A randomized feasibility study of the effect of ascorbic acid on post-angioplasty restenosis of hemodialysis vascular access (NCT03524846)

Abstract

Restenosis remains a significant problem after angioplasty of hemodialysis vascular access. Both experimental and clinical studies have shown a protective effect of antioxidants against post-angioplasty restenosis. A prospective, randomized, feasibility study was conducted to investigate the effect of ascorbic acid to prevent restenosis. Ninety-three hemodialysis patients were randomized into three groups after angioplasty: placebo (n = 31), 300 mg ascorbic acid (n = 31), and 600 mg ascorbic acid (n = 31), treated intravenously 3 times per week for 3 months. Eighty-nine completed the clinical follow-up, and 81 had angiographic follow-up. In the angiographic follow-up, the mean (stand deviation) late loss of luminal diameter for the placebo, 300 mg, and 600 mg groups were 3.15 (1.68) mm, 2.52 (1.70) mm (P = 0.39 vs. placebo group), and 1.59 (1.67) mm (P = 0.006, vs. placebo group), with corresponding angiographic binary restenosis of 79%, 67% (P = 0.38 vs. placebo group), and 54% (P = 0.08 vs. placebo group). The post-interventional primary patency rates at 3 months were 47%, 55% (P = 0.59 vs. placebo group), and 70% (P = 0.18 vs. placebo group) for placebo, 300 mg, and 600 mg groups. Our results demonstrated that intravenous 600 mg ascorbic acid was a feasible therapy and might attenuate restenosis after angioplasty; however, its effect on post-interventional primary patency was modest.

Vascular smooth muscle cells in intimal hyperplasia, an update

“…Given the role of oxidative stress in IH, several clinical trials have assessed whether ascorbic acid (vitamin C) could limit restenosis over the years. Unfortunately, these studies usually reported modest effects of vitamin C on the incidence of restenosis ( Nunes et al, 1995 ; Tomoda et al, 1996 ; Yang et al, 2019 ). In the multivitamins and Probucol (MVP) large study, a combination of antioxidant Probucol, vitamins C and E and beta-carotene showed promising results against restenosis after angioplasty.…”

Targeting smooth muscle cell phenotypic switching in vascular disease

“… 81 In the setting of cancer, where dysregulated TET2 can contribute to oncogenesis, promoting TET activity with vitamin C induces cancer cell cytotoxicity and slows tumor growth. 82 Several clinical studies have assessed whether antioxidant therapy can limit restenosis, 83 , 84 , 85 reporting that oral vitamin C decreased the incidence of restenosis after angioplasty 83 and vitamin C, in combination with vitamin E, decreased coronary allograft vasculopathy. 86 Intravenous vitamin C also decreased restenosis after angioplasty for dialysis access.…”

“… 86 Intravenous vitamin C also decreased restenosis after angioplasty for dialysis access. 84 Another trial found no benefit of vitamin C after PCI, but this discrepancy could be due to the confounding effects of coadministered compounds. 85 Improved delivery, such as intravenously or via a stent, could potentially improve outcomes; cancer trials have revealed the importance of pharmacokinetics, with far greater plasma vitamin C concentrations achievable with intravenous vs oral administration.…”

Evaluation of Therapeutic Effects of Computed Tomography Imaging Classification Algorithm-Based Transcatheter Arterial Chemoembolization on Primary Hepatocellular Carcinoma

“…Even if they receive surgical treatment, 5-year survival rate reaches only 7% [5]. ere are many local therapeutic methods for unresectable tumors, and the primary one is transcatheter arterial chemoembolization (TACE) [6]. Imaging examination is a signi cant means of diagnosing liver tumors, which can re ect the overall condition of tumors noninvasively.…”