Provisional Side Branch-Stenting for Coronary Bifurcation Lesions: Evidence of Improving Procedural and Clinical Outcomes With Contemporary Techniques.

Provisional side branch-stenting for coronary bifurcation lesions: Evidence of improving procedural and clinical outcomes with contemporary techniques.

Catheter Cardiovasc Interv. 2013 Feb 25;
Mylotte D, Routledge H, Harb T, Garot P, Hovasse T, Benamer H, Unterseeh T, Chevalier B, Morice MC, Louvard Y, Lefèvre T

OBJECTIVES: To determine whether recent technical modifications have improved clinical outcomes for patients undergoing contemporary bifurcation lesion percutaneous coronary intervention (PCI). BACKGROUND: Provisional side branch (SB)-stenting has become the preferred strategy for bifurcation PCI. Newer generation drug-eluting stents, the proximal optimization technique (POT), and the use of non-compliant (NC) balloons for final kissing inflation (FKI) have the potential to optimize outcomes. METHOD: We compared baseline characteristics, procedural and clinical outcomes in 300 consecutive patient pairs treated in 2005 and 2009. The primary outcome measure was the cumulative incidence of major adverse cardiac events (MACE) at 2-years. RESULTS: Compared to 2005, patients undergoing PCI in 2009 were at higher risk: prior MI (18%vs 8%,p=0.0004), left ventricular function (EF 54±13% vs 61±12%,p<0.0001). Cypher (53vs3%,p<0.001) and Taxus (47vs11%,p< 0.0001) stents were used more frequently in 2005, and Xience V in 2009 (0vs47%,p< 0.0001). In 2009, the POT was performed in 36% and NC balloons used for FKI in 81%. Side branch stenting was required less frequently in 2009 (9%vs 22%,p<0.001). Two-year MACE was significantly lower in 2009 than 2005 (5.7 vs 11.3%,p=0.02), a difference driven by fewer cardiac deaths (2.0vs5.0%,p=0.05). MACE was independently associated with left main bifurcation treatment (hazard ratio [HR] 1.85:95%, CI 1.04-3.29;p=0.036), side-branch stenting (HR 2.31:95% CI 1.27-4.20;p=0.006), and PCI in 2005 (HR 1.86:95% CI 1.03-3.37;p=0.004). CONCLUSIONS: Together, contemporary techniques and newer generation DES appear to improve outcomes and are both recommended for widespread uptake in patients undergoing provisional SB stenting for coronary bifurcation lesions. © 2013 Wiley Periodicals, Inc. HubMed – drug


One-year head to head comparison of the neointimal response between sirolimus eluting stent with reservoir technology and everolimus eluting stent. An optical coherence tomography study.

Catheter Cardiovasc Interv. 2013 Feb 25;
Shiratori Y, Brugaletta S, Alvarez-Contreras L, Azpeitia Y, Ospino N, Gaido S, Delahanty A, Santos A, Martin-Yuste V, Masotti M, Serruys PW, Windecker S, Sabaté M

Objective: to compare the vascular healing process between the sirolimus-eluting NEVO and the everolimus-eluting Xience stent by optical coherence tomography (OCT) at 1-year follow-up. Background: Presence of durable polymer on a drug-eluting metallic stent may be the basis of an inflammatory reaction with abnormal healing response. The NEVO stent, having a bioresorbable polymer eluted by reservoir technology, may overcome this problem. Methods: All consecutive patients, who received NEVO or Xience stent implantation between September 2010 and October 2010 in our institution, were included. Vascular healing was assessed at 1-year as percentage of uncovered struts, neointimal thickness, in-stent / stent area obstruction and pattern of neointima. Results: A total 47 patients (2:1 randomization, n=32 NEVO, n=15 Xience) were included. Eighteen patients underwent angiographic follow-up (8 patients with 9 lesions for NEVO vs. 10 patients with 11 lesions for Xience). The angiographic late loss was numerically higher but not statistically different in NEVO compared with Xience treated lesions (0.38 ± 0.47 mm vs. 0.18 ± 0.27 mm; p=0.171). OCT analysis of 4912 struts demonstrated similar rates of uncovered struts (0.5% vs. 0.7%, p=0.462), higher mean neointimal thickness (177.76 ± 87.76 µm vs. 132.22 ± 30.91 µm; p=0.170) and in stent / stent area obstruction (23.02 ± 14.74% vs. 14.17 ± 5.94%, p=0.120) in the NEVO as compared with Xience. Conclusion: The NEVO stent with a reservoir technology seems to exhibit more neointimal proliferation as compared to Xience stent. The findings of our study, which currently represent the unique data existing on this reservoir technology, would need to be confirmed in a large population. © 2013 Wiley Periodicals, Inc. HubMed – drug


Bactericidal Activity of Methanol Extracts of Crabapple Mangrove Tree (Sonneratia caseolaris Linn.) Against Multi-Drug Resistant Pathogens.

Indian J Pharm Sci. 2012 May; 74(3): 230-6
Yompakdee C, Thunyaharn S, Phaechamud T

The crabapple mangrove tree, Sonneratia caseolaris Linn. (Family: Sonneratiaceae), is one of the foreshore plants found in estuarine and tidal creek areas and mangrove forests. Bark and fruit extracts from this plant have previously been shown to have an anti-oxidative or cytotoxic effect, whereas flower extracts of this plant exhibited an antimicrobial activity against some bacteria. According to the traditional folklore, it is medicinally used as an astringent and antiseptic. Hence, this investigation was carried out on the extract of the leaves, pneumatophore and different parts of the flower or fruit (stamen, calyx, meat of fruit, persistent calyx of fruit and seeds) for antibacterial activity using the broth microdilution method. The antibacterial activity was evaluated against five antibiotic-sensitive species (three Gram-positive and two Gram-negative bacteria) and six drug-resistant species (Gram-positive i.e. Methicillin-resistant Staphylococcus aureus, Enterococcus faecalis, Enterococcus faecium and Gram-negative i.e. Extended-spectrum beta-lactamase-Escherichia coli, multidrug-resistant-Pseudomonas aeruginosa and Acenetobacter baumannii). The methanol extracts from all tested parts of the crabapple mangrove tree exhibited antibacterial activity against both Gram-positive and Gram-negative bacteria, but was mainly a bactericidal against the Gram-negative bacteria, including the multidrug-resistant strains, when compared with only bacteriostatic on the Gram-positive bacteria. Using Soxhlet apparatus, the extracts obtained by sequential extraction with hexane, dichloromethane and ethyl acetate revealed no discernable antibacterial activity and only slightly, if at all, reduced the antibacterial activity of the subsequently obtained methanol extract. Therefore, the active antibacterial compounds of the crabapple mangrove tree should have a rather polar structure. HubMed – drug


Functional roles of glycogene and N-glycan in multidrug resistance of human breast cancer cells.

IUBMB Life. 2013 Feb 26;
Ma H, Miao X, Ma Q, Zheng W, Zhou H, Jia L

Drug resistance is a major problem in cancer chemotherapy. Aberrant glycosylation has been known to be associated with cancer chemoresistance. Aim of this work is to investigate the alterations of glycogene and N-glycan involved in multidrug resistance (MDR) in human breast cancer cell lines. Using real-time polymerase chain reaction (PCR) for quantification of glycogenes, fluorescein isothiocyanate (FITC)-lectin binding for glycan profiling, and mass spectrometry for N-glycan composition, the expression of glycogenes, glycan profiling, and N-glycan composition differed between drug-resistant MCF/ADR cells and the parental MCF-7 line. Further analysis of the N-glycan regulation by tunicamycin (TM) application or PNGase F treatment in MCF/ADR cells showed partial inhibition of the N-glycan biosynthesis and increased sensitivity to chemotherapeutic drugs dramatically both in vitro and in vivo. Using an RNA interference strategy, we showed that the downregulation of MGAT5 in MCF/ADR cells could enhance the chemosensitivity to antitumor drugs both in vitro and in vivo. Conversely, a stable high expression of MGAT5 in MCF-7 cells could increase resistance to chemotherapeutic drugs both in vitro and in vivo. In conclusion, the alterations of glycogene and N-glycan in human breast cancer cells correlate with tumor sensitivity to chemotherapeutic drug and have significant implications for the development of new treatment strategies. © 2013 IUBMB Life, 2013. HubMed – drug