~(192)Ir高线量率血管腔内照射对抑制兔血管平滑肌细胞增殖及新生内膜过度增生的研究

目的　研究192 Ir高线量率血管腔内照射对用切割球囊导管行经皮血管腔内成形术(PTA)后的日本白兔髂动脉平滑肌细胞增殖抑制的经时反应和效果。方法　 2 0只日本白兔经左侧颈总动脉放置切割球囊导管行髂动脉PTA术 ,随机于一侧髂动脉施行 12Gy剂量的血管腔内照射 ,非照射侧作为对照侧。实验动物于术后 1、2、3、4、8及 12周处死。根据新生内膜的形成情况 ,血管成形术后接受血管腔内照射的血管段按时间分为 3组 :即 1周组 5只、2～ 4周组 9只、8～ 12周组 6只。随后对标本进行了组织病理、形态学测量和免疫组织化学分析。结果　 1周时 ,与照射侧比较 ,对照侧血管段创口修复处可见明显的新生内膜增生 ,新生内膜中抗增殖细胞核抗原 (PCNA)阳性细胞率呈一峰值 ;2～ 4周期间 ,与对照侧比较 ,照射侧血管段新生内膜增生明显减弱 (P <0 .0 1) ,新生内膜中PCNA阳性细胞率较对照侧低 ,差异有显著性意义 (P <0 .0 1) ;8～ 12周 ,照射侧血管段增生的新生内膜较对照侧仍处较低水平 ,新生内膜中PCNA阳性细胞率约低于 1%。经抗平滑肌细胞α胶原免疫组织化学染色 ,证实新生内膜中主要为平滑肌细胞。结论　由照射所致的新生内膜增生过程的抑制作用从开始时即已启动。 12Gy的192 Ir高线量率照射能有效地抑制用切割球囊导管损     

188Re血管内照射抑制犬颈总动脉成形术后再狭窄

颈动脉支架成形术(CAS)后1年的颈动脉再狭窄率达到3.46%～7.4%[1].近年来,有研究表明血管内照射治疗能有效降低再狭窄的发生率[2].笔者采用血管内介入方法,用球囊过度扩张犬颈动脉以获得稳定的颈动脉再狭窄动物模型,探讨188Re血管内照射抑制犬颈总动脉内皮损伤后再狭窄的价值,现报道如下.     

^192Ir高线量率血管腔内照射对抑制兔血管平滑肌细胞增殖及新生内膜过度增生的研究

目的 研究^192I搞线量率血管腔内照射对用切割球囊导管行经皮血管腔内成形术（PTA）后的日本白兔髂动脉平滑肌细胞增殖抑制的经时反应和效果。方法 20只日本白兔经左侧颈总动脉放置切割球囊导管行髂动脉PTA术，随机于一侧髂动脉施行12Gy剂量的血管腔内照射，非照射侧作为对照侧。实验动物于术后1、2、3、4、8及12周处死。根据新生内膜的形成情况，血管成形术后接受血管腔内照射的血管段按时间分为3组：即1周组5只、2－4周组9只、8－12周组6只。随后对标本进行了组织病理、形态学测量和免疫组织化学分析。结果 1周时，与照射侧比较，对照侧血管段创口修复处可明显的新生内膜增生，新生内膜中抗增殖细胞核抗原（PCNA）阳性细胞率呈一峰值；2－4周期间，与对照侧比较，照射侧血管段新生内膜增生明显减弱（P＜0．01），新生内膜中PCNA阳性细胞率较对照侧低，差异有显著性意义（P＜0．01）；8－12周，照射侧血管段增生的新生内膜较对照侧仍处较低水平，新生内膜中PCNA阳性细胞率约低于1％。经抗平滑肌细胞α胶原免疫组织化学染色，证实新生内膜中主要为平滑肌细胞。结论 由照射所致的新生内膜增生过程的抑制作用从开始时即已启动。12Gy的^192Ir高线量率照射能有效地抑制用切割球囊导管损伤引起的日本白兔髂动脉新生内膜的过渡增生。     

经动脉途径行外伤后复杂颈内动脉海绵窦痿的血管内治疗

目前血管内治疗外伤性颈内动脉海绵窦瘘(carotid-cavernousfistula,CCF)已被广泛接受。经典的方法是经动脉导入一可脱性球囊入海绵窦阻塞瘘口。但某些病例,如外伤性颈内动脉闭塞或既往行结扎或孤立手术(瘘仍经其它吻合支有血供),经动脉途径到达瘘口则不可能。作者报道了3例外伤性复杂CCF(1例为单侧双瘘口型,另外2例因解剖学原因经动脉途径困难)。例1,男,20岁,外伤性右CCF。最初曾行孤立术失败,三年后病人明显突眼。血管造影显示瘘口经后交通动脉供血,并且已结扎的颈总动脉(CCA)仍有持续缓慢的血流通过。用带孔球囊微导管经动脉途径对已结扎的CCA行扩张成形,并     

粒细胞集落刺激因子对大鼠颈动脉PCI后内膜修复和增生的影响

目的　探讨重组人粒细胞集落刺激因子(rhG CSF)对大鼠颈总动脉球囊损伤后再内皮化和内膜增生的影响。方法　5 6只Wistar大鼠随机分为2组。观察组2 8只:皮下注射rhG CSF30 μg·kg- 1 ·d- 1 。7d后行左颈总动脉球囊导管拉伤。术后1h、3、5、7、14d用扫描电镜、伊文氏蓝染色、HE染色、免疫组织化学方法,观察血管再内皮化、新生内膜增厚及细胞增殖情况。对照组2 8只:用生理盐水代替rhG CSF ,其余同观察组。结果　发现观察组的内膜再生面积(An)和An At(内膜损伤总面积)比值明显高于对照组(P <0 .0 1) ;内膜厚度(Ti)、Ti Tm(中膜厚度)比值及PCNA阳性细胞率均明显低于对照组(P<0 .0 1)。结论　干细胞动员剂rhG CSF显著促进球囊损伤后血管内皮化、抑制SMC和内皮细胞过度增生,从而抑制了球囊损伤后再狭窄的发生     

超声观察脉压对高血压患者颈总动脉的影响

目的 :探讨超声观察脉压 (pulsepressure ,PP)对高血压患者颈总动脉 (commoncarotidanery,CCA)的不同类型斑块的发生情况和物理性状影响的方法。方法 :用二维高频超声 (B modehighfrequencyultrasond ,B IFUS)和M型超声 (M modeul trasond ,M US)观察 6 0例正常对照人群和 1 72例高血压患者 (80例脉压 <6 0mmHg和 92例脉压≥ 6 0mmHg)颈总动脉的不同类型斑块的发生情况、内中膜厚度、收缩期管径 (systolicdiameter,Ds)、舒张期管径 (diastolicdiameter,Dd) ,结合血压 ,计算颈总动脉的动脉硬化指数 (arterialsclerosisindex ,ASI)、动脉可扩张度 (arterialexpandingdegree ,AED)和周向扩张率。结果 :低脉压组和正常对照组比较、高脉压组和低脉压组比较 ,斑块的检出率明显增加 (P <0 0 5 ,P <0 0 1 ) ,中内膜明显增厚 (P <0 0 5 ,P<0 0 1 ) ,内径明显增加 (P <0 0 5 ,P <0 0 5 ) ,动脉硬化指数明显增加 (P <0 0 1 ,P <0 0 1 ) ,动脉可扩张度明显下降 (P <0 0 1 ,P <0 0 1 ) ,周向扩张率明显下降 (P <0 0 5 ,P <0 0 1 )。结论 :超声可显示脉压与高血压患者颈总动脉变化的关系 ,从而为高血压的防治提供帮助。     

rhG-CSF对大鼠颈动脉血管内皮细胞增殖及eNOSmRNA表达的影响

目的　研究重组人粒细胞集落刺激因子(rhG CSF)对大鼠颈总动脉损伤后再内皮化和内膜增生过程的影响。方法　5 6只Wistar大鼠随机分为2组。观察组2 8只:rhG CSF皮下注射注射7d后,行左颈总动脉球囊导管拉伤。术后1h、3、5、7、14d取损伤处颈动脉内膜;对照组2 8只:用生理盐水0 .5ml皮下注射代替rhG CSF ,其余操作同观察组。应用免疫组化法观察细胞增殖情况。通过RT PCR方法分析eNOSmRNA表达的影响。结果　发现rhG CSF组PCNA阳性细胞率显著低于对照组(P <0 .0 1) ,eNOSmRNA表达明显高于对照组。结论　rhG CSF对大鼠颈总动脉球囊损伤科促进血管再内皮化和抑制内膜增生过程     

PTA术后再狭窄：机理及预防

自从1964年Dotter和Judkins首次施行经皮穿刺血管成形术20多年来,经皮穿刺血管球囊扩张成形术(PTA)广泛应用于临床。但未能解决再狭窄或早期血管阻塞问题,它发生率约为25—35%。急性阻塞的机制已较清楚,再狭窄的机理尚在研究之中。PTA术后动脉管壁改变当球囊扩张血管壁时,在外力作用下,内皮细胞脱屑,斑块碎裂,弹力纤维伸直;     

不同踝下流出道病变程度糖尿病足患者接受膝下动脉球囊扩张的疗效及其影响因素北大核心CSCD

目的探讨不同踝下流出道病变程度糖尿病足患者接受膝下动脉球囊扩张的疗效及其影响因素。方法选择2020年10月至2021年10月福建医科大学附属闽东医院介入血管外科收治的糖尿病足患者153例。所有患者术前经全球肢体解剖分期系统(GLASS)评估踝下流出道病变程度,并依此将患者分为P0组34例,P1组61例,P2组58例。术后3、6、12个月电话随访和门诊复查,统计靶血管通畅率以及靶血管再狭窄发生情况。比较不同踝下流出道病变程度糖尿病足患者靶血管通畅率和再狭窄发生率差异,分析影响糖尿病足患者接受膝下动脉球囊扩张术后靶血管再狭窄的因素。结果P0组术后3、6、12个月一期、二期靶血管通畅率高于P1组、P2组(P<0.017),P1组和P2组比较差异无统计学意义(P>0.017)。随访期间3组靶血管再狭窄率差异有统计学意义(χ^(2)=12.330,P<0.05)。TASCⅡ分级D级、踝下流出道病变程度是糖尿病足患者接受膝下动脉球囊扩张术后靶血管再狭窄的危险因素(P<0.05),药物涂层球囊是保护因素(P<0.05)。结论踝下流出道不良可能与糖尿病足患者接受膝下动脉球囊扩张治疗后靶血管再狭窄有关,改善踝下流出道可能有助于提高临床疗效。     

白藜芦醇对颈总动脉球囊损伤术后大鼠血管的修复作用

目的 探讨白藜芦醇(RSV)对颈总动脉球囊损伤术后大鼠血管的修复作用.方法 将40只SD大鼠随机分为假手术组、模型组、溶剂对照组(DSMO组)与RSV组,每组10只.制备左颈总动脉球囊损伤模型后,模型组不给药,DMSO组和RSV组在颈总动脉球囊损伤段外周分别给予相同剂量的溶剂DMSO和RSV.假手术组仅结扎颈外动脉.1...     

Treatment of restenosis after percutaneous transluminal angioplasty for internal carotid artery stenosis

The efficacy of repeated percutaneous transluminal angioplasty (PTA) and carotid endarterectomy (CEA) was examined in patients with restenosis after PTA for carotid stenosis. After percutaneous transluminal angioplasty (PTA) for 63 cases of internal carotid stenoses 13 cases of restenosis appeared. They were treated by PTA or carotid endarterectomy. The treatment was chosen by the patient after explanation of each treatment. We initially treated seven patients by repeat PTA and six by carotid endarterectomy. The degree of stenosis improved from 82 % to 30 % on average after repeated PTA. However, one patient in the PTA group had restenosis, and carotid endarterectomy was then performed. The other cases also had restenosis and were treated by PTA. The six cases treated by carotid endarterectomy were successfully treated without difficulty. The success rate of PTA was 5/7 (71 %) in the restenosis cases. Patients with a greater residual stenosis after initial PTA had significantly more frequent restenosis. Repeat PTA and CEA both appeared effective treatment for restenosis after initial PTA, although PTA had a restenosis rate similar to that of initial PTA. Received: 21 December 1998 Accepted: 21 July 1999     

Endovascular gamma irradiation of femoropopliteal de novo stenoses immediately after PTA: interim results of prospective randomized controlled trial

PURPOSE: To report an interim analysis of whether centered endovascular irradiation with the iridium 192 ((192)Ir) source immediately after percutaneous transluminal angioplasty (PTA) of de novo femoropopliteal stenoses lowers the restenosis rate. MATERIALS AND METHODS: Thirty patients undergoing PTA to treat femoropopliteal stenoses were randomized for prophylaxis against restenosis with centered endovascular irradiation with a (192)Ir source (a dose of 14 Gy 2 mm deep to the vessel wall, irradiation group) or no irradiation (control group). Angiographic follow-up was available for 22 patients at 6 months (irradiation group, n = 10) and 12 patients at 12 months (irradiation group, n = 6). Duplex sonography, treadmill testing, and interviews were performed the day before and the day after PTA and after 1, 3, 6, 9, and 12 months. Results of angiography, duplex sonography, treadmill testing, and interviews were evaluated with a t test and multivariate analysis of variance (clinical characteristics, chi(2) test). RESULTS: Baseline characteristics were comparable in the two groups. Interim analysis of the 6-month follow-up data revealed a trend toward a significantly lower restenosis rate in the irradiation group. The change in the degree of stenosis compared with that after PTA was -14.7% +/- 20.8 (mean +/- SD) in the irradiation group versus 37.7% +/- 27.3 in the control group (P =.001) and became even more marked at 12 months (-9.5% +/- 34.5 vs 45.5% +/- 40.7 [P =.03], respectively). The follow-up results of treadmill testing and interviews showed a nonsignificant benefit for the irradiation group. One thromboembolic complication occurred during irradiation. No side effects were observed during follow-up. CONCLUSION: Endovascular irradiation with a centered (192)Ir source immediately after PTA of de novo femoropopliteal stenoses reduces the restenosis rate.     

Vascular inflammation and percutaneous transluminal angioplasty of the femoropopliteal artery: association with restenosis

PURPOSE: To determine the association of pre- and postprocedural serum levels of C-reactive protein (CRP), serum amyloid A (SAA), and fibrinogen at 6-month evaluation of restenosis after percutaneous transluminal angioplasty (PTA) of the femoropopliteal artery. MATERIALS AND METHODS: In a prospective cohort study, 172 consecutive patients with peripheral artery disease of Fontaine stage IIa, IIb, or III who underwent successful PTA of the superficial femoral and popliteal arteries were included. Patency at 6 months was evaluated by using oscillography, ankle-brachial index, and color-coded duplex ultrasonography. The association of restenosis and CRP, SAA, and fibrinogen levels at baseline, 24 hours, and 48 hours after intervention was assessed by means of multivariate analysis with adjustment for known risk factors for restenosis. RESULTS: Restenosis was found in 56 patients (33%) within 6 months. CRP values at baseline (adjusted odds ratio, 2.2; 95% CI: 1.1, 4.2) and 48 hours after intervention (adjusted odds ratio, 2.3; 95% CI: 1.6, 3.1) were independently associated with 6-month restenosis. SAA and fibrinogen values at any time interval were not significantly associated with patency in the multivariate models. CONCLUSION: The extent of vascular inflammation as measured by means of acute-phase reactants before and after PTA of the femoropopliteal artery is associated with 6-month restenosis. Baseline and 48-hour CRP levels were independent predictors of postangioplasty outcome.     

PTA Versus Carbofilm-Coated Stents in Infrapopliteal Arteries: Pilot Study

Purpose: To determine the primary success and short-term patency of stent application as a primary treatment modality for high-grade lesions of the infrapopliteal arteries compared with treatment with percutaneous transluminal angioplasty (PTA) in critical limb ischemia in a randomized prospective study. Methods: Endovascular therapy was performed on 95 lesions in 51 patients (mean age 72.0 years, range 47–80 years) who presented clinically with Fontaine stages III and IV. One patient underwent treatment in both limbs. After angiographic lesion identification, patients were randomized for treatment by PTA (53 lesions in 27 patients) or stent application (42 lesions in 24 patients). Follow-up by clinical investigation and conventional angiography or spiral CT angiography was performed in 37 patients (57 lesions) 6 to 12 months after the procedure, or when clinically indicated. Evaluation was performed by two observers, double-blinded, with thresholds for lesion restenosis of 50% and 70%. Statistical evaluation was performed on a lesion basis by Kaplan–Meier estimated probability rates, and log-rank and Wilcoxon tests. The primary endpoint was the angiographic patency rate of treated lesions. Results: The inter-reader agreement was high (κ = 0.82). For the stent group the cumulative primary patency at 6 months was 83.7% at the 70% restenosis threshold, and 79.7% at the 50% restenosis threshold. For PTA, the primary patency at 6 months was 61.1% at the 70% restenosis threshold and 45.6% at the 50% restenosis threshold. Both results were statistically significant (p < 0.05). Conclusion: Infrapopliteal stent application is an effective treatment modality for high-grade lesions in chronic critical limb ischemia. Compared with PTA, higher patency rates can be expected after 6 months.     

Endovascular brachytherapy for prophylaxis of restenosis after femoropopliteal angioplasty: five-year follow-up--prospective randomized study

PURPOSE: To report the 5-year results from the prospective randomized Vienna-2 trial, which was designed to evaluate the safety and effectiveness of adjunctive endovascular brachytherapy (EBT) compared with no further treatment after successful revascularization in patients with long-segment femoropopliteal lesions. MATERIALS AND METHODS: Each patient gave written informed consent to participate in the study, which was approved by the hospital's ethics committee. One hundred two patients (men, 53.9%; mean age, 72.1 years +/- 8.7 [standard deviation]; lesion length, 8.1 cm +/- 4.9) underwent percutaneous transluminal angioplasty (PTA) without further stent implantation. Patients were then assigned to either receive EBT (n = 51) by using an iridium 192 source, with a prescribed dose of 12 Gy at 3 mm from the source axis, or no further treatment (n = 51). Radiation was delivered without a centering catheter. Data were analyzed by using a Student t test for continuous values and a chi(2) test to compare categorical values. A Cox proportional hazards regression analysis was performed to evaluate predictors of recurrence at follow-up. RESULTS: After 6 months, the restenosis rate for the 102 patients with completed 5-year follow-up was significantly reduced for the PTA plus EBT group versus the PTA alone group (29.4% vs 56.9%, P < .05). During follow-up we observed a late catch-up phenomenon, and after 5 years the recurrence rate was comparable in both groups (72.5% vs 72.5%, P > .99). Time to recurrence, however, was significantly delayed in the PTA plus EBT group (17.5 months +/- 14.7 vs 7.4 months +/- 6.8 for the PTA alone group, P < .05). CONCLUSION: At 5-year follow-up, PTA followed by gamma radiation EBT with a dose of 12 Gy resulted in a delay but not an inhibition of restenosis when compared with that of PTA alone.     

Endovascular brachytherapy: restenosis in de novo versus recurrent lesions of femoropopliteal artery--the Vienna experience

PURPOSE: To determine the effectiveness of endovascular brachytherapy in the prevention of restenosis in recurrent versus de novo femoropopliteal lesions. MATERIALS AND METHODS: Ethics committee approval and patient informed consent were obtained. After they had undergone femoropopliteal angioplasty, 199 patients (mean age, 71.9 years +/- 9.6; 115 men, 84 women) were treated with either percutaneous transluminal angioplasty (PTA) and brachytherapy (n = 100) or PTA alone (n = 99). The patients were part of prospective randomized trials, the Vienna 2 and 3 trials, and were evaluated according to the stratification criterion of de novo or recurrent disease. Sixty-six of 134 patients with a de novo lesion and 34 of 65 patients with a recurrent lesion were randomly assigned to the PTA and brachytherapy arm; the remaining patients were treated with PTA alone. Outcomes were compared between the groups. The Student t test or one-way analysis of variance was used to compare continuous variables, and the chi2 test or Fisher exact test was used to assess dichotomous variables. Kaplan-Meier curves were calculated, and the log-rank test was performed to determine freedom from recurrence at 12 months in both groups. A multivariate Cox proportional hazard regression analysis was performed to evaluate the multivariate predictors of recurrence at 12-month follow-up. RESULTS: For patients with de novo lesions, the frequency of recurrence at 12 months was not significantly different between those who underwent brachytherapy and PTA and those who underwent PTA alone (24 [36%] of 66 patients vs 30 [44%] of 68 patients, P = .32). For patients with recurrent lesions, however, the 12-month recurrence rate was significantly lower in those who received brachytherapy than in those who did not (nine [26%] of 34 patients vs 22 [71%] of 31 patients, P = .004). CONCLUSION: Endovascular brachytherapy with gamma radiation significantly reduces the restenosis rate after femoropopliteal angioplasty of recurrent but not de novo lesions.     

Cutting-Balloon Angioplasty Versus Balloon Angioplasty as Treatment for Short Atherosclerotic Lesions in the Superficial Femoral Artery: Randomized Controlled Trial

Purpose

To evaluate the treatments of a short-segment atherosclerotic stenosis in the superficial femoral arteries with the cutting balloon angioplasty (CBA) versus conventional balloon angioplasty [percutaneous transluminal angioplasty (PTA)] in a randomized controlled trial.

Material and Methods

The study group comprised 60 patients (33 men, 27 women; average age 64 years) with a short (≤5 cm) focal SFA de novo atherosclerotic stenosis associated with a history of intermittent claudication or rest pain. The primary end point of this study was the rate of binary restenosis in the treated segment 12 months after the intervention. All patients were evenly randomized to either the PTA or CBA treatment arms. Follow-up angiograms and ankle–brachial index (ABI) measurements were performed after 12 months. The evaluation of the restenosis rates and factors influencing its occurrence were calculated by logistic regression analysis.

Results

In the intention-to-treat analysis, restenosis rates after 2-month follow-up were 9 of 30 (30 %) in the PTA group and 4 of 30 (13 %) in the CBA group (p = 0.117). In the actual treatment analysis, after exclusion of patients who required nitinol stent placement for a suboptimal result after angioplasty alone (5 patients in the PTA group and none in the CBA group), restenosis rates were 9 of 25 (36 %) and 4 of 30 (13 %), respectively (p = 0.049). In the intention-to-treat analysis there were also significant differences in ABI values between the PTA and CBA groups at 0.77 ± 0.11 versus 0.82 ± 0.12, respectively (p = 0.039), at 12 months.

Conclusion

Based on the presented results of the trial, CBA seems to be a safer and more effective than PTA for treatment of short atherosclerotic lesions in the superior femoral artery.     

Endovascular brachytherapy for prophylaxis against restenosis after long-segment femoropopliteal placement of stents: initial results

PURPOSE: To evaluate the feasibility, safety, and effectiveness of endovascular brachytherapy for the prevention of restenosis after long-segment femoropopliteal percutaneous transluminal angioplasty (PTA) and stent implantation. MATERIALS AND METHODS: Thirty-three patients (23 men, 10 women; mean age, 66 years) with femoropopliteal lesions (mean treated length, 17 cm; range, 4-30 cm) underwent PTA and stent implantation followed by brachytherapy with a centering catheter. A dose of 14 Gy was delivered to the adventitia by using an iridium 192 source. Long-term pharmacotherapy with acetylsalicylic acid was combined with clopidogrel for 1 month. Follow-up examinations included measurement of the ankle-brachial index, color-coded duplex ultrasonography, and angiography. RESULTS: The overall 6-month recurrence rate was 30% (10 of 33 arteries). Seven patients developed sudden late thrombotic occlusion of the segment with the stent 3.5-6 months after stent implantation. Considering the overall results after successful local thrombolysis in six of these seven patients, only four (12%) of 33 arteries with a stent had in-stent restenosis caused by neointimal hyperplasia. CONCLUSION: The study results are promising concerning the possibility of reducing in-stent restenosis by means of brachytherapy after long-segment femoropopliteal placement of stents. The high incidence of late thrombotic occlusion requires optimization of the antithrombotic regimen.     

Interleukin-6 promoter genotype and restenosis after femoropopliteal balloon angioplasty: initial observations

PURPOSE: To investigate whether there is an association between a functional polymorphism in the interleukin (IL)-6 gene promoter (-174)G/C and restenosis after percutaneous transluminal angioplasty (PTA) of the femoropopliteal artery. MATERIALS AND METHODS: A total of 281 patients underwent PTA of the femoropopliteal artery during the study period; 23 (8%) patients had to be excluded due to missing genetic data. We studied 258 patients with intermittent claudication (n = 174) or critical limb ischemia (n = 84). The IL-6 promoter genotype was determined from venous blood samples before intervention by using a mutagenically separated polymerase chain reaction, and patients were followed up for 6 months with duplex ultrasonography for the occurrence of restenosis (> or =50%) after angioplasty. Multivariate Cox proportional hazards analysis was performed to assess the association between the IL-6 promoter genotype and restenosis, with adjustment for possible confounders such as atherosclerotic risk factors and angiographic covariates. RESULTS: The 6-month restenosis rate was 26% (23 of 90) in patients with the (-174)GG genotype, 28% (33 of 117) with the (-174)GC genotype, and 43% (22 of 51) with the (-174)CC genotype (P =.044). Homozygous carriers of the (-174)C allele ([-174]CC) exhibited a 2.42-fold increased adjusted risk for restenosis (95% CI: 1.28, 4.58; P =.007) compared with homozygous (-174)G allele carriers ([-174]GG). Heterozygous carriers ([-174]GC) had no significantly increased restenosis risk (hazard ratio, 1.37; 95% CI: 0.84, 2.22; P =.21). CONCLUSION: The IL-6 promoter polymorphism (-174)G/C seems to influence the occurrence of restenosis after PTA. Homozygous carriers of the (-174)C allele have an increased rate of intermediate-term restenosis.     

The Role of Multi-slice Spiral CT Angiography in Patient Management After Endovascular Therapy

Objectives To bring out the role of multi-slice spiral CT angiography (MS-CTA) in patient management after endovascular therapy of subclavian artery stenosis. Methods Twenty-one consecutive patients with clinically suspected restenosis after endovascular treatment of subclavian artery stenosis or occlusion were included in the study. Eleven patients had been treated with percutaneous transluminal angioplasty (PTA) alone and 10 with PTA and stenting. The mean follow-up period after PTA or stenting was 57 (±27 SD) months. CTA was performed using a bolus-triggered high-resolution protocol with biphasic intravenous contrast medium injection. Axial images and curved planar reformations (CPRs) were rated by three readers with regard to patency of supra-aortic vessels. Imaging findings were correlated with a standardized clinical assessment. Results All examinations were of diagnostic quality. Of 21 referred patients, 7 had significant reobstruction of the treated subclavian artery. Six of the 7 patients with significant restenosis on CTA were treated conservatively (antiplatelet agents), despite 2 of them being symptomatic on the standardized clinical assessment, which showed a sensitivity and specificity of 86% in predicting stenosis. One patient was treated with PTA and stent deployment because of strong subjective suffering. Conclusion MS-CTA is useful for exclusion or quantification of clinically suspected restenosis in carefully selected patients after endovascular therapy where ultrasound is inconclusive and/or contrast-enhanced magnetic resonance angiography is contraindicated.