Pathophysiology and pharmacological approaches for prevention of coronary artery restenosis following coronary artery balloon angioplasty and related procedures

Landzberg, Brian R.; Frishman, William H.; Lerrick, Kenneth

doi:10.1016/s0033-0620(97)80034-5

Cited by 58 publications

(37 citation statements)

References 226 publications

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“…8,9 Despite the intensive study of therapeutic agents aimed at arresting SMC growth and migration, no widely effective treatment exists for the prevention of human restenosis. 10,11 A likely explanation for this fact is the unpredictable, multifactorial nature of human restenosis. 10,12,13 Accordingly, new therapeutic approaches should be aimed at targeting not 1 but several processes implicated in the pathogenesis of acute vascular occlusive disease.…”

mentioning

confidence: 99%

“…10,11 A likely explanation for this fact is the unpredictable, multifactorial nature of human restenosis. 10,12,13 Accordingly, new therapeutic approaches should be aimed at targeting not 1 but several processes implicated in the pathogenesis of acute vascular occlusive disease. Retinoids 14 are natural and synthetic derivatives of vitamin A that exert their pleiotropic biological effects through receptor-mediated changes in gene expression.…”

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confidence: 99%

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all- Trans -Retinoic Acid Reduces Neointimal Formation and Promotes Favorable Geometric Remodeling of the Rat Carotid Artery After Balloon Withdrawal Injury

et al. 1998

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Background-The multifactorial and unpredictable nature of human restenosis will probably necessitate interventional strategies that target multiple processes involved in acute vascular narrowing. Retinoids (eg, all-trans-retinoic acid, atRA) represent a growing class of pleiotropic biological response modifiers with demonstrable efficacy in managing several pathological conditions. In this report, we have initiated studies to examine the hypothesis that atRA limits neointimal formation after experimental vascular injury. Methods and Results-Rats were predosed with atRA (30 mg ⅐ kg Ϫ1 ⅐ d Ϫ1 PO) or corn oil 4 days before balloon withdrawal injury (BWI) of the left common carotid artery and continued on this drug regimen for an additional 14 days. High-performance liquid chromatographic analysis documented therapeutic levels of atRA in serum and vascular tissue. atRA depressed peak DNA synthesis in the tunica media of BWI vessels (PϽ0.05). Histomorphometry revealed atRA-mediated reductions in neointimal area, neointimal cell number, and intimal/medial area ratio as well as significant increases in vessel wall perimeter (PϽ0.05). Such changes in vascular architecture contributed to a 35% to 37% increase in the luminal area of BWI vessels exposed to atRA (PϽ0.005 compared with controls). Conclusions-atRA reduces neointimal mass and elicits favorable geometric remodeling of the injured rat carotid artery.

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confidence: 99%

mentioning

confidence: 99%

all- Trans -Retinoic Acid Reduces Neointimal Formation and Promotes Favorable Geometric Remodeling of the Rat Carotid Artery After Balloon Withdrawal Injury

et al. 1998

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“…The complications of balloon angioplasty rnost commonly responsible for unsuccessful clinical outcornes are rapid and chronic occlusion of the reopened arteries. Rapid closure of a distended coronary vessel is estirnated to occur in 2 to 11% of patients and can often lead to myocardial infarction, the need for emergency bypass surgery, or even death (6).…”

Section: Percutaneous Transluminal Coronary Angioplastymentioning

confidence: 99%

“…Restenosis has been defined as a loss of at least 50% of the gain from PTCA, or as an increase of at least 30% in occlusive diameter from the immediate post-procedure stenosis upon follow-up angiography (1 5). Alternatively, restenosis has been characterized clinically by recurrent ischemic symptorns within 6 months after angioplasty (6). In addition to the repeat diagnostic and therapeutic catheterkations made necessary by restenosis, its marked prevalence, currently estimated to occur in 35 to 50% of angioplasty patients, and cost (estimated at $1.5 billion per year in the United States alone), clearly compromise the long-term beneffis of PTCA (1 6,17).…”

Section: Percutaneous Transluminal Coronary Angioplastymentioning

confidence: 99%

Inhibitory Mechanisms by Which Suramin May Attenuate Neointimal Formation After Balloon Angioplasty

Gray¹,

Strauss²,

Hinek³

1999

Journal of Cardiovascular Pharmacology

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“…1 Intracoronary stent placement reduced the problem of restenosis by virtually eliminating recoil and remodeling. However, stents do not decrease; in fact, they increase the proliferative component of restenosis.…”

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confidence: 99%

Dosimetric Measurements in Isolated Human Coronary Arteries

et al. 2002

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Background-Intravascular brachytherapy is being applied more and more in patients with coronary artery disease for the prevention of restenosis subsequent to balloon angioplasty, in particular after stent implantation. Several radiation sources (␤-and ␥-emitters) are available in clinical routine. It was the purpose of this study to compare the radiation doses at the level of the adventitia in diseased and stented human coronary arteries for 192 Ir and 90 Sr/Y emitters in routine use. In contrast to previously published work, we performed dosimetry instead of calculating depth-dose distribution by use of the Monte Carlo system. Methods and Results-Postmortem calcified human coronary artery segments were stented and placed in an organ bath.Commercially available ␥-emitters ( 192 Ir; Cordis Checkmate) and ␤-emitters ( 90 Sr/Y; Novoste Beta-Cath) were used. Relative dose distributions along the adventitia were measured by a specially designed scintillation detector system. Whereas dose perturbations caused by stents and calcified plaque were negligible for the 192 Ir source, radiation from the beta source was significantly impaired (as much as 40%) at the level of the adventitia (3.0-mm vessel diameter). Dose perturbation was clearly dependent on the extent and severity of calcification, less affected by stent material. Conclusions-Dose perturbation caused by calcified plaque and metallic stents is significant for ␤-sources. This dosimetric difference between ␤-and ␥-emitters in diseased coronary arteries should be considered when calculating doses in intravascular brachytherapy.

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Pathophysiology and pharmacological approaches for prevention of coronary artery restenosis following coronary artery balloon angioplasty and related procedures

Cited by 58 publications

References 226 publications

all- Trans -Retinoic Acid Reduces Neointimal Formation and Promotes Favorable Geometric Remodeling of the Rat Carotid Artery After Balloon Withdrawal Injury

all- Trans -Retinoic Acid Reduces Neointimal Formation and Promotes Favorable Geometric Remodeling of the Rat Carotid Artery After Balloon Withdrawal Injury

Inhibitory Mechanisms by Which Suramin May Attenuate Neointimal Formation After Balloon Angioplasty

Dosimetric Measurements in Isolated Human Coronary Arteries

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