scholarly journals Roles of MicroRNAs in Peripheral Artery In-Stent Restenosis after Endovascular Treatment

2021 ◽  
Vol 2021 ◽  
pp. 1-11
Author(s):  
Mo Wang ◽  
Weichang Zhang ◽  
Lei Zhang ◽  
Lunchang Wang ◽  
Jiehua Li ◽  
...  
Keyword(s):  
Endovascular Repair ◽  
Neointimal Hyperplasia ◽  
Cell Types ◽  
Underlying Mechanism ◽  
Arterial Disease ◽  
Transluminal Angioplasty ◽  
Stent Restenosis ◽  
Peripheral Arterial ◽  
Different Cell Types ◽  
In Stent Restenosis

Endovascular repair including percutaneous transluminal angioplasty (PTA) and stent implantation has become the standard approach for the treatment of peripheral arterial disease; however, restenosis is still the main limited complication for the long-term success of the endovascular repair. Endothelial denudation and regeneration, inflammatory response, and neointimal hyperplasia are major pathological processes occurring during in-stent restenosis (ISR). MicroRNAs exhibit great potential in regulating several vascular biological events in different cell types and have been identified as novel therapeutic targets as well as biomarkers for ISR prevention. This review summarized recent experimental and clinical studies on the role of miRNAs in ISR modification, with the aim of unraveling the underlying mechanism and potential therapeutic strategy of ISR.

Abstract 288: Role of Cilostazol in Preventing Instent Restenosis Among Patients With Peripheral Arterial Disease: A Meta-analysis

2015 ◽  
Vol 35 (suppl_1) ◽  
Author(s):  
Omer Iftikhar ◽  
Karla Oliveros ◽  
Alfonso Tafur ◽  
Ana Casanegra
Keyword(s):  
Peripheral Arterial Disease ◽  
Odds Ratio ◽  
Random Effect ◽  
Random Effect Model ◽  
Arterial Disease ◽  
Primary Patency ◽  
Stent Restenosis ◽  
Number Of Patients ◽  
Peripheral Arterial ◽  
In Stent Restenosis

Objective: Peripheral arterial disease (PAD) is associated with two to six fold increase in the cardiovascular mortality. Revascularization is indicated to relieve life limiting ischemic symptoms and improve wound healing. Primary patency for balloon angioplasty has been reported to be around 40 to 60% in the first year[8]. Stents have improved rates of primary patency but long-term patency rates are not comparable to bypass surgery, with many patients at high risk of in-stent restenosis. Many adjunctive therapies have been proposed to reduce the high restenosis rate. Our aim is to evaluate the use of cilostazol to prevent in-stent restenosis among patients with lower extremity arterial stenting. Methods: We performed a MEDLINE and EMBASE search, and reviewed the abstracts and manuscripts following the PRISMA guidelines. Patency rate after stenting was the primary efficacy outcome. At least 2 abstractors reviewed the study list and selected manuscripts. We calculated Q statistic and a homogeneity formal test. The odds ratio (OR) estimates were pooled by using the Mantel-Haenszel random-effects method. Data were analyzed using the R META package Results: We identified 524 studies, 20 articles were fully abstracted and 4 included in the metaanalysis. The total number of patients was 2434. The cilostazol and control groups were evenly divided. All studies were of moderate quality. Clinical characteristics including age and BMI were similar in the two groups. Stents were placed to treat de novo lesions. Two of the studies compared cilostazol to ticlopidine. Cilostazol group patients had better primary patency rates after endovascular therapy than patients not taking cilostazol (OR 0.55, 95% CI 0.43 - 0.71). Heterogeneity was moderate with I2 of 38% and of moderate clinical relevance not statistically significant thus random effect model was kept. Omitting a single study did not affect the overall odds ratio of the other studies. Funnel plot suggested no publication bias. Conclusions: In stent stenosis among revascularized patients with PAD was 45% lower for patients who were on cilostazol.

Endovascular Repair of Peripheral Arterial Disease

2017 ◽  
Vol 12 (4) ◽  
pp. 287-292
Author(s):  
Kemal Korkmaz ◽  
Hikmet Selcuk Gedik ◽  
Ali Baran Budak ◽  
Serdar Gunaydin ◽  
Kerim Cagli
Keyword(s):  
Endovascular Repair ◽  
Cellular Therapy ◽  
Hybrid Approach ◽  
Early Death ◽  
Arterial Disease ◽  
Transluminal Angioplasty ◽  
Complication Rates ◽  
Technical Success ◽  
Endovascular Interventions ◽  
Peripheral Arterial

Objective One thousand consecutive patients who underwent endovascular repair in an 8-year period were studied retrospectively to evaluate technical success, freedom from reinterventions, early clinical outcome, and risk factors for restenosis/occlusion. Methods Mean ± SD Rutherford class was 3.29 ± 0.8. A total of 755 patients have claudication, 423 from rest pain, and 569 from ischemic ulceration. Results A total of 552 men and 448 women (mean ± SD = 69.84 ± 8 years; range = 19–89 years) underwent endovascular repair. A total of 698 patients received local anesthesia and 302 general anesthesia. A total of 447 patients received percutaneous transluminal angioplasty, 650 stents were placed; 231 atherectomies were performed and 171 patients received hybrid approach. The procedure was successful in 847 patients (84%). There was no early death. There were 151 early occlusions (95 underwent surgery, 56 received stents), 121 dissections (39 underwent surgery, 56 received stents and 26 medical treatment), 32 hematoma, and 13 early leaks. Mean ± SD Rutherford class improved to 3.02 ± 0.9. Freedom from reintervention rate at 8 years was 76%. A total of 63 patients underwent surgery and 59 cellular therapy. A total of 134 finger, 142 below-knee, and 29 above-knee amputations were reported. Conclusions Endovascular interventions can be performed with a satisfactory technical success and low complication rates; however, nonfatal complications and catheter-based reinterventions are frequent.

scholarly journals Treatment strategies for in-stent restenosis in peripheral arterial disease: a systematic review

2018 ◽  
Vol 28 (2) ◽  
pp. 253-261 ◽  
Author(s):  
Shahab Hajibandeh ◽  
Shahin Hajibandeh ◽  
Stavros A Antoniou ◽  
Francesco Torella ◽  
George A Antoniou
Keyword(s):  
Systematic Review ◽  
Peripheral Arterial Disease ◽  
Treatment Strategies ◽  
Arterial Disease ◽  
Stent Restenosis ◽  
Peripheral Arterial ◽  
In Stent Restenosis

scholarly journals Pathogenesis and Clinical Significance of In-Stent Restenosis in Patients with Diabetes

2021 ◽  
Vol 18 (22) ◽  
pp. 11970
Author(s):  
Grzegorz K. Jakubiak ◽  
Natalia Pawlas ◽  
Grzegorz Cieślar ◽  
Agata Stanek
Keyword(s):  
Risk Factor ◽  
Cardiovascular Diseases ◽  
Clinical Significance ◽  
Neointimal Hyperplasia ◽  
Arterial Disease ◽  
Limb Amputation ◽  
Below The Knee ◽  
Stent Restenosis ◽  
Percutaneous Balloon ◽  
In Stent Restenosis

Diabetes mellitus (DM) is a strong risk factor for the development of cardiovascular diseases such as coronary heart disease, cerebrovascular disease, and peripheral arterial disease (PAD). In the population of people living with DM, PAD is characterised by multi-level atherosclerotic lesions as well as greater involvement of the arteries below the knee. DM is also a factor that significantly increases the risk of lower limb amputation. Percutaneous balloon angioplasty with or without stent implantation is an important method of the treatment for atherosclerotic cardiovascular diseases, but restenosis is a factor limiting its long-term effectiveness. The pathogenesis of atherosclerosis in the course of DM differs slightly from that in the general population. In the population of people living with DM, more attention is drawn to such factors as inflammation, endothelial dysfunction, platelet dysfunction, blood rheological properties, hypercoagulability, and additional factors stimulating vascular smooth muscle cell proliferation. DM is a risk factor for restenosis. The purpose of this paper is to provide a review of the literature and to present the most important information on the current state of knowledge on mechanisms and the clinical significance of restenosis and in-stent restenosis in patients with DM, especially in association with the endovascular treatment of PAD. The role of such processes as inflammation, neointimal hyperplasia and neoatherosclerosis, allergy, resistance to antimitotic drugs used for coating stents and balloons, genetic factors, and technical and mechanical factors are discussed. The information on restenosis collected in this publication may be helpful in planning further research in this field, which may contribute to the formulation of more and more precise recommendations for the clinical practice.

scholarly journals Brief Review of Options to Treat In-stent Restenosis of Femoro-popliteal Artery

2021 ◽  
Keyword(s):  
Peripheral Arterial Disease ◽  
Popliteal Artery ◽  
Arterial Disease ◽  
Stent Restenosis ◽  
The World ◽  
Peripheral Arterial ◽  
In Stent Restenosis

Peripheral arterial disease (PAD) is affecting millions of people all around the world. The different kind of stents to treat PAD has been in use from last couple of decades. In-stent restenosis is common problem, faced by endovascular specialists that is still challenging to treat. In this article, we reviewed the different options available to treat in-stent restenosis of the femoral-popliteal artery.

Arterial Preparation by Longitudinal Micro-Incisions Before Balloon Angioplasty of the Superficial Femoral and Popliteal Artery: Acute and 12-Month Results

2021 ◽  
pp. 152660282110570
Author(s):  
Jean-Baptiste Dexpert ◽  
Daniel Hayoz ◽  
Rolf P. Engelberger ◽  
Caroline Krieger ◽  
Marie-Antoinette Rey Meyer ◽  
...  
Keyword(s):  
De Novo ◽  
Arterial Disease ◽  
Target Lesion ◽  
Transluminal Angioplasty ◽  
Target Lesion Revascularization ◽  
Lesion Length ◽  
Stent Restenosis ◽  
Stent Length ◽  
Peripheral Arterial ◽  
Vessel Preparation

Purpose: Percutaneous transluminal angioplasty (PTA) with conventional plain old balloon (POBA) and/or drug-coated balloon (DCB) is the primary intervention to treat peripheral artery stenoses. However, acute dissections during the procedure and potential for future target lesion revascularization remain procedural complications. The purpose of this study was to assess the acute and 12-month outcomes in patients who underwent novel vessel preparation with longitudinal, controlled-depth micro-incisions prior to PTA. Materials and Methods: Patients with symptomatic lower extremity peripheral arterial disease with a Rutherford class of 2 to 6 and >70% de novo stenosis of the superficial femoral or popliteal arteries were included in this retrospective study. Patients with thrombotic or embolic lesions, restenosis, or in-stent restenosis were excluded. The FLEX Vessel Prep System (FLEX VP) was used to prepare the vessel prior to PTA by creating micro-incisions at the target lesion. The FLEX VP was followed by POBA or paclitaxel DCB. Results: The study included 65 patients. Lesion characteristics were 90% median stenosis (range = 70%–100%), 75.4% mild-to-severe calcifications, and 33.8% occlusion rate, and median lesion length was 196 (range = 10–480) mm. Following vessel preparation, 82.1% of the patients had low severity dissection or no flow-limiting dissection. The provisional stent rate postprocedure was 16.9%, with a median stent length of 60 mm. The freedom from target lesion revascularization (FFTLR) in 63 evaluable patients at 6 and 12 months was 98.4% and 93.7%, respectively. Freedom from amputation was 100%. Conclusion: In this real-world/all-comers patient population with long, stenotic lesions across the calcification spectrum, vessel preparation with longitudinal micro-incisions prior to PTA was associated with low dissection rate, low dissection severity, low stent implantation, and high FFTLR with the absence of amputation at 12 months relative to published reports in long-lesion cohorts. These results support vessel preparation via micro-incisions.

Continuous Subcutaneous Angiopeptin Treatment Significantly Reduces Neointimal Hyperplasia in a Porcine Coronary In-Stent Restenosis Model

Circulation ◽  
1997 ◽  
Vol 95 (2) ◽  
pp. 449-454 ◽  
Author(s):  
Mun K. Hong ◽  
Kenneth M. Kent ◽  
Roxana Mehran ◽  
Gary S. Mintz ◽  
Fermin O. Tio ◽  
...  
Keyword(s):  
Neointimal Hyperplasia ◽  
Stent Restenosis ◽  
In Stent Restenosis
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