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Mølstad PM, Nordrehaug JE, Steigen TK, Wilsgaard T, Wiseth R, Rotevatn S, Mannsverk J, Larsen T, Larsby KE, Skarstad SÅ, Fosse EØ, Dahl-Eriksen Ø, Bønaa KH. Drug-eluting versus bare metal stents in saphenous vein grafts compared to native coronary vessels. The NORSTENT study. Cardiology 2021; 147:14-22. [PMID: 34879374 DOI: 10.1159/000521085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 11/06/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND Drug-eluting stents (DES) reduce target lesion revascularization (TLR) with no effect on mortality or myocardial infarction (MI) compared to bare metal stents (BMS) in native vessels. Randomized stent studies in saphenous vein grafts (SVG) are few and the reported effects are ambiguous. The NORSTENT study is the first to randomize lesions to percutaneous coronary intervention (PCI) in native vessels and SVG. AIMS To compare rate of mortality, MI and TLR across stent and vessel types. METHODS In this substudy 6087 patients with a single lesion in native vessels and 164 in SVG, were followed for 5 years. RESULTS MI was more frequent in SVG (subdistributional hazard ratio (SHR) 4.95 (3.75 - 6.54, p<0.001), but not affected by stent type. In the first 500 days DES reduced TLR in native vessels (SHR 0.21 ( 0.15 - 0.30)p<0.001) and SVG (SHR 0.18 (0.04 - 0.80) p=0.02). Thereafter DES and BMS were equivalent in native vessels, but DES had a higher TLR rate than BMS in SVG (SHR 3.31 (1.23 - 8.94) p=0.02). After 5 years the TLR rate was still significantly lower for DES in native vessels (3.2 % versus 7.8 %, p<0.001) but not in SVG (21.4 % vs 18. 4%). CONCLUSION In SVG no difference in TLR between DES and BMS was observed after 5 years in contrast to persistent benefit in native vessels. The high rate of TLR and myocardial infarction in SVG makes treatment of native vessels a preference whenever feasible and better treatment options for SVG are warranted. .
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Affiliation(s)
| | | | - Terje K Steigen
- Cardiovascular Research Group, UiT The Arctic University of Norway, Tromsø, Norway
- Department of Cardiology, University Hospital of North Norway, Tromsø, Norway
| | - Tom Wilsgaard
- Department of Community Medicine, UiT The Arctic University of Norway, Tromsø, Norway
| | - Rune Wiseth
- Clinic of Cardiology, St. Olavs University Hospital, Trondheim, Norway
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway
| | - Svein Rotevatn
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| | - Jan Mannsverk
- Department of Cardiology, University Hospital of North Norway, Tromsø, Norway
| | - Tommy Larsen
- Cardiological Department, Akershus University Clinic Gardermoen, Jessheim, Norway
| | | | | | - Eivind Øygard Fosse
- Department of Cardiology, University Hospital of North Norway, Tromsø, Norway
| | | | - Kaare Harald Bønaa
- Clinic of Cardiology, St. Olavs University Hospital, Trondheim, Norway
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway
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Autar A, Taha A, van Duin R, Krabbendam-Peters I, Duncker DJ, Zijlstra F, van Beusekom HMM. Endovascular procedures cause transient endothelial injury but do not disrupt mature neointima in Drug Eluting Stents. Sci Rep 2020; 10:2173. [PMID: 32034227 PMCID: PMC7005772 DOI: 10.1038/s41598-020-58938-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Accepted: 01/21/2020] [Indexed: 12/31/2022] Open
Abstract
Extensive application of coronary intravascular procedures has led to the increased need of understanding the injury inflicted to the coronary arterial wall. We aimed to investigate acute and prolonged coronary endothelial injury as a result of guidewire use, repeated intravascular imaging and stenting. These interventions were performed in swine (N = 37) and injury was assessed per coronary segment (n = 81) using an Evans Blue dye-exclusion-test. Scanning electron microscopy and light microscopy were then used to visualize the extent and nature of acute (<4 hours) and prolonged (5 days) endothelial injury. Guidewire and imaging injury was mainly associated with denudation and returned to control levels at 5 days. IVUS and OCT combined (Evans Blue staining 28 ± 16%) did not lead to more acute injury than IVUS alone (33 ± 15%). Stent placement caused most injury (85 ± 4%) and despite early stent re-endothelialization at 5 days, the endothelium proved highly permeable (97 ± 4% at 5 days; p < 0.001 vs acute). Imaging of in-stent neointima at 28 days after stent placement did not lead to neointimal rupture. Guidewire, IVUS and OCT induce acute endothelial cell damage, which does not increase during repeated imaging, and heals within 5 days. Interestingly, endothelial permeability increases 5 days post stenting despite near complete re-endothelialization.
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Affiliation(s)
- Anouchska Autar
- Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.,Department of Neurology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Aladdin Taha
- Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.,Department of Hematology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Richard van Duin
- Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Ilona Krabbendam-Peters
- Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Dirk J Duncker
- Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Felix Zijlstra
- Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Heleen M M van Beusekom
- Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.
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3
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Leukocyte Adhesion as an Indicator of Oxygenator Thrombosis During Extracorporeal Membrane Oxygenation Therapy? ASAIO J 2018; 64:24-30. [DOI: 10.1097/mat.0000000000000586] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
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Cho JY, Hong SJ, Lim DS. Effects of angiotensin receptor blockers on neointimal characteristics in angina patients requiring stent implantation: optical coherence tomography analysis. BMC Cardiovasc Disord 2017; 17:278. [PMID: 29141596 PMCID: PMC5688760 DOI: 10.1186/s12872-017-0709-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Accepted: 11/08/2017] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Angiotensin receptor blockers (ARBs) are known for its anti-inflammatory and anti-proliferative effects. The aim of the study was to evaluate long-term effects of ARBs on morphologic characteristics of stent restenosis in patients with coronary artery disease requiring stent implantation by optical coherence tomography (OCT). METHODS Patients with coronary artery disease having history of drug-eluting stent implantation (n = 407) were analyzed on the basis of ARB therapy as the ARB group (n = 162) and the non-ARB group (n = 245). Neointimal characterizations were performed at lesions with diameter stenosis >30% with OCT in each group. Major adverse cardiovascular events (MACEs), lumen area, stent area, neointimal area, neointimal thickness, nonapposed struts, uncovered struts, and intraluminal mass between two groups were also observed. RESULTS More patients in the ARB group revealed homogeneous and layered neointimal pattern (44.9% vs. 35.6%, P < 0.001, and 16.8% vs. 10.6%, P < 0.001, respectively), and whereas patients in the non-ARB group revealed heterogeneous neointimal pattern (1.1% vs. 7.6%, P < 0.001). Mean neointimal area (1.09 ± 1.00 mm2 vs. 1.38 ± 1.24 mm2) and mean neointimal thickness (140.6 ± 112.0 μm vs. 189.6 ± 423.1 μm) with OCT were smaller in the ARB group when compared to the non-ARB group. Percentage of covered stents was significantly higher in the ARB group when compared to the Non-ARB group (97.3% vs. 92.6%, P = 0.015). Other factors such as follow-up % diameter stenosis, late lumen loss, binary restenosis, MACEs, various neointimal characteristics analyzed by image analyzing software did not show significant differences. CONCLUSION The use of ARBs after drug-eluting stent implantation demonstrated difference in neointimal characteristics, less amount of neointimal area and fewer number of uncovered stent struts during the follow-up OCT, indicating the anti-proliferative and anti-inflammatory effects of ARBs.
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Affiliation(s)
- Jae Young Cho
- Department of Cardiology, Korea University Anam Hospital, Inchon-ro 73, Seongbuk-gu, Seoul, South Korea
| | - Soon Jun Hong
- Department of Cardiology, Korea University Anam Hospital, Inchon-ro 73, Seongbuk-gu, Seoul, South Korea
| | - Do-Sun Lim
- Department of Cardiology, Korea University Anam Hospital, Inchon-ro 73, Seongbuk-gu, Seoul, South Korea.
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van Ditzhuijzen NS, Kurata M, van den Heuvel M, Sorop O, van Duin RWB, Krabbendam-Peters I, Ligthart J, Witberg K, Murawska M, Bouma B, Villiger M, Garcia-Garcia HM, Serruys PW, Zijlstra F, van Soest G, Duncker DJ, Regar E, van Beusekom HMM. Neoatherosclerosis development following bioresorbable vascular scaffold implantation in diabetic and non-diabetic swine. PLoS One 2017; 12:e0183419. [PMID: 28898243 PMCID: PMC5595285 DOI: 10.1371/journal.pone.0183419] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Accepted: 08/03/2017] [Indexed: 11/19/2022] Open
Abstract
Background DM remains a risk factor for poor outcome after stent-implantation, but little is known if and how DM affects the vascular response to BVS. Aim The aim of our study was to examine coronary responses to bioresorbable vascular scaffolds (BVS) in swine with and without diabetes mellitus fed a ‘fast-food’ diet (FF-DM and FF-NDM, respectively) by sequential optical coherence tomography (OCT)-imaging and histology. Methods Fifteen male swine were evaluated. Eight received streptozotocin-injection to induce DM. After 9 months (M), 32 single BVS were implanted in epicardial arteries with a stent to artery (S/A)-ratio of 1.1:1 under quantitative coronary angiography (QCA) and OCT guidance. Lumen, scaffold, neointimal coverage and composition were assessed by QCA, OCT and near-infrared spectroscopy (NIRS) pre- and/or post-procedure, at 3M and 6M. Additionally, polarization-sensitive (PS)-OCT was performed in 7 swine at 6M. After sacrifice at 3M and 6M, histology and polymer degradation analysis were performed. Results Late lumen loss was high (~60%) within the first 3M after BVS-implantation (P<0.01 FF-DM vs. FF-NDM) and stabilized between 3M and 6M (<5% change in FF-DM, ~10% in FF-NDM; P>0.20). Neointimal coverage was highly heterogeneous in all swine (DM vs. NDM P>0.05), with focal lipid accumulation, irregular collagen distribution and neointimal calcification. Likewise, polymer mass loss was low (~2% at 3M, ~5% at 6M;P>0.20) and not associated with DM or inflammation. Conclusion Scaffold coverage showed signs of neo-atherosclerosis in all FF-DM and FF-NDM swine, scaffold polymer was preserved and the vascular response to BVS was not influenced by diabetes.
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Affiliation(s)
- Nienke S. van Ditzhuijzen
- Department of Cardiology, Thoraxcenter, Cardiovascular Research school COEUR, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Mie Kurata
- Department of Cardiology, Thoraxcenter, Cardiovascular Research school COEUR, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Mieke van den Heuvel
- Department of Cardiology, Thoraxcenter, Cardiovascular Research school COEUR, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Oana Sorop
- Department of Cardiology, Thoraxcenter, Cardiovascular Research school COEUR, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Richard W. B. van Duin
- Department of Cardiology, Thoraxcenter, Cardiovascular Research school COEUR, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Ilona Krabbendam-Peters
- Department of Cardiology, Thoraxcenter, Cardiovascular Research school COEUR, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Jurgen Ligthart
- Department of Cardiology, Thoraxcenter, Cardiovascular Research school COEUR, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Karen Witberg
- Department of Cardiology, Thoraxcenter, Cardiovascular Research school COEUR, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Magdalena Murawska
- Department of Biostatistics, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Brett Bouma
- Wellman Center for Photomedicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Martin Villiger
- Wellman Center for Photomedicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
| | | | | | - Felix Zijlstra
- Department of Cardiology, Thoraxcenter, Cardiovascular Research school COEUR, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Gijs van Soest
- Department of Cardiology, Thoraxcenter, Cardiovascular Research school COEUR, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Dirk-Jan Duncker
- Department of Cardiology, Thoraxcenter, Cardiovascular Research school COEUR, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Evelyn Regar
- Department of Cardiology, Thoraxcenter, Cardiovascular Research school COEUR, Erasmus University Medical Center, Rotterdam, The Netherlands
- Dept. of Cardiovascular Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Heleen M. M. van Beusekom
- Department of Cardiology, Thoraxcenter, Cardiovascular Research school COEUR, Erasmus University Medical Center, Rotterdam, The Netherlands
- * E-mail:
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Gliesche DG, Hussner J, Witzigmann D, Porta F, Glatter T, Schmidt A, Huwyler J, Meyer Zu Schwabedissen HE. Secreted Matrix Metalloproteinase-9 of Proliferating Smooth Muscle Cells as a Trigger for Drug Release from Stent Surface Polymers in Coronary Arteries. Mol Pharm 2016; 13:2290-300. [PMID: 27241028 DOI: 10.1021/acs.molpharmaceut.6b00033] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Cardiovascular diseases are the leading causes of death in industrialized countries. Atherosclerotic coronary arteries are commonly treated with percutaneous transluminal coronary intervention followed by stent deployment. This treatment has significantly improved the clinical outcome. However, triggered vascular smooth muscle cell (SMC) proliferation leads to in-stent restenosis in bare metal stents. In addition, stent thrombosis is a severe side effect of drug eluting stents due to inhibition of endothelialization. The aim of this study was to develop and test a stent surface polymer, where cytotoxic drugs are covalently conjugated to the surface and released by proteases selectively secreted by proliferating smooth muscle cells. Resting and proliferating human coronary artery smooth muscle cells (HCASMC) and endothelial cells (HCAEC) were screened to identify an enzyme exclusively released by proliferating HCASMC. Expression analyses and enzyme activity assays verified selective and exclusive activity of the matrix metalloproteinase-9 (MMP-9) in proliferating HCASMC. The principle of drug release exclusively triggered by proliferating HCASMC was tested using the biodegradable stent surface polymer poly-l-lactic acid (PLLA) and the MMP-9 cleavable peptide linkers named SRL and AVR. The specific peptide cleavage by MMP-9 was verified by attachment of the model compound fluorescein. Fluorescein release was observed in the presence of MMP-9 secreting HCASMC but not of proliferating HCAEC. Our findings suggest that cytotoxic drug conjugated polymers can be designed to selectively release the attached compound triggered by MMP-9 secreting smooth muscle cells. This novel concept may be beneficial for stent endothelialization thereby reducing the risk of restenosis and thrombosis.
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Affiliation(s)
- Daniel G Gliesche
- Biopharmacy, Department of Pharmaceutical Sciences, University of Basel , 4056 Basel, Switzerland
| | - Janine Hussner
- Biopharmacy, Department of Pharmaceutical Sciences, University of Basel , 4056 Basel, Switzerland
| | - Dominik Witzigmann
- Pharmaceutical Technology, Department of Pharmaceutical Sciences, University of Basel , Basel 4056, Switzerland
| | - Fabiola Porta
- Pharmaceutical Technology, Department of Pharmaceutical Sciences, University of Basel , Basel 4056, Switzerland
| | - Timo Glatter
- Proteomics Core Facility, Biozentrum, University of Basel , Basel 4056, Switzerland
| | - Alexander Schmidt
- Proteomics Core Facility, Biozentrum, University of Basel , Basel 4056, Switzerland
| | - Jörg Huwyler
- Pharmaceutical Technology, Department of Pharmaceutical Sciences, University of Basel , Basel 4056, Switzerland
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Akhtar M, Liu W. Use of intravascular ultrasound vs. optical coherence tomography for mechanism and patterns of in-stent restenosis among bare metal stents and drug eluting stents. J Thorac Dis 2016; 8:E104-8. [PMID: 26904234 DOI: 10.3978/j.issn.2072-1439.2016.01.48] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
This article is a perspective responses to the "Mechanisms and Patterns of Intravascular Ultrasound In-Stent Restenosis Among Bare Metal Stents and First- and Second-Generation Drug-Eluting Stents" by Goto et al., The above mentioned article outlines the use of intravascular ultrasound (IVUS) in visualizing the patterns and mechanisms of in-stent restenosis (ISR) post percutaneous coronary intervention (PCI). Although IVUS is an appropriate method of choice for this scenario, IVUS has certain limitations which can be overcome by using optical coherent tomography (OCT). OCT is not only able to overcome IVUS's limitations but is also able to provide additional information to enhance the understanding of in-stent restenotic lesions. This article also outlines the future directions for OCT both in clinical and investigation settings.
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Affiliation(s)
- Muzina Akhtar
- Cardiology Department, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China
| | - Wei Liu
- Cardiology Department, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China
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Lavin B, Phinikaridou A, Lorrio S, Zaragoza C, Botnar RM. Monitoring vascular permeability and remodeling after endothelial injury in a murine model using a magnetic resonance albumin-binding contrast agent. Circ Cardiovasc Imaging 2015; 8:CIRCIMAGING.114.002417. [PMID: 25873720 PMCID: PMC4405074 DOI: 10.1161/circimaging.114.002417] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Despite the beneficial effects of vascular interventions, these procedures may damage the endothelium leading to increased vascular permeability and remodeling. Re-endothelialization of the vessel wall, with functionally and structurally intact cells, is controlled by endothelial nitric oxide synthase (NOS3) and is crucial for attenuating adverse effects after injury. We investigated the applicability of the albumin-binding MR contrast agent, gadofosveset, to noninvasively monitor focal changes in vascular permeability and remodeling, after injury, in NOS3-knockout (NOS3(-/-)) and wild-type (WT) mice in vivo. METHODS AND RESULTS WT and NOS3(-/-) mice were imaged at 7, 15, and 30 days after aortic denudation or sham-surgery. T1 mapping (R1=1/T1, s(-1)) and delayed-enhanced MRI were used as measurements of vascular permeability (R1) and remodeling (vessel wall enhancement, mm(2)) after gadofosveset injection, respectively. Denudation resulted in higher vascular permeability and vessel wall enhancement 7 days after injury in both strains compared with sham-operated animals. However, impaired re-endothelialization and increased neovascularization in NOS3(-/-) mice resulted in significantly higher R1 at 15 and 30 days post injury compared with WT mice that showed re-endothelialization and lack of neovascularization (R1 [s(-1)]=15 days: NOS3 (-/-)4.02 [interquartile range, IQR, 3.77-4.41] versus WT2.39 [IQR, 2.35-2.92]; 30 days: NOS3 (-/-)4.23 [IQR, 3.94-4.68] versus WT2.64 [IQR, 2.33-2.80]). Similarly, vessel wall enhancement was higher in NOS3(-/-) but recovered in WT mice (area [mm(2)]=15 days: NOS3 (-/-)5.20 [IQR, 4.68-6.80] versus WT2.13 [IQR, 0.97-3.31]; 30 days: NOS3 (-/-)7.35 [IQR, 5.66-8.61] versus WT1.60 [IQR, 1.40-3.18]). Ex vivo histological studies corroborated the MRI findings. CONCLUSIONS We demonstrate that increased vascular permeability and remodeling, after injury, can be assessed noninvasively using an albumin-binding MR contrast agent and may be used as surrogate markers for evaluating the healing response of the vessel wall after injury.
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Affiliation(s)
- Begoña Lavin
- From the Division of Imaging Sciences and Biomedical Engineering, King's College London, King's Health Partners, St. Thomas' Hospital, London, United Kingdom (B.L., A.P., S.L., R.M.B.); The British Heart Foundation Centre of Excellence, Cardiovascular Division (B.L., A.P., R.M.B.) and Wellcome Trust and EPSRC Medical Engineering Center (B.L., R.M.B.), King's College London, London, United Kingdom; Cardiovascular Research Unit, University Francisco de Vitoria/Hospital Ramón y Cajal, Ctra. Colmenar Viejo, km 9,100, Madrid 28034, Spain (C.Z.).
| | - Alkystis Phinikaridou
- From the Division of Imaging Sciences and Biomedical Engineering, King's College London, King's Health Partners, St. Thomas' Hospital, London, United Kingdom (B.L., A.P., S.L., R.M.B.); The British Heart Foundation Centre of Excellence, Cardiovascular Division (B.L., A.P., R.M.B.) and Wellcome Trust and EPSRC Medical Engineering Center (B.L., R.M.B.), King's College London, London, United Kingdom; Cardiovascular Research Unit, University Francisco de Vitoria/Hospital Ramón y Cajal, Ctra. Colmenar Viejo, km 9,100, Madrid 28034, Spain (C.Z.)
| | - Silvia Lorrio
- From the Division of Imaging Sciences and Biomedical Engineering, King's College London, King's Health Partners, St. Thomas' Hospital, London, United Kingdom (B.L., A.P., S.L., R.M.B.); The British Heart Foundation Centre of Excellence, Cardiovascular Division (B.L., A.P., R.M.B.) and Wellcome Trust and EPSRC Medical Engineering Center (B.L., R.M.B.), King's College London, London, United Kingdom; Cardiovascular Research Unit, University Francisco de Vitoria/Hospital Ramón y Cajal, Ctra. Colmenar Viejo, km 9,100, Madrid 28034, Spain (C.Z.)
| | - Carlos Zaragoza
- From the Division of Imaging Sciences and Biomedical Engineering, King's College London, King's Health Partners, St. Thomas' Hospital, London, United Kingdom (B.L., A.P., S.L., R.M.B.); The British Heart Foundation Centre of Excellence, Cardiovascular Division (B.L., A.P., R.M.B.) and Wellcome Trust and EPSRC Medical Engineering Center (B.L., R.M.B.), King's College London, London, United Kingdom; Cardiovascular Research Unit, University Francisco de Vitoria/Hospital Ramón y Cajal, Ctra. Colmenar Viejo, km 9,100, Madrid 28034, Spain (C.Z.)
| | - René M Botnar
- From the Division of Imaging Sciences and Biomedical Engineering, King's College London, King's Health Partners, St. Thomas' Hospital, London, United Kingdom (B.L., A.P., S.L., R.M.B.); The British Heart Foundation Centre of Excellence, Cardiovascular Division (B.L., A.P., R.M.B.) and Wellcome Trust and EPSRC Medical Engineering Center (B.L., R.M.B.), King's College London, London, United Kingdom; Cardiovascular Research Unit, University Francisco de Vitoria/Hospital Ramón y Cajal, Ctra. Colmenar Viejo, km 9,100, Madrid 28034, Spain (C.Z.)
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Hougaard M, Thayssen P, Kaltoft A, Tilsted HH, Maeng M, Flensted Lassen J, Thuesen L, Okkels Jensen L. Long-term outcome following percutaneous coronary intervention with drug-eluting stents compared with bare-metal stents in saphenous vein graft lesions: From Western Denmark heart registry. Catheter Cardiovasc Interv 2013; 83:1035-42. [DOI: 10.1002/ccd.25279] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2013] [Revised: 10/02/2013] [Accepted: 10/23/2013] [Indexed: 11/09/2022]
Affiliation(s)
- Mikkel Hougaard
- Department of Cardiology; Odense University Hospital; Odense Denmark
| | - Per Thayssen
- Department of Cardiology; Odense University Hospital; Odense Denmark
| | - Anne Kaltoft
- Department of Cardiology; Aarhus University Hospital; Skejby Aarhus Denmark
| | | | - Michael Maeng
- Department of Cardiology; Aarhus University Hospital; Skejby Aarhus Denmark
| | | | - Leif Thuesen
- Department of Cardiology; Aarhus University Hospital; Skejby Aarhus Denmark
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Yazdani SK, Farb A, Nakano M, Vorpahl M, Ladich E, Finn AV, Kolodgie FD, Virmani R. Pathology of drug-eluting versus bare-metal stents in saphenous vein bypass graft lesions. JACC Cardiovasc Interv 2012; 5:666-74. [PMID: 22721663 PMCID: PMC3407956 DOI: 10.1016/j.jcin.2011.12.017] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2011] [Revised: 12/07/2011] [Accepted: 12/22/2011] [Indexed: 11/30/2022]
Abstract
OBJECTIVES The purpose of this study was to assess the pathological responses of atherosclerotic saphenous vein bypass grafts (SVBGs) to drug-eluting stents (DES) versus bare-metal stents (BMS). BACKGROUND Repeat bypass surgery is typically associated with a high rate of morbidity and mortality. Percutaneous coronary interventions have emerged as the preferred treatment; however, only limited data are available on SVBGs pathological responses to DES and BMS. METHODS Formalin-fixed SVBG of >2 years duration (n = 31) were collected to histologically characterize advanced atherosclerotic lesions in native SVBG. In a separate group, SVBGs treated with DES (n = 9) and BMS (n = 9) for >30 days duration were assessed for morphological and morphometric changes. RESULTS Necrotic core lesions were identified in 25% of SVBG sections, and plaque rupture with luminal thrombosis was observed in 6.3% of histological sections (32% [10 of 31] vein grafts examined). Morphometry of DES demonstrated reduction in neointimal thickening versus BMS (0.13 mm [interquartile range: 0.06 to 0.16 mm] vs. 0.30 mm [interquartile range: 0.20 to 0.48 mm], p = 0.004). DES lesions also showed greater delayed healing characterized by increased peristrut fibrin deposition, higher percentage of uncovered struts, and less endothelialization compared with BMS. Stent fractures (DES 56% vs. BMS 11%, p = 0.045) and late stent thrombosis (DES 44% vs. BMS 0%, p = 0.023) were more common in DES versus BMS. CONCLUSIONS Advanced SVBG atherosclerotic lesions are characterized by large hemorrhagic necrotic cores. Stenting of such lesions is associated with delayed vascular healing and late thrombosis particularly following DES implantation, which may help explain the higher rates of cardiovascular events observed in SVBG stenting as compared with native coronary arteries.
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MESH Headings
- Aged
- Aged, 80 and over
- Angioplasty, Balloon, Coronary/adverse effects
- Angioplasty, Balloon, Coronary/instrumentation
- Angioplasty, Balloon, Coronary/mortality
- Atherosclerosis/etiology
- Atherosclerosis/mortality
- Atherosclerosis/pathology
- Atherosclerosis/therapy
- Autopsy
- Chi-Square Distribution
- Coronary Artery Bypass/adverse effects
- Coronary Artery Bypass/mortality
- Coronary Thrombosis/etiology
- Coronary Thrombosis/pathology
- Drug-Eluting Stents
- Female
- Fixatives
- Formaldehyde
- Graft Occlusion, Vascular/etiology
- Graft Occlusion, Vascular/mortality
- Graft Occlusion, Vascular/pathology
- Graft Occlusion, Vascular/therapy
- Humans
- Male
- Metals
- Middle Aged
- Necrosis
- Neointima
- Plaque, Atherosclerotic
- Prosthesis Design
- Prosthesis Failure
- Registries
- Risk Assessment
- Risk Factors
- Saphenous Vein/pathology
- Saphenous Vein/transplantation
- Stents
- Time Factors
- Tissue Fixation
- Treatment Outcome
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Affiliation(s)
| | - Andrew Farb
- Office of Device Evaluation, Center for Devices and Radiological Health, U.S. Food and Drug Administration, Silver Spring, MD
| | | | | | | | - Aloke V. Finn
- Department of Cardiology, Emory University School of Medicine, Atlanta, GA
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12
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Wykrzykowska JJ, Onuma Y, Serruys PW. Vascular restoration therapy: the fourth revolution in interventional cardiology and the ultimate "rosy" prophecy. EUROINTERVENTION 2012; 5 Suppl F:F7-8. [PMID: 22100680 DOI: 10.4244/eijv5ifa1] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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13
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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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14
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Nair S, Fath-Ordoubadi F, Clarke B, El-Omar M, Foley J, Fraser DG, Mahadevan VS, Neyses L, Khattar RS, Mamas MA. Late outcomes of drug eluting and bare metal stents in saphenous vein graft percutaneous coronary intervention. EUROINTERVENTION 2011; 6:985-91. [PMID: 21330247 DOI: 10.4244/eijv6i8a170] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS PCI with drug eluting stents (DES) has been shown to reduce restenosis and major adverse cardiac event (MACE) rates compared to bare metal stents (BMS) in native coronary vessels, although outcomes in saphenous vein graft (SVG) lesions are less clear. We retrospectively studied 388 consecutive patients admitted to our centre for SVG PCI to assess mortality and MACE outcomes (defined as composite endpoint of all-death, stroke, myocardial infarction, stent thrombosis and target lesion (TLR)/vessel (TVR) revascularisation) associated with BMS and DES use. METHODS AND RESULTS Two hundred and nineteen (219) patients had BMS and 169 had DES (total 388 patients). Mean follow up was 41.9±23.5 months. No significant differences were observed in mortality (14.2% vs. 11.8%) or MACE (37.6% vs. 35.8%) between the BMS and DES groups at four years follow-up or at other intervening time points studied. Similarly, no differences in TVR/TLR rates were observed over a similar time period (19.8% vs. 21.6%). CONCLUSIONS We have observed that DES and BMS use in SVG PCI have comparable mortality and MACE rates, and that in contrast to PCI in native coronary arteries, DES do not reduce revascularisation rates in our study cohort.
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Affiliation(s)
- Satheesh Nair
- Manchester Heart Centre, Manchester Royal Infirmary, Biomedical Research Centre, and Manchester Academic Health Science Center, University of Manchester, Manchester, United Kingdom
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15
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Nakazawa G, Otsuka F, Nakano M, Vorpahl M, Yazdani SK, Ladich E, Kolodgie FD, Finn AV, Virmani R. The pathology of neoatherosclerosis in human coronary implants bare-metal and drug-eluting stents. J Am Coll Cardiol 2011; 57:1314-22. [PMID: 21376502 DOI: 10.1016/j.jacc.2011.01.011] [Citation(s) in RCA: 702] [Impact Index Per Article: 54.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2010] [Revised: 12/06/2010] [Accepted: 01/05/2011] [Indexed: 01/10/2023]
Abstract
OBJECTIVES Human coronary bare-metal stents (BMS) and drug-eluting stents (DES) from autopsy cases with implant duration >30 days were examined for the presence of neointimal atherosclerotic disease. BACKGROUND Neointimal atherosclerotic change (neoatherosclerosis) after BMS implantation is rarely reported and usually occurs beyond 5 years. The incidence of neoatherosclerosis after DES implantation has not been reported. METHODS All available cases from the CVPath stent registry (n = 299 autopsies), which includes a total of 406 lesions-197 BMS, 209 DES (103 sirolimus-eluting stents [SES] and 106 paclitaxel-eluting stents [PES])-with implant duration >30 days were examined. Neoatherosclerosis was recognized as clusters of lipid-laden foamy macrophages within the neointima with or without necrotic core formation. RESULTS The incidence of neoatherosclerosis was significantly greater in DES lesions (31%) than BMS lesions (16%; p < 0.001). The median stent duration with neoatherosclerosis was shorter in DES than BMS (DES, 420 days [interquartile range [IQR]: 361 to 683 days]; BMS, 2,160 days [IQR: 1,800 to 2,880 days], p < 0.001). Unstable lesions characterized as thin-cap fibroatheromas or plaque rupture were more frequent in BMS (n = 7, 4%) than in DES (n = 3, 1%; p = 0.17), with relatively shorter implant durations for DES (1.5 ± 0.4 years) compared to BMS (6.1 ± 1.5 years). Independent determinants of neoatherosclerosis identified by multiple logistic regression included younger age (p < 0.001), longer implant durations (p < 0.001), SES usage (p < 0.001), PES usage (p = 0.001), and underlying unstable plaques (p = 0.004). CONCLUSIONS Neoatherosclerosis is a frequent finding in DES and occurs earlier than in BMS. Unstable features of neoatherosclerosis are identified for both BMS and DES with shorter implant durations for the latter. The development of neoatherosclerosis may be yet another rare contributing factor to late thrombotic events.
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16
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MAMAS MAMASA, FOLEY JAMES, NAIR SATHEESH, WIPER ANDREW, CLARKE BERNARD, EL-OMAR MAGDI, FRASER DOUGLASG, KHATTAR RAJDEEP, NEYSES LUDWIG, FATH-ORDOUBADI FARZIN. A Comparison of Drug-Eluting Stents versus Bare Metal Stents in Saphenous Vein Graft PCI Outcomes: A Meta-Analysis. J Interv Cardiol 2011; 24:172-80. [DOI: 10.1111/j.1540-8183.2010.00620.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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17
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Lupi A, Navarese EP, Lazzero M, Sansa M, Servi SD, Serra A, Bongo AS, Buffon A. Drug-Eluting Stents vs. Bare Metal Stents in Saphenous Vein Graft Disease - Insights From a Meta-Analysis of 7,090 Patients -. Circ J 2011; 75:280-9. [DOI: 10.1253/circj.cj-10-0186] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
| | - Eliano Pio Navarese
- Istituto di Cardiologia, Università Cattolica del Sacro Cuore
- Interventional Cardiology Unit, Hospital de la Santa Creu i Sant Pau
| | | | - Mara Sansa
- Cardiologia 2, Ospedale Maggiore della Carità
| | | | - Antonio Serra
- Interventional Cardiology Unit, Hospital de la Santa Creu i Sant Pau
| | | | - Antonio Buffon
- Istituto di Cardiologia, Università Cattolica del Sacro Cuore
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18
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Yamamoto M, Takano M, Murakami D, Inami T, Kimata N, Inami S, Okamatsu K, Ohba T, Seino Y, Mizuno K. Optical coherence tomography analysis for restenosis of drug-eluting stents. Int J Cardiol 2011; 146:100-3. [DOI: 10.1016/j.ijcard.2010.06.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2010] [Accepted: 06/04/2010] [Indexed: 11/29/2022]
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19
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20
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Testa L, Agostoni P, Vermeersch P, Biondi-Zoccai G, Van Gaal W, Bhindi R, Brilakis E, Latini RA, Laudisa ML, Pizzocri S, Lanotte S, Brambilla N, Banning A, Bedogni F. Drug eluting stents versus bare metal stents in the treatment of saphenous vein graft disease: a systematic review and meta-analysis. EUROINTERVENTION 2010; 6:527-36. [PMID: 20884442 DOI: 10.4244/eij30v6i4a87] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- Luca Testa
- Department of Interventional Cardiology, Istituto clinico S. Ambrogio, Milan, Italy.
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21
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Affiliation(s)
- Zuzana Motovska
- Third Medical Faculty, Charles University and University Hospital, Kralovske Vinohrady, Prague, Czech Republic.
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22
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Sanchez-Recalde A, Jiménez Valero S, Moreno R, Barreales L, Lozano Í, Galeote G, Martín Reyes R, Calvo L, Lopez-Sendon J. Safety and efficacy of drug-eluting stents versus bare-metal stents in saphenous vein grafts lesions: a meta-analysis. EUROINTERVENTION 2010. [DOI: 10.4244/eijv6i1a22] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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23
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Gonzalo N, Serruys PW, Okamura T, van Beusekom HM, Garcia-Garcia HM, van Soest G, van der Giessen W, Regar E. Optical coherence tomography patterns of stent restenosis. Am Heart J 2009; 158:284-93. [PMID: 19619707 DOI: 10.1016/j.ahj.2009.06.004] [Citation(s) in RCA: 239] [Impact Index Per Article: 15.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2009] [Accepted: 06/02/2009] [Indexed: 10/20/2022]
Abstract
BACKGROUND Stent restenosis is an infrequent but poorly understood clinical problem in the drug-eluting stent era. The aim of the study was to evaluate the morphologic characteristics of stent restenosis by optical coherence tomography (OCT). METHODS Patients (n = 24, 25 vessels) presenting with angiographically documented stent restenosis were included. Quantitative OCT analysis consisted of lumen and stent area measurement and calculation of restenotic tissue area and burden. Qualitative restenotic tissue analysis included assessment of tissue structure, backscattering and symmetry, visible microvessels, lumen shape, and presence of intraluminal material. RESULTS By angiography, restenosis was classified as diffuse, focal, and at the margins in 9, 11, and 5 vessels, respectively. By OCT, restenotic tissue structure was layered in 52%, homogeneous in 28%, and heterogeneous in 20%. The predominant backscatter was high in 72%. Microvessels were visible in 12%. Lumen shape was irregular in 28% and there was intraluminal material in 20%. The mean restenotic tissue symmetry ratio was 0.58 +/- 0.19. Heterogeneous and low scattering restenotic tissue was more frequent in focal (45.5% and 54.5%, respectively) than in diffuse (0 and 11.1%) and margin restenosis (0 and 0%) (P = .005 for heterogeneous, P = .03 for low scattering). Restenosis patients with unstable angina symptoms presented more frequently irregular lumen shape (60 vs 6.7%, P = .007). Stents implanted </=12 months ago had more frequently restenotic tissue with layered appearance (84.6% vs 16.7%, P = .003). CONCLUSIONS We demonstrate the ability of OCT to identify differential patterns of restenotic tissue after stenting. This information could help in understanding the mechanism of stent restenosis.
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24
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Assali A, Raz Y, Vaknin-Assa H, Ben-Dor I, Brosh D, Teplitsky I, Fuchs S, Kornowski R. Beneficial 2-years results of drug-eluting stents in saphenous vein graft lesions. EUROINTERVENTION 2008; 4:108-14. [DOI: 10.4244/eijv4i1a18] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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25
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Mamas M, Fraser D, Fath-Ordoubadi F. The role of thrombectomy and distal protection devices during percutaneous coronary interventions. EUROINTERVENTION 2008; 4:115-23. [DOI: 10.4244/eijv4i1a19] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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26
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Ozer N, Tangurek B, Firat F, Ozer S, Tartan Z, Ozturk R, Ozay B, Ciloglu F, Yilmaz H, Cam N. Effects of drug-eluting stents on systemic inflammatory response in patients with unstable angina pectoris undergoing percutaneous coronary intervention. Heart Vessels 2008; 23:75-82. [PMID: 18389330 DOI: 10.1007/s00380-007-1020-y] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2007] [Accepted: 09/21/2007] [Indexed: 12/29/2022]
Abstract
Inflammatory markers are elevated in acute coronary syndromes, and are also known to play a crucial role in the pathogenesis of neointimal proliferation and stent restenosis. Drug-eluting stents (DESs) have been shown to decrease stent restenosis in different studies. In this study, we aimed to investigate the effect of treatment with DESs on systemic inflammatory response in patients with unstable angina pectoris who underwent percutaneous coronary intervention (PCI). We compared plasma high-sensitivity C-reactive protein (hsCRP), human tumor necrosis factor alpha (Hu TNF-alpha), and interleukin 6 (IL-6) levels after DES (dexamethasone-eluting stent [DEXES], and sirolimuseluting stent [SES]) implantation with levels after bare metal stent (BMS) implantation. We performed PCI with a single stent in 90 patients (62 men; 59 +/- 9 years of age; n = 30 in the BMS group, n = 30 in the DEXES group, n = 30 in the SES group) who had acute coronary syndrome. Plasma hsCRP, Hu TNF-alpha, and IL-6 levels were determined before intervention and at 24 h, 48 h, and 1 week after PCI. The results were as follows. Plasma hsCRP levels at 48 h (11.19 +/- 4.54, 6.43 +/- 1.63 vs 6.23 +/- 2.69 mg/l, P = 0.001) after stent implantation were significantly higher in the BMS group than in the DES group; this effect persisted for 7 days (P = 0.001). Plasma Hu TNF-alpha levels at each time point were higher in the SES group than in the BMS and DEXES groups (P < 0.05). The time course of Hu TNF-alpha values was similar in all groups. Although IL-6 levels at baseline and at 24 and 48 h showed no statistically significant difference between the study groups, postprocedural values at 7 days were slightly statistically significant in the SES group (P = 0.045). Drug-eluting stents showed significantly lower plasma hsCRP levels after PCI compared with BMSs. This may reflect the potent effects of DESs on acute inflammatory reactions induced by PCI.
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Affiliation(s)
- Nihat Ozer
- Cardiology Department, Siyami Ersek Cardiovascular and Thoracic Surgery Center, Istanbul, Turkey.
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27
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Ribichini F, Pugno F, Ferrero V, Wijns W, Vacca G, Vassanelli C, Virmani R. Long-term histological and immunohistochemical findings in human venous aorto-coronary bypass grafts. Clin Sci (Lond) 2008; 114:211-20. [PMID: 17848140 DOI: 10.1042/cs20070243] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The aim of the present study was to analyse the long-term histology and immunohistochemistry of the plaque composition and cellular infiltration of SVGs (saphenous vein grafts) containing metallic stents. Percutaneous interventions in SVGs have a worse long-term clinical outcome compared with stenting of coronary arteries. Whether the pathological features of old degenerated SVGs condition the efficacy of drug-eluting stents is also unknown. Histology and immunohistochemistry of seven SVGs in the coronary circulation containing 12 metallic stents implanted 5 to 61 months before retrieval were analysed in patients undergoing a second aorto-coronary bypass surgery at a mean time of 11±6 years. The pathology of the old SVGs showed an important thrombotic and necrotic composition of the plaque, with plaque protrusion through the stent wires and a fragile media layer that could easily be damaged by stent placement with subsequent neointimal proliferation; indeed, stents with medial fracture had significantly greater mean neointimal thickness than those without (1.37±0.68 compared with 0.81±0.47 mm2; P<0.02). Neointimal inflammatory cell density correlated with increased neointimal thickness in patent vessels (r2=0.43, P<0.001). Immunostaining showed the total absence of ERs (oestrogen receptors), a poor cellular proliferative state as indicated by the presence of the Ki-67 marker, and persistent inflammation close to the stent wires as revealed by KP-1 and ACE (angiotensin-converting enzyme) immunostaining in most inflammatory cells in contact with the metal. These pathological findings may contribute to the more severe progression of disease and worse clinical outcome observed after conventional stented angioplasty of SVGs and might also interfere with the efficacy of drug-eluting stents in this specific atherosclerotic milieu.
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Affiliation(s)
- Flavio Ribichini
- Division of Cardiology, Department of Biomedical Sciences and Surgery, University of Verona, 37126 Verona, Italy.
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28
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Nishino M, Hoshida S, Kato H, Egami Y, Shutta R, Yamaguchi H, Tanaka K, Tanouchi J, Hori M, Yamada Y. Preprocedural Statin Administration can Reduce Thrombotic Reaction After Stent Implantation. Circ J 2008; 72:232-7. [DOI: 10.1253/circj.72.232] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
| | | | | | | | - Ryu Shutta
- Division of Cardiology, Osaka Rosai Hospital
| | | | | | | | - Masatsugu Hori
- Department of Cardiology, Osaka University Graduate School of Medicine
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29
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30
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Diwan A, Krenz M, Syed FM, Wansapura J, Ren X, Koesters AG, Li H, Kirshenbaum LA, Hahn HS, Robbins J, Jones WK, Dorn GW. Inhibition of ischemic cardiomyocyte apoptosis through targeted ablation of Bnip3 restrains postinfarction remodeling in mice. J Clin Invest 2007; 117:2825-33. [PMID: 17909626 PMCID: PMC1994631 DOI: 10.1172/jci32490] [Citation(s) in RCA: 239] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2007] [Accepted: 07/25/2007] [Indexed: 01/14/2023] Open
Abstract
Following myocardial infarction, nonischemic myocyte death results in infarct expansion, myocardial loss, and ventricular dysfunction. Here, we demonstrate that a specific proapoptotic gene, Bnip3, minimizes ventricular remodeling in the mouse, despite having no effect on early or late infarct size. We evaluated the effects of ablating Bnip3 on cardiomyocyte death, infarct size, and ventricular remodeling after surgical ischemia/reperfusion (IR) injury in mice. Immediately following IR, no significant differences were observed between Bnip3(-/-) and WT mice. However, at 2 days after IR, apoptosis was diminished in Bnip3(-/-) periinfarct and remote myocardium, and at 3 weeks after IR, Bnip3(-/-) mice exhibited preserved LV systolic performance, diminished LV dilation, and decreased ventricular sphericalization. These results suggest myocardial salvage by inhibition of apoptosis. Forced cardiac expression of Bnip3 increased cardiomyocyte apoptosis in unstressed mice, causing progressive LV dilation and diminished systolic function. Conditional Bnip3 overexpression prior to coronary ligation increased apoptosis and infarct size. These studies identify postischemic apoptosis by myocardial Bnip3 as a major determinant of ventricular remodeling in the infarcted heart, suggesting that Bnip3 may be an attractive therapeutic target.
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Affiliation(s)
- Abhinav Diwan
- Center for Molecular Cardiovascular Research and
Department of Pediatrics, University of Cincinnati, Cincinnati, Ohio, USA.
Imaging Research Center, Department of Radiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA.
Department of Pharmacology, University of Cincinnati, Cincinnati, Ohio, USA.
Institute of Cardiovascular Sciences, St. Boniface General Hospital Research Centre, Winnipeg, Manitoba, Canada.
Charles F. Kettering Memorial Hospital, Dayton, Ohio, USA
| | - Maike Krenz
- Center for Molecular Cardiovascular Research and
Department of Pediatrics, University of Cincinnati, Cincinnati, Ohio, USA.
Imaging Research Center, Department of Radiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA.
Department of Pharmacology, University of Cincinnati, Cincinnati, Ohio, USA.
Institute of Cardiovascular Sciences, St. Boniface General Hospital Research Centre, Winnipeg, Manitoba, Canada.
Charles F. Kettering Memorial Hospital, Dayton, Ohio, USA
| | - Faisal M. Syed
- Center for Molecular Cardiovascular Research and
Department of Pediatrics, University of Cincinnati, Cincinnati, Ohio, USA.
Imaging Research Center, Department of Radiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA.
Department of Pharmacology, University of Cincinnati, Cincinnati, Ohio, USA.
Institute of Cardiovascular Sciences, St. Boniface General Hospital Research Centre, Winnipeg, Manitoba, Canada.
Charles F. Kettering Memorial Hospital, Dayton, Ohio, USA
| | - Janaka Wansapura
- Center for Molecular Cardiovascular Research and
Department of Pediatrics, University of Cincinnati, Cincinnati, Ohio, USA.
Imaging Research Center, Department of Radiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA.
Department of Pharmacology, University of Cincinnati, Cincinnati, Ohio, USA.
Institute of Cardiovascular Sciences, St. Boniface General Hospital Research Centre, Winnipeg, Manitoba, Canada.
Charles F. Kettering Memorial Hospital, Dayton, Ohio, USA
| | - Xiaoping Ren
- Center for Molecular Cardiovascular Research and
Department of Pediatrics, University of Cincinnati, Cincinnati, Ohio, USA.
Imaging Research Center, Department of Radiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA.
Department of Pharmacology, University of Cincinnati, Cincinnati, Ohio, USA.
Institute of Cardiovascular Sciences, St. Boniface General Hospital Research Centre, Winnipeg, Manitoba, Canada.
Charles F. Kettering Memorial Hospital, Dayton, Ohio, USA
| | - Andrew G. Koesters
- Center for Molecular Cardiovascular Research and
Department of Pediatrics, University of Cincinnati, Cincinnati, Ohio, USA.
Imaging Research Center, Department of Radiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA.
Department of Pharmacology, University of Cincinnati, Cincinnati, Ohio, USA.
Institute of Cardiovascular Sciences, St. Boniface General Hospital Research Centre, Winnipeg, Manitoba, Canada.
Charles F. Kettering Memorial Hospital, Dayton, Ohio, USA
| | - Hairong Li
- Center for Molecular Cardiovascular Research and
Department of Pediatrics, University of Cincinnati, Cincinnati, Ohio, USA.
Imaging Research Center, Department of Radiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA.
Department of Pharmacology, University of Cincinnati, Cincinnati, Ohio, USA.
Institute of Cardiovascular Sciences, St. Boniface General Hospital Research Centre, Winnipeg, Manitoba, Canada.
Charles F. Kettering Memorial Hospital, Dayton, Ohio, USA
| | - Lorrie A. Kirshenbaum
- Center for Molecular Cardiovascular Research and
Department of Pediatrics, University of Cincinnati, Cincinnati, Ohio, USA.
Imaging Research Center, Department of Radiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA.
Department of Pharmacology, University of Cincinnati, Cincinnati, Ohio, USA.
Institute of Cardiovascular Sciences, St. Boniface General Hospital Research Centre, Winnipeg, Manitoba, Canada.
Charles F. Kettering Memorial Hospital, Dayton, Ohio, USA
| | - Harvey S. Hahn
- Center for Molecular Cardiovascular Research and
Department of Pediatrics, University of Cincinnati, Cincinnati, Ohio, USA.
Imaging Research Center, Department of Radiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA.
Department of Pharmacology, University of Cincinnati, Cincinnati, Ohio, USA.
Institute of Cardiovascular Sciences, St. Boniface General Hospital Research Centre, Winnipeg, Manitoba, Canada.
Charles F. Kettering Memorial Hospital, Dayton, Ohio, USA
| | - Jeffrey Robbins
- Center for Molecular Cardiovascular Research and
Department of Pediatrics, University of Cincinnati, Cincinnati, Ohio, USA.
Imaging Research Center, Department of Radiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA.
Department of Pharmacology, University of Cincinnati, Cincinnati, Ohio, USA.
Institute of Cardiovascular Sciences, St. Boniface General Hospital Research Centre, Winnipeg, Manitoba, Canada.
Charles F. Kettering Memorial Hospital, Dayton, Ohio, USA
| | - W. Keith Jones
- Center for Molecular Cardiovascular Research and
Department of Pediatrics, University of Cincinnati, Cincinnati, Ohio, USA.
Imaging Research Center, Department of Radiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA.
Department of Pharmacology, University of Cincinnati, Cincinnati, Ohio, USA.
Institute of Cardiovascular Sciences, St. Boniface General Hospital Research Centre, Winnipeg, Manitoba, Canada.
Charles F. Kettering Memorial Hospital, Dayton, Ohio, USA
| | - Gerald W. Dorn
- Center for Molecular Cardiovascular Research and
Department of Pediatrics, University of Cincinnati, Cincinnati, Ohio, USA.
Imaging Research Center, Department of Radiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA.
Department of Pharmacology, University of Cincinnati, Cincinnati, Ohio, USA.
Institute of Cardiovascular Sciences, St. Boniface General Hospital Research Centre, Winnipeg, Manitoba, Canada.
Charles F. Kettering Memorial Hospital, Dayton, Ohio, USA
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Van Belle E, Susen S, Jude B, Bertrand ME. Drug-eluting stents: trading restenosis for thrombosis? J Thromb Haemost 2007; 5 Suppl 1:238-45. [PMID: 17635732 DOI: 10.1111/j.1538-7836.2007.02486.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Within the last 6 years, it has been demonstrated that drug-eluting stents (DES) reduce significantly angiographic and clinical restenosis after percutaneous coronary interventions. These results are consistent across several clinical randomized controlled trials comparing these new devices with bare metallic stents (BMS), which themselves have already markedly improved the results obtained with balloon angioplasty in the early days of this method of myocardial revascularization. Nevertheless, some concerns have been raised regarding a delayed endothelialization of the coated prostheses leading to late stent thrombosis occurring mainly when antiplatelet therapy is discontinued in the follow-up. The most recent data show that, in comparison with BMS, there is a small excess of late (> 1 year) stent thrombosis but this is not associated with an increased risk of death or myocardial infarction or all cause mortality. These concerns do not outweigh the strong benefits of DES in preventing restenosis but require a number of measures concerning a longer dual antiplatelet treatment (than initially expected), to control patient treatment compliance and to provide a complete education of patients and physicians. Future devices dealing with the two issues (antiproliferative properties with rapid controlled endothelialization preventing thrombosis) would be the next major advance in this rapidly evolving field.
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Affiliation(s)
- E Van Belle
- Departments of Cardiology, and Haematology, Centre Hospitalier Universitaire, Lille, France.
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Agostoni P, Vermeersch P, Semeraro O, Verheye S, Van Langenhove G, Van den Heuvel P, Convens C, Van den Branden F, Bruining N. Intravascular ultrasound comparison of sirolimus-eluting stent versus bare metal stent implantation in diseased saphenous vein grafts (from the RRISC [Reduction of Restenosis In Saphenous Vein Grafts With Cypher Sirolimus-Eluting Stent] trial). Am J Cardiol 2007; 100:52-8. [PMID: 17599440 DOI: 10.1016/j.amjcard.2007.02.052] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2007] [Revised: 02/12/2007] [Accepted: 02/12/2007] [Indexed: 11/24/2022]
Abstract
The randomized Reduction of Restenosis In Saphenous Vein Grafts with Cypher Sirolimus-Eluting Stent trial compared angiographic outcomes of sirolimus-eluting stents (SESs) versus bare metal stents (BMSs) in saphenous vein grafts (SVG). Using intravascular ultrasound (IVUS) performed during 6-month follow-up angiography, we compared the vascular effects of the 2 types of stent on SVGs. Of 75 patients (96 lesions) included, 59 patients underwent IVUS in 61 SVGs; 29 patients received 40 SESs for 34 lesions, and 30 patients received 42 BMSs for 39 lesions. IVUS parameters (diameters, areas, and volumes) were compared in the 2 groups. A specific analysis was performed for overlapping SESs. Median neointimal volume was 1.3 mm(3) (interquartile range 0 to 13.1) in SESs versus 24.5 (7.8 to 39.5) in BMSs (p <0.001). Minimal incomplete stent apposition was detected at only 3 stent edges (2 BMSs, 1 SES) next to ectatic regions of the SVG. Compared with single SESs, overlapping SESs showed significant increases in neointimal reaction, with a neointimal volume of 0.6 mm(3)/mm of stent (0.1 to 1.8) versus 0 (0 to 0.4) in single SESs (p = 0.03), and this phenomenon was mainly localized in overlapping SES segments, where neointimal volume per millimeter of stent was 1.1 mm(3)/mm (0.6 to 4.4) versus 0 (0 to 1.3) in nonoverlapping segments (p = 0.05). In conclusion, SESs effectively inhibit neointimal hyperplasia volume compared with BMSs in diseased vein grafts, without evidence of increased incomplete apposition risk. The neointimal response to overlapping SES layers seems higher than to a single SES layer.
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Vermeersch P, Agostoni P, Verheye S, Van den Heuvel P, Convens C, Van den Branden F, Van Langenhove G. Increased Late Mortality After Sirolimus-Eluting Stents Versus Bare-Metal Stents in Diseased Saphenous Vein Grafts. J Am Coll Cardiol 2007; 50:261-7. [PMID: 17631219 DOI: 10.1016/j.jacc.2007.05.010] [Citation(s) in RCA: 228] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2007] [Revised: 05/18/2007] [Accepted: 05/21/2007] [Indexed: 11/20/2022]
Abstract
OBJECTIVES We sought to provide long-term follow-up data of sirolimus-eluting stents (SES) versus bare-metal stents (BMS) in saphenous vein grafts (SVG) from the RRISC (Reduction of Restenosis In Saphenous vein grafts with Cypher) trial. BACKGROUND We have previously shown that, in SVG, the use of SES reduces 6-month restenosis and repeated revascularization procedures versus the use of BMS. These data are consistent with trials in native coronary arteries. However, recently published long-term follow-up data of these trials have revealed an increased risk of adverse events (particularly very late stent thrombosis) after SES. METHODS A total of 75 patients with 96 SVG lesions were randomized to SES versus BMS. All patients underwent clinical follow-up up to 3 years. Specific outcomes assessed in this secondary post-hoc analysis were all-cause mortality, myocardial infarction, and target vessel revascularization. RESULTS Thirty-eight patients received 60 SES for 47 lesions, whereas 37 patients received 54 BMS for 49 lesions. At a median follow-up time of 32 months (interquartile range 26.5 to 36 months), 11 deaths (7 cardiac, of which 1 was caused by very late stent thrombosis and, 3 were sudden) occurred after SES (29% [95% confidence interval (CI) 17% to 45%]) versus 0 after BMS (0% [95% CI 0% to 9%]) with an absolute difference of 29% ([95% CI 14% to 45%], p < 0.001). The rates of myocardial infarction and target vessel revascularization were not different: 18% and 34% after SES, respectively, versus 5% and 38% after BMS, respectively (p = 0.15 and p = 0.74, respectively). CONCLUSIONS In this secondary post-hoc analysis, BMS were associated with lower long-term mortality than SES for SVG disease. Also, the 6-month reduction in repeated revascularization procedures with SES was lost at longer-term follow-up. (RRISC Study: Reduction of Restenosis In Saphenous Vein Grafts With Cypher Sirolimus-Eluting Stent; http://clinicaltrials.gov/ct/show/NCT00263263?order=1; NCT00263263).
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Affiliation(s)
- Paul Vermeersch
- Antwerp Cardiovascular Institute Middelheim, AZ Middelheim, Antwerp, Belgium
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Vermeersch P, Agostoni P, Verheye S, Van den Heuvel P, Convens C, Bruining N, Van den Branden F, Van Langenhove G. Randomized Double-Blind Comparison of Sirolimus-Eluting Stent Versus Bare-Metal Stent Implantation in Diseased Saphenous Vein Grafts. J Am Coll Cardiol 2006; 48:2423-31. [PMID: 17174178 DOI: 10.1016/j.jacc.2006.09.021] [Citation(s) in RCA: 207] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2006] [Revised: 07/17/2006] [Accepted: 07/18/2006] [Indexed: 11/26/2022]
Abstract
OBJECTIVES We sought to compare, in a randomized fashion, sirolimus-eluting stents (SES) versus bare-metal stents (BMS) in saphenous vein grafts (SVGs). BACKGROUND Sirolimus-eluting stents reduce restenosis and repeated revascularization in native coronary arteries compared with BMS. However, randomized data in SVG are absent. METHODS Patients with SVG lesions were randomized to SES or BMS. All were scheduled to undergo 6-month coronary angiography. The primary end point was 6-month angiographic in-stent late lumen loss. Secondary end points included binary angiographic restenosis, neointimal volume by intravascular ultrasound and major adverse clinical events (death, myocardial infarction, target lesion, and vessel revascularization). RESULTS A total of 75 patients with 96 lesions localized in 80 diseased SVGs were included: 38 patients received 60 SES for 47 lesions, whereas 37 patients received 54 BMS for 49 lesions. In-stent late loss was significantly reduced in SES (0.38 +/- 0.51 mm vs. 0.79 +/- 0.66 mm in BMS, p = 0.001). Binary in-stent and in-segment restenosis were reduced, 11.3% versus 30.6% (relative risk [RR] 0.37; 95% confidence interval [CI] 0.15 to 0.97, p = 0.024) and 13.6% versus 32.6% (RR 0.42; 95% CI 0.18 to 0.97, p = 0.031), respectively. Median neointimal volume was 1 mm(3) (interquartile range 0 to 13) in SES versus 24 (interquartile range 8 to 34) in BMS (p < 0.001). Target lesion and vessel revascularization rates were significantly reduced, 5.3% versus 21.6% (RR 0.24; 95% CI 0.05 to 1.0, p = 0.047) and 5.3% versus 27% (RR 0.19; 95% CI 0.05 to 0.83, p = 0.012), respectively. Death and myocardial infarction rates were not different. CONCLUSIONS Sirolimus-eluting stents significantly reduce late loss in SVG as opposed to BMS. This is associated with a reduction in restenosis rate and repeated target lesion and vessel revascularization procedures. (The RRISC Study; http://clinicaltrials.gov/ct/show; NCT00263263).
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Affiliation(s)
- Paul Vermeersch
- Antwerp Cardiovascular Institute Middelheim, AZ Middelheim, Antwerp, Belgium.
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Scott NA. Restenosis following implantation of bare metal coronary stents: pathophysiology and pathways involved in the vascular response to injury. Adv Drug Deliv Rev 2006; 58:358-76. [PMID: 16733073 DOI: 10.1016/j.addr.2006.01.015] [Citation(s) in RCA: 104] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2005] [Accepted: 01/31/2006] [Indexed: 02/06/2023]
Abstract
This review summarizes the restenotic process that occurs after the implantation of bare metal coronary stents. The pathology of in-stent restenosis is distinct from that seen after balloon angioplasty and is characterized by neointimal proliferation and extracellular matrix deposition. The degree of neointimal proliferation is proportional to the amount of injury, the intensity of the inflammatory infiltrate and the association of stent struts with lipid-filled plaque. In-stent restenosis also appears to be associated with systemic markers of inflammation. Shear stress has an important influence on restenosis as does the presence and adhesiveness of vascular progenitor cells. Clinical predictors (e.g., artery size, stent length, diabetes, and gender) may affect the incidence of restenosis seen after stent placement. A number of catheter-based interventions have been used to treat in-stent restenosis. Although preliminary data suggest that the use of drug-eluting stents may be effective, only intracoronary radiation has shown consistent efficacy in randomized trials.
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Affiliation(s)
- Neal A Scott
- Camino Cardiovascular Associates, 525 South Drive, Suite 107, Mountain View, CA 94040, USA.
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Vermeersch P, Agostoni P. Should Degenerated Saphenous Vein Grafts Routinely Be Sealed with Drug-Eluting Stents? J Interv Cardiol 2005; 18:467-73. [PMID: 16336427 DOI: 10.1111/j.1540-8183.2005.00087.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
The percutaneous treatment of patients with obstructive atherosclerotic disease in degenerated coronary saphenous vein bypass grafts still remains one of the great challenges in interventional cardiology. In this review, we discuss the actual evidence-based knowledge for the percutaneous management of this lesion subset, focusing in particular on the devices that are actually considered the "gold standard" for this treatment: bare metal stents and distal protection devices. We also comment on the negative results of the randomized trials regarding the promising polytetrafluoroethylene-covered stent-grafts. We finally offer insights into the currently available evidence for the use of drug-eluting stents in saphenous vein grafts. These devices are potentially the principal promise for the long-term successful sealing of vein graft disease; however, clear and definitive data coming from controlled trials are requested.
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Affiliation(s)
- Paul Vermeersch
- The Department of Cardiology, AZ Middelheim, Antwerp, Belgium.
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Kim JY, Ko YG, Shim CY, Park S, Hwang KC, Choi D, Jang Y, Chung N, Shim WH, Cho SY. Comparison of effects of drug-eluting stents versus bare metal stents on plasma C-reactive protein levels. Am J Cardiol 2005; 96:1384-8. [PMID: 16275183 DOI: 10.1016/j.amjcard.2005.07.042] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2005] [Revised: 06/30/2005] [Accepted: 06/30/2005] [Indexed: 11/24/2022]
Abstract
After coronary stenting, inflammatory mechanisms play a crucial role in the pathogenesis of neointimal proliferation and in-stent restenosis. Drug-eluting stents (DESs) have been shown to decrease in-stent restenosis in different studies. We compared plasma C-reactive protein (CRP) levels after DES implantation with levels after bare metal stent (BMS) implantation. We performed percutaneous coronary intervention with a single stent in 67 patients (54 men; 59 +/- 9 years of age; n = 21 in the BMS group, n = 46 in the DES group) who had stable angina. Plasma CRP levels were determined before intervention and at 48 hours, 72 hours, and 2 weeks after coronary stenting. There was no difference in clinical and angiographic baseline characteristics except that the DES group had more patients with diabetes (34.8% vs 9.5%, p = 0.04), smaller reference vessels (2.95 +/- 0.53 vs 3.29 +/- 0.53 mm, p = 0.02), and smaller stent diameters (3.0 +/- 0.4 mm vs 3.4 +/- 0.5 mm, p <0.01). Plasma CRP levels at 48 hours (13.4 +/- 14.7 vs 5.9 +/- 4.9 mg/L, p <0.01) and 72 hours (16.7 +/- 19.8 vs 5.4 +/- 3.9 mg/L, p <0.01) after stent implantation were significantly higher in the BMS than in the DES group. In conclusion, DESs showed significantly lower plasma CRP levels after coronary stenting compared with BMSs. This may reflect the potent effects of DESs on acute inflammatory reactions induced by coronary intervention.
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Affiliation(s)
- Jong-Youn Kim
- The Cardiology Division, Yonsei Cardiovascular Center and Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
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Tsuchida K, Ong ATL, Aoki J, van Mieghem CAG, Rodriguez-Granillo GA, Valgimigli M, Sianos G, Regar E, McFadden EP, van der Giessen WJ, de Feyter PJ, de Jaegere PPT, van Domburg RT, Serruys PW. Immediate and one-year outcome of percutaneous intervention of saphenous vein graft disease with paclitaxel-eluting stents. Am J Cardiol 2005; 96:395-8. [PMID: 16054466 DOI: 10.1016/j.amjcard.2005.03.084] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2005] [Revised: 03/21/2005] [Accepted: 03/21/2005] [Indexed: 11/28/2022]
Abstract
The aim of this study was to evaluate the outcome after paclitaxel-eluting stent implantation in 40 patients with 52 saphenous vein graft lesions. By Kaplan-Meier estimates, the probability of major adverse cardiac event-free survival for 1 year was 92.5%. A paclitaxel-eluting stent for saphenous vein graft disease appears to be feasible and safe, with a low rate of reintervention at 1 year, but late follow-up is needed to confirm these observations.
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Affiliation(s)
- Keiichi Tsuchida
- Department of Interventional Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands
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Beadsworth M, Waitt C, Jenkins N, Amadi A, Nye F, Beeching N. A retained intravascular medical device and Streptococcus bovis infection, providing early diagnosis of an occult malignancy. J Infect 2005; 50:165-7. [PMID: 15667921 DOI: 10.1016/j.jinf.2004.08.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Gorbet MB, Sefton MV. Biomaterial-associated thrombosis: roles of coagulation factors, complement, platelets and leukocytes. Biomaterials 2005; 25:5681-703. [PMID: 15147815 DOI: 10.1016/j.biomaterials.2004.01.023] [Citation(s) in RCA: 857] [Impact Index Per Article: 45.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2003] [Accepted: 01/19/2004] [Indexed: 01/18/2023]
Abstract
Our failure to produce truly non-thrombogenic materials may reflect a failure to fully understand the mechanisms of biomaterial-associated thrombosis. The community has focused on minimizing coagulation or minimizing platelet adhesion and activation. We have infrequently considered the interactions between the two although we are generally familiar with these interactions. However, we have rarely considered in the context of biomaterial-associated thrombosis the other major players in blood: complement and leukocytes. Biomaterials are known agonists of complement and leukocyte activation, but this is frequently studied only in the context of inflammation. For us, thrombosis is a special case of inflammation. Here we summarize current perspectives on all four of these components in thrombosis and with biomaterials and cardiovascular devices. We also briefly highlight a few features of biomaterial-associated thrombosis that are not often considered in the biomaterials literature: The importance of tissue factor and the extrinsic coagulation system. Complement activation as a prelude to platelet activation and its role in thrombosis. The role of leukocytes in thrombin formation. The differing time scales of these contributions.
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Affiliation(s)
- Maud B Gorbet
- Department of Chemical Engineering and Applied Chemistry, Institute of Biomaterials and Biomedical Engineering, University of Toronto, 4 Taddle Creek Road, Room 407D, Toronto, Ont., Canada M5S 3G9
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van Beusekom HMM, Post MJ, Whelan DM, de Smet BJGL, Duncker DJ, van der Giessen WJ. Metalloproteinase inhibition by batimastat does not reduce neointimal thickening in stented atherosclerotic porcine femoral arteries. ACTA ACUST UNITED AC 2004; 4:186-91. [PMID: 15321056 DOI: 10.1016/j.carrad.2004.02.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2004] [Revised: 02/24/2004] [Accepted: 02/24/2004] [Indexed: 11/25/2022]
Abstract
BACKGROUND Vascular injury results in specific temporal patterns of increased matrix metalloproteinase (MMP) activity. MMPs are known to play a role in remodeling and neointimal (NI) thickening. Although in vitro data on the role of metalloproteinases and their inhibitors on smooth muscle cell migration and proliferation are compelling, evidence for inhibition of NI thickening in vivo is inconsistent and is mostly generated in models of balloon angioplasty instead of the more prevalent stent placement. Data from atherosclerotic models are scarce. The objective of the study was to investigate whether the nonspecific MMP inhibitor batimastat, in concentrations known to influence remodeling, could also inhibit NI thickening following stent placement in an atherosclerotic model. METHODS Stents were placed in atherosclerotic femoral arteries in Yucatan micropigs on a high cholesterol diet and followed for 6 weeks. Batimastat or vehicle was administered intraperitoneally. NI thickening was assessed by morphometry. RESULTS The main finding was that batimastat did not result in a significant decrease in NI thickness. Only following correlation to the amount of preexisting plaque was the difference of 146 microm (19%) statistically significant. Batimastat did not impair wound healing following stenting. CONCLUSION Batimastat does not significantly influence the degree of NI thickening at 6 weeks following stenting of atherosclerotic porcine femoral arteries, except when correlated to plaque thickness. Batimastat does not affect vascular wound healing.
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Affiliation(s)
- Heleen M M van Beusekom
- Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, P.O. Box 1738, 3000 DR Rotterdam, The Netherlands.
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Elsayed E, Becker RC. The impact of heparin compounds on cellular inflammatory responses: a construct for future investigation and pharmaceutical development. J Thromb Thrombolysis 2004; 15:11-8. [PMID: 14574071 DOI: 10.1023/a:1026184100030] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Atherosclerotic disease is recognized as a chronic inflammatory disorder with intermittent and widely variable phases of cellular proliferation and heightened thrombotic activity. The multi-tiered links between inflammation, atherogenesis and thrombogenesis provide a unique opportunity for research and development of pharmaceuticals which target one or more critical pathobiologic steps (Fig. 1). The purpose of the following review on heparin compounds is to comprehensively examine the multi-cellular, pleuripotential effects of a commonly used anticoagulant drug in the context of normal and disease-altered vascular responses and illustrate possible constructs for avenues of subsequent investigation in the field of atherothrombosis. The overview is divided into five integrated parts; antiinflammatory properties of the normal vessel wall, the relationship between glycosaminoglycans and inflammation, heparin-mediated effects on cellular inflammatory responses, association between molecular weight and antiinflammatory capabilities, and oral heparin compounds for achieving prolonged cell-based inhibition.
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Affiliation(s)
- Essam Elsayed
- Department of Medicine, UMass-Memorial Medical Center, Cardiovascular Thrombosis Research Center, University of Massachusetts Medical School, Worcester, MA, USA
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Herdeg C, Fitzke M, Oberhoff M, Baumbach A, Schroeder S, Karsch KR. Effects of atorvastatin on in-stent stenosis in normo- and hypercholesterolemic rabbits. Int J Cardiol 2003; 91:59-69. [PMID: 12957730 DOI: 10.1016/s0167-5273(02)00588-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND In-stent stenosis is characterized by a prolonged proliferation and inflammatory reactions around the stent struts. Potentially the antiproliferative and lipid-lowering effects of atorvastatin can synergistically limit neointima formation after stenting. METHODS Palmaz-Schatz stents were placed in the iliac arteries of white New Zealand rabbits. One half of the animals was fed an 0.5% hypercholesterolemic diet, the other half was normocholesterolemic. Both groups received either atorvastatin (3 mg/kg bodyweight) daily or placebo (n=10 each in the four groups). After 28 days the segments were excised. RESULTS Injury scores as a result of vessel trauma induced by stent-overstretch injury differed significantly between the four groups (median 1.0-1.9) and the stent-induced injury outweighed the beneficial effects of statin therapy on neointima formation by far. Smooth-muscle-cell proliferation was significantly increased in both hypercholesterolemic groups. Intimal and medial proliferation as well as inflammatory infiltrates around the stent strut were reduced by 20-40% in animals that received statin therapy although the injury score in both statin groups was 19 and 60% higher than in control animals. CONCLUSION Thus, the data of this study indicate that smooth muscle cell proliferation and inflammation in stented vessels can be reduced by atorvastatin both in hypercholesterolemic rabbits and in animals with normal lipid levels.
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Affiliation(s)
- Christian Herdeg
- Department of Medicine, University of Tuebingen, Otfried-Mueller-Strasse 10, D-72076 Tuebingen, Germany.
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Baker DM, Osborn LA. Acute coronary syndrome secondary to a complex lesion within a stent implanted over 6 years previously. Catheter Cardiovasc Interv 2003; 59:366-8. [PMID: 12822161 DOI: 10.1002/ccd.10541] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
We report on an acute coronary syndrome resulting from a complex severe lesion within a stent over 6 years after implantation. This may represent an uncommon long-term limitation of coronary artery stenting.
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Affiliation(s)
- David M Baker
- Department of Internal Medicine, Division of Cardiology, University of New Mexico School of Medicine, Albuquerque Veterans Affairs Hospital, Albuquerque, New Mexico, USA
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Moustapha A, Salloum J, Saikia S, Awadallah H, Ghani M, Sdringola S, Schroth G, Assali A, Smalling RW, Anderson HV, Rosales O. Combined cutting balloon angioplasty and intracoronary beta radiation for treatment of in-stent restenosis: clinical outcomes and effect of pullback radiation for long lesions. Catheter Cardiovasc Interv 2002; 57:325-9. [PMID: 12410508 DOI: 10.1002/ccd.10328] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Intracoronary beta (beta) radiation decreases the incidence of target lesion revascularization after percutaneous intervention (PCI) for in-stent restenosis (ISR). Cutting balloon (CB) angioplasty may also be superior to other percutaneous techniques for the treatment of ISR. We sought to study the outcomes of patients with ISR who underwent both CB angioplasty and intracoronay beta radiation and compare them to patients with ISR who underwent other PCI techniques without concomitant radiation. We also sought to evaluate the safety and efficacy of pullback intracoronary beta radiation for the treatment of long ISR lesions. Between January 2001 and November 2001, 102 patients (mean age = 55 +/- 13 years) with ISR underwent both CB angioplasty and intracoronay beta radiation. beta radiation was delivered using the Beta Cath (Novoste) 30 mm system, and pullback radiation was performed in 41 patients. A comparison group included a total of 393 patients with ISR who underwent other PCI techniques without concomitant intracoronary radiation therapy. Follow-up was obtained in 99 patients (97%) in the CB angioplasty with intracoronary radiation group and 377 patients (96%) in the comparison group. At follow-up, both target vessel revascularization (TVR) and major adverse cardiovascular events (MACE) occurred significantly less in the CB angioplasty with intracoronary radiation group than in the comparison group (7% vs. 18% for TVR, and 14% vs. 24% for MACE; P < 0.05 for both). In the pullback radiation group, TVR was performed in five patients (12%), and MACE occurred in eight patients (20%). A combination of CB angioplasty and intracoronay beta radiation for ISR seems to yield low rates of subsequent target vessel revascularization and adverse cardiac events. In addition, pullback beta radiation using the Beta Cath (Novoste) 30 mm system is safe and can be used to treat long ISR lesions effectively. Further randomized trials are needed to confirm these findings.
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Affiliation(s)
- Ali Moustapha
- Division of Cardiology, University of Texas Houston Medical School and Memorial Hermann Hospital, Houston, Texas, USA
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Glover C, Ma X, Chen YX, Miller H, Veinot J, Labinaz M, O'Brien E. Human in-stent restenosis tissue obtained by means of coronary atherectomy consists of an abundant proteoglycan matrix with a paucity of cell proliferation. Am Heart J 2002; 144:702-9. [PMID: 12360168 DOI: 10.1067/mhj.2002.123577] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND In-stent restenosis (ISR) is a shortcoming of percutaneous coronary revascularization. Although neointimal cell proliferation is suspected to be the cause of this problem, little histological characterization of this tissue or data on cell replication exist. The purpose of this study was to examine the histologic features and proliferation profile of coronary ISR tissue derived from atherectomy procedures performed on patients with clinical evidence of ISR. METHODS ISR tissue retrieved by means of atherectomy from 20 coronary lesions was subjected to histomorphological analyses and immunocytochemistry as a means of examining proteoglycan expression. Cell proliferation was assessed with 2 sensitive markers of replication, in situ hybridization for histone 3 messenger RNA expression and immunocytochemistry for Ki-67 expression. RESULTS The ISR atherectomy specimens consisted primarily of smooth muscle cells, with occasional focal collections of inflammatory cells and organizing thrombus. All specimens had low levels of interstitial collagen and an abundant proteoglycan matrix, with biglycan being overexpressed more commonly than decorin. Cell proliferation was found in only 1 of 20 specimens (2 cells). CONCLUSION Established ISR lesions contained an abundant proteoglycan matrix and a paucity of proliferating cells. Future therapeutic strategies for ISR should include targeting extracellular matrix production.
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Affiliation(s)
- Chris Glover
- Vascular Biology Laboratory, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
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Moustapha A, Assali AR, Sdringola S, Yusuf SW, Vaughn WK, Fish RD, Schroth GW, Krajcer Z, Rosales OR, Smalling RW, Anderson HV. Abciximab administration and clinical outcomes after percutaneous intervention for in-stent restenosis. Catheter Cardiovasc Interv 2002; 56:184-7. [PMID: 12112910 DOI: 10.1002/ccd.10166] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Abciximab therapy improves clinical outcomes after percutaneous interventions for de novo coronary artery disease. We sought to determine whether clinical outcomes after percutaneous intervention for in-stent restenosis are affected by abciximab administration. Between January 1996 and July 1999, 322 consecutive patients underwent percutaneous intervention for in-stent restenosis; 157 patients received abciximab and 165 patients were treated without abciximab based on operator discretion. Baseline clinical and angiographic variables and type of percutaneous intervention were recorded. Follow-up information was obtained and clinical endpoints were recorded. A multivariate analysis was performed to determine the independent variables associated with adverse clinical outcomes. Baseline clinical and angiographic variables were similar in both groups. Patients who received abciximab were more likely to be treated with rotational atherectomy and less likely to have only balloon angioplasty or repeat stenting. Mean follow-up duration was 19 +/- 12 months. There were no significant differences in the incidence of angina/myocardial infarction (29% vs. 30%; P = 0.9), target vessel revascularization (18% vs. 21%; P = 0.5), death (8% vs. 7%; P = 0.4), or major adverse cardiovascular events (38% vs. 39%; P = 0.9) in both groups. Abciximab administration was not an independent variable associated with adverse outcomes. In this observational study, clinical outcomes after percutaneous intervention for in-stent restenosis did not seem to be affected by abciximab administration. Randomized trials are needed to identify the role of platelet glycoprotein IIb/IIIa inhibitors in the management of in-stent restenosis.
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Affiliation(s)
- Ali Moustapha
- University of Texas Medical School at Houston and Memorial Hermann Hospital, Houston, Texas, USA
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Iijima K, Yoshizumi M, Hashimoto M, Akishita M, Kozaki K, Ako J, Watanabe T, Ohike Y, Son B, Yu J, Nakahara K, Ouchi Y. Red wine polyphenols inhibit vascular smooth muscle cell migration through two distinct signaling pathways. Circulation 2002; 105:2404-10. [PMID: 12021228 DOI: 10.1161/01.cir.0000016349.36385.fb] [Citation(s) in RCA: 75] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Red wine polyphenols (RWPs) have been shown to have an antiatherogenic activity mainly through antioxidative effects on LDL oxidation. Although vascular smooth muscle cell (SMC) migration is critical to atherosclerosis formation, the effect of RWPs on SMC migration has not been elucidated. In this study, we investigated whether RWPs could affect the migration of cultured SMCs stimulated by growth factors. METHODS AND RESULTS RWP concentration dependently inhibited platelet-derived growth factor (PDGF)-BB-induced and serum-induced SMC migration in wounding assay and Boyden chamber assay. However, these inhibitory effects of RWPs were not seen in serum-stimulated vascular endothelial cell migration in either assay. Moreover, specific inhibitors of phosphatidylinositol-3' kinase (PI3K) and p38 mitogen-activated protein kinase (p38(MAPK)), but not of extracellular signal-regulated protein kinases 1 and 2 (ERK1/2), reduced PDGF-BB-induced SMC migration. To elucidate the signaling mechanism underlying the RWP effects, we investigated the effects of RWPs on the activity of PI3K and the phosphorylation of MAPK pathways in PDGF-BB-stimulated SMCs. RWPs inhibited the PI3K activity and p38(MAPK) phosphorylation, but not ERK1/2 phosphorylation, in a concentration-dependent manner. Moreover, the phosphorylation of MKK3/6, an upstream kinase of p38(MAPK), was also inhibited by RWP treatment in a concentration-dependent manner, suggesting that the inhibitory effect of RWPs on the p38(MAPK) pathway works upstream of MKK3/6. The concentration-effect relationship of RWPs necessary for the inhibition of PI3K and p38(MAPK) pathways was similar to that of cell migration assays. CONCLUSIONS RWPs inhibit the SMC migration through the inhibition of 2 distinct signaling pathways and thus exert antiatherogenic actions.
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MESH Headings
- Animals
- Becaplermin
- Blood Proteins/pharmacology
- Cattle
- Cell Division/drug effects
- Cell Movement/drug effects
- Cells, Cultured
- Chemotaxis/drug effects
- Diffusion Chambers, Culture
- Dose-Response Relationship, Drug
- Endothelium, Vascular/cytology
- Endothelium, Vascular/drug effects
- Enzyme Inhibitors/pharmacology
- Flavonoids
- Humans
- Mitogen-Activated Protein Kinase 1/antagonists & inhibitors
- Mitogen-Activated Protein Kinase 3
- Mitogen-Activated Protein Kinases/antagonists & inhibitors
- Muscle, Smooth, Vascular/cytology
- Muscle, Smooth, Vascular/drug effects
- Phenols/chemistry
- Phenols/pharmacology
- Phosphoinositide-3 Kinase Inhibitors
- Phosphorylation/drug effects
- Platelet-Derived Growth Factor/pharmacology
- Polymers/chemistry
- Polymers/pharmacology
- Polyphenols
- Proto-Oncogene Proteins c-sis
- Rats
- Rats, Sprague-Dawley
- Recombinant Proteins/pharmacology
- Signal Transduction/drug effects
- Wine
- p38 Mitogen-Activated Protein Kinases
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Affiliation(s)
- Katsuya Iijima
- Department of Geriatric Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
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Lewis AL, Tolhurst LA, Stratford PW. Analysis of a phosphorylcholine-based polymer coating on a coronary stent pre- and post-implantation. Biomaterials 2002; 23:1697-706. [PMID: 11922473 DOI: 10.1016/s0142-9612(01)00297-6] [Citation(s) in RCA: 186] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
There has been a move towards surface treatments for metallic coronary stents in an effort to improve their compatibility within the body and to provide a vehicle for the delivery of therapeutics. The Biodiv Ysio range of stents is characterised by a biocompatible coating comprised of a crosslinked phosphorylcholine (PC)-based polymer. In addition to a review of some of the data collected to support safety and efficacy of this device, this paper also describes a number of techniques that have been employed to both visualise and quantify the coating on the stent. Explantation of both coated and uncoated stents from porcine coronary arteries revealed that both coated and uncoated stents were >90% endothelialised after 5 days. Typical histological analysis of stented vessel sections after 4 and 12 weeks implantation showed the presence of cell types characteristic of the inflammatory response associated with the trauma caused by stent placement, with no evidence for any additional coating-related adverse inflammatory sequelae. Finally, it was demonstrated by AFM and SEM that both the thickness and force required to remove the coating were essentially unchanged after 6 months implantation. Thus, both the long-term stability and relative biological inertness of the coating has been confirmed in vivo, supporting its use as a vehicle for local drug delivery.
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Affiliation(s)
- A L Lewis
- Drug Delivery Division, Biocompatibles Ltd, Farnham, Surrey, UK.
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50
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Inoue S, Koyama H, Miyata T, Shigematsu H. Pathogenetic heterogeneity of in-stent lesion formation in human peripheral arterial disease. J Vasc Surg 2002; 35:672-8. [PMID: 11932661 DOI: 10.1067/mva.2002.122021] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
PURPOSE Intimal hyperplasia is known to promote in-stent restenosis after vascular stent implantation. Although previous studies have presented a variety of evidence that suggests the mechanisms of intimal lesion formation, it is still controversial which factor(s) predominantly contribute to the development of in-stent restenosis. In this study, we hypothesized that heterogeneous mechanisms coexist in the same lesion and then assessed the validity with resected whole arteries with in-stent lesions. METHODS Whole arterial specimens with in-stent lesions were surgically resected from five patients who had undergone implantation of a Palmaz-Schatz stent 7 to 19 months previously and were histologically analyzed. For assessment of the pathogenetic heterogeneity of in-stent lesions, we divided each cross section into three parts: the inner intima within 250 microm from the luminal surface (zone A), the area surrounding the stent struts within 250 microm from the strut hole (zone B), and the remaining part of the intimal layer (zone C). We then evaluated cell density, cell replication, and cellular composition in each zone. Cell replication and cellular composition were analyzed with immunohistologic staining with antibodies against proliferating cell nuclear antigen and cell-specific antibodies. Each section was also stained with Alcian blue or Elastica van Gieson method for detection of matrix components. RESULTS In all samples, the cell density of zone A was significantly higher than that of zone B (P <.05). Proliferating cell nuclear antigen staining results showed significantly higher cell replication in zone A as compared with that in other zones (P <.05). To the contrary, cell-specific immunostaining results revealed marked accumulation of leukocytes, macrophages, and T lymphocytes in zone B (P <.05). Regarding matrix components, proteoglycan was predominantly stained around stent struts and in the inner intima. CONCLUSION The data of this study showed that two different pathogenetic processes in different zones possibly contributed to in-stent lesion formation at the same time. One process was an increase of cell number in the inner intima, which was the result of a prolonged increase of cell replication. The other process was accumulation of matrix around stent struts, which was suggested to be linked to infiltration of inflammatory cells in the same zone.
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Affiliation(s)
- Shinya Inoue
- Division of Vascular Surgery, Department of Surgery, Graduate School of Medicine, The University of Tokyo, Japan
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