Late-phase inflammatory response as a feature of in-stent restenosis after drug-eluting stent implantation

Yoneda, Shuichi; Abe, Shichiro; Kanaya, Tomoaki; Oda, Kazuhiro; Nishino, Seiji; Kageyama, Michiya; Tanaka, Isao; Masawa, Nobuhide; Inoue, Teruo

doi:10.1097/mca.0b013e32836222ec

Cited by 30 publications

(14 citation statements)

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“…On the basis of previous literature, a higher number of T lymphocytes and macrophages is observed in DES lesions than in BMS lesions, suggesting the mechanism of restenosis after DES implantation may be different from that observed after BMS implantation. 13 …”

Section: Discussionmentioning

confidence: 99%

Persistent Inflammatory Activity in Blood Cells and Artery Tissue from Patients with Previous Bare Metal Stent

Farsky¹,

Hirata²,

Arnoni³

et al. 2018

Arquivos Brasileiros De Cardiologia

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BackgroundStudies have pointed out a higher mortality after coronary artery bypass surgery (CABG) in patients with stent.ObjectiveTo evaluate inflammatory markers in peripheral blood cells and in coronary artery tissue samples obtained during CABG in patients with stent compared to controls.MethodsThe case series consisted of two groups, one with previous stent implantation (n = 41) and one control (n = 26). The expression of the LIGHT, IL-6, ICAM, VCAM, CD40, NFKB, TNF, IFNG genes was analyzed in peripheral blood cells collected preoperatively. The coronary artery was evaluated for: interleukin-6, ICAM, VCAM, CD40, NFKB, TNF-alpha and IFN-gamma by immunohistochemistry. A total of 176 tissue samples were grouped for analysis in: A1- arteries with stent (n = 38); A2- native arteries from patients with stent in another artery (n = 68); and A3- arteries without stent from controls undergoing routinely CABG surgery (n = 70). A significance level of 0.05 was adopted.ResultsPatients with stent showed higher TNF (p = 0.03) and lower CD40 gene expression (p = 0.01) in peripheral blood cells than controls without stent. In coronary artery samples, the TNF-alpha protein staining was higher in the group A1, not only in the intima-media layer (5.16 ± 5.05 vs 1.90 ± 2.27; p = 0.02), but also in the adipose tissue (6.69 ± 3.87 vs 2.27 ± 4.00; p < 0.001). Furthermore, group A1 had a higher interleukin-6 protein staining in adipose tissue than group A3 (p = 0.04).ConclusionWe observed a persistently higher systemic TNF expression associated with exacerbated TNF-alpha and interleukin-6 local production in patients with stents. This finding may contribute to a worse clinical outcome.

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Section: Discussionmentioning

confidence: 99%

Persistent Inflammatory Activity in Blood Cells and Artery Tissue from Patients with Previous Bare Metal Stent

Farsky¹,

Hirata²,

Arnoni³

et al. 2018

Arquivos Brasileiros De Cardiologia

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“…However, major limitation of angioplasty is in-stent restenosis (ISR), which is characterized by neo-intimal hyperplasia and blood vessel re-narrowing. Additionally, ISR strategies also cause endothelial injury and dysfunction due to lacerations of intimal walls [ 1 , 21 ] that leads to recruitment and proliferation of inflammatory and smooth muscle cells [ 22 ]. In this study we have shown that IL-10 therapy strongly inhibited neo-intimal hyperplasia and improved ReEndo after coronary artery injury.…”

Section: Discussionmentioning

confidence: 99%

IL-10 Accelerates Re-Endothelialization and Inhibits Post-Injury Intimal Hyperplasia following Carotid Artery Denudation

et al. 2016

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The role of inflammation on atherosclerosis and restenosis is well established. Restenosis is thought to be a complex response to injury, which includes early thrombus formation, acute inflammation and neo-intimal growth. Inflammatory cells are likely contributors in the host response to vascular injury, via cytokines and chemokines secretion, including TNF-alpha (TNF). We have previously shown that IL-10 inhibits TNF and other inflammatory mediators produced in response to cardiovascular injuries. The specific effect of IL-10 on endothelial cell (ECs) biology is not well elucidated. Here we report that in a mouse model of carotid denudation, IL-10 knock-out mice (IL-10KO) displayed significantly delayed Re-endothelialization and enhanced neo-intimal growth compared to their WT counterparts. Exogenous recombinant IL-10 treatment dramatically blunted the neo-intimal thickening while significantly accelerating the recovery of the injured endothelium in WT mice. In vitro, IL-10 inhibited negative effects of TNF on ECs proliferation, ECs cell cycle, ECs-monocyte adhesion and ECs apoptosis. Furthermore, IL-10 treatment attenuated TNF-induced smooth muscle cells proliferation. Our data suggest that IL-10 differentially regulate endothelial and vascular smooth cells proliferation and function and thus inhibits neo-intimal hyperplasia. Thus, these results may provide insights necessary to develop new therapeutic strategies to limit vascular restenosis during percutaneous coronary intervention (PCI) in the clinics.

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“…25 Cytostatic drugs deployed in DES, though effective in ameliorating neo-intimal hyperplasia by blocking medial smooth muscle proliferation, are nonspecific and leave behind a denuded endothelium infiltrated with thrombotic material and chronic inflammatory cells. 26 In histologic sections of stented and unstented coronary atherosclerotic lesions, Yoneda and colleagues 27 reported higher concentrations of T-lymphocytes and macrophages in DES, compared with bare metal stents and unstented lesions, at 10 months poststenting.…”

Section: Discussionmentioning

confidence: 99%

Impact of prior intracoronary stenting on late outcomes of coronary artery bypass surgery in diabetics with triple-vessel disease

Nauffal

Schwann

Yammine

et al. 2015

The Journal of Thoracic and Cardiovascular Surgery

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Objective Recent studies have indicated that coronary artery bypass grafting (CABG) outcomes in patients with prior stents are suboptimal. We aimed to study the impact of prior percutaneous coronary intervention (PCI) with stenting (PCI-S) on late CABG mortality in diabetic patients with triple-vessel disease. Methods We reviewed the primary nonemergency CABG experience from a single U.S. institution (n = 7005; 1996–2007, Toledo, Ohio). Diabetics with triple-vessel disease (n = 1583) were identified and divided into 2 groups: (1) prior PCI-S (n = 202); and (2) no prior PCI (No-PCI [n = 1381]). Hierarchic Cox proportional hazards models were used to assess the effect of prior PCI-S on 5-year mortality after CABG. A propensity score for PCI-S and No-PCI patients was derived using a nonparsimonious logistic regression and used to generate a 1:1 (PCI-S to No-PCI) matched cohort. Results In model 1, after adjusting for preoperative clinical characteristics, medications, off-pump surgery, and isolated CABG surgery status, prior PCI-S was associated with a 39% increased risk of mortality (hazard ratio [HR] = 1.39, with 95% confidence interval [CI; 1.02, 1.90]; P = .04). Further adjustment for date of surgery (model 2) (HR = 1.39, with 95% CI [1.02, 1.91]; P = .04) or operative parameters (model 3) (HR = 1.38, with 95% CI [1.01, 1.88]; P = .046) did not alter the association. The 1:1 matched-cohort analysis confirmed the increased risk associated with PCI-S (HR = 1.61, with 95% CI [1.03, 2.51]; P = .037). Conclusions Patients who have both diabetes and triple-vessel disease, and have undergone prior PCI-S, have poorer long-term outcomes after CABG compared with those who have had no prior PCI-S.

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Late-phase inflammatory response as a feature of in-stent restenosis after drug-eluting stent implantation

Abstract: Pathological features of restenotic tissues after DES implantation showed a stronger inflammatory response compared with those after BMS implantation. Thus, the mechanism of restenosis after DES implantation may be different from that observed after BMS implantation.

Cited by 30 publications

References 0 publications

Persistent Inflammatory Activity in Blood Cells and Artery Tissue from Patients with Previous Bare Metal Stent

Persistent Inflammatory Activity in Blood Cells and Artery Tissue from Patients with Previous Bare Metal Stent

IL-10 Accelerates Re-Endothelialization and Inhibits Post-Injury Intimal Hyperplasia following Carotid Artery Denudation

Impact of prior intracoronary stenting on late outcomes of coronary artery bypass surgery in diabetics with triple-vessel disease

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