Textbook of Coronary Stenting
- 1st Edition
- Authors: Martin B. Leon, Gregg W. Stone
- Language: English
Coronary stenting is the most dynamic area of interventional cardiology, producing highly effective results with minimal patient problems. Drs Stone and Leon have gathered the… Read more
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Coronary stenting is the most dynamic area of interventional cardiology, producing highly effective results with minimal patient problems. Drs Stone and Leon have gathered the leading contributors in the world to produce the textbook reference to stenting. This book approaches the use of stents by explaining the science and clinical trial results of each stent type, their purpose and best practice patient management results. Approaches to complex problems are addressed in a special section on Controversies, including details of a variety of approaches and outcomes. This book is a must for the practicing interventionalist!
Foreword.
Coronary Stents - A Breakthrough Technology
Section I. The History of Coronary Stent Development: From Concept to Widespread Acceptance
1. Advantages and limitations of balloon angioplasty
2. The Schneider Self-Expanding Wallstent
I. From developmental concepts to the first human implant-
II. Early clinical experiences - lessons learned and challenges to overcome
3. Development of the Cook Gianturco-Roubin-I Stent
4. Clinical studies with the Gianturco-Roubin-I stent in acute and threatened closure and in de novo lesions
5. Development of the Johnson and Johnson Interventional Systems Palmaz and Palmaz-Schatz Stents
6. Clinical studies with the Palmaz-Schatz StentI. The BENESTENT I Trial. The STRESS Trials
7. The corporate journey to bring the Palmaz-Schatz stent to market
8. A chronicle of the regulatory process of stent approval
9. Widespread acceptance of stents
I. Enhanced deliverability and the reduction of subacute thrombosis
II. Proof of superiority vs. PTCA in randomized controlled trials
III. Durable long-term clinical and angiographic results
10. The cost-effectiveness of coronary stents
Section II. Evolution of the Metallic Stent: From Bench to Bedside
1. Design methodology and animal models to evaluate stent performance
2. Impact of metallic stent composition and configuration on thrombogenesity and neointimal
3. Importance of stent geometry, the stent-host interface, and manufacturing processes on stent thrombosis and restenosis
4. Healing responses to coronary stents: insights from human necropsy studies
5. Impact of strut thickness and stent design on early and late outcomes of coronary stenting
6. Factors influencing stent performance: radial strength, visibility, side branch access, trackability, shortening.
7. Stainless steel stents I: The JJIS/Cordis line
8. Stainless steel stents II: The Guidant line
9. Stainless steel stents III: The Boston Scientific/Schneider/Medinol line
10. Stainless steel stents IV: The Medtronic/AVE/USCI line
11. Stainless steel stents V: The Cook line
12. Stainless steel stents VI: The Abbot/Biocompatibles line
13. The stent vs. stent randomized controlled trials
14. Other stainless steel stents available outside the U.S. and in development
15. Self-expanding and nitinol based stents: The Radius, Wallstent and PAS stents
16. Gold coated stents
17. Cobalt-chrome - the next generation metallic stent platform
18. Beyond metallic stents - Development of bioerodable platforms
Section III. Technical Aspects and Guidance of Coronary
1. Selection and use of guide catheters and guide wires to facilitate stent delivery
2. Direct stenting (without pre-dilatation): pros and cons
3. The evolution of stent technique: high pressure, optimal sizing, IVUS guidance and anticoagulation
4. Debulking prior to stent implantation: rationale and
5. Utility of IVUS during coronary stenting
I. Insights into the mechanisms of stent thrombosis and restenosis
II. Observational and randomized trials of IVUS guided stenting
6. Physiologic lesion assessment during coronary stenting
I: Evaluation of borderline lesions
II: Assessment of procedural outcomes
III: Provisional stenting
7. Pharmacologic considerations for optimal stenting
I: Aspirin, thienopyridines, lipid lowering agents, etc
II: Procedural anticoagulation (UFH, LMWH, direct anti-thrombins
III: Glycoprotein IIb/IIIa inhibitors
8. Common and unusual roadblocks arising during stenting (and solutions): 1-800-FIX-A-STENT
9. Vascular access considerations: the radial, brachial and femoral approaches
10. Arteriotomy site hemostasis: from manual compression to the spectrum of closure devices
Section IV. Complications of Coronary Stenting
1. Success and complications after coronary stenting: historical overview and evolution (the NHLBI and other registries
2. Procedural and angiographic complications
I. Edge dissections, no-reflow, and acute and side branch compromise
II. Coronary artery perforation
III. Hemodynamic collapse and cardiac arrest
IV. Lost and displaced stents and angioplasty equipment
3. Peri-procedural myonecrosis and myocardial infarction
4. Subacute stent thrombosis
I. Incidence, predictors, presentation and treatment
II. Impact of optimal stent implantation and adjunct pharmacotherapy
5. Post procedural complications
I. Vascular and hemorrhagic complications
II. Contrast induced renal insufficiency
III. Hematologic complications
6. Radiation exposure and toxicity in the cardiac catheterization laboratory
Section V. Lesion-specific Stenting: Technique and
1. Differentiating complex vs. high-risk coronary intervention
2. Stenting for acute and threatened closure after PTCA: Comparison with elective
3. Bifurcation stenting
I. French analysis and approach
II. Italian analysis and approach
4. Ostial lesion stenting
5. Small vessel stenting
6. Stenting long lesions and diffuse disease
7. Stenting calcified
8. Multivessel stenting: approach, observational data and randomized controlled trials of stents vs. surgery
9. Recanalization and stenting of chronic total
10. Left main stenting - protected and unprotected
11. Stent implantation in the thrombotic lesion
12. Stenting of bypass graft conduits
I. Saphenous vein and arterial bypass graft stenting
II. Distal protection during saphenous vein graft
Section VI. Patient-specific Stenting: Technique and
1. Gender specific considerations for stenting in acute and chronic coronary artery disease
2. Stenting in the elderly
3. Stenting in the patient with diabetes mellitus
4. Stenting in unstable angina
5. Stenting in acute myocardial infarction
6. Rescue stenting for failed thrombolytic therapy
7. Stenting in patients with left ventricular dysfunction, hypotension and cardiogenic shock
Section VII. In-stent Restenosis: Prevention and Management
1. The scope of restenosis in ideal and "real-world" lesions
2. Predictors of in-stent (and recurrent in-stent) restenosis
3. Classification of in-stent restenosis
4. Systemic pharmacologic approaches for the prevention of in-stent restenosis - failures and promising
5. Treatment of in-stent restenosis with PTCA, laser, atherectomy and repeat stenting
6. Cutting balloon atherotomy for in-stent restenosis: rationale and results
7. Vascular brachytherapy for de novo lesions and in-stent restenosis
I: Gamma emitter systems and results
II: Beta emitter systems and results
III: radioactive stents
8. Vascular brachytherapy pitfalls
I: the edge effect and geographic miss
II: late stent thrombosis
9. Logistical elements of establishing a vascular brachytherapy program
Section VIII. Thromboresistant Stent Coatings and Materials
1. Heparin coated stents
I: formulations and the experimental basis of thromboresistance
II: Evidence of thromboresistance from randomized trials
III: Evidence of thromboresistance from the HOPE study and Hep@net registry
2. Phosphorycholine coated stents. In vitro and clinical evidence of biocompatibility and thromboresistance
3. Carbon coated stents
I: the Sorin CarboStent
II: the Biotronik silicon carbide coated stent
III: the Phytis DLC stent
4. Novel thromboresistant stent coatings: Abciximab, protein C, hirudin, iloprost and others
Section IX. Anti Restenotic Drug Eluting Stents: Basic Science and Pre Clinical
1. Cellular mechanisms and the histopathology of restenosis
2. The molecular basis of restenosis: identifying targets for interruption
3. The role of inflammation and inflammatory modulators in the restenotic
4. Role of the endothelium in modulating neointimal proliferation
5. Lessons from non stent based local drug delivery
6. Standards for the preclinical evaluation of site-specific local drug delivery: review of a consensus document
7. Components of a drug-eluting stent: Core concepts
I: Importance of release kinetics, stent geometry and penetration depth
II. Polymer and non polymer drug release mechanisms and considerations
III: Cytotoxic vs. cytostatic effects, and the toxic-therapeutic window
8. Phosphorylcholine coated stents as a drug delivery platform
Chapter 9. Unique drug delivery stents: The Conor stent, the JoMed ceramic platform, and
Chapter 10. Regulatory considerations for drug-eluting stents
Section X. Anti Restenotic Drug Eluting Stents: Agents in (or Soon to be in) Human
1. Paclitaxel I: Basic science and pre-clinical studies
I. Structure, mechanisms, and delivery considerations
II: Pre-clinical studies - evaluation of dosing, efficacy and toxicity
2. Paclitaxel II: Clinical results with non polymer based taxol eluting stents
3. Paclitaxel III: Rationale and design of a pivotal trial with a non polymer based taxol eluting stent: DELIVER
4. Paclitaxel IV: Clinical results with polymer based taxol eluting stents: TAXUS I - III
5. Paclitaxel V: Rationale and design of the pivotal U.S. trials with polymer based taxol eluting stents: TAXUS IV and V
6. Sirolimus I: Basic science and pre-clinical studies
I. Structure, mechanisms, and delivery considerations
II. In vitro evaluation of dosing, efficacy and toxicity
7. Sirolimus II: First-in-man experiences and IVUS insights
8. Sirolimus III: The RAVEL trial and European experiences
9. Sirolimus IV: The SIRIUS randomized trials and registries
10. Sirolimus V: Outcomes of the Cypher stent in diabetes mellitus, and the FREEDOM trial
11. Sirolimus VI: Treatment of complex lesion and patient subsets: bifurcation disease, in-stent restenosis, and radiation
12. Rapamycin analogues for stent based local drug delivery (ABT-578, Everolimus, Micophenolic acid)
13. Stent based tacrolimus delivery: mechanism of action, animal data and human
14. Agents promoting endothelial re-growth
I. Stent based 17-Beta-Estradiol delivery: mechanism, animal data and clinical
II. Nitric oxide donors: basic science insights, pre-clinical results and human studies
III. Cell seeding of stents
15. Stent based dexamethasone delivery: from pre-clinical data to human studies
16. Stent-based delivery of bis-phosphonates
17. Local drug delivery of a 3rd generation c-myc antisense oligonucleotide
18. Stent based angiopeptin delivery: mechanism of action and animal data
19. Results with a statin releasing stent
20. Stent based halofuginone delivery: mechanism of action, animal data and future pathways
21. Background and experiences with a cyclosporine eluting stent
22. VEGF-eluting stents
23. The PLLA bioerodable stent as a drug delivery platform - pre-clinical and clinical experiences with stent based tranilast and a tyrosine kinase inhibitor
24. Results and lessons learned from "unsuccessful" drug eluting stent programs
I. Taxane
II. Actinomycin-D
III. Batimistat
25. Drug eluting stents: Unresolved issues
Section XI. Stent Grafts
1. Autologous vein covered stents
2. Bovine pericardium covered stents
3. Fibrin coated stents
4. The JoMed PTFE coated stent graft
I. Device description and use in saphenous vein graft
II. Treatment of coronary perforations, aneurysms and arteriovenous
5. The Boston Scientific Symbiot PTFE coated stent graft: Device description and clinical
Section XII. Controversies in Coronary Stenting - Pro and Con
Coronary Stents - A Breakthrough Technology
Section I. The History of Coronary Stent Development: From Concept to Widespread Acceptance
1. Advantages and limitations of balloon angioplasty
2. The Schneider Self-Expanding Wallstent
I. From developmental concepts to the first human implant-
II. Early clinical experiences - lessons learned and challenges to overcome
3. Development of the Cook Gianturco-Roubin-I Stent
4. Clinical studies with the Gianturco-Roubin-I stent in acute and threatened closure and in de novo lesions
5. Development of the Johnson and Johnson Interventional Systems Palmaz and Palmaz-Schatz Stents
6. Clinical studies with the Palmaz-Schatz StentI. The BENESTENT I Trial. The STRESS Trials
7. The corporate journey to bring the Palmaz-Schatz stent to market
8. A chronicle of the regulatory process of stent approval
9. Widespread acceptance of stents
I. Enhanced deliverability and the reduction of subacute thrombosis
II. Proof of superiority vs. PTCA in randomized controlled trials
III. Durable long-term clinical and angiographic results
10. The cost-effectiveness of coronary stents
Section II. Evolution of the Metallic Stent: From Bench to Bedside
1. Design methodology and animal models to evaluate stent performance
2. Impact of metallic stent composition and configuration on thrombogenesity and neointimal
3. Importance of stent geometry, the stent-host interface, and manufacturing processes on stent thrombosis and restenosis
4. Healing responses to coronary stents: insights from human necropsy studies
5. Impact of strut thickness and stent design on early and late outcomes of coronary stenting
6. Factors influencing stent performance: radial strength, visibility, side branch access, trackability, shortening.
7. Stainless steel stents I: The JJIS/Cordis line
8. Stainless steel stents II: The Guidant line
9. Stainless steel stents III: The Boston Scientific/Schneider/Medinol line
10. Stainless steel stents IV: The Medtronic/AVE/USCI line
11. Stainless steel stents V: The Cook line
12. Stainless steel stents VI: The Abbot/Biocompatibles line
13. The stent vs. stent randomized controlled trials
14. Other stainless steel stents available outside the U.S. and in development
15. Self-expanding and nitinol based stents: The Radius, Wallstent and PAS stents
16. Gold coated stents
17. Cobalt-chrome - the next generation metallic stent platform
18. Beyond metallic stents - Development of bioerodable platforms
Section III. Technical Aspects and Guidance of Coronary
1. Selection and use of guide catheters and guide wires to facilitate stent delivery
2. Direct stenting (without pre-dilatation): pros and cons
3. The evolution of stent technique: high pressure, optimal sizing, IVUS guidance and anticoagulation
4. Debulking prior to stent implantation: rationale and
5. Utility of IVUS during coronary stenting
I. Insights into the mechanisms of stent thrombosis and restenosis
II. Observational and randomized trials of IVUS guided stenting
6. Physiologic lesion assessment during coronary stenting
I: Evaluation of borderline lesions
II: Assessment of procedural outcomes
III: Provisional stenting
7. Pharmacologic considerations for optimal stenting
I: Aspirin, thienopyridines, lipid lowering agents, etc
II: Procedural anticoagulation (UFH, LMWH, direct anti-thrombins
III: Glycoprotein IIb/IIIa inhibitors
8. Common and unusual roadblocks arising during stenting (and solutions): 1-800-FIX-A-STENT
9. Vascular access considerations: the radial, brachial and femoral approaches
10. Arteriotomy site hemostasis: from manual compression to the spectrum of closure devices
Section IV. Complications of Coronary Stenting
1. Success and complications after coronary stenting: historical overview and evolution (the NHLBI and other registries
2. Procedural and angiographic complications
I. Edge dissections, no-reflow, and acute and side branch compromise
II. Coronary artery perforation
III. Hemodynamic collapse and cardiac arrest
IV. Lost and displaced stents and angioplasty equipment
3. Peri-procedural myonecrosis and myocardial infarction
4. Subacute stent thrombosis
I. Incidence, predictors, presentation and treatment
II. Impact of optimal stent implantation and adjunct pharmacotherapy
5. Post procedural complications
I. Vascular and hemorrhagic complications
II. Contrast induced renal insufficiency
III. Hematologic complications
6. Radiation exposure and toxicity in the cardiac catheterization laboratory
Section V. Lesion-specific Stenting: Technique and
1. Differentiating complex vs. high-risk coronary intervention
2. Stenting for acute and threatened closure after PTCA: Comparison with elective
3. Bifurcation stenting
I. French analysis and approach
II. Italian analysis and approach
4. Ostial lesion stenting
5. Small vessel stenting
6. Stenting long lesions and diffuse disease
7. Stenting calcified
8. Multivessel stenting: approach, observational data and randomized controlled trials of stents vs. surgery
9. Recanalization and stenting of chronic total
10. Left main stenting - protected and unprotected
11. Stent implantation in the thrombotic lesion
12. Stenting of bypass graft conduits
I. Saphenous vein and arterial bypass graft stenting
II. Distal protection during saphenous vein graft
Section VI. Patient-specific Stenting: Technique and
1. Gender specific considerations for stenting in acute and chronic coronary artery disease
2. Stenting in the elderly
3. Stenting in the patient with diabetes mellitus
4. Stenting in unstable angina
5. Stenting in acute myocardial infarction
6. Rescue stenting for failed thrombolytic therapy
7. Stenting in patients with left ventricular dysfunction, hypotension and cardiogenic shock
Section VII. In-stent Restenosis: Prevention and Management
1. The scope of restenosis in ideal and "real-world" lesions
2. Predictors of in-stent (and recurrent in-stent) restenosis
3. Classification of in-stent restenosis
4. Systemic pharmacologic approaches for the prevention of in-stent restenosis - failures and promising
5. Treatment of in-stent restenosis with PTCA, laser, atherectomy and repeat stenting
6. Cutting balloon atherotomy for in-stent restenosis: rationale and results
7. Vascular brachytherapy for de novo lesions and in-stent restenosis
I: Gamma emitter systems and results
II: Beta emitter systems and results
III: radioactive stents
8. Vascular brachytherapy pitfalls
I: the edge effect and geographic miss
II: late stent thrombosis
9. Logistical elements of establishing a vascular brachytherapy program
Section VIII. Thromboresistant Stent Coatings and Materials
1. Heparin coated stents
I: formulations and the experimental basis of thromboresistance
II: Evidence of thromboresistance from randomized trials
III: Evidence of thromboresistance from the HOPE study and Hep@net registry
2. Phosphorycholine coated stents. In vitro and clinical evidence of biocompatibility and thromboresistance
3. Carbon coated stents
I: the Sorin CarboStent
II: the Biotronik silicon carbide coated stent
III: the Phytis DLC stent
4. Novel thromboresistant stent coatings: Abciximab, protein C, hirudin, iloprost and others
Section IX. Anti Restenotic Drug Eluting Stents: Basic Science and Pre Clinical
1. Cellular mechanisms and the histopathology of restenosis
2. The molecular basis of restenosis: identifying targets for interruption
3. The role of inflammation and inflammatory modulators in the restenotic
4. Role of the endothelium in modulating neointimal proliferation
5. Lessons from non stent based local drug delivery
6. Standards for the preclinical evaluation of site-specific local drug delivery: review of a consensus document
7. Components of a drug-eluting stent: Core concepts
I: Importance of release kinetics, stent geometry and penetration depth
II. Polymer and non polymer drug release mechanisms and considerations
III: Cytotoxic vs. cytostatic effects, and the toxic-therapeutic window
8. Phosphorylcholine coated stents as a drug delivery platform
Chapter 9. Unique drug delivery stents: The Conor stent, the JoMed ceramic platform, and
Chapter 10. Regulatory considerations for drug-eluting stents
Section X. Anti Restenotic Drug Eluting Stents: Agents in (or Soon to be in) Human
1. Paclitaxel I: Basic science and pre-clinical studies
I. Structure, mechanisms, and delivery considerations
II: Pre-clinical studies - evaluation of dosing, efficacy and toxicity
2. Paclitaxel II: Clinical results with non polymer based taxol eluting stents
3. Paclitaxel III: Rationale and design of a pivotal trial with a non polymer based taxol eluting stent: DELIVER
4. Paclitaxel IV: Clinical results with polymer based taxol eluting stents: TAXUS I - III
5. Paclitaxel V: Rationale and design of the pivotal U.S. trials with polymer based taxol eluting stents: TAXUS IV and V
6. Sirolimus I: Basic science and pre-clinical studies
I. Structure, mechanisms, and delivery considerations
II. In vitro evaluation of dosing, efficacy and toxicity
7. Sirolimus II: First-in-man experiences and IVUS insights
8. Sirolimus III: The RAVEL trial and European experiences
9. Sirolimus IV: The SIRIUS randomized trials and registries
10. Sirolimus V: Outcomes of the Cypher stent in diabetes mellitus, and the FREEDOM trial
11. Sirolimus VI: Treatment of complex lesion and patient subsets: bifurcation disease, in-stent restenosis, and radiation
12. Rapamycin analogues for stent based local drug delivery (ABT-578, Everolimus, Micophenolic acid)
13. Stent based tacrolimus delivery: mechanism of action, animal data and human
14. Agents promoting endothelial re-growth
I. Stent based 17-Beta-Estradiol delivery: mechanism, animal data and clinical
II. Nitric oxide donors: basic science insights, pre-clinical results and human studies
III. Cell seeding of stents
15. Stent based dexamethasone delivery: from pre-clinical data to human studies
16. Stent-based delivery of bis-phosphonates
17. Local drug delivery of a 3rd generation c-myc antisense oligonucleotide
18. Stent based angiopeptin delivery: mechanism of action and animal data
19. Results with a statin releasing stent
20. Stent based halofuginone delivery: mechanism of action, animal data and future pathways
21. Background and experiences with a cyclosporine eluting stent
22. VEGF-eluting stents
23. The PLLA bioerodable stent as a drug delivery platform - pre-clinical and clinical experiences with stent based tranilast and a tyrosine kinase inhibitor
24. Results and lessons learned from "unsuccessful" drug eluting stent programs
I. Taxane
II. Actinomycin-D
III. Batimistat
25. Drug eluting stents: Unresolved issues
Section XI. Stent Grafts
1. Autologous vein covered stents
2. Bovine pericardium covered stents
3. Fibrin coated stents
4. The JoMed PTFE coated stent graft
I. Device description and use in saphenous vein graft
II. Treatment of coronary perforations, aneurysms and arteriovenous
5. The Boston Scientific Symbiot PTFE coated stent graft: Device description and clinical
Section XII. Controversies in Coronary Stenting - Pro and Con
- Language: English
- Edition: 1
- Published:
- Imprint: Saunders
ML
Martin B. Leon
Affiliations and expertise
Director and CEO, Cardiovascular Research Foundation, Senior Attending Physician, Lenox Hill Heart and Vascular Institute of New York, NY; Clinical Professor of Medicine, Georgetown University Medical CenterGS
Gregg W. Stone
Affiliations and expertise
Vice President and Director, Cardiovascular Research and Education, The Cardiovascular Research Foundation, Lenox Hill Heart and Vascular Institute, Partner, Lenox Hill Interventional Cardiology Department, P.C. Lenox Hill Hospital, New York, NY