BACKGROUND AND OBJECTIVES: In the era of stents, lesion length remains an important predictor of restenosis. Drug-eluting stents (DESs) have significantly reduced in-stent restenosis (ISR), but results in long lesions are still lacking. Therefore, we investigated the impact of DESs on clinical outcomes in patients with diffuse coronary lesions. SUBJECTS AND METHODS: Between January 2004 and January 2005, 80 patients (94 lesions) with lesions >20 mm in length were treated with one or more DESs and underwent follow-up coronary angiography. The patients were divided into three groups: Group 1 was composed of those with lesions 21 to 35 mm in length, Group 2 was composed of those with lesions 36 to 50 mm in length, and Group 3 was composed of those with lesions > or =51 mm in length. RESULTS: The mean clinical follow-up duration was 9 months. On the 6-month follow-up angiogram, 6.4% of the lesions had binary ISR (5.0% in group 1, 8.7% in group 2, and 9.1% in group 3). The percent diameter stenosis was 6.0+/-18.15% in Group 1, 12.61+/-21.99% in Group 2, and 19.81+/-31.26% in Group 3(p< 0.05). Late lumen loss was 0.17+/-0.50 mm in Group 1, 0.39+/-0.66 mm in Group 2, and 0.59+/-0.93 mm in Group 3 (p<0.05). Lesion length was associated with an increase in percent diameter stenosis and late lumen loss (of 6.9% and 0.21 mm per 15 mm). CONCLUSION: DES implantation is considered safe and effective in the treatment of diffuse lesions. However, lesion length may be associated with an increase in percent diameter stenosis and late lumen loss at 6-month follow-up.
Constriction, Pathologic ; Coronary Angiography ; Coronary Restenosis ; Coronary Stenosis ; Drug-Eluting Stents ; Follow-Up Studies ; Humans ; Stents

BACKGROUND AND OBJECTIVES: This prospective single-center randomized clinical study was designed to evaluate the long-term angiographic and clinical outcomes of elective treatment using the Crossflex (coil stent) as compared with the NIR (tubular stent) in patients with native coronary artery disease. SUBJECTS AND METHODS: 104 patients with 107 de novo discrete coronary stenoses were randomly assigned to the NIR stent (54 coronary stenoses) or the Crossflex stent (53 coronary stenoses). Six-month follow-up angiograms were obtained in 83 patients with 86 lesions (80%). Clinical follow up was available in all patients and the period averaged 23.1+/-5.3 months in the Crossflex group and 23.1+/-6.2 months in the NIR group. RESULTS: Procedural success was measured at 100% in both groups. There were no cases of stent thrombosis in either group. Although a higher loss index and more severe follow-up diameter stenosis occurred in the crossflex group, the angiographic restenosis rate was not significantly different in between the groups.
Constriction, Pathologic ; Coronary Artery Disease ; Coronary Disease ; Coronary Restenosis ; Coronary Stenosis ; Follow-Up Studies ; Humans ; Prospective Studies* ; Stents* ; Thrombosis

No abstract available.
Coronary Angiography ; Coronary Stenosis

Percutaneous coronary angioplasty is well established therapeutic modality in the management of coronary artery disease. However, the high restenosis rate of 30 to 50% limits its usefulness. The principal mechanism of restenosis, ntimalhyperplasia, is the proliferative response of vessel wall to injury, which consists largely of smooth muscle cells. A large body of animal investigations and a limited number of clinical studies have established the ability of ionizing radiation to reduce neointimal proliferation and restenosis rate significantly. Human studies have been reported that intravascular radiation after first restenosis inhibits a second restenosis. Encouraged by these reports, we are also conducting a double blind, placebo-controlled, randomized trial to evaluate this new therapeutic modality in patients with coronary artery stenosis. The objective of our trial is to determine the safety and efficacy of catheter-based solutional beta emitting radioisotope system in preventing restenosis after angioplasty. This review describes the vascular brachytherapy systems and isotopes that have been utilized in the initial clinical trials performed in this area of post PTCA coronary restenosis. The results of many worldwide ongoing clinical trials will determine whether this new technology will change the future practice of vascular intervention.
Angioplasty* ; Animals ; Brachytherapy ; Coronary Artery Disease ; Coronary Restenosis ; Coronary Stenosis ; Humans ; Isotopes ; Myocytes, Smooth Muscle ; Radiation, Ionizing

Coronary intervention is now a well established method for the treatment of coronary artery disease. Coronary restenosis is one of the major limitations after coronary intervention. So medical teams advise the patients to get the follow-up coronary angiogram in 6 months after coronary intervention to know if the coronary artery stenosis recurs or not. This study was done in order to know how many patients complied with the advice, and to identify the relative factors to the compliance with getting the follow-up coronary angiogram. The subjects were 101 patients (male: 58 female: 22, mean age: 61+/-15), who received coronary interventions from Jan. 1st to Mar. 31st 1997, and their data were collected from them by questionnaires one year after intervention. The questionnaires consisted of family support scale, self efficacy scale and compliance with sick role behavior scale. The result may be summarized as follows. 1. The number of patients who complied with getting the follow-up coronary angiogram were 37 people(36.6%) and did not comply with it were 64 people(63.4%). All scores of family support(t=5.56, p<.0001), self efficacy (t=4.13, p<.0001) and compliance with sick role behavior(t=5.66, p<.0001) were significantly higher in the patients who got the follow-up coronary angiogram than in those who did not get it. But there was not any relative factor in demographic variables (p>.05). 2. The major motivations for getting follow-up coronary angiogram were recurrence of subjective symptom(40.5%), the advice of medical team(32.4%), and fear of recurrence (27.1%). The restenosis rate in patients who got the follow-up coronary angiogram was 37.8%. 3.The restenosis rate was higher in the patients who had subjective symptoms than in those who did not have any subjective symptom. So subjective symptom and restenosis rate showed a high positive correlation(r=39.9, p<.001). However, 27.2% of the patients who did not have any subjective symptom showed coronary restenosis. 4. The reasons why they did not get the follow-up coronary angiogram were economic burden(37.5%), improved symptom(34.4%), busy life schedule(10.9%), fear of invasive procedure(9.4%), negative reaction of family member(3.1%), no helper for patient(3.1%) and worry about medical team's mistake (1.6%). The relative fators on compliance with getting the follow-up coronary angiogram after coronary intervention were family support, self-efficacy and Compliance with sick role behavior. And the most important reason why the patients did not get the follow-up coronary angiogram after coronary intervention was an economic burden.
Compliance* ; Coronary Artery Disease ; Coronary Restenosis ; Coronary Stenosis ; Female ; Follow-Up Studies* ; Humans ; Recurrence ; Self Efficacy ; Sick Role ; Surveys and Questionnaires

BACKGROUND AND OBJECTIVES: Heavy metal ions released from a stainless steel stent can induce an inflammatory reaction that might be associated with in-stent restenosis. A carbon ion implantation technique, which physically integrates carbon ions into the surface of the stainless steel lattice, can block heavy metal ion diffusion, and improve the biocompatibility. This study was designed to evaluate the efficacy of a carbon ion implanted Arthosinert stent on the reduction of in-stent restenosis and the improvement in the clinical outcomes. SUBJECTS AND METHODS: 193 de novo coronary lesions in 191 anginal patients at 14 centers, with reference diameters from 2.75 to 4.5 mm, were randomly assigned to either an Arthosinert (100 patients, 102 lesions) or an Arthos (91 patients, 91 lesions) stent. The lesion length was 14.1+/-5.7 mm. The ACC/AHA (American College of Cardiology/American Heart Association) lesion classifications were A:15.0%, B1:36.8%, B2:35.8% and C:12.4%. The study end points are angiographic restenosis, during a six-month follow-up, and Major adverse cardiac event. In-stent restenosis was defined as a diameter of stenosis > or =50%. RESULTS: A six-month angiographic follow-up was obtained for 72.3% (138/191) of the subjects. There were no significant differences between the Arthosinert and Arthos groups in the rates of restenosis (17.8% vs. 31.8%, p=0.055) and Target vessel revascularization (7.0% vs. 11.0%, p=0.476). There were no deaths or non-fatal myocardial infarction in either group. CONCLUSION: The treatment of de novo coronary stenosis, with carbon ion implanted stents, showed a tendency for lower six-month angiographic restenosis rates than the conventional 316L stainless steel stents. A larger trial will be needed to confirm the efficacy of the carbon ion implanted stent.
Carbon* ; Classification ; Constriction, Pathologic ; Coronary Restenosis ; Coronary Stenosis ; Diffusion ; Follow-Up Studies ; Heart ; Humans ; Ions ; Myocardial Infarction ; Stainless Steel ; Stents

Coronary Restenosis ; prevention & control ; therapy ; Coronary Stenosis ; therapy ; Drug Delivery Systems ; Humans ; Medicine, Chinese Traditional ; methods ; Stents

BACKGROUND AND OBJECTIVE: Adiponectin is an adipocyte derived plasma protein that is known to have an anti-atherogenic effect. Low plasma adiponectin concentrations are found in obesity, diabetes and coronary artery disease. The measurement of the plasma adiponectin level is helpful in the assessment of the risk for coronary artery disease. The intercellular adhesion molecule (ICAM)-1 is associated with the atherosclerotic inflammatory response. An elevated ICAM-1 concentration is associated with increased risk of future coronary events, independent of other risk factors. The relationships between serum adiponectin and ICAM-1 levels and the progression of coronary artery stenosis with instent restenosis of previous stent sites were analyzed. SUCJECTS AND METHODS: 83 patients who had percutaneous transluminal coronary angioplasty and stent insertion were enrolled. The initial angiographic finding was compared with that at the 6 month follow up. The serum adiponectin and ICAM-1 level were measured with the plasma lipid profiles prior to percutaneous coronary intervention. These biochemical parameters were analyzed according to the progression of coronary artery stenosis (> or =10%) and instent restenosis (> or =50%). RESULTS: In the coronary artery stenosis progression group, there were significantly lower adiponectin (3.91+/-1.24 microgram/mL vs. 4.66+/-1.36 microgram/mL, p=0.03) and higher ICAM-1 levels (199.16+/-79.13 ng/mL vs. 150.54+/-63.65 ng/mL, p=0.03). The instent restenosis group also showed lower adiponectin (3.99+/-1.22 microgram/mL vs. 4.33+/-1.38 microgram/mL) and higher ICAM-1 (195.17+/-68.45 ng/mL vs. 171.47+/-80.48 ng/mL) levels, but without statistical significance. CONCLUSION: The serum adiponectin and ICAM-1 levels are related to the progression of coronary artery stenosis. However, further study will be required to confirm the relationships between the serum adiponectin and ICAM-1 levels and instent restenosis.
Adipocytes ; Adiponectin* ; Angioplasty, Balloon, Coronary ; Coronary Artery Disease ; Coronary Restenosis ; Coronary Stenosis* ; Coronary Vessels* ; Follow-Up Studies ; Humans ; Intercellular Adhesion Molecule-1 ; Obesity ; Percutaneous Coronary Intervention ; Plasma ; Risk Factors ; Stents

BACKGROUND: A measurement of the coronary flow velocity reserve (CFVR) with transthoracic Doppler echocardiography (TDE) is a good noninvasive method for detecting a coronary stenosis. However, microcirculatory impairment is a major limitation in assessing the coronary stenosis by CFVR. The effect of microcirculatory impairment on the CFVR can be minimized, and the diagnostic accuracy for detecting a coronary restenosis can be improved using serial evaluations of the CFVR. METHODS: This study prospectively measured the CFVR in 36 consecutive patients (age; 57+/-11 years, 23 men), in whom a successful PCI of the left anterior descending artery (LAD) was performed. The coronary flow velocity in the distal LAD was measured by TDE, and the CFVR was calculated. The initial CFVR measurement (CFVR0) was performed the next day after the PCI, and a follow-up CFVR measurement (CFVR1) was obtained on the day before the 6-month follow-up CAG. A significant decrease in the CFVR1 was defined as (CFVR0-CFVR1)/CFVR0>0.1, and a restenosis was defined as >50% of the stenosis diameter on a quantitative CAG. RESULTS: Adequate TDE studies for the CFVR were performed in all patients, and the follow-up CAG showed a restenosis in 9 (25%) patients. The sensitivity and specificity of the CFVR1 <2.0 was 5/9 (56%), 27/27 (100%), and those of the CFVR1 <2.5 were 8/9 (89%), 22/27 (81%) for predicting a LAD restenosis, respectively. The significant decrease in the CFVR had a sensitivity of 9/9 (100%) and a specificity of 25/27 (93%). In addition, in the 15 patients with either diabetes or LVH, the significant decrease in the CFVR was more accurate (15/15, 100%) than the CFVR1 <2.5 (11/15, 73%). CONCLUSIONS: Regardless of the associated microvascular impairment, a serial noninvasive assessment of the CFVR by TDE can improve the diagnostic accuracy of CFVR for detecting a LAD restenosis.
Arteries ; Blood Flow Velocity ; Constriction, Pathologic ; Coronary Disease ; Coronary Restenosis* ; Coronary Stenosis ; Dichlorodiphenyldichloroethane ; Echocardiography* ; Echocardiography, Doppler ; Follow-Up Studies ; Humans ; Prospective Studies ; Sensitivity and Specificity

OBJECTIVETo evaluate the clinical outcomes of treating bifurcation lesions with two drug-eluting stent (DES) techniques.

METHODSFrom October 2003 to June 2005, 112 patients with 113 bifurcation lesions with severe stenosis at the ostium of side branch and the diameter > or = 2.50 mm were treated by two DES. Sixty-two of the bifurcation lesions were located in LAD/diagonal (54.9%), 32 in distal left main coronary arteries (28.3%), 18 in LCX/OM (15.9%) and 1 distal RCA (0.9%). Sixty-four lesions were treated with Crush technique, 27 with "T-form" stent implanting technique, 11 with modified "Y-form" stent implanting technique, 5 with kissing technique, 3 with "V-form" stent implanting technique and 3 with Culotta technique. Ninety-one Cypher or Cypher select DES stents, 74 TAXUS DES stents, 67 Firebird stents were used for 226 lesions. Final kissing balloon inflation was performed in 60 bifurcation lesions (93.7%) after 64 Crush stenting procedure.

RESULTSSuccess rate of PCI procedure for the bifurcation lesions was 100%. One patient developed subacute stent thrombosis and underwent successful urgent revascularization. In-hospital major adverse cardiac events (death, AMI, revascularization, MACE) rate was 0.89% (1/112). Nine months follow-up was made in all 112 patients and all patients were alive and MACE rate was 8.04% (9/112) with 1 AMI occurred during the follow-up period in 1 patient due to late thrombosis. Follow-up coronary angiography at 9 months was performed in 48 patients (42.9%) and evidenced 8 in-stent restenosis (16.7%) and 1 patient received CABG, re-PCI was performed in 5 patients.

CONCLUSIONTwo DES technique for the treatment of bifurcation lesions is safe and effective and short- and long-term outcomes is satisfactory.

Adult ; Aged ; Coronary Artery Disease ; therapy ; Coronary Restenosis ; therapy ; Coronary Stenosis ; therapy ; Drug-Eluting Stents ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Treatment Outcome