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Nugteren MJ, Ünlü Ç, Samim M, Scheffer HJ, de Borst GJ, Hazenberg CEVB. Inter- and Intra-observer Agreement of the Peripheral Arterial Calcium Scoring System in Patients Undergoing (Infra)Popliteal Endovascular Interventions. Cardiovasc Intervent Radiol 2024:10.1007/s00270-024-03839-1. [PMID: 39187653 DOI: 10.1007/s00270-024-03839-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2024] [Accepted: 08/10/2024] [Indexed: 08/28/2024]
Abstract
PURPOSE Peripheral arterial calcification is an important predictor of outcomes after both conservative and endovascular treatment. Digital subtraction angiography (DSA)-based calcification scores are limited by low sensitivity and inter-observer agreement. The Peripheral Arterial Calcium Scoring System (PACSS) assesses the severity of target lesion calcification. The newly introduced modified PACSS (mPACSS) also evaluates target vessel calcification. This study aimed to assess the inter- and intra-observer reliability of PACSS and mPACSS on computed tomography angiography (CTA) in (infra)popliteal endovascular interventions. METHODS A random sample of 50 limbs from the prospective multicenter Dutch Chronic Lower Limb-Threatening Ischemia Registry (THRILLER) were included. Three experienced independent raters scored PACSS on CTA. Three months later, one blinded rater assessed the same 50 CTA scans, keeping track of assessment time. The reliability of the original 5-step PACSS, a simplified binary PACSS (0-2 vs 3-4) and the 7-step mPACSS were tested using Cohen's and Fleiss' kappa statistics. RESULTS In total, 50 limbs (mean age 70.1 ± 11.0, 29 men) with 41 popliteal and 40 infrapopliteal lesions were scored. Inter-observer agreement of PACSS and binary PACSS were moderate (κ = 0.60) and substantial (κ = 0.72), respectively, while intra-observer agreement was almost perfect in both scores (κ = 0.86). Inter- and intra-observer agreement of mPACSS were moderate (κ = 0.48) and substantial (κ = 0.77), respectively. Mean assessment time for an experienced rater was 3.43 ± 0.93 min per CTA scan. CONCLUSION Both the semi-quantitative PACSS and mPACSS scores for (infra)popliteal arteries can be performed reliably on pre-operative CTA.
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Affiliation(s)
- Michael J Nugteren
- Department of Vascular Surgery, University Medical Center Utrecht, Heidelberglaan 100, 3584CX, Utrecht, The Netherlands.
- Department of Vascular Surgery, Noordwest Ziekenhuisgroep, Alkmaar, The Netherlands.
| | - Çağdaş Ünlü
- Department of Vascular Surgery, Noordwest Ziekenhuisgroep, Alkmaar, The Netherlands
| | - Morsal Samim
- Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Hester J Scheffer
- Department of Radiology, Noordwest Ziekenhuisgroep, Alkmaar, The Netherlands
| | - Gert J de Borst
- Department of Vascular Surgery, University Medical Center Utrecht, Heidelberglaan 100, 3584CX, Utrecht, The Netherlands
| | - Constantijn E V B Hazenberg
- Department of Vascular Surgery, University Medical Center Utrecht, Heidelberglaan 100, 3584CX, Utrecht, The Netherlands
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Li T, Xu R, Ma Y, Wang T, Yang B, Jiao L. Calcification is a risk factor for intracranial in-stent restenosis: an optical coherence tomography study. J Neurointerv Surg 2024; 16:897-901. [PMID: 37536931 DOI: 10.1136/jnis-2023-020624] [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] [Received: 05/22/2023] [Accepted: 07/20/2023] [Indexed: 08/05/2023]
Abstract
BACKGROUND The frequent occurrence of calcification in intracranial artery stenosis increases the risk of ischemic stroke. In previous cases, we have observed a possible relationship between calcification and intracranial in-stent restenosis (ISR) using optical coherence tomography (OCT). Therefore, our study aimed to demonstrate the relationship between intracranial calcification and ISR with a larger sample size. METHODS For our study patients who underwent OCT for intracranial artery stenosis before stenting were included from May 2020 to October 2022. Follow-up assessments were performed using transcranial color-coded duplex (TCCD) sonography ultrasonography to detect cases of ISR. RESULTS We recruited 54 patients, 15 of them were excluded as they did not meet the study criteria. Our study included 39 patients, of whom 21 had calcification, and 18 did not. The results of our study revealed a significant association between calcification and intracranial ISR (9 (42.86) vs 2 (11.11), p=0.0375). Notably, patients with macrocalcification were more likely to undergo ISR than patients with spotty calcification (77.78% vs 22.22%, p=0.03). CONCLUSION OCT imaging demonstrates that calcification is an essential risk factor for intracranial ISR. These findings have important implications for individualized treatment. They provide valuable insights for optimizing stent design and exploring potential mechanisms of intracranial ISR. TRIAL REGISTRATION NUMBER ClinicalTrials.gov Identifier: NCT05550077.
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Affiliation(s)
- Tianhua Li
- Department of Neurosurgery, Xuanwu Hospital Capital Medical University, Beijing, China
- China International Neuroscience Institute (China-INI), Beijing, China
| | - Ran Xu
- Department of Neurosurgery, Xuanwu Hospital Capital Medical University, Beijing, China
- China International Neuroscience Institute (China-INI), Beijing, China
| | - Yan Ma
- Department of Neurosurgery, Xuanwu Hospital Capital Medical University, Beijing, China
- China International Neuroscience Institute (China-INI), Beijing, China
| | - Tao Wang
- Department of Neurosurgery, Xuanwu Hospital Capital Medical University, Beijing, China
- China International Neuroscience Institute (China-INI), Beijing, China
| | - Bin Yang
- Department of Neurosurgery, Xuanwu Hospital Capital Medical University, Beijing, China
- China International Neuroscience Institute (China-INI), Beijing, China
| | - Liqun Jiao
- Department of Neurosurgery, Xuanwu Hospital Capital Medical University, Beijing, China
- China International Neuroscience Institute (China-INI), Beijing, China
- Department of Interventional Neuroradiology, Xuanwu Hospital Capital Medical University, Beijing, China
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Qi Y, Zhang H, Zhao J, Yuan D, Wang J, Ge J, Huang B, Weng C, Wang T. Safety and efficacy of drug-eluting stents versus heparin-bonded stents in treatment of femoropopliteal peripheral artery disease: study protocol for a multicentre, prospective randomised controlled trial in China (ELITE trial). BMJ Open 2024; 14:e080560. [PMID: 39117410 DOI: 10.1136/bmjopen-2023-080560] [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] [Indexed: 08/10/2024] Open
Abstract
INTRODUCTION Endovascular therapy has emerged as a prominent strategy for managing femoropopliteal peripheral artery disease, offering acceptable safety and efficacy compared with open surgical bypass. Both paclitaxel-eluting stents and heparin-bonded covered stents have exhibited enhanced clinical outcomes compared with bare metal stents. However, there is currently a lack of level I evidence comparing the safety and efficacy of paclitaxel-eluting stents and heparin-bonded covered stents. Therefore, the primary objective of this study is to systematically evaluate the efficacy and safety outcomes of these two types of stents. METHODS AND ANALYSIS The ELITE trial is a prospective, multicentre, parallel, randomised controlled trial. A total of 450 patients will be recruited. The primary endpoints of the study include primary patency at 1 year post-index procedure. ETHICS AND DISSEMINATION Ethical approval for this study was obtained from the Ethics Committee of West China Hospital of Sichuan University (approval number: 2023-1186). The results will be submitted to a major clinical journal for peer review and publication. TRIAL REGISTRATION ELITE trial was registered on 27 September 2023 in the Chinese Clinical Trials Registry (ChiCTR2300076236).
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Affiliation(s)
- Yuhan Qi
- Division of Vascular Surgery, Department of General Surgery, West China Hospital, Sichuan University, Sichuan Province, China
- West China School of Medicine, Sichuan University, Chengdu, China
| | - Huawei Zhang
- Department of Radiology and Huaxi MR Research Center (HMRRC), Functional and Molecular Imaging Key Laboratory of Sichuan Province, West China Hospital, Sichuan University, Chengdu, China
| | - Jichun Zhao
- Division of Vascular Surgery, Department of General Surgery, West China Hospital, Sichuan University, Sichuan Province, China
| | - Ding Yuan
- Division of Vascular Surgery, Department of General Surgery, West China Hospital, Sichuan University, Sichuan Province, China
| | - Jiarong Wang
- Division of Vascular Surgery, Department of General Surgery, West China Hospital, Sichuan University, Sichuan Province, China
| | - Jinting Ge
- Division of Vascular Surgery, Department of General Surgery, West China Hospital, Sichuan University, Sichuan Province, China
| | - Bin Huang
- Division of Vascular Surgery, Department of General Surgery, West China Hospital, Sichuan University, Sichuan Province, China
| | - Chengxin Weng
- Division of Vascular Surgery, Department of General Surgery, West China Hospital, Sichuan University, Sichuan Province, China
| | - Tiehao Wang
- Division of Vascular Surgery, Department of General Surgery, West China Hospital, Sichuan University, Sichuan Province, China
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Gouveia E Melo R, Torsello G, Argyriou A, Chlouverakis G, Bisdas T, Beropoulis E, Tsilimparis N, Stavroulakis K. Impact of Calcification on the Outcomes of Femoropopliteal Artery Endovascular Treatment Using a Polymer Coated Drug-Eluting Stent. Cardiovasc Intervent Radiol 2024; 47:543-553. [PMID: 38332120 DOI: 10.1007/s00270-024-03662-8] [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: 05/14/2023] [Accepted: 01/10/2024] [Indexed: 02/10/2024]
Abstract
PURPOSE The aim of this study was to analyze the impact of calcification on the 12 and 24 months outcomes of the Eluvia™ (Boston Scientific®) drug-eluting stent (DES) for femoropopliteal occlusive disease using three different calcium scoring systems. MATERIAL AND METHODS A single-center, retrospective cohort-study (March-2016 to December-2018) of patients treated with the Eluvia™ DES for femoropopliteal atherosclerosis was performed. Outcomes included primary and secondary patency rates and freedom from target lesion revascularization (FTLR) and were analyzed by comparing the impact of calcium burden according to the following calcium scores: Peripheral Arterial Calcium Scoring System (PACSS) score, number of vessel quadrants affected (0-4) and calcification score per Peripheral Academic Research Consortium (PARC) definitions. RESULTS In total, 111 Patients were included (mean age: 71.2 ± 7.9; 64% male). Most patients presented with Rutherford class 3 (79.9%), followed by class 5 (12.7%), class 4 (10%) and class 6 (6.4%). The mean lesion length was 197.6 ± 108.5 mm and 74.3% of patients had chronic total occlusions. There were no differences in primary patency between the calcification scores at 12 months (PACSS, LogRank = 0.28; quadrants, LogRank = 0.29; PARC, LogRank = 0.42) and 24 months (PACSS, LogRank = 0.13; quadrants, LogRank = 0.42; PARC, LogRank = 0.13). FTLR was significantly lower at 12 months in patients with calcification affecting 3 or 4 quadrants (LogRank = 0.022) but not at 24 months (LogRank = 0.36). CONCLUSIONS In this study, the Eluvia™ DES showed promising performance in calcified disease and the analysis according to the quadrant model predicted an increased risk for TLR at 12 months.
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Affiliation(s)
- Ryan Gouveia E Melo
- Vascular Surgery Department, Ludwig Maximilian University Hospital, Campus Grosshadern, Marchioninistrasse 15, 81377, Munich, Germany.
| | - Giovanni Torsello
- Department of Vascular Surgery, St. Franziskus-Hospital GmbH, Münster, Germany
| | - Angeliki Argyriou
- Department of Vascular and Endovascular Surgery, Marien Hospital, Herne, Germany
| | - Gregory Chlouverakis
- Division of Biostatistics, School of Medicine, University of Heraklion, Heraklion, Greece
| | - Theodosios Bisdas
- Department of Vascular Surgery, St. Franziskus-Hospital GmbH, Münster, Germany
- Department of Vascular and Endovascular Surgery, Athens Medical Center, Athens, Greece
| | | | - Nikolaos Tsilimparis
- Vascular Surgery Department, Ludwig Maximilian University Hospital, Campus Grosshadern, Marchioninistrasse 15, 81377, Munich, Germany
| | - Konstantinos Stavroulakis
- Vascular Surgery Department, Ludwig Maximilian University Hospital, Campus Grosshadern, Marchioninistrasse 15, 81377, Munich, Germany
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Gierig M, Gaziano P, Wriggers P, Marino M. Post-angioplasty remodeling of coronary arteries investigated via a chemo-mechano-biological in silico model. J Biomech 2024; 166:112058. [PMID: 38537368 DOI: 10.1016/j.jbiomech.2024.112058] [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] [Received: 12/12/2023] [Revised: 03/20/2024] [Accepted: 03/21/2024] [Indexed: 04/13/2024]
Abstract
This work presents the application of a chemo-mechano-biological constitutive model of soft tissues for describing tissue inflammatory response to damage in collagen constituents. The material model is implemented into a nonlinear finite element formulation to follow up a coronary standard balloon angioplasty for one year. Numerical results, compared with available in vivo clinical data, show that the model reproduces the temporal dynamics of vessel remodeling associated with subintimal damage. Such dynamics are bimodular, being characterized by an early tissue resorption and lumen enlargement, followed by late tissue growth and vessel constriction. Applicability of the modeling framework in retrospective studies is demonstrated, and future extension towards prospective applications is discussed.
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Affiliation(s)
- Meike Gierig
- Institute of Continuum Mechanics, Leibniz University of Hannover, An der Universität 1, 30823 Garbsen, Germany
| | - Pierfrancesco Gaziano
- Department of Civil Engineering and Computer Science Engineering, University of Rome Tor Vergata, Via del Politecnico 1, 00133 Rome, Italy
| | - Peter Wriggers
- Institute of Continuum Mechanics, Leibniz University of Hannover, An der Universität 1, 30823 Garbsen, Germany
| | - Michele Marino
- Department of Civil Engineering and Computer Science Engineering, University of Rome Tor Vergata, Via del Politecnico 1, 00133 Rome, Italy.
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Nakao S, Iida O, Takahara M, Okamoto S, Ishihara T, Tsujimura T, Hata Y, Toyoshima T, Higashino N, Mano T. Impact of Procedural Techniques on Midterm Patency of Fluoropolymer-Based Drug-Eluting Stent Placed in the Femoropopliteal Artery. J Vasc Interv Radiol 2024; 35:259-268. [PMID: 37898458 DOI: 10.1016/j.jvir.2023.10.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 10/16/2023] [Accepted: 10/20/2023] [Indexed: 10/30/2023] Open
Abstract
PURPOSE To investigate the impact of compliance with recommended procedural techniques on the midterm patency of a fluoropolymer-based drug-eluting stent (FP-DES) in the femoropopliteal artery. MATERIALS AND METHODS This retrospective study included 200 femoropopliteal lesions (chronic limb-threatening ischemia, 59%; chronic total occlusion, 41%) in 173 patients (male, 66%; diabetes mellitus, 62%; hemodialysis, 40%) with lower extremity arterial disease who underwent intravascular ultrasound (IVUS)-guided endovascular therapy with FP-DES between January 2016 and July 2021. The primary outcome measure was restenosis, defined as a peak systolic velocity ratio of >2.4 based on the duplex US findings. The association between procedural techniques and incidence of restenosis was investigated using Cox proportional hazards regression models. RESULTS The 2-year cumulative incidence of restenosis was 19.5% (SD ± 3.3). Multivariate analysis revealed that noncompliance with recommended procedural techniques, such as plaque burden at the stent edge of <50%, a minimum stent area (MSA) of >12 mm2, and stent placement within the P1 segment, was independently associated with an increased risk of restenosis (hazard ratios [HRs], 3.22, 4.71, and 4.67 and P = .004, P < .001, and P < .001, respectively). The 2-year restenosis risk for procedures performed in compliance with all 3-technical criteria was 8.4% (SD ± 3.4), whereas the risks for those in compliance with 2-technical criteria or 0- or 1-technical criteria were 25.0% (SD ± 6.2) and 48.6% (SD ± 10.4), respectively. HRs relative to 3-technical criteria compliance were 3.79 (P = .007) and 11.85 (P < .001), respectively. CONCLUSIONS Noncompliance with recommended procedural techniques, including plaque burden at the stent edge of <50%, MSA of >12 mm2, and stent placement within the P1 segment, was significantly associated with an increased risk of 2-year restenosis after FP-DES implantation in the femoropopliteal artery.
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Affiliation(s)
- Sho Nakao
- Cardiovascular Center, Kansai Rosai Hospital, Inabaso, Amagasaki, Hyogo, Japan.
| | - Osamu Iida
- Cardiovascular Center, Kansai Rosai Hospital, Inabaso, Amagasaki, Hyogo, Japan
| | - Mitsuyoshi Takahara
- Department of Diabetes Care Medicine, Osaka University Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Shin Okamoto
- Cardiovascular Center, Kansai Rosai Hospital, Inabaso, Amagasaki, Hyogo, Japan
| | - Takayuki Ishihara
- Cardiovascular Center, Kansai Rosai Hospital, Inabaso, Amagasaki, Hyogo, Japan
| | - Takuya Tsujimura
- Cardiovascular Center, Kansai Rosai Hospital, Inabaso, Amagasaki, Hyogo, Japan
| | - Yosuke Hata
- Cardiovascular Center, Kansai Rosai Hospital, Inabaso, Amagasaki, Hyogo, Japan
| | - Taku Toyoshima
- Cardiovascular Center, Kansai Rosai Hospital, Inabaso, Amagasaki, Hyogo, Japan
| | - Naoko Higashino
- Cardiovascular Center, Kansai Rosai Hospital, Inabaso, Amagasaki, Hyogo, Japan
| | - Toshiaki Mano
- Cardiovascular Center, Kansai Rosai Hospital, Inabaso, Amagasaki, Hyogo, Japan
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Csore J, Drake M, Roy TL. Peripheral arterial disease treatment planning using noninvasive and invasive imaging methods. J Vasc Surg Cases Innov Tech 2023; 9:101263. [PMID: 37767348 PMCID: PMC10520537 DOI: 10.1016/j.jvscit.2023.101263] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 06/06/2023] [Indexed: 09/29/2023] Open
Abstract
With the growing prevalence and mortality of peripheral arterial disease, preoperative assessment, risk stratification, and determining the correct indication for endovascular and open surgical procedures are essential for therapeutic decision-making. The effectiveness of interventional procedures is significantly influenced by the plaque composition and calcification pattern. Therefore, the identification of patients for whom endovascular treatment is the most appropriate therapeutic solution often remains a challenge. The most commonly used imaging techniques have their own limitations and do not provide findings detailed enough for specific, personalized treatment planning. Using state-of-the-art noninvasive and invasive imaging modalities, it is now possible to obtain a view, not only of the complex vascular anatomy and plaque burden of the lower extremity arterial system, but also of complex plaque structures and various pathologic calcium distribution patterns. In the future, as these latest advancements in diagnostic methods become more widespread, we will be able to obtain more accurate views of the plaque structure and anatomic complexity to guide optimal treatment planning and device selection. We reviewed the implications of the most recent invasive and noninvasive lower extremity imaging techniques and future directions.
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Affiliation(s)
- Judit Csore
- DeBakey Heart and Vascular Center, Houston Methodist Hospital, Houston, TX
| | - Madeline Drake
- DeBakey Heart and Vascular Center, Houston Methodist Hospital, Houston, TX
| | - Trisha L. Roy
- DeBakey Heart and Vascular Center, Houston Methodist Hospital, Houston, TX
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Aboloyoun H, Zaki HM, Hasaballa A, Elbadawy A. Dichotomous grouping of peripheral arterial calcification grades: A practical predictor of outcome after endovascular therapy in peripheral arterial disease. Vascular 2023:17085381231214313. [PMID: 37937717 DOI: 10.1177/17085381231214313] [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: 11/09/2023]
Abstract
BACKGROUND There is a general agreement that arterial calcification affects the results of endovascular therapy for peripheral arterial disease (PAD). In addition to lacking evidence for their impact, existing calcification scores are complex, and not practical in everyday decision making. The global limb anatomic staging system (GLASS) adopted dichotomous grouping of calcification grades. OBJECTIVE In this study we aim to investigate the impact of peripheral arterial calcification scoring after dichotomous grouping on midterm outcomes following endovascular therapy for PAD. METHODS This prospective study included all consecutive patients with PAD indicated for endovascular therapy procedure who presented to our tertiary referral center in the period between October 2020 and October 2021. Patients were grouped into Group A (n = 40): with no-to mild calcification (PACSS grade 0,1 and 2), and Group B (n = 53): with severe calcification (PACSS grades 3 and 4). Primary endpoints included technical success rate, primary patency rates, and major adverse limb events rate (MALE) during 2 years of follow-up. RESULTS The mean age of the studied cases (n = 93) was 59.31 ± 6.46 years (range 50-75). 70 patients (75.3%) were males, and 23 (24.7%) were females. There was no statistically significant difference between the two groups regarding technical success rate (97.5% in group A versus 94.33% in Group B, p = .457). The Primary patency rate after 1 year was lower in group B (74%) compared to group A (89.7%), but this difference was not statistically significant (p = .059). However, the 2-year primary patency rate was significantly lower in group B compared to group A (64% versus 84.6% respectively, p = .034). MALE rate after 2 years was significantly higher in group B (28%) as compared to group A (10.4%), P = .048. Studying suspected risk factors revealed that severe calcification was more common in patients with ischemic heart disease (34%) and chronic kidney disease (11%), P= .003 and .002 respectively. Logistic regression analysis showed that patients suffered from IHD and those with length of lesion ≥ 5 cm are about five times more likely to have severe calcification compared to their counterparts (OR = 4.875, 95%CI = 1.293-18.383, p = .019, and OR = 4.513, 95% CI = 11.138-17.893, p = .032), respectively. CONCLUSION The presence of severe calcification is associated with significantly lower midterm primary patency rates and higher rate of major adverse limb events after endovascular intervention for lower limb denovo arterial lesions.
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Affiliation(s)
- Hesham Aboloyoun
- Department of Vascular and Endovascular Surgery, Assiut University Hospitals, Assiut, Egypt
| | - Hazem Mohamed Zaki
- Department of Vascular and Endovascular Surgery, Assiut University Hospitals, Assiut, Egypt
| | - Ayman Hasaballa
- Department of Vascular and Endovascular Surgery, Assiut University Hospitals, Assiut, Egypt
| | - Ahmed Elbadawy
- Department of Vascular and Endovascular Surgery, Assiut University Hospitals, Assiut, Egypt
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Wang X, Nai YH, Gan J, Lian CPL, Ryan FK, Tan FSL, Chan DYS, Ng JJ, Lo ZJ, Chong TT, Hausenloy DJ. Multi-Modality Imaging of Atheromatous Plaques in Peripheral Arterial Disease: Integrating Molecular and Imaging Markers. Int J Mol Sci 2023; 24:11123. [PMID: 37446302 DOI: 10.3390/ijms241311123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 06/14/2023] [Accepted: 06/28/2023] [Indexed: 07/15/2023] Open
Abstract
Peripheral artery disease (PAD) is a common and debilitating condition characterized by the narrowing of the limb arteries, primarily due to atherosclerosis. Non-invasive multi-modality imaging approaches using computed tomography (CT), magnetic resonance imaging (MRI), and nuclear imaging have emerged as valuable tools for assessing PAD atheromatous plaques and vessel walls. This review provides an overview of these different imaging techniques, their advantages, limitations, and recent advancements. In addition, this review highlights the importance of molecular markers, including those related to inflammation, endothelial dysfunction, and oxidative stress, in PAD pathophysiology. The potential of integrating molecular and imaging markers for an improved understanding of PAD is also discussed. Despite the promise of this integrative approach, there remain several challenges, including technical limitations in imaging modalities and the need for novel molecular marker discovery and validation. Addressing these challenges and embracing future directions in the field will be essential for maximizing the potential of molecular and imaging markers for improving PAD patient outcomes.
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Affiliation(s)
- Xiaomeng Wang
- Cardiovascular & Metabolic Disorders Program, Duke-National University of Singapore Medical School, Singapore 169857, Singapore
| | - Ying-Hwey Nai
- Clinical Imaging Research Centre, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117599, Singapore
| | - Julian Gan
- Siemens Healthineers, Singapore 348615, Singapore
| | - Cheryl Pei Ling Lian
- Health and Social Sciences Cluster, Singapore Institute of Technology, Singapore 138683, Singapore
| | - Fraser Kirwan Ryan
- Infocomm Technology Cluster, Singapore Institute of Technology, Singapore 138683, Singapore
| | - Forest Su Lim Tan
- Infocomm Technology Cluster, Singapore Institute of Technology, Singapore 138683, Singapore
| | - Dexter Yak Seng Chan
- Department of General Surgery, Khoo Teck Puat Hospital, Singapore 768828, Singapore
| | - Jun Jie Ng
- Division of Vascular and Endovascular Surgery, Department of Cardiac, Thoracic and Vascular Surgery, National University Heart Centre, Singapore 119074, Singapore
- Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119228, Singapore
| | - Zhiwen Joseph Lo
- Vascular Surgery Service, Department of Surgery, Woodlands Health, Singapore 258499, Singapore
- Centre for Population Health Sciences, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore 308232, Singapore
| | - Tze Tec Chong
- Department of Vascular Surgery, Singapore General Hospital, Singapore 168752, Singapore
- Surgical Academic Clinical Programme, Singapore General Hospital, Singapore 169608, Singapore
- Vascular SingHealth Duke-NUS Disease Centre, Singapore 168752, Singapore
| | - Derek John Hausenloy
- Cardiovascular & Metabolic Disorders Program, Duke-National University of Singapore Medical School, Singapore 169857, Singapore
- National Heart Research Institute Singapore, National Heart Centre, Singapore 169609, Singapore
- Yong Loo Lin School of Medicine, National University Singapore, Singapore 117597, Singapore
- The Hatter Cardiovascular Institute, University College London, London WC1E 6HX, UK
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Pan J, Guo L, Fang X, Feng Z, Li Q, He C, Sang H, Shi W, Shi Z, Wang B, Qiu C, Wu Z, Ye M. Protocol of the evolution study: A prospective, multicenter, observational study evaluating the effect and health economics of endovascular treatment in patients with moderate and severe calcification of femoropopliteal artery. Front Cardiovasc Med 2022; 9:1039313. [PMID: 36330013 PMCID: PMC9622936 DOI: 10.3389/fcvm.2022.1039313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 10/04/2022] [Indexed: 11/21/2022] Open
Abstract
Objectives Peripheral artery disease with calcification is extremely prevalent in the elderly. Due to the calcification, it requires a different clinical approach than the more common arteriosclerosis obliterans of the lower extremity. The introduction of novel technologies such as the drug-coated balloon, directional atherectomy, supera and drug-eluting stent has improved the prognosis of these patients. This study will contribute to the development of higher-quality evidence-based medicine for clinical treatment by assessing the quality of life (QOL), clinical treatment effect, and health economics of patients with calcification. Method and analysis The Evolution study is designed as a prospective, multicenter, observational, real-world study. From January 2021 to December 2022, 600 patients with moderate to severe femoropopliteal artery calcification will be recruited from ten locations in China. After discharge, information on demographics, disease history, procedure details, imaging findings, and follow-up will be collected. Patients will undergo follow-up at 1, 6, 12, 18, and 24 months after operation. Technical success rate, vascular quality of life questionnaire, primary patency rate of the target lesion, clinically driven target lesion revascularization rate (CD-TLR), and health economics evaluation are all included as outcome measures. Conclusions The Evolution study helps to investigate the clinical and financial results of various endovascular therapy modalities for patients with moderate and severe femoropopliteal artery calcification. These actual facts may help to harmonize therapy recommendations for peripheral artery disease. Clinical trial registration The study protocol was registered at www.clinicaltrials.gov (registration number: NCT04716361).
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Affiliation(s)
- Jun Pan
- Department of Vascular Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Lianrui Guo
- Department of Vascular Surgery, Xuanwu Hospital Capital Medical University, Beijing, China
| | - Xin Fang
- Department of Vascular Surgery, Affiliated Hangzhou First People's Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Zibo Feng
- Department of Vascular Surgery, Liyuan Hospital Affiliated Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China
| | - Qiang Li
- Department of Vascular Surgery, Qingdao Haici Hospital Affiliated to Qingdao University, Qingdao, China
| | - Chunshui He
- Department of Vascular Surgery, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Hongfei Sang
- Department of Vascular Surgery, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Weihao Shi
- Department of Vascular Surgery, School of Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Zhenyu Shi
- Department of Vascular Surgery, School of Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Bing Wang
- Department of Vascular Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Chenyang Qiu
- Department of Vascular Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Ziheng Wu
- Department of Vascular Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
- *Correspondence: Ziheng Wu
| | - Meng Ye
- Department of Vascular Surgery, School of Medicine, Renji Hospital, Shanghai Jiaotong University, Shanghai, China
- Meng Ye
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11
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Weng W, Ku Y, Chen Z, Zheng H, Xu C, Ding H, Li L, Wang G. Superficial femoral artery calcification segmentation and detection in CT angiography using convolutional neural network. Comput Biol Med 2022; 148:105951. [PMID: 35981455 DOI: 10.1016/j.compbiomed.2022.105951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 04/29/2022] [Accepted: 08/06/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE Calcification detection and segmentation in CT angiography (CTA) is the basis of preoperative calcification assessment and treatment determination in endovascular interventional surgery for lower-extremity atherosclerotic occlusion disease. However, the complex calcification-lumen contrast and difficult-to-locate occluded superficial femoral artery (SFA) make it challenging. This paper proposes a fast and accurate method without artery extraction to segment and detect SFA calcification in CTA using a convolutional neural network. METHOD The thigh region containing the target SFA is first automatically extracted based on the human anatomical position. Then, 3D Unet with a large receptive field is used to segment calcifications in image patches with a large field of view. The lumen label is introduced and a calcification-lumen contrast data augmentation method is developed to improve the segmentation performance on images with varying calcification-lumen contrast. Finally, false-positive errors far from the SFA are eliminated based on the SFA centerline estimated from the segmentation results. RESULTS Five-fold cross validation experiments were conducted on a local dataset of CTA images containing 128 SFAs. The average Dice scores of calcification segmentation on the entire, occluded and non-occluded arteries achieved 89.12%, 92.98% and 88.96%, respectively. The average recall and precision of calcification detection on each slice were 93.50% and 91.51%, respectively. The total processing time was about 2 min. CONCLUSIONS This paper proposes a CNN-based method to segment and detect SFA calcification in CTA without artery extraction for varying calcification-lumen intensity contrast and arterial occlusion situations. The work can be used to improve clinical calcification analysis.
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Affiliation(s)
- Wenhai Weng
- Department of Biomedical Engineering, School of Medicine, Tsinghua University, Beijing, 100084, China.
| | - Yijie Ku
- Department of Biomedical Engineering, School of Medicine, Tsinghua University, Beijing, 100084, China.
| | - Zhong Chen
- Department of Vascular Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, 100029, China.
| | - Huanqin Zheng
- Department of Vascular Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, 100029, China.
| | - Chuang Xu
- Department of Vascular Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, 100029, China.
| | - Hui Ding
- Department of Biomedical Engineering, School of Medicine, Tsinghua University, Beijing, 100084, China.
| | - Lei Li
- Vascular Surgery Department, No.1 Hospital of Tsinghua University, Beijing, 100016, China.
| | - Guangzhi Wang
- Department of Biomedical Engineering, School of Medicine, Tsinghua University, Beijing, 100084, China.
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12
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Mochidome T, Takahara M, Miura T, Soga Y, Fujihara M, Kawasaki D, Hirano K, Choi D, Iida O. Vascular Pathology and Impact of Stent Eccentricity for Stent Restenosis in Femoropopliteal Endovascular Therapy. J Vasc Interv Radiol 2022; 33:1089-1096. [PMID: 35671987 DOI: 10.1016/j.jvir.2022.05.021] [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] [Received: 09/08/2021] [Revised: 04/18/2022] [Accepted: 05/28/2022] [Indexed: 11/18/2022] Open
Abstract
PURPOSE To explore the clinical features associated with stent eccentricity and reveal the impact of stent eccentricity on 1-year restenosis risk after femoropopliteal stent implantation for symptomatic atherosclerotic peripheral artery disease (PAD). MATERIALS AND METHODS The effect of stent asymmetry expansion immediately after treatment on long-term patency has not been fully investigated. We used the clinical database of a multicenter prospective study registering 2,018 limbs of 1,766 patients in whom intravascular ultrasound (IVUS)-supported femoropopliteal endovascular therapy (EVT) for symptomatic atherosclerotic PAD was planned from November 2015 to June 2017. We included 1,233 limbs of 1,088 patients implanted with either a bare nitinol stent, drug-eluting stent (DES), or stent graft, and administered two or more antithrombotic drugs. Stent eccentricity was evaluated using IVUS calculated as ((maximum diameter)/(minimum diameter) - 1) at the cross-section segment with the lowest lumen area after stent implantation. RESULTS Chronic total occlusion and bilateral arterial calcification (peripheral artery calcification scoring system grades 3 and 4) were positively associated with stent eccentricity, whereas renal failure on dialysis, DES, and stent graft use were negatively associated with stent eccentricity (all p<0.05). Stent eccentricity was associated with an increased risk of 1-year restenosis (odds ratio (OR) 1.18, 95% confidence interval (CI) 1.01-1.37; p=0.034). However, after adjustment for the lesion severity and implanted stent types, the association was no longer significant (OR 1.07, 95% CI 0.91-1.24; p=0.43). CONCLUSION Stent eccentricity was not significantly associated with 1-year restenosis risk after femoropopliteal EVT.
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Affiliation(s)
| | - Mitsuyoshi Takahara
- Department of Metabolic Medicine, Osaka University Graduate School of Medicine, Osaka, Japan; Department of Diabetes Care Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Takashi Miura
- Department of Cardiology, Nagano Municipal Hospital, Nagano, Japan
| | - Yoshimitsu Soga
- Department of Cardiology, Kokura Memorial Hospital, Fukuoka, Japan
| | - Masahiko Fujihara
- Department of Cardiology, Kishiwada Tokushukai Hospital, Morinomiya Hospital, Osaka, Japan
| | - Daizo Kawasaki
- Department of Cardiology, Morinomiya Hospital, Osaka, Japan
| | - Keisuke Hirano
- Department of Cardiovascular Medicine, Toyohashi Heart Center, Aichi, Japan
| | - Donghoon Choi
- Department of Cardiology, Yonsei University Severance Hospital, Seoul, South Korea
| | - Osamu Iida
- Cardiovascular Center, Kansai Rosai Hospital, Hyogo, Japan
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13
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Bernini M, Colombo M, Dunlop C, Hellmuth R, Chiastra C, Ronan W, Vaughan TJ. Oversizing of self-expanding nitinol vascular stents – A biomechanical investigation in the superficial femoral artery. J Mech Behav Biomed Mater 2022; 132:105259. [DOI: 10.1016/j.jmbbm.2022.105259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 04/20/2022] [Accepted: 04/29/2022] [Indexed: 10/18/2022]
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Bontinis V, Antonopoulos CN, Bontinis A, Koutsoumpelis A, Giannopoulos A, Ktenidis K. A systematic review and meta-analysis of Supera interwoven nitinol stents for the treatment of infrainguinal peripheral arterial disease. THE JOURNAL OF CARDIOVASCULAR SURGERY 2022; 63:137-145. [PMID: 35005877 DOI: 10.23736/s0021-9509.22.12129-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Stenting of infrainguinal lesions can be rather challenging due to the mechanical stress applied on the arteries during motion. We assessed the short-term and mid-term safety and efficacy of Supera interwoven nitinol stent for the treatment of infrainguinal arterial disease. EVIDENCE ACQUISITION We conducted a systematic review for articles published from December 2011 up to May 2021 regarding studies assessing the safety and efficacy of Supera interwoven nitinol stents for the treatment of infra-inguinal peripheral arterial disease. Studies that involved synchronous application of the Supera stent and drug delivering devices, or any alternative endoprosthesis were excluded. Pooled Kaplan-Meier survival curves and smoothed hazard estimates were generated. Data were meta-analyzed using a random effects model. Primary endpoints included primary patency and freedom from clinically driven target lesion revascularization (TRL). Secondary endpoints included technical success and major amputation at 1 year post intervention. EVIDENCE SYNTHESIS Seventeen studies with 2015 patients (65.3% males) and a mean lesion length of 137.2 mm were included. Of the total treated lesions, 44.9% involved femoropopliteal artery and 37.4% the popliteal artery. Chronic total occlusions made up 49% of the treated lesions. There were no stent fractures reported. The pooled technical success rate is 99.84% (95% CI: 99.26-100). Pooled major amputation rate at 1 year is 1.48% (95% CI: 0.47-2.87). Pooled primary patency and freedom from TLR rates at 1 year are 83.5% (95% CI: 80.24-86.54) and 90.32% (95% CI: 88.75-91.79), respectively. Pooling of individual patient data produced primary patency and freedom from TLR rates of 84.48% (95% CI: 82.66-86.11) and 90.81% (95% CI: 88.64-92.58) respectively. According to the smoothed hazard ratio estimate the risk for losing primary patency peaked between 4 and 5 months while the risk for TLR peaked between 7 and 8 months after the intervention. CONCLUSIONS This review and meta-analysis indicated the safety and efficacy of Supera stents for the treatment of challenging infrainguinal lesions in the short-term and mid-term periods, with acceptable primary patency and freedom from TLR rates. Clinicians should be aware that between 4 and 5 months patients face a higher risk for event occurrence.
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Affiliation(s)
- Vangelis Bontinis
- Department of Vascular Surgery, Aristotle University of Thessaloniki, AHEPA University General Hospital, Thessaloniki, Greece -
| | - Constantine N Antonopoulos
- Department of Vascular Surgery, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece
| | - Alkis Bontinis
- Department of Vascular Surgery, Aristotle University of Thessaloniki, AHEPA University General Hospital, Thessaloniki, Greece
| | - Andreas Koutsoumpelis
- Department of Vascular Surgery, Aristotle University of Thessaloniki, AHEPA University General Hospital, Thessaloniki, Greece
| | - Argirios Giannopoulos
- Department of Vascular Surgery, Aristotle University of Thessaloniki, AHEPA University General Hospital, Thessaloniki, Greece
| | - Kiriakos Ktenidis
- Department of Vascular Surgery, Aristotle University of Thessaloniki, AHEPA University General Hospital, Thessaloniki, Greece
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He R, Zhao L, Silberschmidt VV, Feng J, Serracino-Inglott F. Personalised nitinol stent for focal plaques: Design and evaluation. J Biomech 2021; 130:110873. [PMID: 34883344 DOI: 10.1016/j.jbiomech.2021.110873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 11/01/2021] [Accepted: 11/16/2021] [Indexed: 10/19/2022]
Abstract
The purpose of this study is to develop personalised nitinol stents for arteries with one and two opposite focal plaques. Novel designs are evaluated through comparison with a commercial stent design, in terms of lumen gain and shape as well as stress levels in the media layer after stenting. METHODS Personalised stents are developed for arteries with one and two opposite focal plaques, based on medical imaging of patients and computer simulations. In silico analysis is then carried out for assessment of stent performance in the diseased arteries. RESULTS Personalised designs significantly increase the lumen gain, reduce the stresses in the media layer, and improve the lumen shape compared to the commercial nitinol stent. CONCLUSION The personalised designs show outstanding performance compared to the commercial stent. SIGNIFICANCE This pilot study proves that personalised nitinol stents are able to deliver desirable treatment outcomes.
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Affiliation(s)
- Ran He
- Wolfson School of Mechanical, Electrical and Manufacturing Engineering, Loughborough University, Epinal Way, Loughborough LE11 3TU, UK.
| | - Liguo Zhao
- Wolfson School of Mechanical, Electrical and Manufacturing Engineering, Loughborough University, Epinal Way, Loughborough LE11 3TU, UK
| | - Vadim V Silberschmidt
- Wolfson School of Mechanical, Electrical and Manufacturing Engineering, Loughborough University, Epinal Way, Loughborough LE11 3TU, UK
| | - Jiling Feng
- Department of Engineering, Manchester Metropolitan University, Manchester M15 6BH, UK
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Lin C, Zhang LJ, Li B, Zhang F, Shen QR, Kong GQ, Wang XF, Cui SH, Dai R, Cao WQ, Zhang P. Selenium-Containing Protein From Selenium-Enriched Spirulina platensis Attenuates High Glucose-Induced Calcification of MOVAS Cells by Inhibiting ROS-Mediated DNA Damage and Regulating MAPK and PI3K/AKT Pathways. Front Physiol 2020; 11:791. [PMID: 32733280 PMCID: PMC7363841 DOI: 10.3389/fphys.2020.00791] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Accepted: 06/15/2020] [Indexed: 01/29/2023] Open
Abstract
Hyperglycemia is the main feature of diabetes and may increase the risk of vascular calcification (VC), which is an independent predictor for cardiovascular and cerebrovascular diseases (CCD). Selenium (Se) may decrease the risk of CCD, and previous studies confirmed that Se-containing protein from Se-enriched Spirulina platensis (Se-SP) exhibited novel antioxidant potential. However, the effect of Se-SP against VC has been not investigated. Herein, the protective effect and underlying mechanism of Se-SP against high glucose-induced calcification in mouse aortic vascular smooth muscle cells (MOVAS) were explored. Inductively coupled plasma atomic emission spectroscopy (ICP-AES) results showed time-dependent uptake of Se-SP in MOVAS cells, which significantly inhibited high glucose-induced abnormal proliferation. Se-SP co-treatment also effectively attenuated high glucose-induced calcification of MOVAS cells, followed by decreased activity and expression of alkaline phosphatase (ALP). Further investigation revealed that Se-SP markedly prevented reactive oxygen species (ROS)-mediated DNA damage in glucose-treated MOVAS cells. ROS inhibition by glutathione (GSH) effectively inhibited high glucose-induced calcification, indicating that Se-SP could act as ROS inhibitor to inhibit high glucose-induced DNA damage and calcification. Moreover, Se-SP dramatically attenuated high glucose-induced dysfunction of mitogen-activated protein kinases (MAPKs) and phosphatidylinositol-3-kinase/AKT (PI3K/AKT) pathways. Se-SP after Se addition achieved enhanced potential in inhibiting high glucose-induced calcification, which validated that Se-SP as a new Se species could be a highly effective treatment for human CCD.
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Affiliation(s)
- Cong Lin
- Department of Cardiology, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Li-Jun Zhang
- Department of Neurology, People's Hospital of Linyi Affiliated to Qingdao University, Linyi, China
| | - Bo Li
- Department of Emergency, Taian City Central Hospital, Taian, China
| | - Feng Zhang
- Physical Examination Center, Taian City Central Hospital, Taian, China
| | - Qing-Rong Shen
- Department of Emergency, Taian City Central Hospital, Taian, China
| | - Guo-Qing Kong
- Department of Emergency, Taian City Central Hospital, Taian, China
| | - Xiao-Fan Wang
- Department of Emergency, Taian City Central Hospital, Taian, China
| | - Shou-Hong Cui
- Department of Emergency, Taian City Central Hospital, Taian, China
| | - Rong Dai
- Department of Emergency, Taian City Central Hospital, Taian, China
| | - Wen-Qiang Cao
- Department of Biotechnology, Zhuhai Hopegenes Medical and Phamaceutical Institute, Zhuhai, China
| | - Pu Zhang
- Department of Cardiovascular Medicine, Taian City Central Hospital, Taian, China
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Chang Z, Yan G, Yan H, Zheng J, Liu Z. Reticulocalbin 2 enhances osteogenic differentiation of human vascular smooth muscle cells in diabetic conditions. Life Sci 2019; 233:116746. [DOI: 10.1016/j.lfs.2019.116746] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 07/19/2019] [Accepted: 08/08/2019] [Indexed: 12/12/2022]
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18
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Lejay A, Ohana M, Chakfe N. Arterial Occlusion Is Not Just About Length: There's More than Meets the Eye! Eur J Vasc Endovasc Surg 2019; 58:223. [PMID: 30799271 DOI: 10.1016/j.ejvs.2019.02.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Accepted: 02/01/2019] [Indexed: 11/17/2022]
Affiliation(s)
- Anne Lejay
- Department of Vascular Surgery and Kidney Transplantation, University Hospital of Strasbourg, France.
| | - Mickaël Ohana
- Department of Radiology, University Hospital of Strasbourg, France
| | - Nabil Chakfe
- Department of Vascular Surgery and Kidney Transplantation, University Hospital of Strasbourg, France
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