Stent selection

PCI was performed using standard techniques (6,30). All 100 patients received one or more identical close cell-stent design. The same stent design was used in order to avoid potential bias with stent selection in both groups. All patients received 325 mg/day of aspirin indefinitely and clopidogrel as a loading dose of 300 mg on the day of the procedure and 75 mg/day thereafter for one month. Statins were given to all patients indefinitely. 

The cholangiographic findings during ERCP should be used to aid stent selection. The length of the chosen stent should be based on measurements obtained with a ruled catheter or wire that can be pulled through the stricture (Seibert 1997). Ideally, plastic stents should completely span the stricture and protrude 1-2 cm from the ampulla. Performance of a biliary sphincterotomy prior to stent placement may reduce the incidence of acute pancreatitis in patients who have a proximal stricture of the bile duct (Tamsky et al. 1997). Other reports suggest that the routine use of biliary sphincterotomy increases the duration of the procedure as well as the complication rate (Margulies et al. 1999). 

Seibert DG (1997) Biliary stricture measurement and stent selection. Am J Gastroenterol 92 1510-1514 Seitz U, Vadeyar H, Soehendra N (1994) Prolonged patency with a new-design Teflon biliary prosthesis. Endoscopy 26 478-482... 

Srivatsa SS, Tsao P, Holmes DR et al (1997) Selective av(33 integrin blockade limits neointima hyperplasia and lumen stenosis in stented porcine coronary artery injury in Pig. Cardiovasc Res 36 408-428... 

Percutaneous coronary intervention (PCI) such as coronary angioplasty and stent implantation has become a worldwide routine strategy for coronary arterial occlusive diseases. Along with the recognition that thrombus formation is very likely to be involved in acute coronary syndrome (ACS), selection of the optimal anticoagulant is becoming essential to achieve reliable anticoagulation for successful PCI. 

The major advantages of the systemic approach to restenosis should be the relatively inexpensive and also powerful and safety method to reduce restenosis in selected group of patients. Oral rapamycin can also be used in determining high risk subsets of patients such as those with diabetes, bifurcations, and in-stent restenotic lesions, alone or in conjunction with DES. In insulin-dependant diabetic patients, oral rapamycin together with DES may help to reduce the still higher than acceptable risk of restenosis that is currently reported with DES. 

Inflammatory response after stent implantation plays an important role in the cascade of neointimal formation. A positive correlation between inflammatory reaction and restenosis has been observed (16). Perivasculitis caused by stent deployment also participates in the neointimal formation (17). Corticosteroids, as an anti-inflammatory agent, have been evaluated. Methylprednisolone (MP)-loaded stents with different doses showed a positive dose-related effect on neointimal hyperplasia (18). Furthermore, MP-coated stents showed decreased macrophages at the stented sites (19). In clinic, dexamethasone-coated stents showed an inhibitive effect on neointimal hyperplasia in selected patients (20), although no beneficial effect was observed in a randomized trial compared to bare stents (21). For other type of drugs with anti-inflammatory characteristics, such as ibuprofen, colchicine, aton/astatin, and probucol, no favorable effects on neointimal hyperplasia were observed (18,22,23). 

Rogers CDK, Drug-eluting stents role of stent design, delivery vehicle, and drug selection. Rev Cardiovasc Med 2002 3 SI 0-SI 5. 

A total of five animal studies, ranging from five days to three months implantation, have been conducted with the batimastat-loaded Biod/VYs/o Stent (Fig. 2). A summary of the preclinical studies is shown in Table 2. In all the animal studies, batimastat was loaded on either the Biod/VYs/o AS or OC stents since these stents are more applicable to the vessel size of the selected animal models. 

One hundred and seventy-three patients (134 males and 39 females), symptomatic patients with stable angina pectoris (Canadian Cardiovascular Society I, 2, 3, or 4) or unstable angina pectoris with documented ischaemia (Braunwald Class IB-C, IIB-C, or IIIB-C) or documented ischemia with a single de novo lesion in a coronary artery suitable for treatment with a single BiodivYsio DD OC-coated coronary stent preloaded with Batimastat of I 1, 15, 18, 22, or 28 mm length by 3.0, 3.5, or4.0-mm diameter were included in the study, providing they met the selection criteria. 

Li CW, Cantor WJ, Robinson R, etal. Matrix metalloproteinase inhibitor GM600I selectively reduces intimal hyperplasia and intima collagen in stented but not balloon treated arteries. Can J Cardiol 2000 16(suppl F) I43E... 

With the ongoing refinement of endovascular devices and techniques for carotid revascularization, catheter-based therapy has become technically feasible in most patients. Notwithstanding, appropriate case selection is required to ensure procedural safety, Here within we review new concepts pertaining to patient selection and technical procedural considerations that we consider crucial for enhancing clinical outcomes following carotid stenting,... 

Though randomized trial data are not available, some have suggested that in symptomatic patients stents of the closed cell design might afford superior clinical outcome (60). Clearly, such observational data must be considered hypothesis generating and further research is necessary before device design can be selected based upon clinical and/or angiographic features. 

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