AIM: To assess the occurrence of late clinical events after the discontinuation of dual antiplatelet treatment in patients with drug-eluting stent implantation, complex coronary artery disease and high clinical risk profile. METHODS: Between January 2004 and December 2005, 2080 patients underwent percutaneous coronary intervention, including 276 patients (13%) who were treated with drug-eluting stents. At the 6-month follow-up, 273 patients remained event-free and of these, 171 completed the 12-month and 18-month follow-ups and have been enrolled in the analysis. Dual antiplatelet treatment was administered for 6 months in all patients. RESULTS: At the 18-month follow-up, stent thrombosis had occurred in 10 patients (5.8%), resulting in five sudden deaths and five target-vessel nonfatal myocardial infarctions. The majority (80%) of the events had developed within 7-12 months. The larger stent area and left main interventions were significantly associated with stent thrombosis (P=0.031 and P=0.001, respectively). CONCLUSIONS: Our study confirmed worrisome results concerning drug-eluting stent thrombosis after the discontinuation of dual antiplatelet treatment. The rate of stent thrombosis-related events in our high-risk cohort of patients reached almost 6% with a 50% mortality. The majority (80%) of the events occurred within the months 7-12.
- MeSH
- balónková koronární angioplastika přístrojové vybavení metody MeSH
- inhibitory agregace trombocytů farmakologie MeSH
- kohortové studie MeSH
- lidé středního věku MeSH
- lidé MeSH
- nemoci koronárních tepen mortalita terapie MeSH
- přežití po terapii bez příznaků nemoci MeSH
- registrace MeSH
- riziko MeSH
- senioři MeSH
- stenóza MeSH
- stenty uvolňující léky * MeSH
- trombóza MeSH
- výsledek terapie MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- Názvy látek
- inhibitory agregace trombocytů MeSH
The aim of this study was to evaluate the incidence and the cause of "edge restenosis" after implantation of high activity 41.1 microCi +/- 1.2 microCi = 1520 kBq +/- 44 kBq, beta-emitting (55Co) stents. Proton bombarding in cyclotron has brought the radioactivity. Intravascular ultrasound (IVUS) investigation has been completed in 10 patients. The angiographies performed at 6 month revealed restenosis >50% in 5 cases (50%). The analysis of edges (5 mm distally and proximally to the last stent struts) showed no significant changes in TVV (187.3 +/- 62.60 mm3 and 176.9 +/- 53.5 mm3) but PMV increase significantly (i.e. neointimal proliferation) from 61.9 +/- 31.2 mm3 to 82.2 +/- 43.4 mm3 (p<0.04) and was the major contributor (from 66%) to lumen volume loss (125.4 +/- 40.7 mm3 and 94.7 +/- 22.2 mm3, p<0.02). In conclusion, neither statistically significant positive nor negative remodelling at the "stent edges", were present. Statistically significant increase in plaque +/- media volume (i.e. neointimal hyperplasia) and reduction in lumen volume were found. The cause of "edge restenosis" was especially (from 66%) due to increase in plaque +/- media volume (i.e. neointimal hyperplasia). Probably, main reason for "edge effect"/neointimal hyperplasia was in this trial sharp fall-off in radiation at the edges of the stents.
- MeSH
- balónková koronární angioplastika MeSH
- beta částice MeSH
- intervenční ultrasonografie MeSH
- koronární nemoc terapie MeSH
- koronární restenóza diagnostické zobrazování prevence a kontrola MeSH
- lidé středního věku MeSH
- lidé MeSH
- radioizotopy kobaltu aplikace a dávkování MeSH
- senioři MeSH
- stenty * MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
- Názvy látek
- radioizotopy kobaltu MeSH
