Chapter 41 Flashcards
A rapamycin analogue released from a phosphorylcholine- coated stent that was initially evaluated in the Endeavor stent (Medtronic Vascular, Santa Rosa, California).
Zotarolimus
Zotarolimus- Eluting Stents
Late lumen loss was higher with the Endeavor stent compared with both first- generation DES. This was felt to be a stent design issue rather than a drug- failure issue as zotarolimus was eluted within a few weeks from the polymer, with 95% of the drug released within about two weeks.
Resolute- ZES has since been replaced by Resolute Onyx. The biggest difference is thinner struts in Resolute Onyx (81 [for stents ≤4.0 mm] vs. 91 μm) and improved radiographic visibility.
Trials:
Resolute- ZES
RESOLUTE All Comers Trial of 2292 patients, the Resolute zotarolimus- eluting stent was found to be noninferior to everolimus- eluting stents for the primary endpoint of target- lesion failure
A semisynthetic analogue of sirolimus (rapamycin), with both immunosuppressive and antiproliferative effects. Two versions are available: one with cobalt chromium (Xience, Abbott Vascular, Chicago, Illinois) and one with platinum chromium (Promus, Boston Scientific, Marlborough, Massachusetts).
Everolimus- Eluting Stents
Trial:
What DES has US FDA approval for a new 1- month DAPT labeling among patients at high bleeding risk?
Resolute Onyx DES
The only DES that is available for PCI in very small (2.0 mm) or very large (5.0 mm) vessels
Anatomic (or angiographic) success after PCI:
Attainment of a residual diameter stenosis of less than 50%, which is generally associated with at least a 20% improvement in diameter stenosis and relief of ischemia
Angiographic criterion for success is ≤20% stenosis when stents are used
Procedural success after PCI:
Angiographic success without the occurrence of major complications (death, MI, or CABG) within 30 days of the procedure
Clinical success after PCI:
Procedural success without the need for urgent repeated PCI or surgical revascularization within the first 30 days of the procedure.
Lesion-specific factors that increase the likelihood of stent thrombosis: (5)
> Residual dissection at the margin of the stent
Impaired flow into or out of the stent
Small stent diameter (<3 mm)
Long stent length
Treatment of acute MI
