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Ramses R, Kennedy S, Good R, Oldroyd KG, Mcginty S. Performance of drug-coated balloons in coronary and below-the-knee arteries: Anatomical, physiological and pathological considerations. Vascul Pharmacol 2024; 155:107366. [PMID: 38479462 DOI: 10.1016/j.vph.2024.107366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Revised: 02/24/2024] [Accepted: 03/08/2024] [Indexed: 03/22/2024]
Abstract
Below-the-knee (infrapopliteal) atherosclerotic disease, which presents as chronic limb-threatening ischemia (CLTI) in nearly 50% of patients, represents a treatment challenge when it comes to the endovascular intervention arm of management. Due to reduced tissue perfusion, patients usually experience pain at rest and atrophic changes correlated to the extent of the compromised perfusion. Unfortunately, the prognosis remains unsatisfactory with 30% of patients requiring major amputation and a mortality rate of 25% within 1 year. To date, randomized multicentre trials of endovascular intervention have shown that drug-eluting stents (DES) increase patency rate and lower target lesion revascularization rate compared to plain balloon angioplasty and bare-metal stents. The majority of these trials recruited patients with focal infrapopliteal lesions, while most patients requiring endovascular intervention have complex and diffuse atherosclerotic disease. Moreover, due to the nature of the infrapopliteal arteries, the use of long DES is limited. Following recent results of drug-coated balloons (DCBs) in the treatment of femoropopliteal and coronary arteries, it was hoped that similar effective results would be achieved in the infrapopliteal arteries. In reality, multicentre trials have failed to support the proposed hypothesis and no advantage was found in using DCBs in comparison to plain balloon angioplasty. This review aims to explore anatomical, physiological and pathological differences between lesions of the infrapopliteal and coronary arteries to explain the differences in outcome when using DCBs.
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Affiliation(s)
- Rafic Ramses
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Institute of Cardiology, Catholic University of the Sacred Heart, Rome, Italy; Division of Biomedical Engineering, University of Glasgow, United Kingdom
| | - Simon Kennedy
- School of Cardiovascular and Metabolic Health, University of Glasgow, United Kingdom
| | - Richard Good
- School of Cardiovascular and Metabolic Health, University of Glasgow, United Kingdom; West of Scotland Regional Heart & Lung Centre, Golden Jubilee National Hospital, Glasgow, United Kingdom
| | - Keith G Oldroyd
- School of Cardiovascular and Metabolic Health, University of Glasgow, United Kingdom; West of Scotland Regional Heart & Lung Centre, Golden Jubilee National Hospital, Glasgow, United Kingdom
| | - Sean Mcginty
- Division of Biomedical Engineering, University of Glasgow, United Kingdom.
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Abdelaziz TA, Mohamed RH, Saadawy SF. Association of Endothelial Nitric Oxide Synthase and Angiotensin-Converting Enzyme Genes Polymorphism With In-Sent Restenosis of Bare Metal Stents vs Drug-Eluting Stents in Egyptians. Angiology 2023:33197231219837. [PMID: 38039959 DOI: 10.1177/00033197231219837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 12/03/2023]
Abstract
Despite its unequivocal superiority compared with balloon angioplasty, coronary stenting did not abolish restenosis. We aimed to evaluate the associations between a common single nucleotide polymorphism occurring in endothelial nitric oxide synthase (eNOS) and angiotensin-converting enzyme (ACE) genes and the risk of in-stent restenosis (ISR) of bare metal stents vs drug-eluting stents (BMS vs DES) implanted in Egyptian patients. Two hundred patients who had coronary stenting were divided into group I (n = 98) who received a BMS and group II (n = 102) who received a DES. eNOS and ACE genes polymorphism were analyzed by polymerase chain reaction (PCR). We found that the GA and AA genotypes of the eNOS gene were associated with the ISR with both BMS and DES. However, the ACE gene was not associated with ISR. We concluded that eNOS gene polymorphism is associated with ISR. Hypertension, stent length, and AA genotype of the eNOS gene were found to be independent predictors of the occurrence of ISR after both BMS and DES use.
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Affiliation(s)
- Tarek A Abdelaziz
- Cardiology Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Randa H Mohamed
- Medical Biochemistry Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Sara F Saadawy
- Medical Biochemistry Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
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Lv F, Jiang Y, Wang Y, Zhang T, Zhou Y. AGTR1rs5186 Polymorphism Is Associated with the Risk of Restenosis after Percutaneous Coronary Intervention: A Meta-Analysis. J Cardiovasc Dev Dis 2022; 9:jcdd9110406. [PMID: 36421941 PMCID: PMC9693694 DOI: 10.3390/jcdd9110406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 11/04/2022] [Accepted: 11/16/2022] [Indexed: 11/23/2022] Open
Abstract
Background: Progress has been made in genetic investigations on restenosis for the past 20 years, many studies regarding AGTR1 rs5186 polymorphism and restenosis after percutaneous coronary intervention (PCI) have been published, but the result remains controversial. The study aimed to explore the relationship between rs5186 polymorphism and the risk of restenosis after PCI. Methods: We performed a systematic search on PubMed, Web of Science, Embase, CNKI, and Wan Fang databases up to December 2021. Two authors individually extracted all useful data of each study involved in this meta-analysis and assessed the study quality using the Newcastle-Ottawa scale. Odds ratios (ORs) and 95% confidence intervals (CIs) were combined in different genetic models for evaluation using a random-effects model or fixed-effect model. Results: There were eventually 8 studies of 1111 cases and 4097 controls eligible for this meta-analysis. Significant associations were found between rs5186 polymorphism and restenosis after PCI.allelic (OR: 1.31, 95% CI: 1.17−1.47, p < 0.001), homozygous (OR: 1.90, 95% CI: 1.50−2.44, p < 0.001), heterozygous (OR: 1.10, 95% CI: 0.93−1.29, p = 0.27), recessive (OR: 1.80, 95% CI: 1.37−2.36, p < 0.001), dominant genetic model (OR: 1.24, 95% CI: 1.06−1.44, p = 0.006). Subgroup analyses indicated a significant association in Asians. Conclusions: The rs5186 polymorphism in the AGTR1 gene increases the risk of restenosis after PCI in Asians significantly.
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Affiliation(s)
- Feng Lv
- Department of Cardiology, Suzhou Dushu Lake Hospital, Dushu Lake Hospital Affiliated to Soochow University, Medical Center of Soochow University, Suzhou 215125, China
- Department of Cardiology, Shengzhou People’s Hospital, The First Affiliated Hospital of Zhejiang University Shengzhou Branch, Shengzhou 312400, China
| | - Yufeng Jiang
- Department of Cardiology, Suzhou Dushu Lake Hospital, Dushu Lake Hospital Affiliated to Soochow University, Medical Center of Soochow University, Suzhou 215125, China
| | - Yebao Wang
- Department of Cardiology, Suzhou Dushu Lake Hospital, Dushu Lake Hospital Affiliated to Soochow University, Medical Center of Soochow University, Suzhou 215125, China
| | - Ting Zhang
- Department of Cardiology, Suzhou Dushu Lake Hospital, Dushu Lake Hospital Affiliated to Soochow University, Medical Center of Soochow University, Suzhou 215125, China
| | - Yafeng Zhou
- Department of Cardiology, Suzhou Dushu Lake Hospital, Dushu Lake Hospital Affiliated to Soochow University, Medical Center of Soochow University, Suzhou 215125, China
- Correspondence:
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Chen M, Ma F, Su B, Wang C, Zheng Q, Zhang Y, Li M, Liu S, Zhang S, Yuan L. Treatment effect of metformin combined with atorvastatin in reducing in-stent restenosis after percutaneous coronary intervention in coronary artery disease patients with type 2 diabetic patients. Medicine (Baltimore) 2022; 101:e31107. [PMID: 36254086 PMCID: PMC9575712 DOI: 10.1097/md.0000000000031107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
To investigate the effectiveness of metformin and atorvastatin in preventing in-stent restenosis (ISR) on coronary patients with type 2 diabetes mellitus with percutaneous coronary intervention within 8 to 12 months after rapamycin-eluting stent implantation. A total of 1278 consecutive patients implanted with rapamycin-eluting stent from January 2012 to December 2019, who underwent coronary computed tomography or coronary angiography within 8 to 12 months. The patients were categorized into atorvastatin 20 mg, or atorvastatin 20 mg + metformin 1.5/d, or atorvastatin 40 mg + metformin 1.5/d groups. The clinical characteristics of the 3 groups were compared. The correlation between variables and ISR was analyzed. A total of 701 patients participated in the study. The ratio of ISR/nonstenosis (P = .039) and fasting blood sugar (P = .001) differed significantly in the 3 groups. Logistic regression showed that d, L, different therapeutic agents, and dosage groups were independent risk factors of ISR. The longer L and smaller d may increase ISR incidence with 8 to 12 months after percutaneous coronary intervention. Both metformin and atorvastatin are beneficial in reducing stent restenosis by a dose-dependent manner. An increasing dose of atorvastatin and a combination of metformin decreases the incidence of ISR in patients.
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Affiliation(s)
- Mingli Chen
- Department of Cardiovascular, Harrison International Peace Hospital Affiliated to Hebei Medical University, Hengshui, China
| | - Fangfang Ma
- Department of Cardiovascular, Harrison International Peace Hospital Affiliated to Hebei Medical University, Hengshui, China
| | - Baohua Su
- Department of Medicine, Zaoqiang Country People's Hospital, Hengshui, China
| | - Caihong Wang
- Department of Cardiovascular, Harrison International Peace Hospital Affiliated to Hebei Medical University, Hengshui, China
| | - Qun Zheng
- Department of Cardiovascular, Harrison International Peace Hospital Affiliated to Hebei Medical University, Hengshui, China
| | - Yu Zhang
- Department of Cardiovascular, Harrison International Peace Hospital Affiliated to Hebei Medical University, Hengshui, China
| | - Meng Li
- Department of Cardiovascular, Harrison International Peace Hospital Affiliated to Hebei Medical University, Hengshui, China
| | - Shuai Liu
- Department of Cardiovascular, Harrison International Peace Hospital Affiliated to Hebei Medical University, Hengshui, China
| | - Shuzhi Zhang
- Department of Cardiovascular, Harrison International Peace Hospital Affiliated to Hebei Medical University, Hengshui, China
| | - Lansuo Yuan
- Department of Cardiovascular, Harrison International Peace Hospital Affiliated to Hebei Medical University, Hengshui, China
- *Correspondence: Lansuo Yuan, Department of Cardiovascular, Harrison International Peace Hospital Affiliated to Hebei Medical University, Hengshui 053000,China (e-mail: )
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Esposito A, Cotta CK, Lacchini R. Beyond eNOS: Genetic influence in NO pathway affecting drug response. Genet Mol Biol 2022; 45:e20220157. [PMID: 36264109 PMCID: PMC9583294 DOI: 10.1590/1678-4685-gmb-2022-0157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 05/03/2022] [Accepted: 09/08/2022] [Indexed: 11/04/2022] Open
Abstract
Nitric Oxide (NO) has important biological functions, and its production may be
influenced by genetic polymorphisms. Since NO mediates the drug response, the
same genetic polymorphism that alter NO levels may also impact drug therapy. The
vast majority of studies in the literature that assess the genetic influence on
NO-related drug response focus on NOS3 (which encodes
endothelial nitric oxide synthase), however several other proteins are
interconnected in the same pathway and may also impact NO availability and drug
response. The aim of this study was to review the literature regarding genetic
polymorphisms that influence NO in response to pharmacological agents located in
genes other than NOS3. Articles were obtained from Pubmed and
consisted of 17 manuscripts that assessed polymorphisms of the following
targets: Arginases 1 and 2 (ARG1 and ARG2),
dimethylarginine dimethylaminohydrolases 1 and 2 (DDAH1 and
DDAH2), and vascular endothelial growth factor
(VEGF). Here we analyze the main results of these articles,
which show promising evidences that may suggest that the NO-driven
pharmacological response is affected by more than the eNOS gene. The search for
genetic markers may result in better understanding of the variability of drug
response and turn pharmacotherapy involving NO safer and more effective.
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Affiliation(s)
- Aline Esposito
- Universidade de São Paulo, Departamento de Farmacologia, Ribeirão
Preto, São Paulo, SP, Brazil
| | - Cezar Kayzuka Cotta
- Universidade de São Paulo, Departamento de Farmacologia, Ribeirão
Preto, São Paulo, SP, Brazil
| | - Riccardo Lacchini
- Universidade de São Paulo, Departamento de Enfermagem Psiquiátrica e
Ciências Humanas, Ribeirão Preto, São Paulo, SP, Brazil
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Jakubiak GK, Pawlas N, Cieślar G, Stanek A. Pathogenesis and Clinical Significance of In-Stent Restenosis in Patients with Diabetes. Int J Environ Res Public Health 2021; 18:ijerph182211970. [PMID: 34831726 PMCID: PMC8617716 DOI: 10.3390/ijerph182211970] [Citation(s) in RCA: 47] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Revised: 11/11/2021] [Accepted: 11/13/2021] [Indexed: 12/13/2022]
Abstract
Diabetes mellitus (DM) is a strong risk factor for the development of cardiovascular diseases such as coronary heart disease, cerebrovascular disease, and peripheral arterial disease (PAD). In the population of people living with DM, PAD is characterised by multi-level atherosclerotic lesions as well as greater involvement of the arteries below the knee. DM is also a factor that significantly increases the risk of lower limb amputation. Percutaneous balloon angioplasty with or without stent implantation is an important method of the treatment for atherosclerotic cardiovascular diseases, but restenosis is a factor limiting its long-term effectiveness. The pathogenesis of atherosclerosis in the course of DM differs slightly from that in the general population. In the population of people living with DM, more attention is drawn to such factors as inflammation, endothelial dysfunction, platelet dysfunction, blood rheological properties, hypercoagulability, and additional factors stimulating vascular smooth muscle cell proliferation. DM is a risk factor for restenosis. The purpose of this paper is to provide a review of the literature and to present the most important information on the current state of knowledge on mechanisms and the clinical significance of restenosis and in-stent restenosis in patients with DM, especially in association with the endovascular treatment of PAD. The role of such processes as inflammation, neointimal hyperplasia and neoatherosclerosis, allergy, resistance to antimitotic drugs used for coating stents and balloons, genetic factors, and technical and mechanical factors are discussed. The information on restenosis collected in this publication may be helpful in planning further research in this field, which may contribute to the formulation of more and more precise recommendations for the clinical practice.
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Affiliation(s)
- Grzegorz K. Jakubiak
- Department and Clinic of Internal Medicine, Angiology, and Physical Medicine, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Batorego 15 St., 41-902 Bytom, Poland; (G.K.J.); (G.C.)
| | - Natalia Pawlas
- Department of Pharmacology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Jordana 38 St., 41-800 Zabrze, Poland;
| | - Grzegorz Cieślar
- Department and Clinic of Internal Medicine, Angiology, and Physical Medicine, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Batorego 15 St., 41-902 Bytom, Poland; (G.K.J.); (G.C.)
| | - Agata Stanek
- Department and Clinic of Internal Medicine, Angiology, and Physical Medicine, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Batorego 15 St., 41-902 Bytom, Poland; (G.K.J.); (G.C.)
- Correspondence:
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Timizheva KB, Azova MM, Aissa AA, Aghajanyan AV, Tskhovrebova LV, Blagonravov ML. Association of Gene Polymorphisms of Some Endothelial Factors with Stent Reendothelization after Elective Coronary Artery Revascularization. Bull Exp Biol Med 2021; 171:194-7. [PMID: 34173092 DOI: 10.1007/s10517-021-05193-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Indexed: 10/21/2022]
Abstract
Restenosis remains the main complication after percutaneous coronary interventions in patients with coronary heart disease. The causes of its development include, in particular, genetic factors. We studied polymorphic loci of genes encoding endothelin-1 (EDN1 rs5370), endothelin-1 receptor (EDNRA rs5333), endothelin-converting enzyme (ECE1 rs1076669), and endothelial NO synthase (eNOS rs1549758, eNOS rs1799983, and eNOS rs2070244) in the context of in-stent restenosis development. It was found that the analyzed polymorphisms of the endothelin system genes were more significant for patients aged ≥ 65 years, while the polymorphic loci of the endothelial NO synthase gene (eNOS rs1799983 and eNOS rs1549758) were predominantly associated with time of in-stent restenosis. The obtained results can be useful for comprehensive assessment of the restenosis risk factors and the choice of optimal treatment for patients with coronary heart disease before elective surgical intervention.
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Cotta Filho CK, Oliveira-Paula GH, Rondon Pereira VC, Lacchini R. Clinically relevant endothelial nitric oxide synthase polymorphisms and their impact on drug response. Expert Opin Drug Metab Toxicol 2020; 16:927-951. [DOI: 10.1080/17425255.2020.1804857] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
| | | | | | - Riccardo Lacchini
- Department of Psychiatric Nursing and Human Sciences, University of Sao Paulo, Ribeirao Preto, Brazil
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Zhou S, Mu G, Wei S, Liu Z, Wang Z, Xiang Q, Cui Y. Associations Between Polymorphisms of Endothelial Nitric Oxide Synthase, Matrix Metalloproteinase 3, Angiotensinogen, and Angiotensin II Type 1 Receptor and Risk of Restenosis After Percutaneous Coronary Intervention: A Meta-analysis. Clin Ther 2020; 42:458-74. [DOI: 10.1016/j.clinthera.2020.01.018] [Citation(s) in RCA: 3] [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] [Received: 11/07/2019] [Revised: 01/22/2020] [Accepted: 01/26/2020] [Indexed: 01/21/2023]
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Chen HJ, Mo N, Zhang YF, Su GZ, Wu HD, Pei F. Role of Gene Polymorphisms/Haplotypes and Plasma Level of TGF-β1 in Susceptibility to In-Stent Restenosis Following Coronary Implantation of Bare Metal Stent in Chinese Han Patients. Int Heart J 2018; 59:161-169. [DOI: 10.1536/ihj.17-190] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
| | - Ni Mo
- Department of Cardiology, Gaozhou People's Hospital
| | | | - Guo-Zhu Su
- Department of Cardiology, Gaozhou People's Hospital
| | - Han-Dong Wu
- Department of Cardiology, Guangdong Provincial People's Hospital
| | - Fang Pei
- Department of Cardiology, Chongqing Municipal Corps Hospital of Chinese People's Armed Police Forces
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