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 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.

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

Lipoprotein(a) as a unique primary risk factor for early atherosclerotic peripheral arterial disease

2021 ◽  
Vol 14 (6) ◽  
pp. e243231
Author(s):  
John Mayo ◽  
Thomas Hoffman ◽  
Ryan Smith ◽  
Dwight Kellicut
Keyword(s):  
Risk Factor ◽  
Cardiovascular Diseases ◽  
Peripheral Arterial Disease ◽  
Arterial Disease ◽  
Common Condition ◽  
Elevated Plasma ◽  
Early Screening ◽  
Lipoprotein A ◽  
Peripheral Arterial ◽  
Primary Risk Factor

Elevated plasma lipoprotein(a) is a relatively common condition that contributes to many cardiovascular diseases. However, the awareness and testing for this condition remain low. Herein, we present a case of an otherwise healthy and active man who developed symptoms of peripheral arterial disease starting at age 49, and was found to have hyper-lipoprotein(a) as his only notable risk factor. Diagnosis was not made until years later, after an extensive workup. Upon further screening, he was also found to have subclinical coronary and carotid artery atherosclerotic disease. The patient was treated with aspirin, statin, niacin and angioplasty to bilateral superficial femoral arteries with good symptom resolution. Early screening of his son also revealed a similarly elevated lipoprotein(a) level. It is important to raise awareness of this condition and its relationship to early-onset peripheral arterial disease so patients and their families can be appropriately identified, counselled and treated.

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 Three-Year Sustained Clinical Efficacy of Drug-Coated Balloon Angioplasty in a Real-World Femoropopliteal Cohort

2020 ◽  
Vol 27 (5) ◽  
pp. 693-705
Author(s):  
Giovanni Torsello ◽  
Konstantinos Stavroulakis ◽  
Marianne Brodmann ◽  
Antonio Micari ◽  
Gunnar Tepe ◽  
...  
Keyword(s):  
Real World ◽  
Popliteal Artery ◽  
Limb Amputation ◽  
Lesion Length ◽  
Stent Restenosis ◽  
Kaplan Meier ◽  
Global Study ◽  
Drug Coated Balloon ◽  
Major Target ◽  
In Stent Restenosis

Purpose: To report the 36-month outcomes from the prospective, multicenter, single-arm IN.PACT Global Study ( ClinicalTrials.gov identifier NCT01609296) evaluating the performance of the IN.PACT Admiral drug-coated balloon (DCB) in real-world patients with femoropopliteal occlusive disease. Materials and Methods: The IN.PACT Global Study was conducted at 64 international sites and enrolled 1535 patients with complex lesions, which included bilateral disease, multiple lesions, de novo in-stent restenosis, long lesions, and chronic total occlusions. The predefined full clinical cohort included 1406 patients (mean age 68.6 years; 67.8% men) with claudication or rest pain treated with the study DCB. Mean lesion length was 12.09±9.54 cm; 18.0% had in-stent restenosis, 35.5% were totally occluded, and 68.7% were calcified. Freedom from clinically-driven target lesion revascularization (CD-TLR) was evaluated through 36 months. The safety composite endpoint was freedom from device- and procedure-related death through 30 days and freedom from major target limb amputation and clinically-driven target vessel revascularization within 36 months. All safety and revascularization events were reviewed by an independent clinical events committee. Results: The Kaplan-Meier estimate of freedom from CD-TLR through 36 months was 76.9%. The composite safety endpoint was achieved in 75.6% of patients. The 36-month all-cause mortality rate was 11.6%, and the major target limb amputation rate was 1.0%. The Kaplan-Meier estimate of freedom from CD-TLR through 36 months was significantly lower in patients with chronic limb-threatening ischemia (CLTI) compared with claudicants (67.6% vs 78.0%; p=0.003). Lesions affecting both the superficial femoral artery (SFA) and popliteal artery had lower Kaplan-Meier freedom from CD-TLR through 36 months (69.2%) than either isolated SFA (79.7%) or popliteal artery lesions (76.5%; log- rank p<0.001). Predictors of CD-TLR through 36 months included increased lesion length, reference vessel diameter ≤4.5 mm, in-stent restenosis, bilateral disease, CLTI, and hyperlipidemia. Conclusion: DCB angioplasty with the IN.PACT Admiral DCB for femoropopliteal disease in a diverse and complex real-world population is associated with sustained clinical efficacy and low rates of reinterventions at 3 years after the initial procedure.

scholarly journals Interprocedural interval as a risk factor for recurrent restenosis after treatment of in-stent restenosis: differential response with and without brachytherapy

2002 ◽  
Vol 39 ◽  
pp. 65
Author(s):  
Michael P. Savage ◽  
David L. Fischman ◽  
Richard K. Valicenti ◽  
Warren K. Laskey ◽  
Theodore A. Bass ◽  
...  
Keyword(s):  
Risk Factor ◽  
Differential Response ◽  
Stent Restenosis ◽  
In Stent Restenosis

scholarly journals A tough endothelium-like dressing for vascular stents

2021 ◽  
Author(s):  
Yin Chen ◽  
Peng Gao ◽  
Lu Huang ◽  
Xing Tan ◽  
Ningling Zhou ◽  
...  
Keyword(s):  
Smooth Muscle ◽  
Smooth Muscle Cells ◽  
Surface Engineering ◽  
De Novo ◽  
Neointimal Hyperplasia ◽  
Muscle Cells ◽  
Vascular Stents ◽  
Stent Restenosis ◽  
In Stent Restenosis

Abstract Vascular stent is viewed as one of the greatest advancements in interventional cardiology. However, current approved stents suffer from in-stent restenosis associated with neointimal hyperplasia or stent thrombosis. To address this issue, we developed an endothelium-like (EL) dressing for vascular stents inspired by the importance and biological functions of native endothelium for cardiovascular system. Our EL dressing is based on a de novo designed hydrogel that is mechanically tough and could preserve integrity on stents during angioplasty. Due to its physiochemical similarities to subendothelial extracellular matrix, the EL dressing facilitated the adhesion and growth of endothelial cells. Besides, it is non-thrombotic and capable of inhibiting smooth muscle cells thanks to the capacity to catalyze nitric oxide generation. Transcriptome analysis further unraveled the EL dressing could modulate the inflammatory response and induce the relaxation of smooth muscle cells, while potentially promoting angiogenesis by stimulating the expression of angiogenic factors. In vivo study demonstrated vascular stents encapsulated by it promoted rapid restoration of native endothelium and persistently suppressed in-stent restenosis in both leporine and swine models. We expect such EL dressing will open a new avenue to the surface engineering of vascular implants for better clinical outcomes.

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.

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