151
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Patel N, Banning AP. Bioabsorbable scaffolds for the treatment of obstructive coronary artery disease: the next revolution in coronary intervention? Heart 2013; 99:1236-43. [DOI: 10.1136/heartjnl-2012-303346] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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152
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Tan A, Farhatnia Y, de Mel A, Rajadas J, Alavijeh MS, Seifalian AM. Inception to actualization: Next generation coronary stent coatings incorporating nanotechnology. J Biotechnol 2013; 164:151-70. [DOI: 10.1016/j.jbiotec.2013.01.020] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2012] [Revised: 01/09/2013] [Accepted: 01/11/2013] [Indexed: 02/07/2023]
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153
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154
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Kang CK, Lim WH, Kyeong S, Choe WS, Kim HS, Jun BH, Lee YS. Fabrication of biofunctional stents with endothelial progenitor cell specificity for vascular re-endothelialization. Colloids Surf B Biointerfaces 2013; 102:744-51. [DOI: 10.1016/j.colsurfb.2012.09.008] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2012] [Accepted: 09/05/2012] [Indexed: 02/01/2023]
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155
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Abstract
OPINION STATEMENT Coronary artery disease remains one of the major causes of morbidity and mortality worldwide. Percutaneous coronary intervention has been shown to be an effective treatment for angina pectoris, although it does not provide any prognostic benefit in stable patients. Drug-eluting stents (DES) have revolutionised the practice of interventional cardiology by permitting the percutaneous treatment of increasingly complex coronary artery lesions, which historically would have only been treated with surgery. There have been concerns with their long-term safety; however, the most recent large meta-analysis appears to suggest that these concerns are no longer a pertinent issue with the newest generation of stents. Consequently, DES are being used in complex patients and lesion types, and clinical data and guideline recommendations support this. New stent designs are also continually being developed, with the aim to further improve the safety profile of these devices. It must, however, be kept in mind that complacency following the impressive result from initial DES studies lead to, amongst others things, sub-optimal and careless stent deployment, and inappropriate patient selection, which may have ultimately contributed to the prior safety concerns. It is vital, therefore, that this is not repeated in light of the reassuring data, or with newer devices. Finally, as stent design improves, it is becoming increasingly difficult to identify meaningful and clinically relevant differences in stent performance without the requirement of a very large, expensive, randomised trial.
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156
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Cheng J, Zheng Y. In vitrostudy on newly designed biodegradable Fe-X composites (X = W, CNT) prepared by spark plasma sintering. J Biomed Mater Res B Appl Biomater 2013; 101:485-97. [DOI: 10.1002/jbm.b.32783] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2012] [Revised: 06/20/2012] [Accepted: 07/07/2012] [Indexed: 12/15/2022]
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157
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Naghavi N, de Mel A, Alavijeh OS, Cousins BG, Seifalian AM. Nitric oxide donors for cardiovascular implant applications. SMALL (WEINHEIM AN DER BERGSTRASSE, GERMANY) 2013; 9:22-35. [PMID: 23136136 DOI: 10.1002/smll.201200458] [Citation(s) in RCA: 114] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2012] [Revised: 06/13/2012] [Indexed: 06/01/2023]
Abstract
In an era of increased cardiovascular disease burden in the ageing population, there is great demand for devices that come in to contact with the blood such as heart valves, stents, and bypass grafts that offer life saving treatments. Nitric oxide (NO) elution from healthy endothelial tissue that lines the vessels maintains haemostasis throughout the vasculature. Surgical devices that release NO are desirable treatment options and N-diazeniumdiolates and S-nitrosothiols are recognized as preferred donor molecules. There is a keen interest to investigate newer methods by which NO donors can be retained within biomaterials so that their release and kinetic profiles can be optimized. A range of polymeric scaffolds incorporating microparticles and nanomaterials are presenting solutions to current challenges, and have been investigated in a range of clinical applications. This review outlines the application of NO donors for cardiovascular therapy using biomaterials that release NO locally to prevent thrombosis and intimal hyperplasia (IH) and enhance endothelialization in the fabrication of next generation cardiovascular device technology.
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Affiliation(s)
- Noora Naghavi
- UCL Centre for Nanotechnology & Regenerative Medicine, University College London, UK
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158
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Zhang K, Li JA, Deng K, Liu T, Chen JY, Huang N. The endothelialization and hemocompatibility of the functional multilayer on titanium surface constructed with type IV collagen and heparin. Colloids Surf B Biointerfaces 2013; 108:295-304. [PMID: 23563297 DOI: 10.1016/j.colsurfb.2012.12.053] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2012] [Revised: 11/29/2012] [Accepted: 12/29/2012] [Indexed: 10/27/2022]
Abstract
The type IV collagen/heparin (IVCol/Hep) multilayer was developed on amino-silanized titanium (Ti) surface layer by layer self-assembly. Ti, TiOH, TiOHA and TiOHA(HC)3H were characterized by Fourier transform infrared spectroscopy (FTIR), water contact angle measurements and scanning electron microscopy (SEM), respectively. Alcian Blue 8GX staining and immunofluorescence staining were used to characterize the heparin (Hep) and type IV collagen (IVCol), respectively. The blood compatibilities of Ti and the treated Ti were evaluated by platelet adhesion test and clotting time using PRP. Blood compatibility tests reveal that the assembled functional multilayer displayed less platelets adhesion and prolonged APTTs time compared with the controlled Ti. Endothelial cells (ECs) culture results showed more attached and proliferated ECs on the TiOHA(HC)3H than that on Ti, especially compared with that on TiOH and TiOHA. Thus, the assembled Hep and IVCol multilayer can improve the cell compatibility and the blood compatibility. We anticipate that this IVCol/Hep functional multilayer will be beneficial to enhance the biocompatibility of the Ti-based biomaterial devices.
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Affiliation(s)
- Kun Zhang
- Key Laboratory for Advanced Technologies of Materials, Ministry of Education, Southwest Jiaotong University, Chengdu 610031, PR China
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159
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Sternberg K, Petersen S, Grabow N, Senz V, zu Schwabedissen HM, Kroemer HK, Schmitz KP. Implant-associated local drug delivery systems based on biodegradable polymers: customized designs for different medical applications. ACTA ACUST UNITED AC 2013; 58:417-27. [DOI: 10.1515/bmt-2012-0049] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2012] [Accepted: 05/17/2013] [Indexed: 12/17/2022]
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160
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Iqbal J, Gunn J, Serruys PW. Coronary stents: historical development, current status and future directions. Br Med Bull 2013; 106:193-211. [PMID: 23532779 DOI: 10.1093/bmb/ldt009] [Citation(s) in RCA: 174] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
INTRODUCTION Coronary angioplasty with stenting has revolutionized the treatment of coronary artery disease. This article describes the history of coronary angioplasty and stenting, reviews the contemporary stents and recommendations and highlights the on-going work and potential future directions. SOURCES OF DATA This review examined the data on coronary stents available in PubMed. AREAS OF AGREEMENT Coronary artery stenting is the treatment of choice for patients requiring coronary angioplasty. Stents, and particularly drug-eluting stents, reduce the risk of restenosis, but may be associated with the hazard of late stent thrombosis. Dual anti-platelet treatment is recommended for patients receiving coronary stents. AREAS OF CONTROVERSY The selection of stents for various lesions and patients and the duration of anti-platelet therapy remain debated areas. AREAS TIMELY FOR DEVELOPING RESEARCH There are on-going preclinical and clinical studies to develop better stent platforms, more biocompatible polymers, novel anti-proliferative and anti-platelet drugs, pro-healing stents and bioresorbable scaffolds.
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Affiliation(s)
- Javaid Iqbal
- Thorax Centre, Erasmus Medical Centre, Rotterdam, The Netherlands.
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161
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Kim HK, Jeong MH. Coronary stent thrombosis: current insights into new drug-eluting stent designs. Chonnam Med J 2012; 48:141-9. [PMID: 23323218 PMCID: PMC3539093 DOI: 10.4068/cmj.2012.48.3.141] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2012] [Revised: 10/25/2012] [Accepted: 10/26/2012] [Indexed: 01/15/2023] Open
Abstract
The advances of interventional cardiology have been achieved by new device development, finding appropriate drug regimes, and understanding of pathomechanism. Drug-eluting stents (DES) implantation with dual anti-platelet therapy reduced revascularization without increasing mortality or myocardial infarction compared with bare-metal stenting. However, late-term stent thrombosis (ST) and restenosis limited its value and raised the safety concern. Main mechanisms of this phenomenon are impaired endothelialization and hypersensitivity reaction with polymer. The second generation DES further improved safety and/or efficacy by using thinner stent strut and biocompatible polymer. Recently, new concept DES with biodegradable polymer, polymer-free and bioabsorbable scaffold are under investigation in the quest to minimize the risk of ST.
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Affiliation(s)
- Hyun Kuk Kim
- The Heart Research Center Nominated by Korea Ministry of Health and Welfare, Chonnam National University Hospital, Gwangju, Korea. ; Korea Cardiovascular Stent Research Institute, Chonnam National University, Gwangju, Korea
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162
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Andukuri A, Sohn YD, Anakwenze CP, Lim DJ, Brott BC, Yoon YS, Jun HW. Enhanced human endothelial progenitor cell adhesion and differentiation by a bioinspired multifunctional nanomatrix. Tissue Eng Part C Methods 2012; 19:375-85. [PMID: 23126402 DOI: 10.1089/ten.tec.2012.0312] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Endothelial progenitor cell (EPC)-capturing techniques have led to revolutionary strategies that can improve the performance of cardiovascular implant devices and engineered tissues by enhancing re-endothelialization and angiogenesis. However, these strategies are limited by controversies regarding the phenotypic identities of EPCs as well as their inability to target and prevent the other afflictions associated with current therapies, namely, thrombosis and neointimal hyperplasia. Therefore, the goal of this study was to study the efficacy of a bioinspired multifunctional nanomatrix in recruiting and promoting the differentiation of EPCs toward an endothelial lineage. The bioinspired nanomatrix combines multiple components, including self-assembled peptide amphiphiles (PAs) that include cell adhesive ligands, nitric oxide (NO)-producing donors, and enzyme-mediated degradable sequences to achieve an endothelium-mimicking character. In this study, human peripheral blood mononuclear cells (PBMNCs) were isolated and cultured on the bioinspired multifunctional nanomatrix. Initial cell adhesion, lectin staining, acetylated low-density lipoprotein uptake, and expression of endothelial markers, including CD31, CD34, von Willebrand Factor, and VEGFR2, were analyzed. The results from this study indicate that the NO releasing bioinspired multifunctional nanomatrix promotes initial adhesion of EPCs when compared to control surfaces. The expression of endothelial markers is also increased on the bioinspired multifunctional nanomatrix, suggesting that it directs the differentiation of EPCs toward an endothelial phenotype. The bioinspired nanomatrix therefore provides a novel biomaterial-based platform for capturing as well as directing EPC behavior. Therefore, this study has the potential to positively impact the patency of cardiovascular devices such as stents and vascular grafts as well as enhanced angiogenesis for ischemic or engineered tissues.
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Affiliation(s)
- Adinarayana Andukuri
- Department of Biomedical Engineering, University of Alabama at Birmingham, Birmingham, AL 35294, USA
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163
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Kunadian V, Harper AR, Bawamia B, Zaman A. Drug-eluting stents versus bare-metal stents in primary percutaneous coronary intervention. Interv Cardiol 2012. [DOI: 10.2217/ica.12.66] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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164
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Sethi A, Bahekar A, Bhuriya R, Bajaj A, Singh PP, Arora R, Khosla S. Zotarolimus-eluting stent versus sirolimus-eluting and paclitaxel-eluting stents for percutaneous coronary intervention: a meta-analysis of randomized trials. Arch Cardiovasc Dis 2012. [PMID: 23177483 DOI: 10.1016/j.acvd.2012.01.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND The zotarolimus-eluting stent (ZES) is a new drug-eluting stent that delivers zotarolimus, a synthetic analogue of sirolimus, through a biocompatible phosphorylcholine polymer coating. ZES has shown promising results compared with bare-metal stents, but its safety and efficacy against sirolimus-eluting (SES) and paclitaxel-eluting (PES) stents is yet to be established. AIMS We aimed to summarize current evidence from randomized trials comparing ZES with SES and PES. METHODS We searched the Medline, Embase and CENTRAL databases for randomized studies comparing ZES with SES and PES for percutaneous coronary intervention. Relevant clinical and angiographic outcomes were extracted and combined using random and fixed-effect models for heterogeneous and homogenous outcomes, respectively. RESULTS Seven randomized trials met the inclusion criteria: ZES group, n=3787; SES group, n=2606; PES group, n=1966. Compared with SES, ZES was associated with significantly higher odds of clinically driven target vessel revascularization (odds ratio [OR] 2.36, 95% confidence interval [CI] 1.78-3.14) and target lesion revascularization (OR 2.46, 95% CI 1.36-4.46). Compared with SES, ZES had higher in-stent restenosis (OR 6.13, 95% CI 3.96-9.50), late lumen loss 'in-stent' (mean difference [MD] 0.39 mm, 95% CI 0.34-0.44) and late lumen loss 'in-segment' (MD 0.18 mm, 95% CI 0.15-0.21). ZES was associated with higher in-stent late lumen loss than PES (MD 0.18 mm, 95% CI 0.07-0.28). There were no differences in mortality, reinfarction or stent thrombosis with ZES compared with SES and PES. CONCLUSION ZES is not superior to PES and is inferior to SES in terms of angiographic outcomes and clinically driven revascularization.
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Affiliation(s)
- Ankur Sethi
- Department of Medicine, Rosalind Franklin University of Medicine and Sciences, North Chicago, IL 60064, USA.
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165
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Rodríguez G, Fernández-Gutiérrez M, Parra J, López-Bravo A, Molina M, Duocastella L, San Román J. Bioactive coatings for coronary stents: Modulation of cell proliferation by controlled release of anti-proliferative drugs. J BIOACT COMPAT POL 2012. [DOI: 10.1177/0883911512465699] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Drug eluting coronary stents coated with a bioactive and biostable polymer system (THBA70), based on acrylate copolymers bearing a salicylic acid derivative as side substituent, were evaluated. The microstructural architecture of the copolymer THBA70 comprises a random copolymer of a methacrylate derivative from triflusal (4-trifluoromethyl salicylic acid) with 45 mol% of THEMA (2-methacryloyloxyethyl [2-(acetyloxy)-4-(trifluoromethyl)] benzoate), which makes the system anti-thrombogenic with good adhesion to the surface of metallic stents. The bioactive coating prevented thrombosis, an adverse effect associated with the implantation of drug-eluting stents. The in vitro drug delivery of drug-eluting stents under dynamic conditions indicated excellent controlled drug release. The THBA70 films loaded with relatively low concentrations of taxol or simvastatin in contact with fibroblasts produced inhibition of cell proliferation with a dose-dependent bioactivity.
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Affiliation(s)
- Gema Rodríguez
- Biomaterials Group, Polymeric Nanomaterials and Biomaterials Department, Institute of Polymer Science and Technology, CSIC, Madrid, Spain
- Biomedical Research Networking Center in Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Zaragoza, Spain
| | - Mar Fernández-Gutiérrez
- Biomaterials Group, Polymeric Nanomaterials and Biomaterials Department, Institute of Polymer Science and Technology, CSIC, Madrid, Spain
- Biomedical Research Networking Center in Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Zaragoza, Spain
| | - Juan Parra
- Biomedical Research Networking Center in Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Zaragoza, Spain
- Associate Unit CSIC-Avila’s Provincial Hospital, Ávila, Spain
| | - Antonio López-Bravo
- Biomedical Research Networking Center in Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Zaragoza, Spain
- Associate Unit CSIC-Avila’s Provincial Hospital, Ávila, Spain
| | | | | | - Julio San Román
- Biomaterials Group, Polymeric Nanomaterials and Biomaterials Department, Institute of Polymer Science and Technology, CSIC, Madrid, Spain
- Biomedical Research Networking Center in Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Zaragoza, Spain
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166
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Stevenson CL, Santini JT, Langer R. Reservoir-based drug delivery systems utilizing microtechnology. Adv Drug Deliv Rev 2012; 64:1590-602. [PMID: 22465783 DOI: 10.1016/j.addr.2012.02.005] [Citation(s) in RCA: 170] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2011] [Revised: 02/09/2012] [Accepted: 02/15/2012] [Indexed: 11/30/2022]
Abstract
This review covers reservoir-based drug delivery systems that incorporate microtechnology, with an emphasis on oral, dermal, and implantable systems. Key features of each technology are highlighted such as working principles, fabrication methods, dimensional constraints, and performance criteria. Reservoir-based systems include a subset of microfabricated drug delivery systems and provide unique advantages. Reservoirs, whether external to the body or implanted, provide a well-controlled environment for a drug formulation, allowing increased drug stability and prolonged delivery times. Reservoir systems have the flexibility to accommodate various delivery schemes, including zero order, pulsatile, and on demand dosing, as opposed to a standard sustained release profile. Furthermore, the development of reservoir-based systems for targeted delivery for difficult to treat applications (e.g., ocular) has resulted in potential platforms for patient therapy.
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Affiliation(s)
- Cynthia L Stevenson
- On Demand Therapeutics, Inc., One Industrial Way, Unit 1A, Tyngsboro, MA 01879, USA.
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167
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Hemocompatibility of drug-eluting coronary stents coated with sulfonated poly (styrene-block-isobutylene-block-styrene). Biomaterials 2012; 33:8204-12. [DOI: 10.1016/j.biomaterials.2012.07.066] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2012] [Accepted: 07/30/2012] [Indexed: 11/23/2022]
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168
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Morlacchi S, Migliavacca F. Modeling stented coronary arteries: where we are, where to go. Ann Biomed Eng 2012; 41:1428-44. [PMID: 23090621 DOI: 10.1007/s10439-012-0681-6] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2012] [Accepted: 10/16/2012] [Indexed: 01/09/2023]
Abstract
In the last two decades, numerical models have become well-recognized and widely adopted tools to investigate stenting procedures. Due to limited computational resources and modeling capabilities, early numerical studies only involved simplified cases and idealized stented arteries. Nowadays, increased computational power allows for numerical models to meet clinical needs and include more complex cases such as the implantation of multiple stents in bifurcations or curved vessels. Interesting progresses have been made in the numerical modeling of stenting procedures both from a structural and a fluid dynamics points of view. Moreover, in the drug eluting stents era, new insights on drug elution capabilities are becoming essential in the stent development. Lastly, image-based methods able to reconstruct realistic geometries from medical images have been proposed in the recent literature aiming to better describe the peculiar anatomical features of coronary vessels and increase the accuracy of the numerical models. In this light, this review provides a comprehensive analysis of the current state-of-the-art in this research area, discussing the main methodological advances and remarkable results drawn from a number of significant studies.
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Affiliation(s)
- Stefano Morlacchi
- Laboratory of Biological Structure Mechanics, Structural Engineering Department, Politecnico di Milano, Piazza L. da Vinci 32, 20133 Milan, Italy.
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169
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170
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Sprague EA, Tio F, Ahmed SH, Granada JF, Bailey SR. Impact of Parallel Micro-Engineered Stent Grooves on Endothelial Cell Migration, Proliferation, and Function. Circ Cardiovasc Interv 2012; 5:499-507. [DOI: 10.1161/circinterventions.111.967901] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background—
Stent luminal surface characteristics influence surface endothelialization. We hypothesize that luminal stent microgrooves created in the direction of coronary flow accelerate endothelial cell migration, resulting in lower levels of neointimal formation.
Methods and Results—
Surface coverage efficiency was evaluated in vitro by allowing human aortic endothelial cells (HAEC) to migrate onto microgrooved (G) or smooth (NG) surfaces. HAEC functionality was assessed by proliferation rate, apoptosis rate, nitric oxide production, and inflammatory markers TNF-α and VCAM-1 expression. Early endothelialization and restenosis studies were performed using the porcine coronary injury model. Stainless steel stents of identical design with (GS) and without (NGS) luminal microgrooves were used. The commercially available Multi-Link Vision (MLVS) stent of identical design was used as a control. The degree of GS and NGS surface endothelialization was compared at 3 days. Biocompatibility and tissue response outcomes were evaluated at 28 days. The in vitro study demonstrated that at 7 days the presence of surface microgrooves increased HAEC migration distance >2-fold. Cell proliferation rate and nitric oxide production were increased and apoptosis rate was decreased. There was no difference in inflammatory marker expression. At 3 days, coronary artery stent endothelialization was significantly increased in GS compared with NGS (81.3% versus 67.5%,
P
=0.0002). At 28 days, GS exhibited lower neointimal thickness compared with either NGS (21.1%,
P
=0.011) or MLVS (40.8%,
P
=0.014).
Conclusion—
Parallel microgrooves on coronary stent luminal surfaces promote endothelial cell migration and positively influence endothelial cell function, resulting in decreased neointimal formation in the porcine coronary injury model.
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Affiliation(s)
- Eugene A. Sprague
- From the University of Texas Health Science Center at San Antonio, San Antonio, TX (E.A.S., F.T., S.H.A., S.R.B.); and Skirball Center for Cardiovascular Research, Cardiovascular Research Foundation, Columbia University Medical Center, New York, NY (J.F.G.)
| | - Fermin Tio
- From the University of Texas Health Science Center at San Antonio, San Antonio, TX (E.A.S., F.T., S.H.A., S.R.B.); and Skirball Center for Cardiovascular Research, Cardiovascular Research Foundation, Columbia University Medical Center, New York, NY (J.F.G.)
| | - S. Hinan Ahmed
- From the University of Texas Health Science Center at San Antonio, San Antonio, TX (E.A.S., F.T., S.H.A., S.R.B.); and Skirball Center for Cardiovascular Research, Cardiovascular Research Foundation, Columbia University Medical Center, New York, NY (J.F.G.)
| | - Juan F. Granada
- From the University of Texas Health Science Center at San Antonio, San Antonio, TX (E.A.S., F.T., S.H.A., S.R.B.); and Skirball Center for Cardiovascular Research, Cardiovascular Research Foundation, Columbia University Medical Center, New York, NY (J.F.G.)
| | - Steven R. Bailey
- From the University of Texas Health Science Center at San Antonio, San Antonio, TX (E.A.S., F.T., S.H.A., S.R.B.); and Skirball Center for Cardiovascular Research, Cardiovascular Research Foundation, Columbia University Medical Center, New York, NY (J.F.G.)
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171
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Byrne RA, Kastrati A. No country for old stents? Improving long-term patient outcomes with biodegradable polymer drug-eluting stents. Expert Rev Cardiovasc Ther 2012; 10:429-32. [PMID: 22458576 DOI: 10.1586/erc.12.29] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Biodegradable polymer-coated drug-eluting stents (DESs) represent an attractive approach to improve vascular healing after coronary intervention. The proof-of-concept chain of investigation includes preclinical safety assessment, surrogate end point clinical efficacy studies and large-scale clinical outcome studies, in which noninferiority against benchmark devices is assessed at 12 months, with adjudication of hypothesized clinical advantage at long-term follow-up. The 4-year outcome data from large-scale trials such as the LEADERS study represents a final link in this process. Data from this trial show maintenance of noninferiority and an overall improvement in the composite of death, myocardial infarction and revascularization with biodegradable polymer DESs versus durable polymer sirolimus-eluting stents that is statistically significant and perhaps also clinically important (risk ratio: 0.81; 95% CI: 0.66-1.00; p-value for superiority = 0.05). Furthermore, although reductions in the incidence of stent thrombosis with biodegradable polymer stents at 4 years did not reach statistical significance, in keeping with the hypothesized mechanism of benefit, the observed risk differences seemed to be driven by a reduction in very late events beyond 1 year after intervention. These findings are backed up by those from a pooled analysis of the three largest biodegradable polymer DES randomized trials. With the availability of high-quality biodegradable polymer devices and the phasing out of earlier generation devices, the next 5 years will see increasing uptake of this therapy in routine practice. Whether improvements in outcomes with biodegradable polymer DESs can also be demonstrated against second-generation durable polymer stents is the subject of a number of ongoing clinical trials.
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Affiliation(s)
- Robert A Byrne
- Deutsches Herzzentrum, Technische Universität, Lazarettstrasse 36, 80636 Munich, Germany
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172
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Chang X, Gorbet M. The effect of shear on in vitro platelet and leukocyte material-induced activation. J Biomater Appl 2012; 28:407-15. [DOI: 10.1177/0885328212454689] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The failure to understand the mechanisms of biomaterial-associated thrombosis prevents us from improving the blood compatibility of stents and mechanical heart valves. Blood-material interactions trigger a complex series of events and anticoagulant and anti-platelet therapies are needed to reduce the risks of thrombotic complications with most cardiovascular materials. While material interaction with platelets has been widely studied, little is currently known on material-induced leukocyte activation in the presence of shear. In vitro experiments were performed to assess the effect of flow on blood cell activation induced by medical grade metals, ST316L and TiAl6V4. Blood was circulated in flow chambers preloaded with or without metal wires at shear rates of 100, 500, and 1500 s−1. Platelet and leukocyte activation, leukocyte-platelet aggregation, and tissue factor expression on monocytes were measured by flow cytometry. Metal surfaces were characterized by scanning electron microscopy. Under physiological shear rates, no significant platelet microparticle formation was observed. However, significant CD11b up-regulation, leukocyte-platelet aggregates, and tissue factor expression were observed at 100 s−1. As shear rate increased to 1500 s−1, leukocyte activation reduced to control values. TiAl6V4-induced leukocyte activation was generally lower than that of ST316L. Adhesion significantly decreased with increasing shear rate to 1500 s−1. In blood, increase within physiological shear rates led to a significant reduction in in vitro material-induced leukocyte activation, suggesting that difference between material biocompatibility may be better identified at low shear rates or under pathological shear conditions.
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Affiliation(s)
- Xiaojian Chang
- Department of Systems Design Engineering, University of Waterloo, Waterloo, ON, Canada
| | - Maud Gorbet
- Department of Systems Design Engineering, University of Waterloo, Waterloo, ON, Canada
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173
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Carlyle WC, McClain JB, Tzafriri AR, Bailey L, Zani BG, Markham PM, Stanley JRL, Edelman ER. Enhanced drug delivery capabilities from stents coated with absorbable polymer and crystalline drug. J Control Release 2012; 162:561-7. [PMID: 22800575 DOI: 10.1016/j.jconrel.2012.07.004] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2012] [Accepted: 07/07/2012] [Indexed: 11/16/2022]
Abstract
Current drug eluting stent (DES) technology is not optimized with regard to the pharmacokinetics of drug delivery. A novel, absorbable-coating sirolimus-eluting stent (AC-SES) was evaluated for its capacity to deliver drug more evenly within the intimal area rather than concentrating drug around the stent struts and for its ability to match coating erosion with drug release. The coating consisted of absorbable poly-lactide-co-glycolic acid (PLGA) and crystalline sirolimus deposited by a dry-powder electrostatic process. The AC-SES demonstrated enhanced drug stability under simulated use conditions and consistent drug delivery balanced with coating erosion in a porcine coronary implant model. The initial drug burst was eliminated and drug release was sustained after implantation. The coating was absorbed within 90 days. Following implantation into porcine coronary arteries the AC-SES coating is distributed in the surrounding intimal tissue over the course of several weeks. Computational modeling of drug delivery characteristics demonstrates how distributed coating optimizes the load of drug immediately around each stent strut and extends drug delivery between stent struts. The result was a highly efficient arterial uptake of drug with superior performance to a clinical bare metal stent (BMS). Neointimal thickness (0.17±0.07 mm vs. 0.28±0.11 mm) and area percent stenosis (22±9% vs. 35±12%) were significantly reduced (p<0.05) by the AC-SES compared to the BMS 30 days after stent implantation in an overlap configuration in porcine coronary arteries. Inflammation was significantly reduced in the AC-SES compared to the BMS at both 30 and 90 days after implantation. Biocompatible, rapidly absorbable stent coatings enable the matching of drug release with coating erosion and provide for the controlled migration of coating material into tissue to reduce vicissitudes in drug tissue levels, optimizing efficacy and reducing potential toxicity.
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Affiliation(s)
- Wenda C Carlyle
- Micell Technologies, Inc., 801 Capitola Drive, Suite 1, Durham, NC 27713-4384 USA.
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174
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Khan W, Farah S, Domb AJ. Drug eluting stents: Developments and current status. J Control Release 2012; 161:703-12. [PMID: 22366546 DOI: 10.1016/j.jconrel.2012.02.010] [Citation(s) in RCA: 121] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2011] [Revised: 02/07/2012] [Accepted: 02/11/2012] [Indexed: 11/27/2022]
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175
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TURCO MARKA, KANSAL ANURAAGR, STERN SEAN, AMOROSI STACEYL, UNDERWOOD PAULL, LISSOVOY GREGDE, DAWKINS KEITHD. Economic Modeling of New Stent Platforms to Evaluate Cost Effectiveness: Analysis of the TAXUS Liberté Versus TAXUS Express Stents. J Interv Cardiol 2012; 25:353-63. [DOI: 10.1111/j.1540-8183.2012.00737.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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176
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Guagliumi G, Capodanno D, Ikejima H, Bezerra HG, Sirbu V, Musumeci G, Fiocca L, Lortkipanidze N, Vassileva A, Tahara S, Valsecchi O, Costa MA. Impact of different stent alloys on human vascular response to everolimus-eluting stent: An optical coherence tomography study: The OCTEVEREST. Catheter Cardiovasc Interv 2012; 81:510-8. [DOI: 10.1002/ccd.24374] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2012] [Accepted: 02/12/2012] [Indexed: 02/03/2023]
Affiliation(s)
| | - Davide Capodanno
- Cardiology Department; Ferrarotto Hospital, Catania, and University of Catania; Catania; Italy
| | | | - Hiram G. Bezerra
- University Hospitals Case Medical Center; Case Western Reserve University; Cleveland; Ohio
| | - Vasile Sirbu
- Cardiovascular Department; Ospedali Riuniti; Bergamo; Italy
| | | | - Luigi Fiocca
- Cardiovascular Department; Ospedali Riuniti; Bergamo; Italy
| | | | | | - Satoko Tahara
- University Hospitals Case Medical Center; Case Western Reserve University; Cleveland; Ohio
| | | | - Marco A. Costa
- University Hospitals Case Medical Center; Case Western Reserve University; Cleveland; Ohio
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177
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Granada JF. Stents con polímeros durables: ¿hay diferencias geográficas en los resultados clínicos? REVISTA COLOMBIANA DE CARDIOLOGÍA 2012. [DOI: 10.1016/s0120-5633(12)70119-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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178
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Drug eluting stents based on Poly(ethylene carbonate): Optimization of the stent coating process. Eur J Pharm Biopharm 2012; 80:562-70. [DOI: 10.1016/j.ejpb.2011.12.006] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2011] [Revised: 12/11/2011] [Accepted: 12/13/2011] [Indexed: 11/22/2022]
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179
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Conroy J, Baber U, Mehran R. Future Perspectives on Percutaneous Coronary Interventions in Women. Interv Cardiol Clin 2012; 1:251-258. [PMID: 28582099 DOI: 10.1016/j.iccl.2012.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
In the United States alone, more than 1 million cardiac catheterizations are performed each year, with approximately 600,000 patients undergoing percutaneous coronary intervention (PCI). A meaningful perspective on the future of PCI in women requires not only reflection on some of the major developments in interventional cardiology but also a look back more generally at the changing patterns in the burden of coronary disease in the population and at the gains accrued in understanding and combating cardiovascular disease in women.
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Affiliation(s)
- Jennifer Conroy
- Department of Medicine, Mount Sinai School of Medicine, One Gustave L. Levy Place, Box 1030, New York, NY 10029, USA.
| | - Usman Baber
- Department of Medicine, Mount Sinai School of Medicine, One Gustave L. Levy Place, Box 1030, New York, NY 10029, USA
| | - Roxana Mehran
- Department of Medicine, Mount Sinai School of Medicine, One Gustave L. Levy Place, Box 1030, New York, NY 10029, USA
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Spencer JA, Hermiller JB. Evaluation and treatment of coronary bifurcation disease: current strategies and new technologies. Interv Cardiol 2012. [DOI: 10.2217/ica.12.12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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181
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Brugaletta S, Radu MD, Garcia-Garcia HM, Heo JH, Farooq V, Girasis C, van Geuns RJ, Thuesen L, McClean D, Chevalier B, Windecker S, Koolen J, Rapoza R, Miquel-Hebert K, Ormiston J, Serruys PW. Circumferential evaluation of the neointima by optical coherence tomography after ABSORB bioresorbable vascular scaffold implantation: can the scaffold cap the plaque? Atherosclerosis 2012; 221:106-12. [PMID: 22209268 DOI: 10.1016/j.atherosclerosis.2011.12.008] [Citation(s) in RCA: 98] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2011] [Revised: 12/03/2011] [Accepted: 12/05/2011] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To quantify the circumferential healing process at 6 and 12 months following scaffold implantation. BACKGROUND The healing process following stent implantation consists of tissue growing on the top of and in the space between each strut. With the ABSORB bioresorbable vascular scaffold (BVS), the outer circumference of the scaffold is detectable by optical coherence tomography (OCT), allowing a more accurate and complete evaluation of the intra-scaffold neointima. METHODS A total of 58 patients (59 lesions), who received an ABSORB BVS 1.1 implantation and a subsequent OCT investigation at 6 (n=28 patients/lesions) or 12 (n=30 patients with 31 lesions) months follow-up were included in the analysis. The thickness of the neointima was calculated circumferentially in the area between the abluminal side of the scaffold and the lumen by means of an automated detection algorithm. The symmetry of the neointima thickness in each cross section was evaluated as the ratio between minimum and maximum thickness. RESULTS The neointima area was not different between 6 and 12 months follow-up (1.57±0.42 mm(2) vs. 1.64±0.77 mm(2); p=0.691). No difference was also found in the mean thickness of the neointima (median [IQR]) between the two follow-up time points (210 μm [180-260]) vs. 220 μm [150-260]; p=0.904). However, the symmetry of the neointima thickness was higher at 12 than at 6 months follow-up (0.23 [0.13-0.28] vs. 0.16 [0.08-0.21], p=0.019). CONCLUSIONS A circumferential evaluation of the healing process following ABSORB implantation is feasible, showing the formation of a neointima layer, that resembles a thick fibrous cap, known for its contribution to plaque stability.
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182
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Alviar CL, Tellez A, Wang M, Potts P, Smith D, Tsui M, Budzynski W, Raizner AE, Kleiman NS, Lev EI, Granada JF, Kaluza GL. Low-dose sirolimus-eluting hydroxyapatite coating on stents does not increase platelet activation and adhesion ex vivo. J Thromb Thrombolysis 2012; 34:91-8. [DOI: 10.1007/s11239-012-0696-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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183
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Basalus MWZ, Tandjung K, van Westen T, Sen H, van der Jagt PKN, Grijpma DW, van Apeldoorn AA, von Birgelen C. Scanning electron microscopic assessment of coating irregularities and their precursors in unexpanded durable polymer-based drug-eluting stents. Catheter Cardiovasc Interv 2012; 79:644-53. [PMID: 21805599 DOI: 10.1002/ccd.23273] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2011] [Accepted: 06/11/2011] [Indexed: 11/10/2022]
Abstract
OBJECTIVES To assess and quantify coating irregularities on unexpanded and expanded durable polymer-based drug-eluting stents (DES) to gain insights into the origin of coating irregularities. BACKGROUND Previous scanning electron microscopy (SEM) studies in various expanded DES revealed differences in frequency and size of coating irregularities between DES types and specific distribution patterns, however, the origin of these irregularities is unclear. METHODS We assessed at bench side a total of 1,200 SEM images obtained in 30 DES samples (15 expanded and 15 unexpanded) of Cypher Select Plus, Taxus Liberté, Endeavor, Xience V, and resolute. RESULTS For most coating irregularities seen on expanded DES (72%; 23/32), a matching irregularity (n = 18/23) and/or its precursor (n = 11/23) was observed in unexpanded DES. Unexpanded Cypher select showed (small) crater lesions and cracks together with precursors of "peeling." On unexpanded Taxus Liberté, thinning of polymer, small bare metal areas, wrinkles, and one precursor type were found. Unexpanded endeavor showed cracks, small bare metal areas, crater lesions, and precursors of the latter. Unexpanded Xience V and resolute mainly revealed crater lesions and their precursors. On unexpanded versus expanded DES, there was no difference in measured frequency of coating irregularities and precursors (P = ns) with the exception of more bare metal areas on expanded Taxus Liberte (P = 0.01). CONCLUSIONS Most coating irregularities, or the potential to develop them, are inherent to the unexpanded DES. Important determinants of the formation of coating irregularities may be the stent geometry and the physical properties of the coating, while stent-balloon interaction plays no major role.
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Affiliation(s)
- Mounir W Z Basalus
- Department of Cardiology, Thoraxcentrum Twente, Enschede, The Netherlands
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184
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Serruys PW, Onuma Y, Dudek D, Smits PC, Koolen J, Chevalier B, de Bruyne B, Thuesen L, McClean D, van Geuns RJ, Windecker S, Whitbourn R, Meredith I, Dorange C, Veldhof S, Hebert KM, Sudhir K, Garcia-Garcia HM, Ormiston JA. Evaluation of the second generation of a bioresorbable everolimus-eluting vascular scaffold for the treatment of de novo coronary artery stenosis: 12-month clinical and imaging outcomes. J Am Coll Cardiol 2012; 58:1578-88. [PMID: 21958884 DOI: 10.1016/j.jacc.2011.05.050] [Citation(s) in RCA: 294] [Impact Index Per Article: 24.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2011] [Revised: 05/24/2011] [Accepted: 05/31/2011] [Indexed: 12/23/2022]
Abstract
OBJECTIVES The aim of this study was to demonstrate that the prevention of early scaffold area shrinkage of the ABSORB BVS (Rev.1.1, Abbott Vascular, Santa Clara, California) was sustained and not simply delayed by a few months. BACKGROUND With improved scaffold design and modified manufacturing process of its polymer, the second iteration of ABSORB (BVS 1.1) has improved performance to prevent a scaffold area reduction at 6 months. METHODS Fifty-six patients were enrolled and received 57 ABSORB scaffolds. Quantitative coronary angiography, intravascular ultrasound (IVUS), analysis of radiofrequency backscattering, echogenicity and optical coherence tomography (OCT) were performed at baseline and at 12-month follow-up. RESULTS Overall the scaffold area remained unchanged with IVUS as well as with OCT, whereas the radiofrequency backscattering and the echogenicity of the struts decreased by 16.8% (p < 0.001) and 20% (p < 0.001), respectively; more specifically, the strut core area on OCT decreased by 11.4% (p = 0.003). Despite the absence of scaffold area loss, pharmacological vasomotion was restored. On an intention-to-treat basis, the angiographic late lumen loss amounted to 0.27 ± 0.32 mm with an IVUS relative decrease in minimal lumen area of 1.94% (p = 0.12), without significant changes in mean lumen area. The OCT at follow-up showed that 96.69% of the struts were covered and that malapposition, initially observed in 18 scaffolds was only detected at follow-up in 4 scaffolds. Two patients experienced peri-procedural and iatrogenic myocardial infarction, respectively, whereas 2 underwent repeat intervention, resulting in the major adverse cardiac event rate of 7.1% (4 of 56). CONCLUSIONS The 12-month performance of the second-generation ABSORB bioresorbable everolimus-eluting scaffold justifies the conduct of a randomized trial against current best standards. (A Clinical Evaluation of the Bioabsorbable Everolimus Eluting Coronary Stent System [BVS EECSS] in the Treatment of Patients With de Novo Native Coronary Artery Lesions; NCT00856856).
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Affiliation(s)
- Patrick W Serruys
- Thorax Center, Erasmus Medical Center, Gravendijkwal 230, Rotterdam, the Netherlands.
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185
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Tamburino C, Capodanno D, Di Salvo ME, Sanfilippo A, Cascone I, Incardona V, Longo G, Giacoppo D, Capranzano P, Sgroi C, Ussia G, Monaco A, La Manna A. Safety and effectiveness of the Catania Polyzene-F coated stent in real world clinical practice: 12-month results from the ATLANTA 2 registry. EUROINTERVENTION 2012; 7:1062-8. [DOI: 10.4244/eijv7i9a169] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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186
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Sangiorgi G, Biondi-Zoccai G, Modena MG. Repetita iuvant (repeating helps): why another paper on a new stent is important. EUROINTERVENTION 2011; 7:1014-7. [PMID: 22207225 DOI: 10.4244/eijv7i9a162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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187
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Gomez-Lara J, Heo JH, Brugaletta S, Garg S, Garcia-Garcia HM, van Geuns RJ, Silber S, Windecker S, Serruys PW. Risk of target lesion failure in relationship to vessel angiographic geometry and stent conformability using the second generation of drug-eluting stents. Am Heart J 2011; 162:1069-1079.e2. [PMID: 22137081 DOI: 10.1016/j.ahj.2011.09.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2011] [Accepted: 09/13/2011] [Indexed: 10/15/2022]
Abstract
BACKGROUND Vessel angulation and large changes in vessel geometry after stent implantation have been associated with an increased risk of target lesion failure (TLF) using bare-metal stents. Second-generation drug-eluting stents (DES)offer superior conformability and inhibition of neointima. The aim of the study is to investigate the relationship between pre and post-implant vessel geometry and the occurrence of TLF at 1 year after treatment with second-generation DES; and to compare the conformability of Resolute and Xience stents. METHODS The RESOLUTE All-Comers trial randomized 2292 patients (3366 lesions) to Resolute zotarolimus-DES (Medtronic CardioVascular) or Xience everolimus-DES (Abbott Vascular). At 1 year, 176 lesions (121 patients)presented with TLF; a composite of cardiac death, acute myocardial infarction (AMI) and target lesion revascularization (TLR). Lesions with TLF were matched with 176 lesions (168 patients) without TLF adjusting for clinical and procedural characteristics. The number of bends, vessel curvature and angulation were assessed with quantitative coronary angiography pre and post-implantation. The absolute difference post minus pre-implantation was used as a surrogate of stent conformability. RESULTS At pre-implantation, lesions without and with TLF had similar numbers of bends/lesion (1.81 vs 1.74; P = .35), vessel curvature (0.295 cm(-1) vs 0.363 cm(-1); P = .13) and vessel angulation (46.3° vs 43.5°; P = .80), respectively. Lesions without and with TLR also had similar numbers of bends/lesion (1.39 vs 1.39; P = .83), vessel curvature (0.368 cm(-1) vs 0.325 cm(-1); P = .33) and angulation (40.2° vs 37.2°; P = .19). Lesions without and with in-hospital AMI also presented with similar number of bends/lesion (1.69 vs 1.81; P = .48), vessel curvature (0.349 cm(-1) vs 0.345 cm(-1); P = .91) and vessel angulation (43.53° vs 48.45°; P = .38). The absolute difference post- - pre-implantation was similar in lesions without and with TLF, TLR and In-hospital AMI. The absolute difference post- - pre-implantation was similar with both Resolute and Xience in vessel curvature (-0.046 cm(-1) vs -0.047 cm(-1); P = .66) and was smaller in number of bends/lesion (-0.08 vs -0.16; P = .13) and in vessel angulation (-6.0° vs -10.1°; P = .03) with the Resolute. CONCLUSIONS Bended, curved, and angulated lesions and changes in the number of bends/lesion, vessel curvature, and angulation from pre to post-implantation have no relation with TLF and TLR at 1 year and have no relation with In-hospital AMI using second-generation of DES. Resolute appears to be more conformable than Xience.
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188
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Nauta ST, Van Mieghem NM, Magro M, Deckers JW, Simsek C, Jan Van Geuns R, Van Der Giessen WJ, De Jaegere P, Regar E, Van Domburg RT, Serruys PW. Seven-year safety and efficacy of the unrestricted use of drug-eluting stents in saphenous vein bypass grafts. Catheter Cardiovasc Interv 2011; 79:912-8. [DOI: 10.1002/ccd.23145] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2011] [Accepted: 03/19/2011] [Indexed: 11/10/2022]
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189
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St Laurent P. Acute coronary syndrome: new and evolving therapies. Crit Care Nurs Clin North Am 2011; 23:559-71. [PMID: 22118114 DOI: 10.1016/j.ccell.2011.08.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
There are many new developments in both the invasive and noninvasive treatment of ACS. As technology, pharmaceuticals, and research continue to bring new therapies to the forefront, it is essential that clinicians stay current in their understanding of how this new knowledge will impact patients and alter clinical outcomes.
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Affiliation(s)
- Paul St Laurent
- Baylor Heart and Vascular Hospital, 621 North Hall Street, Dallas, TX 75226, USA.
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190
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Abstract
The techniques and materials used during percutaneous coronary intervention have advanced considerably over the past 3 decades, yet restenosis remains one of the major drawbacks of this procedure. Many innovative technologies, including drug-eluting stents, with or without specific polymers, and fully biodegradable stents have been and continue to be developed in the search for a safe and effective antirestenosis therapy. Remarkable advances in stent design and nanoparticle delivery systems ('nanovehicles') have already fueled revolutionary changes in the prevention and treatment of in-stent restenosis. In this Review we provide an overview of the latest innovations for optimizing outcomes of coronary stenting, and up-to-date information about prevention and treatment of in-stent restenosis.
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191
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Singh IM, Holmes DR. Myocardial Revascularization by Percutaneous Coronary Intervention: Past, Present, and the Future. Curr Probl Cardiol 2011; 36:375-401. [DOI: 10.1016/j.cpcardiol.2011.05.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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192
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Kempe H, Kates SA, Kempe M. Nanomedicine's promising therapy: magnetic drug targeting. Expert Rev Med Devices 2011; 8:291-4. [PMID: 21542699 DOI: 10.1586/erd.10.94] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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193
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Cortese B, Bertoletti A. Paclitaxel coated balloons for coronary artery interventions: a comprehensive review of preclinical and clinical data. Int J Cardiol 2011; 161:4-12. [PMID: 21955612 DOI: 10.1016/j.ijcard.2011.08.855] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2011] [Revised: 08/25/2011] [Accepted: 08/30/2011] [Indexed: 10/17/2022]
Abstract
After the "mechanical era" in interventional cardiology (represented by balloon angioplasty and bare metal stent implantation), arrived the "local dispensing" era, began with the intracoronary delivery of antithrombotic or antirestenotic drugs. However, even drug eluting stents have some pitfalls and cannot be used in all clinical subsets. In this article we will review the significant data on the paclitaxel-coated balloons for the treatment of coronary artery disease. Particularly, we will review the rationale of this new treatment strategy, the preclinical data and will focus on available clinical studies in humans. After the initial boost of the paclitaxel coated balloons with the Paccocath technology in in-stent restenotic lesions, the experimentation of newer devices in native coronary arteries raised some concerns on their efficacy and safety. We will comment on this topic trying to understand the reasons of this failure, and will discuss on possible future developments and applications for these devices for the treatment of coronary artery disease.
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Affiliation(s)
- Bernardo Cortese
- Interventional Cardiology, Cliniche Humanitas Gavazzeni, Bergamo, Italy.
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194
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Ielasi A, Latib A, Colombo A. Current and future drug-eluting coronary stent technology. Expert Rev Cardiovasc Ther 2011; 9:485-503. [PMID: 21517732 DOI: 10.1586/erc.11.5] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Despite the impressive benefits obtained following the introduction of the drug-eluting stent, safety concerns have been raised over their long-term safety with particular regard to stent thrombosis. Various mechanisms such as delayed endothelialization, local hypersensitivity and endothelial dysfunction owing to the durable polymer coating and/or the drug itself have been suggested as possible causes of this phenomenon. Therefore, to address these concerns, a newer-generation of drug-eluting stents has been developed and they are currently undergoing preclinical and clinical evaluation in order to increase both the safety and biocompatibility by optimizing the three major components of drug-eluting stents: the stent platform, the polymer and the drug. This article critically reviews the key clinical trials and the current status of these new coronary devices as well as preventing future perspectives for their continued development.
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Affiliation(s)
- Alfonso Ielasi
- Interventional Cardiology Unit, San Raffaele Scientific Institute, 20100, Milan, Italy
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195
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Bikkina M, Koneru J. Long-term effectiveness and safety of sirolimus drug-eluting stents. MEDICAL DEVICES-EVIDENCE AND RESEARCH 2011; 4:117-24. [PMID: 22915938 PMCID: PMC3417882 DOI: 10.2147/mder.s11749] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
The root cause of coronary artery disease is atherosclerosis, ie, intraluminal narrowing (stenosis) of the arteries that supply blood to tissues of the heart. The introduction of the drug-eluting stent over the past decade has revolutionized the field of interventional cardiology. It is used extensively in clinical practice for the treatment of coronary artery disease. The first drug-eluting stent to receive US Food and Drug Administration approval was the sirolimus-eluting stent. Recently, two other stent analogs of sirolimus were approved, ie, the zotarolimus-eluting stent and the everolimus-eluting stent. However, concern has arisen in recent years about the long-term safety and efficacy of drug-eluting stents, due to the occurrence of late adverse clinical events, such as stent thrombosis. This review focuses on clinical studies that have been performed with the sirolimus-eluting stent or its analogs. We discuss the pharmacology, safety, and various therapeutic options that exist when choosing stents for coronary artery disease. Our aim is to provide a thorough review of the long-term efficacy and safety of sirolimus drug-eluting stents, and also to discuss currently approved and promising investigational drug-eluting stents, in an effort to provide insight into how these stents are currently evolving and generate further investigation in this area.
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Affiliation(s)
- Mahesh Bikkina
- St Joseph Regional Medical Center, Paterson, Seton Hall University, NJ, USA
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196
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Tamburino C, Giacoppo D, Capodanno D. The Rapid Evaluation of Vessel Healing after Angioplasty (REVEAL) trial. Interv Cardiol 2011. [DOI: 10.2217/ica.11.34] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Cyrus T, Wickline SA, Lanza GM. Nanotechnology in interventional cardiology. WILEY INTERDISCIPLINARY REVIEWS-NANOMEDICINE AND NANOBIOTECHNOLOGY 2011; 4:82-95. [PMID: 21748858 DOI: 10.1002/wnan.154] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
High-grade atherosclerotic stenoses are reduced to zero or minimal residual stenosis grades by a single or a series of balloon angioplasties. Currently, stents are implanted to prevent immediate vascular recoil and elution of an antimitotic drug from the stent struts minimizes restenosis. An unwanted side-effect of this drug elution is delayed re-endothelialization which requires treatment with two anti-platelet drugs, in many cases for a minimum of 1 year to prevent acute in-stent thrombosis. Advances in stent design and drug elution technology, now in its fourth generation, have not abated this issue. Nanotechnology-based local drug delivery has the potential to achieve restenosis prevention while not impeding endothelial healing. Molecularly targeted drugs can be aimed to specifically bind to epitopes in the injured media and adventitia. Thus, endothelial healing may progress unhindered. To prevent restenosis, this technology may be used with bare metal or biodegradable stents. In this article novel nanoparticulate agents will be compared regarding their potential to deliver drugs to molecular targets within the vascular wall. Potential molecular targets, targeting mechanisms, drug-delivery propensities, and biocompatibility will be reviewed.
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Affiliation(s)
- Tillmann Cyrus
- Division of Cardiology, University of Missouri, One Hospital Drive, Columbia, MO, USA.
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198
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Bates ER, Menees DS. My stent is better than your stent...Or is it? JACC Cardiovasc Interv 2011; 4:551-3. [PMID: 21596328 DOI: 10.1016/j.jcin.2011.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2011] [Revised: 02/08/2011] [Accepted: 02/18/2011] [Indexed: 10/18/2022]
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199
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Lei L, Guo SR, Chen WL, Rong HJ, Lu F. Stents as a platform for drug delivery. Expert Opin Drug Deliv 2011; 8:813-31. [DOI: 10.1517/17425247.2011.572068] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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200
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Umeoka K, Kominami S, Mizunari T, Murai Y, Kobayashi S, Teramoto A. Cerebral artery restenosis following transluminal balloon angioplasty for vasospasm after subarachnoid hemorrhage. Surg Neurol Int 2011; 2:43. [PMID: 21660269 PMCID: PMC3108445 DOI: 10.4103/2152-7806.79758] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2010] [Accepted: 03/14/2011] [Indexed: 01/08/2023] Open
Abstract
Background: Although percutaneous transluminal angioplasty (PTA) is a widely used less invasive method to treat coronary artery stenosis, 10% of treated patients experience restenosis. Restenosis also occurs in approximately 5% of patients subjected to carotid artery stenting. Animal and human data suggested that restenosis is a response to injury incurred during PTA. As PTA has come into wide use to manage symptomatic cerebral vasospasm after subarachnoid hemorrhage (SAH) we studied the incidence of restenosis after PTA for cerebral vasospasm. Methods: Our study population consisted of 32 patients who had undergone PTA. They were followed by cerebral or 3DCT angiography or MRA for 6 126 months post-PTA (mean 48.65 months) to diagnose restenosis of the cerebral artery. We compared the size of the cerebral artery on the PTA and the contralateral side. Results: All 32 patients underwent successful PTA of 38 vascular territories and all manifested angiographic improvement of vasospasm. None suffered restenosis during the follow up period. Conclusion: PTA resulted in a significant improvement in the vessel diameter in patients with vasospasm after SAH and they did not suffer restenosis in the course of prolonged follow-up.
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Affiliation(s)
- Katsuya Umeoka
- Department of Neurosurgery, Nippon Medical School, Chiba-Hokusou Hospital, 1715 Kamakari, Inzaishi, Chiba, 270-1694, Japan
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