Left internal mammary graft stenosis and restenosis following angioplasty and stenting

Coronary bypass grafts using the internal mammary artery usually have an excellent record of success and long term patency. We report a 42 year old man who initially presented with a history of atypical left sided chest pain, who had coronary artery bypass surgery for a severe stenosis in his proximal left anterior descending coronary artery (LAD) and moderate stenosis of his proximal circumflex artery, with his LIMA being grafted to his mid-LAD and a saphenous venous graft to the proximal LAD. He subsequently developed multiple stenoses in the LIMA graft which required coronary augioplasty and stenting, on more than one occasion, in view of very rapid restenosis within the LIMA graft.


Keywords: graft patency; left internal mammary artery grafts; restenosis; stenosis     

Immediate and chronic results of cutting balloon angioplasty: A matched comparison with conventional angioplasty

Background: At the initial stages of percutaneous transluminal coronary angioplasty (PTCA), several studies reported on the feasibility of coronary artery incision and dilatation leading to the extension of the PTCA technique. Hypothesis: This study was designed to determine the immediate and chronic results of cutting balloon (CB) angioplasty. Methods: This procedure was performed on 127 lesions in 110 patients (male 83%, age 61.8 ± 9.3 years). Results: The overall procedural success rates for the CB were 93.7% (119 lesions) and 92.7% (102 patients), while solitary CB without pre- and/or postdilatation was 76.4% (91 lesions). There was one major in-hospital complication (Q-wave myocardial infarction, 0.9%), but there were no deaths or emergency coronary artery bypass graftings. Significant angiographic dissections (≥ grade C) occurred in four patients, and coronary perforation occurred in one. The successfully treated CB group (95 lesions) was matched with the successful conventional angioplasty group (PTCA group) for chronic result assessment in regard to reference vessel size and lesion characteristics. In the CB group, postprocedural minimal luminal diameters were significantly larger and the percentage of stenosis at the stenotic site was significantly lower compared with the PTCA group. Restenosis occurred in 22 lesions (23.1%). This showed a significantly lower restenosis rate compared with the PTCA group (42.1%). In addition, the restenosis rate of the CB without inclusion of the pre- and/or postdilatation-treated lesions was 19.7%. Conclusions: (1) Cutting balloon angioplasty procedures can be performed with high success rates with few major in-hospital events. (2) The restenosis rate in the CB group was significantly lower compared with the PTCA group.     

Usefulness of multidetector CT imaging to assess vascular stents in children with congenital heart disease: An in vivo and in vitro study

Objective : To evaluate varying CT settings to visualize pediatric vascular stents in comparison to digital angiography (DA). Background : There is a great clinical interest in substituting noninvasive methods to follow up children with congenital heart disease after interventional treatment. Materials and Methods : CT studies in small children with transcatheter placed stents were reviewed, retrospectively. Furthermore, eight stents were implanted in tubes and partially obstructed. CT exams were performed on varying scanners (4 up to 64 slices) with corresponding tube settings. The effects of dose on image quality were evaluated regarding stent size, strut thickness, and in‐stent stenoses in comparison to DA. Results : Fourteen children with 28 implanted stents were identified. Significant differences between higher and lower radiation settings were not found, corresponding with the phantom, where moderate tube setting showed the best results. In vitro, there was an improvement with increasing number of detector rows, which resulted in a decrease of stent strut overestimation (295% down to 201%; P < 0.0001) and a better agreement with DA measurements for mild (78% up to 91%; P = 0.003) and moderate in‐stent stenoses (80% up to 99%; P = 0.0001). Conclusion : Higher radiation exposure settings did not improve image quality, suggesting that the exams could be performed at a lower radiation dose. © 2008 Wiley‐Liss, Inc.     

The NUGGET study: NIR ultra gold-gilded equivalency trial.

This study should clarify whether the gold-coated NIROYAL stent is equivalent to the stainless steel NIR stent. Patients were randomized to either NIR stent (n = 298) or a NIROYAL stent (n = 305). The primary endpoint was the minimum lumen diameter of the target lesion at 6 months postprocedure. Secondary endpoints focused on clinical events. At 30 days, adverse events were similar in both groups. At 6 months, the minimal lumen diameter was 1.83/1.64 mm (P < 0.001; 95% CI = 0.08-0.30) and the angiographic restenosis rate was 20.6%/37.7% (P < 0.001; 95% CI = -24.7 to -9.3) for NIR/NIROYAL. The 6-month MACE rates were NIR 7.4% and NIROYAL 10.5% (95% CI = -7.7 to 1.4). Compared to stainless steel stent, the NIROYAL stent demonstrated a smaller minimal lumen diameter, a higher late loss (i.e., higher neointimal hyperplasia in spite of a significantly better initial gain), with higher restenosis and similar MACE rates at 6 months.     

倾向性评分匹配法评价冠心病支架置入术后再狭窄

目的引入倾向性评分匹配法(PSM)比较伴糖尿病的冠心病患者与单纯冠心病患者支架置入术后再狭窄的差异。方法回顾性分析在本院接受冠状动脉支架植入术患者资料,伴糖尿病的冠心病患者137例(CHD+DM组),单纯冠心病283例(CHD组)。使用SPSS软件的PSM功能对两组采用1∶1最邻近匹配法,得到组间协变量均衡的样本。匹配后的样本采用Cox比例风险模型评估支架术后再狭窄的危险因素。结果两组匹配成功各120例。Cox比例风险模型多因素分析,吸烟史(HR=2.50,95%CI:1.34~4.64,P=0.004)、高血压史(HR=2.24,95%CI:1.08~4.63,P=0.030)、肌酐清除率110ml/min(HR=3.12,95%CI:1.22~5.03,P=0.024)、冠状动脉多支病变(HR=2.15,95%CI:1.14~4.07,P=0.018)和伴糖尿病(HR=2.22,95%CI:1.14~4.33,P=0.020)是冠心病支架术后再狭窄的独立危险因素。PSM后,CHD+DM组1、3、5年的累计狭窄率分别为10.70%,40.30%和43.80%,CHD组为4.70%,23.70%和29.60%,差异有统计学意义(P=0.023)。结论应用PSM可以有效地均衡非随机研究组间的协变量,糖尿病是冠心病患者支架置入术再狭窄的危险因素。     

Clinical outcome following coronary angioplasty in dialysis patients: a case-control study in the era of coronary stenting

BACKGROUND—Balloon coronary angioplasty has been reported to be ineffective in patients treated for end stage renal disease because of a high restenosis rate.
OBJECTIVE—To compare the clinical outcome following coronary angioplasty with provisional stenting in dialysis versus non-dialysis patients.
DESIGN—A case-control study.
PATIENTS—Of 1428 consecutive patients who underwent coronary angioplasty, 100 (7%) were being treated for end stage renal disease. These were compared with 100 control patients matched for age, sex, coronary lesions, presence of diabetes mellitus, and rate of coronary stenting (40%).
MAIN OUTCOME MEASURES—In-hospital and one year clinical outcome.
RESULTS—The rates of procedural success (90% v 93%), in-hospital mortality (1% v 0%), stent thrombosis (0% v 0%), and Q wave myocardial infarction (0% v 1%) were similar in dialysis and non-dialysis patients. One year clinical outcome after coronary angioplasty was similar in the two groups in terms of clinical restenosis (31% v 28%) and myocardial infarction (6% v 2%), but cardiac death was more common in dialysed patients (11% v 2%, p < 0.03).
CONCLUSIONS—Dialysis does not increase the risk of clinical restenosis after coronary angioplasty with provisional stenting. Coronary angioplasty is a safe and effective therapeutic procedure in selected dialysis patients with culprit lesions accessible to stenting. However, the one year survival is reduced in this high risk population.


Keywords: renal disease; angioplasty; stents; restenosis     

冠状动脉药物洗脱支架置入术后再狭窄与胆红素和纤维蛋白原关系探讨

目的探讨冠状动脉药物洗脱支架术后支架内再狭窄与血清总胆红素(TB)和纤维蛋白原(Fib)的关系。方法收集PCI置入药物洗脱支架术后1年行冠状动脉造影随访的782例患者,分为再狭窄组130例和对照组652例。回顾性分析2组患者临床资料的差异。结果再狭窄组与无再狭窄组患者血清TB[(11.82±4.53)μmol/Lvs(12.95±5.06)μmol/L]、Fib[(3.04±0.65)g/L vs(2.83±0.60)g/L]比较,差异有统计学意义(P<0.05,P<0.01)。支架内再狭窄与糖尿病(OR=1.763,95%CI:1.158².683)、Fib(OR=1.678,95%CI:1.2422.683)、Fib(OR=1.678,95%CI:1.242².266)呈正相关,与血清TB(OR=0.922,95%CI:0.8602.266)呈正相关,与血清TB(OR=0.922,95%CI:0.860⁰.988)、支架直径(OR=0.615,95%CI:0.4440.988)、支架直径(OR=0.615,95%CI:0.444⁰.850)呈负相关。结论糖尿病、Fib为支架内再狭窄的危险因素,支架直径和血清TB为支架内再狭窄保护因素。     

Inhibition of neo‐intimal hyperplasia in porcine coronary arteries utilizing a novel paclitaxel‐coated scoring balloon catheter

Objective: Scoring balloons are particularly useful in the acute treatment of fibro‐calcific, bifurcation and in‐stent restenosis lesions but have not been shown to affect the restenosis rate. Conventional balloons coated with paclitaxel have recently been shown to reduce restenosis rates in certain lesion subsets, but are associated with suboptimal acute results. A novel paclitaxel‐coated scoring balloon was developed to overcome these limitations. Design: AngioSculpt^® scoring balloons (SB) were coated with paclitaxel admixed with a specific excipient. Setting and Interventions: Four in vitro and in vivo studies were performed: (a) loss of the drug during passage to the lesion, (b) transfer of the drug to the vessel wall; (c) inhibition of neo‐intimal proliferation in porcine coronary arteries as compared to uncoated SB and the Paccocath?, and (d) evaluation of the dose‐response to 1.5–12 μg of paclitaxel/mm². Main outcome measures and Results: Drug loss during delivery to the lesion was 17% ± 8%, and transfer to the vessel wall was 9% ± 4% of dose on unused balloons. The paclitaxel‐coated SB resulted in a lower late lumen loss of 0.27 ± 0.24 mm compared to 1.4 ± 0.7 mm with the uncoated SB (P = 0.001). Histomorphometry revealed larger luminal areas of 6.8 ± 1.6 mm² (paclitaxel‐coated SB) and 5.8 ± 1.7 mm² (Paccocath) as compared to the uncoated SB (2.3 ± 1.5 mm²; P = 0.001). No coating related adverse effects were observed on follow‐up angiography or histologic examination at the treatment site or downstream myocardium. Conclusion: A novel paclitaxel‐coated SB leads to a significant inhibition of neointimal proliferation in the porcine coronary model. © 2013 Wiley Periodicals, Inc.