1. Mechanisms of Medial Wall Thinning in Chronic Total Occlusion.
- Author
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Konishi T, Kawakami R, Vozenilek AE, Ghosh SKB, Xu W, Grogan A, Shah P, Tanaka T, Sekimoto T, Shiraki T, Kawai K, Sato Y, Mori M, Sakamoto A, Hisadome H, Ashida K, Bellissard A, Williams D, Dryanovski D, Kutys R, Cheng Q, Romero M, Chahal D, Virmani R, and Finn AV
- Subjects
- Humans, Male, Female, Middle Aged, Aged, Chronic Disease, Risk Factors, Treatment Outcome, Apoptosis, Vascular Remodeling, Tunica Media pathology, Tunica Media diagnostic imaging, Case-Control Studies, Coronary Angiography, Coronary Occlusion diagnostic imaging, Coronary Occlusion pathology, Percutaneous Coronary Intervention adverse effects, Percutaneous Coronary Intervention instrumentation, Coronary Vessels diagnostic imaging, Coronary Vessels pathology
- Abstract
Background: The success rate of percutaneous coronary intervention (PCI) for chronic total occlusion (CTO) is lower and the risk for complications higher compared with other non-CTO PCI. Although interventionalists focus on intimal plaque characteristics, the coronary media is an important (especially for techniques involving antegrade dissection and re-entry) but poorly understood structure in CTO PCI., Objectives: The aim of the present study was to investigate coronary medial wall thinning in CTO lesions and determine how this thinning might affect CTO PCI., Methods: A total of 2,586 sections were investigated, from arteries with evidence of CTO from 54 subjects (1,383 sections) and arteries without evidence of CTO from 54 subjects with non-coronary-related deaths (1,203 sections) after matching for age, gender, body weight, and body height., Results: The medial thickness in subjects with CTO was lower than that in those with non-coronary-related death (P < 0.001). In subjects with CTO, CTO lesions had thinner medial walls compared with those with lower luminal narrowing (P < 0.001). At the CTO distal segments, the 6- to 12-mm distal segment from the distal end of the CTO had significantly less luminal narrowing (P < 0.001), and similar medial thickness, compared with the distal end of the CTO. Immunohistochemical analysis revealed that short-duration CTO had more cleaved caspase-3-positive cells in media and had significantly more CD3
+ , CD4+ , CD8+ , and CD4+ CD28null T cells compared with long-duration CTO., Conclusions: CTO lesions demonstrated coronary medial thinning compared with non-CTO lesions. Further investigation of the cause-and-effect relationship among inflammation, apoptosis, and coronary medial wall thinning is warranted in future mechanistic studies., Competing Interests: Funding Support and Author Disclosures This study was supported by the CVPath Institute. Drs Virmani and Finn have received institutional research support from the National Institutes of Health (grant HL141425), a Leducq Foundation grant, 480 Biomedical, 4C Medical, 4Tech, Abbott, AccuMedical, Amgen, Biosensors, Boston Scientific, Cagent Vascular, Cardiac Implants, CeloNova BioSciences, Claret Medical, Concept Medical, Cook, Cardiovascular Systems, DuNing, Edwards Lifesciences, Emboline, Endotronix, Envision Scientific, Lutonix Bard, Gateway, LifeTech, LimFlow, MedAlliance, Medtronic, Mercator, Merill, MicroPort Medical, MicroVention, Mitralign, Mitra Assist, North American Science Associates, Nanova, Neovasc, Nipro, Novogate, Occlutech, OrbusNeich Medical, Phenox, Profusa, Protembis, Qool, Recor, Senseonics, Shockwave Medical, SINOMED, Spectranetics, Surmodics, Symic, Vesper, W.L. Gore, and Xeltis. Dr Finn has received honoraria from Abbott Vascular, Biosensors, Boston Scientific, CeloNova BioSciences, Cook Medical, Cardiovascular Systems, Lutonix Bard, Sinomed, and Terumo; and is a consultant to Amgen, Abbott Vascular, Boston Scientific, CeloNova BioSciences, Cook Medical, Lutonix Bard, and Sinomed. Dr Virmani has received honoraria from Abbott Vascular, Biosensors, Boston Scientific, CeloNova BioSciences, Cook Medical, Cordis, Cardiovascular Systems, Lutonix Bard, Medtronic, OrbusNeich Medical, SINOMED, Recor, Terumo, W.L. Gore, and Spectranetics; and is a consultant for Abbott Vascular, Boston Scientific, CeloNova BioSciences, Cook Medical, Cordis, Cardiovascular Systems, Edwards Lifesciences, Lutonix Bard, Medtronic, OrbusNeich Medical, Recor, SINOMED, Spectranetics, Surmodics, Terumo, W. L. Gore, and Xeltis. Dr Konishi has received a research grant from the Ito Foundation. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose., (Copyright © 2024 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.)- Published
- 2024
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