Percutaneous Coronary Intervention/trends

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Editorial

Are We Reaching the End of the Evolutionary Road to Metallic Drug-Eluting Stents? Which 4th Generation Stents Do We Need?

Stents are the cornerstone of current PCI. It guarantees safety, a predictable acute angiographic upshot, and long-term acceptable clinical outcomes.

Its current accomplishment is, undoubtedly, linked to a successful evolutionary road driven by continuous unmet medical needs endured by device companies eager to gain market shares.

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Original Article

Overview of Percutaneous Coronary Interventions for Chronic Total Occlusions Treated at Brazilian Centers Participating in the LATAM CTO Registry

Antonio Carlos Botelho da Silva et al. João Eduardo Tinoco de Paula Carlos M. Campos Marcelo Harada Ribeiro … Evandro Martins Filho Marcos Danillo Peixoto Oliveira Leandro Assumpção Côrtes Aníbal Pereira Abelin Cleverson Neves Zukowski Gustavo Cervino Martinelli Fábio Sândoli de Brito Antônio José Muniz Marcelo José de Carvalho Cantarelli Pedro Beraldo de Andrade César Rocha Medeiros Breno de Alencar Araripe Falcão Felipe Costa Fuchs Leonardo Sinnott Silva Tammuz Fattah Ramiro Caldas Degrazia José Armando Mangione Cristiano Guedes Bezerra Sandra Baradel João Brum Silveira Luiz Fernando Ybarra Daniel Weillenmann Carlos Gottschall Viviana Lemke Franciele Rosa da Silva Marcia Moura Schmidt Karlyse Claudino Belli Pedro Piccaro de Oliveira Alexandre Schaan de Quadros

Abstract

Background

Major advances have been seen in techniques and devices for performing percutaneous coronary interventions (PCIs) for chronic total occlusions (CTOs), but there are limited real-world practice data from developing countries.

Objectives

To report clinical and angiographic characteristics, procedural aspects, and clinical outcomes of CTO PCI performed at dedicated centers in Brazil.

Methods

Included patients underwent CTO PCI at centers participating in the LATAM CTO Registry, a Latin American multicenter registry dedicated to prospective collection of these data. Inclusion criteria were procedures performed in Brazil, age 18 years or over, and presence of CTO with PCI attempt. CTO was defined as a 100% lesion in an epicardial coronary artery, known or estimated to have lasted at least 3 months.

Results

Data on 1196 CTO PCIs were included. Procedures were performed primarily for angina control (85%) and/or treatment of moderate/severe ischemia (24%). Technical success rate was 84%, being achieved with antegrade wire approaches in 81% of procedures, antegrade dissection and re-entry in 9%, and retrograde approaches in 10%. In-hospital adverse cardiovascular events occurred in 2.3% of cases, with a mortality rate of 0.75%.

Conclusions

CTOs can be treated effectively in Brazil by using PCI, with low complication rates. The scientific and technological development observed in this area in the past decade is reflected in the clinical practice of dedicated Brazilian centers.

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Editorial

Rosuvastatin Decreases the Formation of Neointima by Increasing Apo J, Reducing Restenosis after Balloon Injury in Rats

Paulo Magno Martins Dourado

The study by Yang et al. brings new light on the action of Apolipoprotein (Apo) J, also called clusterin (CLU), a heterodimeric glycoprotein consisting of α and β subunits linked by disulfide bond.^, The coding gene of Apo J is located on chromosome 8p21-p12, encoding two main isoforms, including secreted (sCLU) and nuclear (nCLU) on restenosis following balloon percutaneous transluminal carotid angioplasty (PTCA) in an experimental model in rats; this was published in this edition of the Brazilian Archives of Cardiology, because there is a controversy in the literature whether Apo J, which is elevated in atherosclerosis and post-angioplasty, plays a protective or promoting role for restenosis. Apo J is involved in several important pathological processes in the transport of lipids, and in the differentiation of vascular smooth muscle cells (VSMC), including cell death by apoptosis, cell cycle regulation, cell adhesion, tissue remodeling, regulation of the immune system and oxidative stress, playing a role in the development of clinical atherosclerosis.^, In the process of attenuating atherosclerosis, Apo J can promote the export of cholesterol and phospholipids from foam cells of macrophages, and show cytoprotective and anti-inflammatory actions interacting with many known inflammatory proteins that may act in the initial phase of clinical cardiovascular events, and may play an important role in mediating atherosclerotic disease, such as C-reactive protein, paraoxonase and leptin. There are studies reporting that Apo J can stimulate the proliferation and migration of VSMC, and promote restenosis,^, and there have been studies showing that overexpression of CLUs can inhibit migration and proliferation of VSMC, and inhibit cellular apoptosis. In view of these controversial results, the authors sought to elucidate the role of Apo J in neointimal hyperplasia, using the rat carotid artery in vivo, with or without rosuvastatin.

The results of the study published here suggest that rosuvastatin can inhibit intimal hyperplasia due to the high expression of Apo J in the active proliferation and migration phase of VSMC, after balloon injury in rats. In the present study, the authors evidenced an increase in the intimal/media (I/M) area rate after the balloon injury that reached the maximum value in the fourth week in the model group; in addition, I/M was increased at week 2, and such increase ceased after the administration of rosuvastatin. These results suggest that rosuvastatin can significantly reduce the degree of intimal hyperplasia in the balloon-injured carotid arteries in rats. The levels of Messenger Ribonucleic Acid (mRNA) and Apo J were increased in the carotid arteries in the group using rosuvastatin, when compared to the model group, reaching the maximum in the second week, earlier than in the model group, suggesting that rosuvastatin can inhibit intimal hyperplasia by increasing Apo J after balloon injury in rats. Therefore, Apo J has been identified as having a central role in the migration, adhesion and vascular proliferation process, and that it can contribute significantly to restenosis after vascular injury.

[…]

Read Full Article

Are We Reaching the End of the Evolutionary Road to Metallic Drug-Eluting Stents? Which 4th Generation Stents Do We Need?

Overview of Percutaneous Coronary Interventions for Chronic Total Occlusions Treated at Brazilian Centers Participating in the LATAM CTO Registry

Abstract

Background

Objectives

Methods

Results

Conclusions

Rosuvastatin Decreases the Formation of Neointima by Increasing Apo J, Reducing Restenosis after Balloon Injury in Rats

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Electronic Document Format (ISO)

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