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[PMID]: 29505511
[Au] Autor:Grzybowski A; Elikowski W; Gaca-Wysocka M
[Ad] Address:Department of Ophthalmology, Poznan City Hospital, Poznan.
[Ti] Title:Cardiovascular risk factors in patients with combined central retinal vein occlusion and cilioretinal artery occlusion: Case report.
[So] Source:Medicine (Baltimore);97(1):e9255, 2018 Jan.
[Is] ISSN:1536-5964
[Cp] Country of publication:United States
[La] Language:eng
[Ab] Abstract:RATIONALE: To analyze cardiovascular risk factors and comorbidity of acute unilateral visual loss due to combined central retinal vein occlusion (CRVO) and cilioretinal artery occlusion (CLRAO). PATIENT CONCERNS: Among patients with retinal vein or artery occlusion hospitalized at the Department of Ophthalmology between January 2011 and August 2017, subjects with combined CRVO/CLRAO were selected. All of them underwent ophthalmologic and cardiologic examination, including fluorescein angiography, optical coherence tomography, 12-lead electrocardiogram, transthoracic and transesophageal echocardiography, carotid Doppler sonography, cerebral magnetic resonance imaging, and a panel of laboratory tests. DIAGNOSES: Four subjects with coexisting CRVO and CLRAO were found among 146 patients with retinal vein or artery occlusion. There were no other types of concomitance of CRVO and retinal artery occlusion. INTERVENTIONS: All patients were treated with low molecular heparin in a full dose for 2 weeks, then with 1 mg/kg once daily for the next 2 weeks, followed by acetylsalicylic acid 75 mg/kg/d. Other medication included long-term statins, angiotensin-converting-enzyme inhibitor in 3 patients and beta-blocker in one patient. OUTCOMES: All patients with CRVO/CLRAO presented multiple cardiovascular risk factors, including hypertension, obesity, hyperlipidemia, chronic nicotine addiction, and a positive family history of coronary artery disease or stroke. In all of them, echocardiography revealed left ventricular hypertrophy and atherosclerotic lesions in the descending aorta; in addition, 3 patients had insignificant atherosclerotic plaques in the carotid artery. Also, in 3 subjects, focal ischemic cerebral changes were diagnosed. LESSONS: Patients with combined CRVO and CLRAO present numerous cardiovascular risk factors and abnormalities on imaging examinations, which should be routinely evaluated and treated.
[Mh] MeSH terms primary: Retinal Artery Occlusion/complications
Retinal Vein Occlusion/complications
Vision Disorders/etiology
[Mh] MeSH terms secundary: Adult
Aged, 80 and over
Carotid Arteries/diagnostic imaging
Child, Preschool
Echocardiography, Transesophageal
Female
Humans
Magnetic Resonance Imaging
Male
Middle Aged
Neuroimaging
Retinal Artery Occlusion/diagnostic imaging
Retinal Vein Occlusion/diagnostic imaging
Risk Factors
Vision Disorders/diagnostic imaging
[Pt] Publication type:CASE REPORTS; JOURNAL ARTICLE
[Em] Entry month:1803
[Cu] Class update date: 180309
[Lr] Last revision date:180309
[Js] Journal subset:AIM; IM
[Da] Date of entry for processing:180306
[St] Status:MEDLINE
[do] DOI:10.1097/MD.0000000000009255

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[PMID]: 29338536
[Au] Autor:Kupka D; Sibbing D
[Ad] Address:a Department of Cardiology , LMU München , Munich , Germany.
[Ti] Title:P2Y receptor inhibitors: an evolution in drug design to prevent arterial thrombosis.
[So] Source:Expert Opin Drug Metab Toxicol;14(3):303-315, 2018 Mar.
[Is] ISSN:1744-7607
[Cp] Country of publication:England
[La] Language:eng
[Ab] Abstract:INTRODUCTION: P2Y12 inhibitors are a critical component of dual antiplatelet therapy (DAPT), which is the superior strategy to prevent arterialthrombosis in patients with acute coronary syndromes (ACS) and undergoing stent implantation.. Areas covered: Basic science articles, clinical studies, and reviews from 1992-2017 were searched using Pubmed library to collet impactful literature. After an introduction to the purinergic receptor biology, this review summarizes current knowledge on P2Y12 receptor inhibitors. Furthermore, we describe the subsequent improvements of next-generation P2Y12 receptor inhibitors facing the ambivalent problem of bleeding events versus prevention of arterial thrombosis in a variety of clinical settings. Therefore, we summarize data from relevant preclinical and clinical trials of currently approved P2Y12 receptor inhibitors (clopidogrel, prasugrel, ticagrelor, cangrelor) and provide strategies of drug switching and management of bleeding events. Expert opinion: An enormous amount of pharmacologic and clinical data is available for the application of P2Y12 receptor inhibitors. Today prasugrel, ticagrelor and clopidogrel are the standard of care drugs during dual antiplatelet therapy for ACS patients, but have considerable rates of bleeding. Recent and future clinical trials will provide evidence for subsequent escalation and de-escalation strategies of P2Y12 receptor inhibition. These data may pave the way for an evidence-based, individualized P2Y12 receptor inhibitor therapy.
[Mh] MeSH terms primary: Drug Design
Purinergic P2Y Receptor Antagonists/pharmacology
Thrombosis/prevention & control
[Mh] MeSH terms secundary: Acute Coronary Syndrome/complications
Acute Coronary Syndrome/drug therapy
Animals
Drug Therapy, Combination
Hemorrhage/chemically induced
Hemorrhage/epidemiology
Humans
Platelet Aggregation Inhibitors/administration & dosage
Platelet Aggregation Inhibitors/adverse effects
Platelet Aggregation Inhibitors/pharmacology
Purinergic P2Y Receptor Antagonists/administration & dosage
Purinergic P2Y Receptor Antagonists/adverse effects
Thrombosis/etiology
[Pt] Publication type:JOURNAL ARTICLE; REVIEW
[Nm] Name of substance:0 (Platelet Aggregation Inhibitors); 0 (Purinergic P2Y Receptor Antagonists)
[Em] Entry month:1803
[Cu] Class update date: 180309
[Lr] Last revision date:180309
[Js] Journal subset:IM
[Da] Date of entry for processing:180118
[St] Status:MEDLINE
[do] DOI:10.1080/17425255.2018.1428557

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[PMID]: 29316284
[Au] Autor:Zhao YJ; Teng M; Khoo AL; Ananthakrishna R; Yeo TC; Lim BP; Loh JP; Chan MY
[Ad] Address:Pharmacy and Therapeutics Office, Group Corporate Development, National Healthcare Group, Singapore City, Singapore.
[Ti] Title:A propensity score-matched comparison of biodegradable polymer vs second-generation durable polymer drug-eluting stents in a real-world population.
[So] Source:Cardiovasc Ther;36(2), 2018 Apr.
[Is] ISSN:1755-5922
[Cp] Country of publication:England
[La] Language:eng
[Ab] Abstract:AIMS: The safety and efficacy of BP-DES compared to second-generation DP-DES remain unclear in the real-world setting. We compared the clinical outcomes of biodegradable polymer drug-eluting stents (BP-DES) with second-generation durable polymer drug-eluting stents (DP-DES) in an all-comer percutaneous coronary intervention (PCI) registry. METHODS/RESULTS: The study included a cohort of 1065 patients treated with either BP-DES or DP-DES from January 2009 through October 2015. Propensity score matching was performed to account for potential confounders and produced 497 matched pairs of patients. The primary endpoint was target lesion failure (TLF) at one-year follow-up. The rates of TLF were comparable between BP-DES and DP-DES (8.7% vs 9.1%, P = .823) at 1 year. The rates of stent thrombosis at 30 days (0.4% vs 0.4%, P = 1.00) and 1 year (0.8% vs 0.8%, P = 1.00) did not differ between BP-DES and DP-DES. There were no significant differences in other clinical outcomes including target vessel failure (8.9% vs 9.5%, P = .741), in-stent restenosis (1.8% vs 1.0%, P = .282), and cardiac death (6.4% vs 7.4%, P = .533) at 1 year. Multivariate cox regression analysis showed that the risk of TLF at one-year did not differ significantly between BP-DES and DP-DES (hazard ratio 0.94, P = .763). CONCLUSIONS: Efficacy and safety of BP-DES were not better than DP-DES at one-year follow-up.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1801
[Cu] Class update date: 180310
[Lr] Last revision date:180310
[St] Status:In-Process
[do] DOI:10.1111/1755-5922.12319

  4 / 27762 MEDLINE  
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[PMID]: 29521570
[Au] Autor:Selhorst G; Schmidtler F; Ott A; Hitzke E; Tomelden J; Antoni D; Hoffmann E; Rieber J
[Ad] Address:a Department of Cardiology, Bogenhausen Academic Teaching Hospital , Technical University of Munich , Munich , Germany.
[Ti] Title:Platelet reactivity in patients with acute coronary syndrome treated with prasugrel or ticagrelor in comparison to clopidogrel: a retrospective pharmacodynamic analysis.
[So] Source:Platelets;:1-7, 2018 Mar 09.
[Is] ISSN:1369-1635
[Cp] Country of publication:England
[La] Language:eng
[Ab] Abstract:Dual antiplatelet therapy (DAPT) with aspirin and a P2Y inhibitor is a mainstay of the prevention of stent thrombosis following percutaneous coronary intervention (PCI). In the 2015 European guidelines for the management of acute coronary syndrome (ACS), prasugrel (PRA) and ticagrelor (TICA) combined with aspirin are recommended as first-line therapy. Clopidogrel (CLO) is recommended as an alternative medication for patients with contradictions to these new drugs. This single-center study analyzed the platelet function of 809 ACS patients undergoing PCI and treatment with DAPT. The platelet response to ADP was determined using Multiplate® analyzer at a median of 3 days after PCI in 254 patients treated with PRA (loading dose [LD] 60 mg, 10 mg qd), 162 patients receiving TICA (LD 180 mg, D 90 mg bid), and 393 CLO-treated patients (LD 600 mg, 75 mg qd). An aggregation >468 arbitrary units (AU)*min was defined as "high on-treatment platelet reactivity" (HPR), <188 AU*min as "low on-treatment platelet reactivity" (LPR). Platelet response in PRA-treated patients was lower compared to CLO or TICA (median; interquartile range: PRA 220 [163-275] AU*min vs. CLO 268 [186-387] AU*min, p < 0.001 vs. TICA 245 [190-320] AU*min, p = 0.001). Only 1.6% of PRA patients were stratified as HPR and 34.6% as LPR, while in the TICA group 1.9% fulfilled the criteria of HPR and 24.1% criteria of LPR. Sixteen percent of CLO patients were stratified as HPR and 26.2% as LPR. In a real-world cohort of ACS patients following PCI, PRA results in more potent inhibition of platelet function compared to CLO and TICA. TICA achieves a consistent antiplatelet effect with reduced rates of HPR and LPR in relation to CLO.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1803
[Cu] Class update date: 180309
[Lr] Last revision date:180309
[St] Status:Publisher
[do] DOI:10.1080/09537104.2018.1445836

  5 / 27762 MEDLINE  
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[PMID]: 29519377
[Au] Autor:Rossini R; Tarantini G; Musumeci G; Masiero G; Barbato E; Calabrò P; Capodanno D; Leonardi S; Lettino M; Limbruno U; Menozzi A; Marchese UOA; Saia F; Valgimigli M; Ageno W; Falanga A; Corcione A; Locatelli A; Montorsi M; Piazza D; Stella A; Bozzani A; Parolari A; Carone R; Angiolillo DJ; Italian Society of Interventional Cardiology (SICI-GISE); Italian Society for the Study of Haemostasis and Thrombosis (SISET); Italian Society of Anesthesia and Intensive Care Medicine (SIAARTI); Italian Society of Surgery (SIC); Italian Society for Cardiac Surgery (SICCH); Italian Society of Vascular and Endovascular Surgery (SICVE); Italian Society of Urology (SIU); Italian Orthopaedic Society (SIOT); Italian Society of Thoracic Surgeons (SICT); Italian Federation of Scientific Societies of Digestive System Diseases (FISMAD); Italian Society of Digestive Endoscopy (SIED); Italian Association of Hospital Gastroenterology and Digestive Endoscopy (AIGO); Italian Association of Gastroenterology and Digestive Endoscopy (SIGE); Italian Society of Maxillofacial Surgery (SICMF); Italian Society of Reconstructive Plastic Surgery and Aesthetics (SICPRE); Italian Society of Gynecology and Obstetrics (SIGO); Italian Society of Neurosurgery (SINch); Italian Association of Hospital Pulmonologist (AIPO); Italian Society of Periodontology (SIdP); Italian Society of Ophthalmology (SOI); Italian Association of Hospital Otorhinolaryngologist (AOOI); Italian Association of Hospital Surgeons (ACOI); Association of Obstetricians Gynecologists Italian Hospital (AOGOI)
[Ad] Address:Dipartimento Emergenze e Aree Critiche, Ospedale Santa Croce e Carle, Cuneo, Italy. Electronic address: roberta.rossini2@gmail.com.
[Ti] Title:A Multidisciplinary Approach on the Perioperative Antithrombotic Management of Patients With Coronary Stents Undergoing Surgery: Surgery After Stenting 2.
[So] Source:JACC Cardiovasc Interv;11(5):417-434, 2018 Mar 12.
[Is] ISSN:1876-7605
[Cp] Country of publication:United States
[La] Language:eng
[Ab] Abstract:Perioperative management of antithrombotic therapy in patients treated with coronary stents undergoing surgery remains poorly defined. Importantly, surgery represents a common reason for premature treatment discontinuation, which is associated with an increased risk in mortality and major adverse cardiac events. However, maintaining antithrombotic therapy to minimize the incidence of perioperative ischemic complications may increase the risk of bleeding complications. Although guidelines provide some recommendations with respect to the perioperative management of antithrombotic therapy, these have been largely developed according to the thrombotic risk of the patient and a definition of the hemorrhagic risk specific to each surgical procedure, key to defining the trade-off between ischemia and bleeding, is not provided. These observations underscore the need for a multidisciplinary collaboration among cardiologists, anesthesiologists, hematologists and surgeons to reach this goal. The present document is an update on practical recommendations for standardizing management of antithrombotic therapy management in patients treated with coronary stents (Surgery After Stenting 2) in various types of surgery according to the predicted individual risk of thrombotic complications against the anticipated risk of surgical bleeding complications. Cardiologists defined the thrombotic risk using a "combined ischemic risk" approach, while surgeons classified surgeries according to their inherent hemorrhagic risk. Finally, a multidisciplinary agreement on the most appropriate antithrombotic treatment regimen in the perioperative phase was reached for each surgical procedure.
[Pt] Publication type:JOURNAL ARTICLE; REVIEW
[Em] Entry month:1803
[Cu] Class update date: 180309
[Lr] Last revision date:180309
[St] Status:In-Data-Review

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[PMID]: 29519378
[Au] Autor:Zocca P; Kok MM; Tandjung K; Danse PW; Jessurun GAJ; Hautvast RWM; van Houwelingen KG; Stoel MG; Schramm AR; Tjon Joe Gin RM; de Man FHAF; Hartmann M; Louwerenburg JHW; Linssen GCM; Löwik MM; Doggen CJM; von Birgelen C
[Ad] Address:Department of Cardiology, Thoraxcentrum Twente, Medisch Spectrum Twente, Enschede, the Netherlands.
[Ti] Title:5-Year Outcome Following Randomized Treatment of All-Comers With Zotarolimus-Eluting Resolute Integrity and Everolimus-Eluting PROMUS Element Coronary Stents: Final Report of the DUTCH PEERS (TWENTE II) Trial.
[So] Source:JACC Cardiovasc Interv;11(5):462-469, 2018 Mar 12.
[Is] ISSN:1876-7605
[Cp] Country of publication:United States
[La] Language:eng
[Ab] Abstract:OBJECTIVES: The study sought to evaluate for the first time the 5-year outcomes after treating an all-comers population with newer-generation cobalt chromium-based Resolute Integrity zotarolimus-eluting stents (ZES) (Medtronic, Santa Rosa, California) versus platinum chromium-based PROMUS Element everolimus eluting stents (EES) (Boston Scientific, Natick, Massachusetts). BACKGROUND: The DUTCH PEERS (TWENTE II) (DUrable polymer-based sTent CHallenge of Promus ElemEnt versus ReSolute integrity: TWENTE II) trial is a randomized, multicenter, single-blinded, investigator-initiated all-comers trial that found at its main analysis similar 1-year safety and efficacy for both drug-eluting stents. It is the first randomized trial ever to investigate the Resolute Integrity ZES and the first trial to compare both devices. METHODS: In total, 1,811 patients were 1:1 randomized to ZES versus EES. We performed a pre-specified assessment of the 5-year clinical outcomes in terms of safety and efficacy. The main endpoint target vessel failure (TVF) is a composite of cardiac death, target vessel-related myocardial infarction, or target vessel revascularization. Secondary endpoints included the individual components of TVF, and stent thrombosis. The study was independently monitored, and adverse clinical events were independently adjudicated. RESULTS: Five-year clinical follow-up data was available in 1,798 (99.3%) patients. The ZES and EES groups showed favorable outcomes, with similar 5-year incidence of TVF (13.2% vs. 14.2%; p = 0.62) and its individual components: cardiac death (4.5% vs. 4.9%; p = 0.69), target vessel-related myocardial infarction (3.1% vs. 2.6%; p = 0.47), and target vessel revascularization (7.6% vs. 8.6%; p = 0.46). The 5-year incidence of definite or probable stent thrombosis was similar (1.5% vs. 1.3%; p = 0.83). CONCLUSIONS: At 5-year follow-up, the Resolute Integrity ZES and PROMUS Element EES showed similar and sustained results in terms of safety and efficacy for treating a broad population of all-comers.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1803
[Cu] Class update date: 180309
[Lr] Last revision date:180309
[St] Status:In-Data-Review

  7 / 27762 MEDLINE  
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[PMID]: 29454730
[Au] Autor:Lee SY; Hong MK; Palmerini T; Kim HS; Valgimigli M; Feres F; Colombo A; Gilard M; Shin DH; Kim JS; Kim BK; Ko YG; Choi D; Jang Y; Stone GW
[Ad] Address:Sanbon Hospital, Wonkwang University College of Medicine, Gunpo, Korea.
[Ti] Title:Short-Term Versus Long-Term Dual Antiplatelet Therapy After Drug-Eluting Stent Implantation in Elderly Patients: A Meta-Analysis of Individual Participant Data From 6 Randomized Trials.
[So] Source:JACC Cardiovasc Interv;11(5):435-443, 2018 Mar 12.
[Is] ISSN:1876-7605
[Cp] Country of publication:United States
[La] Language:eng
[Ab] Abstract:OBJECTIVES: This study sought to evaluate the optimal duration of dual antiplatelet therapy (DAPT) after the implantation of a drug-eluting stent (DES) in elderly patients. BACKGROUND: Qualified studies to evaluate the optimal duration of DAPT in elderly patients have been very limited. METHODS: Using 6 randomized trials that compared short-term (≤6 months) and long-term (12 months) DAPT, individual participant data meta-analysis was performed in elderly patients (≥65 years of age). The primary study outcome was the 12-month risk of a composite of myocardial infarction, definite or probable stent thrombosis, or stroke. The major secondary outcome was the 12-month risk of major bleeding. RESULTS: The primary outcome risk did not significantly differ between patients receiving short-term and long-term DAPT (hazard ratio [HR]: 1.12; 95% confidence interval [CI]: 0.88 to 1.43; p = 0.3581) in the overall group of study participants. In subgroup analysis, a significant interaction between age and DAPT duration was observed for primary outcome risk (p for interaction = 0.0384). In the subset of younger patients (<65 years of age, n = 6,152), short-term DAPT was associated with higher risk of primary outcome (HR: 1.67; 95% CI: 1.14 to 2.44; p = 0.0082). In elderly patients (n = 5,319), however, the risk of primary outcome did not significantly differ between patients receiving short-term and long-term DAPT (HR: 0.84; 95% CI: 0.60 to 1.16; p = 0.2856). Short-term DAPT was associated with a significant reduction in major bleeding compared with long-term DAPT (HR: 0.50; 95% CI: 0.30 to 0.84; p = 0.0081) in the overall group, and particularly in elderly patients (HR: 0.46; 95% CI: 0.24-0.88; p = 0.0196). CONCLUSIONS: Short-term DAPT after new-generation DES implantation may be more beneficial in elderly patients than in younger patients.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1802
[Cu] Class update date: 180309
[Lr] Last revision date:180309
[St] Status:In-Data-Review

  8 / 27762 MEDLINE  
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[PMID]: 29454725
[Au] Autor:Zukowski C; Maia F; Oliveira M; Mattos LA; Pontes A; Costa RA; Chamié D
[Ad] Address:Hospital Copa D'Or, Rio de Janeiro, Brazil.
[Ti] Title:Suboptimal Bifurcation Stenting: A Case When the Check Comes Late.
[So] Source:JACC Cardiovasc Interv;11(5):e37-e40, 2018 Mar 12.
[Is] ISSN:1876-7605
[Cp] Country of publication:United States
[La] Language:eng
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1802
[Cu] Class update date: 180309
[Lr] Last revision date:180309
[St] Status:In-Data-Review

  9 / 27762 MEDLINE  
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[PMID]: 29438080
[Au] Autor:Ducroux C; Di Meglio L; Loyau S; Delbosc S; Boisseau W; Deschildre C; Ben Maacha M; Blanc R; Redjem H; Ciccio G; Smajda S; Fahed R; Michel JB; Piotin M; Salomon L; Mazighi M; Ho-Tin-Noe B; Desilles JP
[Ad] Address:From the Université Paris Diderot, Sorbonne Paris Cite, Laboratory of Vascular Translational Science, U1148 Institut National de la Santé et de la Recherche Médicale (INSERM), France (C. Ducroux, L.D.M., S.L., S.D., W.B., C. Deschildre, R.B., J.-B.M., M.P., M.M., B.H.-T.-N., J.-P.D.); Department of
[Ti] Title:Thrombus Neutrophil Extracellular Traps Content Impair tPA-Induced Thrombolysis in Acute Ischemic Stroke.
[So] Source:Stroke;49(3):754-757, 2018 03.
[Is] ISSN:1524-4628
[Cp] Country of publication:United States
[La] Language:eng
[Ab] Abstract:BACKGROUND AND PURPOSE: Neutrophil Extracellular Traps (NETs) are DNA extracellular networks decorated with histones and granular proteins produced by activated neutrophils. NETs have been identified as major triggers and structural factors of thrombosis. A recent study designated extracellular DNA threads from NETs as a potential therapeutic target for improving tissue-type plasminogen activator (tPA)-induced thrombolysis in acute coronary syndrome. The aim of this study was to assess the presence of NETs in thrombi retrieved during endovascular therapy in patients with acute ischemic stroke (AIS) and their impact on tPA-induced thrombolysis. METHODS: We analyzed thrombi from 108 AIS patients treated with endovascular therapy. Thrombi were characterized by hematoxylin/eosin staining, immunostaining, and ex vivo enzymatic assay. Additionally, we assessed ex vivo the impact of deoxyribonuclease 1 (DNAse 1) on thrombolysis of AIS thrombi. RESULTS: Histological analysis revealed that NETs contributed to the composition of all AIS thrombi especially in their outer layers. Quantitative measurement of thrombus NETs content was not associated with clinical outcome or AIS pathogenesis but correlated significantly with endovascular therapy procedure length and device number of passes. Ex vivo, recombinant DNAse 1 accelerated tPA-induced thrombolysis, whereas DNAse 1 alone was ineffective. CONCLUSIONS: This study suggests that thrombus NETs content may be responsible for reperfusion resistance, including mechanical or pharmacological approaches with intravenous tPA, irrespectively of their etiology. The efficacy of a strategy involving an administration of DNAse 1 in addition to tPA should be explored in the setting of AIS. CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT02907736.
[Pt] Publication type:JOURNAL ARTICLE; RESEARCH SUPPORT, NON-U.S. GOV'T
[Em] Entry month:1802
[Cu] Class update date: 180309
[Lr] Last revision date:180309
[Cl] Clinical Trial:ClinicalTrial
[St] Status:In-Process
[do] DOI:10.1161/STROKEAHA.117.019896

  10 / 27762 MEDLINE  
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[PMID]: 29409866
[Au] Autor:Post A; Kishan AP; Diaz-Rodriguez P; Tuzun E; Hahn M; Cosgriff-Hernandez E
[Ad] Address:Department of Biomedical Engineering, Texas A&M University, College Station, TX 77843, United States. Electronic address: apost10103@tamu.edu.
[Ti] Title:Introduction of sacrificial bonds to hydrogels to increase defect tolerance during suturing of multilayer vascular grafts.
[So] Source:Acta Biomater;69:313-322, 2018 Mar 15.
[Is] ISSN:1878-7568
[Cp] Country of publication:England
[La] Language:eng
[Ab] Abstract:Small-caliber vascular grafts used in coronary artery bypass procedures typically fail due to the development of intimal hyperplasia or thrombosis. Our laboratory has developed a multilayered vascular graft with an electrospun polyurethane outer layer with improved compliance matching and a hydrogel inner layer that is both thromboresistant and promotes endothelialization. Initial in vivo studies showed that hydrogel particulates were dislodged from the hydrogel layer of the grafts during suturing. To address this problem, we developed and characterized a new hydrogel formulation that resists damage during suturing. Introduction of sacrificial, hydrogen bonds to poly(ethylene glycol)-based hydrogels via co-polymerization with n-vinyl pyrrolidone (NVP) increased the fracture energy as determined by single edge notch testing. This enhanced defect tolerance resulted in a hydrogel layer that was resistant to suture-induced damage with no dislodged particles observed. Importantly, the incorporation of NVP did not affect the thromboresistance, bioactivity, or biostability of the hydrogel layer. In addition to eliminating complications due to hydrogel particle generation in our multilayer graft design, this defect tolerant hydrogel formulation has broad potential use in many cardiovascular and soft tissue applications. STATEMENT OF SIGNIFICANCE: Small-caliber vascular grafts used in coronary artery bypass procedures typically fail due to development of intimal hyperplasia or thrombosis. Our laboratory has developed a multilayered vascular graft with an electrospun polyurethane outer layer with improved compliance matching and a hydrogel inner layer that is both thromboresistant and promotes endothelialization. However, hydrogel particulates were dislodged from the hydrogel layer during suturing in vivo. This work describes a hydrogel formulation based on poly(ethylene glycol) that is resistant to suture-induced damage. The introduction of sacrificial, hydrogen bonds by co-polymerization with n-vinyl pyrrolidone (NVP) resulted in an increase fracture energy without affecting the thromboresistance, bioactivity, or biostability. This defect-tolerant hydrogel formulation and the methodology to assess hydrogel defect tolerance has broad potential use in cardiovascular and soft tissue applications.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1802
[Cu] Class update date: 180309
[Lr] Last revision date:180309
[St] Status:In-Data-Review


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