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Kim S, Lee JS, Kim YH, Kim JS, Lim SY, Kim SH, Kim M, Ahn JC, Song WH. Favorable Vasomotor Function after Drug-Coated Balloon-Only Angioplasty of De Novo Native Coronary Artery Lesions. J Clin Med 2022; 11:299. [PMID: 35053994 DOI: 10.3390/jcm11020299] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 01/05/2022] [Accepted: 01/05/2022] [Indexed: 02/05/2023] Open
Abstract
Balloon-injured coronary segments are known to harbor abnormal vasomotion. We evaluated whether de novo coronary lesions treated using drug-coated balloon (DCB) are prone to vasospasm and how they respond to ergonovine and nitrate. Among 132 DCB angioplasty recipients followed, 89 patients underwent ergonovine provocation test at 6–9 months follow-up. Within-subject ergonovine- and nitrate-induced diameter changes were compared among three different sites: DCB-treated vs. angiographically normal vs. segment showing prominent vasoreactivity (spastic). No patient experienced clinically refractory vasospastic angina or symptom-driven revascularization during follow-up. Ergonovine induced vasospasm in seven patients; all were multifocal spasm either involving (n = 2) or rather sparing DCB-treated segments (n = 5). None showed focal spasm that exclusively involved DCB-treated lesions. Among 27 patients with vasospastic features, DCB-treated segments showed less vasoconstriction than spastic counterparts (p < 0.001). A total of 110 DCB-treated lesions were analyzed to assess vasomotor function. Vasomotor function, defined as a combined constrictor and dilator response, was comparable between DCB-treated and angiographically normal segments (p = 0.173), while significant differences were observed against spastic counterparts (p < 0.001). In our study, DCB-treated lesions were not particularly vulnerable to vasospasm and were found to have vasomotor function similar to angiographically normal segments, supporting safety of DCB-only strategy in treating de novo native coronary lesions.
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Zanaty M, Osorno-Cruz C, Byer S, Roa JA, Limaye K, Ishii D, Nakagawa D, Torner J, Yongjun L, Ortega-Gutiérrez S, Samaniego EA, Allan L, Hasan D. Tirofiban Protocol Protects Against Delayed Cerebral Ischemia: A Case-Series Study. Neurosurgery 2020; 87:E552-E556. [DOI: 10.1093/neuros/nyaa170] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Accepted: 03/17/2020] [Indexed: 11/13/2022] Open
Abstract
Abstract
BACKGROUND
There has not been any effective prophylaxis for delayed cerebral ischemia delayed cerebral ischemia (DCI) since the introduction of nimodipine. Platelet inhibition may reduce the risk by preventing the formation of microthrombi. Tirofiban has been used as a single monotherapy bridge given its safety profile and controlled platelet inhibition.
OBJECTIVE
To assess the risk of DCI in aneurysmal subarachnoid hemorrhages (aSAH) patients treated with the tirofiban protocol.
METHODS
aSAH patients between December 2010 and March 2019 who were treated with stent assisted coiling or flow-diverting device were started on a continuous tirofiban infusion protocol and were compared with patients who underwent coil embolization without antiplatelet therapy. Safety analysis was performed to assess DCI, hemorrhagic, and ischemic events.
RESULTS
A total of 21 patients were included in the tirofiban series and 81 in the control group. There was no statistical difference in age, gender, Hunt-Hess grade, and Fisher scale between the 2 groups except for a higher Fisher grade II in the tirofiban group. Multivariate analysis revealed tirofiban to reduce the risk of vasospasm by 72 percent (OR .28, P = .03), without affecting the risk of hemorrhagic complications (OR = 0.50, P = .26). Tirofiban reduced the risk of symptomatic stroke endovascular procedure but it did not reach significance (P = .06). DCI, older age, and postprocedural symptomatic stroke were significant predictors of mortality. Tirofiban reduced the mortality risk, but this association was not statistically significant.
CONCLUSION
The tirofiban protocol in aSAH patients reduces the risk of DCI without conferring additional risks. This supports previous findings were antiplatelet therapy reduced DCI in human and animal models.
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Affiliation(s)
- Mario Zanaty
- Department of Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - Carlos Osorno-Cruz
- Department of Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - Stefano Byer
- Department of Neurology, University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - Jorge A Roa
- Department of Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa
- Department of Neurology, University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - Kaustubh Limaye
- Department of Neurology, University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - Daizo Ishii
- Department of Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - Daichi Nakagawa
- Department of Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa
- Department of Neurosurgery, University of Tokyo, Tokyo, Japan
| | - James Torner
- Department of Epidemiology, University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - Lu Yongjun
- Department of Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | | | - Edgar A Samaniego
- Department of Neurology, University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - Lauren Allan
- Department of Surgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - David Hasan
- Department of Neurosurgery, University of Tokyo, Tokyo, Japan
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Cornelissen A, Vogt FJ. The effects of stenting on coronary endothelium from a molecular biological view: Time for improvement? J Cell Mol Med 2018; 23:39-46. [PMID: 30353645 PMCID: PMC6307786 DOI: 10.1111/jcmm.13936] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Accepted: 08/27/2018] [Indexed: 12/13/2022] Open
Abstract
Coronary artery stenting following balloon angioplasty represents the gold standard in revascularization of coronary artery stenoses. However, stent deployment as well as percutaneous transluminal coronary angioplasty (PTCA) alone causes severe injury of vascular endothelium. The damaged endothelium is intrinsically repaired by locally derived endothelial cells and by circulating endothelial progenitor cells from the blood, leading to re‐population of the denuded regions within several weeks to months. However, the process of re‐endothelialization is often incomplete or dysfunctional, promoting in‐stent thrombosis and restenosis. The molecular and biomechanical mechanisms that influence the process of re‐endothelialization in stented segments are incompletely understood. Once the endothelium is restored, endothelial function might still be impaired. Several strategies have been followed to improve endothelial function after coronary stenting. In this review, the effects of stenting on coronary endothelium are outlined and current and future strategies to improve endothelial function after stent deployment are discussed.
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Affiliation(s)
- Anne Cornelissen
- Department of Cardiology, Pneumology, Angiology, and Internal Intensive Medicine, University Hospital Aachen, Aachen, Germany
| | - Felix Jan Vogt
- Department of Cardiology, Pneumology, Angiology, and Internal Intensive Medicine, University Hospital Aachen, Aachen, Germany
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Liu X, Fan L, Ying C, Cheng Y, Wang M. Traumatic extracranial internal carotid-jugular fistula leading to serious injury: a case report in forensic assessment. Forensic Sci Res 2018; 5:170-173. [PMID: 32939433 PMCID: PMC7476610 DOI: 10.1080/20961790.2017.1421499] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Accepted: 12/22/2017] [Indexed: 11/13/2022] Open
Abstract
Extracranial carotid artery injuries may produce severe haemorrhage, cerebral damage or arteriovenous fistula. Examples of traumatic extracranial carotid-jugular fistula are not frequently reported, especially in forensic medicine. We report a controversial case of an extracranial internal carotid-jugular fistula resulting from a stab wound to the neck. The degree of the injury was classified under "The Standard of Human Body Injury Assessment (2014)" (SIA) in China by forensic examiners. We believe this case report will provide information for the forensic assessment of similar cases.
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Affiliation(s)
- Xia Liu
- Department of Clinical Forensic Medicine, Shanghai Key Laboratory of Forensic Medicine, Shanghai Forensic Platform, Academy of Forensic Science, Shanghai, China
| | - Lihua Fan
- Department of Clinical Forensic Medicine, Shanghai Key Laboratory of Forensic Medicine, Shanghai Forensic Platform, Academy of Forensic Science, Shanghai, China
| | - Chongliang Ying
- Department of Clinical Forensic Medicine, Shanghai Key Laboratory of Forensic Medicine, Shanghai Forensic Platform, Academy of Forensic Science, Shanghai, China
| | - Yibin Cheng
- Department of Clinical Forensic Medicine, Shanghai Key Laboratory of Forensic Medicine, Shanghai Forensic Platform, Academy of Forensic Science, Shanghai, China
| | - Maowen Wang
- Department of Clinical Forensic Medicine, Shanghai Key Laboratory of Forensic Medicine, Shanghai Forensic Platform, Academy of Forensic Science, Shanghai, China
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Nagahama Y, Allan L, Nakagawa D, Zanaty M, Starke RM, Chalouhi N, Jabbour P, Brown RD, Derdeyn CP, Leira EC, Broderick J, Chimowitz M, Torner JC, Hasan D. Dual antiplatelet therapy in aneurysmal subarachnoid hemorrhage: association with reduced risk of clinical vasospasm and delayed cerebral ischemia. J Neurosurg 2017; 129:702-710. [PMID: 29099296 DOI: 10.3171/2017.5.jns17831] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Clinical vasospasm and delayed cerebral ischemia (DCI) are devastating complications of aneurysmal subarachnoid hemorrhage (aSAH). Several theories involving platelet activation have been postulated as potential explanations of the development of clinical vasospasm and DCI. However, the effects of dual antiplatelet therapy (DAPT; aspirin and clopidogrel) on clinical vasospasm and DCI have not been previously investigated. The objective of this study was to evaluate the effects of DAPT on clinical vasospasm and DCI in aSAH patients. METHODS Analysis of patients treated for aSAH during the period from July 2009 to April 2014 was performed in a single-institution retrospective study. Patients were divided into 2 groups: patients who underwent stent-assisted coiling or placement of flow diverters requiring DAPT (DAPT group) and patients who underwent coiling only without DAPT (control group). The frequency of symptomatic clinical vasospasm and DCI and of hemorrhagic complications was compared between the 2 groups, utilizing univariate and multivariate logistic regression. RESULTS Of 312 aSAH patients considered for this study, 161 met the criteria for inclusion and were included in the analysis (85 patients in the DAPT group and 76 patients in the control group). The risks of clinical vasospasm (OR 0.244, CI 95% 0.097-0.615, p = 0.003) and DCI (OR 0.056, CI 95% 0.01-0.318, p = 0.001) were significantly lower in patients receiving DAPT. The rates of hemorrhagic complications associated with placement of external ventricular drains and ventriculoperitoneal shunts were similar in both groups (4% vs 2%, p = 0.9). CONCLUSIONS The use of DAPT was associated with a lower risk of clinical vasospasm and DCI in patients treated for aSAH, without an increased risk of hemorrhagic complications.
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Affiliation(s)
| | - Lauren Allan
- 2Department of General Surgery, Mercy Medical Center, Des Moines, Iowa
| | | | | | | | - Nohra Chalouhi
- 5Department of Neurosurgery, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Pascal Jabbour
- 5Department of Neurosurgery, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Robert D Brown
- 6Department of Neurology, Mayo Clinic, Rochester, Minnesota
| | | | - Enrique C Leira
- 8Department of Neurology, University of Iowa College of Medicine.,9Department of Epidemiology, University of Iowa, Iowa City
| | - Joseph Broderick
- 10Department of Neurology, University of Cincinnati Medical Center, Cincinnati, Ohio; and
| | - Marc Chimowitz
- 11Department of Neurology, Medical University of South Carolina, Charleston, South Carolina
| | - James C Torner
- 9Department of Epidemiology, University of Iowa, Iowa City
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Rey M, Kramberg M, Hess P, Morrison K, Ernst R, Haag F, Weber E, Clozel M, Baumann M, Caroff E, Hubler F, Riederer MA, Steiner B. The reversible P2Y 12 antagonist ACT-246475 causes significantly less blood loss than ticagrelor at equivalent antithrombotic efficacy in rat. Pharmacol Res Perspect 2017; 5. [PMID: 28805949 PMCID: PMC5625150 DOI: 10.1002/prp2.338] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Accepted: 06/01/2017] [Indexed: 11/07/2022] Open
Abstract
The P2Y12 receptor is a validated target for prevention of major adverse cardiovascular events in patients with acute coronary syndrome. The aim of this study was to compare two direct-acting, reversible P2Y12 antagonists, ACT-246475 and ticagrelor, in a rat thrombosis model by simultaneous quantification of their antithrombotic efficacy and surgery-induced blood loss. Blood flow velocity was assessed in the carotid artery after FeCl3 -induced thrombus formation using a Doppler flow probe. At the same time, blood loss after surgical wounding of the spleen was quantified. Continuous infusions of ACT-246475 and ticagrelor prevented the injury-induced reduction of blood flow in a dose-dependent manner. High doses of both antagonists normalized blood flow and completely abolished thrombus formation as confirmed by histology. Intermediate doses restored baseline blood flow to ≥65%. However, ACT-246475 caused significantly less increase of blood loss than ticagrelor; the difference in blood loss was 2.6-fold (P < 0.01) at high doses and 2.7-fold (P < 0.05) at intermediate doses. Potential reasons for this unexpected difference were explored by measuring the effects of ACT-246475 and ticagrelor on vascular tone. At concentrations needed to achieve maximal antithrombotic efficacy, ticagrelor compared with ACT-246475 significantly increased carotid blood flow velocity in vivo (P = 0.003), induced vasorelaxation of precontracted rat femoral arteries, and inhibited contraction of femoral artery induced by electrical field stimulation or by phenylephrine. Overall, ACT-246475 showed a significantly wider therapeutic window than ticagrelor. The absence of vasodilatory effects due to high selectivity of ACT-246475 for P2Y12 provides potential arguments for the observed safety advantage of ACT-246475 over ticagrelor.
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Affiliation(s)
- Markus Rey
- Idorsia Pharmaceuticals Ltd.Hegenheimermattweg 91AllschwilCH‐4123Switzerland
| | - Markus Kramberg
- Idorsia Pharmaceuticals Ltd.Hegenheimermattweg 91AllschwilCH‐4123Switzerland
| | - Patrick Hess
- Idorsia Pharmaceuticals Ltd.Hegenheimermattweg 91AllschwilCH‐4123Switzerland
| | - Keith Morrison
- Idorsia Pharmaceuticals Ltd.Hegenheimermattweg 91AllschwilCH‐4123Switzerland
| | - Roland Ernst
- Idorsia Pharmaceuticals Ltd.Hegenheimermattweg 91AllschwilCH‐4123Switzerland
| | - Franck Haag
- Idorsia Pharmaceuticals Ltd.Hegenheimermattweg 91AllschwilCH‐4123Switzerland
| | - Edgar Weber
- Idorsia Pharmaceuticals Ltd.Hegenheimermattweg 91AllschwilCH‐4123Switzerland
| | - Martine Clozel
- Idorsia Pharmaceuticals Ltd.Hegenheimermattweg 91AllschwilCH‐4123Switzerland
| | - Martine Baumann
- Idorsia Pharmaceuticals Ltd.Hegenheimermattweg 91AllschwilCH‐4123Switzerland
| | - Eva Caroff
- Idorsia Pharmaceuticals Ltd.Hegenheimermattweg 91AllschwilCH‐4123Switzerland
| | - Francis Hubler
- Idorsia Pharmaceuticals Ltd.Hegenheimermattweg 91AllschwilCH‐4123Switzerland
| | - Markus A. Riederer
- Idorsia Pharmaceuticals Ltd.Hegenheimermattweg 91AllschwilCH‐4123Switzerland
| | - Beat Steiner
- Idorsia Pharmaceuticals Ltd.Hegenheimermattweg 91AllschwilCH‐4123Switzerland
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7
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Mattsson E, Jansen I, Edvinsson L, Bergqvist D. Endothelial Influence on Vessel Wall Induced Vasospasm after Balloon Angioplasty. Acta Radiol 1993; 34:156-61. [DOI: 10.1177/028418519303400211] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Aortic segments from 47 New Zealand rabbits were used, of which 14 were denuded of endothelium. Balloon angioplasty was performed on the aortic segments in vitro. The inner surfaces were perfused and the perfusates then given to vessel segments with or without endothelium. The contraction evoked was then counteracted by adding either vasoactive intestinal polypeptide (VIP), substance P (SP), acetylcholine (ACh), or nitroglycerin (NTG) in increasing concentrations. Perfusates from aortic segments with or without endothelium and previously treated with angioplasty induced vasoconstriction of similar magnitude in the segments used for vasomotor investigation irrespective of whether the endothelium was intact in these or not. Endothelial dependent dilators (ACh, SP) did not counteract the contraction whereas endothelial independent dilators did (NTG, VIP). Neither the induction nor the reversal of vessel wall induced vasoconstriction after balloon angioplasty seems to depend on the presence of endothelial cells.
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8
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Johnson E, Ports T. Unstable Angina Pectoris: An Interventional Approach to Management. J Intensive Care Med 2016. [DOI: 10.1177/088506668800300404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The therapy of unstable angina has changed consider ably in the last 15 years. An improved understanding of the pathophysiology has led to many of the changes. Thrombus, platelet activation, progression of athero sclerosis, and coronary vasospasm all appear to have a role. Initial management in unstable angina should begin with aggressive medical therapy with nitrates, calcium antagonists, beta blockers, and aspirin. In patients who are refractory to aggressive medical management, early cardiac catheterization and coronary arteriography is in dicated. The literature appears to confirm that patients with unstable angina who are stabilized with aggressive medical therapy fare as well as those treated with emer gency bypass surgery. Percutaneous transluminal coro nary angioplasty (PTCA) is the treatment of choice in medically refractory unstable angina patients with single-vessel coronary disease. New approaches include culprit lesion angioplasty, thrombolytic therapy, coronary sinus retroperfusion, and new catheter-based revascularization methods such as intracoronary stents, laser methods and atherectomy. Culprit lesion angioplasty involves angioplasty of only the angina-producing artery in patients with multivessel coronary disease. Early data suggest that this may be an effective short-term alternative to multivessel PTCA or bypass surgery. Recent data also suggest a beneficial role for thrombolytic therapy and synchronized coronary si nus retroperfusion with arterial blood in patients with unstable angina. New catheter-based approaches are in the early stages of development, and their eventual role in the treatment of coronary artery disease and unstable angina remains to be elucidated.
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Affiliation(s)
- Eric Johnson
- Cardiovascular Research Institute, University of California, San Francisco, CA
| | - Thomas Ports
- Cardiovascular Research Institute, University of California, San Francisco, CA
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Paderi JE, Stuart K, Sturek M, Park K, Panitch A. The inhibition of platelet adhesion and activation on collagen during balloon angioplasty by collagen-binding peptidoglycans. Biomaterials 2011; 32:2516-23. [DOI: 10.1016/j.biomaterials.2010.12.025] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2010] [Accepted: 12/15/2010] [Indexed: 10/18/2022]
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10
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Maassenvandenbrink A, Centurión D, Villalón CM. Crosstalk of vascular 5-HT1 receptors with other receptors: Clinical implications. Neuropharmacology 2008; 55:986-93. [DOI: 10.1016/j.neuropharm.2008.06.051] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2008] [Revised: 06/24/2008] [Accepted: 06/25/2008] [Indexed: 01/02/2023]
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SANGHI PRAMOD, VIRMANI RENU, DO DAT, ERIKSON JOHN, ELLIOTT JAMES, CILINGIROGLU MEHMET, MATTHEWS HOLLY, KAZI MASOOD, RICKER ROBERT, BAILEY STEVENR. A Comparative Evaluation of Arterial Blood Flow and the Healing Response after Femoral Artery Closure Using Angio-Seal STS Plus and StarClose in a Porcine Model. J Interv Cardiol 2008; 21:329-36. [DOI: 10.1111/j.1540-8183.2008.00367.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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12
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Rallidis LS, Zolindaki MG, Manioudaki HS, Laoutaris NP, Velissaridou AH, Papasteriadis EG. Prognostic value of C-reactive protein, fibrinogen, interleukin-6, and macrophage colony stimulating factor in severe unstable angina. Clin Cardiol 2007; 25:505-10. [PMID: 12430780 PMCID: PMC6654719 DOI: 10.1002/clc.4960251106] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Inflammatory process plays an important role in the pathogenesis of acute coronary syndromes. HYPOTHESIS The study was undertaken to evaluate whether admission levels of C-reactive protein (CRP), fibrinogen, interleukin-6 (IL-6). and macrophage colony stimulating factor (MCSF) can predict short-term prognosis in patients with unstable angina. METHODS C-reactive protein, fibrinogen, IL-6, and MCSF were measured on admission in 141 consecutive patients, aged 59 +/- 10 years, with unstable angina (Braunwald class IIIb). Patients were divided into two groups according to their in-hospital outcome: Group 1 comprised 77 patients with a complicated course (2 died, 15 developed nonfatal myocardial infarction, and 60 had recurrence of angina), and Group 2 comprised 64 patients with an uneventful course. RESULTS Admission median levels of CRP (8.8 vs. 3.1 mg/l, p = 0.0002). fibrinogen (392 vs. 340 mg/dl, p = 0.008), IL-6 (8.8 vs. 4.5 pg/ml, p = 0.03), and MCSF (434 vs. 307 pg/ml, p = 0.0001) were higher in Group I than in Group 2. The MCSF levels were an independent risk factor for in-hospital events, with an adjusted odds ratio for eventful in-hospital outcome of 3.3 (95% confidence interval 1-10.9, p = 0.04), and correlated with levels of IL-6 (r(s) = 0.52, p = 0.0001), CRP (r(s) = 0.43, p = 0.0001), and fibrinogen (r(s) = 0.25, p = 0.004). CONCLUSIONS These findings suggest that among the studied inflammatory indices only increased admission levels of MCSF are strongly and independently related with adverse short-term prognosis in patients with severe unstable angina.
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Katritsis DG, Pantos J, Efstathopoulos E. Hemodynamic factors and atheromatic plaque rupture in the coronary arteries: from vulnerable plaque to vulnerable coronary segment. Coron Artery Dis 2007; 18:229-37. [PMID: 17429298 DOI: 10.1097/mca.0b013e328012a93d] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Coronary plaque disruption with superimposed thrombosis is the underlying pathology in the acute coronary syndromes and sudden death. Coronary plaques are constantly stressed by a variety of mechanical and hemodynamic forces that may precipitate or 'trigger' disruption of vulnerable or, at extreme conditions, even stable plaques. This paper reviews the exciting new evidence on the hemodynamic factors that may play a role in this process and provides the rationale for the introduction of the concept of the vulnerable coronary segment in the study of acute coronary syndromes.
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14
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Leineweber K, Böse D, Vogelsang M, Haude M, Erbel R, Heusch G. Intense Vasoconstriction in Response to Aspirate From Stented Saphenous Vein Aortocoronary Bypass Grafts. J Am Coll Cardiol 2006; 47:981-6. [PMID: 16516081 DOI: 10.1016/j.jacc.2005.10.053] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2005] [Revised: 09/29/2005] [Accepted: 10/10/2005] [Indexed: 11/23/2022]
Abstract
OBJECTIVES We sought to identify soluble vasoconstrictor substances that are released during stent implantation into saphenous vein aortocoronary bypass grafts. BACKGROUND Atherosclerotic saphenous vein aortocoronary bypass grafts are particularly vulnerable to plaque rupture. Protection devices prevent particulate debris from being embolized. Additional soluble vasoconstrictor substances possibly also contribute to impaired microvascular perfusion. METHODS Peripheral venous blood (VB) and aspirate (AS) were obtained from 14 patients with a significant stenosis in a saphenous vein graft during stent implantation under protection with a distal balloon occlusion device. In five additional patients, arterial blood (AB) was also taken distal to the stented lesion before intervention. Vasomotor substances in VB, AB, and AS plasma were identified in a bioassay of rat mesenteric arteries with intact (+E) and denuded endothelium (-E). Vasoconstriction was normalized to that induced by potassium chloride depolarization (100%). RESULTS Venous blood, AB, and AS plasma induced maximum vasoconstriction within six minutes. The AS plasma induced a vasoconstriction of 138 +/- 13% (-E) and 87 +/- 14% (+E); VB, of 70 +/- 14% (-E) and 23 +/- 4% (+E); and AB plasma obtained before intervention, of 49 +/- 9% (-E) and 36 +/- 8% (+E). The vasoconstrictor potency of AS plasma in endothelium-denuded vessels was related to the severity of anginal symptoms, angiographic stenosis severity, plaque volume, and plaque burden as determined by intravascular ultrasound. The AS plasma-induced vasoconstriction was largely attenuated by combined serotonin/5-hydroxytryptamine (5-HT)(2A/2C)- and 5-HT(1A/1B)-receptor blockade and eliminated by additional thromboxane A2 thromboxane-prostanoid (TP)-receptor blockade. CONCLUSIONS Stent implantation releases, apart from and in addition to particulate debris, soluble vasoconstrictor substances that possibly contribute to impaired microvascular perfusion.
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Affiliation(s)
- Kirsten Leineweber
- Institute of Pathophysiology, University of Essen School of Medicine, Essen, Germany
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Wahidi MM, Garland R, Feller-Kopman D, Herth F, Becker HD, Ernst A. Effect of Clopidogrel With and Without Aspirin on Bleeding Following Transbronchial Lung Biopsy. Chest 2005; 127:961-4. [PMID: 15764782 DOI: 10.1378/chest.127.3.961] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Clopidogrel, a potent inhibitor of platelet aggregation, is being commonly prescribed in the elderly population due to its benefits in patients with atherosclerotic diseases. It is currently unknown whether clopidogrel increases the risk of bleeding during invasive pulmonary procedures. METHODS Pigs of the Yorkshire species were randomized to one of the following two arms: clopidogrel (75 mg/d) alone; or clopidogrel plus aspirin (75 mg/d and 325 mg/d, respectively). The animals underwent flexible bronchoscopy with transbronchial lung biopsies under fluoroscopic guidance at baseline and after 1 week of daily oral intake of their assigned drugs. The main outcome of the study was the quantity of blood collected through the bronchoscope following transbronchial lung biopsy (TBLB). RESULTS Sixteen animals were enrolled in the study, with 8 animals randomized to each arm. No statistically significant difference was found in the average quantity of blood resulting from transbronchial lung biopsies between procedures performed at baseline and those performed after animals received either clopidogrel (mean [+/- SD] dose, 1.41 +/- 1.14 mL) or clopidogrel plus aspirin (mean dose, 1.75 +/- 1.28 mL; p = 0.42). CONCLUSIONS Clopidogrel, with or without aspirin, does not increase bleeding complications after TBLB in healthy pigs.
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Affiliation(s)
- Momen M Wahidi
- Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
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Rallidis LS, Zolindaki MG, Pentzeridis PC, Poulopoulos KP, Velissaridou AH, Apostolou TS. Raised concentrations of macrophage colony stimulating factor in severe unstable angina beyond the acute phase are strongly predictive of long term outcome. Heart 2004; 90:25-9. [PMID: 14676235 PMCID: PMC1768029 DOI: 10.1136/heart.90.1.25] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To evaluate the long term prognostic value of macrophage colony stimulating factor (MCSF), interleukin-6 (IL-6), and tumour necrosis factor alpha (TNFalpha) measured in serum six weeks after the occurrence of unstable angina. SUBJECTS 119 consecutive patients, mean (SD) age 58 (10) years, with severe unstable angina (Braunwald class IIIb); controls were 96 subjects of similar age and sex distribution. DESIGN MCSF, IL-6, and TNFalpha were measured on admission, at discharge, and six weeks later, and the patients were followed for two years. Clinical end points were: cardiac death, readmission for acute coronary syndromes, and revascularisation. SETTING District general hospital. RESULTS 113 patients completed follow up, during which two died of non-cardiac causes. Of the remaining 111 patients, 39 (35.1%) had a cardiac event (two deaths, 15 revascularisations, and 22 readmissions for acute coronary syndromes). MCSF and IL-6 concentrations at six weeks were higher in patients with cardiac events than in those without (424 v 306 pg/ml, p = 0.0008, and 6.6 v 4.5 pg/ml, p = 0.01, respectively). Cytokine concentrations at six weeks were also significantly higher than in the control group. Logistic regression analysis showed that MCSF concentrations were the only independent predictors of future events, with an adjusted odds ratio for events of 4.1 (95% confidence interval 1.1 to 14.8; p = 0.03). The two year survival free of cardiac events was significantly lower in patients with MCSF concentrations in the highest tertile (values > or = 468 pg/ml) than in those with values < 468 pg/ml. CONCLUSIONS Increased MCSF concentrations beyond the acute phase are strongly predictive of long term outcome in patients with severe unstable angina.
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Affiliation(s)
- L S Rallidis
- Department of Cardiology, General Hospital of Nikea, Piraeus, Greece.
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Hofmann LV, Sood S, Liddell RP, Gupta A, Arepally A, Rodriguez ER, Eng J. Arteriographic and pathologic evaluation of two suture-mediated arterial closure devices in a porcine model. J Vasc Interv Radiol 2003; 14:755-61. [PMID: 12817043 DOI: 10.1097/01.rvi.0000079985.80153.17] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
PURPOSE To determine the acute and short-term effects the Sutura 8-F SuperStitch and Perclose 6-F Closer devices have on the femoral artery, as determined by angiography and pathologic examination. MATERIALS AND METHODS From a common carotid artery cutdown, eight pigs underwent pelvic angiography (i) before placement of bilateral common femoral artery vascular sheaths, (ii) after sheath insertion, and (iii) after device deployment. Two pigs were immediately killed; six survived 4 weeks for repeat angiography and vessel harvest. RESULTS Average vessel diameter before sheath insertion was 5.9 mm +/- 0.6 and 5.8 mm +/- 0.6 for vessels with Perclose and Sutura devices, respectively. After deployment of the Sutura device, there was a 44.7% (P =.001) mean diameter reduction from preprocedural diameters, compared to a 59.3% reduction (P <.001) with the Perclose device. After deployment of the Sutura device, there was a mean vessel diameter reduction of 14.1% (P =.53) versus the diameter immediately after sheath placement. After deployment of the Perclose device, there was a mean vessel diameter reduction of 43.8% (P =.05) versus the diameter immediately after sheath placement. At 4-week angiography, all vessels returned to their original diameters before sheath insertion. Pathologic examination showed mild adventitial fibrosis creating a "fibrous hood" surrounding the suture and vessel. CONCLUSIONS Despite significant luminal compromise after device deployment, all vessels appeared normal on angiography at 4 weeks. Contrary to the normal angiographic findings, both devices incited periadventitial fibrosis, which created a fibrous hood around the suture and vessel.
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Affiliation(s)
- Lawrence V Hofmann
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Medical Institutions, Blalock 545, 600 North Wolfe Street, Baltimore, Maryland 21287, USA.
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18
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Abstract
Somatostatin analogues are capable of inhibiting vascular smooth muscle and endothelial cell proliferation. However, little is known about the effect of somatostatin on vascular responses in endothelium-denuded coronary arteries in vitro. The aim of this work was to determine whether or not somatostatin prevented the contractile response induced by 5-hydroxytryptamine and acetylcholine in endothelium-denuded rabbit coronary arteries. Somatostatin attenuated the contraction produced by 5-hydroxytryptamine in both proximal (PC) and distal coronary (DC) arteries (contraction induced by 10(-4) M 5-hydroxytryptamine was inhibited by 10(-6) M somatostatin by 90.8 +/- 11.0% (P < 0.001, n = 9) and by 46.2 +/- 14.0% (P < 0.05, n = 9) in DC and PC, respectively), but concentration-dependently decreased the contraction induced by U46619 (11alpha-epoxy-methanoprostaglandin F2alpha) only in PC arteries, suggesting that the response of PC and DC arteries to somatostatin were qualitatively different. Furthermore, we suggest that somatostatin may enhance acetylcholine-induced relaxation by combination of increasing endothelium-dependent relaxation (by a NO-dependent mechanism) and blocking contraction at the muscle level.
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Affiliation(s)
- Emilio Ruiz
- Department of Pharmacology, School of Medicine, Universidad Complutense, Madrid, Spain
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Hamasaki S, Al Suwaidi J, Higano ST, Miyauchi K, Holmes DR, Lerman A. Attenuated coronary flow reserve and vascular remodeling in patients with hypertension and left ventricular hypertrophy. J Am Coll Cardiol 2000; 35:1654-60. [PMID: 10807473 DOI: 10.1016/s0735-1097(00)00594-5] [Citation(s) in RCA: 129] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVES The purpose of this study was to evaluate the association between hypertension and left ventricular hypertrophy (LVH) with both coronary vascular remodeling and endothelial function. BACKGROUND The association between endothelial and nonendothelial coronary flow reserve with vascular remodeling in patients with hypertension and LVH is still unclear. METHODS One hundred and eleven patients with normal or mildly diseased coronary arteries at angiography underwent intravascular ultrasound examination of the left anterior descending coronary artery. Patients were divided into three groups: group 1: n = 13, hypertensive patients with LVH; group 2: n = 30, hypertensive patients without LVH; group 3: n = 68, normotensive patients. Vessel and lumen area and atherosclerotic plaque area were evaluated. Vascular reactivity was examined using intracoronary adenosine and acetylcholine. RESULTS Vessel area in group 1 (with LVH) was significantly (p < 0.01) greater than that in group 2 (without LVH), whereas, vessel area in both groups 1 and 3 was similar (12.8 +/- 0.8 mm2, 10.7 +/- 0.4 mm2 and 11.5 +/- 0.3 mm2). Coronary blood flow at baseline for patients in group 1 (with LVH) was significantly greater than it was for patients in groups 2 and 3 (81.1 +/- 9.9 ml/min, 56.5 +/- 6.2 ml/min and 48.1 +/- 3.2 ml/min, both p < 0.05). In comparison with groups 2 and 3, the response to both acetylcholine and adenosine was significantly impaired in patients with LVH. CONCLUSIONS The current study demonstrates that hypertension with LVH is associated with both coronary vascular remodeling and attenuated endothelial and nonendothelial coronary flow reserve.
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Affiliation(s)
- S Hamasaki
- Center for Coronary Physiology and Imaging, Department of Internal Medicine, Mayo Clinic and Mayo Foundation, Rochester, Minnesota 55905, USA
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20
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Abstract
Since its introduction into clinical practice, more than 20 years ago, percutaneous transluminal coronary angioplasty (PTCA) has proven to be an effective, minimally invasive alternative to coronary artery bypass grafting (CABG). During this time there have been great improvements in the design of balloon catheters, operative procedures and adjuvant drug therapy, and this has resulted in low rates of primary failure and short-term complications. However, the potential benefits of angioplasty are diminished by the high rate of recurrent disease. Up to 40% of patients undergoing angioplasty develop clinically significant restenosis within a year of the procedure. Although the deployment of endovascular stents at the time of angioplasty improves the short-term outcome, 'in-stent' stenosis remains an enduring problem. In order to gain an insight into the mechanisms of restenosis, several experimental models of angioplasty have been developed. These have been used together with the tools provided by recent advances in molecular biology and catheter design to investigate restenosis in detail. It is now possible to deliver highly specific molecular antagonists, such as antisense gene sequences, to the site of injury. The knowledge provided by these studies may ultimately lead to novel forms of intervention. The present review is a synopsis of our current understanding of the pathological mechanisms of restenosis.
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Affiliation(s)
- G A Ferns
- Centre for Clinical Science and Measurement, School of Biological Sciences, University of Surrey, Guildford; The Royal Surrey County Hospital, Guildford, UK.
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21
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Connors J. Intracranial Atherosclerosis: Natural History, Therapy, and Results. J Vasc Interv Radiol 2000. [DOI: 10.1016/s1051-0443(00)70073-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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TIEDE DANIELJ, BRADY PETERA, GARRATT KIRKN, HOLMES DAVIDR. Resolution of the "No-Reflow" Phenomenon with Intracoronary Administration of Adenosine. J Interv Cardiol 2000. [DOI: 10.1111/j.1540-8183.2000.tb00690.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Chesebro JH, Badimon JJ, Hassinger NL, McBane RD, Fuster V V. Acute Myocardial Infarction and the Role of Aspirin, Heparin, and Warfarin. J Thromb Thrombolysis 1995; 1:231-5. [PMID: 10608000 DOI: 10.1007/BF01060732] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Acute myocardial infarction is initiated by plaque disruption of a fatty plaque with a thin fibrous cap which has been infiltrated by macrophages. The macrophages are attracted and stimulated by oxidized lipids to secrete metalloproteinases which dissolve collagen and arterial wall matrix and to synthesize tissue factor which accumulates in the fatty gruel, and initiates the thrombotic process when exposed to flowing blood after plaque disruption. This initiates thrombin generation which is greatly amplified by the coagulation cascade.Minute amounts of thrombin initiate platelet aggregation, deposition and secretion with growth of platelet-rich thrombus and an accompanying network of fibrin which is at the base of platelet deposition, and increased over regions of deep injury where there appears to be enhanced thrombin generation. Thrombin is necessary for upregulation of platelet membrane receptors, growth of thrombus, maintenance of platelet cohesion, conversion of fibrinogen to fibrin, cross-linking of fibrin and, in part, for activation of the fibrinolytic system.Thrombosis is directly related to local rheology (shear force, turbulence), thrombogenicity of the exposed arterial wall substrates, and modified by systemic factors. Acute vasoconstriction is directly related to platelet deposition, enhanced by endothelial dysfunction or absence, and increased by hypercholesterolemia which induces production of the potent vasoconstrictor endothelin.Direct thrombin inhibition with a high affinity inhibitor, such as hirudin, totally blocks growth of thrombus, inhibits fibrin formation at lower doses and platelet deposition at somewhat higher doses, and enhances dissolution of residual thrombus. Dissolution of residual thrombus reduces luminal obstruction, and may reduce the need for revascularization procedures since plaque disruption most often occurs in arteries with minor obstruction (<50% stenosis).Current recommendations include intravenous heparin 5000 U bolus + 1,000 U/hr to maintain the aPTT at 60-85 sec, and aspirin (160-325 mg loading followed by 80 mg/day). Maximal inhibition of thrombus at the culprit lesion includes maintenance of heparin infusion plus daily aspirin and conversion of heparin to warfarin to maintain the INR at 2.0-3.0 for 3-6 months along with aspirin 80 mg/day as suggested by the ATACS trial. The value of fixed-dose warfarin plus low-dose aspirin in the acute and chronic phase after myocardial infarction is currently being evaluated in the Coumadin Aspirin Reinfarction Study.
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Al Suwaidi J, Higano ST, Holmes DR, Rihal CS, Lerman A. Measuring maximal percent area stenosis poststent placement with intracoronary Doppler and the continuity equation and correlation with intracoronary ultrasound and angiography. Am J Cardiol 1999; 84:650-4. [PMID: 10498133 DOI: 10.1016/s0002-9149(99)00410-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Quantitative coronary angiography (QCA) and intracoronary ultrasound (ICUS) are methods for anatomic assessment of stent deployment. Intracoronary Doppler is primarily a method for the physiologic assessment of coronary stenoses. It correlates well with traditional noninvasive measurements of lesion significance. Intracoronary Doppler was used for the anatomic assessment of de novo coronary artery stenosis with variable success; however, its use for anatomic assessment of adequate stent deployment is unavailable. A rapid, automated software program was developed based on a modified continuity equation to calculate the maximal in-stent percent area stenosis by comparing the maximal in-stent velocity to an average reference velocity (proximal and distal). This study was designed to compare the Doppler method of an anatomic assessment with QCA and ICUS in 15 patients. Physiologic success of stent deployment was determined by the distal coronary flow reserve to 24 to 36 microg of intracoronary adenosine. Following successful stent deployment, distal coronary flow reserve increased significantly from a baseline of 1.6 +/- 0.5 to 2.9 +/- 1.1. There was a significant correlation between the maximal in-stent percent area stenosis as measured by Doppler and both QCA (r = 0.78, p <0.01) and ICUS (r = 0.84, p <0.01). This study demonstrates that maximal in-stent percent area stenosis can be measured by intracoronary Doppler and a novel software program. The intracoronary Doppler guidewire method can assess the adequacy of stent deployment using both anatomic and physiologic principles and may supplement other quantitative methodologies.
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Affiliation(s)
- J Al Suwaidi
- Center for Coronary Physiology and Imaging, the Division of Cardiovascular Diseases, Mayo Clinic and Mayo Foundation, Rochester, Minnesota, USA
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Abstract
OBJECT A retrospective analysis of a 9-year experience with balloon angioplasty for intracranial atherosclerotic stenosis was undertaken with the goals of illustrating development of a safe technique for treatment of intracranial atherosclerotic disease and reporting the immediate results in this series of patients. METHODS Three distinct periods are defined, based on the technique used. In the early period, in which eight patients were treated, the angioplasty balloon size approximated the vessel size, but was always smaller. Angioplasty was moderately rapid and brief (15-30 seconds). Clinical improvement occurred in seven (87.5%) of eight patients, dissection without consequence occurred in four (50%) of eight, and residual stenosis greater than 50% was found in three (37.5%) of eight. No neurological complications occurred. In the middle period, in which 12 patients were treated, the balloon size approximated the vessel size, but oversizing by up to 0.25 mm was permitted. Angioplasty was extremely rapid and brief. Angiographically visible dissection occurred in nine (75%) of 12 patients, necessitating urokinase infusion in five (41.7%) of 12 and producing abrupt occlusion in one (8.3%) of 12, resulting in death. Occlusion secondary to the recrossing of the lesion occurred in one (8.3%) of 12, resulting in stroke. Good outcome was eventually achieved in 10 (83.3%) of 12. In the current period, in which 50 patients have been treated, the balloon is always undersized and inflation is extremely slow (several minutes). Dissection occurred in seven (14%) of 50 patients, necessitating fibrinolysis in two of 50 (4%, both uneventful) and producing no abrupt occlusion or stroke. Residual stenosis greater than 50% occurred in eight (16%) of 50, with no stenosis greater than 70%. Late restenosis occurred in four (9%) of 44 and successful repeated angioplasty was performed in all four. One guidewire vessel perforation occurred (2%), resulting in the patient's death. Good angiographic and short-term clinical outcome was achieved in the other 49 patients (98%). CONCLUSIONS Extremely slow balloon inflation combined with balloon undersizing results in decreased intimal damage, decreased acute platelet/thrombus deposition, and decreased acute closure. This technique sometimes yields suboptimal angiographic results but achieves the clinical goal safely. Intracranial angioplasty can be safely performed using this technique and modern equipment.
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Affiliation(s)
- J J Connors
- Department of Radiology, Louisiana State University School of Medicine, New Orleans, USA.
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Connors J, Wojak J. Development of a Safer Technique for Intracranial Angioplasty for Atherosclerosis by Analysis of 9 Years’ Experience in 68 Patients. J Vasc Interv Radiol 1999; 10:181-183. [DOI: 10.1016/s1051-0443(99)71083-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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27
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Li S, Zhao H, Guo Z. [The experimental investigation on the preventive effects of API0134 against the re-occlusion of coronary arteries after therapeutic thrombolysis in dogs]. Curr Med Sci 1999; 19:108-11. [PMID: 12840851 DOI: 10.1007/bf02886888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/1998] [Indexed: 10/19/2022]
Affiliation(s)
- S Li
- Abteilung für Notfallmedizin, Tongji Klinik, Tongji Medizinische Universität, Wuhan 430030
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Dongay B, Dol-Gleizes F, Herbert JM. Effect of fantofarone, a new Ca2+ channel antagonist, on angioplasty-induced vasospasm in an atherosclerotic rabbit model. Biochem Pharmacol 1998; 55:2047-50. [PMID: 9714327 DOI: 10.1016/s0006-2952(98)00026-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
In order to prevent and treat angioplasty-induced vasospasm, we investigated the effects of a new Ca2+ channel antagonist, fantofarone, a nondihydropyridine compound with a novel site of action on the L-type Ca2+ channel, in an animal model of angioplasty in rabbits with femoral atherosclerotic lesions. Vasospasm which occurred in saline-treated animals following angioplasty was markedly reduced by fantofarone (50 microg/kg, i.v.) at both the distal and proximal sites. Although it totally inhibited distal vasospasm, isosorbide dinitrate (0.3 mg/kg, i.v.) did not significantly affect proximal diameter decrease. Verapamil (0.2 mg/kg, i.v.) was much less potent than fantofarone in reducing angioplasty-induced vasospasm. Our results confirm the preventive effects of Ca2+ blockers on this phenomenon and extend this observation to a potent compound: fantofarone.
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Affiliation(s)
- B Dongay
- Haemobiology Research Department, Sanofi Recherche, Toulouse, France
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Marzilli M, Gliozheni E, Marraccini P, Fedele S. Primary coronary angioplasty in acute myocardial infarction: clinical correlates of the 'no reflow' phenomenon. Int J Cardiol 1998; 65 Suppl 1:S23-8. [PMID: 9706823 DOI: 10.1016/s0167-5273(98)00060-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
The purpose of this study was to assess clinical correlates of the 'no reflow' phenomenon in 21 consecutive patients with acute myocardial infarction and complete occlusion of the infarct related artery (TIMI 0 flow) that underwent successful direct PTCA. After successful recanalization, 11 patients (group I) maintained TIMI 3 flow and ten patients presented with the 'no reflow' phenomenon (Group II). New Q wave on the surface ECG appeared in six patients in group I and in nine patients in group II (P=NS), clinical and radiologic signs of cardiac failure were detected in two patients in group I and in seven patients in group II (P<0.03). Early recurrence of ischemia was reported in three patients of group II but not in group I (P=NS). We conclude that the 'no reflow' phenomenon occurs in about half the cases of direct PTCA for complete occlusion and predicts adverse clinical events.
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Affiliation(s)
- M Marzilli
- CNR-Institute of Clinical Physiology, Pisa, Italy
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Abstract
Our previous studies have shown that menadione is cytotoxic to platelets, leading to substantial release of vasoactive substances. To test whether platelet lysis induced by menadione could cause vasoconstriction, we investigated the effect of platelet lysate induced by menadione on rat aorta in organ bath system. We showed that menadione-induced platelet lysate caused vasoconstriction in a dose- and time-dependent manner. These effects were seen in aortic rings both with and without endothelium, but it was much greater in rings without intact endothelium. The time course of vasoconstriction was well correlated with the time courses of platelet lysis (assessed by lactate dehydrogenase release) as well as serotonin release. The vasoconstriction by platelet lysate was blocked by serotonin antagonists, ketanserin, and LY53,857, but not by thromboxane A2 (TXA2) receptor antagonist, SQ29,548, suggesting that vasoconstriction mainly occurred secondary to the release of serotonin in our in vitro system. However, potentiation of vasoconstriction by combined treatment of serotonin and a stable TXA2 mimic, U46619, suggests the possibility of the increased risk for vasoconstriction in vivo. In addition, the serotonin-induced vasoconstriction was potentiated by residual menadione present in the organ bath. These results suggest that chemically induced platelet cytotoxicity can provoke alteration in vasomotor tone by release of serotonin.
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Affiliation(s)
- J Y Lee
- College of Pharmacy, Seoul National University, Korea
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Sawada M, Hashimoto N, Nishi S, Sampei K, Fukao S, Yoshimura S. Restenosis after transluminal angioplasty for atherosclerotic vertebral and subclavian artery stenosis. J Clin Neurosci 1998; 5:220-225. [DOI: 10.1016/s0967-5868(98)90044-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/1996] [Accepted: 04/18/1996] [Indexed: 11/17/2022]
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Abstract
Substantial evidence of postangioplasty vasoconstriction is available, both at the dilated site and distal to balloon injury, demonstrating its frequent occurrence. It is likely that even mild or moderate vasoconstriction at the site of balloon injury may create flow turbulence, promoting platelet aggregation and contributing to thrombotic vessel closure. The regulation of arterial smooth muscle tone is a complex process and should be distinguished from elastic recoil, which occurs at the site of balloon injury due to passive elastic properties of the artery, generally immediately after balloon deflation. The contribution of a variety of messengers generated by humoral, neurogenic, myogenic, and endothelium-derived factors in this regulatory process has been implicated. The possible mechanisms of post-percutaneous transluminal coronary angioplasty vasoconstriction at the dilated site (local) and in segments of coronary artery beyond the dilated site (distal) are reviewed in this article.
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Affiliation(s)
- V K Misra
- Division of Cardiology/Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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Mandinov L, Kaufmann P, Staub D, Buckingham TA, Amann FW, Hess OM. Coronary vasomotion after percutaneous transluminal coronary angioplasty depends on the severity of the culprit lesion. J Am Coll Cardiol 1997; 30:682-8. [PMID: 9283526 DOI: 10.1016/s0735-1097(97)00212-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVES This study sought to evaluate coronary vasomotor response to percutaneous transluminal coronary angioplasty (PTCA) and its influence on proximal and distal vessel diameters with regard to stenosis severity and coronary blood flow. BACKGROUND Coronary vasoconstriction of the distal vessel segment has been reported after PTCA. This vasoconstrictive effect was thought to be due to balloon-induced injury of the vessel wall, with release of local vasoconstrictors or stimulation of the sympathetic system with release of catecholamines, or both. METHODS Thirty-nine patients were prospectively studied before and after PTCA. Patients were classified into two groups according to the severity of the culprit lesion: group 1 = > or = 70% to < or = 85% diameter stenosis (n = 23); and group 2 = > 85% to < or = 95% diameter stenosis (n = 16). The coronary vessel diameter of the proximal and distal vessel segments as well as the minimal lumen diameter were determined by quantitative coronary angiography. In a subgroup of 16 patients, basal and maximal coronary flow velocity was measured before and after PTCA with the Doppler FloWire system. RESULTS The groups were comparable with regard to age, gender, serum cholesterol levels and medical therapy. The proximal vessel segment remained unchanged after PTCA in group 1 ([mean +/- SD] 0.9 +/- 3.5%, p = 0.8) but showed vasodilation in group 2 (+13.7 +/- 3.6%, p < 0.05). However, the distal segment showed vasoconstriction in group 1 (-6.7 +/- 2.0%, p < 0.01) and vasodilation in group 2 (+31 +/- 8.0%, p < 0.01). A significant correlation was found between the change in distal vessel diameter after PTCA and stenosis severity (r = 0.61, p < 0.0001). Changes in blood flow were directly correlated to stenosis severity (r = 0.85, p < 0.002); that is, rest flow increased after PTCA in narrow lesions but remained unchanged in moderate lesions. The diameter changes in the distal vessel segment after PTCA were significantly related to flow changes (r = 0.90, p < 0.0001). Coronary distending pressure of the distal vessel segment increased significantly in both groups; however, this increase was significantly greater in group 2 than in group 1 (55 +/- 4 vs. 14 +/- 3 mm Hg, p < 0.0001). CONCLUSIONS Coronary vasomotion of the proximal and distal vessel segments after PTCA depends on the severity of the culprit lesion; that is, vasoconstriction of the distal segment is found in patients with moderate lesions and vasodilation in those with severe lesions. Thus, vasomotion of the post-stenotic vessel segment depends on the severity of the culprit lesion and is influenced by changes in coronary flow or distending pressure, or both.
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Affiliation(s)
- L Mandinov
- Department of Cardiology, University Hospital, Zurich, Switzerland
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Arakawa K, Mizuno K, Shibuya T, Etsuda H, Tabata H, Nagayoshi H, Satomura K, Isojima K, Kurita A, Nakamura H. Angioscopic coronary macromorphology after thrombolysis in acute myocardial infarction. Am J Cardiol 1997; 79:197-202. [PMID: 9193025 DOI: 10.1016/s0002-9149(97)89290-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
In addition to a disruption of yellow plaque, vasospasm may also play a role in thrombotic occlusions of coronary arteries in small cases of infarction. Macroscopic vascular injury and thrombus seemed to be unnecessary for vasospasm culminating in myocardial infarction.
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Affiliation(s)
- K Arakawa
- Department of Internal Medicine I, National Defense Medical College, Saitama, Japan
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Abstract
OBJECTIVES This study sought to investigate whether changes in nervous autonomic tone may have a role in the mechanisms triggering spontaneous coronary spasm in variant angina. BACKGROUND Previous studies have suggested that both sympathetic and vagal activation may act as a trigger of epicardial artery spasm in patients with variant angina, but the actual role of autonomic changes in spontaneous coronary spasm remains unknown. METHODS We analyzed the changes in heart rate variability associated with episodes of ST segment elevation detected on Holter monitoring in 23 patients with variant angina (18 men, 5 women; mean [+/-SD] age 59 +/- 12 years). For study purposes, episodes of transmural ischemia lasting > or = 3 min and without any ST segment changes in the previous 40 min were selected for analysis. Heart rate variability indexes were calculated at 2-min intervals, at 30,15,5 and 1 min before ST elevation and at peak ST segment elevation. Ninety-three of 239 total ischemic episodes (39%) fulfilled the inclusion criteria. RESULTS The results showed that 1) high frequency (HF) (0.04 to 0.15 Hz), a heart rate variability index specific for vagal activity, decreased in the 2 min preceding ST segment elevation (p < 0.001) and returned to basal levels at peak ST segment elevation; 2) heart rate and low frequency (0.04 to 0.15 Hz), which are partially correlated with sympathetic activity, showed a significant increase at peak ST segment elevation (p < 0.001 for both); 3) the pattern of the HF reduction before ST segment elevation was consistently confirmed in several subgroups of ischemic episodes, including those of patients with or without coronary stenoses, those of patients with anterior or inferior ST segment elevation, those occurring during daily or nightly hours and silent episodes. There were no significant variations in heart rate variability in control periods selected from Holter tapes of patients and before ST segment elevation induced by balloon inflation in 20 patients undergoing coronary angioplasty. CONCLUSIONS Our data show that changes in autonomic tone are likely to contribute to trigger or predispose to epicardial spasm. In particular, although not excluding an active role for adrenergic mechanisms, our data suggest that a vagal withdrawal may often be a component of the mechanisms leading to spontaneous coronary vasospasm.
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Affiliation(s)
- G A Lanza
- Instituto di Cardiologia, Universitá Cattolica del Sacro Cuore, Rome, Italy
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Affiliation(s)
- P A Ribeiro
- Section of Cardiology, Loma Linda University Medical Center, California, USA
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Barrabés JA, Garcia-Dorado D, Oliveras J, González MA, Ruiz-Meana M, Solares J, Burillo AG, Lidón RM, Antolín M, Castell J, Soler-Soler J. Intimal injury in a transiently occluded coronary artery increases myocardial necrosis. Effect of aspirin. Pflugers Arch 1996; 432:663-70. [PMID: 8764967 DOI: 10.1007/s004240050183] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
This study tested the hypothesis that intimal injury in a transiently occluded coronary artery limits myocardial salvage. The effect of intimal injury on reactive hyperaemia was investigated in 17 pigs submitted to a 30-min occlusion of the left anterior descending coronary artery (LAD), not resulting in myocardial infarction. Catheter-induced intimal damage increased local platelet deposition (99mTc) and reduced hyperaemia, but did not modify myocardial platelet or polymorphonuclear leucocyte content (myeloperoxidase activity) after 6 h reperfusion. To investigate the influence of intimal injury on the extent of myocardial necrosis secondary to a more prolonged coronary occlusion, and the role of platelets on this influence, 52 pigs were submitted to a double randomization (2x2 factorial design) to 250 mg i.v. aspirin vs. placebo and to coronary intimal injury vs. no coronary damage before a 48-min occlusion of the LAD and 6 h of reperfusion. After excluding 12 animals with reocclusion, coronary intimal injury was associated with larger infarcts (triphenyltetrazolium reaction) in animals receiving placebo (36.2+/-7.0% of the area at risk in animals with intimal injury vs. 10.8+/-3.9% in animals without coronary injury, P=0.006) but not in those receiving aspirin (20.3+/-6.5 vs. 21.7+/-6.5% of the area at risk in animals with and without intimal injury respectively). These results suggest that coronary intimal injury in the reperfused artery may have adverse effects on myocardial salvage by mechanisms other than reocclusion or embolization of platelet aggregates.
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Affiliation(s)
- J A Barrabés
- Servicio de Cardiología, Hospital General Universitario Vall d'Hebron, Pg. Vall d'Hebron 119-129, E-08035 Barcelona, Spain
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Sakata K, Hoshino T, Yoshida H, Shugino H, Miura F, Takada A. Characteristics of vasospastic angina with exercised-induced ischemia--analysis of parameters of hemostasis and fibrinolysis. Jpn Circ J 1996; 60:277-84. [PMID: 8803721 DOI: 10.1253/jcj.60.277] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
To characterize the vasospastic angina patients with exercise-induced ischemia, we measured hemostasis (platelet factor 4; PF4, fibrinopeptide A; FPA) and fibrinolytic parameters (tissue plasminogen activator antigen; t-PA, free plasminogen activator inhibitor-1 antigen; free PAI-1) in 15 normal subjects and 33 vasospastic angina patients without significant coronary artery stenosis (less than 50% stenosis). All of the vasospastic angina patients began to feel chest pain within 3 months before diagnostic coronary angiography. Blood samples were obtained from all of the study patients at 8:30-9:30 am before exercise 201Tl emission computed tomography. Vasospastic angina patients were divided into 2 groups; 15 patients with exercise-induced ischemia (group 1) and 18 patients without exercise-induced ischemia (group 2). On coronary angiography, the severity of coronary artery stenosis at the site of spasm in group 1 (34 +/- 5%) was greater than that in group 2 (18 +/- 3%). Plasma FPA and PF 4 levels in group 1 were also significantly higher than those in normal subjects and group 2. Plasma t-PA and free PAI-1 levels in group 1 were significantly higher than those in normal subjects and group 2. Plasma levels of free PAI-1 group 2 were also significantly higher than those in normal subjects. The present study demonstrated that all of the patients with vasospastic angina had impaired fibrinolysis, and these patients with exercise-induced ischemia showed enhanced platelet activation, an enhanced coagulation system, and advanced atherosclerotic lesions. These results suggest that vasospastic angina with exercise-induced ischemia puts patients at increased risk for thrombus formation.
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Affiliation(s)
- K Sakata
- Department of Cardiology, Shizuoka General Hospital, Japan
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Abstract
The basic mechanisms of atherosclerotic progression have been well elucidated during the last few years. In this brief presentation on the acute coronary syndromes, the fate of plaque rupture and our understanding of "passive" versus "active" rupture are defined. In addition to the phenomenon of plaque rupture, the thrombogenicity of atherosclerotic plaques in the genesis of coronary syndromes is defined. The combination of plaque disruption and high thrombogenic risk profile--including local and systemic factors--is vital to understanding the genesis of the acute coronary syndromes.
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Affiliation(s)
- V Fuster
- Cardiovascular Institute, Mount Sinai Medical Center, New York, New York 10029-6574, USA
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42
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Affiliation(s)
- E Falk
- Department of Interventional Cardiology, Skejby University Hospital, Aarhus, Denmark
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Nishimura RA, Lerman A, Chesebro JH, Ilstrup DM, Hodge DO, Higano ST, Holmes DR, Tajik AJ. Epicardial vasomotor responses to acetylcholine are not predicted by coronary atherosclerosis as assessed by intracoronary ultrasound. J Am Coll Cardiol 1995; 26:41-9. [PMID: 7797774 DOI: 10.1016/0735-1097(95)00142-m] [Citation(s) in RCA: 75] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
OBJECTIVES The purpose of this study was to use intravascular ultrasound to determine the morphologic appearance of the coronary arteries, relating the absence, presence and extent of atherosclerosis to the response of the coronary arteries to acetylcholine infusion. BACKGROUND Endothelial function plays a major role in the pathophysiology of myocardial ischemia and angina pectoris. The response of the coronary arteries to selective infusion of acetylcholine has been used to examine endothelial function, with vasoconstriction occurring in the absence of intact endothelial function. Vasoconstriction to acetylcholine infusion in humans without overt coronary artery disease has been attributed to early atherosclerosis not detected by coronary angiography. METHODS Twenty-nine patients without overt coronary artery disease underwent selective coronary angiography and selective intracoronary infusion of increasing concentrations of acetylcholine (10(-6), 10(-5) and 10(-4) mol/liter), followed by intravascular ultrasound imaging. RESULTS The response of the coronary arteries to acetylcholine infusion was not dependent on the absence or presence of atherosclerotic plaque, as detected by intravascular ultrasound. The percent change in epicardial coronary artery diameter during acetylcholine infusion versus baseline was -14 +/- 28% (mean +/- SD) in the seven patients with no visible atherosclerosis on intravascular ultrasound versus -9 +/- 20% in the 22 patients with visible atherosclerosis on intravascular ultrasound (p = NS, confidence interval -14% to 25%). There was a greater vasoconstrictive response to acetylcholine infusion in patients with risk factors for coronary artery disease than in those without risk factors (p = 0.003). CONCLUSIONS The vasoreactive response to acetylcholine is not necessarily dependent on ultrasound detection of the presence or absence of atherosclerosis.
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Affiliation(s)
- R A Nishimura
- Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, Rochester, Minnesota 55905, USA
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44
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Abstract
The controlled arterial injury that occurs with balloon angioplasty and other coronary interventions is characterized by evanescent endothelial denudation and vascular disruption. As a consequence, platelet activation occurs at the treated site, and there is a risk of thrombotic occlusion. This risk is heightened by several factors including unstable clinical presentation, lesion complexity, deep injury, and dissection. Aspirin has been shown to unquestionably reduce, although not eliminate, acute complications and is now part of the routine periprocedural regimen. Heparinization with more intense anticoagulation than is conventionally used is also standard treatment and is initiated before vessel instrumentation. Adjunctive thrombolysis is rarely necessary unless refractory thrombus precedes or complicates the procedure. However, thrombolysis may have a role in the treatment of saphenous vein graft obstructive lesions in which guide wire- or catheter-induced distal thromboembolization may cause infarction in spite of successful graft recanalization. In contrast to their success in the periprocedural phase of coronary interventions, anticoagulants and a wide variety of platelet active agents have been ineffective in reducing the 30% to 40% incidence of restenosis. Only 7E3, which targets the final common pathway of platelet aggregation by irreversibly blocking the IIb/IIIa receptor, has been shown to decrease the 6-month clinical event rate after balloon angioplasty, possibly by a surface pacification mechanism. This suggests that newer more potent antiplatelet and anticoagulant agents may also find a role in the long-term management of these patients.
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Affiliation(s)
- L Schwartz
- Toronto General Hospital, Ontario, Canada
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Hirasawa Y, Nishio M, Maeda K, Yoshida K, Kita Y. Comparison of antiplatelet effects of FK409, a spontaneous nitric oxide releaser, with those of TRK-100, a prostacyclin analogue. Eur J Pharmacol 1995; 272:39-43. [PMID: 7713147 DOI: 10.1016/0014-2999(94)0062s-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
The anti-platelet effects of FK409 ((+/-)-(E)-ethyl-2-[(E)-hydroxyimino]-5-nitro-3-hexeneamide) , a new spontaneous nitric oxide releaser, and TRK-100 (sodium dl-4-[(1R,2R,3aS,8bS)-1,2,3a,8b-tetra-hydro-2-hydroxy-1-[(3S ,4RS)-3-hydroxy- 4-methyl-oct-6-yen-(E)-1-enyl]-5-cyclopenta[b]benzofuranyl]butyrate), a stable prostacyclin analogue, were studied both in vivo and in vitro. FK409 and TRK-100 inhibited ADP-induced platelet aggregation in rat platelet-rich plasma at 1.0 and 0.032 microM, respectively. In a rat extracorporeal shunt model, FK409 suppressed thrombus formation dose dependently and significantly at 1.0 mg/kg and showed the maximum inhibition (52% inhibition) at 10 mg/kg. TRK-100 showed 79% inhibition of thrombus formation at 1.0 mg/kg, but not at less than 1.0 mg/kg. At the doses required for antiplatelet effects, TRK-100 decreased mean blood pressure significantly but FK409 did not alter the blood pressure. These data suggest that FK409 shows more selective activities on platelets than TRK-100 in these experiments.
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Affiliation(s)
- Y Hirasawa
- Department of Pharmacology, Fujisawa Pharmaceutical Co., Ltd., Osaka, Japan
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Indolfi C, Piscione F, Rapacciuolo A, Esposito G, Esposito N, Ceravolo R, Di Lorenzo E, Maione A, Condorelli M, Chiariello M. Coronary artery vasoconstriction after successful single angioplasty of the left anterior descending artery. Am Heart J 1994; 128:858-64. [PMID: 7942475 DOI: 10.1016/0002-8703(94)90580-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Percutaneous transluminal coronary angioplasty is associated with spontaneous transient vasoconstriction. The mechanisms by which coronary vasoconstriction occurs distally to a successful dilated stenosis after coronary artery angioplasty are still unknown. The present study was planned to investigate the effect of successful coronary artery angioplasty on coronary vasomotion distal to a dilated stenosis and in the control vessel and the role of alpha-adrenergic receptors on coronary vasomotion after successful coronary artery angioplasty. We prospectively studied 32 consecutive patients scheduled for elective single coronary artery angioplasty of the left anterior descending coronary artery. Only aspirin, 325 mg, or nitroglycerin was allowed in the week before the study; no premedication with diazepam or other drugs was given. In group 1 (control patients, n = 20), quantitative coronary angiography was performed in the control state; 5 and 15 minutes after coronary artery angioplasty; and after intracoronary nitroglycerin infusion, 300 micrograms. In group 2 (n = 12), intracoronary phentolamine, 2 mg, was infused regionally through the balloon catheter before the coronary artery angioplasty, and coronary angiography was performed at baseline, 15 minutes after balloon deflation, and after nitroglycerin infusion. In group 1, constriction of the coronary segment distal to a dilated stenosis (2.4 +/- 0.8 to 2.1 +/- 0.6 mm, -14.6% vs baseline; p < 0.05) and of the circumflex coronary artery segment (2.8 +/- 0.7 to 2.5 +/- 0.6 mm, -10.7% vs baseline, p < 0.05) occurred 15 minutes after coronary artery angioplasty. The degree of vasoconstriction was not correlated with the lesion severity before coronary artery angioplasty.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- C Indolfi
- Division of Cardiology, University of Naples Federico II, Italy
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47
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Abstract
Myocardial infarction is the most frequent cause of mortality in the United States as well as in most western countries. In this review, the processes leading to myocardial infarction are described based on the most recent studies of vascular biology; in addition, evolving strategies for prevention are outlined. The following was specifically discussed. (1) Five phases of the progression of coronary atherosclerosis (phases 1 to 5) and eight morphologically different lesions (types I, II, III, IV, Va, Vb, Vc, and VI) in the various phases are defined. (2) The present understanding of the pathogenesis of each of the phases of progression and of the various lesion types preceding myocardial infarction is described; particular emphasis is placed on the physical, structural, cellular, and chemical characteristics of the "vulnerable or unstable plaques" prone to disruption (types IV and Va lesions). (3) The fate of plaque disruption (type VI lesion) in the genesis of the various coronary syndromes and especially acute myocardial infarction is defined; particular emphasis is placed on the combination of plaque disruption and a high thrombogenic risk profile--local factors (ie, degree of plaque disruption, exposure of lipid-macrophage-rich plaque, etc) and systemic factors (ie, catecholamines, RAS, fibrinogen, etc)--in the genesis of myocardial infarction. (4) Strategies of regression or stabilization of "vulnerable or unstable plaques" for prevention of myocardial infarction are presented within the context of recent favorable experience with risk factor modification and lipid-modifying angiographic trials, beta-blockade and angiotensin-converting enzyme inhibition, antithrombotic strategies, and the possible role of estrogens. The recent past has been very fruitful in yielding a better understanding of the processes leading to myocardial infarction, and the near future appears very promising in terms of preventing the number 1 killer in the western world.
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Affiliation(s)
- V Fuster
- Cardiovascular Institute, Mount Sinai Medical Center, New York, NY 10029-6574
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Abstract
BACKGROUND Experimental studies in vitro suggest that neutrophils can modulate platelet function and vasomotor responses. In the present study, the interactions among neutrophils, platelets, and arterial responses to injury in vivo were assessed. METHODS AND RESULTS The acute thrombotic and vasomotor responses of porcine carotid arteries to balloon injury in vivo were evaluated in three groups of animals: neutropenic pigs treated (n = 11) or not treated (n = 12) with aspirin and healthy untreated control pigs (n = 15). Neutropenia was achieved by treatment with cyclophosphamide (50 mg/kg, 4 days before the experiment), which decreased circulating leukocyte count by 92% and almost abolished neutrophil aggregation to N-formyl-methionyl-leucyl-phenylalanine without affecting blood platelet count, hematocrit, hemoglobin concentration, or whole blood platelet aggregation to ADP. 51Cr platelet deposition on deeply injured and uninjured arterial segments was not statistically influenced by neutrophil depletion, whereas the angiographic vasoconstrictive response at the site of endothelial injury distally was significantly reduced by 41% from 46.3 +/- 2.9% in the control group to 27.2 +/- 4.1% in the neutropenic group (P < .05). Aspirin treatment in combination with neutropenia produced a 50% reduction in whole blood platelet aggregation, resulted in a significant inhibition of platelet deposition to deeply injured arteries, and decreased vasoconstriction by 66% to 15.6 +/- 3.0% (P < .05 versus control and neutropenic). CONCLUSIONS Neutrophils can influence the vasoconstrictive response at the site of endothelial injury in vivo. In addition to platelets, neutrophil interaction with the injured vessel wall may be implicated in the pathophysiological response to arterial injury in vivo.
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Affiliation(s)
- Y Merhi
- Laboratory of Thrombosis and Atherosclerosis, Montreal Heart Institute, Quebec, Canada
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49
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Abstract
BACKGROUND Although abnormal vasoconstriction may be involved in the pathogenesis of the acute coronary syndromes, the vasoreactivity of the lesion responsible for unstable angina (culprit lesion) has not been directly investigated. It is also unknown if enhanced vasoreactivity is found downstream to this lesion or extends to uninvolved coronary arteries. METHODS AND RESULTS We studied seven unstable angina patients whose condition had sufficiently stabilized to allow ergometric bicycle exercise and a cold pressor test to be performed as provocative stimuli during coronary arteriography. We measured the luminal diameter of the culprit lesion, a normal-appearing distal segment, and the segment of an uninvolved coronary artery using quantitative coronary angiography. Seven stable angina patients served as controls. Antianginal medications were tapered and interrupted. The culprit lesion constricted significantly with exercise and the cold pressor test compared with a stable angina control lesion. The culprit lesion measured 1.41 +/- 0.07 mm at baseline and diminished to 1.09 +/- 0.07 mm with exercise (P = .001). It measured 1.26 +/- 0.07 mm before the cold pressor test and diminished to 1.09 +/- 0.03 mm with this test (P = .015). In contrast, the profile of the stable lesion in the stable angina control group differed significantly (P = .006). Its luminal diameter measured 1.42 +/- 0.17 mm at baseline and 1.48 +/- 0.21 mm with exercise (P = NS). It measured 1.57 +/- 0.18 mm before and 1.55 +/- 0.18 mm with the cold pressor test (P = NS). There were no significant changes to these stimuli in the uninvolved coronary artery segments in unstable angina and in the distal segments in both unstable and stable angina patients. CONCLUSIONS This study demonstrates increased vasoreactivity of the culprit lesion in unstable angina compared with a control lesion in stable angina. The lack of an effect either in the uninvolved coronary artery or downstream to the culprit lesion suggests that systemic neurohumoral or seeding mechanisms are not operative. This abnormal vasoreactivity might predispose to, or be a marker for, the recurrence of acute ischemia at this site.
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Affiliation(s)
- P Bogaty
- Cardiovascular Research Unit, Royal Postgraduate Medical School, Hammersmith Hospital, London, UK
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50
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Abstract
OBJECTIVES To determine whether excision of complex, ulcerated plaque improves the risk of patients with unstable angina to the level of those with stable angina, the results of directional coronary atherectomy were compared in patients with these two syndromes. BACKGROUND The procedural results of angioplasty in the setting of unstable angina are not as favorable as those observed for chronic stable angina, presumably because thrombus-associated plaque augments the risk of abrupt closure. METHODS Two hundred eighty-seven consecutive patients who had undergone directional atherectomy for a single new stenosis were studied. Seventy-seven patients had stable angina (Group I); 110 patients had progressively worsening angina in the absence of rest or postinfarction angina (Group II); and 100 patients had rest or postinfarction angina, or both (Group III). RESULTS Major ischemic complications (death, Q wave infarction, emergency bypass surgery) occurred more frequently in Group III (1.3% [Group I] vs. 0.9% [Group II] vs. 7% [Group III], p = 0.036). This difference was largely due to a higher incidence of emergency surgery in Group III (1.3% [Group I] vs. 0% [Group II] vs. 5% [Group III], p = 0.05). Clinical follow-up was obtained in 97% of successful procedures for a mean follow-up period of 22 months (range 9 to 52) and revealed a higher incidence of hospital admission for angina (p = 0.05) and a trend toward more bypass surgery (p = 0.09) and myocardial infarction (p = 0.16) in Group III. There was no difference in repeat percutaneous interventions among the three groups (range 19% to 24%, p = 0.75). CONCLUSIONS These results show that the definition of unstable angina is important in determining the immediate outcome of directional atherectomy. In the absence of rest or postinfarction angina, the immediate results are not significantly different from those obtained in stable angina. Our results also suggest that both the immediate and short-term outcome in unstable angina are not greatly influenced by atherectomy but more so by the pathophysiology of unstable angina, which increases the complications of percutaneous interventions.
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Affiliation(s)
- A E Abdelmeguid
- Department of Cardiology, Cleveland Clinic Foundation, Ohio 44195
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