1
|
Meunier L, Godin M, Souteyrand G, Mottin B, Valy Y, Lordet V, Benoit C, Bakdi R, Laurençon V, Genereux P, Waliszewski M, Allix-Béguec C. Prospective, single-centre evaluation of the safety and efficacy of percutaneous coronary interventions following a decision tree proposing a no-stent strategy in stable patients with coronary artery disease (SCRAP study). Clin Res Cardiol 2023; 112:1164-1174. [PMID: 35776144 PMCID: PMC10449686 DOI: 10.1007/s00392-022-02054-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 06/13/2022] [Indexed: 11/25/2022]
Abstract
AIM We evaluated a decision algorithm for percutaneous coronary interventions (PCI) based on a no-stent strategy, corresponding to a combination of scoring balloon angioplasty (SCBA) and drug-coated balloon (DCB), as a first line approach. Stents were used only in unstable patients, or in case of mandatory bailout stenting (BO-stent). METHODS From April 2019 to March 2020, 984 consecutive patients, including 1922 lesions, underwent PCI. The 12-month primary end-point was a composite of major adverse cardiac events (MACE) defined as all-cause death, nonfatal myocardial infarction, nonfatal stroke, and target lesion revascularization. Patients were classified into conventional or no-stent strategy groups according to the PCI strategy. In the no-stent strategy group, they were further classified into BO-stent or DCB-only groups. Their metal index was calculated by stent length divided by the total lesion length. RESULTS The no-stent strategy was applied in 85% of the patients, and it was successful for 65% of them. MACE occurred in 7.1% of the study population, including 4.2% of all-cause death. Target lesion revascularization was required in 1.4%, 3.6%, and 1.5% of patients in the conventional DES, BO-stent, and DCB-only groups, respectively. MACE occurred more often in the elderly and in those treated with at least one stent (metal index greater than 0). CONCLUSIONS The no-stent strategy, i.e., revascularization of coronary lesions by SCBA followed by DCB and with DES bailout stenting, was effective and safe at 1 year. This PCI approach was applicable on a daily practice in our cath lab. TRIAL REGISTRATION This study was registered with clinicaltrials.gov (NCT03893396, first posted on March 28, 2019). Feasibility, safety and efficacy of percutaneous coronary interventions following a decision tree proposing a no-stent strategy in stable patients with coronary artery disease. DES: drug eluting stent; SCBA: scoring balloon angioplasty; BO-stent: at least one stent; DCB: drug coated balloon; BMS: bare metal stent; Bailout (dash lines); MACE: major adverse cardiac event.
Collapse
Affiliation(s)
- Ludovic Meunier
- Cardiology Department, Centre Hospitalier La Rochelle, La Rochelle, France
| | - Matthieu Godin
- Cardiology Department, Clinique St-Hilaire, Rouen, France
| | - Géraud Souteyrand
- Département de Cardiologie, CHU Clermont-Ferrand, ISIT, CaVITI, CNRS (UMR-6284), Université d'Auvergne, Clermont-Ferrand, France
| | - Benoît Mottin
- Cardiology Department, Centre Hospitalier La Rochelle, La Rochelle, France
| | - Yann Valy
- Cardiology Department, Centre Hospitalier La Rochelle, La Rochelle, France
| | - Vincent Lordet
- Cardiology Department, Centre Hospitalier La Rochelle, La Rochelle, France
| | - Christian Benoit
- Cardiology Department, Centre Hospitalier La Rochelle, La Rochelle, France
| | - Ronan Bakdi
- Cardiology Department, Centre Hospitalier La Rochelle, La Rochelle, France
| | - Virginie Laurençon
- Clinical Trials Unit, Centre Hospitalier La Rochelle, La Rochelle, France
| | - Philippe Genereux
- Clinical Trials Center, Cardiovascular Research Foundation, New York, NY, USA
- Morristown Medical Center, Gagnon Cardiovascular Institute, Morristown, NJ, USA
| | - Matthias Waliszewski
- Medical Scientific Affairs, B.Braun Melsungen AG, Berlin, Germany
- Department of Internal Medicine and Cardiology, Charité - Universitätsmedizin Berlin, Campus Virchow, Berlin, Germany
| | | |
Collapse
|
2
|
Li G, Qiao H, Lin H, Wang R, Chen F, Li S, Yang W, Yin L, Cen X, Zhang Y, Cheng X, Wang AYC. Application of drug-coated balloons for intracranial atherosclerosis disease: a systematic review. Clin Neurol Neurosurg 2021; 213:107065. [PMID: 34991058 DOI: 10.1016/j.clineuro.2021.107065] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 11/21/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND Although percutaneous transluminal angioplasty and stenting (PTAS) was an effective and safe alternative treatment for severe intracranial atherosclerosis disease (ICAD), the high rate of restenosis remained a major issue for this endovascular procedure. Recently, the application of drug-coated balloons (DCB) in ICAD was developed to reduce restenosis. This systematic review aimed to evaluate the efficacy and safety of DCB angioplasty for ICAD. METHODS We searched relevant databases for eligible studies enrolling ICAD patients treated with DCB. The event rates of restenosis and periprocedural complications in the follow-up period were pooled with random-/fixed-effect models using Freeman-Tukey double arcsine transformation. Heterogeneity tests and publication bias tests were performed. RESULTS Two hundred and twenty-four ICAD patients treated with DCB from 9 eligible studies were included. Rate of stenosis in the DCB arm before treatment was ranged from 62% to 90% and reported median follow-up was ranged from 3 to 10.7 months. The pooled incidence of restenosis were 5.7% (95% confidence interval [CI] 2.6%-9.7%; I2 = 0%, p = 0.516) and 5.9% for periprocedural complications (95% CI: 2.5-10.3%; I2 = 0%, p = 0.649) in follow-up term. CONCLUSION With the limitation of the low quality of the available evidence, angioplasty with DCB appears to be effective and safe in severe ICAD. Further larger randomized trials are needed to provide more definitive evidence and to address the ideal clinical context for their application.
Collapse
Affiliation(s)
- Guoming Li
- Neurology Department, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Dade Road No.111, Guangzhou, Guangdong 510120, China.
| | - Hanzi Qiao
- Neurology Department, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Dade Road No.111, Guangzhou, Guangdong 510120, China.
| | - Hao Lin
- Neurology Department, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Dade Road No.111, Guangzhou, Guangdong 510120, China.
| | - Rongfei Wang
- Neurology Department, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Dade Road No.111, Guangzhou, Guangdong 510120, China.
| | - Fajun Chen
- Neurology Department, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Dade Road No.111, Guangzhou, Guangdong 510120, China.
| | - Shaoxue Li
- Neurology Department, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Dade Road No.111, Guangzhou, Guangdong 510120, China.
| | - Weilin Yang
- Neurology Department, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Dade Road No.111, Guangzhou, Guangdong 510120, China.
| | - Lei Yin
- Neurology Department, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Dade Road No.111, Guangzhou, Guangdong 510120, China.
| | - Xuecheng Cen
- Neurology Department, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Dade Road No.111, Guangzhou, Guangdong 510120, China.
| | - Yingguang Zhang
- Neurology Department, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Dade Road No.111, Guangzhou, Guangdong 510120, China.
| | - Xiao Cheng
- Neurology Department, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Dade Road No.111, Guangzhou, Guangdong 510120, China; Guangdong Provincial Chinese Emergency Key Laboratory, Guangzhou 510120, China; Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou 510006, China.
| | - Alvin Yi-Chou Wang
- Neurology Department, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Dade Road No.111, Guangzhou, Guangdong 510120, China.
| |
Collapse
|
3
|
|
4
|
Acute and sub-acute stent thrombosis: Frequency, predictors and features in patients undergoing primary percutaneous intervention at a tertiary care cardiac centre. IJC HEART & VASCULATURE 2019; 26:100427. [PMID: 31763441 PMCID: PMC6864178 DOI: 10.1016/j.ijcha.2019.100427] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Revised: 09/07/2019] [Accepted: 09/21/2019] [Indexed: 11/24/2022]
Abstract
Early stent thrombosis (ST) is relatively frequent in patients undergoing primary PCI. Diabetic and hypertensive patients are at an increased risk of ST. Presentation of patients in Killip Class III-IV is an independent predictor of early ST.
Objectives To assess the frequency of early (acute and sub-acute) stent thrombosis (ST) after primary percutaneous coronary intervention (pPCI) and to identify its potential predictors. Background ST is a serious clinical event associated with a high mortality rate. A very limited data are available regarding the incidence rate of early ST after pPCI and its predictors, especially for Pakistani population. Methods Study included consecutive patients who underwent primary PCI. Telephonic follow-ups were made to obtain 30-days outcomes including ST, mortality, and re-occurrence of symptoms. ST was defined as per the standardized definition proposed by the Academic Research Consortium and classified as acute (during the procedure) and sub-acute (within 30 days). Results A total of 569 patients were included with 80.5% (485) male patients. The stent thrombosis (acute or sub-acute) was observed in 33 (5.8%) patients out of which 3 (9.1%) were definite ST while remaining 30 (90.9%) were probable ST. Patients who develop ST were predominantly male, hypertensive, diabetic, with reduced pre PCI LVEF (%) and Killip Class. A significantly higher in-hospital mortality rate was observed in patients with ST as compared to without ST, 36.4% (12/33) vs. 0.2% (1/536); p-value < 0.001 respectively. Killip Class (III-IV) was found to be the independent predictor of ST with an adjusted odds ratio of 5.2 [1.76–15.32]. Conclusions Early stent thrombosis (ST) is relatively frequent in patients undergoing primary PCI. Diabetic and hypertensive patients are at an increased risk of ST and presentation of patients in Killip Class III-IV is an independent predictor of early ST.
Collapse
|
5
|
Mohtashami Z, Esmaili Z, Vakilinezhad MA, Seyedjafari E, Akbari Javar H. Pharmaceutical implants: classification, limitations and therapeutic applications. Pharm Dev Technol 2019; 25:116-132. [DOI: 10.1080/10837450.2019.1682607] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Affiliation(s)
- Zahra Mohtashami
- Pharmaceutics Department, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
| | - Zahra Esmaili
- Pharmaceutics Department, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
| | | | | | - Hamid Akbari Javar
- Pharmaceutics Department, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
| |
Collapse
|
6
|
Xue Y, Liu X, Sun A, Zhang P, Fan Y, Deng X. Hemodynamic Performance of a New Punched Stent Strut: A Numerical Study. Artif Organs 2015; 40:669-77. [PMID: 26581476 DOI: 10.1111/aor.12638] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Local flow disturbance by arterial stent struts has been shown to play an important role in stent thrombosis. To reduce the local flow disturbance near a stent strut, we proposed a new concept of stent design with small holes in the stent struts. The present study evaluated the new design numerically by comparing it with the traditional stent in terms of local hemodynamic parameters such as flow velocity, flow recirculation area, time-averaged wall shear stress (TAWSS), oscillating shear index (OSI), and relative residence time (RRT). The results demonstrated that when compared with the traditional strut, the new design could significantly enhance flow velocity and reduce the flow recirculation zone in the vicinity of the strut. Moreover, the new design would significantly elevate TAWSS and remarkably reduce OSI and RRT along the host arterial wall. In conclusion, the new design of stent struts with punched holes is advantageous over the traditional one in the aspect of improving local hemodynamics, which may reduce thrombosis formation and promote re-endothelialization after stenting.
Collapse
Affiliation(s)
- Yan Xue
- Key Laboratory for Biomechanics and Mechanobiology of the Ministry of Education, School of Biological Science and Medical Engineering, Beihang University, Beijing, China
| | - Xiao Liu
- Key Laboratory for Biomechanics and Mechanobiology of the Ministry of Education, School of Biological Science and Medical Engineering, Beihang University, Beijing, China
| | - Anqiang Sun
- Key Laboratory for Biomechanics and Mechanobiology of the Ministry of Education, School of Biological Science and Medical Engineering, Beihang University, Beijing, China
| | - Peng Zhang
- Key Laboratory for Biomechanics and Mechanobiology of the Ministry of Education, School of Biological Science and Medical Engineering, Beihang University, Beijing, China
| | - Yubo Fan
- Key Laboratory for Biomechanics and Mechanobiology of the Ministry of Education, School of Biological Science and Medical Engineering, Beihang University, Beijing, China
| | - Xiaoyan Deng
- Key Laboratory for Biomechanics and Mechanobiology of the Ministry of Education, School of Biological Science and Medical Engineering, Beihang University, Beijing, China
| |
Collapse
|
7
|
Franck C, Eisenberg MJ, Dourian T, Grandi SM, Filion KB. Very late stent thrombosis in patients with first-generation drug-eluting stents: A systematic review of reported cases. Int J Cardiol 2014; 177:1056-8. [DOI: 10.1016/j.ijcard.2014.11.030] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2014] [Accepted: 11/04/2014] [Indexed: 10/24/2022]
|
8
|
Pellegrini DO, Gomes VO, Lasevitch R, Smidt L, Azeredo MA, Ledur P, Bodanese R, Sinnott L, Moriguchi E, Caramori P. Efficacy and safety of drug-eluting stents in the real world: 8-year follow-up. Arq Bras Cardiol 2014; 103:174-82. [PMID: 25098375 PMCID: PMC4193064 DOI: 10.5935/abc.20140110] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2013] [Accepted: 03/14/2014] [Indexed: 12/02/2022] Open
Abstract
Background: Drug-eluting stents have been used in daily practice since 2002, with the clear
advantages of reducing the risk of target vessel revascularization and an
impressive reduction in restenosis rate by 50%-70%. However, the occurrence of a
late thrombosis can compromise long-term results, particularly if the risks of
this event were sustained. In this context, a registry of clinical cases gains
special value. Objective: To evaluate the efficacy and safety of drug-eluting stents in the real world. Methods: We report on the clinical findings and 8-year follow-up parameters of all patients
that underwent percutaneous coronary intervention with a drug-eluting stent from
January 2002 to April 2007. Drug-eluting stents were used in accordance with the
clinical and interventional cardiologist decision and availability of the
stent. Results: A total of 611 patients were included, and clinical follow-up of up to 8 years was
obtained for 96.2% of the patients. Total mortality was 8.7% and nonfatal
infarctions occurred in 4.3% of the cases. Target vessel revascularization
occurred in 12.4% of the cases, and target lesion revascularization occurred in 8%
of the cases. The rate of stent thrombosis was 2.1%. There were no new episodes of
stent thrombosis after the fifth year of follow-up. Comparative subanalysis showed
no outcome differences between the different types of stents used, including
Cypher®, Taxus®, and Endeavor®. Conclusion: These findings indicate that drug-eluting stents remain safe and effective at very
long-term follow-up. Patients in the "real world" may benefit from drug-eluting
stenting with excellent, long-term results.
Collapse
Affiliation(s)
- Denise Oliveira Pellegrini
- Mailing Address: Denise Machado de Oliveira Pellegrini, Avenida Alegrete
423/1601, Petrópolis. Postal Code 90460-100, Porto Alegre, RS, Brazil.
;
| | | | | | | | | | | | | | | | | | | |
Collapse
|
9
|
From Histology and Imaging Data to Models for In-Stent Restenosis. Int J Artif Organs 2014; 37:786-800. [DOI: 10.5301/ijao.5000336] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/29/2014] [Indexed: 11/20/2022]
Abstract
The implantation of stents has been used to treat coronary artery stenosis for several decades. Although stenting is successful in restoring the vessel lumen and is a minimally invasive approach, the long-term outcomes are often compromised by in-stent restenosis (ISR). Animal models have provided insights into the pathophysiology of ISR and are widely used to evaluate candidate drug inhibitors of ISR. Such biological models allow the response of the vessel to stent implantation to be studied without the variation of lesion characteristics encountered in patient studies. This paper describes the development of complementary in silico models employed to improve the understanding of the biological response to stenting using a porcine model of restenosis. This includes experimental quantification using microCT imaging and histology and the use of this data to establish numerical models of restenosis. Comparison of in silico results with histology is used to examine the relationship between spatial localization of fluid and solid mechanics stimuli immediately post-stenting. Multi-scale simulation methods are employed to study the evolution of neointimal growth over time and the variation in the extent of neointimal hyperplasia within the stented region. Interpretation of model results through direct comparison with the biological response contributes to more detailed understanding of the pathophysiology of ISR, and suggests the focus for follow-up studies. In conclusion we outline the challenges which remain to both complete our understanding of the mechanisms responsible for restenosis and translate these models to applications in stent design and treatment planning at both population-based and patient-specific levels.
Collapse
|
10
|
Ratner BD, Hoffman AS, Schoen FJ, Lemons JE. Biomaterials Science: An Evolving, Multidisciplinary Endeavor. Biomater Sci 2013. [DOI: 10.1016/b978-0-08-087780-8.00153-4] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
|
11
|
CHEVALIER BERNARD, MOULICHON ROBERT, TEIGER EMMANUEL, BRUNEL PHILIPPE, METZGER JEANPHILIPPE, PANSIERI MICHEL, CARRIE DIDIER, STOLL HANSPETER, WITTEBOLS KRISTEL, SPAULDING CHRISTIAN, FAJADET JEAN. One-Year Results of the CRISTAL Trial, a Randomized Comparison of Cypher Sirolimus-Eluting Coronary Stents versus Balloon Angioplasty for Restenosis of Drug-Eluting Stents. J Interv Cardiol 2012; 25:586-95. [DOI: 10.1111/j.1540-8183.2012.00769.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
|
12
|
Shannon J, Colombo A, Alfieri O. Do hybrid procedures have proven clinical utility and are they the wave of the future? : hybrid procedures have proven clinical utility and are the wave of the future. Circulation 2012; 125:2492-503; discussion 2503. [PMID: 22615420 DOI: 10.1161/circulationaha.111.041186] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
|
13
|
Abstract
Cardiovascular devices such as coronary artery stents, ventricular assist devices, pacemakers, automated implantable cardioverter-defibrillators and septal closure devices are life saving and improve quality of life for millions of patients each year. Complications of these devices include thrombosis/thromboembolism, infection, structural failure and adverse material-tissue interactions. These findings should be sought when these devices are encountered on the surgical pathology bench or at autopsy.
Collapse
Affiliation(s)
- Robert F Padera
- Department of Pathology, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA
| |
Collapse
|
14
|
King L, Byrne RA, Mehilli J, Schömig A, Kastrati A, Pache J. Five-year clinical outcomes of a polymer-free sirolimus-eluting stent versus a permanent polymer paclitaxel-eluting stent: Final results of the intracoronary stenting and angiographic restenosis - test equivalence between two drug-eluting stents (ISAR-TES. Catheter Cardiovasc Interv 2012; 81:E23-8. [PMID: 22431239 DOI: 10.1002/ccd.24375] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2011] [Accepted: 02/13/2012] [Indexed: 11/05/2022]
Affiliation(s)
- Lamin King
- Deutsches Herrzentrum, Technische Universitãt, Munich, Germany.
| | | | | | | | | | | |
Collapse
|
15
|
Lee CH, Chen CJ, Liu SJ, Hsiao CY, Chen JK. The Development of Novel Biodegradable Bifurcation Stents for the Sustainable Release of Anti-Proliferative Sirolimus. Ann Biomed Eng 2012; 40:1961-70. [DOI: 10.1007/s10439-012-0556-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2012] [Accepted: 03/21/2012] [Indexed: 12/18/2022]
|
16
|
Singh IM, Holmes DR. Myocardial Revascularization by Percutaneous Coronary Intervention: Past, Present, and the Future. Curr Probl Cardiol 2011; 36:375-401. [DOI: 10.1016/j.cpcardiol.2011.05.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
|
17
|
Vajda Z, Güthe T, Perez MA, Heuschmid A, Schmid E, Bäzner H, Henkes H. Neurovascular in-stent stenoses: treatment with conventional and drug-eluting balloons. AJNR Am J Neuroradiol 2011; 32:1942-7. [PMID: 21885715 DOI: 10.3174/ajnr.a2644] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE ISRs remain a major issue in the endovascular management of ICAD, requiring retreatment by reangioplasty. The aim of the present study was to evaluate the technical feasibility, safety, and efficiency of the novel DEBs for neurovascular ISRs. MATERIALS AND METHODS Fifty-one patients (median age, 67 years; age range, 34-82 years; male/female ratio, 37:14) underwent 63 balloon dilation procedures for ISRs in intracranial stented arterial segments between November 2007 and August 2010 in a single center. Of the 63 procedures, 20 (32%) were performed by using a conventional balloon and 43 (68%), by using a paclitaxel-eluting balloon (SeQuent Please). 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 a recurrent ISR after reangioplasty were analyzed. RESULTS Technical success, defined as <50% residual stenosis was achieved in all cases (100%), with failure of the DEB treatment in 6% of the attempts; those lesions were finally successfully treated with a conventional balloon. The combined permanent neurologic morbidity and mortality rate (stroke, ICH, and SAH) at 30 days was 1.6%. Substantial difference was found in the rate of recurrent stenosis when comparing conventional balloons and DEBs, with recurrent stenosis rates of 50% and 9%, respectively. CONCLUSIONS The initial results of reangioplasty of intracranial ISRs with DEBs are encouraging; further technical developments are, nevertheless, mandatory.
Collapse
Affiliation(s)
- Z Vajda
- Klinik für Neuroradiologie, Bürgerhospital, Klinikum Stuttgart, Germany
| | | | | | | | | | | | | |
Collapse
|
18
|
In-vitro release of anti-proliferative paclitaxel from novel balloon-expandable polycaprolactone stents. MATERIALS SCIENCE & ENGINEERING. C, MATERIALS FOR BIOLOGICAL APPLICATIONS 2011. [DOI: 10.1016/j.msec.2011.04.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
|
19
|
Lilli A, Vecchio S, Chechi T, Vittori G, Giuliani G, Spaziani G, Consoli L, Giannotti F, Baldereschi G, Margheri M. Left ventricular support device for cardiogenic shock during myocardial infarction due to stent thrombosis: A single centre experience. Int J Cardiol 2011; 148:337-40. [DOI: 10.1016/j.ijcard.2009.11.028] [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] [Received: 05/29/2008] [Revised: 07/11/2009] [Accepted: 11/29/2009] [Indexed: 11/26/2022]
|
20
|
Novel Drug Eluting Stent Systems. Interv Cardiol 2011. [DOI: 10.1002/9781444319446.ch37] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
|
21
|
Tahir H, Hoekstra AG, Lorenz E, Lawford PV, Hose DR, Gunn J, Evans DJW. Multi-scale simulations of the dynamics of in-stent restenosis: impact of stent deployment and design. Interface Focus 2011; 1:365-73. [PMID: 22670206 DOI: 10.1098/rsfs.2010.0024] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2010] [Accepted: 03/03/2011] [Indexed: 12/11/2022] Open
Abstract
Neointimal hyperplasia, a process of smooth muscle cell re-growth, is the result of a natural wound healing response of the injured artery after stent deployment. Excessive neointimal hyperplasia following coronary artery stenting results in in-stent restenosis (ISR). Regardless of recent developments in the field of coronary stent design, ISR remains a significant complication of this interventional therapy. The influence of stent design parameters such as strut thickness, shape and the depth of strut deployment within the vessel wall on the severity of restenosis has already been highlighted but the detail of this influence is unclear. These factors impact on local haemodynamics and vessel structure and affect the rate of neointima formation. This paper presents the first results of a multi-scale model of ISR. The development of the simulated restenosis as a function of stent deployment depth is compared with an in vivo porcine dataset. Moreover, the influence of strut size and shape is investigated, and the effect of a drug released at the site of injury, by means of a drug-eluting stent, is also examined. A strong correlation between strut thickness and the rate of smooth muscle cell proliferation has been observed. Simulation results also suggest that the growth of the restenotic lesion is strongly dependent on the stent strut cross-sectional profile.
Collapse
Affiliation(s)
- Hannan Tahir
- Computational Science, Faculty of Science , University of Amsterdam , Amsterdam , The Netherlands
| | | | | | | | | | | | | |
Collapse
|
22
|
KARJALAINEN PASIP, YLITALO ANTTI, AIRAKSINEN JUHANIKE, NAMMAS WAIL. Five-Year Clinical Outcome of Titanium-Nitride-Oxide-Coated Bioactive Stent Implantation in a Real-World Population: A Comparison with Paclitaxel-eluting Stents: The PORI Registry. J Interv Cardiol 2010; 24:1-8. [DOI: 10.1111/j.1540-8183.2010.00601.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
|
23
|
Airaksinen KEJ, Ylitalo A, Karjalainen PP. Drug-eluting stents in patients on long-term oral anticoagulation therapy: a mission impossible? Interv Cardiol 2010. [DOI: 10.2217/ica.10.13] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
|
24
|
Patterns of use of thienopyridine therapy after percutaneous coronary interventions with drug-eluting stents and bare-metal stents. Am Heart J 2009; 158:592-598.e1. [PMID: 19781419 DOI: 10.1016/j.ahj.2009.06.030] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2009] [Accepted: 06/10/2009] [Indexed: 11/24/2022]
Abstract
BACKGROUND Twelve months of uninterrupted thienopyridine therapy after drug-eluting stents (DES) implantation was recently recommended, but limited data are available regarding long-term use in clinical practice. The objective of the study was to determine the adherence to thienopyridine therapy after stent implantation, factors associated with suboptimal adherence, and association of suboptimal adherence with mortality. METHODS We evaluated 5,263 older patients (>65 years) who received DES and 6,081 older patients who received bare-metal stents (BMS) from December 1, 2003, to March 31, 2006, in Ontario, Canada, who were eligible to receive 12 months of thienopyridine at minimal cost. RESULTS Primary nonadherence was observed among 6.9% in the DES group and 7.1% in the BMS group that did not fill a single prescription of thienopyridine within 1 year of stent implantation. Premature discontinuation occurred in a progressive manner, with 28% in the DES group and 34% in the BMS group discontinuing therapy by 6 months. Low-income patients eligible for a waiver of deductible and dispensing fee were almost 70% more likely to fill their first prescription. For DES patients, primary nonadherence (hazard ratio [HR] 2.68, 95% CI 1.77-4.07), 12-months proportional days covered <80% (HR 2.39, 95% CI 1.67-3.43), and prematurely discontinuing therapy within 6 months (HR 2.64, 95% 1.60-4.35) were associated with an increased risk of death. CONCLUSIONS We found suboptimal patterns of adherence to thienopyridine therapy after DES implantation that was strongly associated with an increased mortality risk. Eliminating any costs for thienopyridine therapy may be an effective strategy to increase medication adherence.
Collapse
|
25
|
Sarısözen C, Arıca B, Hıncal AA, Çalış S. Development of biodegradable drug releasing polymeric cardiovascular stents andin vitroevaluation. J Microencapsul 2009; 26:501-12. [DOI: 10.1080/02652040802465792] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
|
26
|
van Tiel CM, Bonta PI, Rittersma SZH, Beijk MAM, Bradley EJ, Klous AM, Koch KT, Baas F, Jukema JW, Pons D, Sampietro ML, Pannekoek H, de Winter RJ, de Vries CJM. p27kip1-838C>A single nucleotide polymorphism is associated with restenosis risk after coronary stenting and modulates p27kip1 promoter activity. Circulation 2009; 120:669-76. [PMID: 19667240 DOI: 10.1161/circulationaha.108.842179] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND The cyclin-dependent kinase inhibitor p27(kip1) is a key regulator of smooth muscle cell and leukocyte proliferation in vascular disease, including in-stent restenosis. We therefore hypothesized that common genetic variations or single nucleotide polymorphisms in p27(kip1) may serve as a useful tool in risk stratification for in-stent restenosis. METHODS AND RESULTS Three single nucleotide polymorphisms concerning the p27(kip1) gene (-838C>A, rs36228499; -79C>T, rs34330; +326G>T, rs2066827) were determined in a cohort of 715 patients undergoing coronary angioplasty and stent placement. We discovered that the p27(kip1)-838C>A single nucleotide polymorphism is associated with clinical in-stent restenosis; the -838AA genotype decreases the risk of target vessel revascularization (hazard ratio, 0.28; 95% confidence interval, 0.10 to 0.77). This finding was replicated in another cohort study of 2309 patients (hazard ratio, 0.61; 95% confidence interval, 0.40 to 0.93). No association was detected between this end point and the p27(kip1)-79C>T and +326G>T single nucleotide polymorphisms. We subsequently studied the functional importance of the -838C>A single nucleotide polymorphism and detected a 20-fold increased basal p27(kip1) transcriptional activity of the -838A allele containing promoter. CONCLUSIONS Patients with the p27(kip1)-838AA genotype have a decreased risk of in-stent restenosis corresponding with enhanced promoter activity of the -838A allele of this cell-cycle inhibitor, which may explain decreased smooth muscle cell proliferation.
Collapse
Affiliation(s)
- Claudia M van Tiel
- Department of Medical Biochemistry, University of Amsterdam, the Netherlands
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
27
|
Byrne RA, Iijima R, Mehilli J, Pinieck S, Bruskina O, Schömig A, Kastrati A. Durability of antirestenotic efficacy in drug-eluting stents with and without permanent polymer. JACC Cardiovasc Interv 2009; 2:291-9. [PMID: 19463439 DOI: 10.1016/j.jcin.2008.11.015] [Citation(s) in RCA: 135] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2008] [Accepted: 11/09/2008] [Indexed: 12/01/2022]
Abstract
OBJECTIVES We sought to assess changes in antirestenotic efficacy of drug-eluting stents (DES) by restudying subjects at 2 time points after coronary stenting (6 to 8 months and 2 years) and to compare differences in time courses of late luminal loss (LLL) between 3 different DES platforms in use at our institution. BACKGROUND DES therapy is associated with low levels of LLL at 6 to 8 months. The temporal course of neointimal formation after this time point remains unclear. METHODS This prospective, observational, systematic angiographic follow-up study was conducted at 2 centers in Munich, Germany. Patients underwent stenting with permanent-polymer rapamycin-eluting stents (RES), polymer-free RES, or permanent-polymer paclitaxel-eluting stents (PES). The primary end point was delayed LLL (the difference in in-stent LLL between 6 to 8 months and 2 years). RESULTS Of 2,588 patients undergoing stenting, 2,030 patients (78.4%) had 6- to 8-month angiographic follow-up and were enrolled in the study. Target lesion revascularization was performed in 259 patients; these patients were not considered for further angiographic analysis. Of 1,771 remaining patients, 1,331 had available 2-year reangiographic data (75.2%). Overall mean (SD) delayed LLL was 0.12 +/- 0.49 mm (0.17 +/- 0.50 mm, 0.01 +/- 0.42 mm, and 0.13 +/- 0.50 mm in permanent-polymer RES, polymer-free RES, and permanent-polymer PES groups, respectively [p < 0.001]). In multivariate analysis, only stent type (in favor of polymer-free RES) predicted delayed LLL. CONCLUSIONS Ongoing erosion of luminal caliber beyond 6 to 8 months after the index procedure is observed following DES implantation. Absence of permanent polymer from the DES platform seems to militate against this effect.
Collapse
Affiliation(s)
- Robert A Byrne
- Deutsches Herzzentrum, Technische Universität, Munich, Germany.
| | | | | | | | | | | | | |
Collapse
|
28
|
Zhang RY, Zhu ZB, Zhang Q, Yang ZK, Hu J, Lv AK, Zhang JS, Shen WF. Impact of moderate or severe renal insufficiency on long-term outcomes in patients undergoing drug-eluting stent based coronary intervention. Int J Cardiol 2009; 136:72-9. [DOI: 10.1016/j.ijcard.2008.04.028] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2007] [Revised: 02/26/2008] [Accepted: 04/23/2008] [Indexed: 11/25/2022]
|
29
|
Karjalainen PP, Annala AP, Ylitalo A, Vahlberg T, Airaksinen KEJ. Long-term clinical outcome with titanium-nitride-oxide-coated stents and paclitaxel-eluting stents for coronary revascularization in an unselected population. Int J Cardiol 2009; 144:42-6. [PMID: 19403187 DOI: 10.1016/j.ijcard.2009.03.120] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2008] [Revised: 01/07/2009] [Accepted: 03/26/2009] [Indexed: 10/20/2022]
Abstract
BACKGROUND The aim of this study was to evaluate long-term clinical events in patients treated with titanium-nitride-oxide-coated bio-active stents (BAS) and paclitaxel-eluting stents (PES) in routine clinical practice. METHODS All patients undergoing percutaneous coronary intervention (PCI) were eligible for this single-centre registry between May 2003 and November 2004. The primary end point of the study was major adverse cardiac events (MACE) at 3 years including myocardial infarction (MI), cardiac death and target vessel revascularization (TVR). RESULTS A total of 201 patients received BAS and 204 patients PES. In addition, during the same study period, 184 patients were treated with bare-metal stents (BMS) and 125 patients underwent CABG. Complete follow-up datasets were available in all patients. After 3 years of follow-up, the rate of MACE was 13.9% for BAS and 23.5% for PES (adjusted HR 2.0, 95% CI 1.2-3.2, p=0.006). This difference was mainly driven by a higher incidence of MI in the PES group (19.1%) compared with the BAS (7.5%) group (adjusted HR 3.2, 95% CI 1.7-5.8, p<0.001). The rate of MACE was 31.5% in the BMS group and 4% in the CABG group. At 3 years, stent thrombosis occurred in 15 patients in the PES (7.4%) group. There was no stent thrombosis in the BAS group. CONCLUSIONS After the 3 year follow-up, BAS resulted in better long-term outcome compared with PES with infrequent need for TVR.
Collapse
Affiliation(s)
- Pasi P Karjalainen
- Department of Cardiology, Satakunta Central Hospital, Sairaalantie 3, FIN-28100, Pori, Finland.
| | | | | | | | | |
Collapse
|
30
|
Zhao DX, Leacche M, Balaguer JM, Boudoulas KD, Damp JA, Greelish JP, Byrne JG. Routine Intraoperative Completion Angiography After Coronary Artery Bypass Grafting and 1-Stop Hybrid Revascularization. J Am Coll Cardiol 2009; 53:232-41. [DOI: 10.1016/j.jacc.2008.10.011] [Citation(s) in RCA: 118] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2008] [Revised: 10/09/2008] [Accepted: 10/14/2008] [Indexed: 10/21/2022]
|
31
|
Ayyanathan S, Hersh D, Coplan NL, Garratt K. The problem of stent thrombosis associated with drug-eluting stents and the optimal duration of dual antiplatelet therapy. PREVENTIVE CARDIOLOGY 2009; 12:59-64. [PMID: 19476578 DOI: 10.1111/j.1751-7141.2009.00031.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Drug-eluting stents have significantly reduced the problem of restenosis, but there is an association between drug-eluting stents and stent thrombosis that can be a significant clinical problem resulting in myocardial infarction or death. The risk for stent thrombosis increases in certain clinical situations and has been reduced through the use of dual antiplatelet therapy for prolonged periods. Until new therapies are developed, it is essential that patients who have had drug-eluting stents implanted continue with dual-antiplatelet therapy for at least 1 year and possibly for an indefinite period.
Collapse
|
32
|
Hess OM, Karjalainen P, James S, Wallentin L, de Winter RJ. Why don't we return to bare metal stents? EUROINTERVENTION 2008; 4:36-41. [PMID: 19112775 DOI: 10.4244/eijv4i1a6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Otto M Hess
- Swiss Cardiovascular Center, University Hospital, 3010 Bern, Switzerland.
| | | | | | | | | |
Collapse
|
33
|
Philpott AC, Southern DA, Clement FM, Galbraith PD, Traboulsi M, Knudtson ML, Ghali WA. Long-term outcomes of patients receiving drug-eluting stents. CMAJ 2008; 180:167-74. [PMID: 19095719 DOI: 10.1503/cmaj.080050] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND We sought to establish the long-term safety of drug-eluting stents compared with bare-metal stents in a usual care setting. METHODS Using data from a prospective multicentre registry, we compared rates of death and of death or repeat revascularization during 3 years of follow-up of 6440 consecutive patients who underwent angioplasty with either drug-eluting or bare-metal stents between Apr. 1, 2003, and Mar. 31, 2006. RESULTS Drug-eluting stents were inserted in 1120 patients and bare-metal stents in 5320. The drug-eluting stents were selected for patients who had a greater burden of comorbid illness, including diabetes mellitus (32.8% v. 20.8% in the bare-metal group, p < 0.001) and renal disease (7.4% v. 5.0%, p = 0.001). At 1-year follow-up, the drug-eluting stents were associated with a mortality of 3.0%, as compared with 3.7% with the bare-metal stents (adjusted odds ratio [OR] 0.62, 95% confidence interval [CI] 0.46-0.83). The rate of the composite outcome of death or repeat revascularization was 12.0% for the drug-eluting stents and 15.8% for the bare-metal stents (adjusted OR 0.40, 95% CI 0.33-0.49). In the subgroup of patients who had acute coronary syndromes, the adjusted OR for this composite outcome was 0.46 (95% CI 0.35-0.61). During the 3 years of observation, the relative risks for death and repeat revascularization varied over time. In year 1, there was an initial period of lower risk in the group with drug-eluting stents than in the group with bare-metal stents; this was followed by a shift toward outcome rates favouring bare-metal stents in years 2 and 3. The adjusted relative risk of the composite outcome of death or repeat revascularization associated with drug-eluting stents relative to bare-metal stents was 0.73 early in the first year of follow-up; it then rose gradually over time, to a peak of 2.24 at 3 years. INTERPRETATION Drug-eluting stents are safe and effective in the first year following insertion. Thereafter, the possibility of longer term adverse events cannot be ruled out.
Collapse
|
34
|
Sarembock IJ. From systemic shotgun to site-specific nanoparticle-targeted delivery: a new paradigm for drug delivery. Arterioscler Thromb Vasc Biol 2008; 28:1879-81. [PMID: 18946050 DOI: 10.1161/atvbaha.108.175190] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
MESH Headings
- Angioplasty, Balloon/adverse effects
- Angioplasty, Balloon/instrumentation
- Animals
- Anti-Inflammatory Agents/administration & dosage
- Anti-Inflammatory Agents/chemistry
- Anti-Inflammatory Agents/pharmacology
- Atherosclerosis/drug therapy
- Atherosclerosis/metabolism
- Atherosclerosis/pathology
- Atherosclerosis/therapy
- Benzamidines/chemistry
- Cell Proliferation/drug effects
- Constriction, Pathologic
- Disease Models, Animal
- Fatty Acids/chemistry
- Humans
- Iliac Artery/drug effects
- Iliac Artery/injuries
- Injections, Intravenous
- Liposomes
- Metals
- Muscle, Smooth, Vascular/drug effects
- Muscle, Smooth, Vascular/injuries
- Muscle, Smooth, Vascular/metabolism
- Muscle, Smooth, Vascular/pathology
- Nanoparticles
- Prednisolone/administration & dosage
- Prednisolone/chemistry
- Prednisolone/pharmacokinetics
- Prosthesis Design
- Secondary Prevention
- Stents
Collapse
|
35
|
Menasché P. Revascularisation myocardique 30 ans après : la chirurgie toujours d’actualité. Presse Med 2008; 37:1569-74. [DOI: 10.1016/j.lpm.2008.01.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2007] [Accepted: 01/02/2008] [Indexed: 11/29/2022] Open
|
36
|
Abstract
September 2007 marked the 30-year anniversary of the first human percutaneous coronary intervention, an index event that changed the course of modern-day cardiovascular care. Before that first procedure, adult invasive cardiology focused on diagnostic angiography as well as hemodynamic assessment of structural heart disease. Since that initial procedure, percutaneous coronary intervention has become the most frequently performed coronary revascularization procedure worldwide. Several factors have been responsible for this dramatic paradigm shift, the most prominent being identification of opportunities for technical improvement and the application of innovation and investigation in concert with colleagues, professional societies, and industry. These approaches will continue to be of paramount importance as new technologies are brought to bear on an increasingly broader group of patients with cardiovascular disease.
Collapse
Affiliation(s)
- David R. Holmes
- From the Mayo Clinic, Rochester, Minn (D.R.H.), and Rhode Island Hospital, Providence, RI (D.O.W.)
| | - David O. Williams
- From the Mayo Clinic, Rochester, Minn (D.R.H.), and Rhode Island Hospital, Providence, RI (D.O.W.)
| |
Collapse
|
37
|
Sabatini PJB, Zhang M, Silverman-Gavrila R, Bendeck MP, Langille BL. Homotypic and endothelial cell adhesions via N-cadherin determine polarity and regulate migration of vascular smooth muscle cells. Circ Res 2008; 103:405-12. [PMID: 18617695 DOI: 10.1161/circresaha.108.175307] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Migration of smooth muscle cells from the arterial media to the intima is central to several vascular pathologies including restenosis. This study demonstrates that, like directional migration of other cells, smooth muscle migration is accompanied by a dramatic, polarized reorganization of the cell cytoskeleton that is accompanied by activation of the Rho GTPase Cdc42 and inactivation of glycogen synthase kinase-3beta. We also show, for the first time, that signals generated at the posterior-lateral aspects of wound edge cells by the cell-cell adhesion molecule N-cadherin are required for polarization and rapid migration of vascular smooth muscle. Importantly, when a cohort of migrating smooth muscle cells encounter CHO cells or the A10 smooth muscle cell line, neither of which expresses N-cadherin, polarity is only slightly suppressed. However, when smooth muscle cells encounter stably transfected, N-cadherin-expressing A10 cells or (N-cadherin-expressing) vascular endothelium, they rapidly lose their polarized phenotype. The latter finding indicates that endothelial signaling to innermost smooth muscle cells via N-cadherin may be critical to normal vessel wall stability. We infer that asymmetrical distribution of N-cadherin is necessary for the establishment of cell polarity during migration and that N-cadherin ligation is highly effective in abrogating polarized migration. Finally, we showed that endothelial cell polarity does not depend on N-cadherin; therefore, this molecule may be an attractive target for therapies to prevent restenosis without suppressing endothelial repair and risking late thrombosis.
Collapse
Affiliation(s)
- Peter J B Sabatini
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada M5G 1L7
| | | | | | | | | |
Collapse
|
38
|
Han Y, Guo L, Yan C, Guo P, Deng J, Mai X, Kang J, Li S. Adenovirus-mediated intra-arterial delivery of cellular repressor of E1A-stimulated genes inhibits neointima formation in rabbits after balloon injury. J Vasc Surg 2008; 48:201-9. [DOI: 10.1016/j.jvs.2008.01.061] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2007] [Revised: 01/31/2008] [Accepted: 01/31/2008] [Indexed: 11/17/2022]
|
39
|
Brinker J. The Left Main Facts: Faced, Spun, But Alas Too Few. J Am Coll Cardiol 2008; 51:893-8. [DOI: 10.1016/j.jacc.2007.10.046] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2007] [Accepted: 10/24/2007] [Indexed: 10/22/2022]
|
40
|
Abstract
This review aims to provide a glimpse into the future of drug-eluting stents (DES). Since their arrival in 2002, DES have transformed the practice of interventional cardiology by drastically reducing restenosis and the need for repeat revascularization. However, data about the potentially fatal long-term risk of stent thrombosis have spurred on research and development to improve upon the first generation of devices. The initial commercially available DES used a stainless steel platform coated with a permanent polymer to provide controlled release of the anti-restenotic drug. The platform, polymer and drug are all targets for improvement. More advanced metallic and fully biodegradable stent platforms are currently under investigation. The permanent polymer coating, a likely contributor adverse events, is being superseded by biocompatible and bioabsorbable alternatives. New drugs and drug combinations are also a research goal, as interventional cardiologists and the industry strive towards safer anti-restenotic DES.
Collapse
|
41
|
Coceani M. Management of atrial fibrillation. Lancet 2007; 370:1607; author reply 1608. [PMID: 17993358 DOI: 10.1016/s0140-6736(07)61681-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
42
|
Brunner-La Rocca HP, Kaiser C, Bernheim A, Zellweger MJ, Jeger R, Buser PT, Osswald S, Pfisterer M. Cost-effectiveness of drug-eluting stents in patients at high or low risk of major cardiac events in the Basel Stent KostenEffektivitäts Trial (BASKET): an 18-month analysis. Lancet 2007; 370:1552-9. [PMID: 17980734 DOI: 10.1016/s0140-6736(07)61660-2] [Citation(s) in RCA: 67] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Our aim was to determine whether drug-eluting stents are good value for money in long-term, everyday practice. METHODS We did an 18-month cost-effectiveness analysis of the Basel Stent KostenEffektivitäts Trial (BASKET), which randomised 826 patients 2:1 to drug-eluting stents (n=545) or to bare-metal stents (281). We used non-parametric bootstrap techniques to determine incremental cost-effectiveness ratios (ICERs) of drug-eluting versus bare-metal stents, to compare low-risk (> or =3.0 mm stents in native vessels; n=558, 68%) and high-risk patients (<3.0 mm stents/bypass graft stenting; n=268, 32%), and to do sensitivity analyses by altering costs and event rates in the whole study sample and in predefined subgroups. Quality-adjusted life-years (QALYs) were assessed by EQ-5D questionnaire (available in 703/826 patients). FINDINGS Overall costs were higher for patients with drug-eluting stents than in those with bare-metal stents (11,808 euros [SD 400] per patient with drug-eluting stents and 10,450 euros [592] per patient with bare-metal stents, mean difference 1358 euros [717], p<0.0001), due to higher stent costs. We calculated an ICER of 64,732 euros to prevent one major adverse cardiac event, and of 40,467 euros per QALY gained. Stent costs, number of events, and QALYs affected ICERs most, but unrealistic alterations would have been required to achieve acceptable cost-effectiveness. In low-risk patients, the probability of drug-eluting stents achieving an arbitrary ICER of 10,000 euros or less to prevent one major adverse cardiac event was 0.016; by contrast, it was 0.874 in high-risk patients. INTERPRETATION If used in all patients, drug-eluting stents are not good value for money, even if prices were substantially reduced. Drug-eluting stents are cost effective in patients needing small vessel or bypass graft stenting, but not in those who require large native vessel stenting.
Collapse
|