Treatment of coronary chronic total occlusion by transradial approach: Current trends and expert recommendations

Bryniarski, Leszek; Zabojszcz, Michał; Bryniarski, Krzysztof

doi:10.5603/cj.a2017.0067

Cited by 6 publications

(1 citation statement)

References 19 publications

(27 reference statements)

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“…Most commonly the formation of an arteriosclerotic plaque leads to the obstruction of the vessel's lumen: the arterial wall becomes stiffer, compliance is reduced, and the constriction of blood flow decreases the oxygen levels leading to tissue necrosis and ultimately patient death [2]. Treatment to restore blood flow most commonly involves the use of minimally invasive procedures such as balloon angioplasty and stenting, but if they fail, a bypass is required to divert the flow around the blockage [3]. The current gold standard treatment in bypass surgery remains autograft implantation [4] [5].…”

Section: Introductionmentioning

confidence: 99%

Melt electrowritten scaffold architectures to mimic vasculature mechanics and control neo-tissue orientation

Federici

Tornifoglio

Lally

et al. 2023

Preprint

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Cardiovascular disease is one of the leading causes of death worldwide, commonly associated with the development of an arteriosclerotic plaque and impairment of blood flow in arteries. Current adopted grafts to bypass the stenosed vessel fail to recapitulate the unique mechanical behaviour of native vessels, particularly in the case of small diameter vessels (<6 mm), leading to graft failure. Therefore, in this study, melt-electrowriting (MEW) was adopted to produce a range of fibrous grafts to mimic the extracellular matrix (ECM) architecture of the tunica media of vessels, in an attempt to match the mechanical and biological behaviour of the native tissue. Initially, the range of collagen architectures within the native vessel was determined, and subsequently replicated using MEW (winding angles (WA) 45, 26.5, 18.4, 11.3 degrees). These scaffolds recapitulated the anisotropic, non-linear mechanical behaviour of native carotid blood vessels. Moreover, these grafts facilitated human mesenchymal stromal/stem cell (hMSC) infiltration, differentiation, and ECM deposition that was independent of WA. The bioinspired MEW fibre architecture promoted cell alignment and preferential neo-tissue orientation in a manner similar to that seen in native tissue, particularly for WA 18.4 and 11.3, which is a mandatory requirement for long-term survival of the regenerated tissue post-scaffold degradation. Lastly, the WA 18.4 was translated to a tubular graft and was shown to mirror the mechanical behaviour of small diameter vessels within physiological strain. Taken together, this study demonstrates the capacity to use MEW to fabricate bioinspired grafts to mimic the tunica media of vessels and recapitulate vascular mechanics which could act as a framework for small diameter graft development and functional long-term tissue regeneration.

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Section: Introductionmentioning

confidence: 99%

Melt electrowritten scaffold architectures to mimic vasculature mechanics and control neo-tissue orientation

Federici

Tornifoglio

Lally

et al. 2023

Preprint

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Muticomponent Melt‐Electrowritten Vascular Graft to Mimic and Guide Regeneration of Small Diameter Blood Vessels

Federici,

Garcia,

Kelly

et al. 2024

Adv Funct Materials

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Cardiovascular disease is a leading cause of morbidity. Current treatments include vessel substitution using autologous/synthetic vascular grafts, but these commonly fail in small diameter applications, largely due to compliance mismatch and clot formation. In this study, a multicomponent vascular graft, that takes inspiration from native vessel architecture, is developed to overcome these limitations. Melt electrowriting (MEW) is used to produce tubular scaffolds with vascular‐mimetic fiber architecture and mechanics, which is combined with a lyophilized fibrinogen matrix with tailored degradation kinetics to generate a hybrid graft. The MEW framework not only contributes to graft mechanics, but also provides contact guidance to direct cell/neotissue orientation and mimic the native tunica media. This construct is further functionalized with heparin, which in combination with the smooth extracellular matrix (ECM) surface, reduced platelet adhesion and clot formation providing a substrate for endothelization, thereby mimicking the function of the intima. Lastly, an outer electrospun layer representing the adventitia is added to improve elasticity and reduce permeability. This graft satisfies ISO implantability requirements, matches the compliance of native vessels, and reestablishes physiological flow with minimal clot formation in a preclinical model. Therefore, this graft represents an innovative off‐the‐shelf alternative to address the unmet clinical need for small‐diameter vascular grafts.

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Meta-Analysis on the Safety and Efficacy of Transradial Approach in Chronic Total Occlusion Percutaneous Coronary Intervention

Nguyen¹,

Nguyen²,

Pham³

et al. 2023

The American Journal of Cardiology

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Treatment of coronary chronic total occlusion by transradial approach: Current trends and expert recommendations

Cited by 6 publications

References 19 publications

Melt electrowritten scaffold architectures to mimic vasculature mechanics and control neo-tissue orientation

Melt electrowritten scaffold architectures to mimic vasculature mechanics and control neo-tissue orientation

Muticomponent Melt‐Electrowritten Vascular Graft to Mimic and Guide Regeneration of Small Diameter Blood Vessels

Meta-Analysis on the Safety and Efficacy of Transradial Approach in Chronic Total Occlusion Percutaneous Coronary Intervention

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