Association between Proliferative Scars and In-Stent Restenosis

2007 ◽  
Vol 11 (6) ◽  
pp. 206-210 ◽  
Author(s):  
Cagdas Ozdol ◽  
Sibel Turhan ◽  
Cansin Tulunay ◽  
A. Timucin Altin ◽  
Yusuf Atmaca ◽  
...  
Keyword(s):  
Heart Surgery ◽  
Healing Process ◽  
Open Heart Surgery ◽  
Median Sternotomy ◽  
Multivariate Logistic Regression Analysis ◽  
Coronary Stenting ◽  
Wound Healing Process ◽  
Angiographic Restenosis ◽  
Stent Restenosis ◽  
In Stent Restenosis

Background: Keloid and hypertrophic scars are two types of proliferative scars at sites of cutaneous injury that form as a result of an abnormal wound-healing process. Proliferative scar formation after skin injury and restenosis after coronary stenting have common features. The aim of this study was to investigate the association of proliferative scars with coronary stent restenosis. Methods: Patients with previous open heart surgery with median sternotomy who had coronary stenting after the surgery and were admitted for control angiography were included in the study. The patients were divided into two groups according to the presence or absence of proliferative scars. The primary end point was the incidence of angiographic restenosis in patient groups. Results: The study group consisted of 80 patients (64 men; mean age 64 ± 9 years). Twenty-three patients (29%) have a proliferative scar. In general, two groups were comparable with regard to baseline lipid profiles, demographics, and cardiovascular risk factors. Restenosis was significantly more prevalent in patients with proliferative scars than with controls ( p = .04). By multivariate logistic regression analysis, stent length (odds ratio [OR] 1.12, p = .005), diabetes (OR 3.3, p = .03), and proliferative scar (OR 4.2, p = .02) independently predicted in-stent restenosis. Conclusion: The findings of this study suggest that patients with proliferative scars may have a higher risk of in-stent restenosis.

scholarly journals Vitamin D for prevention of sternotomy healing complications: REINFORCE-D trial

Trials ◽  
2020 ◽  
Vol 21 (1) ◽  
Author(s):  
Michal Čečrle ◽  
Dalibor Černý ◽  
Eva Sedláčková ◽  
Barbora Míková ◽  
Vlasta Dudková ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Cardiac Surgery ◽  
Heart Surgery ◽  
Soft Tissues ◽  
Healing Process ◽  
Hospital Readmissions ◽  
Open Heart Surgery ◽  
Median Sternotomy ◽  
Complication Rates ◽  
Mechanical Lung Ventilation

Abstract Background Most cardiac surgery patients undergo median sternotomy during open heart surgery. Sternotomy healing is an arduous, very complex, and multifactorial process dependent on many independent factors affecting the sternum and the surrounding soft tissues. Complication rates for median sternotomy range from 0.5 to 5%; however, mortality rates from complications are very variable at 7–80%. Low calcidiol concentration below 80 nmol/L results in calcium absorptive impairment and carries a risk of bone loss, which is considered as a risk factor in the sternotomy healing process. The primary objective of this clinical trial is to compare the incidence of all postoperative sternotomy healing complications in two parallel patient groups administered cholecalciferol or placebo. The secondary objectives are focused on general patient recovery process: sternal bone healing grade at the end of the trial, length of hospitalization, number of days spent in the ICU, number of days spent on mechanical lung ventilation, and number of hospital readmissions for sternotomy complications. Methods This clinical trial is conducted as monocentric, randomized, double-blind, placebo-controlled, with planned enrollment of 600 patients over 4 years, approximately 300 in the placebo arm and 300 in the treatment arm. Males and females from 18 to 95 years of age who fulfill the indication criteria for undergoing cardiac surgery with median sternotomy can be included in this clinical trial, if they meet the eligibility criteria. Discussion REINFORCE-D is the first monocentric trial dividing patients into groups based on serum calcidiol levels, and with dosing based on serum calcidiol levels. This trial may help to open up a wider range of postoperative healing issues. Trial registration EU Clinical Trials Register, EUDRA CT No: 2016-002606-39. Registered on September 8, 2016.

scholarly journals Association of seven renin angiotensin system gene polymorphisms with restenosis in patients following coronary stenting

2017 ◽  
Vol 18 (1) ◽  
pp. 147032031668877 ◽  
Author(s):  
Min Zhu ◽  
Minjun Yang ◽  
Jiangbo Lin ◽  
Huanhuan Zhu ◽  
Yifei Lu ◽  
...  
Keyword(s):  
Angiotensin Ii ◽  
Angiotensin Converting Enzyme ◽  
Neointimal Hyperplasia ◽  
Renin Angiotensin System ◽  
Coronary Stenting ◽  
Converting Enzyme ◽  
Angiotensin System ◽  
Renin Angiotensin ◽  
Stent Restenosis ◽  
In Stent Restenosis

Background and objective: Percutaneous coronary intervention, despite being effective for coronary revascularization, causes in-stent restenosis due to neointimal hyperplasia in a large number of patients. The renin-angiotensin system is involved in neointimal hyperplasia. This study sought to evaluate seven gene polymorphisms of key renin-angiotensin system components, including angiotensinogen, angiotensin-converting enzyme and angiotensin II type 1a receptors, and their associations with in-stent restenosis in patients with coronary artery disease following coronary stenting. Methods and results: Three hundred and fifty-two patients undergoing coronary drug-eluting stent implantation were recruited. Seventy-five patients (21.3%) were diagnosed as restenosis by angiography. Genotyping for angiotensin-converting enzyme insertion/deletion demonstrated a significant association of angiotensin-converting enzyme DD genotype with the occurrence of restenosis. Direct DNA sequencing revealed no association of angiotensinogen (M235T, G217A, G152A, G-6A, and A-20C) or angiotensin II type I receptor A1166C polymorphisms with in-stent restenosis. However, angiotensin II type 1a A1166C polymorphism was significantly associated with increased susceptibility to restenosis in a subgroup of patients aged more than 60 years. Conclusion: Thus, our study suggests that genetic polymorphisms of angiotensin-converting enzyme insertion/deletion are associated with in-stent restenosis in coronary artery disease patients following coronary stenting.

scholarly journals An example of late regression of in-stent restenosis after bare metal coronary stenting

2009 ◽  
Vol 17 (8) ◽  
pp. 305-306
Author(s):  
A. A. C. M. Heestermans ◽  
J. W. van Werkum ◽  
A. W. J. van ’t Hof
Keyword(s):  
Coronary Stenting ◽  
Bare Metal ◽  
Stent Restenosis ◽  
In Stent Restenosis

Abstract 16128: Vascular Healing Response After Everolimus Eluting Stent Implantation in Patients With or Without Diabetes Mellitus -Evaluation With Optical Coherence Tomography

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Yutaka Goryo ◽  
Shiro Uemura ◽  
Yoko Dote ◽  
Yu Sugawara ◽  
Tomoya Ueda ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Optical Coherence Tomography ◽  
Cross Sections ◽  
Healing Process ◽  
Drug Eluting Stent ◽  
Optical Coherence ◽  
Cross Sectional ◽  
Stent Restenosis ◽  
Neointimal Coverage ◽  
In Stent Restenosis

Introduction: Clinical introduction of percutaneous coronary intervention (PCI) with drug eluting stent has substantially decreased the rate of in-stent restenosis (ISR). However, it is reported that patients with diabetes mellitus (DM) still have higher incidence of restenosis and secondary cardiovascular events than patients without DM. Using intravascular optical coherence tomography (OCT), we evaluated the effect of DM on healing process of coronary artery after everolimus eluting stents (EES) implantation in the comparison with non-DM patients. Methods and Results: We studied 26 DM patients (65.1±11.9y/o) and 59 non-DM patients (68.1±9.4y/o) who received OCT-guided EES implantation. The second OCT examination was performed on 296±71.1 days after implantation (291±74.2days vs. 298±70.3days, p=0.51). OCT cross-sectional images of the second study were examined to determine the condition of neointimal coverage over every strut in 1mm interval (DM; 725 cross-sections and 5742 struts, non-DM; 1482 cross-sections and 12098 struts). In addition, neointimal thickness (NIT) over each strut measured and tissue characteristics were examined. One in-stent restenosis with clinical manifestation was observed in each group. Average NIT was significantly thicker in DM group than in non-DM group (107±99.2μm vs. 92±74.6μm, p<0.01). The incidence of malapposed struts without neointimal coverage were very low and similar in both groups (0.22±0.54 vs. 0.13±0.72%, p=0.43). The frequency of OCT-defined unstable neointimal characteristics was significantly higher rate in DM than non-DM group (14.5±18.9% vs. 6.67±14.5%, p=0.03). Conclusions: EES implanted in DM patients showed acceptable neointimal proliferation and uncovered stent struts similar to non-DM patients, suggesting the mid-term efficacy and safety of EES in DM patients. However, long-term follow-up should be necessary because of the high incidence of unstable neointimal characteristics which might be a substrate for the future development of neoatherosclerosis.

Cardiac Compression due to Closure of the Median Sternotomy in Open Heart Surgery

CHEST Journal ◽  
1975 ◽  
Vol 67 (1) ◽  
pp. 113-114 ◽  
Author(s):  
Mohammad Riahi ◽  
Luis A. Tomatis ◽  
Ralph J. Schlosser ◽  
Enrique Bertolozzi ◽  
Daniel W. Johnston
Keyword(s):  
Heart Surgery ◽  
Open Heart Surgery ◽  
Median Sternotomy ◽  
Open Heart ◽  
Cardiac Compression

Sternal Anomalies in Asymptomatic Patients after Median Sternotomy and Potential Influencing Factors

2017 ◽  
Vol 66 (06) ◽  
pp. 517-522
Author(s):  
Simon Sündermann ◽  
Hatem Alkadhi ◽  
Michele Genoni ◽  
Francesco Maisano ◽  
Maximilian Emmert ◽  
...  
Keyword(s):  
Risk Factors ◽  
Heart Surgery ◽  
Plate Fixation ◽  
Treatment Options ◽  
Open Heart Surgery ◽  
Median Sternotomy ◽  
Patient Specific ◽  
Asymptomatic Patients ◽  
Increased Risk ◽  
Potential Risk Factors

Background We aimed to assess asymptomatic patients who had open-heart surgery with median sternotomy for potential sternal anomalies (SA), their related patient-specific risk factors, and treatment options for the prevention of SA. Methods Multiplanar CT scans (CTs) from 131 asymptomatic consecutive patients were analyzed retrospectively. Of these, 83 underwent CABG (63.4%), and 48 had aortic valve (AV) procedures via median sternotomy. Sternal bone healing was analyzed for SA and their exact location. Results In total, 49 SA were identified in 42 (32.1%) patients; 65% SA were found in the manubrium (n = 32). Five hundred thirty-two wires were implanted (4.2 ± 0.5 wires/patient), out of which 96.1% (n = 511) were figure 8 wires. There was no difference between normal and abnormal sterna with regard to the number of wires used for sternal closure (4.2 ± 0.5 vs. 4.3 ± 0.6, p = ns). The distance between wire placement to the proximal edge of the manubrium in normal and abnormal sterna was comparable (11.2 ± 4.2 vs. 10.9 ± 4.8 mm, p = ns). Patients who underwent CABG had a significantly higher risk for SA (OR = 2.4, p ≤ 0.05, 95% CI [1.2–4.9]). The use of BIMA (OR = 4.4, p ≤ 0.05, 95% CI [1.1–17.9]) and body mass index (BMI) > 31 kg/m2 (OR = 3.4, p ≤ 0.01, 95% CI [1.4–8.3]) significantly increased the risk of SA. Conclusion At least 30% of patients were at an increased risk for SA after receiving a median sternotomy. CABG, use of BIMA, and a BMI > 30 kg/m2 were potential risk factors for the development of SA and warrant close clinical follow-up. Sternal plate fixation, particularly in the manubrium, could be beneficial in such patients.

scholarly journals Immunosuppressive Therapy for Restenosis Prevention after Coronary Bare-Metal Stent Implantation -A Meta-Analysis

2019 ◽  
Author(s):  
Yun-Lang Dai ◽  
Jing Zhou ◽  
Yu-Feng Jiang ◽  
Sheng-Da Hu ◽  
Yong-Ming He
Keyword(s):  
Immunosuppressive Therapy ◽  
Meta Analysis ◽  
Bare Metal Stents ◽  
Metal Stents ◽  
Bare Metal ◽  
Angiographic Restenosis ◽  
Stent Restenosis ◽  
Risk Patients ◽  
In Stent Restenosis

Abstract Background: Previous studies revealed controversial results regarding the prevention of in-stent restenosis after coronary bare-metal stents (BMS) placement with systemic administration of immunosuppressive drugs. We therefore conducted a meta-analysis to investigate the role played by immunosuppressive therapy (IST) in reducing both in-stent restenosis and adverse clinical events after BMS implantation. Methods: We searched PubMed, EMBASE, Cochrane Central Register of Controlled Trials, and ClinicalTrials.gov databases for randomized, controlled studies that investigated the therapeutic effects of IST after BMS insertions. Endpoints assessed were: (1) angiographic restenosis by the end of at least 6 months of follow-up; (2) target vessel revascularization (TVR); and (3) risk of major adverse cardiovascular events (MACE). MACE was defined as death, myocardial infarction and TVR. Results: Nine randomized, controlled trials including 1576 patients (mean age 62 years; follow-up of 6-12 months) were included in this analysis. Meta-analysis showed periprocedural IST + BMS significantly reduced in-stent restenosis as compared to BMS alone (RR: 0.59 [0.39-0.90], P = 0.01). In particular, IST reduced restenosis in high-risk patients (defined as patients with mean reference diameter < 3.0 mm or high periprocedural C-reactive protein level) (RR: 0.34 [0.15,0.74], P = 0.006) rather than in low-risk patients ( P for interaction = 0.06). Similarly, IST also reduced the risk of MACE (RR: 0.63 [0.50-0.80], P < 0.01) and TVR (RR: 0.57 [0.33-0.97], P = 0.04). Conclusions: Periprocedural IST reduces the risk of angiographic restenosis, TVR and MACE in patients with BMS implantation. The advantage of IST is driven mainly by a lower risk of in-stent restenosis in high-risk patients. Key words: immunosuppressive therapy, restenosis, bare-metal stents , meta-analysis

Abstract 2163: Long-term Follow-up (>3 Years) of Patients Treated With Sirolimus-Eluting Stents for In-stent Restenosis. Results of a Randomized Study.

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Fernando Alfonso ◽  
Maria J Perez-Vizcayno ◽  
Armando Bethencourt ◽  
Vicens Martí ◽  
Jose R Lopez-Minguez ◽  
...  
Keyword(s):  
Clinical Outcome ◽  
Randomized Study ◽  
Bare Metal Stent ◽  
Long Term Results ◽  
Target Vessel Revascularization ◽  
Angiographic Restenosis ◽  
Stent Restenosis ◽  
In Stent Restenosis

Background: The value of drug-eluting stents in patients (P) with in-stent restenosis (ISR) has been established. However, the long-term results of this strategy in P with ISR remains unknown. Objective: We sought to determine the long-term clinical outcome of P treated with sirolimus-eluting stents (SES) for ISR. Methods: A systematic, pre-specified, long-term clinical follow-up (FU) was performed in all P included in the RIBS II (Restenosis Intra-stent: Balloon angioplasty [BA] vs elective SES implantation) randomized trial. In RIBS II 150 P with ISR after bare-metal stent implantation were included: 74 allocated to BA and 76 to SES. Late angiography was obtained in 96% of eligible P. A structured clinical questionnaire (cardiac/non cardiac death, myocardial infarction [MI], target vessel revascularization [TVR], thrombosis [TH], and medical therapy) was used during FU. Results: Angiographic restenosis (primary end-point) was more frequently found in the BA arm (39% vs 11%, p<0.001). Clinical FU at 1-year was obtained in 150 P (100%). During this time period 6 P died (3 SES, 3 BA), 4 P suffered a MI (2 SES, 2 BA), 2 P experienced TH (1 P in each arm) and 30 required TVR (8 SES, 22 BA, p<0.01). A complete clinical FU >3 years was obtained in 145 P (97%) (mean 38±9 months, median 40 months [IQR 37–42]). Late events (after 1 year, non-exclusive) included: 3 deaths (1 SES, 2 BA), 3 MI (3 SES, 2 due to late TH) and 7 late TVR (5 SES, 2 BA). At 4 years, event-free survival was 76% in the SES arm and 65% in the BA arm (p=0.03). Survival free from TVR at 4 years was 80% in the SES arm and 67% in the BA arm (p=0.02). Conclusion: In P with ISR SES implantation improve the long-term clinical outcome as compared with BA treatment.

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