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Elwany MN, Abskharoun M, Dawood M, Al-Tahan SM, Sanhoury M. The utility and effectiveness of the newer generation high-resolution coronary computed tomography angiography in the evaluation of coronary in-stent restenosis. Curr Probl Cardiol 2024; 49:102212. [PMID: 37993007 DOI: 10.1016/j.cpcardiol.2023.102212] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 11/18/2023] [Indexed: 11/24/2023]
Abstract
BACKGROUND The importance of coronary computerized tomography angiography (CCTA) in detecting native coronary artery stenosis has been established. However, very few studies investigated the efficacy of CCTA in the assessment of in-stent restenosis (ISR) in symptomatic patients after percutaneous coronary intervention (PCI). AIM OF THE STUDY To evaluate the value of CCTA in diagnosing ISR. METHODS We included 102 symptomatic patients with stable angina, presented one to five years after PCI. All patients were subjected to CCTA, and the patients with significant coronary artery disease were directed for invasive coronary angiography (ICA). CCTA results were compared to ICA as the gold standard tool for detecting ISR. RESULTS In 88 (86.3 %) patients, CCTA could successfully exclude ISR together with the ICA (true negative), but in two cases, ICA detected an ISR which was not detected by CCTA (false negative). In eight patients, CCTA detected ISR. These were confirmed by ICA (true positive) and revascularized. In four patients (3.9 %), ISR was suspected by CCTA but excluded by ICA (false positive). In our study, according to the agreement of CCTA in detection or exclusion of ISR, sensitivity, specificity, PPV, NPV and accuracy were 80.0 %, 96.65 %, 66.67 %, 97.78 %, 94.12 %, respectively. These results were statistically significant (P < 0.001). CONCLUSIONS In up to 86 % of symptomatic patients with previous PCI, ISR was accurately excluded by CCTA. CCTA was demonstrated by this study as a high yielding tool for ruling out ISR, abolishing the need for more invasive and expensive diagnostic procedures.
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Affiliation(s)
- Mostafa N Elwany
- Lecturer of Cardiology and Angiology, Faculty of Medicine, Alexandria University, Egypt
| | - Michael Abskharoun
- MBBCh, Resident at Cardiology and Angiology Department, Alexandria University, Egypt
| | - Moustafa Dawood
- Assistant Lecturer of Cardiology and Angiology, Department of Cardiology and Angiology, Faculty of Medicine, Alexandria University, Egypt.
| | - Salah M Al-Tahan
- Professor of Cardiology and Angiology, Faculty of Medicine, Alexandria University, Egypt
| | - Mohamed Sanhoury
- Assistant Professor of Cardiology and Angiology, Faculty of Medicine, Alexandria University, Egypt
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Moroni A, Marin F, Venturi G, Scarsini R, Ribichini F, De Maria GL, Banning AP. Management of failed stenting of the unprotected left main coronary artery. Catheter Cardiovasc Interv 2023; 101:1001-1013. [PMID: 37002949 DOI: 10.1002/ccd.30636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 02/16/2023] [Accepted: 03/03/2023] [Indexed: 04/03/2023]
Abstract
Percutaneous coronary intervention (PCI) is increasingly accepted as treatment for unprotected left main coronary artery (ULMCA) disease especially in those patients who are unsuitable for cardiac surgery. Treatment of any stent failure is associated with increased complexity and worse clinical outcomes when compared with de novo lesion revascularization. Intracoronary imaging has provided new insight into mechanisms of stent failure and treatment options have developed considerably over the last decade. There is paucity of evidence on the management strategy for stent failure in the specific setting of ULMCA. Treating any left main with PCI requires careful consideration and consequently treatment of failed stents in ULMCA is complex and provides unique challenges. Consequently, we provide an overview of ULMCA stent failure, proposing a tailored algorithm to guide best management and decision in daily clinical practice, with a special focus on intracoronary imaging characterization of causal mechanisms and specific technical and procedural considerations.
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Affiliation(s)
- Alice Moroni
- Clinical and Interventional Cardiology Department, IRCCS Policlinico San Donato, University of Milan, San Donato Milanese, Italy
| | - Federico Marin
- Deparment of Cardiology, Oxford Heart Centre, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Gabriele Venturi
- Division of Cardiology, Department of Medicine, University of Verona, Verona, Italy
| | - Roberto Scarsini
- Division of Cardiology, Department of Medicine, University of Verona, Verona, Italy
| | - Flavio Ribichini
- Division of Cardiology, Department of Medicine, University of Verona, Verona, Italy
| | - Giovanni Luigi De Maria
- Deparment of Cardiology, Oxford Heart Centre, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Adrian P Banning
- Deparment of Cardiology, Oxford Heart Centre, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
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Abstract
Major advances in coronary interventional techniques and pharmacotherapy as well as the use of drug-eluting stents (DESs) have considerably reduced the risk of in-stent restenosis (ISR). However, ISR remains a major clinical challenge. Inflammation and platelet activation are important processes that underlie the pathophysiology of ISR. Parameters related to blood cells, entailing both cell count and morphology, are useful markers of the inflammatory response and platelet activation in clinical practice. Recent studies have highlighted several new combined or derived parameters related to blood cells that independently predict ISR after DES implantation. The neutrophil/lymphocyte ratio, an inflammatory marker, is regarded as a predictor of the risk of ISR and the stability of atherosclerotic plaques. The mean platelet volume, a widely used platelet activation parameter, has been shown to be a predictor of the risk of ISR and the efficacy of antiplatelet therapy. Other markers considered include the platelet/lymphocyte ratio, red blood cell distribution width, and platelet distribution width. This review provides an overview of these parameters that may help stratify the risk of coronary angiographic and clinical outcomes related to ISR.
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Affiliation(s)
- Zhichao Wang
- 1 Department of Cardiology, Tongji Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Chi Liu
- 2 Department of Rehabilitation, Jing An District Central Hospital, Shanghai, China
| | - Hong Fang
- 1 Department of Cardiology, Tongji Hospital, School of Medicine, Tongji University, Shanghai, China
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Tomizawa N, Yamamoto K, Inoh S, Nojo T, Nakamura S. High-risk Plaque and Calcification Detected by Coronary CT Angiography to Predict Future Cardiovascular Events After Percutaneous Coronary Intervention. Acad Radiol 2018; 25:486-493. [PMID: 29195787 DOI: 10.1016/j.acra.2017.10.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Revised: 10/24/2017] [Accepted: 10/27/2017] [Indexed: 12/28/2022]
Abstract
RATIONALE AND OBJECTIVES The purpose of this study was to investigate whether high-risk plaque (HRP) and calcium assessed by coronary computed tomography (CT) could predict future cardiovascular events after second-generation drug-eluting stent (DES) placement. MATERIALS AND METHODS We analyzed 317 patients from December 2012 to April 2015 who underwent coronary CT followed by DES placement. HRP was defined as a plaque with positive remodeling and low attenuation or a plaque with a napkin-ring sign. Coronary calcium was assessed by Agatston score (AS). Patients were divided into three groups: low risk, HRP negative and AS <400; intermediate risk, HRP positive and AS ≥400; high risk, HRP positive and AS ≥400. The primary end point was a composite of all-cause mortality, myocardial infarction, fatal arrhythmia, or repeated revascularization. Kaplan-Meier analysis was used to estimate the distribution of time to events. RESULTS A total of 74 events (23%) occurred during a median follow-up of 25.8 months. Patients with primary end points had HRP more frequently (70% vs 51%, P = 0.003) and were more calcified (AS, 471 [interquartile range, 143-1614] vs 289 [interquartile range, 63-787]; P = 0.01) than patients without primary end points. The frequency of primary end point increased significantly in the intermediate- and high-risk patients (P = 0.0011). Multivariate analysis showed that the hazard ratio of the intermediate- and high-risk groups was 1.91 (95% confidence interval, 1.04-3.77; P = 0.037) and 2.66 (95% confidence interval, 1.27-5.73; P = 0.009), respectively. CONCLUSION Plaque and calcification analysis by coronary CT could predict future cardiovascular events after second-generation DES placement.
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Affiliation(s)
- Nobuo Tomizawa
- Department of Radiology, New Tokyo Hospital, 1271 Wanagaya, Matsudo, Chiba 270-2232, Japan.
| | - Kodai Yamamoto
- Department of Radiology, New Tokyo Hospital, 1271 Wanagaya, Matsudo, Chiba 270-2232, Japan
| | - Shinichi Inoh
- Department of Radiology, New Tokyo Hospital, 1271 Wanagaya, Matsudo, Chiba 270-2232, Japan
| | - Takeshi Nojo
- Department of Radiology, New Tokyo Hospital, 1271 Wanagaya, Matsudo, Chiba 270-2232, Japan
| | - Sunao Nakamura
- Department of Cardiology, New Tokyo Hospital, Matsudo, Chiba, Japan
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Liu S, Yang Y, Jiang S, Tang N, Tian J, Ponnusamy M, Tariq MA, Lian Z, Xin H, Yu T. Understanding the role of non-coding RNA (ncRNA) in stent restenosis. Atherosclerosis 2018; 272:153-161. [PMID: 29609130 DOI: 10.1016/j.atherosclerosis.2018.03.036] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Revised: 03/08/2018] [Accepted: 03/21/2018] [Indexed: 02/02/2023]
Abstract
Coronary heart disease (CHD) is one of the leading disorders with the highest mortality rate. Percutaneous angioplasty and stent implantation are the currently available standard methods for the treatment of obstructive coronary artery disease. However, the stent being an exogenous substance causes several complications by promoting the proliferation of vascular smooth muscle cells, immune responses and neointima formation after implantation, leading to post-stent restenosis (ISR) and late thrombosis. The prevention of these adverse vascular events is important to achieve long-term proper functioning of the heart after stent implantation. Non-coding ribonucleic acids (ncRNAs) are RNA molecules not translated into proteins, theyhave a great potential in regulating endothelial cell and vascular smooth muscle function as well as inflammatory reactions. In this review, we outline the regulatory functions of different classes of ncRNA in cardiovascular disease and propose ncRNAs as new targets for stent restonosis treatment.
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Affiliation(s)
- Shaoyan Liu
- Department of Cardiology, The Affiliated Hospital of Qingdao University, 266000, People's Republic of China
| | - Yanyan Yang
- Institue for Translational Medicine, Qingdao University, 266021, People's Republic of China
| | - Shaoyan Jiang
- Department of Cardiology, The Affiliated Cardiovascular Hospital of Qingdao University, 266000, People's Republic of China
| | - Ningning Tang
- Institue for Translational Medicine, Qingdao University, 266021, People's Republic of China
| | - Jiawei Tian
- Department of Emergency, The Affiliated Hospital of Qingdao University, 266000, People's Republic of China
| | - Murugavel Ponnusamy
- Institue for Translational Medicine, Qingdao University, 266021, People's Republic of China
| | - Muhammad Akram Tariq
- Department of Biomolecular Engineering, Jack Baskin School of Engineering, University of California, Santa Cruz, CA, United states
| | - Zhexun Lian
- Department of Cardiology, The Affiliated Hospital of Qingdao University, 266000, People's Republic of China
| | - Hui Xin
- Department of Cardiology, The Affiliated Hospital of Qingdao University, 266000, People's Republic of China.
| | - Tao Yu
- Institue for Translational Medicine, Qingdao University, 266021, People's Republic of China.
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Li Y, Yu M, Li W, Lu Z, Wei M, Zhang J. Third generation dual-source CT enables accurate diagnosis of coronary restenosis in all size stents with low radiation dose and preserved image quality. Eur Radiol 2018; 28:2647-2654. [PMID: 29349698 DOI: 10.1007/s00330-017-5256-3] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Revised: 12/05/2017] [Accepted: 12/18/2017] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To investigate the diagnostic performance of low dose stent imaging in patients with large (≥ 3 mm) and small (< 3 mm) calibre stents by third-generation dual-source CT. METHODS Symptomatic patients suspected of having in-stent restenosis (ISR) were prospectively enrolled. Coronary computed tomography angiography (CCTA) and invasive coronary angiography (ICA) were performed within 1 month for correlation. Binary ISR was defined as an in-stent neointimal proliferation with diameter stenosis ≥ 50%. The radiation dose and image quality of CCTA were also assessed. RESULTS Sixty-nine patients with 140 stents were ultimately included for analysis. The mean total radiation dose of CCTA was 1.3 ± 0.72 mSv in all patients and 0.95 ± 0.17 mSv in patients with high pitch acquisition. The overall diagnostic accuracy of CCTA stent imaging of patient-based, lesion-based and stent-based analysis was 95.7%, 94.1% and 94.3%, respectively. Further, the diagnostic accuracy of CCTA in the small calibre stent group (diameter < 3 mm) was slightly lower than that of the large calibre stent group (diameter ≥ 3 mm) (88.5% versus 98.7%, p = 0.01). CONCLUSIONS Third-generation dual-source CT enables accurate diagnosis of coronary ISR of both large and small calibre stents. Low radiation dose could be achieved with preserved image quality. KEY POINTS • Third-generation DSCT enables accurate diagnosis of coronary ISR of all size stents. • Low radiation dose could be achieved with preserved image quality. • The diagnostic accuracy of CCTA of small calibre stents was 88.5%.
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Affiliation(s)
- Yuehua Li
- Institute of Diagnostic and Interventional Radiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, #600, Yishan Rd, Shanghai, 200233, China
| | - Mengmeng Yu
- Institute of Diagnostic and Interventional Radiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, #600, Yishan Rd, Shanghai, 200233, China
| | - Wenbin Li
- Institute of Diagnostic and Interventional Radiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, #600, Yishan Rd, Shanghai, 200233, China
| | - Zhigang Lu
- Department of Cardiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, #600, Yishan Rd, Shanghai, China
| | - Meng Wei
- Department of Cardiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, #600, Yishan Rd, Shanghai, China
| | - Jiayin Zhang
- Institute of Diagnostic and Interventional Radiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, #600, Yishan Rd, Shanghai, 200233, China.
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Bradaric C, Eser K, Preuss S, Dommasch M, Wustrow I, Langwieser N, Haller B, Ott I, Fusaro M, Heemann U, Laugwitz KL, Kastrati A, Ibrahim T. Drug-eluting stents versus bare metal stents for the prevention of restenosis in patients with renovascular disease. EUROINTERVENTION 2017; 13:e248-e255. [PMID: 28044987 DOI: 10.4244/eij-d-16-00697] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS The aim of this study was to assess the impact of drug-eluting stents (DES) compared to bare metal stents (BMS) for the endovascular treatment of atherosclerotic renal artery stenosis (ARAS). METHODS AND RESULTS We retrospectively evaluated all of our endovascular BMS and DES implantations performed in de novo ARAS between 2000 and 2014 at our institution. The occurrence of in-stent restenosis (ISR) detected by ultrasound or angiography, kidney function, blood pressure (BP), and the number of antihypertensive drugs were analysed as endpoints. Overall, 338 renal arteries were treated in 298 patients. BMS were implanted in 163 (48%), and DES in 175 lesions (52%). Of the 175 lesions treated with DES, 55 (31%) were treated with a BMS-in-DES hybrid technique. For reasons of comparability, only lesions treated with balloon sizes of 4-6.5 mm were included in the final analysis. After 12 months, the rate of ISR >50% was 18.6% in the BMS group and 7.2% in the DES group (p=0.031). None of the BMS-in-DES-treated (hybrid) lesions developed ISR (hybrid technique vs. BMS only p=0.008, hybrid technique vs. DES only p=0.034). Systolic BP and number of antihypertensive drugs remained unchanged in the BMS group but declined in the DES group (p=0.02). Renal function significantly deteriorated in the BMS group (p=0.03) but did not change significantly in the DES group (p=0.188). CONCLUSIONS DES were superior to BMS in preventing ISR. Overall, the BMS-in-DES-technique (hybrid) achieved the lowest risk for ISR.
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Affiliation(s)
- Christian Bradaric
- Medizinische Klinik und Poliklinik, Klinikum Rechts der Isar, Technische Universität München, Munich, Germany
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Schächtele J. On the Design of Passive Resonant Circuits to Measure Local Pulse Wave Velocity in a Stent. IEEE TRANSACTIONS ON BIOMEDICAL CIRCUITS AND SYSTEMS 2016; 10:612-622. [PMID: 26800547 DOI: 10.1109/tbcas.2015.2496420] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
In-stent restenosis is a frequent complication after stent implantation. This article investigates the design of a passive sensor system to be integrated into a stent for the detection of an in-stent restenosis by measuring the local pulse wave velocity (PWV). The proposed system uses two resonant circuits consisting of a capacitive pressure sensor and a coil as transponders. The pressure sensors are located at the proximal and distal end of the stent. An alternating external magnetic field with a constant frequency is applied such that the resonance frequencies of the transponders cross the excitation frequency when the pulse wave passes. The time delay between the resonances at the transponders can be captured to obtain the PWV. A model for the measurement system and a correlation between transponder design parameters and minimal resolvable time delay are derived. This correlation is based on the criterion that the 3 dB bandwidth of the transponder resonances may not overlap in the measurement time interval. This correlation can be used to design and analyze a transponder system for the proposed measurement system. In an experiment, in which the pressure sensors have been emulated by varactor diodes, it could be shown that the model is valid and that the criterion is suitable. Finally, the relevant design parameters of the transponders have been identified and their limitations investigated.
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Han B, Ge CQ, Zhang HG, Zhou CG, Ji GH, Yang Z, Zhang L. Effects of tripterygium glycosides on restenosis following endovascular treatment. Mol Med Rep 2016; 13:4959-68. [PMID: 27108914 PMCID: PMC4878561 DOI: 10.3892/mmr.2016.5149] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2015] [Accepted: 01/12/2016] [Indexed: 11/06/2022] Open
Abstract
The mechanism and associated factors of restenosis following intravascular stent implantation remain to be elucidated. The present two‑part experimental and clinical study aimed to investigate the effects of tripterygium glycosides on in‑stent restenosis subsequent to intra‑arterial therapy. Following endovascular stent implantation in rabbit iliac arteries, post‑stent outcomes were evaluated in cyclosporine groups, low‑dose and high‑dose tripterygium glycosides groups and controls. Post‑operative angiography indicated that vessel diameters were similar between groups; however, at 28 days after receiving the therapeutic agents, vessels of the cyclosporine and tripterygium glycosides groups were significantly larger than those of the controls. Furthermore, three groups of patients had comparable baseline levels of interleukin (IL)‑10, IL‑18 and C‑reactive protein, and intima‑media thickness. However, 1 month after stent implantation, levels of IL‑10 and IL‑18 were markedly reduced in the high‑ and low‑dose tripterygium glycosides groups compared with controls. At 6 months after surgery, the stent patency rate in patients with bare stents was significantly lower than in patients receiving tripterygium glycosides (P≤0.009). In addition, the ankle‑brachial index was also higher than in those without tripterygium glycosides (P<0.001). Results of the experimental and clinical studies suggest that tripterygium glycosides may inhibit and possibly aid in the prevention of in‑stent restenosis formation following endovascular treatment of lower‑extremity artery disease.
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Affiliation(s)
- Bing Han
- Department of Vascular Surgery, The Second Hospital of Baoding, Baoding, Hebei 071051, P.R. China
| | - Chang-Qing Ge
- Department of Vascular Surgery, The Second Hospital of Baoding, Baoding, Hebei 071051, P.R. China
| | - Hong-Guang Zhang
- Department of Vascular Surgery, The Second Hospital of Baoding, Baoding, Hebei 071051, P.R. China
| | - Chen-Guang Zhou
- Department of Vascular Surgery, The Second Hospital of Baoding, Baoding, Hebei 071051, P.R. China
| | - Guo-Hui Ji
- Department of Vascular Surgery, The Second Hospital of Baoding, Baoding, Hebei 071051, P.R. China
| | - Zheng Yang
- Department of Vascular Surgery, The Second Hospital of Baoding, Baoding, Hebei 071051, P.R. China
| | - Liang Zhang
- Department of Vascular Surgery, The Second Hospital of Baoding, Baoding, Hebei 071051, P.R. China
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Role of red blood cell distribution in predicting drug-eluting stent restenosis in patients with stable angina pectoris after coronary stenting. Coron Artery Dis 2016; 26:220-4. [PMID: 25647458 DOI: 10.1097/mca.0000000000000221] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND It has been reported that increased red blood cell distribution width (RDW) predicts adverse events in cardiovascular disease and in patients undergoing percutaneous coronary intervention. However, the role of serum RDW levels in drug-eluting stent (DES) restenosis remains unclear. We aimed to investigate the relationship between serum RDW levels and in-stent restenosis (ISR) after coronary stenting with DES in stable angina pectoris (SAP) patients. MATERIALS AND METHODS A total of 293 consecutive chronic SAP patients with coronary DES implantation were enrolled in this study. The ISR was analyzed by coronary angiography analysis at a mean follow-up of 8 months. According to whether ISR was detected, patients were divided into two groups: the ISR group (n=45) and the non-ISR group (n=247). Serum RDW was assessed both at admission and at the 8-month follow-up in all patients. Standard medication was continued throughout the investigation period. RESULTS Baseline characteristics of the two groups were similar. Patients in the ISR group had significantly higher RDW levels compared with patients in the non-ISR group both at admission and at follow-up (P<0.01, respectively). Furthermore, the ISR group had significantly longer stent length and lower stent diameter compared with the non-ISR group (P<0.01, respectively). In a multivariate analysis, diabetes mellitus, current smoking, RDW levels, C-reactive protein levels, stent length, and stent diameter were associated independently with ISR. CONCLUSION Serum RDW level may independently predict ISR at both admission and follow-up in SAP patients with coronary DES implantation, which indicates that a chronic inflammatory response might be involved in the pathogenesis of ISR.
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Zhao K, Li Y, Jin Z, Gao S. The association of red blood cell distribution width with drug-eluting stent restenosis in unstable angina pectoris patients. Int J Cardiol 2015; 191:1-3. [DOI: 10.1016/j.ijcard.2015.04.237] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2015] [Revised: 04/23/2015] [Accepted: 04/30/2015] [Indexed: 10/23/2022]
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12
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Li M, Liu S, Zhang J, Lu Z, Wei M, Chun EJ, Lu B. Coronary competitive reverse flow: Imaging findings at CT angiography and correlation with invasive coronary angiography. J Cardiovasc Comput Tomogr 2015; 9:202-8. [PMID: 25843241 DOI: 10.1016/j.jcct.2015.01.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2014] [Revised: 01/28/2015] [Accepted: 01/28/2015] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To study the imaging features of coronary competitive reverse flow and incidence of a "reverse attenuation gradient" in coronary CT angiography (CTA) with correlation to invasive coronary angiography (ICA). METHODS Patients who had undergone coronary CTA and ICA within 2 weeks were retrospectively identified in our database and reviewed. All cases with ICA-confirmed competitive reverse flow or chronic total occlusions (CTOs) were included for further analysis. The "reverse attenuation gradient sign" was defined as a reverse intraluminal opacification gradient of vessels which showed higher opacification in more distal compared with proximal segments. ICA findings were recorded and served as the reference to identify the clinical implications of this sign. RESULTS In total, 134 patients (mean age, 68.1 ± 11.3 years; range, 38-90 years; 104 men) were included in our study. ICA revealed 11 cases of coronary competitive reverse flow and 123 cases of CTO. A reverse attenuation gradient sign was present in 9 of 11 patients (82%) with coronary competitive reverse flow and 72 of 123 (59%) chronically occluded coronary arteries. Myocardial bridges, distal collateral filling, as well as direct visualization of collateral connection were all more frequent in cases with coronary competitive reverse flow group compared with cases with a CTO. CONCLUSIONS The reverse attenuation gradient sign distal to an upstream coronary severe stenosis indicates the presence of competitive collateral flow. Coronary CTA is able to correctly detect coronary competitive collateral flow and differentiate it from CTOs.
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Affiliation(s)
- Minghua Li
- Institute of Diagnostic and Interventional Radiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, No. 600, Yishan Road, Shanghai 200233, China
| | - Shuyong Liu
- Shandong University, School of Medicine, Jinan, China
| | - Jiayin Zhang
- Institute of Diagnostic and Interventional Radiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, No. 600, Yishan Road, Shanghai 200233, China.
| | - Zhigang Lu
- Department of Cardiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Meng Wei
- Department of Cardiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Eun-Ju Chun
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam City, Korea
| | - Bin Lu
- Department of Radiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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