Cutting balloon angioplasty of ostial coronary lesions: do we need the stent support?
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Angioplasty, Balloon, Coronary↗
Biomedical subjects
A Colombo
Publications and source records attributed to A Colombo.
Is There Still a Role for Ultrasound-Guided Coronary Stenting to Lower Thrombosis and Restenosis?
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Journal Article↗
Angiographic and intravascular ultrasound predictors of in-stent restenosis.
OBJECTIVES: This study was performed to determine predictors of in-stent restenosis from a high volume, single-center practice. BACKGROUND: Intracoronary stents have been shown to reduce the restenosis rate as compared with balloon angioplasty, but in-stent restenosis continues to be an important clinical problem. METHODS: Between April 1993 and March 1997, 1,706 patients with 2,343 lesions were treated with a variety of intracoronary stents. The majority of stents were placed with high pressure balloon inflations and intravascular ultrasound (IVUS) guidance. Angiographic follow-up was obtained in 1,173 patients with 1,633 lesions (70%). Clinical, angiographic and IVUS variables were prospectively recorded and analyzed by univariate and multivariate models for the ability to predict the occurrence of in-stent restenosis defined as a diameter stenosis > or =50%. RESULTS: In-stent restenosis was angiographically documented in 282 patients with 409 lesions (25%). The restenosis group had a significantly longer total stent length, smaller reference lumen diameter, smaller final minimal lumen diameter (MLD) by angiography and smaller stent lumen cross-sectional area (CSA) by IVUS. In lesions where IVUS guidance was used, the restenosis rate was 24% as compared with 29% if IVUS was not used (p < 0.05). By multivariate logistic regression analysis, longer total stent length, smaller reference lumen diameter and smaller final MLD were strong predictors of in-stent restenosis. In lesions with IVUS guidance, IVUS stent lumen CSA was a better independent predictor than the angiographic measurements. CONCLUSIONS: Achieving an optimal stent lumen CSA by using IVUS guidance during the procedure and minimizing the total stent length may reduce in-stent restenosis.
Aged↗
Angiographic and clinical outcome following coronary stenting of small vessels: a comparison with coronary stenting of large vessels.
OBJECTIVES: Stent implantation reduces restenosis in vessels > or =3 mm compared with balloon angioplasty, but few data are available for stents implanted in vessels <3 mm. The aim of this study was to evaluate immediate and follow-up patient outcomes after stent implantation in vessels <3 mm compared to stent implantation in vessels > or =3 mm. METHODS: Between March 1993 and May 1996, a total of 1,298 consecutive patients (1,673 lesions) underwent coronary stenting. The study population was divided into two groups based on angiographic vessel diameter. In case of multivessel stenting, patients were randomly assigned only one lesion. Group I included 696 patients (696 lesions) in whom stents were implanted in vessels > or =3 mm, and group II included 602 patients (602 lesions) in whom stents were implanted in vessels <3 mm. RESULTS: There was no difference in procedural success (95.4% in group I and 95.9% in group II), or subsequent subacute stent thrombosis (1.5% in group I and 1.4% in group II, p=NS). The postprocedure residual diameter stenosis was 3.31+/-12.4% in group I and -2.45+/-16.2% in group II. Angiographic follow-up was performed in 75% of patients, restenosis occurred in 19.9% of patients in group I and 32.6% in group II (p <0.0001). Absolute lumen gain was significantly higher in group I compared to group II, but absolute late lumen loss was similar in the two groups (1.05+/-0.91 mm in group I vs. 1.11+/-0.85 mm in group II, p=NS). Subsequently, the loss index was more favorable in group I (0.45 vs. 0.56; p=0.0006). Independent predictors of freedom from restenosis by multivariate logistic regression in the total population were: larger baseline reference diameter (odds ratio 2.032 p=0.006), larger postprocedure minimal stent cross-sectional area (odds ratio 1.190, p=0.0001) and shorter lesions (odds ratio 1.037, p=0.01). At long-term clinical follow-up, patients with small vessels had a lower rate of event-free survival (63% vs. 71.3%, p=0.007). CONCLUSIONS: Coronary stenting can be performed in small vessels with a high success rate and low incidence of stent thrombosis. However, the long-term angiographic and clinical outcome of patients undergoing stent implantation in small vessels is less favorable than that of patients with large vessels.
Aged↗
Stenting after optimal lesion debulking (sold) registry. Angiographic and clinical outcome.
BACKGROUND: Coronary stenting has reduced restenosis in focal de novo lesions, but its impact has been less pronounced in complex lesion subsets. Preliminary data suggest a role for plaque burden in promoting intimal hyperplasia after stent implantation. The aim of this study was to test the hypothesis that plaque removal with directional atherectomy before stent implantation may lower the intensity of late neointimal hyperplasia, reducing the incidence of in-stent restenosis. METHODS AND RESULTS: Seventy-one patients with 90 lesions underwent directional atherectomy before coronary stenting. Intravascular ultrasound-guided stenting was performed in 73 lesions (81%). Clinical success was achieved in 96% of patients. Procedural complications were as follows: emergency bypass surgery in 1 patient (1.4%), who died 2 weeks later; Q-wave myocardial infarction in 2 patients (2.8%); and non-Q-wave myocardial infarction in 8 patients (11.3%). None of the patients had stent thrombosis at follow-up. Angiographic follow-up was performed in 89% of eligible patients at 5.7+/-1.7 months. Loss index was 0.33 (95% CI, 0.26 to 0.40), and angiographic restenosis was 11% (95% CI, 5% to 20%). Clinical follow-up was performed in all patients at 18+/-3 months. Target lesion revascularization was 7% (95% CI, 3% to 14%). CONCLUSIONS: Directional atherectomy followed by coronary stenting could be performed with good clinical success rate. Also, these data point to a possible reduction in angiographic restenosis and a significant reduction in the need for repeated coronary interventions. Therefore, a randomized clinical trial seems appropriate to test the validity of this approach.
Aged↗
Randomised comparison of implantation of heparin-coated stents with balloon angioplasty in selected patients with coronary artery disease (Benestent II)
BACKGROUND: The multicentre, randomised Benestent-II study investigated a strategy of implantation of a heparin-coated Palmar-Schatz stent plus antiplatelet drugs compared with the use of balloon angioplasty in selected patients with stable or stabilised unstable angina, with one or more de-novo lesions, less than 18 mm long, in vessels of diameter 3 mm or more. METHODS: 827 patients were randomly assigned stent implantation (414 patients) or standard balloon angioplasty (413 patients). The primary clinical endpoint was event-free survival at 6 months, including death, myocardial infarction, and the need for revascularisation. The secondary endpoints were the restenosis rate at 6 months and the cost-effectiveness at 12 months. There was also one-to-one subrandomisation to either clinical and angiographic follow-up or clinical follow-up alone. Analyses were by intention to treat. FINDINGS: Four patients (one stent group, three angioplasty group) were excluded from analysis since no lesion was found. At 6 months, a primary clinical endpoint had occurred in 53 (12.8%) of 413 patients in the stent group and 79 (19.3%) of 410 in the angioplasty group (p=0.013). This significant difference in clinical outcome was maintained at 12 months. In the subgroup assigned angiographic follow-up, the mean minimum lumen diameter was greater in the stent group than in the balloon-angioplasty group, (1.89 [SD 0.65] vs 1.66 [0.57] mm, p=0.0002), which corresponds to restenosis rates (diameter stenosis > or =50%) of 16% and 31% (p=0.0008). In the group assigned clinical follow-up alone, event-free survival rate at 12 months was higher in the stent group than the balloon-angioplasty group (0.89 vs 0.79, p=0.004) at a cost of an additional 2085 Dutch guilders (US$1020) per patient. INTERPRETATION: Over 12-month follow-up, a strategy of elective stenting with heparin-coated stents is more effective but also more costly than balloon angioplasty.
Adult↗
Interleukin-12 release by mitogen-stimulated mononuclear cells in the elderly.
Defects involving cellular expression of activation molecules, cell mediated immune response and natural killer (NK) activity are commonly observed in the elderly. Herein, data are reported on the evaluation of IL-12 production by old subjects. IL-12 is, actually, considered the key molecule for the induction of a T helper 1 (Th1) -type and NK response. IL-12 production from old subjects peripheral blood mononuclear cells (PBMNC) was evaluated using T-independent (bacterial lipopolysaccharide, LPS) or -dependent (phytoemagglutinin, PHA; immobilized anti-CD3 monoclonal antibodies, anti-CD3) mitogens. The IL-12 production after LPS stimulation was not reduced in cultures from old subjects when compared to that from young ones. On the contrary, IL-12 production by PHA or anti-CD3 stimulated PBMNC from old subjects was decreased. Furthermore, we have demonstrated a reduced CD40 and CD40 ligand (CD40L) expression on PBMNC from old subjects. This finding fits very well with the reduced cytokine production observed in the T-dependent stimulation systems, being the CD40-CD40L interaction mandatory for an efficient IL-12 production. All together, these results seem to suggest that defects in cell expression of activation molecules can affect the IL-12 secretion and in consequence other Th1-type cytokines.
Adult↗
Comparison of aggressive versus nonaggressive balloon dilatation for stent deployment on late loss and restenosis in native coronary arteries.
Aggressive balloon dilatation is currently performed to assure full stent expansion and minimize the risk of stent thrombosis. It is not known if aggressive stent expansion leads to further increases in intimal proliferation and restenosis. A retrospective analysis was performed of 688 consecutive coronary narrowings in which stents were implanted. Angiographic follow-up was performed and quantitative coronary angiographic measurements were obtained using electronic calipers. Patients were divided into 2 groups. Group A (212 narrowings) had stents implanted before 1993, before the routine use of aggressive stent expansion techniques. Group B (476 narrowings) had stents implanted after 1993, when oversized balloons or high-pressure inflations were performed inside stents. Comparisons were made between angiographic changes and clinical outcomes between the 2 groups. Group B lesions had less favorable characteristics due to longer lengths of lesions. Despite this there was less angiographic and clinical restenosis in this cohort. There was no difference in late loss between the 2 groups. Thus, aggressive stent implantation techniques were not associated with increased late loss or restenosis.
Aged↗
Comparison of angiographic and clinical outcomes of coronary stenting of chronic total occlusions versus subtotal occlusions.
The objective of this study was to assess the short- and long-term outcome of patients undergoing coronary stenting for chronic total occlusions compared with a control patient population with nonocclusive stenoses. A total of 789 consecutive patients (1,043 lesions) underwent coronary stenting using a high-pressure stent optimization technique. The study population was divided into total occlusion group (94 consecutive patients [95 lesions] with chronic total occlusions) and subtotal occlusion group (695 consecutive patients [948 lesions] with nonocclusive stenoses). There was no difference in post-procedure angiographic minimum lumen diameter (3.13 +/- 0.48 vs 3.15 +/- 0.57 mm, p = 0.72) and minimum intrastent cross-sectional area by intravascular ultrasound (7.31 +/- 2.06 vs 7.64 +/- 2.53 mm2, p = 0.26) between the total and subtotal groups, respectively. Subacute thrombosis occurred in 2 patients (2.1%) in the total group compared with 9 patients (1.3%) in the subtotal group (p = 0.63). Angiographic restenosis occurred in 27% vs 22% (p = 0.40) and repeat angioplasty in 15% vs 13% (p = 0.62) in the total and subtotal groups, respectively. Thus, coronary stenting of chronic total occlusions after successful recanalization could be performed with a high success rate. In addition, the incidence of stent thrombosis, angiographic restenosis, and the need for target lesion revascularization is comparable to that of an unselected cohort of patients with nonocclusive stenoses.
Aged↗
Atherectomy for ostial LAD stenosis: "a cut above".
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Atherectomy, Coronary↗
Modified "T" stenting: a technique for kissing stents in bifurcational coronary lesion.
The kissing stenting using a new technique in two patients is reported. A stent was positioned at the ostium of the side branch. Another stent was advanced into the main vessel until the center of the stent was positioned near the origin of the side branch. The stent at the ostium of the side branch was deployed and the balloon and the guidewire were removed from the side branch. Thereafter, the stent in the main vessel was deployed. The follow-up angiogram of those patients showed no restenosis in both the vessels.
Aged↗
Focal stent collapse in a patient with systemic sclerosis.
We report a patient with systemic sclerosis having implantation of a 35 mm beStent with immediate success but developing angina at follow-up. A focal stent collapse with focal hyperplasia in and outside the stent was documented by ultrasound after 2 mos. A 14mm Palmaz-Schatz stent was successfully deployed into the collapsed beStent, with good 6-mo angiographic result. The stent collapse was probably due to unequal distribution of radial forces and possibly reactive hyperplasia in this unique patient with systemic sclerosis.
Aged↗
Low restenosis rate in lesions of the left anterior descending coronary artery with stenting following directional coronary atherectomy.
The present study evaluated acute and late results with stenting following directional coronary atherectomy (DCA) for the lesions in the left anterior descending coronary artery (LAD). Between April 1995 and January 1997, 200 LAD lesions with > or =3 mm reference vessel diameter were treated with coronary stents. The lesions were divided as to whether or not DCA was performed before stenting; 1) stenting alone (n = 163) and 2) debulking and stenting (n = 37). There were no significant differences in the incidences of complications except for non-Q-wave myocardial infarction that was more frequent in patients with debulking and stenting than in those with stenting alone (13.5% vs. 2.4%, P < 0.05). A greater acute lumen gain (2.85 +/- 0.66 vs. 2.25+/-0.60 mm, P < 0.01) and minimal lumen diameter (3.64+/-0.56 vs. 3.15+/-0.41 mm, P < 0.01) after stenting were observed in patients with debulking and stenting than in those with stenting alone. At follow-up patients with debulking and stenting continued to have a greater minimal lumen diameter (2.88+/-0.72 vs. 2.15+/-0.85 mm, P < 0.01) and had a lower restenosis rate (6.3% vs. 23.1%, P < 0.05) than those with stenting alone. Stenting following DCA appears to be advantageous in the LAD lesions with > or =3 mm reference vessel diameter.
Aged↗
Clinical feasibility of 0.018-inch intravascular ultrasound imaging device.
OBJECTIVES: Intravascular ultrasound imaging (IVUS) is limited by the size of the imaging catheter. To facilitate imaging before and during interventions, a 30-MHz ultrasonic imaging device was developed that is the same dimension as a 0.018-inch guide wire. The purpose of this study was to evaluate the clinical feasibility of this device. METHODS AND RESULTS: The imaging core was tested in 8 patients with the use of a monorail guiding sheath that was advanced through a 7F catheter. In addition, after coronary interventions, the standard guide wire was removed, the imaging core was placed inside a compatible balloon, and imaging was performed. In 4 patients, imaging was also performed with a standard 3.2F IVUS catheter. The lumen-plaque interface and the media-plaque interface were clearly visualized in all patients. There was no detectable loss in image quality between the new imaging device and the larger IVUS catheter, and measurements of lumen cross-sectional area were not statistically different. CONCLUSIONS: Improvements in manufacturing technology have permitted the development of a mechanically rotating ultrasound imaging core 0.018 inches in diameter. It is compatible with current balloon catheters without degradation of image quality.
Cardiac Catheterization↗
Mechanical recanalization of total coronary occlusions with the use of a new guide wire.
The mechanical approach in the recanalization of total coronary occlusions consisted of the use of a new 0.014-inch standard coronary guide wire with jointless spring coil design that improves steering characteristics and tip stiffness. In addition, a 0.014-inch soft tip wire with hydrophilic coating and low-profile 1.5 mm over-the-wire balloons were used. The first wire was used selectively in 86 patients to treat 95 total occlusions, of which 51 (54%) were older than 3 months. Unfavorable angiographic characteristics were present in 79 (83%) of 95 lesions. Overall crossing success was 71% (67 of 95 lesions). Complications were one coronary perforation with cardiac tamponade necessitating emergency bypass surgery. In conclusion, the mechanical approach with the use of the standard coronary guide wire with jointless spring coil design provides a high success rate in the recanalization of unfavorable total occlusions.
Angioplasty, Balloon, Coronary↗
Molecular approaches to evaluate pollutants.
Many organisms are in use to test pollutants and their extensive variability clearly emerges from reviews since researchers in the world are involved in continuous effort to set up new assays and to improve those already in use. In the present paper we focus the attention on the mixed function oxidase system and the DNA adduct formation which are two biomarkers widely used and extensively studied in mammals and fish by different Authors. We compare their results with the ones we obtained in amphibians, which result to be a good model. Moreover we present some significative results obtained by the use of cultured cell lines to test the herbicide MCPA. The results obtained demonstrate that the amphibian Xenopus is a suitable indicator for induction of cytochrome P-450 by B[a]P as well as for production of DNA adducts. Cultured cells evidenced that cytoskeletal array and thiol proteins are molecular targets of the herbicide used, demonstrating that risk assessment can be properly analysed in in vitro systems.
2-Methyl-4-chlorophenoxyacetic Acid↗
Identification of a multixenobiotic resistance mechanism in Xenopus laevis embryos.
In the '90's a membrane-associated transport protein, discovered in aquatic organisms, was considered to be expressed in response to environmental xenobiotics. Like the multidrug resistance protein found in mammalian tumor cell lines, this protein confers resistance in organisms in polluted areas by binding xenobiotics and transporting them out of the cells in an energy-dependent manner. This study investigates the expression and the activity of a P-glycoprotein (Pgp) involved in a multixenobiotic resistance mechanism (MXRM) during the early developmental stages and in tissues of adult Xenopus laevis.
ATP Binding Cassette Transporter, Subfamily B, Mem↗
Bioindicators for toxicity assessment of effluents from a wastewater treatment plant.
The discharge of effluents and toxic compounds into aquatic systems represents a growing environmental problem involving an impact on water ecology and potential effect on human health. Most municipal wastewaters are complex mixtures; their complexity led as to carry out a hazard assessment using chemical analyses and biological tests. This study investigates biochemical alteratiobns in two sentinel organisms, the Anodonta cygnea mussel and the Xenopus laevis frog exposed for different lengths of time to various concentration of wastewater of the S. Antonino Ticino treatment plant. The results point out the long-life of toxic compounds.
Animals↗