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Wilson S, Mone P, Kansakar U, Jankauskas SS, Donkor K, Adebayo A, Varzideh F, Eacobacci M, Gambardella J, Lombardi A, Santulli G. Diabetes and restenosis. Cardiovasc Diabetol 2022; 21:23. [PMID: 35164744 PMCID: PMC8845371 DOI: 10.1186/s12933-022-01460-5] [Citation(s) in RCA: 42] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 01/21/2022] [Indexed: 01/05/2023] Open
Abstract
Restenosis, defined as the re-narrowing of an arterial lumen after revascularization, represents an increasingly important issue in clinical practice. Indeed, as the number of stent placements has risen to an estimate that exceeds 3 million annually worldwide, revascularization procedures have become much more common. Several investigators have demonstrated that vessels in patients with diabetes mellitus have an increased risk restenosis. Here we present a systematic overview of the effects of diabetes on in-stent restenosis. Current classification and updated epidemiology of restenosis are discussed, alongside the main mechanisms underlying the pathophysiology of this event. Then, we summarize the clinical presentation of restenosis, emphasizing the importance of glycemic control in diabetic patients. Indeed, in diabetic patients who underwent revascularization procedures a proper glycemic control remains imperative.
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Affiliation(s)
- Scott Wilson
- grid.251993.50000000121791997Department of Medicine, Einstein Institute for Aging Research, Einstein-Mount Sinai Diabetes Research Center (ES-DRC), The Fleischer Institute for Diabetes and Metabolism (FIDAM), Albert Einstein College of Medicine, New York, NY USA
| | - Pasquale Mone
- grid.251993.50000000121791997Department of Medicine, Einstein Institute for Aging Research, Einstein-Mount Sinai Diabetes Research Center (ES-DRC), The Fleischer Institute for Diabetes and Metabolism (FIDAM), Albert Einstein College of Medicine, New York, NY USA ,grid.251993.50000000121791997Department of Molecular Pharmacology, Wilf Family Cardiovascular Research Institute, Institute for Neuroimmunology and Inflammation (INI),, Albert Einstein College of Medicine, New York, NY USA
| | - Urna Kansakar
- grid.251993.50000000121791997Department of Medicine, Einstein Institute for Aging Research, Einstein-Mount Sinai Diabetes Research Center (ES-DRC), The Fleischer Institute for Diabetes and Metabolism (FIDAM), Albert Einstein College of Medicine, New York, NY USA ,grid.251993.50000000121791997Department of Molecular Pharmacology, Wilf Family Cardiovascular Research Institute, Institute for Neuroimmunology and Inflammation (INI),, Albert Einstein College of Medicine, New York, NY USA
| | - Stanislovas S. Jankauskas
- grid.251993.50000000121791997Department of Medicine, Einstein Institute for Aging Research, Einstein-Mount Sinai Diabetes Research Center (ES-DRC), The Fleischer Institute for Diabetes and Metabolism (FIDAM), Albert Einstein College of Medicine, New York, NY USA ,grid.251993.50000000121791997Department of Molecular Pharmacology, Wilf Family Cardiovascular Research Institute, Institute for Neuroimmunology and Inflammation (INI),, Albert Einstein College of Medicine, New York, NY USA
| | - Kwame Donkor
- grid.251993.50000000121791997Department of Medicine, Einstein Institute for Aging Research, Einstein-Mount Sinai Diabetes Research Center (ES-DRC), The Fleischer Institute for Diabetes and Metabolism (FIDAM), Albert Einstein College of Medicine, New York, NY USA
| | - Ayobami Adebayo
- grid.251993.50000000121791997Department of Medicine, Einstein Institute for Aging Research, Einstein-Mount Sinai Diabetes Research Center (ES-DRC), The Fleischer Institute for Diabetes and Metabolism (FIDAM), Albert Einstein College of Medicine, New York, NY USA
| | - Fahimeh Varzideh
- grid.251993.50000000121791997Department of Medicine, Einstein Institute for Aging Research, Einstein-Mount Sinai Diabetes Research Center (ES-DRC), The Fleischer Institute for Diabetes and Metabolism (FIDAM), Albert Einstein College of Medicine, New York, NY USA ,grid.251993.50000000121791997Department of Molecular Pharmacology, Wilf Family Cardiovascular Research Institute, Institute for Neuroimmunology and Inflammation (INI),, Albert Einstein College of Medicine, New York, NY USA
| | - Michael Eacobacci
- grid.251993.50000000121791997Department of Medicine, Einstein Institute for Aging Research, Einstein-Mount Sinai Diabetes Research Center (ES-DRC), The Fleischer Institute for Diabetes and Metabolism (FIDAM), Albert Einstein College of Medicine, New York, NY USA
| | - Jessica Gambardella
- grid.251993.50000000121791997Department of Molecular Pharmacology, Wilf Family Cardiovascular Research Institute, Institute for Neuroimmunology and Inflammation (INI),, Albert Einstein College of Medicine, New York, NY USA ,grid.4691.a0000 0001 0790 385XInternational Translational Research and Medical Education (ITME) Consortium, Department of Advanced Biomedical Sciences, “Federico II” University, Naples, Italy
| | - Angela Lombardi
- grid.251993.50000000121791997Department of Medicine, Einstein Institute for Aging Research, Einstein-Mount Sinai Diabetes Research Center (ES-DRC), The Fleischer Institute for Diabetes and Metabolism (FIDAM), Albert Einstein College of Medicine, New York, NY USA
| | - Gaetano Santulli
- grid.251993.50000000121791997Department of Medicine, Einstein Institute for Aging Research, Einstein-Mount Sinai Diabetes Research Center (ES-DRC), The Fleischer Institute for Diabetes and Metabolism (FIDAM), Albert Einstein College of Medicine, New York, NY USA ,grid.251993.50000000121791997Department of Molecular Pharmacology, Wilf Family Cardiovascular Research Institute, Institute for Neuroimmunology and Inflammation (INI),, Albert Einstein College of Medicine, New York, NY USA ,grid.4691.a0000 0001 0790 385XInternational Translational Research and Medical Education (ITME) Consortium, Department of Advanced Biomedical Sciences, “Federico II” University, Naples, Italy
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Zhu Z, Zhu J, Du R, Zhang H, Ni J, Quan W, Hu J, Ding F, Yang Z, Zhang R. Efficacy of Zotarolimus-Eluting Stents in Treating Diabetic Coronary Lesions: An Optical Coherence Tomography Study. Adv Ther 2020; 37:1579-1590. [PMID: 32146703 DOI: 10.1007/s12325-020-01273-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND Diabetes mellitus (DM) plays an important role in restenosis and late in-stent thrombosis (ST). The current study using optical coherence tomography (OCT) aims to compare target lesion neointima in patients with or without diabetes after zotarolimus-eluting stent (ZES) treatment. METHODS OCT images of 90,212 struts and quantitative coronary angiography (QCA) in 62 patients (32 with DM and 30 without DM) with 69 de novo coronary lesions (34 DM and 35 non-DM) both after ZES implantation and 12 ± 1 month angiographic follow-up were recorded. Patient characteristics, lesion characteristics, clinical outcomes, and OCT findings including neointimal thickness, coverage, malapposition, and intimal morphology were analyzed. RESULTS Baseline patient characteristics and lesion characteristics data were similar between the two groups. Higher neointimal thickness (0.14 ± 0.09 mm vs. 0.09 ± 0.04 mm, p = 0.021), more neovascularization (3.03 ± 6.24 vs. 0.52 ± 1.87, p = 0.017) and higher incidence of layered signal pattern (12.19 ± 19.91% vs. 4.28 ± 9.02%, p = 0.049) were observed in diabetic lesions comparing with non-diabetic lesions. No differences were found in malapposition, uncovered percentage, and thrombus between the two groups (all p > 0.05). Occurrence of clinical adverse events was also similar during the follow-up period (p > 0.05). CONCLUSION Although more neointimal proliferation and more neovascularization were found in diabetic coronary lesions when compared with non-diabetic lesions, treatment with ZES showed similar stent malapposition rate at 1-year follow-up. The data indicated that ZES treatment could possibly be effective in treating diabetic coronary lesions. TRIAL REGISTRATION ClinicalTrials.gov identifier, NCT01747356.
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Affiliation(s)
- Zhengbin Zhu
- Department of Cardiology, Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Cardiovascular Research Institution, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jinzhou Zhu
- Department of Cardiology, Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Cardiovascular Research Institution, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Run Du
- Department of Cardiology, Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Cardiovascular Research Institution, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Haotian Zhang
- Department of Cardiology, Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jinwei Ni
- Department of Cardiology, Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Weiwei Quan
- Department of Cardiology, Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jian Hu
- Department of Cardiology, Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Fenghua Ding
- Department of Cardiology, Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Cardiovascular Research Institution, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zhenkun Yang
- Department of Cardiology, Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ruiyan Zhang
- Department of Cardiology, Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
- Cardiovascular Research Institution, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
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Xi Y, Chen J, Bi Y, Xie S, Liao T, Zhang Y, Kislauskis E, Wu T, Laham R, Xiao J. Long-term clinical safety and efficacy of drug-coated balloon in the treatment of in-stent restenosis: A meta-analysis and systematic review. Catheter Cardiovasc Interv 2019; 96:E129-E141. [PMID: 31714010 DOI: 10.1002/ccd.28572] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Revised: 08/22/2019] [Accepted: 10/25/2019] [Indexed: 11/07/2022]
Abstract
OBJECTIVES The aim of this study was to evaluate the long-term clinical safety and efficacy of drug-coated balloon (DCB) in the treatment of in-stent restenosis (ISR). BACKGROUND There is a long-term safety issue in peripheral arterial disease patients treated with paclitaxel-coated balloon, this has also raised concerns on DCB in coronary intervention. METHODS Nine randomized controlled trials (RCTs) and nine observational studies (OSs) were included with a total of 3,782 patients (1,827 in the DCB group, 1,955 in the drug-eluting stent [DES] group) being analyzed. The primary outcome measure-major adverse cardiovascular events (MACEs), target lesion revascularization (TLR), target vessel revascularization (TVR), myocardial infarction (MI), cardiac death (CD), stent thrombosis (ST), all-cause death (AD), and coronary angiography outcomes included late lumen loss (LLL), minimum luminal diameter (MLD), diameter stenosis (DS) were analyzed. RESULTS DCB treatment significantly reduced the LLL (MD: -0.13; [CI -0.23 to -0.03], p = .01). No difference was found for MLD (MD: -0.1; [CI -0.24 to 0.04], p = .17) and DS% (RR = 0.98 [CI 0.80-1.20], p = .86). There was no significant difference in TLR, TVR, MI, CD, ST, AD, and the overall incidence of MACEs between the two groups up to 3 years follow-up. Subgroup analysis for different type of ISR and DES showed no significant difference in the incidence of endpoints, and there is no difference when considering RCTs or OSs only. CONCLUSIONS The safety and efficacy of the DCB and DES in the treatment of ISR is comparable at up to 3 years follow-up.
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Affiliation(s)
- Yangbo Xi
- Department of Cardiology, The Dongguan Affiliated Hospital (Dongguan 5th People's Hospital), Jinan University School of Medicine, Dongguan, China.,Department of The First Clinical Medical College, Jinan University, Guangzhou, China
| | - Jiahao Chen
- Department of Cardiology, The Dongguan Affiliated Hospital (Dongguan 5th People's Hospital), Jinan University School of Medicine, Dongguan, China
| | - Yuying Bi
- Department of Cardio Vascular, VasoTech, Inc., Lowell, Massachusetts.,Department of Plastic Engineering, University of Massachusetts Lowell, Lowell, Massachusetts
| | - Shuling Xie
- Department of Cardiology, The Dalang Hospital of Dongguan, Dongguan, China
| | - Tong Liao
- Department of Cardiology, The Dalang Hospital of Dongguan, Dongguan, China
| | - Yuanchun Zhang
- Department of Cardiology, The Dalang Hospital of Dongguan, Dongguan, China
| | - Edward Kislauskis
- Department of Cardio Vascular, VasoTech, Inc., Lowell, Massachusetts
| | - Tim Wu
- Department of Cardio Vascular, Dongguan TT Medical, Inc, Dongguan, China.,Department of Cardio Vascular, VasoTech, Inc., Lowell, Massachusetts.,Department of Plastic Engineering, University of Massachusetts Lowell, Lowell, Massachusetts
| | - Roger Laham
- Department of Cardiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Jianmin Xiao
- Department of Cardiology, The Dongguan Affiliated Hospital (Dongguan 5th People's Hospital), Jinan University School of Medicine, Dongguan, China
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