Target lesions

Instrumentation. The future of radiopharmaceuticals is highly dependent on imaging instmmentation. Instmmental methods can evolve rapidly. Performance and characteristics of these instmments are important in the choice of disease target, lesion size, location, and contrast. 

Partial response (PR) At least a 30% decrease in the sum of the longest diameter of target lesions from baseline... 

Erythema multiforme Target lesions, limbs Absent Anticonvulsants (including lamolrigine), sulfonamide antibiotics, allopurinol, NSAIDs, dapsone Supportive0... 

Target lesion coronary artery Left anterior descending 223 Other 33S... 

Abbreviations MI, myocardial infarction PCI, percutaneous coronary intervention PER primary end-point RA, refractory angina TLR, target lesion revascularization TVR, target vessel revascularization TNK, tenecteplase UFH, Unfractionated heparin UR, urgent reintervention. 

Abbreviations CDK, cyclin-dependent kinase CREST, cilostazol for restenosis trial MACE, major adverse cardiac events ORAR, oral rapamycin to prevent restenosis ORBIT, oral rapamune to inhibit restenosis REAR, peroxisome proliferator-activated receptor PRESTO, prevention of restenosis with tranilast and its outcomes SMC. smooth muscle cell ThR, target lesion revascularization tREAT, Tranilast restenosis following angioplasty trials TVR, target vessel failure. ... 

Since the introduction of coronary angioplasty, restenosis of the target lesion has been the main limitation of this procedure,... 

A small pilot trial from Brazil reporting 6.6% of in-stent restenosis with 0.61 mm of late loss and with no target lesion revascularization or any major events after two years of follow-up (47) also confirmed these positive results. 

The rate of clinically driven target lesion or target vessel revascularization was significantly lower in oral sirolimus compared with control (Table 7). Target vessel revascularization was 5/60 (8.3%) versus 21/55 (38%), respectively (P < 0.001), and the target lesion revascularization was 5/66 (7.6%) versus 22/59 (37.2%), respectively (P < 0.001). Target vessel failure and major adverse cardiovascular events were also improved with oral sirolimus therapy (P = 0.01 and P = 0.03 I, respectively, Table 7). 

This prospective, randomized and controlled trial in patients with de novo lesions demonstrated a significant reduction of angiographic binary restenosis and late loss when patients were allocated to the oral sirolimus arm, and both the endpoints were determined by blind operators. Clinical safety and efficacy parameters of restenosis such as target vessel, target lesion revascularization, and Major Adverse Cardiovascular Events at follow-up were also significantly improved with oral sirolimus therapy As we can see in Table 10, compared with control... 

In 1997, Condado et al. was the first to investigate the effectiveness of ICB after PTCA in human coronary arteries. Twenty-one patients who underwent PTCA for unstable angina received ICB (gamma radiation) for prevention of restenosis, Immediate and six-month follow-up revealed improved freedom from major adverse cardiac event (MACE) defined as death, myocardial infarction or target lesion revascularization compared with several previously completed balloon angioplasty trials (20), More importantly, this trial demonstrated that ICB was a feasible technique for the prevention of restenosis without any unexpected acute complications in humans. 

Also, studies investigating the use of ICB with patients with SVG ISR had a significantly reduced need for repeat target-lesion revascularization, but not target-vessel revascularization (TVR) or combined TVR-MACE endpoints (28,29). 

Similar studies have used intravascular ultrasound (IVUS) at six-month follow-up to evaluate differences in target-lesion healing and have found less intimal hyperplasia and late lumen loss due to increased plaque burden in patients who had received DES without ICB for the treatment of BMS ISR (41). On the other hand, other IVUS-guided studies have described a significant black-hole phenomenon in patients who have undergone ICB. The black hole, a homogeneous, echolucent intraluminal entity depicted on IVUS, is felt to be a result of an impaired response to endothelial injury and an altered molecular proliferative response (Fig. 2). This intraluminal tissue, which accounted for —50% of the neo-intimal growth in areas of restenosis after radioactive stent... 

See color plate) Sustained freedom from target lesion revascularization in TAXUS clinical trials. Abbreviations BMS, bare-metal stent MR, moderate-release PES, paclitaxel-eluting stent SR, slow-release. Source From Ref. 73. 

In long-term follow-up of the RAVEL trial (73), clinical benefit with sirolimus-eluting coronary stents has been maintained. Using cumulative one to three-year event-free survival rates, treatment with sirolimus-eluting stents was associated with a sustained clinical benefit and very low rates of target lesion revascularization up to three years after device implantation. As recently shown by both Kastrati and coworkers (74) and Windecker et al. (75), the Cypher stent eluting sirolimus is highly effective and may have clinical benefit beyond alternative DES products. 

PTCA). The primary objective was to evaluate the occurrence of major adverse cardiac events (MACE) [death, recurrent myocardial infarction (Ml), or clinically driven target lesion revascularization] 30 days postprocedure. The secondary objectives were to evaluate the binary restenosis, incidence of (sub)acute stent thrombosis at 30 days follow-up, MACE at 6 and 12 months and the QCA endpoints at 6 months. This study was designed to allow a comparison with the patient population and the results of a larger randomized DISTINCT (BiodivYsio stent in controlled clinical trial) study previously conducted in the U.S. 

All patients were required to agree to a six-month clinical and angiographic follow-up and had to be over 18 years old, The reference vessel diameter (R.VD) of the treated lesion was visually estimated >2.75 and <3.5 mm in diameter, target lesion stenosis >50% and < 100%. Noncaldfied lesions, de novo lesions within a native coronary artery, <25 mm long, requiring one appropriately sized BiodivYsio Batimastat OC stent were included. 

Structure of BRILLIANT EU. Abbreviations IVUS, intravascular ultrasound MACE, major adverse cardiac events MLA, minimal luminal area MLD, minimal luminal diameter QCA, qualitative coronary angiography SAT, subacute stent thrombosis TLR, target lesion revascularization TVF, target vessel failure TVR, target vessel revascularization. 

Primary endpoint MACE (death, recurrent myocardial infarction or clinically driven target lesion revascularisation) at 30 days. 

The most frequent locations of the target lesion were the mid-left anterior descending vessel (39 patients, 23%), proximal left descending vessel (37 patients, 21 %), and mid-right coronary artery (35 patients, 20%). Mean lesion length was I 1.5 5.0 mm (range from 4 to 25 mm). The most commonly recorded target lesion classification was type BI (86 patients, 50%). 

Abbreviations BRILLIANT-EU, Batimastat (BB94) anti-restenosis trial utilizing the BiodivYsio local drug delivery PC-stent CABG, coronary artery bypass graft MACE, major adverse cardiac events Ml. myocardial infarction TLR, target lesion revascularization. 

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