Carotid endarterectomy has been the standard of therapy for carotid occlusive disease in stroke prevention. This paper reviews the current status of carotid stenting, including results from clinical trials, technical aspects and controversial issues and strategies to provide cerebral protection from embolization.

Pubmed abstract

Boston Scientific announced that the data from its TAXUS Clinical Trial Program, including the Meta Analysis, shows excellent efficacy and safety in treatment of small vessels (<2.5mm diameter).

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Enhancement of the generation of nitric oxide (NO) and vascular endothelial growth factor (VEGF) are suggested to prevent restenosis after angioplasty. Accordingly, authors tested whether the local delivery of L-arginine (L-Arg), a substrate for NO generation and the VEGF gene, alone or in combination, can influence neointima formation in hypercholesterolemic rabbits.

Abstract

Coronary artery disease is a major cause of morbidity and mortality in diabetic patients. Coronary revascularization, using percutaneous coronary intervention (PCI) and/or coronary artery bypass graft (CABG), haved lower prognosis in terms of repeated interventions and mortality in diabetic compared with the non-diabetic population. In the late 80s, the BARI trial [1988-1991] demonstrated that diabetic patients with three-vessel disease or two-vessel disease involving the proximal left anterior descending artery had greater survival with CABG compared with PCI (without stenting) (76.4% versus 55.7%, p=0.0011) even though at 7-years there was no difference in the non-diabetic population.

Abstract

Rapid reestablishment of infarct vessel patency and microvascular flow provides the best opportunity for minimizing mortality in the patient post myocardial infarction (MI). Early infarct artery patency can be restored by thrombolysis, primary angioplasty, or facilitated percutaneous coronary intervention (PCI). In comparative studies, primary angioplasty offers a greater mortality benefit than thrombolysis in patients with acute MI.

Abstract

Objectives: To study the clinical significance of infarct location during long term follow up in a trial comparing thrombolysis with primary angioplasty. Design: Retrospective longitudinal cohort analysis of prospectively entered data. Setting: Patients with acute ST elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention (PCI). Patients: In the Zwolle trial 395 patients with acute STEMI were randomly assigned to intravenous streptokinase or PCI. Main outcome measures: Survival according to infarct location and treatment after 8 (2) years of follow up.

Abstract

The combination of oral anticoagulation (OAC) and aspirin was the antithrombotic treatment initially adopted after coronary stenting (PCI-S). Although dual antiplatelet therapy with aspirin and a thienopyridine subsequently proved safer and more effective, OAC and aspirin combination is still used in patients with an indication for long-term OAC undergoing PCI-S.

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Researchers at Rensselaer Polytechnic Institute and University of North Carolina at Chapel Hill have discovered an alternative way to produce heparin, a drug commonly used to stop or prevent blood from clotting.

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S0601, consisting of active ingredients (Chuangxiongol and paeoniflorin), has been shown to inhibit arterial neointimal hyperplasia in animal models and in preliminary human studies. The objective of this study was to evaluate the safety and efficacy of XS0601 in preventing restenosis following percutaneous coronary intervention (PCI).

PubMed abstract

he Food and Drug Administration said Friday it would work with Boston Scientific Corp. to quickly resolve corporate-wide regulatory deficiencies.

In a statement, the agency acknowledged it met with top company officials earlier Friday to discuss the serious regulatory problems the FDA outlined in a rare corporate warning letter issued last week.

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Results from a prospective, randomized clinical trial of small coronary vessels suggest that the CYPHER(R) Stent outperformed the Taxus Stent in three key endpoints that are utilized to assess efficacy: late lumen loss (primary endpoint), restenosis and target lesion revascularization (secondary). The ISAR-SMART Trial results appear today in the February issue of the European Heart Journal.

At 12 months follow-up, patients treated with the CYPHER(R) Stent demonstrated significantly better results than those patients treated with the Taxus Stent: In-stent late lumen loss in the Taxus Stent group was 0.56 +/- 0.59, compared to the CYPHER(R) Stent patient group 0.25 +/- 0.55 (p value= 0.001). Angiographic binary restenosis (greater than or equal to 50% diameter stenosis) was found in 19.0 percent of the lesions in the Taxus Stent group and 11.4 percent of the lesions in the CYPHER(R) Stent group (p value= 0.047). Furthermore, target lesion revascularization was conducted in 14.7 percent of the lesions treated with the Taxus Stent versus 6.6 percent of the lesions treated with the CYPHER(R) Stent (p value=0.008)

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A total of 2950 patients were included in the meta-analysis (1476 received PCI, and 1474 received conservative treatment). There was no significant difference between the 2 treatment strategies with regard to mortality, cardiac death or myocardial infarction, nonfatal myocardial infarction, CABG, or PCI during follow-up. By random effects, the risk ratios (95% CIs) for the PCI versus conservative treatment arms were 0.94 (0.72 to 1.24), 1.17 (0.88 to 1.57), 1.28 (0.94 to 1.75), 1.03 (0.80 to 1.33), and 1.23 (0.80 to 1.90) for these 5 outcomes, respectively.

Abstract

This study evaluated the effects of localized delivery of nitric oxide (NO) from hydrogels covalently modified with S-nitrosocysteine (Cys-NO) on neoinitma formation, a key component of restenosis, in a rat balloon-injury model.

Abstract

ngiotech Pharmaceuticals Inc., maker of the drug coating used in Boston Scientific Corp.’s Taxus cardiac stents, agreed to buy American Medical Instruments Holdings Inc. for $785 million in cash to acquire tools used by surgeons and radiologists.

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For more than 80 years, the name Terumo® has been synonymous with innovative medical devices.

Terumo is now a comprehensive resource for peripheral embolization technologies. Terumo account representatives support a portfolio that includes Bead Block™ Compressible Microspheres, Progreat™ ? Microcatheters, Glidewire® GT Gold Coil Guidewires, Glidecath® XP Hydrophilic Coated Catheters, and Glidesheath™ Hydrophilic Coated Introducer Sheaths. These devices, as well as the company’s account services and customer support, offer the dependability, predictability, and consistency—the overall excellence— that have become the hallmarks of Terumo.

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