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1.
Gene Ther ; 23(2): 196-204, 2016 Feb.
Article in English | MEDLINE | ID: mdl-26348595

ABSTRACT

The X-linked RP3 gene codes for the ciliary protein RPGR and accounts for over 10% of inherited retinal degenerations. The critical RPGR-ORF15 splice variant contains a highly repetitive purine-rich linker region that renders it unstable and difficult to adapt for gene therapy. To test the hypothesis that the precise length of the linker region is not critical for function, we evaluated whether adeno-associated virus-mediated replacement gene therapy with a human ORF15 variant containing in-frame shortening of the linker region could reconstitute RPGR function in vivo. We delivered human RPGR-ORF15 replacement genes with deletion of most (314 codons, 'short form') or 1/3 (126 codons, 'long form') of the linker region to Rpgr null mice. Human RPGR-ORF15 expression was detected post treatment with both forms of ORF15 transgenes. However, only the long form correctly localized to the connecting cilia and led to significant functional and morphological rescue of rods and cones. Thus the highly repetitive region of RPGR is functionally important but that moderate shortening of its length, which confers the advantage of added stability, preserves its function. These findings provide a theoretical basis for optimizing replacement gene design in clinical trials for X-linked RP3.


Subject(s)
Dependovirus/genetics , Eye Proteins/genetics , Genetic Therapy , Retinitis Pigmentosa/therapy , Alternative Splicing , Animals , Disease Models, Animal , G-Protein-Coupled Receptor Kinase 1/genetics , Humans , Mice , Mice, Inbred C57BL , Promoter Regions, Genetic , Retinal Cone Photoreceptor Cells/physiology , Retinal Rod Photoreceptor Cells/physiology , Retinitis Pigmentosa/genetics
2.
Gene Ther ; 17(1): 117-31, 2010 Jan.
Article in English | MEDLINE | ID: mdl-19710705

ABSTRACT

Aryl hydrocarbon receptor-interacting protein-like 1 (AIPL1) is required for the biosynthesis of photoreceptor phosphodiesterase (PDE). Gene defects in AIPL1 cause a heterogeneous set of conditions ranging from Leber's congenital amaurosis (LCA), the severest form of early-onset retinal degeneration, to milder forms such as retinitis pigmentosa (RP) and cone-rod dystrophy. In mice, null and hypomorphic alleles cause retinal degeneration similar to human LCA and RP, respectively. Thus these mouse models represent two ends of the disease spectrum associated with AIPL1 gene defects in humans. We evaluated whether adeno-associated virus (AAV)-mediated gene replacement therapy in these models could restore PDE biosynthesis in rods and cones and thereby improve photoreceptor survival. We validated the efficacy of human AIPL1 (isoform 1) replacement gene controlled by a promoter derived from the human rhodopsin kinase (RK) gene, which is active in both rods and cones. We found substantial and long-term rescue of the disease phenotype as a result of transgene expression. This is the first gene therapy study in which both rods and cones were targeted successfully with a single photoreceptor-specific promoter. We propose that the vector and construct design used in this study could serve as a prototype for a human clinical trial.


Subject(s)
Carrier Proteins/genetics , G-Protein-Coupled Receptor Kinase 1/genetics , Genetic Therapy , Optic Atrophy, Hereditary, Leber/therapy , Retinal Degeneration/therapy , Retinal Rod Photoreceptor Cells/metabolism , Adaptor Proteins, Signal Transducing , Animals , Eye Proteins , Gene Transfer Techniques , Humans , Mice , Phosphoric Diester Hydrolases/metabolism , Retinal Cone Photoreceptor Cells/metabolism
3.
Prikl Biokhim Mikrobiol ; 43(4): 424-31, 2007.
Article in Russian | MEDLINE | ID: mdl-17929569

ABSTRACT

The fructofuranosidases (EC 3.2.1.26) of Aspergillus niger St-0018 and A. foetidus St-0194 were used to produce fructooligosaccharides (FOS) under periodic and continuous conditions. The incorporation of cells into calcium alginate gel gave the most efficient immobilized biocatalysts. The feasibility of transforming residual sucrose into palatinose and trehalulose using isomaltulose synthase (EC 5.4.99.11) was demonstrated.


Subject(s)
Isomaltose/analogs & derivatives , Oligosaccharides/biosynthesis , Sucrose/metabolism , Trehalose/metabolism , beta-Fructofuranosidase/biosynthesis , Aspergillus/enzymology , Catalysis , Disaccharides/biosynthesis , Gammaproteobacteria/enzymology , Intramolecular Transferases/metabolism , Isomaltose/biosynthesis
4.
Prikl Biokhim Mikrobiol ; 43(1): 42-6, 2007.
Article in Russian | MEDLINE | ID: mdl-17345857

ABSTRACT

Cyclodextrin glucanotransferases (CGTase, EC 2.4.1.19) produced by mesophilic, thermophilic, and halophilic bacilli, as well as maltase (EC 3.2.1.20) produced by various strains of Saccharomyces cerevisiae have been applied for transglycosylation of L-ascorbic acid using starch, maltodextrin, gamma-cyclodextrin, and maltose as donors of glucosyl residue. The CGTases produced by thermophilic strains are the most efficient. The degree of transglucosylation is more than 60%.


Subject(s)
Ascorbic Acid/chemistry , Glucosyltransferases/chemistry , alpha-Glucosidases/chemistry , Bacillus/enzymology , Glycosylation , Polysaccharides/chemistry , Saccharomyces cerevisiae/enzymology , gamma-Cyclodextrins/chemistry
5.
J Am Coll Cardiol ; 38(3): 672-9, 2001 Sep.
Article in English | MEDLINE | ID: mdl-11527615

ABSTRACT

OBJECTIVES: The purpose of the study was to determine whether cutting balloon angioplasty (CBA) has advantages over other modalities in treatment of in-stent restenosis (ISR). BACKGROUND: Controversies exist regarding optimal treatment for ISR. Recently, CBA emerged as a tool in management of ISR. METHODS: A total of 648 lesions treated for ISR were divided into four groups according to the treatment strategy: CBA, rotational atherectomy (ROTA), additional stenting (STENT), and percutaneous transluminal coronary angioplasty (PTCA). Following the matching process, 258 lesions were entered into the analysis. RESULTS: Baseline clinical and angiographic characteristics were similar among the groups (p = NS). Acute lumen gain was significantly higher in the STENT group (2.12 +/- 0.7 mm), whereas in the CBA group the gain was similar to one achieved following ROTA and following PTCA (1.70 +/- 0.6 vs. 1.79 +/- 0.5 mm and 1.56 +/- 0.7 mm, respectively; p = NS). The lumen loss at follow-up was lower for the CBA versus ROTA and versus STENT (0.63 +/- 0.6 vs. 1.30 +/- 0.8 mm and 1.36 +/- 0.8 mm, respectively; p < 0.0001), yielding a lower recurrent restenosis rate (20% vs. 35.9% and 41.4%, respectively; p < 0.05). By multivariate analysis, CBA (odds ratio [OR] = 0.17; confidence interval [CI], 0.06 to 0.51; p = 0.001) and diffuse restenosis type at baseline (OR = 2.07; CI, 1.15 to 3.71; p = 0.02) were identified as predictors of target lesion revascularization. CONCLUSIONS: We conclude that CBA is a safe and efficient technique for treatment of ISR, with immediate results similar to atheroablation and better clinical and angiographic outcomes at follow-up. This approach might be implemented as a viable option in management of focal ISR and to prepare diffuse ISR for brachytherapy treatment.


Subject(s)
Angioplasty, Balloon, Coronary/methods , Atherectomy, Coronary , Coronary Disease/therapy , Stents , Aged , Coronary Angiography , Coronary Disease/diagnostic imaging , Female , Humans , Male , Middle Aged , Multivariate Analysis , Recurrence , Treatment Outcome , Ultrasonography, Interventional
6.
Invest Ophthalmol Vis Sci ; 42(9): 1955-62, 2001 Aug.
Article in English | MEDLINE | ID: mdl-11481257

ABSTRACT

PURPOSE: To test the hypothesis that a lack of Tubby-like protein 1 (TULP1) function causes aberrant transport of nascent rhodopsin and to examine the functional relationship between the homologous proteins TULP1 and Tubby by studying mice carrying combined mutations. METHODS: Subcellular localization of TULP1 and rhodopsin in photoreceptors was determined by immunofluorescence and by postembedding immunoelectron microscopy. Mice carrying different tulp1/tubby allele combinations were examined by histology, electroretinograms (ERGs), and immunofluorescence microscopy. RESULTS: TULP1 is distributed throughout the photoreceptor cytoplasm but is excluded from the outer segments and the nuclei. In the tulp1-/- mice, ectopic accumulation of rhodopsin occurs at an early age. Both the vesicular profiles in the interphotoreceptor space and the inner segment plasma membranes are immunoreactive for rhodopsin. Mice doubly homozygous for null mutations in the tulp1 and tubby genes initially develop photoreceptors and express a battery of photoreceptor markers at age 14 days. Thereafter their photoreceptors undergo a fulminant degeneration that reaches completion by postnatal day 17. The disease phenotype in the double homozygote is much more severe than either single homozygote. Double heterozygotes are phenotypically normal. CONCLUSIONS: A lack of TULP1 function results in misrouting of nascent rhodopsin. TULP1 may be a component of the cellular machinery that targets nascent rhodopsin to the outer segments. Comparison of disease phenotypes in the single and double mutants suggests that TULP1 and Tubby are not functionally interchangeable in photoreceptors nor do they form an obligate functional complex.


Subject(s)
Eye Proteins/physiology , Rhodopsin/metabolism , Animals , Biological Transport , Cell Membrane , Electroretinography , Fluorescent Antibody Technique, Indirect , Mice , Mice, Inbred C57BL , Mice, Knockout , Microscopy, Fluorescence , Microscopy, Immunoelectron , Phenotype , Photoreceptor Cells, Vertebrate/metabolism
8.
Atherosclerosis ; 156(2): 277-87, 2001 Jun.
Article in English | MEDLINE | ID: mdl-11395023

ABSTRACT

Lipid rich, soft plaques in the clinic are a common forerunner to occlusive thrombus formation, even with modest arterial stenosis. Animal models of atherosclerosis, obtained by various methods, do not generally allow direct in vivo evaluation of the lesion and, furthermore, cannot be examined more than once. The aim of the study was the generation of a rabbit model of atherosclerosis, with morphological characteristics similar to human lipid-rich, soft atheromatous plaques, and the evaluation of the reliability of intravascular ultrasound (IVUS) technology in the study of the development of atherosclerotic lesions in this model. Briefly, New Zealand white rabbits undergo perivascular electrical injury at both common carotid arteries, together with a 1.5% cholesterol diet for up to 90 days. The lesioned arterial segments show progressive changes, from diffuse cellular mortality, to macrophage infiltration in the media, up to the final migration of macrophages to the neointima, resulting in bulky, eccentric, macrophage and lipid-rich lesions. At IVUS, the produced lesions clearly resemble those described as 'soft plaques' in the clinical setting, with minimal calcification and reduced echo-reflectivity versus the adventitial layer. Quantitative and morphometric analysis of plaques shows a significant correlation between histological and IVUS measurements at each time point. In conclusion, vascular injury in the common carotids of rabbits generates atherosclerotic lipid-rich, soft plaques, that can be properly assessed by the IVUS methodology. The easy accessibility of the arterial lesion allows serial IVUS investigations and the direct evaluation of a number of locally or generally delivered therapeutic agents.


Subject(s)
Arteriosclerosis/diagnostic imaging , Arteriosclerosis/pathology , Tunica Intima/diagnostic imaging , Tunica Intima/pathology , Ultrasonography, Interventional , Analysis of Variance , Animals , Arterial Occlusive Diseases/diagnostic imaging , Arterial Occlusive Diseases/pathology , Cholesterol, Dietary , Culture Techniques , Disease Models, Animal , Lipids/analysis , Male , Probability , Rabbits , Reference Values , Risk Assessment , Sensitivity and Specificity , Time Factors
9.
J Invasive Cardiol ; 13(4): 279-86, 2001 Apr.
Article in English | MEDLINE | ID: mdl-11287712

ABSTRACT

Myocardial fractional flow reserve (FFR) < 0.75 is a reliable index of a functionally severe coronary stenosis. FFR is best assessed by a sensor-tipped pressure monitoring guidewire (PW). The purpose of this study was to assess whether a multifunctional probing catheter (MFP), a 3 French dual-lumen monorail catheter, can be used to accurately measure intracoronary pressure and FFR. In 35 lesions (35 patients; learning group), we calculated FFR by both PW (FFRPW) and MFP (FFRMFP). Using ROC analysis, the FFRMFP value of 0.65 had the highest sensitivity with the FFRPW < 0.75. FFRMFP cut-off (0.65) was tested in 40 patients (testing group). In all cases, lumen diameter was documented by an intracoronary ultrasound examination. In the learning group, the FFRPW was 0.82 +/- 0.17 and FFRMFP was 0.70 +/- 0.23 (r = 0.88; p < 0.001). The FFRMFP cut-off value (0.65) correctly predicted the FFRPW in 37/40 cases in the testing group. In the 3 discordant cases, FFR was critical (< 0.65) by MFP and normal (> 0.75) by PW. In all these cases, minimal lumen cross-sectional area was < 2.8 mm2. When FFRMFP is > 0.65, FFRPW is always > 0.75. These data demonstrate that even with larger cross-sectional area than a pressure wire, the MFP catheter can easily and reliably be used to assess the functional severity of coronary stenosis.


Subject(s)
Cardiac Catheterization , Coronary Circulation , Coronary Disease/diagnosis , Cardiac Catheterization/instrumentation , Coronary Angiography , Coronary Disease/physiopathology , Female , Humans , Male , Middle Aged , Ultrasonography, Interventional
10.
Am J Cardiol ; 87(2): 136-41, 2001 Jan 15.
Article in English | MEDLINE | ID: mdl-11152827

ABSTRACT

The functional significance of coronary artery stenoses of intermediate severity is important in determining strategy in patient care. Intravascular ultrasound (IVUS) is often used to evaluate coronary stenosis severity. However, at present, few data are available about the role IVUS in the assessment of functional significance of intermediate lesions. Myocardial fractional flow reserve (FFR) <0.75 is a reliable index of a functionally severe coronary stenosis. In 53 lesions we assessed (1) by pressure wire: FFR (index of functional significance), and (2) by IVUS: minimal lumen cross-sectional area (MLA, square millimeters), minimal lumen diameter (MLD, millimeters), lesion length (millimeters), and percent area stenosis at the lesion site. By regression analysis, percent area stenosis and lesion length had a significant inverse correlation with FFR (r = -0.58, p <0.001, r = -0.41, p <0.004, respectively). MLD and MLA showed a significant positive relation with FFR (r = 0.51, p <0.001, r = 0.41, p <0.004, respectively). By using a receiver operating characteristic (ROC) curve, we identified a percent area stenosis > 70% (sensitivity 100%, specificity 68%), a MLD < or = 1.8 mm (sensitivity 100%, specificity 66%), a MLA < or =4.0 mm2 (sensitivity 92%, specificity 56%), and a lesion length of >10 mm (sensitivity 41%, specificity 80%) to be the best cut-off values to fit with a FFR <0.75. The combined evaluation of both percent area stenosis and MLD made the IVUS examination more specific (sensitivity 100%, specificity 76%). In 53 intermediate coronary lesions found by angiography, IVUS area stenosis >70%, MLD < or =1.8 mm, MLA < or =4.0 mm2, and lesion length > 10 mm reliably identified functionally critical intermediate coronary stenoses.


Subject(s)
Coronary Disease/diagnostic imaging , Ultrasonography, Interventional , Cardiac Catheterization , Coronary Angiography , Coronary Disease/diagnosis , Female , Humans , Linear Models , Male , Sensitivity and Specificity
11.
Jpn Circ J ; 65(1): 50-1, 2001 Jan.
Article in English | MEDLINE | ID: mdl-11153822

ABSTRACT

A 64-year-old male with unstable angina underwent direct stenting in the proximal and mid-left anterior descending coronary artery (LAD) lesions. Although coronary angiography showed a good result, intravascular ultrasound imaging revealed a dissection flap protruding through the struts of the stent in the proximal LAD. Another stent was deployed in the first stent (stent-in-stent) to seal it. The patient's in-hospital course was uneventful. Subacute stent thrombosis was not observed.


Subject(s)
Angina, Unstable/surgery , Stents/adverse effects , Angina, Unstable/complications , Angina, Unstable/therapy , Angiography , Constriction, Pathologic/etiology , Constriction, Pathologic/surgery , Coronary Vessels/surgery , Humans , Male , Middle Aged , Ultrasonography, Interventional
12.
J Biol Chem ; 276(15): 12091-9, 2001 Apr 13.
Article in English | MEDLINE | ID: mdl-11104772

ABSTRACT

Retinitis pigmentosa (RP) is a blinding retinal disease in which the photoreceptor cells degenerate. Mutations in the gene for retinitis pigmentosa GTPase regulator (RPGR) are a frequent cause of RP. The function of RPGR is not well understood, but it is thought to be a putative guanine nucleotide exchange factor for an unknown G protein. Ablation of the RPGR gene in mice suggested a role in maintaining the polarized distribution of opsin across the cilia. To investigate its function, we used a protein interaction screen to identify candidate proteins that may interact physiologically with RPGR. One such protein, designated RPGR-interacting protein (RPGRIP), is expressed specifically in rod and cone photoreceptors. It consists of an N-terminal region predicted to form coiled coil structures linked to a C-terminal tail that binds RPGR. In vivo, both proteins co-localize in the photoreceptor connecting cilia. RPGRIP is stably associated with the ciliary axoneme independent of RPGR and is resistant to extraction under conditions that partially solubilized other cytoskeletal components. When over-expressed in heterologous cell lines, RPGRIP appears in insoluble punctate and filamentous structures. These data suggest that RPGRIP is a structural component of the ciliary axoneme, and one of its functions is to anchor RPGR within the cilium. RPGRIP is the only protein known to localize specifically in the photoreceptor connecting cilium. As such, it is a candidate gene for human photoreceptor disease. The tissue-specific expression of RPGRIP explains why mutations in the ubiquitously expressed RPGR confer a photoreceptor-specific phenotype.


Subject(s)
Carrier Proteins/metabolism , Ciliary Body/metabolism , Eye Proteins , Photoreceptor Cells, Vertebrate/metabolism , Retinitis Pigmentosa/metabolism , Amino Acid Sequence , Animals , COS Cells , Carrier Proteins/chemistry , Carrier Proteins/genetics , Ciliary Body/ultrastructure , Cloning, Molecular , DNA, Complementary , Mice , Microscopy, Electron , Molecular Sequence Data , Protein Binding
13.
Am J Ophthalmol ; 130(6): 790-2, 2000 Dec.
Article in English | MEDLINE | ID: mdl-11124299

ABSTRACT

PURPOSE: To compare histologic findings in an autopsy eye of an 84-year-old man with advanced retinitis pigmentosa and rhodopsin, Glu181Lys, with two cases of autosomal dominant retinitis pigmentosa (one with rhodopsin, Pro23His, and one with rhodopsin, Cys110Arg) and with a normal control, all of comparable age. METHODS: All eyes were prepared for light and electron microscopy within 6 hours after death. RESULTS: Extensive photoreceptor degeneration was revealed in the eyes with retinitis pigmentosa. Some macular cones showed membranous swirls only in the eye with rhodopsin, Glu181Lys. CONCLUSION: The retinal degeneration caused by rhodopsin, Glu181Lys, can feature membranous swirls in the inner segments of cones in the macula. These swirls have not been reported in other cases of dominant retinitis pigmentosa studied so far, and their pathogenesis remains to be defined.


Subject(s)
Photoreceptor Cells, Vertebrate/ultrastructure , Point Mutation , Retinitis Pigmentosa/pathology , Rhodopsin/genetics , Adult , Aged , Aged, 80 and over , Autopsy , DNA Mutational Analysis , Family , Female , Humans , Male , Pedigree , Retinitis Pigmentosa/genetics
14.
Catheter Cardiovasc Interv ; 51(3): 347-51, 2000 Nov.
Article in English | MEDLINE | ID: mdl-11066124

ABSTRACT

We report a new stenting technique employed in 10 patients to treat lesions immediately proximal to a bifurcation (pseudobifurcation). A stent is mounted on two balloon catheters and advanced into the lesion immediately proximal to the bifurcation until the distal portion of the balloon catheters enters each branch at the bifurcation. This is followed by kissing balloon inflation for stent deployment. In all 10 cases, the final angiogram showed a good result at the lesion site and no ostial compromise of any of the branches. Cathet. Cardiovasc. Intervent. 51:347-351, 2000.


Subject(s)
Angioplasty, Balloon, Coronary , Coronary Disease/therapy , Stents , Aged , Angina Pectoris/therapy , Coronary Angiography , Coronary Disease/diagnostic imaging , Humans , Male , Middle Aged
15.
J Invasive Cardiol ; 12(10): 505-12, 2000 Oct.
Article in English | MEDLINE | ID: mdl-11022209

ABSTRACT

PURPOSE: The aim of this study was to evaluate the immediate and long-term outcomes following percutaneous treatment of an unselected series of saphenous vein graft (SVG) lesions. METHODS AND RESULTS: Consecutive interventions on 129 saphenous vein graft lesions in 101 patients were reviewed. Stents were implanted in 114 lesions (88%), which included the use of polytetrafluoroethylene-covered stents in 22 lesions (17%) and abciximab in 20 patients (20%). Angiographic success was achieved in 125 lesions (97%). In-hospital major adverse cardiac events (MACE) occurred in 11 patients (11%), with myocardial infarction being the most frequent event. Treatment of degenerated SVG lesions and SVG lesions with larger reference diameters correlated with the incidence of in-hospital MACE [odds ratio (OR) = 7.69 and 2.65, respectively; 95% confidence interval (CI) = 1.80Eth 32.8 and 0.99Eth 7.10, respectively)]. Clinical follow-up was achieved in all patients at 25 +/- 21 months. Successful revascularization to all three distributions of the major coronary arteries negatively correlated [relative risk (RR) = 0.43; 95% CI = 0.20Eth 0.92)], while treatment of a degenerated SVG positively correlated (RR = 1.92; 95% CI = 1.05Eth 3.51) with the occurrence of follow-up MACE. A final effective blood supply to the anterior wall and a higher left ventricular ejection fraction was found to negatively correlate with the occurrence of follow-up death (RR = 0. 20 and 0.61, respectively; 95% CI = 0.06Eth 0.60 and 0.41Eth 0.90, respectively). CONCLUSION: Treatment of SVG lesions continues to be associated with a high incidence of myocardial infarction, particularly in cases of degenerated SVG lesions. An effective blood supply to the anterior wall and a higher left ventricular ejection fraction were protective for the occurrence of death during the follow-up period.


Subject(s)
Coronary Artery Bypass/adverse effects , Graft Occlusion, Vascular/therapy , Saphenous Vein/transplantation , Stents , Aged , Aged, 80 and over , Confidence Intervals , Coronary Angiography , Coronary Artery Bypass/methods , Female , Follow-Up Studies , Graft Occlusion, Vascular/diagnostic imaging , Graft Occlusion, Vascular/mortality , Graft Rejection , Graft Survival , Humans , Male , Middle Aged , Odds Ratio , Probability , Retrospective Studies , Survival Rate , Treatment Outcome
17.
Ital Heart J ; 1(6): 420-5, 2000 Jun.
Article in English | MEDLINE | ID: mdl-10929743

ABSTRACT

BACKGROUND: At present, only few data are available on the early and late outcome following multivessel coronary stenting. Of note, in these studies, the left anterior descending (LAD) artery was treated in less than 40% of cases. These patients may not fully represent the population commonly referred for surgical revascularization. METHODS: In-hospital and long-term (18 +/- 4 months) events were evaluated in 272 consecutive patients who had multivessel stent implantation including the LAD artery in each case. All clinical, angiographic, and procedural variables were analyzed to identify the predictors of acute and long-term major adverse coronary events. RESULTS: Eighteen patients (6.6%) had in-hospital major adverse coronary events (death 0.7%, coronary artery bypass grafting 0.4%, and myocardial infarction 6.3%). Acute and subacute stent thrombosis rates were 1.5 and 1.1%, respectively. At 18 +/- 4 months, event-free survival was 71%. Target lesion revascularization was performed in 54 (20%) patients (42 coronary angioplasty and 12 coronary artery bypass grafting). The jeopardy score was the predictor of in-hospital major adverse coronary events (p = 0.016, odds ratio 1.34, 95% confidence interval 1.05-1.69), and diabetes mellitus was the predictor of long-term major adverse coronary events (p = 0.027, odds ratio 2.80, 95 % confidence interval 1.12-6.96). CONCLUSIONS: Multivessel coronary stent implantation with treatment of the LAD artery in all instances is a safe procedure with low acute and long-term major adverse coronary events. The risk-benefit ratio must be assessed carefully for each patient, particularly taking into account the jeopardy score and the presence of diabetes mellitus.


Subject(s)
Angioplasty, Balloon, Coronary , Coronary Disease/therapy , Stents , Aged , Angioplasty, Balloon, Coronary/adverse effects , Confounding Factors, Epidemiologic , Coronary Angiography , Coronary Disease/etiology , Diabetes Complications , Female , Humans , Male , Middle Aged , Risk Assessment , Risk Factors , Stents/adverse effects , Time Factors , Treatment Outcome
18.
Catheter Cardiovasc Interv ; 50(4): 390-7, 2000 Aug.
Article in English | MEDLINE | ID: mdl-10931606

ABSTRACT

The impact of stenting on small vessels (< 3.0 mm) with complex lesions (B2-C) is still controversial. Restenosis rate in this population is high (> 40%). We compared early and late outcome of patients with complex coronary lesions in small vessel treated with traditional coronary angioplasty (angioplasty group) and with elective stent implantation (stent group). Angioplasty group (n = 97) and stent group (n = 112) were comparable for all clinical and angiographic characteristics. All patients in the two groups had clinical and angiographic follow-up. Major adverse cardiac events (MACE) and restenosis rate were evaluated. No patients in the two groups experienced in-hospital death or bypass surgery. Myocardial infarction occurred in four patients in the angioplasty group and in seven patients in the stent group (P = 0.36). No patients in either the angioplasty or the stent group had acute stent thrombosis, whereas subacute stent thrombosis occurred in only one patients of the stent group (0.9%). Long-term MACEs (20 +/- 4 month) were not different in the two groups (angioplasty group 39% vs. stent group 44%, P = 0.35). Target lesion revascularization rate was 33% in the angioplasty group and 34% in the stent group (P = 0.50). Restenosis rate was not statistically different in the two groups (stent group 41% vs. angioplasty group 38%, P = 0.41). In conclusion, compared to balloon angioplasty, elective stent implantation in small vessels with complex lesions does not improve early and late outcome. Cathet. Cardiovasc. Intervent. 50:390-397, 2000.


Subject(s)
Angioplasty, Balloon, Coronary , Blood Vessel Prosthesis Implantation , Coronary Disease/therapy , Stents , Coronary Angiography , Coronary Disease/diagnostic imaging , Elective Surgical Procedures , Female , Humans , Male , Middle Aged , Recurrence , Retrospective Studies
19.
Am J Cardiol ; 86(3): 343-6, 2000 Aug 01.
Article in English | MEDLINE | ID: mdl-10922449

ABSTRACT

We compared the outcome of patients with saphenous graft disease treated with polytetrafluoroethylene (PTFE)-covered stents or noncovered stents. Angiographic success was similar; non-Q-wave myocardial infarction was lower in the PTFE group (p = 0.06) and long-term major cardiac events and restenosis rate were similar in the 2 groups. Implantation of PTFE-covered stent in vein graft disease seems to reduce the occurrence of distal embolization.


Subject(s)
Coated Materials, Biocompatible , Coronary Artery Bypass , Graft Occlusion, Vascular/therapy , Polytetrafluoroethylene , Stents , Veins/transplantation , Aged , Female , Graft Occlusion, Vascular/mortality , Humans , Male , Middle Aged , Myocardial Infarction/mortality , Myocardial Infarction/prevention & control , Prosthesis Design , Recurrence , Risk Factors
20.
Circulation ; 101(21): 2454-7, 2000 May 30.
Article in English | MEDLINE | ID: mdl-10831516

ABSTRACT

BACKGROUND: A high restenosis rate has been reported at the edges ("edge restenosis") of (32)P radioactive stents with an initial activity level of 3 to 12 microCi. This edge effect might be due to balloon injury and to a low dose of radiation at the stent margins. The aim of this study was to evaluate whether the implantation of (32)P radioactive stents with a higher activity level (12 to 21 microCi) combined with a nonaggressive stent implantation strategy could solve the problem of edge restenosis. METHODS AND RESULTS: We compared the results of lesions treated with single radioactive BX stents with an activity of 12 to 21 microCi (group 2, n = 54 lesions) with the results of lesions treated by single radioactive BX stents with an initial activity level of 3 to 12 microCi (group 1, n = 42 lesions). There were no procedural events. At the 6-month follow-up, no myocardial infarctions, deaths, or stent thromboses had occurred. Intrastent binary restenosis was 0% in group 1 versus 4% in group 2 (n = 2, both at the ostium of the right coronary artery, P = NS). Intrastent neointimal hyperplasia was significantly lower in group 2 than in group 1. The intralesion (intrastent plus peri-stent) restenosis rate was 38% in group 1 versus 30% in group 2 (P = NS). Conclusions-Single (32)P radioactive stents with an initial activity level of 12 to 21 microCi reduced intrastent neointimal hyperplasia compared with stents of 3 to 12 microCi, but they did not solve the problem of edge restenosis, even if a nonaggressive stent implantation strategy was used.


Subject(s)
Angioplasty, Balloon, Coronary/methods , Brachytherapy/methods , Coronary Disease/prevention & control , Coronary Disease/therapy , Radiotherapy Dosage , Stents , Angioplasty, Balloon, Coronary/adverse effects , Coronary Angiography , Female , Humans , Male , Middle Aged , Phosphorus Radioisotopes , Recurrence
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