In 2005, we've experienced evidence showing the efficacy of drug-eluting stents as the primary device for revascularization. The debate comparing drug-eluting stents with bare metal stents has shifted to one that compares the approved drug-eluting stent programs in the United States. Such publications of head-to-head trials such as SIRTAX, ISAR DIABETES, and ISAR DESIRE have sparked this debate. Numerous reports have followed; some supporting the findings and some contradicting them. I would urge investigators and readers not to draw premature conclusions from these trials because they carry many limitations. It will most likely take more than 10,000 patients enrolled in a multicenter, blinded, randomized study with meaningful clinical end points to determine the efficacy superiority of one stent over the other, and probably even more patients to determine differences in safety end points such as late thrombosis. Until then, we should not fall into industry propaganda traps that tend to highlight the results that most favor their stent.
This edition of Cardiovascular Revascularization Medicine boasts three Clinical Original articles. In the first, López-Minguez and colleagues have determined that, in their experience, the Cypher stent is superior to the Taxus stent when treating populations with a high percentage of complex lesions excluded from the trials. Vicario et al. next conclude that autologous unfractionated bone marrow via coronary sinus appears to be safe and is feasible in patients with chronic refractory angina after 1-year follow-up. And Kuchulakanti et al. sought to examine whether an escalation in dose to 21 Gy is safe and confers additional benefit in reducing repeat revascularization and major adverse cardiac events in patients with diffuse in-stent restenosis.
Cui and colleagues, in our first Biology Original article, aimed to develop an appropriate large-animal model for optimal procedural success during and after patch implantation surgery. Then, in their submission, Samsamshariat et al. determined that using their specified method, left anterior descending artery ligation can safely be performed in rats 1 to 2 mm below the junction of the pulmonary conus and the left atrial appendage with a very low mortality rate.
In the first of two Case Reports, Ribichini and associates show the efficacy of an innovative radiofrequency guidewire to recanalize a chronic and complex total occlusion and the antiproliferative effect of high-dose oral prednisone in patients treated with implantation of multiple bare metal stents. Secondly, Zavala-Alarcon et al. describe the no-flow phenomenon during diagnostic coronary angiography and how prompt recognition and adequate management prevents certain death in this population.
In our only Clinical Review, collaborators Gianluca and Giorgio Rigatelli aimed to evaluate the pitfalls of Doppler ultrasound and the role of carotid angiography before carotid stenting in evaluating internal carotid artery disease in patients with aortic valve stenosis.
Finally, good news for vascular brachytherapy users. Recently, the only available vascular brachytherapy system, the Novoste Beta-Cath™ System, was acquired by Best Medical International via Best Vascular, which will provide the assurance that service will continue, including supply of the system to those interested in the technology both inside and outside the United States.
With continued reports of restenosis and drug-eluting stent failures, vascular brachytherapy may continue to have its clinical niche in the cardiovascular revascularization field. Cardiovascular Revascularization Medicine is committed to publishing scientific data related to this topic in upcoming issues of the journal.
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