Restenosis After Successful Percutaneous Transluminal Coronary Angioplasty: Serial Angiographic Follow-Up of 229 Patients

Nobuyoshi, Masakiyo; Kimura, Takeshi; Nosaka, Hideyuki; Mioka, Sokei; Ueno, Katsumi; Yokoi, Hiroatsu; Hamasaki, Naoya; Horiuchi, Hisanori; Ohishi, Hiroto

doi:10.1016/s0735-1097(88)80046-9

Cited by 837 publications

(259 citation statements)

References 24 publications

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“…Restenosis after PTCA occurs in 30-40% (9)(10)(11)(12) of cases but may remain asymptomatic for long periods. However, since the advent of intracoronary stenting, this rate has signifi cantly decreased.…”

Section: After Percutaneous Transluminal Coronary Angioplasty (Ptca)mentioning

confidence: 99%

Value of nuclear cardiology for the diagnosis and risk stratification of coronary artery disease

Libhaber

Vangu

2017

SAHJ

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Value of nuclear cardiology for the diagnosis and risk stratifi cation of coronary artery disease 106 INTRODUCTIONNuclear cardiology has undergone an outstanding growth during the last 25 years.With technical improvements and new radiopharmaceuticals, higher sensitivity and specifi city of myocardial perfusion imaging (MPI) scans has been achieved for detection and evaluation of ischemic heart disease.MPI is performed with the administration of radiopharmaceuticals which are taken up by the myocardial cells. Different radiotracers can be used, such as: 99m Tc- Sestamibi, 99m Tc-Tetrofosmin, etc.The investigation is performed at rest and stress, providing semiquantitative information on areas of myocardial infarction and ischemia.Beller et al. showed in the "anginal cascade"(1) that, with increasing stress time and myocardial oxygen demand, ischemic ST depression and anginal symptoms appear after fl ow heterogeneity, regional myocardial dysfunction, signifi cant perfusion defects and global left ventricular dysfunction. This accounts for the increased sensitivity, specifi city and accuracy of MPI over symptoms and stress ECG in the diagnosis and follow-up of coronary artery disease.It has developed into one of the most contributory fi elds in clinical decision making for the detection and risk stratifi cation in patients with suspected and known coronary artery disease. USE OF MYOCARDIAL PERFUSION SCINTIGRAPHY IN THE CLINICAL SETTINGMyocardial perfusion SPECT (single photon emission computed tomography) is a widely utilized noninvasive imaging modality for the diagnosis and management of ischemic heart disease. This modality allows a three-dimensional assessment and quantitation of the myocardium and functional assessment through ECG-gating of the perfusion images. Vol. 5, No. 3, 2008 There are several indications for the use of myocardial perfusion SPECT, whether it is for a patient who is not known to have coronary artery disease and the aim is confi rm or rule out the diagnosis, or in the patient with known ischemic heart disease, whether symptomatic or not, for risk-stratifi cation (Table 1). Indications for myocardial perfusion scintigraphy If the patient does not have diagnosis of CADTo exclude or diagnose CAD in patients with suspected CAD As a screening test in those with intermediate or high risk of CAD, e.g. familial hyperlipidemia, type II diabetes mellitus, family history of CAD, and those with atypical symptoms of ischemic heart disease (IHD). In patients with high pretest likelihood for CAD, MPI is mainly useful for risk stratifi cation purposes.In patients with non-diagnostic electrocardiography (ECG), at rest or post-stress. While there are many causes for an abnormal baseline ECG (Table 2), STRESS-ECG is frequently not conclusive. (range 17 to 100).Patients who are at risk of developing peri or postoperative cardiovascular events, i.e. peripheral vascular disease, aortic aneurysm, and the elderly.Acute chest pain -diagnosis of CAD.LBBB can induce perfusion defect in the basal ante...

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Section: After Percutaneous Transluminal Coronary Angioplasty (Ptca)mentioning

confidence: 99%

Value of nuclear cardiology for the diagnosis and risk stratification of coronary artery disease

Libhaber

Vangu

2017

SAHJ

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“…The long-term benefit of PCI is hampered by the possibility of restenosis of the treated segment, which occurs in 20-50% of patients (Nobuyoshi et al 1988;Hirshfeld et al 1991;Waller, 1989). Intracoronary stent implantation along with balloon angioplasty is highly effective in the treatment of acute vessel closure (Sigwart et al 1987;Roubin et al 1992;de Jaegere et al 1993a;Fischman et al 1994).…”

Section: Hypothesismentioning

confidence: 99%

Homocysteine and Malondialdehyde as Predictors of Restenosis Following Percutaneous Coronary Intervention

et al. 2006

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Restenosis is one of the major adverse outcomes of Percutaneous CoronaryIntervention (PCI). Previous studies have shown conflicting reports for homocysteine as a predictor of restenosis following PCI. The conflicting reports may be due to oxidative factors (stimulation of polymorphonuclear leukocyte [PMNL]-induced reactive oxygen species generation, xanthine-xanthine oxidase, and arachidonic acid metabolism) other than homocysteine which could cause endothelial cell dysfunction leading to restenosis.Malondialdehyde (MDA), a lipid peroxidation product, is a marker for oxidative stress and is related to all oxidative factors. Therefore, it is possible that serum MDA may be a better predictor of restenosis than plasma homocysteine. The purpose of this study is to determine whether or not the pre-procedural serum MDA and plasma homocysteine levels are elevated in patients who develop restenosis post PCI.The study included fifty-one patients undergoing elective PCI who consented to participate in a protocol that was approved by the Ethics Committee of the University of Saskatchewan. Homocysteine and malondialdehyde were measured in the plasma and serum respectively. Blood samples were collected pre-procedural, 0 time, 8 hours, 24 hours, and 6 months post-procedure. Exercise tolerance tests were performed at two weeks, and six months post-procedure to determine if there was any evidence of restenosis.The results of the study showed that pre-procedural values of plasma homocysteine in the restenosis and non-restenosis groups were 10.37 ± 0.46 and 10.73 ± 0.49 respectively. These values were not significantly different (p=0.60) between the groups. The pre-procedural levels of plasma homocysteine were not significantly ii different (p=0.08) from the post-PCI values of those patients who did not develop restenosis at the 6-month time interval. However, the pre-procedural levels of plasma homocysteine were significantly different from the post-PCI values of those patients in the restenosis group at the 24hr (p=0.04) and 6-month (p=0.002) time intervals. In the restenosis group there was a significant increase (24%) after six months in the values of homocysteine from the pre-procedural levels. Thus, this indicates that restenosis is associated with higher post-PCI levels of homocysteine.The pre-procedural levels of serum MDA in the restenosis and non-restenosis groups were 0.124± 0.16 and 0.147± 0.02 respectively. There was no significant difference (p=0.60) between the two groups. There was also no significant difference The results suggest that pre-procedural levels of plasma homocysteine and serum MDA were not predictors of restenosis following PCI. However, the post-PCI sixmonth levels of both homocysteine and MDA are predictors of restenosis. Moreover, the post-PCI levels of MDA were better predictors of restenosis than the post-PCI levels of homocysteine because the increase in MDA levels were greater at six months than the rise in homocysteine levels at the same time interval.iii ACKNOWLEDGEMENTS

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“…Available online November 23, 2009. Published January 11, 2010. Although atherogenesis, percutaneous transluminal coronary angioplasty, and the subsequent anastomotic restenosis of the vasculature is a complicated pathological process involving multiple factors (1)(2)(3), the over-production of extracellular matrix by smooth muscle cells of the injured vessel, their hyperproliferation and their migration to the intima play a key role in lesion formation (4). Local endogenous early growth response factor-1 (Egr-1) is rapidly expressed and activated following vascular injury (5).…”

Section: Introductionmentioning

confidence: 99%

A DNA enzyme targeting Egr-1 inhibits rat vascular smooth muscle cell proliferation by down-regulation of cyclin D1 and TGF-β1

Han

Liu

2010

Braz J Med Biol Res

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Restenosis After Successful Percutaneous Transluminal Coronary Angioplasty: Serial Angiographic Follow-Up of 229 Patients

Cited by 837 publications

References 24 publications

Value of nuclear cardiology for the diagnosis and risk stratification of coronary artery disease

Value of nuclear cardiology for the diagnosis and risk stratification of coronary artery disease

Homocysteine and Malondialdehyde as Predictors of Restenosis Following Percutaneous Coronary Intervention

A DNA enzyme targeting Egr-1 inhibits rat vascular smooth muscle cell proliferation by down-regulation of cyclin D1 and TGF-β1

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