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Invasive Cardiology Board Review > Stents and Stent Thrombosis > Flashcards

Stents and Stent Thrombosis Flashcards

1
Q

Who implanted the first coronary stent and what was its name?

A

Jacques Puel implanted the Wallstent in 1986.

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2
Q

What was the first balloon-expandable stent?

A

The Palmaz–Schatz stent, implanted in December 1987.

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3
Q

What type of stent was the Igaki–Tamai stent?

A

The first fully bioabsorbable stent.

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4
Q

What was the first drug-eluting stent approved by the FDA?

A

The sirolimus-eluting Cypher stent in 2002.

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5
Q

What was the median time for very late stent thrombosis occurrence according to a recent study?

A

4.7 years.

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6
Q

What were the most frequent findings in very late stent thrombosis cases?

A
  • Strut malapposition (34.5%)
  • Neoatherosclerosis (27.6%)
  • Uncovered struts (12.1%)
  • Stent underexpansion (6.9%)
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7
Q

True or False: Uncovered and malapposed struts were more frequent in thrombosed regions compared to nonthrombosed regions.

A

True.

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8
Q

What are key prerequisites of coronary artery stents?

A
  • Sealing of coronary artery dissections
  • Prevention of elastic recoil after balloon angioplasty
  • Limited deformability for bifurcation stenting
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9
Q

What is a rare adverse process observed with metallic drug-eluting stents?

A

Positive arterial remodeling.

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10
Q

What is the purpose of covered stents?

A

Emergency treatment of coronary perforations or exclusion of giant coronary aneurysms.

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11
Q

What was the outcome of the randomized multicenter trial comparing PTFE-covered stents to BMS?

A

No advantage in terms of percent diameter stenosis or major adverse cardiac events.

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12
Q

What are some drawbacks of self-expanding stents?

A
  • Less precise placement
  • Negative recoil
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13
Q

What is the risk of stent thrombosis with radial access compared to femoral access?

A

The risk is similar.

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14
Q

What is a characteristic of bioresorbable vascular scaffolds (BVS)?

A

They theoretically leave no permanent implant.

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15
Q

What was the primary endpoint in the AIDA trial comparing BVS and metallic EES?

A

Target vessel failure.

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16
Q

What did the meta-analysis reveal about BVS compared to metallic EES?

A

BVS had a higher rate of device thrombosis and target lesion failure.

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17
Q

What does the PSP score predict?

A

1-year device-oriented composite endpoint (DoCE).

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18
Q

What is a satisfactory minimal stent area generally considered?

A

> 5 mm².

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19
Q

What is the in-hospital mortality rate reported from the ACC/National Cardiovascular Data Registry?

A

0.7%.

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20
Q

What is the TIMI risk score used for?

A

Estimating mortality in ACS patients.

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21
Q

What factors are included in the DAPT score?

A
  • Diabetes
  • Prior MI
  • PES stent implantation
  • PCI stenting of vein graft
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22
Q

What is a recommendation for PCI for SVGs?

A

Use embolic protection devices when technically feasible.

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23
Q

What is PCI for SVGs associated with?

A

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.

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24
Q

What do embolic protection devices do in PCI for SVGs?

A

Reduce periprocedural MIs and are recommended when technically feasible.

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25
Q

What is the evidence regarding DES vs BMS in SVGs?

A

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.

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26
Q

How are lesions classified as CTOs?

A

When there is TIMI 0 flow within the occluded segment and an occlusion duration >3 months.

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27
Q

When is CTO recanalization generally indicated?

A

In patients with symptoms and evidence of ischemia.

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28
Q

What should be preferred in CTO cases, DES or BMS?

A

DES should be preferred to BMS.

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29
Q

What is the Medina classification used for?

A

Indicates the presence or absence of stenosis at the site of bifurcation in three segments.

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30
Q

What does the first digit in the Medina classification represent?

A

The proximal main vessel.

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31
Q

At 5 years, how do PCI and CABG compare in rates of death, MI, and stroke?

A

Similar rates, but TVR was significantly higher in PCI-treated patients.

Refer to Gargiulo G, et al. Int J Cardiol 2015;195:79–81.

32
Q

What is the EXCEL trial’s main finding regarding PCI with EES vs CABG?

A

PCI with EES was noninferior to CABG for the composite endpoint of death, stroke, or MI at 3 years.

33
Q

What did the NOBLE trial reveal about PCI vs CABG?

A

CABG was significantly better than PCI for major adverse cardiovascular and cerebrovascular events.

34
Q

What is a common late complication of stent implantation?

A

Stent fracture.

35
Q

What factors correlate with the risk of stent fracture?

A
  • Lesion location in the RCA
  • Severely tortuous vessels
  • Long/overlapping stents
  • Stent implantation duration.
36
Q

What is the rate of acute closure associated with intraluminal linear dissection?

A

3%.

37
Q

What defines definite stent thrombosis?

A

Angiographic or postmortem evidence of thrombotic stent occlusion with symptoms consistent with acute MI.

38
Q

What is the PRECISE-DAPT score used for?

A

Predicting out-of-hospital bleeding during DAPT.

39
Q

What is a bifurcation coronary lesion?

A

A lesion occurring at, or adjacent to, a significant division of a major epicardial coronary artery.

40
Q

What percentage of PCIs involve coronary bifurcations?

A

15% to 20%.

41
Q

What is one independent predictor of stent thrombosis identified in studies?

A

Diabetes.

42
Q

True or False: DAPT prolongation reduces the risk of MACE.

A

False.

43
Q

Fill in the blank: The definition of stent thrombosis according to the Academic Research Consortium includes early stent thrombosis defined as _______.

A

≤1 month.

44
Q

What is a cation coronary lesion?

A

A lesion occurring at, or adjacent to, a significant division of a major epicardial coronary artery.

45
Q

What percentage of all PCIs involve coronary bifurcations?

A

15% to 20%.

46
Q

What is the main recommendation from the European Bifurcation Club (EBC) for PCI of bifurcation lesions?

A

Use main vessel stenting with a proximal optimization technique and provisional side-branch stenting as a preferred approach.

47
Q

What is the Medina classification?

A

A simplified and universal classification of bifurcation lesions.

48
Q

What does the MADS classification describe?

A

Bifurcation stenting techniques grouped in families based on stent position and implantation order.

49
Q

What does the ‘M’ in MADS stand for?

A

Starts with a stent in the proximal part of the main vessel.

50
Q

What is indicated for stenting of the side branch during the provisional approach?

A

When side-branch flow is compromised, in the presence of a major side-branch dissection, or when the side branch is significantly diseased.

51
Q

True or False: OCT is superior to IVUS in evaluating the side branch ostium.

A

True.

52
Q

What is the significance of combining probable and possible stent thrombosis?

A

It provides a high sensitivity suitable for the detection of safety signals.

53
Q

What is the Nobori stent?

A

A new-generation Biolimus A9–eluting stent.

54
Q

What are known risk factors for bleeding during stent procedures?

A
  • Advanced age
  • Oral anticoagulation
  • Use of NSAIDs
  • History of bleeding
55
Q

What is the impact of bleeding on prognosis after ACS?

A

Bleeding is known to impact mortality significantly.

56
Q

What is the primary end point in the BIOFLOW-II trial?

A

Late lumen loss (LLL) at 9 months.

57
Q

What is unique about the Orsiro stent’s coating?

A

It has a hybrid combination of passive (PROBIO) and active (PLLA) coatings.

58
Q

What polymer does the SYNERGY stent use?

A

A fully biodegradable PLGA polymer.

59
Q

Fill in the blank: The AXXESS stent is a _______ dedicated device.

A

[bifurcation]

60
Q

What are the components of the Biotronik absorbable magnesium scaffolds?

A
  • AMS1
  • AMS2
  • AMS3 (DREAMS 1G)
  • DREAMS 2G
61
Q

What is the main difference between the Nobori and BioMatrix BES stents?

A

The coating process.

62
Q

What are the characteristics of durable polymers used in first-generation DES?

A
  • Thick
  • Associated with inflammatory responses
  • Linked to mechanical complications
63
Q

What was the result of the SORT OUT VII trial comparing Orsiro and Nobori stents?

A

Noninferiority for target lesion failure at 1 year and lower definite stent thrombosis in the Orsiro group.

64
Q

What does the acronym DES stand for?

A

Drug-Eluting Stent.

65
Q

What are durable polymers used in first-generation DES associated with?

A

Inflammatory responses and local toxicity

These polymers have been linked to mechanical complications such as polymer delamination.

66
Q

What issues have been identified with durable polymers in DES?

A

Mechanical complications and nonuniform coating

Nonuniform coating resulted in abnormal drug distribution.

67
Q

What are biodegradable polymers capable of in drug-eluting stents?

A

Allow drug elution by drug diffusion or matrix degradation

This contrasts with durable polymers, which use particle dissolution.

68
Q

Name three stents that are classified as durable polymer DES.

A
  • Promus (EES)
  • Xience (EES)
  • Resolute (ZES)

These stents incorporate more biocompatible materials compared to first-generation DES.

69
Q

What materials are used in the newer durable polymer DES compared to first-generation DES?

A
  • Acrylic
  • Fluoropolymers
  • Cobalt
  • Platinum–chromium

These materials allow for thinner struts and lower crossing profiles.

70
Q

What was the focus of the network meta-analysis involving BMS, durable polymer DES, and biodegradable polymer DES?

A

Outcomes of 258,544 patient-years of follow-up

This included data from 126 randomized trials.

71
Q

Which newer generation durable polymer DES showed the most efficacy according to the meta-analysis?

A

Resolute-ZES, cobalt–chromium EES, and platinum–chromium EES

These stents had reduced rates of target vessel revascularization (TVR).

72
Q

Which stent was found to be the safest in terms of reducing stent thrombosis, MI, and death?

A

Cobalt–chromium EES

This stent demonstrated significant reductions in adverse outcomes compared to BMS.

73
Q

What concerns have been raised regarding bioresorbable vascular scaffolds (BVS)?

A

Concerns particularly in unselected patients

BVS should be considered in selected cases only.

74
Q

What was the outcome of the Norwegian Coronary Stent Trial (NORSTENT) regarding repeat revascularization?

A

Lower rates in the group receiving DES

There were no significant differences in death or nonfatal spontaneous MI between DES and BMS.

75
Q

True or False: Paclitaxel-eluting stents (PES) have demonstrated a reduction in death or stent thrombosis.

A

False

PES has not shown a reduction in these outcomes.

Invasive Cardiology Board Review (42 decks)

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