Misdiagnosis of ameloblastoma in a patient with clear cell odontogenic carcinoma: a case report

Clear cell odontogenic carcinoma (CCOC), a rare tumor in the head and neck region, displays comparable properties with other tumors clinically and pathologically. In consequence, an incorrect diagnosis may be established. A 51-year-old male patient who was admitted to the Department of Oral and Maxillofacial Surgery at Pusan National University Dental Hospital was initially diagnosed with ameloblastoma via incisional biopsy. However, the excised mass of the patient was observed to manifest histopathological characteristics of ameloblastic carcinoma. The lesion was ultimately diagnosed as clear cell odontogenic carcinoma by the Department of Oral Pathology of Pusan National Dental University. Therefore, segmental mandibulectomy and bilateral neck dissection were performed, followed by reconstruction with fibula free flap and reconstruction plate. Concomitant chemotherapy radiotherapy was not necessary. The patient has been followed up, and no recurrence has occurred 6 months after surgery.

Misdiagnosis of ameloblastoma in a patient with clear cell odontogenic carcinoma: a case report

Clear cell odontogenic carcinoma (CCOC), a rare tumor in the head and neck region, displays comparable properties with other tumors clinically and pathologically. In consequence, an incorrect diagnosis may be established. A 51-year-old male patient who was admitted to the Department of Oral and Maxillofacial Surgery at Pusan National University Dental Hospital was initially diagnosed with ameloblastoma via incisional biopsy. However, the excised mass of the patient was observed to manifest histopathological characteristics of ameloblastic carcinoma. The lesion was ultimately diagnosed as clear cell odontogenic carcinoma by the Department of Oral Pathology of Pusan National Dental University. Therefore, segmental mandibulectomy and bilateral neck dissection were performed, followed by reconstruction with fibula free flap and reconstruction plate. Concomitant chemotherapy radiotherapy was not necessary. The patient has been followed up, and no recurrence has occurred 6 months after surgery.

The rate and stability of mandibular block bone graft in recent 5 years / 대한악안면성형재건외과학회지

BACKGROUND: The purposes of the present study were to compare implant stabilities of mandibular block bone graft and bovine bone graft and to evaluate influencing factors for implant stability in mandibular block bone (MBB) graft. METHODS: This retrospective study investigated 1224 cases and 389 patients treated by one surgeon in the Department of Oral and Maxillofacial Surgery of Pusan National University Dental Hospital (Yangsan, Korea) between January 2010 and December 2014. Proportions that MBB graft cases constitute in all implant restoration cases and in all bone graft cases were measured. Implant stability quotient (ISQ) values were achieved by the same surgeon before loading. The average ISQ values of the experimental groups were compared. In addition, ISQ values of influencing factors, such as age, sex, implant size, and implant placement site, were compared within the MBB group using OsstellTM Mentor (Osstell®, Göteborg, Sweden). Paired t test and ANOVA were conducted for statistical analysis with a significance level of 0.05. RESULTS: Fifty-five percent of all implant restoration cases performed bone graft while MBB cases constituted 34% of all implant restoration cases and 61% of all bone graft cases. Comparing ISQ values according to bone graft materials, the MBB group manifested sufficient implant stability by presenting comparable ISQ value to that of the experimental group without bone graft. Among the reviewed factors, females, mandibular molar regions, and implants in larger diameter displayed greater implant stabilities. CONCLUSIONS: Satisfactory implant stability was accomplished upon administration of MBB graft. Within the limitation of this study, gender, implant site, and implant diameter were speculated to influence on implant stability in MBB graft.

Stent Graft for a Coronary Arteriovenous Fistula in Acute Myocardial Infarction

The stent graft has recently been used for the treatment of coronary artery aneurysms, perforations, dissection and arteriovenous fistula. An 81-year-old male presented with chest pain of 2-day duration. A 12-lead electrocardiogram showed atrial fibrillation and ST-T changes over the precordial leads. A diagnostic left coronary angiogram (CAG) revealed critical stenosis in the proximal left anterior descending coronary artery (LAD) and prestenotic dilatation with large coronary arteriovenous fistula draining into the main pulmonary artery. After predilation, a polytetrafluoroethylene (PTFE) covered stent graft (3.0x16 mm JoStent Graft Master(r), JoMed, Germany) for fistula and an additional conventional stent for just below the graft stented site of proximal LAD stenosis were implanted successfully. After stenting, no visible large fistula or remaining stenosis was demonstrated on CAG. The stent graft was deployed with a high success rate. The restenosis rate was not higher than expected for bare stents. However, as subacute occlusion may occur more frequently, long-term ticlopidine or clopidogrel treatment should be required.

Successful Stent Grafting for a Coronary Aneurysm

The stent graft can be used for the treatment of coronary artery aneurysms, perforations, dissection and arteriovenous fistula. A 54-year-old man presented with progressively worsening chest pain for several months. A diagnostic coronary angiogram revealed critical stenosis with a huge aneurysmal sac (6.0x8.2 mm in size) in the proximal right coronary artery. We implanted two membrane covered stent grafts (3.0x16 mm, JoStent GraftMaster(r), JoMed, Germany) without complication. No visible coronary aneurysm or residual stenosis was demonstrated after stent grafting. A two-month follow-up coronary angiogram showed patent stent grafted right coronary artery.

Video-assisted Thoracoscopic Decortication for Management of Postpneumonia Empyema / 대한흉부외과학회지

BACKGROUND: Video-assisted thoracoscopic surgery (VATS) for decortication or debridement in the management of empyema thoracis has increased the available treatment options but requires validation. We present and evaluate our technique and experience with thoracoscopic management of pleural empyema, irrespective of chronicity. MATERIAL AND METHOD: VATS debridement or decortication was performed with endoscopic shaver system in 40 consecutive patients presented with pleural space infections. A retrospective review was performed and the effect of this technique on perioperative outcome was assessed. RESULT: VATS evacuation of infected pleural fluid and decortication was successfully performed in 35 of 40 patients. The mean duration of preoperative symptoms before referral was 23 +/- 1.8 days. The mean duration of hospitalization before transfer was 13.5 +/- 1.5 days. Blood loss was 250 to 200 mL. Intercostal drainage was required for 5 +/- 3 days. The postoperative hospital stay was 5 +/- 0.7 days. There were no operative mortalities. CONCLUSION: Video-assisted evacuation of infected pleural fluid and decortication is an effective modality in the management of the fibropurulent stage of empyema. An organized empyema should be approached thoracoscopically, but may require open decortication.

Long-term Clinical and Angiographic Results of Coronary Stenting in Diabetic Patients

BACKGROUND: Diabetes is a major risk factor for restenosis and high mortality after percutaneous coronary intervention. The impact of coronary stenting on the clinical outcome of diabetic patients remains controversial. METHOD: The in-hospital and long-term clinical outcomes of 104 consecutive diabetic (60+/-8 year-old, 74 male) and age-matched 193 control (57+/-10 year-old, 162 male) patents underwent coronary stenting between January 1998 and March 1999 at Chonnam National University Hospital were compared. RESULTS: 1) Coronary stenting was successful in 98% of diabetic patients and 97% of non-diabetic patients. Post-procedural minimal luminal diameter (MLD) was not different between two groups(2.89+/-0.42 vs. 2.95+/-0.62 mm), but follow-up MLD was lower in diabetics than that in non-diabetics (1.70+/-0.96 vs. 2.05+/-0.72 mm, P < 0.05). 2) Restenosis rate on follow-up coronary angiograpy was not different between two groups (40.7% in diabetics and 32.0% in non-diabetics. 3) In-hospital outcome was not different between two groups. Long-term clinical follow-up (16+/-11 months) revealed higher overall major adverse cardiac events in diabetics than in non-diabetics (38.7 vs. 30.7 %, P < 0.05). CONCLUSION: Coronary stenting in diabetics can be performed with acceptable short-term results. However, long-term clinical outcome in diabetic patients was worse than in non-diabetics.

Early outcome and Restenosis rate after Coronary Artery Stenting in the Elderly

BACKGROUND AND OBJECTIVES: With the prolonged life expectancy and changes in dietary habits in Korea, the number and percentage of elderly patients with ischemic heart disease(IHD) has been increased. Primary success rate and long-term clinical outcomes of elderly patients were compared with younger patients, who underwent coronary artery stent(CAS). MATERIALS AND METHOD: A retrospective analysis of 379 patients, who underwent CAS at Chonnam National University Hospital from January 1993 to June 1998, was performed. Clinical characteristics, lipid profiles, coronary angiographic findings, success rates and in-hospital mortality rates and follow-up coronary angiographic findings of elderly patients older than 70 years (Group I; n=1, 73+/-4 years) were compared with the patients under the age of 70 years (Group II; n=88, 56+/-11 years). RESULTS: Female was more prevalent in Group I than Group II (41/91, 45.1% vs. 57/288, 19.9%, P < 0.001). Ejection fraction was lower in Group I than in Group II (56.9+/-6.4 vs. 63.8+/-15.3 %, P < 0.05) and left ventricular end-diastolic pressure was higher in Group I (17.9+/-7.9 vs. 14.0+/-7.7 mmHg, respectively P < 0.05) than in Group II. There were no significant differences in the distribution of the risk factor except for smoking (Group I; 26/91, 28.6% vs Group II; 130/288, 45.3%, P < 0.05). Lesion and procedural characteristics were not different between two groups. Primary success rate of Group I was 94.5%(86/91) and 96.5%(278/288), which were not different between two groups. On follow-up coronary angiogram, restenosis rate was not different between two groups (Group I: 9/37, 24.37% vs. Group II 50/154, 32.5%, P=S). CONCLUSION: The initial success rate and restenosis rate of coronary stenting in the elderly patients are not different from those of younger group. Thus coronary stent can be performed effectively in elderly patients.

Predictive Factors for the Restenosis after Long Coronary Stent Implantation

BACKGROUND AND OBJECTIVES: In-stent coronary restenosis remains one of major clinical problems in percutaneous coronary intervention. Long stent has been known to be associated with high restenosis rate. Predictive clinical and angiographic factors were analyzed after long coronary stenting. METHODS: One hundred four patients (57.2+/-9.6 year-old, 105 male) who underwent long coronary stent implantation and follow-up coronary angiogram, out of 237 patients implanted long coronary stents between June 1996 and January 1999 at Chonnam National University Hospital. RESULTS: Primary success rate was 100%. Lesion length was 18.5 +/- 9.2 mm and the length of stent was 27.3 +/- 6.1 mm. Mean duration of clinical follow-up and follow-up coronary angiogram was 20.1+/-6.8 months and 6.3+/-2.7 months respectively. Restenosis rate according to follow-up coronary angiogram was 42.5% (57/134). Clinical variables of age, sex, clinical diagnosis, risk factors, and angiographic variables of target artery and lesion types, indications for stenting, stent types, reference diameter, lesion length, minimal luminal diameter, and acute gain were not related with late stent restenosis. Diameter stenosis before stenting was higher in the group with restenosis (81.9+/-16.9 %) than in group without restenosis (71.1+/-18.5%; p<0.05), and lower lower in the group with restenosis (-7.6+/-15.7%) and in the group without restenosis (5.6+/-22.4%; p<0.05) after stenting. CONCLUSIONS: Primary success rate was comparable. Severe luminal stenosis before stenting and overdilation after stenting are associated with restenosis after long coronary stenting.

A Giant Aneurysm of the Sinus of Valsalva with Calcification

Aneurysms of sinus of Valsalva often remain undiagnosed until they rupture. A huge, heavily calcified unruptured aneurysm originating from the right sinus of Valsalva was detected incidentally in a 61-year-old man. Chest X-ray showed cardiomegaly and 10 cm sized huge calcified mass lesion around the cardiac shadow. Two-dimensional echocardiogrm revealed pericardial effusion with huge calcified mass compressing right ventricular outflow and color-flow Doppler echocardiogram visualized blood flow from aortic root into aneurysm. Chest CT scan and MRI revealed a large thrombosed aneurysm arising from aortic root measuring 1010cm. After pericardiocentesis cardiac catheterization was performed, which showed elevated right ventricular systolic pressure up to 80 mmHg. Aortic root angiogram revealed huge unruptured calcified aneurysm in the sinus of Valsalva arising from the right coronary sinus. The patient underwent surgical correction for the prevention of aneurysmal rupture and the relief of right ventricular outflow obstruction.

A long stent is the only predictive factor for coronary stent restenosis / 대한내과학회지

BACKGROUND: Coronary stenting is one of the most effective methods of percutaneous coronary interventions (PCI) in the treatment of intimal dissection and prevention of restenosis after balloon angioplasty. However, coronary stent restenosis still remains a major clinical limitation. METHODS: Three hundreds seventy three patients who underwent coronary stent implantations and follow-up coronary aniograms at Chonnam National University Hospital between June 1996 and December 1999, were divided into two groups: 123 patients with restenosis (Group A: 98 male, 25 female, 58.5+/-9.4 year-old) and 240 patients without restenosis (Group B: 193 male, 47 female). RESULTS: The prevalence of clinical diagnosis and risk factors for the atherosclerosis were not different between two groups. The indications for stenting and stent types, reference vessel diameter and minimal luminal diameter before stenting were not different. However, stent length was 23.4+/-7.57 mm in Group A and 20.8+/-6.58 mm in Group B, which were longer in Group A than in Group B (p=001). By multiple logistic regression analysis for the independent predictive factors for stent restenosis, the long stent more than 25mm in length was the only significant predictive factor after correction according to age, sex, risk factor, lipid profiles (OR=2.590, 95% C.I.=1.40-4.78). CONCLUSION: The long coronary stent more than 25 mm in length is a predictive factor of restenosis after coronary stenting.

Acute and Long-term Clinical Outcomes after Coronary Stenting of CrossFlex, GFX and NIR Stents

BACKGROUND AND OBJECTIVES: New coronary stents are displacing for the broader array of lesions, but disagreement remains which device is more advantageous and whether design determines outcomes. The present study investigates the impact of stent design on early and one year outcomes. MATERIALS AND METHODS: A retrospective analysis of 350 patients with 378 lesions (60+/-10 years, 265 male), that underwent 181 CrossFlex, 95 GFX, 102 NIR coronary stentings at Chonnam National University Hospital from January 1996 to December 1999, was performed. Early procedural success rates, major adverse cardiac event (MACE) within one year and follow-up angiographic findings in 227 patients (240 lesions, follow-up duration=8.1+/-5.9 months) were compared among three groups. METHODS: 1) There were no significant differences in the baseline clinical and angiographic characteristics except the lesion length (CrossFlex: GFX: NIR=11.5+/-5.2: 14.5+/-6.7: 13.9+/-5.7 mm, p<0.05). 2) There were no significant differences in early angiographic success rates among three groups (CrossFlex: 98.9%, GFX: 100.0%, NIR: 99.0%). 3) There were no significant differences in late luminal loss (CrossFlex: GFX: NIR=1.03+/-0.69: 1.11+/-0.75: 1.09+/-0.70 mm, p=NS), restenosis rates (CrossFlex: 30.6%, GFX: 30.8%, NIR: 28.4%, p=NS) and MACE (CrossFlex: GFX: NIR=27.6%: 29.5%: 27.5%, p=NS) among three groups. CONCLUSION: Despite different lesions length, the early and late angiographic outcomes, and MACE within one year were not different among three different types of coronary stents.

The long-term clinical significance of troponin and electrocardiogram in patients with unstable angina / 대한내과학회지

BACKGROUND: The early assessment of cardiac risk is important in patients with unstable angina (UA). The present study investigates the prognostic value capacities of cardiac specific troponin T (cTnT), cardiac specific troponin I (cTnI) and ECG change in Korean patients with UA. METHODS: Two hundred thirty patients (61+/-11 year, male:female=172:58) admitted to Chonnam National University Hospital via emergency room under the diagnosis of UA and underwent diagnostic coronary angiography (CAG) between July 1998 and June 1999, were analyzed according to the ECG findings of ST depression (STD), T wave inversion (TWI), cTnT and cTnI. Clinical characteristics, initial and follow-up CAG findings, and major adverse cardiac events (MACE) within one year were compared. RESULTS: Among the enrolled patients, 164 (71.3%) patients had significant coronary artery stenosis (CAS). During the one-year follow-up period, 40 patients developed MACE : 2 patients died, 7 patients had acute myocardial infarction and 34 patients developed restenosis. Positivity of cTnT and cTnI was associated with presence of CAS (p<0.001) and multi-vessel diseases (p<0.001). Levels of cTnT (5.7+/-8.4 vs 1.6+/-3.1 mg/dL, p<0.001) and cTnI (0.11+/-0.18 vs 0.03+/-0.19 mg/dL, p<0.001) were associated with MACE. The presence of STD was associated with the presence of CAS (p<0.001), multi-vessel diseases (p<0.001), low Thrombolysis In Myocardial Infarction (TIMI) flow (p<0.01), ACC/AHA types (p<0.001) and MACE (p<0.05). TWI was associated with TIMI flow (p<0.05), ACC/AHA types (p<0.001). In the patients with negative cTnT or cTnI, the negative predictive value of MACE within 1 year was 87.1% and 93.4%, respectively. In the absence of STD, that of MACE within 1 year was 87.1%. CONCLUSION: The level of troponin and electrocardiograhic findings are valuable in the early stratification of cardiac risks in Korean patients with UA and the prediction of MACE.

The Long-term Clinical Outcomes after Rescue Percutaneous Coronary Intervention in Patients with Acute Myocardial Infarction

BACKGROUND AND OBJECTIVES: A rescue percutaneous coronary intervention (PCI) has been used to treat the patients after failed thrombolysis in acute myocardial infarction. However, short- and long-term benefits of rescue PCI has not been known exactly. The goal of this study was to examine the clinical and angiographic outcomes, success rate of the procedure, and long-term survival rate after rescue PCI. MATERIALS AND METHODS: Clinical and angiographic outcomes of 31 patients (Group I; 59.7+/-11.4 years, 80.6% male), who underwent rescue PCI were compared with those of 177 patients (Group II; 59.7+/-9.7 years, 79.7% male), primary PCI at Chonnam National University Hospital between January 1997 and December 1999. RESULTS: There were no significant differences in the risk factors for coronary artery diseases except for smoking (Group I; 24/31, 77.4% vs. Group II; 76/177, 42.9%, P<0.05). The incidence of cardiogenic shock was higher in Group I than in Group II (Group I; 7/31, 22.6% vs. Group II; 11/177, 6.2%, P<0.05). The coronary angiographic findings were not different between two groups. Thrombolysis in Myocardial Infarction flow of Group I was lower than in Group II (Group I; 1.14+/-0.93 vs. Group II; 1.61+/-1.14, P<0.05). Primary success rate was 93.6% (29/31) in Group I and 94.9% (168/177) in Group II (P<0.05). Baseline ejection fraction was lower in Group I than in Group II (Group I; 44.2+/-8.9% vs. Group II; 50.8+/-11.7, P<0.05), which improved in both groups (Group I; 51.7+/-7.9% vs. Group II; 60.7+/-13.4%, P<0.05) at six months after the procedures. The survival rate of Group I was 93.5%, 93.5% and 90.3% and that of Group II was 94.5%, 93.7% and 91% at 1 month, 6 and 12 months, respectively. CONCLUSION: Rescue PCI was associated with the risk factor of smoking and the high incidence of cardiogenic shock. The success rate of rescue PCI was comparable with primary PCI and left ventricular function was improved after rescue PCI on long-term clinical follow-up with relatively high survival rate.

Long-Term Clinical Follow-up in A Case of Takayasu's Arteritis Involving the Ostium of Left Coronary Artery after Ostioplasty

A 25-year-old woman presented with effort-induced chest pain. Physical examination revealed different blood pressures, 180/100 mmHg in right arm and 100/60 mmHg in left arm. Resting electrocardiogram was normal, but down-slope depression of ST segment more than 3 mm in V3-6, II, III, aVF developed at the stage 1 of treadmill exercise test. Stress Thallium-201 scan showed severe ischemia in the anteroseptal and lateral wall of left ventricle. Diagnostic coronary angiogram showed critical stenosis in the ostium of left main coronary artery. The left subclavian artery was occluded totally with well-developed collateral circulation. The patient underwent ostioplasty of left coronary ostium using pericardial patch, and her symptom improved after surgery. Follow-up coronary angiogram one year after surgery showed patent coronary artery ostium with good flow and myocardial perfusion improved on follow-up Thallium-201 SPECT. She has no major cardiac events during 7-year clinical follow-up.

Prediction of head-up tilt test result in patients with syncope of unknown origin / 대한내과학회지

BACKGROUND: Vasovagal syncope has been believed to account for the majority of syncope of unknown origin (SUO). Head-up tilt test (HUT) has been well recognized as a useful test in the evaluation of SUO. The purpose of this study was to determine the predictors of HUT to develop a less time-consuming test protocol and get an information on the pathophysiology of vasovagal syncope. METHODS: Eighty five patients (mean age, 43+/-18 years: 47 men, 38 women) underwent a 80 degree HUT without or with isoproterenol infusion (2 migcrogram/min and 5 migcrogram/min, each for 6 minutes) for unexplained syncope or pre-syncope. Positive HUT was defined as symptomatic hypotension (systolic blood pressure or = 10 seconds) or asystole > or = 3 seconds. The patients were divided into two groups according to the result of the HUT: Group I included 47 patients (M:F=25:22) with positive result, Group II, 38 patients (M:F=22:16) with negative result. RESULTS: Group I patients had more episodes of syncope than Group II (3.1+/-2.5/year vs. 2.0+/-2.1/year, p<0.05). There were no significant differences between the 2 groups in the heart rate (HR), systolic and diastolic blood pressure (BP) at the baseline supine position. BP after tilt was not significantly different between 2 groups except for systolic BP at 6 minutes after tilt, which was significantly lower in Group I than Group II (109.5+/-17.5 mm Hg vs. 118.1+/-18.2 mm Hg, p<0.05).However, HR after tilt was significantly faster in Group I than Group II (81.1+/-15.1/min vs. 74.2+/-14.9/min, p<0.05 at 2 minutes after tilt; 83.7+/-14.4/min vs. 74.6+/-14.7/min, p<0.01 at 4 minutes after tilt). The increase in HR was greater in Group I than Group II (19.9+/-12.6/min vs. 12.8+/-10.6/min, p<0.001). In the prediction of positive HUT with HR rise above 14/min during the early 6 minute of baseline head-up tilting, the specificity, sensitivity, and positive predictive value were 63.2%, 70.2%, and 70.2%, respectively. CONCLUSION: In patients with SUO, positive HUT can be predicted with the early HR response during head-up tilt. This result shows that vasovagal syncope is triggered by exaggerated HR response to the decreased venous return and allow us to develop a less time-consuming HUT protocol.

Acute Inferior Myocardial Infarction due to Septic Embolism into the Left Anterior Descending Artery from Infected Bicuspid Aortic Valve in A Young Man

A bicuspid aortic valve is one of common congenital cardiac anomaly. But the septic embolism from bicuspid aortic valve into the left anterior descending artery (LAD) resulting in acute inferior myocardial infarction is very rare. A twenty eight year-old man suffered from severe chest pain and fever of four-week's duration. Acute inferior myocardial infarction was diagnosed on electrocardiogram. Transesophageal echocardiogram demonstrated vegetation on the bicuspid aortic valve directed into left coronary artery ostium, and diagnostic coronary angiogram revealed round filling defect within the distal LAD. He underwent operation for aortic valve replacement, which indicated vegetated bicuspid aortic valve directed into the ostium of left coronary artery.

A Case of Successful Primary Coronary Intervention for the Total Occlusion of Left Main Stem with the Aid of Abciximab

A 61-yr-old male patient presented with severe chest pain with cardiogenic shock due to an extensive anterolateral myocardial infarction. Two-dimensional echocardiogram showed severe left ventricular systolic dysfunction (ejection fraction=17%). Emergent coronary angiogram obtained immediately after placing temporary pacing electrode revealed total thrombotic occlusion in the left main stem. We performed direct coronary intervention using kissing balloon technique with the aid of Abciximab (ReoPro(R)) infusion. Residual stenosis with thrombus remained even after high pressure balloon dilatations, therefore we placed two stents, one in the ostia of left anterior descending (LAD) and the other in left circumflex artery (LCX). Coronary angiogram after kissing stents showed improved LAD and LCX flows without residual stenosis. Chest pain resolved and blood pressure normalized after coronary intervention. The whole procedure time was 15 min. Follow-up coronary angiogram taken one week later showed patent previous stented arteries, and echocardiography demonstrated 40% of left ventricular ejection fraction. The clinical course for one-year follow-up was uneventful.

The inhibitory effect of platelet glycoprotein IIb/IIIa receptor blocker-coated stent on porcine coronary stent restenosis / 대한내과학회지

BACKGROUND: The problems of coronary stent thrombosis and restenosis still remain to be solved.The glycoprotein IIb/IIIa receptor blocker, Abciximab (ReoPro), plays important roles in the treatment of high-risk patient with acute platelet-rich thrombus and in the inhibition of smooth muscle cell proliferation. The aim of this study was to determine whether the use of ReoPro-coated stents could reduce the neointimal formation in a porcine coronary stent restenosis model. METHODS: ReoPro was coated on the surface of stent by means of plasma polymerization followed by chemical grafting. Stent overdilation injury was performed with control bare stent (Group I, n=13), and ReoPro-coated stents (Group II, n=14). Follow-up quantitative coronary angiogram was performed at 4 weeks after stenting and histopathologic assessment were compared in both groups. RESULTS: The diameter stenosis by QCA between two groups was significantly higher in Group I (23+/-5 % vs. 15+/-7 %, p=0.003). On histopathologic examination, no in-stent thrombus was observed. The percent area stenosis was significantly higher in Group I than in Group II (48+/-17 % vs. 30+/-16 %, p=0.01). The area of neoinima was larger in Group I than in Group II (3.2+/-1.2 mm2 vs. 2.0+/-1.0 mm2, p=0.01). By immunocytochemistry, proliferation cell nuclear antigen indices were higher in Group I (4.2+/-2.1 %, vs 2.4+/-1.8 % p=0.03). CONCLUSION: The ReoPro-coated stent is safe and effective in the prevention of in-stent thrombus and restenosis, which may be related with the inhibition of platelet thrombus and neointimal cell proliferation.

The Effects of Lipoprotein(a) on Coronary Stent Restenosis

BACKGROUND: Lipoprotein (a) [Lp(a)] contains apolipoprotein(a), which is a structural homologue of plasminogen and competes with it for binding sites. It also acts by increasing plasminogen activator inhibitor-1 expression. The objective of this study was to evaluate the relationship between Lp(a) levels and restenosis rate after successful coronary stent placement. METHODS: The study included 306 patients who underwent coronary stent placement and follow-up coronary angiogram at Chonnam National University Hospital from August 1996 to June 2000. Restenosis rate was analyzed according to the level of Lp(a); Group I with high Lp(a) (n=7, Lp(a) 36 mg/dL, 58.98.8 years, female: 35.1%) and Group II with low Lp(a) (n=29, Lp(a) < 36 mg/dL, 57.79.8 years, female: 18.8%). RESULTS: 1) There was no significant differences in risk factors of atherosclerosis, clinical diagnosis, the number of involved coronary artery, left ventricular function, angiographic lesion characteristics by American College of Cardiology/American Heart Association clasification and Thrombolysis In Myocardial Infarction flow in two groups. 2) Angiographic restenosis rates were not different between two groups (group I : 33.8%, group II : 35.4%). CONCLUSION: Plasma Lp(a) levels are not related with the angiographic restenosis rate after coronary stent placement.