Impact of drug-eluting stents on distal vessels.

MedStar author(s):
Citation: Circulation: Cardiovascular Interventions. 5(2):211-9, 2012 Apr.PMID: 22496083Institution: MedStar Heart & Vascular InstituteForm of publication: Journal ArticleMedline article type(s): Comparative Study | Journal Article | Multicenter Study | Randomized Controlled Trial | Research Support, Non-U.S. Gov'tSubject headings: *Blood Vessel Prosthesis Implantation | *Coronary Artery Disease/dt [Drug Therapy] | *Coronary Occlusion/dt [Drug Therapy] | *Drug-Eluting Stents/ae [Adverse Effects] | *Paclitaxel/ad [Administration & Dosage] | *Postoperative Complications/dt [Drug Therapy] | Aged | Coronary Artery Disease/pa [Pathology] | Coronary Artery Disease/su [Surgery] | Coronary Occlusion/pa [Pathology] | Coronary Occlusion/su [Surgery] | Female | Follow-Up Studies | Humans | Male | Middle Aged | Paclitaxel/ae [Adverse Effects] | Postoperative Complications/pa [Pathology] | Postoperative Complications/su [Surgery] | Ultrasonography, Interventional | Wound HealingYear: 2012Local holdings: Available online from MWHC library: 2008 - presentISSN:
  • 1941-7640
Name of journal: CirculationAbstract: BACKGROUND: Previous studies have not addressed vessel response >5 mm distal to the stent edge. Therefore, we investigated the impact of paclitaxel-eluting stents (PES) versus bare metal stents (BMS) on distal vessels in the serial intravascular ultrasound substudies of TAXUS IV, V, and VI.CLINICAL TRIAL REGISTRATION: URL: HTTP://WWW.CLINICALTRIAL.GOV. Unique identifiers: TAXUS IV: NCT00292474; TAXUS V: NCT00301522; TAXUS VI: NCT00297804.CONCLUSIONS: PES use was associated with plaque increase from baseline to 9-month follow-up >5 mm distal to the stent along with positive remodeling, whereas BMS use was associated with negative remodeling and no plaque increase. These vessel responses were consistent in 5-mm long subsegments: 0 to 5 mm versus 5 to 10 mm versus 10 to 15 mm distal to the stent.METHODS AND RESULTS: TAXUS IV, V, and VI were double-blind, randomized, multicenter, controlled trials comparing PES with BMS. In their intravascular ultrasound substudies, 103 patients (54 BMS, 49 PES) had intravascular ultrasound data >=10 mm distal to the stent both postprocedure and at 9 months follow-up. Baseline characteristics were similar between the 2 groups. Multilevel modeling was used to account for the variation between patients and within patients among distal segments. Effect of stent type, time, and their interaction was tested using a mixed effect model controlling for distal segments. Postprocedure lumen and vessel were not significantly different between PES versus BMS; however, lumen (P=0.006) and vessel (P=0.0001) were significantly reduced for BMS at 9-month follow-up but not for PES. Conversely, there was a significant plaque increase from postprocedure to 9-month follow-up for PES (P=0.0008) but not for BMS. These vessel responses were statistically consistent among 0- to 5-mm versus 5- to 10-mm versus 10- to 15-mm segments distal to the stent in both groups.All authors: Desale S, Ellis SG, Grube E, Laynez-Carnicero A, Mintz GS, Ormiston JA, Pakala R, Pichard AD, Romaguera R, Sardi G, Stone GW, Turco MA, Wakabayashi K, Waksman R, Weissman NJ, Xue ZFiscal year: FY2012Digital Object Identifier: Date added to catalog: 2013-09-17
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Item type Current library Collection Call number Status Date due Barcode
Journal Article MedStar Authors Catalog Article 22496083 Available 22496083

Available online from MWHC library: 2008 - present

BACKGROUND: Previous studies have not addressed vessel response >5 mm distal to the stent edge. Therefore, we investigated the impact of paclitaxel-eluting stents (PES) versus bare metal stents (BMS) on distal vessels in the serial intravascular ultrasound substudies of TAXUS IV, V, and VI.

CLINICAL TRIAL REGISTRATION: URL: HTTP://WWW.CLINICALTRIAL.GOV. Unique identifiers: TAXUS IV: NCT00292474; TAXUS V: NCT00301522; TAXUS VI: NCT00297804.

CONCLUSIONS: PES use was associated with plaque increase from baseline to 9-month follow-up >5 mm distal to the stent along with positive remodeling, whereas BMS use was associated with negative remodeling and no plaque increase. These vessel responses were consistent in 5-mm long subsegments: 0 to 5 mm versus 5 to 10 mm versus 10 to 15 mm distal to the stent.

METHODS AND RESULTS: TAXUS IV, V, and VI were double-blind, randomized, multicenter, controlled trials comparing PES with BMS. In their intravascular ultrasound substudies, 103 patients (54 BMS, 49 PES) had intravascular ultrasound data >=10 mm distal to the stent both postprocedure and at 9 months follow-up. Baseline characteristics were similar between the 2 groups. Multilevel modeling was used to account for the variation between patients and within patients among distal segments. Effect of stent type, time, and their interaction was tested using a mixed effect model controlling for distal segments. Postprocedure lumen and vessel were not significantly different between PES versus BMS; however, lumen (P=0.006) and vessel (P=0.0001) were significantly reduced for BMS at 9-month follow-up but not for PES. Conversely, there was a significant plaque increase from postprocedure to 9-month follow-up for PES (P=0.0008) but not for BMS. These vessel responses were statistically consistent among 0- to 5-mm versus 5- to 10-mm versus 10- to 15-mm segments distal to the stent in both groups.

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