| Impact of Diabetes Mellitus on Vessel Response in the Drug-Eluting Stent Era: Pooled Volumetric Intravascular Ultrasound Analyses. | |
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MedLine Citation:
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PMID: 23149332 Owner: NLM Status: Publisher |
Abstract/OtherAbstract:
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BACKGROUND: EXAGGERATED NEOINTIMAL HYPERPLASIA IS CONSIDERED AS THE PRIMARY MECHANISM FOR INCREASED RESTENOSIS IN PATIENTS WITH DIABETES MELLITUS (DM) TREATED WITH BARE-METAL STENT. HOWEVER, THE VESSEL RESPONSE IN DM AND NON-DM TREATED WITH DIFFERENT DRUG-ELUTING STENTS (DES) HAS NOT BEEN SYSTEMATICALLY EVALUATED.METHODS AND RESULTS: WE INVESTIGATED 3D INTRAVASCULAR ULTRASOUND (POSTPROCEDURE AND 6 TO 9 MONTHS) IN 971 PATIENTS (267 WITH DM AND 704 WITHOUT DM) TREATED WITH SIROLIMUS- (N=104), PACLITAXEL- (N=303), ZOTAROLIMUS- (N=391), OR EVEROLIMUS- (N=173) ELUTING STENTS. VOLUMETRIC DATA WERE STANDARDIZED BY LENGTH AS VOLUME INDEX (VI). AT POSTPROCEDURE, LUMEN VI AT THE STENTED SEGMENT WAS SIGNIFICANTLY SMALLER IN DM THAN IN NON-DM, WHEREAS VESSEL VI WAS SIMILAR BETWEEN THE 2 GROUPS. AT FOLLOW-UP, NEOINTIMAL OBSTRUCTION AND MAXIMUM CROSS-SECTIONAL NARROWING (NEOINTIMAL AREA/STENT AREA) WERE NOT SIGNIFICANTLY DIFFERENT BETWEEN THE 2 GROUPS WITH NO INTERACTION FOR THE DES TYPE. CONSEQUENTLY, LUMEN VI WAS SMALLER IN DM THAN IN NON-DM AT FOLLOW-UP. IN THE REFERENCE SEGMENTS, RESIDUAL PLAQUE BURDEN AT POSTPROCEDURE WAS SIGNIFICANTLY GREATER IN DM THAN IN NON-DM, ALTHOUGH CHANGE IN LUMEN VI WAS SIMILAR BETWEEN THE 2 GROUPS. THE ARTERIAL RESPONSES AT THE REFERENCE SEGMENTS ALSO SHOWED NO INTERACTION FOR THE DES TYPE.CONCLUSIONS: DM and non-DM lesions showed similar vessel response in both in-stent and reference segments regardless of the DES type. In the DES era, the follow-up lumen in DM patients seems to be determined primarily by the smaller lumen at postprocedure rather than exaggerated neointima within the stent or plaque proliferation at the reference segments. |
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Authors:
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Kenji Sakata; Katsuhisa Waseda; Teruyoshi Kume; Hiromasa Otake; Daisaku Nakatani; Paul G Yock; Peter J Fitzgerald; Yasuhiro Honda |
Publication Detail:
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Type: JOURNAL ARTICLE Date: 2012-11-13 |
Journal Detail:
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Title: Circulation. Cardiovascular interventions Volume: - ISSN: 1941-7632 ISO Abbreviation: Circ Cardiovasc Interv Publication Date: 2012 Nov |
Date Detail:
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Created Date: 2012-11-14 Completed Date: - Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 101499602 Medline TA: Circ Cardiovasc Interv Country: - |
Other Details:
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Languages: ENG Pagination: - Citation Subset: - |
Affiliation:
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Center for Cardiovascular Technology, Stanford University, Stanford, CA. |
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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