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Oguz M, Akbulut T, Saylik F, Sipal A, Erdal E. Association of Coronary Artery Severity and Late In-Stent Restenosis: An Angiographic Imaging Study. Angiology 2024; 75:122-130. [PMID: 36607632 DOI: 10.1177/00033197221150953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Coronary in-stent restenosis (ISR) remains a challenge in interventional cardiology. We investigated the relationship between angiographic pre-interventional grade of lesion stenosis (LS) and the prognosis of late ISR. After exclusions, 110 patients with ISR and 109 patients without ISR were compared. In the ISR group, the grade of LS was greater (P < .001) and the length of the critical segment (LCS) was longer (P < .001). Stent length was longer in the ISR group (P = .008). Compared with the LCS, the grade of LS above 87.5% is 6.9 times more predictive of ISR than the LCS >10.5 mm. Kaplan-Meier curve analysis showed that the grade of initial LS >87.5% had a higher ISR rate than the grade of LS <87.5% (log-rank test P < .001) and critical lesion length over 10.5 mm had a higher ISR rate than critical lesion length under 10.5 mm (log-rank test P < .001). The present study found that the angiographic pre-interventional grades of LS and LCS were important predictors of ISR. Pre-interventional angiographic stenosis >87.5% was significantly predictive of late ISR.
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Affiliation(s)
- Mustafa Oguz
- Department of Cardiology, Sultan Abdülhamid Han Training and Research Hospital, Istanbul, Turkey
| | - Tayyar Akbulut
- Department of Cardiology, SBU Van Training and Research Hospital, Van, Turkey
| | - Faysal Saylik
- Department of Cardiology, SBU Van Training and Research Hospital, Van, Turkey
| | - Abdulcabbar Sipal
- Department of Cardiology, SBU Van Training and Research Hospital, Van, Turkey
| | - Emrah Erdal
- Department of Cardiology, Sultan Abdülhamid Han Training and Research Hospital, Istanbul, Turkey
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2
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Kurihara O, Russo M, Kim HO, Araki M, Shinohara H, Lee H, Takano M, Mizuno K, Jang IK. Clinical significance of healed plaque detected by optical coherence tomography: a 2-year follow-up study. J Thromb Thrombolysis 2021; 50:895-902. [PMID: 32399759 DOI: 10.1007/s11239-020-02076-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Recent studies have shown that healed plaque at the culprit lesion detected by optical coherence tomography (OCT) is a sign of pan-vascular vulnerability and advanced atherosclerosis. However, the clinical significance of healed plaque is unknown. A total of 265 patients who had OCT imaging of a culprit vessel and 2-year clinical follow-up data were included. Patients were stratified based on the presence or absence of a layered plaque phenotype, defined as layers of different optical density by OCT at either culprit or non-culprit lesions. The association between layered plaque and major adverse cardiac events (MACE), defined as cardiac death, acute coronary syndromes (ACS), or revascularization, was studied. Among 265 patients, 96 (36.2%) had the layered plaque phenotype. Layered plaque was more frequently observed in stable angina pectoris patients than in ACS patients (57.8%vs. 25.1%, p < 0.001). The average clinical follow-up period was 672 ± 172 days. Cumulative MACE was significantly higher in patients with layered plaque (p = 0.041), which was primarily driven by the high revascularization rate at 2 years (p = 0.002). Multivariate regression analysis showed that presence of layered plaque and low-density lipoprotein cholesterol levels were independently associated with an increased risk of revascularization (p = 0.026, p = 0.008, respectively). Patients with healed plaque in the culprit vessel had a higher incidence of revascularization, as compared to those without healed plaque, at 2 years.
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Affiliation(s)
- Osamu Kurihara
- Cardiology Division, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, GRB 800, Boston, MA, 02114, USA
| | - Michele Russo
- Cardiology Division, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, GRB 800, Boston, MA, 02114, USA
| | - Hyung Oh Kim
- Cardiology Division, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, GRB 800, Boston, MA, 02114, USA
| | - Makoto Araki
- Cardiology Division, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, GRB 800, Boston, MA, 02114, USA
| | - Hiroki Shinohara
- Cardiology Division, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, GRB 800, Boston, MA, 02114, USA
| | - Hang Lee
- Biostatistics Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Masamichi Takano
- Cardiovascular Center, Nippon Medical School Chiba Hokusoh Hospital, 1715 Kamakari, Inzai, Chiba, 270-1694, Japan.
| | | | - Ik-Kyung Jang
- Cardiology Division, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, GRB 800, Boston, MA, 02114, USA. .,Department of Cardiology, Kyung Hee University Hospital, Seoul, Korea.
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3
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Kurihara O, Shinohara H, Kim HO, Russo M, Araki M, Nakajima A, Lee H, Takano M, Mizuno K, Komuro I, Jang I. Comparison of post‐stent optical coherence tomography findings: Layered versus non‐layered culprit lesions. Catheter Cardiovasc Interv 2020; 97:1320-1328. [DOI: 10.1002/ccd.28940] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Revised: 03/23/2020] [Accepted: 04/12/2020] [Indexed: 11/11/2022]
Affiliation(s)
- Osamu Kurihara
- Cardiology Division, Massachusetts General Hospital Harvard Medical School Boston Massachusetts USA
| | - Hiroki Shinohara
- Cardiology Division, Massachusetts General Hospital Harvard Medical School Boston Massachusetts USA
| | - Hyung Oh Kim
- Cardiology Division, Massachusetts General Hospital Harvard Medical School Boston Massachusetts USA
| | - Michele Russo
- Cardiology Division, Massachusetts General Hospital Harvard Medical School Boston Massachusetts USA
| | - Makoto Araki
- Cardiology Division, Massachusetts General Hospital Harvard Medical School Boston Massachusetts USA
| | - Akihiro Nakajima
- Cardiology Division, Massachusetts General Hospital Harvard Medical School Boston Massachusetts USA
| | - Hang Lee
- Biostatistics Center Massachusetts General Hospital, Harvard Medical School Boston Massachusetts USA
| | - Masamichi Takano
- Cardiovascular Center Nippon Medical School Chiba Hokusoh Hospital Inzai Japan
| | | | - Issei Komuro
- Department of Cardiovascular Medicine, Graduate School of Medicine The University of Tokyo Tokyo Japan
| | - Ik‐Kyung Jang
- Cardiology Division, Massachusetts General Hospital Harvard Medical School Boston Massachusetts USA
- Division of Cardiology Kyung Hee University Hospital Seoul South Korea
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4
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Kang WC, Oh KJ, Han SH, Ahn TH, Chung WJ, Shin MS, Koh KK, Choi IS, Shin EK. Effect of preinterventional arterial remodeling on intimal hyperplasia after implantation of a polymer-based paclitaxel-eluting stent: angiographic and IVUS study. Int J Cardiol 2007; 123:50-4. [PMID: 17321614 DOI: 10.1016/j.ijcard.2006.11.131] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2006] [Revised: 10/20/2006] [Accepted: 11/17/2006] [Indexed: 10/23/2022]
Abstract
BACKGROUND The aim of this study was to evaluate the effect of preinterventional arterial remodeling on in-stent intimal hyperplasia (IH) after the implantation of a polymer-based paclitaxel-eluting stent. METHODS The study population consisted of 55 patients (61 lesions) with a de novo lesion treated with a paclitaxel-eluting stent. The lesions were divided into two groups, positive or intermediate (PR/IR), and negative remodeling (NR) groups, according to the preinterventional arterial remodeling. Angiographic and IVUS examinations were performed preintervention, postintervention and at 9 months of follow-up. RESULTS The remodeling index (RI) was 1.19+/-0.16 in the PR/IR group and 0.81+/-0.10 in the NR group. At follow-up, the late loss was significantly larger in the PR/IR group than in the IR group. (0.65+/-0.58 mm vs. 0.29+/-0.5 mm, p=0.017). The external elastic membrane cross-sectional area (CSA) (18.68+/-5.39 vs. 12.87+/-3.72 mm(2), p=0.000), plaque CSA (16.99+/-4.04 vs. 10.34+/-3.45 Mm(2), p=0.000) and plaque index (85.84+/-5.02 vs. 81.80+/-7.26%, p=0.048) during the preintervention period and IH volume during the follow-up were significantly larger in the PR/IR group than in the NR group (17.98+/-16.7 mm(3) vs. 4.59+/-12.4 mm(3); p<0.001). Further, the percentage of the change in the IH was also larger in the PR/IR group than in the NR group (13.49+/-11.78% vs. 4.12+/-10.76%; p=0.002). A significant positive correlation was found between the preinterventional RI and follow-up IH CSA (r=0.406, p=0.001). CONCLUSIONS The preinterventional arterial remodeling influenced the development of the IH after the implantation of the polymer-based paclitaxel-eluting stent which had a greater effect on reducing the IH accumulation in the lesions with preinterventional negative remodeling characteristics.
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Affiliation(s)
- Woong Chol Kang
- Division of Cardiology, Gil Medical Center, Gachon University of Medicine and Science, 1198 Kuwol-dong, Namdong-gu, Incheon 405-760, Republic of Korea
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5
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Kaneda H, Koizumi T, Ako J, Terashima M, Morino Y, Honda Y, Yock PG, Leon MB, Moses JW, Fitzgerald PJ. Impact of intravascular ultrasound lesion characteristics on neointimal hyperplasia following sirolimus-eluting stent implantation. Am J Cardiol 2005; 96:1237-41. [PMID: 16253589 DOI: 10.1016/j.amjcard.2005.06.063] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2005] [Revised: 06/24/2005] [Accepted: 06/24/2005] [Indexed: 11/26/2022]
Abstract
The effect of lesion characteristics on neointimal hyperplasia after sirolimus-eluting stent implantation was examined in 45 patients who underwent successful preinterventional intravascular ultrasound. There were no differences in neointimal hyperplasia between the moderate/severe calcified lesion group (calcium arc >120 degrees ) and the non/mild calcified lesion group or between the positive vessel remodeling group (external elastic membrane area at the minimal lumen area site larger than that at the proximal reference site) and negative vessel remodeling group. No correlation between preinterventional plaque burden and neointimal hyperplasia was found. In patients who have coronary artery disease, sirolimus-eluting stents continue to demonstrate striking suppression of neointimal proliferation, irrespective of lesion characteristics previously associated with greater restenotic risk.
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Affiliation(s)
- Hideaki Kaneda
- The Center for Research in Cardiovascular Interventions, Stanford University, Stanford, California, USA
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6
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Lee S, Hong M, Kim Y, Park J, Rhee K, Lee CW, Han K, Song J, Kang D, Song J, Kim J, Park S, Park S. Bail-out stenting for left main coronary artery dissection during catheter-based procedure: acute and long-term results. Clin Cardiol 2004; 27:393-5. [PMID: 15298038 PMCID: PMC6654066 DOI: 10.1002/clc.4960270705] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The optimal treatment of patients with left main coronary artery (LMCA) dissection during catheter-based procedure remains uncertain. HYPOTHESIS In cases with significant LMCA dissection occurring during catheter-based procedure, prompt stent implantation may be safe and associated with favorable clinical outcome. METHODS We evaluated the acute and long-term results of bail-out stenting for LMCA dissection occurring during a catheter-based procedure in 10 patients. RESULTS Initially, there was no significant stenosis of LMCA segments in these patients. Catheter-induced dissection occurred in eight patients (during diagnostic angiography in three patients and during guiding catheter manipulation in five patients). Two patients suffered dissection in the setting of stent deployment in other vessels. Therefore, bail-out stenting for LMCA dissection was performed in a total of 10 patients. In four patients, hypotension developed and an intra-aortic balloon pump was placed during the procedure. Stents were successfully deployed in all patients; there was no in-hospital mortality. Six-month angiographic follow-up was performed in eight patients. No angiographic restenosis (diameter stenosis > or = 50%) was observed in any patient at follow-up study. During a mean follow-up of 31 +/- 25 months after hospital discharge, there was no major adverse cardiac event (death, myocardial infarction, and target lesion revascularization). CONCLUSIONS Bail-out LMCA stenting is technically feasible and showed good acute and long-term results in a small series of patients.
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Affiliation(s)
- Seung‐Whan Lee
- Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Myeong‐Ki Hong
- Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Young‐Hak Kim
- Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Jae‐Hyeong Park
- Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Kyoung‐Suk Rhee
- Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Cheol Whan Lee
- Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Ki‐Hoon Han
- Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Jong‐Min Song
- Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Duk‐Hyun Kang
- Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Jae‐Kwan Song
- Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Jae‐Joong Kim
- Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Seong‐Wook Park
- Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Seung‐Jung Park
- Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
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Nakatogawa T, Hibi K, Furukawa E, Sugano T, Kosuge M, Takamura T, Toda N, Tsukahara K, Okuda J, Kimura K, Umemura S. Impact of peri-stent remodeling on in-stent neointimal proliferation in acute myocardial infarction. Am J Cardiol 2004; 94:769-71. [PMID: 15374784 DOI: 10.1016/j.amjcard.2004.05.063] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2004] [Revised: 05/27/2004] [Accepted: 05/27/2004] [Indexed: 11/17/2022]
Abstract
Fifty stented lesions in 50 patients with acute myocardial infarction were studied by intravascular ultrasound (IVUS) before and just after stent implantation and at follow-up. Volumetric IVUS analyses revealed that greater peristent positive remodeling after stent implantation was associated with less neointimal proliferation and greater luminal gain at follow-up.
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Affiliation(s)
- Tomoyori Nakatogawa
- Division of Cardiology, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama 232-0024, Japan
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8
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Ikeno F, Abizaid A, Suzuki T, Rezaee M, Patterson GR, Yeung AC, Virmani R, Sousa JE, Carter AJ. Initial experience with the novel 6 Fr-compatible system for debulking de novo coronary arterial lesions. Catheter Cardiovasc Interv 2004; 62:308-17. [PMID: 15224296 DOI: 10.1002/ccd.20085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The purpose of this study was to determine the efficacy of a novel system for debulking of de novo native coronary arterial lesions. The Helixciser De Novo system is a novel 6 Fr-compatible catheter with a cutter encased in a slotted-orifice housing to excise atheromatous plaque. The cutter rotates at 15,000 rpm, debulking the plaque as it tracks through the lesion over a straight wire or a self-expanding nitinol helical-shaped wire. The tissue is aspirated via an Archimedes screw pump to vacuum collection chamber. The device was evaluated in a porcine toxic coronary stent model of chronic occlusion and in five patients with focal de novo native coronary arterial lesions. Procedural variables along with outcomes were reviewed. Quantitative angiography (QCA) and volumetric intravascular ultrasound (IVUS) analysis were performed. In a porcine model of chronic occlusion, QCA demonstrated pretreatment minimal lumen diameter (MLD) increased from 0.77 +/- 0.59 to 1.88 +/- 0.25 mm postdebulking. IVUS analysis demonstrated pretreatment lumen volume (LV) increased from 15.8 +/- 22.2 to 46.4 +/- 28.9 mm(3) postdebulking. In human clinical feasibility cases, QCA demonstrated pretreatment MLD increased from 0.96 +/- 0.40 to 2.04 +/- 0.19 mm postdebulking. IVUS analysis demonstrated pretreatment LV increased from 38.40 +/- 12.78 to 52.05 +/- 15.68 mm(3) postdebulking. Preliminary results document the feasibility of Helixcision De Novo for treatment of focal de novo native coronary arterial lesions. Quantitative angiographic and IVUS analysis indicate that this system can effectively debulk plaque from selected noncalcified atherosclerotic lesions and thus may represent an alternative treatment strategy for coronary artery disease.
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Affiliation(s)
- Fumiaki Ikeno
- Stanford University Medical Center, Stanford, California, USA
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9
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von der Thüsen JH, Fekkes ML, Passier R, van Zonneveld AJ, Mainfroid V, van Berkel TJC, Biessen EAL. Adenoviral transfer of endothelial nitric oxide synthase attenuates lesion formation in a novel murine model of postangioplasty restenosis. Arterioscler Thromb Vasc Biol 2003; 24:357-62. [PMID: 14699016 DOI: 10.1161/01.atv.0000114235.51044.92] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Restenosis remains a major late complication of percutaneous transluminal coronary angioplasty (PTCA), for which the development of prevention strategies has thus far been hampered by the lack of a representative and practical animal model. We have, therefore, developed a murine model of PTCA-induced restenosis. METHODS AND RESULTS Rigid probe angioplasty of pre-existing atherosclerotic lesions in the carotid arteries of ApoE-deficient mice was found to result in an increase in lesion size (0.14+/-0.04x10(5) microm2 to 0.42+/-0.09x10(5) microm2, P=0.007) with a smooth muscle cell-rich, fibrotic lesion morphology. In an additional experiment, lesions were incubated immediately after angioplasty with adenovirus bearing an endothelial nitric oxide synthase (eNOS) transgene (Ad.APT.eNOS), or an "empty" control virus (Ad.APT.empty) at a titer of 1.5x10(9) pfu/mL. Ad.APT.eNOS treatment was seen to lead to a 73.1% reduction in plaque size (0.27+/-0.04x10(5) microm2 versus 1.02+/-0.39x10(5) microm2, P=0.07), which translated to a significantly lowered average degree of stenosis (33.6+/-4.1% versus 74.6+/-14.0%, P=0.02). Ad.APT.eNOS also decreased lesional collagen content from 29.1% to 4.8% (P<0.001). CONCLUSIONS We believe that we have established a representative murine model of postangioplasty restenosis, which may serve to elucidate the mechanisms underlying restenosis and to evaluate potential antirestenotic therapies.
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MESH Headings
- Adenoviridae/genetics
- Angioplasty, Balloon, Coronary/adverse effects
- Animals
- Apolipoproteins E/deficiency
- Apolipoproteins E/genetics
- Carotid Artery Diseases/enzymology
- Carotid Artery Diseases/etiology
- Carotid Artery Diseases/pathology
- Carotid Artery Diseases/therapy
- Carotid Artery, External/enzymology
- Carotid Artery, External/pathology
- Carotid Artery, External/surgery
- Carotid Artery, External/virology
- Constriction, Pathologic/enzymology
- Constriction, Pathologic/etiology
- Constriction, Pathologic/pathology
- Constriction, Pathologic/therapy
- Coronary Restenosis/enzymology
- Coronary Restenosis/therapy
- Disease Models, Animal
- Efficiency/physiology
- Endothelium, Vascular/enzymology
- Endothelium, Vascular/pathology
- Endothelium, Vascular/virology
- Female
- Frozen Sections/methods
- Genetic Therapy
- Genetic Vectors/biosynthesis
- Genetic Vectors/genetics
- Genetic Vectors/therapeutic use
- Immunohistochemistry
- Mice
- Muscle, Smooth, Vascular/enzymology
- Muscle, Smooth, Vascular/pathology
- Muscle, Smooth, Vascular/virology
- Nitric Oxide Synthase/biosynthesis
- Nitric Oxide Synthase/genetics
- Nitric Oxide Synthase/therapeutic use
- Nitric Oxide Synthase Type II
- Nitric Oxide Synthase Type III
- Transduction, Genetic/methods
- Transduction, Genetic/standards
- beta-Galactosidase/analysis
- beta-Galactosidase/biosynthesis
- beta-Galactosidase/genetics
- beta-Galactosidase/immunology
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Affiliation(s)
- Jan H von der Thüsen
- Division of Biopharmaceutics, Leiden/Amsterdam Center for Drug Research, Gorlaeus Laboratories, Leiden University, Einsteinweg 55, P.O. Box 9502, 2300 RA Leiden, The Netherlands.
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10
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Tanabe K, Serruys PW, Degertekin M, Guagliumi G, Grube E, Chan C, Munzel T, Belardi J, Ruzyllo W, Bilodeau L, Kelbaek H, Ormiston J, Dawkins K, Roy L, Strauss BH, Disco C, Koglin J, Russell ME, Colombo A. Chronic arterial responses to polymer-controlled paclitaxel-eluting stents: comparison with bare metal stents by serial intravascular ultrasound analyses: data from the randomized TAXUS-II trial. Circulation 2003; 109:196-200. [PMID: 14691036 DOI: 10.1161/01.cir.0000109137.51122.49] [Citation(s) in RCA: 86] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Polymer-controlled paclitaxel-eluting stents have shown a pronounced reduction in neointimal hyperplasia compared with bare metal stents (BMS). The aim of this substudy was to evaluate local arterial responses through the use of serial quantitative intravascular ultrasound (IVUS) analyses in the TAXUS II trial. METHODS AND RESULTS TAXUS II was a randomized, double-blind study with 536 patients in 2 consecutive cohorts comparing slow-release (SR; 131 patients) and moderate-release (MR; 135 patients) paclitaxel-eluting stents with BMS (270 patients). This IVUS substudy included patients treated with one study stent who underwent serial IVUS examination after the procedure and at 6-month follow-up (BMS, 152 patients; SR, 81; MR, 81). The analyzed stented segment (15 mm) was divided into 5 subsegments in which mean vessel area (VA), stent area (SA), lumen area (LA), intrastent neointimal hyperplasia area (NIHA), and peristent area (VA-SA) were measured. NIHA was significantly reduced in SR (0.7+/-0.9 mm2, P<0.001) and MR (0.6+/-0.8 mm2, P<0.001) compared with BMS (1.9+/-1.5 mm2), with no differences between the two paclitaxel-eluting release formulations. Longitudinal distribution of neointimal hyperplasia throughout the paclitaxel-eluting stent was uniform. Neointimal growth was independent of peristent area at postprocedure examination in all groups. There were progressive increases in peristent area from BMS to SR to MR (0.5+/-1.7, 1.0+/-1.8, and 1.4+/-2.0 mm2, respectively; P<0.001). The increase in peristent area was directly correlated with increases in VA. CONCLUSIONS Both SR and MR paclitaxel-eluting stents prevent neointimal formation to the same degree compared with BMS. However, the difference in peristent remodeling suggests a release-dependent effect between SR and MR.
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Affiliation(s)
- Kengo Tanabe
- Thoraxcenter, Erasmus MC, Rotterdam, The Netherlands
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11
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Mintz GS, Tinana A, Hong MK, Lee CW, Kim JJ, Fearnot NE, Park SW, Park SJ, Weissman NJ. Impact of preinterventional arterial remodeling on neointimal hyperplasia after implantation of (non-polymer-encapsulated) paclitaxel-coated stents: a serial volumetric intravascular ultrasound analysis from the ASian Paclitaxel-Eluting Stent Clinical Trial (ASPECT). Circulation 2003; 108:1295-8. [PMID: 12952833 DOI: 10.1161/01.cir.0000091254.73351.d6] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND This study used serial volumetric intravascular ultrasound (IVUS) to evaluate the effect of preinterventional arterial remodeling on in-stent intimal hyperplasia (IH) after implantation of non-polymer-encapsulated paclitaxel-coated stents. METHODS AND RESULTS Patients were randomized to placebo or one of two doses of paclitaxel (low dose, 1.28 microg/mm2; high dose, 3.10 microg/mm2). Complete preinterventional, post-stent implantation, and follow-up IVUS were available in 18 low-dose and 21 high-dose patients. IH volumes were similar in low-dose and high-dose patients: 17.6+/-15.1 mm3 in low-dose patients and 13.1+/-13.3 mm3 in high-dose patients (P=0.3). Therefore, IVUS findings in low- and high-dose patients were combined. Preinterventional remodeling was assessed by comparing lesion site to proximal and distal reference arterial area: positive remodeling (lesion>proximal reference, n=13), intermediate remodeling (distal reference<lesion<proximal reference, n=13), and negative remodeling (lesion<distal reference, n=13). During follow-up, there was a decrease in lumen volume in positive remodeling lesions (from 106+/-30 to 90+/-27 mm3; P=0.0067) and in intermediate remodeling lesions (from 97+/-28 to 76+/-31 mm3; P=0.0004), but not in negative remodeling lesions (99+/-27 versus 92+/-32 mm3; P=0.15). The follow-up IH volume was lower in negative remodeling lesions (5+/-7 mm3) compared with positive remodeling (20+/-14 mm3; P=0.0051) and intermediate remodeling lesions (20+/-15 mm3; P=0.0043); however, IH volume was virtually identical in positive and intermediate remodeling lesions. Multivariate linear regression analysis determined that remodeling and inflation pressure were independent predictors of IH volume; variables tested in the model included diabetes, acute coronary syndromes, dose, remodeling, and preinterventional plaque burden. CONCLUSIONS Preinterventional arterial remodeling, especially negative remodeling, influences neointimal hyperplasia suppression after implantation of non-polymer-encapsulated paclitaxel-coated stents.
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Affiliation(s)
- Gary S Mintz
- Cardiovascular Research Foundation, New York, NY, USA
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12
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Takeda Y, Tsuchikane E, Kobayashi T, Terai K, Kobayashi Y, Nakagawa T, Sakurai M, Awata N, Kobayashi T. Effect of plaque debulking before stent implantation on in-stent neointimal proliferation: a serial 3-dimensional intravascular ultrasound study. Am Heart J 2003; 146:175-82. [PMID: 12851628 DOI: 10.1016/s0002-8703(03)00114-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Recent intravascular ultrasound (IVUS) studies have suggested that plaque burden has a role in promoting intimal hyperplasia after stenting. We report on volumetric assessments of in-stent neointimal formation with 3-dimensional IVUS analysis, comparing directional coronary atherectomy (DCA) plus stenting (DCA/stenting) to stenting without DCA. METHODS Twenty-four patients (24 lesions) treated with DCA before stenting were matched to 24 patients (24 lesions) receiving stenting without DCA. All stents were a single Multilink stent. In both groups, serial IVUS was performed before and after intervention and during the 6-month follow-up period. The arterial segments that were analyzed with a computer-based contour detection program were the same as the stented segments analyzed on serial studies. These measurements were obtained: (1) lumen volume (LV), (2) stent volume (SV), (3) vessel volume (VV), (4) in-stent neointimal volume (ISV) calculated as SV-LV, and (5) percent in-stent neointimal volume (%ISV) calculated as ([SV-LV]/SV) x 100. RESULTS Baseline characteristics of the 2 groups were similar. After intervention, both groups achieved similar LV (140.0 mm(3) DCA/stenting vs 135.2 mm(3) stenting alone). However, the follow-up ISV and %ISV were significantly smaller in the DCA/stenting group (19.6 +/- 12.2 mm(3) DCA/stenting vs 44.6 +/- 29.5 mm(3) stenting alone; P =.00040; 15.3% +/- 10.6% DCA/stenting vs 31.5% +/- 17.7% stenting alone; P =.00040). Consequently, the DCA/stenting group showed a significantly greater follow-up LV (121.0 +/- 51.5 mm(3) DCA/stenting vs 91.5 +/- 26.7 mm(3) stenting alone; P =.016). CONCLUSIONS Plaque removal with DCA before stenting inhibits in-stent neointimal hyperplasia.
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Affiliation(s)
- Yoshihiro Takeda
- Department of Cardiology, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka City, Japan.
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Abstract
BACKGROUND Late stent malapposition (LSM) is only detected if intravascular ultrasound (IVUS) is performed at implantation and follow-up. We used a novel "regional" IVUS analysis to assess the mechanism of LSM. METHODS AND RESULTS Corresponding image slices on postimplantation and follow-up IVUS studies of 11 malapposed stents were identified and electronically rotated until they were aligned. The geometric center of the stent was identified, and the angle of late malapposition measured. Radii were drawn from this center through the transition points between complete apposition and LSM. These two circumferences were divided into equal arcs, and radii were drawn to the external elastic membrane (EEM). Measurements included EEM radius and circumference, plaque and media (P&M=EEM minus stent radius) thickness and area, and stent-intima separation. Mean baseline EEM radius and P&M thickness were similar in apposed and malapposed circumferences. At follow-up, mean EEM radius increase within the malapposed circumference (0.57+/-0.34 mm) was larger than within the apposed circumference (0.16+/-0.18 mm; P=0.0004). DeltaEEM for each malapposed radius was greater than for each apposed radius (P<0.05 for all comparisons). Stent-intima separation correlated with EEM radius increase within the malapposed circumference (r=0.83, P=0.0013). At follow-up, the mean P&M thickness decreased in the malapposed circumference (-0.31+/-0.22 mm; P<0.0001). However, the decrease in P&M thickness in the malapposed circumference occurred because the same P&M area was distributed over a larger circumference (4.1+/-1.6 mm to 5.4+/-3.0 mm; P=0.05), the result of positive remodeling. CONCLUSIONS The main cause of LSM is a regional increase in EEM (regional positive remodeling).
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Affiliation(s)
- Gary S Mintz
- Cardiovascular Research Foundation, New York, NY, USA
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14
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Alfonso F, García P, Pimentel G, Hernández R, Sabaté M, Escaned J, Bañuelos C, Fernández C, Macaya C. Predictors and implications of residual plaque burden after coronary stenting: an intravascular ultrasound study. Am Heart J 2003; 145:254-61. [PMID: 12595842 DOI: 10.1067/mhj.2003.49] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND Residual plaque burden after coronary stenting may be visualized by use of intravascular ultrasound. Determinants and implications of residual atherosclerotic plaque burden after coronary stenting are not well established. In particular, the implications of residual plaque burden, after adjusting for confounding factors, are still unknown. METHODS Sixty-two consecutive patients (age 56 +/- 9 years) undergoing coronary stenting under intravascular ultrasound imaging guidance were prospectively studied. A total of 616 slices were analyzed (every 2 mm of stent length) from motorized pull-back recordings. Residual plaque burden was calculated as residual plaque/vessel area x 100. RESULTS In 565 slices (89%), both residual plaque area and stent area could be measured. Mean residual plaque burden was 46.5% +/- 6%. By use of multiple regression analysis, lesion plaque area and reference segment plaque burden were identified as independent predictors of residual plaque burden after stenting. In addition, a significant correlation was found between residual plaque burden and most relevant angiographic parameters at follow-up (including minimal lumen diameter, percent diameter stenosis, and loss index), which persisted after adjustment. Furthermore, stents with a residual plaque burden >or=46% had higher a restenosis rate (relative risk [RR] 4.4, 95% CI 1.09-18.2, P =.03). On logistic regression analysis, residual plaque burden (RR 4.8, 95% CI 4.1-5.6, P =.01) and diabetes (RR 4.3, 95% CI 3.6-5.1, P =.03) emerged as the only independent predictors of restenosis. CONCLUSIONS The amount of residual plaque burden after coronary stenting plays an independent role on the late angiographic outcome of these patients.
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Affiliation(s)
- Fernando Alfonso
- Interventional Cardiology Unit, Cardiovascular Institute, San Carlos University Hospital, Madrid, Spain
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15
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Ikeno F, Hinohara T, Robertson GC, Rezaee M, Yock PG, Reimers B, Colombo A, Grube E, Simpson JB. Early experience with a novel plaque excision system for the treatment of complex coronary lesions. Catheter Cardiovasc Interv 2003; 61:35-43. [PMID: 14696157 DOI: 10.1002/ccd.10727] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
The use of directional coronary atherectomy (DCA) in current practice has been limited. The SilverHawk System is a newly developed plaque excision device that aims to overcome the drawbacks of prior DCA platforms. The device was evaluated in a porcine coronary model and in a series of patients. Procedural variables along with outcomes were reviewed. Quantitative angiography (QCA) was performed and excised tissue fragments were weighed and examined histologically. In porcine cases, pretreatment MLD increased from 0.51 +/- 0.26 to 2.36 +/- 0.59 mm postdebulking and 19.9 +/- 7.6 mg of tissue was retrieved. In human cases, pretreatment MLD increased from 0.8 +/- 0.4 to 2.2 +/- 0.5 mm postdebulking and 15.2 +/- 7.8 mg of tissue was retrieved without complications. These data show that the SilverHawk System may offer significant utility in treating a wide variety of complex coronary lesions.
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Affiliation(s)
- Fumiaki Ikeno
- Division of Cardiovascular Medicine, Stanford University Medical Center, Stanford, California, USA
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16
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Casserly IP, Aronow HD, Schoenhagen P, Tsutsui H, Popovich J, Goormastic M, Popma JJ, Nissen SE, Tuzcu EM. Relationship between residual atheroma burden and neointimal growth in patients undergoing stenting: analysis of the atherectomy before MULTI-LINK improves lumen gain and clinical outcomes trial intravascular ultrasound substudy. J Am Coll Cardiol 2002; 40:1573-8. [PMID: 12427408 DOI: 10.1016/s0735-1097(02)02341-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES The objective of this study was to examine the relationship between quantitative volumetric and cross-sectional measures of residual atheroma burden and neointimal growth after coronary stenting. BACKGROUND Previous intravascular ultrasound (IVUS) studies have demonstrated a correlation between residual atheroma burden and neointimal growth after coronary stenting. However, postmortem studies contradict this finding. METHODS The study population included 34 patients who underwent IVUS six to eight months after stent placement, including 26 patients who underwent IVUS immediately after stent placement and at six to eight months follow-up. Using manual planimetry, the lumen cross-sectional area (LA), stent cross-sectional area (SA) and external elastic membrane cross-sectional area (EEM) were measured at 1-mm intervals after the procedure and at follow-up. Percent neointimal area (NA) and atheroma area (AA) were calculated as: percent neointimal area = ([SA - LA]/SA) x 100; percent AA = ([EEM - SA]/EEM) x 100 in the entire cross section and in individual quadrants. Postinterventional atheroma volume and neointimal volume at follow-up were calculated using Simpsons's rule. RESULTS In pooled analyses using all cross sections and cross-sectional quadrants, there was a weak correlation between percent AA and NA (r = 0.11 and 0.12, respectively). Analysis in individual patients demonstrated no significant relationship between total or quadrant measurements of percent AA and NA (p = 0.47 and 0.4, respectively). No relationship between atheroma volume postintervention and neointimal volume at follow-up was observed (r = 0.1, p = 0.62). CONCLUSIONS This study failed to demonstrate a clinically significant relationship between quantitative volumetric and cross-sectional measures of residual atheroma burden and subsequent neointimal growth.
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Affiliation(s)
- Ivan P Casserly
- Department of Cardiovascular Medicine, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH 44195, USA
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Alfonso F. Residual plaque burden after stenting: does it matter? Am J Cardiol 2002; 90:910. [PMID: 12372590 DOI: 10.1016/s0002-9149(02)02740-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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18
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Takagi T, Di Mario C, Stankovic G, Reimers B, Alberti A, Liistro F, Kovalenko O, Sgura F, Albiero R, Ribichini F, Pugno A, Colombo A. Effective plaque removal with a new 8 French-compatible atherectomy catheter. Catheter Cardiovasc Interv 2002; 56:452-9. [PMID: 12124951 DOI: 10.1002/ccd.10196] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
The purpose of this study was to evaluate the safety and efficacy of the new 8 Fr guide catheter-compatible Flexicut directional atherectomy device and to compare it with the conventional Atherocath GTO catheter. The 6 Fr Flexicut catheter has a larger cutting window and a titanium nitride-coated cutter to effect more tissue removal as well as treat mildly calcified lesions. A group of 143 lesions in 117 consecutive patients treated with the Flexicut catheter in four centers were compared with a control group of 277 lesions in 212 consecutive patients treated with the GTO device. Postatherectomy luminal diameters were larger (2.92 +/- 0.79 vs. 2.52 +/- 0.64 mm; P < 0.0001), with more luminal gain (relative gain: 0.58 +/- 0.24 vs. 0.48 +/- 0.25; P = 0.0007) using fewer directional coronary atherectomy (DCA) cuts (12 +/- 7 vs. 16 +/- 9; P = 0.0001) in the Flexicut group. A residual diameter stenosis < 20% immediately after DCA was obtained in 77% of the lesions in the Flexicut group vs. 45% in the GTO group (P < 0.0001). Histology in the former group revealed large calcium speckles in the retrieved specimens. In the Flexicut group, there was a lower incidence of access site complications and damage to the coronary ostium (2.5% vs. 7.5%; P = 0.08). The new Flexicut catheter is more effective than the conventional GTO catheter with a trend for reduced guiding catheter-related complications.
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Affiliation(s)
- Takuro Takagi
- Interventional Cardiology, San Raffaele Hospital and EMO Centro Cuore Columbus, Milan, Italy
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Leborgne L, Cheneau E, Wolfram R, Ajani A, Pakala R, Canos D, Pinnow E, Pichard AD, Satler LF, Waksman R. The proximal location of stenosis in the left anterior descending coronary artery is not a predictive factor of worse outcome in the era of the stent. CARDIOVASCULAR RADIATION MEDICINE 2002; 3:127-32. [PMID: 12974362 DOI: 10.1016/s1522-1865(03)00095-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND Patients treated for lesions in the proximal left anterior descending coronary artery (P-LAD) have worse outcome after balloon angioplasty as compared to patients treated for lesions in the distal left anterior descending coronary artery (D-LAD). We sought to examine if this discrepancy was still observed after stenting. METHODS A total of 676 consecutive patients with a symptomatic monovessel disease in the LAD artery who underwent angioplasty with stenting were prospectively entered into a dedicated database. Among this cohort, 322 lesions were located in P-LAD and 354 in D-LAD. Patients with total occlusion, acute myocardial infarction (MI) or restenosis were excluded. RESULTS Procedural characteristics were similar in the two groups. Procedural success was high with the same rates of in-hospital death and Q-wave MI for patients treated in P-LAD and D-LAD. At 1 year, the rate of target lesion revascularization (TLR) was 13.9% in the P-LAD group and 16.3% in the D-LAD group (P = .79), and the rate of event-free survival was 81.9% and 81% (P = .67), respectively. The treatment of ostial lesions (n = 23) was not related to worse outcome. In multivariate analysis, lesion location was not a predictor of major adverse cardiac events (MACE). CONCLUSION This study shows that stenting of lesions in the P-LAD is as effective and safe as treatment of lesions located in D-LAD. Therefore, when stenting is feasible, the location of the lesion in the LAD is not predictive of worse outcome and, consequently, should not be taken into account in the choice of the revascularization strategy.
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Affiliation(s)
- Laurent Leborgne
- Division of Cardiology, Cardiovascular Research Institute, Washington Hospital Center, Suite 4B-1, 110 Irving Street, NW, Washington, DC 20100, USA
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