International journal of cardiovascular interventions最新文献

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The impact of adjunctive eptifibatide therapy with percutaneous coronary intervention for acute myocardial infarction. 辅助依替巴肽治疗经皮冠状动脉介入治疗对急性心肌梗死的影响。
International journal of cardiovascular interventions Pub Date : 2005-01-01 DOI: 10.1080/14628840510011180
Eli I Lev, Ran Kornowski, Igal Teplisky, David Hasdai, Eldad Rechavia, Nurit Shor, Alexander Battler, Abid R Assali
{"title":"The impact of adjunctive eptifibatide therapy with percutaneous coronary intervention for acute myocardial infarction.","authors":"Eli I Lev,&nbsp;Ran Kornowski,&nbsp;Igal Teplisky,&nbsp;David Hasdai,&nbsp;Eldad Rechavia,&nbsp;Nurit Shor,&nbsp;Alexander Battler,&nbsp;Abid R Assali","doi":"10.1080/14628840510011180","DOIUrl":"https://doi.org/10.1080/14628840510011180","url":null,"abstract":"<p><p>The role of small molecules anti-glycoprotein (GP) IIb/IIIa pharmacotherapy during acute myocardial infarction (AMI) has not been established. The purpose of our study was to evaluate the clinical outcomes of patients sustaining AMI who underwent emergent percutaneous coronary intervention (PCI) and who were distinguished by the use of the anti-GP IIb/IIIa agent eptifibatide. We studied a consecutive group of 216 patients who underwent PCI for acute ST-elevation myocardial infarction and compared the outcomes of patients who received eptifibatide just prior and following the procedure (n=167) to those who were not on anti GP IIb/IIIa inhibitors (n=49). On average, patients treated using eptifibatide were younger and were more likely to be men, hypertensive, and smokers. The eptifibatide treated patients were less likely to have diabetes and renal failure and had worse angiographic characteristics. There were no significant differences between the groups in any of the clinical outcomes, including the composite endpoint (e.g. death, MI, repeat revascularization) and the rate of sub-acute stent thrombosis. Nonetheless, there was a non-significant trend towards lower 30 day mortality in the eptifibatide group (4.8% versus 12%, P=0.09). We concluded that in our comparative study of periprocedural administration of eptifibatide during emergent AMI angioplasty, there was a non-significant trend towards better short-term survival among eptifibatide treated patients although the composite endpoint did not differ between patients distinguished by the use of anti GP IIb/IIIa small molecule pharmacotherapy.</p>","PeriodicalId":83747,"journal":{"name":"International journal of cardiovascular interventions","volume":"7 1","pages":"41-5"},"PeriodicalIF":0.0,"publicationDate":"2005-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/14628840510011180","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25190700","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 6
Characteristics and clinical outcomes of patients with cardiogenic shock complicating acute myocardial infarction treated by emergent coronary angioplasty. 急诊冠状动脉成形术治疗心源性休克并发急性心肌梗死的特点及临床结果。
International journal of cardiovascular interventions Pub Date : 2005-01-01 DOI: 10.1080/14628840500445566
Abid R Assali, Zaza Iakobishvili, Nili Zafrir, Alejandro Solodky, Igal Teplitsky, Eldad Rechavia, Nader Butto, Nurit Shor, David Hasdai, Shmuel Fuchs, Alexander Battler, Ran Kornowski
{"title":"Characteristics and clinical outcomes of patients with cardiogenic shock complicating acute myocardial infarction treated by emergent coronary angioplasty.","authors":"Abid R Assali,&nbsp;Zaza Iakobishvili,&nbsp;Nili Zafrir,&nbsp;Alejandro Solodky,&nbsp;Igal Teplitsky,&nbsp;Eldad Rechavia,&nbsp;Nader Butto,&nbsp;Nurit Shor,&nbsp;David Hasdai,&nbsp;Shmuel Fuchs,&nbsp;Alexander Battler,&nbsp;Ran Kornowski","doi":"10.1080/14628840500445566","DOIUrl":"https://doi.org/10.1080/14628840500445566","url":null,"abstract":"<p><strong>Background: </strong>Cardiogenic shock (CS) is a dreadful complication of acute myocardial infarction (AMI) associated with a poor prognosis. Percutaneous coronary intervention (PCI) is widely recommended by current treatment guidelines.</p><p><strong>Aim: </strong>To evaluate the in-hospital and 30-day mortality rate and to determine independent predictors of mortality in a cohort of unselected consecutive patients with CS.</p><p><strong>Methods and results: </strong>Rabin Medical Center cardiac catheterization laboratory database was analyzed between 1/2000 and 8/2003. Fifty of the 472 patients (10.6%) treated using emergent PCI for AMI had cardiogenic shock on presentation. Patients with cardiogenic shock were older, more likely to be female and with higher frequency of co-morbidities. The time from symptom onset until seeking medical treatment was longer in cardiogenic shock patients. In-hospital mortality rate was 48.0% in the cardiogenic shock group as compared to 3.3% in the non-cardiogenic shock group (P<0.0001). In patients with shock, total mortality after 30 days was 52% (26/50). Most of these patients (25/26) died within 48 hours following admission because of refractory cardiogenic shock. A multivariate analysis adjusted for baseline differences showed that age 75 years (odds ratio [OR]: 11; 95% confidence interval [CI]: 1.0-1.24, P=0.05), and the use of GP 2b/3a antagonist (OR: 0.97; 95% CI: 0.95-1.0, P=0.05), were independent predictors of all cause mortality at 30 days.</p><p><strong>Conclusion: </strong>Cardiogenic shock remains an important cause of mortality in AMI. Younger age and the use of GP 2b/3a antagonists during primary PCI for cardiogenic shock patients seems to be associated with better clinical outcomes.</p>","PeriodicalId":83747,"journal":{"name":"International journal of cardiovascular interventions","volume":"7 4","pages":"193-8"},"PeriodicalIF":0.0,"publicationDate":"2005-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/14628840500445566","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25766687","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 5
Functional T-lymphocyte dichotomy in the peripheral blood of patients with unstable angina. 不稳定性心绞痛患者外周血功能性t淋巴细胞二分法的研究。
International journal of cardiovascular interventions Pub Date : 2005-01-01 DOI: 10.1080/14628840510039513
Arnon Adler, Yair Levy, Arie Roth, Dov Wexler, Gad Keren, Jacob George
{"title":"Functional T-lymphocyte dichotomy in the peripheral blood of patients with unstable angina.","authors":"Arnon Adler,&nbsp;Yair Levy,&nbsp;Arie Roth,&nbsp;Dov Wexler,&nbsp;Gad Keren,&nbsp;Jacob George","doi":"10.1080/14628840510039513","DOIUrl":"https://doi.org/10.1080/14628840510039513","url":null,"abstract":"<p><strong>Objectives: </strong>Herein, we investigated the percentage of T-helper (Th1) and Th2 cells among the general T-cell population in the peripheral blood of patients with stable angina (SA) and unstable angina (UA).</p><p><strong>Background: </strong>Recent evidence suggests that Th1 cells and the cytokines that they secrete (especially IFN-gamma) have a role in the activation of macrophages, promotion of clot formation and destabilization of atherosclerotic plaques. Thus, Th1 cytokines may contribute to the initiation and progression of UA. In contrast, cytokines secreted by Th2 cells (e.g. IL-10) are known to inhibit activation and proliferation of Th1 cells and the secretion of IFN-gamma, lysosomal enzymes and metalloproteinases. Therefore, we sought to examine whether the ratio of IFN-gamma to IL-10 secreting cells is altered in patients with UA.</p><p><strong>Methods: </strong>The percentage of Th1 and Th2 cells among the general T-cell population was determined by fluorescent intracellular cytokine staining (IFN-gamma and IL-10, out of the total CD3 positive cells).</p><p><strong>Results: </strong>The percentage of T-cells positive for intracellular IFN-gamma was significantly higher in patients with UA (n = 22) in comparison with SA (n = 20) patients (39.0+/-2.8% and 29.6+/-2.7%, respectively. P = 0.02). There was no significant difference in intracellular IL-10 positive cells between the two groups. In addition, there was no significant difference in the ratio between the intracellular IFN-gamma positive cells and the intracellular IL-10 positive cells.</p><p><strong>Conclusions: </strong>There is an increased activity of Th1 cells in patients with UA in comparison with patients with SA. There is no evidence of heightened activity of Th2 cells in either group. Thus, IFN-gamma secreted by peripheral blood T-lymphocytes,may be an important immunomodulator contributing to destabilization of the atheromatous plaque lying at the base of the etiopathogenesis of unstable angina.</p>","PeriodicalId":83747,"journal":{"name":"International journal of cardiovascular interventions","volume":"7 3","pages":"146-51"},"PeriodicalIF":0.0,"publicationDate":"2005-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/14628840510039513","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25651659","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 6
Discrepancy between morphologic and functional criteria of optimal stent deployment using intravascular ultrasound and pressure derived myocardial fractional flow reserve. 血管内超声和压力衍生心肌血流储备的最佳支架部署的形态学和功能标准的差异。
International journal of cardiovascular interventions Pub Date : 2005-01-01 DOI: 10.1080/14628840510039540
Hans-Ulrich Stempfle, Andreas König, Eva Drescher, Uwe Siebert, Volker Klauss
{"title":"Discrepancy between morphologic and functional criteria of optimal stent deployment using intravascular ultrasound and pressure derived myocardial fractional flow reserve.","authors":"Hans-Ulrich Stempfle,&nbsp;Andreas König,&nbsp;Eva Drescher,&nbsp;Uwe Siebert,&nbsp;Volker Klauss","doi":"10.1080/14628840510039540","DOIUrl":"https://doi.org/10.1080/14628840510039540","url":null,"abstract":"<p><strong>Background: </strong>Pressure derived myocardial FFR, a functional index of epicardial stenosis has been proposed for the assessment of optimal stent deployment. The following study evaluated the potential of serial fractional flow reserve (FFR) measurements in comparison to the 'gold standard' intravascular ultrasound (IVUS) for optimal stent deployment and its long-term outcome.</p><p><strong>Methods: </strong>35 patients with a single de novo lesion underwent PTCA followed by stent implantation with an initial inflation pressure of 12 atm. If optimal stent expansion using IVUS-criteria were not fulfilled, re-dilatation at 16 atm as well as additional inflations with larger balloon sizes were performed to reach the procedural end-point. IVUS and FFR were performed after each dilatation (n = 136). Angiography was repeated after 6 months.</p><p><strong>Results: </strong>In 30 pts who fulfilled IVUS criteria, mean lumen area (2.9+/-1.3 mm2) increased after PTCA and stent implantation to 10.0+/-3.0 mm2. In six pts, optimum stent deployment according to a value of FFR0.94 was not reached. Four of six pts reached the IVUS criteria at 12 atm and two pts at 16 atm, respectively. Positive and negative predictive values of FFR were 26 and 64%. Three of the 30 pts (10%) revealed a restenosis at three months follow-up. One of these restenosis was seen in a patient with a post-procedural FFR<0.94.</p><p><strong>Conclusions: </strong>FFR was not valid to predict optimal stent expansion according to IVUS criteria but could delineate under-expanded stents despite a reasonable angiographic appearance. Morphologic (IVUS) and functional criteria (FFR) for optimal stent deployment revealed a comparably low restenosis rate.</p>","PeriodicalId":83747,"journal":{"name":"International journal of cardiovascular interventions","volume":"7 2","pages":"101-7"},"PeriodicalIF":0.0,"publicationDate":"2005-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/14628840510039540","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25240391","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 4
Percutaneous valve procedures: present and future. 经皮瓣膜手术:现在和未来。
International journal of cardiovascular interventions Pub Date : 2005-01-01 DOI: 10.1080/14628840510011199
Zamer Tawn, Dominique Himbert, Eric Brochet, David Messika-Zeitoun, Bernard Iung, Alec Vahanian
{"title":"Percutaneous valve procedures: present and future.","authors":"Zamer Tawn,&nbsp;Dominique Himbert,&nbsp;Eric Brochet,&nbsp;David Messika-Zeitoun,&nbsp;Bernard Iung,&nbsp;Alec Vahanian","doi":"10.1080/14628840510011199","DOIUrl":"https://doi.org/10.1080/14628840510011199","url":null,"abstract":"<p><p>Percutaneous mitral commissurotomy and aortic valvuloplasty have been being performed since the mid-1980s. Balloon commissurotomy has been used in thousands of cases worldwide and it provides good short- and long-term results in a wide range of patients. It has virtually replaced surgical commissurotomy in the treatment of mitral stenosis. In contrast, percutaneous aortic valvuloplasty is almost abandoned worldwide due to its lack of efficacy and the risks involved. The new techniques of percutaneous valve intervention: aortic valve replacement and mitral valve repair are at an early stage: the first in-man applications of these fledgling techniques started in 2002. Preliminary series show that they are feasible; however, they need to be further evaluated in comparison with contemporary treatment to assess accurately how efficient they are and the risks involved. Currently potential applications concern high-risk patients, however, in the future, after thorough evaluation, this may be extended to others. Thus, percutaneous interventions already play an important role in treatment of valvular heart disease, a role that seems set for future expansion.</p>","PeriodicalId":83747,"journal":{"name":"International journal of cardiovascular interventions","volume":"7 1","pages":"14-20"},"PeriodicalIF":0.0,"publicationDate":"2005-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/14628840510011199","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25189277","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 10
Successful crossing of a severe spasm of the brachial artery using a telescopic approach. 用伸缩式入路成功穿过严重痉挛的肱动脉。
International journal of cardiovascular interventions Pub Date : 2005-01-01 DOI: 10.1080/14628840510011216
Omer Goktekin, Leisheng Ru, Julian Collinson, Carlo di Mario
{"title":"Successful crossing of a severe spasm of the brachial artery using a telescopic approach.","authors":"Omer Goktekin,&nbsp;Leisheng Ru,&nbsp;Julian Collinson,&nbsp;Carlo di Mario","doi":"10.1080/14628840510011216","DOIUrl":"https://doi.org/10.1080/14628840510011216","url":null,"abstract":"<p><p>We describe a case of severe brachial artery spasm resistant to vasodilator treatment. A multi-purpose 110 cm diagnostic catheter was used as an inner dilator. This allowed easy negotiation of a guiding catheter through the tortuous segment and successful completion of the angioplasty procedure.</p>","PeriodicalId":83747,"journal":{"name":"International journal of cardiovascular interventions","volume":"7 1","pages":"63-4"},"PeriodicalIF":0.0,"publicationDate":"2005-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/14628840510011216","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25190704","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 2
Clinical and angiographic outcome of stenting of unprotected left main coronary artery bifurcation narrowing. 无保护冠状动脉左主干分叉狭窄支架术的临床和血管造影结果。
International journal of cardiovascular interventions Pub Date : 2005-01-01 DOI: 10.1080/14628840510011243
Didier Carrié, Eric Maupas, Mohamed Hmem, Thibaut Lhermusier, Meyer Elbaz, Jacques Puel
{"title":"Clinical and angiographic outcome of stenting of unprotected left main coronary artery bifurcation narrowing.","authors":"Didier Carrié,&nbsp;Eric Maupas,&nbsp;Mohamed Hmem,&nbsp;Thibaut Lhermusier,&nbsp;Meyer Elbaz,&nbsp;Jacques Puel","doi":"10.1080/14628840510011243","DOIUrl":"https://doi.org/10.1080/14628840510011243","url":null,"abstract":"<p><strong>Purpose: </strong>Improvements in techniques and equipments may result in the wider applicability of percutaneous coronary intervention (PCI) for unprotected left main coronary artery (ULMCA) stenosis. This report is a prospective study focused on the feasibility, effectiveness and long-term results of stenting for treatment of ULMCA bifurcation lesions.</p><p><strong>Methods: </strong>From November 2002 to October 2003, 57 consecutive patients were stented with bare metal stents and the technique of kissing balloon followed by T-provisional stenting was applied for ostial left anterior descending, left circumflex or distal left main coronary lesion.</p><p><strong>Results: </strong>Mean age was 69.5+/-10.7 years. Acute coronary syndrome occurred in 68.4% of patients with a majority of two or three vessel disease (45.10% and 35.30% respectively). GpIIbIIIa inhibitors were used in only 5.8% of cases. Angiographic success was obtained in 100% of patients. Hospital stay was 7.03+/-2.26 days without major adverse cardiac events. At eight months follow-up, cardiac death was 1.7%, non-fatal myocardial infarction 5.1% and target vessel revascularisation 22.8% including CABG 15.7% and repeated PCI 10.5% with an angiographic restenosis rate of 29.8%.</p><p><strong>Conclusion: </strong>In the setting of coronary stenting of the ULMCA stenosis, the use of bare metal stents can no longer be considered contemporary technique and another strategy such as coated stent may be needed.</p>","PeriodicalId":83747,"journal":{"name":"International journal of cardiovascular interventions","volume":"7 2","pages":"97-100"},"PeriodicalIF":0.0,"publicationDate":"2005-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/14628840510011243","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25240390","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 8
MRI-guided myocardial cell therapy. mri引导心肌细胞治疗。
International journal of cardiovascular interventions Pub Date : 2005-01-01 DOI: 10.1080/14628840500342946
Alexander J Dick, Robert J Lederman
{"title":"MRI-guided myocardial cell therapy.","authors":"Alexander J Dick,&nbsp;Robert J Lederman","doi":"10.1080/14628840500342946","DOIUrl":"https://doi.org/10.1080/14628840500342946","url":null,"abstract":"Novel cell based therapies are being developed to treat ischemic heart disease. High local concentrations of agents will likely be necessary for biologic efficacy. Intracoronary artery infusion through patent arteries has been tried with variable success in several clinical trials (1,2). However, first-pass retention of cells is low when they are administered intra-arterially. Moreover, intra-arterial delivery requires patent inflow arteries, which often is not the case in severe chronic myocardial ischemia. Direct injection into the myocardium is attractive because it may accomplish high local delivery while reducing systemic exposure and toxicity. Catheter based injection methods are also attractive compared with open surgical injection by virtue of reduced invasiveness and attendant lower morbidity. X-ray guided catheter based endomyocardial delivery systems are widely available (3,4). Soft tissue contrast provided by contemporary x-ray fluoroscopy is poor. In order to visualize blood spaces, they must be filled with potentially toxic radiocontrast agents. Successful and spatially precise cell delivery to diseased myocardium is not assured, especially with regard to inadvertently overlapping injections. Electromechanical navigation (NOGA with Myostar injection catheter, Cordis-Webster) can be used to guide cell injections. It creates a 3dimensional roadmap by combining an electrical sensing catheter with a electromagnetic position sensor (5–8). This approach is elegant but may be limited because creating the roadmap is timeconsuming, and because the roadmap may misrepresent the current cardiac position based on patient, respiratory, and cardiac motion as well as changes in cardiac rhythm and loading conditions. Furthermore, this technique does not confirm successful cell injection. Even in experienced hands electromechanical mapping has only 80% sensitivity and specificity to distinguish between normal and infarcted myocardium in a non-transmural infarct (9). An ideal delivery system should be able to:","PeriodicalId":83747,"journal":{"name":"International journal of cardiovascular interventions","volume":"7 4","pages":"165-70"},"PeriodicalIF":0.0,"publicationDate":"2005-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/14628840500342946","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25766040","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 14
Drug-eluting versus third-generation bare metal stents: the US strategy. 药物洗脱与第三代裸金属支架:美国的战略。
International journal of cardiovascular interventions Pub Date : 2005-01-01 DOI: 10.1080/14628840500434958
Daniel W Isenbarger, Jon R Resar
{"title":"Drug-eluting versus third-generation bare metal stents: the US strategy.","authors":"Daniel W Isenbarger,&nbsp;Jon R Resar","doi":"10.1080/14628840500434958","DOIUrl":"https://doi.org/10.1080/14628840500434958","url":null,"abstract":"<p><p>Drug-eluting stents have rapidly come to dominate the field of coronary intervention, constituting 85% of the US market just one year after introduction. The current utilization of bare metal stents in coronary intervention in the US is quite limited. This article will review technological advances in third-generation bare metal stents, which optimize procedural performance by means of improved flexibility, lower crossing profile, and thinner struts while maintaining fluoroscopic visibility and may portend a continued role for bare metal stents in some settings. This article will review data pertaining to outcomes with new generation bare metal stents and discuss current options for utilization of drug eluting stents versus bare metal stents in the US.</p>","PeriodicalId":83747,"journal":{"name":"International journal of cardiovascular interventions","volume":"7 4","pages":"171-5"},"PeriodicalIF":0.0,"publicationDate":"2005-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/14628840500434958","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25766041","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 8
Plaque sealing--a concept waiting for support. 牙菌斑密封——一个有待支持的概念。
International journal of cardiovascular interventions Pub Date : 2005-01-01 DOI: 10.1080/14628840510039531
Antonio Colombo, Ioannis Iakovou
{"title":"Plaque sealing--a concept waiting for support.","authors":"Antonio Colombo,&nbsp;Ioannis Iakovou","doi":"10.1080/14628840510039531","DOIUrl":"https://doi.org/10.1080/14628840510039531","url":null,"abstract":"The progress that has been observed in all areas of percutaneous coronary interventions (PCI) has failed to materialize in substantial decreases in mortality in patients treated percutaneously. Normalizing the blood flow in significant stenoses addresses ischemia and its symptoms but does not alter the prognosis (1). The latter is influenced by the vessel closures that occur not only in the hemodynamically significant but also in the nonflow-limiting lesions (1,2). The individual risk of a stenosis to occlude after plaque rupture is related to its severity (3). Nevertheless, non-significant stenoses are in certain, even if smaller, risk for closure and infarction (1). Since there are usually many more mild lesions, the majority of the infarctions occur from non-significant lesions. Little et al. showed in a pivotal paper published 17 years ago, that many non-critical coronary lesions can produce myocardial infarction (2). This observation has been used to support the concept of plaque sealing by coronary interventions either by balloon angioplasty alone or by stenting (4,5). The working hypothesis of this phenomenon has two cornerstones (1). First, a coronary stenosis subjected to PCI will not progress to a total occlusion except if it closes abruptly. The second element of the plaque sealing concept is that even if restenosis occurs, neoinitimal tissue almost precludes endothelial rupture and thrombosis (1,6). As a result, plaque sealing, by preventing plaque rupture, will prevent thrombosis and thus myocardial infarction and death. Despite its theoretical attractiveness, the plaque sealing principle has not been universally accepted for various reasons. The first is that such strategy failed to show any advantage over the current interventional practice (treating lesions with w50% diameter stenosis) (4,7). On the contrary, previous data have shown that stent implantation for narrowingsv50% in diameter are subject to an increased rate of major adverse cardiac events and thus the risk outweighs any hypothetical long-term benefit. In a recently published study, including a total of 3812 patients pooled from 14 different studies of angioplasty alone and stenting, the combined event rate (death, non-fatal myocardial infarction, and repeat revascularization) when angiographically nonsignificant stenoses were treated was over 20% at one year follow-up (7). It is worth noting that the event rate after PCI was not related to stenosis severity (7). Moreover, in the Coronary Artery Surgery Study (CASS) registry, the estimated one-year probability of an anterior myocardial infarction in left anterior descending lesions with a diameter stenosisv50% was 0.6% and with diameter stenosis between 50% and 70% was 2.2% (3). These rates when compared, even if indirectly, to the rates reported in the study of Mercado et al., are significantly lower (7). Similarly, the Deferral Versus Performance of PTCA in Patients without Documented Ischemia (DEFER) trial showed th","PeriodicalId":83747,"journal":{"name":"International journal of cardiovascular interventions","volume":"7 2","pages":"72-4"},"PeriodicalIF":0.0,"publicationDate":"2005-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/14628840510039531","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25240386","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 4
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