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This is a Ph.D. dissertation. Restenosis occurs in 10-50% of patients after PCI, thus remaining a major challenge. Restenosis after PCI is a complex, multifactorial, overlapping wound healing process involving a cascade of cellular and molecular events including platelet activation, inflammatory cell infiltration, smooth muscle cell proliferation, migration and extracellular matrix production. Recent evidence shows that inflammation, matrix metalloproteinases and free oxygen radicals all play a critical role in the restenosis process. Different approaches to prevent restenosis after PCI were studied in this work. Restenosis has been remarkably reduced in the last decade with the introduction of stents. Stents have been optimized regarding their mechanical features, allowing for scaffolding of the plaque and producing an optimal coronary lumen at the end of the procedure. By their metallic nature however, they cause prolonged and chronic inflammation in the vessel wall. Therefore, the long term efficacy remains a concern. In the first study, the author evaluated the long-term follow-up of patients that underwent bare metal stent implantation. The long-term efficacy of this stent was established, and the major adverse cardiac events (MACE) during the long-term follow-up were mainly caused by progression of lesions in other vessels. This study confirmed that implantation of a bare metal stent in an effective treatment modality of atherosclerotic coronary disease. However, in-stent restenosis still results in a failure of this treatment in about 30% of the patients, mostly occurring within the first 6 months.
This book is open access under a CC BY 4.0 license. This quick-reference handbook offers a concise and practical review of key aspects of the treatment of ST-segment elevation myocardial infarction (STEMI) in the era of primary percutaneous coronary intervention (PPCI). In the context of STEMI, PPCI is the preferred mode of emergency revascularization. Access to PPCI is rapidly increasing and is now routinely practiced in both general and specialist hospitals and there has been a recent emphasis on developing STEMI networks to enhance and expedite the referral pathway. This coupled with concurrent developments to enhance the safety and efficacy of the PPCI procedure has heralded an era where STEMI interventions are increasingly considered an important subspecialty within interventional cardiology. Written by leading cardiologists who have been instrumental in the adoption of PPCI in their respective institutions, the book provides junior and senior cardiologists alike with insightful and thought-provoking tips and tricks to enhance the success of PPCI procedures, which may in turn translate into direct improvements in outcomes. The book is also relevant for healthcare providers and emergency department physicians.
Here is expert guidance on one of the most vexing clinical challenges faced by interventional cardiologists. Written by global thought leaders in the area and edited by two internationally-recognized pioneers in interventional cardiology, Bifurcation Stenting covers all techniques, imaging modalities, and devices in current use, including VH-IVUS and OCT. It includes practical tips/tricks from leading experts and a section of challenging cases to further illustrate the material and help readers better understand the treatment of bifurcation lesions.
This book provides a comprehensive, up-to-date summary of drug-coated balloon (DCB) technology and the role of DCBs in the treatment of coronary and peripheral arterial disease. In addition to clear explanation of how DCBs works, readers will find an enlightening analysis of the mistakes and successes of the past decade and the emergence of the latest delivery systems, which combine a more deliverable device with much improved drug delivery to the vessel wall. The full range of current applications of DCBs are reviewed in detail, drawing on the latest scientific evidence. Due attention is paid to newer devices, with provision of technical insights and documentation of the available clinical data. Ongoing research projects, remaining technical challenges, likely future directions, and reimbursement issues are also carefully considered. This book will be a useful tool for any interventional cardiologist, interventional radiologist, or vascular surgeon who wishes to acquire a deep knowledge of this technology and its application in both coronary and peripheral interventions.
This extensively revised third edition provides a practically applicable guide to the pathophysiology, assessment and management of vascular disorders encountered in vascular surgical practice. It features detailed information on the latest developments in the pathophysiology of conditions including atherosclerosis, multi-organ failure, limb compartment syndromes and Raynaud’s phenomenon in a clear easy to digest format. Disorders such as reperfusion injuries, vasculitides, and aortic dissection are covered. Furthermore, key topics in vascular and endovascular practice such as radiation biology and radiation safety are also detailed. Each chapter contains a set of learning objectives and key references, enabling the reader to quickly identify key points. Mechanisms of Vascular Disease: A Textbook for Vascular Specialists comprehensively covers a variety of common and unusual pathophysiologies encountered in vascular surgery, and is an ideal resource for both the trainee, and practicing clinical vascular surgeon seeking an up-to-date resource on the topic.
With the first coronary balloon angioplasty in 1977 came the challenge of the wound healing process of retenosis. Together these events spawned a new field of medicine, vascular brachytherapy, conceived to resolve this leading complication of vascular intervention. In the ensuing 20 year quest to cure restenosis, radiation vascular therapy appears to be the next logical step, but it still needs validation. Just two years after the first edition, this second edition of Vascular Brachytherapy fulfils the promise to provide updated information about the meteoric progress made from recent collaborative investigations within this field. Migrating from ideas and pre-clinical observation to clinical practice, this second edition contains 48 new or revised chapters contributed by well known medical experts from widely disparate fields of medicine. Scientists, cardiologists, radiation safety officers, regulators, engineers and technicians substantiate their observations with clinical and non-clinical data, basic radiation principles and issues from an economic, regulatory and safety perspective. Very little is known about the immediate patient risks, environmental concerns and long term pathobiological responses. For a field which is still in its honeymoon phase due to early technology success, this single volume will serve as a long-range educational tool and trace, giving the field of vascular brachytherapy the intense and continuous evaluation it deserves. For an audience of clinicians, scientists and researchers from all the represented medical disciplines, this book provides in depth information and exposure to subjects within these diverse areas of expertise.
This book focuses on the coronary bioresorbable scaffold, a new interventional treatment for coronary artery disease, differentiated from a permanent metallic stent. The book provides an overview of the technology including non-clinical studies and clinical evidences in order to help clinicians understand the appropriate application of the technology and the optimal techniques of implantation. It covers the basics of bioresorbable scaffolds; bench test results; preclinical studies; clinical evidences; and tips and tricks of implantation.
New updated edition first published with Cambridge University Press. This new edition includes 29 chapters on topics as diverse as pathophysiology of atherosclerosis, vascular haemodynamics, haemostasis, thrombophilia and post-amputation pain syndromes.
This is a Ph.D. dissertation. Introduction: Cardiovascular and myocardial gene transfer, Gene delivery strategies to the cardiovascular system, Gene vector design, Adenovirus-mediated immunity and cardiovascular gene transfer, Myocardial gene transfer to target myocardial ischemia - reperfusion injury; Specific aims; Materials and methods: Construction of recombinant virus, Myocardial transfer and anti-adenoviral immunity, Gene transfer and myocardial ischemia-reperfusion injury, Statistical analysis; Results: Anti-adenoviral immunity and myocardial adenoviral gene transfer, Gene transfer and myocardial ischemia-reperfusion injury; Discussion: Pre-existing anti-adenoviral immunity and adenovirus-mediated myocardial gene transfer, Intramyocardial NOS3 gene transfer and adenovirus-mediated immune responses, Cardioselective NOS3 gene transfer and myocardial protection from reperfusion injury; General conclusions.