1
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Schmitz T, Harmel E, Raake P, Freuer D, Kirchberger I, Heier M, Peters A, Linseisen J, Meisinger C. Association Between Acute Myocardial Infarction Symptoms and Short- and Long-term Mortality After the Event. Can J Cardiol 2024; 40:1355-1366. [PMID: 38278322 DOI: 10.1016/j.cjca.2024.01.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 01/03/2024] [Accepted: 01/15/2024] [Indexed: 01/28/2024] Open
Abstract
BACKGROUND In this study, we investigated various acute myocardial infarction (AMI) symptoms and their associations with short-term (28 day) and long-term mortality. METHODS The analysis was based on 5900 patients, aged 25 to 84 years, with first-time AMI recorded by the population-based Myocardial Infarction Registry Augsburg between 2010 and 2017. Median follow-up time was 3.8 years (interquartile range: 1.1-6.3). As part of a face-to-face interview, the presence (yes/no) of 11 most common AMI symptoms at the acute event was assessed. Using multivariable-adjusted logistic regression and Cox regression models, the association between various symptoms and all-cause mortality was investigated. P values of the regression models were false discovery rate adjusted. RESULTS Pain in various body parts (chest pain, left and right shoulder/arm/hand, between shoulder blades), sweating, nausea/vomiting, dizziness and fear of death/feeling of annihilation were significantly associated with a decreased 28-day mortality after AMI. The pain symptoms and sweating were also significantly associated with a decreased long-term mortality. Shortness of breath was significantly associated with a higher long-term mortality. CONCLUSIONS The absence of several symptoms, including typical chest discomfort (chest pain or retrosternal pressure/tightness), is associated with unfavourable outcomes after AMI. This finding has implications for patient management and public health measures designed to encourage appropriate and prompt medical consultation of patients with atypical AMI symptoms.
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Affiliation(s)
- Timo Schmitz
- Epidemiology, Medical Faculty, University of Augsburg, Augsburg, Germany.
| | - Eva Harmel
- Department of Cardiology, Respiratory Medicine and Intensive Care, University Hospital Augsburg, Augsburg, Germany
| | - Philip Raake
- Department of Cardiology, Respiratory Medicine and Intensive Care, University Hospital Augsburg, Augsburg, Germany
| | - Dennis Freuer
- Epidemiology, Medical Faculty, University of Augsburg, Augsburg, Germany
| | - Inge Kirchberger
- Epidemiology, Medical Faculty, University of Augsburg, Augsburg, Germany
| | - Margit Heier
- University Hospital of Augsburg, KORA Study Centre, Augsburg, Germany; Helmholtz Zentrum München, German Research Center for Environmental Health, Institute for Epidemiology, Neuherberg, Germany
| | - Annette Peters
- Helmholtz Zentrum München, German Research Center for Environmental Health, Institute for Epidemiology, Neuherberg, Germany; Chair of Epidemiology, Institute for Medical Information Processing, Biometry and Epidemiology, Medical Faculty, Ludwig-Maximilians-Universität München, Munich, Germany; German Center for Diabetes Research (DZD), Neuherberg, Germany
| | - Jakob Linseisen
- Epidemiology, Medical Faculty, University of Augsburg, Augsburg, Germany
| | - Christa Meisinger
- Epidemiology, Medical Faculty, University of Augsburg, Augsburg, Germany
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2
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Moore E, Robson AJ, Crisp AR, Cockshell MP, Burzava ALS, Ganesan R, Robinson N, Al-Bataineh S, Nankivell V, Sandeman L, Tondl M, Benveniste G, Finnie JW, Psaltis PJ, Martocq L, Quadrelli A, Jarvis SP, Williams C, Ramage G, Rehman IU, Bursill CA, Simula T, Voelcker NH, Griesser HJ, Short RD, Bonder CS. Study of the Structure of Hyperbranched Polyglycerol Coatings and Their Antibiofouling and Antithrombotic Applications. Adv Healthc Mater 2024:e2401545. [PMID: 38924692 DOI: 10.1002/adhm.202401545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2024] [Revised: 06/10/2024] [Indexed: 06/28/2024]
Abstract
While blood-contacting materials are widely deployed in medicine in vascular stents, catheters, and cannulas, devices fail in situ because of thrombosis and restenosis. Furthermore, microbial attachment and biofilm formation is not an uncommon problem for medical devices. Even incremental improvements in hemocompatible materials can provide significant benefits for patients in terms of safety and patency as well as substantial cost savings. Herein, a novel but simple strategy is described for coating a range of medical materials, that can be applied to objects of complex geometry, involving plasma-grafting of an ultrathin hyperbranched polyglycerol coating (HPG). Plasma activation creates highly reactive surface oxygen moieties that readily react with glycidol. Irrespective of the substrate, coatings are uniform and pinhole free, comprising O─C─O repeats, with HPG chains packing in a fashion that holds reversibly binding proteins at the coating surface. In vitro assays with planar test samples show that HPG prevents platelet adhesion and activation, as well as reducing (>3 log) bacterial attachment and preventing biofilm formation. Ex vivo and preclinical studies show that HPG-coated nitinol stents do not elicit thrombosis or restenosis, nor complement or neutrophil activation. Subcutaneous implantation of HPG coated disks under the skin of mice shows no evidence of toxicity nor inflammation.
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Affiliation(s)
- Eli Moore
- Centre for Cancer Biology, University of South Australia and SA Pathology, Adelaide, South Australia, 5000, Australia
| | - Alexander J Robson
- Department of Chemistry, The University of Sheffield, Dainton Building, Brook Hill, Sheffield, S3 7HF, UK
| | - Amy R Crisp
- School of Engineering, Lancaster University, Lancaster, LA1 4YW, UK
| | - Michaelia P Cockshell
- Centre for Cancer Biology, University of South Australia and SA Pathology, Adelaide, South Australia, 5000, Australia
| | - Anouck L S Burzava
- Future Industries Institute, University of South Australia, Mawson Lakes, South Australia, 5095, Australia
| | - Raja Ganesan
- Centre for Cancer Biology, University of South Australia and SA Pathology, Adelaide, South Australia, 5000, Australia
| | - Nirmal Robinson
- Centre for Cancer Biology, University of South Australia and SA Pathology, Adelaide, South Australia, 5000, Australia
- Adelaide Medical School, University of Adelaide, Adelaide, South Australia, 5000, Australia
| | | | - Victoria Nankivell
- Vascular Research Centre, Heart and Vascular Program, Lifelong Health Theme, South Australian Health and Medical Research Institute, Adelaide, South Australia, 5000, Australia
| | - Lauren Sandeman
- Vascular Research Centre, Heart and Vascular Program, Lifelong Health Theme, South Australian Health and Medical Research Institute, Adelaide, South Australia, 5000, Australia
| | - Markus Tondl
- Centre for Cancer Biology, University of South Australia and SA Pathology, Adelaide, South Australia, 5000, Australia
| | | | - John W Finnie
- Adelaide Medical School, University of Adelaide, Adelaide, South Australia, 5000, Australia
| | - Peter J Psaltis
- Adelaide Medical School, University of Adelaide, Adelaide, South Australia, 5000, Australia
- Vascular Research Centre, Heart and Vascular Program, Lifelong Health Theme, South Australian Health and Medical Research Institute, Adelaide, South Australia, 5000, Australia
- Department of Cardiology, Central Adelaide Local Health Network, Adelaide, South Australia, 5000, Australia
| | - Laurine Martocq
- School of Engineering, Lancaster University, Lancaster, LA1 4YW, UK
| | | | - Samuel P Jarvis
- Department of Physics, Lancaster University, Lancaster, LA1 4YB, UK
| | - Craig Williams
- Microbiology Department, Royal Lancaster Infirmary, Lancaster, LA1 4RP, UK
| | - Gordon Ramage
- Department of Nursing and Community Health, Glasgow Caledonian University, Glasgow, G4 0BA, UK
| | - Ihtesham U Rehman
- School of Medicine, University of Central Lancashire, Preston, PR1 2HE, UK
| | - Christina A Bursill
- Vascular Research Centre, Heart and Vascular Program, Lifelong Health Theme, South Australian Health and Medical Research Institute, Adelaide, South Australia, 5000, Australia
| | - Tony Simula
- TekCyte Limited, Mawson Lakes, South Australia, 5095, Australia
| | - Nicolas H Voelcker
- Monash Institute of Pharmaceutical Sciences, Monash University, Parkville, Victoria, 3052, Australia
- Melbourne Centre for Nanofabrication, Victorian Node of the Australian National Fabrication Facility, Clayton, Victoria, 3168, Australia
| | - Hans J Griesser
- Future Industries Institute, University of South Australia, Mawson Lakes, South Australia, 5095, Australia
| | - Robert D Short
- Department of Chemistry, The University of Sheffield, Dainton Building, Brook Hill, Sheffield, S3 7HF, UK
| | - Claudine S Bonder
- Centre for Cancer Biology, University of South Australia and SA Pathology, Adelaide, South Australia, 5000, Australia
- Adelaide Medical School, University of Adelaide, Adelaide, South Australia, 5000, Australia
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3
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Bjorgvinsdottir O, Ferguson SJ, Snorradottir BS, Gudjonsson T, Wuertz-Kozak K. The influence of physical and spatial substrate characteristics on endothelial cells. Mater Today Bio 2024; 26:101060. [PMID: 38711934 PMCID: PMC11070711 DOI: 10.1016/j.mtbio.2024.101060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2023] [Revised: 03/10/2024] [Accepted: 04/13/2024] [Indexed: 05/08/2024] Open
Abstract
Cardiovascular diseases are a main cause of death worldwide, leading to a growing demand for medical devices to treat this patient group. Central to the engineering of such devices is a good understanding of the biology and physics of cell-surface interactions. In existing blood-contacting devices, such as vascular grafts, the interaction between blood, cells, and material is one of the main limiting factors for their long-term durability. An improved understanding of the material's chemical- and physical properties as well as its structure all play a role in how endothelial cells interact with the material surface. This review provides an overview of how different surface structures influence endothelial cell responses and what is currently known about the underlying mechanisms that guide this behavior. The structures reviewed include decellularized matrices, electrospun fibers, pillars, pits, and grated surfaces.
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Affiliation(s)
- Oddny Bjorgvinsdottir
- Faculty of Pharmaceutical Sciences, University of Iceland, Hofsvallagata 53, 107 Reykjavik, Iceland
| | - Stephen J. Ferguson
- Institute for Biomechanics, ETH Zurich, Gloriastrasse 37 / 39, 8092, Zurich, Switzerland
| | | | - Thorarinn Gudjonsson
- Faculty of Medicine, University of Iceland, Vatnsmyrarvegur 16, 101 Reykjavik, Iceland
| | - Karin Wuertz-Kozak
- Department of Biomedical Engineering, Rochester Institute of Technology (RIT), 160 Lomb Memorial Drive Bldg. 73, Rochester, NY, 14623, USA
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4
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Wiyono AV, Ardinal AP. Revolutionizing Cardiovascular Frontiers: A Dive Into Cutting-Edge Innovations in Coronary Stent Technology. Cardiol Rev 2024:00045415-990000000-00255. [PMID: 38709038 DOI: 10.1097/crd.0000000000000705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/07/2024]
Abstract
Plain balloon angioplasty was the initial method used to enlarge the intracoronary lumen size. However, it was linked to acute coronary closure due to early vessel recoil. This led to the invention of coronary stents, which offer mechanical support to open and maintain the vascular lumen. Nevertheless, the metallic scaffold introduced other issues, such as thrombosis and restenosis caused by neointimal proliferation. To address these concerns, polymers were employed to cover the scaffold, acting as drug reservoirs and regulators for controlled drug release. The use of polymers prevents direct contact between blood and metallic scaffolds. Drugs within the stent were incorporated to inhibit proliferation and expedite endothelialization in the healing process. Despite these advancements, adverse effects still arise due to the inflammatory reaction caused by the polymer material. Consequently, resorbable polymers and scaffolds were later discovered, but they have limitations and are not universally applicable. Various scaffold designs, thicknesses, materials, polymer components, and drugs have their own advantages and complications. Each stent generation has been designed to address the shortcomings of the preceding generation, yet new challenges continue to emerge. Conflicting data regarding the long-term safety and efficacy of coronary stents, especially in the extended follow-up, further complicates the assessment.
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Affiliation(s)
- Alice Valeria Wiyono
- Faculty of Life Sciences & Medicine, King's College London, School of Cardiovascular and Metabolic Medicine, London, United Kingdom
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5
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Elder TA, White TG, Woo HH, Siddiqui AH, Nunna R, Siddiq F, Esposito G, Chang D, Gonzalez NR, Amin-Hanjani S. Future of Endovascular and Surgical Treatments of Atherosclerotic Intracranial Stenosis. Stroke 2024; 55:344-354. [PMID: 38252761 DOI: 10.1161/strokeaha.123.043634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2024]
Abstract
Intracranial atherosclerotic disease and resultant intracranial stenosis is a global leading cause of stroke, and poses an ongoing treatment challenge. Among patients with intracranial stenosis, those with hemodynamic compromise are at high risk for recurrent stroke despite medical therapy and risk factor modification. Revascularization of the hypoperfused territory is the most plausible treatment strategy for these high-risk patients, yet surgical and endovascular therapies have not yet shown to be sufficiently safe and effective in randomized controlled trials. Advances in diagnostic and therapeutic technologies have led to a resurgence of interest in surgical and endovascular treatment strategies, with a growing body of evidence to support their further evaluation in the treatment of select patient populations. This review outlines the current and emerging endovascular and surgical treatments and highlights promising future management strategies.
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Affiliation(s)
- Theresa A Elder
- University Hospitals Cleveland Medical Center/Case Western Reserve University School of Medicine, OH (T.A.E., S.A.-H.)
| | - Timothy G White
- Department of Neurosurgery, Donald and Barbara Zucker School of Medicine at Hofstra Northwell, Manhasset, NY (T.G.W., H.H.W.)
| | - Henry H Woo
- Department of Neurosurgery, Donald and Barbara Zucker School of Medicine at Hofstra Northwell, Manhasset, NY (T.G.W., H.H.W.)
| | - Adnan H Siddiqui
- Departments of Neurosurgery and Radiology and Canon Stroke and Vascular Research Center, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, NY (A.H.S.)
| | - Ravi Nunna
- Department of Neurological Surgery, University of Missouri School of Medicine, Columbia (R.N., F.S.)
| | - Farhan Siddiq
- Department of Neurological Surgery, University of Missouri School of Medicine, Columbia (R.N., F.S.)
| | - Giuseppe Esposito
- Department of Neurosurgery, University Hospital Zurich, University of Zurich, Switzerland (G.E.)
| | - Daniel Chang
- Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, CA (D.C., N.R.G.)
| | - Nestor R Gonzalez
- Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, CA (D.C., N.R.G.)
| | - Sepideh Amin-Hanjani
- University Hospitals Cleveland Medical Center/Case Western Reserve University School of Medicine, OH (T.A.E., S.A.-H.)
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6
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Onea HL, Lazar FL, Olinic DM, Homorodean C, Cortese B. The role of optical coherence tomography in guiding percutaneous coronary interventions: is left main the final challenge? Minerva Cardiol Angiol 2024; 72:41-55. [PMID: 36321887 DOI: 10.23736/s2724-5683.22.06181-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2024]
Abstract
Left main (LM) coronary artery disease is a high-risk lesion subset, with important prognostic implications for the patients. Recent advances in the field of interventional cardiology have narrowed the gap between surgical and percutaneous approach of this complex lesion setting. However, the rate of repeat revascularization remains higher in the case of percutaneous coronary intervention (PCI) on long-term follow-up. As such, the need for better stent optimization strategies has led to the development of intravascular imaging techniques, represented mainly by intravascular ultrasound (IVUS) and optical coherence tomography (OCT). These techniques are both able to provide excellent pre- and post-PCI guidance. While IVUS is an established modality in optimizing LM PCI, and is recommended by international revascularization guidelines, data and experience on the use of OCT are still limited. This review paper deeply analyzes the current role of OCT imaging in the setting of LM disease, particularly focusing on its utility in assessing plaque morphology and distribution, vessel dimensions and proper stent sizing, analyzing mechanisms of stent failure such as malapposition and underexpansion, guiding bifurcation stenting, as well as offering a direct comparison with IVUS in this critical clinical scenario, based on the most recent available data.
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Affiliation(s)
- Horea-Laurentiu Onea
- Department of Interventional Cardiology, Cluj County Emergency Hospital, Cluj-Napoca, Romania
- Medical Clinic Number1, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Florin-Leontin Lazar
- Department of Interventional Cardiology, Cluj County Emergency Hospital, Cluj-Napoca, Romania
| | - Dan-Mircea Olinic
- Department of Interventional Cardiology, Cluj County Emergency Hospital, Cluj-Napoca, Romania
- Medical Clinic Number1, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Calin Homorodean
- Department of Interventional Cardiology, Cluj County Emergency Hospital, Cluj-Napoca, Romania
- Medical Clinic Number1, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Bernardo Cortese
- Fondazione Ricerca e Innovazione Cardiovascolare, Milan, Italy -
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7
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Tang KS, Banerjee S, Tang G, Patel PM, Frangieh AH. Shortened Duration of Dual Antiplatelet Therapy Following Percutaneous Coronary Intervention: A Contemporary Clinical Review. Interv Cardiol 2023; 18:e31. [PMID: 38213748 PMCID: PMC10782423 DOI: 10.15420/icr.2023.19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 10/08/2023] [Indexed: 01/13/2024] Open
Abstract
Percutaneous coronary intervention with stent implantation is an integral aspect of minimally interventional cardiac procedures. The technology and techniques behind stent design and implantation have evolved rapidly over several decades. However, continued discourse remains around optimal peri- and post-interventional management with dual antiplatelet therapy to minimise both major cardiovascular or cerebrovascular events and iatrogenic bleeding risk. Standard guidelines around dual antiplatelet therapy historically recommended long-term dual antiplatelet therapy for 12 months (with consideration for >12 months in certain patients); however, emerging data and generational improvements in the safety of drug-eluting stents have ushered in a new era of short-term therapy to reduce the incidence of major bleeding events. This case review will provide an overview of the current state of guidelines around duration of dual antiplatelet therapy and examine recent updates and continued gaps in existing research.
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Affiliation(s)
- Kevin S Tang
- Division of Internal Medicine, Department of Medicine, University of California Irvine HealthOrange, CA, US
| | - Shoujit Banerjee
- Division of Internal Medicine, Department of Medicine, University of California Irvine HealthOrange, CA, US
| | - George Tang
- Division of Cardiology, Department of Medicine, University of California Irvine HealthOrange, CA, US
| | - Pranav M Patel
- Division of Cardiology, Department of Medicine, University of California Irvine HealthOrange, CA, US
| | - Antonio H Frangieh
- Division of Cardiology, Department of Medicine, University of California Irvine HealthOrange, CA, US
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8
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Merinopoulos I, Gunawardena T, Corballis N, Tsampasian V, Eccleshall SC, Smith J, Vassiliou VS. The role of inflammation in percutaneous coronary intervention, from balloon angioplasty to drug eluting stents. Minerva Cardiol Angiol 2023; 71:631-642. [PMID: 35785928 DOI: 10.23736/s2724-5683.22.06091-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2023]
Abstract
The role of inflammation in percutaneous coronary intervention (PCI) has been investigated in numerous studies. Both pre-PCI and post-PCI inflammatory status have been demonstrated to be linked with patient outcomes. C-reactive protein continues to be the most studied inflammatory biomarker, while a growing number of additional biomarkers, including cytokines and immune cells, are being assessed. As insights are gained into the complexities of the inflammatory response to PCI, it becomes evident that a targeted approach is necessary to ensure optimal patient outcomes. Here, we review the biomarkers that can predict patient outcomes following PCI and specifically how they differ for balloon angioplasty, bare metal stents and drug eluting stents. A specific focus is given to human studies and periprocedural inflammation rather than inflammation associated with myocardial infarction.
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Affiliation(s)
- Ioannis Merinopoulos
- Department of Cardiology, Norfolk and Norwich University Hospital, Norwich, UK
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Tharusha Gunawardena
- Department of Cardiology, Norfolk and Norwich University Hospital, Norwich, UK
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Natasha Corballis
- Department of Cardiology, Norfolk and Norwich University Hospital, Norwich, UK
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Vassiliki Tsampasian
- Department of Cardiology, Norfolk and Norwich University Hospital, Norwich, UK
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Simon C Eccleshall
- Department of Cardiology, Norfolk and Norwich University Hospital, Norwich, UK
| | - James Smith
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Vassilios S Vassiliou
- Department of Cardiology, Norfolk and Norwich University Hospital, Norwich, UK -
- Norwich Medical School, University of East Anglia, Norwich, UK
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9
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Das A, Mehrotra S, Kumar A. Advances in Fabrication Technologies for the Development of Next-Generation Cardiovascular Stents. J Funct Biomater 2023; 14:544. [PMID: 37998113 PMCID: PMC10672426 DOI: 10.3390/jfb14110544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 10/25/2023] [Accepted: 11/07/2023] [Indexed: 11/25/2023] Open
Abstract
Coronary artery disease is the most prevalent cardiovascular disease, claiming millions of lives annually around the world. The current treatment includes surgically inserting a tubular construct, called a stent, inside arteries to restore blood flow. However, due to lack of patient-specific design, the commercial products cannot be used with different vessel anatomies. In this review, we have summarized the drawbacks in existing commercial metal stents which face problems of restenosis and inflammatory responses, owing to the development of neointimal hyperplasia. Further, we have highlighted the fabrication of stents using biodegradable polymers, which can circumvent most of the existing limitations. In this regard, we elaborated on the utilization of new fabrication methodologies based on additive manufacturing such as three-dimensional printing to design patient-specific stents. Finally, we have discussed the functionalization of these stent surfaces with suitable bioactive molecules which can prove to enhance their properties in preventing thrombosis and better healing of injured blood vessel lining.
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Affiliation(s)
- Ankita Das
- Department of Biological Sciences and Bioengineering, Indian Institute of Technology Kanpur, Kanpur 208016, UP, India;
| | - Shreya Mehrotra
- Department of Biological Sciences and Bioengineering, Indian Institute of Technology Kanpur, Kanpur 208016, UP, India;
- Centre for Environmental Sciences and Engineering, Indian Institute of Technology Kanpur, Kanpur 208016, UP, India
| | - Ashok Kumar
- Department of Biological Sciences and Bioengineering, Indian Institute of Technology Kanpur, Kanpur 208016, UP, India;
- Centre for Environmental Sciences and Engineering, Indian Institute of Technology Kanpur, Kanpur 208016, UP, India
- Centre of Excellence for Orthopaedics and Prosthetics, Gangwal School of Medical Sciences and Technology, Indian Institute of Technology Kanpur, Kanpur 208016, UP, India
- The Mehta Family Centre for Engineering in Medicine, Indian Institute of Technology Kanpur, Kanpur 208016, UP, India
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10
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Sahu RA, Nashine A, Mudey A, Sahu SA, Prasad R. Cardiovascular Stents: Types and Future Landscape. Cureus 2023; 15:e43438. [PMID: 37711918 PMCID: PMC10499059 DOI: 10.7759/cureus.43438] [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: 07/19/2023] [Accepted: 08/12/2023] [Indexed: 09/16/2023] Open
Abstract
One of the prominent reasons for mortality and morbidity worldwide is coronary artery disease (CAD), an ailment that manifests itself by the narrowing of the artery with the deposition of plaque. The definitive mode of action for dealing with this condition is using a medical device known as a stent at the affected location. This extremely important tubular equipment helps tremendously with vessel support. It also helps by keeping the path of blood flow clear for the heart muscle masses, its crucial nutrients, and oxygen supply. Several generations of stents have been continuously developed to improve patient outcomes and reduce side effects post-stent implantation. As we move from bare metal stents (BMSs) to drug-eluting stents (DESs) and, more recently, to bioabsorbable stents, the research area continues to develop. The use of this biomedical device has increased the standard of living in many cases; therefore, it is much needed to work on the possible growth areas in the cardiovascular stents and improve them to such an extent that the patients suffering from cardiovascular ailments get to live a comfortable life. Most articles deal with stents that are available for current use and their various types. They also cover the topic of stent optimization, as it is one of the key factors in enhancing stent usability and plays a prominent role in optimizing stent placement in the vessels of the body. To keep in touch with advances in stent technology over the past few decades, this article reviews advances in the devices, working on how available stents can be optimized to create new stents.
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Affiliation(s)
- Rohit A Sahu
- Community Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Aparna Nashine
- Community Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Abhay Mudey
- Community Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Shreya A Sahu
- Obstretics and Gynecology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Roshan Prasad
- Medicine and Surgery, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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11
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Siddiq F, Nunna RS, Beall JM, Khan I, Khan M, Tekle WG, Ezzeldin M, Tanweer O, Burkhardt JK, Jabbour PM, Tjoumakaris SI, Herial NA, Siddiqui AH, Grandhi R, Martin RL, Qureshi AI, Hassan AE. Thirty-Day Outcomes of Resolute Onyx Stent for Symptomatic Intracranial Stenosis: A Multicenter Propensity Score-Matched Comparison With Stenting Versus Aggressive Medical Management for Preventing Recurrent Stroke in Intracranial Stenosis Trial. Neurosurgery 2023; 92:1155-1162. [PMID: 36700730 PMCID: PMC10553131 DOI: 10.1227/neu.0000000000002338] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 11/02/2022] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Symptomatic intracranial atherosclerotic disease (sICAD) is estimated to cause 10% of strokes annually in the United States. However, treatment remains a challenge with several different stenting options studied in the past with unfavorable results. OBJECTIVE To report the 30-day stroke and/or death rate associated with intracranial stent placement for sICAD using Resolute Onyx Zotarolimus-Eluting Stent (RO-ZES) and provide a comparison with the results of Stenting Versus Aggressive Medical Management for Preventing Recurrent Stroke in Intracranial Stenosis (SAMMPRIS) trial. METHODS Prospectively maintained databases across 8 stroke centers were used to identify adult patients treated with RO-ZES for sICAD between January 2019 and December 2021. Primary end point was composite of 30-day stroke, intracerebral hemorrhage, and/or death. Propensity score matching was performed using age, hypertension, lipid disorder, cigarette smoking, and symptomatic target vessel to create a matched group for comparison between RO-ZES and the SAMMPRIS medical management and treatment groups (SAMMPRIS percutaneous angioplasty and stenting [S-PTAS]). RESULTS A total of 132 patients met the inclusion criteria for analysis (mean age: 64.2 years). Mean severity of stenosis was 81.4% (±11.4%). A total of 4 (3.03%) stroke and/or deaths were reported within 30 days of treatment in the RO-ZES group compared with 6.6% in the SAMMPRIS medical management group (OR [odds ratio] 2.26, 95% CI 0.7-9.56, P = .22) and 15.6% in the S-PTAS group (OR 5.9, 95% CI 2.04-23.4, P < .001). Propensity score match analysis of 115 patients in each group demonstrated 30-day stroke and/or death rate of 2.6% in the RO-ZES group and 15.6% in the S-PTAS group (OR 6.88, 95% CI 1.92-37.54, P < .001). CONCLUSION Patients treated with RO-ZES had a relatively low 30-day stroke and/or death rate compared with the S-PTAS group. Further large-scale prospective studies are warranted to evaluate the safety and efficacy of RO-ZES for the treatment of sICAD.
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Affiliation(s)
- Farhan Siddiq
- Department of Neurosurgery, University of Missouri, Columbia, Missouri, USA
| | - Ravi S. Nunna
- Department of Neurosurgery, University of Missouri, Columbia, Missouri, USA
| | - Jonathan M. Beall
- Medical University of South Carolina, Charleston, South Carolina, USA
| | - Inamullah Khan
- Department of Neurosurgery, University of Missouri, Columbia, Missouri, USA
| | - Musharaf Khan
- Department of Neurosurgery, University of Missouri, Columbia, Missouri, USA
| | - Wondwossen G. Tekle
- Department of Neurology, Valley Baptist—University of Texas Rio Grande Valley, Harlingen, Texas, USA
| | - Mohamad Ezzeldin
- Department of Clinical Science, University of Houston, HCA Houston, Houston, Texas, USA
| | - Omar Tanweer
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, USA
| | - Jan-Karl Burkhardt
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Penn Medicine, Philadelphia, Pennsylvania, USA
| | - Pascal M. Jabbour
- Department of Neurosurgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | | | - Nabeel A. Herial
- Department of Neurosurgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Adnan H. Siddiqui
- Department of Neurosurgery, University of Buffalo, Buffalo, New York, USA
| | - Ramesh Grandhi
- Department of Neurosurgery, University of Utah, Salt Lake City, Utah, USA
| | - Renee L. Martin
- Medical University of South Carolina, Charleston, South Carolina, USA
| | - Adnan I. Qureshi
- Zeenat Qureshi Stroke Institute and Department of Neurology, University of Missouri, Columbia, Missouri, USA
| | - Ameer E. Hassan
- Department of Neurology, Valley Baptist—University of Texas Rio Grande Valley, Harlingen, Texas, USA
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12
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Lee YJ, Park M, Kim HY, Kim JK, Kim WK, Lim SC, Kang KW. Circulating small extracellular vesicles promote proliferation and migration of vascular smooth muscle cells via AXL and MerTK activation. Acta Pharmacol Sin 2023; 44:984-998. [PMID: 36450791 PMCID: PMC10104856 DOI: 10.1038/s41401-022-01029-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Accepted: 11/07/2022] [Indexed: 12/03/2022] Open
Abstract
The proliferation and migration of vascular smooth muscle cells (VSMCs) after vascular injury lead to neointimal hyperplasia, thus aggravating vascular diseases. However, the molecular mechanisms underlying neointima formation are not fully elucidated. Extracellular vesicles (EVs) are mediators of various intercellular communications. The potential of EVs as regulators in cardiovascular diseases has raised significant interest. In the current study we investigated the role of circulating small extracellular vesicles (csEVs), the most abundant EVs (1010 EVs/mL serum) in VSMC functions. csEVs were prepared from bovine, porcine or rat serum. We showed that incubation with csEVs (0.5 × 1010-2 × 1010) dose-dependently enhanced the proliferation and migration of VSMCs via the membrane phosphatidylserine (PS). In rats with ligation of right carotid artery, we demonstrated that application of csEVs in the ligated vessels aggravated neointima formation via interaction of membrane PS with injury. Furthermore, incubation with csEVs markedly enhanced the phosphorylation of AXL and MerTK in VSMCs. Pretreatment with BSM777607 (pan-TAM inhibitor), bemcentinib (AXL inhibitor) or UNC2250 (MerTK inhibitor) blocked csEV-induced proliferation and migration of VSMCs. We revealed that csEV-activated AXL and MerTK shared the downstream signaling pathways of Akt, extracellular signal-regulated kinase (ERK) and focal adhesion kinase (FAK) that mediated the effects of csEVs. We also found that csEVs increased the expression of AXL through activation of transcription factor YAP, which might constitute an AXL-positive feedback loop to amplify the signals. Finally, we demonstrated that dual inhibition of AXL/MerTK by ONO-7475 (0.1 µM) effectively hindered csEV-mediated proliferation and migration of VSMCs in ex vivo mouse aorta injury model. Based on these results, we propose an essential role for csEVs in proliferation and migration of VSMCs and highlight the feasibility of dual AXL/MerTK inhibitors in the treatment of vascular diseases.
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Affiliation(s)
- Young Joo Lee
- College of Pharmacy and Research Institute of Pharmaceutical Sciences, Seoul National University, Seoul, 08826, Republic of Korea
| | - Miso Park
- College of Pharmacy and Research Institute of Pharmaceutical Sciences, Seoul National University, Seoul, 08826, Republic of Korea
| | - Hyun Young Kim
- College of Pharmacy and Research Institute of Pharmaceutical Sciences, Seoul National University, Seoul, 08826, Republic of Korea
| | - Jin-Ki Kim
- College of Pharmacy, Hanyang University, Gyeonggi-do, 15588, Republic of Korea
| | - Won-Ki Kim
- Department of Neuroscience, Korea University College of Medicine, Seoul, 02841, Republic of Korea
| | - Sung Chul Lim
- Department of Pathology, Medical school, Chosun University, Gwangju, 61453, Republic of Korea
| | - Keon Wook Kang
- College of Pharmacy and Research Institute of Pharmaceutical Sciences, Seoul National University, Seoul, 08826, Republic of Korea.
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13
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El-Tanani M, Nsairat H, Aljabali AA, Serrano-Aroca-Angel Á, Mishra V, Mishra Y, Naikoo GA, Alshaer W, Tambuwala MM. Role of mammalian target of rapamycin (mTOR) signalling in oncogenesis. Life Sci 2023; 323:121662. [PMID: 37028545 DOI: 10.1016/j.lfs.2023.121662] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 03/07/2023] [Accepted: 03/31/2023] [Indexed: 04/09/2023]
Abstract
The signalling system known as mammalian target of rapamycin (mTOR) is believed to be required for several biological activities involving cell proliferation. The serine-threonine kinase identified as mTOR recognises PI3K-AKT stress signals. It is well established in the scientific literature that the deregulation of the mTOR pathway plays a crucial role in cancer growth and advancement. This review focuses on the normal functions of mTOR as well as its abnormal roles in cancer development.
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Affiliation(s)
- Mohamed El-Tanani
- Pharmacological and Diagnostic Research Center, Faculty of Pharmacy, Al-Ahliyya Amman University, Amman 19328, Jordan; Institute of Cancer Therapeutics, University of Bradford, Bradford, West Yorkshire BD7 1DP, United Kingdom.
| | - Hamdi Nsairat
- Pharmacological and Diagnostic Research Center, Faculty of Pharmacy, Al-Ahliyya Amman University, Amman 19328, Jordan
| | - Alaa A Aljabali
- Department of Pharmaceutics and Pharmaceutical Technology, Yarmouk University, Irbid 21163, Jordan.
| | - Ángel Serrano-Aroca-Angel
- Biomaterials and Bioengineering Laboratory, Centro de Investigación Traslacional San Alberto Magno, Universidad Católica de Valencia San Vicente Mártir, c/Guillem de Castro 94, 46001, Valencia, Spain.
| | - Vijay Mishra
- School of Pharmaceutical Sciences, Lovely Professional University, Phagwara, 144411, Punjab, India
| | - Yachana Mishra
- School of Bioengineering and Biosciences, Lovely Professional University, Phagwara, 144411, Punjab, India
| | - Gowhar A Naikoo
- Department of Mathematics and Sciences, College of Arts and Applied Sciences, Dhofar University, Salalah, PC 211, Oman.
| | - Walhan Alshaer
- Cell Therapy Center, the University of Jordan, Amman 11942, Jordan
| | - Murtaza M Tambuwala
- Lincoln Medical School, University of Lincoln, Brayford Pool Campus, Lincoln LN6 7TS, United Kingdom.
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14
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Dadrass F, Raja SC, Lookstein R. Below-the-Knee Stents and Scaffolds: A Comprehensive Review. Semin Intervent Radiol 2023; 40:167-171. [PMID: 37333740 PMCID: PMC10275668 DOI: 10.1055/s-0043-57263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/20/2023]
Abstract
Below-the-knee intervention of chronic limb-threatening ischemia is an area of increasing interest. Due to lower morbidity and possibly better clinical outcomes, endovascular techniques have become increasingly important in this patient population many of who have limited surgical options. This article serves as a review of existing stent and scaffolding devices utilized for infrapopliteal disease. The authors will additionally discuss current indications and review studies that are investigating novel materials used in treating infrapopliteal arterial disease.
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Affiliation(s)
- Farnaz Dadrass
- Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Sahitya C. Raja
- Department of Vascular and Interventional Radiology, Rush University Medical Center, Chicago, Illinois
| | - Robert Lookstein
- Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, New York
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15
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Park DS, Jeong MH, Jin YJ, Na MH, Sim DS, Kim M, Cho KH, Hyun DY, Oh S, Kim JH, Lim KS, Park JK, Kim HK, Hong YJ, Kim JH, Ahn Y, Kim JH. Preclinical Evaluation of an Everolimus-Eluting Bioresorbable Vascular Scaffold Via a Long-Term Rabbit Iliac Artery Model. Tissue Eng Regen Med 2023; 20:239-249. [PMID: 36881249 PMCID: PMC10070568 DOI: 10.1007/s13770-023-00518-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 12/23/2022] [Accepted: 01/03/2023] [Indexed: 03/08/2023] Open
Abstract
BACKGROUND Biodegradable poly (l-lactic acid) (PLLA), a bio safe polymer with a large elastic modulus, is widely used in biodegradable medical devices. However, because of its poor mechanical properties, a PLLA strut must be made twice as thick as a metal strut for adequate blood vessel support. Therefore, the mechanical properties of a drug-eluting metal-based stents (MBS) and a bioresorbable vascular scaffolds (BVS) were evaluated and their safety and efficacy were examined via a long-term rabbit iliac artery model. METHODS The surface morphologies of the MBSs and BVSs were investigated via optical and scanning electron microscopy. An everolimus-eluting (EE) BVS or an EE-MBS was implanted into rabbit iliac arteries at a 1.1:1 stent-to-artery ratio. Twelve months afterward, stented iliac arteries from each group were analyzed via X-ray angiography, optical coherence tomography (OCT), and histopathologic evaluation. RESULTS Surface morphology analysis of the EE coating on the MBS confirmed that it was uniform and very thin (4.7 μm). Comparison of the mechanical properties of the EE-MBS and EE-BVS showed that the latter outperformed the former in all aspects (radial force (2.75 vs. 0.162 N/mm), foreshortening (0.24% vs. 1.9%), flexibility (0.52 vs. 0.19 N), and recoil (3.2% vs. 6.3%). At all time points, the percent area restenosis was increased in the EE-BVS group compared to the EE-MBS group. The OCT and histopathological analyses indicate no significant changes in strut thickness. CONCLUSION BVSs with thinner struts and shorter resorption times should be developed. A comparable long-term safety/efficacy evaluation after complete absorption of BVSs should be conducted.
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Affiliation(s)
- Dae Sung Park
- The Korean Cardiovascular Stent Research Institute, Jangsung, 57248, Republic of Korea
- The Cardiovascular Convergence Research Center of Chonnam National University Hospital Designated by the Korean Ministry of Health and Welfare, Gwangju, 61469, Republic of Korea
- The Research Institute of Medical Sciences, Chonnam National University, Gwangju, 61469, Republic of Korea
| | - Myung Ho Jeong
- The Korean Cardiovascular Stent Research Institute, Jangsung, 57248, Republic of Korea.
- The Cardiovascular Convergence Research Center of Chonnam National University Hospital Designated by the Korean Ministry of Health and Welfare, Gwangju, 61469, Republic of Korea.
- Department of Cardiology, Chonnam National University Hospital, Gwangju, 61469, Republic of Korea.
| | - Yu Jeong Jin
- The Korean Cardiovascular Stent Research Institute, Jangsung, 57248, Republic of Korea
| | - Mi Hyang Na
- The Korean Cardiovascular Stent Research Institute, Jangsung, 57248, Republic of Korea
| | - Doo Sun Sim
- The Korean Cardiovascular Stent Research Institute, Jangsung, 57248, Republic of Korea
- The Cardiovascular Convergence Research Center of Chonnam National University Hospital Designated by the Korean Ministry of Health and Welfare, Gwangju, 61469, Republic of Korea
- Department of Cardiology, Chonnam National University Hospital, Gwangju, 61469, Republic of Korea
| | - Munki Kim
- The Korean Cardiovascular Stent Research Institute, Jangsung, 57248, Republic of Korea
- The Cardiovascular Convergence Research Center of Chonnam National University Hospital Designated by the Korean Ministry of Health and Welfare, Gwangju, 61469, Republic of Korea
| | - Kyung Hoon Cho
- The Korean Cardiovascular Stent Research Institute, Jangsung, 57248, Republic of Korea
- The Cardiovascular Convergence Research Center of Chonnam National University Hospital Designated by the Korean Ministry of Health and Welfare, Gwangju, 61469, Republic of Korea
- Department of Cardiology, Chonnam National University Hospital, Gwangju, 61469, Republic of Korea
| | - Dae Young Hyun
- The Korean Cardiovascular Stent Research Institute, Jangsung, 57248, Republic of Korea
- The Cardiovascular Convergence Research Center of Chonnam National University Hospital Designated by the Korean Ministry of Health and Welfare, Gwangju, 61469, Republic of Korea
- Department of Cardiology, Chonnam National University Hospital, Gwangju, 61469, Republic of Korea
| | - Seok Oh
- The Korean Cardiovascular Stent Research Institute, Jangsung, 57248, Republic of Korea
- The Cardiovascular Convergence Research Center of Chonnam National University Hospital Designated by the Korean Ministry of Health and Welfare, Gwangju, 61469, Republic of Korea
- Department of Cardiology, Chonnam National University Hospital, Gwangju, 61469, Republic of Korea
| | - Jeong Ha Kim
- The Korean Cardiovascular Stent Research Institute, Jangsung, 57248, Republic of Korea
- The Cardiovascular Convergence Research Center of Chonnam National University Hospital Designated by the Korean Ministry of Health and Welfare, Gwangju, 61469, Republic of Korea
| | - Kyung Seob Lim
- The Futuristic Animal Research Center, The Korean Research Institute of Bioscience and Biotechnology, Ochang, 28116, Republic of Korea
| | | | - Han Ki Kim
- CGBio Co. Ltd., Seoul, Republic of Korea
| | - Young Joon Hong
- The Korean Cardiovascular Stent Research Institute, Jangsung, 57248, Republic of Korea
- The Cardiovascular Convergence Research Center of Chonnam National University Hospital Designated by the Korean Ministry of Health and Welfare, Gwangju, 61469, Republic of Korea
- Department of Cardiology, Chonnam National University Hospital, Gwangju, 61469, Republic of Korea
| | - Ju Han Kim
- The Korean Cardiovascular Stent Research Institute, Jangsung, 57248, Republic of Korea
- The Cardiovascular Convergence Research Center of Chonnam National University Hospital Designated by the Korean Ministry of Health and Welfare, Gwangju, 61469, Republic of Korea
- Department of Cardiology, Chonnam National University Hospital, Gwangju, 61469, Republic of Korea
| | - Youngkeun Ahn
- The Korean Cardiovascular Stent Research Institute, Jangsung, 57248, Republic of Korea
- The Cardiovascular Convergence Research Center of Chonnam National University Hospital Designated by the Korean Ministry of Health and Welfare, Gwangju, 61469, Republic of Korea
- Department of Cardiology, Chonnam National University Hospital, Gwangju, 61469, Republic of Korea
| | - Jeong Hun Kim
- Department of Cardiology, Chonnam National University Hospital, Gwangju, 61469, Republic of Korea
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16
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Adhami M, Martin NK, Maguire C, Courtenay AJ, Donnelly RF, Domínguez-Robles J, Larrañeta E. Drug loaded implantable devices to treat cardiovascular disease. Expert Opin Drug Deliv 2023; 20:507-522. [PMID: 36924328 DOI: 10.1080/17425247.2023.2190580] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2023]
Abstract
INTRODUCTION It is widely acknowledged that cardiovascular diseases (CVDs) continue to be the leading cause of death globally. Furthermore, CVDs are the leading cause of diminished quality of life for patients, frequently as a result of their progressive deterioration. Medical implants that release drugs into the body are active implants that do more than just provide mechanical support; they also have a therapeutic role. Primarily, this is achieved through the controlled release of active pharmaceutical ingredients (API) at the implementation site. AREAS COVERED In this review, the authors discuss drug-eluting stents, drug-eluting vascular grafts, and drug-eluting cardiac patches with the aim of providing a broad overview of the three most common types of cardiac implant. EXPERT OPINION Drug eluting implants are an ideal alternative to traditional drug delivery because they allow for accurate drug release, local drug delivery to the target tissue, and minimise the adverse side effects associated with systemic administration. Despite the fact that there are still challenges that need to be addressed, the ever-evolving new technologies are making the fabrication of drug eluting implants a rewarding therapeutic endeavour with the possibility for even greater advances.
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Affiliation(s)
| | | | | | - Aaron J Courtenay
- School of Pharmacy and Pharmaceutical Sciences, Ulster University, UK
| | | | - Juan Domínguez-Robles
- School of Pharmacy, Queen's University Belfast, UK.,Department of Pharmacy and Pharmaceutical Technology, University of Seville, Seville, Spain
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17
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Barungi S, Hernández-Camarero P, Moreno-Terribas G, Villalba-Montoro R, Marchal JA, López-Ruiz E, Perán M. Clinical implications of inflammation in atheroma formation and novel therapies in cardiovascular diseases. Front Cell Dev Biol 2023; 11:1148768. [PMID: 37009489 PMCID: PMC10061140 DOI: 10.3389/fcell.2023.1148768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 03/06/2023] [Indexed: 03/18/2023] Open
Abstract
Cardiovascular diseases (CVD) are the leading causes of death and disability in the world. Among all CVD, the most common is coronary artery disease (CAD). CAD results from the complications promoted by atherosclerosis, which is characterized by the accumulation of atherosclerotic plaques that limit and block the blood flow of the arteries involved in heart oxygenation. Atherosclerotic disease is usually treated by stents implantation and angioplasty, but these surgical interventions also favour thrombosis and restenosis which often lead to device failure. Hence, efficient and long-lasting therapeutic options that are easily accessible to patients are in high demand. Advanced technologies including nanotechnology or vascular tissue engineering may provide promising solutions for CVD. Moreover, advances in the understanding of the biological processes underlying atherosclerosis can lead to a significant improvement in the management of CVD and even to the development of novel efficient drugs. To note, over the last years, the observation that inflammation leads to atherosclerosis has gained interest providing a link between atheroma formation and oncogenesis. Here, we have focused on the description of the available therapy for atherosclerosis, including surgical treatment and experimental treatment, the mechanisms of atheroma formation, and possible novel therapeutic candidates such as the use of anti-inflammatory treatments to reduce CVD.
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Affiliation(s)
- Shivan Barungi
- Department of Health Sciences, University of Jaén, Jaén, Spain
| | | | | | | | - Juan Antonio Marchal
- Centre for Biomedical Research (CIBM), Biopathology and Regenerative Medicine Institute (IBIMER), University of Granada, Granada, Spain
- Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain
- Department of Human Anatomy and Embryology, Faculty of Medicine, University of Granada, Granada, Spain
- Excellence Research Unit “Modeling Nature” (MNat), University of Granada, Granada, Spain
| | - Elena López-Ruiz
- Department of Health Sciences, University of Jaén, Jaén, Spain
- Excellence Research Unit “Modeling Nature” (MNat), University of Granada, Granada, Spain
- *Correspondence: Elena López-Ruiz, ; Macarena Perán,
| | - Macarena Perán
- Department of Health Sciences, University of Jaén, Jaén, Spain
- Centre for Biomedical Research (CIBM), Biopathology and Regenerative Medicine Institute (IBIMER), University of Granada, Granada, Spain
- Excellence Research Unit “Modeling Nature” (MNat), University of Granada, Granada, Spain
- *Correspondence: Elena López-Ruiz, ; Macarena Perán,
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18
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Williams DF. The plasticity of biocompatibility. Biomaterials 2023; 296:122077. [PMID: 36907003 DOI: 10.1016/j.biomaterials.2023.122077] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 02/19/2023] [Accepted: 03/02/2023] [Indexed: 03/11/2023]
Abstract
Biocompatibility concerns the phenomena that occur within the interactions between biomaterials and human patients, which ultimately control the performance of many facets of medical technology. It involves aspects of materials science, many different forms of engineering and nanotechnology, chemistry, biophysics, molecular and cellular biology, immunology, pathology and a myriad of clinical applications. It is not surprising that an overarching framework of mechanisms of biocompatibility has been difficult to elucidate and validate. This essay discusses one fundamental reason for this; we have tended to consider biocompatibility pathways as essentially linear sequences of events which follow well-understood processes of materials science and biology. The reality, however, is that the pathways may involve a great deal of plasticity, in which many additional idiosyncratic factors, including those of genetic, epigenetic and viral origin, exert influence, as do complex mechanical, physical and pharmacological variables. Plasticity is an inherent core feature of the performance of synthetic materials; here we follow the more recent biological applications of plasticity concepts into the sphere of biocompatibility pathways. A straightforward linear pathway may result in successful outcomes for many patients; we may describe this in terms of classic biocompatibility pathways. In other situations, which usually command much more attention because of their unsuccessful outcomes, these plasticity-driven processes follow alternative biocompatibility pathways; often, the variability in outcomes with identical technologies is due to biological plasticity rather than material or device deficiency.
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Affiliation(s)
- David F Williams
- Wake Forest Institute of Regenerative Medicine, Winston-Salem, North Carolina, USA.
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19
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Zhao J, Song G, Zhao Q, Feng H, Wang Y, Anderson JM, Zhao H, Liu Q. Development of three-dimensionally printed vascular stents of bioresorbable poly(l-lactide-co-caprolactone). J Biomed Mater Res B Appl Biomater 2023; 111:656-664. [PMID: 36420745 DOI: 10.1002/jbm.b.35184] [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: 02/11/2022] [Revised: 08/05/2022] [Accepted: 09/22/2022] [Indexed: 11/27/2022]
Abstract
With the ripening of 3D printing technology and the discovery of a variety of printable materials, 3D-printed vascular stents provide new treatment options for patients with angiocardiopathy. Bioresorbable stent not only combines the advantages of metallic stent and drug-coated balloon, but also avoids the disadvantages of them. 3D printing is also an economical and efficient way to produce stents and makes it possible to construct complex structures. In this study, stents made from poly(l-lactic acid) (PLLA), poly(ε-caprolactone) (PCL) and poly(l-lactide-co-caprolactone) (PLCL) were manufactured by 3D printing and evaluated for radial strength, crystallinity and molecular weight. PLCL copolymerized by different proportions of lactic acid and caprolactone showed different mechanical and degradation properties. This demonstrated the potential of 3D printing as a low-cost and high throughput method for stent manufacturing. The PLLA and PLCL 95/5 stents had similar mechanical properties, whereas PLCL 85/15 and PCL stents both had relatively low radial strength. In general, PLCL 95/5 had a faster degradation rate than PLLA. These two materials were made into peripheral vascular bioresorbable scaffolds (BRS) and further studied by additional bench testing. PLCL 95/5 peripheral BRS had superior mechanical properties in terms of flexural/bending fatigue and compression resistance.
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Affiliation(s)
- Justin Zhao
- Amador Valley High School, Pleasanton, California, USA
| | - Ge Song
- Beijing Advanced Medical Technologies, Ltd Inc., Beijing, People's Republic of China
| | - Qinghua Zhao
- Beijing Advanced Medical Technologies, Ltd Inc., Beijing, People's Republic of China
| | - Hanqing Feng
- Beijing Advanced Medical Technologies, Ltd Inc., Beijing, People's Republic of China
| | - Yunbing Wang
- College of Biomedical Engineering, Sichuan University, Chengdu, Sichuan, People's Republic of China
| | - James M Anderson
- Departments of Pathology and Macromolecular Science and Engineering, Case Western Reserve University, Cleveland, Ohio, USA
| | - Hugh Zhao
- Beijing Advanced Medical Technologies, Ltd Inc., Beijing, People's Republic of China.,College of Biomedical Engineering, Sichuan University, Chengdu, Sichuan, People's Republic of China
| | - Qing Liu
- Beijing Advanced Medical Technologies, Ltd Inc., Beijing, People's Republic of China.,Institute for Translational Nanomedicine, Shanghai East Hospital, the Institute for Biomedical Engineering & Nano Science, Tongji University School of Medicine, Shanghai, People's Republic of China
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20
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Koźlik M, Harpula J, Chuchra PJ, Nowak M, Wojakowski W, Gąsior P. Drug-Eluting Stents: Technical and Clinical Progress. Biomimetics (Basel) 2023; 8:biomimetics8010072. [PMID: 36810403 PMCID: PMC9944483 DOI: 10.3390/biomimetics8010072] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2023] [Revised: 02/02/2023] [Accepted: 02/07/2023] [Indexed: 02/12/2023] Open
Abstract
Drug-eluting stents (DES) demonstrated superior efficacy when compared to bare metal stents and plain-old balloon angioplasty and are nowadays used in almost all percutaneous revascularization procedures. The design of the stent platforms is constantly improving to maximize its efficacy and safety. Constant development of DES includes adoption of new materials used for scaffold production, new design types, improved overexpansion abilities, new polymers coating and, finally, improved antiproliferative agents. Especially nowadays, with the immense number of available DES platforms, it is crucial to understand how different aspects of stents impact the effect of their implantation, as subtle differences between various stent platforms could impact the most important issue-clinical outcomes. This review discusses the current status of coronary stents and the impact of stent material, strut design and coating techniques on cardiovascular outcomes.
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Affiliation(s)
- Maciej Koźlik
- Division of Cardiology and Structural Heart Disease, Medical University of Silesia, 40-635 Katowice, Poland
- Correspondence:
| | - Jan Harpula
- Division of Cardiology and Structural Heart Disease, Medical University of Silesia, 40-635 Katowice, Poland
| | - Piotr J. Chuchra
- Students’ Scientific Society, Department of Cardiology, Faculty of Medical Sciences in Katowice, Medical University of Silesia, 40-635 Katowice, Poland
| | - Magdalena Nowak
- Students’ Scientific Society, Department of Cardiology, Faculty of Medical Sciences in Katowice, Medical University of Silesia, 40-635 Katowice, Poland
| | - Wojciech Wojakowski
- Division of Cardiology and Structural Heart Disease, Medical University of Silesia, 40-635 Katowice, Poland
| | - Paweł Gąsior
- Division of Cardiology and Structural Heart Disease, Medical University of Silesia, 40-635 Katowice, Poland
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Evaluation of coronary stents: A review of types, materials, processing techniques, design, and problems. Heliyon 2023; 9:e13575. [PMID: 36846695 PMCID: PMC9950843 DOI: 10.1016/j.heliyon.2023.e13575] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 01/22/2023] [Accepted: 02/02/2023] [Indexed: 02/11/2023] Open
Abstract
In the world, one of the leading causes of death is coronary artery disease (CAD). There are several ways to treat this disease, and stenting is currently the most appropriate way in many cases. Nowadays, the use of stents has rapidly increased, and they have been introduced in various models, with different geometries and materials. To select the most appropriate stent required, it is necessary to have an analysis of the mechanical behavior of various types of stents. The purpose of this article is to provide a complete overview of advanced research in the field of stents and to discuss and conclude important studies on different topics in the field of stents. In this review, we introduce the types of coronary stents, materials, stent processing technique, stent design, classification of stents based on the mechanism of expansion, and problems and complications of stents. In this article, by reviewing the biomechanical studies conducted in this field and collecting and classifying their results, a useful set of information has been presented to continue research in the direction of designing and manufacturing more efficient stents, although the clinical-engineering field still needs to continue research to optimize the design and construction. The optimum design of stents in the future is possible by simulation and using numerical methods and adequate knowledge of stent and artery biomechanics.
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Madanat L, Donisan T, Balanescu DV, Jabri A, Al-Abdouh A, Alsabti S, Li S, Kheyrbek M, Mertens A, Hanson I, Dixon S. The contemporary use of intracoronary brachytherapy for instent restenosis: A review. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2023; 51:67-74. [PMID: 36732133 DOI: 10.1016/j.carrev.2023.01.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 01/14/2023] [Accepted: 01/24/2023] [Indexed: 01/31/2023]
Abstract
In-stent restenosis (ISR) has been a major limitation in interventional cardiology and constitutes nearly 10 % of all percutaneous coronary interventions in the United States. Drug-eluting stent (DES) restenosis proves particularly difficult to manage and poses a high risk of recurrence and repeat intervention. Intra-coronary brachytherapy (IBT) has been traditionally viewed as a potential treatment modality for ISR. However, its use was hindered by procedural complexity, cost, and the advent of newer-generation DES. Recent data suggests promising results regarding IBT for the treatment of resistant DES-ISR. This review addresses the mechanism of action of IBT, procedural details, and associated risks and complications of its use. It will also highlight the available clinical evidence supporting the use of IBT and the future directions of its utilization in the treatment of ISR.
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Affiliation(s)
- Luai Madanat
- Department of Internal Medicine, Beaumont Hospital, Royal Oak, MI, United States of America.
| | - Teodora Donisan
- Department of Cardiovascular Medicine, Mayo Clinic School of Medicine, Rochester, MN, United States of America
| | - Dinu V Balanescu
- Department of Internal Medicine, Beaumont Hospital, Royal Oak, MI, United States of America
| | - Ahmad Jabri
- Department of Cardiovascular Medicine, Heart and Vascular Center, Metrohealth Medical Center, Cleveland, OH, United States of America
| | - Ahmad Al-Abdouh
- Department of Internal Medicine, University of Kentucky, Lexington, KY, United States of America
| | - Sam Alsabti
- Department of Internal Medicine, Beaumont Hospital, Royal Oak, MI, United States of America
| | - Shuo Li
- Department of Internal Medicine, Beaumont Hospital, Royal Oak, MI, United States of America
| | - Mazhed Kheyrbek
- Department of Internal Medicine, Beaumont Hospital, Royal Oak, MI, United States of America
| | - Amy Mertens
- Department of Cardiovascular Medicine, Beaumont Hospital, Royal Oak, MI, United States of America
| | - Ivan Hanson
- Department of Cardiovascular Medicine, Beaumont Hospital, Royal Oak, MI, United States of America
| | - Simon Dixon
- Department of Internal Medicine, University of Kentucky, Lexington, KY, United States of America
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Song J, Vikulina AS, Parakhonskiy BV, Skirtach AG. Hierarchy of hybrid materials. Part-II: The place of organics- on-inorganics in it, their composition and applications. Front Chem 2023; 11:1078840. [PMID: 36762189 PMCID: PMC9905839 DOI: 10.3389/fchem.2023.1078840] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 01/05/2023] [Indexed: 01/26/2023] Open
Abstract
Hybrid materials or hybrids incorporating organic and inorganic constituents are emerging as a very potent and promising class of materials due to the diverse but complementary nature of their properties. This complementarity leads to a perfect synergy of properties of the desired materials and products as well as to an extensive range of their application areas. Recently, we have overviewed and classified hybrid materials describing inorganics-in-organics in Part-I (Saveleva, et al., Front. Chem., 2019, 7, 179). Here, we extend that work in Part-II describing organics-on-inorganics, i.e., inorganic materials modified by organic moieties, their structure and functionalities. Inorganic constituents comprise of colloids/nanoparticles and flat surfaces/matrices comprise of metallic (noble metal, metal oxide, metal-organic framework, magnetic nanoparticles, alloy) and non-metallic (minerals, clays, carbons, and ceramics) materials; while organic additives can include molecules (polymers, fluorescence dyes, surfactants), biomolecules (proteins, carbohydtrates, antibodies and nucleic acids) and even higher-level organisms such as cells, bacteria, and microorganisms. Similarly to what was described in Part-I, we look at similar and dissimilar properties of organic-inorganic materials summarizing those bringing complementarity and composition. A broad range of applications of these hybrid materials is also presented whose development is spurred by engaging different scientific research communities.
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Affiliation(s)
- Junnan Song
- Nano-BioTechnology Group, Department of Biotechnology, Faculty of Bioscience Engineering, Ghent University, Ghent, Belgium,*Correspondence: Junnan Song, ; Bogdan V. Parakhonskiy, ; Andre G. Skirtach,
| | - Anna S. Vikulina
- Bavarian Polymer Institute, Friedrich-Alexander-Universität Erlangen-Nürnberg, Bayreuth, Germany
| | - Bogdan V. Parakhonskiy
- Nano-BioTechnology Group, Department of Biotechnology, Faculty of Bioscience Engineering, Ghent University, Ghent, Belgium,*Correspondence: Junnan Song, ; Bogdan V. Parakhonskiy, ; Andre G. Skirtach,
| | - Andre G. Skirtach
- Nano-BioTechnology Group, Department of Biotechnology, Faculty of Bioscience Engineering, Ghent University, Ghent, Belgium,*Correspondence: Junnan Song, ; Bogdan V. Parakhonskiy, ; Andre G. Skirtach,
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Wang L, Li X, Li T, Liu L, Wang H, Wang C. Novel application of drug-coated balloons in coronary heart disease: A narrative review. Front Cardiovasc Med 2023; 10:1055274. [PMID: 36937937 PMCID: PMC10017483 DOI: 10.3389/fcvm.2023.1055274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 02/13/2023] [Indexed: 03/06/2023] Open
Abstract
The incidence of coronary heart disease (CAD) has soared over the years, and coronary intervention has become an increasingly important therapeutic approach. The past decade has witnessed unprecedented developments in therapeutic medical instruments. Given that drug-coated balloons bring many benefits, they are indicated for an increasing number of conditions. In this article, we review the results of current clinical trials about drug-coated balloons and summarize their safety and clinical progression in different coronary artery diseases, laying the groundwork for basic research, and clinical therapeutics of this patient population.
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Affiliation(s)
- Lijin Wang
- Department of Cardiology, Tangdu Hospital, Fourth Military Medical University, Xi'an, China
| | - Xiaokang Li
- Department of Cardiology, Tangdu Hospital, Fourth Military Medical University, Xi'an, China
| | - Tian Li
- School of Basic Medicine, Fourth Military Medical University, Xi'an, China
| | - Lin Liu
- Department of Dermatology, Tangdu Hospital, Fourth Military Medical University, Xi'an, China
| | - Haiyan Wang
- Department of Structural Heart Disease, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
- *Correspondence: Haiyan Wang, ; Chiyao Wang,
| | - Chiyao Wang
- Department of Cardiology, Tangdu Hospital, Fourth Military Medical University, Xi'an, China
- *Correspondence: Haiyan Wang, ; Chiyao Wang,
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Multi-Objective Optimization of Bioresorbable Magnesium Alloy Stent by Kriging Surrogate Model. Cardiovasc Eng Technol 2022; 13:829-839. [PMID: 35414048 DOI: 10.1007/s13239-022-00619-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Accepted: 03/28/2022] [Indexed: 01/27/2023]
Abstract
PURPOSE The study proposed a multi-objective optimization method based on Kriging surrogate model and finite element analysis to mitigate the redial recoil and foreshortening ratio of bioresorbable magnesium alloy stent, and investigate the impact of strut thickness on stent expansion behavior. METHODS Finite element analysis have been carried out to compare the expansion behavior of stents with various strut thickness. Latin hypercube sampling (LHS) was adopted to generate train sample points in the design space, and the Kriging surrogate model was constructed between strut parameters and stent behavior. The genetic algorithm (GA) was employed to find the optimal solution in the global design space. RESULTS Stents with thinner struts experience lower stress but suffer from severe radial recoil and foreshortening effects. The radial recoil is decreased by 66%, and foreshortening ratio is reduced by 60% for the optimized stent with U-bend width 90.7 [Formula: see text] and link width 77.9 [Formula: see text]. The errors between Kriging surrogate model and finite element simulation are 6% and 9% for the radial recoil and foreshortening ratio. CONCLUSION Stent expansion behavior are highly dependent on design parameters, i.e. thickness, U-bend and link strut width. The purposed Multi-objective optimization approach based on Kriging surrogate model and finite element analysis is efficient in stent design optimization problem.
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Thakker R, Suthar K, Bhakta P, Lee M, Abu Jazar D, Patel M, Elbadawi A, Albaeni A, Hasan SM, Faluk M, Willis M, Chatila K, Khalife W, Rangasetty U, Motiwala A, Gilani S, Jneid H. Percutaneous Coronary Intervention Outcomes in Patients With Prior Thoracic Radiation Therapy: A Systematic Review and Meta-Analysis. Cardiol Res 2022; 13:333-338. [PMID: 36660068 PMCID: PMC9822675 DOI: 10.14740/cr1426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Accepted: 09/19/2022] [Indexed: 12/23/2022] Open
Abstract
Background Thoracic radiation predisposes patients to accelerated coronary artery disease. There is a paucity of data in both short-term and long-term outcomes following revascularization in patients who have undergone thoracic radiation. Methods We performed a search of the Medline, Cochrane, and Scopus databases for studies that compared outcomes in cancer patients who have undergone thoracic radiation and percutaneous coronary intervention (PCI). The primary outcome of our meta-analysis was all-cause mortality. Secondary outcomes included cardiac mortality, myocardial infarction (MI), and restenosis. Results The analysis included four observational studies with a total of 13,941 patients for the primary outcome of all-cause mortality. There were a total of 1,322 patients analyzed for cardiac mortality, 13,103 for MI, and 10,530 for restenosis. The longest follow-up for the primary outcome was 16 years. There was statistically significant higher risk of all-cause mortality in patients who underwent thoracic radiation (risk ratio (RR): 1.29, 95% confidence interval (CI): 1.08 - 1.54, P = 0.004). There was no statistically significant difference in cardiac mortality (RR: 1.15, 95% CI: 0.83 - 1.61, P = 0.40), MI (RR: 1.01, 95% CI: 0.20 - 5.08, P = 0.99), and restenosis (RR: 1.92, 95% CI: 0.24 - 15.35, P = 0.54). Conclusion In this meta-analysis, we found a higher risk of all-cause mortality in patients with a history of thoracic radiation undergoing PCI, likely from underlying malignancy itself.
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Affiliation(s)
- Ravi Thakker
- Division of Cardiology, University of Texas Medical Branch, Galveston, TX, USA,Corresponding Author: Ravi Thakker, Division of Cardiology, University of Texas Medical Branch, Galveston, TX 77555, USA.
| | - Krishna Suthar
- Division of Hematology and Oncology, Baylor Scott and White Medical Center, Temple, TX, USA
| | - Pooja Bhakta
- Department of Internal Medicine, University of Texas Medical Branch, Galveston, TX, USA
| | - Marissa Lee
- Department of Internal Medicine, University of Texas Medical Branch, Galveston, TX, USA
| | - Deaa Abu Jazar
- Department of Internal Medicine, University of Texas Medical Branch, Galveston, TX, USA
| | - Milee Patel
- Department of Internal Medicine, University of Texas Medical Branch, Galveston, TX, USA
| | - Ayman Elbadawi
- Division of Cardiology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Aiham Albaeni
- Division of Cardiology, University of Texas Medical Branch, Galveston, TX, USA
| | - Syed Mustajab Hasan
- Division of Cardiology, University of Texas Medical Branch, Galveston, TX, USA
| | - Mohammed Faluk
- Division of Cardiology, University of Texas Medical Branch, Galveston, TX, USA
| | - Maurice Willis
- Department of General Oncology, MD Anderson Cancer Center, Galveston, TX, USA
| | - Khaled Chatila
- Division of Cardiology, University of Texas Medical Branch, Galveston, TX, USA
| | - Wissam Khalife
- Division of Cardiology, University of Texas Medical Branch, Galveston, TX, USA
| | | | - Afaq Motiwala
- Division of Cardiology, University of Texas Medical Branch, Galveston, TX, USA
| | - Syed Gilani
- Division of Cardiology, University of Texas Medical Branch, Galveston, TX, USA
| | - Hani Jneid
- Division of Cardiology, University of Texas Medical Branch, Galveston, TX, USA
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Sobolev B, Kuramoto L. Time of coronary revascularization: methodology of a mediation analysis study. CMAJ Open 2022; 10:E1052-E1058. [PMID: 36735232 PMCID: PMC9828946 DOI: 10.9778/cmajo.20210183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND The advantage of coronary artery bypass grafting (CABG) over percutaneous coronary intervention (PCI), established in trials, may not be generalizable to populations in which the method of treatment determines the time to treatment. We sought to describe the methodology of a population-based observational study for assessing how changes in time to treatment may affect the comparative effectiveness of these 2 methods of coronary revascularization. METHODS We propose a framework of causal mediation analysis to compare the outcomes of choosing CABG over PCI, if patients selected for either method waited the same amount of time had they undergone a PCI. We will include patients who underwent a first-time, nonurgent isolated CABG or single-session PCI for multivessel or left main coronary artery disease from January 2001 to December 2016, in British Columbia. We will use absolute risk difference as a measure of the total effect of choosing CABG over PCI and partition it into the direct effect of the treatment choice and the effect mediated by the treatment-specific timing. INTERPRETATION Understanding how time to treatment mediates the relation between method of revascularization and outcomes will have implications for treatment selection, resource allocation and planning benchmarks. Findings on the benefits and risks of performing PCI or CABG within a certain time will guide multidisciplinary teams in determining the appropriate revascularization method for individual patients.
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Affiliation(s)
- Boris Sobolev
- School of Population and Public Health (Sobolev), University of British Columbia; Centre for Clinical Epidemiology and Evaluation (Kuramoto), Vancouver Coastal Health Research Institute, Vancouver, BC
| | - Lisa Kuramoto
- School of Population and Public Health (Sobolev), University of British Columbia; Centre for Clinical Epidemiology and Evaluation (Kuramoto), Vancouver Coastal Health Research Institute, Vancouver, BC
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Exarchos V, Zacharova E, Neuber S, Giampietro C, Motta SE, Hinkov H, Emmert MY, Nazari-Shafti TZ. The path to a hemocompatible cardiovascular implant: Advances and challenges of current endothelialization strategies. Front Cardiovasc Med 2022; 9:971028. [PMID: 36186971 PMCID: PMC9515323 DOI: 10.3389/fcvm.2022.971028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Accepted: 08/01/2022] [Indexed: 11/13/2022] Open
Abstract
Cardiovascular (CV) implants are still associated with thrombogenicity due to insufficient hemocompatibility. Endothelialization of their luminal surface is a promising strategy to increase their hemocompatibility. In this review, we provide a collection of research studies and review articles aiming to summarize the recent efforts on surface modifications of CV implants, including stents, grafts, valves, and ventricular assist devises. We focus in particular on the implementation of micrometer or nanoscale surface modifications, physical characteristics of known biomaterials (such as wetness and stiffness), and surface morphological features (such as gratings, fibers, pores, and pits). We also review how biomechanical signals originating from the endothelial cell for surface interaction can be directed by topography engineering approaches toward the survival of the endothelium and its long-term adaptation. Finally, we summarize the regulatory and economic challenges that may prevent clinical implementation of endothelialized CV implants.
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Affiliation(s)
- Vasileios Exarchos
- Cardiosurgical Research Group, Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany
- Translational Cardiovascular Regenerative Technologies Group, Berlin Institute of Health at Charité – Universitätsmedizin Berlin, BIH Center for Regenerative Therapies, Berlin, Germany
| | - Ema Zacharova
- Cardiosurgical Research Group, Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany
- Translational Cardiovascular Regenerative Technologies Group, Berlin Institute of Health at Charité – Universitätsmedizin Berlin, BIH Center for Regenerative Therapies, Berlin, Germany
- Department of Life Sciences, IMC University of Applied Sciences Krems, Krems an der Donau, Austria
| | - Sebastian Neuber
- Cardiosurgical Research Group, Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany
- Translational Cardiovascular Regenerative Technologies Group, Berlin Institute of Health at Charité – Universitätsmedizin Berlin, BIH Center for Regenerative Therapies, Berlin, Germany
| | - Costanza Giampietro
- Experimental Continuum Mechanics, Empa Swiss Federal Laboratories for Materials Science and Technology, Dübendorf, Switzerland
- Department of Mechanical and Process Engineering, Institute for Mechanical Systems, ETH Zürich, Zurich, Switzerland
| | - Sarah E. Motta
- Institute for Regenerative Medicine, University of Zurich, Zurich, Switzerland
| | - Hristian Hinkov
- Cardiosurgical Research Group, Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany
- Translational Cardiovascular Regenerative Technologies Group, Berlin Institute of Health at Charité – Universitätsmedizin Berlin, BIH Center for Regenerative Therapies, Berlin, Germany
| | - Maximilian Y. Emmert
- Cardiosurgical Research Group, Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany
- Translational Cardiovascular Regenerative Technologies Group, Berlin Institute of Health at Charité – Universitätsmedizin Berlin, BIH Center for Regenerative Therapies, Berlin, Germany
- Institute for Regenerative Medicine, University of Zurich, Zurich, Switzerland
- Clinic for Cardiovascular Surgery, Charité – Universitätsmedizin Berlin, Berlin, Germany
- Department of Health Sciences and Technology, ETH Zürich, Zurich, Switzerland
| | - Timo Z. Nazari-Shafti
- Cardiosurgical Research Group, Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany
- Translational Cardiovascular Regenerative Technologies Group, Berlin Institute of Health at Charité – Universitätsmedizin Berlin, BIH Center for Regenerative Therapies, Berlin, Germany
- Berlin Institute of Health at Charité – Universitätsmedizin Berlin, BIH Biomedical Innovation Academy, BIH Charité (Junior) (Digital) Clinician Scientist Program, Berlin, Germany
- *Correspondence: Timo Z. Nazari-Shafti,
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Oh S, Jeong MH, Park DS, Kim M, Kim JH, Hyun DY, Cho KH, Kim MC, Sim DS, Hong YJ, Kim JH, Ahn Y. Successful implantation of a novel polymer-free everolimus-eluting stent using nitrogen-doped titanium dioxide film with good patency on follow-up angiography: A case report. Medicine (Baltimore) 2022; 101:e29666. [PMID: 35866823 PMCID: PMC9302256 DOI: 10.1097/md.0000000000029666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
RATIONALE Despite technological advances in interventional cardiology during the last decades, many concerns remain regarding the narrowing and occlusion of the in-stent area. Particularly, polymer materials pose several problems, including chronic arterial inflammation, impaired arterial healing, and stent thrombosis. To avoid these complications, we invented the TIGEREVOLUTION stent with a cobalt-chromium alloy-based stent platform deposited with N-TiO2 film, which has demonstrated good biocompatibility. As this stent is not coated with polymer, it is expected to have decreased risk of stent thrombosis. PATIENT CONCERNS A 62-year-old Korean man visited our department because of angina. We commenced coronary angiography (CAG). DIAGNOSIS CAG revealed critical stenosis in the mid-portion of the right coronary artery, with a minimum lumen area of 1.08mm2 on optical coherence tomography (OCT). INTERVENTION Percutaneous coronary intervention was performed with implantation of a novel 3.5 × 26-mm polymer-free everolimus-eluting stent using nitrogen-doped titanium dioxide film (TIGEREVOLUTION® stent). Post-percutaneous coronary intervention OCT showed good stent expansion and apposition, and the patient was discharged successfully and uneventfully. OUTCOMES Eight months later, follow-up coronary angiography demonstrated good stent patency with no definitive evidence of in-stent restenosis, with thin stent strut coverage demonstrated on OCT. LESSONS We report the first case of TIGEREVOLUTION stent implantation with follow-up OCT at 8 months.
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Affiliation(s)
- Seok Oh
- Department of Cardiology, Chonnam National University Hospital, Gwangju, Korea
| | - Myung Ho Jeong
- Department of Cardiology, Chonnam National University Hospital, Gwangju, Korea
- Department of Cardiology, Chonnam National University Medical School, Gwangju, Korea
- *Correspondence: Myung Ho Jeong, Department of Cardiology, Chonnam National University Hospital; Department of Cardiology, Chonnam National University Medical School, 42, Jebong-ro, Dong-gu, Gwangju 61469, Korea (e-mail: )
| | - Dae Sung Park
- Cardiovascular Research Center, Chonnam National University Hospital, Gwangju, Korea
| | - Munki Kim
- Cardiovascular Research Center, Chonnam National University Hospital, Gwangju, Korea
| | - Jung Ha Kim
- Cardiovascular Research Center, Chonnam National University Hospital, Gwangju, Korea
| | - Dae Young Hyun
- Department of Cardiology, Chonnam National University Hospital, Gwangju, Korea
| | - Kyung Hoon Cho
- Department of Cardiology, Chonnam National University Hospital, Gwangju, Korea
| | - Min Chul Kim
- Department of Cardiology, Chonnam National University Hospital, Gwangju, Korea
- Department of Cardiology, Chonnam National University Medical School, Gwangju, Korea
| | - Doo Sun Sim
- Department of Cardiology, Chonnam National University Hospital, Gwangju, Korea
- Department of Cardiology, Chonnam National University Medical School, Gwangju, Korea
| | - Young Joon Hong
- Department of Cardiology, Chonnam National University Hospital, Gwangju, Korea
- Department of Cardiology, Chonnam National University Medical School, Gwangju, Korea
| | - Ju Han Kim
- Department of Cardiology, Chonnam National University Hospital, Gwangju, Korea
- Department of Cardiology, Chonnam National University Medical School, Gwangju, Korea
| | - Youngkeun Ahn
- Department of Cardiology, Chonnam National University Hospital, Gwangju, Korea
- Department of Cardiology, Chonnam National University Medical School, Gwangju, Korea
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Yang H, He C, Bi Y, Zhu X, Deng D, Ran T, Ji X. Synergistic effect of VEGF and SDF-1α in endothelial progenitor cells and vascular smooth muscle cells. Front Pharmacol 2022; 13:914347. [PMID: 35910392 PMCID: PMC9335858 DOI: 10.3389/fphar.2022.914347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 06/27/2022] [Indexed: 11/13/2022] Open
Abstract
Vascular endothelial growth factor (VEGF) is a potent agonist of angiogenesis that induces proliferation and differentiation of endothelial progenitor cells (EPCs) after vascular injury. Previous studies have suggested that stromal cell-derived factor 1-alpha (SDF-1α) and VEGF have a synergistic effect on vascular stenosis. The aim of the present study was to investigate whether VEGF and SDF-1α act synergistically in EPCs and vascular smooth muscle cells (VSMCs). In this study, EPCs were isolated from rat bone marrow and their morphology and function were studied. Subsequently, VEGF was delivered into EPCs using an adenoviral vector. Tube formation, migration, proliferation, and apoptosis of VEGF-overexpressing EPCs was analyzed. Then, EPCs were co-cultured with VSMCs in the presence or absence of SDF-1α, the migration, proliferation, apoptosis, and differentiation capacity of EPCs and VSMCs were analyzed respectively. The isolated EPCs showed typical morphological features, phagocytic capacity, and expressed surface proteins. While stable expression of VEGF remarkably enhanced tube formation, migration, and proliferation capacity of EPCs, apoptosis was decreased. Moreover, the proliferation, migration, and differentiation capacity of EPCs in the co-cultured model was enhanced in the presence of SDF-1α, and apoptosis was decreased. However, these effects were reversed in VSMCs. Therefore, our results showed that VEGF and SDF-1α synergistically increased the migration, differentiation, and proliferation capabilities of EPCs, but not VSMCs. This study suggests a promising strategy to prevent vascular stenosis.
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Affiliation(s)
- Haiyan Yang
- Department of Ultrasound, Chongqing General Hospital, Chongqing, China
- Department of Macromolecular Science, State Key Laboratory of Molecular Engineering of Polymers, Fudan University, Shanghai, China
| | - Cancan He
- Department of Pediatrics, The Affiliated Hospital of Zunyi Medical University, Guizhou Children’s Hospital, Zunyi, GZ, China
| | - Yang Bi
- Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical and Research Center of Child Health and Disorders, Chongqing Engineering Research Center of Stem Cell Therapy, Department of Ultrasound, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Children’s Hospital of Chongqing Medical University, Chongqing, China
| | - Xu Zhu
- Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical and Research Center of Child Health and Disorders, Chongqing Engineering Research Center of Stem Cell Therapy, Department of Ultrasound, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Children’s Hospital of Chongqing Medical University, Chongqing, China
| | - Dan Deng
- School of Medical Imaging, Changsha Medical University, Changsha, China
| | - Tingting Ran
- Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical and Research Center of Child Health and Disorders, Chongqing Engineering Research Center of Stem Cell Therapy, Department of Ultrasound, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Children’s Hospital of Chongqing Medical University, Chongqing, China
| | - Xiaojuan Ji
- Department of Ultrasound, Chongqing General Hospital, Chongqing, China
- *Correspondence: Xiaojuan Ji,
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Hu FW, Chang S, Li Q, Zhu YX, Wang XY, Cheng YW, Zhou QH, Liu B, Iqbal J, Tang XX, Zhang YJ. Long-Term Clinical Outcomes After Percutaneous Coronary Intervention With Drug-Coated Balloon-Only Strategy in de novo Lesions of Large Coronary Arteries. Front Cardiovasc Med 2022; 9:882303. [PMID: 35911516 PMCID: PMC9329593 DOI: 10.3389/fcvm.2022.882303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 06/20/2022] [Indexed: 11/13/2022] Open
Abstract
Background and ObjectivesUse of drug-coated balloon (DCB)-only strategy for revascularization of native large coronary artery lesions is on the rise. The long-term efficacy of this approach for bifurcation and non-bifurcation lesions remains unknown. We aim to assess the long-term clinical outcomes of DCB-only strategy for the treatment of de novo bifurcation and non-bifurcation lesions in large coronary arteries.MethodsThis multicenter, prospective, observational study enrolled 119 patients with de novo coronary lesions in vessels ≥2.75 mm. The primary end point was the rate of clinically driven target lesion failure (TLF), a composite of cardiac death, target vessel myocardial infarction, and clinically driven target lesion revascularization (TLR). Patients were followed up for a median of 2 years.ResultsOf 119 patients with 138 lesions, 66 patients (75 lesions) had bifurcation and 53 patients (63 lesions) had non-bifurcation lesions. Average reference vessel diameter was 3.1 ± 0.3 mm, and there was no difference in bifurcation and non-bifurcation group (3.0 ± 0.3 vs. 3.1 ± 0.3mm; p = 0.27). At 2-year follow-up, the TLF occurred in five (4.2%), TLR in four (3.4%), and target vessel revascularization (TVR) in five (4.2%) cases. The frequency of TLR and TVR was higher in the non-bifurcation group (p = 0.04 and 0.02, respectively), but there were no differences in TLF between the two groups (p = 0.17). The cumulative incidence of TLF (Kaplan–Meier estimates) was also not different in the two groups (log-rank p = 0.11).ConclusionDCB-only strategy for de novo lesions in large coronary arteries appears to be safe and effective for both bifurcation and non-bifurcation lesions. Further randomized clinical trials are warranted to confirm the value of DCB-only strategy in de novo bifurcation lesions of large vessels.
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Affiliation(s)
- Feng-Wang Hu
- Department of Cardiology, Xuzhou Third People’s Hospital, Xuzhou Medical University, Xuzhou, China
| | - Shang Chang
- Department of Cardiology, Xuzhou Third People’s Hospital, Xuzhou Medical University, Xuzhou, China
| | - Qian Li
- Department of Cardiology, Xuzhou Third People’s Hospital, Xuzhou Medical University, Xuzhou, China
| | - Yong-Xiang Zhu
- Department of Cardiology, Xuzhou Third People’s Hospital, Xuzhou Medical University, Xuzhou, China
| | - Xin-Yu Wang
- Department of Cardiology, Xuzhou Third People’s Hospital, Xuzhou Medical University, Xuzhou, China
| | - You-Wei Cheng
- Department of Cardiology, Xuzhou Third People’s Hospital, Xuzhou Medical University, Xuzhou, China
| | - Qi-Hua Zhou
- Department of Cardiology, Xuzhou Renci Hospital, Xuzhou, China
| | - Bing Liu
- Department of Cardiology, Peixian County Guotai Hospital, Xuzhou, China
| | - Javaid Iqbal
- Department of Cardiology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom
| | - Xiao-Xia Tang
- Department of Cardiology, Xuzhou Third People’s Hospital, Xuzhou Medical University, Xuzhou, China
- *Correspondence: Xiao-Xia Tang,
| | - Yao-Jun Zhang
- Department of Cardiology, Xuzhou Third People’s Hospital, Xuzhou Medical University, Xuzhou, China
- Yao-Jun Zhang,
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Current Status and Outlook of Temporary Implants (Magnesium/Zinc) in Cardiovascular Applications. METALS 2022. [DOI: 10.3390/met12060999] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Medical application materials must meet multiple requirements, and the designed material must mimic the structure, shape. and support the formation of the replacing tissue. Magnesium (Mg) and Zinc alloys (Zn), as a “smart” biodegradable material and as “the green engineering material in the 21st century”, have become an outstanding implant material due to their natural degradability, smart biocompatibility, and desirable mechanical properties. Magnesium and Zinc are recognized as the next generation of cardiovascular stents and bioresorbable scaffolds. At the same time, improving the properties and corrosion resistance of these alloys is an urgent challenge. particularly to promote the application of magnesium alloys. A relatively fast deterioration rate of magnesium-based materials generally results in premature mechanical integrity compromise and local hydrogen build-up, resulting in restricted applicability. This review article aims to give a comprehensive comparison between Zn-based alloys and Mg-based alloys, focusing primarily on degradation and biocompatibility for cardiovascular applications. The recent clinical trials using these biodegradable metals have also been addressed.
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Duggan JP, Peters AS, Trachiotis GD, Antevil JL. Epidemiology of Coronary Artery Disease. Surg Clin North Am 2022; 102:499-516. [PMID: 35671770 DOI: 10.1016/j.suc.2022.01.007] [Citation(s) in RCA: 44] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Although the mortality of coronary artery disease (CAD) has declined over recent decades, CAD remains the leading cause of death in the United States (US) and presents a significant economic burden. Epidemiologic studies have identified numerous risk factors for CAD. Some risk factors-including smoking, hypertension, dyslipidemia, and physical inactivity-are decreasing within the US population while Others, including advanced age, diabetes, and obesity are increasing. The most significant historic advances in CAD therapy were the development of coronary artery bypass grafting (CABG), percutaneous coronary intervention (PCI), and lipid-lowering medications. Contemporary management of CAD includes primary and secondary prevention via medical management and revascularization when appropriate based on best available evidence. Despite the increasing prevalence of CAD nationwide, there has been a steady decline in the number of CABGs and PCIs performed in the US for the past decade. Patients with CABG are becoming older and with more comorbid conditions, although mortality associated with CABG has remained steady.
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Affiliation(s)
- John P Duggan
- Department of Surgery, Walter Reed National Military Medical Center, 4494 Palmer Road North, Bethesda, MD 20814, USA
| | - Alex S Peters
- Department of Surgery, Walter Reed National Military Medical Center, 4494 Palmer Road North, Bethesda, MD 20814, USA
| | - Gregory D Trachiotis
- Division of Cardiology, Cardiothoracic Surgery and Heart Center, Veterans Affairs Medical Center, 50 Irving Street Northwest, Washington, DC 20422, USA; Department of Surgery, George Washington University Hospital, 2300 I Street NW, Washington, DC 20052, USA
| | - Jared L Antevil
- Division of Cardiothoracic Surgery, Veterans Affairs Medical Center, 50 Irving Street Northwest, Washington, DC 20422, USA.
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Zhang M, Yuan Y, Gao Y, Lu R, Deng Y. The effectiveness of Salvianolate injection for in-stent restenosis after percutaneous coronary intervention: A protocol for systematic review and meta-analysis. Medicine (Baltimore) 2022; 101:e29153. [PMID: 35482985 PMCID: PMC9276184 DOI: 10.1097/md.0000000000029153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 03/07/2022] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND In-stent restenosis (ISR) caused by vascular remodeling after percutaneous coronary intervention limits the long-term efficacy of this method. Salvianolate injection is now widely used in the clinical treatment of ISR. However, there is no systematic review or meta-analysis to evaluate the effects of Salvianolate injection on ISR. METHODS We will search articles in 8 electronic databases, including the Cochrane Central Register of Controlled Trials, PubMed, Embase, the Web of Science, China National Knowledge Infrastructure, the Chinese Biomedical Literature Database, Wanfang Database, and the Chinese Scientific Journal Database for randomized controlled trials of ISR treated by Salvianolate injection from their inception to February 27, 2022. The primary outcome measure will be the restenosis rate. The data meeting the inclusion criteria were analyzed by RevMan V.5.4 software. Two authors evaluated the study using the Cochrane collaborative risk bias tool. We will use a scoring method to assess the overall evidence supporting the main results. RESULTS This study will analyze the clinical effectiveness of Salvianolate injection in the treatment of ISR. CONCLUSION The findings of this systematic review will provide evidence to evaluate the effectiveness of Salvianolate injection for the treatment of ISR. INPLASY REGISTRATION NUMBER INPLASY202220117.
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Affiliation(s)
- Miao Zhang
- Doctor of Medicine, School of Traditional Chinese Medicine, Changchun University of Chinese Medicine, Changchun, China
| | - Yue Yuan
- Doctor of Medicine, School of Basic Medicine, Changchun University of Chinese Medicine, Changchun, China
| | - Ying Gao
- Doctor of Medicine, School of Traditional Chinese Medicine, Changchun University of Chinese Medicine, Changchun, China
| | - Ruozhu Lu
- Doctor of Medicine, School of Traditional Chinese Medicine, Changchun University of Chinese Medicine, Changchun, China
| | - Yue Deng
- Affiliated Hospital, Changchun University of Chinese Medicine, Changchun, China
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35
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Wearable and implantable devices for drug delivery: Applications and challenges. Biomaterials 2022; 283:121435. [DOI: 10.1016/j.biomaterials.2022.121435] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 01/26/2022] [Accepted: 02/17/2022] [Indexed: 12/19/2022]
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d'Entremont MA, Yagi R, Salia SJS, Zhang S, Shaban L, Bene-Alhasan Y, Papatheodorou S, Couture ÉL, Huynh T, Nguyen M, Hamaya R. The effect of diabetes on surgical versus percutaneous left main revascularization outcomes: a systematic review and meta-analysis. J Cardiothorac Surg 2022; 17:61. [PMID: 35365159 PMCID: PMC8973812 DOI: 10.1186/s13019-022-01795-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 03/12/2022] [Indexed: 12/02/2022] Open
Abstract
Background The optimal method of coronary revascularization for diabetes mellitus (DM) patients with left main coronary artery disease (LMCAD) is controversial in the drug-eluting stent (DES) era. Methods We performed a systematic review and meta-analysis comparing DES-based percutaneous coronary intervention (PCI) to coronary artery bypass grafting (CABG) for LMCAD in DM patients and tested for effect measure modification (EMM) by diabetes for adverse events. We included all randomized controlled trials (RCTs) and observational studies comparing CABG to DES-based PCI including DM patients with LMCAD published up to March 1, 2021. We completed separate random-effects meta-analyses for four RCTs (4356 patients, mean follow-up of 4.9 years) and six observational studies (9360 patients, mean follow-up of 5.2 years). Results In RCTs among DM patients, DES-based PCI, compared to CABG, was associated with a 30% increased relative risk (RR) (RR 1.30, 95% CI 1.09–1.56, I2 = 0%), while among non-DM patients, there was a 25% increased relative risk (RR 1.25, 95% CI 1.07–1.44, I2 = 0%) for the composite endpoint of all-cause mortality, myocardial infarction, stroke, and unplanned revascularization (MACCE). There was no evidence of EMM (p-value for interaction = 0.70). The mean weighted SYNTAX score was 25.7. In observational studies, there was no difference between DES-based PCI and CABG for all-cause mortality in patients with DM (RR 1.13, 95% CI 0.91–1.40, I2 = 0%). Conclusions CABG was superior to PCI for LMCAD in RCTs in DM patients for MACCE. Heart teams may consider DM as one of the many components in the clinical decision-making process, but may not want to consider DM as a primary deciding factor between DES-based PCI and CABG for LMCAD with low to intermediate anatomical complexity in the other coronary arteries. Study registration CRD42021246931 (PROSPERO). Supplementary Information The online version contains supplementary material available at 10.1186/s13019-022-01795-w.
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Affiliation(s)
- Marc-André d'Entremont
- Division of Cardiology, Department of Medicine, Sherbrooke University Hospital Center (CHUS), 3001, 12e Avenue Nord, Sherbrooke, QC, J1H 5N4, Canada. .,Harvard T.H. Chan School of Public Health, Boston, MA, USA.
| | - Ryuichiro Yagi
- Harvard T.H. Chan School of Public Health, Boston, MA, USA.,Saiseikai Central Hospital, Tokyo, Japan
| | | | - Shuqi Zhang
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Lamyaa Shaban
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | | | | | - Étienne L Couture
- Division of Cardiology, Department of Medicine, Sherbrooke University Hospital Center (CHUS), 3001, 12e Avenue Nord, Sherbrooke, QC, J1H 5N4, Canada
| | - Thao Huynh
- McGill Health University Center, Montreal, QC, Canada
| | - Michel Nguyen
- Division of Cardiology, Department of Medicine, Sherbrooke University Hospital Center (CHUS), 3001, 12e Avenue Nord, Sherbrooke, QC, J1H 5N4, Canada
| | - Rikuta Hamaya
- Harvard T.H. Chan School of Public Health, Boston, MA, USA.,Brigham and Women's Hospital, Boston, MA, USA
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Williamson PN, Docherty PD, Yazdi SG, Khanafer A, Kabaliuk N, Jermy M, Geoghegan PH. Review of the Development of Hemodynamic Modeling Techniques to Capture Flow Behavior in Arteries Affected by Aneurysm, Atherosclerosis, and Stenting. J Biomech Eng 2022; 144:1128816. [PMID: 34802061 DOI: 10.1115/1.4053082] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Indexed: 02/05/2023]
Abstract
Cardiovascular diseases (CVDs) are the leading cause of death in the developed world. CVD can include atherosclerosis, aneurysm, dissection, or occlusion of the main arteries. Many CVDs are caused by unhealthy hemodynamics. Some CVDs can be treated with the implantation of stents and stent grafts. Investigations have been carried out to understand the effects of stents and stent grafts have on arteries and the hemodynamic changes post-treatment. Numerous studies on stent hemodynamics have been carried out using computational fluid dynamics (CFD) which has yielded significant insight into the effect of stent mesh design on near-wall blood flow and improving hemodynamics. Particle image velocimetry (PIV) has also been used to capture behavior of fluids that mimic physiological hemodynamics. However, PIV studies have largely been restricted to unstented models or intra-aneurysmal flow rather than peri or distal stent flow behaviors. PIV has been used both as a standalone measurement method and as a comparison to validate the CFD studies. This article reviews the successes and limitations of CFD and PIV-based modeling methods used to investigate the hemodynamic effects of stents. The review includes an overview of physiology and relevant mechanics of arteries as well as consideration of boundary conditions and the working fluids used to simulate blood for each modeling method along with the benefits and limitations introduced.
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Affiliation(s)
- Petra N Williamson
- Department of Mechanical Engineering, University of Canterbury, Private Bag 4800, Christchurch 8140, New Zealand
| | - Paul D Docherty
- Department of Mechanical Engineering, University of Canterbury, Private Bag 4800, Christchurch 8140, New Zealand
| | - Sina G Yazdi
- Department of Mechanical Engineering, University of Canterbury, Private Bag 4800, Christchurch 8140, New Zealand
| | - Adib Khanafer
- Vascular, Endovascular, and Renal Transplant Unit, Christchurch Hospital, Canterbury District Health Board, Riccarton Avenue, Christchurch 8053, New Zealand; Christchurch School of Medicine, University of Otago, Dunedin 9016, New Zealand
| | - Natalia Kabaliuk
- Department of Mechanical Engineering, University of Canterbury, Private Bag 4800, Christchurch 8140, New Zealand
| | - Mark Jermy
- Department of Mechanical Engineering, University of Canterbury, Private Bag 4800, Christchurch 8140, New Zealand
| | - Patrick H Geoghegan
- School of Life and Health Sciences, Aston University, Birmingham B4 7ET, UK; Department of Mechanical and Industrial Engineering, University of South Africa, Johannesburg 2006, South Africa
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Chopra H, Bibi S, Mishra AK, Tirth V, Yerramsetty SV, Murali SV, Ahmad SU, Mohanta YK, Attia MS, Algahtani A, Islam F, Hayee A, Islam S, Baig AA, Emran TB. Nanomaterials: A Promising Therapeutic Approach for Cardiovascular Diseases. JOURNAL OF NANOMATERIALS 2022; 2022:1-25. [DOI: 10.1155/2022/4155729] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
Abstract
Cardiovascular diseases (CVDs) are a primary cause of death globally. A few classic and hybrid treatments exist to treat CVDs. However, they lack in both safety and effectiveness. Thus, innovative nanomaterials for disease diagnosis and treatment are urgently required. The tiny size of nanomaterials allows them to reach more areas of the heart and arteries, making them ideal for CVDs. Atherosclerosis causes arterial stenosis and reduced blood flow. The most common treatment is medication and surgery to stabilize the disease. Nanotechnologies are crucial in treating vascular disease. Nanomaterials may be able to deliver medications to lesion sites after being infused into the circulation. Newer point-of-care devices have also been considered together with nanomaterials. For example, this study will look at the use of nanomaterials in imaging, diagnosing, and treating CVDs.
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Affiliation(s)
- Hitesh Chopra
- Chitkara College of Pharmacy, Chitkara University, Punjab 140401, India
| | - Shabana Bibi
- Yunnan Herbal Laboratory, College of Ecology and Environmental Sciences, Yunnan University, Kunming, 650091 Yunnan, China
- The International Joint Research Center for Sustainable Utilization of Cordyceps Bioresources in China and Southeast Asia, Yunnan University, Kunming, 650091 Yunnan, China
| | - Awdhesh Kumar Mishra
- Department of Biotechnology, Yeungnam University, Gyeongsan, Gyeongsangbuk-do, Republic of Korea
| | - Vineet Tirth
- Mechanical Engineering Department, College of Engineering, King Khalid University, Abha, 61421 Asir, Saudi Arabia
- Research Center for Advanced Materials Science (RCAMS), King Khalid University, Guraiger, Abha, 61413 Asir, P.O. Box No. 9004, Saudi Arabia
| | - Sree Vandana Yerramsetty
- Department of Chemical and Biotechnology, SASTRA Deemed University, Thanjavur, Tamil Nadu 613402, India
| | - Sree Varshini Murali
- Department of Chemical and Biotechnology, SASTRA Deemed University, Thanjavur, Tamil Nadu 613402, India
| | - Syed Umair Ahmad
- Department of Bioinformatics, Hazara University, Mansehra, Pakistan
| | - Yugal Kishore Mohanta
- Department of Applied Biology, University of Science and Technology Meghalaya, Ri-Bhoi 793101, India
| | - Mohamed S. Attia
- Department of Pharmaceutics, Faculty of Pharmacy, Zagazig University, Zagazig 44519, Egypt
| | - Ali Algahtani
- Mechanical Engineering Department, College of Engineering, King Khalid University, Abha, 61421 Asir, Saudi Arabia
- Research Center for Advanced Materials Science (RCAMS), King Khalid University, Guraiger, Abha, 61413 Asir, P.O. Box No. 9004, Saudi Arabia
| | - Fahadul Islam
- Department of Pharmacy, Faculty of Allied Health Sciences, Daffodil International University, Dhaka 1207, Bangladesh
| | - Abdul Hayee
- Department of Immunology, Faculty of Medicine, Academic Assembly, University of Toyama, Toyama, Japan
| | - Saiful Islam
- Civil Engineering Department, College of Engineering, King Khalid University, Abha, 61421 Asir, Saudi Arabia
| | - Atif Amin Baig
- Unit of Biochemistry, Faculty of Medicine, Universiti Sultan Zainal Abidin, Malaysia
| | - Talha Bin Emran
- Department of Pharmacy, BGC Trust University Bangladesh, Chittagong 4381, Bangladesh
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Liu X, Liu G, Ye P, Luo Q, Chang Z. Investigation of mechanical behaviors and improved design of V-shaped braid stents. Proc Inst Mech Eng H 2022; 236:9544119221076946. [PMID: 35102787 DOI: 10.1177/09544119221076946] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
V-shaped braid stents (VBSs), as highly retrievable and flexible nitinol stents, are extensively applied in endovascular diseases. They also cause less damage to vessel wall compared to tube-cutting stents. However, poor performance of VBS or suboptimal operation can give rise to unwanted clinical situations such as thrombosis and intimal hyperplasia. Therefore, research on designing factors affecting the performance of these devices is of great significance. Furthermore, simulation of stenting process can help designers understand the interactions of stents and vessel wall to reduce time to market. Thus, finite element analysis (FEA) and bench test are performed taking into account both designing factors and stenting process of VBS, including development of parametric modeling tool, research on the relationships among structural parameters and radial force, exploration of the interactions of VBS and vessel wall and pulsating load effect. This research was performed using a commercial solver Abaqus/standard with a user material subroutine (UMAT/nitinol). Structural parameters of VBS, unit-cell height and wire diameter have significant impacts on radial force, unit-cell number has slight influence on radial force, and arc diameter has almost negligible impact on radial force. Without pulsatile load, maximum stress and strain always occur in arc position; however, in pulsatile load, maximum stress and strain are gradually transformed to strut position. The stress created near vessel wall and VBS interface is higher than interaction stress due to pulsating load. The obtained result provided valuable information on the structural design of stents as well as the effects of stent on vessel wall and that vessel wall on stent deformation.Graphical abstract[Formula: see text].
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Affiliation(s)
- Xiangkun Liu
- Shanghai Institute for Minimally Invasive Therapy, School of Health Science and Engineering, University of Shanghai for Science and Technology, Shanghai, China
| | - Guochao Liu
- Shanghai Institute for Minimally Invasive Therapy, School of Health Science and Engineering, University of Shanghai for Science and Technology, Shanghai, China
| | - Ping Ye
- Shanghai Institute for Minimally Invasive Therapy, School of Health Science and Engineering, University of Shanghai for Science and Technology, Shanghai, China
| | - Qiyi Luo
- Shanghai Institute for Minimally Invasive Therapy, School of Health Science and Engineering, University of Shanghai for Science and Technology, Shanghai, China
| | - Zhaohua Chang
- Shanghai Institute for Minimally Invasive Therapy, School of Health Science and Engineering, University of Shanghai for Science and Technology, Shanghai, China
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Lee JS, Lee SJ, Hong JM, Alverne FJAM, Lima FO, Nogueira RG. Endovascular Treatment of Large Vessel Occlusion Strokes Due to Intracranial Atherosclerotic Disease. J Stroke 2022; 24:3-20. [PMID: 35135056 PMCID: PMC8829471 DOI: 10.5853/jos.2021.01375] [Citation(s) in RCA: 33] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 12/08/2021] [Indexed: 11/23/2022] Open
Abstract
Mechanical thrombectomy (MT) has become the gold-standard for patients with acute large vessel occlusion strokes (LVOS). MT is highly effective in the treatment of embolic occlusions; however, underlying intracranial atherosclerotic disease (ICAD) represents a therapeutic challenge, often requiring pharmacological and/or mechanical rescue treatment. Glycoprotein IIb/IIIa inhibitors have been suggested as the best initial approach, if reperfusion can be achieved after thrombectomy, with angioplasty and/or stenting being reserved for the more refractory cases. In this review, we focus on the therapeutic considerations surrounding the endovascular treatment of ICAD-related acute LVOS.
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Affiliation(s)
- Jin Soo Lee
- Department of Neurology, Ajou University Hospital, Ajou University School of Medicine, Suwon, Korea
| | - Seong-Joon Lee
- Department of Neurology, Ajou University Hospital, Ajou University School of Medicine, Suwon, Korea
| | - Ji Man Hong
- Department of Neurology, Ajou University Hospital, Ajou University School of Medicine, Suwon, Korea
| | | | | | - Raul G. Nogueira
- Department of Neurology and Neurosurgery, University of Pittsburg Medical Center, UPMC Stroke Institute, Pittsburg, PA, USA
- Correspondence: Raul G. Nogueira Department of Neurology and Neurosurgery, University of Pittsburg Medical Center, UPMC Stroke Institute, C-400 PUH, 200 Lothrop Street, Pittsburgh, PA 15213, USA Tel: +1-412-647-8080 Fax: +1-412-647-8445 E-mail:
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41
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Jourdi G, Godier A, Lordkipanidzé M, Marquis-Gravel G, Gaussem P. Antiplatelet Therapy for Atherothrombotic Disease in 2022—From Population to Patient-Centered Approaches. Front Cardiovasc Med 2022; 9:805525. [PMID: 35155631 PMCID: PMC8832164 DOI: 10.3389/fcvm.2022.805525] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Accepted: 01/06/2022] [Indexed: 12/20/2022] Open
Abstract
Antiplatelet agents, with aspirin and P2Y12 receptor antagonists as major key molecules, are currently the cornerstone of pharmacological treatment of atherothrombotic events including a variety of cardio- and cerebro-vascular as well as peripheral artery diseases. Over the last decades, significant changes have been made to antiplatelet therapeutic and prophylactic strategies. The shift from a population-based approach to patient-centered precision medicine requires greater awareness of individual risks and benefits associated with the different antiplatelet strategies, so that the right patient gets the right therapy at the right time. In this review, we present the currently available antiplatelet agents, outline different management strategies, particularly in case of bleeding or in perioperative setting, and develop the concept of high on-treatment platelet reactivity and the steps toward person-centered precision medicine aiming to optimize patient care.
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Affiliation(s)
- Georges Jourdi
- Research Center, Montreal Heart Institute, Montreal, QC, Canada
- Faculty of Pharmacy, Université de Montréal, Montreal, QC, Canada
- *Correspondence: Georges Jourdi
| | - Anne Godier
- Université de Paris, Innovative Therapies in Haemostasis, INSERM UMR_S1140, Paris, France
- Department of Anesthesiology and Critical Care, AP-HP, Université de Paris, Hôpital Européen Georges Pompidou, Paris, France
| | - Marie Lordkipanidzé
- Research Center, Montreal Heart Institute, Montreal, QC, Canada
- Faculty of Pharmacy, Université de Montréal, Montreal, QC, Canada
| | - Guillaume Marquis-Gravel
- Research Center, Montreal Heart Institute, Montreal, QC, Canada
- Faculty of Medicine, Université de Montréal, Montreal, QC, Canada
| | - Pascale Gaussem
- Université de Paris, Innovative Therapies in Haemostasis, INSERM UMR_S1140, Paris, France
- Service d'Hématologie Biologique, AP-HP, Université de Paris, Hôpital Européen Georges Pompidou, Paris, France
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42
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Ng JCK, Toong DWY, Ow V, Chaw SY, Toh H, Wong PEH, Venkatraman S, Chong TT, Tan LP, Huang YY, Ang HY. Progress in drug-delivery systems in cardiovascular applications: stents, balloons and nanoencapsulation. Nanomedicine (Lond) 2022; 17:325-347. [PMID: 35060758 DOI: 10.2217/nnm-2021-0288] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Drug-delivery systems in cardiovascular applications regularly include the use of drug-eluting stents and drug-coated balloons to ensure sufficient drug transfer and efficacy in the treatment of cardiovascular diseases. In addition to the delivery of antiproliferative drugs, the use of growth factors, genetic materials, hormones and signaling molecules has led to the development of different nanoencapsulation techniques for targeted drug delivery. The review will cover drug delivery and coating mechanisms in current drug-eluting stents and drug-coated balloons, novel innovations in drug-eluting stent technologies and drug encapsulation in nanocarriers for delivery in vascular diseases. Newer technologies and advances in nanoencapsulation techniques, such as the use of liposomes, nanogels and layer-by-layer coating to deliver therapeutics in the cardiovascular space, will be highlighted.
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Affiliation(s)
- Jaryl Chen Koon Ng
- National Heart Research Institute Singapore, National Heart Centre Singapore, 5 Hospital Drive, Singapore, 169609, Singapore.,Department of Biomedical Engineering, National University of Singapore, 4 Engineering Drive 3, Singapore, 117583, Singapore
| | - Daniel Wee Yee Toong
- Department of Materials Science and Engineering, Nanyang Technological University, Nanyang Avenue, Singapore, 639798, Singapore
| | - Valerie Ow
- Department of Biomedical Engineering, National University of Singapore, 4 Engineering Drive 3, Singapore, 117583, Singapore
| | - Su Yin Chaw
- Duke-National University of Singapore Medical School, 8 College Road, Singapore, 169857, Singapore
| | - Hanwei Toh
- National Heart Research Institute Singapore, National Heart Centre Singapore, 5 Hospital Drive, Singapore, 169609, Singapore.,Department of Biomedical Engineering, National University of Singapore, 4 Engineering Drive 3, Singapore, 117583, Singapore
| | - Philip En Hou Wong
- National Heart Research Institute Singapore, National Heart Centre Singapore, 5 Hospital Drive, Singapore, 169609, Singapore.,Duke-National University of Singapore Medical School, 8 College Road, Singapore, 169857, Singapore
| | - Subbu Venkatraman
- Department of Material Science Engineering, National University of Singapore, 9 Engineering Drive 1, Singapore, 117575, Singapore
| | - Tze Tec Chong
- Duke-National University of Singapore Medical School, 8 College Road, Singapore, 169857, Singapore.,Department of Vascular Surgery, Singapore General Hospital, Outram Road, Singapore, 169608, Singapore
| | - Lay Poh Tan
- Department of Materials Science and Engineering, Nanyang Technological University, Nanyang Avenue, Singapore, 639798, Singapore
| | - Ying Ying Huang
- Department of Materials Science and Engineering, Nanyang Technological University, Nanyang Avenue, Singapore, 639798, Singapore
| | - Hui Ying Ang
- National Heart Research Institute Singapore, National Heart Centre Singapore, 5 Hospital Drive, Singapore, 169609, Singapore.,Department of Biomedical Engineering, National University of Singapore, 4 Engineering Drive 3, Singapore, 117583, Singapore.,Duke-National University of Singapore Medical School, 8 College Road, Singapore, 169857, Singapore
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43
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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: 0.5] [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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44
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Yang R, Liu W, Wang A, Deng X, Feng Y, Zhang Q, Li Z, Luo F, Li J, Tan H. Shape memory polyurethane potentially used for vascular stents with water-induced stiffening and improved hemocompatibility. J Mater Chem B 2022; 10:8918-8930. [DOI: 10.1039/d2tb01681h] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
We designed a shape memory polyurethane potentially used for vascular stents with water-induced stiffening in vivo and improved hemocompatibility.
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Affiliation(s)
- Ruibo Yang
- College of Polymer Science and Engineering, State Key Laboratory of Polymer Materials Engineering, Med-X Center for Materials, Sichuan University, Chengdu 610065, China
| | - Wenkai Liu
- College of Polymer Science and Engineering, State Key Laboratory of Polymer Materials Engineering, Med-X Center for Materials, Sichuan University, Chengdu 610065, China
| | - Ao Wang
- College of Polymer Science and Engineering, State Key Laboratory of Polymer Materials Engineering, Med-X Center for Materials, Sichuan University, Chengdu 610065, China
| | - Xiaobo Deng
- College of Polymer Science and Engineering, State Key Laboratory of Polymer Materials Engineering, Med-X Center for Materials, Sichuan University, Chengdu 610065, China
| | - Yuan Feng
- College of Polymer Science and Engineering, State Key Laboratory of Polymer Materials Engineering, Med-X Center for Materials, Sichuan University, Chengdu 610065, China
| | - Qiao Zhang
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu 610065, China
| | - Zhen Li
- College of Polymer Science and Engineering, State Key Laboratory of Polymer Materials Engineering, Med-X Center for Materials, Sichuan University, Chengdu 610065, China
| | - Feng Luo
- College of Polymer Science and Engineering, State Key Laboratory of Polymer Materials Engineering, Med-X Center for Materials, Sichuan University, Chengdu 610065, China
| | - Jiehua Li
- College of Polymer Science and Engineering, State Key Laboratory of Polymer Materials Engineering, Med-X Center for Materials, Sichuan University, Chengdu 610065, China
| | - Hong Tan
- College of Polymer Science and Engineering, State Key Laboratory of Polymer Materials Engineering, Med-X Center for Materials, Sichuan University, Chengdu 610065, China
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45
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Wang Y, Huang Y, Du R, Ge S, Li Y, Wang G, Wang Y, Yin T. The crosstalk between arterial components and the bioresorbable, 3-D printed poly-l-lactic acid scaffolds. Biomater Sci 2022; 10:5121-5133. [DOI: 10.1039/d2bm00732k] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Bioresorbable scaffolds (BRS) are designed to provide a temporary support that subsequently leaves behind native vessels after their complete degradation. The accumulation of mechanical changes influences the vascular histological characteristics...
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46
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Khalaj R, Tabriz AG, Okereke MI, Douroumis D. 3D printing advances in the development of stents. Int J Pharm 2021; 609:121153. [PMID: 34624441 DOI: 10.1016/j.ijpharm.2021.121153] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Revised: 09/28/2021] [Accepted: 09/29/2021] [Indexed: 02/07/2023]
Abstract
3D printing technologies have found several applications within the biomedical sector including in the fabrication of medical devices, advanced visualization, diagnosis planning and simulation of surgical procedures. One of the areas in which of 3D printing is anticipated to revolutionised is the manufacturing of implantable bioresorbable drug-eluting scaffolds (stents). The ability to customize and create personalised tailor-made bioresorbable scaffolds has the potential to help solve many of the challenges associated with stenting, such as inappropriate stent sizing and design, abolish late stent thrombosis and help artery growth; 3D printing offers a rapid prototyping and effective method of producing stents making customization of designs feasible. This review provides an overview of the subjects and summarizes the latest research in the 3D printing technologies employed for the design and fabrication of bioresorbable stents including materials with the required printable and mechanical properties. Finally, we present a regulatory perspective on the development and engineering of 3D printed implantable stents.
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Affiliation(s)
- Roxanne Khalaj
- School of Science, University of Greenwich, Central Avenue, Chatham Maritime, Chatham, Kent ME4 4TB, UK; CIPER Centre for Innovation and Process Engineering Research, Kent ME4 4TB, UK
| | - Atabak Ghanizadeh Tabriz
- School of Science, University of Greenwich, Central Avenue, Chatham Maritime, Chatham, Kent ME4 4TB, UK; CIPER Centre for Innovation and Process Engineering Research, Kent ME4 4TB, UK
| | - Michael I Okereke
- Mathematical Modelling for Engineering Research Group, Department of Engineering Science, University of Greenwich, UK
| | - Dennis Douroumis
- School of Science, University of Greenwich, Central Avenue, Chatham Maritime, Chatham, Kent ME4 4TB, UK; CIPER Centre for Innovation and Process Engineering Research, Kent ME4 4TB, UK.
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47
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Disney L, Ramaiah C, Ramaiah M, Keshavamurthy S. Left Main Coronary Artery Disease in Diabetics: Percutaneous Coronary Intervention or Coronary Artery Bypass Grafting? Int J Angiol 2021; 30:194-201. [PMID: 34776819 DOI: 10.1055/s-0041-1730446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
The choice between coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) for myocardial revascularization in patients with left main disease (LMD) is controversial. There is general agreement that CABG is appropriate for all patients, and PCI is acceptable for those with low-to-intermediate anatomic complexity. However, there is uncertainty about the relative safety and efficacy of PCI in patients with more complex LMD and with comorbidities such as diabetes. No direct comparison trial has focused on revascularization in diabetic patients with LMD, and thus conclusions on the topic are subject to the limitations of subgroup analysis, as well as the heterogeneous exclusion criteria, and methodologies of individual trials. The available evidence suggests that among diabetics, CABG is superior in patients with LMD with SYNTAX (SYNergy between percutaneous coronary intervention with TAXus and dardiac surgery) score greater than 33, distal bifurcation disease, or multivessel disease. PCI may be appropriate in those with less-extensive disease or those with limited life expectancy or high surgical risk.
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Affiliation(s)
- Logan Disney
- University of Kentucky College of Medicine, Lexington, Kentucky
| | | | | | - Suresh Keshavamurthy
- Division of Cardiothoracic Surgery, Department of Surgery, University of Kentucky College of Medicine, Lexington, Kentucky
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48
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Cho KH, Jeong MH, Park DS, Kim M, Kim J, Park JK, Han X, Hyun DY, Kim MC, Sim DS, Hong YJ, Kim JH, Ahn Y. Preclinical Evaluation of a Novel Polymer-free Everolimus-eluting Stent in a Mid-term Porcine Coronary Restenosis Model. J Korean Med Sci 2021; 36:e259. [PMID: 34664799 PMCID: PMC8524232 DOI: 10.3346/jkms.2021.36.e259] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 08/22/2021] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Titanium dioxide films exhibit good biocompatibility and may be effective as drug-binding matrices for drug-eluting stents. We conducted a mid-term evaluation of a novel polymer-free everolimus-eluting stent using nitrogen-doped titanium dioxide film deposition (TIGEREVOLUTION®) in comparison with a commercial durable polymer everolimus-eluting stent (XIENCE Alpine®) in a porcine coronary restenosis model. METHODS Twenty-eight coronary arteries from 14 mini-pigs were randomly allocated to TIGEREVOLUTION® stent and XIENCE Alpine® stent groups. The stents were implanted in the coronary artery at a 1.1-1.2:1 stent-to-artery ratio. Eleven stented coronary arteries in each group were finally analyzed using coronary angiography, optical coherence tomography, and histopathologic evaluation 6 months after stenting. RESULTS Quantitative coronary analysis showed no significant differences in the pre-procedural, post-procedural, and 6-month lumen diameters between the groups. In the volumetric analysis of optical coherence tomography at 6 months, no significant differences were observed in stent volume, lumen volume, and percent area stenosis between the groups. There were no significant differences in injury score, inflammation score, or fibrin score between the groups, although the fibrin score was zero in the TIGEREVOLUTION® stent group (0 vs. 0.07 ± 0.11, P = 0.180). CONCLUSION Preclinical evaluation, including optical coherence tomographic findings 6 months after stenting, demonstrated that the TIGEREVOLUTION® stent exhibited efficacy and safety comparable with the XIENCE Alpine® stent, supporting the need for further clinical studies on the TIGEREVOLUTION® stent.
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Affiliation(s)
- Kyung Hoon Cho
- Department of Cardiology, Chonnam National University Hospital, Gwangju, Korea
| | - Myung Ho Jeong
- Department of Cardiology, Chonnam National University Hospital, Gwangju, Korea
- Department of Cardiology, Chonnam National University Medical School, Hwasun, Korea.
| | - Dae Sung Park
- Cardiovascular Research Center, Chonnam National University Hospital, Gwangju, Korea
| | - Moonki Kim
- Cardiovascular Research Center, Chonnam National University Hospital, Gwangju, Korea
| | - JungHa Kim
- Cardiovascular Research Center, Chonnam National University Hospital, Gwangju, Korea
| | | | - Xiongyi Han
- Department of Cardiology, Chonnam National University Hospital, Gwangju, Korea
| | - Dae Young Hyun
- Department of Cardiology, Chonnam National University Hospital, Gwangju, Korea
| | - Min Chul Kim
- Department of Cardiology, Chonnam National University Hospital, Gwangju, Korea
- Department of Cardiology, Chonnam National University Medical School, Hwasun, Korea
| | - Doo Sun Sim
- Department of Cardiology, Chonnam National University Hospital, Gwangju, Korea
- Department of Cardiology, Chonnam National University Medical School, Hwasun, Korea
| | - Young Joon Hong
- Department of Cardiology, Chonnam National University Hospital, Gwangju, Korea
- Department of Cardiology, Chonnam National University Medical School, Hwasun, Korea
| | - Ju Han Kim
- Department of Cardiology, Chonnam National University Hospital, Gwangju, Korea
- Department of Cardiology, Chonnam National University Medical School, Hwasun, Korea
| | - Youngkeun Ahn
- Department of Cardiology, Chonnam National University Hospital, Gwangju, Korea
- Department of Cardiology, Chonnam National University Medical School, Hwasun, Korea
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49
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Ghafari C, Carlier S. Stent visualization methods to guide percutaneous coronary interventions and assess long-term patency. World J Cardiol 2021; 13:416-437. [PMID: 34621487 PMCID: PMC8462039 DOI: 10.4330/wjc.v13.i9.416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 05/24/2021] [Accepted: 07/22/2021] [Indexed: 02/06/2023] Open
Abstract
Evaluation of acute percutaneous coronary intervention (PCI) results and long-term follow-up remains challenging with ongoing stent designs. Several imaging tools have been developed to assess native vessel atherosclerosis and stent expansion, improving overall PCI results and reducing adverse cardiac events. Quantitative coronary analysis has played a crucial role in quantifying the extent of coronary artery disease and stent results. Digital stent enhancement methods have been well validated and improved stent strut visualization. Intravascular imaging remains the gold standard in PCI guidance but adds costs and time to the procedure. With a recent shift towards non-invasive imaging assessment and coronary computed tomography angiography imaging have shown promising results. We hereby review novel stent visualization techniques used to guide PCI and assess stent patency in the modern PCI era.
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Affiliation(s)
| | - Stéphane Carlier
- Department of Cardiology, UMONS, Mons 7000, Belgium
- Department of Cardiology, CHU Ambroise Paré, Mons 7000, Belgium
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50
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Wu J, Jin L, Tan JY, Chen XF, Wang QQ, Yuan GY, Chen TX. The effects of a biodegradable Mg-based alloy on the function of VSMCs via immunoregulation of macrophages through Mg-induced responses. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:1292. [PMID: 34532429 PMCID: PMC8422083 DOI: 10.21037/atm-21-1375] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 06/24/2021] [Indexed: 12/12/2022]
Abstract
Background Restenosis is one of the worst side effects of percutaneous coronary intervention (PCI) due to neointima formation resulting from the excessive proliferation and migration of vascular smooth muscle cells (VSMCs) and continuous inflammation. Biodegradable Mg-based alloy is a promising candidate material because of its good mechanical properties and biocompatibility, and biodegradation of cardiovascular stents. Although studies have shown reduced neointima formation after Mg-based CVS implantation in vivo, these findings were inconsistent with in vitro studies, demonstrating magnesium-mediated promotion of the proliferation and migration of VSMCs. Given the vital role of activated macrophage-driven inflammation in neointima formation, along with the well-demonstrated crosstalk between macrophages and VSMCs, we investigated the interactions of a biodegradable Mg-Nd-Zn-Zr alloy (denoted JDBM), which is especially important for cardiovascular stents, with VSMCs via macrophages. Methods JDBM extracts and MgCl2 solutions were prepared to study their effect on macrophages. To study the effects of the JDBM extracts and MgCl2 solutions on the function of VSMCs via immunoregulation of macrophages, conditioned media (CM) obtained from macrophages was used to establish a VSMC-macrophage indirect coculture system. Results Our results showed that both JDBM extracts and MgCl2 solutions significantly attenuated the inflammatory response stimulated by lipopolysaccharide (LPS)-activated macrophages and converted macrophages into M2-type cells. In addition, JDBM extracts and MgCl2 solutions significantly decreased the expression of genes related to VSMC phenotypic switching, migration, and proliferation in macrophages. Furthermore, the proliferation, migration, and proinflammatory phenotypic switching of VSMCs were significantly inhibited when the cells were incubated with CMs from macrophages treated with LPS + extracts or LPS + MgCl2 solutions. Conclusions Taken together, our results suggested that the magnesium in the JDBM extract could affect the functions of VSMCs through macrophage-mediated immunoregulation, inhibiting smooth muscle hyperproliferation to suppress restenosis after implantation of a biodegradable Mg-based stent.
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Affiliation(s)
- Jing Wu
- Division of Immunology, Institute of Pediatric Translational Medicine, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.,Allergy/Immunology Innovation Team, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.,Department of Rheumatology/Immunology, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Liang Jin
- Division of Immunology, Institute of Pediatric Translational Medicine, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.,Department of Rheumatology/Immunology, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.,College of Life Sciences, Zhejiang Chinese Medical University, Hangzhou, China.,School of Biomedical Engineering, Med-X Research Institute, Shanghai Jiao Tong University, Shanghai, China
| | - Jin-Yun Tan
- Department of Vascular Surgery, Huashan Hospital of Fudan University, Shanghai, China
| | - Xia-Fang Chen
- Division of Immunology, Institute of Pediatric Translational Medicine, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.,Department of Neonatology, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | | | - Guang-Yin Yuan
- School of Biomedical Engineering, Med-X Research Institute, Shanghai Jiao Tong University, Shanghai, China.,National Engineering Research Center of Light Alloys Net Forming and State Key Laboratory of Metal Matrix Composite, Shanghai Jiao Tong University, Shanghai, China
| | - Tong-Xin Chen
- Division of Immunology, Institute of Pediatric Translational Medicine, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.,Allergy/Immunology Innovation Team, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.,Department of Rheumatology/Immunology, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
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