on May 17, 2007
Published online before print May 17, 2007, doi: 10.1161/ATVBAHA.107.144220
| |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Submitted on March 16, 2007
Accepted on April 30, 2007
Vascular Responses to Drug Eluting Stents. Importance of Delayed Healing
Aloke V. Finn ;
From CVPath, Institute Inc (G.N., M.J., F.K., R.V.), Gaithersburg, Md; Cardiac Unit (A.V.F., H.K.G.), Department of Internal Medicine, Massachusetts General Hospital, Boston; and Miami Dade County Medial Examiner Department (E.K.M.), Miami, Fla.
* To whom correspondence should be addressed. E-mail: rvirmani{at}cvpath.org.
Abstract--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.
Key words: stents • thrombosis • endothelium
This article has been cited by other articles:
 |
|
 |
|
  C. Stettler, S. Allemann, S. Wandel, A. Kastrati, M. C. Morice, A. Schomig, M. E Pfisterer, G. W Stone, M. B Leon, J. S. d. Lezo, et al. Drug eluting and bare metal stents in people with and without diabetes: collaborative network meta-analysis BMJ, August 29, 2008; 337(aug29_3): a1331 - a1331. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 P. J.B. Sabatini, M. Zhang, R. Silverman-Gavrila, M. P. Bendeck, and B. L. Langille Homotypic and Endothelial Cell Adhesions via N-Cadherin Determine Polarity and Regulate Migration of Vascular Smooth Muscle Cells Circ. Res., August 15, 2008; 103(4): 405 - 412. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 T. Shinke, J. Li, J. P. Chen, L. Pendyala, T. Goodchild, R. Jabara, S. Geva, T. Ueno, N. Chronos, K. Robinson, et al. High Incidence of Intramural Thrombus After Overlapping Paclitaxel-Eluting Stent Implantation: Angioscopic and Histopathologic Analysis in Porcine Coronary Arteries Circ Cardiovasc Intervent, August 1, 2008; 1(1): 28 - 35. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. Joner, G. Nakazawa, A. V. Finn, S. C. Quee, L. Coleman, E. Acampado, P. S. Wilson, K. Skorija, Q. Cheng, X. Xu, et al. Endothelial Cell Recovery Between Comparator Polymer-Based Drug-Eluting Stents J. Am. Coll. Cardiol., July 29, 2008; 52(5): 333 - 342. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. V. Finn, G. Nakazawa, E. Ladich, F. D. Kolodgie, and R. Virmani Does Underlying Plaque Morphology Play a Role in Vessel Healing After Drug-Eluting Stent Implantation? J. Am. Coll. Cardiol. Img., July 1, 2008; 1(4): 485 - 488. [Full Text] [PDF]
|
|
|
|
|
|
M. I. Hamilos, M. Ostojic, B. Beleslin, D. Sagic, L. Mangovski, S. Stojkovic, M. Nedeljkovic, D. Orlic, B. Milosavljevic, D. Topic, et al. Differential effects of drug-eluting stents on local endothelium-dependent coronary vasomotion. J. Am. Coll. Cardiol., June 3, 2008; 51(22): 2123 - 2129. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. Jimenez-Valero, R. Moreno, A. Sanchez-Recalde, G. Galeote, L. Calvo, A. Viana, E. Lopez de Sa, and J. Lopez-Sendon Review: Avoiding restenosis: is there a role for glucocorticoids in the drug-eluting stent era? Therapeutic Advances in Cardiovascular Disease, June 1, 2008; 2(3): 137 - 146. [Abstract] [PDF]
|
|
|
|
 |
|
 R. C. Becker, T. W. Meade, P. B. Berger, M. Ezekowitz, C. M. O'Connor, D. A. Vorchheimer, G. H. Guyatt, D. B. Mark, and R. A. Harrington The Primary and Secondary Prevention of Coronary Artery Disease: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition) Chest, June 1, 2008; 133(6_suppl): 776S - 814S. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. W. Krucoff, D. J. Kereiakes, J. L. Petersen, R. Mehran, V. Hasselblad, A. J. Lansky, P. J. Fitzgerald, J. Garg, M. A. Turco, C. A. Simonton III, et al. A novel bioresorbable polymer paclitaxel-eluting stent for the treatment of single and multivessel coronary disease: primary results of the COSTAR (Cobalt Chromium Stent With Antiproliferative for Restenosis) II study. J. Am. Coll. Cardiol., April 22, 2008; 51(16): 1543 - 1552. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
G. Nakazawa, Q. Cheng, X. Xu, A. V. Finn, F. D. Kolodgie, and R. Virmani Drug-eluting stent implantation may not affect vasomotor function in early phase. J. Am. Coll. Cardiol., March 18, 2008; 51(11): 1124 - 1125. [Full Text] [PDF]
|
|
|
|
 |
|
 J. Aoki, A. Kirtane, M. B. Leon, and G. Dangas Coronary Artery Aneurysms After Drug-Eluting Stent Implantation J. Am. Coll. Cardiol. Intv., February 1, 2008; 1(1): 14 - 21. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. Jabara, N. Chronos, D. Conway, W. Molema, and K. Robinson Evaluation of a Novel Slow-Release Paclitaxel-Eluting Stent With a Bioabsorbable Polymeric Surface Coating J. Am. Coll. Cardiol. Intv., February 1, 2008; 1(1): 81 - 87. [Abstract] [Full Text] [PDF]
|
|