Effect of percutaneous transluminal coronary angioplasty on circulating endothelin levels

Ameli, Sean; Kaul, Sanjay; Castro, Loni; Arora, Chandra; Mirea, A.; Shah, Prediman K.

doi:10.1016/0002-9149(93)90178-f

Cited by 35 publications

(11 citation statements)

References 22 publications

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“…A number of studies have shown that ET-1 levels increase after PTCA either locally in the heart [10,14,16,[19][20][21], and/or in the peripheral circulation [11][12][13]15,17,18,22]. Initial studies supported the idea that this was due to myocardial ischemia.…”

Section: Et-1 Levels During Ptcamentioning

confidence: 99%

“…In vitro studies have shown that among other stimuli, various physical factors acting on vascular endothelium, like shear stress [5,6], mechanical stretching [7], or mechanical pressure [8,9], modify ET-1 gene expression and also lead to ET-1 secretion from endothelial cells. The corresponding clinical model is percutaneous transluminal coronary angioplasty (PTCA), during which ET-1 has been shown to increase, and this has been attributed to mechanical trauma of the coronary endothelial cells [10][11][12][13][14][15][16][17][18][19][20][21][22]. Most studies to date have examined the effect of single-vessel, single-lesion PTCA on ET-1 plasma levels.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Release of endothelin-1 from human endocardium after radiofrequency catheter ablation and coronary angioplasty: comparative results

Davlouros

Simeonidou

Tsakas

et al. 2005

International Journal of Cardiology

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Section: Et-1 Levels During Ptcamentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Release of endothelin-1 from human endocardium after radiofrequency catheter ablation and coronary angioplasty: comparative results

Davlouros

Simeonidou

Tsakas

et al. 2005

International Journal of Cardiology

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“…Multiple explanations have been put forward in order to explain this surprising finding which has to be interpreted in view of angiographically optimal results on the one hand and the frequent CK elevation on the other hand. Mechanical factors such as dissection, elastic recoil, intramural hematoma and microcirculatory vasoconstriction are being discussed [4,14,82,102,108,130,131,158]. Coronary stenting after angioplasty is able to increase coronary blood ¡ beyond the level of PTCA alone, and normalizes it in up to 80% of the patients with single vessel disease [82,102].…”

Section: Mkroembofization Durÿ Coronary Interventionsmentioning

confidence: 99%

“…A pre-existing reduction of coronary flow reserve in patients with diabetes mellitus, hypertension, and previous myocardial infarction may limit the restoration of flow [109,134]. In addition, vasoconstriction may occur induced by serotonin [149], and endothelin after PTCA [14]. Since PTCA destroys the endothelium at the lesion site, acetylcholine can induce coronary constriction rather than coronary vasodilatation [76,77,257].…”

Section: Mkroembofization Durÿ Coronary Interventionsmentioning

confidence: 99%

Koronate Mikroembolisierung — Bedeutung bei akuten koronaren Syndromen und bei interventionellen Eingriffen

Erbel¹,

Heusch²

1999

Herz

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The diagnosis coronary artery disease is classically based on patient's symptoms and morphology, as analyzed by angiography. The importance of risk factors for the development of coronary atherosclerosis and disturbance of coronary vasomotion is clearly established. However, microembolization of the coronary circulation has also to be taken into account. Microembolization may occur as a single or as multiple, repetitive events, and it may induce inflammatory responses. Spontaneous microembolization may occur, when the fibrous cap of an atheroma or fibroatheroma (Stary i.v. and Va) ruptures and the lipid pool with or without additional thrombus formation is washed out of the atheroma into the microcirculation. Such events with progressive thrombus formation are known as cyclic flow variations. Plaque rupture occurs more frequently than previously assumed, i.e. in 9% of patients without known heart disease suffering a traffic accident and in 22% of patients with hypertension and diabetes. Also, in patients dying from sudden death microembolization is frequently found. Patients with stable and unstable angina show not only signs of coronary plaque rupture and thrombus formation, but also microemboli and microinfarcts, the only difference between those with stable and unstable angina being the number of events. Appreciation of microembolization may help to better understand the pathogenesis of ischemic cardiomyopathy, diabetic cardiomyopathy and acute coronary syndromes, in particular in patients with normal coronary angiograms, but plaque rupture detected by intravascular ultrasound. Also, the benefit from glycoprotein IIb/IIIa receptor antagonist is better understood, when not only the prevention of thrombus formation in the epicardial atherosclerotic plaque, but also that of microemboli is taken into account. Microembolization also occurs during PTCA, inducing elevations of troponin T and I and elevations of the ST segment in the EKG. Elevated baseline coronary blood flow velocity, as a potential consequence of reactive hyperemia in myocardium surrounding areas of microembolization, is more frequent in patients with high frequency rotablation than in patients with stenting and in patients with PTCA. The hypothesis of iafrogenic microembolization during coronary interventions is now supported by the use of aspiration and filtration devices, where particles with a size of up to 700 microns have been retrieved. In the experiment, microembolization is characterized by perfusion-contraction mismatch, as the proportionate reduction of flow and function seen with an epicardial stenosis is lost and replaced by contractile dysfunction in the absence of reduced flow. The analysis of the coronary microcirculation, in addition to that of the morphology and function of epicardial coronary arteries, and in particular appreciation of the concept of microembolization will further improve the understanding of the pathophysiology and clinical symptoms of coronary artery disease.

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“…A administração de L-arginina, precursor do óxido nítrico, resulta em uma significativa redução da hiperplasia da íntima em modelo experimental 37 . A lesão do endotélio também induz a liberação de endotelina 38 que atua como mitógeno para a CML vascular. Experimentalmente, a hiperplasia da íntima é mais intensa nas áreas onde a regeneração endotelial ocorre mais tardiamente 39,40 .…”

Section: Papel Do Endotéliounclassified

Reestenose pós-angioplastia. Fisiopatogenia

Caramori¹,

Yamamoto²,

Zago³

1997

Arq. Bras. Cardiol.

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A angioplastia coronária transluminal percutânea (ACTP), desde sua introdução por Andreas Grüntzig 1 , adquiriu papel destacado no manejo da cardiopatia isquêmica. Atualmente, grande parte das lesões coronárias obstrutivas são passíveis de tratamento percutâneo, com um índice de sucesso primário -lesão residual <50% e ausência de complicações maiores ->90%. Entretanto, reestenose ou recorrência da lesão persiste, sendo a principal limitação dos procedimentos coronários intervencionistas, ocorrendo em 20 a 40% das obstruções inicialmente dilatadas com sucesso 2,3 . A necessidade de procedimentos diagnósticos e terapêu-ticos repetitivos determina um marcante prejuízo à evolução dos pacientes que desenvolvem reestenose e eleva, significativamente, os custos globais do tratamento. A despeito de que múltiplas alternativas tenham sido avaliadas, poucas abordagens têm se mostrado promissoras na tentativa de reduzir a incidência de reestenose. O implante de próteses endocoronárias ou stents é a única intervenção que determina redução clinicamente significativa da reestenose 2,3 . Entretanto, seu uso implica elevados custos. Além disso, os efeitos da permanência a longo prazo de um corpo estranho na parede coronária ainda não foram totalmente definidos.A reestenose desenvolve-se, fundamentalmente, nos primeiros meses após a angioplastia, tendo o pico de incidência entre o 3º e o 6º mês após o procedimento 4,5 . Sua fisiopatologia é complexa e multifatorial, não estando completamente entendida. Observa-se que a redução no diâme-tro luminal coronário que leva a reestenose pós-angioplastia pode se estabelecer de forma precoce ou tardia. Nas primeiras horas após a angioplastia, pode haver redução do lúmen coronário por formação de trombo mural ou por retração elástica. A trombose mural muitas vezes está vinculada a eventos agudos e à oclusão arterial, especialmente na angioplastia no infarto agudo do miocárdio ou angina instável. Quando subclínica, é provável que esteja associada à redução tardia do lúmen coronário. Por sua vez, a retração elástica que provavelmente é causada pela elasticidade do segmento não aterosclerótico da parede vascular, freqüentemente, ocorre de maneira assintomática e parece ser um importante determinante dos resultados a longo prazo, principalmente da angioplastia por cateter-balão 4 . Os eventos que ocorrem tardiamente ao procedimento -após os primeiros dias -são os principais determinantes da reestenose, independentemente da técnica utilizada: cateter-balão, aterectomia direcionada ou rotacional, laser ou stent. Neste artigo, são discutidos os dois mecanismos fundamentais de reestenose, que são a hiperplasia da íntima e o remodelamento geométrico negativo ( fig. 1). A HIPERPLASIA DA ÍNTIMAEm praticamente todos os pacientes submetidos a ACTP ocorre algum grau de hiperplasia da camada íntima, ou formação de neo-íntima. Este espessamento intimal é uma característica da resposta da parede vascular à injúria e ocorre independentemente da técnica de angioplastia utilizada 6,7 . Histologicamente, a hipe...

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Effect of percutaneous transluminal coronary angioplasty on circulating endothelin levels

Cited by 35 publications

References 22 publications

Release of endothelin-1 from human endocardium after radiofrequency catheter ablation and coronary angioplasty: comparative results

Release of endothelin-1 from human endocardium after radiofrequency catheter ablation and coronary angioplasty: comparative results

Koronate Mikroembolisierung — Bedeutung bei akuten koronaren Syndromen und bei interventionellen Eingriffen

Reestenose pós-angioplastia. Fisiopatogenia

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