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Krackhardt MF, Waliszewski M, Pansieri M, Lozano F, Heang TM, Hudec M, Studencan M, Mauri J, Toušek P, Garcia B, Ahn T, Kocka V, Janek B, Sebagh L, Herberger D, Levy G, Tomulic V, Rischner J. TCT CONNECT-249 Real-World Dual Antiplatelet Therapy Following Polymer-free, Sirolimus-Eluting Stent Implantations to Treat Coronary Artery Disease. J Am Coll Cardiol 2020. [DOI: 10.1016/j.jacc.2020.09.266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Krackhardt F, Waliszewski M, Kočka V, Toušek P, Janek B, Hudec M, Lozano F, Roman KGS, Del Blanco BG, Mauri J, Heang TM, Ahn TH, Jeong MH, Herberger D, Tomulic V, Levy G, Sebagh L, Rischner J, Pansieri M. Real-World Dual Antiplatelet Therapy Following Polymer-Free Sirolimus-Eluting Stent Implantations to Treat Coronary Artery Disease. Cardiovasc Drugs Ther 2020; 34:335-344. [PMID: 32212061 PMCID: PMC8626401 DOI: 10.1007/s10557-020-06963-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Objectives The objective of this post hoc analysis was to analyze real-world dual antiplatelet therapy (DAPT) regimens following polymer-free sirolimus-eluting stent (PF-SES) implantations in an unselected patient population. Methods Patient-level data from two all-comers observational studies (ClinicalTrials.gov Identifiers: NCT02629575 and NCT02905214) were pooled and analyzed in terms of their primary endpoint. During the data verification process, we observed substantial deviations from DAPT guideline recommendations. To illuminate this gap between clinical practice and guideline recommendations, we conducted a post hoc analysis of DAPT regimens and clinical event rates for which we defined the net adverse event rate (NACE) consisting of target lesion revascularization (TLR, primary endpoint of all-comers observational studies) all-cause death, myocardial infarction (MI), stent thrombosis (ST), and bleeding events. A logistic regression was utilized to determine predictors why ticagrelor was used in stable coronary artery disease (CAD) patients instead of the guideline-recommended clopidogrel. Results For stable CAD, the composite endpoint of clinical, bleeding, and stent thrombosis, i.e., NACE, between the clopidogrel and ticagrelor treatment groups was not different (5.4% vs. 5.1%, p = 0.745). Likewise, in the acute coronary syndrome (ACS) cohort, the NACE rates were not different between both DAPT strategies (9.2% vs. 9.3%, p = 0.927). There were also no differences in the accumulated rates for TLR, myocardial infarction ([MI], mortality, bleeding events, and stent thrombosis in elective and ACS patients. The main predictors for ticagrelor use in stable CAD patients were age < 65 years, smaller vessels, treatment of ostial and calcified lesions, and in-stent restenosis. Conclusion Within the framework of a post hoc analysis based on a real-world, large cohort study, there were no differences in the combined endpoint of major adverse cardiac events (MACE), bleeding and thrombotic events for clopidogrel and ticagrelor in stable CAD or ACS patients. Despite the recommendation for clopidogrel by the European Society of Cardiology (ESC), real-world ticagrelor use was observed in subgroups of stable CAD patients that ought to be explored in future trials.
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Affiliation(s)
- Florian Krackhardt
- Department of Internal Medicine and Cardiology, Charité - Universitätsmedizin Berlin, Campus Virchow, Augustenburger Platz 1, D-13353, Berlin, Germany.
| | - Matthias Waliszewski
- Department of Internal Medicine and Cardiology, Charité - Universitätsmedizin Berlin, Campus Virchow, Augustenburger Platz 1, D-13353, Berlin, Germany
- Medical Scientific Affairs, B.Braun Melsungen AG, Berlin, Germany
| | - Viktor Kočka
- University Hospital Královské Vinohrady, Prague, Czech Republic
| | - Petr Toušek
- University Hospital Královské Vinohrady, Prague, Czech Republic
| | | | | | - Fernando Lozano
- Hospital General Universitario de Ciudad Real, Ciudad Real, Spain
| | | | | | - Josepa Mauri
- Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | | | - Tae Hoon Ahn
- Gachon University Gil Medical Center, Incheon, South Korea
| | | | - Denny Herberger
- Medical Scientific Affairs, B.Braun Melsungen AG, Berlin, Germany
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Krackhardt F, Kočka V, Waliszewski M, Toušek P, Janek B, Trenčan M, Krajči P, Lozano F, Roman KGS, Otaegui I, del Blanco BG, del Olmo VV, Nofrerías EF, Wachowiak L, Heang TM, Ahn TH, Jeong MH, Jung BC, Han KR, Piot C, Sebagh L, Rischner J, Pansieri M, Leschke M. Unrestricted use of polymer-free sirolimus eluting stents in routine clinical practice. Medicine (Baltimore) 2020; 99:e19119. [PMID: 32080086 PMCID: PMC7034709 DOI: 10.1097/md.0000000000019119] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Stent designs with ultrathin struts may further increase the procedural success of challenging lesion subsets. The objective of this study was to assess the safety and efficacy of ultrathin strut, polymer-free sirolimus eluting stent (PF-SES) implantations in a large scale, unselected patient population.Adult patients underwent percutaneous coronary interventions (PCI) with a thin-strut PF-SES. Data from two all-comers observational studies having the same protocol (ClinicalTrials.gov Identifiers: NCT02629575 and NCT02905214) were pooled. The accumulated target lesion revascularization (TLR) rate at 9-12 months was the primary endpoint. All dual antiplatelet therapy strategies according to the applicable guidelines were permissible.In total, 7243 patients were prospectively enrolled for PCI with PF-SES in stable coronary artery disease or acute coronary syndrome (ACS). Major risk factors in the overall cohort were diabetes (37.3%), ST elevation myocardial infarction (18.1%) and non-ST myocardial infarction (24.6%). The follow-up rate was 88.6% in the overall population. The TLR rate in the overall cohort was 2.2% whereas definite/probable stent thrombosis (ST) occurred in 0.7%. In patients with in-stent restenosis lesions, the major adverse cardiac events rate was 6.4% whereas the corresponding rate for isolated left main coronary artery (LMCA) disease was highest with 6.7% followed by patients with culprit lesions in vein bypasses (VB, 7.1%). The mortality rate in patients treated in VB lesions was highest with 5.4%, followed by the isolated LMCA subgroup (3.4%) and ACS (2.6%).PCI with PF-SES in an unselected patient population, is associated with low clinical event and ST rates. Furthermore, PF-SES angioplasty in niche indications demonstrated favorable safety and efficacy outcomes with high procedural success rates.
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Affiliation(s)
- Florian Krackhardt
- Department of Internal Medicine and Cardiology, Charité – Universitätsmedizin Berlin, Campus Virchow Klinikum, Berlin
| | - Viktor Kočka
- University Hospital Královské Vinohrady Prague, Czech Republic
| | - Matthias Waliszewski
- Department of Internal Medicine and Cardiology, Charité – Universitätsmedizin Berlin, Campus Virchow Klinikum, Berlin
- Medical Scientific Affairs, B.Braun Melsungen AG, Berlin, Germany
| | - Petr Toušek
- University Hospital Královské Vinohrady Prague, Czech Republic
| | | | | | | | | | | | | | | | | | | | - Lucie Wachowiak
- Medical Scientific Affairs, B.Braun France, Saint Cloud, France
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Krackhardt F, Waliszewski M, Wan Ahmad WA, Kočka V, Toušek P, Janek B, Trenčan M, Krajči P, Lozano F, Garcia-San Roman K, Otaegui Irurueta I, Garcia del Blanco B, Wachowiak L, Vilalta del Olmo V, Fernandez Nofrerías E, Ho Jeong M, Jung BC, Han KR, Piot C, Sebagh L, Rischner J, Pansieri M, Leschke M, Ahn TH. Polymer-free sirolimus-eluting stent use in Europe and Asia: Ethnic differences in demographics and clinical outcomes. PLoS One 2020; 15:e0226606. [PMID: 31929543 PMCID: PMC6957170 DOI: 10.1371/journal.pone.0226606] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Accepted: 11/29/2019] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND The objective of this study was to assess regional and ethnic differences in an unselected patient population treated with polymer-free sirolimus-eluting stents (PF-SES) in Asia and Europe. METHODS Two all-comers observational studies based on the same protocol (ClinicalTrials.gov Identifiers: NCT02629575 and NCT02905214) were combined for data analysis to assure sufficient statistical power. The primary endpoint was the accumulated target lesion revascularization (TLR) rate at 9-12 months. RESULTS Of the total population of 7243 patients, 44.0% (3186) were recruited in the Mediterranean region and 32.0% (2317) in central Europe. The most prominent Asian region was South Korea (17.6%, 1274) followed by Malaysia (5.7%, 413). Major cardiovascular risk factors varied significantly across regions. The overall rates for accumulated TLR and MACE were low with 2.2% (140/6374) and 4.4% (279/6374), respectively. In ACS patients, there were no differences in terms of MACE, TLR, MI and accumulated mortality between the investigated regions. Moreover, dual antiplatelet therapy (DAPT) regimens were substantially longer in Asian countries even in patients with stable coronary artery disease as compared to those in Europe. CONCLUSIONS PF-SES angioplasty is associated with low clinical event rates in all regions. Further reductions in clinical event rates seem to be associated with longer DAPT regimens.
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Affiliation(s)
- Florian Krackhardt
- Department of Internal Medicine and Cardiology, Charité–Universitätsmedizin Berlin, Campus Virchow, Berlin, Germany
- * E-mail:
| | - Matthias Waliszewski
- Department of Internal Medicine and Cardiology, Charité–Universitätsmedizin Berlin, Campus Virchow, Berlin, Germany
- Medical Scientific Affairs, B.Braun Melsungen AG, Berlin, Germany
| | | | - Viktor Kočka
- University Hospital Královské Vinohrady Prague, Czech Republic
| | - Petr Toušek
- University Hospital Královské Vinohrady Prague, Czech Republic
| | | | | | | | - Fernando Lozano
- Hospital General Universitario de Ciudad Real, Ciudad Real, Spain
| | | | | | | | - Lucie Wachowiak
- Medical Scientific Affairs, B.Braun France, Saint-Cloud, France
| | | | | | | | | | - Kyu-Rock Han
- Kangdong Sacred Heart Hospital, Kangdong, South Korea
| | | | | | | | | | | | - Tae Hoon Ahn
- Gachon University Gil Medical Center, Incheon, South Korea
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Helft G, Steg PG, Le Feuvre C, Georges JL, Carrie D, Dreyfus X, Furber A, Leclercq F, Eltchaninoff H, Falquier JF, Henry P, Cattan S, Sebagh L, Michel PL, Tuambilangana A, Hammoudi N, Boccara F, Cayla G, Douard H, Diallo A, Berman E, Komajda M, Metzger JP, Vicaut E. Stopping or continuing clopidogrel 12 months after drug-eluting stent placement: the OPTIDUAL randomized trial. Eur Heart J 2015; 37:365-74. [PMID: 26364288 DOI: 10.1093/eurheartj/ehv481] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2015] [Accepted: 08/24/2015] [Indexed: 11/12/2022] Open
Abstract
AIM This open-label, randomized, and multicentre trial tested the hypothesis that, on a background of aspirin, continuing clopidogrel would be superior to stopping clopidogrel at 12 months following drug-eluting stent (DES) implantation. METHODS AND RESULTS Patients (N = 1799) who had undergone placement of ≥1 DES for stable coronary artery disease or acute coronary syndrome were included in 58 French sites (January 2009-January 2013). Patients (N = 1385) free of major cardiovascular/cerebrovascular events or major bleeding and on aspirin and clopidogrel 12 months after stenting were eligible for randomization (1:1) between continuing clopidogrel 75 mg daily (extended-dual antiplatelet therapy, DAPT, group) or discontinuing clopidogrel (aspirin group). The primary outcome was net adverse clinical events defined as the composite of death, myocardial infarction, stroke, or major bleeding. Follow-up was planned from a minimum of 6 to a maximum of 36 months after randomization. Owing to slow recruitment, the study was stopped after enrolment of 1385 of a planned 1966 patients. Median follow-up after stenting was 33.4 months. The primary outcome occurred in 40 patients (5.8%) in the extended-DAPT group and 52 in the aspirin group (7.5%; hazard ratio 0.75, 95% confidence interval 0.50-1.28; P = 0.17). Rates of death were 2.3% in the extended-DAPT group and 3.5% in the aspirin group (HR 0.65, 95% CI 0.34-1.22; P = 0.18). Rates of major bleeding were identical (2.0%, P = 0.95). CONCLUSIONS Extended DAPT did not achieve superiority in reducing net adverse clinical events compared to 12 months of DAPT after DES placement. The power of the OPTIDUAL trial was however low and reduced by premature termination of enrolment. CLINICALTRIALSGOV NUMBER NCT00822536.
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Affiliation(s)
- Gérard Helft
- Institut de Cardiologie, Hôpital Pitié-Salpétrière, Assistance Publique Hôpitaux de Paris, Université Pierre et Marie Curie, boulevard de l'Hôpital, 75013 Paris, France IHU, Institute of Cardiometabolism and Nutrition, Hôpital Pitié-Salpétrière, Paris, France
| | - Philippe Gabriel Steg
- DHU FIRE, Université Paris-Diderot, Sorbonne-Paris-Cité, Paris, France Hôpital Bichat, Assistance Publique Hôpitaux de Paris, INSERM-U1148, Paris, France NHLI, Royal Brompton Hospital, Imperial College, London, UK
| | - Claude Le Feuvre
- Institut de Cardiologie, Hôpital Pitié-Salpétrière, Assistance Publique Hôpitaux de Paris, Université Pierre et Marie Curie, boulevard de l'Hôpital, 75013 Paris, France
| | | | - Didier Carrie
- Centre Hospitalier Universitaire Rangueil, Toulouse, France
| | | | - Alain Furber
- Centre Hospitalier Universitaire, Angers, France
| | | | - Hélène Eltchaninoff
- Centre Hospitalier Universitaire, Rouen, France INSERM U 1096, Rouen, France
| | | | - Patrick Henry
- Hôpital Lariboisière, Assistance Publique Hôpitaux de Paris, Paris 7, Paris, France
| | - Simon Cattan
- Centre Hospitalier Intercommunal Le Raincy-Montfermeil, Montfermeil, France
| | | | | | | | - Nadjib Hammoudi
- Institut de Cardiologie, Hôpital Pitié-Salpétrière, Assistance Publique Hôpitaux de Paris, Université Pierre et Marie Curie, boulevard de l'Hôpital, 75013 Paris, France IHU, Institute of Cardiometabolism and Nutrition, Hôpital Pitié-Salpétrière, Paris, France
| | - Franck Boccara
- Hôpital Saint-Antoine, Assistance Publique Hôpitaux de Paris, Paris Pierre et Marie Curie, Paris, France INSERM UMR_S 938, Paris, France
| | - Guillaume Cayla
- Centre Hospitalier Universitaire Nîmes, Université de Montpellier, Nîmes, France
| | - Hervé Douard
- Centre Hospitalier Universitaire, Bordeaux, France
| | - Abdourahmane Diallo
- Unité de Recherche Clinique Lariboisière St Louis Hôpital Fernand Widal, Assistance Publique Hôpitaux de Paris, Université Paris-Diderot, Paris, France
| | - Emmanuel Berman
- Institut de Cardiologie, Hôpital Pitié-Salpétrière, Assistance Publique Hôpitaux de Paris, Université Pierre et Marie Curie, boulevard de l'Hôpital, 75013 Paris, France
| | - Michel Komajda
- Institut de Cardiologie, Hôpital Pitié-Salpétrière, Assistance Publique Hôpitaux de Paris, Université Pierre et Marie Curie, boulevard de l'Hôpital, 75013 Paris, France IHU, Institute of Cardiometabolism and Nutrition, Hôpital Pitié-Salpétrière, Paris, France
| | - Jean-Philippe Metzger
- Institut de Cardiologie, Hôpital Pitié-Salpétrière, Assistance Publique Hôpitaux de Paris, Université Pierre et Marie Curie, boulevard de l'Hôpital, 75013 Paris, France
| | - Eric Vicaut
- Unité de Recherche Clinique Lariboisière St Louis Hôpital Fernand Widal, Assistance Publique Hôpitaux de Paris, Université Paris-Diderot, Paris, France PARTNERS/F-CRIN, Paris, France
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Helft G, Le Feuvre C, Georges JL, Carrie D, Leclercq F, Eltchaninoff H, Furber A, Prunier F, Sebagh L, Cattan S, Cayla G, Vicaut E, Metzger JP. Efficacy and safety of 12 versus 48 months of dual antiplatelet therapy after implantation of a drug-eluting stent: the OPTImal DUAL antiplatelet therapy (OPTIDUAL) trial: study protocol for a randomized controlled trial. Trials 2013; 14:56. [PMID: 23433461 PMCID: PMC3598827 DOI: 10.1186/1745-6215-14-56] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2012] [Accepted: 02/11/2013] [Indexed: 12/12/2022] Open
Abstract
Background Dual antiplatelet therapy with aspirin and thienopyridine is required after placement of coronary drug-eluting stents (DES) to prevent thrombotic complications. Current clinical guidelines recommend at least 6 to 12 months of treatment after a DES implantation, but it may be beneficial to apply dual antiplatelet therapy for a longer duration. Methods/design The optimal dual antiplatelet therapy (OPTIDUAL) study aims to compare the benefits and risks of dual antiplatelet therapy applied for either 12 or 48 months. We will examine the occurrence of major adverse cardiovascular and cerebrovascular events (MACCE) in patients undergoing percutaneous coronary intervention with DES for the treatment of coronary lesions. The OPTIDUAL study is an open-label multicenter, randomized, national trial that will include 1,966 patients treated with DES. All patients will be treated with dual antiplatelet therapy for 12 months (+/− 3). Then, patients with no MACCE or major bleeding will be randomized to receive either 36 additional months of clopidogrel plus aspirin or aspirin only. The primary end-point is the combination of death from all causes, myocardial infarction, stroke and major bleeding. The secondary end points include the individual components of the primary end-point, stent thrombosis, repeat revascularization of the treated vessel and minor bleeding. Discussion This randomized trial is designed to assess the benefits and safety of 12 versus 48 months of dual antiplatelet therapy in patients that receive a DES. We aim to determine whether substantial prolongation of clopidogrel (a thienopyridine) after DES implantation offers an advantage over its discontinuation. Trial registration ClinicalTrials.gov Identifier: NCT00822536
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Affiliation(s)
- Gérard Helft
- bd Vincent Auriol, Institut de Cardiologie, Hôpital Pitié-Salpétrière, Paris, France.
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Vochelet F, Tron C, Eltchaninoff H, Sebagh L, Tavildari A, Cribier A. [Immediate results and clinical follow-up of patients treated with drug eluting stents implantation in routine clinical practice]. Ann Cardiol Angeiol (Paris) 2006; 55:199-203. [PMID: 16922169 DOI: 10.1016/j.ancard.2006.01.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
Multiple recent randomized studies have demonstrated the superiority of drug eluting stents (DES) compared to bare stents for reduction of restenosis rates after angioplasty. We sought to study if the results obtained in these studies with highly selected patients could be translated to patients treated in routine clinical practice. To this end, we retrospectively reviewed hospital charts of 134 consecutive patients treated in our center with 202 DES implantation between November 2002 and January 2004. Thirty nine % of patients had diabetes and 59% had multivessel disease. Coronary lesions were often complex (type B2: 24%, type C: 35%). Mean percent diameter stenosis was 68 +/- 13% with a reference artery diameter of 2.62 +/- 0.5 mm. One patient (0.75%) died in-hospital from cardiogenic shock. At a mean follow-up of 12 +/- 2.6 months, 7 patients (5.3%) died, including 2 extracardiac deaths. Recurrent chest pain occurred in 16 patients (12%), with only 3 (2.3%) in-stent restenosis. Major adverse cardiac event rate was 8.2%. This study confirms that in a non-selected population, the rate of subsequent revascularization after DES implantation is very low. It can be hoped that the indications of implantations will progressively spread with a lowered cost of these DES.
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Affiliation(s)
- F Vochelet
- Service de cardiologie, hôpital Charles-Nicolle, 1, rue de Germont, 76000 Rouen, France
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Agatiello C, Eltchaninoff H, Tron C, Bauer F, Babaliaros V, Nercolini D, Sebagh L, Vochelet F, Tapiero S, Cribier A. [Balloon aortic valvuloplasty in the adult. Immediate results and in-hospital complications in the latest series of 141 consecutive patients at the University Hospital of Rouen (2002-2005)]. Arch Mal Coeur Vaiss 2006; 99:195-200. [PMID: 16618021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
UNLABELLED With the aging population, elderly patients with degenerative, severely calcified, and symptomatic aortic stenosis are becoming a frequent problem in medical decision making, particularly because many are declined for surgical valve replacement. For these patients, balloon aortic dilatation could be a palliative treatment. PATIENTS AND METHODS we analyzed retrospectively our techniques and complications during hospitalization for percutaneous aortic balloon dilatation in 141 consecutive patients (45% women, mean age 83 +/- 10 y) from January 2002 to April 2005. The Parsonnet's score was 41 +/- 8 and the Euroscore was 10 +/- 2. We excluded the patients enrolled for percutaneous aortic valve implantation. This technique was performed under local anesthesia, from retrograde or antegrade approach. Rapid pacing stimulation (220/bpm) with a pacing-lead placed in the right ventricle was performed during balloon inflation. RESULTS the aortic valve area was increased from 0.59 +/- 0.19 to 1.02 +/- 0.34 cm2 (p < 0.001) and the transvalvular mean gradient decreased from 49.3 +/- 21.2 to 22.2 +/- 11.8 mmHg (p < 0.001). Six patients (4%) died (3 during aortic valve dilatation) and 9 patients (6%) had non fatal complications: 2 transitory strokes, 8 non surgical vascular complications and 5 episodes of atrio-ventricular complete block (these complication were non exclusive). The patients were discharged at 5, 6 +/- 3 days. CONCLUSION In the hands of skilled operators, aortic percutaneous balloon dilatation has become a simple technique, associated with a low risk of complications despite a very ill patient population. This technique remains a good option for a number of patients before the onset of percutaneous aortic valve implantation.
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Affiliation(s)
- C Agatiello
- Hôpital Charles Nicolle, service de cardiologie, 1, rue de Germont, 76031 Rouen
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Gauliard E, Tavildari A, Eltchaninoff H, Tron C, Sebagh L, Vochelet F, Agatiello C, Baala B, Cribier A. [Intra-stent restenosis following implantation of a bare endoprosthesis]. Arch Mal Coeur Vaiss 2006; 99:13-8. [PMID: 16479884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
The aim of this retrospective study was to evaluate the immediate and long-term results of various treatments for patients with a primary lesion of intra-stent restenosis (ISR). The study included 214 patients (233 endoprostheses, site of a primary ISR), with an average age of 61+/-11 years. These patients had received one of the following treatments: balloon angioplasty alone (101 patients), implantation of a second endoprosthesis (32 patients), medical treatment (65 patients), or revascularisation surgery with aorto-coronary bypass (16 patients). After retrospective analysis of the initial data, clinical follow-up was studied for all patients, and severe cardiac events were recorded. The immediate treatment of the ISR with angioplasty or bypass had an initial success rate of 100%. At the end of follow up (26+/-1.8 months) for the series as a whole, 9 patients (4.1%) had died, 7 (3.2%) had suffered a myocardial infarction, and 22 (10.3%) had had to undergo a secondary revascularisation procedure. 111 (52%) patients had angiographic follow up. A second ISR was noted in 43 cases (39%). The type of treatment provided was not a predictive factor for the occurrence of a severe cardiac event. In conclusion, whatever treatment of ISR is used, the immediate result is satisfactory. The rate of severe cardiac events is acceptable and in 10.3% of cases necessitates a secondary revascularisation procedure within 2 years. The very promising recent development of new active endoprostheses could alter the management of coronary patients in the years to come.
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Affiliation(s)
- E Gauliard
- Service de cardiologie, hôpital Charles Nicolle, 1, rue de Germont, 76031 Rouen Cedex
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Vochelet F, Tron C, Eltchaninoff H, Sebagh L, Cribier A. [Treatment of acute myocardial infarction due to embolism by a thromboaspiration catheter]. Arch Mal Coeur Vaiss 2005; 98:263-6. [PMID: 15816332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
Although rare, coronary embolism poses a therapeutic problem. Thromboaspiration is an elegant alternative to implantation of a stent. The place of stenting in acute myocardial infarction depends on the results of randomised trials. The authors report the case of a 69 year old woman who presented with an apico-lateral infarction probably due to a coronary embolism after postoperative thrombosis of a mechanical mitral valve prosthesis. The authors performed a percutaneous revascularisation by thromboaspiration with a good result.
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Affiliation(s)
- F Vochelet
- Hôpital Charles Nicolle, Service de Cardiologie Rouen.
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Tron C, Eltchaninoff H, Bauer F, Agatiello C, Sebagh L, Nercolini D, Vochelet F, Cribier A. [Percutaneous correction of acquired aortic stenosis and mitral insufficiency in adults]. Ann Cardiol Angeiol (Paris) 2004; 53:234-8. [PMID: 15532447 DOI: 10.1016/j.ancard.2004.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Aortic stenosis and mitral regurgitation are the most common valvular diseases in western countries. Surgical treatment, aortic valve replacement or mitral valve repair, is the treatment of choice. Innovative technologies could offer an alternative therapeutic option to the patients with increased operative risk. This article will report the early experience with these promising techniques as presented at the High-Tech 2004 meeting.
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Affiliation(s)
- C Tron
- Service de cardiologie, hôpital Charles-Nicolle, 1, rue de Germont, 76000 Rouen, France.
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Eltchaninoff H, Tron C, Sebagh L, Cribier A. [Treatment of intrastent restenosis]. Pathol Biol (Paris) 2004; 52:218-22. [PMID: 15145135 DOI: 10.1016/j.patbio.2004.01.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2003] [Accepted: 01/28/2004] [Indexed: 04/29/2023]
Abstract
In-stent restenosis (ISR) remains an important limitation after stent implantation occurring in 20-30% of patients. Different techniques and treatments have been evaluated in this setting. Repeat balloon angioplasty alone has been rapidly followed by ablative techniques such as laser, rotational atherectomy or implantation of a second stent within the stent. Cutting balloon represents another alternative technique. None of these techniques has proven its superiority over plain balloon angioplasty alone. Brachytherapy is the only effective treatment for ISR by significantly decreasing recurrent restenosis rate at follow-up. However, its use is limited by cost and infrastructure associated with the risk of late thrombosis requiring prolonged antiplatelet therapy. Surgical treatment can be proposed in recurrent ISR as well as medical therapy alone in pauci-symptomatic patients. New drug-eluting stents are under evaluation in this indication.
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Affiliation(s)
- H Eltchaninoff
- Hôpital Charles-Nicolle, 1, rue de Germont, 76000 Rouen, France.
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Eltchaninoff H, Carlot R, Tron C, Sanchez-Giron C, Sebagh L, Agatiello C, Cribier A. Analysis of nonintervention strategy for in-stent restenosis in Pauci- or asymptomatic patients. Am J Cardiol 2004; 93:1038-40. [PMID: 15081452 DOI: 10.1016/j.amjcard.2004.01.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2003] [Revised: 01/03/2004] [Accepted: 01/05/2004] [Indexed: 11/20/2022]
Abstract
Between January 1996 and May 2000, we retrospectively identified 66 patients (61 +/- 11 years) with in-stent restenosis who did not undergo percutaneous coronary intervention and/or bypass surgery and were maintained on medical treatment alone. In-stent restenosis was diffuse or proliferative in 86% of these patients. At 33 +/- 11 months, 2 patients died, none developed myocardial infarction, and 6 (9%) had target lesion revascularization only (repeat percutaneous transluminal coronary angioplasty). Medical treatment alone was associated with a good long-term clinical follow-up in selected patients with significant documented in-stent restenosis.
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Bauer F, Eltchaninoff H, Tron C, Agatiello C, Sebagh L, Cribier A. 824-4 Echocardiographic findings in patients undergoing percutaneous aortic valve replacement. J Am Coll Cardiol 2004. [DOI: 10.1016/s0735-1097(04)91832-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Eltchaninoff H, Tron C, Bauer F, Agatiello C, Sebagh L, Nusimovici D, Cribier A. 1116-26 Early experience with percutaneous aortic valve implantation in patients with severe nonoperable aortic stenosis. J Am Coll Cardiol 2004. [DOI: 10.1016/s0735-1097(04)90105-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Cribier A, Eltchaninoff H, Tron C, Bauer F, Agatiello C, Sebagh L, Bash A, Nusimovici D, Litzler PY, Bessou JP, Leon MB. Early experience with percutaneous transcatheter implantation of heart valve prosthesis for the treatment of end-stage inoperable patients with calcific aortic stenosis. J Am Coll Cardiol 2004; 43:698-703. [PMID: 14975485 DOI: 10.1016/j.jacc.2003.11.026] [Citation(s) in RCA: 437] [Impact Index Per Article: 21.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVES This study was done to assess the results of percutaneous heart valve (PHV) implantation in non-surgical patients with end-stage calcific aortic stenosis. BACKGROUND Replacement of PHV has been shown to be feasible in animals and humans. We developed a PHV composed of three pericardial leaflets inserted within a balloon-expandable stainless steel stent. We report the acute and early follow-up results of the initial six PHV implantations. METHODS An anterograde approach was used in all cases. The PHV, crimped over a 22-mm diameter balloon, was advanced through a 24-F sheath from the femoral vein to the aortic valve and delivered by balloon inflation. Clinical, hemodynamic, and echocardiographic outcomes were assessed serially. RESULTS All patients were in New York Heart Association functional class IV. The PHV was successfully delivered in five patients. Early migration with subsequent death occurred in one patient who presented with a torn native valve. Acute hemodynamic and angiographic results showed no residual gradient, mild (three patients) or severe (two patients) aortic regurgitation, and patent coronary arteries. On echocardiography, the aortic valve area was increased from 0.5 +/- 0.1 cm(2) to 1.70 +/- 0.03 cm(2) and the aortic regurgitation was paravalvular. Marked and sustained hemodynamic and clinical improvement was observed after successful PHV implants. The first three patients died of a non-cardiac cause at 18, 4, and 2 weeks, respectively, and the other patients are alive at 8 weeks with no signs of heart failure. CONCLUSIONS Implantation of the PHV can be achieved in patients with end-stage calcific aortic stenosis and might become an important therapeutic option for patients not amenable to surgical valve replacement.
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Affiliation(s)
- Alain Cribier
- Department of Cardiology, Charles Nicolle Hospital, University of Rouen, Rouen, France.
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