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Coronary stenting I: Intracoronary stents – Form and function
Published in Ever D. Grech, Practical Interventional Cardiology, 2017
Varinder K Randhawa, Patrick Teefy
Polymers adhered to the stent surface bind and permit controlled release (elution) of the anti-proliferative/immunosuppressive medication. The polymers affixed to first-generation DES were permanent/durable consisting of SIBS (polystyrene-b-isobutylene-b-styrene) for TAXUS stent (Boston Scientific, Natick, Massachusetts) eluting 10% of paclitaxel over the first 10 days (the remainder fixed) and PEVA (polyethylene-co-vinyl acetate)/PBMA (polyhexyl methacrylate) for CYPHER stent (Cordis Corp, Miama, Florida) eluting 80% of the sirolimus during the first 30 days.
Coronary artery stenting
Published in Debabrata Mukherjee, Eric R. Bates, Marco Roffi, Richard A. Lange, David J. Moliterno, Nadia M. Whitehead, Cardiovascular Catheterization and Intervention, 2017
Raffaele Piccolo, Stephan Windecker
The first SES was the Cypher stent (developed by Cordis Corporation, Warren, NJ). It consisted of sirolimus in a concentration of 140 pg/cm2 incorporated in an amalgam of two biostable polymers, with the polymer/drug matrix then applied onto the tubular 316L stainless steel BX Velocity stent. The Cypher stent was the first DES to receiveCE-mark in April 2002 and was subsequently approved by the FDA in 2003. An analysis of individual data on 4,958 patients enrolled in 14 randomized trials comparing SES with BMS showed a significant 57% relative reduction in the risk of death, MI, or reintervention favoring SES.32 This benefit was largely driven by a pronounced reduction in the need for repeat revascularization. Despite its efficacy, the use of SES was associated with a higher risk of very late stent thrombosis, particularly in more complex patient and lesion subsets.33 The manufacturer ceased production at the end of 2011.
Role of antegrade blunt dissection for coronary and peripheral chronic total occlusions
Published in George D Dangas, Roxana Mehran, Jeffrey W Moses, Handbook of Chronic Total Occlusions, 2007
Patrick L Whitlow, Matthew Selmon
With improvements in wire technology and technique, the Frontrunner has emerged as a tool for refractory CTO cases failing new guidewire technology. Case 1 (Figure 17.5) is an example of a man with a 12-year-old occlusion of the mid-LAD (left anterior descending coronary artery) that failed aggressive guidewire attempts. Guidewire attempts were abandoned and the proximal fibrous cap was then re-crossed with the Frontrunner. This new entry enabled an Asahi Miraclebros 3 wire to traverse the lesion in the true lumen. This wire was successfully steered into the distal LAD and the LAD was then recanalized with a Cypher stent. Follow-up catheterization 6 months later documented wide patency from this CTO intervention.
Review of safety reports of cardiac MR-imaging in patients with recently implanted coronary artery stents at various field strengths
Published in Expert Review of Medical Devices, 2021
Christian David Schenk, Rolf Gebker, Alexander Berger, Burkert Pieske, Christian Stehning, Sebastian Kelle
This underlines the guidelines of German Cardiac Society [7], which confirm the safety of performing MRI in patients with chronic implanted BMS. Although the guidelines [7] also describe the safety of performing MRI shortly after stent implantation, data situation is not as clear as for chronic implanted stents and there is also a case study mentioned, which describes a dislocation of a 3,5 x 8 mm Cypher Stent, which was implanted in the LMS 14 days before a 1.5 Tesla MRI-examination of the head [27]. Moreover the mentioned guidelines especially refer to non-eluting stents (BMS) [7]. Because of the characteristics of DES, it takes a longer time until endothelialization and arterial healing are completed than in BMS [28]. The delay in arterial healing and endothelialization and therefore the longer time, in which stents are in direct contact with bloodflow, generate a higher risk of stent thrombosis [28]. This is the reason why it is also very important to have a closer look on MRI safety especially of DES. Also the guideline mentions that safety is given for 3.0 Tesla MRI-examinations as well, but they give only 1 reference [12], which is only an in-vitro study, to prove this thesis [7].
The Cre8 amphilimus-eluting stent for the treatment of coronary artery disease: safety and efficacy profile
Published in Expert Review of Medical Devices, 2020
Carlo A. Pivato, Pier Pasquale Leone, Gennaro Petriello, Jorge Sanz-Sanchez, Mauro Chiarito, Giulio G. Stefanini
In a preclinical, in vivo investigation, Moretti et al. confirmed the biological safety of the Cre8 stent implanted in porcine coronary arteries with subsequent histological and morphometric evaluations [21]. Compared with two controls – the Cre8 platform loaded only with an amphiphilic carrier and the Cypher Select Plus® sirolimus-eluting stent (Cordis, Johnson & Johnson, Warren, NJ, USA) – the Cre8 stent showed a significantly reduced neointimal thickness at 90-day follow-up (Cre8 stent 0.15 ± 0.07 mm; Cre8 platform 0.21 ± 0.12 mm; Cypher 0.31 ± 0.15 mm; Cre8 stent vs. Cypher stent p < 0.05). This could be partially explained by the reduced inflammation, since the vessel wall inflammation score according to Kornowski [23] was <1 in 100% of the analyzed Cre8 stent, 71.5% of Cre8 platform, and 66.7% of Cypher stent at 30 days (Cre8 stent vs. Cypher stent, p = ns), and in 100% of Cre8 stent, 100% of Cre8 platform, and 66.7% of Cypher stent (Cre8 stent vs. Cypher stent p = ns) at 90 days.