Stents and Stent Thrombosis Flashcards
Who implanted the first coronary stent and what was its name?
Jacques Puel implanted the Wallstent in 1986.
What was the first balloon-expandable stent?
The Palmaz–Schatz stent, implanted in December 1987.
What type of stent was the Igaki–Tamai stent?
The first fully bioabsorbable stent.
What was the first drug-eluting stent approved by the FDA?
The sirolimus-eluting Cypher stent in 2002.
What was the median time for very late stent thrombosis occurrence according to a recent study?
4.7 years.
What were the most frequent findings in very late stent thrombosis cases?
- Strut malapposition (34.5%)
- Neoatherosclerosis (27.6%)
- Uncovered struts (12.1%)
- Stent underexpansion (6.9%)
True or False: Uncovered and malapposed struts were more frequent in thrombosed regions compared to nonthrombosed regions.
True.
What are key prerequisites of coronary artery stents?
- Sealing of coronary artery dissections
- Prevention of elastic recoil after balloon angioplasty
- Limited deformability for bifurcation stenting
What is a rare adverse process observed with metallic drug-eluting stents?
Positive arterial remodeling.
What is the purpose of covered stents?
Emergency treatment of coronary perforations or exclusion of giant coronary aneurysms.
What was the outcome of the randomized multicenter trial comparing PTFE-covered stents to BMS?
No advantage in terms of percent diameter stenosis or major adverse cardiac events.
What are some drawbacks of self-expanding stents?
- Less precise placement
- Negative recoil
What is the risk of stent thrombosis with radial access compared to femoral access?
The risk is similar.
What is a characteristic of bioresorbable vascular scaffolds (BVS)?
They theoretically leave no permanent implant.
What was the primary endpoint in the AIDA trial comparing BVS and metallic EES?
Target vessel failure.
What did the meta-analysis reveal about BVS compared to metallic EES?
BVS had a higher rate of device thrombosis and target lesion failure.
What does the PSP score predict?
1-year device-oriented composite endpoint (DoCE).
What is a satisfactory minimal stent area generally considered?
> 5 mm².
What is the in-hospital mortality rate reported from the ACC/National Cardiovascular Data Registry?
0.7%.
What is the TIMI risk score used for?
Estimating mortality in ACS patients.
What factors are included in the DAPT score?
- Diabetes
- Prior MI
- PES stent implantation
- PCI stenting of vein graft
What is a recommendation for PCI for SVGs?
Use embolic protection devices when technically feasible.
What is PCI for SVGs associated with?
Suboptimal results due to high rates of periprocedural MI and high rates of restenosis requiring TLR.
Refer to Savage MP, et al. N Engl J Med 1997;337(11):740–747 for more details.
What do embolic protection devices do in PCI for SVGs?
Reduce periprocedural MIs and are recommended when technically feasible.
What is the evidence regarding DES vs BMS in SVGs?
Lower evidence investigating potential benefits of DES over BMS, but majority show DES superiority.
Refer to Aggarwal V, et al. J Am Coll Cardiol 2014;64(17):1825–1836; Wiisanen ME, et al. JACC 2010;3(12):1262–1273; Alam M, et al. Clin Cardiol 2012;35(5):291–296.
How are lesions classified as CTOs?
When there is TIMI 0 flow within the occluded segment and an occlusion duration >3 months.
When is CTO recanalization generally indicated?
In patients with symptoms and evidence of ischemia.
What should be preferred in CTO cases, DES or BMS?
DES should be preferred to BMS.
What is the Medina classification used for?
Indicates the presence or absence of stenosis at the site of bifurcation in three segments.
What does the first digit in the Medina classification represent?
The proximal main vessel.
At 5 years, how do PCI and CABG compare in rates of death, MI, and stroke?
Similar rates, but TVR was significantly higher in PCI-treated patients.
Refer to Gargiulo G, et al. Int J Cardiol 2015;195:79–81.
What is the EXCEL trial’s main finding regarding PCI with EES vs CABG?
PCI with EES was noninferior to CABG for the composite endpoint of death, stroke, or MI at 3 years.
What did the NOBLE trial reveal about PCI vs CABG?
CABG was significantly better than PCI for major adverse cardiovascular and cerebrovascular events.
What is a common late complication of stent implantation?
Stent fracture.
What factors correlate with the risk of stent fracture?
- Lesion location in the RCA
- Severely tortuous vessels
- Long/overlapping stents
- Stent implantation duration.
What is the rate of acute closure associated with intraluminal linear dissection?
3%.
What defines definite stent thrombosis?
Angiographic or postmortem evidence of thrombotic stent occlusion with symptoms consistent with acute MI.
What is the PRECISE-DAPT score used for?
Predicting out-of-hospital bleeding during DAPT.
What is a bifurcation coronary lesion?
A lesion occurring at, or adjacent to, a significant division of a major epicardial coronary artery.
What percentage of PCIs involve coronary bifurcations?
15% to 20%.
What is one independent predictor of stent thrombosis identified in studies?
Diabetes.
True or False: DAPT prolongation reduces the risk of MACE.
False.
Fill in the blank: The definition of stent thrombosis according to the Academic Research Consortium includes early stent thrombosis defined as _______.
≤1 month.
What is a cation coronary lesion?
A lesion occurring at, or adjacent to, a significant division of a major epicardial coronary artery.
What percentage of all PCIs involve coronary bifurcations?
15% to 20%.
What is the main recommendation from the European Bifurcation Club (EBC) for PCI of bifurcation lesions?
Use main vessel stenting with a proximal optimization technique and provisional side-branch stenting as a preferred approach.
What is the Medina classification?
A simplified and universal classification of bifurcation lesions.
What does the MADS classification describe?
Bifurcation stenting techniques grouped in families based on stent position and implantation order.
What does the ‘M’ in MADS stand for?
Starts with a stent in the proximal part of the main vessel.
What is indicated for stenting of the side branch during the provisional approach?
When side-branch flow is compromised, in the presence of a major side-branch dissection, or when the side branch is significantly diseased.
True or False: OCT is superior to IVUS in evaluating the side branch ostium.
True.
What is the significance of combining probable and possible stent thrombosis?
It provides a high sensitivity suitable for the detection of safety signals.
What is the Nobori stent?
A new-generation Biolimus A9–eluting stent.
What are known risk factors for bleeding during stent procedures?
- Advanced age
- Oral anticoagulation
- Use of NSAIDs
- History of bleeding
What is the impact of bleeding on prognosis after ACS?
Bleeding is known to impact mortality significantly.
What is the primary end point in the BIOFLOW-II trial?
Late lumen loss (LLL) at 9 months.
What is unique about the Orsiro stent’s coating?
It has a hybrid combination of passive (PROBIO) and active (PLLA) coatings.
What polymer does the SYNERGY stent use?
A fully biodegradable PLGA polymer.
Fill in the blank: The AXXESS stent is a _______ dedicated device.
[bifurcation]
What are the components of the Biotronik absorbable magnesium scaffolds?
- AMS1
- AMS2
- AMS3 (DREAMS 1G)
- DREAMS 2G
What is the main difference between the Nobori and BioMatrix BES stents?
The coating process.
What are the characteristics of durable polymers used in first-generation DES?
- Thick
- Associated with inflammatory responses
- Linked to mechanical complications
What was the result of the SORT OUT VII trial comparing Orsiro and Nobori stents?
Noninferiority for target lesion failure at 1 year and lower definite stent thrombosis in the Orsiro group.
What does the acronym DES stand for?
Drug-Eluting Stent.
What are durable polymers used in first-generation DES associated with?
Inflammatory responses and local toxicity
These polymers have been linked to mechanical complications such as polymer delamination.
What issues have been identified with durable polymers in DES?
Mechanical complications and nonuniform coating
Nonuniform coating resulted in abnormal drug distribution.
What are biodegradable polymers capable of in drug-eluting stents?
Allow drug elution by drug diffusion or matrix degradation
This contrasts with durable polymers, which use particle dissolution.
Name three stents that are classified as durable polymer DES.
- Promus (EES)
- Xience (EES)
- Resolute (ZES)
These stents incorporate more biocompatible materials compared to first-generation DES.
What materials are used in the newer durable polymer DES compared to first-generation DES?
- Acrylic
- Fluoropolymers
- Cobalt
- Platinum–chromium
These materials allow for thinner struts and lower crossing profiles.
What was the focus of the network meta-analysis involving BMS, durable polymer DES, and biodegradable polymer DES?
Outcomes of 258,544 patient-years of follow-up
This included data from 126 randomized trials.
Which newer generation durable polymer DES showed the most efficacy according to the meta-analysis?
Resolute-ZES, cobalt–chromium EES, and platinum–chromium EES
These stents had reduced rates of target vessel revascularization (TVR).
Which stent was found to be the safest in terms of reducing stent thrombosis, MI, and death?
Cobalt–chromium EES
This stent demonstrated significant reductions in adverse outcomes compared to BMS.
What concerns have been raised regarding bioresorbable vascular scaffolds (BVS)?
Concerns particularly in unselected patients
BVS should be considered in selected cases only.
What was the outcome of the Norwegian Coronary Stent Trial (NORSTENT) regarding repeat revascularization?
Lower rates in the group receiving DES
There were no significant differences in death or nonfatal spontaneous MI between DES and BMS.
True or False: Paclitaxel-eluting stents (PES) have demonstrated a reduction in death or stent thrombosis.
False
PES has not shown a reduction in these outcomes.
