Coronary Artery Disease: Serruys PW

Daemen J, Simoons ML, Wijns W, Bagust A, Bos G, Bowen JM, Braunwald E, Camenzind E, Chevaliers B, DiMario C, Fajadeto J, Gitt A, Guagliumi G, Hillege HL, James S, Jüni P, Kastrati A, Kloth S, Kristensen SD, Krucoff M, Legrand V, Pfisterer M, Rothman M, Serruys PW, Silber S, Steg PG, Tariah I, Wallentin L, Windecker SW, Aimonetti A, Allocco D, Berenger M, Boam A, Calle JP, Campo G, Carlier S, de Schepper J, Di Bisceglie G, Dobbels H, Farb A, Ghislain JC, Hellbardt S, ten Hoedt R, Isaia C, de Jong P, Lekehal M, LeNarz L, Mhullain FN, Nagai H, Patteet A, Paunovic D, Potgieter A, Purdy I, Raveau-Landon C, Ternstrom S, Van Wuytswinkel J, Waliszewski M, Anonymous00071. · Thoraxcenter, Erasmus MC, Rotterdam, The Netherlands. · EuroIntervention. · Pubmed #19284063 No free full text.

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Dawkins KD, Morel MA, Serruys PW. · No affiliation provided · EuroIntervention. · Pubmed #19577980 No free full text.

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Kukreja N, Serruys PW. · No affiliation provided · Pol Arch Med Wewn. · Pubmed #18476454 links to  free full text

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Serruys PW, Garcia-Garcia HM, Regar E. · No affiliation provided · J Am Coll Cardiol. · Pubmed #17765121 No free full text.

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Vaina S, Tsuchida K, Serruys PW. · No affiliation provided · Expert Rev Cardiovasc Ther. · Pubmed #16509809 No free full text.

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Hamburger JN, Serruys PW. · No affiliation provided · Eur Heart J. · Pubmed #11071794 links to  free full text

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Kukreja N, Onuma Y, Serruys PW. · Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands. · Expert Rev Med Devices. · Pubmed #19419279 No free full text.

Abstract: Drug-eluting stents are widely used for the treatment of coronary artery disease to reduce the risk of restenosis found with bare-metal stents. Nevertheless, there are concerns about device deliverability and safety with the initial generation of drug-eluting stents. The second-generation Xience V everolimus-eluting stent incorporates advanced design features such as a cobalt-chromium stent platform coated with an antirestenotic drug, everolimus, incorporated into a biocompatible polymer with a long history of medical use. The efficacy of the stent has been demonstrated with low rates of angiographic restenosis, whilst randomized trials comparing the Xience V everolimus-eluting stent to the first-generation Taxus paclitaxel-eluting stent have found a reduction in repeat revascularization rates. Further randomized trials, including 'all-comer' patients and registries of unselected patients are currently further evaluating the efficacy and safety of the Xience V stent in high-risk, complex cases.

Wykrzykowska JJ, Onuma Y, Serruys PW. · Department of Interventional Cardiology, Thoraxcentrum, Erasmus MC, 's Gravendijkwal 230, Ba583, 3015CE Rotterdam, The Netherlands. · Expert Opin Drug Deliv. · Pubmed #19239384 No free full text.

Abstract: This expert opinion review offers a perspective on the future developments in drug-eluting stent design. Initial efforts were focused on reduction of in-stent restenosis, which the drug-eluting stents addressed effectively. Current concerns are predominantly with regard to risk of stent thrombosis and delayed endothelialization. All three components of the stent have been modified to achieve the goal of endothelialization and vessel healing: drug, polymer and the platform. We review different approaches to reduce this risk from design of different drug combinations, through less traumatic metallic stent platforms, via biodegradable polymers and, finally, fully biodegradable stents. It seems at this time that fully biodegradable solutions to stenting hold the greatest promise, but larger long-term studies are needed to evaluate fully their safety and efficacy in 'all-comer' patient populations. At the time of this review, design of a safe drug-eluting stent still remains a challenge.

Gonzalo N, Serruys PW, Regar E. · Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands. · Minerva Cardioangiol. · Pubmed #18813186 No free full text.

Abstract: Optical coherencet tomography (OCT) is a light-based imaging modality that can provide in vivo high-resolution images of the coronary artery. In the last years there has been a continuous technical development that has improved the image quality and has simplified the acquisition procedure in order to spread the clinical applicability of this technique. Due to its high resolution OCT, can be a very valuable tool for the evaluation of the coronary vessel wall, the acute and long-term impact of catheter-based intervention on plaque structure and vessel architecture and the assessment of stents. During stenting, OCT offers the possibility to evaluate stent apposition in great detail and can identify the presence of vessel injury due to stent implantation. At follow-up, the tissue coverage of individual struts can be imaged with OCT. This is of increasing interest in drug-eluting stents in which the neointimal proliferation is inhibited to such extent that it might not be visualized with conventional intracoronary imaging techniques such as IVUS. Regarding the analysis of the coronary vessel wall, OCT holds promise for the identification of thin cap fibroatheroma due to its ability to provide information about plaque composition, presence of macrophages and thickness of the fibrous cap.

Ramcharitar S, Serruys PW. · Department of Interventional, Cardiology Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands · Minerva Cardioangiol. · Pubmed #18319699 No free full text.

Abstract: Bioabsorbable stents must be biocompatible and as well as their degenerated products. The challenge is to find material that exhibit minimal recoil and remain in situ for several months before complete bio-absorption. There are now some worthy polymer based and metallic bioabsorbable stents with encouraging preclinical and clinical data. Their behaviour will not only redefine current percutaneous coronary intervention but may also have a wider role in the cardiovascular system as whole.

García-García HM, Gonzalo N, Granada JF, Regar E, Serruys PW. · Thoraxcenter, Erasmus MC, Rotterdam, The Netherlands. · Expert Rev Cardiovasc Ther. · Pubmed #18248275 No free full text.

Abstract: Thin-capped fibroatheroma is the morphology that most resembles plaque rupture. Detection of these vulnerable plaques in vivo is essential to being able to study their natural history and evaluate potential treatment modalities and, therefore, may ultimately have an important impact on the prevention of acute myocardial infarction and death. Currently, conventional grayscale intravascular ultrasound, virtual histology and palpography data are being collected with the same catheter during the same pullback. A combination of this catheter with either thermography capability or additional imaging, such as optical coherence tomography or spectroscopy, would be an exciting development. Intravascular magnetic resonance imaging also holds much promise. To date, none of the techniques described above have been sufficiently validated and, most importantly, their predictive value for adverse cardiac events remains elusive. Very rigorous and well-designed studies are compelling for defining the role of each diagnostic modality. Until we are able to detect in vivo vulnerable plaques accurately, no specific treatment is warranted.

Daemen J, Serruys PW. · Thoraxcenter, Erasmus Medical Center, Dr Molewaterplein 40, 3015 GD Rotterdam, The Netherlands. · Circulation. · Pubmed #17709651 links to  free full text

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Ramcharitar S, Vaina S, Serruys PW. · Department of Interventional Cardiology, Thorax Center, Erasmus Medical Center, Dr Molewaterplein 40, GD 3015 Rotterdam, The Netherlands. · Am J Cardiovasc Drugs. · Pubmed #17503880 No free full text.

Abstract: Drug-eluting stents have radically changed the way we treat coronary artery disease. They offer lower restenotic rates compared with the bare metal stents and this enables more challenging and complex lesions to be treated. However, there are still limitations as restenosis has not been completely abolished and there are concerns about stent thrombosis. The next generation stents offer the technology to address these pertinent issues. This review examines the new analogs of the sirolimus family and their use in novel stent platforms, including the use of biodegradable and bioabsorbable materials employed in both stents and on the polymer. "Reservoir stents" that are specially designed to contain layers of drugs in pockets with different release profiles are discussed and an insight into the emerging field of bioengineered stents is highlighted.

Serruys PW, Daemen J. · Department of Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, the Netherlands. · Circulation. · Pubmed #17344323 links to  free full text

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Vaina S, Serruys PW. · Thoraxcentre, Ba 583, Erasmus Medical Centre, Dr Molewaterplein 40, 3015 GD Rotterdam, The Netherlands. · Expert Opin Drug Deliv. · Pubmed #17076600 No free full text.

Abstract: The CYPHER (Cordis, Johnson & Johnson) sirolimus-eluting stent and the TAXU (Boston Scientific) paclitaxel-eluting stent have been extensively evaluated and have been proven to be significant novel tools for the treatment of coronary artery disease. Several sirolimus derivatives have already emerged, receiving CE Mark approval. However, in the future, it is likely that drugs presently under investigation will address additional mechanisms associated with neointimal formation, either as single agents or in combination with antiproliferative compounds. Concurrently, alterations on stent platform design (helicoidal, open-closed cell), coatings (biodegradable, bioabsorbable, nanoporous) and polymers are being explored.

Daemen J, Serruys PW. · Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands. · Curr Opin Cardiol. · Pubmed #17053410 No free full text.

Abstract: PURPOSE OF REVIEW: The aim of this article is to review the current status of optimal revascularization strategies in patients presenting with multivessel coronary artery disease. RECENT FINDINGS: Coronary artery bypass surgery is the gold standard for patients with multivessel disease. Recent developments in the interventional field, like drug-eluting stents, which significantly reduced restenosis and the need for repeat revascularizations, have cut back one of the largest limitations of percutaneous coronary intervention. SUMMARY: There is currently little evidence to believe that in a general population, opting for either coronary artery bypass surgery or percutaneous coronary intervention would imply a better long-term survival. Coronary artery bypass surgery is still associated with higher rates of complete revascularization and a higher durability than percutaneous coronary intervention, resulting in lower rates of repeat revascularization. The current evidence, however, is based on sub-optimal inconclusive data from single center or multicenter registries. Until the results of several dedicated ongoing randomized trials are presented, the choice for a revascularization strategy should be made not only on the basis of feasibility but also by taking into account each patient's co-morbidities and risk factors. Careful monitoring of glycemic control and lipid concentrations and an optimal pharmacological treatment are at least as important in achieving an optimal outcome.

Lasala JM, Stone GW, Dawkins KD, Serruys PW, Colombo A, Grube E, Koglin J, Ellis S. · Division of Cardiology, Washington University School of Medicine, St. Louis, Missouri 63110, USA. · J Interv Cardiol. · Pubmed #17020567 No free full text.

Abstract: Restenosis remains a problem following percutaneous coronary intervention in patients with coronary artery disease. Drug-eluting stents (DES), which combine mechanical and pharmacologic properties, have been shown to prevent or reduce neointimal growth after deployment. This review describes the TAXUS paclitaxel-eluting stent clinical trial expansion program (TAXUS Express, Boston Scientific, Natick, MA). This program comprises the largest data set of randomized controlled trials (RCTs) of DES to date, with over 6,200 patients enrolled since 2000. The program includes treatment of de novo lesions, as well as higher-risk lesion and patient populations. In this review, we discuss the results from the TAXUS family of randomized clinical trials, and compare the findings with data from TAXUS registries. The data from the randomized clinical trials suggest that the paclitaxel-eluting stent provides consistent and durable benefits across multiple lesion and patient types. Evidence from peri-and post-approval registries, where patient populations are more heterogeneous than those eligible and included in the RCTs, corroborate these findings, with overall low rates of cardiac events, including reinterventions.

Kukreja N, Garcia-Garcia HM, Serruys PW. · Thoraxcenter, Erasmus Medical Center, Dr. Molewaterplein 40, 3015 GD Rotterdam, the Netherlands. · Minerva Cardioangiol. · Pubmed #17019397 No free full text.

Abstract: Coronary artery disease is the leading cause of mortality and morbidity in the Western world and an ever-increasing problem in developing countries. Unheralded acute coronary syndromes (ACS) are common initial manifestations of coronary atherosclerosis and are often caused by lesions which have previously not generated symptoms. Histopathological studies have identified several plaque morphologies associated with ACS. However, the natural history of these high-risk or vulnerable lesions remains unknown and the limited knowledge about their eventual prognosis is provided by retrospective histopathological studies. Detection of these vulnerable plaques in vivo is essential to study their natural history and to evaluate potential treatment modalities and, therefore, may ultimately have an important impact on the prevention of acute myocardial infarction and death. Currently, there are several diagnostic imaging tools capable of evaluating determinants of plaque vulnerability. These techniques can provide information on the vessel lumen and wall size, tissue composition and the status of inflammation. This article aims to review the current status of these imaging techniques.

Saia F, Schaar J, Regar E, Rodriguez G, De Feyter PJ, Mastik F, Marzocchi A, Marrozzini C, Ortolani P, Palmerini T, Branzi A, van der Steen AF, Serruys PW. · Department of Interventional Cardiology, Erasmus Medical Centre, Thoraxcentre, Rotterdam, The Netherlands. · J Cardiovasc Med (Hagerstown). · Pubmed #16645356 No free full text.

Abstract: Rupture of a vulnerable plaque is the main cause of acute coronary syndromes and myocardial infarction. The features of rupture-prone atherosclerotic plaques have been previously described by pathologists. However, identification of vulnerable plaques in vivo is essential to study their natural history and to evaluate potential treatment modalities. Coronary angiography is the gold standard for the diagnosis of coronary artery disease, but it is unable to distinguish between stable and unstable plaques and to accurately predict future cardiac events. This current perspective describes the recently developed invasive imaging techniques to detect atherosclerotic vulnerable plaques in the coronary tree.

Serruys PW, Kutryk MJ, Ong AT. · Department of Interventional Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands. · N Engl J Med. · Pubmed #16452560 No free full text.

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Rodríguez-Granillo GA, Regar E, Schaar JA, Serruys PW. · Interventional Cardiology, Thoraxcenter, Erasmus MC, Rotterdam, The Netherlands. · Rev Esp Cardiol. · Pubmed #16238988 links to  free full text

Abstract: Sudden cardiac death or unheralded acute coronary syndromes are common initial manifestations of coronary atherosclerosis and most such events occur at sites of non-flow limiting coronary atherosclerosis. Autopsy data suggests that plaque composition is a key determinant of the propensity of atherosclerotic lesions to provoke clinical events. Most of these events are related to plaque rupture and subsequent thrombotic occlusion at the site of non-flow limiting atherosclerotic lesions in epicardial coronary arteries. Detection of these non-obstructive, lipid rich, high-risk plaques may have an important impact on the prevention of acute myocardial infarction and sudden death. Currently, there are several intravascular tools capable of locally evaluating determinants of plaque vulnerability such as the size of the lipid core, thickness of the fibrous cap, inflammation within the cap and positive remodeling. These new modalities have the potential to provide insights into the pathophysiology of the natural history of coronary plaque by means of prospective studies.

Aoki J, Rodríguez-Granillo GA, Serruys PW. · Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands. · Rev Esp Cardiol. · Pubmed #16053830 links to  free full text

Abstract: Despite the advances in the treatment of patients with coronary artery disease, sudden cardiac death is still unacceptably prevalent. Patients with ischemic heart disease usually require a combination of therapies (drugs and coronary intervention) and may continue to experience symptoms. Recently, numerous percutaneous interventional treatments and diagnostic tools have been developed to diagnose the vulnerable plaque and to treat the large number of patients with myocardial ischemia. Ongoing research on the use of drug eluting stents, catheter based bypass graft (percutaneous approaches that use the adjacent venous circulation to bypass an obstructed artery and stent-based approach for ventricle to coronary artery bypass), therapeutic angiogenesis and myogenesis, and the catheter based devices to detect the plaque vulnerability and composition (lipid-rich atheromatous core, thin fibrous cap, and expansive vessel remodeling) may result in additional diagnostic and therapeutic options for patients with coronary artery disease.

Ong AT, Aoki J, Kutryk MJ, Serruys PW. · Erasmus MC Thoraxcenter, Rotterdam, The Netherlands. · Arch Mal Coeur Vaiss. · Pubmed #15787303 No free full text.

Abstract: Coronary artery stenting is currently the most frequently performed percutaneous coronary intervention for the treatment of coronary artery disease. The endothelium is a single layer of endothelial cells lining the vascular wall and plays an integral part in maintaining vascular homeostasis. Stenting however causes significant injury to the vascular wall and endothelium, resulting in inflammation, repair and the development of neointimal hyperplasia. The ability of the endothelium to repair itself depends on both the migration of surrounding mature endothelial cells, and the attraction and adhesion of circulating endothelial progenitor cells (EPCs) to the injured region, which then differentiate into endothelial-like cells. Current therapies with drug-eluting stents interrupt the natural response to damage. Accelerating the reendothelialization of the damaged arterial segment following stent implantation is an attractive form of therapy as it is seen as hastening the natural process of repair. It potentially has the benefit of reducing the amount of neointimal hyperplasia and stent thrombosis. Studies have been performed to identify agents that augment the mobilisation and recruitment of EPCs to the injured area (statins, exercise, estrogen and cytokines). Other studies have looked at seeding stents with endothelial cells or EPCs. The most current approach is to coat anti-CD34 antibodies on a stent surface to attract circulating EPCs to the stent which then differentiate into endothelial-like cells. This approach is currently being tested in safety and feasibility clinical studies.

Agostoni P, Biondi-Zoccai GG, Gasparini GL, Anselmi M, Morando G, Turri M, Abbate A, McFadden EP, Vassanelli C, Zardini P, Colombo A, Serruys PW. · Department of Biomedical and Surgical Sciences, Section of Cardiology, University of Verona, Piazzale Stefani 1, 37126 Verona, Italy. · Eur Heart J. · Pubmed #15681573 links to  free full text

Abstract: AIMS: To compare, by meta-analytical techniques, the clinical impact of bare-metal stenting vs. balloon angioplasty for the treatment of lesions in small coronary arteries. METHODS AND RESULTS: We included trials with random allocation and prospective comparison of angioplasty vs. stenting, reference vessel diameter<3 mm, and follow-up>or=6 months. Random effect odds ratios (OR) for death, myocardial infarction (MI), repeat revascularization (RR), and major adverse cardiac events (MACEs) were computed. In a pre-specified subgroup analysis, we compared stenting with optimal (post-procedural stenosis<20%) and suboptimal (>20%) angioplasty. Thirteen studies (4383 patients) were selected. No differences were found in terms of death and MI, while MACEs, mainly driven by RR, were significantly less common after stenting (17.6%) than after angioplasty (22.7%), OR 0.71 (0.57-0.90). Heterogeneity among trials was present. When considering only optimal angioplasty, MACE rates were homogeneously similar, 17.9 vs. 21.1%, OR 0.86 (0.66-1.11). If angioplasty were suboptimal, MACEs were significantly more common after angioplasty (24%) than after stenting (17.3%), OR 0.62 (0.44-0.88). CONCLUSION: Stenting is superior to balloon angioplasty for the treatment of small vessels, in particular after suboptimal angioplasty. However, MACE and RR rates remain high after stenting, and the advantage of stent over angioplasty is moderate. An optimal balloon angioplasty strategy (with provisional stenting) may achieve results not inferior to routine stenting.

Regar E, Schaar JA, Mont E, Virmani R, Serruys PW. · Department of Cardiology, Thoraxcentre, Erasmus Medical Centre-Rotterdam, Bd 406, Dr. Molewaterplein 40, NL-3015 GD Rotterdam, The Netherlands. · Cardiovasc Radiat Med. · Pubmed #15321058 No free full text.

Abstract: BACKGROUND: Optical coherence tomography (OCT) is a light-based imaging modality that can be used in biological systems to study tissues in vivo with near-histologic, ultrahigh resolution. The rationale for intravascular application of OCT is its potential for in vivo visualisation of the coronary artery microstructure. METHODS AND RESULTS: The principle is analogous to pulse-echo ultrasound imaging; however, light is used rather than sound to create the image. Low-coherent near-infrared light is emitted by a superluminescent diode and reflected by the microstructures within biological tissues. The echo time delay of reflected light waves is converted into a two-dimensional spatial image. The intensity of the reflected light waves is translated into an intensity map. Experimental studies confirmed the ability of intravascular OCT for plaque characterisation and accurate assessment of vascular structures that are close to the luminal surface. Preliminary clinical experience proved in vivo feasibility of intravascular OCT. A variety of atherosclerotic plaque structures including thin cap fibroatheromas can be visualized in vivo. CONCLUSIONS: Intravascular OCT allows for accurate assessment of vessel structures close to the luminal side. Clinical application is feasible. To date, however, the clinical relevance of OCT findings in coronary arteries is unclear and further validation of OCT imaging is mandatory.