The application of optical coherence tomography to the cardiovascular system has led to intense interest, both clinically and also on the research front. Based on sound optical physics, intracoronary, in vivo imaging with high resolution (∼15 µm) has given unique insights into not only atherosclerotic plaques but also the tissue responses underlying stent implantation. This article will introduce the application of optical coherence tomography technology to coronary arteries, with particular reference to the evaluation of stents, and will also give a glimpse into current and future developments that will see optical coherence tomography remain a key tool in the armamentarium of researchers and interventional cardiologists alike.
Intracoronary radiation is a promising therapy to reduce restenosis after percutaneous coronary intervention. It may be anticipated that radiation and intracoronary stents - the current standard coronary revascularization procedure - have a synergic antirestenosis effect. However, this potential benefit has not been proven in the clinical scenario. Indeed, this combined approach (stenting plus brachytherapy) may even be harmful. Delayed endothelialization and late stent malapposition are important drawbacks of implanting a metallic prosthesis in the setting of radiation therapy. Owing to the relatively high frequency of late thrombosis after stenting irradiated coronary arteries, the Food and Drug Administration required that the labeling of both gamma- and beta-radiation devices recently approved for clinical use explicitly advise avoidance of the placement of new stents. The pathophysiologic aspects as well as the clinical implications of the implantation of a new stent in association with radiation delivered by radioactive stents or catheter-based systems are discussed in this paper.
No abstract is provided for this article.
Assembly 5 of the European Respiratory Society (ERS) is the Inflammatory Airway Diseases and Clinical Allergy Assembly and consists of three Scientific Groups: 1) Airway Pharmacology and Treatment; 2) Monitoring Airway Diseases; and 3) Allergy and Immunology. The original focus of the Assembly was mostly on asthma, but in recent years, it has increasingly begun to encompass chronic obstructive pulmonary disease (COPD). A substantial number of pharmacologists and basic scientists have joined clinicians to work together to unravel mechanisms of and improve diagnosis and treatment of these common chronic airway diseases. The Airway Pharmacology and Treatment Group focuses its activities on the pharmacology of the drugs used in asthma and COPD, and the development of scientific rationales for new drugs. The Monitoring Airway Disease Group evolved from the Airway Regulation and Provocation Group. Initially, focus was on the evaluation of bronchial responsiveness but in the past 20 years, important new technologies have developed, such as sputum induction, and measurement of exhaled nitric oxide (eNO) and exhaled breath condensate for noninvasive evaluation of airways inflammation. The Allergy and Immunology Group focuses mainly on airway and lung immunology, a rapidly advancing field that is crucial to our understanding of cellular and molecular backgrounds of allergy and inflammatory airways diseases. The majority of adult asthma patients can now be treated by a combination of inhaled corticosteroids and long-acting inhaled β2-agonists. Combination inhalers are highly effective, relatively inexpensive and safe. The scientific rationale is based on knowledge derived from both basic science and landmark clinical trials, in which prominent members of our Assembly have taken the lead 1–3. More recently, the …
Objectives This study examined the clinical outcomes at 5 years in RAVEL (A Randomized Comparison of a Sirolimus-Eluting Stent With a Standard Stent for Coronary Revascularization), the first controlled trial of drug-eluting stents. Background The 6-month rate of angiographic coronary restenosis has been markedly lowered by sirolimus-eluting stents (SES). The long-term performance of drug-eluting stents, however, is under close scrutiny. Methods The trial included 238 patients (mean age 60.7 ± 10.4 years, 76% men) with a single, de novo native coronary artery lesion, randomly assigned to treatment with SES versus bare-metal stents (BMS). Rates of major adverse cardiac events (MACE), defined as all-cause mortality, myocardial infarction, and percutaneous or surgical revascularization up to 5 years of follow-up, and rates of stent thrombosis were compared between the 2 treatment groups. Results Complete datasets were available in 92.5% of patients treated with SES and 89.1% of patients assigned to BMS. The 1-, 3-, and 5-year rates of survival free from target lesion revascularization (TLR) were, respectively, 99.2%, 93.8%, and 89.7% in the SES group versus 75.9%, 75.0%, and 74.0% in the control group (p < 0.001; log-rank). Rates of all MACE at 5 years were 25.8% in patients treated with SES versus 35.2% in patients assigned to BMS (p = 0.03; log-rank). Rates of stent thrombosis, per protocol or by the Academic Research Consortium definitions, were similar in both groups. Conclusions The 5-year rate of TLR associated with SES was significantly lower than that with BMS. There was no apparent adverse effect associated with the use of SES, although the trial was not powered to examine uncommon complications.
