Late stent malapposition and marked positive vessel remodeling after sirolimus-eluting coronary stent implantation

It has been reported that positive remodeling, regression of neointimal hyperplasia, and late malapposition are associated with brachytherapy, one of the approaches to prevent first-time and recurrent in-stent restenosis. Recently, some drug-eluting stents have been demonstrated to dramatically reduce restenosis rates. Despite these promising results, these drug-eluting stents may have the same potential risks as brachytherapy, with some similarities between the 2 technologies in anti-proliferative effects on vascular smooth muscle cells and endothelial cells. We reported a case of late stent malapposition and marked positive vessel remodeling after sirolimus-eluting coronary stent implantation.

Effects of Puerarin on Pulmonary Vascular Remodeling and Protein Kinase C-α in Chronic Cigarette Smoke Exposure Smoke-exposed Rats

In order to investigate the effects of puerarin on pulmonary vascular remodeling and protein kinase C-α （PKC-α） in chronic exposure smoke rats, 54 male Wistar rats were randomly divided into 7 groups： control group （C group）, smoke exposure groups （S4w group, S8w group）, puerarin groups （P4w group, P8w group）, propylene glycol control groups （PC4w group, PC8w group）. Rats were exposed to cigarette smoke or air for 4 to 8 weeks. Rats in puerarin groups also received puerarin. To evaluate vascular remodeling, alpha-smooth muscle actin （α-SM-actin） staining was used to count the percentage of completely muscularised vessels to intraacinar pulmonary arteries （CMA/IAPA） which was determined by morphometric analysis of histological sections. Pulmonary artery smooth muscle cell （PASMC） apoptosis was detected by in situ end labeling technique （TUNEL）, and proliferation by proliferating cell nuclear antigen （PCNA） staining. Reverse transcription-polymerase chain reaction （RT-PCR）, immunofluorescence staining and Western blot analysis were done to detect the PKC-α mRNA and protein expression in pulmonary arteries. The results showed that in cigarette smoke-exposed rats the percentage of CMA/IAPA and α-SM-actin expression were increased greatly, PASMC apoptosis was increased and proliferation was markedly increased; Apoptosis indices （AI） and proliferation indices （PI） were higher than in C group; AI and PI were correlated with vascular remodeling indices; The expression of PKC-α mRNA and protein in pulmonary arteries was significantly higher than in C group. In rats treated with puerarin, the percentage of CMA/IAPA and cell proliferation was reduced, whereas PASMC apoptosis was increased; The expression levels of PKC-α mRNA and protein were lower than in smoke exposure rats. There was no difference among all these data between S groups and PC groups. These findings suggested that cigarette smoke-induced pulmonary vascular remodeling was most likely an effect of the imbalance of PASMC proliferation and apoptosis. Puerarin appears to be able to reduce cell proliferation and vascular remodeling possibly through PKC signaling transduction pathway.

Rapid development of late stent malappositon and coronary aneurysm following implantation of a paclitaxel-eluting coronary stent

Late stent malapposition （LSM）, an unusual intravascular ultrasound （IVUS） finding at follow-up,has been reported to be more common alter drug-eluting stem （DES） implantation than after bare metal stent （BMS） implantation. However, there has been no clear elucidation of time course and mechanism. We reported a case who developed LSM and coronary aneurysm very early after paclitaxel-eluting stent （PES） implantation. A review of the literature reveals no previous report describing rapid development of LSM and coronary aneurysm after PES implantation.