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Lozano Í, Bangueses R, Rodríguez I, Pevida M, Rodríguez-Aguilar R, Rodríguez D, Espasandín-Arias M, Llames S, Meana Á, Suárez A, Rodríguez-Carrio J. In-stent restenosis is associated with proliferative skin healing and specific immune and endothelial cell profiles: results from the RACHEL trial. Front Immunol 2023; 14:1138247. [PMID: 37325628 PMCID: PMC10265483 DOI: 10.3389/fimmu.2023.1138247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 05/22/2023] [Indexed: 06/17/2023] Open
Abstract
Introduction In-stent restenosis (ISR) is a major challenge in interventional cardiology. Both ISR and excessive skin healing are aberrant hyperplasic responses, which may be functionally related. However, the cellular component underlying ISR remains unclear, especially regarding vascular homeostasis. Recent evidence suggest that novel immune cell populations may be involved in vascular repair and damage, but their role in ISR has not been explored. The aims of this study is to analyze (i) the association between ISR and skin healing outcomes, and (ii) the alterations in vascular homeostasis mediators in ISR in univariate and integrative analyses. Methods 30 patients with ≥1 previous stent implantation with restenosis and 30 patients with ≥1 stent without restenosis both confirmed in a second angiogram were recruited. Cellular mediators were quantified in peripheral blood by flow cytometry. Skin healing outcomes were analyzed after two consecutive biopsies. Results Hypertrophic skin healing was more frequent in ISR patients (36.7%) compared to those ISR-free (16.7%). Patients with ISR were more likely to develop hypertrophic skin healing patterns (OR 4.334 [95% CI 1.044-18.073], p=0.033), even after correcting for confounders. ISR was associated with decreased circulating angiogenic T-cells (p=0.005) and endothelial progenitor cells (p<0.001), whereas CD4+CD28null and detached endothelial cells counts were higher (p<0.0001 and p=0.006, respectively) compared to their ISR-free counterparts. No differences in the frequency of monocyte subsets were found, although Angiotensin-Converting Enzyme expression was increased (non-classical: p<0.001; and intermediate: p<0.0001) in ISR. Despite no differences were noted in Low-Density Granulocytes, a relative increase in the CD16- compartment was observed in ISR (p=0.004). An unsupervised cluster analysis revealed the presence of three profiles with different clinical severity, unrelated to stent types or traditional risk factors. Conclusion ISR is linked to excessive skin healing and profound alterations in cellular populations related to vascular repair and endothelial damage. Distinct cellular profiles can be distinguished within ISR, suggesting that different alterations may uncover different ISR clinical phenotypes.
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Affiliation(s)
- Íñigo Lozano
- Department of Cardiology, Hospital Universitario Cabueñes, Gijón, Asturias, Spain
- Cardiac Pathology Research Group, Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Asturias, Spain
| | - Roi Bangueses
- Department of Cardiology, Hospital Universitario Cabueñes, Gijón, Asturias, Spain
| | - Isabel Rodríguez
- Cardiac Pathology Research Group, Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Asturias, Spain
| | - Marta Pevida
- Blood Tansfusion Center and Tissue Bank of Asturias, Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Oviedo, Asturias, Spain
- Grupo de Investigación en Oftalmología, Ciencias de la Visión y Terapias Avanzadas (GOVITA), Instituto de Salud del Principado de Asturias (ISPA), Oviedo, Asturias, Spain
- Instituto Universitario Fernández-Vega, Fundación de Investigación Oftalmológica, Oviedo, Asturias, Spain
| | - Raúl Rodríguez-Aguilar
- Department of Pathology Anatomy, Hospital Universitario Cabueñes, Gijón, Asturias, Spain
| | - Diana Rodríguez
- Department of Pathology Anatomy, Hospital Universitario Cabueñes, Gijón, Asturias, Spain
| | | | - Sara Llames
- Blood Tansfusion Center and Tissue Bank of Asturias, Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Oviedo, Asturias, Spain
- Grupo de Investigación en Oftalmología, Ciencias de la Visión y Terapias Avanzadas (GOVITA), Instituto de Salud del Principado de Asturias (ISPA), Oviedo, Asturias, Spain
- Centro de Investigación Biomédica en Red en Enfermedades Raras (CIBERER), Instituto de Salud Carlos III, Madrid, Spain
- Fundación Jiménez Díaz, Madrid, Spain
| | - Álvaro Meana
- Blood Tansfusion Center and Tissue Bank of Asturias, Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Oviedo, Asturias, Spain
- Grupo de Investigación en Oftalmología, Ciencias de la Visión y Terapias Avanzadas (GOVITA), Instituto de Salud del Principado de Asturias (ISPA), Oviedo, Asturias, Spain
- Instituto Universitario Fernández-Vega, Fundación de Investigación Oftalmológica, Oviedo, Asturias, Spain
| | - Ana Suárez
- Area of Immunology, Department of Functional Biology, University of Oviedo, Oviedo, Asturias, Spain
- Grupo de Investigación Básica y Traslacional en Enfermedades Inflamatorias, Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo, Asturias, Spain
| | - Javier Rodríguez-Carrio
- Area of Immunology, Department of Functional Biology, University of Oviedo, Oviedo, Asturias, Spain
- Grupo de Investigación Básica y Traslacional en Enfermedades Inflamatorias, Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo, Asturias, Spain
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Jakobsen L, Christiansen EH, Freeman P, Kahlert J, Veien K, Maeng M, Raungaard B, Ellert J, Kristensen SD, Christensen MK, Terkelsen CJ, Thim T, Eftekhari A, Jensen RV, Støttrup NB, Junker A, Hansen HS, Jensen LO. Impact of acute coronary syndrome on clinical outcomes after revascularization with the dual-therapy CD34 antibody-covered sirolimus-eluting Combo stent and the sirolimus-eluting Orsiro stent. Catheter Cardiovasc Interv 2023; 101:13-21. [PMID: 36378691 PMCID: PMC10100152 DOI: 10.1002/ccd.30480] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 09/05/2022] [Accepted: 11/02/2022] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To compare the efficacy and safety of the dual-therapy CD34 antibody-covered sirolimus-eluting Combo stent (DTS) and the sirolimus-eluting Orsiro stent (O-SES) in patients with and without acute coronary syndrome (ACS) included in the SORT OUT X study. BACKGROUND The incidence of target lesion failure (TLF) after treatment with modern drug-eluting stents has been reported to be significantly higher in patients with ACS when compared to patients without ACS. Whether the results from the SORT OUT X study apply to patients with and without ACS remains unknown. METHODS In total, 3146 patients were randomized to stent implantation with DTS (n = 1578; ACS: n = 856) or O-SES (n = 1568; ACS: n = 854). The primary end point, TLF, was a composite of cardiac death, target-lesion myocardial infarction (MI), or target lesion revascularization (TLR) within 1 year. RESULTS At 1 year, the rate of TLF was higher in the DTS group compared to the O-SES group, both among patients with ACS (6.7% vs. 4.1%; incidence rate ratio: 1.65 [95% confidence interval, CI: 1.08-2.52]) and without ACS (6.0% vs. 3.2%; incidence rate ratio: 1.88 [95% CI: 1.13-3.14]). The differences were mainly explained by higher rates of TLR, whereas rates of cardiac death and target lesion MI did not differ significantly between the two stent groups in patients with or without ACS CONCLUSION: Compared to the O-SES, the DTS was associated with a higher risk of TLF at 12 months in patients with and without ACS. The differences were mainly explained by higher rates of TLR.
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Affiliation(s)
- Lars Jakobsen
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | | | - Phillip Freeman
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | - Johnny Kahlert
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - Karsten Veien
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | - Michael Maeng
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Bent Raungaard
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | - Julia Ellert
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | | | | | | | - Troels Thim
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Ashkan Eftekhari
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark.,Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | - Rebekka V Jensen
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | | | - Anders Junker
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | - Henrik S Hansen
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | - Lisette O Jensen
- Department of Cardiology, Odense University Hospital, Odense, Denmark
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El-Medany A, Kandoole V, Lonsdale N, Doolub G, Felekos I. In-stent Thrombosis and COVID-19 Infection: Current Insights on the Mechanistic Relationship. Curr Cardiol Rev 2023; 19:e120522204669. [PMID: 35549872 PMCID: PMC10201881 DOI: 10.2174/1573403x18666220512142019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 02/16/2022] [Accepted: 03/02/2022] [Indexed: 02/08/2023] Open
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection has been demonstrated as a major risk factor in inducing coronary stent thrombosis due to its propensity to create a pro-thrombotic state. This review explores the mechanisms that may contribute to the increased thrombosis risk seen in COVID-19. Furthermore, we discuss the patient and haematological factors that predispose to an increased risk of stent thrombosis, as well as the role of certain antiplatelet and anticoagulation therapies, including ticagrelor and enoxaparin, that may reduce the likelihood and severity of in-stent thrombosis, in SARS-CoV-2 infection. To counter the proinflammatory and pro-thrombotic state shown in COVID-19, anti-thrombotic therapy in the future may be optimised using point-of-care platelet inhibition testing and inflammation-modifying therapies. Large-scale randomised trials with long-term follow-up are increasingly necessary to assess the intersection of COVID-19 and stent optimisation as well as the reduction of stent thrombosis after drug-eluting stent (DES) implantation.
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Affiliation(s)
- Ahmed El-Medany
- Bristol Heart Institute, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, England
| | - Vanessa Kandoole
- Bristol Heart Institute, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, England
| | - Nicholas Lonsdale
- Weston General Hospital, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Gemina Doolub
- Bristol Heart Institute, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, England
| | - Ioannis Felekos
- Bristol Heart Institute, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, England
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4
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Gori T. Restenosis after Coronary Stent Implantation: Cellular Mechanisms and Potential of Endothelial Progenitor Cells (A Short Guide for the Interventional Cardiologist). Cells 2022; 11:cells11132094. [PMID: 35805178 PMCID: PMC9265311 DOI: 10.3390/cells11132094] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 06/26/2022] [Accepted: 06/28/2022] [Indexed: 02/05/2023] Open
Abstract
Coronary stents are among the most common therapies worldwide. Despite significant improvements in the biocompatibility of these devices throughout the last decades, they are prone, in as many as 10–20% of cases, to short- or long-term failure. In-stent restenosis is a multifactorial process with a complex and incompletely understood pathophysiology in which inflammatory reactions are of central importance. This review provides a short overview for the clinician on the cellular types responsible for restenosis with a focus on the role of endothelial progenitor cells. The mechanisms of restenosis are described, along with the cell-based attempts made to prevent it. While the focus of this review is principally clinical, experimental evidence provides some insight into the potential implications for prevention and therapy of coronary stent restenosis.
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Affiliation(s)
- Tommaso Gori
- German Center for Cardiac and Vascular Research (DZHK) Standort Rhein-Main, Department of Cardiology, University Medical Center Mainz, 55131 Mainz, Germany
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5
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Li Y, Cui W, Song B, Ye X, Li Z, Lu C. Autophagy-Sirtuin1(SIRT1) Alleviated the Coronary Atherosclerosis (AS)in Mice through Regulating the Proliferation and Migration of Endothelial Progenitor Cells (EPCs) via wnt/β-catenin/GSK3β Signaling Pathway. J Nutr Health Aging 2022; 26:297-306. [PMID: 35297474 DOI: 10.1007/s12603-022-1750-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND AND PURPOSE SIRT1 was associated with AS risk and EPCs were reported to participate in the endothelial repair in Coronary Atherosclerosis (CAS). In this study, we explored the role of SIRT1 in AS mice and also its modulation in EPCs. METHODS AND MATERIALS ApoE-/-mice were fed on high-fat and high-glucose diet to establish the AS animal model with the normally-raised C57BL/6 mice as a control group. SIRT1 activator, SRT 2104 was injected intravenously into 5 ApoE-/-mice and its inhibitor Nicotinamide was injected in tail in another 5 ApoE-/-mice. Weight changes were recorded. Blood samples were taken from posterior orbital venous plexus and were detected by automatic biochemical analyzer. HE staining displayed the pathological conditions while Immunohistochemistry (IHC) evaluated the CD34+/VEGFR2+ relative density in the aorta tissues. EPCs were isolated from bone marrow and verified using immunofluorescence staining (IFS). The modulatory mechanism of SIRT1 in EPCs were studied by using RT-PCR, MTT, Western Blot and colony formation, scratch methods. RESULTS SIRT1 activator negatively regulated the weight and TC, TG and LDL levels, alleviated the lesion conditions and decreased the CD34+/VEGFR2+ density compared to the AS control. In vitro, SIRT1 activator promoted the proliferation and migration of EPCs and activated wnt/β-catenin/GSK3β signaling pathway. SIRT1 activator also inhibited the autophagy biomarkers ATG1 and LC3II. Furthermore, inhibitor of autophagy promoted SIRT1 expression and induced EPC proliferation, migration and activated wnt/β-catenin/GSK3β pathway. The suppression of the wnt/β-catenin/GSK3β pathway inhibited SIRT1 expression in EPCs, attenuated the proliferation and migration and promoted autophagy of EPCs. CONCLUSION SIRT1 activation might be protective in AS mice through autophagy inhibition in EPCs via wnt/β-catenin/GSK3β signaling pathway.
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Affiliation(s)
- Y Li
- Chengzhi Lu, Department of Cardiology, Tianjin First Central Hospital, 24 Fukang Road, Nankai District, Tianjin, 300110, China, ,
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6
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Shah P, Chandra S. Review on emergence of nanomaterial coatings in bio-engineered cardiovascular stents. J Drug Deliv Sci Technol 2022. [DOI: 10.1016/j.jddst.2022.103224] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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7
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Pelliccia F, Pasceri V, Zimarino M, De Luca G, De Caterina R, Mehran R, Dangas G. Endothelial progenitor cells in coronary atherosclerosis and percutaneous coronary intervention: A systematic review and meta-analysis. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2022; 42:94-99. [DOI: 10.1016/j.carrev.2022.02.025] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 02/23/2022] [Accepted: 02/24/2022] [Indexed: 12/19/2022]
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8
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Mause SF, Ritzel E, Deck A, Vogt F, Liehn EA. Endothelial Progenitor Cells Modulate the Phenotype of Smooth Muscle Cells and Increase Their Neointimal Accumulation Following Vascular Injury. Thromb Haemost 2021; 122:456-469. [PMID: 34214997 DOI: 10.1055/s-0041-1731663] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Smooth muscle cells (SMCs) are the main driver of neointima formation and restenosis following vascular injury. In animal models, endothelial progenitor cells (EPCs) accelerate endothelial regeneration and reduce neointima formation after arterial injury; however, EPC-capture stents do not reduce target vessel failure compared with conventional stents. Here we examined the influence of EPCs on features of SMCs pivotal for their impact on injury-induced neointima formation including proliferation, migration, and phenotype switch. METHODS AND RESULTS EPCs, their conditioned medium, and EPC-derived microparticles induced proliferation of SMCs while limiting their apoptosis. In transwell membrane experiments and scratch assays, EPCs stimulated migration of SMCs and accelerated their recovery from scratch-induced injury. Treatment of SMCs with an EPC-derived conditioned medium or microparticles triggered transformation of SMCs toward a synthetic phenotype. However, co-cultivation of EPCs and SMCs enabling direct cell-cell contacts preserved their original phenotype and protected from the transformative effect of SMC cholesterol loading. Adhesion of EPCs to SMCs was stimulated by SMC injury and reduced by blocking CXCR2 and CCR5. Interaction of EPCs with SMCs modulated their secretory products and synergistically increased the release of selected chemokines. Following carotid wire injury in athymic mice, injection of EPCs resulted not only in reduced neointima formation but also in altered cellular composition of the neointima with augmented accumulation of SMCs. CONCLUSION EPCs stimulate proliferation and migration of SMCs and increase their neointimal accumulation following vascular injury. Furthermore, EPCs context-dependently modify the SMC phenotype with protection from the transformative effect of cholesterol when a direct cell-cell contact is established.
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Affiliation(s)
- Sebastian F Mause
- Department of Internal Medicine I, Cardiology, University Hospital Aachen, RWTH Aachen University, Aachen, Germany
| | - Elisabeth Ritzel
- Department of Otorhinolaryngology Head and Neck Surgery, Klinikum Stuttgart, Stuttgart, Germany.,Institute for Molecular Cardiovascular Research, University Hospital Aachen, RWTH Aachen University, Aachen, Germany
| | - Annika Deck
- Department of Internal Medicine I, Cardiology, University Hospital Aachen, RWTH Aachen University, Aachen, Germany
| | - Felix Vogt
- Department of Internal Medicine I, Cardiology, University Hospital Aachen, RWTH Aachen University, Aachen, Germany
| | - Elisa A Liehn
- Department of Internal Medicine I, Cardiology, University Hospital Aachen, RWTH Aachen University, Aachen, Germany.,Institute for Molecular Cardiovascular Research, University Hospital Aachen, RWTH Aachen University, Aachen, Germany
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9
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Wei S, Xu Y, Wang Z, Li M, Sun P, Xie B, Xing Y, Bai H, Kan Q, Li J, Dardik A. Hydrogel-coated needles prevent puncture site bleeding. Acta Biomater 2021; 128:305-313. [PMID: 33894348 DOI: 10.1016/j.actbio.2021.04.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 03/22/2021] [Accepted: 04/05/2021] [Indexed: 12/20/2022]
Abstract
INTRODUCTION Incomplete hemostasis after vascular cannulation can cause a hematoma or pseudoaneurysm. We hypothesized that a hydrogel-coated needle would effectively and rapidly stop bleeding after vascular cannulation. METHODS A hydrogel composed of sodium alginate, hyaluronic acid, and calcium carbonate was coated onto the surface of suture needles. Needles were observed using scanning electronic microscopy (SEM) and immunofluorescence. Cannulation was performed in both mouse and rat models; the liver, kidney, jugular vein, inferior vena cava and aorta were punctured using uncoated and hydrogel-coated needles. Needles coated with a hydrogel with and without CD34 antibody were used to puncture the rat jugular vein and aorta. Tissues were examined by histology and immunofluorescence. RESULTS The hydrogel was successfully coated onto the surface of 22G and 30G needles and confirmed by SEM. Hydrogel-coated needles rapidly stopped bleeding after cannulation of the liver, kidney, jugular vein, inferior vena cava and aorta. Hydrogel-coated needles that contained CD34 antibody attracted vascular progenitor cells near the puncture site; there were fewer M1-type macrophages and more M2-type macrophages. CONCLUSION Hydrogel-coated needles can effectively and rapidly stop puncture-site bleeding. The hydrogel that contains CD34 antibody attracted vascular progenitor cells, potentially promoting healing of the site after cannulation. STATEMENT OF SIGNIFICANCE Incomplete hemostasis after vascular cannulation can cause a hematoma or pseudoaneurysm and remains a significant clinical problem. We developed a hydrogel composed of sodium alginate, hyaluronic acid, and calcium carbonate; hydrogel-coated needles effectively and rapidly stopped bleeding after vascular cannulation. Interestingly, the hydrogel can also serve as a carrier for drugs that are delivered to the puncture site during the short time of cannulation that could additionally promote puncture site healing. Hydrogel-coated needles may be a new method for rapid hemostasis with application to patients especially at risk for bleeding.
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10
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Jakobsen L, Christiansen EH, Freeman P, Kahlert J, Veien K, Maeng M, Raungaard B, Ellert J, Villadsen AB, Kristensen SD, Ahlehoff O, Christensen MK, Terkelsen CJ, Erik Bøtker H, Aaroe J, Thim T, Thuesen L, Aziz A, Eftekhari A, Jensen RV, Støttrup NB, Rasmussen JG, Junker A, Jensen SE, Hansen HS, Jensen LO. Randomized Clinical Comparison of the Dual-Therapy CD34 Antibody-Covered Sirolimus-Eluting Combo Stent With the Sirolimus-Eluting Orsiro Stent in Patients Treated With Percutaneous Coronary Intervention: The SORT OUT X Trial. Circulation 2021; 143:2155-2165. [PMID: 33823606 DOI: 10.1161/circulationaha.120.052766] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Target lesion failure remains an issue with contemporary drug-eluting stents. Thus, the dual-therapy sirolimus-eluting and CD34+ antibody-coated Combo stent (DTS) was designed to further improve early healing. This study aimed to investigate whether the DTS is noninferior to the sirolimus-eluting Orsiro stent (SES) in an all-comers patient population. METHODS The SORT OUT X (Combo Stent Versus Orsiro Stent) trial, was a large-scale, randomized, multicenter, single-blind, 2-arm, noninferiority trial with registry-based follow-up. The primary end point target lesion failure was a composite of cardiac death, myocardial infarction, or target lesion revascularization within 12 months, analyzed using intention-to-treat. The trial was powered for assessing target lesion failure noninferiority of the DTS compared with the SES with a predetermined noninferiority margin of 0.021. RESULTS A total of 3146 patients were randomized to treatment with the DTS (1578 patients; 2008 lesions) or SES (1568 patients; 1982 lesions). At 12 months, intention-to-treat analysis showed that 100 patients (6.3%) assigned the DTS and 58 patients (3.7%) assigned the SES met the primary end point (absolute risk difference, 2.6% [upper limit of 1-sided 95% CI, 4.1%]; P (noninferiority)=0.76). The SES was superior to the DTS (incidence rate ratios for target lesion failure, 1.74 [95% CI, 1.26-2.41]; P=0.00086). The difference was explained mainly by a higher incidence of target lesion revascularization in the DTS group compared with the SES group (53 [3.4%] vs. 24 [1.5%]; incidence rate ratio, 2.22 [95% CI, 1.37-3.61]; P=0.0012). CONCLUSIONS The DTS did not confirm noninferiority to the SES for target lesion failure at 12 months in an all-comer population. The SES was superior to the DTS mainly because the DTS was associated with an increased risk of target lesion revascularization. However, rates of death, cardiac death, and myocardial infarction at 12 months did not differ significantly between the 2 stent groups. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT03216733.
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Affiliation(s)
- Lars Jakobsen
- Department of Cardiology (L.J., E.H.C., M.M., S.D.K., C.J.T., H.E.B., T.T., A.E., R.V.J., N.B.S.), Aarhus University Hospital, Denmark
| | - Evald H Christiansen
- Department of Cardiology (L.J., E.H.C., M.M., S.D.K., C.J.T., H.E.B., T.T., A.E., R.V.J., N.B.S.), Aarhus University Hospital, Denmark
| | - Phillip Freeman
- Department of Cardiology, Aalborg University Hospital, Denmark (P.F., B.R., A.B.V., M.K.C., J.A., L.T., J.G.R., S.E.J.)
| | - Johnny Kahlert
- Department of Clinical Epidemiology (J.K.), Aarhus University Hospital, Denmark
| | - Karsten Veien
- Department of Cardiology, Odense University Hospital, Denmark (K.V., J.E., O.A., A.A., A.J., H.S.H., L.O.J.)
| | - Michael Maeng
- Department of Cardiology (L.J., E.H.C., M.M., S.D.K., C.J.T., H.E.B., T.T., A.E., R.V.J., N.B.S.), Aarhus University Hospital, Denmark
| | - Bent Raungaard
- Department of Cardiology, Aalborg University Hospital, Denmark (P.F., B.R., A.B.V., M.K.C., J.A., L.T., J.G.R., S.E.J.)
| | - Julia Ellert
- Department of Cardiology, Odense University Hospital, Denmark (K.V., J.E., O.A., A.A., A.J., H.S.H., L.O.J.)
| | - Anton B Villadsen
- Department of Cardiology, Aalborg University Hospital, Denmark (P.F., B.R., A.B.V., M.K.C., J.A., L.T., J.G.R., S.E.J.)
| | - Steen D Kristensen
- Department of Cardiology (L.J., E.H.C., M.M., S.D.K., C.J.T., H.E.B., T.T., A.E., R.V.J., N.B.S.), Aarhus University Hospital, Denmark
| | - Ole Ahlehoff
- Department of Cardiology, Odense University Hospital, Denmark (K.V., J.E., O.A., A.A., A.J., H.S.H., L.O.J.)
| | - Martin K Christensen
- Department of Cardiology, Aalborg University Hospital, Denmark (P.F., B.R., A.B.V., M.K.C., J.A., L.T., J.G.R., S.E.J.)
| | - Christian J Terkelsen
- Department of Cardiology (L.J., E.H.C., M.M., S.D.K., C.J.T., H.E.B., T.T., A.E., R.V.J., N.B.S.), Aarhus University Hospital, Denmark
| | - Hans Erik Bøtker
- Department of Cardiology (L.J., E.H.C., M.M., S.D.K., C.J.T., H.E.B., T.T., A.E., R.V.J., N.B.S.), Aarhus University Hospital, Denmark
| | - Jens Aaroe
- Department of Cardiology, Aalborg University Hospital, Denmark (P.F., B.R., A.B.V., M.K.C., J.A., L.T., J.G.R., S.E.J.)
| | - Troels Thim
- Department of Cardiology (L.J., E.H.C., M.M., S.D.K., C.J.T., H.E.B., T.T., A.E., R.V.J., N.B.S.), Aarhus University Hospital, Denmark
| | - Leif Thuesen
- Department of Cardiology, Aalborg University Hospital, Denmark (P.F., B.R., A.B.V., M.K.C., J.A., L.T., J.G.R., S.E.J.)
| | - Ahmed Aziz
- Department of Cardiology, Odense University Hospital, Denmark (K.V., J.E., O.A., A.A., A.J., H.S.H., L.O.J.)
| | - Ashkan Eftekhari
- Department of Cardiology (L.J., E.H.C., M.M., S.D.K., C.J.T., H.E.B., T.T., A.E., R.V.J., N.B.S.), Aarhus University Hospital, Denmark
| | - Rebekka V Jensen
- Department of Cardiology (L.J., E.H.C., M.M., S.D.K., C.J.T., H.E.B., T.T., A.E., R.V.J., N.B.S.), Aarhus University Hospital, Denmark
| | - Nicolaj B Støttrup
- Department of Cardiology (L.J., E.H.C., M.M., S.D.K., C.J.T., H.E.B., T.T., A.E., R.V.J., N.B.S.), Aarhus University Hospital, Denmark
| | - Jeppe G Rasmussen
- Department of Cardiology, Aalborg University Hospital, Denmark (P.F., B.R., A.B.V., M.K.C., J.A., L.T., J.G.R., S.E.J.)
| | - Anders Junker
- Department of Cardiology, Odense University Hospital, Denmark (K.V., J.E., O.A., A.A., A.J., H.S.H., L.O.J.)
| | - Svend E Jensen
- Department of Cardiology, Aalborg University Hospital, Denmark (P.F., B.R., A.B.V., M.K.C., J.A., L.T., J.G.R., S.E.J.)
| | - Henrik S Hansen
- Department of Cardiology, Odense University Hospital, Denmark (K.V., J.E., O.A., A.A., A.J., H.S.H., L.O.J.)
| | - Lisette O Jensen
- Department of Cardiology, Odense University Hospital, Denmark (K.V., J.E., O.A., A.A., A.J., H.S.H., L.O.J.)
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Blessing R, Ahoopai M, Geyer M, Brandt M, Zeiher AM, Münzel T, Wenzel P, Gori T, Dimitriadis Z. The Bioengineered Combo Dual-Therapy CD34 Antibody-Covered Sirolimus-Eluting Coronary Stent in Patients with Chronic Total Occlusion Evaluated by Clinical Outcome and Optical Coherence Tomography Imaging Analysis. J Clin Med 2020; 10:jcm10010080. [PMID: 33379321 PMCID: PMC7794972 DOI: 10.3390/jcm10010080] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Revised: 12/20/2020] [Accepted: 12/21/2020] [Indexed: 01/25/2023] Open
Abstract
We sought to determine the effects of the use of a Bioengineered Combo Dual-Therapy CD34 Antibody-Covered Sirolimus-Eluting Coronary Stent (Combo® DTS) in patients with chronic total occlusion (CTO) by evaluating clinical outcomes and by performing an optical coherence tomography (OCT) analysis. We retrospectively analyzed data from 39 patients who had successfully undergone OCT-guided revascularization of a CTO being treated with a Combo® DTS. Clinical assessment, angiography (with quantitative coronary angiography analysis) and OCT examination were performed at baseline and at follow-up. The median follow-up period was 189 days, ranging from 157 to 615 days. At follow-up, revascularization was required due to angiographic restenosis in 40% (14 of 35) of patients. OCT analysis detected neointima proliferation in 23 (76.6%) patients. Neointima formation was often associated with microvessels in 18 patients (60%). Neoatheroslcerosis was observed in 2 (6.6%) patients. Malapposition was found in 4 patients (13.3%), and stent fractures were found in 11 patients (36.6%). Rate of strut coverage was 96.3% at follow-up. In conclusion, the implantation of a Combo® DTS after successful CTO recanalization was associated with a restenosis rate of 40% despite good stent implantation at baseline, proven by OCT. Neointima formation was found as a main contributor to restenosis. Nevertheless, we observed a low rate of major cardiovascular events in our follow-up.
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Affiliation(s)
- Recha Blessing
- Department of Cardiology, Cardiology I, University Medical Center of the Johannes Gutenberg University, 55131 Mainz, Germany; (R.B.); (M.A.); (M.G.); (M.B.); (T.M.); (P.W.); (T.G.)
| | - Majid Ahoopai
- Department of Cardiology, Cardiology I, University Medical Center of the Johannes Gutenberg University, 55131 Mainz, Germany; (R.B.); (M.A.); (M.G.); (M.B.); (T.M.); (P.W.); (T.G.)
| | - Martin Geyer
- Department of Cardiology, Cardiology I, University Medical Center of the Johannes Gutenberg University, 55131 Mainz, Germany; (R.B.); (M.A.); (M.G.); (M.B.); (T.M.); (P.W.); (T.G.)
| | - Moritz Brandt
- Department of Cardiology, Cardiology I, University Medical Center of the Johannes Gutenberg University, 55131 Mainz, Germany; (R.B.); (M.A.); (M.G.); (M.B.); (T.M.); (P.W.); (T.G.)
- Center for Thrombosis and Hemostasis (CTH), Johannes Gutenberg University, 55131 Mainz, Germany
| | - Andreas M. Zeiher
- Department of Cardiology, Center of Internal Medicine, Goethe University Frankfurt, 60590 Frankfurt, Germany;
| | - Thomas Münzel
- Department of Cardiology, Cardiology I, University Medical Center of the Johannes Gutenberg University, 55131 Mainz, Germany; (R.B.); (M.A.); (M.G.); (M.B.); (T.M.); (P.W.); (T.G.)
- German Center for Cardiovascular Research (DZHK), Partner Site Rhine-Main, 55131 Mainz, Germany
| | - Philip Wenzel
- Department of Cardiology, Cardiology I, University Medical Center of the Johannes Gutenberg University, 55131 Mainz, Germany; (R.B.); (M.A.); (M.G.); (M.B.); (T.M.); (P.W.); (T.G.)
- Center for Thrombosis and Hemostasis (CTH), Johannes Gutenberg University, 55131 Mainz, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Rhine-Main, 55131 Mainz, Germany
| | - Tommaso Gori
- Department of Cardiology, Cardiology I, University Medical Center of the Johannes Gutenberg University, 55131 Mainz, Germany; (R.B.); (M.A.); (M.G.); (M.B.); (T.M.); (P.W.); (T.G.)
- German Center for Cardiovascular Research (DZHK), Partner Site Rhine-Main, 55131 Mainz, Germany
| | - Zisis Dimitriadis
- Department of Cardiology, Center of Internal Medicine, Goethe University Frankfurt, 60590 Frankfurt, Germany;
- Correspondence: ; Tel.: +49-69-6301-7387; Fax: +49-69-6301
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Wang X, Wang H, He F, Zhang J. In Vitro Cell Migration through Three-Dimensional Interfaces of Varying Depths, Widths, and Curvatures on Micropatterned Polymer Surfaces. ACS APPLIED BIO MATERIALS 2020; 3:7472-7482. [DOI: 10.1021/acsabm.0c00697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Xuan Wang
- School of Biological Science and Medical Engineering, Beihang University, 100083 Beijing, China
- Hefei Innovation Research Institute, Beihang University, 230013 Hefei, China
| | - Hua Wang
- School of Biological Science and Medical Engineering, Beihang University, 100083 Beijing, China
- Hefei Innovation Research Institute, Beihang University, 230013 Hefei, China
| | - Fang He
- Hefei Innovation Research Institute, Beihang University, 230013 Hefei, China
| | - Jicong Zhang
- School of Biological Science and Medical Engineering, Beihang University, 100083 Beijing, China
- Hefei Innovation Research Institute, Beihang University, 230013 Hefei, China
- Beijing Advanced Innovation Centre for Biomedical Engineering, Beihang University, 100083 Beijing, China
- Beijing Advanced Innovation Centre for Big Data-Based Precision Medicine, Beihang University, 100083 Beijing, China
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