Angioplasty, Balloon, Coronary ; Humans ; Percutaneous Coronary Intervention ; methods ; Tungsten

Angioplasty, Balloon, Coronary ; methods ; Arteries ; Drug-Eluting Stents ; Humans

Angioplasty, Balloon, Coronary ; methods ; China ; Drug-Eluting Stents ; Humans

Angioplasty, Balloon, Coronary ; methods ; Coronary Artery Bypass ; methods ; Coronary Vessels ; surgery ; Humans

Aged, 80 and over ; Angioplasty, Balloon, Coronary ; methods ; Brachial Artery ; Humans ; Intra-Aortic Balloon Pumping ; Male

Coronary heart disease is one of the most important causes of death in human, and consumes vast medical resources. Percutaneous coronary intervention (PCI) has been a significant breakthrough for its treatment. However, clinical application has been hampered by in-stent restenosis (ISR). Although drug eluting stent (DES) has reduced the occurrence of restenosis, incidence of ISR is still about 5% to 10%. The main reasons for restenosis after PCI are hyperplasia of vascular endothelial cells and smooth muscle cell migration. The exact mechanism of personalized differences in restenosis is not clear yet, but there may be a variety of risk factors. In addition to aging, smoking and diabetes, an increasing number of studies have found that genetic and epigenetic factors play an important role in ISR. In this article, authors have reviewed genetic and epigenetic factors on the progression of ISR, which may help to determine the genetic risk factors in patients with ISR after PCI.
Angioplasty, Balloon, Coronary ; methods ; Coronary Restenosis ; etiology ; genetics ; Disease Progression ; Epigenomics ; methods ; Humans ; Stents ; Treatment Outcome

A patient presented with exertional chest pain two months prior to admission. Coronary angiography revealed a subocclusive stenosis within the boundaries of the stent. Optical coherence tomography showed remarkable intimal growth inside the stent, which demonstrated a heterogeneous appearance including low-intensity areas. These findings were congruent with the morphology of fibroatheroma in the native coronary artery and suggested that new atherosclerotic progression of the intima within the stent had occurred over 17 years following bare metal stent implantation. To the best of our knowledge, this is one of the most delayed instances of a bare metal stent restenosis described in the medical literature.
Aged ; Angioplasty, Balloon, Coronary ; Coronary Restenosis/*diagnosis ; Female ; Humans ; Tomography, Optical Coherence/*methods

Angioplasty, Balloon, Coronary ; instrumentation ; methods ; Coronary Restenosis ; immunology ; prevention & control ; Drug-Eluting Stents

BACKGROUNDThe radial approach has been increasingly used as an alternative to femoral access. And more procedures using repeated transradial coronary intervention (r-TRI) are performed. However, few data about r-TRI has been obtained. Therefore, we investigated the safety and feasibility of r-TRI using the same route.

METHODSA total of 423 consecutive eligible patients undergoing r-TRI were enrolled in the r-TRI group, and 846 patients with initial TRI (i-TRI) were assigned to the i-TRI group in a 2:1 matching ratio compared to r-TRI group. The primary endpoint included the success rate of the procedure and the incidence of vascular related complications.

RESULTSThe baseline clinical characteristics in the two groups were comparable. The success rate of procedures in the r-TRI and i-TRI was similar (96.0% vs. 97.5%, P = 0.130). In subgroup analysis (coronary angiography only or angiography with pecutaneous coronary intervention), similar results were also observed. The puncture numbers and incidence of radial artery spasm in the r-TRI group were significantly higher than in the i-TRI group (P = 0.024 and P < 0.001, respectively). The other procedural outcomes in the two groups were identical. With respect to the incidence of overall vascular related complication and independent events, there were no significant differences in spite of a higher incidence of radial artery occlusion (RAO) in the r-TRI group (RAO: 1.2% vs. 0.7%, P = 0.521). The patients in the i-TRI group had more comfortable feeling than patients in the r-TRI group (P = 0.001).

CONCLUSIONSR-TRI produces a comparable procedure success rate and incidence of vascular complication when compared to i-TRI. It should be considered as an acceptable and safe procedure.

Adult ; Aged ; Angioplasty, Balloon, Coronary ; adverse effects ; methods ; Coronary Angiography ; Female ; Humans ; Male ; Middle Aged

BACKGROUNDThe mechanisms responsible for the occurrence of a kissing unsatisfied (KUS) result after classical crush stenting remain unclear. The present study aimed at analyzing the mechanisms and clinical significance of KUS.

METHODSTwo hundred and thirteen patients with true bifurcation lesions treated with classical crush stenting and final kissing balloon inflation (FKBI) were assigned to upper, middle, and lower groups according to the position of the side branch re-wiring assessed by visual estimation, quantitative coronary analysis (QCA) and intravascular ultrasound (IVUS). Angiographic follow-up was indexed at 12 months.

RESULTSThe upper group was characterized by a larger bifurcation angle of 55.53 degrees +/- 25.25 degrees (P = 0.030) and a longer procedural time (42.43 +/- 23.92) minutes (P = 0.015). The overall rate of KUS by visual estimation was 10.48%, with 5.4% in the upper group, 3.9% in middle group, and 36.1% in lower group (P < 0.001). For the diagnosis of KUS, visual inspection demonstrated a good correlation with both QCA and IVUS. Smaller stent diameter was the main reason for KUS in the upper group, while extra-stent side wire location, or re-wire in a low position was the main mechanism attributed to KUS in the lower group. The Lower group had more restenosis, with most restenotic lesions at a lower position of the side branch ostium. KUS (HR 1.652, 95% CI 1.332 - 2.088, P < 0.001) and re-wiring position (HR 2.341, 95% CI 1.780 - 4.329, P < 0.001) were two independent predictors of side branch restenosis. Re-wiring position (OR 0.458, 95%CI 0.336 - 0.874, P = 0.001) and side stent expansion (OR 3.122, 95%CI 2.883 - 5.061, P = 0.014) were factors predicting the findings of KUS.

CONCLUSIONSSide wire outside side stents resulted in more KUS and restenosis. Different restenotic lesion types reflected individual mechanisms contributing to the development of plaque proliferation.

Aged ; Angioplasty, Balloon, Coronary ; methods ; Coronary Disease ; therapy ; Female ; Humans ; Male ; Middle Aged ; Stents ; Treatment Outcome