Coronary lesions

The pivotal US trial for the Paclitaxel stent was the TAXUS IV trial, which enrolled 1,314 patients with single de novo coronary lesions (Length 10-28 mm and diameter 2.5-3.75 mm) [67] (Fig. 5.7). Target vessel revascularization based on ischemic symptoms was reduced from 12 to 4.7% p < 0.001). The rate of restenosis by angiography was considerable lower (7.9% versus 26.6% p < 0.001), with no difference in the rate of cardiac death, myocardial infarction, or stent thrombosis. 

Grube E, Silber S, Hauptmann KE, et al. Six and twelve-month results from a randomized, double blind tial on a slow-release Pachtaxel-eluting stent for de novo coronary lesion. Circulation 2003 107 38 2. 

Nesto RW, Waxman S, Mittleman MA, et al. Angioscopy of culprit coronary lesions in unstable angina pectoris and correlation of clinical presentation with plaque morphology. Am J Cardiol 1998 81 225-228. 

Waksman R, Ajani AE, Pichard AD, et al, Oral Rapamune to Inhibit Restenosis study, Oral rapamycin to inhibit restenosis after stenting of de novo coronary lesions the Oral Rapamune to Inhibit Restenosis (ORBIT) study, J Am Coll Cardiol 2004 44 1386-1392. 

Bullesfeld L, Gerckens U, Muller R, Grube E. Long-term evaluation of paditaxel-coated stents for treatment of native coronary lesions. First results of both the clinical and angiographic 18 month follow-up of TAXUS I. Z Kardiol 2003 92(l0) 825-832. 

Lansky AJ, Costa RA, Mintz GS, et al. Non-polymer-based paclitaxel-coated coronary stents for the treatment of patients with de novo coronary lesions angiographic followup of the DELIVER clinical trial. Circulation 2004 109(16) 1948-1954. 

Bloomington, Indiana, U.S.A.) coated with escalating doses of paclitaxel (0,2, 0,7, 1.4, and 2.7 jig/mm2 of stent surface area) applied directly to stent surface. In both trials, there was a dose-dependent effect on the angiographic parameters of restenosis (64). However, clinical outcomes at 6 and 12 months were not improved in these studies (65). The subsequent Drug ELuting coronary stent systems in the treatment of patients with de noVo nativE coronaRy lesions... 

The first human experience with a 17(3-estradiol-eluting stent was recently published (35). The Estrogen and Stents to Eliminate Restenosis (EASTER) trial was a single-center feasibility study testing l7(3-estradiol-eluting BiodivYsio stents in 30 patients with de novo coronary lesions. The purpose of the EASTER study was to evaluate the feasibility of 17(3-estra-diol-eluting stents to inhibit restenosis in humans. 

Serruys PW, Foley DR Suttorp M-J, et al. A randomized comparison of the value of additional stenting after optimal balloon angioplasty for long coronary lesions. J Am Coll Cardiol 2002 39 393-399. 

Shimokawa, H., Morishige, K., Miyata, K., Kandabashi, T., Eto, Y., et al. 2001. Long-term inhibition of Rho-kinase induces a regression of arteriosclerotic coronary lesions in a porcine model in vivo. Cardiovasc. Res. 51 169-177. 

Rats, rabbits, or female rhesus monkeys exposed to 0, 17, 33, 66,100, or 220 ppm methyl bromide 7-8 h per day, 5 days per week for 6 months exhibited mortality in rats and monkeys at 100 ppm. Rabbits showed mortality at 33 ppm. Severe effects, including paralysis, were seen after exposure to 66 ppm in rabbits and monkeys. No signs of overt toxicity were noted at 17 ppm. Other studies have shown focal lesions in the brain and heart in rats after inhalation of 150 ppm methyl bromide (4h per day, 5 days per week for 11 weeks). Rats exposed to 0, 200, 300, or 400 ppm methyl bromide (4h per day, 5 days per week for 6 weeks) exhibited coronary lesions and exposures of 300 ppm or greater resulted in neurologic dysfunction including ataxia and paralysis. Testicular atrophy was noted at 400 ppm. 

Diderholm E, Andren B, Frostfeldt G et al. ST depression in ECG at entry indicates severe coronary lesions and large benefits of an early invasive treatment strategy in unstable coronary artery disease the FRISC II ECG substudy. The fast revascularisation during instability in coronary artery disease. Eur Heart J 2002 23 41. 

A combination of bile acid sequestrants with nicotinic acid or probucol or an HMG-CoA reductase inhibitor can be used to produce synergistic effects in lowering plasma lipoprotein levels, particularly LDL. The efficacy of drug treatment was shown in a recent study in which lovas-tatin and colestipol were used to reduce cholesterol levels in men with CHD. The rate of progression of coronary lesions was decreased and that of regression increased. These changes also were associated with reduced cardiovascular abnormalities. 

In summary, the failure of medical therapy, a history of recent MI (<3 months), demonstration of significant inducible ischemia, detection of unequivocally reduced fractional flow reserve, or the presence of specific angiographic features of coronary stenoses should guide utilization of PCI in patients with stable coronary lesions (8). 

Pan M, de Lezo JS, Medina A, et al. Rapamycin-eluting stents for the treatment of bifurcated coronary lesions a randomized comparison of a simple versus complex strategy. Am Heart J 2004 148 (5) 857—64. 

As previously discussed, ejection fraction remains the most important prognostic marker, and echocardiography is perhaps the most widely used tool for its assessment. In addition to this finding, however, echocardiography can also assess the functional importance of coronary lesions by evaluating for inducible regional wall motion abnormalities or even global left ventricular dysfunction. 

Since the first report of coronary angioplasty by Gruentzig, et al. in 1987, percutaneous coronary intervention (PCI) has become the most common revascularization procedure for occluded coronary artery disease [3]. The procedure provided a novel technique to expand the stenotic coronary lesion with a balloon catheter and thereby relieve the myocardial ischemia, which was only treated by coronary artery bypass graft surgery prior to the discovery of this technique. 

Weisz, G., Leon, M.B., Holmes, D.R., et al. Two-year outcomes after sirolimus-Eluting stent implantation results from the sirolimus-Eluting in de Novo Native Coronary Lesions (SIRIUS) trial. J. Am. Coll. Cardiol. 47, 1350-1355 (2006)... 

Costantini C R, Londero H, DeScheeder I,Tarbine S G, Costantini C O, Cabrera MJ, Santos M F, Darwich R Z, Maranhao M C, Bubna M, Andrade M S and Yared A (2005), Final results and two year outcomes of a trial assessing a nitric oxide preserver polymer-coated stent implantation in De Novo Coronary lesions clinical, angiographic, and stent volumetric analysis from NOBLESSE trial. Am J Cardiol, 96(suppl 7A), 39H. 

Mean regression of coronary lesions in intensively treated groups vi. progression in control group (P< 0.003) clinical events reduced by 73% (P<0.05)... 

Angiographic regression of coronary lesions with niacin-statin combination therapy (P<0.001 vs. placebo) clinical events reduced by 70% (P=0.03)... 

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