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3 years ago
More than 170 million people suffer from diabetes mellitus worldwide and their number is growing continuously. About 65% of diabetics die of cardiovascular disease and diabetes accounts for over a quarter of percutaneous coronary interventions (PCIs).
Diabetes mellitus has been consistently shown to be an important predictor of poor outcomes after PCI. Diabetic patients have an increased risk…
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3 years ago
Stent thrombosis (ST) is the sudden occlusion of a stented coronary artery due to thrombus formation. The clinical consequences of ST are frequently catastrophic – most episodes occur within two weeks of stent implantation – and include death in 20–48% or major myocardial infarction (MI) in 60–70% of cases.1–3 When bare-metal stents (BMS) were first introduced, ST was a common complication…
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3 years ago
Drug-eluting stents (DES) are the standard percutaneous treatment strategy in patients with coronary artery disease (CAD). Their use has further reduced the incidence of restenosis and repeat revascularisation in single vessel de novo disease. These stents have bioactive coatings that, through a complex mechanism, allow the release of various anti-inflammatory and anti-proliferative drugs at high…
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3 years ago
When Andreas Grüntzig introduced balloon coronary angioplasty in 1977 it represented the first alternative to coronary artery bypass graft surgery. However, balloon dilatation had inherent limitations – including elastic recoil and vessel closure in the acute phase, as well as negative remodelling and restenosis in the late phase – which limited its applicability and further expansion. In the…
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3 years ago
An unintended consequence of the market success of drug-eluting stents has been a growing concern about their safety and safety-related costs. These devices have been so quickly and widely adopted that their market penetration already equals that of some of the most popular pharmaceutical drugs. Consequently, the absolute significance of even a low incidence of side effects becomes magnified by…
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3 years ago
Late stent thrombosis has been a concern for interventional cardiologists since the early days of drug-eluting stent (DES) technology. Although the problem did not appear common, a series of angiographically documented late stent thromboses from the Thoraxcenter Rotterdam was published in 2004, sounding a cautionary, albeit non-alarmist, note.1 In 2005, a prospective observational cohort study of…
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Added:
3 years ago
An unintended consequence of the market success of drug-eluting stents has been a growing concern about their safety and safety-related costs. These devices have been so quickly and widely adopted that their market penetration already equals that of some of the most popular pharmaceutical drugs. Consequently, the absolute significance of even a low incidence of side effects becomes magnified by…
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Added:
3 years ago
The treatment of acute myocardial infarction (AMI) has substantially improved in recent decades. Thrombolysis, the former first-line therapy, which is inexpensive and may be administered without noteworthy delay in primary care or pre-hospital settings, has been replaced by primary percutaneous coronary intervention (PCI) despite the inherent delay of transfering patients to a cardiac…
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3 years ago
The rare but catastrophic occurrence of stent thrombosis, in particular 'late' stent thrombosis, in association with deployment of drug-eluting stents has focused attention on the adequacy of the current dual anti-platelet regimen of aspirin and clopidogrel. Stent thrombosis is due to multiple factors. These include, specific stent features (delayed healing or polymer hypersensitivity),…
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Added:
3 years ago
Drug-eluting stents (DES) have been recognised as a ‘breakthrough technology’ since 2003 due to their unique capacity to reduce clinical restenosis. The difference in restenosis rates, as assessed by angiography, was so large between DES and bare-metal stents (BMS) in the first trials – 0% versus 26% after six months in the first published trial (RAVEL) with the sirolimus-eluting stent (SES),1…
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