Coronary In-stent Restenosis Research Articles

Assessment of the Association Between Clinical and Laboratory Parameters and Past Coronavirus Infection in Patients with Coronary Artery Restenosis

Understanding the risk factors for coronary in-stent restenosis is particularly important in patients with coronavirus disease (COVID-19). Such patients require careful monitoring, priority treatment, and prevention.The aim of our study was to assess the association between clinical and laboratory parameters and previous coronavirus infection in patients with coronary artery restenosis.Materials and methods. A cross-sectional study was conducted on a continuous sample of patients with coronary artery disease who underwent repeated myocardial revascularization in the period from 2020 to 2023 (931 patients). 420 patients in the main group had coronary artery stent restenosis, of which 162 (38.5 %) had suffered from coronavirus infection (CVI). The control group included 511 patients with repeated myocardial revascularization without stent restenosis, of whom 107 (20.9 %) had undergone CVI. Laboratory tests included troponin I, D-dimer, creatine kinase (CK), creatine kinase-MB (CK-MB), serum creatinine and glucose, C-reactive protein (CRP), alanine aminotransferase (ALT), aspartate aminotransferase (AST) and fibrinogen, IgG and IgM antibodies to coronavirus and RNA detection by polymerase chain reaction. Statistical calculations were performed using SPSS version 20.0 software.Results: It was established that there were statistically significantly higher levels of IgG antibodies to coronavirus and C-reactive protein in the main study group compared to the control group. When dividing the study groups into subgroups of individuals with and without previous CVI, statistically significant differences in troponin levels were found (p<0.001): between the level in the group with restenosis and CVI compared to groups without restenosis with CVI, with restenosis without CVI, and in groups with revascularization without CVI and with restenosis without CVI. The levels of D-dimer, CPK, CPK-MB, CRP, and APTT had statistically significant differences in the groups with previous CVI compared to the groups without CVI. The results of multiple regression analysis indicated a statistically significant positive relationship in the study groups between the development of myocardial infarction and such indicators as CRP, blood glucose, low-density lipoproteins (LDL), previous CVI, as well as a negative relationship with left ventricular ejection fraction and high-density lipoproteins (HDL). The role of these predictors in the development of myocardial infarction was confirmed using ROC analysis.Conclusion: The results of our study indicated a relationship between previous coronavirus infection and an increased risk of coronary artery restenosis in patients with previous myocardial revascularization.

CYP2C19 polymorphism and coronary in-stent restenosis: A systematic review and meta-analysis

Background In-stent restenosis (ISR) remains a major drawback in coronary stenting. The association between the CYP2C19 loss of function (LOF) gene and the prevalence of ISR after coronary stenting remains controversial. Previous studies have produced conflicting results and have been limited by their small population sizes. We conducted this systematic review and meta-analysis to determine the association between the presence of the CYP2C19 LOF gene and the prevalence of ISR. Methods A systematic online database search was performed until April 2021. The primary outcome was ISR and assessed using OR with 95% CI. Quality of the study was assessed using the Newcastle Ottawa Scale. I2 was applied to examine heterogeneities among the studies. Results A total of 284 patients (four non-randomized controlled trial studies) were included in this study. Two hundred and six patients had wild-type genotypes, while 78 patients had the LOF genotype. Among the 78 patients with the LOF gene, 38 patients had an ISR. Meanwhile, of the 206 patients with a wild-type gene, 69 patients had an ISR. LOF gene was associated with a higher risk of ISR (OR 95% CI = 2.71 [1.42–5.16], P = 0.003). However, study-specific variability should be considered when applying these findings clinically. Conclusions Patients with LOF genes, regardless of the allele variation, treated with clopidogrel, had a higher likelihood of ISR after coronary stenting.

Recurrent drug eluting stent, in-stent restenosis (DES-ISR): Epidemiology, pathophysiology & treatment.

Coronary artery in-stent restenosis (ISR) is driven by neointimal hyperplasia and neo-atherosclerosis in previously placed stents. Drug eluting stents (DES) have been adopted as first line therapy for the initial episode of ISR. However, recurrent ISR has limited durable salvage options. In this article we review the pathophysiology, incidence, and management options of recurrent DES- ISR.

Drug-Coated Balloons for the Treatment of Coronary Artery Disease

Drug-coated balloon (DCB) angioplasty has emerged as an alternative to drug-eluting stent (DES) implantation for percutaneous coronary intervention (PCI) in patients with coronary in-stent restenosis (ISR) as well as de novo coronary artery disease. DCBs are balloons coated with antiproliferative agents and excipients, whose aim is to foster favorable vessel healing after appropriate lesion preparation. By providing homogeneous antiproliferative drug delivery in the absence of permanent foreign body implantation, DCBs offer multiple advantages over DES, including preservation of vessel anatomy and function and positive vessel remodeling. As such, DCBs have become appealing for treatment of ISR, small-vessel disease, long lesions, simplification of bifurcation procedures, and treatment of diffuse distal disease after recanalization of chronic total occlusions. In addition, patients with high bleeding risk, diabetes, and acute coronary syndrome might also stand to benefit from DCB angioplasty. Although commercially available in numerous countries now for more than a decade, DCB only recently obtained US Food and Drug Administration approval for the treatment of coronary ISR. Moreover, preliminary results from newer generation devices tested in different clinical scenarios have raised the interest of the international community. Accordingly, an up-to-date review is timely particularly with the anticipated wave of research on the matter. Herein, this review encompasses DCB technologies, their worldwide usage, details on relevant indications, and key procedural aspects of DCB angioplasty.

Intravascular imaging and functional assessment for coronary in-stent restenosis: Current status and future directions.

Despite significant advancements in drug-eluting stent technology, in-stent restenosis (ISR) still occurs in approximately 10 % of patients undergoing percutaneous coronary intervention, remaining a significant global health concern. The mechanisms underlying ISR are complex and multifactorial, yet recent innovations in intravascular imaging and functional assessment have substantially advanced our understanding, enabling more targeted and individualized therapeutic strategies. This review synthesizes the latest insights into ISR, emphasizing the pivotal roles of advanced imaging modalities, such as optical coherence tomography (OCT) and intravascular ultrasound, and functional assessments like quantitative flow ratio and optical flow ratio in guiding ISR management. Additionally, we explore the clinical implications of neoatherosclerosis and calcified nodules as key pathological mechanisms influencing restenosis progression and patient outcomes. The review also highlights the significance of OCT-based ISR classifications in refining treatment approaches. By integrating these diagnostic and therapeutic advances, this work provides clinicians and researchers with an updated foundation and actionable insights for optimizing ISR management through tailored, imaging-guided strategies.

First-in-man study of a novel everolimus-coated balloon for the treatment of coronary in-stent restenosis.

Treatment of patients with in-stent restenosis (ISR) remains challenging. In this setting the use of drug-coated balloons (DCB) represents an attractive approach to avoid adding another metal layer to the coronary wall. The Chansu Vascular Technologies (CVT)-ISR trial aimed to evaluate the safety and efficacy of a novel everolimus-DCB (CVT-DCB) using a new coating formulation and crystalline everolimus. The CVT-ISR trial was a prospective, multicenter, open, single-arm, first-in-man (FIM) study. A total of 51 patients (mean age 69.2 years, 74.5% male) with single ISR coronary lesions (≤24 mm in length) were enrolled at nine sites in Europe. The primary safety endpoint, freedom from target lesion failure (TLF) at 180 days, was 92.2%, with the lower bound of the 95% confidence interval (81.1%), above the protocol-defined objective performance criterion (OPC) (65% for conventional balloon angioplasty, P < 0.05). At 1 year freedom from TLF was 90.2%. The primary efficacy endpoint, in-stent late lumen loss at 180 days (evaluated in a predefined subgroup of 25 patients scheduled for late angiography), was 0.40 mm (median 0.30 mm), lower than the protocol-defined OPC of the plain balloon angioplasty historical control (0.80 mm, P < 0.001). This FIM study demonstrated the superior efficacy of the new everolimus CVT-DCB compared with conventional balloon angioplasty in the treatment of patients with ISR. NCT05731700.

Abstract 4125106: Paclitaxel-Coated Balloon vs Uncoated Balloon for Coronary In-Stent Restenosis; A Meta-Analysis.

Background: Internationally, drug-coated balloons have emerged as a new treatment approach in In-Stent Restenosis (ISR) offering localized drug delivery to inhibit neointimal growth without the need for additional stent layers. However, their use has not been assessed or approved in the United States. Paclitaxel-coated balloons (PCBs) are gaining traction as alternatives for in-stent restenosis patients. Yet, their safety and effectiveness compared to uncoated balloons remain uncertain. This meta-analysis seeks to systematically assess PCBs' safety and efficacy for ISR treatment by comparing them to uncoated balloons. Research Question: Are paclitaxel-coated balloons (PCBs) superior to uncoated balloons (UCBs) in terms of safety and efficacy for the treatment of coronary in-stent restenosis (ISR)? Aims: Systematically assess the safety and efficacy of paclitaxel-coated balloons (PCBs) compared to uncoated balloons (UCBs) for the treatment of coronary in-stent restenosis (ISR). Methods: A comprehensive literature review was conducted utilizing multiple databases up to May 2024, focusing on randomized controlled trials comparing PCB vs UCB in patients with coronary in-stent restenosis. Six randomized controlled trials with a total of 1,347 patients who completed 1-year follow-up were included. Dichotomous data were calculated as odds ratios (ORs) and 95% confidence intervals (95% CI). P&lt;0.05 was considered to indicate a statistically significant difference. The primary outcomes included Target Lesion Revascularization (TLR), Myocardial Infarction (MI), Stent Thrombosis (ST) and Total Mortality (TM). Results: Compared with patients who underwent UCB angioplasty, those in the PCB group exhibited a clear superiority in TLR [odds ratio (OR), 0.21; 95% CI [ 0.11,0.41]; P&lt;0.00001], and MI [odds ratio (OR), 0.55; 95% CI [0.33,0.91]; P&lt;0.02]. ST was numerically lower in the PCB arm without statistical significance (OR, 0.21; 95% CI [0.03,1.48]; P=0.11). TM was also numerically lower with PCB without reaching statistical significance (OR, 0.60; 95% CI [0.32,1.11]; P=0.10). Conclusion: This meta analysis supports that PCBs are associated with superior outcomes when compared with UCBs in the management of ISR. Paclitaxel-coated balloons are an effective treatment option for patients with coronary in-stent restenosis as demonstrated by superior outcomes in target lesion revascularization and recurrent myocardial infarction.

Abstract 4136442: Efficacy and Safety of Paclitaxel-coated balloons versus Uncoated balloons in the Management of Coronary in-stent restenosis: a Meta Analysis of Randomized Controlled Trials

Introduction: Coronary in-stent restenosis (ISR) remains challenging despite stent technology advancements. Paclitaxel-coated balloons (PCB) offer a promising non-implant approach to deliver antiproliferative agents directly to the vessel wall. This meta-analysis aims to evaluate the comparative effectiveness of PCB versus uncoated balloons (UCB) in managing coronary ISR to address emerging safety concerns. Methodology: Medline, Scopus and Embase were searched until April 2024 for randomized controlled trials (RCTs) comparing PCB versus UCB in patients undergoing coronary ISR. Primary outcomes were in-segment late lumen loss (LLL), binary restenosis, target lesion revascularization (TLR), major adverse cardiac events (MACE), and mortality. Secondary outcomes included in-stent LLL, in-stent binary restenosis, myocardial infarction (MI), cardiac death, target vessel MI, and target vessel revascularization (TVR). Results: This meta-analysis includes seven RCTs with 1,408 patients (PCB = 864, UCB = 544). PCB significantly reduced in-segment LLL (MD= -0.50, 95% CI [-0.67, -0.33]; P &lt; 0.00001), in-segment binary restenosis (RR= 0.25, 95% CI [0.14, 0.45]; P &lt; 0.00001), target lesion revascularization (RR= 0.43, 95% CI [0.32, 0.58]; P &lt; 0.00001), mortality (RR=0.56, 95% CI [0.39, 0.80]; P=0.001), and MACE (RR= 0.36, 95% CI [0.25, 0.51]; P &lt; 0.00001). PCB also significantly decreased in-stent LLL (MD= -0.52, 95% CI [-0.72, -0.32]; P &lt; 0.00001), in-stent binary restenosis (RR = 0.19, 95% CI [0.11, 0.35]; P &lt; 0.00001), and TVR (RR = 0.45, 95% CI [0.29, 0.70]; P = 0.0003). PCB showed a short-term reduction in MACE and target lesion revascularization at 6 months, 1 year and 3 years of followup. No difference was observed in MI, cardiac death, or target vessel MI. Conclusion: In patients with coronary ISR, PCB are associated with reduced in-segment LLL, in-segment binary restenosis events, target lesion revascularization, mortality, MACE, in-stent LLL, in-stent binary restenosis and target vessel revascularization.

Abstract 4137019: Paclitaxel-Coated Balloon vs Uncoated Balloon for Coronary In-Stent Restenosis: A Systematic Review and Meta-analysis of Randomized Controlled Trials

Background: Despite the effectiveness of drug-eluting stents (DES) in preventing restenosis, many patients still experience DES restenosis. Neointimal hyperplasia and neoatherosclerosis can develop within these stents, leading to recurrent coronary syndromes. Hypothesis: Repeated stenting with DES is limited by additional metal layers, the need for prolonged dual antiplatelet therapy, and heightened risks of stent thrombosis. Locally acting drugs with sustained efficacy may prevent this progression. Paclitaxel delivery via contrast medium or drug-coated balloon catheters could exert antiproliferative effects, reducing neointimal proliferation. Aims: To synthesize existing evidence on the efficacy and safety of Paclitaxel-Coated Balloons versus Uncoated Balloons in coronary in-stent restenosis. Methods: Following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, we searched five electronic databases (PubMed, EMBASE, Cochrane Library, Scopus, and Web of Science) to identify eligible studies reported up to March 23, 2024. Using R version 4.4.0, we reported outcomes as risk ratios (RRs) or mean differences (MD) and confidence intervals (CIs). This review has been registered and published in PROSPERO (CRD42024527412). Results: The meta-analysis included a total of six trials with 1,541 patients. PCB significantly reduced the incidence of myocardial infarction (RR 0.65, 95% CI [0.42, 1.00], p = 0.052), stent thrombosis (RR 0.26, 95% CI 0.08, to 0.83], p = 0.023), major adverse cardiac events (RR 0.32, 95% CI 0.25, to 0.42], P &lt; 0.001), target lesion revascularization (RR 0.34, 95% CI [0.14, 0.84], p &lt; 0.001). No significant differences were observed between PCB and UCB regarding cardiac-related mortality, target vessel revascularization, percutaneous coronary intervention, all-cause death, Q wave and non-Q wave myocardial infarction, coronary artery bypass grafting, and target vessel failure. Conclusion: PCB for ISR significantly reduced the incidence of myocardial infarction, MACE, and stent thrombosis compared to UCB.

Abstract 4120966: Outcomes Following Balloon Angioplasty with Drug Coated Versus Uncoated Balloons in Patients with Coronary In-Stent Restenosis: A Systematic Review and Meta-Analysis

Background &lt;div&gt; &lt;/div&gt; &lt;div&gt;The development of in-stent restenosis (ISR) has emerged as a substantial barrier to interventional treatment for coronary heart disease. Drug-coated balloon (DCB) is an efficacious interventional technique for the management of ISR. This meta-analysis compares the efficacy of DCB in the treatment of ISR with that of an uncoated balloon (UCB).&lt;/div&gt; &lt;div&gt; &lt;/div&gt; &lt;div&gt;Methods&lt;/div&gt; &lt;div&gt; &lt;/div&gt; &lt;div&gt;We comprehensively searched literature on MEDLINE, Embase, Cochrane, and clinicaltrials.gov using MeSH terms and relevant keywords for “Balloon Angioplasty” and “in-stent Restenosis” from inception to June 1, 2024, followed by a meta-analysis of all randomized controlled trials (RCTs) to assess both strategies for treatment of ISR. Random effects model was used to aggregate the risk ratios (RR) for dichotomous and mean differences (MD) for continuous outcomes, with 95% confidence intervals (CI).&lt;/div&gt; &lt;div&gt; &lt;/div&gt; &lt;div&gt;Results&lt;/div&gt; &lt;div&gt; &lt;/div&gt; &lt;div&gt;The search strategy retrieved 2330 studies. Duplicates and irrelevant articles were removed and data from seven RCTs (1,408 patients) was extracted. The mean age ranged from 64 to 74 years. The mean clinical follow-up ranged from 1 to 10 years. DCB was found to be superior to UCB at latest follow up in terms of target lesion revascularization (TLR) (RR 0.34, 95% CI 0.19-0.58; p 0.0001; I2 79%), major adverse cardiovascular events (MACE) (RR 0.41, 95% CI 0.23-0.73; p 0.003; I2 84%), late lumen loss (LLL) (MD -0.46 mm, 95% CI -0.64- -0.28]; p &lt;0.00001; I2 64%), and target vessel revascularization (TVR) (RR 0.45, 95% CI 0.29-0.70; p 0.0003; I2 67%). The two groups were comparable at latest follow up in terms of mortality (RR 0.87, 95% CI 0.65-1.16; p 0.35; I2 0%), cardiac death (RR 0.89, 95% CI 0.66-1.19; p 0.43; I2 0%), myocardial infarction (MI) (RR 0.70, 95% CI 0.39-1.24; p 0.22; I2 28%) and stent thrombosis (RR 0.22, 95% CI 0.04-1.10; p 0.06; I2 46%).&lt;/div&gt; &lt;div&gt; &lt;/div&gt; &lt;div&gt; &lt;/div&gt; &lt;div&gt; &lt;/div&gt; &lt;div&gt;Conclusion&lt;/div&gt; &lt;div&gt; &lt;/div&gt; &lt;div&gt;DCB showed promising results in the treatment of patients with coronary ISR. DCB outperformed UCB in significantly reducing TLR, MACE, LLL and TVR risks. The risk of mortality, cardiac death, MI, and stent thrombosis was similar between DCB and UCB.&lt;/div&gt; &lt;div&gt; &lt;/div&gt; &lt;div&gt; &lt;/div&gt;

Outcome of Coronary Edge In-stent Restenosis Management by Restenting Versus Drug-Eluting Balloon

Abstract Background: The optimal therapeutic strategy for coronary intervention in edge in-stent restenosis (edge ISR) remains less well-defined. Aim: The aim of this study was to assess 12-month outcomes of re-stenting using drug-eluting stents (DESs) versus using drug-eluting balloon (DEB) for managing coronary edge ISR. Patients and Methods: One hundred and four patients with edge ISR were randomly assigned to either DES or DEB. The primary endpoint was stent failure at 12-month follow-up. Results: Significantly lower target vessel revascularization among the DEB group compared to restenting group, (7.7% vs. 23.1%, P = 0.04). Likewise, target vessel-related myocardial infarction rate was significantly lower among the DEB group than restenting (5.7% vs. 23.1%, P = 0.04). On the other hand, there were no significant differences in the rates of deaths or restenosis between the two groups. Conclusion: The DEB is superior to the DES with better both safety and efficacy.

Comparative outcomes of drug-coated balloon angioplasty versus second-generation drug-eluting stent for in-stent restenosis: a real-world data analysis

Abstract Background Coronary in-stent restenosis (ISR) poses a significant challenge in interventional cardiology, with optimal treatment strategies being the subject of ongoing debate. Current clinical guidelines offer a choice between drug-coated balloon angioplasty (DCB) and repeat stenting with second-generation drug-eluting stents (DES), each with distinct implications for long-term patient outcomes. Purpose The aim of this study is to compare 1-year outcomes between DCB angioplasty and second-generation DES in the treatment of ISR. Longitudinal real-world data are used from the OBSERVABLE database, which comprises German health claims data between 2012 and 2021. Methods A total of 10,440 ISR individuals undergoing DCB or DES intervention were identified. After exclusion of bare-metal stents, first generation stents and non-DCBs, 3,810 propensity score-matched individuals remained. The primary outcome was the composite of all-cause mortality and myocardial infraction (MI). Secondary outcomes included all-cause death, MI, and bleeding as a safety outcome. Results At 1-year follow-up, the primary outcome of all-cause mortality and MI was observed in 246 individuals (12.9%) in the DES group, compared with 201 individuals (10.6%) in the DCB group (HR, 1.27; 95% CI, 1.06-1.53). Sensitivity analysis confirmed the robustness of these findings. Secondary outcomes revealed higher all-cause mortality in the DES group (7.9%) compared to the DCB group (6.3%) (HR, 1.31; 95% CI, 1.03-1.66), with no difference in MI. Bleeding events were comparable between the two treatments, with 244 individuals (12.8%) in the DES group and 206 individuals (10.8%) in the DCB group (HR, 1.17; 95% CI, 0.89-1.53). Conclusion This real-world data analysis demonstrated a higher incidence of the primary composite endpoint of all-cause mortality and MI within one year, after treatment with DES compared to DCB. Our results support prior findings about the safety profile of repeated DES implantation and strengthen DCB as a potential superior alternative to DES in ISR management.

Diagnostic performance of coronary computed tomography angiography for coronary in-stent re-stenosis

Abstract Background Through the development of CT equipment and proper preparation before CT scanning, the accuracy of Coronary computed tomography angiography (CCTA) diagnosis of ischemic heart disease (IHD) is improving, and the role of CCTA in treatment decision is gradually expanding. The latest guidelines recommend CCTA as Class IIa to evaluate stent patency and native vessels in patients with chronic coronary disease. However, diagnostic performance of CCTA to evaluate stent patency in patients who underwent coronary stent was not clarified, respectively the role of CCTA in the evaluation of IHD in native coronary artery was established.. Purpose In the present study, we evaluate the agreement between CCTA and CAG in assessing stent patency in patients with de novo ischemic chest pain who underwent percutaneous coronary intervention (PCI) and evaluated which factors contribute to the differences. Methods From January 1, 2010 to December 31, 2020, we analyzed 845 patients who underwent new CCTA and CAG sequentially for the evaluation of chest pain previously underwent PCI. In CAG and CCTA, ISR is equally defined as a stenosis greater than 50% of the vessel diameter of within the stented segment or its edge (5-mm segments adjacent to the stent). The degree of In-stent restenosis was analyzed by an independently by quantitative coronary angiography (QCA). Results A total of 208 stents were analyzed, the pooled sensitivity and specificity for CCTA on the diagnosis of ISR were 0.78 (0.65-0.89) and 0.93 (0.88-0.96), respectively. LR+ and LR- were 11.19 (6.22-20.15) and 0.23 (0.14-0.39). As a result of analyzing the ISR diagnostic agreement of CCTA by dividing into ACS and CCD group, the agreement of CCTA for ISR diagnosis was relatively low in the ACS group (Sensitivity 0.69 (0.48-0.86) vs. 0.88 (0.69-0.97), specificity 0.92 (0.84-0.97) vs. 0.94 (0.86-0.98), LR+ 9 (4-20.24) vs. 13.9 (5.88-32.88), LR- 0.33 (0.19-0.6) vs. 0.13 (0.04-0.37)) (Table 1). As a result of analyzing related factors in cases of discrepancy in ISR diagnosis, the degree of stenosis in both ACS and CCD groups was mostly intermediate stenosis, which often required additional clinical evaluation (Figure 1). Conclusion When new ischemic chest pain occurred in a patient who previously underwent PCI, the diagnostic accuracy of ISR by CCTA differed depending on the patient’s IHD category. In the CCD group, the diagnostic usefulness of CCTA was comparable both native vessels and ISR, but not in the ACS group. As majority of ISR diagnostic discrepancies were in intermediate lesions, even in the ACS group, CCTA may be considered as a diagnostic tool.

Data-driven reduced order surrogate modeling for coronary in-stent restenosis

Background:The intricate process of coronary in-stent restenosis (ISR) involves the interplay between different mediators, including platelet-derived growth factor, transforming growth factor-β, extracellular matrix, smooth muscle cells, endothelial cells, and drug elution from the stent. Modeling such complex multiphysics phenomena demands extensive computational resources and time. Methods:This paper proposes a novel non-intrusive data-driven reduced order modeling approach for the underlying multiphysics time-dependent parametrized problem. In the offline phase, a 3D convolutional autoencoder, comprising an encoder and decoder, is trained to achieve dimensionality reduction. The encoder condenses the full-order solution into a lower-dimensional latent space, while the decoder facilitates the reconstruction of the full solution from the latent space. To deal with the 5D input datasets (3D geometry + time series + multiple output channels), two ingredients are explored. The first approach incorporates time as an additional parameter and applies 3D convolution on individual time steps, encoding a distinct latent variable for each parameter instance within each time step. The second approach reshapes the 3D geometry into a 2D plane along a less interactive axis and stacks all time steps in the third direction for each parameter instance. This rearrangement generates a larger and complete dataset for one parameter instance, resulting in a singular latent variable across the entire discrete time-series. In both approaches, the multiple outputs are considered automatically in the convolutions. Moreover, Gaussian process regression is applied to establish correlations between the latent variable and the input parameter. Results:The constitutive model reveals a significant acceleration in neointimal growth between 30−60 days post percutaneous coronary intervention (PCI). The surrogate models applying both approaches exhibit high accuracy in pointwise error, with the first approach showcasing smaller errors across the entire evaluation period for all outputs. The parameter study on drug dosage against ISR rates provides noteworthy insights of neointimal growth, where the nonlinear dependence of ISR rates on the peak drug flux exhibits intriguing periodic patterns. Applying the trained model, the rate of ISR is effectively evaluated, and the optimal parameter range for drug dosage is identified. Conclusion:The demonstrated non-intrusive reduced order surrogate model proves to be a powerful tool for predicting ISR outcomes. Moreover, the proposed method lays the foundation for real-time simulations and optimization of PCI parameters.

Mitophagy related diagnostic biomarkers for coronary in-stent restenosis identified using machine learning and bioinformatics

Percutaneous coronary intervention (PCI) combined with stent implantation is currently one of the most effective treatments for coronary artery disease (CAD). However, in-stent restenosis (ISR) significantly compromises its long-term efficacy. Mitophagy plays a crucial role in vascular homeostasis, yet its role in ISR remains unclear. This study aims to identify mitophagy-related biomarkers for ISR and explore their underlying molecular mechanisms. Through differential gene expression analysis between ISR and Control samples in the combined dataset, 169 differentially expressed genes (DEGs) were identified. Twenty-three differentially expressed mitophagy-related genes (DEMRGs) were identified by intersecting with mitophagy-related genes (MRGs) from the GeneCards, and functional enrichment analysis indicated their significant involvement in mitophagy-related biological processes. Using Weighted Gene Co-expression Network Analysis (WGCNA) and three machine learning algorithms (Logistic-LASSO, RF, and SVM-RFE), LRRK2, and ANKRD13A were identified as mitophagy-related biomarkers for ISR. The nomogram based on these two genes also exhibited promising diagnostic performance for ISR. Gene Set Enrichment Analysis (GSEA) as well as immune infiltration analyses showed that these two genes were closely associated with immune and inflammatory responses in ISR. Furthermore, potential small molecule compounds with therapeutic implications for ISR were predicted using the connectivity Map (cMAP) database. This study systematically investigated mitophagy-related biomarkers for ISR and their potential biological functions, providing new insights into early diagnosis and precision treatment strategies for ISR.

TCT-493 Drug-Coated Balloon Angioplasty vs Plain Balloon Angioplasty in Patients With Coronary In-Stent Restenosis: A Meta-Analysis of Randomized Controlled Trials

TCT-493 Drug-Coated Balloon Angioplasty vs Plain Balloon Angioplasty in Patients With Coronary In-Stent Restenosis: A Meta-Analysis of Randomized Controlled Trials

TCT-494 Between a Stent and a Hard Place: Insights Into Percutaneous Coronary Interventions and In-Stent Restenosis in Cancer Patients

TCT-494 Between a Stent and a Hard Place: Insights Into Percutaneous Coronary Interventions and In-Stent Restenosis in Cancer Patients

TCT-501 Paclitaxel-Coated Balloon vs Uncoated Balloon Angioplasty for Coronary In-Stent Restenosis: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

TCT-501 Paclitaxel-Coated Balloon vs Uncoated Balloon Angioplasty for Coronary In-Stent Restenosis: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

TCT-495 The Impact of Cutting Balloon Predilation on the Outcomes of Paclitaxel Drug-Coated Balloon Treatment for Coronary In-Stent Restenosis

TCT-495 The Impact of Cutting Balloon Predilation on the Outcomes of Paclitaxel Drug-Coated Balloon Treatment for Coronary In-Stent Restenosis

In-Stent Re-Endothelialization Strategies: Cells, Extracellular Matrix, and Extracellular Vesicles.

Arterial stenosis caused by atherosclerosis often requires stent implantation to increase the patency of target artery. However, such external devices often lead to in-stent restenosis due to inadequate re-endothelialization and subsequent inflammatory responses. Therefore, re-endothelialization strategies after stent implantation have been developed to enhance endothelial cell recruitment or to capture circulating endothelial progenitor cells. Notably, recent research indicates that coating stent surfaces with biogenic materials enhances the long-term safety of implantation, markedly diminishing the risk of in-stent restenosis. In this review, we begin by describing the pathophysiology of coronary artery disease and in-stent restenosis. Then, we review the characteristics and materials of existing stents used in clinical practice. Lastly, we explore biogenic materials aimed at accelerating re-endothelialization, including extracellular matrix, cells, and extracellular vesicles. This review helps overcome the limitations of current stents for cardiovascular disease and outlines the next phase of research and development.