Clinical outcome of stent implantation in small coronary arteries using different types of coronary stents.

PURPOSE: We evaluated the results of stent placement in small coronary arteries. SUBJECTS: The subjects were divided into 2 groups: the first contained 911 lesions treated with stenting in the coronary arteries (stent group), and the second contained 1,203 background- and patient-matched lesions treated with balloon angioplasty (POBA group). There was no significant difference in the background of patients or lesions between the groups. A "small coronary artery" was defined as a coronary artery with a reference vessel diameter < 3.0 mm. RESULTS: There was no significant difference in incidence of acute myocardial infarction (AMI), coronary artery bypass grafting, or death between the groups. In the stent group, acute occlusion (0.8%) and subacute thrombosis (2.1%) occurred. The restenosis rate of 29.8% in the stent group was significantly lower than in the POBA group (38.2%; p < 0.01). The restenosis rate of 19.4% in stented vessels 3.0 mm diameter was significantly lower than in vessels < 3.0 mm diameter (29.8%; p < 0.01). The rate of restenosis was 22.9% for the Multi-Link stent, 24.4% for the NIR stent, 34.1% for the GFX stent, and 35.3% for the PS stent. The restenosis rate of 23.8% in stented vessels > 2.5 mm diameter and < or = 20 mm length was significantly lower than in vessels , < or = 2.5 mm diameter and > 20 mm length (32.7%; p < 0.01). Factors associated with restenosis, analyzed using a stepwise multivariate logistic regression model, included ostial lesions and post-procedural minimum lumen diameter. CONCLUSIONS: Stent implantation in vessels < 3.0 mm diameter using a newly designed coronary stent yielded favorable clinical results, while there was a high prevalence of restenosis, leading to diffused stenotic lesions, in vessels < 2.5 mm diameter.

Efficacy of cutting balloon angioplasty for in-stent restenosis: an intravascular ultrasound evaluation.

BACKGROUND: The increase in the use of stents has seen the increasing emergence of in-stent restenosis (ISR). Reports suggest that the Cutting Balloon (Interventional Technologies, San Diego, California) may be a useful treatment modality for this new clinical entity. METHODS: In this study, we compared the efficacy of Cutting Balloon angioplasty (CBA) with conventional balloon angioplasty (PTCA) for ISR in 47 patients (47 lesions). Results were evaluated with intravascular ultrasound (IVUS). The CBA group included 25 patients (mean age, 65 +/- 78 years; 7 females) and the PTCA group included 22 patients (mean age, 69 +/- 51 years; 6 females). RESULTS: The procedural success rate was 100% in both groups. IVUS showed that luminal area acute gain was larger in the CBA group (2.5 +/- 0.8 mm2) compared to the PTCA group (1.8 +/- 1.0 mm2), while late loss was smaller in the CBA group (0.5 +/- 0.4 mm2) compared to the PTCA group (1.3 +/- 0.5 mm2). The change in total area was similar in both groups. The increase in area at the stented portion was 0.4 +/- 0.8 mm2 in the CBA group and 1.2 +/- 0.5 mm2 in the PTCA group. The restenosis rate at follow-up (mean follow-up, 5.4 months) was higher in PTCA patients (59%) than in the CBA patients (24%). CONCLUSION: CBA may result in no increase in total vessel area, a constant stent area, a decrease in plaque area, and an increase in lumen area (induced by the decrease in plaque area). Our IVUS findings suggest that compared to PTCA, the dilatation mechanism of CBA may be associated with reduced dilatation of both the total vessel area and the stent area for ISR. The mechanism of this modality may minimize injury to the intimal membrane and may potentially be a primary device for in-stent restenosis in the future.

Intravascular ultrasound findings in patients with abnormal coronary flow reserve after stenting.

A coronary flow reserve (CFR) of 2.0 has been advocated as the endpoint for coronary intervention therapy. Experience shows, however, that CFR does indeed exceed 2.0 in many cases poststenting, while remaining below 2.0 in others. In this study, we assessed the clinical characteristics and IVUS findings of patients whose CFR remained below 2.0 after stent implantation, specifically 16 patients with CFR below 2.0 (22 lesions, 64 +/- 9 years, 4 female), and 102 patients with CFR above 2.0 (112 lesions, mean age 66 +/- 11 years, 22 female). Patient population comprised patients selected for retrospective study, but participants were selected on the basis of matching patient and lesion characteristics. The IVUS findings showed that incidence of calcified lesions and post-PTCA dissection of hard plaque were higher among patients with CFR < 2.0. Further, IVUS-obtained vascular measurements showed post-PTCA area stenosis to be 58.7 +/- 15.2% in the CFR < 2.0 group, and 45.3 +/- 12.5% among CFR > or = 2.0 patients (P < 0.05). These findings indicate that patients with diffuse calcified lesions or high post-PTCA % area stenosis, as determined by IVUS, are more likely to have lower CFR after stenting.

Vitrification of bovine embryos in a mixture of ethylene glycol and dimethyl sulfoxide.

The influence of equilibration time before vitrification on the viability of vitrified morula- to blastocyst-stage bovine embryos and in vivo viability of vitrified embryos following transfer to recipients were investigated. In experiment 1, the embryos were exposed to an equilibration solution (50% VSED) containing 12.5% v/v ethylene glycol and 12.5% v/v dimethyl sulfoxide in modified Dulbecco's phosphate buffered saline with 4 mg/ml BSA (m-PBS) for 1, 2 and 5 minutes at room temperature (22 to 24 degrees C). The embryos were then placed in 15mul vitrification solution (VSED) consisting of 25% v/v ethylene glycol and 25% v/v dimethyl sulfoxide in m-PBS and were loaded into 0.25 ml plastic straws at room temperature. After 30 seconds, the straws were placed in liquid nitrogen (LN(2)) vapor for 2 minutes, plunged and stored in LN(2). To thaw, the straws were warmed in water at 20 degrees C for 15 seconds and the contents of the straws were expelled into a plastic dish. The embryos were diluted in 0.5 M sucrose + m-PBS for 5 minutes and were cultured in TCM-199 supplemented with bovine oviductal epithelial tissue. Viability of the embryos was assessed by the forming or reforming of the blastocoele after 24 hours of culture. High in vitro survival rates (73 approximately 90%) of vitrified embryos were obtained after 1 and 2 minute equilibrations, but was reduced (P<0.05) after 5 minute equilibration. In Experiment 2, morula- to blastocyst-stage embryos were vitrified after 1 minute equilibration in 50% VSED and 30 seconds of exposure to VSED. The vitrified-warmed embryos were transferred to recipient heifers at 7 days after estrus (1 embryo per recipient). Five (38%) of 13 (40%) of 10 recipients that had received blastocysts were diagnosed as pregnant using ultrasonography 60 days following transfer.

Factors affecting survival of mouse blastocysts vitrified by a mixture of ethylene glycol and dimethyl sulfoxide.

The present study was conducted to determine suitable conditions for mouse blastocysts vitrified by a solution containing 25% v/v (4.5M) ethylene glycol and 25% v/v (3.4M) dimethyl sulfoxide (VSi). In Experiment 1, blastocysts were exposed to 50% diluted VSi (50% VSi) for 10 minutes then to VSi for 0.5 minutes at room temperature (22 approximately 24 degrees C) or at 4 degrees C, followed by vitrification. The survival rates of these embryos exposed at each temperature were not significantly different. In Experiment 2, embryos were exposed directly to VSi for various time periods at room temperature and diluted in mPBS with 0.5 M sucrose without vitrification. The viability of embryos decreased after more than a 3 minute exposure. When the embryos were exposed to VSi for 0.5, 1, 1.5 and 2 minutes followed by vitrification, the survival rates were 78, 80, 76 and 50%, respectively. In Experiment 3, embryos were vitrified after exposure to 50% VSi for various time periods and then to VSi for 0.5 minutes at room temperature. One minute exposure to 50% VSi resulted in the highest survival rate. In Experiment 4 and 5, the cooling rate (from approximately 70 to approximately 2500 degrees C/minute), sucrose concentration (0, 0.5 and 1 M) of dilution solution, and dilution time (1 or 5 minutes) did not affect the viability of the vitrified embryos. Following exposure to 50% VSi for 1 minute and to VSi for 0.5 minutes at room temperature, embryos were cooled 1) at approximately 2500 degrees C/minute and diluted in 0.5 M sucrose in mPBS after warming or 2) at approximately 200 degrees C/minute and diluted in mPBS. In vivo development rates after the transfer to recipients were 38 and 42%, respectively. These values were similar to that of fresh control embryos.