Sirolimus-Eluting stents

At least 2 to 3 months for sirolimus-eluting stent placement. 

For patients undergoing PCI and receiving stents, the recommended dose is 325 once daily for at least 30 days with bare metal stents, for 3 months with a sirolimus-eluting stent, and for 6 months with a paclitaxel-eluting stent, followed by 75 to 162 mg once daily thereafter. 

Morice MC, Serruys PW, Sousa JE, et al. A randomized comparison of a sirolimus-eluting stent with a standard stent for coronary revascularization. N Engl J Med 2002 346 1773-1780. 

Rapamycin (sirolimus), a macrolide antibiotic, has been used recently in organ transplantation for its potent immunosuppressive actions by inhibiting both cytokine mediated and growth factor mediated proliferation of smooth muscle cells and lymphocytes [55, 56]. In the RAVEL trial of non-acute single vessel lesions, the Sirolimus-eluting stent was compared to bare metal stent (BMS) in a 1 1 fashion [57]. One-year major adverse cardiovascular events and 6 month neointimal proliferation as assessed by late luminal loss (-0.01 0.33 mm in Sirolimus stent versus 0.80 0.53 mm in BMS) were improved. The Sirolimus-eluting stent thus virtually eliminated in-stent restenosis with no evidence of edge effect, dissection, or in-stent thrombosis. 

Holmes DR Jr, Leon MB, Moses JW, Popma JJ, Cutlip D, Fitzgerald PI, Brown C, Fischell T, Wong SC, Midei M, Snead D, Kuntz RE. Analysis of 1-year clinical outcomes in the SIRIUS trial a randomized trial of a sirolimus-eluting stent versus a standard stent in patients at high risk for coronary restenosis. Circulation. 2004 Feb 10 109(5) 634-40. 

Moses J, Leon M, Popma J, et al. Sirolimus-eluting stents versus standard stents in patients with stenosis in a native coronary artery. N Engl J Med 2003 349 1315-1323. 

Sirolimus has also been used in the production of sirolimus-eluting stents. These stents are used to treat obstructive coronary arteries. The rationale for the use of sirolimus in these stents is due to its antiproliferative activity. It has also received attention for cancer treatment due to its antiproliferative effects. In animal studies, sirolimus has shown some potential in the treatment of cancer where in combination with doxorubicin, a remission for Akt-positive lymphomas has been observed. 

Schluter M, Schofer J. Direct stenting with sirolimus-eluting stents. Am Heart HospJ. 2005 3 182-186, 192. 

Kotani J, Awata M, Nanto S, et al. Incomplete neointimal coverage of sirolimus-eluting stents Angioscopic findings. J Am Coll Cardiol 2006 47 2108-2111. 

Recent studies have demonstrated evidence for coronary endothelial dysfunction after drug-eluting stenting, logni et al. (77) studied coronary endothelial function in 25 patients six months after stent deployment and found paradoxic exercise-induced vasoconstriction in coronary segments adjacent to sirolimus-eluting stents, but vasodilation in patients with bare-metal stents. Similarly, Hofma et al. (78) noted a pronounced... 

Togni M, Windecker S, Cocchia R, et al, Sirolimus-eluting stents associated with paradoxic coronary vasoconstriction. J Am Coll Cardiol 2005 46 23 1-236. 

Hofma SH, van der Giessen WJ, van Dalen BM, et al. Indication of long-term endothelial dysfunction after sirolimus-eluting stent implantation. Eur Heart J 2006 27 166-170. 

SousaJE, Costa MA, Abizaid AC, et al, Sustained suppression of neointimal proliferation by sirolimus-eluting stents. One-year angiographic and intravascular ultrasound follow-up. Circulation. 2001 104 2007-201 I. 

Schampaert E, Cohen EA, Schluter M, et al. The Canadian study of the sirolimus-eluting stent in the treatment of patients with long de novo lesions in small native coronary arteries (C-SIRIUS). J Am Coll Cardiol 2004 43 1 I 10-1 I 15. 

Schofer J, Schluter M, Gershlick AH, et al. Sirolimus-eluting stents for treatment of patients with long atherosclerotic lesions in small coronary arteries. Double-blind, randomized controlled trial. (E-SIRIUS). Lancet 2003 362 1093-1099. 

Virmani R, Guagliumi G, Farb A, et al. Localized Hypersensitivity and late coronary thrombosis secondary to a sirolimus-eluting stent. Should we be cautious Circulation 2004 109 701-705. 

Lemos PA, Lee CH, Degertekin M, etal. Early outcome after sirolimus-eluting stent implantation in patients with acute coronary syndromes insights from the Rapamycin-Eluting Stent Evaluated At Rotterdam Cardiology Hospital (RESEARCH) registry, J Am Coll Cardiol 2003 41(1 l) 2093-2099. 

Sousa JE, Costa MA, Farb A, et al. Images in cardiovascular medicine, Vascular healing 4 years after the implantation of sirolimus-eluting stent in humans a histopathological examination, Circulation 2004 I 10( I ) e5—e6. 

Klugherz BD, Lianos G, Lieuallen W, et al. Dose-dependent inhibition of neointimal formation using a sirolimus-eluting stent [abstr], Eur HeartJ 2000 2l(suppl) 283. 

Klugherz BD, Llanos G, Lieuallen W, et al. Twenty-eight-day efficacy and pharmacokinetics of the sirolimus-eluting stent. Coron Artery Dis 2002 13(3) 183-188. 

Carter AJ, Aggarwal M, Kopia GA, et al. Long-term effects of polymer-based, slow-release, sirolimus-eluting stents in a porcine coronary model. Cardiovasc Res 2004 63(4) 617-624. 

Rensing BJ, Vos J, Smits PC, et al. Coronary restenosis elimination with a sirolimus eluting stent first European human experience with 6-month angiographic and intravascular ultrasonic follow-up. Eur Heart J 2001 22(22) 2125-2130. 

Hoye A, Tanabe K, Lemos PA, et al. Significant reduction in restenosis after the use of sirolimus-eluting stents in the treatment of chronic total occlusions. J Am Coll Cardiol 2004 43(1 I) 1954-1958. 

Kwok OH, Chow WH, Law TC, et al. First human experience with angiopeptin-eluting stent a quantitative coronary angiography and three-dimensional intravascular ultrasound study. Catheter Cardiovasc Interv2005 66(4) 54l-546. Nakamura M, Wada M, Hara H, et al. Angiographic and clinical outcomes of a pharmacokinetic study of sirolimus-eluting stents lesson from restenosis cases. Circ J 2005 69(10) ... 

Randomized comparison of sirolimus-eluting stent versus standard stent for percutaneous coronary revascularization in diabetic patients the diabetes and sirolimus-eluting stent (DIABETES) trial. Circulation 2005 112(14) ... 

Commeau R Barragan PT Roquebert PO, Simeoni JB. ISR II study a long-term evaluation of sirolimus-eluting stent in the treatment of patients with in-stent restenotic native coronary artery lesions. Catheter Cardiovasc Interv 2005 66(2) 158-162. 

Voudris V Alexopoulos E, Karyofillis R et al. Prospective native coronary artery stenosis treated with sirolimus-eluting stent (ONASSIS) registry—acute results and mid-term outcomes a single-center experience. J Invasive Cardiol 2005 17(8)401-405. 

Hofma SH, Ong AT Aoki J, et al. One year clinical follow up of paclitaxel eluting stents for acute myocardial infarction compared with sirolimus eluting stents, Heart 2005 91 (9) I 176-1 180. 

Ge L, lakovou I, Cosgrave J, et al. Immediate and mid-term outcomes of sirolimus-eluting stent implantation for chronic total occlusions. Eur HeartJ 2005 26(1 I) 1056-1062,... 

Polymers used in the CYPHER sirolimus-eluting stent... 

Polymers used in the CYPHER sirolimus-eluting stent. Abbreviations PBMA, poly-n-butyl methacrylate PEVA, polyethylene-co-vinyl acetate. 

PCI, percutaneous coronary intervention PES, paclitaxel-eluting stent PTCA, percutaneous transluminal coronary angioplasty FTCA balloon angioplasty rotational atherectomy directional atherectomy, or excimer laser angioplasty SES, sirolimus-eluting stent. 

Holmes DR, Teirstein R Satlet L, et al, Sirolimus-eluting stents vs vascular brachytherapy for in-stent restenosis within bare-metal stents the SISR randomized trial. JAMA 2006 295 1264-1273. 

Cordis Corporation. A Multi-Center, Non-Randomised Study of the CYPHER Sirolimus-Eluting Stent in the Treatment of Patient With an in-Stent Restenotic Native Coronary Artery Lesion (TROPICAL Study), 2006. 

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