1
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Zhang Y, Fang Q, Niu K, Gan Z, Yu Q, Gu T. Time-dependently slow-released multiple-drug eluting external sheath for efficient long-term inhibition of saphenous vein graft failure. J Control Release 2019; 293:172-182. [DOI: 10.1016/j.jconrel.2018.12.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2018] [Revised: 11/19/2018] [Accepted: 12/01/2018] [Indexed: 12/22/2022]
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2
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Tianshu-Chu, Congrong-Gao, Zhiwei-Zhao, Fei-Ling, Ayu-Sun, Yuanbiao-Zheng, Jing-Cao, Ge J. Rapamycin Combined with α-Cyanoacrylate Contributes to Inhibiting Intimal Hyperplasia in Rat Models. Arq Bras Cardiol 2018; 112:3-10. [PMID: 30570064 PMCID: PMC6317635 DOI: 10.5935/abc.20180247] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Accepted: 07/23/2018] [Indexed: 11/30/2022] Open
Abstract
Background Vein graft restenosis has an adverse impact on bridge vessel circulation and
patient prognosis after coronary artery bypass grafting. Objectives We used the extravascular supporter α-cyanoacrylate (α-CA), the
local application rapamycin/sirolimus (RPM), and a combination of the two
(α-CA-RPM) in rat models of autogenous vein graft to stimulate vein
graft change. The aim of our study was to observe the effect of α-CA,
RPM, and α-CA-RPM on vein hyperplasia. Methods Fifty healthy Sprague Dawley (SD) rats were randomized into the following 5
groups: sham, control, α-CA, RPM, and α-CA-RPM. Operating
procedure as subsequently described was used to build models of grafted rat
jugular vein on carotid artery on one side. The level of endothelin-1 (ET-1)
was determined by enzyme-linked immunosorbent assay (ELISA). Grafted veins
were observed via naked eye 4 weeks later; fresh veins were observed via
microscope and image-processing software in hematoxylin-eosin (HE) staining
and immunohistochemistry after having been fixed and stored” (i.e. First
they were fixed and stored, and second they were observed); α-Smooth
Muscle Actin (αSMA) and von Willebrand factor (vWF) were measured
with reverse transcription-polymerase chain reaction (RT-PCR). Comparisons
were made with single-factor analysis of variance and Fisher’s least
significant difference test, with p < 0.05 considered significant. Results We found that intimal thickness of the α-CA, RPM, and α-CA-RPM
groups was lower than that of the control group (p < 0.01), and the
thickness of the α-CA-RPM group was notably lower than that of the
α-CA and RPM groups (p < 0.05). Conclusion RPM combined with α-CA contributes to inhibiting intimal hyperplasia
in rat models and is more effective for vascular patency than individual use
of either α-CA or RPM.
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Affiliation(s)
| | | | | | - Fei-Ling
- Anhui Medical University, Hefei - China
| | - Ayu-Sun
- Anhui Medical University, Hefei - China
| | | | - Jing-Cao
- Anhui Medical University, Hefei - China
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3
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Ha FJ, Nogic J, Montone RA, Cameron JD, Nerlekar N, Brown AJ. Drug eluting versus bare metal stents for percutaneous coronary intervention of saphenous vein graft lesions: An updated meta-analysis of randomized controlled trials. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2018; 19:837-844. [DOI: 10.1016/j.carrev.2018.03.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2018] [Revised: 03/16/2018] [Accepted: 03/27/2018] [Indexed: 10/17/2022]
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4
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Shavelle DM, Banerjee S, Maini B, Schreiber TL, Kapasi N, O'Neill WW, Popma J, Matthews RV. Comparison of Outcomes of Percutaneous Coronary Intervention on Native Coronary Arteries Versus on Saphenous Venous Aorta Coronary Conduits in Patients With Low Left Ventricular Ejection Fraction and Impella Device Implantation Achieved or Attempted (from the PROTECT II Randomized Trial and the cVAD Registry). Am J Cardiol 2018; 122:966-972. [PMID: 30057231 DOI: 10.1016/j.amjcard.2018.06.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Revised: 05/31/2018] [Accepted: 06/06/2018] [Indexed: 11/17/2022]
Abstract
Patients with prior coronary artery bypass grafting (CABG) represent a high-risk cohort given associated medical conditions and worse outcome of saphenous vein graft compared with native vessel percutaneous coronary intervention (PCI). The goal of the current analysis was to compare clinical outcomes in 591 patients with and without prior CABG and multivessel coronary artery disease or unprotected left main disease and severely reduced left ventricular systolic function underwent Impella supported PCI from the PROTECT II randomized trial and the cVAD Registry. Patients with prior CABG surgery (n = 201) were compared with those without prior CABG surgery (n = 390). The primary end point of this analysis was overall mortality at 30 days. Patients with prior CABG surgery had greater Society of Thoracic Surgery mortality score compared with patients without prior CABG surgery, 7.6 ± 6.4 versus 5.1 ± 5.5, respectively, p <0.001. Saphenous vein graft PCI was performed in 17% of patients with prior CABG surgery. Number of vessels treated was lower in patients with prior CABG surgery compared with patients without prior CABG surgery, 1.66 ± 0.56 versus 1.89 ± 0.64, respectively, p <0.001. Achievement of TIMI 3 flow post PCI and overall PCI success was similar in the two groups. Overall mortality at 30 days was similar in patients with prior CABG surgery compared with patients without prior CABG surgery, 6.75% versus 6.61%, respectively, p = 1.0. In conclusion, in this high-risk cohort of patients underwent hemodynamically supported PCI, prior CABG surgery was not associated with worse outcome. The use of hemodynamic support appears to mitigate the increased risk of PCI associated with prior CABG.
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Affiliation(s)
- David M Shavelle
- Division of Cardiovascular Medicine, University of Southern California, Los Angeles, California.
| | - Subhash Banerjee
- Veterans Affairs North Texas Health Care System and University of Texas Southwestern Medical Center, Dallas, Texas
| | | | | | - Neel Kapasi
- Division of Cardiovascular Medicine, University of Southern California, Los Angeles, California
| | | | - Jeffrey Popma
- Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Ray V Matthews
- Division of Cardiovascular Medicine, University of Southern California, Los Angeles, California
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5
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Nef HM, Abdel-Wahab M, Achenbach S, Joner M, Levenson B, Mehilli J, Möllmann H, Thiele H, Zahn R, Zeus T, Elsässer A. Medikamentenfreisetzende Koronarstents/-scaffolds und medikamentenbeschichtete Ballonkatheter. DER KARDIOLOGE 2018. [DOI: 10.1007/s12181-017-0202-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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6
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Lee M, Kong J. Current State of the Art in Approaches to Saphenous Vein Graft Interventions. Interv Cardiol 2017; 12:85-91. [PMID: 29588735 PMCID: PMC5808481 DOI: 10.15420/icr.2017:4:2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2017] [Accepted: 06/20/2017] [Indexed: 12/13/2022] Open
Abstract
Saphenous vein grafts (SVGs), used during coronary artery bypass graft surgery for severe coronary artery disease, are prone to degeneration and occlusion, leading to poor long-term patency compared with arterial grafts. Interventions used to treat SVG disease are susceptible to high rates of periprocedural MI and no-reflow. To minimise complications seen with these interventions, proper stents, embolic protection devices (EPDs) and pharmacological selection are crucial. Regarding stent selection, evidence has demonstrated superiority of drug-eluting stents over bare-metal stents in SVG intervention. The ACCF/AHA/SCA American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Society for Cardiovascular Angiography and Interventions guidelines recommend the use of EPDs during SVG intervention to decrease the risk of periprocedural MI, distal embolisation and no-reflow. The optimal pharmacological treatment for slow or no-reflow remains unclear, but various vasodilators show promise.
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7
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Picard F, Marquis-Gravel G, Avram R, Ly HQ, Dorval JF, Doucet S, de Hemptinne Q, L'allier PL, Tanguay JF. Everolimus-eluting bioresorbable vascular scaffold implantation to treat saphenous vein graft disease, single-center initial experience. J Interv Cardiol 2017; 30:433-439. [DOI: 10.1111/joic.12425] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Revised: 07/18/2017] [Accepted: 07/19/2017] [Indexed: 11/28/2022] Open
Affiliation(s)
- Fabien Picard
- Interventional Cardiology; Department of Medicine; Montreal Heart Institute; Université de Montréal; Montréal QC Canada
| | - Guillaume Marquis-Gravel
- Interventional Cardiology; Department of Medicine; Montreal Heart Institute; Université de Montréal; Montréal QC Canada
| | - Robert Avram
- Interventional Cardiology; Department of Medicine; Montreal Heart Institute; Université de Montréal; Montréal QC Canada
| | - Hung Q. Ly
- Interventional Cardiology; Department of Medicine; Montreal Heart Institute; Université de Montréal; Montréal QC Canada
| | - Jean-François Dorval
- Interventional Cardiology; Department of Medicine; Montreal Heart Institute; Université de Montréal; Montréal QC Canada
| | - Serge Doucet
- Interventional Cardiology; Department of Medicine; Montreal Heart Institute; Université de Montréal; Montréal QC Canada
| | - Quentin de Hemptinne
- Interventional Cardiology; Department of Medicine; Montreal Heart Institute; Université de Montréal; Montréal QC Canada
| | - Philippe L. L'allier
- Interventional Cardiology; Department of Medicine; Montreal Heart Institute; Université de Montréal; Montréal QC Canada
| | - Jean-François Tanguay
- Interventional Cardiology; Department of Medicine; Montreal Heart Institute; Université de Montréal; Montréal QC Canada
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8
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Drug-eluting stents appear superior to bare metal stents for vein-graft PCI in vessels up to a stent diameter of 4 mm. Heart Int 2016; 11:e17-e24. [PMID: 27924213 PMCID: PMC5072290 DOI: 10.5301/heartint.5000228] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/09/2016] [Indexed: 12/03/2022] Open
Abstract
Background Research trials have shown improved short-term outcome with drug-eluting stents (DES) over bare metal stents (BMS) in saphenous vein graft (SVG) percutaneous coronary intervention (PCI), primarily by reducing target vessel revascularization (TVR) for in-stent restenosis. We compared the outcomes in patients undergoing SVG stent implantation treated with DES or BMS. In exploratory analyses we investigated the influence of stent generation and diameter. Methods Data were obtained from a prospective database of 657 patients who underwent PCI for SVG lesions between 2003 and 2011. A total of 344 patients had PCI with BMS and 313 with DES. Propensity scores were developed based on 15 observed baseline covariates in a logistic regression model with stent type as the dependent variable. The nearest-neighbour-matching algorithm with Greedy 5-1 Digit Matching was used to produce two patient cohorts of 313 patients each. We assessed major adverse cardiac events (MACE) out to a median of 3.3 years (interquartile range: 2.1-4.1). MACE was defined as all-cause mortality, myocardial infarction (MI), TVR and stroke. Results There was a significant difference in MACE between the two groups in favour of DES (17.9% DES vs. 31.2% BMS group; p = 0.0017) over the 5-year follow-up period. MACE was driven by increased TVR in the BMS group. There was no difference in death, MI or stroke. Adjusted Cox analysis confirmed a decreased risk of MACE for DES compared with BMS 0.75 (95% confidence interval (CI) 0.52-0.94), with no difference in the hazard of all-cause mortality (hazard ratio: 1.08; 95% CI: 0.77-1.68). However, when looking at stent diameters greater than 4 mm, no difference was seen in MACE rates between BMS and DES. Conclusions Overall in our cohort of patients who had PCI for SVG disease, DES use resulted in lower MACE rates compared with BMS over a 5-year follow-up period; however, for stent diameters over 4 mm no difference in MACE rates was seen.
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9
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Mehilli J. The VELETI II Trial (Sealing Moderate Coronary Saphenous Vein Graft Lesions With Paclitaxel-Eluting Stents): Local Mechanical Intervention Fails to Stop Atheroprogression in Saphenous Vein Grafts. Circ Cardiovasc Interv 2016; 9:CIRCINTERVENTIONS.116.004542. [PMID: 27815345 DOI: 10.1161/circinterventions.116.004542] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Julinda Mehilli
- From the Department of Cardiology, Munich University Clinic, Ludwig-Maximilians University, Germany; and DZHK (German Center for Cardiovascular Research), Partner site Munich Heart Alliance, Munich, Germany.
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10
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Nakazawa G, Torii S, Ijichi T, Nagamatsu H, Ohno Y, Kurata F, Yoshikawa A, Nakano M, Shinozaki N, Yoshimachi F, Ikari Y. Comparison of Vascular Responses Following New-Generation Biodegradable and Durable Polymer-Based Drug-Eluting Stent Implantation in an Atherosclerotic Rabbit Iliac Artery Model. J Am Heart Assoc 2016; 5:JAHA.116.003803. [PMID: 27792651 PMCID: PMC5121480 DOI: 10.1161/jaha.116.003803] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Background Incomplete endothelialization is the primary substrate of late stent thrombosis; however, recent reports have revealed that abnormal vascular responses are also responsible for the occurrence of late stent failure. The aim of the current study was to assess vascular response following deployment of biodegradable polymer‐based Synergy (Boston Scientific) and Nobori (Terumo) drug‐eluting stents and the durable polymer‐based Resolute Integrity stent (Medtronic) in an atherosclerotic rabbit iliac artery model. Methods and Results A total of 24 rabbits were fed an atherogenic diet, and then a balloon injury was used to induce atheroma formation. Synergy, Nobori, and Resolute Integrity stents were randomly implanted in iliac arteries. Animals were euthanized at 28 days for scanning electron microscopic evaluation and at 90 days for histological analysis. The percentage of uncovered strut area at 28 days was lowest with Synergy, followed by Resolute Integrity, and was significantly higher with Nobori stents (Synergy 1.1±2.2%, Resolute Integrity 2.0±3.9%, Nobori 4.6±3.0%; P<0.001). At 90 days, inflammation score was lowest for Synergy (0.27±0.45), followed by Nobori (0.62±0.59), and was highest for Resolute Integrity (0.89±0.46, P<0.001). Foamy macrophage infiltration within neointima (ie, neoatherosclerosis) was significantly less with Synergy (0.62±0.82) compared with Nobori (0.85±0.74) and Resolute Integrity (1.39±1.32; P=0.034). Conclusions The biodegradable polymer‐coated thin‐strut Synergy drug‐eluting stent showed the fastest stent strut neointimal coverage and the lowest incidence of neoatherosclerosis in the current animal model.
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Affiliation(s)
- Gaku Nakazawa
- Department of Cardiology, Tokai University School of Medicine, Isehara, Kanagawa, Japan
| | - Sho Torii
- Department of Cardiology, Tokai University School of Medicine, Isehara, Kanagawa, Japan
| | - Takeshi Ijichi
- Department of Cardiology, Tokai University School of Medicine, Isehara, Kanagawa, Japan
| | - Hirofumi Nagamatsu
- Department of Cardiology, Tokai University School of Medicine, Isehara, Kanagawa, Japan
| | - Yohei Ohno
- Department of Cardiology, Tokai University School of Medicine, Isehara, Kanagawa, Japan
| | - Fumi Kurata
- Department of Cardiology, Tokai University School of Medicine, Isehara, Kanagawa, Japan
| | - Ayako Yoshikawa
- Department of Cardiology, Tokai University School of Medicine, Isehara, Kanagawa, Japan
| | - Masataka Nakano
- Department of Cardiology, Tokai University School of Medicine, Isehara, Kanagawa, Japan
| | - Norihiko Shinozaki
- Department of Cardiology, Tokai University School of Medicine, Isehara, Kanagawa, Japan
| | - Fuminobu Yoshimachi
- Department of Cardiology, Tokai University School of Medicine, Isehara, Kanagawa, Japan
| | - Yuji Ikari
- Department of Cardiology, Tokai University School of Medicine, Isehara, Kanagawa, Japan
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11
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Shi HT, Chu HX, Gu W, Cai XY, Guo JJ, Ding ZG, Gao W, Ma LL, Zhu JB, Liu HB, Huang ZY, Wang QB, Ge JB, Wen SJ. Second-generation versus first-generation drug-eluting stents in saphenous vein graftdisease: A meta-analysis of randomized controlled trials. Int J Cardiol 2016; 214:393-7. [PMID: 27085653 DOI: 10.1016/j.ijcard.2016.03.228] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Accepted: 03/27/2016] [Indexed: 10/22/2022]
Abstract
BACKGROUND Second-generation drug-eluting stents (DESs) have become increasingly popular devices for patients with saphenous vein graft (SVG) disease. Second-generation DESs were designed to have more safety and efficacy than first-generation DES, but clinical outcomes in SVG disease remain conflicting. METHODS AND RESULTS Randomized controlled trials (RCTs) were identified when comparing second- versus first-generation DESs in SVG disease. The main endpoint was all-cause death. The time of follow-up was at least 30days. The secondary endpoints were major adverse cardiovascular events (MACEs), target vessel revascularization (TVR), target lesion revascularization (TLR), myocardial infarction (MI), and stent thrombosis. These endpoints were assessed at 30days, 12months and 24months. Four RCTs with 1077 SVG patients undergoing the implantation of DES were collected in the current meta-analysis. As a result, second-generation DES-treated patients had the significantly lower MACE rates at 12months (P=0.03; OR: 0.69, 95% CI: 0.49,0.97). No differences in two groups were seen in all-cause death, MI, TVR, stent thrombosis and TLR. CONCLUSIONS Our limited evidence indicated that, second-generation DES in SVG patients, compared with first-generation DES, offered similar levels of safety, but were more effective than the former one.
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Affiliation(s)
- Hong-Tao Shi
- Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, 200032 Shanghai, PR China
| | - Hong-Xia Chu
- Department of Cardiology, Yuhuangding Hospital, Qingdao Medical College, Qingdao University, 264000 Yantai, Shandong Province, PR China
| | - Wei Gu
- Department of Hypertension Research, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Diseases, 100029 Beijing, PR China
| | - Xin-Yong Cai
- Department of Cardiology, Jiangxi Provincial People's Hospital, 330006 Nanchang, Jiangxi Province, PR China
| | - Jun-Jie Guo
- Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, 200032 Shanghai, PR China; Department of Cardiology, the Affiliated Hospital of Qingdao University, 266003 Qingdao, Shandong Province, PR China
| | - Zhao-Gang Ding
- Department of Cardiology, Rizhao City Hospital of Traditional Chinese Medicine, 276800 Rizhao, Shandong Province, PR China
| | - Wei Gao
- Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, 200032 Shanghai, PR China
| | - Lei-Lei Ma
- Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, 200032 Shanghai, PR China
| | - Jian-Bing Zhu
- Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, 200032 Shanghai, PR China
| | - Hai-Bo Liu
- Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, 200032 Shanghai, PR China
| | - Zhe-Yong Huang
- Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, 200032 Shanghai, PR China
| | - Qi-Bing Wang
- Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, 200032 Shanghai, PR China
| | - Jun-Bo Ge
- Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, 200032 Shanghai, PR China.
| | - Shao-Jun Wen
- Department of Hypertension Research, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Diseases, 100029 Beijing, PR China.
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12
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Lee MS, Manthripragada G. Saphenous Vein Graft Interventions. Interv Cardiol Clin 2016; 5:135-141. [PMID: 28582199 DOI: 10.1016/j.iccl.2015.12.002] [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: 06/07/2023]
Abstract
Saphenous vein graft interventions compose a small but important subset of percutaneous coronary revascularization. Because of their unique biology, percutaneous angioplasty and stenting require tailored patient and lesion selection and modification of intervention technique to optimize outcomes. The use of embolic protection and appropriate adjunctive pharmacology can help minimize periprocedural complications, such as the no-reflow phenomenon. Recommendations for best practice in saphenous vein graft interventions continue to evolve with emerging research and therapy.
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Affiliation(s)
- Michael S Lee
- Cardiology Division, Department of Medicine, 100 Medical Plaza, Suite 630, Los Angeles, CA 90095, USA.
| | - Gopi Manthripragada
- Cardiology Division, Department of Medicine, 100 Medical Plaza, Suite 630, Los Angeles, CA 90095, USA
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13
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Kolte D, Dawn Abbott J. Saphenous vein graft lesions: Are second-generation drug-eluting stents better? Catheter Cardiovasc Interv 2016; 87:41-2. [PMID: 27410952 DOI: 10.1002/ccd.26390] [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] [Received: 11/25/2015] [Accepted: 12/05/2015] [Indexed: 11/11/2022]
Abstract
Long-term outcomes were similar in patients treated with first- or second-generation drug-eluting stents (DES) for saphenous vein graft (SVG) lesions. Patients presenting with acute myocardial infarction as a result of occluded SVG may derive some benefit from the use of second- versus first-generation DES Randomized clinical trials are needed to determine whether newer DES types including those with bioabsorbable polymer or scaffolds offer a distinct advantage in the treatment of SVG lesions.
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Affiliation(s)
- Dhaval Kolte
- Division of Cardiology, Warren Alpert Medical School, Brown University, Providence, Rhode Island
| | - J Dawn Abbott
- Division of Cardiology, Warren Alpert Medical School, Brown University, Providence, Rhode Island
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14
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Gori T, Jansen T, Weissner M, Foin N, Wenzel P, Schulz E, Cook S, Münzel T. Coronary evaginations and peri-scaffold aneurysms following implantation of bioresorbable scaffolds: incidence, outcome, and optical coherence tomography analysis of possible mechanisms. Eur Heart J 2015; 37:2040-9. [PMID: 26543048 DOI: 10.1093/eurheartj/ehv581] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2015] [Accepted: 08/27/2015] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Peri-stent coronary evaginations may disturb flow and have been proposed as possible risk factor for late stent thrombosis. We describe incidence, predictors, and possible mechanisms of coronary evaginations 12 months after implantation of bioresorbable vascular scaffolds (BVS). METHODS AND RESULTS One hundred and two BVS implanted in 90 patients (age 63 ± 13 years, 71 males, 14 diabetics) were analysed with angiography and optical coherence tomography (OCT) 12 months after implantation. Evaginations were identified as any hollow in the luminal vessel contour between well-apposed struts and were classified as major when extending ≥3 mm with a depth ≥10% of the BVS diameter. Fifty-five (54%) of the BVS (50(56%) of the patients) had at least one evagination (6.1 ± 6.2 evaginations per BVS), with a mean volume of 1.9 ± 1.9 mm(3). Major evaginations were only found in one patient, and in-BVS aneurysms in three patients (4BVS). The presence of evaginations was strongly associated with that of malapposition (P = 0.003) and strut fractures (P = 0.01). No association could be shown between the presence and volume of the evaginations and any clinical variable or the presence of uncovered struts (P > 0.5). Peri-strut low-intensity areas (PSLIA) were present in 29 (53%) of the BVS with evaginations and 12 (26%) of those without (P = 0.0049); their presence was independently associated with the presence, the number (P < 0.003) and volume of the evaginations (P = 0.004) and with that of strut fracture. CONCLUSIONS Optical coherence tomography-detected evaginations are relatively common after BVS implantation, but, as for modern drug-eluting metallic stents, major evaginations are very rare. Optical coherence tomography evidence of immature neointima and strut fractures were associated with more severe development of evaginations.
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Affiliation(s)
- Tommaso Gori
- II. Medizinische Klinik und Poliklinik, University Medical Center Mainz, Langenbeckstrasse 1, Mainz 55131 and Deutsches Zentrum für Herz und Kreislauf Forschung, Standort Rhein-Main, Germany
| | - Thomas Jansen
- II. Medizinische Klinik und Poliklinik, University Medical Center Mainz, Langenbeckstrasse 1, Mainz 55131 and Deutsches Zentrum für Herz und Kreislauf Forschung, Standort Rhein-Main, Germany
| | - Melissa Weissner
- II. Medizinische Klinik und Poliklinik, University Medical Center Mainz, Langenbeckstrasse 1, Mainz 55131 and Deutsches Zentrum für Herz und Kreislauf Forschung, Standort Rhein-Main, Germany
| | - Nicolas Foin
- National Heart Centre Singapore, Singapore, Singapore
| | - Philip Wenzel
- II. Medizinische Klinik und Poliklinik, University Medical Center Mainz, Langenbeckstrasse 1, Mainz 55131 and Deutsches Zentrum für Herz und Kreislauf Forschung, Standort Rhein-Main, Germany
| | - Eberhard Schulz
- II. Medizinische Klinik und Poliklinik, University Medical Center Mainz, Langenbeckstrasse 1, Mainz 55131 and Deutsches Zentrum für Herz und Kreislauf Forschung, Standort Rhein-Main, Germany
| | - Stephane Cook
- Hospital and University of Fribourg, Fribourg, Switzerland
| | - Thomas Münzel
- II. Medizinische Klinik und Poliklinik, University Medical Center Mainz, Langenbeckstrasse 1, Mainz 55131 and Deutsches Zentrum für Herz und Kreislauf Forschung, Standort Rhein-Main, Germany
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15
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Pokala NR, Menon RV, Patel SM, Christopoulos G, Christakopoulos GE, Kotsia AP, Rangan BV, Roesle M, Abdullah S, Grodin J, Kumbhani DJ, Hastings J, Banerjee S, Brilakis ES. Long-term outcomes with first- vs. second-generation drug-eluting stents in saphenous vein graft lesions. Catheter Cardiovasc Interv 2015; 87:34-40. [DOI: 10.1002/ccd.25982] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2014] [Accepted: 04/04/2015] [Indexed: 11/05/2022]
Affiliation(s)
- Nagendra R. Pokala
- Department of Cardiovascular Diseases; VA North Texas Healthcare System and UT Southwestern Medical Center; Dallas Texas
| | - Rohan V. Menon
- Department of Cardiovascular Diseases; VA North Texas Healthcare System and UT Southwestern Medical Center; Dallas Texas
| | - Siddharth M. Patel
- Department of Cardiovascular Diseases; VA North Texas Healthcare System and UT Southwestern Medical Center; Dallas Texas
| | - George Christopoulos
- Department of Cardiovascular Diseases; VA North Texas Healthcare System and UT Southwestern Medical Center; Dallas Texas
| | - Georgios E. Christakopoulos
- Department of Cardiovascular Diseases; VA North Texas Healthcare System and UT Southwestern Medical Center; Dallas Texas
| | - Anna P. Kotsia
- Department of Cardiovascular Diseases; VA North Texas Healthcare System and UT Southwestern Medical Center; Dallas Texas
| | - Bavana V. Rangan
- Department of Cardiovascular Diseases; VA North Texas Healthcare System and UT Southwestern Medical Center; Dallas Texas
| | - Michele Roesle
- Department of Cardiovascular Diseases; VA North Texas Healthcare System and UT Southwestern Medical Center; Dallas Texas
| | - Shuaib Abdullah
- Department of Cardiovascular Diseases; VA North Texas Healthcare System and UT Southwestern Medical Center; Dallas Texas
| | - Jerrold Grodin
- Department of Cardiovascular Diseases; VA North Texas Healthcare System and UT Southwestern Medical Center; Dallas Texas
| | - Dharam J. Kumbhani
- Department of Cardiovascular Diseases; VA North Texas Healthcare System and UT Southwestern Medical Center; Dallas Texas
| | - Jeffrey Hastings
- Department of Cardiovascular Diseases; VA North Texas Healthcare System and UT Southwestern Medical Center; Dallas Texas
| | - Subhash Banerjee
- Department of Cardiovascular Diseases; VA North Texas Healthcare System and UT Southwestern Medical Center; Dallas Texas
| | - Emmanouil S. Brilakis
- Department of Cardiovascular Diseases; VA North Texas Healthcare System and UT Southwestern Medical Center; Dallas Texas
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Spitzer E, Windecker S. Paclitaxel-eluting stents in ST-segment elevation myocardial infarction. ACTA ACUST UNITED AC 2014; 67:974-9. [PMID: 25444381 DOI: 10.1016/j.rec.2014.07.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2014] [Accepted: 07/15/2014] [Indexed: 10/24/2022]
Affiliation(s)
- Ernest Spitzer
- Department of Cardiology, Bern University Hospital, Bern, Switzerland
| | - Stephan Windecker
- Department of Cardiology, Bern University Hospital, Bern, Switzerland.
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Spitzer E, Windecker S. Stents liberadores de paclitaxel en el infarto agudo de miocardio con elevación del segmento ST. Rev Esp Cardiol 2014. [DOI: 10.1016/j.recesp.2014.07.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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