No abstract available.
*Angioplasty, Balloon, Coronary ; Coronary Artery Disease/*drug therapy ; Coronary Vessels/*drug effects/pathology ; Humans ; Hydroxymethylglutaryl-CoA Reductase Inhibitors/*pharmacology ; Metals ; Simvastatin/*pharmacology ; *Stents ; Ultrasonography, Interventional

OBJECTIVEThe aim of this study was to investigate the mechanism and efficacy of tetramethylpyrazine-eluting stents (TES) on inhibiting neointima formation in porcine coronary arteries.

METHODSTES was prepared by tetramethylpyrazine spray-coated in bare metal stents (BMS). Pigs were implanted with TES or BMS (n = 7 each), respectively. Quantitative coronary angiography (QCA) and intravascular ultrasound (IVUS) were performed before, immediately after stenting and at 28 days after stenting. Coronary arteries segments (5 cm) before and post stenting area (5 cm) as well as at stenting location were harvested at 28 days post stenting for histopathological examinations (inflammation, vascular smooth muscle cells proliferation and apoptosis).

RESULTSFollow up QCA at 28 days showed that percentage diameter stenosis were significantly lower in the TES group than that in the BMS group [(10.0 +/- 2.1)% vs (60.2 +/- 23.5)%, P = 0.01]. The lumen area determined by IVUS was similar between the two groups and there was no in-stent thrombosis in TES or BMS treated animals. Internal elastic lamina area was significantly larger while the neointimal area [(1.51 +/- 0.45) mm(2) vs (4.60 +/- 1.39) mm(2), P = 0.04] was significantly smaller in the TES group than that in the BMS group. Histopathological assessments showed fewer inflammatory cells in the stented-coronary artery walls than those at the border zones of stenting in both groups. The number of proliferating cells were significantly decreased while apoptotic cells were significantly increased in the TES group compared with the BMS group (all P < 0.05).

CONCLUSIONTES could effectively reduce in-stent restenosis in this porcine model by attenuating vascular smooth muscle proliferation and enhancing vascular smooth muscle apoptosis post stenting.

Animals ; Coronary Restenosis ; prevention & control ; Coronary Vessels ; pathology ; Disease Models, Animal ; Double-Blind Method ; Drug-Eluting Stents ; Pyrazines ; administration & dosage ; Swine ; Tunica Intima ; drug effects ; pathology

OBJECTIVETo study the relationship between inflammation and neointimal proliferation after coronary stent implantation in porcine model.

METHODSTwenty normal minipigs were randomly divided into group A (implanted with 316L bare metal stents), group B (implanted with 605L bare metal stents), group C (implanted with PLGA coating 605L stents), and group D (implanted with rapamycin-loaded PLGA coating 605L stents). Each minipig was implanted with two same stents in left anterior descending artery and right coronary artery. Four weeks later, the animals were sacrificed and histomorphometric measurements on the stent-segment coronary arteries were made to calculate the correlation between inflammation area and neointimal area.

RESULTSGroup D had the smallest neointimal area [(0.64 +/- 0.38) mm2, P < 0. 001] and inflammation area (median 0.00 mm2, P = 0.009) among all the groups, while there were no statistical differences among group A, B, and C in neointimal area [(2.09 +/- 0.90), (2.11 +/- 1.07), and (1.42 +/- 0.35) mm2 respectively] and in inflammation area (0.22 , 0.21, and 0.09 mm2, respectively). Bivariate correlation analysis showed that the inflammation area was positively correlated with the neointimal area (P < 0.001, correlation coefficient = 0.719). When stent type, mean injury score, and EEL area were adjusted, partial correlations analysis showed that the inflammation area was still positively correlated with the neointimal area (P = 0.01, correlation coefficient = 0.498).

CONCLUSIONInflammation promotes the neointimal proliferation after coronary stent implantation. Sirolimus-eluting stent may reduce the inflammatory response.

Animals ; Coronary Vessels ; pathology ; Drug-Eluting Stents ; adverse effects ; Inflammation ; pathology ; Neointima ; pathology ; Stents ; adverse effects ; Swine ; Swine, Miniature ; Tunica Intima ; pathology

OBJECTIVETo examine the effect of the zedoary essential component-eluting stent (ZES) on a porcine coronary neointimal formation.

METHODSZES, sirolimus-eluting stents (SES), and bare metal stents (BMS) were randomly implanted in three different major epicardial vessels in 36 balloon-injured pigs. Coronary angiography, optical coherence tomography, and histomorphological analysis were used to determine antihyperplasia effects.

RESULTSZES and SES had a significantly larger lumen diameter and area, and reduced diameter and area of stenosis in arteries at 30 and 90 days compared with arteries implanted with BMS (P<0.01). Histomorphometric analysis showed moderate inflammatory responses, such as infiltration of mononuclear cells, lymphocytes, and multinucleated giant cells in some arteries with SES compared with ZES (P<0.05). Injury scores were not different among the three groups at 30 and 90 days. The endothelialization score in the SES group was 2.69 ± 0.42 at 30 days and 2.83 ± 0.39 at 90 days compared with the ZES and BMS groups (both were 3.00 ± 0.00 at either 30 or 90 days, P<0.05). Well developed endothelium was observed in the ZES group, while incomplete endothelium and inflammatory cells were observed with stent struts partly naked at the vessel lumen in the SES group.

CONCLUSIONThe ZES inhibits neointimal hyperplasia with good endothelia coverage in the porcine balloon injury coronary model.

Animals ; Coated Materials, Biocompatible ; pharmacology ; Coronary Stenosis ; pathology ; Coronary Vessels ; drug effects ; pathology ; Curcuma ; chemistry ; Endothelium, Vascular ; drug effects ; pathology ; Inflammation ; pathology ; Microscopy, Electron, Scanning ; Neointima ; pathology ; Prosthesis Implantation ; Stents ; Sus scrofa ; Time Factors

BACKGROUNDLesions at coronary bifurcations always are a big challenge for interventionists even with the advent of drug eluting stents (DES). Even as more clinical trials are published, operators still can not confirm that one strategy is more efficient than another. Selection of patients and short term follow-up contribute to the difficulty in comparing strategies.

METHODSFrom April 2004 to April 2008, 505 consecutive Chinese patients underwent DES implantation for true bifurcation lesions; including 258 using crush strategy (213 male, (56.7 +/- 10.8) years old) and 247 using no crush strategy (206 male, (58.1 +/- 10.1) years old) were analyzed.

RESULTSThe follow-up period ranged from 237 to 1223 days, average (537 +/- 340) days for the crush group and (538 +/- 351) days for the no crush group. There was no significant difference of major adverse cardiac events (MACE) rate between the two groups (10.1% vs 12.1%; P = 0.481), nor in cardiac death, nonfatal myocardial infarction (MI) or in the target vessel revascularization (TVR) (0.4% vs 1.6%; P = 0.207, 2.7% vs 2.8; P = 1.000 and 7.0% vs 7.7%; P = 0.865). The stent thrombosis rate was similar in the two groups (1.6% vs 2.0%; P = 0.409), late and very late stent thrombosis in both groups were very low (0.4% vs 0.4%; P = 1.000). Seven-month angiographic follow-up showed no significant difference of the restenosis rate between the two groups (11.0% vs 13.5%; P = 0.786). During the follow-up, cardiac death, nonfatal MI, TVR and ST free survival rate showed no significant difference between the two groups. The only variant identified as a predictor of MACE was percutaneous coronary intervention (PCI) in the first two years, which accounted for 47% of patients of all cases in four years.

CONCLUSIONCrush technique showed similar long-term clinical effect compared with other two DES techniques for coronary bifurcation lesions, the surgeons' skills are very important for reducing clinical events.

Aged ; Angioplasty, Balloon, Coronary ; adverse effects ; methods ; Coronary Angiography ; Coronary Artery Disease ; mortality ; pathology ; therapy ; Coronary Vessels ; pathology ; Drug-Eluting Stents ; adverse effects ; Female ; Humans ; Male ; Middle Aged ; Survival Analysis ; Treatment Outcome

OBJECTIVETo evaluate neointimal proliferation following placement of a new drug-eluting stent (BUMA) by optical coherence tomography (OCT).

METHODSTwenty-two patients with coronary artery disease were randomized into BUMA group (n=15) and Endeavor group (n=7) and underwent OCT imaging after 9 months of stent implantation.

RESULTSThe neointima hyperplasia (NIH) thickness in BUMA group were significantly smaller than that in endeavor group (0.220-/+0.140 mm vs 0.269-/+0.207 mm, P<0.001), and the uncovered Struts were significantly lower in BUMA group than in Endeavor group (5.65% vs 6.56%, P<0.0001). The luminal late loss in BUMA group was also significantly lower (34.87-/+11.50 vs 40.82-/+18.53, P=0.025).

CONCLUSIONBUMA stent is safe and effective for treatment of coronary artery disease.

Angioplasty, Balloon, Coronary ; adverse effects ; Cell Proliferation ; Coronary Artery Disease ; pathology ; therapy ; Coronary Vessels ; pathology ; Drug-Eluting Stents ; adverse effects ; Humans ; Prospective Studies ; Tomography, Optical Coherence ; Tunica Intima ; pathology

INTRODUCTION: The pathophysiology and mechanism of in-stent restenosis (ISR) after implantation of second-generation drug-eluting stents (DESs) are not fully clear. We compared the morphological characteristics of ISR between first- and second-generation DESs using frequency domain optical coherence tomography (OCT). METHODS: Patients who underwent follow-up coronary angiography (CAG) after first-generation (CYPHER™ and TAXUS™) and second-generation (Nobori®, PROMUS Element™, Resolute Integrity and XIENCE) DES implantations were examined. ISR was defined as lesions of over 50% diameter stenosis at follow-up CAG. Frequency domain OCT was performed at the time of revascularisation of ISR. Tissue morphology was assessed at minimum lumen area. OCT images of DESs at both early (≤ 1 year) and late (> 1 year) phase follow-up were compared. RESULTS: On qualitative OCT assessment, the ratios of homogeneous, layered, heterogeneous without-attenuation and heterogeneous with-attenuation morphologies were 57.1%, 17.1%, 20.0% and 5.7%, respectively, for second-generation DES ISR (n = 35), and 16.7%, 25.0%, 25.0% and 33.3%, respectively, for first-generation DES ISR (n = 36). At late phase follow-up, homogeneous morphology was significantly more common for second-generation DES ISR compared to first-generation DES ISR (first-generation: 8.0% vs. second-generation: 50.0%; p < 0.01) while heterogeneous with-attenuation morphology was significantly more common for first-generation DES ISR (first-generation: 44.0% vs. second-generation: 5.6%; p < 0.01). CONCLUSION Homogeneous tissue morphology was more frequently found for second-generation than first-generation DES ISR, especially in the late phase. This suggested that neointimal hyperplasia was the main mechanism in second-generation DES ISR, and that the neointima was stabilised, much like in bare metal stent implantation.
Aged ; Constriction, Pathologic ; pathology ; Coronary Angiography ; Coronary Restenosis ; diagnostic imaging ; pathology ; Coronary Vessels ; diagnostic imaging ; pathology ; surgery ; Drug-Eluting Stents ; adverse effects ; Female ; Humans ; Incidence ; Male ; Metals ; Middle Aged ; Neointima ; Retrospective Studies ; Tomography, Optical Coherence

In this study of the inhibitory effects of angiopeptin and aspirin on the development of accelerated graft atherosclerosis (AGAS), 22 B10.BR mice received intra-abdominal heterotopic heart transplants from B10.A mice, without immunosuppression. Group 1 (n = 5) received no pharmacological intervention, Group 2 (n = 6) was treated with angiopeptin, Group 3 (n = 5) with aspirin, and Group 4 (n = 6) with both. There was no significant difference in the incidence of AGAS among these groups. The magnitude of intimal lesion development showed less narrowing of large vessels (> 100 microns in diameter) in groups 2 and 4--i.e. the groups received angiopeptin (Group 1 = 46.9 +/- 9.3%, Group 2 = 28.5 +/- 9.2%, Group 3 = 44.1 +/- 10.9%, Group 4 = 24.2 +/- 5.9%; p < 0.01). Comparison of the fraction of tropomyosin-positive staining cells in the intima revealed a lesser degree of staining in Group 2 (p < 0.01). No intervention was effective in preventing smooth muscle cell proliferation in the media or inflammatory cell infiltration in the adventitia. In conclusion, our data suggest that angiopeptin is effective in the direct inhibition of intimal smooth muscle cell proliferation in relatively large vessels, whereas aspirin exhibits no inhibitory role in the progression of AGAS. Angiopeptin appears to be a potential therapeutic agent for inhibiting the progression of postoperative AGAS in clinical heart transplantation.
Animal ; Aspirin/pharmacology* ; Cardiovascular Agents/pharmacology* ; Coronary Arteriosclerosis/pathology ; Coronary Arteriosclerosis/immunology* ; Coronary Vessels/pathology ; Coronary Vessels/drug effects ; Heart/drug effects* ; Heart Transplantation/immunology* ; Immunohistochemistry ; Mice ; Mice, Inbred Strains ; Myocardium/pathology ; Myocardium/immunology ; Oligopeptides/pharmacology* ; Somatostatin/pharmacology ; Somatostatin/analogs & derivatives* ; Transplantation, Homologous/immunology ; Tropomyosin/metabolism

OBJECTIVETo observe the effects of rapamycin on the expressions of Rho-kinase and p27 mRNA during vascular intimal proliferation in a porcine model of coronary stenosis induced by interleukin-1beta (IL-1beta).

METHODSThe proximal segments of LAD and LCX were wrapped with cotton mesh that had absorbed sepharose bead solution with or without IL-1beta. Selective coronary angiography was performed two weeks later and the animals were killed for collecting the samples for histopathology and RT-PCR analyzing of Rho-kinase and p27 mRNA.

RESULTSThe expressions of Rho-kinase and p27 mRNA could be visualized in normal coronary wall. The expression of Rho-kinase mRNA was significantly enhanced and the expression of p27 mRNA was significantly decreased during the process of intimal proliferation induced by IL-1beta. Rapamycin significantly inhibited the intimal proliferation, reduced the infiltration of inflammatory cells, reduced the expression of Rho-kinase mRNA and increased the expression of p27 mRNA.

CONCLUSIONSThe expression of Rho-kinase mRNA is upregulated and p27 mRNA downregulated in coronary artery stenosis induced by IL-1beta and these effects could be abolished by cotreatment with rapamycin.

Animals ; Coronary Angiography ; Coronary Vessels ; drug effects ; metabolism ; pathology ; Disease Models, Animal ; Interleukin-1beta ; pharmacology ; Male ; RNA, Messenger ; metabolism ; Sirolimus ; pharmacology ; Swine ; Tunica Intima ; drug effects ; metabolism ; pathology ; rho-Associated Kinases ; metabolism

PURPOSE: The effects on the side-branch (SB) ostium, following paclitaxel-coated balloon (PCB) treatment of de novo coronary lesions of main vessels have not been previously investigated. This study was aimed at evaluating the serial morphological changes of the SB ostium after PCB treatment of de novo coronary lesions of main vessels using optical coherence tomography (OCT). MATERIALS AND METHODS: This prospective, single-center observational study enrolled patients with de novo lesions, which were traversed by at least one SB (≥1.5 mm) and were treated with PCB. The SB ostium was evaluated with serial angiographic and OCT assessments pre- and post-procedure, and at 9-months follow-up. RESULTS: Sixteen main vessel lesions were successfully treated with PCB, and 26 SBs were included for analysis. Mean SB ostial lumen area increased at 9-months follow-up (0.92±0.68 mm2 pre-procedure, 1.03±0.77 mm2 post-procedure and 1.42±1.18 mm2 at 9-months). The SB ostial lumen area gain was 0.02±0.24 mm2 between pre- and post-procedure, 0.37±0.64 mm2 between post-procedure and 9-months, and 0.60±0.93 mm2 between pre-procedure and 9-months. The ostial lumen area increased by 3.9% [interquartile range (IQR) of -33.3 to 10.4%] between pre- and post-procedure, 52.1% (IQR of -0.7 to 77.3%) between post-procedure and 9-months and 76.1% (IQR of 18.2 to 86.6%) between pre-procedure and 9-months. CONCLUSION: PCB treatment of de novo coronary lesions of main vessels resulted in an increase in the SB ostial lumen area at 9-months.
Aged ; Angioplasty, Balloon, Coronary/*methods ; Coronary Angiography ; Coronary Stenosis/diagnosis/*therapy ; Coronary Vessels/*pathology ; *Drug-Eluting Stents/adverse effects ; Female ; Humans ; Male ; Middle Aged ; Paclitaxel/*administration & dosage ; Prospective Studies ; Tomography, Optical Coherence/*methods ; Treatment Outcome ; Tubulin Modulators/administration & dosage