TY - JOUR. T1 - The sirolimus-eluting cypher select coronary stent for the treatment of bare-metal and drug-eluting stent restenosis. T2 - Insights from the e-select 64-71 (multicenter post-market surveillance) registry. AU - Abizaid, Alexandre. AU - Costa, J. Ribamar. AU - Banning, Adrian. AU - Bartorelli, Antonio L.. AU - Dzavik, Vladimir. AU - Ellis, Stephen. AU - Gao, Runlin. AU - Holmes, David R.. AU - Jeong, Muyng Ho. AU - Legrand, Victor. AU - Neumann, Franz Josef. AU - Nyakern, Maria. AU - Orlick, Amy. AU - Spaulding, Christian. AU - Worthley, Stephen. AU - Urban, Philip M.. PY - 2012/1/1. Y1 - 2012/1/1. N2 - This study sought to compare the 1-year safety and efficacy of Cypher Select or Cypher Select Plus (Cordis Corporation, Bridgewater, New Jersey) sirolimus-eluting stents (SES) with the treatment of bare-metal stents (BMS) and drug-eluting stent (DES) in-stent restenosis (ISR) in nonselected, real-world patients. There is paucity of consistent data on DES for the treatment of ISR, ...

In 2001, when Morice et al. (1) presented the initial results of RAVEL (The Randomized Study With the Sirolimus-Coated Bx Velocity Balloon-Expandable Stent in the Treatment of Patients With De Novo Native Coronary Artery Lesions), showing 0% angiographic restenosis 6 months after implantation of a sirolimus-eluting stent, very few people would have envisaged that more than 10 years later, there would be a need for a trial to evaluate the best treatment strategy for drug-eluting stent (DES) in-stent restenosis (ISR).. Although widespread use of DES (versus bare-metal stents [BMS]), advances in stent design, and greater operator experience have all significantly reduced the incidence of restenosis and resultant target vessel revascularization (2), a low rate of ISR continues to exist and it is not benign. Outcomes are even poorer for those with DES compared with individuals presenting with BMS-ISR (3).. There are several treatment options for DES-ISR (e.g., repeat percutaneous coronary ...

Background: Differences in restenosis pattern and timing between bare-metal stent and drug-eluting stent (DES) have been reported. However, little is known about the effect of the type of DES on restenosis pattern and timing.. Methods: From November 2002 to August 2010, 6676 consecutive patients were treated with sirolimus-eluting stent (SES: 6321 lesions), paclitaxel-eluting stent (PES: 1520 lesions), zotarolimus-eluting stent (ZES: 599 lesions), everolimus-eluting stent (EES: 924 lesions), and biolimus-eluting stent (BES: 288 lesions), and underwent midterm follow-up coronary angiography (f/u CAG) at 8 months after implantation. Of these, patients without restenosis underwent late f/u CAG at 12 months after midterm f/u. We defined early restenosis as restenosis at midterm f/u and late restenosis as restenosis at late f/u without early restenosis. Restenosis patterns were classified into two groups according to Mehran classification: focal (pattern I) and diffuse (pattern II, III, ...

The principal findings of the ISAR-DESIRE 2 study are that in cases of DES restenosis occurring within a SES: 1) the implantation of a second DES is feasible and safe; 2) a strategy of either repeat SES implantation or switch to a PES is associated with comparable anti-restenotic efficacy; and 3) the neointimal inhibition observed with repeat SES implantation is somewhat lower than expected, indicative perhaps of the existence of some degree of drug hyporesponsiveness at an individual patient level.. The widespread adoption of DES therapy coupled with an overall increase in the number of PCI procedures has generated significant absolute numbers of patients presenting with DES restenosis (2). Clinically, the treatment of these DES restenotic lesions seems to be associated with slightly higher rates of recurrent restenosis than that observed after treatment of bare-metal stent restenosis. For example, the use of DES to treat bare-metal stent restenosis has been associated with repeat TLR rates at ...

TY - JOUR. T1 - Association of Triglyceride Deposit Cardiomyovasculopathy with Drug-Eluting Stent Restenosis among Patients with Diabetes. AU - Nakano, Yusuke. AU - Suzuki, Mayu. AU - Hirano, Ken Ichi. AU - Ando, Hirohiko. AU - Takashima, Hiroaki. AU - Takahashi, Hiroshi. AU - Amano, Tetsuya. PY - 2020/8. Y1 - 2020/8. UR - http://www.scopus.com/inward/record.url?scp=85089301356&partnerID=8YFLogxK. UR - http://www.scopus.com/inward/citedby.url?scp=85089301356&partnerID=8YFLogxK. U2 - 10.1001/jamanetworkopen.2020.12583. DO - 10.1001/jamanetworkopen.2020.12583. M3 - Article. C2 - 32766797. AN - SCOPUS:85089301356. VL - 3. JO - JAMA network open. JF - JAMA network open. SN - 2574-3805. IS - 8. M1 - e2012583. ER - ...

1. The patient has an in-stent restenosis of , 50% (by subjective angiographic determination of the minimal luminal diameter compared to the distal reference diameter) within a native coronary artery which has previously undergone stent placement ( 4 weeks). Lesions must meet ISR Classification I-III.. 2. The patient has a history, signs of, or laboratory studies that suggest coronary ischemia attributable to the target stenosis. The diagnosis of angina pectoris is defined by Canadian Cardiovascular Society Classification (CCS I, II, III, or IV) OR unstable angina pectoris (Braunwald Classification B&C, I-II) OR patients with documented silent ischemia;. 3. The study target lesion must be located in an in-stent restenotic native coronary artery measuring , 2.75mm and 3.5mm in diameter and , 15mm and 40mm in length to allow treatment with a maximum of three 18mm stents. The target lesion must have undergone coronary interventional treatment , 4 weeks previously. Patients with one or more prior ...

Drug-eluting balloon for in-stent restenosis Yin Chen, Shilian Hu, Lei Wu To the Editor: We read with interest the meta-analysis by Indermuehle A et al which reported that drug-eluting balloon (DEB) appears to show great promise for in-stent restenosis (ISR), and could reduce the risk for major adverse cardiac events (MACE) compared with plain balloon angioplasty (BA)or implantation of drug-eluting stent (DES) in the treatment of ISR (1).Coronary ISR, happened after coronary stent implantation, continued to be a major problem. The authors raised a critical concern assessing the effectiveness of DEB, and long-term outcomes were adequately discussed in the article. Actually, for the PACCOCATH (Treatment of ISR by Paclitaxel Coated PTCA Balloon) trial, the short-term outcomes were not identified in the meta- analysis (2, 3), and the subgroup analysis according to control group (BA or DES) was only adopted for late lumen loss. DEB appears to be more effective in the reduction of binary restenosis ...

In the first-in-human study, 50 patients with in-stent restenosis (following either a drug-eluting stent or bare metal stent) underwent coronary angioplasty with the Virtue balloon. The primary safety endpoint was the 30-day rate of target lesion failure-a composite of cardiac death, target vessel myocardial infarction, and clinically-driven target lesion revascularisation-and the primary performance endpoint was in-stent late lumen loss at six months.. Results. Verheye et al comment: No target lesion failures were reported through the 30-day follow-up for the entire 50 patient study population. Among the 49 intention-to-treat patients at the six month follow-up, one underwent coronary artery bypass and four received target lesion revascularisation for a target lesion failure rate of 8.2% and major adverse cardiac event rate of 10.2%. They add that in-segment late lumen loss was 0.31±0.52mm which met the established criteria for superiority to historical plain balloon angioplasty values ...

Background: The aim of this study was to investigate the efficacy and safety of paclitaxel-coated balloon (PCB) for the treatment of the bare-metal stent restenosis (BMS-ISR) and drug-eluting stent restenosis (DES-ISR).. Methods: This study was a prospective, multicenter, randomized (2:1) trial conducted in 208 patients with 213 in-stent restenosis lesions (BMS-ISR; 123 lesions, DES-ISR; 90 lesions) at 13 centers in Japan. Patients were randomly assigned to PCB group (PCB group, 137 patients with 142 lesions) or conventional balloon angioplasty group (BA group, 71 patients with 71 lesions). The primary endpoint was target vessel failure (TVF) at 6-month follow-up.. Results: Clinical and angiographic follow-up 6 months after intervention was performed in 207 patients (99.5%) with 208 lesions (97.7%). TVF was noted in 6.6% of PCB group and 31.0% of BA group (p,0.001). Recurrent restenosis occurred in 4.3% of PCB group and 31.9% of BA group (p,0.001). Late lumen loss was lower in PCB group than in ...

Background In-stent restenosis is considered to be a gradual and progressive condition and there is scant data on myocardial infarction (MI) as a clinical presentation. Methods and Results Of 2,462 consecutive patients who underwent percutaneous coronary intervention between June 2001 and December 2002, clinical in-stent restenosis occurred in 212 (8.6%), who were classified into 3 groups: ST elevation MI (STEMI), non-ST elevation MI (NSTEMI) and non-MI. Of the 212 patients presenting with clinical in-stent restenosis, 22 (10.4%) had MI (creatine kinase (CK) ≥2 × baseline with elevated CKMB). The remaining 190 (89.6%) patients had stable angina or evidence of ischemia by stress test without elevation of cardiac enzymes. Median interval between previous intervention and presentation for clinical in-stent restenosis was shorter for patients with MI than for non-MI patients (STEMI, 90 days; NSTEMI, 79 days; non-MI, 125 days; p=0.07). Diffuse in-stent restenosis was more frequent in MI patients ...

TY - JOUR. T1 - The basis of molecular strategies for treating coronary restenosis after angioplasty. AU - Epstein, Stephen E.. AU - Speir, Edith. AU - Unger, Ellis F.. AU - Guzman, Raul J.. AU - Finkel, Toren. PY - 1994. Y1 - 1994. N2 - Excessive smooth muscle cell proliferation significantly contributes to restenosis, which occurs in 25% to 50% of patients within 6 months of coronary angioplasty. Because successful treatment will probably depend on our acquiring a comprehensive knowledge of the molecular and cellular mechanisms involved, this report reviews 1) information relevant to the molecular and cellular mechanisms responsible for the smooth muscle cell(s) response to vascular injury, and 2) several molecular-based therapeutic strategies currently being explored as possible approaches to the control of restenosis, including recombinant DNA technology to target delivery of cytotoxic molecules to proliferating smooth muscle cell(s), antisense strategies to inhibit expression of gene ...

TY - JOUR. T1 - Drug-eluting balloon versus second generation drug eluting stents in the treatment of in-stent restenosis. T2 - a systematic review and meta-analysis. AU - Liou, Kevin. AU - Jepson, Nigel. AU - Cao, Christopher. AU - Luo, Roger. AU - Pala, Sarvpreet. AU - Ooi, Sze-Yuan. PY - 2016/12. Y1 - 2016/12. N2 - Background In-stent restenosis (ISR) remains a significant mode of stent failure following PCI. The optimal treatment strategy, however, remains undefined and the role of drug-eluting balloons (DEB) in the management of ISR is also unclear.Methods A meta-analysis was performed to compare the efficacy of DEB in the treatment of ISR against second generation drug eluting stents (DES).Results Seven studies comprised of 1,065 patients were included for analysis. The follow-up period ranged from 12-25 months. The use of DEB was associated with an inferior acute gain in minimal luminal diameter (MLD) (0.36, 95% CI: 0.16-0.57 mm), higher late loss in MLD (0.11, 0.02-0.19 mm) and a higher ...

Restenosis is the recurrence of stenosis, a narrowing of a blood vessel, leading to restricted blood flow. Restenosis usually pertains to an artery or other large blood vessel that has become narrowed, received treatment to clear the blockage and subsequently become renarrowed. This is usually restenosis of an artery, or other blood vessel, or possibly a vessel within an organ. Restenosis is a common adverse event of endovascular procedures. Procedures frequently used to treat the vascular damage from atherosclerosis and related narrowing and renarrowing (restenosis) of blood vessels include vascular surgery, cardiac surgery, and angioplasty. When a stent is used and restenosis occurs, this is called in-stent restenosis or ISR. If it occurs following balloon angioplasty, this is called post-angioplasty restenosis or PARS. The diagnostic threshold for restenosis in both ISR or PARS is ≥50% stenosis. If restenosis occurs after a procedure, follow-up imaging is not the only way to initially ...

The use of SES has been shown in randomised clinical trials to result in an in-stent lumen loss of −0.01 to 0.20 mm for de novo coronary lesions.6,7,8,9,10 Slightly higher lumen loss ranging from 0.12 (0.41) to 0.21 (0.62) mm has been reported in small registries with the use of SES for ISR lesions.21,22 In this study in-stent lumen loss in the SES group was 0.30 (0.49) mm if patients with failed IRT were included and 0.23 (0.41) mm if only patients with SES used for first time ISR were analysed. Thus, the results are comparable with those of previous studies on the use of SES for ISR.. It is important to note that not all ISR lesions have a similar risk of recurrence.13 This has to be considered if angiographic and clinical follow up results for different treatment modalities for ISR are compared. Most studies analysing the procedural and follow up results of different treatment strategies for ISR were not randomised or matched comparisons.23 In this study ISR lesions treated with SES were ...

This study demonstrated that rosiglitazone significantly reduced restenosis rate in the 6 months after coronary stenting in the type 2 diabetic patients. These effects were independent of glycemic control, since there were no significant relationships between the restenosis percentage and the changes in glucose concentrations and because the glycemic indexes were similar in the two groups, either at the baseline or at the follow-up angiography.. Because the proliferations of neointimal tissue and/or the medial vascular smooth muscle cells (VSMCs) are pivotal to the pathophysiology of a postintervention restenosis (20,21), inhibiting cellular proliferation for preventing an in-stent restenosis is a rational strategy. Although numerous therapies, including mechanical or pharmacological approaches, to block or inhibit the pathological processes of vascular proliferation have been studied, clinical trials have generally failed to recapitulate the efficacy documented in animal studies (8-11). ...

The use of drug-eluting stents and of drug-coated balloons have mitigated the prevalence of in-stent restenosis, however in-stent remains a problem that continues to affect the long-term outcomes of femoro-popliteal endovascular therapy. This paper will provide an overview on the latest data with regard to the treatment of femoro-popliteal in-stent restenosis.. ...

Treatment of in-stent restenosis.: Although in-stent restenosis is the result of neointimal hyperplasia, mechanical problems (e.g. stent underexpansion) that oc

Endovascular treatment of symptomatic peripheral arterial disease in the femoropopliteal (FP) artery is fraught with high rates of restenosis. Success of the antiproliferative drug, paclitaxel, in the coronary arteries, has lead to the investigation of paclitaxel in the peripheral arteries to treat restenosis. This article reviews restenosis rates for the major treatment modalities used in the FP segment. Use of drug-elution for restenosis is also reviewed, including the use of drug-eluting balloons and drug-eluting stents.. ...

restenosis - MedHelps restenosis Center for Information, Symptoms, Resources, Treatments and Tools for restenosis. Find restenosis information, treatments for restenosis and restenosis symptoms.

The concept of systemic pharmacological treatment to reduce inflammation after stenting has been applied in many preclinical and clinical studies with varying success.3,4,18,19 Because of a lack of drug specificity requires high dosages to achieve sustained effects on neointimal growth, systemic side-effects are of major concern and have hindered the general acceptance of systemic pharmacological approaches to prevent restenosis. Steroids have been proven to be effective in reducing neointimal growth in preclinical and clinical settings2-4,20 but, nonetheless, systemic administration of glucocorticoids to prevent in-stent restenosis could not gain acceptance in routine clinical practice because of a lack of efficacy at concentrations low enough to avoid the hazard of steroid side-effects.. The targeted use of pharmacologically modified steroids with high affinity for sites of arterial injury, as demonstrated by our study, might be a valuable approach to effectively prevent restenosis at dosages ...

Objective: Drug-eluting stents (DES) have reduced restenosis rates compared with bare-metal stents. P27 and P53 play important roles in the signal transduction leading to neointimal growth inhibition and induction of apoptosis of smooth muscle cells due to rapamycin and paclitaxel. We hypothesized that genetic variants of P27 and P53 influence the development of restenosis and the clinical outcome of patients receiving DES. Methods: Polymorphisms in the genes encoding for P27 and P53 were tested for their association with restenosis and major adverse cardiac events. P27 C-79T and P53 G72C polymorphism genotypes were determined in a series of 433 consecutive patients receiving DES. Follow-up angiography after 6 months was performed in 87% of the patients. Genotyping was performed with PCR-based methods. Results: For patients with the respective P27 C-79T and P53 G72C genotypes, the angiographic restenosis rates were between 5.0 and 22.0%, and the clinical restenosis rates were between 0.0 and ...

Results of the ISAR-DESIRE 4 Trial Presented at TCT 2015 SAN FRANCISCO - October 14, 2015 - Results from the ISAR-DESIRE 4 trial indicate that use of a scoring balloon plus a paclitaxel-coated balloon (PCB) was angiographically superior to a paclitaxel-coated balloon alone for the treatment of restenosis within limus-eluting stents.. Findings from study were presented today at the 27th annual Transcatheter Cardiovascular Therapeutics (TCT) scientific symposium. Sponsored by the Cardiovascular Research Foundation (CRF), TCT is the worlds premier educational meeting specializing in interventional cardiovascular medicine.. Restenosis after drug-eluting stent implantation (DES) in patients with coronary artery disease occurs in up to 5 to 10% of cases and the most appropriate treatment strategy remains unclear. Drug-coated balloons (DCB) are novel devices that can effectively treat in-stent restenosis. Scoring balloon (SCB) devices prevent balloon slippage and enhance local plaque disruption during ...

Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the contacts provided below. For general information, Learn About Clinical Studies. ...

The argument went that the same would likely be true for reversed saphenous veins. Randomized trials in the past supported this notion. RRISC (2006) showed that angiographic restenosis occurred more frequently with BMS (33 percent vs. 14 percent with DES), but there were only 75 patients in the trial. Notably, there was no difference in major adverse cardiovascular events (MACE) at 32 months. The SOS trial (2009 with 80 patients) supported this finding with a 51 percent vs. 9 percent angiographic restenosis rate at 12 months with BMS and DES respectively. Target vessel failure also occurred more frequently with BMS at 35 months.. More recent trials, ISAR CABG and BASKET-SAVAGE (2011 and 2016 respectively) also found DES to be superior. These trials used composite endpoints of death or cardiac death, target lesion or target vessel revascularization and myocardial infarction as endpoints. That makes comparison of actual restenosis rates difficult. Nonetheless, the number of patients was larger and ...

At three-year follow-up target lesion revascularisation was significantly less in the 192Ir group (15.4% vs 48.3%; P ,0.01). The dichotomous restenosis rate at 3 years was also significantly less in 192Ir patients (33% vs 64%; P ,0.05). No events occurred at either the 6 months or 3 year follow-up to suggest an adverse effect of vascular radiotherapy. ...

At three-year follow-up target lesion revascularisation was significantly less in the 192Ir group (15.4% vs 48.3%; P ,0.01). The dichotomous restenosis rate at 3 years was also significantly less in 192Ir patients (33% vs 64%; P ,0.05). No events occurred at either the 6 months or 3 year follow-up to suggest an adverse effect of vascular radiotherapy. ...

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The FDA approved Medtronics IN.PACT Admiral drug-coated balloon Sept. 13 to treat in-stent restenosis in patients with peripheral artery disease.

In the REMEDEE trial, the Combo stent was found to be noninferior to the PES with respect to 9-month angiographic in-stent LLL and thereby met its primary endpoint. The observed in-stent LLL of 0.39 mm for the Combo stent was greater than that reported for conventional SES, where Cypher (Cordis, Miami Lakes, Florida) LLL values have been reported up to 0.24 mm, including diabetic patients (13-15). These angiographic results are in line with the expected capture of circulating EPCs by the CD34 antibody, creating a fast and complete layer of cells leading to the covering of the stent struts. Experimental data have shown that the abluminal release of sirolimus by the Combo stent results in a similar effective dosage in the stented arterial wall, as with the omnidirectional release by the SES, yet with a drastically reduced release to the circulation (6).. Angiographic LLL has been used as a surrogate for DES efficacy in preventing angiographic restenosis and the need for repeat TLR (16,17). A ...

This study demonstrated that rosiglitazone significantly reduced restenosis rate in the 6 months after coronary stenting in the type 2 diabetic patients. These effects were independent of glycemic control, since there were no significant relationships between the restenosis percentage and the changes in glucose concentrations and because the glycemic indexes were similar in the two groups, either at the baseline or at the follow-up angiography.. Because the proliferations of neointimal tissue and/or the medial vascular smooth muscle cells (VSMCs) are pivotal to the pathophysiology of a postintervention restenosis (20,21), inhibiting cellular proliferation for preventing an in-stent restenosis is a rational strategy. Although numerous therapies, including mechanical or pharmacological approaches, to block or inhibit the pathological processes of vascular proliferation have been studied, clinical trials have generally failed to recapitulate the efficacy documented in animal studies (8-11). ...

Hi. My wife has had 3 angioplasties, the 1st in 2001, the second in 2008 and the last this year (2009). The procedure in 2008 resulted in restenosis of a stent and caused her to return in 2009. It seem...

ISR can be defined clinically or angiographically. Definitions ISR can be defined clinically or angiographically. Clinically, it is defined as the presentation of recurrent ischaemia Angiographically, ISR is the presence of >50% diameter stenosis in the stented segment. 50%-70% : moderate %-99% : severe Teirstein PS, N Engl J Med, 1997

Este video muestra cómo utilizar un modelo preclínico de bajo costo y confiable para estudiar los procesos fisiopatológicos...

In the initial evaluation, there was a significant benefit for use of the LifeStent. Results from the 12-month analyses indicate that although there was no difference in freedom from major adverse cardiac events between the control and test group, primary patency and freedom from target lesion revascularisation (TLR) were significantly increased in the patients treated with the LifeStent. In addition, results from the 24-month follow-up indicate that freedom from TLR in patients treated with the LifeStent is almost double that of patients treated with angioplasty alone. However, although the results from patients treated with the LifeStent were better overall, Scheinert added that an angioplasty-only strategy has a role in patients with less complex lesions such as those that are shorter or less-severely calcified.. ...

Vinay Malhotra, MD, a cardiologist at the Cardiac Study Center inTacoma, Wash., evaluated in-stent restenosis (ISR) and chronic totalocclusions (CTO) in the lecture series

A medical stent is sized for placement in a ureter. The stent includes a first section which includes a first material, defines a lumen, and includes a first coil completing at least one revolution. A second section of the stent includes a second material, defines a lumen, and includes a second coil completing at least one revolution. A third section defines a lumen and is located between the first and second sections. The third section includes a co-extrusion of the first and second materials. One of the first or second sections is harder than the other section.

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Le Creuset stent j til madlavning og servering.velegnet til brug i ovn op til 260 C og under ovnens grillelement. T ler desuden mikroovn, fryser og maskinopvask. M IKKE anvendes direkte p komfuret! Le Creuset stent j har en emaljeret overflade, der er nem at reng re.

ႏွလုံးေသြးေၾကာက်ဥ္းကုသမႈတစ္ခုျဖစ္တဲ့ Stent ( စတန႔္)ထည့္တယ္ဆိုတာဘာလဲ

Denne procedure er alene gældende for MR-sektionen på Rigshospitalet. Aktuelle procedure kan naturligvis anvendes som inspirationskilde til udvikling af egne sikkerhedsforskrifter. ...

واشنطن، العاصمة ــ في ظل الاضطرابات في أوكرانيا، ومراقبة الولايات المتحدة وروسيا لتحركات كل منهما الأخرى بحذر، يبدو العالم وكأنه على شفا مواجهة طويلة أشبه بالحرب الباردة. ولكن هل هذا صحيح حقا؟. لقد قامت روسيا، التي تتهم الغرب بدعم انقلاب قام به فاشيون وإرهابيون في كييف، بضم شبه جزيرة القرم، واختبرت صاروخاً باليستياً عابراً للقارات، واحتفظت بحق التدخل عسكرياً في شرق أوكرانيا لحماية السكان الروس هناك. وفرضت الولايات المتحدة عقوبات على روسيا واعتبرت ضم شبه جزيرة القرم تصرفاً غير قانوني. ولكنها دعت أيضاً إلى التعاون لحل الموقف سلمياً وأعلنت أن ...

TY - JOUR. T1 - Brachytherapy with gamma radiation of a coronary artery for in-stent restenosis may induce the regression of in-stent restenosis of an adjacent coronary artery without angioplasty. First case report and review of the literature. AU - Movahed, Mohammad Reza. PY - 2004/10/1. Y1 - 2004/10/1. N2 - Here, we present a case of a 63-year-old male who presented with in-stent restenosis of two coronary arteries simultaneously (mid circumflex and proximal ramus). After the brachytherapy of the circumflex artery for in-stent restenosis, the patient refused the staged procedure for the ramus in-stent restenosis. After approximately 2 years, the patient underwent coronary angiography for recurrent chest pain. Surprisingly, the proximal ramus stent showed marked regression of in-stent restenosis. We hypothesized that the gamma brachytherapy of the circumflex artery could have induced the regression of in-stent restenosis of the adjacent ramus artery due to the deep tissue penetration of gamma ...

The FAIR trials objective was to assess safety and efficacy of angioplasty with drug-eluting balloon vs. standard angioplasty for the treatment of symptomatic superficial femoral artery in-stent restenosis. The primary endpoint was binary (≥50%) restenosis rate at six months as assessed by duplex ultrasound corelab adjudication (PSVR≥2.4). The secondary endpoints were primary angiographic success (,50% residual stenosis), six-month recurrent in-stent restenosis (≥70%) and 12-month recurrent in-stent restenosis (≥50%), six- and 12-month clinically-driven target lesion revascularisation, and clinical/haemodynamic assessment (walking distance, ankle brachial index, Rutherford category) at one, six and 12 months. The investigators also assessed the major adverse vascular events (MAVE) at 12 months.. Patients who had Rutherford class 2-4 lesions and superficial femoral artery in-stent restenosis between 70-100% as assessed by duplex ultrasound were included. Further, to be included, patients ...

Drug-eluting stents reduce clinical events related to restenosis but may be complicated by late stent-thrombosis. Whereas assessment of target-vessel ischemia by myocardial perfusion scintigraphy identifies relevant restenosis noninvasively, it is unknown whether this technique may also predict late clinical events related to late stent-thrombosis and to restenosis after drug-eluting stent implantation. METHODS: All 826 patients treated with stenting between May 2003 and May 2004 were included in the Basel Stent Cost Effectiveness Trial (Basel Stent Kosten-Effektivitäts Trial, or BASKET) and randomized (2:1) to drug-eluting stents or bare metal stents. Myocardial scintigraphy was performed on 476 (64%) of 747 patients without major events after 6 mo. Patients were followed for 1 y for cardiac death, nonfatal myocardial infarction, and target-vessel revascularization due to restenosis or late stent-thrombosis. RESULTS: The rate of target-vessel ischemia in these patients was lower with ...

Hello and welcome to the December issue of Vascular Disease Management. I have chosen to comment on Deepika Kalisetta and colleagues case report on Balloon Assisted Dislodgement of a Trapped Directional Atherectomy Catheter (the Ocelot device) During Treatment of In-Stent Restenosis (ISR).. Stenting of femoropopliteal arterial obstructive lesions has been demonstrated to result in higher primary patency than standard balloon angioplasty. Stenting is also routinely utilized to treat flow-limiting dissections following PTA and atherectomy. Therefore, stenting is commonly utilized in treating symptomatic femoral and popliteal arterial obstructions. Unfortunately, restenosis and reocclusion are common following stenting. Whereas stent grafts tend to develop recurrent stenosis only at the edge of the stents, standard nitinol self-expanding stents often develop diffuse in-stent restenosis secondary to neointimal hyperplasia and reocclusion when there is superimposed thrombus. Stent restenosis can ...

Boston Scientifics Jetstream atherectomy system has received CE mark for a new in-stent restenosis indication. This indication gives EU physicians another safe and effective treatment option for in-stent restenosis, a disease state that has historically been challenging to treat with traditional therapies, says a Boston Scientific press release.. The indication is supported by data from the Jetstream-ISR feasibility study, in which the device demonstrated a strong safety profile, with zero device-stent interactions. The study included long, complex lesions (62% were TASC C&D). Six-month freedom from target lesion revascularisation was 86.2% with patency at 72%.. ...

Multi-detector computed tomography angiography (MDCTA)of the coronary arteries after stenting has been evaluated in multiple studies. The purpose of this study was to perform a structured review and meta-analysis of the diagnostic performance of MDCTA for the detection of in-stent restenosis in the coronary arteries. A Pubmed and manual search of the literature on in-stent restenosis (ISR) detected on MDCTA compared with conventional coronary angiography (CA) was performed. Bivariate summary receiver operating curve (SROC) analysis, with calculation of summary estimates was done on a stent and patient basis. In addition, the influence of study characteristics on diagnostic performance and number of non-assessable segments (NAP) was investigated with logistic meta-regression. Fourteen studies were included. On a stent basis, Pooled sensitivity and specificity were 0.82(0.72-0.89) and 0.91 (0.83-0.96). Pooled negative likelihood ratio and positive likelihood ratio were 0.20 (0.13-0.32) and 9.34 (4.68-18

196 of 205 patients assigned to treatment of placebo were followed clinically and 177 had repeat angiography. There was no difference between groups in the following: average age 61 years, 22% were women, 40% were smokers, 28% diabetics, lipids, homocysteine (11μm/L), or treatment with statins (71%), beta blockers (65%), and ACIi (35%), use of stents (50%). Treatment lowered homocysteine levels from 11.1 +/- 4.3μm/L to 7.2 +/- 2.4 μm/L. The rate of restenosis was significantly lower on treatment (19.6% vs 37.6%, p = 0.01) as was the need for target vessel revascularization (10.8% vs. 22.3%, p = 0.047). The followup minimal luminal diameter and percent stenosis was also significantly better in the folate group. There was no difference in other coronary events. The benefit was predominately in those with PTCA without stenting ...

In-stent restenosis has long remained the major limitation of coronary stenting. Recent randomized trials have shown that the use of drug-eluting stents (DES) markedly reduce the risk of in-stent restenosis following treatment of de novo lesions,1-4 even lesions at high risk for in-stent restenosis.5,6 Calcified lesions are often undilatable with conventional balloons and are a predictor of late in-stent thrombosis.7 Stent underexpansion is also associated with restenosis8 and in-stent thrombosis after successful DES implantati

Clinical and Doppler ultrasound follow-up was performed at 1 and 6 months and shows no related complications and no signs of ISR (PSV=128cm/s).. Discussion. The occurrence of in-stent restenosis (ISR) after carotid artery stenting (CAS) ranges from 3% to 20% and varies with patient risk factors, lesion characteristics, and the location of the stent(s).2,5-7 However, the relatively wide range of ISR rates reported in previous studies may be the result of different definitions/diagnostic testing for ISR, patient selection bias, and length of follow-up.5. DUS is often used to monitor the patency of the stent and the occurrence of ISR. For routine evaluation of unstented carotid arteries, DUS is a well validated diagnostic test and the cut-off criteria for the different degrees of stenosis are clear.8,9 The peak systolic velocity (PSV) is the best predictor for the severity of the stenosis.10 However, the degree of restenosis in a stented carotid artery, measured according to the North American ...

Clinical trial for Transluminal | Coronary Restenosis | Percutaneous Coronary | Angioplasty , Effects of Celecoxib On Restenosis After Coronary Intervention and Evolution of Atherosclerosis Trial

OBJECTIVE: To assess the safety and efficacy of the Genous™ endothelial progenitor cell (EPC) capturing stent in conjunction with HmG-CoA-reductase inhibitors (statins) to stimulate EPC recruitment, in the treatment of patients with de novo coronary artery lesions. METHODS AND RESULTS: The HEALING IIB study was a multi-center, prospective trial, including 100 patients. The primary efficacy endpoint was late luminal loss by QCA at 6-month follow-up (FU). Although statin therapy increased relative EPC levels by 5.6-fold, the angiographic outcome at 6 month FU was not improved in patients with an overall in-stent late luminal loss of 0.76±0.50 mm. The composite major adverse cardiac events (MACE) rate was 9.4%, whereas 6.3% clinically justified target lesion revascularizations (TLRs) were observed. 2 Patients died within the first 30 days after stent implantation due to angiographically verified in-stent thrombosis. At 12 month FU, MACE and TLR increased to 15.6% and 11.5% respectively and stabilized

PARIS--(BUSINESS WIRE)--May 16, 2012-- Physicians presented today at EuroPCR 2012 the results of two multicenter, randomized controlled trials, the BELLO and PACIFIER studies, each one showing statistically significant advantages of using an IN.PACT drug-eluting balloon from Medtronic, Inc. (NYSE: MDT) over a corresponding conventional treatment for coronary and peripheral artery disease.. Medtronic IN.PACT drug-eluting balloons received CE (Conformité Européenne) mark in 2008 and 2009 and are available in many countries around the world. They are not commercially available in the United States.. BELLO The physician-initiated BELLO (Balloon Elution and Late Loss Optimization) study enrolled 182 patients across 15 hospitals in Italy to evaluate the safety and effectiveness of the Medtronic IN.PACT Falcon(TM) drug-eluting balloon versus the Taxus drug-eluting stent (DES) from Boston Scientific Corp. in reducing late lumen loss in small-vessel coronary artery disease. With both devices eluting ...

TY - JOUR. T1 - A proliferation analysis of arterial neointimal hyperplasia. T2 - Lessons for antiproliferative restenosis therapies. AU - Schwartz, Robert S.. AU - Chu, Aloysius. AU - Edwards, William D.. AU - Srivatsa, Sanjay S.. AU - Simari, Robert D.. AU - Isner, Jeffrey M.. AU - Holmes, David R.. PY - 1996/1. Y1 - 1996/1. N2 - Medial smooth muscle cell proliferation is frequently implicated as the major cause of coronary restenosis. Although antiproliferative agents have shown efficacy in animal studies, they are ineffective in human trials. To better understand these discrepancies, we performed a mathematical kinetic analysis of cellular proliferation in the neointimal hyperplasia of rats, pigs, and patients. A model was derived using a differential expression for proliferation, proportional to the number of cells present. Additional terms were included for inhibition of proliferation proportional to neointimal mass and time. The resulting equation was solved in closed form for the number ...

A 93 patient randomised trial of a sirolimus-coated nitinol stent vs. the same, uncoated device in relatively long lesions (mean length 8.3 ± 4.5 cm) ended with high long-term efficacy of BMS: the two-year angiographic restenosis rate was 21% in both groups. Two-year target lesion revascularisation was very low overall and there was no significantly different restenosis between the BMS and the DES arm: 13% vs. 6% (15). Nevertheless, it could be expected that this figure was twice that of the BMS group, and the difference would have reached significant figures with a bigger sample size.. Polimer-free paclitaxel-coated DES implantation or balloon dilatation (PTA), debatable results: In a subsequent larger trial, 479 symptomatic patients were assigned to polimer-free paclitaxel-coated DES implantation or balloon dilatation (PTA) of femoro-popliteal stenoses with a mean length of 6.3 ± 4 cm. (16). Patients in the balloon arm were further randomised to BMS or DES during the intervention if balloon ...

Hellenic J Cardiol 2011; 52: Original Research Long-Term Results After Drug-Eluting Stent Implantation in Diabetic Patients According to Diabetic Treatment Vassilis Voudris, Panagiotis Karyofillis,

The principal findings from the present report, representing the final 5-year analysis from the TAXUS clinical trial development program, are that in patients undergoing PCI of a single de novo lesion of varying complexity, treatment with the slow-release PES versus an otherwise identical BMS resulted in: 1) significant 1-year reductions in ischemia-driven TLR and TVR in simple and complex patients and lesions, differences that were maintained throughout 5 years of follow-up, with no evidence of late catch-up apparent; 2) nonsignificant differences in the cumulative rates of all-cause mortality, cardiac mortality, MI, and cardiac death or MI at the end of the 5-year follow-up period; 3) an increase in the 5-year cumulative rate of stent thrombosis, which reached statistical significance when defined by the pre-specified protocol definition of stent thrombosis, but not by the ARC definite or probable definition; and 4) similar rates of cardiac death or MI and protocol-defined stent thrombosis ...

12-month data from the RESTORE pilot clinical trial between December 2011 and July 2012 were also presented at TCT. The RESTORE trial was designed to evaluate safety and performance of the first generation ReZolve sirolimus-eluting bioresorbable coronary scaffold. Imaging results of patients treated with ReZolve who remained event free after treatment demonstrated a mean in-stent late loss of 0.29 mm. When imaging results for patients who had undergone retreatment for focal in-stent restenosis the mean in-stent late loss was 0.69 mm ...

A pooled analysis of safety data from Medtronics Endeavor clinical programme has affirmed the superior safety of the Endeavor drug-eluting coronary stent compared to the best-in-class Medtronic bare metal stent, Driver.

A stent is a small, expandable tube that can be inserted into a blood vessel and expanded using a small balloon during a procedure called angioplasty. A stent is used to open a narrowed or clotted blood vessel.. When the balloon inside the stent is inflated, the stent expands and presses against the walls of the artery. This traps any fat and calcium buildup against the walls of the artery and allows blood to flow through the artery. The stent helps prevent the artery from closing again (restenosis). It can also help prevent small pieces of plaque from breaking off and causing a heart attack or stroke.. To insert the stent, a flexible, thin tube (catheter) is passed through an artery in the groin or arm into the narrowed artery. Then the balloon inside the stent is inflated.. Some stents, called drug-eluting stents, are coated with a medicine to more effectively prevent restenosis. ...

Gene-eluting stents can have profound impact in the treatment of coronary restenosis, especially when the encoded protein can re-endothelialize the arterial lumen. In this study, we have examined gene...

Interventional cardiology has made lifestyle changes obsolete. Angioplasty surgery can open clogged vessels and put a stent in. But what about life after stent?

CardioMind, Inc., a developer of stents for small, difficult-to-treat blood vessels, announced today that it has begun a First-in-Human clinical trial of its drug-eluting stent.

Terumo has received the CE mark for its Ultimaster Tansei drug-eluting stent. Building on the Ultimaster stent, a press release reports, the Ultimaster Tansei features optimised technology that will benefit clinicians and their patients worldwide.

A stent is a wire mesh tube (scaffold) thats inserted into a narrowed coronary artery to keep it open and allow heart muscle to get the blood flow and oxygen it needs. Drug-eluting stents have a coating that releases a drug over time to help keep blockages from happening.. ...

Although the increased use of balloon expandable stents is a valuable contribution for diminishing the restenosis rate after PTCA 3, a number of papers reporting several severe complications have been published. The complications can be related to the site of percutaneous insertion (15% of all cases, 50% of which need surgical treatment 3,4 ) or the site of the coronary stent deployment, such as subacute stent thrombosis ( 3-5% in elective and 10-20% in emergency cases 4). In our case two complications were described: a peripheral one, a pseudoaneurysm, and a coronary one, an unsuccessful deployment of a balloon extended stent. The use of stents for lesions located in the proximal third of the LAD is a routine procedure. We also decided to use a stent in order to reduce the risk of restenosis. This type of stent is advanced across the lesion without a protective sheath. After placing the stent in the correct position, the balloon was expanded and unsuccessfully deployed, due to the fact that it ...

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SAN DIEGO and BUELACH, Switzerland, Sept. 24, 2018 /PRNewswire/ -- Today, BIOTRONIK announced two-year data from the BIOFLOW-V randomized trial comparing the Orsiroa and Xienceb drug-eluting stents (DES). The data shows statistically improved outcomes for patients treated with Orsiro across a range of clinical...

Technavio analysts forecast the global drug-eluting balloons market to grow to USD 664.35 million by 2021, at a CAGR of more than 27%.

Randomized Clinical Trial Intracoronary Stenting and Angiographic Results: Optimizing Treatment of Drug-Eluting Stent In-Stent Restenosis 4

A method for inhibiting restenosis is described. The method comprises implanting a stent in a patients vasculature and simultaneously delivering a restenosis-inhibiting medicine to the treatment site by adjuvant therapy.

An intravascular stent reduces the risk of restenosis due to stent implantation by using 17beta-estradiol as a vessel healing substance after implantation of an intravascular stent. The 17beta-estradiol coats at least a portion of the surface of the stent and is adhered to the stent with an adhesive layer containing DLC (

A mounting and transfer device and method for installing a stent on a delivery device that inserts the stent into a body lumen. The device includes a generally cylindrical mandrel for receiving and frictionally holding a stent, a handle at a first end of the mandrel and a guide rod extending axially from the second of the mandrel. The second end of the mandrel has a conical recess surrounding the guide rod exit. In use, a stent is placed on the mandrel, the distal end of the guide rod is fully inserted into a guide wire lumen at an end a delivery system such as a catheter and the stent is slid from the mandrel onto the balloon and crimped in place. A tube of heat shrinkable material may be placed over the stent on the mandrel and heat shrunk to lightly press against the stent. The tube and stent are transferred to the balloon and crimped. The tube protects the stent against damage during transfer and crimping and is easily removed thereafter since crimping reduces the outside diameter of the stent to

Dr. J mark Rheudasil answered: Not removed: Very unusual to remove stents unless infected (rare). They may be redilated or a surgical bypass may be needed.

Many patients have been saved open heart surgery by placing a stent in a blocked artery via a vein in the leg. Unfortunately, these stents have a high likelihood of closing back up in a relatively short period.

FINAL CLINICAL STUDY DATA PRESENTED TODAY BY DR. MICHAEL DAKE AT THE TRANSCATHETER CARDIOVASCUALR THERAPEUTICS (TCT) CONFERENCE IN WASHINGTON, DC VANCOUVER, Sep

Angioplasty has completely transformed the treatment of coronary artery disease and is widely used, with more than 800,000 procedures performed worldwide per year. However, the enthusiasm for angiopla

A composite intraluminal device is deployable within a body vessel. The composite device includes an elongate radially expandable tubular stent having an interior luminal surface and an opposed exterior surface extending along a longitudinal stent axis. A stent cover is formed of unsintered ePTFE which is expandable. The stent cover is positioned about the stent so as to permit expansion of the cover upon the radial expansion of the stent.

The present invention is directed to a stent for use in a bifurcated body lumen having a main branch and a side branch. The stent comprises a radially expandable generally tubular stent body having proximal and distal opposing ends with a body wall having a surface extending therebetween. The surface has a geometrical configuration defining a first pattern, and the first pattern has first pattern struts and connectors arranged in a predetermined configuration. The stent also comprises a branch portion comprised of a second pattern, wherein the branch portion is at least partially detachable from the stent body.

The present invention is directed to a stent for use in a bifurcated body lumen having a main branch and a side branch. The stent comprises a radially expandable generally tubular stent body having proximal and distal opposing ends with a body wall having a surface extending therebetween. The surface has a geometrical configuration defining a first pattern, and the first pattern has first pattern struts and connectors arranged in a predetermined configuration. The stent also comprises a branch portion comprised of a second pattern, wherein the branch portion is at least partially detachable from the stent body.

A stent includes a first stent section, a second stent section, and at least one connecting member. The connecting member has a first end attached to the first stent section, a second end attached to the second stent section and a physically separable portion.

What Medical Conditions Are Treated with a Stent? - Learn how stents are used to treat blockages and how a stent may reduce the risk of a heart attack. Watch this...