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

BACKGROUND AND OBJECTIVES: Possible correlations between the serologic status concerning Cytomegalovirus(CMV), Chlamydia pneumoniae (CP), Helicobacter pylori(HP), their related markers of C-reactive protein(CRP), erythrocyte sedimentation rate(ESR), and the restenosis(RS) in patients underwent percutaneous coronary intervention(PCI) were analyzed. Materials and METHODS: The 142 patients(58.010.9 year-old, M;F=116:26) with 189 coronary lesions, who underwent follow-up angiography after PCI, were evaluated. RESULTS: The overall RS rate was 47.1%(89/189), and the RS rate according to clinical diagnosis was 50.6% in acute myocardial infarction(MI), 41.8% in unstable angina(UA), 6.3% in stable angina(SA), and 1.3% in old MI. The values of RS rate in acute MI and UA were higher than those of old MI and SA(p=0.02). Thrombolysis In Myocardial Infarction(TIMI) flow was significantly lower in group with RS than without RS(p=0.039). Seropositivities of CMV, CP, HP were not different between groups with and without RS. Titers of CMV and HP were not different between two groups. Positivity of CRP was 56.3% in group with RS and 30.2% in group without RS(p=0.005). Titers of ESR and CRP were higher in group with RS than without RS(20.322.4 mm/hr, 2.24.5 mg/dL vs. 11.811.6 mm/hr, 0.70.8 mg/dL, p=0.007, p=0.010 respectively). CONCLUSION: RS rate after PCI is higher in patients with acute coronary syndrome and low TIMI flow. Inflammatory markers, such as CRP and ESR, might be associated with the RS after PCI.
Acute Coronary Syndrome ; Angiography ; Blood Sedimentation ; Chlamydophila pneumoniae ; Coronary Restenosis* ; Diagnosis ; Follow-Up Studies ; Helicobacter ; Humans ; Inflammation* ; Percutaneous Coronary Intervention*

BACKGROUND AND OBJECTIVES: In-stent coronary restenosis remains one of major clinical problems in percutaneous coronary intervention. Long stent has been known to be associated with high restenosis rate. Predictive clinical and angiographic factors were analyzed after long coronary stenting. METHODS: One hundred four patients (57.2+/-9.6 year-old, 105 male) who underwent long coronary stent implantation and follow-up coronary angiogram, out of 237 patients implanted long coronary stents between June 1996 and January 1999 at Chonnam National University Hospital. RESULTS: Primary success rate was 100%. Lesion length was 18.5 +/- 9.2 mm and the length of stent was 27.3 +/- 6.1 mm. Mean duration of clinical follow-up and follow-up coronary angiogram was 20.1+/-6.8 months and 6.3+/-2.7 months respectively. Restenosis rate according to follow-up coronary angiogram was 42.5% (57/134). Clinical variables of age, sex, clinical diagnosis, risk factors, and angiographic variables of target artery and lesion types, indications for stenting, stent types, reference diameter, lesion length, minimal luminal diameter, and acute gain were not related with late stent restenosis. Diameter stenosis before stenting was higher in the group with restenosis (81.9+/-16.9 %) than in group without restenosis (71.1+/-18.5%; p<0.05), and lower lower in the group with restenosis (-7.6+/-15.7%) and in the group without restenosis (5.6+/-22.4%; p<0.05) after stenting. CONCLUSIONS: Primary success rate was comparable. Severe luminal stenosis before stenting and overdilation after stenting are associated with restenosis after long coronary stenting.
Arteries ; Constriction, Pathologic ; Coronary Restenosis ; Diagnosis ; Follow-Up Studies ; Humans ; Jeollanam-do ; Percutaneous Coronary Intervention ; Phenobarbital ; Risk Factors ; Stents*

BACKGROUND: One of major limitations of percutaneous transluminal coronary angioplasty(PTCA) is restenosis. The reliable factors predicting restenosis after successful PTCA might be important in the prevention and treatment of coronary restenosis after PTCA. METHODS: To see whether any of the clinical, angiographic. or procedural factors is likely coronary angiography due to recurrent ischemic symptoms and positive stress tests among 529 patients recived PTCA between Jul '90 and Sep '93 at the Chonnam University Hospital were analysed. RESULTS: 1) Follow-up coronary angiogram demonstrated restenosis in 67 patient(group A, 55.1+/-10.3 year, 58 male, 9 female) and no restenosis in 27 patients(group B, 55.4+/-10.3 year, 24 male, 3 female) demonstrating restenosis rate of 60.6% in this clinically suspicious group. 2) Age, sex, class and duration of angina, and clinical diagnosis were not different from each other between two groups. But the time interval from PTCA to follow-up angiogram was shorter in group A (5.3 +/-5.2 months) than in group B(9.1+/-5.6 months) and hypertension was more prevalent in group A (83.3%) than in group B(16.7%). 3) Angiographic findings such as AHA lesion types, lesion sites, TIMI flow, angulation, lesion length, branching lesion, dissection and residual stenosis were similar in two groups. But all of the eleven lesions with coronary artery calcification were found to develop restenosis. 4) As procedural factors, total ballon inflation time, the numbers of repeated inflations and maximal inflation pressure were not significantly different between two groups. CONCLUSION: Above results show that any single or combined clinical and angiographic findings except symptoms or signs suggesting myocardial ischemia, hypertension and coronary calcification could not predict the development of coronary restenosis ie the patients with shorter duration from PTCA to the clinical evidence suggestive of myocardial ischemia, hypertension and coronary calcification demonstrated by cineangiography were more likely to develop subsequent restenosis.
Angioplasty, Balloon, Coronary* ; Cineangiography ; Constriction, Pathologic ; Coronary Angiography ; Coronary Restenosis ; Coronary Vessels ; Diagnosis ; Exercise Test ; Follow-Up Studies ; Humans ; Hypertension ; Inflation, Economic ; Jeollanam-do ; Male ; Myocardial Ischemia

BACKGROUND: One of major limitations of percutaneous transluminal coronary angioplasty(PTCA) is restenosis. The reliable factors predicting restenosis after successful PTCA might be important in the prevention and treatment of coronary restenosis after PTCA. METHODS: To see whether any of the clinical, angiographic. or procedural factors is likely coronary angiography due to recurrent ischemic symptoms and positive stress tests among 529 patients recived PTCA between Jul '90 and Sep '93 at the Chonnam University Hospital were analysed. RESULTS: 1) Follow-up coronary angiogram demonstrated restenosis in 67 patient(group A, 55.1+/-10.3 year, 58 male, 9 female) and no restenosis in 27 patients(group B, 55.4+/-10.3 year, 24 male, 3 female) demonstrating restenosis rate of 60.6% in this clinically suspicious group. 2) Age, sex, class and duration of angina, and clinical diagnosis were not different from each other between two groups. But the time interval from PTCA to follow-up angiogram was shorter in group A (5.3 +/-5.2 months) than in group B(9.1+/-5.6 months) and hypertension was more prevalent in group A (83.3%) than in group B(16.7%). 3) Angiographic findings such as AHA lesion types, lesion sites, TIMI flow, angulation, lesion length, branching lesion, dissection and residual stenosis were similar in two groups. But all of the eleven lesions with coronary artery calcification were found to develop restenosis. 4) As procedural factors, total ballon inflation time, the numbers of repeated inflations and maximal inflation pressure were not significantly different between two groups. CONCLUSION: Above results show that any single or combined clinical and angiographic findings except symptoms or signs suggesting myocardial ischemia, hypertension and coronary calcification could not predict the development of coronary restenosis ie the patients with shorter duration from PTCA to the clinical evidence suggestive of myocardial ischemia, hypertension and coronary calcification demonstrated by cineangiography were more likely to develop subsequent restenosis.
Angioplasty, Balloon, Coronary* ; Cineangiography ; Constriction, Pathologic ; Coronary Angiography ; Coronary Restenosis ; Coronary Vessels ; Diagnosis ; Exercise Test ; Follow-Up Studies ; Humans ; Hypertension ; Inflation, Economic ; Jeollanam-do ; Male ; Myocardial Ischemia

BACKGROUNDIn-stent restenosis (ISR) has become one of the most challenging problems in patients with coronary heart disease. At present, using non-invasive methods to assess ISR is a hot topic. In this investigation we attempted to explore the potential of magnetocardiography (MCG) in diagnosis of in-stent restenosis.

METHODSMCG was analyzed in 52 patients with coronary artery disease for three times: before stenting, one month and 7 months after successful intracoronary stenting.

RESULTSThe average classification of total maps (ACTM) and the ratio of abnormal maps (RAM) were lower in 1 month after intracoronary stenting compared with that obtained before stent planting (2.91 vs 2.52, 65.74% vs 42.80%, P < 0.01), while complex ventricular excitation index (CVEI) increased from -42.63 to -20.05 (P < 0.01). In ISR subgroup (n = 16), RAM decreased in 1 month after intracoronary stenting compared to it before stenting (68.99% vs 45.26%, P < 0.05). ACTM increased in 7 months compared to that obtained in 1 month after stenting (3.15 vs 2.51, P < 0.05). According to the ROC curve, ACTM showed its unique diagnostic value in restenosis patients. The sensitivity and specificity of ACTM were 80.0%, 69.40%, respectively. Its positive predictive value and negative predictive value were 54.6% and 88.5%, respectively.

CONCLUSIONSAfter successful intracoronary stenting, most parameters of MCG were improved. ACTM was of prognostic value in diagnosing ISR.

Adult ; Aged ; Angioplasty, Balloon, Coronary ; Coronary Artery Disease ; diagnosis ; Coronary Restenosis ; diagnosis ; Female ; Humans ; Magnetocardiography ; methods ; Male ; Middle Aged ; Stents ; adverse effects

The occurrence rate of restenosis after percutaneous transluminal coronary intervention (PCI) was quite high. Traditional Chinese medicine (TCM) has been proved to have the effect in preventing and curing restenosis. In this article, turbid-phlegm was proved to be directly related with restenosis after PCI in aspects of coronary arteriography, blood lipid, blood viscosity, fibrolysis system, free radicals, plasma homocysteine, insulin resistance, etc. So it is one of the important pathogenetic factors of restenosis after PCI in TCM.
Angioplasty, Balloon, Coronary ; Coronary Restenosis ; drug therapy ; etiology ; Diagnosis, Differential ; Drugs, Chinese Herbal ; therapeutic use ; Humans ; Medicine, Chinese Traditional ; Myocardial Infarction ; drug therapy ; therapy ; Phytotherapy

BACKGROUNDIn-stent restenosis is a common complication after stent implantation. However, the assessment of stent lumen in computed tomography (CT) coronary angiography is limited by multiple factors. Our study aimed to evaluate the accuracy and the suspected affecting factors in diagnosing coronary in-stent restenosis by dual-source CT (DSCT) compared with coronary angiography.

METHODSOne hundred and fifteen stents in 50 patients were evaluated with DSCT before coronary angiography for the detection of coronary in-stent restenosis (≥ 50% luminal narrowing). Patency of each stent was analyzed by two independent expert radiologists blinded to the results of coronary angiography. The relationship between diagnostic accuracy and the suspected factors including age, body mass index (BMI), heart rate, variation of heart rate, radiation dose, image quality, location and stent characteristics (type, material, diameter, length and strut thickness) was assessed with both univariate and multivariate analysis. The fitting of a Logistic regression model was evaluated using a receiver operating characteristic (ROC) curve.

RESULTSMean stent diameter was (2.9 ± 0.4) mm. Sensitivity, specificity, positive and negative predictive values and accuracy of DSCT in detection of in-stent restenosis were 69.2%, 91.2%, 50.0%, 95.9%, and 88.7%, respectively. In a subgroup of stents with a diameter ≥ 3.0 mm, sensitivity, specificity, positive and negative predictive values and accuracy were 100.0%, 96.5%, 75.0%, 100.0%, and 96.8%, respectively. Stent diameter < 3.0 mm and poor image quality were associated with poor diagnostic accuracy (P < 0.05). The area under curve of ROC was 0.79.

CONCLUSIONDSCT can provide high accuracy for the assessment of in-stent restenosis in stents with a diameter = 3.0 mm, and can play an important role in ruling out in-stent restenosis.

Adult ; Aged ; Aged, 80 and over ; Body Mass Index ; Coronary Angiography ; methods ; Coronary Restenosis ; diagnosis ; diagnostic imaging ; Female ; Humans ; Male ; Middle Aged ; Tomography, X-Ray Computed ; methods

This is a retrospective study aimed at the clinical application of 64-slice computed tomography angiography (CTA) in evaluation the lumen before and after coronary artery stent implantation. We collected the coronary artery imaging data of 46 patients undergoing 64-slice CT before coronary artery stent implantation from July 2006 through May 2007; we also collected the data of 21 patients with 34 coronary artery stents in the same period to determine the diagnostic accuracy of CTA before and after coronary artery stent implantation. The results showed that, in 46 patients, 64-slice CT enabled the visualization of the entire coronary tree with diagnostic image quality. Sensitivity, specificity, and accuracy for the detection of stenosis > or = 50% were 92.11%, 95.64% and 94.97%, respectively. In 21 patients with 34 stents implanted, 23 (67.65%) stents showed no stenosis, 8 (23.53%) stents showed low degree of restenosis, and 3 (8.83%) stents showed high degree of restenosis. In conclusion, we can accurately evaluate the degree of stenosis of lumen before and after coronary artery stent implantation with the application of 64-slice CTA.
Adult ; Aged ; Angioplasty, Balloon, Coronary ; Coronary Angiography ; methods ; Coronary Artery Disease ; diagnostic imaging ; therapy ; Coronary Restenosis ; diagnosis ; diagnostic imaging ; Female ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Sensitivity and Specificity ; Stents ; Tomography, Spiral Computed ; methods

OBJECTIVETo investigate the correlation of blood-stasis syndrome (BSS) and its accompanied syndromes with pathological changes showed in coronary angiography and restenosis after percutaneous coronary intervention (PCI).

METHODSA total of 335 coronary heart disease patients after successful PCI were randomized into the treated group treated with Xiongshao Capsule (XC) and the control group treated with placebo for 6 months. BSS score was evaluated before and 6 months after PCI, and coronary angiography was followed up 6 months after the operation to perform the correlation analysis on BSS and its accompanied syndromes with types and complexity of coronary lesion, and the Logistic multivariate stepwise regression analysis (LMSRA) on the influencing factors of restenosis.

RESULTSThere were 334 cases with complete angiographic data, of which 308 cases (91.9%) finished the study, and among them 147 cases received a follow-up with angiography. Correlation analysis showed that the BSS score was significantly correlated to the maximal stenosis degree and coronary lesion score demonstrated by coronary angiography before PCI (P < 0.01), and the correlation was accentuated along with the increasing of the patients' age and the course of disease. Among the accompanied syndromes, the yang-deficiency syndrome was significantly correlated to the complexity of coronary lesions and the degree of stenosis, while the turbid- phlegm syndrome was correlated with calcification of the lesions. The difference of BSS score before and after treatment in the treated group was significantly higher than that in the control group. LMSRA showed that the recurrence of angina and BSS score were the important influencing factors on the occurrence of coronary restenosis after PCI. The incidence of restenosis was not correlated to the accompanied syndromes, and also showed no significant difference among patients with different syndrome types.

CONCLUSIONThere is a certain correlation between BSS and the complexity of coronary lesions. The lesion is more severe in patients accompanied with yang-deficiency syndrome. The severity of BSS was an important influencing factor on the occurrence of restenosis after PCI, but no significant correlation was found between the occurrence and the type of accompanied syndromes.

Adult ; Aged ; Angioplasty, Balloon, Coronary ; Coronary Angiography ; Coronary Disease ; diagnostic imaging ; therapy ; Coronary Restenosis ; diagnostic imaging ; prevention & control ; Diagnosis, Differential ; Double-Blind Method ; Drugs, Chinese Herbal ; therapeutic use ; Female ; Humans ; Logistic Models ; Male ; Medicine, Chinese Traditional ; Middle Aged ; Phytotherapy