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Sample records for coronary restenosis model

  1. Influence of local peroxisome proliferator-activated receptor gamma (PPARγ) activation of restenosis/in-stent restenosis following experimental coronary intervention in the porcine stent model

    OpenAIRE

    Klinowski, Jens

    2011-01-01

    Background: Coronary heart disease (CHD) remains the main cause of mortality in the industrial countries. In approximately 80% of all coronary interventions, coronary stents are inserted. Bare metal stents (BMS) show a restenosis rate of around 10 – 30%, and with drug eluting stents (DES) the restenosis rate drops to 5 – 10%. Coronary restenosis following percutaneous coronary intervention (PCI) represents a serious problem, both clinically and economically. Patients with Diabetes mellitus...

  2. Intramural coronary delivery of advanced antisense oligonucleotides reduces neointimal formation in the porcine stent restenosis model.

    Science.gov (United States)

    Kipshidze, Nicholas N; Kim, Han Soo; Iversen, Patrick; Yazdi, Hamid A; Bhargava, Balram; New, Gishel; Mehran, Roxana; Tio, Fermin; Haudenschild, Christian; Dangas, George; Stone, Gregg W; Iyer, Sriram; Roubin, Gary S; Leon, Martin B; Moses, Jeffrey W

    2002-05-15

    We evaluated the long-term influence of intramural delivery of advanced c-myc neutrally charged antisense oligonucleotides (Resten-NG) on neointimal hyperplasia after stenting in a pig model. Neointimal hyperplasia after percutaneous coronary interventions is one of the key components of the restenotic process. The c-myc is a critical cell division cycle protein involved in the formation of neointima. In short-term experiments, different doses (from 500 microg to 5 mg) of Resten-NG or saline were delivered to the stent implantation site with an infiltrator delivery system (Interventional Technologies, San Diego, California). Animals were euthanized at 2, 6 and 18 h after interventions, and excised vessels were analyzed for c-myc expression by Western blot. In long-term experiments, either saline or a dose of 1, 5 or 10 mg of Resten-NG was delivered in the same fashion, and animals were euthanized at 28 days after the intervention. Western blot analysis demonstrated inhibition of c-myc expression and was dose dependent. Morphometry showed that the intimal area was 3.88 +/- 1.04 mm(2) in the control. There was statistically significant reduction of intimal areas in the 5 and 10 mg groups (2.01 +/- 0.66 and 1.95 +/- 0.91, respectively, p 0.5) in comparison with control. This study demonstrated that intramural delivery of advanced c-myc neutrally charged antisense morpholino compound completely inhibits c-myc expression and dramatically reduces neointimal formation in a dose dependent fashion in a porcine coronary stent restenosis model, while allowing for complete vascular healing.

  3. [Stent implantation as initial coronary interventional therapy? A theoretical model on clinical and economical consequences of in-stent restenosis].

    Science.gov (United States)

    Pfund, A; Wendland, G; Baer, F; Lauterbach, K; Höpp, H W

    2000-08-01

    The reduction of acute complications and late restenosis compared to conventional PTCA has led to a rapid increase in stent implantation as initial treatment for coronary stenosis. As a result, in-stent restenosis has become an important clinical and economical problem, especially the diffuse form, which is much more likely to reappear. In order to compare the consequences of initial stenting and initial angioplasty, we developed an analytic model, considering the differences between diffuse and focal in-stent restenosis. The simulation based on the optimized therapeutic proceeding following an elective 1-vessel revascularization of a 60-year-old patient, dealing with probabilities for acute complications and late restenosis taken from the literature and in-hospital costs obtained from 200 elective interventions. In the stent group 71.0% of patients were free of any target lesion-related event, compared to 60.2% in the PTCA group. Catheter reintervention was necessary for 32.1% of the patients initially treated with angioplasty and for 17.6% of the initially stented patients, whereas 7.7% of the stent patients had to undergo elective bypass surgery as final treatment compared to 2.8% in the PTCA arm. Long-term medical costs for initial stenting (6,237 Euros) were 14% higher than for conventional PTCA (5,345 Euros). Taking also into consideration the indirect costs (loss of productivity) for a collective with an employment rate of 50%, the difference between stent implantation (9,067 Euros) and angioplasty (8,581 Euros) is smaller. Initial treatment of coronary stenosis by stent implantation decreases the rate of repeat revascularization compared to initial PTCA, but there is a greater likelihood that elective bypass surgery will become necessary. This difference in following treatment is related to the occurrence of diffuse in-stent restenosis. When calculating the long-term costs stenting still appeared to be more expensive than PTCAA because the savings in

  4. Restenosis after coronary angioplasty: the paradox of increased lumen diameter and restenosis

    NARCIS (Netherlands)

    K.J. Beatt (Kevin); P.W.J.C. Serruys (Patrick); H.E. Luijten; B.J.W.M. Rensing (Benno); H. Suryapranata (Harry); P.J. de Feyter (Pim); M.J.B.M. van den Brand (Marcel); G-J. Laarman (GertJan); G.A. van Es (Gerrit Anne); J.R.T.C. Roelandt (Jos)

    1992-01-01

    textabstractRestenosis after coronary angioplasty is the single complication that most limits this revascularization procedure in clinical practice. The process is largely unpredictable and the lesion-related factors predisposing to restenosis are poorly understood, with little consensus in publishe

  5. Relationship between coronary angioscopic and intravascular ultrasound imaging and restenosis.

    Science.gov (United States)

    Xu, S; Nomura, M; Kurokawa, H; Ando, T; Kimura, M; Ishii, J; Hasegawa, H; Kondo, T; Tadiki, S; Qi, P

    1995-10-01

    In order to investigate the relationship between restenosis and the morphology detected by coronary angioscopy (CASC) and introvascular ultrasound imaging (IVUS), 17 patients were detected by CASC and IVUS immediately and 3 months after percutaneous transluminal coronary angioscopy (PTCA). The results showed that the dilation index by IVUS (DIu) was significantly lower in restenosis patients than in non-restenosis patients (0.42 +/- 0.08 versus 0.78 +/- 0.16, P < 0.01) and that the elastic recoil (ER) was higher in restenosis patients than in non-restenosis patients (4.51 +/- 1.42 mm2 versus 1.63 +/- 1.20 mm2, P < 0.01), and that the elastic recoil rate (ERR) was also higher in restenosis patients than in non-restenosis patients (57.3 +/- 8.07% versus 21.80 +/- 16.84% P < 0.01), and that coronary dissection, atheromatous plaque and calcification as well as the colour of inner coronary artery had no relation with chronic restenosis. In conclusion, the elastic recoil is one of the important factors of chronic restenosis after PTCA.

  6. Multivariate Analysis of Clinical Factors in Restenosis after Coronary Stenting

    Institute of Scientific and Technical Information of China (English)

    Wen Shangyu; Mao Jieming; Guo Liiun; Zhao Yiming; Zhang Fuchun; Guo Jingxlan; Cheng Mingzhe

    2000-01-01

    Ojbective To find the independent predictors for restenosis after coronary stenting.Methods Quantitative angiography was performed on 60 cases (67 successfully dilated lesions) after angioplasty over 6-months follow-up, and both univariate and multivariate logistic regression analysis were done to identify the correlations of restenosis with clinical factors. Results The total restenosis rate was 31.3%(21 of 67 lesions), and according to univariate analysis the patients who underwent coronary stenting ≥3.5mm had a lower rate of restenosis ( P < 0. 01).Collateral circulation to the obstruction site, high maximal inflation pressure, smoking and the less minimal lumen diameter after PTCA made the rate of restenosis higherower ( P < 0.05) . Multivariate logistic regression analysis showed that coronary stenting ≥ 3.5mm had a low rate of restenosis, but high maximal inflation pressure and smoking made the restenosis rate higher. Conclusion Coronary stent size, maximal inflation pressure and. smoking were independent predictors for restenosis.

  7. Postangioplasty restenosis rate between segments of the major coronary arteries

    NARCIS (Netherlands)

    W.R.M. Hermans (Walter); B.J.W.M. Rensing (Benno); J.C. Kelder (Johannes); P.J. de Feyter (Pim); P.W.J.C. Serruys (Patrick)

    1992-01-01

    markdownabstract__Abstract__ Conflicting data have been published regarding the rate of postangioplasty restenosis observed in diverse segments of the coronary tree. However, these studies may be criticized for their biased selection of patients, methods of analysis, and definitions of restenosis.

  8. Computer modeling of restenosis and heating stent thermal effects in the coronary artery

    OpenAIRE

    Zdravković-Petrović, Nataša; Nikolić, Dalibor; Milošević, Žarko; Themis, Exarchos; Parodi, Oberdan; Filipović, Nenad; id_orcid 0000-0001-9964-5615

    2013-01-01

    The understanding and the prediction of the evolution of atherosclerotic plaques either into vulnerable plaques or into stable plaques are very important for the medical community. Stents in the coronary arteries are routinely used in the management of patients with angina or myocardial infarction where percutaneous coronary intervention is the clinically appropriate procedure. In this study we analysed stent deployment in the specific patient and simulation of the temperature distribution fo...

  9. Prevention of restenosis after coronary balloon angioplasty: rationale and design of the Fluvavastatin Angioplasty Restenosis (FLARE) Trial

    NARCIS (Netherlands)

    J.J.R.M. Bonnier (Hans); G. Jackson (Graham); C.M. Miguel (Carlos); J. Shepherd; M.C. Vrolix (Mathias); P.W.J.C. Serruys (Patrick); D.P. Foley (David)

    1994-01-01

    textabstractPrevention of restenosis after successful percutaneous transluminal coronary balloon angioplasty (PTCA) continues to present the greatest therapeutic challenge in interventional cardiology. Experimental and pathological studies describe restenosis as no more than the biologic healing res

  10. Coated stents to prevent restenosis in coronary heart disease

    Directory of Open Access Journals (Sweden)

    Hagen, Anja

    2005-11-01

    Full Text Available Background: In-stent-restenosis (ISR is considered to be an essential limiting factor of stenting in coronary heart disease (CHD. The development of coated stents has raised expectations on substantial lowering restenosis after stenting with decreasing the rate of restenosis and a reduction in the rate of clinical events. Objectives: The present analysis addresses the questions on medical effectiveness and cost-effectiveness of the use of various coated stent types in CHD. Methods: The literature was searched in December 2004 in the most relevant medical and economic databases. The medical evaluation was conducted on the basis of published RCT. The data from the studies regarding various angiographic, sonographic and clinical endpoints were checked for methodical quality and summarised in meta-analyses. Within the scope of economic evaluation the primary studies were analysed and modelling was performed, applying clinical effect estimates from the meta-analyses of the medical evaluation and current estimates of German costs. Results: Medical evaluation: Ten different stenttypes were used in the included 26 RCT. The results for heparin, silicon-carbide, carbon and PTFE coated stenttypes could not reveal any significant differences between the medical effectiveness of coated and uncoated stents. The application of sirolimus, paclitaxel, everolimus and 7-hexanoyltaxol eluting stents showed a significant lower restenosis at 6-9 months with decrease in the rate of restenosis for polymer-based sirolimus, paclitaxel and 7-hexanoyltaxol eluting stents. In contrast, the use of gold-coated and actinomycin-D eluting stents was associated with a significantly higher restenosis. The polymer-based sirolimus and paclitaxel eluting stents also showed a significant and considerable reduction in the rate of repeated percutaneous revascularisations at 6-12 months (3.5% vs. 19.7%; p<0.0001, RR=0.19 [95%CI: 0.11; 0.33] and 3.5% vs. 12.2%; p<0.0001, RR=0.30 [95%CI: 0

  11. Clinical and Angiographic Factors Associated With Asymptomatic Restenosis After Percutaneous Coronary Intervention

    NARCIS (Netherlands)

    P.N. Ruygrok (Peter); M.W.I. Webster (Mark); V. de Valk (Vincent); G.A. van Es (Gerrit Anne); J.A. Ormiston (John); M-A.M. Morel (Marie-Angèle); P.W.J.C. Serruys (Patrick)

    2001-01-01

    textabstractBACKGROUND: Angiographic restenosis after percutaneous coronary interventional procedures is more common than recurrent angina. Clinical and angiographic factors associated with asymptomatic versus symptomatic restenosis after percutaneous coronary intervention were compared. METHODS AND

  12. Genetic inflammatory factors predict restenosis after percutaneous coronary interventions

    NARCIS (Netherlands)

    Monraats, PS; Pires, NMM; Agema, WRP; Zwinderman, AH; Schepers, A; de Maat, MPM; Doevendans, PA; de Winter, RJ; Tio, RA; Waltenberger, J; Frants, RR; Quax, PHA; van Vlijmen, BJM; Atsma, DE; van der Laarse, A; van der Wall, EE; Jukema, JW

    2005-01-01

    Background - Restenosis is a negative effect of percutaneous coronary intervention (PCI). No clinical factors are available that allow good risk stratification. However, evidence exists that genetic factors are important in the restenotic process as well as in the process of inflammation, a pivotal

  13. Coronary CT angiography-derived quantitative markers for predicting in-stent restenosis

    NARCIS (Netherlands)

    Tesche, Christian; De Cecco, Carlo N.; Vliegenthart, Rozemarijn; Duguay, Taylor M.; Stubenrauch, Andrew C.; Rosenberg, Russell D.; Varga-Szemes, Akos; Bayer, Richard R.; Yang, Junjie; Ebersberger, Ullrich; Baguet, Moritz; Jochheim, David; Hoffmann, Ellen; Steinberg, Daniel H.; Chiaramida, Salvatore A.; Schoepf, U. Joseph

    2016-01-01

    Objective: To evaluate quantitative markers derived from coronary CT angiography (coronary CTA) performed prior to percutaneous coronary intervention (PCI) with stent placement for predicting in-stent restenosis (ISR) as defined by quantitative coronary angiography (QCA). Materials and methods: We

  14. Drug- and Gene-eluting Stents for Preventing Coronary Restenosis

    Science.gov (United States)

    Lekshmi, Kamali Manickavasagam; Che, Hui-Lian; Cho, Chong-Su

    2017-01-01

    Coronary artery disease (CAD) has been reported to be a major cause of death worldwide. Current treatment methods include atherectomy, coronary angioplasty (as a percutaneous coronary intervention), and coronary artery bypass. Among them, the insertion of stents into the coronary artery is one of the commonly used methods for CAD, although the formation of in-stent restenosis (ISR) is a major drawback, demanding improvement in stent technology. Stents can be improved using the delivery of DNA, siRNA, and miRNA rather than anti-inflammatory/anti-thrombotic drugs. In particular, genes that could interfere with the development of plaque around infected regions are conjugated on the stent surface to inhibit neointimal formation. Despite their potential benefits, it is necessary to explore the various properties of gene-eluting stents. Furthermore, multifunctional electronic stents that can be used as a biosensor and deliver drug- or gene-based on physiological condition will be a very promising way to the successful treatment of ISR. In this review, we have discussed the molecular mechanism of restenosis, the use of drug- and gene-eluting stents, and the possible roles that these stents have in the prevention and treatment of coronary restenosis. Further, we have explained how multifunctional electronic stents could be used as a biosensor and deliver drugs based on physiological conditions. PMID:28184335

  15. Clinical and Angiographic Factors Associated With Asymptomatic Restenosis After Percutaneous Coronary Intervention

    OpenAIRE

    Ruygrok, Peter; Webster, Mark; de Valk, Vincent; Es, Gerrit Anne; Ormiston, John; Morel, Marie-Angèle; Serruys, Patrick

    2001-01-01

    textabstractBACKGROUND: Angiographic restenosis after percutaneous coronary interventional procedures is more common than recurrent angina. Clinical and angiographic factors associated with asymptomatic versus symptomatic restenosis after percutaneous coronary intervention were compared. METHODS AND RESULTS: All patients with angiographic restenosis from the BENESTENT I, BENESTENT II pilot, BENESTENT II, MUSIC, WEST 1, DUET, FINESS 2, FLARE, SOPHOS, and ROSE studies were analyzed. Multivariat...

  16. Diagnostic accuracy of 64 multislice CT angiography in the assessment of coronary in-stent restenosis: A meta-analysis

    Energy Technology Data Exchange (ETDEWEB)

    Sun Zhonghua [Discipline of Medical Imaging, Department of Imaging and Applied Physics, Curtin University of Technology, Perth, WA (Australia)], E-mail: z.sun@curtin.edu.au; Almutairi, Abdulrahman Marzouq D. [Discipline of Medical Imaging, Department of Imaging and Applied Physics, Curtin University of Technology, Perth, WA (Australia)

    2010-02-15

    Purpose: The aim of this study was to perform a meta-analysis of the diagnostic accuracy of 64-slice CT angiography for the detection of coronary in-stent restenosis in patients treated with coronary stents when compared to conventional coronary angiography. Materials and methods: A search of PUBMED/MEDLINE, ProQuest and Cochrane library databases for English literature was performed. Only studies comparing 64-slice CT angiography with conventional coronary angiography for the detection of coronary in-stent restenosis (more than 50% stenosis) were included for analysis. Sensitivity and specificity estimates pooled across studies were tested using a fixed effects model. Results: Fourteen studies met selection criteria for inclusion in the analysis. The mean value of assessable stents was 89%. Prevalence of in-stent restenosis following coronary stenting was 20% among these studies. Pooled estimates of the sensitivity and specificity of overall 64-slice CT angiography for the detection of coronary in-stent restenosis was 90% (95% CI: 86%, 94%) and 91% (95% CI: 90%, 93%), respectively, based on the evaluation of assessable stents. Diagnostic value of 64-slice CT angiography was found to decrease significantly when the analysis was performed with inclusion of nonassessable segments in five studies, with pooled sensitivity and specificity being 79% (95% CI: 68%, 88%) and 81% (95% CI: 77%, 84%). Stent diameter is the main factor affecting the diagnostic value of 64-slice CT angiography. Conclusion: Our results showed that 64-slice CT angiography has high diagnostic value (both sensitivity and specificity) for detection of coronary in-stent restenosis based on assessable segments when compared to conventional coronary angiography.

  17. Expression and function of calcium-activated potassium channels following in-stent restenosis in a porcine coronary artery model

    Directory of Open Access Journals (Sweden)

    Mais F. Absi

    2012-04-01

    Functional analysis using 1-EBIO and Bradykinin produced hyperpolarization of neointimal but not medial myocytes, which indicated the expression of functional endothelial SK3 and IKCa in the former and not in the latter. The expression of IKCa and SK3 within the neointimal layer suggested that some degree of recovery of both endothelial as well as smooth muscle regeneration had occurred. Future development of selective modulators of IKCa and SK3 channels may decrease the progression of ISR and improve coronary vascular function after stent placement, and is an area for future investigation.

  18. Systematic testing of literature reported genetic variation associated with coronary restenosis: results of the GENDER Study.

    Directory of Open Access Journals (Sweden)

    Jeffrey J W Verschuren

    Full Text Available BACKGROUND: Coronary restenosis after percutaneous coronary intervention still remains a significant problem, despite all medical advances. Unraveling the mechanisms leading to restenosis development remains challenging. Many studies have identified genetic markers associated with restenosis, but consistent replication of the reported markers is scarce. The aim of the current study was to analyze the joined effect of previously in literature reported candidate genes for restenosis in the GENetic DEterminants of Restenosis (GENDER databank. METHODOLOGY/PRINCIPAL FINDINGS: Candidate genes were selected using a MEDLINE search including the terms 'genetic polymorphism' and 'coronary restenosis'. The final set included 36 genes. Subsequently, all single nucleotide polymorphisms (SNPs in the genomic region of these genes were analyzed in GENDER using set-based analysis in PLINK. The GENDER databank contains genotypic data of 2,571,586 SNPs of 295 cases with restenosis and 571 matched controls. The set, including all 36 literature reported genes, was, indeed, significantly associated with restenosis, p = 0.024 in the GENDER study. Subsequent analyses of the individual genes demonstrated that the observed association of the complete set was determined by 6 of the 36 genes. CONCLUSION: Despite overt inconsistencies in literature, with regard to individual candidate gene studies, this is the first study demonstrating that the joint effect of all these genes together, indeed, is associated with restenosis.

  19. Relative risk analysis of angiographic predictors of restenosis within the coronary Wallstent

    NARCIS (Netherlands)

    B.H. Strauss (Bradley); P.W.J.C. Serruys (Patrick); I.K. de Scheerder (Ivan); J.G.P. Tijssen (Jan); M.E. Bertrand (Michel); J. Puel (Jacques); B. Meier (Bernard); U. Kaufmann; J.C. Stauffer; A.F. Rickards (Anthony); U. Sigwart (Ulrich)

    1991-01-01

    textabstractBACKGROUND. Late angiographic narrowing has been observed following coronary implantation of the Wallstent. To identify the angiographic variables that predict restenosis within the stented segment, a retrospective study of data from the European Wallstent core laboratory was performed.

  20. Restenosis of the coronary stenotic lesions treated by holmium:YAG laser coronary angioplasty

    Science.gov (United States)

    Miyazaki, Shunichi; Nonogi, Hiroshi; Goto, Yoichi; Itoh, Akira; Ozono, Keizaburo; Daikoku, Satoshi; Haze, Kazuo

    1994-07-01

    Clinical efficacy of newly developed Holmium YAG laser coronary angioplasty (HLCA) was assessed for 30 patients with angina. There were 12 near left main trunk (LMT) lesions and 4 aorto- ostial lesions. Adjunctive balloon angioplasty was performed for 25 of 30 lesions. Delivered energy ranged from 1.5 to 2.5 watts/pulse and the total exposure time ranged from 6 to 55 seconds. External diameter of laser catheter was 1.5 mm for 13 lesions, 1.4 mm for 17 lesions, and 1.7 mm for 5 lesions. Laser success, defined as 20% reduction of stenotic ratio, was obtained in 21 of 30 (70%) and overall procedural success rate was 93%. There were 3 cases with acute coronary occlusions relieved by adjunctive balloon angioplasty and one coronary perforation without manifestation of cardiac tamponade. There were no large coronary dissection which involved more than 5 mm of the coronary artery. Follow up coronary angiography after 3 months showed restenosis in 14 of 27 patients (52%). Percent stenosis after lasering (56%) was similar to that at 3 months after (62%). HLCA is acutely effective treatment for lesions near LMT, because of low incidence of large coronary dissection. However, angiographical restenosis rate is high at 3 months after HLCA. This may be attributed to the relatively large residual stenosis after the procedure and vessel injury caused by shock wave.

  1. Directional atherectomy for treatment of restenosis within coronary stents: clinical, angiographic and histologic results

    NARCIS (Netherlands)

    B.H. Strauss (Bradley); V.A.W.M. Umans (Victor); R-J. van Suylen (Robert-Jan); P.J. de Feyter (Pim); J. Marco (Jean); G. Robertson; J. Renkin; G.R. Heyndrickx (Guy); V.D. Vuzevski (Vojislav); F.T.B. Bosman (Fré); P.W.J.C. Serruys (Patrick)

    1992-01-01

    textabstractAbstract OBJECTIVES: The safety and long-term results of directional coronary atherectomy in stented coronary arteries were determined. In addition, tissue studies were performed to characterize the development of restenosis. METHODS: Directional coronary atherectomy was performed in r

  2. Diagnostic accuracy of in-stent coronary restenosis detection with multislice spiral computed tomography: a meta-analysis

    Energy Technology Data Exchange (ETDEWEB)

    Hamon, Michele [University Hospital of Caen, Department of Radiology, 14033 Caen Cedex, Normandy (France); Champ-Rigot, Laure; Riddell, John W. [University Hospital of Caen, Department of Cardiology, 14033 Caen Cedex, Normandy (France); Morello, Remy [University Hospital of Caen, Department of Statistics, 14033 Caen Cedex, Normandy (France); Hamon, Martial [University Hospital of Caen, Department of Cardiology, 14033 Caen Cedex, Normandy (France); Institut Pasteur de Lille, INSERM 744, Lille (France); Centre Hospitalier Universitaire de Caen, Service des Maladies du Coeur et des Vaisseaux, 14033 Caen Cedex, Normandy (France)

    2008-02-15

    This study was designed to define the current role of multislice spiral computed tomography (MSCT) for the diagnosis of coronary in-stent restenosis using a meta-analytic process. Restenosis remains a limitation after coronary stent implantation and contributes to a substantial number of coronary re-assessments by conventional invasive coronary angiography (CA). We identified 15 studies (807 patients) evaluating in-stent restenosis by means of both MSCT ({>=}16 slices) and conventional CA until February 2007. After data extraction the analysis was performed according to a random-effects model. The analysis pooled the results from 15 studies with a total of 1,175 stents. A substantial number of unassessable stents (13%) were excluded from the analysis underscoring the shortcomings of MSCT. With this major limitation the diagnostic performance of MSCT for in-stent restenosis detection can be summarized as follows: the sensitivity and specificity were 84% [95% confidence interval (CI) 77-89%] and 91% (95% CI 89-93%), respectively, with positive and negative likelihood ratios of 12.2 (95% CI 6.6-22.6) and 0.23 (95% CI 0.17-0.31), respectively, and with a diagnostic odds ratio of 67.9 (95% CI 34.4-134.1). MSCT has shortcomings difficult to overcome in daily practice for in-stent restenosis detection and continues to have moderately high sensitivity and specificity. The diagnostic role of this emerging technology as an alternative to CA for in-stent restenosis detection remains limited. (orig.)

  3. Mechanisms of restenosis.

    OpenAIRE

    Casscells, W; Engler, D; Willerson, J. T.

    1994-01-01

    Restenosis after percutaneous transluminal coronary angioplasty remains a problem, which suggests that we still do not fully understand its mechanisms. We review here the current understanding of the cell biology of restenosis, including clinical correlation (risk factors), randomized clinical trials, human histology, animal models, and in vitro studies.

  4. Potential role of Chinese medicinal herbs in the prevention of coronary artery restenosis

    Institute of Scientific and Technical Information of China (English)

    2006-01-01

    @@ Percutaneous coronary intervention (PCI) especially stent implantation has now become a mainstay of therapeutic armamentarium in the treatment of patients with coronary artery disease even at clinically or angiographically high risk. However, restenosis requiring reintervention remains a major limitation and a challenging problem of percutaneous revascularization. 1 Despite the use of coronary stents, the rate of restenosis is still relatively high, affecting a quarter or more of overall patients treated by bare- metal stents and around 10% of those treated by drug- eluting stents, which may be even higher for complex PCI (long lesion, bifurcation, small vessel disease) or at unfavorable clinical conditions (diabetes, chronic renal failure). 2,3

  5. The Control of Drug Release and Vascular Endothelialization after Hyaluronic Acid-Coated Paclitaxel Multi-Layer Coating Stent Implantation in Porcine Coronary Restenosis Model

    Science.gov (United States)

    Bae, In-Ho; Jeong, Myung Ho; Park, Yong Hwan; Lim, Kyung Seob; Park, Dae Sung; Shim, Jae Won; Kim, Jung Ha; Ahn, Youngkeun; Hong, Young Joon; Sim, Doo Sun

    2017-01-01

    Background and Objectives Hyaluronic acid (HA) is highly biocompatible with cells and the extracellular matrix. In contrast to degradation products of a synthetic polymer, degradation products of HA do not acidify the local environment. The aim of this study was to fabricate an HA-coated paclitaxel (PTX)-eluting stent via simple ionic interactions and to evaluate its effects in vitro and in vivo. Materials and Methods HA and catechol were conjugated by means of an activation agent, and then the stent was immersed in this solution (resulting in a HA-coated stent). After that, PTX was immobilized on the HA-coated stent (resulting in a hyaluronic acid-coated paclitaxel-eluting stent [H-PTX stent]). Study groups were divided into 4 groups: bare metal stent (BMS), HA, H-PTX, and poly (L-lactide)-coated paclitaxel-eluting stent (P-PTX). Stents were randomly implanted in a porcine coronary artery. After 4 weeks, vessels surrounding the stents were isolated and subjected to various analyses. Results Smoothness of the surface was maintained after expansion of the stent. In contrast to a previous study on a PTX-eluting stent, in this study, the PTX was effectively released up to 14 days (a half amount of PTX in 4 days). The proliferation of smooth muscle cells was successfully inhibited (by 80.5±12.11% at 7 days of culture as compared to the control) by PTX released from the stent. Animal experiments showed that the H-PTX stent does not induce an obvious inflammatory response. Nevertheless, restenosis was clearly decreased in the H-PTX stent group (9.8±3.25%) compared to the bare-metal stent group (29.7±8.11%). Conclusion A stent was stably coated with PTX via simple ionic interactions with HA. Restenosis was decreased in the H-PTX group. These results suggest that HA, a natural polymer, is suitable for fabrication of drug-eluting stents (without inflammation) as an alternative to a synthetic polymer.

  6. Levels of circulating CD34+/KDR+ cells do not predict coronary in-stent restenosis.

    Science.gov (United States)

    Haine, Steven E; Van Craenenbroeck, Emeline M; Hoymans, Vicky Y; Miljoen, Hielko P; Vandendriessche, Tom R; Claeys, Marc J; Frederix, Geert; Conraads, Viviane M; Bosmans, Johan M; Vrints, Christiaan J

    2014-01-01

    Angiographic and clinical parameters are poor predictors of in-stent restenosis. Bone marrow-derived CD34(+) cells that coexpress a receptor for vascular endothelial growth factor (kinase insert domain receptor [KDR]) are committed to endothelial lineage. Mobilization and infusion of CD34(+)/KDR(+) cells accelerates re-endothelialization and reduces neointimal thickness in vascular injury models. Bioengineered stents capturing CD34(+) cells also show expedited re-endothelialization. We examined whether circulating CD34(+)/KDR(+) cell counts can be used to predict restenosis in a bare-metal stent (BMS). CD34(+)/KDR(+) cells were counted by flow cytometry in 124 nondiabetic patients before BMS implantation and the relation to in-stent late luminal loss (LLL) was examined by angiography at 6 months (primary end point). Neointima was also quantified as the maximum percentage area stenosis (M%AS) and percentage volume intima hyperplasia (%VIH) on intravascular ultrasonography (secondary end points). Multiple linear regression analysis, taking into account implanted stent length and diameter, revealed no relation between CD34(+)/KDR(+) cell counts and LLL (partial regression coefficient b = 0.11; 95% confidence interval [CI], -0.19-0.42; P = 0.46). Similarly, no relation between CD34(+)/KDR(+) cell counts and M%AS or %VIH could be demonstrated. Moreover, the increase in CD34(+)/KDR(+) cell counts over 6 months was unrelated to LLL (b = -0.15; 95% CI, -0.42-0.12; P = 0.28), M%AS, and %VIH. Although our study does not exclude a pathophysiologic role for CD34(+)/KDR(+) cells in the formation of neointima, cell counts before percutaneous coronary intervention proved to be unrelated to LLL or intravascular ultrasonographically derived restenosis parameters in coronary BMSs at 6 months. Copyright © 2014 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.

  7. Brachytherapy on restenosis. {sup 32}P radioisotope in animal model

    Energy Technology Data Exchange (ETDEWEB)

    Bergoc, R.; Rivera, E.; Cocca, C.; Martin, G.; Cricco, G. [Buenos Aires Univ. (Argentina). School of Pharmacy and Biochemistry; Croci, M.; Guzman, L.

    2000-05-01

    Despite a notorious decline in age-adjusted death rates for cardiovascular pathologies, coronary artery disease still remains as the main cause of mortality above the age of 40 in men and 60 in women. More than 25% of death in persons over the age of 35 are due to coronary disease. In about 50% of men and 30% of women, the first manifestation of the disease is an acute myocardial infarction and 10% a sudden cardiac death. In Argentina it is estimated that in 1998 about 100.000-115.000 people suffered as first manifestation of coronary illness a myocardial acute infarct. Angioplasty has an important and well established site in the treatment of the coronary illness and restenosis represents the principal complication of this method for myocardial re-vascularization. About a 35-40% of treated arteries present restenosis within the first six month the intervention with the concomitant need of re-interventions, re-hospitalizations, by-pass surgery, work discontinuity and the high cost for the health system. A number of drugs were tested as anti-restenosis: anticoagulants, aspirin, antispasmodics and lipid-lowering agents but none was clearly efficient; also, experimental studies in which intravascular irradiation with different source types and energies, radiation doses and doses rate to prevent restenosis was utilized; however, there is no consensus in many aspects of this intravascular brachytherapy. The first step in this work was to induce the experimental model in rabbits. Afterwards, by means of the balloon methodology and stent implantation, brachytherapy experiments were carried out to evaluate the biological effect on different layers of arteries, with different Doses using a beta particle emitting radioisotope ({sup 32}P). The arteriosclerotic lesions were induced in New Zealand rabbits through the administration of a diet with high cholesterol content. Angioplastic interventions on femoral arteries were done with balloon methodology and controlled by

  8. Pathway Analysis Using Genome-Wide Association Study Data for Coronary Restenosis – A Potential Role for the PARVB Gene

    Science.gov (United States)

    Verschuren, Jeffrey J. W.; Trompet, Stella; Sampietro, M. Lourdes; Heijmans, Bastiaan T.; Koch, Werner; Kastrati, Adnan; Houwing-Duistermaat, Jeanine J.; Slagboom, P. Eline; Quax, Paul H. A.; Jukema, J. Wouter

    2013-01-01

    Background Coronary restenosis after percutaneous coronary intervention (PCI) still remains a significant limitation of the procedure. The causative mechanisms of restenosis have not yet been fully identified. The goal of the current study was to perform gene-set analysis of biological pathways related to inflammation, proliferation, vascular function and transcriptional regulation on coronary restenosis to identify novel genes and pathways related to this condition. Methods The GENetic DEterminants of Restenosis (GENDER) databank contains genotypic data of 556,099SNPs of 295 cases with restenosis and 571 matched controls. Fifty-four pathways, related to known restenosis-related processes, were selected. Gene-set analysis was performed using PLINK, GRASS and ALIGATOR software. Pathways with a p<0.01 were fine-mapped and significantly associated SNPs were analyzed in an independent replication cohort. Results Six pathways (cell-extracellular matrix (ECM) interactions pathway, IL2 signaling pathway, IL6 signaling pathway, platelet derived growth factor pathway, vitamin D receptor pathway and the mitochondria pathway) were significantly associated in one or two of the software packages. Two SNPs in the cell-ECM interactions pathway were replicated in an independent restenosis cohort. No replication was obtained for the other pathways. Conclusion With these results we demonstrate a potential role of the cell-ECM interactions pathway in the development of coronary restenosis. These findings contribute to the increasing knowledge of the genetic etiology of restenosis formation and could serve as a hypothesis-generating effort for further functional studies. PMID:23950981

  9. Modelling and simulating in-stent restenosis with complex automata

    NARCIS (Netherlands)

    Hoekstra, A.G.; Lawford, P.; Hose, R.

    2010-01-01

    In-stent restenosis, the maladaptive response of a blood vessel to injury caused by the deployment of a stent, is a multiscale system involving a large number of biological and physical processes. We describe a Complex Automata Model for in-stent restenosis, coupling bulk flow, drug diffusion, and s

  10. Modelling and simulating in-stent restenosis with complex automata

    NARCIS (Netherlands)

    Hoekstra, A.G.; Lawford, P.; Hose, R.

    2010-01-01

    In-stent restenosis, the maladaptive response of a blood vessel to injury caused by the deployment of a stent, is a multiscale system involving a large number of biological and physical processes. We describe a Complex Automata Model for in-stent restenosis, coupling bulk flow, drug diffusion, and s

  11. Prevention of restenosis future directions.

    Science.gov (United States)

    Bauters, C; Van Belle, E; Meurice, T; Letourneau, T; Lablanche, J M; Bertrand, M E

    1997-04-01

    Restenosis remains the major limitation of percutaneous transluminal coronary angioplasty. Restenosis after balloon angioplasty is due to vascular remodeling and neointimal hyperplasia. In spite of encouraging results in animal models, most of the pharmacological trials of prevention of restenosis in humans have produced negative results. This has prompted interest in the potential role of locally delivered drugs and various balloon catheter systems that are now available to achieve local delivery of therapeutic agents at the site of arterial injury. In 1997, implantation of a coronary stent in conjunction with balloon angioplasty is performed in an increasing number of patients. Randomized studies have shown that coronary stenting may reduce the risk of restenosis. In addition, restenosis after coronary stenting is mainly due to neointimal hyperplasia. Restenosis within coronary stents might thus be much more sensitive to therapies designed to inhibit neointimal hyperplasia than restenosis after balloon angioplasty. Thus, the future prevention of restenosis might well be the combination of a mechanical device that produces the widest possible lumen and prevents vessel constriction with a pharmacologic approach to inhibit the proliferative process. (Trends Cardiovasc Med 1997;7:90-94). © 1997, Elsevier Science Inc.

  12. Incidence of definite stent thrombosis or in-stent restenosis after drug-eluting stent implantation for treatment of coronary in-stent restenosis

    DEFF Research Database (Denmark)

    Jensen, Jesper Khedri; Jensen, Lisette Okkels; Terkelsen, Christian Juhl;

    2013-01-01

    There are limited data on the optimal management of in-stent restenosis after percutaneous coronary intervention (PCI) with bare metal stent (BMS) or drug-eluting stent (DES) implantations. We assessed the clinical presentation, the incidence, and prognosis of definite stent thrombosis...

  13. Genetic polymorphism of angiotensin converting enzyme and risk of coronary restenosis after percutaneous transluminal coronary angioplasties: evidence from 33 cohort studies.

    Directory of Open Access Journals (Sweden)

    Shen Wang

    Full Text Available BACKGROUND: In the past decade, a number of cohort studies studies have been carried out to investigate the relationship between the insertion/deletion polymorphism of the gene encoding angiotensin-converting enzyme and risk of restenosis after percutaneous transluminal coronary angioplasties in patients. However, these studies have yielded contradictory results. Genetic association studies addressing this issue are frequently hampered by insufficient power. We therefore performed a meta-analysis of the published studies to clarify this inconsistency and to establish a comprehensive picture of the relationship between ACE I/D polymorphism and post-PTCA restenosis risk. METHODS: Databases including Pubmed, EMBASE, ISI Web of Science, EBSCO, Cochrane Library databases and CNKI were searched to find relevant studies. Odds ratios (ORs with 95% confidence intervals (CIs were used to assess the strength of association. The random-effects model was applied, addressing heterogeneity and publication bias. RESULTS: A total of 33 cohort studies involving 11,099 subjects were included. In a combined analysis, the OR for post-PTCA restenosis of the ACE DD genotype was 1.61 (95% CI: 1.27-2.04; P<10(-5. In the subgroup analysis by intervention, significantly increased risks were also found in PTCA-stent and PTCA-balloon for the DD genotype of the polymorphism. CONCLUSIONS: Our meta-analysis showed that the DD genotype of ACE I/D polymorphism was significantly associated with increased risk of restenosis, particularly for PTCA-stent.

  14. 冠状动脉球囊成形术及支架术后再狭窄%Restenosis after percutaneous transluminal coronary angioplasty and stent implantation

    Institute of Scientific and Technical Information of China (English)

    沈珠军

    2001-01-01

    Percutaneous transluminal coronary angioplasty (PTCA) has become one of the most important treatment method in coronary artery disease along with coronary bypass operation and medicine in recent years.Restenosis after intervention becomes the Achili's heel in our daily treatment.In some degree stenting can reduce restenosis,but the restenosis after stenting is still over 20%.The focus of the treatment of restenosis over the last 2 decades has been through the application of pharmacologically active agents and mechanical approaches using a host of different devices.But this frequent and costly complication of percutaneous revascularization techniques has proved refractory to all such therapies.This review will focus on the studies that have been done during recent years,it will cover the mechanism of restenosis after PTCA and stenting,the risk factors involved in the restenosis,and the prevention and treatment of restenosis.

  15. Association between cholesterol efflux capacity and coronary restenosis after successful stent implantation.

    Science.gov (United States)

    Imaizumi, Satoshi; Miura, Shin-Ichiro; Takata, Kohei; Takamiya, Yosuke; Kuwano, Takashi; Sugihara, Makoto; Ike, Amane; Iwata, Atsushi; Nishikawa, Hiroaki; Saku, Keijiro

    2016-08-01

    The measurement of high-density lipoprotein (HDL) functionality could be useful for identifying patients who have an increased risk of coronary restenosis after stent implantation. In the present study, we elucidates whether HDL functionality can predict restenosis. The participants included 48 consecutive patients who had stable angina and were successfully implanted with a drug-eluting stent (DES) or bare-metal stent. Follow-up coronary angiography was performed after 6-8 months of stenting. Cholesterol efflux and the anti-inflammatory capacity of HDL were measured before stenting (at baseline) and at follow-up. The mean age was 64 ± 11 years and the body mass index was 24 ± 3 kg/m(2). While HDL cholesterol (HDL-C) significantly increased from baseline to follow-up, there was no significant association between HDL-C level at baseline and in-stent late loss. Cholesterol efflux capacity was significantly increased from baseline to follow-up. The efflux capacity at baseline was negatively correlated with in-stent late loss, whereas the anti-oxidative activity of HDL at baseline was not associated with in-stent late loss. We analyzed the predictors of in-stent late loss using independent variables (efflux capacity and anti-oxidative capacity at baseline in addition to age, gender, HDL-C and low-density lipoprotein cholesterol at baseline, hypertension, diabetes mellitus, smoking, lesion length and DES implantation, history of myocardial infarction and prior percutaneous coronary intervention) by a multiple regression analysis. The efflux capacity at baseline was only independently associated with in-stent late loss. In conclusion, cholesterol efflux capacity at baseline could predict coronary restenosis in patients with successful stent implantation.

  16. Histopathological heterogeneity of in-stent restenosis in four coronary endarterectomy specimens.

    Science.gov (United States)

    Takashima, Akira; Shimabukuro, Michio; Tabata, Minoru; Fukuda, Daiju; Uematsu, Etsuko; Ishibashi-Ueda, Hatsue; Takanashi, Shuichiro; Sata, Masataka

    2015-01-01

    Here, we histopathologically compare four patients undergoing coronary artery bypass with coronary endarterectomy and onlay patch grafting for in-stent restenosis (ISR) after the implantation of a bare-metal stent (BMS), sirolimus-eluting stent (SES), or paclitaxel-eluting stent (PES) in an everolimus-eluting stent (EES). Heterogeneity of ISR was noted histopathologically. In ISR for BMS, restenosis is likely caused by so-called neoatherosclerosis that occurred which altered the healing process of BMS implantation. Two ISR cases for SES showed a histopathological heterogeneity: one showed nodular calcified thrombus around stent strut protruding into the lumen, and the other showed concentric neointima composed of CD68-positive foam cell proliferation. In the ISR lesion for PES in EES, infiltrations with foam cells macrophages, particularly numerous eosinophilic cell infiltrations, suggest a peristent strut hypersensitivity reaction. We found a remarkable histopathological heterogeneity of ISR. The study using coronary endarterectomy specimens can give us pivotal information about the histopathological heterogeneity of ISR. Copyright © 2014 Elsevier Inc. All rights reserved.

  17. The TRAPIST Study. A multicentre randomized placebo controlled clinical trial of trapidil for prevention of restenosis after coronary stenting, measured by 3-D intravascular ultrasound.

    NARCIS (Netherlands)

    P.W.J.C. Serruys (Patrick); D.P. Foley (David); M. Pieper (Michael); J.A. Kleijne; P.J. de Feyter (Pim)

    2001-01-01

    textabstractBACKGROUND: Studies have reported benefit of oral therapy with the phosphodiesterase inhibitor, trapidil, in reducing restenosis after coronary angioplasty. Coronary stenting is associated with improved late outcome compared with balloon angioplasty, but significant neointimal hyperplasi

  18. Diagnostic accuracy and its affecting factors of dual-source CT for assessment of coronary stents patency and in-stent restenosis

    Institute of Scientific and Technical Information of China (English)

    ZHANG Xing-hua; YANG Li; WU Jian; JU Hai-yue; ZHANG Fan; HE Bin; CHEN Yun-dai

    2012-01-01

    Background In-stent restenosis is a common complication after stent implantation.However,the assessment of stent lumen in computed tomography (CT) coronary angiography is limited by multiple factors.Our study aimed to evaluate the accuracy and the suspected affecting factors in diagnosing coronary in-stent restenosis by dual-source CT (DSCT) compared with coronary angiography.Methods One hundred and fifteen stents in 50 patients were evaluated with DSCT before coronary angiography for the detection of coronary in-stent restenosis (≥ 50% luminal narrowing).Patency of each stent was analyzed by two independent expert radiologists blinded to the results of coronary angiography.The relationship between diagnostic accuracy and the suspected factors including age,body mass index (BMI),heart rate,variation of heart rate,radiation dose,image quality,location and stent characteristics (type,material,diameter,length and strut thickness) was assessed wilh both univariate and multivariate analysis.The fitting of a Logistic regression model was evaluated using a receiver operating characteristic (ROC) curve.Results Mean stent diameter was (2.9±0.4) mm.Sensitivity,specificity,positive and negative predictive values and accuracy of DSCT in detection of in-stent restenosis were 69.2%,91.2%,50.0%,95.9%,and 88.7%,respectively.In a subgroup of stents with a diameter ≥3.0 mm,sensitivity,specificity,positive and negative predictive values and accuracy were 100.0%,96.5%,75.0%,100.0%+ and 96.8%,respectively.Stent diameter <3.0 mm and poor image quality were associated with poor diagnostic accuracy (P <0.05).The area under curve of ROC was 0.79.Conclusion DSCT can provide high accuracy for the assessment of in-stent restenosis in stents with a diameter ≥3.0mm,and can play an important role in ruling out in-stent restenosis.

  19. Markers of inflammation and antioxidant enzyme activities in restenosis following percutaneous coronary intervention

    Directory of Open Access Journals (Sweden)

    Pantović Snežana

    2015-01-01

    Full Text Available The efficacy of percutaneous coronary intervention (PCI is often compromised by the need for repeat revascularization, because of restenosis development. Numerous studies have tried to establish the predictive value of different biochemical markers of restenosis, with conflicting results. The aim of this study was to assess the prognostic significance of inflammatory and lipid markers, and major antioxidant enzyme activity for the development of in-stent restenosis (ISR following PCI. Serum high sensitive C-reactive protein (hs-CRP, soluble intercellular cell adhesion molecule-1 (sICAM-1, transforming growth factor-beta (TGF-β, lipoprotein(a and oxidized low-density lipoprotein (oxLDL levels, as well as serum extracellular superoxide dismutase (EC-SOD and catalase (CAT activity were determined in 44 patients before stent implantation procedure, and after 6-month follow-up. Results after follow-up revealed that, in patients that developed angiografically confirmed ISR, the increase in serum hs-CRP levels was significanty higher, compared to those without stenosis. Stent implantation induced compensatory increase in serum antioxidant enzyme activities at follow-up, with significantly lower CAT activity in patients with ISR, possibly contributing to stenosis development. No significant changes in circulating levels of ICAM-1, TGF-β, oxLDL and Lp(a were observed between the groups. In conclusion, serum hs-CRP level and CAT activity may be considered as useful biochemical markers for monitoring patients during follow-up after stent implantation.

  20. Polymorphism K469E of intercellular adhesion molecule-1 gene and restenosis after coronary stenting in Chinese patients

    Institute of Scientific and Technical Information of China (English)

    刘兆平; 霍勇; 李建平; 张岩; 薛琳; 赵春玉; 洪秀梅; 黄爱群; 高炜

    2004-01-01

    Background Inflammation is a major cause of restenosis after coronary stenting. Intercellular adhesion molecule-1 ( ICAM-1 ) is an important adhesion molecule that plays a key role in the tight adhesion between leukocytes and vascular endothelium. The object of this study was to investigate the association between the K469E polymorphism of the ICAM-1 gene and restenosis after coronary stenting in North Chinese population.Methods The ICAM-1 K469E polymorphism was genotyped using polymerase chain reaction- restriction fragment length polymorphism method in 124 patients who had undergone coronary stenting and coronary angiography at least 3 months earlier. Information on clinical risk factors and procedure- related data were also collected. Results Of 124 enrolled patients in total, there were 72 cases of in-stent restenosis. The restenosis rate in this population was 58. 1%. The frequencies of the three possible genotypes of the ICAM-1 K469E polymorphism were: KK genotype 50.8%, EE genotype 41.9%, and EK genotype 41.9%.Among restenosis patients, the frequency of the KK genotype was 58. 3% and the frequency of E allele carriers was 41.7%. Among non-restenosis patients, the frequency of the KK genotype was 40.4%, and the frequency of E allele carriers was 59. 6%. The distribution of these two genotype groups between restenosis and non-restenosis patients was significantly different (P=0.049). Using multivariate logistic regression, the difference between the two groups was more apparent. The odds ratio of KK homozygotes vs E allele carriers was 2.6, with 95% confidence interval 1.2 -5.8 (P =0. 018). After grading of risk factors, we found that the KK genotype was a stronger predictor of in- stent restenosis in obesity or hyperlipemia patients, with an odds ratio of 9.3 and 3.7, respectively (P<0.05).Conclusion In our study population, KK homozygotes of the ICAM-1 codon 469 mutation had a higher risk of restenosis after coronary stenting, especially in the case of obese

  1. Towards a self-reporting coronary artery stent--measuring neointimal growth associated with in-stent restenosis using electrical impedance techniques.

    Science.gov (United States)

    Shedden, Laurie; Kennedy, Simon; Wadsworth, Roger; Connolly, Patricia

    2010-10-15

    Implantable medical devices have become the standard method for treating a variety of cardiovascular diseases (NICE, 2003, 2009), such as coronary artery disease, where coronary artery stents are the device of choice (Fischman et al., 1994; Babapulle et al., 2004). One post-operative problem with these devices is the long-term monitoring of the device-tissue interface, with respect to the complications that often arise from in-stent restenosis. This monitoring, where it is available, is currently performed using imaging techniques such as contrast angiography, IVUS, CT and MRI. In this study we propose an alternative method for the non-invasive monitoring of restenosis in coronary artery stents. This preliminary study uses impedance spectroscopy to measure the electrical impedance of cells and tissues associated with the neointimal growth that characterises in-stent restenosis in coronary artery stents. An in vitro organ culture model, using a stent implanted in a section of pig coronary artery, simulated tissue growth inside a stent. Impedance measurements were made regularly over a 28-day culture period. In a novel step, the stent itself was employed as an electrode. Differences in electrical impedance could be seen between control (stent alone) and artery-embedded stents in culture, which were associated with the presence of biological tissue. This method could potentially be developed to produce a stent that was capable of self-reporting in-stent restenosis. The advantages of such a device would be that monitoring could be non-invasively and easily carried out, allowing more routine follow-ups and the early identification and management of any device complications.

  2. Clinical Study of Xiongshao Capsule (芎芍胶囊) in Preventing Restenosis after Coronary Interventional Treatment

    Institute of Scientific and Technical Information of China (English)

    徐浩; 陈可冀; 史大卓; 马晓昌; 吕树铮; 毛节明

    2002-01-01

    Objective: To evaluate the effect of Xiongshao Capsule (XS, 芎芍胶囊) in preventing clinical and angiographic restenosis after coronary angioplasty or/and stenting. Methods: The total of 108 coronary heart disease patients with successful coronary angioplasty or/and stenting were randomly divided into the control group (55 cases, routine treatment) and the XS group (53 cases, routine treatment combined with XS). The recurrence of angina, clinical end-point events, changing of blood-stasis syndrome score (BSSS) and coronary angiography within 6 month after coronary angioplasty or/and stenting were observed. Results: Follow-up angiography was performed in 42 patients including 18 cases in the XS group (restenosis was observed in 7 patients) and 24 cases in the control group (restenosis was observed in 17 patients), there was significant difference between the occurrence of restenosis in XS and that in control group (P<0.05). The occurrence of clinical end-point events (death, nonfatal target lesion myocardial infarction, coronary artery bypass graft surgery, or repeat target-vessel angioplasty) in the XS group (18.8%) was significantly lower than that in the control group (40%)(P<0.05). The recurrent angina was observed in 13 cases in the XS group, there was significant difference as compared with 27 cases in the control group (P<0.05). There was also remarkable significance for the difference of base-line and follow-up BSSS between groups (P<0.01). Logistic multivariate stepwise regress analysis and multivariate regress analysis of the related factors with restenosis confirmed by coronary angiography showed that, the base-line BSSS and the difference of base-line and follow-up BSSS were important influencing factors on the occurrence of restenosis after interventional treatment (P<0.05). Conclusion: XS could markedly reduce the occurrence of angiographic restenosis, clinical end-point events and recurrent angina, improve condition of blood-stasis after coronary

  3. XS0601 reduces the incidence of restenosis: a prospective study of 335 patients undergoing percutaneous coronary intervention in China

    Institute of Scientific and Technical Information of China (English)

    2006-01-01

    Background XS0601, consisting of active ingredients (Chuangxiongol and paeoniflorin), has been shown to inhibit arterial neointimal hyperplasia in animal models and in preliminary human studies. The objective of this study was to evaluate the safety and efficacy of XS0601 in preventing restenosis following percutaneous coronary intervention (PCI). Methods A multi-center, randomized, double-blind, placebo-controlled trial was conducted. A total of 335 patients were randomized into treatment with the oral administration of XS0601, or a placebo for 6 months after successful PCI. Angiographic follow-up was scheduled at 6 months, and clinical follow-ups performed at 1, 3 and 6 months after PCI. The primary end point was angiographic restenosis. The secondary end points were the combined incidence of death, target lesion nonfatal myocardial infarction, repeat angioplasty, and coronary artery bypass graft surgery.Results A total of 308 patients (91.9%) completed the study and 145 cases (47.1%) received angiographic follow-up. The restenosis rates were significantly reduced in the XS0601 group as compared with the placebo group (26.0% vs. 47.2%, P < 0.05), and the minimum lumen diameter (MLD) was greater [(2.08 ± 0.89) mm for XS0601 vs. (1.73 ± 0.94) mm for placebo, P < 0.05]. XS0601 also significantly reduced the combined incidence of major adverse cardiac event (10.4% in the XS0601 group vs. 22.7% in the placebo group, P < 0.05). The incidence of recurrent angina at 3 and 6 months after PCI was also significantly reduced in XS0601 group (7.1% and 11.0%) as compared with those in placebo group (19.5% and 42.9%) (P < 0.05). No significant side effects occurred within the 6-month follow-up period in the XS0601 group.Conclusion Administration of XS0601 for 6 months is demonstrated to be safe and effective in reducing restenosis in post-PCI patients.

  4. Diagnostic accuracy of 16-slice multidetector-row CT for detection of in-stent restenosis vs detection of stenosis in nonstented coronary arteries.

    Science.gov (United States)

    Kefer, Joelle M; Coche, Emmanuel; Vanoverschelde, Jean-Louis J; Gerber, Bernhard L

    2007-01-01

    The purpose of this study was to assess the diagnostic accuracy of 16-slice multidetector-row computed tomography (MDCT) for detecting in-stent restenosis. Fifty patients with 69 previously implanted coronary stents underwent 16-slice MDCT before quantitative coronary angiography (QCA). Diagnostic accuracy of MDCT for detection of in-stent restenosis defined as >50% lumen diameter stenosis (DS) in stented and nonstented coronary segments >1.5-mm diameter was computed using QCA as reference. According to QCA, 18/69 (25%) stented segments had restenosis. In addition, 33/518 (6.4%) nonstented segments had >50% DS. In-stent restenosis was correctly identified on MDCT images in 12/18 stents, and absence of restenosis was correctly identified in 50/51 stents. Stenosis in native coronary arteries was correctly identified in 22/33 segments and correctly excluded in 482/485 segments. Thus, sensitivity (67% vs 67% p=1.0), specificity (98% vs 99%, p=0.96) and overall diagnostic accuracy (90% vs 97%, p=0.68) was similarly high for detecting in-stent restenosis as for detecting stenosis in nonstented coronary segments. MDCT has similarly high diagnostic accuracy for detecting in-stent restenosis as for detecting coronary artery disease in nonstented segments. This suggests that MDCT could be clinically useful for identification of restenosis in patients after coronary stenting.

  5. Diagnostic accuracy of 16-slice multidetector-row CT for detection of in-stent restenosis vs detection of stenosis in nonstented coronary arteries

    Energy Technology Data Exchange (ETDEWEB)

    Kefer, Joelle M.; Vanoverschelde, Jean-Louis J.; Gerber, Bernhard L. [Cliniques Universitaires St. Luc UCL, Department of Cardiology, Brussels (Belgium); Coche, Emmanuel [Cliniques Universitaires St. Luc UCL, Department of Radiology, Brussels (Belgium)

    2007-01-15

    The purpose of this study was to assess the diagnostic accuracy of 16-slice multidetector-row computed tomography (MDCT) for detecting in-stent restenosis. Fifty patients with 69 previously implanted coronary stents underwent 16-slice MDCT before quantitative coronary angiography (QCA). Diagnostic accuracy of MDCT for detection of in-stent restenosis defined as >50% lumen diameter stenosis (DS) in stented and nonstented coronary segments >1.5-mm diameter was computed using QCA as reference. According to QCA, 18/69 (25%) stented segments had restenosis. In addition, 33/518 (6.4%) nonstented segments had >50% DS. In-stent restenosis was correctly identified on MDCT images in 12/18 stents, and absence of restenosis was correctly identified in 50/51 stents. Stenosis in native coronary arteries was correctly identified in 22/33 segments and correctly excluded in 482/485 segments. Thus, sensitivity (67% vs 67% p=1.0), specificity (98% vs 99%, p=0.96) and overall diagnostic accuracy (90% vs 97%, p=0.68) was similarly high for detecting in-stent restenosis as for detecting stenosis in nonstented coronary segments. MDCT has similarly high diagnostic accuracy for detecting in-stent restenosis as for detecting coronary artery disease in nonstented segments. This suggests that MDCT could be clinically useful for identification of restenosis in patients after coronary stenting. (orig.)

  6. Diagnostic value of magnetocardiography in patients with coronary heart disease and in-stent restenosis

    Institute of Scientific and Technical Information of China (English)

    QUAN Wei-wei; LU Guo-ping; QI Wen-hang; LI Ying-mei; SHEN Yue; YUAN Rong

    2008-01-01

    Background In-stent restenosis (ISR) has become one of the most challenging problems in patients with coronary heart disease. At present, using non-invasive methods to assess ISR is a hol topic. In this investigation we attempted to explore the potential of magnetocardiography (MCG) in diagnosis of in-stent restenosis.Methods MCG was analyzed in 52 patients with coronary artery disease for three times: before stenting, one month and 7 months after successful intracoronary stenting.Results The average classification of total maps (ACTM) and the ratio of abnormal maps (RAM) were Iower in 1 month after intracoronary stenting compared with that obtained before stent planting (2.91 vs 2.52, 65.74% vs 42.80%, P<0.01),while complex ventricular excitation Index (CVEI) increased from -42.63 to -20.05 (P<0.01). In ISR subgroup (n=16),RAM decreased in 1 month after intracoronary stenting compared to it before stenting (68.99% vs 45.26%, P<0.05).ACTM increased in 7 months compared to that obtained in 1 month after stenting (3.15 vs 2.51, P<0.05). According to the ROC curve, ACTM showed its unique diagnostic value in restenosis patients. The sensitivity and specificity of ACTM were 80.0%, 69.40%, respectively. Its positive predictive value and negative predictive value were 54.6% and 88.5%,respectively.Conclusions After successful intracoronary stenting, most parameters of MCG were improved. ACTM was of prognostic value in diagnosing ISR.

  7. Usefulness of intravascular low-power laser illumination in preventing restenosis after percutaneous coronary intervention.

    Science.gov (United States)

    Derkacz, Arkadiusz; Protasiewicz, Marcin; Poreba, Rafal; Szuba, Andrzej; Andrzejak, Ryszard

    2010-10-15

    Despite the several years of studies, no factor that could reduce the restenosis rate without significant limitations has been introduced. The aim of the present study was to evaluate the influence of low-power 808-nm laser illumination of coronary vessels after percutaneous angioplasty in preventing restenosis. The procedure of laser intravascular illumination was performed on 52 patients (laser group), and another 49 patients formed the control group. All patients were monitored for major adverse cardiac events (MACE) at the 6- and 12-month follow-up points. The MACE rate after 6 and 12 months was 7.7% in the laser group at both points. The MACE rate was 14.3% and 18.5% at 6 and 12 months of follow-up in the control group, respectively (p = NS). Follow-up coronary angiography was performed after 6 months. The difference in the restenosis rate was insignificant (15.0% vs 32.4%); however, significant differences were observed in the minimal lumen diameter (2.18 ± 0.70 vs 1.76 ± 0.74 mm; p laser group. In conclusion, the new therapy seemed effective and safe. Marked differences between late loss, late loss index, and minimal lumen diameter were observed. The late lumen loss in the laser group was only slightly greater than that in studies of drug-eluting stents, and MACE rate remained within very comparable ranges. This suggests that intravascular laser illumination could bring advantages comparable to those of drug-eluting stents without the risk of late thrombosis. Copyright © 2010 Elsevier Inc. All rights reserved.

  8. Impact of obstructive sleep apnea on the occurrence of restenosis after elective percutaneous coronary intervention in ischemic heart disease

    Directory of Open Access Journals (Sweden)

    Behrendt Dominik

    2008-06-01

    Full Text Available Abstract Rationale There is growing evidence that obstructive sleep apnea is associated with coronary artery disease. However, there are no data on the course of coronary stenosis after percutaneous coronary intervention in patients with obstructive sleep apnea. Objectives To determine whether sleep apnea is associated with increased late lumen loss and restenosis after percutaneous coronary intervention. Methods 78 patients with coronary artery disease who underwent elective percutaneous coronary intervention were divided in 2 groups: 43 patients with an apnea hypopnea – Index 10/h (group II. Late lumen loss, a marker of restenosis, was determined using quantitative coronary angiography after 6.9 ± 3.1 months. Main results Angiographic restenosis (>50% luminal diameter, was present in 6 (14% of group I and in 9 (25% of group II (p = 0.11. Late lumen loss was significant higher in pt. with an AHI > 10/h (0.7 ± 0.69 mm vs. 0.38 ± 0.37 mm, p = 0.01. Among these 35 patients, 21(60% used their CPAP devices regularly. There was a marginally lower late lumen loss in treated patients, nevertheless, this difference did not reach statistical significance (0.57 ± 0.47 mm vs. 0.99 ± 0.86 mm, p = 0.08. There was no difference in late lumen loss between treated patients and the group I (p = 0.206. Conclusion In summary, patients with OSA and coronary artery disease have a higher degree of late lumen loss, which is a marker of restenosis and vessel remodeling after elective percutaneous intervention.

  9. Effect of Shuxinyin (舒心饮) on In-Stent Restenosis after Coronary Artery Stenting

    Institute of Scientific and Technical Information of China (English)

    王显; 林钟香; 葛均波; 刘旭; 何燕; 张振贤; 沈琳

    2002-01-01

    Objective: To evaluate the effect of anti-platelet regimens and it's combination with Shuxinyin (SXY, 舒心饮,) on in-stent restenosis after stent implantation. Methods: Forty-four patients with successful stent implantation in a coronary artery were randomly assigned to the treated group (n=20) and the control group (n=24). The treated group received: SXY and anti-platelet therapy. The control group were treated with anti-platelet regimens only. Platelet activation was assessed before and immediately after the stenting by flow cytometry, the expression of P-selectin (CD62P) and glycoprotein(GP) Ⅱb/Ⅲa receptor. It was reassessed on the 30th day after stenting. Plasma fibrinogen (Fg) and C-reaction protein (CRP) were measured by biuret and laser scattering turbidimetry respectively at the same time. Observation was made on the scoring of the symptoms of Qi deficiency syndrome, Qi-Yin deficiency syndrome and blood stasis syndrome in the two groups. Differences between groups were compared. Results: Compared with the control group, combination with SXY and anti-platelet therapy was remarkable in reducing plasma CRP (P<0.05), and also with the tendency to decrease plasma Fg, GPⅡb/Ⅲa and CD62P. It could also evidently decrease the scoring of Qi-Yin deficiency syndrome, Qi deficiency syndrome and blood stasis syndrome after stenting (P<0.05, 0.01, 0.01) respectively. Follow-up survey found 40% relapse of angina pectoris with 4 cases of in-stent restenosis proved by angiography in the treated group. But the relapse of angina pectoris in the control group was 67% with 2 cases of myocardial infarction (MI), 7 cases of in-stent restenosis proved by angiography and one death. Conclusions: Combination with SXY and anti-platelet regimens can prevent stent thrombosis and in-stent restenosis after stent implantation, and it seems superior to anti-platelet therapy only.

  10. Development of radiolabelled compound using reactor producted RI - Evaluation of Ho-166 endovascular therapy to prevent restenosis after PTCA or stenting for occlusive coronary artery disease

    Energy Technology Data Exchange (ETDEWEB)

    Park, Chan Hee; Choi, Byung Il; Kim, Han Soo [Ajou University, Suwon (Korea)

    2000-04-01

    Occlusive coronary artery disease is managed successfully by percutaneous transfemoral coronary angioplasty (PTCA) or stenting with 95% success rate. However, restenosis after PTCA is not uncommon and the reported incidence of reocclusion is about 30 {approx} 40%. Therefore, the objective of the research was to develop endovascular brachytherapy using liquid form of Ho-166 in order to inhibit neointimal hyperplasia responsible for restenosis following PTCA or stenting. Our research was carried out in 3 stages: First stage - The effectiveness of radiation was confirmed by using animal model. Following over-sized balloon injury to rat carotid artery and porcine coronary artery, various external radiation doses were delivered. Second stage - For radiation dose distribution within the coronary artery and its surrounding tissues, Gafchromic film was used. In vitro dose distribution of Ho-166 utilizing water phantom and Gafchromic film was measured. Third stage - None uniform dose distribution from Ho-166 within the balloon caused by small air bubbles was eliminated by negative suction method. More accurate dose distribution was also possible using newly developed micrometer by our physicist. Limited number of human trial was performed without adverse effect. 40 refs. (Author)

  11. Factors Associated with In-stent Restenosis in Patients Following Percutaneous Coronary Intervention

    Directory of Open Access Journals (Sweden)

    Dedi Wihanda

    2015-07-01

    Full Text Available Aim: to determine factors associated with In-Stent Restenosis (ISR in patients following Percutaneous Coronary Intervention (PCI. Methods: a retrospective cross-sectional study was conducted using secondary information from medical records of post-PCI patients who underwent follow-up of angiography PCI between January 2009 and March 2014 at The Integrated Cardiovascular Service Unit, Cipto Mangunkusumo Hospital, Jakarta. Angiographic ISR was defined when the diameter of stenosis ≥50% at follow-up angiography including the diameter inside the stent and diameter with five-mm protrusion out of the proximal and distal ends of the stent. Results: there were 289 subjects including 133 subjects with and 156 subjects without ISR. The incidence of ISR in patients using of bare-metal stent (BMS and drug-eluting stent (DES were 61.3% and 40.7%, respectively. Factors associated with ISR are stent-type (OR=4.83, 95% CI 2.51-9.30, stent length (OR=3.71, 95% CI 1.99-6.90, bifurcation lesions (OR=2.43, 95% CI 1.16-5.10, smoking (OR=2.30, 95% CI 1.33-3.99, vascular diameter (OR=2.18, 95% CI 1.2-3.73, hypertension (OR=2.16, 95% CI 1.16-4.04 and diabetes mellitus (OR=2.14, 95% CI 1.23-3.70. Conclusion: stent type, stent length, bifurcation lesions, smoking, vascular diameter, hypertension and DM are factors associated with ISR in patients following PCI. Key words: bare-metal stent; drug-eluting stent; in-stent restenosis.

  12. Clinical Coronary In-Stent Restenosis Follow-Up after Treatment and Analyses of Clinical Outcomes

    Directory of Open Access Journals (Sweden)

    Barbara Campos Abreu Marino

    2015-05-01

    Full Text Available Background: Clinical in-stent restenosis (CISR is the main limitation of coronary angioplasty with stent implantation. Objective: Describe the clinical and angiographic characteristics of CISR and the outcomes over a minimum follow-up of 12 months after its diagnosis and treatment. Methods: We analyzed in 110 consecutive patients with CISR the clinical presentation, angiographic characteristics, treatment and combined primary outcomes (cardiovascular death, nonfatal acute myocardial infarction [AMI] and combined secondary (unstable angina with hospitalization, target vessel revascularization and target lesion revascularization during a minimal follow-up of one year. Results: Mean age was 61 ± 11 years (68.2% males. Clinical presentations included acute coronary syndrome (ACS in 62.7% and proliferative ISR in 34.5%. CISR was treated with implantation of drug-eluting stents (DES in 36.4%, Bare Metal Stent (BMS in 23.6%, myocardial revascularization surgery in 18.2%, balloon angioplasty in 15.5% and clinical treatment in 6.4%. During a median follow-up of 19.7 months, the primary outcome occurred in 18 patients, including 6 (5.5% deaths and 13 (11.8% AMI events. Twenty-four patients presented a secondary outcome. Predictors of the primary outcome were CISR with DES (HR = 4.36 [1.44–12.85]; p = 0.009 and clinical treatment for CISR (HR = 10.66 [2.53–44.87]; p = 0.001. Treatment of CISR with BMS (HR = 4.08 [1.75–9.48]; p = 0.001 and clinical therapy (HR = 6.29 [1.35–29.38]; p = 0.019 emerged as predictors of a secondary outcome. Conclusion: Patients with CISR present in most cases with ACS and with a high frequency of adverse events during a medium-term follow-up.

  13. Clinical Coronary In-Stent Restenosis Follow-Up after Treatment and Analyses of Clinical Outcomes

    Science.gov (United States)

    Marino, Barbara Campos Abreu; Nascimento, Guilherme Abreu; Rabelo, Walter; Marino, Marcos Antônio; Marino, Roberto Luiz; Ribeiro, Antonio Luiz Pinho

    2015-01-01

    Background Clinical in-stent restenosis (CISR) is the main limitation of coronary angioplasty with stent implantation. Objective Describe the clinical and angiographic characteristics of CISR and the outcomes over a minimum follow-up of 12 months after its diagnosis and treatment. Methods We analyzed in 110 consecutive patients with CISR the clinical presentation, angiographic characteristics, treatment and combined primary outcomes (cardiovascular death, nonfatal acute myocardial infarction [AMI]) and combined secondary (unstable angina with hospitalization, target vessel revascularization and target lesion revascularization) during a minimal follow-up of one year. Results Mean age was 61 ± 11 years (68.2% males). Clinical presentations included acute coronary syndrome (ACS) in 62.7% and proliferative ISR in 34.5%. CISR was treated with implantation of drug-eluting stents (DES) in 36.4%, Bare Metal Stent (BMS) in 23.6%, myocardial revascularization surgery in 18.2%, balloon angioplasty in 15.5% and clinical treatment in 6.4%. During a median follow-up of 19.7 months, the primary outcome occurred in 18 patients, including 6 (5.5%) deaths and 13 (11.8%) AMI events. Twenty-four patients presented a secondary outcome. Predictors of the primary outcome were CISR with DES (HR = 4.36 [1.44–12.85]; p = 0.009) and clinical treatment for CISR (HR = 10.66 [2.53–44.87]; p = 0.001). Treatment of CISR with BMS (HR = 4.08 [1.75–9.48]; p = 0.001) and clinical therapy (HR = 6.29 [1.35–29.38]; p = 0.019) emerged as predictors of a secondary outcome. Conclusion Patients with CISR present in most cases with ACS and with a high frequency of adverse events during a medium-term follow-up. PMID:25651344

  14. Restenosis in coronary bare metal stents. Importance of time to follow-up: a comparison of coronary angiograms 6 months and 4 years after implantation

    DEFF Research Database (Denmark)

    Jørgensen, Erik; Helqvist, Steffen; Kløvgaard, Lene

    2008-01-01

    Objectives. Angiographic late lumen loss measured 6 to 9 month after bare metal stent implantation in the coronary arteries is a validated restenosis parameter. Design. We performed a second angiographic follow-up after 4 years in event free survivors from the DANSTENT trial cohort. Results....... Quantitative comparison of paired coronary angiograms at 6 months and 4 years showed a reduction of late loss from 0.68+/-0.52mm to 0.42 (+/-0.52) (mean difference 0.26 (0.17 to 0.36), p...% confidence interval: -0.34mm to -0.14mm, pstenosis decreased from 24.8+/-14.2% to 18.6+/-9.3% (mean difference 6.16%, 95% confidence interval: 2.82 to 9.48%, p=0.0006). This observed spontaneous decrease of instent restenosis corresponds to a 19% increase of minimal cross...

  15. Bioabsorbable drug-eluting vascular scaffold for the treatment of coronary in-stent restenosis: A two center registry

    Energy Technology Data Exchange (ETDEWEB)

    Moscarella, Elisabetta [Division of Cardiology, Seconda Università degli studi di Napoli, AO Dei cColli, PO Monaldi (Italy); Varricchio, Attilio [Division of Cardiology, Department of Advanced Biomedical Sciences, University of Napoli “Federico II”, Napoli (Italy); Stabile, Eugenio, E-mail: geko50@hotmail.com [Laboratory of Invasive Cardiology, Dipartimento di Cardiologia, Presidio Ospedaliero “Monaldi”, Azienda Ospedaliera “Dei Colli”, Napoli (Italy); Franzone, Anna [Laboratory of Invasive Cardiology, Dipartimento di Cardiologia, Presidio Ospedaliero “Monaldi”, Azienda Ospedaliera “Dei Colli”, Napoli (Italy); Granata, Francesco [Division of Cardiology, Seconda Università degli studi di Napoli, AO Dei cColli, PO Monaldi (Italy); Rapacciuolo, Antonio; Galasso, Gennaro [Laboratory of Invasive Cardiology, Dipartimento di Cardiologia, Presidio Ospedaliero “Monaldi”, Azienda Ospedaliera “Dei Colli”, Napoli (Italy); Capozzolo, Claudia [Division of Cardiology, Department of Advanced Biomedical Sciences, University of Napoli “Federico II”, Napoli (Italy); Cirillo, Plinio [Laboratory of Invasive Cardiology, Dipartimento di Cardiologia, Presidio Ospedaliero “Monaldi”, Azienda Ospedaliera “Dei Colli”, Napoli (Italy); and others

    2015-10-15

    Background/purpose: Coronary in-stent restenosis (ISR) is a clinical problem for which a satisfactory solution has not been found yet. Bioabsorbable drug eluting vascular scaffolds (BVSs) provide transient vessel scaffolding combined with prolonged drug delivery capability. The aim of this study was to investigate the safety of BVS for the treatment of coronary ISR. Methods/materials: Between January 2013 and June 2013, 27 patients (31 lesions), presenting with either stable or unstable angina due to coronary ISR, were enrolled in a single arm, prospective, open label registry. Primary end point was the occurrence of target vessel revascularization (TVR) at 12 months. Secondary end point was the composite of death, myocardial infarction and TVR at 12 months. Results: A diffuse ISR pattern was present in 70% of the lesions; mean lesion length was 34.6 ± 15. BVS was successfully implanted in all patients with no in hospital MACE. At twelve months of follow up, MACE rate was 18.5%. One patient died for non-cardiac reason, one patient died due to a possible stent thrombosis and TVR was necessary in 3 patients (11.1%). Conclusions: Our data suggest that BVS is safe and technically feasible for treatment of long and diffuse coronary ISR. These data could be considered hypothesis generator for a randomized clinical trial. - Highlights: • A safe therapeutic option for the treatment of diffuse ISR; • Technically feasible; • Associated to a low rate of restenosis recurrence at nine month.

  16. A Complex Automata approach for in-stent restenosis: two-dimensional multiscale modelling and simulations

    NARCIS (Netherlands)

    Caiazzo, A.; Evans, D.; Falcone, J.-L.; Hegewald, J.; Lorenz, E.; Stahl, B.; Wang, D.; Bernsdorf, J.; Chopard, B.; Gunn, J.; Hose, R.; Krafczyk, M.; Lawford, P.; Smallwood, R.; Walker, D.; Hoekstra, A.

    2011-01-01

    In-stent restenosis, the maladaptive response of a blood vessel to injury caused by the deployment of a stent, is a multiscale system involving a large number of biological and physical processes. We describe a Complex Automata model for in-stent restenosis, coupling bulk flow, drug diffusion, and s

  17. Towards a Complex Automata multiscale model of in-stent restenosis

    NARCIS (Netherlands)

    Caiazzo, A.; Evans, D.; Falcone, J.-L.; Hegewald, J.; Lorenz, E.; Stahl, B.; Wang, D.; Bernsdorf, J.; Chopard, B.; Gunn, J.; Hose, R.; Krafczyk, M.; Lawford, P.; Smallwood, R.; Walker, D.; Hoekstra, A.G.

    2009-01-01

    In-stent restenosis, the maladaptive response of a blood vessel to injury caused by the deployment of a stent, is a multiscale problem involving a large number of processes. We describe a Complex Automata Model for in-stent restenosis, coupling a bulk flow, drug diffusion, and smooth muscle cell mod

  18. Effect of force-induced mechanical stress at the coronary artery bifurcation stenting: Relation to in-stent restenosis

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Cheng-Hung [Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Linkou, Chang Gung University College of Medicine, Tao-Yuan, Taiwan (China); Department of Mechanical Engineering, Chang Gung University, Tao-Yuan, Taiwan (China); Jhong, Guan-Heng [Graduate Institute of Medical Mechatronics, Chang Gung University, Tao-Yuan, Taiwan (China); Hsu, Ming-Yi; Wang, Chao-Jan [Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital, Linkou, Tao-Yuan, Taiwan (China); Liu, Shih-Jung, E-mail: shihjung@mail.cgu.edu.tw [Department of Mechanical Engineering, Chang Gung University, Tao-Yuan, Taiwan (China); Hung, Kuo-Chun [Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Linkou, Chang Gung University College of Medicine, Tao-Yuan, Taiwan (China)

    2014-05-28

    The deployment of metallic stents during percutaneous coronary intervention has become common in the treatment of coronary bifurcation lesions. However, restenosis occurs mostly at the bifurcation area even in present era of drug-eluting stents. To achieve adequate deployment, physicians may unintentionally apply force to the strut of the stents through balloon, guiding catheters, or other devices. This force may deform the struts and impose excessive mechanical stresses on the arterial vessels, resulting in detrimental outcomes. This study investigated the relationship between the distribution of stress in a stent and bifurcation angle using finite element analysis. The unintentionally applied force following stent implantation was measured using a force sensor that was made in the laboratory. Geometrical information on the coronary arteries of 11 subjects was extracted from contrast-enhanced computed tomography scan data. The numerical results reveal that the application of force by physicians generated significantly higher mechanical stresses in the arterial bifurcation than in the proximal and distal parts of the stent (post hoc P < 0.01). The maximal stress on the vessels was significantly higher at bifurcation angle <70° than at angle ≧70° (P < 0.05). The maximal stress on the vessels was negatively correlated with bifurcation angle (P < 0.01). Stresses at the bifurcation ostium may cause arterial wall injury and restenosis, especially at small bifurcation angles. These finding highlight the effect of force-induced mechanical stress at coronary artery bifurcation stenting, and potential mechanisms of in-stent restenosis, along with their relationship with bifurcation angle.

  19. A genome-wide association study identifies a region at chromosome 12 as a potential susceptibility locus for restenosis after percutaneous coronary intervention

    Science.gov (United States)

    Sampietro, M. Lourdes; Trompet, Stella; Verschuren, Jeffrey J.W.; Talens, Rudolf P.; Deelen, Joris; Heijmans, Bastiaan T.; de Winter, Robbert J.; Tio, Rene A.; Doevendans, Pieter A.F.M.; Ganesh, Santhi K.; Nabel, Elizabeth G.; Westra, Harm-Jan; Franke, Lude; van den Akker, Erik B.; Westendorp, Rudi G.J.; Zwinderman, Aeilko H.; Kastrati, Adnan; Koch, Werner; Slagboom, P.Eline; de Knijff, Peter; Jukema, J. Wouter

    2011-01-01

    Percutaneous coronary intervention (PCI) has become an effective therapy to treat obstructive coronary artery diseases (CAD). However, one of the major drawbacks of PCI is the occurrence of restenosis in 5–25% of all initially treated patients. Restenosis is defined as the re-narrowing of the lumen of the blood vessel, resulting in renewed symptoms and the need for repeated intervention. To identify genetic variants that are associated with restenosis, a genome-wide association study (GWAS) was conducted in 295 patients who developed restenosis (cases) and 571 who did not (controls) from the GENetic Determinants of Restenosis (GENDER) study. Analysis of ∼550 000 single nucleotide polymorphisms (SNPs) in GENDER was followed by a replication phase in three independent case–control populations (533 cases and 3067 controls). A potential susceptibility locus for restenosis at chromosome 12, including rs10861032 (Pcombined = 1.11 × 10−7) and rs9804922 (Pcombined = 1.45 × 10−6), was identified in the GWAS and replication phase. In addition, both SNPs were also associated with coronary events (rs10861032, Padditive = 0.005; rs9804922, Padditive = 0.023) in a trial based cohort set of elderly patients with (enhanced risk of) CAD (PROSPER) and all-cause mortality in PROSPER (rs10861032, Padditive = 0.007; rs9804922, Padditive = 0.013) and GENDER (rs10861032, Padditive = 0.005; rs9804922, Padditive = 0.023). Further analysis suggests that this locus could be involved in regulatory functions. PMID:21878436

  20. Aggressive restenosis after percutaneous intervention in two coronary loci in a patient with human immunodeficiency virus infection

    Science.gov (United States)

    Alkhalil, Mohammad; Conlon, Christopher P; Ashrafian, Houman; Choudhury, Robin P

    2017-01-01

    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. PMID:28255546

  1. Effect of force-induced mechanical stress at the coronary artery bifurcation stenting: Relation to in-stent restenosis

    Science.gov (United States)

    Lee, Cheng-Hung; Jhong, Guan-Heng; Hsu, Ming-Yi; Liu, Shih-Jung; Wang, Chao-Jan; Hung, Kuo-Chun

    2014-05-01

    The deployment of metallic stents during percutaneous coronary intervention has become common in the treatment of coronary bifurcation lesions. However, restenosis occurs mostly at the bifurcation area even in present era of drug-eluting stents. To achieve adequate deployment, physicians may unintentionally apply force to the strut of the stents through balloon, guiding catheters, or other devices. This force may deform the struts and impose excessive mechanical stresses on the arterial vessels, resulting in detrimental outcomes. This study investigated the relationship between the distribution of stress in a stent and bifurcation angle using finite element analysis. The unintentionally applied force following stent implantation was measured using a force sensor that was made in the laboratory. Geometrical information on the coronary arteries of 11 subjects was extracted from contrast-enhanced computed tomography scan data. The numerical results reveal that the application of force by physicians generated significantly higher mechanical stresses in the arterial bifurcation than in the proximal and distal parts of the stent (post hoc P stenting, and potential mechanisms of in-stent restenosis, along with their relationship with bifurcation angle.

  2. Adenosine triphosphate stress 99mTc-methoxyisobutylisonitrile gated myocardial perfusion imaging efficacy in diagnosing stent restenosis following coronary stent implantation

    Science.gov (United States)

    Zhang, Pengfei; Chen, Song; Li, Yang; Du, Qiuhong; Wang, Lijuan; Sun, Yingxian; Li, Yaming

    2016-01-01

    Coronary stent restenosis rate following implantation is considerably high. The adenosine stress gated myocardial perfusion imaging (G-MPI) method has been widely used in the diagnosis, risk stratification and prognosis evaluation of coronary heart disease; however, the high cost of adenosine limits its clinical application. The aim of the present study was to investigate the efficacy of adenosine triphosphate (ATP) stress 99mTc-methoxyisobutylisonitrile (99mTc-MIBI) G-MPI for diagnosis in-stent restenosis following coronary stent implantation. Data from 66 patients with typical angina pectoris symptoms who had undergone percutaneous coronary stent implantation >3 months prior to participation in the study were analyzed. All the patients underwent ATP stress 99mTc-MIBI G-MPI and coronary artery angiography as the criterion diagnostic standard within 1 month. The sensitivity, specificity, and accuracy of ATP stress 99mTc-MIBI G-MPI in the assessment of in-stent restenosis were calculated. In addition, Fisher's exact probability methods were used to compare differences between experimental groups. Among 66 patients with a total of 99 implanted coronary arterial branches, 39 patients (59%) with 45 coronary arteries (45%) presented in-stent restenosis. The diagnostic sensitivity, specificity, accuracy, positive predictive and negative predictive value of ATP stress 99mTc-MIBI G-MPI for assessing stent restenosis in all patients were 85, 89, 86, 92 and 80%, respectively. Similarly, these values in patients with myocardial infarction were 79, 88, 83, 88 and 78%, respectively, while in patients without myocardial infarction the values were 90, 91, 90, 95 and 83%, respectively. Therefore, the diagnostic efficacy of ATP stress 99mTc-MIBI G-MPI in patients without myocardial infarction was higher compared with those with myocardial infarction; however, no significant difference was observed between the two groups. Furthermore, the sensitivity, specificity and accuracy for

  3. Adenosine triphosphate stress (99m)Tc-methoxyisobutylisonitrile gated myocardial perfusion imaging efficacy in diagnosing stent restenosis following coronary stent implantation.

    Science.gov (United States)

    Zhang, Pengfei; Chen, Song; Li, Yang; Du, Qiuhong; Wang, Lijuan; Sun, Yingxian; Li, Yaming

    2016-12-01

    Coronary stent restenosis rate following implantation is considerably high. The adenosine stress gated myocardial perfusion imaging (G-MPI) method has been widely used in the diagnosis, risk stratification and prognosis evaluation of coronary heart disease; however, the high cost of adenosine limits its clinical application. The aim of the present study was to investigate the efficacy of adenosine triphosphate (ATP) stress (99m)Tc-methoxyisobutylisonitrile ((99m)Tc-MIBI) G-MPI for diagnosis in-stent restenosis following coronary stent implantation. Data from 66 patients with typical angina pectoris symptoms who had undergone percutaneous coronary stent implantation >3 months prior to participation in the study were analyzed. All the patients underwent ATP stress (99m)Tc-MIBI G-MPI and coronary artery angiography as the criterion diagnostic standard within 1 month. The sensitivity, specificity, and accuracy of ATP stress (99m)Tc-MIBI G-MPI in the assessment of in-stent restenosis were calculated. In addition, Fisher's exact probability methods were used to compare differences between experimental groups. Among 66 patients with a total of 99 implanted coronary arterial branches, 39 patients (59%) with 45 coronary arteries (45%) presented in-stent restenosis. The diagnostic sensitivity, specificity, accuracy, positive predictive and negative predictive value of ATP stress (99m)Tc-MIBI G-MPI for assessing stent restenosis in all patients were 85, 89, 86, 92 and 80%, respectively. Similarly, these values in patients with myocardial infarction were 79, 88, 83, 88 and 78%, respectively, while in patients without myocardial infarction the values were 90, 91, 90, 95 and 83%, respectively. Therefore, the diagnostic efficacy of ATP stress (99m)Tc-MIBI G-MPI in patients without myocardial infarction was higher compared with those with myocardial infarction; however, no significant difference was observed between the two groups. Furthermore, the sensitivity, specificity and

  4. GenousTM endothelial progenitor cell capturing stent vs. the Taxus Liberte stent in patients with de novo coronary lesions with a high-risk of coronary restenosis: a randomized, single-centre, pilot study

    NARCIS (Netherlands)

    M.A.M. Beijk; M. Klomp; N.J.W. Verouden; N. van Geloven; K.T. Koch; J.P.S. Henriques; J. Baan; M.M. Vis; E. Scheunhage; J.J. Piek; J.G.P. Tijssen; R.J. de Winter

    2010-01-01

    Aims The purpose of this study was to evaluate the Genous(TM) endothelial progenitor cell capturing stent vs. the Taxus Liberté paclitaxel-eluting stent in patients with de novo coronary lesions with a high-risk of coronary restenosis. Methods and results We randomly assigned 193 patients with lesio

  5. [Efficacy and mechanism of local delivery of rapamycin and rapamycin-loaded poly(lactic-co-glycolic) acid nanoparticles on coronary restenosis of injury-stenosis model of minipigs].

    Science.gov (United States)

    Miao, L F; Yin, Y P; Cui, Y L; Chen, L F; Zeng, Y; Huang, C L; Zhu, W L; Song, C X; Zhang, H; She, M P; Yang, J

    2016-01-05

    To determine whether intramural administration of rapamycin (RPM)-loaded polylactic-polyglycolic acid (PLGA) nanoparticles (NPs) can reduce intimal thickening and affect the mRNA expressions of matrix metalloproteinase (MMP)-2, tissue inhibitor of metalloproteinase (TIMP)-2 and p27(kipl) in a coronary injury-stenosis model of minipigs. Twenty eight minipigs were randomly separated into four groups: saline group (n=7), blank PLGA NPs group (5.0 mg/ml)(n=7), RPM group (1.0 mg/ml)(n=7), and RPM-PLGA NPs(5.0 mg/ml)group (n=7), respectively. Different treatments were intracoronary locally delivered via a Dispatch™ catheter for 10 minutes. Serial angiography was performed pre-and post-modeling 30 days and the percent stenosis degree was assessed. Hematoxylin-Eosin (HE) staining, Weigert's resorcin fuchsin staining and picric acid-sirius red staining were used for morphometric analysis. Immunohistochemistry was performed to assess the levels of proliferating cell nuclear antigen (PCNA), MMP-2, and TIMP-2 at early and late time points, respectively. The expression of p27(kip1) mRNA was detected by in situ hybridization staining. Data from 21 minipigs had been collected at the end of the experiment with 6, 4, 5, and 6 from the former mentioned 4 groups, respectively. For the instant injury index, there was no significant difference among the four groups. The percent stenosis degree of RPM-PLGA NPs group was significantly lower than that of the other three groups respectively (all Pstenosis degree and shows excellent acute procedural results in the minipig interventional coronary artery oversized balloon injury model. The results from minipig model further support that this approach could be a potential clinical procedure for vascular proliferative disease.

  6. Metabolic syndrome and risk of restenosis in patients undergoing percutaneous coronary intervention

    NARCIS (Netherlands)

    Wouterjukema, J; Monraats, PS; Zwinderman, AH; De Maat, MPM; Kastelein, JJP; Doevendans, PAF; De Winter, RJ; Tio, RA; Frants, RR; Van der Laarse, A; Van der Wall, EE; Jukema, JW

    OBJECTIVE - Patients with metabolic syndrome have increased risk of cardiovascular events. The number of patients With Metabolic syndrome is rapidly increasing, and these patients Often need revascularization. However, only limited data are available on the effect of metabolic syndrome on restenosis

  7. Matrix Metalloproteinases 2 and 3 Gene Polymorphisms and the Risk of Target Vessel Revascularization after Percutaneous Coronary Intervention: Is There Still Room for Determining Genetic Variation of MMPs for Assessment of an Increased Risk of Restenosis?

    Directory of Open Access Journals (Sweden)

    J.J.W. Verschuren

    2010-01-01

    Full Text Available Objective: Mixed results have been reported of matrix metalloproteinases (MMP and their association with restenosis after percutaneous coronary intervention (PCI. The current study examines whether multiple single nucleotide polymorphisms (SNPs, covering the full genomic region of MMP2 and MMP3, were associated with restenosis in the GENDER study population.

  8. The microsatellite polymorphism of heme oxygenase-1 is associated with baseline plasma IL-6 level but not with restenosis after coronary in-stenting

    Institute of Scientific and Technical Information of China (English)

    LI Ping; Mohamed A. Elrayess; Abuzeid H. Gomma; Jutta Palmen; Emma Hawe; Kim M. Fox; Steve E.Humphries

    2005-01-01

    Background Vascular smooth muscle cells (VSMCs) can express heme-oxygenase (HO), a rate-limiting enzyme in the degradation of heme to bilirubin, ferritin and carbon monoxide (CO). VSMC-derived CO can suppress VSMC proliferation and 05-serve as an antiproliferation factor. The promoter region of HO-1 shows a polymorphism with different (GT)n repeats that has been reported to differently induce gene expression. The objective of this study was to examine the effect of this variation on the occurrence of restenosis after in-stent treatment in patients with coronary artery disease. Methods Candidates who underwent coronary stent implantation were genotyped for the HO-1 promoter polymorphism using polymerase chain reaction (PCR) and automated DNA capillary sequencer. Serum levels of IL-6 and C-reactive protein (CRP) were obtained at baseline, 24 hours and 48 hours after stenting. The primary end point for the study was angiographic evidence of in-stent restenosis at 6 months. All parameters for evaluation of restenosis were analysed by quantitatve computer-assisted angiographic analysis (QCA). Results One hundred and eighty-seven patients who underwent coronary stent implantation were studied of whom 27.8% showed ≥50% restenosis after 6 months. The distribution of (GT)n repeats of all patients in the promoter region of HO-1 genotype ranged from 22 to 42, with (GT)25 and (GT)32 being the two most common alleles. The allelic repeats were divided into the short class (S) with 29 (GT)n, the middle class (M) with 30-37 (GT)n and the long class (L) with 38 (GT)n. There was no significant difference in the restenosis between the genotype groups or between post operation levels of inflammation markers, but carriers of the S allele (n=120) had 33.3% lower baseline IL-6 compared with non-S carriers (n=67, P=0.0008). Conclusions Although no association was observed between the HO-1 promoter polymorphism and coronary in-stent restenosis following the stent procedure, the

  9. Influence of Simvastatin for In-stent Restenosis Rate and Blood Lipid Level and Inflammation Actor after Coronary Artery Stent Implantation

    Institute of Scientific and Technical Information of China (English)

    2007-01-01

    To investigate the effect of simvastatin on the probability of restenosis after stent implantation and serum level of lipids as well as high-sensitivity C-reactive protein (hs-CRP) in patients with coronary heart disease (CHD).Methods 118 patients with CHD after stenting therapy were divided into treatment group (n = 62) and control group(n =56) randomly. All patients were treated withaspirin (100 mg/d) and clopidogrel (75 mg/d) while treatment group patients took simvastatin (40 mg qn) additionally. All patients underwent coronary angiography (CAG) to compare the difference of restenosis and the serum level of total cholesterol (TC), low-density lipoprotein cholesterol(LDL-c), high-density lipoprotein cholesterol (HDL-c), triglyceride (TG) as well as hs-CRP after the drug treatment for 6 months. Results The probability of restenosis was significantly lower in the treatment group than that of control group ( P < 0.01 ) and the results were similar between the patients with bare metal stent ( P < 0.01 ) and those with sirolimus-eluting stent ( P<0.01 ). The serum levels of TC (P<0.01 ), LDL-c( P<0.01 ), TG (P<0.05 ) and hsCRP (P<0.01) were obviously lower while the HDL-c (P<0.05 ) level was higher in the treatment group than those of control group. There was no death case. Conclusions Simvastatin could decrease the probability of restenosis significantly after coronary stent implantation with dose of 40 mg/d. It also has good performance on lipids control and lightening inflammatory reactions with its undoubtedly safety.

  10. LOW-DOSE RADIOACTIVE ENDOVASCULAR STENTS PREVENT NEOINTIMAL HYPERPLASIA IN RABBITS RESTENOSIS MODEL

    Institute of Scientific and Technical Information of China (English)

    任晓庆; 黄定九; 黄刚; 毛家亮

    2002-01-01

    Objective To evaluate the effects of low-dose radioactive stents on the prevention of restenosis in rabbit model. Methods The stents were bombarded with suitable charged particles of adapted energy in the cyclotron to create a proper mixture of the radionuclides 59Fe, 60Co, 58Co, 51Cr, and 54Mn. The radioactive stents were implanted in the iliac arteries of rabbits. The effects of radioactive stents on prevention of restenosis were assessed by angiography, histomorphometry and immunocytochemistry. Results All the iliac arteries that had been implanted with radioactive stents were patent on angiography and had no radiation complication during the 1~2 months of follow-up. There was a significant reduction in neointimal area (0.37±0.14mm2 vs. 0.81±0.10mm2, P<0.01), percent area stenosis (6.7±2.9% vs. 13.2±1.4%, P<0.01) and PCNA immunoreactive rate (2.00±1.58% vs. 10.88±6.98%, P<0.05) in the radioactive stent group compared with the control stent group. Conclusion Radioactive stents with an active of 0.91~1.65 μCi could inhibit SMC proliferation and neointimal hyperplasia in animal restenosis model. The low-dose radioactive stents are safe and feasible for prevention of restenosis.

  11. Effects of abciximab on key pattern of human coronary restenosis in vitro: impact of the SI/MPL-ratio

    Directory of Open Access Journals (Sweden)

    Baur Regine

    2006-04-01

    Full Text Available Abstract Background The significant reduction of angiographic restenosis rates in the ISAR-SWEET study (intracoronary stenting and antithrombotic regimen: is abciximab a superior way to eliminate elevated thrombotic risk in diabetes raises the question of whether abciximab acts on clopidogrel-independent mechanisms in suppressing neointimal hyperplasia. The current study investigates the direct effect of abciximab on ICAM-1 expression, migration and proliferation. Methods ICAM-1: Part I of the study investigates in cytoflow studies the effect of abciximab (0.0002, 0.002, 0.02, 0.2, 2.0, and 20.0 μg/ml on TNF-α induced expression of intercellular adhesion molecule 1 (ICAM-1. Migration: Part II of the study explored the effect of abciximab (0.0002, 0.002, 0.02, 0.2, 2.0, and 20.0 μg/ml on migration of HCMSMC over a period of 24 h. Proliferation: Part III of the study investigated the effect of abciximab (0.0002, 0.002, 0.02, 0.2, 2.0, and 20.0 μg/ml on proliferation of HUVEC, HCAEC, and HCMSMC after an incubation period of 5 days. Results ICAM-1: In human venous endothelial cells (HUVEC, human coronary endothelial cells (HCAEC and human coronary medial smooth muscle cells (HCMSMC no inhibitory or stimulatory effect on expression of ICAM-1 was detected. Migration: After incubation of HCMSMC with abciximab in concentrations of 0.0002 – 2 μg/ml a stimulatory effect on cell migration was detected, statistical significance was achieved after incubation with 0.002 μg/ml (p 1. Conclusion Thus, the anti-restenotic effects of systemically administered abciximab reported in the ISAR-SWEET-study were not caused by a direct inhibitory effect on ICAM-1 expression, migration or proliferation.

  12. Prevention of restenosis in coronary arteries: ionic radiation, non-ionic radiation and drug eluting stents

    NARCIS (Netherlands)

    E.S. Regar (Eveline)

    2002-01-01

    textabstractOver the last decade, coronary stents have revolutionized the field of interventional cardiology. Stent implantation has become the new standard angioplasty procedure1-3. This popularity has grown because of 2 main reasons: first, the unique capability to master a major complication of b

  13. The risk and prognostic impact of definite stent thrombosis or in-stent restenosis after coronary stent implantation

    DEFF Research Database (Denmark)

    Thayssen, Per; Jensen, Lisette Okkels; Lassen, Jens Flensted;

    2012-01-01

    of death (HR=2.71 [95% CI: 1.72-4.27]) compared to cases without stent thrombosis. In-stent restenosis had no substantial impact (HR=1.17 [95% CI: 0.79-1.75]). However, in-stent restenosis presenting as non-ST-segment elevation myocardial infarction (NSTEMI) was associated with a greater mortality risk...

  14. Novel A20-gene-eluting stent inhibits carotid artery restenosis in a porcine model

    Directory of Open Access Journals (Sweden)

    Zhou ZH

    2016-08-01

    Full Text Available Zhen-hua Zhou,1 Jing Peng,1 Zhao-you Meng,1 Lin Chen,1 Jia-Lu Huang,1 He-qing Huang,1 Li Li,2 Wen Zeng,2 Yong Wei,2 Chu-Hong Zhu,2 Kang-Ning Chen1 1Department of Neurology, Cerebrovascular Disease Research Institute, Southwest Hospital, 2Department of Anatomy, Key Laboratory for Biomechanics of Chongqing, Third Military Medical University, Chongqing, People’s Republic of China Background: Carotid artery stenosis is a major risk factor for ischemic stroke. Although carotid angioplasty and stenting using an embolic protection device has been introduced as a less invasive carotid revascularization approach, in-stent restenosis limits its long-term efficacy and safety. The objective of this study was to test the anti-restenosis effects of local stent-mediated delivery of the A20 gene in a porcine carotid artery model.Materials and methods: The pCDNA3.1EHA20 was firmly attached onto stents that had been collagen coated and treated with N-succinimidyl-3-(2-pyridyldithiolpropionate solution and anti-DNA immunoglobulin fixation. Anti-restenosis effects of modified vs control (the bare-metal stent and pCDNA3.1 void vector stents were assessed by Western blot and scanning electron microscopy, as well as by morphological and inflammatory reaction analyses.Results: Stent-delivered A20 gene was locally expressed in porcine carotids in association with significantly greater extent of re-endothelialization at day 14 and of neointimal hyperplasia inhibition at 3 months than stenting without A20 gene expression.Conclusion: The A20-gene-eluting stent inhibits neointimal hyperplasia while promoting re-endothelialization and therefore constitutes a novel potential alternative to prevent restenosis while minimizing complications. Keywords: restenosis, A20, gene therapy, stent, endothelialization

  15. Cell adhesion molecules and the coronary restenosis after percutaneous transluminal corcnary angioplasty%粘附分子与冠脉成形术后再狭窄

    Institute of Scientific and Technical Information of China (English)

    刘云海; 徐标; 张丽容

    2003-01-01

    @@ 冠心病的介入治疗,尤其是经皮腔内冠脉成形术(percutaneous transluminal coronary angioplasty, PTCA)及冠脉内支架术(intracoronary stenting, ICS)已成为冠心病治疗的主要手段之一,但30%~50%的PTCA术后及10%~15%的ICS术后的再狭窄(restenosis, RS)率已成为影响冠脉成形术远期疗效的重要因素.

  16. Correlation of microalbuminuria and coronary stenting restenosis 1 year after percutaneous coronary intervention%尿微量白蛋白与冠心病支架植入术后1年再狭窄的相关性

    Institute of Scientific and Technical Information of China (English)

    艾民; 颜昌福; 夏福纯; 周双陆; 贺剑; 顾定平; 付国齐

    2013-01-01

    AIM: To explore the correlation of microalbuminuria ( MAU) and stent restenosis 1 year after percutaneous coronary intervention (PCI). METHODS: Serum microalbuminuria was tested in patients prior to PCI. One year after PCI, patients were divided into restenosis group and no-restenosis group by coronary artery angiography and the results were compared. RESULTS: Serum microalbuminuria levels (59 ±16) mg/L in restenosis group were significantly higher than in the no-restenosis group (39 ±15) mg/L (t=4.316, P<0. 05). Serum MAU levels were, respectively, (40 ±3) mg/L in single-vessel lesions, (55 ±5) mg/L in two-vessel lesions, and (82 ±11) mg/L in three-vessel lesions (F value = 61.426, P<0.05). The difference was statistically significant. CONCLUSIONS: Microalbuminuria is a good predictive index for coronary artery stent restenosis 1 year after PCI.%目的:分析尿微量白蛋白(MAU)与冠心病患者行支架植入术后1年支架内再狭窄的相关性.方法:收集2009年3月~2011年6月我科139例冠心病经皮冠状动脉介入治疗患者,支架植入术前检测患者MAU,术后1年根据患者冠状动脉造影结果分为再狭窄组和未狭窄组.结果:再狭窄组患者MAU水平[(59±16) mg/L]显著高于未狭窄组患者[(39 ±15) mg/L](P<0.05);再狭窄组中单支病变[(40 ±3) mg/L]、两支病变[(55 ±5) mg/L]和三支病变[(82±11) mg/L]患者MAU水平比较差异有统计学意义(P<0.05).结论:冠心病患者支架植入术后1年支架内再狭窄与患者支架术前的MAU水平相关,MAU是支架术后再狭窄的很好预测指标.

  17. Serial changes of left ventricular filling flow pattern on doppler echocardiography concerning perfusion recovery and restenosis after successful coronary angioplasty

    Energy Technology Data Exchange (ETDEWEB)

    Han, Xirui; Yonekura, Shuji; Nakata, Tomoaki; Tsuchihashi, Kazufumi; Shimamoto, Kazuaki [Sapporo Medical Univ. (Japan)

    1997-10-01

    We tested whether diastolic indices on pulse Doppler echocardiography, i.e., the peak early diastolic filling velocity (E, cm/sec), the acceleration slope of E (AC, cm/sec{sup 2}), and the ratio of peak diastolic filling to peak atrial filling velocity (E/A) might be changed early after PTCA in relation with perfusion recovery on thallium scintigraphy. Additionally, the clinical usefulness of these indices for the detection of restenosis after PTCA was also examined in 35 patients, including 12 patients with old Q wave myocardial infarction (OMI), on whom PTCA had been successfully performed. Perfusion abnormalities on stress {sup 201}Tl scintigraphy was quantitatively evaluated by severity score (SS) and extent score (ES). In patients with angina pectoris, early recoveries of values on E, AC, and E/A were observed, but not in patients with 0MI. The percent changes of these indices had significant correlations with changes of SS in scintigraphy. In the chronic period, recovery of values E, AC, and E/A were also seen in OMI without restenosis, but not in those with restenosis. Percent E and %A{<=}105 could predict restenosis by sensitivity 100% and specificity 94.4% in all subjects. These results reveal that a follow-up of the indices on pulse Doppler echocardiography has clinical usefulness in the detection not only of functional recovery of left ventricular diastolic function, but also of restenosis after successful PTCA. (K.H.)

  18. Three-dimensional virtual surgery models for percutaneous coronary intervention (PCI) optimization strategies

    Science.gov (United States)

    Wang, Hujun; Liu, Jinghua; Zheng, Xu; Rong, Xiaohui; Zheng, Xuwei; Peng, Hongyu; Silber-Li, Zhanghua; Li, Mujun; Liu, Liyu

    2015-06-01

    Percutaneous coronary intervention (PCI), especially coronary stent implantation, has been shown to be an effective treatment for coronary artery disease. However, in-stent restenosis is one of the longstanding unsolvable problems following PCI. Although stents implanted inside narrowed vessels recover normal flux of blood flows, they instantaneously change the wall shear stress (WSS) distribution on the vessel surface. Improper stent implantation positions bring high possibilities of restenosis as it enlarges the low WSS regions and subsequently stimulates more epithelial cell outgrowth on vessel walls. To optimize the stent position for lowering the risk of restenosis, we successfully established a digital three-dimensional (3-D) model based on a real clinical coronary artery and analysed the optimal stenting strategies by computational simulation. Via microfabrication and 3-D printing technology, the digital model was also converted into in vitro microfluidic models with 3-D micro channels. Simultaneously, physicians placed real stents inside them; i.e., they performed “virtual surgeries”. The hydrodynamic experimental results showed that the microfluidic models highly inosculated the simulations. Therefore, our study not only demonstrated that the half-cross stenting strategy could maximally reduce restenosis risks but also indicated that 3-D printing combined with clinical image reconstruction is a promising method for future angiocardiopathy research.

  19. [The role of haemodynamic factors in the development of in-stent restenosis].

    Science.gov (United States)

    Wasilewski, Jarosław; Osadnik, Tadeusz; Peryt Stawiarska, Sylwia; Poloński, Lech

    2012-01-01

    Despite improvements in stent technology, including introduction of drug eluting stents, problem of neointimal hyperplasia and restenosis remains. These phenomena are associated with multiple risk factors and gene polymorphisms. Well known periprocedural risk factors of restenosis such as site of stenting, oversizing, implantation of overlapping stents along with change in vessel geometry affect blood flow conditions. Both experimental and clinical studies provide a number of arguments regarding importance of hemodynamic factors like oscillatory shear stresses in the process of restenosis. Computational fluid dynamic (CFD) enables calculation of indices describing fluid flow including tangential shear stress. This method enables the virtual representation of the physical forces in the flow system and depicting them in graphical form. Flow modeling is used in the process of designing of coronary stents, which allows for the assessment of restenosis risk in the project phase. In the nearest future CFD will be used for prediction of restenosis risk after stent implantation.

  20. Cost-effectiveness of paclitaxel-coated balloon angioplasty and paclitaxel-eluting stent implantation for treatment of coronary in-stent restenosis in patients with stable coronary artery disease.

    Science.gov (United States)

    Bonaventura, Klaus; Leber, Alexander W; Sohns, Christian; Roser, Mattias; Boldt, Leif-Hendrik; Kleber, Franz X; Haverkamp, Wilhelm; Dorenkamp, Marc

    2012-07-01

    Recent studies have demonstrated the safety and efficacy of drug-coated balloon (DCB) angioplasty for the treatment of coronary in-stent restenosis (ISR). The cost-effectiveness of this practice is unknown. A Markov state-transition decision analytic model accounting for varying procedural efficacy rates, complication rates, and cost estimates was developed to compare DCB angioplasty with drug-eluting stent (DES) placement in patients with bare-metal stent (BMS)-ISR. Data on procedural outcomes associated with both treatment strategies were derived from the literature, and the cost analysis was conducted from a health care payer perspective. Effectiveness was expressed as life-years gained. In the base-case analysis, initial procedure costs amounted to €3,604.14 for DCB angioplasty and to €3,309.66 for DES implantation. Over a 12-month time horizon, the DCB strategy was found to be less costly (€4,130.38 vs. €5,305.30) and slightly more effective in terms of life expectancy (0.983 vs. 0.976 years) than the DES strategy. Extensive sensitivity analyses indicated that, in comparison with DES implantation, the cost advantage of the DCB strategy was robust to clinically plausible variations in the values of key model input parameters. The variables with the greatest impact on base-case results were the duration of dual antiplatelet therapy with acetylsalicylic acid and clopidogrel after DCB angioplasty, the use of generic clopidogrel, and variations in the costs associated with the DCB device. DCB angioplasty is a cost-effective treatment option for coronary BMS-ISR. The higher initial costs of DCB are more than offset by later cost-savings, predominantly as a result of reduced medication costs.

  1. Influence of a pressure gradient distal to implanted bare-metal stent on in-stent restenosis after percutaneous coronary intervention

    DEFF Research Database (Denmark)

    Jensen, Lisette Okkels; Thayssen, Per; Thuesen, Leif

    2007-01-01

    BACKGROUND: Fractional flow reserve predicts cardiac events after coronary stent implantation. The aim of the present study was to assess the 9-month angiographic in-stent restenosis rate in the setting of optimal stenting and a persisting gradient distal to the stent as assessed by a pressure wire...... performed in the target vessel: (1) P(d)/P(a) as distal to the artery as possible (fractional flow reserve per definition); (2) P(d)/P(a) just distal to the stent; (3) P(d)/P(a) just proximal to the stent; and (4) P(d)/P(a) at the ostium. Residual abnormal P(d)/P(a) was defined as a pressure drop between P......(d)/P(a) measured at points 1 and 2. Fractional flow reserve distal to the artery after stenting was significantly lower (0.88+/-0.21 versus 0.97+/-0.05; P

  2. The Relationship Between Lymphocyte-to-Monocyte Ratio and Bare-Metal Stent In-Stent Restenosis in Patients With Stable Coronary Artery Disease.

    Science.gov (United States)

    Murat, Sani Namik; Yarlioglues, Mikail; Celik, Ibrahim Etem; Kurtul, Alparslan; Duran, Mustafa; Kilic, Alparslan; Oksuz, Fatih

    2017-04-01

    In-stent restenosis (ISR) is a common clinical problem in patients with coronary artery disease treated with percutaneous coronary intervention. Inflammatory process plays a pivotal role in the development of ISR. Both lymphocytes and monocytes are associated with inflammatory status. Recently, it has been shown that the lymphocyte-to-monocyte ratio (LMR) is a novel inflammatory marker. We aimed to investigate the association of serum LMR levels and ISR in patients undergoing bare-metal stent (BMS) implantation. The study included 273 patients (aged 61 ± 11 years, 66.5% men) with a history of BMS implantation and a further control coronary angiography due to stable angina pectoris. Patients were divided into 2 groups: patients with and without ISR. The LMR levels were significantly lower in patients with ISR than in those without ISR (2.50 ± 0.95 vs 3.87 ± 1.51, respectively, P ISR (odds ratio [OR]: 0.310, 95% confidence interval: 0.166-0.579, P ISR in patients treated with BMS implantation.

  3. Randomised trial of coronary intervention with antibody against platelet IIb/IIIa integrin for reduction of clinical restenosis: results at six months. The EPIC Investigators.

    Science.gov (United States)

    Topol, E J; Califf, R M; Weisman, H F; Ellis, S G; Tcheng, J E; Worley, S; Ivanhoe, R; George, B S; Fintel, D; Weston, M

    1994-04-09

    Restenosis after coronary angioplasty occurs in at least 30% of patients in the first six months and, as yet, there is no known treatment to decrease this event. We tested a monoclonal antibody Fab fragment (c7E3) directed against the platelet glycoprotein IIb/IIIa integrin, the receptor mediating the final common pathway of platelet aggregation, to see whether it reduced the frequency of clinical restenosis. Patients who had unstable angina, recent or evolving myocardial infarction, or high-risk angiographic morphology, were randomised to receive c7E3 bolus and a 12 hour infusion of c7E3 (708 patients), c7E3 bolus and placebo infusion (695 patients), or placebo bolus and placebo infusion (696 patients). With maintenance of the double-blind state, patients were followed-up for at least 6 months to determine the need for repeat angioplasty or surgical coronary revascularisation and the occurrence of ischaemic events. By 30 days, 12.8% of placebo bolus/placebo infusion patients had had a major ischaemic event (death, myocardial infarction, urgent revascularisation), compared with 8.3% of c7E3 bolus/c7E3 infusion patients, yielding a 4.5% difference (35% reduction, p = 0.008). At 6 months, the absolute difference in patients with major ischaemic event or elective revascularisation was 8.1% between placebo bolus/placebo infusion and c7E3 bolus/c7E3 infusion patients (35.1% vs 27.0%; 23% reduction p = 0.001). The favourable long-term effect was mainly due to less need for bypass surgery or repeat angioplasty in patients with an initial successful procedure, since need for repeat target vessel revascularisation was 26% less for c7E3 bolus/c7E3 infusion than for placebo treatment (16.5% vs 22.3%; p = 0.007). The c7E3 bolus/placebo infusion group had an intermediate outcome which was not significantly better than that of the placebo bolus/placebo infusion group. These results extend the benefit of c7E3 bolus/c7E3 infusion from reducing abrupt closure and acute

  4. Relationship of interleukin-6-572C/G promoter polymorphism and serum levels to post-percutaneous coronary intervention restenosis

    Institute of Scientific and Technical Information of China (English)

    GAO Jing; LIU Yin; CUI Rang-zhuang; MAO Yong-min; ZHOU Jin; CHEN Qian; ZHAO Fu-mei

    2013-01-01

    Background It has been recently reported that inflammatory mechanisms play an important role in in-stent restenosis (ISR) processes.Inflammatory factors after percutaneous coronary intervention (PCI) for dynamic monitoring can probably predict ISR.Functional polymorphisms in the promoter region of genes coding for inflammatory factors might be important for determining the magnitude of the inflammatory response.Thus,in the present study,we aimed to investigate the serial changes in serum interleukin-6 (IL-6) levels before and after PCI and the relationship between the -572C/G polymorphism in the promoter region of the IL-6 gene and ISR.We also discussed genetic polymorphisms in the inflammatory response to PCI.Methods A total of 437 patients who successfully underwent bare metal stent (BMS) implantation with a follow-up angiography were divided into an ISR group (n=166) and a non-ISR (NISR) group (n=271).The IL-6 gene promoter polymorphism at position-572 was determined by restricted fragment length polymorphism using the polymerase chain reaction (PCR-RFLP) method.The serum IL-6 levels before and one day,five days and 180 days after PCI were determined by the radioimmunoassay method.Results ISR patients showed higher IL-6 serum levels than NISR patients before PCI ((324.42±28.14) ng/L vs.(283.22±47.30) ng/L,P<0.001),and one day post-PCI IL-6 serum levels in the ISR group also showed a significantly higher level than in the NISR group (P <0.001).Increased IL-6 after PCI persisted at a statistically significant level throughout the study in ISR patients,whereas IL-6 levels had normalized five days after the procedure in NISR patients.One day post-PCI serum IL-6 level was the most accurate marker for diagnosis of ISR,the area under the ROC curve being 0.927 (95% C/0.878-0.977).The cut-off value for IL-6 to predict ISR was over 355.50 ng/L,with a sensitivity of 0.968 and a specificity of 0.865.There were no significant differences in frequencies of-572

  5. Cutting balloon angioplasty for intrastent restenosis treatment

    Directory of Open Access Journals (Sweden)

    João Orávio de Freitas Jr

    1999-05-01

    Full Text Available We describe here two patients with angiographic diagnosis of intrastent restenosis and regional myocardial ischemia. One stent restenosis was located in a native coronary artery and the other in a vein graft. Both were treated with cutting balloon angioplasty (CBA, inflated at low pressures. Angiographic success was obtained and both patients were discharged in the day after the procedure. Cutting balloon angioplasty using low inflation pressures achieved important luminal gains, in these two cases of intrastent restenosis. Further studies are necessary before the effectiveness of this procedure can be precisely defined.

  6. Effect of pioglitazone on in-stent restenosis after coronary drug-eluting stent implantation: a meta-analysis of randomized controlled trials.

    Directory of Open Access Journals (Sweden)

    Ming-duo Zhang

    Full Text Available In-stent restenosis (ISR remains a common life-threatening complication and some studies have shown that pioglitazone can reduce the incidence of ISR in patients with drug-eluting stents (DES implantation. We conducted a meta-analysis to assess the effect of pioglitazone in preventing ISR after DES implantation.Randomized controlled trials (RCTs investigating the effects of pioglitazone for ISR after DES implantation were identified by systematic searches of multiple online databases and manual searches of related reference lists of identified trials through May 2014. The primary endpoint was the rate of ISR. Secondary endpoints included minimum lumen diameter, percentage stenosis of stented vessels, late loss, in-stent neointimal volume, target vessel revascularization (TVR, target lesion revascularization, myocardial infarction, stent thrombosis and death.Five studies, comprising 255 pioglitazone-treated patients and 245 controls, were identified in the current meta-analysis. Pioglitazone did not significantly reduce the rate of ISR (P = 0.20 with low heterogeneity (I2 = 13.3%, P = 0.32. For the secondary outcomes, pioglitazone did not substantially affect the pooled estimates of these endpoints except late loss (P = 0.01 and TVR (P = 0.04.The limited evidence indicates that pioglitazone does not demonstrate markedly beneficial effect in patients subjected to coronary DES implantation. However, the results should be interpreted with care given the small sample size. Further large-scale RCTs are needed.

  7. Metabolic background determines the importance of NOS3 polymorphisms in restenosis after percutaneous coronary intervention: A study in patients with and without the metabolic syndrome

    NARCIS (Netherlands)

    Pons, D.; Monraats, P.S.; Zwinderman, A.H.; de Maat, M.P.M.; Doevendans, P.A.F.M.; de Winter, R.J.; Tio, R.A.; Waltenberger, J.; Jukema, J.W.

    2009-01-01

    Variation in the NOS3 gene has been related to the development of restenosis. The Glu298Asp polymorphism has previously been investigated for its effect on NO levels and the development of restenosis. However, the variability of findings gave rise to the hypothesis that the functional significance

  8. Metabolic background determines the importance of NOS3 polymorphisms in restenosis after percutaneous coronary intervention : A study in patients with and without the metabolic syndrome

    NARCIS (Netherlands)

    Pons, Douwe; Monraats, Pascalle S.; Zwinderman, Aeilko H.; de Maat, Moniek P. M.; Doevendans, Pieter A. F. M.; de Winter, Robbert J.; Tio, Rene A.; Waltenberger, Johannes; Jukema, J. Wouter

    2009-01-01

    Variation in the NOS3 gene has been related to the development of restenosis. The Glu298Asp polymorphism has previously been investigated for its effect on NO levels and the development of restenosis. However, the variability of findings gave rise to the hypothesis that the functional significance

  9. Novel stents for the prevention of restenosis.

    Science.gov (United States)

    McKenna, C J; Holmes, D R; Schwartz, R S

    1997-10-01

    Since the introduction of Interventional Cardiology in 1976, there has been rapid expansion both in its clinical application and the tools of the trade. This growth was accelerated with the introduction of the intra-coronary stent in 1987. The demonstration that stents may reduce the incidence of restenosis after percutaneous coronary revascularization has further stimulated the search for the perfect endovascular prosthesis. By creating a hybrid stent, incorporating natural coatings and local drug delivery in the design, it is hoped that the complications associated with stent thrombosis and restenosis can be eradicated. (Trends Cardiovasc Med 1997;7:245-249). © 1997, Elsevier Science Inc.

  10. Experiment Study of The Preventive Effects of Valsartan Eluting Stent on In- stent Restenosis

    Institute of Scientific and Technical Information of China (English)

    陈津; 陈纪言; 周颖玲; 李光; 罗建方; 余丹青; 张励庭; 黄文晖

    2003-01-01

    Objectives Background -Neointima hyperplasia and arterial re modeling are themain mechanisms of restenosis after percutaneoustransluminal coronary angioplasty. The successful useof coronary stents neutralizes the ac ute elastic recoiland improves the remodeling mode with reducingrestenosis rate by 10 % . But the in - stent neointimahyperplasia becomes more severe. This study aims toset up model of in - stent restenosis in vivo, and to e-valuate the preventive role of implantation of valsartaneluting stent for restenosis. Methods and ResultsTwenty -two male New Zealand white rabbits were di-vided into control group and valsartan group. In-travascular ultrasonic (IVUS) results showed the in-trastent neointimal areas of the control group werelarger than those of the valsartan group ( P < 0.01 ) .The minimal lumen area of control group was smallerthan that of the valsartan group ( P < 0.01). Angiog-raphy results showed the normal lumen diameters weresimilar between two groups ( P> 0.05) . The lumenstenosis rates compared with the normal diameters ofthe valsartan group were significantly improved overthat of the control group ( P < 0. 05) . It was compa-rable to the IVUS analysis. There were no cases of a-neurysm or thrombosis. Conclusions Valsartan e-luting stents produced a significant inhibition ofneointimal hyperplasia and luminal encroachment inrabbits without obviously producing any serious side -effects. These results demonstrate the potential thera-peutic benefit of valsartan eluting stents in the pre-vention and treatment of human coronary restenosis.

  11. The ASSURE ROT Registry: Bioresorbable Vascular Scaffold Following Rotablation for Complex Coronary Lesions

    Science.gov (United States)

    2015-02-05

    Cardiovascular Diseases; Coronary Artery Disease; Myocardial Ischemia; Coronary Disease; Coronary Restenosis; Heart Diseases; Coronary Stenosis; Arteriosclerosis; Arterial Occlusive Diseases; Vascular Diseases

  12. 双源CT与冠状动脉造影评估冠状动脉支架内再狭窄%Dual-Source Computed Tomography and Coronary Angiography in Evaluation of In-Stent Restenosis

    Institute of Scientific and Technical Information of China (English)

    王联发; 纪勤炯; 朱有志; 侯勇; 黄猛珣; 顾磊

    2012-01-01

    目的 对比分析双源CT( dual-source CT,DSCT)与冠状动脉造影(coronary angiography,CAG)评估支架内再狭窄( in stent restenosis,ISR)的结果,探讨支架所在部位及支架大小对DSCT评估冠状动脉ISR的影响.方法 106例同期行DSCT及SCAG检查的支架术后的患者,以SCAG结果为标准,比较DSCT评估不同部位及大小支架ISR的敏感性、特异性及准确性.结果 173枚支架中有156枚支架DSCT显影良好.DSCT显示有ISR的支架33枚,CAG证实存在ISR的支架38枚,DSCT诊断ISR的敏感度和特异度分别为78.9%和97.5%,阳性预测值90.9%,阴性预测值93.5%,一致率为92.9%.DSCT对近心端支架再狭窄的检出率优于远心端支架;直径≥3.0 mm支架的ISR检出率优于直径<3.0mm支架.结论 支架内径大小及所在部位影响DSCT图像的显示.DSCT在评估ISR方面,可基本取代SCAG作为冠脉近端支架及大直径支架(支架直径≥3 mm)通畅情况的评估方式.%Objective To compare the results of dual-source CT(DSCT) and coronary angiography (CAG) in the diagnosis of in-stent restenosis ( ISR) , and discuss the influence of the positions and size of stents on the evaluation results of ISR by DSCT. Methods The 106 patients in the same period underwent DSCT and CAG were included in the study, analysis and comparison ISR of DSCT diagnostic sensitivity, specificity and accuracy to detect in-stent restenosis was evaluated referring to coronary angiography. ISR was defined as a lesion demonstrating stenosis greater than 50%. Results In all 173 stents, 156 stents could be assessed by DSCT. 33 stents could be detected ISR by DSCT.38 stents with ISR indicated by CAG. The sensitivity,specificity,positive and negative predictive value and accuracy to identify ISR was 78.9% ,97.5% ,90.9% and 93.5% ,92.9% .respectively. DSCT coronary artery proximal in-stent restenosis detection rate were superior to the distal stent. The detection with DSCT in-stent restenosis of positive

  13. Effect of Rehabilitation Exercise on Coronary Restenosis after Percutaneous Coronary Intervention in Patients with Coronary Heart Disease:A Meta-Analysis%康复运动疗法对经皮冠状动脉介入术后冠状动脉再狭窄影响的Meta分析

    Institute of Scientific and Technical Information of China (English)

    冯高科; 蒋学俊; 易欣; 任珊

    2013-01-01

    Objective To assess the effect of rehabilitation exercise on coronary restenosis after percutaneous coronary intervention in patients with coronary heart disease( CHD ). Methods Cochrane Central Register of Controlled Trials ( CENTRAL ),MEDLINE,CBM,CNKI, Wanfang Database were searched for the Randomized controlled trials( RCTs ) from the date of establishment of the above databases to April 1st,2012. Two independent researchers used the grading methtxl recommended by GRADE to evaluate the included studies. Rev-Man 5. 1 software was used to conduct Meta-analysis. Results A total of 8 trials including 509 cases were analyzed, in which 262 cases of the control group and 247 cases of rehabilitation exercise group. The patients were followed up for 6 months ,71 cases of coronary restenosis in control group ( 27. 10% ) ,33 cases of coronary restenosis in rehabilitation exercise group( 13. 36% ). Test for heterogeneity ,P = 0. 54 , I2 = 0% , homogeneity existed among studies; The sensitivity test showed that the results of Meta-analysis had good stability,reliable data;merge OR =0.40,95% confidence interval,0. 25 to 0.64. After 6-month follow-up,the incidence of coronary restenosis of rehabilitation exercise group was lower than that of control group( P < 0. 01 ). Conclusion Proper rehabilitation exercise could improve the incidence of coronary restenosis after PCI in patients with CHD.%目的 评价康复运动疗法对经皮冠状动脉介入术(PCI)后患者冠状动脉再狭窄的影响.方法 计算机检索Cochrane Central Register of Controlled Trials(CENTRAL)、MEDLINE、中国生物医学文献数据库(CBM)、中国知识资源总库(CNKI)、万方数据库数据库收录的中、英文文献,收集康复运动疗法对PCI术后患者冠状动脉再狭窄影响的随机对照试验,检索截止日期为2012年4月1日.由2名研究员根据GRADE 系统推荐分级方法对纳入研究的文献质量严格进行评价并提取资料,采用RevMan5.1

  14. Influence of lipopolysaccharide on growth of in vitro human coronary artery smooth muscle cells: an investigation on establishing in-stent restenosis inflammatory cell model%脂多糖对体外培养的人冠状动脉平滑肌细胞生长的影响——对建立支架内再狭窄炎症细胞模型的探索

    Institute of Scientific and Technical Information of China (English)

    李红梅; 王显

    2016-01-01

    目的 探讨不同浓度脂多糖(LPS)作用不同时间对体外培养的人冠状动脉平滑肌细胞(HCASMC)生长的影响,分析其应用于HCASMC的无毒性反应浓度范围,为开展介入术后再狭窄相关研究建立HCASMC炎症活化模型提供实验数据支持.方法 体外培养的HCASMC 3~5代,加入96孔细胞培养板,用噻唑蓝比色实验(MTT法)检测不同浓度(0μg/ml,0.01μg/ml,0.1μg/ml,0.5μg/ml,1μg/ml,5μg/ml,10μg/ml,100μg/ml)LPS在不同作用时间(24 h,46 h,72 h)下对HCASMC活力影响,酶标仪492 nm处测定各组A值,细胞活力=(实验组A值-调零孔A值)/对照组A值.结果 LPS在低于100μg/ml浓度范围内,干预HCASMC时间短于48 h未出现细胞毒性,多表现为促细胞增殖效应,而干预时间大于48 h则显现出较为明显的细胞毒性,且细胞活力随LPS浓度的增大而减低;干预72 h后LPS浓度在0~0.01μg/ml范围内有促增殖作用,0.1~0.5μg/ml浓度则产生轻微的细胞抑制作用,但细胞毒性不明显,在1~100μg/ml浓度下HCASMC毒性反应逐渐出现,且HCASMC活力随LPS浓度的升高而减低.同一浓度水平的LPS随着作用时间延长,HCASMC的细胞活力逐步下降,且作用时间越长下降越明显.结论LPS在浓度0.1μg/ml以下未出现明显的细胞毒性,其中LPS浓度0.01μg/ml干预24 h,人冠状动脉平滑肌细胞增殖最显著,可作为建立炎症诱导人冠状动脉平滑肌细胞活化模型的最佳条件.%Objective To investigate the influence of lipopolysaccharide (LPS) in different doses on growth of in vitro human coronary artery smooth muscle cells (HCASMC) at different times, analyze non-toxic concentration range of LPS to HCASMC, and provide test data for establishing HCASMC inflammation activation model in studies related to restenosis after interventional therapy.Methods HCASMC was cultured in vitro for 3-5 generations, and seeded onto 96-well plates. The influences of LPS in different doses (0 μg/mL, 0.01 μg/mL, 0.1

  15. A Computational Model to Assess Poststenting Wall Stresses Dependence on Plaque Structure and Stenosis Severity in Coronary Artery

    Directory of Open Access Journals (Sweden)

    Zuned Hajiali

    2014-01-01

    Full Text Available The current study presents computational models to investigate the poststenting hemodynamic stresses and internal stresses over/within the diseased walls of coronary arteries which are in different states of atherosclerotic plaque. The finite element method is applied to build the axisymmetric models which include the plaque, arterial wall, and stent struts. The study takes into account the mechanical effects of the opening pressure and its association with the plaque severity and the morphology. The wall shear stresses and the von Mises stresses within the stented coronary arteries show their strong dependence on the plaque structure, particularly the fibrous cap thickness. Higher stresses occur in severely stenosed coronaries with a thinner fibrous cap. Large stress concentrations around the stent struts cause injury or damage to the vessel wall which is linked to the mechanism of restenosis. The in-stent restenosis rate is also highly dependent on the opening pressure, to the extent that stenosed artery is expanded, and geometry of the stent struts. The present study demonstrates, for the first time, that the restenosis is to be viewed as a consequence of biomechanical design of a stent repeating unit, the opening pressure, and the severity and morphology of the plaque.

  16. Professor GUO Weiqin’s experience on restenosis after coronary stent%郭维琴教授防治冠心病支架术后再狭窄经验介绍

    Institute of Scientific and Technical Information of China (English)

    孟伟; 王亚红; 郭维琴

    2016-01-01

    Professor GUO Weiqin has unique insights on restenosis after coronary stent,and she believes deficiency,blood stasis and heat toxic are key pathogenesis.The pathogenesis is blood stasis due to qi deficiency and stagnated toxic heat.Benefiting qi for activating blood circulation and removing toxic sub-stance and resolving stagnation is an important method for treating restenosis after coronary stent and she picks up herbs to make the empirical formula,Fangzhai Huayu Decoction.Professor GUO emphasizes u-sing clearing heat and cooling blood and removing toxic substance and resolving stagnation as soon as pos-sible based on benefiting qi for activating blood circulation after coronary stent.The most common herbs are Mudanpi,Chishao,Jinyinhua,Lianqiao,Shancigu and Ezhu,etc.%郭维琴教授对防治冠心病支架术后再狭窄有独特认识,认为虚、瘀、热毒是支架术后再狭窄的病机关键,气虚血瘀、热毒内结是支架术后再狭窄的重要病机,益气活血、解毒化结是防治支架术后再狭窄的重要治法,并精选药物,组成经验方防窄化瘀汤。郭教授强调冠心病支架术后应在益气活血的基础上尽早使用清热凉血、解毒化结的药物,如牡丹皮、赤芍、金银花、连翘、山慈菇、莪术等。

  17. A randomized trial assessing the effect of coumarins started before coronary angioplasty on restenosis: results of the 6-month angiographic substudy of the Balloon Angioplasty and Anticoagulation Study (BAAS).

    Science.gov (United States)

    ten Berg, Jurriën M; Kelder, Johannes C; Suttorp, Maarten Jan; Verheugt, Freek W A; Plokker, H W Thijs

    2003-01-01

    Thrombus formation during coronary angioplasty may play a role in the restenosis process. The effect of pretreatment with coumarins on 6-month angiographic outcome was studied. In addition, the effect of "optimal" anticoagulation, defined as an international normalized ratio >70% of the follow-up time in the target range, was studied. A total of 261 patients were assigned to aspirin alone (ASA group) and 270 patients to aspirin plus coumarins started 1 week before the procedure (coumarin group). The mean international normalized ratio was 2.7 +/- 1.2 at the start of the procedure and 3.1 +/- 0.5 during follow up. Quantitative coronary analysis was performed on 301 lesions in the ASA group and of 297 lesions in the coumarin group. At 6 months, the minimal luminal diameter was similar in the ASA and coumarin groups. Optimal anticoagulation, however, was an independent predictor of a larger minimal luminal diameter at follow up (P =.01). Overall, coumarins do not improve angiographic outcome 6 months after coronary angioplasty.

  18. Development of a rabbit model for a preclinical comparison of coronary stent types in-vivo.

    Science.gov (United States)

    Lee, Joo Myung; Lee, Jaewon; Jeong, Heewon; Choe, Won Seok; Seo, Won-Woo; Lim, Woo-Hyun; Kim, Young-Chan; Hur, Jin; Lee, Sang Eun; Yang, Han-Mo; Cho, Hyun-Jai; Kim, Hyo-Soo

    2013-11-01

    Along with the development of innovative stent designs, preclinical trials in animal models are essential. Many animal models have been used and appear to yield comparable results to clinical trials despite substantial criticisms about their validity. Among the animal models, porcine coronary artery models have been the standard models for the preclinical evaluation of endovascular devices. However, rapid growth rate, high body weight potential, and the propensity to develop granulomatous inflammatory reactions are major limitations of the porcine coronary artery model. Compared with porcine coronary artery models, the comparative rabbit iliac artery model has the advantages of being small and easy to handle and relatively inexpensive. Furthermore, the rabbit model has been known to reliably reflect human restenosis histopathologically and have major advantages such as pairwise comparison, which makes each animal serve as its own control subject, therefore, maximizing its statistical power for comparative testing. However, despite the widespread use of this model, a systematic description of the procedure and harvest protocols has never been published. This article describes the surgical procedure, stent implantation procedure, method for tissue harvesting, and how measurements are performed. Although the results of animal models may not perfectly extrapolate to humans, the comparative rabbit iliac artery model may be a useful tool for assessing and comparing the efficacy of new coronary stents with conventional stent systems. This thorough description of the techniques required for vascular access, stent implantation, tissue preparation, and measurement, should aid investigators wishing to begin using the comparative rabbit iliac artery model.

  19. Influence of a history of smoking on short term (six month) clinical and angiographic outcome after successful coronary angioplasty

    NARCIS (Netherlands)

    A.G. Violaris (Andonis); A. Thury (Attila); R. Melkert (Rein); P.W.J.C. Serruys (Patrick); E.S. Regar (Eveline)

    2000-01-01

    textabstractOBJECTIVES: To assess the influence of smoking on restenosis after coronary angioplasty. DESIGN AND PATIENTS: The incidence of smoking on restenosis was investigated in 2948 patients. They were prospectively enrolled in four major restenosis trials in which quantitative

  20. Incidence and classification of neointimal proliferation and in-stent restenosis in post-stenting patients at 1-year interval: Findings from non-invasive coronary computed tomography angiography

    Energy Technology Data Exchange (ETDEWEB)

    Xu, Nan, E-mail: southmuch@hotmail.com [Department of Radiology, East Hospital, Tongji University School of Medicine, No. 150, Jimo Road, Shanghai 200120 (China); Zhang, Jiayin, E-mail: andrewssmu@msn.com [Department of Radiology, Shanghai Jiao Tong University Affiliated Sixth People' s Hospital, No. 600, Yishan Road, Shanghai 200233 (China); Li, Minghua, E-mail: drliminghua@gmail.com [Department of Radiology, Shanghai Jiao Tong University Affiliated Sixth People' s Hospital, No. 600, Yishan Road, Shanghai 200233 (China); Pan, Jingwei, E-mail: drpanjingwei@gmail.com [Department of Cardiology, Shanghai Jiao Tong University Affiliated Sixth People' s Hospital, No. 600, Yishan Road, Shanghai 200233 (China); Lu, Zhigang, E-mail: drluzhigang@gmail.com [Department of Cardiology, Shanghai Jiao Tong University Affiliated Sixth People' s Hospital, No. 600, Yishan Road, Shanghai 200233 (China)

    2014-10-15

    Highlights: • The incidence of silent in-stent restenosis at 1-year as revealed by CT is 7.6%. • The incidence of neointimal proliferation at 1-year as revealed by CT is 12.6%. • Diabetes are associated with higher incidence of neointimal proliferation. - Abstract: Objectives: To evaluate the incidence of coronary in-stent restenosis (ISR) and neointimal proliferation by coronary CT angiography (CCTA) at 1-year follow-up in asymptomatic patients. Methods: 234 patients (mean age: 67 ± 10.2 years, range 39–88 years, 180 males and 54 females) with 379 stents were prospectively enrolled in this study. Binary ISR was classified by CCTA into 4 types using Mehran classification. Neointimal proliferation was similarly classified into focal and diffuse types. All patients with CCTA-revealed ISR or neointimal proliferation underwent further invasive coronary angiography (ICA) for validation. Fisher's exact test was used for comparison. Results: ICA revealed patent stents with neointimal proliferation in 39 patients (16.7%, 39/234) and binary ISR in 23 patients (9.8%, 23/234). Lesion-based analysis showed 12 type I ISR lesions, 4 type II ISR lesions, 1 type III ISR lesion and 7 type IV ISR lesions. Among cases with neointimal proliferation, 27 lesions were classified as focal type whereas 13 lesions were classified as diffuse type. Patients with diabetes mellitus were associated with higher incidence of CCTA-revealed neointimal proliferation (21/77 vs. 18/157, p = 0.002) as well as ISR (12/77 vs. 11/157, p = 0.038), compared to patients without diabetes. CCTA was found to have good diagnostic performance for neointimal proliferation and ISR detection as well as classification, with an overall accuracy of 84.4% (54/64). Conclusions: Silent ISR as well as neointimal proliferation is not uncommon findings in asymptomatic post-stenting patients at 1-year interval, as revealed by CCTA. Patients with diabetes are prone to have higher incidence of neointimal

  1. Heme oxygenase-1 alleviates cigarette smoke-induced restenosis after vascular angioplasty by attenuating inflammation in rat model.

    Science.gov (United States)

    Ni, Leng; Wang, Zhanqi; Yang, Genhuan; Li, Tianjia; Liu, Xinnong; Liu, Changwei

    2016-03-14

    Cigarette smoke is not only a profound independent risk factor of atherosclerosis, but also aggravates restenosis after vascular angioplasty. Heme oxygenase-1 (HO-1) is an endogenous antioxidant and cytoprotective enzyme. In this study, we investigated whether HO-1 upregulating by hemin, a potent HO-1 inducer, can protect against cigarette smoke-induced restenosis in rat's carotid arteries after balloon injury. Results showed that cigarette smoke exposure aggravated stenosis of the lumen, promoted infiltration of inflammatory cells, and induced expression of inflammatory cytokines and adhesion molecules after balloon-induced carotid artery injury. HO-1 upregulating by hemin treatment reduced these effects of cigarette smoke, whereas the beneficial effects were abolished in the presence of Zincprotoporphyrin IX, an HO-1 inhibitor. To conclude, hemin has potential therapeutic applications in the restenosis prevention after the smokers' vascular angioplasty. Copyright © 2016. Published by Elsevier Ireland Ltd.

  2. Late and very late catch-up after 90Sr/90Y beta-irradiation for the treatment of coronary in-stent restenosis.

    Science.gov (United States)

    Schiele, Thomas M; Herbst, Jan; Pöllinger, Barbara; Rieber, Johannes; König, Andreas; Sohn, Hae-Young; Krötz, Florian; Leibig, Marcus; Belka, Claus; Klauss, Volker

    2011-03-01

    Since late vessel failure has been speculated as a significant limitation of vascular brachytherapy (VBT), we conducted a prospective clinical evaluation at 6, 12, 24, 36 and 60 months follow-up after irradiation with (90)Sr/(90)Y for in-stent restenosis (ISR) regardless of the patient's symptomatic status. Complete five-year follow-up is reported for 104 consecutive patients. The cumulative rate of death was 13.5% (6 months: 0.96%; 12 months: 2.88%; 24 months: 4.81%; 36 months: 7.69%), of acute myocardial infarction 4.81% (2.88%; 4.81%; 4.81%; 4.81%), of late thrombotic occlusion 4.81% (3.85%; 4.81%; 4.81%; 4.81%), of target lesion revascularization (TLR) 27.9% (8.65%; 12.5%; 17.3%; 21.2%), of target vessel revascularization (TVR) 43.3% (12.5%; 19.2%; 22.1%; 29.8%), and of all major adverse cardiovascular events (MACE) 61.5% (16.3%; 26.9%; 31.7%; 42.3%), respectively. Considered that the annual incidence of TVR after the first year following drug-eluting stenting for in-stent restenosis has been reported as approximately 3% per year, an incidence of 5.8% per year following VBT of our study population clearly indicates a more pronounced, delayed and, even in the fifth year after the index procedure, ongoing restenotic process following beta-irradiation of in-stent restenotic lesions associated with clinically relevant adverse cardiovascular events.

  3. Results of Prevention of REStenosis with Tranilast and its Outcomes (PRESTO) trial

    NARCIS (Netherlands)

    D.R. Holmes Jr (David); J.R. Granett (Jeffrey); J.J. Popma (Jeffrey); P.J. Fitzgerald (Peter); D. Fischman (David); J.J. Ferguson (James); A.M. Lincoff (Michael); S. Goldberg (Sheldon); J.A. Brinker; R. Chan; B.R. Davis (Barry); M. Poland; A.M. Zeiher (Andreas); J.T. Willerson (James); S.B. King 3rd (Spencer); L.M. Shapiro; M. Savage (Michael); J.M. Lablanche (Jean Marc); J.E. Tcheng (James); L. Grip (Lars); P.W.J.C. Serruys (Patrick)

    2002-01-01

    textabstractBACKGROUND: Restenosis after percutaneous coronary intervention (PCI) is a major problem affecting 15% to 30% of patients after stent placement. No oral agent has shown a beneficial effect on restenosis or on associated major adverse cardiovascular events. In limited trials, the oral age

  4. Effect of Coronary Plaque Composition on In-Stent Restenosis in Patients After Percutaneous Coronary Intervention Treatment%斑块成份对经皮冠状动脉介入治疗术后再狭窄的影响

    Institute of Scientific and Technical Information of China (English)

    罗江宾; 王天松; 方明

    2013-01-01

    Objective:To assess the effect of coronary plaque composition on in-stent restenosis in patients after percutaneous coronary intervention (PCI) treatment by intravascular ultrasound-virtual histology (IVUS-VH).Methods:A total of 300 consecutive non-diabetic patients with the indication of elective PCI were studied.Before PCI,all culprit lesions were detected by IVUS and the plaque compositions obtained by VH software analysis.After PCI,all patients were followed-up for 1 year and examined by coronary angiography.The restenosis was defined as the reduction of lumen diameter≥50% at instent and at 5mm of near or remote sites of stent respectively.There were 8 patients lost contact and the rest 292 patients were divided into two groups as Non-restenosis group,n=245 and Restenosis group,n=47,the clinical characteristics and plaque compositions were compared between two groups.Results:The necrotic core in Restenosis group was higher than that in Non-restenosis group as (22.9 ± 10.2)% vs.(14.7 + 6.9)%,P<0.05,and the calcification in Non-restenosis group was higher as (17.6 + 8.5)% vs.(10.2 + 6.8)%,P<0.05.There were significant differences in hs-CRP between two groups,P<0.05.Logistic multi-regression analysis presented that hs-CRP (OR=1.24,95% CI:1.05~1.81,P=0.027) and the ratio of necrotic core (OR=1.18,95% CI:1.05~1.66,P=0.041)were the independent risk factors for restenosis in patients after PCI treatment.Conclusion:For culprit lesions,more necrotic core may cause higher incidence of in-stent restenosis,and inflammation is also an important risk factor for restenosis in patients after PCI.%目的:应用血管内超声虚拟组织成像技术(IVUS-VH)量化评价斑块成份对经皮冠状动脉介入治疗(PCI)术后再狭窄的影响.方法:连续纳入300例具有择期PCI指征的非糖尿病患者.在支架置人术前,对所有罪犯病变行血管内超声检查,并应用虚拟组织学软件分析斑块成份;随访1年,复查冠状

  5. 炎症因子对冠心病患者经皮冠状动脉介入术后支架再狭窄的影响%Effect of inflammation factors on stent restenosis after percutaneous coronary intervention in patients with coronary heart disease

    Institute of Scientific and Technical Information of China (English)

    胡桃红; 马会利; 靳志涛; 高国杰; 丁力平; 邹建宏; 赵贵锋; 王承竹; 任江华

    2013-01-01

    Objective To understand certain inflammatory factors of in-stent restenosis among coronary heart disease (CHD) patients undergoing percutaneous coronary intervention (PCI).Methods Totally 748 patients diagnosed by coronary angiography (luminal stenosis ≥ 50%) were treated by PCI.222 cases with the original stent vascular diameter stenosis ≥ 50% were confirmed by coronary angiography.The history,physical examination,the blood test,blood glucose,lipid screening,plasma fibrinogen,C reactive protein,liver and renal function were recorded on the day of admission in two groups(restenosis group 86 cases,none-restenosis group 136 cases).These data was analyzed and summarized.Results Compared with restenosis group,age,peripheral blood neutrophils,platelets and blood lipid levels were not statistically different in none-restenosis group (P > 0.05);Smoking,hypertension,diabetes mellitus,peripheral white blood cell count,plasma C reactive protein and fibrinogen in restenosis group were higher than those in none-stenosis group [smoking:63.9% (55/86)vs 48.5% (66/136),hypertension:77.9% (67/86) vs 64.7 % (88/136),diabetes mellitus:50.0% (43/86) vs 22.8% (31/ 136),white blood cell count:(8.8 ± 1.2) × 109/L vs(7.1 ±2.5) × 109/L,C reactive protein:(15 ±26) mg/L vs (7 ± 16) mg/L,fibrinogen:(3.6 ± 0.8) g/L vs (3.3 ± 0.9) g/L,P < 0.05].Logistic regression analysis showed that smoking,diabetes and peripheral white blood cell count could increase in-stent restenosis (P < 0.05).Conclusion Inflammatory leukocytes,plasma C reactive protein and fibrinogen levels can aggrandize stent restenosis in patients after PCI; traditional risk factors such as smoking,diabetes mellitus,hypertension can significantly delay the recovery of inflammation and increase the incidence of in-stent restenosis in patients after PCI.%目的 了解白细胞、C反应蛋白、纤维蛋白原等炎症因子对冠心病(CHD)患者经皮冠状动脉介入(PCI)术后

  6. Impact of high lipoprotein(a) levels on in-stent restenosis and long-term clinical outcomes of angina pectoris patients undergoing percutaneous coronary intervention with drug-eluting stents in Asian population.

    Science.gov (United States)

    Park, Sang-Ho; Rha, Seung-Woon; Choi, Byoung-Geol; Park, Ji-Young; Jeon, Ung; Seo, Hong-Seog; Kim, Eung-Ju; Na, Jin-Oh; Choi, Cheol-Ung; Kim, Jin-Won; Lim, Hong-Euy; Park, Chang-Gyu; Oh, Dong-Joo

    2015-06-01

    Lipoprotein(a) (Lp(a)) is known to be associated with cardiovascular complications and atherothrombotic properties in general populations. However, it has not been examined whether Lp(a) levels are able to predict adverse cardiovascular outcomes in patients undergoing percutaneous coronary intervention (PCI) with drug-eluting stents (DES). A total of 595 consecutive patients with angina pectoris who underwent elective PCI with DES were enrolled from 2004 to 2010. The patients were divided into two groups according to the levels of Lp(a): Lp(a) 50 mg/dL was significantly associated with the 3-year adverse clinical outcomes including any myocardial infarction, revascularization (target lesion revascularization (TLR) and target vessel revascularization (TVR)), TLR-major adverse cardiac events (MACEs), TVR-MACE, and All-MACEs. In our study, high Lp(a) level ≥ 50 mg/dL in angina pectoris patients undergoing elective PCI with DES was significantly associated with binary restenosis and 3-year adverse clinical outcomes in an Asian population.

  7. The Relationships between Polymorphisms in Genes Encoding the Growth Factors TGF-β1, PDGFB, EGF, bFGF and VEGF-A and the Restenosis Process in Patients with Stable Coronary Artery Disease Treated with Bare Metal Stent.

    Directory of Open Access Journals (Sweden)

    Tadeusz Osadnik

    Full Text Available Neointima forming after stent implantation consists of vascular smooth muscle cells (VSMCs in 90%. Growth factors TGF-β1, PDGFB, EGF, bFGF and VEGF-A play an important role in VSMC proliferation and migration to the tunica intima after arterial wall injury. The aim of this paper was an analysis of functional polymorphisms in genes encoding TGF-β1, PDGFB, EGF, bFGF and VEGF-A in relation to in-stent restenosis (ISR.265 patients with a stable coronary artery disease (SCAD hospitalized in our center in the years 2007-2011 were included in the study. All patients underwent stent implantation at admission to the hospital and had another coronary angiography performed due to recurrence of the ailments or a positive result of the test assessing the coronary flow reserve. Angiographically significant ISR was defined as stenosis >50% in the stented coronary artery segment. The patients were divided into two groups-with angiographically significant ISR (n = 53 and without significant ISR (n = 212. Additionally, the assessment of late lumen loss (LLL in vessel was performed. EGF rs4444903 polymorphism was genotyped using the PCR-RFLP method whilst rs1800470 (TGFB1, rs2285094 (PDGFB rs308395 (bFGF and rs699947 (VEGF-A were determined using the TaqMan method.Angiographically significant ISR was significantly less frequently observed in the group of patients with the A/A genotype of rs1800470 polymorphism (TGFB1 versus patients with A/G and G/G genotypes. In the multivariable analysis, LLL was significantly lower in patients with the A/A genotype of rs1800470 (TGFB1 versus those with the A/G and G/G genotypes and higher in patients with the A/A genotype of the VEGF-A polymorphism versus the A/C and C/C genotypes. The C/C genotype of rs2285094 (PDGFB was associated with greater LLL compared to C/T heterozygotes and T/T homozygotes.The polymorphisms rs1800470, rs2285094 and rs6999447 of the TGFB1, PDGFB and VEGF-A genes, respectively, are associated with LLL

  8. Increase of ADAM10 level in coronary artery in-stent restenosis segments in diabetic minipigs: high ADAM10 expression promoting growth and migration in human vascular smooth muscle cells via Notch 1 and 3.

    Directory of Open Access Journals (Sweden)

    Ke Yang

    Full Text Available BACKGROUND: This study aimed to identify major proteins in the pathogenesis of coronary artery in-stent restenosis (ISR in diabetic minipigs with sirolimus-eluting stenting, and to investigate the roles of key candidate molecules, particularly ADAM10, in human arterial smooth muscle cells (HASMCs. METHODS AND RESULTS: The stents were implanted in the coronary arteries of 15 diabetic and 26 non-diabetic minipigs, and angiography was repeated at six months. The intima of one vascular segment with significant ISR and one with non-ISR in diabetic minipigs were isolated and cultured in conditioned medium (CM. The CM was analyzed by LC-MS/MS to uncover proteins whose levels were significantly increased (≥ 1.5-fold in ISR than in non-ISR tissues. After literature searching, we focused on the identified proteins, whose biological functions were most potentially related to ISR pathophysiology. Among them, ADAM10 was significantly increased in diabetic and non-diabetic ISR tissues as compared with non-ISR controls. In cell experiments, retrovirus-mediated overexpression of ADAM10 promoted growth and migration of HASMCs. The effects of ADAM10 were more remarkable in high-glucose culture than in low-glucose culture. Using shRNA and an inhibitor of γ-secretase (GSI, we found that the influences of ADAM10 were in part mediated by Notch1 and notch 3 pathway, which up-regulated Notch downstream genes and enhanced nuclear translocation of the small intracellular component of Notch1 and Notch3. CONCLUSIONS: This study has identified significantly increased expression of ADAM10 in the ISR versus non-ISR segment in diabetic minipigs and implicates ADAM10 in the enhanced neointimal formation observed in diabetes after vascular injury.

  9. Model generation of coronary artery bifurcations from CTA and single plane angiography

    Energy Technology Data Exchange (ETDEWEB)

    Cardenes, Ruben; Diez, Jose L.; Duchateau, Nicolas; Pashaei, Ali; Frangi, Alejandro F. [Center for Computational Imaging and Simulation Technologies in Biomedicine (CISTIB)-Universitat Pompeu Fabra and Networking Biomedical Research Center on Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Barcelona 08018 (Spain); Cardiology Department, University Hospital Dr. Peset, Valencia 46017 (Spain); Hospital Clinic Provincial de Barcelona, Institut d' investigacions Biomediques August Pi i Sunyer-Universitat de Barcelona, Barcelona 08036 (Spain); Center for Computational Imaging and Simulation Technologies in Biomedicine (CISTIB)-Universitat Pompeu Fabra and Networking Biomedical Research Center on Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Barcelona 08018 (Spain); Center for Computational Imaging and Simulation Technologies in Biomedicine (CISTIB)-Universitat Pompeu Fabra and Networking Biomedical Research Center on Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Barcelona 08018, Spain and Department of Mechanical Engineering, University of Sheffield, Sheffield S1 3JD (United Kingdom)

    2013-01-15

    Purpose: To generate accurate and realistic models of coronary artery bifurcations before and after percutaneous coronary intervention (PCI), using information from two image modalities. Because bifurcations are regions where atherosclerotic plaque appears frequently and intervention is more challenging, generation of such realistic models could be of high value to predict the risk of restenosis or thrombosis after stent implantation, and to study geometrical and hemodynamical changes. Methods: Two image modalities have been employed to generate the bifurcation models: computer tomography angiography (CTA) to obtain the 3D trajectory of vessels, and 2D conventional coronary angiography (CCA) to obtain radius information of the vessel lumen, due to its better contrast and image resolution. In addition, CCA can be acquired right before and after the intervention in the operation room; therefore, the combination of CTA and CCA allows the generation of realistic preprocedure and postprocedure models of coronary bifurcations. The method proposed is semiautomatic, based on landmarks manually placed on both image modalities. Results: A comparative study of the models obtained with the proposed method with models manually obtained using only CTA, shows more reliable results when both modalities are used together. The authors show that using preprocedure CTA and postprocedure CCA, realistic postprocedure models can be obtained. Analysis carried out of the Murray's law in all patient bifurcations shows the geometric improvement of PCI in our models, better than using manual models from CTA alone. An experiment using a cardiac phantom also shows the feasibility of the proposed method. Conclusions: The authors have shown that fusion of CTA and CCA is feasible for realistic generation of coronary bifurcation models before and after PCI. The method proposed is efficient, and relies on minimal user interaction, and therefore is of high value to study geometric and

  10. Restenosis following balloon dilation of benign esophageal stenosis

    Institute of Scientific and Technical Information of China (English)

    Ying-Sheng Cheng; Ming-Hua Li; Ren-Jie Yang; Hui-Zhen Zhang; Zai-Xian Ding; Qi-Xin Zhuang; Zhi-Ming Jiang; Ke-Zhong Shang

    2003-01-01

    AIM: To elucidate the mechanism of restenosis following balloon dilation of benign esophageal stenosis.METHODS: A total of 49 rats with esophageal stenosis were induced in 70 rats using 5 ml of 50 % sodium hydroxide solution and the double-balloon method, and an esophageal restenosis (RS) model was developed by esophageal stenosis using dilation of a percutaneous transluminal coronary angioplasty (PTCA) balloon catheter. These 49 rats were divided into two groups: rats with benign esophageal stricture caused by chemical burn only (control group, n=21) and rats with their esophageal stricture treated with balloon catheter dilation (experimental group, n=28). Imaging analysis and immunohistochemistry were used for both quantitative and qualitative analyses of esophageal stenosis and RS formation in the rats, respectively.RESULTS: Cross-sectional areas and perimeters of the esophageal mucosa layer, muscle layer, and the entire esophageal layers increased significantly in the experimental group compared with the control group. Proliferating cell nuclear antigen (PCNA) was expressed on the 5th day after dilation, and was still present at 1 month. Fibronectin (FN)was expressed on the 1st day after dilation, and was still present at 1 month.CONCLUSION: Expression of PCNA and FN plays an important role in RS after balloon dilation of benign esophageal stenosis.

  11. Restenosis after infrapopliteal angioplasty - clinical importance, study update and further directions.

    Science.gov (United States)

    Baumann, Frederic; Diehm, Nicolas

    2013-11-01

    Patients with critical limb ischemia (CLI) represent the most severe form of peripheral arterial disease (PAD) and exhibit high mortality rates. Frequently, PAD in CLI patients involves the infrapopliteal arterial segment challenging endovascular revascularization strategies. Restenosis remains the major drawback of tibial angioplasty encountered in more than two thirds of CLI patients undergoing tibial revascularization. In contrast to earlier observations, tibial patency was recently shown to be essential to attain an optimal clinical outcome in CLI patients subsequent to tibial angioplasty. The exact pathopyhsiological mechanisms of tibial restenosis remains unclear. To date, most of our knowledge on tibial restenosis and its pathophysiology is derived from coronary arteries, based on the similarity of coronary arteries to tibial artery morphology. Nervertheless, multiple antirestenosis concepts are investigated within clinical trials to reduce tibial restenosis.Purpose of the present manuscript is to provide a current update on the pathophysiology of tibial restenosis and potential antirestenosis strategies.

  12. Efficacy of beta radiation in prevention of post-angioplasty restenosis : An interim report from the beta energy restenosis trial

    NARCIS (Netherlands)

    D. Meerkin; R. Bonan (Raoul); I.R. Crocker; A. Arsenault (André); P. Chougule; V.L.M.A. Coen (Veronique); D.O. Williams (David); P.W.J.C. Serruys (Patrick); S.B. King 3rd (Spencer)

    1998-01-01

    textabstractRestenosis remains a major limitation of coronary angioplasty in spite of major advances in techniques and technology. Recent studies have demonstrated that ionizing radiation may limit the degree of this problem. Gamma radiation has been shown to be effective in reducing in stent resten

  13. Restenosis and Therapy

    Directory of Open Access Journals (Sweden)

    Laszlo Denes

    2012-01-01

    Full Text Available The vascular disease involves imbalanced function of the blood vessels. Risk factors playing a role in development of impaired vessel functions will be briefly discussed. In ischemia/reperfusion (I/R, ischemic hypoxia is one of the cardinal risk factors of restenosis. Various insults are shown to initiate the phenotype switch of VSMCs. The pathological process, leading to activated inflammatory process, complement activation, and release of growth factors, initiate the proliferation of VSMCs in the media and cause luminal narrowing and impaired vascular function. The review summarizes the alteration process and demonstrates some of the clinical genetic background showing the role of complement and the genotypes of mannose-binding lectin (MBL2. Those could be useful markers of carotid restenosis after stent implantation. Gene therapy and therapeutic angiogenesis is proposed for therapy in restenosis. We suggest a drug candidate (iroxanadine, which ensures a noninvasive treatment by reverse regulation of the highly proliferating VSMCs and the disturbed function of ECs.

  14. 含铜不锈钢材料对冠状动脉支架植入后再狭窄的抑制作用探讨%The Discussion of Copper Stainless Steel for the Inhibition of Restenosis after Coronary Stent Implantation

    Institute of Scientific and Technical Information of China (English)

    尹洪涛; 费倩; 李今朝; 张军

    2014-01-01

    Percutaneous coronary stent implantation has become one of the main effective methods of coronary heart disease , however ,restenosis remains a major risk of postoperative stent foreign objects and mechanical damage to the vessel wall inevitably become a restenosis initiating factor , platelet activation and subsequent series of inflammatory cells , inflammatory cells and endothelial cells release a variety of inflammatory mediators , thereby activating the excessive inflammatory response , resulting in the accumulation of vascular smooth muscle cell migration and proliferation , extracellular matrix ,neointimal formation ,vascular remodeling ,causing restenosis .Inflammation as a central part of restenosis has been our starting point to crack restenosis ,while copper has antibacterial stainless steel confirmed in a variety of tests ,to promote appreciation and early apoptotic endothelial cells .The study on restenosis and inflammation and suppress the central link of the copper material over the role of inflammation does a discussion .%经皮冠状动脉内支架植入术已经成为冠心病的主要有效治疗方法之一,然而再狭窄的发生仍然是术后的主要隐患,支架异物及其对血管壁的机械损伤不可避免地成为了再狭窄的始动因素,随后激活血小板及一系列炎症细胞,炎症细胞及内皮细胞释放多种炎症介质,从而激活过度的炎症反应,最终导致血管平滑肌细胞的迁移和增殖、细胞外基质的堆积、新生内膜形成、血管重构,引起再狭窄。炎症反应作为再狭窄的中心环节一直是我们破解再狭窄的切入点,而含铜不锈钢材料在多种试验中证实具有抗菌、促进内皮细胞增殖及早期凋亡的特性。本研究就再狭窄与中心环节的炎症反应和铜材料的抑制过度炎症反应作用做一探讨。

  15. 冠状动脉介入治疗后支架内再狭窄相关因素%Investigation of factors related to the occurrence of in-stent restenosis after percutaneous coronary intervention

    Institute of Scientific and Technical Information of China (English)

    潘春仰; 邱建平; 陆林; 张奇; 张瑞岩; 沈卫峰

    2015-01-01

    目的:探讨冠状动脉药物洗脱支架(DES)植入术后支架内再狭窄(ISR)相关因素。方法选择2010年9月至2014年9月上海交通大学医学院附属瑞金医院治疗的连续258例雷帕霉素DES植入术后至少1年冠状动脉造影复查确诊为ISR患者(ISR组)和同期262例年龄和性别匹配但无ISR患者(对照组),比较两组患者临床特征、生化指标、术后用药、超声心动图左室射血分数(LVEF)及DES植入治疗特征,采用多因素Logistic回归方法分析与ISR相关因素。结果与对照组相比,ISR组患者既往心肌梗死史、糖尿病和吸烟多见,血清高敏C反应蛋白(hs-CRP)、糖化血红蛋白、低密度脂蛋白胆固醇(LDL-C)和载脂蛋白B水平显著增高,但LVEF减低(P 均<0.05)。尽管两组冠状动脉病变数和支架植入部位无显著差异,但ISR组支架直径较小、长度较长,分叉病变多见(P<0.05)。 Logistic回归分析显示既往心肌梗死史、糖尿病、吸烟、hs-CRP、LDL-C、支架长度是ISR独立危险因素,而支架直径、LVEF与ISR呈负相关。结论雷帕霉素DES植入术后ISR发生与多个临床和冠状动脉病变或介入因素相关,有效控制冠心病危险因素、改善左心室功能,对预防ISR具有重要作用,尤其是小血管、长支架和分叉病变患者。%Objective To investigate the factors related to the occurrence of in-stent restenosis (ISR) after percutaneous coronary drug-eluting stent (DES) implantation. Methods A total of 258 consecutive patients with coronary angiography confirmed ISR that occurred at least one year after coronary sirolimus-eluting stent implantation, who were encountered at the Affiliated Ruijin Hospital of Shanghai Jiaotong University during the period from September 2010 to September 2014 , were collected as ISR group; and other 260 age-and sex-matched patients with no ISR at least one year after coronary sirolimus

  16. Erythropoietin prevention trial of coronary restenosis and cardiac remodeling after ST-elevated acute myocardial infarction (EPOC-AMI): a pilot, randomized, placebo-controlled study.

    Science.gov (United States)

    Taniguchi, Norimasa; Nakamura, Takeshi; Sawada, Takahisa; Matsubara, Kinya; Furukawa, Keizo; Hadase, Mitsuyoshi; Nakahara, Yoshifumi; Nakamura, Takashi; Matsubara, Hiroaki

    2010-11-01

    Erythropoietin (EPO) enhances re-endothelialization and anti-apoptotic action. Larger clinical studies to examine the effects of high-dose EPO are in progress in patients with acute myocardial infarction (AMI). The aim of this multi-center pilot study was to investigate the effect of `low-dose EPO' (6,000 IU during percutaneous coronary intervention (PCI), 24 h and 48 h) in 35 patients with a first ST-elevated AMI undergoing PCI who was randomly assigned to EPO or placebo (saline) treatment. Neointimal volume, cardiac function and infarct size were examined in the acute phase and 6 months later (ClinicalTrials.gov identifier: NCT00423020). No significant regression in in-stent neointimal volume was observed, whereas left ventricular (LV) ejection fraction was significantly improved (49.2% to 55.7%, P=0.003) and LV end-systolic volume was decreased in the EPO group (47.7 ml to 39.0 ml, P=0.036). LV end-diastolic volume tended to be reduced from 90.2% to 84.5% (P=0.159), whereas in the control group it was inversely increased (91.7% to 93.7%, P=0.385). Infarction sizes were significantly reduced by 38.5% (P=0.003) but not in the control group (23.7%, P=0.051). Hemoglobin, peak creatine kinase values, and CD34(+)/CD133(+)/CD45(dim) endothelial progenitors showed no significant changes. No adverse events were observed during study periods. This is a first study demonstrating that short-term `low-dose' EPO to PCI-treated AMI patients did not prevent neointimal hyperplasia but rather improved cardiac function and infarct size without any clinical adverse effects.

  17. The Prevention and Treatment of Restenosis in The Era of Drug-eluting Stent

    Institute of Scientific and Technical Information of China (English)

    ZHANG Min-zhou

    2007-01-01

    @@ Ever since the first percutaneous transluminal coronary angioplasty(PTCA) was completed successfully by Gruentzig in 1977,postoperational restenosis(RS) has been puzzling constantly the progress of percutaneous coronary intervention(PCI),and it is known as the Achilles Heel of PCI.In a certain sense,the development history of PCI is also the history of continually overcoming RS.

  18. 支架置入后再狭窄病生机制及其防治的中西医研究进展%Research Progress on Pathophysiology, Prevention and Treatment of Restenosis after Percutaneous Coronary Intervention by Integrative Medicine

    Institute of Scientific and Technical Information of China (English)

    司春婴; 王贺; 罗明华; 解金红; 陈玉善; 关怀敏; 沈晓君

    2015-01-01

    随着中国人群冠心病患病率与发病率的逐年上升,对冠心病的防治工作刻不容缓。自1977年Gruentzig教授完成人类第一例经皮冠脉腔内成形术(PTCA),从此冠心病介入治疗(PCI)迈进了崭新的一页。经过30多年的发展,PCI技术日趋成熟和完善,由最初的PTCA,发展到了如今的支架时代。随着支架的问世,PCI后的再狭窄率由30%-50%显著降低至10%-20%。但却仍然无法根治再狭窄这一问题。如何防治支架术后再狭窄,成为临床和基础医学长期探索的一大课题。因此,本文现将中西医对支架后再狭窄的病因病机、相关危险因素、最新诊断手段及防治作一综述。%With the increasing incidence and mortality of coronary heart disease (CHD) in China, the prevention and treatment of CHD is no time to delay. Since Professor Gruentzig completed the first human case of percutaneous transluminal coronary angioplasty (PTCA) in 1977, percutaneous coronary intervention (PCI) had reached to a new page. After three decades of development and change, PCI has been improved and matured gradually from the early PTCA to the current stent era. With the advent of stents, the rate of restenosis after PCI was significantly reduced from 30%-50% to 10%-20%. But stent restenosis was still with no total cure. The issue of how to prevent the stent restenosis has become a long-term major issue for the exploration in both clinical and preclinical medicine. Therefore, this paper reviewed the etiology, pathology, related risk factors, latest diagnosis methods, prevention and treatment of stent restenosis by integrative medicine.

  19. Vascular brachytherapy revisited for in-stent restenosis in the drug-eluting stent era: current status and future perspective

    Institute of Scientific and Technical Information of China (English)

    LI Xiong-jie; Seung-Woon Rha; Sunil-P Wani; WANG Lin; Kanhaiya-L Poddar; Dong-Joo Oh

    2009-01-01

    @@ Percutaneous coronary intervention (PCI) with drug-eluting stents (DESs) has revolutionized the management of atherosclerotic coronary artery disease. However, in-stent restenosis (ISR) has been the downside of all coronary interventions with the devices that have been tested so far, even in the DES era.

  20. Luminal narrowing after percutaneous transluminal coronary angioplasty. A study of clinical, procedural, and lesional factors related to longterm angiographic outcome : Coronary Artery Restenosis Prevention on Repeated Thromboxane Antogonism (CARPORT) Study Group

    NARCIS (Netherlands)

    B.J.W.M. Rensing (Benno); W.R.M. Hermans (Walter); J. Vos (Jeroen); J.G.P. Tijssen (Jan); W.R. Rutsch (Wolfgang); N. Danchin (Nicolas); G.R. Heyndrickx (Guy); E.G. Mast (Gijs); W. Wijns (William); P.W.J.C. Serruys (Patrick)

    1993-01-01

    textabstractBackground. The renarrowing process after successful percutaneous transluminal coronary angioplasty (PTCA) is now believed to be caused by a response-to-injury vessel wall reaction. The magnitude of this process can be assessed by the change in minimal lumen diameter (MLD) at follow-up

  1. Effects and mechanisms of non-restrictive external stent for prevention of vein graft restenosis in a rabbit model

    Institute of Scientific and Technical Information of China (English)

    TIAN Xiao-dong; ZHOU Nai-kang; LI Bo-jun; XIAO Cang-song; LIU Xi; LIANG Chao-yang; ZHANG Tao; GAO Chang-qing

    2010-01-01

    Background Among various treatments preventing vein graft restenosis, external stent is receiving more and more attention. This study aimed to investigate the effect of non-restrictive external stent on the prevention of vein graft restenosis and the potential mechanisms of platelet-derived growth factor (PDGF) in the process of restenosis.Methods Thirty-six "New Zealand white rabbits" were randomly divided into two groups, stented group (group S) and control group (non-stented group, group NS). Each rabbit underwent a reversed autologous external jugular vein into common carotid artery bypass grafting. In group S, the vein grafts were surrounded by a non restrictive stent which was 6 mm in diameter (a kind of Dacron vascular prosthesis); and in group NS, there was no stent to support the vein grafts.The grafts were harvested at the first week (1W), second week (2W) and fourth week (4W) after surgery respectively. The dimensions (including the thickness and area of the intima and media, luminal area) were measured by computer-aided image analysis system, and the intimal hyperplasia ratio was defined as the percentage of the area enclosed by the internal elastic lamina occupied by the intima.Results At 1W, the difference of the thickness and area of the intima between groups S and NS was not significant (P >0.05); at 2W and 4W, the thickness and area of the intima and the intimal hyperplasia ratio in group S were less significant than those in group NS (P <0.05); from 1W to 4W, the thickness and area of the media in group S were smaller than those in group NS (P<0.05). Immunocytochemistry staining of PDGF-B showed that the percentage of positive cells of intima in both two groups was peaked at 2W, and a significantly smaller percentage was detected in group S compared with that in group NS at 2W and 4W (P <0.05); the percentage of PDGF-B positive cells of media in both two groups was also peaked at 2W, and that in group S was smaller than that in group NS

  2. [The role of micro-RNA/143/145 in evolution of intra-stent restenosis].

    Science.gov (United States)

    Popovich, I M

    2011-01-01

    The mechanisms of neointima formation and hyperplasia in restenosis remain non-elucidated yet. Because micro-ribonucleic acids/143/145(micro-RNA/143 and micro-RNA/145) participate in the regulation and sustaining of the genotype of mature vascular myocytes we have measured their expression in tissue content of restenoses taken postmortem from 5 patients who underwent angioplasty and subsequently died, and studied its association with actin quantity and fibrillar collagen type I degradation degree. It has been found that during restenosis progression quantity of micro-RNA/143 and micro-RNA/145 decreases in media and intima of coronary artery. This finding has been associated with appearance in coronary intima of coronary myocytes with reduced size likely of secretory phenotype, diminution of number of myocytes with contractile phenotype, and increase of quantity of denaturized collagen type I-phenomena characteristic for neointima hyperplasia, a substrate of intra-stent restenosis.

  3. Biomimicry, vascular restenosis and coronary stents.

    Science.gov (United States)

    Schwartz, R S; van der Giessen, W J; Holmes, D R

    1998-01-01

    Biomimicry is in its earliest stages and is being considered in the realm of tissue engineering. If arterial implants are to limit neointimal thickening, purely passive structures cannot succeed. Bioactivity must be present, either by pharmacologic intervention or by fabricating a 'living stent' that contains active cellular material. As tissue engineering evolves, useful solutions will emerge from applying this knowledge directly to vascular biologic problems resulting from angioplasty, stenting, and vascular prosthesis research.

  4. Percutaneous transradial artery approach for coronary stent implantation.

    Science.gov (United States)

    Kiemeneij, F; Laarman, G J

    1993-10-01

    A new approach for implantation of Palmaz Schatz coronary stents is reported. We describe the technique and rationale of coronary stenting with miniaturized angioplasty equipment via the radial artery. This technique is illustrated in three patients. One patient underwent Palmaz Schatz stent implantation for a saphenous vene coronary bypass graft stenosis, the second patient for a restenosis in the anterior descending coronary artery after atherectomy, and the third patient for a second restenosis after balloon angioplasty in the circumflex coronary artery.

  5. Study of Pioglitazone Reducing Coronary In-stent Restenosis on Insulin Resistance in Non-diabetic Patients%吡格列酮降低胰岛素抵抗非糖尿病患者冠脉支架内再狭窄的研究

    Institute of Scientific and Technical Information of China (English)

    张由建; 张晓

    2013-01-01

    Investigate the effects and mechanisms of Pioglitazone on coronary in—stent restenosis in insulin resistance in non — diabetic patients. Sixty patients with coronary in—stent restenosis in insulin resistance in non—diabetic patients were randomly divided into 2 groups; Pioglitazone group and control group, the experimental group was given six months Pioglitazone 15 mg/d besides the routine therapy. The result showed that Pioglitazone group stenosis rate, serum hsCRP, Adi-ponectin, ET— 1 and Leptin levels were significantly lower(P<0. 05), Adiponectin level was significantly higher (P<0. 05). Stenosis area was negatively correlated with serum Adiponectin level, stenosis area was significantly positively relate with HOMA—IR, leptin, ET—1 and hsCRP. The conclusion is that Pioglitazone can reduce the coronary in—stent restenosis in insulin resistance in non—diabetic patients.%研究吡格列酮对胰岛素抵抗非糖尿病患者冠脉支架内再狭窄的影响,探讨其作用机制.选择60例接受冠脉支架植入并发胰岛素抵抗非糖尿病患者,随机分为吡格列酮组和对照组.吡格列酮组在常规治疗基础上给予6个月吡格列酮15mg/d.结果显示吡格列酮组支架内再狭窄率明显降低(P<0.05),血清hsCRP、瘦素和ET-1水平显著降低和血清脂联素水平显著升高(P<0.05),管腔狭窄面积与血清脂联素呈显著负相关,与胰岛素抵抗指数、瘦素、内皮素、C反应蛋白水平呈显著正相关.因此,吡格列酮能降低胰岛素抵抗非糖尿病患者冠脉支架内再狭窄,加强了支架的保护作用.

  6. Restenosis detection; Depistage de la restenose. Evaluation des interventions de revascularisation coronaire par les techniques de cardiologie nucleaire. Surveillance cardiologique des patients ayant beneficie d`une angioplastie: importance de la scintigraphie myocardique avec epreuve d`effort

    Energy Technology Data Exchange (ETDEWEB)

    Py, M.; Karcher, G.; Bertrand, A. [Centre Hospitalier Universitaire, 54 -Nancy (France); Guyon, P.; Caussin, C.; Bourachot, M.L.; Elhadad, S.; Dib, J.C.; Wartski, M.; Zerbib, E.; Lancelin, B. [Centre chirurgical Marie-Lannelongue, 92 - Le Plessis-Robinsson (France)

    1997-12-31

    Coronary angioplasty is now a very useful technique of revascularization. However, restenosis represents a major problem of this technique. P.Y. Marie details the performance of nuclear cardiology techniques in the evaluation of aorto-coronary bypass and coronary angioplasty. P. Guyon reports on the experience of the surgical center Marie-Lannelongue in the follow-up patients having coronary angioplasty. Then, discussions point out the patho-physiological aspects of restenosis. (authors). 31 refs.

  7. PTCA后再狭窄的中医药防治研究进展%Progression on prevention & treatment of coronary artery restenosis following percutaneous transluminal coronary angioplasty by using traditional Chinese medicine

    Institute of Scientific and Technical Information of China (English)

    方平; 王发渭

    2004-01-01

    经皮腔内冠状动脉成形术(Percutaneous transluminal coronary angioplasty,PTCA)由Gmentzing等人于1977年发明至今,已作为有效治疗冠心病的一种方法广泛应用于临床。随着临床经验的不断积累及手术装置的不断改善,成为心血管疾病介入治疗的主要手段之一。但此后20余年间,术后再狭窄的高发病率(据报道达30%-50%)一直是困扰西

  8. On the necessity of modelling fluid-structure interaction for stented coronary arteries.

    Science.gov (United States)

    Chiastra, Claudio; Migliavacca, Francesco; Martínez, Miguel Ángel; Malvè, Mauro

    2014-06-01

    Although stenting is the most commonly performed procedure for the treatment of coronary atherosclerotic lesions, in-stent restenosis (ISR) remains one of the most serious clinical complications. An important stimulus to ISR is the altered hemodynamics with abnormal shear stresses on endothelial cells generated by the stent presence. Computational fluid dynamics is a valid tool for studying the local hemodynamics of stented vessels, allowing the calculation of the wall shear stress (WSS), which is otherwise not directly possible to be measured in vivo. However, in these numerical simulations the arterial wall and the stent are considered rigid and fixed, an assumption that may influence the WSS and flow patterns. Therefore, the aim of this work is to perform fluid-structure interaction (FSI) analyses of a stented coronary artery in order to understand the effects of the wall compliance on the hemodynamic quantities. Two different materials are considered for the stent: cobalt-chromium (CoCr) and poly-l-lactide (PLLA). The results of the FSI and the corresponding rigid-wall models are compared, focusing in particular on the analysis of the WSS distribution. Results showed similar trends in terms of instantaneous and time-averaged WSS between compliant and rigid-wall cases. In particular, the difference of percentage area exposed to TAWSS lower than 0.4Pa between the CoCr FSI and the rigid-wall cases was about 1.5% while between the PLLA cases 1.0%. The results indicate that, for idealized models of a stented coronary artery, the rigid-wall assumption for fluid dynamic simulations appears adequate when the aim of the study is the analysis of near-wall quantities like WSS.

  9. Indirect evidence for a role of a subpopulation of activated neutrophils in the remodelling process after percutaneous coronary intervention

    NARCIS (Netherlands)

    Costa, MA; de Wit, LEA; de Valk, V.; Serrano, P; Wardeh, AJ; Serruys, PW; Sluiter, W

    2001-01-01

    Aim Leukocytes have been implicated in restenosis following percutaneous transluminal coronary angioplasty. We investigated the link between the activated status of circulating neutrophils and restenosis after angioplasty. Methods and Results The population of 108 patients with single, de novo lesio

  10. Impact of metabolic syndrome on re-stenosis development: role of drug-eluting stents.

    Science.gov (United States)

    Goyal, S N; Bharti, S; Krishnamurthy, B; Agrawal, Y; Ojha, S K; Arya, D S

    2012-07-01

    Metabolic syndrome (MetS) is defined as a cluster of numerous cardiovascular risk factors, which encompasses obesity, dyslipidaemia, insulin resistance and hypertension. Patients with MetS are more prone to developing cardiovascular events than other patients. To date, several approaches such as physical exercise, dietary control and invasive and non-invasive therapeutic interventions for dyslipidaemia, hypertension and insulin resistance have been used to manage MetS. However, there is a progressive elevation in the incidence of fatal and non-fatal cardiovascular events due to the increased prevalence of obesity and diabetes. Percutaneous coronary intervention has emerged over the last few years as an effective revascularisation strategy for those with coronary artery disease, in parallel with the development of effective anti-platelet medications and newer drug-eluting stents. In recent years, considerable research efforts have been undertaken to elucidate the pathophysiology of re-stenosis and develop strategies to prevent re-stenosis following percutaneous transluminal coronary angioplasty and stent implantation. Although the rate of stent re-stenosis and target-lesion revascularisation has been reduced, there is little information in the literature on the outcome of MetS in the pathophysiology of re-stenosis. In this review article, we summarise the recent development and progress on re-stenosis and the role of drug-eluting stents, particularly in MetS.

  11. 冠心病患者冠状动脉支架内再狭窄与抑郁障碍的相关性研究%The correlation study between coronary in-stent restenosis and depression disorder in patients with coronary heart disease

    Institute of Scientific and Technical Information of China (English)

    张金国; 谭洪勇; 张传芝; 刘向群; 廖玉华

    2010-01-01

    目的 探讨冠心病(coronary heart disease,CHD)患者经皮冠状动脉支架置人(PCI)术后抑郁障碍对支架内再狭窄(In-stent Restenosis,ISR)的影响,以及可能的病理生理学机制.方法 根据患者汉密尔顿抑郁量表(HAMD-24)、抑郁自评量表(SDS)评分,选择冠心病行PCI术后合并抑郁障碍(HAMD-24评分>8分并SDS评分>53分)的95例患者为研究组,246例冠心病行PCI无抑郁障碍患者为对照组,观察两组患者12月内ISR的发生情况,并测定术后血清醛固酮(aldosterone,ALD)、高敏C反应蛋白(hs-CRP)及瘦素(Leptin)水平.结果 研究组患者发生ISR者明显高于对照组(P=0.003);研究组不同抑郁程度的患者其ISR差异有显著性(χ2=8.148,P=0.017);研究组患者血清ALD、hs-CRP及Leptin水平术后分别高于对照组[ALD(277.4±35.9)ng/L,(258.9±60.9)ng/L,t=3.459,P=0.001 ;hs-CRP(12.03±3.06)mg/L.(11.10±2.806)mg/L,t=2.573,P=0.008;Leptin(5.27±1.07)ng/L,(4.98±0.99)ng/L,t=2.323,P=0.021];Pearson相关分析显示,研究组患者HAMD-24评分分别与术后血清ALD、hs-CRP及;Lptin相关(r=0.291,P=0.026;r=0.350,P=0.014;r=0.312,P=0.023),SDS评分与血清hs-CRP具有相关性(r=0.302,P=0.020).结论 冠心病PCI术后合并抑郁障碍患者血清ALD、hs-CRP及Leptin水平较高,ISR发生率明显高于无抑郁障碍冠心病患者,且随抑郁程度加重ISR发生率增加.%Objective To study the impact of depression disorder in patients after coronary stent implantation on incidence rate of in-stent restenosis (ISR) in the coronary heart disease( CHD ), and its possible pathophysiological mechanisms. Methods According to the Hamilton Depression Scale (HAMD-24) and Self-rating Depression Scale(SDS) score,95 patients with unstable angina received coronary drug-eluting stent implantation combined with depression disorder were serve as the study group; randomly selecte 246 cases without depression due to unstable angina pectoris after coronary stent implantation as the

  12. Usefulness of the monocyte-to-high-density lipoprotein cholesterol ratio to predict bare metal stent restenosis.

    Science.gov (United States)

    Yilmaz, Samet; Akboga, Mehmet K; Sen, Fatih; Balcı, Kevser G; Aras, Dursun; Temizhan, Ahmet; Aydogdu, Sinan

    2016-09-01

    The aim of the present study was to investigate the predictive value of preprocedural monocyte count-to-high-density lipoprotein cholesterol ratio (MHR) on development of in-stent restenosis in patients undergoing coronary bare-metal stent (BMS) implantation. Data from 705 patients who had undergone BMS implantation and additional control coronary angiography were analyzed. Patients were divided into three tertiles based on preprocedural MHR. Restenosis occurred in 59 patients (25%) in the lowest tertile, 84 (35%) in the middle tertile and 117 (50%) in the highest MHR tertile (p MHR and C-reactive protein levels emerged as independent predictors of in-stent restenosis. High preprocedural MHR is related to BMS restenosis.

  13. EXPRESSION AND ROLE OF PLASMINOGEN SYSTEM IN PROCESS OF RESTENOSIS

    Institute of Scientific and Technical Information of China (English)

    ZHAO Hai-guang; LU Xin-wu; HUANG Ying; JIANG Mi-er

    2005-01-01

    Objective To study the expression and role of plasminogen system in the process of restenosis.Methods We established a double-injury model of atherosclerotic restenosis in rabbit iliac artery mimicking human arterial restenosis. The time course of tissue plaminogen activator (tPA), urokinase plasminogen activator (uPA), urokinase plasminogen activator receptor (uPAR) and plasminogen activator inhibitor-1 (PAI-1) was investigated by immunohistochemistry. The mRNA expression of uPA and uPAR were detected after vascular procedures by in situ hybridization. Results In uninjured arteries, the weak expression of tPA and PAI-1 was detected in intimal and endothelial cells. The expression of tPA, uPA, uPAR and PAI-1 was significantly induced after double-injury, but after double-injury 14d, the expression of tPA restore to preinjury levels. The expression of uPA and uPAR in intimal was higher than that of media and maintain high levels in intimal within 42d and 56d. Conclusion Whereas t-PA is primarily involved in clot dissolution and play a limited role in the process of restenosis, in plasminogen system, uPA and uPAR play a prominent role in the process of restenosis.

  14. Diagnostic accuracy of 64-slice multidetector CT for detection of in-stent restenosis in an unselected, consecutive patient population

    Energy Technology Data Exchange (ETDEWEB)

    Haraldsdottir, Sigurdis, E-mail: sigurdisha@gmail.com [Boston Medical Center, 72 East Concord Street (Evans 124), Boston, MA, 02118 (United States); Gudnason, Thorarinn, E-mail: thorgudn@landspitali.is [Landspitali University Hospital, Hringbraut, 101 Reykjavik (Iceland); Sigurdsson, Axel F., E-mail: axelfsig@landspitali.is [Landspitali University Hospital, Hringbraut, 101 Reykjavik (Iceland); Gudjonsdottir, Jonina, E-mail: jonina@rd.is [Rontgen Domus Medica, Egilsgata 3, 101 Reykjavik (Iceland); Lehman, Sam J., E-mail: slehman@partners.org [Massachusetts General Hospital, 165 Cambridge Street, Suite 400, Boston, MA 02114 (United States); Eyjolfsson, Kristjan, E-mail: kristey@landspitali.is [Landspitali University Hospital, Hringbraut, 101 Reykjavik (Iceland); Scheving, Sigurpall S., E-mail: sigurpal@landspitali.is [Landspitali University Hospital, Hringbraut, 101 Reykjavik (Iceland); Gibson, C. Michael, E-mail: mgibson@perfuse.org [Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA 02115 (United States); Hoffmann, Udo, E-mail: uhoffmann@partners.org [Massachusetts General Hospital, 165 Cambridge Street, Suite 400, Boston, MA 02114 (United States); Jonsdottir, Birna, E-mail: birna@rd.is [Rontgen Domus Medica, Egilsgata 3, 101 Reykjavik (Iceland); Andersen, Karl, E-mail: andersen@landspitali.is [Landspitali University Hospital, Hringbraut, 101 Reykjavik (Iceland)

    2010-11-15

    Objectives: To investigate the diagnostic accuracy of 64-slice multidetector computed tomography (64-CT) for detection of in-stent restenosis (ISR) in an unselected, consecutive patient population. Background: Detection of in-stent restenosis by cardiac CT would be a major advance for the evaluation of patients suspected of having ISR. However, the diagnostic accuracy of current generation 64-CT in this context is not fully established. Methods: We conducted a prospective study on patients with stable angina or acute coronary syndrome with no prior history of coronary artery disease. Six months after percutaneous coronary intervention (PCI) with stent placement they underwent a 64-CT scan (Toshiba Multi-Slice Aquilion 64) and consequently a repeat coronary angiography for comparison. Cardiac CT data sets were analyzed for the presence of in-stent restenosis by two independent expert readers blinded to the coronary angiographic data. Results: Ninety-three patients with a total of 140 stents were evaluated. Males comprised 82% of the study group and the mean age was 63 {+-} 10 years. The mean time from PCI to the repeat coronary angiography was 208 {+-} 37 days and the mean time from 64-CT to repeat coronary angiography was 3.7 {+-} 4.9 days. The restenosis rate according to coronary angiography was 26%. Stent diameter, strut thickness, heart rate and body mass index (BMI) significantly affected image quality. The sensitivity, specificity, positive and negative predictive values of 64-CT for detection of in-stent restenosis were 27%, 95%, 67% and 78%, respectively. Conclusions: Current generation, 64-slice CT, remains limited in its ability to accurately detect in-stent restenosis.

  15. Renin-angiotensin system intervention to prevent in-stent restenosis - An unclosed chapter

    NARCIS (Netherlands)

    Langeveld, B; Roks, AJM; Tio, RA; Voors, AA; Zijlstra, F; van Gilst, WH

    2005-01-01

    The occurrence of in-stent restenosis is a major drawback of percutaneous transluminal coronary angioplasty with stent placement. Target vessel revascularization is necessary in 15% of patients who receive a stent. Recent advances in the development of drug-eluting stents have reduced these numbers

  16. Coronary stent on coronary CT angiography: Assessment with model-based iterative reconstruction technique

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Eun Chae; Kim, Yeo Koon; Chun, Eun Ju; Choi, Sang IL [Dept. of of Radiology, Seoul National University Bundang Hospital, Seongnam (Korea, Republic of)

    2016-05-15

    To assess the performance of model-based iterative reconstruction (MBIR) technique for evaluation of coronary artery stents on coronary CT angiography (CCTA). Twenty-two patients with coronary stent implantation who underwent CCTA were retrospectively enrolled for comparison of image quality between filtered back projection (FBP), adaptive statistical iterative reconstruction (ASIR) and MBIR. In each data set, image noise was measured as the standard deviation of the measured attenuation units within circular regions of interest in the ascending aorta (AA) and left main coronary artery (LM). To objectively assess the noise and blooming artifacts in coronary stent, we additionally measured the standard deviation of the measured attenuation and intra-luminal stent diameters of total 35 stents with dedicated software. All image noise measured in the AA (all p < 0.001), LM (p < 0.001, p = 0.001) and coronary stent (all p < 0.001) were significantly lower with MBIR in comparison to those with FBP or ASIR. Intraluminal stent diameter was significantly higher with MBIR, as compared with ASIR or FBP (p < 0.001, p = 0.001). MBIR can reduce image noise and blooming artifact from the stent, leading to better in-stent assessment in patients with coronary artery stent.

  17. Human Internal Mammary Artery (IMA) Transplantation and Stenting: A Human Model to Study the Development of In-Stent Restenosis

    Science.gov (United States)

    Hua, Xiaoqin; Deuse, Tobias; Michelakis, Evangelos D.; Haromy, Alois; Tsao, Phil S.; Maegdefessel, Lars; Erben, Reinhold G.; Bergow, Claudia; Behnisch, Boris B.; Reichenspurner, Hermann; Robbins, Robert C.; Schrepfer, Sonja

    2012-01-01

    Preclinical in vivo research models to investigate pathobiological and pathophysiological processes in the development of intimal hyperplasia after vessel stenting are crucial for translational approaches1,2. The commonly used animal models include mice, rats, rabbits, and pigs3-5. However, the translation of these models into clinical settings remains difficult, since those biological processes are already studied in animal vessels but never performed before in human research models6,7. In this video we demonstrate a new humanized model to overcome this translational gap. The shown procedure is reproducible, easy, and fast to perform and is suitable to study the development of intimal hyperplasia and the applicability of diverse stents. This video shows how to perform the stent technique in human vessels followed by transplantation into immunodeficient rats, and identifies the origin of proliferating cells as human. PMID:22617624

  18. Coronary microvascular dysfunction in a porcine model of early atherosclerosis and diabetes

    NARCIS (Netherlands)

    Heuvel, van den M.; Sorop, O.; Koopmans, S.J.; Dekker, R.A.; Vries, de R.; Beusekom, H.M.M.; Eringa, E.C.; Duncker, D.J.; Danser, A.H.J.; Giessen, W.J.

    2012-01-01

    Detailed evaluation of coronary function early in diabetes mellitus (DM)-associated coronary artery disease (CAD) development is difficult in patients. Therefore, we investigated coronary conduit and small artery function in a preatherosclerotic DM porcine model with type 2 characteristics.

  19. Flow regulation in coronary vascular tree: a model study.

    Directory of Open Access Journals (Sweden)

    Xinzhou Xie

    Full Text Available Coronary blood flow can always be matched to the metabolic demand of the myocardium due to the regulation of vasoactive segments. Myocardial compressive forces play an important role in determining coronary blood flow but its impact on flow regulation is still unknown. The purpose of this study was to develop a coronary specified flow regulation model, which can integrate myocardial compressive forces and other identified regulation factors, to further investigate the coronary blood flow regulation behavior.A theoretical coronary flow regulation model including the myogenic, shear-dependent and metabolic responses was developed. Myocardial compressive forces were included in the modified wall tension model. Shear-dependent response was estimated by using the experimental data from coronary circulation. Capillary density and basal oxygen consumption were specified to corresponding to those in coronary circulation. Zero flow pressure was also modeled by using a simplified capillary model.Pressure-flow relations predicted by the proposed model are consistent with previous experimental data. The predicted diameter changes in small arteries are in good agreement with experiment observations in adenosine infusion and inhibition of NO synthesis conditions. Results demonstrate that the myocardial compressive forces acting on the vessel wall would extend the auto-regulatory range by decreasing the myogenic tone at the given perfusion pressure.Myocardial compressive forces had great impact on coronary auto-regulation effect. The proposed model was proved to be consistent with experiment observations and can be employed to investigate the coronary blood flow regulation effect in physiological and pathophysiological conditions.

  20. [Intravascular irradiation in the combined therapy and prevention of restenosis. Overview].

    Science.gov (United States)

    Baumgart, D; Quast, U; Erbel, R

    1997-12-01

    Despite numerous efforts in catheter technology and procedural approaches the problem of restenosis in interventional cardiology persists. Although the implantation of coronary stents has significantly reduced restenosis rates based on the inhibition of elastic recoil, intimal proliferation as the second major mechanism for postinterventional restenosis could not effectively be suppressed. Intimal proliferation is the response to vessel injury following interventional procedure, e.g. balloon angioplasty. It results in the adhesion of mono- and lymphocytes which themselves trigger the colonisation of myofibroblasts. Intracoronary irradiation seeks to prevent this proliferative process as it destroys or irreversibly alters DNA structures of cells at the site of balloon injury. The antiproliferative effect depends on the irradiation dosis, the timing and the cell cycle phase. Mainly beta- and gamma-radiation is used for intracoronary irradiation. Beta-emitters are characterized by a sharp decline of dose rate within millimeters from the actual source. The exposure to surrounding tissue as well the catheter staff can be kept to a minimum. The high intensity of beta-emitters allow a short treatment period of minutes to gain an effective radiation dose to the target. In contrast, gamma-emitters have a low radial dose distribution resulting in high dosage even centimeters away from the source. These emitters require additional shielding in the catheter laboratory and lead to excessive whole body doses. To achieve a sufficient dose in the target tissue, irradiation times of more than 20 minutes are necessary which prolongs the interventional procedure substantially. At present, catheter based systems or radioactive implantable stents are available to deliver the required dose. Catheter based systems seem more flexible in a number of considerations. On the other hand they require a substantial amount of hardware. Beta-emitting stents are implanted via a conventional stent

  1. Lentivirus-mediated RNAi knockdown of the gap junction protein, Cx43, attenuates the development of vascular restenosis following balloon injury.

    Science.gov (United States)

    Han, Xiao-Jian; Chen, Min; Hong, Tao; Zhu, Ling-Yu; He, Dan; Feng, Jiu-Geng; Jiang, Li-Ping

    2015-04-01

    Percutaneous coronary intervention [PCI or percutaneous transluminal coronary angioplasty (PTCA)] has been developed into a mature interventional treatment for atherosclerotic cardiovascular disease. However, the long-term therapeutic effect is compromised by the high incidence of vascular restenosis following angioplasty, and the underlying mechanisms of vascular restenosis have not yet been fully elucidated. In the present study, we investigated the role of the gap junction (GJ) protein, connexin 43 (Cx43), in the development of vascular restenosis. To establish vascular restenosis, rat carotid arteries were subjected to balloon angioplasty injury. At 0, 7, 14 and 2 days following balloon injury, the arteries were removed, and the intimal/medial area of the vessels was measured to evaluate the degree of restenosis. We found that the intimal area gradually increased following balloon injury. Intimal hyperplasia and restenosis were particularly evident at 14 and 28 days after injury. In addition, the mRNA and protein expression of Cx43 was temporarily decreased at 7 days, and subsequently increased at 14 and 28 days following balloon injury, as shown by RT-PCR and western blot analysis. To determine the involvement of Cx43 in vascular restenosis, the lentivirus vector expressing shRNA targeting Cx43, Cx43-RNAi-LV, was used to silence Cx43 in the rat carotid arteries. The knockdown of Cx43 effectively attenuated the development of intimal hyperplasia and vascular restenosis following balloon injury. Thus, our data indicate the vital role of the GJ protein, Cx43, in the development of vascular restenosis, and provide new insight into the pathogenesis of vascular restenosis. Cx43 may prove to be a novel potential pharmacological target for the prevention of vascular restenosis following PCI.

  2. Engineering Radioactive Stents for the Prevention of Restenosis

    Energy Technology Data Exchange (ETDEWEB)

    Bruce Thomadsen; Robert J. Nickles; Larry DeWerd; Douglass Henderson; Jonathan Nye; Wes Culberson; Stephen Peterson; Michael Meltsner; Liyong Lin

    2004-09-10

    Radiation has become an accepted treatment for the prevention of restenosis (re-blockage) of coronary arteries following angioplasty. Radioactive stents could be the easiest method of delivery for the radiation, although clinical trials were disappointing. One likely reason was the choice of P-32 as the radionuclide, which fails to match the biological needs of the problem. What radionuclide would perform best remains unknown. This project established the physical infrastructure necessary for a rational investigation to determine the optimum radiological characteristics for radioactive stents in the prevention of restenosis following angioplasty. The project investigated methods to activate coronary stents with radionuclides that spanned a range of energies and radiation types that could provide a mapping of the biological response. The project also provided calibration methods to determine the strength of the stents, an a process to calculate the dose distribution actually delivered to the patient's artery--quantities necessary for any future scientific study to improve the effectiveness of radioactive stents. Such studies could benefit the thousands of patients who receive angioplasty each year.

  3. Celecoxib to prevent restenosis--results from the COREA-TAXUS trial.

    Science.gov (United States)

    Doggrell, Sheila A

    2008-02-01

    Celecoxib inhibits Akt, which is stimulated during restenosis. Cell and animal studies showed that celecoxib inhibited Akt stimulation and restenosis. Recently, the COREA-TAXUS (Effect of Celecoxib on Restenosis after Coronary Angioplasty with Taxus stent) trial was performed in subjects with angina or a positive-stress test receiving paclitaxel-eluting stents. The primary end point at 6 months was the in-stent, late luminal loss, which was 0.49 mm in the celecoxib-treated group; less than the 0.75 mm in the group not treated with celecoxib. The rate of revascularisation of the target lesion was lower in celecoxib-treated subjects (5%) than in the untreated subjects (15%). In conclusion, this is an excellent demonstration of translating a mechanism of action of a drug into a clinical use.

  4. Computational hemodynamics of an implanted coronary stent based on three-dimensional cine angiography reconstruction.

    Science.gov (United States)

    Chen, Mounter C Y; Lu, Po-Chien; Chen, James S Y; Hwang, Ned H C

    2005-01-01

    Coronary stents are supportive wire meshes that keep narrow coronary arteries patent, reducing the risk of restenosis. Despite the common use of coronary stents, approximately 20-35% of them fail due to restenosis. Flow phenomena adjacent to the stent may contribute to restenosis. Three-dimensional computational fluid dynamics (CFD) and reconstruction based on biplane cine angiography were used to assess coronary geometry and volumetric blood flows. A patient-specific left anterior descending (LAD) artery was reconstructed from single-plane x-ray imaging. With corresponding electrocardiographic signals, images from the same time phase were selected from the angiograms for dynamic three-dimensional reconstruction. The resultant three-dimensional LAD artery at end-diastole was adopted for detailed analysis. Both the geometries and flow fields, based on a computational model from CAE software (ANSYS and CATIA) and full three-dimensional Navier-Stroke equations in the CFD-ACE+ software, respectively, changed dramatically after stent placement. Flow fields showed a complex three-dimensional spiral motion due to arterial tortuosity. The corresponding wall shear stresses, pressure gradient, and flow field all varied significantly after stent placement. Combined angiography and CFD techniques allow more detailed investigation of flow patterns in various segments. The implanted stent(s) may be quantitatively studied from the proposed hemodynamic modeling approach.

  5. Design and modeling balloon-expandable coronary stent for manufacturability

    Science.gov (United States)

    Suryawan, D.; Suyitno

    2017-02-01

    Coronary artery disease (CAD) is a disease that caused by narrowing of the coronary artery. The narrowing coronary artery is usually caused by cholesterol-containing deposit (plaque) which can cause a heart attack. CAD is the most common cause mortality in Indonesia. The commonly CAD treatment use the stent to opens or alleviate the narrowing coronary artery. In this study, the stent design is optimized for the manufacturability. Modeling is used to determine the free stent expansion due to applied pressure in the inner surface of the stent. The stress distribution, outer diameter change, and dogboning phenomena are investigated in the simulation. The result of modeling and simulating was analyzed and used to optimize the stent design before it is manufactured using EDM (Electric Discharge Machine) in the next research.

  6. Cutting balloon angioplasty vs. conventional balloon angioplasty in patients receiving intracoronary brachytherapy for the treatment of in-stent restenosis.

    Science.gov (United States)

    Fasseas, Panayotis; Orford, James L; Lennon, Ryan; O'Neill, Jessica; Denktas, Ali E; Panetta, Carmelo J; Berger, Peter B; Holmes, David R

    2004-10-01

    The objective of this study was to evaluate the safety and efficacy of cutting balloon angioplasty (CBA) for the treatment of in-stent restenosis prior to intracoronary brachytherapy (ICB). Cutting balloon angioplasty may reduce the incidence of uncontrolled dissection requiring adjunctive stenting and may limit "melon seeding" and geographic miss in patients with in-stent restenosis who are subsequently treated with ICB. We performed a retrospective case-control analysis of 134 consecutive patients with in-stent restenosis who were treated with ICB preceded by either CBA or conventional balloon angioplasty. We identified 44 patients who underwent CBA and ICB, and 90 control patients who underwent conventional percutaneous transluminal coronary angioplasty (PTCA) and ICB for the treatment of in-stent restenosis. Adjunctive coronary stenting was performed in 13 patients (29.5%) in the CBA/ICB group and 41 patients (45.6%; P 0.05). Despite sound theoretical reasons why CBA may be better than conventional balloon angioplasty for treatment of in-stent restenosis with ICB, and despite a reduction in the need for adjunctive coronary stenting, we were unable to identify differences in clinical outcome.

  7. Investigation of long-term implantation of BuMA stent in a porcine coronary model

    Institute of Scientific and Technical Information of China (English)

    CHEN Ming; WANG Xin-gang; ZHENG Bo; PENG Hong-yu; Zhang Xiao-yan; ZHANG Bin; HUO Yong

    2012-01-01

    hyperplasia and in-stent restenosis.Re-endothelialization of the BuMA stent is as good as that of the BMS in the porcine coronary model due to the reduced inflammation response to the BuMA stent.

  8. Evaluation of in-stent restenosis in the APPROACH trial (assessment on the prevention of progression by Rosiglitazone on atherosclerosis in diabetes patients with cardiovascular history)

    NARCIS (Netherlands)

    H.M. Garcia-Garcia (Hector); S.A. Garg (Scot); S. Brugaletta (Salvatore); G. Morocutti (Giorgio); R.E. Ratner (Robert); N.S. Kolatkar (Nikheel); B.G. Kravitz (Barbara); D.M. Miller (Diane); C. Huang (Chunmei); R.W. Nesto (Richard); P.W.J.C. Serruys (Patrick); R.P. Aftring (R.); N.S. Kolatkar (Nikheel); B.G. Kravitz (Barbara); J. Wolstenholme (Jane); J. Saarinen (Jari); R. Fowler (R.); J. Hoffman (Jonathan); D. Steele-Norwood (D.); R. Russell (Robert); S. Young (S.); Y.F. Chou; S. McMorn (Steve); C. Kirsch (Courtney); B. Louridas (Bonnie); T. Olivieria (Teresa); D. Mattioli (Debra); D. Miller (D.); C. Huang (Chunmei); C. Nguyen (C.); K. Jahnke (Kristoph); G.S. Mintz (Gary); J. Lachin (J.); M. Abrahamson (M.); P. Carson (P.); P. Jones

    2012-01-01

    textabstractTo determine (1) the medium-term effect of rosiglitazone and glipizide on intra-stent neointima hyperplasia, (2) restenosis pattern as assessed by intravascular ultrasound (IVUS) and quantitative coronary angiography (QCA) in patients with T2DM and coronary artery disease. A total of 462

  9. Relevant factors for in-stent restenosis in coronary artery disease patients with multiple risk factors%伴有多种危险因素的冠心病患者支架内再狭窄的影响因素

    Institute of Scientific and Technical Information of China (English)

    王芳; 章安迪

    2016-01-01

    目的:分析伴有多种危险因素的冠心病患者发生支架内再狭窄(in-stent restenosis,ISR)的影响因素。方法:收集207例1年前接受冠状动脉介入治疗且伴有2个或2个以上危险因素的冠心病患者,其中100例发生ISR(ISR组),107例无ISR(对照组),分析2组患者的一般资料及实验室检查结果。结果:ISR的发生与冠心病传统危险因素的多少无关。 ISR组患者的糖尿病患病率高于对照组(51%比32%,P=0.01),而ISR组的平均体质量指数(body mass index,BMI)则低于对照组(24.90±3.16和25.91±3.53,P=0.03);同时,ISR组的尿酸[(343.79±103.40)μmol/L比(331.99±84.05)μmol/L,P=0.046]及红细胞分布宽度(red blood cell distribution width,RDW)[(13.88±1.05)%比(13.24±0.74)%,P<0.01)]水平亦均高于对照组。多元回归分析显示,糖尿病、低BMI、高RDW及糖尿病患者使用胰岛素治疗与ISR的发生间有相关性,尿酸不是ISR的独立危险因素,可能与其他危险因素相互作用从而增加了ISR的发生率。结论:糖尿病、低BMI、高RDW可能是冠心病患者发生ISR的危险因素,其中糖尿病患者的胰岛素治疗或可减少ISR的发生率。%Objective: To analyze the relevant factors of in-stent restenosis in coronary artery disease patients under-gone successful percutaneous coronary intervention (PCI) one year before. Methods: The demographic and laboratory data of 207 post-PCI patients with 2 or more risk factors of coronary artery disease were retrospectively analyzed. Among these patients, 100 developed in-stent restenosis (ISR),and the remaining 107 patients without restenosis were served as the control group. Results: The incidence of ISR had no relationship with the number of risk factors for coronary heart di-sease. The number of diabetic patients in ISR group was more than that in control group (51% vs 32%, P=0.01), and the average body mass

  10. Intracoronary brachytherapy in the treatment of in-stent restenosis. Initial experience in Brazil

    Directory of Open Access Journals (Sweden)

    Fábio Sândoli de Brito Jr

    2001-09-01

    Full Text Available Intracoronary brachytherapy using beta or gamma radiation is currently the most efficient type of therapy for preventing the recurrence of coronary in-stent restenosis. Its implementation depends on the interaction among interventionists, radiotherapists, and physicists to assure the safety and quality of the method. The authors report the pioneering experience in Brazil of the treatment of 2 patients with coronary in-stent restenosis, in whom beta radiation was used as part of the international multicenter randomized PREVENT study (Proliferation REduction with Vascular ENergy Trial. The procedures were performed rapidly and did not require significant modifications in the traditional techniques used for conventional angioplasty. Alteration in the radiological protection devices of the hemodynamic laboratory were also not required, showing that intracoronary brachytherapy using beta radiation can be incorporated into the interventional tools of cardiology in our environment.

  11. 冠状动脉内放射治疗防止血管成形术后再狭窄的研究进展%Endocoronary radiation for the prevention of restenosis after angioplasty

    Institute of Scientific and Technical Information of China (English)

    曾勇; 朱文玲

    2001-01-01

    Percutaneous transluminal coronary angioplasty (PTCA) is a very effective approach to treat coronary artery disease.However,restenosis after PTCA affects 40% to 60% of patients in the months after an initially successful intervention.Although a number of new techniques and pharmacological approaches have been tried to reduce the rate of restenosis,only a few have shown even preliminary efficacy.Radiation therapy seems to provide an interesting,nonpharmacological approach to prevent the restenosis after PTCA during recent years.The experiments and clinical data of this new approach are reviewed in this paper.

  12. In vitro study on the feasibility of magnetic stent hyperthermia for the treatment of cardiovascular restenosis

    OpenAIRE

    Li, Li; Wang, Rui; Shi, Huan-Huan; Xie, Le; LI, JING-DING-SHA; KONG, WEI-CHAO; Tang, Jin-Tian; KE, DA-NIAN; ZHAO, LING-YUN

    2013-01-01

    Thermal treatment or hyperthermia has received considerable attention in recent years due to its high efficiency, safety and relatively few side-effects. In this study, we investigated whether it was possible to utilize targeted thermal or instent thermal treatments for the treatment of restenosis following percutaneous transluminal coronary angioplasty (PTCA) through magnetic stent hyperthermia (MSH). A 316L stainless steel stent and rabbit vascular smooth muscle cells (VSMCs) were used in t...

  13. Cox regression analysis of related risk factors for in-stent restenosis after coronary artery stent implanting%冠状动脉支架植入术后支架内再狭窄相关危险因素Cox回归分析

    Institute of Scientific and Technical Information of China (English)

    张园; 陆欣

    2016-01-01

    目的:回顾性分析冠状动脉支架植入术后冠心病患者的临床资料,探讨支架内再狭窄(in-stent restenosis,ISR)的危险因素。方法选择2012年8月至2014年7月于本院行冠状动脉支架植入术后的120例冠心病患者为研究对象,根据冠状动脉造影结果将其分为ISR组(38例)和非ISR组(82例)。回顾性分析两组患者的临床资料,采用Cox回归分析冠状动脉支架植入术后患者发生ISR的相关危险因素。结果 ISR组与非ISR组吸烟、糖尿病、术后不规范抗凝患者所占比例及使用非药物涂层支架数量、支架直径、支架长度比较差异均具有显著性(P<0.05)。ISR组患者脂蛋白a、纤维蛋白原、总胆红素、低密度脂蛋白水平均显著高于非ISR组(P<0.05)。Cox回归分析表明:吸烟、使用非药物支架、支架长度>20 mm、支架直径<3 mm是冠心病患者支架植入术后发生ISR的独立危险因素(P<0.05)。结论冠状动脉支架植入术后发生ISR的危险因素为吸烟、使用非药物涂层支架、支架长度>20 mm与支架直径<3 mm,需加强对危险人群的监测,以降低ISR的发生风险。%Objective To investigate the related risk factors for in-stent restenosis (ISR) after coronary artery stent implanting by retrospective analysis clinical data of patients with coronary heart disease. Method A total of 120 patients with coronary heart disease who underwent coronary artery stent implanting for treatment from August 2012 to July 2014 in our hospital were selected as objects of study. According to the results of coronary angiography, they were divided into ISR group (38 cases) and non-ISR group (82 cases). The clinical data of patients between the two groups were retrospectively analyzed. Related risk factors of ISR after coronary artery seutimplanting were analyzed by Cox regression analysis. Result The rate of smoking, diabetes, unstandardized

  14. Correlation of restenosis after rabbit carotid endarterectomy and inflammatory cytokines

    Institute of Scientific and Technical Information of China (English)

    Jun-Jun Liang; Wei Xue; Li-Zhi Lou; Cheng Liu; Zhao-Fen Wang; Qing-Guo Li; Shao-Hua Huang

    2014-01-01

    Objective:To establish rabbit model of restenosis after carotid endarterectomy surgery, and to study tissue inflammatory cytokines(TNF-α,IL-6) involved in restenosis.Methods:A total of32 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 time points after the surgery was observed byRT-PCR, and the changes of serum inflammatory cytokines(TNF-α, IL -6) were detected byELISA.Results:The new intima appeared after7 daysof the injury and reached the peak on28 d which is uneven and significantly thicker than the control group (P<0.01).The tissue inflammatory cytokines(TNF-α,IL-6) were significantly 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.

  15. Endothelin Receptor Antagonist and the Prevention of Percutaneous Transluminal Coronary Angioplasty Restenosis%内皮素受体抗体与PTCA术后再狭窄的防治

    Institute of Scientific and Technical Information of China (English)

    陆平; 盛净

    2004-01-01

    经皮腔内冠状动脉成形术(percutaneous transluminal coronary angioplasty,PTCA)已广泛应用于冠心病的治疗.但是术后再狭窄限制其发展.再狭窄的发生常伴随内皮素(endothelin,ET)和其受体表达增多,抑制ET受体可以减轻再狭窄的发生.本文阐述内皮素受体抗体与PTCA术后再狭窄的关系.

  16. CT coronary angiography vs. invasive coronary angiography in CHD

    Directory of Open Access Journals (Sweden)

    Anja Hagen

    2012-04-01

    Full Text Available Scientific background: Various diagnostic tests including conventional invasive coronary angiography and non-invasive computed tomography (CT coronary angiography are used in the diagnosis of coronary heart disease (CHD. Research questions: The present report aims to evaluate the clinical efficacy, diagnostic accuracy, prognostic value cost-effectiveness as well as the ethical, social and legal implications of CT coronary angiography versus invasive coronary angiography in the diagnosis of CHD. Methods: A systematic literature search was conducted in electronic data bases (MEDLINE, EMBASE etc. in October 2010 and was completed with a manual search. The literature search was restricted to articles published from 2006 in German or English. Two independent reviewers were involved in the selection of the relevant publications. The medical evaluation was based on systematic reviews of diagnostic studies with invasive coronary angiography as the reference standard and on diagnostic studies with intracoronary pressure measurement as the reference standard. Study results were combined in a meta-analysis with 95 % confidence intervals (CI. Additionally, data on radiation doses from current non-systematic reviews were taken into account. A health economic evaluation was performed by modelling from the social perspective with clinical assumptions derived from the meta-analysis and economic assumptions derived from contemporary German sources. Data on special indications (bypass or in-stent-restenosis were not included in the evaluation. Only data obtained using CT scanners with at least 64 slices were considered. Results: No studies were found regarding the clinical efficacy or prognostic value of CT coronary angiography versus conventional invasive coronary angiography in the diagnosis of CHD. Overall, 15 systematic reviews with data from 44 diagnostic studies using invasive coronary angiography as the reference standard (identification of obstructive

  17. Everolimus-eluting coronary stents

    Directory of Open Access Journals (Sweden)

    Alejandro Saez

    2010-09-01

    Full Text Available Alejandro Saez, Raul MorenoDivision of Interventional Cardiology, University Hospital La Paz, Madrid, SpainAbstract: Bare metal stents enabled a reduction in the risk of early procedural complications and restenosis in comparison with balloon angioplasty alone, but introduced a new and device-specific iatrogenic condition, ie, in-stent restenosis due to increased neointimal hyperplasia. Sirolimus- and paclitaxel-eluting stents reduce restenosis and the need for new revascularizations in comparison with bare metal stents, although at the cost of a slight increase in the risk of late stent thrombosis and a need for prolonged dual antiplatelet therapy. Everolimus is an analog of sirolimus with an increased solubility. In this review, the currently available evidence for everolimus-eluting stents is revised, including randomized trials against bare metal stents, and head-to-head trials comparing this stent with other drug-eluting stents.Keywords: coronary stents, restenosis, everolimus, review

  18. Association of ABO blood types with the risk of in-stent restenosis.

    Science.gov (United States)

    Pourafkari, L; Ghaffari, S; Ahmadi, M; Tajlil, A; Nader, N D

    2015-09-01

    To investigate the prevalence of in-stent restenosis (ISR) in patients with various ABO blood types. Clinical information from 150 patients with a confirmed diagnosis of ISR and 150 patients with a diagnosis of patent coronary stents in the secondary angiography was collected. Comprehensive demographic and laboratory data, including ABO and Rhesus blood groups, as well as comorbid conditions and vessel and stent characteristics, were recorded for each patient. The association of ABO blood groups with the risk of ISR before and after controlling for coronary risk factors was determined. Categorical data were analyzed with the Chi-square test and numerical values were analyzed with t-tests. Binary logistic regression models were constructed to compare type A and non-A for the frequency of risk factors. A total of 392 stents were implanted in 300 patients. Two hundred and fourteen stents (54.6%) were patent and 178 stents (45.4%) were stenosed. Blood group A was significantly more common in the ISR group (43.3% vs. 28.7%, p=0.03). However, the frequencies of other blood types, as well as Rh antigen, were similar between the two groups. Triglyceride and low-density lipoproteins were the only significantly different variables (221 ± 198 mg/dL vs. 138 ± 76 mg/dL, p<0.001 and 108 ± 36 mg/dL vs. 96 ± 73 mg/dL, p=0.04, in type-A vs. non-A, respectively). After matching for coronary risk factors, there was no difference between A blood type patients and their controls. ISR is significantly more prevalent in individuals with the type A blood group. However, this higher association is most likely due to higher atherogenic conditions in patients within this population. © The Author(s) 2015.

  19. Postoperative internal carotid artery restenosis after local anesthesia: presence of risk factors versus intraoperative shunt.

    Science.gov (United States)

    Hudorovic, Narcis; Lovricevic, Ivo; Hajnic, Hrvoje; Ahel, Zaky

    2010-08-01

    Published data suggest that the regional anesthetic technique used for carotid endarterectomy (CEA) increases the systolic arterial blood pressure and heart rate. At the same time local anesthesia reduced the shunt insertion rate. This study aimed to analyze risk factors and ischemic symptomatology in patients with postoperative internal carotid artery restenosis. The current retrospective study was undertaken to assess the results of CEA in 8000 patients who were operated during a five-year period in six regional cardiovascular centers. Carotid color coded flow imaging, medical history, clinical findings and atherosclerotic risk factors were analyzed. Among them, there were 33 patients (0.4%) with postoperative re-occlusion after CEA. The patients with restenosis were re-examined with carotid color coded flow imaging and data were compared with 33 consecutive patients with satisfactory postoperative findings to serve as a control group. In the restenosis group eight risk factors were analyzed (hypertension, smoking, hyperlipidemia, diabetes mellitus, history of stroke, transitory ischemic attack, heart attack and coronary disease), and compared with risk factors in control group. Study results suggested that early postoperative internal carotid artery restenosis was not caused by atherosclerosis risk factors but by intraoperative shunt usage.

  20. 炫速双源CT的客观测量在诊断冠状动脉支架内再狭窄中的应用%Usefulness of flash dual-source computed tomography for evaluation of coronary artery in-stent restenosis

    Institute of Scientific and Technical Information of China (English)

    章盈; 毛萍; 王欢; 杜常青; 王亚利; 汤益民; 唐礼江

    2016-01-01

    Objective To investigate the value of flash dual- source computed tomography (CT) angiography in the evaluation of coronary artery in- stent restenosis (ISR). Methods 101 patients with 167 coronary stents underwent dual- source CT angiography for re- examination. CT values of different segments of vessels with stents were measured for evaluation of ISR and compared with the results of elective coronary angiography performed during fol owing 60 days. The accuracy and cut- off value of dual- source CT in the diagnosis of ISR were calculated. Results The CT image quality of 151 stents (90.5%) was suitable for evaluation. The diameter of stent was a main factor influencing CT image quality. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of dual- source CT for the diagnosis of ISR were 83.8%, 82.8%, 77.0%, 88.2%and 83.2%, respectively. The cutoff points of a difference in CT value from aortic root to the vessel 5~10mm proximal to the stent, proximal end of the stent, in- stent lumen, distal end of the stent, and the vessel 5~10mm distal to the stent for diagnosing ISR were 7.5Hu, 16.0Hu, 42.5Hu, 47.5Hu and 56.0Hu, respectively. Conclusion The in- stent lumen of coronary artery can be imaged clearly by dual- source CT, which could provide higher diagnostic accuracy of ISR.%目的:探讨炫速双源CT在诊断冠状动脉支架内再狭窄(ISR)中的应用。方法对101例患者植入的167枚冠脉支架行炫速双源CT血管显像复查,测量支架段各部位的CT值评价支架内再狭窄,并与随后60d内所做的选择性冠状动脉造影结果对比,计算炫速双源CT诊断ISR的准确程度及诊断ISR的CT临界值。结果炫速双源CT显示151枚(90.5%)支架的影像质量适于诊断,支架直径是主要影响因素。炫速双源CT评价冠状动脉ISR的敏感度、特异度、阳性预测值、阴性预测值和符合率分别为83.8%、82.8%、77.0%、88.2%和83.2%。诊断ISR

  1. Bioresorbable stent restenosis: new devices, novel situations.

    Science.gov (United States)

    Núñez-Gil, Iván J; Echavarría, Mauro; Escaned, Javier; Biagioni, Corina; Feltes, Gisela; Fernández-Ortiz, Antonio

    2014-12-01

    A 58-year-old man presented to our hospital with effort angina. Ten months prior, he was treated with a Bioresorbable vascular scaffold (BVS). During the current admission, an image angiographically compatible with in-BVS restenosis at the circumflex ostium with a radiolucent image in the ostial left anterior descending artery was shown. BVS failure is very infrequent and this is one of the first cases of BVS restenosis described. Thus, data on the best management option are scarce. We treated it like a drug-eluting stent restenosis, performing first an intracoronary optical coherence tomography scan in order to identify the left descending radiolucent image and to prepare the best treatment strategy.

  2. Cost-effectiveness modelling of percutaneous coronary interventions in stable coronary artery disease

    Institute of Scientific and Technical Information of China (English)

    Ariel; Beresniak; Thibaut; Caruba; Brigitte; Sabatier; Yves; Juillière; Olivier; Dubourg; Nicolas; Danchin

    2015-01-01

    The objective of this study is to develop a cost-effectiveness model comparing drug eluting stents(DES) vs bare metal stent(BMS) in patients suffering of stable coronary artery disease. Using a 2-years time horizon, two simulation models have been developed: BMS first line strategy and DES first line strategy. Direct medical costs were estimated considering ambulatory and hospital costs. The effectiveness endpoint was defined as treatment success, which is the absence of major adverse cardiac events. Probabilistic sensitivity analyses were carried out using 10000 Monte-Carlo simulations. DES appeared slightly more efficacious over 2 years(60% of success) when compared to BMS(58% of success). Total costs over 2 years were estimated at 9303  for the DES and at 8926  for bare metal stent. Hence, corresponding mean cost-effectiveness ratios showed slightly lower costs(P < 0.05) per success for the BMS strategy(15520 /success), as compared to the DES strategy(15588 /success). Incremental costeffectiveness ratio is 18850  for one additional percent of success. The sequential strategy including BMS as the first option appears to be slightly less efficacious but more cost-effective compared to the strategy including DES as first option. Future modelling approaches should confirm these results as further comparative data in stable coronary artery disease and long-term evidence become available.

  3. Coronary microvascular dysfunction in a porcine model of early atherosclerosis and diabetes

    NARCIS (Netherlands)

    Heuvel, van den M.; Sorop, O.; Koopmans, S.J.; Dekker, R.A.; Vries, de R.; Beusekom, H.M.M.; Eringa, E.C.; Duncker, D.J.; Danser, A.H.J.; Giessen, W.J.

    2012-01-01

    Detailed evaluation of coronary function early in diabetes mellitus (DM)-associated coronary artery disease (CAD) development is difficult in patients. Therefore, we investigated coronary conduit and small artery function in a preatherosclerotic DM porcine model with type 2 characteristics. Streptoz

  4. A comparison of directional atherectomy with coronary angioplasty in patients with coronary artery disease

    NARCIS (Netherlands)

    E.J. Topol (Eric); F. Leya; C.A. Pinkerton; P.L. Whitlow (Patrick); B. Hofling; C.A. Simonton; R.R. Masden; P.W.J.C. Serruys (Patrick); M.B. Leon (Martin); D.O. Williams (David); S.B. King 3rd (Spencer); B. Daniel; D.B. Mark (Daniel); J.M. Isner; D.R. Holmes Jr (David); S.G. Ellis (Stephen); K.L. Lee (Kerry); G.P. Keeler; L.G. Berdan (Lisa); T. Hinohara; R.M. Califf (Robert)

    1993-01-01

    textabstractBACKGROUND. Directional coronary atherectomy is a new technique of coronary revascularization by which atherosclerotic plaque is excised and retrieved from target lesions. With respect to the rate of restenosis and clinical outcomes, it is not known how this procedure compares with ballo

  5. A comparison of directional atherectomy with coronary angioplasty in patients with coronary artery disease

    NARCIS (Netherlands)

    E.J. Topol (Eric); F. Leya; C.A. Pinkerton; P.L. Whitlow (Patrick); B. Hofling; C.A. Simonton; R.R. Masden; P.W.J.C. Serruys (Patrick); M.B. Leon (Martin); D.O. Williams (David); S.B. King 3rd (Spencer); B. Daniel; D.B. Mark (Daniel); J.M. Isner; D.R. Holmes Jr (David); S.G. Ellis (Stephen); K.L. Lee (Kerry); G.P. Keeler; L.G. Berdan (Lisa); T. Hinohara; R.M. Califf (Robert)

    1993-01-01

    textabstractBACKGROUND. Directional coronary atherectomy is a new technique of coronary revascularization by which atherosclerotic plaque is excised and retrieved from target lesions. With respect to the rate of restenosis and clinical outcomes, it is not known how this procedure compares with

  6. Theoretical models for coronary vascular biomechanics: Progress & challenges

    Science.gov (United States)

    Waters, Sarah L.; Alastruey, Jordi; Beard, Daniel A.; Bovendeerd, Peter H.M.; Davies, Peter F.; Jayaraman, Girija; Jensen, Oliver E.; Lee, Jack; Parker, Kim H.; Popel, Aleksander S.; Secomb, Timothy W.; Siebes, Maria; Sherwin, Spencer J.; Shipley, Rebecca J.; Smith, Nicolas P.; van de Vosse, Frans N.

    2013-01-01

    A key aim of the cardiac Physiome Project is to develop theoretical models to simulate the functional behaviour of the heart under physiological and pathophysiological conditions. Heart function is critically dependent on the delivery of an adequate blood supply to the myocardium via the coronary vasculature. Key to this critical function of the coronary vasculature is system dynamics that emerge via the interactions of the numerous constituent components at a range of spatial and temporal scales. Here, we focus on several components for which theoretical approaches can be applied, including vascular structure and mechanics, blood flow and mass transport, flow regulation, angiogenesis and vascular remodelling, and vascular cellular mechanics. For each component, we summarise the current state of the art in model development, and discuss areas requiring further research. We highlight the major challenges associated with integrating the component models to develop a computational tool that can ultimately be used to simulate the responses of the coronary vascular system to changing demands and to diseases and therapies. PMID:21040741

  7. Drug-eluting stents, restenosis and revascularization.

    Science.gov (United States)

    Ramcharitar, Steve; Gaster, Anne Louise; Daemen, Joost; Serruys, Patrick

    2007-06-01

    Several meta-analyses have demonstrated the superiority of drug-eluting stents (DES) in reducing the incidence of restenosis, target vessel revascularization and target lesion revascularization compared to their predecessor, the bare-metal stent. In comparing Cypher and Taxus stents, the two most recent meta-analyses have given the edge to the Cypher. However, it must be stressed that the superiority of one DES over another remains debatable due to ever changing "real-world data" compared to those attained from randomized trials. The newer sirolimus analogs and selective inhibitors are challenging the old guard in their quest to further limit restenosis. So too are the newer "high-tech" polymers and additionally by using more biodegradable material in the stent's design. Stents aimed at targeting lesions are a new armament in the battle against restenosis and together with combination therapies are exciting key areas to watch. The ideal way to treat a DES in-stent restenosis is still a challenge and hence the impetus is to avoid it from happening in the first place.

  8. Biocompatibility of Coronary Stents

    Directory of Open Access Journals (Sweden)

    Thamarasee M. Jeewandara

    2014-01-01

    Full Text Available Cardiovascular disease is the dominant cause of mortality in developed countries, with coronary artery disease (CAD a predominant contributor. The development of stents to treat CAD was a significant innovation, facilitating effective percutaneous coronary revascularization. Coronary stents have evolved from bare metal compositions, to incorporate advances in pharmacological therapy in what are now known as drug eluting stents (DES. Deployment of a stent overcomes some limitations of balloon angioplasty alone, but provides an acute stimulus for thrombus formation and promotes neointimal hyperplasia. First generation DES effectively reduced in-stent restenosis, but profoundly delay healing and are susceptible to late stent thrombosis, leading to significant clinical complications in the long term. This review characterizes the development of coronary stents, detailing the incremental improvements, which aim to attenuate the major clinical complications of thrombosis and restenosis. Despite these enhancements, coronary stents remain fundamentally incompatible with the vasculature, an issue which has largely gone unaddressed. We highlight the latest modifications and research directions that promise to more holistically design coronary implants that are truly biocompatible.

  9. Randomized Comparison of the Nobori Biolimus A9-Eluting Coronary Stent With the Taxus Liberté Paclitaxel-Eluting Coronary Stent in Patients With Stenosis in Native Coronary Arteries: The NOBORI 1 Trial—Phase 2

    National Research Council Canada - National Science Library

    Chevalier, Bernard; Silber, Sigmund; Park, Seung-Jung; Garcia, Eulogio; Schuler, Gerhard; Suryapranata, Harry; Koolen, Jacques; Hauptmann, Karl E; Wijns, William; Morice, Marie-Claude; Carrie, Didier; van Es, Gerrit-Anne; Nagai, Hirofumi; Detiege, Danny; Paunovic, Dragica; Serruys, Patrick W

    2009-01-01

    BACKGROUND—The newly developed Nobori coronary stent coated with a bioresorbable polymer, polylactic acid, and the antiproliferative agent Biolimus A9 has the potential to reduce restenosis by suppressing neointima formation...

  10. Coronary microembolization.

    Science.gov (United States)

    Skyschally, Andreas; Leineweber, Kkirsten; Gres, Petra; Haude, Michael; Erbel, Raimund; Heusch, Gerd

    2006-09-01

    Atherosclerotic plaque rupture is the key event in the pathogenesis of acute coronary syndromes and it also occurs during coronary interventions. Atherosclerotic plaque rupture does not always result in complete thrombotic occlusion of the epicardial coronary artery with subsequent impending myocardial infarction, but may in milder forms result in the embolization of atherosclerotic and thrombotic debris into the coronary microcirculation. This review summarizes the present experimental pathophysiology of coronary microembolization in animal models of acute coronary syndromes and highlights the main consequences of coronary microembolization--reduced coronary reserve, microinfarction, inflammation and oxidative modification of contractile proteins, contractile dysfunction and perfusion-contraction mismatch.Furthermore, the review presents the available clinical evidence for coronary microembolization in patients and compares the clinical observations with observations in the experimental model.

  11. Does the new angiotensin converting enzyme inhibitor cilazapril prevent restenosis after percutaneous transluminal coronary angioplasty? Results of the MERCATOR study: a multicenter, randomized, double-blind placebo-controlled trial

    NARCIS (Netherlands)

    P.W.J.C. Serruys (Patrick); W.R. Rutsch (Wolfgang); N. Danchin (Nicolas); W. Wijns (William); H.U. Emanuelsson (Hakan); F. Chappuis; W.R.M. Hermans (Walter)

    1992-01-01

    textabstractBACKGROUND. Cilazapril is a novel angiotensin converting enzyme inhibitor with antiproliferative effects in the rat model after balloon injury. METHODS AND RESULTS. We conducted a randomized, double-blind placebo-controlled trial to assess the effect of cilazapril in angiographic resteno

  12. A comparison of balloon-expandable-stent implantation with balloon angioplasty in patients with coronary artery disease

    NARCIS (Netherlands)

    P.W.J.C. Serruys (Patrick); P.P.T. de Jaegere (Peter); F. Kiemeneij (Ferdinand); C.M. Miguel (Carlos); W.R. Rutsch (Wolfgang); G.R. Heyndrickx (Guy); H.U. Emanuelsson (Hakan); J. Marco (Jean); V.M.G. Legrand (Victor); P.H. Materne (Phillipe); J.A. Belardi (Jorge); U. Sigwart (Ulrich); A. Colombo (Antonio); J-J. Goy (Jean-Jacques); P.A. van den Heuvel (Paul); J. Delcan; M-A.M. Morel (Marie-Angèle)

    1994-01-01

    textabstractBalloon-expandable coronary-artery stents were developed to prevent coronary restenosis after coronary angioplasty. These devices hold coronary vessels open at sites that have been dilated. However, it is unknown whether stenting improves long-term angiographic and clinical outcomes as c

  13. A comparison of balloon-expandable-stent implantation with balloon angioplasty in patients with coronary artery disease.

    NARCIS (Netherlands)

    P.W.J.C. Serruys (Patrick); P.P.T. de Jaegere (Peter); F. Kiemeneij (Ferdinand); C.M. Miguel (Carlos); W.R. Rutsch (Wolfgang); G.R. Heyndrickx (Guy); H.U. Emanuelsson (Hakan); J. Marco (Jean); V.M.G. Legrand (Victor); P.H. Materne (Phillipe); J.A. Belardi (Jorge); U. Sigwart (Ulrich); A. Colombo (Antonio); J-J. Goy (Jean-Jacques); P. van den Heuvel; J. Delcan; M-A.M. Morel (Marie-Angèle)

    1994-01-01

    textabstractBACKGROUND. Balloon-expandable coronary-artery stents were developed to prevent coronary restenosis after coronary angioplasty. These devices hold coronary vessels open at sites that have been dilated. However, it is unknown whether stenting improves long-term angiographic and clinical o

  14. Study of interleukin-18,interleukin-10 and matrix metalloproteinase-9 levels in restenosis after percutaneous coronary intervention%冠心病 PCI 术后再狭窄患者 IL-18、IL-10和基质金属蛋白酶-9水平的研究

    Institute of Scientific and Technical Information of China (English)

    刘永胜; 江华; 刘文卫; 李婷; 周登明

    2014-01-01

    目的:观察冠心病经皮冠状动脉介入治疗(PCI)术后再狭窄患者血清白细胞介素(IL)-18、IL-10和基质金属蛋白酶-9(MMP-9)水平,探讨炎性因子在冠心病 PCI 术后再狭窄中的作用。方法冠心病 PCI 术后患者,根据再次冠脉造影是否存在支架内再狭窄分为支架内再狭窄(ISR)组(n=68)和非再狭窄(非 ISR)组(n=173),109例疑似但经冠脉造影排除冠心病的人群作为对照组。测定各组血清 IL-18、IL-10和 MMP-9浓度。结果ISR 组和非 ISR 组血清 IL-18和 MMP-9浓度明显高于对照组,而血清 IL-10浓度则明显低于对照组;与非 ISR 组相比,ISR 组血清 IL-18和 MMP-9水平明显增高,而 IL-10浓度则明显降低,差异均有统计学意义(P <0.05)。结论IL-18、IL-10和 MMP-9与再狭窄有关,炎性反应可能是冠心病 PCI 术后再狭窄的重要影响因素之一。%Objective To investigate the levels of IL-18,IL-10 and MMP-9 in coronary heart disease(CAD)patients with in-stent restenosis(ISR)after percutaneous coronary intervention (PCI)treatment,so as to discuss the influence of inflammatory fac-tors to ISR after PCI.Methods CAD patients with ISR after PCI were angiographically re-evaluated and formed the ISR group(n=68)and the non-ISR group(n=173)based on the presence or absence of ISR.109 subjects without angiographic evidence of CAD formed a reference control group(control group).The plasma IL-18,IL-10 and MMP-9 concentrations of subjects were measured. Results The concentrations of serum IL-18 and MMP-9 in ISR group and non-ISR group were significantly higher than control group,while IL-10 level was the opposite.Contrasted with non-ISR group,the concentrations of serum IL-18 and MMP-9 in ISR group were significantly higher,but IL-10 level was the opposite too.There were significantly statistical differences(P <0.05)Con-clusion There is significant correlation between ISR and serum levels of

  15. Use of Reactor-Produced Radioisotopes for Prevention Restenosis After Angioplasty

    Energy Technology Data Exchange (ETDEWEB)

    Knapp, F.F.; Pipes, D.W.

    1999-12-21

    Coronary heart disease leads to myocardial infarction and is a major cause of death in the US. Myocardial infarctions result from atherosclerotic plaque deposits in the coronary arteries, reducing blood flow through these arteries which supply oxygen and nutrients to the heart muscle. The two major approaches for restoring adequate blood flow are coronary bypass graft surgery and coronary angioplasty. Angioplasty is a routinely used clinical procedure, where a deflated balloon attached to the end of a long catheter is inserted into an artery in the leg and then advanced through the aorta into the blocked regions of the coronary arteries. After positioning in the occluded region of the artery, the balloon is inflated with a pressurized saline solution which opens the artery restoring blood flow by pressing the atherosclerotic plaque into the vessel wall. Angioplasty is a widely performed procedure with the coronary arteries and is a much less expensive alternative to coronary bypass surgery. The best patients for angioplasty are those with single occlusions and this method is preferred over bypass grafting because of the significantly reduced expense. The reformation of plaque deposits in arteries (restenosis) following angioplasty, however, is a major clinical problem encountered in as high as 40 percent of patients. Because reduction of health care costs is a major national priority, development of effective new preventative methods for restenoses is an important national priority.

  16. Characterisation of a novel porcine coronary artery CTO model.

    Science.gov (United States)

    Fefer, Paul; Robert, Normand; Qiang, Beiping; Liu, Garry; Munce, Nigel; Anderson, Kevan; Osherov, Azriel B; Ladouceur-Wodzak, Michelle; Qi, Xiuling; Dick, Alexander; Weisbrod, Max; Samuel, Michelle; Butany, Jagdish; Wright, Graham; Strauss, Bradley H

    2012-04-01

    To create a large animal coronary chronic total occlusion (CTO) model. Presence of microvessels within the CTO lumen facilitates guidewire crossing. The patterns and time profiles of matrix changes and microvessel formation during coronary CTO maturation are unknown. CTO were created in 15 swine by percutaneous deployment of a collagen plug. Matrix changes were assessed by histology. Intraluminal neovascularisation was assessed by histology and several imaging modalities, including conventional and 3D spin angiography, micro-computed tomography (micro-CT) imaging, and contrast-enhanced magnetic resonance imaging (MRI), at six and 12 weeks following CTO creation. Matrix changes included an intense inflammatory reaction at six weeks which had partially abated by 12 weeks. A proteoglycan-rich matrix at six weeks was partially replaced with collagen by 12 weeks. Similar changes were noted in the proximal cap which was acellular. Three patterns of microvessel formation were identified and defined based on the presence and extent of a "lead" neovessel. No major differences in pattern or extent of neovascularisation were noted between six and 12 weeks. Heterogeneity in neovascularisation patterns occurs during coronary CTO development in a porcine model. Non-invasive imaging to determine the predominant type of neovascularisation prior to and during CTO revascularisation may improve guidewire crossing success rates. This model may be useful for further exploration of CTO pathophysiology, and may aid in further refinements of in vivo imaging of CTO and development of novel therapeutic approaches to revascularisation of CTO, such as manipulations of the proximal cap, matrix composition, neovessel induction, and device testing.

  17. Costs and clinical outcomes for non-invasive versus invasive diagnostic approaches to patients with suspected in-stent restenosis.

    Science.gov (United States)

    Min, James K; Hasegawa, James T; Machacz, Susanne F; O'Day, Ken

    2016-02-01

    This study compared costs and clinical outcomes of invasive versus non-invasive diagnostic evaluations for patients with suspected in-stent restenosis (ISR) after percutaneous coronary intervention. We developed a decision model to compare 2 year diagnosis-related costs for patients who presented with suspected ISR and were evaluated by: (1) invasive coronary angiography (ICA); (2) non-invasive stress testing strategy of myocardial perfusion imaging (MPI) with referral to ICA based on MPI; (3) coronary CT angiography-based testing strategy with referral to ICA based on CCTA. Costs were modeled from the payer's perspective using 2014 Medicare rates. 56 % of patients underwent follow-up diagnostic testing over 2 years. Compared to ICA, MPI (98.6 %) and CCTA (98.1 %) exhibited lower rates of correct diagnoses. Non-invasive strategies were associated with reduced referrals to ICA and costs compared to an ICA-based strategy, with diagnostic costs lower for CCTA than MPI. Overall 2-year costs were highest for ICA for both metallic as well as BVS stents ($1656 and $1656, respectively) when compared to MPI ($1444 and $1411) and CCTA. CCTA costs differed based upon stent size and type, and were highest for metallic stents >3.0 mm followed by metallic stents 3.0 mm ($1466 vs. $1242 vs. $855 vs. $490, respectively). MPI for suspected ISR results in lower costs and rates of complications than invasive strategies using ICA while maintaining high diagnostic performance. Depending upon stent size and type, CCTA results in lower costs than MPI.

  18. AUTOPERFUSION BALLOON CATHETER FOR COMPLICATED CORONARY ANGIOPLASTY - A PROSPECTIVE-STUDY WITH RETROSPECTIVE CONTROLS

    NARCIS (Netherlands)

    DEMUINCK, ED; VANDIJK, RB; DENHEIJER, P; MEEDER, JG; LIE, KI

    1992-01-01

    Prolonged angioplasty balloon inflation with an autoperfusion balloon for failed conventional coronary angioplasty, was compared with emergency surgery for this condition. Restenosis was assessed 6 weeks after successful intervention with the autoperfusion balloon. Forty consecutive patients with pe

  19. AUTOPERFUSION BALLOON CATHETER FOR COMPLICATED CORONARY ANGIOPLASTY - A PROSPECTIVE-STUDY WITH RETROSPECTIVE CONTROLS

    NARCIS (Netherlands)

    DEMUINCK, ED; VANDIJK, RB; DENHEIJER, P; MEEDER, JG; LIE, KI

    1992-01-01

    Prolonged angioplasty balloon inflation with an autoperfusion balloon for failed conventional coronary angioplasty, was compared with emergency surgery for this condition. Restenosis was assessed 6 weeks after successful intervention with the autoperfusion balloon. Forty consecutive patients with

  20. Numerical Simulation of Coronary Artery Bypass Graft with an Assistant Graft

    Institute of Scientific and Technical Information of China (English)

    WANG Wei; WANG Feng

    2014-01-01

    The conventional bypass design is to implant a graft on the stenosed host artery allowing blood to flow bypass the stenotic artery. However, restenosis is a challenging problem which finally results in reoperation. The purpose of this paper is to propose a new bypass graft design of coronary artery with an assistant graft for the treatment of coronary artery stenosis. An additional assistant graft was employed in the new design compared with the conventional ETS anastomosis. Numerical simulations were performed by means of finite volume method using computational fluid dynamics (CFD) solver. Results demonstrated that the new anastomoses model provided a more smooth flow at the distal ETS anastomosis without any stagnation point on anastomotic bed and vortex formation in the heel region. Oscillatory shear index (OSI) and time-averaged wall shear stress gradient (TAWSSG) at the artery bed of the distal ETS anastomosis were reduced. The coronary artery bypass graft with an assistant graft is feasible to improve the local hemodynamics and diminish the probability of restenosis in the treatment of coronary artery stenosis.

  1. Evolution of Coronary Flow in an Experimental Slow Flow Model in Swines: Angiographic and Pathological Insights

    Directory of Open Access Journals (Sweden)

    Yupeng Bai

    2015-01-01

    Full Text Available Objective. Pathomechanism of coronary slow flow phenomenon remains largely unclear now. Present study observed the pathological and angiographic evolution in a pig model of coronary slow flow. Methods. Coronary slow flow was induced by repeat coronary injection of small doses of 40 µm microspheres in 18 male domestic pigs and angiographic and pathological changes were determined at 3 hours, 7 days, and 28 days after microspheres injection. Results. Compared to control group treated with coronary saline injection n=6 and baseline level, coronary flow was significantly reduced at 3 hours and 7 days but completely recovered at 28 days after coronary microsphere injection in slow flow group. Despite normal coronary flow at 28 days after microsphere injection, enhanced myocardial cytokine expression, left ventricular dysfunction, adverse remodelling, and ischemia/microembolism related pathological changes still persisted or even progressed from 3 hours to 28 days after coronary microsphere injection. Conclusions. Our results show that this large animal slow flow model could partly reflect the chronic angiographic, hemodynamic, and pathological changes of coronary slow flow and could be used to test new therapy strategies against the slow flow phenomenon.

  2. Drug delivery patterns for different stenting techniques in coronary bifurcations: a comparative computational study.

    Science.gov (United States)

    Cutrì, Elena; Zunino, Paolo; Morlacchi, Stefano; Chiastra, Claudio; Migliavacca, Francesco

    2013-08-01

    The treatment of coronary bifurcation lesions represents a challenge for the interventional cardiologists due to the lower rate of procedural success and the higher risk of restenosis. The advent of drug-eluting stents (DES) has dramatically reduced restenosis and consequently the request for re-intervention. The aim of the present work is to provide further insight about the effectiveness of DES by means of a computational study that combines virtual stent implantation, fluid dynamics and drug release for different stenting protocols currently used in the treatment of a coronary artery bifurcation. An explicit dynamic finite element model is developed in order to obtain realistic configurations of the implanted devices used to perform fluid dynamics analysis by means of a previously developed finite element method coupling the blood flow and the intramural plasma filtration in rigid arteries. To efficiently model the drug release, a multiscale strategy is adopted, ranging from lumped parameter model accounting for drug release to fully 3-D models for drug transport to the artery. Differences in drug delivery to the artery are evaluated with respect to local drug dosage. This model allowed to compare alternative stenting configurations (namely the Provisional Side Branch, the Culotte and the Inverted Culotte techniques), thus suggesting guidelines in the treatment of coronary bifurcation lesions and addressing clinical issues such as the effectiveness of drug delivery to lesions in the side branch, as well as the influence of incomplete strut apposition and overlapping stents.

  3. Intracoronary gamma-radiation therapy after angioplasty inhibits recurrence in patients with in-stent restenosis

    NARCIS (Netherlands)

    R. Waksman (Ron); L.R. White (Larry); R.C. Chan; B.G. Bass (Bill); M.B. Leon (Martin); L. Geirlach; G.S. Mintz (Gary); L.F. Satler; A.D. Pichard; R. Mehran (Roxana); K.M. Kent (Kenneth); A.J. Lansky (Alexandra); B. Bhargava; P.W.J.C. Serruys (Patrick); P.J. Fitzgerald (Peter)

    2000-01-01

    textabstractBACKGROUND: Treatment of in-stent restenosis presents a critical limitation of intracoronary stent implantation. Ionizing radiation has been shown to decrease neointimal formation within stents in animal models and in initial clinical trials. We studied the effects of i

  4. Bioresorbable scaffolds in the treatment of coronary artery disease

    NARCIS (Netherlands)

    Y. Zhang (Yaojun); C.V. Bourantas (Christos); V. Farooq (Vasim); T. Muramatsu (Takashi); R. Diletti (Roberto); Y. Onuma (Yoshinobu); H.M. Garcia-Garcia (Hector); P.W.J.C. Serruys (Patrick)

    2013-01-01

    textabstractDrug-eluting stents have reduced the risk of in-stent restenosis and have broadened the application in percutaneous coronary intervention in coronary artery disease. However, the concept of using a permanent metallic endovascular device to restore the patency of a stenotic artery has inh

  5. Application of intravascular ultrasound in analysis on influencing factors of prognosis in patients with different coronary artery in-stent restenosis%血管内超声在冠状动脉支架术后再狭窄患者预后影响因素分析中的应用

    Institute of Scientific and Technical Information of China (English)

    崔燕; 史永锋; 郭子源; 刘斌; 王金鹏; 赵雷; 王珺楠; 朴金花

    2016-01-01

    目的:收集应用血管内超声技术(IVUS)检测发生冠状动脉支架术后支架内再狭窄(ISR)患者的影像学数据及相关资料,分析 ISR 的危险因素,提出合理的干预策略。方法:将50例 ISR 患者随机分为 ISR≤50%组(药物组)14例和 ISR>50%组36例(根据患者意愿及经济情况分为药物球囊治疗组16例和支架治疗组20例)。应用 IVUS 虚拟组织学技术,比较各组患者采用不同治疗方法治疗前后斑块面积、病变位置、组织构成和血栓等影响预后的因素,并随访6个月后的数据变化。结果:IVUS 检测,与术前比较,行介入干预治疗的ISR 患者斑块面积和斑块负荷均明显减少(P <0.05),但药物球囊治疗组患者斑块缩减程度小于支架治疗组(P <0.05),纤维组织成分无明显变化(P >0.05),钙化组织所占比例升高,但差异无统计学意义(P >0.05)。结论:病变狭窄程度高且纤维成分多,斑块成分不均一且分布弥漫伴迂曲钙化的患者 ISR 发生率均较高。ISR发生与斑块壁厚薄、脂质成分含量、斑块不稳定程度和坏死组织多少无明显关联。%Objective:To collect the imaging data and related materials of the patients with in-stent restenosis (ISR)after coronary artery stent operation with intravascular ultrasound (IVUS),and to analyze the risk factors of ISR,and to propose the reasonable intervention strategies.Methods:Fifty patients with ISR were divided into ISR ≤ 50% drug group (n = 14 )and ISR > 50% drug group (n = 36),including drug-coated balloon therapy group (n=16)and stent treatment group (n=20);IVUS virtual organization technology was used to compare the plaque area,location,tissue composition,thrombus and other factors of the patients in various groups after treatment;the data changes after 6 months of follow-up were analyzed.Results:The IVUS results showed the plaque areas and plaque loads of the

  6. 术前血清氧化低密度脂蛋白水平与冠状动脉支架内再狭窄相关性的Meta分析%Association between Preprocedural Serum Level of Oxidized Low-Density Lipoprotein and Coronary In-Stent Restenosis:A Meta-Analysis

    Institute of Scientific and Technical Information of China (English)

    何文军; 黄家平; 莫翔; 梁伟东; 梁少华

    2013-01-01

    Objective To explore the association between preprocedural serum level of oxidized low-density lipoprotein( ox-LDL ) and in-stent restenosis( ISR ) in patients undergoing percutaneous coronary intervention( PCI ). Methods A search for the related Chinese or English studies( from January 1990 to March 2012 ) on the association between preprocedural serum ox-LDL level and ISR in PCI patients was conducted in databases including MEDLINE, CBM, VIP and CNKI. A Meta-analysis was performed. Results Seven cohort studies including 782 patients( 165 ISR and 617 no-ISR patients ) were included. The result of Meta-analysis showed that no significant association was found between high preprocedural serum ox-LDL level and ISR( P > 0. 05 ), significant heterogeneity existed among studies ( P <0. 001 ),patients' age was the major source of heterogeneity( P <0.05 ). Significant association of high preprocedural serum ox-LDL level with ISR was found in patients aged 60 years or older( P <0.05 ). Conclusion Association of higher preprocedural serum ox-LDL level with ISR can not be found in PCI patients except the ones aged 60 years or older.%目的 探讨术前血清氧化低密度脂蛋白(ox-LDL)水平与冠状动脉支架内再狭窄(ISR)相关性.方法 在MEDLINE、CBM、VIP、中国期刊全文数据库(CNKI)等检索1990年1月至2012年3月有关术前血清ox-LDL水平与ISR相关性的中、英文文献,采用Meta分析方法 进行分析.结果 纳入7篇文献共782例患者,其中ISR组165例,非ISR 617例.Meta分析结果 表明,术前血清ox-LDL水平高与ISR无相关性(P>0.05),单个研究之间存在显著异质性(P<0.001),患者年龄为异质性来源(P<0.05).年龄≥60岁组、术前血清ox-LDL水平高与ISR存在相关性(P<0.05).结论 行经皮冠状动脉介入术患者术前血清ox-LDL水平高与ISR无相关性,但对于年龄≥60岁的患者术前血清ox-LDL水平高与ISR存在相关性.

  7. Novel Use of an Orbital Atherectomy Device for In-Stent Restenosis: Lessons Learned

    Directory of Open Access Journals (Sweden)

    K. Shaikh

    2016-01-01

    Full Text Available We present a case of a 67-year-old man with stage III chronic kidney disease, uncontrolled diabetes mellitus, coronary artery disease, and high surgical risk who presented with two episodes of acute coronary syndrome attributed to in-stent restenosis (ISR associated with heavily calcified lesions. In this case, we were able to improve luminal patency with orbital atherectomy system (OAS; however, withdrawal of the device resulted in a device/stent interaction, causing failure of the device. Given limitations in current evidence and therapies, managing ISR can be a technical and cognitive challenge. Balloon expansion of the affected region often provides unsatisfactory results, possibly related to significant calcium burden. OAS could be an efficacious way of reestablishing luminal patency in ISR lesions, as these lesions are often heavily calcified.

  8. In vitro study on the feasibility of magnetic stent hyperthermia for the treatment of cardiovascular restenosis.

    Science.gov (United States)

    Li, Li; Wang, Rui; Shi, Huan-Huan; Xie, LE; Li, Jing-Ding-Sha; Kong, Wei-Chao; Tang, Jin-Tian; Ke, DA-Nian; Zhao, Ling-Yun

    2013-08-01

    Thermal treatment or hyperthermia has received considerable attention in recent years due to its high efficiency, safety and relatively few side-effects. In this study, we investigated whether it was possible to utilize targeted thermal or instent thermal treatments for the treatment of restenosis following percutaneous transluminal coronary angioplasty (PTCA) through magnetic stent hyperthermia (MSH). A 316L stainless steel stent and rabbit vascular smooth muscle cells (VSMCs) were used in the present study, in which the inductive heating characteristics of the stent under alternative magnetic field (AMF) exposure, as well as the effect of MSH on the proliferation, apoptosis, cell cycle and proliferating cell nuclear antigen (PCNA) expression of the rabbit VSMCs, were evaluated. The results demonstrated that 316L stainless steel coronary stents possess ideal inductive heating characteristics under 300 kHz AMF exposure. The heating properties were shown to be affected by the field intensity of the AMF, as well as the orientation the stent axis. MSH had a significant effect on the proliferation and apoptosis of VSMCs, and the effect was temperature-dependent. While a mild temperature of 43°C demonstrated negligible effects on the growth of VSMCs, MSH treatment above 47°C effectively inhibited the VSMC proliferation and induced apoptosis. Furthermore, a 47°C treatment exhibited a significant and long-term inhibitory effect on VSMC migration. The results strongly suggested that MSH may be potentially applied in the clinic as an alternative approach for the prevention and treatment of restenosis.

  9. No association between metal allergy and cardiac in-stent restenosis in patients with dermatitis-results from a linkage study

    DEFF Research Database (Denmark)

    Thyssen, Jacob P; Engkilde, Kåre; Menné, Torkil

    2011-01-01

    , and it remains unclear whether individuals who are allergic to these metals have an increased risk of restenosis after PCI with stent implantation. Objectives. To further evaluate whether dermatitis patients with nickel and/or chromium allergy had an increased risk of developing cardiac in-stent restenosis......Background. Percutaneous coronary intervention (PCI) with implantation of a metal stent is a common procedure performed in patients with symptomatic ischaemic heart disease. Intracoronary stents typically have a backbone of stainless steel, which contains nickel, chromium, and molybdenum....... Results. One hundred and forty-nine (0.8%) dermatitis patients who had undergone PCI with a metal stent were included. One hundred and forty-seven were patch-tested before undergoing PCI. Of the patients, 14.1% (21/149) had cardiac in-stent restenosis. Among patients with metal allergy, 2 (11.8%) had...

  10. Cost-effectiveness of paclitaxel-coated balloon angioplasty in patients with drug-eluting stent restenosis.

    Science.gov (United States)

    Dorenkamp, Marc; Boldt, Julia; Leber, Alexander W; Sohns, Christian; Roser, Mattias; Boldt, Leif-Hendrik; Haverkamp, Wilhelm; Bonaventura, Klaus

    2013-07-01

    The economic impact of drug-eluting stent (DES) in-stent restenosis (ISR) is substantial, highlighting the need for cost-effective treatment strategies. Compared to plain old balloon angioplasty (POBA) or repeat DES implantation, drug-coated balloon (DCB) angioplasty is a cost-effective therapy for DES-ISR. A Markov state-transition model was used to compare DCB angioplasty with POBA and repeat DES implantation. Model input parameters were obtained from the literature, and the cost analysis was conducted from a German healthcare payer's perspective. Extensive sensitivity analyses were performed. Initial procedure costs amounted to €3488 for DCB angioplasty and to €2782 for POBA. Over a 6-month time horizon, the DCB strategy was less costly (€4028 vs €4169) and more effective in terms of life-years (LYs) gained (0.497 versus 0.489) than POBA. The DES strategy incurred initial costs of €3167 and resulted in 0.494 LYs gained, at total costs of €4101 after a 6-month follow-up. Thus, DCB angioplasty was the least costly and most effective strategy. Base-case results were influenced mostly by initial procedure costs, target lesion revascularization rates, and the costs of dual antiplatelet therapy. DCB angioplasty is a cost-effective treatment option for coronary DES-ISR. The higher initial costs of the DCB strategy compared to POBA or repeat DES implantation are offset by later cost savings. © 2013 Wiley Periodicals, Inc.

  11. 血清Hcy、sCD40L及LDL-C与冠状动脉支架内再狭窄的相关性研究%Postprocedural serum Hcy, sCD40L and LDL-C are associated with coronary in-stent restenosis in patients with drug-coated stent implantation

    Institute of Scientific and Technical Information of China (English)

    陈玉映; 胡允兆; 陈盈文; 何宗云; 郑素琳; 吴焱贤

    2012-01-01

    目的:探讨血清同型半胱氨酸(Hcy)、LDL-C、可溶性白细胞表面抗原40配体(sCD40L)等因素在冠状动脉支架内再狭窄发生过程中的临床意义.方法:收集冠状动脉药物涂层支架植入术后因胸痛再发/术后6个月常规行冠状动脉造影随访患者共120例,其中88例造影未出现支架内再狭窄(对照组),32例出现再狭窄(再狭窄组),回顾分析两组患者的年龄、性别、高血压病史、糖尿病史、心肌梗死病史及冠心痛家族史,收集患者支架植入术后1周以及胸痛再发/术后6个月冠状动脉造影检查这两个时间点的BMI、肾小球滤过率(GFP)、甘油三酯、总胆固醇、糖化血红蛋白( GHbA1c)、LDL-C、HDL-C、Hcy、sCD40L等指标.结果:两组患者在支架植入术后1周各指标比较差异无统计学意义,因胸痛再发/术后6个月行冠状动脉造影随访时发现再狭窄组的LDL-C、Hey、sCD40L和对照组比较差异有统计学意义(P<0.01),二分类变量Logistic回归分析显示,LDL-C、sCD40L及Hcy的升高会增加再狭窄的风险,且Hcy与LDL-C(r=0.36,P=0.002)、sCD40L(r=0.27,P=0.001)呈正相关.结论:支架植入术后LDL-C、Hcy、sCD40L升高是支架内再狭窄的危险因子,并且Hcy与LDL-C、sCD40L呈正相关.%Objective: To evaluate the roles of serum homocysteine ( Hey), low density lipoprotein cholesterol (LDL-C) and soluble leukocyte surface antigens 40 ligand (sCD40L) in in-stent restenosis (ISR) after successful primary percutaneous coronary intervention (PCI). Methods; Body mass index (BMI) , glomerular filtration rate (GFP) , total triglycerides (TG) , total cholesterol (TC) , glycosylated hemoglobin (GHbAlc) , LDL-C, high density lipoprotein ( HDL-C) , Hey and sCD40L levels were measured in 120 consecutive patients 1 week and 6 months ( or chest pain occurred) after PCI. These patients were grouped as ISR and non-ISR based on angiography during follow-up time. Besides, age, sex, hypertension, diabetes

  12. In-Vitro Evaluation of Coronary Stents and 64-Detector-Row Computed Tomography Using a Newly Developed Model of Coronary Artery Stenosis

    Energy Technology Data Exchange (ETDEWEB)

    Schlosser, T.; Scheuermann, T.; Ulzheimer, S.; Mohrs, O.K.; Kuehling, M.; Albrecht, P.E.; Voigtlaender, T.; Barkhausen, J.; Schmermund, A. (Cardiovascular Center Bethanien (CCB), Frankfurt (DE))

    2008-02-15

    Background: Stent implantation is the predominant therapy for non-surgical myocardial revascularization in patients with coronary artery disease. However, despite substantial advances in multidetector computed tomography (MDCT) coronary imaging, a reliable detection of coronary in-stent restenosis is currently not possible. Purpose: To examine the ability of 64-detector-row CT to detect and to grade in-stent stenosis in coronary stents using a newly developed ex-vivo vessel phantom with a realistic CT density pattern, artificial stenosis, and a thorax phantom. Material and Methods: Four different stents (Liberte and Lunar ROX, Boston Scientific; Driver, Medtronic; Multi-Link Vision, Guidant) were examined. The stents were placed on a polymer tube with a diameter of 2.5, 3.0, 3.5, or 4.0 mm. Different degrees of stenosis (0%, 30%, 50%, 70-80%) were created inside the tube. For quantitative analysis, attenuation values were measured in the non-stenotic vessel outside the stent, in the non-stenotic vessel inside the stent, and in the stenotic area inside the stent. The grade of stenosis was visually assessed by two observers. Results: All stents led to artificial reduction of attenuation, the least degree of which was found in the Liberte stent (11.3+-10.2 HU) and the Multi-Link Vision stent (17.6+-17.9 HU; P 0.25). Overall, the non-stenotic vessel was correctly diagnosed in 55.5%, the low-grade stenosis in 58.3%, the intermediate stenosis in 63.8%, and the high-grade stenosis in 80.5%. In the 3.0-, 3.5-, and 4.0-mm vessels, in none of the cases was a non-stenotic or low-grade stenotic vessel misdiagnosed as intermediate or high-grade stenosis. The average deviation from the real grade of stenosis was 0.40 for the Liberte stent, 0.46 for the Lunar ROX stent, 0.45 for the Driver stent, and 0.58 for the Multi-Link Vision stent. Conclusion: Our ex-vivo data show that non-stenotic stents and low-grade in-stent stenosis can be reliably differentiated from intermediate and

  13. EFFECTS OF CERTAIN VASOACTIVE PEPTIDES ON PATHOGENESIS OF VASCULAR RESTENOSIS

    Institute of Scientific and Technical Information of China (English)

    刘乃奎; 陈光慧; 王晓红; 姚兴海; 苏加林; 李田昌; 武旭东; 张勇刚; 汤健; 唐朝枢

    2003-01-01

    Objective.To investigate the effects of several vasoactive peptides on the development of arterial restenosis after balloon angioplasty. Methods. In rat aortic artery restenosis model produced by denudation of aortic endothelia,we observed changes of endothelin(ET),angiotensin II(AII),calcitonin gene-related peptide(CGRP)and adrenomedullin(Adm)in plasma and aorta with radioimmunoassay and expression of hypertension-related gene(HRG-1)with semi-quantitative RT-PCR,and studied the effects of these peptides on intimal hyperplasia,intima/media ratio and MAPK activities of aortic artery after angioplasty respectively. Furthermore,in cultured cells,we studied the effects of these peptides on vascular smooth muscle cell(VSMC) proliferation and expression of HRG-1 of VSMC from spontaneously hypertensive rats(SHR)and Wistar-Kyoto(WKY)rats with 3H-TdR incorporation and RT-PCR respectively. Results. After angioplasty,the levels of ET and AII in plasma and aorta significantly increased,accompanied with VSMC proliferation and neointima hyperplasia. On day 10 after angioplasty,the levels of ET in plasma and aorta increased by 69% and 124% respectively,compared with sham group(P<0.01);and the level of aortic AII increased by 80%(P< 0.01). Antiserum against ET or inhibitors of angiotensin converting enzyme(ACE)could significantly inhibit the proliferation of VSMC and neointima formation. Compared with the sham group,on day 3 after angioplasty,the CGRP levels in plasma and aorta increased by 64% and 89% respectively(P< 0.01)and the Adm levels in plasma and tissue increased by 129% and 102% respectively(P< 0.01). On day 10,intravenous administration of CGRP significantly inhibited the proliferation of VSMC and neointima forma-tion induced by balloon aortic injury(by 66% and 79% respectively,P< 0.01). In addition,ET and AII attenuated the expression of HRG-1 in aorta and stimulated mitogen-activated protein kinase(MAPK)activity,while CGRP and Adm potentiated the expression of HRG-1

  14. A laboratory model of the aortic root flow including the coronary arteries

    Science.gov (United States)

    Querzoli, Giorgio; Fortini, Stefania; Espa, Stefania; Melchionna, Simone

    2016-08-01

    Cardiovascular flows have been extensively investigated by means of in vitro models to assess the prosthetic valve performances and to provide insight into the fluid dynamics of the heart and proximal aorta. In particular, the models for the study of the flow past the aortic valve have been continuously improved by including, among other things, the compliance of the vessel and more realistic geometries. The flow within the sinuses of Valsalva is known to play a fundamental role in the dynamics of the aortic valve since they host a recirculation region that interacts with the leaflets. The coronary arteries originate from the ostia located within two of the three sinuses, and their presence may significantly affect the fluid dynamics of the aortic root. In spite of their importance, to the extent of the authors' knowledge, coronary arteries were not included so far when modeling in vitro the transvalvular aortic flow. We present a pulse duplicator consisting of a passively pulsing ventricle, a compliant proximal aorta, and coronary arteries connected to the sinuses of Valsalva. The coronary flow is modulated by a self-regulating device mimicking the physiological mechanism, which is based on the contraction and relaxation of the heart muscle during the cardiac cycle. Results show that the model reproduces satisfyingly the coronary flow. The analysis of the time evolution of the velocity and vorticity fields within the aortic root reveals the main characteristics of the backflow generated through the aorta in order to feed the coronaries during the diastole. Experiments without coronary flow have been run for comparison. Interestingly, the lifetime of the vortex forming in the sinus of Valsalva during the systole is reduced by the presence of the coronaries. As a matter of fact, at the end of the systole, that vortex is washed out because of the suction generated by the coronary flow. Correspondingly, the valve closure is delayed and faster compared to the case with

  15. Sirolimus-eluting stent fractures associated with aneurysm and very late stent thrombosis in the right coronary artery

    Institute of Scientific and Technical Information of China (English)

    LIU Xuebo; Gary S.Mintz; Stéphane G.Carlier; Martin B.Leon

    2007-01-01

      Although the occurrence of coronary stent fracture is rare,recent reports showed that stent fracture after sirolimus-eluting stent(SES)implantation may be associated with neointimal hyperplasia and restenosis.We report two cases of stent fracture that occurred late after elective SES implantation into the right coronary artery(RCA)that were related to the aneurysm,restenosis,thrombosis,and vessel occlusion.……

  16. Towards Patient-Specific Modeling of Coronary Hemodynamics in Healthy and Diseased State

    Directory of Open Access Journals (Sweden)

    Arjen van der Horst

    2013-01-01

    Full Text Available A model describing the primary relations between the cardiac muscle and coronary circulation might be useful for interpreting coronary hemodynamics in case multiple types of coronary circulatory disease are present. The main contribution of the present study is the coupling of a microstructure-based heart contraction model with a 1D wave propagation model. The 1D representation of the vessels enables patient-specific modeling of the arteries and/or can serve as boundary conditions for detailed 3D models, while the heart model enables the simulation of cardiac disease, with physiology-based parameter changes. Here, the different components of the model are explained and the ability of the model to describe coronary hemodynamics in health and disease is evaluated. Two disease types are modeled: coronary epicardial stenoses and left ventricular hypertrophy with an aortic valve stenosis. In all simulations (healthy and diseased, the dynamics of pressure and flow qualitatively agreed with observations described in literature. We conclude that the model adequately can predict coronary hemodynamics in both normal and diseased state based on patient-specific clinical data.

  17. Reduction of in-stent restenosis risk on nickel-free stainless steel by regulating cell apoptosis and cell cycle.

    Directory of Open Access Journals (Sweden)

    Liming Li

    Full Text Available High nitrogen nickel-free austenitic stainless steel (HNNF SS is one of the biomaterials developed recently for circumventing the in-stent restenosis (ISR in coronary stent applications. To understand the ISR-resistance mechanism, we have conducted a comparative study of cellular and molecular responses of human umbilical vein endothelial cells (HUVECs to HNNF SS and 316L SS (nickel-containing austenitic 316L stainless steel which is the stent material used currently. CCK-8 analysis and flow cytometric analysis were used to assess the cellular responses (proliferation, apoptosis, and cell cycle, and quantitative real-time PCR (qRT-PCR was used to analyze the gene expression profile of HUVECs exposed to HNNF SS and 316L SS, respectively. Flow cytometry analysis revealed that 316L SS could activate the cellular apoptosis more efficiently and initiate an earlier entry into the S-phase of cell cycle than HNNF SS. At the molecular level, qRT-PCR results showed that the genes regulating cell apoptosis and autophagy were overexpressed on 316L SS. Further examination indicated that nickel released from 316L SS triggered the cell apoptosis via Fas-Caspase8-Caspase3 exogenous pathway. These molecular mechanisms of HUVECs present a good model for elucidating the observed cellular responses. The findings in this study furnish valuable information for understanding the mechanism of ISR-resistance on the cellular and molecular basis as well as for developing new biomedical materials for stent applications.

  18. CYP2C19⁎2 Polymorphism in Chilean Patients with In-Stent Restenosis Development and Controls

    Directory of Open Access Journals (Sweden)

    Jenny Ruedlinger

    2017-01-01

    Full Text Available Clopidogrel is an antiplatelet drug especially used in patients undergoing percutaneous coronary interventions (PCI. Polymorphisms within CYP2C19 can result in important interindividual variations regarding therapeutic efficacy. Therefore, we aimed to evaluate the impact of the CYP2C19⁎2 variant (rs4244285 on in-stent restenosis occurrence in Chilean patients who underwent PCI and received clopidogrel. A total of 77 cases with stenosis >50% in the angioplasty site (62.75 ± 9.8 years, 80.5% males and 86 controls (65.45 ± 9.8 years, 72.1% males were studied. The polymorphism was genotyped using TaqMan® Drug Metabolism Genotyping Assays. Overall, CYP2C19⁎2 allele frequency was 8.3%. Diabetes, chronic lesions, and bare metal stents (BMS were observed more often in cases than in controls (p = 0.05, p = 0.04, and p = 0.02, resp.. Genotypic frequencies did not differ significantly between the groups (p = 0.15. Nonetheless, the mutated allele was observed in a greater proportion in patients without in-stent restenosis (p = 0.055. There was no significant association between the rs4244285 variant and the occurrence of in-stent restenosis after PCI (OR = 0.44; 95% CI: 0.19 to 1.04; p = 0.06. In summary, no association was identified between the CYP2C19⁎2 variant and the development of coronary in-stent restenosis.

  19. Involvement of innate and adaptive immunity in a murine model of coronary arteritis mimicking Kawasaki disease.

    Science.gov (United States)

    Schulte, Danica J; Yilmaz, Atilla; Shimada, Kenichi; Fishbein, Michael C; Lowe, Emily L; Chen, Shuang; Wong, Michelle; Doherty, Terence M; Lehman, Thomas; Crother, Timothy R; Sorrentino, Rosalinda; Arditi, Moshe

    2009-10-15

    Kawasaki disease (KD) is the most common cause of acquired cardiac disease and acute vasculitis in children in the developed world. Injection of a cell wall extract isolated from Lactobacillus casei (LCCWE) into mice causes a focal coronary arteritis that histopathologically mimics the coronary lesions observed in KD patients. In this study we used this model to investigate the participation of T cells, B cells, and dendritic cells (DC) in the development of coronary arteritis. RAG1(-/-), B cell(null), and wild-type (WT) mice were injected with a single dose of LCCWE (500 microg/mouse i.p.). None of the RAG1(-/-) mice developed coronary arteritis, whereas 70% of WT and 100% of B cell(null) mice developed coronary lesions, indicating that T cells were required for lesion formation. When splenocytes isolated from LCCWE-treated mice were restimulated with LCCWE, we observed significant IFN-gamma secretion in WT but not in RAG1(-/-) mice. Immunohistochemical staining showed F4/80(+) macrophages, activated MIDC-8(+) myeloid DCs (mDC), plasmacytoid DCs, and colocalization of CD3(+) T cells with mDCs in coronary artery lesions, suggesting an Ag-driven process. T cells but not B cells are required for LCCWE-induced coronary arteritis. Similar to human lesions, the coronary lesions contain macrophages, activated mDCs, and plaslmacytoid DCs all in close proximity to T cells, further strengthening the relevance of this mouse model to the immunopathology of coronary disease in KD. These studies are consistent with the interpretation that macrophages and DCs may collaborate with T cells in the pathological mechanisms of coronary arteritis.

  20. A comparison of balloon-expandable-stent implantation with balloon angioplasty in patients with coronary artery disease. Benestent Study Group.

    OpenAIRE

    Serruys, P.W.; de Jaegere, P; Kiemeneij, F.; Macaya, C; Rutsch, W; Heyndrickx, G.; Emanuelsson, H.; Marco, J.; Legrand, Victor; Materne, P.

    1994-01-01

    BACKGROUND: Balloon-expandable coronary-artery stents were developed to prevent coronary restenosis after coronary angioplasty. These devices hold coronary vessels open at sites that have been dilated. However, it is unknown whether stenting improves long-term angiographic and clinical outcomes as compared with standard balloon angioplasty. METHODS: A total of 520 patients with stable angina and a single coronary-artery lesion were randomly assigned to either stent implantation (262 patients)...

  1. A mathematical model for the vessel recruitment in coronary microcirculation in the absence of active autoregulation.

    Science.gov (United States)

    Saracco, Alice; Bauckneht, Matteo; Verna, Edoardo; Ghiringhelli, Sergio; Repetto, Rodolfo; Sambuceti, Gianmario; Provasoli, Stefano; Storace, Marco

    2016-03-01

    This paper proposes a mathematical model for vessel recruitment in the microvascular coronary network. The model is based on microvascular network units (MVNUs), where we define a MVNU as a portion of the microvascular network comprising seven generations of identical, parallel-arranged vessels (upstream arteries, large and small arterioles, capillaries, small and large venules, and downstream veins). The model implements a new mechanism to describe the variation in the number of MVNU in response to sudden variations of the local input pressure. In particular, it describes a recruitment mechanism dependent on distal pressure which operates in the coronary microcirculatory network even in maximally dilated conditions. We apply the model to interpret data from 29 patients who underwent revascularization by percutaneous coronary intervention (PCI). Treated vessels were the left anterior descending coronary artery, the left circumflex and the right coronary artery in 26, 2 and 1 patients, respectively. Following intracoronary adenosine administration, distal coronary pressure and blood flow were 48 ± 18 mmHg and 45 ± 30 ml/min before PCI, respectively, and significantly increased afterwards to 80 ± 17 mmHg and 68 ± 32 ml/min (p<0.001). The model predicts an increase in MVNU number in patients with preserved wall motion in the myocardial region which underwent PCI. On the contrary, a decrease in MVNU number is predicted by the model in patients with regional dysfunction and implies a relatively lower response of maximal flow to revascularization.

  2. Changes in coronary bifurcations after stent placement in the main vessel and balloon opening of stent cells:theory and practical verification on a bench-test model

    Institute of Scientific and Technical Information of China (English)

    Dobrin Vassilev; Robert Gil

    2008-01-01

    Objective To describe changes that occur in stent morphology and structure after its implantation in coronary bifurcation.Side branch (SB) compromise after stenting of main vessel in coronary bifurcation is a major intraprocedural problem and for the long term,as a place of restenosis.Methods We created an elastic wall model (parent vessel diameter 3.5mm,daughter branches 3.5mm and 2.75mm)with 30,45 and 60 degree distal angulation between branches.After stent implantation,struts to the side branch were opened with 2.0mm and consequently 3.0mm diameter balloons.Subsequent balloon redilatations and kissing balloon inflations (KBI) were performed.All stages of the procedure were photographed with magnification up to 100 times.Results We found that the leading mechanism for side branch compromise was carina displacement,and discovered theoretical description for expected ostial stenosis severity.Based on our model we found that displacement of bifurcation flow divider cause SB stenosis with almost perfect coincidence with our theoretical predictions.Opening of stent cells through the proximal and distal stent struts always increased interslrut distance,but never achieved good apposition to the wall.Balloon diameter increase didn't give proportional enlargement in stent cell diameters.KBI leads to some small better stent positioning,correcting main vessel strut dislodgment from wall,but never gave full strut-wall contact.Distance between struts and wall was minimal only when the stent cell perfectly faced ostium of SB.This was also our observation that the shape of ostium of SB becomed eUiptically-bean shaped after stent implantation and generally kept that shape during consequent stages of experiment.Measured diameter and area stenosis were perfectly fitted and theoretically predicted from our concept Conclusion We have described stent-wall deformations in stent-balloon technique for treatment of coronary bifurcation demonstrating carina displacement as possibly main

  3. Nuclear Receptor Nurr1 Is Expressed In and Is Associated With Human Restenosis and Inhibits Vascular Lesion Formation In Mice Involving Inhibition of Smooth Muscle Cell Proliferation and Inflammation

    NARCIS (Netherlands)

    P.I. Bonta; T.W.H. Pols; C.M. van Tiel; M. Vos; E.K. Arkenbout; J. Rohlena; K.T. Koch; M.P.M. de Maat; M.W.T. Tanck; R.J. de Winter; H. Pannekoek; E.A.L. Biessen; I. Bot; C.J.M. de Vries

    2010-01-01

    Background-Restenosis is the major drawback of percutaneous coronary interventions involving excessive activation and proliferation of vascular smooth muscle cells (SMCs). The nuclear receptor Nurr1 is an early response gene known mainly for its critical role in the development of dopamine neurons.

  4. A logistic regression model of Coronary Artery Disease among Male Patients in Punjab

    Directory of Open Access Journals (Sweden)

    Sohail Chand

    2005-07-01

    Full Text Available This is a cross-sectional retrospective study of 308 male patients, who were presented first time for coronary angiography at the Punjab Institute of Cardiology. The mean age was 50.97 + 9.9 among male patients. As the response variable coronary artery disease (CAD was a binary variable, logistic regression model was fitted to predict the Coronary Artery Disease with the help of significant risk factors. Age, Chest pain, Diabetes Mellitus, Smoking and Lipids are resulted as significant risk factors associated with CAD among male population.

  5. Carotid artery grafting for restenosis after carotid endarterectomy.

    Science.gov (United States)

    Pokrovskiĭ, A V; Kuntsevich, G I; Beloiartsev, D F; Burtseva, E A; Fedorov, E E

    2007-01-01

    The paper analyzes outcomes of 12 internal carotid artery (ICA) graftings for repeat stenosis after carotid endarterectomy (CEA) in 11 patients. In 6 cases restenosis occurred after eversion CEA, in 5 - after conventional patch CEA, and in 1 case - after ICA patch angioplasty for post-CEA restenosis. Critical restenosis >75% in reconstruction area was an indication for surgical intervention. There was 1 case of graft thrombosis in early postoperative period with hemispherical stroke and lethal outcome. Eight patients were examined in late postoperative period. Mean follow-up was 34?+/-?8.44 months (from 16 to 48 months). No cerebrovascular disturbances in operated ICA feeding area were detected. In 6 patients graft patency was good, while 2 smoking patients with diabetes mellitus and hyperlipidemia demonstrated repeat restenosis of proximal anastomosis >70%.

  6. Small coronary vessel angioplasty: outcomes and technical considerations

    Directory of Open Access Journals (Sweden)

    Sudhir Rathore

    2010-10-01

    Full Text Available Sudhir RathoreDepartment of Cardiology, Atkinson Morley wing, St George’s Healthcare NHS Trust, London, UKAbstract: Small vessel (<3 mm coronary artery disease is common and has been identified as independent predictor of restenosis after percutaneous coronary intervention. It remains controversial whether bare-metal stent (BMS implantation in small vessels has an advantage over balloon angioplasty in terms of angiographic and clinical outcomes. Introduction of drug-eluting stent (DES has resulted in significant reduction in restenosis and the need for repeat revascularization. Several DESs have been introduced resulting in varying reduction in outcomes as compared with BMS. However, their impact on outcomes in small vessels is not clearly known. It is expected that DES could substantially reduce restenosis in smaller vessels. Large, randomized studies are warranted to assess the impact of different DESs on outcomes in patients with small coronary arteries.Keywords: small coronary arteries, coronary artery disease, stent, drug-eluting stent, restenosis 

  7. Simulation of stent deployment in a realistic human coronary artery

    Directory of Open Access Journals (Sweden)

    van der Steen Anton FW

    2008-08-01

    Full Text Available Abstract Background The process of restenosis after a stenting procedure is related to local biomechanical environment. Arterial wall stresses caused by the interaction of the stent with the vascular wall and possibly stress induced stent strut fracture are two important parameters. The knowledge of these parameters after stent deployment in a patient derived 3D reconstruction of a diseased coronary artery might give insights in the understanding of the process of restenosis. Methods 3D reconstruction of a mildly stenosed coronary artery was carried out based on a combination of biplane angiography and intravascular ultrasound. Finite element method computations were performed to simulate the deployment of a stent inside the reconstructed coronary artery model at inflation pressure of 1.0 MPa. Strut thickness of the stent was varied to investigate stresses in the stent and the vessel wall. Results Deformed configurations, pressure-lumen area relationship and stress distribution in the arterial wall and stent struts were studied. The simulations show how the stent pushes the arterial wall towards the outside allowing the expansion of the occluded artery. Higher stresses in the arterial wall are present behind the stent struts and in regions where the arterial wall was thin. Values of 200 MPa for the peak stresses in the stent strut were detected near the connecting parts between the stent struts, and they were only just below the fatigue stress. Decreasing strut thickness might reduce arterial damage without increasing stresses in the struts significantly. Conclusion The method presented in this paper can be used to predict stresses in the stent struts and the vessel wall, and thus evaluate whether a specific stent design is optimal for a specific patient.

  8. Clinical and angiographic follow-up study of sirolimus-eluting stent for treatment of in-stent restenosis

    Institute of Scientific and Technical Information of China (English)

    LIU You-wen; LIU Qiang; PAN Chu-mei; JIN Guang-lin; LUO Jian-feng; XIA Zhi-qi; AI Shu-zhi; WANG Feng-shan

    2005-01-01

    @@ With widespread performance of coronary artery stenting, the number of in-stent restenosis (ISR) has increased in recent years. How to treat ISR effectively has been a great challenge in the field of cardiology. Recently, some notable clinical trials have confirmed that sirolimus-eluting stents (SESs) (CYPHERTM, Cordis, J&J Inc, USA) reduce ISR rate dramatically. So far, there have been few reports on the efficacy of using SESs to treat ISR.1,2 So, we used SESs to treat 27 patients with ISR and followed up for at least six months.

  9. Bioresorbable drug-eluting magnesium-alloy scaffold for treatment of coronary artery disease

    NARCIS (Netherlands)

    C.A.M. Campos (Carlos); T. Muramatsu (Takashi); A. Iqbal (Anwarul); Y.-J. Zhang (Ya-Jun); Y. Onuma (Yoshinobu); H.M. Garcia-Garcia (Hector); M. Haude; P.A. Lemos Neto (Pedro); B. Warnack (Boris); P.W.J.C. Serruys (Patrick)

    2013-01-01

    textabstractThe introduction of metallic drug-eluting stents has reduced the risk of restenosis and widened the indications of percutaneous coronary intervention in treatment of coronary artery disease. However, this medical device can induce hypersensitive reaction that interferes with the endothel

  10. Quantitative angiographic follow-up of the coronary wallstent in native vessels and bypass grafts (European experience - March 1986 to March 1990)

    NARCIS (Netherlands)

    B.H. Strauss (Bradley); P.W.J.C. Serruys (Patrick); M.E. Bertrand (Michel); J. Puel (Jacques); B. Meier (Bernard); J-J. Goy (Jean-Jacques); L. Kappenberger (Lukas); A.F. Rickards (Anthony); U. Sigwart (Ulrich); M-A.M. Morel (Marie-Angèle); E.W.J. Montauban van Swijndregt (Eline)

    1992-01-01

    textabstractThe coronary stent has been investigated as an adjunct to percutaneous transluminal coronary angioplasty to obviate the problems of early occlusion and late restenosis. From March 1986 to March 1990, 265 patients (308 lesions) were implanted with the coronary Wallstent in 6 European cent

  11. Clinical results of Intracoronary Brachytherapy (ICBT) for multiple in-stent restenosis

    Energy Technology Data Exchange (ETDEWEB)

    Stadler, P. [Dept. of Radiotherapy and Radiation Oncology, Univ. Hospital Regensburg (Germany); Praxis Muehleninsel, Landshut-Muehldorf-Dingolfing (Germany); Schaefer, C.; Chaber, S.; Putnik, K.; Treutwein, M.; Koelbl, O. [Dept. of Radiotherapy and Radiation Oncology, Univ. Hospital Regensburg (Germany); Muders, F. [Dept. of Cardiology, Univ. Hospital Regensburg (Germany)

    2006-06-15

    Background and purpose: treatment of in-stent restenosis (ISR) with percutaneous coronary intervention (PCI) alone is often followed by early re-restenosis. The present study focused on the effect of intracoronary brachytherapy (ICBT) on multiple in-stent restenosis (MISR) after repeated PCI. Patients and methods: 40 patients (27 male, 13 female, age: 66 {+-} 9 years) with MISR (two to six ISRs, median three ISRs) were retrospectively analyzed. All patients were treated by using the Novoste {sup registered} Beta-Cath trademark 3.5F System after PCI. The target vessel received 18.4-25.3 Gy of radiation at a depth of 2 mm from the center of the source. The restenosis-free survival and overall survival were calculated by Kaplan-Meier analysis (log-rank). The time interval between last PCI without ICBT and the consecutive recurrence was compared with the follow-up time after PCI with ICBT. Results: the 3-year overall survival rate after ICBT was 93%. The 0.5-, 1-, 2-, and 3-year ISR-free survival rates after PCI + ICBT were 81%, 72%, 52%, and 38%, respectively. After PCI alone, the 0.5-, 1-, and 2-year ISR-free survival rates were 30%, 13%, and 0%, respectively. This difference was highly significant (p < 0.0001). Patients with more than three ISRs before ICBT had a better outcome (3-year ISR-free survival: 80%) than patients with only two or three ISRs before ICBT (3-year ISR-free survival: 25%; p < 0.05). Conclusion: ICBT is highly effective and safe in patients with ISR. The results of this study are in accordance with the WRIST and BETA-WRIST data. After 6 months both studies revealed an ISR-free survival rate of 86% (WRIST) and 66% (BETA-WRIST), respectively. The ISR rates in the own control group (70%) were comparable to the placebo groups in WRIST (68%) and BETA-WRIST (72%). Interestingly, patients with more than three ISRs before ICBT had the lowest ISR rate after ICBT. (orig.)

  12. Safety and efficacy of everolimus-eluting stents for bare-metal in-stent restenosis

    Energy Technology Data Exchange (ETDEWEB)

    Ota, Hideaki [Division of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC 20010 (United States); Mahmoudi, Michael [University of Surrey, Guildford Road, Surrey, GU2-7XH (United Kingdom); Torguson, Rebecca; Satler, Lowell F.; Suddath, William O.; Pichard, Augusto D. [Division of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC 20010 (United States); Waksman, Ron, E-mail: ron.waksman@medstar.net [Division of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC 20010 (United States)

    2015-04-15

    Objective: The aim of this study was to compare the safety and efficacy of the everolimus-eluting stents (EES) with the paclitaxel-eluting stent (PES) and sirolimus-eluting stent (SES) for the treatment of bare-metal in-stent restenosis. Background: The optimal treatment for bare-metal in-stent restenosis remains controversial. Methods: The study cohort comprised 322 consecutive patients (543 lesions) who presented with bare-metal in-stent restenosis to our institution and underwent coronary artery stent implantation with EES (114 patients; 181 lesions), PES (65 patients; 116 lesions) and SES (143 patients; 246 lesions). The analyzed clinical parameters were the 1-year rates of death, Q-wave myocardial infarction (MI), target lesion revascularization (TLR), target vessel revascularization (TVR), definite stent thrombosis (ST) and major adverse cardiac events (MACE) defined as the composite of death, MI, or TLR at 1-year. Results: The three groups were well matched for the conventional risk factors except for age and chronic kidney disease. The 1-year analyzed clinical parameters were similar in the three groups: death (EES = 3.5%, PES = 4.6%, SES = 4.2%; p = 0.94), MI (EES = 3.5%, PES = 6.3%, SES = 2.1%; p = 0.31), TLR (EES = 9.8%, PES = 9.5%, SES = 5.7%; p = 0.42), TVR (EES = 14.3%, PES = 11.1%, SES = 11.3%; p = 0.74), definite ST (EES = 0.9%, PES = 3.1%, SES = 3.5%; p = 0.38) and MACE (EES = 14.0%, PES = 15.4%, SES = 10.5%; p = 0.54). Male gender (hazard ratio = 0.47; 95% confidence interval = 0.25–0.88) and number of treated lesions (hazard ratio = 1.47; 95% confidence interval = 1.06–2.05) were found to be independent predictors of MACE. Conclusion: The results of the present study indicate that EES may provide similar safety and efficacy as first generation DES for the treatment of patients presenting with bare-metal in-stent restenosis.

  13. Development of a model of the coronary arterial tree for the 4D XCAT phantom

    Science.gov (United States)

    Fung, George S. K.; Segars, W. Paul; Gullberg, Grant T.; Tsui, Benjamin M. W.

    2011-09-01

    A detailed three-dimensional (3D) model of the coronary artery tree with cardiac motion has great potential for applications in a wide variety of medical imaging research areas. In this work, we first developed a computer-generated 3D model of the coronary arterial tree for the heart in the extended cardiac-torso (XCAT) phantom, thereby creating a realistic computer model of the human anatomy. The coronary arterial tree model was based on two datasets: (1) a gated cardiac dual-source computed tomography (CT) angiographic dataset obtained from a normal human subject and (2) statistical morphometric data of porcine hearts. The initial proximal segments of the vasculature and the anatomical details of the boundaries of the ventricles were defined by segmenting the CT data. An iterative rule-based generation method was developed and applied to extend the coronary arterial tree beyond the initial proximal segments. The algorithm was governed by three factors: (1) statistical morphometric measurements of the connectivity, lengths and diameters of the arterial segments; (2) avoidance forces from other vessel segments and the boundaries of the myocardium, and (3) optimality principles which minimize the drag force at the bifurcations of the generated tree. Using this algorithm, the 3D computational model of the largest six orders of the coronary arterial tree was generated, which spread across the myocardium of the left and right ventricles. The 3D coronary arterial tree model was then extended to 4D to simulate different cardiac phases by deforming the original 3D model according to the motion vector map of the 4D cardiac model of the XCAT phantom at the corresponding phases. As a result, a detailed and realistic 4D model of the coronary arterial tree was developed for the XCAT phantom by imposing constraints of anatomical and physiological characteristics of the coronary vasculature. This new 4D coronary artery tree model provides a unique simulation tool that can be

  14. Comparison of Bare metal Vs Drug eluting stents for in-stent Restenosis among Diabetics

    Directory of Open Access Journals (Sweden)

    Kakhaber Etsadashvili

    2011-06-01

    Full Text Available Background: Diabetes mellitus is associated with an increased risk of restenosis, stent thrombosis, and death afterpercutaneous coronary interventions. Little is known about the late outcome of patients with diabetes mellitus whoreceive drug-eluting stents (DES or bare metal stents (BMS.Methods: From January 2008 to January 2010, six patients with DES and 20 with BMS, ISR were identified at ourinstitution.Results: The median age of our diabetic cohort was 63 years, and 87 of the patients were male. For two years, ratesof repeat target-vessel revascularization were significantly lower among diabetic patients treated with DEScompared with those treated with BMS (5.8% vs. 17.0%, p=0.003.Conclusions: DES is effective among diabetic patients in substantially reducing the need for repeat TVR.

  15. Association of Serum HMGB2 Levels With In-Stent Restenosis: HMGB2 Promotes Neointimal Hyperplasia in Mice With Femoral Artery Injury and Proliferation and Migration of VSMCs.

    Science.gov (United States)

    He, Yu Hu; Wang, Xiao Qun; Zhang, Jian; Liu, Zhu Hui; Pan, Wen Qi; Shen, Ying; Zhu, Zheng Bin; Wang, Ling Jie; Yan, Xiao Xiang; Yang, Ke; Zhang, Rui Yan; Shen, Wei Feng; Ding, Feng Hua; Lu, Lin

    2017-04-01

    In a previous study, we established diabetic and nondiabetic minipig models with coronary artery in-stent restenosis (ISR). Mass spectrometry showed that high-mobility group box (HMGB) 2 level was higher in ISR than in non-ISR tissue from diabetic minipigs. We here investigated whether serum HMGB2 levels were related to ISR in coronary artery disease patients. The effect of HMGB2 was evaluated in mice with femoral artery wire injury and in human aortic smooth muscle cells. From 2513 patients undergoing coronary artery intervention and follow-up angiography at ≈1 year, 262 patients were diagnosed with ISR, and 298 patients with no ISR were randomly included as controls. Serum HMGB2 levels were significantly higher in patients with ISR than in those without ISR and were associated with ISR severity. Multivariable logistic regression analysis showed that HMGB2 level was independently associated with ISR. In experiments, HMGB2 expression was increased in vascular tissue after injury. Perivascular HMGB2 administration promoted injury-induced neointimal hyperplasia in C57Bl/6 mice compared with in the control, whereas such pathophysiological features were attenuated in Hmgb2(-/-) mice. Mechanistically, HMGB2 enhanced neointimal hyperplasia in mice and proliferation and migration in human aortic smooth muscle cells by inducing reactive oxygen species through increased p47phox phosphorylation. Knocking down p47phox, however, inhibited HMGB2-induced effects in human aortic smooth muscle cells. Finally, HMGB2-induced effects were significantly declined in receptor of advanced glycation end products knockdown or deficient cells, but not in Toll-like receptor 4 knockdown or deficient cells. Serum HMGB2 levels were associated with ISR in patients. HMGB2 promoted neointimal hyperplasia in mice with arterial wire injury through reactive oxygen species activation. © 2017 American Heart Association, Inc.

  16. Long-Term Type 1 Diabetes Enhances In-Stent Restenosis after Aortic Stenting in Diabetes-Prone BB Rats

    NARCIS (Netherlands)

    Onuta, Geanina; Groenewegen, Hendrik C.; Klatter, Flip A.; Boer, Mark Walther; Goris, Maaike; van Goor, Harry; Roks, Anton J. M.; Rozing, Jan; de Smet, Bart J. G. L.; Hillebrands, Jan-Luuk

    2011-01-01

    Type 1 diabetic patients have increased risk of developing in-stent restenosis following endovascular stenting. Underlying pathogenetic mechanisms are not fully understood partly due to the lack of a relevant animal model to study the effect(s) of long-term autoimmune diabetes on development of in-s

  17. Inhibition of restenosis with beta-emitting radiotherapy: Report of the Proliferation Reduction with Vascular Energy Trial (PREVENT)

    NARCIS (Netherlands)

    A.E. Raizner (Albert); A. Colombo (Antonio); Y.L. Lim; A.C. Yeung (Alan); N.M. Ali (Nadir); L. Vandertie (Lynn); G.L. Kaluza (Grzegorz); J.K. Chiu; P.J. Fitzgerald (Peter); L.R. White (Larry); S.N. Oesterle; R. Waksman (Ron); P.W.J.C. Serruys (Patrick); W.J. van der Giessen (Wim)

    2000-01-01

    textabstractBACKGROUND: Intracoronary gamma- and beta-radiation have reduced restenosis in animal models. In the clinical setting, the effectiveness of beta-emitters has not been studied in a broad spectrum of patients, particularly those receiving stents. METHODS AND RESULTS: A pr

  18. Optimization of cardiovascular stent against restenosis: factorial design-based statistical analysis of polymer coating conditions.

    Directory of Open Access Journals (Sweden)

    Gayathri Acharya

    Full Text Available The objective of this study was to optimize the physicodynamic conditions of polymeric system as a coating substrate for drug eluting stents against restenosis. As Nitric Oxide (NO has multifunctional activities, such as regulating blood flow and pressure, and influencing thrombus formation, a continuous and spatiotemporal delivery of NO loaded in the polymer based nanoparticles could be a viable option to reduce and prevent restenosis. To identify the most suitable carrier for S-Nitrosoglutathione (GSNO, a NO prodrug, stents were coated with various polymers, such as poly (lactic-co-glycolic acid (PLGA, polyethylene glycol (PEG and polycaprolactone (PCL, using solvent evaporation technique. Full factorial design was used to evaluate the effects of the formulation variables in polymer-based stent coatings on the GSNO release rate and weight loss rate. The least square regression model was used for data analysis in the optimization process. The polymer-coated stents were further assessed with Differential scanning calorimetry (DSC, Fourier transform infrared spectroscopy analysis (FTIR, Scanning electron microscopy (SEM images and platelet adhesion studies. Stents coated with PCL matrix displayed more sustained and controlled drug release profiles than those coated with PLGA and PEG. Stents coated with PCL matrix showed the least platelet adhesion rate. Subsequently, stents coated with PCL matrix were subjected to the further optimization processes for improvement of surface morphology and enhancement of the drug release duration. The results of this study demonstrated that PCL matrix containing GSNO is a promising system for stent surface coating against restenosis.

  19. Influence of anatomical dominance and hypertension on coronary conduit arterial and microcirculatory flow patterns: a multiscale modeling study.

    Science.gov (United States)

    Mynard, Jonathan P; Smolich, Joseph J

    2016-07-01

    Coronary hemodynamics are known to be affected by intravascular and extravascular factors that vary regionally and transmurally between the perfusion territories of left and right coronary arteries. However, despite clinical evidence that left coronary arterial dominance portends greater cardiovascular risk, relatively little is known about the effects of left or right dominance on regional conduit arterial and microcirculatory blood flow patterns, particularly in the presence of systemic or pulmonary hypertension. We addressed this issue using a multiscale numerical model of the human coronary circulation situated in a closed-loop cardiovascular model. The coronary model represented left or right dominant anatomies and accounted for transmural and regional differences in vascular properties and extravascular compression. Regional coronary flow dynamics of the two anatomical variants were compared under normotensive conditions, raised systemic or pulmonary pressures with maintained flow demand, and after accounting for adaptations known to occur in acute and chronic hypertensive states. Key findings were that 1) right coronary arterial flow patterns were strongly influenced by dominance and systemic/pulmonary hypertension; 2) dominance had minor effects on left coronary arterial and all microvascular flow patterns (aside from mean circumflex flow); 3) although systemic hypertension favorably increased perfusion pressure, this benefit varied regionally and transmurally and was offset by increased left ventricular and septal flow demands; and 4) pulmonary hypertension had a substantial negative effect on right ventricular and septal flows, which was exacerbated by greater metabolic demands. These findings highlight the importance of interactions between coronary arterial dominance and hypertension in modulating coronary hemodynamics.

  20. Effects of sirolimus-eluting stent on calcified coronary lesions

    Institute of Scientific and Technical Information of China (English)

    LI Jian-jun; WU Yong-jian; YUAN Jin-qing; CHEN Jue; YOU Shi-jie; DAI Jun; XIA Ran; GAO Run-lin; XU Bo; YANG Yue-jin; CHEN Ji-lin; QIAO Shu-bing; MA Wei-hua; QIN Xue-wen; YAO Min; LIU Hai-bo

    2008-01-01

    Background Calcified coronary lesions carry the risk of suboptimal stent expansion, subsequently leading to restenosis. The effectiveness of sirolimus-eluting stents (SES) for the treatment of calcified lesion has not been fully investigated. In the present study, therefore, we evaluated the effectiveness of SES Implantation for the treatment of calcified coronary lesions.Mothods A total of 333 consecutive patients with 453 lesions were enrolled in this study. They were divided into two groups according to whether the lesion treated with SES was calcified or not; no calcification group (n=264) and calcification group (n=189). Lesions treated with SES were subjected to quantitative coronary angiography (QCA) immediately and 8 months following stenting.Results Baseline clinical, demographic or angiographic characteristics were well balanced in both groups. Angiographic follow-up at 8 months, the in-stent restenosis and in-segment restenosis rates were not significantly different between the two groups; in-stent restenosis: 3.8% vs 4.2%; P=0.081; in-segment restenosis: 8.7% vs 10.6%, P=0.503. The target lesion revascularization (TLR) was also not significantly different between the two groups; 4.9% vs 6.9%, P=0.378. In addition, the in-stent late loss was similar in both groups; (0.16±0.40) mm vs (0.17±0.33) mm, P>0.05. Meantime, overall thrombosis rates were also similar in both groups; 1.6% vs 1.6%, P>0.05.Conclusion Although calcified coronary lesion was hard to stent, successful percutaneous coronary intervention with SES stenting for calcified lesions was conferred by the similar favorable results that were seen when comparing non-calcified and calcified coronary lesions.

  1. Experimental Study of Nicotine on Angiogenesis and Restenosis

    Institute of Scientific and Technical Information of China (English)

    Yin Ruixing; Bi Qi; Liu Tangwei

    2005-01-01

    Objectives To investigate the effects of nicotine on angiogenesis and restenosis in a rabbit model of critical limb ischemia and balloon catheter denuding injury iliac artery. Methods Forty male New Zealand White rabbits were randomly divided into control, low-, middle-, and high-dose (0.005,0.05 or 5 μg/kg, respectively) nicotine groups.Balloon catheter denuding injury iliac artery and ligation of a femoral artery were performed in all animals fed with a high-cholesterol diet (HCD)beginning 2 weeks before operation. Nicotine was administered daily by intramuscular injection in the ischemic hindlimb for 3 weeks. Control rabbits received an equal volume of phosphate-buffered saline alone.Collateral vessels of the ischemic hindlimb were observed by angiography of abdominal aorta, and the density of intramuscular microvessels in ischemic hindlimb was examined by immunohistochemistry. The levels of blood lipids and the indexes of hepatic or renal functions were also determined before HCD and after nicotine treatment. Results One rabbit in control, two in low-, one in middle- and two in high-dose group died during the experiment. The remaining 34 rabbits were included in the study. Two or five weeks after HCD, the levels of blood lipids were significantly increased in all groups, but there was no significant difference on the levels between control and nicotine-treated groups three weeks after nicotine treatment; The indexes of hepatic or renal functions were no significant changes three weeks after nicotine treatment; There were no significant differences on collateral vessels shown by angiography in all four groups; The density of intramuscular microvessels in three nicotine-treated groups was significantly higher than that in control group; But the intimal area in all three nicotine-treated groups was also larger than that in control group.Conclusions The present study shows that intramuscular administration of nicotine for three weeks could not increase

  2. Maximizing benefit of drug-eluting stent by direct coronary stenting because of further reduction of inflammatory response

    Institute of Scientific and Technical Information of China (English)

    LI Jian-jun; GAO Run-lin

    2009-01-01

    @@ Coronary stents have been used as standard mechanical devices for percutaneous coronary intervention (PCI) in patients with coronary artery disease (CAD).1-3 They provide vessel wall scaffolding and prevent early elastic recoil and restenosis, which are major limitations of balloon angioplasty.4,5 Consequently, coronary stenting has a higher successful rate of PCI and improves the clinical outcome of the patients with CAD.6

  3. Endovascular brachytherapy to prevent restenosis after angioplasty; Endovaskulaere Brachytherapie in der Restenoseprophylaxe nach Angioplastie und Stentimplantation: Eine Uebersicht

    Energy Technology Data Exchange (ETDEWEB)

    Wohlgemuth, W.A.; Bohndorf, K. [Klinikum Augsburg (Germany). Klinik fuer Diagnostische Radiologie und Neuroradiologie

    2003-02-01

    Endovascular radiotherapy is the first effective prophylaxis of restenosis after percutaneous transluminal angioplasty (PTA) and stenting. The FDA recently approved two devices for the delivery of intracoronary radiation following coronary artery stenting. Published multicenter, double-blind, randomized trials of intracoronary radiation therapy report good results for preventing in-stent restenosis, while the data for the peripheral circulation are still inconclusive. Beta-emitters are easier applicable and probably also safer, whereas gamma-emitters have been more extensively evaluated clinically so far. Primary indication for endovascular brachytherapy are patients at high risk for restenosis, such as previous restenoses, in-stent hyperplasia, long stented segment, long PTA lesion, narrow residual vascular lumen and diabetes. Data from coronary circulation suggest a safety margin of at least 4 to 10 mm at both ends of the angioplastic segment to avoid edge restenosis. To prevent late thrombosis of the treated coronary segment, antiplatelet therapy with clopidogrel and aspirin are recommended for at least 6 months after PTA and for 12 months after a newly implanted stent. An established medication regimen after radiotherapy of peripheral arteries is still lacking. (orig.) [German] Die endovaskulaere Radiotherapie stellt das erste erfolgreiche Therapiekonzept in der Restenoseprophylaxe nach PTA und Stentimplantation dar. Am 3.11.2000 hat die amerikanische Food and Drug Administration erstmalig zwei Brachytherapiegeraete zur Restenoseprophylaxe nach Koronararterien-Stenting zugelassen. Grosse multizentrische, kontrollierte Studien wurden fuer das koronare Stromgebiet mit positiven Ergebnissen publiziert, die Datenlage im peripheren Stromgebiet ist noch ungenuegend. Beta-Strahler bieten Vorteile in der Anwendung, moeglicherweise auch in der Sicherheit, Gamma-Strahler dagegen sind besser klinisch evaluiert. Die primaere Indikation zur endovaskulaeren Brachytherapie

  4. A Clinical model to identify patients with high-risk coronary artery disease

    NARCIS (Netherlands)

    Y. Yang (Yelin); L. Chen (Li); Y. Yam (Yeung); S. Achenbach (Stephan); M. Al-Mallah (Mouaz); D.S. Berman (Daniel); M.J. Budoff (Matthew); F. Cademartiri (Filippo); T.Q. Callister (Tracy); H.-J. Chang (Hyuk-Jae); V.Y. Cheng (Victor); K. Chinnaiyan (Kavitha); R.C. Cury (Ricardo); A. Delago (Augustin); A. Dunning (Allison); G.M. Feuchtner (Gudrun); M. Hadamitzky (Martin); J. Hausleiter (Jörg); R.P. Karlsberg (Ronald); P.A. Kaufmann (Philipp); Y.-J. Kim (Yong-Jin); J. Leipsic (Jonathon); T.M. LaBounty (Troy); F.Y. Lin (Fay); E. Maffei (Erica); G.L. Raff (Gilbert); L.J. Shaw (Leslee); T.C. Villines (Todd); J.K. Min (James K.); B.J.W. Chow (Benjamin)

    2015-01-01

    textabstractObjectives This study sought to develop a clinical model that identifies patients with and without high-risk coronary artery disease (CAD). Background Although current clinical models help to estimate a patient's pre-test probability of obstructive CAD, they do not accurately identify th

  5. A Clinical model to identify patients with high-risk coronary artery disease

    NARCIS (Netherlands)

    Y. Yang (Yelin); L. Chen (Li); Y. Yam (Yeung); S. Achenbach (Stephan); M. Al-Mallah (Mouaz); D.S. Berman (Daniel); M.J. Budoff (Matthew); F. Cademartiri (Filippo); T.Q. Callister (Tracy); H.-J. Chang (Hyuk-Jae); V.Y. Cheng (Victor); K. Chinnaiyan (Kavitha); R.C. Cury (Ricardo); A. Delago (Augustin); A. Dunning (Allison); G.M. Feuchtner (Gudrun); M. Hadamitzky (Martin); J. Hausleiter (Jörg); R.P. Karlsberg (Ronald); P.A. Kaufmann (Philipp); Y.-J. Kim (Yong-Jin); J. Leipsic (Jonathon); T.M. LaBounty (Troy); F.Y. Lin (Fay); E. Maffei (Erica); G.L. Raff (Gilbert); L.J. Shaw (Leslee); T.C. Villines (Todd); J.K. Min (James K.); B.J.W. Chow (Benjamin)

    2015-01-01

    textabstractObjectives This study sought to develop a clinical model that identifies patients with and without high-risk coronary artery disease (CAD). Background Although current clinical models help to estimate a patient's pre-test probability of obstructive CAD, they do not accurately identify th

  6. A new beating-heart off-pump coronary artery bypass grafting training model

    NARCIS (Netherlands)

    Bouma, Wobbe; Kuijpers, Michiel; Bijleveld, Aanke; De Maat, Gijs E.; Koene, Bart M.; Erasmus, Michiel E.; Natour, Ehsan; Mariani, Massimo A.

    OBJECTIVES: Training models are essential in mastering the skills required for off-pump coronary artery bypass grafting (OPCAB). We describe a new, high-fidelity, effective and reproducible beating-heart OPCAB training model in human cadavers. METHODS: Human cadavers were embalmed according to the

  7. Prevention and treatment of in-stent restenosis.

    Science.gov (United States)

    Bosiers, M; Deloose, K; Keirs, K; Verbist, J; Peeters, P

    2010-08-01

    In-stent restenosis has always been an important issue, since the launch of the first stents on the market. The occurrence of in-stent restenosis (ISR) is due to two main reasons. First, the presence of stent fractures significantly influences restenosis rates. Second, the continuous interaction between the permanently implanted artificial material and the vessel tissue, leads to physical irritation, long-term endothelial dysfunction, or chronic inflammatory reactions. In the Literature only very limited data on ISR treatment in the peripheral arteries are available. There are no peer-reviewed publications or studies with in-depth follow-up on this specific indication. The underlying reason for this probably being that currently available treatments do not yield satisfactory results. However, the continuing search for better solutions and the technological evolution lead to the introduction of the Viabahn with PROPATEN coating, DES and DCB, which may result in the first promising treatment options for ISR.

  8. Study of restenosis in drug eluting stents: new insights from greyscale intravascular ultrasound and virtual histology.

    Science.gov (United States)

    Garcia-Garcia, Hector M; Shen, Zhujun; Piazza, Nicolo

    2009-05-01

    In current cardiology practice, many patients undergo secondary revascularisation due to reduced long-term vein graft patency or in-stent restenosis. In this report, we describe causes of drug-eluting stent restenosis identifiable by intravascular ultrasound imaging (IVUS) and variables related to restenosis used for reporting greyscale IVUS. In addition, IVUS findings in bypass grafts and the long-term results after stent implantation are provided. Finally, the usefulness of IVUS virtual histology for the study of restenosis is described.

  9. 支架内再狭窄的机制及防治进展%Mechanism of In-stent Restenosis and Progress of the Prevention and Treatment

    Institute of Scientific and Technical Information of China (English)

    刘雯

    2012-01-01

    In-stent restenosis is an important medical problem of coronary atherosclerotic heart disease ( coronary disease for short intervention. Its main mechanism includes: elastic recoil of vessels, formation of thrombus,hyperplasia of smooth muscle and inflammatory reaction and so on. According to the main mechanism there are several methods to prevent stent restenosis including antiplatelet drugs,drug-eluting stents and new material stents and so on. Here is to summarize the main mechanism and the progress of prevention and treatment of in-stent restenosis.%支架内再狭窄是冠状动脉粥样硬化性心脏病介入治疗技术中面临的重要医学难题.目前研究其主要发生机制有血管弹性回缩、血栓形成、平滑肌过度增生和炎性反应等.针对其主要机制的防治支架内再狭窄的方法有抗血小板药物的使用、药物涂层支架的使用和新型材料支架的使用等.现就支架内再狭窄发生机制及防治进展予以综述.

  10. Recruitable collateral blood flow index predicts coronary instent restenosis after percutaneous coronary intervention

    DEFF Research Database (Denmark)

    Jensen, Lisette Okkels; Thayssen, Per; Lassen, Jens Flensted

    2007-01-01

    in patients undergoing PCI with bare metal stents and using optimal antithrombotic treatment. METHODS AND RESULTS: In 95 patients, 95 de novo lesions were treated with PCI and a bare metal stent. Fractional flow reserve (FFR) at maximum hyperaemia induced by intravenous adenosine was determined. The pressure.......25) had a lower pre-interventional FFR (0.50 +/- 0.14 vs. 0.72 +/- 0.18, P ratio 1.07, 95% CI 1...

  11. Antiplatelet therapy in the era of percutaneous coronary intervention with drug-eluting balloons.

    Science.gov (United States)

    Bonaventura, Klaus; Sonntag, Steffen; Kleber, Franz X

    2011-05-01

    The high rate of restenosis associated with percutaneous coronary intervention (PCI) procedures can be reduced with the implantation of metallic stents into the stenotic vessels. The knowledge that neointimal formation can result in restenosis after stent implantation led to the development of drug-eluting stents (DES) which require long lasting antiplatelet therapy to avoid thrombotic complications. In the last years, the drug-eluting balloon (DEB) technology has emerged as an alternative option for the treatment of coronary and peripheral arteries. Clinical studies demonstrated the safety and effectiveness of DEB in various clinical scenarios and support the use of paclitaxel-eluting balloons for the treatment of in-stent restenosis, of small coronary arteries and bifurcations lesions. The protocols of DEB studies suggest that the dual antiplatelet therapy with aspirin and clopidogrel of four weeks after DEB is safe and effective.

  12. Long-term Luminal Renarrowing After Successful Elective Coronary Angioplasty of Total Occlusions : A Quantitative Angiographic Analysis

    NARCIS (Netherlands)

    A.G. Violaris (Andonis); R. Melkert (Rein); P.W.J.C. Serruys (Patrick)

    1995-01-01

    textabstractBackground The long-term angiographic outcome after successful dilatation of coronary occlusions remains unclear. The objective of this study was to examine long-term restenosis after successful balloon dilatation of coronary occlusions at a predetermined time interval with quantitative

  13. Role of endovascular irradiation in the prevention of vascular restenosis following angioplasty; Role de la curietherapie endovasculaire dans la prevention de la restenose vasculaire apres angioplastie

    Energy Technology Data Exchange (ETDEWEB)

    Noel, G.; Feuvret, L.; Mazeron, J.J.; Pousset, F. [Hopital Pitie-Salpetriere, 75 - Paris (France); Bourhis, J.; Gerbaulet, A. [Institut Gustave Roussy, 94 - Villejuif (France); Popowski, Y. [Hopital Universitaire, Geneve (Switzerland)

    1998-07-01

    About 30% of patients who underwent percutaneous transluminal coronary angioplasty show evidence of restenosis, which appears to be independent of the angioplasty method used. The restenosis is due of two factors, Firstly migration of smooth vascular muscle cells of the vascular media to the intima and multiplication which lead to the formation of a neo-intima. Irradiation limits the proliferation by acting of the cells in the mitotic stage. The vascular target volume is not very thick and is difficult to define it, that why brachytherapy seems to be the best procedure to prevent restenosis. However, the development of this treatment present many difficulties. Different irradiation techniques have been studied. Such techniques include catheter containing radioactive sealed source, radioactive stent, or balloon containing radioactive liquid inside. Each of these methods have their own advantages, inconveniences, problems and risks. Radioisotope may be either beta or gamma emitters.Gamma emitter presents problems for radioprotection but the satisfactory dose distribution may be difficult to obtain using beta emitter. Choice of dose, dose rate and delay between the end of angioplasty and the beginning of brachytherapy is subject to some discuss. Animal experiments using radioisotope have shown reduction in cell proliferation. Human trials showed feasibility, safety of the method and real impact on restenosis prevention. However, long-term efficacy has not been proved because the follow-up of the patients is too short. A randomized trial of {sup 192}Ir brachytherapy for prevention of restenosis has recently shown the efficacy in short and median term. However, long term efficiency and secondary effects have not yet been established as the follow up time of this study is still too short. That is why, collaboration between cardiologists and radiotherapists and physicists is indispensable to enable the development of an optimal technique. (authors)

  14. Assessment of collateral artery function and growth in a pig model of stepwise coronary occlusion

    NARCIS (Netherlands)

    de Groot, Daphne; Grundmann, Sebastian; Timmers, Leo; Pasterkamp, Gerard; Hoefer, Imo E.

    2011-01-01

    de Groot D, Grundmann S, Timmers L, Pasterkamp G, Hoefer IE. Assessment of collateral artery function and growth in a pig model of stepwise coronary occlusion. Am J Physiol Heart Circ Physiol 300: H408-H414, 2011. First published October 15, 2010; doi: 10.1152/ajpheart.00070.2010.-Therapeutic stimul

  15. Comparison of neointimal morphology of in-stent restenosis with sirolimus-eluting stents versus bare metal stents: virtual histology-intravascular ultrasound analysis.

    Science.gov (United States)

    Yamamoto, Yoshihiro; Otani, Hajime; Iwasaka, Junji; Park, Haengnam; Sakuma, Takao; Kamihata, Hiroshi; Iwasaka, Toshiji

    2011-09-01

    Sirolimus-eluting stents (SES) have reduced the incidence of restenosis and target lesion revascularization compared to bare metal stents (BMS). However, inhibition of endothelialization and neointimal formation after SES implantation may produce vulnerable plaques. The present study compared the neointimal morphology of in-stent restenosis (ISR) between SES and BMS using virtual histology-intravascular ultrasound (VH-IVUS). Thirty ISR lesions (SES n = 15, BMS n = 15) demonstrated by coronary angiography in 30 patients with stable angina pectoris were analyzed with VH-IVUS between 6 months to 3 years after stent implantation. Tissue maps were reconstructed from radiofrequency data using VH-IVUS software. ISR lesions after SES implantation consisted of a significantly increased necrotic core (NC) compared to BMS (12.9 vs. 5.6% of neointimal volume, p stent thrombosis after SES implantation.

  16. Coronary microembolization with normal epicardial coronary arteries and no visible infarcts on nitrobluetetrazolium chloride-stained specimens: Evaluation with cardiac magnetic resonance imaging in a swine model

    Energy Technology Data Exchange (ETDEWEB)

    Jin, Hang; Yun, Hong; Zeng, Meng Su [Dept. of Radiology, Zhongshan Hospital, Fudan University and Shanghai Institute of Medical Imaging, Shanghai (China); Ma, Jian Ying; Chen, Zhang Wei; Chang, Shu Fu [Dept. of Cardiology, Zhongshan Hospital, Fudan University and Shanghai Institute of Cardiovascular Diseases, Shanghai (China)

    2016-02-15

    To assess magnetic resonance imaging (MRI) features of coronary microembolization in a swine model induced by small-sized microemboli, which may cause microinfarcts invisible to the naked eye. Eleven pigs underwent intracoronary injection of small-sized microspheres (42 µm) and catheter coronary angiography was obtained before and after microembolization. Cardiac MRI and measurement of cardiac troponin T (cTnT) were performed at baseline, 6 hours, and 1 week after microembolization. Postmortem evaluation was performed after completion of the imaging studies. Coronary angiography pre- and post-microembolization revealed normal epicardial coronary arteries. Systolic wall thickening of the microembolized regions decreased significantly from 42.6 ± 2.0% at baseline to 20.3 ± 2.3% at 6 hours and 31.5 ± 2.1% at 1 week after coronary microembolization (p < 0.001 for both). First-pass perfusion defect was visualized at 6 hours but the extent was largely decreased at 1 week. Delayed contrast enhancement MRI (DE-MRI) demonstrated hyperenhancement within the target area at 6 hours but not at 1 week. The microinfarcts on gross specimen stained with nitrobluetetrazolium chloride were invisible to the naked eye and only detectable microscopically. Increased cTnT was observed at 6 hours and 1 week after microembolization. Coronary microembolization induced by a certain load of small-sized microemboli may result in microinfarcts invisible to the naked eye with normal epicardial coronary arteries. MRI features of myocardial impairment secondary to such microembolization include the decline in left ventricular function and myocardial perfusion at cine and first-pass perfusion imaging, and transient hyperenhancement at DE-MRI.

  17. COMPARISON OF SHORT- AND LONG-TERM OUTCOMES BETWEEN CYPHER AND TAXUS DRUG-ELUTING STENTS FOR IN-STENT RESTENOSIS

    Institute of Scientific and Technical Information of China (English)

    Ji-lin Chen; Jue Chen; Shi-jie You; Jun Dai; Jian-jun Li; Run-lin Gao; Yue-jin Yang; Shu-bin Qiao; Min Yao; Xue-wen Qin; Bo Xu; Hai-bo Liu; Yong-jian Wu; Jin-qing Yuan

    2007-01-01

    Objective To compare the short- and long-term clinical outcomes between sirolimus-eluting stent (Cypher stent) and paclitaxel-eluting stent (TAXUS stent) in patients with in-stent restenosis (ISR) lesions of the coronary arteries.Methods From December 2002 to March 2005, 253 patients with ISR lesions of the coronary arteries were selected and divided into two groups. Cypher group (152 cases) was treated with Cypher or Cypher Select stents, and TAX-US group (101 cases) with TAXUS stents. A total of 262 ISR lesions in these patients were treated with 308 drug-eluting stents (DESs), including 176 Cypher or Cypher Select stents and 132 TAXUS stents. All patients were followed up for 10 months. Procedure success rates of DES implantation in both groups were observed. Major adverse cardiac events (MACE) rates in hospital and at 10 months follow-up, as well as in-DES restenosis observed using coronary angiogra-phy at follow-up were compared between two groups.Results Success rate of DES implantation was 100% in both groups. No significant difference in MACE rate during hospitalization was found between the two groups. However, at 10 months follow-up, MACE rate was higher in TAXUS group than in Cypher group (16.00% vs. 6.67% , P = 0.031). As for coronary angiography at 10 months follow-up, we observed an increasing tendency of in-DES restenosis rate in TAXUS group compared with Cypher group (29.41% vs. 14.04%, P= 0.075).Conclusions Cypher and TAXUS DESs both have good short- and long-term outcomes in treating ISR. Cypher DES proved better long-term clinical outcome than TAXUS DES.

  18. Cutting balloon for in-stent restenosis: acute and long-term results.

    Science.gov (United States)

    Rahel, Braim M; Suttorp, Maarten Jan; ten Berg, Jurrien M; Bal, Egbert T; Ernst, Sjef M P G; Rensing, Benno J; Kelder, Johannes C; Plokker, H W Thijs

    2004-08-01

    Conventional percutaneous coronary intervention for the treatment of in-stent restenosis (ISR) has shown a high rate of ISR (30-55%). Considering the need for both extrusion of hyperplastic intima and additional stent expansion, a cutting balloon might be more effective for the treatment of ISR. We prospectively assessed the immediate and 8-month outcome of balloon angioplasty using the Barath Cutting Balloon in 100 consecutive patients (mean age: 60.5 +/- 10.8 years, 71% male). In 73 lesions (73%), a good result was reached with the cutting balloon only. In 21 lesions (21%) postdilatation and in 6 lesions (6%) predilatation with a conventional balloon was necessary. The mean inflation pressure was 8.7 +/- 2.0 (range: 6.0-18.0) atm. Before the procedure the mean minimal luminal diameter (MLD) was 0.95 +/- 0.45 mm. Quantitative coronary analysis showed a mean diameter stenosis of 65%+/- 16%. Immediately after the procedure the mean MLD was 2.42 +/- 0.54 mm with a mean diameter stenosis of 19%+/- 13%. Two patients died during the follow-up period (1 stroke, 1 nonvascular). At 8-month follow-up 26 patients (26%) reported to have anginal complaints CCS class II-IV of whom 16 (16%) needed target lesion revascularization. Treatment of ISR using the Barath Cutting Balloon can be performed safely with good immediate results and a relatively low need for repeated target lesion revascularization at 8-month follow-up.

  19. A potential marker of bare metal stent restenosis: monocyte count - to- HDL cholesterol ratio.

    Science.gov (United States)

    Ucar, Fatih Mehmet

    2016-10-03

    Oxidation and inflammation play significant roles in the pathogenesis of coronary artery diseases. Monocyte count to high-density lipoprotein (HDL) cholesterol ratio (MHR) is a new marker and has revealed as an indicator of inflammation in the literature. The present study aimed to search the effect of MHR on in-stent restenosis (ISR) in patients with stable or unstable angina pectoris undergoing bare-metal stent (BMS) implantation. A total of 468 consecutive stable or unstable angina pectoris patients (mean age 60.3 ± 10.1 and 70 % men) who had undergone successful BMS implantation were included the study. Serum samples were obtained before the procedure. The mean period between two coronary angiography procedures was 14 ± 7.9 months. The baseline MHR levels were significantly higher in patients that had ISR (odds ratio, 3.64; 95 % confidence interval, 2.45- 4.84; P MHR levels emerged as independent predictors of ISR. Our results indicate that elevated MHR is an independent and powerful predictor of ISR in patients with stable or unstable angina pectoris who underwent successful BMS implantation.

  20. Assessment Of Coronary Artery Aneurysms Using Transluminal Attenuation Gradient And Computational Modeling In Kawasaki Disease Patients

    Science.gov (United States)

    Grande Gutierrez, Noelia; Kahn, Andrew; Shirinsky, Olga; Gagarina, Nina; Lyskina, Galina; Fukazawa, Ryuji; Owaga, Shunichi; Burns, Jane; Marsden, Alison

    2015-11-01

    Kawasaki Disease (KD) can result in coronary artery aneurysms (CAA) in up to 25% of patients, putting them at risk of thrombus formation, myocardial infarction and sudden death. Clinical guidelines recommend CAA diameter >8 mm as the arbitrary criterion for initiating systemic anticoagulation. KD patient specific modeling and flow simulations suggest that hemodynamic data can predict regions at increased risk of thrombosis. Transluminal Attenuation Gradient (TAG) is determined from the change in radiological attenuation per vessel length and has been proposed as a non-invasive method for characterizing coronary stenosis from CT Angiography. We hypothesized that CAA abnormal flow could be quantified using TAG. We computed hemodynamics for patient specific coronary models using a stabilized finite element method, coupled numerically to a lumped parameter network to model the heart and vascular boundary conditions. TAG was quantified in the major coronary arteries. We compared TAG for aneurysmal and normal arteries and we analyzed TAG correlation with hemodynamic and geometrical parameters. Our results suggest that TAG may provide hemodynamic data not available from anatomy alone. TAG represents a possible extension to standard CTA that could help to better evaluate the risk of thrombus formation in KD.

  1. New stent design for use in small coronary arteries during percutaneous coronary intervention

    Directory of Open Access Journals (Sweden)

    Juan F Granada

    2010-10-01

    Full Text Available Juan F Granada1, Barbara A Huibregtse2, Keith D Dawkins21The Jack H Skirball Center for Cardiovascular Research, Cardiovascular Research Foundation, Columbia University Medical Center, New York, NY, USA; 2Boston Scientific Corporation, Natick, MA, USAAbstract: Patients with diabetes mellitus, of female gender, increased age, and/or with peripheral vascular disease often develop coronary stenoses in small caliber vessels. This review describes treatment of these lesions with the paclitaxel-eluting 2.25 mm TAXUS® Liberté® Atom™ stent. Given the same stent composition, polymer, antirestenotic drug (paclitaxel, and release kinetics as the first-generation 2.25 mm TAXUS® Express® Atom™ stent, the second-generation TAXUS Liberté Atom stent incorporates improved stent design characteristics, including thinner struts (0.0038 versus 0.0052 inches, intended to increase conformability and deliverability. In a porcine noninjured coronary artery model, TAXUS Liberté Atom stent implantation in small vessels demonstrated complete strut tissue coverage compared with the bare metal stent control, suggesting a similar degree of tissue healing between the groups at 30, 90, and 180 days. The prospective, single-armed TAXUS ATLAS Small Vessel trial demonstrated improved instent late loss (0.28 ± 0.45 versus 0.84 ± 0.57 mm, P < 0.001, instent binary restenosis (13.0% versus 38.1%, P < 0.001, and target lesion revascularization (5.8% versus 17.6%, P < 0.001 at nine months with the TAXUS Liberté Atom stent as compared with the bare metal Express stent control, with similar safety measures between the two groups. The TAXUS Liberté Atom also significantly reduced nine-month angiographic rates of both instent late loss (0.28 ± 0.45 versus 0.44 ± 0.61 mm, P = 0.03 and instent binary restenosis (13.0% versus 25.9%, P = 0.02 when compared with the 2.25 mm TAXUS Express Atom control. The observed reduction in target lesion revascularization with the TAXUS

  2. PIV-validated numerical modeling of pulsatile flows in distal coronary end-to-side anastomoses.

    Science.gov (United States)

    Xiong, F L; Chong, C K

    2007-01-01

    This study employed particle image velocimetry (PIV) to validate a numerical model in a complementary approach to quantify hemodynamic factors in distal coronary anastomoses and to gain more insights on their relationship with anastomotic geometry. Instantaneous flow fields and wall shear stresses (WSS) were obtained from PIV measurement in a modified life-size silastic anastomosis model adapted from a conventional geometry by incorporating a smooth graft-artery transition. The results were compared with those predicted by a concurrent numerical model. The numerical method was then used to calculate cycle-averaged WSS (WSS(cyc)) and spatial wall shear stress gradient (SWSSG), two critical hemodynamic factors in the pathogenesis of intimal thickening (IT), to compare the conventional and modified geometries. Excellent qualitative agreement and satisfactory quantitative agreement with averaged normalized error in WSS between 0.8% and 8.9% were achieved between the PIV experiment and numerical model. Compared to the conventional geometry, the modified geometry produces a more uniform WSS(cyc) distribution eliminating both high and low WSS(cyc) around the toe, critical in avoiding IT. Peak SWSSG on the artery floor of the modified model is less than one-half that in the conventional case, and high SWSSG at the toe is eliminated. The validated numerical model is useful for modeling unsteady coronary anastomotic flows and elucidating the significance of geometry regulated hemodynamics. The results suggest the clinical relevance of constructing smooth graft-artery transition in distal coronary anastomoses to improve their hemodynamic performance.

  3. Continuum damage model for bioresorbable magnesium alloy devices - Application to coronary stents.

    Science.gov (United States)

    Gastaldi, D; Sassi, V; Petrini, L; Vedani, M; Trasatti, S; Migliavacca, F

    2011-04-01

    The main drawback of a conventional stenting procedure is the high risk of restenosis. The idea of a stent that "disappears" after having fulfilled its mission is very intriguing and fascinating, since it can be expected that the stent mass decreases in time to allow the gradual transmission of the mechanical load to the surrounding tissues owing to controlled dissolution by corrosion. Magnesium and its alloys are appealing materials for designing biodegradable stents. The objective of this work is to develop, in a finite element framework, a model of magnesium degradation that is able to predict the corrosion rate, thus providing a valuable tool for the design of bioresorbable stents. Continuum damage mechanics is suitable for modeling several damage mechanisms, including different types of corrosion. In this study, the damage is assumed to be the superposition of stress corrosion and uniform microgalvanic corrosion processes. The former describes the stress-mediated localization of the corrosion attack through a stress-dependent evolution law, while the latter affects the free surface of the material exposed to an aggressive environment. Comparisons with experimental tests show that the developed model can reproduce the behavior of different magnesium alloys subjected to static corrosion tests. The study shows that parameter identification for a correct calibration of the model response on the results of uniform and stress corrosion experimental tests is reachable. Moreover, three-dimensional stenting procedures accounting for interaction with the arterial vessel are simulated, and it is shown how the proposed modeling approach gives the possibility of accounting for the combined effects of an aggressive environment and mechanical loading.

  4. Ventricular Fibrillation Waveform Changes during Controlled Coronary Perfusion Using Extracorporeal Circulation in a Swine Model

    Science.gov (United States)

    Kaufman, Christopher L.; Baetiong, Alvin; Radhakrishnan, Jeejabai

    2016-01-01

    Background Several characteristics of the ventricular fibrillation (VF) waveform have been found predictive of successful defibrillation and hypothesized to reflect the myocardial energy state. In an open-chest swine model of VF, we modeled “average CPR” using extracorporeal circulation (ECC) and assessed the time course of coronary blood flow, myocardial metabolism, and myocardial structure in relation to the amplitude spectral area (AMSA) of the VF waveform without artifacts related to chest compression. Methods VF was induced and left untreated for 8 minutes in 16 swine. ECC was then started adjusting its flow to maintain a coronary perfusion pressure of 10 mmHg for 10 minutes. AMSA was calculated in the frequency domain and analyzed continuously with a 2.1 s timeframe and a Tukey window that moved ahead every 0.5 s. Results AMSA progressively declined during untreated VF. With ECC, AMSA increased from 7.0 ± 1.9 mV·Hz (at minute 8) to 12.8 ± 3.3 mV·Hz (at minute 14) (p < 0.05) without subsequent increase and showing a modest correlation with coronary blood flow of borderline statistical significance (r = 0.489, p = 0.0547). Myocardial energy measurements showed marked reduction in phosphocreatine and moderate reduction in ATP with increases in ADP, AMP, and adenosine along with myocardial lactate, all indicative of ischemia. Yet, ischemia did not resolve during ECC despite a coronary blood flow of ~ 30% of baseline. Conclusion AMSA increased upon return of coronary blood flow during ECC. However, the maximal level was reached after ~ 6 minutes without further change. The significance of the findings for determining the optimal timing for delivering an electrical shock during resuscitation from VF remains to be further explored. PMID:27536996

  5. Structural Model of psychological risk and protective factors affecting on quality of life in patients with coronary heart disease: A psychocardiology model

    OpenAIRE

    Zohreh Khayyam Nekouei; Alireza Yousefy; Hamid Taher Neshat Doost; Gholamreza Manshaee; Masoumeh Sadeghei

    2014-01-01

    Background: Conducted researches show that psychological factors may have a very important role in the etiology, continuity and consequences of coronary heart diseases. This study has drawn the psychological risk and protective factors and their effects in patients with coronary heart diseases (CHD) in a structural model. It aims to determine the structural relations between psychological risk and protective factors with quality of life in patients with coronary heart disease. Materials and M...

  6. Safety and efficacy of limus-eluting stents and balloon angioplasty for sirolimus-eluting in-stent restenosis

    Energy Technology Data Exchange (ETDEWEB)

    Ota, Hideaki [Division of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC 20010 (United States); Mahmoudi, Michael [University of Surrey, Guildford Road, Surrey, GU2-7XH (United Kingdom); Kitabata, Hironori; Torguson, Rebecca; Chen, Fang; Satler, Lowell F.; Suddath, William O.; Pichard, Augusto D. [Division of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC 20010 (United States); Waksman, Ron, E-mail: ron.waksman@medstar.net [Division of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC 20010 (United States)

    2015-03-15

    Objectives: The aim of this study was to compare the safety and efficacy of everolimus-eluting stent (EES), sirolimus-eluting stent (SES), and plain old balloon angioplasty (POBA) for the treatment of SES in-stent restenosis (S-ISR). Background: The optimal treatment for drug-eluting in-stent restenosis remains controversial. Methods: The study cohort comprised 310 consecutive patients (444 lesions) who presented with S-ISR to our institution and underwent treatment with EES (43 patients), SES (102), or POBA (165). The analyzed clinical parameters were the 1-year rates of death, Q-wave myocardial infarction (MI), target lesion revascularization (TLR), target vessel revascularization (TVR), definite stent thrombosis (ST) and major adverse cardiac event (MACE) defined as the composite of death, MI, or TLR at 1-year. Results: The three groups were well matched for the conventional risk factors for coronary artery disease except for smoking. The 1-year analyzed clinical parameters were similar in the three groups: MACE (EES = 14%, SES = 18%, POBA = 20%; p = 0.65), death (EES = 2.3%, SES = 6.2%, POBA = 6.1%; p = 0.61), MI (EES = 4.8%, SES = 2.1%, POBA = 2.5%; p = 0.69), TLR (EES = 11.9%, SES = 12.1%, POBA = 24%; p = 0.78), and TVR (EES = 11.9%, SES = 24.8%, POBA = 22.2%; p = 0.23). There were no cases of definite ST. MACE-free rate was significantly lower in patients with recurrent in-stent restenosis (log-rank p = 0.006). Presentation with acute MI, number of treated lesions and a previous history of MI were found to be independent predictors of MACE. Conclusions: In patients presenting with S-ISR, treatment with implantation of an EES, SES, or POBA is associated with similar clinical outcomes. Patients presenting with recurrent ISR may have a poorer clinical outcome.

  7. Sappan Lignum Extract Inhibits Restenosis in the Injured Artery through the Deactivation of Nuclear Factor-κB

    Directory of Open Access Journals (Sweden)

    Guang Long

    2014-08-01

    Full Text Available The aim of the study was to explore whether Sappan Lignum Extract (SLE would inhibit vascular restenosis in injured artery and its inhibitory mechanism by using a balloon-injured rat carotid artery restenosis model. Different doses of SLE were administered to the rats by tube feeding, starting from four days before surgery and continuing twice per day for two weeks after carotid injury. Injured carotid arteries isolated from rats were embedded in paraffin block and tissue sections were stained with H&E to assess restenosis. The Effects of SLE on vascular restenosis, which are involved in smooth muscle cell cycle, NF-κB p65 expression, and Superoxide (O2- production, was assessed by RT-PCR, western blot assay, and immunohistochemistry. The results showed that in a rat carotid model of balloon dilatation injury, SLE significantly reduced the intimal-to-medial area ratio and vascular restenosis after 14 days of the injury. Immunohistochemistry study revealed no inhibited PCNA expression caused by SLE. Rat serum containing Sappan Lignum (RSC was found neither anti-proliferative effect in cultured vascular smooth muscle cells (VSMCs and nor arrest cell cycle progress detected by flow cytometry. RSC remarkably decreased the expression of TNF-α mRNA and protein in cultured VSMCs. Electrophoretic mobility shift assay proved that RSC inhibited the binding of NF-κB to specific DNA sequences in TNF-α treated VSMCs. Western blot pronounced that RSC and N-acetyl-L-cysteine (NAC reduced expression of NF-κB p65 in nuclear extracts in TNF-α treated VSMCs. RSC and NAC also attenuated superoxide anion generation in TNF-α treated VSMCs. In summary, the inhibitory effects of SLE on vascular restenosis may not be mediated through inhibiting vascular cell proliferation, but through inhibiting vascular inflammation instead, which may be attributed to the inhibition of TNF-α and subsequent deactivation of NF-κB, which was in part mediated through inhibiting

  8. Andrographolide inhibits NF-kappaBeta activation and attenuates neointimal hyperplasia in arterial restenosis.

    Science.gov (United States)

    Wang, Yu-Jiu; Wang, Jin-Tao; Fan, Quan-Xin; Geng, Jian-Guo

    2007-11-01

    The NF-kappaBeta transcription factors modulate the expression of tissue factor (TF), E-selectin (CD62E) and vascular cell adhesion molecule-1 (VCAM-1), which are essential for thrombosis and inflammation. We have previously shown that andrographolide (Andro) covalently modifies the reduced cysteine(62) of p50 - a major subunit of NF-kappaBeta transcription factors, thus blocking the binding of NF-kappaBeta transcription factors to the promoters of their target genes, preventing NF-kappaBeta activation and inhibiting inflammation in vitro and in vivo. Here we report that Andro, but not its inactive structural analog 4H-Andro, significantly suppressed the proliferation of arterial neointima ( approximately 60% reduction) in a murine model of arterial restenosis. Consistently, p50(-/-) mice manifested attenuated neointimal hyperplasia upon arterial ligation. Notably, the same dosage of Andro did not further reduce neointimal formation in p50(-/-) mice, which implicates the specificity of Andro on p50 for treating experimental arterial restenosis. The upregulation of NF-kappaBeta target genes, including TF, E-selectin and VCAM-1, and the increased deposition of leukocytes (mainly CD68+ macrophages) were clearly detected within the injured arterial walls, all of which were significantly abolished by treatment with Andro or genetic deletion of p50. The expression of TF, E-selectin and VCAM-1 was also markedly upregulated in the patient sample of thrombotic vasculitis, indicating the clinical relevance of NF-kappaBeta activation in the pathogeneses of occlusive arterial diseases. Our data thus indicate that, by the downregulation of the NF-kappaBeta target genes that are critical in thrombosis and inflammation, specific inhibitors of p50, such as Andro, may be therapeutically valuable for preventing and treating thrombotic arterial diseases, including neointimal hyperplasia in arterial restenosis.

  9. A validated 3D microstructure-based constitutive model of coronary artery adventitia.

    Science.gov (United States)

    Chen, Huan; Guo, Xiaomei; Luo, Tong; Kassab, Ghassan S

    2016-07-01

    A structure-based model that accurately predicts micro- or macromechanical behavior of blood vessels is necessary to understand vascular physiology. Based on recently measured microstructural data, we propose a three-dimensional microstructural model of coronary adventitia that incorporates the elastin and collagen distributions throughout the wall. The role of ground substance was found to be negligible under physiological axial stretch λz = 1.3, based on enzyme degradation of glycosaminoglycans in swine coronary adventitia (n = 5). The thick collagen bundles of outer adventitia (n = 4) were found to be undulated and unengaged at physiological loads, whereas the inner adventitia consisted of multiple sublayers of entangled fibers that bear the majority of load at higher pressures. The microstructural model was validated against biaxial (inflation and extension) experiments of coronary adventitia (n = 5). The model accurately predicted the nonlinear responses of the adventitia, even at high axial force (axial stretch ratio λz = 1.5). The model also enabled a reliable estimation of material parameters of individual fibers that were physically reasonable. A sensitivity analysis was performed to assess the effect of using mean values of the distributions for fiber orientation and waviness as opposed to the full distributions. The simplified mean analysis affects the fiber stress-strain relation, resulting in incorrect estimation of mechanical parameters, which underscores the need for measurements of fiber distribution for a rigorous analysis of fiber mechanics. The validated structure-based model of coronary adventitia provides a deeper understanding of vascular mechanics in health and can be extended to disease conditions.

  10. Risk-prediction model for ischemic stroke in patients hospitalized with an acute coronary syndrome (from the global registry of acute coronary events [GRACE]).

    Science.gov (United States)

    Park, Kay Lee; Budaj, Andrzej; Goldberg, Robert J; Anderson, Frederick A; Agnelli, Giancarlo; Kennelly, Brian M; Gurfinkel, Enrique P; Fitzgerald, Gordon; Gore, Joel M

    2012-09-01

    The risk of stroke in patients hospitalized with an acute coronary syndrome (ACS) ranges from ischemic stroke in patients with ACS to help guide clinicians in the acute management of these high-risk patients. Data were obtained from 63,118 patients enrolled from April 1999 to December 2007 in the Global Registry of Acute Coronary Events (GRACE), a multinational registry involving 126 hospitals in 14 countries. A regression model was developed to predict the occurrence of in-hospital ischemic stroke in patients hospitalized with an ACS. The main study outcome was the development of ischemic stroke during the index hospitalization for an ACS. Eight risk factors for stroke were identified: older age, atrial fibrillation on index electrocardiogram, positive initial cardiac biomarkers, presenting systolic blood pressure ≥ 160 mm Hg, ST-segment change on index electrocardiogram, no history of smoking, higher Killip class, and lower body weight (c-statistic 0.7). The addition of coronary artery bypass graft surgery and percutaneous coronary intervention into the model increased the prediction of stroke risk. In conclusion, the GRACE stroke risk score is a simple tool for predicting in-hospital ischemic stroke risk in patients admitted for the entire spectrum of ACS, which is widely applicable to patients in various hospital settings and will assist in the management of high-risk patients with ACS. Copyright © 2012 Elsevier Inc. All rights reserved.

  11. Comparison of iodinated contrast media for the assessment of atherosclerotic plaque attenuation values by CT coronary angiography: Observations in an ex vivo model

    NARCIS (Netherlands)

    L. la Grutta (Ludovico); M. Galia (Massimo); G. Gentile; G. Lo Re (G.); E. Grassedonio (Emanuele); F. Coppolino; E. Maffei (Erica); E. Maresi (E.); A. Lo Casto (A.); F. Cademartiri (Filippo); M. Midiri (Massimo)

    2013-01-01

    textabstractObjective: To compare the influence of different iodinated contrast media with several dilutions on plaque attenuation in an ex vivo coronary model studied by multislice CT coronary angiography. Methods: In six ex vivo left anterior descending coronary arteries immersed in oil, CT (slice

  12. The conical stent in coronary artery improves hemodynamics compared with the traditional cylindrical stent.

    Science.gov (United States)

    Yu, Yi; Zhou, Yujie; Ma, Qian; Jia, Shuo; Wu, Sijing; Sun, Yan; Liu, Xiaoli; Zhao, Yingxin; Liu, Yuyang; Shi, Dongmei

    2017-01-15

    This study sought to explore the efficacy of the conical stent implantation in the coronary artery by comparing the effects of cylindrical and conical stents on wall shear stress (WSS) and velocity of flow and fractional flow reserve (FFR). The traditional cylindrical stent currently used in the percutaneous coronary intervention (PCI) has a consistent diameter, which does not match the physiological change of the coronary artery. On the contrary, as a new patent, the conical stent with tapering lumen is consistent with the physiological change of vascular diameter. However, the effect of the conical stent implantation on the coronary hemodynamics remains unclear. The coronary artery, artery stenosis and two stent models were established by Solidworks software. All models were imported into the computational fluid dynamics (CFD) software ANSYS ICEM-CFD to establish the fluid model. After the boundary conditions were set, CFD analysis was proceeded to compare the effects of two stent implantation on the change of WSS, velocity of flow and FFR. Hemodynamic indexes including FFR, blood flow velocity distribution (BVD) and WSS were improved by either the cylindrical or the conical stent implantation. However, after the conical stent implantation, the change of FFR seemed to be slower and more homogenous; the blood flow velocity was more appropriate without any obvious blood stagnation and direction changes; the WSS after the conical stent implantation was uniform from the proximal to distal side of the stent. Compared with the cylindrical stent, the conical stent implantation in the coronary artery can make the changes of vascular hemodynamic more closer to the physiological condition, which can reduce the incidence of intra-stent restenosis and thrombosis, thus making it more suitable for PCI therapy. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  13. A Novel High Nitrogen Nickel-free Coronary Stents System:Evaluation in a Porcine Model

    Institute of Scientific and Technical Information of China (English)

    ZHANG Bin; CHEN Ming; ZHENG Bo; WANG Xin Gang; WANG Xi Ting; FAN Yuan Yuan; HUO Yong

    2014-01-01

    Objective To study the safety of the novel high nitrogen nickel-free austenitic stainless steel bare metal stents (BMS) in a recognized porcine coronary model and to select a better grid structure of it. Methods Three types of stents were randomly implanted in different coronary arteries of the same pig: 316L stainless steel BMS (316L-BMS) (n=12), novel high nitrogen nickel-free stents Grid A (NF-A-BMS) (n=12) and novel high nitrogen nickel-free stents Grid B (NF-B-BMS) (n=12). In total, eighteen animals underwent successful random placement of 36 oversized stents in the coronary arteries. Coronary angiography was performed after 36 d of stents implantation. Nine animals were respectively sacrificed after 14 d and 36 d for histomorphologic analysis. Results Quantitative coronary angiography (QCA) showed similar luminal loss (LL) in the three groups:(0.21±0.17) mm for 316L-BMS, (0.16±0.12) mm for NF-A-BMS, (0.24±0.15) mm for NF-B-BMS (P>0.05). Histomorphomeric analysis after 15 d and 36 d revealed that there was also no significant difference among the three groups in neointimal area (NA) with similar injury scores respectively. High magnification histomorphologic examination showed similar inflammation scores in the three groups, but NF-A-BMS group had poorer endothelialization scores compared with NF-B-BMS group, 2.00±0.63 vs. 2.83±0.41 (P=0.015) at 15 d, which also could be proved by the scanning electron microscope. However, the difference could not been observed at 36 d. Conclusion The novel NF-BMS showed similar safety as 316L-BMS during the short-term study. NF-B-BMS had better endothelialization than NF-A-BMS and this may owe to the specific strut units.

  14. Advances in nanotechnology for the management of coronary artery disease.

    Science.gov (United States)

    Rhee, June-Wha; Wu, Joseph C

    2013-02-01

    Nanotechnology holds tremendous potential to advance the current treatment of coronary artery disease. Nanotechnology may assist medical therapies by providing a safe and efficacious delivery platform for a variety of drugs aimed at modulating lipid disorders, decreasing inflammation and angiogenesis within atherosclerotic plaques, and preventing plaque thrombosis. Nanotechnology may improve coronary stent applications by promoting endothelial recovery on a stent surface utilizing bio-mimetic nanofibrous scaffolds, and also by preventing in-stent restenosis using nanoparticle-based delivery of drugs that are decoupled from stents. Additionally, nanotechnology may enhance tissue-engineered graft materials for application in coronary artery bypass grafting by facilitating cellular infiltration and remodeling of a graft matrix.

  15. Reconstruction of coronary artery centrelines from x-ray rotational angiography using a probabilistic mixture model

    Science.gov (United States)

    Ćimen, Serkan; Gooya, Ali; Frangi, Alejandro F.

    2016-03-01

    Three-dimensional reconstructions of coronary arterial trees from X-ray rotational angiography (RA) images have the potential to compensate the limitations of RA due to projective imaging. Most of the existing model based reconstruction algorithms are either based on forward-projection of a 3D deformable model onto X-ray angiography images or back-projection of 2D information extracted from X-ray angiography images to 3D space for further processing. All of these methods have their shortcomings such as dependency on accurate 2D centerline segmentations. In this paper, the reconstruction is approached from a novel perspective, and is formulated as a probabilistic reconstruction method based on mixture model (MM) representation of point sets describing the coronary arteries. Specifically, it is assumed that the coronary arteries could be represented by a set of 3D points, whose spatial locations denote the Gaussian components in the MM. Additionally, an extra uniform distribution is incorporated in the mixture model to accommodate outliers (noise, over-segmentation etc.) in the 2D centerline segmentations. Treating the given 2D centreline segmentations as data points generated from MM, the 3D means, isotropic variance, and mixture weights of the Gaussian components are estimated by maximizing a likelihood function. Initial results from a phantom study show that the proposed method is able to handle outliers in 2D centreline segmentations, which indicates the potential of our formulation. Preliminary reconstruction results in the clinical data are also presented.

  16. CT virtual endoscopy and 3D stereoscopic visualisation in the evaluation of coronary stenting.

    Science.gov (United States)

    Sun, Z; Lawrence-Brown

    2009-10-01

    The aim of this case report is to present the additional value provided by CT virtual endoscopy and 3D stereoscopic visualisation when compared with 2D visualisations in the assessment of coronary stenting. A 64-year old patient was treated with left coronary stenting 8 years ago and recently followed up with multidetector row CT angiography. An in-stent restenosis of the left coronary artery was suspected based on 2D axial and multiplanar reformatted images. 3D virtual endoscopy was generated to demonstrate the smooth intraluminal surface of coronary artery wall, and there was no evidence of restenosis or intraluminal irregularity. Virtual fly-through of the coronary artery was produced to examine the entire length of the coronary artery with the aim of demonstrating the intraluminal changes following placement of the coronary stent. In addition, stereoscopic views were generated to show the relationship between coronary artery branches and the coronary stent. In comparison with traditional 2D visualisations, virtual endoscopy was useful for assessment of the intraluminal appearance of the coronary artery wall following coronary stent implantation, while stereoscopic visualisation improved observers' understanding of the complex cardiac structures. Thus, both methods could be used as a complementary tool in cardiac imaging.

  17. A Nonparametric Shape Prior Constrained Active Contour Model for Segmentation of Coronaries in CTA Images

    Science.gov (United States)

    Wang, Yin; Jiang, Han

    2014-01-01

    We present a nonparametric shape constrained algorithm for segmentation of coronary arteries in computed tomography images within the framework of active contours. An adaptive scale selection scheme, based on the global histogram information of the image data, is employed to determine the appropriate window size for each point on the active contour, which improves the performance of the active contour model in the low contrast local image regions. The possible leakage, which cannot be identified by using intensity features alone, is reduced through the application of the proposed shape constraint, where the shape of circular sampled intensity profile is used to evaluate the likelihood of current segmentation being considered vascular structures. Experiments on both synthetic and clinical datasets have demonstrated the efficiency and robustness of the proposed method. The results on clinical datasets have shown that the proposed approach is capable of extracting more detailed coronary vessels with subvoxel accuracy. PMID:24803950

  18. Modeling of Stenotic Coronary Artery and Implications of Plaque Morphology on Blood Flow

    Directory of Open Access Journals (Sweden)

    Carlos Moreno

    2013-01-01

    Full Text Available A diseased coronary artery has been modeled to study the implications of plaque morphology on the fluid dynamics. In our previous study, we have successfully classified the coronary plaques of 42 patients who underwent intravascular ultrasound (IVUS into four-types (Type I, Type II, Type III, and Type IV based on the plaque morphology. In this study, we demonstrate that, for the same degree of stenosis (height of the plaques, hemodynamics parameters are strongly dependent on the plaque shape. This study is the first one to clearly demonstrate that in addition to wall shear stress, presence of turbulence and location of transition from laminar to turbulence state are additional hemodynamics parameters to identify plaques vulnerable to rupture.

  19. A Nonparametric Shape Prior Constrained Active Contour Model for Segmentation of Coronaries in CTA Images

    Directory of Open Access Journals (Sweden)

    Yin Wang

    2014-01-01

    Full Text Available We present a nonparametric shape constrained algorithm for segmentation of coronary arteries in computed tomography images within the framework of active contours. An adaptive scale selection scheme, based on the global histogram information of the image data, is employed to determine the appropriate window size for each point on the active contour, which improves the performance of the active contour model in the low contrast local image regions. The possible leakage, which cannot be identified by using intensity features alone, is reduced through the application of the proposed shape constraint, where the shape of circular sampled intensity profile is used to evaluate the likelihood of current segmentation being considered vascular structures. Experiments on both synthetic and clinical datasets have demonstrated the efficiency and robustness of the proposed method. The results on clinical datasets have shown that the proposed approach is capable of extracting more detailed coronary vessels with subvoxel accuracy.

  20. On the statistical modelling of coronary arteriographic data : Dynamics of coronary atherosclerosis related to systemic and focal parameters

    NARCIS (Netherlands)

    Zwinderman, AH; Jukema, JW; Van Boven, AJ; Reiber, JHC

    1997-01-01

    Existing methods to analyse data from repeated arteriographic progression/regression studies are restrictive and do not fully explore the dynamics of coronary artherosclerosis. We present a new approach making a distinction between new occlusions, new lesions, and growth of existing lesions, Random

  1. Exercise training intervention after coronary angioplasty: the ETICA trial.

    Science.gov (United States)

    Belardinelli, R; Paolini, I; Cianci, G; Piva, R; Georgiou, D; Purcaro, A

    2001-06-01

    The goal of this study was to determine the effects of exercise training (ET) on functional capacity and quality of life (QOL) in patients who received percutaneous transluminal coronary angioplasty (PTCA) or coronary stenting (CS), the effects on the restenosis rate and the outcome. It is unknown whether ET induces beneficial effects after coronary angioplasty. We studied 118 consecutive patients with coronary artery disease (mean age 57+/-10 years) who underwent PTCA or CS on one (69%) or two (31%) native epicardial coronary arteries. Patients were randomized into two matched groups. Group T (n = 59) was exercised three times a week for six months at 60% of peak VO2. Group C (n = 59) was the control group. Only trained patients had significant improvements in peak VO2 (26%, p < 0.001) and quality of life (26.8%, p = 0.001 vs. C). The angiographic restenosis rate was unaffected by ET (T: 29%; C: 33%, P = NS) and was not significantly different after PTCA or CS. However, residual diameter stenosis was lower in trained patients (-29.7%, p = 0.045). In patients with angiographic restenosis, thallium uptake improved only in group T (19%; p < 0.001). During the follow-up (33+/-7 months) trained patients had a significantly lower event rate than controls (11.9 vs. 32.2%, RR: 0.71, 95% confidence interval [CI]: 0.60 to 0.91, p = 0.008) and a lower rate of hospital readmission (18.6 vs. 46%, RR: 0.69, 95% CI: 0.55 to 0.93, p < 0.001). Moderate ET improves functional capacity and QOL after PTCA or CS. During the follow-up, trained patients had fewer events and a lower hospital readmission rate than controls, despite an unchanged restenosis rate.

  2. Inflammation in coronary artery diseases

    Institute of Scientific and Technical Information of China (English)

    LI Jian-jun

    2011-01-01

    The concept that atherosclerosis is an inflammation has been increasingly recognized,and subsequently resulted in great interest in revealing the inflammatory nature of the atherosclerotic process.More recently,a large body of evidence has supported the idea that inflammatory mechanisms play a pivotal role throughout all phases of atherogenesis,from endothelial dysfunction and the formation of fatty streaks to plaque destabilization and the acute coronary events due to vulnerable plaque rupture.Indeed,although triggers and pathways of inflammation are probably multiple and vary in different clinical entities of atherosclerotic disorders,an imbalance between anti-inflammatory mechanisms and pro-inflammatory factors will result in an atherosclerotic progression.Vascular endothelial dysfunction and lipoprotein retention into the arterial intima have been reported as the earliest events in atherogenesis with which inflammation is linked.Inflammatory has also been extended to the disorders of coronary microvasculature,and associated with special subsets of coronary artery disease such as silent myocardial ischemia,myocardial ischemia-reperfusion,cardiac syndrome X,variant angina,coronary artery ectasia,coronary calcification and in-stent restenosis.Inflammatory biomarkers,originally studied to better understand the pathophysiology of atherosclerosis,have generated increasing interest among researches and clinicians.The identification of inflammatory biomarkers and cellular/molecular pathways in atherosclerotic disease represent important goals in cardiovascular disease research,in particular with respect of the development of therapeutic strategies to prevent or reverse atherosclerotic diseases.

  3. Mathematical modelling of atheroma plaque formation and development in coronary arteries

    Science.gov (United States)

    Cilla, Myriam; Peña, Estefanía; Martínez, Miguel A.

    2014-01-01

    Atherosclerosis is a vascular disease caused by inflammation of the arterial wall, which results in the accumulation of low-density lipoprotein (LDL) cholesterol, monocytes, macrophages and fat-laden foam cells at the place of the inflammation. This process is commonly referred to as plaque formation. The evolution of the atherosclerosis disease, and in particular the influence of wall shear stress on the growth of atherosclerotic plaques, is still a poorly understood phenomenon. This work presents a mathematical model to reproduce atheroma plaque growth in coronary arteries. This model uses the Navier–Stokes equations and Darcy's law for fluid dynamics, convection–diffusion–reaction equations for modelling the mass balance in the lumen and intima, and the Kedem–Katchalsky equations for the interfacial coupling at membranes, i.e. endothelium. The volume flux and the solute flux across the interface between the fluid and the porous domains are governed by a three-pore model. The main species and substances which play a role in early atherosclerosis development have been considered in the model, i.e. LDL, oxidized LDL, monocytes, macrophages, foam cells, smooth muscle cells, cytokines and collagen. Furthermore, experimental data taken from the literature have been used in order to physiologically determine model parameters. The mathematical model has been implemented in a representative axisymmetric geometrical coronary artery model. The results show that the mathematical model is able to qualitatively capture the atheroma plaque development observed in the intima layer. PMID:24196695

  4. Mathematical modelling of atheroma plaque formation and development in coronary arteries.

    Science.gov (United States)

    Cilla, Myriam; Peña, Estefanía; Martínez, Miguel A

    2014-01-06

    Atherosclerosis is a vascular disease caused by inflammation of the arterial wall, which results in the accumulation of low-density lipoprotein (LDL) cholesterol, monocytes, macrophages and fat-laden foam cells at the place of the inflammation. This process is commonly referred to as plaque formation. The evolution of the atherosclerosis disease, and in particular the influence of wall shear stress on the growth of atherosclerotic plaques, is still a poorly understood phenomenon. This work presents a mathematical model to reproduce atheroma plaque growth in coronary arteries. This model uses the Navier-Stokes equations and Darcy's law for fluid dynamics, convection-diffusion-reaction equations for modelling the mass balance in the lumen and intima, and the Kedem-Katchalsky equations for the interfacial coupling at membranes, i.e. endothelium. The volume flux and the solute flux across the interface between the fluid and the porous domains are governed by a three-pore model. The main species and substances which play a role in early atherosclerosis development have been considered in the model, i.e. LDL, oxidized LDL, monocytes, macrophages, foam cells, smooth muscle cells, cytokines and collagen. Furthermore, experimental data taken from the literature have been used in order to physiologically determine model parameters. The mathematical model has been implemented in a representative axisymmetric geometrical coronary artery model. The results show that the mathematical model is able to qualitatively capture the atheroma plaque development observed in the intima layer.

  5. ASSOCIATION OF HIGH LIPOPROTEIN(a LEVELS WITH CORONARY ARTERY PATENCY DURING THE FIRST YEAR AFTER PERCUTANEOUS CORONARY INTERVENTIONS

    Directory of Open Access Journals (Sweden)

    M. V. Ezhov

    2011-01-01

    Full Text Available Objective: to study an association of high lipoprotein(a [Lp(a] levels with the development of restenosis and the progression of coronaryatherosclerosis after percutaneous coronary interventions (PCI in patients with chronic coronary heart disease (CHD.Subjects and methods. From 502 enrolled patients (mean age 54.7 ± 8.9 years, 92 underwent routine percutaneous transluminal coronary angioplasty (PTCA, 270 had PTCA with the bare metal stent (BMS being implantation, 140 had PTCA using drug-eluting stents (DES. Functionalclasses III and IV angina have been registered in 337 (67 % patients; history of one myocardial infarction (MI was noted in 234 (47 % cases, 171 (34 % had experienced 2 or more MIs. Blood samples for lipid and Lp(a measurements were taken in all the patients. Restenosis was defined as at least 50 % lumen narrowing of the coronary artery segment after angioplasty. Coronary atherosclerosis progression was established in cases of the new occlusion occurring, as well as identifying a 10 % decrease in lumen diameter in comparison with baseline angiograms.Results. Repeated coronary angiography revealed the signs of restenosis in 103 of 243 patients. Dividing patients into 3 groups according to the type of intervention demonstrated that the level of Lp(a (median 25–75 % quartiles was significantly higher in the restenosis group after implantation of BMS (33; 11–62 and 16; 6–39 mg/dl, respectively; p = 0.014 versus those who had undergone DES implantation (23; 10–30 and 20; 6–60 mg/dl; p = 0.7 or balloon angioplasty (17; 4–48 and 9; 4–36 mg/dl; p = 0.3. Patients with progression of coronary atherosclerosis had difference only in Lp(a levels compared to the group without progression (36; 13–62 versus 12; 4–26 mg/dl, p < 0,001.Conclusion. During the first year after elective PCI Lp(a concentration determined the severity of coronary atherosclerosis in non-culprit lesionsand associated with the risk of in

  6. ASSOCIATION OF HIGH LIPOPROTEIN(a LEVELS WITH CORONARY ARTERY PATENCY DURING THE FIRST YEAR AFTER PERCUTANEOUS CORONARY INTERVENTIONS

    Directory of Open Access Journals (Sweden)

    M. V. Ezhov

    2014-07-01

    Full Text Available Objective: to study an association of high lipoprotein(a [Lp(a] levels with the development of restenosis and the progression of coronaryatherosclerosis after percutaneous coronary interventions (PCI in patients with chronic coronary heart disease (CHD.Subjects and methods. From 502 enrolled patients (mean age 54.7 ± 8.9 years, 92 underwent routine percutaneous transluminal coronary angioplasty (PTCA, 270 had PTCA with the bare metal stent (BMS being implantation, 140 had PTCA using drug-eluting stents (DES. Functionalclasses III and IV angina have been registered in 337 (67 % patients; history of one myocardial infarction (MI was noted in 234 (47 % cases, 171 (34 % had experienced 2 or more MIs. Blood samples for lipid and Lp(a measurements were taken in all the patients. Restenosis was defined as at least 50 % lumen narrowing of the coronary artery segment after angioplasty. Coronary atherosclerosis progression was established in cases of the new occlusion occurring, as well as identifying a 10 % decrease in lumen diameter in comparison with baseline angiograms.Results. Repeated coronary angiography revealed the signs of restenosis in 103 of 243 patients. Dividing patients into 3 groups according to the type of intervention demonstrated that the level of Lp(a (median 25–75 % quartiles was significantly higher in the restenosis group after implantation of BMS (33; 11–62 and 16; 6–39 mg/dl, respectively; p = 0.014 versus those who had undergone DES implantation (23; 10–30 and 20; 6–60 mg/dl; p = 0.7 or balloon angioplasty (17; 4–48 and 9; 4–36 mg/dl; p = 0.3. Patients with progression of coronary atherosclerosis had difference only in Lp(a levels compared to the group without progression (36; 13–62 versus 12; 4–26 mg/dl, p < 0,001.Conclusion. During the first year after elective PCI Lp(a concentration determined the severity of coronary atherosclerosis in non-culprit lesionsand associated with the risk of in

  7. Porcine Models of Accelerated Coronary Atherosclerosis: Role of Diabetes Mellitus and Hypercholesterolemia

    Directory of Open Access Journals (Sweden)

    Damir Hamamdzic

    2013-01-01

    Full Text Available Animal models of atherosclerosis have proven to be an invaluable asset in understanding the pathogenesis of the disease. However, large animal models may be needed in order to assess novel therapeutic approaches to the treatment of atherosclerosis. Porcine models of coronary and peripheral atherosclerosis offer several advantages over rodent models, including similar anatomical size to humans, as well as genetic expression and development of high-risk atherosclerotic lesions which are similar to humans. Here we review the four models of porcine atherosclerosis, including the diabetic/hypercholesterolemic model, Rapacz-familial hypercholesterolemia pig, the (PCSK9 gain-of-function mutant pig model, and the Ossabaw miniature pig model of metabolic syndrome. All four models reliably represent features of human vascular disease.

  8. Intracoronary radiation for the prevention of restenosis following PTCA; Intrakoronare Bestrahlung zur Verhinderung einer Restenose nach PTCA

    Energy Technology Data Exchange (ETDEWEB)

    Silber, S. [Kardiologische Praxis in der Klinik Dr. Mueller, Muenchen (Germany)

    2001-12-01

    The prevention and treatment of a restenosis, which occurs in ca. 30% of the cases following balloon dilatation of coronary stenoses, using intravascular radiation relies on the proliferation deterrent that is inherent in every radiation therapy. A total of 12 placebo-controlled, randomized trials have been completed: 7 regarding in-stent restenosis, 2 regarding de-novo stenosis (or restenosis without a stent) as strict inclusion criteria, and 3 with all types of stenoses. In these 12 trials, 1,676 patients were allotted to the placebo groups and 1,794 to the therapy groups. For in-stent restenoses, vessel size as defined for inclusion was between 2.4 mm und 5.5 mm, stenosis length between < 20 mm and {<=} 80 mm. In all trials with in-stent restenosis, the primary endpoints were reached; the restenosis rate in the longest coronary segment analyzed was between 45% and 68.8% in the control groups and between 21% and 53.5% in the brachytherapy groups. The respective values for the TVR were between 24.1% and 67.6% in the control groups and between 16% and 41.7% in the brachytherapy groups. In the control groups, MACE was between 25.9% and 67.6%; it was between 18% and 41.7% in the brachytherapy groups. Attaining results for de-novo stenoses was problematic due to 'geographic miss' apparently playing a larger role in these cases; but when taking this into consideration, good results were also attained. The known limitations due to late stent thromboses (4-15% in older trials) were to the most part eliminated by administration of clopidogrel for one year and the limitations due to the 'edge effect' by the application of longer radiation sources. With antiproliferative coated stents as treatment for de-novo stenoses, we can count on intracoronary brachytherapy losing significance in this area. But for in-stent restenoses, intracoronary brachytherapy is the only evidence-based interventional form of therapy. (orig.) [German] Die Verhinderung bzw

  9. Influence of metal alloy and the profile of coronary stents in patients with multivessel coronary disease

    Directory of Open Access Journals (Sweden)

    Luciano Maurício de Abreu Filho

    2011-01-01

    Full Text Available BACKGROUND: In Brazil, despite the recommendations of the Brazilian Society of Hemodynamics and Interventional Cardiology, the National Health System has not yet approved the use of drug-eluting stents. In percutaneous coronary interventions performed in the public and part of the private health care system, bare metal stents are used as the only option. Therefore, new information on bare metal stents is of great importance. The primary endpoint was to evaluate the influence of the alloy and the profile of coronary stents on late loss and restenosis rates 6 months after implantation in patients with multivessel coronary disease. METHODS: Single center, randomized and prospective study comparison of cobalt-chromium versus stainless steel stent implantation in 187 patients with multivessel coronary disease. At least one cobalt-chromium and one stainless steel stent were implanted per patient. RESULTS: Mean age of patients was 59.5 + 10.1 years with a prevalence of males (66.3% and patients with acute coronary syndrome (56%. Baseline clinical characteristics were similar with hypertension in 146 (78%, dyslipidemia in 85 (45.5% and diabetes in 68 (36.4%. Two hundred and twenty-nine cobalt-chromium and 284 stainless steel stents were implanted. Angiographic variables showed no statistically significant difference. Angiographic follow-up to 6 months after implantation showed similar late loss and restenosis rates. CONCLUSION: The use of two different alloys, stainless steel and cobalt-chrome stents, in the same patient and in the same vessel produced similar 6-month restenosis and late loss rates.

  10. Comparison of zotarolimus-eluting and everolimus-eluting coronary stents

    DEFF Research Database (Denmark)

    Serruys, Patrick W; Silber, Sigmund; Garg, Scot

    2010-01-01

    New-generation coronary stents that release zotarolimus or everolimus have been shown to reduce the risk of restenosis. However, it is unclear whether there are differences in efficacy and safety between the two types of stents on the basis of prospectively adjudicated end points endorsed by the ...

  11. Coronary aneurysm and very late stent thrombosis formation associated with sirolimus-eluting stent implantation

    Institute of Scientific and Technical Information of China (English)

    XIE Hong-zhi; ZHANG Shu-yang; ZENG Yong; SHEN Zhu-jun; FANG Quan

    2009-01-01

    @@ Since drug-eluting stents (DES) can significantly reduce the risk of instant restenosis compared with bare-metal stents, they have been widely used in interventional therapy for coronary heart disease. With bare-metal stents being rapidly replaced by DES there is a great concern about the safety of DES due to stent thrombosis.~(1,2)

  12. Comparison of zotarolimus-eluting and everolimus-eluting coronary stents

    DEFF Research Database (Denmark)

    Serruys, Patrick W; Silber, Sigmund; Garg, Scot;

    2010-01-01

    New-generation coronary stents that release zotarolimus or everolimus have been shown to reduce the risk of restenosis. However, it is unclear whether there are differences in efficacy and safety between the two types of stents on the basis of prospectively adjudicated end points endorsed...

  13. Coronary stenting: A matter of revascularization.

    Science.gov (United States)

    Bonaventura, Aldo; Montecucco, Fabrizio; Liberale, Luca

    2017-03-26

    In the last few decades, the recommended treatment for coronary artery disease has been dramatically improved by percutaneous coronary intervention (PCI) and the use of balloon catheters, bare metal stents (BMSs), and drug-eluting stents (DESs). Catheter balloons were burdened by acute vessel occlusion or target-lesion re-stenosis. BMSs greatly reduced those problems holding up the vessel structure, but showed high rates of in-stent re-stenosis, which is characterized by neo-intimal hyperplasia and vessel remodeling leading to a re-narrowing of the vessel diameter. This challenge was overtaken by first-generation DESs, which reduced re-stenosis rates to nearly 5%, but demonstrated delayed arterial healing and risk for late in-stent thrombosis, with inflammatory cells playing a pivotal role. Finally, new-generation DESs, characterized by innovations in design, metal composition, surface polymers, and anti-proliferative drugs, finally reduced the risk for stent thrombosis and greatly improved revascularization outcomes. New advances include bioresorbable stents potentially changing the future of revascularization techniques as the concept bases upon the degradation of the stent scaffold to inert particles after its function expired, thus theoretically eliminating risks linked with both stent thrombosis and re-stenosis. Talking about DESs also dictates to consider dual antiplatelet therapy (DAPT), which is a fundamental moment in view of the good outcome duration, but also deals with bleeding complications. The better management of patients undergoing PCI should include the use of DESs and a DAPT finely tailored in consideration of the potentially developing bleeding risk in accordance with the indications from last updated guidelines.

  14. Intraperitoneal Bilirubin Administration Decreases Infarct Area in a Rat Coronary Ischemia/Reperfusion Model

    Directory of Open Access Journals (Sweden)

    Ron eBen-Amotz

    2014-02-01

    Full Text Available Bilirubin was previously considered a toxin byproduct of heme catabolism. However, a mounting body of evidence suggests that at physiological doses, bilirubin is a powerful antioxidant and anti-atherosclerotic agent. Recent clinical studies have shown that human beings with genetically-induced hyperbilirubinemia (Gilbert Syndrome are protected against coronary heart disease. The purpose of this study was to investigate whether administration of exogenous bilirubin to normal rats would convey similar protective effects in an experimental model of coronary ischemia. We hypothesized that intraperitoneal bilirubin administration 1 hour before injury would decrease infarct area and preserve left ventricular (LV systolic function when compared to non-treated rats. Coronary ischemia was induced by temporary (30 min ligation of the left anterior descending coronary artery in control or bilirubin treated rats, followed by a 1-hour period of reperfusion. LV function was estimated by measurements of fractional shortening and fractional area shortening using echocardiography. LV function decreased in both experimental groups after ischemia and reperfusion, although in bilirubin-treated rats fractional shortening was less depressed during the period of ischemia (18.8 vs 25.8%, p = 0.034. Infarct size was significantly reduced in the bilirubin treated group compared to the non-treated group (13.34% vs 25.5%, p = 0.0067. Based on the results of this study, bilirubin supplementation appears to provide significant decrease in infarct size although protective effects on LV function were noted only during the period of ischemia. This result also suggests that lipid soluble antioxidant bilirubin prevents the oxidation of cardiolipin and decreases the infarct size in the heart during ischemia.

  15. Bioresorbable Drug-Eluting Magnesium-Alloy Scaffold for Treatment of Coronary Artery Disease

    OpenAIRE

    Campos, Carlos M.; Takashi Muramatsu; Javaid Iqbal; Ya-Jun Zhang; Yoshinobu Onuma; Garcia-Garcia, Hector M.; Michael Haude; Lemos, Pedro A.; Boris Warnack; Serruys, Patrick W.

    2013-01-01

    The introduction of metallic drug-eluting stents has reduced the risk of restenosis and widened the indications of percutaneous coronary intervention in treatment of coronary artery disease. However, this medical device can induce hypersensitive reaction that interferes with the endothelialization and healing process resulting in late persistent or acquired malapposition of the permanent metallic implant. Delayed endotheliaization and malapposition may lead to late and very late stent thrombo...

  16. Development of a computer-generated model for the coronary arterial tree based on multislice CT and morphometric data

    Science.gov (United States)

    Fung, George S. K.; Segars, W. Paul; Taguchi, Katsuyuki; Fishman, Elliot K.; Tsui, Benjamin M. W.

    2006-03-01

    A detailed four-dimensional model of the coronary artery tree has great potential in a wide variety of applications especially in biomedical imaging. We developed a computer generated three-dimensional model for the coronary arterial tree based on two datasets: (1) gated multi-slice computed tomography (MSCT) angiographic data obtained from a normal human subject and (2) statistical morphometric data obtained from porcine hearts. The main coronary arteries and heart structures were segmented from the MSCT data to define the initial segments of the vasculature and geometrical details of the boundaries. An iterative rule-based computer generation algorithm was then developed to extend the coronary artery tree beyond the initial segmented branches. The algorithm was governed by the following factors: (1) the statistical morphometric measurements of the connectivities, lengths, and diameters of the arterial segments, (2) repelling forces from other segments and boundaries, and (3) optimality principles to minimize the drag force at each bifurcation in the generated tree. Using this algorithm, the segmented coronary artery tree from the MSCT data was optimally extended to create a 3D computational model of the largest six orders of the coronary arterial tree. The new method for generating the 3D model is effective in imposing the constraints of anatomical and physiological characteristics of coronary vasculature. When combined with the 4D NCAT phantom, a computer model for the human anatomy and cardiac and respiratory motions, the new model will provide a unique tool to study cardiovascular characteristics and diseases through direct and medical imaging simulation studies.

  17. Evaluation of coronary blood flow velocity during cardiac arrest with circulation maintained through mechanical chest compressions in a porcine model

    Directory of Open Access Journals (Sweden)

    Wagner Henrik

    2011-12-01

    Full Text Available Abstract Background Mechanical chest compressions (CCs have been shown capable of maintaining circulation in humans suffering cardiac arrest for extensive periods of time. Reports have documented a visually normalized coronary blood flow during angiography in such cases (TIMI III flow, but it has never been actually measured. Only indirect measurements of the coronary circulation during cardiac arrest with on-going mechanical CCs have been performed previously through measurement of the coronary perfusion pressure (CPP. In this study our aim was to correlate average peak coronary flow velocity (APV to CPP during mechanical CCs. Methods In a closed chest porcine model, cardiac arrest was established through electrically induced ventricular fibrillation (VF in eleven pigs. After one minute, mechanical chest compressions were initiated and then maintained for 10 minutes upon which the pigs were defibrillated. Measurements of coronary blood flow in the left anterior descending artery were made at baseline and during VF with a catheter based Doppler flow fire measuring APV. Furthermore measurements of central (thoracic venous and arterial pressures were also made in order to calculate the theoretical CPP. Results Average peak coronary flow velocity was significantly higher compared to baseline during mechanical chests compressions and this was observed during the entire period of mechanical chest compressions (12 - 39% above baseline. The APV slowly declined during the 10 min period of mechanical chest compressions, but was still higher than baseline at the end of mechanical chest compressions. CPP was simultaneously maintained at > 20 mmHg during the 10 minute episode of cardiac arrest. Conclusion Our study showed good correlation between CPP and APV which was highly significant, during cardiac arrest with on-going mechanical CCs in a closed chest porcine model. In addition APV was even higher during mechanical CCs compared to baseline. Mechanical

  18. Simultaneous modelling of operative mortality and long-term survival after coronary artery bypass surgery.

    Science.gov (United States)

    Ghahramani, M; Dean, C B; Spinelli, J J

    2001-07-15

    Typical analyses of lifetime data treat the time to death or failure as the response variable and use a variety of modelling strategies such as proportional hazards or fully parametric, to investigate the relationship between the response and covariates. In certain circumstances it may be more natural to view the distribution of the response variable as consisting of two or more parts since the survival curve appears segmented. This article addresses such a scenario and we propose a model for simultaneously investigating the effects of covariates over the two segments. The model is an analogue of that proposed by Lambert for zero-inflated Poisson regression. The application is central to the model development and is concerned with survival after coronary artery bypass surgery. Here operative mortality, defined as death within 30 days after surgery, and long-term mortality, are viewed as distinct outcomes. For the application considered, the survivor function displays much steeper descent during the first 30 days after surgery, that is, for operative mortality, than after this period. An investigation of the effects of covariates on operative and long-term mortality after coronary artery bypass surgery illustrates the usefulness of the proposed model.

  19. Granulocyte colony-stimulating factor ameliorates coronary artery elastin breakdown in a mouse model of Kawasaki disease

    Institute of Scientific and Technical Information of China (English)

    Liu Junfeng; Chen Zhi; Du Zhongdong; Lu Dunxiang

    2014-01-01

    Background Coronary artery damage from Kawasaki disease (KD) is closely linked to the dysfunction of the endothelial progenitor cells (EPCs).The aim of the present study was to evaluate the modulatory effect of granulocyte colony stimulating factor (G-CSF) on EPCs and elastin breakdown of coronary arteries in a KD mouse model.Methods A Lactobacillus casei cell wall extract (LCWE)-induced KD model was established in C57BL/6 mice that were subsequently administrated with recombinant human G-CSF (rhG-CSF).Nω-nitro-L-arginine methyl ester (L-NAME) was administrated for the negative intervention.Evaluations included coronary artery lesions,EPC number and functions,and the plasma concentration of nitric oxide (NO).Results Elastin breakdown was found in the coronary arteries of model mice 56 days after injection of LCWE.The number of circulating EPCs,plasma concentration of NO,and functions of bone marrow EPCs,including proliferation,adhesion,and migration abilities,were all lower in the KD model group compared with those in the control group.After administration of rhG-CSF,the number of circulating EPCs and plasma concentration of NO were increased significantly compared with those in the KD model group.There were also increases in the functional indexes of EPCs.Furthermore,rhG-CSF administration improved the elastin breakdown effectively.However,these protective effects of rhG-CSF on coronary arteries were attenuated by L-NAME.Conclusion The present study indicated that the administration of G-CSF prevents elastin breakdown of the coronary arteries by enhancing the number and functions of EPCs via the NO system,and then accelerates the repair of coronary artery lesions in the KD.

  20. Safety and efficacy of coronary drug eluting stent for atherosclerotic stenosis of the small renal artery

    Institute of Scientific and Technical Information of China (English)

    LI Chun-jie; WU Zheng; YAN Hong-bing; WANG Jian; ZHAO Han-jun

    2009-01-01

    @@ Small diameter renal artery refers to the renal artery with the cross-section diameter less than 5 mm, the incidence of which is approximately 8%.1 Small diameter renal artery is common in patients with congenital multi-branch renal arteries, diabetes and multi-coronary artery lesions. Renal artery bare-mental stent (BMS) implantation is the standard treatment for ostial renal artery stenosis.2,3 However, the restenosis rate4-6 is too high and becomes one of the relative contraindications for small diameter renal artery stent implantation. Clinical trials (e.g. RAVEL,7,8 SIRIUS9 and TAXUS-IV10) have proved that drug eluting stent (DES), compared with BMS, can reduce the restenosis rate after the percutanous coronary intervention (PCI). And Huda et al11 claimed that DES had the better results than BMS in the treatment of obstructive superficial femoral artery disease. However,there are few studies involved restenosis after the renal artery intervention. We hypothesized that coronary DES applied in renal artery stenosis might inhibit intimal proliferation effectively as in coronary artery disease;therefore we evaluated the results of 25 patients with atherosclerotic renal artery stenosis treated using coronary DES to assess the safety and efficacy of coronary DES in patients with small renal artery stenotic lesions.

  1. Prediction of coronary plaque location on arteries having myocardial bridge, using finite element models.

    Science.gov (United States)

    Nikolić, Dalibor; Radović, Miloš; Aleksandrić, Srđan; Tomašević, Miloje; Filipović, Nenad

    2014-11-01

    This study was performed to evaluate the influences of the myocardial bridges on the plaque initializations and progression in the coronary arteries. The wall structure is changed due to the plaque presence, which could be the reason for multiple heart malfunctions. Using simplified parametric finite element model (FE model) of the coronary artery having myocardial bridge and analyzing different mechanical parameters from blood circulation through the artery (wall shear stress, oscillatory shear index, residence time), we investigated the prediction of "the best" position for plaque progression. We chose six patients from the angiography records and used data from DICOM images to generate FE models with our software tools for FE preprocessing, solving and post-processing. We found a good correlation between real positions of the plaque and the ones that we predicted to develop at the proximal part of the myocardial bridges with wall shear stress, oscillatory shear index and residence time. This computer model could be additional predictive tool for everyday clinical examination of the patient with myocardial bridge.

  2. Coronary Stents: The Impact of Technological Advances on Clinical Outcomes.

    Science.gov (United States)

    Mennuni, Marco G; Pagnotta, Paolo A; Stefanini, Giulio G

    2016-02-01

    Percutaneous coronary interventions (PCI) were proposed in the late 1970s as an alternative to surgical coronary artery bypass grafting for the treatment of coronary artery disease. Important technological progress has been made since. Balloon angioplasty was replaced by bare metal stents, which allowed to permanently scaffold the coronary vessel avoiding acute recoil and abrupt occlusion. Thereafter, the introduction of early generation drug-eluting stents (DES) has significantly improved clinical outcomes, primarily by markedly reducing the risk of restenosis. New generation DES with thinner stent struts, novel durable or biodegradable polymer coatings, and new limus antiproliferative agents, have further improved upon the safety and efficacy profile of early generation DES. The present article aims to review the impact of technological advances on clinical outcomes in the field of PCI with coronary stents, and to provide a brief overview on clinical margins of improvement and unmet needs of available DES.

  3. Exercise stress testing before and after successful multivessel percutaneous transluminal coronary angioplasty

    Directory of Open Access Journals (Sweden)

    W.A. Chalela

    2006-04-01

    Full Text Available Controversy exists regarding the diagnostic accuracy, optimal technique, and timing of exercise testing after percutaneous coronary intervention. The objectives of the present study were to analyze variables and the power of exercise testing to predict restenosis or a new lesion, 6 months after the procedure. Eight-four coronary multi-artery diseased patients with preserved ventricular function were studied (66 males, mean age of all patients: 59 ± 10 years. All underwent coronary angiography and exercise testing with the Bruce protocol, before and 6 months after percutaneous coronary intervention. The following parameters were measured: heart rate, blood pressure, rate-pressure product (heart rate x systolic blood pressure, presence of angina, maximal ST-segment depression, and exercise duration. On average, 2.33 lesions/patient were treated and restenosis or progression of disease occurred in 46 (55% patients. Significant increases in systolic blood pressure (P = 0.022, rate-pressure product (P = 0.045 and exercise duration (P = 0.003 were detected after the procedure. Twenty-seven (32% patients presented angina during the exercise test before the procedure and 16 (19% after the procedure. The exercise test for the detection of restenosis or new lesion presented 61% sensitivity, 63% specificity, 62% accuracy, and 67 and 57% positive and negative predictive values, respectively. In patients without restenosis, the exercise duration after percutaneous coronary intervention was significantly longer (460 ± 154 vs 381 ± 145 s, P = 0.008. Only the exercise duration permitted us to identify patients with and without restenosis or a new lesion.

  4. Risk model for suspected acute coronary syndrome is of limited value in an emergency department

    DEFF Research Database (Denmark)

    Mogensen, Christian Backer; Christiansen, Maja; Jørgensen, Jess Bjerre

    2015-01-01

    INTRODUCTION: Among patients with acute chest pain, acute coronary syndrome (ACS) is seen only in a minority of the patients, which raises the question, whether it is possible to separate a group with a high risk of ACS for admission to a cardiac care unit (CCU) from those with a low risk who would...... be treated at an emergency department (ED). The aim of this study was to describe a risk stratification model for a Danish context. METHODS: This was a historic prospective cohort study of patients with suspicion of ACS. The patient was defined as a low-risk patient and admitted to the ED if: 1...

  5. Risk prediction models for major adverse cardiac event (MACE) following percutaneous coronary intervention (PCI): A review

    Science.gov (United States)

    Manan, Norhafizah A.; Abidin, Basir

    2015-02-01

    Five percent of patients who went through Percutaneous Coronary Intervention (PCI) experienced Major Adverse Cardiac Events (MACE) after PCI procedure. Risk prediction of MACE following a PCI procedure therefore is helpful. This work describes a review of such prediction models currently in use. Literature search was done on PubMed and SCOPUS database. Thirty literatures were found but only 4 studies were chosen based on the data used, design, and outcome of the study. Particular emphasis was given and commented on the study design, population, sample size, modeling method, predictors, outcomes, discrimination and calibration of the model. All the models had acceptable discrimination ability (C-statistics >0.7) and good calibration (Hosmer-Lameshow P-value >0.05). Most common model used was multivariate logistic regression and most popular predictor was age.

  6. Metabolic syndrome and coronary artery disease in Ossabaw compared with Yucatan swine.

    Science.gov (United States)

    Neeb, Zachary P; Edwards, Jason M; Alloosh, Mouhamad; Long, Xin; Mokelke, Eric A; Sturek, Michael

    2010-08-01

    Metabolic syndrome (MetS), a compilation of associated risk factors, increases the risk of type 2 diabetes and coronary artery disease (CAD, atherosclerosis), which can progress to the point of artery occlusion. Stents are the primary interventional treatment for occlusive CAD, and patients with MetS and hyperinsulinemia have increased restenosis. Because of its thrifty genotype, the Ossabaw pig is a model of MetS. We tested the hypothesis that, when fed high-fat diet, Ossabaw swine develop more features of MetS, greater native CAD, and greater stent-induced CAD than do Yucatan swine. Animals of each breed were divided randomly into 2 groups and fed 2 different calorie-matched diets for 40 wk: control diet (C) and high-fat, high-cholesterol atherogenic diet (H). A bare metal stent was placed in the circumflex artery, and pigs were allowed to recover for 3 wk. Characteristics of MetS, macrovascular and microvascular CAD, in-stent stenosis, and Ca(2+) signaling in coronary smooth muscle cells were evaluated. MetS characteristics including, obesity, glucose intolerance, hyperinsulinemia, and elevated arterial pressure were elevated in Ossabaw swine compared to Yucatan swine. Ossabaw swine with MetS had more extensive and diffuse native CAD and in-stent stenosis and impaired coronary blood flow regulation compared with Yucatan. In-stent atherosclerotic lesions in Ossabaw coronary arteries were less fibrous and more cellular. Coronary smooth muscle cells from Ossabaw had impaired Ca(2+) efflux and intracellular sequestration versus cells from Yucatan swine. Therefore, Ossabaw swine are a superior model of MetS, subsequent CAD, and cellular Ca(2+) signaling defects, whereas Yucatan swine are leaner and relatively resistant to MetS and CAD.

  7. Cell Area and Strut Distribution Changes of Bent Coronary Stents: A Finite Element Analysis

    Institute of Scientific and Technical Information of China (English)

    ZHAO Yang; WU Wei; YANG Da-zhi; QI Min

    2009-01-01

    Coronary stents are metal coils or mesh tubes delivered to blocked vessels through catheters, which are expanded by balloons to reopen and scaffold target vessels. Recently,special drugs are carried by stents (drug-eluting stents) to further reduce in-stent restenosis rate after stenting procedure. However,continual study on biomechanical characteristics of stents is necessary for better interactions between stents and tissue, or to provide a more suitable drug loading platform for drug-eluting stents. The purpose of this paper is to show how finite element methods can be used to study cell area and strut distribution changes of bent coronary stents. A same bending deformation was applied to two commercial coronary stent models by a rigid curved vessel. Results show that the stent design influenced the changes of cell area and strut distribution under bending situation. The stent with links had more cell area changes at outer curvature, and the stent with peak-peak (><) strut design could have strut contact and overlapping at inner curvature. In conclusion, this finite element method can be used to study and compare cell area and strut distribution changes of bent stents,and to provide a convenient tool for designers in testing and improving biomechanical characteristics of new stents.

  8. Unipolar Depression and the Progression of Coronary Artery Disease : Toward an Integrative Model

    NARCIS (Netherlands)

    Ormel, Johan; de Jonge, Peter

    2011-01-01

    Background: Despite extensive research on the relationship between depression and coronary artery disease (CAD) after an acute coronary syndrome (ACS), causal interpretations are still difficult. This uncertainty has led to much confusion regarding screening and treatment for depression in CAD

  9. Transthoracic coronary flow reserve and dobutamine derived myocardial function: a 6-month evaluation after successful coronary angioplasty

    Directory of Open Access Journals (Sweden)

    Pardo Moira

    2004-12-01

    Full Text Available Abstract After percutaneous transluminal coronary angioplasty (PTCA, stress-echocardiography and gated single photon emission computerized tomography (g-SPECT are usually performed but both tools have technical limitations. The present study evaluated results of PTCA of left anterior descending artery (LAD six months after PTCA, by combining transthoracic Doppler coronary flow reserve (CFR and color Tissue Doppler (C-TD dobutamine stress. Six months after PTCA of LAD, 24 men, free of angiographic evidence of restenosis, underwent standard Doppler-echocardiography, transthoracic CFR of distal LAD (hyperemic to basal diastolic coronary flow ratio and C-TD at rest and during dobutamine stress to quantify myocardial systolic (Sm and diastolic (Em and Am, Em/Am ratio peak velocities in middle posterior septum. Patients with myocardial infarction, coronary stenosis of non-LAD territory and heart failure were excluded. According to dipyridamole g-SPECT, 13 patients had normal perfusion and 11 with perfusion defects. The 2 groups were comparable for age, wall motion score index (WMSI and C-TD at rest. However, patients with perfusion defects had lower CFR (2.11 ± 0.4 versus 2.87 ± 0.6, p m at high-dose dobutamine (p m of middle septum (r = 0.55, p In conclusion, even in absence of epicardial coronary restenosis, stress perfusion imaging reflects a physiologic impairment in coronary microcirculation function whose magnitude is associated with the degree of regional functional impairment detectable by C-TD.

  10. IL-1β is Crucial for Induction of Coronary Artery Inflammation in a Mouse Model of Kawasaki Disease

    Science.gov (United States)

    Lee, Young Ho; Schulte, Danica J.; Shimada, Kenichi; Chen, Shuang; Crother, Timothy R.; Chiba, Norika; Fishbein, Michael C.; Lehman, Thomas J.A.; Arditi, Moshe

    2012-01-01

    Background Kawasaki disease (KD) is the most common cause of acute vasculitis and acquired cardiac disease in US children. Untreated, children may develop coronary artery aneurysms, myocardial infarction and sudden death as a result of the illness. Up to a third of KD patients fail to respond to intravenous gammaglobulin (IVIG), the standard therapy, and alternative treatments are being investigated. Genetic studies have indicated a possible role for IL-1β in KD. We therefore explored the role of IL-1β in a murine model of KD. Methods and Results Using an established mouse model of KD that involves injection of Lactobacillus casei cell wall extract (LCWE), we investigated the role of IL- 1β and caspase-1 (activated by the inflammasome and required for IL-1β maturation) in coronary arteritis, and evaluated the efficacy of IL-1 receptor antagonist (IL-1Ra) as a potential treatment. LCWE-induced IL-1β maturation and secretion was dependent on the NLRP3 inflammasome in macrophages. Both caspase1-deficient and IL-1R-deficient mice were protected from LCWE-induced coronary lesions. Injection of recombinant IL-1β to caspase-1-deficient mice restored the ability of LCWE to cause coronary lesions in response to LCWE. Furthermore, daily injections of the IL-1Ra prevented LCWE-mediated coronary lesions, up to three days after LCWE injection. Conclusions Our results strongly suggest that caspase-1 and IL-1β play critical roles in the development of coronary lesions in this KD mouse model, blocked by IL-1Ra. Therefore, anti-IL-1β treatment strategies may constitute an effective, more targeted treatment of KD to prevent coronary lesions. PMID:22361326

  11. Cardiovascular Surgery Residency Program: Training Coronary Anastomosis Using the Arroyo Simulator and UNIFESP Models.

    Science.gov (United States)

    Maluf, Miguel Angel; Gomes, Walter José; Bras, Ademir Massarico; Araújo, Thiago Cavalcante Vila Nova de; Mota, André Lupp; Cardoso, Caio Cesar; Coutinho, Rafael Viana dos S

    2015-01-01

    Engage the UNIFESP Cardiovascular Surgery residents in coronary anastomosis, assess their skills and certify results, using the Arroyo Anastomosis Simulator and UNIFESP surgical models. First to 6th year residents attended a weekly program of technical training in coronary anastomosis, using 4 simulation models: 1. Arroyo simulator; 2. Dummy with a plastic heart; 3. Dummy with a bovine heart; and 4. Dummy with a beating pig heart. The assessment test was comprised of 10 items, using a scale from 1 to 5 points in each of them, creating a global score of 50 points maximum. The technical performance of the candidate showed improvement in all items, especially manual skill and technical progress, critical sense of the work performed, confidence in the procedure and reduction of the time needed to perform the anastomosis after 12 weeks practice. In response to the multiplicity of factors that currently influence the cardiovascular surgeon training, there have been combined efforts to reform the practices of surgical medical training. 1 - The four models of simulators offer a considerable contribution to the field of cardiovascular surgery, improving the skill and dexterity of the surgeon in training. 2 - Residents have shown interest in training and cooperate in the development of innovative procedures for surgical medical training in the art.

  12. Cardiovascular Surgery Residency Program: Training Coronary Anastomosis Using the Arroyo Simulator and UNIFESP Models

    Directory of Open Access Journals (Sweden)

    Miguel Angel Maluf

    2015-10-01

    Full Text Available ABSTRACT OBJECTIVE: Engage the UNIFESP Cardiovascular Surgery residents in coronary anastomosis, assess their skills and certify results, using the Arroyo Anastomosis Simulator and UNIFESP surgical models. METHODS: First to 6th year residents attended a weekly program of technical training in coronary anastomosis, using 4 simulation models: 1. Arroyo simulator; 2. Dummy with a plastic heart; 3. Dummy with a bovine heart; and 4. Dummy with a beating pig heart. The assessment test was comprised of 10 items, using a scale from 1 to 5 points in each of them, creating a global score of 50 points maximum. RESULTS: The technical performance of the candidate showed improvement in all items, especially manual skill and technical progress, critical sense of the work performed, confidence in the procedure and reduction of the time needed to perform the anastomosis after 12 weeks practice. In response to the multiplicity of factors that currently influence the cardiovascular surgeon training, there have been combined efforts to reform the practices of surgical medical training. CONCLUSION: 1 - The four models of simulators offer a considerable contribution to the field of cardiovascular surgery, improving the skill and dexterity of the surgeon in training. 2 - Residents have shown interest in training and cooperate in the development of innovative procedures for surgical medical training in the art.

  13. Sirolimus inhibits key events of restenosis in vitro/ex vivo: evaluation of the clinical relevance of the data by SI/MPL- and SI/DES-ratio's

    Directory of Open Access Journals (Sweden)

    Kountides Margaratis

    2007-05-01

    Full Text Available Abstract Background Sirolimus (SRL, Rapamycin has been used successfully to inhibit restenosis both in drug eluting stents (DES and after systemic application. The current study reports on the effects of SRL in various human in vitro/ex vivo models and evaluates the theoretical clinical relevance of the data by SI/MPL- and SI/DES-ratio's. Methods Definition of the SI/MPL-ratio: relation between significant inhibitory effects in vitro/ex vivo and the maximal plasma level after systemic administration in vivo (6.4 ng/ml for SRL. Definition of the SI/DES-ratio: relation between significant inhibitory effects in vitro/ex vivo and the drug concentration in DES (7.5 mg/ml in the ISAR drug-eluting stent platform. Part I of the study investigated in cytoflow studies the effect of SRL (0.01–1000 ng/ml on TNF-α induced expression of intercellular adhesion molecule 1 (ICAM-1 in human coronary endothelial cells (HCAEC and human coronary smooth muscle cells (HCMSMC. Part II of the study analysed the effect of SRL (0.01–1000 ng/ml on cell migration of HCMSMC. In part III, IV, and V of the study ex vivo angioplasty (9 bar was carried out in a human organ culture model (HOC-model. SRL (50 ng/ml was added for a period of 21 days, after 21 and 56 days cell proliferation, apoptosis, and neointimal hyperplasia was studied. Results Expression of ICAM-1 was significantly inhibited both in HCAEC (SRL ≥ 0.01 ng/ml and HCMSMC (SRL ≥ 10 ng/ml. SRL in concentrations ≥ 0.1 ng/ml significantly inhibited migration of HCMSMC. Cell proliferation and neointimal hyperplasia was inhibited at day 21 and day 56, significance (p Conclusion SI/MPL-ratio's ≤ 1 (ICAM-1 expression, cell migration characterize inhibitory effects of SRL that can be theoretically expected both after systemic and local high dose administration, a SI/MPL-ratio of 7.81 (cell proliferation represents an effect that was achieved with drug concentrations 7.81-times the MPL. SI/DES-ratio's between 10

  14. 吡格列酮降低非糖尿病患者冠状动脉药物洗脱支架再狭窄的研究%Study of pioglitazone reducing in-stent restenosis on non-diabetic patients with drug-eluting stents

    Institute of Scientific and Technical Information of China (English)

    魏广和; 刘立新; 王铁成; 王建军; 高荣华; 张韶辉

    2012-01-01

    Objective:To investigate the effects and mechanisms of pioglitazone on in-stent restenosis after coronary stenting in nondiabetic patients with coronary artery disease. Method:One hundred and twenty-eight nondia-betic patients after rapamycin eluting stent implantation were randomly assigned to pioglitazone (pioglitazone group, h=71, 30 mg/d) or placebo (control group, n = 57) treatment in addition to standard therapy. Selective coronary angiography was performed at 6 —8 months follow-up. Fasting blood glucose, fasting insulin, leptin, adiponectin as well as lipid parameters were measured at study entry and 6 — 8 months follow-up. In addition, the homeostasis model assessment of insulin resistance index (HOMA-IR) of patients were calculated. Result: The incidence of in-stent restenosis in pioglitazone group was significantly lower than the control group (2.82% vs 12. 28% , P = 0. 037). After 6 — 8 months follow-up, there was no significant difference of serum lipids and fasting blood glucose in 2 group. However, HOMA-IR, adiponectin and A/L in pioglitazone group were significantly different from the control group. Conclusion: Pioglitazone can reduce the restenosis of non-diabetic patients with drug-eluting stents. Improving insulin resistance and endothelial dysfunction is probably the important mechanisms of pioglitazone preventing in-stent restenosis.%目的:探讨吡格列酮对非糖尿病患者冠状动脉(冠脉)支架内再狭窄的影响及其可能机制.方法:选择置入雷帕霉素洗脱支架的非糖尿病患者128例,并排除糖耐量异常者,随机分成吡格列酮组(71例)和对照组(57例),吡格列酮组在对照组常规治疗的基础上加用吡格列酮(30mg,qd);冠脉支架置入术后6~8个月行选择性冠脉造影术,于治疗前及随访6~8个月复查时先后分别测定血脂、空腹血糖、空腹胰岛素、血清瘦素及血清脂联素,并计算胰岛素抵抗指数(HOMA-IR).结果:吡格列酮组支架内再

  15. Experimental coronary sclerosis induced by immobilization of rabbits: A new model of arteriosclerosis

    Science.gov (United States)

    Tyavokin, V. V.; Tjawokin, W. W.

    1980-01-01

    A new method for producing arteriosclerosis with coronary insufficiency in rabbits by means of immobilization is described and discussed. The experimentally induced atherosclerosis develops due to hypodynamics imposed by the reduced muscular activity without overloading with exogenous cholesterol. The atherosclerosis and coronary insufficiency are associated. With variations in the duration and extent of immobilization, coronary insufficiency alone or with atherosclerosis can be produced.

  16. In silico coronary wave intensity analysis: application of an integrated one-dimensional and poromechanical model of cardiac perfusion.

    Science.gov (United States)

    Lee, Jack; Nordsletten, David; Cookson, Andrew; Rivolo, Simone; Smith, Nicolas

    2016-12-01

    Coronary wave intensity analysis (cWIA) is a diagnostic technique based on invasive measurement of coronary pressure and velocity waveforms. The theory of WIA allows the forward- and backward-propagating coronary waves to be separated and attributed to their origin and timing, thus serving as a sensitive and specific cardiac functional indicator. In recent years, an increasing number of clinical studies have begun to establish associations between changes in specific waves and various diseases of myocardium and perfusion. These studies are, however, currently confined to a trial-and-error approach and are subject to technological limitations which may confound accurate interpretations. In this work, we have developed a biophysically based cardiac perfusion model which incorporates full ventricular-aortic-coronary coupling. This was achieved by integrating our previous work on one-dimensional modelling of vascular flow and poroelastic perfusion within an active myocardial mechanics framework. Extensive parameterisation was performed, yielding a close agreement with physiological levels of global coronary and myocardial function as well as experimentally observed cumulative wave intensity magnitudes. Results indicate a strong dependence of the backward suction wave on QRS duration and vascular resistance, the forward pushing wave on the rate of myocyte tension development, and the late forward pushing wave on the aortic valve dynamics. These findings are not only consistent with experimental observations, but offer a greater specificity to the wave-originating mechanisms, thus demonstrating the value of the integrated model as a tool for clinical investigation.

  17. A Numerical Multiscale Framework for Modeling Patient-Specific Coronary Artery Bypass Surgeries

    Science.gov (United States)

    Ramachandra, Abhay B.; Kahn, Andrew; Marsden, Alison

    2014-11-01

    Coronary artery bypass graft (CABG) surgery is performed to revascularize diseased coronary arteries, using arterial, venous or synthetic grafts. Vein grafts, used in more than 70% of procedures, have failure rates as high as 50% in less than 10 years. Hemodynamics is known to play a key role in the mechano-biological response of vein grafts, but current non-invasive imaging techniques cannot fully characterize the hemodynamic and biomechanical environment. We numerically compute hemodynamics and wall mechanics in patient-specific 3D CABG geometries using stabilized finite element methods. The 3D patient-specific domain is coupled to a 0D lumped parameter circulatory model and parameters are tuned to match patient-specific blood pressures, stroke volumes, heart rates and heuristic flow-split values. We quantify differences in hemodynamics between arterial and venous grafts and discuss possible correlations to graft failure. Extension to a deformable wall approximation will also be discussed. The quantification of wall mechanics and hemodynamics is a necessary step towards coupling continuum models in solid and fluid mechanics with the cellular and sub-cellular responses of grafts, which in turn, should lead to a more accurate prediction of the long term outcome of CABG surgeries, including predictions of growth and remodeling.

  18. Late stent malapposition and marked positive vessel remodeling after sirolimus-eluting coronary stent implantation

    Institute of Scientific and Technical Information of China (English)

    ZHANG Feng; QIAN Ju-ying; GE Jun-bo

    2006-01-01

    @@ It has been reported that positive remodeling, regression of neointimal hyperplasia, and late malapposition are associated with brachytherapy, one of the approaches to prevent first-time and recurrent in-stent restenosis.1,2 Recently, some drug-eluting stents have been demonstrated to dramatically reduce restenosis rates.3,4 Despite these promising results, these drug-eluting stents may have the same potential risks as brachytherapy, with some similarities between the 2 technologies in anti- proliferative effects on vascular smooth muscle cells and endothelial cells. We reported a case of late stent malapposition and marked positive vessel remodeling after sirolimus-eluting coronary stent implantation.

  19. The coronary heart team.

    Science.gov (United States)

    Yanagawa, Bobby; Puskas, John D; Bhatt, Deepak L; Verma, Subodh

    2017-09-01

    The concept of a Coronary Heart Team has generated increased interest, including support from major practice guidelines. Here, we review the rationale and the published experience of Coronary Heart Teams. A Coronary Heart Team should be led by both cardiology and cardiac surgery with a shared decision-making approach. The team should incorporate data from anatomic and clinical risk prediction models to offer individualized care. Most teams focus on management of complex patients and those with indications for both coronary artery bypass graft and percutaneous coronary intervention. The potential benefits of a Coronary Heart Team include balanced decision-making, greater adherence to evidence-based practice guidelines, as well as promoting greater collegiality and exchange of knowledge between specialties. Single-center series have demonstrated consistency in decision-making by Coronary Heart Teams but prospective data demonstrating improved patient outcomes and/or cost effectiveness are necessary. The concept of a Coronary Heart Team is gaining traction for patients with complex coronary artery disease. There is a growing literature in support of Coronary Heart Teams but comparative and prospective data demonstrating improved patient outcomes are needed.

  20. Beyond Oncogenesis: The Role of S-Phase Kinase-Associated Protein-2 (SKP2 In Vascular Restenosis

    Directory of Open Access Journals (Sweden)

    Yih-Jer Wu

    2008-12-01

    Full Text Available The clinical benefits of percutaneous coronary intervention, the most prevalent procedure nowadays for the treatment of symptomatic coronary artery disease, are frequently offset by the occurrence of vascular restenosis. Although the introduction of drug-eluting stents has significantly reduced restenotic rates, the rare, but potentially fatal, delayed thrombosis remains a clinical threat. Further refinement of the drug-eluting stent based on a better understanding of cell cycle regulation between the vascular smooth muscle cell (VSMC and endothelial cell (EC is required. In this review, we discuss the role of S-phase kinase-associated protein-2 (Skp2, previously known as an oncoprotein, in the regulation of VSMC proliferation and its signaling axis. The currently available evidence suggests that the Rac1-Skp2-p27Kip1 signaling axis acts as a common final pathway for many factors that regulate VSMC proliferation, such as growth factors, extracellular matrices and cyclic nucleotides. Importantly, although EC proliferation is also shown to be regulated by the same axis, cAMP seems to regulate this axis differentially between VSMC and EC, rendering the underlying mechanism of this differential regulation a promising target for the development of a new generation of drug-eluting stent.

  1. Quantification of the uncertainty in coronary CTA plaque measurements using dynamic cardiac phantom and 3D-printed plaque models

    Science.gov (United States)

    Richards, Taylor; Sturgeon, Gregory M.; Ramirez-Giraldo, Juan Carlos; Rubin, Geoffrey; Segars, Paul; Samei, Ehsan

    2017-03-01

    The purpose of this study was to quantify the accuracy of coronary computed tomography angiography (CTA) stenosis measurements using newly developed physical coronary plaque models attached to a base dynamic cardiac phantom (Shelley Medical DHP-01). Coronary plaque models (5 mm diameter, 50% stenosis, and 32 mm long) were designed and 3D-printed with tissue equivalent materials (calcified plaque with iodine enhanced lumen). Realistic cardiac motion was achieved by fitting known cardiac motion vectors to left ventricle volume-time curves to create synchronized heart motion profiles executed by the base cardiac phantom. Realistic coronary CTA acquisition was accomplished by synthesizing corresponding ECG waveforms for gating and reconstruction purposes. All scans were acquired using a retrospective gating technique on a dual-source CT system (Siemens SOMATOM FLASH) with 75ms temporal resolution. Multi-planar reformatted images were reconstructed along vessel centerlines and the enhanced lumens were manually segmented by 5 independent operators. On average, the stenosis measurement accuracy was 0.9% positive bias for the motion free condition (0 bpm). The measurement accuracy monotonically decreased to 18.5% negative bias at 90 bpm. Contrast-tonoise (CNR), vessel circularity, and segmentation conformity also decreased monotonically with increasing heart rate. These results demonstrate successful implementation of the base cardiac phantom with 3D-printed coronary plaque models, adjustable motion profiles, and coordinated ECG waveforms. They further show the utility of the model to ascertain metrics of coronary CT accuracy and image quality under a variety of plaque, motion, and acquisition conditions.

  2. In vitro evaluation of 56 coronary artery stents by 256-slice multi-detector coronary CT

    Energy Technology Data Exchange (ETDEWEB)

    Steen, Henning, E-mail: henning.steen@med.uni-heidelberg.de [University of Heidelberg, Department of Cardiology, Im Neuenheimer Feld 410, Heidelberg 69120 (Germany); Andre, Florian, E-mail: Florian.Andre@med.uni-heidelberg.de [University of Heidelberg, Department of Cardiology, Im Neuenheimer Feld 410, Heidelberg 69120 (Germany); Korosoglou, Grigorios, E-mail: Grigorios.Korosoglou@med.uni-heidelberg.de [University of Heidelberg, Department of Cardiology, Im Neuenheimer Feld 410, Heidelberg 69120 (Germany); Mueller, Dirk, E-mail: Dirk.Mueller@philips.com [Philips GmbH Healthcare Division, Luebeckertordamm 5, Hamburg 20099 (Germany); Hosch, Waldemar, E-mail: Waldemar.Hosch@med.uni-heidelberg.de [University of Heidelberg, Department of Diagnostic and Interventional Radiology, Im Neuenheimer Feld 410, Heidelberg 69120 (Germany); Kauczor, Hans-Ulrich, E-mail: Hans-Ulrich.Kauczor@med.uni-heidelberg.de [University of Heidelberg, Department of Diagnostic and Interventional Radiology, Im Neuenheimer Feld 410, Heidelberg 69120 (Germany); Giannitsis, Evangelos, E-mail: Evangelos.Giannitsis@med.uni-heidelberg.de [University of Heidelberg, Department of Cardiology, Im Neuenheimer Feld 410, Heidelberg 69120 (Germany); Katus, Hugo A., E-mail: Hugo.Katus@med.uni-heidelberg.de [University of Heidelberg, Department of Cardiology, Im Neuenheimer Feld 410, Heidelberg 69120 (Germany)

    2011-10-15

    Objective: We sought to investigate stent lumen visibility of 56 coronary stents with the newest 256-multi-slice-CT (256-MDCT) technology for different reconstruction algorithms in an in vitro model. Background: Early identification of in-stent restenosis (ISR) is important to avoid recurrent ischemia and prevent acute myocardial infarction (AMI). Since angiography has the disadvantage of high costs and its invasiveness, MDCT could be a convenient and safe non-invasive alternative for detection of ISR. Material and methods: Percentages of in-stent lumen diameter and in-stent signal attenuation (measured as contrast-to-noise ratio (CNR)) of 56 coronary stents (group A {<=}2.5 mm; group B = 2.75-3.0 mm; group C = 3.5-4.0 mm) were evaluated in a coronary vessel in vitro phantom (iodine-filled plastic tubes) employing four different reconstruction algorithms (XCD, CC, CD, XCB) on a novel 256-MDCT (Philips-iCT, collimation = 128 mm x 0.625 mm; rotation time = 270 ms; tube current = 800 mA s with 120 kV). Analysis was conducted with the semi-automatical full-width-at-half-maximum (FWHM) method. P-values <0.05 were regarded statistically significant. Results: In-stent lumen diameter >60% for group C stents was significantly larger and CNR was significantly lower (both p < 0.05) for sharp kernels (CD; XCD) when compared to groups A/B. The FWHM-method showed significantly smaller in-stent lumen diameter (p < 0.05) when compared to the manual method. Conclusion: 256-MDCT could potentially be employed for clinical assessment of stent patency in stents >3.0 mm when analysed with cardio-dedicated sharp kernels, although clinical studies corroborating this claim should be performed. However, stents {<=}3.0 mm reconstructed by soft kernels revealed insufficient in-stent lumen visualisation and should not be used in clinical practice. Further improvements in spatial and temporal image resolution as well as reductions of radiation exposure and image noise have to be accomplished

  3. Proliferation and extracellular matrix synthesis of smooth muscle cells cultured from human coronary atherosclerotic and restenotic lesions

    NARCIS (Netherlands)

    D.C. MacLeod (Donald); B.H. Strauss (Bradley); J. Escaned (Javier); V.A.W.M. Umans (Victor); R-J. van Suylen (Robert-Jan); A. Verkerk (Anton); P.J. de Feyter (Pim); P.W.J.C. Serruys (Patrick); M. de Jong (Marcel)

    1994-01-01

    textabstractOBJECTIVES. The purpose of this study was to examine the proliferative capacity and extracellular matrix synthesis of human coronary plaque cells in vitro. BACKGROUND. Common to both primary atherosclerosis and restenosis are vascular smooth muscle cell proliferation and production of ex

  4. Which angiographic variable best describes functional status 6 months after successful single-vessel coronary balloon angiopasty?

    NARCIS (Netherlands)

    B.J.W.M. Rensing (Benno); W.R.M. Hermans (Walter); P.J. de Feyter (Pim); P.W.J.C. Serruys (Patrick); J.W. Deckers (Jaap)

    1993-01-01

    textabstractOBJECTIVES. The aim of this study was to determine which quantitative angiographic variable best describes functional status 6 months after coronary balloon angioplasty. BACKGROUND. Several angiographic restenosis criteria have been developed. These can be divided into those that describ

  5. Subacute coronary stent thrombosis in a patient with angina treated with double antiplatelet drugs for six days

    Institute of Scientific and Technical Information of China (English)

    XUE Feng; YANG Xiang-jun; CHENG Xu-jie; HUI Jie; JIANG Ting-bo; CHEN Tan; LIU Zhi-hua; SONG Jian-ping; JIANG Wen-ping

    2009-01-01

    @@ Stent implantation has been a great advance in percutaneous coronary intervention (PCI), decreasing the frequency of acute closure and restenosis. But stent thrombosis is a severe complication of this therapy regardless of the stent type: bare-metal stent (BMS) and drug-eluting stent (DES).

  6. An in silico study on the role of smooth muscle cell migration in neointimal formation after coronary stenting

    NARCIS (Netherlands)

    Tahir, H.; Niculescu, I.; Bona-Casas, C.; Merks, R.M.H.; Hoekstra, A.G.

    2015-01-01

    Excessive migration and proliferation of smooth muscle cells (SMCs) has been observed as a major factor contributing to the development of in-stent restenosis after coronary stenting. Building upon the results from in vivo experiments, we formulated a hypothesis that the speed of the initial tissue

  7. Comparison of models for predicting outcomes in patients with coronary artery disease focusing on microsimulation

    Directory of Open Access Journals (Sweden)

    Masoud Amiri

    2012-01-01

    Full Text Available Background: Physicians have difficulty to subjectively estimate the cardiovascular risk of their patients. Using an estimate of global cardiovascular risk could be more relevant to guide decisions than using binary representation (presence or absence of risk factors data. The main aim of the paper is to compare different models of predicting the progress of a coronary artery diseases (CAD to help the decision making of physician. Methods: There are different standard models for predicting risk factors such as models based on logistic regression model, Cox regression model, dynamic logistic regression model, and simulation models such as Markov model and microsimulation model. Each model has its own application which can or cannot use by physicians to make a decision on treatment of each patient. Results: There are five main common models for predicting of outcomes, including models based on logistic regression model (for short-term outcomes, Cox regression model (for intermediate-term outcomes, dynamic logistic regression model, and simulation models such as Markov and microsimulation models (for long-term outcomes. The advantages and disadvantages of these models have been discussed and summarized. Conclusion: Given the complex medical decisions that physicians face in everyday practice, the multiple interrelated factors that play a role in choosing the optimal treatment, and the continuously accumulating new evidence on determinants of outcome and treatment options for CAD, physicians may potentially benefit from a clinical decision support system that accounts for all these considerations. The microsimulation model could provide cardiologists, researchers, and medical students a user-friendly software, which can be used as an intelligent interventional simulator.

  8. A clinical model to identify patients with high-risk coronary artery disease.

    Science.gov (United States)

    Yang, Yelin; Chen, Li; Yam, Yeung; Achenbach, Stephan; Al-Mallah, Mouaz; Berman, Daniel S; Budoff, Matthew J; Cademartiri, Filippo; Callister, Tracy Q; Chang, Hyuk-Jae; Cheng, Victor Y; Chinnaiyan, Kavitha; Cury, Ricardo; Delago, Augustin; Dunning, Allison; Feuchtner, Gudrun; Hadamitzky, Martin; Hausleiter, Jörg; Karlsberg, Ronald P; Kaufmann, Philipp A; Kim, Yong-Jin; Leipsic, Jonathon; LaBounty, Troy; Lin, Fay; Maffei, Erica; Raff, Gilbert L; Shaw, Leslee J; Villines, Todd C; Min, James K; Chow, Benjamin J W

    2015-04-01

    This study sought to develop a clinical model that identifies patients with and without high-risk coronary artery disease (CAD). Although current clinical models help to estimate a patient's pre-test probability of obstructive CAD, they do not accurately identify those patients with and without high-risk coronary anatomy. Retrospective analysis of a prospectively collected multinational coronary computed tomographic angiography (CTA) cohort was conducted. High-risk anatomy was defined as left main diameter stenosis ≥50%, 3-vessel disease with diameter stenosis ≥70%, or 2-vessel disease involving the proximal left anterior descending artery. Using a cohort of 27,125, patients with a history of CAD, cardiac transplantation, and congenital heart disease were excluded. The model was derived from 24,251 consecutive patients in the derivation cohort and an additional 7,333 nonoverlapping patients in the validation cohort. The risk score consisted of 9 variables: age, sex, diabetes, hypertension, current smoking, hyperlipidemia, family history of CAD, history of peripheral vascular disease, and chest pain symptoms. Patients were divided into 3 risk categories: low (≤7 points), intermediate (8 to 17 points) and high (≥18 points). The model was statistically robust with area under the curve of 0.76 (95% confidence interval [CI]: 0.75 to 0.78) in the derivation cohort and 0.71 (95% CI: 0.69 to 0.74) in the validation cohort. Patients who scored ≤7 points had a low negative likelihood ratio (risk CAD was 1% in patients with ≤7 points and 16.7% in those with ≥18 points. We propose a scoring system, based on clinical variables, that can be used to identify patients at high and low pre-test probability of having high-risk CAD. Identification of these populations may detect those who may benefit from a trial of medical therapy and those who may benefit most from an invasive strategy. Copyright © 2015 American College of Cardiology Foundation. Published by

  9. Drug-eluting stents to prevent stent thrombosis and restenosis.

    Science.gov (United States)

    Im, Eui; Hong, Myeong-Ki

    2016-01-01

    Although first-generation drug-eluting stents (DES) have significantly reduced the risk of in-stent restenosis, they have also increased the long-term risk of stent thrombosis. This safety concern directly triggered the development of new generation DES, with innovations in stent platforms, polymers, and anti-proliferative drugs. Stent platform materials have evolved from stainless steel to cobalt or platinum-chromium alloys with an improved strut design. Drug-carrying polymers have become biocompatible or biodegradable and even polymer-free DES were introduced. New limus-family drugs (such as everolimus, zotarolimus or biolimus) were adopted to enhance stent performances. As a result, these new DES demonstrated superior vascular healing responses on intracoronary imaging studies and lower stent thrombotic events in actual patients. Recently, fully-bioresorbable stents (scaffolds) have been introduced, and expanding their applications. In this article, the important concepts and clinical results of new generation DES and bioresorbable scaffolds are described.

  10. Investigations with GMC2021 in experimental models predictive of antimigraine activity and coronary side-effect potential

    NARCIS (Netherlands)

    Saxena, P.R; Heiligers, J.P C; Maassen Vandenbrink, A; Bax, W.A; Barf, T.A; Wikström, H.V

    1996-01-01

    Several acutely acting antimigraine drugs, including sumatriptan and other second generation 5-HT1D receptor agonists, have the ability to constrict porcine carotid arteriovenous anastomoses as well as the human isolated coronary artery. These two experimental models seem to serve as indicators, res

  11. A coronary heart disease risk model for predicting the effect of potent antiretroviral therapy in HIV-1 infected men

    DEFF Research Database (Denmark)

    May, Margaret; Sterne, Jonathan A C; Shipley, Martin;

    2007-01-01

    Many HIV-infected patients on highly active antiretroviral therapy (HAART) experience metabolic complications including dyslipidaemia and insulin resistance, which may increase their coronary heart disease (CHD) risk. We developed a prognostic model for CHD tailored to the changes in risk factors...

  12. Using a Markov simulation model to assess the impact of changing trends in coronary heart disease incidence on requirements for coronary artery revascularization procedures in Western Australia

    Directory of Open Access Journals (Sweden)

    Knuiman Matthew

    2010-01-01

    Full Text Available Abstract Background The population incidence of coronary heart disease (CHD has been declining in Australia and many other countries. This decline has been due to reduced population levels of risk factors for CHD and improved medical care for those at higher risk of CHD. However, there are signs that there may be a slowing down or even reversal in the decline of CHD incidence due to the 'obesity epidemic' and other factors and this will have implications for the requirements for surgical treatments for those with CHD. Methods Using a validated Markov simulation model applied to the population of Western Australia, different CHD incidence trend scenarios were developed to explore the effect of changing CHD incidence on requirements for coronary artery bypass graft (CABG and percutaneous coronary interventions (PCI, together known as coronary artery revascularization procedures (CARPs. Results The most dominant component of CHD incidence is the risk of CHD hospital admission for those with no history of CHD and if this risk leveled off and the trends in all other risks continued unchanged, then the projected numbers of CABGs and PCIs are only minimally changed. Further, the changes in the projected numbers remained small even when this risk was increased by 20 percent (although it is an unlikely scenario. However, when the other CHD incidence components that had also been declining, namely, the risk of CABG and that of CHD death for those with no history of CHD, were also projected to level off as these were declining in 1998-2000 and the risk of PCI for those with no history of CHD (which was already increasing was projected to further increase by 5 percent, it had a substantial effect on the projected numbers of CARPs. Conclusion There needs to be dramatic changes to several CHD incidence components before it has a substantial impact on the projected requirements for CARPs. Continued monitoring of CHD incidence and also the mix of initial

  13. Modelling Future Coronary Heart Disease Mortality to 2030 in the British Isles.

    Science.gov (United States)

    Hughes, John; Kabir, Zubair; Bennett, Kathleen; Hotchkiss, Joel W; Kee, Frank; Leyland, Alastair H; Davies, Carolyn; Bandosz, Piotr; Guzman-Castillo, Maria; O'Flaherty, Martin; Capewell, Simon; Critchley, Julia

    2015-01-01

    Despite rapid declines over the last two decades, coronary heart disease (CHD) mortality rates in the British Isles are still amongst the highest in Europe. This study uses a modelling approach to compare the potential impact of future risk factor scenarios relating to smoking and physical activity levels, dietary salt and saturated fat intakes on future CHD mortality in three countries: Northern Ireland (NI), Republic of Ireland (RoI) and Scotland. CHD mortality models previously developed and validated in each country were extended to predict potential reductions in CHD mortality from 2010 (baseline year) to 2030. Risk factor trends data from recent surveys at baseline were used to model alternative future risk factor scenarios: Absolute decreases in (i) smoking prevalence and (ii) physical inactivity rates of up to 15% by 2030; relative decreases in (iii) dietary salt intake of up to 30% by 2030 and (iv) dietary saturated fat of up to 6% by 2030. Probabilistic sensitivity analyses were then conducted. Projected populations in 2030 were 1.3, 3.4 and 3.9 million in NI, RoI and Scotland respectively (adults aged 25-84). In 2030: assuming recent declining mortality trends continue: 15% absolute reductions in smoking could decrease CHD deaths by 5.8-7.2%. 15% absolute reductions in physical inactivity levels could decrease CHD deaths by 3.1-3.6%. Relative reductions in salt intake of 30% could decrease CHD deaths by 5.2-5.6% and a 6% reduction in saturated fat intake might decrease CHD deaths by some 7.8-9.0%. These projections remained stable under a wide range of sensitivity analyses. Feasible reductions in four cardiovascular risk factors (already achieved elsewhere) could substantially reduce future coronary deaths. More aggressive polices are therefore needed in the British Isles to control tobacco, promote healthy food and increase physical activity.

  14. Modelling Future Coronary Heart Disease Mortality to 2030 in the British Isles.

    Directory of Open Access Journals (Sweden)

    John Hughes

    Full Text Available Despite rapid declines over the last two decades, coronary heart disease (CHD mortality rates in the British Isles are still amongst the highest in Europe. This study uses a modelling approach to compare the potential impact of future risk factor scenarios relating to smoking and physical activity levels, dietary salt and saturated fat intakes on future CHD mortality in three countries: Northern Ireland (NI, Republic of Ireland (RoI and Scotland.CHD mortality models previously developed and validated in each country were extended to predict potential reductions in CHD mortality from 2010 (baseline year to 2030. Risk factor trends data from recent surveys at baseline were used to model alternative future risk factor scenarios: Absolute decreases in (i smoking prevalence and (ii physical inactivity rates of up to 15% by 2030; relative decreases in (iii dietary salt intake of up to 30% by 2030 and (iv dietary saturated fat of up to 6% by 2030. Probabilistic sensitivity analyses were then conducted.Projected populations in 2030 were 1.3, 3.4 and 3.9 million in NI, RoI and Scotland respectively (adults aged 25-84. In 2030: assuming recent declining mortality trends continue: 15% absolute reductions in smoking could decrease CHD deaths by 5.8-7.2%. 15% absolute reductions in physical inactivity levels could decrease CHD deaths by 3.1-3.6%. Relative reductions in salt intake of 30% could decrease CHD deaths by 5.2-5.6% and a 6% reduction in saturated fat intake might decrease CHD deaths by some 7.8-9.0%. These projections remained stable under a wide range of sensitivity analyses.Feasible reductions in four cardiovascular risk factors (already achieved elsewhere could substantially reduce future coronary deaths. More aggressive polices are therefore needed in the British Isles to control tobacco, promote healthy food and increase physical activity.

  15. Secreted Matrix Metalloproteinase-9 of Proliferating Smooth Muscle Cells as a Trigger for Drug Release from Stent Surface Polymers in Coronary Arteries.

    Science.gov (United States)

    Gliesche, Daniel G; Hussner, Janine; Witzigmann, Dominik; Porta, Fabiola; Glatter, Timo; Schmidt, Alexander; Huwyler, Jörg; Meyer Zu Schwabedissen, Henriette E

    2016-07-01

    Cardiovascular diseases are the leading causes of death in industrialized countries. Atherosclerotic coronary arteries are commonly treated with percutaneous transluminal coronary intervention followed by stent deployment. This treatment has significantly improved the clinical outcome. However, triggered vascular smooth muscle cell (SMC) proliferation leads to in-stent restenosis in bare metal stents. In addition, stent thrombosis is a severe side effect of drug eluting stents due to inhibition of endothelialization. The aim of this study was to develop and test a stent surface polymer, where cytotoxic drugs are covalently conjugated to the surface and released by proteases selectively secreted by proliferating smooth muscle cells. Resting and proliferating human coronary artery smooth muscle cells (HCASMC) and endothelial cells (HCAEC) were screened to identify an enzyme exclusively released by proliferating HCASMC. Expression analyses and enzyme activity assays verified selective and exclusive activity of the matrix metalloproteinase-9 (MMP-9) in proliferating HCASMC. The principle of drug release exclusively triggered by proliferating HCASMC was tested using the biodegradable stent surface polymer poly-l-lactic acid (PLLA) and the MMP-9 cleavable peptide linkers named SRL and AVR. The specific peptide cleavage by MMP-9 was verified by attachment of the model compound fluorescein. Fluorescein release was observed in the presence of MMP-9 secreting HCASMC but not of proliferating HCAEC. Our findings suggest that cytotoxic drug conjugated polymers can be designed to selectively release the attached compound triggered by MMP-9 secreting smooth muscle cells. This novel concept may be beneficial for stent endothelialization thereby reducing the risk of restenosis and thrombosis.

  16. [Factor models of the Beck Depression Inventory-II. Validation with coronary patients and a critique of Ward's model].

    Science.gov (United States)

    del Pino Pérez, Antonio; Ibáñez Fernández, Ignacio; Bosa Ojeda, Francisco; Dorta González, Ruth; Gaos Miezoso, María Teresa

    2012-02-01

    The objective of this study was to validate in a sample of 205 coronary patients a factor model for the BDI-II, especially a model that would allow for modeling of depressive symptoms after explicitly removing bias related to somatic symptoms of depression that would overlap those of heart disease. Exploratory and confirmatory factor analyses for ordinal data were conducted. A one-factor model, six correlated two-factor models and, derivatives thereof, seven models with a single General Depression factor and two uncorrelated factors, were analyzed. Exploratory analysis extracted two factors, Somatic-affective and Cognitive. Confirmatory factor analyses showed the worst fit for the one-factor model. Two-factor models were surpassed in goodness of fit by the models of general-factor and group factors. Among these, the General, Somatic-affective and Cognitive (G-Sa-C) model of Beck with students is noteworthy. The reduced General, Somatic and Cognitive (G-S-C) model of Ward showed the worst goodness of fit. Our model surpasses the cutoff criteria of all fit indexes. We conclude that the inclusion of a general-factor and group factors in all the models surpasses the results of G-S-C model and, therefore, questions it. The G-Sa-C model is strengthened.

  17. Lack of cardioprotection from metabolic support with glutamine or glutamate in a porcine coronary occlusion model

    DEFF Research Database (Denmark)

    Kristensen, Jens; Mæng, Michael; Mortensen, Ulrik;

    2005-01-01

    OBJECTIVE: Previous experimental studies indicate that glutamine or glutamate may provide cardioprotection by improving the oxidative metabolism in myocardial ischemia. We investigated the effect of glutamine or glutamate, given during reperfusion, on resulting infarct size and hemodynamic recovery...... vascular resistance, while glutamate preserved cardiac output during infusion. CONCLUSION: Substrate supplementation with the anaplerotic precursors glutamine and glutamate is ineffective as adjunctive therapy for severe myocardial ischemia. Beneficial effects documented in less complex experimental....... DESIGN: A porcine coronary occlusion model was applied. Infusions were initiated 15 min before reperfusion and supplemented with intracoronary bolus doses at reperfusion. The primary outcome measure was infarct size in relation to area at risk determined by a standard tissue staining procedure. Secondary...

  18. Deformable known component model-based reconstruction for coronary CT angiography

    Science.gov (United States)

    Zhang, X.; Tilley, S.; Xu, S.; Mathews, A.; McVeigh, E. R.; Stayman, J. W.

    2017-03-01

    Purpose: Atherosclerosis detection remains challenging in coronary CT angiography for patients with cardiac implants. Pacing electrodes of a pacemaker or lead components of a defibrillator can create substantial blooming and streak artifacts in the heart region, severely hindering the visualization of a plaque of interest. We present a novel reconstruction method that incorporates a deformable model for metal leads to eliminate metal artifacts and improve anatomy visualization even near the boundary of the component. Methods: The proposed reconstruction method, referred as STF-dKCR, includes a novel parameterization of the component that integrates deformation, a 3D-2D preregistration process that estimates component shape and position, and a polyenergetic forward model for x-ray propagation through the component where the spectral properties are jointly estimated. The methodology was tested on physical data of a cardiac phantom acquired on a CBCT testbench. The phantom included a simulated vessel, a metal wire emulating a pacing lead, and a small Teflon sphere attached to the vessel wall, mimicking a calcified plaque. The proposed method was also compared to the traditional FBP reconstruction and an interpolation-based metal correction method (FBP-MAR). Results: Metal artifacts presented in standard FBP reconstruction were significantly reduced in both FBP-MAR and STF- dKCR, yet only the STF-dKCR approach significantly improved the visibility of the small Teflon target (within 2 mm of the metal wire). The attenuation of the Teflon bead improved to 0.0481 mm-1 with STF-dKCR from 0.0166 mm-1 with FBP and from 0.0301 mm-1 with FBP-MAR - much closer to the expected 0.0414 mm-1. Conclusion: The proposed method has the potential to improve plaque visualization in coronary CT angiography in the presence of wire-shaped metal components.

  19. Early Identification of Patients with the Risk for Postoperative Carotid Restenosis Development

    OpenAIRE

    Strenja-Linić, Ines; Kovačević, Miljenko; Kovačić, Slavica; Ivančić, Aldo; Budiselić, Berislav

    2011-01-01

    Multiple randomized trials over the last decade for both symptomatic and asymptomatic carotid stenosis have proven the efficacy of carotid endarterectomy (CEA) in reducing the risk of stroke. The aim of this prospective non-randomizing cohort study was to determine the incidence of carotid arteries restenosis after CEA as well as to ascertain the clinical and etiological characteristics for the development of restenosis. Treatment data from 178 KBC Rijeka patients that had undergo...

  20. Coronary Motion Modeling for CTA to X-Ray Angiography Registration

    NARCIS (Netherlands)

    C.T. Metz (Coert)

    2011-01-01

    textabstractThe goal of the work described in this thesis is to develop and validate techniques to make 3D coronary computed tomography angiography available during percutaneous coronary interventions. The accurate alignment of the preoperative image with the intraoperative situation is very challen

  1. Familial hypercholesterolaemic downsized pig with human-like coronary atherosclerosis: a model for preclinical studies

    DEFF Research Database (Denmark)

    Thim, Troels; Hagensen, Mette; Drouet, L.

    2010-01-01

    site-specifically by inflicting coronary artery balloon injury. Both spontaneously developed and balloon accelerated coronary plaques mirrored pertinent human plaque features, including a large necrotic core covered by a thin and inflamed fibrous cap as seen in the most common type of thrombosis...

  2. Matrix metalloproteinase 9 level as an indicator for restenosis following cervical and intracranial angioplasty and stenting

    Institute of Scientific and Technical Information of China (English)

    Jun-peng Liu; Yin-zhou Wang; Yong-kun Li; Qiong Cheng; Zheng Zheng

    2015-01-01

    Cervical and intracranial angioplasty and stenting is an effective and safe method of reducing the risk of ischemic stroke, but it may be affected by in-stent restenosis. The present study in-vestigated serum level of matrix metalloproteinase 9 as a predictor of restenosis after 40 patients underwent cervical and/or intracranial angioplasty and stenting. Results showed that resteno-sis occurred in 30% (3/10) of patients when the serum level of matrix metalloproteinase 9 at 3 days after surgery was 2.5 times higher than preoperative level. No restenosis occurred when the serum level of matrix metalloproteinase 9 at 3 days after surgery was not 2.5 times higher than preoperative level. Restenosis occurred in 12% (2/17) of patients when the serum level of matrix metalloproteinase 9 was higher than preoperative level for more than 30 days after surgery, but only occurred in 4% (1/23) of patients when the serum level of matrix metalloproteinase 9 was higher than preoperative level for less than 30 days after surgery. However, the differences observed were not statistically signiifcant (P > 0.05). Experimental ifndings indicate that when the serum level of matrix metalloproteinase 9 is 2.5 times higher than preoperative level at 3 days after cervi-cal and intracranial angioplasty and stenting, it may serve as a predictor of in-stent restenosis.

  3. Matrix metalloproteinase 9 level as an indicator for restenosis following cervical and intracranial angioplasty and stenting

    Directory of Open Access Journals (Sweden)

    Jun-peng Liu

    2015-01-01

    Full Text Available Cervical and intracranial angioplasty and stenting is an effective and safe method of reducing the risk of ischemic stroke, but it may be affected by in-stent restenosis. The present study investigated serum level of matrix metalloproteinase 9 as a predictor of restenosis after 40 patients underwent cervical and/or intracranial angioplasty and stenting. Results showed that restenosis occurred in 30% (3/10 of patients when the serum level of matrix metalloproteinase 9 at 3 days after surgery was 2.5 times higher than preoperative level. No restenosis occurred when the serum level of matrix metalloproteinase 9 at 3 days after surgery was not 2.5 times higher than preoperative level. Restenosis occurred in 12% (2/17 of patients when the serum level of matrix metalloproteinase 9 was higher than preoperative level for more than 30 days after surgery, but only occurred in 4% (1/23 of patients when the serum level of matrix metalloproteinase 9 was higher than preoperative level for less than 30 days after surgery. However, the differences observed were not statistically significant (P > 0.05. Experimental findings indicate that when the serum level of matrix metalloproteinase 9 is 2.5 times higher than preoperative level at 3 days after cervical and intracranial angioplasty and stenting, it may serve as a predictor of in-stent restenosis.

  4. The inhibition of calpains ameliorates vascular restenosis through MMP2/TGF-β1 pathway.

    Science.gov (United States)

    Tang, Lianghu; Pei, Haifeng; Yang, Yi; Wang, Xiong; Wang, Ting; Gao, Erhe; Li, De; Yang, Yongjian; Yang, Dachun

    2016-07-25

    Restenosis limits the efficacy of vascular percutaneous intervention, in which vascular smooth muscle cell (VSMC) proliferation and activation of inflammation are two primary causal factors. Calpains influence VSMC proliferation and collagen synthesis. However, the roles of calpastatin and calpains in vascular restenosis remain unclear. Here, restenosis was induced by ligating the left carotid artery, and VSMCs were pretreated with platelet-derived growth factor (PDGF)-BB. Adenovirus vector carrying MMP2 sequence and specific small interfering RNA against calpain-1/2 were introduced. Finally, restenosis enhanced the expression of calpain-1/2, but reduced calpastatin content. In calpastatin transgenic mice, lumen narrowing was attenuated gradually and peaked on days 14-21. Cell proliferation and migration as well as collagen synthesis were inhibited in transgenic mice, and expression of calpain-1/2 and MMP2/transforming growth factor-β1 (TGF-β1). Consistently, in VSMCs pretreated with PDGF-BB, calpastatin induction and calpains inhibition suppressed the proliferation and migration of VSMCs and collagen synthesis, and reduced expression of calpain-1/2 and MMP2/TGF-β1. Moreover, simvastatin improved restenosis indicators by suppressing the HIF-1α/calpains/MMP2/TGF-β1 pathway. However, MMP2 supplementation eliminated the vascular protection of calpastatin induction and simvastatin. Collectively, calpains inhibition plays crucial roles in vascular restenosis by preventing neointimal hyperplasia at the early stage via suppression of the MMP2/TGF-β1 pathway.

  5. Synergistic effect of anti-platelet and anti-inflammation of drug-coated Co-Cr substrates for prevention of initial in-stent restenosis.

    Science.gov (United States)

    Lih, Eugene; Jung, Jee Won; Joung, Yoon Ki; Ahn, Dong June; Han, Dong Keun

    2016-04-01

    Antiplatelet and antithrombotic therapies are systematically considered to prevent restenosis following coronary stent implantation. Currently, patients receiving medicated stents are prescribed to orally take anticoagulants and antiplatelet drugs such as aspirin (ASP) and prasugrel (PRAS). Propolis (PROP) known as a natural organic compound was recently evaluated for its antiplatelet activity, antibiotics and immunomodulatory activities. In this study, antiplatelet drug-coated Co-Cr substrates were prepared with biodegradable poly(d,l-lactide) (PDLLA) containing ASP, PRA, or PROP using electrospray and the blood compatibility of the different substrates was investigated by measuring protein adsorption and platelet adhesion. In addition, the anti-inflammatory properties of the modified Co-Cr surfaces were assessed by measuring IL-8 and IL-6 expression levels in human endothelial cell cultures. Drug-coated surfaces were found to resist the adsorption of fibrinogen when compared to bare Co-Cr or PDLLA-coated Co-Cr. Interestingly, ASP- and PROP-containing substrates not only showed reduced adhesion of platelets and delayed coagulation time, but also drastically reduced the expression level of IL-8 and IL-6. Such results are supported that ASP- or PROP-coated Co-Cr can be potentially used as a stent material to mitigate early stage of restenosis. The developed coating materials might be an interesting alternative to systemic anticoagulant therapies prescribed after stent implantation. Copyright © 2016 Elsevier B.V. All rights reserved.

  6. Validity of Global Registry of Acute Coronary Events in Acute Coronary Syndrome Prediction Model for In-hospital Mortality in A Sub-population of Chongqing

    Institute of Scientific and Technical Information of China (English)

    Khalill Ramjane; Han LEI; Jing CHANG

    2009-01-01

    Objectives To determine the validity and applicability of the global registry of acute coronary events (GRACE) pre-diction model for in-hospital mortality in all forms of acute coronary syndrome (ACS) in a sub population of Chongqing. Methods Data of 669 ACS patients were collected retrospectively from Jan 2005 to Apr 2008 and were re-corded on a standardized case report form. For each patient the GRACE risk score (GRACE RS) was calculated (using the GRACE calculator available from the grace website) using specific variables collected at admission. Patients with missing data and those transferred from other hospitals were excluded. Receiver operating characteristic (ROC) curves were plotted for the GRACE risk score. Results Among 576 ACS patients, 98 (17.01%), 36 (6. 25 %), and 442 (76. 74 %) presented with ST-elevation myocardial infarction (MI), non-ST elevation MI and unstable angina, re-spectively. The GRACE risk score could not be determined in 91 (9. 3 %) patients due to missing data or for patients who were transferred from other hospitals and were excluded from the analysis. The median GRACE risk score was 133 (interquartile range: 92 - 174) and, the in-hospital rates of death and death/(re-) MI were 6. 1% and 7.6 %, respec-tively. The GRACE risk score demonstrated excellent discrimination (c-statistic = 0. 86, 95 % CI 0. 79 - 0. 91, P < 0. 001) for in-hospital death/ (re) -MI. Conclusions The GRACE RS study had a good predictive accuracy for death or MI across the wide range of ACS in this population. It may be a useful risk stratification tool that helps identify high-risk patients who will benefit most from myocardial revascularization and low risk patients who may be spared from un-dergoing more aggressive interventional treatment.

  7. Assessment of the safety and performance of the STENTYS self-expanding coronary stent in acute myocardial infarction: Results from the APPOSITION I study

    NARCIS (Netherlands)

    G. Amoroso (Giovanni); R.J.M. van Geuns (Robert Jan); C.M. Spaulding (Christian); S. Manzo-Silberman (Stephane); K. Hauptmann (Karl); R. Spaargaren (René); H.M. Garcia-Garcia (Hector); P.W.J.C. Serruys (Patrick); S. Verheye (Stefan)

    2011-01-01

    textabstractAims: In the setting of ST-elevation myocardial infarction (STEMI), epicardial vasoconstriction and throm- bus load may lead to stent undersizing and malapposition after primary percutaneous coronary intervention (PPCI), which can both be responsible for stent thrombosis or restenosis.

  8. Efficacy and safety of zotarolimus-eluting and sirolimus-eluting coronary stents in routine clinical care (SORT OUT III): a randomised controlled superiority trial

    DEFF Research Database (Denmark)

    Rasmussen, Klaus; Maeng, Michael; Kaltoft, Anne

    2010-01-01

    In low-risk patients, the zotarolimus-eluting stent has been shown to reduce rates of restenosis without increasing the risk of stent thrombosis. We compared the efficacy and safety of the zotarolimus-eluting stent versus the sirolimus-eluting stent in patients with coronary artery disease who we...

  9. Assessment of the safety and performance of the STENTYS self-expanding coronary stent in acute myocardial infarction: Results from the APPOSITION I study

    NARCIS (Netherlands)

    G. Amoroso (Giovanni); R.J.M. van Geuns (Robert Jan); C.M. Spaulding (Christian); S. Manzo-Silberman (Stephane); K. Hauptmann (Karl); R. Spaargaren (René); H.M. Garcia-Garcia (Hector); P.W.J.C. Serruys (Patrick); S. Verheye (Stefan)

    2011-01-01

    textabstractAims: In the setting of ST-elevation myocardial infarction (STEMI), epicardial vasoconstriction and throm- bus load may lead to stent undersizing and malapposition after primary percutaneous coronary intervention (PPCI), which can both be responsible for stent thrombosis or restenosis. A

  10. Lumen narrowing after percutaneous transluminal coronary balloon angioplasty follows a near gaussian distribution: a quantitative angiographic study in 1,445 successfully dilated lesions

    NARCIS (Netherlands)

    B.J.W.M. Rensing (Benno); W.R.M. Hermans (Walter); P.J. de Feyter (Pim); J.G.P. Tijssen (Jan); P.W.J.C. Serruys (Patrick); J.W. Deckers (Jaap)

    1992-01-01

    textabstractTo determine whether significant angiographic narrowing and restenosis after successful coronary balloon angioplasty is a specific disease entity occurring in a subset of dilated lesions or whether it is the tail end of a gaussian distributed phenomenon, 1,445 successfully dilated lesion

  11. An in silico study on the role of smooth muscle cell migration in neointimal formation after coronary stenting. Journal of the Royal Society Interface, 12(108), 20150358.

    NARCIS (Netherlands)

    H. Tahir (Hannan); I. Niculescu (Ioana); C. Bona-Casa; R.M.H. Merks (Roeland); A.G. Hoekstra

    2015-01-01

    htmlabstractExcessive migration and proliferation of smooth muscle cells (SMCs) has been observed as a major factor contributing to the development of in-stent restenosis after coronary stenting. Building upon the results from in vivo experiments, we formulated a hypothesis that the speed of the

  12. Antidepressant indatraline induces autophagy and inhibits restenosis via suppression of mTOR/S6 kinase signaling pathway

    Science.gov (United States)

    Cho, Yoon Sun; Yen, Chih-na; Shim, Joong Sup; Kang, Dong Hoon; Kang, Sang Won; Liu, Jun O.; Kwon, Ho Jeong

    2016-01-01

    Indatraline is an antidepressive agent and a non-selective monoamine transporter inhibitor that blocks the reuptake of neurotransmitters (dopamine, serotonin, and norepinephrine). In this study, we report that indatraline induces autophagy via the suppression of mTOR/S6 kinase signaling. Autophagy induction was examined by a cell-based high content screening system using LysoTracker, which was followed by monodansylcadaverine staining and transmission electron microscope observation. Indatraline increased the number of EGFP-LC3 cells expressing autophagosomes in the cytoplasm. Conversion of LC3 was further validated by immunoblotting. Indatraline induced autophagy by affecting the AMPK/mTOR/S6K signaling axis and had no influence on the PI3K/AKT/ERK signaling. Moreover, indatraline induced autophagy in smooth muscle cells (SMCs); further, it exhibited therapeutic potential for restenosis by inhibiting SMC accumulation in a rat restenosis model. These results provide new insights into the role of monoamine transporters in autophagy regulation and identify indatraline as a novel agent for inducing autophagy. PMID:27694974

  13. Effects of avitriptan, a new 5 HT(1B/1D) receptor agonist, in experimental models predictive of antimigraine activity and coronary side-effect potential

    NARCIS (Netherlands)

    P.R. Saxena (Pramod Ranjan); P.A.M. de Vries (Peter); W. Wang (Wei); J.P. Heiligers (Jan); A. Maassen VanDenBrink (Antoinette); W.A. Bax (Willem); F.D. Yocca (Frank)

    1997-01-01

    markdownabstractAbstract Several acutely acting antimigraine drugs, including ergotamine and sumatriptan, have the ability to constrict porcine arteriovenous anastomoses as well as the human isolated coronary artery. These two experimental models seem to serve as indicators, respectively, for the

  14. Energy loss and coronary flow simulation following hybrid stage I palliation: a hypoplastic left heart computational fluid dynamic model.

    Science.gov (United States)

    Shuhaiber, Jeffrey H; Niehaus, Justin; Gottliebson, William; Abdallah, Shaaban

    2013-08-01

    The theoretical differences in energy losses as well as coronary flow with different band sizes for branch pulmonary arteries (PA) in hypoplastic left heart syndrome (HLHS) remain unknown. Our objective was to develop a computational fluid dynamic model (CFD) to determine the energy losses and pulmonary-to-systemic flow rates. This study was done for three different PA band sizes. Three-dimensional computer models of the hybrid procedure were constructed using the standard commercial CFD softwares Fluent and Gambit. The computer models were controlled for bilateral PA reduction to 25% (restrictive), 50% (intermediate) and 75% (loose) of the native branch pulmonary artery diameter. Velocity and pressure data were calculated throughout the heart geometry using the finite volume numerical method. Coronary flow was measured simultaneously with each model. Wall shear stress and the ratio of pulmonary-to-systemic volume flow rates were calculated. Computer simulations were compared at fixed points utilizing echocardiographic and catheter-based metric dimensions. Restricting the PA band to a 25% diameter demonstrated the greatest energy loss. The 25% banding model produced an energy loss of 16.76% systolic and 24.91% diastolic vs loose banding at 7.36% systolic and 17.90% diastolic. Also, restrictive PA bands had greater coronary flow compared with loose PA bands (50.2 vs 41.9 ml/min). Shear stress ranged from 3.75 Pascals with restrictive PA banding to 2.84 Pascals with loose banding. Intermediate PA banding at 50% diameter achieved a Qp/Qs (closest to 1) at 1.46 systolic and 0.66 diastolic compared with loose or restrictive banding without excess energy loss. CFD provides a unique platform to simulate pressure, shear stress as well as energy losses of the hybrid procedure. PA banding at 50% provided a balanced pulmonary and systemic circulation with adequate coronary flow but without extra energy losses incurred.

  15. Differential Progressive Remodeling of Coronary and Cerebral Arteries and Arterioles in an Aortic Coarctation Model of Hypertension

    Directory of Open Access Journals (Sweden)

    Heather N. Hayenga

    2012-11-01

    Full Text Available OBJECTIVES: Effects of hypertension on arteries and arterioles often manifest first as a thickened wall, with associated changes in passive material properties (e.g., stiffness or function (e.g., cellular phenotype, synthesis and removal rates, and vasomotor responsiveness. Less is known, however, regarding the relative evolution of such changes in vessels from different vascular beds.METHODS: We used an aortic coarctation model of hypertension in the mini-pig to elucidate spatiotemporal changes in geometry and wall composition (including layer-specific thicknesses as well as presence of collagen, elastin, smooth muscle, endothelial, macrophage, and hematopoietic cells in three different arterial beds, specifically aortic, cerebral, and coronary, and vasodilator function in two different arteriolar beds, the cerebral and coronary.RESULTS: Marked geometric and structural changes occurred in the thoracic aorta and left anterior descending coronary artery within 2 weeks of the establishment of hypertension and continued to increase over the 8-week study period. In contrast, no significant changes were observed in the middle cerebral arteries from the same animals. Consistent with these differential findings at the arterial level, we also found a diminished nitric oxide-mediated dilation to adenosine at 8 weeks of hypertension in coronary arterioles, but not cerebral arterioles.CONCLUSION: These findings, coupled with the observation that temporal changes in wall constituents and the presence of macrophages differed significantly between the thoracic aorta and coronary arteries, confirm a strong differential progressive remodeling within different vascular beds. Taken together, these results suggest a spatiotemporal progression of vascular remodeling, beginning first in large elastic arteries and delayed in distal vessels.

  16. Particles deposition induced by the magnetic field in the coronary bypass graft model

    Energy Technology Data Exchange (ETDEWEB)

    Bernad, Sandor I., E-mail: sandor.bernad@upt.ro [Centre of Advanced Research in Engineering Sciences, Romanian Academy, Timisoara Branch, 300223 Timisoara (Romania); Totorean, Alin F. [Department of Mechanical Machines, Equipment and Transportation, Politehnica University of Timisoara, RO-300222 Timisoara (Romania); Vekas, Ladislau, E-mail: vekas.ladislau@gmail.com [Centre of Advanced Research in Engineering Sciences, Romanian Academy, Timisoara Branch, 300223 Timisoara (Romania)

    2016-03-01

    Bypass graft failures is a complex process starting with intimal hyperplasia development which involve many hemodynamic and biological factors. This work presents experimental results regarding the possibility to use magnetic drug delivery to prevent the development of the intimal hyperplasia using a simplified but intuitive model. The primary goal is to understand the magnetic particle deposition in the anastomosis region of the bypass graft taking into account the complex flow field created in this area which involves recirculation region, flow mixing and presence of particles with high residence time. The three-dimensional geometry model was used to simulate the motion and accumulation of the particles under the magnetic field influence in anastomotic region of the coronary bypass graft. The flow patterns are evaluated both numerically and experimentally and show a good correlation in term of flow parameters like vortex length and flow stagnation point positions. Particle depositions are strongly dependent on the magnet position and consequently of the magnetic field intensity and field gradient. Increased magnetic field controlled by the magnet position induces increased particle depositions in the bypass graft anastomosis. The result shows that particle depositions depend on the bypass graft angle, and the deposition shape and particle accumulation respectively, depend by the flow pattern in the anastomosis region. - Highlights: • Particularity of the particle targeting in the bypass graft anastomosis. • Hemodynamic characteristics influence about the particle deposition. • Particle accumulation induces changes of the flow field in the graft anastomosis. • Bypass graft geometries influence the particle deposition.

  17. Particles deposition induced by the magnetic field in the coronary bypass graft model

    Science.gov (United States)

    Bernad, Sandor I.; Totorean, Alin F.; Vekas, Ladislau

    2016-03-01

    Bypass graft failures is a complex process starting with intimal hyperplasia development which involve many hemodynamic and biological factors. This work presents experimental results regarding the possibility to use magnetic drug delivery to prevent the development of the intimal hyperplasia using a simplified but intuitive model. The primary goal is to understand the magnetic particle deposition in the anastomosis region of the bypass graft taking into account the complex flow field created in this area which involves recirculation region, flow mixing and presence of particles with high residence time. The three-dimensional geometry model was used to simulate the motion and accumulation of the particles under the magnetic field influence in anastomotic region of the coronary bypass graft. The flow patterns are evaluated both numerically and experimentally and show a good correlation in term of flow parameters like vortex length and flow stagnation point positions. Particle depositions are strongly dependent on the magnet position and consequently of the magnetic field intensity and field gradient. Increased magnetic field controlled by the magnet position induces increased particle depositions in the bypass graft anastomosis. The result shows that particle depositions depend on the bypass graft angle, and the deposition shape and particle accumulation respectively, depend by the flow pattern in the anastomosis region.

  18. Inflammatory response, drug-eluting stent and restenosis

    Institute of Scientific and Technical Information of China (English)

    LI Jian-jun

    2008-01-01

    @@ Cardiovascular diseases are the major cause of mortality in the Western world and it is expected that this will remain so during the foreseeable future.1Among them,coronary artery disease(CAD)is the most important underlying cause of death due to cardiovascular disease.2Current treatment of patients with CAD includes mainly risk factor management,drug therapy and revascularization techniques.

  19. Differences in optical coherence tomographic findings and clinical outcomes between excimer laser and cutting balloon angioplasty for focal in-stent restenosis lesions.

    Science.gov (United States)

    Nishino, Masami; Lee, Yasuharu; Nakamura, Daisuke; Yoshimura, Takahiro; Taniike, Masayuki; Makino, Nobuhiko; Kato, Hiroyasu; Egami, Yasuyuki; Shutta, Ryu; Tanouchi, Jun; Yamada, Yoshio

    2012-10-01

    In-stent restenosis (ISR), especially focal ISR, after percutaneous coronary intervention (PCI) remains one of the major clinical problems in the drug-eluting stent (DES) era. Several reports have revealed that excimer laser coronary angioplasty (ELCA) is useful for ISR; however, detailed findings after ELCA are unknown. Therefore, we investigated the condition of the neointima after ELCA for ISR with optical coherence tomography (OCT) and compared the OCT findings and clinical outcome between ELCA and cutting-balloon angioplasty (CBA). Twenty-one consecutive patients with focal ISR who underwent ELCA or CBA were enrolled. All patients underwent 12- to 15-month follow-up coronary angiography. OCT was performed immediately after successful PCI to evaluate the neointimal condition in the ISR lesion. We compared the following OCT parameters between ELCA and CBA groups: maximal thickness of remaining in-stent neointima (MTN), number of tears, minimum lumen dimension (MLD), and minimum lumen area (MLA). We also evaluated clinical outcomes, including target vessel revascularization, acute myocardial infarction, death, and stent thrombosis. MLA in the ELCA group (n = 10) was significantly larger than in the CBA group, and number of tears in the ELCA group was significantly lower than in the CBA group. A trend was shown toward lower TLR with ELCA versus CBA (10.0% vs 45.5%). OCT immediately after ELCA for ISR lesions revealed larger lumen area and smaller number of tears compared with CBA, which may support favorable effects of ELCA for focal ISR.

  20. Augmented TLR2 Expression on Monocytes in both Human Kawasaki Disease and a Mouse Model of Coronary Arteritis

    OpenAIRE

    I-Chun Lin; Ho-Chang Kuo; Ying-Jui Lin; Feng-Shen Wang; Lin Wang; Shun-Chen Huang; Shao-Ju Chien; Chien-Fu Huang; Chih-Lu Wang; Hong-Ren Yu; Rong-Fu Chen; Yang, Kuender D.

    2012-01-01

    BACKGROUND: Kawasaki disease (KD) of unknown immunopathogenesis is an acute febrile systemic vasculitis and the leading cause of acquired heart diseases in childhood. To search for a better strategy for the prevention and treatment of KD, this study compared and validated human KD immunopathogenesis in a mouse model of Lactobacillus casei cell wall extract (LCWE)-induced coronary arteritis. METHODS: Recruited subjects fulfilled the criteria of KD and were admitted for intravenous gamma globul...

  1. Clinical outcome after management of unprotected left main in-stent restenosis after bare metal or drug-eluting stents

    Institute of Scientific and Technical Information of China (English)

    CHEN Shao-liang; QIAN Jun; Kwan Tak W; XU Bo; Gary Mintz; YE Fei; ZHANG Jun-jie; KAN Jing; SUN Xue-wen; ZHANG Ai-ping; CHEN Jin-guo

    2010-01-01

    Background Implantation of either bare metal stent (BMS) or drug-eluting stent (DES) has been used in every day practice for patients with unprotected left main stenosis (UPLMS). There are still a lack of data regading the subsequent results of UPLMS in-stent restenosis (ISR). The present study aimed at determing the clinical outcome of UPLMS ISR patients after implantation of either BMS or DES.Methods Patients with UPLMS ISR after stenting were included. The primary endpoint was the cumulative major adverse cardiac events (MACE), including cardiac death, myocardial infarction (Ml), and target vessel revascularization (TVR).Results UPLMS ISR rate was 14.8% (n=73, 15.7% after BMS, 14.5% for DES) after average of (3.89±2.01) years (range from 1 to 10.5 years) follow-up. Angiographic follow-up between 6-8 months was available in 85.3%. Of these,repeat percutaneous coronary intervention (PCI) was used in 62 (84.9%) patients, with medicine only in 9 (12.4%) and coronary artery bypass graft (CABG) in 2 (2.7%). Most repeat PCI patients were with unstable angina (87.0%), and had decreased left ventricular ejection fraction ((42.58±5.12)%), fewer focal/ostial left circumflex branch (LCX) lesions, in relative to medicine only group. After (31.9±23.3) months, the MACE, Ml, TVR and cardiac death were 31.5%, 1.4%, 24.1% and 8.2%, respectively. Definite and possible stent thrombosis occurred in 1 (1.4%) patient.Conclusions Medical therapy for asymptomatic isolated ostial LCX was safe. Repeat PCI for UPLMS ISR was associated with acceptable early and short-term clinical outcome. Further study was needed to elucidate the role of CABG in treating UPLMS ISR.

  2. High-intensity interval training in patients with coronary heart disease: Prescription models and perspectives.

    Science.gov (United States)

    Ribeiro, Paula A B; Boidin, Maxime; Juneau, Martin; Nigam, Anil; Gayda, Mathieu

    2017-01-01

    Recently, high-intensity interval training (HIIT) has emerged as an alternative and/or complementary exercise modality to continuous aerobic exercise training (CAET) in CHD patients. However, the literature contains descriptions of many HIIT protocols with different stage durations, nature of recovery and intensities. In this review, we discuss the most recent forms of validated HIIT protocols in patients with coronary heart disease (CHD) and how to prescribe and use them during short- and long-term (phase II and III) cardiac rehabilitation programs. We also compare the superior and/or equivalent short- and long-term effects of HIIT versus CAET on aerobic fitness, cardiovascular function, and quality of life; their efficiency, safety, and tolerance; and exercise adherence. Short interval HIIT was found beneficial for CHD patients with lower aerobic fitness and would ideally be used in initiation and improvement stages. Medium and/or long interval HIIT protocols may be beneficial for CHD patients with higher aerobic fitness, and would be ideally used in the improvement and maintenance stages because of their high physiological stimulus. Finally, we propose progressive individualized models of HIIT programs (phase II to III) for patients with CHD and how to ideally use them according to the clinical status of patients and phase of the cardiac rehabilitation program.

  3. IVUS-based FSI models for human coronary plaque progression study: components, correlation and predictive analysis.

    Science.gov (United States)

    Wang, Liang; Wu, Zheyang; Yang, Chun; Zheng, Jie; Bach, Richard; Muccigrosso, David; Billiar, Kristen; Maehara, Akiko; Mintz, Gary S; Tang, Dalin

    2015-01-01

    Atherosclerotic plaque progression is believed to be associated with mechanical stress conditions. Patient follow-up in vivo intravascular ultrasound coronary plaque data were acquired to construct fluid-structure interaction (FSI) models with cyclic bending to obtain flow wall shear stress (WSS), plaque wall stress (PWS) and strain (PWSn) data and investigate correlations between plaque progression measured by wall thickness increase (WTI), cap thickness increase (CTI), lipid depth increase (LDI) and risk factors including wall thickness (WT), WSS, PWS, and PWSn. Quarter average values (n = 178-1016) of morphological and mechanical factors from all slices were obtained for analysis. A predictive method was introduced to assess prediction accuracy of risk factors and identify the optimal predictor(s) for plaque progression. A combination of WT and PWS was identified as the best predictor for plaque progression measured by WTI. Plaque WT had best overall correlation with WTI (r = -0.7363, p WTI: (r = -0.3208, p < 1E-10); cap thickness: (r = 0.4541, p < 1E-10); CTI: (r = -0.1719, p = 0.0190); LD: (r = -0.2206, p < 1E-10); LDI: r = 0.1775, p < 0.0001). WSS had mixed correlation results.

  4. Augmented TLR2 expression on monocytes in both human Kawasaki disease and a mouse model of coronary arteritis.

    Directory of Open Access Journals (Sweden)

    I-Chun Lin

    Full Text Available BACKGROUND: Kawasaki disease (KD of unknown immunopathogenesis is an acute febrile systemic vasculitis and the leading cause of acquired heart diseases in childhood. To search for a better strategy for the prevention and treatment of KD, this study compared and validated human KD immunopathogenesis in a mouse model of Lactobacillus casei cell wall extract (LCWE-induced coronary arteritis. METHODS: Recruited subjects fulfilled the criteria of KD and were admitted for intravenous gamma globulin (IVIG treatment at the Kaohsiung Chang Gung Memorial Hospital from 2001 to 2009. Blood samples from KD patients were collected before and after IVIG treatment, and cardiovascular abnormalities were examined by transthoracic echocardiography. Wild-type male BALB/c mice (4-week-old were intraperitoneally injected with LCWE (1 mg/mL to induce coronary arteritis. The induced immune response in mice was examined on days 1, 3, 7, and 14 post injections, and histopathology studies were performed on days 7 and 14. RESULTS: Both human KD patients and LCWE-treated mice developed coronary arteritis, myocarditis, valvulitis, and pericarditis, as well as elevated plasma levels of interleukin (IL-2, IL-6, IL-10, monocyte chemoattractant protein (MCP-1, and tumor necrosis factor (TNF-α in acute phase. Most of these proinflammatory cytokines declined to normal levels in mice, whereas normal levels were achieved in patients only after IVIG treatment, with a few exceptions. Toll-like receptor (TLR-2, but not TLR4 surface enhancement on circulating CD14+ monocytes, was augmented in KD patients before IVIG treatment and in LCWE-treated mice, which declined in patients after IVIG treatment. CONCLUSION: This result suggests that that not only TLR2 augmentation on CD14+ monocytes might be an inflammatory marker for both human KD patients and LCWE-induced CAL mouse model but also this model is feasible for studying therapeutic strategies of coronary arteritis in human KD by

  5. Augmented TLR2 expression on monocytes in both human Kawasaki disease and a mouse model of coronary arteritis.

    Science.gov (United States)

    Lin, I-Chun; Kuo, Ho-Chang; Lin, Ying-Jui; Wang, Feng-Shen; Wang, Lin; Huang, Shun-Chen; Chien, Shao-Ju; Huang, Chien-Fu; Wang, Chih-Lu; Yu, Hong-Ren; Chen, Rong-Fu; Yang, Kuender D

    2012-01-01

    Kawasaki disease (KD) of unknown immunopathogenesis is an acute febrile systemic vasculitis and the leading cause of acquired heart diseases in childhood. To search for a better strategy for the prevention and treatment of KD, this study compared and validated human KD immunopathogenesis in a mouse model of Lactobacillus casei cell wall extract (LCWE)-induced coronary arteritis. Recruited subjects fulfilled the criteria of KD and were admitted for intravenous gamma globulin (IVIG) treatment at the Kaohsiung Chang Gung Memorial Hospital from 2001 to 2009. Blood samples from KD patients were collected before and after IVIG treatment, and cardiovascular abnormalities were examined by transthoracic echocardiography. Wild-type male BALB/c mice (4-week-old) were intraperitoneally injected with LCWE (1 mg/mL) to induce coronary arteritis. The induced immune response in mice was examined on days 1, 3, 7, and 14 post injections, and histopathology studies were performed on days 7 and 14. Both human KD patients and LCWE-treated mice developed coronary arteritis, myocarditis, valvulitis, and pericarditis, as well as elevated plasma levels of interleukin (IL)-2, IL-6, IL-10, monocyte chemoattractant protein (MCP)-1, and tumor necrosis factor (TNF)-α in acute phase. Most of these proinflammatory cytokines declined to normal levels in mice, whereas normal levels were achieved in patients only after IVIG treatment, with a few exceptions. Toll-like receptor (TLR)-2, but not TLR4 surface enhancement on circulating CD14+ monocytes, was augmented in KD patients before IVIG treatment and in LCWE-treated mice, which declined in patients after IVIG treatment. This result suggests that that not only TLR2 augmentation on CD14+ monocytes might be an inflammatory marker for both human KD patients and LCWE-induced CAL mouse model but also this model is feasible for studying therapeutic strategies of coronary arteritis in human KD by modulating TLR2-mediated immune activation on CD14

  6. Virtual Resting Pd/Pa From Coronary Angiography and Blood Flow Modelling: Diagnostic Performance Against Fractional Flow Reserve.

    Science.gov (United States)

    Papafaklis, Michail I; Muramatsu, Takashi; Ishibashi, Yuki; Bourantas, Christos V; Fotiadis, Dimitrios I; Brilakis, Emmanouil S; Garcia-Garcia, Héctor M; Escaned, Javier; Serruys, Patrick W; Michalis, Lampros K

    2017-05-03

    Fractional flow reserve (FFR) has been established as a useful diagnostic tool. The distal coronary pressure to aortic pressure (Pd/Pa) ratio at rest is a simpler physiologic index but also requires the use of the pressure wire, whereas recently proposed virtual functional indices derived from coronary imaging require complex blood flow modelling and/or are time-consuming. Our aim was to test the diagnostic performance of virtual resting Pd/Pa using routine angiographic images and a simple flow model. Three-dimensional quantitative coronary angiography (3D-QCA) was performed in 139 vessels (120 patients) with intermediate lesions assessed by FFR. The resting Pd/Pa for each lesion was assessed by computational fluid dynamics. The discriminatory power of virtual resting Pd/Pa against FFR (reference: ≤0.80) was high (area under the receiver operator characteristic curve [AUC]: 90.5% [95% CI: 85.4-95.6%]). Diagnostic accuracy, sensitivity and specificity for the optimal virtual resting Pd/Pa cut-off (≤0.94) were 84.9%, 90.4% and 81.6%, respectively. Virtual resting Pd/Pa demonstrated superior performance (pvirtual resting Pd/Pa and FFR (r=0.69, pVirtual resting Pd/Pa using routine angiographic data and a simple flow model provides fast functional assessment of coronary lesions without requiring the pressure-wire and hyperaemia induction. The high diagnostic performance of virtual resting Pd/Pa for predicting FFR shows promise for using this simple/fast virtual index in clinical practice. Copyright © 2017 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). Published by Elsevier B.V. All rights reserved.

  7. Multiobjective design optimisation of coronary stents.

    Science.gov (United States)

    Pant, Sanjay; Limbert, Georges; Curzen, Nick P; Bressloff, Neil W

    2011-11-01

    We present here a multi-objective and multi-disciplinary coronary stent design optimization paradigm. Coronary stents are tubular, often mesh-like, structures which are deployed in diseased (stenosed) artery segments to provide a scaffolding feature that compresses atheromatus plaque, hence restoring luminal area and maintaining vessel patency. A three variable geometry parameterisation of a CYPHER (Cordis Corporation, Johnson & Johnson co.) type stent is proposed to explore the functionality of a sequence of circumferential rings connected by 'n' shaped links. The performance of each design is measured by six figures of merit (objectives/metrics) representing (i) acute recoil, (ii) tissue stresses, (iii) haemodynamic disturbance, (iv) drug delivery, (v) uniformity of drug distribution, and (vi) flexibility. These metrics are obtained from computational simulations of (i) structural deformation through balloon inflated expansion of a stent into contact with a stenosed vessel, (ii) pulsatile flow over the deformed stent embedded in the vessel wall, (iii) steady-state drug distribution into the tissue, and (iv) flexibility of a stent in response to an applied moment. Design improvement is obtained by a multi-objective surrogate modelling approach using a non-dominated sorting genetic algorithm (NSGA-II) to search for an optimal family of designs. A number of trade-offs between the different objectives are identified. In particular a conflict between pairs of the following objectives are shown -- (a) volume average stress vs. recoil, (b) volume average drug vs. volume average stress, (c) flexibility vs. volume average stress, (d) flexibility vs. haemodynamic disturbance, (e) volume average drug vs. haemodynamic disturbance, and (f) uniformity of drug vs. volume average stress. Different paradigms to choose the optimal designs from the obtained Pareto fronts are presented and under each such paradigm, the optimal designs and there relative positions with respect to a

  8. Microsimulation Modeling of Coronary Heart Disease: Maximizing the Impact of Nonprofit Hospital-Based Interventions.

    Science.gov (United States)

    Orenstein, Peggy Vadillo; Shi, Lu

    We use microsimulation to forecast changes in coronary heart disease (CHD) among adults 45 or above over a 20-year time horizon in Los Angeles County (N = 3.4 million), a county with 12 635 CHD deaths in 2010. We simulate individuals' life course and calibrate CHD trends to observed trends in the past. Using the Health Forecasting Community Health Simulation Model, we simulate CHD prevalence and CHD mortality in 2 CHD prevention scenarios: (1) "comprehensive hypertension intervention" and (2) "gradual reduction of the average adult body mass index back to the year 2000 level." We use microsimulation methodology so that nonprofit hospitals can easily use our model to forecast intervention results in their specific hospital catchment area. Our baseline model (without intervention) forecasts an increase in CHD prevalence that will reach 13.01% among those 45+ in Los Angeles County in 2030. Under scenario 1, the increase in CHD prevalence is slower (12.47% in 2030), and the prevalence in scenario 2 reaches 12.83% in 2030. The baseline scenario projects a number of 21 300 CHD deaths in 2030, whereas there will be 20 070 CHD deaths under scenario 1 and 20 970 CHD deaths under scenario 2. At the population level, the CHD mortality outcome, as compared with the metric of CHD prevalence, might be more sensitive to preventive lifestyle interventions. Both CHD prevalence and CHD mortality might be more sensitive to the hypertension intervention than to the obesity reduction in the time horizon of 20 years.

  9. Mathematical modeling of coupled drug and drug-encapsulated nanoparticle transport in patient-specific coronary artery walls

    KAUST Repository

    Hossain, Shaolie S.

    2011-08-20

    The majority of heart attacks occur when there is a sudden rupture of atherosclerotic plaque, exposing prothrombotic emboli to coronary blood flow, forming clots that can cause blockages of the arterial lumen. Diseased arteries can be treated with drugs delivered locally to vulnerable plaques. The objective of this work was to develop a computational tool-set to support the design and analysis of a catheter-based nanoparticulate drug delivery system to treat vulnerable plaques and diffuse atherosclerosis. A threedimensional mathematical model of coupled mass transport of drug and drug-encapsulated nanoparticles was developed and solved numerically utilizing isogeometric finite element analysis. Simulations were run on a patient-specific multilayered coronary artery wall segment with a vulnerable plaque and the effect of artery and plaque inhomogeneity was analyzed. The method captured trends observed in local drug delivery and demonstrated potential for optimizing drug design parameters, including delivery location, nanoparticle surface properties, and drug release rate. © Springer-Verlag 2011.

  10. Mathematical modeling of coupled drug and drug-encapsulated nanoparticle transport in patient-specific coronary artery walls

    Science.gov (United States)

    Hossain, Shaolie S.; Hossainy, Syed F. A.; Bazilevs, Yuri; Calo, Victor M.; Hughes, Thomas J. R.

    2012-02-01

    The majority of heart attacks occur when there is a sudden rupture of atherosclerotic plaque, exposing prothrombotic emboli to coronary blood flow, forming clots that can cause blockages of the arterial lumen. Diseased arteries can be treated with drugs delivered locally to vulnerable plaques. The objective of this work was to develop a computational tool-set to support the design and analysis of a catheter-based nanoparticulate drug delivery system to treat vulnerable plaques and diffuse atherosclerosis. A three-dimensional mathematical model of coupled mass transport of drug and drug-encapsulated nanoparticles was developed and solved numerically utilizing isogeometric finite element analysis. Simulations were run on a patient-specific multilayered coronary artery wall segment with a vulnerable plaque and the effect of artery and plaque inhomogeneity was analyzed. The method captured trends observed in local drug delivery and demonstrated potential for optimizing drug design parameters, including delivery location, nanoparticle surface properties, and drug release rate.

  11. Appraisal of the Prognosis in Patients with Acute Myocardial Infarction Treated with Primary Percutaneous Coronary Intervention

    Institute of Scientific and Technical Information of China (English)

    马晓娟; 殷惠军; 陈可冀

    2009-01-01

    Acute myocardial infarction(AMI) is still the leading factor causing crippling and death in cardiovascular disease.Percutaneous coronary intervention(PCI) can significantly reduce inpatient mortality and incidence of complication.But owing to the existence of restenosis,in-stent thrombosis,etc.,recurrent post-PCI cardiovascular events and high repeatability of hospitalization,as well as its crippling rate and mortality, remain a serious threat to the society and the patients' family.Therefore,the apprais...

  12. Major risk-stratification models fail to predict outcomes in patients with multivessel coronary artery disease undergoing simultaneous hybrid procedure

    Institute of Scientific and Technical Information of China (English)

    WANG Hao-ran; ZHENG Zhe; XIONG Hui; XU Bo; LI Li-huan; GAO Run-lin; HU Sheng-shou

    2013-01-01

    Background The hybrid procedure for coronary heart disease combines minimally invasive coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) and is an alternative to revascularization treatment.We sought to assess the predictive value of four risk-stratification models for risk assessment of major adverse cardiac and cerebrovascular events (MACCE) in patients with multivessel disease undergoing hybrid coronary revascularization.Methods The data of 120 patients were retrospectively collected and the SYNTAX score,EuroSCORE,SinoSCORE and the Global Risk Classification (GRC) calculated for each patient.The outcomes of interest were 2.7-year incidences of MACCE,including death,myocardial infarction,stroke,and any-vessel revascularization.Results During a mean of 2.7-year follow-up,actuarial survival was 99.17%,and no myocardial infarctions occurred.The discriminatory power (area under curve (AUC)) of the SYNTAX score,EuroSCORE,SinoSCORE and GRC for 2.7-year MACCE was 0.60 (95% confidence interval 0.42-0.77),0.65 (0.47-0.82),0.57 (0.39-0.75) and 0.65 (0.46-0.83),respectively.The calibration characteristics of the SYNTAX score,EuroSCORE,SinoSCORE and GRC were 3.92 (P=0.86),5.39 (P=0.37),13.81 (P=0.32) and 0.02 (P=0.89),respectively.Conclusions In patients with multivessel disease undergoing a hybrid procedure,the SYNTAX score,EuroSCORE,SinoSCORE and GRC were inaccurate in predicting MACCE.Modifying risk-stratification models to improve the predictive value for a hybrid procedure is needed.

  13. Particle motion within in vitro models of stenosed internal carotid and left anterior descending coronary arteries.

    Science.gov (United States)

    Cao, J; Rittgers, S E

    1998-01-01

    Asymmetric 75% and 95% area reduction, transparent Sylgard stenotic models were operated under internal carotid artery (ICA) [Womersley parameter, alpha=5.36, Re(mean) =213 and 180, respectively, and Re(peak)=734 and 410, respectively] and left anterior descending coronary artery (LAD) flow wave forms (alpha=2.65, Re(mean)=59 and 57, respectively, and Re(peak)= 137 and 94, respectively) to evaluate the effect of these conditions on particle residence times downstream of the stenoses. Amberlite particles (1.05 g/cm3, 400 microm) were added to the fluid to simulate platelets and their motion through the stenotic region and were traced using a laser light sheet flow visualization method with pseudo-color display. Two-dimensional (2D) particle motions were recorded and particle washout in the stenotic throat and downstream section were computed for all cases. All four model cases demonstrated jetting through the stenosis which followed an arching pattern around a large separation zone downstream. Considerable mixing was observed within these vortex regions during high flow phases. Particle washout profiles showed no clear trend between the degrees of stenosis although particles downstream of the stenoses tended to remain longer for LAD conditions. The critical washout cycle (1% of particles remaining downstream of the stenosis), however, was longer for the 95% stenoses cases under each flow condition due to the larger protected region immediately downstream and maximal for the LAD 95% case. Results of this study suggest that particle residence times downstream of 75% and 95% stenoses (approximately 3-6 s for ICA and approximately 8-10 s for LAD) exceed the minimum time for platelet adhesion (approximately 1 s) for at least 1% of cells and, thus, may be sufficient to initiate thrombus formation under resting conditions.

  14. Construction of an odds model of coronary heart disease using published information: the Cardiovascular Health Improvement Model (CHIME

    Directory of Open Access Journals (Sweden)

    Potts Henry WW

    2008-10-01

    Full Text Available Abstract Background There is a need for a new cardiovascular disease model that includes a wider range of relevant risk factors, in particular lifestyle factors, to aid targeting of interventions and improve population models of the impact of cardiovascular disease and preventive strategies. The model needs to be applicable to a wider population including different ethnic groups, different countries and to those with and without cardiovascular disease. This paper describes the construction of the Cardiovascular Health Improvement Model that aims to meet these requirements. Method An odds model is used. Information was taken from 2003 mortality statistics for England and Wales, the Health Survey for England 2003 and published data on relative risk in those with and without CVD and mean blood pressure values in hypertensives. The odds ratios used were taken from the INTERHEART study. Results A worked example is given calculating the 10-year coronary heart disease risk for a 57 year-old non-diabetic male with no personal or family history of cardiovascular disease, who smokes 30 cigarettes a day and has a systolic blood pressure of 137 mmHg, a total cholesterol (TC of 6.2 mmol/l, a high density lipoprotein (HDL of 1.3 mol/l, and a body mass index of 21. He neither drinks regularly nor exercises. He can give no reliable information about his mental health or fruit and vegetable intake. His 10-year risk of CHD death is 2.47%. Conclusion This paper demonstrates a method for developing a CHD risk model. Further improvements could be made to the model with additional information. The method is applicable to other causes of death.

  15. A Multivariate Model for Prediction of Obstructive Coronary Disease in Patients with Acute Chest Pain: Development and Validation

    Directory of Open Access Journals (Sweden)

    Luis Cláudio Lemos Correia

    Full Text Available Abstract Background: Currently, there is no validated multivariate model to predict probability of obstructive coronary disease in patients with acute chest pain. Objective: To develop and validate a multivariate model to predict coronary artery disease (CAD based on variables assessed at admission to the coronary care unit (CCU due to acute chest pain. Methods: A total of 470 patients were studied, 370 utilized as the derivation sample and the subsequent 100 patients as the validation sample. As the reference standard, angiography was required to rule in CAD (stenosis ≥ 70%, while either angiography or a negative noninvasive test could be used to rule it out. As predictors, 13 baseline variables related to medical history, 14 characteristics of chest discomfort, and eight variables from physical examination or laboratory tests were tested. Results: The prevalence of CAD was 48%. By logistic regression, six variables remained independent predictors of CAD: age, male gender, relief with nitrate, signs of heart failure, positive electrocardiogram, and troponin. The area under the curve (AUC of this final model was 0.80 (95% confidence interval [95%CI] = 0.75 - 0.84 in the derivation sample and 0.86 (95%CI = 0.79 - 0.93 in the validation sample. Hosmer-Lemeshow's test indicated good calibration in both samples (p = 0.98 and p = 0.23, respectively. Compared with a basic model containing electrocardiogram and troponin, the full model provided an AUC increment of 0.07 in both derivation (p = 0.0002 and validation (p = 0.039 samples. Integrated discrimination improvement was 0.09 in both derivation (p < 0.001 and validation (p < 0.0015 samples. Conclusion: A multivariate model was derived and validated as an accurate tool for estimating the pretest probability of CAD in patients with acute chest pain.

  16. Bioresorbable scaffolds in the treatment of coronary artery disease

    Directory of Open Access Journals (Sweden)

    Zhang Y

    2013-03-01

    Full Text Available Yaojun Zhang,1,2 Christos V Bourantas,1 Vasim Farooq,1 Takashi Muramatsu,1 Roberto Diletti,1 Yoshinobu Onuma,1 Hector M Garcia-Garcia,1 Patrick W Serruys11Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands; 2Division of Cardiovascular Diseases, Nanjing First Hospital, Nanjing Medical University, Nanjing, People's Republic of ChinaAbstract: Drug-eluting stents have reduced the risk of in-stent restenosis and have broadened the application in percutaneous coronary intervention in coronary artery disease. However, the concept of using a permanent metallic endovascular device to restore the patency of a stenotic artery has inherited pitfalls, namely the presence of a foreign body within the artery causing vascular inflammation, late complications such as restenosis and stent thrombosis, and impeding the restoration of the physiologic function of the stented segment. Bioresorbable scaffolds (BRS were introduced to potentially overcome these limitations, as they provide temporary scaffolding and then disappear, liberating the treated vessel from its cage. Currently, several BRSs are available, undergoing evaluation either in clinical trials or in preclinical settings. The aim of this review is to present the new developments in BRS technology, describe the mechanisms involved in the resorption process, and discuss the potential future prospects of this innovative therapy.Keywords: bioresorbable scaffold, drug-eluting stent, biodegradable, design, mechanism, coronary artery disease

  17. The Clinicaal and Angiograghic Outcome of 290 Cases after Stent Placement in Small Coronary Vessels

    Institute of Scientific and Technical Information of China (English)

    郭文怡; 贾国良; 李伟杰; 秦涛; 李成祥; 栾荣华; 吕安林; 王小燕; 李媛

    2003-01-01

    Objectives To invest the success procedure,immediate outcome after procedure,the rate of main adverse cardiac events after procedure and restenosis after stent placement in small coronary vessels. Methods 290 patients with selected or emergency stent implantation in small vessels from April, 1997 to March, 2002. Total 299 vessels, 304 lesions and 316 stents were statisted. The successs rate of procedure, immediate outcome after procedure, the rate of main adverse cardiac events after procedure and restenosis after stent placement in small coronary vessels were assessed. The patients were followed up l month to 4 years. Re-catheter angiography were done in 122/290 patients. Results The narrow rate of lesion dropped from 89% ± 12% before procedure to 5% ±5% after procedure (diameter). 202 patients were followed up 1 month(69.7% ). 197/202 cases were survival. 5/202 cases died in 3hrs to 7days. 2/5 cases died of persistent hypotension after procedure. 1/5 case died of acute left heart failure. 2/5 cases died of sudden death. 180 cases were followed up 5 months to 4 years. The non-event survival (NES) rate was 73.3% (132/180). The re-angiography were done in 122 cases. Restenosis happened in 39 cases (30.3%). 37 patients repeated PCI. 2 patients went to CABG. 2 cases got angina recurrence and were proved second time restenosis by re-angiography. The third time PCI was done in 1 patient. The other patients went to CABG. 1 case died of chronic heart failure after 2 years. 1 case suffered acute myocardial infarction on artery stent implanted. Conclusions There are high success rate of procedure and perfect immediate outcome in stent placement in small vessels.Main adverse cardiac events did not increased. Non-event survial was satisfied in long term follow - up.Restenosis rate was showed slightly higher than the one of main vessels.

  18. Dissecting the Effects of Ischemia and Reperfusion on the Coronary Microcirculation in a Rat Model of Acute Myocardial Infarction.

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    Maurits R Hollander

    Full Text Available Microvascular injury (MVI after coronary ischemia-reperfusion is associated with high morbidity and mortality. Both ischemia and reperfusion are involved in MVI, but to what degree these phases contribute is unknown. Understanding the etiology is essential for the development of new potential therapies.Rats were divided into 3 groups receiving either 30 minutes ischemia, 90 minutes ischemia or 30 minutes ischemia followed by 60 minutes reperfusion. Subsequently hearts were ex-vivo perfused in a Langendorff-model. Fluorescence and electron microscopy was used for analysis of capillary density, vascular permeability and ultrastructure. Most MVI was observed after 30 minutes ischemia followed by 60 minutes reperfusion. In comparison to the 30' and 90' ischemia group, wall thickness decreased (207.0±74 vs 407.8±75 and 407.5±71, p = 0.02. Endothelial nuclei in the 30'-60' group showed irreversible damage and decreased chromatin density variation (50.5±9.4, 35.4±7.1 and 23.7±3.8, p = 0.03. Cell junction density was lowest in the 30'-60' group (0.15±0.02 vs 2.5±0.6 and 1.8±0.7, p<0.01. Microsphere extravasation was increased in both the 90' ischemia and 30'-60' group.Ischemia alone for 90 minutes induces mild morphological changes to the coronary microcirculation, with increased vascular permeability. Ischemia for 30 minutes, followed by 60 minutes of reperfusion, induces massive MVI. This shows the direct consequences of reperfusion on the coronary microcirculation. These data imply that a therapeutic window exists to protect the microcirculation directly upon coronary revascularization.

  19. Impact of coronary tortuosity on coronary pressure: numerical simulation study.

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    Yang Li

    Full Text Available BACKGROUND: Coronary tortuosity (CT is a common coronary angiographic finding. Whether CT leads to an apparent reduction in coronary pressure distal to the tortuous segment of the coronary artery is still unknown. The purpose of this study is to determine the impact of CT on coronary pressure distribution by numerical simulation. METHODS: 21 idealized models were created to investigate the influence of coronary tortuosity angle (CTA and coronary tortuosity number (CTN on coronary pressure distribution. A 2D incompressible Newtonian flow was assumed and the computational simulation was performed using finite volume method. CTA of 30°, 60°, 90°, 120° and CTN of 0, 1, 2, 3, 4, 5 were discussed under both steady and pulsatile conditions, and the changes of outlet pressure and inlet velocity during the cardiac cycle were considered. RESULTS: Coronary pressure distribution was affected both by CTA and CTN. We found that the pressure drop between the start and the end of the CT segment decreased with CTA, and the length of the CT segment also declined with CTA. An increase in CTN resulted in an increase in the pressure drop. CONCLUSIONS: Compared to no-CT, CT can results in more decrease of coronary blood pressure in dependence on the severity of tortuosity and severe CT may cause myocardial ischemia.

  20. Optimizing radiation dose by using advanced modelled iterative reconstruction in high-pitch coronary CT angiography

    Energy Technology Data Exchange (ETDEWEB)

    Gordic, Sonja; Husarik, Daniela B.; Alkadhi, Hatem [University Hospital Zurich, University of Zurich, Institute of Diagnostic and Interventional Radiology, Zurich (Switzerland); Desbiolles, Lotus; Leschka, Sebastian [University Hospital Zurich, University of Zurich, Institute of Diagnostic and Interventional Radiology, Zurich (Switzerland); Kantonsspital, Divison of Radiology and Nuclear Medicine, St. Gallen (Switzerland); Sedlmair, Martin; Schmidt, Bernhard [Siemens Healthcare, Computed Tomography Division, Forchheim (Germany); Manka, Robert [University Hospital Zurich, University of Zurich, Institute of Diagnostic and Interventional Radiology, Zurich (Switzerland); University Hospital Zurich, University of Zurich, Clinic of Cardiology, Zurich (Switzerland); University and ETH Zurich, Institute for Biomedical Engineering, Zurich (Switzerland); Plass, Andre; Maisano, Francesco [University Hospital Zurich, University of Zurich, Clinic for Cardiovascular Surgery, Zurich (Switzerland); Wildermuth, Simon [Kantonsspital, Divison of Radiology and Nuclear Medicine, St. Gallen (Switzerland)

    2016-02-15

    To evaluate the potential of advanced modeled iterative reconstruction (ADMIRE) for optimizing radiation dose of high-pitch coronary CT angiography (CCTA). High-pitch 192-slice dual-source CCTA was performed in 25 patients (group 1) according to standard settings (ref. 100 kVp, ref. 270 mAs/rot). Images were reconstructed with filtered back projection (FBP) and ADMIRE (strength levels 1-5). In another 25 patients (group 2), high-pitch CCTA protocol parameters were adapted according to results from group 1 (ref. 160 mAs/rot), and images were reconstructed with ADMIRE level 4. In ten patients of group 1, vessel sharpness using full width at half maximum (FWHM) analysis was determined. Image quality was assessed by two independent, blinded readers. Interobserver agreements for attenuation and noise were excellent (r = 0.88/0.85, p < 0.01). In group 1, ADMIRE level 4 images were most often selected (84 %, 21/25) as preferred data set; at this level noise reduction was 40 % compared to FBP. Vessel borders showed increasing sharpness (FWHM) at increasing ADMIRE levels (p < 0.05). Image quality in group 2 was similar to that of group 1 at ADMIRE levels 2-3. Radiation dose in group 2 (0.3 ± 0.1 mSv) was significantly lower than in group 1 (0.5 ± 0.3 mSv; p < 0.05). In a selected population, ADMIRE can be used for optimizing high-pitch CCTA to an effective dose of 0.3 mSv. (orig.)

  1. New animal model for the study of postmenopausal coronary and cerebral artery function: the Watanabe heritable hyperlipidemic rabbit fed on a diet avoiding phytoestrogens

    DEFF Research Database (Denmark)

    Dalsgaard, T; Larsen, C R; Mortensen, A

    2002-01-01

    to treatment for 16 weeks with either 17 beta-estradiol or placebo. The chow used was semi-synthetic, thereby avoiding the influence of phytoestrogens. Ring segments of cerebral and coronary arteries were mounted for isometric tension recordings in myographs. The passive and active length-tension relationships...... in the proximal coronary arteries. No changes were observed for the passive length-tension relationships. CONCLUSIONS: Long-term treatment with 17 beta-estradiol lowered the electromechanical tonus of atherosclerotic coronary arteries proximally, where the atherosclerosis is most developed. This could be one......OBJECTIVE: To evaluate the effect of estrogen replacement therapy (ERT) on the functional characteristics of coronary and cerebral arteries in a new rabbit model for postmenopausal vascular function. METHODS: Female ovariectomized Watanabe heritable hyperlipidemic (WHHL) rabbits were randomized...

  2. Dietary manipulation and social isolation alter disease progression in a murine model of coronary heart disease.

    Directory of Open Access Journals (Sweden)

    Yumiko Nakagawa-Toyama

    Full Text Available BACKGROUND: Mice with a deficiency in the HDL receptor SR-BI and low expression of a modified apolipoprotein E gene (SR-BI KO/ApoeR61(h/h called 'HypoE' when fed an atherogenic, 'Paigen' diet develop occlusive, atherosclerotic coronary arterial disease (CHD, myocardial infarctions (MI, and heart dysfunction and die prematurely (50% mortality ~40 days after initiation of this diet. Because few murine models share with HypoE mice these cardinal, human-like, features of CHD, HypoE mice represent a novel, small animal, diet-inducible and genetically tractable model for CHD. To better describe the properties of this model, we have explored the effects of varying the composition and timing of administration of atherogenic diets, as well as social isolation vs. group housing, on these animals. METHODOLOGY/PRINCIPAL FINDINGS: HypoE mice were maintained on a standard lab chow diet (control until two months of age. Subsequently they received one of three atherogenic diets (Paigen, Paigen without cholate, Western or control diet for varying times and were housed in groups or singly, and we determined the plasma cholesterol levels, extent of cardiomegaly and/or survival. The rate of disease progression could be reduced by lowering the severity of the atherogenic diet and accelerated by social isolation. Disease could be induced by Paigen diets either containing or free of cholate. We also established conditions under which CHD could be initiated by an atherogenic diet and then subsequently, by replacing this diet with standard lab chow, hypercholesterolemia could be reduced and progression to early death prevented. CONCLUSIONS/SIGNIFICANCE: HypoE mice provide a powerful, surgery-free, diet-'titratable' small animal model that can be used to study the onset of recovery from occlusive, atherosclerotic CHD and heart failure due to MI. HypoE mice can be used for the analysis of the effects of environment (diet, social isolation on a variety of features of

  3. Study of Traditional Chinese Medicine in Intervening Vascular Remodeling after Percutaneous Transluminal Coronary Angioplasty

    Institute of Scientific and Technical Information of China (English)

    鹿小燕; 徐浩; 史大卓; 陈可冀

    2004-01-01

    Interventional therapy of coronary heart disease (CHD) includes percutaneous transluminal coronary angioplasty (PTCA), stent implantation etc. Owing to its revascularization without cardiac surgery, it has been the main effective method in treating CHD. But at the same time, there exists the problem of restenosis (RS). After PTCA, RS rate can reach 30% to 50%, even with direct stenting into the vessels, it still reaches 20% to 35%. So this affects long-term effect of interventional therapy, which directly relates to prognosis of patients with CHD and has been a hot spot of study in the field of preventing and treating CHD.

  4. Study of Traditional Chinese Medicine in Intervening Vascular Remodeling after Percutaneous Transluminal Coronary Angioplasty

    Institute of Scientific and Technical Information of China (English)

    鹿小燕; 徐浩; 史大卓; 陈可冀

    2004-01-01

    Interventional therapy of coronary heart disease (CHD) includes percutaneous transluminal coronary angioplasty (PTCA), stent implantation etc. Owing to its revascularization without cardiac surgery, it has been the main effective method in treating CHD. But at the same time, there exists the problem of restenosis (RS). After PTCA, RS rate can reach 30% to 50%, even with directstenting into the vessels, it still reaches 20% to 35%. So this affects long-term effect of interventional therapy, which directly relates to prognosis of patients with CHD and has been a hot spot of study in the field of preventing and treating CHD.

  5. Topical negative pressure effects on coronary blood flow in a sternal wound model

    DEFF Research Database (Denmark)

    Lindstedt, Sandra; Malmsjö, Malin; Gesslein, Bodil

    2008-01-01

    Several studies have suggested that mediastinitis is a strong predictor for poor long-term survival after coronary artery bypass surgery (CABG). In those studies, several conventional wound-healing techniques were used. Previously, we have shown no difference in long-term survival between CABG...

  6. Does a "continuous care model" affect the quality of life of patients undergoing coronary artery bypass grafting?

    Science.gov (United States)

    Razmjoee, Nasrin; Ebadi, Abbas; Asadi-Lari, Mohsen; Hosseini, Marziyeh

    2017-03-01

    The physical and mental needs of patients with coronary heart disease are affected by both the disease and the heart surgery in different ways. Such diverse needs require different approaches. A continuous care model, which involves orientation, sensitization, control, and evaluation, may favorably influence patient outcomes following coronary artery bypass grafting (CABG). We were interested to ascertain whether a continuous care model might lead to improved quality of life, compared with a routine care model, in patients undergoing CABG. A total of 66 patients scheduled for CABG were identified and randomized to receive either continuous care (based on the continuous care model) or routine postoperative management for 2 months. The subjects' quality of life and its physical and mental dimensions were measured by the 12-item Short-Form Health Survey. Each dimension was scored between 0 and 100, and higher scores indicated better quality of life. One and 2 months after the intervention, the scores of quality of life and its two dimensions were significantly higher in the intervention group than in the control group (P care model can promote health-related quality of life in patients after CABG.

  7. Blockade of the intermediate-conductance calcium-activated potassium channel as a new therapeutic strategy for restenosis

    DEFF Research Database (Denmark)

    Köhler, Ralf; Wulff, Heike; Eichler, Ines

    2003-01-01

    BACKGROUND: Angioplasty stimulates proliferation and migration of vascular smooth muscle cells (VSMC), leading to neointimal thickening and vascular restenosis. In a rat model of balloon catheter injury (BCI), we investigated whether alterations in expression of Ca2+-activated K+ channels (KCa......) channels. Two weeks after BCI, expression of BKCa was significantly reduced in neointimal VSMC, whereas expression of intermediate-conductance KCa (IKCa1) channels was upregulated. In the aortic VSMC cell line, A7r5 epidermal growth factor (EGF) induced IKCa1 upregulation and EGF-stimulated proliferation...... hyperplasia was accompanied by decreased neointimal cell content, with no change in the rate of apoptosis or collagen content. CONCLUSIONS: The switch toward IKCa1 expression may promote excessive neointimal VSMC proliferation. Blockade of IKCa1 could therefore represent a new therapeutic strategy to prevent...

  8. [Two cases of acute coronary syndrome after intake of Clavis Panax].

    Science.gov (United States)

    Atar, Aslı İnci; Er, Okan; Güven, Abdullah; Eryonucu, Beyhan

    2012-04-01

    Atherosclerotic cardiovascular disease is an epidemic in today's world. It is one of the most common causes of hospitalization and death. Therefore, remedies to control or heal the disease are continuously sought. In addition to scientifically researched therapies, patients frequently utilize alternative medicine. However, effective and toxic doses, metabolisms, and drug interactions of the herbs and herbal nutrition supplements are largely unknown. Herein, we present two cases with acute coronary syndrome. The first case was admitted with a diagnosis of acute inferior myocardial infaction (MI) and a stent was implanted to the occluded right coronary artery (RCA). There was a 50% stenosis in his left anterior descending artery (LAD). He was admitted with a diagnosis of non-ST elevation MI (NSTEMI) 6 months later. In the coronary angiogram, there was stent restenosis in RCA, the lesion in LAD had become thrombotic and progressed to a stenosis of 90%. He was referred to surgical revascularization. The second case was admitted for acute inferior MI and a stent was implanted to the occluded circumflex artery. Two months later, he was hospitalized for NSTEMI. Progression of coronary plaques to stenosis and stent restenosis was detected and he was referred to surgical revascularization. Both patients used the product sold as Clavis Panax, which contains panax ginseng, tribulus terrestris, and oat, after their first coronary intervention. Intake of a mixture of plant extracts may have serious consequences in humans as drug interactions and side effects are unknown.

  9. Technical options for treatment of in-stent restenosis after carotid artery stenting

    NARCIS (Netherlands)

    Pourier, Vanessa E C; de Borst, Gert J.

    2016-01-01

    Objective This review summarizes the available evidence and analyzes the current trends on treatments for carotid in-stent restenosis (ISR) after carotid artery stenting (CAS). Methods An update of a 2010 review of the literature (which included 20 articles) was conducted using PubMed and Embase. Al

  10. Ballooning-induced bradycardia during carotid stenting in primary stenosis and restenosis

    Energy Technology Data Exchange (ETDEWEB)

    Nano, Giovanni; Dalainas, Ilias; Bianchi, Paolo; Stegher, Silvia; Malacrida, Giovanni; Tealdi, Domenico G. [University of Milan, Istituto Policlinico San Donato, Milan (Italy); Bet, Luciano [University of Milan, Neurology Department, Istituto Policlinico San Donato, Milan (Italy)

    2006-08-15

    We compared the incidence of intraprocedural bradycardia and hypotension during carotid artery stenting in patients with primary carotid artery stenosis and those with prior ipsilateral carotid endarterectomy. A total of 213 carotid stenting procedures were performed in our institution in a 4-year period. The mean degree of stenosis was 78% (range 60-99%). Of these 213 procedures, 43 were performed for carotid restenosis, 9 after stenting and 34 after endarterectomy, and 170 for primary stenosis. Atropine was selectively administrated if patients suffered bradycardia (a decrease in heart rate to <50% or an absolute heart rate of <40 bpm) or hypotension (systolic blood pressure <90 mmHg). We compared the group of patients with primary stenosis (n=170) and the group of patients with restenosis after carotid endarterectomy (n=34) in relation to intraprocedural hypotension or bradycardia/need for atropine administration. Hypotension occurred in 49 patients with primary stenosis and 2 patients with restenosis. The difference was statistically significant. Atropine was administered for bradycardia to 58 patients with primary stenosis and 3 patients with restenosis. The difference was statistically significant. Intraprocedural bradycardia and hypotension occur more frequently in patients with primary carotid artery stenosis. (orig.)

  11. miRNA-146a induces vascular smooth muscle cell apoptosis in a rat model of coronary heart disease via NF-κB pathway.

    Science.gov (United States)

    Wu, Z W; Liu, Y F; Wang, S; Li, B

    2015-12-29

    The aim of this study was to investigate the role of miRNA-146a in modulating the function of vascular smooth muscle cells in a rat model of coronary heart disease. Vascular smooth muscle cells were isolated and cultured from the rat coronary heart disease model and normal rats (controls). miRNA-146a levels were measured in vascular smooth muscle cells obtained from rats with coronary heart disease and control rats. The proliferation, growth, apoptosis, and activation of the NF-κB pathway in the vascular smooth muscle cells were detected using the MTT assay and flow cytometry, respectively. The role of the NF-κB pathway in modulating the apoptosis of vascular smooth muscle cells was investigated by measuring the reactivity of the cells to an NF-κB pathway inhibitor (TPCA-1). Vascular smooth muscle cells from the disease model exhibited higher levels of miRNA-146a than that by the normal controls (P = 0.0024). The vascular smooth muscle cells obtained from rats with coronary heart disease showed decreased proliferation and growth and increased apoptosis. miRNA-146a overexpression elevated the rate of cell apoptosis. The NF-κB pathway was activated in vascular smooth muscle cells obtained from rats with coronary heart disease. Inhibition of the NF- κB pathway significantly decreased the rate of vascular smooth muscle cell apoptosis in coronary heart disease rats (P = 0.0038). In conclusion, miRNA- 146a was found to induce vascular smooth muscle cell apoptosis in rats with coronary heart disease via the activation of the NF-κB signal pathway.

  12. A Risk-Scoring Model to Predict One-year Major Adverse Cardiac Events after Percutaneous Coronary Intervention

    Directory of Open Access Journals (Sweden)

    Seyed-Ebrahim Kassaian

    2015-12-01

    Full Text Available Background: The aim of the present study was to develop a scoring system for predicting 1-year major adverse cardiac events (MACE, including mortality, target vessel or target lesion revascularization, coronary artery bypass graft surgery, and non-fatal myocardial infarction after percutaneous coronary intervention (PCI.Methods: The data were extracted from a single center PCI registry. The score was created based on the clinical, procedural, and laboratory characteristics of 8206 patients who underwent PCI between April 2004 and October 2009. Consecutive patients undergoing PCI between November 2009 and February 2011 (n= 2875 were included as a validation data set. Results: Diabetes mellitus, increase in the creatinine level, decrease in the left ventricular ejection fraction, presentation with the acute coronary syndrome, number of diseased vessels, primary PCI, PCI on the left anterior descending artery and saphenous vein graft, and stent type and diameter were identified as the predictors of the outcome and used to develop the score (R² = 0.795. The models had adequate goodness of fit (Hosmer-Lemeshow statistic; p value = 0.601 and acceptable ability of discrimination (c-statistics = 0.63. The score categorized the individual patients as low-, moderate-, and high-risk for the occurrence of MACE. The validation of the model indicated a good agreement between the observed and expected risks.Conclusion: An individual risk-scoring system based on both clinical and procedural variables can be used conveniently to predict 1-year MACE after PCI. Risk classification based on this score can assist physicians in decision-making and postprocedural health care. 

  13. Usefulness of Drug-Eluting Balloons for Bare-Metal and Drug-Eluting In-Stent Restenosis (from the RIBS IV and V Randomized Trials).

    Science.gov (United States)

    Alfonso, Fernando; Pérez-Vizcayno, María José; García Del Blanco, Bruno; García-Touchard, Arturo; López-Mínguez, José-Ramón; Sabaté, Manel; Zueco, Javier; Melgares, Rafael; Hernández, Rosana; Moreno, Raul; Domínguez, Antonio; Sanchís, Juan; Moris, Cesar; Moreu, José; Cequier, Angel; Romaguera, Rafael; Rivero, Fernando; Cuesta, Javier; Gonzalo, Nieves; Jiménez-Quevedo, Pilar; Cárdenas, Alberto; Fernández, Cristina

    2017-01-05

    Treatment of patients with drug-eluting stent (DES) in-stent restenosis (ISR) is particularly challenging. We sought to compare results of drug-eluting balloons in patients with DES-ISR with those in patients with bare-metal stent (BMS) ISR. A pooled analysis of the Restenosis Intra-Stent: Drug-Eluting Balloon versus Everolimus-Eluting Stent IV and V randomized trials was performed. Both trials had identical inclusion and exclusion criteria. Results of drug-eluting balloons in 95 patients with BMS-ISR and 154 patients with DES-ISR were compared. Patients with DES-ISR were more frequently diabetics, presented more often as an acute coronary syndrome and had more severe lesions and more frequently a focal pattern, including edge-ISR. Late angiographic findings (92% of eligible patients), including minimal lumen diameter (1.80 ± 0.6 vs 2.01 ± 0.6 mm, p = 0.001; absolute mean difference 0.21 mm; 95% confidence interval 0.04 to 0.38; p = 0.014) and restenosis rate (19% vs 9.5%, p ISR. Results were consistent across 10 prespecified subgroups. Moreover, on multiple linear regression analysis, minimal lumen diameter at follow-up remained significantly smaller in patients with DES-ISR after adjusting for potential confounders (adjusted absolute mean difference 0.17 mm; 95% confidence interval 0.04 to 0.41; p = 0.019). Finally, at 1-year clinical follow-up (100% of patients), rates of target vessel revascularization (16% vs 6%, p = 0.02) and of the main combined clinical end point (18% vs 8%, p = 0.03) were significantly higher in patients treated for DES-ISR. In conclusion, this study confirms the efficacy of DEB for patients with ISR. However, the long-term clinical and angiographic results of DEB are poorer in patients with DES-ISR than in those with BMS-ISR. (ClinicalTrials.govIdentifier:NCT01239953&NCT01239940).

  14. Association of morphologic characteristics on optical coherence tomography and angiographic progression patterns of late restenosis after drug-eluting stent implantation

    Energy Technology Data Exchange (ETDEWEB)

    Yamaguchi, Hiroshi, E-mail: yhclinic@po5.synapse.ne.jp [Division of Cardiology, Tenyoukai Central Hospital, Izumi-cho, Kagoshima city, Kagoshima (Japan); Arikawa, Ryo; Takaoka, Junichiro; Miyamura, Akihiro; Atsuchi, Nobuhiko; Ninomiya, Toshiko; Atsuchi, Yoshihiko [Division of Cardiology, Tenyoukai Central Hospital, Izumi-cho, Kagoshima city, Kagoshima (Japan); Ohishi, Mitsuru [Department of Cardiovascular Medicine and Hypertension, Graduate School of Medical and Dental Science, Kagoshima University, Kagoshima (Japan); Terashima, Mitsuyasu [Department of Cardiology, Toyohashi Heart Center, Toyohashi (Japan); Kaneda, Hideaki [Okinaka Memorial Institute for Medical Research, Tokyo (Japan); Translational Research Informatics Center, Foundation for Biomedical Research and Innovation, Kobe (Japan)

    2015-01-15

    Objectives: To gain insight into the pathophysiology of late drug-eluting stent (DES) restenosis. Background: Restenosis of DES has a different time course from that of bare metal stents. Methods: Patients who underwent follow-up coronary angiography (CAG) twice (six to nine months and 18 to 24 months) after DES implantation were examined using optical coherence tomography (OCT). All lesions with target lesion revascularization at first follow-up were excluded. Late catch-up was defined as lesions that progressed from less than 50% diameter stenosis (DS) at the first CAG to more than 50% DS at the second CAG. Lesions with the late catch-up were further divided into two groups; lesions with jump-up (less than 25% DS at the first CAG) and lesions with gradual progression (25–50% DS at the first CAG). Results: Of the 25 patients who had late ISR, 23 patients (10 jump-up/13 gradual progression) were examined with OCT at late follow-up and enrolled in this study. In the qualitative OCT assessment, each ratio of homogeneous, layered, heterogeneous with or without attenuation tissue morphologies were in jump-up group, and gradual progression group were 0% and 15%, 0% and 23%, and 60% and 8%, and 40% and 54%, respectively. All of jump-up group showed heterogeneous restenotic tissue, while 62% of gradual progression group showed heterogeneous restenotic tissue (P = .04). Conclusions: These findings suggest different pathophysiology of the late catch-up after DES implantation between the jump-up and gradual progression groups.

  15. Experimental Study of Adenovirus Vector Mediated-hVEGF165 Gene on Prevention of Restenosis after Angioplasty

    Institute of Scientific and Technical Information of China (English)

    刘启功; 陆再英; 岳远坤; 林立; 张卫东; 颜进

    2004-01-01

    This study evaluated the effects of adenovirus vector mediated human vascular endothelial growth factor-165 (hVEGF165) gene on prevention of restenosis after angioplasty. Rabbit models of bilateral carotid artery injury were established by balloon denudation. The recombinant adenoviruses containing hVEGF165 cDNA was directly injected into left side of the injured carotid arteries.On day 3 and week 3 after transfection the expression of VEGF was observed by RT-PCR and immunohistochemistry. The thrombokinesis, reendothelialization (rET) and intimal hyperplasia in carotid arteries were evaluated by computerized image analysis system 3 weeks after gene transfer.The changes in the VEGF gene-treated side were compared with the control side. Our results showed that 3 days and 3 weeks after hVEGF165 gene transfer the VEGF mRNA and antigen expression were detected in vivo. 3 weeks after the transfer, the carotid artery rET was markedly better in the VEGF gene-treated group compared with the control. The thrombokinesis, intima area/media area (I/M), maximal intimal and medial thicknesses (ITmax and MTmax) demonstrated a statistically significant decrease in arteries treated with VEGF gene as compared with the control group. It is concluded that VEGF gene transfer could be achieved by intra-arterial injection of recombinant adenoviruses. It might accelerate the restoration of endothelial integrity, inhibit thrombokinesis and attenuate intimal hyperplasia in the injured arteries after VEGF gene transfer. This procedure could be useful in preventing restenosis after angioplasty.

  16. Simple balloon dilation for drug-eluting in-stent restenosis: An optical coherent tomography analysis

    Energy Technology Data Exchange (ETDEWEB)

    Arikawa, Ryo [Division of Cardiology, Tenyoukai Central Hospital, Izumi-cho, Kagoshima City, Kagoshima (Japan); Yamaguchi, Hiroshi, E-mail: hyamaguchi@tsm.bbiq.jp [Division of Cardiology, Tenyoukai Central Hospital, Izumi-cho, Kagoshima City, Kagoshima (Japan); Takaoka, Junichiro; Miyamura, Akihiro; Atsuchi, Nobuhiko; Ninomiya, Toshiko; Atsuchi, Yoshihiko [Division of Cardiology, Tenyoukai Central Hospital, Izumi-cho, Kagoshima City, Kagoshima (Japan); Ohishi, Mitsuru [Department of Cardiovascular Medicine and Hypertension, Graduate School of Medical and Dental Science, Kagoshima University, Kagoshima (Japan); Terashima, Mitsuyasu [Department of Cardiology, Toyohashi Heart Center, Toyohashi (Japan); Kaneda, Hideaki [Okinaka Memorial Institute for Medical Research, Tokyo (Japan)

    2015-01-15

    Background: Although drug-eluting stent (DES) has significantly reduced restenosis, the treatment of DES-in-stent restenosis (ISR) remains a challenge with high restenosis rate. Methods: We examined whether morphologic appearance of restenosis tissue by optical coherent tomography (OCT) had an impact on outcomes after balloon angioplasty for DES-ISR. The morphologic appearance of restenosis tissue was qualitatively assessed for tissue structures such as homogeneous, layered, and heterogeneous patterns. Results: Using OCT, 50 patients with DES-ISR were divided into 2 groups: 25 lesions with homogeneous or layered patterns (homo/layered group) and 25 lesions with heterogeneous patterns (hetero group). Acute gain was larger in the hetero group (1.33 ± 0.41 mm vs. 1.06 ± 0.32 mm in the homo/layered group, P = 0.03). On intravascular ultrasound analysis, post-procedural percent neointimal area was smaller in the hetero group (27.4 ± 9.2% vs. 34.0 ± 11.2% in the homo/layered group, P = 0.05). Angiographic follow-up was performed in 37 lesions (74%). Follow-up minimal lumen diameter was larger in the hetero group (1.75 ± 0.89 mm vs. 1.01 ± 0.81 mm in the homo/layered group, P = 0.04). Target lesion revascularization rates tended to be lower in the hetero group (20% vs. 43% in the homo/layered group, P = 0.12). Conclusions: Balloon angioplasty was more effective for DES-ISR with heterogeneous tissue appearance than DES-ISR with homogeneous/layered tissue appearance. OCT assessment of DES-ISR morphology may be a useful adjunct in determining clinical strategies. Simple balloon dilatation is a possible treatment strategy for DES-ISR lesions with a heterogeneous appearance on OCT images.

  17. Echocardiographic assessment of coronary artery flow in normal canines and model dogs with myocardial infarction.

    Science.gov (United States)

    Park, Nohwon; Kim, Jaehwan; Lee, Miyoung; Lee, Soyun; Song, Sunhye; Lee, Seungjun; Kim, Soyoung; Park, Yangwoo; Eom, Kidong

    2014-01-01

    This study was conducted to evaluate the usefulness of coronary arterial profiles from normal dogs (11 animals) and canines (six dogs) with experimental myocardial infarction (MI) induced by ligation of the left coronary artery (LCA). Blood velocity of the LCA and right coronary artery (RCA) were evaluated following transthoracic pulsed-wave Doppler echocardiography. The LCA was observed as an infundibular shape, located adjacent to the sinus of Valsalva. The RCA appeared as a tubular structure located 12 o'clock relative to the aorta. In normal dogs, the LCA and RCA mean peak diastolic velocities were 20.84 ± 3.24 and 19.47 ± 2.67 cm/sec, respectively. The LCA and RCA mean diastolic deceleration times were 0.91 ± 0.14 sec and 1.13 ± 0.20 sec, respectively. In dogs with MI, the LCA had significantly (p < 0.01) lower peak velocities (14.82 ± 1.61 cm/sec) than the RCA (31.61 ± 2.34 cm/sec). The RCA had a significantly (p < 0.01) rapid diastolic deceleration time (0.71 ± 0.06 sec) than that found in the LCA (1.02 ± 0.22 sec) of MI dogs. In conclusion, these profiles may serve as a differential factor for evaluating cardiomyopathy in dogs.

  18. Coronary artery anatomy of the goat.

    Science.gov (United States)

    Lipovetsky, G; Fenoglio, J J; Gieger, M; Srinivasan, M R; Dobelle, W H

    1983-05-01

    The coronary arteries of the goat heart were studied using angiographic techniques and molds of the coronary vessel trees. Blood supplies to the left and right ventricles, interventricular septum, atrioventricular node, and apex of the caprine heart were studied. The goat possesses a left dominant pattern of coronary supply with relatively uniform coronary anatomy and may provide a good large animal model for testing cardiovascular assist devices.

  19. Transthoracic Doppler echocardiography – noninvasive diagnostic window for coronary flow reserve assessment

    Directory of Open Access Journals (Sweden)

    Dimitrow Paweł

    2003-04-01

    Full Text Available Abstract This review focuses on transthoracic Doppler echocardiography as noninvasive method used to assess coronary flow reserve (CFR in a wide spectrum of clinical settings. Transthoracic Doppler echocardiography is rapidly gaining appreciation as popular tool to measure CFR both in stenosed and normal epicardial coronary arteries (predominantly in left anterior descending coronary artery. Post-stenotic CFR measurement is helpful in: functional assessment of moderate stenosis, detection of significant or critical stenosis, monitoring of restenosis after revascularization. In the absence of stenosis in the epicardial coronary artery, decreased CFR enable to detect impaired microvascular vasodilatation in: reperfused myocardial infarct, arterial hypertension with or without left ventricular hypertrophy, diabetes mellitus, hypercholesterolemia, syndrome X, hypertrophic cardiomyopathy. In these diseases, noninvasive transthoracic Doppler echocardiography allows for serial CFR evaluations to explore the effect of various pharmacological therapies.

  20. Percutaneous laser-assisted thermal coronary angioplasty in native coronary arteries and saphenous vein grafts: initial results and angiographic follow-up.

    Science.gov (United States)

    Linnemeier, T J; Rothbaum, D A; Cumberland, D C; Landin, R J; Hodes, Z I; Ball, M W

    1990-01-01

    Percutaneous laser-assisted thermal coronary angioplasty was attempted in 29 vessels (27 patients): 10 left anterior descending, 2 left circumflex and 17 mid-shaft (non-anastomotic) saphenous vein grafts. Argon or YAG laser thermal energy was applied via a 1.3, 1.6 or 1.9 mm metal capped probe followed by conventional balloon angioplasty in 27 vessels and sole thermal laser therapy in two vessels. The laser probe successfully crossed 83% (24/29) of vessels and subsequent balloon dilatation increased the success rate to 93% (25/27). Perforation occurred in a vein graft resulting in one in-hospital death post repeat emergency coronary artery bypass graft surgery. Angiographic follow-up was obtained in 85% (24/28) of vessels. Angiographic restenosis ( greater than 50% reduction in lumen diameter) occurred in 27% (3/11) of native coronary arteries and 62% (8/13) of saphenous vein grafts. Therefore, despite high initial success rates, the application of laser thermal energy with small laser probes relative to vessel size, followed by conventional balloon angioplasty, does not appear to alter restenosis. Further evaluation of coronary laser systems should be continued only with catheters that are capable of creating channels closer to the size of the vessel treated.

  1. Development of a Coronary Heart Disease Risk Prediction Model for Type 1 Diabetes: The Pittsburgh CHD in Type 1 Diabetes Risk Mode

    NARCIS (Netherlands)

    Zgibor, J.C.; Ruppert, K.; Orchard, T.J.; Soedamah-Muthu, S.S.; Fuller, J.H.; Chaturvedi, N.; Roberts, M.S.

    2010-01-01

    Aim - To create a coronary heart disease (CHD) risk prediction model specific to type 1 diabetes. Methods - Development of the model used data from the Pittsburgh Epidemiology of Diabetes Complications Study (EDC). EDC subjects had type 1 diabetes diagnosed between 1950 and 1980, received their

  2. Sulforaphane inhibits restenosis by suppressing inflammation and the proliferation of vascular smooth muscle cells.

    Science.gov (United States)

    Kwon, Jin-Sook; Joung, Hosouk; Kim, Yong Sook; Shim, Young-Sun; Ahn, Youngkeun; Jeong, Myung Ho; Kee, Hae Jin

    2012-11-01

    Sulforaphane, a naturally occurring organosulfur compound in broccoli, has chemopreventive properties in cancer. However, the effects of sulforaphane in vascular diseases have not been examined. We therefore aimed to investigate the effects of sulforaphane on vascular smooth muscle cell (VSMC) proliferation and neointimal formation and the related mechanisms. The expression of vascular cell adhesion molecule 1 (VCAM-1) and intercellular adhesion molecule 1 (ICAM-1) was examined in VSMCs. The nuclear translocation of nuclear factor-κB (NF-κB) and GATA6 expression was examined in VSMCs and in a carotid artery injury model by Western blot and immunohistochemistry. We also investigated whether local delivery of sulforaphane affected neointimal formation. Sulforaphane inhibited the mRNA and protein expression of VCAM-1 induced by tumor necrosis factor (TNF)-α in VSMCs. Treatment of VSMCs with sulforaphane blocked TNF-α-induced IκBα degradation and NF-κB p65 and GATA6 expression. Furthermore, NF-κB p65 and GATA6 expression were reduced in sulforaphane-treated carotid injury sections. Notably, binding of GATA6 to the VCAM-1 promoter was dramatically reduced by sulforaphane. The MTT, BrdU incorporation, and in vitro scratch assays revealed that the proliferation and migration of VSMCs were reduced by sulforaphane. Furthermore, local administration of sulforaphane significantly reduced neointima formation 14 days after vascular injury in rats. Our results indicate that sulforaphane inhibits neointima formation via targeting of adhesion molecules through the suppression of NF-κB/GATA6. Furthermore, sulforaphane regulates migration and proliferation in VSMCs. Sulforaphane may be a potential therapeutic agent for preventing restenosis after vascular injury. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

  3. Computational Modelling of Multi-folded Balloon Delivery Systems for Coronary Artery Stenting: Insights into Patient-Specific Stent Malapposition.

    Science.gov (United States)

    Ragkousis, Georgios E; Curzen, Nick; Bressloff, Neil W

    2015-08-01

    Despite the clinical effectiveness of coronary artery stenting, percutaneous coronary intervention or "stenting" is not free of complications. Stent malapposition (SM) is a common feature of "stenting" particularly in challenging anatomy, such as that characterized by long, tortuous and bifurcated segments. SM is an important risk factor for stent thrombosis and recently it has been associated with longitudinal stent deformation. SM is the result of many factors including reference diameter, vessel tapering, the deployment pressure and the eccentric anatomy of the vessel. For the purpose of the present paper, virtual multi-folded balloon models have been developed for simulated deployment in both constant and varying diameter vessels under uniform pressure. The virtual balloons have been compared to available compliance charts to ensure realistic inflation response at nominal pressures. Thereafter, patient-specific simulations of stenting have been conducted aiming to reduce SM. Different scalar indicators, which allow a more global quantitative judgement of the mechanical performance of each delivery system, have been implemented. The results indicate that at constant pressure, the proposed balloon models can increase the minimum stent lumen area and thereby significantly decrease SM.

  4. Fluid-structure Interaction Analysis of Coronary Artery Bypass Graft Based on the CT Images%基于CT成像的冠状动脉搭桥血管的流固耦合分析

    Institute of Scientific and Technical Information of China (English)

    刘赵淼; 高立丹; 史艺

    2013-01-01

    For the personalized reconstructed model of restenosis after coronary artery bypass graft,the influence of geometry model and elastic vessel wall on hemodynamic resuhing in restenosis is studied by using computational fluid dynamics.Based on the original CT data of coronary artery bypass graft from patients,the surface model of coronary artery bypass graft is constructed and vessel wall is generated,and the surface model of coronary artery bypass graft is constructed and vessel wall is generated in MIMICS.The coupled model of vessel wall and blood established,fluid-structure interaction based on the two-way is carried out in ANSYS Mechanical and CFX modules by using the finite element method.The wall shear stress and deformation of elastic wall and rigid wall are compared with in a given pulse pressure condition.Results show that the maximum wall shear stress and displacement of the personalized model are higher than those of the simplified CAD model,and locations of maximum displacements in both models are absolutely different.The maximum wall shear stress and displacement are lower than those of the rigid model.Simulation results provide more realistic reference data for diagnosis of restenosis after coronary artery bypass graft.%针对冠状动脉旁路再狭窄重建个性化血管模型,通过计算流体力学方法研究血管几何模型和弹性血管壁对血流动力学特性变化导致的冠脉搭桥血管再狭窄的影响.根据冠状动脉搭桥手术患者的原始CT数据,导入到MIMICS软件中构造出冠状动脉移植血管的三维表面模型,并生成血管壁NURBS曲面模型,进而建立血管壁/血液耦合模型,采用有限元方法在ANSYS Mechanical和CFX两个模块的基础上,通过专用的流固耦合算法实现弹性血管壁和血液的双向耦合计算,在给定脉冲压条件下模拟出弹性管壁和刚性壁面的壁剪应力分布和变形情况,并且进行比较.研究结果表明:个性化模型的最大壁面

  5. Coronary artery fistula

    Science.gov (United States)

    Congenital heart defect - coronary artery fistula; Birth defect heart - coronary artery fistula ... A coronary artery fistula is often congenital, meaning that it is present at birth. It generally occurs when one of the coronary arteries ...

  6. Knockdown of connexin 43 attenuates balloon injury-induced vascular restenosis through the inhibition of the proliferation and migration of vascular smooth muscle cells.

    Science.gov (United States)

    Han, Xiao-Jian; He, Dan; Xu, Liang-Jing; Chen, Min; Wang, Yi-Qi; Feng, Jiu-Geng; Wei, Min-Jun; Hong, Tao; Jiang, Li-Ping

    2015-11-01

    Coronary artery disease (CAD) or atherosclerotic heart disease is one of the most common types of cardiovascular disease. Although percutaneous coronary intervention [PCI or percutaneous transluminal coronary angioplasty (PTCA)] is a mature, well-established technique used to treat atherosclerotic heart disease, its long‑term therapeutic effects are compromised by a high incidence of vascular restenosis (RS) following angioplasty. In our previous study, we found that the principal gap junction protein, connexin 43 (Cx43), in vascular smooth muscle cells (VSMCs) was involved in the development of vascular RS following angioplasty-induced balloon injury. However, the exact role action of Cx43 in vascular RS remains unclear. In the present study, we aimed to further examine whether the knockdown of Cx43 attenuates the development of vascular RS through the inhibition of the proliferation and migration of VSMCs. We found that the use of a lentiviral vector expressing shRNA targeting Cx43 (Cx43‑RNAi-LV) efficiently silenced the mRNA and protein expression of Cx43 in cultured VSMCs. In addition, MTT and Transwell assays were used to examined the proliferation and migration of the VSMCs, respectively. The results revealed that the knockdown of Cx43 by Cx43-RNAi-LV at a multiplicity of infection (MOI) of 100 significantly inhibited the proliferation and migration of the VSMCs in vitro. Notably, the knockdown of Cx43 also effectively attenuated the development of vascular RS and intimal hyperplasia following balloon injury in vivo. Taken together, our data suggest that Cx43 is involved in the development of vascular RS and intimal hyperplasia through the regulation of the proliferation and migration of VSMCs. Thus, the present study provides new insight into the pathogenesis of vascular RS, and suggests that further comfirms that Cx43 may well be a novel potential pharmacological target for preventing vascular RS following PCI.

  7. Effect of Circular ANRIL on the Inflammatory Response of Vascular Endothelial Cells in a Rat Model of Coronary Atherosclerosis

    Directory of Open Access Journals (Sweden)

    Chun-Li Song

    2017-07-01

    Full Text Available Background/Aims: This study aims to investigate the role of circular antisense non-coding RNA at the INK4 locus (cANRIL in the inflammatory response of vascular endothelial cells (ECs in a rat model of coronary atherosclerosis (AS. A rat model of AS was established with rats that were injected with a large dose of vitamin D3 and fed a high-fat diet. Methods: Sixty Wistar rats were randomly assigned into control, model, empty vector, over-expressed cANRIL and low-expressed cANRIL groups (12 rats in each group. Sixteen weeks later, the ultrastructure of their coronary arteries was observed via transmission electron microscopy. Rat serum lipid levels were analyzed using an automatic biochemical analyzer, and their atherogenic index (AI values were calculated. Hematoxylin and eosin staining was used to observe the endothelial morphology of rats. Additionally, rat EC apoptosis was tested via a TUNEL assay. Enzyme-linked immunosorbent assays (ELISAs were applied to measure serum levels of interleukin-1 (IL-1, IL-6, matrix metalloproteinase-9 (MMP-9 and C-reactive protein (CRP. The cANRIL, Bax, bcl-2 and caspase-3 mRNA expression levels were measured with a quantitative real-time polymerase chain reaction (qRT-PCR. The protein expression levels of Bax, bcl-2 and caspase-3 were detected using immunohistochemistry. Results: In the control group, ECs were closely arranged with normal structures, and there was no proliferation. In the model, empty vector and over-expressed cANRIL groups, some cells were not present, and atherosclerotic plaques and thrombi appeared. However, in the under-expressed cANRIL group, the cells had a normal structure. Compared with the model and empty vector groups, the levels of total cholesterol (CHOL, triglycerides (TGs, low density lipoprotein (LDL, IL-1, IL-6, MMP-9, CRP, cANRIL, Bax, and caspase-3, AI values, and rates of EC apoptosis decreased in the low-expressed cANRIL group, while HDL (high density lipoprotein levels and

  8. Using a Markov simulation model to assess the impact of changing trends in coronary heart disease incidence on requirements for coronary artery revascularization procedures in Western Australia

    OpenAIRE

    Knuiman Matthew; Mannan Haider R; Hobbs Michael

    2010-01-01

    Abstract Background The population incidence of coronary heart disease (CHD) has been declining in Australia and many other countries. This decline has been due to reduced population levels of risk factors for CHD and improved medical care for those at higher risk of CHD. However, there are signs that there may be a slowing down or even reversal in the decline of CHD incidence due to the 'obesity epidemic' and other factors and this will have implications for the requirements for surgical tre...

  9. Recent developments in drug-eluting coronary stents.

    Science.gov (United States)

    Yildiz, Mustafa; Yildiz, Banu Sahin; Gursoy, Mustafa Ozan; Akin, Ibrahim

    2014-01-01

    The interventional treatment of coronary artery disease was introduced in 1970`s by Andreas Grüntzig. The initial treatment strategy with plain old balloon angioplasty (POBA) was associated with high restenosis rates. The introduction of coronary stents, especially drug-eluting stents (DES) in 2002 has improved the results by lowering the rate of in-stent restenosis from 20-40% in the era of bare-metal stent (BMS) to 6-8%. However, in 2006 with the observation of late stent thrombosis the reputations of DES have decreased. However, improvements in stent design especially antiproliferative agents, polymeric agents as well as stent platforms improved newer generation DES. In controlled trials as well as registries the use of second-generation DES as compared to bare-metal stents (BMS) was associated with better clinical and angiographic results. A further development of these stents with use of biodegradable polymers, polymer-free stents, and biodegradable stents on the basis of poly L-lactide (PLLA) or magnesium resulted in third-generation DES and has been evaluated in preclinical and first clinical trials. However, to date, there is a lack of data comparing these third-generation DES with first- and second-generatrion DES in a large scale.

  10. Coronary flow reserve evaluated by {sup 201}Tl myocardial perfusion SPECT after coronary artery bypass grafting (CABG) for angina pectoris

    Energy Technology Data Exchange (ETDEWEB)

    Ishino, Yoichi; Nakata, Hajime [Univ. of Occupational and Environmental Health, Kitakyusyu, Fukuoka (Japan)

    2000-11-01

    We compared the flow reserves of the coronary bypass vessels between arterial and venous grafts by {sup 201}Tl myocardial perfusion SPECT on the patients with angina pectoris who had no past history of myocardial infarction or intervention therapy such as PTCA. Thirty two patients had undergone a total of 70 bypass grafts and 66 of them were proved to be patent at postoperative CAG. Reversible defects were observed in 6 of 40 segments (15.0%) covered by patent venous grafts, and in 11 of 26 segments (42.3%) by patent arterial grafts. The rate of postoperative reversible defects was higher in the areas grafted by artery but this had no relation with the severity of coronary artery stenosis before CABG. This reversible defect is most likely to be caused by the character of artery graft itself and this should not be considered to highly suggest the restenosis or occlusion of the graft vessel. (author)

  11. Primary stenting of occluded native coronary arteries: final results of the Primary Stenting of Occluded Native Coronary Arteries (PRISON) study.

    Science.gov (United States)

    Rahel, Braim M; Suttorp, Maarten J; Laarman, Gert J; Kiemeneij, Ferdinand; Bal, Egbert T; Rensing, Benno J; Ernst, Sjef M P G; ten Berg, Jurriën M; Kelder, Johannes C; Plokker, H W Thijs

    2004-05-01

    Primary intracoronary stent placement after successfully crossing chronic total coronary occlusions may decrease the high restenosis rate at long-term follow-up compared with conventional balloon angioplasty. In a prospective, randomized trial, balloon angioplasty was compared with stent implantation for the treatment of chronic total occlusions. Patients were followed for 12 months with angiographic follow-up at 6 months. Quantitative coronary analysis was performed by an independent core lab. A total of 200 patients were enrolled. Baseline characteristics were evenly distributed. After the procedure the mean minimal luminal diameter in the conventional group was 2.34 +/- 0.46 mm versus 2.90 +/- 0.41 mm in the stented group (P 50% diameter stenosis) was seen in 33% in the conventional group versus 22% in the stented group (P =.137). The reocclusion rates were 7.3% and 8.2%, respectively (P = 1.00). At 12 month follow-up, the rate of target lesion revascularization was significantly higher in the conventional group (29% versus 13%, P <.0001). These data demonstrate that stenting of chronic total occlusions is superior to balloon angioplasty alone with a statistically significant reduction in the need for target lesion revascularization and a lower, but not significant, restenosis rate.

  12. Local drug-delivery balloon for proliferative occlusive in-stent restenosis after drug-eluting stent

    Institute of Scientific and Technical Information of China (English)

    Gianluca Rigatelli; Paolo Cardaioli; Fabio Dell'Avvocata; Massimo Giordan

    2011-01-01

    Drug-coated balloon has been developed as an alternative to drug-eluting stents for in-stent restenosis but the performance of drug infusion balloon in such setting has not been previously described. We present a case of particularly aggressive in-stent restenosis after drug eluting stent implantation treated with a new kind of drug infusion balloon developed in order to overcome the impossibility to inflate regular drug-coated balloon for several dilatation.

  13. The Development of Coronary Artery Stents: From Bare-Metal to Bio-Resorbable Types

    Directory of Open Access Journals (Sweden)

    Ming-Yun Ho

    2016-07-01

    Full Text Available Coronary artery disease is the leading cause of death worldwide. Conventional balloon angioplasty is associated with high rates of complications such as coronary dissection and vessel recoil. The deployment of bare-metal stents (BMSs can overcome these problems and achieve a better patency rate than simple balloon angioplasty. It has been shown that the stent design including structure platform, size, length, and strut thickness has a major influence on the clinical results. Even though angioplasty with BMS implantation is widely used in coronary interventions, the restenosis rate due to neointimal hyperplasia remains high. Therefore, drug-eluting stents (DESs coated with anti-proliferative agents and polymers have been developed to reduce the restenosis rate and improve the clinical outcomes. Although the repeat revascularization rate of DESs is lower than that of BMSs, the long-term stent thrombosis rate is higher than for BMSs. Therefore, new and emerging generations of stents, in which, for example, thinner struts and bioresorbable polymers are used, are available for clinical use. However, there are only a limited number of clinical trials, in which these newer stents have been compared with BMSs and first- and second-generation DESs. The purpose of this review was to provide up-to-date information on the evolution of coronary artery stents from BMSs to DESs to bioresorbable stents (BRSs.

  14. [Short and long-term results of endovascular treatment of bifurcational coronary stenosis].

    Science.gov (United States)

    Shugushev, Z Kh; Movsesiants, M Iu; Maksimkin, D A; Baranovich, V Iu; Faĭbushevich, A G; Stefanov, S A; Tarichko, Iu V

    2010-01-01

    Short and long-term results of endovascular treatment of true bifurcational coronary stenosis were analyzed in 229 patients. 68 patients received a "provisional-T" stenting on the first stage of the study. On the next stage 40 patients received the same "provisional-T" stenting, a total bifurcational stenting was conducted in 37 patients. Only coated stents were used. Independent risk factors of "provisional-T" stenting conversion to total bifurcational stenting were revealed. There were no differences between "provisional-T" and total bifurcational stenting considering the short-term treatment results. Long-term results (12-18 months) were analyzed in 70 patients. There were no restenosis of the main artery, whereas restenosis of the lateral branch was noticed in 5.5 and 2.94%, respectively, in the groups of "provisional-T" and total bifurcational stenting. Late thrombosis was registered in 1 case from the group of total bifurcational stenting.

  15. Preventive role of palladium-103 radioactive stent on in-stent restenosis in rabbit iliac arteries

    Institute of Scientific and Technical Information of China (English)

    LUO Quan-Yong; CHEN Li-Bo; YUAN Zhi-Bin; LU Han-Kui; ZHU Rui-Sen

    2005-01-01

    The abilility of γ-emitting palladium-103 stent implantation to inhibit in-stent restenosis in rabbit iliac arteries was investigated. Quantitative histomorphometry of the stented iliac segments 28 days after the implantation indicated that palladium-103 stents made a significant reduction in neointimal area and percent area stenosis compared with the nonradioactive stents. Lumen area in the palladium-103 stents treatment group was larger than the control group. However, the reduction of neointima formation by palladium-103 stents implantation was in a non-dose-dependent fashion. Low ionizing radiation doses via γ-emitting palladiurn-103 stent are effective in preventing neointimal hyperplasia in iliac arteries of rabbits. Palladium-103 stents can be employed as a possible novel means to prevent in-stent restenosis.

  16. Mitral restenosis in the early postoperative period of a patient with systemic lupus erythematosus

    Directory of Open Access Journals (Sweden)

    Pomerantzeff Pablo Maria Alberto

    1999-01-01

    Full Text Available A forty eight year old woman, who had undergone mitral comissurotomy and subsequently developed early restenosis, presented with major comissural fusion and verrucous lesions on the cuspid edges of the mitral valve, with normal subvalvar apparatus. Patient did well for the first six months after surgery when she began to present dyspnea on light exertion. A clinical diagnosis of restenosis was made, which was confirmed by an echocardiogram and cardiac catheterization. She underwent surgery, and a stenotic mitral valve with verrucous lesions suggesting Libman-Sacks' endocarditis was found. Because the diagnosis of systemic lupus erythematosus (SLE had not been confirmed at that time, a bovine pericardium bioprosthesis (FISICS-INCOR was implanted. The patient did well in the late follow-up and is now in NYHA Class I .

  17. Carotid stenting using tapered and nontapered stents: associated neurological complications and restenosis rates.

    Science.gov (United States)

    Brown, Katherine E; Usman, Asad; Kibbe, Melina R; Morasch, Mark D; Matsumura, Jon S; Pearce, William H; Amaranto, Daniel J; Eskandari, Mark K

    2009-01-01

    Self-expanding stent design systems for carotid artery stenting (CAS) have morphed from nontapered (NTS) to tapered (TS); however, the impact of this change is unknown. We reviewed the outcomes of CAS with these two broad categories of stents in a single-center retrospective review of 308 CAS procedures from May 2001 to July 2007. Nitinol self-expanding TS or NTS coupled with cerebral embolic protection devices were used to treat extracranial carotid occlusive disease. Data analysis included demographics, procedural records, duplex exams, and conventional arteriography. Mean follow-up was 18 months (range 1-69). Restenosis was defined as >or=80% in-stent carotid artery stenosis by angiography. The mean age of the entire cohort was 71.3 years (75% men, 25% women). Of the 308 cases, 233 were de novo lesions and 75 had a prior ipsilateral carotid endarterectomy (n = 44) or external beam radiation exposure (n = 31). Preprocedure neurological symptoms were present in 30% of patients. TS were used in 156 procedures and NTS in 152 procedures. The 30-day ipsilateral stroke and death rates were 1.3% and 0.3%, respectively. An additional three (1.0%) posterior circulation strokes occurred. There was no statistically significant difference in the 30-day total stroke rates between TS (3.2%, n = 5) and NTS (1.3%, n = 2) (p = 0.5). At midterm follow-up, restenosis or asymptomatic occlusion was detected in eight cases (2.6%). All occurred in arteries treated with NTS, and this was statistically different when compared to arteries treated with TS (p = 0.03). Furthermore, a post-hoc subgroup analysis revealed significant correlation (chi(2) = 0.02) for restenosis in "hostile necks" when separated by TS vs. NTS. Early CAS outcomes between TS and NTS are comparable. In contrast, self-expanding nitinol TS may have a lower incidence of significant restenosis or asymptomatic occlusion when compared to NTS.

  18. Oversizing and Restenosis with Self-Expanding Stents in Iliofemoral Arteries

    Energy Technology Data Exchange (ETDEWEB)

    Saguner, Ardan M., E-mail: ardan.saguner@usz.ch; Traupe, Tobias; Raeber, Lorenz; Hess, Nina [University Hospital, Swiss Cardiovascular Center (Switzerland); Banz, Yara [University of Bern, Institute of Pathology (Switzerland); Saguner, Arhan R.; Diehm, Nicolas; Hess, Otto M. [University Hospital, Swiss Cardiovascular Center (Switzerland)

    2012-08-15

    Purpose: Uncoated self-expanding nitinol stents (NS) are commonly oversized in peripheral arteries. In current practice, 1-mm oversizing is recommended. Yet, oversizing of NS may be associated with increased restenosis. To provide further evidence, NS were implanted in porcine iliofemoral arteries with a stent-to-artery-ratio between 1.0 and 2.3. Besides conventional uncoated NS, a novel self-expanding NS with an antiproliferative titanium-nitride-oxide (TiNOX) coating was tested for safety and efficacy. Methods: Ten uncoated NS and six TiNOX-coated NS (5-6 mm) were implanted randomly in the iliofemoral artery of six mini-pigs. After implantation, quantitative angiography (QA) was performed for calculation of artery and minimal luminal diameter. Follow-up was performed by QA and histomorphometry after 5 months. Results: Stent migration, stent fracture, or thrombus formation were not observed. All stents were patent at follow-up. Based on the location of the stent (iliac/femoral) and the stent-to-artery-ratio, stent segments were divided into 'normal-sized' (stent-to-artery-ratio < 1.4, n = 12) and 'oversized' (stent-to-artery-ratio {>=} 1.4, n = 9). All stent segments expanded to their near nominal diameter during follow-up. Normal-sized stent segments increased their diameter by 6% and oversized segments by 29%. A significant correlation between oversizing and restenosis by both angiography and histomorphometry was observed. Restenosis rates were similar for uncoated NS and TiNOX-coated NS. Conclusions: TiNOX-coated NS are as safe and effective as uncoated NS in the porcine iliofemoral artery. All stents further expand to near their nominal diameter during follow-up. Oversizing is linearly and positively correlated with neointimal proliferation and restenosis, which may not be reduced by TiNOX-coating.

  19. Risk assessment by myocardial perfusion imaging for coronary revascularization, medical therapy, and noncardiac surgery.

    Science.gov (United States)

    Papaioannou, Georgios I; Heller, Gary V

    2003-01-01

    Stress myocardial perfusion imaging (MPI) has become an important tool in risk stratification of patients with known coronary artery disease. A normal myocardial perfusion scan has a high negative predictive value and is associated with low annual mortality rate ( 20% of the left ventricle), defects in more than 1 coronary vascular territory, transient or persistent left ventricular cavity dilation, and ejection fraction less than 45% have a high annual mortality rate (> 3%). Those patients should undergo coronary revascularization whenever feasible, as the cardiac event rate increases in proportion to the magnitude of the jeopardized myocardium. Stress MPI can be used to demonstrate ischemia in patients with symptoms early after coronary artery bypass surgery (/= 5 years) after coronary artery bypass surgery. With respect to patients who underwent percutaneous interventions, stress MPI can help detect in-stent restenosis early after the intervention (3-6 months) or assess the progression of native coronary disease afterward. Since preliminary data suggest that a reduction in the perfusion defect size may translate to a reduction of coronary events, stress MPI can help assess the efficacy of medical management of coronary disease. Finally, stress MPI is indicated for perioperative cardiac risk stratification for noncardiac surgery in patients with intermediate risk predictors (mild angina, prior myocardial infarction or heart failure symptoms, diabetes mellitus, renal insufficiency) and poor functional capacity or in those who undergo high-risk surgery with significant implications in further preoperative management.

  20. The development of 3-D, in vitro, endothelial culture models for the study of coronary artery disease

    Directory of Open Access Journals (Sweden)

    Fraser Richard

    2009-10-01

    Full Text Available Abstract The response of the vascular endothelium to wall shear stress plays a central role in the development and progression of atherosclerosis. Current studies have investigated endothelial response using idealized in vitro flow chambers. Such cell culture models are unable to accurately replicate the complex in vivo wall shear stress patterns arising from anatomical geometries. To better understand this implication, we have created both simplified/tubular and anatomically realistic in vitro endothelial flow models of the human right coronary artery. A post-mortem vascular cast of the human left ventricular outflow tract was used to create geometrically accurate silicone elastomer models. Straight, tubular models were created using a custom made mold. Following the culture of human abdominal aortic endothelial cells within the inner lumen, cells were exposed to steady flow (Re = 233 for varying time periods. The resulting cell morphology was analyzed in terms of shape index and angle of orientation relative to the flow direction. In both models a progressive elongation and alignment of the endothelium in the flow direction was observed following 8, 12, and 24 hours. This change, however, was significantly less pronounced in the anatomical model (as observed from morphological variations indicative of localized flow features. Differences were also observed between the inner and outer walls at the disease-prone proximal region. Since morphological adaptation is a visual indication of endothelial shear stress activation, the use of anatomical models in endothelial genetic and biochemical studies may offer better insight into the disease process.

  1. Evaluating the Framingham hypertension risk prediction model in young adults: the Coronary Artery Risk Development in Young Adults (CARDIA) study.

    Science.gov (United States)

    Carson, April P; Lewis, Cora E; Jacobs, David R; Peralta, Carmen A; Steffen, Lyn M; Bower, Julie K; Person, Sharina D; Muntner, Paul

    2013-12-01

    A prediction model was developed in the Framingham Heart Study (FHS) to evaluate the short-term risk of hypertension. Our goal was to determine the predictive ability of the FHS hypertension model in a cohort of young adults advancing into middle age and compare it with the predictive ability of prehypertension and individual components of the FHS model. We studied 4388 participants, aged 18 to 30 years without hypertension at baseline, enrolled in the Coronary Artery Risk Development in Young Adults (CARDIA) Study, who participated in 2 consecutive examinations occurring 5 years apart between the baseline (1985-1986) and year 25 examination (2010-2011). Weibull regression was used to assess the association of the FHS model overall, individual components of the FHS model, and prehypertension with incident hypertension. During the 25-year follow-up period, 1179 participants developed incident hypertension. The FHS hypertension model (c-index=0.84; 95% confidence interval, 0.83-0.85) performed well in discriminating those who did and did not develop hypertension and was better than prehypertension alone (c-index=0.71; 95% confidence interval, 0.70-0.73). The predicted risk from the FHS hypertension model was systematically lower than the observed hypertension incidence initially (χ(2)=249.4; Padults with a high risk for developing hypertension.

  2. Distinctive effects of CD34- and CD133-specific antibody-coated stents on re-endothelialization and in-stent restenosis at the early phase of vascular injury

    DEFF Research Database (Denmark)

    Wu, Xue; Yin, Tieying; Tian, Jie

    2015-01-01

    It is not clear what effects of CD34- and CD133-specific antibody-coated stents have on re-endothelialization and in-stent restenosis (ISR) at the early phase of vascular injury. This study aims at determining the capabilities of different coatings on stents (e.g. gelatin, anti-CD133 and anti-CD34...... experiment using a rabbit model in which the coated stents with different substrates were implanted showed that anti-CD34 and anti-CD133 antibody-coated stents markedly reduced the intima area and restenosis than bare mental stents (BMS) and gelatin-coated stents. Compared with the anti-CD34 antibody...

  3. [Comparison of the results of coronary angioplasty and stenting during one year following surgery].

    Science.gov (United States)

    Simonenko, V B; Seĭdov, V G; Zakharov, S V; Evsiukov, V V; Liubchuk, I V

    2007-01-01

    The purpose of the study was to compare long-term results of angioplasty and coronary arterial stenting (CAS) depending on the initial degree of coronary arterial (CA) lesion according to morphological stenosis classification, as well as to evaluate the influence of re-stenosis on myocardial contractility dynamics, anginal recurrence rate, and exercise tolerance. The subjects, 228 men after angioplasty and 184 men after CAS with wire stents without drug coating, were included in the study between 1989 and 2005. Coronarography was repeated in 358 patients one year after surgery. The patients were divided into two groups. The first group consisted of 161 patients, to who 180 stents were implanted. The second group consisted of 197patients, in who 226 angioplasty procedures were performed. Data were processed using standard variational statistical methods, i.e. the calculation of mean values and standard deviation. Statistical calculations were carried out using Analysis ToolPak- VBA software of Microsoft Excel 2000. The study found that one year after either intervention the number of patients without anginal symptoms fell significantly compared with this number during the in-hospital period. In group 2 the frequency of restenosis was higher and the number of patients with anginal symptoms was significantly bigger than in group 1; the number of asymptomatic patients was significantly bigger in group 1. Initial morphological characteristics of CA lesion had a significant effect on the long-term frequency of restenosis following endovascular treatment. Restenosis was 2 to 2.5 times more frequent in patients with C type CA lesion vs. patients with A type regardless the method of endovascular intervention. The results of the study demonstrate the importance of taking into account initial morphological characteristics of CA lesion; CAS is more preferable than angioplasty, especially in patients with C type CA lesion.

  4. Examining a hypothetical quantitative model for better approximation of culprit coronary artery and site of stenosis on 99mTc-sestamibi gated myocardial perfusion SPECT.

    Science.gov (United States)

    Pal, Sushanta; Sen, Srabani; Das, Debasis; Basu, Sandip

    2016-10-01

    A hypothetical quantitative model of analyzing gated myocardial perfusion SPECT is proposed and examined for the feasibility of its use as a predictor of diseased coronary artery and approximating the site of stenosis to determine whether it could serve as a useful noninvasive complement for coronary angiography. The extent and severity of perfusion defects on rest gated myocardial perfusion imaging SPECT-images were assessed on a five-point scale in a standard 17-segment model and total perfusion deficit was quantified by automated software. The first step was to locate the diseased coronary artery using a quantitative method: for this, the score of each segment belonging to a particular coronary artery was determined using a systematic presumptive approach. After determination of specific coronary artery segments, the scores of the contiguous segments in three short axis slices (apical, middle, and basal) were summed for six subdivisions (anterior, anterolateral, inferolateral, inferior, anteroseptal, and inferoseptal). The site of stenosis was determined from (a) the initial approximation of the involved segments with a defect score of 2-4 and (b) subsequent calculation of the defect score of each of the six subdivisions and allocating the site through a preassigned number for each coronary artery. For each coronary artery, only the subdivision with the highest defect score was considered. Proximal, middle, and distal segments of left anterior descending artery (LAD) were considered to be represented when the summed value of a subdivision within a particular arterial territory was more than or equal to 7, between 5 and 7, 5 and 3, respectively. For the left circumflex and right coronary artery, summed scores (of respective subdivisions) of more than or equal to 5 and between 3 and 5 were preassigned to proximal and distal stenosis, respectively. The results were then correlated with the coronary angiographic data. On coronary angiography, proximal LAD occlusion

  5. An economic evaluation of salt reduction policies to reduce coronary heart disease in England: a policy modeling study.

    Science.gov (United States)

    Collins, Marissa; Mason, Helen; O'Flaherty, Martin; Guzman-Castillo, Maria; Critchley, Julia; Capewell, Simon

    2014-07-01

    Dietary salt intake has been causally linked to high blood pressure and increased risk of cardiovascular events. Cardiovascular disease causes approximately 35% of total UK deaths, at an estimated annual cost of £30 billion. The World Health Organization and the National Institute for Health and Care Excellence have recommended a reduction in the intake of salt in people's diets. This study evaluated the cost-effectiveness of four population health policies to reduce dietary salt intake on an English population to prevent coronary heart disease (CHD). The validated IMPACT CHD model was used to quantify and compare four policies: 1) Change4Life health promotion campaign, 2) front-of-pack traffic light labeling to display salt content, 3) Food Standards Agency working with the food industry to reduce salt (voluntary), and 4) mandatory reformulation to reduce salt in processed foods. The effectiveness of these policies in reducing salt intake, and hence blood pressure, was determined by systematic literature review. The model calculated the reduction in mortality associated with each policy, quantified as life-years gained over 10 years. Policy costs were calculated using evidence from published sources. Health care costs for specific CHD patient groups were estimated. Costs were compared against a "do nothing" baseline. All policies resulted in a life-year gain over the baseline. Change4life and labeling each gained approximately 1960 life-years, voluntary reformulation 14,560 life-years, and mandatory reformulation 19,320 life-years. Each policy appeared cost saving, with mandatory reformulation offering the largest cost saving, more than £660 million. All policies to reduce dietary salt intake could gain life-years and reduce health care expenditure on coronary heart disease. Copyright © 2014 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

  6. Chronic oxidative-nitrosative stress impairs coronary vasodilation in metabolic syndrome model rats.

    Science.gov (United States)

    Kagota, Satomi; Maruyama, Kana; Tada, Yukari; Fukushima, Kazuhito; Umetani, Keiji; Wakuda, Hirokazu; Shinozuka, Kazumasa

    2013-07-01

    Metabolic syndrome (MetS) is a combination of clinical disorders that together increase the risk for cardiovascular disease and diabetes. SHRSP.Z-Lepr(fa)/IzmDmcr (SHRSP.ZF) rats with MetS show impaired nitric oxide-mediated relaxation in coronary and mesenteric arteries, and angiotensin II receptor type 1 blockers protect against dysfunction and oxidative-nitrosative stress independently of metabolic effects. We hypothesize that superoxide contributes to functional deterioration in SHRSP.ZF rats. To test our hypothesis, we studied effects of treatment with tempol, a membrane-permeable radical scavenger, on impaired vasodilation in SHRSP.ZF rats. Tempol did not alter body weight, high blood pressure, or metabolic abnormalities, but prevented impairment of acetylcholine-induced and nitroprusside-induced vasodilation in the coronary and mesenteric arteries. Furthermore, tempol reduced the levels of serum thiobarbituric acid reactive substance (TBARS) and 3-nitrotyrosine content in mesenteric arteries. Systemic administration of tempol elevated the expression of soluble guanylate cyclase (sGC) above basal levels in mesenteric arteries of SHRSP.ZF rats. However, acute treatment with tempol or ebselen, a peroxynitrite scavenger, did not ameliorate impaired relaxation of isolated mesenteric arteries. No nitration of tyrosine residues in sGC was observed; however, sGC mRNA expression levels in the arteries of SHRSP.ZF rats were lower than those in the arteries of Wistar-Kyoto rats. Levels of Thr(496)- and Ser(1177)-phosphorylated endothelial nitric oxide synthase (eNOS) were lower in arteries of SHRSP.ZF rats, and acetylcholine decreased Thr(496)-phosphorylated eNOS levels. These results indicated that prolonged superoxide production, leading to oxidative-nitrosative stress, was associated with impaired vasodilation in SHRSP.ZF rats with MetS. Down-regulated sGC expression may be linked to dysfunction, while reduced NO bioavailability/eNOS activity and modified s

  7. Chinese Herbal Medicines Might Improve the Long-Term Clinical Outcomes in Patients with Acute Coronary Syndrome after Percutaneous Coronary Intervention: Results of a Decision-Analytic Markov Model

    Directory of Open Access Journals (Sweden)

    Shao-Li Wang

    2015-01-01

    Full Text Available Aims. The priority of Chinese herbal medicines (CHMs plus conventional treatment over conventional treatment alone for acute coronary syndrome (ACS after percutaneous coronary intervention (PCI was documented in the 5C trial (chictr.org number: ChiCTR-TRC-07000021. The study was designed to evaluate the 10-year effectiveness of CHMs plus conventional treatment versus conventional treatment alone with decision-analytic model for ACS after PCI. Methods and Results. We constructed a decision-analytic Markov model to compare additional CHMs for 6 months plus conventional treatment versus conventional treatment alone for ACS patients after PCI. Sources of data came from 5C trial and published reports. Outcomes were expressed in terms of quality-adjusted life years (QALYs. Sensitivity analyses were performed to test the robustness of the model. The model predicted that over the 10-year horizon the survival probability was 77.49% in patients with CHMs plus conventional treatment versus 77.29% in patients with conventional treatment alone. In combination with conventional treatment, 6-month CHMs might be associated with a gained 0.20% survival probability and 0.111 accumulated QALYs, respectively. Conclusions. The model suggested that treatment with CHMs, as an adjunctive therapy, in combination with conventional treatment for 6 months might improve the long-term clinical outcome in ACS patients after PCI.

  8. Coronary anomaly: the single coronary artery

    Institute of Scientific and Technical Information of China (English)

    QIN Xu-guang; XIONG Wei-guo; LU Chun-peng; GONG Cheng-jie; SHANG Li-hua

    2010-01-01

    @@ Single coronary artery (SCA), defined as an artery that arises from the arterial trunk and nourishes the entire myocardium, is rare. We report two cases of SCA, one is the right coronary artery (RCA) originating from the middle of left descending artery (LAD), and the other is the left main coronary artery (LMCA) arising from the proximal right coronary artery.

  9. Analysis on Related Etiology Factors of In-stent Restenosis%冠脉支架术后患者导致 ISR 的相关因素分析

    Institute of Scientific and Technical Information of China (English)

    李涛

    2014-01-01

    目的:对冠状动脉支架植入术( PCI)后行冠脉造影复查的患者进行回顾性分析,探讨导致支架内再狭窄( ISR)的相关因素。方法:收集2010年1月至2012年12月在我院接受PCI并进行冠脉造影随访的冠心病患者100例,将其分为ISR组及非ISR组,分析可能导致ISR的可能性因素。结果:通过对可能与ISR相关的因素进行多因素Logistic 回归分析显示,ISR 的危险因素有:2型糖尿病(OR=5.697,95%CI 2.627-12.357)、支架长度>20mm(OR=4.832,95%CI 2.385-9.667)、支架直径<3mm(OR=3.022,95%CI 1.899-4.809)、非药物涂层支架(OR=8.827,95%CI 2.758-28.249)以及多支病变( OR=9.095,95%CI 1.012-81.759)。结论:糖尿病、支架长度>20mm、支架直径<3mm、非药物涂层支架及多支血管病变是可以独立预测ISR发生的危险因素。%Objective:To analyze the in-stent restenosis ( ISR) by recheck the coronary angiograms of the patients who accepted ( percutaneous coronary intervention ) PCI therapy , in order to find the possible risk factors of ISR .Method:100 ( coronary heart disease ) CHD patients who underwent ( coronary angiogra-phy) CAG after PCI therapy in our hospital from Jan .2010 to Dec.2012 were included in the study .They were divided into 2 groups:restenosis group and non-restenosis group .Then the two groups were compared to estimate the risk factors .Result: By the multiple logistic regression analysis , it was revealed that there were five significant risk factors for ISR:Diabetes mellitus (OR=5.697,95%CI 2.627-12.357), the length of stent≥20mm (OR=4.832,95%CI 2.385-9.667), the diameter of stent ≤3mm (OR=3.022,95%CI 1. 899-4.809), non-drug-coated stents (OR=8.827,95%CI 2.758-28.249) and muti-vessel lesion (OR=9.095,95%CI 1.012-81.759).Conclusion:The major reasons of in-stent restenosis are diabetes mullitus , the length of stent ≥20mm, the

  10. Clinical experience in coronary stenting with the Vivant Z Stent.

    Science.gov (United States)

    Chee, K H; Siaw, F S; Chan, C G; Chong, W P; Imran, Z A; Haizal, H K; Azman, W; Tan, K H

    2005-06-01

    This single centre study was designed to demonstrate feasibility, safety and efficacy of the Vivant Z stent (PFM AG, Cologne, Germany). Patients with de novo lesion were recruited. Coronary angioplasty was performed with either direct stenting or after balloon predilatation. Repeated angiogram was performed 6 months later or earlier if clinically indicated. Between January to June 2003, a total of 50 patients were recruited (mean age 55.8 +/- 9 years). A total of 52 lesions were stented successfully. Mean reference diameter was 2.77 mm (+/-0.59 SD, range 2.05-4.39 mm) with mean target lesion stenosis of 65.5% (+/-11.6 SD, range 50.1-93.3%). Forty-six lesions (88.5%) were American College of Cardiologist/American Heart Association class B/C types. Direct stenting was performed in 18 (34.6%) lesions. Mean stent diameter was 3.18 mm (+/-0.41 SD, range 2.5-4 mm), and mean stent length was 14.86 mm (+/-2.72 SD, range 9-18 mm). The procedure was complicated in only one case which involved the loss of side branch with no clinical sequelae. All treated lesions achieved Thrombolysis In Myocardial Infarction 3 flow. Mean residual diameter stenosis was 12.2% (+/-7.55 SD, range 0-22.6%) with acute gain of 1.72 mm (+/-0.50 SD, range 0.5-2.8). At 6 months, there was no major adverse cardiovascular event. Repeated angiography after 6 months showed a restenosis rate of 17% (defined as >50% diameter restenosis). Mean late loss was 0.96 mm (+/-0.48 SD) with loss index of 0.61 (+/-0.38 SD). The restenosis rate of those lesions less than 3.0 mm in diameter was 22.2% compared with 6.25% in those lesions more than 3.0 mm in diameter. The Vivant Z stent was shown to be safe and efficacious with low restenosis rate in de novo coronary artery lesion.

  11. Coronary collaterals

    NARCIS (Netherlands)

    Koerselman, Jeroen

    2004-01-01

    Cardiovascular diseases, in particular coronary artery disease, are the leading cause of death and disease in industrialized countries. Atherosclerotic changes of the arterial vessel wall constitute one of the major causes for the occurrence of cardiovascular disease. Important risk factors for

  12. Coronary collaterals

    NARCIS (Netherlands)

    Koerselman, Jeroen

    2004-01-01

    Cardiovascular diseases, in particular coronary artery disease, are the leading cause of death and disease in industrialized countries. Atherosclerotic changes of the arterial vessel wall constitute one of the major causes for the occurrence of cardiovascular disease. Important risk factors for card

  13. Differential regulation of functional gene clusters in overt coronary artery disease in a transgenic atherosclerosis-hypertensive rat model.

    OpenAIRE

    Herrera, Victoria M. L.; Didishvili, Tamara; Lopez, Lyle V.; Ruiz-Opazo, Nelson

    2002-01-01

    BACKGROUND: Human acute coronary syndrome refers to the spectrum of clinical manifestations of overt coronary artery (CAD) disease characterized by atherosclerotic plaque destabilization and resultant myocardial injury. Typically studied as distinct pathologies, emerging pathogenic paradigms implicate multiple processes beyond thrombosis and ischemic cell injury respectively, with significant pathway overlap involving inflammation, apoptosis, matrix degradation, and oxidative stress. However,...

  14. In-vivo measurements of coronary blood flow using 16-slice multidetector spiral computed tomography (MDCT) in a porcine model

    Energy Technology Data Exchange (ETDEWEB)

    Krug, Kathrin Barbara; Bovenschulte, H. [Klinikum der Koeln Univ. (Germany). Inst. fuer Radiologische Diagnostik; Geissler, H.J. [Klinikum der Koeln Univ. (DE). Klinik und Poliklinik fuer Herz- und Thoraxchirurgie] (and others)

    2009-03-15

    To determine whether CTCA supplemented with CT flow measurements can be used to demonstrate and semiquantitatively evaluate poststenotic coronary blood flow in a porcine model. In 10 thoracotomized pigs, transit time flow meter probes were attached to the aorta and left anterior descending artery (LAD) for real-time blood flow volumetry. A vascular silicone occluder was deployed around the LAD proximal to the probe to create medium-grade (MGS) and high-grade stenoses (HGS). The blood flow was measured by CT without vessel occlusion and distal to the stenoses. Time-density curves were generated from CT data. The curves were evaluated by calculating and cross-plotting the variables ''slope of the density increase'', ''peak density'' and ''slope of the post-peak density decrease'' from the LAD and aortic CT data. The flow in the LAD dropped to 41 % {+-} 9 % (mean {+-} SD) for MGS and 12 % {+-} 6 % for HGS of the baseline. Coronary time-density curves plateaued proportional to luminal narrowing. Unimpaired flow could be differentiated statistically significant from poststenotic flow adjacent to MGS and HGS (p < 0.000 and p < 0.002, respectively). Flow adjacent to MGS and HGS was successfully differentiated for ''slope of the density increase'' and ''slope of the post-peak density decrease'' (p < 0.003 and p < 0.030, respectively). (orig.)

  15. In vitro blood flow model with physiological wall shear stress for hemocompatibility testing-An example of coronary stent testing.

    Science.gov (United States)

    Engels, Gerwin Erik; Blok, Sjoerd Leendert Johannes; van Oeveren, Willem

    2016-09-18

    Hemocompatibility of blood contacting medical devices has to be evaluated before their intended application. To assess hemocompatibility, blood flow models are often used and can either consist of in vivo animal models or in vitro blood flow models. Given the disadvantages of animal models, in vitro blood flow models are an attractive alternative. The in vitro blood flow models available nowadays mostly focus on generating continuous flow instead of generating a pulsatile flow with certain wall shear stress, which has shown to be more relevant in maintaining hemostasis. To address this issue, the authors introduce a blood flow model that is able to generate a pulsatile flow and wall shear stress resembling the physiological situation, which the authors have coined the "Haemobile." The authors have validated the model by performing Doppler flow measurements to calculate velocity profiles and (wall) shear stress profiles. As an example, the authors evaluated the thrombogenicity of two drug eluting stents, one that was already on the market and one that was still under development. After identifying proper conditions resembling the wall shear stress in coronary arteries, the authors compared the stents with each other and often used reference materials. These experiments resulted in high contrast between hemocompatible and incompatible materials, showing the exceptional testing capabilities of the Haemobile. In conclusion, the authors have developed an in vitro blood flow model which is capable of mimicking physiological conditions of blood flow as close as possible. The model is convenient in use and is able to clearly discriminate between hemocompatible and incompatible materials, making it suitable for evaluating the hemocompatible properties of medical devices.

  16. The Prevalence of Risk Factors of Coronary Artery Disease in the Patients who Underwent Coronary Artery Bypass Graft, Shiraz, Iran: Suggesting a Model

    Directory of Open Access Journals (Sweden)

    Mohammad Ali Ostovan

    2014-12-01

    Full Text Available Background: Cardiovascular diseases are the main cause of 40% of deaths in Iran annually. Many patients undergoing coronary artery bypass graft surgery have previous cardiovascular risk factors which could be prevented. Objectives: The present study aimed to assess the prevalence of cardiovascular risk factors in the patients undergoing coronary artery bypass graft surgery. Materials and Methods: In this cross-sectional (descriptive – analytical study, a data collecting form was used. A total of 246 patients were selected from six hospitals of Shiraz using random stratification. Descriptive statistics were presented through figures and tables and t-test was used to analyze the continuous variables. All the statistical analyses were performed using the SPSS statistical software (version 15.0. Besides, P < 0.05 was considered as statistically significant. Results: Among the study patients, only 11.67% had no risk factors and 88.33% had one or more risk factors. The most common risk factors observed in the patients were hypertension, obesity and overweight, hyperlipidemia, and diabetes mellitus. The results showed a significant difference between males and females regarding the prevalence of hypertension (P = 0.001, diabetes (P = 0.028, hypercholesterolemia (P = 0.020, and cigarette smoking (P = 0.001. In addition, the patients' mean levels of cholesterol, LDL, triglyceride, and fasting blood sugar were higher than the acceptable level, while that of HDL was lower than the accepted level. Conclusions:: These patients are recommended to be trained regarding lifestyle changes. Also, prevention strategies can play an important role in reducing patient morbidity and mortality.

  17. Late thrombosis of coronary bare-metal stent: Case report

    Directory of Open Access Journals (Sweden)

    Apostolović Svetlana

    2006-01-01

    Full Text Available Stent thrombosis remains the primary cause of death after percutaneous coronary interventions (PCI. Despite modern concepts of PCI, stent thrombosis occurs in 0.5% -2% of elective procedures and even 6% of patients with the acute coronary syndrome (ACS. Stent thrombosis most often develops within the first 48 hours after the PCI, and rarely after a week of stent implantation. Angiographically documented late (>6 months thrombosis of coronary bare-metal stent (BMS is rare, because the stent endothelialization is considered to be completed after four weeks of the intervention. Our patient is a 41 year old male and he had BMS thrombosis 345 days after the implantation, which was clinically manifested as an acute myocardial infarction in the inferoposterolateral localization. Stent Clinical Centre of Serbia, Belgrade thrombosis occurred despite a long term dual antiplatelet therapy and control of known risk factors. Thrombolytic therapy (Streptokinase in a dose of 1 500 000 IU was not successful in reopening the occluded vessel, so the flow through the coronary artery was achieved by rescue balloon angioplasty, followed by implantation of drug eluting stent in order to prevent restenosis.

  18. Cardiological-interventional therapy of coronary artery disease today; Kardiologisch-interventionelle Therapie der koronaren Herzerkrankung heute

    Energy Technology Data Exchange (ETDEWEB)

    Reynen, K.; Henssge, R. [Technische Univ. Dresden (Germany). Klinik fuer Kardiologie

    1999-07-01

    The current importance of the interventional therapy of coronary artery disease may be deduced from the exponential increase in procedures performed in Germany in the last decade - at least 125,840 in 1996. Today, by improved catheter and balloon materials as well as by growing experience of the cardiologists, even complex lesions may be treated. Limitations of balloon angioplasty include acute vessel closure and restenosis - newer angioplasty devices like directional or rotational atherectomy or excimer-laser angioplasty did not overcome these limitations; only by coronary stenting, acute vessel closure could be managed and the likelihood of restenosis - at least in particular groups of patients - could be reduced. For a few years, intracoronary brachytherapy of the segments dilated with beta- or gamma-emitters has been seeking to reduce restenosis rate; the department of cardiology of the Dresden Cardiovascular Institute is participating in such a multicentre study using the beta-emitter {sup 188}renium. Further main topics of our department represent primary angioplasty in patients with acute myocardial infarction and invasive diagnostic or interventional procedures by the transradial approach. (orig.)

  19. Permanent ligation of the left anterior descending coronary artery in mice: a model of post-myocardial infarction remodelling and heart failure.

    Science.gov (United States)

    Muthuramu, Ilayaraja; Lox, Marleen; Jacobs, Frank; De Geest, Bart

    2014-12-02

    Heart failure is a syndrome in which the heart fails to pump blood at a rate commensurate with cellular oxygen requirements at rest or during stress. It is characterized by fluid retention, shortness of breath, and fatigue, in particular on exertion. Heart failure is a growing public health problem, the leading cause of hospitalization, and a major cause of mortality. Ischemic heart disease is the main cause of heart failure. Ventricular remodelling refers to changes in structure, size, and shape of the left ventricle. This architectural remodelling of the left ventricle is induced by injury (e.g., myocardial infarction), by pressure overload (e.g., systemic arterial hypertension or aortic stenosis), or by volume overload. Since ventricular remodelling affects wall stress, it has a profound impact on cardiac function and on the development of heart failure. A model of permanent ligation of the left anterior descending coronary artery in mice is used to investigate ventricular remodelling and cardiac function post-myocardial infarction. This model is fundamentally different in terms of objectives and pathophysiological relevance compared to the model of transient ligation of the left anterior descending coronary artery. In this latter model of ischemia/reperfusion injury, the initial extent of the infarct may be modulated by factors that affect myocardial salvage following reperfusion. In contrast, the infarct area at 24 hr after permanent ligation of the left anterior descending coronary artery is fixed. Cardiac function in this model will be affected by 1) the process of infarct expansion, infarct healing, and scar formation; and 2) the concomitant development of left ventricular dilatation, cardiac hypertrophy, and ventricular remodelling. Besides the model of permanent ligation of the left anterior descending coronary artery, the technique of invasive hemodynamic measurements in mice is presented in detail.

  20. Coronary Artery Stent Evaluation Using a Vascular Model at 64-Detector Row CT: Comparison between Prospective and Retrospective ECG-Gated Axial Scans

    Energy Technology Data Exchange (ETDEWEB)

    Suzuki, Shigeru; Furui, Shigeru; Kaminaga, Tatsuro; Miyazawa, Akiyoshi; Ueno, Yasunari; Konno, Kumiko [Teikyo University School of Medicine, Tokyo (Japan); Kuwahara, Sadatoshi; Mehta, Dhruv [Philips Electronics Japan, Ltd. Medical Systems, Tokyo (Japan)

    2009-06-15

    We wanted to evaluate the performance of prospective electrocardiogram (ECG)-gated axial scans for assessing coronary stents as compared with retrospective ECG-gated helical scans. As for a vascular model of the coronary artery, a tube of approximately 2.5-mm inner diameter was adopted and as for stents, three (Bx-Velocity, Express2, and Micro Driver) different kinds of stents were inserted into the tube. Both patent and stenotic models of coronary artery were made by instillating different attenuation (396 vs. 79 Hounsfield unit [HU]) of contrast medium within the tube in tube model. The models were scanned with two types of scan methods with a simulated ECG of 60 beats per minute and using display field of views (FOVs) of 9 and 18 cm. We evaluated the in-stent stenosis visually, and we measured the attenuation values and the diameter of the patent stent lumen. The visualization of the stent lumen of the vascular models was improved with using the prospective ECG-gated axial scans and a 9-cm FOV. The inner diameters of the vascular models were underestimated with mean measurement errors of -1.10 to -1.36 mm. The measurement errors were smaller with using the prospective ECG-gated axial scans (Bx-Velocity and Express2, p < 0.0001; Micro Driver, p = 0.0004) and a 9-cm FOV (all stents: p < 0.0001), as compared with the other conditions, respectively. The luminal attenuation value was overestimated in each condition. For the luminal attenuation measurement, the use of prospective ECG-gated axial scans provided less measurement error compared with the retrospective ECG-gated helical scans (all stents: p < 0.0001), and the use of a 9-cm FOV tended to decrease the measurement error. The visualization of coronary stents is improved by the use of prospective ECG-gated axial scans and using a small FOV with reduced blooming artifacts and increased spatial resolution.

  1. Restenosis of the sigmoid sinus after stenting for treatment of intracranial venous hypertension: case report

    Energy Technology Data Exchange (ETDEWEB)

    Tsumoto, T.; Miyamoto, T.; Shimizu, M.; Inui, Y.; Nakakita, K.; Hayashi, S. [Department of Neurosurgery, Minami Wakayama National Hospital, Wakayama (Japan); Terada, T. [Department of Neurological Surgery, Wakayama Medical University, Wakayama (Japan)

    2003-12-01

    We report what we believe to be the first case of restenosis of the sigmoid sinus after stenting, in a 42-year-old man with an arteriovenous malformation with progressive right hemiparesis secondary to venous hypertension. Angiography revealed severe stenosis of the left sigmoid sinus, which was dilated with a self-expandable stent. Six months after the procedure, however, the sinus was again severely stenosed. Intravascular sonography revealed intimal proliferation in the stented sinus. It was dilated percutaneously, and the venous pressure decreased from 51 to 33 mmHg. On sonography, the intimal tissue decreased in thickness and the diameter of the stent enlarged a little. (orig.)

  2. Prosthetic bypass for restenosis after endarterectomy or stenting of the carotid artery.

    Science.gov (United States)

    Illuminati, Giulio; Belmonte, Romain; Schneider, Fabrice; Pizzardi, Giulia; Calió, Francesco G; Ricco, Jean-Baptiste

    2017-06-01

    The objective of this study was to evaluate the results of prosthetic carotid bypass (PCB) with polytetrafluoroethylene (PTFE) grafts as an alternative to carotid endarterectomy (CEA) in treatment of restenosis after CEA or carotid artery stenting (CAS). From January 2000 to December 2014, 66 patients (57 men and 9 women; mean age, 71 years) presenting with recurrent carotid artery stenosis ≥70% (North American Symptomatic Carotid Endarterectomy Trial [NASCET] criteria) were enrolled in a prospective study in three centers. The study was approved by an Institutional Review Board. Informed consent was obtained from all patients. During the same period, a total of 4321 CEAs were completed in the three centers. In these 66 patients, the primary treatment of the initial carotid artery stenosis was CEA in 57 patients (86%) and CAS in nine patients (14%). The median delay between primary and redo revascularization was 32 months. Carotid restenosis was symptomatic in 38 patients (58%) with transient ischemic attack (n = 20) or stroke (n = 18). In this series, all patients received statins; 28 patients (42%) received dual antiplatelet therapy, and 38 patients (58%) received single antiplatelet therapy. All PCBs were performed under general anesthesia. No shunt was used in this series. Nasal intubation to improve distal control of the internal carotid artery was performed in 33 patients (50%), including those with intrastent restenosis. A PTFE graft of 6 or 7 mm in diameter was used in 6 and 60 patients, respectively. Distal anastomosis was end to end in 22 patients and end to side with a clip distal to the atherosclerotic lesions in 44 patients. Completion angiography was performed in all cases. The patients were discharged under statin and antiplatelet treatment. After discharge, all of the patients underwent clinical and Doppler ultrasound follow-up every 6 months. Median length of follow-up was 5 years. No patient died, sustained a stroke, or presented with a

  3. Education and risk of coronary heart disease: assessment of mediation by behavioral risk factors using the additive hazards model.

    Science.gov (United States)

    Nordahl, Helene; Rod, Naja Hulvej; Frederiksen, Birgitte Lidegaard; Andersen, Ingelise; Lange, Theis; Diderichsen, Finn; Prescott, Eva; Overvad, Kim; Osler, Merete

    2013-02-01

    Educational-related gradients in coronary heart disease (CHD) and mediation by behavioral risk factors are plausible given previous research; however this has not been comprehensively addressed in absolute measures. Questionnaire data on health behavior of 69,513 participants, 52 % women, from seven Danish cohort studies were linked to registry data on education and incidence of CHD. Mediation by smoking, low physical activity, and body mass index (BMI) on the association between education and CHD were estimated by applying newly proposed methods for mediation based on the additive hazards model, and compared with results from the Cox proportional hazards model. Short (vs. long) education was associated with 277 (95 % CI: 219, 336) additional cases of CHD per 100,000 person-years at risk among women, and 461 (95 % CI: 368, 555) additional cases among men. Of these additional cases 17 (95 % CI: 12, 22) for women and 37 (95 % CI: 28, 46) for men could be ascribed to the pathway through smoking. Further, 39 (95 % CI: 30, 49) cases for women and 94 (95 % CI: 79, 110) cases for men could be ascribed to the pathway through BMI. The effects of low physical activity were negligible. Using contemporary methods, the additive hazards model, for mediation we indicated the absolute numbers of CHD cases prevented when modifying smoking and BMI. This study confirms previous claims based on the Cox proportional hazards model that behavioral risk factors partially mediates the effect of education on CHD, and the results seems not to be particularly model dependent.

  4. The Effect of Using Peplau's Therapeutic Relationship Model on Anxiety of Coronary Artery Bypass Graft Surgery Candidates

    Directory of Open Access Journals (Sweden)

    Maghsoodi

    2014-08-01

    Full Text Available Background Anxiety is a one of the psychological aftereffect of cardiac surgery, which affects the outcome of treatment. One of the most effective ways to reduce anxiety is to train and establish a targeted relationship based on a functional model. Objectives The present study aimed to determine the effect of Peplau's therapeutic relationship model on anxiety of patients who were candidate for coronary artery bypass graft surgery (CABG. Patients and Methods In this clinical trial, 74 patients were enrolled according to eligibility criteria and were randomly allocated to intervention and control groups of 37 people. We evaluated anxiety of the patients using the Beck anxiety inventory before, immediately after, and two and four months after intervention. Based on Peplau's therapeutic relationship model, therapeutic communication sessions were conducted in four phases during seven sessions. Data analysis was performed with the statistical test of covariance analysis using SPSS version 16. Results The results of our study showed that after therapeutic communication, the mean score of anxiety decreased from 30.35 to 25.38 in the intervention group (P < 0.001, while the scores decreased from 33.22 to 31.46 in the control group. Furthermore, the mean score of anxiety in the intervention group decreased at two and four months after the intervention. Conclusions The findings showed a positive effect of therapeutic relationship based on Peplau's model on reducing anxiety of patients undergoing CABG. Therefore, health care teams, including nurses, should take advantage of appropriate communication with patients in their care procedures. In that regard, Peplau's communication model is recommended as a simple, low-cost, and efficient method.

  5. Mid-Term Follow-Up of Drug-Eluting Stenting for In-Stent Restenosis: Bare-Metal Stents versus Drug- Eluting Stents

    Directory of Open Access Journals (Sweden)

    Negar Faramarzi

    2015-10-01

    Full Text Available Background: Despite major advances in percutaneous coronary intervention (PCI, in-stent restenosis (ISR remains a therapeutic challenge. We sought to compare the mid-term clinical outcomes after treatment with repeat drug-eluting stent (DES implantation (“DES sandwich” technique with DES placement in the bare-metal stent (DES-in-BMS in a "real world" setting.Methods: We retrospectively identified and analyzed clinical and angiographic data on 194 patients previously treated with the DES who underwent repeat PCI for ISR with a DES or a BMS. ISR was defined, by visual assessment, as a luminal stenosis greater than 50% within the stent or within 5 mm of its edges. We recorded the occurrence of major adverse cardiac events (MACE, defined as cardiac death, non-fatal myocardial infarction, and the need for target vessel revascularization (TVR.Results: Of the 194 study participants, 130 were men (67.0% and the mean ± SD of age was 57.0 ± 10.4 years, ranging from37 to 80 years. In-hospital events (death and Q-wave myocardial infarction occurred at a similar frequency in both groups. Outcomes at twelve months were also similar between the groups with cumulative clinical MACE at one-year follow-up of 9.6% and 11.3% in the DES-in-BMS and the DES-in-DES groups, respectively (p value = 0.702. Although not significant, there was a trend toward a higher TVR rate in the intra-DES ISR group as compared to the intra-BMS ISR group (0.9% BMS vs. 5.2% DES; p value = 0.16.Conclusion: Our study suggests that the outcome of the patients presenting with ISR did not seem to be different between the two groups of DES-in-DES and DES-in-BMS at one-year follow-up, except for a trend toward more frequent TVR in the DES-in-DES group. Repeat DES implantation for DES restenosis could be feasible and safe with a relatively low incidence of MACE at mid-term follow-up.

  6. The Impact of the Acute Results on the Long - Term Outcome after the Treatment of In- stent Restenosis: A Serial Intravascular Ultrasound Study

    Institute of Scientific and Technical Information of China (English)

    2002-01-01

    @@ Stenting reduces acute complications and restenosis compared to balloon angioplasty and other devices. However, in- stent restenosis (ISR) is an important clinical problem. The current serial intravascular ultrasound (IVUS)analysis was undertaken to determine whether the acute results obtained during the treatment of ISR influence the long term results and whether this is true for patients treated with and without adjunct brachytherapy.

  7. Caracterización de la restenosis de stents coronarios convencionales y liberadores de medicamentos en pacientes incluidos en el registro DRug Eluting STent (DREST

    Directory of Open Access Journals (Sweden)

    Jorge A. Arroyave C., MD

    2012-05-01

    Conclusiones: las tasas de restenosis intrastent y las características relacionadas encontradas, son similares a lo publicado. La dislipidemia aparece como factor asociado significativo. La restenosis intrastent se manifestó como síndrome coronario agudo en 60% de los casos; no puede considerarse como un proceso benigno en esta población.

  8. 椎动脉起始部支架置入术后再狭窄的发生情况及影响因素%Risk factors of in-stent restenosis of vertebral artery origin

    Institute of Scientific and Technical Information of China (English)

    赵慧玭; 李慎茂

    2013-01-01

    stenting.Methods A total of 144 continuous cases were collected for this retrospective analysis.More than 50% of stenosis in the original sites after treatment was defined as restenosis.Patients were divided into restenosis group (39 patients) and none-restenosis group (105 patients).The risk factors associated with restenosis were compared between the two groups by Chi-square test,including sex,age,presence of hypertension,diabetes,coronary heart disease,hyperlipidemia,smoking and drinking,the difference of preoperative neurological symptoms,combination with other vessels,stenosis,as well as stent type and stent size.Logistic regression was used to test the risk factors for restenosis.Results The incidence of restenosis of vertebral artery origin after stenting was 26.4%,and all of them occurred in 5 months.Between the two groups,there was no significant difference of distribution of sex (male 89,female 34,x2 =0.804,P =0.370),age(60 vs 21 patients of more than 60 years old,x2 =2.358,P =0.125),hypertension (67 vs 28 patients,x2 =0.253,P =0.615),diabetes (27 vs 9 patients,x2 =0.914,P =0.91),hyperlipidemia (6 vs 5 patients,x2 =0.478,P =0.489),coronary heart disease(32 vs 6 patients,x2 =2.489,P =0.115),smoking (50 vs 24 patients,x2 =0.129,P =0.719),drinking(20 vs 13 patients,x2 =0.001,P =0.978),diameter of stents (53 vs 18 patients of more than 4 mm,x2 =0.213,P =0.645),length of stents (45 vs 19 patients of more than 15 mm,x2 =0.927,P =0.336),preoperative neurological symptoms (93 vs 29 patients,x2 =0.250,P =0.617).There was significant difference of factors including combination with the bilateral stenosis (43 vs 24 patients,x2 =4.844,P =0.028),combination with the internal carotid artery stenosis(49 vs 26 patients,x2 =4.558,P =0.033) and stent types(59 vs 11 patients of drug eluting stent,x2 =8.916,P =0.003) between the two groups.Bare stents and combination with internal carotid artery stenosis were independent risk factors for restenosis by logistic regression

  9. 5A/6A Polymorphism of the Stromelysin-1 Gene and Angiographic Restenosis After Coronary Artery Stenting

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    Kuan-Rau Chiou

    2005-11-01

    Conclusion: There is a low frequency of the stromelysin-1 promoter 5A allele in the Chinese population in Taiwan. How stromelysin-1 5A/6A polymorphism affects ISR appears to be linked to angina status. These results merit further study to identify patients carrying genotypes which put them at increased risk of ISR, and which matrix metalloproteinase inhibitors or drug-eluting stents are more effective for those at risk.

  10. DK crush technique: modified treatment of bifurcation lesions in coronary artery

    Institute of Scientific and Technical Information of China (English)

    CHEN Shao-liang; GE Jun-bo; YE Fei; ZHANG Jun-jie; ZHU Zhong-sheng; LIN Song; SHAN Shou-jie; LIU Zhi-zhong; LIU Yan; DUAN Bao-xiang

    2005-01-01

    @@ Bifurcation lesions are still technically challenging even in the era of modern stents.1 High incidence of restenosis both in main vessel and side branch limits the long-term prognosis although several kinds of techniques have been identified to be successful for coronary bifurcations.2-5 Reports have demonstrated the main reason for higher incidence of ostial side branch even though drug-eluting stent used in side vessel lies in that there were gaps in metal coverage and drug application.6-9 Therefore, new technique ensuring complete vessel scaffolding without gaps in drug delivery at the bifurcation is crush technique which is similar to other techniques including T- and Y- stenting still needing postdilatation of kissing balloon angioplasty to expand the stent fully in the ostial side branch and to prevent stent distortion in main vessel.10 As a result, kissing balloon angioplasty is a key step to improve the final result and to reduce the restenosis after stenting bifurcation lesions. However, kissing angioplasty is difficult to be underwent or impossible because operators usually fail to rewire two layers of metal strut, which would result in suboptimal stent deployment, a main reason of high incidence of restenosis, and acute- or-late-thrombosus. The present study reports modified DK crush technique improving success rate of kissing balloon angioplasty under the guidance of intravascular ultrasound (IVUS).

  11. Atorvastatin Inhibits Myocardial Apoptosis in a Swine Model of Coronary Microembolization by Regulating PTEN/PI3K/Akt Signaling Pathway

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    Jiangyou Wang

    2016-01-01

    Full Text Available Background/Aims: Phosphatase and tensin homolog deleted on chromosome ten (PTEN has been recognized as a promoter of apoptosis in various tissues, and revealed to be up-regulated in circumstances of coronary microembolization (CME. However, whether this functional protein could be modified by pretreatment of atorvastatin in models of CME has not been disclosed yet. Methods: Swine CME was induced by intra-coronary injection of inertia plastic microspheres (diameter 42 μm into left anterior descending coronary, with or without pretreatment of atorvastatin or PTEN siRNA. Echocardiologic measurements, pathologic examination, TUNEL staining and western blotting were applied to assess their functional, morphological and molecular effects in CME. Results: PTEN were aberrantly up-regulated in cardiomyocytes following CME, with both the mRNA and protein levels increased after CME modeling. Pretreatment with atorvastatin could attenuate the induction of PTEN. Furthermore, down-regulation of PTEN in vivo via siRNA was associated with an improved cardiac function, attenuated myocardial apoptosis, and concomitantly inhibited expressions of key proapoptotic proteins such as Bax, cleaved-caspase-3. Interestingly, atorvastatin could markedly attenuate PTEN expression and therefore partially reverse cardiac dysfunction and attenuate the apoptosis of the myocardium following CME. Conclusion: Modulation of PTEN was probably as a potential mechanism involved in the beneficial effects of pretreatment of atorvastatin to cardiac function and apoptosis in large animal models of CME.

  12. Comparison of model-based and expert-rule based electrocardiographic identification of the culprit artery in patients with acute coronary syndrome.

    Science.gov (United States)

    Kamphuis, Vivian P; Wagner, Galen S; Pahlm, Olle; Man, Sumche; Olson, Charles W; Bacharova, Ljuba; Swenne, Cees A

    2015-01-01

    Culprit coronary artery assessment in the triage ECG of patients with suspected acute coronary syndrome (ACS) is relevant a priori knowledge preceding percutaneous coronary intervention (PCI). We compared a model-based automated method (Olson method) with an expert-rule based method for the culprit artery assessment. In each of the 53 patients who were admitted with the working diagnosis of suspected ACS, scheduled for emergent angiography with a view on revascularization as initial treatment and subsequently found to have an angiographically documented completely occluded culprit artery, culprit artery location was assessed in the preceding ECG by both the model-based Olson method and the expert-rule based method that considered either visual or computer-measured J-point amplitudes. ECG culprit artery estimations were compared with the angiographic culprit lesion locations. Proportions of correct classifications were compared by a Z test at the 5% significance level. The Olson method performed slightly, but not significantly, better, when the expert-rule based method used visual assessment of J-point amplitudes (88.7% versus 81.1% correct; P=0.28). However, the Olson method performed significantly better when the expert-rule based method used computer-measured J-point amplitudes (88.7% versus 71.7% correct; P<0.05). The automated model-based Olson method performed at least at the level of expert cardiologists using a manual rule-based method. Copyright © 2015 Elsevier Inc. All rights reserved.

  13. Myocardial Perfusion SPECT Imaging in Patients after Percutaneous Coronary Intervention.

    Science.gov (United States)

    Georgoulias, Panagiotis; Valotassiou, Varvara; Tsougos, Ioannis; Demakopoulos, Nikolaos

    2010-05-01

    Coronary artery disease (CAD) is the most prevalent form of cardiovascular disease affecting about 13 million Americans, while more than one million percutaneous transluminal intervention (PCI) procedures are performed annually in the USA. The relative high occurrence of restenosis, despite stent implementation, seems to be the primary limitation of PCI. Over the last decades, single photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI), has proven an invaluable tool for the diagnosis of CAD and patients' risk stratification, providing useful information regarding the decision about revascularization and is well suited to assess patients after intervention. Information gained from post-intervention MPI is crucial to differentiate patients with angina from those with exo-cardiac chest pain syndromes, to assess peri-intervention myocardial damage, to predict-detect restenosis after PCI, to detect CAD progression in non-revascularized vessels, to evaluate the effects of intervention if required for occupational reasons and to evaluate patients' long-term prognosis. On the other hand, chest pain and exercise electrocardiography are largely unhelpful in identifying patients at risk after PCI.Although there are enough published data demonstrating the value of myocardial perfusion SPECT imaging in patients after PCI, there is still debate on whether or not these tests should be performed routinely.

  14. Marked Acceleration of Atherosclerosis following Lactobacillus casei induced Coronary Arteritis in a Mouse Model of Kawasaki Disease

    Science.gov (United States)

    Chen, Shuang; Lee, Young Ho; Crother, Timothy R.; Fishbein, Michael; Zhang, Wenxuan; Yilmaz, Atilla; Shimada, Kenichi; Schulte, Danica J; Lehman, Thomas J.A.; Shah, Prediman K.; Arditi, Moshe

    2012-01-01

    Objective To investigate if Lactobacillus casei cell wall extract (LCWE)-induced Kawasaki Disease (KD) accelerates atherosclerosis in hypercholesterolemic mice. Method and Resuslts Apoe−/− or Ldlr−/− mice were injected with LCWE (KD mice) or PBS, fed high fat diet for 8 weeks, and atherosclerotic lesions in aortic sinuses (AS), arch (AC) and whole aorta were assessed. KD mice had larger, more complex aortic lesions with abundant collagen, and both extracellular and intracellular lipid and foam cells, compared to lesions in control mice despite similar cholesterol levels. Both Apoe−/− KD and Ldlr−/− KD mice showed dramatic acceleration in atherosclerosis vs. controls, with increases in en face aortic atherosclerosis and plaque size in both the AS and AC plaques. Accelerated atherosclerosis was associated with increased circulating IL-12p40, IFN-γ, TNF-α, and increased macrophage, DC, and T cell recruitment in lesions. Furthermore, daily injections of the IL-1Ra, which inhibits LCWE induced KD vasculitis, prevented the acceleration of atherosclerosis. Conclusions Our results suggest an important pathophysiologic link between coronary arteritis/vasculitis in the KD mouse model and subsequent atherosclerotic acceleration, supporting the concept that a similar relation may also be present in KD patients. These results also suggest that KD in childhood may predispose to accelerated and early atherosclerosis as adults. PMID:22628430

  15. Contribution of Trans-Fatty Acid Intake to Coronary Heart Disease Burden in Australia: A Modelling Study

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    Jason H. Y. Wu

    2017-01-01

    Full Text Available Trans-fatty acids (TFAs intake has been consistently associated with a higher risk of coronary heart disease (CHD mortality. We provided an updated assessment of TFA intake in Australian adults in 2010 and conducted modeling to estimate CHD mortality attributable to TFA intake. Data of the 2011–2012 National Nutrition and Physical Activity Survey was used to assess TFA intake. The CHD burden attributable to TFA was calculated by comparing the current level of TFA intake to a counterfactual setting where consumption was lowered to a theoretical minimum distribution of 0.5% energy. The average TFA intake among adults was 0.59% energy, and overall 10% of adults exceeded the World Health Organization (WHO recommended limit of 1% energy. Education and income were moderately and inversely associated with TFA intake (p-value ≤ 0.001, with one in seven adults in the lowest income and education quintile having >1% energy from TFA. Australia had 487 CHD deaths (95% uncertainty interval, 367–615 due to TFA exposure, equivalent to 1.52% (95% uncertainty limits: 1.15%–1.92% of all CHD mortality. The relative impact of TFA exposure on CHD mortality in Australia is limited, but, in absolute terms, still substantial. Policies aimed at reducing industrial TFA exposure can reduce socioeconomic inequalities in health and may therefore be desirable.

  16. Iterative model reconstruction: Improved image quality of low-tube-voltage prospective ECG-gated coronary CT angiography images at 256-slice CT

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    Oda, Seitaro, E-mail: seisei0430@nifty.com [Department of Cardiology, MedStar Washington Hospital Center, 110 Irving Street, NW, Washington, DC 20010 (United States); Department of Diagnostic Radiology, Faculty of Life Sciences, Kumamoto University, 1-1-1 Honjyo, Chuo-ku, Kumamoto, 860-8556 (Japan); Weissman, Gaby, E-mail: Gaby.Weissman@medstar.net [Department of Cardiology, MedStar Washington Hospital Center, 110 Irving Street, NW, Washington, DC 20010 (United States); Vembar, Mani, E-mail: mani.vembar@philips.com [CT Clinical Science, Philips Healthcare, c595 Miner Road, Cleveland, OH 44143 (United States); Weigold, Wm. Guy, E-mail: Guy.Weigold@MedStar.net [Department of Cardiology, MedStar Washington Hospital Center, 110 Irving Street, NW, Washington, DC 20010 (United States)

    2014-08-15

    Objectives: To investigate the effects of a new model-based type of iterative reconstruction (M-IR) technique, the iterative model reconstruction, on image quality of prospectively gated coronary CT angiography (CTA) acquired at low-tube-voltage. Methods: Thirty patients (16 men, 14 women; mean age 52.2 ± 13.2 years) underwent coronary CTA at 100-kVp on a 256-slice CT. Paired image sets were created using 3 types of reconstruction, i.e. filtered back projection (FBP), a hybrid type of iterative reconstruction (H-IR), and M-IR. Quantitative parameters including CT-attenuation, image noise, and contrast-to-noise ratio (CNR) were measured. The visual image quality, i.e. graininess, beam-hardening, vessel sharpness, and overall image quality, was scored on a 5-point scale. Lastly, coronary artery segments were evaluated using a 4-point scale to investigate the assessability of each segment. Results: There was no significant difference in coronary arterial CT attenuation among the 3 reconstruction methods. The mean image noise of FBP, H-IR, and M-IR images was 29.3 ± 9.6, 19.3 ± 6.9, and 12.9 ± 3.3 HU, respectively, there were significant differences for all comparison combinations among the 3 methods (p < 0.01). The CNR of M-IR was significantly better than of FBP and H-IR images (13.5 ± 5.0 [FBP], 20.9 ± 8.9 [H-IR] and 39.3 ± 13.9 [M-IR]; p < 0.01). The visual scores were significantly higher for M-IR than the other images (p < 0.01), and 95.3% of the coronary segments imaged with M-IR were of assessable quality compared with 76.7% of FBP- and 86.9% of H-IR images. Conclusions: M-IR can provide significantly improved qualitative and quantitative image quality in prospectively gated coronary CTA using a low-tube-voltage.

  17. The Mechanical Study of Vascular Endothelial Growth Factor on the Prevention of Restenosis after Angioplasty

    Institute of Scientific and Technical Information of China (English)

    LIU Qigong; LU Zaiying; ZHOU Honglian; YAN Jin; ZHANG Weidong

    2001-01-01

    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 hVEGF165 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 dosedependent 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 hVEGF165 gene could promote the proliferation of VECs and im prove NO, PGI2 secretion, inhibit ET secretionand PDGF-B mRNA transcription in the VECs. Theabove results offered further theoretical evidence for VEGF on the prevention of restenosis after angioplasty.

  18. A randomized comparison of balloon angioplasty versus rotational atherectomy in complex coronary lesions (COBRA study).

    Science.gov (United States)

    Dill, T; Dietz, U; Hamm, C W; Küchler, R; Rupprecht, H J; Haude, M; Cyran, J; Ozbek, C; Kuck, K H; Berger, J; Erbel, R

    2000-11-01

    Rotablation is a widely used technique for the treatment of complex coronary artery lesions but is so far only poorly supported by controlled studies. The Comparison of Balloon-Angioplasty versus Rotational Atherectomy study (COBRA) is a multicentre, prospective, randomized trial to compare short- and long-term effects of percutaneous transluminal coronary angioplasty (PTCA) and rotablation in patients with angiographically pre-defined complex coronary artery lesions. At seven clinical sites 502 patients with pre-defined complex coronary artery lesions were assigned to either PTCA (n=250) or rotablation (n=252). Primary end-points were procedural success, 6-month restenosis rates in the treated segments, and major cardiac events during follow-up. Procedural success was achieved in 78% (PTCA), and 85% (rotablation) (P=0.038) of cases. Crossover from PTCA to rotablation was 4% and 10% vice versa (P=0.019). There was no difference between PTCA and rotablation with respect to procedure-related complications such as Q wave infarctions (2.4% each), emergency bypass surgery (1.2% versus 2.4%), and death (1.6% versus 0.4%). However, more stents were required after PTCA (14.9% versus 6.4%, P<0.002), predominantly for bailout or unsatisfactory results. Including bail-out stents as an end-point, the procedural success rates were 73% for angioplasty and 84% for rotablation (P=0.006). At 6 months, symptomatic outcome, target vessel reinterventions and restenosis rates (PTCA 51% versus rotablation 49%, P=0.33) were not different. Complex coronary artery lesions can be treated with a high level of success and low complication rates either by PTCA with adjunctive stenting or rotablation. The long-term clinical and angiographic outcome is comparable.

  19. Myocardial FFR (Fractional Flow Reserve in patients with angiographically intermediate coronary artery stenosis - an initial institutional experience

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    Jagadish H. Ramaiah

    2013-02-01

    Full Text Available Background: The clinical significance of coronary artery stenosis of intermediate severity can be difficult to determine. The management of intermediate coronary lesions, defined by a diameter stenosis of ¡I40% to ¡U70%, continues to be a therapeutic dilemma for cardiologists. The 2-dimensional representation of the arterial lesion provided by angiography is limited in distinguishing intermediate lesions that require stenting from those that simply need appropriate medical therapy. In the era of drug-eluting stents, some might propose that stenting all intermediate coronary lesions is an appropriate solution. However, the possibility of procedural complications such as coronary dissection, no reflow phenomenon, in-stent restenosis, and stent thrombosis requires accurate stratification of patients with intermediate coronary lesions to appropriate therapy. Myocardial fractional flow reserve (FFR is an index of the functional severity of coronary stenosis that is calculated from pressure measurements made during coronary angiography. The objective of the study is to evaluate the usefulness of FFR in patients with angiographically intermediate coronary artery stenosis. Methods: 20 patients with intermediate coronary stenosis and chest pain of uncertain origin. The Exercise Electrocardiography (TMT, Myocardial Perfusion Imaging study (MPI, Quantitative Coronary Angiography (QCA were compared with the results of FFR measurements. Results: 20 patients were undergone FFR measurement during the study period. With the mean age of 57.25¡À11.2 and male patients were 16 (80%, female patients 4 (20%, in all 13 patients with an FFR of 0.75 tested negative for reversible myocardial ischemia on TMT and MPI study. No revascularization procedures were performed in 7 (35% patients, and no adverse cardiovascular events were noted in all these patients during 6 months of follow-up. Conclusions: In patients with coronary stenosis of intermediate severity, FFR

  20. Crush stenting in treating coronary bifurcate lesions: paclitaxel eluting stents versus sirolimus eluting stents

    Institute of Scientific and Technical Information of China (English)

    CHEN Shao-liang; SUN Xue-wen; HU Da-yi; Tak W. Kwan; ZHANG Jun-jie; YE Fei; CHEN Yun-dai; ZHU Zhong-sheng; LIN Song; TIAN Nai-liang; LIU Zhi-zhong; FANG Wei-yi

    2008-01-01

    Background Because no data regarding the comparison of crush stenting with pactitaxel(PES)or sirolimus eluting stents(SES)for coronary bifurcate lesions have been reported,we compared the clinical outcomes of these two types of stents.Methods Two hundred and thirty patients with 242 bifurcate lesions were enrolled in a prospective,nonrandomized trial.Primary endpoints included myocardial infarction,cardiac death and target vessel revascularization at 8 months.Results All patients were followed up clinically and 82%angiographically at 8 months.Final kissing balloon inflation was performed in 72%in the PES and 75%in the SES groups(P>0.05).Compared to the SES group,PES group had a higher late loss and incidence of restenosis(P=0.04)in the prebifurcation vessel segment.The postbifurcation vessel segment in the PES group had a greater late loss((0.7+0.6)mm vs(0.3±0.4)mm,P<0.001)and higher restenosis in the side branch(25.5%vs 15.6%,P=0.04)when compared to the SES group.There was significant difference of insegment restenosis in the entire main vessel between PES and SES groups (P=0.004).Target lesion revascularization was more frequently seen in the PES group as compared to the SES group(P=0.01).There was significant difference in the accumulative MACE between these two groups(P=0.01).The survival rate free from target lesion revascularization was significantly higher in the SES group when compared to the PES group(P<0.001).Conclusion SES is superior to PES in reducing restenosis and target lesion revascularization by 8-month follow-up after crush stenting for bifurcate lesions.

  1. Strut thickness effect on restenosis of Multi-Link and Tri-Star stenting

    Institute of Scientific and Technical Information of China (English)

    Honin Kanaya

    2003-01-01

    @@ Background Increased thrombegenicity and smooth muscle cell proliferative response induced by the metal struts compromise the advantages of coronary stenting. Adnan Kastrati et al. reported in the ISAR-STEREO trial that a reduced strut thickness of coronary stent is associated with improved follow up angiographic and clincal results.

  2. Improving CCTA-based lesions' hemodynamic significance assessment by accounting for partial volume modeling in automatic coronary lumen segmentation.

    Science.gov (United States)

    Freiman, Moti; Nickisch, Hannes; Prevrhal, Sven; Schmitt, Holger; Vembar, Mani; Maurovich-Horvat, Pál; Donnelly, Patrick; Goshen, Liran

    2017-03-01

    The goal of this study was to assess the potential added benefit of accounting for partial volume effects (PVE) in an automatic coronary lumen segmentation algorithm that is used to determine the hemodynamic significance of a coronary artery stenosis from coronary computed tomography angiography (CCTA). Two sets of data were used in our work: (a) multivendor CCTA datasets of 18 subjects from the MICCAI 2012 challenge with automatically generated centerlines and 3 reference segmentations of 78 coronary segments and (b) additional CCTA datasets of 97 subjects with 132 coronary lesions that had invasive reference standard FFR measurements. We extracted the coronary artery centerlines for the 97 datasets by an automated software program followed by manual correction if required. An automatic machine-learning-based algorithm segmented the coronary tree with and without accounting for the PVE. We obtained CCTA-based FFR measurements using a flow simulation in the coronary trees that were generated by the automatic algorithm with and without accounting for PVE. We assessed the potential added value of PVE integration as a part of the automatic coronary lumen segmentation algorithm by means of segmentation accuracy using the MICCAI 2012 challenge framework and by means of flow simulation overall accuracy, sensitivity, specificity, negative and positive predictive values, and the receiver operated characteristic (ROC) area under the curve. We also evaluated the potential benefit of accounting for PVE in automatic segmentation for flow simulation for lesions that were diagnosed as obstructive based on CCTA which could have indicated a need for an invasive exam and revascularization. Our segmentation algorithm improves the maximal surface distance error by ~39% compared to previously published method on the 18 datasets from the MICCAI 2012 challenge with comparable Dice and mean surface distance. Results with and without accounting for PVE were comparable. In contrast

  3. The role of superficial femoral artery endoluminal bypass in long de novo lesions and in-stent restenosis.

    NARCIS (Netherlands)

    Doomernik, D.E.; Golchehr, B.; Lensvelt, M.M.A.; Reijnen, M.M.P.J.

    2012-01-01

    AIM: Results of endovascular treatment for long de novo lesions of the superficial femoral artery (SFA) are limited by in-stent restenosis (ISR). Polytetrafluoroethylene (PTFE) covered stents are developed to reduce the incidence of ISR. This study was conducted to summarize available data on the us

  4. Evaluation of restenosis, renal function and blood pressure after the renal artery stenting in patients with atherosclerosis renovascular disease

    Institute of Scientific and Technical Information of China (English)

    王焱

    2006-01-01

    Objective To evaluate the restenosis, renal function and blood pressure after renal artery stenting in patients with atherosclerosis renovascular disease. Methods Percutaneous renal artery stent (PTRAS) was performed in 135 patients with single or bilateral renal artery stenosis (≥70%). Clinical data of above patients were studied during follow-up period. Results A total of 147

  5. Pharmacological approaches to the prevention of restenosis following angioplasty. The search for the Holy Grail? (part II)

    NARCIS (Netherlands)

    J.P.R. Herrman; W.R.M. Hermans (Walter); J. Vos (Jeroen); P.W.J.C. Serruys (Patrick)

    1993-01-01

    textabstractPart I of this article reviewed the results of studies investigating the effectiveness of antithrombotic, antiplatelet, antiproliferative, anti-inflammatory, calcium channel blocker and lipid-lowering drugs in preventing or reducing restenosis after angioplasty. However, despite 15 years

  6. Direct Coronary Intervention Therapy in Patients with Acute Myocardial Infarction

    Institute of Scientific and Technical Information of China (English)

    朱铁兵; 杨志健; 王连生; 马根山; 曹克将; 黄峻; 马文珠

    2002-01-01

    Objective To introduce the initial experience of direct pereutaneous transluminalcoronary angioplasty (PTCA) and intracoronary stenting in patients with acute myocardial infarction(AMl) from October t998 to Novermber 200l in our hospital. Methods Primary PTCA was per-formed in 38 patients with acute myocardial infarction. 29 cases were 20 male and 9 female, rangingin age from 30 to 76 old years. 23 cases hvad anterior and 15 lind inferior wall infarction. The patients we chose for direct coronary intervention therapy had stable hemodynamics. Of the 38 infarct re-lated arteries (IRA), 23 were left anterior descend arteries (LAD), 4 left circumflex (LCX) andl 1 right coronary arteries (RCA). 33 IRA were TIMI 0 flow and 5 TIMI 1 flow. The indicationsOf the 38 patients with AMI, PTCA tns successful in 35. Two patients were given up because 014guide-wire entered into false lumen. One was selected for emergency coronary artery bypass graft because of LAD infarct related artery accompanied by 70% stenosis of left main. 35 intracoronarystenls were implanted. 16 patients were followed up, of whom 2 patients trod restenosis and were suc-cessful in the second attempt. Conclusion Direct PTCA and stent implantation are effective andsafe means of treatment for AMI and stent implantation can prevent and cure the arute reocclusion after PTCA.

  7. Adapting a Markov Monte Carlo simulation model for forecasting the number of coronary artery revascularisation procedures in an era of rapidly changing technology and policy.

    Science.gov (United States)

    Mannan, Haider R; Knuiman, Matthew; Hobbs, Michael

    2008-06-25

    Treatments for coronary heart disease (CHD) have evolved rapidly over the last 15 years with considerable change in the number and effectiveness of both medical and surgical treatments. This period has seen the rapid development and uptake of statin drugs and coronary artery revascularization procedures (CARPs) that include Coronary Artery Bypass Graft procedures (CABGs) and Percutaneous Coronary Interventions (PCIs). It is difficult in an era of such rapid change to accurately forecast requirements for treatment services such as CARPs. In a previous paper we have described and outlined the use of a Markov Monte Carlo simulation model for analyzing and predicting the requirements for CARPs for the population of Western Australia (Mannan et al, 2007). In this paper, we expand on the use of this model for forecasting CARPs in Western Australia with a focus on the lack of adequate performance of the (standard) model for forecasting CARPs in a period during the mid 1990s when there were considerable changes to CARP technology and implementation policy and an exploration and demonstration of how the standard model may be adapted to achieve better performance. Selected key CARP event model probabilities are modified based on information relating to changes in the effectiveness of CARPs from clinical trial evidence and an awareness of trends in policy and practice of CARPs. These modified model probabilities and the ones obtained by standard methods are used as inputs in our Markov simulation model. The projected numbers of CARPs in the population of Western Australia over 1995-99 only improve marginally when modifications to model probabilities are made to incorporate an increase in effectiveness of PCI procedures. However, the projected numbers improve substantially when, in addition, further modifications are incorporated that relate to the increased probability of a PCI procedure and the reduced probability of a CABG procedure stemming from changed CARP preference

  8. Adapting a Markov Monte Carlo simulation model for forecasting the number of Coronary Artery Revascularisation Procedures in an era of rapidly changing technology and policy

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    Knuiman Matthew

    2008-06-01

    Full Text Available Abstract Background Treatments for coronary heart disease (CHD have evolved rapidly over the last 15 years with considerable change in the number and effectiveness of both medical and surgical treatments. This period has seen the rapid development and uptake of statin drugs and coronary artery revascularization procedures (CARPs that include Coronary Artery Bypass Graft procedures (CABGs and Percutaneous Coronary Interventions (PCIs. It is difficult in an era of such rapid change to accurately forecast requirements for treatment services such as CARPs. In a previous paper we have described and outlined the use of a Markov Monte Carlo simulation model for analyzing and predicting the requirements for CARPs for the population of Western Australia (Mannan et al, 2007. In this paper, we expand on the use of this model for forecasting CARPs in Western Australia with a focus on the lack of adequate performance of the (standard model for forecasting CARPs in a period during the mid 1990s when there were considerable changes to CARP technology and implementation policy and an exploration and demonstration of how the standard model may be adapted to achieve better performance. Methods Selected key CARP event model probabilities are modified based on information relating to changes in the effectiveness of CARPs from clinical trial evidence and an awareness of trends in policy and practice of CARPs. These modified model probabilities and the ones obtained by standard methods are used as inputs in our Markov simulation model. Results The projected numbers of CARPs in the population of Western Australia over 1995–99 only improve marginally when modifications to model probabilities are made to incorporate an increase in effectiveness of PCI procedures. However, the projected numbers improve substantially when, in addition, further modifications are incorporated that relate to the increased probability of a PCI procedure and the reduced probability of a CABG

  9. Prognostic Impact of 9-Month High-Sensitivity C-Reactive Protein Levels on Long-Term Clinical Outcomes and In-Stent Restenosis in Patients at 9 Months after Drug-Eluting Stent Implantation.

    Directory of Open Access Journals (Sweden)

    I-Chang Hsieh

    Full Text Available The level of 9-month high-sensitivity C-reactive protein (hsCRP in predicting cardiovascular outcomes is scanty in patients at 9 months after receiving drug-eluting stent (DES implantations. This study aims to evaluate the relationship between 9-month follow-up hsCRP levels and long-term clinical outcomes in patients at 9 months after receiving DES.A total of 1,763 patients who received 9-month follow-up angiography were enrolled and grouped according to hsCRP level 9 months after the DES implantation: group I (718 patients, hsCRP3.0 mg/L.Group III patients had a lower cardiovascular event-free survival rate than group I or II patients during a follow-up of 64 ± 45 months (64.5% vs. 71.6% vs. 72.8%, respectively, p = 0.012. Multivariate analysis showed that a follow-up hsCRP level <3.0 mg/L was an independent predictor of a major adverse cardiovascular event (cardiac death, reinfarction, target lesion revascularization, stenting in a new lesion, or coronary bypass surgery. Group III patients had a higher restenosis rate (11.3% vs. 5.8% vs. 6.6%, respectively, p = 0.002 and loss index (0.21 ± 0.32 vs. 0.16 ± 0.24 vs. 0.18 ± 0.28, respectively, p = 0.001 than group I or II patients in 9-month follow-up angiography.A high 9-month follow-up hsCRP level is an independent predictor of long-term clinical cardiovascular outcomes in patients at 9 months after DES implantation. It is also associated with a higher restenosis rate, larger late loss and loss index at 9 months after DES implantation.

  10. INTRAVASCULAR ULTRASOUND EVALUATING CORONARY STENTS FOR PATIENTS WITH CORONARY ARTERY DISEASE: COMPARED OLD WITH NEW MULTILINK STENTS

    Institute of Scientific and Technical Information of China (English)

    2002-01-01

    Objective.It was suggested that coronary stent design and coating may affect stent performance and hence induce varying degrees of thrombogenesis and neointimal hyperplasia.The purpose of this study is to compare the 6 month follow up results between old and new Multilink stents with the method of intravascular ultrasound (IVUS) imaging.Methods.We have performed old (n=40) and new (n=35) Multilink stent implantations on 75 patients with coronary artery disease.Coronary angiography was performed before,immediately after,and 6 months after the in stent procedure respectively.Six month follow up IVUS imaging was performed and analyzed off line.Results.Minimal lumen cross sectional area (CSA) of new Multilink stents was significantly larger than that of old Multilink stents (P=0.0053).Mean stent lumen area of new Multilink stents was significantly larger than that of old Multilink stents (P=0.040).Similarly,minimal lumen diameter (MLD) of new Multilink stents was larger than that of old Multilink stents (P= 0.011).Old Multilink stents had a higher percentage of plaque area than new Multilink stents.Conclusion.The new Multilink stent is obviously superior to old Multilink stents,in particular,in the stent MLD and lumen CSA- - major determinants of the restenosis.

  11. Percutaneous coronary interventions and antiplatelet therapy in renal transplant recipients.

    Science.gov (United States)

    Summaria, Francesco; Giannico, Maria Benedetta; Talarico, Giovanni Paolo; Patrizi, Roberto

    2016-04-01

    Cardiovascular disease is the leading cause of mortality and morbidity following renal transplantation (RT), accounting for 40-50% of all deaths. After renal transplantation, an adverse cardiovascular event occurs in nearly 40% of patients; given the dialysis vintage and the average wait time, the likelihood of receiving coronary revascularization is very high. There is a significant gap in the literature in terms of the outcomes of prophylactic coronary revascularization in renal transplantation candidates. Current guidelines on myocardial revascularization stipulate that renal transplant patients with significant coronary artery disease (CAD) should not be excluded from the potential benefit of revascularization. Compared with percutaneous coronary intervention (PCI), however, coronary artery bypass grafting is associated with higher early and 30-day mortality. About one-third of renal transplant patients with CAD have to be treated invasively and so PCI is currently the most popular mode of revascularization in these fragile and compromised patients. A newer generation drug-eluting stent (DES) should be preferred over a bare metal stent (BMS) because of its lower risk of restenosis and improved safety concerns (stent thrombosis) compared with first generation DES and BMS. Among DES, despite no significant differences being reported in terms of efficacy, the newer everolimus and zotarolimus eluting stents should be preferred given the possibility of discontinuing, if necessary, dual antiplatelet therapy before 12 months. Since there is a lack of randomized controlled trials, the current guidelines are inadequate to provide a specifically tailored antiplatelet therapeutic approach for renal transplant patients. At present, clopidogrel is the most used agent, confirming its central role in the therapeutic management of renal transplant patients undergoing PCI. While progress in malignancy-related mortality seems a more distant target, a slow but steady reduction in

  12. Coronary Artery Ligation and Intramyocardial Injection in a Murine Model of Infarction

    OpenAIRE

    Virag, Jitka A.I.; Lust, Robert M.

    2011-01-01

    Mouse models are a valuable tool for studying acute injury and chronic remodeling of the myocardium in vivo. With the advent of genetic modifications to the whole organism or the myocardium and an array of biological and/or synthetic materials, there is great potential for any combination of these to assuage the extent of acute ischemic injury and impede the onset of heart failure pursuant to myocardial remodeling. Here we present the methods and materials used to reliably perform this micros...

  13. Lack of acute cardioprotective effect from preischaemic erythropoietin administration in a porcine coronary occlusion model

    DEFF Research Database (Denmark)

    Kristensen, Jens; Mæng, Michael; Rehling, Michael;

    2005-01-01

    by myocardial perfusion imaging (MPI) and postmortem by a histochemical procedure (at 150 min of reperfusion). RESULTS: IS/AAR did not differ significantly between control (C), EPO1 and EPO2 groups, neither measured by MPI (mean+/-SD for C: 0.87+/-0.13; EPO1: 0.92+/-0.08; EPO2: 0.87+/-0.11), nor histochemically...... of reperfusion in our porcine model....

  14. Patient-specific computer modelling of coronary bifurcation stenting: the John Doe programme.

    Science.gov (United States)

    Mortier, Peter; Wentzel, Jolanda J; De Santis, Gianluca; Chiastra, Claudio; Migliavacca, Francesco; De Beule, Matthieu; Louvard, Yves; Dubini, Gabriele

    2015-01-01

    John Doe, an 81-year-old patient with a significant distal left main (LM) stenosis, was treated using a provisional stenting approach. As part of an European Bifurcation Club (EBC) project, the complete stenting procedure was repeated using computational modelling. First, a tailored three-dimensional (3D) reconstruction of the bifurcation anatomy was created by fusion of multislice computed tomography (CT) imaging and intravascular ultrasound. Second, finite element analysis was employed to deploy and post-dilate the stent virtually within the generated patient-specific anatomical bifurcation model. Finally, blood flow was modelled using computational fluid dynamics. This proof-of-concept study demonstrated the feasibility of such patient-specific simulations for bifurcation stenting and has provided unique insights into the bifurcation anatomy, the technical aspects of LM bifurcation stenting, and the positive impact of adequate post-dilatation on blood flow patterns. Potential clinical applications such as virtual trials and preoperative planning seem feasible but require a thorough clinical validation of the predictive power of these computer simulations.

  15. Analysing recent socioeconomic trends in coronary heart disease mortality in England, 2000-2007: a population modelling study.

    Directory of Open Access Journals (Sweden)

    Madhavi Bajekal

    Full Text Available BACKGROUND: Coronary heart disease (CHD mortality in England fell by approximately 6% every year between 2000 and 2007. However, rates fell differentially between social groups with inequalities actually widening. We sought to describe the extent to which this reduction in CHD mortality was attributable to changes in either levels of risk factors or treatment uptake, both across and within socioeconomic groups. METHODS AND FINDINGS: A widely used and replicated epidemiological model was used to synthesise estimates stratified by age, gender, and area deprivation quintiles for the English population aged 25 and older between 2000 and 2007. Mortality rates fell, with approximately 38,000 fewer CHD deaths in 2007. The model explained about 86% (95% uncertainty interval: 65%-107% of this mortality fall. Decreases in major cardiovascular risk factors contributed approximately 34% (21%-47% to the overall decline in CHD mortality: ranging from about 44% (31%-61% in the most deprived to 29% (16%-42% in the most affluent quintile. The biggest contribution came from a substantial fall in systolic blood pressure in the population not on hypertension medication (29%; 18%-40%; more so in deprived (37% than in affluent (25% areas. Other risk factor contributions were relatively modest across all social groups: total cholesterol (6%, smoking (3%, and physical activity (2%. Furthermore, these benefits were partly negated by mortality increases attributable to rises in body mass index and diabetes (-9%; -17% to -3%, particularly in more deprived quintiles. Treatments accounted for approximately 52% (40%-70% of the mortality decline, equitably distributed across all social groups. Lipid reduction (14%, chronic angina treatment (13%, and secondary prevention (11% made the largest medical contributions. CONCLUSIONS: The model suggests that approximately half the recent CHD mortality fall in England was attributable to improved treatment uptake. This benefit

  16. Energy-efficient implantable transmitter for restenosis monitoring with intelligent-stents.

    Science.gov (United States)

    Rivas, David; Miguel, Jose A; Lechuga, Yolanda; Allende, Miguel A; Martinez, Mar

    2015-01-01

    An analog circuit forming part of an intelligent-stent system is proposed with the aim of converting pressure-related capacitance measurements into a FM signal (around 800 MHz) to be analyzed outside of the patient body. Based on the information obtained from this signal, a reliable restenosis monitoring can be carried out. An energy-saver block controls the oscillator and reduces the power consumption of the whole circuit from 547.1 μW in active state to 152.1 μW in idle state, in order to comply with energy restriction imposed by inductive coupling powering. The design is implemented in TSMC 0.18 μm CMOS technology.

  17. ISR II study: a long-term evaluation of sirolimus-eluting stent in the treatment of patients with in-stent restenotic native coronary artery lesions.

    Science.gov (United States)

    Commeau, Philippe; Barragan, Paul T; Roquebert, Pierre O; Siméoni, Jean B

    2005-10-01

    The aim of this pilot study was to determine the safety and long-term efficacy of treating intrastent restenosis (ISR) with the slow-release sirolimus-eluting stent Bx Velocity (Cypher stent) without intravascular ultrasound (IVUS) guidance. Of patients who received a bare metal stent implantation and presented an ISR, 30-80% of the patients will develop a second restenosis within the stent, at the stent edges or both. To date, intravascular brachytherapy using beta- and gamma-radiation has been the only effective treatment for ISR. Twenty-three patients with ISR and evidence of ischemia were treated with Cypher stent. Clinical information was collected 1, 8, 12, and 24 months after stent implantation. During the first 8 months of the study, in-stent lumen diameter remained essentially unchanged from postprocedure in 80% of the case. The target lesion repeat revascularization (TLR) was 17%, of which 50% were oculostenotic reflexes. Only one patient presented a restenosis greater than 70%. During the 2-year study period, the TLR rate was 17%; the major adverse coronary event rate was 26%, and the non-Q-wave myocardial infarction (MI) rate was 9%. There were no reports of death, coronary artery bypass grafting, or Q-wave MI during the study. This study demonstrates the feasibility of using sirolimus-eluting stents without IVUS guidance for the treatment of ISR, providing long-term stability of immediate results.

  18. Emergency coronary stenting with the Palmaz-Schatz stent for failed transluminal coronary angioplasty: results of a learning phase.

    Science.gov (United States)

    Kiemeneij, F; Laarman, G J; van der Wieken, R; Suwarganda, J

    1993-07-01

    This study describes initial results of Palmaz-Schatz stent implantation in our department to restore and maintain vessel patency in 52 patients with obstructive dissection, defined as an intraluminal filling defect with coronary flow impairment after percutaneous transluminal coronary angioplasty (PTCA). The majority of patients (62%) underwent PTCA for unstable angina (n = 28), defined as angina at rest with documented ST segment changes resistant to nitrates, or acute myocardial infarction (n = 4). In six patients (11%) the stent could not be delivered. Seven of the remaining 46 patients (15%) had coronary artery bypass surgery performed because of increased risk for subacute stent occlusion, residual thrombosis, residual obstruction near the stent, coronary artery diameter less than 3.0 mm, or multiple and overlapping stents. One patient (3%) died in hospital from intracranial bleeding. Nine patients (23%) had subacute stent occlusion, retrospectively unpredictable in four patients. Nine of 29 patients (29%) with an uncomplicated clinical course after stenting had angiographic restenosis at a mean follow-up of 6.0 +/- 1.4 months (range 12 days to 8.3 months). Two patients (7%) died 3 months after successful stenting: one patient because of stent thrombosis after stopping warfarin before an abdominal operation and one patient after acute vascular surgery for late traumatic groin bleeding. Of the 39 medically treated patients with a stent, three (8%) had major bleeding complications. It is concluded that stent implantation is feasible in most patients with obstructive dissection after PTCA. After successful stent delivery, coronary flow is temporarily restored.(ABSTRACT TRUNCATED AT 250 WORDS)

  19. Impact of the distance from the stent edge to the residual plaque on edge restenosis following everolimus-eluting stent implantation.

    Directory of Open Access Journals (Sweden)

    Masao Takahashi

    Full Text Available OBJECTIVES: This study aimed to assess the relation between stent edge restenosis (SER and the distance from the stent edge to the residual plaque using quantitative intravascular ultrasound. BACKGROUND: Although percutaneous coronary intervention with drug-eluting stents has improved SER rates, determining an appropriate stent edge landing zone can be challenging in cases of diffuse plaque lesions. It is known that edge vascular response can occur within 2 mm from the edge of a bare metal stent, but the distance to the adjacent plaque has not been evaluated for drug-eluting stents. METHODS: A total of 97 proximal residual plaque lesions (plaque burden [PB] >40% treated with everolimus-eluting stents were retrospectively evaluated to determine the distance from the stent edge to the residual plaque. RESULTS: The SER group had significantly higher PB (59.1 ± 6.1% vs. 51.9 ± 9.1% for non-SER; P = 0.04. Higher PB was associated with SER, with the cutoff value of 54.74% determined using receiver operating characteristic (ROC curve analysis. At this cutoff value of PB, the distance from the stent edge to the lesion was significantly associated with SER (odds ratio = 2.05, P = 0.035. The corresponding area under the ROC curve was 0.725, and the cutoff distance value for predicting SE