The effectiveness of Salvianolate injection for in-stent restenosis after percutaneous coronary intervention: A protocol for systematic review and meta-analysis.

BACKGROUND: In-stent restenosis (ISR) caused by vascular remodeling after percutaneous coronary intervention limits the long-term efficacy of this method. Salvianolate injection is now widely used in the clinical treatment of ISR. However, there is no systematic review or meta-analysis to evaluate the effects of Salvianolate injection on ISR. METHODS: We will search articles in 8 electronic databases, including the Cochrane Central Register of Controlled Trials, PubMed, Embase, the Web of Science, China National Knowledge Infrastructure, the Chinese Biomedical Literature Database, Wanfang Database, and the Chinese Scientific Journal Database for randomized controlled trials of ISR treated by Salvianolate injection from their inception to February 27, 2022. The primary outcome measure will be the restenosis rate. The data meeting the inclusion criteria were analyzed by RevMan V.5.4 software. Two authors evaluated the study using the Cochrane collaborative risk bias tool. We will use a scoring method to assess the overall evidence supporting the main results. RESULTS: This study will analyze the clinical effectiveness of Salvianolate injection in the treatment of ISR. CONCLUSION: The findings of this systematic review will provide evidence to evaluate the effectiveness of Salvianolate injection for the treatment of ISR. INPLASY REGISTRATION NUMBER: INPLASY202220117.

Gold nanorods as a theranostic platform for in vitro and in vivo imaging and photothermal therapy of inflammatory macrophages.

Inflammatory macrophages play pivotal roles in the development of atherosclerosis. Theranostics, a promising approach for local imaging and photothermal therapy of inflammatory macrophages, has drawn increasing attention in biomedical research. In this study, gold nanorods (Au NRs) were synthesized, and their in vitro photothermal effects on the macrophage cell line (Ana-1 cells) under 808 nm near infrared reflection (NIR) were investigated by the CCK8 assay, calcein AM/PI staining, flow cytometry, transmission electron microscopy (TEM), silver staining and in vitro micro-computed tomography (CT) imaging. These Au NRs were then applied to an apolipoprotein E knockout (Apo E) mouse model to evaluate their effects on in vivo CT imaging and their effectiveness as for the subsequent photothermal therapy of macrophages in femoral artery restenosis under 808 nm laser irradiation. In vitro photothermal ablation treatment using Au NRs exhibited a significant cell-killing efficacy of macrophages, even at relatively low concentrations of Au NRs and low NIR powers. In addition, the in vivo results demonstrated that the Au NRs are effective for in vivo imaging and photothermal therapy of inflammatory macrophages in femoral artery restenosis. This study shows that Au nanorods are a promising theranostic platform for the diagnosis and photothermal therapy of inflammation-associated diseases.

Excimer laser atherectomy to overcome intraprocedural obstacles in chronic total occlusion percutaneous intervention: Case examples.

Technical advances and the development of the Hybrid algorithm have been associated with higher success rates in chronic total occlusion percutaneous coronary intervention (CTO-PCI). Nevertheless, there are still intraprocedural obstacles that result in failure or prolonged procedure time. The Excimer coronary laser (EL) has been repurposed in CTO-PCI to overcome such obstacles. This case series illustrates the use of the EL in four technically complex scenarios including the balloon resistant lesion, the impenetrable proximal cap, device resistance in stent restenosis, and difficulty with device tracking in the subintima.

Modulation of NO and ROS production by AdiNOS transduced vascular cells through supplementation with L-Arg and BH4: implications for gene therapy of restenosis.

OBJECTIVE: Gene therapy with viral vectors encoding for NOS enzymes has been recognized as a potential therapeutic approach for the prevention of restenosis. Optimal activity of iNOS is dependent on the intracellular availability of L-Arg and BH4 via prevention of NOS decoupling and subsequent ROS formation. Herein, we investigated the effects of separate and combined L-Arg and BH4 supplementation on the production of NO and ROS in cultured rat arterial smooth muscle and endothelial cells transduced with AdiNOS, and their impact on the antirestenotic effectiveness of AdiNOS delivery to balloon-injured rat carotid arteries. METHODS AND RESULTS: Supplementation of AdiNOS transduced endothelial and vascular smooth muscle cells with L-Arg (3.0 mM), BH4 (10 µM) and especially their combination resulted in a significant increase in NO production as measured by nitrite formation in media. Formation of ROS was dose-dependently increased following transduction with increasing MOIs of AdiNOS. Exposure of RASMC to AdiNOS tethered to meshes via a hydrolyzable cross-linker, modeling viral delivery from stents, resulted in increased ROS production, which was decreased by supplementation with BH4 but not L-Arg or L-Arg/BH4. Enhanced cell death, caused by AdiNOS transduction, was also preventable with BH4 supplementation. In the rat carotid model of balloon injury, intraluminal delivery of AdiNOS in BH4-, L-Arg-, and especially in BH4 and L-Arg supplemented animals was found to significantly enhance the antirestenotic effects of AdiNOS-mediated gene therapy. CONCLUSIONS: Fine-tuning of iNOS function by L-Arg and BH4 supplementation in the transduced vasculature augments the therapeutic potential of gene therapy with iNOS for the prevention of restenosis.

[Acute upper gastrointestinal bleeding after coronary intervention in acute myocardial infarction]. / Akute obere gastrointestinale Blutung nach Koronarintervention bei akutem Myokardinfarkt.

HISTORY AND ADMISSION FINDINGS: A 73-year-old man with NSTEMI (non-ST segment elevation myocardial infarction) underwent coronary angiography and an in-stent restenosis and thrombosis in ramus circumflexus was found. A drug-eluting stent (DES) was implanted. 12 h after intervention during threefold platelet inhibition the patient presented a gastrointestinal bleeding with melena and the hemoglobin level dropped from 15.3 g/dl to 9.7 g/dl. INVESTIGATIONS: Blood tests revealed a considerable elevation of cardiac enzymes, troponin I, leukocytes and C-reactive protein but normal hemoglobin. In coronary angiography, the stent in ramus circumflexus was found to be occluded. Therefore, a percutaneous coronary intervention with implantation of a DES (Taxus) was performed. In gastroscopy, a 2.5-cm necrotic formation resembling a tumor with an oozing bleeding was identified. The bleeding was stopped after injection of adrenaline. Histological evaluation showed no criteria of malignancy. TREATMENT AND COURSE: With high-dose proton pump blocker therapy, calculated Helicobacter pylori eradication with amoxicillin and clarithromycin, and cessation of NSAID (nonsteroidal anti-inflammatory drugs), the hemoglobin level was stable with 9.7 g/dl. No blood transfusion and no interruption of the dual platelet inhibition were necessary. In control gastroscopy, the initial endoscopically malignancy-suspicious formation presented as a small, superficial, healing ulcer. CONCLUSION: Bleeding complications after stent implantation create a dilemma situation. The risk of a hemorrhagic shock by continuing platelet inhibition therapy and the risk of an acute stent thrombosis with interruption of the platelet inhibition should be carefully calculated considering individual facts and the guidelines.

[Integrative medical intervention strategies for recurrent angina after coronary revascularization].

Coronary revascularization (CRV), mainly by means of percutaneous coronary intervention or coronary artery bypass graft surgery, has been developed nowadays to rescue patients with myocardial ischemia. Nevertheless, the recurrent angina after coronary revascularization (RACR) remains a concernful problem in clinical practice, its management is still a real challenge to physicians. Therefore, the prevention and treatment of RACR become vital for keeping the benefits of CRV. The common causes of RACR and the adoptable integrative medical approaches for its diagnosis and treatment were discussed in this paper.

Meditations on secondary revascularisation in the aftermath of the SYNTAX trial.

Many patients will experience a return of symptoms after their initial revascularisation procedure necessitating secondary revascularisation (SR). The options for this second procedure are inherently influenced by the primary method adopted for revascularisation. Patients with single vessel disease are most suited to percutaneous coronary intervention (PCI) for both primary and secondary revascularisation. The arrival of drug eluting stents, and evidence from trials of highly select populations has threatened the place of coronary artery bypass grafting (CABG) as the preferred method of revascularisation in those with multivessel disease. At present, and without robust evidence, PCI is increasingly being used to treat highly complex lesions, such that many question whether CABG is still has a role in primary revascularisation. The consequence for SR is that currently it is increasingly likely to be in response to in-stent restenosis, whereby previously it was performed in those with prior CABG. The recent SYNTAX trial has reaffirmed the position of CABG in the treatment of those with complex coronary disease. Consequently we believe that matters have turned a full circle, and expect that SR in the future is most likely to be in form of PCI on patients 8-15 years post primary CABG.

Secondary coronary revascularisation: an emerging issue.

Coronary revascularisation should be considered as a healthcare process rather than a series of episodic interventions. At a time when the number of surgical and interventional procedures worldwide continues to increase, secondary coronary revascularisation appears as an unavoidable subject. Atherosclerosis progression, long-term failure of surgical grafts or stents, and patient profile contribute to the increased risk of secondary revascularisation. The absence of a grouping category, however, has contributed to suboptimal implementation of evidence-based knowledge on the subject, which is scattered in the literature and scantily covered in clinical practice guidelines. Assembling a critical mass of expertise in the field results mandatory for comprehensive patient management and for highlighting avenues for future research. Knowledge sharing between physicians, interventionalists and surgeons appears indispensable to reduce unilateral decision-making. Awareness of all health professionals about the likelihood of repeated revascularisation appears as the first step towards a process-oriented and holistic management of patients requiring coronary revascularisation.

[Systematic review of randomized controlled trials on preventing and treating restenosis after percutaneous coronary intervention with Chinese medicine].

OBJECTIVE: To evaluate the randomized controlled trials on preventing and treating restenosis after percutaneous coronary intervention (PCI) with Chinese medicine adopting the principle of evidence-based medicine (EBM). METHODS: Pertinent literatures were retrieved roundly, and scored depending on Jadad Quality Scale. Meta-analysis was applied on the total effect of outcomes reported using RevMan 4. 2 software. Moreover, the sensitivity was analyzed, the publication bias was identified with funnel-plot and the adverse reaction of medicine was reported. RESULTS: Among the 17 literatures met the inclusion criteria, only two double-blinded trials were appraised as high quality. The analysis on the recurrence rates of restenosis post-PCI and angina pectoris in patients treated with Chinese medicine illustrated that the rates in the treatment group were all lower than those in the control group with statistical significance (P < 0.01). Sensitivity analysis revealed a relatively stable result of the evaluation. Funnel-plot displayed an asymmetrical figure, indicating the possible existence of publication bias. CONCLUSION: TCM has definite therapeutic effect on preventing and treating restenosis after PCI and reducing the recurrence rate of angina pectoris in patients.

[Increased myocardial blood flow after spinal cord stimulation in patients with refractory angina pectoris]. / Verbesserte myokardiale Durchblutung nach epiduraler Rückenmarkstimulation bei therapierefraktärer Angina pectoris.

BACKGROUND: In spite of great progresses in surgical and catheter interventional techniques there is an increasing number of patients with coronary heart disease not suitable for these conventional treatment strategies. THERAPY: A recent review of the Study Group on the treatment of refractory angina pectoris of the European Society of Cardiology (ESC) recommends spinal cord stimulation (SCS) as first-line therapy. SCS is a well-known and often used therapy for refractory angina in other European countries but not in Germany. The present studies show that SCS is an efficient therapy. By reduction of angina symptoms and a consecutive increase of exercise capacity, the patients experience a great improvement in quality of life. In addition, recent data of our own study suggest a significant decrease in myocardial ischemia in patients under SCS. This might be a direct effect of SCS or due to a better collateralization because of the improved exercise capacity. CONCLUSION: In agreement with the study group of the ESC, we would recommend SCS as first-line therapy for refractory angina pectoris. As a matter of course, conventional treatment strategies should not be replaced by SCS. Hence, a strict evaluation before implanting a SCS device is indispensable.

Estrogen-eluting, phosphorylcholine-coated stent implantation is associated with reduced neointimal formation but no delay in vascular repair in a porcine coronary model.

Estrogen can inhibit intimal proliferation and accelerate endothelial regeneration after angioplasty. This suggests that estrogen may prevent in-stent restenosis. Unlike other therapies to prevent restenosis, estrogen may also not delay endothelial regrowth, thereby avoiding the risk of late stent thrombosis. The purpose of this work was to determine the effect of a 17beta-estradiol-eluting stent on neointimal formation in a porcine model. Each artery of six pigs was randomized to either a control, low-dose, or high-dose 17beta-estradiol-eluting stent. All animals were sacrificed at 30 days for histopathological analysis. There was a 40% reduction in intimal area in the high-dose stents compared with control stents (2.54 +/- 1.0 vs. 4.13 +/- 1.1 mm(2), for high dose vs. control, respectively; P < 0.05). There was complete endothelial regeneration at 30 days and similar inflammatory response to stenting on histopathology in all the stent groups. This is the first study to show that 17beta-estradiol-eluting stents are associated with reduced neointimal formation without affecting endothelial regeneration in the pig model of in-stent restenosis. Estrogen-coated stents may have a potential benefit in the prevention and treatment of in-stent restenosis.