Five‐year outcomes of self‐expanding nitinol stent implantation for chronic total occlusion of the superficial femoral and proximal popliteal artery

Sakamoto, Yasunari; Hirano, Keisuke; Iida, Osamu; Soga, Yoshimitsu; Suzuki, Kenji; Muramatsu, Toshiya; Tsukahara, Reiko

doi:10.1002/ccd.24935

Cited by 28 publications

(19 citation statements)

References 27 publications

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“…Furthermore, in the setting of vascular injury, potential detrimental effects of estrogens have been inferred. This inference has been primarily based on women's increased risk for vascular restenosis after stent placement 1,5 -especially younger women 6 and especially with the earlier bare metal stents. 7 Thus, estrogens might mediate both beneficial and detrimental vascular effects.…”

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confidence: 99%

Extent of Vascular Remodeling Is Dependent on the Balance Between Estrogen Receptor α and G-Protein–Coupled Estrogen Receptor

et al. 2016

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Abstract-Estrogens are important regulators of cardiovascular function. Some of estrogen's cardiovascular effects are mediated by a G-protein-coupled receptor mechanism, namely, G-protein-coupled estrogen receptor (GPER). Estradiol-mediated regulation of vascular cell programmed cell death reflects the balance of the opposing actions of GPER versus estrogen receptor α (ERα). However, the significance of these opposing actions on the regulation of vascular smooth muscle cell proliferation or migration in vitro is unclear, and the significance in vivo is unknown.To determine the effects of GPER activation in vitro, we studied rat aortic vascular smooth muscle cells maintained in primary culture. GPER was reintroduced using adenoviral gene transfer. Both estradiol and G1, a GPER agonist, inhibited both proliferation and cell migration effects that were blocked by the GPER antagonist, G15. To determine the importance of the GPER-ERα balance in regulating vascular remodeling in a rat model of carotid ligation, we studied the effects of upregulation of GPER expression versus downregulation of ERα. Reintroduction of GPER significantly attenuated the extent of medial hypertrophy and attenuated the extent of CD45 labeling. Downregulation of ERα expression comparably attenuated the extent of medial hypertrophy and inflammation after carotid ligation. These studies demonstrate that the balance between GPER and ERα regulates vascular remodeling. Receptor-specific modulation of estrogen's effects may be an important new approach in modifying vascular remodeling in both acute settings like vascular injury and perhaps in longer term regulation like in hypertension. Our initial focus on ERα (versus ER β , which is also expressed in rat aortic vascular smooth muscle cells [VSMCs]) was based on our demonstration that in isolated rat VSMCs, estradiol's (E2) antiapoptotic effects were mediated via ERα. 30 In contrast, E2 acting via GPER was proapoptotic. However, the in vivo implications of these receptor-specific opposing effects of estradiol on growth regulation have yet to be established.In these studies, we examined the process of vascular remodeling to understand how E2 regulates vascular growth via GPER versus ERα. Remodeling occurs subsequent to several vascular stressors including hypertension, 31 atherosclerosis, 32 and vascular injury 33 and can be associated with both adaptive responses (as in vascular injury) and maladaptive responses (as in hypertension and in vascular restenosis). The VSMC hypertrophy and hyperplasia that occurs in remodeling processes has been linked to a shift in the balance between proliferative and apoptotic mechanisms and a dedifferentiation of VSMCs from a contractile phenotype, as seen under normal conditions in situ, to a so-called synthetic phenotype, 34 as seen after vascular injury. This latter phenotype is characterized as having higher proliferative rates and greater migratory behavior. This synthetic phenotype is more similar to the phenotype of VSMCs maintained in primary culture, 35 th...

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confidence: 99%

Extent of Vascular Remodeling Is Dependent on the Balance Between Estrogen Receptor α and G-Protein–Coupled Estrogen Receptor

et al. 2016

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“…Above all, patients prefer less invasive procedures to open bypass surgery. However, the optimal therapy for F-P artery disease remains controversial [1][2][3][4][5][6]. Among them, the treatment strategies for complex lesions such as heavy calcification, long diffuse disease, CTO, and/or previous surgical reconstructions need further improvement.…”

Section: Discussionmentioning

confidence: 97%

“…Mostly, balloon angioplasty and stenting are performed for femoro-popliteal (F-P) artery disease but, in some cases, balloon angioplasty may not be effective for complex calcified lesions or chronic total occlusions (CTOs) [4][5][6]. In heavily calcified lesions, the EVT approach is difficult and challenging.…”

Section: Introductionmentioning

confidence: 99%

Application of rotational atherectomy for a calcified superficial femoral artery lesion

Fukuda

Yokoi

2014

Cardiovasc Interv and Ther

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A 78-year-old man on dialysis with a history of femoro-popliteal bypass grafting of his right superficial femoral artery was presented with a recurrence of intermittent claudication. Angiography revealed new heavily calcified stenosis located distal to the anastomosis of the graft. A guide wire was crossed the lesion, however, a balloon catheter could not pass. Rotational atherectomy with Rotablator enabled the balloon to cross the lesion with full dilatation. Due to residual stenosis and dissection, a stent was implanted. Final angiogram showed no residual stenosis with TIMI 3 flow. The patient remained free of symptoms during the 1-year follow-up.

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“…Primary nitinol stenting is preferable for the treatment of femoro-popliteal artery occlusive disease, despite conflicting results regarding its long-term benefit [15,16]. In biomechanical studies, stents in the femoro-popliteal artery were shown to be subject to compression and bending by articular movement, which was postulated to lead to stent failure in the long term [17].…”

Section: Discussionmentioning

confidence: 99%

Endovascular treatment of femoro-popliteal artery stenosis/obstruction using a repositionable self-expanding nitinol stent: a preliminary study

Yılmaz¹,

Yilmaz

Barış³

et al. 2016

Acta Angiologica

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Five‐year outcomes of self‐expanding nitinol stent implantation for chronic total occlusion of the superficial femoral and proximal popliteal artery

Abstract: Women and patients requiring small stents failed to maintain primary patency when treated with self-expanding nitinol stents for CTO lesions in the SFPA. Although primary patency was low, the secondary patency rate was acceptable.

Cited by 28 publications

References 27 publications

Extent of Vascular Remodeling Is Dependent on the Balance Between Estrogen Receptor α and G-Protein–Coupled Estrogen Receptor

Extent of Vascular Remodeling Is Dependent on the Balance Between Estrogen Receptor α and G-Protein–Coupled Estrogen Receptor

Application of rotational atherectomy for a calcified superficial femoral artery lesion

Endovascular treatment of femoro-popliteal artery stenosis/obstruction using a repositionable self-expanding nitinol stent: a preliminary study

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