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Yamaguchi T, Yamazaki T, Yoshida H, Matsumoto K, Yahiro R, Nakao K, Kure Y, Okai T, Shimada T, Otsuka K, Izumiya Y, Fukuda D. Tissue responses to everolimus-eluting stents implanted in severely calcified lesions following atherectomy. Cardiovasc Interv Ther 2024; 39:34-44. [PMID: 37864118 PMCID: PMC10764536 DOI: 10.1007/s12928-023-00965-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 09/27/2023] [Indexed: 10/22/2023]
Abstract
Histopathological examination has revealed that stents on severely calcified plaques were associated with delayed vascular healing. Although atherectomy devices can increase the number of malapposed struts, tissue responses to implanted drug eluting stents in atherectomy patients remain largely unknown. This retrospective observational study included 30 patients who underwent atherectomy and everolimus-eluting stent (EES) deployment for severely calcified coronary lesions (biodegradable polymer EES (BP-EES), n = 15; durable polymer EES (DP-EES), n = 15). Optical coherence tomography was carried out at baseline and follow-up, and struts with acute stent malapposition (ASM) were categorized as struts on modified calcium (mod-Ca), non-modified calcium (non-mod-Ca), or non-calcium (non-Ca). Adequate vascular healing, defined as ASM resolution with neointimal coverage, was compared between the BP-EES and DP-EES groups. Multivariate linear regression analysis using a generalized estimated equation revealed that BP-EES use was associated with significantly better adequate vascular healing compared with DP-EES (odds ratio [OR]: 3.691, 95% confidence interval [CI] 1.175-11.592, P = 0.025). adequate vascular healing was associated with the underlying plaque morphology (mod-Ca vs non-mod-Ca: OR 2.833, 95% CI 1.491-5.384, P = 0.001; non-Ca vs non-mod-Ca: OR 1.248, 95% CI 0.440-3.543, P = 0.677). This study demonstrates that drug-eluting stent selection and calcium modification are possible factors affecting vascular healing of malapposed struts in severely calcified lesions.
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Affiliation(s)
- Tomohiro Yamaguchi
- Department of Cardiovascular Medicine, Osaka Metropolitan University Graduate School of Medicine, 1-4-3 Asahimachi, Abeno-Ku, Osaka, 545-8585, Japan
| | - Takanori Yamazaki
- Department of Cardiovascular Medicine, Osaka Metropolitan University Graduate School of Medicine, 1-4-3 Asahimachi, Abeno-Ku, Osaka, 545-8585, Japan.
| | - Hisako Yoshida
- Department of Medical Statistics, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
| | - Kotaro Matsumoto
- Department of Cardiovascular Medicine, Osaka Metropolitan University Graduate School of Medicine, 1-4-3 Asahimachi, Abeno-Ku, Osaka, 545-8585, Japan
| | - Ryosuke Yahiro
- Department of Cardiovascular Medicine, Kashiwara Municipal Hospital, Osaka, Japan
| | - Kazuhiro Nakao
- Department of Cardiovascular Medicine, Ishikiri Seiki Hospital, Osaka, Japan
| | - Yusuke Kure
- Department of Cardiovascular Medicine, Osaka Metropolitan University Graduate School of Medicine, 1-4-3 Asahimachi, Abeno-Ku, Osaka, 545-8585, Japan
| | - Tsukasa Okai
- Department of Cardiovascular Medicine, Osaka Metropolitan University Graduate School of Medicine, 1-4-3 Asahimachi, Abeno-Ku, Osaka, 545-8585, Japan
| | - Takenobu Shimada
- Department of Cardiovascular Medicine, Osaka Metropolitan University Graduate School of Medicine, 1-4-3 Asahimachi, Abeno-Ku, Osaka, 545-8585, Japan
| | - Kenichiro Otsuka
- Department of Cardiovascular Medicine, Osaka Metropolitan University Graduate School of Medicine, 1-4-3 Asahimachi, Abeno-Ku, Osaka, 545-8585, Japan
| | - Yasuhiro Izumiya
- Department of Cardiovascular Medicine, Osaka Metropolitan University Graduate School of Medicine, 1-4-3 Asahimachi, Abeno-Ku, Osaka, 545-8585, Japan
| | - Daiju Fukuda
- Department of Cardiovascular Medicine, Osaka Metropolitan University Graduate School of Medicine, 1-4-3 Asahimachi, Abeno-Ku, Osaka, 545-8585, Japan
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Matsuhiro Y, Egami Y, Okamoto N, Kusuda M, Sakio T, Nohara H, Sugae H, Kawanami S, Kawamura A, Ukita K, Nakamura H, Yasumoto K, Tsuda M, Matsunaga-Lee Y, Yano M, Nishino M, Tanouchi J. Early vascular healing of ultra-thin strut polymer-free sirolimus-eluting stents in acute coronary syndrome: USUI-ACS study. Cardiovasc Interv Ther 2023; 38:55-63. [PMID: 35477831 DOI: 10.1007/s12928-022-00862-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 04/15/2022] [Indexed: 01/06/2023]
Abstract
Ultra-thin strut polymer-free sirolimus-eluting stent (UPF-SES) have two novel characteristics, ultra-thin strut and polymer-free coating, which have the potential to achieve early re-endotherialization. However, a little is known whether early vascular healing of UPF-SES can be achieved in patients with acute coronary syndrome (ACS). The aim of this study was to evaluate the vascular healing after an implantation of UPF-SES in patients with ACS using optical coherence tomography (OCT) at 3 months after the stent implantation. From September 2020 and January 2021, a total of 31 consecutive patients presenting with ACS who underwent OCT-guided percutaneous coronary intervention (PCI) and 3 month follow-up OCT examination were enrolled in the USUI-ACS study. The endpoints of this study were neointimal strut coverage, malapposition, and mean neointimal hyperplasia (NIH) thickness at 3 month follow-up. Over a mean follow-up of 91 days after the initial PCI, the follow-up OCT was examined. The median percentage of covered struts was 98.4% and malapposed struts 0%, and the mean NIH thickness was 80 μm. UPF-SES exhibited an excellent early vascular healing at 3 months in patients with ACS.
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Kawamura A, Egami Y, Kawanami S, Sugae H, Ukita K, Nakamura H, Matsuhiro Y, Yasumoto K, Tsuda M, Okamoto N, Matsunaga-Lee Y, Yano M, Nishino M, Tanouchi J. Preferable vascular healing of ultrathin strut biodegradable-polymer sirolimus-eluting stents in patients with acute coronary syndrome. Cardiovasc Interv Ther 2022; 37:681-690. [PMID: 35113330 DOI: 10.1007/s12928-022-00842-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 01/24/2022] [Indexed: 11/02/2022]
Abstract
This study aimed to compare the strut coverage between Orsiro ultrathin struts biodegradable polymer sirolimus-eluting stents (O-SES) and Xience thin struts durable polymer everolimus-eluting stents (X-EES) in acute coronary syndrome (ACS) patients using optical coherence tomography (OCT). In BIOSTEMI trial, O-SESs were superior to X-EESs with respect to target lesion failure in ACS patients. However, there were few reports comparing intravascular imaging between the two stents in ACS. Between August 2016 and February 2020, 49 lesions from 49 ACS patients who underwent OCT-guided percutaneous coronary intervention were enrolled. We compared vascular healing using OCT between O-SESs and X-EESs at 8 months after stenting. The protocol was approved by the Osaka Rosai Hospital ethics committee. Among 49 lesions, the X-EES group consisted of 24 lesions and the O-SES of 25 lesions. The percentage of covered strut, the percentage of malapposed strut and mean neointimal thickness at 8 months were evaluated. In the 8-month OCT analysis, the proportion of covered strut was significantly higher in the O-SES group than in in the X-EES group (97.3% vs. 92.5%; p = 0.010). On the other hand, there were no significant differences in the frequency of malapposed strut (0.4% vs 0.3%, p = 0.609). The O-SES group had the significantly thinner neointima compared to the X-EES group (60 μm vs 84 μm, p = 0.001). Compared to X-EESs, O-SESs showed better strut coverage and thinner neointima in ACS patients at 8 months follow-up. Ultra-thin strut and silicon carbide passive coating may play a key role in better vascular healing.
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Affiliation(s)
- Akito Kawamura
- Division of Cardiology, Osaka Rosai Hospital, 1179-3, Nagasone-cho, kita-ku, Sakai-city, Osaka, 591-8025, Japan
| | - Yasuyuki Egami
- Division of Cardiology, Osaka Rosai Hospital, 1179-3, Nagasone-cho, kita-ku, Sakai-city, Osaka, 591-8025, Japan
| | - Shodai Kawanami
- Division of Cardiology, Osaka Rosai Hospital, 1179-3, Nagasone-cho, kita-ku, Sakai-city, Osaka, 591-8025, Japan
| | - Hiroki Sugae
- Division of Cardiology, Osaka Rosai Hospital, 1179-3, Nagasone-cho, kita-ku, Sakai-city, Osaka, 591-8025, Japan
| | - Kohei Ukita
- Division of Cardiology, Osaka Rosai Hospital, 1179-3, Nagasone-cho, kita-ku, Sakai-city, Osaka, 591-8025, Japan
| | - Hitoshi Nakamura
- Division of Cardiology, Osaka Rosai Hospital, 1179-3, Nagasone-cho, kita-ku, Sakai-city, Osaka, 591-8025, Japan
| | - Yutaka Matsuhiro
- Division of Cardiology, Osaka Rosai Hospital, 1179-3, Nagasone-cho, kita-ku, Sakai-city, Osaka, 591-8025, Japan
| | - Koji Yasumoto
- Division of Cardiology, Osaka Rosai Hospital, 1179-3, Nagasone-cho, kita-ku, Sakai-city, Osaka, 591-8025, Japan
| | - Masaki Tsuda
- Division of Cardiology, Osaka Rosai Hospital, 1179-3, Nagasone-cho, kita-ku, Sakai-city, Osaka, 591-8025, Japan
| | - Naotaka Okamoto
- Division of Cardiology, Osaka Rosai Hospital, 1179-3, Nagasone-cho, kita-ku, Sakai-city, Osaka, 591-8025, Japan
| | - Yasuharu Matsunaga-Lee
- Division of Cardiology, Osaka Rosai Hospital, 1179-3, Nagasone-cho, kita-ku, Sakai-city, Osaka, 591-8025, Japan
| | - Masamichi Yano
- Division of Cardiology, Osaka Rosai Hospital, 1179-3, Nagasone-cho, kita-ku, Sakai-city, Osaka, 591-8025, Japan
| | - Masami Nishino
- Division of Cardiology, Osaka Rosai Hospital, 1179-3, Nagasone-cho, kita-ku, Sakai-city, Osaka, 591-8025, Japan.
| | - Jun Tanouchi
- Division of Cardiology, Osaka Rosai Hospital, 1179-3, Nagasone-cho, kita-ku, Sakai-city, Osaka, 591-8025, Japan
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Zahreddine R, Davezac M, Buscato M, Smirnova N, Laffargue M, Henrion D, Adlanmerini M, Lenfant F, Arnal JF, Fontaine C. A historical view of estrogen effect on arterial endothelial healing: From animal models to medical implication. Atherosclerosis 2021; 338:30-38. [PMID: 34785429 DOI: 10.1016/j.atherosclerosis.2021.10.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 10/18/2021] [Accepted: 10/29/2021] [Indexed: 12/11/2022]
Abstract
Endothelial barrier integrity is required for maintaining vascular homeostasis and fluid balance between the circulation and surrounding tissues. In contrast, abnormalities of endothelial cell function and loss of the integrity of the endothelial monolayer constitute a key step in the onset of atherosclerosis. Endothelial erosion is directly responsible for thrombus formation and cardiovascular events in about one-third of the cases of acute coronary syndromes. Thus, after endothelial injury, the vascular repair process is crucial to restore endothelial junctions and rehabilitate a semipermeable barrier, preventing the development of vascular diseases. Endothelial healing can be modulated by several factors. In particular, 17β-estradiol (E2), the main estrogen, improves endothelial healing, reduces neointimal accumulation of smooth muscle cells and atherosclerosis in several animal models. The aim of this review is to highlight how various experimental models enabled the progress in the cellular and molecular mechanisms underlying the accelerative E2 effect on arterial endothelial healing through the estrogen receptor (ER) α, the main receptor mediating the physiological effects of estrogens. We first summarize the different experimental procedures used to reproduce vascular injury. We then provide an overview of how the combination of transgenic mouse models impacting ERα signalling with pharmacological tools demonstrated the pivotal role of non-genomic actions of ERα in E2-induced endothelial repair. Finally, we describe recent advances in the action of selective estrogen receptor modulators (SERMs) on this beneficial vascular effect, which surprisingly involves different cell types and activates different ERα subfunctions compared to E2.
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Affiliation(s)
- Rana Zahreddine
- I2MC, Institut National de la Santé et de la Recherche Médicale (INSERM) UMR1297, University of Toulouse3, Toulouse, France
| | - Morgane Davezac
- I2MC, Institut National de la Santé et de la Recherche Médicale (INSERM) UMR1297, University of Toulouse3, Toulouse, France
| | - Melissa Buscato
- I2MC, Institut National de la Santé et de la Recherche Médicale (INSERM) UMR1297, University of Toulouse3, Toulouse, France
| | - Natalia Smirnova
- I2MC, Institut National de la Santé et de la Recherche Médicale (INSERM) UMR1297, University of Toulouse3, Toulouse, France
| | - Muriel Laffargue
- I2MC, Institut National de la Santé et de la Recherche Médicale (INSERM) UMR1297, University of Toulouse3, Toulouse, France
| | - Daniel Henrion
- MITOVASC Institute, CARFI Facility, INSERM U1083, UMR CNRS 6015, University of Angers, France
| | - Marine Adlanmerini
- I2MC, Institut National de la Santé et de la Recherche Médicale (INSERM) UMR1297, University of Toulouse3, Toulouse, France
| | - Françoise Lenfant
- I2MC, Institut National de la Santé et de la Recherche Médicale (INSERM) UMR1297, University of Toulouse3, Toulouse, France
| | - Jean-François Arnal
- I2MC, Institut National de la Santé et de la Recherche Médicale (INSERM) UMR1297, University of Toulouse3, Toulouse, France
| | - Coralie Fontaine
- I2MC, Institut National de la Santé et de la Recherche Médicale (INSERM) UMR1297, University of Toulouse3, Toulouse, France.
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de la Torre Hernandez JM, Otaegui I, Subinas A, Gomez-Menchero A, Moreno R, Rondan J, Muñoz-Garcia E, Sainz-Laso F, Garcia Del Blanco B, Rumoroso JR, Diaz JF, Berenguer A, Gomez-Lara J, Zueco J. First-in-Man Evaluation of a Sirolimus-Eluting Stent With Abluminal Fluoropolymeric/Triflusal Coating With Ultrathin Struts by OCT at 9 Months' Follow-Up: The PROMETHEUS Study. Cardiovasc Revasc Med 2021; 32:18-24. [PMID: 33386256 DOI: 10.1016/j.carrev.2020.12.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Revised: 12/22/2020] [Accepted: 12/22/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVES We sought to investigate stent healing and neointimal hyperplasia with ihtDEStiny drug-eluting stent (DES) by optical coherence tomography (OCT) examination conducted 9 months after implantation. BACKGROUND The currently used DES present certain features that have been linked separately to their better performance in terms of efficacy and safety. METHODS First-in-man, prospective and multicenter study including patients treated with ihtDEStiny stent undergoing OCT examination at 9 months follow up. The ihtDEStiny stent is a sirolimus eluting stent with an oval shape ultrathin struts (68 μm) and an abluminal coating of a fluoropolymer containing the antiplatelet agent triflusal. Primary endpoint was the percentage of obstruction of the in-stent volume by the neointima. RESULTS In 58 patients (63 lesions) in-stent late lumen loss was 0.11 ± 0.23 mm (95% CI 0.05-0.16) with only in 6% of stents being > 0.5 mm and in-segment binary stenosis was 1.6%. In OCT mean neointima volume obstruction was 10.5 ± 6.9% with a mean neointima thickness of 110.9 ± 89.8 μm. The proportion of uncovered struts was 2.5%, malapposed struts 1.1% and malapposed/uncovered struts 0.7% and no subclinical thrombi detected. Mean incomplete stent apposition area was 0.1 ± 0.1 mm2. At 12 months target lesion revascularization rate was 3% and no stent thrombosis was reported. CONCLUSIONS In this study the ihtDEStiny stent has shown a very low degree of neointimal proliferation associated with a low rate of uncovered/malapposed struts and total absence of subclinical thrombi at 9 months follow up.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | - Javier Zueco
- Hospital Marques de Valdecilla, IDIVAL, Santander, Spain
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Matsuhiro Y, Nakamura D, Shutta R, Kawamura A, Nakamura H, Okamoto N, Matsunaga-Lee Y, Yano M, Egami Y, Sakata Y, Nishino M, Tanouchi J. Difference of vascular healing between bioabsorbable-polymer and durable-polymer new generation drug-eluting stents: an optical coherence tomographic analysis. Int J Cardiovasc Imaging 2020; 37:1131-1141. [PMID: 33165669 DOI: 10.1007/s10554-020-02094-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 10/28/2020] [Indexed: 11/26/2022]
Abstract
The comparison of bioabsorbable-polymer and durable-polymer stents has continued to be debated, and there is ongoing concern regarding vascular healing and late stent thrombosis. This study compared the vascular healing at 8-month follow-up by optical coherence tomography (OCT) between 4 different kinds of new generation drug-eluting stents (DESs). We enrolled 112 patients (112 de novo lesions) who underwent OCT guided percutaneous coronary intervention with 4 kinds of new generation DESs including bioabsorbable-polymer everolimus-eluting stents (BP-EESs), bioabsorbable-polymer sirolimus-eluting stents (BP-SESs), durable-polymer everolimus-eluting stents (DP-EESs), and durable-polymer zotarolimus-eluting stents (DP-ZESs) and an 8-month follow-up angiogram and OCT were performed between July 2016 and April 2018. We divided them into two groups, namely BP and DP groups. We compared the OCT parameters including the percentage of uncovered struts, malapposed struts and the mean neointimal hyperplasia (NIH) thickness between the two groups. BP group consisted of 51 lesions (BP-EESs were used in 27, BP-SESs in 24 lesions) and DP group consisted of 61 lesions (DP-EESs were used in 35 and DP-ZESs in 26 lesions). The percentage of uncovered struts and malapposed struts were significantly lower (7.2 ± 8.9 vs. 15.0 ± 17.1%, p = 0.01, 0.9 ± 1.7 vs. 2.7 ± 5.2%, p = 0.03) and the mean NIH thickness was significantly thicker in BP group than DP group (112 ± 54 vs. 83 ± 31 µm, p < 0.01). The present OCT study demonstrated that uncovered struts and malapposed struts were less common with bioabsorbable-polymer stents than with durable-polymer stents.
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Affiliation(s)
- Yutaka Matsuhiro
- Division of Cardiology, Osaka Rosai Hospital, 1179-3, Nagasone-cho, Sakai-City, Osaka, 591-8025, Japan
| | - Daisuke Nakamura
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Suita, Japan
| | - Ryu Shutta
- Division of Cardiology, Osaka Rosai Hospital, 1179-3, Nagasone-cho, Sakai-City, Osaka, 591-8025, Japan
| | - Akito Kawamura
- Division of Cardiology, Osaka Rosai Hospital, 1179-3, Nagasone-cho, Sakai-City, Osaka, 591-8025, Japan
| | - Hitoshi Nakamura
- Division of Cardiology, Osaka Rosai Hospital, 1179-3, Nagasone-cho, Sakai-City, Osaka, 591-8025, Japan
| | - Naotaka Okamoto
- Division of Cardiology, Osaka Rosai Hospital, 1179-3, Nagasone-cho, Sakai-City, Osaka, 591-8025, Japan
| | - Yasuharu Matsunaga-Lee
- Division of Cardiology, Osaka Rosai Hospital, 1179-3, Nagasone-cho, Sakai-City, Osaka, 591-8025, Japan
| | - Masamichi Yano
- Division of Cardiology, Osaka Rosai Hospital, 1179-3, Nagasone-cho, Sakai-City, Osaka, 591-8025, Japan
| | - Yasuyuki Egami
- Division of Cardiology, Osaka Rosai Hospital, 1179-3, Nagasone-cho, Sakai-City, Osaka, 591-8025, Japan
| | - Yasushi Sakata
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Suita, Japan
| | - Masami Nishino
- Division of Cardiology, Osaka Rosai Hospital, 1179-3, Nagasone-cho, Sakai-City, Osaka, 591-8025, Japan.
| | - Jun Tanouchi
- Division of Cardiology, Osaka Rosai Hospital, 1179-3, Nagasone-cho, Sakai-City, Osaka, 591-8025, Japan
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Hansen KN, Antonsen L, Maehara A, Mæng M, Ellert J, Ahlehoff O, Veien KT, Hansen KN, Noori M, Fallesen CO, Thim T, Christiansen EH, Jensen LO. Influence of Plaque Characteristics on Early Vascular Healing in Patients With ST-Elevation Myocardial Infarction. Cardiovasc Revasc Med 2020; 30:50-58. [PMID: 33012685 DOI: 10.1016/j.carrev.2020.09.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 09/21/2020] [Accepted: 09/21/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVES To compare the early vascular healing of ruptured plaques (RP) and non-ruptured plaques (NRP) one month after primary percutaneous coronary intervention (PCI) in patients with ST-segment elevation myocardial infarction (STEMI), using optical coherence tomography (OCT). BACKGROUND Vascular healing and strut coverage are important factors in reducing the risk of stent thrombosis after PCI. Influence of underlying lesion characteristics and differences in healing response between RP and NRP are unknown. METHODS Twenty-six STEMI-patients underwent PCI and implantation of a polymer-free drug-coated Biofreedom stent (BF-BES). OCT was performed pre-PCI, post-PCI and at 1-month follow-up. The patients were divided into two groups: RP = 15 and NRP = 11. OCT analyses of culprit lesion, post stent implantation at baseline and follow-up were performed to determine the difference in vascular healing based on presence of uncovered and/or malapposed stent struts and intraluminal filling defects. RESULTS The stent coverage did not differ significantly between the two groups at 1-month follow-up with percentage of uncovered struts: RP 26.5% [IQR 15.0-49.0] and NRP 28.1% [IQR 15.5-38.8] for NRP (p = 0.78). At 1-month, RP showed an increased percentage of late acquired malapposed struts (1.4% [IQR 0.8-2.4] vs. 0.0% [IQR 0.0-1.4], p = 0.03) and a larger total malapposition area (1.3 mm2 [IQR 0.4-2.5] vs. 0.0 mm2 [IQR 0.0-0.9], p = 0.01), compared to NRP. CONCLUSION Three out of four struts were covered within one month after stenting. The vascular healing was comparable in RP and NRP on stent coverage. However, RP had more and larger late acquired malapposition areas.
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Affiliation(s)
- Kirstine N Hansen
- Department of Cardiology, Odense University Hospital, Odense, Denmark.
| | - Lisbeth Antonsen
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | - Akiko Maehara
- Cardiovascular Research Foundation, New York, NY, USA
| | - Michael Mæng
- Department of Cardiology, Aarhus University Hospital, Arhus, Denmark
| | - Julia Ellert
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | - Ole Ahlehoff
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | | | | | - Manijeh Noori
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | | | - Troels Thim
- Department of Cardiology, Aarhus University Hospital, Arhus, Denmark
| | | | - Lisette O Jensen
- Department of Cardiology, Odense University Hospital, Odense, Denmark
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Wan Ahmad WA, Nakayoshi T, Mahmood Zuhdi AS, Ismail MD, Zainal Abidin I, Ino Y, Kubo T, Akasaka T, Fukumoto Y, Ueno T. Different vascular healing process between bioabsorbable polymer-coated everolimus-eluting stents versus bioresorbable vascular scaffolds via optical coherence tomography and coronary angioscopy (the ENHANCE study: ENdothelial Healing Assessment with Novel Coronary tEchnology). Heart Vessels 2019; 35:463-473. [PMID: 31587103 PMCID: PMC7085473 DOI: 10.1007/s00380-019-01516-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Accepted: 09/20/2019] [Indexed: 11/26/2022]
Abstract
Recent clinical trials have raised concerns about the safety and efficacy of ABSORB™ bioresorbable vascular scaffolds (BVS). The difference in the vascular healing process between SYNERGY™ bioabsorbable polymer-coated everolimus-eluting stents (BP-EES) and BVS remains unclear. The aim of the ENHANCE study was to compare vascular healing on BP-EES versus BVS by optical coherence tomography (OCT) and coronary angioscopy (CAS) at 4- and 12-month follow-ups. This is a prospective, non-randomized, single center clinical trial. Thirteen eligible patients with multivessel disease were enrolled. BP-EES and BVS were simultaneously implanted in the same patients, but in different coronary vessels. Imaging follow-up with both OCT and CAS was completed in 11 patients at 12 months. Neointimal coverage rates were similar between the two groups based on OCT measurements. The neointimal thickness of BP-EES was significantly thicker at the 12th month than at the 4th month, whereas the neointimal thickness of BVS did not change between the measurements taken at the 4th and 12th month. Existence of intra-stent thrombus was significantly higher in the BVS group, compared to the BP-EES group. On the other hand, CAS revealed that red-thrombi and yellow-plaque were more frequently observed in BVS at 4 months and up to 12-month follow-ups than in BP-EES. These findings suggested that the evidence of instability remained up to 12 months in the vascular healing with BVS, compared to that with BP-EES. Vascular healing of the stented wall was recognized at the very early phase after BP-EES implantation. However, vascular healing with BVS was still incomplete after 12 months.
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Affiliation(s)
- Wan Azman Wan Ahmad
- Division of Cardiology, Department of Medicine, University Malaya, Kuala Lumpur, Malaysia
| | - Takaharu Nakayoshi
- Department of Internal Medicine, Division of Cardiovascular Medicine, Kurume University School of Medicine, Kurume, Japan
| | | | - Muhammad Dzafir Ismail
- Division of Cardiology, Department of Medicine, University Malaya, Kuala Lumpur, Malaysia
| | - Imran Zainal Abidin
- Division of Cardiology, Department of Medicine, University Malaya, Kuala Lumpur, Malaysia
| | - Yasushi Ino
- Division of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan
| | - Takashi Kubo
- Division of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan
| | - Takashi Akasaka
- Division of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan
| | - Yoshihiro Fukumoto
- Department of Internal Medicine, Division of Cardiovascular Medicine, Kurume University School of Medicine, Kurume, Japan
| | - Takafumi Ueno
- Department of Internal Medicine, Division of Cardiovascular Medicine, Kurume University School of Medicine, Kurume, Japan.
- The Center of Cardiovascular Disease, Kurume University Hospital, 67 Asahi-machi, Kurume, 830-0011, Japan.
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Hansen KN, Antonsen L, Jensen LO. Stent implantation and vascular healing of a spontaneous coronary artery dissection assessed by optical coherence tomography in a patient with acute coronary syndrome. Cardiovasc Revasc Med 2017; 19:376-379. [PMID: 29033367 DOI: 10.1016/j.carrev.2017.08.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Revised: 08/29/2017] [Accepted: 08/29/2017] [Indexed: 11/26/2022]
Abstract
A 60-year old woman with non-ST-segment elevation myocardial infarction, underwent coronary angiogram combined with optical coherence tomography (OCT) revealing a long dissection in the right coronary artery. The patient experienced peri-procedural chest pain, the electrocardiogram showed ST-segment elevations, and compromised coronary blood flow, why mechanical revascularization with percutaneous coronary intervention (PCI) was indicated. At 1-month follow-up, OCT revealed early, competent vascular healing, and a distal stenosis was treated with PCI. The patient has been asymptomatic since the procedure for three years.
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Affiliation(s)
| | - Lisbeth Antonsen
- Department of Cardiology, Odense University Hospital, Odense, Denmark
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10
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Pérez de Prado A, Pérez Martínez C, Cuellas Ramón C, Regueiro Purriños M, López Benito M, Gonzalo Orden JM, Rodríguez Altónaga JA, Estévez Loureiro R, Benito González T, Viñuela Baragaño D, Molina Crisol M, Amorós Aguilar M, Pérez Serranos I, Vidal Parreu A, Benavides Montegordo A, Duocastella Codina L, Fernández Vázquez F. Safety and Efficacy of New Biodegradable Polymer-based Sirolimus-Eluting Stents in a Preclinical Model. ACTA ACUST UNITED AC 2017. [PMID: 28647315 DOI: 10.1016/j.rec.2017.05.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
INTRODUCTION AND OBJECTIVES New drug-eluting stents (DES) designed to overcome the limitations of existing devices should initially be tested in preclinical studies. Our objective was to analyze the safety and efficacy of new biodegradable polymer-based DES compared with bare-metal stents (BMS) and commercially available DES in a model of normal porcine coronary arteries. METHODS We randomly implanted 101 stents (BMS and biodegradable polymer-based sirolimus-eluting stents: 3 test stent iterations [BD1, BD2, and BD3], Orsiro, Biomime and Biomatrix) in the coronary arteries of 34 domestic pigs. Angiographic and histomorphometric studies were conducted 1 month (n = 83) and 3 months (n = 18) later. RESULTS The stents were implanted at a stent/artery ratio of 1.31 ± 0.21, with no significant differences between groups. At 1 month, the new test stents (BD1, BD2 and BD3) showed less late loss and angiographic restenosis, as well as lower histologic restenosis and neointimal area (P < .0005), than the BMS. There were no differences in endothelialization, vascular injury, or inflammation between the new test stents and BMS, although the new stents showed higher fibrin deposition (P = .0006). At 3 months, all these differences disappeared, except for a lower neointimal area with the new BD1 stent (P = .027). No differences at any time point were observed between the new test stents and commercially available controls. CONCLUSIONS In this preclinical model, the new biodegradable polymer-based DES studied showed less restenosis than BMS and no significant differences in safety or efficacy vs commercially available DES.
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Affiliation(s)
- Armando Pérez de Prado
- Grupo Cardiovascular (HemoLeon), Fundación Investigación Sanitaria en León y del Instituto de Biomedicina (IBIOMED), Universidad de León, Hospital Universitario de León, León, Spain.
| | - Claudia Pérez Martínez
- Grupo Cardiovascular (HemoLeon), Fundación Investigación Sanitaria en León y del Instituto de Biomedicina (IBIOMED), Universidad de León, Hospital Universitario de León, León, Spain
| | - Carlos Cuellas Ramón
- Grupo Cardiovascular (HemoLeon), Fundación Investigación Sanitaria en León y del Instituto de Biomedicina (IBIOMED), Universidad de León, Hospital Universitario de León, León, Spain
| | - Marta Regueiro Purriños
- Grupo Cardiovascular (HemoLeon), Fundación Investigación Sanitaria en León y del Instituto de Biomedicina (IBIOMED), Universidad de León, Hospital Universitario de León, León, Spain
| | - María López Benito
- Grupo Cardiovascular (HemoLeon), Fundación Investigación Sanitaria en León y del Instituto de Biomedicina (IBIOMED), Universidad de León, Hospital Universitario de León, León, Spain
| | - José Manuel Gonzalo Orden
- Grupo Cardiovascular (HemoLeon), Fundación Investigación Sanitaria en León y del Instituto de Biomedicina (IBIOMED), Universidad de León, Hospital Universitario de León, León, Spain
| | - José Antonio Rodríguez Altónaga
- Grupo Cardiovascular (HemoLeon), Fundación Investigación Sanitaria en León y del Instituto de Biomedicina (IBIOMED), Universidad de León, Hospital Universitario de León, León, Spain
| | - Rodrigo Estévez Loureiro
- Grupo Cardiovascular (HemoLeon), Fundación Investigación Sanitaria en León y del Instituto de Biomedicina (IBIOMED), Universidad de León, Hospital Universitario de León, León, Spain
| | - Tomás Benito González
- Grupo Cardiovascular (HemoLeon), Fundación Investigación Sanitaria en León y del Instituto de Biomedicina (IBIOMED), Universidad de León, Hospital Universitario de León, León, Spain
| | - David Viñuela Baragaño
- Grupo Cardiovascular (HemoLeon), Fundación Investigación Sanitaria en León y del Instituto de Biomedicina (IBIOMED), Universidad de León, Hospital Universitario de León, León, Spain
| | | | | | | | | | | | | | - Felipe Fernández Vázquez
- Grupo Cardiovascular (HemoLeon), Fundación Investigación Sanitaria en León y del Instituto de Biomedicina (IBIOMED), Universidad de León, Hospital Universitario de León, León, Spain
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11
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Estévez-Loureiro R, Pérez de Prado A, Pérez-Martínez C, Cuellas-Ramón C, Regueiro-Purriños M, Gonzalo-Orden JM, López-Benito M, Molina-Crisol M, Duocastella-Codina L, Fernández-Vázquez F. Safety and Efficacy of New Sirolimus-eluting Stent Models in a Preclinical Study. ACTA ACUST UNITED AC 2015. [PMID: 26206247 DOI: 10.1016/j.rec.2015.02.028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
INTRODUCTION AND OBJECTIVES Initial preclinical studies are required during the process of improving polymers, platforms, and drug-eluting systems for new coronary stent designs. Our objective was to analyze the efficacy and safety of new drug-eluting stent models compared with a conventional stent and commercialized drug-eluting stents in an experimental model with healthy porcine coronary arteries. METHODS Sixty stents (conventional stent, new sirolimus-eluting stents: drug-eluting stents 1, 2 and 3; Cypher(®) and Xience(®)) were randomly placed in the coronary arteries of 20 Large White domestic pigs. Angiographic and histomorphometric studies were done 28 days later. RESULTS The stents were implanted at a stent/artery ratio of 1.34±0.15, with no significant differences between groups. The new stents showed less late loss and angiographic restenosis than conventional stents (P=.006 and P<.001, respectively). Histologically, restenosis and neointimal area were lower with all the new platforms than with the conventional stents (P<.001 for each variable), and no differences were found vs the drug-eluting stents on the market. Safety data showed that endothelialization was lower with drug-eluting stents than with conventional stents, except for drug-eluting stent 3 (P=.084). Likewise, inflammation was lower with drug-eluting stent 3 than with other stents. CONCLUSIONS The new drug-eluting stent platforms studied are associated with less restenosis than conventional stents and showed no significant differences in safety or efficacy vs commercialized drug-eluting stents.
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Affiliation(s)
- Rodrigo Estévez-Loureiro
- Grupo Cardiovascular (HemoLeon), Fundación Investigación Sanitaria en León y del Instituto de Biomedicina (IBIOMED), Universidad de León, Hospital de León, León, Spain.
| | - Armando Pérez de Prado
- Grupo Cardiovascular (HemoLeon), Fundación Investigación Sanitaria en León y del Instituto de Biomedicina (IBIOMED), Universidad de León, Hospital de León, León, Spain
| | - Claudia Pérez-Martínez
- Grupo Cardiovascular (HemoLeon), Fundación Investigación Sanitaria en León y del Instituto de Biomedicina (IBIOMED), Universidad de León, Hospital de León, León, Spain
| | - Carlos Cuellas-Ramón
- Grupo Cardiovascular (HemoLeon), Fundación Investigación Sanitaria en León y del Instituto de Biomedicina (IBIOMED), Universidad de León, Hospital de León, León, Spain
| | - Marta Regueiro-Purriños
- Grupo Cardiovascular (HemoLeon), Fundación Investigación Sanitaria en León y del Instituto de Biomedicina (IBIOMED), Universidad de León, Hospital de León, León, Spain
| | - José M Gonzalo-Orden
- Grupo Cardiovascular (HemoLeon), Fundación Investigación Sanitaria en León y del Instituto de Biomedicina (IBIOMED), Universidad de León, Hospital de León, León, Spain
| | - María López-Benito
- Grupo Cardiovascular (HemoLeon), Fundación Investigación Sanitaria en León y del Instituto de Biomedicina (IBIOMED), Universidad de León, Hospital de León, León, Spain
| | | | | | - Felipe Fernández-Vázquez
- Grupo Cardiovascular (HemoLeon), Fundación Investigación Sanitaria en León y del Instituto de Biomedicina (IBIOMED), Universidad de León, Hospital de León, León, Spain
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Bonello L, Frere C, Cointe S, Laine M, Mancini J, Thuny F, Kerbaul F, Lemesle G, Paganelli F, Guieu R, Arnaud L, Dignat-George F, Sabatier F. Ticagrelor increases endothelial progenitor cell level compared to clopidogrel in acute coronary syndromes: A prospective randomized study. Int J Cardiol 2015; 187:502-7. [PMID: 25846661 DOI: 10.1016/j.ijcard.2015.03.414] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2014] [Revised: 03/27/2015] [Accepted: 03/28/2015] [Indexed: 02/03/2023]
Abstract
BACKGROUND The clinical benefit of ticagrelor compared to clopidogrel in ACS patients suggested off-target property. Such pleiotropic effect could be mediated by circulating endothelial progenitor cells (EPC) which are critical for vascular healing. We aimed to investigate the impact of ticagrelor on EPC in acute coronary syndrome (ACS) patients undergoing percutaneous coronary intervention (PCI). METHODS We prospectively randomized 106 ACS patients to ticagrelor or clopidogrel. Sub-populations of CD34+ circulating progenitor cells (PC) were analyzed by flow cytometry allowing one to determine the levels of CD34+ PC, CD34+CD45+ Hematopoietic PC, CD34+133+ immature PC and CD34+KDR+ EPC on admission and at 1 month. Changes in PC level were calculated as the difference between 1 month and baseline value. RESULTS The 2 groups were similar regarding baseline characteristics including PC numbers on admission. The 2 groups had similar change in overall CD34+ PC and hematopoietic CD34+45+ PC level (p=0.2). On the contrary, when considering CD34+133+ PC and CD34+KDR+ EPC, we observed that patients treated by ticagrelor had a significantly higher increase in levels of these PC subtypes compared to those treated by clopidogrel (0.23 (-0.33; 0.79) vs 0.00 (-0.5; 0.34); p=0.04 and 0.01 (-0.04; 0.05) vs -0.01 (-0.06; 0.03); p=0.02). Changes in the level of CD34+CD133+ PC correlated with platelet activity measured by the VASP index (r=-0.30; p=0.008). By contrast the increase in the level of CD34+KDR+ EPC in the ticagrelor group was independent of platelet activity. CONCLUSIONS Ticagrelor increases the number of EPC in ACS patients suggesting a benefit on endothelial regeneration that may participate in the pleiotropic property of the drug.
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Affiliation(s)
- Laurent Bonello
- Service de Cardiologie, Centre Hospitalier Universitaire de Marseille, Hôpital NORD, Aix-Marseille Université, France; Vascular Research Center of Marseille, INSERM UMR-S 1076, Aix-Marseille Université, Marseille, France.
| | - Corinne Frere
- Vascular Research Center of Marseille, INSERM UMR-S 1076, Aix-Marseille Université, Marseille, France
| | - Sylvie Cointe
- Vascular Research Center of Marseille, INSERM UMR-S 1076, Aix-Marseille Université, Marseille, France
| | - Marc Laine
- Service de Cardiologie, Centre Hospitalier Universitaire de Marseille, Hôpital NORD, Aix-Marseille Université, France
| | - Julien Mancini
- Assistance Publique-Hôpitaux de Marseille, Hôpital de la Timone, BiosTIC, France; Aix-Marseille Université, Inserm, IRD, UMR_S912, SESSTIM, Faculté de Médecine de Marseille, France
| | - Franck Thuny
- Service de Cardiologie, Centre Hospitalier Universitaire de Marseille, Hôpital NORD, Aix-Marseille Université, France
| | - François Kerbaul
- Research Unit of Physiology and Pathophysiology in Extreme Oxygenation Conditions (UMR MD2), Faculty of Medicine, Aix-Marseille University, Marseille, France; Pole RUSH, Assistance-Publique Hôpitaux de Marseille, Marseille, France
| | | | - Franck Paganelli
- Service de Cardiologie, Centre Hospitalier Universitaire de Marseille, Hôpital NORD, Aix-Marseille Université, France
| | - Regis Guieu
- Research Unit of Physiology and Pathophysiology in Extreme Oxygenation Conditions (UMR MD2), Faculty of Medicine, Aix-Marseille University, Marseille, France
| | - Laurent Arnaud
- Vascular Research Center of Marseille, INSERM UMR-S 1076, Aix-Marseille Université, Marseille, France; Laboratoire d'Hématologie et de Biologie Vasculaire, Assistance-Publique Hôpitaux de Marseille, Centre hospitalo-universitaire de la Conception, Marseille, France
| | - Françoise Dignat-George
- Vascular Research Center of Marseille, INSERM UMR-S 1076, Aix-Marseille Université, Marseille, France; Laboratoire d'Hématologie et de Biologie Vasculaire, Assistance-Publique Hôpitaux de Marseille, Centre hospitalo-universitaire de la Conception, Marseille, France
| | - Florence Sabatier
- Vascular Research Center of Marseille, INSERM UMR-S 1076, Aix-Marseille Université, Marseille, France; Laboratoire d'Hématologie et de Biologie Vasculaire, Assistance-Publique Hôpitaux de Marseille, Centre hospitalo-universitaire de la Conception, Marseille, France
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Tajiri K, Sato A, Hoshi T, Kimura T, Nakagawa Y, Sakai S, Aonuma K, Watanabe S. Mechanisms explaining the late "catch-up" phenomenon after sirolimus-eluting stent implantation. Int J Cardiol 2014; 177:44-5. [PMID: 25499335 DOI: 10.1016/j.ijcard.2014.09.116] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2014] [Accepted: 09/21/2014] [Indexed: 11/22/2022]
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Pérez de Prado A, Pérez-Martínez C, Cuellas Ramón C, Regueiro Purriños M, Diego Nieto A, Gonzalo-Orden JM, Molina Crisol M, Gómez Castel A, Duocastella Codina L, Fernández-Vázquez F. Safety and efficacy of different paclitaxel-eluting balloons in a porcine model. ACTA ACUST UNITED AC 2014; 67:456-62. [PMID: 24863594 DOI: 10.1016/j.rec.2013.09.030] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2013] [Accepted: 09/20/2013] [Indexed: 11/23/2022]
Abstract
INTRODUCTION AND OBJECTIVES Paclitaxel-eluting balloons have shown high antiproliferative efficacy in the treatment and prevention of restenosis. Nevertheless, not all available devices are equally effective, which makes it interesting to compare results in a preclinical model. Our objective was to assess the preclinical efficacy and safety of different devices. METHODS We implanted 51 metallic stents (Architect(®), iVascular) in 17 domestic swine (mean, 25 [3] kg), inserting 1 stent per major coronary artery. Stent postdilatation was performed with different control balloons (n=10) or paclitaxel-eluting balloons: paclitaxel-eluting balloon 1 (iVascular) (n=15); paclitaxel-eluting balloon 2 (iVascular) (n=16) and In.Pact Falcon(®) (Medtronic) (n=10). The restenosis rate (using angiography and histomorphometry) and vascular healing parameters (balloon-related vascular injury score, endothelialization rate, and fibrin and inflammation scores) were analyzed at 28 days. RESULTS The distinct paclitaxel-eluting balloons showed a similar degree of stenosis at follow-up, which was significantly lower than that in the control group: diameter stenosis was 9% (12%) vs 34% (18%) by angiography (P<.0001) and was 22% (8%) vs 51% (18%) by histomorphometry (P<.0001). Scores for vascular injury (mean, 0.6 [0.5]) and inflammation (mean, 0.8 [0.3]) were uniformly low across all groups. Drug effect markers differed significantly between the paclitaxel-eluting balloons and control groups, with lower endothelialization rates (87% [10%] vs 99% [2%]; P=.0007) and higher fibrin scores (2.1 [0.7] vs 0.4 [0.5]; P<.0001) in the paclitaxel-eluting balloons groups. There were no differences between the different paclitaxel-eluting balloons. CONCLUSIONS In this preclinical model, the paclitaxel-eluting balloons studied significantly reduced in-stent restenosis compared with the control balloons. Although there were no findings of persistent vascular injury or inflammation, delayed endothelialization and fibrin aggregate suggest a drug deposition response.
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