Vascular responses to drug eluting stents - Importance of delayed healing

被引:744
作者
Finn, Aloke V.
Nakazawa, Gaku
Joner, Michael
Kolodgie, Frank D.
Mont, Erik K.
Gold, Herman K.
Virmani, Renu
机构
[1] CVPath Inst Inc, Gaithersburg, MD 20878 USA
[2] Massachusetts Gen Hosp, Dept Internal Med, Cardiac Unit, Boston, MA 02114 USA
[3] Miami Dade Cty Examiner Dept, Miami, FL USA
关键词
stents; thrombosis; endothelium;
D O I
10.1161/ATVBAHA.107.144220
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Polymer- based sirolimus- ( Cypher) and paclitaxel- eluting ( Taxus) drug eluting stents have become the treatment of choice for patients with symptomatic coronary artery disease undergoing percutaneous coronary intervention ( PCI). Although these stents reduce rates of restenosis compared with bare metal stents ( BMS), late thrombosis, a life threatening complication, has emerged as a major safety concern. Our understanding of the pathophysiology of late DES thrombosis is derived from animal and human pathologic samples taken after implantation of these devices. These data indicate that both DES cause substantial impairment in arterial healing characterized by lack of complete reendothelialization and persistence of fibrin when compared with BMS. This delayed healing is the primary substrate underlying all cases of late DES thrombosis at autopsy. Several additional risk factors for late stent thrombosis such as penetration of necrotic core, malapposition, overlapping stent placement, excessive stent length, and bifurcation lesions represent additional barriers to healing and should be avoided if DES are to be used to minimize the risk of late thrombosis. Because the time course of complete healing with DES in man is unknown, the optimal duration of antiplatelet treatment remains to be determined.
引用
收藏
页码:1500 / 1510
页数:11
相关论文
共 62 条
[1]   Taxanes: Microtubule and Centrosome Targets, and Cell Cycle Dependent Mechanisms of Action [J].
Abal, M. ;
Andreu, J. M. ;
Barasoain, I. .
CURRENT CANCER DRUG TARGETS, 2003, 3 (03) :193-203
[2]  
Axel DI, 1997, CIRCULATION, V96, P636
[3]   Strut position, blood flow, and drug deposition - Implications for single and overlapping drug-eluting stents [J].
Balakrishnan, B ;
Tzafriri, AR ;
Seifert, P ;
Groothuis, A ;
Rogers, C ;
Edelman, ER .
CIRCULATION, 2005, 111 (22) :2958-2965
[4]   Long-term effects of polymer-based, slow-release, sirolimus-eluting stents in a porcine coronary model [J].
Carter, AJ ;
Aggarwal, M ;
Kopia, GA ;
Tio, F ;
Tsao, PS ;
Kolata, R ;
Yeung, AC ;
Llanos, G ;
Dooley, L ;
Falotico, R .
CARDIOVASCULAR RESEARCH, 2004, 63 (04) :617-624
[5]   Time course of stent endothelialization after intravascular radiation therapy in rabbit iliac arteries [J].
Cheneau, E ;
John, MC ;
Fournadjiev, J ;
Chan, RC ;
Kim, HS ;
Leborgne, L ;
Pakala, R ;
Yazdi, H ;
Ajani, AE ;
Virmani, R ;
Waksman, R .
CIRCULATION, 2003, 107 (16) :2153-2158
[6]   Early and late coronary stent thrombosis of sirolimus-eluting and paclitaxel-eluting stents in routine clinical practice:: data from a large two-institutional cohort study [J].
Daemen, Joost ;
Wenaweser, Peter ;
Tsuchida, Keiichi ;
Abrecht, Linda ;
Sophia, Vaina ;
Morger, Cyrill ;
Kukreja, Neville ;
Jueni, Peter ;
Sianos, Georgios ;
Hellige, Gerrit ;
van Domburg, Ron T. ;
Hess, Otto M. ;
Boersma, Eric ;
Meier, Bernhard ;
Windecker, Stephan ;
Serruys, Patrick W. .
LANCET, 2007, 369 (9562) :667-678
[7]   Neointimal thickening after stent delivery of paclitaxel: Change in composition and arrest of growth over six months [J].
Drachman, DE ;
Edelman, ER ;
Seifert, P ;
Groothuis, AR ;
Bornstein, DA ;
Kamath, KR ;
Palasis, M ;
Yang, DC ;
Nott, SH ;
Rogers, C .
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 2000, 36 (07) :2325-2332
[8]   Pathological analysis of local delivery of paclitaxel via a polymer-coated stent [J].
Farb, A ;
Heller, PF ;
Shroff, S ;
Cheng, L ;
Kolodgie, FD ;
Carter, AJ ;
Scott, DS ;
Froehlich, J ;
Virmani, R .
CIRCULATION, 2001, 104 (04) :473-479
[9]   Extracellular matrix changes in stented human coronary arteries [J].
Farb, A ;
Kolodgie, FD ;
Hwang, JY ;
Burke, AP ;
Tefera, K ;
Weber, DK ;
Wight, TN ;
Virmani, R .
CIRCULATION, 2004, 110 (08) :940-947
[10]   Pathological mechanisms of fatal late coronary stent thrombosis in humans [J].
Farb, A ;
Burke, AP ;
Kolodgie, FD ;
Virmani, R .
CIRCULATION, 2003, 108 (14) :1701-1706