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Yuan X, Jiang M, Feng H, Han Y, Zhang X, Chen Y, Gao L. The effect of sex differences on neointimal characteristics of in-stent restenosis in drug-eluting stents: An optical coherence tomography study. Heliyon 2023; 9:e19073. [PMID: 37636400 PMCID: PMC10448073 DOI: 10.1016/j.heliyon.2023.e19073] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 08/09/2023] [Accepted: 08/09/2023] [Indexed: 08/29/2023] Open
Abstract
Background Previous studies have demonstrated that there are sex-related differences in atherosclerosis. However, in terms of the nature of in-stent restenosis (ISR) neointima, the effect of gender on the results is unclear. Methods Patients with ISR of drug-eluting stents (DES) who underwent OCT examination in Senior Department of Cardiology of the Chinese People's Liberation Army General Hospital from March 2010 to March 2022 were included. The patients were divided into male and female groups. Results In this study, a total of 230 DES-ISR patients and 249 DES-ISR target lesions were analyzed. OCT data showed that compared to females, males have a higher incidence of thin-cap fibrous atherosclerosis (TCFA) (37.4% [n = 77] vs. 9.3% [n = 4], p < 0.001) and in-stent neoatherosclerosis (ISNA) (82.0% [n = 169] vs. 62.8% [n = 27]). p = 0.005). In addition, a multivariate logistic regression analysis demonstrated that male was independently associated with a higher incidence of ISNA (OR: 2.659, 95% CI: 1.239-5.707; p = 0.012) and TCFA (OR: 4.216, 95% CI: 1.370-12.976; p = 0.012). Conclusion For DES-ISR patients, the incidence of ISNA in female was significantly lower than that in male and vulnerability of neointimal pattern is lower in female than in male.
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Affiliation(s)
- Xiaohang Yuan
- Medical School of Chinese PLA, No. 28 Fuxing Road, Haidian District, Beijing 100853, China
- Senior Department of Cardiology, Sixth Medical Center of Chinese PLA General Hospital, No. 6 Fucheng Road, Haidian District, Beijing 100853, China
| | - Mengting Jiang
- Medical School of Chinese PLA, No. 28 Fuxing Road, Haidian District, Beijing 100853, China
- Senior Department of Cardiology, Sixth Medical Center of Chinese PLA General Hospital, No. 6 Fucheng Road, Haidian District, Beijing 100853, China
| | - Huanhuan Feng
- Medical School of Chinese PLA, No. 28 Fuxing Road, Haidian District, Beijing 100853, China
- Department of Emergency, The First Medical Center, Chinese PLA General Hospital, No. 28 Fuxing Road, Haidian District, Beijing 100853, China
| | - Yan Han
- Medical School of Chinese PLA, No. 28 Fuxing Road, Haidian District, Beijing 100853, China
- Senior Department of Cardiology, Sixth Medical Center of Chinese PLA General Hospital, No. 6 Fucheng Road, Haidian District, Beijing 100853, China
| | - Xi Zhang
- Medical School of Chinese PLA, No. 28 Fuxing Road, Haidian District, Beijing 100853, China
- Senior Department of Cardiology, Sixth Medical Center of Chinese PLA General Hospital, No. 6 Fucheng Road, Haidian District, Beijing 100853, China
| | - Yundai Chen
- Medical School of Chinese PLA, No. 28 Fuxing Road, Haidian District, Beijing 100853, China
| | - Lei Gao
- Medical School of Chinese PLA, No. 28 Fuxing Road, Haidian District, Beijing 100853, China
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2
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Kulyassa P, Engh MA, Vámosi P, Fehérvári P, Hegyi P, Merkely B, Édes IF. Drug-coated balloon therapy is more effective in treating late drug-eluting stent in-stent restenosis than the early occurring one-a systematic review and meta-analysis. Front Cardiovasc Med 2023; 10:1062130. [PMID: 37342438 PMCID: PMC10277682 DOI: 10.3389/fcvm.2023.1062130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Accepted: 05/02/2023] [Indexed: 06/22/2023] Open
Abstract
Drug-eluting stent in-stent restenosis (DES-ISR) remains one of the important assignments to be resolved in interventional cardiology, as it is present in 5%-10% of total percutaneous coronary intervention cases. Drug-coated balloon (DCB) utilization is promising, as it comes with long-term protection from recurrent restenosis in optimal conditions without the hazard of higher risk for stent thrombosis and in-stent restenosis. We aim to reduce the need for recurrent revascularization in DES-ISR, specifying the population in which the DCB therapy should be used. In this meta-analysis, the results of studies containing data on the time frame between drug-eluting stent implantation and the clinical presentation of in-stent restenosis and concomitant drug-coated balloon treatment were summarized. A systematic search was performed in Medline, Central, Web of Science, Scopus and Embase databases on November 11th, 2021. The QUIPS tool was used to assess the risk of bias in the included studies. The occurrence of a major cardiac adverse events (MACE) composite endpoint, containing target lesion revascularization (TLR), myocardial infarction, and cardiac death, and each of these separately, was assessed at 12 months after the balloon treatment. Random effects meta-analysis models were used for statistical analysis. Data of 882 patients from four studies were analyzed. Across the included studies, a 1.68 OR (CI 1.57-1.80, p < 0.01) for MACE and a 1.69 OR (CI 1.18-2.42 p < 0.01) for TLR were observed, both in favor of late DES-ISR. The main limitation of the study is the relatively low patient number. Nevertheless, this analysis shows the first statistically significant results for the effect of DCB treatment in the early or late presentation of DES-ISR. As to date, intravascular imaging (IVI) remains limitedly accessible, other landmarks as the time frame of in-stent restenosis development are to be pursued to advance therapeutic outcomes. In consideration of other biological, technical and mechanical factors, time frame of occurrence as a prognostic factor could reduce the burden of recurrent revascularization in patients at an already high risk. Systematic Review Registration: identifier [CRD42021286262].
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Affiliation(s)
- Péter Kulyassa
- Heart and Vascular Center, Department of Cardiology, Semmelweis University, Budapest, Hungary
- Centre for Translational Medicine, Semmelweis University, Budapest, Hungary
| | - Marie Anne Engh
- Centre for Translational Medicine, Semmelweis University, Budapest, Hungary
| | - Péter Vámosi
- Heart and Vascular Center, Department of Cardiology, Semmelweis University, Budapest, Hungary
- Centre for Translational Medicine, Semmelweis University, Budapest, Hungary
| | - Péter Fehérvári
- Heart and Vascular Center, Department of Cardiology, Semmelweis University, Budapest, Hungary
- Centre for Translational Medicine, Semmelweis University, Budapest, Hungary
- Department of Biomathematics and Informatics, University of Veterinary Medicine, Budapest, Hungary
| | - Péter Hegyi
- Centre for Translational Medicine, Semmelweis University, Budapest, Hungary
| | - Béla Merkely
- Heart and Vascular Center, Department of Cardiology, Semmelweis University, Budapest, Hungary
| | - István Ferenc Édes
- Heart and Vascular Center, Department of Cardiology, Semmelweis University, Budapest, Hungary
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Mattesini A, Demola P, Shlofmitz R, Shlofmitz E, Waksman R, Jaffer FA, Di Mario C. Optical Coherence Tomography, Near‐Infrared Spectroscopy, and Near‐Infrared Fluorescence Molecular Imaging. Interv Cardiol 2022. [DOI: 10.1002/9781119697367.ch9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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4
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Abstract
In-stent restenosis (ISR) remains the most common cause of stent failure after percutaneous coronary intervention (PCI). Recent data suggest that ISR-PCI accounts for 5-10% of all PCI procedures performed in current clinical practice. This State-of-the-Art review will primarily focus on the management of ISR but will begin by briefly discussing diagnosis and classification. We then move on to detail the evidence base underpinning the various therapeutic strategies for ISR before finishing with a proposed ISR management algorithm based on current scientific data.
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Affiliation(s)
- Fernando Alfonso
- Department of Cardiology, Hospital Universitario de La Princesa, Universidad Autónoma de Madrid, IIS-IP, CIBER-CV, Calle de Diego de León 62, 28006 Madrid, Spain
| | - J. J. Coughlan
- Deutsches Herzzentrum München und Technische Universität München, Munich, Germany,Department of Cardiology, ISAResearch, German Heart Center, Munich, Germany,Cardiovascular Research Institute, Mater Private Network, Dublin, Ireland,School of Pharmacy and Biomolecular Sciences, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Daniele Giacoppo
- Department of Cardiology, ISAResearch, German Heart Center, Munich, Germany,Cardiovascular Research Institute, Mater Private Network, Dublin, Ireland,School of Pharmacy and Biomolecular Sciences, RCSI University of Medicine and Health Sciences, Dublin, Ireland,Department of Cardiology, Alto Vicentino Hospital, Santorso, Italy
| | - Adnan Kastrati
- Deutsches Herzzentrum München und Technische Universität München, Munich, Germany,Department of Cardiology, ISAResearch, German Heart Center, Munich, Germany,German Center for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Munich, Germany
| | - Robert A. Byrne
- Cardiovascular Research Institute, Mater Private Network, Dublin, Ireland,School of Pharmacy and Biomolecular Sciences, RCSI University of Medicine and Health Sciences, Dublin, Ireland
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5
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Kitano D, Migita S, Li Y, Takahashi R, Taniguchi Y, Kurosawa T, Sudo M, Haruta H, Hiro T, Takayama T, Mitsumata M, Matsumoto T, Okumura Y, Hirayama A. Effect of Rivaroxaban and Clopidogrel Combination Therapy on In-Stent Responses After Everolimus-Eluting Stent Implantation in a Porcine Coronary Model. J Atheroscler Thromb 2020; 29:69-81. [PMID: 33208566 PMCID: PMC8737068 DOI: 10.5551/jat.56549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Aim:
According to recent clinical trials, a combination of direct oral anticoagulants with antiplatelet drugs is often recommended for atrial fibrillation patients who receive drug-eluting stents (DESs). Although the optimal combination comprises direct factor Xa inhibitors and a P2Y
12
receptor antagonist (or aspirin), their influence on vascular responses to DESs remains unclear.
Methods:
Pigs were given either aspirin and clopidogrel (dual antiplatelet therapy [DAPT] group), aspirin and rivaroxaban (AR group), or clopidogrel and rivaroxaban (CR group), followed by everolimus-eluting stent (Promus Element) implantation into the coronary artery. Stented coronary arteries were evaluated via intravascular optical coherence tomography (OCT) and histological analysis at 1 and 3 months.
Results:
OCT revealed lower neointimal thickness in the DAPT group and comparable thickness among all groups at 1 and 3 months, respectively. Histological analyses revealed comparable neointimal area among all groups and the smallest neointimal area in the CR group at 1 and 3 months, respectively. In the DAPT and AR groups, the neointima continued to grow from 1 to 3 months. A shortened time course for neointima growth was observed in the CR group, with rapid growth within a month (maintained for 3 months). A higher incidence of in-stent thrombi was observed in the AR group at 1 month; no thrombi were found in either group at 3 months. More smooth muscle cells with contractile features were found in the CR group at both 1 and 3 months.
Conclusions:
Our results proved the noninferiority of the combination of rivaroxaban with an antiplatelet drug, particularly the dual therapy using rivaroxaban and clopidogrel, compared to DAPT after DES implantation.
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Affiliation(s)
- Daisuke Kitano
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine.,Division of Advanced Cardiovascular Imaging, Department of Medicine, Nihon University School of Medicine
| | - Suguru Migita
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine
| | - Yuxin Li
- Division of Advanced Cardiovascular Imaging, Department of Medicine, Nihon University School of Medicine.,Division of Cell Regeneration and Transplantation, Department of Functional Morphology, Nihon University School of Medicine
| | - Rie Takahashi
- Research Support Center, Research Institute of Medical Science, Nihon University School of Medicine
| | - Yoshiki Taniguchi
- Research Support Center, Research Institute of Medical Science, Nihon University School of Medicine
| | - Takafumi Kurosawa
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine
| | - Mitsumasa Sudo
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine.,Division of Advanced Cardiovascular Imaging, Department of Medicine, Nihon University School of Medicine
| | - Hironori Haruta
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine
| | - Takafumi Hiro
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine.,Division of Advanced Cardiovascular Imaging, Department of Medicine, Nihon University School of Medicine
| | | | - Masako Mitsumata
- Division of Pathology, Central Clinical Laboratory, Yamanashi Kosei Hospital
| | - Taro Matsumoto
- Division of Cell Regeneration and Transplantation, Department of Functional Morphology, Nihon University School of Medicine
| | - Yasuo Okumura
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine
| | - Atsushi Hirayama
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine.,Cardiovascular Division, Osaka Police Hospital
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Mehrotra S, Mishra S, Paramasivam G. Imaging during percutaneous coronary intervention for optimizing outcomes. Indian Heart J 2018; 70 Suppl 3:S456-S465. [PMID: 30595307 PMCID: PMC6309719 DOI: 10.1016/j.ihj.2018.08.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2017] [Revised: 08/02/2018] [Accepted: 08/09/2018] [Indexed: 01/29/2023] Open
Abstract
Angiography is the current gold standard for imaging during percutaneous coronary interventions but has significant limitations. Catheter-based intravascular imaging techniques such as intravascular ultrasound and the more recent optical coherence tomography have the potential to overcome these limitations and thus optimize clinical outcomes. In this update, we discussed the current applications of the available imaging techniques, existing evidence, continuing unmet needs, and potential areas for further research.
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Affiliation(s)
| | | | - Ganesh Paramasivam
- Kasturba Medical College, Manipal Academy of Higher Education, Manipal, India
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Comparison of in-stent neoatherosclerosis and tissue characteristics between early and late in-stent restenosis in second-generation drug-eluting stents: an optical coherence tomography study. Int J Cardiovasc Imaging 2017; 33:1463-1472. [DOI: 10.1007/s10554-017-1146-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Accepted: 04/21/2017] [Indexed: 11/24/2022]
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8
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Sabbah M, Kadota K, El-Eraky A, Kamal HM, Abdellah AT, El Hawary A. In-stent neoatherosclerosis and tissue characteristics of restenotic lesions following implantation of second generation drug-eluting stents in unrestricted coronary lesions: Optical frequency domain imaging study. J Interv Cardiol 2017; 30:195-203. [PMID: 28295660 DOI: 10.1111/joic.12375] [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: 12/23/2016] [Revised: 02/17/2017] [Accepted: 02/20/2017] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Differences in stent platform, polymer coatings, and antirestenotic drugs among the current in use second-generation drug-eluting stents (G2-DESs) may induce significant variations in neointimal response and vascular healing, which may impact the prevalence of neoatherosclerosis (NA) and morphological appearance of the restenotic tissue. METHODS AND RESULTS Utilizing Optical frequency domain imaging, two independent reviewers, retrospectively compared the prevalence of neoatherosclerosis (NA), and the morphological differences, and tissue characteristics of 50 G2-DESs in-stent restenosis (ISR) lesions (35 everolimus-eluting stent [22 cobalt-chromium (CoCr), 13 platinum-chromium (PtCr)], and 15 biolimus-eluting stent [BES]) implanted liberally in unrestricted coronary lesions. More than half of the stents were implanted in type C lesions, while 40% of the stents were implanted primarily in lesions with recanalized chronic total occlusion. NA, defined as a neointima formation with the presence of lipids or calcification, was observed in fewer than half (24/50) of all ISR lesions with no significant in-between group differences (41%, 69%, and 40% in CoCr, PtCr, and BES respectively, P = 0.22), nor were there any significant differences in the morphological appearance or tissue characteristics between all G2-DESs subtypes. CONCLUSIONS Acknowledging some limitations, our results may suggest that the prevalence of NA and the morphological appearance of restenotic lesions might not differ when G2-DESs are implanted in unrestricted, rather complex, coronary lesions.
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Affiliation(s)
- Mahmoud Sabbah
- Faculty of Medicine, Department of Cardiology, Suez Canal University, Ismailia, Egypt.,Department of Cardiology, Kurashiki Central Hospital, Kurashiki, Japan
| | - Kazushige Kadota
- Department of Cardiology, Kurashiki Central Hospital, Kurashiki, Japan
| | - Azza El-Eraky
- Faculty of Medicine, Department of Cardiology, Port-Said University, Port-Said, Egypt
| | - Hanan M Kamal
- Faculty of Medicine, Department of Cardiology, Suez Canal University, Ismailia, Egypt
| | | | - Ahmed El Hawary
- Faculty of Medicine, Department of Cardiology, Suez Canal University, Ismailia, Egypt
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9
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Kilic ID, Serdoz R, Fabris E, Jaffer FA, Di Mario C. Optical Coherence Tomography, Near-Infrared Spectroscopy, and Near-Infrared Fluorescence Molecular Imaging. Interv Cardiol 2016. [DOI: 10.1002/9781118983652.ch8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Affiliation(s)
- Ismail Dogu Kilic
- Department of Cardiology; Pamukkale University Hospitals; Denizli Turkey
- National Institute of Health Research (NIHR); Royal Brompton & Harefield NHS Foundation Trust; London
- NHLI Imperial College; London UK
| | - Roberta Serdoz
- National Institute of Health Research (NIHR); Royal Brompton & Harefield NHS Foundation Trust; London
- NHLI Imperial College; London UK
| | - Enrico Fabris
- National Institute of Health Research (NIHR); Royal Brompton & Harefield NHS Foundation Trust; London
- NHLI Imperial College; London UK
- Cardiovascular Department; Ospedali Riuniti and University of Trieste; Trieste Italy
| | - Farouc Amin Jaffer
- Cardiology Division, Massachusetts General Hospital; Harvard Medical School; Boston MA USA
| | - Carlo Di Mario
- National Institute of Health Research (NIHR); Royal Brompton & Harefield NHS Foundation Trust; London
- NHLI Imperial College; London UK
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