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Selbstexpandierende Koronarstents

Indikationen und Limitationen

Self-expanding coronary stents

Indications and limitations

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Der Kardiologe Aims and scope

Zusammenfassung

Selbstexpandierende Koronarstents stellen eine eigenständige Option in der Behandlung von Koronarstenosen dar. Aufgrund der speziellen elastischen Materialeigenschaften ihres Nitinolgerüsts werden sie aktuell bevorzugt zur Therapie von großlumigen Bifurkations- (z. B. distale Hauptstammstenosen), ektatischen und aneurysmatischen Gefäßen, venösen Bypassgrafts sowie Koronardissektionen eingesetzt. Nachteilig sind eine schwierigere Handhabung im Vergleich zu ballonexpandierenden Stents sowie eine erhöhte Rigidität, welche die Freisetzung in stark gewundenen oder verkalkten Gefäßen erschwert. Limitierend ist zudem der aktuell hohe Stückpreis, der im deutschen DRG-System noch unzureichend refinanziert wird. Im Einzelfall kann der Einsatz eines selbstexpandierenden Koronarstents jedoch eine schwierige Koronarpathologie meistern und ist daher eine Bereicherung für das Portfolio eines Katheterlabors.

Abstract

Self-expanding coronary stents represent an independent option in the therapy of coronary artery disease. The specific elastic material property of the nitinol scaffold makes them a preferred treatment for large diameter bifurcations (e. g. distal main stem stenoses), ectatic and aneurysmatic vessels, saphenous vein grafts and dissections. Compared to balloon expandable stents, specific training with self-expanding coronary stents is necessary for adequate handling and their stiffness can hinder insertion in tortuous and calcified lesions. Another limiting factor is their current costs, which are not fully reimbursed by the German diagnosis-related groups (DRG) system; however, in special cases the use of a self-expanding stent can solve a difficult coronary pathology where balloon expandable stents have limitations. Self-expanding stents are therefore an additional asset in any catheter laboratory.

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Abbreviations

ACS:

Akutes Koronarsyndrom

BMS:

„Bare metal stent“ (unbeschichteter Stent)

D1:

„First diagonal branch“ (erster Diagonalast)

F:

French

HS:

Hauptstamm

IVUS:

Intravaskulärer Ultraschall

LAD:

„Left anterior descending“

LCX:

„Left circumflex artery“

MACE:

„Major adverse cardiac outcome“ (schweres unerwünschtes kardiales Ereignis)

NC-Ballon:

Non-compliant-Ballon

NUB:

Neue Untersuchungs- und Behandlungsmethoden

OCT:

Optische Kohärenztomographie

RCA:

„Right coronary artery“

SES:

Sirolimus-Eluting-Stent

STEMI:

ST-Hebungsinfarkt

TAP:

„T and protrusion technique“

TLR:

„Target lesion failure“ (Versagen der Zielläsion)

Literatur

  1. Amoroso G, van Geuns RJ, Spaulding C et al (2011) Assessment of the safety and performance of the STENTYS self-expanding coronary stent in acute myocardial infarction: results from the APPOSITION I study. EuroIntervention 7:428–436

    Article  PubMed  Google Scholar 

  2. Bennet J, Adriaenssens T, Desmet W et al (2016) Complex bifurcation lesions: randomized comparison of a fully bioresorbable modified t stenting strategy versus bifurcation reconstruction with a dedicated self-expanding stent in combination with bioresorbable scaffolds, an OCT study: Rationale and design of the COBRA II trial. Catheter Cardiovasc Interv. doi:10.1002/ccd.26571

    Google Scholar 

  3. Bouki KP, Sakkali E, Toutouzas K et al (2015) Impact of coronary artery stent edge dissections on long-term clinical outcome in patients with acute coronary syndrome: an optical coherence tomography study. Catheter Cardiovasc Interv 86:237–246

    Article  PubMed  Google Scholar 

  4. Briguori C, Visconti G, Donahue M et al (2015) The STENTYS® paclitaxel-eluting stent in the treatment of unprotected distal left main. Cathet Cadiovasc Interv 86:131–139

    Article  Google Scholar 

  5. Buehler WJ, Gilfrichet JV, Wiley RC (1963) Effects of low-temperature phase changes on the mechanical properties of alloys near composition TiNi. J Appl Phys 34:1475

    Article  CAS  Google Scholar 

  6. Buysschaert I, Dubois CL, Dens J et al (2013) Three-year clinical results of the Axxess Biolimus A9 eluting bifurcation stent system: the DIVERGE study. EuroIntervention 9:573–581

    Article  PubMed  Google Scholar 

  7. Buysschaert I, Verheye S (2015) The axess stent. EuroIntervention 11:V143–V144

    Article  PubMed  Google Scholar 

  8. Danzi GB, Sesana M, Arieti M et al (2015) Does optimal lesion preparation reduce the amount of the Absorb BVS? Insights from a real-world population. Catheter Cardiovasc Interv 86:984–991

    Article  PubMed  Google Scholar 

  9. Fröbert O, Sarno G, James SK et al (2013) Effect of stent inflation pressure and post-dilatation on the outcome of coronary artery intervention. A report of more than 90 000 stent implantations. PLOS ONE 8(2):e56348

    Article  PubMed  PubMed Central  Google Scholar 

  10. Grube E, Buellesfeld L, Neumann FJ et al (2007) Six-month clinical and angiographic results of a dedicated drug-eluting stent for the treatment of coronary bifurcation narrowings. Am J Cardiol 99:1691–1697

    Article  CAS  PubMed  Google Scholar 

  11. Hasegawa T, Ako J, Koo BK et al (2009) Analysis of left main coronary artery bifurcation lesions treated with biolimus-eluting DEVAX AXXESS plus nitinol self-expanding stent: intravascular ultrasound results of the AXXENT trial. Catheter Cardiovasc Interv 73:34–41

    Article  PubMed  Google Scholar 

  12. Kim BK, Oh SJ, Jeon DW et al (2007) Is stent underexpansion the main cause of in-stent restenosis after sirolimus-eluting stent implantation? An intravascular ultrasound study. Korean Circ J 37:58–63

    Article  Google Scholar 

  13. Koch K, Grundeken M, Vos N et al (2015) One-year clinical outcomes of the STENTYS self-apposing coronary stent in patients presenting with ST-segment elevation myocardial infarction: results from the APPOSITION III registry. EuroIntervention 11:264–271

    Article  PubMed  Google Scholar 

  14. Lüscher TF, Steffel J, Eberli FR et al (2007) Drug-eluting stent and coronary thrombosis. Biological mechanisms and clinical implications. Circulation 115:1051–1058

    Article  PubMed  Google Scholar 

  15. Moncalvo C, Puma V, Laurenz A et al (2015) Old saphenous vein grafts with important degeneration treated with self-expandable stents: our experience. J Am Coll Cardiol Intv 8:S31

    Article  Google Scholar 

  16. Naber CK, Pyxaras SA, Nef H et al (2016) Final results of a self-apposing paclitaxel-eluting stent fOr the PErcutaNeous treatment of de novo lesions in native bifurcated coronary arteries study. EuroIntervention 12:356–358

    Article  PubMed  Google Scholar 

  17. Sammartin M, Goicolea J, Alfonso F et al (2002) Implications of late expansion of self-expanding stents on neointimal response: a serial study with Intravascular ultrasound. Rev Esp Cardiol 55:16–24

    Article  Google Scholar 

  18. Serruys PW (2015) The treatment of coronary bifurcations, a true art form. EuroIntervention 11:V7

    Article  PubMed  Google Scholar 

  19. Sigwart U, Puel J, Mirkovitch V et al (1987) Intravascular stents to prevent occlusion and restenosis after transluminal angioplasty. N Engl J Med 316:701–706

    Article  CAS  PubMed  Google Scholar 

  20. Siry M (2016) Bewährtes Stentsystem in neuem Outfit: Freisetzung eines selbstexpandierenden Koronarstents mithilfe eines Split-Ballons. Spitzenforschung Herz-Kreislauf-Medizin. Verlag ALPHA Informationsgesellschaft mbH, Lampertheim, S 130–131

  21. Siry M (2016) STEMI in an aneurysmatic right coronary artery - a challenging case – case presentation. EuroPCR, Paris

    Google Scholar 

  22. Siry M, Biesenberger S, May AE (2016) Linkskoronare Hauptstammintervention mittels selbstexpandierender Bifurkations-Stentsystem. Clin Res Cardiol 105(Suppl. 1). doi:10.1007/s00392-014-1100-9

    Google Scholar 

  23. Siry M, Wimmert-Roidl D, May AE (2016) Spontane Koronardissektion und Takotsubo-Kardiomyopathie als Ausdruck eines akuten Koronarsyndroms; Interventioneller Therapie-ansatz mittels eines selbstexpandierenden Stentsystems. Clin Res Cardiol 105(Suppl. 2). doi:10.1007/s00392-016-1036-3

    Google Scholar 

  24. Smolka G, Wańha W, Roleder T et al (2014) Treatment of left main coronary artery stenosis with the STENTYS self-expandable drug-eluting stent – a pilot registry. Postepy Kardiol Interwencyjnej 10:226–230

    PubMed  PubMed Central  Google Scholar 

  25. Stoeckel D, Pelton A, Duering T (2004) Self expanding nitinol stents: material and design considerations. Eur Radiol 14:292–301

    Article  PubMed  Google Scholar 

  26. Talarico GP, Burzotta F, Trani C et al (2010) Thrombus aspiration without additional ballooning or stenting to treat selected patients with ST-elevation myocardial infarction. J Invasive Cardiol 22(10):493

    Google Scholar 

  27. Urban P, Meredith IT, Abizaid A et al (2015) Polymer-free drug-coated coronary stents in patients at high bleeding risk. N Engl J Med 373:2038–2047

    Article  CAS  PubMed  Google Scholar 

  28. Van Geuns RJ, Yetgin T, La Manna A et al (2016) STENTYS Self-Apposing® sirolimus-eluting stent in ST-segment elevation myocardial infarction: results from the randomised APPOSITION IV trial. EuroIntervention 11:1267–1274

    Article  Google Scholar 

  29. Verheye S, Ramcharitar S, Grube E et al (2011) Six-month clinical and angiographic results of the STENTYS(R) self-apposing stent in bifurcation lesions. EuroIntervention 2011:580–587

    Article  Google Scholar 

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Authors and Affiliations

  1. Medizinische Klinik I, Klinikum Memmingen, Bismarckstr. 23, 87700, Memmingen, Deutschland

    M. Siry & A. E. May

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  1. M. Siry
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  2. A. E. May
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Correspondence to M. Siry.

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Interessenkonflikt

M. Siry gibt an, Vortragstätigkeit für STENTYS durchgeführt und Reisekostenunterstützung erhalten zu haben. A.E. May gibt an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

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Siry, M., May, A.E. Selbstexpandierende Koronarstents. Kardiologe 11, 48–55 (2017). https://doi.org/10.1007/s12181-016-0108-y

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