What is a DES procedure?
A drug-eluting stent is the most common type of stent used to treat a blockage of the heart arteries. Many people with heart problems have been successfully treated with drug-eluting stents, preventing the need for more-invasive procedures, such as coronary artery bypass surgery.
What is the difference between DES and BMS?
Drug-eluting stents (DES) compared to bare metal stents (BMS) have shown superior clinical performance, but are considered less suitable in complex cases. Most studies do not distinguish between DES and BMS with respect to their mechanical performance.
What is DES to lad?
Next-generation drug-eluting stents (DES) are associated with improved outcomes for patients undergoing percutaneous coronary intervention (PCI) in the territory of the left anterior descending (LAD) artery or left main (LM) coronary artery, according to new findings published in the Journal of the American Heart ...
What is DES to RCA in medical terms?
Abbreviations. DES=drug eluting stent; DK=double kiss; LAD=left anterior descending; LCx=left circumflex; OM=obtus marginal; PCI= percutaneous coronary intervention; RCA=right coronary artery.
How long do drug eluting stents last?
Once placed, you'll have it for life, which your body can safely tolerate. If your arteries narrow again, you'll need to have the procedure again to correct it. If this happens, it's usually within the first 6 months. One newer type of drug-eluting stent completely dissolves after about 3 years.
What is the cost of drug-eluting stent?
Stent PricingDRUG ELUTING STENTSBRANDMANUFACTURERCEILING PRICE WITH GSTENDEAVOR SPRINTMEDTRONIC13,650.00EVERMINE 50MERIL LIFESCIENCE31,584.00BIOMIME BRANCHMERIL LIFESCIENCE31,584.0019 more rows
Can the LAD artery be stented?
Coronary stenting (STENT) and left internal mammary artery bypass grafting of the LAD (LIMA-LAD) are other options that have been successfully used for single-vessel LAD disease. The optimal mode of revascularization for patients with isolated single-vessel LAD disease is unclear.
Is there a drug that dissolves plaque in arteries?
A drug made from a highly purified form of EPA (an omega-3 fatty acid found in fish) appears to help reduce plaque in the heart's arteries, according to a study published online Aug.
How long does a stent last?
How long will a stent last? It is permanent. There is just a 2–3 per cent risk of narrowing coming back, and if that happens it is usually within 6–9 months. If it does, it can potentially be treated with another stent.
What does DES stand for in medical terms?
Diethylstilbestrol (DES) is a synthetic form of the female hormone estrogen. It was prescribed to pregnant women between 1940 and 1971 to prevent miscarriage, premature labor, and related complications of pregnancy (1).
What is DES placement?
A drug-eluting stent (DES) is a peripheral or coronary stent (a scaffold) placed into narrowed, diseased peripheral or coronary arteries that slowly release a drug to block cell proliferation.
Can the RCA be stented?
The ostium of the right coronary artery (RCA) is not a tubular structure . Hence, sizing, positioning and flaring the stent in the ostium of the RCA demands considerable skill, and occasionally will not yield optimal results.
What is RCA stand for?
Radio Corporation of AmericaRadio Corporation of America.
What is PTCA to RCA?
PTCA – percutaneous transluminal coronary angioplasty; RCA – right coronary artery.
What does RCA stand for in the heart?
The right coronary artery (RCA) is one of the two main coronary arteries that supply the heart with oxygenated blood.
What is PCI to RCA?
Background. Percutaneous coronary intervention (PCI) for anomalous right coronary artery (RCA) arising from the left sinus of Valsalva (LSOV) is a technical challenge due to inadequate guiding catheter support to overcome the acute rightward course of the anomalous RCA.
What is DES?from cancer.gov
Diethylstilbestrol (DES) is a synthetic form of the female hormone estrogen. It was prescribed to pregnant women between 1940 and 1971 to prevent miscarriage, premature labor, and related complications of pregnancy ( 1 ). The use of DES declined after studies in the 1950s showed that it was not effective in preventing these problems.
What is DES in biology?from cancer.gov
DES is now known to be an endocrine -disrupting chemical, one of a number of substances that interfere with the endocrine system to cause cancer, birth defects, and other developmental abnormalities.
What health issues might women who took DES during pregnancy have?from cancer.gov
However, a slight increase in the risk remains for developing ( 28) and dying from ( 29) breast cancer compared with women who did not use DES. No evidence exists to suggest that women who took DES are at higher risk for any other type of cancer ( 4 ).
What should DES-exposed daughters do?from cancer.gov
Women who know or believe they were exposed to DES before birth should be aware of the health effects of DES and inform their health care provider about their possible exposure. It has been recommended that exposed women have an annual medical examination to check for the adverse health effects of DES ( 11 ). A thorough examination may include the following:
Where can DES-exposed people get additional information?from cancer.gov
Since 1992, NCI, in collaboration with research centers throughout the United States, has been conducting the DES Follow-up Study of more than 21,000 mothers, daughters, and sons, to better understand the long-term health effects of exposure to DES.
What is the DESAD project?from cancer.gov
Professional and Public Relations Committee of the DESAD (Diethylstilbestrol and Adenosis) Project of the Division of Cancer Control and Rehabilitation. Exposure in utero to diethylstilbestrol and related synthetic hormones. Association with vaginal and cervical cancers and other abnormalities. JAMA 1976; 236 (10):1107–1109.
How rare is a DES daughter?from cancer.gov
However, this type of cancer is still rare; approximately 1 in 1,000 DES daughters develops it.
What is the design of a drug eluting stent?
Drug-eluting stents generally consist of three parts - the stent platform, a polymer coating that binds the drug to the stent and releases drug ( although stents have been tested that do without a coating), and the drug.
What is a DES stent?
A drug-eluting stent ( DES) is a peripheral or coronary stent (a scaffold) placed into narrowed, diseased peripheral or coronary arteries that slowly releases a drug to block cell proliferation. This prevents fibrosis that, together with clots ( thrombi ), could otherwise block the stented artery, a process called restenosis. The stent is usually placed within the peripheral or coronary artery by an interventional cardiologist or interventional radiologist during an angioplasty procedure.
How long does a clot last after a stent is injected?
For drug-eluting stents (which, by design, delay formation of a new endothelium cover over the stent), the incidence of clot formation within the stent may persist for a longer period of time, perhaps as long as five years after treatment.
How does a stent affect the body?
A stent is a foreign object in the body, and the body responds to the stent’s presence in a variety of ways. Macrophages accumulate around the stent, and nearby smooth muscle cells proliferate. These physiological changes, which can cause restenosis, are limited by the drugs released by the stent, but these drugs also limit formation of a new endothelial layer over the new stent to inhibit clot formation. Endothelialization is a hallmark of vascular healing and is important for the prevention of thrombus formation. Lack of healing caused by antiproliferative drugs can make the stent an exposed surface on which a clot, sometimes life-threatening, can form. For drug-eluting stents (which, by design, delay formation of a new endothelium cover over the stent), the incidence of clot formation within the stent may persist for a longer period of time, perhaps as long as five years after treatment. Drug-eluting stents have been associated with delayed arterial healing and the prevalence of latent thrombus after five years, suggesting patients may continue to be at risk for stent thrombosis for an extended period of time.
When was the first stent approved?
The first successful trials were of sirolimus -eluting stents. A clinical trial in 2002 led to approval of the sirolimus-eluting Cypher stent in Europe in 2002. After a larger pivotal trial (one designed for the purpose of achieving FDA approval), published in 2003, the device received FDA approval and was released in the U.S. in 2003. Soon thereafter, a series of trials of paclitaxel -eluting stents led to FDA approval of the Taxus stent in 2004. Both sirolimus and paclitaxel are natural products, making the drug-eluting stents a specific kind of application totally dominated by drugs directly derived from natural sources.
When were stents first used?
Dotter and Melvin Judkins had suggested using prosthetic devices inside arteries (in the leg) to maintain blood flow after dilation as early as 1964. In 1986, Puel and Sigwart implanted the first coronary stent in a human patient. Several trials in the 1990s showed the superiority of stent placement over balloon angioplasty. Restenosis was reduced because the stent acted as a scaffold to hold open the dilated segment of artery; acute closure of the coronary artery (and the requirement for emergency CABG) was reduced, because the stent repaired dissections of the arterial wall. By 1999, stents were used in 84% of percutaneous coronary interventions (i.e., those done via a catheter, and not by open-chest surgery).
What is the best treatment for thrombosis?
Treatment with the antiplatelet drugs aspirin and clopidogrel appears to be the most important factor reducing this risk of thrombosis, and early cessation of one or both of these drugs after drug-eluting stenting markedly increases the risk of stent thrombosis and myocardial infarction.
What is a DES stent?from en.wikipedia.org
A drug-eluting stent ( DES) is a peripheral or coronary stent (a scaffold) placed into narrowed, diseased peripheral or coronary arteries that slowly releases a drug to block cell proliferation. This prevents fibrosis that, together with clots ( thrombi ), could otherwise block the stented artery, a process called restenosis. The stent is usually placed within the peripheral or coronary artery by an interventional cardiologist or interventional radiologist during an angioplasty procedure.
What is a vascular stent?from en.wikipedia.org
Vascular stents are Class III medical devices that are intended for use as a mechanical radial support to enhance vessel patency over the intended design life of the device . Device properties and the intended use are dependent on results from extensive testing that involve mechanical tests on universal testing machines. Types of mechanical test include bend testing, fatigue testing, radial loading, tensile testing, and torsion testing. Depending on the type of vascular stent, its location and intended use, other tests may include crush resistance, kink resistance, corrosion, coating integrity, and more.
What is the design of a drug eluting stent?from en.wikipedia.org
Drug-eluting stents generally consist of three parts - the stent platform, a polymer coating that binds the drug to the stent and releases drug ( although stents have been tested that do without a coating), and the drug.
Is DES a good treatment for a stent?from en.wikipedia.org
In 2012, a meta-analysis of clinical trial data was published, showing that, for people with stable coronary artery disease, DES has no benefit compared to treatment with drugs. The New York Times interviewed the study's main author, who said that more than half of patients with stable coronary artery disease were implanted with stents without even trying drug treatment and that he believed this happened because hospitals and doctors wanted to make more money. In 2013 the Times of India reported that DES were widely overused and that Indian distributors used profits from high markups on DES to bribe doctors to use them. In 2014 an investigation by the Maharashtra Food and Drug Administration found that high markups and bribery related to DES was still widespread.
What is DES in medicine?
DES. A synthetic preparation possessing estrogenic properties. It is several times more potent than natural estrogens and may be given orally. It is used therapeutically in the treatment of menopausal disturbances and other disorders due to estrogen deficiencies.
How many people are exposed to DES?
An estimated 5 million to 10 million Americans received DES during pregnancy or were exposed to the drug in utero. Those who were exposed to DES in utero were found to be at risk of developing reproductive tract abnormalities such as clear-cell cervicovaginal cancer in women and reproductive tract abnormalities in men.
What is an airway stent?
airway stent. A tube or catheter used as a scaffold to keep an airway open. It is used, e.g., to maintain the patency of a trachea or bronchus that has collapsed as a result of compression by neighboring tissues.
What is a stent?
stent. (stent) [Charles Thomas Stent, Brit. dentist, 1845–1901] 1. Originally, a compound used in making dental molds. 2. Any material or device used to hold tissue in place, to maintain open blood vessels, or to provide a support for a graft or anastomosis while healing is taking place.
When was DES banned?
In 1971, the FDA suggested it not be used during pregnancy and banned its use in 1979 as a growth promoter in livestock.
What is diethylstilbestrol used for?
diethylstilbestrol. a synthetic nonsteroidal estrogen used for palliative treatment of prostatic carcinoma and sometimes advanced breast carcinoma. It was formerly used to relieve vasomotor symptoms associated with menopause, and in primary ovarian failure, female hypogonadism, atrophic vaginitis, kraurosis vulvae, and female castration. ...
Study Questions
What are the long-term outcomes for patients with left main coronary artery disease (CAD) treated with percutaneous coronary intervention (PCI) with drug-eluting stents (DES) versus coronary artery bypass grafting (CABG)?
Methods
The investigators searched MEDLINE, Embase, and the Cochrane database using the search terms “left main,” “percutaneous coronary intervention” or “stent,” and “coronary artery bypass graft” to identify randomized controlled trials (RCTs) published in English between database inception and August 31, 2021, comparing PCI with DES with CABG in patients with left main CAD that had ≥5 years of patient follow-up for all-cause mortality for this individual patient data meta-analysis.
Conclusions
The authors concluded that among patients with left main CAD and, largely, low or intermediate coronary anatomical complexity, there was no statistically significant difference in 5-year all-cause death between PCI and CABG.
Perspective
This individual patient data meta-analysis reports that among patients with left main CAD, there was no statistically significant difference in 5-year all-cause deaths between those treated with PCI with DES and those treated with CABG, while a Bayesian approach suggested that a difference favoring CABG probably exists, which is more likely than not <0.2% per year.
Where is the posterior cross of the heart located?from thoracickey.com
The posterior cross of the heart refers to the cross in the posterior aspect of the heart, located at the connection of the interatrial groove and the interventricular groove. The coronary sinus runs from the left to the right of the atrioventricular groove, forming the transverse line of the cross (Figs. 1.7 and 1.8 ). The posterior margins of the interatrial septum and the interventricular septum compose the upright line. The posterior margin of the interventricular septum is the same line as the posterior interventricular groove, with the posterior descending branch of the coronary artery passing through it.
What is the RAA in the heart?from thoracickey.com
The RAA is a small conical, triangle-shaped muscular pouch. It is attached to the right atrium of the heart and often is short and blunt (Fig. 1.2 ).
Overview
A drug-eluting stent (DES) is a peripheral or coronary stent (a scaffold) placed into narrowed, diseased peripheral or coronary arteries that slowly release a drug to block cell proliferation. This prevents fibrosis that, together with clots (thrombi), could otherwise block the stented artery, a process called restenosis. The stent is usually placed within the peripheral or coronary artery by an interventional c…
Medical uses
Clinical trials have shown the benefits of coronary stenting with bare-metal stents over other methods of angioplasty, including balloon angioplasty and atherectomy. Drug-eluting stents (DES) have also been extensively studied, and are generally superior to bare-metal stents concerning the occurrence of major adverse cardiac events (generally defined as death, myocardial infarction, or the need for a repeat revascularization procedure). Stents are indicated to improve the diamet…
Alternatives to stents
Pharmacological therapy for coronary artery disease may be indicated instead of or in addition to invasive treatment. For those requiring percutaneous coronary intervention or surgery, medical therapy should be viewed as complementary to revascularization procedures, rather than an opposing strategy.
Coronary artery bypass graft surgery is the best treatment for some patients. Differences betwee…
Risks
Like all invasive medical procedures, implanting stents in the coronary arteries carries risk. For the newer drug-eluting stents, very-long-term results are not yet available; however, five years after implantation, sirolimus-eluting stents remained superior to bare-metal stents.
Risks associated with cardiac catheterization procedures include bleeding, aller…
Design
Drug-eluting stents generally consist of three parts - the stent platform, a polymer coating that binds the drug to the stent and releases drug, and the drug. Stents have been tested that work without the coating layer.
The stent platform itself is an expandable framework, generally with an elaborate mesh-like design to allow expansion, flexibility, and in some cases t…
History
The first procedure to treat blocked coronary arteries was coronary artery bypass graft surgery (CABG), wherein a section of vein or artery from elsewhere in the body is used to bypass the diseased segment of coronary artery. In 1977, Andreas Grüntzig introduced percutaneous transluminal coronary angioplasty (PTCA), also called balloon angioplasty, in which a catheter was introduced through a peripheral artery and a balloon expanded to dilate the narrowed segment o…
Society and culture
In 2012, a meta-analysis of clinical trial data was published, showing that, for people with stable coronary artery disease, DES has no benefit compared to treatment with drugs. The New York Times interviewed the study's main author, who said that more than half of patients with stable coronary artery disease were implanted with stents without even trying drug treatment and that he believed this happened because hospitals and doctors wanted to make more money. In 2013 th…
Further reading
• Fischetti, Mark (July 2006). "Vascular Stents: Expanding Use". Scientific American. 295 (1): 94–5. doi:10.1038/scientificamerican0706-94. PMID 16830686. (layperson overview, subscription required)
• Serruys, Patrick W.; Michael J.B. Kutryk; Andrew T.L. Ong (2006-02-02). "Coronary-Artery Stents". New England Journal of Medicine. 354 (5): 483–95. doi:10.1056/NEJMra051091. PMID 16452560. S2CID 13647055. (journal review arti…
• Fischetti, Mark (July 2006). "Vascular Stents: Expanding Use". Scientific American. 295 (1): 94–5. doi:10.1038/scientificamerican0706-94. PMID 16830686. (layperson overview, subscription required)
• Serruys, Patrick W.; Michael J.B. Kutryk; Andrew T.L. Ong (2006-02-02). "Coronary-Artery Stents". New England Journal of Medicine. 354 (5): 483–95. doi:10.1056/NEJMra051091. PMID 16452560. S2CID 13647055. (journal review article, subscription required)