Effect of transcatheter endovascular radiation with holmium-166 on neointimal formation after balloon injury in porcine coronary artery

BACKGROUND: Neointimal formation in response to arterial injury is a major contributing element in restenosis after coronary balloon angioplasty and stenting. Endovascular irradiation has been reported to be effective in reducing restenosis. The purpose of this study was to investigate the effect of beta-emitting holmium-166 for the inhibition of neointimal formation in porcine coronary artery. METHODS AND RESULTS: A total of 34 pigs weighing 25 to 30 kg underwent oversized balloon injury (balloon/artery ratio, 1.3:1.4) at the proximal portion of the left anterior descending and circumflex arteries. One artery was randomly assigned to receive radiation after injury. Ho-166 was left in the balloon within the delivery catheter for a period sufficient to deliver 9 Gy and 18 Gy to a depth of 1 mm from the surface of the balloon. Four weeks later, pigs were sacrificed and hearts were perfusion-fixed, followed by histopathologic analysis and planimetry for measurement of maximal intimal thickness, intimal area, and fracture length. The coronary segment of the pigs in the control group had neointimal area of 1.18+/-0.55 mm2; the pigs in the 9-Gy group had neointimal area of 0.68+/-0.40 mm2 (P<.05 vs. control); and the pigs in the 18-Gy group had neointimal area of 0.29+/-0.12 mm2 (P<.01 vs. control). The maximal intimal thickness in the 18-Gy group (0.14+/-0.11 mm) was significantly reduced compared with the maximal intimal thickness in the control group (0.48+/-0.13 mm) (P<.01). CONCLUSIONS: Intracoronary radiation with liquid Ho-166 contained in a perfusion balloon catheter is feasible and effective in reducing neointimal formation after coronary overstretch injury in pigs. Therefore intracoronary irradiation on the injured segment may further reduce restenosis after balloon injury.     

Various Echocardiographic Patterns of Left Ventricular Systolic Dysfunction Induced by Carbon Monoxide Intoxication

Carbon monoxide (CO) intoxication could cause significant cardiac injury. Although cardiac dysfunction after CO intoxication can be presented, the echocardiographic findings after CO intoxication are poorly defined. The purpose of this study was to evaluate the clinical patterns of left ventricular (LV) systolic dysfunction using echocardiography. A total of 132 CO-intoxicated patients were enrolled. Clinical, demographic and laboratory data and echocardiographic findings were analyzed. The LV dysfunction group (29 patients) showed higher lactate level (5.8 ± 3.3 vs. 4.1 ± 3.5 mmol/L, p = 0.024) and lower base excess (BE) (?8.2 ± 6.0 vs. ?4.8 ± 4.7 mEq/L, p = 0.001) compared with normal LV function group. Among the LV dysfunction group, three different echocardiographic patterns were presented. Regional wall motion abnormality was presented in 14 patients. Apical ballooning, typical finding of stress-induced cardiomyopathy, was presented in eight patients. Global hypokinesia of LV was presented in seven patients. Laboratory findings indicating the severity of CO intoxication, such as lactate level, pH value, BE and aspartate aminotransferase, showed statistical significance according to the patterns of LV dysfunction (p = 0.033, 0.022, 0.02 and 0.006, respectively). Our results demonstrate that CO intoxication could induce various patterns of LV dysfunction. The patterns of LV dysfunction might affect subsequent clinical outcomes.     

冠状动脉左前降支开口部病变的血管内超声观察

目的 探讨冠状动脉左前降支(LAD)开口部病变的重塑类型。方法 对31例LAD开口部病变(甲组)和24例冠状动脉造影正常的LAD(乙组)进行血管内超声检查。分别于病变远端参照部位及开口部病变处测量血管面积、管腔面积及斑块面积。重塑指数定义为开口部病变处血管面积与病变远端参照部位血管面积的比值。结果 甲组的重塑指数明显小于乙组(0.79±0.19比0.97±0.11,P<0.001)。如定义重塑指数<0.92(乙组平均重塑指数的95％可信区间的下限值)为收缩性重塑,则甲组中81％(25/31)为收缩性重塑。在发生收缩性重塑的病变中,病变处管腔面积的减少54％是由病变处血管收缩所致。病变处管腔面积的减少与血管面积的减少的相关性比病变处管腔面积的减少与斑块面积的增加的相关性更强(r=0.75,P<0.001和r=0.62,P<0.01)。结论 LAD开口部病变以收缩性重塑更常见,收缩性重塑是决定LAD开口部病变狭窄程度的重要因素。     

联合应用切割球囊与放射治疗对冠脉支架内再狭窄的作用

目的 :探讨联合应用切割球囊及β射线 （1 66Ho）冠脉内放射治疗对支架内再狭窄的作用。方法 :对 2 0 0 1- 0 1～2 0 0 2 - 0 3韩国亚洲大学医院心脏中心完成的 6 0例支架内再狭窄的患者 ,全部使用切割球囊预扩张 ,满意扩张后使用充满液态 1 66Ho的长球囊 （30～ 40 mm ）进行冠脉内放射治疗。术后随访主要临床不良事件 ,并于术后 8个月行冠状动脉造影 ,用 MEDCON Viewer软件包进行定量冠状动脉造影 （QCA）分析。结果 :6 0例患者 6 5处支架内再狭窄病变均被满意扩张 ,血管内放射治疗全部成功 ,无撕裂、血栓形成等并发症。随访 8个月 ,无 1例死亡。 5例 （8.3%）于术后 3个月出现心绞痛行靶病变血管重建术 ,其余 5 5例患者均于术后 8个月行冠状动脉造影 ,4例于支架内发生再狭窄 （7.3%） ,6例于支架边缘发生再狭窄 （10 .9%） ,全部患者无晚期血栓形成、假性动脉瘤及冠状动脉瘤发生。病变长度为 2 5 .1± 4.7mm。晚期管腔丧失为 0 .19± 0 .6 8mm。最小管腔直径术前为 0 .38± 0 .2 6 mm ,术后即刻为 2 .0 8± 0 .36 m m ,8个月随访时为 1.82± 0 .76 mm。结论 :联合应用切割球囊及β射线 （1 66Ho）冠脉内放射治疗对支架内再狭窄是有效及安全的 ,可在临床推广应用。     

Impact of Coronary Bifurcation Angle on Clinical Outcomes after Percutaneous Coronary Intervention in Real-World Practice: Results from the COBIS Registry

Objectives: Bifurcation angle has emerged as a predictor of outcome after percutaneous coronary intervention (PCI) for bifurcation lesions. We investigated the impact of bifurcation angle on clinical outcomes in patients undergoing bifurcation lesion PCI. Methods: Consecutive patients who received PCI for bifurcation lesions were enrolled from 16 centers in Korea between January 2004 and June 2006. Patients were divided into low-angle and high-angle groups using the median bifurcation angle (50°). We compared major adverse cardiac events, including cardiac death, myocardial infarction and target lesion revascularization as well as periprocedural outcomes between the 2 groups. Results: We evaluated 1,432 patients with bifurcation lesions with a median follow-up duration of 21 months. The rates of interventional side branch procedures such as guide-wiring of side branches, side-branch ballooning, final kissing ballooning and side-branch stenting were higher in the low-angle group. However, the incidences of major adverse cardiac events and target lesion revascularization were not significantly different between the 2 groups (6.6 vs. 6.9%, p = 0.856 and 4.6 vs. 5.7%, p = 0.375, respectively). Conclusions: Bifurcation angle may not influence long-term clinical outcome in patients with non-left main bifurcation lesion undergoing PCI despite its association with more interventional side-branch procedures.     

Trans-Radial versus Trans-Femoral Intervention for the Treatment of Coronary Bifurcations: Results from Coronary Bifurcation Stenting Registry

Trans-radial (TR) approach is increasingly recognized as an alternative to the routine use of trans-femoral (TF) approach. However, there are limited data comparing the outcomes of these two approaches for the treatment of coronary bifurcation lesions. We evaluated outcomes of TR and TF percutaneous coronary interventions (PCI) in this complex lesion. Procedural outcomes and clinical events were compared in 1,668 patients who underwent PCI for non-left main bifurcation lesions, according to the vascular approach, either TR (n = 503) or TF (n = 1,165). The primary outcome was major adverse cardiac events (MACE), including cardiac death, myocardial infarction (MI), and target lesion revascularization (TLR) in all patients and in 424 propensity-score matched pairs of patients. There were no significant differences between TR and TF approaches for procedural success in the main vessel (99.6% vs 98.6%, P = 0.08) and side branches (62.6% vs 66.7%, P = 0.11). Over a mean follow-up of 22 months, cardiac death or MI (1.8% vs 2.2%, P = 0.45), TLR (4.0% vs 5.2%, P = 0.22), and MACE (5.2% vs 7.0%, P = 0.11) did not significantly differ between TR and TF groups, respectively. These results were consistent after propensity score-matched analysis. In conclusion, TR PCI is a feasible alternative approach to conventional TF approaches for bifurcation PCI (clinicaltrials.gov number: NCT00851526).