Stent Thrombosis
1997; Lippincott Williams & Wilkins; Volume: 95; Issue: 5 Linguagem: Inglês
10.1161/01.cir.95.5.1098
ISSN1524-4539
AutoresDonald S. Baim, Joseph P. Carrozza,
Tópico(s)Antiplatelet Therapy and Cardiovascular Diseases
ResumoHomeCirculationVol. 95, No. 5Stent Thrombosis Free AccessResearch ArticleDownload EPUBAboutView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessResearch ArticleDownload EPUBStent ThrombosisClosing in on the Best Preventive Treatment Donald S. Baim and Joseph P. Carrozza, Jr Donald S. BaimDonald S. Baim the Interventional Cardiology Section, Beth Israel–Deaconess Medical Center (East Campus), Boston, Mass. and Joseph P. Carrozza, JrJoseph P. Carrozza, Jr the Interventional Cardiology Section, Beth Israel–Deaconess Medical Center (East Campus), Boston, Mass. Originally published4 Mar 1997https://doi.org/10.1161/01.CIR.95.5.1098Circulation. 1997;95:1098–1100Amazing progress has been made in the use of metallic endoprostheses (stents) in the human coronary circulation since the pioneering work of Sigwart 10 years ago. Of the three initial designs (the self-expanding mesh [Wallstent, Schneider], the coil stent [Gianturco-Roubin, Cook], and the slotted-tube stent [Palmaz-Schatz, Johnson & Johnson]), only the latter two designs are currently available in the United States (the Gianturco-Roubin since mid-1993 and the Palmaz-Schatz since mid-1994). Yet in that short time, coronary stenting has revolutionized catheter intervention. Stents (alone or in combination with other devices such as rotational atherectomy) are now used in >30% of interventions nationally and >50% of interventions in many laboratories, including our own. While their approval was based on abrupt or threatened abrupt closure (Gianturco-Roubin) and reduction of restenosis in focal de novo native lesions (Palmaz-Schatz), the majority of current use falls outside those narrow categories (and includes restenotic lesions, vein grafts, longer lesions, etc), for which registry data suggest clinical benefit over conventional angioplasty, although definitive trials to document benefit over conventional balloon angioplasty are still incomplete.From the beginning of stent implantation, acute ( 20 stents now under clinical investigation) may have a higher or lower thrombotic tendency than the index Palmaz-Schatz stent because of differences in geometry, materials, or surface finish.12 Because the design of the study protocols for all but one of the seven devices now under testing in the United States is based on an 800- to 1000-patient comparison of the new stent with the Palmaz-Schatz stent, with an empirical regimen of aspirin and ticlopidine, it should be possible to evaluate major stent-to-stent differences in thrombotic potential. Beyond intrinsic stent design, various passive or active stent coatings may further alter the profile of stent thrombosis. This appears to be the case with covalently endpoint-attached heparin fragments, as tested in the BENESTENT II trial,13 which reported just 1 thrombotic event in 600 implants (200 in the pilot phase and 400 in the randomized comparison with conventional angioplasty). The current use of ticlopidine just scratches the surface of the coming wave of potent newer antiplatelet agents, however. The new oral agent clopridogril appears to overcome many of the troublesome side effects of ticlopidine, and intravenous agents (including abciximab or newer intravenous/oral blockers of the glycoprotein IIb/IIIa receptor)14 might give more complete inhibition of platelet function and more rapid onset compared with the 2- to 3-day delay to peak activity seen after initiation of ticlopidine therapy.In summary, stent thrombosis is the major downside to this revolutionary technology, which must be prevented rather than just accepted and treated when it occurs. The study by Albiero et al9 is another milestone along the trek to eliminate this troublesome side effect, confirming its reduction to ≤1% compared with the 3.5% rate seen in the STRESS and BENESTENT trials. The mounting data have established fairly clearly that the use of an aggressive antiplatelet regimen (for now, aspirin and ticlopidine) is the best current therapy, although further refinements in drug therapy will almost certainly be needed (particularly for suboptimal stent results or stenting in certain high-risk clinical situations). Although the road toward the goal of eliminating stent thrombosis still stretches off into the distance, this is an appropriate time to pause and reflect on how far we have come in controlling this serious complication (reducing it by an order of magnitude over the last 10 years) by appreciating the central importance of full stent expansion and optimization of the antiplatelet regimen.Selected Abbreviations and AcronymsASA=acetylsalicylic acid, aspirinBENESTENT=BElgian NEtherlands STENT (study)CRUISE=Can Routine Ultrasound Improve Stent ExpansionISAR=Intracoronary Stenting and Antithrombotic Regimen studySTARS=STent Antithrombotic Regimen StudySTRESS=STent REStenosis StudyThe opinions expressed in this editorial are not necessarily those of the editors or of the American Heart Association.FootnotesCorrespondence to Donald S. Baim, MD, Chief, Interventional Cardiology Section, Beth Israel–Deaconess Medical Center (East Campus), 330 Brookline Ave, Boston, MA 02215. References 1 Serruys PW, Strauss BH, Beatt KJ, Bertrand ME, Puel J, Rickards AF, Meier B, Goy JJ, Vogt P, Kappenberger L, Sigwart U. Angiographic follow-up after placement of a self-expanding coronary stent. N Engl J Med.1991; 324:13-17.CrossrefMedlineGoogle Scholar2 Schatz RA, Baim DS, Leon M, Ellis SG, Goldberg S, Hirshfeld JW, Cleman MW, Cabin HS, Walker C, Stagg J, Buchbinder M, Teirstein PS, Topol EJ, Savage M, Perez JA, Curry RC, Whithworth H, Sousa JE, Tio F, Almagor Y, Ponder R, Penn IM, Leonard B, Levine SL, Fish RD, Palmaz JC. Clinical experience with the Palmaz-Schatz coronary stent: initial results of a multicenter study. Circulation.1991; 83:148-161.CrossrefMedlineGoogle Scholar3 Fischman DL, Leon M, Baim DS, Schatz RA, Savage MP, Penn I, Detre K, Veltri L, Ricci D, Nobuyoshi M, Cleman M, Heuser R, Almond D, Teirstein P, Fish D, Colombo A, Brinker J, Moses J, Hirshfeld J, Bailey S, Ellis S, Rake R, Goldberg S. A randomized comparison of coronary stent placement and balloon angioplasty in the treatment of coronary artery disease. N Engl J Med.1994; 331:496-501.CrossrefMedlineGoogle Scholar4 Serruys PW, de Jaegere P, Kiemeneij F, Macaya C, Rutsch W, Heyndrickx G, Emanuelsson H, Marco J, Legrand V, Materne P, Belardi J, Sigwart U, Colombo A, Goy JJ, Van den Heuvel P, Delcan J, Morel MA. A comparison of balloon-expandable stent implantation with balloon angioplasty in patients with coronary artery disease. N Engl J Med.1994; 331:489-495.CrossrefMedlineGoogle Scholar5 Cohen DJ, Krumholz HM, Sukin CA, Ho KKL, Siegrist RB, Cleman M, Heuser RR, Brinker JA, Moses JW, Savage MP, Detre K, Leon MB, Baim DS. In-hospital and one-year economic outcomes after coronary stenting or balloon angioplasty: results from a randomized clinical trial. Circulation.1995; 92:2480-2487.CrossrefMedlineGoogle Scholar6 Colombo A, Hall P, Nakamura S, Almagor Y, Maiello L, Martini G, Gaglione A, Goldberg SL, Tobis JM. Intracoronary stenting without anticoagulation achieved with intravascular ultrasound guidance. Circulation.1995; 91:1676-1688.CrossrefMedlineGoogle Scholar7 Karrillon GJ, Morice MC, Benveniste E, Bunouf P, Aubry P, Cattan S, Chevalier B, Commeau P, Cribier A, Eiferman C, Grollier G, Guerin Y, Henry M, Lefevre T, Livarek B, Louvard Y, Marco J, Makowski S, Monassier JP, Pernes JM, Rioux P, Spaulding C, Zemour G. Intracoronary stent implantation without ultrasound guidance and with replacement of conventional anticoagulation by antiplatelet therapy: 30-day clinical outcome of the French Multicenter Registry. Circulation.1996; 94:1519-1527.CrossrefMedlineGoogle Scholar8 Schomig A, Meumann F-J, Kastrati A, Schulen H, Blasini R, Hadamitzky M, Walker H, Zitzman-Roth EM, Richard G, Alt E, Schmitt C, Ulm K. A randomized comparison of antiplatelet and anticoagulant therapy after placement of coronary-artery stents. N Engl J Med.1996; 334:1084-1089.CrossrefMedlineGoogle Scholar9 Albiero R, Hall P, Blengino S. Results of a consecutive series of patients receiving only antiplatelet therapy after optimized stent implantation: comparison of aspirin alone versus ticlopidine and aspirin therapy. Circulation.1997; 95:1145-1156.CrossrefMedlineGoogle Scholar10 Hall P, Nakamura S, Maiello L, Itoh A, Blengino S, Martini G, Ferraro M, Colombo A. A randomized comparison of ticlopidine and aspirin therapy versus aspirin therapy alone after successful intravascular ultrasound-guided stent implantation. Circulation.1996; 93:215-222.CrossrefMedlineGoogle Scholar11 Leon MD, Baim DS, Gordon P, Giambartolomei A, Williams DO, Diver DJ, Senerchia C, Fitzpatrick M, Popma JJ, Kuntz RE. Clinical and angiographic results from the STent Anticoagulation Regimen Study (STARS). Circulation. 1996;94(suppl I):I-685. Abstract.Google Scholar12 Rogers C, Edelman ER. Endovascular stent design dictates experimental restenosis and thrombosis. Circulation.1995; 91:2995-3001.CrossrefMedlineGoogle Scholar13 Serruys PW, Emanuelsson H, van der Giesson W, Lunn AC, Kiemeney F, Macaya C, Rutsch W, Heyndrickx G, Suryapranata H, Legrand V, Goy JJ, Materne P, Bonnier H, Morice MC, Fajadet J, Belardi J, Colombo A, Garcia E, Ruygrok P, de Jaegere P, Morel MA, on behalf of the Benestent-II Study Group. Heparin coated Palmaz-Schatz stent in human coronary arteries: early outcome of the Benestent II Pilot. Circulation.1996; 93:412-422.CrossrefMedlineGoogle Scholar14 Lefkovits J, Plow EF, Topol EJ. Platelet glycoprotein IIb/IIIa receptors in cardiovascular medicine. N Engl J Med.1995; 332:1553-1559.CrossrefMedlineGoogle Scholar Previous Back to top Next FiguresReferencesRelatedDetailsCited By Gunasekera B, Abou Diwan C, Altawallbeh G, Kalil H, Maher S, Xu S and Bayachou M (2018) Functional Layer-by-Layer Thin Films of Inducible Nitric Oxide (NO) Synthase Oxygenase and Polyethylenimine: Modulation of Enzyme Loading and NO-Release Activity, ACS Applied Materials & Interfaces, 10.1021/acsami.7b17575, 10:9, (7745-7755), Online publication date: 7-Mar-2018. Mennuni M, Pagnotta P and Stefanini G (2015) Coronary Stents: The Impact of Technological Advances on Clinical Outcomes, Annals of Biomedical Engineering, 10.1007/s10439-015-1399-z, 44:2, (488-496), Online publication date: 1-Feb-2016. Yu Y, Wise S, Celermajer D, Bilek M and Ng M (2015) Bioengineering stents with proactive biocompatibility, Interventional Cardiology, 10.2217/ica.15.46, 7:6, (571-584), Online publication date: 1-Dec-2015. Ahrens I and Bode C (2014) Direct Oral Anticoagulants in Acute Coronary Syndrome, Seminars in Hematology, 10.1053/j.seminhematol.2014.03.004, 51:2, (147-151), Online publication date: 1-Apr-2014. Jung T, Lee J, Lee J, Hyon S and Han D (2013) A Study on Effects of EGCG and Design Parameter for Drug-Eluting Biodegradable Polymer Stents, Journal of Biomedical Engineering Research, 10.9718/JBER.2013.34.3.111, 34:3, (111-116), Online publication date: 30-Sep-2013. Aikawa H, Kodama T, Nii K, Tsutsumi M, Onizuka M, Iko M, Matsubara S, Etou H, Sakamoto K and Kazekawa K (2008) Intraprocedural plaque protrusion resulting in cerebral embolism during carotid angioplasty with stenting, Radiation Medicine, 10.1007/s11604-008-0231-1, 26:5, (318-323), Online publication date: 1-Jun-2008. Lemesle G, Sudre A, Modine T, Delhaye C, Rosey G, Gourlay T, Bauters C and Lablanche J (2008) High incidence of recurrent in stent thrombosis after successful treatment of a first in stent thrombosis, Catheterization and Cardiovascular Interventions, 10.1002/ccd.21709, 72:4, (470-478), Online publication date: 1-Oct-2008. Awtry E and Loscalzo J (2007) Aspirin Platelets, 10.1016/B978-012369367-9/50822-3, (1099-1125), . Tsumoto T, Terada T, Tsuura M, Matsumoto H, Masuo O, Yamaga H and Itakura T (2005) Carotid artery stenting for stenosis with intraluminal thrombus, Neuroradiology, 10.1007/s00234-005-0015-6, 48:1, (54-59), Online publication date: 1-Jan-2006. Coolong A and Mauri L (2006) Clopidogrel treatment surrounding percutaneous coronary intervention: When should it be started and stopped?, Current Cardiology Reports, 10.1007/s11886-006-0057-3, 8:4, (267-271), Online publication date: 1-Jul-2006. David Chua S, MacDonald B and Hashmi M (2004) Finite element simulation of slotted tube (stent) with the presence of plaque and artery by balloon expansion, Journal of Materials Processing Technology, 10.1016/j.jmatprotec.2004.04.396, 155-156, (1772-1779), Online publication date: 1-Nov-2004. David Chua S, MacDonald B and Hashmi M (2004) Effects of varying slotted tube (stent) geometry on its expansion behaviour using finite element method, Journal of Materials Processing Technology, 10.1016/j.jmatprotec.2004.04.395, 155-156, (1764-1771), Online publication date: 1-Nov-2004. Kolandaivelu K and Edelman E (2004) Environmental influences on endovascular stent platelet reactivity: Anin vitro comparison of stainless steel and gold surfaces, Journal of Biomedical Materials Research, 10.1002/jbm.a.30023, 70A:2, (186-193), Online publication date: 1-Aug-2004. Barragan P, Bouvier J, Roquebert P, Macaluso G, Commeau P, Comet B, Lafont A, Camoin L, Walter U and Eigenthaler M (2003) Resistance to thienopyridines: Clinical detection of coronary stent thrombosis by monitoring of vasodilator-stimulated phosphoprotein phosphorylation, Catheterization and Cardiovascular Interventions, 10.1002/ccd.10497, 59:3, (295-302), Online publication date: 1-Jul-2003. Söder H, Manninen H, Räsänen H, Kaukanen E, Jaakkola P and Matsi P (2002) Failure of Prolonged Dilation to Improve Long-term Patency of Femoropopliteal Artery Angioplasty: Results of a Prospective Trial, Journal of Vascular and Interventional Radiology, 10.1016/S1051-0443(07)61737-0, 13:4, (361-369), Online publication date: 1-Apr-2002. Kedev S, Guagliumi G, Valsechi O and Tespili M (2018) Heparin-Coated versus Uncoated Palmaz-Schatz Stent in Native Coronary Circulation. A Randomized Study with Blind Angioscopic Assessment, The International Journal of Artificial Organs, 10.1177/039139880202500517, 25:5, (461-469), Online publication date: 1-May-2002. Walter D, Fichtlscherer S, Sellwig M, Auch-Schwelk W, Schächinger V and Zeiher A (2001) Preprocedural C-reactive protein levels and cardiovascular events after coronary stent implantation, Journal of the American College of Cardiology, 10.1016/S0735-1097(00)01193-1, 37:3, (839-846), Online publication date: 1-Mar-2001. Mizuno O, Hojo Y, Ikeda U, Katsuki T, Fukazawa H, Kurosaki K, Fujikawa H and Shimada K (2000) Assessment of coagulation and platelet activation in coronary sinus blood induced by transcatheter coronary intervention for narrowing of the left anterior descending coronary artery, The American Journal of Cardiology, 10.1016/S0002-9149(99)00651-7, 85:2, (154-160), Online publication date: 1-Jan-2000. (2009) Point - Counterpoint: The wide use of IIb/IIIa inhibitors in interventional cardiology - is it justified?, International Journal of Cardiovascular Interventions, 10.1080/acc.2.1.61.70, 2:1, (61-70), Online publication date: 1-Jan-1999. De Servi S, Repetto S, Klugmann S, Bossi I, Colombo A, Piva R, Giommi L, Bartorelli A, Fontanelli A, Mariani G and Klersy C (1999) Stent thrombosis: Incidence and related factors in the R.I.S.E. registry (Registro Impianto Stent Endocoronarico), Catheterization and Cardiovascular Interventions, 10.1002/(SICI)1522-726X(199901)46:1 3.0.CO;2-J, 46:1, (13-18), Online publication date: 1-Jan-1999. Roguin A, Grenadier E, Linn S, Markiewicz W and Beyar R (1999) Continued expansion of the nitinol self-expanding coronary stent: Angiographic analysis and 1-year clinical follow-up, American Heart Journal, 10.1016/S0002-8703(99)70120-1, 138:2, (326-333), Online publication date: 1-Aug-1999. MARAJ R, RERKPATTANAPIPAT P, WONGPRAPARUT N, FRAIFELD M, LEDLEY G, JACOBS L, YAZDANFAR S and KOTLER M (1999) Iatrogenic Cardiovascular Complications: Part III. Interventional Procedures, Journal of Interventional Cardiology, 10.1111/j.1540-8183.1999.tb00262.x, 12:5, (371-388), Online publication date: 1-Oct-1999. McGinnity J, Glazier J, Spears J, Rogers C and Turi Z (1998) Successful redeployment of an unexpanded coronary stent, Catheterization and Cardiovascular Diagnosis, 10.1002/(SICI)1097-0304(199805)44:1 3.0.CO;2-R, 44:1, (52-56), Online publication date: 1-May-1998. Ischinger T (1998) Antithrombotics in interventional cardiology: optimizing treatment and strategies, The American Journal of Cardiology, 10.1016/S0002-9149(98)00109-X, 82:5, (25L-28L), Online publication date: 1-Sep-1998. Roguin A and Beyar R (2008) BeStent—The Serpentine Balloon Expandable Stent: Review of Mechanical Properties and Clinical Experience, Artificial Organs, 10.1046/j.1525-1594.1998.06120.x, 22:3, (243-249), Online publication date: 1-Mar-1998. Leon M, Baim D, Popma J, Gordon P, Cutlip D, Ho K, Giambartolomei A, Diver D, Lasorda D, Williams D, Pocock S and Kuntz R (1998) A Clinical Trial Comparing Three Antithrombotic-Drug Regimens after Coronary-Artery Stenting, New England Journal of Medicine, 10.1056/NEJM199812033392303, 339:23, (1665-1671), Online publication date: 3-Dec-1998. Altman R (2016) Controversies in Antithrombotic Therapy in Cardiovascular Diseases, Clinical and Applied Thrombosis/Hemostasis, 10.1177/107602969800400105, 4:1, (11-24), Online publication date: 1-Jan-1998. Walter D, Schächinger V, Elsner M, Dimmeler S and Zeiher A (1997) Platelet glycoprotein Illa polymorphisms and risk of coronary stent thrombosis, The Lancet, 10.1016/S0140-6736(97)05399-3, 350:9086, (1217-1219), Online publication date: 1-Oct-1997. March 4, 1997Vol 95, Issue 5 Advertisement Article InformationMetrics Copyright © 1997 by American Heart Associationhttps://doi.org/10.1161/01.CIR.95.5.1098 Originally publishedMarch 4, 1997 KeywordsplateletsthrombosisstentangioplastyEditorials Advertisement
Referência(s)