Autoimmune diseases in patients undergoing percutaneous coronary intervention: A risk factor for in-stent restenosis?

Pepe, Martino; Napoli, Gianluigi; Carulli, Eugenio; Moscarelli, Marco; Forleo, Cinzia; Nestola, Palma Luisa; Biondi‐Zoccai, Giuseppe; Giordano, Arturo; Favale, Stefano

doi:10.1016/j.atherosclerosis.2021.08.007

Cited by 11 publications

(7 citation statements)

References 94 publications

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“…Although evidence suggests that neointimal hyperplasia plays an essential role in the development of ISR, the underlying aetiology is yet to be fully elucidated (15). The use of intravascular imaging, for example, intravascular ultrasound (IVUS) and optical lucidness tomography (OCT), has allowed for better characterisation of ISR, yet these evaluations are invasive and expensive (16).…”

Section: Discussionmentioning

confidence: 99%

In Stent Restenosis (Isr) in Patients Undergoing Percutaneous Coronary Intervention (Pci) for Coronary Artery Disease (Cad)

ULLAH,

ARSHAD,

HUSSAIN

2024

Biol Clin Sci Res J

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In-stent restenosis (ISR) remains a significant clinical challenge in patients undergoing percutaneous coronary intervention (PCI) for coronary artery disease (CAD). Objectives: The main aim of the study is to find the In-Stent Restenosis (ISR) in patients undergoing percutaneous coronary intervention (PCI) for coronary artery disease (CAD). Methods: This cross-sectional study was conducted at Prime Teaching Hospital Peshawar from January 2023 till December 2023. Data were collected from 80 patients from both genders. Patients who underwent PCI for CAD and developed ISR, as confirmed by angiographic or intravascular imaging studies, were included. Data were collected in a systematically designed performance. Information was collected from electronic medical records, angiographic reports, and procedural databases. Results: Data were collected from 80 patients according to inclusion criteria. The mean age of the patients was 65.09±8.5 years. There were 52 (65%) male and 48 (35%) female patients. Hypertension was present in 60 (75%), dyslipidemia in 48(60%) and DM in 36 (45%) patients. There was a significant association between older age and increased likelihood of ISR development post-PCI (Mean age ISR: 68.01 ± 7.2 years vs. No ISR: 62.39 ± 9.1 years, p=0.02). However, gender did not significantly influence ISR occurrence (71% male ISR vs. 62% male No ISR, p=0.42). Conclusion: It is concluded that ISR represents a significant challenge in patients post-PCI for CAD, with a substantial incidence observed in this study. Older age, diabetes mellitus, and DES implantation were identified as essential contributors to ISR development.

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Section: Discussionmentioning

confidence: 99%

In Stent Restenosis (Isr) in Patients Undergoing Percutaneous Coronary Intervention (Pci) for Coronary Artery Disease (Cad)

ULLAH,

ARSHAD,

HUSSAIN

2024

Biol Clin Sci Res J

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“…Moreover, a trend toward lower rates of clinically-indicated TLR was observed. Also, evidence is emerging about the association between autoimmune disorders and the risk of ISR [90]. Lesion factors associated with ISR include vessel type, size, and lesion characteristics.…”

Section: In-stent Restenosismentioning

confidence: 99%

Stent Thrombosis and Restenosis with Contemporary Drug-Eluting Stents: Predictors and Current Evidence

Condello

Spaccarotella

Sorrentino

et al. 2023

JCM

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Iterations in stent technologies, advances in pharmacotherapy, and awareness of the implications of implantation techniques have markedly reduced the risk of stent failure, both in the form of stent thrombosis (ST) and in-stent restenosis (ISR). However, given the number of percutaneous coronary interventions (PCI) performed worldwide every year, ST and ISR, albeit occurring at a fairly low rate, represent a public health problem even with contemporary DES platforms. The understanding of mechanisms and risk factors for these two PCI complications has been of fundamental importance for the parallel evolution of stent technologies. Risk factors associated with ST and ISR are usually divided into patient-, lesion-, device- and procedure-related. A number of studies have shown how certain risk factors are related to early (1 month) versus late/very late ST (between 1 month and 1 year and >1 year, respectively). However, more research is required to conclusively show the role of time-dependence of risk factors also in the incidence of ISR (early [1 year] or late [>1 year]). A thorough risk assessment is required due to the complex etiology of ST and ISR. The most effective strategy to treat ST and ISR is still to prevent them; hence, it is crucial to identify patient-, lesion-, device- and procedure-related predictors.

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“…The role of inflammation in the development of ISR is clearly demonstrated by the evidence that autoimmune diseases, including inflammatory bowel diseases, rheumatoid arthritis, systemic lupus erythematosus, antiphospholipid-antibodies syndrome, and Hashimoto’s thyroiditis, are a risk factor for ISR. 18 Indeed, vascular inflammation involves complex interactions between numerous cell types that release pro-inflammatory markers, cytokines, chemokines, and/or express cellular adhesion molecules (CAMs). 19 Specifically, immediately following PCI, the surrounding endothelial cells are activated by pro-inflammatory cytokines, such as C-reactive protein, interleukin-1 beta (IL-1β), IL-6, transforming growth factor-beta (TGF-β), and tumour necrosis factor-alpha (TNF-α) secreted by monocytes ( Figure 5 ).…”

Section: Biological Pathwaysmentioning

confidence: 99%

In-stent restenosis after percutaneous coronary intervention: emerging knowledge on biological pathways

Pelliccia,

Zimarino,

Niccoli

et al. 2023

European Heart Journal Open

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Percutaneous coronary intervention (PCI) has evolved significantly over the past four decades. Since its inception, in-stent restenosis (ISR) – the progressive reduction in vessel lumen diameter after PCI – has emerged as the main complication of the procedure. Although the incidence of ISR has reduced from 30% at 6 months with bare-metal stents (BMS) to 7% at 4 years with drug-eluting stents (DES), its occurrence is relevant in absolute terms because of the dimensions of the population treated with PCI. The aim of this review is to summarize the emerging understanding of the biological pathways that underlie ISR. ISR is associated with several factors, including patient-related, genetic, anatomic, stent, lesion and procedural characteristics. Regardless of associated factors, there are common pathophysiologic pathways involving molecular phenomena triggered by the mechanical trauma caused by PCI. Such biologic pathways are responses to the denudation of the intima during balloon angioplasty and involve inflammation, hypersensitivity reactions, and stem cell mobilization in particular of endothelial progenitor cells (EPCs). The results of these processes are either vessel wall healing or neointimal hyperplasia and/or neoatherosclerosis. Unraveling the key molecular and signal pathways involved in ISR is crucial to identify appropriate therapeutic strategies aimed at abolishing the ‘Achille’s heel’ of PCI. With this regard, we discuss novel approaches to prevent DES restenosis. Indeed, available evidence suggests that EPCs-capturing stents promote a rapid stent re-endothelisation, which in turn has the potential to decrease the risk of stent thrombosis and allow the use of a shorter duration of dual antiplatelet therapy.

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Autoimmune diseases in patients undergoing percutaneous coronary intervention: A risk factor for in-stent restenosis?

Cited by 11 publications

References 94 publications

In Stent Restenosis (Isr) in Patients Undergoing Percutaneous Coronary Intervention (Pci) for Coronary Artery Disease (Cad)

In Stent Restenosis (Isr) in Patients Undergoing Percutaneous Coronary Intervention (Pci) for Coronary Artery Disease (Cad)

Stent Thrombosis and Restenosis with Contemporary Drug-Eluting Stents: Predictors and Current Evidence

In-stent restenosis after percutaneous coronary intervention: emerging knowledge on biological pathways

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