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Lan W, Yang F, Liu L, Yin Q, Li M, Li Z, Sang H, Xu G, Ma M, Zhang Z, Liu Z, Liu X, Zhang R. Tissue kallikrein preventing the restenosis after stenting of symptomatic MCA atherosclerotic stenosis (KPRASS). Int J Stroke 2013; 9:533-5. [PMID: 24354519 DOI: 10.1111/ijs.12229] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2013] [Accepted: 10/10/2013] [Indexed: 11/28/2022]
Abstract
RATIONALE Many recent studies suggest that the kallikrein-kinin system play a protective role in the impairment of vascular smooth muscle cells and vascular endothelial cell. AIMS The study aims to determine whether tissue kallikrein is efficacy for preventing the long-term in-stent restenosis after stenting of symptomatic atherosclerotic stenosis of the middle cerebral artery M1 segment. DESIGN This is a Phase II, randomized, single-blinded, controlled trial. In line with SAMMPRIS stenting indications, patients (n = 90) with the symptomatic the middle cerebral artery M1 segment stenosis ≥ 70% and successfully treated with stent will be enrolled. Eligible patients will be randomized using computer generated numbers, and allocated to receive tissue kallikrein treatment or not. Patients in tissue kallikrein treatment group will be prescribed with intravenous infusion of tissue kallikrein (0.15 PNAU/d, dissolved in 100 ml saline) for 7 days after stenting and then oral administration of pancreatic kallikrein enteric-coated tablet (240 U, 3/d) to the end of study. As the foundation treatment, all the enrolled patients will receive aspirin (100 mg/d), clopidogrel (75 mg/d), and atorvastatin (20 mg/d) for the first 6 months and continue with the combination of aspirin and atorvastatin at the previous dosage. STUDY OUTCOMES Patients will be evaluated at 1, 6 and 12 months after stenting. The primary outcomes are the in-stent restenosis rate, new stroke or aggravation of the previous ischemic stroke ipsilateral to the severe stenotic artery. Secondary outcomes include stroke of other artery territories, myocardial infarction and vascular death. Modification of stroke knowledge, exercise and diet habit, smoking cessation and available laboratory data will also be recorded. CONCLUSION As our pilot study, tissue kallikrein would be expected to prevent the long-term in-stent restenosis after stenting of the symptomatic middle cerebral artery dramatically.
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Affiliation(s)
- Wenya Lan
- Department of Neurology, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China
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2
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Nazneen F, Herzog G, Arrigan DW, Caplice N, Benvenuto P, Galvin P, Thompson M. Surface chemical and physical modification in stent technology for the treatment of coronary artery disease. J Biomed Mater Res B Appl Biomater 2012; 100:1989-2014. [DOI: 10.1002/jbm.b.32772] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2012] [Accepted: 06/20/2012] [Indexed: 12/12/2022]
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Affiliation(s)
- Steven R Bailey
- Division of Cardiology, University of Texas Health Sciences Center at San Antonio, 7703 Floyd Curl Drive, San Antonio, TX 78284, USA.
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Abstract
Within the past decade, focus on radiation to prevent restenosis has moved from a concept developed in the animal laboratory to a clinical treatment. The initial evaluation of coronary artery radiation therapy focused on changes in the function of the artery or lesion formation following overstretch balloon injury in pigs. A number of concepts emerged from this work: (1) radiation inhibits neointima formation in a dose-dependent fashion, (2) radiation prevents negative remodeling, (3) radiation does not reverse established injury, (4) low dose irradiation in an injured area may be injurious, (5) radiation is a useful adjunct to stenting, (6) benefits of radiation in animal models at 6 months are less pronounced than at 1 month, (7) radiation delays healing, (8) permanent stents and radiation delivered from external sources may have very different effects on restenosis, and (9) radiation interferes with vessel wall function. More recent studies of irradiation have looked at the molecular biological effects of radiation in hopes of understanding how this therapy works, and how it may be improved. This article attempts to summarize the known animal and cellular work on radiation in preventing restenosis.
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Affiliation(s)
- Ian Crocker
- Emory University School of Medicine, and Atlanta Cardiovascular Research Institute, Atlanta, GA, USA.
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6
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Salame MY, Verheye S, Mulkey SP, Chronos NA, King SB, Crocker IR, Robinson KA. The effect of endovascular irradiation on platelet recruitment at sites of balloon angioplasty in pig coronary arteries. Circulation 2000; 101:1087-90. [PMID: 10715252 DOI: 10.1161/01.cir.101.10.1087] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Endovascular irradiation (EI) inhibits balloon-induced neointima formation in animals and is now in clinical trials for restenosis prevention. However, little is known of the effect of EI on vessel thrombogenicity due to delayed arterial healing. We investigated EI effects on platelet recruitment in pig coronary arteries. METHODS AND RESULTS EI was performed using (90)Sr/Y at 0 Gray (Gy), 15Gy, or 30Gy at 2 mm after balloon overstretch injury. At 1 day, 1 week, and 1 month, platelet recruitment and thrombus formation were assessed using autologous (111)In-oxine-platelet labeling and light and scanning electron microscopy. In balloon-injured nonirradiated vessels, there was complete reendothelialization at 1 month, and platelet recruitment was similar to normal uninjured arteries. In irradiated vessels, scanning electron microscopy showed incomplete reendothelialization at 1 month, and these areas demonstrated attachment of activated platelets. Light microscopy of irradiated coronaries showed adherent partially organized thrombi and incomplete resolution of intramural hemorrhages. There was a significant increase in platelet recruitment at 1 month in arteries receiving EI at 15Gy (5.1+/-2. 8x10(6), P=0.02) or 30Gy (12.5+/-9.9x10(6), P=0.005) compared with nonirradiated controls (2.7+/-1.5x10(6)); 30Gy was also higher than 15Gy (P=0.05). Platelet recruitment was also increased for 30Gy compared with control at 1 day. CONCLUSIONS Endovascular irradiation at 15Gy or 30Gy after balloon angioplasty results in incomplete endothelial recovery, impaired resolution of intramural hemorrhage, and a dose-dependent increase in platelet recruitment at 1 month.
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Affiliation(s)
- M Y Salame
- Andreas Gruentzig Cardiovascular Center, Department of Medicine (Cardiology), Emory University School of Medicine, Atlanta, GA, USA
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7
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Abstract
The problem of restenosis after coronary angioplasty remains a major limiting factor of the procedure. Intracoronary stenting has led to a modest reduction in the frequency of this event. In the early 1990s, the effectiveness of ionizing radiation combined with balloon angioplasty and stenting was first convincingly demonstrated in animal models of restenosis. Small feasibility studies and two randomized trials have, in general, supported the promise of these initial preclinical studies in the prevention of restenosis. Much remains to be learned about the application of radiation for this therapy. This article reviews the current status of preclinical and clinical investigation of this therapy.
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Affiliation(s)
- I Crocker
- Department of Radiation Oncology, Emory University School of Medicine, Atlanta, Georgia, USA
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8
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Koide Y, Yotsukura M, Ando H, Yoshino H, Ishikawa K. Accuracy of treadmill exercise electrocardiography in detecting restenosis following single-vessel percutaneous transluminal coronary angioplasty. Am J Cardiol 1997; 80:1282-6. [PMID: 9388099 DOI: 10.1016/s0002-9149(97)00666-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
To develop an improved method for diagnosing restenosis using treadmill exercise electrocardiography (ECG) following percutaneous transluminal coronary angioplasty (PTCA), we prospectively evaluated 46 patients who underwent PTCA for the treatment of single-vessel coronary artery disease and who did not have a history of myocardial infarction. Treadmill exercise ECG and coronary angiography were performed 3 months after PTCA to determine their accuracy in diagnosing restenosis based on standard ST-segment depression criteria, the difference between the maximum ST-segment depression before and 3 months after PTCA (< or =0.5 mm: positive; >0.5 mm: negative), and the difference between sigmaST-segment depression before PTCA and 3 months after PTCA (< or = 1.5 mm: positive; > 1.5 mm: negative). The sensitivity, specificity, and diagnostic accuracy of standard ST-segment depression criteria were 65%, 66%, and 65%, respectively. The sensitivity, specificity, and accuracy for the difference in maximum ST-segment depression were 77%, 76%, and 76%, respectively, whereas the values for the difference in sigmaST-segment depression were 77%, 83%, and 80%, respectively. Based on these results, we conclude that using the difference between ST-segment depression before and after PTCA improves the accuracy of treadmill exercise ECG for diagnosing restenosis.
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Affiliation(s)
- Y Koide
- Kyorin University School of Medicine, Tokyo, Japan
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9
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Coplan NL, Curkovic V, Allen KM, Atallah V. Early exercise testing to stratify risk for development of restenosis after percutaneous transluminal coronary angioplasty. Am Heart J 1996; 132:1222-5. [PMID: 8969574 DOI: 10.1016/s0002-8703(96)90466-4] [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: 02/03/2023]
Affiliation(s)
- N L Coplan
- Department of Medicine, Lenox Hill Hospital, New York, NY, USA
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BATCHELOR WAYNEB, CHISHOLM ROBERTJ, STRAUSS BRADLEYH. Dissections Following Excimer Laser-Assisted Angioplasty of Saphenous Vein Bypass Grafts: Analysis of Incidence and Effect of Adjunctive Balloon Angioplasty. J Interv Cardiol 1996. [DOI: 10.1111/j.1540-8183.1996.tb00627.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Yamamoto H, Imazu M, Yamabe T, Ueda H, Hattori Y, Yamakido M. Risk factors for restenosis after percutaneous transluminal coronary angioplasty: role of lipoprotein (a). Am Heart J 1995; 130:1168-73. [PMID: 7484765 DOI: 10.1016/0002-8703(95)90138-8] [Citation(s) in RCA: 27] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
To evaluate serum levels of lipoprotein (a) (Lp[a]) as a predictor of restenosis after percutaneous transluminal coronary angioplasty (PTCA), we evaluated 71 patients who underwent elective single-vessel angioplasty. Patients were divided into two groups according to the presence (n = 24 [34%]; group R) or absence (n = 47 [66%]; group N) of restenosis. Serum insulin levels were similar before and after the glucose challenge test in both groups. The median level of serum Lp(a) was 34.9 mg/dl in group R compared with 19.4 mg/dl in group N (p < 0.01). The frequency of the apo E4 allele was 4 (17%) in group R and 4 (9%) in group N (p = NS). The incidence of restenosis was significantly higher in patients with Lp(a) levels > or = 30 mg/dl than in those with Lp(a) levels < 30 mg/dl (65% vs 26%; p < 0.01). Our results indicate that a serum Lp(a) level > or = 30 mg/dl is a risk factor for restenosis.
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Affiliation(s)
- H Yamamoto
- Second Department of Internal Medicine, Hiroshima University, School of Medicine, Japan
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Petrik PV, Gelabert HA, Moore WS, Quinones-Baldrich W, Law MM. Cigarette smoking accelerates carotid artery intimal hyperplasia in a dose-dependent manner. Stroke 1995; 26:1409-14. [PMID: 7631346 DOI: 10.1161/01.str.26.8.1409] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
BACKGROUND AND PURPOSE Intimal hyperplasia is the single most important cause of early restenosis after carotid endarterectomy. Cigarette smoking is an independent risk factor associated with peripheral vascular disease and cerebrovascular accidents. We undertook a dose-response experiment to determine the effect of cigarette smoke on development of intimal hyperplasia in a rat carotid artery intimal injury model. METHODS Seventy-two rats were divided into six equal groups and underwent standardized balloon injury to the carotid artery. Each group received 0 (controls), 1, 2, 3, 6, or 8 cigarettes per day for 4 weeks. Resultant intimal hyperplasia was expressed as a percentage of original lumen replaced by intimal hyperplasia. RESULTS Percent intimal hyperplasia development (+/- SD) was as follows: controls (0 cigarettes per day), 17.7 +/- 13.2; 1 cigarette per day, 22.8 +/- 15.0; 2 cigarettes per day, 20.0 +/- 14.7; 3 cigarettes per day, 19.2 +/- 12.1; 6 cigarettes per day, 43.5 +/- 15.5; and 8 cigarettes per day, 36.7 +/- 9.8. Six and 8 cigarettes per day significantly increased the development of intimal hyperplasia after intimal injury (P < .01). CONCLUSIONS High-dose cigarette smoke accelerates development of intimal hyperplasia and may pose a significant risk factor in developing carotid restenosis.
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Affiliation(s)
- P V Petrik
- Section of Vascular Surgery, University of California at Los Angeles School of Medicine 90024, USA
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Voisard R, Seitzer U, Baur R, Dartsch PC, Osterhues H, Höher M, Hombach V. A prescreening system for potential antiproliferative agents: implications for local treatment strategies of postangioplasty restenosis. Int J Cardiol 1995; 51:15-28. [PMID: 8522393 DOI: 10.1016/0167-5273(95)02377-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Recent advances in the understanding of the biology of restenosis indicate that it is predominantly caused by a multifactorial stimulation of smooth muscle cell proliferation. The aim of this study was to investigate the in vitro effect of five potential antiproliferative agents on smooth muscle cells from human atherosclerotic femoral arteries. METHODS AND RESULTS Primary stenosing plaque material of 24 patients (aged 63 +/- 14 years) and restenosing plaque material of 7 patients (aged 65 +/- 9 years) was selectively extracted from femoral arteries by the Simpson atherectomy device. Cells were isolated by enzymatic disaggregation and identified as smooth muscle cells by positive reaction with smooth muscle alpha-actin. Dalteparin sodium (0.001-100 anti-Xa units/ml), cyclosporine A (0.005-500 micrograms/ml), colchicine (0.00004-4 pg/ml), etoposide (0.002-200 micrograms/ml), and doxorubicin (0.0005-50 micrograms/ml) were added to the cultures. Six days after seeding, cells were trypsinized and cell number was measured by a cell counter. All five agents tested exhibited a significant inhibition of smooth muscle cell proliferation (P < 0.001). After an incubation time of 48 h, the cytoskeletal components, alpha-actin, vimentin, and microtubules were investigated. At peak concentrations, all five tested agents except dalteparin sodium caused severe damage to the cytoskeleton. CONCLUSIONS All five potential antiproliferative agents exhibited a significant inhibition of smooth muscle cell proliferation. The development of new intravascular delivery systems may open the way for local antiproliferative treatment strategies in interventional cardiology.
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Affiliation(s)
- R Voisard
- Department of Cardiology, Angiology, Nephrology, and Pneumology, University of Ulm, Federal Republic of Germany
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14
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Klein LW, Avula SB, Uretz E, Qurashi MA, Calvin JE, Parrillo JE. Utility of various clinical, noninvasive, and invasive procedures for determining the causes of recurrence of myocardial ischemia or infarction > or = 1 year after percutaneous transluminal coronary angioplasty. Am J Cardiol 1995; 75:1003-6. [PMID: 7747677 DOI: 10.1016/s0002-9149(99)80712-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
In patients with recurrent symptoms > or = 1 year after successful percutaneous transluminal coronary angioplasty (PTCA), the decision of whether to proceed directly with coronary angiography or to evaluate the patient noninvasively can be difficult. To determine which demographic, historical, clinical, and laboratory factors are useful in helping to make this decision, 76 consecutive patients who presented > 1 year (768 +/- 309 days) after successful PTCA with resolution of symptoms were studied. The initial PTCA successfully treated all stenoses (except chronically occluded vessels) in all major vessels and segments. The patient group was predominantly men (68%), with a mean age of 64 +/- 10 years. A prior myocardial infarction was present in 39 patients (51%), and there was a mean of 2.8 risk factors per patient. In patients who presented with recurrent symptoms, the Canadian Cardiovascular Society functional class was 2.0 +/- 0.9; 2 patients presented with acute infarctions, 57 were admitted to the hospital with unstable angina, and 17 had stable angina. New electrocardiographic changes at rest were found in 19 of 74 patients (26%) with recurrent angina. A thallium stress test was performed in 40 patients (53%), with a sensitivity of 77% and a specificity of 36% for the presence of a significant stenosis. No nonangiographic variable was predictive of angiographic findings. At angiography, the number of coronary arteries with > or = 50% diameter narrowing was 1.4 +/- 1.0. Forty-two patients had stenosis at a new site, 7 had restenosis, and 27 had no new stenoses.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- L W Klein
- Section of Cardiology, Rush-Presbyterian-St. Luke's Medical Center, Chicago, Illinois 60612, USA
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15
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Foegh ML, Asotra S, Conte JV, Howell M, Kagan E, Verma K, Ramwell PW. Early inhibition of myointimal proliferation by angiopeptin after balloon catheter injury in the rabbit. J Vasc Surg 1994; 19:1084-91. [PMID: 7911163 DOI: 10.1016/s0741-5214(94)70221-7] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
PURPOSE Coronary artery restenosis after percutaneous transluminal angioplasty occurs in more than 40% of patients. Angiopeptin, a stable synthetic octapeptide analogue of somatostatin, attenuates accelerated coronary artery myointimal thickening in rabbit cardiac allografts and myointimal thickening after arterial injury. In this study the temporal relationship between the angiopeptin treatment schedule and efficacy was explored. The relationship between inhibition of myointimal thickening by angiopeptin and inhibition of vascular cell proliferation was also examined. METHODS The aorta and the common and external iliac arteries of the rabbit underwent balloon injury. Angiopeptin (2 to 200 micrograms/kg/day) was administered for 1 day before injury and for 1, 5, and 21 days after injury. Morphometric studies were performed to determine measurement of intimal thickening. Inhibition of vascular cell proliferation by angiopeptin was evaluated by tritiated thymidine incorporation into the balloon-injured rabbit aorta. Thymidine was either administered intraperitoneally or added ex vivo to aorta segments of rabbits treated with angiopeptin (2, 20, or 200 micrograms/kg/day) from 1 day before injury until sacrifice 72 hours later. RESULTS Administration of angiopeptin (2 to 200 micrograms/kg/day) significantly reduced intimal thickening by approximately 50% in all three vessels when evaluated 3 weeks after injury. This inhibitory effect was unrelated to duration of treatment and dose. Treatment initiated at the time of injury was found to be effective, but delaying treatment for 8, 18, or 27 hours abrogated the inhibitory effect of angiopeptin on myointimal thickening. Angiopeptin treatment significantly decreased thymidine-labeled nuclei of smooth muscle cells in vitro. Angiopeptin treatment similarly inhibited thymidine uptake in vitro by balloon-injured aorta segments. CONCLUSION Angiopeptin significantly inhibits myointimal thickening by inhibiting vascular cell proliferation. Administration of angiopeptin for 2 days is as efficacious as 3 weeks treatment in inhibiting myointimal thickening. Delaying treatment for as little as 8 hours after injury abrogates the inhibitory effects of angiopeptin. This speaks to the importance of early events immediately after vascular tissue injury, suggesting that angiopeptin inhibits the expression of early genes causally related to the vascular injury response and thereby triggering vascular cell proliferation.
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MESH Headings
- Animals
- Aorta/cytology
- Aorta/drug effects
- Aorta/injuries
- Aorta/metabolism
- Catheterization/adverse effects
- Cell Division/drug effects
- Depression, Chemical
- Dose-Response Relationship, Drug
- Iliac Artery/cytology
- Iliac Artery/drug effects
- Iliac Artery/injuries
- Male
- Muscle, Smooth, Vascular/cytology
- Muscle, Smooth, Vascular/drug effects
- Muscle, Smooth, Vascular/injuries
- Muscle, Smooth, Vascular/metabolism
- Oligopeptides/pharmacology
- Peptides, Cyclic
- Rabbits
- Somatostatin/analogs & derivatives
- Somatostatin/pharmacology
- Thymidine/metabolism
- Time Factors
- Tritium
- Tunica Intima/cytology
- Tunica Intima/drug effects
- Tunica Intima/injuries
- Tunica Intima/metabolism
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Affiliation(s)
- M L Foegh
- Department of Surgery, Georgetown University Medical Center, Washington, DC 20007
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Ryan TJ, Bauman WB, Kennedy JW, Kereiakes DJ, King SB, McCallister BD, Smith SC, Ullyot DJ. Guidelines for percutaneous transluminal coronary angioplasty. A report of the American Heart Association/American College of Cardiology Task Force on Assessment of Diagnostic and Therapeutic Cardiovascular Procedures (Committee on Percutaneous Transluminal Coronary Angioplasty). Circulation 1993; 88:2987-3007. [PMID: 8252713 DOI: 10.1161/01.cir.88.6.2987] [Citation(s) in RCA: 257] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Affiliation(s)
- T J Ryan
- Office of Scientific Affairs, American Heart Association, Dallas, TX 75231-4596
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18
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Affiliation(s)
- R E Kuntz
- Department of Medicine, Harvard Medical School, Boston, Mass
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19
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Williams RS. Southwestern Internal Medicine Conference: prospects for gene therapy of ischemic heart disease. Am J Med Sci 1993; 306:129-36. [PMID: 8103285 DOI: 10.1097/00000441-199308000-00013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Discrete steps in the pathophysiology of ischemic heart disease present attractive potential targets for therapeutic applications of gene transfer technologies. This review develops a conceptual basis for gene therapy of ischemic heart disease and provides examples of current research efforts in this field.
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Affiliation(s)
- R S Williams
- University of Texas Southwestern Medical Center, Dallas 75235-8573
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Hong MK, Bhatti T, Matthews BJ, Stark KS, Cathapermal SS, Foegh ML, Ramwell PW, Kent KM. The effect of porous infusion balloon-delivered angiopeptin on myointimal hyperplasia after balloon injury in the rabbit. Circulation 1993; 88:638-48. [PMID: 8101773 DOI: 10.1161/01.cir.88.2.638] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
BACKGROUND Angiopeptin, a synthetic somatostatin analogue, reduces myointimal hyperplasia after experimental balloon angioplasty when given subcutaneously. The feasibility and efficacy of a single dose of angiopeptin delivered locally via the Wolinsky porous balloon on myointimal hyperplasia were studied. METHODS AND RESULTS Three rabbits received 125I-angiopeptin in the mid abdominal aorta via the Wolinsky balloon at 5 atm for 1 minute after balloon injury. Thirty minutes later, autoradiography demonstrated radioactivity in the media and the adventitia. Forty rabbits were divided equally into one control group receiving saline and three angiopeptin groups receiving 1, 10, or 100 micrograms/mL of angiopeptin delivered locally at 5 atm for 1 minute via the Wolinsky balloon into the mid abdominal aorta after balloon injury of the entire abdominal aorta. On day 21, the abdominal aortas were fixed in situ and harvested. There was no statistical difference in the amount of myointimal hyperplasia in the locally treated aorta in the angiopeptin groups compared with the control group. However, in the lower abdominal aorta, where balloon injury without local delivery was performed, there was a significant reduction of myointimal hyperplasia in the highest-concentration angiopeptin group (P < .001 versus the control group). Electron microscopy showed that the control animals had a pseudointima of smooth muscle cells throughout the aorta, whereas in all the angiopeptin-treated animals, endothelial cells were present at both locations. CONCLUSIONS Angiopeptin can be delivered intramurally via the Wolinsky porous balloon and reduces myointimal hyperplasia only in the area distal to the local drug delivery site (downstream effect), possibly by healing the injured endothelium, by transport via the vasa vasora, and/or by systemic effect.
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Affiliation(s)
- M K Hong
- Department of Cardiology, Washington Hospital Center, Washington, DC 20010-2975
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Elmore JR, Hallett JW, Gibbons RJ, Naessens JM, Bower TC, Cherry KJ, Gloviczki P, Pairolero PC. Myocardial revascularization before abdominal aortic aneurysmorrhaphy: effect of coronary angioplasty. Mayo Clin Proc 1993; 68:637-41. [PMID: 8350636 DOI: 10.1016/s0025-6196(12)60598-9] [Citation(s) in RCA: 70] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Percutaneous transluminal coronary angioplasty (PTCA) has assumed an increasing role in the preoperative preparation of patients with an abdominal aortic aneurysm (AAA). The influence of this modality on perioperative morbidity and long-term outcome has not been substantiated. To determine the effect of PTCA, we analyzed a cohort of 2,452 patients who underwent repair of an AAA between 1980 and 1990 at our institution. We compared the cardiac morbidity, mortality, and survival of patients who had preoperative coronary revascularization by PTCA or coronary artery bypass grafting (CABG). The overall perioperative mortality for the 2,452 patients was 2.9%. Preoperative coronary revascularization was necessary in 100 patients (4.1%)--86 had CABG and 14 had PTCA. Of these 100 patients, 95% had cardiac symptoms. Patients selected for PTCA, in comparison with CABG, had significantly less three-vessel disease but not significant differences in cardiac history or ejection fraction. During the study period, the use of PTCA increased significantly. The perioperative rate of myocardial infarction for patients with prior CABG was 5.8% in comparison with 0% for those with prior PTCA. No hospital deaths occurred in either group. The median interval between coronary revascularization and repair of an AAA was 10 days for PTCA and 68 days for CABG. The 3-year survival was not statistically different between CABG (82.8%) and PTCA (92.3%) groups. The rate of late cardiac events (at 3 years) was 56.5% in the PTCA group and 27.3% in the CABG group. We conclude that PTCA as part of a highly selective approach to coronary revascularization before repair of an AAA minimizes cardiac-related events and death.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- J R Elmore
- Division of Vascular Surgery, Mayo Clinic Rochester, MN 55905
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22
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Hoffman JIE. Uses and Limitations of Echocardiography in Neonatal Intensive Care Units. J Intensive Care Med 1993. [DOI: 10.1177/088506669300800301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Julien I. E. Hoffman
- Professor of Pediatrics University of California, San Francisco Box 0545, HSE 1403 San Francisco, CA 94143
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Mertes H, Erbel R, Nixdorff U, Mohr-Kahaly S, Krüger S, Meyer J. Exercise echocardiography for the evaluation of patients after nonsurgical coronary artery revascularization. J Am Coll Cardiol 1993; 21:1087-93. [PMID: 8459062 DOI: 10.1016/0735-1097(93)90229-t] [Citation(s) in RCA: 52] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
OBJECTIVES The purpose of this study was to demonstrate the accuracy of stress echocardiography for detecting the progression of coronary artery disease after nonsurgical revascularization. BACKGROUND The expanding role of nonsurgical coronary revascularization procedures mandates the development of sensitive noninvasive techniques for the detection of recurrent ischemia. METHODS Bicycle stress echocardiography was performed in a series of 86 patients 6.5 +/- 1.3 months after a revascularization procedure. Seven patients were excluded from analysis because of poor echocardiographic image quality. RESULTS Digital analysis achieved a sensitivity of 83% for the entire group and a specificity of 85% for stress echocardiographic detection of significant coronary artery disease. Sensitivity was greater in patients with (88%) than in those without (75%) prior myocardial infarction, but this difference did not reach statistical significance. Additional analysis using an increase in end-systolic volume index or a decrease in ejection fraction during stress as an additional marker for ischemia tended to enhance sensitivity (90% for the entire group and 93% for the subgroup with prior myocardial infarction). CONCLUSIONS Stress echocardiography is a useful and sensitive method for the follow-up of patients undergoing nonsurgical revascularization procedures. The addition of volume determination to routine wall motion analysis may be helpful in patients with prior infarction who have scar tissue that may be difficult to distinguish from an adjacent exercise-induced wall motion abnormality.
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Affiliation(s)
- H Mertes
- Second Medical Clinic and Policlinic, Johannes Gutenberg University, Mainz, Germany
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Benchimol D, Bonnet J, Benchimol H, Drouillet F, Duplaa C, Couffinhal T, Desgranges C, Bricaud H. Biological risk factors for restenosis after percutaneous transluminal coronary angioplasty. Int J Cardiol 1993; 38:7-18. [PMID: 8444504 DOI: 10.1016/0167-5273(93)90198-p] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
In an attempt to discern biological (such as thrombotic or fibrinolytic) risk factors in patients developing restenosis after percutaneous transluminal coronary angioplasty, the following factors were measured prior to angiography in a population of 23 patients (20 men, 3 women, mean age 57 +/- 5 yr) treated by a successful angioplasty (gain > 20% and residual stenosis < 50%) for stable angina pectoris and who had a routine angiographic restudy. The following factors were thus assessed: lipid factors: cholesterol, triglycerides, high density lipoprotein cholesterol, low density lipoprotein cholesterol, apolipoprotein AI, apolipoprotein B; coagulation factors: fibrinogen, antithrombin III, fibrinopeptide A, factor VIII coagulant, factor VIII antigen, protein C; factors of physiological fibrinolysis: plasminogen, alpha 2-antiplasmin, tissue plasminogen activator and euglobulin clot lysis time before and after venous occlusion, plasminogen activator inhibitor before venous occlusion; and factors of platelet release: beta-thromboglobulin, platelet factor 4. Also studied were clinical characteristics: age, gender, diabetes, hypertension, smoking habits, previous myocardial infarction; angiographic data: global extent of coronary artery disease, location of the stenosis in a bend or branch point, complexity of the lesion, initial and residual stenosis and treatment during follow-up. The coronary angiograms were analyzed by a computer-assisted method with automatic edge detection. On angiographic criteria, 6 patients (restenosis group) were judged to have developed a restenosis (30% decrease in diameter and/or return to a 50% stenosis). The other 17 patients (those without restenosis) were considered to have a persistent success. Apart from age (group without restenosis: 55 +/- 6; restenosis group 61 +/- 5, p < 0.04), there were no differences in clinical, angiographic or treatment variables. There were no differences in lipid factors, but significant differences were observed in hemostatic variables: fibrinogen (without restenosis: 3.18 +/- 0.83; restenosis: 3.83 +/- 0.51 milligrams, p = 0.05), tissue plasminogen activator before venous occlusion (without restenosis: 10.9 +/- 26.8; restenosis: 232.5 +/- 371.2 IU, p < 0.04), euglobulin clot lysis time after venous occlusion (without restenosis: 176.5 +/- 100.5; restenosis: 78.6 +/- 40.2 min, p < 0.05) and for marker of the platelet release: platelet factor 4 (without restenosis: 10.8 +/- 7.9; restenosis: 20.5 +/- 7.5 ng/l, p < 0.04). These findings indicate that patients developing restenosis after coronary angioplasty tend to have an imbalance in the prothrombotic-antithrombotic equilibrium prior to the procedure.
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Krause PB, Schaer GL, Parrillo JE, Klein LW. Excimer laser ablation before autoperfusion balloon inflation: a novel therapeutic approach to high grade stenoses in vessels supplying substantial myocardium at risk. CATHETERIZATION AND CARDIOVASCULAR DIAGNOSIS 1992; 27:202-8. [PMID: 1423576 DOI: 10.1002/ccd.1810270309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
The utility of a novel approach employing excimer laser ablation to form a channel for subsequent autoperfusion balloon angioplasty is presented. Two important advantages of this strategy are highlighted: (1) applicability to severe stenoses in vessels supplying substantial myocardium at risk and (2) ability to allow prolonged inflation time to minimize procedure related ischemia and optimize revascularization of the heart. We prospectively selected and studied five patients and performed excimer laser coronary angioplasty using either a 1.3 mm or 1.6 mm laser catheter followed by autoperfusion balloon dilatation. Procedural success was documented by a significant reduction in mean percent diameter stenosis from 89 +/- 4% (S.D.) to 53 +/- 4% after laser angioplasty (p < 0.0001) and subsequently to 20 +/- 4% after autoperfusion balloon angioplasty (p < 0.0001). Clinical success was attained and characterized by resolution of anginal symptoms for at least 4 weeks after hospital discharge. There were no major acute complications encountered; however, restenosis has occurred in 2 out of 5 patients. We therefore recommend this novel pre-dilation strategy with excimer laser followed by autoperfusion balloon angioplasty in selected patients with an extensive amount of myocardium at risk.
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Affiliation(s)
- P B Krause
- Department of Medicine, Rush Medical College, Rush-Presbyterian-St. Luke's Medical Center, Chicago, IL 60612
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Waller BF, Orr CM, Pinkerton CA, Van Tassel J, Peters T, Slack JD. Coronary balloon angioplasty dissections: "the good, the bad and the ugly". J Am Coll Cardiol 1992; 20:701-6. [PMID: 1512351 DOI: 10.1016/0735-1097(92)90027-k] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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Smalling RW, Cassidy DB, Schmidt WA, Barrett R, Fulford S, Kirkeeide RL. Effects of rotational atherectomy in normal canine coronary and diseased human cadaveric arteries: potential for plaque removal from distal, tortuous, and diffusely diseased vessels. CATHETERIZATION AND CARDIOVASCULAR DIAGNOSIS 1991; 24:300-7. [PMID: 1756570 DOI: 10.1002/ccd.1810240418] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
To test the hypothesis that tortuous, diseased vessels could be successfully treated with a flexible rotational atherectomy device we evaluated the BARD atherectomy device with quantitative angiography and histology in normal canine coronary arteries and diseased human below-knee amputation specimens. The mid left anterior descending and the circumflex vessels were treated in 4 dogs serially with 1 wk separating treatments. The acute and follow-up anterior descending artery size was unchanged (1.41 mm before, 1.39 mm after, and 1.59 mm at 1 week). Similar findings were obtained in the circumflex vessels. In 4 adult human amputated legs, diseased peroneal or tibial arteries were treated with a significant reduction in the percent luminal diameter stenosis from 62.75 prior to intervention to 36.5 following intervention (p = 0.021). The luminal diameter increased from 0.81 to 1.54 mm (p = 0.06). In 2 canine arteries there was histologic evidence of localized perforation of the arterial wall, but there was no angiographic evidence of perforation or dissection and no significant myocardial necrosis in the distribution of the treated vessels at 1 wk. The majority of the diseased human vessels demonstrated smoothly cut atheromas with sparing of the media. The rotational atherectomy catheter system holds promise for removal of plaque in relatively small, diffusely diseased, tortuous vessels.
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Affiliation(s)
- R W Smalling
- Department of Pathology and Laboratory Medicine, University of Texas Medical School, Houston
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Abstract
Coronary restenosis remains a major problem for interventional cardiology not only by virtue of its frequency, but also because of the current inability to prevent it. Symptomatic status and non-invasive evaluation have been used to study restenosis, but both lack specificity and sensitivity, particularly in patients with multivessel disease. Angiography remains the reference standard. Several arbitrary definitions have been used, some related to visual estimates of coronary stenosis and others to quantitative angiographic techniques. In another approach, linear modeling is used to assess minimal luminal diameter of lesions on restudy. Although angiographic studies have been essential in the study of restenosis, questions concerning the underlying mechanism and pathophysiology remain. The development of animal models that closely resemble human restenosis should allow evaluation of pathophysiologic mechanisms and development of new strategies to prevent the problem.
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Affiliation(s)
- D R Holmes
- Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, Rochester, Minnesota 55905
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