- Author
-
K. Teeuwen
- Title
- Percutaneous coronary intervention with evolving stent technology for treating totally occluded native coronary arteries
- Supervisors
-
J.G.P. Tijssen
- Co-supervisors
-
M.J. Suttorp
- Award date
- 7 September 2018
- Number of pages
- 227
- ISBN
- 9789462339903
- Document type
- PhD thesis
- Faculty
- Faculty of Medicine (AMC-UvA)
- Abstract
-
Chronic total coronary occlusions (CTO) remain the most complex lesions for percutaneous revascularization. Historically, percutaneous coronary intervention of CTO was hampered by high rates of restenosis and reocclusions. The introduction of drug-eluting stents significantly improved the treatment of CTO-PCI by reducing the rate of restenosis and reocclusions. In this thesis we investigated bare metal stents and first, second -and third-generation drug-eluting stents (DES) in CTO. In the first part we focus on the efficacy and clinical safety of these stents in three multi-centre randomized clinical trials. In Chapter 2, we showed that intima proliferation is continuous at the long-term with first generation and not halted by DES. In Chapter 3 and 4 we showed worse angiographic outcome with second-generation Endeavor zotarolimus-eluting stents compared to first-generation Sirolimus-eluting stents (SES). On the other hand, non-inferiority could be established with second-generation Resolute zotarolimus-eluting stent compared to SES. In Chapter 4-8 we compared the second-generation thin-strut everolimus-eluting stent (EES) to the third-generation ultra thin-strut sirolimus-eluting stent (Hybrid SES). At 9-month, primary non-inferiority angiographic endpoint was not met for Hybrid SES with higher rate of binary restenosis compared to EES. The difference in outcome was mostly attributed in the sub-group of smaller stent diameters. EES showed higher rates of uncovered stent struts, on the other hand Hybrid SES demonstrated higher rates of malapposition and evaginations. In the last part Chapter 9 and 10, we showed that residual distal stenosis behind the CTO could be safely deferred from immediate stenting and that continuous thermodilution is a promising technique to investigate the coronary physiology.
- Persistent Identifier
- https://hdl.handle.net/11245.1/0f165eda-1a70-4b0d-a7d4-79e84476e740
- Downloads
-
Thesis (complete)
Front matter
Chapter 1: Introduction and outline thesis
Chapter 2: Late catch-up in lumen diameter at five-year angiography in MACE-free patients treated with sirolimus-eluting stents in the Primary Stenting of Totally Occluded Native Coronary Arteries: A randomised comparison of bare metal stent implantation with sirolimus-eluting stent implantation for the treatment of total coronary occlusions (PRISON II)
Chapter 3: Primary Stenting of Totally Occluded Native Coronary Arteries III (PRISON III): A randomised comparison of sirolimus-eluting stent implantation with zotarolimus- eluting stent implantation for the treatment of total coronary occlusions
Chapter 4: Three-year clinical outcome in the Primary Stenting of Totally Occluded Native Coronary Arteries III (PRISON III): A randomized comparison of sirolimus-eluting stent implantation with zotarolimus-eluting stent implantation for the treatment of total coronary occlusions
Chapter 5: A randomized multicenter comparison of hybrid sirolimus-eluting stents with bioresorbable polymer versus everolimus-eluting stents with durable polymer in total coronary occlusion: Rationale and design of the Primary Stenting of Occluded Native Coronary Arteries IV study
Chapter 6: Randomized multicenter trial investigating angiographic outcomes of hybrid sirolimus-eluting stents with biodegradable polymer compared with everolimus-eluting stents with durable polymer in chronic total occlusions: The PRISON IV trial
Chapter 7: Optical coherence tomography findings: Insights from the “randomised multicentre trial investigating angiographic outcomes of hybrid sirolimus-eluting stents with biodegradable polymer compared with everolimus-eluting stents with durable polymer in chronic total occlusions” (PRISON IV) trial
Chapter 8: Impact of ultra-thin struts on restenosis after chronic total recanalization: Insights from the randomized PRISON IV trial
Chapter 9: Clinical implications of distal vessel stenosis after successful coronary chronic total occlusion recanalization
Chapter 10: Recovery of absolute coronary flow and resistance one week after Percutaneous coronary intervention of a chronic total occluded coronary artery, using the novel rayflow© infusion catheter
Chapter 11: Discussion and future perspectives; Summary and conclusions; Samenvatting en conclusies
Chapter 12: Dankwoord; List of publications; Curriculum vitae
Stellingen
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