Risk Of Restenosis Research Articles

Clariant begins construction of flame retardants production facility in China

The goal of debulking strategies in endovascular interventions for peripheral arterial disease is to achieve a more uniform angioplasty result through plaque removal or plaque modification. This minimizes vessel wall barotrauma and maximizes acute luminal gain at lower inflation pressures. Improvement in drug delivery and reduced risk of restenosis with the use of a debulking strategy prior to the drug coated balloon (DCB) is hypothesized as an added benefit. However, the long-term benefits of atherectomy remain unclear with some studies suggesting worse outcomes with atherectomy. There are a plethora of debulking devices available to treat calcified peripheral arterial disease which will be reviewed in this book chapter.

Transradial versus trans-femoral access site in high-speed rotational atherectomy in Sweden

BackgroundRadial artery is the preferred access site in contemporary percutaneous coronary intervention (PCI). However, limited data exist regarding utilization pattern, safety, and long-term efficacy of transradial artery access (TRA) PCI in heavily calcified lesions using high-speed rotational atherectomy (HSRA). MethodsAll patients who underwent HSRA-PCI in Sweden between 2005 and 2016 were included. Outcomes were major adverse cardiac events (MACE, including death, myocardial infarction (MI) or target vessel revascularisation (TVR)), in-hospital bleeding and restenosis. Inverse probability of treatment weighting was used to adjust for the non-randomized access site selection. ResultsWe included 1479 patients of whom 649 had TRA and 782 transfemoral artery access (TFA) HSRA-PCI. The rate of TRA increased significantly by 18% per year but remained lower in HSRA-PCI (60%) than in the overall PCI population (85%) in 2016.TRA was associated with comparable angiographic success but significantly lower risk for major (adjusted OR 0.16; 95% CI 0.05–0.47) or any in-hospital bleeding (adjusted OR 0.32; 95% CI 0.13–0.78). At one year, the adjusted risk for MACE (HR 0.87; 95% CI 0.67–1.13) and its individual components did not differ between TRA and TFA patients. The risk for restenosis did not significantly differ between TRA and TFA HSRA-PCI treated lesions (adjusted HR 0.92; 95% CI 0.46–1.81). ConclusionHSRA-PCI by TRA was associated with significantly lower risk for in-hospital bleeding and equivalent long-term efficacy when compared with TFA. Our data support the feasibility and superior safety profile of TRA in HSRA-PCI.

Value of M2BP in predicting in-stent restenosis in patients after coronary drug-eluting stent implantation.

ObjectiveWe evaluated the association between plasma levels of mac‐2 binding protein (M2BP) with the risk of in‐stent restenosis (ISR) after percutaneous coronary intervention (PCI).MethodsPlasma M2BP levels were compared between 258 patients who experienced ISR at 12‐months post‐PCI and 258 patients, matched for age and sex, without angiographic evidence of ISR.ResultsThe plasma M2BP level was significantly higher in the ISR than in the non‐ISR group. On multivariate analysis, adjusted for potential clinical, biochemical, and angiography characteristics, M2BP remained as an independent significant predictor of ISR.ConclusionsM2BP may be an important predictive biomarker of ISR and may be useful in identifying at‐risk patients.

Effect of angiotensin converting enzyme gene polymorphism on patients with in-stent restenosis after percutaneous coronary intervention


 
 
 
 Purpose: To evaluate the association between common single nucleotide polymorphisms (SNPs) in angiotensin converting enzyme (ACE) gene and the risk of in-stent restenosis (ISR) and/or the response to angiotensin converting enzyme inhibitor ACEI in individuals with stable coronary artery disease (CAD) after stent implantation.
 Methods: The total population of this study consisted of 200 Egyptian individuals divided into 2 groups - in-stent restenosis (ISR) and non ISR group). Genomic DNA was withdrawn from EDTA whole blood applying a spin column approach and ACE gene insertion/deletion (I/D) polymorphisms were determined by polymerase chain reaction (PCR).
 Results: Carriers of allele D of ACE gene were significantly more liable to ISR occurrence. However, carriers of allele I were significantly more liable to ISR occurrence after administration of ACEI. There is a negative interaction between DD genotype of ACE gene and ACEI administration on ISR after percutaneous coronary intervention (PCI). However, there is a positive interaction between II and ID genotype of ACE gene and ACEI administration on ISR after PCI with bare metal stents (BMS).
 Conclusion: It is beneficial to implement ACEI in therapeutic regimen in individuals with ID or II genotypes of ACE gene, especially with BMS implementation.
 
 
 

Endothelial Cell Distribution After Flow Exposure With Two Stent Struts Placed in Different Angles.

Stent implantation has been a primary treatment for stenosis and other intravascular diseases. However, the struts expansion procedure might cause endothelium lesion and the structure of the struts could disturb the blood flow environment near the wall of the blood vessel. These changes could damage the vascular innermost endothelial cell (EC) layer and pose risks of restenosis and post-deployment thrombosis. This research aims to investigate the effect of flow alterations on EC distribution in the presence of gap between two struts within the parallel flow chamber. To study how the gap presence impacts EC migration and the endothelialization effect on the surface of the struts, two struts were placed with specific orientations and positions on the EC layer in the flow chamber. After a 24-h exposure under wall shear stress (WSS), we observed the EC distribution conditons especially in the gap area. We also conducted computational fluid dynamics (CFD) simulations to calculate the WSS distribution. High EC-concentration areas on the bottom plate corresponded to the high WSS by the presence of gap between the two struts. To find the relation between the WSS and EC distributions on the fluorescence images, WSS condition by CFD simulation could be helpful for the EC distribution. The endothelialization rate, represented by EC density, on the downstream sides of both struts was higher than that on the upstream sides. These observations were made in the flow recirculation at the gap area between two struts. On two side surfaces between the gaps, meaning the downstream at the first and the upstream at the second struts, EC density differences on the downstream surfaces of the first strut were higher than on the upstream surfaces of the second strut. Finally, EC density varied along the struts when the struts were placed at tilted angles. These results indicate that, by the presence of gap between the struts, ECs distribution could be predicted in both perpendicular and tiled positions. And tiled placement affect ECs distribution on the strut side surfaces.

Predictive Value of Perioperative Cytokine Levels on the Risk for In-Stent Restenosis in Acute Myocardial Infarction Patients.

To investigate the value of perioperative cytokine levels in predicting the risk for in-stent restenosis in patients with acute myocardial infarction. 452 patients with acute myocardial infarction admitted to our hospital between June 2018 and June 2020 were prospectively selected as subjects. All patients underwent percutaneous coronary intervention. The baseline data of the patients were collected. Venous blood was taken before, 24 hours, and 3 days after the operation to detect the levels of related cytokines. Follow-up was performed for 1 year. The patients were assigned to restenosis and nonrestenosis groups according to the presence and absence of restenosis. Multivariate logistic analysis was used to explore the influencing factors of the risk for in-stent restenosis in patients with acute myocardial infarction. By July 1, 2021, 449 cases had been followed up. Of them, 44 cases suffered from in-stent restenosis and 405 cases did not affect in-stent restenosis. The incidence of in-stent restenosis was 9.80%. Before, 24 hours, and 3 days after the operation, the lipoprotein-associated phospholipase A2 (Lp-PLA2) level was significantly higher in the restenosis group than that in the nonrestenosis group. At 3 days after the operation, the interleukin 6 (IL-6) level was significantly higher in the restenosis group than that in the nonrestenosis group (P < 0.05). Multivariate logistic analysis displayed that Lp-PLA2 level preoperatively (OR = 1.048, 95% CI 1.029–1.068), Lp-PLA2 level 24 hours postoperatively (OR = 1.013, 95% CI 1.007–1.019), Lp-PLA2 level 3 days postoperatively (OR = 1.032, 95% CI 1.015–1.048), and IL-6 level 3 days postoperatively (OR = 1.020, 95% CI 1.000–1.040) were risk factors for in-stent restenosis (all P < 0.05). IL-6 and Lp-PLA2 levels can predict the risk for in-stent restenosis in patients with acute myocardial infarction in the perioperative period.

Factors predicting mitral restenosis after successful percutaneous mitral commissurotomy

Percutaneous mitral commissurotomy (PMC) is the alternative treatment of choice for mitral stenosis (MS). Its immediate and medium term results are comparable to those of surgical commissurotomy, however in the long term there is a risk of restenosis. The purpose of this study is to determine the factors predicting restenosis after PMC. Three hundred and twenty-two patients (66% women), average age: 35 ± 13 years (9–75 years) having a tight MS and treated by PMC with Inoué balloon. The anatomic aspect of the mitral apparatus before PMC has been studied according to the criteria of the Wilkins score with a concomitant study of the state of mitral commissures. The primary success of PMC is defined as follows: mitral area (MA) post-PMC >1,5 cm2 and gain in MA > 25% and mitral regurgitation (MR) ≤ grade 2. Mitral restenosis is defined as a MA < 1,5 cm2 and/or loss > 50% of initial gain in MA. The rate of primary success of PMC was 86% and mean MA post PMC was 1,82 ± 0,33 cm2 compared to MA pre-PMC of 1 ± 0,18 cm2 (P < 0.0001). Opening of two commissures has been observed in 74% of patients. After an average period of 62 ± 32 months, only 12% of patients had a dyspnea stage III-IV of NYHA, MA was 1,64 ± 0.3 cm2 (P < 0.001) and mitral restenosis happened in 47 patients (20%) after a period of 60,48 ± 27 months (22–124 months). The independent predictors of mitral restenosis after a successful PMC were: previous surgical commisurotomy, Wilkins score > 8, MA after PMC < 1,8 cm2 and absence of bicommissural opening post PMC. A favorable anatomy of mitral apparatus and the optimisation of immediate result of PMC are the guaranty for the maintain of good result in the long term.

Recent advances in inhibiting atherosclerosis and restenosis: from pathogenic factors, therapeutic molecules to nano-delivery strategies.

Due to dominant atherosclerosis etiology, cardiovascular diseases (CVDs) remain the leading cause of morbidity and mortality worldwide. In clinical trials, advanced atherosclerotic plaques can be removed by angioplasty and vascular transplantation, but the severe risk of vascular restenosis remains, which needs to be urgently improved. After understanding and generalizing the pathological processes and cellular mechanism of certain atherosclerosis and restenosis, their essential pathogenic factors show noteworthy similarity, primarily including endothelium injury, excessive proliferation of smooth muscle cells (SMCs), and pathogenic inflammatory responses. These common pathogenic factors inspire researchers to develop co-target treatments for these atherosclerosis and restenosis. Numerous therapeutic agents such as nucleic acids, proteins, small molecule drugs and gas signaling molecules for co-target treatments are summarized in this paper. To improve the safety and effectiveness of therapeutic agents, high-performance nanodelivery strategies have been developed for anti-atherosclerosis via systemic administration and anti-restenosis via local administration. They can augment blood circulation time and targeting ability for systemic administration, as well as efficient nanodrug load and precise release. Overall, this review aims to recapitulate the emerging therapeutic molecules and nanodelivery strategies for the treatment of atherosclerosis and restenosis, with the goal of mutual enlightenment in exploring therapeutic approaches for these diseases.

ЭКОНОМИЧЕСКАЯ ЭФФЕКТИВНОСТЬ ИСПОЛЬЗОВАНИЯ РАЗЛИЧНЫХ ТИПОВ СТЕНТОВ ПРИ КОРРЕКЦИИ ХРОНИЧЕСКИХ ОККЛЮЗИЙ КОРОНАРНЫХ АРТЕРИЙ

Aim. To study cost-effectiveness of different types of stents in the correction of chronic total occlusion (CTO). Methods. The study included 119 patients after successful coronary artery CTO recanalization in 2009–2012. After 6.1±0.9 months and 12.7±1.6 months a control examination was performed (coronary angiography, intravascular ultrasound, optical coherence tomography). Negative events (in-stent restenosis and thrombosis) were analyzed. Taking into account the obtained data, direct costs were calculated including the cost of implants, and the cost of restenosis and thrombosis treatment. Results. The highest frequency of in-stent restenosis (p &lt; 0.05) was registered after IntrepideTM (in 57.1% cases) and Prolim® (in 47.4% cases) stent implantation while the similar events in cases of Taxus® Express 2, Xience V®/Xience Prime® LL, Endeavor® Resolute, Nobori® stent implantation were registered in 0-11.1% of cases. There weren’t differences in the thrombosis incidence between studied types of implants (p &gt; 0.05). Based on the data obtained, the stents were classified as devices with low rate of adverse events (Taxus® Express 2, Xience V®/Xience Prime® LL, Endeavor® Resolute, Nobori® – LRAE group), and those with a high rate of restenosis and thrombosis (IntrepideTM and Prolim® – HRAE group). The average cost of stents in the LRAE group was 2155.1 US dollars. Endovascular correction of in-stent restenosis were performed in 6.3% of cases, thrombosis – in 1.3%, the average direct treatment cost per patient over 12.7±1.6 months totaled 3906.4 US dollars. In the HRAE group the cheaper devices were implanted (median cost was $1650.8). Repeated PCIs due to restenosis were performed in 52.5% of cases, one patient (2.5%) with verified thrombosis underwent CABG. The average direct treatment cost per patient over 12.7±1.6 months period was 4993.5 US dollars, which was $1,087.1 more than in the LRAE group. Conclusion. The obtained data indicate higher financial cost during 12.7±1.6 months follow-up period after IntrepideTM and Prolim® stent implantation in the recanalized CTO areas. This emphasizes the impotance of using coronary stents with proven minimal risks of in-trastent restenosis and thrombosis in CTO cases.

Computer modeling of the area of carotid endarterectomy with patches of various forms

To describe geometric models of carotid artery bifurcation and computer modeling of carotid endarterectomy (CEA) with patches of various configurations. The method was demonstrated on a reconstructed model of intact vessel based on preoperative CT of the affected vessel in a certain patient. Blood flow is modeled by computational fluid dynamics using Doppler ultrasound data. Risk factors were assessed considering hemodynamic parameters of vascular wall associated with WSS. We studied hemodynamic results of 10 virtual CEA with patches of various shapes on the example of a reconstructed intact artery in a particular patient. Patch implantation is aimed at prevention of carotid artery narrowing since simple suture without a patch can reduce circumference of the artery by 4-5 mm. This result adversely affects blood flow. On the other hand, too wide a patch creates aneurysm-like deformation of internal carotid artery bulb. It is not optimal due to a large recirculation zone. It was found that patch width approximately equal to 3 mm ensures an optimal hemodynamic result. Deviations from this median value, both upward and downward, impair hemodynamics while the absence of a patch results the worst result. The proposed computer modeling technique is able to provide a personalized patch selection for CEA with low risk of restenosis in long-term follow-up period.

Применение расширенной эндоскопической фронтотомии у пациентки c рецидивирующим мукоцеле лобной пазухи

A clinical case in patient with a recurrent frontal sinus mucocele is described. An extended endoscopic frontotomy of the Draf IIb type was performed; a mucoperiosteal flap was used to prevent postoperative stenosis of the neo-ostium. However, within a year after the intervention, ostium stenosis developed with recurrence of the mucocele due to severe hyperostosis, which required repeated surgical treatment. The method of choice was an extended frontotomy of the Draf III type using a combination of pedicled flap and free mucosal graft to reduce the risk of restenosis of the frontal sinus ostium.

MiR-146a gene variant rs2910164 might be associated with coronary in-stent restenosis risk: Results from a pilot study and meta-analysis

Coronary in-stent restenosis (ISR) is an adverse effect that occurs in 20-35% of patients who have undergone percutaneous coronary intervention (PCI) with stent implantation. The fact that not all patients will develop ISR indicates that genetic factors contribute to ISR susceptibility. Previous studies have reported that various micro RNA (miRNA) molecules regulate biological processes underlying ISR development, including miR-146a which is involved in regulation of vascular smooth muscle cells proliferation and neointima formation. Nucleotide variants in miRNA genes can affect the function of mature miRNAs. mir-146a rs2910164 gene variant is located in the seed region of mature miR-146a, key region for the regulation of target mRNAs. The current study aimed to examine the association between rs2910164 variant in mir-146a gene and coronary ISR risk in a group of Serbian patients and to enhance the study by performing a meta-analysis. Samples of peripheral blood were obtained from 61 patients who previously underwent PCI with stent implantation, 25 (41%) of which had angiographically confirmed ISR. There were no significant differences in allele and genotype distribution of rs2910164 variant between patients with and without ISR. In a Serbian group of patients, the analyzed variant was not associated with the ISR risk. Results of the meta-analysis showed that heterozygous GC genotype is associated with decreased risk to ISR (OR=0.475, P=0.006), indicating its protective role in ISR formation.

A Narrative Review of Contemporary Global Perspectives into Epidemiology, Treatment, and Prognosis of Vertebrobasilar Strokes

Blood flow interruptions to the posterior cerebral circulation hallmark vertebrobasilar strokes (VBS), leading to mortality and significant disabilities, yet optimal therapy prevails unpublished. Recent epidemiological evidence indicates that VBS account for nearly 1/5 of all ischemic strokes globally, with acute basilar artery occlusion (BAO) contributing significant disabilities in nearly 1/3 of the victims. The prevalence of VBS in Africa is close to 5%, majorly in large intracranial vessels. Etiologically, Stenosis accounts for 20% of all VBS, while aneurysms face up to a 3% rupture rate. Furthermore, intravenous alteplase is the gold standard medical therapy for the cases presenting within 3 to 4.5 hours post-baseline regarding management options. Nevertheless, there is no consensus for BAO beyond 4.5 hours post-onset. Stent retrievers are the first-line endovascular reperfusion therapy device proposed. However, an 18% risk of in-stent restenosis is a significant drawback. Comprehensive prognostic factors are addressed in this review. However, prospective, multicenter, controlled studies are needed to clarify the time window dilemmas facing posterior circulation strokes. This narrative review explores recent VBS epidemiology, management advances, and prognosis.Rwanda J Med Health Sci 2021;4(3):418-429

Efficacy of drug coated balloon versus conventional balloon in the treatment of coronary de novo bifurcation lesions: a meta-analysis

Objective: To systematically evaluate the efficacy of drug coated balloon (DCB) versus conventional balloon in the treatment of coronary de novo bifurcation lesions. Methods: The databases of PubMed, Embase, Cochrane Library, Web of science, CNKI (China National Knowledge Infrastructure), Wanfang database, VIP, China Biology Medicine disc, Chinese clinical trial registry, American clinical trial registry and cardiovascular related websites until September 2020 were retrieved for collecting the randomized controlled trials (RCT) comparing DCB versus conventional balloon in the treatment of coronary de novo bifurcation lesions. The risk of bias of included studies was assessed using the Cochrane risk assessment tool. The meta-analysis was performed by using Revman 5.3 and Stata 14.0 software. Results: Seven RCTs with a total of 613 patients were included in this meta-analysis. Among the included studies, 4 articles reached the low risk of bias, and the other 3 articles reached the medium risk of bias. The results of meta-analysis showed that there was no significant difference in the major adverse cardiac events (RR=0.65, 95%CI 0.39-1.08, P=0.10), myocardial infarction (RR=0.68, 95%CI 0.25-1.80, P=0.43), target lesion revascularization (RR=0.94, 95%CI 0.53-1.67, P=0.83) between DCB group and conventional balloon group. Late lumen loss of side branch was less in the DCB group than that in the conventional balloon group (WMD=-0.25, 95%CI -0.41--0.09, P<0.01) and the risk of side branch restenosis was also lower in the DCB group than that in the conventional balloon group (RR=0.47, 95%CI 0.22-0.98, P<0.05). However, subgroup analysis showed that the conclusions of domestic studies and foreign studies on late lumen loss and side branch restenosis were inconsistent. The meta-analysis based on domestic literature showed that the risk of side branch restenosis after DCB treatment was lower compared with conventional balloon group (RR=0.29, 95%CI 0.15-0.57, P<0.05), while this parameter derived from foreign literatures remained unchanged between two groups (P=0.53). The meta-analysis results of domestic literature showed that late lumen loss in DCB group was less than that in conventional balloon group (WMD=-0.32, 95%CI -0.51--0.13, P<0.05), but this phenomenon was not observed in foreign literatures (P=0.30). Conclusions: The use of DCB in the treatment of coronary de novo bifurcation lesions has the potential to reduce the rate of restenosis and late lumen loss of side branch compared with conventional balloon group. However, due to the limitation on quantity, quality and results of published studies, more high-quality and large scale RCTs are still needed to confirm these findings.

Effects of residual stenosis on carotid artery after stent implantation: A numerical study

Stent deployments with residual stenosis (RS) were linked to increased risk of in-stent restenosis and thrombosis. The objective of the present work was to explore the underlying biomechanical mechanism(s) for adverse events with RS. The patient-specific carotid models with RS were constructed to investigate wall shear stress (WSS), velocity, relative residence time (RRT), and oscillating shear index (OSI) after stenting in the host artery. The results showed that stented artery accompanied by RS would result in evident vortex, stagnation and recirculation zone at the stenosis throat, where relatively more areas were at abnormal low level of TAWSS, high level of RRT and OSI. Moreover, effects of stenting with RS on velocity, WSS, RRT and OSI in host artery would be significantly enhanced by severe RS, long stent and common carotid artery (CCA) stenting. These results indicated that stenting with RS might aggravate adverse flow around the stent and the other region without stent, leading to increased adverse events in clinic. Therefore, to obtain better poststenting outcomes, stenting with RS requires caution and careful consideration, especially for the host artery with a severe RS, long stent and some locations of stenting.

Candidate Gene of NOS3, MMP3, AGT, and AGT1R and Pathway Analyses for Platelet Reactivity and Clinical Outcomes of Repeat Revascularization After First PCI in Chinese Patients.

Major disadvantages of the percutaneous coronary intervention (PCI) are the high occurrence of repeat revascularization due to restenosis and disease progression. The current study aimed to identify indicators that can predict the risk of repeat revascularization. A total of 143 patients who underwent PCI and had genetic test results were enrolled. We retrospectively reviewed their medical records after the first PCI. P2Y12 reaction unit (PRU) test results were obtained by VerifyNow; 4 candidate genes (NOS3, MMP3, AGT, and AGT1R) and 380 genes related to platelet activation-related processes and clopidogrel activity were selected for analysis. Repeat revascularization and in-stent restenosis (ISR) were used as clinical outcomes, and PRU and ADP aggregation rates were used as platelet function outcomes in analysis. After the first PCI, the incidence of repeat revascularization at 18, 30, and 42months was 14.1% (20/142), 17.5% (24/137), and 39.7% (31/78), respectively. In the candidate gene analysis, rs7830 (NOS3) was associated with both ADP aggregation rate and 18- and 30-month ISR, and rs 62,275,847 (AGTR1) was associated with both ADP aggregation rate and 30-month ISR. In the pathway, gene-set analysis, the linkage rs471683 and rs7785386 of GNAI1|GNAT3 were associated with PRU and ADP aggregation rate, 18-month and 30-month ISR, and repeat revascularization within 30months. Rs1715389 of GNAI1|GNAT3 was associated with both PRU and ADP aggregation rate, 18-month and 30-month ISR, and repeat revascularization within 30months. Rs7313458 of ITPR2 was associated with PRU and ADP aggregation rate, 18-month and 30-month ISR, and repeat revascularization within 18months. The genetic polymorphisms of rs7830 (NOS3), rs62275874 (AGTR1), linkage rs471683 and rs7785386 (GNAI1|GNAT3), rs1715389 (GNAI1|GNAT3), and rs7313458 (ITPR2) may lead to an increased risk of in-stent restenosis and revascularization after the first PCI in Chinese patients by affecting the efficacy of clopidogrel. The above six SNP may be used as potential genetic biomarkers for high risk of in-stent restenosis and revascularization after the first PCI in Chinese patients.

Outcomes of carotid artery stenting in patients with radiation arteritis compared with those with atherosclerotic disease

ObjectiveHead and neck malignancies are often treated with radiotherapy (RT). Nearly 80% of patients who have undergone RT will develop carotid radiation arteritis to some degree and 29% will develop stenosis >50%. Surgery in a radiated neck has higher rates of complications, and carotid artery stenting (CAS) has become the primary therapy. The outcomes for CAS in patients with radiation arteritis have not been rigorously evaluated. The objective of the present study was to evaluate the differences in perioperative outcomes, restenosis rates, the need for reintervention, and freedom from mortality between RT patients and patients with atherosclerotic disease who had undergone CAS. MethodsThe national Vascular Quality Initiative CAS dataset from 2016 to 2019 comprised the sample for analyses (n = 7343). The primary independent variable was previous head and/or neck RT. The primary endpoint was the interval to mortality. The secondary endpoints were the cumulative incidence of restenosis (>50% and >70% by duplex ultrasound) and reintervention. We also examined the following secondary perioperative endpoints: myocardial infarction, in-hospital mortality (death before discharge), neurologic events, ipsilateral stroke, and contralateral stroke. Kaplan-Meier and multivariable Cox proportional hazard models were used to assess for mortality, and cumulative incidence function estimates were used for the nonfatal endpoints. ResultsOf the 7218 patients, 1199 (17%) had undergone prior RT. We found a significant difference in the 3-year estimates of mortality for those with and without prior RT (9.4% and 7.5%, respectively; P = .03). Furthermore, on adjusted analysis, we observed a 58% increase in the risk of mortality for those with prior RT (adjusted hazard ratio, 1.58; 95% confidence interval, 1.13-2.21). We did not observe any differences in the risk of perioperative complications (myocardial infarction, in-hospital mortality, ipsilateral or contralateral stroke), restenosis (>50% or >70%), or reintervention for the prior RT group compared with those without RT. ConclusionsThe CAS patients with RT had significantly greater mortality at all time points compared with those without RT, even after adjusting for other covariates. No significant difference was found in the incidence of perioperative complications, reintervention, or restenosis between the two groups. The present study is unique because of the large sample size and length of follow-up. The results suggest that for this high-risk group, CAS provides the same patency as it does for atherosclerotic carotid stenosis and avoids potentially morbid cranial nerve injury and wound healing complications.

The impact of plaque morphology in patients with peripheral artery disease on vessel dissection: an intravascular ultrasound observational study.

Drug-coated balloon (DCB) is now available for endovascular treatment (EVT) of superficial femoral arteries (SFA). Although it has been reported that severe vessel dissection after balloon angioplasty was risk of restenosis, it is difficult to predict the vessel dissection patterns before balloon angioplasty. We investigated the correlation between plaque morphology and vessel dissection pattern after balloon angioplasty using the intravascular ultrasound (IVUS). A total of 73 de novo SFA lesions were enrolled in this study. IVUS examinations were measured at the minimum lumen area in the control angiogram. Plaque morphology, minimum lumen area (MLA) and vessel diameter at the same point were evaluated before and after the initial balloon angioplasty. Vessel dissection patterns after the initial balloon angioplasty were classified into 7 types (A to F). There were no severe dissection patterns which were more than type D dissection in this study. All patients were treated with DCB without any bailout stenting. No dissection was found in 35.6% (26/73). Type A, B and C dissections were seen in 17.8% (13/73), 40% (27/73) and 9.6% (7/73), respectively. Although there were no relations between plaque morphology and vessel dissection patterns (p = 0.547), the MLA with dissection was larger than that without dissection (5.78mm2 versus 4.63mm2, p = 0.032). Although the dissection patterns could not be predicted in non-severe (Non or A to C) dissection, our result might suggest that IVUS image has the potential to reduce severe dissection.

Abstract 13030: Hyperglycemia Drives In-Stent Restenosis in STEMI Patients

Introduction: Hyperglycemia (HG) has been shown to adversely affect the outcome of ST-elevation myocardial infarction (STEMI). Hypothesis: We hypothesized that HG at hospital admission could increase the risk of in-stent restenosis after primary percutaneous coronary intervention (PCI) for STEMI. Methods: We enrolled consecutive STEMI patients referred to the division of Cardiology of "Antonio Cardarelli" Hospital in Naples, comparing normoglycemic subjects ( NG ), patients without diabetes mellitus but with HG ( HG-non-DM ), and patients with both HG and DM ( HG-DM ). Results: A total of 336 propensity score matched patients were included in the study: 112 NG, 112 HG-non-DM, and 112 HG-DM. At 1-year follow-up, 6.5% of NG patients, 14.0% of HG-non-DM, and 18.5% of HG-DM had been re-hospitalized for restenosis; Kaplan-Meier curves ( p : 0.009) are depicted in the Figure . We then examined these findings applying a multivariate analysis with Cox regression in HG-non-DM patients, observing a significant association with restenosis for glycemia at hospital admission, total and LDL-cholesterol. Conclusions: The present study is the first to evaluate the effects of HG on the risk of restenosis in STEMI patients without DM, comparing the results to both HG-DM and NG subjects. Taken together, our data indicate that HG is associated with adverse outcomes in STEMI patients independently of DM. These findings emphasize the importance of glycemic control in all STEMI patients in order to reduce the risk of complications.

Mean Platelet Volume Predicts Restenosis After Carotid Endarterectomy

Carotid restenosis following carotid endarterectomy (CEA) has a cumulative risk at 5-years up to 32%, which may impact the well-being of patients following CEA. Haematological parameters in the standard complete blood cell count (CBC) are emerging as potential biomarkers, but their application in CEA is scarce. The primary aim of this study was to investigate haematological markers for restenosis following CEA. The secondary aim was to characterize clinical risk factors for restenosis. From January 2012 to January 2019, 151 patients who underwent CEA under regional anaesthesia due to carotid stenosis were selected from a prospectively maintained cohort database. Patients were included if a preoperative CBC was available in the 2 weeks preceding CEA. Multivariable analysis was performed alongside propensity score matching (PSM) analysis, using the preoperative CEA parameters, to reduce confounding factors between categories. The study group comprised 28 patients who developed carotid restenosis. The remaining 123 patients without restenosis composed the control group. Mean age of the patients did not differ significantly between groups (70.25 ± 8.05 vs. 70.32 ± 9.61 YO, P = 0.973), neither did gender (male gender 89.3% vs. 78.9%, P = 0.206). Regarding haematological parameters, only MPV remained statistically significant within multivariable analysis (1.855, aOR [1.174-2.931], P = 0.008), a result supported by PSM analysis (2.072, aOR [1.036-4.147], P = 0.042). MPV was able to predict restenosis 2 years after CEA. Thus, MPV can be incorporated into score calculations to identify patients at greater risk of restenosis, who could benefit from specific monitoring during follow-up. While results are promising, more research is necessary to corroborate them.