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Tibor Szük Zsolt Fejes Ildikó Beke Debreceni Adrienne Kerényi István Édes János Kappelmayer 《Platelets》2016,27(5):410-419
Drug-eluting stenting (DES) has become a reliable tool for coronary stenting; however, its direct effects on platelet and endothelium function differ from those of bare-metal stenting (BMS). This study involved a periprocedural analysis of various biomarkers of cellular activation after elective DES (Xience®, Abbott Vascular, Santa Clara, CA, USA) or BMS (Integrity®, Medtronic, Minneapolis, MI, USA). Forty-nine stable angina patients were recruited: 28 underwent BMS, and 21 received everolimus-eluting stents. Samples were collected (i) prior to stenting, (ii) at 24 hours after procedure, and (iii) after 1 month of dual antiplatelet therapy. Platelet activation was analyzed by surface P-selectin positivity in parallel with plasma levels of soluble P-selectin, CD40L and platelet-derived growth factor (PDGF). Endothelial cell (EC) activation was detected by measuring markers of early (von Willebrand factor) and delayed response (VCAM-1, ICAM-1, E-selectin). Patients were followed for 6 months for the occurrence of restenosis or stent thrombosis. Increased platelet activation was sustained regardless of stent type or antiplatelet medication. Concentrations of most EC markers were more elevated after BMS than after DES. No stent thrombosis was seen, but six BMS subjects displayed restenosis with significantly higher sCD40L (779 [397–899] vs. 381 [229–498] pg/mL; p = 0.032) and sICAM-1 (222 [181–272] vs. 162 [153–223] ng/mL; p = 0.046) levels than in those without complication, while DES patients exhibited significantly decreased PDGF (572 [428–626] vs. 244 [228–311] pg/mL; p = 0.004) after 1 month. Nonresponsiveness to antiplatelet drugs did not influence these changes. In conclusion, the degree of platelet and EC activation suggests that Xience® DES may be regarded a safer coronary intervention than Integrity® BMS, with a lower risk of in-stent restenosis. 相似文献
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P. Bell 《Acta chirurgica Belgica》2013,113(2):141-143
The Sapphire trial was organised as a randomised trial to compare carotid endarterectomy (CEA) with carotid angioplasty and stenting (CAS) using a protection device in so called high risk patients. The trial concluded that CEA and CAS were similar as far as stroke and death are concerned but CAS was superior when other complications were taken into account. The trial was flawed for several reasons. It was commercially funded and the inventor of the protection device was one of the investigators and therefore not in equipoise. The end points of the trial favoured CAS by making a biochemical myocardial event an end point. The surgeons doing CEA in the trial did relatively few CEA’S per year and had a high stroke and death rate. These surgeons also excluded over 400 patients from the trial because they were said to be too difficult or risky to operate on. The precise reasons for this exclusion have never been made clear except that the surgeons were probably inexperienced. Finally the patients were heterogeneous, more than 70% being asymptomatic or suffering from recurrent stenosis. For all of these reasons the Sapphire trial’s conclusions that CAS is equivalent to CEA in high risk patients cannot be scientifically justified. 相似文献
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《European journal of radiology》2014,83(12):2190-2195
Background and purposeTreatment of symptomatic intracranial atherosclerotic disease by angioplasty and stenting (PTAS) is limited by a high rate of periinterventional strokes. We performed a detailed analysis of these strokes at our center in order to identify strategies to reduce the risk of periinterventional complications.MethodsCase records and imaging data of 80 patients with a symptomatic 70–99% stenosis of a major intracranial artery treated with PTAS between July 2007 and December 2013 were reviewed. All patients had a sufficient response to aspirin and clopidogrel. Periinterventional strokes were categorized as either ischemic (perforator territory, distal embolic or delayed stent thrombosis) or hemorrhagic (intraparenchymal, subarachnoid).ResultsPeriinterventional complications occurred in 6/80 (7.5%) patients, consisting of 2 ischemic strokes (2.5%, both perforator territory), 3 hemorrhagic strokes (3.8%, 2 intraparenchymal due to reperfusion injury, 1 subarachnoid due to vessel rupture) and one death (1.3%) unrelated to stroke. All strokes occurred within 24 h after PTAS.ConclusionOur retrospective data analysis suggests that the risk of periinterventional stroke after PTAS of symptomatic intracranial atherosclerotic disease might be reduced by sufficient antiplatelet therapy and optimized management of patients with high risk for reperfusion injury or perforator strokes, including selection of a stenting device adapted to individual vessel morphology. 相似文献
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