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Simard T, Jung R, Di Santo P, Sarathy K, Majeed K, Motazedian P, Short S, Dhaliwal S, Labinaz A, Sarma D, Ramirez FD, Froeschl M, Labinaz M, Holmes DR, Alkhouli M, Hibbert B. Evaluation of a Rabbit Model of Vascular Stent Healing: Application of Optical Coherence Tomography. J Cardiovasc Transl Res 2023; 16:1194-1204. [PMID: 37227686 DOI: 10.1007/s12265-023-10399-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 05/10/2023] [Indexed: 05/26/2023]
Abstract
Percutaneous coronary intervention (PCI) is a management strategy for symptomatic obstructive coronary artery disease (CAD). Despite advancements, in-stent restenosis (ISR) still imparts a 1-2% annual rate of repeat revascularization-a focus of ongoing translational research. Optical coherence tomography (OCT) provides high resolution virtual histology of stents. Our study evaluates the use of OCT for virtual histological assessment of stent healing in a rabbit aorta model, enabling complete assessment of intraluminal healing throughout the stent. ISR varies based on intra-stent location, stent length, and stent type in a rabbit model-important considerations for translational experimental design. Atherosclerosis leads to more prominent ISR proliferation independent of stent-related factors. The rabbit stent model mirrors clinical observations, while OCT-based virtual histology demonstrates utility for pre-clinical stent assessment. Pre-clinical models should incorporate clinical and stent factors as feasible to maximize translation to clinical practice.
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Affiliation(s)
- Trevor Simard
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
- Division of Cardiology, University of Ottawa Heart Institute, 40 Ruskin Street, Room H4238, Ottawa, ON, Canada
- Department of Cellular and Molecular Medicine, University of Ottawa, Ottawa, Canada
| | - Richard Jung
- Division of Cardiology, University of Ottawa Heart Institute, 40 Ruskin Street, Room H4238, Ottawa, ON, Canada
- Department of Cellular and Molecular Medicine, University of Ottawa, Ottawa, Canada
| | - Pietro Di Santo
- Division of Cardiology, University of Ottawa Heart Institute, 40 Ruskin Street, Room H4238, Ottawa, ON, Canada
| | - Kiran Sarathy
- Division of Cardiology, University of Ottawa Heart Institute, 40 Ruskin Street, Room H4238, Ottawa, ON, Canada
- Department of Cardiology, Prince of Wales Hospital, Sydney, Australia
| | - Kamran Majeed
- Division of Cardiology, University of Ottawa Heart Institute, 40 Ruskin Street, Room H4238, Ottawa, ON, Canada
- Department of Cardiology, Royal Perth Hospital, Perth, WA, Australia
| | - Pouya Motazedian
- Division of Cardiology, University of Ottawa Heart Institute, 40 Ruskin Street, Room H4238, Ottawa, ON, Canada
| | - Spencer Short
- Division of Cardiology, University of Ottawa Heart Institute, 40 Ruskin Street, Room H4238, Ottawa, ON, Canada
| | - Shan Dhaliwal
- Division of Cardiology, University of Ottawa Heart Institute, 40 Ruskin Street, Room H4238, Ottawa, ON, Canada
| | - Alisha Labinaz
- Division of Cardiology, University of Ottawa Heart Institute, 40 Ruskin Street, Room H4238, Ottawa, ON, Canada
| | - Dhruv Sarma
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | - F Daniel Ramirez
- Division of Cardiology, University of Ottawa Heart Institute, 40 Ruskin Street, Room H4238, Ottawa, ON, Canada
| | - Michael Froeschl
- Division of Cardiology, University of Ottawa Heart Institute, 40 Ruskin Street, Room H4238, Ottawa, ON, Canada
| | - Marino Labinaz
- Division of Cardiology, University of Ottawa Heart Institute, 40 Ruskin Street, Room H4238, Ottawa, ON, Canada
| | - David R Holmes
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | - Mohamad Alkhouli
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | - Benjamin Hibbert
- Division of Cardiology, University of Ottawa Heart Institute, 40 Ruskin Street, Room H4238, Ottawa, ON, Canada.
- Department of Cellular and Molecular Medicine, University of Ottawa, Ottawa, Canada.
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Sobolev B, Kuramoto L. Time of coronary revascularization: methodology of a mediation analysis study. CMAJ Open 2022; 10:E1052-E1058. [PMID: 36735232 PMCID: PMC9828946 DOI: 10.9778/cmajo.20210183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND The advantage of coronary artery bypass grafting (CABG) over percutaneous coronary intervention (PCI), established in trials, may not be generalizable to populations in which the method of treatment determines the time to treatment. We sought to describe the methodology of a population-based observational study for assessing how changes in time to treatment may affect the comparative effectiveness of these 2 methods of coronary revascularization. METHODS We propose a framework of causal mediation analysis to compare the outcomes of choosing CABG over PCI, if patients selected for either method waited the same amount of time had they undergone a PCI. We will include patients who underwent a first-time, nonurgent isolated CABG or single-session PCI for multivessel or left main coronary artery disease from January 2001 to December 2016, in British Columbia. We will use absolute risk difference as a measure of the total effect of choosing CABG over PCI and partition it into the direct effect of the treatment choice and the effect mediated by the treatment-specific timing. INTERPRETATION Understanding how time to treatment mediates the relation between method of revascularization and outcomes will have implications for treatment selection, resource allocation and planning benchmarks. Findings on the benefits and risks of performing PCI or CABG within a certain time will guide multidisciplinary teams in determining the appropriate revascularization method for individual patients.
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Affiliation(s)
- Boris Sobolev
- School of Population and Public Health (Sobolev), University of British Columbia; Centre for Clinical Epidemiology and Evaluation (Kuramoto), Vancouver Coastal Health Research Institute, Vancouver, BC
| | - Lisa Kuramoto
- School of Population and Public Health (Sobolev), University of British Columbia; Centre for Clinical Epidemiology and Evaluation (Kuramoto), Vancouver Coastal Health Research Institute, Vancouver, BC
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The Importance of Antibacterial Surfaces in Biomedical Applications. ADVANCES IN BIOMEMBRANES AND LIPID SELF-ASSEMBLY 2018. [DOI: 10.1016/bs.abl.2018.05.001] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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Zhang Y, Wang Q, Yang D, Li D, Tang B, Yang Y, Ma S. Expression of mammalian target of rapamycin in atherosclerotic plaques is decreased under diabetic conditions: a mechanism for rapamycin resistance. Mol Med Rep 2014; 9:2388-92. [PMID: 24737099 DOI: 10.3892/mmr.2014.2141] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2013] [Accepted: 03/13/2014] [Indexed: 11/06/2022] Open
Abstract
Our previous study demonstrated that diabetes increases in-stent restenosis following rapamycin-eluting stent placement, which was defined as rapamycin resistance. However, the underlying mechanisms of rapamycin resistance remain to be determined. In the present study, male apolipoprotein E-deficient (ApoE-/-) mice were randomly divided into control and diabetic groups. Diabetes was induced by injecting streptozocin (STZ). The hyperglycemic state, defined as a fasting plasma glucose level >13 mmol/l, was maintained for 8 weeks. At the end of the administration, the plasma levels of triglycerides (TG) and total cholesterol (TC) were significantly elevated in the diabetic group compared with the control mice (all P<0.01). The present study revealed that diabetes increased the atherosclerotic plaque size of the aortic root (P<0.01) and the content of vascular smooth muscle cells (VSMCs) in the atherosclerotic lesion (P<0.01). Furthermore, the protein expression and phosphorylation of mammalian target of rapamycin (mTOR), 4E-binding protein 1 and ribosomal S6 kinase 1 (P<0.01) were significantly decreased in the diabetic mice compared with the control group. The decrease in the expression and phosphorylation of mTOR and its downstream kinases may be one of the molecular mechanisms underlying rapamycin resistance.
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Affiliation(s)
- Yan Zhang
- Department of Cardiology, General Hospital of PLA Chengdu Military Area Command, Chengdu, Sichuan 610083, P.R. China
| | - Qiang Wang
- Department of Cardiology, General Hospital of PLA Chengdu Military Area Command, Chengdu, Sichuan 610083, P.R. China
| | - Dachun Yang
- Department of Cardiology, General Hospital of PLA Chengdu Military Area Command, Chengdu, Sichuan 610083, P.R. China
| | - De Li
- Department of Cardiology, General Hospital of PLA Chengdu Military Area Command, Chengdu, Sichuan 610083, P.R. China
| | - Bing Tang
- Department of Cardiology, General Hospital of PLA Chengdu Military Area Command, Chengdu, Sichuan 610083, P.R. China
| | - Yongjian Yang
- Department of Cardiology, General Hospital of PLA Chengdu Military Area Command, Chengdu, Sichuan 610083, P.R. China
| | - Shuangtao Ma
- Department of Cardiology, General Hospital of PLA Chengdu Military Area Command, Chengdu, Sichuan 610083, P.R. China
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Konstance RP, Eisenstein EL, Anstrom KJ, Shaw LK, Califf RM, Harrington RA, Matchar DB, Schulman KA, Kong DF. Outcomes of second revascularization procedures after stent implantation. J Med Syst 2008; 32:177-86. [PMID: 18461821 DOI: 10.1007/s10916-007-9120-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Drug-eluting stents (DES) reduce subsequent revascularization procedures. Although randomized trials have compared DES to brachytherapy and balloon angioplasty (PTCA) for in-stent restenosis, few long-term comparisons have been made to bare metal stents (BMS) or bypass surgery (CABG), particularly following second procedures. We sought to assess the association between revascularization modality and long-term clinical outcomes of patients receiving a second procedure for coronary artery disease. Between January 2000 and July 2005, 4,666 consecutive patients underwent initial coronary stent implantation (DES or BMS). From this population we identified 569 patients undergoing a second target vessel revascularization (DES, BMS, PTCA or CABG). Outcomes were assessed at 6, 12, and 24 months after the second procedure, with follow-up through September 2006. Adjusted cumulative incidence rates were calculated using inverse probability weighted estimators. We found that at 24 months, there were no significant differences in death or myocardial infarction for PTCA, BMS, DES, and CABG (17.7%, 14.9%, 7.5%, and 10.2%, p = 0.26[3dfl]). DES patients had lower rates of death or myocardial infarction or third target vessel procedures than patients receiving PTCA (14.6% vs. 30.0%, p = 0.01) and BMS (14.6% vs. 42.2%, p < 0.01), but rates similar to CABG patients (14.6% vs. 14.6%, p = 0.99). For patients undergoing a second revascularization procedure, PTCA, BMS, DES, and CABG are associated with a similar risk of death or nonfatal myocardial infarction. DES and CABG are associated with lower rates of third revascularization procedures compared to PTCA and BMS. Further studies are needed to determine the optimum application for CABG vs. DES as a second or third revascularization procedure.
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Albuquerque FC, Levy EI, Turk AS, Niemann DB, Aagaard-Kienitz B, Pride GL, Purdy PD, Welch BG, Woo HH, Rasmussen PA, Hopkins LN, Masaryk TJ, McDougall CG, Fiorella DJ. ANGIOGRAPHIC PATTERNS OF WINGSPAN IN-STENT RESTENOSIS. Neurosurgery 2008. [DOI: 10.1227/01.neu.0000316428.68824.23] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Albuquerque FC, Levy EI, Turk AS, Niemann DB, Aagaard-Kienitz B, Pride GL, Purdy PD, Welch BG, Woo HH, Rasmussen PA, Hopkins LN, Masaryk TJ, McDougall CG, Fiorella DJ. ANGIOGRAPHIC PATTERNS OF WINGSPAN IN-STENT RESTENOSIS. Neurosurgery 2008; 63:23-7; discussion 27-8. [DOI: 10.1227/01.neu.0000335067.53190.a2] [Citation(s) in RCA: 92] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
ABSTRACT
OBJECTIVE
A classification system developed to characterize in-stent restenosis (ISR) after coronary percutaneous transluminal angioplasty with stenting was modified and applied to describe the appearance and distribution of ISR occurring after Wingspan (Boston Scientific, Fremont, CA) intracranial percutaneous transluminal angioplasty with stenting.
METHODS
A prospective, intention-to-treat, multicenter registry of Wingspan treatment for symptomatic intracranial atherosclerotic disease was maintained. Clinical and angiographic follow-up results were recorded. ISR was defined as greater than 50% stenosis within or immediately adjacent (within 5 mm) to the implanted stent(s) and greater than 20% absolute luminal loss. ISR lesions were classified by angiographic pattern, location, and severity in comparison with the original lesion treated.
RESULTS
Imaging follow-up (3–15.5 months) was available for 127 intracranial stenotic lesions treated with Wingspan percutaneous transluminal angioplasty with stenting. Forty-one lesions (32.3%) developed either ISR (n = 36 [28.3%]) or complete stent occlusion (n = 5 [3.9%]) after treatment. When restenotic lesions were characterized using the modified classification system, 25 of 41 (61.0%) were focal lesions involving less than 50% of the length of the stented segment: three were Type IA (focal stenosis involving one end of the stent), 21 were Type IB (focal intrastent stenosis involving a segment completely contained within the stent), and one was Type IC (multiple noncontiguous focal stenoses). Eleven lesions (26.8%) demonstrated diffuse stenosis (>50% of the length of the stented segment): nine were Type II with diffuse intrastent stenosis (completely contained within the stent) and two were Type III with proliferative ISR (extending beyond the stented segment). Five stents were completely occluded at follow-up (Type IV). Of the 36 ISR lesions, 16 were less severe or no worse than the original lesion with respect to severity of stenosis or length of the segment involved; 20 lesions were more severe than the original lesion with respect to the segment length involved (n = 5), actual stenosis severity (n = 6), or both (n = 9). Nine of 10 supraclinoid internal carotid artery ISR lesions and nine of 13 middle cerebral artery ISR lesions were more severe than the original lesion.
CONCLUSION
Wingspan ISR typically occurs as a focal lesion. In more than half of ISR cases, the ISR lesion was more extensive than the original lesion treated in terms of lesion length or stenosis severity. Supraclinoid internal carotid artery and middle cerebral artery lesions have a propensity to develop more severe posttreatment stenosis.
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Affiliation(s)
| | - Elad I. Levy
- Departments of Neurosurgery and Radiology, School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York; and Department of Neurosurgery, Millard Fillmore Gates Hospital, Kaleida Health, Buffalo, New York
| | - Aquilla S. Turk
- Departments of Radiology and Neurosurgery, Medical University of South Carolina, Charleston, South Carolina
| | - David B. Niemann
- Departments of Neurosurgery and Neuroradiology, University of Wisconsin, Madison, Wisconsin
| | | | - G. Lee Pride
- Departments of Neurosurgery and Neuroradiology, University of Texas Southwestern, Dallas, Texas
| | - Phillip D. Purdy
- Departments of Neurosurgery and Neuroradiology, University of Texas Southwestern, Dallas, Texas
| | - Babu G. Welch
- Departments of Neurosurgery and Neuroradiology, University of Texas Southwestern, Dallas, Texas
| | - Henry H. Woo
- Departments of Neurological Surgery and Radiology, University at Stony Brook, State University of New York, Stony Brook, New York
| | - Peter A. Rasmussen
- Departments of Neurosurgery and Neuroradiology, The Cleveland Clinic Foundation, Cleveland, Ohio
| | - L. Nelson Hopkins
- Departments of Neurosurgery and Radiology, School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York; and Department of Neurosurgery, Millard Fillmore Gates Hospital, Kaleida Health, Buffalo, New York
| | - Thomas J. Masaryk
- Departments of Neurosurgery and Neuroradiology, The Cleveland Clinic Foundation, Cleveland, Ohio
| | | | - David J. Fiorella
- Departments of Neurosurgery and Neuroradiology, Barrow Neurological Institute, Phoenix, Arizona
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Romano M, Buffoli F, Tomasi L, Corrado L, Ferrari MR, Zanini R. Safety and effectiveness of drug eluting stent in patients with ST elevation myocardial infarction undergoing primary angioplasty. Catheter Cardiovasc Interv 2008; 71:759-63. [DOI: 10.1002/ccd.21529] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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