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Background: Malignant biliary obstruction is usually attributed to the enlargement of tumors within or adjacent to the biliary tract, leading to blockage or compression of the bile ducts. Common causes include pancreatic head cancer, bile duct cancer, gallbladder cancer, liver cancer, and metastatic diseases. Most cases have an insidious onset, lack effective early screening methods, and 70% of patients cannot undergo surgical resection, with a 5-year survival rate of about 30%. Therefore, relieving biliary tree obstruction is crucial. Biliary stents often mitigate the obstruction but can be hindered by tumor progression, endothelial hyperplasia, and bile sludge. As a result, new treatment approaches are constantly being explored to improve outcomes for patients with malignant biliary obstruction. Current situation: One promising technique that has emerged in recent years is radiofrequency ablation (RFA). This innovative method utilizes high-frequency radio waves to generate heat and selectively target tumor cells through localized heating while preserving surrounding healthy tissue. RFA aims to slow tumor growth and enhance biliary stent durability. Studies on endoscopic RFA for malignant biliary obstruction are encouraging. Integrating it with palliative care may better manage symptoms and extend patient quality of life. Conclusion: In conclusion, while malignant biliary obstruction remains a complex medical challenge with limited treatment options available for some patients, ongoing research into innovative techniques like radiofrequency ablation offers hope for better outcomes in the future. It is crucial for healthcare professionals to stay informed about these advancements and continue exploring new ways to enhance patient care in this difficult clinical scenario. [ABSTRACT FROM AUTHOR]

Background: The optimal therapeutic strategy for coronary intervention in edge in-stent restenosis (edge ISR) remains less well-defined. Aim: The aim of this study was to assess 12-month outcomes of re-stenting using drug-eluting stents (DESs) versus using drug-eluting balloon (DEB) for managing coronary edge ISR. Patients and Methods: One hundred and four patients with edge ISR were randomly assigned to either DES or DEB. The primary endpoint was stent failure at 12-month follow-up. Results: Significantly lower target vessel revascularization among the DEB group compared to restenting group, (7.7% vs. 23.1%, P = 0.04). Likewise, target vessel-related myocardial infarction rate was significantly lower among the DEB group than restenting (5.7% vs. 23.1%, P = 0.04). On the other hand, there were no significant differences in the rates of deaths or restenosis between the two groups. Conclusion: The DEB is superior to the DES with better both safety and efficacy.

Background: The optimal therapeutic strategy for coronary intervention in edge in-stent restenosis (edge ISR) remains less well-defined. Aim: The aim of this study was to assess 12-month outcomes of re-stenting using drug-eluting stents (DESs) versus using drug-eluting balloon (DEB) for managing coronary edge ISR. Patients and Methods: One hundred and four patients with edge ISR were randomly assigned to either DES or DEB. The primary endpoint was stent failure at 12-month follow-up. Results: Significantly lower target vessel revascularization among the DEB group compared to restenting group, (7.7% vs. 23.1%, P = 0.04). Likewise, target vessel-related myocardial infarction rate was significantly lower among the DEB group than restenting (5.7% vs. 23.1%, P = 0.04). On the other hand, there were no significant differences in the rates of deaths or restenosis between the two groups. Conclusion: The DEB is superior to the DES with better both safety and efficacy. [ABSTRACT FROM AUTHOR]

Abstract Background Stent restenosis is a relatively common phenomenon among patients with coronary heart disease undergoing percutaneous coronary intervention (PCI). It seems that a set of clinical, laboratory, and even genetic factors make people susceptible to such a phenomenon and in fact, this is multi-factorial. We aimed to first determine the underlying clinical and laboratory risk factors for the occurrence of stent re-stenosis after PCI based on a systematic review study, and after that, through a bioinformatics study, to evaluate the related genes and microRNAs with the occurrence of stent re-stenosis. Main text In the first step, the manuscript databases including Medline, Web of Knowledge, Google Scholar, Scopus, and Cochrane were deeply searched by the two blinded investigators for all eligible studies based on the considered keywords to introduce clinical and laboratory determinants of stent re-stenosis. In the bioinformatic phase, and following a review of the literature to identify genes and microRNAs involved in restenosis, the interaction of each gene with other genes associated with stent re-stenosis was determined by GeneMANIA network analysis and Cytoscape software. Overall, 67 articles (including 40,789 patients) on clinical and biochemical predictors for stent restenosis and 25 articles on genetic determinants of this event were eligible for the final analysis. The predictors for this event were categorized into four subgroups patient-based parameters including traditional cardiovascular risk profiles, stent-based parameters including type and diametric characteristics of the stents used, coronary lesion-based parameters including several two target lesions and coronary involvement severity and laboratory-based parameters particularly related to activation of inflammatory processes. In the bioinformatic phase, we uncovered 42 genes that have been described to be involved in such a phenomenon considering a special position for genes encoding inflammatory cytokines. Also, 12 microRNAs have been pointed to be involved in targeting genes involved in stent re-stenosis. Conclusions The incidence of stent re-stenosis will be the result of a complex interaction of clinical risk factors, laboratory factors mostly related to the activation of inflammatory processes, and a complex network of gene-to-gene interactions.

Background: Stent restenosis is a relatively common phenomenon among patients with coronary heart disease undergoing percutaneous coronary intervention (PCI). It seems that a set of clinical, laboratory, and even genetic factors make people susceptible to such a phenomenon and in fact, this is multi-factorial. We aimed to first determine the underlying clinical and laboratory risk factors for the occurrence of stent re-stenosis after PCI based on a systematic review study, and after that, through a bioinformatics study, to evaluate the related genes and microRNAs with the occurrence of stent re-stenosis. Main text: In the first step, the manuscript databases including Medline, Web of Knowledge, Google Scholar, Scopus, and Cochrane were deeply searched by the two blinded investigators for all eligible studies based on the considered keywords to introduce clinical and laboratory determinants of stent re-stenosis. In the bioinformatic phase, and following a review of the literature to identify genes and microRNAs involved in restenosis, the interaction of each gene with other genes associated with stent re-stenosis was determined by GeneMANIA network analysis and Cytoscape software. Overall, 67 articles (including 40,789 patients) on clinical and biochemical predictors for stent restenosis and 25 articles on genetic determinants of this event were eligible for the final analysis. The predictors for this event were categorized into four subgroups patient-based parameters including traditional cardiovascular risk profiles, stent-based parameters including type and diametric characteristics of the stents used, coronary lesion-based parameters including several two target lesions and coronary involvement severity and laboratory-based parameters particularly related to activation of inflammatory processes. In the bioinformatic phase, we uncovered 42 genes that have been described to be involved in such a phenomenon considering a special position for genes encoding inflammatory cytokines. Also, 12 microRNAs have been pointed to be involved in targeting genes involved in stent re-stenosis. Conclusions: The incidence of stent re-stenosis will be the result of a complex interaction of clinical risk factors, laboratory factors mostly related to the activation of inflammatory processes, and a complex network of gene-to-gene interactions. [ABSTRACT FROM AUTHOR]

Background: Coronary artery calcification is a predictor of adverse outcomes after percutaneous coronary intervention (PCI). Intravascular lithotripsy (IVL) is a promising tool for the treatment of calcified lesions. The aim of this study was to assess the effectiveness and safety of IVL. Methods: A single-center observational study of PCI procedure, with assessment of the outcomes of patients undergoing PCI using IVL, was performed. Angiographic procedural success was used as the primary effectiveness endpoint. The primary safety endpoint was defined as a composite of cardiac death, myocardial infarction and target vessel revascularization within 30 days. Results: A total of 111 patients were included. Indications for PCI spanned the spectrum of chronic (53.2%) and acute coronary syndromes (43%). Lesion preparation before IVL was performed with non-compliant (42%), cutting or OPN (14.4%) balloons and with atherectomy techniques in 11% of procedures. Intravascular imaging was used in 21.6% of procedures. The primary effectiveness endpoint was achieved in 100% and the primary safety endpoint in 3.6% of procedures. Peri-procedural complications were minimal and successfully resolved. Conclusions: IVL was an effective and safe technique for the treatment of calcified coronary lesions. These findings contribute to the growing body of evidence supporting the use of IVL in the management of these challenging scenarios. [ABSTRACT FROM AUTHOR]

Introduction: Acute Myocardial Infarction (AMI) is one of the main causes of hospitalizations, and consequently, of death in the modern world. Type 4 is the AMI related to stent thrombosis/restenosis in patients who have previously undergone to a endovascular treatment with stent implantation to restore coronary blood flow. Objectives: Investigate and collect data on the epidemiological and clinical profile, risk factors and use of patients' medications and the incidence of stent restenosis/thrombosis, type of stent used (pharmacological or not) and affected arteries in those treated at the Hemodynamics of a large hospital in the North of Paraná. Methodology: Quantitative, retrospective, descriptive, integrative and observational research, through analysis of the medical records of patients undergoing coronary angioplasty due to stent thrombosis/restenosis, in the period from July to December 2022.Result: A rate of 4.1% was found of CTA procedures performed in the service due to stent thrombosis/restenosis, 93.75% over 51 years old, 75% male, 81% with drug-eluting stent, with 93.75% of patients with at least 3 risk factors; 87.5% being hypertensive, followed by 62.5% smokers, 56.5% dyslipidemia, 50% diabetic and 25% sedentary; 62.5% admitted with unstable angina, 37.5% requiring ICU admission, and 12.5% deaths. Argument: as the data collected, there was agreement between the study and those found in the scientific literature, where: the prevalence of restenosis is higher than stent thrombosis, that SAH was the main risk factor in both groups and gender, a strong relationship between risk factor and restenosis and suspected strong association between poor medication adherence and event. Conclusion: This study, carried out by collecting data through analysis of medical records, showed agreement with data from the scientific literature found. With limitations to the study, such as the retrospective analysis that did not allow evaluating conditions other than those provided in the medical records. It is suggested that strategies be developed through continued work, with the possibility of collecting other pertinent data such as medication adherence and other risk factors involved, to reduce events, with an impact not only on mortality but also on the quality of life of these patients. [ABSTRACT FROM AUTHOR]

This study aimed to evaluate the safety and efficacy of pharmacomechanical catheter-directed thrombolysis (PCDT) and stenting for treating acute iliofemoral deep venous thrombosis (DVT) combined with iliac vein compression syndrome (IVCS), and to identify the predictors of stent restenosis. Patients with acute proximal DVT combined with IVCS underwent PCDT and stenting from January 2017 to December 2022 were enrolled. Primary and secondary patency were assessed by duplex ultrasound (DUS). The morbidity of postthrombotic syndrome (PTS) was assessed by the Villalta score. Risk factors for stent restenosis were assessed using univariate and multivariate Cox regression models. Total of 254 patients were included. The mean follow-up time was 36.06 ± 17.66 months. The primary patency rates at 1 year, 3 years, and 5 years were 92.5%±1.7%, 85.4%±2.4%, and 82.4%±2.9%, respectively. The incidence of stent restenosis was 14.2%. Discontinuation of anticoagulants within one year [hazard ratio (HR) = 5.03; P =.048] was the factor associated with acute in-stent thrombosis. Previous DVT history (HR =2.29; P =.037) and stent placement across the inguinal ligament (HR =6.70; P <.001) were identified as independent risk factors significantly associated with stent restenosis. The overall PTS rate was 19.3%. PCDT with stenting is safe and effective for patients with iliofemoral DVT secondary to IVCS, leading to low rates of PTS. Previous DVT history and stents placed across the inguinal ligament may be predictors of stent restenosis. Furthermore, stent restenosis typically occurs within one year and is mainly caused by acute thrombosis due to discontinuation of anticoagulants. [ABSTRACT FROM AUTHOR]

In patients undergoing percutaneous coronary intervention, the second-generation drug-eluting stents (DES) are considered the gold standard of care for revascularization. By reducing neointimal hyperplasia, drug-eluting coronary stents decrease the need for repeat revascularizations compared with conventional coronary stents without an antiproliferative drug coating. It is important to note that early-generation DESs were associated with an increased risk of very late stent thrombosis, most likely due to delayed endothelialization or a delayed hypersensitivity reaction to the polymer. Studies have shown a lower risk of very late stent thrombosis with developing second-generation DESs with biocompatible and biodegradable polymers or without polymers altogether. In addition, research has indicated that thinner struts are associated with a reduced risk of intrastent restenosis and angiographic and clinical results. A DES with ultrathin struts (strut thickness of 70 µm) is more flexible, facilitates better tracking, and is more crossable than a conventional second-generation DES. The question is whether ultrathin eluting drug stents suit all kinds of lesions. Several authors have reported that improved coverage with less thrombus protrusion reduced the risk of distal embolization in patients with ST-elevation myocardial infarction (STEMI). Others have described that an ultrathin stent might recoil due to low radial strength. This could lead to residual stenosis and repeated revascularization of the artery. In CTO patients, the ultrathin stent failed to prove non-inferiority regarding in-segment late lumen loss and showed statistically higher rates of restenosis. Ultrathin-strut DESs with biodegradable polymers have limitations when treating calcified (or ostial) lesions and CTOs. However, they also possess certain advantages regarding deliverability (tight stenosis, tortuous lesions, high angulation, etc.), ease of use in bifurcation lesions, better endothelialization and vascular healing, and reducing stent thrombosis risk. In light of this, ultrathin-strut stents present a promising alternative to existing DESs of the second and third generation. The aims of the study are to compare ultrathin eluting stents with second- and third-generation conventional stents regarding procedural performance and outcomes based on different lesion types and specific populations. [ABSTRACT FROM AUTHOR]

Acute coronary syndromes, such as coronary spasm or acute myocardial infarction, have been reported following allergic reactions. These are known to affect patients of any age, and can have a variety of clinical manifestations, and are collectively referred to as Kounis syndrome [1]. We report 2 cases of acute myocardial infarction complicated by severe cardiac dysrhythmia, following an acute allergic reaction to cutaneous or intravenous allergens. To our knowledge, this is the first instance of a skin contact with caterpillar has been documented to provoke Kounis syndrome complicated by an acute STEMI with polymorphic VT. Management of such patients could be hazardous, particularly in emergency units and cardiac catheter labs, when decisions on drugs and urgent revascularization need to be made on a background of inflammation induced by severe allergic reactions. In theory, bare metal stents (when appropriate), Polymer free, Bio-absorbable scaffolds or rapid healing Drug Eluting Stents offer a better safety profile in emergency PCI, but according to our knowledge, duration of antiplatelet drugs and relative safety of various types of stents with variable drug and polymer combinations have not been formally evaluated in this condition in randomised control trials. The risk of early and late stent thrombosis and restenosis with chronic inflammation may be difficult to predict in the long term, without follow up data from trials. Such trials are very difficult to set up given the low volumes and emergency nature of events, hence review of clinical case series like ours will be invaluable to gain more insight into rapid decision making required in this interesting clinical syndrome. Reassuringly, both our patients who had emergency PCI with either Biolimus, Everolimus eluting or bare metal stents respectively in the acute setting, have not experienced repeat hospitalizations for ACS, arrhythmia or a repeat revascularization procedure at 7 and 5year follow-ups respectively.

Despite recent improvements in percutaneous coronary intervention (PCI), in-stent restenosis (ISR) -- which accounts for 5-10% of all PCI procedures in contemporary clinical practice remains a substantial problem and the most frequent reason for stent failure. While the absolute number of ISR-PCI operations performed in contemporary practice has increased as a result of rising procedural volume and complexity, the relative rate of ISR has decreased with newer-generation drug eluting stents (DESs) in comparison to the bare metal stent (BMS) period. While BMS ISR is usually early and characterized by neointimal hyperplasia, DES ISR tends to be late with neoatherosclerosis as a characteristic feature. According to recent research, drug-coated balloons or DESs are the most effective therapy options for the majority of ISR cases. Future ISR interventional paradigms may be influenced by intravascular imaging (IVI) ISR tissue patterns. IVI can provide useful information to guide treatment options in ISR-PCI. [ABSTRACT FROM AUTHOR]

Iliac vein compression syndrome (IVCS) is a common venous disease caused by joint compression of the right common iliac artery and the lumbosacral vertebrae. The compression of iliac vein not only causes venous hypertension in the lower extremities, but also induces venous valve dysfunction and superficial varicose veins in lower extremities. Moreover, the compression of iliac vein is an important potential factor for iliofemoral vein thrombosis. Currently, open surgery and stent implantation are the main treatment for IVCS. Due to the advantages of minimally invasive and postoperative patency, stent implantation for IVCS has gradually become the standard treatment. However, when the stent is implanted into the iliac vein to treat IVCS, the complications, such as restenosis, deep vein thrombosis (DVT) appear, which affect the patency of stent and hamper the patient recovery. Up to now, the mechanism how the stent implantation induces the restenosis and DVT is still unclear. In this review, we summarized the clinical symptoms, treatment methods of IVCS and the complications after stent implantation, and analyzed the mechanism of stent restenosis and DVT, and finally discuss the iliac vein stent design specifically for treating IVCS.

Circulating endothelial progenitor cells (EPCs) play an important role in the repair processes of damaged vessels, favoring re-endothelization of stented vessels to minimize restenosis. EPCs number and function is diminished in patients with type 2 diabetes, a known risk factor for restenosis. Considering the impact of EPCs in vascular injury repair, we conducted a meta-analysis of microarray to assess the transcriptomic profile and determine target genes during the differentiation process of EPCs into mature ECs. Five microarray datasets, including 13 EPC and 12 EC samples were analyzed, using the online tool ExpressAnalyst. Differentially expressed genes (DEGs) analysis was done by Limma method, with an | log2FC| > 1 and FDR < 0.05. Combined p-value by Fisher exact method was computed for the intersection of datasets. There were 3,267 DEGs, 1,539 up-regulated and 1,728 down-regulated in EPCs, with 407 common DEGs in at least four datasets. Kyoto Encyclopedia of Genes and Genomes (KEGG) analysis showed enrichment for terms related to “AGE-RAGE signaling pathway in diabetic complications.” Intersection of common DEGs, KEGG pathways genes and genes in protein-protein interaction network (PPI) identified four key genes, two up-regulated (IL1B and STAT5A) and two down-regulated (IL6 and MAPK11). MicroRNA enrichment analysis of common DEGs depicted five hub microRNA targeting 175 DEGs, including STAT5A, IL6 and MAPK11, with hsa-miR-124 as common regulator. This group of genes and microRNAs could serve as biomarkers of EPCs differentiation during coronary stenting as well as potential therapeutic targets to improve stent re-endothelization, especially in diabetic patients.

Coronary stents are among the most common therapies worldwide. Despite significant improvements in the biocompatibility of these devices throughout the last decades, they are prone, in as many as 10–20% of cases, to short- or long-term failure. In-stent restenosis is a multifactorial process with a complex and incompletely understood pathophysiology in which inflammatory reactions are of central importance. This review provides a short overview for the clinician on the cellular types responsible for restenosis with a focus on the role of endothelial progenitor cells. The mechanisms of restenosis are described, along with the cell-based attempts made to prevent it. While the focus of this review is principally clinical, experimental evidence provides some insight into the potential implications for prevention and therapy of coronary stent restenosis. [ABSTRACT FROM AUTHOR]

The contemporary issue of in-stent restenosis is reviewed in the article. The widespread use of interventional technologies for the treatment of acute and chronic forms of ischemic heart disease led to the appearance of the problem of coronary artery restenosis at the implantation site. The problem was apparently solved through introduction of drug-eluting stents instead of bare-metal stents. However, these stents also led to restenosis, but in more remote period. The issue of the contemporary cardiology is how to avoid this complication. Risk stratification of restenosis development in various groups of patients is a main task today, as the treatment of this condition is not simple. The article analyzes data of the studies conducted up to date. It studies the pathogenetic mechanisms that would develop restenosis of the previously stented coronary arteries (in various stents) and factors contributing to the formation of restenosis. The results of the studies show that vasculoendothelial growth factor-A (VEFR-A) plays a role in the development of restenosis and might predict the formation of this complication. The review addresses the issues of different genotypes of VEFR-A, which may predispose to the formation of stent restenosis.

Abstract Optical frequency domain imaging‐guided additional low‐speed rotational atherectomy following sufficient high‐speed rotational atherectomy for early calcified in‐stent restenosis might be a safe and useful option for achieving additional large lumen gains and stent expansion.

Optical frequency domain imaging‐guided additional low‐speed rotational atherectomy following sufficient high‐speed rotational atherectomy for early calcified in‐stent restenosis might be a safe and useful option for achieving additional large lumen gains and stent expansion. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to evaluate the first 30-day results of clinical, periprocedural asymptomatic cranial embolism, and long-term restenosis of the multidisciplinary conducted and evaluated carotid artery stenting (CAS) procedure in our patient group with real-life data. Methods: A total of 610 patients who were subjected to consecutive CAS procedures in our center between December 2010 and February 2019 were clinically and radiologically followed up for a mean duration of 6 years. Of the 610 patients, 274 (45%) were symptomatic for carotid artery stenosis, whereas 336 (55%) were identified as asymptomatic. As embolism protection methods, distal protection, proximal protection, and double (distal + proximal) protection was used in 52%, 43%, and 0.3% of patients, respectively. Results: The success rate of the CAS procedure was 96%. Procedure-related death was reported in 4 (0.6%) patients who successfully underwent the CAS procedure. Moreover, acute carotid artery stent thrombosis, hyperperfusion syndrome, periprocedural major stroke, and periprocedural minor stroke was observed in 4 (0.6%), 2 (0.3%), 2 (0.3%), and 12 (1.9%) patients, respectively. The total clinical complication rates during the first 30 periprocedural days were 1.6% (10 patients) and 3.1% (19 patients) in the asymptomatic and symptomatic groups, respectively. On cranial magnetic resonance imaging performed, asymptomatic ipsilateral cranial microembolism, asymptomatic contralateral cranial microembolism, and bilateral asymptomatic cranial microembolism was detected in 61 (11.6%), 20 (3.8%), 23 (4.4%) patients, respectively. Asymptomatic restenosis was observed in 24 (3.9%) patients. Conclusion: The CAS procedure is a reliable treatment option applicable with acceptable complication and success rates as outlined in the guidelines, when performed following a multidisciplinary evaluation, in the treatment of symptomatic and asymptomatic carotid artery stenosis, including high-risk patient groups. [ABSTRACT FROM AUTHOR]

Objectives: Percutaneous coronary angioplasty with stent implantation has been established as the main form of treatment of atherosclerosis. However, 16 to 44% of patients may evolve with stent restenosis. Periodontitis is an inflammatory condition associated with bacterial infection, that may lead to periodontal tissue destruction and tooth loss. This study aimed to evaluate the association between stent restenosis and periodontitis.Materials and Methods: Coronary angiography exams presenting stent imaging with and without restenosis were analyzed. Patients meeting the inclusion and exclusion criteria were selected and allocated in 2 groups: case (restenosis) and control (without restenosis). We evaluated if systemic and periodontal variables were predictors of restenosis (primary outcome) using a multivariable stepwise logistic regression. Additionally, we compared clinical and periodontal conditions between the control and case groups (secondary outcomes) using Chi-square test and ANOVA test.Results: Data from 49 patients (case n = 15; control n = 34) were analyzed. The results showed that stages III and IV periodontitis and lack of physical activity were significant predictors of stent restenosis (OR 5.82 and 5.98, respectively). Comparisons regarding the diagnosis of periodontal conditions between control and case groups did not present significant differences in the incidence of periodontitis and alveolar bone loss.Conclusion: Stages III and IV periodontitis increased the incidence of stent restenosis. These findings suggest that advanced stages of periodontal disease might lead to the occurrence of negative outcomes after coronary angioplasty with stent placement.

Purpose. The aim of the trial was to study the importance of immuno-inflammatory processes and hemo-rheological changes in patients suffering from stable coronary heart disease after coronary angioplasty and stenting, as well as establishing the clinical effect of treatment optimized with anti-inflammatory drugs and immune-correctors.Material and methods. The study included 103 patients in total and 64 patients with an implanted stent. Within 2-28 months after stent implantation, an angiographic study was performed with the definition of a coagulogram, C-reactive protein (CRP), fibrinogen, and pro-inflammatory cytokines - tumor necrosis factor (FNA-α), interleukins (IL), IL-6, IL-8 in the serum of patients with coronary artery disease.Results. After coronary angioplasty and stenting in patients with coronary artery disease, the average concentrations of CRP and cytokines were significantly higher compared with both the control group and the group without restenosis. This indicator in the groups with and without restenosis was 16.4±1.2 (intragroup variation 6-36) mg/L and 6.8±0.4 (intragroup variation 5-10) mg/L, respectively; p

OBJECTIVE: Monocyte to high-density lipoprotein ratio (MHR) has recently been postulated as a novel parameter related to adverse cardiovascular outcomes. In this study, we aimed to investigate the correlation of MHR with stent restenosis (SR) rates after the primary percutaneous coronary intervention (PCI) and bare-metal stent (BMS) implantation. METHODS: In this study, patients who had undergone primary PCI for STEMI and had a control angiogram during follow-up were retrospectively recruited. Patients were categorized according to admission MHR tertiles, clinical and angiographic data were compared. In addition, predictors of SR were evaluated with logistic regression analysis. RESULTS: A total number of 448 patients (240 patients with SR and 208 patients without SR) were included in this study. Patients were categorized into three groups according to tertiles of admission MHR. During a follow-up period of median 12 months, the rate of SR was significantly higher in patients with higher MHR levels (45% in tertile 1, 54% in tertile 2 and 62% in tertile 3, p<0.01). In multivariate Cox regression analysis, male gender, stent length, admission NLR levels and MHR levels (HR 1.03, 95% CI 1.02-1.06, p<0.01) remained as the independent predictors of SR in the study population. CONCLUSION: Gender, stent length, higher MHR and NLR levels are correlated to SR after primary PCI. [ABSTRACT FROM AUTHOR]

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Abstract Coronary artery disease remains the leading cause of mortality in adult diabetic population with however, a high predominance also in non-diabetic subjects. In search of common molecular mechanisms and metabolic by-products with potential pathogenic role, increased advanced glycation end products (AGEs) present a critical biomarker for CAD development in both cases. Interaction of AGEs with their transmembrane cell receptor, RAGE in endothelial and smooth muscle cells as well as in platelets, activates intracellular signaling that leads to endothelial injury, modulation of vascular smooth muscle cell function and altered platelet activity. Furthermore, tissue accumulation of AGEs affects current treatment approaches being involved in stent restenosis. The present review provides an update of AGE-induced molecular mechanisms involved in CAD pathophysiology while it discusses emerging therapeutic interventions targeting AGE reduction and AGE-RAGE signaling with beneficial clinical outcome. Graphical abstract Unlabelled Image Highlights • Advanced glycation end products (AGEs) are involved in CAD pathogenesis. • AGEs crosslink extracellular matrix proteins and increase vascular stiffness. • AGEs-Receptor for AGEs (RAGE) signaling disrupts endothelial homeostasis. • AGEs modulate vascular smooth muscle cells functions and platelet activity. • AGE-RAGE signaling axis is involved in stent restenosis. [ABSTRACT FROM AUTHOR]

Background. Despite recent advances in stent design and constantly improving protective pharmacological strategies, complications and adverse events following percutaneous coronary interventions (PCI) are still major factors influencing morbidity and mortality. Therefore, predicting secondary vascular occlusions represents an unmet medical need.Aim. To triage clinical and laboratory predictors of major adverse clinical events (MACE) following coronary stenting.Material and methods. This was a prospective, case-controlled, single-center study, which included 94 consecutive patients with documented ischemic heart disease (IHD) who underwent PCI with drug-eluting stent implantation. All patients received dual antiplatelet therapy with acetyl salicylic acid and clopidogrel. Numerous clinical characteristics and laboratory biomarkers were assessed before stenting, as well as CYP2C19 genotyping after patient’s discharge and were correlated with poststenting MACE over the mean follow-up of 28 months. MACE included death, nonfatal myocardial infarction, target vessel revascularisation, stroke, stent thrombosis, angina recurrence and in-stent restenosis.Results. Twenty-three patients experienced MACE. According to univariate regression analysis we found following MACE predictors after PCI: diabetes mellitus (p=0.049), P2Y12 Reaction Units (PRU) according to VerifyNow® (p=0.01), number of stented arteries more than 2 (p=0.01), number of implanted stents more than 2 (p=0.01), baseline levels of plasminogen activator inhibitor-1 (PAI-1) (p=0.03) and von Willebrand activity (vWF) (p=0.01). Using multivariate analysis we demonstrated that concomitant diabetes mellitus, PRU ≥202, PAI-1 level ≥75.95 ng/ml, von Willebrand factor activity ≥155.15% are independent predictors of adverse cardiac events after PCI in stable IHD patients. Other clinical characteristics and laboratory indices, including CYP2C19*2 carriage, showed no significant impact on outcomes after elective PCI. Conclusions. Background diabetes mellitus, high on-treatment platelet reactivity (according to VerifyNow®), PAI-1 and vWF presenting activity may be useful for MACE prediction over 28 months of follow-up after PCI with drug-eluting stent implantation.

Coronary stents belong to the most commonly implanted devices worldwide. A number of different types of stent exist, with very different mechanical and biochemical characteristics that influence their interactions with vascular tissues. Inappropriate inflammatory reactions are the major cause of the two major complications that follow implantation of stents in a percentage as high as 5–20%. It is therefore important to understand these reactions and how different they are among different generations of stents.

Aim of the study is to show the pathogenetic importance of myocardial revascularization and to estimate quantitatively effi ciency of the treatment of cardiac allograft vasculopathy after heart transplantation.Materials and methods. 30 percutaneous coronary interventions (PCI) were performed to recipients of heart transplant (8 men and 7 women, aged from 18 to 56 years), who were diagnosed with cardiac allograft vasculopathy by coronary angiography within the time period from 1,5 to 12 years after heart transplantation. Before revascularization and one week after tolerances to physical activity, volume characteristics of the left ventricle were defi ned and diastolic function of heart was estimated. Average term of observation after stenting was 35,5 ± 5,5 months.Results. Tolerance to physical activity (from 76,6 ± 8,5 to 116,9 ± 9,6 W), its duration (from 5,4 ± 2,2 to 8,5 ± 4,1 min) and rate pressure product – RPP (from 198 ± 15 to 247 ± 24 P < 0,05) increased. There was a restoration of diastolic function (Ve/Va from 0,57 ± 0,18 to 1,15 ± 0,2 P < 0,05). Signifi cant distinction in time frames of vasculopathy development, frequency and reasons of repeated interventions depending on age of patients is revealed. In the group of patients younger than 30 years of age (7 patients), the time interval between heart transplantation and vasculopathy development is twice shorter, than in more senior patient group, over 45 years old (8 patients). Young patients showed the expressed tendency to develop stent restenosis (20 coronary interventions).Conclusion. Dynamics in functional condition of the left ventricle as a result of revascularization confi rms the leading role of miocardial ischemia in pathogenesis of transplant insuffi ciency due to vasculopathy. The signifi cant factor infl uencing upon long-term result of coronary intervention is the age of the patient.

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Introducción y objetivos: los stents convencionales presentan tasas de restenosis intrastent entre 10% y 60%, mientras los stents liberadores de fármacos alcanzan el 10%. Para Latinoamérica, no hay reportes de restenosis intrastent en comparación con los stents convencionales y los stents liberadores de fármacos. En este estudio se describen aspectos asociados a este evento en pacientes atendidos en un centro de alta complejidad en Colombia. Métodos: análisis retrospectivo de pacientes con restenosis intrastent incluidos en el registro DRug ELuting STent (DREST) entre los años 1994 y 2011, en el que se compararon características basales, datos técnicos y supervivencia de los pacientes con stent convencional y stent liberador de fármacos. Resultados: se evidenció restenosis intrastent en 269 con stent convencional (11,5%) y en 65 con stent liberador de fármacos (12,2%), sin diferencias significativas al comparar por género (p=0,983) o edad (p=0,55). La dislipidemia fue el factor de riesgo más significativo asociado a la restenosis intrastent de los stents liberadores de fármacos (pIntroduction and Objectives: Bare metal stents have stent restenosis rates between 10% and 60%, while drug-eluting stents reach 10%. In Latin America, there are no reports of stent restenosis between bare-metal stents and drug eluting stents. This study describes aspects associated with this event in patients treated at a center of high complexity in Colombia. Methods: Retrospective analysis of patients with stent restenosis included in the Drug Eluting Stent Registry (DREST) between 1994 and 2011, which compared baseline characteristics, technical data and survival of patients with bare metal stents and drug eluting stents. Results: We found stent restenosis with bare metal stents in 269 patients (11.5%) and in 65 with drug-eluting stent (12.2%) without significant differences between gender (p = 0.983) or age (p = 0 , 55). Dyslipidemia was the most significant risk factor associated with stent restenosis of drug-eluting stents (p

The present study was conducted to determine the correlation between high perfusion syndrome and stent restenosis after cerebral vascular stent implantation. A total of 146 patients diagnosed with cerebral vascular stenosis and stent implantation were selected. A total of 55 cases (37.67%) of cerebral hyperperfusion syndrome patients were diagnosed by xenon-enhanced computer tomography (Xe-CT) examination and clinical symptoms within 3 days after surgery and were chosen as the observation group. A total of 91 cases were selected as the control group. After treatment, blood flow of the anterior cerebral artery, middle cerebral artery, posterior cerebral artery, anterior border zone, posterior border zone and the inner border zone of the two groups increased, with values in the observation group increasing more significantly, and the differences were statistically significant (P<0.05). The rate of restenosis and target lesion diameter one month and one year after operation in the observation group were significantly higher than those in the control group (P<0.05). Multivariate logistic regression analysis showed that the mean systolic blood pressure (mSBP), mean diastolic blood pressure (mDBP), stenosis rate of cerebral vascular diameter and high perfusion syndrome were independent risk factors for restenosis (P<0.05). The application of Xe-CT examination is important for early diagnosis of hyperperfusion syndrome. Hyperperfusion syndrome and the occurrence of stent restenosis are closely related. mSBP, mDBP, cerebral blood vessel diameter stenosis rate and high perfusion comprehensive syndrome are the independent risk factors of restenosis. [ABSTRACT FROM AUTHOR]

Background:Contrast induced nephropathy (CIN) has been proven as a clinical condition related to adverse cardiovascular outcomes. However, relationship between CIN and stent restenosis (SR) remains unclear. In this study, we aimed to investigate the association of CIN with SR rates after primary percutaneous coronary intervention (PCI) and bare metal stent (BMS) implantation. Methods:A total number of 3225 patients who had undergone primary PCI for STEMI were retrospectively recruited. The medical reports of subjects were searched to find whether the patients had a control coronary angiogram (CAG) and 587 patients with control CAG were included in the study. The laboratory parameters of 587 patients were recorded and patients who developed CIN after primary PCI were defined. Contrast induced nephropathy was defined as either a 25% increase in serum creatinine from baseline or 0.5 mg/dL increase in absolute value, within 72 h of intravenous contrast administration. Results:The duration between primary PCI and control CAG was median 12 months [8–24 months]. The rate of SR was significantly higher in CIN (+) group compared to CIN (−) group (64% vs. 46%,p < 0.01). In multivariate Cox regression analysis, male gender, stent length, admission WBC levels and presence of CIN (HR 1.39, 95% CI 1.06–1.82,p < 0.01) remained as the independent predictors of SR in the study population. Conclusion:Gender, stent length, higher serum WBC levels and presence of CIN are independently correlated with SR in STEMI patients treated with BMS implantation. [ABSTRACT FROM AUTHOR]

Peripheral arterial disease, particularly critical limb ischemia, is an area with urgent need for optimized therapies because, to date, vascular interventions often have limited life spans. In spite of initial encouraging technical success after femoropopliteal percutaneous transluminal angioplasty or stenting, postprocedural restenosis remains the major problem. The challenging idea behind the drug-coated balloon (DCB) concept is the biological modification of the injury response after balloon dilatation. Antiproliferative drugs administered via DCBs or drug-eluting stents are able to suppress neointimal hyperplasia, the main cause of restenosis. This article reviews the results of DCB treatments of femoropopliteal and infrapopliteal lesions in comparison to standard angioplasty with uncoated balloons. A systematic literature search was performed in 1) medical journals (ie, MEDLINE), 2) international registers for clinical studies (ie, www.clinicaltrials.gov), and 3) abstracts of scientific sessions. Several controlled randomized trials with follow-up periods of up to 5 years demonstrated the efficacy of paclitaxel -DCB technology. However, calcified lesions seem to affect the efficacy of DCB. Combinations of preconditioning methods with DCBs showed promising results. Although the mechanical abrasion of calcium via atherectomy or laser ablation showed favorable periprocedural results, the long-term impact on restenosis and clinical outcome has to be demonstrated. Major advantages of the DCBs are the rapid delivery of drug at uniform concentrations with a single dose, their efficacy in areas wherein stents have been contraindicated until now (ie, bifurcation, ostial lesions), and in leaving no stent scaffold behind. Reinterventions are easier to perform because DCBs leave no metal behind. Various combinations of DCBs with other treatment modalities may prove to be viable options in future. The follow-up results of clinical studies will evaluate the long-term impact of DCBs. [ABSTRACT FROM AUTHOR]

Despite the favorable impact of drug eluting stents on stent restenosis, their long-term reliability is considered worrisome by some because of stent thrombosis. Often attributed to adverse reactions to the stent platform, both the drugs and polymer characteristics have been further advanced with current technologies. The present review discussed current drug eluting stents and new developments. [ABSTRACT FROM AUTHOR]