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Sample records for in-stent restenosis late

  1. 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.

  2. 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

  3. 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

  4. 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.

  5. 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

  6. 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

  7. 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

  8. 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...

  9. 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.

  10. 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...

  11. [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.

  12. 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

  13. 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

  14. 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

  15. [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

  16. 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.

  17. 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.

  18. 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.

  19. 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.

  20. 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.

  1. 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.

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

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    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.

  3. Simple balloon dilation for drug-eluting in-stent restenosis: An optical coherent tomography analysis

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    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.

  4. 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.

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

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    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.)

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

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    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.

  7. 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

  8. 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

  9. 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.

  10. 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.)

  11. 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.

  12. 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.)

  13. 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.

  14. 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.

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

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    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.

  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 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.

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

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    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. 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.

  20. Combination treatment with asiaticoside and rapamycin: A new hope for in-stent restenosis.

    Science.gov (United States)

    Guo, Tian; Fang, Ming; Zhang, Dadong; Li, Xinming

    2013-08-01

    The aim of this study was to investigate and characterize the efficacy and mechanism of action of asiaticoside in combination with rapamycin in the inhibition of in-stent restenosis (ISR). The effects of asiaticoside combined with rapamycin on cell proliferation in vitro were evaluated by MTT assay. The mRNA expression was analyzed by quantitative polymerase chain reaction (qPCR). Enzyme-linked immunosorbent assay (ELISA) was used to confirm protein synthesis. The cell growth inhibition rate in the combination group was significantly higher compared with those in the asiaticoside and rapamycin groups for human aortic fibroblasts (HAFs; 63.50±3.83, 53.06±8.10 and 60.34±4.9%, respectively) and human aortic smooth muscle cells (HASMCs; 33.12±1.35, 26.21±7.59 and 28.27±4.92, respectively; Pasiaticoside and rapamycin groups were 11.09±1.17, 26.22±4.24 and 34.80±2.80%, respectively (Pasiaticoside combined with rapamycin may be effective in the reduction of ISR.

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

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    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.

  2. 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

  3. 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.

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

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    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.

  5. 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.

  6. 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.

  7. 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.

  8. 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...

  9. 再次置入药物洗脱支架治疗经皮冠状动脉支架置入术后早期与晚期支架内再狭窄的对比研究%Comparison of repeated drug eluting stent for treatment of early and late in-stent restenosis after drug eluting stent implantation

    Institute of Scientific and Technical Information of China (English)

    朱玮玮; 赵林; 郭成军; 方冬平; 何东方; 张晓江; 迟云鹏; 刘梅颜; 吴小凡

    2014-01-01

    目的 比较再次置入药物洗脱支架(DES)治疗置入DES后早期(≤1年)与晚期(>1年)支架内再狭窄(ISR)患者的临床疗效.方法 收集2008年10月至2011年12月在北京安贞医院因DES置入术后ISR接受再次DES置人治疗并完成临床随访的患者资料.根据DES置入术后发生ISR的时间分为早期ISR组和晚期ISR组.对比2组随访期间的主要不良心血管事件(MACE)[包括全因死亡、心肌梗死和靶病变血运重建(TLR)].结果 总计107例患者入选本研究,其中早期ISR组43例,晚期ISR组64例.2组的患者基线资料、靶病变部位、类型、长度、置入支架特征及ISR类型、再次置入支架特征差异均无统计学意义(P>0.05).早期ISR组糖尿病患病率明显低于晚期ISR组[22.7% (10/44)比42.9% (27/63),P<0.01].晚期ISR组MACE发生率明显低于早期ISR组[15.9% (10/63)比47.7% (21/44),P<0.01];晚期ISR组TLR率明显低于早期ISR组[12.7% (8/63))比43.2% (19/44),P<0.01].Logistic回归分析显示,DES术后早期ISR(OR=6.47,95% CI:2.26~18.50,P<0.01)是DES治疗ISR后再次TLR的唯一预测因素.结论 再次DES置入治疗DES置入后ISR安全有效,但治疗早期ISR时TLR明显升高.%Objective To compare the efficiency and safety of repeated drug eluting stent (DES) for treatment of early and late DES in-stent restenosis(ISR).Methods Patients treated with repeated DES for DES ISR in Beijing anzhen hospital between October 2008 and December 2011 were followed up.All lesions were divided into early ISR group(within 1 year) (43 cases)and late ISR group (in > 1 year) (64 cases) by the period ISR occurring after initial DES implantation.Major adverse cardiovascular events (MACE) including all-cause death,myocardial infarction and clinical target lesion revascularization (TLR) were the primary endpoints.Results There were not differences between early ISR group and late ISR group in clinical and angiographic characteristics(P >0

  10. 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.

  11. 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.

  12. 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.

  13. 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.

  14. 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).

  15. Cutting balloon angioplasty for in-stent restenosis of the aortic coarctation in a young boy presenting with systemic hypertension of the upper extremities.

    Science.gov (United States)

    Lee, Meng-Luen

    2013-12-01

    An 8.25-year-old boy was incidentally found to have systemic hypertension of the upper extremities. Blood pressures of the upper extremities were 142-150/86-98 mmHg, and those of the lower extremities 110-116/60-66 mmHg. Doppler echocardiography showed in-stent restenosis of the aortic coarctation. Traditional high-pressure balloon angioplasty failed to dilate this inveterate in-stent restenosis. Instead, a cutting balloon angioplasty was performed. The lumen was dilated from 4.80 mm to 7.89 mm. The pressure gradient dropped from 32 mmHg to 9 mmHg. Blood pressures of the upper extremities were 112-116/76-78 mmHg, and those of the lower extremities 100-104/70-72 mmHg. This paper highlights that a cutting balloon angioplasty can serve as a juste milieu to relieve in-stent restenosis of the aortic coarctation when traditional high-pressure balloon angioplasty is debatable.

  16. Drug-Coated Balloon Venoplasty for In-Stent Restenosis in a Patient With Recurrent Pulmonary Vein Stenosis Post Ablation for Atrial Fibrillation: Initial Experience With a New Treatment Technique.

    Science.gov (United States)

    Rosenberg, Jonathan; Fisher, Westby G; Guerrero, Mayra; Smart, Steve; Levisay, Justin; Feldman, Ted; Salinger, Michael

    2016-05-01

    Pulmonary vein stenosis (PVS) is an uncommon but serious complication following radiofrequency ablation for atrial fibrillation. Occurrence of this complication has risen with increased rates of ablation procedures, with >50,000 AF ablation procedures performed per year, and can occur within weeks to months post procedure. Currently, the main therapies for PVS include percutaneous interventions with balloon angioplasty and stenting, but these treatments are complicated by a high rate of restenosis. The optimal treatment for recurrent pulmonary vein in-stent restenosis has not been determined. We describe the novel use of a paclitaxel drug-coated balloon for the treatment of in-stent restenosis of the pulmonary veins.

  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. 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...

  19. 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.

  20. 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.

  1. 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

  2. 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.

  3. 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.

  4. 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.

  5. Efficacy and safety of drug-eluting stent implantation for the treatment of in-stent restenosis occurring within bare-metal stent and drug-eluting stent*

    OpenAIRE

    Ge, Heng; Zhang, Qing; Zhou, Wei; He, Qing; Han, Zhi-hua; He, Ben

    2010-01-01

    Objective: Although drug-eluting stent (DES) implantation is the primary treatment modality for bare-metal stent (BMS) in-stent restenosis (ISR), little is known about the efficacy and safety profile of DES in the treatment of DES-ISR. The goal of this study was to compare the clinical outcomes following DES treatment for BMS-ISR and DES-ISR. Methods: Rates of major adverse cardiac events (MACE) were compared in 97 consecutive patients who underwent DES implantation for the treatment of ISR (...

  6. Inflammation and in-stent restenosis: the role of serum markers and stent characteristics in carotid artery stenting.

    Directory of Open Access Journals (Sweden)

    Katrin Wasser

    Full Text Available BACKGROUND: Carotid angioplasty and stenting (CAS may currently be recommended especially in younger patients with a high-grade carotid artery stenosis. However, evidence is accumulating that in-stent restenosis (ISR could be an important factor endangering the long-term efficacy of CAS. The aim of this study was to investigate the influence of inflammatory serum markers and procedure-related factors on ISR as diagnosed with duplex sonography. METHODS: We analyzed 210 CAS procedures in 194 patients which were done at a single university hospital between May 2003 and June 2010. Periprocedural C-reactive protein (CRP and leukocyte count as well as stent design and geometry, and other periprocedural factors were analyzed with respect to the occurrence of an ISR as diagnosed with serial carotid duplex ultrasound investigations during clinical long-term follow-up. RESULTS: Over a median of 33.4 months follow-up (IQR: 14.9-53.7 of 210 procedures (mean age of 67.9±9.7 years, 71.9% male, 71.0% symptomatic an ISR of ≥70% was detected in 5.7% after a median of 8.6 months (IQR: 3.4-17.3. After multiple regression analysis, leukocyte count after CAS-intervention (odds ratio (OR: 1.31, 95% confidence interval (CI: 1.02-1.69; p = 0.036, as well as stent length and width were associated with the development of an ISR during follow-up (OR: 1.25, 95% CI: 1.05-1.65, p = 0.022 and OR: 0.28, 95% CI: 0.09-0.84, p = 0.010. CONCLUSIONS: The majority of ISR during long-term follow-up after CAS occur within the first year. ISR is associated with periinterventional inflammation markers and influenced by certain stent characteristics such as stent length and width. Our findings support the assumption that stent geometry leading to vessel injury as well as periprocedural inflammation during CAS plays a pivotal role in the development of carotid artery ISR.

  7. Comparison of the Efficacy of Everolimus-Eluting Stents Versus Drug-Eluting Balloons in Patients With In-Stent Restenosis (from the RIBS IV and V Randomized Clinical Trials).

    Science.gov (United States)

    Alfonso, Fernando; Pérez-Vizcayno, María José; García Del Blanco, Bruno; García-Touchard, Arturo; Masotti, Mónica; López-Minguez, José R; Iñiguez, Andrés; Zueco, Javier; Velazquez, Maite; Cequier, Angel; Lázaro-García, Rosa; Martí, Vicens; Moris, César; Urbano-Carrillo, Cristobal; Bastante, Teresa; Rivero, Fernando; Cárdenas, Alberto; Gonzalo, Nieves; Jiménez-Quevedo, Pilar; Fernández, Cristina

    2016-02-15

    Treatment of patients with in-stent restenosis (ISR) remains a challenge. This study sought to compare the efficacy of everolimus-eluting stents (EESs) and drug-eluting balloons (DEBs) with paclitaxel in patients with ISR. A pooled analysis of the Restenosis Intra-Stent of Drug-Eluting Stents: Drug-Eluting Balloon vs Everolimus-Eluting Stent (RIBS IV) and Restenosis Intra-Stent of Bare-Metal Stents: Drug-Eluting Balloon vs Everolimus-Eluting Stent (RIBS V) randomized trials was performed using patient-level data. In both trials, EESs were compared with DEBs in patients with ISR (RIBS V included 189 patients with bare-metal ISR; RIBS IV included 309 patients with drug-eluting ISR). Inclusion and exclusion criteria were identical in both trials. A total of 249 patients were allocated to EES and 249 to DEB. Clinical follow-up at 1 year was obtained in all (100%) patients and late angiography (median 249 days) in 91% of eligible patients. Compared with patients treated with DEBs, patients treated with EESs obtained better short-term results (postprocedural minimal lumen diameter 2.28 ± 0.5 vs 2.12 ± 0.4 mm, p stent type and treatment effects. At 1-year clinical follow-up, the composite of cardiac death, myocardial infarction, and target vessel revascularization was significantly reduced in the EES arm (8.8% vs 14.5%, p = 0.03; hazard ratio 0.59, 95% CI 0.31 to 0.94) mainly driven by a lower need for target vessel revascularization (6% vs 12.4%, p = 0.01, hazard ratio 0.46, 95% CI 0.25 to 0.86). This pooled analysis of the RIBS IV and RIBS V randomized trials demonstrates the superiority of EES over DEB in the treatment of patients with ISR.

  8. Optimal cut-off criteria for duplex ultrasound for the diagnosis of restenosis in stented carotid arteries: Review and protocol for a diagnostic study

    Directory of Open Access Journals (Sweden)

    Brown Martin M

    2009-07-01

    Full Text Available Abstract Background Carotid angioplasty with stenting is a relatively new, increasingly used, less-invasive treatment for the treatment of symptomatic carotid artery stenosis. It is being evaluated in ongoing and nearly finished randomized trials. An important factor in the evaluation of stents is the occurrence of in-stent restenosis. An un-stented carotid artery is likely to have a more elastic vessel wall than a stented one, even if stenosis is present. Therefore, duplex ultrasound cut-off criteria for the degrees of an in-stent stenosis, based on blood velocity parameters, are probably different from the established cut-offs used for un-stented arteries. Routine criteria can not be applied to stented arteries but new criteria need to be established for this particular purpose. Methods/Design Current literature was systematically reviewed. From the selected studies, the following data were extracted: publication year, population size, whether the study was prospective, duplex ultrasound cut-off criteria reported, which reference test was used, and if there was an indication for selection bias and for verification bias in particular. Previous studies often were retrospective, or the reference test (DSA or CTA was carried out only when a patient was suspected of having restenosis at DUS, which may result in verification bias. Results In general, the velocity cut-off values for stenosis measurements in stented arteries were higher than those reported for unstented arteries. Previous studies often were retrospective, or the reference test (DSA or CTA was carried out only when a patient was suspected of having restenosis at DUS, which may result in verification bias. Discussion To address the deficiencies of the existing studies, we propose a prospective cohort study nested within the International Carotid Stenting Study (ICSS, an international multi-centre trial in which over 1,700 patients have been randomised between stenting and CEA. In this

  9. 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

  10. Number of Blades-up Runs Using JetStream XC Atherectomy for Optimal Tissue Debulking in Patients with Femoropopliteal Artery In-Stent Restenosis.

    Science.gov (United States)

    Shammas, Nicolas W; Shammas, Gail A; Aasen, Nicole; Jarvis, Gary

    2015-12-01

    Rotational atherectomy with the use of the JetStream XC device is indicated for treatment of infrainguinal arterial obstructive disease. The number of blades-up (BU) runs needed for optimal tissue debulking in femoropopliteal in-stent restenosis (ISR) is unknown. In the present series, 6 patients (15 lesions) were treated for femoropopliteal ISR with the JetStream XC device. Minimal luminal diameter or percent stenosis improved significantly from baseline after 2 BU runs, but no further gain was seen between 2 and 4 BU runs (P > .05). However, adjunctive balloon angioplasty reduced percent stenosis significantly following BU runs. In conclusion, the JetStream XC device achieved optimal acute angiographic results in treating femoropopliteal ISR following 2 BU runs and adjunctive balloon angioplasty.

  11. 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.

  12. 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.

  13. Mechanisms and Patterns of Intravascular Ultrasound In-Stent Restenosis Among Bare Metal Stents and First- and Second-Generation Drug-Eluting Stents.

    Science.gov (United States)

    Goto, Kosaku; Zhao, Zhijing; Matsumura, Mitsuaki; Dohi, Tomotaka; Kobayashi, Nobuaki; Kirtane, Ajay J; Rabbani, LeRoy E; Collins, Michael B; Parikh, Manish A; Kodali, Susheel K; Leon, Martin B; Moses, Jeffrey W; Mintz, Gary S; Maehara, Akiko

    2015-11-01

    The most common causes of in-stent restenosis (ISR) are intimal hyperplasia and stent under expansion. The purpose of this study was to use intravascular ultrasound (IVUS) to compare the ISR mechanisms of bare metal stents (BMS), first-generation drug-eluting stents (DES), and second-generation DES. There were 298 ISR lesions including 52 BMS, 73 sirolimus-eluting stents, 52 paclitaxel-eluting stents, 16 zotarolimus-eluting stents, and 105 everolimus-eluting stent. Mean patient age was 66.6 ± 1.1 years, 74.2% were men, and 48.3% had diabetes mellitus. BMS restenosis presented later (70.0 ± 66.7 months) with more intimal hyperplasia compared with DES (BMS 58.6 ± 15.5%, first-generation DES 52.6 ± 20.9%, second-generation DES 48.2 ± 22.2%, p = 0.02). Although reference lumen areas were similar in BMS and first- and second-generation DES, restenotic DES were longer (BMS 21.8 ± 13.5 mm, first-generation DES 29.4 ± 16.1 mm, second-generation DES 32.1 ± 18.7 mm, p = 0.003), and stent areas were smaller (BMS 7.2 ± 2.4 mm(2), first-generation DES 6.1 ± 2.1 mm(2), second-generation DES 5.7 ± 2.0 mm(2), p Stent fracture was seen only in DES (first-generation DES 7 [5.0%], second-generation DES 8 [7.4%], p = 0.13). In conclusion, restenotic first- and second-generation DES were characterized by less neointimal hyperplasia, smaller stent areas, longer stent lengths, and more stent fractures than restenotic BMS.

  14. Efficacy of drug-eluting stents for treating in-stent restenosis of drug-eluting stents (from the Korean DES ISR multicenter registry study [KISS]).

    Science.gov (United States)

    Ko, Young-Guk; Kim, Jung-Sun; Kim, Byeong-Keuk; Choi, Donghoon; Hong, Myeong-Ki; Jeon, Dong Woon; Yang, Joo-Young; Ahn, Young Keun; Jeong, Myung Ho; Yu, Cheol Woong; Yun, Kyeong-Ho; Lim, Do-Sun; Jang, Yangsoo

    2012-03-01

    There is currently no established standard treatment for in-stent restenosis (ISR) after the implantation of a drug-eluting stent (DES). The aim of this study was to investigate the efficacy of DES versus balloon angioplasty (BA) for the treatment of DES ISR in a multicenter registry cohort. After matching propensity scores of 805 patients with DES ISR treated with either DES (n = 422) or BA (n = 383), 268 matched pairs were selected and analyzed for major adverse cardiac events, a composite of death, myocardial infarction, and target-vessel revascularization, as the primary end point. Baseline clinical and lesion characteristics of the matched pairs were similar. Survival free of major adverse cardiac events at 2 years was higher with DES compared to BA (88.9% vs 78.7%, p ISR, and previous implantation of a sirolimus-eluting stent. Survival free of death, myocardial infarction, or stent thrombosis did not differ between the 2 groups. Whereas there was no significant difference in survival free of target vessel revascularization between DES and BA for focal ISR lesions, DES was superior to BA in diffuse ISR lesions (94.3% vs 75.2% at 2 years, p ISR.

  15. 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.

  16. 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.

  17. 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

  18. 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.

  19. 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...

  20. A noise-optimized virtual monochromatic reconstruction algorithm improves stent visualization and diagnostic accuracy for detection of in-stent re-stenosis in lower extremity run-off CT angiography.

    Science.gov (United States)

    Mangold, Stefanie; De Cecco, Carlo N; Schoepf, U Joseph; Yamada, Ricardo T; Varga-Szemes, Akos; Stubenrauch, Andrew C; Caruso, Damiano; Fuller, Stephen R; Vogl, Thomas J; Nikolaou, Konstantin; Todoran, Thomas M; Wichmann, Julian L

    2016-12-01

    To evaluate the impact of noise-optimized virtual monochromatic imaging (VMI+) on stent visualization and accuracy for in-stent re-stenosis at lower extremity dual-energy CT angiography (DE-CTA). We evaluated third-generation dual-source DE-CTA studies in 31 patients with prior stent placement. Images were reconstructed with linear blending (F_0.5) and VMI+ at 40-150 keV. In-stent luminal diameter was measured and contrast-to-noise ratio (CNR) calculated. Diagnostic confidence was determined using a five-point scale. In 21 patients with invasive catheter angiography, accuracy for significant re-stenosis (≥50 %) was assessed at F_0.5 and 80 keV-VMI+ chosen as the optimal energy level based on image-quality analysis. At CTA, 45 stents were present. DSA was available for 28 stents whereas 12 stents showed significant re-stenosis. CNR was significantly higher with ≤80 keV-VMI+ (17.9 ± 6.4-33.7 ± 12.3) compared to F_0.5 (16.9 ± 4.8; all p VMI+ (4.90 ± 0.48-4.88 ± 0.63 vs. 4.60 ± 0.66, p = 0.001, 0.0042). Sensitivity, negative predictive value and accuracy for re-stenosis were higher with 80 keV-VMI+ (100, 100, 96.4 %) than F_0.5 (90.9, 94.1, 89.3 %). 80 keV-VMI+ improves image quality, diagnostic confidence and accuracy for stent evaluation at lower extremity DE-CTA. • The impact of noise-optimized virtual monochromatic imaging on stent visualization was assessed. • Virtual monochromatic imaging significantly improves stent lumen visualization and diagnostic confidence. • At 80 keV diagnostic performance for detection of in-stent restenosis was increased. • 80 keV virtual monochromatic images are recommended for stent evaluation of lower extremity vasculature.

  1. Five-Year Freedom From Target-Lesion Revascularization Using Excimer Laser Ablation Therapy in the Treatment of In-Stent Restenosis of Femoropopliteal Arteries.

    Science.gov (United States)

    Shammas, Nicolas W; Shammas, Gail A; Arikat, Lorraine; Shammas, Andrew N; Darrow, Alec; Banerjee, Avantika; Rudy, Benjamin

    2017-06-01

    Target-lesion revascularization (TLR) and loss of patency remain high following treatment of in-stent restenosis (ISR) of the femoropopliteal (FP) artery. Excimer laser atherectomy (ELA) is effective in reducing TLR and improves patency at 6-month and 1-year follow-up when compared with balloon angioplasty (PTA). The long-term sustainability of these early results is unknown. We present a retrospective analysis from our center on the 5-year outcomes of ELA in the treatment of ISR of the FP arteries. Patients who underwent ELA for FP-ISR from February 2005 to April 2010 at a single medical center were included. Demographics, angiographic and procedural variables were included. Major adverse events and 5-year TLR and target-vessel revascularization were obtained from medical records. Descriptive analysis was performed on all variables. Kaplan-Meier survival curves for TLR were plotted censored for death among patients who died before the occurrence of a TLR. Forty consecutive patients (mean age, 67.2 ± 9.0 years; 57.5% males) were included. Angiographic variables included: lesion length, 210.4 ± 104.0 mm; lesion severity, 93.9 ± 8.9%; and number of vessel runoffs, 1.7 ± 1.0. All patients were treated with adjunctive PTA. Acute procedural success was achieved in 92.5% of vessels. Distal embolization requiring treatment was 2.5%. No unplanned amputation occurred. Total deaths occurred in 8/40 (20%). At 5-year follow-up, TLR occurred in 62.5% with the steepest decline in freedom from TLR occurred in the first year followed by a less decline in the subsequent 2 to 3 years. ELA for FP-ISR continues to show progressive increase in TLR up to 5-year follow-up, but mostly occurs in the first 3 years after index procedure. These data suggest that a minimum follow-up of 3 years is needed to determine stability of treatment of FP-ISR with laser.

  2. Characterization of the kallikrein-kinin system, metalloproteinases, and their tissue inhibitors in the in-stent restenosis after peripheral percutaneous angioplasty.

    Science.gov (United States)

    Ribeiro, Maurício S; Dellalibera-Joviliano, Renata; Becari, Christiane; Teixeira, Felipe Roberti; Araujo, Paula Vasconcelos; Piccinato, Carlos E; Campos, Cesar Presto; Evora, Paulo Roberto B; Joviliano, Edwaldo E

    2014-05-01

    The kallikrein-kinin system (KKS) has several direct and indirect effects on cells and cellular mediators involved in the inflammatory process. Studies about inflammation on percutaneous transluminal angioplasty with stent (PTA/stent) to treat peripheral arterial disease (PAD) in humans are scarce. The matrix metalloproteinases (MMPs) are calcium-dependent zinc-containing endopeptidases expressed in various cells and tissues such as fibroblasts, inflammatory cells, and, smooth muscle cells. Changes in the extracellular matrix (ECM) take place in the pathogenesis of many cardiovascular pathologies. MMPs and their inhibitors (tissue inhibitors of metalloproteinases [TIMPs]) are crucial in ECM remodeling in both physiologic and pathologic conditions. The aim of this study was to evaluate the role of the KKS and the MMP metabolism, which are important mediators that may contribute to tissue repair, in the process of arterial restenosis due to intimal hyperplasia in the femoropopliteal segment with the aim of developing new interventions. Thirty-nine consecutive patients were selected (regardless of ethnic group, age, or sex) for revascularization, who underwent PTA/stent of the femoropopliteal segment. Twenty-five patients with the same clinical characteristics who were scheduled for diagnostic angiography but not subjected to PTA/nitinol stent were also selected. The concentrations in blood of total and kininogen fractions were evaluated using immunoenzymatic methods. Plasma kallikrein was evaluated by the colorimetric method. Tissue kallikrein was evaluated by the spectrophotometric method. The activity of kininase II was measured by fluorometric analysis. Quantification of MMPs was performed by zymography, which is an electrophoresis technique, and TIMPs were measured by enzyme-linked immunosorbent assay. Among the 31 patients who completed the survey, there were 10 cases of angiographically defined restenosis of >50%, and 21 cases without restenosis. There was an

  3. A noise-optimized virtual monochromatic reconstruction algorithm improves stent visualization and diagnostic accuracy for detection of in-stent re-stenosis in lower extremity run-off CT angiography

    Energy Technology Data Exchange (ETDEWEB)

    Mangold, Stefanie [Medical University of South Carolina, Department of Radiology and Radiological Science, Charleston, SC (United States); Eberhard-Karls University Tuebingen, Department of Diagnostic and Interventional Radiology, Tuebingen (Germany); De Cecco, Carlo N.; Yamada, Ricardo T.; Varga-Szemes, Akos; Stubenrauch, Andrew C.; Fuller, Stephen R. [Medical University of South Carolina, Department of Radiology and Radiological Science, Charleston, SC (United States); Schoepf, U.J. [Medical University of South Carolina, Department of Radiology and Radiological Science, Charleston, SC (United States); Medical University of South Carolina, Division of Cardiology, Department of Medicine, Charleston, SC (United States); Caruso, Damiano [Medical University of South Carolina, Department of Radiology and Radiological Science, Charleston, SC (United States); University of Rome ' ' Sapienza' ' , Department of Radiological Sciences, Oncology and Pathology, Rome (Italy); Vogl, Thomas J.; Wichmann, Julian L. [Medical University of South Carolina, Department of Radiology and Radiological Science, Charleston, SC (United States); University Hospital Frankfurt, Department of Diagnostic and Interventional Radiology, Frankfurt (Germany); Nikolaou, Konstantin [Eberhard-Karls University Tuebingen, Department of Diagnostic and Interventional Radiology, Tuebingen (Germany); Todoran, Thomas M. [Medical University of South Carolina, Division of Cardiology, Department of Medicine, Charleston, SC (United States)

    2016-12-15

    To evaluate the impact of noise-optimized virtual monochromatic imaging (VMI+) on stent visualization and accuracy for in-stent re-stenosis at lower extremity dual-energy CT angiography (DE-CTA). We evaluated third-generation dual-source DE-CTA studies in 31 patients with prior stent placement. Images were reconstructed with linear blending (F{sub 0}.5) and VMI+ at 40-150 keV. In-stent luminal diameter was measured and contrast-to-noise ratio (CNR) calculated. Diagnostic confidence was determined using a five-point scale. In 21 patients with invasive catheter angiography, accuracy for significant re-stenosis (≥50 %) was assessed at F{sub 0}.5 and 80 keV-VMI+ chosen as the optimal energy level based on image-quality analysis. At CTA, 45 stents were present. DSA was available for 28 stents whereas 12 stents showed significant re-stenosis. CNR was significantly higher with ≤80 keV-VMI+ (17.9 ± 6.4-33.7 ± 12.3) compared to F{sub 0}.5 (16.9 ± 4.8; all p < 0.0463); luminal stent diameters were increased at ≥70 keV (5.41 ± 1.8-5.92 ± 1.7 vs. 5.27 ± 1.8, all p < 0.001) and diagnostic confidence was highest at 70-80 keV-VMI+ (4.90 ± 0.48-4.88 ± 0.63 vs. 4.60 ± 0.66, p = 0.001, 0.0042). Sensitivity, negative predictive value and accuracy for re-stenosis were higher with 80 keV-VMI+ (100, 100, 96.4 %) than F{sub 0}.5 (90.9, 94.1, 89.3 %). 80 keV-VMI+ improves image quality, diagnostic confidence and accuracy for stent evaluation at lower extremity DE-CTA. (orig.)

  4. 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......-coated stents, the time of cells adhesion was longer and earlier present in the anti-CD133 antibody-coated stents and anti-CD133 antibody-coated stents have superiority in re-endothelialization and inhibition of ISR. In conclusion, this study demonstrated that anti-CD133 antibody as a stent coating...... for capturing EPCs is better than anti-CD34 antibody in promoting endothelialization and reducing ISR....

  5. 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

  6. 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.

  7. 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.

  8. 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

  9. 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

  10. 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.

  11. ST-elevated acute myocardial infarction happening 1 month post stent implantation: late thrombosis in-stents or new lesions?

    Institute of Scientific and Technical Information of China (English)

    SONG Guang-yuan; YANG Yue-jin; XU Bo; LI Jian-jun; GAO Run-lin; QIAO Shu-bin; YUAN Jin-qing; TANG Yi-da; YOU Shi-jie; PEI Han-jun; ZHAO Zhen-yan; WANG Xi-mei; WU Yong-jian

    2009-01-01

    Background ST-elevated acute myocardial infarction (STEAMI) happening in the first month post percutaneous coronary intervention (PCI) is almost related to acute thrombosis or subacute thrombosis in-stents. This study aimed to investigate the possible causes of myocardial infarction one month later. Methods Patients who had a history of successful PCI, and received coronary angiography or re-PCI due to STEAMI were included in this study. The AMI-related lesions and previous angiographic findings such as the number of lesions, the degree of the stenosis, the type of stents and acute results of last PCI were recorded. If the AMI-related lesion was localized in-stents or at the edge of stents (distance apart from the edge <5 mm), it was defined to be late thrombosis; otherwise as a new-lesion induced AMI. Results One hundred and ninety-two patients aged 40-79 years were included in this study. New lesions, as the cause of STEAMI, were found in 144 patients (Group A, 75%), and late thrombosis in 48 patients (Group B, 25%). Almost all newly built thromboses were found at the sites of previous insignificant lesions (diameter stenosis <50%). There was a significant difference in the average time from previous PCI to AMI ((30.1+12.4) vs (20.3+11.9) months) between the two groups. Diabetes mellitus (DM) and drug-eluting stent (DES) utilization were associated with markedly higher morbidity of late thrombosis in adjusted Logistic regression (hazard ratio (HR) 3.4, 95% confidence interval (CI) 1.1-10.9 and 5.3, 95% CI 1.1-26.5). Conclusions STEAMIs happening 1 month after PCI are more likely to develop from previous insignificant lesion rupture than from late thrombosis in-stents. Moreover, DM and DES are associated with the high incidence of latethrombosis, which may indicate that intensive antiplatelet therapy should be considered in patients with diabetes.

  12. 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.

  13. 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.

  14. 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.

  15. 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.

  16. Study on the correlation between the number and function of endothelial progenitor cells and in-stent restenosis after stent-implantation for symptomatic intracranial atherosclerotic stenosis%症状性颅内动脉狭窄支架置入术后内皮祖细胞的数量及功能与再狭窄的相关性研究

    Institute of Scientific and Technical Information of China (English)

    苏江利; 亓立峰; 张锐; 曲怀谦

    2015-01-01

    目的探讨症状性动脉粥样硬化性颅内动脉狭窄( sICAS)患者颅内动脉支架置入术后内皮祖细胞( EPCs)数量、功能及血管内皮生长因子( VEGF)水平变化与术后颅内动脉再狭窄的关系。方法选择2008年1月—2012年10月聊城市人民医院神经内科因sICAS行颅内动脉支架置入术的87例患者进行前瞻性研究。87例患者中,男48例,女39例;年龄48~81岁。均采用颅内动脉支架置入术治疗,术后1年行头颈CTA检查,根据患者颅内动脉狭窄情况分为再狭窄组和无狭窄组,分别对两组患者术后1年外周血EPCs的数量、黏附能力、迁移能力,以及VEGF水平进行测定,并对结果进行对比分析。结果87例sICAS患者均成功行经皮血管内支架置入术。术后1年行头颈CTA检查显示,无狭窄组64例,再狭窄组23例,其中14例患者再狭窄>50%。再狭窄组与无狭窄组比较,术后1年外周血中 EPCs 数量分别为(36.5依4.8)个/mL、(65.6依6.7)个/mL,细胞黏附数量分别为(27.4依7.3)个/mL、(58.5依9.4)个/mL,迁移数量分别为(13.6依3.7)个/mL、(24.7依6.8)个/mL, VEGF的水平(57.79依13.53) pg/mL、(94.36依17.57) pg/mL,差异均有统计学意义(t值分别为19.110、14.376、7.425、9.051, P值均<0.05)。结论 sICAS患者采用颅内动脉支架置入术治疗后,EPCs数量、黏附能力、迁移能力及VEGF水平明显下降的患者,发生血管再狭窄的风险增加;术后检测EPCs、VEGF水平对预测发生血管再狭窄的可能性和判断患者的远期预后可能有一定的临床价值。%Objective To explore the relationship of endothelium progenitor cells( EPCs) number and function, the level of vascular endothelial growth factor ( VEGF ) with in-stent restenosis after stent implantation for symptomatic intracranial atherosclerotic stenosis. Methods From Jan 2008 to October 2012, a total of 87 patients stent-implantation with symptomatic intracranial atherosclerotic stenosis (s

  17. 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.

  18. Microfabrication and nanotechnology in stent design.

    Science.gov (United States)

    Martinez, Adam W; Chaikof, Elliot L

    2011-01-01

    Intravascular stents were first introduced in the 1980s as an adjunct to primary angioplasty for management of early complications, including arterial dissection, or treatment of an inadequate technical outcome due to early elastic recoil of the atherosclerotic lesion. Despite the beneficial effects of stenting, persistent high rates of restenosis motivated the design of drug-eluting stents for delivery of agents to limit the proliferative and other inflammatory responses within the vascular wall that contribute to the development of a restenotic lesion. These strategies have yielded a significant reduction in the incidence of restenosis, but challenges remain, including incomplete repair of the endothelium at the site of vascular wall injury that may be associated with a late risk of thrombosis. A failure of vessel wall healing has been attributed primarily to the use of polymeric stent coatings, but the effects of the eluted drug and other material properties or design features of the stent cannot be excluded. Improvements in stent microfabrication, as well as the introduction of alternative materials may help to address those limitations that inhibit stent performance. This review describes the application of novel microfabrication processes and the evolution of new nanotechnologies that hold significant promise in eliminating existing shortcomings of current stent platforms.

  19. 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.

  20. ATP负荷99Tcm-MIBI门控心肌灌注显像在评价冠状动脉支架植入术后再狭窄中的应用价值%ATP stress 99Tcm-MIBI gated myocardial perfusion imaging in diagnosis of in-stent restenosis

    Institute of Scientific and Technical Information of China (English)

    张鹏飞; 张海山; 陈松; 孙英贤; 李亚明; 王丽娟

    2014-01-01

    目的 探讨ATP负荷99Tcm-MIBI G-MPI在评价冠状动脉(简称冠脉)支架植入术后再狭窄中的应用价值.方法 选择71例冠脉支架植入术后3个月以上且伴有典型心绞痛症状的患者[男56例,女15例,年龄37~ 83 (60.2±9.5)岁]进行前瞻性研究,于1个月内分别行ATP负荷99Tcm-MIBI G-MPI和CAG检查.以CAG作为“金标准”,评价ATP负荷99Tcm-MIBI G-MPI诊断冠脉支架植入术后再狭窄的诊断效能.应用SPSS 17.0软件,采用Fisher确切概率法进行组间比较.结果 71例患者中5例患者出现新发狭窄,予以剔除;66例患者共99支冠脉接受支架植入术,其中39例患者的45支冠脉出现再狭窄.39例中心肌梗死19例,非心肌梗死20例;另27例无再狭窄者中心肌梗死16例,非心肌梗死11例.ATP负荷99Tcm-MIBI G-MPI诊断冠脉支架植入术后再狭窄的Se、Sp、Ac、PPV及NPV分别为:85%(33/39)、89%(24/27)、86%(57/66)、92% (33/36)及80% (24/30);诊断心肌梗死组的相应效能为:79%(15/19)、88%(14/16)、83% (29/35)、88% (15/17)、78%(14/18),非心肌梗死组为:90% (18/20)、91%(10/11)、90%(28/31)、95% (18/19)、83%(10/12),2组间差异均无统计学意义(均P>0.05).结论 ATP负荷99Tcm-MIBI G-MPI在评价冠脉支架植入术后再狭窄中具有较高的诊断效能,是一种安全价廉的检查方法.%Objective To investigate the value of ATP stress 99Tcm-MIBI G-MPI in evaluating instent restenosis.Methods Seventy-one patients (56 males,15 females,age range:37-83 (60.2±9.5) yeas) who had undergone coronary stent implantation at least 3 months ago,accompanying a typical angina pectoris symptom,were included in this perspective study.All patients underwent ATP stress 99Tcm-MIBI G-MPI and CAG (gold standard) within 1 month.The diagnostic efficiency of ATP stress 99Tcm-MIBI G-MPI on in-stent restenosis was evaluated.Fisher exact probability method was used to analyze data with SPSS 17.0.Results Five patients were

  1. 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

  2. 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

  3. 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

  4. 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.

  5. Management of late/very late stent thrombosis: Utility of ıntravenous ultrasonography (IVUS) in clinical practise

    OpenAIRE

    Emre Yalçınkaya; Barış Bugan; Yalçın Gökoğlan; Erkan Yıldırım

    2013-01-01

    To the editor We read with great interest the article by Aksu et al. [1] on the management of very late bare metal stent thrombosis. They performed intracoronary thrombus aspiration and inflated balloon in-stent for restenosis. During percutaneous coronary interventions, interventionalists have often to deal with thrombus-laden lesions in coronary vessels. Plaque characteristics and distribution, severity and extent of calcification, arterial remodeling and the presence of dissection or throm...

  6. 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

    目的 分析椎动脉起始部支架置入术后再狭窄的发生及影响因素并探讨其规律.方法 回顾性分析行椎动脉起始部支架置入术的144例患者的病例资料,按照原治疗部位复发狭窄程度>50%定义为再狭窄,将病例分成再狭窄组(39例)和未狭窄组(105例).采用x2检验分析患者性别、年龄及高血压、糖尿病、冠心病、高脂血症病史,吸烟、饮酒情况,术前后循环供血不足症状、合并其他血管狭窄、置入支架类型及规格与再狭窄的关系,然后行Logistic回归得出结果.结果 144例中,椎动脉起始部支架置入术后再狭窄39例(26.4%),均发生在术后5个月内.x2检验示:未狭窄组和再狭窄组在性别(男89和34例,女16和5例;x2=0.804,p=0.370)、年龄(≥60岁60和21例;x2=2.358,P=0.125)、高血压(67和28例;x2=0.253,P=0.615)、糖尿病(27和9例;x2=0.914,P=0.91)、冠心病(32和6例;x2 =2.489,P=0.115)、高脂血症(6和5例;x2=0.478,p=0.489)、吸烟(50和24例;x2=0.129,P=0.719)、饮酒(20和13例;x2 =0.001,P=0.978)、置入支架直径(≥4 mm 53和18例;x2=0.213,P=0.645)及支架长度(≥15 mm 45和19例;x2=0.927,P=0.336)、手术前后循环供血不足症状(93和29例;x2=0.250,P=0.617)上差异无统计学意义(P>0.05);未狭窄组和再狭窄组在合并对侧椎动脉狭窄(43和24例;x2 =4.844,P=0.028)、合并颈内动脉狭窄(49和26例;x2=4.558,P=0.033)、支架类型(药物支架59和11例;x2=8.916,P=0.003)上差异有统计学意义(P<0.05).进行Logistic回归分析显示:使用裸支架和合并颈内动脉狭窄为再狭窄的独立危险因素.结论 椎动脉起始部支架置入术后再狭窄多发生于支架置入术后5个月内.合并颈内动脉狭窄和使用裸支架会增加术后再狭窄,术前后循环症状为主和合并对侧椎动脉起始部狭窄可能会增加再狭窄.%Objective To evaluate risk factors of restenosis of vertebral artery origin after

  7. 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

  8. 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

  9. 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.

  10. 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.

  11. 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

  12. 老年患者血小板衍生生长因子-B与支架内再狭窄的关系%Association between platelet-derived growth factor-B and in-stent restenosis in elderly patients

    Institute of Scientific and Technical Information of China (English)

    路雅茹; 于珍; 李广平

    2014-01-01

    目的 探讨血小板衍生生长因子(platelet-derived growth factor,PDGF)-B血浆水平及PDGF-B基因rs1800818、rs1800817单核苷酸多态性(single nucleotide polymorphism,SNP)与支架内再狭窄(in-stent restenosis,ISR)发生的关系. 方法 157例支架术后复查冠状动脉造影患者,分为再狭窄组(ISR组,74例)和无再狭窄组(NISR组,83例).酶联免疫吸附法(ELISA)检测血浆PDGF-B生物活性形式PDGF-BB水平、探针法实时定量聚合酶链式反应(PCR)检测PDGF-B基因型. 结果 ISR组与NISR组rs1800818 AA、AG、GG基因型频率差异无统计学意义(x2=4.48,P>0.05),ISR组A等位基因频率高于NISR组(0.446比0.319,x2=5.33,P<0.05).未检出rs1800817 CC基因型,两组间AA、AC基因型频率差异无统计学意义(x2=0.06,P>0.05),A、C等位基频率差异无统计学意义(x2=0.06,P>0.05).血浆PDGF-BB水平ISR组高于NISR组(6.53±3.65) ng/L与(5.07±2.45)ng/L(t=2.92,P<0.01).两组间rs1800818AA基因型PDGF-BB水平分别为(9.94±4.60)ng/L与(5.90±2.98)ng/L,差异有统计学意义(t=2.69,P<0.05).Logistic回归分析示血浆PDGF-B水平(OR=1.187,95% CI:1.054~1.337,P<0.01)是ISR发生的危险因素. 结论 高血浆PDGF-B水平是ISR的危险因素,PDGF-B基因SNP rs1800818、rs1800817与ISR发生无关.%Objective To investigate the association of platelet-derived growth factor(PDGF)-B gene single nucleotide polymorphism(SNP) and plasma PDGF-BB level with in-stent restenosis(ISR) in elderly patients.Methods 157 patients who had undergone coronary artery stenting for more than half year were divided into ISR group(n=74) and NISR group(non-ISR,n=83) according to the angiographic diagnosis of in-stent restenosis (ISR).Plasma level of PDGF-BB was measured by enzyme-linked immunosorbent assay(ELISA).DNA was isolated from leukocytes.Two SNPs of the PDGF-B gene(rs1800818 and rs1800817) were determined by Taqman Quantitative Real-Time PCR with TaqMan-MGB probe.Results There were no significant

  13. 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

  14. 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.

  15. 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

  16. 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

  17. 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

  18. 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

  19. 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.

  20. 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.

  1. 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.

  2. 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

  3. 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

  4. 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.

  5. 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.

  6. 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%.

  7. 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.

  8. Efficacy of antiplatelet aggregation drugs in in-stent restenosis after intra-or extra-cerebral stent placement: evaluation by thrombelastogramy%血栓弹力图评价抗血小板药物疗效对颅内外动脉支架术后再狭窄的影响

    Institute of Scientific and Technical Information of China (English)

    李敏; 刘玲; 葛良; 蓝文雅; 侯华娟; 林颖; 杨昉; 刘亚红

    2013-01-01

    目的 分析血栓弹力图仪(TEG)检测颅内外动脉支架置入术(PTAS)后患者服用阿司匹林和氯吡格雷后血小板聚集的抑制率,了解其疗效对PTAS术后支架内再狭窄(ISR)的影响.方法 收集颅内外动脉PTAS术后因缺血性中风复发或者术后6~12个月常规行脑动脉数字减影血管造影(DSA)随访且行TEG检测的49例患者(64处病变血管)的临床资料.根据DSA-果分为ISR组和对照组(无ISR),比较两组间的各种血管病危险因素、血清超敏C反应蛋白(hs-CRP)水平、花生四烯酸(AA)途径和腺苷二磷酸(ADP)受体途径诱导血小板抑制率间的差异,探讨影响ISR形成的因素.结果 (1)卒中复发组与无复发组比较:复发组(男:女=1:5)与无复发组(男:女=39:4)组间性别组成的差异有统计学意义(P<0.01);复发组血清hs-CRP水平显著高于无复发组[(8.9±11.0) vs (2.9±4.1) mg/L,P<0.05];而其余各变量间差异均无统计学意义(P>0.05).(2) ISR组与对照组比较:ISR组患病年龄显著小于对照组[(58.0+12.8) vs (64.6±9.8)岁;P<0.05];两组间糖尿病患者的比例差异具有统计学意义(P<0.05);ISR组颅内外支架再狭窄比例(6/14 vs 8/14)与对照组(7/50 vs 43/50)间的差异有统计学意义(P< 0.05);ISR组血清hs-CRP浓度显著高于对照组[(6.1+7.6) vs (2.1±2.1)mg/L,P=0.028];ISR组AA和ADP平均抑制率分别为(58.0±43.8)%和(28.1±26.1)%,显著低于对照组的(83.4±23.1)%和(52.8±29.5)%(均P< 0.01).(3)Logistic回归分析显示,在校正了其他因素的影响后,仅ADP抑制率(氯吡格雷疗效)与ISR的形成呈负相关(HR=0.959;95% CI 0.921~0.998;P=0.039).结论 氯吡格雷抗血小板聚集的疗效与ISR的形成呈负相关,即氯吡咯雷抵抗在ISR的形成中起非常重要的作用.%Objective To evaluate the efficacy of antiplatelet aggregation drugs (aspirin and clopridogrel) in in-stent restenosis (ISR) after percutaneous transluminal

  9. Flow disturbances in stent-related coronary evaginations

    DEFF Research Database (Denmark)

    Radu, Maria D; Pfenniger, Aloïs; Räber, Lorenz

    2014-01-01

    Aims: Angiographic ectasias and aneurysms in stented segments have been associated with late stent thrombosis. Using optical coherence tomography (OCT), some stented segments show coronary evaginations reminiscent of ectasias. The purpose of this study was to explore, using computational fluid...

  10. Relationships of oxidized low-density lipoproteins and C reactive protein with in-stent restenosis after PCI%氧化低密度脂蛋白和C反应蛋白与冠状动脉支架置入术后再狭窄的关系研究

    Institute of Scientific and Technical Information of China (English)

    何文军; 黄家平; 梁伟东; 莫翔; 梁少华

    2015-01-01

    Objective To investigate the predictive significance of oxidized low-density lipoproteins (ox-LDL) and C reactive protein (CRP) for in-stent restenosis (ISR) after percutaneous coronary intervention (PCI). Methods A total of 186 patients who were given PCI and followed up for 6 months were enrolled.Of them, 22 patients had ISR(ISR group), while the other 164 patients had not ISR(no-ISR group).The pre-and post-PCI serum ox-LDL and CRP were detected.Results There was no statistical significance between the 2 groups in terms of age, sex, morbidity, serum lipid and vessel lesion(P >0.05).Serum ox-LDL and CRP increased significantly in ISR group at post-PCI compared with pre-PCI (P 0.05).Serum ox-LDL were also higher in ISR group compared with no-ISR group at pre-and post-PCI (P 0.05).However, the significant increase of CRP level in ISR group compared with no-ISR group was present at post-PCI (P <0.05).Correlation analysis revealed that there was positive correlation between pre-and post-PCI for serum ox-LDL and CRP in both ISR and no-ISR groups [ISR group: r(P) values of pre-and post-PCI were 0.392 (0.020) and 0.431 (0.010); no-ISR group: r(P) values of pre-and post-PCI were 0.382 (0.024) and 0.526 (0.001)].The Logistic regression analysis showed that post-PCI ox-LDL [odds ratio (OR) =1.27, 95% confidence interval (CI): 1.05-1.79] and pre-PCI CRP (OR =1.82,95%CI:1.68-2.30) were independent risk factors of ISR.Conclusions Post-PCI ox-LDL and pre-PCI CRP have certain significance in the prediction of ISR.%目的:探讨氧化低密度脂蛋白(ox-LDL)、C 反应蛋白(CRP)对经皮冠状动脉介入治疗(PCI)术后支架内再狭窄(ISR)的预测价值。方法选择行 PCI 术并于术后6个月内接受冠状动脉造影复查的患者186例,其中术后发生 ISR (ISR 组)22例,无 ISR 发生(非 ISR 组)164例。检测两组 PCI 术前和术后血清 ox-LDL、CRP水平。结果 ISR 组和非 ISR 组年龄、性别构成、合并症

  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. 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.

  13. 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.

  14. 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.

  15. Plaque components affect wall stress in stented human carotid artery: A numerical study

    Science.gov (United States)

    Fan, Zhen-Min; Liu, Xiao; Du, Cheng-Fei; Sun, An-Qiang; Zhang, Nan; Fan, Zhan-Ming; Fan, Yu-Bo; Deng, Xiao-Yan

    2016-09-01

    Carotid artery stenting presents challenges of in-stent restenosis and late thrombosis, which are caused primarily by alterations in the mechanical environment of the artery after stent implantation. The present study constructed patient-specific carotid arterial bifurcation models with lipid pools and calcified components based on magnetic resonance imaging. We numerically analyzed the effects of multicomponent plaques on the distributions of von Mises stresses (VMSs) in the patient-specific models after stenting. The results showed that when a stent was deployed, the large soft lipid pool in atherosclerotic plaques cushioned the host artery and reduced the stress within the arterial wall; however, this resulted in a sharp increase of VMS in the fibrous cap. When compared with the lipid pool, the presence of the calcified components led to slightly increased stresses on the luminal surface. However, when a calcification was located close to the luminal surface of the host artery and the stenosis, the local VMS was elevated. Overall, compared with calcified components, large lipid pools severely damaged the host artery after stenting. Furthermore, damage due to the calcified component may depend on location.

  16. Plaque components affect wall stress in stented human carotid artery:A numerical study

    Institute of Scientific and Technical Information of China (English)

    Zhen-Min Fan; Xiao Liu; Cheng-Fei Du; An-Qiang Sun; Nan Zhang; Zhan-Ming Fan; Yu-Bo Fan; Xiao-Yan Deng

    2016-01-01

    Carotid artery stenting presents challenges of in-stent restenosis and late thrombosis, which are caused primarily by alterations in the mechanical environment of the artery after stent implantation. The present study con-structed patient-specific carotid arterial bifurcation models with lipid pools and calcified components based on magnetic resonance imaging. We numerically analyzed the effects of multicomponent plaques on the distributions of von Mises stresses (VMSs) in the patient-specific models after stenting. The results showed that when a stent was deployed, the large soft lipid pool in atherosclerotic plaques cushioned the host artery and reduced the stress within the arterial wall;how-ever, this resulted in a sharp increase of VMS in the fibrous cap. When compared with the lipid pool, the presence of the calcified components led to slightly increased stresses on the luminal surface. However, when a calcification was located close to the luminal surface of the host artery and the stenosis, the local VMS was elevated. Overall, compared with calcified components, large lipid pools severely dam-aged the host artery after stenting. Furthermore, damage due to the calcified component may depend on location.

  17. 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

  18. [Edge effect and late thrombosis -- inevitable complications of vascular brachytherapy?].

    Science.gov (United States)

    Schiele, T M; Staber, L; Kantlehner, R; Pöllinger, B; Dühmke, E; Theisen, K; Klauss, V

    2002-11-01

    Restenosis is the limiting entity after percutaneous coronary angioplasty. Vascular brachytherapy for the treatment of in-stent restenosis has been shown to reduce the repeat restenosis rate and the incidence of major adverse events in several randomized trials. Besides the beneficial effects, brachytherapy yielded some unwanted side effects. The development of new stenoses at the edges of the target lesion treated with radiation is termed edge effect. It occurs after afterloading brachytherapy as well as after implantation of radioactive stents. It is characterized by extensive intimal hyperplasia and negative remodeling. As contributing factors the axial dose fall-off, inherent to all radioactive sources, and the application of vessel wall trauma by angioplasty have been identified. The combination of both factors, by insufficient overlap of the radiation length over the injured vessel segment, has been referred to as geographic miss. It has been shown to be associated with a very high incidence of the edge effect. Avoidance of geographic miss is strongly recommended in vascular brachytherapy procedures. Late thrombosis after vascular brachytherapy is of multifactorial origin. It comprises platelet recruitment, fibrin deposition, disturbed vasomotion, non-healing dissection and stent malapposition predisposing to turbulent blood flow. The strongest predictors for late thrombosis are premature discontinuation of antiplatelet therapy and implantation of new stents during the brachytherapy procedure. With a consequent and prolonged antiplatelet therapy, the incidence of late thrombosis has been reduced to placebo levels. Edge effect and late thrombosis represent unwanted side effects of vascular brachytherapy. By means of a thorough treatment planning and prolonged antiplatelet therapy their incidences can be largely reduced. With regard to the very favorable net effect, they do not constitute relevant limitations of vascular brachytherapy.

  19. 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

  20. 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

  1. 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

  2. Oral mycophenolate mofetil prevents in-stent intimal hyperplasia without edge effect.

    Science.gov (United States)

    Ilkay, Erdogan; Tirikli, Latif; Ozercan, Ibrahim; Yavuzkir, Mustafa; Karaca, Ilgin; Rahman, Ali; Arslan, Nadi

    2006-01-01

    Neointimal hyperplasia is in the forefront in in-stent restenosis. Prevention of in-stent restenosis is possible by reducing and inhibiting the hyperplasia of smooth muscle cells. The authors planned this study to test the hypothesis that when administered orally, mycophenolate mofetil (MMF) could inhibit in-stent neointimal hyperplasia. The study included 14 New Zealand rabbits. The rabbits were allocated to 2 different groups: Group 1 included 7 rabbits that were given MMF, 40 mg/kg/day by oral route. Group 2 included 7 rabbits that were not given MMF after the stenting. Sampling materials were taken before and after stenting by incising the artery so as to cover a 5-mm area. The samples taken from the edge of the stent in Group 1 showed focal neointimal cell proliferation, but it was less than that from the control group. Neointimal thickness was 0.048 +/-0.009 mm and neointimal area was 0.0925 +/-0.019 mm(2). Apparent neointimal cell proliferation and thickening of the intimal layer were observed in Group 2. Neointimal thickness at the stent edge was 0.147 +/-0.051 mm and the neointimal area was 0.154 +/-0.023 mm(2). The differences between groups in terms of neointimal thickness and neointimal area were statistically significant (p=0.001 for thickness and p=0.001 for area). In-stent artery samples of Group 1 showed that some subjects had no neointimal cell proliferation, while others had very limited focal intimal thickening. Neointimal thickening was 0.071 +/-0.003 mm and neointimal area was 0.073 +/-0.003 mm(2). In Group 2 apparent, and mostly focal, neointimal cell proliferation and formation of intimal layer were observed in the stent. Neointimal thickening was 0.154 +/-0.069 mm and neointimal area was 0.279 +/-0.059 mm(2). The comparison between groups showed significant differences (p=0.011 for thickness and p=0.001 for area). It was established in the third month that endothelialization was completed in both groups. Oral MMF decreased in-stent intimal

  3. 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

  4. 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.

  5. 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.

  6. 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

  7. 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.

  8. 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

  9. Intracoronary brachytherapy for in-stent restenosis of drug-eluting stents

    Directory of Open Access Journals (Sweden)

    Nisha Ohri, MD

    2016-01-01

    Conclusions: This is the largest recent known series looking at ICBT for recurrent ISR of DES. ICBT is a safe treatment option with similarly low rates (<5% of procedural and postprocedural complications compared with percutaneous coronary intervention alone. This study establishes the safety of ICBT in a high-risk patient cohort.

  10. 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.

  11. IVUS-Guided Implantation of Bioresorbable Vascular Scaffolds for Very Late Paclitaxel Stent Thrombosis

    Science.gov (United States)

    Lin, Zhe-Zhong; Chang, Wei-Ting; Chiang, Chun-Yen; Chen, Zhih-Cherng; Ku, Po-Ming

    2017-01-01

    Bioresorbable vascular scaffold (BVS) implantation has been shown to be safe in patients with stable coronary disease, and effective against the thrombotic lesion and the in-stent restenosis (ISR) of the drug-eluting stent (DES). BVSs have the advantages of a snow racket concept, positive vessel remodeling, and better conformability compared with DES in acute coronary syndrome (ACS). We report on a young patient with ST-elevation myocardial infarction (STEMI) who presented to our emergency department arising from very late stent thrombosis (VLST) of a 2.5 × 28 mm paclitaxel-eluting stent (Coroflex® Please) three years after its implantation. After the patient was treated with balloon dilation, intravascular ultrasound (IVUS) revealed a short segment of a guide wire outside the DES mesh. Two BVSs were implanted to prevent a DES recoil. Post-scaffold-implantation IVUS showed adequately expanded strut of BVSs. Six months later, optical coherence tomography (OCT) revealed that some segments of the scaffold had been absorbed and that there was no in-scaffold restenosis. The patient had not complained about angina during the out-patient clinic follow-up. This is the first report of successful BVS implantation for a STEMI patient attributable to DES VLST. PMID:28115812

  12. 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.

  13. 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

  14. Advances in stent technologies and their effect on clinical efficacy and safety

    Directory of Open Access Journals (Sweden)

    Nikam N

    2014-06-01

    Full Text Available Navin Nikam, Toby B Steinberg, Daniel H SteinbergDivision of Cardiology, Medical University of South Carolina, Charleston, SC, USAAbstract: The introduction of intracoronary stents represented a major advance in interventional cardiology. While bare metal stents set the benchmark for improved safety over angioplasty, intimal hyperplasia and subsequent restenosis were important limitations. First-generation drug-eluting stents demonstrated significant improvements in efficacy, but not necessarily safety, and further technologic developments have focused on optimizing both. Current advances and understanding in stent design continue to improve on these concepts. This review summarizes past and present technology with particular emphasis on the principles underlying the efficacy and safety of drug-eluting stents, and offers a glimpse into the next generations of stents aimed at treating symptomatic coronary artery disease.Keywords: drug-eluting stents percutaneous coronary intervention, coronary artery disease, bioabsorbable polymers, bioabsorbable struts, polymer free

  15. 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.

  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. Extent and distribution of in-stent intimal hyperplasia and edge effect in a non-radiation stent population.

    Science.gov (United States)

    Weissman, N J; Wilensky, R L; Tanguay, J F; Bartorelli, A L; Moses, J; Williams, D O; Bailey, S; Martin, J L; Canos, M R; Rudra, H; Popma, J J; Leon, M B; Kaplan, A V; Mintz, G S

    2001-08-01

    Intimal hyperplasia within the body of the stent is the primary mechanism for in-stent restenosis; however, stent edge restenosis has been described after brachytherapy. Our current understanding about the magnitude of in vivo intimal hyperplasia and edge restenosis is limited to data obtained primarily from select, symptomatic patients requiring repeat angiography. The purpose of this study was to determine the extent and distribution of intimal hyperplasia both within the stent and along the stent edge in relatively nonselect, asymptomatic patients scheduled for 6-month intravascular ultrasound (IVUS) as part of a multicenter trial: Heparin Infusion Prior to Stenting. Planar IVUS measurements 1 mm apart were obtained throughout the stent and over a length of 10 mm proximal and distal to the stent at index and follow-up. Of the 179 patients enrolled, 140 returned for repeat angiography and IVUS at 6.4 +/- 1.9 months and had IVUS images adequate for analysis. Patients had 1.2 +/- 0.6 Palmaz-Schatz stents per vessel. There was a wide individual variation of intimal hyperplasia distribution within the stent and no mean predilection for any location. At 6 months, intimal hyperplasia occupied 29.3 +/- 16.2% of the stent volume on average. Lumen loss within 2 mm of the stent edge was due primarily to intimal proliferation. Beyond 2 mm, negative remodeling contributed more to lumen loss. Gender, age, vessel location, index plaque burden, hypercholesterolemia, diabetes, and tobacco did not predict luminal narrowing at the stent edges, but diabetes, unstable angina at presentation, and lesion length were predictive of in-stent intimal hyperplasia. In a non-radiation stent population, 29% of the stent volume is filled with intimal hyperplasia at 6 months. Lumen loss at the stent edge is due primarily to intimal proliferation.

  18. 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

  19. 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.

  20. 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.

  1. 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.

  2. 药物洗脱支架置入治疗不同时期冠状动脉支架内再狭窄对比研究%Comparison of drug eluting stent for treatment of early and late in-stent restenosis

    Institute of Scientific and Technical Information of China (English)

    张宇晨; 赵林; 李宇; 陈方

    2014-01-01

    目的 比较药物洗脱支架(DES)治疗早期(≤1年)、晚期(>1年)支架内再狭窄病变(ISR)患者的长期临床疗效.方法 收集2008年10月至2011年12月在北京安贞医院因ISR接受DES置入治疗并完成临床随访的患者资料,根据DES术后发生ISR的时间是否大于1年分为早期ISR组与晚期组.比较两组组患者术后1年的主要不良心血管事件[MACE,包括全因死亡、心肌梗死(MI)和靶病变再次血运重建(TLR)].结果 早期ISR组入选患者80例,晚期ISR组入选患者124例.早期ISR组不稳定型心绞痛发生率明显低于晚期ISR组,差异有统计学意义(27.5%对63.7%,P<0.01);其余基线资料差异无统计学意义(P>0.05).两组在病变部位、病变类型、病变长度方面比较差异均无统计学意义(P>0.05).早期ISR组MACE发生率明显高于晚期ISR组(30%对15.3%,P<0.01),其中早期ISR组TLR明显高于晚期ISR组,差异有统计学意义(26.3%对12.1%,P<0.01).结论 DES治疗ISR患者安全有效,但治疗早期ISR组病变TLR发生率高于晚期ISR组.

  3. Targeting In-Stent-Stenosis with RGD- and CXCL1-Coated Mini-Stents in Mice.

    Science.gov (United States)

    Simsekyilmaz, Sakine; Liehn, Elisa A; Weinandy, Stefan; Schreiber, Fabian; Megens, Remco T A; Theelen, Wendy; Smeets, Ralf; Jockenhövel, Stefan; Gries, Thomas; Möller, Martin; Klee, Doris; Weber, Christian; Zernecke, Alma

    2016-01-01

    Atherosclerotic lesions that critically narrow the artery can necessitate an angioplasty and stent implantation. Long-term therapeutic effects, however, are limited by excessive arterial remodeling. We here employed a miniaturized nitinol-stent coated with star-shaped polyethylenglycole (star-PEG), and evaluated its bio-functionalization with RGD and CXCL1 for improving in-stent stenosis after implantation into carotid arteries of mice. Nitinol foils or stents (bare metal) were coated with star-PEG, and bio-functionalized with RGD, or RGD/CXCL1. Cell adhesion to star-PEG-coated nitinol foils was unaltered or reduced, whereas bio-functionalization with RGD but foremost RGD/CXCL1 increased adhesion of early angiogenic outgrowth cells (EOCs) and endothelial cells but not smooth muscle cells when compared with bare metal foils. Stimulation of cells with RGD/CXCL1 furthermore increased the proliferation of EOCs. In vivo, bio-functionalization with RGD/CXCL1 significantly reduced neointima formation and thrombus formation, and increased re-endothelialization in apoE-/- carotid arteries compared with bare-metal nitinol stents, star-PEG-coated stents, and stents bio-functionalized with RGD only. Bio-functionalization of star-PEG-coated nitinol-stents with RGD/CXCL1 reduced in-stent neointima formation. By supporting the adhesion and proliferation of endothelial progenitor cells, RGD/CXCL1 coating of stents may help to accelerate endothelial repair after stent implantation, and thus may harbor the potential to limit the complication of in-stent restenosis in clinical approaches.

  4. Targeting In-Stent-Stenosis with RGD- and CXCL1-Coated Mini-Stents in Mice.

    Directory of Open Access Journals (Sweden)

    Sakine Simsekyilmaz

    Full Text Available Atherosclerotic lesions that critically narrow the artery can necessitate an angioplasty and stent implantation. Long-term therapeutic effects, however, are limited by excessive arterial remodeling. We here employed a miniaturized nitinol-stent coated with star-shaped polyethylenglycole (star-PEG, and evaluated its bio-functionalization with RGD and CXCL1 for improving in-stent stenosis after implantation into carotid arteries of mice. Nitinol foils or stents (bare metal were coated with star-PEG, and bio-functionalized with RGD, or RGD/CXCL1. Cell adhesion to star-PEG-coated nitinol foils was unaltered or reduced, whereas bio-functionalization with RGD but foremost RGD/CXCL1 increased adhesion of early angiogenic outgrowth cells (EOCs and endothelial cells but not smooth muscle cells when compared with bare metal foils. Stimulation of cells with RGD/CXCL1 furthermore increased the proliferation of EOCs. In vivo, bio-functionalization with RGD/CXCL1 significantly reduced neointima formation and thrombus formation, and increased re-endothelialization in apoE-/- carotid arteries compared with bare-metal nitinol stents, star-PEG-coated stents, and stents bio-functionalized with RGD only. Bio-functionalization of star-PEG-coated nitinol-stents with RGD/CXCL1 reduced in-stent neointima formation. By supporting the adhesion and proliferation of endothelial progenitor cells, RGD/CXCL1 coating of stents may help to accelerate endothelial repair after stent implantation, and thus may harbor the potential to limit the complication of in-stent restenosis in clinical approaches.

  5. 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.

  6. Agreement of duplex ultrasonography vs. computed tomography angiography for evaluation of native and in-stent SFA re-stenosis—Findings from a randomized controlled trial

    Energy Technology Data Exchange (ETDEWEB)

    Langenberger, Herbert, E-mail: herbert.langenberger@meduniwien.ac.at [Department of Cardiovascular and Interventional Radiology, Medical University, Vienna (Austria); Schillinger, Martin [Department of Angiology, Medical University, Vienna (Austria); Plank, Christina [Department of Cardiovascular and Interventional Radiology, Medical University, Vienna (Austria); Sabeti, Schila; Dick, Petra [Department of Angiology, Medical University, Vienna (Austria); Cejna, Manfred; Lammer, Johannes [Department of Cardiovascular and Interventional Radiology, Medical University, Vienna (Austria); Minar, Erich [Department of Angiology, Medical University, Vienna (Austria); Loewe, Christian [Department of Cardiovascular and Interventional Radiology, Medical University, Vienna (Austria)

    2012-09-15

    Background: Multidetector CT angiography (CTA) is a non-invasive imaging technique for evaluation of peripheral vascular disease. CTA might be particularly useful for assessment of intermediate- and long-term morphological outcome after endovascular treatment. Validation of CTA vs. the current imaging standard, colour Doppler ultrasonography (CDUS), for quantification of native and in-stent re-stenosis in the superficial femoral artery (SFA) is required. Methods: Seventy randomized patients who underwent stent implantation (n = 47) or balloon angioplasty (n = 23) underwent 6-month follow-up with CDUS and CTA. CTA was compared with CDUS in both sub-groups of patients in terms of binary re-stenosis (>50% lumen narrowing) and re-occlusion. Agreement between CTA and CDUS was assessed using Kappa (κ) statistics with 95% confidence intervals, and correlation coefficients. Results: Binary re-stenosis was detected in 16/70 (22.9%) patients by CTA and 17/70 (24.3%) patients by CDUS (κ = 0.88, 95% CI: 0.80–0.96). Re-stenosis rates after balloon angioplasty were 39.1% (9/23) on CTA and CDUS (κ = 0.82, 95% CI: 0.66–0.98), and after stent implantation 14.9% (7/47) on CTA and 17.0% (8/47) on CDUS (κ = 0.92, 95% CI: 0.84–1.00). Re-occlusions were detected in 3/70 (4.3%) patients by both CTA and CDUS (κ = 0.65; 95% CI 0.54–0.76). Significant correlations (r = 0.85, p < 0.001) were noted between degree of re-stenosis on CTA and peak velocity ratio on CDUS. The correlation coefficient was higher in patients after balloon angioplasty (r = 0.94, p < 0.001) than in patients after stent implantation (r = 0.71, p < 0.001). Conclusion: CTA and CDUS show excellent agreement for evaluation of native and in-stent re-stenosis after endovascular treatment of SFA obstructions. CTA is an appropriate non-invasive imaging modality for follow-up after endovascular therapy.

  7. Small vessel stents for intracranial angioplasty: in vitro evaluation of in-stent stenoses using CT angiography

    Energy Technology Data Exchange (ETDEWEB)

    Trossbach, M.; Hartmann, M.; Braun, C.; Sartor, K.; Haehnel, S. [Division of Neuroradiology of the Department of Neurology, University of Heidelberg Medical Center, Im Neuenheimer Feld 400, 69120, Heidelberg (Germany)

    2004-06-01

    Our aim was to determine whether CT angiography is suitable for the evaluation of in-stent restenoses in small vessel stents for intracranial angioplasty. Therefore, we simulated stenoses with degrees of 25, 50, 75 and 90% in a total of 12 stents with different designs (MEDTRONIC AVE; ABBOT BioDivYsio, GUIDANT Neurolink, TERUMO Tsunami, COOK V-Flex Plus) and sizes (3.0 mm, 4.0 mm). For each stenosis, the apparent stenotic degree (ASD) was measured by CT angiography. Subjective (viewing at the CT images) and objective (acquisition of a density profile) evaluations were made after the stents were filled with a solution of 0.9% NaCl and with a diluted contrast medium. It was not possible to visualize the patent lumen in any of the stenotic stent segments by viewing at the CT images. After objective evaluation, the degree of the stenoses was generally overestimated. In the group with the 3.0-mm stents, ASD ranged from 73.6 to 100% in 25% degree stenoses. With the exception of one stent, stenoses with a degree of more than 25% appeared as vessel obstruction (ASD =100%) in the 3.0-mm group. In the 4.0-mm group, the mean ASD was 60% for 25% degree stenoses, 76% for 50% degree stenoses, 91% for 75% degree stenoses and 96% for 95% degree stenoses. The minimum diameter of stents for differentiation between in-stent restenosis and vessel occlusion using CT angiography is 4.0 mm. In CT angiography, the degrees of in-stent stenoses are generally overestimated. The evaluation of in-stent restenoses only seems to be possible when CT angiographic images before and after contrast application are evaluated objectively by density profiles. (orig.)

  8. 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.

  9. Late lumen loss and intima hyperplasia after sirolimus-eluting and zotarolimus-eluting stent implantation in diabetic patients: the diabetes and drug-eluting stent (DiabeDES III) angiography and intravascular ultrasound trial

    DEFF Research Database (Denmark)

    Jensen, Lisette Okkels; Mæng, Michael; Thayssen, Per;

    2011-01-01

    Patients with diabetes mellitus have increased risk of in-stent restenosis after coronary stent implantation due to neointimal hyperplasia (NIH). The aim of this study was to use quantitative coronary angiography (QCA) and volumetric intravascular ultrasound (IVUS) to evaluate the effects of the ...

  10. 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.

  11. 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

  12. Magnetic Nanoparticle-Mediated Targeting of Cell Therapy Reduces In-Stent Stenosis in Injured Arteries.

    Science.gov (United States)

    Polyak, Boris; Medved, Mikhail; Lazareva, Nina; Steele, Lindsay; Patel, Tirth; Rai, Ahmad; Rotenberg, Menahem Y; Wasko, Kimberly; Kohut, Andrew R; Sensenig, Richard; Friedman, Gary

    2016-09-19

    Although drug-eluting stents have dramatically reduced the recurrence of restenosis after vascular interventions, the nonselective antiproliferative drugs released from these devices significantly delay reendothelialization and vascular healing, increasing the risk of short- and long-term stent failure. Efficient repopulation of endothelial cells in the vessel wall following injury may limit complications, such as thrombosis, neoatherosclerosis, and restenosis, through reconstitution of a luminal barrier and cellular secretion of paracrine factors. We assessed the potential of magnetically mediated delivery of endothelial cells (ECs) to inhibit in-stent stenosis induced by mechanical injury in a rat carotid artery stent angioplasty model. ECs loaded with biodegradable superparamagnetic nanoparticles (MNPs) were administered at the distal end of the stented artery and localized to the stent using a brief exposure to a uniform magnetic field. After two months, magnetic localization of ECs demonstrated significant protection from stenosis at the distal part of the stent in the cell therapy group compared to both the proximal part of stent in the cell therapy group and the control (stented, nontreated) group: 1.7-fold (p < 0.001) less reduction in lumen diameter as measured by B-mode and color Doppler ultrasound, 2.3-fold (p < 0.001) less reduction in the ratios of peak systolic velocities as measured by pulsed wave Doppler ultrasound, and 2.1-fold (p < 0.001) attenuation of stenosis as determined through end point morphometric analysis. The study thus demonstrates that magnetically assisted delivery of ECs is a promising strategy for prevention of vessel lumen narrowing after stent angioplasty procedure.

  13. 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.

  14. Influence of strut cross-section of stents on local hemodynamics in stented arteries

    Science.gov (United States)

    Jiang, Yongfei; Zhang, Jun; Zhao, Wanhua

    2016-05-01

    Stenting is a very effective treatment for stenotic vascular diseases, but vascular geometries altered by stent implantation may lead to flow disturbances which play an important role in the initiation and progression of restenosis, especially in the near wall in stented arterial regions. So stent designs have become one of the indispensable factors needed to be considered for reducing the flow disturbances. In this paper, the structural designs of strut cross-section are considered as an aspect of stent designs to be studied in details. Six virtual stents with different strut cross-section are designed for deployments in the same ideal arterial model. Computational fluid dynamics (CFD) methods are performed to study how the shape and the aspect ratio (AR) of strut cross-section modified the local hemodynamics in the stented segments. The results indicate that stents with different strut cross-sections have different influence on the hemodynamics. Stents with streamlined cross-sectional struts for circular arc or elliptical arc can significantly enhance wall shear stress (WSS) in the stented segments, and reduce the flow disturbances around stent struts. The performances of stents with streamlined cross-sectional struts are better than that of stents with non-streamlined cross-sectional struts for rectangle. The results also show that stents with a larger AR cross-section are more conductive to improve the blood flow. The present study provides an understanding of the flow physics in the vicinity of stent struts and indicates that the shape and AR of strut cross-section ought to be considered as important factors to minimize flow disturbance in stent designs.

  15. 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.

  16. 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

  17. Assessment of Coronary Stents by 64-slice Computed Tomography:In-stent Lumen Visibility and Patency

    Institute of Scientific and Technical Information of China (English)

    Ling-yan Kong; Zheng-yu Jin; Shu-yang Zhang; Zhu-hua Zhang; Yi-ning Wang; Lan Song; Xiao-na Zhang; Yun-qing Zhang

    2009-01-01

    Objective To assess lumen visibility of coronary stents by 64-slice computed tomography(CT)coronary angiography,and determine the value of 64-slice CT in non-invasive detecting of in-stent restenosis after coronary artery stent implantation.Methods Totally,60 patients(54 males,aged 57.0±12.7 years)and 105 stents were investigated by 64-slice CT at a mean interval of 20.0±16.6 months after coronary stents implantation.Axial multi-planar reconstruction images of the stents and curved-planar reconstruction images through the median of the stents were reconstructed for evaluating stent image quality on a 5-point scale(1=excellent,5=nonassessable),and stent lumen diameter was detected.Conventional coronary angiography was performed in 18 patients,and 32 stents were evaluated.Results Image quality was good to excellent on average(score 1.71±0.76).Stent image quality score was correlated to heart rate(r=0.281,P<0.01)and stent diameter(r=0.480,P<0.001).All the stents were assessable in lumen visibility with an average visible lumen diameter percentage of 60.7% ±13.6% .Visible lumen diameter percentage was correlated to heart rate(r=-0.193,P<0.05),stent diameter (r=0.403,P<0.001),and stent image quality score(r=-0.500,P<0.001).Visible lumen diameter percentage also varied depending on the stent type.In comparison with the conventional coronary angiography,4 of 6 in-stent stenoses were correctly detected.The sensitivity and specificity for the detection of in-stent stenosis were 66.7% and 84.6% ,respectively.Conclusions Using a 64-slice CT,the stent lumen is partly visible in most of the stents.And 64-slice CT may be useful in the assessment of stent patency.

  18. 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

    cervical hematoma during the postoperative period. One transient facial nerve palsy and two transient recurrent nerve palsies occurred. Two late strokes in relation to two PCB occlusions occurred at 2 years and 4 years; no other graft stenosis or infection was observed. At 5 years, overall actuarial survival was 81% ± 7%, and the actuarial stroke-free rate was 93% ± 2%. There were no fatal strokes. PCB with PTFE grafts is a safe and durable alternative to CEA in patients with carotid restenosis after CEA or CAS in situations in which CEA is deemed either hazardous or inadvisable. Copyright © 2017 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.

  19. 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...

  20. 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

  1. 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...

  2. 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.

  3. 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.

  4. 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.

  5. 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

  6. 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

  7. 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.

  8. 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.

  9. 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.

  10. 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

  11. 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.……

  12. 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

  13. Qualitative and quantitative assessment of stent restenosis by optical coherence tomography: comparison between drug-eluting and bare-metal stents.

    Science.gov (United States)

    Nagoshi, Ryoji; Shinke, Toshiro; Otake, Hiromasa; Shite, Junya; Matsumoto, Daisuke; Kawamori, Hiroyuki; Nakagawa, Masayuki; Kozuki, Amane; Hariki, Hirotoshi; Inoue, Takumi; Ohsue, Tsuyoshi; Taniguchi, Yu; Iwasaki, Masamichi; Nishio, Ryo; Hiranuma, Noritoshi; Konishi, Akihide; Kinutani, Hiroto; Miyoshi, Naoki; Takaya, Tomofumi; Yamada, Shinichiro; Yasaka, Yoshinori; Hayashi, Takatoshi; Yokoyama, Mitsuhiro; Kato, Hiroki; Kadotani, Makoto; Ohnishi, Yoshio; Hirata, Ken-ichi

    2013-01-01

    We hypothesized that the tissue components of in-stent restenosis (ISR) might differ between drug-eluting stents (DES) and bare-metal stents (BMS) and that these differences could be distinguished by qualitative and quantitative optical coherence tomography (OCT) analyses. One-hundred and twenty-two initial ISR lesions (sirolimus-eluting stents: n=28; paclitaxel-eluting stents: n=51; BMS: n=43) were evaluated with OCT. Based on their OCT appearance, the lesions were classified as homogeneous, layered or heterogeneous. The optical properties of backscatter, attenuation and signal intensity of the neointimal tissue (NIT) were quantified. To evaluate the vascular response after balloon angioplasty (BA), the rate of reduction of the NIT area (NITA) was calculated (NITA before - after BA/NITA before BA at the minimum lumen cross-sectional area). Among the morphologic OCT patterns, the layered type was predominant with DES, whereas lesions were homogeneous with BMS (P<0.001). Backscatter and signal intensity were significantly higher with BMS (P<0.05 and P<0.001 respectively). The NITA reduction rate was significantly greater in the layered and heterogeneous groups than in the homogeneous group (P<0.01). The morphologic OCT patterns of the NIT in ISR differed significantly between DES and BMS, probably reflecting pathologic differences. Layered and heterogeneous tissues might respond better than homogeneous tissue to simple balloon dilatation, suggesting a possible direction for OCT-based ISR treatment strategies. 

  14. 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...

  15. 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.

  16. 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

  17. Optimal cut-off criteria for duplex ultrasound for the diagnosis of restenosis in stented carotid arteries: Review and protocol for a diagnostic study

    NARCIS (Netherlands)

    Nederkoorn, P.J.; Brown, M.M.

    2009-01-01

    Background: Carotid angioplasty with stenting is a relatively new, increasingly used, less-invasive treatment for the treatment of symptomatic carotid artery stenosis. It is being evaluated in ongoing and nearly finished randomized trials. An important factor in the evaluation of stents is the occur

  18. 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

  19. 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

  20. 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.

  1. Late Intervention-Related Complication - A Huge Subepicardial Hematoma.

    Science.gov (United States)

    Ko, Po-Yen; Chang, Chih-Ping; Yang, Chen-Chia; Lin, Jen-Jyh

    2013-05-01

    A 75-year-old man had a history of triple vessel coronary artery disease. In August 2009, he had undergone successful percutaneous coronary intervention to the left circumflex coronary artery (LCX) for management of an in-stent restenosis (ISR) lesion. However, in September 2010, he began experiencing recurrent episodes of exertional chest pain. Chest radiography showed the left cardiac border bulging upwards. Transthoracic echocardiography and chest computed tomography revealed a huge oval mass of about 10.4 cm × 7.9 cm × 8.6 cm, which showed calcification and was obliterating the LCX. Subsequent coronary angiography revealed significant instent restenosis, with extravasation of a small amount of contrast material at the stent location, suggesting that the coronary artery had ruptured. We implanted a polytetrafluoroethylene-covered stent to seal the coronary perforation and to release the occlusion. The patient was symptom-free and had an uneventful outcome until the 1-year follow up. Coronary artery perforation; Covered stent; Hematoma.

  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. Pitavastatin-incorporated nanoparticle-eluting stents attenuate in-stent stenosis without delayed endothelial healing effects in a porcine coronary artery model.

    Science.gov (United States)

    Tsukie, Noriaki; Nakano, Kaku; Matoba, Tetsuya; Masuda, Seigo; Iwata, Eiko; Miyagawa, Miho; Zhao, Gang; Meng, Wei; Kishimoto, Junji; Sunagawa, Kenji; Egashira, Kensuke

    2013-01-01

    The use of currently marketed drug-eluting stents presents safety concerns including increased late thrombosis, which is thought to result mainly from delayed endothelial healing effects (impaired re-endothelialization resulting in abnormal inflammation and fibrin deposition). We recently developed a bioabsorbable polymeric nanoparticle (NP)-eluting stent using a novel cationic electrodeposition technology. Statins are known to inhibit the proliferation of vascular smooth muscle cells (VSMC) and to promote vascular healing. We therefore hypothesized that statin-incorporated NP-eluting stents would attenuate in-stent stenosis without delayed endothelial healing effects. Among six marketed statins, pitavastatin (Pitava) was found to have the most potent effects on VSMC proliferation and endothelial regeneration in vitro. We thus formulated a Pitava-NP-eluting stent (20µg Pitava per stent). In a pig coronary artery model, Pitava-NP-eluting stents attenuated in-stent stenosis as effectively as polymer-coated sirolimus-eluting stents (SES). At SES sites, delayed endothelial healing effects were noted, whereas no such effects were observed in Pitava-NP-eluting stent sites. Pitava-NP-eluting stents attenuated in-stent stenosis as effectively as SES without the delayed endothelial healing effects of SES in a porcine coronary artery model. This nanotechnology platform could be developed into a safer and more effective device in the future.

  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 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.

  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. 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.

  8. 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.

  9. 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.)

  10. Periluminal expression of a secreted transforming growth factor-β type II receptor inhibits in-stent neointima formation following adenovirus-mediated stent-based intracoronary gene transfer.

    Science.gov (United States)

    Appleby, Clare E; Ranjzad, Parisa; Williams, Paul D; Kakar, Salik J; Driessen, Anita; Tijsma, Edze; Fernandes, Brian; Heagerty, Anthony M; Kingston, Paul A

    2014-05-01

    Transforming growth factor-β1 (TGF-β1) has been shown unequivocally to enhance neointima formation in carotid and ileo-femoral arteries. In our previous studies, however, TGF-β1 expression in coronary arteries actually reduced neointima formation without affecting luminal loss postangioplasty, while expression of a TGF-β1 antagonist (RIIs) in balloon-injured coronary arteries reduced luminal loss without affecting neointima formation. These observed effects may be a consequence of the mode of coronary artery gene transfer employed, but they may also represent differences in the modes of healing of coronary, carotid, and ileo-femoral arteries after endoluminal injury. To help clarify whether a gene therapy strategy to antagonize TGF-β might have application within the coronary vasculature, we have investigated the effect of high-level periluminal expression of RIIs using stent-based adenovirus-mediated intracoronary gene transfer. Porcine coronary arteries were randomized to receive a custom-made CoverStent preloaded with saline only, or with 1×10(9) infectious units of adenovirus expressing RIIs or β-galactosidase (lacZ). Vessels were analyzed 28 days poststenting, at which time angiographic in-stent diameter was significantly greater in RIIs-treated arteries, and in-stent luminal loss significantly reduced. Computerized morphometric minimum in-stent lumen area was ~300% greater in RIIs-exposed vessels than in lacZ or saline-only groups. This was because of significantly reduced neointima formation in the RIIs group. RIIs had no demonstrable effect on cellular proliferation or apoptosis, but greater normalized neointimal/medial collagen content was observed in RIIs-exposed arteries. These data highlight the qualitatively similar effect of TGF-β antagonism on neointima formation in injured coronary and noncoronary arteries, and suggest that since cellular proliferation is unaffected, TGF-β1 antagonism might prevent in-stent restenosis without the delayed

  11. 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.

  12. 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

  13. Delayed complications after flow-diverter stenting: reactive in-stent stenosis and creeping stents.

    Science.gov (United States)

    Cohen, José E; Gomori, John Moshe; Moscovici, Samuel; Leker, Ronen R; Itshayek, Eyal

    2014-07-01

    We assessed the frequency and severity of changes in stent configuration and location after the treatment of intracranial aneurysms, and patterns of in-stent stenosis. We retrospectively reviewed data for consecutive aneurysm patients managed with endovascular implantation of flow-diverter stents (Silk Flow Diverter [Balt Extrusion, Montmorency, France] and Pipeline Embolization Device [ev3/Coviden, Minneapolis, MN, USA]) from October 2011 to July 2012. Routine 2, 6, 9-12, and 16-20 month follow-up angiograms were compared, with a focus on changes in stent configuration and location from immediately after deployment to angiographic follow-up, and the incidence and development of in-stent stenosis. Thirty-four patients with 42 aneurysms met inclusion criteria. The Silk device was implanted in 16 patients (47%, single device in 15), the Pipeline device in 18 (53%, single device in 16). On first follow-up angiography, in-stent stenosis was observed in 38% of Silk devices and 39% of Pipeline devices. In-stent stenosis was asymptomatic in 12 of 13 patients. One woman presented with transient ischemic attacks and required stent angioplasty due to end tapering and mild, diffuse in-stent stenosis. Configuration and location changes, including stent creeping and end tapering were seen in 2/16 patients (13%) with Silk devices, and 0/18 patients with Pipeline devices. We describe stent creeping and end tapering as unusual findings with the potential for delayed clinical complications. In-stent stenosis, with a unique behavior, is a frequent angiographic finding observed after flow-diverter stent implant. The stenosis is usually asymptomatic; however, close clinical and angiographic monitoring is mandatory for individualized management. Copyright © 2013 Elsevier Ltd. All rights reserved.

  14. 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...

  15. 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.

  16. 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.

  17. Comparison of early and late results of a Carbofilm-coated stent versus a pure high-grade stainless steel stent (the Carbostent-Trial).

    NARCIS (Netherlands)

    Sick, P.B.; Gelbrich, G.; Kalnins, U.; Erglis, A.; Bonan, R.; Aengevaeren, W.R.M.; Elsner, D.; Lauer, B.; Woinke, M.; Brosteanu, O.; Schuler, G.

    2004-01-01

    The long-term success of coronary interventions with stents is largely determined by the development of restenosis. The aim of this study was to compare a Carbofilm-coated and a pure stainless steel stent with regard to early and late adverse events. In this prospective, randomized trial, the Carbof

  18. 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.)

  19. Coronary artery stent geometry and in-stent contrast attenuation with 64-slice computed tomography

    Energy Technology Data Exchange (ETDEWEB)

    Schepis, Tiziano; Koepfli, Pascal; Gaemperli, Oliver; Eberli, Franz R.; Luescher, Thomas F. [University Hospital Zurich, Cardiovascular Center, Zurich (Switzerland); Leschka, Sebastian; Desbiolles, Lotus; Husmann, Lars; Wildermuth, Simon; Marincek, Borut; Alkadhi, Hatem [University Hospital Zurich, Institute of Diagnostic Radiology, Zurich (Switzerland); Kaufmann, Philipp A. [University Hospital Zurich, Cardiovascular Center, Zurich (Switzerland); Zurich Center for Integrative Human Physiology, Zurich (Switzerland)

    2007-06-15

    We aimed at assessing stent geometry and in-stent contrast attenuation with 64-slice CT in patients with various coronary stents. Twenty-nine patients (mean age 60 {+-} 11 years; 24 men) with 50 stents underwent CT within 2 weeks after stent placement. Mean in-stent luminal diameter and reference vessel diameter proximal and distal to the stent were assessed with CT, and compared to quantitative coronary angiography (QCA). Stent length was also compared to the manufacturer's values. Images were reconstructed using a medium-smooth (B30f) and sharp (B46f) kernel. All 50 stents could be visualized with CT. Mean in-stent luminal diameter was systematically underestimated with CT compared to QCA (1.60 {+-} 0.39 mm versus 2.49 {+-} 0.45 mm; P < 0.0001), resulting in a modest correlation of QCA versus CT (r = 0.49; P < 0.0001). Stent length as given by the manufacturer was 18.2 {+-} 6.2 mm, correlating well with CT (18.5 {+-} 5.7 mm; r = 0.95; P < 0.0001) and QCA (17.4 {+-} 5.6 mm; r = 0.87; P < 0.0001). Proximal and distal reference vessel diameters were similar with CT and QCA (P = 0.06 and P = 0.03). B46f kernel images showed higher image noise (P < 0.05) and lower in-stent CT attenuation values (P < 0.001) than images reconstructed with the B30f kernel. 64-slice CT allows measurement of coronary artery in-stent density, and significantly underestimates the true in-stent diameter compared to QCA. (orig.)

  20. 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.

  1. [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

  2. Analysis of influence factors of restenosis after stenting of vertebral artery origin symptomatic stenosis%症状性椎动脉开口处狭窄支架成形术后再狭窄的影响因素分析

    Institute of Scientific and Technical Information of China (English)

    倪贵华; 赵卫东; 田向阳; 倪小宇; 孙波; 陈林芳

    2016-01-01

    目的:探讨症状性椎动脉开口处狭窄支架成形术后再狭窄的影响因素。方法收集2010年1月~2015年5月在南京医科大学附属淮安医院住院治疗症状性椎动脉开口处支架成形术的患者的所有临床资料。采用DSA或CTA评估患者术后半年时再狭窄情况,分析再狭窄发生的危险因素。结果44例资料完整的患者被纳入分析,其中共有11例(25%)患者发生支架术后再狭窄,但发生症状性再狭窄需要再次治疗仅1例。再狭窄组与无再狭窄组性别、年龄、饮酒、高血压、糖尿病、高脂血症、狭窄侧别(左侧、右侧)、术前狭窄率、残余狭窄率和狭窄部位长度、随访时间、支架品牌等比较,差异无统计学意义(均P>0.05)。再狭窄组吸烟的比例(54.5%)明显高于无再狭窄组(18.2%)(P=0.045);再狭窄组狭窄处远端正常椎动脉直径[(3.1±0.4) mm]明显小于无再狭窄组[(3.8±0.5) mm](P<0.001)。多因素Logistic回归分析显示,吸烟和椎动脉直径是支架成形术后再狭窄的独立影响因素(均P<0.05)。结论症状性椎动脉开口处狭窄支架成形术后再狭窄与吸烟和椎动脉直径密切相关。%Objective To investigate the influence factors of restenosis after stenting of vertebral artery origin symptomatic stenosis.Methods All clinical data of patients with symptomatic vertebral artery origin stenosis treated with stents were collected during the January 2010 to May 2015 in Huai'an Hospital Affiliated to Nanjing Medical University.The stent restenosis was assessed by digital subtraction angiography or CT angiography 6 months after stenting.Influencing factors of the restenosis in stent were analyzed.Results A total of 44 patients with complete data were included.Among them, 11 patients ( 25%) with stent restenosis occurred.However, only one patient experienced symptomatic restenosis and needed

  3. 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.

  4. 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.)

  5. 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.

  6. 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.

  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. 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

  10. Frequency and consequences of early in-stent lesions after carotid artery stent placement.

    NARCIS (Netherlands)

    Jongen, L.M.; Hendrikse, J.; Waaijer, A.; Worp, H.B. van der; Leijdekkers, V.J.; Lo, R.T.; Mali, W.P.Th.; Prokop, M.

    2009-01-01

    PURPOSE: To examine the prevalence of in-stent lesions 1 month after carotid artery stent placement with multidetector computed tomography (CT) angiography and to evaluate their possible causes and their consequences during 1-year follow-up. MATERIALS AND METHODS: Sixty-nine patients with symptomati

  11. 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.

  12. 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.

  13. 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.

  14. 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

  15. 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

  16. 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

  17. 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.

  18. Initial clinical experience of CrossBoss catheter for in-stent chronic total occlusion lesions

    Science.gov (United States)

    Zhao, Lei; Li, Long-Bo; Wang, Zhi-Hui; Shi, Yong-Feng; Wu, Jun-Duo; Zhang, Ji-Chang; Liu, Bin

    2016-01-01

    Abstract Background: The CrossBoss coronary chronic total occlusion (CTO) crossing catheter has been demonstrated to have greatly improved the success rate of crossing CTO lesions, but there are no published data on its application for in-stent CTO lesions. Methods: In the current study, we retrospectively reviewed the clinical data of 8 patients with in-stent CTO lesions that were managed with the CrossBoss catheter and herein we report the efficacy and safety of the CrossBoss crossing and re-entry system for this clinically challenging condition. Results: The CrossBoss catheter was used for 8 patients with in-stent CTO lesions, which resulted in success in 6 cases and failure in 2 cases, with a 75% success rate. Of the 6 patients with successful treatment, 5 cases had the occlusive lesions crossed with the CrossBoss catheter through a proximal lumen-to-distal lumen approach, whereas the remaining case had his occlusive lesions penetrated by the CrossBoss catheter and the guidewire. Two cases failed in treatment as the CrossBoss catheter could not cross the occlusive lesions. The 6 cases with successful treatment included 3 cases with occlusive lesions in the left anterior descending artery, 1 case with occlusive lesions in the obtuse marginal branches, and 2 cases with occlusive lesions in the right coronary artery, and the 2 cases with failure in treatment had their occlusive lesions in the right coronary artery. In addition, patients with a higher Japan chronic total occlusion score were found to have a lower success rate of crossing the occlusive lesions. None of the patients developed complications. Conclusion: Our study demonstrates that the CrossBoss catheter has a high success rate and is safe for in-stent CTOs and can be recommended for this rather clinically challenging condition. PMID:27749568

  19. In-stent thrombosis when switching ticagrelor to clopidogrel after percutaneous coronary intervention.

    Science.gov (United States)

    Brice, Aaron E; Hernandez, Gabriel A; Sanchez, Mariluz; Haynick, Marshall; Mendoza, Cesar E

    2017-05-01

    Dual antiplatelet therapy with aspirin and a P2Y12 receptor blocker has been proven to reduce subsequent cardiovascular events and in-stent thrombosis in patients undergoing percutaneous coronary intervention. Newer P2Y12 antagonists with faster onset and greater inhibition of platelet activity have improved cardiovascular outcomes but have created uncertainty with the appropriate dosing when switching between agents. Currently, there are no evidence-based guidelines to aid clinicians when switching between P2Y12 receptor blockers. Here we describe two patients that developed in-stent thrombosis when switching from ticagrelor to clopidogrel using a 300 mg clopidogrel loading dose. Both patients presented with ST elevation myocardial infarction and underwent stent placement but then developed in-stent thrombosis 48 hours after switching from ticagrelor to clopidogrel. These cases illustrate the severe consequences of suboptimal platelet inhibition and the need for prospective trials thoroughly powered to assess clinical outcomes in order to determine the most appropriate strategy when switching from ticagrelor to clopidogrel.

  20. 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

  1. Correlation Study on Hematology Indexes and Patients with Post-PCI In-stent Restenosis%部分血液学指标与PCI术后支架内再狭窄的相关性

    Institute of Scientific and Technical Information of China (English)

    范亚红; 刘兴德

    2016-01-01

    目的:探讨红细胞分布宽度(RDW)、胱抑素c(Cysc)、载脂蛋白B(ApoB)和总胆红素(TBil)与经皮冠状动脉介入治疗(PCI)术后患者冠状动脉支架内再狭窄(ISR)的相关性.方法:接受PCI手术以及于术后6~16个月内复查冠状动脉造影的冠心病患者206例,根据冠脉造影结果分为ISR组(51例)和非ISR组(155例);采用单因素及多因素Logistic回归分析方法,分析部分血液学指标与PCI术后ISR的危险因素;根据Logistic回归分析结果,按RDW、TBil、Cysc及ApoB水平(四分位法)分为4组,比较各组ISR的发生率.结果:单因素分析发现,与非ISR组比较,ISR组的RDW、Cysc、总胆固醇(TC)、低密度脂蛋白酯(LDL-C)、ApoB显著增高,而TBil显著降低,差异具有统计学意义(P<0.05或P<0.01);多因素回归分析显示,RDW、Cysc、ApoB是ISR的危险因素,而较高水平的TBil是ISR保护性因素;四分位法分组发现,与相应低四分位数水平的PCI术后患者比较,RDW、Cysc及ApoB为高四分位数水平患者的ISR发生率显著增高(P<0.05或P<0.01);而TBil高四分位数水平患者的ISR发生率显著降低(P<0.01).结论:血清RDW、Cysc、ApoB、TBil与PCI术后冠心病患者的冠状动脉ISR密切相关.

  2. Correlational Factors Analysis of Coronary Artery In-stent Restenosis%冠状动脉支架内再狭窄的相关性因素分析

    Institute of Scientific and Technical Information of China (English)

    杨蕾; 王丽娟

    2013-01-01

    目的 通过分析冠状动脉支架内再狭窄(ISR)的相关性因素,探讨如何降低冠状动脉ISR的发生.方法 选择100例冠状动脉ISR和100例无冠状动脉ISR的患者,通过对比两组患者的冠心病危险因素及冠状动脉支架情况来分析影响冠状动脉ISR的相关因素,并通过Logistic回归分析得出相关因素的相关强度排序.结果 吸烟、血压、血糖、总胆固醇、低密度脂蛋白胆固醇和支架直径、长度、部位、数量在冠状动脉ISR组与无冠状动脉ISR组比较中,有显著性差异(P<0.05);急性心肌梗死患者中,未应用Ⅱb/Ⅲa受体拮抗剂及C反应蛋白增高者在两组比较中有显著性差异(P<0.05).Logistic回归分析结果显示冠状动脉ISR与餐后2h血糖及吸烟相关性较强;冠状动脉ISR与冠状动脉支架情况的相关性强度为:多枚支架>支架直径>支架长度>支架部位.结论 糖尿病、吸烟、高血压、高脂血症及冠状动脉多支病变、重度狭窄、急性心肌梗死患者未应用血小板Ⅱb/Ⅲa受体拮抗剂、C反应蛋白升高是冠状动脉ISR的重要相关因素.

  3. Evaluation of coronary artery in-stent restenosis using 64-slice CT%64层螺旋CT评价冠状动脉支架内再狭窄的价值

    Institute of Scientific and Technical Information of China (English)

    刘新; 李颖; 杨立; 赵锡海; 王新疆; 赵绍宏; 张玉霄; 蔡祖龙

    2006-01-01

    目的 评介64层螺旋CT诊断冠状动脉支架内再狭窄(ISR)的临床价值.方法 采用64层螺旋CT对14例冠状动脉支架置入术后的患者(共37个支架)进行CT冠状动脉成像(CTA).在CTA上,通过肉眼观察和测量支架内CT值两种方法诊断ISR.以冠状动脉造影(ISR≥50%)为标准,计算并比较两种方法诊断ISR的准确性.结果 37个支架中,CCA检出ISR(≥50%)11个,正常(包括ISR<50%)26个.与CCA对照,CTA肉眼观察法正确诊断ISR 2个,正常18个,CT值测量法则分别正确诊断ISR 3个,正常21个.两种方法诊断ISR的敏感性、特异性、阳性预测值和阴性预测值分别为18%、69%、20%、67%和27%、81%、38%、72%.两种方法各项准确性指标之间差异均无统计学意义(P>0.05).结论 64层螺旋CT诊断ISR十分困难,但对排除ISR有一定的作用.

  4. Cyclic strain amplitude dictates the growth response of vascular smooth muscle cells in vitro: role in in-stent restenosis and inhibition with a sirolimus drug-eluting stent.

    Science.gov (United States)

    Colombo, Alberto; Guha, Shaunta; Mackle, Joseph N; Cahill, Paul A; Lally, Caitríona

    2013-08-01

    The putative effects of changes in mean strain and cyclic strain amplitude on vascular smooth muscle cell (vSMC) growth (proliferation and apoptosis) were examined. Subsequently, a quantitative measure of vSMC growth was obtained to determine the prolonged effect of changes in mechanical burden following bare-metal stent (BMS) and sirolimus drug-eluting stent (DES) deployment in vitro. Bovine aortic vSMCs were exposed to prolonged cyclic strain using a Flexercell(TM) Tension system and a novel Sylgard(TM) phantom vessel following stent implantation before the level of vSMC proliferation and apoptosis was assessed by FACS analysis, cell counting, and immunocytochemistry. Physiological cyclic strain (5%) decreased vSMC proliferation and increased apoptosis in a temporal manner. There was no significant difference in cell growth following exposure to varying mean strains with similar amplitude. In contrast, exposure to varying strain amplitudes with similar mean strains resulted in significant differences in cell proliferation and apoptosis. In parallel studies, the level of vSMC proliferation and cell survival was significantly increased within low amplitude, high mean strain regions of a phantom vessel following BMS implantation when compared to regions of higher strain amplitude upstream and downstream of the stent, respectively. Moreover, the level of vSMC growth within the stented region was significantly attenuated following implantation of a sirolimus-coated DES independent of significant changes in cell survival. Cyclic strain amplitude is an important regulator of vSMC growth capacity within a stent and is a target for inhibition using a sirolimus-coated DES.

  5. 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

  6. High Residual Collagen-Induced Platelet Reactivity Predicts Development of Restenosis in the Superficial Femoral Artery After Percutaneous Transluminal Angioplasty in Claudicant Patients

    Energy Technology Data Exchange (ETDEWEB)

    Gary, Thomas, E-mail: thomas.gary@medunigraz.at [Medical University of Graz, Division of Angiology, Department of Internal Medicine (Austria); Prüller, Florian, E-mail: florian.prueller@klinikum-graz.at; Raggam, Reinhard, E-mail: reinhard.raggam@klinikum-graz.at [Medical University of Graz, Clinical Institute of Medical and Chemical Laboratory Diagnostics (Austria); Mahla, Elisabeth, E-mail: elisabeth.mahla@medunigraz.at [Medical University of Graz, Department of Anesthesiology and Intensive Care Medicine (Austria); Eller, Philipp, E-mail: philipp.eller@medunigraz.at; Hafner, Franz, E-mail: franz.hafner@klinikum-graz.at; Brodmann, Marianne, E-mail: marianne.brodmann@medunigraz.at [Medical University of Graz, Division of Angiology, Department of Internal Medicine (Austria)

    2016-02-15

    PurposeAlthough platelet reactivity is routinely inhibited with aspirin after percutaneous angioplasty (PTA) in peripheral arteries, the restenosis rate in the superficial femoral artery (SFA) is high. Interaction of activated platelets and the endothelium in the region of intervention could be one reason for this as collagen in the subendothelium activates platelets.Materials and MethodsA prospective study evaluating on-site platelet reactivity during PTA and its influence on the development of restenosis with a total of 30 patients scheduled for PTA of the SFA. Arterial blood was taken from the PTA site after SFA; platelet function was evaluated with light transmission aggregometry. After 3, 6, 12, and 24 months, duplex sonography was performed and the restenosis rate evaluated.ResultsEight out of 30 patients developed a hemodynamically relevant restenosis (>50 % lumen narrowing) in the PTA region during the 24-month follow-up period. High residual collagen-induced platelet reactivity defined as AUC >30 was a significant predictor for the development of restenosis [adjusted odds ratio 11.8 (9.4, 14.2); P = .04].ConclusionsHigh residual collagen-induced platelet reactivity at the interventional site predicts development of restenosis after PTA of the SFA. Platelet function testing may be useful for identifying patients at risk.

  7. Late Budgets

    DEFF Research Database (Denmark)

    Andersen, Asger Lau; Lassen, David Dreyer; Nielsen, Lasse Holbøll Westh

    The budget forms the legal basis of government spending. If a budget is not in place at the beginning of the fiscal year, planning as well as current spending are jeopardized and government shutdown may result. This paper develops a continuous-time war-of-attrition model of budgeting...... in a presidential style-democracy to explain the duration of budget negotiations. We build our model around budget baselines as reference points for loss averse negotiators. We derive three testable hypotheses: there are more late budgets, and they are more late, when fiscal circumstances change; when such changes...... are negative rather than positive; and when there is divided government. We test the hypotheses of the model using a unique data set of late budgets for US state governments, based on dates of budget approval collected from news reports and a survey of state budget o¢ cers for the period 1988...

  8. Late Budgets

    DEFF Research Database (Denmark)

    Andersen, Asger Lau; Lassen, David Dreyer; Nielsen, Lasse Holbøll Westh

    are negative rather than positive; and when there is divided government. We test the hypotheses of the model using a unique data set of late budgets for US state governments, based on dates of budget approval collected from news reports and a survey of state budget o¢ cers for the period 1988......The budget forms the legal basis of government spending. If a budget is not in place at the beginning of the fiscal year, planning as well as current spending are jeopardized and government shutdown may result. This paper develops a continuous-time war-of-attrition model of budgeting...... in a presidential style-democracy to explain the duration of budget negotiations. We build our model around budget baselines as reference points for loss averse negotiators. We derive three testable hypotheses: there are more late budgets, and they are more late, when fiscal circumstances change; when such changes...

  9. Computational simulation methodologies for mechanobiological modelling: a cell-centred approach to neointima development in stents.

    Science.gov (United States)

    Boyle, C J; Lennon, A B; Early, M; Kelly, D J; Lally, C; Prendergast, P J

    2010-06-28

    The design of medical devices could be very much improved if robust tools were available for computational simulation of tissue response to the presence of the implant. Such tools require algorithms to simulate the response of tissues to mechanical and chemical stimuli. Available methodologies include those based on the principle of mechanical homeostasis, those which use continuum models to simulate biological constituents, and the cell-centred approach, which models cells as autonomous agents. In the latter approach, cell behaviour is governed by rules based on the state of the local environment around the cell; and informed by experiment. Tissue growth and differentiation requires simulating many of these cells together. In this paper, the methodology and applications of cell-centred techniques--with particular application to mechanobiology--are reviewed, and a cell-centred model of tissue formation in the lumen of an artery in response to the deployment of a stent is presented. The method is capable of capturing some of the most important aspects of restenosis, including nonlinear lesion growth with time. The approach taken in this paper provides a framework for simulating restenosis; the next step will be to couple it with more patient-specific geometries and quantitative parameter data.

  10. [A Case of Peritoneal Metastasis in Which Colostomy Was Useful for Restenosis after Stenting].

    Science.gov (United States)

    Tagawa, Hiroko; Yoshimatsu, Kazuhiko; Yokomizo, Hajime; Yano, Yuki; Nakayama, Mao; Okayama, Sachiyo; Satake, Masaya; Sakuma, Akiko; Matsumoto, Atsuo; Fujimoto, Takashi; Shiozawa, Shunichi; Shimakawa, Takeshi; Katsube, Takao; Kato, Hiroyuki; Naritaka, Yoshihiko

    2015-11-01

    We report a case of restenosis after performing stenting twice for ileus caused by peritoneal dissemination that occurred after surgery for sigmoid colon cancer, in which colostomy was performed to improve the patient's QOL. The patient was a 58-year-old woman who underwent sigmoidectomy for sigmoid colon cancer. She presented with a peritoneal recurrence 3 times, and the third surgery was a non-curative resection. Chemotherapy was administered but was discontinued because of severe adverse events, and the patient was followed up with the best supportive care. An anastomotic stricture occurred 4 years after the initial surgery, and despite performing stenting twice, stenosis occurred 3 times within a few months. The third stenosis occurred shortly after the second episode, and colostomy was therefore performed. The patient died from cancer 4 months after colostomy without having another episode of stenosis. Although stenting is effective for patients with malignant colon stenosis, colostomy appears to be more effective for repeated post-stenting stenosis, when the patient is in an eligible general condition.

  11. 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.

  12. Sirolimus-eluting stents for treatment of drug-eluting versus bare-metal stents restenosis: 42-month clinical outcomes from a Chinese single center

    Institute of Scientific and Technical Information of China (English)

    YAN Rong-qiang; LIU Hai-bo; WU Yong-jian; YUAN Jin-qing; CHEN Jue; YOU Shi-jie; DAI Jun; GAO Run-lin; CHEN Ji-lin; GAO Li-jian; YANG Yue-jin; LI Jian-jun; QIAO Shu-bin; XU Bo; YAO Min; QIN Xue-wen

    2012-01-01

    Background Restenosis of bare-metal stents (BMS) and drug-eluting stents (DES) has been increasingly treated with sirolimus-eluting stents (SES),but the long-term outcomes are unknown.Methods In our study,388 consecutive patients (144 DES restenosis and 244 BMS restenosis) with 400 lesions (147 DES restenosis and 253 BMS restenosis) treated with SES were included.The rates of target lesion revascularization (TLR) and major adverse cardiac events (MACE) at 42 months were analyzed.Results At the mean follow-up of 42 months,the rates of death (3.5% vs.3.3%,P=1.000) and myocardial infarction (2.8% vs.1.2%,P=0.431) in the DES group and BMS group were comparable.Compared with the BMS group,ischemia-driven TLR occurred with a higher frequency in the DES group (18.8% vs.10.7%,P=0.024).This translated into an increased rate of MACE in the DES group (22.2% vs.14.0%,P=0.034).Stent thrombosis occurred with a similar frequency in both groups (2.8% vs.1.6%,P=0.475).Multivariate analysis showed that DES restenosis (OR=1.907,95%Cl 1.108-3.285,P=0.020) and smoking (OR=2.069; 95% C/ 1.188-3.605; P=0.010) were independent predictors of MACE.Conclusions Although SES implantation appears to be safe and effective,it was associated with higher TLR recurrence for DES than BMS restenosis.

  13. 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.

  14. 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.

  15. 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.

  16. 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.

  17. Neoatherosclerosis in the stent

    Directory of Open Access Journals (Sweden)

    A. A. Komkov

    2015-01-01

    Full Text Available Achievements of interventional cardiology in the treatment of coronary artery disease are based on coronary balloon angioplasty with implanting bare metal stents and drug eluting stents. Questions of complications such as early stent thrombosis and restenosis of stent were solved in a considerable degree. However, with the lengthening of the followup period, the problem of late complications became obvious. Except endothelization and fibromuscular proliferation in stented coronary arteries the process of plaque formation has an important influence on later complications in follow-up period more than one year. This process was defined as neoatherosclerosis. This is verified by clinical manifestations of the disease, histological studies, angioscopy, intravascular ultrasound and optical-coherence tomography in stented patients. Dynamic observation of the condition in stentedcoronary arteries showed multistep proliferation with restenosis, its regression, and neoatherosclerosis development. Evidences of neoatherosclerosis formation in stented coronary arteries are considered in this review.

  18. Very late bare-metal stent thrombosis, rare but stormy!

    LENUS (Irish Health Repository)

    Ali, Mohammed

    2011-08-01

    Recurrent in-stent thrombosis is rarely reported, with catastrophic clinical consequences of either acute coronary syndrome or death. We present a case of recurrent in-stent thrombosis with its outcome and a concise literature review.

  19. 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

  20. Predictive value of lectin-like ox-LDL receptor-1 level to restenosis after intracoronary stent implantation%凝集素样氧化型低密度脂蛋白受体水平对冠状动脉支架置入术后再狭窄的预测价值

    Institute of Scientific and Technical Information of China (English)

    闫杰; 赵红; 刁增利; 苏鹏宇; 王志军; 李海涛

    2014-01-01

    目的:探讨冠状动脉粥样硬化性心脏病(冠心病)患者冠状动脉支架置入术后血清凝集素样氧化型低密度脂蛋白受体-1(Lox-1)变化趋势及与支架内再狭窄(ISR)的关系。方法连续入选经皮冠状动脉介入治疗并置入冠状动脉支架的冠心病患者128例。分别于术前和术后24h、1周、2周、1月、3月、6月时采集外周静脉血,测定血清Lox-1水平。所有患者术后6月常规复查冠状动脉造影,以支架内径狭窄≥50%为再狭窄,分为再狭窄组(n=24)和无再狭窄组(n=104),并分析两组患者血清Lox-1水平变化趋势及差别。结果术后24h两组患者血清Lox-1水平较术前明显增加,有统计学差异(P<0.05);冠状动脉无再狭窄组患者术后1周血清Lox-1水平有下降趋势,2周时恢复至术前水平,术后1个月、3个月、6个月血清Lox-1水平与术前比较无统计学差异(P>0.05)。冠状动脉再狭窄组患者血清Lox-1水平术后两周、术后1个月、3个月、6个月时血清Lox-1水平呈持续性升高,与无再狭窄组相比,差异有统计学意义(P<0.05)。结论冠状动脉支架置入患者血清Lox-1水平在两周时基本恢复至术前水平,未恢复至术前水平且持续升高者发生支架内再狭窄危险性高。%Objective To discuss the relationship between the change tendency of serum lectin-like ox-LDL receptor-1 (Lox-1) and in-stent restenosis (ISR) in patients with coronary heart disease (CHD) after intracoronary stent implantation. Methods The patients (n=128) with percutaneous coronary intervention (PCI) and intracoronary stent implantation were chosen, and the samples of peripheral venous blood were collected from them respectively before the surgery and after the surgery for 24 h, 1 w, 2 w, 1 m, 3 m and 6 m for detecting the level of serum Lox-1. All patients were given routine reexamination of coronary angiography (CAG), and then they

  1. 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.

  2. 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

  3. 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)

  4. Open and Endovascular Treatment of Trans-Atlantic Inter-Society Consensus Ⅱ D Aortoiliac Occlusive Lesions: What Determines the Rate of Restenosis?

    Institute of Scientific and Technical Information of China (English)

    Chen-Yang Shen; Yun-Feng Liu; Qing-Le Li; Yong-Bao Zhang; Yang Jiao; Miltiadis E Krokidis; Xiao-Ming Zhang

    2015-01-01

    Background: Open surgery is the preferred approach for the treatment of type D lesions according to the Trans-Atlantic Inter-Society Consensus (TASC) Ⅱ guideline, but endovascular solutions also appear to be a valid option in selected patients.The study aimed to identify the risk factors of restenosis after open and endovascular reconstruction of symptomatic TASC Ⅱ D aortoiliac occlusive lesions (AIOLs).Methods: Fifty-six patients (82 limbs) who underwent open repair and endovascular treatment (ET) for symptomatic TASC ⅡD AIOLs between March 2005 and December 2012 were retrospectively reviewed.Baseline characteristics, preoperative and postoperative imaging,and operation procedure reports were reviewed and analyzed.Restenosis after revascularization was assessed by duplex ultrasound or computed tomography angiogram.Kaplan-Meier survival analysis, Log-rank test, and multivariate Cox regression were used to evaluate the relevance between risk factors and patency.Results: The mean duration of follow-up was 42.8 ± 23.5 months (ranging from 3 to 90 months).Primary patency rates at 1-, 3-, 5-,and 7-year were 93.6%, 89.3%, 87.0%, and 70.3%, respectively.Restenosis after revascularization occurred in 11 limbs.Kaplan-Meier survival analysis and the Log-rank test revealed that diabetes, Rutherford classification ≥5th and concurrent femoropopliteal TASC Ⅱ type C/D lesions were significantly related to the duration of primary patency.According to the result of Cox regression, diabetes and femoropopliteal TASC Ⅱ type C/D lesions were identified as the risk factors for restenosis after revascularization.Conclusion: This study demonstrated that diabetes and femoropopliteal TASC Ⅱ type C/D lesions are risk factors associated with restenosis after open and ET of TASC Ⅱ D AIOLs.

  5. Exploring Late Globalization

    DEFF Research Database (Denmark)

    Turcan, Romeo V.

    2016-01-01

    The purpose of this viewpoint paper is to motivate a program of research on late globalization, a program that could eventually lead to one or more significant theories of late globalization. The paper explores the phenomenon of late globalization as well as the idea of “late” by drawing on sparse...... literature on late globalization from sociocultural and economic perspectives. It illustrates in a vignette the character and features of late globalization observable in the withdrawal from foreign locations or deinternationalization of universities, as late globalizing entitis. The paper discusses...... the range of constructs around the core idea of late globalization, generating questions for future work in a late globalization research program....

  6. 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

  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. 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.

  9. 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.

  10. Nanomaterial coatings applied on stent surfaces.

    Science.gov (United States)

    Bagheri, Mahsa; Mohammadi, Marzieh; Steele, Terry Wj; Ramezani, Mohammad

    2016-05-01

    The advent of percutaneous coronary intervention and intravascular stents has revolutionized the field of interventional cardiology. Nonetheless, in-stent restenosis, inflammation and late-stent thrombosis are the major obstacles with currently available stents. In order to enhance the hemocompatibility of stents, advances in the field of nanotechnology allow novel designs of nanoparticles and biomaterials toward localized drug/gene carriers or stent scaffolds. The current review focuses on promising polymers used in the fabrication of newer generations of stents with a short synopsis on atherosclerosis and current commercialized stents, nanotechnology's impact on stent development and recent advancements in stent biomaterials is discussed in context.

  11. 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.

  12. A Nano-Inspired Multifunctional POSS-PCU Covered Stent: Endothelial Progenitor Cell Capture with Stealth Liposomal Drug Release

    OpenAIRE

    Tan, A. J. K.

    2014-01-01

    The 2 main unresolved issues inherent in coronary stents are in-stent restenosis (ISR) and late stent thrombosis (ST). ISR is largely due to vascular smooth muscle cell (VSMC) proliferation, and ST is attributed to a lack of re-endothelialization. This thesis describes the conceptualization and development of a biofunctionalized polyhedral oligomeric silsesquioxane poly(carbonate-urea) urethane (POSS-PCU) platform, for the express purpose of circumventing ISR and ST. A bare-metal stent is emb...

  13. Surface modification of traditional and bioresorbable metallic implant materials for improved biocompatibility

    OpenAIRE

    Walker, Emily Kristine

    2015-01-01

    Due to their strength, elasticity, and durability, a variety of metal alloys are commonly used in medical implants. Traditionally, corrosion-resistant metals have been preferred. These permanent materials can cause negative systemic and local tissue effects in the long-term. Permanent stenting can lead to late-stent thrombosis and in-stent restenosis. Metallic pins and screws for fracture fixation can corrode and fail, cause loss of bone mass, and contribute to inflammation and pain at the im...

  14. Late Accretion and the Late Veneer

    CERN Document Server

    Morbidelli, Alessandro

    2014-01-01

    The concept of Late Veneer has been introduced by the geochemical community to explain the abundance of highly siderophile elements in the Earth's mantle and their chondritic proportions relative to each other. However, in the complex scenario of Earth accretion, involving both planetesimal bombardment and giant impacts from chondritic and differentiated projectiles, it is not obvious what the "Late Veneer" actually corresponds to. In fact, the process of differentiation of the Earth was probably intermittent and there was presumably no well-defined transition between an earlier phase where all metal sunk into the core and a later phase in which the core was a closed entity separated from the mantle. In addition, the modellers of Earth accretion have introduced the concept of "Late Accretion", which refers to the material accreted by our planet after the Moon-forming event. Characterising Late Veneer, Late Accretion and the relationship between the two is the major goal of this chapter.

  15. 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

  16. The Impact of Blood Rheology on Drug Transport in Stented Arteries: Steady Simulations

    Science.gov (United States)

    Vijayaratnam, Pujith R. S.; O’Brien, Caroline C.; Reizes, John A.; Barber, Tracie J.; Edelman, Elazer R.

    2015-01-01

    Background and Methods It is important to ensure that blood flow is modelled accurately in numerical studies of arteries featuring drug-eluting stents due to the significant proportion of drug transport from the stent into the arterial wall which is flow-mediated. Modelling blood is complicated, however, by variations in blood rheological behaviour between individuals, blood’s complex near-wall behaviour, and the large number of rheological models which have been proposed. In this study, a series of steady-state computational fluid dynamics analyses were performed in which the traditional Newtonian model was compared against a range of non-Newtonian models. The impact of these rheological models was elucidated through comparisons of haemodynamic flow details and drug transport behaviour at various blood flow rates. Results Recirculation lengths were found to reduce by as much as 24% with the inclusion of a non-Newtonian rheological model. Another model possessing the viscosity and density of blood plasma was also implemented to account for near-wall red blood cell losses and yielded recirculation length increases of up to 59%. However, the deviation from the average drug concentration in the tissue obtained with the Newtonian model was observed to be less than 5% in all cases except one. Despite the small sensitivity to the effects of viscosity variations, the spatial distribution of drug matter in the tissue was found to be significantly affected by rheological model selection. Conclusions/Significance These results may be used to guide blood rheological model selection in future numerical studies. The clinical significance of these results is that they convey that the magnitude of drug uptake in stent-based drug delivery is relatively insensitive to individual variations in blood rheology. Furthermore, the finding that flow separation regions formed downstream of the stent struts diminish drug uptake may be of interest to device designers. PMID:26066041

  17. Asymptotic analysis of blood flow in stented arteries: time dependency and direct simulations***

    Directory of Open Access Journals (Sweden)

    Pichon Gostaf Kirill

    2010-12-01

    Full Text Available This work aims to extend in two distinct directions results recently obtained in [10]. In a first step we focus on the possible extension of our results to the time dependent case. Whereas in the second part some preliminary numerical simulations aim to give orders of magnitudes in terms of numerical costs of direct 3D simulations. We consider, in the first part, the time dependent rough problem for a simplified heat equation in a straight channel that mimics the axial velocity under an oscillating pressure gradient. We derive first order approximations with respect to ϵ, the size of the roughness. In order to understand the problem and set up correct boundary layer approximations, we perform a time periodic fourier analysis and check that no frequency can interact with the roughness. We show rigorously on this toy problem that the boundary layers remain stationary in time (independent on the frequency number. Finally we perform numerical tests validating our theoretical approach. In the second part, we determine actual limits, when running three-dimensional blood flow simulations of the non-homogenized stented arteries. We solve the stationary Stokes equations for an artery containing a saccular aneurysm. Consecutive levels of uniform mesh refinement, serve to relate spatial resolution, problem scale, and required computation time. Test computations are presented for femoral side aneurysm, where a simplified ten-wire stent model was placed across the aneurysm throat. We advocate the proposed stent homogenization model, by concluding that an actual computation power is not sufficient to run accurate, direct simulations of a pulsatile flow in stented vessels.

  18. 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.

  19. Considerable Risk of Restenosis After Endoscopic Treatment for Hepaticojejunostomy Stricture After Living-Donor Liver Transplantation.

    Science.gov (United States)

    Kamei, H; Imai, H; Onishi, Y; Ishihara, M; Nakamura, M; Kawashima, H; Ishigami, M; Ito, A; Ohmiya, N; Hirooka, Y; Goto, H; Ogura, Y

    2015-10-01

    There are few reports on the short- and long-term follow-up of endoscopic retrograde cholangiography (ERC) in adult patients with hepaticojejunostomy (HJS) stricture after living-donor liver transplantation (LDLT). Nine LDLT recipients underwent ERC with the use of double-balloon endoscopy (DBE) for HJS stricture at Nagoya University Hospital. We assessed the rate of reaching biliary anastomosis, procedure success rate, procedure duration, complications, improvement in liver function test results, and biliary anastomosis patency. In total, 19 ERC procedures with the use of DBE were performed for 9 adult LDLT recipients with HJS stricture from June 2006 to September 2014. Balloon dilation with the use of DBE was successfully performed in 5 of the 9 patients during the 1st procedure. Of the 4 patients in whom DBE-ERC failed to be completed, 3 patients underwent 2nd procedures successfully. Liver function test results were significantly improved in the successful cases. Four patients underwent 2nd DBE-ERC for stricture recurrence at a mean time of 2.3 years after the 1st successful procedure. Of those, 2 patients required 3rd procedures for stricture recurrence after the 2nd procedure. DBE-ERC is promising as a treatment for HJS stricture in adult LDLT recipients in the short term. However, the DBE-ERC procedure may have a considerable risk of restenosis. Copyright © 2015 Elsevier Inc. All rights reserved.

  20. Multi-drug-resistant hypertension caused by severe aortic coarctation presenting in late adulthood.

    Science.gov (United States)

    Meller, Stephanie M; Fahey, John T; Setaro, John F; Forrest, John K

    2015-04-01

    Aortic coarctation, a congenital narrowing in the region of the ligamentum arteriosium, is a rare etiology for multi-drug-resistant hypertension in adulthood; however, advances in stenting modalities may offer long-term improvements in morbidity and possibly even cure. We report on a female patient in her late 50s presenting with refractory hypertension and severely elevated renin levels, ultimately diagnosed with aortic coarctation and treated with percutaneous stent implantation, which resulted in successful blood pressure control with verapamil monotherapy. This case highlights the efficacy of endovascular stent implantation for the treatment of coarctation and the need for clinicians to consider this disease entity in the differential diagnosis of refractory hypertension even in late adulthood.

  1. Late recurrence of medulloblastoma.

    Science.gov (United States)

    Stevens, Brittney; Razzaqi, Faisal; Yu, Lolie; Craver, Randall

    2008-01-01

    We present a child with a cerebellar medulloblastoma, diagnosed at age three, treated with near total surgical resection, radiotherapy, and chemotherapy, that recurred 13 years after the initial diagnosis. This late recurrence exceeds the typical 10-year survival statistics that are in common use, and exceeds the Collins rule. Continued follow-up of these children is justified to increase the likelihood of detecting these late recurrences early and to learn more about these late recurrences.

  2. 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.

  3. Iron-induced platelet aggregation measurement : a novel method to measure platelet function in stenting for ST segment elevation myocardial infarction

    NARCIS (Netherlands)

    Smit, J. J. J.; van Oeveren, W.; Ottervanger, J. P.; Slingerland, R. J.; Remijn, J. A.; Zijlstra, F.; van 't Hof, A. W. J.

    2009-01-01

    Iron and (stainless) steel are potent platelet aggregation activators, and may be involved in stent thrombosis, a serious complication after intracoronary stenting. Current platelet function tests are suboptimal, because of inappropriate agonists and/or lack of reproducibility. We tested the feasibi

  4. Low Resolution Limits and Inaccurate Algorithms Decrease Significantly the Value of Late Loss in Current Drug-Eluting Stent Trials

    Directory of Open Access Journals (Sweden)

    Johannes B. Dahm

    2012-01-01

    Full Text Available Quantitative coronary and vascular angiography (QCA resp., QVA remains the current gold standard for evaluation of restenosis. Late loss as one of the most commonly accepted parameters to highlight efficacy of the various devices has shown high correlation to clinical parameters but, surprisingly, has no impact on the evaluation of the remaining amount of restenostic tissue. The current clinical practice leads to unrealistic late loss calculations. Smaller late loss differences are usually not greater than the inherited resolution limits of QCA, which is especially the case in small differences between the various stents in the drug-eluting stent era. Late loss include additional systematic and random errors, due to the fact that measurements were taken at two different time points including the inherited resolution and calibration limits of QCA on two occasions. Due to the limited value of late loss in discriminating the small differences between the one and other DES, late lumen area loss and clearly defined calculation algorithms (e.g., MLD-relocation should be used in future DES studies also to fulfill the more stringent regulatory requirements.

  5. 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.

  6. Tratamento endovascular da reestenose carotídea: resultados em curto prazo Endovascular treatment of carotid artery restenosis: short term results

    Directory of Open Access Journals (Sweden)

    Ricardo Augusto Carvalho Lujan

    2011-03-01

    Full Text Available CONTEXTO: O tratamento cirúrgico da reestenose carotídea apresenta alta taxa de lesão neurológica. Contrariamente, o tratamento endovascular da doença obstrutiva carotídea extracraniana tem se tornado mais factível e gradualmente menores taxas de risco cirúrgico vêm sendo reportadas, tornando-se uma opção em situações especiais, e provavelmente poderá ser considerado o tratamento padrão para reestenose carotídea. OBJETIVOS: Avaliar a aplicabilidade, a segurança e a eficácia da angioplastia com o uso do stent (ACS no tratamento da reestenose carotídea (REC no intraoperatório e no pós-operatório recente (80%, enquanto quatro (21% eram sintomáticos com estenose >70%. Apenas em um paciente não foi utilizado sistema de proteção cerebral. O sucesso técnico foi obtido em todos os casos. Não houve morte ou acidente vascular encefálico no intra ou no pós-operatório recente (30 dias. CONCLUSÃO: O tratamento endovascular da reestenose carotídea mostrou-se uma abordagem factível e segura em curto prazoCONTEXT: The surgical treatment of carotid artery restenosis presents a high risk of nerve injury. On the contrary, endovascular treatment for extracranial carotid artery obstructive disease has become more feasible. Gradually, lower rates of surgical risk have been reported, which makes the treatment a good option in special situations. It may be considered as the standard treatment for carotid artery restenosis. OBJECTIVE: To evaluate the applicability, safety, and efficacy of the angioplasty with the use of a stent (Carotid Artery Stenting - CAS for the treatment of carotid artery restenosis, in the intraoperative and early (80%, whereas 4 (21% were symptomatic with stenosis >70%. In only one patient a cerebral protection system was not used. Technical success was achieved in all cases. There was no death or stroke in the intraoperative or the early postoperative period (30 days. CONCLUSION: Endovascular treatment of

  7. 超氧化物歧化酶与血管成形术后再狭窄%Superoxide Dismutase and Restenosis after Angioplasty

    Institute of Scientific and Technical Information of China (English)

    吴龙

    2013-01-01

    Angioplasty is the effective treatment in cardiovascular diseases, but the high rate of restenosis after angioplasty has deeply affected its clinical application. In the recent years, the redox hypothesis of restenosis has been more and more recognized. Oxidative stress is the state of imbalance in redox, leading to the increased generation of reactive oxygen species, such as superoxide anion( O-2 ·) A large number of studies have shown that O-2 · is elevated in the developing neointimal after angioplasty and plays an essential role in neointimal vascular smooth muscle cells proliferation. Superoxide dismutase( SOD ) is the only antioxidase which can dismutate O-2 · to hydrogen peroxide. The intensive study of the relationship between SOD and restenosis will potentially provide a new idea in the recognition and prevention of restenosis.%血管成形术是广泛运用于心血管病的有效手段,但术后血管再狭窄的高发生率严重影响其临床疗效.近年来,再狭窄的氧化应激学说越来越受到重视.氧化应激是指氧化还原状态的失衡,导致活性氧簇的产生增多,如超氧阴离子(O-2·).大量研究表明,O-2 ·在血管再狭窄新生内膜形成过程中异常增多,对再狭窄过程中血管平滑肌细胞的增殖起到重要作用.超氧化物歧化酶(SOD)是唯一能将O-2 ·催化成相对稳定的过氧化氢的抗氧化酶,深入研究SOD与再狭窄之间的关系,将对认识和防治再狭窄提供新的思路.

  8. Personality in Late Midlife

    DEFF Research Database (Denmark)

    Mortensen, Erik Lykke; Flensborg-Madsen, Trine; Molbo, Drude

    2014-01-01

    To analyze associations in late midlife between sex, age, education and social class, and the Big Five personality traits; to analyze associations between personality traits and cognitive ability in late midlife; and to evaluate how these associations are influenced by demographic factors....

  9. 4D phase contrast flow imaging for in-stent flow visualization and assessment of stent patency in peripheral vascular stents – A phantom study

    Energy Technology Data Exchange (ETDEWEB)

    Bunck, Alexander C., E-mail: alexander.bunck@uk-koeln.de [Department of Clinical Radiology, University Hospital Münster, Albert-Schweitzer-Campus 1, Building A1, 48149 Muenster (Germany); Department of Radiology, University Hospital Cologne, Kerpener Strasse 62, 50937 Cologne (Germany); Jüttner, Alena, E-mail: alenajuettner@gmx.de [Department of Clinical Radiology, University Hospital Münster, Albert-Schweitzer-Campus 1, Building A1, 48149 Muenster (Germany); Kröger, Jan Robert, E-mail: jr.kroeger@uni-muenster.de [Department of Clinical Radiology, University Hospital Münster, Albert-Schweitzer-Campus 1, Building A1, 48149 Muenster (Germany); Burg, Matthias C., E-mail: m_burg03@uni-muenster.de [Department of Clinical Radiology, University Hospital Münster, Albert-Schweitzer-Campus 1, Building A1, 48149 Muenster (Germany); Kugel, Harald, E-mail: kugel@uni-muenster.de [Department of Clinical Radiology, University Hospital Münster, Albert-Schweitzer-Campus 1, Building A1, 48149 Muenster (Germany); Niederstadt, Thomas, E-mail: tnieders@uni-muenster.de [Department of Clinical Radiology, University Hospital Münster, Albert-Schweitzer-Campus 1, Building A1, 48149 Muenster (Germany); Tiemann, Klaus, E-mail: Klaus.Tiemann@ukmuenster.de [Department of Cardiology and Angiology, University Hospital Münster, Albert-Schweitzer-Campus 1, Building A1, 48149 Muenster (Germany); Schnackenburg, Bernhard, E-mail: bernhard.schnackenburg@philips.com [Philips Medical Systems DMC GmbH, Röntgenstraße 24, 22335 Hamburg (Germany); Crelier, Gerard R., E-mail: crelier@biomed.ee.ethz.ch [Institute for Biomedical Engineering, ETH and University of Zurich, ETZ F 95, Gloriastrasse 35, 8092 Zurich (Switzerland); and others

    2012-09-15

    Purpose: 4D phase contrast flow imaging is increasingly used to study the hemodynamics in various vascular territories and pathologies. The aim of this study was to assess the feasibility and validity of MRI based 4D phase contrast flow imaging for the evaluation of in-stent blood flow in 17 commonly used peripheral stents. Materials and methods: 17 different peripheral stents were implanted into a MR compatible flow phantom. In-stent visibility, maximal velocity and flow visualization were assessed and estimates of in-stent patency obtained from 4D phase contrast flow data sets were compared to a conventional 3D contrast-enhanced magnetic resonance angiography (CE-MRA) as well as 2D PC flow measurements. Results: In all but 3 of the tested stents time-resolved 3D particle traces could be visualized inside the stent lumen. Quality of 4D flow visualization and CE-MRA images depended on stent type and stent orientation relative to the magnetic field. Compared to the visible lumen area determined by 3D CE-MRA, estimates of lumen patency derived from 4D flow measurements were significantly higher and less dependent on stent type. A higher number of stents could be assessed for in-stent patency by 4D phase contrast flow imaging (n = 14) than by 2D phase contrast flow imaging (n = 10). Conclusions: 4D phase contrast flow imaging in peripheral vascular stents is feasible and appears advantageous over conventional 3D contrast-enhanced MR angiography and 2D phase contrast flow imaging. It allows for in-stent flow visualization and flow quantification with varying quality depending on stent type.

  10. Quantitative analysis of high-resolution, contrast-enhanced, cone-beam CT for the detection of intracranial in-stent hyperplasia.

    Science.gov (United States)

    Flood, Thomas F; van der Bom, Imramsjah M J; Strittmatter, Lara; Puri, Ajit S; Hendricks, Gregory M; Wakhloo, Ajay K; Gounis, Matthew J

    2015-02-01

    Intracranial in-stent hyperplasia is a stroke-associated complication that requires routine surveillance. To compare the results of in vivo experiments to determine the accuracy and precision of in-stent hyperplasia measurements obtained with modified C-arm contrast-enhanced, cone-beam CT (CE-CBCT) imaging with those obtained by 'gold standard' histomorphometry. Additionally, to carry out clinical analyses comparing this CE-CBCT protocol with digital subtraction angiography (DSA). A non-binned CE-CBCT protocol (VasoCT) was used that acquires x-ray images with a small field-of-view and applies a full-scale reconstruction algorithm providing high-resolution three-dimensional (3D) imaging with 100 µm isotropic voxels. In an vivo porcine model, VasoCT cross-sectional area measurements were compared with gold standard vessel histology. VasoCT and DSA were used to calculate in-stent stenosis in 23 imaging studies. Porcine VasoCT cross-sectional stent, lumen, and in-stent hyperplasia areas strongly correlated with histological measurements (r(2)=0.97, 0.93, 0.90; slope=1.14, 1.07, and 0.76, respectively; phyperplasia. C-arm VasoCT is a high-resolution 3D capable imaging technique that has been validated in an animal model for measurement of in-stent tissue growth. Successful clinical implementation of the protocol was performed in a small case series. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  11. 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.

  12. Partial stent-in-stent placement of biliary metallic stents using a short double-balloon enteroscopy

    Institute of Scientific and Technical Information of China (English)

    Koichiro Tsutsumi; Hironari Kato; Takeshi Tomoda; Kazuyuki Matsumoto; Ichiro Sakakihara; Naoki Yamamoto; Yasuhiro Noma

    2012-01-01

    Endoscopic intervention is less invasive than percutaneous or surgical approaches and should be considered the primary drainage procedure in most cases with obstructive jaundice.Recently,therapeutic endoscopic retrograde cholangiopancreatography (ERCP) using double-balloon enteroscopy (DBE) has been shown to be feasible and effective,even in patients with surgically altered anatomies.On the other hand,endoscopic partial stent-in-stent (PSIS) placement of selfexpandable metallic stents (SEMSs) for malignant hilar biliary obstruction in conventional ERCP has also been shown to be feasible,safe and effective.We performed PSIS placement of SEMSs for malignant hilar biliary obstruction due to liver metastasis using a short DBE in a patient with Roux-en-Y anastomosis and achieved technical and clinical success.This procedure can result in quick relief from obstructive jaundice in a single session and with short-term hospitalization,even in patients with surgically altered anatomies.

  13. Endovascular brachytherapy (EVBT) with rhenium-188 for restenosis prophylaxis after angioplasty of infrainguinal lesions. Early experience; Endovaskulaere Brachytherapie (EVBT) mit Rhenium-188 zur Restenoseprophylaxe nach Angioplastie infrainguinaler Laesionen. Erste Erfahrungen

    Energy Technology Data Exchange (ETDEWEB)

    Leissner, G.G.; Winterstein, A.; Bohndorf, K.; Wohlgemuth, W.A. [Klinikum Augsburg (Germany). Klinik fuer Diagnostische Radiologie und Neuroradiologie; Wengenmair, H. [Klinikum Augsburg (Germany). Medizinische Physik und Strahlenschutz; Sciuk, J. [Klinikum Augsburg (Germany). Klinik fuer Nuklearmedizin; Woelfle, K.D. [Klinikum Augsburg (Germany). Klinik fuer Gefaesschirurgie; Weinrich, K. [Klinikum Augsburg (Germany). II. Medizinische Klinik, Angiologie

    2011-08-15

    Purpose: Restenosis remains a major problem in percutaneous transluminal angioplasty (PTA) of peripheral arteries. The aim of this feasibility study was to evaluate the technical feasibility and safety of a new endovascular brachytherapy (EVBT) device with Rhenium-188 in restenosis prophylaxis of infrainguinal arteries. Materials and Methods: From March 2006 to April 2009, 52 patients with 71 infrainguinal arterial lesions were treated with Re-188 to prevent restenosis after PTA. 40 patients with 53 lesions (24 de-novo lesions and 29 restenoses) were reexamined (clinic, color-coded duplex ultrasound) after a mean follow-up period of 12.7 months (2.6 to 25.1 months). The liquid beta-emitter Re-188 was introduced to the target lesion via an EVBT certified PTA balloon and a tungsten applicator. After the calculated irradiation time, Re-188 was aspirated back into the tungsten applicator. A dose of 13 Gy was applied at a depth of 2 mm into the vessel wall. Results: After a mean follow-up of 12.7 months, the overall restenosis rate after Re-PTA was 15.1 % (8/53 lesions). The restenosis rate for de-novo lesions was 20.8 % (5/24) and 10.3 % for restenoses (3/29). In 4 patients reintervention was necessary (3 PTAs and 2 major amputations). No periprocedural complications were observed. No elevated radiation dose for the patient or the interventionalist was measured. Conclusion: EVBT with a Re-188 filled balloon catheter was technically feasible and safe after PTA of infrainguinal arterial lesions with restenosis rates lower than expected compared to published results. Treatment of restenoses seems to be more effective than de-novo lesions. (orig.)

  14. 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)

  15. Local Delivery of C-myc Antisense Oligodeoxynucleotide by Gelatin Coated Platinium-Iridium Stent to Prevent Restenosis in a Normal Rabbit Carotid Artery

    Institute of Scientific and Technical Information of China (English)

    Zhang Xinxia; Wei Wenbin; Duan Wen; Xu Xiangguang; Hu Xuesong

    2005-01-01

    Objectives To investigate the feasibility and effect of local deliveryof c-myc antisense oligodeoxynucleotide (ASODN) by gelatin coated Platinium-Iridium stent to prevent restenosis in a normal rabbit carotid artery. Methods Gelatin coated Platinium-Iridium stent were implanted in the right carotid arteries of 32 rabbits under vision. Animals were randomized to the control group and the treated group receiving c-myc ASODN (n=16 respectively).7,14,30,90 days following the stenting procedure,morphometry for caculation of neointimal area and mean neointimal thickness were performed.The expression of c-myc protein was detected by immunohistochemical methods. Results 32 stents were successfully implanted into the right carotid arteries in 32 animals. Morphometric analysis showed that neointimal area and mean neointimal thickness siginificantly increased continuously up to 12 weeks after stent implantation,and at each time point ,neointimal area and mean neointimal thickness were siginificantly smaller in the treated group than control group. (P<0.001 ,respectively).c-myc protein expression was weak positive or negative in treated group and positive in control group. Conclusions Gelatin coated Platinium-Iridium stent mediated local delivery of c-myc ASODN is feasibility , and it can inhibit neointimal hyperplasia to prevent restenosis in a normal rabbit carotid artery.

  16. Late-Stage Caregiving

    Science.gov (United States)

    ... resources, care and ways to engage in meaningful connections. During the late stages, your role as a ... drinks. This will help you track the person's natural routine, and then you can plan a schedule. ...

  17. Suicides in late life.

    Science.gov (United States)

    Van Orden, Kimberly; Conwell, Yeates

    2011-06-01

    Suicide in late life is an enormous public health problem that will likely increase in severity as adults of the baby boom generation age. Data from psychological autopsy studies supplemented with recent studies of suicidal ideation and attempts point to a consistent set of risk factors for the spectrum of suicidal behaviors in late life (suicide ideation, attempts, and deaths). Clinicians should be vigilant for psychiatric illness (especially depression), physical illness, pain, functional impairment, and social disconnectedness. Recent advances in late-life suicide prevention have in common collaborative, multifaceted intervention designs. We suggest that one mechanism shared by all preventive interventions shown to reduce the incidence of late-life suicide is the promotion of connectedness. For the clinician working with older adults, our recommendation is to not only consider risk factors, such as depression, and implement appropriate treatments but to enhance social connectedness as well.

  18. 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.

  19. Long-term risk of carotid restenosis in patients randomly assigned to endovascular treatment or endarterectomy in the Carotid and Vertebral Artery Transluminal Angioplasty Study (CAVATAS): long-term follow-up of a randomised trial.

    LENUS (Irish Health Repository)

    Bonati, Leo H

    2009-10-01

    In the Carotid and Vertebral Artery Transluminal Angioplasty Study (CAVATAS), early recurrent carotid stenosis was more common in patients assigned to endovascular treatment than it was in patients assigned to endarterectomy (CEA), raising concerns about the long-term effectiveness of endovascular treatment. We aimed to investigate the long-term risks of restenosis in patients included in CAVATAS.

  20. 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.

  1. 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

  2. Direct drug-eluting stenting to reduce stent restenosis : a randomized comparison of direct stent implantation to conventional stenting with pre-dilation or provisional stenting in elective PCI patients

    NARCIS (Netherlands)

    Remkes, Wouter S; Somi, Samer; Roolvink, Vincent; Rasoul, Saman; Ottervanger, Jan Paul; Gosselink, A T Marcel; Hoorntje, Jan C A; Dambrink, Jan-Henk E; de Boer, Menko-Jan; Suryapranata, Harry; van 't Hof, Arnoud W J

    2014-01-01

    OBJECTIVES: The aim was to investigate whether a strategy of direct drug-eluting stent (DES) implantation without pre-dilation is associated with a reduced incidence of restenosis compared with CS with pre-dilation or provisional stenting (PS). BACKGROUND: Previous studies were performed comparing d

  3. Late Sovereign Diplomacy

    DEFF Research Database (Denmark)

    Adler-Nissen, Rebecca

    2009-01-01

    the promotion of national interests with those of the Union. In this late sovereign phase of diplomacy, political and legal authorities overlap, territorial exclusivity is replaced with functional boundaries, and states begin to speak with one voice. The article explores three interlinked aspects of late...... sovereign diplomacy: the teleological interpretation of the EC and EU treaties; the intense socialization of state representatives; and the negotiation process, which promotes national positions as part of a European cause, thereby delocalizing the national interest. While the EU has not rendered national...... diplomacy obsolete, it has profoundly changed its meaning and consequences....

  4. Early and late motherhood

    DEFF Research Database (Denmark)

    Christoffersen, Mogens; Lausten, Mette

    2009-01-01

    The study investigates parental child rearing methods, structural factors relating to the family during adolescence geographic segregation, individual resource deficits and social background of first time late live births among 32 to 37 years old women and compare to teenagers before becoming...... teenage mothers. The purpose is to study if results will be consistent with the hypotheses that poverty, social deprivation during adolescence and low education are causes of teen childbearing but also childlessness among elder women in the age group 32 to 37 years old. Could childlessness as well...... pregnant teenagers who had an induced abortion. Quite the opposite pattern is disclosed for late motherhood....

  5. Successful endovascular treatment of a growing megadolichoectasic vertebrobasilar artery aneurysm by flow diversion using the "diverter-in-stent" technique.

    Science.gov (United States)

    Cohen, José E; Gomori, John M; Moscovici, Samuel; Itshayek, Eyal

    2012-01-01

    Giant dolichoectatic and fusiform aneurysms of the vertebrobasilar artery are among the most difficult and dangerous aneurysms to treat. Conservative management may be reasonable in asymptomatic elderly patients. Nevertheless, due to the frequent presence of mass effect on the brainstem and the risks of thromboembolic events and rupture, these aneurysms often demand treatment rather than observation. With the advancement of endovascular techniques some of these lesions have become treatable without the high morbidity and mortality rates associated with open surgical treatment. When dealing with giant, progressively enlarging symptomatic aneurysms, more limited therapeutic alternatives are available. The authors present a case of a growing megadolichoectatic vertebrobasilar artery aneurysm causing major disability due to increasing mass effect in a 51-year-old man. The aneurysm was treated with flow diversion by placing multiple telescoped stents and diverters ("diverter-in-stent" technique), achieving thrombosis of the aneurysm and reduction of the mass effect on the brainstem, with neurological improvement. The successful clinical and angiographic results observed in our case of giant dolichoectasic vertebrobasilar aneurysm contribute to the literature on giant aneurysms treated by means of flow diversion. Copyright © 2011 Elsevier Ltd. All rights reserved.

  6. In-stent Anchoring Facilitating Side-branch Balloon Delivery for Final Kissing: A Prospective, Single-center Registry Study.

    Science.gov (United States)

    Zhou, Yu; Xiao, Han; Wang, Yu-Qing; Liu, Huan-Yun; Bao, Pang; Song, Yao-Ming; Azzalini, Lorenzo; Huang, Lan; Zhao, Xiao-Hui

    2016-11-20

    Recrossing the compromised side branch (SB) with a balloon is sometimes technically challenging. The aim of this study was to evaluate whether in-stent anchoring (ISA) is safe and effective to facilitate SB balloon delivery for final kissing. One hundred and fifty-nine consecutive patients were included (166 bifurcation lesions) in this prospective, single-center registry. ISA was used as a bailout method after unsuccessful SB crossing using conventional techniques, including low-profile balloons. Technique success was defined as SB balloon delivery and final kissing. Kissing-balloon delivery was successfully performed with conventional strategies in 149 of 166 lesions (89.8%). In the remaining 17 lesions (10.2%), recrossing of the main vessel stent strut was not successful; therefore, ISA was attempted. The balloon successfully crossed the stent struts, and final kissing was achieved in 15 of 17 lesions (88.2%). Total final kissing was achieved in 164 of 166 lesions (98.8%), with success rates of 100% in the single-stent group and 97.6% in the two-stent group. Two cases without balloon delivery had complex bifurcation lesions with severe calcification. There was no vessel dissection in the anchoring zone. ISA is safe and effective for recrossing stent struts when conventional low-profile balloons have failed. However, large-scale trials are warranted for further evaluation.

  7. Late Embryogenesis Abundant Proteins

    NARCIS (Netherlands)

    Shih, M.D.; Hoekstra, F.A.; Hsing, Y.I.C.

    2008-01-01

    During the late maturation stage of seed development, water content decreases greatly. One of the most striking characteristics of mature orthodox seeds is their ability to withstand severe desiccation. Mechanisms of plant drought/desiccation tolerance have been studied by numerous groups, and a bro

  8. Never Too Late

    Institute of Scientific and Technical Information of China (English)

    2011-01-01

    A historical issue is being raised on Capitol Hill.In late May,members of the U.S.Congress introduced bipartisan resolutions in both chambers,calling on the federal legislature to acknowledge formally and express regret for discriminatory legislation and how the country accordingly treated Chinese immigrants more than a century ago.

  9. Big Java late objects

    CERN Document Server

    Horstmann, Cay S

    2012-01-01

    Big Java: Late Objects is a comprehensive introduction to Java and computer programming, which focuses on the principles of programming, software engineering, and effective learning. It is designed for a two-semester first course in programming for computer science students.

  10. Was I Late

    Institute of Scientific and Technical Information of China (English)

    叶历来; 罗琪芳

    2011-01-01

    “Get up, Jane!” “Oh... Mom, let me sleep five more minutes. I'm so Ured ( 困的 ).” “It's 7:50. It's too late. ” “OK, three minutes then... Wait! What did you say? What time is it? It's 7:50.”

  11. 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.

  12. Late-Onset Asthma

    DEFF Research Database (Denmark)

    Ulrik, Charlotte Suppli

    2017-01-01

    Late-onset asthma is common, associated with poor outcome, underdiagnosed and undertreated, possibly due to the modifying effect of ageing on disease expression. Although the diagnostic work-up in elderly individuals suspected of having asthma follows the same steps as in younger individuals (case......, to objectively confirm asthma. If necessary, a trial of oral or inhaled corticosteroid might be necessary. Asthma can be diagnosed when increased airflow variability is identified in a symptomatic patient, and if the patient does not have a history of exposure, primarily smoking, known to cause chronic...... obstructive pulmonary disease, the diagnosis is asthma even if the patient does not have fully reversible airflow obstruction. Pharmacological therapy in patients with late-onset asthma follows international guidelines, including treatment with the lowest effective dose of inhaled corticosteroid to minimize...

  13. Late Babylonian Astrology

    Science.gov (United States)

    Steele, John M.

    The last five centuries BC saw the development of several new forms of astrology in Babylonia. Key to these new astrological techniques was the invention of the zodiac in about 400 BC. These new forms of astrology include personal horoscopes, astral medicine, and the exploitation of geometrical relationships between the position of heavenly bodies. Several Late Babylonian astrological doctrines were later adopted within Greek astrology.

  14. 冠心病PCI术后再狭窄患者IL-18基因多态性的研究%A research of IL-18 gene polymorphism of patients with coronary heart disease suffering in-stent restenosis after PCI

    Institute of Scientific and Technical Information of China (English)

    刘文卫; 江华; 刘永胜; 李婷; 王萍; 王炜娜; 赵玉勤; 周登明; 朱通建

    2013-01-01

    目的 研究白细胞介素-18(IL-18)基因多态性对冠心病患者经皮冠状动脉介入术(PCI)术后支架内再狭窄(ISR)易感性的潜在影响.方法 将PCI术后的241例有再发缺血临床症状的冠心病患者作为研究对象,并根据冠状动脉造影结果分为支架内再狭窄(ISR)组(ISR组,n=68)和非ISR组(n=173),另选择109例排除冠心病的人群作为对照组.采用聚合酶链反应对IL-18基因型进行检测,同时测定血清IL-18浓度.结果 ISR组、非ISR组患者G等位基因频率分别为0.93、0.83,二者明显高于对照组(0.73,P<0.01),ISR组患者的G等位基因频率明显高非ISR组(P<0.01).ISR组、非ISR组患者GG基因型频率分别为0.87、0.69,二者明显高于对照组(0.54,P<0.01),ISR组患者GG基因型频率明显高非ISR组(P<0.01).ISR组、非ISR组患者血清IL-18浓度分别为(309.39±86.75)、(245.37±59.04)ng/L,明显高于对照组[(138.41±47.28)ng/L](P<0.01),ISR组患者血清IL-18浓度明显高于非ISR组(P<0.01).结论 IL-18启动子-137G/C基因多态性可能会影响血清IL-18浓度及PCI术后再狭窄发生的易感性.

  15. 血栓弹力图评估抗血小板药物疗效对冠状动脉支架术后支架内再狭窄的影响%Effect of antiplatelet drugs on in-stent restenosis in patients after percutaneous coronary intervention: a study evaluated by thromboelastography

    Institute of Scientific and Technical Information of China (English)

    刘英炜; 孙津津; 张海涛; 王俊华; 吴晓君; 于心亚; 黄丛春

    2015-01-01

    目的 应用血栓弹力图评估抗血小板药物疗效对经皮冠状动脉介入治疗术(PCI)后支架内再狭窄(ISR)的影响.方法 回顾性地分析2011年9月至2014年6月在空军总医院心脏中心成功完成PCI手术并返院复查冠状动脉造影的86例患者,按其是否发生ISR分为ISR组和非ISR组,对比分析两组之间可能引起ISR的危险因素.结果 入选的86例患者共植入药物支架118枚,其中有20人发生ISR,我们发现ISR组和非ISR组在病变长度[(27.20±3.19) vs (22.94±4.67) mm]、C反应蛋白浓度[CRP,(6.36±2.69) vs (3.14±3.23) mg/L]、腺苷二磷酸(ADP)受体抑制率[(35.80±15.58) vs (60.31±20.91)]、尿酸和花生四烯酸(AA)途径抑制率[(68.54±17.63) vs (78.59±20.39)]、糖尿病患者比例和临床表现等方面差异有统计学意义(P<0.05).通过多因素回归分析,校正其他危险因素后发现ADP低抑制率(P=0.011)是发生ISR的危险因素.结论 ADP受体的低抑制率与ISR的发生呈负相关,即氯吡格雷低反应性在ISR的发生中起重要作用.

  16. comparison of drug eluting stent for treatment of in-stent restenosis and de novo lesion%药物洗脱支架治疗冠状动脉支架内再狭窄和冠状动脉原发病变的随访研究

    Institute of Scientific and Technical Information of China (English)

    赵林; 朱玮玮; 郭成军; 张英川; 方冬平; 何东方

    2014-01-01

    目的:比较药物洗脱支架(DES)治疗早期(≤1年)、晚期(>1年)支架内再狭窄病变(ISR)与冠状动脉原发病变(De novo)患者的长期临床疗效.方法:收集自2008年10月至2011年12月,北京安贞医院因ISR接受DES置入治疗并完成临床随访的患者资料,根据DES术后发生ISR的时间是否>1年分为早期ISR组与晚期SR组.选择同期因冠状动脉原发病变(De novo)置入DES治疗的部分患者作为冠状动脉原发病变组(De novo组).比较三组患者术后1年的主要不良心血管事件[MACE,包括全因死亡、心肌梗死(MI)和靶病变再次血运重建(TLR)].结果:早期ISR组入选患者80例,晚期ISR组入选患者124例,De novo组入选患者494例.早期ISR组和晚期ISR组糖尿病患病率明显高于De novo组,差异有统计学意义(36.3% vs.41.1% vs.27.1%,P<0.01);早期ISR组不稳定型心绞痛比例明显低于晚期ISR组和De novo组,差异有统计学意义(27.5% vs.63.7% vs.70.6%,P<0.01);其余基线资料差异无统计学意义(P>0.05).三组在病变部位、病变类型及病变长度方面比较,差异均无统计学意义(P<0.05),而早期ISR组与晚期ISR组直径明显小于De novo组,差异有统计学意义[(2.71±0.36)vs.(2.68±0.41) vs.(3.08±0.54)mm,P<0.01)].早期ISR组MACE发生率明显高于晚期ISR组与De novo组(30%vs.15.3% vs.14.2%,P<0.01),其中早期ISR组TLR明显高于晚期ISR组与De novo组,差异有统计学意义(26.3% vs.12.1% vs.10.7%,P<0.01),而晚期ISR组与De novo组比较差异无统计学意义(15.3%vs.14.2%,P>0.05).结论:DES治疗ISR患者安全有效,但治疗早期ISR组病变TLR发生率高于晚期ISR组及De novo病变.

  17. 血液纤维蛋白原和脂蛋白(a)检测在经PCI治疗后支架内再狭窄的冠心病患者中的临床意义%Clinical significance of blood fibrinogen and lipoprotein(a) detection in coronary heart disease patients who in stent restenosis after PCI treatment

    Institute of Scientific and Technical Information of China (English)

    杨世国; 周闵

    2014-01-01

    目的:探讨血Fg和Lp(a)检测在冠心病患者经PCI治疗后支架内ISR患者中的临床意义.方法:成功冠脉内支架术4~12个月后进行复查的194名冠心病心绞痛患者为对象,进行CAG检查,以CAG直径狭窄率50%为支架内ISR.测定血Fg和Lp(a)浓度,按照患者血浆Fg的水平,把患者分为高Fg组[Fg>4.0g/L]和低艮组[Fg≤4.0g/L];按照患者血清Lp(a)的水平,把患者分为高Lp(a)组[Lp(a)>300mg/L]和低Lp(a)组[Lp(a)≤300mg/L],探讨血Fg和Lp(a)与ISR的关系.结果:194例病变CAG示ISR42例,ISR率21.6%,ISR及无ISR组患者间年龄、性别、高血压和糖尿病因素等无明显的差异;ISR组Fg浓度为(4.10±1.00)g/L,明显高于无ISR组的(3.26±0.49)g/L,两组间比较差异有统计学意义(P<0.05).高Fg组ISR率为71.9%,低Fg组ISR率为11.7%,两组间比较差异有统计学意义(P<0.05).ISR组Lp(a)浓度为(409±119)mg/L,明显高于无ISR组的(249±98)mg/L,两组间比较差异有统计学意义(P<0.05).高Lp(a)组ISR率为43.8%,低Lp(a)组ISR率为8.3%,两组间比较差异有统计学意义(P<0.05).结论:Fg和Lp(a)是ISR发生的危险因素,监测血液Fg和Lp(a)浓度对PCI术后发生支架内再狭窄有一定的预测作用.

  18. P-选择素联合高敏C-反应蛋白对冠脉支架内再狭窄的预测价值%Prediction of in stent restenosis by P-Selectin and Hs-CRP in patients with coronary artery disease

    Institute of Scientific and Technical Information of China (English)

    简政威; 赵洪磊; 朱苗飞

    2012-01-01

    目的 通过血管内超声(IVUS)评估冠状动脉支架内再狭窄(ISR),随访并观察冠脉介入术(PCI)后ISR 组与非ISR 组患者炎症因子的水平,探讨P- 选择素(P-Selectin)联合高敏C- 反应蛋白(Hs-CRP)预测ISR 的可行性.方法 对133 例经皮冠脉介入术后患者进行冠脉造影及IVUS 检查随访,造影证实ISR 组17 例,共22 个病变;非ISR 组103 例,共138 个病变;测量并比较两组外弹力膜横截面面积(EEM)、斑块面积、最小管腔面积(MLA)及内膜增生面积;术前及随访时均检测血清P-Selectin、Hs-CRP 水平.结果 与非ISR 组比较,ISR 组有更大的斑块面积、内膜增生面积及更少的最小管腔面积.其中斑块面积、内膜面积、最小管腔面积比较,差异具有统计学意义(P > 0.05);外弹力膜横截面积比较差异无统计学意义(P > 0.05).非ISR 组经皮冠脉介入术前后P-Selectin、Hs-CRP 水平比较,差异无统计学意义(P > 0.05),ISR组术后P-Selectin 、Hs-CRP 较术前明显升高,差异有统计学意义(P < 0.05).结论 经皮冠脉介入术后支架内再狭窄患者P-Selectin、Hs-CRP 水平较术前升高,监测Hs-CRP 及P- 选择素水平对PCI 术后ISR 有一定的预测作用.

  19. 从瘀热互结论治经皮冠状动脉介入治疗术后再狭窄炎性反应%Discussion on an in-stent restenosis caused by inflammation after PCI based on blood and heat stasis

    Institute of Scientific and Technical Information of China (English)

    陈胤峰; 李敏; 王阶

    2015-01-01

    近年来研究趋向于认为炎性反应主导了经皮冠状动脉介入治疗(PCI)术后再狭窄的病理过程,而目前并没有针对炎性反应的推荐用药.中医药在这方面有潜在优势,通过对PCI术后中医病因病机分析发现瘀热互结证与PCI术后炎性反应存在有机对应关系.文章分析PCI术后病因病机特点,结合临床经验,介绍从瘀热互结入手,针对炎性反应的PCI术后再狭窄防治.

  20. Coping – Late Side Effects

    Science.gov (United States)

    Cancer treatment can cause late side effects that may not show up for months or years after treatment. These late effects may include heart and lung problems, bone loss, eye and hearing changes, lymphedema, and other problems

  1. Late-modern hipsters

    DEFF Research Database (Denmark)

    Andersen, Bjørn Schiermer

    2014-01-01

    The article deals with the cultural significance of a new figure in late-modern Western culture: the hipster. The current hipster culture, so I argue, can be used as a magnifying glass that makes impending changes to our conception of culture and of cultural development visible. It ushers in broa...... redemptive gesture toward the objects of the recent past and its predilection for irony. The article seeks to unfold hipster culture and sociality in an ongoing dialogue with sociological theory in general and conventional ways of thinking subculture in particular....

  2. Late-onset hypogonadism

    Directory of Open Access Journals (Sweden)

    Piotr Dudek

    2017-06-01

    Full Text Available In Poland, the number of men over the age of 50 years exceeds 6 million. It is estimated that about 2-6% of this population develops symptoms of late-onset hypogonadism (LOH. In men, testosterone deficiency increases slightly with age. LOH is a clinically and biochemically defined disease of older men with serum testosterone level below the reference parameters of younger healthy men and with symptoms of testosterone deficiency, manifested by pronounced disturbances of quality of life and harmful effects on multiple organ systems. Testosterone replacement therapy may give several benefits regarding body composition, metabolic control, and psychological and sexual parameters.

  3. Improved coronary in-stent visualization using a combined high-resolution kernel and a hybrid iterative reconstruction technique at 256-slice cardiac CT—Pilot study

    Energy Technology Data Exchange (ETDEWEB)

    Oda, Seitaro, E-mail: seisei0430@nifty.com [Department of Diagnostic Radiology, Faculty of Life Sciences, Kumamoto University, 1-1-1 Honjyo, Kumamoto 860-8556 (Japan); Utsunomiya, Daisuke, E-mail: utsunomi@kumamoto-u.ac.jp [Department of Diagnostic Radiology, Faculty of Life Sciences, Kumamoto University, 1-1-1 Honjyo, Kumamoto 860-8556 (Japan); Funama, Yoshinori, E-mail: funama@kumamoto-u.ac.jp [Department of Medical Physics, Faculty of Life Sciences, Kumamoto University, 1-1-1 Honjyo, Kumamoto 860-8556 (Japan); Takaoka, Hiroko, E-mail: hiroko_takayoka@yahoo.co.jp [Department of Diagnostic Radiology, Kumamoto Chuo Hospital, 1-5-1 Tainoshima, Kumamoto 862-0965 (Japan); Katahira, Kazuhiro, E-mail: yy26kk@yahoo.co.jp [Department of Diagnostic Radiology, Kumamoto Chuo Hospital, 1-5-1 Tainoshima, Kumamoto 862-0965 (Japan); Honda, Keiichi, E-mail: k-book@osu.bbiq.jp [Department of Diagnostic Radiology, Kumamoto Chuo Hospital, 1-5-1 Tainoshima, Kumamoto 862-0965 (Japan); Noda, Katsuo, E-mail: k-noda@kumachu.gr.jp [Department of Cardiology, Kumamoto Chuo Hospital, 1-5-1 Tainoshima, Kumamoto 862-0965 (Japan); Oshima, Shuichi, E-mail: shuoshima@e-mail.jp [Department of Cardiology, Kumamoto Chuo Hospital, 1-5-1 Tainoshima, Kumamoto 862-0965 (Japan); Yamashita, Yasuyuki, E-mail: yama@kumamoto-u.ac.jp [Department of Diagnostic Radiology, Faculty of Life Sciences, Kumamoto University, 1-1-1 Honjyo, Kumamoto 860-8556 (Japan)

    2013-02-15

    Objectives: To investigate the diagnostic performance of 256-slice cardiac CT for the evaluation of the in-stent lumen by using a hybrid iterative reconstruction (HIR) algorithm combined with a high-resolution kernel. Methods: This study included 28 patients with 28 stents who underwent cardiac CT. Three different reconstruction images were obtained with: (1) a standard filtered back projection (FBP) algorithm with a standard cardiac kernel (CB), (2) an FBP algorithm with a high-resolution cardiac kernel (CD), and (3) an HIR algorithm with the CD kernel. We measured image noise and kurtosis and used receiver operating characteristics analysis to evaluate observer performance in the detection of in-stent stenosis. Results: Image noise with FBP plus the CD kernel (80.2 ± 15.5 HU) was significantly higher than with FBP plus the CB kernel (28.8 ± 4.6 HU) and HIR plus the CD kernel (36.1 ± 6.4 HU). There was no significant difference in the image noise between FBP plus the CB kernel and HIR plus the CD kernel. Kurtosis was significantly better with the CD- than the CB kernel. The kurtosis values obtained with the CD kernel were not significantly different between the FBP- and HIR reconstruction algorithms. The areas under the receiver operating characteristics curves with HIR plus the CD kernel were significantly higher than with FBP plus the CB- or the CD kernel. The difference between FBP plus the CB- or the CD kernel was not significant. The average sensitivity, specificity, and positive and negative predictive value for the detection of in-stent stenosis were 83.3, 50.0, 33.3, and 91.6% for FBP plus the CB kernel, 100, 29.6, 40.0, and 100% for FBP plus the CD kernel, and 100, 54.5, 40.0, and 100% for HIR plus the CD kernel. Conclusions: The HIR algorithm combined with the high-resolution kernel significantly improved diagnostic performance in the detection of in-stent stenosis.

  4. Bioresorbable vascular scaffold (BVS) for in-stent chronic total occlusion: Antegrade recanalization and IVUS-guided BVS implantation by radial access

    Energy Technology Data Exchange (ETDEWEB)

    Medda, Massimo [Interventional Cardiology Unit, Istituto Clinico Sant' Ambrogio, Milano (Italy); Casilli, Francesco, E-mail: frcasill@tin.it [Interventional Cardiology Unit, Istituto Clinico Sant' Ambrogio, Milano (Italy); Bande, Marta [Interventional Cardiology Unit, Istituto Clinico Sant' Ambrogio, Milano (Italy); Latini, Maria Giulia [Cardiologia Interventistica, IRCCS Policlinico San Donato, San Donato Milanese, Milano (Italy); Ghommidh, Mehdi [Interventional Cardiology Unit, Istituto Clinico Sant' Ambrogio, Milano (Italy); Del Furia, Francesca [Unità Operativa di Cardiologia, Azienda Ospedaliera di Melegnano, Milano (Italy); Inglese, Luigi [Interventistica Cardiovascolare, Gruppo Sanitario Policlinico di Monza, Milano (Italy)

    2016-01-15

    The completely absorbable stents represent one of the latest innovations in the field of interventional cardiology, prospecting the possibility of “vascular repair”. In the published trials (ABSORB Cohort A and B, ABSORB EXTEND, and ABSORB II, III and IV) chronic total occlusions (CTOs) were considered an exclusion criteria. More recently the CTO-ABSORB pilot study demonstrated the safety and feasibility of bioresorbable vascular scaffold (BVS) use in case of CTO recanalization. We present the first case, to our knowledge, of in-stent occlusion successfully treated with an everolimus-eluting BVS and discuss its potential advantages in such kind of lesions.

  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. 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

  7. 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

  8. Endovascular brachytherapy from Re-188-filled balloon catheter to prevent restenosis following angioplasty; Endovaskulaere Brachytherapie mit einem Re-188-gefuellten Ballonkatheter zur Praevention der Restenose nach Angioplastie

    Energy Technology Data Exchange (ETDEWEB)

    Kotzerke, J. [Ulm Univ. (Germany). Abt. Nuklearmedizin; Kropp, J. [Technische Univ. Dresden (Germany). Klinik und Poliklinik fuer Nuklearmedizin

    2001-12-01

    Stent implantation and endovascular brachytherapy are the single effective methods to reduce restenosis after angioplasty. Gamma- and beta-emitter can be applied. The use of a liquid beta-emitter filled balloon catheter allows nuclear medicine to participate in this new concept of therapy due to the unsealed source. From various beta-emitters Re-188-perrhenate seems to be the most attractive one regarding logistic, radiation protection and costs. Feasibility of the method was demonstrated by several groups. Interim analysis of ECRIS-2 demonstrate an effectiveness comparable to the best of other irradiation data. (orig.) [German] Die endovaskulaere Brachytherapie ist neben der Stentimplantation bisher die einzige Methode, mit der die Restenoserate nach Angioplastie (PTCA) deutlich reduziert werden kann. Sowohl Gamma- wie auch Betastrahler sind einsetzbar. Die Anwendung eines fluessigen Betastrahlers in einem Ballonkatheter erlaubt dem Nuklearmediziner, an diesem Therapiekonzept zu partizipieren, da es sich um die Anwendung eines offenen radioaktiven Isotops handelt. Von den diversen moeglichen Betastrahlern erscheint Re-188-Perrhenat am geeignetsten zu sein im Hinblick auf die Logistik, den Strahlenschutz und die Kosten. Die Praktikabilitaet dieser Methode wurde von mehreren Zentren bestaetigt. Eine Zwischenauswertung der ECRIS-2-Studie aus Ulm ergibt Daten, die grossen amerikanischen Studien keineswegs nachstehen. (orig.)

  9. p21-Activated Kinase 4 Promotes Intimal Hyperplasia and Vascular Smooth Muscle Cells Proliferation during Superficial Femoral Artery Restenosis after Angioplasty

    Directory of Open Access Journals (Sweden)

    Liangxi Yuan

    2017-01-01

    Full Text Available The aim of this study is to explore the function of p21-activated kinase 4 (PAK4 in intimal hyperplasia (IH and vascular smooth muscle cells (VSMCs proliferation. We choose vascular samples from patients undergoing angioplasty in superficial femoral artery (SFA as the experimental group and vascular samples from donors without clinical SFA restenosis as the control group, respectively. We draw from the results that both levels of mRNA and protein of PAK4 in the experimental group increased dramatically compared with the control group. IH arose from angioplasty of SFA. Moreover, overexpression of PAK4 dramatically contributed to cell proliferation of VSMCs and promoted cell cycle progression from G0/G1 phase (71.12±0.69% versus 58.77±0.77%, P<0.001 into S phase (23.99±0.21% versus 31.35±0.33%, P<0.001. Besides, PAK4 downregulated the level of p21 and enhanced the activity of Akt as well. And we conclude that PAK4 acts as a regulator of cell cycle progression of VSMC by mediating Akt signaling and controlling p21 levels, which further modulate IH and VSMCs’ proliferation.

  10. Never too late.

    Science.gov (United States)

    1996-11-01

    Motivated by the belief that education has been central to Japan's economic success, Japan International Cooperation Agency (JICA) promotes universal access to quality basic education. In developing countries, school children rarely learn science through experiments. A new JICA training course, the Science Experiment in Primary Education, involved teacher trainers from Bangladesh, Myanmar, Pakistan, and Sri Lanka. Physics, chemistry, biology, geology, and astronomy experiments that require simple, inexpensive materials were taught. Another JICA project in Satkhira, Bangladesh, sought to raise the economic status of women enrolled in a dressmaking program through a year-long evening literacy class at three sites. Elementary school diplomas (available with proof to a local teacher of basic literacy and minimal arithmetic skills) are required in Bangladesh to apply for nongovernmental organization-initiated vocational schools and loans to start businesses in areas such as dressmaking, agriculture, and livestock raising. By late 1993, the female literacy program had expanded to 18 villages.

  11. Late-Modern Symbolism

    DEFF Research Database (Denmark)

    Andersen, Bjørn Schiermer

    2015-01-01

    Through analysis of key texts, I seek to demonstrate the explanative potential of Durkheim’s sociology of religion in the present context. I critically readdress the idea, found in his early work, that modernity is characterized by a rupture with pre-modern forms of solidarity. First, I investigate...... the ways in which Durkheim sets up a stark distinction between the pre-modern and the modern in his early work, and how this distinction is further cemented by his orthodox critique of the modern economy and its negative effects on social life. Second, I show how another timeless and positive understanding...... of “mechanical” solidarity is to be found behind the “symbolist” template crystalizing in Durkheim’s late work. Third, I develop this template for a modern context by critically addressing and removing other obstacles and prejudices on Durkheim’s part....

  12. Mechanisms and methods to resolve edge effect.

    Science.gov (United States)

    Kuchulakanti, Pramod; Lew, Robert; Waksman, Ron

    2003-06-01

    Vascular brachytherapy (VBT) has established itself as a viable modality to treat in-stent restenosis (ISR). The problems associated with VBT have been understood well and remedied. Late thrombosis has been overcome to a great extent by prolonged antiplatelet therapy. Edge effect is another important limitation of VBT and is due to inadequate radiation coverage of the edges following VBT. It may be overcome by confining injury to the lesion segment and extending the radiation sources by a few millimeters from the injured segment.

  13. Will absorbable metal stent technology change our practice?

    Science.gov (United States)

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

    2006-08-01

    Peripheral stents aim to support revascularization procedures of intravascular stenoses by mechanically preventing vessel recoil and counteracting pathophysiologic processes of luminal re-narrowing triggered by procedural injury of the vessel wall. Despite improvements in stenting techniques and concomitant medication, repeated intervention due to target lesion re-stenosis is necessary on a significant percentage of patients. The permanent presence of an artificial implant plays a prominent role in the discussion of mechanisms causing in-stent restenosis. Permanent metallic implants pose the risk of a continuous interaction between non-absorbable stent and surrounding tissue, leading to physical irritation, long-term endothelial dysfunction, or chronic inflammatory reactions. In addition, there is a risk of stent fracture due to external mechanical forces. To overcome these shortcomings, technology of stenting has moved towards the development of temporary implants composed of biocompatible materials which mechanically support the vessel during the period of high risk for recoil and then completely degrade in the long-term perspective. This removes a potential trigger for late restenosis.

  14. Late Carboniferous to Late Permian carbon isotope stratigraphy

    DEFF Research Database (Denmark)

    Buggisch, Werner; Krainer, Karl; Schaffhauser, Maria

    2015-01-01

    An integrated study of the litho-, bio-, and isotope stratigraphy of carbonates in the Southern Alps was undertaken in order to better constrain δ13C variations during the Late Carboniferous to Late Permian. The presented high resolution isotope curves are based on 1299 δ13Ccarb and 396 δ13Corg a...

  15. Illusory Late Heavy Bombardments.

    Science.gov (United States)

    Boehnke, Patrick; Harrison, T Mark

    2016-09-27

    The Late Heavy Bombardment (LHB), a hypothesized impact spike at ∼3.9 Ga, is one of the major scientific concepts to emerge from Apollo-era lunar exploration. A significant portion of the evidence for the existence of the LHB comes from histograms of (40)Ar/(39)Ar "plateau" ages (i.e., regions selected on the basis of apparent isochroneity). However, due to lunar magmatism and overprinting from subsequent impact events, virtually all Apollo-era samples show evidence for (40)Ar/(39)Ar age spectrum disturbances, leaving open the possibility that partial (40)Ar* resetting could bias interpretation of bombardment histories due to plateaus yielding misleadingly young ages. We examine this possibility through a physical model of (40)Ar* diffusion in Apollo samples and test the uniqueness of the impact histories obtained by inverting plateau age histograms. Our results show that plateau histograms tend to yield age peaks, even in those cases where the input impact curve did not contain such a spike, in part due to the episodic nature of lunar crust or parent body formation. Restated, monotonically declining impact histories yield apparent age peaks that could be misinterpreted as LHB-type events. We further conclude that the assignment of apparent (40)Ar/(39)Ar plateau ages bears an undesirably high degree of subjectivity. When compounded by inappropriate interpretations of histograms constructed from plateau ages, interpretation of apparent, but illusory, impact spikes is likely.

  16. Recent casualties of late globalization

    DEFF Research Database (Denmark)

    Turcan, Romeo V.

    2016-01-01

    In this essay I will expand my thoughts on universities as ‘late globalizers’ and the impact ‘being late’ has on university internationalization or globalization activities. In my earlier essay I viewed universities as ‘late globalizers’ and briefly introduced the impact of being ‘late’, e...

  17. Recent casualties of late globalization

    DEFF Research Database (Denmark)

    Turcan, Romeo V.

    2016-01-01

    In this essay I will expand my thoughts on universities as ‘late globalizers’ and the impact ‘being late’ has on university internationalization or globalization activities. In my earlier essay I viewed universities as ‘late globalizers’ and briefly introduced the impact of being ‘late’, e.g., wi...

  18. Late-life attachment.

    Science.gov (United States)

    Freitas, Mélanie; Rahioui, Hassan

    2017-03-01

    Old age is likely to cause a crisis in one's life because of the vulnerabilities it brings up, acting as stressful elements disrupting the elder's feeling of security. It leads to the activation of what is called his attachment system, consisting in attachment styles and interpersonal emotional regulation strategies. To recover a higher sense of safety, the elder would refer to his attachment figures, that is to say closed people paying attention to him, showing towards him availability and consideration. However older adults particularly see their tolerance threshold lowered, regarding an accumulation of losses (true or symbolic) and stressful events within their lifetime. In a psychological and organic exhaustion phenomenon, the risk is to wear out the interpersonal emotional regulation strategies. These are as much vulnerabilities that may increase psychiatric decompensation, including depression. To resolve the tension of this period and to found a necessary secure feeling, the elder will have to redesign the attachment links previously settled and proceed to adjustments to this new context. The need of relational closeness comes back in the elders' attachment behaviour, counting on attachment figures not only to help their loneliness or dependency, but essentially to support them in a narcissist and affective way. That is why attachment theory enlightens the late life period, such as the new challenges older adults have to face. Many studies recognize its value in understanding the transition to old age, but without proposing conceptualization. We aim first to focus on attachment conception to say how much it is relevant with elderly, and then to describe specific terms of attachment within this population in order to better understand those patients. To finish, we must think about new therapeutic proposals taking into consideration the attachment perspective for a better understanding of old age transition.

  19. Prospective multi-center registry to evaluate efficacy and safety of the newly developed diamond-like carbon-coated cobalt-chromium coronary stent system.

    Science.gov (United States)

    Ando, Kenji; Ishii, Katsuhisa; Tada, Eiji; Kataoka, Kazuaki; Hirohata, Atsushi; Goto, Kenji; Kobayashi, Katsuyuki; Tsutsui, Hiroshi; Nakahama, Makoto; Nakashima, Hitoshi; Uchikawa, Shinichiroh; Kanda, Junji; Yasuda, Satoshi; Yajima, Junji; Kitabayashi, Hiroshi; Sakurai, Shumpei; Nakanishi, Keita; Inoue, Naoto; Noike, Hirofumi; Hasebe, Terumitsu; Sato, Tetsuya; Yamasaki, Masao; Kimura, Takeshi

    2017-07-01

    The purpose of this multi-center, non-randomized, and open-label clinical trial was to determine the non-inferiority of diamond-like carbon (DLC)-coated cobalt-chromium coronary stent, the MOMO DLC coronary stent, relative to commercially available bare-metal stents (MULTI-LINK VISION(®)). Nineteen centers in Japan participated. The study cohort consisted of 99 patients from 19 Japanese centers with single or double native coronary vessel disease with de novo and restenosis lesions who met the study eligibility criteria. This cohort formed the safety analysis set. The efficacy analysis set consisted of 98 patients (one case was excluded for violating the eligibility criteria). The primary endpoint was target vessel failure (TVF) rate at 9 months after stent placement. Of the 98 efficacy analysis set patients, TVF occurred in 11 patients (11.2 %, 95 % confidence interval 5.7-19.2 %) at 9 months after the index stent implantation. The upper 95 % confidence interval for TVF of the study stent was lower than that previously reported for the commercially available MULTI-LINK VISION(®) (19.6 %), demonstrating non-inferiority of the study stent to MULTI-LINK VISION(®). All the TVF cases were related to target vascular revascularization. None of the cases developed in-stent thrombosis or myocardial infarction. The average in-stent late loss and binary restenosis rate at the 6-month follow-up angiography were 0.69 mm and 10.5 %, respectively, which are lower than the reported values for commercially available bare-metal stents. In conclusion, the current pivotal clinical study evaluating the new MOMO DLC-coated coronary stent suggested its low rates of TVF and angiographic binary restenosis, and small in-stent late loss, although the data were considered preliminary considering the small sample size and single arm study design.

  20. Solving the Issue of Restenosis After Stenting of Intracranial Stenoses: Experience with Two Thin-Strut Drug-Eluting Stents (DES)—Taxus Element™ and Resolute Integrity™

    Energy Technology Data Exchange (ETDEWEB)

    Kurre, Wiebke, E-mail: wiebke.kurre@gmx.de; Aguilar-Pérez, Marta [Klinikum Stuttgart, Klinik für Diagnostische und Interventionelle Neuroradiologie (Germany); Fischer, Sebastian [Universitätsklinikum Knappschaftskrankenhaus Bochum GmbH, Institut für Diagnostische und Interventionelle Radiologie, Neuroradiologie und Nuklearmedizin (Germany); Arnold, Guy [Klinikverbund Südwest, Klinikum Sindelfingen, Klinik für Neurologie (Germany); Schmid, Elisabeth; Bäzner, Hansjörg [Klinikum Stuttgart, Klinik für Neurologie (Germany); Henkes, Hans [Klinikum Stuttgart, Klinik für Diagnostische und Interventionelle Neuroradiologie (Germany)

    2015-06-15

    PurposeThin-strut, flexible DES are suitable for intracranial stenting and may improve long-term vessel patency. The purpose of this study was to report our experience with two new-generation DES for the treatment of intracranial atherosclerotic disease.Patients and MethodsWe retrospectively reviewed all patients treated with Taxus Element™ or Resolute Integrity™ stent for an intracranial atherosclerotic stenosis between March 2011 and August 2013. Technical success was defined as the ability to deploy the device at the desired location and reduce the degree of stenosis below 50 %. All procedure-related strokes were recorded. Control angiography was scheduled after 6 weeks, 3, 6, and 12 months and yearly thereafter. A luminal narrowing ≥50 % was regarded as a restenosis. Stroke recurrence in the territory of the treated artery was reported.ResultsIn the defined period we treated 101 patients harboring 117 intracranial stenoses. The procedure was successful in 100 (85.5 %) lesions. Procedure-related strokes occurred in 10 (9.9 %) patients with a permanent morbidity in 3 (3.0 %). Follow-up angiography was available for 83 of 100 (83.0 %) successfully treated lesions with an average of 355 days (IQR 153–482 days). Three (3.6 %) asymptomatic restenoses were detected. All occurred after treatment with Resolute Integrity™, none after Taxus Element™ (p = 0.059). New strokes in the territory of the treated artery were encountered in 2 (2.6 %) occasions.ConclusionThin-strut DES improve long-term patency and reduce the risk of subsequent stroke. Differences between devices may exist. Feasibility is comparable to bare-metal balloon-mounted stents and procedure-related strokes occurred within the expected range.

  1. Taurine suppresses oxidative stress-potentiated expression of lectin-like oxidized low-density lipoprotein receptor and restenosis in balloon-injured rabbit iliac artery.

    Science.gov (United States)

    Gokce, G; Ozsarlak-Sozer, G; Oran, I; Oktay, G; Ozkal, S; Kerry, Z

    2011-12-01

    1. In endothelial cells, the major receptor for the binding and internalization of oxidized low-density lipoprotein (LDL) is the lectin-like oxidized LDL receptor (LOX-1). The aim of the present study was to investigate the effects of taurine on intimal thickening and LOX-1 expression under normal and oxidative conditions. 2. The iliac artery of rabbits were subjected to balloon injury and oxidative stress was induced by 14 days treatment of rabbits with 75 mg/kg, s.c., buthionine sulfoximine (BSO), a specific inhibitor of glutathione synthesis. Taurine was administered in drinking water (1%, w/v) for 14 days in the presence (BSO + Taurine group) and in the absence of BSO treatment (Taurine group). In taurine and placebo groups, rabbits were injected with 4 mL, s.c., 0.9% NaCl (vehicle for BSO) for 14 days. 3. Taurine (1% in drinking water, w/v) preserved plasma levels of anti-oxidants and lowered the increased blood pressure induced by BSO. The stenosis rate of 29.92% in the placebo group increased to 72.20% in the BSO group, which was significantly reduced to 42.21% by taurine (P treatment reduced the BSO-induced increase in LOX-1 expression at both the protein and mRNA levels (P < 0.05 and P < 0.01, respectively). 4. The results demonstrate that the stenosis rate and LOX-1 expression correlate well with oxidative status. Manipulation of LOX-1 expression by taurine may have therapeutic benefits in preventing restenosis.

  2. 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 SER was 1.0 mm. CONCLUSION: An interval less than 1 mm from the proximal stent edge to the nearest point with the determined PB cutoff value of 54.74% was significantly associated with SER in patients with residual plaque lesions.

  3. 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.

  4. Research progress of in-stent magnetic-mediated hyperthermia for tumor treatment%肿瘤磁介导支架热疗研究进展

    Institute of Scientific and Technical Information of China (English)

    刘凯; 赵凌云

    2008-01-01

    磁介导热疗具有加热的特异性强、治疗的靶向性高和诱发机体免疫的特点.学者们从产热机制、可行性研究、体外实验与l临床试验等多个方面对磁介导热疗在消化道支架热疗的应用进行了大量的研究.%Possessing the unique feathers of high targeting and inducing the active immunity of patients,magnetic-mediated hyperthermia(MMH)has been regarded as a very promising cancer-treatment approach.Researches about in-stent MMH for esophagus cancel have been widely carried out with focusing on heating mechanism,feasibility studies and clinical trials.

  5. Causes, Timing, and Impact of Dual Antiplatelet Therapy Interruption for Surgery (from the Patterns of Non-adherence to Anti-platelet Regimens In Stented Patients Registry).

    Science.gov (United States)

    Schoos, Mikkel; Chandrasekhar, Jaya; Baber, Usman; Bhasin, Aarti; Sartori, Samantha; Aquino, Melissa; Vogel, Birgit; Farhan, Serdar; Sorrentino, Sabato; Kini, Annapoorna; Kruckoff, Mitchell; Moliterno, David; Henry, Timothy D; Weisz, Giora; Gibson, C Michael; Iakovou, Ioannis; Colombo, Antonio; Steg, P Gabriel; Witzenbichler, Bernhard; Chieffo, Alaide; Cohen, David; Stuckey, Thomas; Ariti, Cono; Dangas, George; Pocock, Stuart; Mehran, Roxana

    2017-09-15

    Temporary interruption of dual antiplatelet therapy (DAPT) is not infrequently required in patients undergoing percutaneous coronary intervention (PCI). We sought to describe the procedures and outcomes associated with DAPT interruption in patients treated with DAPT following successful PCI from the Patterns of non-adherence to anti-platelet regimens in stented patients registry (n = 5018). DAPT interruption was prespecified as physician recommended cessation for antiplatelet agent was interrupted in 57.2% cases and interruption was frequently recommended by noncardiologists (51.3%). Where type of surgery was reported, majority of DAPT interruptions occurred for minor surgery (68.4% vs 31.6%) and a similar cessation pattern of single versus dual antiplatelet cessation was observed regardless of minor or major surgery. Subsequent to DAPT interruption, 12 patients (2.4%) experienced 1 thrombotic event each, of which 5 (1.0%) occurred during the interruption period. All events occurred in patients who either stopped both agents (8 of 12) or clopidogrel-only (4 of 12), with no events occurring due to aspirin cessation alone. In conclusion, in the Patterns of Non-adherence to Anti-platelet Regiments in Stented Patients registry, 1 in 10 patients were recommended DAPT interruption for surgery within 2 years of PCI. Interruption was more common for a single agent rather than both antiplatelet agents regardless of severity of surgery, and was frequently recommended by noncardiologists. Only 1% of patients with DAPT interruption experienced a subsequent thrombotic event during the interruption period, which mainly occurred in patients stopping both antiplatelet agents. Copyright © 2017 Elsevier Inc. All rights reserved.

  6. Vaginal bleeding in late pregnancy

    Science.gov (United States)

    ... page: //medlineplus.gov/ency/patientinstructions/000627.htm Vaginal bleeding in late pregnancy To use the sharing features ... the blood from soaking your clothes. What Causes Bleeding Later in Pregnancy? When labor begins, the cervix ...

  7. 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.

  8. Late and chronic Lyme disease.

    Science.gov (United States)

    Donta, Sam T

    2002-03-01

    This article reviews the late and chronic manifestations of Lyme disease. Special attention is given to the chronic manifestations of the disease, detailing its pathogenesis, clinical spectrum, and laboratory criteria for the diagnosis. Based on experimental evidence and experience, approaches to the successful treatment of the late and chronic disease are outlined. Much additional work is needed to improve the understanding of the underlying pathophysiology of the disease, its diagnosis and treatment.

  9. Late prematurity: a systematic review

    Directory of Open Access Journals (Sweden)

    Luís Carlos Machado Júnior

    2014-06-01

    Full Text Available Objective: this study aimed to review the literature regarding late preterm births (34 weeks to 36 weeks and 6 days of gestation in its several aspects. Sources: the MEDLINE, LILACS, and Cochrane Library databases were searched, and the references of the articles retrieved were also used, with no limit of time. Data synthesis: numerous studies showed a recent increase in late preterm births. In all series, late preterm comprised the majority of preterm births. Studies including millions of births showed a strong association between late preterm birth and neonatal mortality. A higher mortality in childhood and among young adults was also observed. Many studies found an association with several neonatal complications, and also with long-term disorders and sequelae: breastfeeding problems, cerebral palsy, asthma in childhood, poor school performance, schizophrenia, and young adult diabetes. Some authors propose strategies to reduce late preterm birth, or to improve neonatal outcome: use of antenatal corticosteroids, changes in some of the guidelines for early delivery in high-risk pregnancies, and changes in neonatal care for this group. Conclusions: numerous studies show greater mortality and morbidity in late preterm infants compared with term infants, in addition to long-term disorders. More recent studies evaluated strategies to improve the outcomes of these neonates. Further studies on these strategies are needed.

  10. Late prematurity: a systematic review.

    Science.gov (United States)

    Machado Júnior, Luís Carlos; Passini Júnior, Renato; Rodrigues Machado Rosa, Izilda

    2014-01-01

    this study aimed to review the literature regarding late preterm births (34 weeks to 36 weeks and 6 days of gestation) in its several aspects. the MEDLINE, LILACS, and Cochrane Library databases were searched, and the references of the articles retrieved were also used, with no limit of time. numerous studies showed a recent increase in late preterm births. In all series, late preterm comprised the majority of preterm births. Studies including millions of births showed a strong association between late preterm birth and neonatal mortality. A higher mortality in childhood and among young adults was also observed. Many studies found an association with several neonatal complications, and also with long-term disorders and sequelae: breastfeeding problems, cerebral palsy, asthma in childhood, poor school performance, schizophrenia, and young adult diabetes. Some authors propose strategies to reduce late preterm birth, or to improve neonatal outcome: use of antenatal corticosteroids, changes in some of the guidelines for early delivery in high-risk pregnancies, and changes in neonatal care for this group. numerous studies show greater mortality and morbidity in late preterm infants compared with term infants, in addition to long-term disorders. More recent studies evaluated strategies to improve the outcomes of these neonates. Further studies on these strategies are needed. Copyright © 2014 Sociedade Brasileira de Pediatria. Published by Elsevier Editora Ltda. All rights reserved.

  11. Late effects from hadron therapy

    Energy Technology Data Exchange (ETDEWEB)

    Blakely, Eleanor A.; Chang, Polly Y.

    2004-06-01

    Successful cancer patient survival and local tumor control from hadron radiotherapy warrant a discussion of potential secondary late effects from the radiation. The study of late-appearing clinical effects from particle beams of protons, carbon, or heavier ions is a relatively new field with few data. However, new clinical information is available from pioneer hadron radiotherapy programs in the USA, Japan, Germany and Switzerland. This paper will review available data on late tissue effects from particle radiation exposures, and discuss its importance to the future of hadron therapy. Potential late radiation effects are associated with irradiated normal tissue volumes at risk that in many cases can be reduced with hadron therapy. However, normal tissues present within hadron treatment volumes can demonstrate enhanced responses compared to conventional modes of therapy. Late endpoints of concern include induction of secondary cancers, cataract, fibrosis, neurodegeneration, vascular damage, and immunological, endocrine and hereditary effects. Low-dose tissue effects at tumor margins need further study, and there is need for more acute molecular studies underlying late effects of hadron therapy.

  12. Late effects from hadron therapy.

    Science.gov (United States)

    Blakely, Eleanor A; Chang, Polly Y

    2004-12-01

    Successful cancer patient survival and local tumor control from hadron radiotherapy warrant a discussion of potential secondary late effects from the radiation. The study of late-appearing clinical effects from particle beams of protons, carbon, or heavier ions is a relatively new field with few data. However, new clinical information is available from pioneer hadron radiotherapy programs in the USA, Japan, Germany and Switzerland. This paper will review available data on late tissue effects from particle radiation exposures, and discuss its importance to the future of hadron therapy. Potential late radiation effects are associated with irradiated normal tissue volumes at risk that in many cases can be reduced with hadron therapy. However, normal tissues present within hadron treatment volumes can demonstrate enhanced responses compared to conventional modes of therapy. Late endpoints of concern include induction of secondary cancers, cataract, fibrosis, neurodegeneration, vascular damage, and immunological, endocrine and hereditary effects. Low-dose tissue effects at tumor margins need further study, and there is need for more acute molecular studies underlying late effects of hadron therapy.

  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. Therapy and prophylaxis of acute and late radiation-induced sequelae of the esophagus

    Energy Technology Data Exchange (ETDEWEB)

    Zimmermann, F.B.; Geinitz, H.; Feldmann, H.J. [Klinik und Poliklinik fuer Strahlentherapie und Radiologische Onkologie, Klinikum rechts der Isar, Muenchen (Germany)

    1998-11-01

    Background: Radiation-induced esophagitis is a frequent acute side effect in curative and palliative radiotherapy of thoracal and cervical tumors. Late reactions are rare but might be severe. Methods: A resarch for reports on prophylactic and supportive therapies of radiation-induced esophagitis was performed (Medline, Cancerlit, and others). Results: Nutrition must be ensured and symptomatic relief of sequelae is important, especially in the case of dysphagia. The latter can be improved by topic or systemic analgetics. If esophageal spasm occurs, calcium antagonists might help. In case of gastro-esophageal reflux proton pump inhibitors should be used. There is no effective prophylactic measure for radiation esophagitis. Late side effects with clinical relevance are rare in conventional radiotherapy. Chronic ulcera, fistula or stenosis may develop. Before any treatment, a tumor infiltration of the esophagus should be excluded by biopsy. This can lead more often to late complications than radiation therapy itself. Nutrition should be ensured by endoscopic dilation, stent-implantation, or endoscopic percutaneous gastrostomy. Local injection of steroids might be used to avoid an early restenosis. Conclusions: An intensive symptomatic therapy of acute esophagitis is reasonable. Effective prophylaxis do not exist. Late radiation induced sequelae is rare. Therefore, a tumor recurrenc e should be excluded in cases of dysphagia. Securing nutrition by PEG, stent, or port is well in the fore. (orig.) [Deutsch] Hintergrund: Die radiogene Oesophagitis ist eine haeufige akute Nebenwirkung bei kurativen wie palliativen Bestrahlungen thorakaler und zervikaler Tumoren. Spaete Gewebereaktionen sind selten, koennen aber schwerwiegend sein. Methode: Es wurde eine Literaturrecherche nach prophylaktischen und supportiven Therapien der radiogen verursachten Oesophagitis durchgefuehrt (Medline, Cancerlit und andere). Ergebnisse: Therapeutisch stehen die Sicherung der Ernaehrung und die

  15. Six-month results of a biodegradable polymer and rapamycin-coating stent for coronary artery disease

    Institute of Scientific and Technical Information of China (English)

    Yuxiao ZHANG; Caiyi LU; Qiao XUE; Peng LIU; Wei YAN; Rui CHEN

    2006-01-01

    Objective To assess the safety and efficacy of a novel biodegradable polymer and rapamycin-coating stent, the EXCEL stent, in the treatment of coronary artery disease (CAD), as compared with the CypherTM stent. Methods In this prospective, non-randomized study, 60 consecutive patients with symptomatic CAD received either an EXCEL stent (n=32), or a CypherTM stent(n=28),according to their respective treatment intention. Follow-up angiography was performed at a mean of 180±40 days. The primary endpoint of the study was the occurrence of a major adverse cardiac event (MACE), including death, myocardial infarction, or target-vessel revascularization during the 6 months after stenting. The secondary end points included the in-stent late luminal loss (LLL), percentage of in-stent stenosis of the luminal diameter, and the rate of restenosis (luminal narrowing of 50 percent or more) at 6 months. Results There were no significant differences between the two groups in baseline characteristics, including the distribution of target vessel and lesion types. During the follow up period of 6 months, there were no occurrences of MACE in either group. Twenty-seven patients(84%) in the EXCEL group and 10 (36 %) in the CypherTM group underwent quantitative coronary angiography at 6 months. For these patients, no restenosis occurred, and there were no differences in the in-stent stenosis of the luminal diameter (5.98±5.52% vs 5.21 ±6.3%,P>0.05) and the LLL (-0.02±0.09 mm vs -0.01±0.07 mm, P>0.05). Conclusions Compared with the CypherTM stent, the EXCEL Stent with biodegradable polymer and rapamycin-coating showed similar efficacy in the prevention of neointimal proliferation, restenosis, and associated clinical events in CAD patients.

  16. Late sequelae of superficial irradiation

    Energy Technology Data Exchange (ETDEWEB)

    Hood, I.C.; Young, J.E.

    1984-10-01

    Superficial irradiation results in well recognized late sequelae including not only sclerosis and atrophy of skin and subcutaneous tissue, but also the development of benign and malignant tumors of skin and adjacent structures. The long latency between irradiation and its late effects allowed the early uncontrolled use of radiation treatment for benign conditions. The subsequent recognition of the causal relationship between tumors and previous irradiation has restricted its use to more appropriate purposes, although it is possible that it is still overused in some areas of dermatologic practice. Clinicians need to be aware of the time interval between irradiation and the development of its late sequelae, and the incidence of these sequelae. Appropriate irradiation exposure history should be a part of the evaluation of every patient.

  17. [Late-onset dysthymic states].

    Science.gov (United States)

    Siranchiev, M A

    2002-01-01

    Sixty patients with dysthymic states which had emerged in later age of 60-80 years were examined. Two clinical types of dysthymic states were described: anergic (20 patients) and hypothymic (40 patients). Different comorbid mental disorders--obsessive-phobic (14 cases), somatoform (10), personality deviations (20) and psycho-organic (7)--were found to be characteristic of late-onset dysthymic states. According to developmental features, late dysthymia was primary (first manifested in the elderly) and secondary (develops after several depressive episodes). In diagnostic terms, the former is considered as "dysthymia" (F34.1 ICD-10) and the latter--as "recurrent depressive disorder" (F33).

  18. 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.

  19. A prospective multicenter parallel-controlled trial of TIVOLI biodegradable-polymer-based sirolimus-eluting stent compared to ENDEAVOR zotarolimus-eluting stent for the treatment of coronary artery disease: 8-month angiographic and 2-year clinical follow-up results

    Institute of Scientific and Technical Information of China (English)

    XU Bo; LI Wei-min; CHEN Ji-yan; WANG Lei; WANG Yong; GE Jun-bo; LI Wei; GAO Run-lin; DOU Ke-fei; HAN Ya-ling; L(U) Shu-zheng; YANG Yue-jin; HUO Yong; WANG Le-feng; CHEN Yun-dai; WANG Hai-chang

    2011-01-01

    Background Available drug-eluting stents (DES) have achieved great success in reducing restenosis rates. Recently,investigators have demonstrated that the durable polymer carrier plays a significant role in DES-related hypersensitive reaction and delays vessel healing. TIVOLI stent is a novel sirolimus-eluting coronary stent with biodegradable coating containing sirolimus and polylactic-co-glycolic acid (PLGA) polymer. The present study sought to evaluate the effectiveness and safety of the TIVOLI biodegradable-polymer-based sirolimus-eluting stent in treating patients with coronary artery disease.Methods A prospective, multicenter clinical trial comparing TIVOLI biodegradable coated sirolimus-eluting stent with ENDEAVOR zotarolimus-eluting stent was conducted in 324 patients (TIVOLI group: 168 patients; ENDEAVOR group:156 patients) at 12 centers in China to demonstrate the non-inferiority of in-stent late loss with TIVOLI stent compared to ENDEAVOR stent in subjects with a maximum of two de novo native coronary artery lesions (lesion length ≤40 mm,reference vessel diameter 2.25-4.00 mm). The primary end point was angiographic in-stent late loss at 8-month. The secondary end points were clinical outcomes at 2 years,including major adverse cardiac events (cardiac death,myocardial infarction, or target-lesion revascularization) and stent thrombosis.Results Angiographic late lumen loss at 8 months in the TIVOLI group was superior to the ENDEAVOR group (in-stent (0.25±0.33) mm vs. (0.57±0.55) mm, diff (95% CI)-0.23 (-0.32, -0.14), P <0.0001; in-segment (0.25±-0.33) mm vs. (0.42±-0.55) mm, diff (95% CI) -0.13 (-0.23, -0.02),P=0.0083). The rate of in-stent binary restenosis at 8 months was reduced from 8.6% in the ENDEAVOR group to 2.9% in the TIVOLI group (P=0.0229). Compared to ENDEAVOR stent, TIVOLI stent resulted in a significant reduction in target-lesion revascularization (4.2% vs. 9.6%, P=0.0495) at 2 years. The two-year major adverse cardiac events (MACE

  20. LATE ONSET ATRIOVENTRICULAR NODAL TACHYCARDIA

    NARCIS (Netherlands)

    PENTINGA, ML; MEEDER, JG; CRIJNS, HJGM; DEMUINCK, ED; WIESFELD, ACP; LIE, KI

    AV nodal tachycardia may present at any age, but onset in late adulthood is considered uncommon. To evaluate whether onset of AV nodal tachycardias at older age is related to organic heart disease (possibly setting the stage for re-entry due to degenerative structural changes) 32 consecutive

  1. Late onset globoid cell leukodystrophy.

    Science.gov (United States)

    Grewal, R P; Petronas, N; Barton, N W

    1991-11-01

    A 29 year old male with onset of globoid cell leukodystrophy at age 14 is described. This is the first case of enzymatically confirmed globoid cell leukodystrophy with onset of symptoms after the age of ten. This patient is unique because of the late onset and slow progression and extends the clinical spectrum of globoid cell leukodystrophy.

  2. Clerical Exile in Late Antiquity

    DEFF Research Database (Denmark)

    Engberg, Jakob

    2016-01-01

    This volume results from the international research project ‘The Migration of Faith: Clerical Exile in Late Antiquity (325‒c.600)’. The project is a collaboration between the Department of History at the University of Sheffield, the Seminar für Kirchengeschichte at the University of Halle, and th...

  3. LATE ONSET ATRIOVENTRICULAR NODAL TACHYCARDIA

    NARCIS (Netherlands)

    PENTINGA, ML; MEEDER, JG; CRIJNS, HJGM; DEMUINCK, ED; WIESFELD, ACP; LIE, KI

    1993-01-01

    AV nodal tachycardia may present at any age, but onset in late adulthood is considered uncommon. To evaluate whether onset of AV nodal tachycardias at older age is related to organic heart disease (possibly setting the stage for re-entry due to degenerative structural changes) 32 consecutive patient

  4. Late onset startle induced tics

    NARCIS (Netherlands)

    Tijssen, MAJ; Brown, P; Morris, HR; Lees, A

    1999-01-01

    Three cases of late onset Gilles de la Tourette's syndrome are presented. The motor ties were mainly induced by an unexpected startling stimulus, but the startle reflex was not exaggerated. The ties developed after physical trauma or a period of undue emotional stress. Reflex ties may occur in

  5. Late onset startle induced tics

    NARCIS (Netherlands)

    Tijssen, MAJ; Brown, P; Morris, HR; Lees, A

    1999-01-01

    Three cases of late onset Gilles de la Tourette's syndrome are presented. The motor ties were mainly induced by an unexpected startling stimulus, but the startle reflex was not exaggerated. The ties developed after physical trauma or a period of undue emotional stress. Reflex ties may occur in Gille

  6. Late detection of cleft palate

    NARCIS (Netherlands)

    Hanny, K H; de Vries, I A C; Haverkamp, S J; Oomen, K P Q; Penris, W M; Eijkemans, M J C; Kon, M; Mink van der Molen, A B; Breugem, C C

    2016-01-01

    Cleft palate only (CPO) is a common congenital malformation, and most patients are diagnosed within the first weeks after birth. Late diagnosis of the cleft palate (CP) could initially result in feeding and growth impairment, and subsequently speech and hearing problems later in life. The purpose of

  7. First-in-man randomized comparison of BuMA Supreme biodegradable polymer sirolimus-eluting versus durable polymer zotarolimus-eluting coronary stents: The PIONEER trial.

    Science.gov (United States)

    von Birgelen, Clemens; Asano, Taku; Amoroso, Giovanni; Aminian, Adel; Brugaletta, Salvatore; Vrolix, Mathias; Hernandez-Antolín, Rosana; van de Harst, Pim; Iñiguez, Andres; Janssens, Luc; Smits, Pieter C; Wykrzykowska, Joanna J; Ribeiro, Vasco Gama; Periera, Helder; Canas da Silva, Pedro; Piek, Jan J; Onuma, Yoshinobu; Serruys, Patrick W; Sabaté, Manel

    2017-09-19

    A second iteration of a sirolimus-eluting stent (SES) that has a biodegradable PLGA-polymer coating with electrografting base layer on a thin-strut (80µm) cobalt-chromium platform (BuMA Supreme; SINOMED, Tianjin, China) has been developed. This first-in-man trial assessed the efficacy and safety of the novel device. This randomized, multi-center, single-blinded, non-inferiority trial compared BuMA Supreme SES versus contemporary durable polymer zotarolimus-eluting stents (ZES) in terms of angiographic in-stent late lumen loss (LLL) at 9-months follow-up as the primary endpoint. A total of 170 patients were randomly allocated to treatment with SES (n=83) or ZES (n=87). At 9-month angiographic follow-up, in-stent LLL was 0.29±0.33mm in SES and 0.14±0.37mm in ZES (Pnon-inferiority=0.45). The in-stent percent diameter stenosis and the binary restenosis rate of the two treatment arms were similar (19.2±12.0% vs. 16.1±12.6%, p=0.09, and 3.3% vs. 4.4%, P=1.00, respectively). At 12-month clinical follow-up, there was no difference between treatment arms with regard to a device-oriented composite clinical endpoint (4.9% vs. 5.7%; p=0.72). The PIONEER trial did not meet its primary endpoint in terms of in-stent LLL at 9-month follow-up. However, this result did not translate into any increase in restenosis rate or impairment in 12-month clinical outcomes.

  8. TIMP-2 gene transfer by positively charged PEG-lated monosized polycationic carrier to smooth muscle cells

    Science.gov (United States)

    Laçin, Nelisa; Utkan, Güldem; Kutsal, Tülin; Dedeoğlu, Bala Gür; Yuluğ, Işık G.; Pişkin, Erhan

    2012-02-01

    Remodeling of the extracellular matrix resulting from increased secretion of metalloproteinase enzymes is implicated in restenosis following balloon angioplasty. Matrix metalloproteinases (MMPs) and the tissue inhibitors of metalloproteinases play an essential role in both normal and pathological extracellular matrix degradation. Tissue inhibitor of matrix metalloproteinase-2 is the most extensively studied tissue inhibitor of metalloproteinases in myocardial tissue in animal models and clinical examples of cardiac disease; therefore it is selected for this study. Gene transfer of tissue inhibitor of matrix metalloproteinase-2 may have a therapeutic potential by inhibition of matrix metalloproteinase activity. We have used PEG-lated nanoparticles poly(St/PEG-EEM/DMAPM) which were synthesized previously in our laboratory. The nanoparticles, with an average size of 77.6 ± 2.05 nm with a zeta potential of +64. 4 ± 1.14 mV and 201.9 ± 1.83 nm with +54.2 ± 0.77 mV were used in the transfection studies. Zeta Potential values and size of polyplex were appropriate for an effective transfection. TIMP-2 expression was detected by western blotting. Increased protein level in smooth muscle cells according to non-transfected smooth muscle cells confirms the successful delivery and expression of the tissue inhibitor of matrix metalloproteinase-2 gene with the non-viral vector transfection approach.

  9. TIMP-2 gene transfer by positively charged PEG-lated monosized polycationic carrier to smooth muscle cells

    Energy Technology Data Exchange (ETDEWEB)

    Lacin, Nelisa, E-mail: melisalacin@yahoo.com [Mersin University, Advanced Technology Education, Research and Application Center (Turkey); Utkan, Gueldem [TUBITAK MAM, Enzyme and Fermentation Technology Laboratory, Genetic Engineering and Biotechnology Institute (Turkey); Kutsal, Tuelin [Hacettepe University, Chemical Engineering Department and Bioengineering Division (Turkey); Dedeoglu, Bala Guer; Yulug, Is Latin-Small-Letter-Dotless-I k G. [Bilkent University, Department of Molecular Biology and Genetics, Faculty of Science (Turkey); Piskin, Erhan [Hacettepe University, Chemical Engineering Department and Bioengineering Division and Center for Bioengineering-Biyomedtek (Turkey)

    2012-02-15

    Remodeling of the extracellular matrix resulting from increased secretion of metalloproteinase enzymes is implicated in restenosis following balloon angioplasty. Matrix metalloproteinases (MMPs) and the tissue inhibitors of metalloproteinases play an essential role in both normal and pathological extracellular matrix degradation. Tissue inhibitor of matrix metalloproteinase-2 is the most extensively studied tissue inhibitor of metalloproteinases in myocardial tissue in animal models and clinical examples of cardiac disease; therefore it is selected for this study. Gene transfer of tissue inhibitor of matrix metalloproteinase-2 may have a therapeutic potential by inhibition of matrix metalloproteinase activity. We have used PEG-lated nanoparticles poly(St/PEG-EEM/DMAPM) which were synthesized previously in our laboratory. The nanoparticles, with an average size of 77.6 {+-} 2.05 nm with a zeta potential of +64. 4 {+-} 1.14 mV and 201.9 {+-} 1.83 nm with +54.2 {+-} 0.77 mV were used in the transfection studies. Zeta Potential values and size of polyplex were appropriate for an effective transfection. TIMP-2 expression was detected by western blotting. Increased protein level in smooth muscle cells according to non-transfected smooth muscle cells confirms the successful delivery and expression of the tissue inhibitor of matrix metalloproteinase-2 gene with the non-viral vector transfection approach.

  10. Inhibition of neointima formation by local delivery of estrogen receptor alpha and beta specific agonists

    NARCIS (Netherlands)

    Krom, Y.D.; Pires, N.M.M.; Jukema, J.W.; Vries, M.R. de; Frants, R.R.; Havekes, L.M.; Dijk, K.W. van; Quax, P.H.A.

    2007-01-01

    Objective: Neointima formation is the underlying mechanism of (in-stent) restenosis. 17β-Estradiol (E2) is known to inhibit injury-induced neointima formation and post-angioplasty restenosis. Estrogen receptor alpha (ERα) has been demonstrated to mediate E2 anti-restenotic properties. However, the r

  11. Early and late effects of coumarin therapy started before percutaneous coronary intervention

    Science.gov (United States)

    ten Berg, J.M.; Kelder, J.C.; Suttorp, M.J.; Mast, E.G.; Bal, E.T.; Ernst, J.M.P.G.; Plokker, H.W.M.

    2002-01-01

    Background Coronary angioplasty frequently creates a thrombogenic surface with subsequent mural thrombosis that may lead to acute complications and possibly stimulates the development of restenosis. Whether coumarins can prevent these complications is unclear. Methods In the Balloon Angioplasty and Anticoagulation Study (BAAS), the effect of coumarins started before the procedure on early and late outcome was studied. Patients were randomised to aspirin only or to aspirin plus coumarins. Half of the patients were randomised to undergo six-month angiographic follow-up. Study medication was started one week before coronary angioplasty and the target international normalised ratio (INR) was 2.1-4.8 during angioplasty and six-month follow-up. 'Optimal' anticoagulation was defined as an INR in the target range for at least 70% of the follow-up time. In addition, cost-effectiveness of coumarin treatment was measured. Results At one year death, myocardial infarction, target-lesion revascularisation and stroke were observed in 14.3% of the 530 patients randomised to aspirin plus coumarin versus in 20.3% of the 528 patients randomised to aspirin alone (relative risk 0.71; 95% CI 0.54-0.93). The incidence of major bleedings and false aneurysms during hospitalisation was 3.2% and 1.0%, respectively, (relative risk 3.39; 95% CI 1.26-9.11). Optimal anticoagulation was an independent predictor of late thrombotic events (relative risk, 0.33; 95% CI, 0.19-0.57). Quantitative coronary analysis was performed of 301 lesions in the ASA group and of 297 lesions in the coumarin group. At six months, the minimal luminal diameter was similar in the ASA and coumarin group. However, optimal anticoagulation was an independent predictor of angiographic outcome at six months. Optimal anticoagulation led to a 0.21 mm (95% CI: 0.05-0.37) larger MLD as compared with suboptimal anticoagulation whereas aspirin use led to a 0.12 mm (95% CI -0.28-0.04) smaller MLD. When including all costs, the

  12. Late onset clozapine induced agranulocytosis

    Directory of Open Access Journals (Sweden)

    Rajmohan Velayudhan

    2014-01-01

    Full Text Available Agranulocytosis is defined as an absolute neutrophil count less than 100/mm 3 in association with infectious disease. The risk of agranulocytosis is 0.38% of all clozapine treated cases and there is a relatively lesser incidence in Indian population. The risk of clozapine-induced agranulocytosis and neutropenia is highest in the first 6 months and higher in the initial 18 months after the onset of treatment. There have been very few reports of neutropenia and agranulocytosis after this period. There have so far been no reports of late onset clozapine induced agranulocytosis has been reported from India. A case of late onset clozapine induced agranulocytosis with possible mechanism of the same is reported.

  13. Monomelic amyotrophy with late progression.

    Science.gov (United States)

    Rowin, J; Meriggioli, M N; Cochran, E J

    2001-04-01

    Monomelic amyotrophy is a sporadic juvenile-onset disease that presents with gradual onset of weakness and atrophy in the hand muscles unilaterally. Generally, this disease is considered a 'benign' and non-progressive motor neuron disease, which stabilizes within five years of onset. We discuss a case that illustrates that monomelic amyotrophy may rarely exhibit late clinical progression to the lower extremities after a prolonged period of disease stability.

  14. Late colonization of Easter Island.

    Science.gov (United States)

    Hunt, Terry L; Lipo, Carl P

    2006-03-17

    Easter Island (Rapa Nui) provides a model of human-induced environmental degradation. A reliable chronology is central to understanding the cultural, ecological, and demographic processes involved. Radiocarbon dates for the earliest stratigraphic layers at Anakena, Easter Island, and analysis of previous radiocarbon dates imply that the island was colonized late, about 1200 A.D. Substantial ecological impacts and major cultural investments in monumental architecture and statuary thus began soon after initial settlement.

  15. Comparison of drug eluting stent for treatment of intrastent restenosis and de novo lesion%冠状动脉支架内再狭窄病变与原发病变药物洗脱支架治疗的对比研究

    Institute of Scientific and Technical Information of China (English)

    朱玮玮; 郭成军; 刘现亮; 宋洪勇; 丁冠桥; 赵林

    2014-01-01

    目的:比较药物洗脱支架(DES)治疗支架内再狭窄病变(ISR)与冠状动脉原发病变(De novo)患者的长期临床疗效。方法收集2008年10月至2011年11月在北京安贞医院因ISR接受DES置入治疗的患者作为试验组(ISR组),选择同期因冠状动脉原发病变(De novo)置入DES治疗的患者作为对照组(De novo组)。比较两组患者1年的主要不良心血管事件(MACE),包括全因死亡、心肌梗死(MI)和靶病变血运重建(TLR)。结果204例患者入选ISR组,494例患者入选De novo组。ISR组糖尿病患病率明显高于De novo组(36.6%比27.1%,P<0.05),ISR组不稳定型心绞痛比例明显低于De novo组(26.0%比70.6%,P<0.01),其余基线资料差异无统计学意义(P>0.05);两组在病变部位、病变类型、病变特点方面比较,差异均无统计学意义(P>0.05),而ISR组支架直径明显小于De novo组,差异有统计学意义[(2.72±0.36)mm比(3.08±0.54)mm,P<0.01)。ISR组MACE发生率明显高于De novo组(21.1%比14.2%,P<0.05),其中,ISR组TLR明显高于De novo组(17.2%比10.7%,P<0.05)。结论 DES治疗ISR患者安全有效,但与治疗冠状动脉原发病变比,TLR明显升高。%Objective Compare the efifcacy and safety of drug eluting stent (DES) for treatment of in stent restenosis (ISR) and coronary de novo lesions. Methods Patients treated with DES for ISR and de novo lesions in Beijing Anzhen Hospital between October 2008 and December 2011 were followed up for 1 year. All lesions were divided into ISR and de novo group. Major adverse cardiovascular events (MACE) including all-cause death, myocardial infarction (MI) and clinical target lesion revascularization (TLR) were the primary endpoints. Results The study population consisted of 204 patients in the ISR group and 494 patients in the de novo group. Baseline clinical and angiographic parameters were

  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. 慢性下肢缺血搭桥术后再狭窄分析%A study on restenosis after artificially grafting bypass for chronic ischemia of the lower extremities

    Institute of Scientific and Technical Information of China (English)

    赵克强; 张小明; 沈晨阳; 万峰

    2008-01-01

    目的 探讨慢性下肢缺血患者行人工血管搭桥术后再狭窄的病因及治疗方法.方法 回顾性分析2002年1月至2007年4月收治的慢性下肢缺血患者的临床资料,其中股腘动脉搭桥术后再狭窄行二次手术的52例患者作为实验组,同时随访资料完整的32例搭桥术后人工血管通畅者作为对照组.分析两组问伴随疾病及高危因素,检测血脂、纤维蛋白原及C反应蛋白水平.结果 实验组纤维蛋白原(4.48±1.68)g/L、CRP(9.5±2.6)mg/L、低密度脂蛋白(4.5±1.7)mmol/L高于对照组(3.50±0.72)g/L、(4.0±3.2)mg/L、(2.8±0.9)mmol/L,差异有统计学意义(P<0.01).实验组高密度脂蛋白为(1.02±0.32)mmol/L略低于对照组(1.12±0.28)mmol/L,差异无统计学意义(P>0.05).实验组再次手术中见吻合口处重度内膜增生并继发血栓形成42例,人工血管内原发血栓形成10例.二次术后人工血管保持通畅28例,截肢10例,人工血管感染取出3例,死亡5例.结论 人工血管搭桥术后再狭窄主要原因是吻合口内膜增生.CRP、纤维蛋白原、低密度脂蛋白增高可能是导致吻合口内膜增生、人工血管闭塞的重要高危因素.%Objective To probe the etiology and management of restenosis after artificially grafting bypass for chronic ischemia of the lower extremities. Methods In this study 52 cases suffering from postoperative restenosis and obliteration were compared with 32 cases whose artificial grafts remain patent during the same postoperative follow-up period of 3~62 months.Possible risk factors that lead to restenosis were evaluated.Resuits FIB(4.48±1.68)g/L,CRP(9.5±2.6)mg/L and LDL(4.5±1.7)mmol/L were significantly higher in the restenosis group than FIB(3.50±0.72)g/L,CRP(4.0±3.2)mg/L and LDL(2.8±0.9)mmol/L in the patent group(P<0.01).There were no significant difference between HDL(1.02±0.32)mmol/L in the restenosis group and HDL(1.12±0.28)mmol/L in the patent group (P>0.05).Reoperation

  18. A randomized, prospective, two-center comparison of sirolimus-eluting stent and zotarolimus-eluting stent in acute ST-elevation myocardial infarction: The SEZE trial

    Institute of Scientific and Technical Information of China (English)

    Woo-Young Chung; Sang-Hyun Kim; In-Ho Chae; Joo-Hee Zo; Myung-A Kim; Dong-Ju Choi; Jeehoon Kang; Young-Seok Cho; Hae-Jun Park; Han-Mo Yang; Jae-Bin Seo; Jung-Won Suh; Kwang-Il Kim; Tae-Jin Youn

    2012-01-01

    Background The zotarolimus-eluting stent has shown larger in-stent late lumen loss compared to sirolimus-eluting stents in previous studies.However,this has not been thoroughly evaluated in ST elevation myocardial infarction.Methods This was a prospective,randomized,controlled trial evaluating angiographic outcomes in patients presenting with ST elevation myocardial infarction,treated with zotarolimus-eluting stents or sirolimus-eluting stents.From March 2007 to February 2009,122 patients were randomized to zotarolimus-eluting stents or sirolimus-eluting stents in a 1:1 fashion.The primary endpoint was 9-month in-stent late lumen loss confirmed by coronary angiography,and secondary endpoints were percent diameter stenosis,binary restenosis rate,major adverse cardiac events (a composite of cardiac death,non-fatal myocardial infarction,and target vessel revascularization),and late-acquired incomplete stent apposition.Results Angiographic in-stent late lumen loss was significantly higher in the zotarolimus-eluting stent group compared to the sirolimus-eluting stent group ((0.49±0.65) mm vs.(0.10±0.46) mm,P=0.001).Percent diameter stenosis at 9-month follow-up was also larger in the zotarolimus-eluting stent group ((30.0±17.9)% vs.(17.6±14.0)%,P <0.001).In-segment analysis showed similar findings.There were no significant differences in binary restenosis rate,major adverse cardiac events,and late-acquired incomplete stent apposition.Conclusions Compared to sirolimus-eluting stents,the zotarolimus-eluting stent is associated with significantly higher in-stent late lumen loss at 9-month angiographic follow-up in the treatment of ST elevation myocardial infarction.Although there was no significant difference in 1-year clinical outcomes,the clinical implication of increased late lumen loss should be further studied.

  19. Risk factors for technical failure of endoscopic double self-expandable metallic stent placement by partial stent-in-stent method.

    Science.gov (United States)

    Kawakubo, Kazumichi; Kawakami, Hiroshi; Toyokawa, Yoshihide; Otani, Koichi; Kuwatani, Masaki; Abe, Yoko; Kawahata, Shuhei; Kubo, Kimitoshi; Kubota, Yoshimasa; Sakamoto, Naoya

    2015-01-01

    Endoscopic double self-expandable metallic stent (SEMS) placement by the partial stent-in-stent (PSIS) method has been reported to be useful for the management of unresectable hilar malignant biliary obstruction. However, it is technically challenging, and the optimal SEMS for the procedure remains unknown. The aim of this study was to identify the risk factors for technical failure of endoscopic double SEMS placement for unresectable malignant hilar biliary obstruction (MHBO). Between December 2009 and May 2013, 50 consecutive patients with MHBO underwent endoscopic double SEMS placement by the PSIS method. We retrospectively evaluated the rate of successful double SEMS placement and identified the risk factors for technical failure. The technical success rate for double SEMS placement was 82.0% (95% confidence interval [CI]: 69.2-90.2). On univariate analysis, the rate of technical failure was high in patients with metastatic disease and unilateral placement. Multivariate analysis revealed that metastatic disease was a significant risk factor for technical failure (odds ratio: 9.63, 95% CI: 1.11-105.5). The subgroup analysis after double guidewire insertion showed that the rate of technical success was higher in the laser-cut type SEMS with a large mesh and thick delivery system than in the braided type SEMS with a small mesh and thick delivery system. Metastatic disease was a significant risk factor for technical failure of double SEMS placement for unresectable MHBO. The laser-cut type SEMS with a large mesh and thin delivery system might be preferable for the PSIS procedure. © 2014 Japanese Society of Hepato-Biliary-Pancreatic Surgery.

  20. Prevention of Intracranial In-stent Restenoses: Predilatation with a Drug Eluting Balloon, Followed by the Deployment of a Self-Expanding Stent

    Energy Technology Data Exchange (ETDEWEB)

    Vajda, Zsolt, E-mail: Z.Vajda@klinikum-stuttgart.de; Guethe, Thomas, E-mail: T.Guethe@klinikum-stuttgart.de; Perez, Marta Aguilar, E-mail: M.Aguilar@klinikum-stuttgart.de; Kurre, Wiebke, E-mail: w.kurre@klinikum-stuttgart.de [Klinikum Stuttgart, Katharinenhospital, Klinik fuer Neuroradiologie, Neurozentrum (Germany); Schmid, Elisabeth, E-mail: ESchmid@klinikum-stuttgart.de; Baezner, Hansjoerg, E-mail: H.Baezner@klinikum-stuttgart.de [Klinikum Stuttgart, Klinik fuer Neurologie, Neurozentrum (Germany); Henkes, Hans, E-mail: hhhenkes@aol.com [Klinikum Stuttgart, Katharinenhospital, Klinik fuer Neuroradiologie, Neurozentrum (Germany)

    2013-04-15

    Stenting in intracranial atherosclerotic disease (ICAD) is increasingly debated, due to issues of procedural safety, technical efficacy, and in-stent recurrent stenoses (ISR). In the present study, feasibility, safety, and efficacy of angioplasty using a drug-eluting balloon (DEB) followed by the implantation of a self-expanding stent (Enterprise) were evaluated for the treatment of ICAD lesions. Fifty-two patients (median age: 71 years; range: 54-86 years; male/female ratio 37:15) underwent stenting of high-grade ICAD lesions between February 2010 and November 2011 in a single center. Angioplasty using a paclitaxel coated SeQuent Please (B. Braun, Germany) or DIOR (Eurocor, Germany) coronary PTCA balloon, followed by the implantation of a self-expanding stent (Enterprise, Codman, USA) was performed in 54 lesions. Angiographic and clinical follow-up was performed at 6 and 12 weeks, 6 and 12 months, and yearly thereafter. Technical success rate, periprocedural complications, occurrence of recurrent ischemic symptoms, and the development of an ISR were analyzed. Angioplasty using a DEB followed by stent implantation was successfully performed in 44 (81 %) cases. DEB insertion failed in 19 % of the cases and angioplasty was finally performed using a conventional PTCA balloon. The combined procedure related permanent neurologic morbidity and mortality rate (stroke, ICH, and subarachnoid hemorrhage) at 30 days and beyond was 5 %. Angiographic and clinical follow-up were obtained in 33 (61 %) lesions in 32 patients. Recurrent stenosis was seen in one (3 %) lesion. Angioplasty and stenting using a DEB is safe and yields encouragingly low ISR rates. Further technical developments to improve lesion accessibility are, nevertheless, mandatory.

  1. Late evolution of planetary systems

    Energy Technology Data Exchange (ETDEWEB)

    Morbidelli, A [CNRS, Observatoire de la Cote d' Azur, B P 4299, 06304 Nice Cedex 4 (France); Levison, H F [SWRI, 1050 Walnut St, Suite 300 Boulder, CO 80302 (United States)], E-mail: morby@obs-nice.fr, E-mail: hal@boulder.swri.edu

    2008-08-15

    This chapter discusses some of the main effects of the interaction of planets with remnant planetesimal disks, after the disappearance of the gas. It focuses on planet migration and its possible outcomes. In particular, we discuss the possibility that the migration of the planets leads them into an unstable configuration which changes drastically the structure of the system. The late heavy bombardment (LHB) of the terrestrial planets, occurring 650 Myr after planet formation, is a strong indication that this kind of evolution occurred in our solar system. Other stars show evidence of intense comet showers, which may indicate that LHB-analogs are ongoing in those systems at the current time.

  2. Stents Eluting 6-Mercaptopurine Reduce Neointima Formation and Inflammation while Enhancing Strut Coverage in Rabbits.

    Directory of Open Access Journals (Sweden)

    Matthijs S Ruiter

    Full Text Available The introduction of drug-eluting stents (DES has dramatically reduced restenosis rates compared with bare metal stents, but in-stent thrombosis remains a safety concern, necessitating prolonged dual anti-platelet therapy. The drug 6-Mercaptopurine (6-MP has been shown to have beneficial effects in a cell-specific fashion on smooth muscle cells (SMC, endothelial cells and macrophages. We generated and analyzed a novel bioresorbable polymer coated DES, releasing 6-MP into the vessel wall, to reduce restenosis by inhibiting SMC proliferation and decreasing inflammation, without negatively affecting endothelialization of the stent surface.Stents spray-coated with a bioresorbable polymer containing 0, 30 or 300 μg 6-MP were implanted in the iliac arteries of 17 male New Zealand White rabbits. Animals were euthanized for stent harvest 1 week after implantation for evaluation of cellular stent coverage and after 4 weeks for morphometric analyses of the lesions.Four weeks after implantation, the high dose of 6-MP attenuated restenosis with 16% compared to controls. Reduced neointima formation could at least partly be explained by an almost 2-fold induction of the cell cycle inhibiting kinase p27Kip1. Additionally, inflammation score, the quantification of RAM11-positive cells in the vessel wall, was significantly reduced in the high dose group with 23% compared to the control group. Evaluation with scanning electron microscopy showed 6-MP did not inhibit strut coverage 1 week after implantation.We demonstrate that novel stents coated with a bioresorbable polymer coating eluting 6-MP inhibit restenosis and attenuate inflammation, while stimulating endothelial coverage. The 6-MP-eluting stents demonstrate that inhibition of restenosis without leaving uncovered metal is feasible, bringing stents without risk of late thrombosis one step closer to the patient.

  3. Patency of paclitaxel-eluting versus bare metal stents long term after implantation in acute ST-segment elevation myocardial infarction.

    Science.gov (United States)

    Vink, Maarten A; Van Nooijen, Ferdinand C; Laarman, Gerrit J; Suttorp, Maarten J; Tijssen, Jan G; Slagboom, Ton; Patterson, Mark S; Van Der Schaaf, Rene J; Kiemeneij, Ferdinand; Amoroso, Giovanni; Dirksen, Maurits T

    2011-11-01

    Drug-eluting stents effectively inhibit neointimal hyperplasia within the first year, thereby reducing the need for repeat revascularization. However, a delayed pattern of restenosis might be more prominent in drug-eluting stents compared to bare metal stents (BMSs). The extent of restenosis of paclitaxel-eluting stents (PESs) long term after implantation in acute ST-segment elevation myocardial infarction is currently unknown. The present study was designed to evaluate very late luminal loss (VLLL) of PESs used in ST-segment elevation myocardial infarction compared to BMSs. A total of 116 patients (61 with PESs and 55 with BMSs) initially included in the Paclitaxel Eluting Stent Versus Conventional Stent in ST-segment Elevation Myocardial Infarction (PASSION) trial and who were free from previous lesion failure underwent angiographic follow-up. Off-line quantitative coronary analysis of the angiogram immediately after stent implantation and at follow-up was performed. The primary end point was VLLL within the stent. The presence of binary restenosis was defined as diameter stenosis >50% as a secondary end point. The mean interval between stent implantation and follow-up was 4.1 ± 0.5 years in both stent groups. In-stent VLLL was 0.12 mm (interquartile range -0.03 to 0.42) in the PES group versus 0.30 mm (interquartile range 0.08 to 0.69) in the BMS group (p = 0.011). In-segment binary restenosis was found in 4 patients (6.6%) with a PES and 6 patients (10.9%) with a BMS (p = 0.40). In conclusion, angiographic follow-up 4 years after implantation in ST-segment elevation myocardial infarction showed that in patients prospectively randomized to PESs or BMSs, VLLL was low in both stent groups. PESs were associated with lower VLLL than BMSs, and the observed rate of binary restenosis was not significantly different between the 2 stent groups.

  4. 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。

  5. 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.

  6. [Left pulmonary agenesis diagnosed late].

    Science.gov (United States)

    Deleanu, Oana; Pătraşcu, Natalia; Nebunoiu, Ana-Maria; Vintilă, V; Ulmeanu, Ruxandra; Mihălţan, F D

    2010-01-01

    We present the case of a 51 years old female-patient, with severe dextroscoliosis, having like unique symptom progressive dyspnea. The blood samples reveals polycythemia, the radiological exam shows the opacification of 2/3 of the left thorax, the absence of the lung structure in the other 1/3, the deviation of the mediastinum, and dextroscoliosis; the computed tomography reveals the absence of the left lung artery and the left airways, compensatory hyperinflation of the right lung and dilatation of the trunk and right pulmonary artery; the bronchoscopy does not visualize the carina or the left main bronchus, typical for pulmonary agenesis. Echocardiography confirmed the absence of left pulmonary artery and shows mild pulmonary hypertension (systolic pressure in the pulmonary artery of 33 mmHg) with dilatation of the right cavities, but good cinetics. We face a case of pulmonary agenesis lately diagnosed, with modest functional cardiologic implications, limited therapeutic options and good survival, justified by the late appearance of the pulmonary hypertension of low severity and without worsening in time.

  7. Nine-month Angiographic and Two-year Clinical Follow-up of Novel Biodegradable-polymer Arsenic Trioxide-eluting Stent Versus Durable-polymer Sirolimus-eluting Stent For Coronary Artery Disease

    Directory of Open Access Journals (Sweden)

    Li Shen

    2015-01-01

    Full Text Available Background: Despite great reduction of in-stent restenosis, first-generation drug-eluting stents (DESs have increased the risk of late stent thrombosis due to delayed endothelialization. Arsenic trioxide, a natural substance that could inhibit cell proliferation and induce cell apoptosis, seems to be a promising surrogate of sirolimus to improve DES performance. This randomized controlled trial was to evaluate the efficacy and safety of a novel arsenic trioxide-eluting stent (AES, compared with traditional sirolimus-eluting stent (SES. Methods: Patients with symptoms of angina pectoris were enrolled and randomized to AES or SES group. The primary endpoint was target vessel failure (TVF, and the second endpoint includes rates of all-cause death, cardiac death or myocardial infarction, target lesion revascularization (TLR by telephone visit and late luminal loss (LLL at 9-month by angiographic follow-up. Results: From July 2007 to 2009, 212 patients were enrolled and randomized 1:1 to receive either AES or SES. At 2 years of follow-up, TVF rate was similar between AES and SES group (6.67% vs. 5.83%, P = 0.980. Frequency of all-cause death was significantly lower in AES group (0 vs. 4.85%, P = 0.028. There was no significant difference between AES and SES in frequency of TLR and in-stent restenosis, but greater in-stent LLL was observed for AES group (0.29 ± 0.52 mm vs. 0.10 ± 0.25 mm, P = 0.008. Conclusions: After 2 years of follow-up, AES demonstrated comparable efficacy and safety to SES for the treatment of de novo coronary artery lesions.

  8. Processing of Baculovirus Late and Very Late mRNAs

    Institute of Scientific and Technical Information of China (English)

    Linda A. Guarino

    2007-01-01

    Baculoviruses encode a DNA-directed RNA polymerase that is evolutionarily divergent from cellular polymerases. This RNA polymerase is a multifunctional complex that has the ability to recognize late promoters, transcribe linked genes, and process transcripts at both the 5' and 3' ends. The LEF-4 subunit of the viral RNA polymerase is the mRNA capping enzyme, with both RNA triphosphatase and guanylyltransferase activities. Conversion to cap 1 structures is mediated by the viral enzyme MTase1 and another as yet unidentified methyltransferase. Termination is an intrinsic property of the viral RNA polymerase and occurs at oligoU rich sequences. Polyadenylation of the released transcripts is also a function of the viral RNA polymerase. Thus, although viral mRNAs resemble host messages with respect to their 5' and 3' end structures, the processing is mediated by viral enzymes and, in the case of the 3' ends, by mechanisms that differ from the host cell.

  9. Late veneer and late accretion to the terrestrial planets

    Science.gov (United States)

    Brasser, R.; Mojzsis, S. J.; Werner, S. C.; Matsumura, S.; Ida, S.

    2016-12-01

    It is generally accepted that silicate-metal ('rocky') planet formation relies on coagulation from a mixture of sub-Mars sized planetary embryos and (smaller) planetesimals that dynamically emerge from the evolving circum-solar disc in the first few million years of our Solar System. Once the planets have, for the most part, assembled after a giant impact phase, they continue to be bombarded by a multitude of planetesimals left over from accretion. Here we place limits on the mass and evolution of these planetesimals based on constraints from the highly siderophile element (HSE) budget of the Moon. Outcomes from a combination of N-body and Monte Carlo simulations of planet formation lead us to four key conclusions about the nature of this early epoch. First, matching the terrestrial to lunar HSE ratio requires either that the late veneer on Earth consisted of a single lunar-size impactor striking the Earth before 4.45 Ga, or that it originated from the impact that created the Moon. An added complication is that analysis of lunar samples indicates the Moon does not preserve convincing evidence for a late veneer like Earth. Second, the expected chondritic veneer component on Mars is 0.06 weight percent. Third, the flux of terrestrial impactors must have been low (≲10-6 M⊕ Myr-1) to avoid wholesale melting of Earth's crust after 4.4 Ga, and to simultaneously match the number of observed lunar basins. This conclusion leads to an Hadean eon which is more clement than assumed previously. Last, after the terrestrial planets had fully formed, the mass in remnant planetesimals was ∼10-3 M⊕, lower by at least an order of magnitude than most previous models suggest. Our dynamically and geochemically self-consistent scenario requires that future N-body simulations of rocky planet formation either directly incorporate collisional grinding or rely on pebble accretion.

  10. Dual role of circulating endothelial progenitor cells in stent struts endothelialisation and neointimal regrowth: A substudy of the IN-PACT CORO trial

    Energy Technology Data Exchange (ETDEWEB)

    De Maria, Giovanni Luigi [Institute of Cardiology, Catholic University of the Sacred Heart, Rome (Italy); Porto, Italo, E-mail: italo.porto@gmail.com [Institute of Cardiology, Catholic University of the Sacred Heart, Rome (Italy); Interventional Cardiology Unit, San Donato Hospital, Arezzo (Italy); Burzotta, Francesco; Brancati, Marta Francesca; Trani, Carlo; Pirozzolo, Giancarlo; Leone, Antonio Maria; Niccoli, Giampaolo [Institute of Cardiology, Catholic University of the Sacred Heart, Rome (Italy); Prati, Francesco [Department of Interventional Cardiology, San Giovanni Hospital, Rome (Italy); Crea, Filippo [Institute of Cardiology, Catholic University of the Sacred Heart, Rome (Italy)

    2015-01-15

    higher neointimal volume and a lower rate of uncovered struts at six months of follow up are significantly associated to higher baseline levels of endothelial progenitor cells (EPC) • Baseline EPC level is an independent predictor of neointimal volume and struts coverage rate at six months of follow up. • At the same, the detection of higher neointimal volume in those patients with persistent high EPC levels at follow up suggests the possible involvement of these elements in an exaggerated healing answer to stent-related injury leading to instent restenosis.

  11. Antibiotics in late clinical development.

    Science.gov (United States)

    Fernandes, Prabhavathi; Martens, Evan

    2017-06-01

    Most pharmaceutical companies have stopped or have severely limited investments to discover and develop new antibiotics to treat the increasing prevalence of infections caused by multi-drug resistant bacteria, because the return on investment has been mostly negative for antibiotics that received marketing approved in the last few decades. In contrast, a few small companies have taken on this challenge and are developing new antibiotics. This review describes those antibiotics in late-stage clinical development. Most of them belong to existing antibiotic classes and a few with a narrow spectrum of activity are novel compounds directed against novel targets. The reasons for some of the past failures to find new molecules and a path forward to help attract investments to fund discovery of new antibiotics are described. Copyright © 2016 The Authors. Published by Elsevier Inc. All rights reserved.

  12. Late hemorrhagic disease of newborn.

    Science.gov (United States)

    D'Souza, I E; Rao, S D Subba

    2003-03-01

    The clinical features of 14 infants diagnosed with late hemorrhagic disease of newborn (LHDN), of which 10 did not receive vitamin K prophylaxis, are presented. All infants were exclusively breast-fed and 12 did not have any underlying illness to explain the abnormal coagulation profile. The common presenting symptoms were seizures (71%), vomiting (57%), poor feeding (50%) and altered sensorium (36%). Physical examination shared pallor in all infants and a bulging anterior fontanel in 64%. Intracranial bleed was the predominant manifestation (93%), with CT scan showing intracranial bleed in 78%. Eight infants (57%) succumbed to their illness, while 36%had neurological sequelae. Since LHDN leads to significant morbidity and mortality, it should be prevented by providing vitamin K prophylaxis to all newborns.

  13. Streptococcosis in seabass (Lates calcarifer

    Directory of Open Access Journals (Sweden)

    Wanman, C.

    2005-02-01

    Full Text Available Streptococcus sp. isolated from infected seabass (Lates calcarifer can grow on medium at pH 9.6 and salinity 0 ppt. The lethal dose where the mortality is 50 percent (LD50 was 1.937×103 CFU/ml after 14 days. Diseased fish showed dark body coloration, erratic swimming, exophthalmia, dropsy, pale liver, splenomegaly and hemorrhage in the brain. Blood parameters i.e. haematocrit, haemoglobin, plasma protein and red blood cell of infected fish were decreased, while white blood cells were increased. Histopathological changes in diseased seabass were necrosis, vacuolization and granuloma of the liver, increased number of melanomacrophage in liver and spleen, shrinkage of glomerulus in kidneys, inflammation and necrosis of the spleen and heart, hyperplasia and telangiectasis of the gill, while vacuolization and capsulation of the exophthalmic eyes were observed.

  14. Late onset hereditary episodic ataxia.

    Science.gov (United States)

    Damak, M; Riant, F; Boukobza, M; Tournier-Lasserve, E; Bousser, M-G; Vahedi, K

    2009-05-01

    Episodic ataxias (EA) are hereditary paroxysmal neurological diseases with considerable clinical and genetic heterogeneity. So far seven loci have been reported and four different genes have been identified. Analysis of additional sporadic or familial cases is needed to better delineate the clinical and genetic spectrum of EA. A two generation French family with late onset episodic ataxia was examined. All consenting family members had a brain MRI with volumetric analysis of the cerebellum. Haplotype analysis was performed for the EA2 locus (19p13), the EA5 locus (2q22), the EA6 locus (5p13) and the EA7 locus (19q13). Mutation screening was performed for all exons of CACNA1A (EA2), EAAT1 (EA6) and the coding sequence of KCNA1 (EA1). Four family members had episodic ataxia with onset between 48 and 56 years of age but with heterogeneity in the severity and duration of symptoms. The two most severely affected had daily attacks of EA with a slowly progressive and disabling permanent cerebellar ataxia and a poor response to acetazolamide. Brain MRI showed in three affected members a decrease in the ratio of cerebellar volume:total intracranial volume, indicating cerebellar atrophy. No deleterious mutation was found in CACNA1A, SCA6, EAAT1 or KCNA1. In addition, the EA5 locus was excluded. A new phenotype of episodic ataxia has been described, characterised clinically by a late onset and progressive permanent cerebellar signs, and genetically by exclusion of the genes so far identified in EA.

  15. Healing arterial ulcers: Endothelial lining regeneration upon vascular denudation injury.

    Science.gov (United States)

    McDonald, Austin I; Iruela-Arispe, M Luisa

    2015-09-01

    Thrombosis and restenosis are the most prevalent late complications of coronary artery stenting. Current standards of clinical care focus on prevention of smooth muscle cell proliferation by the use of drug-eluting stents able to release anti-proliferative drugs. Unfortunately, these drugs also block endothelial cell proliferation and, in this manner, prevent recovery of endothelial cell coverage. Continued lack of endothelial repair leaves the root cause of thrombosis and restenosis unchanged, creating a vicious cycle where drug-mediated prevention of restenosis simultaneously implies promotion of thrombosis. In this issue of Vascular Pharmacology, Hussner and colleagues provide in vitro evidence and a mechanistic basis for the use of atorvastatin in stents as a way to bypass this roadblock. Here we review the pathological mechanisms and therapeutic approaches to restore flow in occluded arteries. We argue that rational design of drug eluting stents should focus on specific inhibition of smooth muscle cell proliferation with concurrent stimulation of endothelial regeneration. We comment on the current poor understanding of the cellular and molecular regulation of endothelial cell proliferation in the context of a functional artery, and on the pitfalls of extrapolating from the well-studied process of neovascularization by sprouting vessel formation.

  16. Late veneer and late accretion to the terrestrial planets

    CERN Document Server

    Brasser, R; Werner, S C; Matsumura, S; Ida, S

    2016-01-01

    It is generally accepted that silicate-metal (`rocky') planet formation relies on coagulation from a mixture of sub-Mars sized planetary embryos and (smaller) planetesimals that dynamically emerge from the evolving circum-solar disc in the first few million years of our Solar System. Once the planets have, for the most part, assembled after a giant impact phase, they continue to be bombarded by a multitude of planetesimals left over from accretion. Here we place limits on the mass and evolution of these planetesimals based on constraints from the highly siderophile element (HSE) budget of the Moon. Outcomes from a combination of N-body and Monte Carlo simulations of planet formation lead us to four key conclusions about the nature of this early epoch. First, matching the terrestrial to lunar HSE ratio requires either that the late veneer on Earth consisted of a single lunar-size impactor striking the Earth before 4.45 Ga, or that it originated from the impact that created the Moon. An added complication is th...

  17. Causes for Late onset Alcohol Use Disorder

    DEFF Research Database (Denmark)

    Emiliussen, Jakob; Nielsen, Anette Søgaard; Andersen, Kjeld

    the available literature on the subject. Method A PRISMA style review and search was performed in late May 2014 and covered MEDLINE, EMBASE, PubMed, and PsychInfo. Inclusion was based on if the study had causes for late-onset AUD in their results section. This revealed 24 articles relevant for this study. After...... not increase the risk for late-onset AUD. However, the data was insufficient to give a reliable quantification of these associations. Discussion A common problem for the studies included (and the ones excluded as well) was the lack of common definitions of late-onset, “stress” and “traumatic life events...

  18. Late-term clinical outcomes with zotarolimus- and sirolimus-eluting stents. 5-year follow-up of the ENDEAVOR III (A Randomized Controlled Trial of the Medtronic Endeavor Drug [ABT-578] Eluting Coronary Stent System Versus the Cypher Sirolimus-Eluting Coronary Stent System in De Novo Native Coronary Artery Lesions).

    Science.gov (United States)

    Kandzari, David E; Mauri, Laura; Popma, Jeffrey J; Turco, Mark A; Gurbel, Paul A; Fitzgerald, Peter J; Leon, Martin B

    2011-05-01

    This study sought to compare late safety and efficacy outcomes following percutaneous coronary revascularization with zotarolimus-eluting stents (ZES) and sirolimus-eluting stents (SES). Despite higher late lumen loss and binary restenosis with ZES compared with SES, it is uncertain whether differences in early angiographic measures translate into more disparate late clinical events. Clinical outcomes were prospectively evaluated through 5 years in the ENDEAVOR III (A Randomized Controlled Trial of the Medtronic Endeavor Drug [ABT-578] Eluting Coronary Stent System Versus the Cypher Sirolimus-Eluting Coronary Stent System in De Novo Native Coronary Artery Lesions) that randomized 436 patients of relatively low anatomic and clinical risk to treatment with ZES (n = 323) or SES (n = 113) and evaluated a primary endpoint of 8-month angiographic late lumen loss. At 5 years (completeness of follow-up: 95.2%), pre-specified endpoints of all-cause mortality (5.2% vs. 13.0%, p = 0.02), myocardial infarction (1.0% vs. 4.6%, p = 0.03), and the composite event rates of cardiac death/myocardial infarction (1.3% vs. 6.5%, p = 0.009) and major adverse cardiac events (14.0% vs. 22.2%, p = 0.05) were significantly lower among patients treated with ZES. Rates of target lesion (8.1% ZES vs. 6.5% SES, p = 0.68) and target vessel revascularization were similar between treatment groups. Stent thrombosis was infrequent and similar in both groups (0.7% ZES vs. 0.9% SES, p = 1.0). Between 9 months and 5 years, progression of major adverse cardiac events was significantly more common with SES than with ZES (16.7% vs. 7.8%, p = 0.015). Despite initially higher angiographic late lumen loss, rates of clinical restenosis beyond the protocol-specified angiographic follow-up period remain stable with ZES compared with the rates for SES, resulting in similar late-term efficacy. Over 5 years, significant differences in death, myocardial infarction, and composite endpoints favored treatment with ZES

  19. A randomized multicenter comparison of hybrid sirolimus-eluting stents with bioresorbable polymer versus everolimus-eluting stents with durable polymer in total coronary occlusion: rationale and design of the Primary Stenting of Occluded Native Coronary Arteries IV study

    Directory of Open Access Journals (Sweden)

    Teeuwen Koen

    2012-12-01

    Full Text Available Abstract Background Percutaneous recanalization of total coronary occlusion (TCO was historically hampered by high rates of restenosis and reocclusions. The PRISON II trial demonstrated a significant restenosis reduction in patients treated with sirolimus-eluting stents compared with bare metal stents for TCO. Similar reductions in restenosis were observed with the second-generation zotarolimus-eluting stent and everolimus-eluting stent. Despite favorable anti-restenotic efficacy, safety concerns evolved after identifying an increased rate of very late stent thrombosis (VLST with drug-eluting stents (DES for the treatment of TCO. Late malapposition caused by hypersensitivity reactions and chronic inflammation was suggested as a probable cause of these VLST. New DES with bioresorbable polymer coatings were developed to address these safety concerns. No randomized trials have evaluated the efficacy and safety of the new-generation DES with bioresorbable polymers in patients treated for TCO. Methods/Design The prospective, randomized, single-blinded, multicenter, non-inferiority PRISON IV trial was designed to evaluate the safety, efficacy, and angiographic outcome of hybrid sirolimus-eluting stents with bioresorbable polymers (Orsiro; Biotronik, Berlin, Germany compared with everolimus-eluting stents with durable polymers (Xience Prime/Xpedition; Abbott Vascular, Santa Clara, CA, USA in patients with successfully recanalized TCOs. In total, 330 patients have been randomly allocated to each treatment arm. Patients are eligible with estimated duration of TCO ≥4 weeks with evidence of ischemia in the supply area of the TCO. The primary endpoint is in-segment late luminal loss at 9-month follow-up angiography. Secondary angiographic endpoints include in-stent late luminal loss, minimal luminal diameter, percentage of diameter stenosis, in-stent and in-segment binary restenosis and reocclusions at 9-month follow-up. Additionally, optical coherence

  20. Severe Anaemia during Late Pregnancy

    Directory of Open Access Journals (Sweden)

    Mahenaz Akhtar

    2012-01-01

    Full Text Available Vitamin B12 deficiency is uncommon in pregnancy, it occurs in 10–28% of uncomplicated pregnancies, and is associated with a few complications. We present a case report of a 21-year-old patient with severe anaemia during late pregnancy caused by vitamin B12 deficiency. At 38 weeks gestation and with a BMI of 48.9, a history of rupture of membranes was given but not confirmed. On examination, she appeared pale and therefore full blood counts were done. Interestingly her haemoglobin (Hb levels were 3.7 g/dL. Folate and vitamin B12 levels were also found to be low, and the diagnosis of anaemia caused by vitamin B12 deficiency was made. After treatment with vitamin B12 injections, folic acid and blood transfusions, the patient’s haemoglobin levels improved from 3.7 g/dL to 10.7 g/dL. The conclusion is that effective history taking, diagnosis, and management can prevent many complications that are usually associated with vitamin B12 deficiency anaemia.

  1. Late complications of radiation therapy

    Energy Technology Data Exchange (ETDEWEB)

    Masaki, Norie [Osaka Prefectural Center for Adult Diseases (Japan)

    1998-03-01

    There are cases in which, although all traces of acute radiation complications seem to have disappeared, late complications may appear months or years to become apparent. Trauma, infection or chemotherapy may sometimes recall radiation damage and irreversible change. There were two cases of breast cancer that received an estimated skin dose in the 6000 cGy range followed by extirpation of the residual tumor. The one (12 y.o.) developed atrophy of the breast and severe teleangiectasis 18 years later radiotherapy. The other one (42 y.o.) developed severe skin necrosis twenty years later radiotherapy after administration of chemotherapy and received skin graft. A case (52 y.o.) of adenoidcystic carcinoma of the trachea received radiation therapy. The field included the thoracic spinal cord which received 6800 cGy. Two years and 8 months after radiation therapy she developed complete paraplegia and died 5 years later. A truly successful therapeutic outcome requires that the patient be alive, cured and free of significant treatment-related morbidity. As such, it is important to assess quality of life in long-term survivors of cancer treatment. (author)

  2. Effects of Autologous EPCs Transplantation on Reendothelialization and Restenosis of Ballon-injured Rat Carotis%内皮祖细胞移植加速鼠颈动脉内皮修复预防再狭窄的研究

    Institute of Scientific and Technical Information of China (English)

    孙智山; 周胜华; 曾建平; 黄河

    2011-01-01

    Objective: To investigate the effects of autologous EPCs transplantation on reendothelialization and restenosis of ballon-injured rat carotis. Methods: 30 SD rats were randomly divided to equal 3 groups: sham operation group, placebo group and autologous EPCs transplantation group. In the latter two groups each rat's left carotid was injured by balloon. Three weeks before balloon injure, all rats were drawn 3 ml blood, and total mononuclear cells isolated from peripheral blood by density gradient centrifugation were cultured for three weeks. EPCs were characterized as adherent cells double positive for Dil-acLDL-uptaking and lectin-binding. Immediately after balloon impairment,and 1 x 106 EPCs were autologously transplanted by caudal vein injention. 4 weeks after balloon injury, the restenosis ratio and reendothelialization ratio of each subject was measured. Results: Compared with placebo group, autologous EPCs transplantation not only increased the reendothelialization ratio but also alleviated the restenosis ratio, hi EPCs transplantation group, restenosis ratio was inversely linearly correlated to reendothelialization ratio. Conclusions: Autologous EPCs transdplantation can inhibit restenosis by accelerating endothelial recovery.%目的:以安慰机组作对照,观察EPCs自体移植防治再狭窄的疗效以及该作用与血管再内皮化是否相关.方法:共30只雄性SD大鼠纳入实验,随机均分为假手术组、安慰剂组和EPCs移植组.造模前3周时取血3毫升,M199培养基培养传代,行EPCs鉴定,移植组在球囊损伤后即予尾静脉注射1×106个EPCs自体移植.4周后观察再狭窄和再内皮化程度.结果:与安慰剂组相比,EPCs自体移植组再内皮化程度提高,再狭窄程度减轻;EPCs移植组内膜/中膜比值与再内皮化率呈线性负相关.结论:EPCs体外扩增自体移植可预防再狭窄;其机制与加速再内皮化有关.

  3. MicroRNA expression profiling analysis and target gene validation in human restenosis after arterial reconstruction%动脉重建术后再狭窄相关miRNA表达谱分析及靶基因鉴定

    Institute of Scientific and Technical Information of China (English)

    张亦; 黄英; 李维敏; 陆信武; 黄新天; 陆民; 蒋米尔

    2012-01-01

    Objective To identify artery-specific mircoRNAs (miRNAs) in restenosis after arterial reconstruction in patients with atherosclerosis obliterans (ASO) and validate the target gene of aberrantly expressed miRNA.Methods Superficial femoral artery tissue samples were collected from six patients with ASO and three normal controls who underwent above-knee amputation for limb injury (Group N).The six patients were divided into two groups based on prior arterial reconstruction:Group A,ASO without revascularization ( n =3) and Group R,restenosis following revascularization ( n =3 ).MiRNA expression profiling of all samples was performed using miRNA microarray analysis,the selected aberrantly expressed miRNAs were validated using real-time reverse transcription-polymerase chain reaction (real-time RT-PCR ) analysis and the predicted target gene was assessed using dual-luciferase reporting assays.Results MiRNA microarray analysis showed that miRNA-1 and miRNA-335 were down-regulated whereas there was no miRNA up-regulated in arteries from patient group ( Group A and Group R) as compared to those from Group N.In subgroup analyses,miRNA-1 and miRNA-335 were down-regulated whereas there was no miRNA up-regulated as compared to those from Group N; there were 17 miRNAs down-regulated while only hsa-miR-623 up-regulated in arteries from Group R as compared to those from Group N; there were 17 miRNAs up-regulated and 9 miRNAs down-regulated in arteries from Group R as compared to those from Group A.Among all down-regulated miRNAs,down-regulation of miRNA-1 was the largest,and it was confirmed by real-time RT-PCR (P < 0.05 ).At the same time,dual-luciferase reporting assay data demonstrated that miR-1 targets a putative binding site in the 3' -UTR of kruppel like factor 4 ( KLF4,P < 0.05).Conclusion MiRNAs may play important roles in human restenosis following arterial reconstruction,and they may have therapeutic applications in the prevention of neointimal hyperplasia.MiRNA-1

  4. 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.

  5. The study of inhibit the Slit/Robo pathway on vascular restenosis after angioplasty in rabbits%下调Slit/Robo通路抑制兔血管成形术后血管再狭窄

    Institute of Scientific and Technical Information of China (English)

    曾智桓; 张仁丹; 赵艳群; 郑坚奕; 周万兴; 张卫; 朱桂平; 李博维

    2016-01-01

    目的:探讨下调Slit/Robo 通路对兔血管成形术后血管再狭窄的影响及机制。方法:将30只雄性新西兰大白兔分成3组,即空白组、对照组及实验组,每组10只。高脂饲养,除空白组外均制作髂动脉内皮剥脱血管狭窄模型。普通喂养4周后在血管狭窄部位行经皮球囊扩张成形术制作再狭窄模型。随后予R5抗体进行腹腔注射。继续喂养4周后再次血管造影检查,用图像工作站对血管造影结果行血管狭窄分析,并测定血清中Slit2、Robo1浓度,取髂动脉行HE 染色。结果:成功建立兔髂动脉成形术后血管再狭窄动物模型。对照组及实验组与空白组相比,Slit2、Robo1血清浓度均显著升高(P <0.01),但实验组经R5抗体干预后,Slit2、Robo1血清浓度较对照组明显降低(P <0.05),经血管造影证实髂动脉血管面积狭窄率及直径狭窄率均降低(P <0.05)。结论:兔血管再狭窄模型 Slit2/Robo1的表达显著增高,R5抗体可有效抑制 Slit2/Robo1的表达,下调Slit2/Robo1信号通路可治疗兔血管成形术后再狭窄。%Objective To study the effect and mechanism of down-regulating Silt2/Robo 1 signaling pathway on rabbit iliac artery after angioplasty restenosis. Methods The 30 male New Zealand white rabbits were divided randomly into 3 groups , namely the blank group , the control group , and the experimental group , 10 rabbits in each group. Hign-fat feeding , the rabbits were produced endothelial denudation of iliac artery stenosis model. Another 4 weeks of feeding , percutaneous balloon angioplasty was performed. Then R5 antibody was injected into the abdominal cavity. After 4 weeks of feeding ,angiography again. The results of angiography was analysied by image workstation. The concentrations of Slit2 and Robo1 was detected by ELISA. The iliac artery tissue examined by HE staining. Results The rabbit iliac artery after

  6. Late Registration: May It Rest in Peace

    Science.gov (United States)

    O'Banion, Terry

    2012-01-01

    Almost every institution of higher education engages in late registration. But evidence is mounting that the practice, originally intended to keep the doors of opportunity open for students as long as possible, wreaks havoc on the ability of colleges to achieve the goals of the emerging completion agenda. Despite best intentions, late registration…

  7. Late Registration: May It Rest in Peace

    Science.gov (United States)

    O'Banion, Terry

    2012-01-01

    Almost every institution of higher education engages in late registration. But evidence is mounting that the practice, originally intended to keep the doors of opportunity open for students as long as possible, wreaks havoc on the ability of colleges to achieve the goals of the emerging completion agenda. Despite best intentions, late registration…

  8. Childhood abuse in late-life depression

    NARCIS (Netherlands)

    Comijs, Hannie C; van Exel, Eric; van der Mast, Roos C; Paauw, Anna; Oude Voshaar, Richard; Stek, Max L

    2013-01-01

    Background: Little is known about the role of childhood abuse in late-life depression. The aim of the study is therefore to study whether childhood abuse is associated with late-life depression according to its onset, and which clinical characteristics play a role in this association. Methods: Data

  9. Childhood abuse in late-life depression

    NARCIS (Netherlands)

    Comijs, H.C.; Exel, E. van; Mast, R.C. van der; Paauw, A.; Oude Voshaar, R.C.; Stek, M.L.

    2013-01-01

    BACKGROUND: Little is known about the role of childhood abuse in late-life depression. The aim of the study is therefore to study whether childhood abuse is associated with late-life depression according to its onset, and which clinical characteristics play a role in this association. METHODS: Data

  10. 16 CFR 444.4 - Late charges.

    Science.gov (United States)

    2010-01-01

    ... 16 Commercial Practices 1 2010-01-01 2010-01-01 false Late charges. 444.4 Section 444.4 Commercial Practices FEDERAL TRADE COMMISSION TRADE REGULATION RULES CREDIT PRACTICES § 444.4 Late charges. (a) In connection with collecting a debt arising out of an extension of credit to a consumer in or...

  11. Childhood abuse in late-life depression

    NARCIS (Netherlands)

    Comijs, Hannie C; van Exel, Eric; van der Mast, Roos C; Paauw, Anna; Oude Voshaar, Richard; Stek, Max L

    Background: Little is known about the role of childhood abuse in late-life depression. The aim of the study is therefore to study whether childhood abuse is associated with late-life depression according to its onset, and which clinical characteristics play a role in this association. Methods: Data

  12. 7 CFR 925.141 - Late payments.

    Science.gov (United States)

    2010-01-01

    ... payment charge of 5 percent on the unpaid balance on any handler whose assessment has not been received in... rate of 11/2 percent per month shall be applied to the unpaid balance and late payment charge for the... 7 Agriculture 8 2010-01-01 2010-01-01 false Late payments. 925.141 Section 925.141...

  13. Cycads: Fossil evidence of late paleozoic origin

    Science.gov (United States)

    Mamay, S.H.

    1969-01-01

    Plant fossils from Lower Permian strata of the southwestern United States have been interpreted as cycadalean megasporophylls. They are evidently descended from spermopterid elements of the Pennsylvanian Taeniopteris complex; thus the known fossil history of the cycads is extended from the Late Triassic into the late Paleozoic. Possible implications of the Permian fossils toward evolution of the angiosperm carpel are considered.

  14. Are we ready to predict late effects?

    DEFF Research Database (Denmark)

    Salz, Talya; Baxi, Shrujal S; Raghunathan, Nirupa;

    2015-01-01

    BACKGROUND: After completing treatment for cancer, survivors may experience late effects: consequences of treatment that persist or arise after a latent period. PURPOSE: To identify and describe all models that predict the risk of late effects and could be used in clinical practice. DATA SOURCES:...

  15. Late Abortion: A Comprehensive Review

    Directory of Open Access Journals (Sweden)

    Sheng Chiang

    2005-12-01

    Full Text Available Late termination of pregnancy (LTOP is defined as an abortion carried out beyond 24 gestational weeks, when the fetus has arguably attained viability. In Taiwan, the current abortion law, bearing a eugenic title, allows LTOP on certain medical grounds. However, the fetal and maternal conditions that constitute medical grounds are not clarified and remain legally untested. Professional debate on the abortion issue is also lacking in academia in Taiwan, despite societal concerns. With the advent of technology to detect fetal abnormalities, obstetricians are now confronted more frequently with acute dilemmas regarding LTOP. Quite often, they sail in an uncharted sea with no clinical guidelines from their professional societies or affiliated hospitals. Recently, LTOP at 35 gestational weeks for a fetus with Down syndrome, complicated with polyhydramnios and tetralogy of Fallot, triggered media scrutiny and aroused much public attention. Although the clinical decision making for pregnancies with fetal abnormalities entails increasingly balanced information and consideration in terms of the medical, ethical, legal, psychologic, and societal aspects, society at large is unaware of the complexity and intertwined nature of various abortion issues, especially LTOP. Obstetricians are now in a vulnerable position in Taiwanese society, where litigations relevant to the practice of early abortions are not rare. Therefore, a global and in-depth look into abortion issues from legal and ethical dimensions is indispensable for modern obstetric practice. This review considers the core issues in LTOP, including what conditions constitute a “serious” fetal abnormality to justify LTOP, the incidence of LTOP, legislation regarding LTOP in Western countries, and recent research on ambivalent fetal pain. It will also present procedures, some under the auspices of the ethical committee of a Presbyterian hospital in Taiwan, for clinical decision making, particularly

  16. 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)

  17. Late stent thrombosis: a not negligible issue after drug-eluting stent implantation

    Institute of Scientific and Technical Information of China (English)

    GAO Run-lin

    2007-01-01

    @@ Drug-eluting stent (DES) has markedly reduced restenosis and the need for target lesion revascularization (TLR). The safety profile of DES does not seem to differ from that of bare metal stent in the acute and subacute phases following coronary intervention.

  18. Cholesterol and late-life cognitive decline.

    Science.gov (United States)

    van Vliet, Peter

    2012-01-01

    High cholesterol levels are a major risk factor for cardiovascular disease, but their role in dementia and cognitive decline is less clear. This review highlights current knowledge on the role of cholesterol in late-life cognitive function, cognitive decline, and dementia. When measured in midlife, high cholesterol levels associate with an increased risk of late-life dementia and cognitive decline. However, when measured in late-life, high cholesterol levels show no association with cognitive function, or even show an inverse relation. Although statin treatment has been shown to associate with a lower risk of dementia and cognitive decline in observational studies, randomized controlled trials show no beneficial effect of statin treatment on late-life cognitive function. Lowering cholesterol levels may impair brain function, since cholesterol is essential for synapse formation and maturation and plays an important role in the regulation of signal transduction through its function as a component of the cell membrane. However, membrane cholesterol also plays a role in the formation and aggregation of amyloid-β. Factors that influence cholesterol metabolism, such as dietary intake, are shown to play a role in late-life cognitive function and the risk of dementia. In conclusion, cholesterol associates with late-life cognitive function, but the association is strongly age-dependent. There is no evidence that treatment with statins in late-life has a beneficial effect on cognitive function.

  19. Coating bioabsorption and chronic bare metal scaffolding versus fully bioabsorbable stent.

    Science.gov (United States)

    Waksman, Ron; Pakala, Rajbabu

    2009-12-15

    Advances in coronary stent technology, including refinement of the stent alloy, strut thickness, stent geometry, passive coating, and drug elution, have dramatically enhanced the safety and efficacy of percutaneous coronary intervention (PCI) with stenting. Stents are currently used in over 90% of coronary interventions and the use of drug-eluting stents (DES) has been disseminated to more complex lesion subsets such as total occlusions, long lesions, bifurcation lesions, and for patients with acute myocardial infarction. DES continue to demonstrate reduction in restenosis and the need for repeat revascularisation but are associated with delayed healing and re-endothelialisation, which have led to an increased rates of late stent thrombosis, dependency on prolonged dual antiplatelet therapy, impaired in-vessel reactivity, and chronic inflammation. As scientists and clinicians better understand the mechanism for late restenosis and stent thrombosis, a variety of solutions in regard to stent technology have been proposed, including stent coating, polymer bioabsorption, and fully biodegradable stents. Bare metal stents were improved by the reduction of strut thickness, changes in stent geometry, and the addition of passive coating, which lead to improvements in efficacy and reduction of restenosis. In addition, there is continued improvement in the polymer technology for DES, including new biocompatible, thinner durable polymers, and bioabsorbable polymers that completely bioabsorb within 3-12 months after stent implantation. These features potentially minimise the chronic inflammatory response and late stent thrombosis. Finally, fully bioabsorbable stents, both polymeric and metallic, continue to be developed in order to eliminate any late stenting effects and potentially may enable complete vessel restoration. This manuscript will discuss the wide variety of new stent technologies and compare and contrast durable metallic and polymeric stents to current

  20. Experimental late brood surveys: Southern Saskatchewan: 1991

    Data.gov (United States)

    US Fish and Wildlife Service, Department of the Interior — This report summarizes the late brood surveys for southern Saskatchewan during 1991. Survey methods, weather and habitat conditions, production indices, and tables...

  1. Late onset depression: A recent update

    Directory of Open Access Journals (Sweden)

    Ananya Mahapatra

    2015-01-01

    Full Text Available Late onset depression has recently emerged as a serious mental health issue in the geriatric population with significant public health implications. It is often challenging to diagnose and treat this entity. Various theories have been postulated to elucidate the etiology of late onset depression, but a unifying hypothesis is lacking. Although the vascular hypothesis is most researched; a complex interaction of multiple vulnerability factors is the current focus of attention. Numerous psychosocial variables have been implicated to play a significant role in predicting the onset and severity of late-life depression. Phenomenological differences have been delineated from depression occurring at a younger age, but the findings are equivocal. A better understanding of the natural trajectory of depression in the elderly is required for early diagnosis and effective treatment. This review attempts to summarize the current status of evidence regarding epidemiology, etiology, clinical features, and treatment options available for late-onset depression.

  2. Late Amazonian Glaciations in Utopia Planitia, Mars

    Science.gov (United States)

    Osinski, G. R.; Capitan, R. D.; Kerrigan, M.; Barry, N.; Blain, S.

    2012-03-01

    We present evidence from western Utopia Planitia, including lineated valley fill and lobate debris aprons, for widespread glaciations over a large expanse of the northern plains and dichotomy boundary during Late Amazonian times.

  3. 益气活血法预防糖尿病足腔内介入后再狭窄的观察%Clinical Observation of Yiqihuoxue Therapy on Preventing Diabetic Endovascular Stent Restenosis Foot

    Institute of Scientific and Technical Information of China (English)

    李强; 于宗学; 苗进

    2014-01-01

    目的:观察益气活血法预防糖尿病足腔内介入后再狭窄的临床疗效。方法:选择接受腔内治疗的糖尿病足患者370例,分为中药组与对照组,其中中药组185例,对照组185例。所有患者都给予抗血小板药物口服,中药组予益气活血法辨证加减口服中药。观察两组患者术后24个月间歇性跛行、静息痛、踝肱指数(ABI)、肢体再次溃疡或者坏疽及截肢等情况,并进行统计学分析。结果:24个月后,对照组中,1例患者膝下截肢,1例患者膝上截肢,1例患者出现左足趾溃疡,1例患者出现左足趾坏疽,中药组中仅出现1例左足趾坏疽。其中中药组再次出现间歇性跛行、静息痛症状均少于对照组(P<0.01),中药组ABI明显高于对照组(P<0.05)。结论:益气活血法可明显提高糖尿病足腔内治疗术后血管通畅率,改善肢体缺血症状。%Objective:To observe the clinical effects of Yiqihuoxue therapy on preventing diabetic endovascular stent restenosis foot. Methods: 370 diabetic foot (DF) that successfully underwent endovascular therapy were randomly divided into two groups,the control group and the treatment group,185 in each group. Patients in the control group received antiplatelet treatment,while the treatment group was additionally Yiqihuoxue herbal medicine. Ankle brachial index (ABI),intermittent claudication,rest pain,ulcer,gangrene and the incidence of amputation in the following 24 months were recorded and observed in the two groups. Statistical analysis and comparison of observation was carried out with SPSS17.0. Results: After 24 months, in the control group, 1 patient received an above the knee amputation, 1 patient received an below the knee amputation, 1 patient had ulcer in his left foot,1 patient had gangrene with his left foot. In the treatment group, only 1 patient had gangrene in his left foot without amputation. Compared to the control group

  4. Biological coating materials of intravascular stent surface and intravascular restenosis%血管内支架表面生物涂层材料与血管内再狭窄

    Institute of Scientific and Technical Information of China (English)

    徐海峰

    2011-01-01

    背景:心脏病是威胁人类健康的首要病因之一,现在全世界每年大约有1 500万例冠心病患者需要接受经皮穿刺冠状动脉(冠脉)成形治疗,但是大约10%发生急性或亚急性冠脉阻塞,6个月后再狭窄发生率高达20%~50%,再狭窄已成为制约经皮穿刺冠状动脉(冠脉)成形术发展的最主要因素.目的:探讨药物洗脱支架治疗支架内再狭窄的长期临床效果.方法:作者以"药物洗脱支架,阻塞,再狭窄"为检索词,在中国期刊全文数据库中,采用电子检索的方式进行文献检索.排除Meta分析及重复性研究,共检索到25篇文献,从支架置入治疗进展,不同材料及类型支架对开通率、开通时间的影响,以及预防支架狭窄等方面进行探讨.结果与结论:药物洗脱支架运用先进的支架载药及药物控制释放技术,在支架机械支撑病变血管的同时,具有抑制血管平滑肌细胞增生的药物从支架表面缓慢释放,作用于与支架接触的血管壁,解决了血管弹性回缩、重塑以及内膜的过度增生问题.随着冠状动脉介入治疗设备的改进和创新,药物涂层支架技术也在不断地成熟和发展.目前新出现的药物涂层支架设计理念是建立在药物筛选和可控释放系统基础上的.相信未来的药物涂层支架将能够应用于更多的血管复杂病变(尤其是静脉和多血管损伤)以及其他脏器疾病.%BACKGROUND: Cardiopathy is one of the most important causes of disease which threaten human health. Every year, about 15 million patients with coronary heart disease around the world need percutaneous puncture coronary angioplasty therapy. But about 10% of them develop acute and subacute artery occlusion; 20% to 50% of them develop intravascular restenosis in six months. Restenosis has already become one of the most critical factors that restrict the development of percutaneous puncture coronary angioplasty.OBJECTIVE: To discuss the long

  5. 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.

  6. Impact of Vertebral Artery Stent Implantation on Hemodynamics of Patients With Intracranial Vertebral Artery Stenosis and the Influencing Factors of Postoperative Restenosis%椎动脉支架置入术对颅内椎动脉狭窄患者血流动力学的影响及术后再狭窄的影响因素研究

    Institute of Scientific and Technical Information of China (English)

    王铁军; 石富铭; 陈书阁; 王金梅

    2016-01-01

    Objective to investigate the impact of vertebral artery stent implantation on hemodynamics of patients with intracranial vertebral artery stenosis,to analyze the influencing factors of postoperative restenosis. Methods From February 2012 to February 2014,a total of 106 patients with intracranial vertebral artery stenosis were selected in the Department of Neurology,People′s Hospital of Daxing District,Beijing,all of them received vertebral artery stent implantation and were followed up for 1 year(average). Pulsatility index(PI),peak systolic velocity(PSV)and end diastolic velocity(EDV)of intracranial vertebral artery,arterial diameter,resistance index( RI),PSV and EDV of extracranial vertebral artery were observed before surgery,after 1 week,3 moths,6 months and 12 months of surgery. According to the follow - up result,the 106 patients were divided into A group( occurred postoperative restenosis,n = 38) and B group( did not occurred postoperative restenosis,n = 68),gender,age,smoking status and underlying disease were compared between the two groups,and the influencing factors of postoperative restenosis were analyzed. Results After 1 week,3 moths,6 months and 12 months of surgery,PI of intracranial vertebral artery was statistically significantly higher than before surgery,respectively,while PSV and EDV of intracranial vertebral artery were statistically significantly slower than those before surgery(P 0. 05),while incidence of coronary heart disease and diabetes mellitus of A group was statistically significantly higher than that of B group, respectively( P 0.05);再狭窄组患者冠心病发生率及糖尿病发生率高于无再狭窄组(P <0.05)。结论椎动脉支架置入术能有效改善 IVAS 患者椎动脉颅内段及颅外段血流动力学,增加颅内血流灌注,而 IVAS 患者术后再狭窄可能与基础疾病有关,与性别、年龄及吸烟无关。

  7. LATE TRIASSIC (LATE NORIAN-RHAETIAN RADIOLARIANS FROM THE ANTALYA NAPPES, CENTRAL TAURIDES, SOUTHERN TURKEY

    Directory of Open Access Journals (Sweden)

    UGUR KAGAN TEKIN

    2002-11-01

    Full Text Available The Hocaköy section measured from the Alakirçay Nappe (middle nappe of the Antalya Nappes contain rich radiolarian fauna ranging from late Norian (Late Triassic to middle-late Cenomanian (mid Cretaceous. At the basal part of the section, the Late Triassic (late Norian-Rhaetian Gökdere Formation is characterized by gray to beige cherty limestone at the base and pinkish red chert- gray to beige limestone alternation at the top, with moderately to well-preserved radiolarians in the red chert beds. The overlying Jurassic - Middle Cretaceous Hocaköy Radiolarite is mainly represented by chert-mudstone alternations with some limestone interlayers. Radiolarians of the Gökdere Formation can be well correlated with that of the fauna from the Mino Terrane, central Japan and the fauna from the Queen Charlotte Islands, British Columbia, Canada. Four radiolarian zones from central Japan are recognized in the fauna obtained from Gökdere Formation such as “Praemesosaturnalis multidentatus Lowest Occurrence Zone (TR8A” (late Norian, “Praemesosaturnalis pseudokahleri Lowest Occurrence Zone (TR8B” (late Norian, ? “ Skirt F lowest Occurrence Zone (TR8C” (late Norian-Rhaetian and partly “Haeckelicyrtium breviora Taxon Range Zone (TR8D” (Rhaetian. In comparison with the Queen Charlotte fauna, the two zones “Betraccium deweveri Zone” (late Norian and “Proparvicingula moniliformis Zone” (early Rhaetian are also encountered in the Gökdere Formation. Radiolarians of the uppermost part of the Gökdere Formation indicate that “Globolaxtorum tozeri Zone” defined in Queen Charlotte Islands corresponding to the late Rhaetian, is not present in the section. Five new taxa, Capnuchosphaera okayi, Bistarkum rhaeticum, Praemesosaturnalis heilongjiangensis aksekiensis, P. nobleae, Veghicyclia sanfilippoae were determined within the late Norian-Rhaetian radiolarian fauna of the Gökdere Formation in Hocaköy section.   

  8. Evaluation of safety and efficacy of NexGen – an ultrathin strut and hybrid cell design cobalt-chromium bare metal stent implanted in a real life patient population – the Polish NexGen Registry

    Directory of Open Access Journals (Sweden)

    Krzysztof Milewski

    2016-08-01

    Full Text Available Introduction : Despite the dominance of drug-eluting stents in modern interventional cardiology, there is still a niche for bare metal stents. Aim: The aim of the Polish NexGen registry was to evaluate the safety and efficacy of a new generation cobalt-chromium NexGen stent in a real life patient population. Material and methods : A prospective multi-center registry was conducted in five clinical sites of American Heart of Poland. Three hundred and eighty-three patients who underwent percutaneous coronary intervention (PCI with NexGen stent implantation were included. Clinical follow-up was performed at 1, 6 and 12 months. Additionally, a group of 42 randomly selected patients underwent control angiography at 6 months (10.96% of study population. The primary endpoint was occurrence of target vessel revascularization (TVR at 6-month follow-up. Angiographic endpoints included rates of binary restenosis and late lumen loss at 6-month follow-up based on QCA analysis. Multivessel disease was present in more than 70% of patients, and 52.4% of lesions were complex. The main indications for angiography were non-ST elevation acute coronary syndromes (54.8% and ST elevation myocardial infarction (34.99%. Results : At 6-month follow-up 47 (12.7% patients reached the primary endpoint of TVR. The composite of major acute cardiac event rates at 30-day and 6- and 12-month follow-up was 6.01% (n = 23, 18.5% (n = 69 and 25.21% (n = 92 respectively. Control angiography performed after 6 months showed in-stent late loss of 0.66 ±0.71 mm and a binary restenosis rate of 16.7%. Conclusions : Our study showed that PCI with the NexGen stent is safe and effective at 6- and 12-month follow-up. Angiographic results showed a satisfactory restenosis rate and low late lumen loss.

  9. Precursors and Correlates of Anxiety Trajectories from Late Childhood to Late Adolescence

    Science.gov (United States)

    Letcher, Primrose; Sanson, Ann; Smart, Diana; Toumbourou, John W.

    2012-01-01

    The present research employed a prospective, multi-informant design to examine precursors and correlates of differing anxiety profiles from late childhood to late adolescence. The sample consisted of 626 boys and 667 girls who are participants in the Australian Temperament Project, a large, longitudinal, community-based study that has followed…

  10. Are drug-eluting stents the future of SFA treatment?

    Science.gov (United States)

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

    2010-02-01

    Drug-eluting stent (DES) technology was developed to prevent early thrombosis and late luminal loss to potentially improve long-term patency rates. Although favorable DES results have recently become available with the Zilver PTX and STRIDES studies, the high price of DES is a major drawback for this technology to become the golden standard for peripheral endovascular therapy in de novo femoro-popliteal (FP) lesions. Nevertheless, DES has the potential to make the difference and to establish itself as an important treatment option in patients presenting with TASC C&D FP lesions who are at high-risk for surgery and for the treatment of in-stent restenosis, where until now, no valuable treatment option has proven to be beneficial.

  11. High versus low-pressure balloon inflation during multilinktrade mark stent implantation: acute and long-term angiographic results.

    Science.gov (United States)

    Caixeta, A M; Brito, F S; Rati, M; Perin, M A; da Luz, P L; Ramires, J A; Ambrose, J A; Martinez, E E

    2000-08-01

    We compared the impact of low and high-pressure balloon inflation on acute and late angiographic results of Multilink stent. Low-pressure balloon inflation (9.5 +/- 1.9 atm) was used in 43 stents and high pressure (17.1 +/- 1.5 atm) in 44. A larger immediate luminal gain was achieved in stents with high-pressure balloon inflation (1.80 +/- 0.26 vs. 1.47 +/- 0.62; P = 0.002), resulting in a larger mean diameter in this group (2.71 +/- 0.37 vs. 2.48 +/- 0.47; P = 0.017). At follow-up, a larger luminal diameter was achieved in the high pressure group (1.93 +/- 0.72 vs. 1.45 +/- 0.66; P = 0.002) and a trend to a lower rate of angiographic restenosis (15% vs. 38%, P = 0.08).

  12. Late effects of thoracic irradiation in children

    Energy Technology Data Exchange (ETDEWEB)

    Boelling, T.; Koenemann, S.; Ernst, I.; Willich, N. [Dept. of Radiotherapy, Univ. Hospital of Muenster (Germany)

    2008-06-15

    Purpose: to summarize the literature regarding the late effects of radiotherapy to the thorax in childhood and adolescence with special emphasis on cardiac and pulmonary impairment. Material und methods: the literature was critically reviewed using the PubMed {sup registered} database with the key words 'late effects', 'late sequelae', 'child', 'childhood', 'adolescence', 'radiation', 'radiotherapy', 'thorax', 'lung', 'heart', and 'pulmonary'. Results: 17 publications dealing with radiation-induced pulmonary and cardiac late sequelae in children could be identified and were analyzed in detail. 29 further publications with additional information were also included in the analysis. Pulmonary function impairment after mediastinal irradiation arose in one third of all pediatric patients, even when treatment was performed with normofractionated lower doses (15-25 Gy). Whole lung irradiation was regularly followed by pulmonary function impairment with differing rates in several reports. However, clinically symptomatic function impairment like dyspnea was less frequent. Irradiation of up to 25 Gy (single doses {<=} 2 Gy) to the heart showed little or no cardiac toxicity in analyses of irradiated children (median follow-up 1.3-14.3 years). Doses of > 25 Gy (single doses {<=} 2-3.3 Gy) led to several cardiac dysfunctions. However, new data from adults with longer follow-up may indicate threshold doses as low as 1 Gy. Impairment of skeletal growth, breast hypoplasia, and secondary malignancy were further potential late sequelae. Conclusion: several retrospective reports described radiation-associated late sequelae in children. However, there is still a lack of sufficient data regarding the characterization of dose-volume effects. (orig.)

  13. Infrared Observations of Late Type Stars

    Science.gov (United States)

    Merrill, K. M.

    1977-01-01

    Substantive mass loss resulting in appreciable circumstellar dust envelopes is common in late-type stars. The evolutionary history and physical state of a cool star determine the chemistry within the outer stellar atmosphere mirrored by the molecular and particulate material present in the envelope. The observational consequences of this debris determined by moderate spectral resolution infrared spectrophotometry are reviewed. Significant information is provided by observations of the emergent energy flux of both the cool stellar photosphere and of the circumstellar dust envelope. The observation suggests that mass-loss occurs to some degree throughout late stellar evolutionary phases and that occasional periods of high mass loss are not uncommon.

  14. Late Cretaceous vicariance in Gondwanan amphibians.

    Directory of Open Access Journals (Sweden)

    Ines Van Bocxlaer

    Full Text Available Overseas dispersals are often invoked when Southern Hemisphere terrestrial and freshwater organism phylogenies do not fit the sequence or timing of Gondwana fragmentation. We used dispersal-vicariance analyses and molecular timetrees to show that two species-rich frog groups, Microhylidae and Natatanura, display congruent patterns of spatial and temporal diversification among Gondwanan plates in the Late Cretaceous, long after the presumed major tectonic break-up events. Because amphibians are notoriously salt-intolerant, these analogies are best explained by simultaneous vicariance, rather than by oceanic dispersal. Hence our results imply Late Cretaceous connections between most adjacent Gondwanan landmasses, an essential concept for biogeographic and palaeomap reconstructions.

  15. Climate predictors of late quaternary extinctions

    DEFF Research Database (Denmark)

    Nogués-Bravo, David; Ohlemüller, Ralf; Batra, Persaram

    2010-01-01

    Between 50,000 and 3,000 years before present (BP) 65% of mammal genera weighing over 44 kg went extinct, together with a lower proportion of small mammals. Why species went extinct in such large numbers is hotly debated. One of the arguments proposes that climate changes underlie Late Quaternary...... extinctions, but global quantitative evidence for this hypothesis is still lacking. We test the potential role of global climate change on the extinction of mammals during the Late Quaternary. Our results suggest that continents with the highest climate footprint values, in other words, with climate changes...

  16. The everolimus-eluting Xience stent in small vessel disease: bench, clinical, and pathology view

    Directory of Open Access Journals (Sweden)

    Sanchez OD

    2014-12-01

    Full Text Available Oscar D Sanchez, Kazuyuki Yahagi, Tobias Koppara, Renu Virmani, Michael Joner CVPath Institute, Inc., Gaithersburg, MD, USA Abstract: Coronary artery disease (CAD is the leading cause of morbidity and mortality worldwide. The pathogenesis of CAD relates to the presence of atherosclerotic plaques in the coronary arteries, which are most frequently treated today by percutaneous coronary intervention. Small vessel disease treatment represents one-third of all percutaneous coronary interventions with higher rates of restenosis and major adverse cardiac events. Initially, drug-eluting stents (DES were developed to reduce in-stent restenosis, improving clinical outcomes and reducing the need for target vessel revascularization. However, late and very late stent thrombosis emerged as a new problem compromising DES's long-term results. The cobalt–chromium everolimus-eluting stent (CoCr-EES represents the results of an evolutionary process in DES technology aimed at improving the shortcomings of first-generation DES. Small vessel CAD has historically been an obstacle to long-term patency following implantation of DES. Antirestenotic efficacy has been shown to be of high relevance in small vessels. Therefore, stent selection may play an important role in determining outcomes in this subgroup of patients. This article will review the performance of CoCr-EES in the treatment of small vessel CAD from preclinical, clinical, and pathology perspectives, and it will highlight the most important findings in this regard. Keywords: small vessel, cobalt–chromiun everolimus-eluting stent, Xience V, pathology

  17. Carotid angioplasty and stenting in anatomically high-risk patients: Safe and durable except for radiation-induced stenosis.

    Science.gov (United States)

    Shin, Susanna H; Stout, Christopher L; Richardson, Albert I; DeMasi, Richard J; Shah, Rasesh M; Panneton, Jean M

    2009-10-01

    Carotid angioplasty and stenting (CAS) is used in patients considered high-risk for carotid endarterectomy (CEA). Patients qualify as high-risk because of medical comorbid conditions or for anatomic considerations (previous CEA, radical neck dissection, radiation). We compared the technical feasibility and durability of CAS in medically high-risk patients (MED) vs anatomically high-risk patients (ANAT). A retrospective review was performed of all consecutive patients undergoing CAS by a single vascular surgery group. All patients were high risk and evaluated with duplex ultrasound imaging and angiography. Primary end points were technical success, 30-day stroke, myocardial infarction (MI), death, and in-stent restenosis. Standard statistical analysis included Kaplan-Meier life tables. From January 2003 to December 2007, 230 CAS (98 ANAT, 132 MED) procedures were attempted. The ANAT cohort comprised 84 patients with a single anatomic risk factor: 71 with a previous ipsilateral CEA, 6 high lesions, 6 history of neck radiation, and 1 with a tracheostomy. Ten patients had two or three anatomic risk factors: nine with radical neck dissection and radiation and one with neck radiation and ipsilateral CEA. The mean age was 71.1 years for ANAT vs 73.9 years for MED (P = .021). Technical success rates were 98% in ANAT and 98.5% in MED (P = .76). Thirty-day stroke rate was 1.0% in ANAT and 5.3% in MED (P = .14); the mortality rate was 2.0% in ANAT and 0.8% in MED (P = .79). The 2-year survival free from stroke was MED, 93.6% and ANAT, 98.9% (P = .118); and from restenosis was MED, 91.9%; and ANAT, 91.0% (P = .98). Two-year overall survival was significantly better in ANAT (84.6%) vs MED (70.1%; P = .026). Four of the seven restenoses in the ANAT group occurred in patients with previous neck radiation. The restenosis rate for radiation-induced (RAD) stenosis treated with CAS was significantly higher at 22.2% (4 of 18) compared with 3.8% (3 of 78) in ANAT group patients without

  18. Toetsing van late zwangerschapsafbreking, 2004-2007

    NARCIS (Netherlands)

    Zeeman, G G; Lind, J; Verhagen, Eduard; van de Vathorst, S; Wildschut, H I J; Wolf, H

    2008-01-01

    OBJECTIVE: To provide an inventory of the reported late terminations of pregnancy because ofa severe anomaly of the unborn child, i.e. termination after 24 weeks of pregnancy, in The Netherlands for the period 2004-2007. DESIGN: Inventory and descriptive. METHOD: A description is given of the variou

  19. Shedding further light on late globalization

    DEFF Research Database (Denmark)

    Turcan, Romeo V.

    2016-01-01

    In his opening essay on ‘What and/or Who is Late’, Nikhilesh Dholakia delineated inter alia “stage-setting contexts” or levels of analysis which could shed light on the phenomenon of late globalization, including its causes and effects. Indeed, these, especially the effects in contemporary contex...

  20. Tomato late blight (Phytophthora infestans) in Uganda

    NARCIS (Netherlands)

    Tumwine, J.; Frinking, H.D.; Jeger, M.J.

    2002-01-01

    A survey on the tomato late blight situation and current practices for disease management was carried out in Uganda using an informal structured questionnaire approach. Ten districts from different agroclimatic zones were selected for the survey. Phytophthora infestans isolates from tomatoes were ob

  1. Vocabulary of Toddlers Who Are Late Talkers

    Science.gov (United States)

    MacRoy-Higgins, Michelle; Shafer, Valerie L.; Fahey, Katlin J.; Kaden, Elyssa R.

    2016-01-01

    The purpose of this study was to understand vocabulary characteristics in toddlers who are late talkers (LT) as compared with age-matched (AM) and vocabulary-matched (VM) peers. The semantic categories (e.g., animals, foods, toys) and the percentage of nouns, verbs, and closed-class words in the vocabularies of 36 toddlers (12 LT, 12 AM, 12 VM)…

  2. Fast Mapping in Late-Talking Toddlers

    Science.gov (United States)

    Weismer, Susan Ellis; Venker, Courtney E.; Evans, Julia L.; Moyle, Maura Jones

    2013-01-01

    This study investigated fast mapping in late-talking (LT) toddlers and toddlers with normal language (NL) development matched on age, nonverbal cognition, and maternal education. The fast-mapping task included novel object labels and familiar words. The LT group scored significantly lower than the NL group on novel word comprehension and…

  3. Obsessive-Compulsive Disorder in Late Life

    Science.gov (United States)

    Calamari, John E.; Pontarelli, Noelle K.; Armstrong, Kerrie M.; Salstrom, Seoka A.

    2012-01-01

    Although obsessive-compulsive disorder (OCD) has received increasing attention, the study and treatment of OCD in late life has been neglected. The obsessions and compulsions seen with older adults do not appear to differ from the symptoms experienced by other age groups, although developmental issues might influence symptom focus (e.g., memory…

  4. Cannabinoids in late-onset Alzheimer's disease

    NARCIS (Netherlands)

    Ahmed, A.; Marck, M.A. van der; Elsen, G. van den; Olde Rikkert, M.G.M.

    2015-01-01

    Given the lack of effective treatments for late-onset Alzheimer's disease (LOAD) and the substantial burden on patients, families, health care systems, and economies, finding an effective therapy is one of the highest medical priorities. The past few years have seen a growing interest in the medicin

  5. Late Immersion Foundation Document: Teachers and Administrators

    Science.gov (United States)

    Alberta Education, 2010

    2010-01-01

    The aim of this document is to give teachers and administrators the contextual and pedagogical tools for the late immersion program. It acts as a guide for beginning and experienced teachers who need to update their knowledge regarding this program and its details. For many working in this area, it also confirms their daily practices as well as…

  6. Mobile ICT Acceptance in Late Adopter Countries

    DEFF Research Database (Denmark)

    Gimpel, Gregory; Sudzina, Frantisek; Petrovcikova, Katarina

    2014-01-01

    Despite the rapid global diffusion of the smartphone, some countries have experienced much slower uptake of the technology. The low smartphone penetration within Slovakia provides the opportunity to explore what drives smartphone use in late majority countries. Slovakia is a central European nati...

  7. Language Control Abilities of Late Bilinguals

    Science.gov (United States)

    Festman, Julia

    2012-01-01

    Although all bilinguals encounter cross-language interference (CLI), some bilinguals are more susceptible to interference than others. Here, we report on language performance of late bilinguals (Russian/German) on two bilingual tasks (interview, verbal fluency), their language use and switching habits. The only between-group difference was CLI:…

  8. Nephrogenic systemic fibrosis: late skin manifestations

    DEFF Research Database (Denmark)

    Bangsgaard, Nannie; Marckmann, Peter; Rossen, Kristian

    2009-01-01

    BACKGROUND: Nephrogenic systemic fibrosis (NSF) is a serious disease that occurs in patients with severe renal disease and is believed to be caused by gadolinium-containing contrast agents. A detailed description of the late skin manifestations of NSF is important to help dermatologists and nephr......BACKGROUND: Nephrogenic systemic fibrosis (NSF) is a serious disease that occurs in patients with severe renal disease and is believed to be caused by gadolinium-containing contrast agents. A detailed description of the late skin manifestations of NSF is important to help dermatologists...... confluent dermal plaques with thickening and hardening. In contrast, 3 patients presented with wrinkled, redundant skin as seen in cutis laxa. Patients with NSF had significantly poorer scores than control patients on the Daily Life Quality Index (mean [SD], 11. 4 [7.4] vs 1.5 [2. 3]; P ...: This descriptive case series of patients with NSF gives a detailed clinical picture of the skin manifestations late in the disease. It demonstrates that the clinical picture in the late stage has a varied presentation and that NSF has a significant effect on the quality of life....

  9. Late glacial aridity in southern Rocky Mountains

    Energy Technology Data Exchange (ETDEWEB)

    Davis, O.K.; Pitblado, B.L. [Univ. of Arizona, Tucson, AZ (United States)

    1995-09-01

    While the slopes of the present-day Colorado Rocky Mountains are characterized by large stands of subalpine and montane conifers, the Rockies of the late glacial looked dramatically different. Specifically, pollen records suggest that during the late glacial, Artemisia and Gramineae predominated throughout the mountains of Colorado. At some point between 11,000 and 10,000 B.P., however, both Artemisia and grasses underwent a dramatic decline, which can be identified in virtually every pollen diagram produced for Colorado mountain sites, including Como Lake (Sangre de Cristo Mountains), Copley Lake and Splains; Gulch (near Crested Butte), Molas Lake (San Juan Mountains), and Redrock Lake (Boulder County). Moreover, the same pattern seems to hold for pollen spectra derived for areas adjacent to Colorado, including at sites in the Chuska Mountains of New Mexico and in eastern Wyoming. The implications of this consistent finding are compelling. The closest modem analogues to the Artemisia- and Gramineae-dominated late-glacial Colorado Rockies are found in the relatively arid northern Great Basin, which suggests that annual precipitation was much lower in the late-glacial southern Rocky Mountains than it was throughout the Holocene.

  10. Hypothyroidism in late-onset Pompe disease

    Directory of Open Access Journals (Sweden)

    Joseph Schneider

    2016-09-01

    Conclusions: Hypothyroidism was found at a higher prevalence in patients with late-onset Pompe disease compared to the general adult population at UMMC. Studies in larger populations of patients with Pompe disease would be needed to confirm an association of Pompe disease and hypothyroidism. Challenges include finding an adequate sample size, due the rarity of Pompe disease.

  11. Obsessive-Compulsive Disorder in Late Life

    Science.gov (United States)

    Calamari, John E.; Pontarelli, Noelle K.; Armstrong, Kerrie M.; Salstrom, Seoka A.

    2012-01-01

    Although obsessive-compulsive disorder (OCD) has received increasing attention, the study and treatment of OCD in late life has been neglected. The obsessions and compulsions seen with older adults do not appear to differ from the symptoms experienced by other age groups, although developmental issues might influence symptom focus (e.g., memory…

  12. The late maintenance of hippocampal LTP: requirements, phases, 'synaptic tagging', 'late-associativity' and implications.

    Science.gov (United States)

    Reymann, Klaus G; Frey, Julietta U

    2007-01-01

    Our review focuses on the mechanisms which enable the late maintenance of hippocampal long-term potentiation (LTP; >3h), a phenomenon which is thought to underlie prolonged memory. About 20 years ago we showed for the first time that the maintenance of LTP - like memory storage--depends on intact protein synthesis and thus, consists of at least two temporal phases. Here we concentrate on mechanisms required for the induction of the transient early-LTP and of the protein synthesis-dependent late-LTP. Our group has shown that the induction of late-LTP requires the associative activation of heterosynaptic inputs, i.e. the synergistic activation of glutamatergic and modulatory, reinforcing inputs within specific, effective time windows. The induction of late-LTP is characterized by novel, late-associative properties such as 'synaptic tagging' and 'late-associative reinforcement'. Both phenomena require the associative setting of synaptic tags as well as the availability of plasticity-related proteins (PRPs) and they are restricted to functional dendritic compartments, in general. 'Synaptic tagging' guarantees input specificity and thus the specific processing of afferent signals for the establishment of late-LTP. 'Late-associative reinforcement' describes a process where early-LTP by the co-activation of modulatory inputs can be transformed into late-LTP in activated synapses where a tag is set. Recent evidence from behavioral experiments, which studied processes of emotional and cognitive reinforcement of LTP, point to the physiological relevance of the above mechanisms during cellular and system's memory formation.

  13. Reproductive rights: Current issues of late abortion

    Directory of Open Access Journals (Sweden)

    Mujović-Zornić Hajrija

    2009-01-01

    Full Text Available This article considers the legal issues surrounding induced late abortion in cases when severe medical, therapeutic or ethical reasons have not been in dispute. Generally discussing the essential question about abortion today, it means not anymore legality of abortion but, in the first place, safety of abortion. From the aspect of woman health the most important aim is to detect and avoid possible risks of medical intervention, such as late abortion present. This is the matter of medical law context and also the matter of the woman's reproductive rights, here observed through legislation and court practice. The gynecologist has an obligation to obtain the informed consent of each patient. Information's should be presented in reasonably understandable terms and include alternative modes of treatment, objectives, risks, benefits, possible complications, and anticipated results of such treatment. Pregnant woman should receive supportive counseling before and particularly after the procedure. The method chosen for all terminations should ensure that the fetus is born dead. This should be undertaken by an appropriately trained practitioner. Reform in abortion law, making it legally accessible to woman, is not necessarily the product of a belief in woman's rights, but can be a means of bringing the practice of abortion back under better control. Counseling and good medical practice in performing late abortion are the instruments to drive this point even further home. It does not undermine the woman who wants to make a positive decision about her life and its purpose is not to produce feelings of insecurity and guilt. It concludes that existing law should not be changed but that clear rules should be devised and board created to review late term abortion. In Serbia, this leads to creation and set up guidelines for reconciling medical justification for late abortion with existing law, especially with solutions which brings comparative law. .

  14. LATE RENAL GRAFT REJECTION: PATHOLOGY AND PROGNOSIS

    Directory of Open Access Journals (Sweden)

    E.S. Stolyarevich

    2014-01-01

    Full Text Available Rejection has always been one of the most important cause of late renal graft dysfunction. Aim of the study was to analyze the prevalence of different clinico-pathological variants of rejection that cause late graft dysfunction, and evaluate their impact on long-term outcome. Materials and methods. This is a retrospective study that analyzed 294 needle core biopsy specimens from 265 renal transplant recipients with late (48,8 ± 46,1 months after transplantation allograft dysfunction caused by late acute rejection (LAR, n = 193 or chronic rejection (CR, n = 78 or both (n = 23. C4d staining was performed by immunofl uorescence (IF on frozen sections using a standard protocol. Results. Peritubular capillary C4d deposition was identifi ed in 36% samples with acute rejection and in 62% cases of chronic rejection (including 67% cases of transplant glomerulopathy, and 50% – of isolated chronic vasculopathy. 5-year graft survival for LAR vs CR vs their combination was 47, 13 and 25%, respectively. The outcome of C4d– LAR was (p < 0,01 better than of C4d+ acute rejection: at 60 months graft survival for diffuse C4d+ vs C4d− was 33% vs 53%, respectively. In cases of chronic rejection C4d+ vs C4d– it was not statistically signifi cant (34% vs 36%. Conclusion. In long-term allograft biopsy C4d positivity is more haracteristic for chronic rejection than for acute rejection. Only diffuse C4d staining affects the outcome. C4d– positivity is associated with worse allograft survival in cases of late acute rejection, but not in cases of chronic rejection. 

  15. 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

  16. Early and late effects of coumarin therapy started before percutaneous coronary intervention: Clinical, angiographic and cost-effective outcome of the Balloon Angioplasty and Anticoagulation Study (BAAS).

    Science.gov (United States)

    Ten Berg, J M; Kelder, J C; Suttorp, M J; Mast, E G; Bal, E T; Ernst, J M P G; Plokker, H W M

    2002-05-01

    Coronary angioplasty frequently creates a thrombogenic surface with subsequent mural thrombosis that may lead to acute complications and possibly stimulates the development of restenosis. Whether coumarins can prevent these complications is unclear. In the Balloon Angioplasty and Anticoagulation Study (BAAS), the effect of coumarins started before the procedure on early and late outcome was studied. Patients were randomised to aspirin only or to aspirin plus coumarins. Half of the patients were randomised to undergo six-month angiographic follow-up. Study medication was started one week before coronary angioplasty and the target international normalised ratio (INR) was 2.1-4.8 during angioplasty and six-month follow-up. 'Optimal' anticoagulation was defined as an INR in the target range for at least 70% of the follow-up time. In addition, cost-effectiveness of coumarin treatment was measured. At one year death, myocardial infarction, target-lesion revascularisation and stroke were observed in 14.3% of the 530 patients randomised to aspirin plus coumarin versus in 20.3% of the 528 patients randomised to aspirin alone (relative risk 0.71; 95% CI 0.54-0.93). The incidence of major bleedings and false aneurysms during hospitalisation was 3.2% and 1.0%, respectively, (relative risk 3.39; 95% CI 1.26-9.11). Optimal anticoagulation was an independent predictor of late thrombotic events (relative risk, 0.33; 95% CI, 0.19-0.57). Quantitative coronary analysis was performed of 301 lesions in the ASA group and of 297 lesions in the coumarin group. At six months, the minimal luminal diameter was similar in the ASA and coumarin group. However, optimal anticoagulation was an independent predictor of angiographic outcome at six months. Optimal anticoagulation led to a 0.21 mm (95% CI: 0.05-0.37) larger MLD as compared with suboptimal anticoagulation whereas aspirin use led to a 0.12 mm (95% CI -0.28-0.04) smaller MLD. When including all costs, the savings associated with coumarin

  17. Dosimetry implant for treating restenosis and hyperplasia

    Science.gov (United States)

    Srivastava, Suresh; Gonzales, Gilbert R; Howell, Roger W; Bolch, Wesley E; Adzic, Radoslav

    2014-09-16

    The present invention discloses a method of selectively providing radiation dosimetry to a subject in need of such treatment. The radiation is applied by an implant comprising a body member and .sup.117mSn electroplated at selected locations of the body member, emitting conversion electrons absorbed immediately adjacent selected locations while not affecting surrounding tissue outside of the immediately adjacent area.

  18. Endovascular photodynamic therapy to prevent arterial restenosis

    NARCIS (Netherlands)

    E.E.E. Gabeler

    2003-01-01

    markdownabstract__Abstract__ Since their existence, man has appreciated the benefits of sunlight and described some of its medicinal effects known as heliotherapy. Herodotus in the 6th century BC noticed that sunlight had beneficial effects on bone growth. Hippocrates in 460-375 BC advocated the us

  19. 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.

  20. Dosimetry implant for treating restenosis and hyperplasia

    Energy Technology Data Exchange (ETDEWEB)

    Srivastava, Suresh; Gonzales, Gilbert R; Howell, Roger W; Bolch, Wesley E; Adzic, Radoslav

    2014-09-16

    The present invention discloses a method of selectively providing radiation dosimetry to a subject in need of such treatment. The radiation is applied by an implant comprising a body member and .sup.117mSn electroplated at selected locations of the body member, emitting conversion electrons absorbed immediately adjacent selected locations while not affecting surrounding tissue outside of the immediately adjacent area.

  1. Youth Indicators of Late-M Dwarfs

    Science.gov (United States)

    Feldman, Daniel; Cruz, K.; Lépine, S.; Alpert, N.

    2011-01-01

    We present a study in which we searched for a correlation between weak Na absorption doublet (8183Å, 8194Å) and strong H-Alpha emission (6563Å) in late-M dwarf stars (M6-M9), as both are indicative of youth. Our sample consists of late-M Dwarfs from the LSPM Survey (Lépine and Shara, 2005), which contain stars with measured proper motions of mu > 40 mas/yr. Measurements for emission and absorption strength were made using spectral indices. Our preliminary results are presented; future work will include a similar analysis of early type M Dwarfs, as well as kinematics. This work was funded by the CUNY Summer Undergraduate Research Program, as well as the CUNY Macaulay Honors College, and we acknowledge the hospitality of the American Museum of Natural History.

  2. An emerging antiarrhythmic target: late sodium current.

    Science.gov (United States)

    Banyasz, T; Szentandrássy, N; Magyar, J; Szabo, Z; Nánási, P P; Chen-Izu, Y; Izu, L T

    2015-01-01

    The cardiac late sodium current (INa,L) has been in the focus of research in the recent decade. The first reports on the sustained component of voltage activated sodium current date back to the seventies, but early studies interpreted this tiny current as a product of a few channels that fail to inactivate, having neither physiologic nor pathologic implications. Recently, the cardiac INa,L has emerged as a potentially major arrhythmogenic mechanism in various heart diseases, attracting the attention of clinicians and researchers. Research activity on INa,L has exponentially increased since Ranolazine, an FDA-approved antianginal drug was shown to successfully suppress cardiac arrhythmias by inhibiting INa,L. This review aims to summarize and discuss a series of papers focusing on the cardiac late sodium current and its regulation under physiological and pathological conditions. We will discuss critical evidences implicating INa,L as a potential target for treating myocardial dysfunction and cardiac arrhythmias.

  3. Ribbed vaults of late Gothic in Sardinia

    Directory of Open Access Journals (Sweden)

    Paola Casu

    2012-06-01

    Full Text Available The late Gothic construction practice, settled in the Spanish Mediterranean area, is based on predetermined geometric rules and is shown in religious buildings with ribbed vaults. The proportion between the sides of the area to cover, tracing plan of the ribs as a succession of corner bisectors, stereotomy problems and volumetric aspects, are just some of the elements that can describe the complex construction of a ribbed vault. The aim of this paper is to analyze the dimensional information of the late gothic ribbed vaults of Sardinia, in order to define the geometric and proportional rules for a correct drawing, establishing a standard procedure for the collection of measures and the construction of the 3D model of vaults.

  4. Educating Citizens in Late Modern Societies

    DEFF Research Database (Denmark)

    Christensen, Torben Spanget

    2011-01-01

    . The model is based on the fundamental belief that the overall aim of civic education in democratic, late modern and global societies is empowerment of the citizen in order to establish a self governing citizen who simultaneous is capable of managing and keeping together partly contradictory citizens tasks....... One is being a loyal subject in state and society affairs, a second is being an informed voter in state elections, a third is being a critical participant in state and society affairs and a forth is being an independent, innovative citizen outside state. The model is inspired by rather comprehensive......One way or the other democratic states need to take on the task of educating its rising generation in governmental affairs, societal matters and citizenship in order to sustain the democracy itself. This article presents a model for analysing civic education in late modern, globalised world...

  5. Early- versus Late-Onset Systemic Sclerosis

    Science.gov (United States)

    Alba, Marco A.; Velasco, César; Simeón, Carmen Pilar; Fonollosa, Vicent; Trapiella, Luis; Egurbide, María Victoria; Sáez, Luis; Castillo, María Jesús; Callejas, José Luis; Camps, María Teresa; Tolosa, Carles; Ríos, Juan José; Freire, Mayka; Vargas, José Antonio; Espinosa, Gerard

    2014-01-01

    Abstract Peak age at onset of systemic sclerosis (SSc) is between 20 and 50 years, although SSc is also described in both young and elderly patients. We conducted the present study to determine if age at disease onset modulates the clinical characteristics and outcome of SSc patients. The Spanish Scleroderma Study Group recruited 1037 patients with a mean follow-up of 5.2 ± 6.8 years. Based on the mean ± 1 standard deviation (SD) of age at disease onset (45 ± 15 yr) of the whole series, patients were classified into 3 groups: age ≤30 years (early onset), age between 31 and 59 years (standard onset), and age ≥60 years (late onset). We compared initial and cumulative manifestations, immunologic features, and death rates. The early-onset group included 195 patients; standard-onset group, 651; and late-onset, 191 patients. The early-onset group had a higher prevalence of esophageal involvement (72% in early-onset compared with 67% in standard-onset and 56% in late-onset; p = 0.004), and myositis (11%, 7.2%, and 2.9%, respectively; p = 0.009), but a lower prevalence of centromere antibodies (33%, 46%, and 47%, respectively; p = 0.007). In contrast, late-onset SSc was characterized by a lower prevalence of digital ulcers (54%, 41%, and 34%, respectively; p < 0.001) but higher rates of heart conduction system abnormalities (9%, 13%, and 21%, respectively; p = 0.004). Pulmonary hypertension was found in 25% of elderly patients and in 12% of the youngest patients (p = 0.010). After correction for the population effects of age and sex, standardized mortality ratio was shown to be higher in younger patients. The results of the present study confirm that age at disease onset is associated with differences in clinical presentation and outcome in SSc patients. PMID:24646463

  6. Reengineering Engineering: A Glimpse of Late Professionalism

    OpenAIRE

    Callaham, Arthur A.

    1999-01-01

    The role of the engineer in the late capitalist society of the last half century has been misunderstood at best. The lack of a consistent job description for engineers in various fields, a lack of job security, and a lack of respect from both industry and society have spawned severe angst in the engineering community. A classic remedy for this situation has been the rallying of engineering practitioners under a banner of increased professionalism. If engineers could make themselves more li...

  7. [Late primary abdominal pregnancy. Case report].

    Science.gov (United States)

    Farías, Emigdio Torres; Gómez, Luis Guillermo Torres; Allegre, René Márquez; Higareda, Salvador Hernández

    2008-09-01

    Abdominal advanced pregnancy is an obstetric complication that put at risk maternal and fetal life. We report a case of advanced abdominal pregnancy with intact ovaries and fallopian tubes, without ureteroperitoneal fistulae and, late prenatal diagnosis, in a multiparous patient without risk factors, with alive newborn, and whose pregnancy was attended at Unidad Medica de Alta Especialidad, Hospital de Gineco-Obstetricia, Centro Medico Nacional de Occidente del IMSS, Guadalajara, Jalisco, México.

  8. Late-time cosmological phase transitions

    Energy Technology Data Exchange (ETDEWEB)

    Schramm, D.N. (Chicago Univ., IL (USA) Fermi National Accelerator Lab., Batavia, IL (USA))

    1990-11-01

    It is shown that the potential galaxy formation and large-scale structure problems of objects existing at high redshifts (Z {approx gt} 5), structures existing on scales of 100M pc as well as velocity flows on such scales, and minimal microwave anisotropies ({Delta}T/T) {approx lt} 10{sup {minus}5} can be solved if the seeds needed to generate structure form in a vacuum phase transition after decoupling. It is argued that the basic physics of such a phase transition is no more exotic than that utilized in the more traditional GUT scale phase transitions, and that, just as in the GUT case, significant random gaussian fluctuations and/or topological defects can form. Scale lengths of {approximately}100M pc for large-scale structure as well as {approximately}1 M pc for galaxy formation occur naturally. Possible support for new physics that might be associated with such a late-time transition comes from the preliminary results of the SAGE solar neutrino experiment, implying neutrino flavor mixing with values similar to those required for a late-time transition. It is also noted that a see-saw model for the neutrino masses might also imply a tau neutrino mass that is an ideal hot dark matter candidate. However, in general either hot or cold dark matter can be consistent with a late-time transition. 47 refs., 2 figs.

  9. Pyomyositis of Obturator Muscles: Unusual Late Presentation

    Directory of Open Access Journals (Sweden)

    Prasad Channappa Soraganvi

    2013-04-01

    Full Text Available Introduction: Pyomyositis of obturator muscles is rare condition. Late presentation with deformities of hip misleads the clinician. Late presentation (6 weeks of this condition has not been reported earlier. This report highlights this unusual presentation of Pyomyositis of the obturator muscles. Case Report: We are reporting a 14year old female patient presented with limp and pain in hip since 6 weeks. Her hip radiographs were unremarkable. Patient was admitted and MRI done. MRI findings were consistent with obturator pyomyositis. Diagnosis of pyomyositis confirmed by MRI and we performed percutaneous aspiration and drained about 25ml of purulent material mixed with blood. The culture grew Staphylococcus aureus. Patient received intravenous antibiotic for 1week and oral antibiotic for 2weeks. Patient was immobilized in fixed skin traction in Thomas splint for 5days, later gentle mobilization was started. Her condition improved dramatically after aspiration. A follow up MRI done at 3 weeks following aspiration revealed a significant reduction in intramuscular collection of obturator internus and obturator externus. Three weeks following aspiration patient was relieved of the pain and was able to walk normally. At 6 months follow up visit patient was asymptomatic. Conclusion: Late presentation of obturator pyomyositis is rare. We emphasise on careful examination and need for early imaging for diagnosis. Percutaneous drainage results in successful treatment. Keywords: Pyomyositis, septic arthritis, infection, obturator muscle.

  10. VERY LATE PHOTOMETRY OF SN 2011fe

    Energy Technology Data Exchange (ETDEWEB)

    Kerzendorf, W. E. [Department of Astronomy and Astrophysics, University of Toronto, 50 Saint George Street, Toronto, ON M5S 3H4 (Canada); Taubenberger, S.; Seitenzahl, I. R.; Ruiter, A. J., E-mail: wkerzendorf@gmail.com [Max-Planck-Institut für Astrophysik, Karl-Schwarzschild-Straße 1, D-85748 Garching (Germany)

    2014-12-01

    The Type Ia supernova SN 2011fe is one of the closest supernovae of the past decades. Due to its proximity and low dust extinction, this object provides a very rare opportunity to study the extremely late time evolution (>900 days) of thermonuclear supernovae. In this Letter, we present our photometric data of SN 2011fe taken at an unprecedented late epoch of ≈930 days with GMOS-N mounted on the Gemini North telescope (g = 23.43 ± 0.28, r = 24.14 ± 0.14, i = 23.91 ± 0.18, and z = 23.90 ± 0.17) to study the energy production and retention in the ejecta of SN 2011fe. Together with previous measurements by other groups, our result suggests that the optical supernova light curve can still be explained by the full thermalization of the decay positrons of {sup 56}Co. This is in spite of theoretical predicted effects (e.g., infrared catastrophe, positron escape, and dust) that advocate a substantial energy redistribution and/or loss via various processes that result in a more rapid dimming at these very late epochs.

  11. Very late photometry of SN 2011fe

    CERN Document Server

    Kerzendorf, W E; Seitenzahl, I R; Ruiter, A J

    2014-01-01

    The Type Ia supernova SN 2011fe is one of the closest supernovae of the past decades. Due to its proximity and low dust extinction, this object provides a very rare opportunity to study the extremely late time evolution (> 900 d) of thermonuclear supernovae. These late stages allow for a direct measurement of the decay processes of nuclei synthesized in the core of the explosion. In this paper, we present our photometric data of SN 2011fe taken at an unprecedentedly late epoch of ~ 930 d with GMOS-N mounted on the Gemini North telescope (g=23.37+/- 0.25, r=24.03 +/- 0.09, i=23.90 +/- 0.15, and z=23.74 +/- 0.16) to study the energy production and retention in the ejecta of SN 2011fe. Together with previous measurements by other groups, our result suggests that the optical supernova light curve can still be explained by the full thermalization of the decay positrons of 56Co. This is in spite of several theoretical predictions that advocate a substantial energy redistribution and/or loss via various processes wh...

  12. 椎动脉起始部粥样硬化性狭窄患者血管内支架置入术后再狭窄的危险因素研究%Risk Factors of Restenosis in Postoperative Patients with Atherosclerotic Vertebral Artery Origin Stenosis Treated by Endovascular Stent Implantation

    Institute of Scientific and Technical Information of China (English)

    张广玉

    2016-01-01

    目的:探讨椎动脉起始部粥样硬化性狭窄患者血管内支架置入术后再狭窄的危险因素。方法选择沧州市人民医院2013年1月—2015年6月收治的椎动脉起始部粥样硬化性狭窄患者64例,均行血管内支架置入术并随访6个月,记录其性别、年龄、合并症、吸烟史、病变部位、术前椎动脉直径、支架类型、支架直径、支架长度及术后狭窄长度,分析血管内支架置入术后再狭窄的危险因素。结果所有患者顺利完成血管内支架置入术,随访期间18例出现再狭窄(再狭窄组),46例未出现再狭窄(无再狭窄组),再狭窄发生率为28.1%。两组患者性别、年龄、高血压发生率、糖尿病发生率、高胆固醇血症发生率、病变部位、支架直径、支架长度及术后狭窄长度比较,差异无统计学意义(P ﹥0.05);再狭窄组患者吸烟史阳性率高于无再狭窄组,术前椎动脉直径短于无再狭窄组,采用药物支架者所占比例低于无再狭窄组(P ﹤0.05)。多因素 logistic 回归分析结果显示,有吸烟史〔β=0.098,OR =2.648,95%CI(1.159,4.674),P =0.001〕、术前椎动脉直径〔β=0.956,OR =2.614,95% CI(1.134,6.022),P =0.007〕为椎动脉起始部粥样硬化性狭窄患者血管内支架置入术后再狭窄的危险因素,药物支架〔β=-0.612,OR =1.837,95% CI(1.086,4.597),P =0.029〕为保护因素。结论椎动脉起始部粥样硬化性狭窄患者血管内支架置入术后再狭窄发生率较高,有吸烟史、术前椎动脉直径为血管内支架置入术后再狭窄的危险因素,药物支架为保护因素。%Objective To investigate the risk factors of restenosis in postoperative patients with atherosclerotic vertebral artery origin stenosis treated by endovascular stent implantation. Methods A total of 64 patients with atherosclerotic vertebral artery origin stenosis were selected in

  13. Comparing Measures of Late HIV Diagnosis in Washington State

    Directory of Open Access Journals (Sweden)

    Laura Saganic

    2012-01-01

    Full Text Available As more US HIV surveillance programs routinely use late HIV diagnosis to monitor and characterize HIV testing patterns, there is an increasing need to standardize how late HIV diagnosis is measured. In this study, we compared two measures of late HIV diagnosis, one based on time between HIV and AIDS, the other based on initial CD4+ results. Using data from Washington's HIV/AIDS Reporting System, we used multivariate logistic regression to identify predictors of late HIV diagnosis. We also conducted tests for trend to determine whether the proportion of cases diagnosed late has changed over time. Both measures lead us to similar conclusions about late HIV diagnosis, suggesting that being male, older, foreign-born, or heterosexual increase the likelihood of late HIV diagnosis. Our findings reaffirm the validity of a time-based definition of late HIV diagnosis, while at the same time demonstrating the potential value of a lab-based measure.

  14. Comparing Measures of Late HIV Diagnosis in Washington State

    OpenAIRE

    Laura Saganic; Jason Carr; Rosa Solorio; Maria Courogen; Tom Jaenicke; Ann Duerr

    2011-01-01

    As more US HIV surveillance programs routinely use late HIV diagnosis to monitor and characterize HIV testing patterns, there is an increasing need to standardize how late HIV diagnosis is measured. In this study, we compared two measures of late HIV diagnosis, one based on time between HIV and AIDS, the other based on initial CD4+ results. Using data from Washington's HIV/AIDS Reporting System, we used multivariate logistic regression to identify predictors of late HIV diagnosis. We also con...

  15. Intracranial hemorrhages and late hemorrhagic disease associated cholestatic liver disease

    OpenAIRE

    2012-01-01

    Deficiency of vitamin K predisposes to early, classic or late hemorrhagic disease of the newborn (HDN); of which late HDN may be associated with serious and life-threatening intracranial hemorrhage. Late HDN is characterized intracranial bleeding in infants aged 1 week to 6 months due to severe vitamin K deficiency. Late HDN is still an important cause of mortality and morbidity in developing countries where vitamin K prophylaxis is not routinely practiced. Children with cholestatic liver dis...

  16. 依达拉奉防治大鼠颈动脉球囊成形术后血管再狭窄%Experimental study on edaravone in prevention of restenosis in rat common carotid balloon angioplasty

    Institute of Scientific and Technical Information of China (English)

    周海武; 徐平

    2008-01-01

    Objective To investigate edaravane in prevention of restenosis in rat common catery arteries balloon angioplasty and the possible mechanism of this process. Methods Forty male SD rats were randomly divided into 2 groups: treatment group (whose intima was injured by balloon and was given edaravone 3 mg/kg by peritoneal injection, bid) and control group (whose intima was injured by ballon and was given the same volume NS as edaravone). 1, 3, 7, 14 and 28 days after angioplasty, rats were killed and the local arteries were sectioned for analysis of pathological morphology and the expression of matrix metalloproteinase-2 (MMP-2) analyzed by immunohistochemistry. Results Small amounts of smooth muscle cell appeared at the intima of blood vessel 3 days after the artery injured by balloon. Consecutive intima was formed 7 days after artery injury. The intima was even or uneven thickened and the lumen of artery was significant stenosed 14 and 28 days afterwards. In the control group, the intimal area reached (0.240±0.043) mm2, the intima hyperplasy index were 0.52±0.06, stenosis ratio were 30%±9% 14 days afterwards. The intimal area were (0.420±0.063 )mm2, the intima hyperplasy index were 0.67± 0.07, stenosis ratio were 54%±9% on day 28. In the treatment group, the intimal area were (0.063± 0.025)mm2, the intima hyperplasy index were 0.24±0.07, stenosis ratio were 8%±3% after 14 days. The intimal area were (0.116±0.023) mm2, the intima hyperplasy index were 0.38±0.05, stenosis ratio were 16%±4% after 28 days. Compared with control group at the same time, the intimal area (F values were 50.488 and 81.119 respectively, P < 0.05 ), the intima hyperplasy index ( F values were 41.743 and 48.122 respectively, P<0.05) and stenosis ratio (F values were 24.221 and 81.119 respectively, P< 0.05) were decreased in treatment group. The expressions of MMP-2 raised after balloon injury. In control group, the expressions of MMP-2 were 27.16%±7.15% after 3 days, 22.59%±6

  17. 7 CFR 981.481 - Interest and late payment charges.

    Science.gov (United States)

    2010-01-01

    ..., within 60 days of the invoice date. The late payment charge shall be 10 percent of the unpaid balance. ... 7 Agriculture 8 2010-01-01 2010-01-01 false Interest and late payment charges. 981.481 Section 981... GROWN IN CALIFORNIA Administrative Rules and Regulations § 981.481 Interest and late payment charges. (a...

  18. Late-presenting congenital diaphragmatic hernia

    Directory of Open Access Journals (Sweden)

    Raashid Hamid

    2014-01-01

    Full Text Available Background: This study was undertaken to highlight the clinical profile, misdiagnosis, surgical treatment,and prognosis of late-presenting congenital diaphragmatic hernia (CDH cases in a tertiary level hospital. Patients and Methods: This retrospective study included all the babies and children >1 month of age with CDH who were admitted in our Hospital (Sher-i-Kashmir Institute of Medical Sciences, Srinagar, Kashmir, India during the period between January 2008 and December 2013. Babies with age <1 month were excluded from the study. Data regarding clinical profile, operative records, and follow-up was reviewed and analysed statistically. Results: A total of 20 patients were included in this study. The clinical picture ranged from respiratory distress (13 patients to non-specific gastrointestinal complaints (5 patients. In two patients, CDH was misdiagnosed as pneumothorax and had got chest tube inserted in other hospitals before referral to this tertiary care centre. In 14 patients chest, X-ray revealed the diagnosis of CDH and in remaining five patients (including the two patients with misdiagnosis further investigations were undertaken to establish the diagnosis. Age ranged from 45 days to 17 years with an average age of 58.9 months. There were 12 male and 8 female patients. In all the 20 patients, surgical procedures were undertaken with the retrieval of herniated contents from the thoracic cavity and repair of the diaphragmatic defect. There was no mortality in our series. All the 20 patients were followed-up for a period ranging from 6 months to 5 years (median 3.1 years. Conclusions: Late-presenting CDH can have diverse clinical presentation. Late diagnosis and misdiagnosis can result in significant morbidity and potential mortality if these cases are not managed properly at an appropriate stage. Outcome is favourable if these patients are expeditiously identified and surgically repaired.

  19. Technical bases DWPF Late Washing Facility

    Energy Technology Data Exchange (ETDEWEB)

    Fish, D.L.; Landon, L.F.

    1992-08-10

    A task force recommended that the technical feasibility of a Late Wash' facility be assessed [1]. In this facility, each batch of tetraphenylborate slurry from Tank 49 would be given a final wash to reduce the concentrations of nitrite and radiolysis products to acceptable levels. Laboratory-scale studies have demonstrated that d the nitrite content of the slurry fed to DWPF is reduced to 0.01 M or less (and at least a 4X reduction in concentration of the soluble species is attained), (1) the need for HAN during hydrolysis is eliminated (eliminating the production of ammonium ion during hydrolysis), (2) hydrolysis may be done with a catalyst concentration that will not exceed the copper solubility in glass and (3) the non-polar organic production during hydrolysis is significantly reduced. The first phase of an aggressive research and development program has been completed and all test results obtained to date support the technical feasibility of Late Washing. Paralleling this research and development effort is an aggressive design study directed by DWPF to scope and cost retrofitting the Auxiliary Pump Pit (APP) to enable performing a final wash of each batch of precipitate slurry before R is transferred into the DWPF Soft Processing Cell (SPC). An initial technical bases for the Late Wash Facility was transmitted to DWPF on June 15, 1992. Research and development activities are continuing directed principally at optimization of the cross-f low fitter decontamination methodology and pilot-scale validation of the recommended benzene stripping metodology.

  20. Assessing Fatigue in Late-Midlife

    DEFF Research Database (Denmark)

    Fieo, Robert A; Mortensen, Erik Lykke; Lund, Rikke

    2014-01-01

    late-midlife subjects. Five subdimensions of perceived fatigue were examined in n = 7,233 subjects: general fatigue, physical fatigue, reduced activity, reduced motivation, and mental fatigue. Fatigue burden was compared across age groups (aged 48-52 vs. 57-63) and gender. Mokken item response theory...... was used to investigate dimensionality, monotonicity, and invariant item ordering (IIO). In both age groups, as well as by gender, the Motivation domain presented with weak scalability, suggesting that caution be exercised when interpreting sum scores. For all groupings, the strongest scaling properties...

  1. Late-stage sinking of plutons

    Science.gov (United States)

    Glazner, A.F.; Miller, D.M.

    1997-01-01

    Many granodiorite to diorite plutons in the Great Basin of western North America are surrounded by rim monoclines or anticlines that suggest relative downward movement of the plutons while wall rocks were hot and ductile. We propose that such plutons rise to a level of approximately neutral buoyancy and then founder as their densities increase ??? 40% during crystallization. Late-stage sinking of intermediate to mafic plutons should be common when wall rocks are rich in weak, low-density minerals such as quartz and calcite. Structures related to sinking will overprint those related to initial pluton emplacement and may be mistaken for regional tectonic structures.

  2. Public Schools in Australia from the Late 1970s to the Late 1980s: The Seeds of Change

    Science.gov (United States)

    Barcan, Alan

    2010-01-01

    The period from the late 1970s to the late 1980s were transition years for most public(government) school systems in Australia. A reaction was developing against the neo-progressive and radical (neo-Marxist) innovations of the late 1960s and 1970s such as school-based curricula, activity methods, and "open education". By the early 1980s the…

  3. Angiographic and clinical comparisons of intravascular ultrasound- versus angiography-guided drug-eluting stent implantation for patients with chronic total occlusion lesions: two-year results from a randomised AIR-CTO study.

    Science.gov (United States)

    Tian, Nai-Liang; Gami, Sandeep-Kumar; Ye, Fei; Zhang, Jun-Jie; Liu, Zhi-Zhong; Lin, Song; Ge, Zhen; Shan, Shou-Jie; You, Wei; Chen, Liang; Zhang, Yao-Jun; Mintz, Gary; Chen, Shao-Liang

    2015-04-01

    This study sought to compare angiographic endpoints at one-year follow-up after a drug-eluting stent implantation guided by either intravascular ultrasound (IVUS) or angiography in patients with chronic total occlusion (CTO) lesions. Patients with at least one CTO lesion recanalised successfully were randomly assigned to the IVUS-guided or the angiography-guided group. The use of IVUS for penetration of the true lumen and optimisation of stent expansion was only done in the IVUS-guided group. The primary endpoint was in-stent late lumen loss (LLL) at one-year follow-up. A total of 230 patients with CTO lesions after successful recanalisation were enrolled and followed with office visits or telephone contact up to 24 months. In-stent LLL in the IVUS-guided group was significantly lower compared to the angiography-guided group at one-year follow-up (0.28±0.48 mm vs. 0.46±0.68 mm, p=0.025), with a significant difference in restenosis of the "in-true-lumen" stent between the two groups (3.9% vs.13.7%, p=0.021). The minimal lumen diameter and minimal stent cross-section area significantly and negatively correlated with LLL (all pCTO lesion was associated with less LLL and a lower incidence of "in-true-lumen" stent restenosis. Additional study is required to identify the clinical benefit of the IVUS-guided procedure for CTO lesions. [ChiCTR-TRC-10000996].

  4. First-in-man use of polymer-free valsartan-eluting stents in small coronary vessels: a comparison to polymer-free rapamycin (2%)-eluting stents.

    Science.gov (United States)

    Peters, Stefan; Behnisch, Boris; Heilmann, Torsten; Richter, Christian

    2009-06-01

    Orally administered angiotensin receptor antagonists administered after bare-metal stent implantation and even after drug-eluting stent implantation seem to lower in-stent restenosis rates.Whether valsartan-eluting stents are similarly effective was tested here in a first-in-man trial. The efficacy of a polymer-free drug-eluting stent coated with 300 mcg valsartan was compared to a coating with a 2% rapamycin solution in small (Translumina GmbH, Hechingen, Germany). Fifteen patients (eight males, mean age 64.4+/-7.7 years) were treated with YUKON Choice valsartan-eluting stents and 30 patients (24 males, mean age 65.7+/-8.4 years) received YUKON Choice rapamycin-eluting stents. Clopidogrel was given for six months in all patients. Within the first 30 days, no adverse events occurred in either group. Binary in-stent restenosis rate was 30.8% (four in 13 angiographic controls) in the valsartan-eluting stent group and 35.0% (eight in 20 angiographic controls) in the rapamycin-eluting YUKON Choice stent group. Mean late lumen loss was 0.78+/-0.53 mm and 0.79+/-0.58 mm, respectively. Target lesion and target vessel revascularisation rate was 26.6% and 25.0%, respectively. No restenoses in rapamycin-eluting YUKON Choice stents appeared in 12 patients with adjunct oral valsartan administration. If polymer-free YUKON Choice stents are used in small vessels, valsartan-eluting stents show an identical efficacy as rapamycin-loaded stents. In patients with rapamycin-eluting YUKON Choice stents it seems that the efficacy can be increased by oral valsartan administration.

  5. Enhanced in Vitro and in Vivo Performance of Mg-Zn-Y-Nd Alloy Achieved with APTES Pretreatment for Drug-Eluting Vascular Stent Application.

    Science.gov (United States)

    Liu, Jing; Zheng, Bo; Wang, Pei; Wang, Xingang; Zhang, Bin; Shi, Qiuping; Xi, Tingfei; Chen, Ming; Guan, Shaokang

    2016-07-20

    Bioabsorbable magnesium alloys are becoming prominent as temporary functional implants, as they avoid the risks generated by permanent metallic implants such as persistent inflammation and late restenosis. Nevertheless, the overfast corrosion of Mg alloys under physiological conditions hinders their wider application as medical implant materials. Here we investigate a simple one-step process to introduce a cross-linked 3-amino-propyltrimethoxysilane (APTES) silane physical barrier layer on the surface of Mg-Zn-Y-Nd alloys prior to electrostatic spraying with rapamycin-eluting poly(lactic-co-glycolic acid) (PLGA) layer. Surface microstructure was characterized by scanning electron microscope and Fourier transform infrared spectroscopy. Nanoscratch test verified the superior adhesion strength of PLGA coating in the group pretreated with APTES. Electrochemical tests combined with long-term immersion results suggested that the preferable in vitro anticorrosion behavior could be achieved by dense APTES barrier. Cell morphology and proliferation data demonstrated that APTES pretreated group resulted in remarkably preferable compatibility for both human umbilical vein endothelial cells and vascular smooth muscle cells. On the basis of excellent in vitro m