This Article Abstract Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Sousa, J. E. Articles by Serruys, P. W. Search for Related Content PubMed PubMed Citation Articles by Sousa, J. E. Articles by Serruys, P. W. Pubmed/NCBI databases Compound via MeSH Substance via MeSH Related Collections Restenosis Catheter-based coronary interventions: stents

(Circulation. 2001;103:192.)
© 2001 American Heart Association, Inc.

Clinical Investigation and Reports

Lack of Neointimal Proliferation After Implantation of Sirolimus-Coated Stents in Human Coronary Arteries

A Quantitative Coronary Angiography and Three-Dimensional Intravascular Ultrasound Study

J. Eduardo Sousa, MD, PhD; Marco A. Costa, MD, PhD; Alexandre Abizaid, MD, PhD; Andrea S. Abizaid, MD; Fausto Feres, MD; Ibraim M. F. Pinto, MD; Ana C. Seixas, MD; Rodolfo Staico, MD; Luiz A. Mattos, MD; Amanda G. M. R. Sousa, MD, PhD; Robert Falotico, PhD; Judith Jaeger, BA; Jeffrey J. Popma, MD; Patrick W. Serruys, MD, PhD

From the Institute Dante Pazzanese of Cardiology, São Paulo, Brazil (J.E.S., M.A.C., A.A., A.S.A., F.F., I.M.F.P., A.C.S., R.S., L.A.M., A.G.M.R.S.); Cordis, a Johnson & Johnson Company, Warren, NJ (R.F., J.J.); Brigham and Women’s Hospital, Boston, Mass (J.J.P.); and Thoraxcenter, Dijkzigt University Hospital, Rotterdam, the Netherlands (P.W.S.).

Correspondence to Prof J. Eduardo Sousa, MD, PhD, Director of the Institute Dante Pazzanese of Cardiology, Av Dr Dante Pazzanese, 500 - Ibirapuera, 04012180, São Paulo, Brazil. E-mail diretoriaidpc{at}uol.com.br

	Abstract

Top Abstract Introduction Methods Results Discussion Conclusion References

 
Background—Restenosis remains an important limitation of interventional cardiology. Therefore, we aimed to determine the safety and efficacy of sirolimus (a cell-cycle inhibitor)-coated BX Velocity stents.

Methods and Results—Thirty patients with angina pectoris were electively treated with 2 different formulations of sirolimus-coated stents (slow release [SR], n=15, and fast release [FR], n=15). All stents were successfully delivered, and patients were discharged without clinical complications. Independent core laboratories analyzed angiographic and 3D volumetric intravascular ultrasound data (immediately after procedure and at 4-month follow-up). Eight-month clinical follow-up was obtained for all patients. There was minimal neointimal hyperplasia in both groups (11.0±3.0% in the SR group and 10.4±3.0% in the FR group, P=NS) by ultrasound and quantitative coronary angiography (in-stent late loss, 0.09±0.3 mm [SR] and -0.02±0.3 mm [FR]; in-lesion late loss, 0.16±0.3 mm [SR] and -0.1±0.3 mm [FR]). No in-stent or edge restenosis (diameter stenosis 50%) was observed. No major clinical events (stent thrombosis, repeat revascularization, myocardial infarction, or death) had occurred by 8 months.

Conclusions—The implantation of sirolimus-coated BX Velocity stents is feasible and safe and elicits minimal neointimal proliferation. Additional placebo-controlled trials are required to confirm these promising results.

Key Words: stents • restenosis • angioplasty

	Introduction

Top Abstract Introduction Methods Results Discussion Conclusion References

 
Restenosis remains a vexing problem of percutaneous intervention. The most promising approach to prevent restenosis has been the application of intracoronary radiation¹ ; however, some relevant side effects (edge restenosis and late thrombosis) have been reported.^{2 3} Numerous pharmacological approaches to reduce restenosis have failed, possibly due to insufficient local drug concentrations.⁴ Delivering medication directly to the site of vascular injury via polymeric-coated stents is a rational approach to achieve adequate local drug delivery.^{5 6}

Sirolimus (Rapamune), a natural macrocyclic lactone, is a potent immunosuppressive agent that was developed by Wyeth-Ayerst Laboratories and approved by the Food and Drug Administration for the prophylaxis of renal transplant rejection in 1999.⁷ Sirolimus binds to an intracellular receptor protein and elevates p27 levels, which leads to the inhibition of cyclin/cyclin-dependent kinase complexes and, ultimately, induces cell-cycle arrest in the late G1 phase. It inhibits the proliferation of both rat and human smooth muscle cells in vitro^{8 9} and reduces intimal thickening in models of vascular injury.^{10 11 12} However, the effects of the local administration of sirolimus in a coated stent in humans have not been reported.

The aims of this pilot study were to assess (1) the feasibility and safety of implanting 2 different formulations of the sirolimus-coated BX Velocity stent in atherosclerotic human coronary arteries and (2) the impact of the stents on neointimal proliferation.

	Methods

Top Abstract Introduction Methods Results Discussion Conclusion References

 
From December 1999 to February 2000, a single sirolimus-coated BX Velocity stent was successfully implanted in each of 30 consecutive patients with coronary artery disease. The stent is a laser-cut, 316L stainless steel, balloon-expandable stent that contains a fixed amount of sirolimus per unit of metal surface area (140 µg of sirolimus per cm²).

Sirolimus was blended in a mixture of nonerodable polymers that have been used clinically in bone cements, ocular devices, and a drug-releasing intrauterine device.^{13 14} Fifteen patients received a fast release (FR) formulation (<15-day drug release), and 15 received a slow release (SR) formulation (28-day drug release).

Procedure
All stents were 18 mm long and 3.0 to 3.5 mm in diameter. After predilatation of the target lesion, stents were deployed with high-pressure (>14 atm) postdilatation guided by intravascular ultrasound (IVUS). All patients received aspirin (325 mg/d, indefinitely), which was started at least 12 hours before the procedure, and clopidogrel (300 mg immediately after stent implantation and 75 mg/d for 60 days). The protocol was approved by the Medical Ethics Committee of the Institute Dante Pazzanese of Cardiology, and informed consent was obtained from every patient.

Quantitative Measurements
Quantitative coronary angiography (QCA) and IVUS imaging were performed immediately after the procedure and at 4-month follow-up in all patients after a bolus infusion of intracoronary nitrates. IVUS images were acquired using motorized pull-back at a constant speed of 0.5 mm/s. Quantitative angiographic and volumetric IVUS analyses were performed by independent core laboratories (Brigham and Women’s Hospital, Boston, Mass, and Cardialysis BV, Rotterdam, The Netherlands, respectively).^{15 16 17} Three segments were selected for volumetric IVUS analysis: the stented segment (18 mm long) and 2 edge segments that were axially 5 mm proximal and distal to the stent margins.

Statistical Analysis
Continuous variables are expressed as mean±SD. Comparisons between postintervention and follow-up measurements were performed with a 2-tailed paired t test. Comparisons between groups were performed using an unpaired Student’s t test. P<0.05 was considered statistically significant.

	Results

Top Abstract Introduction Methods Results Discussion Conclusion References

 
Twenty-six patients had stable angina and 4 patients had unstable angina. Their mean age was 57.9±10 years (SR) and 55.1±7 years (FR); 63% of the patients in each group were male. The incidence of prior myocardial infarction was 33.3% (SR) and 53.3% (FR), and 14% (FR) and 26% (SR) of the patients were diabetics. All stents were implanted successfully, and all patients were discharged without complications 24 hours after treatment. Creatine kinase and creatine kinase-MB levels, sampled at 6 and 18 hours after the procedure, were within the normal range in all patients.

Angiographic and volumetric IVUS data are presented in Tables 1 and 2. No patient approached 50% vessel narrowing by QCA or IVUS, and only 3 patients had >15% intimal hyperplasia (IH) by IVUS (Figure 1). In both the edge segments and in the stented segment, lumen loss detected by IVUS was minimal (Figure 2). All patients completed 4 months of angiographic and 8 months of clinical follow-up. There were no repeat revascularizations, stent thromboses, or major clinical events (cerebrovascular accident, myocardial infarction, or death).

View this table: [in this window] [in a new window]   Table 1. Offline Quantitative Coronary Analysis by Core Laboratory

View this table: [in this window] [in a new window]   Table 2. Postprocedure and Follow-Up 3D IVUS Measurements by Core Laboratory

View larger version (40K): [in this window] [in a new window]   Figure 1. Left, Cumulative distribution curves of percent IH in SR and FR groups. Upper right panel shows follow-up IVUS cross-section with largest amount of IH (17.5%), and lower right panel displays IVUS cross-section with lowest amount of IH (4.6%). In both vessels, a FR stent was implanted (arrows).

View larger version (9K): [in this window] [in a new window]   Figure 2. Postprocedure and follow-up mean lumen areas within stent and at 5-mm edge segments (n=30), as assessed by 3D IVUS.

	Discussion

Top Abstract Introduction Methods Results Discussion Conclusion References

 
This is the first human experience with the implantation of sirolimus-coated BX Velocity stents. The absence of adverse events for up to 8 months of follow-up suggests that the implantation of this stent, which is coated with a potent cell-cycle inhibitor, is feasible and safe.

The amount of IH after the implantation of noncoated stents ranges from 19% to 48% of stent volume^{3 18 19} by IVUS, and late loss averages 0.8 to 0.9 mm by QCA.¹⁹ Even in nonrestenotic stents that are 15 mm long, an average IH of 19.7% has been observed by IVUS.¹⁸ Although differences in population and stent design limit scientific comparison with other reports, it is worth noting that the amount of IH detected in the present study (10.7%; essentially zero late loss by QCA) is much lower than previously reported. This is likely due to the cytostatic effect of sirolimus.^{10 11 12 20}

Using the same IVUS methodology, the amount of in-stent IH with radioactive stent implantation varied from 7.4% (6 to 12 µCi radioactive stent) to 16.7% (0.75 to 1.5 µCi).¹⁷ However, neither edge restenosis nor stent thrombosis, both of which have been reported after radiation,^{2 3} were observed after the implantation of sirolimus-coated stents (Figure 2).

As a result of their permanent scaffolding action, stents have become an attractive platform for delivering medications locally.^{5 21} Although some polymers have been associated with a marked inflammatory reaction,²² these findings were not observed with the polymers used in the present investigation or in other clinical situations.^{13 14} In the present study, similar favorable results were observed with both the FR and SR formulations of the sirolimus-coated stent. Whether one sirolimus coating matrix is superior to the other (SR versus FR) requires further investigation.

Limitations
The study comprises a registry of only 30 patients with 4 months of QCA and 3D IVUS data and 8 months of clinical data. However, considering the absence of late loss by QCA and the virtual absence of IH observed in the present study by 3D IVUS and the well-documented degree of late loss with uncoated stents, these early results are promising. Twelve-month angiographic and IVUS follow-up will be performed in all patients to assess whether this effect is sustained.

	Conclusion

Top Abstract Introduction Methods Results Discussion Conclusion References

 
Sirolimus-coated BX Velocity stents seem to be safe and effective in preventing neointimal formation at 4 months after stent implantation in de novo lesions. These seminal findings warrant further confirmation by large, placebo-controlled, multicenter trials.

	Acknowledgments

 
This study was sponsored by Cordis, a Johnson & Johnson Company. We thank Dr Brian Firth for his careful review of the manuscript.

	Footnotes

 
This article originally appeared Online on December 18, 2000.<(/PARAGRAPH> (Circulation. 2000;102:r54–r57.)

Received November 3, 2000; accepted December 4, 2000.

	References

Top Abstract Introduction Methods Results Discussion Conclusion References

 

1. Teirstein PS, Massullo V, Jani S, et al. Catheter-based radiotherapy to inhibit restenosis after coronary stenting. N Engl J Med. 1997;336:1697–1703.[Abstract/Free Full Text]
   
2. Albiero R, Nishida T, Adamian M, et al. Edge restenosis after implantation of high activity (32)P radioactive ß-emitting stents. Circulation. 2000;101:2454–2457.[Abstract/Free Full Text]
   
3. Costa MA, Sabate M, van der Giessen WJ, et al. Late coronary occlusion after intracoronary brachytherapy. Circulation. 1999;100:789–792.[Abstract/Free Full Text]
   
4. Lafont A, Faxon D. Why do animal models of post-angioplasty restenosis sometimes poorly predict the outcome of clinical trials? Cardiovasc Res. 1998;39:50–59.[Free Full Text]
   
5. Lincoff AM, Topol EJ, Ellis SG. Local drug delivery for the prevention of restenosis: fact, fancy, and future. Circulation. 1994;90:2070–2084.[Free Full Text]
   
6. Topol EJ, Serruys PW. Frontiers in interventional cardiology. Circulation. 1998;98:1802–1820.[Free Full Text]
   
7. Groth CG, Backman L, Morales JM, et al. Sirolimus (rapamycin)-based therapy in human renal transplantation: similar efficacy and different toxicity compared with cyclosporine: Sirolimus European Renal Transplant Study Group. Transplantation. 1999;67:1036–1042.[Medline] [Order article via Infotrieve]
   
8. Marx SO, Jayaraman T, Go LO, et al. Rapamycin-FKBP inhibits cell cycle regulators of proliferation in vascular smooth muscle cells. Circ Res. 1995;76:412–417.[Abstract/Free Full Text]
   
9. Poon M, Marx SO, Gallo R, et al. Rapamycin inhibits vascular smooth muscle cell migration. J Clin Invest. 1996;98:2277–2283.[Medline] [Order article via Infotrieve]
   
10. Gregory CR, Huang X, Pratt RE, et al. Treatment with rapamycin and mycophenolic acid reduces arterial intimal thickening produced by mechanical injury and allows endothelial replacement. Transplantation. 1995;59:655–661.[Medline] [Order article via Infotrieve]
    
11. Burke SE, Lubbers NL, Chen YW, et al. Neointimal formation after balloon-induced vascular injury in Yucatan minipigs is reduced by oral rapamycin. J Cardiovasc Pharmacol. 1999;33:829–835.[Medline] [Order article via Infotrieve]
    
12. Gallo R, Padurean A, Jayaraman T, et al. Inhibition of intimal thickening after balloon angioplasty in porcine coronary arteries by targeting regulators of the cell cycle. Circulation. 1999;99:2164–2170.[Abstract/Free Full Text]
    
13. Kindt-Larsen T, Smith D, Jensen J. Innovations in acrylic bone cement and application equipment. J Appl Biomater. 1995;6:75–83.[Medline] [Order article via Infotrieve]
    
14. Revell P, Braden M, Freeman M. Review of biological response to a novel bone cement containing poly(ethyl methacrylate) and n-butyl methacrylate. Biomaterials. 1998;19:1579–1586.[Medline] [Order article via Infotrieve]
    
15. Lansky AJ, Popma JJ, Cutlip D, et al. Comparative analysis of early and late angiographic outcomes using two quantitative algorithms in the Balloon versus Optimal Atherectomy Trial (BOAT). Am J Cardiol. 1999;83:1611–1616.[Medline] [Order article via Infotrieve]
    
16. Costa MA, Sabatt M, Kay IP, et al. Three-dimensional intravascular ultrasonic volumetric quantification of stent recoil and neointimal formation of two new generation tubular stents. Am J Cardiol. 2000;85:135–139.[Medline] [Order article via Infotrieve]
    
17. Kay IP, Sabate M, Costa MA, et al. Positive geometric vascular remodeling is seen after catheter-based radiation followed by conventional stent implantation but not after radioactive stent implantation. Circulation. 2000;102:1434–1439.[Abstract/Free Full Text]
    
18. Dussaillant GR, Mintz GS, Pichard AD, et al. Small stent size and intimal hyperplasia contribute to restenosis: a volumetric intravascular ultrasound analysis. J Am Coll Cardiol. 1995;26:720–724.[Abstract]
    
19. The ERASER investigators. Acute platelet inhibition with abciximab does not reduce in-stent restenosis (ERASER study). Circulation. 1999;100:799–806.[Abstract/Free Full Text]
    
20. Poston RS, Billingham M, Hoyt EG, et al. Rapamycin reverses chronic graft vascular disease in a novel cardiac allograft model. Circulation. 1999;100:67–74.[Abstract/Free Full Text]
    
21. Camenzind E, Kutryk M, Serruys P. Use of locally delivered conventional drug therapies. Semin Interv Cardiol. 1996;1:67–76.[Medline] [Order article via Infotrieve]
    
22. van der Giessen WJ, Lincoff AM, Schwartz RS, et al. Marked inflammatory sequelae to implantation of biodegradable and nonbiodegradable polymers in porcine coronary arteries. Circulation. 1996;94:1690–1697.[Abstract/Free Full Text]
    

This article has been cited by other articles:

				J. Mehilli, R. A. Byrne, A. Wieczorek, R. Iijima, S. Schulz, O. Bruskina, J. Pache, R. Wessely, A. Schomig, A. Kastrati, et al. Randomized trial of three rapamycin-eluting stents with different coating strategies for the reduction of coronary restenosis Eur. Heart J., June 11, 2008; (2008) ehn253v1. [Abstract] [Full Text] [PDF]

				R. A. Nemenoff, P. A. Simpson, S. B. Furgeson, N. Kaplan-Albuquerque, J. Crossno, P. J. Garl, J. Cooper, and M. C.M. Weiser-Evans Targeted Deletion of PTEN in Smooth Muscle Cells Results in Vascular Remodeling and Recruitment of Progenitor Cells Through Induction of Stromal Cell-Derived Factor-1{alpha} Circ. Res., May 9, 2008; 102(9): 1036 - 1045. [Abstract] [Full Text] [PDF]

				N Melikian and W Wijns Drug-eluting stents: a critique Heart, February 1, 2008; 94(2): 145 - 152. [Abstract] [Full Text] [PDF]

				M. N. Helmus, D. F. Gibbons, and D. Cebon Biocompatibility: Meeting a Key Functional Requirement of Next-Generation Medical Devices Toxicol Pathol, January 1, 2008; 36(1): 70 - 80. [Abstract] [Full Text] [PDF]

				E. Grube, K. D. Dawkins, G. Guagliumi, A. P. Banning, K. Zmudka, A. Colombo, L. Thuesen, K. Hauptman, J. Marco, W. Wijns, et al. TAXUS VI 2-year follow-up: randomized comparison of polymer-based paclitaxel-eluting with bare metal stents for treatment of long, complex lesions Eur. Heart J., November 1, 2007; 28(21): 2578 - 2582. [Abstract] [Full Text] [PDF]

				M.-C. Morice, P. W. Serruys, P. Barragan, C. Bode, G.-A. Van Es, H.-P. Stoll, D. Snead, L. Mauri, D. E. Cutlip, and E. Sousa Long-Term Clinical Outcomes With Sirolimus-Eluting Coronary Stents: Five-Year Results of the RAVEL Trial J. Am. Coll. Cardiol., October 2, 2007; 50(14): 1299 - 1304. [Abstract] [Full Text] [PDF]

				D. A. Siqueira, A. A. Abizaid, J. d. R. Costa, F. Feres, L. A. Mattos, R. Staico, A. A. Abizaid, L. F. Tanajura, A. Chaves, M. Centemero, et al. Late incomplete apposition after drug-eluting stent implantation: incidence and potential for adverse clinical outcomes Eur. Heart J., June 1, 2007; 28(11): 1304 - 1309. [Abstract] [Full Text] [PDF]

				K. L. Ma, X. Z. Ruan, S. H. Powis, J. F. Moorhead, and Z. Varghese Anti-atherosclerotic effects of sirolimus on human vascular smooth muscle cells Am J Physiol Heart Circ Physiol, June 1, 2007; 292(6): H2721 - H2728. [Abstract] [Full Text] [PDF]

				M. Menichelli, A. Parma, E. Pucci, R. Fiorilli, F. De Felice, M. Nazzaro, A. Giulivi, D. Alborino, A. Azzellino, and R. Violini Randomized Trial of Sirolimus-Eluting Stent Versus Bare-Metal Stent in Acute Myocardial Infarction (SESAMI) J. Am. Coll. Cardiol., May 15, 2007; 49(19): 1924 - 1930. [Abstract] [Full Text] [PDF]

				Y. Ben-Gal, R. Mohr, R. Braunstein, A. Finkelstein, N. Hansson, A. Hendler, Y. Moshkovitz, and G. Uretzky Revascularization of Left Anterior Descending Artery With Drug-Eluting Stents: Comparison With Minimally Invasive Direct Coronary Artery Bypass Surgery Ann. Thorac. Surg., December 1, 2006; 82(6): 2067 - 2071. [Abstract] [Full Text] [PDF]

				M. Pfisterer, H. P. Brunner-La Rocca, P. T. Buser, P. Rickenbacher, P. Hunziker, C. Mueller, R. Jeger, F. Bader, S. Osswald, C. Kaiser, et al. Late Clinical Events After Clopidogrel Discontinuation May Limit the Benefit of Drug-Eluting Stents: An Observational Study of Drug-Eluting Versus Bare-Metal Stents J. Am. Coll. Cardiol., November 1, 2006; (2006) j.jacc.2006.10.026v1. [Abstract] [Full Text] [PDF]

				T. K. Steigen, M. Maeng, R. Wiseth, A. Erglis, I. Kumsars, I. Narbute, P. Gunnes, J. Mannsverk, O. Meyerdierks, S. Rotevatn, et al. Randomized Study on Simple Versus Complex Stenting of Coronary Artery Bifurcation Lesions: The Nordic Bifurcation Study Circulation, October 31, 2006; 114(18): 1955 - 1961. [Abstract] [Full Text] [PDF]

				E. Ilkay, L. Tirikli, I. Ozercan, M. Yavuzkir, I. Karaca, A. Rahman, and N. Arslan Oral Mycophenolate Mofetil Prevents In-Stent Intimal Hyperplasia Without Edge Effect Angiology, October 1, 2006; 57(5): 577 - 584. [Abstract] [PDF]

				M. Takano, T. Ohba, S. Inami, K. Seimiya, S. Sakai, and K. Mizuno Angioscopic differences in neointimal coverage and in persistence of thrombus between sirolimus-eluting stents and bare metal stents after a 6-month implantation Eur. Heart J., September 2, 2006; 27(18): 2189 - 2195. [Abstract] [Full Text] [PDF]

				J. Fajadet, W. Wijns, G.-J. Laarman, K.-H. Kuck, J. Ormiston, T. Munzel, J. J. Popma, P. J. Fitzgerald, R. Bonan, R. E. Kuntz, et al. Randomized, Double-Blind, Multicenter Study of the Endeavor Zotarolimus-Eluting Phosphorylcholine-Encapsulated Stent for Treatment of Native Coronary Artery Lesions: Clinical and Angiographic Results of the ENDEAVOR II Trial Circulation, August 22, 2006; 114(8): 798 - 806. [Abstract] [Full Text] [PDF]

				A. J. Boyle, S. P. Schulman, and J. M. Hare Stem Cell Therapy for Cardiac Repair: Ready for the Next Step Circulation, July 25, 2006; 114(4): 339 - 352. [Full Text] [PDF]

				F. Liistro, M. Fineschi, P. Angioli, G. Sinicropi, G. Falsini, T. Gori, K. Ducci, A. Bravi, and L. Bolognese Effectiveness and Safety of Sirolimus Stent Implantation for Coronary In-Stent Restenosis: The TRUE (Tuscany Registry of Sirolimus for Unselected In-Stent Restenosis) Registry J. Am. Coll. Cardiol., July 18, 2006; 48(2): 270 - 275. [Abstract] [Full Text] [PDF]

				A. Giordano, R. Avellino, P. Ferraro, S. Romano, N. Corcione, and M. F. Romano Rapamycin antagonizes NF-{kappa}B nuclear translocation activated by TNF-{alpha} in primary vascular smooth muscle cells and enhances apoptosis Am J Physiol Heart Circ Physiol, June 1, 2006; 290(6): H2459 - H2465. [Abstract] [Full Text] [PDF]

				P. W. Serruys Fourth Annual American College of Cardiology International Lecture: A Journey in the Interventional Field J. Am. Coll. Cardiol., May 2, 2006; 47(9): 1754 - 1768. [Full Text] [PDF]

				G. Weisz, M. B. Leon, D. R. Holmes Jr, D. J. Kereiakes, M. R. Clark, B. M. Cohen, S. G. Ellis, P. Coleman, C. Hill, C. Shi, et al. Two-Year Outcomes After Sirolimus-Eluting Stent Implantation: Results From the Sirolimus-Eluting Stent in de Novo Native Coronary Lesions (SIRIUS) Trial J. Am. Coll. Cardiol., April 4, 2006; 47(7): 1350 - 1355. [Abstract] [Full Text] [PDF]

				B. E. Muhs, P. J. Gagne, T. Maldonado, and P. Sheehan Minimally invasive revascularization strategies for chronic lower limb ischemia. International Journal of Lower Extremity Wounds, March 1, 2006; 5(1): 35 - 39. [Abstract] [PDF]

				D. S. Baim, R. Mehran, D. J. Kereiakes, T. P. Gross, M. Simons, D. Malenka, and A. V. Kaplan Postmarket Surveillance for Drug-Eluting Coronary Stents: A Comprehensive Approach Circulation, February 14, 2006; 113(6): 891 - 897. [Full Text] [PDF]

				C.-H. Lee, H.-C. Tan, and Y.-T. Lim Update on Drug-Eluting Stents for Prevention of Restenosis Asian Cardiovasc Thorac Ann, February 1, 2006; 14(1): 75 - 82. [Abstract] [Full Text] [PDF]

				A. E. Rodriguez, J. Mieres, C. Fernandez-Pereira, C. F. Vigo, M. Rodriguez-Alemparte, D. Berrocal, L. Grinfeld, and I. Palacios Coronary Stent Thrombosis in the Current Drug-Eluting Stent Era: Insights From the ERACI III Trial J. Am. Coll. Cardiol., January 3, 2006; 47(1): 205 - 207. [Full Text] [PDF]

				A. E. Rodriguez, J. Mieres, C. Fernandez-Pereira, C. F. Vigo, M. Rodriguez-Alemparte, D. Berrocal, L. Grinfeld, and I. Palacios Coronary Stent Thrombosis in the Current Drug-Eluting Stent Era: Insights From the ERACI III Trial J. Am. Coll. Cardiol., December 13, 2005; (2005) j.jacc.2005.10.016v1. [Full Text] [PDF]

				I. Herz, Y. Moshkovitz, D. Loberman, G. Uretzky, R. Braunstein, A. Hendler, E. Zivi, Y. Ben-Gal, and R. Mohr Drug-Eluting Stents Versus Bilateral Internal Thoracic Grafting for Multivessel Coronary Disease Ann. Thorac. Surg., December 1, 2005; 80(6): 2086 - 2090. [Abstract] [Full Text] [PDF]

				S. Pislaru and R. D. Simari The Translation of Transcription Circ. Res., November 25, 2005; 97(11): 1083 - 1084. [Full Text] [PDF]

				J. Aoki, A. C. Abizaid, P. W. Serruys, A. T.L. Ong, E. Boersma, J. E. Sousa, and N. Bruining Evaluation of Four-Year Coronary Artery Response After Sirolimus-Eluting Stent Implantation Using Serial Quantitative Intravascular Ultrasound and Computer-Assisted Grayscale Value Analysis for Plaque Composition in Event-Free Patients J. Am. Coll. Cardiol., November 1, 2005; 46(9): 1670 - 1676. [Abstract] [Full Text] [PDF]

				A E Rodriguez, M Rodriguez Alemparte, C F Vigo, C Fernandez Pereira, C Llaurado, D Vetcher, A Pocovi, and J Ambrose Role of oral rapamycin to prevent restenosis in patients with de novo lesions undergoing coronary stenting: results of the Argentina single centre study (ORAR trial) Heart, November 1, 2005; 91(11): 1433 - 1437. [Abstract] [Full Text] [PDF]

				A. E. Rodriguez, J. Baldi, C. F. Pereira, J. Navia, M. R. Alemparte, A. Delacasa, F. Vigo, D. Vogel, W. O'Neill, I. F. Palacios, et al. Five-Year Follow-Up of the Argentine Randomized Trial of Coronary Angioplasty With Stenting Versus Coronary Bypass Surgery in Patients With Multiple Vessel Disease (ERACI II) J. Am. Coll. Cardiol., August 16, 2005; 46(4): 582 - 588. [Abstract] [Full Text] [PDF]

				Y. Moshkovitz, R. Mohr, R. Braunstein, E. Zivi, G. Uretzky, Y. Ben-Gal, and I. Herz Revascularization of Left Anterior Descending Coronary Artery in Patients With Single and Multivessel Disease: Comparison Between Off-Pump Internal Thoracic Artery and Drug-Eluting Stent Chest, August 1, 2005; 128(2): 804 - 809. [Abstract] [Full Text] [PDF]

				M. Togni, S. Windecker, R. Cocchia, P. Wenaweser, S. Cook, M. Billinger, B. Meier, and O. M. Hess Sirolimus-Eluting Stents Associated With Paradoxic Coronary Vasoconstriction J. Am. Coll. Cardiol., July 19, 2005; 46(2): 231 - 236. [Abstract] [Full Text] [PDF]

				J. C. Henry, M. M. Bonar, P. N. Kearns, H. Cui, M. M. Mutchler, M. V. Martin, A. R. Orsini, H. L. Elford, C. A. Bush, J. L. Zweier, et al. Inhibition of Ribonucleotide Reductase Reduces Neointimal Formation following Balloon Injury J. Pharmacol. Exp. Ther., July 1, 2005; 314(1): 70 - 76. [Abstract] [Full Text] [PDF]

				L. Mauri, E. J. Orav, and R. E. Kuntz Late Loss in Lumen Diameter and Binary Restenosis for Drug-Eluting Stent Comparison Circulation, June 28, 2005; 111(25): 3435 - 3442. [Abstract] [Full Text] [PDF]

K. Sakakibara, B. Liu, S. Hollenbeck, and K. C. Kent Rapamycin inhibits fibronectin-induced migration of the human arterial smooth muscle line (E47) through the mammalian target of rapamycin Am J Physiol Heart Circ Physiol, June 1, 2005; 288(6): H2861 - H2868. [Abstract]