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AS-115: Short-Term Effect of Tetramethylpyrazine-Eluting Stents on Neointimal Hyperplasia in Renal Arteries
April 24 –27, 2012
AS-115
Peripheral Vascular Intervention (non carotid, non neurovascular): Thursday, April 26, 2012 8:30 AM ⬃ 6:00 PM (Abstract nos. AS-110, AS-115, AS-285, AS-288, AS-289, AS-290)
AS-110 Clinical Impacts of Optimal Revascularization in Severe Stenosis of All Three Infrapopliteal Arteries with Chronic Limb Ischemia. Ki Won Hwang, Jong-Young Lee, Gyung-Min Park, Hae-Geun Song, Jung-Min Ahn, Won-Jang Kim, Duk-Woo Park, Soo-Jin Kang, Seung-Whan Lee, Young-Hak Kim, Cheol-Whan Lee, Seong-Wook Park, Seung-Jung Park. Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea (Republic of).
P O S T E R A B S T R A C T S
Background: Little is known about the optimal limb salvage strategies using infrapopliteal percutaenenous intervention patients with chronic limb ischemia (CLI) in current recommendations. We tried to investigate clinical impacts of optimal revascularization of infrapopliteal arteries in patients with chronic CLI. Methods: Between January 2008 to December 2010, a total of 56 lesions in 51 patients (male⫽48, age ⫽ 69.8 ⫾ 8.3 years) having CLI due to severe stenosis of all three infrapopliteal arteries were enrolled in the current analysis. All procedure were successfully performed without significant complications. CLI was defined as chronic ischemic resting pain, ulcers, or gangrene attributable to objectively proven arterial occlusive disease. According to treatment strategies, study population was classified into two groups: straight-line flow to the foot revascularization (group 1, n⫽37), or both complete revascularization – defined as both anterior and posterior arteries with or without peroneal artery (group 2, n⫽19). Primary endpoint was the composites of repeat revascularization or major amputation at 6 months. Results: Baseline characteristics were not different between groups. The mean age was 69.8 ⫾ 8.4. Diabetic disease was noted in 51 (91.1%) of the treated limbs at the time of the procedure. There were 1 aorto-iliac lesion and 27 limbs femoro-popliteal lesions during infrapopliteal intervention. At 6 months, the incidence of primary endpoint was not significantly different between groups (14.5% and 21.1%, p⫽0.415). At 6 months, 2 patients died of aspiration pneumonia, but were not related to the procedure. For the individual clinical outcomes, repeat revascularization rate at 6 months was 10.8% in the group 1 vs. 10.5% in the group 2 (p⫽ 0.891). Major 3 amputations were performed(1 limb vs. 2 limbs, p⫽0.231). Complete revascularization was not significant predictor of primary endpoint by Cox multiple regression analysis (HR 1.43; 95% CI 0.20-10.21, p⫽0.723). Conclusion: Our study shows that minimal procedure for restoring the straight-line flow to the foot revascularization is efficient therapeutic modality for limb salvage strategies as complete revascularization in severe stenosis of all three infrapopliteal arteries with CLI.
138S
Short-Term Effect of Tetramethylpyrazine-Eluting Stents on Neointimal Hyperplasia in Renal Arteries. Long Chen, Zhong Chen, Zhen Ding, Liuzhang Fan, Genshan Ma. The Affiliated Zhongda Hospital and School of Medicine of Southeast University, Nanjing, China. Background: Studies have proved that Chinese traditional medicine tetramethylpyrazine could inhibit neointimal hyperplasia, platelet aggregation and inflammation. Our primary study shows that coronary tetramethylpyrazine-eluting stents could significantly decrease in-stent restenosis. It is unclear whether tetramethylpyrazine-eluting stents could decrease restenosis after implantation in renal arteries. The present study is designed to evaluate the short-term effects of tetramethylpyrazine-eluting stents on neointimal hyperplasia after renal artery stenting. Methods: Tetramethylpyrazine-eluting stents were prepared by spraying bare metal stents with tetramethylpyrazine monomer (200mg/ per stent), methyl methacrylate copolymer and polyglycolic acid. Ten healthy male mini-swine were randomly divided into two groups: bare metal stent implantation group (BMS) and tetramethylpyrazine-eluting stent implantation group (TES). In each swine a stent was implanted into unilateral renal artery (stent diameter:vessel diameter⫽1.1-1.2: 1.0). Quantity renal arteriography (QRA)and intravascular ultrasound (IVUS) were performed 15 minutes before stenting and 35 days after operation to assess vessel diameter and restenosis. Neointimal hyperplasia was assessed by histomorphometry including hematoxylin-eosin (H&E) staining, immunohistochemistry (proliferating cell nuclear antigen-positive index), and electron microscopy scanning. Results: Five swines models were established in each group, and all swines received stent implantation successfully and completed reexaminations with QRA. QRA showed the lumen loss in TES group was lower than that in the control group [(0.32⫾0.11)mm versus (0.50⫾0.19)mm, P⫽0.07]. IVUS analysis showed in-stent restenosis in the TES group decreased when compared with that in the control group [(9.0⫾2.6)% versus (11.7⫾2.5)%, P⫽0.10]. This trend could also be observed in neointimal area (P⫽0.24) and the numbers of proliferating cell nuclear antigen-positive cells between two groups (P ⫽ 0.13). Electron microscopy scanning revealed satisfactory endothelial coverage in both TES and BMS groups. Conclusion: Tetramethylpyrazine-eluting stents showed a trend to prevent neointimal hyperplasia at 35 days after implantation in renal arteries. However, optimal spraying doseage of tetramethylpyrazine and long-term follow-up results need to be determined.
AS-285 Endovascular Treatment as a Reasonable Option for Extensive Total Occlusion of Iliac Artery. Jung Bum Hong, Yong Sun Jeon, Soon Gu Cho, Jang Yong Kim, Kee Chun Hong. Inha University Hospital, Incheon, Korea (Republic of). Background: Extensive iliac occlusion has been treated by arterial bypass like aortofemoral bypass or extra-anatomic bypass as TASC II recommanded. But, recent report showed feasibility and safety of endovascular treatment. This study was conducted to evaluate results of endovascular treatment for extensive total occlusion of iliac artery and to compare its result to femorofemoral byoass. Methods: This is a retrospective study from prospectively registered data base of patients with extensive total occlusion of iliac artery, who underwent endovascular treatment in Inha university hsopital from 2008 to 2010. The iliac lesions were classified by TASC II classifications. Patient’s demographics, risk factors, indications for treatment, procedure’s details, its reuslts were reviewed by electronic records,
The American Journal of Cardiology姞 APRIL 24 –27, 2012 ANGIOPLASTY SUMMIT ABSTRACTS/Poster
AS-115
Peripheral Vascular Intervention (non carotid, non neurovascular): Thursday, April 26, 2012 8:30 AM ⬃ 6:00 PM (Abstract nos. AS-110, AS-115, AS-285, AS-288, AS-289, AS-290)
AS-110 Clinical Impacts of Optimal Revascularization in Severe Stenosis of All Three Infrapopliteal Arteries with Chronic Limb Ischemia. Ki Won Hwang, Jong-Young Lee, Gyung-Min Park, Hae-Geun Song, Jung-Min Ahn, Won-Jang Kim, Duk-Woo Park, Soo-Jin Kang, Seung-Whan Lee, Young-Hak Kim, Cheol-Whan Lee, Seong-Wook Park, Seung-Jung Park. Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea (Republic of).
P O S T E R A B S T R A C T S
Background: Little is known about the optimal limb salvage strategies using infrapopliteal percutaenenous intervention patients with chronic limb ischemia (CLI) in current recommendations. We tried to investigate clinical impacts of optimal revascularization of infrapopliteal arteries in patients with chronic CLI. Methods: Between January 2008 to December 2010, a total of 56 lesions in 51 patients (male⫽48, age ⫽ 69.8 ⫾ 8.3 years) having CLI due to severe stenosis of all three infrapopliteal arteries were enrolled in the current analysis. All procedure were successfully performed without significant complications. CLI was defined as chronic ischemic resting pain, ulcers, or gangrene attributable to objectively proven arterial occlusive disease. According to treatment strategies, study population was classified into two groups: straight-line flow to the foot revascularization (group 1, n⫽37), or both complete revascularization – defined as both anterior and posterior arteries with or without peroneal artery (group 2, n⫽19). Primary endpoint was the composites of repeat revascularization or major amputation at 6 months. Results: Baseline characteristics were not different between groups. The mean age was 69.8 ⫾ 8.4. Diabetic disease was noted in 51 (91.1%) of the treated limbs at the time of the procedure. There were 1 aorto-iliac lesion and 27 limbs femoro-popliteal lesions during infrapopliteal intervention. At 6 months, the incidence of primary endpoint was not significantly different between groups (14.5% and 21.1%, p⫽0.415). At 6 months, 2 patients died of aspiration pneumonia, but were not related to the procedure. For the individual clinical outcomes, repeat revascularization rate at 6 months was 10.8% in the group 1 vs. 10.5% in the group 2 (p⫽ 0.891). Major 3 amputations were performed(1 limb vs. 2 limbs, p⫽0.231). Complete revascularization was not significant predictor of primary endpoint by Cox multiple regression analysis (HR 1.43; 95% CI 0.20-10.21, p⫽0.723). Conclusion: Our study shows that minimal procedure for restoring the straight-line flow to the foot revascularization is efficient therapeutic modality for limb salvage strategies as complete revascularization in severe stenosis of all three infrapopliteal arteries with CLI.
138S
Short-Term Effect of Tetramethylpyrazine-Eluting Stents on Neointimal Hyperplasia in Renal Arteries. Long Chen, Zhong Chen, Zhen Ding, Liuzhang Fan, Genshan Ma. The Affiliated Zhongda Hospital and School of Medicine of Southeast University, Nanjing, China. Background: Studies have proved that Chinese traditional medicine tetramethylpyrazine could inhibit neointimal hyperplasia, platelet aggregation and inflammation. Our primary study shows that coronary tetramethylpyrazine-eluting stents could significantly decrease in-stent restenosis. It is unclear whether tetramethylpyrazine-eluting stents could decrease restenosis after implantation in renal arteries. The present study is designed to evaluate the short-term effects of tetramethylpyrazine-eluting stents on neointimal hyperplasia after renal artery stenting. Methods: Tetramethylpyrazine-eluting stents were prepared by spraying bare metal stents with tetramethylpyrazine monomer (200mg/ per stent), methyl methacrylate copolymer and polyglycolic acid. Ten healthy male mini-swine were randomly divided into two groups: bare metal stent implantation group (BMS) and tetramethylpyrazine-eluting stent implantation group (TES). In each swine a stent was implanted into unilateral renal artery (stent diameter:vessel diameter⫽1.1-1.2: 1.0). Quantity renal arteriography (QRA)and intravascular ultrasound (IVUS) were performed 15 minutes before stenting and 35 days after operation to assess vessel diameter and restenosis. Neointimal hyperplasia was assessed by histomorphometry including hematoxylin-eosin (H&E) staining, immunohistochemistry (proliferating cell nuclear antigen-positive index), and electron microscopy scanning. Results: Five swines models were established in each group, and all swines received stent implantation successfully and completed reexaminations with QRA. QRA showed the lumen loss in TES group was lower than that in the control group [(0.32⫾0.11)mm versus (0.50⫾0.19)mm, P⫽0.07]. IVUS analysis showed in-stent restenosis in the TES group decreased when compared with that in the control group [(9.0⫾2.6)% versus (11.7⫾2.5)%, P⫽0.10]. This trend could also be observed in neointimal area (P⫽0.24) and the numbers of proliferating cell nuclear antigen-positive cells between two groups (P ⫽ 0.13). Electron microscopy scanning revealed satisfactory endothelial coverage in both TES and BMS groups. Conclusion: Tetramethylpyrazine-eluting stents showed a trend to prevent neointimal hyperplasia at 35 days after implantation in renal arteries. However, optimal spraying doseage of tetramethylpyrazine and long-term follow-up results need to be determined.
AS-285 Endovascular Treatment as a Reasonable Option for Extensive Total Occlusion of Iliac Artery. Jung Bum Hong, Yong Sun Jeon, Soon Gu Cho, Jang Yong Kim, Kee Chun Hong. Inha University Hospital, Incheon, Korea (Republic of). Background: Extensive iliac occlusion has been treated by arterial bypass like aortofemoral bypass or extra-anatomic bypass as TASC II recommanded. But, recent report showed feasibility and safety of endovascular treatment. This study was conducted to evaluate results of endovascular treatment for extensive total occlusion of iliac artery and to compare its result to femorofemoral byoass. Methods: This is a retrospective study from prospectively registered data base of patients with extensive total occlusion of iliac artery, who underwent endovascular treatment in Inha university hsopital from 2008 to 2010. The iliac lesions were classified by TASC II classifications. Patient’s demographics, risk factors, indications for treatment, procedure’s details, its reuslts were reviewed by electronic records,
The American Journal of Cardiology姞 APRIL 24 –27, 2012 ANGIOPLASTY SUMMIT ABSTRACTS/Poster