Restenosis is a common complication following coronary angioplasty.The traditional use of seaweeds for health benefits has increasingly been explored,however few studies exist reporting its protective effects on the d...Restenosis is a common complication following coronary angioplasty.The traditional use of seaweeds for health benefits has increasingly been explored,however few studies exist reporting its protective effects on the development of restenosis and gut dysbiosis.The aim of this study was to investigate the potential of seaweed extracts(SE) of Ascophyllum nodosum and Fucus vesiculosus in inhibiting intimal hyperplasia in a rat model of restenosis and its underlying mechanisms in macrophages and vascular smooth muscle cells(vSMCs).16S rRNA sequencing was done to investigate the regulatory effect of SE on the gut microbiome of injured rats.As indicated by the results,SE significantly inhibited the progression of intimal hyperplasia in vivo,attenuated inflammation in macrophages and could inhibit the proliferation,dedifferentiation and migration of vSMCs.It was observed through immunoblotting assays that treatment with SE significantly upregulated PTEN expression in macrophages and inhibited the upregulation of PI3K and AKT expression in vSMCs.Meanwhile,according to the 16S rRNA gene sequencing analysis,supplementation with SE modulated gut microbiota composition in injured rats.In conclusion,SE could ameliorate intimal hyperplasia by inhibiting inflammation and vSMCs proliferation through the regulation of the PTEN/PI3K/AKT pathway and modulating the gut microbiome.展开更多
Objective To analyze the clinical and angiographic characteristics associated with asymptomatic versus symptomatic restenosis after percutaneous coronary intervention(PCI).Methods One hundred and sixty eight patients ...Objective To analyze the clinical and angiographic characteristics associated with asymptomatic versus symptomatic restenosis after percutaneous coronary intervention(PCI).Methods One hundred and sixty eight patients who underwent percutaneous revascularization and 6 month follow up angiography were recruited from 2001 to 2002, in which Fifty nine patients with angiographic restenosis ( ≥50% diameter stenosis) were analyzed. Multivariate analysis evaluated 24 clinical and angiographic variables, comparing those with and without angina. Results Restenosis occurred in 32 patients with clinical silence (55%) and 27 patients with angina. Male sex ( P =0.03 ), absence of antianginal therapy with nitrates ( P =0.002 ) ,greater reference diameter after the procedure ( P =0.04 ), greater reference diameter at follow up (P=0.01), and less lesion severity at 6 months ( P =0.04 ) were univariate predictors of asymptomatic restenosis. By multivariate analysis, only male, greater reference diameter at follow up, and less lesion severity at 6 months were associated with restenosis without angina.Conclusions Approximately half of patients with angiographic restenosis have no symptoms. The only multivariate predictors of silent restenosis at 6 months were male sex, greater reference diameter at follow up, and less lesion severity on follow up angiography.展开更多
Objective:To establish rabbit model of restenosis after carotid endartereclomy surgery,and to study tissue inflammatory cytokines(TNF-α,IL-61 involved in restenosis.Methods:A total of 32 rabbits were randomly divided...Objective:To establish rabbit model of restenosis after carotid endartereclomy surgery,and to study tissue inflammatory cytokines(TNF-α,IL-61 involved in restenosis.Methods:A total of 32 rabbits were randomly divided into two groups:model group and control group.The right common carotid artery in rabbits was damaged by carotid endar terectomy in model group.The tissues were harvested at different time points respectively,the pathological changes of the vascular wall after operation were observed at different time points.The changes of expression of tissue vascular wall inflammatory cytokines(TNF-α.IL-6)at different lime points after the surgery was observed by RT-PCR,and the changes of serum inflammatory cytokines(TNT-α,IL-6)were detected by F.I.1SA.Results:The new intima appeared after 7 days of the injury and reached the peak on 28 d which is uneven and significantly thicker than the control group(P<0.01).The tissue inflammatory cytokines(TNF-α,IL-6)were significantlv increased after the rabbit common carotid artery injury,which was significant difference compared with normal control group(P<0.05).Conclusions:The tissue inflammatory factors significantly increase after the rabbit carotid artery injury,which suggests the mutual concurrent effects of inflammatory cytokines can result in the proliferation of vascular restenosis.展开更多
Background New-generation drug-eluting stents (DES) was more effective in the treatment of in-stent restenosis (ISR) compared with the first-generation DES. Drug-eluting balloons (DEB) and new-generation DES had been ...Background New-generation drug-eluting stents (DES) was more effective in the treatment of in-stent restenosis (ISR) compared with the first-generation DES. Drug-eluting balloons (DEB) and new-generation DES had been available strategies in treatment of bare-metal stents/DES ISR (BMS/DES-ISR). Six new randomized trials have recently examined the angiographic outcomes and one-year clinical outcomes of DEB and new generation DES in BMS/DES-ISR. However, the optimal management for BMS/DES-ISR lesions remains controversial. Methods We searched the randomized clinical trials evaluating the angiographic outcomes and one-year clinical outcomes of DEB and new-generation DES in patients with BMS/DES-ISR. The primary endpoints were the angiographic outcomes, including the minimal luminal diameter (MLD), diameter stenosis %(DS%), late lumen loss (LLL), and binary restenosis (BR). Results A total of six randomized clinical trials with 1177 BMS/DES-ISR patients were included in our meta-analysis. For angiographic outcomes, there were significantly less MLD and more DS% with DEB compared to new-generation DES (MLD: MD =?0.18, 95% CI:?0.31– ?0.04, P < 0.001;DS%: MD = 5.68, 95% CI: 1.00–10.37, P < 0.001). Moreover, for one-year clinical outcomes, DEB was associated with a significant increase risk in target lesion revascularization (TLR)(RR = 2.93, 95% CI: 1.50–5.72, P = 0.002). However, DEB was associated with higher risks of major adverse cardiac event, target vessel revascularization, TLR, BR, and more DS% only in DES-ISR group. Conclusions DEB and new-generation DES have the similar clinical efficacy for the treatment of BMS-ISR. However, DES showed more MLD, less DS%, and a decreased risk of TLR for the treatment of DES-ISR.展开更多
Treatments of atherogenesis,one of the most common cardiovascular diseases(CVD),are continuously being made thanks to innovation and an increasingly in-depth knowledge of percutaneous transluminal coronary angioplasty...Treatments of atherogenesis,one of the most common cardiovascular diseases(CVD),are continuously being made thanks to innovation and an increasingly in-depth knowledge of percutaneous transluminal coronary angioplasty(PTCA),the most revolutionary medical procedure used for vascular restoration.Combined with an expanding balloon,vascular stents used at stricture sites enable the long-time restoration of vascular permeability.However,complication after stenting,in-stent restenosis(ISR),hinders the advancement of vascular stents and are associated with high medical costs for patients for decades years.Thus,the development of a high biocompatibility stent with improved safety and efficiency is urgently needed.This review provides an overview of current advances and potential technologies for the modification of stents for better treatment and prevention of ISR.In particular,the mechanisms of in-stent restenosis are investigated and summarized with the aim to comprehensively understanding the pathogenesis of stent complications.Then,according to different therapeutic functions,the current stent modification strategies are reviewed,including polymeric drug eluting stents,biological friendly stents,prohealing stents,and gene stents.Finally,the review provides an outlook of the challenges in the design of stents with optimal properties.Therefore,this review is a valuable and practical guideline for the development of cardiovascular stents.展开更多
A 54-year-old black African woman, 22 years human immunodeficiency virus(HIV)-positive, presented with an acute coronary syndrome. She was taking two nucleoside reverse transcriptase inhibitors and two protease inhibi...A 54-year-old black African woman, 22 years human immunodeficiency virus(HIV)-positive, presented with an acute coronary syndrome. She was taking two nucleoside reverse transcriptase inhibitors and two protease inhibitors. Viral load and CD4 count were stable. Angiography revealed a right coronary artery lesion, which was treated with everolimus eluting stent. She also underwent balloon angioplasty to the first diagonal. She re-presented on three different occasions and technically successful coronary intervention was performed. The patient has reported satisfactory compliance with dual anti platelet therapy throughout. She was successfully treated with surgical revascularisation. The patient did not experience any clinical recurrence on follow up. This case demonstrates exceptionally aggressive multifocal and recurrent instent restenosis in a patient treated for HIV infection, raising the possibility of an association with HIV infection or potentially components of retro viral therapy.展开更多
BACKGROUND Budd-Chiari syndrome is defined as hepatic venous outflow tract obstruction.For Asian Budd-Chiari syndrome patients,the major treatment modality is recanalization(percutaneous transluminal angioplasty with ...BACKGROUND Budd-Chiari syndrome is defined as hepatic venous outflow tract obstruction.For Asian Budd-Chiari syndrome patients,the major treatment modality is recanalization(percutaneous transluminal angioplasty with or without stent implantation).The cumulative 1-,5-,and 10-year primary patency rates and survival rates are reported to be excellent or satisfactory,but the long-term outcome of patients with restenosis(the most common complication after recanalization)is unknown.AIM To explore the treatment strategy for restenosis in patients with Budd-Chiari syndrome after interventional therapy and to evaluate the long-term follow-up results.METHODS The clinical data and follow-up results of 60 patients with restenosis after interventional therapy from November 1983 to December 2013 were retrospectively analyzed.RESULTS Sixty patients with restenosis were retrospectively divided into a percutaneous transluminal angioplasty(PTA)group(40 patients)and a PTA+stent group(20 patients)according to the primary recanalization method.For the patients with restenosis in the PTA group,13 refused treatment,and 27 received further treatment;among these patients,five had a second restenosis,two had a third restenosis,and one had a fourth restenosis.For the patients with restenosis in the PTA+stent group,nine refused treatment,ten received PTA alone,and the other received PTA+stent implantation.Among the patients who received further treatment,five had a second restenosis,three had a third restenosis,and one had a fourth restenosis.The 1-,5-,10-,20-,and 25-year cumulative survival rates of the 38 patients who received further treatment after restenosis were 100%,78.3%,78.3%,70.5%,and 70.5%,respectively;however,for the 22 patients who refused treatment,the survival rates were 72.7%,45.9%,30.6%,10.2%,and unavailable,respectively(P<0.001).CONCLUSION Long-term follow-up after interventional therapy is very important.Active treatment for patients with restenosis can improve prognosis,and minimally invasive treatment strategies for restenosis allows to obtain satisfactory results.展开更多
Objective:To compare the efficacy of drug-eluting balloons for de novo and in-stent restenosis(ISR)for lesions of the femoropopliteal arteries during 12-month follow-up.Materials and methods:A retrospective analysis o...Objective:To compare the efficacy of drug-eluting balloons for de novo and in-stent restenosis(ISR)for lesions of the femoropopliteal arteries during 12-month follow-up.Materials and methods:A retrospective analysis of 66 patients was performed.These patients had lower extremity atherosclerosis obliterans and were treated with drug-eluting balloons from June 2016 to June 2017.All the lesions were femoropopliteal,including 47 de novo lesions and 19 ISR lesions.Clinical results were followed up at 6 months and 12 months postoperatively.The primary patency rate,target lesion revascularization,Rutherford classification,ankle-brachial index,amputation rate and mortality were compared between the two groups.Results:All the 66 patients underwent the treatment of femoropopliteal artery lesions with unilateral limbs.The surgical success rates were 100%.No adverse events such as acute ischemia or amputation occurred in the hospital.There was no difference between the two groups'Rutherford classification and the ankle-brachial index at the 6-month follow-up(p>0.05).At the 12-month follow-up,the de novo group's Rutherford classification was lower than the ISR group(p=0.026),and the ankle-brachial index of the ISR group was lower(0.66±0.033 vs 0.52±0.056,p=0.036).There was no difference between the patency rate of the de novo group and the ISR group(93.6%vs 84.2%,p=0.229)at the 6-month follow-up.However,the ISR group patency rate was lower at the 12-month follow-up(63.2%vs 85.1%,p=0.048).As for revascularization there was no significant difference between the two groups at the 6-month follow-up(4.2%vs 10.5%,p=0.334),but a higher rate occurred in the ISR group at the 12-month follow-up(26.3%vs 6.4%,p=0.025).There were no significant differences in the mortality or amputation rate between the two groups(p>0.05).Conclusions:Drug-eluting balloons were effective in treating both de novo lesions and ISR lesions in the atherosclerotic femoropopliteal artery,but the 12-month follow-up results of ISR lesions were less favorable than the de novo lesions.展开更多
The mechanism of vascular endothelial growth factor (VEGF) on the prevention of restenosis after angioplasty was investigated. The cultured vascular endothelial cells (VEC) were incubated with the conditioned medium (...The mechanism of vascular endothelial growth factor (VEGF) on the prevention of restenosis after angioplasty was investigated. The cultured vascular endothelial cells (VEC) were incubated with the conditioned medium (CM) from vascular smooth muscle cells (VSMC) infected with recombinant adenoviruses containing the hVEGF 165 gene. To observe the effects of VEGF on proliferation and NO, ET, 6-keto-PGF1α secretion of VEC, WST-1 method, Griess method and radioimmunoassay were used respectively. The PDGF-B mRNA transcription in VECs was detected by RT-PCR. It was showed that NO, 6-keto-PGF1α and OD value were markedly increased in a dose-dependent manner in the VEGF-treated groups as compared with those in the control group, while ET and PDGF-B mRNA were significantly decreased in the VEGF-treated groups (P<0.05 or P<0.01). Adenovirus vector mediated hVEGF 165 gene could promote the proliferation of VECs and improve NO, PGI 2 secretion, inhibit ET secretion and PDGF-B mRNA transcription in the VECs. The above results offered further theoretical evidence for VEGF on the prevention of restenosis after angioplasty.展开更多
Objectives We compared intravascular ultrasound (IVUS) findings of drug-eluting stent (DES)-treated lesions that developed stent thrombosis versus in-stent restenosis (ISR) to identify underlying mechanical difference...Objectives We compared intravascular ultrasound (IVUS) findings of drug-eluting stent (DES)-treated lesions that developed stent thrombosis versus in-stent restenosis (ISR) to identify underlying mechanical differences. Methods IVUS findings in 15 post-DES thrombosis patients were compared with 45 matched ISR patients who had no evidence of stent thrombosis. Results Minimum stent area [MSA, (3.7±0.8) mm2 vs (4.9±1.8) mm2, P=0.01], minimum stent diameter [(1.9±0.3) mm vs (2.3±0.4) mm, P=0.005], mean stent area [(5.2±0.8) mm2 vs (7.2±2.1) mm2, P【0.01], and both focal [MSA/reference lumen area, (54.7±15.9)% vs (75.0±20.1)%, P=0.001] and diffuse stent expansion [mean stent area/reference lumen area, (76.6±23.0)% vs (110.3±23.3)%, P【0.01] were significantly smaller in the stent thrombosis group (vs the ISR group). An MSA 【4.0 mm2 (73.3% vs 35.6%, P=0.01) or 【5.0 mm2 (86.7% vs 53.3%, P=0.02) was more often found in the stent thrombosis group (vs the ISR group). The MSA site occurred more frequently in the proximal stent segment within the stent thrombosis group compared to the ISR group (60% vs 24.4%, P=0.01). There were no differences in edge dissection, stent fracture, or stent-vessel wall malapposition between the two groups. Independent predictors of stent thrombosis were diffuse stent expansion (OR=1.5, P=0.03) and proximal location of the MSA site (OR=12.7, P=0.04). Conclusion DES-treated lesions that develop thrombosis or restenosis are often underexpanded. Underexpansion appears to be more severe in DES-thrombosis lesions. Lesions with diffuse underexpansion and a proximal (vs distal) underexpanded MSA site are more predisposed to thrombus formation than ISR.展开更多
Background and Objective In-stent restenosis(ISR)remains a major limitation of percutaneous coronary intervention despite improvements in stent design and pharmacological agents,whereas the mechanism of ISR has not be...Background and Objective In-stent restenosis(ISR)remains a major limitation of percutaneous coronary intervention despite improvements in stent design and pharmacological agents,whereas the mechanism of ISR has not been fully clarified.In the present study,we sought to investigate the potential association of serum soluble TREM-1(sTREM-1)levels with the incidence of ISR.The role of TREM-1 was evaluated in cultured vascular smooth muscle cells(VSMCs).展开更多
This work aimed to investigate the effects of calcitonin gene-related peptide(CGRP)-modified mesenchymal stem cells(MSCs)on vascular stenosis in carotid balloon-injured rats.The CGRP gene labeled with EGFP was transfe...This work aimed to investigate the effects of calcitonin gene-related peptide(CGRP)-modified mesenchymal stem cells(MSCs)on vascular stenosis in carotid balloon-injured rats.The CGRP gene labeled with EGFP was transfected into bone marrow MSCs,and CGRP protein expression in MSCs was confirmed by immunofluorescence assays.A rat carotid balloon injury model was established using a surgicalmethod.CGRP-modifiedMSCs were orthotopically transplanted into the injured area of the rats.At 28 days after cell transplantation,EGFP and CD31 expression was detected by immunofluorescence staining.Hematoxylin-eosin(H&E)staining was used to detect the intima/media area of the injured carotid artery stenosis site,and the expression of proliferating cell nuclear antigen(PCNA)was detected by immunohistochemistry.MSCs from rat bone marrow positively expressed CD29 and negatively expressed CD45.In vivo immunofluorescence staining showed that EGFP expression was significantly increased at the vascular injury site of rats transplanted with MSC_CGRP compared with the control group on the 28th day after cell transplantation and that the damaged vessels exhibited continuous CD31 expression.H&E staining showed that the vascular intimal proliferation area of rats transplanted with MSC_CGRP was significantly reduced compared with that of other groups.Furthermore,the immunohistochemistry results showed that PCNA expression in the endothelium of the MSC_CGRP group was lower than that of the other groups.Therefore,MSCs transfected with the CGRP gene can express the CGRP protein,and the implantation of CGRPmodified MSCs at the damaged site after carotid balloon-induced injury can reduce the neointimal area.展开更多
Objective:Intimal hyperplasia is the main cause of restenosis of vein grafts after venous transplantation.MicroRNAs are considered to play a role in vein graft restenosis;however,the expression profi le of microRNAs i...Objective:Intimal hyperplasia is the main cause of restenosis of vein grafts after venous transplantation.MicroRNAs are considered to play a role in vein graft restenosis;however,the expression profi le of microRNAs in neointima has not been reported in detail.We wanted to investigate the differentially expressed microRNAs in the restenosis of vein grafts in rats.Methods:We established a rat model for vein transplantation to explore the pathogenic roles of microRNAs during intimal hyperplasia.Hematoxylin and eosin staining was used to confi rm intimal hyperplasia in the vein grafts.Changes in microRNA expression in the vein grafts were detected 3 and 14 days after surgery by sequencing,reverse transcription–quantitative polymerase chain reaction,and bioinformatics analyses for functional annotation.Results:We detected 711 newly predicted microRNAs among all the comparisons.Among these comparisons,437 differentially expressed microRNAs were detected in the postoperative day 3 group versus the control group,265 were detected in the postoperative day 14 group versus the control group,and 158 were detected in the postoperative day 14 group versus the postoperative day 3 group.Pathway analysis revealed signifi cant enrichment of target genes that mediate Wnt,mitogen-activated protein kinase,vascular smooth muscle contraction,and regulation of actin cytoskeleton signaling.Conclusion:Our results provide insight into the pathogenesis of restenosis and will help develop novel targets in the prevention and treatment of vein graft restenosis.展开更多
BACKGROUNDPercutaneous transluminal angioplasty and stenting represent an effectivetreatment for hepatic artery stenosis after liver transplantation. In the first yearafter stenting, approximately 22% of patients expe...BACKGROUNDPercutaneous transluminal angioplasty and stenting represent an effectivetreatment for hepatic artery stenosis after liver transplantation. In the first yearafter stenting, approximately 22% of patients experience in-stent restenosis,increasing the risk of artery thrombosis and related complications, and 50%experience liver failure. Although angiography is an important tool for diagnosisand the planning of therapeutic interventions, it may raise doubts, especially insmall-diameter arteries, and it provides low resolution rates compared withnewer intravascular imaging methods, such as optical coherence tomography(OCT).CASE SUMMARYA 64-year-old male developed hepatic artery stenosis one year after orthotropicliver transplantation and was successfully treated with percutaneous transluminalangioplasty with stenting. Five months later, the Doppler ultrasound resultsindicated restenosis. Visceral arteriography confirmed hepatic artery tortuositybut was doubtful for significant in-stent restenosis (ISR) and intrahepatic flowreduction. To confirm ISR, identify the etiology and guide treatment, OCT wasperformed. OCT showed severe stenosis due to four mechanisms: Focal andpartial stent fracture, late stent malapposition, in-stent neointimal hyperplasia,and neoatherosclerosis.CONCLUSIONIntravascular diagnostic methods can be useful in evaluating cases in which initialangiography results are not sufficient to provide a proper diagnosis of significantstenosis, especially with regard to ISR. A wide range of diagnoses are provided byOCT, resulting in different treatment options. Interventional radiologists shouldconsider intravascular diagnostic methods as additional tools for evaluatingpatients when visceral angiography results are unclear.展开更多
BACKGROUND The in-stent restenosis(ISR)rates are reportedly inconsistent despite the increased use of second-generation drug eluting stent(DES).Although bioresorbable vascular scaffold(BVS)have substantial advantages ...BACKGROUND The in-stent restenosis(ISR)rates are reportedly inconsistent despite the increased use of second-generation drug eluting stent(DES).Although bioresorbable vascular scaffold(BVS)have substantial advantages with respect to vascular restoration,the rate of scaffold thrombosis is higher with BVS than with DES.Optimal treatment strategies have not been established for DES-ISR to date.CASE SUMMARY We report on a case of a 60-year-old man patient with acute coronary syndrome.He had a history of ST-segment elevation myocardial infarction associated with very late scaffold thrombosis and treated with a DES.Coronary angiography revealed significant stenosis,suggesting DES-ISR on the previous BVS.Optical coherence tomography(OCT)identified a plaque rupture and a disrupted scaffold strut in the neointimal proliferation of DES.To treat the DES-ISR on the previous BVS,we opted for a drug-coated balloon(DCB)after a balloon angioplasty using a semi-compliant and non-compliant balloon.The patient did not experience adverse cardiovascular events on using a DCB following the use of intensive dual antiplatelet therapy and statin for 24 mo.CONCLUSION This case highlights the importance of OCT as an imaging modality for characterizing the mechanism of target lesion failure.The use of a DCB following the administration of optimal pharmacologic therapy may be an optimal strategy for the treatment and prevention of recurrent BVS thrombosis and DES-ISR.展开更多
Background:The purpose of our study was to assess whether the occurrence of ISR might be associated with plasma TMAO levels in patients with ACS after DES implantation.Methods:This was a single center retrospective ca...Background:The purpose of our study was to assess whether the occurrence of ISR might be associated with plasma TMAO levels in patients with ACS after DES implantation.Methods:This was a single center retrospective case-control study,in which 64 symptomatic patients with repeated coronary angiography after PCI and 15 patients with ISR were included in the ISR group,and 49 patients without ISR were included in the non-ISR group.High-performance liquid chromatography with tandem mass spectrometry was used to measure plasma TMAO levels.Results:No significant differences were observed in plasma TMAO between the ISR and non-ISR groups.Plasma TMAO levels showed no significant correlation with ISR,but were significantly positively correlated with diabetes mellitus,serum HbA1c levels and serum creatinine levels;moreover,they were significantly negatively correlated with female sex.ISR was significantly positively correlated with diabetes mellitus,fasting blood glucose levels,the neutro-phil to lymphocyte ratio and syntax score;in addition,it was significantly negatively correlated with platelets.Logistic regression analysis indicated that fasting blood glucose was the only independent predictor of ISR.Conclusion:Plasma TMAO may not be associated with ISR and plaque burden in patients with ACS after DES im-plantation,whereas FBG may predict the development of ISR in these patients.展开更多
BACKGROUND We performed a meta-analysis on observational studies since randomized control trials are not available.We studied intracoronary brachytherapy(ICBT)and recurrent drug eluting stent in-stent restenosis(DES-I...BACKGROUND We performed a meta-analysis on observational studies since randomized control trials are not available.We studied intracoronary brachytherapy(ICBT)and recurrent drug eluting stent in-stent restenosis(DES-ISR)to evaluate the procedural success,target lesion revascularization(TLR),incidence of myocardial infarction(MI)and all-cause mortality at 2 years follow-up.AIM To perform meta-analysis for patients undergoing ICBT for recurrent DES-ISR.METHODS We performed a systematic search of the PubMed/MEDLINE,Cochrane and DARE databases to identify relevant articles.Studies were excluded if intracoronary brachytherapy was used as a treatment modality for initial ISR and studies with bare metal stents.We used a random-effect model with DerSimonian&Laird method to calculate summary estimates.Heterogeneity was assessed using I2 statistics.RESULTS A total of 6 observational studies were included in the final analysis.Procedural angiographic success following intra-coronary brachytherapy was 99.8%.Incidence of MI at 1-year was 2%and 4.1%at 2-years,respectively.The incidence of TLR 14.1%at 1-year and 22.7%at 2-years,respectively.All-cause mortality at 1-and 2-year follow-up was 3%and 7.5%,respectively.CONCLUSION Given the observational nature of the studies included in the analysis,heterogeneity was significantly higher for outcomes.While there are no randomized controlled trials or definitive guidelines available for recurrent ISR associated with DES,this analysis suggests that brachytherapy might be the alternative approach for recurrent DES-ISR.Randomized controlled trials are required to confirm results from this study.展开更多
Background: Patients who underwent percutaneous coronary intervention in left main coronary artery (LMCA) requires special concern, being high risk and increasing patient population. The aim of this study was to asses...Background: Patients who underwent percutaneous coronary intervention in left main coronary artery (LMCA) requires special concern, being high risk and increasing patient population. The aim of this study was to assess the clinical profile, angiographic status, and prevalence of restenosis in patients who underwent percutaneous transluminal coronary angioplasty (PTCA) in LMCA. Materials and Methods: This observational cohort study included 17 patients who underwent PTCA in LMCA during one-year study period at tertiary care centers in Government Medical College, Kozhikode, India. Data including various risk factors, clinical and angiographic details, stent used, procedural complications and outcomes including rate of restenosis were analyzed. Results: A total of 17 patients (mean age 53.88 ± 9.80 years) with 76.47% of males were included in the study. Smoking and hypertension were the most common risk factors presented in 52.94% and 47.06% of patients respectively. Single vessel disease (SVD) of LMCA was the most common pattern observed in 47.10%;the rate of restenosis was observed in 11.76% patients. Revascularization was performed in one patient (5.88%) with coronary artery bypass graft and in one patient (5.88%) with PTCA using drug eluting stent (DES). The overall procedural success was 88.24% in this study. Survival rate was 100% at one-year follow-up period. Conclusion: Our study involved patients who underwent PTCA in LMCA, showed smoking as a most prevalent risk factor for coronary artery disease and SVD as a most common pattern, comparatively low rate of restenosis and 100% of survival rate at one-year follow-up period.展开更多
Background: Few data on the clinical course and management of patients experiencing restenosis after implantation of long drug-eluting stents treatment for coronary arteries was available. Objectives: The aim of this ...Background: Few data on the clinical course and management of patients experiencing restenosis after implantation of long drug-eluting stents treatment for coronary arteries was available. Objectives: The aim of this study was to evaluate the incidence, predictors, and long-term outcomes of patients with in-stent restenosis (ISR) after percutaneous coronary intervention (PCI) with long (33 mm & 38 mm) drug-eluting stents (DES) for long lesions in coronary arteries including left anterior descending artery (LAD), Lt circumflex artery (Lt Cx), right coronary artery (RCA), obtuse marginal artery (OM) & posterior descending artery (PDA). Methods: Between July 2009 and October 2010, 421 long DES had being implanted in 421 consecutive patients with significant coronary artery stenosis, with 371 patients (88%) undergoing routine follow up, clinical follow up done by exercise stress test at 6 & 12 months after stenting for 126 patients (34%), in 124 patients (33.5%) follow up was done by Computed Tomography angiography & 121 patients (32.5%) with clinically driven angiographic follow-up. A major adverse cardiac event was defined as the composite of death, myocardial infarction (MI), or target-lesion revascularization (TLR) within 15 months. Results: All patients who underwent clinical follow up were asymptomatic. The overall incidence of angiographic (CT or conventional) ISR with long (33 mm & 38 mm) DES was 4% (15 out of 371 stents) with 8 (53.3%) focal-type and 7 (46.7%) with diffuse-type ISR. Six patients (40%) under-went repeated PCI, seven (46.7%) underwent bypass surgery, and 2 (13.3%) were treated medically. During long-term follow-up (ranging from 12 - 26 months), there were no deaths, 3 (0.8%) MI, and 13 (3.5%) repeated target-lesion revascularization (PCI or CABG) cases. The incidence of major adverse cardiac event was 5.3% in the medical group, 10.1% in the repeated PCI group, and 21.4% in the bypass surgery group. Multivariate analysis showed that the occurrence of DES-ISR did not affect the risk of death or MI. Conclusions: The incidence of ISR was 4% after long DES stenting for coronary arteries. The long-term clinical prognosis of patients with long DES-ISR associated with coronary artery stenting might be benign, if the patient has optimal treatment.展开更多
In this study, a finite element simulation of in-stent restenosis (ISR) is conducted to simulate the deployment and expansion of a stent in an occluded artery with a contact model and a mechanics-based growth model. A...In this study, a finite element simulation of in-stent restenosis (ISR) is conducted to simulate the deployment and expansion of a stent in an occluded artery with a contact model and a mechanics-based growth model. A tissue growth model based on the multiplicative decomposition of deformation is applied to investigate the growth of the plaque and artery wall upon the stent’s implantation. Due to the high stresses at the contact points between the stent struts and the tissue, further tissue injury or restenosis is observed. The simulation results show that after the stent deployment, the von Mises stress is significantly larger in the plaque compared to the artery wall, especially in the region that is in contact with the stent. However, the growth of the plaque and artery tends to even out the stress concentration over time. The tissue growth is found to be more significant near the inner wall than the outer layer. A 0.77 mm restenosis is predicted, which agrees with published clinical observations. The features of the artery growth are carefully analyzed, and the underlying mechanism is discussed. This study is the first attempt to apply finite element analysis to artery restenosis, which establishes a framework for predicting ISR’s occurrence and severity. The results also provide insights into understanding the underlying mechanism of in-stent restenosis.展开更多
基金supported by the research grants from the Ministry of Science and Technology of Taiwan (MOST108-2320B-038-040-MY3 and MOST 111-2320-B-038-049)the National Science and Technology Council (NSTC111-2320-B-038-049)。
文摘Restenosis is a common complication following coronary angioplasty.The traditional use of seaweeds for health benefits has increasingly been explored,however few studies exist reporting its protective effects on the development of restenosis and gut dysbiosis.The aim of this study was to investigate the potential of seaweed extracts(SE) of Ascophyllum nodosum and Fucus vesiculosus in inhibiting intimal hyperplasia in a rat model of restenosis and its underlying mechanisms in macrophages and vascular smooth muscle cells(vSMCs).16S rRNA sequencing was done to investigate the regulatory effect of SE on the gut microbiome of injured rats.As indicated by the results,SE significantly inhibited the progression of intimal hyperplasia in vivo,attenuated inflammation in macrophages and could inhibit the proliferation,dedifferentiation and migration of vSMCs.It was observed through immunoblotting assays that treatment with SE significantly upregulated PTEN expression in macrophages and inhibited the upregulation of PI3K and AKT expression in vSMCs.Meanwhile,according to the 16S rRNA gene sequencing analysis,supplementation with SE modulated gut microbiota composition in injured rats.In conclusion,SE could ameliorate intimal hyperplasia by inhibiting inflammation and vSMCs proliferation through the regulation of the PTEN/PI3K/AKT pathway and modulating the gut microbiome.
文摘Objective To analyze the clinical and angiographic characteristics associated with asymptomatic versus symptomatic restenosis after percutaneous coronary intervention(PCI).Methods One hundred and sixty eight patients who underwent percutaneous revascularization and 6 month follow up angiography were recruited from 2001 to 2002, in which Fifty nine patients with angiographic restenosis ( ≥50% diameter stenosis) were analyzed. Multivariate analysis evaluated 24 clinical and angiographic variables, comparing those with and without angina. Results Restenosis occurred in 32 patients with clinical silence (55%) and 27 patients with angina. Male sex ( P =0.03 ), absence of antianginal therapy with nitrates ( P =0.002 ) ,greater reference diameter after the procedure ( P =0.04 ), greater reference diameter at follow up (P=0.01), and less lesion severity at 6 months ( P =0.04 ) were univariate predictors of asymptomatic restenosis. By multivariate analysis, only male, greater reference diameter at follow up, and less lesion severity at 6 months were associated with restenosis without angina.Conclusions Approximately half of patients with angiographic restenosis have no symptoms. The only multivariate predictors of silent restenosis at 6 months were male sex, greater reference diameter at follow up, and less lesion severity on follow up angiography.
基金supported by Shandong Provincial Health Department scientific researching fund projects 2005HW116
文摘Objective:To establish rabbit model of restenosis after carotid endartereclomy surgery,and to study tissue inflammatory cytokines(TNF-α,IL-61 involved in restenosis.Methods:A total of 32 rabbits were randomly divided into two groups:model group and control group.The right common carotid artery in rabbits was damaged by carotid endar terectomy in model group.The tissues were harvested at different time points respectively,the pathological changes of the vascular wall after operation were observed at different time points.The changes of expression of tissue vascular wall inflammatory cytokines(TNF-α.IL-6)at different lime points after the surgery was observed by RT-PCR,and the changes of serum inflammatory cytokines(TNT-α,IL-6)were detected by F.I.1SA.Results:The new intima appeared after 7 days of the injury and reached the peak on 28 d which is uneven and significantly thicker than the control group(P<0.01).The tissue inflammatory cytokines(TNF-α,IL-6)were significantlv increased after the rabbit common carotid artery injury,which was significant difference compared with normal control group(P<0.05).Conclusions:The tissue inflammatory factors significantly increase after the rabbit carotid artery injury,which suggests the mutual concurrent effects of inflammatory cytokines can result in the proliferation of vascular restenosis.
基金supported by the National Natural Science Foundation of China(No.81671731)the Capital Clinical Feature Research Project(Z171100001017158)
文摘Background New-generation drug-eluting stents (DES) was more effective in the treatment of in-stent restenosis (ISR) compared with the first-generation DES. Drug-eluting balloons (DEB) and new-generation DES had been available strategies in treatment of bare-metal stents/DES ISR (BMS/DES-ISR). Six new randomized trials have recently examined the angiographic outcomes and one-year clinical outcomes of DEB and new generation DES in BMS/DES-ISR. However, the optimal management for BMS/DES-ISR lesions remains controversial. Methods We searched the randomized clinical trials evaluating the angiographic outcomes and one-year clinical outcomes of DEB and new-generation DES in patients with BMS/DES-ISR. The primary endpoints were the angiographic outcomes, including the minimal luminal diameter (MLD), diameter stenosis %(DS%), late lumen loss (LLL), and binary restenosis (BR). Results A total of six randomized clinical trials with 1177 BMS/DES-ISR patients were included in our meta-analysis. For angiographic outcomes, there were significantly less MLD and more DS% with DEB compared to new-generation DES (MLD: MD =?0.18, 95% CI:?0.31– ?0.04, P < 0.001;DS%: MD = 5.68, 95% CI: 1.00–10.37, P < 0.001). Moreover, for one-year clinical outcomes, DEB was associated with a significant increase risk in target lesion revascularization (TLR)(RR = 2.93, 95% CI: 1.50–5.72, P = 0.002). However, DEB was associated with higher risks of major adverse cardiac event, target vessel revascularization, TLR, BR, and more DS% only in DES-ISR group. Conclusions DEB and new-generation DES have the similar clinical efficacy for the treatment of BMS-ISR. However, DES showed more MLD, less DS%, and a decreased risk of TLR for the treatment of DES-ISR.
基金financial support from the National Key Research and Development Program of China(2017YFB0702500)Natural Science Foundation of China(NSFC Project,81801853)Sichuan Science and Technology Program(19GJHZ0058)。
文摘Treatments of atherogenesis,one of the most common cardiovascular diseases(CVD),are continuously being made thanks to innovation and an increasingly in-depth knowledge of percutaneous transluminal coronary angioplasty(PTCA),the most revolutionary medical procedure used for vascular restoration.Combined with an expanding balloon,vascular stents used at stricture sites enable the long-time restoration of vascular permeability.However,complication after stenting,in-stent restenosis(ISR),hinders the advancement of vascular stents and are associated with high medical costs for patients for decades years.Thus,the development of a high biocompatibility stent with improved safety and efficiency is urgently needed.This review provides an overview of current advances and potential technologies for the modification of stents for better treatment and prevention of ISR.In particular,the mechanisms of in-stent restenosis are investigated and summarized with the aim to comprehensively understanding the pathogenesis of stent complications.Then,according to different therapeutic functions,the current stent modification strategies are reviewed,including polymeric drug eluting stents,biological friendly stents,prohealing stents,and gene stents.Finally,the review provides an outlook of the challenges in the design of stents with optimal properties.Therefore,this review is a valuable and practical guideline for the development of cardiovascular stents.
文摘A 54-year-old black African woman, 22 years human immunodeficiency virus(HIV)-positive, presented with an acute coronary syndrome. She was taking two nucleoside reverse transcriptase inhibitors and two protease inhibitors. Viral load and CD4 count were stable. Angiography revealed a right coronary artery lesion, which was treated with everolimus eluting stent. She also underwent balloon angioplasty to the first diagonal. She re-presented on three different occasions and technically successful coronary intervention was performed. The patient has reported satisfactory compliance with dual anti platelet therapy throughout. She was successfully treated with surgical revascularisation. The patient did not experience any clinical recurrence on follow up. This case demonstrates exceptionally aggressive multifocal and recurrent instent restenosis in a patient treated for HIV infection, raising the possibility of an association with HIV infection or potentially components of retro viral therapy.
文摘BACKGROUND Budd-Chiari syndrome is defined as hepatic venous outflow tract obstruction.For Asian Budd-Chiari syndrome patients,the major treatment modality is recanalization(percutaneous transluminal angioplasty with or without stent implantation).The cumulative 1-,5-,and 10-year primary patency rates and survival rates are reported to be excellent or satisfactory,but the long-term outcome of patients with restenosis(the most common complication after recanalization)is unknown.AIM To explore the treatment strategy for restenosis in patients with Budd-Chiari syndrome after interventional therapy and to evaluate the long-term follow-up results.METHODS The clinical data and follow-up results of 60 patients with restenosis after interventional therapy from November 1983 to December 2013 were retrospectively analyzed.RESULTS Sixty patients with restenosis were retrospectively divided into a percutaneous transluminal angioplasty(PTA)group(40 patients)and a PTA+stent group(20 patients)according to the primary recanalization method.For the patients with restenosis in the PTA group,13 refused treatment,and 27 received further treatment;among these patients,five had a second restenosis,two had a third restenosis,and one had a fourth restenosis.For the patients with restenosis in the PTA+stent group,nine refused treatment,ten received PTA alone,and the other received PTA+stent implantation.Among the patients who received further treatment,five had a second restenosis,three had a third restenosis,and one had a fourth restenosis.The 1-,5-,10-,20-,and 25-year cumulative survival rates of the 38 patients who received further treatment after restenosis were 100%,78.3%,78.3%,70.5%,and 70.5%,respectively;however,for the 22 patients who refused treatment,the survival rates were 72.7%,45.9%,30.6%,10.2%,and unavailable,respectively(P<0.001).CONCLUSION Long-term follow-up after interventional therapy is very important.Active treatment for patients with restenosis can improve prognosis,and minimally invasive treatment strategies for restenosis allows to obtain satisfactory results.
基金This study was supported by the National Natural Science Youth Foundation of China(81700409)the Natural Science Foundation of Zhejiang Province(Y16h020015)Zhejiang Province Medical and Health Science and Technology Project(2018ZH016).
文摘Objective:To compare the efficacy of drug-eluting balloons for de novo and in-stent restenosis(ISR)for lesions of the femoropopliteal arteries during 12-month follow-up.Materials and methods:A retrospective analysis of 66 patients was performed.These patients had lower extremity atherosclerosis obliterans and were treated with drug-eluting balloons from June 2016 to June 2017.All the lesions were femoropopliteal,including 47 de novo lesions and 19 ISR lesions.Clinical results were followed up at 6 months and 12 months postoperatively.The primary patency rate,target lesion revascularization,Rutherford classification,ankle-brachial index,amputation rate and mortality were compared between the two groups.Results:All the 66 patients underwent the treatment of femoropopliteal artery lesions with unilateral limbs.The surgical success rates were 100%.No adverse events such as acute ischemia or amputation occurred in the hospital.There was no difference between the two groups'Rutherford classification and the ankle-brachial index at the 6-month follow-up(p>0.05).At the 12-month follow-up,the de novo group's Rutherford classification was lower than the ISR group(p=0.026),and the ankle-brachial index of the ISR group was lower(0.66±0.033 vs 0.52±0.056,p=0.036).There was no difference between the patency rate of the de novo group and the ISR group(93.6%vs 84.2%,p=0.229)at the 6-month follow-up.However,the ISR group patency rate was lower at the 12-month follow-up(63.2%vs 85.1%,p=0.048).As for revascularization there was no significant difference between the two groups at the 6-month follow-up(4.2%vs 10.5%,p=0.334),but a higher rate occurred in the ISR group at the 12-month follow-up(26.3%vs 6.4%,p=0.025).There were no significant differences in the mortality or amputation rate between the two groups(p>0.05).Conclusions:Drug-eluting balloons were effective in treating both de novo lesions and ISR lesions in the atherosclerotic femoropopliteal artery,but the 12-month follow-up results of ISR lesions were less favorable than the de novo lesions.
文摘The mechanism of vascular endothelial growth factor (VEGF) on the prevention of restenosis after angioplasty was investigated. The cultured vascular endothelial cells (VEC) were incubated with the conditioned medium (CM) from vascular smooth muscle cells (VSMC) infected with recombinant adenoviruses containing the hVEGF 165 gene. To observe the effects of VEGF on proliferation and NO, ET, 6-keto-PGF1α secretion of VEC, WST-1 method, Griess method and radioimmunoassay were used respectively. The PDGF-B mRNA transcription in VECs was detected by RT-PCR. It was showed that NO, 6-keto-PGF1α and OD value were markedly increased in a dose-dependent manner in the VEGF-treated groups as compared with those in the control group, while ET and PDGF-B mRNA were significantly decreased in the VEGF-treated groups (P<0.05 or P<0.01). Adenovirus vector mediated hVEGF 165 gene could promote the proliferation of VECs and improve NO, PGI 2 secretion, inhibit ET secretion and PDGF-B mRNA transcription in the VECs. The above results offered further theoretical evidence for VEGF on the prevention of restenosis after angioplasty.
文摘Objectives We compared intravascular ultrasound (IVUS) findings of drug-eluting stent (DES)-treated lesions that developed stent thrombosis versus in-stent restenosis (ISR) to identify underlying mechanical differences. Methods IVUS findings in 15 post-DES thrombosis patients were compared with 45 matched ISR patients who had no evidence of stent thrombosis. Results Minimum stent area [MSA, (3.7±0.8) mm2 vs (4.9±1.8) mm2, P=0.01], minimum stent diameter [(1.9±0.3) mm vs (2.3±0.4) mm, P=0.005], mean stent area [(5.2±0.8) mm2 vs (7.2±2.1) mm2, P【0.01], and both focal [MSA/reference lumen area, (54.7±15.9)% vs (75.0±20.1)%, P=0.001] and diffuse stent expansion [mean stent area/reference lumen area, (76.6±23.0)% vs (110.3±23.3)%, P【0.01] were significantly smaller in the stent thrombosis group (vs the ISR group). An MSA 【4.0 mm2 (73.3% vs 35.6%, P=0.01) or 【5.0 mm2 (86.7% vs 53.3%, P=0.02) was more often found in the stent thrombosis group (vs the ISR group). The MSA site occurred more frequently in the proximal stent segment within the stent thrombosis group compared to the ISR group (60% vs 24.4%, P=0.01). There were no differences in edge dissection, stent fracture, or stent-vessel wall malapposition between the two groups. Independent predictors of stent thrombosis were diffuse stent expansion (OR=1.5, P=0.03) and proximal location of the MSA site (OR=12.7, P=0.04). Conclusion DES-treated lesions that develop thrombosis or restenosis are often underexpanded. Underexpansion appears to be more severe in DES-thrombosis lesions. Lesions with diffuse underexpansion and a proximal (vs distal) underexpanded MSA site are more predisposed to thrombus formation than ISR.
文摘Background and Objective In-stent restenosis(ISR)remains a major limitation of percutaneous coronary intervention despite improvements in stent design and pharmacological agents,whereas the mechanism of ISR has not been fully clarified.In the present study,we sought to investigate the potential association of serum soluble TREM-1(sTREM-1)levels with the incidence of ISR.The role of TREM-1 was evaluated in cultured vascular smooth muscle cells(VSMCs).
基金This work was supported by the Technology Fund of Guizhou Province(Qian ke he LH zi[2014]7576).
文摘This work aimed to investigate the effects of calcitonin gene-related peptide(CGRP)-modified mesenchymal stem cells(MSCs)on vascular stenosis in carotid balloon-injured rats.The CGRP gene labeled with EGFP was transfected into bone marrow MSCs,and CGRP protein expression in MSCs was confirmed by immunofluorescence assays.A rat carotid balloon injury model was established using a surgicalmethod.CGRP-modifiedMSCs were orthotopically transplanted into the injured area of the rats.At 28 days after cell transplantation,EGFP and CD31 expression was detected by immunofluorescence staining.Hematoxylin-eosin(H&E)staining was used to detect the intima/media area of the injured carotid artery stenosis site,and the expression of proliferating cell nuclear antigen(PCNA)was detected by immunohistochemistry.MSCs from rat bone marrow positively expressed CD29 and negatively expressed CD45.In vivo immunofluorescence staining showed that EGFP expression was significantly increased at the vascular injury site of rats transplanted with MSC_CGRP compared with the control group on the 28th day after cell transplantation and that the damaged vessels exhibited continuous CD31 expression.H&E staining showed that the vascular intimal proliferation area of rats transplanted with MSC_CGRP was significantly reduced compared with that of other groups.Furthermore,the immunohistochemistry results showed that PCNA expression in the endothelium of the MSC_CGRP group was lower than that of the other groups.Therefore,MSCs transfected with the CGRP gene can express the CGRP protein,and the implantation of CGRPmodified MSCs at the damaged site after carotid balloon-induced injury can reduce the neointimal area.
基金a grant from the National Natural Science Foundation of China(no.81600377).
文摘Objective:Intimal hyperplasia is the main cause of restenosis of vein grafts after venous transplantation.MicroRNAs are considered to play a role in vein graft restenosis;however,the expression profi le of microRNAs in neointima has not been reported in detail.We wanted to investigate the differentially expressed microRNAs in the restenosis of vein grafts in rats.Methods:We established a rat model for vein transplantation to explore the pathogenic roles of microRNAs during intimal hyperplasia.Hematoxylin and eosin staining was used to confi rm intimal hyperplasia in the vein grafts.Changes in microRNA expression in the vein grafts were detected 3 and 14 days after surgery by sequencing,reverse transcription–quantitative polymerase chain reaction,and bioinformatics analyses for functional annotation.Results:We detected 711 newly predicted microRNAs among all the comparisons.Among these comparisons,437 differentially expressed microRNAs were detected in the postoperative day 3 group versus the control group,265 were detected in the postoperative day 14 group versus the control group,and 158 were detected in the postoperative day 14 group versus the postoperative day 3 group.Pathway analysis revealed signifi cant enrichment of target genes that mediate Wnt,mitogen-activated protein kinase,vascular smooth muscle contraction,and regulation of actin cytoskeleton signaling.Conclusion:Our results provide insight into the pathogenesis of restenosis and will help develop novel targets in the prevention and treatment of vein graft restenosis.
基金OCT analysis assistance was by Eduardo Ufeni Sandes,BIOMED.
文摘BACKGROUNDPercutaneous transluminal angioplasty and stenting represent an effectivetreatment for hepatic artery stenosis after liver transplantation. In the first yearafter stenting, approximately 22% of patients experience in-stent restenosis,increasing the risk of artery thrombosis and related complications, and 50%experience liver failure. Although angiography is an important tool for diagnosisand the planning of therapeutic interventions, it may raise doubts, especially insmall-diameter arteries, and it provides low resolution rates compared withnewer intravascular imaging methods, such as optical coherence tomography(OCT).CASE SUMMARYA 64-year-old male developed hepatic artery stenosis one year after orthotropicliver transplantation and was successfully treated with percutaneous transluminalangioplasty with stenting. Five months later, the Doppler ultrasound resultsindicated restenosis. Visceral arteriography confirmed hepatic artery tortuositybut was doubtful for significant in-stent restenosis (ISR) and intrahepatic flowreduction. To confirm ISR, identify the etiology and guide treatment, OCT wasperformed. OCT showed severe stenosis due to four mechanisms: Focal andpartial stent fracture, late stent malapposition, in-stent neointimal hyperplasia,and neoatherosclerosis.CONCLUSIONIntravascular diagnostic methods can be useful in evaluating cases in which initialangiography results are not sufficient to provide a proper diagnosis of significantstenosis, especially with regard to ISR. A wide range of diagnoses are provided byOCT, resulting in different treatment options. Interventional radiologists shouldconsider intravascular diagnostic methods as additional tools for evaluatingpatients when visceral angiography results are unclear.
文摘BACKGROUND The in-stent restenosis(ISR)rates are reportedly inconsistent despite the increased use of second-generation drug eluting stent(DES).Although bioresorbable vascular scaffold(BVS)have substantial advantages with respect to vascular restoration,the rate of scaffold thrombosis is higher with BVS than with DES.Optimal treatment strategies have not been established for DES-ISR to date.CASE SUMMARY We report on a case of a 60-year-old man patient with acute coronary syndrome.He had a history of ST-segment elevation myocardial infarction associated with very late scaffold thrombosis and treated with a DES.Coronary angiography revealed significant stenosis,suggesting DES-ISR on the previous BVS.Optical coherence tomography(OCT)identified a plaque rupture and a disrupted scaffold strut in the neointimal proliferation of DES.To treat the DES-ISR on the previous BVS,we opted for a drug-coated balloon(DCB)after a balloon angioplasty using a semi-compliant and non-compliant balloon.The patient did not experience adverse cardiovascular events on using a DCB following the use of intensive dual antiplatelet therapy and statin for 24 mo.CONCLUSION This case highlights the importance of OCT as an imaging modality for characterizing the mechanism of target lesion failure.The use of a DCB following the administration of optimal pharmacologic therapy may be an optimal strategy for the treatment and prevention of recurrent BVS thrombosis and DES-ISR.
基金supported by grant 81970299 from the National Natural Science Foundation of China,Beijing Hospitals Authority Ascent Plan(No.DFL20190902)Beijing Municipal Administration of Hospitals Incubating Program(No.PX2021039)+1 种基金Beijing Hospitals Authority Clinical Medicine development of special funding support(No.ZYLX201831)The Capital Health Research and Development of Special(No.2020-4-2243).
文摘Background:The purpose of our study was to assess whether the occurrence of ISR might be associated with plasma TMAO levels in patients with ACS after DES implantation.Methods:This was a single center retrospective case-control study,in which 64 symptomatic patients with repeated coronary angiography after PCI and 15 patients with ISR were included in the ISR group,and 49 patients without ISR were included in the non-ISR group.High-performance liquid chromatography with tandem mass spectrometry was used to measure plasma TMAO levels.Results:No significant differences were observed in plasma TMAO between the ISR and non-ISR groups.Plasma TMAO levels showed no significant correlation with ISR,but were significantly positively correlated with diabetes mellitus,serum HbA1c levels and serum creatinine levels;moreover,they were significantly negatively correlated with female sex.ISR was significantly positively correlated with diabetes mellitus,fasting blood glucose levels,the neutro-phil to lymphocyte ratio and syntax score;in addition,it was significantly negatively correlated with platelets.Logistic regression analysis indicated that fasting blood glucose was the only independent predictor of ISR.Conclusion:Plasma TMAO may not be associated with ISR and plaque burden in patients with ACS after DES im-plantation,whereas FBG may predict the development of ISR in these patients.
文摘BACKGROUND We performed a meta-analysis on observational studies since randomized control trials are not available.We studied intracoronary brachytherapy(ICBT)and recurrent drug eluting stent in-stent restenosis(DES-ISR)to evaluate the procedural success,target lesion revascularization(TLR),incidence of myocardial infarction(MI)and all-cause mortality at 2 years follow-up.AIM To perform meta-analysis for patients undergoing ICBT for recurrent DES-ISR.METHODS We performed a systematic search of the PubMed/MEDLINE,Cochrane and DARE databases to identify relevant articles.Studies were excluded if intracoronary brachytherapy was used as a treatment modality for initial ISR and studies with bare metal stents.We used a random-effect model with DerSimonian&Laird method to calculate summary estimates.Heterogeneity was assessed using I2 statistics.RESULTS A total of 6 observational studies were included in the final analysis.Procedural angiographic success following intra-coronary brachytherapy was 99.8%.Incidence of MI at 1-year was 2%and 4.1%at 2-years,respectively.The incidence of TLR 14.1%at 1-year and 22.7%at 2-years,respectively.All-cause mortality at 1-and 2-year follow-up was 3%and 7.5%,respectively.CONCLUSION Given the observational nature of the studies included in the analysis,heterogeneity was significantly higher for outcomes.While there are no randomized controlled trials or definitive guidelines available for recurrent ISR associated with DES,this analysis suggests that brachytherapy might be the alternative approach for recurrent DES-ISR.Randomized controlled trials are required to confirm results from this study.
文摘Background: Patients who underwent percutaneous coronary intervention in left main coronary artery (LMCA) requires special concern, being high risk and increasing patient population. The aim of this study was to assess the clinical profile, angiographic status, and prevalence of restenosis in patients who underwent percutaneous transluminal coronary angioplasty (PTCA) in LMCA. Materials and Methods: This observational cohort study included 17 patients who underwent PTCA in LMCA during one-year study period at tertiary care centers in Government Medical College, Kozhikode, India. Data including various risk factors, clinical and angiographic details, stent used, procedural complications and outcomes including rate of restenosis were analyzed. Results: A total of 17 patients (mean age 53.88 ± 9.80 years) with 76.47% of males were included in the study. Smoking and hypertension were the most common risk factors presented in 52.94% and 47.06% of patients respectively. Single vessel disease (SVD) of LMCA was the most common pattern observed in 47.10%;the rate of restenosis was observed in 11.76% patients. Revascularization was performed in one patient (5.88%) with coronary artery bypass graft and in one patient (5.88%) with PTCA using drug eluting stent (DES). The overall procedural success was 88.24% in this study. Survival rate was 100% at one-year follow-up period. Conclusion: Our study involved patients who underwent PTCA in LMCA, showed smoking as a most prevalent risk factor for coronary artery disease and SVD as a most common pattern, comparatively low rate of restenosis and 100% of survival rate at one-year follow-up period.
文摘Background: Few data on the clinical course and management of patients experiencing restenosis after implantation of long drug-eluting stents treatment for coronary arteries was available. Objectives: The aim of this study was to evaluate the incidence, predictors, and long-term outcomes of patients with in-stent restenosis (ISR) after percutaneous coronary intervention (PCI) with long (33 mm & 38 mm) drug-eluting stents (DES) for long lesions in coronary arteries including left anterior descending artery (LAD), Lt circumflex artery (Lt Cx), right coronary artery (RCA), obtuse marginal artery (OM) & posterior descending artery (PDA). Methods: Between July 2009 and October 2010, 421 long DES had being implanted in 421 consecutive patients with significant coronary artery stenosis, with 371 patients (88%) undergoing routine follow up, clinical follow up done by exercise stress test at 6 & 12 months after stenting for 126 patients (34%), in 124 patients (33.5%) follow up was done by Computed Tomography angiography & 121 patients (32.5%) with clinically driven angiographic follow-up. A major adverse cardiac event was defined as the composite of death, myocardial infarction (MI), or target-lesion revascularization (TLR) within 15 months. Results: All patients who underwent clinical follow up were asymptomatic. The overall incidence of angiographic (CT or conventional) ISR with long (33 mm & 38 mm) DES was 4% (15 out of 371 stents) with 8 (53.3%) focal-type and 7 (46.7%) with diffuse-type ISR. Six patients (40%) under-went repeated PCI, seven (46.7%) underwent bypass surgery, and 2 (13.3%) were treated medically. During long-term follow-up (ranging from 12 - 26 months), there were no deaths, 3 (0.8%) MI, and 13 (3.5%) repeated target-lesion revascularization (PCI or CABG) cases. The incidence of major adverse cardiac event was 5.3% in the medical group, 10.1% in the repeated PCI group, and 21.4% in the bypass surgery group. Multivariate analysis showed that the occurrence of DES-ISR did not affect the risk of death or MI. Conclusions: The incidence of ISR was 4% after long DES stenting for coronary arteries. The long-term clinical prognosis of patients with long DES-ISR associated with coronary artery stenting might be benign, if the patient has optimal treatment.
文摘In this study, a finite element simulation of in-stent restenosis (ISR) is conducted to simulate the deployment and expansion of a stent in an occluded artery with a contact model and a mechanics-based growth model. A tissue growth model based on the multiplicative decomposition of deformation is applied to investigate the growth of the plaque and artery wall upon the stent’s implantation. Due to the high stresses at the contact points between the stent struts and the tissue, further tissue injury or restenosis is observed. The simulation results show that after the stent deployment, the von Mises stress is significantly larger in the plaque compared to the artery wall, especially in the region that is in contact with the stent. However, the growth of the plaque and artery tends to even out the stress concentration over time. The tissue growth is found to be more significant near the inner wall than the outer layer. A 0.77 mm restenosis is predicted, which agrees with published clinical observations. The features of the artery growth are carefully analyzed, and the underlying mechanism is discussed. This study is the first attempt to apply finite element analysis to artery restenosis, which establishes a framework for predicting ISR’s occurrence and severity. The results also provide insights into understanding the underlying mechanism of in-stent restenosis.
