The occurrence of balloon slippage ("watermelon seeding"; WMS) during treatment of patients with in-stent restenosis (ISR) has been described, but predisposing factors and the potential implications of this phenomenon remain unknown. In the Restenosis Intrastent: Balloon Angioplasty vs. Elective Stenting (RIBS) randomized study, 450 patients with ISR were included. Of ...

BACKGROUND: Recent data indicate that an elevated serum level of high-sensitivity C-reactive protein (hs-CRP) predicts the risk of recurrent coronary events, and that statin therapy decreases the risk of coronary events. This study assessed the relationship between the pre-procedural hs-CRP level and in-stent neointimal hyperplasia (NIH) after stenting and the ...

BACKGROUND: In an effort to contain procedural costs while limiting the risk of in-stent restenosis, hybrid percutaneous revascularization (ie, stenting with at least one sirolimus-eluting stent [SES] and at least one bare metal stent [BMS] in the same patient) is felt to be a cost-effective alternative to exclusive SES use. ...

The chemokine fractalkine (FKN) recruits leukocytes into lesions of the arterial wall, which may lead to restenosis after stenting. FKN also regulates proliferation of smooth muscle cells, another mechanism pivotal to neointimal thickening. We assessed the hypothesis that functionally important polymorphisms of the FKN receptor CX3CR1 influence restenosis after coronary ...

CD40-CD40 ligand interaction is involved in the inflammatory pathogenesis of atherosclerosis but clinical data about its role in stent restenosis are still limited. We investigated the effect of preprocedural CD40 ligand (sCD40L) on stent restenosis. We enrolled 36 patients (mean age 61.4 +/- 8.5 years) with stable angina who underwent ...

BACKGROUND: Intracoronary polymer-based stent delivery of paclitaxel has been shown to be effective in reducing restenosis in simple coronary lesions, but the evidence base for contemporary use in longer, more complex coronary stenoses is lacking. METHODS AND RESULTS: TAXUS VI is a prospective, multicenter, double-blind, randomized trial assessing clinical and ...

AIMS: Coronary dissections left untreated after percutaneous coronary intervention are associated with unfavourable outcomes. However, their role after drug-eluting stent (DES) implantation is still undescribed. We assessed incidence, predictors, and outcomes of residual dissections in DES-treated lesions. METHODS AND RESULTS: Consecutive patients undergoing DES implantation were enrolled in four Italian ...

It is not known whether taking atorvastatin in the morning versus in the evening has a different effect on major cardiac event and restenosis rates in patients undergoing percutaneous coronary intervention. Therefore, the aim of the present study was to investigate the effects of morning versus evening intake of atorvastatin ...

The success of percutaneous coronary intervention (PCI) has historically been limited by a relatively high rate of restenosis, a response of the coronary artery to trauma induced during PCI. Bare-metal stents, by providing a supportive intravascular scaffolding, have significantly reduced the incidence of restenosis compared with traditional balloon PCI. However, ...

Saphenous vein graft (SVG) intervention is associated with a significantly increased rate of periprocedural complications and late clinical and angiographic restenosis. We examined the efficacy and safety of sirolimus-eluting stents (SESs; Cypher) compared with bare metal stents (BMSs) in SVG intervention. Forty-eight patients who had 50 SVG lesions and underwent ...

BACKGROUND: This study was performed to assess the relationship between oxidized low-density lipoprotein (OxLDL) and restenosis. OxLDL induces up-regulation of inflammatory genes and cytokines and recruits monocytes to the vessel wall. Elevated levels of monocytes post-percutaneous coronary intervention (PCI) are associated with in-stent restenosis. METHODS AND RESULTS: One hundred forty-one ...

BACKGROUND: Sleep-disordered breathing may affect coronary artery disease, so patients treated by percutaneous transluminal coronary angioplasty were studied to investigate the relationship between nocturnal oxygen desaturation (NOD) and the loss index. METHODS AND RESULTS: The nocturnal oxygen desaturation index (ODI) was determined by means of a pulse oximeter in 35 ...

In-stent restenosis is the limiting entity following coronary stent implantation. It is associated with significant morbidity and cost and thus represents a major clinical and economical problem. Worldwide, approximately 250 000 in-stent restenotic lesions per year have to be dealt with. The pathophysiology of instent restenosis is multifactorial and comprises ...

BACKGROUND: Coronary stent deployment is a major advance in interventional treatment, but 20-40% of patients still develop in-stent restenosis (ISR) due to neointimal hyperplasia. Genetic factors play a role in restenosis. This study investigated the frequency of 5A/6A polymorphism in the promoter of the stromelysin-1 gene, and the issue of ...

BACKGROUND: Brachytherapy (IBT) has been the first effective treatment of in-stent restenosis (ISR). However, when IBT is associated with additional stenting, high rates of late thrombosis have been observed. Even though prolongation of a double antiplatelet therapy seems to have overcome this problem, studies analyzing whether additional stenting still remains ...

OBJECTIVE: To evaluate whether a well developed collateral circulation predisposes to restenosis after percutaneous coronary intervention (PCI). DESIGN: Prospective observational study. PATIENTS AND SETTING: 58 patients undergoing elective single vessel PCI in a tertiary referral interventional cardiac unit in the UK. METHODS: Collateral flow index (CFI) was calculated as (Pw-Pv)/(Pa-Pv), ...

Restenosis after stent implantation is mainly caused by neointimal proliferation through the stent struts. Experimental studies performed in the last decade indicate that inflammatory mechanisms play a key role in the process of neointimal proliferation and restenosis. Coronary stenting is a strong inflammatory stimulus, and the acute local and systemic ...

BACKGROUND: Balloon angioplasty yields suboptimal results and increases the rate of restenosis in the ostium of the left anterior descending coronary artery (LAD). Several non-balloon devices have been used to improve the outcome of dilatation of such lesions. METHODS: This investigation retrospectively compared the results of a directional atherectomy (DCA)-based ...

BACKGROUND: A pharmacokinetic (PK) study was conducted to evaluate sirolimus-eluting stents (SES) in Japanese people, representing the first clinical trial of the use of drug-eluting stents in Japan. METHODS AND RESULTS: The PK study was conducted in 20 patients with 30 lesions treated with sirolimus-coated BX Velocity stents. All lesions ...

Some of the earliest experiences of invasive cardiology centred on studying the physiology of congenital heart disease in a series of ongoing attempts to understand pathophysiology and anatomy, and then devising strategies to treat the lesion. Tremendous growth in the field and rapid advances in patient care have become possible ...

OBJECTIVE: The purpose of the present study was to evaluate nonocclusive radial artery injury resulting from transradial access. BACKGROUND: The benefits of transradial access for coronary intervention have been well documented, but resulting intima-media hyperplasia could be a limitation. METHODS: Thirty patients undergoing transradial coronary intervention (Group A: 15 de ...

BACKGROUND: The present study tested the hypothesis that high-sensitivity C-reactive protein (hs-CRP) concentrations might show significant serial changes in patients with unstable angina (UAP), and that elevation of hs-CRP might indicate a progressively obstructive lesion, rather than late restenosis in such patients undergoing coronary stenting. METHODS AND RESULTS: Serum concentrations ...

OBJECTIVES: Coronary stenting is associated with a high incidence of restenosis in patients with diabetes mellitus. Recent data suggest that diabetic patients treated with abciximab have a lower rate of target vessel revascularization (TVR). We sought to investigate whether abciximab can reduce in-stent restenosis after coronary stenting in diabetic patients. ...

The purpose of this prospective nonrandomized study was to evaluate both safety and efficacy of the polymer-based paclitaxel-eluting Taxus stent for treatment of chronic total coronary occlusions. Drug-eluting stents have been proven safe and efficacious in suppressing neointimal proliferation when used in simple native de novo coronary lesions. However, there ...

BACKGROUND: Vascular smooth muscle cells (VSMCs) can express heme-oxygenase (HO), a rate-limiting enzyme in the degradation of heme to bilirubin, ferritin and carbon monoxide (CO). VSMC-derived CO can suppress VSMC proliferation and may serve as an antiproliferation factor. The promoter region of HO-1 shows a polymorphism with different (GT) n ...

Randomized clinical trials have shown that paclitaxel-eluting stents significantly reduce restenosis after percutaneous coronary intervention. The impact of lesion calcification on the efficacy of paclitaxel-eluting stents is unknown. In the TAXUS-IV trial, 1,314 patients who underwent percutaneous coronary intervention were randomly assigned to a bare-metal or paclitaxel-eluting stent. By core ...

Fifty-one patients (42 men; 60 +/- 12 years of age) who had previous stent implantation underwent multislice computed tomographic coronary angiography. All coronary branches > or = 2.0 mm were independently evaluated by 2 observers and screened for in-stent restenosis (> or = 50%) and occlusion. The consensus reading was ...

OBJECTIVES: The purpose of this study was to assess the accuracy of a new generation spiral multidetector computed tomography (MDCT) scanner (Brilliance 40, Philips Medical Systems, Cleveland, Ohio) in the diagnosis of coronary in-stent restenosis (ISR). BACKGROUND: Noninvasive imaging of ISR would be clinically useful, but artifacts caused by metallic ...

BACKGROUND: We undertook this study to investigate whether there is an association between circulating oxidized low-density lipoproteins (OxLDLs) and outcome after coronary stenting. METHODS: The study included 687 patients with coronary artery disease who underwent coronary stenting. Oxidized low-density lipoproteins were measured before coronary angiography. The median of OxLDL concentrations ...

Limited published data exist about how the introduction of drug-eluting stents (DESs) has affected the technical aspects of percutaneous coronary intervention and in-hospital patient outcomes in clinical practice. A total of 2,215 consecutive patients who underwent percutaneous coronary intervention for de novo coronary artery disease were divided into 2 cohorts: ...

The authors conducted this study to compare the restenosis and reocclusion rates of primary balloon angioplasty alone versus angioplasty followed by stenting in Taiwanese patients with chronic total occlusions. They also evaluated whether stenting reduced the incidence of restenosis and improved left ventricular function in these patients. From October 1998 ...

BACKGROUND: Sirolimus-eluting stents (SESs) have not been evaluated systematically in clinical scenarios or with the vascular morphologies associated with the highest rates of restenosis. METHODS: Between May 2002 and August 2003, 1379 percutaneous interventions were carried out at our center, 231 with SES implantation in patients with complex coronary lesions: ...

Coronary lesions in patients with advanced cardiac allograft vasculopathy (CAV) are frequently treated with percutaneous coronary intervention. Despite high primary success rates, long-term outcome is significantly impaired by a high incidence of restenosis. In nontransplanted patients, the use of drug-eluting stents (DES) significantly decreases the rate of coronary in-stent restenosis. ...

BACKGROUND: Allograft vasculopathy remains a major limiting factor in long-term graft survival. The absence of symptoms and diffuse nature of the disease make clinical detection and therapy more difficult. Limited data exist on the long-term outcome of percutaneous interventions in this group of patients. METHODS: Medical records and cardiac catheterizations ...

INTRODUCTION: In this study we present our findings from a series of patients who underwent coronary angioplasty and implantation of drug-eluting stents with rapamycin or paclitaxel. METHODS: Two hundred and twenty-three consecutive patients with 343 coronary lesions underwent angioplasty with implantation of 220 rapamycin-eluting stents (Cypher) and 297 paclitaxel-eluting stents ...

The introduction of drug-eluting stents (DES) to interventional cardiology practice has resulted in a significant improvement in the long-term efficacy of percutaneous coronary interventions. DES successfully combine mechanical benefits of bare-metal stents and stabilizing the lumen, with direct delivery and the controlled elution of a pharmacologic agent to the injured ...

OBJECTIVES: The goal of this study was to evaluate the safety and performance of the Multi-Link Frontier coronary bifurcation stent system (Guidant Corp., Santa Clara, California), a novel dedicated device designed for permanent side branch (SB) access, stent delivery by simultaneous kissing balloon inflation, and optimal main branch (MB) and ...

BACKGROUND: Several studies indicate that ACE-activity is related to atherosclerosis. We investigated the correlation between ACE-activity, in plasma as well as in the atherosclerotic plaque, and in-stent restenosis. METHODS AND RESULTS: ACE-activity was measured in blood samples from 178 patients who underwent a percutaneous coronary intervention with stent placement. During ...

Intervention in coronary artery disease is an area of cardiology where novel drugs, in the form of drug-eluting stents (DES), are being used increasingly commonly. DES are used across the whole range of coronary intervention, from stable angina patients with single or multivessel disease, acute coronary syndromes and acute myocardial ...

OBJECTIVES: We hypothesized that a higher degree of inflammatory response to coronary stenting, as measured by the change in C-reactive protein (CRP) levels after intervention in patients with stable or unstable angina, would be related to a higher risk of in-stent restenosis. METHODS: We studied 1800 consecutive patients with stable ...

OBJECTIVE: To determine the relationship between carotid intima-media thickness (IMT), carotid wall shear stress (WSS) and restenosis after femoro-popliteal percutaneous transluminal angioplasty (PTA). PATIENTS AND METHODS: Thirty-one subjects (18 men, 13 women, median age 69 years) treated with femoro-popliteal PTA for symptomatic peripheral arterial occlusive disease were enrolled. On admission, ...

BACKGROUND: Although target lesion revascularization (TLR) has been dramatically decreased by using drug-eluting stents (DESs) in de-novo lesions, their efficacy for in-stent restenosis (ISR) has not yet been well established. METHODS: We retrospectively analysed patients treated for ISR with DESs from three referral hospitals. RESULTS: Eighty-seven consecutive patients, from June ...

BACKGROUND: Fractional flow reserve (FFR) has become a gold standard in physiological assessment of coronary artery stenosis. An FFR < 0.75 is considered as a reliable physiological parameter indicating functionally significant lesion. Lesion length (LL) may affect the translesional hemodynamics. However, the effect of LL on FFR has not been ...

BACKGROUND: Recently, preliminary data of the ORBIT study have been presented; coronary restenosis after oral treatment with sirolimus (SRL) was merely 7.7%. The present study thought to investigate the antiproliferative profile of SRL and mycophenolate mofetil (MMF), both as individual compounds and as a combined therapy. METHODS AND RESULTS: Proliferation ...

BACKGROUND: Vascular remodeling after percutaneous coronary stent implantation frequently leads to restenosis. Heme oxygenase 1 (HO-1) is involved in the generation of the endogenous antioxidant bilirubin and carbon monoxide, both of which exert antiinflammatory and antiproliferative effects. The aim of the present study was to evaluate the influence of genetic ...

BACKGROUND AND AIM: So far, no studies have assessed whether there is an association between iron status and the incidence of major adverse cardiac events or restenosis after coronary stenting. We conducted this study to investigate whether there is an association between body iron status and clinical outcome in patients ...

BACKGROUND: The factors associated with recurrent restenosis after SES implantation for in-stent restenosis are unknown. This study aimed to assess the clinical outcome and to analyse predictive factors of cardiac events in patients with in-stent restenosis treated with Sirolimus-eluting stent (SES). METHODS: In 3 centers, consecutive patients (n = 100) ...

Early results with polymer-based paclitaxel-eluting stents have shown significant improvements in the clinical and angiographic parameters of restenosis, as well as excellent safety outcomes. However, the duration of these beneficial effects is unknown. Therefore, the clinical outcomes of the TAXUS I study population were evaluated at 2- and 3-year follow-up. ...

BACKGROUND: The efficacy of intracoronary gamma radiation (IRT-gamma) in reducing recurrent in-stent restenosis (ISR) is well established using doses of 14-18 Gy. We sought to examine whether an escalation in dose to 21 Gy is safe and confers additional benefit in reducing repeat revascularization and major adverse cardiac events (MACE) ...

Coronary stents are currently used in most percutaneous coronary interventions, since they have demonstrated to reduce restenosis and allow to solve threatened closure after balloon angioplasty. Despite these beneficial effects, restenosis remains as the main limitation of percutaneous coronary interventions even with the use of coronary stents. In the last ...