14 research outputs found
Intracoronary gamma-radiation therapy after angioplasty inhibits recurrence in patients with in-stent restenosis
BACKGROUND: Treatment of in-stent restenosis presents a critical
limitation of intracoronary stent implantation. Ionizing radiation has
been shown to decrease neointimal formation within stents in animal models
and in initial clinical trials. We studied the effects of intracoronary
gamma-radiation therapy versus placebo on the clinical and angiographic
outcomes of patients with in-stent restenosis. METHODS AND RESULTS: One
hundred thirty patients with in-stent restenosis underwent successful
coronary intervention and were then blindly randomized to receive either
intracoronary gamma-radiation with (192)Ir (15 Gy) or placebo. Four
independent core laboratories blinded to the treatment protocol analyzed
the angiographic and intravascular ultrasound end points of restenosis.
Procedural success and in-hospital and 30-day complications were similar
among the groups. At 6 months, patients assigned to radiation therapy
required less target lesion revascularization and target vessel
revascularization (9 [13.8%] and 17 [26.2%], respectively) compared with
patients assigned to placebo (41 [63.1%, P=0.0001] and 44 [67.7%,
P=0.0001], respectively). Binary angiographic restenosis was lower in the
irradiated group (19% versus 58% for placebo, P=0.001). Freedom from major
cardiac events was lower in the radiation group (29.2% versus 67.7% for
placebo, P<0.001). CONCLUSIONS: Intracoronary gamma-radiation used as
adjunct therapy for patients with in-stent restenosis significantly
reduces both angiographic and clinical restenosis
Results of Prevention of REStenosis with Tranilast and its Outcomes (PRESTO) trial
BACKGROUND: Restenosis after percutaneous coronary intervention (PCI) is a major problem affecting 15% to 30% of patients after stent placement. No oral agent has shown a beneficial effect on restenosis or on associated major adverse cardiovascular events. In limited trials, the oral agent tranilast has been shown to decrease the frequency of angiographic restenosis after PCI. METHODS AND RESULTS: In this double-blind, randomized, placebo-controlled trial of tranilast (300 and 450 mg BID for 1 or 3 months), 11 484 patients were enrolled. Enrollment and drug were initiated within 4 hours after successful PCI of at least 1 vessel. The primary end point was the first occurrence of death, myocardial infarction, or ischemia-driven target vessel revascularization within 9 months and was 15.8% in the placebo group and 15.5% to 16.1% in the tranilast groups (P=0.77 to 0.81). Myocardial infarction was the only component of major adverse cardiovascular events to show some evidence of a reduction with tranilast (450 mg BID for 3 months): 1.1% versus 1.8% with placebo (P=0.061 for intent-to-treat population). The primary reason for not completing treatment was > or =1 hepatic laboratory test abnormality (11.4% versus 0.2% with placebo, P<0.01). In the angiographic substudy composed of 2018 patients, minimal lumen diameter (MLD) was measured by quantitative coronary angiography. At follow-up, MLD was 1.76+/-0.77 mm in the placebo group, which was not different from MLD in the tranilast groups (1.72 to 1.78+/-0.76 to 80 mm, P=0.49 to 0.89). In a subset of these patients (n=1107), intravascular ultrasound was performed at follow-up. Plaque volume was not different between the placebo and tranilast groups (39.3 versus 37.5 to 46.1 mm(3), respectively; P=0.16 to 0.72). CONCLUSIONS: Tranilast does not improve the quantitative measures of restenosis (angiographic and intravascular ultrasound) or its clinical sequelae
Randomized Comparison Between Everolimus-Eluting Bioresorbable Scaffold and Metallic Stent: Multimodality Imaging Through 3 Years
Objectives: The aim of this study was to investigate the vascular responses and fates of the scaffold after bioresorbable vascular scaffold (BVS) implantation using multimodality imaging. Background: Serial comprehen
Consensus standards for acquisition, measurement, and reporting of intravascular optical coherence tomography studies
Objectives: The purpose of this document is to make the output of the International Working Group for Intravascular Optical Coherence Tomography (IWG-IVOCT) Standardization and Validation available to medical and scientific communities, through a peer-reviewed publication, in the interest of improving the diagnosis and treatment of patients with atherosclerosis, including coronary artery disease. Background: Intravascular optical coherence tomography (IVOCT) is a catheter-based modality that acquires images at a resolution of ā¼10 Ī¼m, enabling visualization of blood vessel wall microstructure in vivo at an unprecedented level of detail. IVOCT devices are now commercially available worldwide, there is an active user base, and the interest in using this technology is growing. Incorporation of IVOCT in research and daily clinical practice can be facilitated by the development of uniform terminology and consensus-based standards on use of the technology, interpretation of the images, and reporting of IVOCT results. Methods: The IWG-IVOCT, comprising more than 260 academic and industry members from Asia, Europe, and the United States, formed in 2008 and convened on the topic of IVOCT standardization through a series of 9 national and international meetings. Results: Knowledge and recommendations from this group on key areas within the IVOCT field were assembled to generate this consensus document, authored by the Writing Committee, composed of academicians who have participated in meetings and/or writing of the text. Conclusions: This document may be broadly used as a standard reference regarding the current state of the IVOCT imaging modality, intended for researchers and clinicians who use IVOCT and analyze IVOCT data
Inhibition of restenosis with beta-emitting radiotherapy: Report of the Proliferation Reduction with Vascular Energy Trial (PREVENT)
BACKGROUND: Intracoronary gamma- and beta-radiation have reduced
restenosis in animal models. In the clinical setting, the effectiveness of
beta-emitters has not been studied in a broad spectrum of patients,
particularly those receiving stents. METHODS AND RESULTS: A prospective,
randomized, sham-controlled study of intracoronary radiotherapy with the
beta-emitting (32)P source wire, using a centering catheter and automated
source delivery unit, was conducted. A total of 105 patients with de novo
(70%) or restenotic (30%) lesions who were treated by stenting (61%) or
balloon angioplasty (39%) received 0 (control), 16, 20, or 24 Gy to a
depth of 1 mm in the artery wall. Angiography at 6 months showed a target
site late loss index of 11+/-36% in radiotherapy patients versus 55+/-30%
in controls (P:<0.0001). A low late loss index was seen in stented and
balloon-treated patients and was similar across the 16, 20, and 24 Gy
radiotherapy groups. Restenosis (>/=50%) rates were significantly lower in
radiotherapy patients at the target site (8% versus 39%; P:=0.012) and at
target site plus adjacent segments (22% versus 50%; P:=0.018). Target
lesion revascularization was needed in 5 radiotherapy patients (6%) and 6
controls (24%; P:<0.05). Stenosis adjacent to the target site and late
thrombotic events reduced the overall clinical benefit of radiotherapy.
CONCLUSIONS: beta-radiotherapy with a centered (32)P source is safe and
highly effective in inhibiting restenosis at the target site after stent
or balloon angioplasty. However, minimizing edge narrowing and late
thrombotic events must be accomplished to maximize the clinical benefit of
this modality
A randomised comparison of novolimus-eluting and zotarolimus-eluting coronary stents: 9-Month follow-up results of the EXCELLA II study
Aims: Novolimus, a macrocyclic lactone with anti-proliferative properties, has a similar efficacy to currently available agents; however it requires a lower dose, and less polymer, and is therefore conceivably safer. Methods and results: The EXCELLA II study was a prospective, multicentre, single-blind, non-inferiority clinical trial which randomised 210 patients with a maximum of two de novo coronary artery lesions in two different epicardial vessels in a ratio of 2:1 to treatment with either the Elixir DESyne Novolimus Eluting Coronary Stent System (NES n=139, Elixir Medical, Sunnyvale, CA, USA) or the Endeavor zotarolimus eluting stent (ZES n=71, Medtronic, Santa Rosa, CA, USA). The primary endpoint was in-stent mean late lumen loss (LLL) at 9-months follow-up. In-stent percent volume obstruction (%VO) was measured in a sub-group of 65 patients having 9-month intravascular ultrasound (IVUS) follow-up. Clinical secondary endpoints included a device orientated composite of cardiac death, target vessel myocardial infarction (MI), and clinically indicated target lesion revascularisation (CI-TLR) assessed at 9-months follow-up. At 9-months, the in-stent LLL was 0.11Ā±0.32 mm in the NES arm, as compared to 0.63Ā±0.42 mm in the ZES (p<0.0001 non-inferiority, p<0.0001 superiority). In-stent%VO was 4.5Ā±5.1% and 20.9Ā±11.3% for NES and ZES, respectively (p<0.001). There was no significant difference between stent groups in the device orientated composite endpoint (NES 2.9% vs. ZES 5.6%, -2.8% [-8.8%, 3.3%], p=0.45) or its indi