Stent implantation

Percutaneous coronary intervention (PCI) is one of a host of techniques performed by using a catheter inserted via a major limb artery that aims to relieve nanowing of coronary arteries. For example, percutaneous transluminal coronary angioplasty (PTCA) is the classic PCI that uses a catheter-directed balloon to dilate a stenotic coronary artery, and more recent PCIs include stent implantation, rotational atherectomy, and laser angioplasty. 

Clopidogrel should be considered for most patients, but the duration of therapy is individualized according to the type of ACS and whether the patient is treated medically or undergoes stent implantation. 

As mentioned, Fukuda et al. (46) have recently shown that circulating monocytes count increased and reached its peak two days after human stent implantation (from 350 167 to 515 149/mm ). These data support the correlation between monocytes depletion and prevention of restenosis. Inactivation of systemic monocytes immediately after injury suppresses... 

Betriu A, Masotti M, Serra A, et al. Randomized comparison of coronary stent implantation and balloon angioplasty in the treatment of de novo coronary artery lesions (START) a four-year follow-up. J Am Coll Cardiol 1999 34 1498-1506. 

Angiolillo DJ, Sabata M, Alfonso F, Macaya C. Candy wrapper effect after drug-eluting stent implantation Deja vu or stumbling over the same stone again. Cath Cardiovasc Interv 2004 61 387-391. 

Inoue T, Sohma R, Miyazaki T, Iwasaki Y, Yaguchi I, Morooka S. Comparison of activation process of platelets and neutrophils after coronary stent implantation versus balloon angioplasty for stable angina pectoris. Am J Cardiol 2000 86 1057-1062. 

Fukuda D, Shimada K, Tanaka A, Kawarabayashi T, Yoshiyama M, Yoshikawa J. Circulating monocytes and in-stent neointima after coronary stent implantation. J Am Coll Cardiol 2004 43 18-23. 

Kollum M, Kaiser S, Kinscherf R, Metz J, Kubler W, Hehrlein C. Apoptosis after stent implantation compared with balloon angioplasty in rabbits. Role of macrophages. Arterioscler Thromb Vase Biol 1997 17 2383-2388. 

Feldman LJ, Mazighi M, Scheuble A, et al. Differential expression of matrix metalloproteinases after stent implantation and balloon angioplasty in the hypercholesterolemic rabbit. Circulation 2001 103 3117-3122. 

Feldman LJ, Aguirre L, Ziol M, et al. Interleukin-10 inhibits intimal hyperplasia after angioplasty or stent implantation in hypercholesterolemic rabbits. Circulation 2000 101 908-916. 

Rogers C, Edelman ER, Simon DI. A mAb to the beta2-leukocyte integrin Mac-1 (CDllb/CD18) reduces intimal thickening after angioplasty or stent implantation in rabbits. Proc Natl Acad Sci USA 1998 95 10134—10139. 

Walter DH, Fichtlscherer S, Sellwig M, Auch-Schwelk W, Schachinger V, Zeiher AM. Preprocedural C-reactive protein levels and cardiovascular events after coronary stent implantation. J Am Coll Cardiol 2001 37 839-846. 

Zairis MN, Ambrose JA, Manousakis SJ, et al. The impact of plasma levels of C-reactive protein, lipoprotein (a) and homocysteine on the long-term prognosis after successful coronary stenting the Global evaluation of new events and restenosis after stent implantation study. J Am Coll Cardiol 2002 40 1375-1382. 

Versaci F, Gaspardone A, Tomai F, et al. Immunosuppressive therapy for the prevention of restenosis after coronary artery stent implantation (IMPRESS Study). J Am Coll Cardiol 2002 40 1935-1942. 

Serruys PW, de Jaegere P, Kiemeneij F, et al., for the BENESTENT study group. A comparison of balloon-expandable stent implantation with balloon angioplasty in patients with coronary artery disease. N Engl J Med 1994 331 489 95. 

Grines CL, Cox DA, Stone GW, et al. Coronary angioplasty with or without stent implantation for acute myocardial infarction. N Engl J Med 1999 341 1949-1956. 

Stone GW, Ellis SG, Colombo A, Dawkins KD, Grube E, Cutlip DE, Friedman M, Bairn DS, Koglin J. Offsetting impact of thrombosis and restenosis on the occurrence of death and myocardial infarction after paclitaxel-eluting and bare metal stent implantation. Circulation 2007 Jun 5 115(22) 2842-2847. 

Eisenstein EL, Anstrom KJ, Kong DF, et al. Clopidogrel use and long-term clinical outcomes after drug-eluting stent implantation. JAMA 2007 297 159-168. 

Some patients seem to have an inherent genetic susceptibility to restenosis following coronary stent implantation. Research has shown that patients homozygous for the deletion D) allele of angiotensin converting enzyme ACE) gene polymorphism lack functional enzyme and are at increased risk. These patients have ele-... 

The ACE gene insertion/deletion (ED) polymorphism was characterized in 345 patients who were undergoing coronary stenting. Among them, 115 had the DD genotype. The investigators assigned 91 of these patients to quinapril 40 mg daily or placebo. Treatment was initiated within 48 hours after stent implantation and continued for 6 months. 

Thus, clopidogrel (LD300 mg + 75 mg/day for one month) is the standard of care after bare metallic stent implantation. 

P-selectin in patients undergoing coronary stent implantation. Am HeartJ 2002 143 1 18-123. 

Van Belle E, McFadden EP Lablanche JM, Bauters C, Hamon M, Bertrand ME. Two-pronged antiplatelet therapy with aspirin and ticlopidine without systemic anticoagulation an alternative therapeutic strategy after bailout stent implantation. Coron Artery Dis I 995 6 341-345. 

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. 

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. 

Suzuki S, Sakamoto S, Koide M, etal. Effective anticoagulation by argatroban during coronary stent implantation in a patient with heparin-induced thrombocytopenia. Thromb Res 1997 88 499-502. 

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. 

Walter DH, Schachinger V Eisner M, Mach S, Auch-Schwelk W, Zeiher AM. Effect of statin therapy on restenosis after coronary stent implantation. Am J Cardiol 2000 85 962-968. 

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