Restenosis Group Research Articles

HMOX1 gene promoter polymorphism is not associated with coronary artery disease in Koreans.

BackgroundThe heme oxygenase-1 gene (HMOX1) promoter polymorphisms modulate its transcription in response to oxidative stress. This study screened for HMOX1 polymorphisms and investigated the association between HMOX1 polymorphisms and coronary artery disease (CAD) in the Korean population.MethodsThe study population consisted of patients with CAD with obstructive lesions (n=110), CAD with minimal or no lesions (n=40), and controls (n=107). Thirty-nine patients with CAD with obstructive lesions underwent follow-up coronary angiography after six months for the presence of restenosis. The 5'-flanking region containing (GT)n repeats of the HMOX1 gene was analyzed by PCR.ResultsThe numbers of (GT)n repeats in the HMOX1 promoter showed a bimodal distribution. The alleles were divided into two subclasses, S25 and L25, depending on whether there were less than or equal to and more than 25 (GT)n repeats, respectively. The allele and genotype frequencies among groups were statistically not different. More subjects in the S25-carrier group had the low risk levels of high sensitivity C-reactive protein (hsCRP) for the CAD than those in the non-S25 carrier group (P=0.034). Multivariate logistic regression analysis revealed that the genotypes of (GT)n repeats were not related to CAD status. The restenosis group in the coronary angiography follow-up did not show any significant difference in HMOX1 genotype frequency.ConclusionsThe HMOX1 genotypes were not found to be associated with CAD, but the short allele carrier group contained more individuals with hsCRP values reflecting low risk of cardiovascular disease in the Korean population.

Ultrasound Findings After Endovascular Stent Deployment in Transplant Liver Hepatic Artery Stenosis

Endovascular stenting is a safe, effective treatment of hepatic artery stenosis after liver transplant, but no detailed evaluation has been completed of changes in ultrasound monitoring parameters after stenting. This study aims to improve poststenting surveillance by delineating the expected postoperative findings. Thirty-one stent procedures were performed at our institution for hepatic artery stenosis after liver transplant between October 2010 and October 2012. Of these, 28 (90%) were technically successful, of which 23 met the minimum follow-up time (76 days, defined by the earliest diagnosed restenosis). These patients were followed with serial ultrasound, per the following schedule: within 1 week of stenting, 3 months after stenting, 6 months after stenting, and every 6 months thereafter; additional, unscheduled examinations were frequently performed when indicated on the basis of deterioration of clinical and laboratory status. Follow-up examinations (mean, 268 days total follow-up) were compared with prestenting examinations to evaluate changes in peak systolic velocity (PSV), resistive index (RI), and tardus-parvus waveforms. Data were analyzed to determine a normal range for postprocedure values and time course of change in values. Of the 23 patients, six experienced restenosis. In all patients, mean PSV decreased by 124 cm/s, and mean RI increased by 0.13 within 48 hours after stenting. PSV differed between patency and restenosis groups only at more than 90 days after stenting (mean PSV, 234 and 400 cm/s, respectively), with PSV above 300 cm/s serving as a high-sensitivity threshold for the determination of restenosis. Prestenting RI of below 0.40 had a strong correlation with restenosis. Poststenting RI differed between patency and restenosis groups only at more than 48 hours after stenting, with RI of below 0.55 having a strong correlation with restenosis. Tardus-parvus waveform resolution was often delayed well beyond 48 hours after stenting, and time to tardus-parvus waveform resolution had no correlation with patency or restenosis. Ultrasound is convenient and useful to follow stents in hepatic artery stenosis after liver transplant. Prestenting hemodynamics can have value in predicting restenosis. Diagnosis of restenosis can be made with RI and PSV, whereas resolution time of tardus-parvus waveform is of less concern. These parameters can guide which patients require closer monitoring and aggressive treatment.

Grayscale median analysis of primary stenosis and restenosis after carotid endarterectomy

Several studies have reported that echolucent carotid lesions, as determined by grayscale median (GSM) analysis, are associated with increased perioperative embolic complications during carotid artery stenting (CAS). However, there is limited research of the predictive value of GSM analysis comparing values for primary atherosclerotic lesions in the carotid artery with those for recurrent lesions after carotid endarterectomy (CEA). Retrospective data were collected and analyzed from all patients undergoing CAS from November 2005 to August 2010. Available preoperative images amenable to GSM analysis were processed in Adobe Photoshop (version CS4; San Jose, Calif). Statistical analysis included t-test, Fischer exact test, and generation of a receiver operating characteristic curve. With at least 29 days of follow-up, 212 patients underwent 228 CAS procedures. There were 189 stents placed for primary lesions (CAS for primary stenosis group) and 39 stents placed for restenosis after CEA (CAS for restenosis group). GSM analysis was feasible for 47 patients, and the mean GSM was 45.6 (n = 34; 95% confidence interval, ± 8.3) for the primary stenosis group and 20.5 (n = 13; 95% confidence interval, ±9.6) for the restenosis group (P < .01). The mean time from CEA to CAS intervention for the restenosis group was 8.6 years. There was no statistical difference in procedural individual and combined complications of ipsilateral stroke, 30-day stroke, or 30-day mortality between the CAS for primary stenosis group and the CAS for restenosis group. In the primary stenosis group, the mean GSM was lower in those with procedural complications compared with those without complications (15 ± 22 vs 49 ± 8; P = .02). A low GSM value was associated with increased perioperative risk when CAS was performed for native carotid lesions, but a low GSM value was not associated with higher procedural risk when carotid stenting was performed for carotid stenosis after CEA (restenosis). GSM analysis for restenosis may be altered by the time interval from CEA to restenosis.

Using Oxidized Low-Density Lipoprotein Autoantibodies to Predict Restenosis after Balloon Angioplasty in Patients with Acute Myocardial Infarction

ObjectivesOxidized low-density lipoproteins (oxLDL) and oxidized low-density lipoprotein autoantibodies (OLAB) have been detected in human plasma and atherosclerotic lesions. OLAB appear to play a role in the clearance of oxLDL from circulation. Higher levels of OLAB appear to be associated with a reduced risk of a wide range of cardiovascular diseases. We investigated the prognostic value of plasma oxLDL and OLAB in patients undergoing primary coronary balloon angioplasty for acute ST-elevation myocardial infarction (STEMI).MethodsPlasma oxLDL and OLAB concentrations were measured in 56 patients with acute STEMI before primary angioplasty, and then 3 days, 7 days and 1 month after the acute event. Follow-up angiography was repeated 6 months later to detect the presence of restensosis (defined as >50% luminal diameter stenosis). The thrombolysis in myocardial infarction (TIMI) risk score was calculated to determine the relationship between OLAB/oxLDL ratio and TIMI risk scores.ResultsOf the 56 patients, 18 (31%) had angiographic evidence of restenosis. Plasma OLAB concentrations were significantly lower in the restenosis group before angioplasty (181±114 vs. 335±257 U/L, p = 0.003), and at day 3 (155±92 vs. 277±185 U/L, p<0.001) and day 7 (177±110 vs. 352±279 U/L, p<0.001) after the acute event. There was no difference in oxLDL concentration between the two groups. The ratio of OLAB/oxLDL positively correlated with TIMI risk scores before angioplasty (p for trend analysis, p = 0.004), at day 3 (p = 0.008) and day 7 (p<0.001) after STEMI.SignificanceA relative deficit of OLAB, and hence likely impaired clearance of oxLDL, is associated with the risk of arterial restenosis after primary angioplasty for acute STEMI.

Analysis of restenosis after carotid artery stenting: Preliminary results using computational fluid dynamics based on three-dimensional angiography

Currently carotid artery stenting (CAS) is a widely used technique for the treatment of carotid artery stenosis. However, some patients with restenosis following CAS have been reported, resulting in potential clinical problems. The purpose of this study was to investigate the hemodynamic changes before and after CAS to find the factors that may influence restenosis. Five patients (two with restenosis, three without restenosis) were included in this study. The geometry and rheological conditions of the carotid arteries were obtained from three-dimensional digital subtraction angiography and ultrasound measurements. Computational fluid dynamics (CFD) modelling was performed to calculate wall shear stress (WSS), wall shear stress gradient (WSSG) and internal carotid artery (ICA) flow ratio. In addition, morphologic analysis was carried out. CFD results indicated that the WSSG of the restenosis group was significantly larger than that of the no-restenosis group. In the restenosis group, the WSS distribution after CAS showed a significant variation at the ICA. The average ICA flow ratio of the restenosis group was 43.5%, while in the no-restenosis group it was 68.6%. Furthermore, there were similar significant differences between the two groups during morphology analysis. CFD technology is useful for physicians in estimating haemodynamic changes during ICA stenosis treatment. These parameters, including ICA flow ratio and WSS distribution, may help to predict carotid restenosis. In future, CFD combined with other medical techniques such as digital subtraction angiography, MRI and pathology technologies will be available for the clinical estimation of ICA restenosis.

Impact of drug-eluting balloon for the treatment of restenotic lesions involving coronary bifurcations

Objectives: To report clinical outcomes in patients treated with drug-eluting balloon (DEB) for in-stent restenosis (ISR) involving a bifurcation lesion. Background: Previous studies have examined the role of DEB in ISR but data on its use specifically at bifurcation sites is lacking. Methods: We retrospectively evaluated all patients who underwent percutaneous coronary intervention with DEB for bifurcation ISR between February 2007 and November 2012. Results: A total of 83 bifurcation restenoses (65 main-branch lesions and 73 side-branch lesions) in 77 patients in which DEB was used either in the main-branch and/or side-branch were analyzed. Thirty one (40.3%) patients were diabetic. The majority of restenosis was seen with first-generation drug-eluting stents (49.4%). Twenty-three (27.7%) bifurcations had already received a stent for a previous ISR (stent-in-stent). During the median follow-up period of 390 days, 18 (23.4%) major cardiac adverse events occurred: 2 (2.6%) cardiac deaths, 2 (2.6%) periprocedural myocardial infarctions, and 15 (19.5%) TVR, of which 10 (13.0%) were target lesion revascularizations (TLR) (n=11/83, 13.3% per bifurcation). There were no cases of follow-up MI or stent thrombosis (definite and probable). TLR was more frequently recorded in the stent-in-stent group (n=10/23, 43.5%), as compared to the first restenosis group (n=1/60, 1.7%). Conclusions: Our results demonstrate that DEB for bifurcation restenosis may be an acceptable treatment option, especially in cases where repeat stenting has not already been used for the treatment of a previous restenosis.

Long‐Term Clinical Follow‐Up after Drug‐Eluting Stent Implantation for Bare Metal In‐Stent Restenosis

We aimed to evaluate the long-term safety and efficacy of drug-eluting stent (DES) implantation in the treatment of diffuse bare metal stent (BMS) restenosis as compared to the treatment of de novo coronary lesions in high restenosis risk patient population. To date limited long-term data are available about the treatment of BMS restenosis with DES. Five hundred and fourteen consecutive patients who underwent DES implantation between January 2003 and October 2006 at our institute were studied: 201 patients received DES for treatment of BMS restenosis and 313 patients received DES for high restenosis risk de novo lesions. Outcomes were calculated using propensity score adjustment. Mean follow-up length was 45.6 ± 21.5 months. The rates of acute coronary syndrome, three-vessel disease, and diabetes were high in both restenosis and de novo groups: 44.8% versus 46.3%, 20.9% versus 28.7%, and 34.3% versus 38.9%, respectively. The incidence of ischemia-driven target lesion revascularization (TLR) yielded similar results in the restenosis group and de novo group at 4 years (10.4% vs 12.4%, P = 0.490). All-cause mortality was lower in the restenosis group at 4 years (7.4% vs 14.7%, P = 0.032); however, the incidence of definite and probable stent thrombosis did not differ (1.9% vs 1.6%, P = 0.708) between the 2 groups. DESs are safe in the treatment of diffuse BMS restenosis and the rate of additional TLR is acceptable as compared to the use of DES in de novo lesions.

Risk factors of in-stent restenosis of vertebral artery origin

Objective To evaluate risk factors of restenosis of vertebral artery origin after stenting. Methods A total of 144 continuous cases were collected for this retrospective analysis.More than 50% of stenosis in the original sites after treatment was defined as restenosis.Patients were divided into restenosis group (39 patients) and none-restenosis group (105 patients).The risk factors associated with restenosis were compared between the two groups by Chi-square test,including sex,age,presence of hypertension,diabetes,coronary heart disease,hyperlipidemia,smoking and drinking,the difference of preoperative neurological symptoms,combination with other vessels,stenosis,as well as stent type and stent size.Logistic regression was used to test the risk factors for restenosis. Results The incidence of restenosis of vertebral artery origin after stenting was 26.4%,and all of them occurred in 5 months.Between thetwo groups,there was no significant difference of distribution of sex (male 89,female 34,χ2=0.804,P=0.370),age (60 vs 21 patients of more than 60 years old,χ2=2.358,P=0.125),hypertension (67 vs 28 patients,χ2=0.253,P=0.615),diabetes (27 vs 9 patients,χ2=0.914,P=0.91),hyperlipidemia (6 vs 5 patients,χ2=0.478,P=0.489),coronary heart disease (32 vs 6 patients,χ2=2.489,P=0.115),smoking (50 vs 24 patients,χ2=0.129,P=0.719), drinking (20 vs 13 patients,χ2=0.001,P=0.978),diameter of stents (53 vs 18 patients of more than 4 mm,χ2=0.213,P=0.645),length of stents (45 vs 19 patients of more than 15 mm,χ2=0.927,P=0.336),preoperative neurological symptoms (93 vs 29 patients,χ2=0.250,P=0.617).There was significant difference of factors including combination with the bilateral stenosis (43 vs 24 patients,χ2=4.844,P=0.028),combination with the internal carotid artery stenosis (49 vs 26 patients,χ2=4.558,P=0.033) and stent types (59 vs 11 patients of drug eluting stent,χ2=8.916,P=0.003) between the two groups.Bare stents and combination with internal carotid artery stenosis were independent risk factors for restenosis by logistic regression. Conclusions The incidence of restenosis with vertebral artery origin occurs in 5 months after surgery.Bare stents and combination with internal carotid artery stenosis increased the incidence of restenosis,and preoperative neurological symptoms of vertebrobasilar system and presence of the bilateral stenosis may induce restenosis. Key words: Vertebral artery; Stent; In-stent restenosis; Risk factors

Association between C1019T polymorphism of the connexin37 gene and coronary heart disease in patients with in-stent restenosis

Studies have shown that a C1019T polymorphism of the gene encoding the gap junction protein connexin37 is associated with coronary artery disease (CAD). The aim of the present study was to explore the association between the C1019T polymorphism in the connexin37 gene and CAD patients with in-stent restenosis (ISR). A total of 532 patients who had undergone coronary stenting and coronary angiography at least three months after the procedure were divided according to a clinical diagnosis standard into two groups which were ISR (n=67) and no in-stent restenosis (NISR; n=465) groups. A further 501 healthy individuals were controls. The subjects were genotyped by DNA sequencing. The results demonstrated the following: i) connexin37 gene 1019 sites in the population were distributed by polymorphism into three genetic types (CC, TC and TT types). The distribution frequency of the healthy control, ISR and NISR groups conformed to the Hardy-Weinberg genetic balance rule; ii) in comparison with the healthy controls, the frequency of the connexin37 C allele was higher in the CAD patients (57.05% vs. 41.32%; OR, 1.89; 95% CI, 1.58–2.25; P<0.01). The frequency of the C carriers (CC+TC) was 65.47% in the healthy controls, vs. 79.32% in CAD patients (P<0.01). The CAD risk was significantly increased in the carriers of the C allele (CC+TC) compared with TT homozygotes (OR, 2.03; 95% CI, 1.53–2.80; P<0.01). Stratified analysis demonstrated that a significant difference existed in the frequency of C carriers between the male CAD patients and healthy controls (79.63% vs. 72.45%; OR, 1.48; 95% CI, 1.06–2.09, P=0.02), as well as in the female CAD patients (78.00% vs. 51.50%; OR, 3.34; 95% CI, 1.90–5.86; P<0.01). In the female and male CAD patients, the frequency of the connexin37 C allele was higher than in the healthy controls (male: χ2=12.67, P<0.01; female: χ2=50.20, P<0.01); iii) compared with the NISR group, the frequencies of the connexin37 C allele and C carriers (CC+TC) were significantly higher in the ISR group (frequency of C allele: 72.39% vs. 54.84%; P<0.01; frequency of C carriers: 89.55% vs. 77.85%; P=0.03). Compared with TT homozygotes, the restenosis risk was significantly increased in the carriers of the C allele (CC+TC; OR, 2.44; 95% CI, 1.08–5.50). Subsequent stratified analysis revealed that the frequency of the C allele was significantly higher in the male ISR group than in the male NISR group (78.57% vs. 52.66%; OR, 3.30; 95% CI, 2.05–5.29; P<0.01). The restenosis risk was ∼four-fold higher in the C carriers (CC+TC) than in the TT homozygotes (OR, 3.74; 95% CI, 1.32–10.64). However in the female population, there was no difference in the ISR risk between the carriers of the C allele (CC+TC) and the TT homozygotes (P=0.70). In summary, the C allele of the connexin37 gene is not only is associated with the susceptibility to CAD, but also associated with restenosis following coronary stenting in the population studied herein, particularly the male population.

Incidence of definite stent thrombosis or in‐stent restenosis after drug‐eluting stent implantation for treatment of coronary in‐stent restenosis: From Western Denmark heart registry

There are limited data on the optimal management of in-stent restenosis after percutaneous coronary intervention (PCI) with bare metal stent (BMS) or drug-eluting stent (DES) implantations. We assessed the clinical presentation, the incidence, and prognosis of definite stent thrombosis or restenosis after DES implantation for treatment of restenosis. From January 2002 to June 2005, all consecutive patients with restenosis < 12 months after index PCI with DES or BMS implantation, were identified in the population-based Western Denmark Heart Registry. Patients were followed until 24 months after their first restenosis. A total of 589 lesions were treated for clinically driven restenosis with target lesion revascularization (TLR) within 12 months after the index PCI. Among those, 302 lesions were treated with DES (BMS-restenosis n = 244 and DES-restenosis n = 58). Admission were due to stable angina pectoris (n = 249 (82.4%)), unstable angina pectoris (n = 34 (11.3%)), or non-ST segment elevation myocardial infarction (n = 19 (6.3%)). The clinical indication was not different between patients with BMS restenosis compared to DES restenosis. In the BMS restenosis group, older age, longer lesion, longer stent length, and a higher number of stents used was observed compared to the DES restenosis group. After a first restenosis, clinically driven re-TLR was seen in 26 (8.6%) patients within the following 24 months, stent thrombosis (median duration 155 days, interquartile range (IQR) 9-627 days) was seen in 3 lesions (1.0%), and secondary restenosis (median duration 168 days, IQR 88-266 days) was seen in 23 (7.6%) [DES restenosis group 6.9% vs. BMS restenosis group 7.8%, P = 0.818] lesions. The clinical presentation did not differ between BMS or DES and most patients present with stable angina pectoris. Risk of stent thrombosis or restenosis was not increased in patients with DES restenosis compared to patients with BMS restenosis treated with DES.

THE CORRELATION BETWEEN SERUM SULFATIDE AND RESTENOSIS IN CHINESE PATIENTS WITH CORONARY HEART DISEASE AFTER PERCUTANEOUS CORONARY INTERVENTION

ObjectivesThis study aims to determine the correlation between the concentration of serum sulfatide and restenosis after Percutaneous Coronary Intervention (PCI) in Chinese patients with Coronary Heart Disease (CHD).MethodsWe studied 68...

Angiographic Restenosis and Its Clinical Impact after Infrapopliteal Angioplasty

ObjectiveTo assess 3- and 12-month angiographic restenosis rates and their clinical impact after infrapopliteal angioplasty. DesignProspective multicenter study. Materials and methodsWe analyzed 68 critical ischemic limbs (tissue loss: 58 limbs) from 63 consecutive patients due to isolated infrapopliteal lesions who underwent angioplasty alone. Primary endpoint was 3-month angiographic restenosis rate; secondary endpoints were 12-month angiographic restenosis rate, and 3- and 12-month rates of mortality, major amputation and reintervention. Three- and 12-month frequency of ambulatory status and of freedom from ischemic symptoms, and time to wound healing in the ischemic wound group, were compared between restenotic and non-restenotic groups. Angiographic restenosis predictors were assessed by multivariable analysis. Results95% of cases had 3-month angiography; restenosis rate was 73%: 40% restenosis and 33% re-occlusion. Twelve-month follow-up angiography was conducted for the patients without 3-month angiographic restenosis, and restenosis rate at 12 months was 82%. Non-administration of cilostazol and statin, and chronic total occlusion were 3-month angiographic restenosis predictors. Three- and 12-month mortality was 5% and 12%, respectively. Despite no patients having undergone amputation, 15% had persistent ischemic symptoms, and 48% of limbs underwent reintervention within 12 months. During the same study period, ambulatory status and limbs with complete healing were more frequently observed in the non-restenosis group than in the restenosis group. In the tissue loss group, time to wound healing in the restenosis group was longer than in the non-restenosis group (127 days vs. 66 days, p = 0.02). ConclusionThe extremely high angiographic restenosis rate after infrapopliteal angioplasty may adversely impact clinical status improvement.

Stent implantation in the superficial femoral artery: Short thrombelastometry-derived coagulation times identify patients with late in-stent restenosis

IntroductionThe mechanisms of restenosis, the recurrence of luminal narrowing, are complex and incompletely understood to date. Thrombin, the pivotal enzyme in haemostasis, presumably contributes to the formation of in-stent restenosis (ISR). It was therefore the aim of our study to investigate whether blood coagulation/thrombin generation plays a critical role in the formation of ISR in peripheral artery disease patients with stent angioplasty in the superficial femoral artery. Materials and MethodsWe aimed to examine in this retrospective study whether patients with high-degree restenosis (50-75% lumen diameter reduction, n=20) are in a hypercoaguable state implying enhanced readiness to generate thrombin compared to patients with low-degree restenosis (<50% lumen diameter reduction, n=14). ResultsThe coagulation tests calibrated automated thrombography, activated partial thromboplastin time, platelet aggregation, platelet adhesion, fibrinogen, and microparticles’ procoagulant activity did not indicate a different coagulation status in the two patient groups. However, the thrombelastometry-derived value Coagulation Time (CT) was significantly shorter in the high-degree restenosis group (p=0.012), indicating a hypercoagulable state of patients with high-degree restenosis. Under our experimental conditions, CTs shorter than 444.5s identify patients at high risk (sensitivity=95%) for luminal narrowing. ConclusionsOur study supports the assumption that blood coagulation/thrombin generation plays a critical role in the development of ISR in peripheral arteries after stent insertion and that the thrombelastometry-derived CT might be a suitable value to identify peripheral artery disease patients at risk for development of high-degree in-stent restenosis in the superficial femoral artery.

The Predictive Value of ΣΔST/ΔHR Index for Restenosis after Percutaneous Coronary Intervention

ObjectiveTo find out the predictive value of the ΣΔST/ΔHR index for restenosis after percutaneous coronary intervention (PCI).MethodSubjects of this research were patients who participated in a cardiac rehabilitation (CR) program as six to eight weeks of a hospital-based program after receiving PCI to treat acute coronary syndrome (ACS). The patients received coronary angiography (CAG) at the onset of the ACS and nine months after that, and also received an exercise tolerance test (ETT) at the start of the CR program and several days before receiving a follow-up CAG. In ETT, we used the sum of the ST depression (ΣΔST index) of leads II, III, aVF, V4-6 as well as the sum of the ΔST/ΔHR (heart rate) (ΣΔST/ΔHR index) in the same leads and the sum of the ΔST/ΔRPP (rate pressure product) (ΣΔST/ΔRPP index) in the same leads. We compared the predictive power of each index of ETT for restenosis after PCI.ResultsThe sensitivity, specificity, positive predictive value, and negative predictive value of ΣΔST index were 69%, 47%, 31%, and 82%. The ΣΔST/ΔHR index was 13.7±5.2 in the restenosis group and 9.3±5.6 in the patent group (p=0.017). The sensitivity, specificity, positive predictive value, and negative predictive value of this index were 85%, 63%, 44%, and 92%. The ΣΔST/ΔRPP index were 0.10±0.08 in the restenosis group and 0.06±0.04 in the patent group (p=0.016). The sensitivity, specificity, positive predictive value, and negative predictive value of this index were 54%, 76%, 44%, and 83%.ConclusionThe ΣΔST/ΔHR index showed a much higher sensitivity and negative predictive value for restenosis after PCI compared to the ΣΔST index.

Relations between Plasma von Willebrand Factor or Endothelin-1 and Restenosis following Carotid Artery Stenting

Objective: This study was designed to investigate the relation between plasma von Willebrand factor (VWF) or endothelin-1 (ET-1) and post-carotid artery stenting (CAS) restenosis. Materials andMethods: Plasma levels of VWF and ET-1 were measured in 61 patients (36 males, mean age 64.4 ± 6.8 years) before and after CAS. The mean follow-up time was 13.8 ± 1.7 months (range, 6–63). In-stent restenosis was defined as a >10% narrowing of the vascular lumen with or without ischemic symptoms following CAS. Results: In-stent restenosis was identified in 14 (23%) patients, including 3 with >50% restenosis. In the restenosis group, mean VWF and ET-1 levels at 2 weeks, 1 and 6 months after CAS were higher than the baseline levels (p < 0.05 or p < 0.01). Mean levels of VWF and ET-1 in the restenosis group were higher than in the non-restenosis group within 6 months after CAS (p < 0.05 or p < 0.01). Conclusion: Persistent elevation in plasma VWF and ET-1 within the first 6 months of CAS was found in patients with in-stent restenosis.

Identification of Biomarkers of Stent Restenosis With Serum Metabolomic Profiling Using Gas Chromatography/Mass Spectrometry

Despite the establishment of guidelines for the secondary prevention of coronary artery diseases, many patients still develop restenosis after stent implantation. Therefore, novel and noninvasive serum biomarkers that can identify restenosis-prone conditions are necessary to improve the follow-up and treatment of patients with coronary artery disease. Of late, considerable attention is being focused on metabolomics, which is the comprehensive analysis of low-molecular-weight metabolites. This study investigated the use of serum metabolomics in the identification of biomarkers of restenosis. Gas chromatography/mass spectrometry was used to obtain the serum metabolomic profiles of male patients hospitalized for follow-up coronary angiography 6 months after stent implantation; 23 patients presented with major restenotic lesions (≥75% obstruction), 47 with minor restenotic lesions (≤50% obstruction), and 16 with de novo atherosclerotic lesions. Of 83 serum metabolites analyzed, molecules - isobutylamine, sarcosine, homoserine, ribulose, taurine, glutamine, glucose, and tryptophan - in the major restenosis group were significantly different from those in the minor restenosis group. Differences in correlation among these metabolites imply possible alternations in the activated metabolic pathways. This study provides the first line of evidence for the use of serum metabolic profiling in the identification of specific biomarkers of stent restenosis.

Third in‐stent restenosis in sirolimus eluting stents

We evaluated the predictive factors for recurrent restenosis lesions treated on two previous occasions with sirolimus-eluting stents (SES). Angiography data related to recurrent SES restenosis have not been reported. Binary restenosis was observed in 66 patients with 78 lesions from a total of 1,393 patients with 1,965 lesions who received follow-up angiography after SES implantation. We enrolled 55 patients with 67 lesions who underwent revascularization using another SES with a second follow-up coronary angiography. These restenotic lesions were divided into two groups based on the presence or absence of recurrent restenosis: no recurrent restenosis group (n = 56) and recurrent restenosis group (n = 11). The coronary angiography data during first and second SES implantation were compared between the groups. Minimal lumen diameter (MLD) was smaller before first and second percutaneous coronary interventions (PCI) with SES implantation in the recurrent restenotic group compared with no recurrent restenosis group (first PCI, 0.28 ± 0.19 mm vs. 0.54 ± 0.42 mm, P = 0.040; second PCI, 0.44 ± 0.36 mm vs. 0.69 ± 0.39 mm, P = 0.036, respectively). Acute stent recoil after second SES implantation was significantly greater in the recurrent restenosis group compared with no recurrent restenosis group (0.08 ± 0.17 mm vs. 0.20 ± 0.22 mm, P = 0.049, respectively). Multivariate analysis showed preprocedural MLD at first PCI and acute stent recoil at second PCI as independent predictors of recurrent restenosis. Preprocedural smaller MLD at first PCI and acute stent recoil at second PCI are predictors of recurrent restenosis treated on two previous occasions with SES.

M-008 LOWER OXIDIZED LDL AUTOANTIBODIES PREDICT RESTENOSIS IN ACUTE MYOCARDIAL INFARCTION PATIENT AFTER PRIMARY BALLOON ANGIOPLASTY

Background Oxidized low-density lipoproteins (ox-LDLs) and their autoantibodies (OLAB) have been detected in human plasma and in atherosclerosis lesion. OLAB have a role in the clearance of oxLDLs from circulation and might be protective against the risk of atherosclerosis. However, the prognostic value of circulating OLAB in patients with acute myocardial infarction (AMI) is unknown. Methods and Results Fifty-eight AMI patients undergoing primary coronary balloon angioplasty were recruited. Plasma levels of oxLDLs and OLAB were measured using competitive ELISA method. Measurements were taken before primary angioplasty, on the 3rd day, on the 7th day and at 1 month after acute event. After 6 month follow-up, angiographic coronary artery restenosis occurred in 18 patients (31%). Plasma OLAB levels were significantly lower in restenosis group. The serial OLAB levels were presented as follows: before PCI (190.9 ± 118.5 vs. 330.8 ± 254.8 U/L, P = 0.006), on the 3rd day (155.2 ± 90.00 vs. 273.6 ± 184.1 U/L, P = 0.004), on the 7th day (189.1 ± 120.2 vs. 337.1 ± 276.0 U/L, P = 0.001) and at 30 days (310.2 ± 305.0 vs. 337.1 ± 326.0 U/L, P = 0.769). However, the serial oxLDLs levels were without significant difference between restenosis and non-restenosis group. The oxLDLs levels before PCI (66.80 ± 19.72 vs. 67.24 ± 22.48 mg/dL, P = 0.939), on the 3rd day (59.25 ± 16.17 vs. 66.33 ± 19.91 mg/dL, P = 0.407), on the 7th day (50.82 ± 12.55 vs. 53.62 ± 16.37, P = 0.514) and at 0 days (54.70 ± 22.11 vs. 60.22 ± 29.70, P = 0.476) were presented. Conclusion Lower levels of circulating OLAB in acute and subacute stage of AMI patients, can predict restenosis of infarct related artery after primary angioplasty. Our data support the notion that OLAB play a role in the maintenance of vascular health.

Ambulatory blood pressure variability is associated with restenosis after percutaneous coronary intervention in normotensive patients

BackgroundPrevious studies have showed that BP variability is associated with cardiovascular events. However, no data were available regarding binary restenosis as an end-point after percutenous coronary intervention (PCI). Methods and resultsThis multicenter study included 100 consecutive normotensive patients with stable coronary artery disease who were planned for PCI. Before the index procedure, office BP and 24-h ambulatory BP measurements were performed. BP variability indices including systolic and diastolic 24-h average, the day and the night values of standard deviation (SD) and variation coefficient (VC) were measured and calculated. All patients underwent repeat coronary angiography at 6-month. According to angiographic results, 2 groups were formed; a restenosis group (n=30) with binary restenosis of the stented segment and a control group (n=70) with a stenosis diameter of <50% in stented segment. Systolic SD and VC values for 24-h average (14.0±2.8mmHg vs. 9.5±1.6mmHg, p<0.001 and 16%±3 vs. 11%±2, p<0.001, respectively), the day (15.2±3.9mmHg vs. 10.6±1.7mmHg, p<0.001 and 17%±4 vs. 12%±2, p<0.001, respectively), and the night (12.8±4.1mmHg vs. 8.4±2.4mmHg, p<0.001 and 14%±5 vs. 11%±3, p=0.004, respectively) values were significantly higher in restenosis group compared to control group. Similarly, diastolic SD and VC values for 24-h average (10.6±2.5mmHg vs. 8.1±1.5mmHg, p<0.001 and 12%±3 vs. 9%±2, p=0.001, respectively), the day (11.1±2.9mmHg vs. 9.0±1.8mmHg, p=0.003 and 12%±3 vs. 10%±2, p=0.006, respectively), and the night (10.0±3.6mmHg vs. 7.2±2.0mmHg, p=0.001 and 11%±5 vs. 9%±3, p=0.059, respectively) values were significantly higher in restenosis group compared to no restenosis group except for diastolic VC night. All systolic and diastolic BP variability indices except diastolic VC night were found to be independent predictors of risk of restenosis in multivariate analysis. In addition, the cut-off values of 11.4mmHg and 13% for 24-h systolic SD and VC, respectively, were found to be highly sensitive (93% for both) and specific (94% and 91%, respectively) for predicting binary restenosis at 6-month after PCI. ConclusionsBP variability indices are significantly and independently associated with binary restenosis and higher values can predict restenosis after PCI sensitively and specifically.

Timing of the restenosis following nitinol stenting in the superficial femoral artery and the factors associated with early and late restenoses

We sought to investigate the timing of restenosis and the restenosis factors following nitinol stenting in the superficial femoral artery (SFA). Restenosis following nitinol stenting in the SFA remains unsolved. We analyzed 742 limbs in consecutive 585 patients who underwent successful endovascular therapy for de novo SFA lesions. Patency was assessed by duplex ultrasonography. Primary patency was defined as treated vessels without restenosis and secondary patency was defined as target vessels reopened by repeat revascularization. Receiver-operating characteristic (ROC) analysis was performed to delineate the timing of restenosis. Patients were subsequently classified into three groups: no restenosis, early restenosis, and late restenosis. Cox proportional hazard regression analyses were performed to explore the determinants of restenosis in each restenosis group. Primary and secondary patency was 67 and 86% at 6 years, respectively. ROC curves indicated the 369th day was the best cutoff point distinguishing the early (144 limbs) and the late (42 limbs) restenoses. Sustained patency was observed in 556 limbs. After multivariate analysis, cilostazol (P = 0.0007) was negatively associated; female gender (P = 0.0071), diabetes mellitus (P = 0.0428), critical limb ischemia (P = 0.0435), and stent fracture (P = 0.0004) were positively associated with the early restenosis. Trans Atlantic Inter-Society Consensus II C/D was positively associated with both the early (P = 0.0017) and the late (P = 0.0359) restenoses. Restenosis predominantly occurred within a year following nitinol stenting in the SFA, and the factors associated with the early restenosis were different from those with the late restenosis.