• Title/Summary/Keyword: Very late stent thrombosis

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Very Late Stent Thrombosis after Sole Stent-Assisted Coiling at the Paraclinoid Giant Aneurysm : Could Prophylactic Antiplatelet Therapy Be Ceased at the Only 1 Year after Procedure?

  • Shin, Jung-Hoon;Park, Seong-Ho;Kim, Chang-Hyun;Lee, Chang-Young
    • Journal of Korean Neurosurgical Society
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    • v.56 no.4
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    • pp.344-347
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    • 2014
  • Stent thrombosis is a major limitation of stent-assisted coiling, which is an effective method for treating wide-necked aneurysms. Although early in-stent thrombosis has been reported, very late stent thrombosis (VLST) (>1 year) has not been reported following implantation of a single self-expandable stent designed for coiling. Herein, the authors present a case of VLST that occurred 14 months after single stent implantation in a large paraclinoid aneurysm with an ultra-wide neck involving the parent artery circumferentially. This case indicates the need for establishing guidelines regarding the optimal duration of prophylactic antiplatelet therapy following stent-assisted coiling, which remains undefined in the neuroendovascular field.

Clinical Outcomes of Stent Thrombosis after Drug-Eluting Coronary Stent Implantation (약물방출 관상동맥 스텐트 시술 후 스텐트 혈전증 발생 환자의 임상경과)

  • Kim, In-Soo;Jeong, Myoung-Ho;Han, Jae-Bok;Jang, Young Ill;Jang, Seong-Joo
    • The Journal of the Korea Contents Association
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    • v.13 no.12
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    • pp.880-892
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    • 2013
  • Stent thrombosis after successful drug-eluting stent(DES) implantation has been reported in around 1% of patients in clinical trials. However, the increased risk of ST associated with DES remains a matter of concern. From 1 June 2003 to 30 June 2013, we investigated clinical characteristics, in-hospital outcomes in 10,273 patients who underwent percutaneous coronary intervention in the Heart Center of CNUH. Overall incidence of ST was 1.30% (134 patients). The incidence of ST according to the stent generations and the timing of ST (n=total, early vs. late vs. very late) were 0.79% (n=81, 26 vs. 12 vs. 43) in first-generation, 0.38% (n=39, 21 vs. 9 vs. 9) in second-generation and 0.14% (n=14, 8 vs 3 vs. 3) in third-generation, (p=0.70). The mortality from ST was significantly higher in early ST group compared to the late and very late ST groups (18.2% vs. 8.3% vs. 3.6%, p=0.042). Overall incidence of ST after DES implantation was 1.30% (134 patients). The in-hospital mortality was significantly higher in early ST group compared to the late and very late ST groups.

Occurrence and Prognosis for the Thrombosis in the Drug-Eluting Stents and Bare-Metal Stents (약물 용출 스텐트와 일반 금속 스텐트에서 혈전증에 대한 발생과 예후)

  • Kim, In-Soo;Choi, Nam-Gil;Jang, Seong-Joo;Han, Jae-Bok;Jang, Young-Ill
    • The Journal of the Korea Contents Association
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    • v.12 no.7
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    • pp.273-283
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    • 2012
  • Drug-eluting stents (DES) have significantly reduced in-stent restenosis, compared to bare-metal stents (BMS). However, there remains concern for the increased risk of stent thrombosis (ST) associated with DES. The present study sought to evaluate the incidence, clinical characteristics and outcome of ST in patients with acute myocardial infarction (MI) during a 1-year follow-up. 80 patients who developed ST were divided into 2 groups according to stent type: group I (DES-ST, n = 57 ) and group II (BMS-ST, n = 23 ). There were no differences between group I and II in the overall incidence of ST (2.7% vs. 4.3%, p=0.064) and in the incidence of each type of ST: acute ST (8.8% vs. 2.3%), subacute ST (50.9% vs. 60.9%), late ST (19.3% vs. 8.7%), and very late ST (21.1% vs. 17.4%) (p=0.605). Predictors of 1-year mortality were the occurrence of ST (OR 8.12, 95% CI 2.83-23.61, p<0.001), left ventricular ejection fraction<40% (OR 6.41, 95% CI 2.42-16.96, p<0.001), and age${\geq}$75 years (OR 4.98, 95% CI 1.95-12.74, p=0.001).

Improving Smoothness of Hydrophilic Natural Polymer Coating Layer by Optimizing Composition of Coating Solution and Modifying Chemical Properties of Cobalt-Chrome Stent Surface (코팅 용액의 조성 최적화 및 코발트-크롬 금속스텐트의 화학적 표면개질을 통한 친수성 천연 고분자 코팅층의 표면 거칠기 개선)

  • Kim, Dae Hwan;Kum, Chang Hun
    • Journal of Chitin and Chitosan
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    • v.23 no.4
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    • pp.256-261
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    • 2018
  • Recently, the number of cardiovascular disease-related deaths worldwide has increased. Therefore, the importance of percutaneous cardiovascular intervention and drug-eluting stents (DES) has been highlighted. Despite the great clinical success of DES, the re-endothelialization at the site of stent implantation is retarded owing to the anti-proliferative effect from the coated drug, resulting in late thrombosis or very late restenosis. In order to solve this problem, studies have been actively carried out to excavate new drugs that promote rapid re-endothelialization. In this study, we introduced hydrophilic drug, tauroursodeoxycholate (TUDCA), that improves the proliferation of endothelial progenitor cells and promotes apoptosis of vascular smooth muscle cells. In addition, we utilized shellac, which is a natural resin from lac bug to coat TUDCA on the surface of the metal. When using conventional coating method including biodegradable polymers and organic solvents, phase separation between polymer and drug occurred in the coating layer that caused incomplete incorporation of drug into the polymer layer. However, when using shellac as a coating polymer, no phase separation was observed and drug was fully covered with the polymer matrix. In addition, by adjusting the composition of coating solution and modifying the hydrophilicity of the metal surface using oxygen plasma, the surface roughness decreased due to the increased affinity between coating solution and metal surface. This result provides a method of depositing a hydrophilic drug layer on the stent.