Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_3720_Библиотеки_им_академика_М_И_Перельмана

delivery of the MGuard stent for patients with STEMI, especially with a large thrombotic volume, and for patients un­dergoing revascularization of an SVG with significant atherothrombotic burden. Furthermore, we believe that MGuard utilization should be considered in circumstances of failed aspiration thrombectomy or when implantation of BMS versus DES is not the main issue during the course of PCI, e.g., when the need to achieve acute optimal PCI results is at jeopardy because of a large thrombus load. The MGuard implantation is currently not recommended in highly calcified and/or highly tortuous vessels, because of increased risk of mesh or even stent dislodgment, or within coronary bifurcation lesions with large side branches, because of the risk of side-branch compromise by the double-layer design. In addition, as chronic kidney disease and cardiogenic shock patients were often excluded from studies evaluating MGuard, evidence for these patients is lacking. The relatively high rate of stent dislodgment, especially with the MGuard Prime, is of certain concern; however, according to our experience this problem can be avoided by utilization of meticulous stent delivery technique incorporated with proper guiding catheter support. Moreover, aggressive predilatation potentially may overcome this issue, but, plausibly, at the price of reduced antiembolic protection. When overlapping MGuard stent implantation is considered, it should be performed from the distal to the proximal segment of the artery because of the increased risk of mesh entanglement while passing through a previously implanted stent. As for the STENTYS stent platform, it should be strongly considered in STEMI or for SVG revascularization patients when proper vessel sizing is intricate, in very large arteries, or when a discrepancy between proximal and distal vessel reference diameter exists. Postdilatation is recom­mended in most cases of STENTYS implantation and adjunctive intracoronary imaging should be considered as well. In instances of distal edge dissection involving an MGuard or STENTYS stent, using the same stent type as the original is preferred. The apparent increased risk of restenosis, especially with the MGuard stent, should be kept in mind and highly suspected throughout extended follow-up period. An approach aimed at addressing this specific shortcoming with a drug­eluting MGuard stent is under development as of this writing. It should be emphasized that the dedicated thrombus­containing stents do not completel y abolish the risk of distal embolization; thus the use of additional devices with possibly additive thrombus-restr aining effect should be considered. To emphasize, the use of MGuard or STENTYS stents does not obviate the need for using distal protection devices in appropriate cases. Data regarding adjunctive pre- and postprocedural pharmacotherapy with these stents are sparse (e.g., recommended dual antiplatelet duration); therefore current recommendations are consistent with other equivalent stent types. Additional large prospective randomized controlled trials comparing these stent platforms with other commercially available stents are warranted to better define the appropriate role of these unique stents in the landscape of contemporary interventional cardiology.