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Kern AY, Kreinin Y, Charle L, Epshrein M, Korin N, Mangin PH. A macrofluidic model to investigate the intrinsic thrombogenicity of clinically used stents and develop less thrombogenic stents. Heliyon 2024; 10:e26550. [PMID: 38463800 PMCID: PMC10920166 DOI: 10.1016/j.heliyon.2024.e26550] [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: 08/09/2023] [Revised: 02/08/2024] [Accepted: 02/15/2024] [Indexed: 03/12/2024] Open
Abstract
Microfluidic blood flow models have been instrumental to study the functions of blood platelets in hemostasis and arterial thrombosis. However, they are not suited to investigate the interactions of platelets with the foreign surfaces of medical devices such as stents, mainly because of the dimensions and geometry of the microfluidic channels. Indeed, the channels of microfluidic chips are usually rectangular and rarely exceed 50 to 100 μm in height, impairing the insertion of clinically used stents. To fill this gap, we have developed an original macrofluidic flow system, which precisely reproduces the size and geometry of human vessels and therefore represents a biomimetic perfectly suited to insert a clinical stent and study its interplay with blood cells. The system is a circular closed loop incorporating a macrofluidic flow chamber made of silicone elastomer, which can mimic the exact dimensions of any human vessel, including the coronary, carotid or femoral artery. These flow chambers allow the perfect insertion of stents as they are implanted in patients. Perfusion of whole blood anticoagulated with hirudin through the device at relevant flow rates allows one to observe the specific accumulation of fluorescently labeled platelets on the stent surface using video-microscopy. Scanning electron microscopy revealed the formation of very large thrombi composed of tightly packed activated platelets on the stents.
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Affiliation(s)
- Axelle Y. Kern
- University of Strasbourg, INSERM, EFS Grand-Est, BPPS UMR_S1255, FMTS, F-67065 Strasbourg, France
| | - Yevgeniy Kreinin
- Department of Biomedical Engineering Technion, Israel Institute of Technology, Haifa, Israel
| | - Lise Charle
- University of Strasbourg, INSERM, EFS Grand-Est, BPPS UMR_S1255, FMTS, F-67065 Strasbourg, France
| | - Mark Epshrein
- Department of Biomedical Engineering Technion, Israel Institute of Technology, Haifa, Israel
| | - Netanel Korin
- Department of Biomedical Engineering Technion, Israel Institute of Technology, Haifa, Israel
| | - Pierre H. Mangin
- University of Strasbourg, INSERM, EFS Grand-Est, BPPS UMR_S1255, FMTS, F-67065 Strasbourg, France
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Erbay MI, Pyrpyris N, Susarla S, Ulusan S, Mares AC, Wilson TP, Lee D, Sood A, Gupta R. Comparative safety review of antithrombotic treatment options for patients with atrial fibrillation undergoing percutaneous coronary intervention. Expert Opin Drug Saf 2024; 23:149-160. [PMID: 38214282 DOI: 10.1080/14740338.2024.2305367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 01/10/2024] [Indexed: 01/13/2024]
Abstract
INTRODUCTION Balancing antithrombotic therapy for atrial fibrillation (AF) patients undergoing percutaneous coronary intervention (PCI) remains a clinical challenge due to coexisting thrombogenic risks. This review emphasizes the delicate balance required to prevent ischemic events while minimizing bleeding complications, particularly in the context of risk assessment. AREAS COVERED This review spans from 2010 to October 2023, exploring the complexities of antithrombotic management for AF patients undergoing PCI. It stresses the need for personalized treatment decisions to optimize antithrombotic therapies effectively. EXPERT OPINION The evolving evidence supports double antithrombotic therapy (DAT) over triple antithrombotic therapy (TAT) for these patients, showcasing a more favorable safety profile without compromising efficacy. Non-vitamin K antagonist oral anticoagulant (NOAC)-based DAT strategies exhibit superiority in reducing major bleeding events while effectively preventing ischemic events. Recommendations from the 2023 European Society of Cardiology (ESC) Guidelines advocate for NOAC-based DAT post-PCI, endorsing safer antithrombotic profiles.Challenges persist for specific patient categories requiring both oral anticoagulants and antiplatelets, necessitating personalized approaches. Future advances in intravascular imaging and novel coronary stent technologies offer promising avenues to optimize outcomes and influence antithrombotic strategies in AF-PCI patients.
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Affiliation(s)
- Muhammed Ibrahim Erbay
- Division of Cardiovascular Medicine, Cerrahpasa School of Medicine, Istanbul University Cerrahpasa, Istanbul, Turkey
- Department of Cardiology, The Lundquist Institute at Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Nikolaos Pyrpyris
- First Department of Cardiology, School of Medicine, National and Kapodistrian University of Athens, Hippokration General Hospital, Athens, Greece
| | - Shriraj Susarla
- Department of Cardiology, The Lundquist Institute at Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Sebahat Ulusan
- Faculty of Medicine, Suleyman Demirel University, Isparta, Isparta Province, Turkey
| | - Adriana C Mares
- Division of Cardiovascular Medicine, Yale School of Medicine, Yale University, New Haven CT, USA
| | - Tasha Phillips Wilson
- Department of Internal Medicine, St. George's University School of Medicine, True Bule, Greneda
| | - Duo Lee
- Department of Cardiology, The Lundquist Institute at Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Aayushi Sood
- Department of Medicine, The Wright Center for Graduate Medical Education, Scranton, PA USA
| | - Rahul Gupta
- Department of Cardiology, Lehigh Valley Health Network, Allentown, PA USA
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Abdulrahman B, Jabbour RJ, Curzen N. Is It Really Safe to Discontinue Antiplatelet Therapy 12 Months After Percutaneous Coronary Intervention in Patients with Atrial Fibrillation? Interv Cardiol 2023; 18:e22. [PMID: 37435601 PMCID: PMC10331563 DOI: 10.15420/icr.2022.40] [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: 12/30/2022] [Accepted: 03/29/2023] [Indexed: 07/13/2023] Open
Abstract
The prevalence of AF in patients with coronary artery disease is high. The guidelines from many professional groups, including the European Society of Cardiology, American College of Cardiology/American Heart Association and Heart Rhythm Society, recommend a maximum duration of 12 months of combination single antiplatelet and anticoagulation therapy in patients who undergo percutaneous coronary intervention and who have concurrent AF, followed by anticoagulation alone beyond 1 year. However, the evidence that anticoagulation alone without antiplatelet therapy adequately reduces the well-documented attritional risk of stent thrombosis after coronary stent implantation is relatively sparse, particularly given that very late stent thrombosis (>1 year from stent implantation) is the commonest type. By contrast, the elevated risk of bleeding from combined anticoagulation and antiplatelet therapy is clinically important. The aim of this review is to assess the evidence for long-term anticoagulation alone without antiplatelet therapy 1 year post-percutaneous coronary intervention in patients with AF.
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Affiliation(s)
- Balen Abdulrahman
- Coronary Research Group, University Hospital Southampton NHS Foundation TrustSouthampton, UK
| | - Richard J Jabbour
- Coronary Research Group, University Hospital Southampton NHS Foundation TrustSouthampton, UK
| | - Nick Curzen
- Coronary Research Group, University Hospital Southampton NHS Foundation TrustSouthampton, UK
- Faculty of Medicine, University of SouthamptonSouthampton, UK
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Mohanta M, Thirugnanam A. Development of Multifunctional Commercial Pure Titanium-Polyethylene Glycol Drug-Eluting Substrates with Enhanced Optical and Antithrombotic Properties. Cardiovasc Eng Technol 2023; 14:37-51. [PMID: 35701708 DOI: 10.1007/s13239-022-00637-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 06/02/2022] [Indexed: 12/17/2022]
Abstract
PURPOSE Development of multifunctional advanced stent implants (metal/polymer composite)-drug-eluting stents with superior material and optical properties is still a challenge. In this research work, multifunctional metal-polymer composite drug-eluting substrates (DES) for stent application were developed by using commercially pure titanium (cpTi) and polyethylene glycol (PEG). METHODS Surface modifications on titanium substrates were carried out by sodium hydroxide under various concentrations; 5M (6 and 24 h) and 10M (6 and 24 h). It induces a nanoporous structure which facilitates the larger area for encapsulation of the drug, Aspirin (ASA) via intermolecular forces followed by polymer coating of PEG (MW-20,000) by physical adsorption process, which is structured as layer-by-layer gathering. RESULTS The developed cpTi-PEG DES were characterized using X-ray diffraction (XRD), Fourier transform infrared spectroscopy (FTIR), scanning electron microscopy (SEM), optical energy bandgap, static contact angle measurement, antithrombotic and drug release studies. The development of sodium titanate oxide prompted surface nano-features revealed by SEM and XRD. Moreover, FTIR confirms the presence of ASA and PEG functional groups over the cpTi surface. Drug release studies fitted with Ritger-Peppas kinetic model (≤ 60%), which indicates the super case II transport mechanisms (n > 1). Further UV-visible absorbance spectrum was quantified by the Tauc plot, which shows the broadening of the energy bandgap (Eg). In addition, the shrink in blood clots was more around the Tib2/ASA/PEG.Please confirm the inserted city name in affiliations [1,2] are correct and amend if necessary.Yes, city name "Rourkela" is correct. CONCLUSION Developed cpTi-PEG DES has improved optical properties and prevent thrombus formation which suggesting it a potential substrate to overcome prime clinical challenges.
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Affiliation(s)
- Monalisha Mohanta
- Department of Biotechnology and Medical Engineering, National Institute of Technology Rourkela, Rourkela, Odisha, 769008, India
| | - A Thirugnanam
- Department of Biotechnology & Medical Engineering, National Institute of Technology Rourkela, Room No. 206, Rourkela, Odisha, 769008, India.
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Zhao W, Xiong FJ, Feng SG, Li YM, Lei XH, Jia SJ. Oral Chinese patent medicines for acute myocardial infarction after percutaneous coronary intervention: A protocol for systematic review and network meta-analysis. Medicine (Baltimore) 2022; 101:e31927. [PMID: 36482597 PMCID: PMC9726348 DOI: 10.1097/md.0000000000031927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Acute myocardial infarction (AMI) is a serious and fatal heart disease with one of the highest mortality rates in the world. In some countries, percutaneous coronary intervention (PCI) is the preferred reperfusion strategy after AMI, but it cannot achieve safe and effective treatment of AMI after PCI remains a challenging clinical problem. The potential of oral Chinese patent medicines to treat AMI after PCI has been demonstrated, but which type of oral Chinese patent medicines may be preferred remains controversial. The aim of this network meta-analysis was to investigate the efficacy and safety of multiple oral Chinese patent medicines in the treatment of AMI after PCI. METHODS We will conduct a literature search from China National Knowledge Infrastructure, formerly Chinese Biomedical Database (SinoMed), Wanfang Data, Chongqing VIP, PubMed, Embase, Web of Science and Cochrane Library (The Cochrane Database of Systematic Reviews) from their inception until to November 1, 2022, with language restricted to Chinese and English. Then, the study selection process will follow the Preferred Reporting Items for Meta-Analyses guideline, and the quality assessment will be conducted with Cochrane Collaboration's tool. Pairwise and network meta-analysis will be conducted using the WinBUGS V.1.4.3.37 and STATA V.13. Additionally, sensitivity analysis, subgroup analysis, quality assessment, Small-study effects and publication bias will be performed. ETHICS AND DISSEMINATION This work is based on published research and therefore does not require ethical approval. This review will be published in peer-reviewed journals. PROSPERO REGISTRATION NUMBER CRD42020188065.
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Affiliation(s)
- Wei Zhao
- Xindu Hospital of Traditional Chinese Medicine Affiliated to Chengdu Medical College, Chengdu, China
| | - Fan-Jie Xiong
- Xindu Hospital of Traditional Chinese Medicine Affiliated to Chengdu Medical College, Chengdu, China
| | - Shu-Gui Feng
- Luzhou Traditional Chinese Medicine Hospital Affiliated to Southwest Medical University, Luzhou, China
| | - Yan-Ming Li
- Xindu Hospital of Traditional Chinese Medicine Affiliated to Chengdu Medical College, Chengdu, China
| | - Xing-Hua Lei
- Xindu Hospital of Traditional Chinese Medicine Affiliated to Chengdu Medical College, Chengdu, China
| | - Shi-Jian Jia
- Xindu Hospital of Traditional Chinese Medicine Affiliated to Chengdu Medical College, Chengdu, China
- *Correspondence: Shi-Jian Jia, Xindu Hospital of Traditional Chinese Medicine Affiliated to Chengdu Medical College, No.120 Xiangzhang Road, Xindu District, Chengdu, Sichuan Province 610500, China (e-mail: )
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Herbert R, Elsisy M, Rigo B, Lim HR, Kim H, Choi C, Kim S, Ye SH, Wagner WR, Chun Y, Yeo WH. Fully implantable batteryless soft platforms with printed nanomaterial-based arterial stiffness sensors for wireless continuous monitoring of restenosis in real time. NANO TODAY 2022; 46:101557. [PMID: 36855693 PMCID: PMC9970263 DOI: 10.1016/j.nantod.2022.101557] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
Atherosclerosis is a common cause of coronary artery disease and a significant factor in broader cardiovascular diseases, the leading cause of death. While implantation of a stent is a prevalent treatment of coronary artery disease, a frequent complication is restenosis, where the stented artery narrows and stiffens. Although early detection of restenosis can be achieved by continuous monitoring, no available device offers such capability without surgeries. Here, we report a fully implantable soft electronic system without batteries and circuits, which still enables continuous wireless monitoring of restenosis in real-time with a set of nanomembrane strain sensors in an electronic stent. The low-profile system requires minimal invasive implantation to deploy the sensors into a blood vessel through catheterization. The entirely printed, nanomaterial-based set of soft membrane strain sensors utilizes a sliding mechanism to offer enhanced sensitivity and detection of low strain while unobtrusively integrating with an inductive stent for passive wireless sensing. The performance of the soft sensor platform is demonstrated by wireless monitoring of restenosis in an artery model and an ex-vivo study in a coronary artery of ovine hearts. The capacitive sensor-based artery implantation system offers unique advantages in wireless, real-time monitoring of stent treatments and arterial health for cardiovascular disease.
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Affiliation(s)
- Robert Herbert
- George W. Woodruff School of Mechanical Engineering, Georgia Institute of Technology, Atlanta, GA 30332, USA
- IEN Center for Human-Centric Interfaces and Engineering at the Institute for Electronics and Nanotechnology, Georgia Institute of Technology, Atlanta, GA 30332, USA
| | - Moataz Elsisy
- Department of Industrial Engineering, Swanson School of Engineering, University of Pittsburgh, Pittsburgh, PA 15260, USA
| | - Bruno Rigo
- IEN Center for Human-Centric Interfaces and Engineering at the Institute for Electronics and Nanotechnology, Georgia Institute of Technology, Atlanta, GA 30332, USA
- School of Electrical and Computer Engineering, Georgia Institute of Technology, Atlanta, GA 30332, USA
| | - Hyo-Ryoung Lim
- Major of Human Biocovergence, Division of Smart Healthcare, College of Information Technology and Convergence, Pukyong National University, Busan 48513, Republic of Korea
| | - Hyeonseok Kim
- George W. Woodruff School of Mechanical Engineering, Georgia Institute of Technology, Atlanta, GA 30332, USA
- IEN Center for Human-Centric Interfaces and Engineering at the Institute for Electronics and Nanotechnology, Georgia Institute of Technology, Atlanta, GA 30332, USA
| | - Chanyeong Choi
- George W. Woodruff School of Mechanical Engineering, Georgia Institute of Technology, Atlanta, GA 30332, USA
- IEN Center for Human-Centric Interfaces and Engineering at the Institute for Electronics and Nanotechnology, Georgia Institute of Technology, Atlanta, GA 30332, USA
| | - Seungil Kim
- McGowan Institute for Regenerative Medicine, University of Pittsburgh, Pittsburgh, PA 15260, USA
- Departments of Surgery, University of Pittsburgh, Pittsburgh, PA 15260, USA
| | - Sang-Ho Ye
- McGowan Institute for Regenerative Medicine, University of Pittsburgh, Pittsburgh, PA 15260, USA
- Departments of Surgery, University of Pittsburgh, Pittsburgh, PA 15260, USA
| | - William R. Wagner
- McGowan Institute for Regenerative Medicine, University of Pittsburgh, Pittsburgh, PA 15260, USA
- Departments of Surgery, University of Pittsburgh, Pittsburgh, PA 15260, USA
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA 15261, USA
| | - Youngjae Chun
- Department of Industrial Engineering, Swanson School of Engineering, University of Pittsburgh, Pittsburgh, PA 15260, USA
- McGowan Institute for Regenerative Medicine, University of Pittsburgh, Pittsburgh, PA 15260, USA
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA 15261, USA
| | - Woon-Hong Yeo
- George W. Woodruff School of Mechanical Engineering, Georgia Institute of Technology, Atlanta, GA 30332, USA
- IEN Center for Human-Centric Interfaces and Engineering at the Institute for Electronics and Nanotechnology, Georgia Institute of Technology, Atlanta, GA 30332, USA
- Wallace H. Coulter Department of Biomedical Engineering, Parker H. Petit Institute for Bioengineering and Biosciences, Georgia Institute of Technology, Atlanta, GA 30332, USA
- Institute for Materials, Neural Engineering Center, Institute for Robotics and Intelligent Machines, Georgia Institute of Technology, Atlanta, GA 30332, USA
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Khoso AA, Soomro GH, Mal SB, Malik R, Hanif B, Khan R. Frequency, Risk Factors, and Outcome of Definite Stent Thrombosis: A Single-Center Experience. Cureus 2022; 14:e27240. [PMID: 36035058 PMCID: PMC9399660 DOI: 10.7759/cureus.27240] [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] [Accepted: 07/20/2022] [Indexed: 11/10/2022] Open
Abstract
Introduction Stent thrombosis (ST) is a serious and potentially life-threatening complication of primary or complex high-risk percutaneous coronary intervention (PCI). Multiple factors are said to precipitate ST, related to the patient's clinical comorbidities, lesion characteristics, operative technique, and post-procedural care. The older-generation stents were thought to be involved in early ST. Though the new generation of drug-eluting stents decreases the incidence of early and late ST, patients are still at risk of very late stent thrombosis (VLST). Objective To evaluate the frequency, risk factors, and outcomes of definite ST in developing and resource-constrained countries like Pakistan, where PCIs, including primary PCI, complex PCI, and PCI in high-risk populations, are performed routinely. Methods This observational cross-sectional study included all patients who underwent primary and complex high PCI between 2012 and 2017 at TABBA Heart Institute (THI), Karachi, Pakistan. Results We included a total of 6587 patients in our study, and among the enrolled sample size, 22 (0.33%) had definite ST. Acute stent thrombosis (AST) was found in seven patients, sub-acute stent thrombosis (SAST) in 10, late stent thrombosis (LST) in two, and VLST were observed in three patients. The basic characteristics of our study ST population were as follows: mean age was 58 years, 95.5% were male, 4.5% were female, nine patients (40%) had diabetes mellitus, 15 patients (68%) had hypertension, 11 (50%) had dyslipidemia, and four patients were smokers (18%). Conclusion The frequency, risk factors, and rate of mortality of definite ST in the Pakistani population who underwent primary and complex high-risk PCI reflect nearly equal statistics observed in other studies. As seen in other international studies, the incidence rate of VLST was higher in our population.
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Safety and Efficacy of Ultra Short-Duration Dual Antiplatelet Therapy After Percutaneous Coronary Interventions: A Meta analysis of Randomized Controlled Trials. Curr Probl Cardiol 2022; 47:101295. [PMID: 35760148 DOI: 10.1016/j.cpcardiol.2022.101295] [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: 06/06/2022] [Accepted: 06/17/2022] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Dual antiplatelet therapy (DAPT) is required after percutaneous coronary intervention (PCI) to reduce stent thrombosis, but DAPT increases bleeding risks. The optimal duration of DAPT that provides the maximum protective ischemic effect along with the minimum bleeding risk is unclear. This is the first meta-analysis comparing outcomes for 1-month versus longer DAPT strategies following PCI. METHODS We searched PubMed, Cochrane, and ClinicalTrials.gov databases (from inception to October 2021) for randomized controlled trials (RCTs) that compared 1-month duration versus > 1-month duration of DAPT following PCI. We used a random-effects model to calculate risk ratio (RR) with 95% confidence interval (CI). The co-primary outcomes for study selection were all-cause mortality, major bleeding, and stent thrombosis. Secondary outcomes included myocardial infarction (MI), cardiovascular mortality, ischemic stroke and target vessel revascularization. RESULTS A total of five RCTs were included [n=29,355; 1-month DAPT(n=14,662) vs > 1-month DAPT (n=14,693)]. There was no statistically significant difference between the two groups in terms of all-cause mortality (RR 0.89; 95% CI 0.78-1.03; p = 0.12) and stent thrombosis (RR 1.07; 95% CI 0.80-1.43; p = 0.65). Similarly, there were no significant differences in MI, cardiovascular mortality, ischemic stroke, and target vessel revascularization. The rate of major bleeding was significantly lower in the group treated with DAPT for 1-month (RR 0.74; 95% CI 0.56-0.99, p = 0.04). CONCLUSION There is no difference in all-cause mortality, cardiovascular mortality, MI, stent thrombosis, ischemic stroke and target vessel revascularization with 1-month of DAPT following PCI with contemporary drug eluting stents compared to longer DAPT duration.
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Özcan Abacıoğlu Ö, Yıldırım A, Koyunsever NY, Karadeniz M, Kılıç S. Relationship between atherogenic index of plasma and stent thrombosis in patients with acute coronary syndrome. Anatol J Cardiol 2022; 26:112-117. [PMID: 35190359 PMCID: PMC8878917 DOI: 10.5152/anatoljcardiol.2021.193] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/26/2021] [Indexed: 10/29/2023] Open
Abstract
OBJECTIVE Stent thrombosis (ST) is an uncommon but serious complication in patients undergoing percutaneous coronary intervention (PCI). This study aimed to investigate the effect of atherogenic index of plasma (AIP) on ST. METHODS Among the 10,258 patients who underwent coronary angiography between January 2018 and December 2020, 239 patients who underwent PCI with the diagnosis of acute coronary syndrome (ACS) due to ST were included as the study group (ST group) and 459 patients who underwent percutaneous intervention for ACS and did not have any in-stent lesion as the control group (non-ST group). ST classification was done according to the Academic Research Consortium definition. RESULTS The mean age of the patients was 63.3±10.6 years (483 male, 69.2%). The groups were similar in terms of characteristic properties, comorbidities, and the drugs being used (p>0.05 for all). Drug eluting stents were used in 86.5% of the patients. In the ST group, the median time from stent implantation to thrombosis was 285 days. Mean AIP and the ratio of triglyceride to high-density lipoprotein cholesterol (TG/HDL-C) were statistically significantly higher in the ST group than in the controls (p<0.001 and p=0.018, respectively), and a positive correlation was observed between time from stent implantation to thrombosis and AIP and TG/HDL-C (rS=0.229, p=0.010 and rS=0.222, p=0.010, respectively). Multivariate logistic regression analysis revealed that stent length, prior ST elevation myocardial infarction, TG/HDL-C, and AIP were independent predictors of ST. CONCLUSION AIP is an easy calculable biomarker, and the performance of AIP to predict ST is better than TG/HDL-C.
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Affiliation(s)
- Özge Özcan Abacıoğlu
- Department of Cardiology, Adana City Training and Research Hospital; Adana-Turkey
| | - Arafat Yıldırım
- Department of Cardiology, Adana City Training and Research Hospital; Adana-Turkey
| | | | - Mine Karadeniz
- Department of Hematology, Faculty of Medicine, Hacettepe University; Ankara-Turkey
| | - Salih Kılıç
- Department of Cardiology, Adana City Training and Research Hospital; Adana-Turkey
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Lim YH, Youn JH, Hong SJ, Ahn TH, Yoon J, Park JK, Kim HS. A First-in-Man Clinical Evaluation of Sirolimus and Ascorbic Acid-Eluting Stent Systems: a Multicenter, Subject-Blinded, Randomized Study. Korean Circ J 2021; 51:1001-1014. [PMID: 34854580 PMCID: PMC8636762 DOI: 10.4070/kcj.2021.0161] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 09/01/2021] [Accepted: 09/02/2021] [Indexed: 01/01/2023] Open
Abstract
This prospective, multi-center, randomized, comparative, and pivotal clinical study in patients with coronary artery occlusive disease was conducted to evaluate the safety and efficacy of D+Storm™ drug-eluting stent (DES), a sirolimus-eluting stent coated with polylactic acid and ascorbic acid. Our results showed that in-segment late lumen loss of D+Storm™ DES group was non-inferior to BioMatrix Flex™ DES group and the total procedural success rate of D+Storm™ DES group was 100%. In addition, the safety of the D+Storm™ DES group at 36 weeks was also demonstrated in this study. Background and Objectives This clinical trial was conducted to evaluate the safety and efficacy of D+Storm™ drug-eluting stent (DES) and BioMatrix Flex™ DES. Methods This study was a multicenter, subject-single-blind, randomized, and confirmed comparative clinical trial. According to the inclusion criteria, those diagnosed with stable angina, unstable angina, silent ischemia, or non-ST-segment myocardial infarction were selected among patients with coronary artery stenosis as subjects. Among the subjects with 50% stenosis on coronary angiography, the experiment was performed on those who had a lesion with reference vessel 2.5–4.0 mm in diameter and ≤40 mm in length. The primary endpoint was an in-segment late loss and the secondary endpoints were in-stent late lumen loss, stent malapposition, the incidence of mortality, myocardial infarction, reoperation, and stent thrombosis at 36 weeks. Results 57 patients in the D+Storm™ DES group and 55 patients in the BioMatrix Flex™ DES group were enrolled in the study. Fifty-seven patients in the D+Storm™ DES group and Fifty-five patients in the BioMatrix Flex™ DES group were enrolled in the study. An average of in-segment late lumen loss was 0.08±0.13 mm in the D+Storm™ DES group and 0.14±0.32 mm in the BioMatrix Flex™ DES group with no significant difference between the 2 groups (p=0.879). In addition, there was no significant difference in adverse events between D+Storm™ DES and BioMatrix Flex™ DES. Conclusions This study demonstrated the clinical effectiveness and safety of D+Storm™ DES implantation in patients with coronary artery disease over a 36-week follow-up period.
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Affiliation(s)
- Young-Hyo Lim
- Division of Cardiology, Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
| | | | - Soon-Jun Hong
- Division of Cardiology, Cardiovascular Center, Korea University Anam Hospital, Seoul, Korea
| | - Tae-Hoon Ahn
- Division of Cardiology, Cardiovascular Center, Korea University Anam Hospital, Seoul, Korea
| | - Junghan Yoon
- Department of Cardiology, Yonsei University Wonju Severance Christian Hospital, Wonju, Korea
| | | | - Hyo-Soo Kim
- Department of Internal Medicine and Cardiovascular Center, Seoul National University College of Medicine, Seoul, Korea.
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Sweedo A, Wise LM, Roka-Moiia Y, Arce FT, Saavedra SS, Sheriff J, Bluestein D, Slepian MJ, Purdy JG. Shear-Mediated Platelet Activation is Accompanied by Unique Alterations in Platelet Release of Lipids. Cell Mol Bioeng 2021; 14:597-612. [PMID: 34900013 PMCID: PMC8630256 DOI: 10.1007/s12195-021-00692-x] [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: 01/21/2021] [Accepted: 07/16/2021] [Indexed: 10/20/2022] Open
Abstract
INTRODUCTION Platelet activation by mechanical means such as shear stress exposure, is a vital driver of thrombotic risk in implantable blood-contacting devices used in the treatment of heart failure. Lipids are essential in platelets activation and have been studied following biochemical activation. However, little is known regarding lipid alterations occurring with mechanical shear-mediated platelet activation. METHODS Here, we determined if shear-activation of platelets induced lipidome changes that differ from those associated with biochemically-mediated platelet activation. We performed high-resolution lipidomic analysis on purified platelets from four healthy human donors. For each donor, we compared the lipidome of platelets that were non-activated or activated by shear, ADP, or thrombin treatment. RESULTS We found that shear activation altered cell-associated lipids and led to the release of lipids into the extracellular environment. Shear-activated platelets released 21 phospholipids and sphingomyelins at levels statistically higher than platelets activated by biochemical stimulation. CONCLUSIONS We conclude that shear-mediated activation of platelets alters the basal platelet lipidome. Further, these alterations differ and are unique in comparison to the lipidome of biochemically activated platelets. Many of the released phospholipids contained an arachidonic acid tail or were phosphatidylserine lipids, which have known procoagulant properties. Our findings suggest that lipids released by shear-activated platelets may contribute to altered thrombosis in patients with implanted cardiovascular therapeutic devices. SUPPLEMENTARY INFORMATION The online version contains supplementary material available at 10.1007/s12195-021-00692-x.
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Affiliation(s)
- Alice Sweedo
- Department of Biomedical Engineering, University of Arizona, Tucson, AZ USA
| | - Lisa M. Wise
- Department of Immunobiology, University of Arizona, 1656 E. Mabel Street, PO Box 245221, Tucson, AZ 85724 USA
- BIO5 Institute, University of Arizona, Tucson, AZ USA
| | - Yana Roka-Moiia
- Department of Medicine, Sarver Heart Center, University of Arizona, Tucson, AZ USA
| | - Fernando Teran Arce
- Department of Biomedical Engineering, University of Arizona, Tucson, AZ USA
- Department of Medicine, Sarver Heart Center, University of Arizona, Tucson, AZ USA
| | - S. Scott Saavedra
- Department of Biomedical Engineering, University of Arizona, Tucson, AZ USA
- BIO5 Institute, University of Arizona, Tucson, AZ USA
- Department of Chemistry and Biochemistry, University of Arizona, Tucson, AZ USA
| | - Jawaad Sheriff
- Department of Biomedical Engineering, Stony Brook University, Stony Brook, NY USA
| | - Danny Bluestein
- Department of Biomedical Engineering, Stony Brook University, Stony Brook, NY USA
| | - Marvin J. Slepian
- Department of Biomedical Engineering, University of Arizona, Tucson, AZ USA
- BIO5 Institute, University of Arizona, Tucson, AZ USA
- Department of Medicine, Sarver Heart Center, University of Arizona, Tucson, AZ USA
- Department of Biomedical Engineering, Stony Brook University, Stony Brook, NY USA
- Department of Material Sciences and Engineering, University of Arizona, Tucson, AZ USA
| | - John G. Purdy
- Department of Immunobiology, University of Arizona, 1656 E. Mabel Street, PO Box 245221, Tucson, AZ 85724 USA
- BIO5 Institute, University of Arizona, Tucson, AZ USA
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12
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Nguyen DT, Smith AF, Jiménez JM. Stent strut streamlining and thickness reduction promote endothelialization. J R Soc Interface 2021; 18:20210023. [PMID: 34404229 PMCID: PMC8371379 DOI: 10.1098/rsif.2021.0023] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Accepted: 07/22/2021] [Indexed: 12/15/2022] Open
Abstract
Stent thrombosis (ST) carries a high risk of myocardial infarction and death. Lack of endothelial coverage is an important prognostic indicator of ST after stenting. While stent strut thickness is a critical factor in ST, a mechanistic understanding of its effect is limited and the role of haemodynamics is unclear. Endothelialization was tested using a wound-healing assay and five different stent strut models ranging in height between 50 and 150 µm for circular arc (CA) and rectangular (RT) geometries and a control without struts. Under static conditions, all stent strut surfaces were completely endothelialized. Reversing pulsatile disturbed flow caused full endothelialization, except for the stent strut surfaces of the 100 and 150 µm RT geometries, while fully antegrade pulsatile undisturbed flow with a higher mean wall shear stress caused only the control and the 50 µm CA geometries to be fully endothelialized. Modest streamlining and decrease in height of the stent struts improved endothelial coverage of the peri-strut and stent strut surfaces in a haemodynamics dependent manner. This study highlights the impact of the stent strut height (thickness) and geometry (shape) on the local haemodynamics, modulating reendothelialization after stenting, an important factor in reducing the risk of stent thrombosis.
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Affiliation(s)
- Duy T. Nguyen
- Department of Mechanical and Industrial Engineering, University of Massachusetts Amherst, Amherst, MA 01003, USA
| | - Alexander F. Smith
- Department of Biomedical Engineering, University of Massachusetts Amherst, Amherst, MA 01003, USA
| | - Juan M. Jiménez
- Department of Mechanical and Industrial Engineering, University of Massachusetts Amherst, Amherst, MA 01003, USA
- Department of Biomedical Engineering, University of Massachusetts Amherst, Amherst, MA 01003, USA
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13
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Firkowska-Boden I, Helbing C, Dauben TJ, Pieper M, Jandt KD. How Nanotopography-Induced Conformational Changes of Fibrinogen Affect Platelet Adhesion and Activation. LANGMUIR : THE ACS JOURNAL OF SURFACES AND COLLOIDS 2020; 36:11573-11580. [PMID: 32921061 DOI: 10.1021/acs.langmuir.0c02094] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
The conformational state of adsorbed human plasma fibrinogen (HPF) has been recognized as the determinant factor in platelet adhesion and thrombus formation on blood-contacting biomaterials. Studies have highlighted the ability to control the HPF conformation merely by tailoring surface nanotopographical features. However, a clear relationship between the conformational changes of adsorbed HPF and the degree of platelet adhesion and activation achieved with different surface nanotopographies is still unclear. Here, we examined HPF assembly characteristics on nanostructured polybutene-1 (PB-1) surfaces with nanosized lamellar crystals (LCs), needle-like crystals (NLCs), and a nanostructured high-density polyethylene (HDPE) surface with shish-kebab crystals (SKCs), at a biologically relevant HPF concentration. By exposing the nanostructured surfaces with preadsorbed HPF to human platelets, significant differences in platelet response on LCs/SKCs and NLCs were identified. The former presented a uniform monolayer in the advanced stage of activation, whereas the latter exhibited minimal adhesion and the early stage of activation. Distinct platelet response was related to the postadsorption conformational changes in HPF, which were confirmed by topography-dependent shifts of the amide I band in attenuated total reflection-Fourier transform infrared (ATR-FTIR) analysis. Supported by atomic force microscopy (AFM) characterization, we propose that the mechanism behind the nanotopography-induced HPF conformation is driven by the interplay between the aspect ratios of polymeric crystals and HPF. From the biomedical perspective, our work reveals that surface structuring in a nanoscale size regime can provide a fine-tuning mechanism to manipulate HPF conformation, which can be exploited for the design of thromboresistant biomaterials surfaces.
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Affiliation(s)
- Izabela Firkowska-Boden
- Chair of Materials Science, Otto Schott Institute of Materials Research, Faculty of Physics and Astronomy, Friedrich Schiller University Jena, Löbdergraben 32, 07743 Jena, Germany
| | - Christian Helbing
- Chair of Materials Science, Otto Schott Institute of Materials Research, Faculty of Physics and Astronomy, Friedrich Schiller University Jena, Löbdergraben 32, 07743 Jena, Germany
| | - Thomas J Dauben
- Chair of Materials Science, Otto Schott Institute of Materials Research, Faculty of Physics and Astronomy, Friedrich Schiller University Jena, Löbdergraben 32, 07743 Jena, Germany
| | - Maja Pieper
- Chair of Materials Science, Otto Schott Institute of Materials Research, Faculty of Physics and Astronomy, Friedrich Schiller University Jena, Löbdergraben 32, 07743 Jena, Germany
| | - Klaus D Jandt
- Chair of Materials Science, Otto Schott Institute of Materials Research, Faculty of Physics and Astronomy, Friedrich Schiller University Jena, Löbdergraben 32, 07743 Jena, Germany
- Jena Center for Soft Matter, Friedrich Schiller University Jena, Philosophenweg 7, 07743 Jena, Germany
- Jena School for Microbial Communication (JSMC), Neugasse 23, 07743 Jena, Germany
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14
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Namazi MH, Saemifard F, Pishgahi M. One-Month Outcomes of Cases Receiving Ticagrelor after Percutaneous Coronary Intervention; a Case Series. ARCHIVES OF ACADEMIC EMERGENCY MEDICINE 2020; 8:e42. [PMID: 32259131 PMCID: PMC7130436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
INTRODUCTION Ticagrelor is the first reversibly binding oral P2Y12 receptor antagonist that can block ADP-induced platelet aggregation. This study aimed to describe one-month follow-up findings of cases undergoing ticagrelor therapy after percutaneous coronary intervention (PCI). METHODS This case series was performed on acute coronary syndrome (ACS) patients who were candidates for PCI and received aspirin plus ticagrelor after PCI. Patients were followed for one month and their outcomes were described. RESULTS 156 cases with the mean age of 59.74 ± 9.24 years were studied (63% male). 45 (28.8%) cases complained of dyspnea (39 cases with mild and 6 cases with severe dyspnea). Bleeding occurred in 4 (2.5%) cases (intra-cranial hemorrhage (ICH) in one, hematuria in two, and skin hemorrhage in one case). There were no cases with bradycardia or thrombosis. One (0.6%) patient developed drug hypersensitivity reaction, which manifested as skin rash. The use of drug was stopped in 10 (6.4%) cases due to severe dyspnea (n= 6), ICH (n=1), skin rash (n=1), and concomitant left ventricular (LV) clot (n=2). CONCLUSION The most important finding of one-month ticagrelor consumption were dyspnea, bleeding, and hypersensitivity reaction. No case of bradycardia and stent thrombosis was detected. In our study , iranian population has more susceptibility to dyspnea than PLATO result. The rate of drug discontinuation in this series of cases was 6.4 %.
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Affiliation(s)
- Mohammad Hasan Namazi
- Interventional Cardiology department, Shahid Modarres Heart Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Farzam Saemifard
- Interventional Cardiology department, Shahid Modarres Heart Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mehdi Pishgahi
- Interventional Cardiology Department, Shohadaye Tajrish hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Corresponding author: Mehdi Pishgahi; Interventional Cardiology Department, Shohadaye Tajrish hospital, Tajrish Square, Tehran, Iran. , ORCID: 0000-0002-1196-6535, Tel: 00989123387486. Emails and ORCIDS: ; ORCID: 0000- 0001-5801-9925,
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15
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Clauder F, Czerniak AS, Friebe S, Mayr SG, Scheinert D, Beck-Sickinger AG. Endothelialization of Titanium Surfaces by Bioinspired Cell Adhesion Peptide Coatings. Bioconjug Chem 2019; 30:2664-2674. [DOI: 10.1021/acs.bioconjchem.9b00573] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Affiliation(s)
- Franziska Clauder
- Institute of Biochemistry, Faculty of Life Sciences, Leipzig University, Brüderstrasse 34, 04103 Leipzig, Germany
| | - Anne Sophie Czerniak
- Institute of Biochemistry, Faculty of Life Sciences, Leipzig University, Brüderstrasse 34, 04103 Leipzig, Germany
| | - Sabrina Friebe
- Leibniz-Institute of Surface Engineering (IOM), Permoserstrasse 15, 04318 Leipzig, Germany
| | - Stefan G. Mayr
- Leibniz-Institute of Surface Engineering (IOM), Permoserstrasse 15, 04318 Leipzig, Germany
| | - Dierk Scheinert
- Department of Angiology, University Hospital Leipzig, Liebigstrasse 20, 04103 Leipzig, Germany
| | - Annette G. Beck-Sickinger
- Institute of Biochemistry, Faculty of Life Sciences, Leipzig University, Brüderstrasse 34, 04103 Leipzig, Germany
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Skopets IS, Vezikova NN, Malygin AN, Ispravnikova AA, Nilva ES, Belozerov GN. Very late biolimus-eluting coronary stent thrombosis: case report. KARDIOLOGIYA 2018; 58:58-64. [PMID: 30625090 DOI: 10.18087/cardio.2538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Accepted: 12/14/2018] [Indexed: 11/18/2022]
Abstract
The case of very late everolimus-eluting stent thrombosis in left arteria descendant (LAD) was presented. Risk factors and possible ways of this complication prevention are discussed.
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Abizaid A, Kedev S, Kedhi E, Talwar S, Erglis A, Hlinomaz O, Masotti M, Fath-Ordoubadi F, Lemos PA, Milewski K, Botelho R, Costa R, Bangalore S. Randomised comparison of a biodegradable polymer ultra-thin sirolimus-eluting stent versus a durable polymer everolimus-eluting stent in patients with de novo native coronary artery lesions: the meriT-V trial. EUROINTERVENTION 2018; 14:e1207-e1214. [DOI: 10.4244/eij-d-18-00762] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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18
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Mohiaddin H, Wong TDFK, Burke-Gaffney A, Bogle RG. Drug-Coated Balloon-Only Percutaneous Coronary Intervention for the Treatment of De Novo Coronary Artery Disease: A Systematic Review. Cardiol Ther 2018; 7:127-149. [PMID: 30368735 PMCID: PMC6251821 DOI: 10.1007/s40119-018-0121-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Indexed: 02/06/2023] Open
Abstract
Percutaneous coronary intervention (PCI) with a drug coated balloon (DCB) is a novel treatment which seeks to acutely dilate a coronary stenosis and deliver an anti-proliferative drug to the vessel wall (reducing the risk of re-stenosis), without implanting a drug eluting stent (DES). In this study, we performed a systematic review of stentless DCB-only angioplasty in de novo coronary artery disease. We identified 41 studies examining the effects of DCB-only PCI in a variety of clinical scenarios including small vessels, bifurcations, calcified lesions, and primary PCI. DCB-only PCI appears to be associated with comparable clinical outcomes to DESs and superior angiographic outcomes to plain-old balloon angioplasty. Although current data are promising, there is still a need for further long-term randomized control trial data comparing a DCB-only approach specifically against a second- or third-generation DES. A 4-week period of dual antiplatelet therapy provides a real advantage for the DCB-only PCI approach, which is not possible with most DESs. Since rates of adverse clinical outcomes are very low for all PCI procedures attention should be turned to the development of robust endpoints with which to compare DCB-only PCI approaches to the standard treatment with a DES.
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Affiliation(s)
| | | | - Anne Burke-Gaffney
- Vascular Biology, National Heart & Lung Institute (NHLI), Faculty of Medicine, Imperial College London, London, UK
| | - Richard G Bogle
- Clinical Academic Group, St George's University Foundation Hospitals NHS Trust, London, UK
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Coronary stents with inducible VEGF/HGF-secreting UCB-MSCs reduced restenosis and increased re-endothelialization in a swine model. Exp Mol Med 2018; 50:1-14. [PMID: 30174328 PMCID: PMC6119684 DOI: 10.1038/s12276-018-0143-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Revised: 05/30/2018] [Accepted: 06/07/2018] [Indexed: 12/12/2022] Open
Abstract
Atherosclerotic plaques within the vasculature may eventually lead to heart failure. Currently, cardiac stenting is the most effective and least invasive approach to treat this disease. However, in-stent restenosis is a complex chronic side effect of stenting treatment. This study used coronary stents coated with stem cells secreting angiogenic growth factors via an inducible genome-editing system to reduce stent restenosis and induce re-endothelialization within the artery. The characteristics of the cells and their adhesion properties on the stents were confirmed, and the stents were transplanted into a swine model to evaluate restenosis and the potential therapeutic use of stents with stem cells. Restenosis was evaluated using optical coherence tomography (OCT), microcomputed tomography (mCT) and angiography, and re-endothelialization was evaluated by immunostaining after cardiac stent treatment. Compared to a bare metal stent (BMS) or a parental umbilical cord blood-derived mesenchymal stem cell (UCB-MSC)-coated stent, the stents with stem cells capable of the controlled release of hepatocyte growth factor (HGF) and vascular endothelial growth factor (VEGF) successfully reduced restenosis within the stent and induced natural re-endothelialization. Furthermore, UCB-MSCs exhibited the ability to differentiate into endothelial cells in Matrigel, and HGF and VEGF improved this differentiation. Our study indicates that stents coated with UCB-MSCs secreting VEGF/HGF reduce the restenosis side effects of cardiac stenting with improved re-endothelialization.
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20
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D'Angelo RG, McGiness T, Waite LH. Antithrombotic Therapy in Patients With Atrial Fibrillation Undergoing Percutaneous Coronary Intervention: Where Are We Now? Ann Pharmacother 2018; 52:884-897. [PMID: 29577768 DOI: 10.1177/1060028018766837] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
OBJECTIVE To synthesize the literature and provide guidance to practitioners regarding double therapy (DT) and triple therapy (TT) in patients with atrial fibrillation (AF) requiring percutaneous coronary intervention (PCI). DATA SOURCES PubMed and MEDLINE (January 2000 to February 2018) were searched using the following terms: atrial fibrillation, myocardial infarction, acute coronary syndrome, percutaneous coronary intervention, anticoagulation, dual-antiplatelet therapy, clopidogrel, aspirin, ticagrelor, prasugrel, and triple therapy. STUDY SELECTION AND DATA EXTRACTION The results included randomized and nonrandomized clinical trials and meta-analyses. Each study was reported based on study design, population, intervention, comparator, and key cardiovascular (CV) and bleeding outcomes. DATA SYNTHESIS A total of 15 studies were included in the review. The majority of studies evaluating DT and TT utilized clopidogrel and warfarin as components of the regimen, although there are emerging data with newer agents. Evidence purporting DT regimens to be equally effective in preventing CV events and improved safety profiles compared with TT regimens included populations with relatively low risk for recurrent CV events, and many of these studies were observational in nature. Overall, current evidence as well as American and European guidelines support the use of TT in patients with AF who require PCI for the least possible amount of time, depending on patient-specific factors involving bleeding and thrombosis. CONCLUSIONS In the majority of patients with AF who require PCI, TT should be used for the shortest period of time possible. DT regimens may be used in patients requiring PCI who have low risk for thrombosis and/or high bleeding risk.
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Affiliation(s)
- Ryan G D'Angelo
- 1 University of the Sciences-Philadelphia College of Pharmacy, Philadelphia, PA, USA.,2 Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Thaddeus McGiness
- 1 University of the Sciences-Philadelphia College of Pharmacy, Philadelphia, PA, USA.,2 Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Laura H Waite
- 1 University of the Sciences-Philadelphia College of Pharmacy, Philadelphia, PA, USA.,2 Hospital of the University of Pennsylvania, Philadelphia, PA, USA
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