ISBN 978-93-5547-374-5 (Print)
ISBN 978-93-5547-375-2 (eBook)
DOI: 10.9734/bpi/mono/978-93-5547-374-5

 

Cardiovascular diseases are the most important disease that can cause approximately one-third of deaths worldwide. It consists of ischemic heart disease, peripheral arterial disease, heart failure and stroke. The major form of cardiovascular diseases in the general population is coronary heart disease, which remains a significant proplem over the past several years. The treatment of coronary artery disease has been developed by the use of percutaneous coronary intervention, which becomes the focus of many researches in the cardiology field. However, the novel complication associated with this medical procedure is inflammatory reaction after coronary interventionthat might be interfering with patient outcome. Balloon angioplasty was the first landmark in treatment of coronary artery disease and was performed by Andreas Grüntzig in 1977. However, this technique had two major drawbacks: thrombosis and acute occlusion occurred in patients immediately after the procedure, and development of neointimal proliferation with restenosis occurred in patients within the first six months. Further efforts encouraged the introduction of bare metal stent which performed by Sigwart et al. following balloon angioplasty. In 1987 the bare metal stent was the first food and drug administration approved stent in the USA. Also this new technology had major problems: stent thrombosis and in-stent restenosis. However, during 1he 1990s follow-up studies sought to elucidate the molecular mechanisms underlying the vascular response to percutaneous coronary intervention and stenting. The introduction of the first generation of drug-eluting stent aimed at reducing neointimal hyperplasia has been explored. Second-generation drug eluting stent showed superiority to first-generation drug eluting stent by lower rates of stent thrombosis. To overcome the hypersensitivity reaction to the durable polymer, non-polymeric third-generation drug eluting stent with biodegradable polymers also developed. In parallel, fourth-generation drug eluting stent constructed with fully bioresorbable scaffolds designed to provide vessel support and deliver the antiproliferative drug to prevent neointimal proliferation for a defined period after coronary intervention procedure followed by gradual resorption leaving behind no permanent foreign material. In 2017, the FDA released a warning related to the increased incidence of device thrombosis and it was subsequently removed from the global market. Inflammation plays an important role in the development of atherosclerosis which is the underlying cause for most cardiovascular disease and is a process that starts early in life and progresses slowly and silently for decades. Recent studies has demonstrated that implant of coronary artery stents induces the beginning of a local and systemic inflammatory response and restenosis after percutaneous coronary intervention. An initial acute inflammatory cell response was shown within 0 to 3 days but  acute inflammation subsides is replaced by chronic inflammatory cells within 2 to 4 weeks post intervention. This inflammatory reaction triggered by the stent insertion is maintained by the mechanism of stent expansion with vessel wall rupture, in addition to permanent radial mechanical strain applied to arterial wall and thepresence of an intravascular residual metallic foreign material. Several studies have demonstrated that percutaneous coronary intervention induces the release of multiple inflammatory markers that are associated with a later poor prognosis in patients.


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Contents


Inflammatory Response to Percutaneous Coronary Intervention

Najah R. Hadi, Bashaer M. Muhammad-Baqir, Mustafa H. Ahmed

Inflammatory Response to Percutaneous Coronary Intervention, 23 November 2021, Page 1
https://doi.org/10.9734/bpi/mono/978-93-5547-374-5/CH0

Atherosclerosis is now considered an inflammatory disease. Inflammation has been demonstrated to contribute to its initiation as well as its progression. Coronary artery disease is a leading cause of death worldwide. The treatment of coronary artery disease has been transformed by the introduction of percutaneous coronary intervention, which remains the focus of intensive research and development. Percutaneous coronary intervention produces a significant inflammatory reaction in the injured vessel wall, that may lead to the development of neointimal thickening and restenosis. Balloon coronary angioplasty or stent deployment is associated with significant platelet activation, which promotes leukocyte recruitment to the injured vessel wall and it has also been shown to induce an inflammatory response. Inflammation plays a major role in determining stent restenosis via neointimal proliferation. Several acute-phase reactants, cytokines, and soluble cellular adhesion molecules have been implicated in this inflammatory process. Moreover, increased inflammatory protein levels in peripheral blood have been found in atherosclerotic diseases, such as unstable angina pectoris, acute myocardial infarction and angiographically documented coronary heart disease. Thus, high levels of acute phase reactants correlate with a worse prognosis.

Conclusion: Percutaneous coronary intervention induces a significant inflammatory reaction in the injured vessel wall that leads to the development of neointimal thickening and restenosis. Post procedural inflammatory response in patients undergoing coronary intervention reveal a wide range of mechanisms, including mechanical disruption of atherosclerotic plaque, arterial wall injury, myocardial necrosis due to distal embolization and endothelial dysfunction, and release of inflammatory factors followed by leukocytes and platelet activation along with the ischaemiareperfusion injury. The inflammatory reaction plays an equally important role as arterial injury in neointimal formation after coronary stenting, and that anti-inflammatory approaches may be of value to reduce in-stent restenosis.

Percutaneous Coronary Intervention: Historical Development

Najah R. Hadi, Bashaer M. Muhammad-Baqir, Mustafa H. Ahmed

Inflammatory Response to Percutaneous Coronary Intervention, 23 November 2021, Page 2-12
https://doi.org/10.9734/bpi/mono/978-93-5547-374-5/CH1

Atherosclerosis, the underlying cause for most cardiovascular disease is a process that starts early in life and progresses slowly and silently for decades, usually becoming manifest in the form of angina, myocardial infarction, stroke, or sudden death. Although several established risk factors are involved in this process, inflammation is now considered to play an important role. Treatment of cardio vascular disease aims to minimize symptoms and improve the prognosis, which could be achieved by lifestyle changes, medical treatment, and myocardial revascularization which includes percutaneous coronary intervention. The subspecialty of interventional cardiology has made significant progress in the management of coronary artery disease over the past three decades with the development of percutaneous coronary intervention.

Inflammation and Cardiovascular Disease

Najah R. Hadi, Bashaer M. Muhammad-Baqir, Mustafa H. Ahmed

Inflammatory Response to Percutaneous Coronary Intervention, 23 November 2021, Page 13-34
https://doi.org/10.9734/bpi/mono/978-93-5547-374-5/CH2

Cardiovascular disease is the leading cause of death in the all world. One of its most important forms is coronary heart disease due to atherosclerosis. There is increasing evidence that inflammatory system has a role in the pathogenesis of cardiovascular disease and its complications. Inflammatory mechanisms also appear to determine clinical presentation and disease outcome. Plasma levels of several markers of inflammation has been associated with coronary artery disease and various studies have shown increased levels during chronic stable angina, acute myocardial infarction, and percutaneous coronary intervention and have been found to be associated with future cardiovascular risk in a variety of clinical settings.

Inflammatory Response Post PCI Technique

Najah R. Hadi, Bashaer M. Muhammad-Baqir, Mustafa H. Ahmed

Inflammatory Response to Percutaneous Coronary Intervention, 23 November 2021, Page 35-59
https://doi.org/10.9734/bpi/mono/978-93-5547-374-5/CH3

Each year, millions of patients with coronary heart disease worldwide are treated by means of percutaneous coronary intervention which induces a significant inflammatory reaction in the injured vessel wall that leads to the development of neointimal thickening and restenosis. The systemic inflammatory response after technique that can be measured in the plasma by the inflammatory markers and can be detected by the concentration of  these markers after the procedure and its related to a greater risk of adverse clinical outcomes. There was a strong correlation between the extent of inflammatory reaction and the amount of neointimal formation within the stents and both inflammatory changes and the arterial injury can cause a neointimal reaction independently, even in the absence of the other.

Systemic and Local Treatment of Inflammation

Najah R. Hadi, Bashaer M. Muhammad-Baqir, Mustafa H. Ahmed

Inflammatory Response to Percutaneous Coronary Intervention, 23 November 2021, Page 60-68
https://doi.org/10.9734/bpi/mono/978-93-5547-374-5/CH4

The inflammatory response to percutaneous coronary intervention is largely driven by direct mechanical trauma induced by balloon inflation and/or stent deployment. The role of inflammation in the development of restenosis after percutaneous coronary interventions has been investigated in several studies. There is an interaction of inflammatory activation and vascular wall response to injury leading to intimal hyperplasia. In the clinical setting there are several methods for the recognition of the inflammatory activation and the treatment of inflammation before, after percutaneous coronary interventions.