24 research outputs found
Drug-eluting stent implantation in coronary trifurcation lesions
No full textBACKGROUND: There is no specific study evaluating the outcome of DES implantation in trifurcation lesions.OBJECTIVE: To evaluate the mid-term clinical and angiographic outcome of drug-eluting stent (DES) implantation in trifurcation lesions.METHODS: All complications and major adverse cardiac events, including cardiac death, Q-wave myocardial infarction (MI), target lesion revascularization (TLR), and target vessel revascularization (TVR) were recorded in-hospital and during clinical follow up.RESULTS: A total of 15 consecutive patients undergoing percutaneous coronary intervention with DES in de novo trifurcation lesions were identified. Lesions were located as follows: 13 (86.7%) at the distal left main coronary artery (LMCA) comprising the left anterior descending artery (LAD), the left circumflex artery (LCX) and an intermediate branch; 1 between the LAD, diagonal, and septal branches; and 1 between the LCX, obtuse marginal and posterior lateral branches. Stenting was performed in all 3 branches in 8 patients, in 2 branches in 6 patients, and in 1 branch in 1 patient. The mean follow-up period was 19.0 +/- 8.3 months. TLR occurred in 3 patients (20%) with LMCA lesions. TVR occurred in 6 patients (40%). Of those, 3 were due to TLR, while the other 3 for progression of nontarget lesions. No deaths, Q-wave MIs or stent thromboses were recorded.CONCLUSION: Most trifurcation lesions were found in the distal LMCA. DES implantation in trifurcation lesions can be performed with a low incidence of death, Q-wave MI or stent thrombosis
Reply to ‘Differential diagnoses and extracardiac manifestations in left ventricular noncompaction’
No full textMyocardial ischemia due to a large coronary–pulmonary fistula with plexus-like morphology
No full text
Drug-eluting stent implantation in coronary trifurcation lesions
No full textBACKGROUND: There is no specific study evaluating the outcome of DES implantation in trifurcation lesions.
OBJECTIVE: To evaluate the mid-term clinical and angiographic outcome of drug-eluting stent (DES) implantation in trifurcation lesions.
METHODS: All complications and major adverse cardiac events, including cardiac death, Q-wave myocardial infarction (MI), target lesion revascularization (TLR), and target vessel revascularization (TVR) were recorded in-hospital and during clinical follow up.
RESULTS: A total of 15 consecutive patients undergoing percutaneous coronary intervention with DES in de novo trifurcation lesions were identified. Lesions were located as follows: 13 (86.7%) at the distal left main coronary artery (LMCA) comprising the left anterior descending artery (LAD), the left circumflex artery (LCX) and an intermediate branch; 1 between the LAD, diagonal, and septal branches; and 1 between the LCX, obtuse marginal and posterior lateral branches. Stenting was performed in all 3 branches in 8 patients, in 2 branches in 6 patients, and in 1 branch in 1 patient. The mean follow-up period was 19.0 +/- 8.3 months. TLR occurred in 3 patients (20%) with LMCA lesions. TVR occurred in 6 patients (40%). Of those, 3 were due to TLR, while the other 3 for progression of nontarget lesions. No deaths, Q-wave MIs or stent thromboses were recorded.
CONCLUSION: Most trifurcation lesions were found in the distal LMCA. DES implantation in trifurcation lesions can be performed with a low incidence of death, Q-wave MI or stent thrombosis
[SICI-GISE Position paper on the use of the magnesium bioresorbable scaffold Magmaris in clinical practice]
No full textBioresorbable scaffolds have emerged as a potential breakthrough for the treatment of coronary artery lesions. The need for drug release and plaque scaffolding is temporary, and leaving a permanent stent once the process of plaque recoil and vessel healing has ended might be superfluous or even deleterious exposing the patient to the risk of very late thrombosis, eliminating vessel reactivity, impairing non-invasive imaging and precluding possible future surgical revascularization. This long-term potential limitation of permanent bare metal stents might be overcome by using a resorbable scaffold. The metallic and antithrombotic properties makes the resorbable magnesium scaffold an appealing technology for the treatment of coronary artery lesions. Notwithstanding this, its mechanical properties substantially differ from those of conventional bare metal stents, and previous experience using polymer-based scaffolds has shown that a standardized implantation technique and optimal patient and lesion selection are key factors for a successful implantation. A panel of expert cardiologists gathered to find a consensus on the best practices for Magmaris implantation in a selected patient population and to discuss the rationale for new potential future indications
Sustained Safety and Efficacy of Magnesium Reabsorbable Scaffold: 2-Year Follow-Up Analysis From First Magmaris Multicenter Italian Registry
No full textBackground: Magnesium Reabsorbable Scaffold (MRS), is the newest reabsorbable technology with low thrombogenicity, short scaffolding time and almost complete resorption at 12-months (95%). Preliminary 12 -months data in selected patients has shown that safety and efficacy are comparable with second generation Drug Eluting Stent (DES). Magmaris Multicenter registry showed 1-and 2-years clinical outcome on the first pa-tients suitable for MRS enrolled in 4 Italian centers.Methods: We evaluated 12-and 24-months clinical results in "real world" experience with Magnesium Reabosrbable Scaffold in terms of Target Lesion Failure (TLF) and scaffold thrombosis (ST). TLF is the primary endpoint and was defined as composite of cardiac mortality, target vessel myocardial infarction (MI), and ischemia-driven target lesion revascularization (ID-TLR). 4P's strategy (Patient/lesion selection, Pre-dilatation, Proper scaffold sizing and Post-dilatation) was strongly recommended. Dual Antiplatelet Therapy (DAPT) has been recommended for 12 months.Results: Data from 207 patients, including initial experience, have been collected. Patients were 83% male, 20% di-abetic and Acute Coronary Syndrome (ACS) in 23%. Lesion type were A-B1 in 54% and B2\\C in 46%. 4P's strategy was respected in 94%. Procedural success was 98% (2% peri-procedural MI). Compliance at 12-months follow up was 97.6%, TLF rate was 5.4% (including 1 case of myocardial infarction with late scaffold thrombosis (ST), all pa-tients were successfully treated with in-scaffold segment DES implantation). At 24-months compliance was 92.8% (192 patients) and TLF was 7.4%. In the period between 13 and 24 months only 4 patients had TLF (includ-ing 1 case of myocardial infarction, all patients were successfully treated with in-scaffold segment DES implanta-tion). None of the patients died for a cardiac reason.Conclusion: Our 2-years results confirm safety and efficacy showed at 12-months, reinforcing long-term perfor-mance with only 2% rate of TLF increase and no ST after 1 year.(c) 2022 Published by Elsevier Inc
One-Year Results of the Magmaris BRS in Coronary Artery Disease Patients: The IT-MASTERS Registry
No full textRecent studies have highlighted the potential of the Magmaris Resorbable Magnesium Scaffold (RMS; Biotronik AG, Bülach, Switzerland) in routine clinical practice. However, limited data are available on its clinical and procedural performance in challenging coronary lesions. The IT-MASTERS registry is a prospective, investigator-initiated study conducted at 21 Italian centers, aiming to evaluate the safety and efficacy of Magmaris in a real-world cohort. The primary endpoint was the cumulative incidence of target lesion failure (TLF) at 1 year, with scaffold thrombosis (ST) as a secondary endpoint. Clinical follow-up was scheduled at 30 days, 6, 12, and 24 months. A total of 367 patients with 417 lesions were included (median age 59 years; 83% male; 17.2% had diabetes; 48% ACS). The median lesion length was 20 mm, with a median reference vessel diameter of 3.2 mm; 49% of lesions were type B2/C, 16% involved bifurcations, and 37% were located in the proximal LAD. Adherence to the “4P” rule—proper patient selection, scaffold sizing, pre-dilation (93%), and post-dilation (97%)—resulted in procedural and device success rates of 100% and 99%, respectively, with no adverse events reported at 30 days. The 12-month TLF was 5.0% [95% confidence interval, CI 2.7% to 7.3%]: 1.7% myocardial infarction; 4.7% clinically driven target lesion revascularization. ST was 0.6% up to 12 months. In conclusion, the IT-MASTERS registry confirms that the Magmaris RMS is safe and effective in a highly selected population with low rates of TLF and ST at 12 months
Polymer-free amphilimus-eluting stent versus biodegradable polymer biolimus-eluting stent in patients with and without diabetes mellitus
No full textObjectives: This study sought to compare clinical outcome of polymer-free amphilimus-eluting stent (PF-AES) versus biodegradable-polymer biolimus-eluting stent (BD-BES) in “all-comer” diabetes mellitus (DM) and non-DM
patients who underwent percutaneous coronary intervention.
Background: The PF-AES has shown promising preliminary results in patients with DM.
Methods: Data from 2 multicentre-national registries (the ASTUTE and the INSPIRE-1) were used to analyse 1776 patients stratified in non-DM and DM. A double 1:1 propensity-score matched analysis (PF-AES vs. BD-BES) was performed in each group to adjust for clinical and procedural characteristics. Primary stent-efficacy and stentsafety endpoints were 1-year target-lesion revascularization (TLR) and target-lesion failure (TLF, composed of cardiac-death, target-vessel myocardial infarction and any TLR).
Results: After propensity-score matching, 850 patients were stratified as non-DM (425 PF-AES/425 BD-BES) and 480 as DM patients (240 PF-AES/240 BD-BES). Both TLF (20 of 425 [5%] vs. 24 of 425 [6%]; Plog-rank = 0.527) and
TLR (9 of 425 [2%] vs. 18 of 425 [4%]; Plog-rank = 0.079) were similar between PF-AES and BD-BES in non-DM patients. In DM, TLF (12 of 240 [5%] vs. 31 of 240 [13%]; Plog-rank = 0.002) and TLR (9 of 240 [4%] vs. 21 of 240 [9%]; Plog-rank = 0.019) were significantly lower in PF-AES compared to BD-BES. Upon multivariate analysis, the most powerful predictors of TLF were chronic kidney disease in non-DM (OR 4.24, 95% CI: 2.07–8.70, p b 0.001) and stent type in DM patients (OR 2.76, 1.36–5.56, p = 0.005).
Conclusions: This matched-cohort study suggests that PF-AES has better safety and efficacy profile than BD-BES in patients with DM
