Current Treatment of In-Stent Restenosis

Alfonso, Fernándo; Byrne, Robert A.; Rivero, Fernando; Kastrati, Adnan

doi:10.1016/j.jacc.2014.02.545

Cited by 466 publications

(367 citation statements)

References 97 publications

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“…Coronary angiogram revealed a mid-proximal LAD stenosis (Fig. 1J) adjacent to the proximal LAD BRS (scaffold restenosis, according to the current definition within 5 mm proximal and distal to the stent/scaffold [5]). The lesion was treated with a sirolimus drug-eluting stent.…”

mentioning

confidence: 94%

“Full Plastic-Jacket“: Reconstruction of 18 cm of coronary arteries with bioresorbable vascular scaffolds in a young patient with ST-elevation myocardial infarction and multivessel disease

Denegri

Frangieh²,

D’Ascenzo

et al. 2017

Cardiol J.

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mentioning

confidence: 94%

“Full Plastic-Jacket“: Reconstruction of 18 cm of coronary arteries with bioresorbable vascular scaffolds in a young patient with ST-elevation myocardial infarction and multivessel disease

Denegri

Frangieh²,

D’Ascenzo

et al. 2017

Cardiol J.

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“…Additionally, an extreme inflammatory response was detected post MI, and the improvement of inflammation had an important role in ventricular remodeling and promotion of left ventricular ejection fraction (LVEF) (5). In addition, In-Stent Restenosis (ISR) is one of the important complications after PCI, which depends on CV risk factors (6,7), such as inflammation (8), hyperlipidemia (9), and lesion features (10). A prior study indicated that Copyright ISR was common in patients undergoing PCI (6,11).…”

Section: Introductionmentioning

confidence: 99%

Effects of Therapeutic Lifestyle Change Diet and Q10 Plus L-Carnitine Supplementation on Inflammatory Biomarkers of In-Stent Restenosis, Lipid Profile, and Left Ventricular Ejection Fraction in Myocardial Infarction: A Randomized Clinical Trial

Sharifi

Eftekhari

Ostovan

et al. 2017

Iran Red Crescent Med J

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Background: Following Myocardial Infarction (MI) and percutaneous coronary intervention (PCI), the modification of cardiovascular risk factors and inflammation can improve MI progression and PCI outcomes. Up to now, no certain conclusions have been drawn regarding the effect of therapeutic lifestyle change (TLC) diet and a combination of Q10 plus L-carnitine (LC) supplementation on inflammatory biomarkers of In-Stent Restenosis (ISR), lipid profile, and Left ventricular ejection fraction (LVEF).Objectives: This study aimed to evaluate the effects of TLC diet and Q10 plus LC supplementation on inflammatory biomarkers of ISR, lipid profile, and LVEF following MI and PCI.Methods: This single-blind randomized controlled trial was conducted on 128 subjects. After randomization for treatment allocation, the subjects were divided into the study groups through block randomization. The MI patients were admitted to 2 hospitals, namely Al-Zahra and Kowsar (Shiraz, Iran), between April 2015 and May 2016. The patients were divided into 4 groups receiving TLC diet (A), oral Q10 150 mg/d and LC 1200 mg/d (B), a combination of LC plus Q10 and TLC diet (C), and the routine care (D). This study evaluated Interleukin-6 (IL-6) and high sensitive C-reactive protein (hs-CRP) as inflammatory biomarkers of ISR, lipid profile, and LVEF in 128 patients with MI undergoing PCI before and 3 months after the intervention. Results:The results showed a significant decrease in hs-CRP in groups B (11.8 ± 4.3 to 2.0 ± 1 mg/L) and C (11.7±3.9 to 1.3±1.1 mg/L) (P < 0.0001 and P < 0.0001, respectively), but not in group A. Also, a significant reduction was found in IL-6 in groups A (38.0 ± 15 to 9.4 ± 2 pg/mL), B (34.6 ± 12 to 5.1 ± 2.4 pg/mL), and C (33.7 ± 12 to 4.8 ± 2.1 pg/mL) (P < 0.0001, P < 0.0001, and P < 0.0001, respectively). Additionally, LDL and total cholesterol, but not TG, levels significantly decreased in groups A (150 ± 17 to 80 ± 13 mg/dL), B (148 ± 15 to 77.2 ± 14 mg/dL), and C (142 ± 11 to 64.8 ± 10 mg/dL) (P < 0.0001, P < 0.001, and P < 0.0001, respectively). Nevertheless, only group C showed a significant improvement in LVEF (45.1 ± 8 to 53.6 ± 8) (P < 0.027).Conclusions: An adjuvant therapy with TLC diet and supplementation with Q10 and LC seems to be required for secondary prevention following MI and PCI. TLC diet and Q10 plus LC appeared to be effective in inflammatory biomarkers of ISR as well as LDL reduction.

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“…Drug eluting stent in‐stent restenosis (DES‐ISR) is a known limitation in clinical practice following percutaneous coronary intervention 1. Despite its inherent biological and technical limitations, the use of a second DES (“stent sandwich”) is a common therapeutic approach among practicing physicians 2.…”

Section: Introductionmentioning

confidence: 99%

Biological effect on drug distribution and vascular healing via paclitaxel‐coated balloon technology in drug eluting stent restenosis swine model

Li¹,

Téllez²,

Rousselle³

et al. 2015

Cathet Cardio Intervent

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ObjectivesTo evaluate the biological effect of a paclitaxel‐coated balloon (PCB) technology on vascular drug distribution and healing in drug eluting stent restenosis (DES‐ISR) swine model.BackgroundThe mechanism of action and healing response via PCB technology in DES‐ISR is not completely understood.MethodsA total of 27 bare metal stents were implanted in coronary arteries and 30 days later the in‐stent restenosis was treated with PCB. Treated segments were harvested at 1 hr, 14 days and 30 days post treatment for the pharmacokinetic analysis. In addition, 24 DES were implanted in coronary arteries for 30 days, then all DES‐ISRs were treated with either PCB (n = 12) or uncoated balloon (n = 12). At day 60, vessels were harvested for histology following angiography and optical coherence tomography (OCT).ResultsThe paclitaxel level in neointimal tissue was about 18 times higher (P = 0.0004) at 1 hr C max, and retained about five times higher (P = 0.008) at day 60 than that in vessel wall. A homogenous distribution of paclitaxel in ISR was demonstrated by using fluorescently labeled paclitaxel. Notably, in DES‐ISR, both termination OCT and quantitative coronary angioplasty showed a significant neointimal reduction and less late lumen loss (P = 0.05 and P = 0.03, respectively) post PCB versus post uncoated balloon. The PES‐ISR + PCB group displayed higher levels of peri‐strut inflammation and fibrin scores compared to the ‐limus DES‐ISR + PCB group.ConclusionsIn ISR, paclitaxel is primarily deposited in neointimal tissue and effectively retained over time following PCB use. Despite the presence of metallic struts, a uniform distribution was characterized. PCB demonstrated an equivalent biological effect in DES‐ISR without significantly increasing inflammation. © 2015 Wiley Periodicals, Inc.

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Current Treatment of In-Stent Restenosis

Cited by 466 publications

References 97 publications

“Full Plastic-Jacket“: Reconstruction of 18 cm of coronary arteries with bioresorbable vascular scaffolds in a young patient with ST-elevation myocardial infarction and multivessel disease

“Full Plastic-Jacket“: Reconstruction of 18 cm of coronary arteries with bioresorbable vascular scaffolds in a young patient with ST-elevation myocardial infarction and multivessel disease

Effects of Therapeutic Lifestyle Change Diet and Q10 Plus L-Carnitine Supplementation on Inflammatory Biomarkers of In-Stent Restenosis, Lipid Profile, and Left Ventricular Ejection Fraction in Myocardial Infarction: A Randomized Clinical Trial

Biological effect on drug distribution and vascular healing via paclitaxel‐coated balloon technology in drug eluting stent restenosis swine model

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