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

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

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

OBJECTIVETo study the efficacy and safety of cutting balloons in coronary interventions.

METHODSTwenty-two patients with 23 narrowed coronary arteries and 25 lesions enrolled the study, 17 of whom had 18 diseased coronary arteries and 18 lesions were in-stent restenosis. The average time from previous stenting was 7.60 +/- 3.53 months. The lesions were dilated with cutting balloons.

RESULTSAll of the lesions were dilated successfully by 5.16 +/- 2.30 inflations of a cutting balloon. The mean total duration of balloon inflation was 233.96 +/- 94.83 seconds at pressures up to 9.40 +/- 1.96 bars. The severity of vascular stenosis was lessened substantially (89.64 +/- 8.65% vs 17.60 +/- 17.15%, P = 0.000) without severe complications. Three restenotic lesions were further dilated with conventional balloons, another one was stented again because of a dissection distal to the previous stent. Three primary lesions were stented for dissection or residual stenosis. Angina pectoris reoccurred in two patients in a mean follow-up period of 7.42 +/- 6.87 (range 0.5-20) months.

CONCLUSIONCutting balloon dilation is an effective and safe choice in interventions for coronary disease especially for in-stent restenosis.

Adult ; Aged ; Angioplasty, Balloon, Coronary ; methods ; Coronary Angiography ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged