Stent Thrombogenicity Early in High Risk Interventional Settings is Driven by Stent Design and Deployment, and Protected by Polymer-Drug Coatings
Author Manuscript: 2012 April 5
| Main Authors: | , , , , , , , , |
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| Other Authors: | |
| Format: | Article |
| Language: | en_US |
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American Heart Association
2012
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| Online Access: | http://hdl.handle.net/1721.1/75397 https://orcid.org/0000-0003-3159-8175 https://orcid.org/0000-0002-7832-7156 |
| _version_ | 1826205713438867456 |
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| author | Kolandaivelu, Kumaran Swaminathan, Rajesh Gibson, William J. Kolachalama, Vijaya Bhasker Nguyen-Ehrenreich, Kim-Lien Giddings, Virginia L. Coleman, Leslie Wong, Gee K. Edelman, Elazer R. |
| author2 | Institute for Medical Engineering and Science |
| author_facet | Institute for Medical Engineering and Science Kolandaivelu, Kumaran Swaminathan, Rajesh Gibson, William J. Kolachalama, Vijaya Bhasker Nguyen-Ehrenreich, Kim-Lien Giddings, Virginia L. Coleman, Leslie Wong, Gee K. Edelman, Elazer R. |
| author_sort | Kolandaivelu, Kumaran |
| collection | MIT |
| description | Author Manuscript: 2012 April 5 |
| first_indexed | 2024-09-23T13:17:25Z |
| format | Article |
| id | mit-1721.1/75397 |
| institution | Massachusetts Institute of Technology |
| language | en_US |
| last_indexed | 2024-09-23T13:17:25Z |
| publishDate | 2012 |
| publisher | American Heart Association |
| record_format | dspace |
| spelling | mit-1721.1/753972022-09-28T13:11:44Z Stent Thrombogenicity Early in High Risk Interventional Settings is Driven by Stent Design and Deployment, and Protected by Polymer-Drug Coatings Kolandaivelu, Kumaran Swaminathan, Rajesh Gibson, William J. Kolachalama, Vijaya Bhasker Nguyen-Ehrenreich, Kim-Lien Giddings, Virginia L. Coleman, Leslie Wong, Gee K. Edelman, Elazer R. Institute for Medical Engineering and Science Harvard University--MIT Division of Health Sciences and Technology Kolandaivelu, Kumaran Swaminathan, Rajesh Gibson, William J. Kolachalama, Vijaya Bhasker Wong, Gee K. Edelman, Elazer R. Author Manuscript: 2012 April 5 Background—Stent thrombosis is a lethal complication of endovascular intervention. Concern has been raised about the inherent risk associated with specific stent designs and drug-eluting coatings, yet clinical and animal support is equivocal. Methods and Results—We examined whether drug-eluting coatings are inherently thrombogenic and if the response to these materials was determined to a greater degree by stent design and deployment with custom-built stents. Drug/polymer coatings uniformly reduce rather than increase thrombogenicity relative to matched bare metal counterparts (0.65-fold; P=0.011). Thick-strutted (162 μm) stents were 1.5-fold more thrombogenic than otherwise identical thin-strutted (81 μm) devices in ex vivo flow loops (P<0.001), commensurate with 1.6-fold greater thrombus coverage 3 days after implantation in porcine coronary arteries (P=0.004). When bare metal stents were deployed in malapposed or overlapping configurations, thrombogenicity increased compared with apposed, length-matched controls (1.58-fold, P=0.001; and 2.32-fold, P<0.001). The thrombogenicity of polymer-coated stents with thin struts was lowest in all configurations and remained insensitive to incomplete deployment. Computational modeling–based predictions of stent-induced flow derangements correlated with spatial distribution of formed clots. Conclusions—Contrary to popular perception, drug/polymer coatings do not inherently increase acute stent clotting; they reduce thrombosis. However, strut dimensions and positioning relative to the vessel wall are critical factors in modulating stent thrombogenicity. Optimal stent geometries and surfaces, as demonstrated with thin stent struts, help reduce the potential for thrombosis despite complex stent configurations and variability in deployment. 2012-12-11T20:30:25Z 2012-12-11T20:30:25Z 2011-02 2010-04 Article http://purl.org/eprint/type/JournalArticle 0009-7322 1524-4539 http://hdl.handle.net/1721.1/75397 Kolandaivelu, K. et al. “Stent Thrombogenicity Early in High-Risk Interventional Settings Is Driven by Stent Design and Deployment and Protected by Polymer-Drug Coatings.” Circulation 123.13 (2011): 1400–1409. https://orcid.org/0000-0003-3159-8175 https://orcid.org/0000-0002-7832-7156 en_US http://dx.doi.org/10.1161/circulationaha.110.003210 Circulation Creative Commons Attribution-Noncommercial-Share Alike 3.0 http://creativecommons.org/licenses/by-nc-sa/3.0/ application/pdf American Heart Association PMC |
| spellingShingle | Kolandaivelu, Kumaran Swaminathan, Rajesh Gibson, William J. Kolachalama, Vijaya Bhasker Nguyen-Ehrenreich, Kim-Lien Giddings, Virginia L. Coleman, Leslie Wong, Gee K. Edelman, Elazer R. Stent Thrombogenicity Early in High Risk Interventional Settings is Driven by Stent Design and Deployment, and Protected by Polymer-Drug Coatings |
| title | Stent Thrombogenicity Early in High Risk Interventional Settings is Driven by Stent Design and Deployment, and Protected by Polymer-Drug Coatings |
| title_full | Stent Thrombogenicity Early in High Risk Interventional Settings is Driven by Stent Design and Deployment, and Protected by Polymer-Drug Coatings |
| title_fullStr | Stent Thrombogenicity Early in High Risk Interventional Settings is Driven by Stent Design and Deployment, and Protected by Polymer-Drug Coatings |
| title_full_unstemmed | Stent Thrombogenicity Early in High Risk Interventional Settings is Driven by Stent Design and Deployment, and Protected by Polymer-Drug Coatings |
| title_short | Stent Thrombogenicity Early in High Risk Interventional Settings is Driven by Stent Design and Deployment, and Protected by Polymer-Drug Coatings |
| title_sort | stent thrombogenicity early in high risk interventional settings is driven by stent design and deployment and protected by polymer drug coatings |
| url | http://hdl.handle.net/1721.1/75397 https://orcid.org/0000-0003-3159-8175 https://orcid.org/0000-0002-7832-7156 |
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