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Kereiakes DJ, Ali ZA, Riley RF, Smith TD, Shlofmitz RA. Intravascular Lithotripsy for Treatment of Calcified Coronary Artery Disease. Interv Cardiol Clin 2022; 11:393-404. [PMID: 36243485 DOI: 10.1016/j.iccl.2022.02.004] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Intravascular lithotripsy (IVL) uses acoustic shock waves in a balloon-based delivery system to modify severely calcified atherosclerotic coronary vascular lesions in preparation for stent implantation. IVL results in circumferential and longitudinal calcium fracture, which improves transmural vessel compliance and facilitates subsequent stent expansion without requiring high-pressure balloon dilation. Clinical trials have demonstrated IVL to be safe (low rates of major adverse cardiac events in hospital and to 1 year; low rates of severe angiographic complications), effective (high rates of procedural success), and easy to use (little or no learning curve) when applied in the treatment of severely calcified coronary arteries.
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Affiliation(s)
- Dean J Kereiakes
- The Carl and Edyth Lindner Center for Research and Education at The Christ Hospital, 2123 Auburn Avenue Suite 424, Cincinnati, OH 45219, USA.
| | - Ziad A Ali
- Columbia University Medical Center, 622 W 168th Street, New York, NY 10032, USA
| | - Robert F Riley
- The Carl and Edyth Lindner Center for Research and Education at The Christ Hospital, 2123 Auburn Avenue Suite 424, Cincinnati, OH 45219, USA
| | - Timothy D Smith
- The Carl and Edyth Lindner Center for Research and Education at The Christ Hospital, 2123 Auburn Avenue Suite 424, Cincinnati, OH 45219, USA
| | - Richard A Shlofmitz
- St. Francis Hospital & Heart Center, 100 Port Washington Boulevard Suite 105, Roslyn, NY 11576, USA
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刘 一, 刘 进. [Perioperative Antiplatelet Therapy in Patients with Coronary Stents Undergoing Elective Non-Cardiac Surgery]. Sichuan Da Xue Xue Bao Yi Xue Ban 2022; 53:49-53. [PMID: 35048599 PMCID: PMC10408853 DOI: 10.12182/20220160508] [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] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Indexed: 06/14/2023]
Abstract
Among patients undergoing elective non-cardiac surgery (NCS), those with coronary stent implants are gradually becoming a patient group that cannot be easily overlooked. Previous history of heart disease, coronary stents and antiplatelet agents expose these patients to dual perioperative risks of thrombosis and bleeding. Formulating appropriate plans for perioperative antiplatelet therapy will help reduce the risks and ensure the safety of patients. We herein reviewed and analyzed various aspects of perioperative antiplatelet therapy for patients with coronary stent implants undergoing elective NCS, and discussed prospective research directions in the field.
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Affiliation(s)
- 一君 刘
- 四川大学华西医院 麻醉手术中心 (成都 610041)Anesthesia & Operation Center, West China Hospital, Sichuan University, Chengdu 610041, China
| | - 进 刘
- 四川大学华西医院 麻醉手术中心 (成都 610041)Anesthesia & Operation Center, West China Hospital, Sichuan University, Chengdu 610041, China
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Hess NR, Kilic A, Wang Y, Yoon PD, Navid F, Sultan I, Chu D. Revascularization Strategies for Multivessel Coronary Artery Disease in the Elderly Population. J Surg Res 2021; 270:444-54. [PMID: 34798427 DOI: 10.1016/j.jss.2021.10.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Revised: 09/23/2021] [Accepted: 10/10/2021] [Indexed: 12/25/2022]
Abstract
BACKGROUND Prospective trials comparing coronary artery bypass grafting (CABG) with percutaneous coronary intervention (PCI) for the treatment of multivessel coronary disease (MVCAD) have included mostly younger patients. We compared treatment strategies in the elderly population. MATERIALS AND METHODS We performed a propensity-score-matched comparison of patients ≥75 y who underwent isolated CABG or PCI for MVCAD between 2011 and 2018, excluding those with prior cardiac surgery and/or significant left main disease. The primary outcome was 5-year Kaplan Meier survival, and secondary outcomes included readmissions and major adverse cardiovascular and cerebrovascular events (MACCE). RESULTS Propensity-matching yielded 536 patients (266 PCI and 266 CABG). Rates of complete revascularization of all stenotic lesions were higher in the CABG arm (86.8% versus 21.8%; P < 0.001). Thirty-d mortality was similar between cohorts, though PCI recipients had shorter hospital stay and greater likelihood of discharge to home. Unadjusted one- (89.1% versus 88.4%) and 5-year (73.8% versus 60.1%) survival were both higher in patients who underwent CABG (P = 0.0332). Patients undergoing CABG had reduced, but nonsignificant cumulative incidence of all-cause hospital readmission and MACCE at 5 y. Subgroup analysis of patients 80 y or older revealed similar late survival benefit with CABG when compared to PCI. Among patients undergoing CABG, there did not appear to be any 5-year benefits from multi-arterial grafting. CONCLUSIONS Despite longer hospitalization and higher rate of nonhome discharge, CABG was associated with improved late survival over PCI in the elderly population. Cardiac surgeons should be included in the multidisciplinary evaluation of older patients with MVCAD.
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Nardone EW, Madsen BM, McCarey MM, Fischman DL, Ruggiero NJ, Walinsky P, Vishnevsky A, Savage MP. Percutaneous coronary intervention of totally occluded coronary venous bypass grafts: An exercise in futility? World J Cardiol 2021; 13:493-502. [PMID: 34621494 PMCID: PMC8462047 DOI: 10.4330/wjc.v13.i9.493] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 05/27/2021] [Accepted: 07/27/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Percutaneous coronary intervention (PCI) of diseased saphenous vein grafts (SVG) continues to pose a clinical challenge. Current PCI guidelines give a class III recommendation against performing PCI on chronically occluded SVG. However, contemporary outcomes after SVG intervention have incrementally improved with distal protection devices, intracoronary vasodilators, drug-eluting stents, and prolonged dual antiplatelet therapy.
AIM To reassess the procedural and long-term outcomes of PCI for totally occluded SVG with contemporary techniques.
METHODS This was a retrospective observational study conducted at a single university hospital. The study population consisted of 35 consecutive patients undergoing PCI of totally occluded SVG. Post-procedure dual antiplatelet therapy was continued for a minimum of one year and aspirin was continued indefinitely. Clinical outcomes were assessed at a mean follow-up of 1221 ± 1038 d. The primary outcome was freedom from a major adverse cardiac event (MACE) defined as the occurrence of any of the following: death, myocardial infarction, stroke, repeat bypass surgery, repeat PCI, or graft reocclusion.
RESULTS The study group included 29 men and 6 women with a mean age of 69 ± 12 years. Diabetes was present in 14 (40%) patients. All patients had Canadian Heart Classification class III or IV angina. Clinical presentation was an acute coronary syndrome in 34 (97%) patients. Mean SVG age was 12 ± 5 years. Estimated duration of occlusion was acute (< 24 h) in 34% of patients, subacute (> 24 h to 30 d) in 26%, and late (> 30 d) in 40%. PCI was initially successful in 29/35 SVG occlusions (83%). Total stent length was 52 ± 35 mm. Intraprocedural complications of distal embolization or no-reflow occurred in 6 (17%) patients. During longer term follow-up, MACE-free survival was only 30% at 3 years and 17% at 5 years.
CONCLUSION PCI of totally occluded SVG can be performed with a high procedural success rate. However, its clinical utility remains limited by poor follow-up outcomes.
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Affiliation(s)
- Evan W Nardone
- Department of Medicine, Thomas Jefferson University, Philadelphia, PA 19107, United States
| | - Brandon M Madsen
- Department of Anesthesiology, Medstar Georgetown University Hospital, Washington, DC 20007, United States
| | - Melissa M McCarey
- Jefferson Clinical Research Institue, Thomas Jefferson University, Philadelphia, PA 19107, United States
| | - David L Fischman
- Department of Medicine, Thomas Jefferson University, Philadelphia, PA 19107, United States
| | - Nicholas J Ruggiero
- Department of Medicine, Thomas Jefferson University, Philadelphia, PA 19107, United States
| | - Paul Walinsky
- Department of Medicine, Thomas Jefferson University, Philadelphia, PA 19107, United States
| | - Alec Vishnevsky
- Department of Medicine, Thomas Jefferson University, Philadelphia, PA 19107, United States
| | - Michael P Savage
- Department of Medicine, Thomas Jefferson University, Philadelphia, PA 19107, United States
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Cao D, Chandiramani R, Chiarito M, Claessen BE, Mehran R. Evolution of antithrombotic therapy in patients undergoing percutaneous coronary intervention: a 40-year journey. Eur Heart J 2021; 42:339-351. [PMID: 33367641 DOI: 10.1093/eurheartj/ehaa824] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 09/02/2020] [Accepted: 09/22/2020] [Indexed: 12/12/2022] Open
Abstract
Since its introduction in 1977, percutaneous coronary intervention has become one of the most commonly performed therapeutic procedures worldwide. Such widespread diffusion, however, would have not been possible without a concomitant evolution of the pharmacotherapies associated with this intervention. Antithrombotic agents are fundamental throughout the management of patients undergoing coronary stent implantation, starting from the procedure itself to the long-term prevention of cardiovascular events. The last 40 years of interventional cardiology have seen remarkable improvements in both drug therapies and device technologies, which largely reflected a progressive understanding of the pathophysiological mechanisms of coronary artery disease, as well as procedure- and device-related adverse events. The purpose of this article is to provide an overview of the important milestones in antithrombotic pharmacology that have shaped clinical practice of today while also providing insights into knowledge gaps and future directions.
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Affiliation(s)
- Davide Cao
- Center for Interventional Cardiovascular Research and Clinical Trials, The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1030, New York, NY 10029-6574, USA
| | - Rishi Chandiramani
- Center for Interventional Cardiovascular Research and Clinical Trials, The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1030, New York, NY 10029-6574, USA
| | - Mauro Chiarito
- Center for Interventional Cardiovascular Research and Clinical Trials, The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1030, New York, NY 10029-6574, USA.,Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090 Pieve Emanuele, Milan, Italy.,Cardio Center, Humanitas Clinical and Research Hospital IRCCS, Via Alessandro Manzoni 56, 20090 Rozzano, Milan, Italy
| | - Bimmer E Claessen
- Center for Interventional Cardiovascular Research and Clinical Trials, The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1030, New York, NY 10029-6574, USA
| | - Roxana Mehran
- Center for Interventional Cardiovascular Research and Clinical Trials, The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1030, New York, NY 10029-6574, USA
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6
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Sane M, Dighe V, Patil R, Hassan PA, Gawali S, Patravale V. Bivalirudin and sirolimus co-eluting coronary stent: Potential strategy for the prevention of stent thrombosis and restenosis. Int J Pharm 2021; 600:120403. [PMID: 33711467 DOI: 10.1016/j.ijpharm.2021.120403] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 02/12/2021] [Accepted: 02/13/2021] [Indexed: 11/19/2022]
Abstract
Localized drug delivery with sustained elution characteristics from nanocarrier coated stents represents a viable therapeutic approach to circumvent concerns related to coronary stent therapy. We fabricated a Sirolimus (SRL) and Bivalirudin (BIV) releasing nanoparticles (NPs) coated stent for concurrent mitigation of vascular restenosis and acute stent thrombosis. SRL NPs were prepared by nanoprecipitation method whereas the BIV vesicles were generated using hydrophobic ion pair approach followed by micellization phenomenon. MTT assay and confocal microscopic analysis indicated superior anti-proliferative activity and higher cellular uptake of SRL NPs into human coronary artery smooth muscle cells, respectively. DSC and ATR-FTIR techniques confirmed the formation of complex between BIV and phosphatidylglycerol via some weak physical interactions. More than 2 fold rise in log P value was obtained for DSPG-BIV at 3:1 M ratio compared with native BIV solution. The SAXS analysis indicated formation of oligolamellar vesicles of DSPG-BIV complex which was preferentially entrapped into lipophilic lamellae of vesicles. APTT, PT, and TT tests revealed that the BIV vesicles caused significant prolongation of clotting time compared to native BIV solution. The SEM analysis showed uniform and defect free stent coating. In vitro release study demonstrated that SRL and BIV were eluted in a sustained manner from coated stents.
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Affiliation(s)
- Mangesh Sane
- Department of Pharmaceutical Sciences & Technology, Institute of Chemical Technology, N.P. Marg, Matunga, Mumbai 400 019, Maharashtra, India
| | - Vikas Dighe
- National Centre for Preclinical Reproductive and Genetic Toxicology, National Institute for Research in Reproductive Health, J. M. Street, Parel, Mumbai 400 012, Maharashtra, India
| | - Rucha Patil
- Department of Haemostasis & Thrombosis, National Institute of Immunohaematology, Indian Council of Medical Research, 13th Floor, New Multi-storeyed Building, KEM Hospital Campus, Parel, Mumbai 400 012, India
| | | | - Santosh Gawali
- Chemistry Division, Bhabha Atomic Research Centre, Trombay, Mumbai 400 085, India
| | - Vandana Patravale
- Department of Pharmaceutical Sciences & Technology, Institute of Chemical Technology, N.P. Marg, Matunga, Mumbai 400 019, Maharashtra, India.
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Zhu T, Gao W, Fang D, Liu Z, Wu G, Zhou M, Wan M, Mao C. Bifunctional polymer brush-grafted coronary stent for anticoagulation and endothelialization. Mater Sci Eng C Mater Biol Appl 2020; 120:111725. [PMID: 33545876 DOI: 10.1016/j.msec.2020.111725] [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] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Revised: 11/09/2020] [Accepted: 11/11/2020] [Indexed: 01/21/2023]
Abstract
At present, cardiovascular stent intervention faces clinical complications such as delayed endothelialization, late thrombosis and restenosis after implantation. In this work, a kind of bifunctional polymer brush-grafted coronary stent with anticoagulant and endothelial functions was developed. First, a block copolymer brush with zwitterionic structure consisting of sulfoethyl methacrylate (SBMA) and glycidyl methacrylate (GMA) was surface-induced grafted onto the surface of bare metal coronary stent by atom transfer radical polymerization. The diethylenetriamine NONOate (DETA NONOate), acted as nitric oxide (NO) donor to promote endothelialization, was then attached to polyglycidyl methacrylate (PGMA) brush by a reactive epoxy group to produce NO. The process of chemical modification and the release behavior of NO were characterized in detail. Moreover, the results of anticoagulant test, cytotoxicity test, endothelial cells (ECs) proliferation test and animal experiment of this bifunctional polymer brush-grafted coronary stent we proposed indicate that the zwitterion modified and NO supplied bifunctional coatings has good anticoagulant property, no cytotoxicity and significant endothelialization effect. This work opens the door to combine biological activity of NO and anticoagulant effect of zwitterions, which has great potential to address post-operative side effects associated with restenosis and late stent thrombosis.
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Affiliation(s)
- Tianyu Zhu
- National and Local Joint Engineering Research Center of Biomedical Functional Materials, School of Chemistry and Materials Science, Nanjing Normal University, Nanjing 210023, China
| | - Wentao Gao
- Department of Vascular Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing 210008, China
| | - Dan Fang
- National and Local Joint Engineering Research Center of Biomedical Functional Materials, School of Chemistry and Materials Science, Nanjing Normal University, Nanjing 210023, China
| | - Zhiyong Liu
- National and Local Joint Engineering Research Center of Biomedical Functional Materials, School of Chemistry and Materials Science, Nanjing Normal University, Nanjing 210023, China
| | - Guangyan Wu
- Department of Vascular Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing 210008, China
| | - Min Zhou
- Department of Vascular Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing 210008, China.
| | - Mimi Wan
- National and Local Joint Engineering Research Center of Biomedical Functional Materials, School of Chemistry and Materials Science, Nanjing Normal University, Nanjing 210023, China
| | - Chun Mao
- National and Local Joint Engineering Research Center of Biomedical Functional Materials, School of Chemistry and Materials Science, Nanjing Normal University, Nanjing 210023, China.
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Florin Ferent I, Mester A, Hlinomaz O, Groch L, Rezek M, Sitar J, Semenka J, Novak M, Benedek I. Intracoronary Imaging for Assessment of Vascular Healing and Stent Follow-up in Bioresorbable Vascular Scaffolds. Curr Med Imaging 2020; 16:123-134. [PMID: 32003312 DOI: 10.2174/1573405614666180604093621] [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: 12/15/2016] [Revised: 08/10/2017] [Accepted: 03/19/2018] [Indexed: 11/22/2022]
Abstract
Bioresorbable Vascular Scaffolds (BVS) are polymer-based materials implanted in the coronary arteries in order to treat atherosclerotic lesions, based on the concept that once the lesion has been treated, the material of the implanted stent will undergo a process of gradual resorption that will leave, in several years, the vessel wall smooth, free of any foreign material and with its vasomotion restored. However, after the first enthusiastic reports on the efficacy of BVSs, the recently published trials demonstrated disappointing results regarding long-term patency following BVS implantation, which were mainly attributed to technical deficiencies during the stenting procedure. Intracoronary imaging could play a crucial role for helping the operator to correctly implant a BVS into the coronary artery, as well as providing relevant information in the follow-up period. This review aims to summarize the role of intracoronary imaging in the follow-up of coronary stents, with a particular emphasis on the role of intravascular ultrasound and optical coherence tomography for procedural guidance during stent implantation and also for follow-up of bioabsorbable scaffolds.
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Affiliation(s)
- Ioan Florin Ferent
- Department of Cardiology, Laboratory of Advanced Research in Multimodality Cardiac Imaging, University of Medicine and Pharmacy of Targu Mures, Targu Mures, Romania
| | - Andras Mester
- Department of Cardiology, Laboratory of Advanced Research in Multimodality Cardiac Imaging, University of Medicine and Pharmacy of Targu Mures, Targu Mures, Romania
| | - Ota Hlinomaz
- International Clinical Research Center, St. Anne´s Hospital and Masaryk University, Brno, Czech Republic
| | - Ladislav Groch
- International Clinical Research Center, St. Anne´s Hospital and Masaryk University, Brno, Czech Republic
| | - Michal Rezek
- International Clinical Research Center, St. Anne´s Hospital and Masaryk University, Brno, Czech Republic
| | - Jan Sitar
- International Clinical Research Center, St. Anne´s Hospital and Masaryk University, Brno, Czech Republic
| | - Jiri Semenka
- International Clinical Research Center, St. Anne´s Hospital and Masaryk University, Brno, Czech Republic
| | - Martin Novak
- International Clinical Research Center, St. Anne´s Hospital and Masaryk University, Brno, Czech Republic
| | - Imre Benedek
- Department of Cardiology, Laboratory of Advanced Research in Multimodality Cardiac Imaging, University of Medicine and Pharmacy of Targu Mures, Targu Mures, Romania
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Deo S, Tyagi H, Chatterjee C, Molakapuri H. Did India's price control policy for coronary stents create unintended consequences? Soc Sci Med 2019; 246:112737. [PMID: 31887627 DOI: 10.1016/j.socscimed.2019.112737] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Revised: 11/19/2019] [Accepted: 12/13/2019] [Indexed: 10/25/2022]
Abstract
In February 2017, India capped the retail price of coronary stents and restricted the channel margin to bring Percutaneous Transluminal Coronary Angioplasty (PTCA) procedure, which uses coronary stents, within reach of millions of patients who previously could not afford it. Prior research shows that care providers respond to such regulations in a way that compensates for their loss in profits because of price control. Therefore, price control policies often introduce unintended consequences, such as distortions in clinical decision making. We investigate such distortions through empirical analysis of claims data from a representative public insurance program in the Indian state of Karnataka. Our data comprises 25,769 insurance claims from 69 private and seven public hospitals from February 2016 to February 2018. The public insurance context is ideal for investigating distortions in clinical decisions as the price paid by patients, and thereby access to the treatment, does not change after price control. We find that the change in the average volume of PTCA procedures per hospital per month after price control disproportionately increased when compared to the change in the clinical alternative - Coronary Artery Bypass Graft (CABG) procedures. This increase corresponds to 6% of the average number of PTCA procedures and 28% of the average number of CABG procedures before the price control. In addition, disproportionate increase in PTCA procedures occurred only among private hospitals, indicating the possibility of profit-maximization intentions driving the clinical choices. Such clinical distortions can have negative implications for patient health outcomes in the long run. We discuss alternative policies to improve access and affordability to healthcare products and services which are likely to not suffer from similar distortions.
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Affiliation(s)
| | - Hanu Tyagi
- Carlson School of Management, University of Minnesota, United States.
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Khalilimeybodi A, Alishzadeh Khoei A, Sharif-Kashani B. Future Balloon-Expandable Stents: High or Low-Strength Materials? Cardiovasc Eng Technol 2020; 11:188-204. [PMID: 31836964 DOI: 10.1007/s13239-019-00450-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Accepted: 12/07/2019] [Indexed: 10/25/2022]
Abstract
PURPOSE Recent progress in material science allows researchers to use novel materials with enhanced capabilities like optimum biodegradability, higher strength, and flexibility in the design of coronary stents. Considering the wide range of mechanical properties of existing and newfangled materials, finding the influence of variations in mechanical properties of stent materials is critical for developing a practical design. METHODS The sensitivity of stent functional characteristics to variations in its material plastic properties is obtained through FEM modeling. Balloon-expandable coronary stent designs: Absorb BVS, and Xience are examined for artificial and commercial polymeric, and metallic materials, respectively. Standard tests including (1) the crimping process followed by stent implantation in an atherosclerotic artery and (2) the three-point bending test, have been simulated according to ASTM standards. RESULTS In Absorb BVS, materials with higher yield stress than PLLA have similar residual deflection and maximum bending force to PLLA, which is not the case for Xience stent and Co-Cr. Moreover, elevated yield stress significantly reduces stent flexibility only in Xience stent. For both stents, with different degree of influence, an increase in yield or ultimate stress improves stent radial strength and stiffness and reduces arterial stress and plastic strain of stent, which consequently enhances the stent mechanical performance. Contrarily, yield or ultimate stress elevation increases stent recoil which adversely affects stent performance. CONCLUSION Using high-strength materials has a double-edged sword effect on the stent performance and existing uncertainty in the precise estimate of stent mechanical properties adversely affects the reliability of numerical models' predictions.
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Shen X, Zhu H, Jiang J, Deng Y, Ji S. Multi-Objective Optimization Design of Balloon-Expandable Coronary Stent. Cardiovasc Eng Technol 2019; 10:10-21. [PMID: 30673977 DOI: 10.1007/s13239-019-00401-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Accepted: 01/11/2019] [Indexed: 01/10/2023]
Abstract
PURPOSE Recent studies suggested that suboptimal delivery and longitudinal stent deformation can result in in-stent restenosis. Therefore, the purpose of this paper was to study the effect of stent geometry on stent flexibility and longitudinal stiffness (LS) and optimize the two metrics simultaneously. Then, the reliable and accurate relationships between metrics and design variables were established. METHODS A multi-objective optimization method based on finite element analysis was proposed for the investigation and improvement of stent flexibility and LS. The relative influences of design variables on the two metrics were evaluated on the basis of the main effects. Three surrogate models, namely, the response surface model (RSM), radial basis function neural network (RBF), and Kriging were employed and compared. RESULTS The accuracies of the three models in fitting flexibility were nearly similar, although Kriging made more accurate prediction in LS. The link width played important roles in flexibility and LS. Although the flexibility of the optimal stent decreased by 13%, the LS increased by 48.3%. CONCLUSIONS The obtained results showed that the multi-objective optimization method is efficient in predicting an optimal stent design. The method presented in this paper can be useful in optimizing stent design and improving the comprehensive mechanical properties of stents.
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Arokiaraj MC. A novel method of inducing thrombosis in target arteries using coronary stents for therapeutic occlusion. BMC Res Notes 2018; 11:429. [PMID: 29970171 PMCID: PMC6029168 DOI: 10.1186/s13104-018-3511-6] [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: 04/19/2018] [Accepted: 06/18/2018] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVES Peripheral artery embolizations are often required for therapeutic purposes. The therapeutic embolizations are usually performed using embolization particles and coils. These procedures are also associated with complications. Coils and their delivery cables, and the expertise are not always available in all catheterization centers. Hence, a novel, simple controlled technique for arterial closure would be useful in emergency settings. RESULTS Following is a report of seven cases where embolization was performed successfully on an emergency basis after stenting using coronary stents for better closure of the target artery. Six patients underwent bronchial artery embolization for recurrent massive hemoptysis, and one another patient had pseudoaneurysm following percutaneous nephrolithotomy, and presented with hematuria and persistent and increasing blood discharge in drainage catheter. The stents were deployed in the target artery using 6F Judkin's diagnostic catheter over the 014 wires, which are easily available in all cardiac catheterization laboratories. This is a novel method to establish a metal platform inside the target arteries using coronary stents for better closure of the target arteries in combination with embolization techniques. The procedures were performed as lifesaving measures when small coils and the delivery cables were not available at the time of the procedures.
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Handl J, Meloun M, Mužáková V. Inflammatory markers in dependence on the plasma concentration of 37 fatty acids after the coronary stent implantation. J Pharm Biomed Anal 2018; 149:96-105. [PMID: 29107850 DOI: 10.1016/j.jpba.2017.10.033] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Revised: 10/26/2017] [Accepted: 10/27/2017] [Indexed: 12/31/2022]
Abstract
Using the regression model building the relationships between the concentration of 37 fatty acids of blood plasma phospholipids of 41 patients with coronary artery disease after coronary stent implantation, the inflammatory response and oxidative stress markers were estimated. The dynamics of the inflammatory response and the oxidative stress was indicated by measuring plasma concentrations of highly sensitive C-reactive protein, interleukin-6, serum amyloid A and malondialdehyde before, 24h after stent implantation. The multiple linear regression analysis was preceded by an exploratory data analysis, principal component analysis, factor analysis and cluster analysis, which proved a hidden internal relation of 37 fatty acids. The concentration of cerotic acid (C26:0) has been positively associated with an increase of malondialdehyde concentration after stent implantation, while the concentrations of tetracosatetraenoic (C24:4 N6) and nonadecanoic (C19:0) acids were associated with decrease of lipoperoxidation. The increase of interleukin-6 during the 24h after implantation was associated with higher levels of pentadecanoic acid (C15:0) and lower levels of α-linolenic acid (C18:3 N3). Regression models found several significant fatty acids at which the strength of the parameter β for each fatty acid on selected markers of C-reactive protein, malondialdehyde, interleukin-6 and serum amyloid A was estimated. Parameter β testifies to the power of the positive or negative relationship of the fatty acid concentration on the concentration of selected markers. The influencing effect of the cerotic acid (C26:0) concentration in plasma phospholipids exhibiting parameter β=140.4 is, for example, 3.5 times higher than this effect of n-3 tetracosapentaenoic acid (C24:5 N3) with β=40.0. Composition of fatty acids in plasma phospholipids shows spectrum of fatty acids available for intercellular communication in systemic inflammatory response of organism and should affect clinical outcomes.
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Capodanno D. Bioresorbable Scaffolds in Coronary Intervention: Unmet Needs and Evolution. Korean Circ J 2018; 48:24-35. [PMID: 29322695 PMCID: PMC5764868 DOI: 10.4070/kcj.2017.0194] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [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: 08/21/2017] [Revised: 09/13/2017] [Accepted: 09/15/2017] [Indexed: 11/12/2022] Open
Abstract
Bioresorbable scaffolds (BRS) represent a novel paradigm in the 40-year history of interventional cardiology. Restoration of cyclic pulsatility and physiologic vasomotion, adaptive vascular remodeling, plaque regression, and removal of the trigger for late adverse events are expected BRS benefits over current metallic drug-eluting stents. However, first-generation BRS devices have significant manufacturing limitations and rely on optimal implantation technique to avoid experiencing an excess of clinical events. There are currently at least 22 BRS devices in different stages of development, including many trials of device iterations with thinner (<150 µm) struts than first-generation BRS. This article reviews the outcomes of commercially available and potentially upcoming BRS, focusing on the most recent stages of clinical development and future directions for each scaffold type.
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Affiliation(s)
- Davide Capodanno
- Division of Cardiology, Cardio-Thoracic-Vascular Department, Azienda Ospedaliero Universitaria "Policlinico-Vittorio Emanuele" and Department of General Surgery and Medical-Surgical Specialties, University of Catania, Catania, Italy.
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15
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Ozcan Cetin EH, Ozeke O, Ilkay E, Aras D, Topaloglu S, Golbasi Z, Aydogdu S, Ozer C. Palliative treatment of coronary "atherosclerotic cancer" by drug-eluting or bare-metal stents: From oculo-stenotic reflex period to age of precision medicine. Indian Heart J 2018; 70:191-193. [PMID: 29455777 PMCID: PMC5902819 DOI: 10.1016/j.ihj.2017.07.008] [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] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2017] [Revised: 07/04/2017] [Accepted: 07/13/2017] [Indexed: 02/07/2023] Open
Abstract
Medications and treatments are said to have a palliative effect if they relieve symptoms without having a curative effect on the underlying disease such as atherosclerosis or cancer. Some authors speculated that atherosclerotic coronary artery disease (CAD) could be considered a "cancer of the coronary arterial wall". Although the percutaneous coronary intervention (PCI) has proven to be effective in decreasing mortality rates among patients with acute coronary syndromes, the previous meta-analyses of PCI versus optimal medical therapy for stable CAD have not been able to demonstrate a reduction in major adverse cardiac outcomes. However, few cardiologists discussed the evidence-based benefits of angiogram and PCI for stable CAD, and some implicitly or explicitly overstated the benefits. Recently, the precision medicine is defined as an evidence-based approach that uses innovative tools and biological and data science to customize disease prevention, detection, and treatment, and improve the effectiveness and quality of patient care. Providing patients with accurate and complete information appears to be an effective way to combat the reliance on the oculostenotic reflex. The foundation of precision medicine is the ability to tailor therapy based upon the expected risks and benefits of treatment for each individual patient. As said by Doctor William Osler, "The good physician treats the disease; the great physician treats the patient who has the disease."
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Affiliation(s)
- Elif Hande Ozcan Cetin
- Health Sciences University, Turkiye Yuksek Ihtisas Training and Research Hospital , Department of Cardiology, Ankara, Turkey
| | - Ozcan Ozeke
- Health Sciences University, Turkiye Yuksek Ihtisas Training and Research Hospital , Department of Cardiology, Ankara, Turkey.
| | - Erdogan Ilkay
- Health Sciences University, Turkiye Yuksek Ihtisas Training and Research Hospital , Department of Cardiology, Ankara, Turkey
| | - Dursun Aras
- Health Sciences University, Turkiye Yuksek Ihtisas Training and Research Hospital , Department of Cardiology, Ankara, Turkey
| | - Serkan Topaloglu
- Health Sciences University, Turkiye Yuksek Ihtisas Training and Research Hospital , Department of Cardiology, Ankara, Turkey
| | - Zehra Golbasi
- Health Sciences University, Turkiye Yuksek Ihtisas Training and Research Hospital , Department of Cardiology, Ankara, Turkey
| | - Sinan Aydogdu
- Health Sciences University, Turkiye Yuksek Ihtisas Training and Research Hospital , Department of Cardiology, Ankara, Turkey
| | - Can Ozer
- Health Sciences University, Turkiye Yuksek Ihtisas Training and Research Hospital , Department of Cardiology, Ankara, Turkey
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16
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Panoulas VF, Demir OM, Ruparelia N, Malik I. Longitudinal deformation of a third generation zotarolimus eluting stent: “The concertina returns!”. World J Cardiol 2017; 9:60-64. [PMID: 28163838 PMCID: PMC5253196 DOI: 10.4330/wjc.v9.i1.60] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Revised: 09/15/2016] [Accepted: 11/17/2016] [Indexed: 02/06/2023] Open
Abstract
In the current case series we describe two cases of longitudinal stent deformation in ostial lesions treated with a new generation zotarolimus eluting stent and review current literature on longitudinal stent deformation. Historically not a common occurrence, longitudinal deformation occurred mainly in Promus Element everolimus eluting stents, which had only two rather than the commonly used 3 links between stent rings. Longitudinal deformation commonly occurs secondary to compression of the proximal edge of the stent by either the guide catheters, or intravascular balloons and imaging catheters. The degree of deformation however, depends on the longitudinal strength and design of the stent.
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17
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Dave B. Bioresorbable Scaffolds: Current Evidences in the Treatment of Coronary Artery Disease. J Clin Diagn Res 2016; 10:OE01-OE07. [PMID: 27891384 DOI: 10.7860/jcdr/2016/21915.8429] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [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: 06/07/2016] [Accepted: 08/10/2016] [Indexed: 01/12/2023]
Abstract
Percutaneous coronary revascularization strategies have gradually progressed over a period of last few decades. The advent of newer generation drug-eluting stents has significantly improved the outcomes of Percutaneous Coronary Intervention (PCI) by substantially reducing in-stent restenosis and stent thrombosis. However, vascular inflammation, restenosis, thrombosis, and neoatherosclerosis due to the permanent presence of a metallic foreign body within the artery limit their usage in complex Coronary Artery Disease (CAD). Bioresorbable Scaffolds (BRS) represent a novel approach in coronary stent technology. Complete resorption of the scaffold liberates the treated vessel from its cage and restores pulsatility, cyclical strain, physiological shear stress, and mechanotransduction. In this review article, we describe the advances in this rapidly evolving technology, present the evidence from the pre-clinical and clinical evaluation of these devices, and provide an overview of the ongoing clinical trials that were designed to examine the effectiveness of BRS in the clinical setting.
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Affiliation(s)
- Bhargav Dave
- Clinical Research Analyst and Professor, Srinivas University , Mangaluru, Karnataka, India
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18
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Woolard AA, Ehrenfeld JM, Eagle SS, Wanderer JP. A retrospective study showing the extent of compliance with perioperative guidelines in patients with coronary stents with regard to double antiplatelet therapy. J Clin Anesth 2016; 33:179-84. [PMID: 27555160 DOI: 10.1016/j.jclinane.2016.01.030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2014] [Revised: 01/16/2016] [Accepted: 01/21/2016] [Indexed: 11/21/2022]
Abstract
STUDY OBJECTIVE To evaluate perioperative dual antiplatelet therapy management in patients with previously placed coronary stents. DESIGN Retrospective medical record review. SETTING Academic medical center. PATIENTS A total of 1891 surgical cases performed at Vanderbilt University Medical Center in 2012 were evaluated using a perioperative database. Of these, 161 had complete data records that were evaluated using 2 evidence-based and expert opinion-supported protocols. INTERVENTIONS N/A. MEASUREMENTS This study is meant to evaluate perioperative antiplatelet management decisions in patients with coronary stents. MAIN RESULTS Management decisions were consistent with guidelines regarding antiplatelet therapy in 13% (21/161) of patients. Of the 87% (140/161) of cases where decisions were not consistent, 88% (123/140) were due to discontinuing aspirin preoperatively when there was not a high risk of surgical bleeding. CONCLUSIONS This study revealed suboptimal adherence to current perioperative antiplatelet management guidelines in patients with coronary stents. The lack of adherence to current guidelines is concerning and could be used to support the notion of an anesthesiologist-led Perioperative Surgical Home.
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Abstract
The history of coronary angioplasty began with the groundbreaking work of Andreas Grüntzig, who was the first to use balloon-expandable catheters for the treatment of flow-limiting atherosclerotic coronary artery lesions. Thereafter, early investigators tested self-expanding springs as a solution to abrupt closure and restenosis seen with balloon angioplasty but these devices suffered from difficult delivery and a high complication rate. Julio Palmaz and Richard Schatz introduced the first balloon-expandable stent as a mechanical support to improve vessel patency. Their pioneering work launched a new era in the treatment of coronary artery disease.
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Affiliation(s)
- Christina Tan
- Division of Cardiology, Scripps Clinic, 10666 North Torrey Pines Road, La Jolla, CA 92037, USA
| | - Richard A Schatz
- Division of Cardiology, Scripps Clinic, 10666 North Torrey Pines Road, La Jolla, CA 92037, USA.
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Affiliation(s)
- Olivier Fouquet
- Department of Thoracic and Cardiovascular Surgery, University Hospital of Angers, Angers Cedex, France Service de Chirurgie Cardiaque, Centre Hospitalier Universitaire, Angers Cedex, France
| | - Mathurin Gomez
- Department of Thoracic and Cardiovascular Surgery, University Hospital of Angers, Angers Cedex, France
| | - Wissam Abi-Khalil
- Department of Cardiology, University Hospital of Angers, Angers Cedex, France
| | - Patrice Binuani
- Department of Thoracic and Cardiovascular Surgery, University Hospital of Angers, Angers Cedex, France
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Abstract
Implantation of drug-eluting stents (DESs) via percutaneous coronary intervention is the most popular treatment option to restore blood flow to occluded vasculature. The many devices currently used in clinic and under examination in research laboratories are manufactured using a variety of coating techniques to create the incorporated drug release platforms. These coating techniques offer various benefits including ease of use, expense of equipment, and design variability. This review paper discusses recent novel DES designs utilizing individual or a combination of these coating techniques and their resulting drug release profiles.
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Affiliation(s)
- Megan Livingston
- Department of Regenerative Medicine and Orthopaedics, Houston Methodist Research Institute, Houston, USA
| | - Aaron Tan
- Centre for Nanotechnology & Regenerative Medicine, UCL Division of Surgery & Interventional Science, UCL Medical School, University College London (UCL), London, UK
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22
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Pesenti-Rossi D, Allouch P, Gibault-Genty G, Baron N, Augusto S, Convers-Domart R, Almeida S, Aubert S, Squara P, Livarek B. [Coronary stent evaluation with cardiac CT: Literature review]. Ann Cardiol Angeiol (Paris) 2015; 64:362-7. [PMID: 26492985 DOI: 10.1016/j.ancard.2015.09.041] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2015] [Accepted: 09/03/2015] [Indexed: 11/20/2022]
Abstract
Since the introduction of the 64-generation scanners, the accuracy and robustness of the diagnosis of coronary artery disease has progressed. The main advantage of cardiac CT is the exclusion of coronary artery disease by its excellent negative predictive value. Currently, cardiac CT applications extend thanks to innovations both in terms of technological development systems scanner or stents implanted. This is a literature review of stent evaluation with cardiac CT.
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23
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Olafiranye O, Vlachos H, Mulukutla SR, Marroquin OC, Selzer F, Kelsey SF, Williams DO, Strollo PJ, Reis SE, Lee JS, Smith AJC. Comparison of long-term safety and efficacy outcomes after drug-eluting and bare-metal stent use across racial groups: Insights from NHLBI Dynamic Registry. Int J Cardiol 2015; 184:79-85. [PMID: 25697874 DOI: 10.1016/j.ijcard.2015.01.071] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2014] [Revised: 12/07/2014] [Accepted: 01/26/2015] [Indexed: 01/18/2023]
Abstract
BACKGROUND Long-term data on outcomes after percutaneous coronary intervention (PCI) with drug-eluting stent (DES) and bare-metal stent (BMS) across racial groups are limited, and minorities are under-represented in existing clinical trials. Whether DES has better long-term clinical outcomes compared to BMS across racial groups remains to be established. Accordingly, we assessed whether longer-term clinical outcomes are better with DES compared to BMS across racial groups. METHODS Using the multicenter National Heart, Lung, and Blood Institute (NHLBI)-sponsored Dynamic Registry, 2-year safety (death, MI) and efficacy (repeat revascularization) outcomes of 3326 patients who underwent PCI with DES versus BMS were evaluated. RESULTS With propensity-score adjusted analysis, the use of DES, compared to BMS, was associated with a lower risk for death or MI at 2 years for both blacks (adjusted Hazard Ratio (aHR)=0.41, 95% CI 0.25-0.69, p<0.001) and whites (aHR=0.67, 95% CI 0.51-0.90, p=0.007). DES use was associated with a significant 24% lower risk of repeat revascularization in whites (aHR=0.76, 95% CI 0.60-0.97, p=0.03) and with nominal 34% lower risk in blacks (aHR=0.66, 95% CI 0.39-1.13, p=0.13). CONCLUSION The use of DES in PCI was associated with better long-term safety outcomes across racial groups. Compared to BMS, DES was more effective in reducing repeat revascularization in whites and blacks, but this benefit was attenuated after statistical adjustment in blacks. These findings indicate that DES is superior to BMS in all patients regardless of race. Further studies are needed to determine long-term outcomes across racial groups with newer generation stents.
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Affiliation(s)
- Oladipupo Olafiranye
- Pittsburgh Heart, Lung, Blood and Vascular Medicine Institute, University of Pittsburgh, Pittsburgh, PA, United States.
| | - Helen Vlachos
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA, United States
| | - Suresh R Mulukutla
- Pittsburgh Heart, Lung, Blood and Vascular Medicine Institute, University of Pittsburgh, Pittsburgh, PA, United States
| | - Oscar C Marroquin
- Pittsburgh Heart, Lung, Blood and Vascular Medicine Institute, University of Pittsburgh, Pittsburgh, PA, United States
| | - Faith Selzer
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA, United States
| | - Sheryl F Kelsey
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA, United States
| | - David O Williams
- Division of Cardiology, Brigham and Women's Hospital, Boston, MA, United States
| | - Patrick J Strollo
- Pittsburgh Heart, Lung, Blood and Vascular Medicine Institute, University of Pittsburgh, Pittsburgh, PA, United States
| | - Steven E Reis
- Pittsburgh Heart, Lung, Blood and Vascular Medicine Institute, University of Pittsburgh, Pittsburgh, PA, United States
| | - Joon S Lee
- Pittsburgh Heart, Lung, Blood and Vascular Medicine Institute, University of Pittsburgh, Pittsburgh, PA, United States
| | - A J Conrad Smith
- Pittsburgh Heart, Lung, Blood and Vascular Medicine Institute, University of Pittsburgh, Pittsburgh, PA, United States
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Poon EKW, Barlis P, Moore S, Pan WH, Liu Y, Ye Y, Xue Y, Zhu SJ, Ooi ASH. Numerical investigations of the haemodynamic changes associated with stent malapposition in an idealised coronary artery. J Biomech 2014; 47:2843-51. [PMID: 25132633 DOI: 10.1016/j.jbiomech.2014.07.030] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2014] [Revised: 07/10/2014] [Accepted: 07/29/2014] [Indexed: 10/24/2022]
Abstract
The deployment of a coronary stent near complex lesions can sometimes lead to incomplete stent apposition (ISA), an undesirable side effect of coronary stent implantation. Three-dimensional computational fluid dynamics (CFD) calculations are performed on simplified stent models (with either square or circular cross-section struts) inside an idealised coronary artery to analyse the effect of different levels of ISA to the change in haemodynamics inside the artery. The clinical significance of ISA is reported using haemodynamic metrics like wall shear stress (WSS) and wall shear stress gradient (WSSG). A coronary stent with square cross-sectional strut shows different levels of reverse flow for malapposition distance (MD) between 0mm and 0.12 mm. Chaotic blood flow is usually observed at late diastole and early systole for MD=0mm and 0.12 mm but are suppressed for MD=0.06 mm. The struts with circular cross section delay the flow chaotic process as compared to square cross-sectional struts at the same MD and also reduce the level of fluctuations found in the flow field. However, further increase in MD can lead to chaotic flow not only at late diastole and early systole, but it also leads to chaotic flow at the end of systole. In all cases, WSS increases above the threshold value (0.5 Pa) as MD increases due to the diminishing reverse flow near the artery wall. Increasing MD also results in an elevated WSSG as flow becomes more chaotic, except for square struts at MD=0.06 mm.
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Affiliation(s)
- Eric K W Poon
- Department of Mechanical Engineering, Melbourne School of Engineering, The University of Melbourne, Victoria 3010, Australia.
| | - Peter Barlis
- Department of Mechanical Engineering, Melbourne School of Engineering, The University of Melbourne, Victoria 3010, Australia; North West Academic Centre, Melbourne Medical School, The University of Melbourne, Victoria 3010, Australia
| | - Stephen Moore
- IBM Research Collaboratory for Life Sciences-Melbourne, Victoria Life Sciences Computation Initiative, The University of Melbourne, Victoria 3010, Australia
| | - Wei-Han Pan
- Department of Mechanical Engineering, Melbourne School of Engineering, The University of Melbourne, Victoria 3010, Australia
| | - Yun Liu
- Department of Mechanical Engineering, Melbourne School of Engineering, The University of Melbourne, Victoria 3010, Australia
| | - Yufei Ye
- Department of Mechanical Engineering, Melbourne School of Engineering, The University of Melbourne, Victoria 3010, Australia
| | - Yuan Xue
- Department of Mechanical Engineering, Melbourne School of Engineering, The University of Melbourne, Victoria 3010, Australia
| | - Shuang J Zhu
- Department of Mechanical Engineering, Melbourne School of Engineering, The University of Melbourne, Victoria 3010, Australia
| | - Andrew S H Ooi
- Department of Mechanical Engineering, Melbourne School of Engineering, The University of Melbourne, Victoria 3010, Australia
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Gennari M, Kassem S, Teruzzi G, Agrifoglio M. Coronary artery disease associated with severe mitral and tricuspid valve regurgitation after left pneumonectomy: report of a successful hybrid procedure. Interact Cardiovasc Thorac Surg 2014; 19:318-20. [PMID: 24771204 DOI: 10.1093/icvts/ivu120] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The literature concerning heart surgery after pneumonectomy is still poor. Moreover, there is still a lack of a standardized approach to such a patient in the decision-making process. Here, we report a case of a patient who had previously had left pneumonectomy for malignancy and who had coronary artery disease and mitral and tricuspid regurgitation treated with a hybrid procedure.
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Affiliation(s)
- Marco Gennari
- Department of Cardiovascular Disease, Cardiac Surgery Unit II, IRCCS Centro Cardiologico Monzino, Milan, Italy
| | - Samer Kassem
- Department of Cardiovascular Disease, Cardiac Surgery Unit II, IRCCS Centro Cardiologico Monzino, Milan, Italy
| | - Giovanni Teruzzi
- Interventional Cardiology Unit, IRCCS Centro Cardiologico Monzino, Milan, Italy
| | - Marco Agrifoglio
- Department of Cardiovascular Disease, Cardiac Surgery Unit II, IRCCS Centro Cardiologico Monzino, Milan, Italy
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26
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Lim KS, Jeong MH, Park JE, Bae IH, Park DS, Kim JM, Kim JH, Sim DS, Park KH, Hong YJ, Ahn Y. Single coronary artery originating from the right aortic sinus without a left anterior descending and circumflex artery in conventional swine. Lab Anim Res 2013; 29:226-8. [PMID: 24396388 DOI: 10.5625/lar.2013.29.4.226] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2013] [Revised: 11/02/2013] [Accepted: 11/23/2013] [Indexed: 12/04/2022] Open
Abstract
Single coronary artery is a rare coronary artery anomaly. Very few previous reports of this anatomical malformation in swine have been found. A 22 kg Yorkshire X Landrace F1 crossbred castrated male swine was presented for enrollment in a coronary stent implantion study. Coronary angiography revealed a single coronary artery arising from the right aortic sinus. The right coronary artery and anomalous left coronary artery were implanted with novel coronary stents without any side effects.
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27
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Mohan C, Chennazhi K, Menon D. In vitro hemocompatibility and vascular endothelial cell functionality on titania nanostructures under static and dynamic conditions for improved coronary stenting applications. Acta Biomater 2013; 9:9568-77. [PMID: 23973390 DOI: 10.1016/j.actbio.2013.08.023] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2013] [Revised: 07/24/2013] [Accepted: 08/14/2013] [Indexed: 02/03/2023]
Abstract
The usefulness of nanoscale topography in improving vascular response in vitro was established previously on hydrothermally modified titanium surfaces. To propose this strategy of surface modification for translation onto clinically used metallic stents, it is imperative that the surface should be also hemocompatible: an essential attribute for any blood-contacting device. The present in vitro study focuses on a detailed hemocompatibility evaluation of titania nanostructures created through an alkaline hydrothermal route on metallic Ti stent prototypes. Direct interactions of TiO2 nanocues of various morphologies with whole blood were studied under static conditions as well as using an in vitro circulation model mimicking arterial flow, with respect to a polished Ti control. Nanomodified stent surfaces upon contact with human blood showed negligible hemolysis under constant shear and static conditions. Coagulation profile testing indicated that surface roughness of nanomodified stents induced no alterations in the normal clotting times, with insignificant thrombus formation and minimal inflammatory reaction. Endothelialized nanomodified Ti surfaces were found to inhibit both activation as well as aggregation of platelets compared with the control surface, with the endothelium formed on the nanosurfaces having an increased expression of anti-thrombogenic genes. Such a nanotextured Ti surface, which is anti-thrombogenic and promotes endothelialization, would be a cost-effective alternative to drug-eluting stents or polymer-coated stents for overcoming in-stent restenosis.
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28
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Abstract
Ischemic heart disease (IHD) occurs when myocardial oxygen supply is not adequate for myocardial oxygen demand. Patients with IHD who are undergoing surgery are at risk for development of perioperative cardiac events (PCEs), and this risk depends on the type of surgery, the presence of clinical risk factors, and functional status of the patients. Appropriate perioperative management of medications such as dual antiplatelet therapy and β-blockers has a significant impact on outcomes. Perioperative management decisions should be communicated clearly between the surgeon, cardiologist, and anesthesiologist in charge of the patient. Appropriate perioperative management reduces the incidence of PCEs.
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Affiliation(s)
- Patrick N Odonkor
- Department of Anesthesiology, University of Maryland School of Medicine, Suite S8D12 22 South Greene Street, Baltimore, MD 21201, USA
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29
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Moreno R, García E, Teles R, Rumoroso JR, Cyrne Carvalho H, Goicolea FJ, Moreu J, Mauri F, Sabaté M, Mainar V, Patricio L, Valdés M, Cuellas C, Almeida M, Sánchez-Recalde A, Galeote G, Jimenez-Valero S, Calvo L, Plaza I, Lopez-Sendón JL, Martín JLR. Techniques and material used in the percutaneous treatment of chronic coronary occlusions. Data from the CIBELES study. Rev Port Cardiol 2013; 32:593-9. [PMID: 23896301 DOI: 10.1016/j.repc.2012.11.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [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: 10/03/2012] [Accepted: 11/01/2012] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION In recent years, various specific techniques and materials have been developed for the treatment of coronary chronic total occlusions (CTO). OBJECTIVE To evaluate the current situation in the treatment of CTO (techniques and material) in our setting. METHODS We evaluated data on techniques and material used in the CIBELES (ChronIc coronary occlusion treated By EveroLimus Eluting Stent) trial, a randomized comparison of sirolimus- and everolimus-eluting stents in 207 patients with CTO in 13 centers in Spain and Portugal. RESULTS A radial approach was used in 23% of patients, and retrograde techniques were used in only 5%. A high number of balloons were used (2.2±0.9 per patient). Microcatheters were used in 33% of patients, and post-dilatation balloons in only 25%. The mean number of stents implanted per patient was 2.1±1.0, with a mean total stent length of 49±24 mm. Other devices and techniques used were: Tornus penetration catheter in 4% of patients, rotational atherectomy in 2%, and cutting balloon in 1%. Intracoronary ultrasound was used in only 6% of patients. In 34% of cases, operators used guidewires that were not specifically for CTO. Considerable variability between centers was detected in the use of different techniques, the highest and lowest variability being observed in the use of intracoronary ultrasound and the use of CTO guidewires, respectively. CONCLUSIONS In the CIBELES trial, techniques and devices specifically designed for the treatment of CTO were used in a relatively low proportion of patients. Considerable variability between centers was detected.
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Affiliation(s)
- Raul Moreno
- Interventional cardiology, University Hospital La Paz, Madrid, Spain.
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