(Circulation. 1996;93:2114-2120.)
© 1996 American Heart Association, Inc.
Articles |
Six-Month Clinical and Angiographic Outcome of the New, Less Shortening Wallstent in Native Coronary Arteries
From the Catheterization Laboratory, Thoraxcenter, Erasmus University, Rotterdam, Netherlands.
 |
Abstract |
|---|
 Top Abstract IntroductionMethodsResultsDiscussionReferences |
|---|
Background The new, less shortening, self-expanding Wallstent is characterized by longitudinal flexibility, a protective membrane, a low profile, and a customized range of diameters (3.5 to 6.0 mm). The recent modification of the braiding angle of the Wallstent has resulted in a new device with less shortening on expansion and a concomitant reduction in radial force. We hypothesized that the enforced mechanical remodeling produced by the selection of an oversized Wallstent might result in improved accommodation of subsequent reactive intimal hyperplasia and prevention of chronic recoil of the vessel.
Methods and Results To prove this hypothesis, we recently implanted 44 new, less shortening Wallstents in 35 native coronary arteries in 35 patients with acute or threatened closure after balloon angioplasty, according to a strategy of oversizing of Wallstent diameter and complete coverage of the lesion length. The initial and 6-month follow-up angiograms were analyzed with a computer-based quantitative coronary angiography (QCA) system. Acute gain (minimal luminal diameter [MLD] post minus MLD pre) and late loss (MLD post minus MLD at follow-up) were examined. Stent deployment was successful in 44 of 44 attempts (100%). Nominal stent diameter used was 1.40 mm larger than the maximal vessel diameter. One patient (3%) with a dilated but unstented lesion proximal to the stented segment sustained a subacute occlusion on day 1 associated with myocardial infarction. Event-free survival at 30 days after stent implantation was 97% (34 of 35 patients). Of the 34 patients eligible for 6-month angiographic follow-up, 3 who were asymptomatic declined repeat angiography. MLD (and percent diameter stenosis [% DS]) changed from 0.83±0.50 mm (72%) pre through 3.06±0.48 mm (15%) post to 2.27±0.74 mm (28%) at follow-up. Acute gain was 2.23±0.63 mm, and late loss was 0.78±0.61 mm. Angiographic restenosis (>50% DS) was observed in 5 of 31 patients (16%) at 6 months, all of whom underwent repeat angioplasty. Thus, the overall event-free survival at 6-month follow-up was 83% (29 of 35 patients).
Conclusions The oversized Wallstent implantation with complete coverage of the lesion length conveyed a favorable 6-month clinical and angiographic outcome. The large acute gain obtained by the Wallstent afforded greater accommodation of the subsequent late loss. The enforced mechanical remodeling by oversized new Wallstents may result in prevention of acute and chronic recoil of the vessel wall and subsequently a lower restenosis rate at follow-up.
Key Words: arteries • stents • coronary disease • restenosis • angiography • angioplasty
|
Introduction |
|---|
|
TopAbstractIntroductionMethodsResultsDiscussionReferences |
|---|
The new, less shortening, self-expanding Wallstent is characterized by longitudinal flexibility, a protective membrane, a low profile, and a customized range of diameters (3.5 to 6.0 mm) and lengths (12 to 42 mm). The recent modification in braiding angle has resulted in a new device with less shortening on expansion and a concomitant reduction in radial force.1 2 The fine mesh structure of the Wallstent provides maximal scaffolding to the vessel wall, which has previously encouraged extensive implantation of the original Wallstent prototype for the treatment of friable coronary vein grafts and a limited and less favorable implantation experience in native coronary arteries in the late 1980s.3 4 5 6 7 8 However, the safety and efficacy of implantation of the new, less shortening Wallstent in native coronary arteries is unknown. While we have long recognized that the greater the gain, the greater the loss,9 we also recognize that achieving a greater acute luminal gain allows greater subsequent accommodation of loss (in accordance with simple geometry and percent tax laws), and thus, although the absolute loss is greater, the net gain is also greater. Additionally, a recent multicenter stent study using a Palmaz-Schatz stent matched to vessel size demonstrated that the greater initial luminal gain contributed to a significantly lower restenosis rate in the stented group compared with the balloon angioplasty group.10 We hypothesized that implantation of the oversized new Wallstents in native coronary arteries (a policy of resetting the vessel size into undiseased condition) would produce enforced mechanical remodeling of the coronary vessel with subsequent reduction in subacute occlusion and improved accommodation of reactive intimal hyperplasia.
To test this hypothesis, we recently implanted 44 Wallstents into 35 native coronary arteries in 35 patients with acute or threatened closure post coronary balloon angioplasty. Wallstents were selected to produce oversizing of the stent diameter and complete coverage of the lesion length. QCA measurements were made pre primary balloon angioplasty and post Wallstent implantation and the follow-up angiogram by use of a QCA analysis system (CAAS II).
|
Methods |
|---|
|
TopAbstractIntroductionMethodsResultsDiscussionReferences |
|---|
Study Patients
To determine the feasibility and safety of deployment of the oversized new, less shortening Wallstent, we deployed 44 Wallstents in 35 native coronary arteries in 35 patients. Patients who had acute or threatened closure post coronary intervention with a dissected lesion length of >18 mm, an MVD of >3.0 mm, absence of significant disease in the major side branches, and absence of clinical contraindication to anticoagulation were included in the study.
Study End Points and Definition
The primary clinical end point of the study was the occurrence
of any of the following adverse cardiac events: acute or subacute
stent thrombosis, repeat coronary intervention,
coronary bypass surgery, myocardial infarction, or death.
Procedural success was defined as technically successful deployment of
the stent in the absence of an adverse cardiac event. Angiographic
success was defined as a <30% residual diameter stenosis
after final deployment of the stent. Stent thrombosis was defined as a
clinical event leading to catheterization that
identified stent thrombosis within 14 days of deployment. Long-term
clinical outcome included all cardiovascular events
occurring within 6 months of stent deployment. Angiographic
restenosis was defined as luminal narrowing 
50% diameter
stenosis at follow-up.
Criteria of Acute and Threatened Vessel Closure
Post balloon angioplasty (primary coronary angioplasty),
lesion morphology was categorized according to the dissection criteria
proposed by Huber et al,11 and coronary flow
distal to the lesion was classified according to the TIMI
criteria.12 Acute occlusion was defined as TIMI 0 flow.
Threatened closure was defined as TIMI 1, 2, or 3 flow with visible
dissection type C, D, E, or F or as dissection type A or B and TIMI 1,
2, or 3 flow with a residual diameter stenosis of
>50%.11 12
Stent Implantation
Balloon angioplasty and stent deployment were performed
according to standard clinical practice by the femoral approach at the
Thoraxcenter (Rotterdam, Netherlands). Recent intracoronary
ultrasound studies reported that atherosclerotic plaque is frequently
present even in angiographically normal proximal reference segments
in patients with significant coronary
stenosis.13 14 We therefore used the MVD from
on-line QCA, which would be expected to be closer to the original
vessel diameter in the nondiseased condition compared with the more
traditional use of the IRD for stent sizing. After determination of the
MVD on the diameter function of the on-line QCA analysis
system (in millimeters), a Wallstent with a nominal diameter of 1.0 mm
greater than the MVD and nominal length 5 to 10 mm longer than the
lesion length was selected (see Fig 1
). Of the 44 stents
used in 35 lesions, 3 were 4 mm in diameter, 11 were 4.5 mm in
diameter, 10 were 5 mm in diameter, 15 were 5.5 mm in diameter, and 5
were 6 mm in diameter. Of the 44 stents, 3 were 18 mm long, 26 were 23
to 28 mm long, 8 were 35 mm long, and 7 were 42 mm long. Twenty-two
patients received a single Wallstent, 7 received two Wallstents, and 1
had three Wallstents implanted. During the primary balloon angioplasty,
the balloon diameter was 3.0±0.6 mm and the maximum inflation pressure
was 10.6±3.1 atm. After delivery of the stent, high-pressure
intrastent balloon inflations (14.2±3.3 atm) using balloon diameters
of 4.0±0.6 mm to optimize stent expansion were performed in all 35
patients.
|
Anticoagulant Therapy
At the beginning of the procedure, patients were given an
intravenous bolus dose of 10 000 IU heparin and
subsequently 5000 IU as required to maintain the activated
clotting time >300 seconds throughout the procedure. All patients
received 100 mg/d aspirin. The postintervention anticoagulant regimen
was conventional15 : 1 hour after removal of the femoral
sheath, an intravenous heparin infusion was commenced to
maintain the activated partial thromboplastin time between 70
and 90 seconds until oral anticoagulant therapy (warfarin) had achieved
a prothrombin time international normalized ratio of 2.5 to 3.5.
Warfarin was prescribed for 3 months post stent implantation, and
aspirin indefinitely.16
QCA Analysis
The new version of the computer-based CAAS (CAAS
II)16 was used to perform both the on-line QCA
analysis (for immediate guidance of stent sizing in the
catheterization laboratory) as well as the subsequent
off-line cinefilm analysis. In the CAAS analysis,
which has previously been described elsewhere,17 18 19 20 21 22 23 the
entire cineframe, 18x24 mm, is digitized at a resolution of 1329x1772
pixels. Correction for pincushion distortion is performed before
analysis. Boundaries of a selected coronary segment are
detected automatically. The absolute diameter of the stenosis
(in millimeters) is determined by use of the guiding catheter as
a scaling device.24 To standardize the method of
analysis of the initial and follow-up angiograms, the
following measures were taken: all study frames selected for
analysis were end-diastolic to minimize motion
artifact, and arterial segments were measured between the
same identifiable branch points after the administration of isosorbide
dinitrate.25 26
QCA Parameters
Acute gain and late loss represent the improvement in
MLD achieved at intervention (MLD post stenting minus MLD pre) and the
changes at follow-up (MLD post stenting minus MLD at
follow-up), respectively. Net gain (gain minus loss), net gain
index (net gain divided by IRD pre), relative loss (loss divided by IRD
pre), and loss index (loss divided by gain) were studied. Acute stent
recoil (MLD during intrastent balloon inflation minus final MLD post
stenting) and percent acute stent recoil (acute recoil divided by MLD
during intrastent balloon inflation) were measured.27
|
Results |
|---|
|
TopAbstractIntroductionMethodsResultsDiscussionReferences |
|---|
Clinical Characteristics
The baseline clinical characteristics of the 35 patients are provided in Table 1
. Thirty of the patients were men,
and the mean age was 60±9 years (range, 40 to 76 years).
Twenty-seven patients had stable angina, and 8 had unstable
angina.28 Of the 8 patients with unstable angina, 5 had
Braunwald type II and 3 had type III.28
|
Angiographic Characteristics
The angiographic characteristics of the treated lesions are
given in Table 2. Of 35 lesions, 22 were in the right
coronary artery, 11 were in the left anterior descending
coronary artery, and the remaining 2 were in the circumflex
coronary artery. Seven of the lesions were ostial, and 16 were
at sites of a bifurcation. Pre balloon angioplasty, the lesions were
categorized according to the American College of
Cardiology/American Heart Association Task Force
criteria.29 Of the 35 lesions, 1 was type A, 22 were type
B, and the remaining 12 were type C. Post primary balloon angioplasty
and before Wallstent implantation, 1 lesion had a type A dissection, 6
a type B dissection, 24 a type C dissection, 2 a type D dissection, and
2 a type F dissection.11 TIMI flow12 was
grade 0 in 2 lesions, grade 2 in 1 lesion, and grade 3 in 32 lesions.
Intracoronary thrombus (intraluminal filling defect on
angiography) was evident in 8 lesions.30
|
Clinical Outcome
Stent deployment was successful in 44 of 44 stents (100%) in 35
patients. Fig 2 shows the clinical outcome of the 35
patients. One patient with a dilated but unstented lesion proximal to
the stented segment sustained a subacute occlusion on day 1
associated with a Q-wave myocardial infarction (creatine phosphokinase,
1840 IU/L) and was subsequently treated by proximal implantation of a
Palmaz-Schatz stent. The event-free survival at 30-day
follow-up was 97% (34 of 35 patients). Of the 34 patients eligible
for 6-month angiographic follow-up, 3 who were
asymptomatic declined repeat angiography. Angiographic
restenosis (>50% DS) was observed in 5 of 31 patients
(16%) at 6 months, all of whom underwent repeat angioplasty. Thus, the
overall event-free survival at 6-month follow-up was 83% (29
of 35 patients).
|
QCA Analysis
Table 3 shows the relationship between the nominal
diameter and length of the Wallstents selected and QCA analysis
results. The average nominal diameter of the Wallstents used was 1.40
mm greater than the MVD and 9.4 mm longer than the lesion length. Fig 3 provides an example of the serial angiographic outcome
in an individual patient; Fig 4 displays the results of
serial luminal diameter changes measured by QCA analysis for
the study population. MLD was 0.83±0.50 mm pre intervention. Post
stent implantation, high-pressure intrastent balloon dilatation of
14.2±3.3 atm with balloons 4.0±0.6 mm in diameter was performed in
all lesions. Implantation of the Wallstent increased the MLD to
3.06±0.48 mm.
|
|
|
Acute stent recoil and percent acute stent recoil were 0.52±0.31 mm
and 14±8%. Acute gain was 2.23±0.63 mm, late loss 0.78±0.61 mm, net
gain 1.47±0.92 mm, net gain index 0.55±0.37, relative loss
0.29±0.23, and loss index 0.38±0.37. Angiographic success (<30%
residual diameter stenosis) was achieved in all lesions
(100%). Of the 31 patients who underwent follow-up angiography, 5
had angiographic restenosis, yielding an angiographic
restenosis rate of 16% (5 of 31 patients). Fig 5 shows the sequential changes in % DS for the study
population. Average % DS decreased significantly from 72% pre
intervention to a final residual value of 28% at follow-up.
|
|
Discussion |
|---|
|
TopAbstractIntroductionMethodsResultsDiscussionReferences |
|---|
The novel findings of this study were as follows. (1) Delivery of the new, less shortening Wallstent to the target lesion can be achieved in a high proportion of cases (44 of 44 stents). (2) After delivery of the stent, angiographic success as defined by <30% residual diameter stenosis can be achieved with high-pressure intrastent balloon inflations in a high proportion of cases (35 of 35 lesions). (3) Despite the bailout indication, oversizing of the stent diameter and complete coverage of the lesion length resulted in a low risk of subacute stent thrombosis (3%) and subsequently conveyed a low restenosis rate at 6-month follow-up (16%).
Procedural Outcome
The high successful delivery rate of the Wallstent may be
attributed to a number of factors. First, the 1.57-mm profile of the
unexpanded Wallstent delivery system compares favorably with that of
other stents, and thus, an intraprocedural exchange of the guiding
catheter should rarely be necessary.2 Second, the
unconnected junctions of each filament of the Wallstent enhance the
longitudinal flexibility of the stent to aid the negotiation of
tortuous vessels. Third, the protective rolling membrane of the
Wallstent prevents dislodgment of the stent off the delivery system
during the delivery process to the target lesion. Fourth, the operators
who implanted the stents have extensive previous experience with the
Wallstent delivery system, which relative to other stents is
user-unfriendly and has a longer learning curve.
Early Outcome
Previous studies of bailout stenting have been reported for the
Gianturco-Roubin stent,31 32 33 34 35 the Palmaz-Schatz
stent,36 37 38 39 40 the original Wallstent
prototype,7 8 and the new AVE Microstent.41
These have been associated with a deployment success rate of 89% to
100%, a myocardial infarction rate of 4% to 43%, a coronary
bypass surgery rate of 0% to 60%, and a subacute thrombosis rate
of 7% to 16%. In the present study, 34 of 35 lesions had
dissection types B, C, D, E, and F, with a lesion length of >18 mm
after primary angioplasty; however, stenting was effective in tacking
back the dissection flap and restoring TIMI 3 flow in all 35 lesions.
Although 7 of the lesions had angiographic evidence of
intracoronary thrombus before stenting, deployment of the
Wallstent without the administration of intracoronary
thrombolytic therapy resulted in a low subacute
thrombosis rate (3%). Complete coverage of the dissection flaps
(average stent length, 35.6 mm) and optimal stent expansion by
high-pressure intrastent balloon inflation (14.2±3.3 atm) of the
oversized new, self-expanding Wallstent are all factors that may
have contributed to the low rate of subacute thrombosis and a low
risk of early clinical events.42
Late Outcome
While the reported angiographic restenosis rates
(50% DS at follow-up) have ranged from 21% to 53% for the
Gianturco-Roubin stent,31 32 33 34 35 43 13% to 38% for the
Palmaz-Schatz stent,10 36 37 38 39 40 44 45 and 14% to 34% for
the original Wallstent prototype,3 4 5 the angiographic
restenosis rate in this study was 16%. In our study, the
oversized Wallstent resulted in larger MLD post stenting (3.06 mm) that
was even greater than the reference vessel diameter pre intervention
(2.92 mm). While in previous stent studies, acute luminal gain at stent
implantation has ranged from 1.40 to 1.95 mm and late loss at
follow-up from 0.65 mm to 0.92 mm associated with
restenosis rates ranging from 22% to
38%,10 16 39 44 in our study, acute luminal gain at the
stent implantation was 2.23 mm and late loss at follow-up was 0.78
mm associated with a restenosis rate of 16%. The low loss
index of 0.38 and large net gain index of 0.55 indicate that our policy
of oversizing of the new Wallstent results in sufficient mechanical
remodeling of the vessel to enable accommodation of the limited luminal
loss and resultant low restenosis rate. Although the
presence of dissection has not been found to convey a more favorable
angiographic outcome after balloon angioplasty,46 the
vessels in which the internal elastic lamina has been disrupted before
stent placement may be more predisposed to a greater initial luminal
gain post stenting. The increased arterial distensibility
resulting from significant dissections might also contribute to an
improved long-term angiographic outcome in a stented vessel
compared with a stented vessel without significant dissection. This may
be one of the elements contributing to our more favorable loss index
compared with that recently reported for elective stenting in the
BENESTENT and STRESS studies.10 16 It should be
acknowledged that adoption of an oversizing policy with more rigid
balloon-expandable stents such as the Palmaz-Schatz stent may be
entirely inappropriate and unsafe, and the implications of our study
should be limited to the self-expanding new Wallstent. Furthermore,
it remains to be seen (a multicenter trial with the new Wallstent has
been initiated) whether such a policy can be safely executed at other
centers with less experience with the Wallstent.
Study Limitations
The number of patients reported in this early single-center
experience is small, and further multicenter experience with this new
stent design will be required before our policy of oversizing of the
new, less shortening Wallstent can be recommended.
Conclusions
Despite the indication of bailout management and the selection of
long, dissected lesions, implantation of the oversized new Wallstent
conveys a favorable acute and 6-month clinical and angiographic
outcome. The enforced mechanical remodeling by the oversized
self-expanding Wallstent may result in prevention of subacute
occlusion and chronic recoil of the vessel and subsequently improved
restenosis rates at follow-up.
|
Selected Abbreviations and Acronyms |
|---|
|
|
Acknowledgments |
|---|
Dr Ozaki is a recipient of a grant from Takeda Medical Research (Taisha Ijo) Foundation, Osaka, Japan. Dr Keane is a recipient of a travel grant from the Peel Medical Research Trust, London, UK. We gratefully acknowledge Dr Masakiyo Nobuyoshi for his helpful advice. We thank Marie-Angèle Morel for her preparation of the figures.
|
Footnotes |
|---|
Reprint requests to Patrick W. Serruys, MD, PhD, FESC, FACC, Professor of Interventional Cardiology, Thoraxcenter, Erasmus University, PO Box 1738, 3000 DR Rotterdam, The Netherlands.
Received September 5, 1995; revision received December 28, 1995; accepted January 2, 1996.
|
References |
|---|
|
TopAbstractIntroductionMethodsResultsDiscussionReferences |
|---|
-
Keane D, Buis B, Reifart N, Plokker TH, Ernst J,
Mast E, Renkin J, Heyndrickx G, Morel M, de Jaegere P, Serruys
PW. Clinical and angiographic outcome following implantation of
the new less shortening Wallstent in aorto-coronary vein
grafts: introduction of a second generation stent in the clinical
arena. J Intervent Cardiol. 1994;7:557-564. [Medline]
[Order article via Infotrieve]
-
Keane D, de Jaegere P, Serruys PW. Structural
design, clinical experience and current indications of the
coronary Wallstent. Cardiol Clin. 1994;12:689-697. [Medline]
[Order article via Infotrieve]
-
Sigwart U, Puel J, Mircowitch V, Joffre F,
Kappenberger L. Intravascular stents to prevent occlusion and
restenosis after transluminal angioplasty.
N Engl J Med. 1987;316:701-706. [Abstract]
-
Serruys PW, Strauss BH, Beatt KJ, Bertrand ME, Puel J,
Rickards A, Meier B, Goy JJ, Vogt P, Kappenberger L, Sigwart U.
Angiographic follow-up after placement of a self-expanding
coronary artery stent. N Engl J
Med. 1991;334:13-17.
[Abstract/Free Full Text]
-
Strauss BH, Serruys PW, Bertrand ME, Puel J, Meier B,
Goy JJ, Kappenberger L, Rickards AF, Sigwart U. Quantitative
angiographic follow-up of the coronary Wallstent in native
vessels and bypass grafts (European experience March 1986 to March
1990). Am J Cardiol. 1992;69:475-481. [Medline]
[Order article via Infotrieve]
-
deScheerder IK, Strauss BH, de Feyter PJ, Beatt KJ,
Baur LHB, Wihns W, Heyndrickx G, Suryapranata H, van den Brand M, Buis
B, Serruys PW. Stenting of venous bypass grafts: a new treatment
modality for patients who are poor candidates for
reintervention. Am Heart J. 1992;123:1046-1054. [Medline]
[Order article via Infotrieve]
-
Sigwart U, Urban P, Golf S, Kaufmann U, Imbert C,
Fisher A, Kappenberger L. Emergency stenting for acute occlusion
after coronary balloon angioplasty.
Circulation. 1988;78:1121-1127.
[Abstract/Free Full Text]
-
de Feyter PJ, DeScheerder I, van den Brand M, Laarman
GJ, Suryapranata H, Serruys PW. Emergency stenting for
refractory acute coronary occlusion during coronary
angioplasty. Am J Cardiol. 1990;66:1147-1150. [Medline]
[Order article via Infotrieve]
-
Rensing BJ, Hermans WRM, Vos J, Beatt KJ, Bossuyt P,
Rutsch W, Serruys PW. Angiographic risk factors of luminal
narrowing after coronary balloon angioplasty using balloon
measurements to reflect stretch and elastic recoil at the dilatation
site. Am J Cardiol. 1992;69:584-591. [Medline]
[Order article via Infotrieve]
-
Fischman DL, Leon MB, Baim DS, Schatz RA, Savage MP,
Penn IM, Detre K, Veltri L, Ricci D, Nobuyoshi M, Cleman MW, Heuser R,
Almond D, Teirstein PS, Fish RD, Colombo A, Brinker J, Moses J,
Shaknovich A, Hirshfeld J, Bailey S, Ellis S, Rake R, Goldberg
S. A randomized comparison of coronary stent placement
and balloon angioplasty in the treatment of coronary artery
disease. N Engl J Med. 1994;331:496-501.
[Abstract/Free Full Text]
-
Huber MS, Mooney JF, Madison J, Mooney MR. Use
of a morphologic classification to predict clinical outcome after
dissection from coronary angioplasty. Am J
Cardiol. 1991;68:467-471. [Medline]
[Order article via Infotrieve]
-
The TIMI Study Group. The Thrombolysis in
Myocardial Infarction (TIMI) Trial. N Engl J
Med. 1985;312:932-936. [Medline]
[Order article via Infotrieve]
-
St Goar FG, Pinto FJ, Alderman EL, Fitzgerald PJ,
Stadius ML, Popp RL. Intravascular imaging of angiographically
normal coronary arteries: an in vivo comparison with
quantitative angiography. J Am Coll
Cardiol. 1991;18:952-958. [Abstract]
-
Leung WH, Alderman EL, Lee TC, Stadius ML.
Quantitative arteriography of apparently normal coronary
segments with nearby or distant disease suggests presence of occult
nonvisualized atherosclerosis. J
Am Coll Cardiol. 1995;25:311-317. [Abstract]
-
Serruys PW, de Jaegere P, Kiemeneij F, Macaya C, Rutsch
W, Heyndrickx G, Emanuelsson H, Marco J, Legrand V, Materne P, Belardi
J, Sigwart U, Colombo A, Goy JJ, van den Heuvel P, Delcan J, Morel MA,
on behalf of 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;331:489-495.
[Abstract/Free Full Text]
-
Haase J, Escaned J, van Swijndregt EM, Ozaki Y,
Gronenschild E, Slager CJ, Serruys PW. Experimental validation
of geometric and densitometric coronary measurements on the new
generation cardiovascular angiography analysis
system (CAAS II). Cathet Cardiovasc Diagn. 1993;30:104-114. [Medline]
[Order article via Infotrieve]
-
Serruys PW, Booman F, Troost GJ, Reiber JHC, Gerbrands
JJ, van den Brand M, Cherrier F, Hugenholtz PG. Computerized
quantitative coronary angiography applied to
percutaneous transluminal coronary angioplasty:
advantages and limitations. In: Kaltenbach M, Gruentzig A, Rentrop K,
Bussmann WD, eds. Transluminal Coronary
Angiography and Intracoronary Thrombolysis.
Coronary Heart Disease IV. Berlin, Germany:
Springer-Verlag; 1982:110-124.
-
Serruys PW, Foley DP, de Feyter PJ, eds.
Quantitative Angiography in Clinical Practice. Dordrecht,
Netherlands: Kluwer Academic Publishers; 1994.
-
Ozaki Y, Keane D, Herrman JP, Foley D, Haase J, den
Boer A, Di Mario C, Serruys PW. Coronary arteriography
for quantitative analysis: an experimental and clinical
comparison of cinefilm and video recordings. Am
Heart J. 1995;129:471-475. [Medline]
[Order article via Infotrieve]
-
Ozaki Y, Keane D, Serruys PW. Fluctuation of
spastic location: a quantitative angiographic study.
J Am Coll Cardiol. 1995;26:1606-1614. [Abstract]
-
Keane D, Haase J, Slager CJ, van Swijndregt EM,
Lehmann KG, Ozaki Y, di Mario C, Kirkeeide R, Serruys PW.
Comparative validation of quantitative coronary angiography
systems: results and implications from a multicenter study using a
standardized approach. Circulation. 1995;91:2174-2183.
[Abstract/Free Full Text]
-
Ozaki Y, Keane D, Serruys PW. Progression and
regression of coronary stenosis in the long-term
follow-up of vasospastic angina.
Circulation. 1995;92:2446-2456.
[Abstract/Free Full Text]
-
Ozaki Y, Keane D, Nobuyoshi M, Hamasaki N, Popma JJ,
Serruys PW. Coronary lumen at 6 month follow-up of
the new radiopaque Cordis tantalum stent using quantitative angiography
and intracoronary ultrasound. Am J
Cardiol. 1995;76:1135-1143. [Medline]
[Order article via Infotrieve]
-
Herrmann JP, Keane D, Ozaki Y, den Boer A, Serruys
PW. Radiological quality of coronary guiding catheters:
a quantitative analysis. Cathet Cardiovasc
Diagn. 1994;33:55-60. [Medline]
[Order article via Infotrieve]
-
Keane D, Serruys PW. Quantitative
coronary angiography: an integral component of interventional
cardiology. In: Topol EJ, Serruys PW, eds.
Current Review of Interventional Cardiology.
2nd ed. Philadelphia, Pa: Current Medicine; 1995:205-233.
-
Ozaki Y, Keane D, Serruys PW. Relationship of
basal coronary tone and vasospastic activity in patients with
variant angina: a quantitative angiographic study. Br
Heart J. 1996;75:267-273.
[Abstract/Free Full Text]
-
Hermans WRM, Rensing BJ, Strauss BH, Serruys PW.
Methodological problems related to the quantitative assessment of
stretch, elastic recoil and balloon-artery ratio.
Cathet Cardiovasc Diagn. 1992;25:174-185. [Medline]
[Order article via Infotrieve]
-
Braunwald E. Unstable angina: a
classification. Circulation. 1989;80:410-414.
[Free Full Text]
-
Ryan TJ, Faxon DP, Gunnar RM, Kennedy JW, King SB III,
Loop FD, Peterson KL, Reeves TJ, Williams DO, Winters WL Jr. Guidelines
for percutaneous transluminal coronary
angioplasty: a report of the American College of
Cardiology/American Heart Association Task Force on
assessment of diagnostic and therapeutic
cardiovascular procedures (subcommittee on
percutaneous transluminal coronary
angioplasty). Circulation. 1988;78:486-502.
[Free Full Text]
-
Capone G, Wolf NM, Meyer B, Meister SG.
Frequency of intracoronary filling defects by angiography
in angina pectoris at rest. Am J Cardiol. 1985;56:403-406. [Medline]
[Order article via Infotrieve]
-
Roubin GS, Cannon AD, Agrawal SK, Macander PJ, Dean LS,
Baxley WA, Breland J. Intracoronary stenting for
acute and threatened closure complicating percutaneous
transluminal coronary angioplasty.
Circulation. 1992;85:916-927.
[Abstract/Free Full Text]
-
Hearn JA, King SB, Douglas JS, Carlin SF, Lembo NJ,
Ghazzal ZMB. Clinical and angiographic outcome after
coronary artery stenting for acute or threatened closure after
percutaneous transluminal coronary angioplasty:
initial results with a balloon-expandable, stainless steel
design. Circulation. 1993;88:2086-2096.
[Abstract/Free Full Text]
-
Lincoff AM, Topol EJ, Chapekis AT, George BS, Candela
RJ, Muller DW, Zimmerman CA, Ellis SG. Intracoronary
stenting compared with conventional therapy for abrupt vessel closure
complicating coronary angioplasty: a matched case-control
study. J Am Coll Cardiol. 1993;21:866-875. [Abstract]
-
George BS, Voorhees WD, Roubin GS, Fearnot NE,
Pinkerton A, Raizner AE, King SB, Holmes DR, Topol EJ, Kereiakes DJ,
Hartzler GO. Multicenter investigation of coronary
stenting to treat acute or threatened closure after
percutaneous transluminal coronary angioplasty:
clinical and angiographic outcomes. J Am Coll
Cardiol. 1993;22:135-143. [Abstract]
-
Sutton JM, Ellis SG, Roubin GS, Pinkerton GA, King SB,
Raizner AE, Holmes DR, Kereiakes DJ, Topol EJ for the Gianturco-Roubin
Intracoronary Stent Investigator Group. Major clinical
events after coronary stenting: the multicenter registry of
acute and elective Gianturco-Roubin stent placement.
Circulation. 1994;89:1126-1137.
[Abstract/Free Full Text]
-
Herrmann HC, Buchbinder M, Clemen MW, Fishman D,
Goldberg S, Leon MB, Schatz RA, Tierstein P, Walker CM, Hirshfeld
JW. Emergent use of balloon-expandable coronary
artery stenting for failed percutaneous transluminal
coronary angioplasty. Circulation. 1992;86:812-819.
[Abstract/Free Full Text]
-
Haude M, Erbel R, Straub U, Dietz U, Schatz R, Meyer
J. Results of intracoronary stents for management of
coronary dissection after balloon angioplasty. Am
J Cardiol. 1991;67:691-696. [Medline]
[Order article via Infotrieve]
-
Schömig A, Kastrati A, Mudra H, Blasini R,
Schühlen H, Klauss V, Richardt G, Neumann FJ.
Four-year experience with Palmaz-Schatz stenting in
coronary angioplasty complicated by dissection with threatened
or present vessel closure.
Circulation. 1994;90:2716-2724.
[Abstract/Free Full Text]
-
Schömig A, Kastrati A, Dietz R, Rauch B, Neumann
FJ, Katus HH, Busch U. Emergency coronary stenting for
dissection during percutaneous transluminal
coronary angioplasty: angiographic follow-up after stenting
and after repeat angioplasty of the stented segment.
J Am Coll Cardiol. 1994;23:1053-1060. [Abstract]
-
Colombo A, Goldberg SL, Almagor Y, Maiello L, Finci
L. A novel strategy for stent deployment in the treatment of
acute or threatened closure complicating balloon coronary
angioplasty. J Am Coll Cardiol. 1993;22:1887-1891. [Abstract]
-
Ozaki Y, Keane D, Ruykrok P, de Feyter PJ, Stertzer S,
Serruys PW. Acute clinical and angiographic results with the new
AVE micro coronary stent in bailout management.
Am J Cardiol. 1995;76:112-116. [Medline]
[Order article via Infotrieve]
-
Colombo A, Hall P, Nakamura S, Almagor Y, Maiello
L, Martini G, Gaglione A, Goldberg SL, Tobis JM.
Intracoronary stenting without anticoagulation accomplished
with intravascular ultrasound guidance.
Circulation. 1995;91:1676-1688.
[Abstract/Free Full Text]
-
Rodriguez AE, Santaera O, Larribau M, Fernandez M,
Sarmiento R, Baliño NP, Newell JB, Roubin GS, Palacios IF.
Coronary stenting decreases restenosis in lesions
with early loss in luminal diameter 24 hours after successful
PTCA. Circulation. 1995;91:1397-1402.
[Abstract/Free Full Text]
-
Savage MP, Fischman DL, Schatz RA, Teirstein PS, Leon
MB, Baim DS, Ellis S, Topol EJ, Hirshfeld J, Cleman MW, Buchbinder M,
Bailey S, Heuser R, Walker CM, Curry RC Jr, Gebhardt S, Rake R,
Goldberg S, on behalf of the Palmaz-Schatz Stent Study Group.
Long-term angiographic and clinical outcome after implantation of a
balloon-expandable stent in the native coronary
circulation. J Am Coll Cardiol. 1994;24:1207-1212. [Abstract]
-
Kimura T, Nosaka H, Yokoi H, Iwabuchi M, Nobuyoshi
M. Serial angiographic follow-up after Palmaz-Schatz stent
implantation: comparison with conventional balloon angioplasty.
J Am Coll Cardiol. 1993;21:1557-1563. [Abstract]
-
Hermans WM, Rensing BJ, Foley DP, Decker JW, Rutsch W,
Emanuelsson H, Danchin N, Wijns W, Chappuis F, Serruys PW.
Therapeutic dissection after successful coronary balloon
angioplasty: no influence on restenosis or on clinical
outcome in 693 patients. J Am Coll
Cardiol. 1992;20:767-780.[Abstract]
This article has been cited by other articles:
 |
|
 |
|
  J. Berkefeld, B. Turowski, A. Dietz, H. Lanfermann, M. Sitzer, T. Schmitz-Rixen, H. Steinmetz, and F. E. Zanella Recanalization Results after Carotid Stent Placement AJNR Am. J. Neuroradiol., January 1, 2002; 23(1): 113 - 120. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 P.W. Serruys, D.P. Foley, M. Pieper, J.A. Kleijne, and P.J. de Feyter on behalf of the TRAPIST investigators The TRAPIST Study. A multicentre randomized placebo controlled clinical trial of trapidil for prevention of restenosis after coronary stenting, measured by 3-D intravascular ultrasound Eur. Heart J., October 2, 2001; 22(20): 1938 - 1947. [Abstract] [PDF]
|
|
|
|
 |
|
 J. J. Wentzel, R. Krams, J. C. H. Schuurbiers, J. A. Oomen, J. Kloet, W. J. van der Giessen, P. W. Serruys, and C. J. Slager Relationship Between Neointimal Thickness and Shear Stress After Wallstent Implantation in Human Coronary Arteries Circulation, April 3, 2001; 103(13): 1740 - 1745. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 R. Kornowski, B. Bhargava, D. M. S. Fuchs, A. J. Lansky, L. F. Satler, A. D. Pichard, M. K. Hong, K. M. Kent, R. Mehran, G. W. Stone, et al. Procedural results and late clinical outcomes after percutaneous interventions using long (>=25 mm) versus short (<20 mm) stents J. Am. Coll. Cardiol., March 1, 2000; 35(3): 612 - 618. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. R. Holmes Jr., J. Hirshfeld Jr., D. Faxon, R. Vlietstra, A. Jacobs, S. B. King III, T. M. Bashore, N. D. Bridges, C. B. Higgins, L. F. Hiratzka, et al. ACC expert consensus document on coronary artery stents: Document of the American College of Cardiology J. Am. Coll. Cardiol., November 1, 1998; 32(5): 1471 - 1482. [Full Text] [PDF]
|
|
|
|
|
|
Y. Ozaki, A. G. Violaris, T. Kobayashi, D. Keane, E. Camenzind, C. Di Mario, P. de Feyter, J. R. T. C. Roelandt, and P. W. Serruys Comparison of Coronary Luminal Quantification Obtained From Intracoronary Ultrasound and Both Geometric and Videodensitometric Quantitative Angiography Before and After Balloon Angioplasty and Directional Atherectomy Circulation, July 15, 1997; 96(2): 491 - 499. [Abstract] [Full Text]
|
|
| |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||