Prospective Study to Assess DES Re-endothelization in BMS Restenosis and De-novo Lesions (DESERT)
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The hypothesis of this study is that strut coverage occurs earlier when a DES is implanted to treat a BMS restenosis compared with atherosclerotic de-novo lesion. This hypothesis is supported by two different observations: first, when a DES is implanted to treat a BMS restenosis, stent struts are deployed and drugs are eluted on a soft tissue mostly characterized by extracellular matrix with a regular surface. In this case stent malposition is less likely to occur compared to atherosclerotic lesion whose surface is often more irregular and rich in calcium. Second, patients who develop in-stent restenosis after BMS implantation are likely to show a more pronounced neointima hyperplasia and, when a DES is implanted to treat restenosis, reendothelialization is likely to occur earlier. If this hypothesis was verified, duration of dual antiplatelet therapy could be shortened after DES implantation on BMS restenosis with a clinical advantage in terms of bleeding risk. Furthermore, a higher bleeding risk is often a reason for choosing a BMS instead of a DES; thus, patients presenting with BMS restenosis are likely to have a higher bleeding risk and to benefit from a shorter period of dual antiplatelet therapy.
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Ages Eligible for Study:
18 Years to 90 Years (Adult, Senior)
Sexes Eligible for Study:
Accepts Healthy Volunteers:
Paziente affected by either stable coronary artery disease or silent myocardial ischemia
Patients suitable for implantation of everolimus-eluting stents (Xcience V, Xience Prime) because of stable/unstable angina or silent myocardial ischemia due to:
Group A: single BMS restenosis (> 50% of luminal diameter)
Group B: single de-novo lesion (> 50% of luminal diameter)
contraindications to dual antiplatelet therapy
acute myocardial infarction within the previous 48 hours
significant left main coronary artery disease
reference vessel diameter < 2.5 mm,
chronic kidney disease with serum creatinine > 2 mg/dl
allergy to contrast agent, everolimus, aspirin, clopidogrel
life expectancy < 24 months
patients with possible low adherence to medical therapy