Intracoronary stent

GPIIb/IIIa antagonists have to be administered parenterally. They are currently used prophylactically during intracoronary interventions such as percutaneous transluminal revascularization with balloon angioplasty or intracoronary stenting, as well as to treat acute coronary syndromes like unstable angina and acute myocardial infarction. The main complications... 

Clopidogrel is indicated for prevention of vascular ischaemic events in patients with symptomatic atherosclerosis. It is also used, along with aspirin, for the prevention of thromboembolism after placement of an intracoronary stent. Platelet inhibition can be demonstrated two hours after a single dose of oral clopidogrel, but the onset of action is slow, so that a loading-dose is usually administered. Although rare, severe neutropenia and also thrombotic thrombocytopenic purpura may occur. 

I 5 Kastrati A, Mehilli J, Schuhlen H, et al. Intracoronary stenting and antithrombotic regimen-rapid eariy action for coronary treatment study investigators. A clinical trial of abciximab in elective percutaneous coronary intervention after pretreatment with clopidogrel. N Engl J Med 2004 350 232-238. 

Karrillon GJ, Morice MC, Benveniste E, et al. Intracoronary stent implantation without ultrasound guidance and with replacement of conventional anticoagulation by antiplatelet therapy. 30-day clinical outcome of the French Multicenter Registry. Circulation I 996 94 1 51 9-1 527. 

Urban P Macaya C, Rupprecht HJ, et al. Randomized evaluation of anticoagulation versus antiplatelet therapy after coronary stent implantation in high-risk patients the multicenter aspirin and ticlopidine trial after intracoronary stenting (MATTIS). Circulation 1998 98 2126-2132. 

Lee CW, Chae J K, Lim HY Prospective randomized trial of corticosteroids for the prevention of restenosis after intracoronary stent implantation. Am Heart J 1999 138 60-63. 

Mehran R, Aymong ED, Ashby DT et al. Safety of an aspirin-alone regimen after intracoronary stenting with a heparin-coated stent final results of the HOPE (HEPACOAT and an Antithrombotic Regimen of Aspirin Alone) study. Circulation 2003 108(9) 1078-1083. 

De Scheerder I, Wang K, Wilczek K, et al, Local methylpred-nisolone inhibition of foreign body response to coated intracoronary stents, Coronary Artery Dis 1996 7 161-166. Baker J, Nikolaychik V Zulich A, et al, Fibrin coated stents as depot to deliver RGD peptide inhibit vascular reaction in atherosclerosis rabbit model [abstr], J Am Coll Cardiol I 996 27 197A,... 

Klugherz BD, Lianos G, Lieuallen W, et al. Intramural kinetics of sirolimus eluting from an intracoronary stent [abstr]. Circulation 2000 102(18) ll-733. 

Scott NA, Candal FJ, Robinson KA, et al. Seeding of intracoronary stents with immortalized human microvascular endothelial cells. Am Heart J 1995 129 860-866. 

Klugherz BD, Chen w, Jones PL, et al. Successful gene transfer to the arterial wall using a DNA-eluting polymer-coated intracoronary stent in swine [abstr], Eur Heart J 1999 20 367. 

Ahmed JM, Mintz GS, Weissman NJ, et al, Mechanism of lumen enlargement during intracoronary stent implantation an intravascular ultrasound study. Circulation 2000 102 7-10. 

Intracoronary stenting and antithrombotic regimen is abciximab a superior way to eliminate elevated thrombotic risk in diabetics. Abbreviations MI, myocardial infarction ... 

Singh M, Lennon Ryan J, Darbar D. Effect of peripheral arterial disease in patients undergoing percutaneous coronary intervention with intracoronary stents. Mayo Clin Proc 2004 79(9) I I 13-1 I 18. 

Kastrati A, Mehilli J, Dirschinger J, et al. Intracoronary Stenting and Angiographic Results Strut Thickness Effect On Restenosis Outcome (ISAR-STEREO) trial. Circulation 2001 103 2816-2821. 

Schuhlen H, Kastrati A, Pache J, et al. Sustained benefit over four years from an initial combined antiplatelet regimen after coronary stent placement in the ISAR trial. Intracoronary Stenting and Antithrombotic Regimen. Am J Cardiol 2001 87 397- 00. 

Since the proximate cause of MI is intracoronary thrombosis, reperfusion therapies are critically important, employing, when possible, direct percutaneous coronary interventions (PCIs) for acute MI, usually using drug-eluting intracoronary stents. Thrombolytic agents are administered at hospitals where emergency PCI is not performed, but outcomes are better with direct PCI than with thrombolytic therapy. 

The development of novel and powerful antiplatelet agents has improved outcomes after PCI. In the CADILLAC trial, the use of a glycoprotein Ilb-IIIa inhibitor improved outcome in those treated with either balloon angioplasty or an intracoronary stent (21). Similarly, treatment with clopidogrel, a thienopyridine, decreases the incidence of adverse events after PCI (22,23). Neither thienopyridines nor glycoprotein Ilb-IIIa antagonists were available at the time the early trials designed to test the potential clinical efficacy of a combined approach were performed. 

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