Endovascular therapy in femoropopliteal territory has become the standard, mainly with self-expanding stents, aimed at preventing early vascular recoil and late constrictive remodeling. Randomized studies have shown that the use of Paclitaxel drug eluting stents (DES) reduces the number of new revascularizations (even though these studies compared mostly against conventional balloons, which is why we...
New generation DES present better results in vein grafts than older DES and BMS
There is little information comparing contemporary drug eluting stents (DES) against bare metal stents (BMS), for PCI in saphenous vein grafts in patients receiving (CABG). This study aimed to assess clinical outcomes after PCI in saphenous vein grafts in patients receiving BMS, first generation DES, and new generation DES between 2006 and 2013. The study...
Everolimus DES are more effective and less costly than conventional BMS
Courtesy of Dr. Guillermo Migliaro. Drug eluting stents (DES) represented the greatest technological advance in the treatment of instent restenosis from conventional metallic stents (BMS), especially cobalt chromium everolimus eluting stents (CoCr EES), which have shown an excellent profile, and are mostly safer, compared to first generation DES. Indeed, several randomized studies and meta-analyzis have...
Stent thrombosis: Comparative analysis between BMS, DES and BRS
Original Title: Stent Thrombosis with Drug Eluting Stents and Bioresorbable Scaffolds. Evidence from a Network Meta-Analysis of 147 trials. Reference: Kang S et al. J Am Coll Cardiol Intv 2016 doi 10.1016. Courtesy of Dr. Guillermo Migliaro. When treating heart disease, drug eluting stents (DES) have become essential for PCI. Its main advantage lies on...
High bleeding risk: is BMS still justifiable?
Original Title: Is Bare-Metal Stent Implantation Still Justifiable in High Bleeding Risk Patients Undergoing Percutaneous Coronary Intervention? A Pre-Specified Analysis From the ZEUS Trial. Reference: Sara Ariotti et al. J Am Coll Cardiol Intv. 2016;9(5):426-436. This work studied ischemic and bleeding events in high bleeding risk patients randomized to the zotarolimus eluting stent (ZEZ) Endeavor...
Meta-analysis confirms the reduction in ischemic events with 2nd generation DES versus BMS
This paper included 5 studies that randomized patients to conventional stent versus chromium cobalt everolimus eluting stent; at 2 years, a significantly lower risk of cardiac death (2.7% for the everolimus eluting stent versus 4% for conventional stent, p = 0013) was observed. Myocardial infarction was reduced by over 80% with drug-eluting stent (0.08% versus...
RIBS V: Pharmacological balloon vs second-generation drug-eluting stent in the treatment of BMS restenosis
The ideal therapy for treating in-stent restenosis continues to be debated . The pharmacological balloons showed good results in this context, but no direct comparisons available of pharmacological balloonsversus second-generation DES.This prospective, multicenter randomized 189 patients with in-stent restenosis of conventional stents receiving pharmacological balloon or everolimusDES.The primary endpoint was angiographicat 9 months spotting a...
Reduced risk of acute, late and very late thrombosis with new generations of DES versus BMS in the acute myocardial context
Original title: Stent thrombosis in new-generation drug-eluting stents in patients with STEMI undergoing primary PCI: a report from SCAAR. Reference: Sarno G et al. J Am Coll Cardiol. 2014;Epub ahead of print. This study evaluated 34147 consecutive patients suffering acute myocardial infarction with ST-segment elevation included in the SCAAR registry (Swedish Coronary Angiography and Angioplasty Registry) undergoing primary...
Everolimus-eluting stent and DEB in restenosis for BMS. Good results of both with some expected differences.
Original title: A Randomized Comparison of Drug-Eluting Balloon Versus Everolimus-Eluting Stent in Patients With Bare-Metal Stent In-Stent Restenosis: The RIBS V Clinical Trial. Reference: Fernando Alfonso et al. J Am Coll Cardiol. 2014; Epub ahead of print. Drug-eluting stents (DES) have proven to be superior in terms of restenosis than bare metal stents (BMS). BMS, however due...
Drug eluting balloon followed BMS versus DES in de novo lesions
Original title: Elutax paclitaxel-eluting balloon followed by bare-metal stent compared with Xience V drug-eluting stent in the treatment of de novo coronary stenosis: A randomized trial. Reference: Francesco Liistro et al. Am Heart J 2013;166:920-6. Recently, drug eluting balloons (DEB) have emerged as a potential alternative to drug-eluting stents (DES). Paclitaxel is an appropriate drug for DEBs given...