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Teira Calderón A, Chiarito M, Santos IA, Cao D, Vaquerizo Montilla B, Jurado Román A, Pulido Garrido P, Tartaglia F, García-García HM, Díez-Gil JL, Sanz-Sánchez J. Uninterrupted direct-acting oral anticoagulation in patients undergoing transradial percutaneous coronary procedures: The DOAC-NOSTOP study rationale and design. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2024; 63:68-72. [PMID: 38307792 DOI: 10.1016/j.carrev.2024.01.013] [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: 11/29/2023] [Revised: 01/19/2024] [Accepted: 01/23/2024] [Indexed: 02/04/2024]
Abstract
BACKGROUND patients with atrial fibrillation (AF) under treatment with chronic oral anticoagulation (OAC) often require coronary angiography with or without percutaneous coronary intervention (PCI). Deciding the management of OAC during this periprocedural period requires balancing the risks of hemorrhage and thrombotic complications. Guidelines recommend an uninterrupted strategy in patients receiving Vitamin-K Antagonists (VKA). However, for patients undergoing coronary angiography or PCI while on direct oral anticoagulants (DOACs), withdrawal 12-24 h prior to the procedure is still recommended. This is based on expert opinions given the lack of evidence. Therefore, whether DOAC discontinuation prior to trans-radial coronary procedures should be the strategy of choice is a matter of debate and solid evidence is needed to guide clinical decision making. METHODS The DOAC-NOSTOP study is a prospective, single-arm, open-label study evaluating the safety of DOACs continuation in 200 patients undergoing transradial percutaneous coronary procedures. DOAC treatment will not be interrupted throughout the periprocedural period. Primary outcome will be Bleeding Academic Research Consortium (BARC) type 2, 3, or 5 events, assessed at a 30-day follow-up. CONCLUSIONS The DOAC-NOSTOP is the first study prospectively assessing the risk of bleeding with uninterrupted DOAC in patients undergoing trans-radial percutaneous coronary procedures.
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Affiliation(s)
| | - Mauro Chiarito
- Humanitas Clinical and Research Hospital IRCCS, Rozzano, Milan, Italy; Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Ignacio Amat Santos
- Hospital Clínico Universitario de Valladolid, Valladolid, Spain; Centro de Investigación Biomedica en Red (CIBERCV) - Madrid, Spain
| | - Davide Cao
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy; The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America
| | - Beatriz Vaquerizo Montilla
- Centro de Investigación Biomedica en Red (CIBERCV) - Madrid, Spain; Interventional Cardiology Unit, Department of Cardiology, Hospital del Mar, Barcelona, Spain; Hospital del Mar Research Institute (IMIM), Barcelona, Spain; Department of Medicine, Pompeu Fabra University, Barcelona, Spain
| | | | | | - Francesco Tartaglia
- Humanitas Clinical and Research Hospital IRCCS, Rozzano, Milan, Italy; Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | | | - Jose Luis Díez-Gil
- Hospital Universitari i Politecnic La Fe, Valencia, Spain; Centro de Investigación Biomedica en Red (CIBERCV) - Madrid, Spain
| | - Jorge Sanz-Sánchez
- Hospital Universitari i Politecnic La Fe, Valencia, Spain; Centro de Investigación Biomedica en Red (CIBERCV) - Madrid, Spain.
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Zuccarelli V, Andreaggi S, Walsh JL, Kotronias RA, Chu M, Vibhishanan J, Banning AP, De Maria GL. Treatment and Care of Patients with ST-Segment Elevation Myocardial Infarction-What Challenges Remain after Three Decades of Primary Percutaneous Coronary Intervention? J Clin Med 2024; 13:2923. [PMID: 38792463 PMCID: PMC11122374 DOI: 10.3390/jcm13102923] [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: 04/19/2024] [Revised: 05/11/2024] [Accepted: 05/13/2024] [Indexed: 05/26/2024] Open
Abstract
Primary percutaneous coronary intervention (pPCI) has revolutionized the prognosis of ST-segment elevation myocardial infarction (STEMI) and is the gold standard treatment. As a result of its success, the number of pPCI centres has expanded worldwide. Despite decades of advancements, clinical outcomes in STEMI patients have plateaued. Out-of-hospital cardiac arrest and cardiogenic shock remain a major cause of high in-hospital mortality, whilst the growing burden of heart failure in long-term STEMI survivors presents a growing problem. Many elements aiming to optimize STEMI treatment are still subject to debate or lack sufficient evidence. This review provides an overview of the most contentious current issues in pPCI in STEMI patients, with an emphasis on unresolved questions and persistent challenges.
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Affiliation(s)
- Vittorio Zuccarelli
- Oxford Heart Centre, Oxford University Hospitals NHS Trust, Oxford OX3 9DU, UK; (V.Z.); (S.A.); (J.L.W.); (R.A.K.); (M.C.); (J.V.); (A.P.B.)
| | - Stefano Andreaggi
- Oxford Heart Centre, Oxford University Hospitals NHS Trust, Oxford OX3 9DU, UK; (V.Z.); (S.A.); (J.L.W.); (R.A.K.); (M.C.); (J.V.); (A.P.B.)
- Division of Cardiology, Department of Medicine, University of Verona, 37129 Verona, Italy
| | - Jason L. Walsh
- Oxford Heart Centre, Oxford University Hospitals NHS Trust, Oxford OX3 9DU, UK; (V.Z.); (S.A.); (J.L.W.); (R.A.K.); (M.C.); (J.V.); (A.P.B.)
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford OX1 2JD, UK
| | - Rafail A. Kotronias
- Oxford Heart Centre, Oxford University Hospitals NHS Trust, Oxford OX3 9DU, UK; (V.Z.); (S.A.); (J.L.W.); (R.A.K.); (M.C.); (J.V.); (A.P.B.)
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford OX1 2JD, UK
| | - Miao Chu
- Oxford Heart Centre, Oxford University Hospitals NHS Trust, Oxford OX3 9DU, UK; (V.Z.); (S.A.); (J.L.W.); (R.A.K.); (M.C.); (J.V.); (A.P.B.)
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford OX1 2JD, UK
| | - Jonathan Vibhishanan
- Oxford Heart Centre, Oxford University Hospitals NHS Trust, Oxford OX3 9DU, UK; (V.Z.); (S.A.); (J.L.W.); (R.A.K.); (M.C.); (J.V.); (A.P.B.)
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford OX1 2JD, UK
| | - Adrian P. Banning
- Oxford Heart Centre, Oxford University Hospitals NHS Trust, Oxford OX3 9DU, UK; (V.Z.); (S.A.); (J.L.W.); (R.A.K.); (M.C.); (J.V.); (A.P.B.)
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford OX1 2JD, UK
- National Institute for Health Research (NIHR), Oxford Biomedical Research Centre, Oxford OX3 9DU, UK
| | - Giovanni Luigi De Maria
- Oxford Heart Centre, Oxford University Hospitals NHS Trust, Oxford OX3 9DU, UK; (V.Z.); (S.A.); (J.L.W.); (R.A.K.); (M.C.); (J.V.); (A.P.B.)
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford OX1 2JD, UK
- National Institute for Health Research (NIHR), Oxford Biomedical Research Centre, Oxford OX3 9DU, UK
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Zhao C, Hou K, Cao L, Wang J. The Effect of Angiotensin Receptor Blockers on In-Stent Restenosis After Stent Implantation: A Meta-Analysis. Heart Lung Circ 2024; 33:486-492. [PMID: 38423849 DOI: 10.1016/j.hlc.2024.01.024] [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: 06/10/2023] [Revised: 01/02/2024] [Accepted: 01/14/2024] [Indexed: 03/02/2024]
Abstract
AIM Angiotensin receptor blockers (ARBs) have been shown to inhibit restenosis in vitro and in vivo, but the evidence found in humans is inconsistent. This study aimed to evaluate the effectiveness of ARBs in preventing in-stent restenosis after percutaneous coronary intervention (PCI). METHOD Databases including the Cochrane Library, MEDLINE, Web of Science, EMBASE, and CNKI were searched to collect randomised controlled trials on ARBs inhibiting restenosis that were published before October 2022. A total of 1,056 patients enrolled in eight trials were included in the study. RESULTS The ARBs group showed lower target lesion revascularisation than the control group (RR 0.54; 95% CI 0.34-0.86; p=0.01), but the restenosis incidence between these two groups was not statistically significant (RR 0.85; 95% CI 0.65-1.11; p>0.05). CONCLUSION This study found that ARBs might have a potential effect on reducing target lesion revascularisation after PCI in coronary heart disease patients but has no impact on angiographic restenosis.
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Affiliation(s)
- Cui Zhao
- Department of Cardiology, Chest Hospital, Tianjin University, Tianjin, China; Clinical School of Thoracic, Tianjin Medical University, Tianjin, China
| | - Kai Hou
- Department of Cardiology, Chest Hospital, Tianjin University, Tianjin, China
| | - Lu Cao
- Department of Cardiology, Chest Hospital, Tianjin University, Tianjin, China.
| | - Jixiang Wang
- Department of Cardiology, Chest Hospital, Tianjin University, Tianjin, China.
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Zeng Y, Xu J, Deng Y, Li X, Chen W, Tang Y. Drug-eluting stents for coronary artery disease in the perspective of bibliometric analysis. Front Cardiovasc Med 2024; 11:1288659. [PMID: 38440210 PMCID: PMC10910058 DOI: 10.3389/fcvm.2024.1288659] [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: 09/04/2023] [Accepted: 01/30/2024] [Indexed: 03/06/2024] Open
Abstract
Drug-eluting stents (DES) play a crucial role in treating coronary artery disease (CAD) by preventing restenosis. These stents are coated with drug carriers that release antiproliferative drugs within the vessel. Over the past two decades, DES have been employed in clinical practice using various materials, polymers, and drug types. Despite optimizations in their design and materials to enhance biocompatibility and antithrombotic properties, evaluating their long-term efficacy and safety necessitates improved clinical follow-up and monitoring. To delineate future research directions, this study employs a bibliometric analysis approach. We comprehensively surveyed two decades' worth of literature on DES for CAD using the Web of Science Core Collection (WOSCC). Out of 5,778 articles, we meticulously screened them based on predefined inclusion and exclusion criteria. Subsequently, we conducted an in-depth analysis encompassing annual publication trends, authorship affiliations, journal affiliations, keywords, and more. Employing tools such as Excel 2021, CiteSpace 6.2R3, VOSviewer 1.6.19, and Pajek 5.17, we harnessed bibliometric methods to derive insights from this corpus. Analysis of annual publication data indicates a recent stabilisation or even a downward trend in research output in this area. The United States emerged as the leading contributor, with Columbia University and CRF at the forefront in both publication output and citation impact. The most cited document pertained to standardized definitions for clinical endpoints in coronary stent trials. Our author analysis identifies Patrick W. Serruys as the most prolific contributor, underscoring a dynamic exchange of knowledge within the field.Moreover, the dual chart overlay illustrates a close interrelation between journals in the "Medicine," "Medical," and "Clinical" domains and those in "Health," "Nursing," and "Medicine." Frequently recurring keywords in this research landscape include DES coronary artery disease, percutaneous coronary intervention, implantation, and restenosis. This study presents a comprehensive panorama encompassing countries, research institutions, journals, keyword distributions, and contributions within the realm of DES therapy for CAD. By highlighting keywords exhibiting recent surges in frequency, we elucidate current research hotspots and frontiers, thereby furnishing novel insights to guide future researchers in this evolving field.
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Affiliation(s)
- Ying Zeng
- Jiangxi Medical College, Nanchang University, Jiangxi Provincial People's Hospital, The First Affiliated Hospital of Nanchang Medical College, Nanchang, China
| | - Jiawei Xu
- Jiangxi Medical College, Nanchang University, Jiangxi Provincial People's Hospital, The First Affiliated Hospital of Nanchang Medical College, Nanchang, China
| | - Yuxuan Deng
- Department of Endocrinology and Metabolism, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, China
| | - Xiaoxing Li
- The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, China
| | - Wen Chen
- Jiangxi Cancer Hospital, Nanchang, China
| | - Yu Tang
- Jiangxi Provincial People's Hospital, The First Affiliated Hospital of Nanchang Medical College, Nanchang, China
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Masuda S, Muramatsu T, Ishibashi Y, Kozuma K, Tanabe K, Nakatani S, Kogame N, Nakamura M, Asano T, Okamura T, Miyazaki Y, Tateishi H, Ozaki Y, Nakazawa G, Morino Y, Katagiri Y, Garg S, Hara H, Ono M, Kawashima H, Lemos PA, Serruys PW, Onuma Y. Reduced-dose prasugrel monotherapy without aspirin after PCI with the SYNERGY stent in East Asian patients presenting with chronic coronary syndromes or non-ST-elevation acute coronary syndromes: rationale and design of the ASET Japan pilot study. ASIAINTERVENTION 2023; 9:39-48. [PMID: 36936091 PMCID: PMC10018289 DOI: 10.4244/aij-d-22-00033] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Accepted: 09/01/2022] [Indexed: 06/18/2023]
Abstract
The Acetyl Salicylic Elimination Trial (ASET) Japan pilot study is a multicentre, single-arm, open-label, proof-of-concept study with a stopping rule based on the occurrence of definite stent thrombosis. This study aims to demonstrate the feasibility and safety of low-dose prasugrel monotherapy following percutaneous coronary intervention (PCI) in Japanese patients presenting with chronic coronary syndromes (CCS) or non-ST-elevation acute coronary syndromes (NSTE-ACS). Four hundred patients with a SYNTAX score <23 requiring PCI due to CCS or NSTE-ACS will be screened and considered eligible for the study. The enrolment is planned in two phases: 1) 200 patients presenting with CCS, followed by 2) 200 patients presenting with NSTE-ACS. After optimal PCI with implantation of a SYNERGY (Boston Scientific) stent, patients will be enrolled and loaded with prasugrel 20 mg, followed by a maintenance dose of prasugrel 3.75 mg once daily without aspirin continued for 3 months in Phase 1 (CCS patients), and for 12 months in Phase 2 (NSTE-ACS patients). After these follow-up periods, prasugrel will be replaced by standard antiplatelet therapy according to local practice. The primary endpoint is a composite of cardiac death, target vessel myocardial infarction, or definite stent thrombosis after the index procedure. The primary bleeding endpoint is any Bleeding Academic Research Consortium type 3 or 5 bleeding occurring within 3 months of the index PCI for CCS patients, or 12 months for NSTE-ACS patients. The ASET Japan study is designed to demonstrate the feasibility and safety of reduced-dose prasugrel monotherapy after PCI in East Asian patients with acute and chronic coronary syndromes.
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Affiliation(s)
- Shinichiro Masuda
- Department of Cardiology, National University of Ireland Galway (NUIG), Galway, Ireland
| | - Takashi Muramatsu
- Department of Cardiology, Fujita Health University Hospital, Toyoake, Japan
| | - Yuki Ishibashi
- Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine, Kanagawa, Japan
| | - Ken Kozuma
- Department of Cardiology, Teikyo University Hospital, Tokyo, Japan
| | - Kengo Tanabe
- Division of Cardiology, Mitsui Memorial Hospital, Tokyo, Japan
| | - Shimpei Nakatani
- Department of Cardiology, JCHO Hoshigaoka Medical Center, Osaka, Japan
| | - Norihiro Kogame
- Division of Cardiovascular Medicine, Toho University Ohashi Medical Center, Tokyo, Japan
| | - Masato Nakamura
- Division of Cardiovascular Medicine, Toho University Ohashi Medical Center, Tokyo, Japan
| | - Taku Asano
- Department of Cardiology, St. Luke's International Hospital, Tokyo, Japan
| | - Takayuki Okamura
- Division of Cardiology, Department of Clinical Science and Medicine, Yamaguchi University Graduate School of Medicine, Yamaguchi, Japan
| | - Yosuke Miyazaki
- Division of Cardiology, Department of Clinical Science and Medicine, Yamaguchi University Graduate School of Medicine, Yamaguchi, Japan
| | - Hiroki Tateishi
- Division of Cardiology, Department of Clinical Science and Medicine, Yamaguchi University Graduate School of Medicine, Yamaguchi, Japan
- Department of Cardiology, Shibata Hospital, Aichi, Japan
| | - Yukio Ozaki
- Department of Cardiology, Fujita Health University Okazaki Medical Center, Aichi, Japan
| | - Gaku Nakazawa
- Department of Cardiology, Kindai University Faculty of Medicine, Osaka, Japan
| | - Yoshihiro Morino
- Department of Cardiology, Iwate Medical University Hospital, Iwate, Japan
| | - Yuki Katagiri
- Department of Cardiology, Sapporo Higashi Tokushukai Hospital, Hokkaido, Japan
| | - Scot Garg
- Department of Cardiology, Royal Blackburn Hospital, Blackburn, UK
| | - Hironori Hara
- Department of Cardiology, National University of Ireland Galway (NUIG), Galway, Ireland
| | - Masafumi Ono
- Department of Cardiology, National University of Ireland Galway (NUIG), Galway, Ireland
| | - Hideyuki Kawashima
- Department of Cardiology, National University of Ireland Galway (NUIG), Galway, Ireland
- Department of Cardiology, Teikyo University Hospital, Tokyo, Japan
| | - Pedro A Lemos
- Heart Institute (InCor), University of São Paulo, São Paulo, Brazil
- Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Patrick W Serruys
- Department of Cardiology, National University of Ireland Galway (NUIG), Galway, Ireland
| | - Yoshinobu Onuma
- Department of Cardiology, National University of Ireland Galway (NUIG), Galway, Ireland
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Search for holy grail of stent coating will go on. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2022; 42:100-101. [DOI: 10.1016/j.carrev.2022.06.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Accepted: 06/20/2022] [Indexed: 11/19/2022]
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Characterizing the Mechanical Performance of a Bare-Metal Stent with an Auxetic Cell Geometry. APPLIED SCIENCES-BASEL 2022. [DOI: 10.3390/app12020910] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
This study develops and characterizes the distinctive mechanical features of a stainless-steel metal stent with a tailored structure. A high-precision femtosecond laser was used to micromachine a stent with re-entrant hexagonal (auxetic) cell geometry. We then characterized its mechanical behavior under various mechanical loadings using in vitro experiments and through finite element analysis. The stent properties, such as the higher capability of the stent to bear upon bending, exceptional advantage at elevated levels of twisting angles, and proper buckling, all ensured a preserved opening to maintain the blood flow. The outcomes of this preliminary study present a potential design for a stent with improved physiologically relevant mechanical conditions such as longitudinal contraction, radial strength, and migration of the stent.
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Frequency of recurrence of peripheral artery disease among angioplasty and stenting patients. Ann Med Surg (Lond) 2021; 72:103146. [PMID: 34925825 PMCID: PMC8649217 DOI: 10.1016/j.amsu.2021.103146] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 12/01/2021] [Accepted: 12/01/2021] [Indexed: 12/25/2022] Open
Abstract
Background Peripheral artery disease (PAD) is a cardiovascular disease that is characterized by obstruction of peripheral artery. It is associated with comorbidities, reduced quality of life and mortality. The aim of this study was to determine the frequency of recurrence of PAD among patients who underwent angioplasty or stenting and associated risk factors. Methods In this retrospective study, all patients referred to the cardiovascular center of (XXX) with the diagnosis of lower extremity PAD were included. Patients’ demographic information, age, gender, smoking status, history of diabetes, history of hypertension, dyslipidemia, number of vessels, type of stent, recurrence of the disease, and size of the lesion were obtained from the hospital database. Endovascular revascularization therapy was either performed by angioplasty or stenting method. The data were analyzed by SPSS v21. Results Of 88 patients included in this study, 12.5% were reported with restenosis. Gender, age, size of the lesion, the status of smoking, history of hypertension, and dyslipidemia were not significantly associated with the recurrence of stenosis, p > 0.05. There was a significant relationship between the vessels involved and the type of revascularization method and the recurrence of the PAD. Conclusion Endovascular revascularization technique and type of vessel involved in PAD are significant factors contributing to restenosis in our population of study. However, further studies with a greater sample size are required in this area. Peripheral artery disease is a cardiovascular disease with obstruction of peripheral artery. It is associated with comorbidities, reduced quality of life and even mortality. Endovascular revascularization technique in PAD are significant factor in our study. However, further studies with greater sample size are required in this area.
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Yu WP, Gong Y, Wang Z, Lu C, Ding JL, Liu XL, Zhu GD, Lin F, Xu JJ, Zhou JL. The biofunctionalization of titanium nanotube with chitosan/genipin heparin hydrogel and the controlled release of IL-4 for anti-coagulation and anti-thrombus through accelerating endothelialization. RSC Adv 2021; 11:16510-16521. [PMID: 35479169 PMCID: PMC9031326 DOI: 10.1039/d0ra09295a] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Accepted: 04/18/2021] [Indexed: 12/29/2022] Open
Abstract
The valve replacement is the main treatment of heart valve disease. However, thrombus formation following valve replacement has always been a major clinical drawback. Accelerating the endothelialization of cardiac valve prosthesis is the main approach to reduce thrombus. In the current study, a titanium nanotube was biofunctionalized with a chitosan/genipin heparin hydrogel and the controlled release of interleukin-4 (IL-4), and its regulation of macrophages was investigated to see if it could influence endothelial cells to eventually accelerate endothelialization. TNT60 (titanium dioxide nanotubes, 60 V) with nanoarray was obtained by anodic oxidation of 60 V, and IL-4 was loaded into the nanotube by vacuum drying. The hydrogel (chitosan : genipin = 4 : 1) was applied to the surface of the nanotubes following drying, and the heparin drops were placed on the hydrogel surface with chitosan as the polycation and heparin as the polyanion. A TNT/IL-4/G (G = gel, chitosan/genipin heparin) delivery system was prepared. Our results demonstrated that the biofunctionalization of titanium nanotube with chitosan/genipin heparin hydrogel and the controlled release of IL-4 had a significant regulatory effect on macrophage M2 polarization, reducing the inflammatory factor release and higher secretion of VEGF (vascular endothelial growth factor), which can accelerate the endothelialization of the implant.
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Affiliation(s)
- Wen Peng Yu
- Department of Cardiovascular Surgery, The Second Affiliated Hospital of Nanchang University No. 1 Minde Road Nanchang 330006 Jiangxi China +86 137 6711 7511
| | - Yi Gong
- Department of Cardiovascular Surgery, The Second Affiliated Hospital of Nanchang University No. 1 Minde Road Nanchang 330006 Jiangxi China +86 137 6711 7511
| | - Ziyao Wang
- Department of Clinical Pathology, The First Affiliated Hospital of Gannan Medical College Ganzhou China
| | - Chao Lu
- Department of Cardiovascular Surgery, The Second Affiliated Hospital of Nanchang University No. 1 Minde Road Nanchang 330006 Jiangxi China +86 137 6711 7511
| | - Jing Li Ding
- Department of Gastroenterology, The Second Affiliated Hospital of Nanchang University Nanchang China
| | - Xin Liang Liu
- Department of Cardiovascular Surgery, The Second Affiliated Hospital of Nanchang University No. 1 Minde Road Nanchang 330006 Jiangxi China +86 137 6711 7511
| | - Guo Dong Zhu
- Department of Cardiovascular Surgery, The Second Affiliated Hospital of Nanchang University No. 1 Minde Road Nanchang 330006 Jiangxi China +86 137 6711 7511
| | - Feng Lin
- Department of Cardiovascular Surgery, The Second Affiliated Hospital of Nanchang University No. 1 Minde Road Nanchang 330006 Jiangxi China +86 137 6711 7511
| | - Jian Jun Xu
- Department of Cardiovascular Surgery, The Second Affiliated Hospital of Nanchang University No. 1 Minde Road Nanchang 330006 Jiangxi China +86 137 6711 7511
| | - Jian Liang Zhou
- Department of Cardiovascular Surgery, The Second Affiliated Hospital of Nanchang University No. 1 Minde Road Nanchang 330006 Jiangxi China +86 137 6711 7511
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Doshi R, Thakkar S, Patel K, Majmundar M, Shlofmitz E, Kumar A, Gupta N, Adalja D, Patel HP, Jauhar R, Meraj P. Short term outcomes of rotational atherectomy versus orbital atherectomy in patients undergoing complex percutaneous coronary intervention: a systematic review and meta-analysis. SCAND CARDIOVASC J 2021; 55:129-137. [PMID: 33461347 DOI: 10.1080/14017431.2021.1875139] [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] [Indexed: 10/22/2022]
Abstract
OBJECTIVE Coronary artery calcification (CAC) is one of the paramount hurdles for percutaneous coronary intervention (PCI) since it impedes stent delivery and complete expansion. This study intended to evaluate the short-term clinical and procedural outcomes comparing rotational atherectomy (RA) and orbital atherectomy (OA) in patients with heavily calcified coronary lesions undergoing PCI. Design: This systematic review and meta-analysis included all head-to-head published comparisons of coronary RA versus OA. Procedural endpoints and post-procedural clinical outcomes (30 days/in-hospital), were compared. RevMan 5.3 software was used for data analysis. Results: Seven retrospective observational investigations with a total of 4623 patients, including 3203 patients in the RA group and 1420 patients in the OA group, were incorporated. Compared with OA, the RA group was associated with a higher incidence of myocardial infarction at short-term follow-up (OR: 1.56, 95% CI: 1.07-2.29, p = .02, I2 = 0%). No difference was noted among other short-term post-procedural clinical outcomes including all-cause mortality, target vessel revascularization, or major adverse cardiac events. Among procedural complications, RA was associated with reduced coronary artery dissection and arterial perforation. Increased fluoroscopy time was observed in the RA cohort as compared with OA (MD: 4.78, 95% CI: 2.25-7.30, p = .0002, I2 = 80%). Conclusion: RA was associated with fewer vascular complications, but at a cost of higher incidence of myocardial infarction and higher fluoroscopy time compared with OA, at short term follow-up. OA is a safe and effective alternative for the management of CAC.
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Affiliation(s)
- Rajkumar Doshi
- Department of Internal Medicine, University of Nevada Reno School of Medicine, Reno, NV, USA
| | - Samarthkumar Thakkar
- Department of Internal Medicine, Rochester Regional Hospital, Rochester, NY, USA
| | - Krunalkumar Patel
- Department of Internal Medicine, St. Mary Medical Center, Langhorne, PA, USA
| | - Monil Majmundar
- Department of Internal Medicine, Metropolitan Hospital Center, New York Medical College, New York, NY, USA
| | - Evan Shlofmitz
- Department of Cardiology, St. Francis Hospital, Roslyn, NY, USA
| | - Ashish Kumar
- Department of Critical Care, St John's Medical College Hospital, Bangalore, India
| | - Neelesh Gupta
- Department of Internal Medicine, University of South Alabama, Mobile, AL, USA
| | - Devina Adalja
- Department of Medicine, GMERS Gotri Medical College, Vadodara, India
| | - Harsh P Patel
- Department of Internal Medicine, Louis A. Weiss Memorial Hospital, Chicago, IL, USA
| | - Rajiv Jauhar
- Department of Cardiology, North Shore University Hospital, Manhasset, NY, USA
| | - Perwaiz Meraj
- Department of Cardiology, North Shore University Hospital, Manhasset, NY, USA
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Kogame N, Guimarães PO, Modolo R, De Martino F, Tinoco J, Ribeiro EE, Kawashima H, Ono M, Hara H, Wang R, Cavalcante R, Moulin B, Falcão BA, Leite RS, de Almeida Sampaio FB, Morais GR, Meireles GC, Campos CM, Onuma Y, Serruys PW, Lemos PA. Aspirin-Free Prasugrel Monotherapy Following Coronary Artery Stenting in Patients With Stable CAD. JACC Cardiovasc Interv 2020; 13:2251-2262. [DOI: 10.1016/j.jcin.2020.06.023] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 05/19/2020] [Accepted: 06/09/2020] [Indexed: 01/09/2023]
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12
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Kawashima H, Zocca P, Buiten RA, Smits PC, Onuma Y, Wykrzykowska JJ, de Winter RJ, von Birgelen C, Serruys PW. The 2010s in clinical drug-eluting stent and bioresorbable scaffold research: a Dutch perspective. Neth Heart J 2020; 28:78-87. [PMID: 32780336 PMCID: PMC7419418 DOI: 10.1007/s12471-020-01442-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Dutch researchers were among the first to perform clinical studies in bare metal coronary stents, the use of which was initially limited by a high incidence of in-stent restenosis. This problem was greatly solved by the introduction of drug-eluting stents (DES). Nevertheless, enthusiasm about first-generation DES was subdued by discussions about a higher risk of very-late stent thrombosis and mortality, which stimulated the development, refinement, and rapid adoption of new DES with more biocompatible durable polymer coatings, biodegradable polymer coatings, or no coating at all. In terms of clinical DES research, the 2010s were characterised by numerous large-scale randomised trials in all-comers and patients with minimal exclusion criteria. Bioresorbable scaffolds (BRS) were developed and investigated. The Igaki-Tamai scaffold without drug elution was clinically tested in the Netherlands in 1999, followed by an everolimus-eluting BRS (Absorb) which showed favourable imaging and clinical results. Afterwards, multiple clinical trials comparing Absorb and its metallic counterpart were performed, revealing an increased rate of scaffold thrombosis during follow-up. Based on these studies, the commercialisation of the device was subsequently halted. Novel technologies are being developed to overcome shortcomings of first-generation BRS. In this narrative review, we look back on numerous devices and on the DES and BRS trials reported by Dutch researchers.
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Affiliation(s)
- H Kawashima
- Department of Clinical and Experimental Cardiology, Heart Center, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.,Department of Cardiology, National University of Ireland, Galway (NUIG), Galway, Ireland
| | - P Zocca
- Department of Cardiology, Thoraxcentrum Twente, Medisch Spectrum Twente, Enschede, The Netherlands
| | - R A Buiten
- Department of Cardiology, Thoraxcentrum Twente, Medisch Spectrum Twente, Enschede, The Netherlands.,Health Technology and Services Research, Faculty of Behavioural Management and Social Sciences, Technical Medical Centre, University of Twente, Enschede, The Netherlands
| | - P C Smits
- Department of Cardiology, Maasstad Hospital, Rotterdam, The Netherlands
| | - Y Onuma
- Department of Cardiology, National University of Ireland, Galway (NUIG), Galway, Ireland
| | - J J Wykrzykowska
- Department of Clinical and Experimental Cardiology, Heart Center, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - R J de Winter
- Department of Clinical and Experimental Cardiology, Heart Center, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - C von Birgelen
- Department of Cardiology, Thoraxcentrum Twente, Medisch Spectrum Twente, Enschede, The Netherlands.,Health Technology and Services Research, Faculty of Behavioural Management and Social Sciences, Technical Medical Centre, University of Twente, Enschede, The Netherlands
| | - P W Serruys
- Department of Cardiology, National University of Ireland, Galway (NUIG), Galway, Ireland. .,Imperial College London, London, UK.
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13
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The quest for effective pharmacological suppression of neointimal hyperplasia. Curr Probl Surg 2020; 57:100807. [PMID: 32771085 DOI: 10.1016/j.cpsurg.2020.100807] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Accepted: 04/22/2020] [Indexed: 12/15/2022]
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14
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Blum NT, Gyorkos CM, Narowetz SJ, Mueller EN, Goodwin AP. Phospholipid-Coated Hydrophobic Mesoporous Silica Nanoparticles Enhance Thrombectomy by High-Intensity Focused Ultrasound with Low Production of Embolism-Inducing Clot Debris. ACS APPLIED MATERIALS & INTERFACES 2019; 11:36324-36332. [PMID: 31556582 PMCID: PMC8051144 DOI: 10.1021/acsami.9b11095] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
Here we report the efficacy of a nanoparticle-assisted high-intensity focused ultrasound (HIFU) treatment that selectively destroys blood clots while minimizing generation of microparticles, or microemboli, that can cause further complications postsurgery. Treatment of malignant blood clots (thrombi) and the resulting emboli are critical problems for numerous patients, and treatments addressing these conditions would benefit from advancements in noninvasive procedures such as HIFU. While recanalization of occlusive blood clots is currently addressed with surgical intervention that seeks to minimize formation of large emboli, there is a danger of microemboli (micrometer-size particles) that have been theorized to be responsible for the poor correlation between apparent surgical success and patient outcome. Here, the addition of phospholipid-coated hydrophobically modified silica nanoparticles (P@hMSNs) improved the efficacy of HIFU treatment by serving as cavitation nuclei for mechanical disruption of thrombi. This treatment was evaluated for the ability to clear the HIFU focal area of a thick and dense thrombus within 10 min. Moreover, it was found that the use of P@hMSN+HIFU treatment generated a significantly smaller microembolic load as compared to comparison techniques, including a HIFU + microbubble contrast agent, HIFU alone, and direct mechanical disruption. This reduction in the microembolic load can occur either with primary removal of the clot by P@hMSN+HIFU or by insonation of the clot fragments after mechanical thrombectomy. Lastly, this method was evaluated in a flow model, where nonocclusive model thrombi and model emboli were mechanically ablated within the focal area within 15 s. Together, these results represent a combination therapy capable of resolving thrombi and microembolisms resulting from thrombectomy through localized destruction of clotted material.
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15
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van Schoonhoven AV, Gout-Zwart JJ, de Vries MJS, van Asselt ADI, Dvortsin E, Vemer P, van Boven JFM, Postma MJ. Costs of clinical events in type 2 diabetes mellitus patients in the Netherlands: A systematic review. PLoS One 2019; 14:e0221856. [PMID: 31490989 PMCID: PMC6730996 DOI: 10.1371/journal.pone.0221856] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Accepted: 08/18/2019] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Type 2 diabetes mellitus (T2DM) is an established risk factor for cardiovascular and nephropathic events. In the Netherlands, prevalence of T2DM is expected to be as high as 8% by 2025. This will result in significant clinical and economic impact, highlighting the need for well-informed reimbursement decisions for new treatments. However, availability and consistent use of costing methodologies is limited. OBJECTIVE We aimed to systematically review recent costing data for T2DM-related cardiovascular and nephropathic events in the Netherlands. METHODS A systematic literature review in PubMed and Embase was conducted to identify available Dutch cost data for T2DM-related events, published in the last decade. Information extracted included costs, source, study population, and costing perspective. Finally, papers were evaluated using the Consolidated Health Economic Evaluation Reporting Standards (CHEERS). RESULTS Out of initially 570 papers, 36 agreed with the inclusion criteria. From these studies, 150 cost estimates for T2DM-related clinical events were identified. In total, 29 cost estimates were reported for myocardial infarction (range: €196-€27,038), 61 for stroke (€495-€54,678), fifteen for heart failure (€325-€16,561), 24 for renal failure (€2,438-€91,503), and seventeen for revascularisation (€3,000-€37,071). Only four estimates for transient ischaemic attack were available, ranging from €587 to €2,470. Adherence to CHEERS was generally high. CONCLUSIONS The most expensive clinical events were related to renal failure, while TIA was the least expensive event. Generally, there was substantial variation in reported cost estimates for T2DM-related events. Costing of clinical events should be improved and preferably standardised, as accurate and consistent results in economic models are desired.
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Affiliation(s)
- Alexander V. van Schoonhoven
- Unit of PharmacoTherapy, Epidemiology & Economics (PTE2), Department of Pharmacy, University of Groningen, Groningen, the Netherlands
| | - Judith J. Gout-Zwart
- Asc Academics, Groningen, the Netherlands
- Department of Nephrology, University of Groningen, University Medical Centre Groningen (UMCG), Groningen, the Netherlands
| | - Marijke J. S. de Vries
- Unit of PharmacoTherapy, Epidemiology & Economics (PTE2), Department of Pharmacy, University of Groningen, Groningen, the Netherlands
| | - Antoinette D. I. van Asselt
- Department of Epidemiology, University Medical Centre Groningen, Groningen, the Netherlands
- Department of Health Sciences, University of Groningen, University Medical Centre Groningen (UMCG), Groningen, the Netherlands
| | | | - Pepijn Vemer
- Unit of PharmacoTherapy, Epidemiology & Economics (PTE2), Department of Pharmacy, University of Groningen, Groningen, the Netherlands
- Department of Epidemiology, University Medical Centre Groningen, Groningen, the Netherlands
| | - Job F. M. van Boven
- Department of General Practice & Elderly Care, University of Groningen, University Medical Center Groningen (UMCG), Groningen, the Netherlands
- Department of Clinical Pharmacy & Pharmacology, University of Groningen, University Medical Centre Groningen (UMCG), Groningen, the Netherlands
| | - Maarten J. Postma
- Unit of PharmacoTherapy, Epidemiology & Economics (PTE2), Department of Pharmacy, University of Groningen, Groningen, the Netherlands
- Department of Health Sciences, University of Groningen, University Medical Centre Groningen (UMCG), Groningen, the Netherlands
- Department of Economics, Econometrics & Finance, University of Groningen, Faculty of Economics & Business, Groningen, The Netherlands
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16
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Shiraishi J, Kataoka E, Ozawa T, Shiraga A, Ikemura N, Matsubara Y, Nishimura T, Ito D, Kojima A, Kimura M, Kishita E, Nakagawa Y, Hyogo M, Sawada T. Angiographic and Clinical Outcomes After Stent-less Coronary Intervention Using Rotational Atherectomy and Drug-Coated Balloon in Patients with De Novo Lesions. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2019; 21:647-653. [PMID: 31494063 DOI: 10.1016/j.carrev.2019.08.020] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2019] [Revised: 08/04/2019] [Accepted: 08/19/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVES We investigated angiographic and clinical outcomes in patients with de novo lesions undergoing rotational atherectomy (RA) followed by drug-coated balloon (DCB) dilation (RA/DCB). BACKGROUND Implantation of drug-eluting stent (DES) has been a mainstay of the interventional treatment of coronary artery disease (CAD); however, there still remain several DES-unsuitable clinical/lesion conditions. Nowadays DCB for de novo lesions has attracted more attention, and RA, which tends not to cause major dissection but to debulk intima, might be one of suitable pre-treatments before DCB. METHODS AND RESULTS Thirty patients (34 lesions) undergoing RA/DCB for de novo lesions were enrolled. Clinical/lesion background included severe calcification, calcified nodule, inlet/outlet of aneurysm, ostial lesion, severe thrombocytopenia, bleeding tendency, and/or sequelae of Kawasaki disease. The largest burr size used was 1.83 ± 0.23 mm, and the mean DCB diameter was 2.71 ± 0.47 mm. Angiographic success was obtained in 94% of the lesions. No acute closure but 1 no reflow occurred. Repeat angiography (mean, 6.6 months after procedure) was performed for 19 lesions. Frequency of binary restenosis was 21.1%, and late lumen loss was 0.34 ± 0.30 mm. During a mean follow-up period of 13.1 months, 6 deaths (2 sudden deaths, 1 cardiac death, 3 non-cardiac deaths), 2 strokes, and 2 target lesion revascularizations were observed. CONCLUSIONS Stent-less PCI using RA/DCB might be an alternative revascularization therapy for CAD patients complicated with DES-unsuitable conditions.
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Affiliation(s)
- Jun Shiraishi
- Department of Cardiology, Kyoto First Red Cross Hospital, Honmachi, Higashiyama-ku, Kyoto 605-0981, Japan.
| | - Eisuke Kataoka
- Department of Cardiology, Kyoto First Red Cross Hospital, Honmachi, Higashiyama-ku, Kyoto 605-0981, Japan
| | - Takaaki Ozawa
- Department of Cardiology, Kyoto First Red Cross Hospital, Honmachi, Higashiyama-ku, Kyoto 605-0981, Japan
| | - Akiko Shiraga
- Department of Cardiology, Kyoto First Red Cross Hospital, Honmachi, Higashiyama-ku, Kyoto 605-0981, Japan
| | - Nariko Ikemura
- Department of Cardiology, Kyoto First Red Cross Hospital, Honmachi, Higashiyama-ku, Kyoto 605-0981, Japan
| | - Yuki Matsubara
- Department of Cardiology, Kyoto First Red Cross Hospital, Honmachi, Higashiyama-ku, Kyoto 605-0981, Japan
| | - Tetsuro Nishimura
- Department of Cardiology, Kyoto First Red Cross Hospital, Honmachi, Higashiyama-ku, Kyoto 605-0981, Japan
| | - Daisuke Ito
- Department of Cardiology, Kyoto First Red Cross Hospital, Honmachi, Higashiyama-ku, Kyoto 605-0981, Japan
| | - Akiteru Kojima
- Department of Cardiology, Kyoto First Red Cross Hospital, Honmachi, Higashiyama-ku, Kyoto 605-0981, Japan
| | - Masayoshi Kimura
- Department of Cardiology, Kyoto First Red Cross Hospital, Honmachi, Higashiyama-ku, Kyoto 605-0981, Japan
| | - Eigo Kishita
- Department of Cardiology, Kyoto First Red Cross Hospital, Honmachi, Higashiyama-ku, Kyoto 605-0981, Japan
| | - Yusuke Nakagawa
- Department of Cardiology, Kyoto First Red Cross Hospital, Honmachi, Higashiyama-ku, Kyoto 605-0981, Japan
| | - Masayuki Hyogo
- Department of Cardiology, Kyoto First Red Cross Hospital, Honmachi, Higashiyama-ku, Kyoto 605-0981, Japan
| | - Takahisa Sawada
- Department of Cardiology, Kyoto First Red Cross Hospital, Honmachi, Higashiyama-ku, Kyoto 605-0981, Japan
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17
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Kim DD, Trikalinos TA, Wong JB. Leveraging Cumulative Network Meta-analysis and Value of Information Analysis to Understand the Evolving Value of Medical Research. Med Decis Making 2019; 39:119-129. [PMID: 30678537 DOI: 10.1177/0272989x18823008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Leveraging cumulative network meta-analysis (NMA) and value of information (VOI) analysis, this article aims to understand the evolving value of medical research and to identify gaps in the evidence for future research. METHODS As an illustration, we identified 31 randomized controlled trials (RCT) from 1980 to 2013 that examined a network of 3 interventions for coronary artery disease: medical therapy (MED), percutaneous coronary intervention (PCI), and coronary artery bypass graft (CABG) surgery. We conducted Bayesian NMA to combine evidence from a new RCT with existing knowledge. Then, using the Duke Databank for Cardiovascular Diseases database, we developed an accelerated failure time model to estimate the joint effects of patient characteristics and treatment choices on survival outcomes. With the estimated coefficients and covariance matrices, we projected survival benefits and its surrounding uncertainty among 50,000 simulated patients treated with MED, PCI, or CABG. The value of resolving residual uncertainty from future trials was quantified through the VOI analysis. We repeated these steps for each published RCT to estimate dynamic changes in VOI estimates. RESULTS Our cumulative NMA found that CABG conferred a lower, but not statistically significant, mortality than PCI (hazard ratio [HR], 0.90; 95% uncertainty interval, 0.80-1.05). MED had a nonsignificantly higher long-term mortality than PCI (HR, 1.11; 0.98-1.31) but significantly higher than CABG (HR, 1.07; 1.23-1.41). The greatest potential gains from future research would come from additional head-to-head trials between CABG v. PCI with the value of future research equaling 0.27 life years per patient. CONCLUSIONS The combination of cumulative NMA and VOI approaches can improve the efficiency of comparative effectiveness research by using all of the available evidence to determine future research priorities.
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Affiliation(s)
- David D Kim
- Center for the Evaluation of Value and Risk in Health, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA
| | - Thomas A Trikalinos
- Department of Health Services, Policy & Practice, Brown University School of Public Health, Brown University, Providence, RI
| | - John B Wong
- Division of Clinical Decision Making, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA
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18
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Asano T, Serruys PW, Collet C, Miyazaki Y, Takahashi K, Chichareon P, Katagiri Y, Modolo R, Tenekecioglu E, Morel MA, Garg S, Wykrzykowska J, Piek JJ, Sabate M, Morice MC, Chevalier B, Windecker S, Onuma Y. Angiographic late lumen loss revisited: impact on long-term target lesion revascularization. Eur Heart J 2018; 39:3381-3389. [DOI: 10.1093/eurheartj/ehy436] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Accepted: 07/10/2018] [Indexed: 01/21/2023] Open
Affiliation(s)
- Taku Asano
- Academic Medical Center, University of Amsterdam, Meibergdreef 9, AZ Amsterdam, The Netherlands
- St. Luke's International Hospital, 9-1 Akashicho, Chūō, Tokyo, Japan
| | - Patrick W Serruys
- NHLI, Imperial College London, Dovehouse Street, Chelsea, London, UK
| | - Carlos Collet
- Academic Medical Center, University of Amsterdam, Meibergdreef 9, AZ Amsterdam, The Netherlands
- Department of Cardiology, Universitair Ziekenhuis Brussel, Avenue du Laerbeek 101, Jette, Belgium
| | - Yosuke Miyazaki
- ThoraxCenter, Erasmus Medical Center, Doctor Molewaterplein 40, GD Rotterdam, The Netherlands
| | - Kuniaki Takahashi
- Academic Medical Center, University of Amsterdam, Meibergdreef 9, AZ Amsterdam, The Netherlands
| | - Ply Chichareon
- Academic Medical Center, University of Amsterdam, Meibergdreef 9, AZ Amsterdam, The Netherlands
| | - Yuki Katagiri
- Academic Medical Center, University of Amsterdam, Meibergdreef 9, AZ Amsterdam, The Netherlands
| | - Rodrigo Modolo
- Academic Medical Center, University of Amsterdam, Meibergdreef 9, AZ Amsterdam, The Netherlands
| | - Erhan Tenekecioglu
- ThoraxCenter, Erasmus Medical Center, Doctor Molewaterplein 40, GD Rotterdam, The Netherlands
| | | | - Scot Garg
- East Lancashire Hospitals NHS Trust, Casterton Ave, Burnley, UK
| | - Joanna Wykrzykowska
- Academic Medical Center, University of Amsterdam, Meibergdreef 9, AZ Amsterdam, The Netherlands
| | - Jan J Piek
- Academic Medical Center, University of Amsterdam, Meibergdreef 9, AZ Amsterdam, The Netherlands
| | - Manel Sabate
- Cardiovascular Institute, Hospital Clinic, IDIBAPS, University of Barcelona, Carrer del Rosselló, 149, Barcelona, Spain
| | - Marie-Claude Morice
- Institut Cardiovasculaire Paris Sud, 6 Avenue du Noyer Lambert, Massy, France
| | - Bernard Chevalier
- Institut Cardiovasculaire Paris Sud, 6 Avenue du Noyer Lambert, Massy, France
| | | | - Yoshinobu Onuma
- ThoraxCenter, Erasmus Medical Center, Doctor Molewaterplein 40, GD Rotterdam, The Netherlands
- Cardialysis, Westblaak 98, KM Rotterdam, The Netherlands
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19
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Affiliation(s)
- B. Stegmayr
- Department of Internal Medicine, University Hospital, Umeå - Sweden
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20
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Davidson I, Hackerman C, Kapadia A, Minhajuddin A. Heparin Bonded Hemodialysis e-PTFE Grafts Result in 20% Clot Free Survival Benefit. J Vasc Access 2018; 10:153-6. [DOI: 10.1177/112972980901000303] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Luminal surface heparin bonded hemodialysis e-PTFE grafts (N=83) with prolonged bioactivity retention (CBAS® technology) were compared to 67 control e-PTFE grafts using Kaplan-Meier survival curve estimates. Log-rank tests were used for statistical comparisons between groups. Heparin bonded graft recipients were on average 3.5 years older (NS), and had upper arm grafts in 66% vs. 43% (p=0.003) compared to controls. There was no clot-free survival (CFS) difference between groups for upper arm vs. forearm placed grafts (p=0.792). Patient mortality at one year was 15%, with no group difference. The overall combined clot-free survival for all 150 e-PTFE grafts was 69% at 12 months. At 6 and 12 months, CFS for the heparin bonded graft group was 88% and 78%, which is significantly higher than that of 69% and 58% for the control group, respectively, (p=0.007). It is concluded that heparin binding technology to artificial surfaces has evolved to a clinically powerful technique for the hemodialysis patient resulting in a 20% improved primary graft patency of about 80% at one year.
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Affiliation(s)
- Ingemar Davidson
- Departments of Surgery and Clinical Sciences, University of Texas Southwestern Medical Center, and Parkland Memorial Hospital, Dallas TX - USA
| | - Clayton Hackerman
- Departments of Surgery and Clinical Sciences, University of Texas Southwestern Medical Center, and Parkland Memorial Hospital, Dallas TX - USA
| | - Aschmeeta Kapadia
- Departments of Surgery and Clinical Sciences, University of Texas Southwestern Medical Center, and Parkland Memorial Hospital, Dallas TX - USA
| | - Abu Minhajuddin
- Departments of Surgery and Clinical Sciences, University of Texas Southwestern Medical Center, and Parkland Memorial Hospital, Dallas TX - USA
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21
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Freeman J, Chen A, Weinberg RJ, Okada T, Chen C, Lin PH. Sustained Thromboresistant Bioactivity with Reduced Intimal Hyperplasia of Heparin-Bonded Polytetrafluoroethylene Propaten Graft in a Chronic Canine Femoral Artery Bypass Model. Ann Vasc Surg 2017; 49:295-303. [PMID: 29197605 DOI: 10.1016/j.avsg.2017.09.017] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Revised: 08/27/2017] [Accepted: 09/20/2017] [Indexed: 01/08/2023]
Abstract
BACKGROUND Bypass graft thrombosis remains a significant mode of failure in prosthetic graft revascularization. The purpose of this investigation was to evaluate the long-term thromboresistant effect of heparin-bonded expanded polytetrafluoroethylene (ePTFE) graft using Carmeda BioActive Surface technology in a canine model. METHODS Bilateral femorofemoral artery bypass grafts with ePTFE grafts were performed in 25 adult grayhound dogs. In each animal, a heparin-bonded ePTFE graft (Propaten, WL Gore) was placed on one side, whereas a control nonheparin graft was placed on the contralateral side. The graft patency was assessed at 1, 6, 12, 18, and 24 months (n = 5 per group) following the bypass. Heparin bioactivity of the graft material was analyzed. The effect of intimal hyperplasia was also assessed. RESULTS All bypass grafts were patent at 1 month. Significantly greater patency rates were noted in the Propaten group compared to the control group at 12, 18, and 24 months, which were 84%, 80%, and 80% vs. 55%, 35%, and 20%, respectively (P < 0.02). There was a significant reduction in the anastomotic neointimal area and neointimal cell proliferation in Propaten grafts compared with control grafts at all groups between 6 and 24 months (P < 0.05). Heparin bioactivity as measured by antithrombin binding assay was demonstrated in the Propaten graft between 1 and 24 months. Mean heparin activities on Propaten grafts ranged from 26.3 ± 6.4 pmol/cm2 to 18.4 ± 8.7 pmol/cm2 between 1 and 24 months, which were significantly greater than the control group (P < 0.001). Differences between mean heparin activities of explanted Propaten graft samples at the various time points were nonsignificant (P > 0.05). CONCLUSIONS Heparin-bonded ePTFE graft provides a thromboresistant surface and reduced anastomotic intimal hyperplasia at 2 years. The stable heparin bioactivity of the Propaten graft confers an advantage in long-term graft patency.
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Affiliation(s)
- John Freeman
- Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX
| | - Aaron Chen
- Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX
| | - Roy J Weinberg
- Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX
| | - Tamuru Okada
- Division of Biology and Biological Engineering, California Institute of Technology, Pasadena, CA
| | - Changyi Chen
- Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX
| | - Peter H Lin
- Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX; Department of Vascular Surgery, University Vascular Associates, Los Angeles, CA.
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22
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Rizas KD, Mehilli J. Stent Polymers: Do They Make a Difference? Circ Cardiovasc Interv 2017; 9:CIRCINTERVENTIONS.115.002943. [PMID: 27193905 DOI: 10.1161/circinterventions.115.002943] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2015] [Accepted: 03/15/2016] [Indexed: 01/03/2023]
Abstract
The necessity of polymers on drug-eluting stent (DES) platforms is dictated by the need of an adequate amount and optimal release kinetic of the antiproliferative drugs for achieving ideal DES performance. However, the chronic vessel wall inflammation related to permanent polymer persistence after the drug has been eluted might trigger late restenosis and stent thrombosis. Biodegradable polymers have the potential to avoid these adverse events. A variety of biodegradable polymer DES platforms have been clinically tested, showing equal outcomes with the standard-bearer permanent polymer DES within the first year of implantation. At longer-term follow-up, promising lower rates of stent thrombosis have been observed with the early generation biodegradable polymer DES platforms compared to first-generation DES. Whether this safety benefit still persists with newer biodegradable polymer DES generations against second-generation permanent polymer DES needs to be explored.
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Affiliation(s)
- Konstantinos D Rizas
- From the Department of Cardiology, Munich University Clinic, Ludwig-Maximilian University, Munich, Germany (K.D.R., J.M.); and Munich Heart Alliance at DZHK, Munich, Germany (J.M.)
| | - Julinda Mehilli
- From the Department of Cardiology, Munich University Clinic, Ludwig-Maximilian University, Munich, Germany (K.D.R., J.M.); and Munich Heart Alliance at DZHK, Munich, Germany (J.M.).
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23
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Shlofmitz E, Martinsen BJ, Lee M, Rao SV, Généreux P, Higgins J, Chambers JW, Kirtane AJ, Brilakis ES, Kandzari DE, Sharma SK, Shlofmitz R. Orbital atherectomy for the treatment of severely calcified coronary lesions: evidence, technique, and best practices. Expert Rev Med Devices 2017; 14:867-879. [DOI: 10.1080/17434440.2017.1384695] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Affiliation(s)
- Evan Shlofmitz
- Division of Cardiology, Columbia University Medical Center, New York, NY, USA
- Cardiovascular Research Foundation, New York, NY, USA
| | - Brad J. Martinsen
- Department of Clinical and Scientific Affairs, Cardiovascular Systems, Inc., St. Paul, MN, USA
| | - Michael Lee
- Division of Cardiology, UCLA Medical Center, Los Angeles, CA, USA
| | - Sunil V. Rao
- Duke Clinical Research Institute, Durham, NC, USA
| | - Philippe Généreux
- Cardiovascular Research Foundation, New York, NY, USA
- Morristown Medical Center, Morristown, NJ, USA
- Hôpital du Sacré-Coeur de Montréal, Université de Montréal, Montréal, Canada
| | - Joe Higgins
- Department of Engineering, Cardiovascular Systems, Inc., St. Paul, MN, USA
| | - Jeffrey W. Chambers
- Metropolitan Heart and Vascular Institute, Mercy Hospital, Minneapolis, MN, USA
| | - Ajay J. Kirtane
- Division of Cardiology, Columbia University Medical Center, New York, NY, USA
| | | | | | - Samin K. Sharma
- Division of Cardiology, Mount Sinai Hospital, New York, NY, USA
| | - Richard Shlofmitz
- Department of Cardiology, St. Francis Hospital-The Heart Center, Roslyn, NY, USA
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Feinberg J, Nielsen EE, Greenhalgh J, Hounsome J, Sethi NJ, Safi S, Gluud C, Jakobsen JC. Drug-eluting stents versus bare-metal stents for acute coronary syndrome. Cochrane Database Syst Rev 2017; 8:CD012481. [PMID: 28832903 PMCID: PMC6483499 DOI: 10.1002/14651858.cd012481.pub2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
BACKGROUND Approximately 3.7 million people died from acute coronary syndrome worldwide in 2012. Acute coronary syndrome, also known as myocardial infarction or unstable angina pectoris, is caused by a sudden blockage of the blood supplied to the heart muscle. Percutaneous coronary intervention is often used for acute coronary syndrome, but previous systematic reviews on the effects of drug-eluting stents compared with bare-metal stents have shown conflicting results with regard to myocardial infarction; have not fully taken account of the risk of random and systematic errors; and have not included all relevant randomised clinical trials. OBJECTIVES To assess the benefits and harms of drug-eluting stents versus bare-metal stents in people with acute coronary syndrome. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, LILACS, SCI-EXPANDED, and BIOSIS from their inception to January 2017. We also searched two clinical trials registers, the European Medicines Agency and the US Food and Drug Administration databases, and pharmaceutical company websites. In addition, we searched the reference lists of review articles and relevant trials. SELECTION CRITERIA Randomised clinical trials assessing the effects of drug-eluting stents versus bare-metal stents for acute coronary syndrome. We included trials irrespective of publication type, status, date, or language. DATA COLLECTION AND ANALYSIS We followed our published protocol and the methodological recommendations of Cochrane. Two review authors independently extracted data. We assessed the risks of systematic error by bias domains. We conducted Trial Sequential Analyses to control the risks of random errors. Our primary outcomes were all-cause mortality, major cardiovascular events, serious adverse events, and quality of life. Our secondary outcomes were angina, cardiovascular mortality, and myocardial infarction. Our primary assessment time point was at maximum follow-up. We assessed the quality of the evidence by the GRADE approach. MAIN RESULTS We included 25 trials randomising a total of 12,503 participants. All trials were at high risk of bias, and the quality of evidence according to GRADE was low to very low. We included 22 trials where the participants presented with ST-elevation myocardial infarction, 1 trial where participants presented with non-ST-elevation myocardial infarction, and 2 trials where participants presented with a mix of acute coronary syndromes.Meta-analyses at maximum follow-up showed no evidence of a difference when comparing drug-eluting stents with bare-metal stents on the risk of all-cause mortality or major cardiovascular events. The absolute risk of death was 6.97% in the drug-eluting stents group compared with 7.74% in the bare-metal stents group based on the risk ratio (RR) of 0.90 (95% confidence interval (CI) 0.78 to 1.03, 11,250 participants, 21 trials/22 comparisons, low-quality evidence). The absolute risk of a major cardiovascular event was 6.36% in the drug-eluting stents group compared with 6.63% in the bare-metal stents group based on the RR of 0.96 (95% CI 0.83 to 1.11, 10,939 participants, 19 trials/20 comparisons, very low-quality evidence). The results of Trial Sequential Analysis showed that we did not have sufficient information to confirm or reject our anticipated risk ratio reduction of 10% on either all-cause mortality or major cardiovascular events at maximum follow-up.Meta-analyses at maximum follow-up showed evidence of a benefit when comparing drug-eluting stents with bare-metal stents on the risk of a serious adverse event. The absolute risk of a serious adverse event was 18.04% in the drug-eluting stents group compared with 23.01% in the bare-metal stents group based on the RR of 0.80 (95% CI 0.74 to 0.86, 11,724 participants, 22 trials/23 comparisons, low-quality evidence), and Trial Sequential Analysis confirmed this result. When assessing each specific type of adverse event included in the serious adverse event outcome separately, the majority of the events were target vessel revascularisation. When target vessel revascularisation was analysed separately, meta-analysis showed evidence of a benefit of drug-eluting stents, and Trial Sequential Analysis confirmed this result.Meta-analyses at maximum follow-up showed no evidence of a difference when comparing drug-eluting stents with bare-metal stents on the risk of cardiovascular mortality (RR 0.91, 95% CI 0.76 to 1.09, 9248 participants, 14 trials/15 comparisons, very low-quality evidence) or myocardial infarction (RR 0.98, 95% CI 0.82 to 1.18, 10,217 participants, 18 trials/19 comparisons, very low-quality evidence). The results of the Trial Sequential Analysis showed that we had insufficient information to confirm or reject our anticipated risk ratio reduction of 10% on cardiovascular mortality and myocardial infarction.No trials reported results on quality of life or angina. AUTHORS' CONCLUSIONS The current evidence suggests that drug-eluting stents may lead to fewer serious adverse events compared with bare-metal stents without increasing the risk of all-cause mortality or major cardiovascular events. However, our Trial Sequential Analysis showed that there currently was not enough information to assess a risk ratio reduction of 10% for all-cause mortality, major cardiovascular events, cardiovascular mortality, or myocardial infarction, and there were no data on quality of life or angina. The evidence in this review was of low to very low quality, and the true result may depart substantially from the results presented in this review.More randomised clinical trials with low risk of bias and low risks of random errors are needed if the benefits and harms of drug-eluting stents for acute coronary syndrome are to be assessed properly. More data are needed on the outcomes all-cause mortality, major cardiovascular events, quality of life, and angina to reduce the risk of random error.
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Affiliation(s)
- Joshua Feinberg
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, Department 7812, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, Copenhagen, Denmark, 2100
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Morino Y, Tobaru T, Yasuda S, Kataoka K, Tanabe K, Hirohata A, Kozuma K, Kimura T. Biodegradable polymer-based, argatroban-eluting, cobalt-chromium stent (JF-04) for treatment of native coronary lesions: final results of the first-in-man study and lessons learned. EUROINTERVENTION 2017; 12:1271-1278. [PMID: 27866136 DOI: 10.4244/eijv12i10a208] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS The aim of the study was to investigate the six-month angiographic and nine-month clinical follow-up outcomes in a first-in-man study using the biodegradable polymer-based cobalt-chromium argatroban-eluting stent (JF-04) for treatment of native coronary atherosclerotic lesions. METHODS AND RESULTS A total of 31 patients with either stable or unstable angina, or silent myocardial ischaemia, exhibiting de novo coronary lesions were enrolled at seven Japanese sites. The lesions were treated with the JF-04 stent after predilatation. The primary endpoint was angiographic in-stent late loss six months after implantation. The secondary endpoints included angiographic restenosis and in-stent volume obstruction by intravascular ultrasound at six months and target vessel failure (TVF) at nine months. Procedural success was achieved in 100% of cases. At six months, angiographic in-stent late loss was 1.01±0.48 mm and binary restenosis was observed in nine cases (29.0%). Among these restenotic cases, most (n=8) demonstrated advanced angiographic restenosis patterns, including diffuse/proliferative restenosis and total occlusion. At nine months, TVF was observed in four cases (12.9%), exclusively attributed to target vessel revascularisation. CONCLUSIONS This argatroban-eluting stent failed to inhibit neointimal hyperplasia sufficiently, despite the theoretical benefits and promising clinical experience with local drug delivery.
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Affiliation(s)
- Yoshihiro Morino
- Division of Cardiology, Iwate Medical University, Morioka, Iwate, Japan
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26
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Tabasum S, Noreen A, Kanwal A, Zuber M, Anjum MN, Zia KM. Glycoproteins functionalized natural and synthetic polymers for prospective biomedical applications: A review. Int J Biol Macromol 2017; 98:748-776. [PMID: 28111295 DOI: 10.1016/j.ijbiomac.2017.01.078] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Revised: 01/05/2017] [Accepted: 01/16/2017] [Indexed: 02/06/2023]
Abstract
Glycoproteins have multidimensional properties such as biodegradability, biocompatibility, non-toxicity, antimicrobial and adsorption properties; therefore, they have wide range of applications. They are blended with different polymers such as chitosan, carboxymethyl cellulose (CMC), polyvinyl pyrrolidone (PVP), polycaprolactone (PCL), heparin, polystyrene fluorescent nanoparticles (PS-NPs) and carboxyl pullulan (PC) to improve their properties like thermal stability, mechanical properties, resistance to pH, chemical stability and toughness. Considering the versatile charateristics of glycoprotein based polymers, this review sheds light on synthesis and characterization of blends and composites of glycoproteins, with natural and synthetic polymers and their potential applications in biomedical field such as drug delivery system, insulin delivery, antimicrobial wound dressing uses, targeting of cancer cells, development of anticancer vaccines, development of new biopolymers, glycoproteome research, food product and detection of dengue glycoproteins. All the technical scientific issues have been addressed; highlighting the recent advancement.
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Affiliation(s)
- Shazia Tabasum
- Institute of Chemistry, Government College University, Faisalabad 38030, Pakistan
| | - Aqdas Noreen
- Institute of Chemistry, Government College University, Faisalabad 38030, Pakistan
| | - Arooj Kanwal
- Institute of Chemistry, Government College University, Faisalabad 38030, Pakistan
| | - Mohammad Zuber
- Institute of Chemistry, Government College University, Faisalabad 38030, Pakistan
| | | | - Khalid Mahmood Zia
- Institute of Chemistry, Government College University, Faisalabad 38030, Pakistan.
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Feinberg J, Nielsen EE, Greenhalgh J, Hounsome J, Sethi NJ, Safi S, Gluud C, Jakobsen JC. Drug-eluting stents versus bare-metal stents for acute coronary syndrome. Cochrane Database Syst Rev 2016. [DOI: 10.1002/14651858.cd012481] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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28
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Nielsen EE, Feinberg J, Greenhalgh J, Hounsome J, Sethi NJ, Safi S, Gluud C, Jakobsen JC. Drug-eluting stents versus bare-metal stents for stable ischaemic heart disease. Cochrane Database Syst Rev 2016. [DOI: 10.1002/14651858.cd012480] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Affiliation(s)
- Emil Eik Nielsen
- Department 7812, Rigshospitalet, Copenhagen University Hospital; Copenhagen Trial Unit, Centre for Clinical Intervention Research; Blegdamsvej 9 Copenhagen Denmark 2100
| | - Joshua Feinberg
- Department 7812, Rigshospitalet, Copenhagen University Hospital; Copenhagen Trial Unit, Centre for Clinical Intervention Research; Blegdamsvej 9 Copenhagen Denmark 2100
| | - Janette Greenhalgh
- University of Liverpool; Liverpool Reviews and Implementation Group; Sherrington Building Ashton Street Liverpool UK L69 3GE
| | - Juliet Hounsome
- University of Liverpool; Liverpool Reviews and Implementation Group; Sherrington Building Ashton Street Liverpool UK L69 3GE
| | - Naqash J Sethi
- Department 7812, Rigshospitalet, Copenhagen University Hospital; Copenhagen Trial Unit, Centre for Clinical Intervention Research; Blegdamsvej 9 Copenhagen Denmark 2100
| | - Sanam Safi
- Department 7812, Rigshospitalet, Copenhagen University Hospital; Copenhagen Trial Unit, Centre for Clinical Intervention Research; Blegdamsvej 9 Copenhagen Denmark 2100
| | - Christian Gluud
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, Department 7812, Rigshospitalet, Copenhagen University Hospital; The Cochrane Hepato-Biliary Group; Blegdamsvej 9 Copenhagen Denmark DK-2100
| | - Janus C Jakobsen
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, Department 7812, Rigshospitalet, Copenhagen University Hospital; The Cochrane Hepato-Biliary Group; Blegdamsvej 9 Copenhagen Denmark DK-2100
- Holbaek Hospital; Department of Cardiology; Holbaek Denmark 4300
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29
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Hatano T, Tsukahara T, Araki K, Kawakami O, Murakami N. Stenting for Stenoses of the Proximal Vertebral Artery. Interv Neuroradiol 2016; 5:301-6. [DOI: 10.1177/159101999900500406] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/1999] [Accepted: 10/25/1999] [Indexed: 11/16/2022] Open
Abstract
We report our initial experience of stenting for symptomatic stenoses of the proximal vertebral artery. A total of 25 lesions affecting the proximal vertebral artery were treated by PTA with stent in 23 patients. The lesions involved the vertebral artery ostium in 20 lesions and the nonostial V1 portion in five lesions. The mean stenosis rate of those lesions was 81% pre-stenting and was reduced to 4% post-stenting. There were two transient neurological complications: hemiparesis in one patient and visual acuity disturbance in another. Angiographic follow-up studies more than three months after treatment demonstrated restenosis in three patients. One of these patients was symptomatic. These restenoses were successfully treated by PTA. Our initial results demonstrated that stenting is a feasible and safe method of treating stenosis of the proximal vertebral artery.
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Affiliation(s)
- T. Hatano
- Department of Neurosurgery and Clinical Research Unit, Kyoto National Hospital; Kyoto, Japan
| | - T. Tsukahara
- Department of Neurosurgery and Clinical Research Unit, Kyoto National Hospital; Kyoto, Japan
| | - K. Araki
- Department of Neurosurgery and Clinical Research Unit, Kyoto National Hospital; Kyoto, Japan
| | - O. Kawakami
- Department of Neurosurgery and Clinical Research Unit, Kyoto National Hospital; Kyoto, Japan
| | - N. Murakami
- Department of Neurosurgery and Clinical Research Unit, Kyoto National Hospital; Kyoto, Japan
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30
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Falcone C, Emanuele E, Buzzi M, Ballerini L, Repetto A, Canosi U, Mazzucchelli I, Schirinzi S, Sbarsi I, Boiocchi C, Cuccia M. The-374T/A Variant of the Rage Gene Promoter is Associated with Clinical Restenosis after Coronary Stent Placement. Int J Immunopathol Pharmacol 2016; 20:771-7. [DOI: 10.1177/039463200702000413] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Upregulation of the receptor for advanced glycation end products (RAGE) may play a crucial role in neointimal formation upon vessel injury. The −374T/A variant of the RAGE gene promoter, which has been associated with an altered expression of the cell-surface receptor, could exert a protective effect toward the development of vascular disease. The aim of this study is to determine the impact of this common genetic variant in the occurrence of clinical in-stent restenosis after coronary stent implantation. The −374T/A polymorphism of the RAGE gene promoter was evaluated by PCR-RFLPs in 267 patients with coronary artery disease who underwent coronary stent implantation and a subsequent coronary angiography 6–9 months later for suspected restenosis. In-stent restenosis was assessed by means of quantitative angiography. Carriers of the-374AA genotype showed a significantly reduced risk of developing restenosis after percutaneous transluminal intervention than non-carriers. To determine whether the protective effect of the homozygous AA genotype toward clinical restenosis was independent of potential confounders, we performed multivariable logistic regression analysis. After allowance for clinical and biochemical risk factors and stent length, the AA genotype remained significantly associated with a reduced prevalence of in-stent restenosis. No relation was evident between the RAGE genotype and established cardiovascular risk factors. In conclusion, the −374AA genotype of the RAGE gene promoter could be associated with a reduced risk of in-stent restenosis after coronary stent implantation.
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Affiliation(s)
- C. Falcone
- Department of Cardiology, University Hospital Foundation IRCCS San Matteo, Pavia
- Interdepartmental Center for Research in Prevention of Cardiovascular and Metabolic Diseases (CIRMC), University of Pavia, Pavia, Italy
| | - E. Emanuele
- Interdepartmental Center for Research in Prevention of Cardiovascular and Metabolic Diseases (CIRMC), University of Pavia, Pavia, Italy
| | - M.P. Buzzi
- Department of Cardiology, University Hospital Foundation IRCCS San Matteo, Pavia
| | - L. Ballerini
- Department of Cardiology, University Hospital Foundation IRCCS San Matteo, Pavia
| | - A. Repetto
- Department of Cardiology, University Hospital Foundation IRCCS San Matteo, Pavia
| | - U. Canosi
- Department of Cardiology, University Hospital Foundation IRCCS San Matteo, Pavia
| | - I. Mazzucchelli
- Interdepartmental Center for Research in Prevention of Cardiovascular and Metabolic Diseases (CIRMC), University of Pavia, Pavia, Italy
| | - S. Schirinzi
- Department of Cardiology, University Hospital Foundation IRCCS San Matteo, Pavia
| | - I. Sbarsi
- Department of Genetics and Microbiology, University of Pavia, Pavia, Italy
| | - C. Boiocchi
- Department of Genetics and Microbiology, University of Pavia, Pavia, Italy
| | - M. Cuccia
- Department of Genetics and Microbiology, University of Pavia, Pavia, Italy
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Chambers JW, Behrens AN, Martinsen BJ. Atherectomy Devices for the Treatment of Calcified Coronary Lesions. Interv Cardiol Clin 2016; 5:143-151. [PMID: 28582200 DOI: 10.1016/j.iccl.2015.12.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
The presence of moderate and severe coronary artery calcification (CAC) is associated with higher rates of angiographic complications during percutaneous coronary intervention (PCI), as well as higher major adverse cardiac events compared with noncalcified lesions. Diabetes mellitus, a risk factor for CAC, is increasing in the United States. Vessel preparation before PCI with atherectomy can facilitate successful stent delivery and expansion that may otherwise not be possible. We review here CAC prevalence, risk factors, and impact on PCI, as well as the currently available coronary atherectomy devices including rotational atherectomy, orbital atherectomy, and laser atherectomy.
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Affiliation(s)
- Jeffrey W Chambers
- Metropolitan Heart and Vascular Institute, The Heart Center, Mercy Hospital, Suite 120, 4040 Coon Rapids Boulevard, Minneapolis, MN 55433, USA.
| | - Ann N Behrens
- Science & Research Department, Cardiovascular Systems, Inc, 1225 Old Highway 8 NW, St Paul, MN 55112, USA
| | - Brad J Martinsen
- Science & Research Department, Cardiovascular Systems, Inc, 1225 Old Highway 8 NW, St Paul, MN 55112, USA
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32
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Non-acute percutaneous coronary intervention versus medical therapy in patients with ischaemic heart disease. Cochrane Database Syst Rev 2016. [DOI: 10.1002/14651858.cd012068] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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Beresniak A, Caruba T, Sabatier B, Juillière Y, Dubourg O, Danchin N. Cost-effectiveness modelling of percutaneous coronary interventions in stable coronary artery disease. World J Cardiol 2015; 7:594-602. [PMID: 26516413 PMCID: PMC4620070 DOI: 10.4330/wjc.v7.i10.594] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2015] [Revised: 03/06/2015] [Accepted: 09/30/2015] [Indexed: 02/06/2023] Open
Abstract
The objective of this study is to develop a cost-effectiveness model comparing drug eluting stents (DES) vs bare metal stent (BMS) in patients suffering of stable coronary artery disease. Using a 2-years time horizon, two simulation models have been developed: BMS first line strategy and DES first line strategy. Direct medical costs were estimated considering ambulatory and hospital costs. The effectiveness endpoint was defined as treatment success, which is the absence of major adverse cardiac events. Probabilistic sensitivity analyses were carried out using 10000 Monte-Carlo simulations. DES appeared slightly more efficacious over 2 years (60% of success) when compared to BMS (58% of success). Total costs over 2 years were estimated at 9303 € for the DES and at 8926 € for bare metal stent. Hence, corresponding mean cost-effectiveness ratios showed slightly lower costs (P < 0.05) per success for the BMS strategy (15520 €/success), as compared to the DES strategy (15588 €/success). Incremental cost-effectiveness ratio is 18850 € for one additional percent of success. The sequential strategy including BMS as the first option appears to be slightly less efficacious but more cost-effective compared to the strategy including DES as first option. Future modelling approaches should confirm these results as further comparative data in stable coronary artery disease and long-term evidence become available.
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Polavarapu A, Polavarapu RS, Prajapati J, Thakkar K, Raheem A, Mayall T, Thakkar A. Clinical Outcomes from Unselected "Real-World" Patients with Long Coronary Lesion Receiving 40 mm Biodegradable Polymer Coated Sirolimus-Eluting Stent. SCIENTIFICA 2015; 2015:613089. [PMID: 26579328 PMCID: PMC4633579 DOI: 10.1155/2015/613089] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Revised: 10/03/2015] [Accepted: 10/08/2015] [Indexed: 06/05/2023]
Abstract
Background. Long lesions being implanted with drug-eluting stents (DES) are associated with relatively high restenosis rates and higher incidences of adverse events. Objectives. We aimed to examine the safety and efficacy of the long (40 mm) biodegradable polymer coated Indolimus sirolimus-eluting stent (SES) in real-world patients with long coronary lesions. Methods. This study was observational, nonrandomized, retrospective, and carried out in real-world patients. A total of 258 patients were enrolled for the treatment of long coronary lesions, with 40 mm Indolimus. The primary endpoints in the study were incidence of major adverse cardiac events (MACE), a miscellany of cardiac death, myocardial infarction (MI), target lesion revascularization (TLR) or target vessel revascularization (TVR), and stent thrombosis (ST) up to 6-month follow-up. Results. The study population included higher proportion of males (74.4%) and average age was 53.2 ± 11.0 years. A total of 278 lesions were intervened successfully with 280 stents. The observed MACE at 6-month follow-up was 2.0%, which included 0.8% cardiac death and 1.2% MI. There were no TLR or TVR and ST observed during 6-month follow-up. Conclusions. The long (40 mm) Indolimus stent demonstrated low MACE rate and was proven to be safe and effective treatment for long lesions in "real-world" patients.
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Affiliation(s)
- Anurag Polavarapu
- Lalitha Super Specialty Hospital Pvt. Ltd., Heart and Brain Centre, Kothapet, Guntur, Andhra Pradesh 522001, India
| | - Raghava Sarma Polavarapu
- Lalitha Super Specialty Hospital Pvt. Ltd., Heart and Brain Centre, Kothapet, Guntur, Andhra Pradesh 522001, India
| | | | - Kamlesh Thakkar
- Lions Sterling Super Specialty Hospital, Mehsana, Gujarat 384002, India
| | - Asif Raheem
- Yashfeen Cardiac Hospital, Navsari, Gujarat 396445, India
| | - Tamanpreet Mayall
- Department of Clinical Trials, Sahajanand Medical Technologies Pvt. Ltd., Surat, Gujarat 395004, India
| | - Ashok Thakkar
- Department of Clinical Trials, Sahajanand Medical Technologies Pvt. Ltd., Surat, Gujarat 395004, India
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Preparation and experimental research into retrievable rapamycin- and heparin-coated vena cava filters: a pilot study. J Thromb Thrombolysis 2015; 41:422-32. [PMID: 26364298 DOI: 10.1007/s11239-015-1278-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
The use of retrievable vena cava filters (RVCFs) was once commonplace, but filter retrieval was often very difficult. Most unsuccessful retrieval was due to intimal hyperplasia of the inferior vena cava and in-filter thrombosis. This pilot study aimed to design a drug-eluting RVCF. The hypothesis was that coated drugs could be released continuously to inhibit vena intimal hyperplasia and thrombosis, and thus improve the retrieval rates of RVCFs. Various concentrations of polycaprolactone (PCL)/chloroform solution were made from a mixture of Rapamycin and Heparin according to the quality of PCL. The drug was coated onto the surface of the filters by a process of dipping. In vitro tests were performed to check stability and in vitro drug release. Animals receiving filter implantation were divided into 4 groups, the experimental intervention group (EI), experimental laparotomy group (EL), control intervention group (CI), and control laparotomy group (CL). Filters were retrieved by laparotomy in the EL and CL groups, and by interventional operation in the EI and CI groups at 10, 20 and 30 days after implantation. Pathological endothelia biopsies were performed with wood grain-eosin (HE) staining and immunohistochemical examination, with the proliferating cell nuclear antigen (PCNA) index, and the results were compared between the experimental and control groups. The weight of thrombus within the filters was also measured by scale and compared. The coating concentration that succeeded in completely covering the surface was 0.2 g/ml. There was better coverage by SEM at this concentration, and the coated drugs had no obvious loss after filter release. The drug release curves showed that the amount of Heparin released was more than 50 % at day 1; Rapamycin released little in the first few days, beginning in earnest at 20 to 30 days. The filters were easy to retrieve at 10 days for both groups, while neither could be retrieved at 30 days. However, at 20 days the filter in the EI group could be retrieved with some difficulty, but the filter in the CI group couldn't be removed at all. The pathological examination and immunohistochemical PCNA examination results showed that the use of drug-eluting filters could effectively inhibit endothelial hyperplasia at 10 and 20 days, but was less effective at 30 days. There was no apparent difference in the total weight of blood clots between the experimental and control groups. We successfully conducted a pilot study into preparing Rapamycin- and Heparin-coated RVCFs. In vitro and in vivo tests further proved the possibility of improving the retrieval rates of RVCFs by effectively inhibiting vein endothelial proliferation, but the anticoagulation and antithrombosis effects of Heparin were unsatisfactory.
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Simulated Thrombin Generation in the Presence of Surface-Bound Heparin and Circulating Tissue Factor. Ann Biomed Eng 2015; 44:1072-84. [PMID: 26168717 DOI: 10.1007/s10439-015-1377-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2015] [Accepted: 06/24/2015] [Indexed: 10/23/2022]
Abstract
An expanded computational model of surface induced thrombin generation was developed that includes hemodynamic effects, 22 biochemical reactions and 44 distinct chemical species. Surface binding of factors V, VIII, IX, and X was included in order to more accurately simulate the formation of the surface complexes tenase and prothrombinase. In order to model these reactions, the non-activated, activated and inactivated forms were all considered. This model was used to investigate the impact of surface bound heparin on thrombin generation with and without the additive effects of thrombomodulin (TM). In total, 104 heparin/TM pairings were evaluated (52 under venous conditions, 52 under arterial conditions), the results demonstrating the synergistic ability of heparin and TM to reduce thrombin generation. Additionally, the role of circulating tissue factor (TF(p)) was investigated and compared to that of surface-bound tissue factor (TF(s)). The numerical results suggest that circulating TF has the power to amplify thrombin generation once the coagulation cascade is already initiated by surface-bound TF. TF(p) concentrations as low as 0.01 nM were found to have a significant impact on total thrombin generation.
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37
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Marino BCA, Nascimento GA, Rabelo W, Marino MA, Marino RL, Ribeiro ALP. Clinical Coronary In-Stent Restenosis Follow-Up after Treatment and Analyses of Clinical Outcomes. Arq Bras Cardiol 2015; 104:375-86. [PMID: 25651344 PMCID: PMC4495452 DOI: 10.5935/abc.20140216] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2014] [Revised: 10/22/2014] [Accepted: 11/04/2014] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Clinical in-stent restenosis (CISR) is the main limitation of coronary angioplasty with stent implantation. OBJECTIVE Describe the clinical and angiographic characteristics of CISR and the outcomes over a minimum follow-up of 12 months after its diagnosis and treatment. METHODS We analyzed in 110 consecutive patients with CISR the clinical presentation, angiographic characteristics, treatment and combined primary outcomes (cardiovascular death, nonfatal acute myocardial infarction [AMI]) and combined secondary (unstable angina with hospitalization, target vessel revascularization and target lesion revascularization) during a minimal follow-up of one year. RESULTS Mean age was 61 ± 11 years (68.2% males). Clinical presentations included acute coronary syndrome (ACS) in 62.7% and proliferative ISR in 34.5%. CISR was treated with implantation of drug-eluting stents (DES) in 36.4%, Bare Metal Stent (BMS) in 23.6%, myocardial revascularization surgery in 18.2%, balloon angioplasty in 15.5% and clinical treatment in 6.4%. During a median follow-up of 19.7 months, the primary outcome occurred in 18 patients, including 6 (5.5%) deaths and 13 (11.8%) AMI events. Twenty-four patients presented a secondary outcome. Predictors of the primary outcome were CISR with DES (HR = 4.36 [1.44-12.85]; p = 0.009) and clinical treatment for CISR (HR = 10.66 [2.53-44.87]; p = 0.001). Treatment of CISR with BMS (HR = 4.08 [1.75-9.48]; p = 0.001) and clinical therapy (HR = 6.29 [1.35-29.38]; p = 0.019) emerged as predictors of a secondary outcome. CONCLUSION Patients with CISR present in most cases with ACS and with a high frequency of adverse events during a medium-term follow-up.
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Affiliation(s)
- Barbara Campos Abreu Marino
- Programa de Pós-Graduação em
Ciências da Saúde do Adulto. Faculdade de Medicina – Universidade Federal
de Minas Gerais (UFMG), Belo Horizonte, Minas Gerais, Brasil
- Departamento de Cardiologia do Hospital Madre Teresa, Belo
Horizonte, Minas Gerais – Brazil
| | - Guilherme Abreu Nascimento
- Departamento de Cardiologia Intervencionista do Hospital
Madre Teresa, Belo Horizonte, Minas Gerais – Brazil
| | - Walter Rabelo
- Departamento de Cardiologia do Hospital Madre Teresa, Belo
Horizonte, Minas Gerais – Brazil
| | - Marcos Antônio Marino
- Departamento de Cardiologia Intervencionista do Hospital
Madre Teresa, Belo Horizonte, Minas Gerais – Brazil
| | - Roberto Luiz Marino
- Departamento de Cardiologia do Hospital Madre Teresa, Belo
Horizonte, Minas Gerais – Brazil
| | - Antonio Luiz Pinho Ribeiro
- Programa de Pós-Graduação em
Ciências da Saúde do Adulto. Faculdade de Medicina – Universidade Federal
de Minas Gerais (UFMG), Belo Horizonte, Minas Gerais, Brasil
- Departamento de Clínica Médica, Faculdade de
Medicina – Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Minas Gerais,
Brasil
- Divisão de Cardiologia e Cirurgia Cardiovascular,
Hospital das Clínicas – Universidade Federal de Minas Gerais (UFMG). Belo
Horizonte, Minas Gerais – Brazil
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Taniguchi T, Kyung KH, Shiratori S. Layer-by-layer self-assembled thin films of chitin fibers and heparin with anti-thrombus characteristics. RSC Adv 2015. [DOI: 10.1039/c5ra01853f] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
Layer-by-layer assembled films of chitin nanofibers and heparin with anti-thrombus characteristics.
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Surgical versus percutaneous revascularization in patients with multivessel coronary artery disease. Curr Atheroscler Rep 2014; 16:461. [PMID: 25344743 DOI: 10.1007/s11883-014-0461-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
New-generation stents have been continually developed in order to improve the safety and efficacy of percutaneous coronary intervention (PCI). Several randomized clinical trials have been conducted over the last two decades to compare the outcomes of PCI with coronary artery bypass grafting (CABG), which has been the time-tested treatment of multivessel coronary artery disease. The Synergy between PCI with Taxus and Cardiac Surgery (SYNTAX) trial is one of the most recent and largest randomized controlled trials comparing PCI using the paclitaxel-eluting first-generation stent with CABG and was uniquely formulated to represent "real world" daily practice. The final 5-year main results of this trial and its various prespecified subgroups have been published in the past year. These results will form the basis of the new guidelines that will be published in the near future. This review is a compilation of the results of the SYNTAX trial and comparisons with other contemporary trials, meta-analyses, and retrospective studies of large registries and how these results help cardiac surgeons and cardiologists in judicious decision-making for their patients with multivessel coronary artery disease requiring revascularization.
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Eller JL, Snyder KV, Siddiqui AH, Levy EI, Hopkins LN. Endovascular Treatment of Carotid Stenosis. Neurosurg Clin N Am 2014; 25:565-82. [DOI: 10.1016/j.nec.2014.04.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Jorge L Eller
- Department of Neurosurgery, University at Buffalo, State University of New York, Buffalo, NY, USA; Department of Neurosurgery, Gates Vascular Institute, Kaleida Health, Buffalo, NY, USA; Cerebrovascular Neurosurgery, PeaceHealth Sacred Heart Medical Center, 333 Riverbend Drive, Springfield, OR 97477, USA
| | - Kenneth V Snyder
- Department of Neurosurgery, University at Buffalo, State University of New York, Buffalo, NY, USA; Department of Neurosurgery, Gates Vascular Institute, Kaleida Health, Buffalo, NY, USA; Department of Neurology, University at Buffalo, State University of New York, Buffalo, NY, USA; Department of Radiology, University at Buffalo, State University of New York, Buffalo, NY, USA; School of Medicine and Biomedical Sciences, Toshiba Stroke and Vascular Research Center, University at Buffalo, State University of New York, Buffalo, NY, USA
| | - Adnan H Siddiqui
- Department of Neurosurgery, University at Buffalo, State University of New York, Buffalo, NY, USA; Department of Neurosurgery, Gates Vascular Institute, Kaleida Health, Buffalo, NY, USA; Department of Radiology, University at Buffalo, State University of New York, Buffalo, NY, USA; School of Medicine and Biomedical Sciences, Toshiba Stroke and Vascular Research Center, University at Buffalo, State University of New York, Buffalo, NY, USA; Jacobs Institute, Buffalo, NY, USA
| | - Elad I Levy
- Department of Neurosurgery, University at Buffalo, State University of New York, Buffalo, NY, USA; Department of Neurosurgery, Gates Vascular Institute, Kaleida Health, Buffalo, NY, USA; Department of Radiology, University at Buffalo, State University of New York, Buffalo, NY, USA; School of Medicine and Biomedical Sciences, Toshiba Stroke and Vascular Research Center, University at Buffalo, State University of New York, Buffalo, NY, USA
| | - L Nelson Hopkins
- Department of Neurosurgery, University at Buffalo, State University of New York, Buffalo, NY, USA; Department of Neurosurgery, Gates Vascular Institute, Kaleida Health, Buffalo, NY, USA; Department of Radiology, University at Buffalo, State University of New York, Buffalo, NY, USA; School of Medicine and Biomedical Sciences, Toshiba Stroke and Vascular Research Center, University at Buffalo, State University of New York, Buffalo, NY, USA; Jacobs Institute, Buffalo, NY, USA.
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Martínez-Ríos MA, Alvarez-León E, Totomoch A, Angeles J, Peña-Duque MA, Delgadillo-Rodríguez H, Martínez-Rodríguez N, Ramírez-Fuentes S, Fragoso JM, Vargas-Alarcón G. Haplotypes of the angiotensin-converting enzyme (ACE) gene are associated with coronary artery disease but not with restenosis after coronary stenting. Exp Mol Pathol 2014; 97:166-70. [PMID: 24995885 DOI: 10.1016/j.yexmp.2014.06.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2014] [Accepted: 06/27/2014] [Indexed: 10/25/2022]
Abstract
The aim of the present study was to establish the role of ACE gene polymorphisms in the risk of developing in-stent restenosis and/or coronary artery disease (CAD). Eight ACE gene polymorphisms were genotyped by 5' exonuclease TaqMan genotyping assays in 236 patients with CAD who underwent coronary artery stenting. Basal and procedure coronary angiographies were analyzed searching for angiographic predictors of restenosis and follow-up angiography was analyzed looking for binary restenosis. A group of 455 individuals without clinical and familial antecedents of cardiovascular diseases were included as controls. Haplotypes were constructed after linkage disequilibrium analysis. Distribution of ACE polymorphisms was similar in patients with and without restenosis. Similar results were observed when the analysis was made comparing the whole group of patients (with and without restenosis) and healthy controls. Six out of eight polymorphisms were in high linkage disequilibrium and were included in five haplotypes (AAAGCA, GGGATG, GAGATG, AGAGCA and AAGACA). The distribution of these haplotypes was similar in patients with and without restenosis. However, CAD patients showed an increased frequency of the AAAGCA haplotype (OR=1.31, 95% CI: 1.04-1.66, P=0.018) and decreased frequencies of GAGATG (OR=0.47, 95% CI: 0.25-0.88, P=0.011) and AGAGCA (OR=0.15, 95% CI: 0.02-0.65, P=0.002) haplotypes when compared to healthy controls. Haplotypes of the ACE gene could be a genetic factor related to coronary artery disease in the Mexican individuals, but do not support its role as a risk factor for developing restenosis after coronary stenting.
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Affiliation(s)
| | - Edith Alvarez-León
- Department of Molecular Biology, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City, Mexico
| | - Armando Totomoch
- Department of Molecular Biology, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City, Mexico
| | - Javier Angeles
- Department of Molecular Biology, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City, Mexico
| | - Marco Antonio Peña-Duque
- Interventional Cardiology, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City, Mexico
| | | | - Nancy Martínez-Rodríguez
- Department of Molecular Biology, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City, Mexico
| | - Silvestre Ramírez-Fuentes
- Department of Molecular Biology, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City, Mexico
| | - José Manuel Fragoso
- Department of Molecular Biology, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City, Mexico
| | - Gilberto Vargas-Alarcón
- Department of Molecular Biology, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City, Mexico.
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Amoroso NS, Bangalore S. Drug-eluting versus bare-metal coronary stents: where are we now? J Comp Eff Res 2014; 1:501-8. [PMID: 24236469 DOI: 10.2217/cer.12.64] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Drug-eluting stents have dramatically reduced the risk of restenosis, but concerns of an increased risk of stent thrombosis have provided uncertainty about their use. Recent studies have continued to show improved procedural and clinical outcomes with drug-eluting stents both in the setting of acute coronary syndromes and stable coronary artery disease. Newer generation drug-eluting stents (especially everolimus-eluting stents) have been shown to be not only efficacious but also safe with reduced risk of stent thrombosis when compared with bare-metal stents, potentially changing the benchmark for stent safety from bare-metal stents to everolimus-eluting stents. While much progress is being made in the development of bioabsorbable polymer stents, nonpolymer stents and bioabsorbable stent technology, it remains to be seen whether these stents will have superior safety and efficacy outcomes compared with the already much improved rates of revascularization and stent thrombosis seen with newer generation stents (everolimus-eluting stents and resolute zotarolimus-eluting stents).
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Affiliation(s)
- Nicholas S Amoroso
- Cardiovascular Clinical Research Center, The Leon H. Charney Division of Cardiology, New York University School of Medicine, New York, NY 10016, USA
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Liu T, Zeng Z, Liu Y, Wang J, Maitz MF, Wang Y, Liu S, Chen J, Huang N. Surface modification with dopamine and heparin/poly-L-lysine nanoparticles provides a favorable release behavior for the healing of vascular stent lesions. ACS APPLIED MATERIALS & INTERFACES 2014; 6:8729-8743. [PMID: 24731022 DOI: 10.1021/am5015309] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Surface biofunctional modification of coronary artery stents to prevent thrombosis and restenosis formation, as well as accelerate endothelialization, has become a new hot spot. However, bioactive coatings on implants are not yet sufficiently developed for long-term activity, as they quickly lose efficiency in vivo and finally fail. On the basis of a novel time-ordered concept of biofunctionality for vascular stents, heparin/poly l-lysine nanoparticle (NP) was developed and immobilized on a polydopamine-coated titanium surface, with the aim of regulating and maintaining the intravascular biological response within the normal range after biomaterial implantation. An in vitro dynamic release model was established to mimic the blood flow condition in vivo with three phases: (1) An early phase (1-7 days) with release of predominantly anticoagulant and anti-inflammatory substances and to a minor degree antiproliferative effects against smooth muscle cells (SMCs); (2) this is followed by a phase (7-14 days) of supported endothelial cell (ECs) proliferation and suppressed SMC proliferation with persisting high antithrombogenicity and anti-inflammatory properties of the surface. (3) Finally, a stable stage (14-28 days) with adequate biomolecules on the surface that maintain hemocompatibility and anti inflammation as well as inhibit SMCs proliferation and promote ECs growth. In vivo animal tests further confirmed that the NP-modified surface provides a favorable release behavior to apply a stage-adjusted remedy. We suggested that these observations provide important guidance and potential means for reasonable and suitable platform construction on a stent surface.
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Affiliation(s)
- Tao Liu
- Key Laboratory of Advanced Technology of Materials, Ministry of Education, Southwest Jiaotong University , Chengdu 610031, PR China
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Caruba T, Katsahian S, Schramm C, Charles Nelson A, Durieux P, Bégué D, Juillière Y, Dubourg O, Danchin N, Sabatier B. Treatment for stable coronary artery disease: a network meta-analysis of cost-effectiveness studies. PLoS One 2014; 9:e98371. [PMID: 24896266 PMCID: PMC4045726 DOI: 10.1371/journal.pone.0098371] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2014] [Accepted: 05/01/2014] [Indexed: 11/18/2022] Open
Abstract
Introduction and Objectives Numerous studies have assessed cost-effectiveness of different treatment modalities for stable angina. Direct comparisons, however, are uncommon. We therefore set out to compare the efficacy and mean cost per patient after 1 and 3 years of follow-up, of the following treatments as assessed in randomized controlled trials (RCT): medical therapy (MT), percutaneous coronary intervention (PCI) without stent (PTCA), with bare-metal stent (BMS), with drug-eluting stent (DES), and elective coronary artery bypass graft (CABG). Methods RCT comparing at least two of the five treatments and reporting clinical and cost data were identified by a systematic search. Clinical end-points were mortality and myocardial infarction (MI). The costs described in the different trials were standardized and expressed in US $ 2008, based on purchasing power parity. A network meta-analysis was used to compare costs. Results Fifteen RCT were selected. Mortality and MI rates were similar in the five treatment groups both for 1-year and 3-year follow-up. Weighted cost per patient however differed markedly for the five treatment modalities, at both one year and three years (P<0.0001). MT was the least expensive treatment modality: US $3069 and 13 864 after one and three years of follow-up, while CABG was the most costly: US $27 003 and 28 670 after one and three years. PCI, whether with plain balloon, BMS or DES came in between, but was closer to the costs of CABG. Conclusions Appreciable savings in health expenditures can be achieved by using MT in the management of patients with stable angina.
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Affiliation(s)
- Thibaut Caruba
- Pharmacie, Hôpital Européen Georges Pompidou, APHP, Paris, France
- * E-mail:
| | - Sandrine Katsahian
- URC Hôpital Henri Mondor, APHP, Créteil, France
- Equipe 22, Centre de Recherche des Cordeliers, UMRS 762 INSERM, Paris, France
| | | | | | - Pierre Durieux
- Equipe 22, Centre de Recherche des Cordeliers, UMRS 762 INSERM, Paris, France
- Département de Santé Publique et Informatique, Hôpital Européen Georges Pompidou, APHP, Paris, France
| | - Dominique Bégué
- Faculté de Pharmacie, Université René Descartes, Paris, France
| | - Yves Juillière
- Cardiologie, Institut Lorrain du Cœur et des Vaisseaux Louis Mathieu, Nancy, France
| | - Olivier Dubourg
- Cardiologie, Hôpital Ambroise Paré, APHP, Boulogne Billancourt, France
- Université de Versailles-Saint Quentin, Montigny-Le-Bretonneux, France
| | - Nicolas Danchin
- Cardiologie, Hôpital Européen Georges Pompidou, APHP, Paris, France
- Faculté de Médecine, Université René Descartes, Paris, France
| | - Brigitte Sabatier
- Pharmacie, Hôpital Européen Georges Pompidou, APHP, Paris, France
- Equipe 22, Centre de Recherche des Cordeliers, UMRS 762 INSERM, Paris, France
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Liu T, Liu Y, Chen Y, Liu S, Maitz MF, Wang X, Zhang K, Wang J, Wang Y, Chen J, Huang N. Immobilization of heparin/poly-(L)-lysine nanoparticles on dopamine-coated surface to create a heparin density gradient for selective direction of platelet and vascular cells behavior. Acta Biomater 2014; 10:1940-54. [PMID: 24342042 DOI: 10.1016/j.actbio.2013.12.013] [Citation(s) in RCA: 101] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2013] [Revised: 11/22/2013] [Accepted: 12/09/2013] [Indexed: 12/23/2022]
Abstract
Restenosis, thrombosis formation and delayed endothelium regeneration continue to be problematic for coronary artery stent therapy. To improve the hemocompatibility of the cardiovascular implants and selectively direct vascular cell behavior, a novel kind of heparin/poly-l-lysine (Hep/PLL) nanoparticle was developed and immobilized on a dopamine-coated surface. The stability and structural characteristics of the nanoparticles changed with the Hep:PLL concentration ratio. A Hep density gradient was created on a surface by immobilizing nanoparticles with various Hep:PLL ratios on a dopamine-coated surface. Antithrombin III binding quantity was significantly enhanced, and in plasma the APTT and TT times as coagulation tests were prolonged, depending on the Hep density. A low Hep density is sufficient to prevent platelet adhesion and activation. The sensitivity of vascular cells to the Hep density is very different: high Hep density inhibits the growth of all vascular cells, while low Hep density could selectively inhibit smooth muscle cell hyperplasia but promote endothelial progenitor cells and endothelial cell proliferation. These observations provide important guidance for modification of surface heparinization. We suggest that this method will provide a potential means to construct a suitable platform on a stent surface for selective direction of vascular cell behavior with low side effects.
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Affiliation(s)
- Tao Liu
- Key Laboratory of Advanced Technology of Materials, Ministry of Education, Southwest Jiaotong University, Chengdu 610031, People's Republic of China
| | - Yang Liu
- Key Laboratory of Advanced Technology of Materials, Ministry of Education, Southwest Jiaotong University, Chengdu 610031, People's Republic of China
| | - Yuan Chen
- Key Laboratory of Advanced Technology of Materials, Ministry of Education, Southwest Jiaotong University, Chengdu 610031, People's Republic of China
| | - Shihui Liu
- Key Laboratory of Advanced Technology of Materials, Ministry of Education, Southwest Jiaotong University, Chengdu 610031, People's Republic of China; Naton Medical Group, Peking 100082, People's Republic of China
| | - Manfred F Maitz
- Key Laboratory of Advanced Technology of Materials, Ministry of Education, Southwest Jiaotong University, Chengdu 610031, People's Republic of China; Leibniz Institute of Polymer Research Dresden, Max Bergmann Center of Biomaterials, Hohe Str. 06, 01069 Dresden, Germany
| | - Xue Wang
- Key Laboratory of Advanced Technology of Materials, Ministry of Education, Southwest Jiaotong University, Chengdu 610031, People's Republic of China
| | - Kun Zhang
- Key Laboratory of Advanced Technology of Materials, Ministry of Education, Southwest Jiaotong University, Chengdu 610031, People's Republic of China
| | - Jian Wang
- Key Laboratory of Advanced Technology of Materials, Ministry of Education, Southwest Jiaotong University, Chengdu 610031, People's Republic of China
| | - Yuan Wang
- Key Laboratory of Advanced Technology of Materials, Ministry of Education, Southwest Jiaotong University, Chengdu 610031, People's Republic of China
| | - Junying Chen
- Key Laboratory of Advanced Technology of Materials, Ministry of Education, Southwest Jiaotong University, Chengdu 610031, People's Republic of China.
| | - Nan Huang
- Key Laboratory of Advanced Technology of Materials, Ministry of Education, Southwest Jiaotong University, Chengdu 610031, People's Republic of China
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Chambers JW, Feldman RL, Himmelstein SI, Bhatheja R, Villa AE, Strickman NE, Shlofmitz RA, Dulas DD, Arab D, Khanna PK, Lee AC, Ghali MG, Shah RR, Davis TP, Kim CY, Tai Z, Patel KC, Puma JA, Makam P, Bertolet BD, Nseir GY. Pivotal Trial to Evaluate the Safety and Efficacy of the Orbital Atherectomy System in Treating De Novo, Severely Calcified Coronary Lesions (ORBIT II). JACC Cardiovasc Interv 2014; 7:510-8. [DOI: 10.1016/j.jcin.2014.01.158] [Citation(s) in RCA: 190] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2013] [Revised: 12/18/2013] [Accepted: 01/04/2014] [Indexed: 12/24/2022]
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Eller JL, Dumont TM, Sorkin GC, Mokin M, Levy EI, Snyder KV, Hopkins LN, Siddiqui AH. Endovascular Advances for Extracranial Carotid Stenosis. Neurosurgery 2014; 74 Suppl 1:S92-101. [DOI: 10.1227/neu.0000000000000223] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Abstract
Carotid artery stenting has become a viable alternative to carotid endarterectomy in the management of carotid stenosis. Over the past 20 years, many trials have attempted to compare both treatment modalities and establish the indications for each one, depending on clinical and anatomic features presented by patients. Concurrently, carotid stenting techniques and devices have evolved and made endovascular management of carotid stenosis safe and effective. Among the most important innovations are devices for distal and proximal embolic protection and new stent designs. This paper reviews these advances in the endovascular management of carotid artery stenosis within the context of the historical background.
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Affiliation(s)
- Jorge L. Eller
- Department of Neurosurgery, School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, New York
- Department of Neurosurgery, Gates Vascular Institute, Kaleida Health, Buffalo, New York
| | - Travis M. Dumont
- Department of Neurosurgery, School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, New York
- Department of Neurosurgery, Gates Vascular Institute, Kaleida Health, Buffalo, New York
| | - Grant C. Sorkin
- Department of Neurosurgery, School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, New York
- Department of Neurosurgery, Gates Vascular Institute, Kaleida Health, Buffalo, New York
| | - Maxim Mokin
- Department of Neurosurgery, School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, New York
- Department of Neurosurgery, Gates Vascular Institute, Kaleida Health, Buffalo, New York
| | - Elad I. Levy
- Department of Neurosurgery, School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, New York
- Department of Neurosurgery, Gates Vascular Institute, Kaleida Health, Buffalo, New York
- Department of Radiology, School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, New York
- Toshiba Stroke and Vascular Research Center, University at Buffalo, State University of New York, Buffalo, New York
| | - Kenneth V. Snyder
- Department of Neurosurgery, School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, New York
- Department of Neurosurgery, Gates Vascular Institute, Kaleida Health, Buffalo, New York
- Department of Radiology, School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, New York
- Toshiba Stroke and Vascular Research Center, University at Buffalo, State University of New York, Buffalo, New York
- Department of Neurology, School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, New York
| | - L. Nelson Hopkins
- Department of Neurosurgery, School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, New York
- Department of Neurosurgery, Gates Vascular Institute, Kaleida Health, Buffalo, New York
- Department of Radiology, School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, New York
- Toshiba Stroke and Vascular Research Center, University at Buffalo, State University of New York, Buffalo, New York
- The Jacobs Institute, Buffalo, New York
| | - Adnan H. Siddiqui
- Department of Neurosurgery, School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, New York
- Department of Neurosurgery, Gates Vascular Institute, Kaleida Health, Buffalo, New York
- Department of Radiology, School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, New York
- Toshiba Stroke and Vascular Research Center, University at Buffalo, State University of New York, Buffalo, New York
- The Jacobs Institute, Buffalo, New York
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Garg S, Serruys P. Benefits of and safety concerns associated with drug-eluting coronary stents. Expert Rev Cardiovasc Ther 2014; 8:449-70. [DOI: 10.1586/erc.09.138] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Conn G, Kidane AG, Punshon G, Kannan RY, Hamilton G, Seifalian AM. Is there an alternative to systemic anticoagulation, as related to interventional biomedical devices? Expert Rev Med Devices 2014; 3:245-61. [PMID: 16515390 DOI: 10.1586/17434440.3.2.245] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
To reduce the toxic effects, related clinical problems and complications such as bleeding disorders associated with systemic anticoagulation, it has been hypothesized that by coating the surfaces of medical devices, such as stents, bypass grafts, extracorporeal circuits, guide wires and catheters, there will be a significant reduction in the requirement for systemic anticoagulation or, ideally, it will no longer be necessary. However, current coating processes, even covalent ones, still result in leaching followed by reduced functionality. Alternative anticoagulants and related antiplatelet agents have been used for improvement in terms of reduced restenosis, intimal hyperphasia and device failure. This review focuses on existing heparinization processes, their application in clinical devices and the updated list of alternatives to heparinization in order to obtain a broad overview, it then highlights, in particular, the future possibilities of using heparin and related moieties to tissue engineer scaffolds.
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Affiliation(s)
- Gemma Conn
- Biomaterials & Tissue Engineering Centre, Academic Division of Surgical and Interventional Sciences, University College London, Rowland Hill Street, Hampstead, London NW3 2PF, UK
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