Impact of Preinterventional Arterial Remodeling on Neointimal Hyperplasia After Implantation of (Non–Polymer-Encapsulated) Paclitaxel-Coated Stents

Mintz, Gary S.; Tinana, A.M.; Hong, Myeong Ki; Lee, Cheol Whan; Kim, Jae Joong; Fearnot, Neal E.; Park, Seong Wook; Weissman, Neil J.

doi:10.1161/01.cir.0000091254.73351.d6

Cited by 35 publications

(20 citation statements)

References 14 publications

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“…These proteolytic enzymes may play an important role in the outward expansion of the coronary arterial wall, 29,30 and the active biochemical reaction may lead to plaque instability and restenosis after PCI of positive remodeling lesions. 18,19,31,32 Cholesterol crystalli- zation may also be a mechanism of plaque instability in lipid-rich positive remodeling lesions. 33 The mechanism of negative remodeling is also not fully understood.…”

Section: Discussionmentioning

confidence: 99%

“…If there were several MLA sites, the MLA site with the largest external elastic membrane (EEM) cross-sectional area (CSA) was chosen for evaluation. 4,[18][19][20] The proximal reference segment was defined as the segment within 10 mm of the proximal border of the entire culprit lesion and distal to any major side branch. The proximal reference site was selected from the proximal reference segment as the site with the largest lumen and least plaque burden calculated as plaque plus media divided by EEM CSA.…”

Section: Ivus Rf Data Acquisition and Analysismentioning

confidence: 99%

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Relationship Between Coronary Artery Remodeling and Plaque Composition in Culprit Lesions An Intravascular Ultrasound Radiofrequency Analysis

Higashikuni

Tanabe

Yamamoto

et al. 2007

Circ J

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any clinical studies have shown that coronary arteries respond to plaque growth by either outward expansion of the vessel wall (positive remodeling) 1-3 or vessel shrinkage (negative remodeling). 4,5 The difference in plaque morphology between positive and negative remodeling lesions in vivo has been investigated in several clinical studies using intravascular ultrasound (IVUS), but it is difficult to evaluate the detailed plaque composition with gray-scale IVUS.Recently, spectral analysis of IVUS radiofrequency (RF) data was shown to provide detailed quantitative and qualitative information on coronary plaque composition in vivo. [6][7][8][9] A preliminary in vitro study showed that 4 components (eg, fibrous, fibrofatty, dense calcium components, and necrotic core) correlated with a specific spectrum of the RF signal. 10 Nasu et al used a color-coded mapping method by Virtual Histology (VH) that was able to identify atherosclerotic plaque composition of human coronary arteries in vivo. 11 Previous studies using necropsy specimens or gray-scale IVUS have consistently found a large lipid burden in positive remodeling lesions, 12-14 but the role of calcium deposition in coronary artery remodeling is still controversial. 4,[13][14][15][16] In the present study, we used spectral analysis of IVUS RF data to evaluate the relationship between coronary artery remodeling and culprit plaque composition in patients undergoing percutaneous coronary intervention (PCI) in order to confirm the findings of previous studies on lipid burden and to elucidate the role of calcium deposition. Methods Patients and LesionsBetween June 2005 and January 2006, a pre-interventional IVUS examination was performed prospectively in 93 consecutive de novo culprit lesions of 81 patients undergoing PCI; 18 lesions were excluded from analyses because we could not cross the lesion completely with the IVUS transducer; the images of 6 lesions could not be analyzed because of poor image quality; and for 13 lesions, no proximal reference site could be defined because the lesion involved the ostium (n=3) or a bifurcation (n=10). Finally, IVUS RF analyses were performed for 56 culprit lesions of 52 patients.Informed, written consent was given by all the patients. DefinitionsHyperlipidemia was defined as total cholesterol level ≥220 mg/dl, high-density lipoprotein cholesterol level <40 mg/dl, triglyceride level ≥150 mg/dl, low-density lipoprotein (LDL) level ≥140 mg/dl, or/and lipid-lowering medication use. Hypertension was defined as systolic blood pressure ≥140 mmHg, diastolic blood pressure ≥90 mmHg, or/and use of an antihypertensive drug. Diabetes mellitus was defined by a previous physician's diagnosis and treatment with diet, oral hypoglycemic agents, or insulin.Circ J 2007; 71: 654 -660 (Received September 13, 2006; revised manuscript received January 15, 2007; accepted February 9, 2007

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Section: Discussionmentioning

confidence: 99%

Section: Ivus Rf Data Acquisition and Analysismentioning

confidence: 99%

Relationship Between Coronary Artery Remodeling and Plaque Composition in Culprit Lesions An Intravascular Ultrasound Radiofrequency Analysis

Higashikuni

Tanabe

Yamamoto

et al. 2007

Circ J

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“…24, 25 Of note is the higher risk profile of patients/lesions enrolled in the present study as compared with the ASPECT trial, which may partially explain these differing results. The present patients had, for example, a higher rate of diabetes (31.6% vs. 7.0%) and also higher lesion complexity (ratio of B2/C lesions: 67.4% vs. 4.0%) than the subjects in that previous study.…”

Section: Discussionmentioning

confidence: 73%

“…The present patients had, for example, a higher rate of diabetes (31.6% vs. 7.0%) and also higher lesion complexity (ratio of B2/C lesions: 67.4% vs. 4.0%) than the subjects in that previous study. 24, 25 An increase in plaque area at the distal edge with subsequent reduction in LA was also clinically reflected by a higher rate of TVR at the distal edge in the PF-PES group compared to PB-PES (0% vs. 7.8%; P=0.240), which was not statistically significant due to small sample size. In any case the overall rate of TVR was higher in PF-PES than in PB-PES, indicating that lack of polymer may negatively influence neointimal response also inside the stent.…”

Section: Discussionmentioning

confidence: 96%

Edge Vascular Response After Polymer-Free vs. Polymer-Based Paclitaxel-Eluting Stent Implantation

Otsuki

Shiratori

Brugaletta

et al. 2014

Circ J

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Circulation Journal Official Journal of the Japanese Circulation Society http://www. j-circ.or.jp arterial tissue. 12 Restenosis of polymer-based paclitaxel=eluting stent (PB-PES) has been shown, for example, to be more frequent at the proximal than the distal edge, exhibiting positive vascular remodeling at the distal edge, probably due to higher downstream concentration of the drug at this level. 13-18 The AXXION TM stent is a polymer-free paclitaxel-eluting stent (PF-PES), the drug dose of which is approximately 3-fold higher than in PB-PES, and which allows faster release of paclitaxel as compared to PB-PES. The combination of paclitaxel with a polymer-free platform on EVR has not been investigated.The purpose of this study was to evaluate EVR between ompared with bare metal stents (BMS), polymer-based drug-eluting stents (DES) reduce in-stent restenosis and target vessel revascularization. 1-4 The permanent polymer coating, however, has been variously associated with impaired vascular healing and incomplete stent malapposition, which may eventually provoke stent thrombosis. 5,6 Therefore, many attempts have been done to reduce this phenomenon by introducing polymer-free or biodegradable-polymer DES. 7-11Edge vascular response (EVR) is another cautionary problem after DES implantation, because it is considered 1 of the causes of edge restenosis because of a potential toxic effect of drug on Background: It is unknown if lack of polymer can provoke a different edge response in drug-eluting stents. The aim of this study was to compare edge vascular response between polymer-free paclitaxel-eluting stent (PF-PES) and polymer-based paclitaxel-eluting stents (PB-PES).

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“…Mintz et al reported about the impact of pre-interventional arterial remodeling on NIH after implantation of non-polymerencapsulated paclitaxel-coated stents. 26 In Mintz's study, % NIH measured 18±13% in PR, 23±22% in IR, and 6±20% in NR lesions. Therefore, they concluded that drug-eluting stents may have a greater effect on reducing NIH accumulation in lesions with pre-interventional NR characteristics.…”

Section: Discussionmentioning

confidence: 91%

Impact of Preinterventional Arterial Remodeling on In-Stent Neointimal Hyperplasia and In-Stent Restenosis After Coronary Stent Implantation-An Intravascular Ultrasound Study-

Hong

Jeong

Hyun

et al. 2005

Circ J

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Impact of Preinterventional Arterial Remodeling on Neointimal Hyperplasia After Implantation of (Non–Polymer-Encapsulated) Paclitaxel-Coated Stents

Cited by 35 publications

References 14 publications

Relationship Between Coronary Artery Remodeling and Plaque Composition in Culprit Lesions An Intravascular Ultrasound Radiofrequency Analysis

Relationship Between Coronary Artery Remodeling and Plaque Composition in Culprit Lesions An Intravascular Ultrasound Radiofrequency Analysis

Edge Vascular Response After Polymer-Free vs. Polymer-Based Paclitaxel-Eluting Stent Implantation

Impact of Preinterventional Arterial Remodeling on In-Stent Neointimal Hyperplasia and In-Stent Restenosis After Coronary Stent Implantation-An Intravascular Ultrasound Study-

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