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Smith AH, Dash S, Steenberge S, Quatromoni JG, Rowse JW, Caputo FJ, Kirksey L, Graham LM, Lyden SP, Smolock CJ. Hypogastric artery luminal diameter predicts common-external iliac stent patency and major adverse limb events in patients with aortoiliac occlusive disease. Vascular 2024; 32:804-810. [PMID: 36802992 DOI: 10.1177/17085381221141737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
Abstract
OBJECTIVE Hypogastric coverage may be required for occlusive disease at the iliac arterial bifurcation. In this study, we sought to determine patency rates of common-external iliac artery (C-EIA) bare metal stents (BMS) spanning the hypogastric origin in patients with aortoiliac occlusive disease (AIOD). In addition, we sought to identify predictors of C-EIA BMS patency loss and major adverse limb events (MALE) in patients requiring hypogastric coverage. We hypothesized that worsening stenosis of the hypogastric origin would negatively influence C-EIA stent patency and freedom from MALE. METHODS This is a single center, retrospective review of consecutive patients undergoing elective, endovascular treatment of aortoiliac disease (AIOD) between 2010 and 2018. Only patients with C-EIA BMS coverage of a patent IIA origin were included in the study. Hypogastric luminal diameter was determined from preoperative CT angiography. Analysis was performed using Kaplan-Meier survival analysis, univariable and multivariable logistic regression, and receiver operator characteristics (ROC). RESULTS There were 236 patients (318 limbs) who were included in the study. AIOD was TASC C/D in 236/318 (74.2%) of cases. C-EIA stent primary patency was 86.5% (95% confidence interval: 81.1, 91.9) at 2 years and 79.7% (72.8, 86.7) at 4 years. Freedom from ipsilateral MALE was 77.0% (71.1, 82.9) at 2 years and 68.7% (61.3, 76.2) at 4 years. Luminal diameter of the hypogastric origin was most strongly associated with loss of C-EIA BMS primary patency in multivariable analysis (hazard ratio: 0.81, p = .02). Insulin-dependent diabetes, Rutherford's class IV or above, and stenosis of the hypogastric origin were significantly predictive of MALE in both univariable and multivariable analyses. In ROC analysis, luminal diameter of the hypogastric origin was superior to chance in prediction of C-EIA primary patency loss and MALE. Hypogastric diameter >4.5 mm had a negative predictive value of 0.94 for C-EIA primary patency loss and 0.83 for MALE. CONCLUSIONS Patency rates of C-EIA BMS are high. Hypogastric luminal diameter is an important and potentially modifiable predictor of C-EIA BMS patency and MALE in patients with AIOD.
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Affiliation(s)
- Andrew H Smith
- Aortic Center and Heart Vascular and Thoracic Institute, Department of Vascular Surgery, Cleveland Clinic, Cleveland, OH, USA
| | - Siddhartha Dash
- Aortic Center and Heart Vascular and Thoracic Institute, Department of Vascular Surgery, Cleveland Clinic, Cleveland, OH, USA
| | - Sean Steenberge
- Aortic Center and Heart Vascular and Thoracic Institute, Department of Vascular Surgery, Cleveland Clinic, Cleveland, OH, USA
| | - Jon G Quatromoni
- Aortic Center and Heart Vascular and Thoracic Institute, Department of Vascular Surgery, Cleveland Clinic, Cleveland, OH, USA
| | - Jarrad W Rowse
- Aortic Center and Heart Vascular and Thoracic Institute, Department of Vascular Surgery, Cleveland Clinic, Cleveland, OH, USA
| | - Francis J Caputo
- Aortic Center and Heart Vascular and Thoracic Institute, Department of Vascular Surgery, Cleveland Clinic, Cleveland, OH, USA
| | - Levester Kirksey
- Aortic Center and Heart Vascular and Thoracic Institute, Department of Vascular Surgery, Cleveland Clinic, Cleveland, OH, USA
| | - Linda M Graham
- Aortic Center and Heart Vascular and Thoracic Institute, Department of Vascular Surgery, Cleveland Clinic, Cleveland, OH, USA
| | - Sean P Lyden
- Aortic Center and Heart Vascular and Thoracic Institute, Department of Vascular Surgery, Cleveland Clinic, Cleveland, OH, USA
| | - Christopher J Smolock
- Aortic Center and Heart Vascular and Thoracic Institute, Department of Vascular Surgery, Cleveland Clinic, Cleveland, OH, USA
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Ranno AM, Manjunatha K, Glitz A, Schaaps N, Reese S, Vogt F, Behr M. In-silico analysis of hemodynamic indicators in idealized stented coronary arteries for varying stent indentation. Comput Methods Biomech Biomed Engin 2024:1-22. [PMID: 39086224 DOI: 10.1080/10255842.2024.2382819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2024] [Revised: 05/22/2024] [Accepted: 06/27/2024] [Indexed: 08/02/2024]
Abstract
In this work, we investigate the effects of stent indentation on hemodynamic indicators in stented coronary arteries. Our aim is to assess in-silico risk factors for in-stent restenosis (ISR) and thrombosis after stent implantation. The proposed model is applied to an idealized artery with Xience V stent for four indentation percentages and three mesh refinements. We analyze the patterns of hemodynamic indicators arising from different stent indentations and propose an analysis of time-averaged WSS (TAWSS), topological shear variation index (TSVI), oscillatory shear index (OSI), and relative residence time (RRT). We observe that higher indentations display higher frequency of critically low TAWSS, high TSVI, and non-physiological OSI and RRT. Furthermore, an appropriate mesh refinement is needed for accurate representation of hemodynamics in the stent vicinity. The results suggest that disturbed hemodynamics could play a role in the correlation between high indentation and ISR.
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Affiliation(s)
- A M Ranno
- Chair for Computational Analysis of Technical Systems (CATS), RWTH Aachen University, Aachen, Germany
| | - K Manjunatha
- Institute of Applied Mechanics (IFAM), RWTH Aachen University, Aachen, Germany
| | - A Glitz
- Department of Cardiology, Vascular Medicine and Intensive Care (CARD), RWTH Aachen University, Aachen, Germany
| | - N Schaaps
- Department of Cardiology, Vascular Medicine and Intensive Care (CARD), RWTH Aachen University, Aachen, Germany
| | - S Reese
- Institute of Applied Mechanics (IFAM), RWTH Aachen University, Aachen, Germany
| | - F Vogt
- Department of Cardiology, Vascular Medicine and Intensive Care (CARD), RWTH Aachen University, Aachen, Germany
| | - M Behr
- Chair for Computational Analysis of Technical Systems (CATS), RWTH Aachen University, Aachen, Germany
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Bacigalupi E, Pizzicannella J, Rigatelli G, Scorpiglione L, Foglietta M, Rende G, Mantini C, Fiore FM, Pelliccia F, Zimarino M. Biomechanical factors and atherosclerosis localization: insights and clinical applications. Front Cardiovasc Med 2024; 11:1392702. [PMID: 39119184 PMCID: PMC11306036 DOI: 10.3389/fcvm.2024.1392702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Accepted: 07/15/2024] [Indexed: 08/10/2024] Open
Abstract
Although the entire vascular bed is constantly exposed to the same risk factors, atherosclerosis manifests a distinct intra-individual pattern in localization and progression within the arterial vascular bed. Despite shared risk factors, the development of atherosclerotic plaques is influenced by physical principles, anatomic variations, metabolic functions, and genetic pathways. Biomechanical factors, particularly wall shear stress (WSS), play a crucial role in atherosclerosis and both low and high WSS are associated with plaque progression and heightened vulnerability. Low and oscillatory WSS contribute to plaque growth and arterial remodeling, while high WSS promotes vulnerable changes in obstructive coronary plaques. Axial plaque stress and plaque structural stress are proposed as biomechanical indicators of plaque vulnerability, representing hemodynamic stress on stenotic lesions and localized stress within growing plaques, respectively. Advancements in imaging and computational fluid dynamics techniques enable a comprehensive analysis of morphological and hemodynamic properties of atherosclerotic lesions and their role in plaque localization, evolution, and vulnerability. Understanding the impact of mechanical forces on blood vessels holds the potential for developing shear-regulated drugs, improving diagnostics, and informing clinical decision-making in coronary atherosclerosis management. Additionally, Computation Fluid Dynamic (CFD) finds clinical applications in comprehending stent-vessel dynamics, complexities of coronary bifurcations, and guiding assessments of coronary lesion severity. This review underscores the clinical significance of an integrated approach, concentrating on systemic, hemodynamic, and biomechanical factors in atherosclerosis and plaque vulnerability among patients with coronary artery disease.
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Affiliation(s)
- Elena Bacigalupi
- Department of Neuroscience, Imaging and Clinical Sciences, “G. D'Annunzio” University of Chieti-Pescara, Chieti, Italy
| | - Jacopo Pizzicannella
- Department of Engineering and Geology, University “G. d’ Annunzio” Chieti-Pescara, Pescara, Italy
| | | | - Luca Scorpiglione
- Department of Neuroscience, Imaging and Clinical Sciences, “G. D'Annunzio” University of Chieti-Pescara, Chieti, Italy
| | - Melissa Foglietta
- Department of Neuroscience, Imaging and Clinical Sciences, “G. D'Annunzio” University of Chieti-Pescara, Chieti, Italy
- Cardiology Department, SS. Annunziata Hospital, Chieti, Italy
| | - Greta Rende
- Department of Neuroscience, Imaging and Clinical Sciences, “G. D'Annunzio” University of Chieti-Pescara, Chieti, Italy
| | - Cesare Mantini
- Department of Neuroscience, Imaging and Clinical Sciences, “G. D'Annunzio” University of Chieti-Pescara, Chieti, Italy
| | - Franco M. Fiore
- Division of Vascular Surgery, SS. Annunziata Hospital, Chieti, Italy
| | | | - Marco Zimarino
- Department of Neuroscience, Imaging and Clinical Sciences, “G. D'Annunzio” University of Chieti-Pescara, Chieti, Italy
- Cardiology Department, SS. Annunziata Hospital, Chieti, Italy
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Elborae A, Hassan M, Meguid MA, Bakry K, Samir A, Brilakis E, Kandil H, ElGuindy A. Self-Apposing Stents in Coronary Chronic Total Occlusions: A Pilot Study. Heart Lung Circ 2024; 33:500-509. [PMID: 38448254 DOI: 10.1016/j.hlc.2024.01.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 12/22/2023] [Accepted: 01/01/2024] [Indexed: 03/08/2024]
Abstract
OBJECTIVES This pilot study assessed the 12-month angiographic and clinical outcomes of self-apposing (SA) stents in patients undergoing chronic total occlusion (CTO) percutaneous coronary intervention (PCI). BACKGROUND Self-apposing (SA) stents may decrease incomplete strut apposition and stent strut coverage that are common after CTO PCI. METHODS We compared 20 patients who underwent CTO PCI using SA drug-eluting stents (DESs) with 20 matched control patients who underwent CTO PCI using balloon-expandable (BE)-DESs. All patients were followed up clinically for 12 months and had coronary angiography with optical coherence tomography at the end of the follow-up period. The primary end points were stent strut malapposition and strut coverage. The secondary end point was composite major adverse cardiovascular events (MACEs) at 12 months. RESULTS Both groups had high prevalence of diabetes mellitus, and most of the treated lesions were complex, with 62% having a J-CTO score of ≥3. All CTO PCI techniques were allowed for recanalisation, and 75% of the procedures were guided by intravascular ultrasound. At 12 months, the SA-DES group had fewer malapposed struts (0% [interquartile range (IQR) 0%-0%] vs 4.5% [IQR 0%-20%]; p<0.001) and uncovered struts (0.08% [IQR 0%-1.6%] vs 8.2% [IQR 0%-16%]; p<0.001). However, they showed significantly higher rates of MACEs due to clinically-driven target lesion revascularisation (45% vs 15%; p=0.038). CONCLUSIONS In this pilot study, compared with conventional BE-DESs, SA-DESs used in CTO PCI were associated with fewer malapposed and uncovered stent struts but also with significantly higher rates of in-stent restenosis and MACEs, mainly caused by clinically driven target lesion revascularisation.
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Affiliation(s)
- Ahmed Elborae
- Department of Cardiovascular Medicine, Faculty of Medicine, Cairo University, Giza, Egypt; Department of Cardiology, Aswan Heart Centre, Magdi Yacoub Global Heart Foundation, Aswan, Egypt.
| | - Mohamed Hassan
- Department of Cardiovascular Medicine, Faculty of Medicine, Cairo University, Giza, Egypt
| | - Mohammed Abdel Meguid
- Department of Cardiovascular Medicine, Faculty of Medicine, Cairo University, Giza, Egypt
| | - Karim Bakry
- Department of Cardiovascular Medicine, Faculty of Medicine, Cairo University, Giza, Egypt; Department of Cardiology, Aswan Heart Centre, Magdi Yacoub Global Heart Foundation, Aswan, Egypt
| | - Ahmad Samir
- Department of Cardiovascular Medicine, Faculty of Medicine, Cairo University, Giza, Egypt; Department of Cardiology, Aswan Heart Centre, Magdi Yacoub Global Heart Foundation, Aswan, Egypt
| | | | - Hossam Kandil
- Department of Cardiovascular Medicine, Faculty of Medicine, Cairo University, Giza, Egypt
| | - Ahmed ElGuindy
- Department of Cardiology, Aswan Heart Centre, Magdi Yacoub Global Heart Foundation, Aswan, Egypt
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Ubachs R, van der Sluis O, Smith S, Mertens J. Computational modeling of braided venous stents - Effect of design features and device-tissue interaction on stent performance. J Mech Behav Biomed Mater 2023; 142:105857. [PMID: 37099918 DOI: 10.1016/j.jmbbm.2023.105857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 03/25/2023] [Accepted: 04/12/2023] [Indexed: 04/28/2023]
Abstract
Designing venous stents with desired properties is challenging due to the partly conflicting performance criteria, e.g., enhancing flexibility may be at odds with increasing patency. To evaluate the effect of design parameters on the mechanical performance of braided stents, computational simulations are performed using finite element analysis. Model validation is performed through comparison with measurements. Considered design features are stent length, wire diameter, pick rate, number of wires, and stent end-type, being either open-ended or closed looped. Based on the requirements of venous stents, tests are defined to study the effect of design variations with respect to the following key performance criteria: chronic outward force, crush resistance, conformability, and foreshortening. Computational modeling is demonstrated to be a valuable tool in the design process through its ability of assessing sensitivities of various performance metrics to the design parameters. Additionally, it is shown, using computational modeling, that the interaction between a braided stent and its surrounding anatomy has a significant impact on its performance. Therefore, taking into account device-tissue interaction is crucial for the proper assessment of stent performance.
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Affiliation(s)
- René Ubachs
- Philips Research, High Tech Campus 34, 5656 AE Eindhoven, The Netherlands
| | - Olaf van der Sluis
- Philips Research, High Tech Campus 34, 5656 AE Eindhoven, The Netherlands; Eindhoven University of Technology, Eindhoven, The Netherlands.
| | - Scott Smith
- Philips Image Guided Therapy Devices, 5905 Nathan Lane, Plymouth, MN, United States
| | - Jake Mertens
- Philips Image Guided Therapy Devices, 5905 Nathan Lane, Plymouth, MN, United States
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McQueen A, Escuer J, Schmidt AF, Aggarwal A, Kennedy S, McCormick C, Oldroyd K, McGinty S. An intricate interplay between stent drug dose and release rate dictates arterial restenosis. J Control Release 2022; 349:992-1008. [PMID: 35921913 DOI: 10.1016/j.jconrel.2022.07.037] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 07/14/2022] [Accepted: 07/26/2022] [Indexed: 10/15/2022]
Abstract
Since the introduction of percutaneous coronary intervention (PCI) for the treatment of obstructive coronary artery disease (CAD), patient outcomes have progressively improved. Drug eluting stents (DES) that employ anti-proliferative drugs to limit excess tissue growth following stent deployment have proved revolutionary. However, restenosis and a need for repeat revascularisation still occurs after DES use. Over the last few years, computational models have emerged that detail restenosis following the deployment of a bare metal stent (BMS), focusing primarily on contributions from mechanics and fluid dynamics. However, none of the existing models adequately account for spatiotemporal delivery of drug and the influence of this on the cellular processes that drive restenosis. In an attempt to fill this void, a novel continuum restenosis model coupled with spatiotemporal drug delivery is presented. Our results indicate that the severity and time-course of restenosis is critically dependent on the drug delivery strategy. Specifically, we uncover an intricate interplay between initial drug loading, drug release rate and restenosis, indicating that it is not sufficient to simply ramp-up the drug dose or prolong the time course of drug release to improve stent efficacy. Our model also shows that the level of stent over-expansion and stent design features, such as inter-strut spacing and strut thickness, influence restenosis development, in agreement with trends observed in experimental and clinical studies. Moreover, other critical aspects of the model which dictate restenosis, including the drug binding site density are investigated, where comparisons are made between approaches which assume this to be either constant or proportional to the number of smooth muscle cells (SMCs). Taken together, our results highlight the necessity of incorporating these aspects of drug delivery in the pursuit of optimal DES design.
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Affiliation(s)
- Alistair McQueen
- Division of Biomedical Engineering, University of Glasgow, Glasgow, UK
| | - Javier Escuer
- Aragón Institute for Engineering Research (I3A), University of Zaragoza, Zaragoza, Spain
| | | | - Ankush Aggarwal
- Glasgow Computational Engineering Centre, Division of Infrastructure and Environment, University of Glasgow, Glasgow, UK
| | - Simon Kennedy
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | | | - Keith Oldroyd
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Sean McGinty
- Division of Biomedical Engineering, University of Glasgow, Glasgow, UK; Glasgow Computational Engineering Centre, Division of Infrastructure and Environment, University of Glasgow, Glasgow, UK.
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Csató G, Erdei N, Ványai B, Balla T, Czuriga D, Csanádi Z, Koszegi Z, Édes I, Szabó GT. Predictors of restenosis following percutaneous coronary stent implantation: The role of trimetazidine therapy. Front Cardiovasc Med 2022; 9:873899. [PMID: 35935652 PMCID: PMC9353214 DOI: 10.3389/fcvm.2022.873899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 07/04/2022] [Indexed: 11/23/2022] Open
Abstract
Aims In-stent restenosis (ISR) is an unresolved problem following percutaneous coronary intervention (PCI), having a negative impact on clinical outcome. The main goal of this study was to find new independent predictors that may influence the development of ISR. Methods and results In this retrospective analysis, 653 PCI patients were involved. All patients had coronary stent implantation and a follow-up coronary angiography. Based on the presence of ISR at follow-up, patients were divided into two groups: 221 in the ISR and 432 in the control group. When evaluating the medical therapy of patients, significantly more patients were on trimetazidine (TMZ) in the control compared to the ISR group (p = 0.039). TMZ was found to be an independent predictor of a lower degree of ISR development (p = 0.007). TMZ treatment was especially effective in bare metal stent (BMS)-implanted chronic coronary syndrome (CCS) patients with narrow coronary arteries. The inflammation marker neutrophil to lymphocyte ratio (NLR) was significantly elevated at baseline in the ISR group compared to controls. The reduction of post-PCI NLR was associated with improved efficacy of TMZ to prevent ISR development. Drug eluting stent implantation (p < 0.001) and increased stent diameter (p < 0.001) were the most important independent predictors of a lower degree of ISR development, while the use of longer stents (p = 0.005) was a major independent predictor of an increased ISR risk. Conclusion TMZ reduces the occurrence of ISR following PCI, with special effectiveness in BMS-implanted patients having CCS and narrow coronary arteries. TMZ treatment may help to lower ISR formation in countries with high BMS utilization rates.
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Affiliation(s)
- Gábor Csató
- Department of Cardiology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Nóra Erdei
- Department of Cardiology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Beatrix Ványai
- Department of Dermatology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Tímea Balla
- Department of Cardiology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Dániel Czuriga
- Department of Cardiology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Zoltán Csanádi
- Department of Cardiology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Zsolt Koszegi
- Department of Cardiology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - István Édes
- Department of Cardiology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Gábor Tamás Szabó
- Department of Cardiology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
- *Correspondence: Gábor Tamás Szabó
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8
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Wang H, Sun A, Li Y, Xi Y, Fan Y, Deng X, Chen Z. A systematic review of DVT and stent restenosis after stent implantation for iliac vein compression syndrome. MEDICINE IN NOVEL TECHNOLOGY AND DEVICES 2022. [DOI: 10.1016/j.medntd.2022.100125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Saleem T, Raju S. An overview of in-stent restenosis in iliofemoral venous stents. J Vasc Surg Venous Lymphat Disord 2021; 10:492-503.e2. [PMID: 34774813 DOI: 10.1016/j.jvsv.2021.10.011] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Accepted: 10/13/2021] [Indexed: 12/31/2022]
Abstract
BACKGROUND Although endovenous stents have been associated with overall low morbidity, they can require reinterventions to correct stent malfunction due to in-stent restenosis (ISR). ISR has often occurred iliofemoral venous stents but has not been well described. It has been reported to develop in >70% of patients who have undergone iliofemoral venous stenting. We sought to provide an overview of ISR in iliofemoral venous stents, including the pathologic, diagnostic, and management considerations and the identification of several areas of potential research in the future. METHODS A search of reported English-language studies was performed in PubMed and the Cochrane Library. "In-stent restenosis," "vein," "venous," "iliac," and "iliofemoral" were used as keywords. The pertinent reports included in the present review had addressed the pathology, diagnosis, and current management options for ISR. RESULTS ISR refers to the narrowing of the luminal caliber of the stent owing to the development of stenosis inside the stent itself. ISR should be differentiated from stent compression. Two main types of ISR have been described: soft and hard lesions. These lesions respond differently to angioplasty. Stent inflow and shear stress are important factors in the development of ISR. The treatment options available at present include balloon angioplasty (hyperdilation or isodilation), laser ablation, atherectomy, and Z-stent placement. CONCLUSIONS Reintervention for ISR should be determined by the presence of residual or recurrent symptoms and not simply by a numeric value obtained from an imaging study. Overall stent occlusion due to ISR is rare, and no role exists for prophylactic angioplasty to treat asymptomatic ISR. The current treatment options for ISR are mostly durable and effective. However, more research is needed on methods to prevent the development of ISR. The role of antiplatelet and anticoagulant agents in the prevention of ISR requires further investigation, with particular attention to unique subset of patients (after thrombosis vs nonthrombotic iliac vein lesions). For high-risk, post-thrombotic patients, anticoagulation can be considered to prevent ISR. The role of triple therapy (anticoagulation and dual antiplatelet therapy) in the prevention of ISR remains unclear.
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Affiliation(s)
- Taimur Saleem
- The RANE Center for Venous and Lymphatic Diseases, Jackson, Miss.
| | - Seshadri Raju
- The RANE Center for Venous and Lymphatic Diseases, Jackson, Miss
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Aoki J, Tanabe K. Mechanisms of drug-eluting stent restenosis. Cardiovasc Interv Ther 2020; 36:23-29. [PMID: 33222019 DOI: 10.1007/s12928-020-00734-7] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Accepted: 11/06/2020] [Indexed: 01/03/2023]
Abstract
Drug-eluting stents (DES) were developed to overcome in-stent restenosis (ISR), which has long been considered the main complication limiting the long-term efficacy of coronary stenting. New-generation DES which composed of advanced stent design with and without specific biocompatible polymer contributes a reduction of the incidence of ISR to rate ranging from 5 to 10%. The precise reasons of DES restenosis are still controversial and not fully understood. Angiographic and coronary images at the index procedure, systemic status of patients, medications, and intracoronary imaging at ISR site are all considered to find the possible mechanisms of DES restenosis. Multiple biological, genetic, mechanical, and technical factors might intricately contribute to DES restenosis. Biological and genetic factors of ISR are not able to be sufficiently modified by the current medical approaches. Tailored treatments avoiding mechanical and technical factors of ISR are required to reduce DES restenosis. Elucidation of DES restenosis leads to further improvement in the current DES system and finds the optimal approach to treat DES restenosis. The possible mechanisms of DES restenosis are discussed in this review.
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Affiliation(s)
- Jiro Aoki
- Division of Cardiology, Mitsui Memorial Hospital, 1 Kanda-Izumicho, Chiyoda-ku, Tokyo, 101-8643, Japan.
| | - Kengo Tanabe
- Division of Cardiology, Mitsui Memorial Hospital, 1 Kanda-Izumicho, Chiyoda-ku, Tokyo, 101-8643, Japan
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11
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Kretschmann T, Usai MV, Taneva GT, Pitoulias GA, Torsello G, Donas KP. The role of open and endovascular treatment of patients with chronic aortoiliac Leriche syndrome. Vascular 2019; 28:68-73. [PMID: 31272340 DOI: 10.1177/1708538119859782] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objectives Leriche syndrome, defined as a chronic obliteration of a segment of the infrarenal aorta and the iliac arteries, represents a challenging pathology. Surgical reconstruction represents the standard treatment option. However, the endovascular therapy is gaining ever greater applicability in several vascular territories comparable with the open repair results. The aim of the present study was to evaluate the role of endovascular repair in patients with chronic Leriche syndrome. Methods Between January 2008 and September 2016, 82 patients with Leriche syndrome underwent surgical and endovascular repair at two European vascular centers. After risk stratification, 40 patients were matched based on chronic TASC D obstructive arterial disease with involvement of the aortic bifurcation and bilateral iliac arteries, the age, and the cardiovascular risk factors identifying finally 20 patients who underwent surgical repair (open group) and 20 patients who were treated by deployment of stents/stent-grafts in the aortic and iliac segment (endo group). Kaplan–Meier estimation for patency and freedom from reintervention were calculated and univariate analyses were performed. Results Estimated primary patency rate was 100% vs. 84% at one year for the open group vs. endovascular group, respectively ( p = .05). Freedom from reintervention was 100% vs. 89% at one year for the open group vs. endo group ( p = .09). During the entire follow-up of 34.9 ± 23.1 months, five reinterventions were performed for the endo group vs. two for the open group ( p = .212). Additionally, the major adverse cardiac and cerebrovascular events were 5/20 vs. 2/20 for the endovascular vs. open group, respectively ( p = .212). The postoperative ankle–brachial index improved in 0.66 in the endo group vs. 0.71 in the open group ( p = .624). Conclusions Endovascular techniques for the treatment of complex chronic Leriche lesions seem not to be associated with better early or mid-term outcomes compared to surgical repair.
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Affiliation(s)
- Tim Kretschmann
- Department of Vascular Surgery, St. Franziskus Hospital Münster, Münster, Germany
| | - Marco V Usai
- Clinic of Vascular and Endovascular Surgery, University of Münster, Münster, Germany
| | - Gergana T Taneva
- Ramón y Cajal University Hospital, Ctra Colmenar Viejo, km. 9, 100, 28034, Madrid, Spain
| | - Georgios A Pitoulias
- Department of Vascular Surgery, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Giovanni Torsello
- Department of Vascular Surgery, St. Franziskus Hospital Münster, Münster, Germany
| | - Konstantinos P Donas
- Department of Vascular Surgery, St. Franziskus Hospital Münster, Münster, Germany
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Üveges Á, Jenei C, Kiss T, Szegedi Z, Tar B, Szabó GT, Czuriga D, Kőszegi Z. Three-dimensional evaluation of the spatial morphology of stented coronary artery segments in relation to restenosis. Int J Cardiovasc Imaging 2019; 35:1755-1763. [PMID: 31127455 PMCID: PMC6773821 DOI: 10.1007/s10554-019-01628-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Accepted: 05/13/2019] [Indexed: 11/30/2022]
Abstract
To investigate the correlations between the three-dimensional (3D) parameters of target coronary artery segments and restenosis after stent implantation. Sixty-four patients after single, cobalt chromium platform stent (27 BM stents and 37 DES) implantation were investigated retrospectively 12 ± 6 months after the index procedure. 3D coronary artery reconstruction was performed before and after the stent implantation using appropriate projections by a dedicated reconstruction software. The curve of the target segment was characterized by the ratio of the vessel length measured at midline (arc: A) and the distance between the edge points of the stent (chord: C): A/C ratio (ACr). Age, diabetes and hyperlipidaemia were taken into account for the statistical evaluation. 22 patients were diagnosed with ISR, while 42 patients without any restenosis served as controls. The two groups did not differ regarding major cardiovascular risk factors, proportion of the treated vessels or the type of stents. Higher initial ACr values were associated with greater straightening of the vessel curvature in all groups (p < 0.001). Significant negative correlations were found in cases of proximal or distal edge bending angles (p < 0.001). Pre-stent edge bending angles < 7° often showed an increase after the stent implantation, while in case of higher initial values, the bending angles generally decreased. Using multivariate logistic regression modelling we found that the pre-stent ACr was an independent predictor of in-stent restenosis (odds ratio for 1% increase of the ACr: 1.08; p = 0.012). Changes of angles at the stent edges following stent implantation correlate with the initial local bending angles. The ACr predispose to chronic shear stress in the vessel wall, which may contribute to the pathological intimal proliferation.
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Affiliation(s)
- Áron Üveges
- Division of Cardiology, Department of Cardiology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary. .,Szabolcs - Szatmár - Bereg County Hospitals and University Teaching Hospital, Nyíregyháza, Hungary.
| | - Csaba Jenei
- Division of Cardiology, Department of Cardiology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Tibor Kiss
- Szabolcs - Szatmár - Bereg County Hospitals and University Teaching Hospital, Nyíregyháza, Hungary
| | - Zoltán Szegedi
- Szabolcs - Szatmár - Bereg County Hospitals and University Teaching Hospital, Nyíregyháza, Hungary
| | - Balázs Tar
- Szabolcs - Szatmár - Bereg County Hospitals and University Teaching Hospital, Nyíregyháza, Hungary
| | - Gábor Tamás Szabó
- Division of Cardiology, Department of Cardiology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Dániel Czuriga
- Division of Cardiology, Department of Cardiology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Zsolt Kőszegi
- Division of Cardiology, Department of Cardiology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary.,Szabolcs - Szatmár - Bereg County Hospitals and University Teaching Hospital, Nyíregyháza, Hungary
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Zhang W, Liu D, Han X, Ren J, Zhou P, Ding P. MicroRNA-451 inhibits vascular smooth muscle cell migration and intimal hyperplasia after vascular injury via Ywhaz/p38 MAPK pathway. Exp Cell Res 2019; 379:214-224. [PMID: 30930138 DOI: 10.1016/j.yexcr.2019.03.033] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Revised: 03/22/2019] [Accepted: 03/26/2019] [Indexed: 01/09/2023]
Abstract
Increasing evidence has indicated that intimal hyperplasia is a common event in the pathophysiology of many vascular diseases including atherosclerosis (AS). Recently, deregulated microRNAs (miRNAs) have been reported to be associated with the pathophysiology of AS. However, the biological function and regulatory mechanisms of miRNAs in intimal hyperplasia in AS remain largely unclear. The aim of this study was to investigate the effects of miRNAs on intimal hyperplasia and reveal the underlying mechanisms of their effects. Firstly, the model of rat vascular injury was successfully constructed in vivo. Then, the miRNAs expression profiles were analyzed by miRNA microarray. It was observed that miR-451 was significantly downregulated in injury carotid arteries. Subsequently, we investigated miR-451 function and found that upregulation of miR-451 by agomir-451 improves intimal thickening in rats following vascular injury. It was also observed that miR-451 was downregulated in the VSMCs following platelet-derived growth factor type BB (PDGF-BB) stimulation. The upregulation of miR-451 attenuated PDGF-BB-induced VSMCs injury, as evidenced by inhibition of proliferation, invasion and migration. Besides, overexpression of miR-451 blocked the activation of p38 MAPK signaling pathway in PDGF-BB treated VSMCs, as demonstrated by the downregulation of phosphorylated (p-) p38. In addition, Ywhaz, a positive regulator of p38 MAPK signaling pathway, was found to be a direct target of miR-451 in the VSMCs and this was validated using a luciferase reporter assay. Overexpression of Ywhaz partially abolished the inhibitory effects of miR-451 overexpression on PDGF-BB induced VSMCs injury. Collectively, these findings indicated that miR-451 protected intimal hyperplasia and PDGF-BB-induced VSMCs injury by Ywhaz/p38 MAPK pathway, and miR-451 may be considered as a potential therapeutic target in the treatment of AS.
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Affiliation(s)
- Wenguang Zhang
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, Henan, China
| | - Dongmei Liu
- Department of Radiation Oncology, Henan Province Cancer Hospital, Zhengzhou, 450008, Henan, China
| | - Xinwei Han
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, Henan, China.
| | - Jianzhuang Ren
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, Henan, China
| | - Pengli Zhou
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, Henan, China
| | - Pengxu Ding
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, Henan, China
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Fluid-structure interaction (FSI) analysis of stent-graft for aortic endovascular aneurysm repair (EVAR): Material and structural considerations. J Mech Behav Biomed Mater 2018; 87:95-110. [DOI: 10.1016/j.jmbbm.2018.07.020] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Revised: 07/10/2018] [Accepted: 07/12/2018] [Indexed: 01/07/2023]
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Wall shear stress promotes intimal hyperplasia through the paracrine H 2O 2-mediated NOX-AKT-SVV axis. Life Sci 2018; 207:61-71. [PMID: 29847774 DOI: 10.1016/j.lfs.2018.05.045] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Revised: 05/21/2018] [Accepted: 05/26/2018] [Indexed: 12/24/2022]
Abstract
AIMS Oscillatory wall shear stress (WSS)-linked oxidative stress promotes intimal hyperplasia (IH) development, but the underlying mechanisms are not completely understood. MATERIALS AND METHODS We used an in vivo rabbit carotid arterial stenosis model representing different levels of WSS and found that WSS was increased at 1 month with 50% stenosis and was accompanied by VSMCs proliferation and interstitial collagen accumulation. Increased WSS promoted the expression of NOX, AKT, and survivin (SVV) and the proliferation/migration of VSMCs and reduced apoptosis. KEY FINDINGS Our in vitro study suggested that H2O2 promoted proliferation and migration while suppressing apoptosis in cultured human umbilical vascular endothelial cells. SIGNIFICANCE We demonstrated that the elevation of WSS promotes VSMC proliferation and migration through the H2O2-mediated NOX-AKT-SVV axis, thereby accelerating IH development.
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Chiastra C, Migliori S, Burzotta F, Dubini G, Migliavacca F. Patient-Specific Modeling of Stented Coronary Arteries Reconstructed from Optical Coherence Tomography: Towards a Widespread Clinical Use of Fluid Dynamics Analyses. J Cardiovasc Transl Res 2017; 11:156-172. [PMID: 29282628 PMCID: PMC5908818 DOI: 10.1007/s12265-017-9777-6] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Accepted: 12/18/2017] [Indexed: 11/30/2022]
Abstract
The recent widespread application of optical coherence tomography (OCT) in interventional cardiology has improved patient-specific modeling of stented coronary arteries for the investigation of local hemodynamics. In this review, the workflow for the creation of fluid dynamics models of stented coronary arteries from OCT images is presented. The algorithms for lumen contours and stent strut detection from OCT as well as the reconstruction methods of stented geometries are discussed. Furthermore, the state of the art of studies that investigate the hemodynamics of OCT-based stented coronary artery geometries is reported. Although those studies analyzed few patient-specific cases, the application of the current reconstruction methods of stented geometries to large populations is possible. However, the improvement of these methods and the reduction of the time needed for the entire modeling process are crucial for a widespread clinical use of the OCT-based models and future in silico clinical trials.
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Affiliation(s)
- Claudio Chiastra
- Laboratory of Biological Structure Mechanics (LaBS), Department of Chemistry, Materials and Chemical Engineering "Giulio Natta", Politecnico di Milano, Piazza Leonardo da Vinci 32, 20133, Milan, Italy.
| | - Susanna Migliori
- Laboratory of Biological Structure Mechanics (LaBS), Department of Chemistry, Materials and Chemical Engineering "Giulio Natta", Politecnico di Milano, Piazza Leonardo da Vinci 32, 20133, Milan, Italy
| | - Francesco Burzotta
- Institute of Cardiology, Catholic University of the Sacred Heart, Rome, Italy
| | - Gabriele Dubini
- Laboratory of Biological Structure Mechanics (LaBS), Department of Chemistry, Materials and Chemical Engineering "Giulio Natta", Politecnico di Milano, Piazza Leonardo da Vinci 32, 20133, Milan, Italy
| | - Francesco Migliavacca
- Laboratory of Biological Structure Mechanics (LaBS), Department of Chemistry, Materials and Chemical Engineering "Giulio Natta", Politecnico di Milano, Piazza Leonardo da Vinci 32, 20133, Milan, Italy
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di Palma G, Cortese B. Left Main restenosis in the DES era - a call for action. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2017; 19:466-470. [PMID: 29169984 DOI: 10.1016/j.carrev.2017.11.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Revised: 11/01/2017] [Accepted: 11/03/2017] [Indexed: 10/18/2022]
Abstract
Percutaneous treatment of the unprotected left main trunk (ULM), defined as a vessel without patent bypass graft either to the left circumflex (LCX) or left anterior descending (LAD) artery, has gained a precise role thanks to recent scientific evidence. Although new generation drug-eluting stents have already proven to be safer, there is still a consistent risk of restenosis and late adverse events. The optimal management of a ULM restenosis is still debated. Here we aim at presenting a review of the available data in literature and show our choice for treating it.
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Affiliation(s)
- Gaetano di Palma
- Unità Operativa di Cardiologia, ASST Fatebenefratelli-Sacco, P.O. Fatebenefratelli, Milano, Italy
| | - Bernardo Cortese
- Unità Operativa di Cardiologia, ASST Fatebenefratelli-Sacco, P.O. Fatebenefratelli, Milano, Italy.
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