Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 19 de 19
Filtrar
1.
J Clin Hypertens (Greenwich) ; 26(2): 155-165, 2024 02.
Artigo em Inglês | MEDLINE | ID: mdl-38214206

RESUMO

Total neointima implantation (patch neointima technique + triple-branched stent graft placement) has been performed in proximal aortic repair for acute type A aortic dissection (ATAAD) for more than 10 years at a center. However, there is no report on the mid-term outcomes with a control group of the surgical procedure. Consequently, the authors aimed to evaluate the safety and efficacy of this technique in this study. Patients who underwent the total neointima implantation were classified as Group A, and those who underwent the conventional aortic root reconstruction with the "sandwich" technique and the total aortic arch replacement were classified as Group B. Furthermore, the authors described the preoperative characteristics, operative data, and patient outcomes. Group A patients experienced a shorter surgery duration, lower volumes of perioperative bleeding, and fewer red blood cell transfusions. The incidence of neurological complications was significantly reduced in Group A. All patients maintained a normal range of proximal aortic sizes after surgery. Kaplan-Meier analysis revealed no significant differences between the patients in the two groups regarding cumulative mortality and the incidence of moderate-to-severe aortic insufficiency. In well-selected patients, total neointima implantation is an alternative procedure for the surgical repair of ATAAD.


Assuntos
Aneurisma da Aorta Torácica , Dissecção Aórtica , Implante de Prótese Vascular , Hipertensão , Humanos , Aneurisma da Aorta Torácica/etiologia , Aneurisma da Aorta Torácica/cirurgia , Aorta Torácica/cirurgia , Implante de Prótese Vascular/efeitos adversos , Implante de Prótese Vascular/métodos , Neointima/etiologia , Neointima/cirurgia , Hipertensão/etiologia , Dissecção Aórtica/cirurgia , Stents , Resultado do Tratamento , Estudos Retrospectivos
2.
Ann Thorac Surg ; 112(1): 75-82, 2021 07.
Artigo em Inglês | MEDLINE | ID: mdl-33098877

RESUMO

BACKGROUND: The patch neointima technique is a modified valve-sparing aortic root repair surgery for acute type A aortic dissection and the short-term outcomes are satisfactory. The midterm outcomes have not been reported. METHODS: From January 2009 to December 2012, 147 patients underwent valve-sparing aortic root repair with the patch neointima technique for type A aortic dissection in our center. The midterm outcomes of the patients were evaluated by echocardiography and aortic computed tomography angiography. RESULTS: Of 147 patients, 32 patients (21.8%) underwent proximal arch repair, and 115 patients (78.2%) underwent proximal arch repair combined with triple-branched stent graft implantation. The perioperative mortality was 5.4%. Preoperative aortic insufficiency (AI) was observed in 94 patients (63.9%); 131 patients (89.1%) left the operating room with 0 AI; the remaining 16 patients (10.9%) had trace or less than 1+ AI. A total of 128 patients (87.1%) completed 7-year follow-up. The mean follow-up time was 5.7 ± 1.2 years. As many as 82% of patients (105) were 0 AI and 15.6% of patients (20) were 0.5+ trace or less than 1+ AI. No reoperation was performed for the aortic root. The diameters of sinotubular junction and sinus were reduced to the normal range (28.3 ± 4.2 mm and 30.5 ± 3.6 mm, respectively) and remained stable (28.9 ± 5.6 mm, P = .300, and 30.8 ± 4.2 mm, P = .540, respectively) during 7 years of follow-up. CONCLUSIONS: Valve-sparing aortic root repair with patch neointima technique was associated with stable function of the aortic valves and no expansion of the aortic root in the midterm.


Assuntos
Aneurisma da Aorta Torácica/cirurgia , Dissecção Aórtica/cirurgia , Neointima/cirurgia , Doença Aguda , Adulto , Dissecção Aórtica/diagnóstico , Angiografia por Tomografia Computadorizada , Ecocardiografia , Feminino , Seguimentos , Humanos , Masculino , Neointima/diagnóstico , Estudos Retrospectivos , Fatores de Tempo , Resultado do Tratamento
3.
J Interv Cardiol ; 2019: 6515129, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31772538

RESUMO

OBJECTIVES: We aimed to compare the results of neointimal modification before drug-coated balloon (DCB) treatment with excimer laser coronary atherectomy (ELCA) plus scoring balloon predilation versus scoring balloon alone in patients presenting with in-stent restenosis (ISR). BACKGROUND: Treatment of ISR with ELCA typically results in superior acute gain by neointima debulking. However, the efficacy of combination therapy of ELCA and DCB remains unknown. METHODS: A total of 42 patients (44 ISR lesions) undergoing DCB treatment with ELCA plus scoring balloon (ELCA group, n = 18) or scoring balloon alone (non-ELCA group, n = 24) were evaluated via serial assessment by optical coherence tomography (OCT) performed before, after intervention, and at 6 months. RESULTS: Although there was significantly greater frequency of diffuse restenosis and percent diameter stenosis (%DS) after intervention in the ELCA group, comparable result was shown in %DS, late lumen loss, and binary angiographic restenosis at follow-up. On OCT analysis, a decreased tendency in the minimum lumen area and a significant decrease in the minimum stent area were observed in the ELCA group between 6-month follow-up and after intervention (-0.89 ± 1.36 mm2 vs. -0.09 ± 1.25 mm2, p = 0.05, -0.49 ± 1.48 mm2 vs. 0.28 ± 0.78 mm2, p = 0.03, respectively). The changes in the neointimal area were similar between the groups, and target lesion revascularization showed comparable rates at 1 year (11.1% vs. 11.4%, p = 0.85). CONCLUSIONS: Despite greater %DS after intervention, ELCA before DCB had possible benefit for late angiographic and clinical outcome.


Assuntos
Angioplastia Coronária com Balão , Aterectomia Coronária , Angiografia Coronária/métodos , Reestenose Coronária , Neointima , Tomografia de Coerência Óptica , Idoso , Angioplastia Coronária com Balão/efeitos adversos , Angioplastia Coronária com Balão/instrumentação , Angioplastia Coronária com Balão/métodos , Aterectomia Coronária/efeitos adversos , Aterectomia Coronária/instrumentação , Aterectomia Coronária/métodos , Reestenose Coronária/diagnóstico , Reestenose Coronária/cirurgia , Stents Farmacológicos , Feminino , Humanos , Japão/epidemiologia , Lasers de Excimer/uso terapêutico , Masculino , Neointima/diagnóstico por imagem , Neointima/etiologia , Neointima/cirurgia , Avaliação de Processos e Resultados em Cuidados de Saúde , Estudos Retrospectivos , Fatores de Tempo , Tomografia de Coerência Óptica/métodos , Tomografia de Coerência Óptica/estatística & dados numéricos
4.
Nagoya J Med Sci ; 81(2): 313-323, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31239599

RESUMO

Neointimal calcification after stent implantation has been reported as one of the forms of neoatherosclerosis. There are a few patients with in-stent restenosis (ISR) and an undilatable calcified neointima who require rotational atherectomy to achieve sufficient acute gain in lumen diameter. However, the clinical outcomes of rotational atherectomy for undilatable calcified ISR have not been fully elucidated. Therefore, we investigated the safety and efficacy of rotational atherectomy for treating calcified ISR. This retrospective study included 17 patients (20 lesions) who had undergone percutaneous coronary intervention including rotational atherectomy to treat ISR with severely calcified neointima. Kaplan-Meier analysis was used to analyze the data. The mean age of the enrolled patients was 67±18 years, and 71% were men. The patients had highly atherogenic characteristics: 65% had diabetes mellitus and 53% were receiving hemodialysis. Procedural success was obtained in 19 (95%) patients, and the acute gain in lumen diameter was acceptable (1.7±0.6 mm). However, during a median follow-up of 571 days, the incidences of major adverse cardiac and cerebrovascular events per patient and clinical-driven target lesion revascularizations per lesion were relatively high. There were no differences in clinical outcomes according to the baseline characteristics, type of restenotic stents, and therapeutic strategy. In conclusion, clinical outcomes of rotational atherectomy for severely calcified ISR were unfavorable despite a high success rate and acceptable acute gain in lumen diameter.


Assuntos
Aterectomia/métodos , Reestenose Coronária/cirurgia , Stents Farmacológicos/efeitos adversos , Idoso , Idoso de 80 Anos ou mais , Humanos , Estimativa de Kaplan-Meier , Pessoa de Meia-Idade , Neointima/cirurgia , Estudos Retrospectivos
5.
Int J Cardiol ; 258: 42-49, 2018 05 01.
Artigo em Inglês | MEDLINE | ID: mdl-29544956

RESUMO

BACKGROUND: Drug-eluting stents with biodegradable polymer coatings have shown promising outcomes in randomised studies. METHODS: We compared neointimal healing patterns including strut coverage and assessed neointimal maturity using a novel algorithm in coronary lesions treated with sirolimus-eluting stents with biodegradable polymer coating (BP-SES) or everolimus eluting stents with permanent polymer coating (PP-EES) using optical coherence tomography after 6months. RESULTS: A total of 39 patients were randomised to BP-SES (n=19) or PP-EES (n=20) for the treatment of coronary lesions. Of those, 29 patients (14 BP-SES and 15 PP-EES) underwent optical coherence tomography (OCT) and angiography at 6-month follow-up. Tissue coverage and apposition were assessed in a total of 6162 struts (BP-SES, n=2889; PP-EES, n=3273). Neointimal maturity was assessed in 3672 neointimal regions above struts using grey scale intensity analysis. OCT analysis showed neointimal coverage of 2433 (BP-SES) vs. 2702 (PP-EES) struts (84.2% vs. 82.6%, p=0.70), whereas the remainder was uncovered after 6months. Mean neointimal thickness did not differ significantly between groups (54.3±7.8µm vs. 80±14.6µm, p=0.12). The rate of malapposed struts was comparable between groups (1.3% vs. 2.2%, p=0.27). Grey scale signal intensity analysis showed mature tissue coverage of struts in 46.2% in BP-SES vs. 31.8% in PP-EES (p=0.31) of neointimal regions. CONCLUSION: The present study showed comparable early vascular healing response characterised by neointimal coverage with mainly immature neointima in both BP-SES and PP-EES.


Assuntos
Implantes Absorvíveis/tendências , Doença da Artéria Coronariana/cirurgia , Stents Farmacológicos/tendências , Polímeros/administração & dosagem , Sirolimo/administração & dosagem , Tomografia de Coerência Óptica/tendências , Idoso , Idoso de 80 Anos ou mais , Doença da Artéria Coronariana/diagnóstico por imagem , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Neointima/diagnóstico por imagem , Neointima/cirurgia , Intervenção Coronária Percutânea/métodos , Intervenção Coronária Percutânea/tendências , Tomografia de Coerência Óptica/métodos
6.
J Neurointerv Surg ; 10(11): 1097-1101, 2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-29511117

RESUMO

BACKGROUND: Optical coherence tomography (OCT) is a high-resolution, intra-vascular diagnostic technique widely used for the characterization of vascular pathologies and optimization of stent implantation during percutaneous coronary intervention. OCT was used to investigate the in vivo vascular response to a new phosphorylcholine surface modified flow diverter (sPED). METHODS: In an in vivo rabbit aneurysmal model, we used two different types of flow diverters (classic Pipeline - cPED; and sPED) with or without dual antiplatelet therapy (four groups, n=10 per group). OCT cross-sectional area measurements were compared with histology in all animals. Neointimal hyperplasia (NIH) ratio was compared between OCT and histology at five different levels for each stent. The severity of NIH was also compared between the different stents, antiplatelet protocols, and vessel locations. RESULTS: OCT was used to calculate in-stent hyperplasia in 227 different locations corresponding to histology sections. OCT measurement strongly correlated with gold standard histology (r2=0.83; slope=0.988; P<0.0001). sPED had significantly less in-stent NIH than non-treated flow diverters (mean percent of lumen reduction 5.7% for sPED versus 8.9% for cPED; P<0.0001). The NIH ratio was slightly higher with dual antiplatelet therapy (DAPT) (NIH ratio=7.9% with DAPT versus 6.8% without DAPT; P<0.05). Complete and near complete occlusion rates of the aneurysms were not different with the cPED or sPED. CONCLUSION: OCT is a promising technique for immediate and long-term evaluation of flow diverter stent treatments. In an animal model, phosphorylcholine surface modified flow diverters induces less NIH after stent implant without reducing aneurysm occlusion rates.


Assuntos
Aneurisma Intracraniano/cirurgia , Neointima/cirurgia , Fosforilcolina , Stents Metálicos Autoexpansíveis , Animais , Vasos Coronários , Procedimentos Endovasculares/instrumentação , Procedimentos Endovasculares/métodos , Hiperplasia/diagnóstico por imagem , Hiperplasia/etiologia , Aneurisma Intracraniano/diagnóstico por imagem , Neointima/diagnóstico por imagem , Intervenção Coronária Percutânea/instrumentação , Intervenção Coronária Percutânea/métodos , Coelhos , Distribuição Aleatória , Stents Metálicos Autoexpansíveis/efeitos adversos , Tomografia de Coerência Óptica/métodos
7.
Cell Physiol Biochem ; 42(4): 1303-1312, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28715799

RESUMO

BACKGROUND/AIMS: Neointimal formation following vascular injury remains a major mechanism of restenosis, whereas the precise sources of neointimal cells are still uncertain. We tested the hypothesis that both injured arterial cells and non-arterial cells contribute to intimal hyperplasia. METHODS: Following allograft transplantation of the balloon-injured carotid common artery (n = 3-6), the cellular composition of the transplant grafts and the origins of neointimal cells were measured by immunohistochemistry and immunofluorescence staining. RESULTS: Smooth muscle actin (SMA)-positive and CD68-positive cells were clearly observed 14 days later in the neointima after allograft transplantation of the balloon-injured carotid common artery, where re-endothelialization was not yet complete. Green fluorescent protein (GFP) and wild-type (WT) allograft transplantation revealed that the majority of the neointima cells were apparently from the recipient (≈85%) versus the donor (≈15%). Both monocyte chemotactic protein-1 (MCP-1)/CCR2 and stromal cell-derived factor-1 (SDF-1)/CXCR4 signaling were involved in intimal hyperplasia, with bone marrow-derived cells also playing a role. CONCLUSION: These data support the hypothesis that intimal hyperplasia could develop in our novel rat allograft transplantation model of arterial injury, where neointima is attributable not only to local arterial cells but also non-arterial cells including the bone marrow.


Assuntos
Células da Medula Óssea/patologia , Lesões das Artérias Carótidas/patologia , Artéria Carótida Primitiva/patologia , Células Endoteliais/patologia , Neointima/patologia , Transplante de Tecidos , Túnica Íntima/lesões , Actinas/genética , Actinas/imunologia , Animais , Antígenos CD/genética , Antígenos CD/imunologia , Antígenos de Diferenciação Mielomonocítica/genética , Antígenos de Diferenciação Mielomonocítica/imunologia , Células da Medula Óssea/imunologia , Lesões das Artérias Carótidas/genética , Lesões das Artérias Carótidas/imunologia , Lesões das Artérias Carótidas/cirurgia , Artéria Carótida Primitiva/imunologia , Artéria Carótida Primitiva/cirurgia , Linhagem da Célula/imunologia , Rastreamento de Células , Quimiocina CCL2/genética , Quimiocina CCL2/imunologia , Quimiocina CXCL12/genética , Quimiocina CXCL12/imunologia , Células Endoteliais/imunologia , Regulação da Expressão Gênica , Genes Reporter , Proteínas de Fluorescência Verde/genética , Proteínas de Fluorescência Verde/imunologia , Neointima/genética , Neointima/imunologia , Neointima/cirurgia , Ratos , Ratos Endogâmicos Lew , Ratos Transgênicos , Receptores CCR2/genética , Receptores CCR2/imunologia , Receptores CXCR4/genética , Receptores CXCR4/imunologia , Transdução de Sinais , Transplante Homólogo , Túnica Íntima/imunologia , Túnica Íntima/cirurgia
8.
Cardiovasc Intervent Radiol ; 40(9): 1473-1476, 2017 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-28386707

RESUMO

Transjugular intrahepatic portosystemic shunt (TIPS) dysfunction is conventionally managed with balloon angioplasty, stent extension, and sharp recanalization when necessary. We describe percutaneous transjugular recanalization and neointimal excision of a chronically occluded 17-year-old TIPS using excimer laser after conventional techniques were unsuccessful. Patient clinical improvement and shunt patency were documented three weeks post-intervention.


Assuntos
Oclusão de Enxerto Vascular/cirurgia , Terapia a Laser/métodos , Lasers de Excimer/uso terapêutico , Neointima/cirurgia , Derivação Portossistêmica Transjugular Intra-Hepática/métodos , Doença Crônica , Humanos , Resultado do Tratamento
9.
Acta Biochim Biophys Sin (Shanghai) ; 49(3): 246-253, 2017 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-28159982

RESUMO

Reendothelialization in the aneurysm neck is pivotal to vascular repair for intracranial aneurysm after flow diverter (FD) implantation. Recombinant human stromal cell-derived factor 1α (rhSDF-1α) is a vital chemoattractant to stem cells and potentially facilitates reendothelialization. Here, we sought to investigate the therapeutic effects of intravenous administration of rhSDF-1α and uncover its potential mechanism for promoting aneurysm neck reendothelialization. Recombinant pET32a-186 plasmid was transformed into Escherichia coli to produce the rhSDF-1α protein with biological activity. FD was implanted into the elastase-induced saccular aneurysm in New Zealand white rabbits. rhSDF-1α (50 µg/kg/day) was intravenously administrated for consecutive 7 days after FD implantation. After these procedures, aneurysms were harvested after 2 or 4 weeks. Scanning electron microscopy was used to measure the neointima thickness and count the endothelial-like cells at aneurysm neck. Four weeks later, the mRNA levels of endothelial markers in the neointima at aneurysm neck were examined. Migration assay showed that rhSDF-1α could induce migration of endothelial progenitor cells in a dose-dependent manner. Two weeks after stent implantation, follow-up angiography showed partial aneurysm occlusion in one of each group and total aneurysm occlusion in 17 saccular aneurysm rabbits (9 of the rhSDF-1α group and 8 of the control group). No significant change of neointima thickness at aneurysm neck was observed. Intriguingly, more endothelial-like cells were observed at aneurysm neck in the rhSDF-1α group at 2 weeks (55 vs 13 cells per high-power field) and 4 weeks (104 vs 60 cells per high-power field). The mRNA levels of Tie-2, VE-cadherin, KDR and E-selectin were significantly enhanced compared with those of the control group. These results showed that intravenous administration of rhSDF-1α can accelerate reendothelialization in the aneurysm neck after FD implantation. Our study reveals an important role of rhSDF-1α in inducing aneurysm occlusion and suggests that it achieves its function through modulating the reendothelialization.


Assuntos
Aneurisma/patologia , Quimiocina CXCL12/administração & dosagem , Endotélio Vascular/patologia , Procedimentos Endovasculares/instrumentação , Implantação de Prótese/efeitos adversos , Proteínas Recombinantes/administração & dosagem , Aneurisma/etiologia , Aneurisma/metabolismo , Aneurisma/cirurgia , Animais , Endotélio Vascular/efeitos dos fármacos , Endotélio Vascular/metabolismo , Humanos , Masculino , Neointima/etiologia , Neointima/metabolismo , Neointima/patologia , Neointima/cirurgia , Coelhos
10.
EuroIntervention ; 12(12): 1551-1558, 2016 Dec 20.
Artigo em Inglês | MEDLINE | ID: mdl-27998849

RESUMO

AIMS: This study sought to investigate differences in vascular response between self-expanding bare metal nitinol stents (BMS) and paclitaxel-eluting nitinol stents (PES), in superficial femoral artery (SFA) disease, using optical frequency domain imaging (OFDI). METHODS AND RESULTS: Six months after stent implantation, follow-up quantitative vascular angiography (QVA) and OFDI assessment were scheduled to evaluate vascular response. Volume index (VI) was defined as volume divided by stent length. The primary endpoint was OFDI-derived late lumen area loss, defined as lumen VI post stent implantation minus lumen VI at follow-up. A total of 28 SFA lesions were analysed, with cases randomised to receive either BMS or PES implantation. QVA-derived diameter stenosis at six-month follow-up was lower in the PES group than in the BMS group (28.5% vs. 39.7%, p=0.04). After six months, BMS VI increased by 33.8% (20.7±3.7 to 27.7±3.5 mm3/mm), whilst PES exhibited an increase of 32.1% (19.0±2.3 to 25.1±4.7 mm3/mm). Neointimal VI was smaller (7.4±2.6 mm3/mm vs. 10.5±3.2 mm3/mm, p<0.01) and late lumen area loss was lower (2.9±1.3 mm3/mm vs. 5.6±2.8 mm3/mm, p<0.01) in the PES group. CONCLUSIONS: Serial volumetric OFDI analyses confirmed significantly smaller amounts of neointimal tissue and lower late lumen area loss following PES implantation for SFA lesions at short-term follow-up.


Assuntos
Ligas/uso terapêutico , Stents Farmacológicos , Artéria Femoral/cirurgia , Neointima/cirurgia , Imagem Óptica , Paclitaxel/uso terapêutico , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neointima/diagnóstico , Imagem Óptica/métodos , Ultrassonografia de Intervenção/métodos
11.
EuroIntervention ; 11(14): e1619-26, 2016 Apr 08.
Artigo em Inglês | MEDLINE | ID: mdl-25420791

RESUMO

AIMS: To compare tissue coverage in coronary lesions stented with durable fluoropolymer-coated everolimus-eluting stents (EES) vs. biodegradable polymer-coated biolimus A9-eluting stents (BES). METHODS AND RESULTS: Sixty-four patients (64 lesions) with de novo coronary artery lesions were randomised to percutaneous treatment with XIENCE EES (Abbott Vascular, Santa Clara, CA, USA) vs. BioMatrix BES (Biosensors, Morges, Switzerland). The primary endpoint was the percentage of uncovered struts, as assessed with OCT, at nine months. The average percentage of uncovered struts was significantly lower with EES (4.3±4.8% vs. 8.7±7.8% with BES, p=0.019). There was no difference in the average percentage of malapposed struts at baseline (6.8±6.9% vs. 6.9±7.0%, respectively, p=0.974) and at follow-up (0.1±0.3% vs. 0.6±1.3%, p=0.143). Neointimal thickness at nine months was 109±43 µm in EES vs. 64±18 µm in BES (p<0.001), and angiographic LLL was 0.15 mm in EES vs. 0.10 mm in BES (p=0.581). We did not observe differences in the incidence of MACE and ST. CONCLUSIONS: A significantly higher percentage of uncovered struts was detected in the BioMatrix BES compared with the XIENCE EES at nine-month follow-up. Our findings do not support a preferential use of stents with biodegradable polymer-based biolimus elution to reduce the risk for ST.


Assuntos
Doença da Artéria Coronariana/terapia , Reestenose Coronária/cirurgia , Vasos Coronários/cirurgia , Stents Farmacológicos , Imunossupressores/uso terapêutico , Infarto do Miocárdio com Supradesnível do Segmento ST/terapia , Adulto , Idoso , Idoso de 80 Anos ou mais , Reestenose Coronária/patologia , Vasos Coronários/patologia , Everolimo/uso terapêutico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neointima/patologia , Neointima/cirurgia , Intervenção Coronária Percutânea/métodos , Tomografia de Coerência Óptica/métodos , Resultado do Tratamento
12.
Vascular ; 23(2): 124-31, 2015 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-24803551

RESUMO

PURPOSE: The effect of adenosine (9-ß-0-ribifuranosyladenine) on the endothelial cell proliferation and neointimal hyperplasia is investigated in the rabbit carotid artery anastomosis model. METHODS: Twenty-eight New Zealand white rabbits were arranged in four groups of seven animals each. The right carotid arteries of each animal were transsected and re-anastomosed. The left sides remained as control. In Group A, no medication was used. In Group B, subcutaneous Adenosine was applied for 3 days. In Group C, the same dose was applied for 7 days, and in Group D for 21 days. After 28 days, the luminal diameters, luminal areas, intima/media ratios were all measured by using histopathological evaluation. FINDINGS: The mean luminal diameters and areas of the four groups were smaller than the control ones. Massive thickening of smooth muscle cell proliferation and dense intensifying in the connecting tissues were observed most prominently in Group A, in decreasing degrees within other groups. Intima/media ratio was highest in Group A. Scoring the quantity of e-NOS positive staining also revealed a significant difference between the experimental groups and their control associates. CONCLUSION: The process of endothelial cell proliferation and neointimal hyperplasia can be significantly reduced by the use of adenosine.


Assuntos
Adenosina/farmacologia , Artérias Carótidas/cirurgia , Proliferação de Células/efeitos dos fármacos , Miócitos de Músculo Liso/efeitos dos fármacos , Neointima/cirurgia , Túnica Íntima/cirurgia , Anastomose Cirúrgica/métodos , Animais , Artérias Carótidas/patologia , Modelos Animais de Doenças , Endotélio Vascular/efeitos dos fármacos , Endotélio Vascular/patologia , Hiperplasia , Coelhos
13.
Pathol Res Pract ; 210(12): 1026-30, 2014 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-24815534

RESUMO

Restenosis after stenting occurs secondary to the neointima formation. Neovessels have been found in the neointima within stents. However, there are few studies correlating neointimal angiogenesis and in-stent restenosis in humans. We analyzed 65 post-mortem stented arteries from 33 patients with duration >3 months. Cause of death was determined incidental to the coronary findings in every case. Stented segments were embedded in paraffin and stained immunohistochemically for CD68 (macrophages), and endothelial marker PECAM-1 (CD31). Computerized morphometry was performed to quantitate neovessel density for CD31, macrophage infiltrates, as well as plaque and neointimal area. In-stent restenosis was defined as luminal narrowing ≥ 75% cross-section of the stented area. Underlying plaque morphology was classified as fibrous or atheromatous. Neovessels were present in the neointima of 57 stented segments (88%). Mean neovessel density was greater in restenotic vs. non-restenotic neointimas (p = 0.009) and macrophage density was also greater (p = 0.006). Neointimal area correlated positively with density of neointimal vessels (p = 0.002), as well as neointimal macrophage density (p = 0.006), but not type of stent, underlying plaque type, or underlying plaque macrophage score. We conclude that in-stent restenosis is associated with neointimal angiogenesis which is accompanied by macrophage inflammation. The relevance of these findings to treatment and prevention of in-stent restenosis needs to be further explored.


Assuntos
Reestenose Coronária/patologia , Vasos Coronários/patologia , Macrófagos/patologia , Neointima/patologia , Neovascularização Patológica/patologia , Placa Aterosclerótica/patologia , Vasos Coronários/cirurgia , Feminino , Humanos , Masculino , Neointima/cirurgia , Placa Aterosclerótica/cirurgia , Sistema de Registros , Stents/efeitos adversos
14.
Cardiovasc Res ; 101(3): 454-63, 2014 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-24319016

RESUMO

AIMS: Cathepsin S (Cat S) is a potent lysosomal protease that is secreted into the extracellular space and has been implicated in elastin and collagen degradation in diseases such as atherosclerosis. Elastin degradation plays an important role in vascular remodelling. However, the mechanism by which Cat regulates this process and its contribution to vein graft remodelling remains unclear. METHODS AND RESULTS: Using a murine vein graft model, we examined the expression pattern of Cat family members. Expression of cathepsin genes was induced in vein grafts, with that of Cat S being the highest. Elevated Cat S expression was confirmed in both mouse and human vein grafts. To explore the role of Cat S, vein grafts were created between wild-type (WT) littermates and Cat S knockout (Cat S KO) mice. Knockout of Cat S in the recipients (vein(CatS-KO)-artery(CatS-KO) or vein(WT)-artery(CatS-KO)) significantly inhibited neointima formation and reduced the accumulation of macrophages and proliferation of smooth muscle cells in vein grafts. Knockout of Cat S preserved the elastic fibre integrity of vein grafts and inhibited the migration of macrophages across the elastin fibres. CONCLUSION: These results demonstrated that Cat S contributes to macrophage migration via degradation of elastic fibre integrity to facilitate neointima formation of vein grafts, which might provide a novel therapeutic target for preserving vein graft patency.


Assuntos
Catepsinas/metabolismo , Movimento Celular , Tecido Elástico/patologia , Hiperplasia/metabolismo , Macrófagos/metabolismo , Neointima/patologia , Animais , Catepsinas/genética , Modelos Animais de Doenças , Hiperplasia/patologia , Macrófagos/citologia , Camundongos , Camundongos Endogâmicos C57BL , Camundongos Knockout , Miócitos de Músculo Liso/metabolismo , Neointima/metabolismo , Neointima/cirurgia , Transdução de Sinais/fisiologia , Veias/transplante
15.
Circulation ; 128(11 Suppl 1): S50-S58, 2013 Sep 10.
Artigo em Inglês | MEDLINE | ID: mdl-24030421

RESUMO

BACKGROUND: Endothelial cell (EC) survival and regeneration are important determinants of the response to vascular injury that leads to neointimal hyperplasia and accelerated atherosclerosis. Nitric oxide (NO) is a key regulator of EC and endothelial progenitor cell function, but the pathophysiological mechanisms that regulate endothelial NO synthase in endothelial regeneration remain unclear. METHODS AND RESULTS: Endothelium-targeted overexpression of GTP cyclohydrolase (GCH) I increased levels of the endothelial NO synthase cofactor, tetrahydrobiopterin, in an EC-specific manner and reduced neointimal hyperplasia in experimental vein grafts in GCH/apolipoprotein E-knockout mice. These effects were mediated through enhanced donor-derived survival and recipient-derived repopulation of GCH transgenic ECs, revealed by tracking studies in Tie2-LacZ/GCH-Tg/apolipoprotein E-knockout recipient mice or donor grafts, respectively. Endothelial GCH overexpression increased endothelial NO synthase coupling and enhanced the proliferative capacity of ECs and circulating endothelial progenitor cell numbers after vascular injury. CONCLUSIONS: These observations indicate that endothelial tetrahydrobiopterin availability modulates neointimal hyperplasia after vascular injury via accelerated EC repopulation and growth. Targeting tetrahydrobiopterin-dependent endothelial NO synthase regulation in the endothelium is a rational therapeutic target to enhance endothelial regeneration and reduce neointimal hyperplasia in vascular injury states.


Assuntos
Biopterinas/análogos & derivados , Sobrevivência Celular/fisiologia , Células Endoteliais/fisiologia , Regeneração/fisiologia , Regulação para Cima/fisiologia , Animais , Biopterinas/fisiologia , Células Endoteliais/patologia , Humanos , Hiperplasia/patologia , Hiperplasia/cirurgia , Masculino , Camundongos , Camundongos Endogâmicos C57BL , Camundongos Knockout , Camundongos Transgênicos , Neointima/patologia , Neointima/cirurgia , Transplantes , Veia Cava Inferior/citologia , Veia Cava Inferior/fisiologia
16.
Cardiovasc Revasc Med ; 13(6): 350-2, 2012.
Artigo em Inglês | MEDLINE | ID: mdl-22898053

RESUMO

An increasing number of studies have reported intimal atherosclerotic changes, or neoatherosclerosis in the late phase after bare metal stent implantation, however, only a few reports have showed the presence of severe intimal calcification in a bare metal stent. We herein report a case of a 68-year-old male with severely calcified neointima occurring 9 years after the bare metal stent implantation. Pre-procedural coronary computed tomography angiography and peri-procedural intravascular ultrasound demonstrated severe calcification within the in-stent restenotic lesion. Although the pre-dilation balloon ruptured due to the calcification, the lesion was nevertheless successfully dilated with the stent. Calcified lesions often require complex techniques, and we therefore should be aware of the potential occurrence of a severely calcified neointima in coronary stents, and performing coronary computed tomography angiography in advance is a great help for performing effective coronary intervention.


Assuntos
Aterosclerose/cirurgia , Reestenose Coronária/patologia , Metais/efeitos adversos , Neointima/cirurgia , Stents/efeitos adversos , Calcificação Vascular/cirurgia , Idoso , Aterosclerose/diagnóstico , Angiografia Coronária/métodos , Reestenose Coronária/diagnóstico por imagem , Humanos , Masculino , Neointima/diagnóstico por imagem , Resultado do Tratamento , Ultrassonografia de Intervenção/métodos
17.
J Vasc Surg ; 55(5): 1338-44; discussion 1344-5, 2012 May.
Artigo em Inglês | MEDLINE | ID: mdl-22459751

RESUMO

OBJECTIVE: We report the midterm results of external iliac artery reconstruction in 25 high-performance cyclists. METHODS: Cyclists undergoing arterial reconstruction for symptomatic external iliac arteriopathy at a single institution between October 2004 and August 2010 were identified. With Institutional Review Board approval, data were collected from medical record review and telephone interview. Results were analyzed with χ(2) or independent t-test. RESULTS: Twenty-five patients (31 limbs) underwent operation, which included arterial reconstruction with or without inguinal ligament release. The average patient age at operation was 43.8 ± 5.0 for graft and 35.1 ± 1.9 for patch (P = .08). The average time from competitive cycling until operation was 18.2 ± 5.8 years for graft and 20.0 ± 2.5 for patch repairs (NS). Patients included 14 males and 11 females. There were 23 unilateral and four bilateral arterial reconstructions, including 26 patch angioplasties for localized disease and five interposition grafts for extensive disease; three patients underwent contralateral reconstruction as a separate procedure. Concomitant ipsilateral inguinal ligament release was performed in 25 patients (28 limbs), with contralateral release done in 12 patients (12 limbs). Three patients with isolated ligament release required subsequent arterial intervention. Follow-up averaged 32 months (range, 2-74). Primary patency for all reconstructions was 100%; the four reoperations (five limbs; one bilateral) were for symptom recurrence, two postgraft and two postangioplasty. Three reoperations were for recurrent intimal hyperplasia, one for disease distal to the anastomosis, and one for concomitant atherosclerotic disease. Based on available data, postexercise ankle-brachial indices were improved in 18 of 23 limbs. Seventeen patients completed questions regarding satisfaction: 10 were satisfied or very satisfied (zero graft, 10 patch; P = .25), while four were unsatisfied (three graft, two patch; P = .017, including one patient with both a patch and graft repair). All 20 patients for whom follow-up data were available are still cycling, 10 competitively. Two of the four reoperated patients were unsatisfied; all four are still cycling, one competitively. CONCLUSIONS: External iliac arteriopathy is a disease of prolonged, sustained, and repetitive trauma. Patch angioplasty yields a low rate of reoperation, more satisfied patients, return to competitive activity, and improvement in postexercise ankle-brachial indices. Interposition grafting is associated with slightly older patients, more extensive disease, and less satisfying results. Intimal hyperplasia is the most frequent complication necessitating reoperation. Both the decision to pursue arterial reconstruction and patient expectations must be tempered by the pattern of disease and the potential for unsatisfactory results.


Assuntos
Angioplastia , Ciclismo/lesões , Implante de Prótese Vascular , Artéria Ilíaca/cirurgia , Procedimentos Cirúrgicos Vasculares , Lesões do Sistema Vascular/cirurgia , Adulto , Índice Tornozelo-Braço , Distribuição de Qui-Quadrado , Endarterectomia , Feminino , Humanos , Artéria Ilíaca/lesões , Artéria Ilíaca/fisiopatologia , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Neointima/etiologia , Neointima/cirurgia , Satisfação do Paciente , Recuperação de Função Fisiológica , Reoperação , Estudos Retrospectivos , Fatores de Tempo , Resultado do Tratamento , Grau de Desobstrução Vascular , Procedimentos Cirúrgicos Vasculares/efeitos adversos , Lesões do Sistema Vascular/diagnóstico , Lesões do Sistema Vascular/etiologia , Lesões do Sistema Vascular/fisiopatologia , Virginia , Adulto Jovem
18.
Cardiovasc Intervent Radiol ; 35(2): 418-21, 2012 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-21904810

RESUMO

In-stent reocclusion is a frequent complication of endovascular treatment and stenting, especially in the superficial femoral artery. Neointimal hyperplasia is the main cause of this problem, but in many cases, it occurs as a result of the presence of stent strut fractures. The two treatment options are endovascular and surgical intervention. The effectiveness of endovascular interventions in patients with critical limb ischemia has been well established, but in some cases, crossing the occluded stent is difficult. We describe a new technique to recanalize long in-stent superficial femoral artery occlusions characterized by direct stent puncture, followed by retrograde-antegrade recanalization after antegrade failures.


Assuntos
Arteriopatias Oclusivas/terapia , Procedimentos Endovasculares/métodos , Artéria Femoral/cirurgia , Stents/efeitos adversos , Idoso , Arteriopatias Oclusivas/diagnóstico por imagem , Arteriopatias Oclusivas/etiologia , Artéria Femoral/diagnóstico por imagem , Seguimentos , Humanos , Masculino , Neointima/etiologia , Neointima/cirurgia , Artéria Poplítea/diagnóstico por imagem , Radiografia , Resultado do Tratamento , Ultrassonografia , Grau de Desobstrução Vascular
19.
Chin Med J (Engl) ; 124(24): 4286-92, 2011 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-22340401

RESUMO

BACKGROUND: Recent studies indicate that bone marrow-derived cells may significantly contribute to atherosclerosis, post-angioplasty restenosis and transplantation-associated vasculopathy. The responsible bone marrow (BM) cells and mechanisms regulating the mobilization of these cells are currently unclear. The purpose of this study was to investigate the expression of granulocyte colony-stimulating factor (G-CSF) on injured arteries and its effects on mesenchymal stem cells (MSCs) differentiation into vascular smooth muscle cells (VSMCs) in the process of vascular remodeling. METHODS: Balloon-mediated vascular injury was established in female rats (n = 100) which received radioprotective whole female BM cells by tail vein injection and male MSCs through a tibial BM injection after lethal irradiation. The injured and contralateral carotid arteries were harvested at 3, 7, 14 and 28 days after treatment. RESULTS: Morphometric analysis indicated that intima to media area-ratio (I/M ratio) significantly increased at 28 days, 0.899 ± 0.057 (P < 0.01), compared with uninjured arteries. Combining fluorescence in situ hybridization (FISH) and immunohistochemical analysis showed that a significant number of the neointimal cells derived from MSCs, (45.2 ± 8.5)% at 28 days (P = 0.01), compared with (23.5 ± 6.3)% at 14 days. G-CSF was induced in carotid arteries subject to balloon angioplasty (fold mRNA change = 8.67 ± 0.63 at three days, relative G-CSF protein = 0.657 ± 0.011 at three days, P < 0.01, respectively, compared with uninjured arteries). G-CSF was chemotactic for MSCs but did not affect the differentiation of MSCs into smooth-muscle-like cells. CONCLUSION: Increased expression of G-CSF by injured arteries plays an essential role in contribution to recruitment and homing of MSCs to the site of the arterial lesion.


Assuntos
Fator Estimulador de Colônias de Granulócitos/metabolismo , Células-Tronco Mesenquimais/citologia , Lesões do Sistema Vascular/cirurgia , Lesões do Sistema Vascular/terapia , Angioplastia com Balão , Animais , Western Blotting , Artérias Carótidas/cirurgia , Diferenciação Celular , Movimento Celular , Células Cultivadas , Ensaio de Imunoadsorção Enzimática , Feminino , Imuno-Histoquímica , Hibridização in Situ Fluorescente , Masculino , Miócitos de Músculo Liso/citologia , Neointima/cirurgia , Neointima/terapia , Ratos , Ratos Sprague-Dawley , Reação em Cadeia da Polimerase Via Transcriptase Reversa
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA