Early coronary aneurysm with Paclitaxel-eluting stent

Coronary aneurysm may occur after implantation of a paclitaxel-eluting stent. However, early coronary aneurysms arevery rare. We report an early coronary aneurysm at one month in a middle-aged man who had anterior descendingartery infarct angioplasty done with two overlapped Taxus Liberte stents. Our finding was a fortuitous one. The casedescribed here illustrates the need for a higher index of suspicion for a coronary aneurysm when overlapping drug-eluting stents are used, especially in an infarct angioplasty.     

New stent design for autologous venous graft-covered stent preparation: first human application for sealing of a coronary aneurysm.

In this case report, we present the first clinical application of a new stent design for autologous venous graft-covered stent preparation. This stent consists of a main body, resembling the configuration of conventional stents, and two connecting arms at the edges of the stent for the stabilization of the venous graft on the external surface of the stent. This new stent design was applied in a patient with an aneurysm in a stented segment in the right coronary artery. The immediate and long-term angiographic evaluation after the covered stent implantation showed complete sealing of the aneurysm without restenosis.     

Distal stent delivery with guideliner catheter: First in man experience

Failure to deliver stents is one of the commonest causes of procedural failure in contemporary PCI practice. We describe successful use of the Guideliner Catheter, the first purpose designed FDA and CE marked device delivery catheter in 13 complex cases in native coronary vessels and bypass grafts performed via the radial route to enable distal stent delivery following failure of conventional techniques. We discuss how the Guideliner catheter may be used to facilitate difficult radial cases. © 2010 Wiley‐Liss, Inc.     

Pharmacokinetics of melatonin in man: first pass hepatic metabolism

Hepatic clearance concepts were applied to existing data on iv and oral administration of melatonin to man. A high hepatic extraction ratio was calculated, suggesting prominent first pass hepatic metabolism and reduced bioavailability for orally administered melatonin. Using clearance parameters and previous data, endogenous production rates for melatonin were determined for normal individuals and patients with cirrhosis. Normal melatonin production was 28.8 micrograms/day, while the production rate for cirrhotic patients was 12.3 micrograms/day. Thus, not only do cirrhotic patients have decreased melatonin elimination, as noted in the original report, but they also have decreased daily melatonin production.     

支架影像增强显影技术在冠脉支架植入术中的应用效果观察

目的：评价支架增强显影（ SB）技术在冠脉支架植入术中的应用效果。方法将204例行冠状动脉支架植入术的患者随机分为观察组和对照组,各102例。两组均采用常规冠状动脉造影方法行冠状动脉造影,并在其指导下进行冠状动脉支架植入术。对照组支架植入后采用QCA自动分析系统测量支架直径的相关参数（包括支架直径的最小值、最大值、均值）并计算支架偏心指数。同时进行支架可视性和球囊内扩张必要性评分。观察组在支架植入后行SB,测量上述指标并进行上述评分。观察组26例支架植入后行血管内超声（ IVUS）检查,测量上述指标并进行上述评分。结果对照组支架植入后支架可视性得分低于观察组, P＜0．05。对照组发现30处、观察组发现48处有球囊内扩张必要性而行支架球囊内扩张术。两组QCA、SB、IVUS测得植入支架最小直径、最大直径、直径均值和支架偏心指数差异无统计学意义。 Pearson相关性分析显示QCA与SB、QCA与IVUS、SB与IVUS测得支架最小直径均有良好的相关性,r分别为0．772、0．775、0．782,P均＜0．05。结论 SB可明显提高支架的可视性,有效指导支架的球囊内扩张,在测量支架直径方面甚至可以替代冠脉内超声。     

The Paclitaxel-eluting PTCA-balloon in combination with a cobalt-chromium stent in two different sequences to treat de novo coronary artery lesions: An angiographic follow up study

IntroductionThe paclitaxel-coated balloon catheter (DCB) based on the PACCOCATH^® technology has yielded angiographic and clinical results superior to drug-eluting stents (DES) in situations like in-stent restenosis (ISR) and a trend towards superior results in small coronary vessels and side branches of coronary bifurcations. Using the DCB followed by cobalt–chromium stent (CoCr) deployment or with a reverse sequence may yield different outcomes in terms of late loss.Methods97 patients with de-novo coronary stenosis (55.6 ± 10.7 years, 79.4% male, ≥70%, length: ≤25 mm, vessel diameter: 2.5–4.0 mm) were randomly treated with the DCB (3 μg/mm²) followed by a CoCr-stent or stent first and DCB later. Six-month angiographic and one-year clinical follow-up intention-to-treat analyses were performed.ResultsAngiographic and demographic baseline data was comparable between the two groups. When comparing balloon first versus stent first technique, the primary outcome variables were not statistically different for mean in-segment (0.51 ± 0.56 mm vs. 0.36 ± 0.55 mm, p = 0.23) and in-stent (0.52 ± 0.55 mm vs. 0.46 ± 0.52 mm, p = 0.65) late lumen loss. The lesion related 12-month MACE rates were 5/49 (10.2%) and 2/48 (4.2%) (p = 0.44). Lesion related thrombotic events occurred in three patients in balloon first and in one patient in stent first group, two of which were associated with early discontinuation of continuous dual anti-platelet therapy, two with suboptimal PCI, and one each were performed in a thrombotic lesion and a bifurcation type 1.1.0.ConclusionDrug-coated balloon first followed by cobalt chromium stent deployment versus a reverse sequence is not associated with statistically significantly different 6-month angiographic or 12-month clinical outcomes.     

High incidence of recurrent in stent thrombosis after successful treatment of a first in stent thrombosis

Objectives: We attempted to investigate incidence and predictors of recurrent in stent thrombosis (IST) after successful treatment of a first IST. Background: The occurrence of recurrent IST after successful treatment of a first IST may be a decisive factor for patient clinical outcome. However, incidence and predictors of recurrent IST are currently poorly described in the literature. Methods: Between 2003 and 2005, 2,190 patients underwent a percutaneous coronary intervention in our center. During a median follow‐up of 19.4 months, 49 patients (2.24%) presented a first definite IST. Patients presenting with a first IST were followed during an additional median period of 40 months. Their baseline characteristics were listed and cardiovascular events especially recurrent IST as defined by the Academic Research Consortium definition were systematically indexed. Results: Altogether 39 (80%) patients were successfully treated with an effective reperfusion after percutaneous coronary intervention. Fourteen (36%) patients presented a recurrent IST and three presented multiple recurrent IST. The median occurrence time of recurrent IST was 5 days, range between 1 and 11 days. Multivariate analysis identified history of neoplasia (HR = 11.53, 95% CI 2.32–57.37, P = 0.003), residual diameter stenosis (HR = 1.15, 95% CI 1.02–1.29, P = 0.02), and residual dissection after treatment (HR = 8.78, 95% CI 1.85–41.62, P = 0.006), as independent predictors of recurrent IST. Conclusion: Recurrent IST is a frequent and early event after successful treatment of a first IST. Our results suggest that mechanical factors like residual dissection and residual diameter stenosis should be carefully tracked down. In addition, patients with multiple recurrent IST and the early time course of recurrent IST also suggest a potential role of inadequate antiplatelet therapy. © 2008 Wiley‐Liss, Inc.     

Serial angioscopic evaluation of neointimal coverage and incidence of thrombus formation after Paclitaxel-eluting stent implantation: comparison between 6- and 18-month follow-up

Background:

Long‐term serial angioscopic follow‐up data after paclitaxel‐eluting stent (PES) implantation has not previously been published. The aim of this study is to compare the angioscopic parameters such as neointimal coverage grade and prevalence of red mural thrombus at 6‐ and 18‐month follow‐up after PES implantation.

Hypothesis:

Neointimal formation continues to grow and prevalence of angioscopic thrombus formation becomes low over time after PES implantation.

Methods:

We retrospectively enrolled 17 patients with 19 stents who underwent both 6‐ and 18‐month follow‐up coronary angioscopy after PES implantation. We evaluated the minimum and maximum neointimal coverage grade within 1 stent using coronary angioscopy by classifying neointimal coverage grade into 4 categories. Neointimal coverage grade and incidence of angioscopic red mural thrombus were compared between 6‐ and 18‐month follow‐up groups.

Results:

Minimum neointimal coverage grade at 18 months become lower than that at the 6‐month follow‐up (0.95 ± 0.62 at 6 mo vs 0.58 ± 0.51 at 18 mo, P = 0.035), whereas maximum grade was not significantly different (2.16 ± 0.83 at 6 mo vs 2.37 ± 0.76 at 18 mo, P = 0.248). High incidence of angioscopic red mural thrombus at 6 months was maintained even at 18‐month follow‐up (68% at 6 mo vs 84% at 18 mo, P = 0.224).

Conclusions:

Long‐term serial angioscopic follow‐up demonstrated persistent high incidence of red mural thrombus formation at 18 months after PES implantation. © 2011 Wiley Periodicals, Inc. The authors have no funding, financial relationships, or conflicts of interest to disclose.     

小血管支架的临床应用

目的　评价具有磷酸胆碱涂层的小血管支架治疗细小冠状动脉病变 (≤ 3 0mm)的疗效。方法　选择 4 5例冠心病患者 ,男 35例 ,女 10例 ,年龄 (5 4 2± 10 5 )岁。常规行冠状动脉造影 ,以美国GE公司研制的血管造影机 (GEAdvantx)测量系统实时测量病变血管直径。小于 3 0mm的病变血管共 5 4支 ,平均血管直径为 (2 0± 0 4 5 )mm ,植入PC涂层 (BiodivYsioSV)支架 5 9个。结果　 5 4支病变血管均经球囊扩张后植入支架 ,手术成功率为 10 0 %。支架植入后平均狭窄直径减至 0 %～10 %,无一例急性或亚急性支架内血栓形成。全部病例随访 (6± 2 4 )个月 ,无一例死亡。 10例于术后(4± 1 2 )个月出现心绞痛复发 ,经冠状动脉造影证实 8例为支架内再狭窄 ,2例出现其他部位血管病变。结论　应用具有磷酸胆碱涂层的支架治疗小血管病变 ,再狭窄率低 ,临床疗效肯定。     

Yolk-sac hematopoiesis: the first blood cells of mouse and man

OBJECTIVE: To review the process of blood-cell formation in the murine and human yolk sac. DATA SOURCES: Most articles were selected from the PubMed database. DATA SYNTHESIS: The yolk sac is the first site of blood-cell production during murine and human ontogeny. Primitive erythroid cells originate in the yolk sac and complete their maturation, including enucleation, in the bloodstream. Though species differences exist, the pattern of hematopoietic progenitor cell emergence in the yolk sac is similar in mouse and man. In both species, there is a stage of development where both primitive red blood cells and definitive erythroid progenitors are produced in the yolk sac. An "embryonic" hematopoietic stem cell that engrafts in myeloablated newborn but not adult mice can be detected in the murine yolk sac and embryo. Stem-cell activity in the human yolk sac has not been reported. CONCLUSIONS: The yolk sac is the sole site of embryonic erythropoiesis. However, definitive erythroid, myeloid, and multipotential progenitors also originate in the yolk sac. The relationship between these progenitors and the "embryonic" hematopoietic stem cell has not been elucidated. Yolk sac-derived progenitor cells may seed the developing liver via the circulation and serve as the immediate source of the mature blood cells that are required to meet the metabolic needs of the rapidly growing fetus.     

Self-expanding stainless steel stent application in rectosigmoid stricture

In recent years, several reports on the experimental and clinical applications of the Gianturco stent (self-expanding stainless steel stent) have been published. However, to our knowledge, the use of stents in rectosigmoid strictures has not been reported. We used self-expanding stainless steel stents to dilate rectosigmoid strictures caused by nonresectable recurrent neoplasm. Insertion and dilation (sigmoid colon and rectum) in two patients were successful. Accordingly, these patients were able to maintain bowel activity and avoid palliative loop colostomy. We believe that this procedure is effective for nonresectable rectosigmoid stricture due to recurrent neoplasm.     

Drug-eluting stents in patients on chronic hemodialysis: Paclitaxel-eluting stents vs. limus-eluting stents

BackgroundPatients requiring chronic hemodialysis (HD) are at high risk for restenosis after percutaneous coronary intervention (PCI) with bare metal stents. Outcome data on drug-eluting stent (DES) implantation in HD patients are limited and suggest superiority of paclitaxel-eluting stents (PES) over limus-eluting stents (LES).MethodsIn total, 218 consecutive patients were prospectively enrolled. A comparison of post-PCI outcomes up to 2 years was carried out between patients receiving PES (n = 62) and LES (n = 156; SES n = 112, EES n = 44). The primary end point was 2-year major adverse cardiac events [MACE; death, Q-wave myocardial infarction and target lesion revascularization (TLR)].ResultsBaseline characteristics were comparable. The overall prevalence of diabetes mellitus was 71%. On clinical follow-up to 2 years, MACE rates were similar [PES 32/51 (62.7%) vs. LES 77/132 (58.3%), p = 0.59]; however, clinically-driven revascularization occurred more than twice as frequently in LES patients: TLR [PES 4/36 (11.1%) vs. LES 24/93 (25.8%), p = 0.07] and target vessel revascularization [5/37 (13.5%) vs. 33/96 (34.4%), p = 0.02]. Given that overall mortality was nominally higher for PES patients [31/50 (62.0%) vs. 61/127 (48.0%), p = 0.09], a competing outcome analysis was implemented for TLR against mortality, which demonstrated that the trend for increased TLR with LES was no longer apparent (p = 0.282). On multivariable adjustment, only diabetes mellitus was independently associated with TLR (use of PES was not).ConclusionsPatients on chronic HD experience high rates of clinically driven TLR despite DES implantation. Use of PES does not demonstrate a significant advantage over LES in this population.