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Congenital pulmonary valve stenosis（PS）is a common congenital heart disease. Simple PS makes up approximately 8%~10% of congenital heart disease，and 20% of complex congenital heart disease complicated with PS. Percutaneous balloon pulmonary valvuloplasty（PBPV），which has undergone nearly 40 years of continuous improvement，has emerged as the preferred treatment for PS due to its superior safety and less trauma. However，residual stenosis was found in some patients during long-term follow-up，and repeat PBPV or even surgical repair was required. Identifying the risk factors for postoperative restenosis will further improve postoperative outcomes and reduce the probability of reintervention in the future. This article reviews the risk factors for restenosis of PS after PBPV including age，severity，morphologic characteristics of the valve leaflets and the choice of the balloon.
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Objective To investigate the clinical effect of rapamycin-eluting vertebral artery stent in the treatment of severe ostial vertebral artery stenosis(OV AS),and to analyze the incidence of postoperative in-stent restenosis(ISR).Methods A total of 96 patients with severe OVAS,who received stenting angioplasty at authors'hospital between November 2020 and May 2022,were retrospectively collected.The patients were divided into the observation group(n=48)and the control group(n=48).For the patients of the observation group implantation of rapamycin-eluting vertebral artery stent was carried out,while for the patients of the control group implantation of peripheral balloon dilatation bare metal stent(BMS)was performed.The perioperative basic data,the incidence of complications during follow-up period,and the postoperative incidence of ISR were compared between the two groups.Results Successful stent implantation was achieved in all patients of both groups.During perioperative period no complications such as transient ischemia attack(TIA),dropping-off or fracture of the stent,vertebral artery or stent-related stroke occurred.No statistically significant differences in the length and the diameter of the implanted stents,in the preoperative vertebral artery stenosis ratio,and in the postoperative residual stenosis ratio existed between the two groups(all P＞0.05).In both groups,the postoperative residual stenosis ratio was＜20％.The patients were followed up for a mean period of(12.33±5.82)months(range of 6-18 months),the incidence of postoperative vertebral artery or stent-related stroke in the observation group and the control group was 0％and 4.17％respectively,the difference between the two groups was not statistically significant(P＞0.05).The improvement of clinical symptoms such as dizziness,vertigo,etc.was observed in 47 patients of the observation group and in 45 patients of the control group,and no recurrent posterior circulation TIA or stent-related thrombotic event occurred.The incidence of postoperative restenosis in the observation group was 10.42％,which was significantly lower than 29.17％in the control group(P＜0.05).Conclusion Rapamycin-eluting vertebral artery stent can safely and effectively treat severe OVAS and reduce the incidence of postoperative ISR.(J Intervent Radiol,2024,33:275-279)
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Objective To investigate the efficacy and safety of Rotarex mechanical thrombectomy combined with drug-coated balloon(DCB)dilatation for the treatment of in-stent restenosis(ISR)in femoropopliteal atherosclerotic occlusive disease.Methods A total of 53 patients with in-stent restenosis after stent implantation(9 covered stents and 44 bare stents)from March 2020 to March 2022 were retrospectively analyzed.All the cases were treated with Rotarex mechanical thrombectomy combined with DCB dilatation.Antiplatelet and anticoagulant therapy were used after operation.Results All the 53 patients had successful recanalization of the lower limb arteries.Imaging after Rotarex mechanical thrombectomy combined with DCB dilatation showed 3 cases of residual thrombus in the stent treated with indwelling thrombolytic catheters for thrombolysis,with follow-up angiography showing blood flow recovery,and 5 cases of embolism of the below-knee arteries intraoperatively,including 3 cases at the opening of the tibiofibular trunk artery,which were opened with 6F peripheral thrombus aspiration catheter until unobstructed blood flow,and 2 cases of proximal occlusion of the posterior tibial artery,which were opened with balloon dilatation.Three cases of residual stenosis>30%were treated with remedial stents placement.There were no postoperative complications related to the puncture point,cardiovascular or cerebrovascular accidents,or deaths.The ankle brachial index(ABI)was0.33±0.06 preoperatively and0.84±0.07 postoperatively at the time of discharge(t =-39.443,P<0.001).All the 53 cases completed 3-month follow-ups,52 cases completed 6-month follow-ups,and 49 cases completed 12-month follow-ups.The phaseⅠpatency rates were 100%(53/53)at 3 months,92%(48/52)at 6 months,and 84%(41/49)at12 months,postoperatively.Recurrence of lower limb ischemic symptoms happened in 2 cases,which were given DCB dilatation at 9 and 10 months postoperatively,respectively.The 12-month freedom from clinically-driven target vessel reintervention was 95.9%(47/49).There were 4 deaths(1 case of gastrointestinal hemorrhage,2 cases of COVID-19,and 1 case of unknown cause)and 3 cases of amputation beyond the ankle joint.Conclusion The Rotarex mechanical thrombectomy combined with DCB is safe and effective in treating ISR of the femoropopliteal artery with satisfactory patency and reintervention rates.
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This review summarizes the progress of significant clinical studies in the field of coronary heart disease in 2023.The authors search from top-class medical journals on the Web of Science website,using'heart''cardi*''myocardi*''coronary''arrhythmi*''valv*''hypertension'as keywords.Various original researches that are highly quoted and have much value for clinical guidance are finally screened out,mainly focusing on intravascular imaging,strategy of percutaneous coronary revascularization,in-stent restenosis,antiplatelet therapy,and lipid management.From optimizing technologies of diagnosis and treatment to developing new types of drugs,we hope the achievements could effectively reduce the global burden of coronary heart disease.
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The Chinese Journal of Interventional Cardiology,Volume 31,Issue 6,published the Chinese expert consensus on the clinical application of drug coated balloon(2nd Edition)in June 2023.The new consensus incorporates the evidence-based medicine evidence of drug-coated balloons in the field of interventional therapy for coronary heart disease in recent years,updating the indications,standardized operations,intracoronary imaging,and the application of coronary functional studies in the treatment of drug-coated balloons.Based on clinical diagnosis and treatment practices and evidence-based medicine evidence,this article interprets the highlights of the new guidelines,aiming to provide references for clinical practice.
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Objectives:To compare the efficacy of the combination of excimer laser coronary angioplasty(ELCA)and drug-coated balloon(DCB)for in-stent restenosis(ISR)and to evaluate the impact of neointimal tissue characteristics on treatment outcomes. Methods:A total of 96 ISR lesions from 86 patients who underwent optical coherence tomography(OCT)evaluation and DCB with or without ELCA treatment at The First Medical Center of Chinese PLA General Hospital from January 2019 to May 2023 were retrospectively analyzed.ISR lesions were divided into ELCA+DCB group(n=30)and DCB group(n=66).Additionally,ISR lesions were classified as homogeneous and non-heterogeneous patterns based on the OCT characteristics of the neointimal tissue,and the impact on acute lumen gains was compared between different ISR patterns.Acute lumen gain(ΔMLA)was defined as the changes in minimum lumen area before and after the intervention. Results:The ELCA+DCB group had a significantly greater ΔMLA than the DCB group([3.2±0.8]mm2 vs.[2.6±1.4]mm2,P=0.015).Among the ISR with a homogeneous pattern,the ΔMLA of the ELCA+DCB group was significantly greater than that of the DCB group([3.0±0.9]mm2 vs.[2.2±1.1]mm2,P=0.030).There was no significant difference in ΔMLA between the two ISR groups with the non-homogeneous pattern([3.4±0.7]mm2 vs.[3.2±1.5]mm2,P=0.533).There was no death,the rate of target lesion revascularization was similar between the patients with lesions receiving DCB treatment and patients receiving ELCA +DCB treatment(7.4%vs.4.2%,P＞0.05). Conclusions:The combination of ELCA and DCB is an effective strategy for treating ISR,which can achieve greater acute lumen gain compared to DCB treatment alone,especially for the treatment of homogenous ISR pattern characterized by OCT.
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Objective:To investigate the image quality, radiation dose, and diagnostic efficiency of the regimen of GE 256-slice Revolution CT low-dose scanning, combined with an individualized contrast agent, in the assessment of coronary in-stent restenosis.Methods:A total of 120 patients (with 142 stents) treated with coronary stent implantation at the Beijing Renhe Hospital from August 2020 to August 2022 were enrolled in this study. They were randomly divided into an observation group (60 cases with 70 stents) and a conventional group (60 cases with 72 stents) using the random number table method. Both groups received GE 256-slice Revolution CT examinations. Patients in the conventional group were injected with 70 ml of iopromide as a contrast agent each, while those in the observation group were given individualized doses based on their body mass indices (BMIs). A tube voltage of 120 kV and a tube current of 534 mA were applied to the conventional group, whereas the tube voltage and current for the observation group were adjusted within the ranges of 80-120 kV and 150-534 mAs based on patients’ BMIs. Both groups received coronary angiography 7-14 d after coronary computed tomography angiography (CCTA). Finally, the CT image quality, radiation dose, iodine intake, and diagnostic efficiency were compared between the two groups.Results:Both groups exhibited no significant differences in CT values, contrast-to-noise ratios, blooming artifacts, and stent diameters of the left main coronary artery ( P > 0.05). The conventional group manifested higher CT dose index, CT dose length product, effective dose, and iodine intake compared to the observation group ( t = 10.30, 8.75, 10.27, 4.60, P < 0.05). With coronary angiography result as the gold standard, the observation and conventional groups yielded Kappa values of 0.904 and 0.879, respectively, suggesting high consistency in diagnostic performance. Additionally, the two groups demonstrated nonsignificant differences in sensitivity and specificity ( P > 0.05). Conclusions:The regimen of GE 256-slice Revolution CT low-dose scanning, combined with an individualized contrast agent, yielding image quality and diagnostic efficiency equivalent to those of the conventional regimen, can effectively reduce radiation dose and iodine intake. Therefore, this regimen merits wide applicability.
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@#Objective To explore the relationship between postoperative restenosis and vascular endothelial function in patients with lower extremity arterial disease(LEAD).Methods A retrospective analysis was performed on 133 patients with diabetic lower extremity arteriopathy who had successfully undergone interventional therapy in our hospital,and the patients were followed up for one year,and the patients were grouped according to whether restenosis occurred,with 25 cases in the restenosis group and 108 cases in the non-stenosis group.The patient's vascular endothelial function index,inflammatory factor level,blood lipid four items and hemoglobin A1c(HbAlc)were detected,and peripheral blood cells of patients in the stenosis group and non-stenosis group were isolated for transcriptome sequencing.Multivariate unconditional logistic regression analysis was used to screen for independent risk factors for vascular endothelial function in postoperative restenosis.Results Serum endothelin-1(ET-1),von Willebrand factor(vWF),thromboxane B2(TXB2),vascular cell adhesion protein 1(VCAM-1),and nitric oxide(NO)were significantly higher in the stenosis group than in the non-stenosis group,while endothelial nitric oxide synthase(eNOS)and vascular endothelial growth factor(VEGF)were significantly lower than those in the non-stenosis group(P<0.01).There was no significant difference in blood lipids between the two groups(P>0.05).The HbAlc of the stenosis group was significantly higher than that of the non-stenosis group(P<0.01).The inflammatory factors in the stenosis group were significantly higher than those in the non-stenosis group(P<0.05).Transcriptome sequencing analysis results are consistent with test results.Multivariate Logistic regression analysis showed that TNF-α,IL-6,ET-1,and vWF were independent risk factors for LEAD vascular restenosis(P<0.05).Conclusion Vascular endothelial function indexes(ET-1,vWF)and inflammatory factors(TNF-α,IL-6)are independent risk factors for restenosis after interventional surgery.
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@#Objective To investigate the effect of simvastatin and mechanical pretreatment on intimal hyperplasia of venous graft and its mechanism. Methods Twelve New Zealand rabbits were selected and randomly divided into 4 groups: a blank control group, a simvastatin topical treatment group, a mechanical precondition group and a combined group (n=3 in each group). Ultrasound was used to evaluate the changes of graft wall and blood flow velocity in the graft, and pathological section was used to evaluate the intimal hyperplasia. Human umbilical cord endodermal cells were cultured in vitro. A simvastatin group and a solvent control group were set to detect YAP phosphorylation, downstream target gene expression and cell proliferation. Results Vascular ultrasound showed that except the simvastatin topical treatment group, the flow velocity in vein grafts in the other three groups significantly increased 21 days after surgery compared with 7 days after surgery (P<0.01). Pathological sections showed that the thickness of new intima in the simvastatin topical treatment group, mechanical precondition group, combined group and blank control group were 45.56±4.11 μm, 201.28±16.71 μm, 143.57±7.82 μm, 249.45±13.33 μm, respectively, and there were statistical differences compared with the blank control group (P<0.05). In vitro results showed that compared with the solvent control group, cell death was observed in high concentration simvastatin (5 mmol/L) group, cell proliferation was inhibited in low concentration simvastatin (2.5 mmol/L) group (P<0.05), the expression of YAP protein in the simvastatin group was unchanged, but the expression of phosphorylated YAP protein significantly increased (P<0.05), and the expression of downstream target gene ccn1 was down-regulated (P<0.001). Conclusion Intravascular local application of simvastatin and mechanical preconditioning alone or in combination can inhibit intimal hyperplasia of venous graft. High concentration of simvastatin has cytotoxicity, while low concentration of simvastatin has inhibitory effect on cell proliferation. Simvastatin can inhibit the formation of new intima by inhibiting the entry of YAP into the nucleus and reducing the transcription of cell proliferation-related target gene ccn1.
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Lower extremity arteriosclerosis obliterans is a clinical manifestation of atherosclerosis in the lower extremities.At present, the main treatment methods include stent implantation, balloon angioplasty.However the incidence of restenosis after interventional surgery is high, which seriously affects the effect of surgical treatment and the prognosis of patients.This article reviews the mechanism, influencing factors and the latest progress in the prevention and treatment of vascular restenosis after arteriosclerosis obliterans of the lower extremity orteriosclerosis obliterans intervention, which is of important clinical significance to the early prevention and treatment of instent restenosis.
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Objective:To analyze the status of in stent restenosis (ISR) in patients with acute myocardial infarction (AMI) and diabetes mellitus (DM) one year after percutaneous coronary intervention (PCI), and explore the risk factors.Methods:From December 2019 to December 2020, 158 patients with AMI and DM who were treated by PCI in Qionghai Hospital of Traditional Chinese Medicine and the First Affiliated Hospital of Hainan Medical College were selected. They were followed up for one year after surgery to calculate the incidence of ISR. The patients were divided into ISR group and non ISR group according to whether ISR occurred. The difference of clinical data between the two groups was compared. Logistic regression was used to analyze the risk factors for the occurrence of ISR in AMI patients with DM 1 year after PCI.Results:55 patients were followed up for 1 year, and the incidence of ISR was 34.81% (55/158). There were significant difference between ISR group and non ISR group in hypertension history, old myocardial infarction history, smoking, exercise ratio, preoperative low density lipoprotein cholesterol (LDL-C), total bilirubin (TBIL), blood uric acid (UA), plasma fibrinogen (FIB), glycosylated hemoglobin (HbA 1c) levels, coronary artery lesion number, stenosis degree, stent length, stent diameter (all P<0.05). Multivariate logistic regression analysis showed that hypertension history, smoking, LDL-C, FIB, HbA 1c and stent length were independent risk factors for ISR in AMI patients with DM after PCI, and exercise and appropriate increase of stent diameter were protective factors (all P<0.05). Conclusions:The incidence of ISR in AMI patients with DM at 1 year after PCI is relatively high, and its occurrence is related to many factors. In order to reduce the risk of ISR after PCI, we should encourage smoking cessation, exercise, strengthen the monitoring of biochemical indicators, and appropriately increase the diameter of stent during PCI.
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Objective:To investigate the risk factors of restenosis after dilation of anastomotic stenosis in patients with esophageal cancer surgery.Methods:Clinical data of 997 patients who underwent endoscopic dilation due to anastomotic stenosis after esophageal cancer radical surgery in the Affiliated Huai′an First Hospital of Nanjing Medical University from June 2015 to July 2021, were retrospectively analyzed. There were 486 cases receiving single dilation (single dilation group) and 511 cases receiving more than two dilations (multiple dilation group). The risk factors of restenosis were explored using univariate and multivariate logistic regression analysis.Results:There were 682 males and 315 females with a median age of 65 years, the median distance between the stenosis and incisor was 20 (20, 22) cm, the median stenosis diameter was 4 (3, 5) mm, and the median stenosis diameter after dilation was 11 (11, 13) mm. Univariate analysis showed that there were significant differences in the distance of the stenosis and incisor ( Z=-2.303, P<0.05), stenosis diameter ( Z=-4.637, P<0.05) and stenosis diameter after dilation ( Z=-5.773, P<0.05) between single and multiple dilation groups. Stratified multivariate logistic regression showed that for male patients, risk of multiple dilations dropped by approximately 3% for every 1-mm increase in the distance between the stenosis and incisor ( OR=0.97, 95% CI:0.93-1.00, P=0.047); the risk of multiple dilations decreased by about 15%, for every 1-mm increase in stenosis diameter ( OR=0.85, 95% CI:0.76-0.94, P=0.004); the risk of multiple dilations decreased by about 13% for every 1-mm increase in stenosis diameter after dilation ( OR=0.87, 95% CI:0.78-0.96, P=0.007). For females patients under 60 years old, the risk of multiple dilations decreased by about 31%, for every 1-mm increase in stenosis diameter after dilation ( OR=0.69, 95% CI:0.47-0.98, P=0.049); for female patients≥60 years old, the risk decreased by about 5%, for every 1-year increase in age ( OR=0.95, 95% CI:0.91-1.00, P=0.037), risk of multiple dilations dropped by 17%( OR=0.83, 95% CI:0.70-0.99, P=0.039) for every 1 mm increase in stenosis diameter after dilation. Stratified smooth curve fitting indicated that the distance between the stenosis and incisor≤23 mm, stenosis diameter≤4.5 mm, stenosis diameter after dilation≤12 mm were risk factors for multiple dilations. Conclusions:The study indicates that patients with the distance between the stenosis and incisor≤23 mm, stenosis diameter≤4.5 mm, stenosis diameter after dilation≤12 mm may need multiple dilations; and the first dilation should expand the stenosis diameter to 12 mm or above as far as possible to reduce the risk of restenosis in patients receiving esophageal cancer radical surgery.
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Objective:To explore the association between serum high density lipoprotein subtype 3 cholesterol (HDL3-C) levels and the severity and in-stent restenosis of patients with coronary artery disease.Methods:124 patients with coronary artery diseases and 62 healthy controls were included in this clinical case-control retrospective study. Participants were hospitalized from November 2020 to November 2021 at Jinling Hospital, Medical School of Nanjing University were enrolled. Patients with coronary artery disease were as follows: 28 patients with acute coronary syndrome and 96 patients with stable coronary heart disease. Serum HDL3-C levels as well as total cholesterol (TC), triglyceride (TG), high-density lipoprotein cholesterol (HDL-C) and low-density lipoprotein cholesterol (LDL-C) levels were determined. According to the coronary artery angiography results of all patients at the time of admission, Gensini scores were calculated and patients were divided into in-stent restenosis group ( n=22), no in-stent stenosis group ( n=23) and non-stent implantation group ( n=79). The correlation between HDL3-C levels and other parameters was analyzed by Pearson or Spearman correlation analyses. Multivariate Logistic regression analyses were used to determine the impact of HDL3-C on the in-stent restenosis of coronary artery diseases. Results:Compared with controls, serum levels of HDL3-C and HDL-C were significantly decreased in patients with coronary artery diseases (all P<0.05). There was a significantly negative correlation between HDL3-C levels and Gensini scores ( r=-0.201, P=0.043). Among patients with coronary artery disease, serum levels of HDL3C, TC and TG in the in-stent restenosis group were significantly lower than in no in-stent stenosis group as well as than in the non-stent implantation group (all P<0.05). Multivariate Logistic regression analyses showed that after adjusting for age, sex, lipid-lowering drugs and TC, TG, LDLC parameters, HDL3-C ( OR=0.885, 95% CI 0.791-0.990, P=0.033) and HDL-C ( OR=0.018, 95% CI 0.001-0.426, P=0.013) levels were both independently associated with the occurrence of coronary artery disease; only HDL3-C levels (no in-stent stenosis group as the reference: OR=0.833, 95% CI 0.698-0.994, P=0.042; non-stent implantation group as the reference: OR=0.812, 95% CI 0.685-0.963, P=0.017) were independently associated with the presence of in-stent restenosis ( P<0.05). Conclusions:Serum HDL3-C levels are decreased in patients with coronary artery disease, especially in patients with in-stent restenosis. HDL3-C levels are associated with the severity of coronary artery lesions and the presence of in-stent restenosis of coronary arteries.
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Objective:Percutaneous coronary intervention(PCI)is one of the most important treatments for coronary artery disease(CAD).However,in-stent restenosis(ISR)after PCI is a serious complication without effective measures for prevention and treatment.This study aims to investigate the Ras-related protein 1A(Rap1A)level in ISR patients and in the tumor necrosis factor-α(TNF-α)-induced inflammatory injury model of human umbilical vein endothelial cells(HUVECs),to explore the role of Rap1A in regulating TNF-α-induced inflammation in HUVECs and to provide a new potential target for ISR prevention and treatment. Methods:A total of 60 CAD patients,who underwent PCI between December 2020 and July 2022 from the Department of Cardiovascular Medicine of Xiangya Hospital,Central South University,and re-examined coronary angiography(CAG)1 year after the operation,were included.After admission,27 patients were diagnosed with ISR and 33 patients were diagnosed with non-in-stent restenosis(non-ISR)according to the CAG.Clinical data were collected,and the plasma Rap1A level was determined by enzyme linked immunosorbent assay(ELISA).In cell experiments,an inflammatory injury model was established with TNF-α treatment(10 ng/mL,24 h)in HUVECs.The mRNA and protein expression levels of Rap1A,interlukin-6(IL-6),and vascular cell adhesion molecule-1(VCAM-1)were measured by real-time reverse transcription PCR and Western blotting.Small interfering RNA(siRNA)was used to explore the role of Rap1A in regulating TNF-α-induced inflammation in HUVECs. Results:Compared with the non-ISR patients,a higher proportion of ISR patients had a history of smoking(P=0.005)and diabetes(P=0.028),and higher levels of glycosylated hemoglobin(HbA1c)(P=0.012),low-density lipoprotein cholesterol(LDL-c)(P=0.014),and hypersensitive C-reactive protein(hs-CRP)(P=0.027).The remaining projects did not show significant differences(all P＞0.05).The plasma level of Rap1A in the ISR group was significantly higher than that in the non-ISR group[942.14(873.28 to 1 133.81)μg/mL vs 886.93(812.61 to 930.98)μg/mL;P=0.004].Diabetes,LDL-c,and Rap1A were risk factors for ISR by univariate logistic regression analysis(all P＜0.05).The mRNA and protein expression levels of inflammatory factors IL-6 and VCAM-1 were increased in HUVECs after 10 ng/mL TNF-α treatment for 24 h compared with the control group(all P＜0.05),while the mRNA and protein levels of Rap1A were increased(both P＜0.05).After inhibition of Rap1A in HUVECs,the mRNA and protein expression levels of IL-6 and VCAM-1 were significantly decreased(all P＜0.05). Conclusion:The plasma Rap1A level was significantly elevated in patients with ISR,suggesting that Rap1A may be a potential biomarker for predicting ISR.In the TNF-α-induced HUVECs inflammatory injury model,the expression level of Rap1A was increased.The level of TNF-α-induced endothelial cell inflammation was decreased after inhibition of Rap1A expression,suggesting that Rap1A may be a potential target for the treatment of endothelial cell inflammation in ISR.
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Objective:To explore the stent apposition and safety of Neuroform EZ and Enterprise 2 stents in treatment of symptomatic intracranial atherosclerotic stenosis (sICAS), and their influencing factors for in-stent restenosis.Methods:A total of 143 sICAS patients treated by Enterprise 2 stents (implanted 143 Enterprise 2 stents, E2 group) and 202 patients treated by Neuroform EZ stents (implanted 202 Neuroform EZ stents, EZ group) were selected from Department of Interventional Radiology, First Affiliated Hospital of Zhengzhou University from January 2017 to January 2022. Stent apposition was evaluated based on reconstructive images of high-resolution flat detector CT. The complications 30 d after surgery and during 6-24 months of follow-up were recorded. Based on DSA or CTA 6 months after surgery, the patency of the two stents was evaluated. Univariate analysis and multivariate Logistic regression analysis were used to determine the independent risk factors for in-stent restenosis.Results:(1) Forty-nine patients had incomplete stent apposition (ISA) after stent release: 24 patients with ISA in E2 group (16.8%, 24/143; 15 of type I and 9 of type II) and 25 with ISA in the EZ group (12.4%, 25/202, 11 of type I and 14 of type II) were found, without statistical difference ( χ 2=1.334, P=0.248); however, ISA incidence in the EZ group (19.0% and 10.3%) was significantly lower than that in the E2 group (41.4% and 25.6%) when the diameter ratio of anterior and posterior vessels of the stenosis lesions≥1.30 or the angle of stent≥75° ( χ 2=4.228, P=0.040; χ 2=4.531, P=0.033). (2) Within 30 d of stenting, 17 patients developed neurological dysfunction-related complications: 8 patients in EZ group and 9 in E2 group were noted, without significant difference ( P=0.324). Clinical follow-up was obtained in 317 patients, and 20 patients developed long-term stroke associated with responsible lesion vessels: 12 patients in EZ group and 8 in E2 group were noted, without significant difference ( P=0.995). (3) Totally, 298 patients received imaging follow-up 6 months after surgery, and 65 patients developed in-stent restenosis: 36 patients in EZ group and 29 in E2 group were noted, without significant difference ( χ 2=0.309, P=0.578). Multivariate Logistic regression analysis showed that diabetes ( OR=2.714, 95% CI: 1.437-5.126, P=0.002), stent apposition ( OR=3.435, 95% CI: 1.223-9.652, P=0.019), lesion stenosis length ( OR=1.176, 95% CI: 1.065-1.300, P=0.001) and immediate postoperative residual stenosis ( OR=1.038, 95% CI: 1.004-1.074, P=0.029) were independent influencing factors for in-stent restenosis. Conclusions:Enterprise 2 and Neuroform EZ stents have high stent apposition and safety in sICAS treatment, but in cases with large diameter ratio of the anterior and posterior vessels of the stenosis lesions (diameter ratio≥1.30) or large angle of the stent (≥75°), Neuroform EZ stent has better stent apposition. Patients with diabetes, ISA, long lesion stenosis or high residual stenosis may trend to have in-stent restenosis.
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Objective:To establish the carotid artery in-stent restenosis (ISR) models in Bama pigs after Neuroform EZ stent implantation, and observe and summarize their imaging and pathological characteristics.Methods:Thirteen healthy Bama pigs from Guangxi Province were chosen; carotid artery intima was injuried by balloon over-dilation; Neuroform EZ stents were implanted at the vascular injury sites to establish ISR models. Blood flow at areas accepted carotid artery stent implantation in Bama pigs was monitored by bedside color ultrasound every 2 weeks after surgery; once hemodynamic changes (acceleration or deceleration of the blood flow) in stents were detected, DSA, intravascular ultrasound (IVUS), optical coherence tomography (OCT) and high-resolution MRI (HR-MRI) were performed immediately. Bama pigs were then sacrificed and tissues at the stents were taken; HE staining was used to observe the pathological changes.Results:Thirteen Neuroform EZ stents were implanted into 13 Bama pigs after balloon over-dilation of the unilateral carotid arteries with a technical success rate of 100%. Hemodynamic changes in stents were detected in these 13 pigs (10 with acceleration and 3 with deceleration) at (12.46±3.57) weeks after stenting (ranged from 6-18 weeks); ISR of different degrees was found in all these 13 pigs by DSA with an average stenosis rate of (44.23±9.39)%. IVUS and OCT found that the main body of stents was covered by hyperplastic intima, and thickened intima resulted in local lumen stenosis; and obvious vascular wall enhancement in these lumens was shown on HR-MRI. HE staining showed rupture of intravascular internal elastic lamina and severely arterial intimal hyperplasia;and the hyperplastic intima was mainly composed of smooth muscle cells.Conclusion:Carotid artery ISR models in Bama pigs can be accurately and reliably established at approximately 12 weeks by tearing endovascular intima with balloon over-dilation and implanting Neuroform EZ stents, and multiple imaging and pathology methods confirm that ISR is caused by hyperplastic intima.
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Objective:To establish the common carotid artery aneurysm models of Wallstent double stent overlapping implantation in miniature pigs, and evaluate the safety and effectiveness of this procedure by observing the imaging and pathological changes.Methods:Sidewall aneurysm and fusiform aneurysm models in Bama miniature pigs were established surgically and 2 Wallstent stents were overlapped and implanted in situ. Aneurysm healing immediately after surgery and during 8 weeks of follow-up were evaluated according to 2D-DSA by O'Kelly-Marotta (OKM) grading scale and Kamran scale; degrees of stent adhesion immediately after surgery and status of stent endothelialization and aneurysm healing at 2, 4, and 8 weeks after surgery were observed by high resolution C-arm CT(HR-CBCT) and optical coherence tomography (OCT); and the changes of stent endothelialization were evaluated by comparing the HR-CBCT and OCT results with histopathology at 8 weeks after surgery. Perioperative adverse events were recorded.Results:After successful establishment of common carotid artery aneurysm models (including 4 sidewall aneurysms and 4 fusiform aneurysms with average diameter of [11.0±2.8] mm) in 8 miniature pigs, a total of 16 Wallstent stents (2 in each aneurysm) were implanted across the aneurysmal neck, with a technical success rate of 100%. No serious complications such as acute stent thrombosis, or aneurysm rupture and bleeding were observed in the perioperative period. The 2D-DSA immediately after surgery showed obvious intracranial contrast agent retention in 6 patients (1 patient in grading 1, 3 in grading 2, and 2 in grading 3) and aneurysm occlusion in 2 patients (grading 4). Eight weeks after follow-up, all 8 aneurysms had complete occlusions (grading 4); and 2 experimental pigs had in-stent restenosis, with stenosis rates of 52% and 67%, respectively. HR-CBCT and OCT immediately after surgery and during follow-up indicated that the stent metal braid was gradually covered by proliferating intima, with disappeared aneurysm. The cause of in-stent restenosis in 2 experimental pigs was local intima hyperplasia resulted from poor stent adhesion, and pathological findings indicated that the intima hyperplasia was mainly composed of smooth muscle cells and fibrous connective tissues.Conclusion:In animal models, Wallstent stent overlapping implantation is safe and effective in common carotid aneurysms, but intraoperative adverse adhesion of overlapping stent should be avoided.
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As a crucial regulatory molecule in the context of vascular stenosis, transforming growth factor-β (TGF-β), plays a pivotal role in its initiation and progression. TGF-β, a member of the TGF-β superfamily, can bind to the TGF-β receptor and transduce extracellular to intracellular signals through canonical Smad dependent or noncanonical signaling pathways to regulate cell growth, proliferation, differentiation, and apoptosis. Restenosis remains one of the most challenging problems in cardiac, cerebral, and peripheral vascular disease worldwide. The mechanisms for occurrence and development of restenosis are diverse and complex. The TGF-β pathway exhibits diversity across various cell types. Hence, clarifying the specific roles of TGF-β within different cell types and its precise impact on vascular stenosis provides strategies for future research in the field of stenosis.
Asunto(s)
Humanos , Factor de Crecimiento Transformador beta/metabolismo , Constricción Patológica , Transducción de Señal , Diferenciación Celular , Enfermedades Vasculares , Factores de Crecimiento Transformadores , Factor de Crecimiento Transformador beta1RESUMEN
Objective To explore the safety and efficacy of combining excimer laser coronary angioplasty with drug-coated balloon in the treatment of recurrent in-stent restenosis(R-ISR).Methods Clinical data from a cohort of 27 patients with a total of 30 R-ISR lesions,who underwent treatment with combined excimer laser coronary angioplasty and drug-coated balloons at our hospital from October 2019 to April 2023,were retrospectively analyzed.Patient baseline information,coronary angiography results,procedural details,and in-hospital complications were collected.Follow-up assessments were conducted at 1,3,and 6 months post-intervention to document major clinical events.Results A total of 27 patients[mean age(66.4±9.8)years]with 30 lesions(100％)achieved procedural and treatment success.There were no cases of acute myocardial infarction,coronary perforation,cardiac tamponade,urgent target lesion revascularization,or death during hospitalization.After 6 months of follow-up,there were no occurrences of acute myocardial infarction or death.Two patients(with a total of two lesions)underwent target lesion revascularization,one patient received repeated drug-balloon dilatation,and one patient underwent coronary artery bypass grafting.Conclusions Excimer laser coronary angioplasty combined with drug-coated balloons is a safe and effective treatment strategy for recurrent in-stent stenosis,but further studies are needed for confirmation.
RESUMEN
Intravascular lithotripsy (IVL) is associated with excellent angiographic and short-term results in patients with calcified lesions requiring percutaneous coronary intervention. We conducted a 1-year follow up of a retrospective cohort of 47 patients (61 lesions) who underwent IVL. The primary outcome was target vessel revascularization (TVR) at 1-year from index procedure. Four percent of patients required TVR within 1 year; 96% who underwent IVL remained free from repeat intervention on the same vessel. One patient suffered a myocardial infarction; the culprit vessel had not been previously treated with IVL. IVL is an effective and durable modality for treatment of highly calcified coronary lesions in high-risk patients