The activation of platelets or leukocytes plays an important role in development of intimal hyperplasia. We investigated whether the local blood serotonin and soluble P-selectin levels changed during endovascular therapy of the iliac artery.
Blood samples were obtained from the iliac artery of 18 lower limbs undergoing percutaneous balloon angioplasty alone (8 limbs, group I) or percutaneous balloon angioplasty and primary stenting (10 limbs, group II). The serotonin levels in platelet-poor plasma were measured in all limbs. In group I the urinary level of the serotonin metabolite 5-hydroxyindoleacetic acid was also measured 24 hours before and 24 hours after the procedures. The soluble P-selectin levels were measured in the 6 patients in group II.
Before angioplasty the mean (+/- SEM) serotonin concentrations were 1.2 +/- 0.2, 1.2 +/- 0.4, and 1.2 +/- 0.3 ng/mL in all cases, group I, and group II, respectively. After angioplasty these values changed to 1.7 +/- 0.4 (P =.0750), 1.2 +/- 0.4 (P =.8001), and 2.1 +/- 0.6 ng/mL (P =.0529), respectively. In group I urinary 5-hydroxyindoleacetic acid concentrations 24 hours before and 24 hours after the procedures were 0.0026 +/- 0.0004 and 0.0031 +/- 0.0006 mg/mg creatinine, respectively (P =.2566). In group II the soluble P-selectin levels significantly increased after intervention, from 26.0 +/- 5.7 to 33.9 +/- 5.3 ng/mL (P =.0296).
Although the serotonin levels did not change significantly, the soluble P-selectin levels increased significantly after intervention. Leukocyte activation may therefore contribute to the progression of restenosis after peripheral endovascular therapy.
[Show abstract][Hide abstract] ABSTRACT: Objective:
Our experience with unilateral iliac reconstructive surgery was retrospectively reviewed, and the long-term patency and the morphological information was disclosed. In addition, the prognosis of contralateral iliac artery was examined, because future contralateral iliac events seem to be important for durability of unilateral iliac revascularizations.
Materials and methods:
148 patients (mean age, 66.9 years; 88% male) who had undergone unilateral aortoiliac reconstruction without contralateral iliac lesions were evaluated. The unilateral aortoiliac reconstructive procedures included 112 (76%) aorto or iliofemoral bypasses, 27 (18%) femorofemoral bypasses, and 9 (6%) axillofemoral bypasses. The indications for arterial reconstruction were disabling claudication and limb salvage in 125 (84%) and 23 (16%) patients, respectively. Preoperative arteriograms were reviewed to determine the Inter-Society Consensus (TASC II) classification categorizing iliac artery lesions. Contralateral iliac events were defined as any arterial reconstructive procedure, intervention, amputation for progression of contralateral iliac disease, or repair of abdominal aortic aneurysm (AAA). The Kaplan-Meier survival analysis was used to predict long-term results in patients grouped based on various factors which were compared using univariate and multivariate analyses.
In the 148 patients, unilateral iliac reconstructive procedures were undertaken in 83 (56%) patients with TASC II type D lesions, 34 (23%) patients with TASC II type C lesions, and 31 (21%) patients with TASC II type B lesions. Overall primary and secondary patency rates were 93.8% and 96.5% at 3 years and 90.0% and 93.9% at 5 years. A multivariate analysis disclosed critical limb ischemia influencing primary patency rates, and type of aortoiliac reconstruction or gender influencing secondary patency rates. TASC II classification did not affect primary or secondary patency rates. During the follow-up period, 15 contralateral iliac events occurred, including 11 aortoiliac reconstructive or interventional procedures, 3 repairs of AAA, and one case of bilateral thigh amputation due to acute aortic occlusion. The overall probability of contralateral iliac events was 2.2% at 3 years and 5.9% at 5 years.
The long-term patency following unilateral iliac reconstructive surgery was satisfactory, and not affected by morphology of the iliac artery. Also, the future risk of contralateral iliac events appeared to be low.
Annals of Vascular Diseases 01/2010; 3(1):60-7. DOI:10.3400/avd.AVDoa09033
[Show abstract][Hide abstract] ABSTRACT: OBJECTIVES: The study aimed at evaluating inclacumab for reduction of myocardial damage during percutaneous coronary intervention (PCI) in patients with non-ST segment elevation myocardial infarction (NSTEMI). BACKGROUND: P-selectin is an adhesion molecule involved in interactions between endothelial cells, platelets and leukocytes. Inclacumab is a recombinant monoclonal antibody against P-selectin, with potential anti-inflammatory, anti-thrombotic and anti-atherogenic properties. METHODS: Patients (n=544) with NSTEMI scheduled for coronary angiography and possible ad hoc PCI were randomized to receive one pre-procedural infusion of inclacumab 5 or 20 mg/kg or placebo. The primary endpoint, evaluated in patients who underwent PCI, received study medication and had available efficacy data (n=322), was the change from baseline in troponin I (TnI) at 16 and 24 hours after PCI. RESULTS: There was no effect of inclacumab 5 mg/kg. Placebo-adjusted geometric mean percent changes in TnI with inclacumab 20 mg/kg were -24.4% at 24 hours (p=0.05) and -22.4% at 16 hours (p=0.07). Peak TnI was reduced by 23.8% (p=0.05) and area under the curve over 24 hours by 33.9% (p=0.08). CK-MB yielded similar results, with changes of -17.4% at 24 hours (p=0.06) and -16.3% at 16 hours (p=0.09). The incidence of CK-MB increases >3 times ULN within 24 hours was 18.3% and 8.9% in the placebo and inclacumab 20 mg/kg groups (p=0.05). Placebo-adjusted changes in soluble p-selectin level were -9.5% (p=0.25) and -22.0% (p<0.01) with inclacumab 5 and 20 mg/kg. There was no significant difference in adverse events between groups. CONCLUSIONS: Inclacumab appears to reduce myocardial damage after PCI in patients with NSTEMI.
Journal of the American College of Cardiology 03/2013; 61(20). DOI:10.1016/j.jacc.2013.03.003 · 16.50 Impact Factor
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