• Title/Summary/Keyword: Restenosis

Search Result 159, Processing Time 0.098 seconds

Brachytherapy in Coronary Artery Disease (관상동맥질환의 방사성동위원소 치료)

  • Song, Ho-Chun
    • Nuclear Medicine and Molecular Imaging
    • /
    • v.40 no.2
    • /
    • pp.113-119
    • /
    • 2006
  • Coronary artery disease is a loading cause of morbidity and mortality across the world. Percutaneous coronary intervention has become the major technique of revascularization. However, restenosis remains a major limitation of this procedure. Recently the need for repeat intervention due to restenosis, the most vexing long-term failure of percutaneous coronary intervention, has been significantly reduced owing to the introduction of two major advances, intracoronary brachytherapy and the drug-eluting stents. Intracoronary brachytherapy has been employed in recent years to prevent restenosis lesions with effective results, principally in in-stent restenosis. Restenosis is generally considered as au excessive form of normal wound healing divided up in precesses: elastic recoil, neointimal hyperplasia, and negative vascular remodeling. Restenosis has previously been regarded as a proliferative process in which neointimal thickening, mediated by a cascade of inflammatory mediators and other factors, is the key factor. Ionizing radiation has been shown to decrease the proliferative response to injury in animal models of restenosis. Subsequently, several randomized, double blind trials have demonstrated that intracoronary brachytherapy can reduce the rates of both angiographic restenosis and clinical event rates in patients undergoing percutaneous coronary intervention for in stent restenosis. Some problems, such as late thrombosis and edge restenosis, have been identified as limiting factors of this technique. Brachytherapy is a promising method of preventing and treating coronary artery restenosis.

Intracoronary Radiation Therapy Using Re-188 after percutaneous Coronary Angioplasty (경피적 관동맥혈관성형술 후 Re-188을 이용한 혈관 내 방사선조사요법)

  • Chae, In-Ho;Lee, Myoung-Mook;Lee, Dong-Soo
    • 대한핵의학회:학술대회논문집
    • /
    • 1999.05a
    • /
    • pp.228-241
    • /
    • 1999
  • Percutaneous coronary angioplasty is well established therapeutic modality in the management of coronary artery disease. However, the high restenosis rate of 30 to 50% limits its usefulness. The principal mechanism of restenosis, intimal hyperplasia, is the proliferative response of vessel wall to injury, which consists largely of smooth muscle cells. A large body of animal investigations and a limited number of clinical studies have established the ability of ionizing radiation to reduce neointimal proliferation and restenosis rate significantly. Human studies have been reported that intravascular radiation after first restenosis inhibits a second restenosis. Encouraged by these reports, we are also conducting a double blind, placebo-controlled, randomized trial to evaluate this new therapeutic modality in patients with coronary artery stenosis. The objective of our trial is to determine the safety and efficacy of catheter-based solutional beta emitting radioisotope system in preventing restenosis after angioplasty. This review describes the vascular brachytherapy systems and isotopes that have been utilized in the initial clinical trials performed in this area of post PTCA coronary restenosis. The results of many worldwide ongoing clinical trials will determine whether this new technology will change the future practice of vascular intervention.

  • PDF

Restenosis and Remodeling (관동맥성형술 후의 혈관 재협착 및 재형성)

  • Chae, Jei-Keon
    • 대한핵의학회:학술대회논문집
    • /
    • 1999.05a
    • /
    • pp.205-208
    • /
    • 1999
  • Percutaneous Transluminal Coronary Angioplasty (PTCA) remains limited by restenosis that occurs in 30 to 50% of patients with coronary artery disease. During the last decade, numerous agents have been used to prevent restenosis. Despite positive results in animal models, no pharmacological therapy has been found to significantly decrease the risk of restenosis in humans. These discrepancies between animal models and clinical situation were probably related to an incomplete understanding of the mechanism of restenosis. Neointimal thickening occurs in response to experimental arterial injury with a balloon catheter. Neointimal formation involves different steps: smooth muscle cell activation, proliferation and migration, and the production of extracellular matrix. The factors that control neointimal hyperplasia include growth factors, humoral factors and mechanical factors. Arterial remodeling also plays a major role in the restenosis process. Studies performed in animal and human subjects have established the potentials for "constrictive remodeling" to reduce the post-angioplasty vessel area, thereby indirectly narrowing the vessel lumen and thus contributing to restenosis. The reduction of restenosis rate in patients with intracoronary stent implantation has been attributed to the preventive effect of stent itself for this negative remodeling. In addition to these mochanisms for restenosis, intraluminal or intra-plaque thrombus formation, reendothelialization and apoptosis theories have been introduced and confirmed at least in part.

  • PDF

Intracoronary Radiation Therapy (관동맥혈관 내 방사선 근접 치료)

  • Moon, Dae-Hyuk;Park, Seong-Wook;Hong, Myeong-Ki;Oh, Seung-Jun;Bom, Hee-Seung;Lee, Hee-Kyung
    • 대한핵의학회:학술대회논문집
    • /
    • 2001.05a
    • /
    • pp.24-34
    • /
    • 2001
  • Restenosis remains a major limitation of percutaneous coronary interventions. Numerous studios including pharmacological approaches and new devices failed to reduce the restenosis rate except coronary stenting. Since the results of $BENESTENT^{1)}\;and\;STRESS^{2)}$ studies came out, coronary stenting has been the most popular interventional strategy in the various kinds of coronary stenotic lesions, although the efficacy of stenting was shown only in the discrete lesion of the large coronary artery. The widespread use of coronary stenting has improved the early and late outcomes after coronary intervention, but it has also led to a new and serious problem, e.g., in-stent restenosis. Intravascular radiation for prevention of restenosis is a new technology in the field of percutaneous coronary intervention. Recent animal experiments and human trials have demonstrated that local irradiation, in conjunction with coronary interventions, substantially diminished the rate of restenosis. This paper reviews basic radiation biology of intracoronary radiation and its role in the inhibition of restenosis. The current status of intracoronary radiation therapy using Re-188 liquid balloon is also discussed.

  • PDF

Options in Intracoronary Radiation Therapy (관동맥혈관 내 방사선 근접 치료: 치료 방법의 비교와 선택)

  • Moon, Dae-Hyuk;Oh, Seung-Jun;Lee, Hee-Kyung;Yi, Byong-Yong;Kim, Eun-Hee;Park, Seong-Wook
    • 대한핵의학회:학술대회논문집
    • /
    • 1999.05a
    • /
    • pp.209-221
    • /
    • 1999
  • Coronary restenosis is still regarded as Achilles' Hill of interventional cardiology despite relentless efforts of many investigators. Recent experimental and clinical studies have suggested that both gamma and beta radiation can reduce restenosis after angioplasty. Currently, intracoronary brachytherapy for the prevention of restenosis has become a new evolving treatment modality in interventional cardiology. This report discusses a physical aspect of gamma and beta radiation, initial clinical results and delivery systems used in intracoronary brachytherapy. We shall take a brief overview of methods and their advantages in intra-coronary brachytherapy. Future work should provide further insight for the best way of treating restenosis.

  • PDF

Three Cases Report of Mitral Restenosis (승모판 재협착증의 3 치험례)

  • 최병우;유재업;유회성
    • Journal of Chest Surgery
    • /
    • v.3 no.2
    • /
    • pp.153-157
    • /
    • 1970
  • The problembs of mitral reste'1osis following primary mitral comissurotomy for mitral stenosis have been increased gradually, and also its incidence of mitral restenosis has showed the increasing time by time. We report 3 cases operation.l of mitral restenosis among several cases which have followed primary operatioa for 254 cases of mitral stenosis from Jan. 1959 to Dec. 1969. at the department of thoracic and cardiovascuar surgery, Natioaal Medical Center, with a review of literatures.

  • PDF

Alkoxybenzylcyanoguanidine Analogs as a Novel Class of Inhibitors for Restenosis

  • Lee, Sun-Kyung;Yi, Kyu-Yang;Hwang, Sun-Kyung;Suh, Jee-Hee;Lee, Byung-Ho;Yoo, Sung-Eun
    • Bulletin of the Korean Chemical Society
    • /
    • v.25 no.7
    • /
    • pp.1003-1008
    • /
    • 2004
  • A novel class of alkoxybenzylcyanoguanidine analogs as the inhibitors of restenosis was discovered, which showed the inhibitory effects on angiotensin II-induced cell proliferation, determined by $[^3H]$thymidine incorporation method. The compound, N'-(4-nitrophenyl)guanidine analog 19, showed 62% inhibition of $[^3H]$thymidine incorporation at 1 ${\mu}M$ concentration. In addition, the compound 19 inhibited intimal thickening dose-dependently after balloon injury, which suggests the therapeutic potential for restenosis.

Coating defects in polymer-coated drug-eluting stents

  • Bedair, Tarek M.;Cho, Youngjin;Park, Bang Ju;Joung, Yoon Ki;Han, Dong Keun
    • Biomaterials and Biomechanics in Bioengineering
    • /
    • v.1 no.3
    • /
    • pp.131-150
    • /
    • 2014
  • Vascular stenting has a great attention as a treatment for coronary arteries diseases as compared with percutaneous balloon angioplasty. In-stent restenosis and thrombosis are side effects resulting from using bare metal stent (BMS). Employing platelet therapy allowed to reduce the rate of thrombosis, however, the rate of restenosis remains a major problem. In 2002, drug-eluting stents (DESs) were introduced as an effort to reduce the restenosis. The commercially available DESs continue to suffer from coating defects that might lead to a series of adverse effects. Most importantly, multiple concerns remain regarding the polymer coating integrity on metal surfaces or the relation of polymer irregularities to longterm adverse events.

An Experience of The Microwave Tissue Coagulation Therapy in The Restenosis of The Esophagogastrostomy (식도위 문합술후 재협착증에 대한 microwave 조직응고법적 치험 례)

  • Nam, Chung-Hui;An, Uk-Su;Lee, Gil-No
    • Journal of Chest Surgery
    • /
    • v.20 no.4
    • /
    • pp.859-864
    • /
    • 1987
  • The microwave tissue coagulator was originally used for hemostasis in the hepatic surgery, which is effectively applied in the endoscopic surgery such as the hemostasis of gastric ulcer or tumor bleeding, stenosis relieving of esophageal or rectal stenosis and tumor reduction in inoperable early cancer cases. We experienced the good result of the microwave tissue coagulation therapy in the patient with the restenosis of esophagogastrostomy. The patient was 67 year-old female, who was admitted due to the lye stricture of esophagus for 40 years. We made the lower esophagectomy and the esophagogastrostomy with the upper intact esophagus in the right thorax. But the restenosis occurred at the esophagogastrostomy site because of the polypoid mucosal protrusion at one month after operation. We applied the microwave tissue coagulator 3 times with 6 day interval under esophagoscopy and the good symptomatic and endoscopic relief was alleviated. We think that the microwave tissue coagulation is a very convenient and advisable method in the case of restenosis after esophageal surgery.

  • PDF

Delayed Carotid Wallstent Shortening Resulting in Restenosis Following Successful Carotid Artery Angioplasty and Stenting

  • Yoon, Seok-Mann;Jo, Kwang-Wook;Baik, Min-Woo;Kim, Young-Woo
    • Journal of Korean Neurosurgical Society
    • /
    • v.46 no.5
    • /
    • pp.495-497
    • /
    • 2009
  • Carotid angioplasty and stenting (CAS) for carotid stenosis has been increasingly used as an alternative treatment in patients not eligible for surgery. Even though CAS can be performed relatively simply in many cases, various complications can occur. We report four cases of CAS using the Carotid Wallstent, which were complicated by delayed shortening of the stent, resulting in restenosis after successful CAS.