Skip to main content
Hauptrubriken
CME Facharzt-Training Webinare Zeitschriften Bücher e.Medpedia Podcast
Service
Jobbörse Info & Hilfe
Fachgebiete
Anästhesiologie Allgemeinmedizin Arbeitsmedizin Augenheilkunde Chirurgie Dermatologie Gynäkologie und Geburtshilfe HNO Innere Medizin Kardiologie Neurologie Onkologie und Hämatologie Orthopädie und Unfallchirurgie Pädiatrie Pathologie Psychiatrie Radiologie Rechtsmedizin Urologie Zahnmedizin
Themen
Klimawandel und Gesundheit Neues aus dem Markt COVID-19 Praxis und Beruf Seltene Erkrankungen GOÄ & EBM Panorama
Sammlungen
Kasuistiken Algorithmen & Infografiken Blickdiagnosen Arthropedia FlapFinder (für Dermatochirurgen) Videos Kongressberichterstattung Medizin für Apothekerinnen und Apotheker Für Ärztinnen und Ärzte in Weiterbildung Für Medizinstudierende
Erweiterte Suche
Anmelden
nach oben
Clinical Research in Cardiology
Erschienen in: Clinical Research in Cardiology 4/2008

01.04.2008 | ORIGINAL PAPER

Sirolimus-eluting stents in the treatment of chronic total coronary occlusions

Results from the prospective multi-center German Cypher™ Stent Registry

verfasst von: Christian Zellerhoff, MD, Steffen Schneider, Ph.D, Jochen Senges, MD, Thomas Pfannebecker, Christian Hamm, MD, Ulrich Tebbe, MD

Erschienen in: Clinical Research in Cardiology | Ausgabe 4/2008

Einloggen, um Zugang zu erhalten

Abstract

Objectives

We assessed the effectiveness and safety of the sirolimus-eluting stent (SES) in the treatment of chronic total coronary occlusions.

Background

Chronic total occlusions (CTO) of coronary vessels have an unacceptable high restenosis rate of approximately 50% after stenting. Few data exist about the performance of drug eluting stents (DES) in the treatment of CTO.

Methods

All coronary interventions using the Cypher™ stent performed at 122 centers engaged in the German Cypher registry between April 2002 and December 2004 were analyzed; a total of 5,344 patients; 374 with and 4,970 without CTO were compared.

Results

There was no significant difference between both groups regarding demographics, coronary status and left ventricular function. Patients in the CTO group had a higher level of angina symptoms, the coronary lesions were more complex and the stents used were smaller and longer than in the No-CTO group. The In-hospital outcome was similar in both groups, with importantly no difference regarding mortality and complications. Stenting was as successful in the CTO as in the No-CTO group; during a follow-up of 6.6 months we found no significant difference regarding the rate of mortality, complications, and revascularization between both groups.

Conclusions

Implantation of the Cypher™ stent reduces the restenosis rate and seems to be a safe and effective tool for the treatment of chronic total coronary occlusions.
Literatur
1.
Agostoni P, Valgimigli M, Biondi-Zoccai G, Abbate A, et al. (2006) Clinical effectiveness of bare-metal stenting compared with balloon angioplasty in total coronary occlusions: insights from a systematic overview of randomized trials in light of the drug-eluting stent era. Am Heart J 151(3):682–689PubMedCrossRef
2.
3.
Arslan U, Balcioglu AS, Timurkaynak T, Cengel A (2006) The clinical outcomes of percutaneous coronary intervention in chronic total coronary occlusion. Int Heart J 47(6):811–819PubMedCrossRef
4.
Aziz S, Stables RH, Grayson AD, Perry RA, Ramsdale DR (2007) Percutaneous coronary intervention for chronic total occlusions: improved survival for patients with successful revascularization compared to a failed procedure. Catheter Cardiovas Interv 70(1):15–20CrossRef
5.
Baks T, van Geuns RJ, Duncker DJ, Cademartiri F, Mollet NR, Krestin GP, Serruys PW, de Feyter PJ (2006) Prediction of left ventricular function after drug-eluting stent implantation for chronic total coronary occlusions. J Am Coll Cardiol 47(4):721–725PubMedCrossRef
6.
Bauters C, Hubert E, Prat A, et al. (1998) Predictors of restenosis after coronary stent implantation. J Am Coll Cardiol 31:1291–1298PubMedCrossRef
7.
Bell MR, et al. (1992) Initial and long-term outcome of 354 patients following coronary balloon angioplasty of total coronary artery occlusions. Circulation 85:1003–1011PubMed
8.
Buller CE, et al. (1999) Primary stenting versus balloon angioplasty in occluded coronary arteries: the total occlusion study of Canada (TOSCA). Circulation 100:236–242PubMed
9.
Carlsson J, von Wagenheim B, Linder R, Anwari TM, Qvist J, Petersson I, Magounakis T, Lagerqvist B (2007) Is late stent thrombosis in drug-eluting stents a real clinical issue?: a single-center experience and review of the literature. Clin Res Cardiol 96(2):86–93PubMedCrossRef
10.
Centurion OA (2007) The open artery hypothesis: beneficial effects and long-term prognostic importance of patency of the infarct-related coronary artery. Angiology 58(1):34–44PubMedCrossRef
11.
Cook S, Walker A, Hügli O, Togni M, Meier B (2007) Percutaneous coronary interventions in Europe: prevalence, numerical estimates and projections based on data up to 2004. Clin Res Cardiol 96(6):375–382PubMedCrossRef
12.
Fischman DL, et al. (1994) A randomised comparison of coronary—stent placement and balloon angioplasty in the treatment of coronary artery disease. N Engl J Med 331:496–501PubMedCrossRef
13.
Ge L, Iakovou I, Cosgrave J, Chieffo A, Colombo A, et al. (2005) Immediate and mid-term outcomes of sirolimus-eluting stent implantation for chronic total occlusions. Eur Heart J 26(11):1056–1062PubMedCrossRef
14.
Gordon PC, Gibson CM, Cohen DJ, et al. (1993) Mechanism of restenosis and redilatation within coronary stents: quantitative angiographic assessment. J Am Coll Cardiol 21:1166–1174PubMed
15.
Hoffmann R, Mintz GS, Dussaillant GR, et al. (1996) Patterns and mechanisms of in-stent restenosis. A serial intravascular ultrasound study. Circulation 94:1247–1254PubMed
16.
Holmes DR Jr, et al. (1984) Angioplasty in total coronary artery occlusions. J Am Coll Cardiol 3:845–849PubMed
17.
Holmes DR Jr, et al. (1994) Restenosis with chronic total occlusion: the MARCATOR randomised trial experience (abstract). J Am Coll Cardiol 23:470A
18.
Jang JS, Hong MK, Lee CW, Park DW, Lee BK, Kim YH, Han KH, Kim JJ, Park SW, Park SJ (2006) Comparison between sirolimus- and Paclitaxel-eluting stents for the treatment of chronic total occlusions. J Invasive Cardiol 18:205–208PubMed
19.
Kandzari DE (2004) The challenges of chronic total coronary occlusions: an old problem in a new perspective. J Interv Cardiol 17(4):259–267PubMedCrossRef
20.
Kastrati A, Schömig A, Elezi S, et al. (1997) Predictive factors of restenosis after coronary stent placement. J Am Coll Cardiol 30:1428–1436PubMedCrossRef
21.
Khattab AA, Hamm CW, Senges J, Toelg R, Geist V, Bonzel T, Kelm M, Levenson B, Nienaber CA, Sabin G, Tebbe U, Schneider S, Richardt G (2007) Incidence and predictors of target vessel revascularization after sirolimus-eluting stent treatment for proximal left anterior descending artery stenoses among 2274 patients from the prospective multicenter German Cypher Stent Registry. Clin Res Cardiol 96(5):279–284PubMedCrossRef
22.
Kornowski R, Hong MK, Tio FO, et al. (1998) In-stent restenosis: contributions of inflammatory responses and arterial injury to neointimal hyperplasia. J Am Coll Cardiol 31:224–230PubMedCrossRef
23.
Lotan C, et al. (2000) Stents in total occlusion for restenosis prevention. Eur Heart J 21(23):1960–1966PubMedCrossRef
24.
Machecourt J, Danchin N, Lablanche JM, Fauvel JM, Bonnet JL, Marliere S, Foote A, Quesada JL, Eltchaninoff H, Vanzetto G (2007) EVASTENT Investigators. Risk factors for stent thrombosis after implantation of sirolimus-eluting stents in diabetic and nondiabetic patients: the EVASTENT Matched-Cohort Registry. J Am Coll Cardiol 50(6):501–508PubMedCrossRef
25.
Meier B (1991) Total coronary occlusion: a different animal? J Am Coll Cardiol 17:50B–57BPubMed
26.
Migliorini A, Moschi G, Vergara R, Parodi G, Carraba N, Antoniucci D (2006) Drug-eluting stent-supported percutaneous coronary intervention for chronic total coronary occlusion. Catheter Cardiovasc Interv 67(3):344–348PubMedCrossRef
27.
Morice MC, Serruys PW, Sousa JE, et al. (2002) for the RAVEL study group: a randomised comparison of a sirolimus-eluting stent with a standard stent for coronary revascularisation. N Engl J Med 346:1773–1780PubMedCrossRef
28.
Moses JW, Leon MB, Popma JJ, et al. (2003) Sirolimus-eluting stents versus standard stents in patients with stenosis in a native coronary artery. N Engl J Med 349:1315–1323PubMedCrossRef
29.
Motz W, Kaiser R (2006) Stent therapy with diabetic patients who have coronary artery disease. Clin Res Cardiol 95(supp 1):i27–i30PubMedCrossRef
30.
Nikolsky E, Gruberg L, Rosenblatt E, et al. (2004) Chronic total occlusion due to diffuse in-stent restenosis: is brachytherapy the solution? Int J Cardiovasc Intervent 6(1):33–38PubMed
31.
Prasad A, Rihal CS, Lennon RJ, Wiste HJ, Singh M, Holmes DR Jr (2007) Trends in outcomes after percutaneous coronary intervention for chronic total occlusions: a 25-year experience from the Mayo Clinic. J Am Coll Cardiol 49(15):1611–1618PubMedCrossRef
32.
Rubartelli P, Verna E, Niccolli L, et al. (2003) Coronary stent implantation is superior to balloon angioplasty for chronic coronary occlusions: six-year clinical follow-up of the GISSOC-trial. J Am Coll Cardiol 41(9):1488–1492PubMedCrossRef
33.
Safian RD, et al. (1988) Initial success and long-term follow-up of percutaneous transluminal coronary angioplasty in chronic total occlusions versus conventional stenoses. Am J Cardiol 61:23G–28GPubMedCrossRef
34.
Segev A, Strauss BH (2004) Novel approaches for the treatment of chronic total coronary occlusions. J Interv Cardiol 17(6):411–416PubMedCrossRef
35.
Serruys PW, et al. (1985) Elective PTCA of totally occluded coronary arteries not associated with acute myocardial infarction: short-term and long-term results. Eur Heart J 6:2–12PubMed
36.
Serruys PW, et al. (1994) A comparison of balloon—expandable—stent-implantation with balloon angioplasty in patients with coronary artery disease. N Engl J Med 331:489–495PubMedCrossRef
37.
Sheiban I, Moretti C, Kumar P, et al. (2004) Immediate and medium-term outcomes following the treatment of very long chronic total coronary artery occlusions. J Invasive Cardiol 16(1):5–9PubMed
38.
Simes PA, et al. (1996) Stenting in chronic total occlusion (SICCO): a randomised controlled trial of adding stent implantation after successful angioplasty. J Am Coll Cardiol 28:1444–1451CrossRef
39.
Sousa JE, Costa MA, Abizaid AC, et al. (2001) Sustained suppression of neointimal proliferation by sirolimus-eluting stents: one-year angiographic and intravascular ultrasound follow-up. Circulation 104:2007–2011PubMedCrossRef
40.
Stone GW, et al. (1990) Procedural outcome of angioplasty for total coronary artery occlusion: an analysis of 971 lesions in 905 patients. J Am Coll Cardiol 15:849–856PubMedCrossRef
41.
Unverdorben M, Degenhardt R, Wiemer M, Horstkotte D, Schneider H, Nienaber C, Bocksch W, Gross M, Boxberger M, Vallbracht C; for the PECOPS I Investigators. (2007) The Paclitaxel-Eluting Coroflextrade mark Please Stent Pilot Study (PECOPSI): the one-year clinical follow-up. Clin Res Cardiol; Epub ahead of print Please update the reference (Unverdorben et al., 2007)
42.
Weisz G, Moses JW (2007) New percutaneous approaches for chronic total occlusion of coronary arteries. Expert Rev Cardiovasc Ther 5(2):231–241PubMedCrossRef
43.
Werner GS, Fritzenwanger M, Prochnau D, Schwarz G, Krack A, Ferrari M, Figulla HR (2007) Improvement of the primary success rate of recanalization of chronic total coronary occlusions with the safe-cross system after failed conventional wire attempts. Clin Res Cardiol 96(7):489–496PubMedCrossRef
44.
Werner S, Krack A, Schwarz G, et al. (2004) Prevention of lesion recurrence in chronic total coronary occlusions by paclitaxel-eluting stents. J Am Coll Cardiol 44(12):2301–2306PubMedCrossRef
45.
Zahn R, Hamm CW, Schneider S, Zeymer U, Richardt G, Kelm M, Levenson B, Bonzel T, Tebbe U, Sabin G, Nienaber CA, Pfannebecker T, Senges J (2007) The Sirolimus-eluting coronary stent in daily routine practice in Germany: trends in indications over the years. Results from the prospective multi-centre German Cypher Stent Registry. Clin Res Cardiol 96(8):548–556PubMedCrossRef
46.
Zahn R, Hamm CW, Zeymer U, et al. (2004) “Real life” use of sirolimus-eluting coronary stents in Germany. Results from the prospective multi-centre German Cypher Registry. Z Kardiol 93(4):287–294PubMedCrossRef
47.
Zimarino M, Ausiello A, Contegiacomo G, Riccardi I, Renda G, Di Iorico C, De Caterina R (2006) Rapid decline of collateral circulation increases suspectibility to myocardial ischemia: the trade-off of successful percutaneous recanalization of chronic total occlusions. J Am Coll Cardiol 48(1):59–65PubMedCrossRef
Metadaten
Titel
Sirolimus-eluting stents in the treatment of chronic total coronary occlusions
Results from the prospective multi-center German Cypher™ Stent Registry
verfasst von
Christian Zellerhoff, MD
Steffen Schneider, Ph.D
Jochen Senges, MD
Thomas Pfannebecker
Christian Hamm, MD
Ulrich Tebbe, MD
Publikationsdatum
01.04.2008
Verlag
D. Steinkopff-Verlag
Erschienen in
Clinical Research in Cardiology / Ausgabe 4/2008
Print ISSN: 1861-0684
Elektronische ISSN: 1861-0692
DOI
https://doi.org/10.1007/s00392-007-0618-5

Weitere Artikel der Ausgabe 4/2008

Clinical Research in Cardiology 4/2008 Zur Ausgabe

ORIGINAL PAPER

Low HDL levels and the risk of death, sepsis and malignancy

ORIGINAL PAPER

Anomalous origin of the left coronary artery from the pulmonary artery: mid-term results after surgical correction

CRITICAL PERSPECTIVE

Abdominal aortic aneurysm repair in cardiac high risk patients – medication, surgery or stent?

CLINICAL CORRESPONDENCE

Cardiac magnetic resonance imaging: an essential diagnostic aid in suspected myocardial re-infarction in a 40 year old woman

CLINICAL CORRESPONDENCE

Delayed enhancement magnetic resonance imaging in isolated noncompaction of ventricular myocardium

CLINICAL CORRESPONDENCE

Left circumflex coronary artery fistula to the superior vena cava: assessment of the exact anatomy by multidetector CT

Neu im Fachgebiet Kardiologie

Die „Zehn Gebote“ des Endokarditis-Managements

30.04.2024 Endokarditis Leitlinie kompakt

Worauf kommt es beim Management von Personen mit infektiöser Endokarditis an? Eine Kardiologin und ein Kardiologe fassen die zehn wichtigsten Punkte der neuen ESC-Leitlinie zusammen.

Strenge Blutdruckeinstellung lohnt auch im Alter noch

30.04.2024 Arterielle Hypertonie Nachrichten

Ältere Frauen, die von chronischen Erkrankungen weitgehend verschont sind, haben offenbar die besten Chancen, ihren 90. Geburtstag zu erleben, wenn ihr systolischer Blutdruck < 130 mmHg liegt. Das scheint selbst für 80-Jährige noch zu gelten.

Sind Frauen die fähigeren Ärzte?

30.04.2024 Gendermedizin Nachrichten

Patienten, die von Ärztinnen behandelt werden, dürfen offenbar auf bessere Therapieergebnisse hoffen als Patienten von Ärzten. Besonders gilt das offenbar für weibliche Kranke, wie eine Studie zeigt.

Dihydropyridin-Kalziumantagonisten können auf die Nieren gehen

30.04.2024 Hypertonie Nachrichten

Im Vergleich zu anderen Blutdrucksenkern sind Kalziumantagonisten vom Diyhdropyridin-Typ mit einem erhöhten Risiko für eine Mikroalbuminurie und in Abwesenheit eines RAS-Blockers auch für ein terminales Nierenversagen verbunden.

Update Kardiologie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

Newsletter bestellen
Bildnachweise