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Coronary Artery Disease: HELP
Articles by Alessandro Sticchi
Based on 16 articles published since 2008
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Between 2008 and 2019, Alessandro Sticchi wrote the following 16 articles about Coronary Artery Disease.
 
+ Citations + Abstracts
1 Review Fractional flow reserve (FFR) as a guide to treat coronary artery disease. 2018

Mangiacapra, Fabio / Bressi, Edoardo / Sticchi, Alessandro / Morisco, Carmine / Barbato, Emanuele. ·a Unit of Cardiovascular Science , Campus Bio-Medico University , Rome , Italy. · b Department of Advanced Biomedical Sciences , University of Naples Federico II , Napoli , Italy. · c Cardiovascular Research Center Aalst , OLV Hospital , Aalst , Belgium. ·Expert Rev Cardiovasc Ther · Pubmed #29923434.

ABSTRACT: INTRODUCTION: The presence and extent of myocardial ischemia are the major determinants of prognosis in patients with coronary artery disease (CAD). Unlike coronary angiography alone, fractional flow reserve (FFR) has enabled interventional cardiologists to accurately determine whether coronary atherosclerotic plaques are responsible for myocardial ischemia, and therefore deserve to be revascularized. Areas covered: An overview on the role of FFR in the diagnosis and treatment of coronary artery disease, as well as the potential related controversies is provided. Authors describe the coronary physiology underneath this technique and all the procedural aspects in the catheterization laboratory. The landmark trials and the current applications in different coronary lesions and syndromes are also described and potential future research involving FFR and comparisons with other methodologies for the evaluation of coronary physiology are introduced. Expert commentary: FFR is still unsurpassed in diagnostic performance when compared to non-hyperemic indices and noninvasive techniques, and remains the gold standard for the detection of ischemia-inducing coronary stenoses. FFR-guided PCI has been demonstrated superior to an angiography-guided PCI and over medical therapy alone, and ongoing investigation will clarify whether it could perform better, or at least equalize the results of cardiac surgery in patients with severe multivessel disease.

2 Review Newly available and recent advances in drug-eluting stents. 2013

Costopoulos, Charis / Latib, Azeem / Naganuma, Toru / Sticchi, Alessandro / Giannini, Francesco / Colombo, Antonio. ·Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy. ·Expert Rev Cardiovasc Ther · Pubmed #23621138.

ABSTRACT: The introduction of drug-eluting stents has revolutionized the treatment of coronary artery disease. First-generation stents, however, were associated with relatively high revascularization rates and the risk of stent thrombosis. This has led to a worldwide search for improvements in stent technology that will reduce adverse cardiac events following stent implantation while providing optimal treatment. Here, the authors discuss recent advances in stent technology from improvements in stent platform and stent polymer to newer mechanisms of drug delivery and the incorporation of proendothelizing agents. The authors also introduce some of the newly available stents and discuss the evidence associated with their use in clinical practice.

3 Article Transradial versus transfemoral ancillary approach in complex structural, coronary, and peripheral interventions. Results from the multicenter ancillary registry: A study of the Italian Radial Club. 2018

Cortese, Bernardo / Rigattieri, Stefano / Aranzulla, Tiziana C / Russo, Filippo / Latib, Azeem / Burzotta, Francesco / Agostoni, Pierfrancesco / Ielasi, Alfonso / Tarantino, Fabio / Sticchi, Alessandro / Di Palma, Gaetano / de Benedictis, Mauro / Trani, Carlo / Boccaletti, Roberto / Miccoli, Rosa / Valsecchi, Orazio / Colombo, Antonio. ·Interventional Cardiology, A.O. Fatebenefratelli, Milano, and Fondazione Monasterio CNR-Regione Toscana, Italy. · Interventional Cardiology, Sandro Pertini Hospital, Rome, Italy. · Interventional Cardiology, Mauriziano Hospital, Torino, Italy. · Cardiovascular Interventional Unit, Cardiology Department, S. Anna Hospital, Como, Italy. · Interventional Cardiology, San Raffaele Scientific Institute and EMO-GVM Centro Cuore Columbus, Milan, Italy. · Institute of Cardiology, Catholic University of the Sacred Heart, Rome, Italy. · St. Antonius Hospital, Nieuwegein, The Netherlands. · Interventional Cardiology, Bolognini Hospital, Seriate, Italy. · Interventional Cardiology, Ospedale Morgagni-Pierantoni, Forlì, Italy. · Interventional Cardiology, Ospedale Papa Giovanni, Bergamo, Italy. ·Catheter Cardiovasc Interv · Pubmed #28463463.

ABSTRACT: OBJECTIVES: to understand the role of a transradial (TR) secondary approach during complex percutaneous interventions. BACKGROUND: The value of the TR route for ancillary vascular approach has not been adequately validated in this setting, and there is scant data on its role in reducing bleeding complications. METHODS: In the present study we retrospectively included patients undergoing the following interventions requiring two vascular approaches at nine high-volume centers in Italy: structural cardiac interventions, complex PCI, endovascular aortic repair (EVAR) and complex lower limb angioplasty. We compared procedural outcomes according to the type of ancillary vascular approach selected, namely TR or transfemoral/transbrachial (TF/TB). Primary endpoints of the study were procedural success and in-hospital BARC grade 3-5 bleedings. RESULTS: We included 906 patients, 433 receiving TR and 473 TF/TB ancillary approaches. Baseline characteristics did not differ significantly. Patients underwent the following types of intervention: structural 50%, complex coronary PCI 37%, EVAR 11%, peripheral angioplasty 2%. Procedural success was similar (90% in TR and 92% TF/TB, P = NS). In-hospital BARC 3/5 bleedings were more common in TF/TB group as compared to TR group (19.7% vs. 6.7%,P < 0.001). In TF/TB group we also observed a higher postprocedural hemoglobin drop (1.92 vs 1.13 g/dl, P = 0.008) and longer hospital stay as compared to TR group. Similar results were observed in a propensity score-matched population of 450 patients. CONCLUSIONS: In our study TR ancillary approach was associated with a significant reduction in the risk of major bleedings, without jeopardizing the success of complex structural, coronary, and peripheral percutaneous interventions. The value of the transradial route for ancillary vascular approach during percutaneous interventions has not been adequately validated yet. We retrospectively included 906 patients, 433 receiving TR and 473 TF/TB ancillary approach at nine high-volume centers for the following interventions: structural cardiac interventions, complex PCI, EVAR and complex peripheral angioplasty. Procedural success was similar, whereas in-hospital BARC bleedings were more common in the transfemoral/brachial group. Similar results were observed in a propensity score-matched population. In our study TR ancillary approach was associated with a significant reduction in the risk of major bleedings, without jeopardizing the success of complex interventions. © 2017 Wiley Periodicals, Inc.

4 Article Expansion in calcific lesions and overall clinical outcomes following bioresorbable scaffold implantation optimized with intravascular ultrasound. 2017

Kawamoto, Hiroyoshi / Ruparelia, Neil / Latib, Azeem / Miyazaki, Tadashi / Sato, Katsumasa / Tanaka, Akihito / Naganuma, Toru / Sticchi, Alessandro / Chieffo, Alaide / Carlino, Mauro / Montorfano, Matteo / Colombo, Antonio. ·Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy. · Interventional Cardiology Unit, EMO-GVM Centro Cuore Columbus, Milan, Italy. · Interventional Cardiology Unit, New Tokyo Hospital, Chiba, Japan. · Department of Cardiology, Imperial College, London, United Kingdom. · Department of Cardiovascular Medicine, Juntendo University Hospital, Tokyo, Japan. · Department of Cardiology, Fukuyama Cardiovascular Hospital, Hiroshima, Japan. ·Catheter Cardiovasc Interv · Pubmed #27545845.

ABSTRACT: OBJECTIVES: This study aimed to investigate clinical outcomes following bioresorbable scaffold (BRS) optimized with intravascular ultrasound (IVUS), and furthermore expansion of BRS in calcific lesions. BACKGROUND: Although IVUS use has contributed to improved clinical outcomes with metallic stent implantation, it is unclear if this is also true with regards to BRS, especially in calcified lesions. METHODS: Between May 2012 and April 2015, 291 lesions in 198 patients were treated with BRS with IVUS use. We evaluated overall clinical outcomes at 1-year and investigated the expansion and eccentricity index of BRS amongst quadrants categorized by calcium arc (CA) every 90-degrees. RESULTS: The rates of major adverse cardiac events were 5.4% (at 6 months) and 10.7% (at 12 months). TLR was observed in 3.1% at 6-month and 7.5% at 12-month follow up. Although there was a significant difference among quadrants regarding to eccentricity of calcium (0°≦CA < 90°: 0.82 ± 0.09, 90°≦CA < 180°: 0.75 ± 0.12, 180°≦CA < 270°: 0.78 ± 0.11, and 270°≦CA≦360°: 0.79 ± 0.09, ANOVA P = 0.002), the BRS expansion index [minimal scaffold area (MSA) divided by BRS area expanded at a nominal pressure] was comparable between quadrants. CONCLUSIONS: The use of IVUS to optimize BRS implantation results in favorable clinical outcomes even for complex lesions. Although eccentric calcium distribution resulted in asymmetric expansion of BRS, the final MSA was comparable irrespective of calcium distribution. © 2016 Wiley Periodicals, Inc.

5 Article Treatment of drug-eluting stent restenosis: Comparison between drug-eluting balloon versus second-generation drug-eluting stents from a retrospective observational study. 2016

Basavarajaiah, Sandeep / Naganuma, Toru / Latib, Azeem / Sticchi, Alessandro / Ciconte, Giuseppe / Panoulas, Vasilis / Chieffo, Alaide / Montorfano, Matteo / Carlino, Mauro / Colombo, Antonio. ·Heart of England NHS Trust, Birmingham, United Kingdom. sandeep270478@gmail.com. · EMO-GVM Centro Cuore Columbus, Milan, Italy. sandeep270478@gmail.com. · San Raffaele Scientific Institute, Milan, Italy. sandeep270478@gmail.com. · EMO-GVM Centro Cuore Columbus, Milan, Italy. · San Raffaele Scientific Institute, Milan, Italy. ·Catheter Cardiovasc Interv · Pubmed #26715370.

ABSTRACT: OBJECTIVES: To compare drug-eluting balloons (DEBs) versus second-generation DES in the treatment of drug-eluting stent restenosis (DES-ISR). BACKGROUND: The optimal treatment of DES-ISR remains unclear. Several modes of treatment ranging from plain-old balloon angioplasty to repeated use of DES have yielded disappointing results. DEBs are increasingly been used in restenotic lesions; however, their use in DES-ISR is less established. METHODS: We evaluated all procedures between 2009 and 2011, involving DES-ISR that were treated either with DEB or second-generation DES. The measured end-points during the follow-up period were cardiac-death, target-vessel MI, TLR, TVR, and MACE defined as composite of cardiac-death, TV-MI, and TVR. RESULTS: Two hundred and forty-seven patients (302 lesions) with DES-ISR were treated with either DEB (81 patients; 104 lesions) or second-generation DES (166 patients; 198 lesions). The mean age of patients was 66.1 ± 9.4 years. There were higher numbers of patients with diabetes in the DEB group (DEB 47% vs DES 33%; p = 0.03). The mean length of DEB was significantly longer than the DES (35.4 vs 19.8 mm; p < 0.001). During the 12-month follow-up, there were no significant differences in the MACE rates (12.3% vs 8.4%; p = 0.3) and TLR rates (9.9% vs 7.8%; p = 0.6) between DEB and DES, respectively. On the multivariate analysis, use of DEB or DES was not the predictor of MACE (hazard ratio: 0.84, 95% CI: 0.46-1.85; p = 0.6). There were no cases of definite or probable stent thrombosis in either group. CONCLUSION: There were no significant differences in the clinical outcomes between DEB and second-generation DES in the treatment of DES-ISR. These results should encourage operators to consider DEB in the treatment of DES-ISR, which offers certain advantages over DES. © 2015 Wiley Periodicals, Inc.

6 Article Biolimus-Eluting StenT For de-novo coRonary artery dIsease in patiENts with Diabetes mellituS: the BESTFRIENDS multicentre registry. 2016

Meliga, Emanuele / Lupi, Alessandro / Latib, Azeem / Gagnor, Andrea / Boccuzzi, Giacomo / Alcantara, Marco / Lombardi, Primiano / Sticchi, Alessandro / Aranzulla, Tiziana C / Scrocca, Innocenzo / Varbella, Ferdinando / De Benedictis, Mauro / Colombo, Antonio / Conte, Maria Rosa. ·aMauriziano: Meliga, Aranzulla, Scrocca, De Benedictis, Conte bMaggiore: Lupi cSan Raffaele: Latib, Sticchi, Colombo dDegli Infermi: Gagnor, Varbella eSG Bosco: Boccuzzi fCentro Medico: Alcantara gCardinal Massaia: Lombardi. ·J Cardiovasc Med (Hagerstown) · Pubmed #26599681.

ABSTRACT: AIMS: Coronary inflammation and healing influence outcomes of diabetic patients treated with Percutaneous coronary revascularization (PCI). Stents covered with biodegradable polymers (bp) may offer advantages over nonerodible polymer ones, because polymer reabsorption extinguish coronary inflammation and favours healing. Aim of our study was to assess the safety and efficacy of bp-biolimus-eluting stent (bp-BES) in a large series of consecutive diabetic patients. METHODS: From 2009 to 2013 we retrospectively enrolled consecutive diabetic patients treated with PCI and bp-BES implantation. Primary end points were target lesion revascularization (TLR) and stent thrombosis rates. RESULTS: Study cohort counted 747 patients. Multivessel disease was present in 48.2% with a mean stent/patient ratio of 1.860.78. During the hospital stay no stent thrombosis occurred. At 3-year follow-up we observed a 1.5% cumulative incidence of cardiac death, 1.1% of myocardial infarction and 6.3% of TLR. Stent thrombosis occurred in 1.1% of patients, all in the first 2 years of follow-up. Kaplan-Meier analysis showed a TLR-free survival at 1 and 3 years of 97.2 and 96.1%, respectively. CONCLUSION: PCI with bp-BES seems to be well tolerated and effective in a large unselected population of diabetic patients. The good results observed were maintained at 3 years of follow-up.

7 Article Clinical outcomes following target lesion revascularization for bioresorbable scaffold failure. 2016

Tanaka, Akihito / Ruparelia, Neil / Kawamoto, Hiroyoshi / Sticchi, Alessandro / Figini, Filippo / Carlino, Mauro / Chieffo, Alaide / Montorfano, Matteo / Latib, Azeem / Colombo, Antonio. ·Interventional Cardiology Unit, EMO-GVM Centro Cuore Columbus, Milan, Italy. · Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy. · Imperial College, London, United Kingdom. ·Catheter Cardiovasc Interv · Pubmed #26331577.

ABSTRACT: OBJECTIVES: To investigate clinical outcomes following target lesion revascularization (TLR) for bioresorbable scaffold (BRS) failure in a real world population. BACKGROUND: BRS has become a new option in percutaneous coronary intervention, and may be potentially advantages because of the absence of a permanent metallic cage and the possibility for restoration of vasomotion and endothelial function. However, the requirement for TLR following BRS has been reported, but data on outcomes following reintervention are currently lacking. METHODS: Eighteen patients (20 lesions) who underwent TLR for BRS failure were identified at two high-volume centers in Milan, Italy. Clinical outcomes including all cause death, myocardial infarction, and repeat TLR after TLR for BRS failure were examined. RESULTS: The type of scaffold failure at TLR was classified into focal pattern in 15 lesions, diffuse pattern in two lesions, restenosis at side branch ostium in one lesion and scaffold thrombosis in two lesions. TLR was treated with plain old balloon angioplasty (POBA) in two lesions, with drug-coating balloon in three lesions, drug eluting stent implantation in 11 lesions, further BRS implantation in four lesions. During the followup (median: 345 days after TLR), one sudden death and three repeat TLRs were observed. CONCLUSION: In our series, we observed an adverse event rate of 20% of during the followup period following TLR for BRS failure. The optimal treatment option for these patients remains to be determined.

8 Article Procedural outcomes of patients with calcified lesions treated with bioresorbable vascular scaffolds. 2016

Panoulas, Vasileios F / Miyazaki, Tadashi / Sato, Katsumasa / Naganuma, Toru / Sticchi, Alessandro / Kawamoto, Hiroyoshi / Figini, Filippo / Chieffo, Alaide / Carlino, Mauro / Montorfano, Matteo / Latib, Azeem / Colombo, Antonio. ·National Heart and Lung Institute, Imperial College London, London, United Kingdom. ·EuroIntervention · Pubmed #25868742.

ABSTRACT: AIMS: To compare the feasibility, procedural and clinical outcomes after implantation of bioresorbable vascular scaffolds (BVS) in patients with calcified lesions. METHODS AND RESULTS: We assessed the feasibility of BVS implantation and procedural outcomes in patients with and without calcific lesions. The primary outcome was angiographic and procedural success. Secondary outcomes included major adverse cardiovascular events (MACE). Of 163 patients, 62 (38%) had calcified lesions. Patients with calcific lesions had a higher prevalence of diabetes (35.5% vs. 22.8%, p=0.078) and chronic kidney disease (31.1% vs. 13.9%, p=0.008), and higher SYNTAX scores (18.9±9.7 vs. 15.1±9.0, p=0.017). Calcific lesions required longer procedures (126.4±39.8 vs. 106.9±37.1 min, p=0.015), more frequent use of dedicated devices and IVUS. Acute gain (1.83±0.6 vs. 1.86±0.6, p=0.732) and angiographic success were similar (98% non-calcific vs. 95.2% calcific, p=0.369), whereas procedural success was reduced in patients with calcific lesions (94.1% vs. 83.9%, p=0.034) due to higher rates of periprocedural myocardial infarction (MI) (5% vs. 13.1%, p=0.067). During the median follow-up time of 14 months MACE rates (10.9% non-calcific vs. 12.9% calcific, plog-rank=0.546) were similar. CONCLUSIONS: Treating calcific lesions with BVS is feasible with high angiographic success rates, at the expense of longer procedure times, aggressive lesion preparation and increased rates of periprocedural MI.

9 Article Impact of Strut Width in Periprocedural Myocardial Infarction: A Propensity-Matched Comparison Between Bioresorbable Scaffolds and the First-Generation Sirolimus-Eluting Stent. 2015

Kawamoto, Hiroyoshi / Panoulas, Vasileios F / Sato, Katsumasa / Miyazaki, Tadashi / Naganuma, Toru / Sticchi, Alessandro / Figini, Filippo / Latib, Azeem / Chieffo, Alaide / Carlino, Mauro / Montorfano, Matteo / Colombo, Antonio. ·Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy; Interventional Cardiology Unit, EMO-GVM Centro Cuore Columbus, Milan, Italy. · Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy; Interventional Cardiology Unit, EMO-GVM Centro Cuore Columbus, Milan, Italy; Interventional Cardiology Unit, National Heart and Lung Institute, Imperial College London, London, United Kingdom. · Faculty of Medicine, New Tokyo Hospital, Chiba, Japan. · Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy. · Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy; Interventional Cardiology Unit, EMO-GVM Centro Cuore Columbus, Milan, Italy. Electronic address: info@emocolumbus.it. ·JACC Cardiovasc Interv · Pubmed #26003020.

ABSTRACT: OBJECTIVES: This study aimed to assess the clinical impact of strut width (evaluated by abluminal strut surface area [ASSA]) on periprocedural myocardial infarction (PMI) and clinical outcomes in patients treated with bioresorbable scaffolds (BRS) versus first-generation sirolimus-eluting stents (SES). BACKGROUND: To date, there are no reports on the impact of ASSA on PMI and clinical outcomes. METHODS: We compared the impact of ASSA on outcomes and PMI in propensity-matched patients treated with BRS and SES. The primary outcome was the incidence of major adverse cardiac events (MACE), defined as the combination of all-cause mortality, follow-up myocardial infarction, and target vessel revascularization, at 30-days and 1-year follow-ups. The secondary endpoint was the incidence of PMI. RESULTS: After propensity-matched analysis, 499 patients (147 BRS patients vs. 352 SES patients) were evaluated. Mean ASSA was higher in patients treated with BRS versus SES (BRS: 132.3 ± 76.7 mm(2) vs. SES: 67.6 ± 48.4 mm(2), p < 0.001). MACE was not significantly different between groups (30-days MACE: BRS: 0% vs. SES: 1.4%, p = 0.16, and 1-year MACE: BRS: 15.7% vs. SES: 11.4%, p = 0.67). The incidence of PMI was significantly higher in the BRS group (BRS: 13.1% vs. SES: 7.5%, p = 0.05). Multivariable analyses indicated that treatment of left anterior descending artery and ASSA were independent predictors of PMI. CONCLUSIONS: BRS implantation, compared with SES implantation, was associated with a higher incidence of PMI. MACE at 30 days and 1 year were not significantly different. Left anterior descending artery percutaneous coronary intervention and ASSA were independent predictors of PMI.

10 Article First generation versus new generation drug-eluting stents for the treatment of ostial/midshaft lesions in unprotected left main coronary artery: the Milan and New-Tokyo (MITO) registry. 2015

Naganuma, Toru / Chieffo, Alaide / Takagi, Kensuke / Panoulas, Vasileios F / Mitomo, Satoru / Sticchi, Alessandro / Latib, Azeem / Miyazaki, Tadashi / Sato, Katsumasa / Costopoulos, Charis / Fujino, Yusuke / Montorfano, Matteo / Carlino, Mauro / Nakamura, Sunao / Colombo, Antonio. ·Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy; EMO-GVM Centro Cuore Columbus, Milan, Italy; Interventional Cardiology Unit, New Tokyo Hospital, Chiba, Japan. ·Catheter Cardiovasc Interv · Pubmed #25099758.

ABSTRACT: OBJECTIVES: To compare the clinical outcomes following unprotected left main coronary artery (ULMCA) percutaneous coronary intervention (PCI) of ostial/midshaft lesions between first and new generation drug-eluting stents (DES). BACKGROUND: Clinical outcomes after treatment of ostial/midshaft lesions in ULMCA with first generation DES were favorable. However, to date, data regarding treatment for those lesion subsets with new generation DES have not been reported. METHODS: A total of 219 patients with ostial/midshaft lesions in ULMCA treated with first (n = 139) or new generation DES (n = 80) were analyzed. RESULTS: There was a higher prevalence of IVUS use (35.2% vs. 50.0%, P = 0.032) and postdilation (70.5% vs. 93.8%, P < 0.001) with larger maximum balloon diameter (3.81 ± 0.45 vs. 4.08 ± 0.44, P < 0.001) in the new generation DES group. At a median follow-up period of 730 days, there were no significant differences in the propensity-score adjusted analyses, for major adverse cardiac events (MACE) defined as composite endpoint of all-cause death, myocardial infarction, and target vessel revascularization (hazard ratio (HR) [new vs. first generation DES]: 1.22; 95% confidence interval (CI): 0.64-2.31; P = 0.549). Of note, target lesion revascularization rates at 2-years were only 0.9% and 2.7%, for first and new generation DES groups, respectively (P = 0.339). On multivariable analysis, SYNTAX score (HR: 1.06; 95% CI: 1.02-1.11, P = 0.006) and European System for Cardiac Operative Risk Evaluation (HR: 1.14; 95% CI: 1.00-1.31, P = 0.051) were independent predictors for MACE. CONCLUSIONS: This study suggests that new generation DES for ostial/midshaft lesions in ULMCA are associated with favorable clinical outcomes, similar to those observed with first generation DES.

11 Article Comparison of early clinical outcomes between ABSORB bioresorbable vascular scaffold and everolimus-eluting stent implantation in a real-world population. 2015

Costopoulos, Charis / Latib, Azeem / Naganuma, Toru / Miyazaki, Tadashi / Sato, Katsumasa / Figini, Filippo / Sticchi, Alessandro / Carlino, Mauro / Chieffo, Alaide / Montorfano, Matteo / Colombo, Antonio. ·Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy; Interventional Cardiology Unit, EMO-GVM Centro Cuore Columbus, Milan, Italy; Imperial College London, London, United Kingdom. ·Catheter Cardiovasc Interv · Pubmed #24909303.

ABSTRACT: OBJECTIVES: To compare the early clinical outcomes between ABSORB bioresorbable vascular scaffold (BVS) (Abbott Vascular, Santa Clara, CA) and cobalt chromium everolimus-eluting stents in real-world patients with mostly complex disease. BACKGROUND: BVS represents the most interesting development in the drug-eluting stent field over recent years with promising results emerging from clinical trials. Available data however on the use of the ABSORB in real-world patients is limited. METHODS: All patients (n = 92) treated with BVS and 1296 patients treated with EES were included in this study. Propensity score matching was performed to adjust for differences in baseline clinical characteristics, yielding 92 patient pairs (BVS = 92 patients with 137 lesions and EES = 92 patients with 124 lesions). Clinical outcomes were examined between the 2 groups at 6-months. RESULTS: In both groups, most lesions were classified as either B2 or C (83.9% vs. 77.4%, P = 0.19). Predilatation (97.8% vs. 75.8%, P < 0.01) as well as postdilation (99.3% vs. 77.4%, P < 0.01) was more common in the BVS group. Clinical outcomes at 6-months were similar between the two groups with respect to both target lesion revascularization (3.3% vs. 5.4%, P = 0.41) and major adverse cardiac events (defined as the composite of target vessel revascularization, follow-up myocardial infraction and all-cause death) (3.3% vs. 7.6%, P = 0.19). CONCLUSIONS: ABSORB BVS for the treatment of complex lesions appears to be associated with good procedural and early clinical outcomes similar to those observed with conventional drug-eluting stents. Larger studies with long-term follow-up are required in order to fully assess the role of BVS in the treatment of such lesions and how this compares with that of conventional stents. © 2014 Wiley Periodicals, Inc.

12 Article Drug-eluting balloon in the treatment of in-stent restenosis and diffuse coronary artery disease: real-world experience from our registry. 2014

Basavarajaiah, Sandeep / Latib, Azeem / Shannon, Joanne / Naganuma, Toru / Sticchi, Alessandro / Bertoldi, Letizia / Costopoulos, Charis / Figini, Filippo / Carlino, Mauro / Chieffo, Alaide / Montorfano, Matteo / Colombo, Antonio. ·Interventional Cardiology Unit, EMO-GVM Centro Cuore Columbus, Milan, Italy; Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy; Interventional Cardiology Unit, The Heart of England Trust, Birmingham, United Kingdom; Interventional Cardiology Unit, Imperial College, London, United Kingdom. ·J Interv Cardiol · Pubmed #24815951.

ABSTRACT: OBJECTIVES: To report a single-center experience of drug-eluting balloons (DEB) in the treatment of in-stent restenosis (ISR) and de novo coronary artery disease. BACKGROUND: DEB are emerging as an alternative treatment for coronary stenosis especially when metal scaffolding is undesirable (in-stent restenosis and small-vessel de novo disease). Although there are various randomized trials and registry studies, the data from real-world cohorts are lacking. METHODS: Consecutive patients treated with the In.Pact Falcon™ (Medtronic Inc., Minneapolis, MN, USA) paclitaxel-eluting balloon between January 2009 and December 2011 were retrospectively studied. The measured end-points were cardiac death, myocardial infarction (MI), target lesion revascularization (TLR), target vessel revascularization (TVR), and major adverse cardiac events (MACE) defined as combination of cardiac death, MI, and TVR. RESULTS: A total of 275 lesions were successfully treated in 184 patients. The mean age was 66.2 ± 9.6 years, and 87% were males. The predominant indication for DEB use was ISR (62%), with de novo lesions accounting for the remainder (38%). A mean of 1.48 ± 0.9 DEB were used per patient. Bailout stenting was required in 24% of lesions. The median clinical follow-up was 14.6 months (IQR 12-23). The overall rates of cardiac death, MI, TLR, TVR, and MACE were 3.8%, 1.6%, 16.8%, 17.9%, and 21.7%, respectively. The overall rate of stent thrombosis was 0.5% (n = 1). CONCLUSION: Our results suggests that DEB can be considered in lesions where the use of stents is not desirable, especially restenotic lesions. Further long-term follow-up of these patients will provide us more insights on the long-term outcomes.

13 Article Comparison of abluminal biodegradable polymer biolimus-eluting stents and durable polymer everolimus-eluting stents in the treatment of coronary bifurcations. 2014

Costopoulos, Charis / Latib, Azeem / Naganuma, Toru / Sticchi, Alessandro / Ferrarello, Santo / Regazzoli, Damiano / Chieffo, Alaide / Figini, Filippo / Carlino, Mauro / Montorfano, Matteo / Naim, Charbel / Kawaguchi, Masanori / Gerasimou, Argyrios / Giannini, Francesco / Godino, Cosmo / Colombo, Antonio. ·Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy; Interventional Cardiology Unit, EMO-GVM Centro Cuore Columbus, Milan, Italy; Imperial College London, London, United Kingdom. ·Catheter Cardiovasc Interv · Pubmed #23804318.

ABSTRACT: OBJECTIVES: To compare biodegradable polymer biolimus-eluting (BES) with abluminal drug elution and durable polymer everolimus-eluting (EES) stents in the treatment of bifurcation lesions. BACKGROUND: The persistence of a polymer in drug-eluting stents (DES) following drug elution has been viewed as a possible culprit for restenosis. DES with biodegradable polymer may thus be associated with improved clinical outcomes, especially in high-risk lesions such as those at bifurcation sites. METHODS: We performed a retrospective study of consecutive de novo bifurcation lesions treated with EES between October 2006 and October 2011 and BES between February 2008 and March 2012. Study endpoints included major adverse cardiac events (MACE) defined as all-cause death, myocardial infarction (MI), including peri-procedural MI, and target vessel revascularization (TVR) as well as target lesion revascularization (TLR) separately. RESULTS: We analyzed 236 bifurcation lesions treated with either BES (79 lesions in 69 patients) or EES (157 lesions in 154 patients). Patient and procedural characteristics were broadly similar between the two groups. Estimated MACE and TVR rates at 2-year follow-up were similar between the BES and EES groups (MACE = 13.6 ± 4.6% vs. 14.6 ± 3.2% (P = 0.871); TVR = 6.9 ± 3.5% vs. 8.0 ± 2.7% (P = 0.889). No significant differences were noted between the two groups following propensity-score matched analysis. There was no probable or definite stent thrombosis. CONCLUSION: BES use in the treatment of bifurcation lesions appears to be associated with good clinical outcomes, comparable to those seen with EES, at long-term follow-up. These results are hypothesis-generating and need to be validated with larger studies.

14 Article The role of drug-eluting balloons alone or in combination with drug-eluting stents in the treatment of de novo diffuse coronary disease. 2013

Costopoulos, Charis / Latib, Azeem / Naganuma, Toru / Sticchi, Alessandro / Figini, Filippo / Basavarajaiah, Sandeep / Carlino, Mauro / Chieffo, Alaide / Montorfano, Matteo / Naim, Charbel / Kawaguchi, Masanori / Giannini, Francesco / Colombo, Antonio. ·Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy; Interventional Cardiology Unit, EMO-GVM Centro Cuore Columbus, Milan, Italy; Imperial College London, London, United Kingdom. ·JACC Cardiovasc Interv · Pubmed #24262615.

ABSTRACT: OBJECTIVES: This study sought to investigate the role of drug-eluting balloons (DEB) alone or in combination with drug-eluting stents (DES) in the treatment of diffuse de novo coronary artery disease (CAD) (>25 mm). BACKGROUND: The use of DEB in diffuse CAD, either alone or in combination with DES, offers an alternative to stenting alone. Data regarding DEB in this context are limited. METHODS: We retrospectively evaluated all patients treated with DEB for diffuse CAD between June 2009 and October 2012. Endpoints analyzed were major adverse cardiac events, defined as all-cause death, myocardial infarction, and target vessel revascularization (TVR), as well as TVR and target lesion revascularization separately. Results were compared with those obtained from a cohort of patients with similar characteristics treated with DES alone. RESULTS: A total of 69 patients (93 lesions) were treated with DEB ± DES, and 93 patients with DES alone (93 lesions). A high proportion of patients were diabetic (46.4% vs. 44.1%, p = 0.77). Of the DEB-treated lesions, 56.0% were treated with DEB alone, 7.4% with DEB and DES as bail out, and 36.6% with DES and DEB as part of a hybrid approach for very long disease. Outcome rates with DEB ± DES were comparable to those with DES alone at 2-year follow-up (major adverse cardiac events = 20.8% vs. 22.7%, p = 0.74; TVR = 14.8% vs. 11.5%, p = 0.44; target lesion revascularization = 9.6% vs. 9.3%, p = 0.84). CONCLUSIONS: DEB may have a role in the treatment of diffuse de novo CAD, either alone in smaller vessels or in combination with DES in very long disease.

15 Article First- versus second-generation drug-eluting stents for the treatment of coronary bifurcations. 2013

Costopoulos, Charis / Latib, Azeem / Ferrarello, Santo / Naganuma, Toru / Sticchi, Alessandro / Filippo, Figini / Giannini, Francesco / Basavarajaiah, Sandeep / Kawaguchi, Masanori / Naim, Charbel / Candreva, Alessandro / Carlino, Mauro / Chieffo, Alaide / Montorfano, Matteo / Colombo, Antonio. ·Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy; Interventional Cardiology Unit, EMO Centro Cuore Columbus, Milan, Italy; Department of Cardiology, Imperial College University, London, UK. ·Cardiovasc Revasc Med · Pubmed #24157311.

ABSTRACT: BACKGROUND: Randomized controlled trials have demonstrated that second-generation drug-eluting stents (DESs) for the treatment of obstructive coronary artery disease are associated with comparable, if not improved, clinical outcomes as compared to those of their first-generation counterparts. The aim of this study was to compare the long-term clinical outcomes associated with first- versus second-generation DESs for the treatment of coronary bifurcation lesions. METHODS AND MATERIALS: This was a retrospective study of consecutive de novo bifurcation lesions, excluding those at the left main, treated with either second-generation DES (everolimus-eluting or resolute zotarolimus-eluting stents) between October 2006 and October 2011 (199 bifurcation lesions in 192 patients) or first-generation DES (sirolimus-eluting or paclitaxel-eluting stents) between April 2002 and December 2005 (289 bifurcation lesions in 273 patients). RESULTS: Second-generation DES use in this setting was associated with less major adverse cardiac events (MACE) (23.1% vs. 14.4%, p=0.02) as well as lower target vessel revascularization (TVR) rates (15.5% vs. 8.3%, p=0.01) at 2-year follow-up. Target lesion revascularization, both per patient (12.6% vs. 7.4%, p=0.02) and per bifurcation (11.8% vs. 7.0%, p=0.03), was also improved with second-generation DES over the same follow-up period. Propensity-score adjusted analysis suggested that second-generation DES was associated with a lower incidence of MACE (HR, 0.53; 95% CI, 0.33-0.85; p=0.01) and TVR (HR, 0.44; 95% CI, 0.24-0.83; p=0.01). CONCLUSIONS: Our results suggest that the use of second-generation DES for the treatment of bifurcation lesions is associated with better clinical outcomes as compared to first-generation DES, largely due to a lower need for repeat revascularization.

16 Article The role of everolimus-eluting and resolute zotarolimus-eluting stents in the treatment of coronary bifurcations. 2013

Ferrarello, Santo / Costopoulos, Charis / Latib, Azeem / Naganuma, Toru / Sticchi, Alessandro / Figini, Filippo / Basavarajaiah, Sandeep / Carlino, Mauro / Chieffo, Alaide / Montorfano, Matteo / Kawaguchi, Masanori / Naim, Charbel / Giannini, Francesco / Colombo, Antonio. ·Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy. ·J Invasive Cardiol · Pubmed #23995715.

ABSTRACT: OBJECTIVES: To compare the long-term clinical outcomes of everolimus-eluting (EES) and Resolute zotarolimus-eluting (R-ZES) stents in the treatment of coronary bifurcation lesions. BACKGROUND: Recent studies have suggested that the R-ZES is comparable to the EES in the treatment of de novo coronary artery disease. Available data on how these compare in the treatment of bifurcation lesions are limited. METHODS: We retrospectively analyzed consecutive de novo bifurcation lesions, including left main stem lesions, treated with either EES or R-ZES between October 2006 and October 2011. Study endpoints examined included major adverse cardiac events (MACEs), defined as the composite of all-cause death, myocardial infarction (MI), including periprocedural MI, and target vessel revascularization (TVR). Target lesion revascularization (TLR) per patient and per bifurcation as well as stent thrombosis (ST) were also analyzed. RESULTS: We identified 235 bifurcation lesions treated with either EES (157 lesions in 154 patients) or R-ZES (78 lesions in 73 patients). Baseline clinical and procedural characteristics were broadly similar between the two groups. No significant differences in MACE (14.6% vs 11.5%; P=.99) or TVR (8.0% vs 7.3%; P=.45) rates were noted between the two groups at 2-year follow-up. The incidence of ST was low and similar in both groups (0% vs 1.4%). CONCLUSIONS: EES and R-ZES are associated with acceptable and comparable long-term clinical outcomes when used in the treatment of bifurcation lesions. Further evaluation into the role of currently available drug-eluting stents in bifurcation percutaneous coronary intervention is required.