Arterial lesion

Although atherosclerosis and rheumatoid arthritis (RA) are distinct disease states, both disorders are chronic inflammatory conditions and may have common mechanisms of disease perpetuation. At sites of inflammation, such as the arterial intima undergoing atherogen-esis or the rheumatoid joint, oxygen radicals, in the presence of transition-metal ions, may initiate the peroxidation of low-density lipoprotein (LDL) to produce oxidatively modified LDL (ox-LDL). Ox-LDL has several pro-inflammatory properties and may contribute to the formation of arterial lesions (Steinberg et /., 1989). Increased levels of lipid peroxidation products have been detected in inflammatory synovial fluid (Rowley et /., 1984 Winyard et al., 1987a Merry et al., 1991 Selley et al., 1992 detailed below), but the potential pro-inflammatory role of ox-LDL in the rheumatoid joint has not been considered. We hypothesize that the oxidation of LDL within the inflamed rheumatoid joint plays a pro-inflammatory role just as ox-LDL has the identical capacity within the arterial intima in atherosclerosis. 

Two-vessel coronary artery disease (60% right coronary artery [RCA] and 80% left anterior descending artery [LAD] occlusion) after intracoronary CYPHER stent placement to the mid-LAD artery lesion 10 months ago. 

Finally, a new area of research has concentrated on monocyte chemotactic protein-1 (MCP-1), a 76-amino acid peptide that is one of the best-studied members of the C-C chemokine subfamily. Recent human and animal studies indicate that the recruitment of macrophages to the arterial lesion is predom-... 

Betriu A, Masotti M, Serra A, et al. Randomized comparison of coronary stent implantation and balloon angioplasty in the treatment of de novo coronary artery lesions (START) a four-year follow-up. J Am Coll Cardiol 1999 34 1498-1506. 

Ormiston J, Serruys PW, Regar E, et al. A bioabsorb-able everolimus-eluting coronary stent system for patients with single de-novo coronary artery lesions (ABSORB) a prospective open-label trial. Lancet 2008 371 899-907. 

In a study by Bartunek et al. [134], 35 patients were infused with AC 133 bone marrow cells after AMI. The mean dose was 12.6 million cells, and the mean infusion was 11.4 days after the index event. At 4-month follow-up, treated patients had an improved mean LVEF but higher rates of stent restenosis, stent reocclusion, and de novo coronary artery lesions than did the controls. 

Dosages exceeding 4000 I.U./day may cause varying degrees of toxicity in humans Symptoms include anorexia, nausea, thirst, and diarrhea. There also may be polyuria, muscular weakness, and joint pains. Scrum calcium increases and calcification of soft (issues (arteries, muscle) may commence. Arterial lesions and kidney injury have been noted in rats. 

In summary, the final chapter in the story of oral contraceptives and arterial lesions has not yet been written. However, in the light of long experience there is currently reason for optimism. There is no reasonable evidence that oral contraceptives, whatever their biochemical effects, actually do increase the risk of atherosclerosis as to the occurrence of acute arterial events, these are explained largely or entirely by the presence of risk factors other than oral contraception. 

Colombo A, DrzewieckiJ, Banning A, etal, Randomized study to assess the effectiveness of slow- and moderate-release polymer based pac I itaxe I-eluting stents for coronary artery lesions, Circulation 2003 108 788-794. 

Serruys PW, Degertekin M, Tanabe K, etal. Intravascular ultrasound findings in the multicenter, randomized, double-blind RAVEL (RAndomized study with the sirolimus-eluting VEIocrty balloon-expandable stent in the treatment of patients with de novo native coronary artery Lesions) trial. Circulation 2002 ... 

Commeau R Barragan PT Roquebert PO, Simeoni JB. ISR II study a long-term evaluation of sirolimus-eluting stent in the treatment of patients with in-stent restenotic native coronary artery lesions. Catheter Cardiovasc Interv 2005 66(2) 158-162. 

The pivotal Sirolimus-coated BX VELOCITY Balloon-Expandable Stent in Treatment of Patients with De Novo Coronary Artery Lesions (SIRIUS) study of the CYPHER SES demonstrated a low rate of reintervention compared with... 

Dawkins KD, Grube E, Guagliumi G, et al. Clinical efficacy of polymer-based paclitaxel-eluting stents in the treatment of complex, long coronary artery lesions from a multicenter, randomized trial support for the use of drug-eluting stents in contemporary clinical practice, Circulation 2005 ... 

In addition, attempts to deliver radiation therapy to symptomatic de novo or restenotic native coronary-artery lesions included the deployment of very low activity 32P radioactive stents. Preliminary data for clinical endpoints (e.g., subacute stent thrombosis, TLR, and death at 30 days) appeared promising, but the long-term angiographic follow-up revealed an unacceptable restenosis rate at or beyond the stent edges (21,22). Consequently, further studies to evaluate this technique were abandoned. 

Cordis Corporation. A Multi-Center, Non-Randomised Study of the CYPHER Sirolimus-Eluting Stent in the Treatment of Patient With an in-Stent Restenotic Native Coronary Artery Lesion (TROPICAL Study), 2006. 

Serruys PW, Ong AT, Colombo A, et al. Arterial Revascularization Therapies Part II sirolimus-eluting stent for the treatment of patients with multivessel do novo coronary artery lesions. Late-breaking trial presented at the American College of Cardiology Scientific Session, 2005. 

Moussa I, Leon MB, Bairn DS, et al. Impact of sirolimus-eluting stents on outcome in diabetic patients a SIRIUS (SIRollmUS-coated Bx Velocity balloon-expandable stent in the treatment of patients with de novo coronary artery lesions) substudy. Circulation 2004 109 2273-2278. 

Kushwaha et al. (1991) determined the effect of oestrogen and progesterone on plasma cholesterol concentrations and on arterial lesions in ovarectomized and hysterectomized baboons fed a high-cholesterol/high-saturated-fat diet. 

Bettermann K (2006). Transient global amnesia the continuing quest for a source. Archives of Neurology 63 1336-1338 Bogousslavsky J, Hachinski VC, Boughner DR et al. (1986). Clinical predictors of cardiac and arterial lesions in carotid ischaemic attacks. Archives of Neurology 43 229-233... 

Previous strokes and/or TIAs in different vascular territories are more likely with a proximal embolic source in the heart, or arch of the aorta, than with a single arterial lesion. Attacks going back months or more make certain causes such as infective endocarditis and arterial dissection unlikely. 

Grosveld WJ, Lawson JA, Eikelboom BCC et al. (1988). Clinical and haemodynamic significance of innominate artery lesions evaluated by ultrasonography and digital angiography. Stroke 19 958-962 Gur AY, Bova I, Bornstein NM (1996). 

Joint study of extracranial arterial occlusion. V. Progress report of prognosis following surgery or nonsurgical treatment for transient cerebral ischaemic attacks and cervical carotid artery lesions. Journal of the American Medical Association 211 1993-2003... 

Several case series have described angioplasty and stenting of symptomatic vertebral and basilar stenosis (Cloud et al. 2003) (Figs. 26.2 and 26.3 see also Fig. 12.4). A recent review (Eberhardt et al. 2006) of more than 600 cases published up to 2005 provides useful information on perioperative complication rates, particularly the difference in complication rates in treatment of proximal versus distal vertebrobasilar artery lesions. In early studies, proximal lesions were treated primarily with angioplasty, but this was associated with restenosis in 15-31% of patients after 15 to 30 months of follow-up. More recently, stenting has been used for the proximal vertebral system, especially ostial lesions. Several series have reported low periprocedural or post-interventional stroke rates (Eberhardt et al. 2006). 

Fig. 13 Coronal tomographic image of a patient with carotid atherosclerotic lesions obtained 4h after IV administration of In-111 labeled negative-charge modified murine-human chimeric Z2D3 F(ab )2 (B). The arrow denotes the carotid lesion. (A) The crotid angiogram demonstrating a severe right internal carotid artery lesion (arrow) is shown.

Intracoronary adenosine has been compared with intravenous adenosine for the measure of fractional flow reserve in 52 patients with coronary artery lesions (44). The intravenous dose was 140 micrograms/kg/minute and the intracoronary bolus dose was 15-20 micrograms to the right coronary artery and 18-24 micrograms to the left coronary artery. The two routes of administration were equally effective in measuring hyperemic flow, and adverse effects were limited to two patients who received intravenous adenosine one patient had severe nausea and one patient with asthma had an episode of bronchospasm. 

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