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Kawai K, Virmani R, Finn AV. In-Stent Restenosis. Interv Cardiol Clin 2022; 11:429-443. [PMID: 36243488 DOI: 10.1016/j.iccl.2022.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
In-stent restenosis (ISR) remains a potential complication after percutaneous coronary intervention, even in the era of drug-eluting stents, and its treatment remains suboptimal. Neoatherosclerosis is an important component of the pathology of ISR and is accelerated in drug-eluting stents compared with bare-metal stents. Coronary angiography is the gold standard for evaluating the morphology of ISR, although computed tomography angiography is emerging as an alternative noninvasive modality to evaluate the presence of ISR. Drug-coated balloons and stent reimplantation are the current mainstays of treatment for ISR, and the choice of treatment should be based on clinical background and lesion morphology.
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Affiliation(s)
- Kenji Kawai
- CVPath Institute, 19 Firstfield Road, Gaithersburg, MD 20878, USA
| | - Renu Virmani
- CVPath Institute, 19 Firstfield Road, Gaithersburg, MD 20878, USA
| | - Aloke V Finn
- CVPath Institute, 19 Firstfield Road, Gaithersburg, MD 20878, USA; University of Maryland, School of Medicine, 22 South Greene Street, Baltimore, MD 21201, USA.
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2
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Wang L, Zhao LP, Chen YQ, Chang XS, Xiong H, Zhang DM, Xu WT, Chen JC. Adropin inhibits the phenotypic modulation and proliferation of vascular smooth muscle cells during neointimal hyperplasia by activating the AMPK/ACC signaling pathway. Exp Ther Med 2021; 21:560. [PMID: 33850532 PMCID: PMC8027754 DOI: 10.3892/etm.2021.9992] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Accepted: 08/26/2020] [Indexed: 12/12/2022] Open
Abstract
In-stent restenosis (ISR) remains an inevitable problem for some patients receiving drug-eluting stent (DES) implantation. Intimal hyperplasia is an important biological cause of ISR. It has been previously reported that adropin is a potentially protective factor in cardiovascular disease. Therefore, the present study investigated the function of adropin in inhibiting smooth muscle cell (SMC) phenotype modulation and proliferation, causing intimal hyperplasia. A total of 56 patients who visited the hospital consecutively (25 with ISR and 31 without ISR), who were followed up between April 2016 and March 2019, 1 year following DES, were analyzed to evaluate the association between in-stent neointimal volume and adropin serum levels. Rat aorta smooth muscle cells (RASMCs) were used to determine the effects of adropin on their phenotypic modulation and proliferation using western blot, MTT, PCR and immunofluorescence analyses. Adropin serum levels in the ISR group were significantly lower than those in the non-ISR group. Furthermore, linear regression analysis revealed that only adropin levels were negatively associated with neointimal volume in both groups. The overall adropin levels of the 56 patients and the percentages of neointimal volume revealed a strong negative association. In vitro, adropin suppressed angiotensin II (Ang II)-induced phenotypic modulation in RASMCs by restoring variations of osteopontin and α-smooth muscle actin. Furthermore, compared with the Ang II group, adropin markedly decreased the percentage of G2/M-phase cells. Finally, adropin negatively regulated the phenotypic modulation and proliferation of RASMCs via the AMP-activated protein kinase/acetyl-CoA carboxylase (AMPK/ACC) signaling pathway. In conclusion, an independent, negative association was revealed between adropin and intimal hyperplasia; specifically, adropin inhibited the phenotypic modulation and proliferation of RASMCs by activating the AMPK/ACC signaling pathway. Therefore, adropin may be used as a potential predictor and therapeutic target for intimal hyperplasia and ISR.
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Affiliation(s)
- Li Wang
- Department of Cardiology, The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215151, P.R. China.,Emergency Department, The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215151, P.R. China
| | - Liang-Ping Zhao
- Department of Cardiology, The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215151, P.R. China
| | - Yu-Qi Chen
- Department of Cardiology, The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215151, P.R. China
| | - Xian-Song Chang
- Department of Cardiology, The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215151, P.R. China
| | - Hui Xiong
- Department of Cardiology, The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215151, P.R. China
| | - Dai-Min Zhang
- Department of Cardiology, Nanjing First Hospital, Nanjing, Jiangsu 210006, P.R. China
| | - Wei-Ting Xu
- Department of Cardiology, The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215151, P.R. China
| | - Jian-Chang Chen
- Department of Cardiology, The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215151, P.R. China
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3
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Correa-Sadouet C, Rodríguez-Granillo AM, Gallardo C, Mieres J, Fontana L, Curotto MV, Wainer P, Allende NG, Fernández-Pereira C, M Vetulli H, la Hoz RPD, Kastrati A, Rodríguez AE. Randomized comparison between bare-metal stent plus colchicine versus drug-eluting stent alone in prevention of clinical adverse events after percutaneous coronary intervention. Future Cardiol 2020; 17:539-547. [PMID: 33174761 DOI: 10.2217/fca-2020-0161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
The use of colchicine is associated with a significant reduction of cardiac adverse events in patients with coronary artery disease. Past small randomized trials with oral immunosuppressive or anti-inflammatory therapies have demonstrated a reduction of adverse clinical events after bare metal stent implantation. The potential role of adjunctive colchicine after bare-metal stent implantation, compared with drug-eluting stent alone, is unknown. The primary end point of the study will be to compare cost-effectiveness at 1 year of follow-up of coronary intervention with bare-metal stent implantation plus 1 mg of colchicine during 3 months versus percutaneous coronary intervention with drug-eluting stent implantation alone. ClinicalTrials.gov identifier: NCT04382443.
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Affiliation(s)
| | - A Matías Rodríguez-Granillo
- Cardiology Department, Sanatorio Otamendi, Ciudad de Buenos Aires, Argentina.,Interventional Cardiology Department, Sanatorio Otamendi, Ciudad de Buenos Aires, Argentina.,Centro de Estudios en Cardiología Intervencionista, Ciudad de Buenos Aires, Argentina
| | - Camila Gallardo
- Cardiology Department, Sanatorio Otamendi, Ciudad de Buenos Aires, Argentina
| | - Juan Mieres
- Interventional Cardiology Department, Sanatorio Otamendi, Ciudad de Buenos Aires, Argentina.,Centro de Estudios en Cardiología Intervencionista, Ciudad de Buenos Aires, Argentina
| | - Lucía Fontana
- Cardiology Department, Sanatorio Otamendi, Ciudad de Buenos Aires, Argentina
| | | | - Pedro Wainer
- Internal Medicine Department, Sanatorio Otamendi, Ciudad de Buenos Aires, Argentina
| | - N Gustavo Allende
- Cardiology Department, Clínica IMA, Adrogué, Provincia de Buenos Aires, Argentina
| | - Carlos Fernández-Pereira
- Interventional Cardiology Department, Sanatorio Otamendi, Ciudad de Buenos Aires, Argentina.,Centro de Estudios en Cardiología Intervencionista, Ciudad de Buenos Aires, Argentina
| | - Héctor M Vetulli
- Cardiology Department, Sanatorio Otamendi, Ciudad de Buenos Aires, Argentina
| | - R Pérez de la Hoz
- Cardiology Department, Hospital de Clínicas José de San Martín, Ciudad de Buenos Aires, Argentina
| | | | - Alfredo E Rodríguez
- Interventional Cardiology Department, Sanatorio Otamendi, Ciudad de Buenos Aires, Argentina.,Centro de Estudios en Cardiología Intervencionista, Ciudad de Buenos Aires, Argentina
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4
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Mieres J, Alfredo E Rodríguez, Fernández-Pereira C, Ascarrunz-Cattoretti D. Increased incidence of serious late adverse events with drug-eluting stents when compared with coronary artery bypass surgery: a cause of concern. Future Cardiol 2020; 16:711-723. [PMID: 32643395 DOI: 10.2217/fca-2020-0033] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Percutaneous coronary intervention (PCI) and coronary artery bypass graft (CABG) in pre-drug-eluting stents (DESs) era, randomized trials and meta-analysis showed that the extension of coronary artery disease was not associated with a better survival with CABG, and only diabetic patients had an inferior survival with PCI. After the introduction of DES, we would expect a substantial improvement in PCI results compared with CABG, narrowing the gap between both revascularization strategies, However, on the contrary, most randomized studies between DES and CABG showed that rate of recurrences remained and there is an unexpected increased of late serious adverse events including spontaneous myocardial infarction and death. In this review, we try to described each of these problems and find out explanations for these new findings searching for potential solutions.
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Affiliation(s)
- Juan Mieres
- Cardiac Unit Otamendi Hospital Cardiovascular Research Center (CECI) Azcuenaga 870, Buenos Aires, Argentina
| | - Alfredo E Rodríguez
- Cardiac Unit Otamendi Hospital Cardiovascular Research Center (CECI) Azcuenaga 870, Buenos Aires, Argentina
| | - Carlos Fernández-Pereira
- Cardiac Unit Otamendi Hospital Cardiovascular Research Center (CECI) Azcuenaga 870, Buenos Aires, Argentina
| | - Diego Ascarrunz-Cattoretti
- Cardiac Unit Otamendi Hospital Cardiovascular Research Center (CECI) Azcuenaga 870, Buenos Aires, Argentina
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5
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Abstract
Despite on-going evolution and iteration of drug-eluting stent (DES) technology, the prevalence of in-stent restenosis (ISR) remains relatively unchanged, encompassing ≈10% of percutaneous coronary interventions. The mechanism of ISR is multifactorial, including biological, mechanical, patient, and operator-related factors. The main mechanical contributors are stent underexpansion or fracture, while biological factors include local inflammation leading to aggressive neointimal proliferation and late neoatherosclerosis. Intracoronary imaging is critical to identify the mechanism of ISR and tailor therapy accordingly. The presentation of DES-ISR is not benign and is challenging for optimal treatment. Among the proposed treatment modalities are scoring and high-pressure balloons, percutaneous coronary intervention with additional DES, atheroablative therapies by laser or mechanical atherectomy, drug-coated balloons, vascular brachytherapy, and surgical revascularization. We propose a new classification for ISR that differentiates among mechanical, biological, and mixed etiologies. Stratifying ISR by mechanism guides individualized treatment of DES-ISR to improve clinical outcomes. An algorithmic approach, guided by intracoronary imaging, for the treatment of DES-ISR, is recommended based on the specific cause of restenosis.
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Affiliation(s)
- Evan Shlofmitz
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC
| | - Micaela Iantorno
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC
| | - Ron Waksman
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC
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6
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Nikolova AP, Kobashigawa JA. Cardiac Allograft Vasculopathy: The Enduring Enemy of Cardiac Transplantation. Transplantation 2019; 103:1338-1348. [PMID: 31241553 DOI: 10.1097/tp.0000000000002704] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Cardiac allograft vasculopathy remains a major limiting factor in the long-term survival of the heart transplant recipient. Our understanding of its pathogenesis is continuously evolving as advances in imaging modalities have allowed a direct window into the natural history of the disease. Innovation in diagnostic modalities has spurred the proliferation of prognostic tools and biomarkers. And in parallel, pharmacological advances have emerged that have helped ameliorate the disease's progressive course.
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Affiliation(s)
- Andriana P Nikolova
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Jon A Kobashigawa
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA
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7
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Rodriguez AE, Larribau M, Fernandez-Pereira C, Iravedra J, Santaera O, Haiek C, Lloberas J, Montoya M, Sisu E, Menendez M, Pavlovsky H, Rodriguez-Granillo AM, Mieres J, Romero G, Ming Z, Pan W, Antoniucci D. One-Year Follow-Up Results From the Observational, Multicenter, Prospective, and Controlled Registry: The WALTZ All-Comers Study. CLINICAL MEDICINE INSIGHTS-CARDIOLOGY 2019; 13:1179546819854059. [PMID: 31285655 PMCID: PMC6600492 DOI: 10.1177/1179546819854059] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Accepted: 04/25/2019] [Indexed: 11/26/2022]
Abstract
The aim of this study was to evaluate 1-year follow-up results in an all “comers”
population treated with a new cobalt chromium bare-metal stent (BMS) design.
Since August 2016 to March 2017, 201 (9.7% of screening population) consecutive
patients undergoing coronary stent implantation in 11 centers in Argentina were
prospectively included in our registry. The inclusion criteria were
multiple-vessel disease and/or unprotected left main disease, acute coronary
syndromes (ACS) with at least one severe (⩾70%) stenosis in any of major
epicardial vessel. In-stent restenosis, protected left main stenosis, or
impossibility to receive dual-antiplatelet therapy was an exclusion criterion.
Major adverse cardiac events (MACE) were the primary endpoint and included
cardiac death, myocardial infarction (MI), and target lesion revascularization
(TLR); also, all components of the primary endpoint were separately analyzed.
Completeness of revascularization was analyzed as post hoc data using residual
SYNTAX or ERACI risk scores. Demographic characteristics showed that 6.5% of
patients were very elderly, 22.5% have diabetes, 47% have multiple-vessel
disease, 67% have ACS, and 32% have ST elevation MI. At a mean of
376 ± 18.1 days of follow-up, MACE was observed in 10.4% of patients:
death + MI + cardiovascular accident (CVA) in 3% (6 of 201) and cardiac
death + MI + CVA in 1.5% (3 of 201). Residual ERACI score ⩽5 was associated with
98% of event-free survival (P < .04). In conclusion, this
prospective, multicenter, and observational all-comers registry with this novel
BMS design showed a low incidence of adverse events at 1 year mainly due to
coronary restenosis.
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Affiliation(s)
- Alfredo E Rodriguez
- Cardiovascular Research Center (CECI), Buenos Aires, Argentina.,Department of Interventional Cardiology, Sanatorio Otamendi, Buenos Aires, Argentina
| | - Miguel Larribau
- Department of Interventional Cardiology, Hospital Español de Mendoza, Mendoza, Argentina.,Department of Interventional Cardiology, Clinica de Cuyo, Mendoza, Argentina
| | - Carlos Fernandez-Pereira
- Cardiovascular Research Center (CECI), Buenos Aires, Argentina.,Department of Interventional Cardiology, Sanatorio Otamendi, Buenos Aires, Argentina.,Department of Interventional Cardiology, Sanatorio Las Lomas SA, Buenos Aires, Argentina
| | - Jorge Iravedra
- Department of Interventional Cardiology, Clinica 25 de Mayo, Buenos Aires, Argentina
| | - Omar Santaera
- Department of Interventional Cardiology, Sanatorio Las Lomas SA, Buenos Aires, Argentina
| | - Carlos Haiek
- Department of Interventional Cardiology, Sanatorio de la Trinidad Quilmes, Buenos Aires, Argentina
| | - Juan Lloberas
- Department of Interventional Cardiology, Sanatorio San Miguel, Buenos Aires, Argentina
| | - Mario Montoya
- Department of Interventional Cardiology, Clinica La Sagrada Familia, Buenos Aires, Argentina
| | - Elias Sisu
- Department of Interventional Cardiology, Clinica Ipensa, Buenos Aires, Argentina
| | | | - Hernan Pavlovsky
- Department of Interventional Cardiology, Sanatorio Otamendi, Buenos Aires, Argentina.,Department of Interventional Cardiology, Clinica IMA Adrogue, Buenos Aires, Argentina.,Department of Interventional Cardiology, Sanatorio Las Lomas SA, Buenos Aires, Argentina
| | - Alfredo M Rodriguez-Granillo
- Department of Clinical Cardiology, Sanatorio Otamendi, Buenos Aires, Argentina.,Department of Biostatistical Analysis, Cardiovascular Research Center (CECI), Buenos Aires, Argentina
| | - Juan Mieres
- Cardiovascular Research Center (CECI), Buenos Aires, Argentina.,Department of Interventional Cardiology, Sanatorio Otamendi, Buenos Aires, Argentina.,Department of Interventional Cardiology, Clinica IMA Adrogue, Buenos Aires, Argentina.,Department of Interventional Cardiology, Sanatorio Las Lomas SA, Buenos Aires, Argentina
| | - Graciela Romero
- Cardiovascular Research Center (CECI), Buenos Aires, Argentina
| | - Zheng Ming
- Shanghai MicroPort Medical (Group) Co., Ltd., Shanghai, China
| | - William Pan
- Shanghai MicroPort Medical (Group) Co., Ltd., Shanghai, China
| | - David Antoniucci
- Division of Cardiology, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
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8
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Granada JF, Tellez A, Baumbach WR, Bingham B, Keng YF, Wessler J, Conditt G, McGregor J, Stone G, Kaluza GL, Leon MB. In vivo delivery and long-term tissue retention of nano-encapsulated sirolimus using a novel porous balloon angioplasty system. EUROINTERVENTION 2017; 12:740-7. [PMID: 26428893 DOI: 10.4244/eijy15m10_01] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS Among antirestenotic compounds, sirolimus displays a superior safety profile compared to paclitaxel, but its pharmacokinetic properties make it a challenging therapeutic candidate for single-time delivery. Herein we evaluate the feasibility of delivery, long-term retention and vascular effects of sirolimus nanoparticles delivered through a novel porous angioplasty balloon in normal porcine arteries and in a swine model of in-stent restenosis (ISR). METHODS AND RESULTS Sirolimus nanoparticle formulation was delivered via porous balloon angioplasty to 753 coronary artery segments for pharmacokinetic studies and 26 segments for biological effect of sirolimus delivery in different clinical scenarios (de novo [n=8], ISR [n=6] and following stent implantation [n=12]). Sirolimus coronary artery concentrations were above the target therapeutic level of 1 ng/mg after 26 days, and were >100-fold higher in coronary artery treatment sites than in distal myocardium and remote tissues at all time points. At 28 days, reduction in percent stenosis in formulation-treated sites compared to balloon angioplasty treatment was noted in all three clinical scenarios, with the largest effect seen in the de novo study. CONCLUSIONS Local coronary delivery of sirolimus nanoparticles in the porcine model using a novel porous balloon delivery system achieved therapeutic long-term intra-arterial drug levels without significant systemic residual exposure.
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Affiliation(s)
- Juan F Granada
- CRF-Skirball Center for Innovation, Orangeburg, New York, NY, USA
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Cheng R, Vanichsarn C, Patel JK, Currier J, Chang DH, Kittleson MM, Makkar R, Kobashigawa JA, Azarbal B. Long-term clinical and angiographic outcomes of percutanenous coronary intervention with everolimus-eluting stents for the treatment of cardiac allograft vasculopathy. Catheter Cardiovasc Interv 2016; 90:48-55. [DOI: 10.1002/ccd.26830] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2016] [Revised: 09/21/2016] [Accepted: 10/08/2016] [Indexed: 11/09/2022]
Affiliation(s)
- Richard Cheng
- Cedars-Sinai Heart Institute; Los Angeles California
| | | | | | - Jesse Currier
- Division of Cardiology; VA Greater Los Angeles Healthcare System; Los Angeles California
| | | | | | - Raj Makkar
- Cedars-Sinai Heart Institute; Los Angeles California
| | | | - Babak Azarbal
- Cedars-Sinai Heart Institute; Los Angeles California
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Nochioka K, Biering-Sørensen T, Hansen KW, Sørensen R, Pedersen S, Jørgensen PG, Iversen A, Shimokawa H, Jeger R, Kaiser C, Pfisterer M, Galatius S. Long-term outcomes in patients with rheumatologic disorders undergoing percutaneous coronary intervention: a BAsel Stent Kosten-Effektivitäts Trial-PROspective Validation Examination (BASKET-PROVE) sub-study. EUROPEAN HEART JOURNAL-ACUTE CARDIOVASCULAR CARE 2016; 6:778-786. [DOI: 10.1177/2048872616649860] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Kotaro Nochioka
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Clinical Research, Innovation and Education Center, Tohoku University Hospital, Sendai, Japan
| | | | - Kim Wadt Hansen
- Department of Cardiology, Bispebjerg University Hospital, Copenhagen, Denmark
| | - Rikke Sørensen
- Department of Cardiology, Gentofte University Hospital, Copenhagen, Denmark
| | - Sune Pedersen
- Department of Cardiology, Gentofte University Hospital, Copenhagen, Denmark
| | | | - Allan Iversen
- Department of Cardiology, Gentofte University Hospital, Copenhagen, Denmark
| | - Hiroaki Shimokawa
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Clinical Research, Innovation and Education Center, Tohoku University Hospital, Sendai, Japan
| | - Raban Jeger
- Department of Cardiology, University Hospital, Basel, Switzerland
| | - Christoph Kaiser
- Department of Cardiology, University Hospital, Basel, Switzerland
| | | | - Søren Galatius
- Department of Cardiology, Bispebjerg University Hospital, Copenhagen, Denmark
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Liang JJ, Sio TT, Miller RC, Sandhu G, Prasad A. Reply: coronary in-stent restenosis in patients treated with thoracic external beam radiation for cancer. JACC Cardiovasc Interv 2015; 8:642. [PMID: 25907095 DOI: 10.1016/j.jcin.2015.01.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2015] [Accepted: 01/13/2015] [Indexed: 11/30/2022]
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