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Drug-eluting stents show delayed healing: paclitaxel more pronounced than sirolimus

Aims To understand wound healing after drug-eluting stents (DES) placement in humans, we studied the histology of in-stent restenosis (ISR) tissue obtained by atherectomy from bare metal stents (BMS) and DES in comparison with de novo atherosclerosis. Methods and results The tissue was retrieved fro...

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Published in:European heart journal 2007-04, Vol.28 (8), p.974-979
Main Authors: van Beusekom, Heleen M.M., Saia, Francesco, Zindler, Jaap D., Lemos, Pedro A., Hoor, Stijn L. Swager-ten, van Leeuwen, Maarten A.H., de Feijter, Pim J., Serruys, Patrick W., van der Giessen, Willem J.
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container_end_page 979
container_issue 8
container_start_page 974
container_title European heart journal
container_volume 28
creator van Beusekom, Heleen M.M.
Saia, Francesco
Zindler, Jaap D.
Lemos, Pedro A.
Hoor, Stijn L. Swager-ten
van Leeuwen, Maarten A.H.
de Feijter, Pim J.
Serruys, Patrick W.
van der Giessen, Willem J.
description Aims To understand wound healing after drug-eluting stents (DES) placement in humans, we studied the histology of in-stent restenosis (ISR) tissue obtained by atherectomy from bare metal stents (BMS) and DES in comparison with de novo atherosclerosis. Methods and results The tissue was retrieved from ISR in ten sirolimus-eluting stents (SES) and nine paclitaxel-eluting stents (PES), six BMS, and nine stenotic de novo atherosclerotic lesions and processed for histology and immunocytochemistry. Patients with ISR in PES showed a significantly higher incidence of unstable angina upon presentation for re-intervention (P = 0.046). De novo tissue tended to be more collagen rich, whereas ISR tissue tended to be more proteoglycan rich. In all groups, cell content consisted almost exclusively of smooth muscle cells. Histology showed that fibrinoid in ISR tissue was present only in DES (P = 0.004), as late as 2 years following DES placement, indicating a persistent incomplete healing response. The amount of fibrinoid, given as a percentage of total tissue in each atherectomy specimen, was greater in PES than in SES (17 vs. 5%, P = 0.026). Conclusion ISR in DES shows incomplete neointimal healing as late as 2 years after implantation. Patients with ISR in PES presented with more unstable angina and showed more pronounced signs of delayed healing than SES.
doi_str_mv 10.1093/eurheartj/ehm064
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Swager-ten ; van Leeuwen, Maarten A.H. ; de Feijter, Pim J. ; Serruys, Patrick W. ; van der Giessen, Willem J.</creator><creatorcontrib>van Beusekom, Heleen M.M. ; Saia, Francesco ; Zindler, Jaap D. ; Lemos, Pedro A. ; Hoor, Stijn L. Swager-ten ; van Leeuwen, Maarten A.H. ; de Feijter, Pim J. ; Serruys, Patrick W. ; van der Giessen, Willem J.</creatorcontrib><description>Aims To understand wound healing after drug-eluting stents (DES) placement in humans, we studied the histology of in-stent restenosis (ISR) tissue obtained by atherectomy from bare metal stents (BMS) and DES in comparison with de novo atherosclerosis. Methods and results The tissue was retrieved from ISR in ten sirolimus-eluting stents (SES) and nine paclitaxel-eluting stents (PES), six BMS, and nine stenotic de novo atherosclerotic lesions and processed for histology and immunocytochemistry. Patients with ISR in PES showed a significantly higher incidence of unstable angina upon presentation for re-intervention (P = 0.046). De novo tissue tended to be more collagen rich, whereas ISR tissue tended to be more proteoglycan rich. In all groups, cell content consisted almost exclusively of smooth muscle cells. Histology showed that fibrinoid in ISR tissue was present only in DES (P = 0.004), as late as 2 years following DES placement, indicating a persistent incomplete healing response. The amount of fibrinoid, given as a percentage of total tissue in each atherectomy specimen, was greater in PES than in SES (17 vs. 5%, P = 0.026). Conclusion ISR in DES shows incomplete neointimal healing as late as 2 years after implantation. Patients with ISR in PES presented with more unstable angina and showed more pronounced signs of delayed healing than SES.</description><identifier>ISSN: 0195-668X</identifier><identifier>EISSN: 1522-9645</identifier><identifier>DOI: 10.1093/eurheartj/ehm064</identifier><identifier>PMID: 17434882</identifier><language>eng</language><publisher>Oxford: Oxford University Press</publisher><subject>Aged ; Aged, 80 and over ; Antibacterial agents ; Antibiotics. Antiinfectious agents. Antiparasitic agents ; Biological and medical sciences ; Cardiology. Vascular system ; Coronary Restenosis - physiopathology ; Coronary Restenosis - prevention &amp; control ; Drug Implants ; Female ; Humans ; Immunosuppressive Agents - administration &amp; dosage ; Male ; Medical sciences ; Middle Aged ; Paclitaxel - administration &amp; dosage ; Pharmacology. Drug treatments ; Sirolimus - administration &amp; dosage ; Stents ; Tubulin Modulators - administration &amp; dosage ; Wound Healing - drug effects</subject><ispartof>European heart journal, 2007-04, Vol.28 (8), p.974-979</ispartof><rights>The European Society of Cardiology 2007. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org 2007</rights><rights>2007 INIST-CNRS</rights><rights>Copyright Oxford University Press(England) Apr 2007</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c390t-bce7f08459ba91e1bdfdfc36d461e0bce5c2087141686b304632bc9e9a4700963</citedby></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27924,27925</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&amp;idt=18728459$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/17434882$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>van Beusekom, Heleen M.M.</creatorcontrib><creatorcontrib>Saia, Francesco</creatorcontrib><creatorcontrib>Zindler, Jaap D.</creatorcontrib><creatorcontrib>Lemos, Pedro A.</creatorcontrib><creatorcontrib>Hoor, Stijn L. Swager-ten</creatorcontrib><creatorcontrib>van Leeuwen, Maarten A.H.</creatorcontrib><creatorcontrib>de Feijter, Pim J.</creatorcontrib><creatorcontrib>Serruys, Patrick W.</creatorcontrib><creatorcontrib>van der Giessen, Willem J.</creatorcontrib><title>Drug-eluting stents show delayed healing: paclitaxel more pronounced than sirolimus</title><title>European heart journal</title><addtitle>Eur Heart J</addtitle><description>Aims To understand wound healing after drug-eluting stents (DES) placement in humans, we studied the histology of in-stent restenosis (ISR) tissue obtained by atherectomy from bare metal stents (BMS) and DES in comparison with de novo atherosclerosis. Methods and results The tissue was retrieved from ISR in ten sirolimus-eluting stents (SES) and nine paclitaxel-eluting stents (PES), six BMS, and nine stenotic de novo atherosclerotic lesions and processed for histology and immunocytochemistry. Patients with ISR in PES showed a significantly higher incidence of unstable angina upon presentation for re-intervention (P = 0.046). De novo tissue tended to be more collagen rich, whereas ISR tissue tended to be more proteoglycan rich. In all groups, cell content consisted almost exclusively of smooth muscle cells. Histology showed that fibrinoid in ISR tissue was present only in DES (P = 0.004), as late as 2 years following DES placement, indicating a persistent incomplete healing response. The amount of fibrinoid, given as a percentage of total tissue in each atherectomy specimen, was greater in PES than in SES (17 vs. 5%, P = 0.026). Conclusion ISR in DES shows incomplete neointimal healing as late as 2 years after implantation. Patients with ISR in PES presented with more unstable angina and showed more pronounced signs of delayed healing than SES.</description><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Antibacterial agents</subject><subject>Antibiotics. Antiinfectious agents. Antiparasitic agents</subject><subject>Biological and medical sciences</subject><subject>Cardiology. Vascular system</subject><subject>Coronary Restenosis - physiopathology</subject><subject>Coronary Restenosis - prevention &amp; control</subject><subject>Drug Implants</subject><subject>Female</subject><subject>Humans</subject><subject>Immunosuppressive Agents - administration &amp; dosage</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Paclitaxel - administration &amp; dosage</subject><subject>Pharmacology. 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Vascular system</topic><topic>Coronary Restenosis - physiopathology</topic><topic>Coronary Restenosis - prevention &amp; control</topic><topic>Drug Implants</topic><topic>Female</topic><topic>Humans</topic><topic>Immunosuppressive Agents - administration &amp; dosage</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Paclitaxel - administration &amp; dosage</topic><topic>Pharmacology. Drug treatments</topic><topic>Sirolimus - administration &amp; dosage</topic><topic>Stents</topic><topic>Tubulin Modulators - administration &amp; dosage</topic><topic>Wound Healing - drug effects</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>van Beusekom, Heleen M.M.</creatorcontrib><creatorcontrib>Saia, Francesco</creatorcontrib><creatorcontrib>Zindler, Jaap D.</creatorcontrib><creatorcontrib>Lemos, Pedro A.</creatorcontrib><creatorcontrib>Hoor, Stijn L. Swager-ten</creatorcontrib><creatorcontrib>van Leeuwen, Maarten A.H.</creatorcontrib><creatorcontrib>de Feijter, Pim J.</creatorcontrib><creatorcontrib>Serruys, Patrick W.</creatorcontrib><creatorcontrib>van der Giessen, Willem J.</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Calcium &amp; Calcified Tissue Abstracts</collection><collection>ProQuest Health &amp; Medical Complete (Alumni)</collection><collection>MEDLINE - Academic</collection><jtitle>European heart journal</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>van Beusekom, Heleen M.M.</au><au>Saia, Francesco</au><au>Zindler, Jaap D.</au><au>Lemos, Pedro A.</au><au>Hoor, Stijn L. Swager-ten</au><au>van Leeuwen, Maarten A.H.</au><au>de Feijter, Pim J.</au><au>Serruys, Patrick W.</au><au>van der Giessen, Willem J.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Drug-eluting stents show delayed healing: paclitaxel more pronounced than sirolimus</atitle><jtitle>European heart journal</jtitle><addtitle>Eur Heart J</addtitle><date>2007-04-01</date><risdate>2007</risdate><volume>28</volume><issue>8</issue><spage>974</spage><epage>979</epage><pages>974-979</pages><issn>0195-668X</issn><eissn>1522-9645</eissn><abstract>Aims To understand wound healing after drug-eluting stents (DES) placement in humans, we studied the histology of in-stent restenosis (ISR) tissue obtained by atherectomy from bare metal stents (BMS) and DES in comparison with de novo atherosclerosis. Methods and results The tissue was retrieved from ISR in ten sirolimus-eluting stents (SES) and nine paclitaxel-eluting stents (PES), six BMS, and nine stenotic de novo atherosclerotic lesions and processed for histology and immunocytochemistry. Patients with ISR in PES showed a significantly higher incidence of unstable angina upon presentation for re-intervention (P = 0.046). De novo tissue tended to be more collagen rich, whereas ISR tissue tended to be more proteoglycan rich. In all groups, cell content consisted almost exclusively of smooth muscle cells. Histology showed that fibrinoid in ISR tissue was present only in DES (P = 0.004), as late as 2 years following DES placement, indicating a persistent incomplete healing response. The amount of fibrinoid, given as a percentage of total tissue in each atherectomy specimen, was greater in PES than in SES (17 vs. 5%, P = 0.026). Conclusion ISR in DES shows incomplete neointimal healing as late as 2 years after implantation. Patients with ISR in PES presented with more unstable angina and showed more pronounced signs of delayed healing than SES.</abstract><cop>Oxford</cop><pub>Oxford University Press</pub><pmid>17434882</pmid><doi>10.1093/eurheartj/ehm064</doi><tpages>6</tpages></addata></record>
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identifier ISSN: 0195-668X
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language eng
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source Oxford Journals Online
subjects Aged
Aged, 80 and over
Antibacterial agents
Antibiotics. Antiinfectious agents. Antiparasitic agents
Biological and medical sciences
Cardiology. Vascular system
Coronary Restenosis - physiopathology
Coronary Restenosis - prevention & control
Drug Implants
Female
Humans
Immunosuppressive Agents - administration & dosage
Male
Medical sciences
Middle Aged
Paclitaxel - administration & dosage
Pharmacology. Drug treatments
Sirolimus - administration & dosage
Stents
Tubulin Modulators - administration & dosage
Wound Healing - drug effects
title Drug-eluting stents show delayed healing: paclitaxel more pronounced than sirolimus
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