• Title/Summary/Keyword: Coronary stents

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Numerical Evaluation and Shape Design of Coronary Artery Stent (관상동맥혈관용 스텐트의 수치해석 및 형상 설계)

  • Kim, Dae-Young;Lee, Seung-Yeol;Kim, Heon-Young
    • Journal of the Korean Society for Precision Engineering
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    • v.29 no.1
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    • pp.103-108
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    • 2012
  • Restenosis symptom, which is well known as a problem of stents, is due to the recoil and expansion pressure depending on shapes of stent. In order to reduce the effect of recoil problem, study on pattern and shape for the stent is required and the expansion pressure and recoil should be evaluated. This paper aims at evaluating mechanical characteristics of stent used in surgery for vessel stenosis. The expansion process of coronary artery stent in vessel for two models including the Cypher$^{(R)}$ from Johnson & Johnson$^{TM}$ and a suggested model were simulated using the Finite Element Analysis. Comparison of the directional recoil simulation results was made. The issues in the deformed shape of vessel and recoil of Cypher$^{(R)}$ were partially resolved in the suggested model. Therefore, the shape design suggested in this paper was able to reduce the restenosis symptom.

Influence of the Concomitant Use of Clopidogrel and Proton Pump Inhibitors on Adverse Cardiovascular Events in Korean Patients with Acute Coronary Syndrome (Clopidogrel에 Proton Pump Inhibitors 병용 시 급성 관동맥 증후군 환자의 심장관련 부작용에 미치는 영향)

  • Kim, Su Hyun;Lee, Yu Jeung
    • Korean Journal of Clinical Pharmacy
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    • v.24 no.2
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    • pp.106-114
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    • 2014
  • Purpose: Recent investigations suggest that the antiplatelet effect of clopidogrel may be decreased when this medication is taken together with certain proton pump inhibitors (PPIs). However, there has been no study conducted in Korea regarding the clinical effect of clopidogrel-PPI interaction. This study targeted patients who received stents to investigate the effect of the concomitant use of clopidogrel and PPIs on the occurrence of adverse cardiovascular events in Korean patients. Methods: The patients who received a stent insertion at the Yeouido St. Mary's Hospital between January 2010 and April 2011 were included. The patients were divided into two groups, clopidogrel and clopidogrel + PPI, and followed for 12 months after the date of stent insertion using prescription history and medical records. The recurrence rates of the cardiovascular events among the two patient groups were statistically analyzed. Results: There was no difference between the two groups in the basic characteristics of the 157 patients in the clopidogrel group and the 62 patients in the clopidogrel+PPI group. Simple logistic regression showed a significantly higher rate of re-hospitalization in the clopidogrel+PPI group (OR=1.893, 95% CI 1.040-3.445, p=0.037). However, the results of the multivariate logistic regression of the variables found to have statistical significance by crosstabulation showed no significant difference in the rate of adverse cardiovascular events or re-hospitalization between the two groups. Conclusions: There was no significant difference between the clopidogrel and clopidogrel+PPI group among new patients with cardiovascular stents with respect to the occurrence of revascularization procedures, stent thrombosis, or chest pain, or with respect to the re-hospitalization rate for all cardiovascular events.

The Developing Trend in Bioresorbable Stent for Treatment of Coronary Artery Disease (관상동맥질환 치료를 위한 생체흡수형스텐트의 개발 동향)

  • Jeong, Gyeong-Won;Kim, Tae-Hoon;Nah, Jae-Woon;Park, Jun-Kyu
    • Applied Chemistry for Engineering
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    • v.29 no.5
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    • pp.497-502
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    • 2018
  • The coronary artery disease (CAD) is rapidly increasing such as angina pectoris and atherosclerosis. The CAD is induce by cholesterol and calcium like plaque absortion to artery wall. The percutaneouss coronary intervention is non-invasive treatment that narrowed-artery is expand by using balloon catheter and bare metallic stent. The metallic stents have been effective in reducing the dead by coronary artery disease, but the permanent presence of the metallic stent has been associated with persistent inflammation, and incidence of late thrombosis. Therefore, development bioresorbable vascular scaffold (BRS) is rapidly increasing for treatment of long-term complications and arterial restenosis by permanentmetal prosthesis such as stent. The review discusses the BRS trend for successfully development.

Clinical Outcomes of Stent Thrombosis after Drug-Eluting Coronary Stent Implantation (약물방출 관상동맥 스텐트 시술 후 스텐트 혈전증 발생 환자의 임상경과)

  • Kim, In-Soo;Jeong, Myoung-Ho;Han, Jae-Bok;Jang, Young Ill;Jang, Seong-Joo
    • The Journal of the Korea Contents Association
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    • v.13 no.12
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    • pp.880-892
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    • 2013
  • Stent thrombosis after successful drug-eluting stent(DES) implantation has been reported in around 1% of patients in clinical trials. However, the increased risk of ST associated with DES remains a matter of concern. From 1 June 2003 to 30 June 2013, we investigated clinical characteristics, in-hospital outcomes in 10,273 patients who underwent percutaneous coronary intervention in the Heart Center of CNUH. Overall incidence of ST was 1.30% (134 patients). The incidence of ST according to the stent generations and the timing of ST (n=total, early vs. late vs. very late) were 0.79% (n=81, 26 vs. 12 vs. 43) in first-generation, 0.38% (n=39, 21 vs. 9 vs. 9) in second-generation and 0.14% (n=14, 8 vs 3 vs. 3) in third-generation, (p=0.70). The mortality from ST was significantly higher in early ST group compared to the late and very late ST groups (18.2% vs. 8.3% vs. 3.6%, p=0.042). Overall incidence of ST after DES implantation was 1.30% (134 patients). The in-hospital mortality was significantly higher in early ST group compared to the late and very late ST groups.

Association of Clusterin Polymorphisms (-4453T<G, 5608T<C) with Coronary Heart Disease in Korean Population (한국인에서의 Clusterin의 유전자다형성(-4453T<G, 5608T<C)과 관상동맥질환과의 연관성)

  • Kim, Su-Won;Yoo, Min
    • Journal of Life Science
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    • v.20 no.4
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    • pp.584-588
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    • 2010
  • Clusterin is an 80 kDa heterodimetric glycosylated protein which plays diverse biological roles in various tissues and organs. Clusterin is reported to be associated with the pathogenesis of coronary artery disease and atherosclerosis. Therefore, we investigated the genotype for the T

Percutaneous Cardiopulmonary Bypass Support in a Patient with Acute Myocardial Infarction by Stent Thrombosis Complicated with Ventricular Tachycardia (스텐트 혈전에 의한 재발성 심실성 빈맥을 동반한 급성 심근경색에 경피적 심폐순환보조)

  • Kim Sang-Pil;Lee Jun-Wan
    • Journal of Chest Surgery
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    • v.39 no.5 s.262
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    • pp.399-402
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    • 2006
  • Stent thrombosis is a rare complication after percutaneous coronary intervention (PCI), but it might be related to fatal outcomes. We report a case of patient who suffered from acute myocardial infarction complicated with cardiogenic shock and ventricular tachycardia caused by stent thrombosis and successfully resuscitated by percutaneous cardiopulmonary bypass support.

Comparison between Basic and Inverse Dual Drug and Peptide-coated Stents in a Porcine Restenosis Model

  • Jang, Eun-Jae;Lee, So-Youn;Bae, In-Ho;Park, Dae Sung;Jeong, Myung Ho;Park, Jun-Kyu
    • Applied Chemistry for Engineering
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    • v.31 no.5
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    • pp.502-508
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    • 2020
  • Dual drug-eluting stents (DES) is a primary treatment method for coronary arterial diseases in current interventional cardiology practice. However, their pathological results according to the sequence of coating of drugs have not been reported yet. The peptide-dopamine dissolved in acetonitrile was coated onto the Chonnam National University Hospital (CNUH) stent using an electrospinning coating machine. For secondary coating (e.g., sirolimus coating, designated as SPS), sirolimus (SRL) and poly lactic-glycolic acid (PLGA) were mixed in tetrahydrofuran (THF), and the solution was then coated on the CNUH stent that had underwent the primary peptide coating using an electrospinning and spray technique. Next, the peptide-dopamine was coated on the SRL-PLGA coated stent (PSS). In this study, it was confirmed that endothelialization was promoted without being significantly affected by the coating order (SPS or PSS). The sequence of drug and peptide coating may affect the development of restenosis and PSS was effective in the prevention of restenosis compared to that of using SPS.

Material Design and Analysis of Coronary Artery Stents (관상동맥혈관용 스텐트의 구조해석과 재료설계)

  • Park, Joong-Gwun;Kang, Tae-Won;Lee, Kee-Sung;Kim, Tae-Woo
    • Journal of the Korean Ceramic Society
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    • v.44 no.7
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    • pp.362-367
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    • 2007
  • Stent is a tiny structure made with either ceramic coating and/or bare metal. Being approximately $1{\sim}2 mm$ in diameter, it consists of holes, slots, or void space and is designed to cover entire medical lesions. Stent implantation into patients' arteries has been practiced for a little more than a decade in order to widen the blocked artery. The adoption of the stent has significantly improved the efficacy when compared with the previous medical practice by balloon angioplasty alone. Yet better biomedical performance of the stent is being demanded in order to eliminate the still existing problem of artery restenosis, which means the artery becomes narrowed again. Recent literature survey shows researches on ceramic coatings onto the stent surface, or material design to improve the mechanical response of the stent. This study focuses more on the material design and mechanical analysis. The results showed that the void configuration within the stent affects the mechanical response significantly. The rectangular shape was found to yield expansion at a relatively lower pressure than the elliptical slot for a slotted tube stent. The present results, when combined with research on coating at the stent surface, may provide stents with improved bio-medical performance.

Hybrid Off-pump Coronary Artery Bypass Combined with Percutaneous Coronary Intervention: Indications and Early Results (심폐바이패스 없이 시행하는 관상동맥우회술과 경피적 관상동맥중재술의 병합요법 : 적응증 및 조기성적)

  • Hwang Ho Young;Kim Jin Hyun;Cho Kwang Ree;Kim Ki-Bong
    • Journal of Chest Surgery
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    • v.38 no.11 s.256
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    • pp.733-738
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    • 2005
  • Background: The possibility of incomplete revascularization and development of flow competition after revascularization of the borderline lesion made the hybrid strategy as an option for complete revascularization. Material and Method: From January f998 to July 2004, 25 $(3.2\%)$ patients underwent hybrid revascularization among 782 total OPCAB procedures. Clinical results and angiographic patencies were evalulated. Percutaneous coronary intervention (PCI) was peformed before CABG in 8 patients and after CABG in 47 patients. Result: The causes of PCIs before CABG were to achieve complete revascularization with minimally invasive surgery (n=7) and emergent PCI for culprit lesion (n=1). The indications of PCIs after CABG were high possibility of flow competition in the borderline lesion of right coronary artery territory (n=8), diffuse atheromatous lesion preventing anastomosis of graft (n=5), severe calcified ascending aorta with no more arterial grafi available (n=3), and intramyocardial coronary lesion (n=1). Mean number of distal anastomoses was $2.3\pm1.0$. Mean number of lesions treated by PCI was $1.2\pm0.4$. There was no operative or procedure-related mortality. PCI-related complication was periprocedural myocardial infarction in one patient, and complications related to CABG were transient atrial fibrillation (n=5), perioperative myocardial infarction (n=1), and transient renal dysfunction (n=1). Early postoperative coronary angiography $(1.8{pm}1.6days)$ revealed $100\%$ patency rate of grafts (57/57). The stenosis occurred in one patient performed PCI before CABG, which was successfully treated with re-ballooning. During midterm follow-up (mean; $25{\pm}26$ months), 1 patient died of congestive heart failure. All survivors (n=24) accomplished follow-up coronary angiographics, which showed .all grafts (56/57) were patent except one string sign. In-stent restenosis was developed in 2 patients who received bare metal stents. Conclusion: In selected patients, complete revascularization was achieved with low risk by taking the hybrid strategy.

Improvement in Image Quality and Visibility of Coronary Arteries, Stents, and Valve Structures on CT Angiography by Deep Learning Reconstruction

  • Chuluunbaatar Otgonbaatar;Jae-Kyun Ryu;Jaemin Shin;Ji Young Woo;Jung Wook Seo;Hackjoon Shim;Dae Hyun Hwang
    • Korean Journal of Radiology
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    • v.23 no.11
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    • pp.1044-1054
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    • 2022
  • Objective: This study aimed to investigate whether a deep learning reconstruction (DLR) method improves the image quality, stent evaluation, and visibility of the valve apparatus in coronary computed tomography angiography (CCTA) when compared with filtered back projection (FBP) and hybrid iterative reconstruction (IR) methods. Materials and Methods: CCTA images of 51 patients (mean age ± standard deviation [SD], 63.9 ± 9.8 years, 36 male) who underwent examination at a single institution were reconstructed using DLR, FBP, and hybrid IR methods and reviewed. CT attenuation, image noise, signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR), and stent evaluation, including 10%-90% edge rise slope (ERS) and 10%-90% edge rise distance (ERD), were measured. Quantitative data are summarized as the mean ± SD. The subjective visual scores (1 for worst -5 for best) of the images were obtained for the following: overall image quality, image noise, and appearance of stent, vessel, and aortic and tricuspid valve apparatus (annulus, leaflets, papillary muscles, and chordae tendineae). These parameters were compared between the DLR, FBP, and hybrid IR methods. Results: DLR provided higher Hounsfield unit (HU) values in the aorta and similar attenuation in the fat and muscle compared with FBP and hybrid IR. The image noise in HU was significantly lower in DLR (12.6 ± 2.2) than in hybrid IR (24.2 ± 3.0) and FBP (54.2 ± 9.5) (p < 0.001). The SNR and CNR were significantly higher in the DLR group than in the FBP and hybrid IR groups (p < 0.001). In the coronary stent, the mean value of ERS was significantly higher in DLR (1260.4 ± 242.5 HU/mm) than that of FBP (801.9 ± 170.7 HU/mm) and hybrid IR (641.9 ± 112.0 HU/mm). The mean value of ERD was measured as 0.8 ± 0.1 mm for DLR while it was 1.1 ± 0.2 mm for FBP and 1.1 ± 0.2 mm for hybrid IR. The subjective visual scores were higher in the DLR than in the images reconstructed with FBP and hybrid IR. Conclusion: DLR reconstruction provided better images than FBP and hybrid IR reconstruction.