CC May 2015 Coronary artery stents

echoecho's version from 2015-05-06 16:17


Question Answer
What type of option was introduced in the late 1970s for chronic angina due to stable atherosclerotic coronary artery disease patients and those who suffered an AMI (acute myocardial infarction)?PCI (percutaneous coronary intervention)
What does balloon angioplasty do?it opens blockages in narrowed vessels using catheter-associated devices
What 2 complications could occur with balloon angioplasty?1. dissection 2. restenoses resulting in vessel closure
What was the next development that could maintain the luminal integrity of reopened vessels?implantable coronary artery stents
What was the first implantable coronary artery stents?bare metal stents
What 3 different types of metal were used in bare metal stents?1. stainless steel 2. chromium 3. alloys of stainless steel and chromium
What 3 disadvantages were seen with bare metal stents?1. proliferative endothelial reactions 2. subsequent restenosis of the native artery 3. required repeat revascularization in as many as 1 out of 3 patients
Because of the 3 disadvantages of bare metal stents, what stent was developed?DES (drug-eluting stent)
How did DES (drug-eluting stents) work?released antiproliferative agents in a controlled manner
What was the advantage of DES (drug-eluting stents) over bare metal stents?the DES (drug-eluting stents) reduced the risk of restenosis
What 2 drugs did the early-generation DES (drug-eluting stents) use?1. sirolimus (Cypher) 2. paclitaxel (Taxus)
The early-generation DES (drug-eluting stents) used what type of frame? stainless steel frame
What 3 vessel conditions did the early-generation DES (drug-eluting stents) lessen?1. lessened endothelialization of the stent 2. lessened vessel remodeling 3. lessened persistent fibrin and platelet deposition
What 2 drugs did the newer-generation DES (drug-eluting stents) use?1. everolimus (Promus PREMIER) 2. zotarolimus (Resolute, Endeavor)
The newer-generation DES (drug-eluting stents) used what type of 2 frames?1. cobalt-chrome 2. platinum-chrome
How were the newer-generation DES (drug-eluting stents) better in way of improved endothelial coverage?they produced struts that were more biocompatible
Comparison of the bare metal stents, 7 patients need to receive _____-eluting stents and 8 patients have to receive _____- eluting stents to prevent one episode of restenosis?sirolimus ; paclitaxel
Trials have shown similar efficacy with everolimus and sirolimus stents, but with reduced rates of ______ with everolimus and zotarolimus when compared to paclitaxel?restenosis
What is another significant risk for patients receiving any type of stent. What 3 sequelae can occur as a result? 1. acute thrombosis of the stent 2. vessel occlusion, AMI, death
List the 5 risk factors for stent thrombosis?1. stent placement after an acute coronary syndrome 2. technically difficult placements 3. placement in pts with diabetes 4. those who have an inherent resistant to antiplatelet therapy 5. those who prematurely discontinue antiplatelet therapy
The risk of stent thrombosis is highest in the first ____ days after placement of a bare metal stent?30
What two medications recommended to be used for at least 30 days after placement of a bare metal stent?DUAL antiplatelet therapy of 1) aspirin AND 2) a P2Y12 inhibitor (clopidogrel [Plavix])
***The risk of stent thrombosis persists for much longer in what type of stent and current recommendations are to continue dual antiplatelet therapy for at least 12 months after placement?DES (drug-eluting stents)
What was the conclusion from the REAL-LATE and ZEST-LATE trials regarding during of treatment with dual antiplatelet therapy after DES (drug-eluting stent) placement?the use of dual antiplatelet therapy BEYOND 12 months AFTER implantation of DES (drug-eluting stents) did not reduce mortality or AMi when compared to ASA alone
Is there sufficient evidence to recommend a shorter course of therapy (albeit changing dual antiplatetlet therapy to single antiplatelet therapy may result in similar cardiovascular outcomes and less risk of bleeding)?no
*** The ACC/AHA guidelines for PCI make several recommendations. After PCI, how long should patients remain on aspirin?indefinitely
*** The ACC/AHA guidelines for PCI make several recommendations. For patients with stable coronary artery disease requiring elective PCI, what type of stent is recommended (only if they can adhere to dual antiplatelet therapy for a prolonged period of time)?DES (drug-eluting stents)
For patients with AMI, where urgent PCI remains the standard of care, which type of stent should has better outcomes in respect to mortality and subsequent AMI?there is no differences between a bare metal stent and DES (drug-eluting stent) in respect to mortality and subsequent AMI?
What 2 causes are contributory to the fact that there is no difference between bare metal stents and DES (drug-eluting stents) in respect to mortality and subsequent AMI?1. even though the risk of restenosis and need for revascularlixation is LOWER for DES (drug-eluting stents), the risk of stent thrombosis is HIGHER with DES (drug-eluting stents) over time 2. there is a risk of noncompliance with dual antiplatelet therapy
The ACC/AHA gives a ______ recommendation to DES use in patients with AMi due to their reduced risk of revascularization?1A
What type of stent does the ACC/AHA recommend for patients with diabetes?recommends the newer-generation of DES (drug-eluting stents) over bare metal stents or early generation DES (drug-eluting stents)
Which of the 2 newer-generation DES (drug-eluting stents) has the most favorable outcomes for diabetic patients?everolimus-eluting stents
Why do diabetic patients have a higher risk of restenosis?they seem to induce an exaggerated intimal hyperplasia
What is recommended for those with mullti-vessel disease?a discussion of risks and benefits (by a multidisciplinary heart team) of stent placement compared to coronary artery bypass graft surgery
Which type of stent is preferred in patients with contraidincations to dual antiplatelet therapy?bare metal stents