Prevention of Vascular Restenosis After Vascular Angioplasty
Percutaneous transluminal angioplasty (PTA) and stenting are widely used methods for the treatment of vascular stenosis and much less invasive than surgery, but restenosis still occurs in 30–60 % of coronary artery cases, in no less than 5 % of carotid ar
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Wataro Tsuruta, Tetsuya Yamamoto, and Akira Matsumura
Contents 30.1 Introduction ................................................................................................................
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30.2 Modalities for the Prevention of Restenosis .............................................................
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30.3 Application of BNCT for the Prevention of Restenosis .......................................... 30.3.1 Boron Concentration in Vascular Tissue ........................................................ 30.3.2 Efficacy for Prevention of Restenosis ............................................................
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30.4 Perspectives .................................................................................................................
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References ..............................................................................................................................
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30.1
Introduction
Acute myocardial and cerebral infarction as a result of arteriosclerotic occlusion are major causes of human death. In the case of ischemic heart disease, the indication for surgical revascularization has substantially decreased due to the successful evolution of percutaneous coronary intervention. And while the widely used methods of percutaneous transluminal angioplasty (PTA) and stenting are much less invasive
W. Tsuruta • A. Matsumura Department of Neurosurgery, Institute of Clinical Medicine, Graduate School of Comprehensive Human Science, University of Tsukuba, 1-1-1 Tennohdai, Tsukuba, Ibaraki, 305-8575, Japan e-mail: [email protected]; [email protected] T. Yamamoto (*) Department of Neurosurgery and Radiation Oncology, Institute of Clinical Medicine, Graduate School of Comprehensive Human Science, University of Tsukuba, Tsukuba, Japan e-mail: [email protected] W.A.G. Sauerwein et al. (eds.), Neutron Capture Therapy, DOI 10.1007/978-3-642-31334-9_30, © Springer-Verlag Berlin Heidelberg 2012
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than surgery for the treatment of coronary artery stenosis, restenosis occurs in 30–60 % of cases [5]. As for treatment of carotid artery stenosis, carotid endarterectomy (CEA) has been the gold standard based on randomized control trials [13, 22]. Recently, carotid artery stenting (CAS) has proven beneficial in patients who are at high risk for CEA [28] and is expected to be widely used in the near future. However, restenosis still occurs after CAS in no less than 5 % of cases [11, 12, 17] and in 10–40 % of intracranial artery stenosis cases [1, 8, 19]. The mechanism of restenosis seems to involve intimal hyperplasia [6, 7], which in turn results from the migration and proliferation of vascular smooth muscle cells (VSMCs) and from the migration and myofibroblastic transformation of adventitia cells. Inhibition of intimal hyperplasia is thus important for the prevention of restenosis. Though several modalities, such as drug-eluting stents or brachytherapy, have been introduced and proven to have efficacy for the inhibition of intimal hype
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