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A large-scale, international, prospective, randomized trial was performed to compare and address the limitations of paclitaxel-eluting stents with bare-metal stents in patients with evolving ST-segment elevation myocardial infarction. Compared to bare-metal stents, the use of paclitaxel-eluting stents reduced angiographic restenosis and recurrent ischemia necessitating repeat revascularization procedures within the first year.

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.ahj.2008.09.010 Byline: Olivier F. Bertrand, Eric Larose, Josep Rodes-Cabau, Onil Gleeton, Isabelle Taillon, Louis Roy, Paul Poirier, Olivier Costerousse, Robert De Larochelliere Abstract: Bleeding has recently emerged as predictor of early and late mortality after percutaneous coronary intervention (PCI) using femoral approach. Transradial PCI is associated with a lower risk of access-site complications than femoral approach. We evaluated the predictors of bleeding and the impact of major bleeding on death and major adverse cardiac events (MACE) after transradial PCI and maximal antiplatelet therapy. Author Affiliation: HA[acute accent]pital Laval, Institut Universitaire de Cardiologie et de Pneumologie, Quebec City, Quebec, Canada Article History: Received 6 April 2008; Accepted 14 September 2008 Article Note: (footnote) This study was designed as investigator-initiated trial and funded by unrestricted grants from Eli-Lilly (Indianapolis, IN), Bristol-Myers-Squibb (New York, NY)/Sanofi-Aventis (Paris, France), Regie Regionale de Quebec, and Corporation de l'Institut de cardiologie de Quebec (both of Quebec City, Quebec). O. F. Bertrand and P. Poirier are research-scholars from Quebec Foundation for Health Research., Results have been presented in part during scientific sessions of the American Heart Association (New Orleans, November 8-12, 2008) and published in abstract form (Circulation 2008;118:S638)., Registered Clinical Trial #: NCT001169819.

A study was conducted to compare outcomes of Medicare beneficiaries who underwent non emergent coronary stenting before and after the availability of drug-eluting stents. Findings reveal that the widespread adoption of drug-eluting stents into routine practice is associated with decline in the need for repeat revascularization procedures.

Carotid atherosclerotic stenosis is a known risk factor for ischemic stroke. Methods for detecting stenosis and revascularization abound. The objective of this review was to summarize the evidence for diagnosing [...]

Shear stress is known to play a central role in restenosis formation and is sensitive to stent geometry. Local flow alterations created by a different stents without and with flow divider were studied to compare the hemodynamic effects of Stent design properties on restenosis in stented human coronary artery. Blood pressure and shear stress values were computed in three different sites, including stented arterial segment, pre-stent and post-stent regions using computational fluid dynamics. Blood flow was assumed as pulsatile, incompressible and Newtonian flow. Rigid boundary conditions were assumed for all models. The governing Navier-Stokes equations were solved using commercial software package (Fluent V6.0.12). Stents are assumed with real structure and modeled using the commercial software package (Gambit, V2.0). The arterial wall shear stress distribution was investigated in three major regions and critical sites were located. It is concluded that the wall shear stress between stent struts was sensitive to strut spacing, profile of strut, number of struts and curvature. Our 3D computational fluid dynamics modeling demonstrate that with increasing the angle between two sides of the stent strut the percentage of intrastrut area that exposed to critical value of WSS decreases. By application of a flow divider, the wall shear stress in stented segment increases markedly and so is the pressure gradient in stented segment. Flow divider influences the blood flow pattern in proximal of stented segment. In this section, the WSS increases with application of the flow divider. The results for different diameters of flow divider show that optimum diameter for flow divider is D/3. Key words: Stent, shear stress, restenosis, coronary artery, computational fluid dynamics., Atherosclerosis is a vascular disease that reduces arterial lumen size through plaque formation and arterial wall thickening. The pathological complications of atherosclerosis, namely heart disease and stroke, remain the leading [...]

Drug-eluting stents are increasingly used to reduce in-stent restenosis and adverse cardiac events after percutaneous coronary interventions. However, the race for the ideal drug-eluting stent is still on, with special regard to the best stent-coating system and the most effective and less toxic drug. Fludarabine, a nucleoside analog, has both anti-inflammatory and antiproliferative cellular effects. The aim of the present study was to assess the cellular and molecular effects of fludarabine on vascular smooth muscle cell (VSMC) growth in vitro and in vivo and the feasibility and efficacy of a fludarabine-eluting stent. To study the biomolecular effects of fludarabine on VSMC proliferation in vitro, rat VSMCs were grown in the presence of 50 [micro]M fludarabine or in the absence of the same. To evaluate the in vivo effect of this drug, male Wistar rats underwent balloon injury of the carotid artery, and fludarabine was locally delivered at the time of injury. Finally, fludarabine-eluting stents were in-laboratory manufactured and tested in a rabbit model of in-stent restenosis. Fludarabine markedly inhibited VSMC proliferation in cell culture. Furthermore, fludarabine reduced neointimal formation after balloon angioplasty in a dose-dependent manner, and fludarabine-eluting stents reduced neointimal hyperplasia by ~50%. These in vitro and in vivo cellular effects were specifically associated with the molecular switch-off of signal transducer and activator of transcription (STAT)-1 activation, without affecting other STAT proteins. Fludarabine abolishes VSMC proliferation in vitro and reduces neointimal formation after balloon injury in vivo through specific inhibition of STAT-I activation. Fludarabine-eluting stents are feasible and effective in reducing in-stent restenosis in rabbits. signal transduction; drug-eluting stents; smooth muscle cells doi:10.1152/ajpheart.00887.2006

A hierarchical classification of stent thrombosis is used for uniform evaluation of events in a pooled analysis of randomized trials of the U.S. Food and Drug Administration (FDA) approved sirolimus- and paclitaxel-eluting stents, as compared with their respective bare-metal stents. The results have shown that the incidence of stent thrombosis did not differ much between patients with drug-eluting stents and those with bare-metal stents in randomized clinical trials.

A pooled analysis data from four randomized trials is used to evaluate the safety of sirolimus-eluting stents as compared with bare-metal stents. The results have shown no significant differences between the two treatments in rates of death, myocardial infarction, or stent thrombosis.

A pooled analysis of data from four double-blind trials is performed to examine the safety and the efficacy of paclitaxel- and sirolimus-eluting stents and bare-metal stents. The results have shown that stent thrombosis after 1 year was more common with both sirolimus-eluting stents and paclitaxel-eluting stents than with bare-metal stents, but there were no significant differences in the cumulative rates of death or myocardial infarction at 4 years.

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.ahj.2004.12.012 Byline: Carlo Briguori (a)(b), Antonio Colombo (b), Flavio Airoldi (b), Amelia Focaccio (a), Ioannis Iakovou (b), Alaide Chieffo (b), Iassen Michev (b), Matteo Montorfano (b), Erminio Bonizzoni (c), Bruno Ricciardelli (a), Gerolama Condorelli (d) Abstract: Restenosis rate is lower after sirolimus-eluting stent (SES) implantation than after bare metal stent (BS) implantation. We evaluated the impact of SES implantation on immediate and 12-month outcome in diabetic patients with multivessel coronary artery disease (MVD). Author Affiliation: (a) Laboratory of Interventional Cardiology, Clinica Mediterranea, Naples, Italy (b) Laboratory of Interventional Cardiology, 'Vita e Salute' University School of Medicine, San Raffaele Hospital, Milan, Italy (c) Institute of Medical Statistics and Biometry, University of Milan, Milan, Italy (d) Department of Biology, Cellular and Molecular Pathology, 'Federico II' University, Naples, Italy Article History: Received 20 October 2004; Accepted 12 December 2004

A stent that releases small amounts of the drug sirolimus over a period of time may reduce the chances that a patient's coronary arteries will become blocked again, according to a study of 1,058 patients. Some of these patients had diabetes, small coronary arteries, or more extensive atherosclerosis. Stents are small cylindrical devices that are placed inside arteries to keep the artery open.

A coronary artery stent that slowly releases small amounts of the drug paclitaxel may prevent coronary arteries from becoming blocked again after angioplasty, according to a study of 176 patients. Angioplasty is used to open blocked arteries, but they can become blocked again. A stent is a small plastic or metal cylinder that is placed inside the artery to keep it open. Paclitaxel prevents cell proliferation, which also helps keep the artery open.

Minimally invasive bypass surgery may be better than a stent for some patients with coronary artery disease in only one artery, according to a study of 220 patients. Although surgery is more risky than placing a stent, patients who had surgery were less likely to have chest pain six months later. A stent is a small cylinder placed inside an artery to keep it open.

A stent that gradually releases the drug sirolimus can substantially reduce the chances that a coronary artery will become blocked again several months after an angioplasty. A stent is a small cylinder that is placed inside an artery to keep it open.

All patients with coronary artery disease who have angioplasty should also receive a stent, according to a study of 2082 patients. The patients who received a stent were much less likely to have the artery become blocked again or to need angioplasty again. A stent is a small cylinder that is placed inside an artery to keep it open.

The anticoagulant drug abciximab appears to improve blood flow and decrease postoperative mortality rates in heart attack patients who receive a stent. Stents are small cylindrical devices that are inserted in arteries to keep them open.

Coronary artery stenting is less expensive than coronary artery bypass surgery, but patients who receive stents will need additional treatments to keep the artery open. Stents are small cylinders that are placed inside coronary arteries to keep them open.

A coronary stent plus the drug abciximab appears to be more effective for heart attack patients than tissue plasminogen activator (tPA), according to a study of 140 patients. A stent is a small cylinder that keeps an artery open, abciximab is an anticoagulant, and tPA breaks up the blood clots that cause most heart attacks.

A stent appears to be more effective in opening clogged arteries and keeping them open than angioplasty. Both techniques are used to treat coronary artery disease as well as patients having a heart attack. Researchers randomly assigned 900 heart attack patients to receive angioplasty only or angioplasty plus a stent, which is a small cylindrical device placed inside the artery. Six months later, fewer patients who received a stent had angina or needed a repeat procedure compared to the other group. Six-month death rates were 4% in the stent group and 2.7% in the angioplasty-only group.

Patients who receive a stent to open clogged coronary arteries and keep them open are less likely to need further treatment. A stent is a small cylindrical device that is placed inside arteries to treat coronary artery disease. Angioplasty is also used for this purpose, but the artery can become clogged again, leading to repeat angioplasties. In a study of 9,594 procedures using angioplasty or a stent, patients who received the stent were less likely to need repeat treatments than those who received angioplasty.