Allograft vasculopathyRe-stenosis After Drug-eluting Stents in Cardiac Allograft Vasculopathy
Section snippets
Methods
The study population consisted of all cardiac transplant patients with a diagnosis of transplant vasculopathy who received at least one DES for a previously untreated coronary lesion at the University of Alabama at Birmingham (UAB). These patients were retrospectively followed until February 2007. At our institution, coronary angiograms are routinely performed to screen for CAV at yearly intervals. Once CAV is diagnosed or suspected, angiograms are performed at shorter intervals based on the
Results
The population consisted of 35 patients who underwent PCI with DES on 84 de novo lesions at UAB. The baseline characteristics of the study population are shown in Table 1. The population was 33% women and 31% non-white, with a mean age of 56 ± 12 years.
The characteristics of the coronary lesions treated are listed in Table 2. Of the lesions treated with a DES, 82% were done after a screening coronary angiogram rather than precipitated by symptoms. Cypher stents (Cordis, Johnson & Johnson, San
Discussion
In this study we have reported on the largest series to date investigating the use of DES in de novo lesions of CAV since their introduction into the clinical arena. Patients were followed for a mean of 22 months, clinically and using routine angiograms looking for the progression of coronary vasculopathy, rates of DES re-stenosis and re-vascularization thereafter, complications, death and cardiac re-transplantation.
CAV remains the “Achilles heel” of cardiac transplantation and is the main
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Cited by (20)
Tissue characterization of progressive cardiac allograft vasculopathy in patients with everolimus therapy compared with donor-transmitted atherosclerosis assessed using serial intravascular imaging: A case report
2014, Transplantation ProceedingsCitation Excerpt :A previous study showed that mechanical interventions such as drug-eluting stents produce at least a temporary benefit; however, due to the diffuse nature of the epicardial and intramyocardial arterial lesions observed, stents are a suboptimal treatment. The report concluded that medical therapy, including everolimus, should be more effective than mechanical interventions [2,15]. To this effect, Nakatani et al reported that potent regression of proliferative neointima was observed in CAV after everolimus administration [16].
Diagnosis, prevention and treatment of cardiac allograft vasculopathy
2012, Revista Portuguesa de CardiologiaComparison of drug-eluting versus bare metal stents in cardiac allograft vasculopathy
2011, American Journal of CardiologyCitation Excerpt :Still, PCI can provide palliation, and our study has demonstrated that DESs offers angiographic and clinical benefit compared to BMSs, with no additional risk conferred. Not all previous studies evaluating the use of stents in transplant recipients with CAV have demonstrated an advantage of lower restenosis with DESs versus BMSs, although there is certainly a trend in that direction.8–12 Only 2 studies have found no difference in restenosis,13,14 and 3 have shown a significantly lower restenosis rate with DES.15–17
Diverse morphologic manifestations of cardiac allograft vasculopathy: A pathologic study of 64 allograft hearts
2011, Journal of Heart and Lung TransplantationCitation Excerpt :CAV is currently not entirely preventable or treatable. Mechanical interventions such as drug-eluting stents20 have shown at least temporary benefit; however, due to the diffuse nature of the epicardial and intramyocardial arterial lesions observed, stents are a sub-optimal treatment. Drug therapy, such as everolimus, should be more effective than mechanical interventions.21
Sirolimus-eluting stent fractures leading to restenosis in cardiac allograft vasculopathy
2010, Cardiovascular Revascularization MedicineCitation Excerpt :Balloon angioplasty and bare-metal stents (BMS) have been used for revascularization of focal lesions, but they are associated with a high risk of restenosis [9]. Limited data have shown favorable results with drug-eluting stents (DES) [10–12]. Several cases of restenosis in DES in association with stent fractures (SFs) were recently reported.
The first three authors (R.A., B.J.W., F.G.H.) contributed equally to this work.