 and the other 67 years of age, underwent stent placement in the VA origin to treat symptomatic and angiographically significant stenosis in this vessel. Sirolimus-eluting coronary stents (Cypher) were used in both cases. Four months after placement of the devices, the symptoms recurred. Follow-up angiography performed 5 months after insertion of the devices revealed a transverse stent fracture with separation of the fragments and severe in-stent Restenosis in both cases. The restenoses were treated with reinsertion of coronary stents (Cypher and Jostent FlexMaster) by using the stent-in-stent technique. After stent reinsertion, the patients exhibited relief of symptoms. This paper is the first report of fracture in a drug-eluting stent and Restenosis after stent placement in the VA origin. Restenosis caused by such a fracture can be managed successfully by performing the stent-in-stent maneuver. The physical properties of metallic devices, stent strut geometry, and anatomical peculiarities of the subclavian artery may be associated with stent fractures. Earlier follow-up angiography studies (within 6 months) are warranted.
P W Serruys - One of the best experts on this subject based on the ideXlab platform.
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reference chart derived from post stent implantation intravascular ultrasound predictors of 6 month expected Restenosis on quantitative coronary angiography
Circulation, 1999Co-Authors: P J De Feyter, P Kay, Clemens Disco, P W SerruysAbstract:Background—Intravascular ultrasound (IVUS)–guided stent implantation and the availability of a reference chart to predict the expected in-stent Restenosis rate based on operator-dependent IVUS parameters may interactively facilitate optimal stent placement. The use of IVUS guidance protects against undue risks of dissection or rupture. Methods and Results—IVUS-determined post–stent-implantation predictors of 6-month in-stent Restenosis on quantitative coronary angiography (QCA) were identified by logistic regression analysis. These predictors were used to construct a reference chart that predicts the expected 6-month QCA Restenosis rate. IVUS and QCA data were obtained from 3 registries (MUSIC [Multicenter Ultrasound Stenting in Coronaries study], WEST-II [West European Stent Trial II], and ESSEX [European Scimed Stent EXperience]) and 2 randomized in-stent Restenosis trials (ERASER [Evaluation of ReoPro And Stenting to Eliminate Restenosis] and TRAPIST [TRApidil vs placebo to Prevent In-STent intimal hyp...
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patient lesion and procedural variables as risk factors for luminal re narrowing after successful coronary angioplasty a quantitative analysis in 653 patients with 778 lesions multicenter european research trial with cilazapril after angioplasty to p
Journal of Cardiovascular Pharmacology, 1993Co-Authors: Walter R M Hermans, Wolfgang Rutsch, Benno J Rensing, David P Foley, J G P Tijssen, Hakan Emanuelsson, N Danchin, William Wijns, F Chappuis, P W SerruysAbstract:Follow-up angiography at 6 months was obtained in 94% of the 693 patients (778 successfully dilated coronary lesions) enrolled in the Multicenter European Research trial with Cilazapril after Angioplasty to prevent Transluminal Coronary Obstruction and Restenosis (MERCATOR) trial--a double-blind, placebo-controlled trial--to study the effects of cilazapril 5 mg b.i.d. on Restenosis [defined as the mean loss in minimal luminal diameter during follow-up, assessed by an interpolated edge detection technique (coronary angiography analysis system)] and long-term clinical outcome. No statistically significant difference could be detected between treatment and placebo groups with regard to clinical outcome or Restenosis. The purpose of this ancillary study was to determine which, if any, patient, lesion, or procedural factors were predictive of Restenosis. The identification of such factors could be helpful in the selection of lesions suitable for angioplasty and, if modifiable or controllable, potentially reduce Restenosis. A stepwise multiple linear regression analysis was performed to identify independent predictors of Restenosis. The following variables were retained in the model in order of significance: (a) relative gain (difference between the minimal luminal diameter pre- and post-percutaneous transluminal coronary angioplasty (PTCA), normalized for vessel size), (b) minimal luminal diameter post-PTCA, and (c) dilatation of another vessel than right coronary artery. The fit of the model was poor; where the predicted change in minimal luminal diameter was 0.3 mm, the corresponding percent correct classification was 30, 52, and 55%. The present study illustrates that the Restenosis phenomenon cannot accurately be predicted by patient, lesion, and procedural variables.
Richard E Kuntz - One of the best experts on this subject based on the ideXlab platform.
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late loss in lumen diameter and binary Restenosis for drug eluting stent comparison
Circulation, 2005Co-Authors: Laura Mauri, John E Orav, Richard E KuntzAbstract:Background— Published rates of coronary Restenosis have fallen below 10% in drug-eluting stent trials. Early evaluations of new stents have used continuous end points that are presumed surrogates for Restenosis, but the generalizability and power of such end points have not been examined systematically. Methods and Results— We examined the relationship between incremental changes in observed late loss in lumen diameter and the probability of Restenosis using reported late loss from 22 published trials of various types of stents (bare-metal, drug-eluting, and small-vessel stents). Next, the power of late loss differences was compared with that of corresponding binary Restenosis rates. The relationship between mean late loss and its SD was linear and did not vary with stent type (drug-eluting or bare-metal) or vessel diameter. At all levels of late loss examined (0 to 1 mm), incremental changes were associated with increasing Restenosis risk (with an increasing magnitude of effect at higher levels of late l...
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clinical Restenosis after coronary stenting perspectives from multicenter clinical trials
Journal of the American College of Cardiology, 2002Co-Authors: Jeffrey J Popma, Donald E. Cutlip, Manish S Chauhan, Donald S Baim, Joseph P Carrozza, David J Cohen, Richard E KuntzAbstract:Abstract Objectives We sought to evaluate clinical Restenosis in a large population of patients who had undergone coronary stent placement. Background One-year success after coronary stenting is limited mainly by Restenosis of and requirement for repeat revascularization of the treated lesion. Methods We studied 6,186 patients (6,219 lesions) pooled from several recently completed coronary stent trials. Clinical Restenosis was defined using three different definitions: target lesion revascularization (TLR) beyond 30 days, target vessel revascularization (TVR) beyond 30 days, and target vessel failure (TVF), defined as TVR, any death, or myocardial infarction (MI) of the target vessel territory after hospital discharge. Results By one year, 638 (12.2%) patients had TLR, 748 (14.3%) had TVR, and 848 (16.0%) had TVF, more than two-thirds higher than the rate of these end points at six months. The severity of angiographic Restenosis (≥50% follow-up diameter stenosis [DS]) in 419 of 1,437 (29%) patients undergoing routine angiographic follow-up correlated directly with the likelihood of TLR (73% vs. 26% for >70% DS compared with Conclusions At one year after stenting, most clinical Restenosis reflected TLR, which was predicted by the same variables previously associated with an increased risk of angiographic Restenosis. The lower absolute rate of clinical Restenosis relative to angiographic Restenosis was due to infrequent TLR in lesions with less severe (
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analysis of late lumen narrowing after excimer laser facilitated coronary angioplasty
Journal of the American College of Cardiology, 1994Co-Authors: John A Bittl, Donald S Baim, Richard E Kuntz, Pedro Estella, Timothy A SanbornAbstract:Abstract Objectives. The purpose of this study was to analyze the quantitative angiographic factors affecting Restenosis after excimer laser-facilitated coronary angioplasty. Background. Restenosis after balloon angioplasty, directional atherectomy and coronary stenting has been analyzed using both dichotomous (≥ 50% diameter stenosis) and continuous (late lumen narrowing) end points, leading to the conclusion that achieving a large lumen diameter at the time of the procedure is associated with a lower risk of angiographic Restenosis. Methods. Quantitative angiographic measurements were made before treatment, after laser angioplasty, after adjunctive balloon angioplasty and at 6-month angiographic follow-up in 168 patients with 179 treated lesions. Results. The immediate increase in lumen diameter (total acute gain 1.45 ± 0.71 mm [mean ± SD]) was due to the combination of laser treatment (0.79 ± 0.61 mm) and subsequent adjunctive balloon angioplasty (0.66 ± 0.55 mm). At follow-up, the minimal lumen diameter had decreased (late loss 0.71 ± 0.84 mm), yielding an overall Restenosis rate of 50% (defined dichotomously by ≥ 50% diameter stenosis). Multivariable regression analyses showed that Restenosis was related to vessel diameter, as well as minimal lumen diameter, achieved immediately after the proceure. Conclusion. Although the Restenosis rales for the small vessels typically treated with excimer laser angioplasty were high, the lowest Restenosis rates were seen to large vessels with the largest postprocedural minimal lumen diameters. The goal of this procedure should be to safely achieve the largest lumen possible with the combination of laser treatment and adjunctive balloon dilation.
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frequency and consequences of intimal hyperplasia in specimens retrieved by directional atherectomy of native primary coronary artery stenoses and subsequent restenoses
American Journal of Cardiology, 1993Co-Authors: Michael J Miller, Richard E Kuntz, Steven P Friedrich, Gilbert A Leidig, Robert F Fishman, Stuart J SchnittAbstract:Although intimal hyperplasia is a frequent occurrence after arterial interventional procedures, the overall frequency and significance of intimal hyperplasia in primary coronary lesions has not been previously addressed. The incidence of intimal hyperplasia was therefore examined using standard light microscopy in specimens obtained from native coronary arteries of patients undergoing directional coronary atherectomy. The associated clinical history, angiographic results and clinical outcomes were also tabulated. Intimal hyperplasia was identified in 51 of 55 patients (93%) treated with directional coronary atherectomy for Restenosis after a prior intervention. These Restenosis lesions had less acute gain in lumen diameter after directional coronary atherectomy, a smaller late lumen diameter, more severe late stenosis (p or = 50% (Restenosis rate 40% for prior Restenosis vs 26% for primary lesions). Surprisingly, however, intimal hyperplasia was also identified in 45 of 102 (44%) primary stenoses. Primary lesions (n = 45) with intimal hyperplasia were more likely to occur in younger patients and in the left anterior descending artery than were either primary lesions without intimal hyperplasia (n = 57) or prior Restenosis lesions. There were otherwise no differences in the baseline characteristics, angiographic findings or clinical outcome of primary lesions with or without intimal hyperplasia (Restenosis rate 28 and 24%, respectively). The event-free survival (72% at 12 months) was similar in all 3 groups. Thus, even though intimal hyperplasia is an almost universal finding in Restenosis lesions, intimal hyperplasia is not specific for Restenosis since histologically identical hyperplasia may be found in nearly half of primary coronary artery stenoses.(ABSTRACT TRUNCATED AT 250 WORDS)
Antonio Colombo - One of the best experts on this subject based on the ideXlab platform.
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preliminary observations regarding angiographic pattern of Restenosis after rapamycin eluting stent implantation
Circulation, 2003Co-Authors: Antonio Colombo, Flavio Airoldi, Matteo Montorfano, Mauro Carlino, Dejan Orlic, Goran Stankovic, Nicola Corvaja, Vassilis Spanos, Francesco Liistro, Alaide ChieffoAbstract:Background— Restenosis after implantation of drug-eluting stents (DES) is a rare phenomenon, occurring more frequently peri-stent. Methods and Results— We evaluated the pattern of Restenosis occurring after implantation of DES in unselected lesions. From April 15 to December 6, 2002, we treated 368 patients with 735 lesions by using 841 rapamycin-eluting stents (Cypher, Cordis, a Johnson & Johnson Company). Mean baseline lesion length was 17.48±12.19 mm, and mean stent length was 27.59±14.02 mm. Follow-up ischemia-driven angiography was performed in 24 patients. Eleven patients had angiographic Restenosis (≥50% diameter stenosis) in 14 stented segments (stent and 5 mm proximal and distal to the stent). The pattern of Restenosis in all 14 stented segments was focal, and in 6 of them it was multifocal, occurring inside the stents. Mean length of restenotic lesions was 5.62±1.90 mm, with a range from 2.54 to 8.44 mm. One multifocal Restenosis involved also the distal stent margin. Intravascular ultrasound ev...
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Angiographic and intravascular ultrasound predictors of in-stent Restenosis
Journal of the American College of Cardiology, 1998Co-Authors: Shunji Kasaoka, Jonathan M. Tobis, Tatsuro Akiyama, Bernhard Reimers, Carlo Di Mario, Nathan D. Wong, Antonio ColomboAbstract:Abstract Objectives. This study was performed to determine predictors of in-stent Restenosis from a high volume, single-center practice. Background. Intracoronary stents have been shown to reduce the Restenosis rate as compared with balloon angioplasty, but in-stent Restenosis continues to be an important clinical problem. Methods. Between April 1993 and March 1997, 1,706 patients with 2,343 lesions were treated with a variety of intracoronary stents. The majority of stents were placed with high pressure balloon inflations and intravascular ultrasound (IVUS) guidance. Angiographic follow-up was obtained in 1,173 patients with 1,633 lesions (70%). Clinical, angiographic and IVUS variables were prospectively recorded and analyzed by univariate and multivariate models for the ability to predict the occurrence of in-stent Restenosis defined as a diameter stenosis ≥50%. Results. In-stent Restenosis was angiographically documented in 282 patients with 409 lesions (25%). The Restenosis group had a significantly longer total stent length, smaller reference lumen diameter, smaller final minimal lumen diameter (MLD) by angiography and smaller stent lumen cross-sectional area (CSA) by IVUS. In lesions where IVUS guidance was used, the Restenosis rate was 24% as compared with 29% if IVUS was not used (p Conclusions. Achieving an optimal stent lumen CSA by using IVUS guidance during the procedure and minimizing the total stent length may reduce in-stent Restenosis.
Minwoo Baik - One of the best experts on this subject based on the ideXlab platform.
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stent fracture and Restenosis after placement of a drug eluting device in the vertebral artery origin and treatment with the stent in stent technique
Journal of Neurosurgery, 2007Co-Authors: Minwoo Baik, Ikseong ParkAbstract:✓ The authors report two cases of stent fracture and Restenosis after placement of a drug-eluting device in the vertebral artery (VA) origin, and describe management of Restenosis with the stent-in-stent technique. Two women, one 62 and the other 67 years of age, underwent stent placement in the VA origin to treat symptomatic and angiographically significant stenosis in this vessel. Sirolimus-eluting coronary stents (Cypher) were used in both cases. Four months after placement of the devices, the symptoms recurred. Follow-up angiography performed 5 months after insertion of the devices revealed a transverse stent fracture with separation of the fragments and severe in-stent Restenosis in both cases. The restenoses were treated with reinsertion of coronary stents (Cypher and Jostent FlexMaster) by using the stent-in-stent technique. After stent reinsertion, the patients exhibited relief of symptoms. This paper is the first report of fracture in a drug-eluting stent and Restenosis after stent placement in t...
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stent fracture and Restenosis after placement of a drug eluting device in the vertebral artery origin and treatment with the stent in stent technique
Journal of Neurosurgery, 2007Co-Authors: Seongrim Kim, Minwoo Baik, Ikseong Park, Seunghoon Yoo, Sangdon Kim, M C KimAbstract:The authors report two cases of stent fracture and Restenosis after placement of a drug-eluting device in the vertebral artery (VA) origin, and describe management of Restenosis with the stent-in-stent technique. Two women, one 62 and the other 67 years of age, underwent stent placement in the VA origin to treat symptomatic and angiographically significant stenosis in this vessel. Sirolimus-eluting coronary stents (Cypher) were used in both cases. Four months after placement of the devices, the symptoms recurred. Follow-up angiography performed 5 months after insertion of the devices revealed a transverse stent fracture with separation of the fragments and severe in-stent Restenosis in both cases. The restenoses were treated with reinsertion of coronary stents (Cypher and Jostent FlexMaster) by using the stent-in-stent technique. After stent reinsertion, the patients exhibited relief of symptoms. This paper is the first report of fracture in a drug-eluting stent and Restenosis after stent placement in the VA origin. Restenosis caused by such a fracture can be managed successfully by performing the stent-in-stent maneuver. The physical properties of metallic devices, stent strut geometry, and anatomical peculiarities of the subclavian artery may be associated with stent fractures. Earlier follow-up angiography studies (within 6 months) are warranted.
