PubMed · 8350438
The source did not provide an abstract. Follow the original record for more information.
Explore connections, maps & timelines
J A DeWeese, R Leather, J Porter. 1993. Practice guidelines: lower extremity revascularization.. https://pubmed.ncbi.nlm.nih.gov/8350438/
Cite the original work for its findings. Save a collection to share your selection of sources.
KEEP EXPLORING
This study is based on the observation that deposition of thrombus within the arterial wall and on its surface is a consistent response to the vascular injury of angioplasty and of angioplasty lesions at risk of rapid restenosis. Mitogenic activity is stimulated by fibrin degradation products in extracts of human atherosclerotic plaques and plasmin digests of fibrin, and this has been attributed to products that include fibrin fragment E. The effect of human fibrin degradation products on smooth muscle outgrowth from rabbit aortic medial explants now has been explored in culture. Every batch of fibrin degradation products was first tested on the in vivo chick chorioallantoic membrane model for the ability to stimulate cell proliferation, including angiogenesis as shown previously. Increasing concentrations of fibrin degradation products were stimulated significantly earlier and with greater outgrowth of smooth muscle cells than controls, up to an optimum at 92 microg/mL fibrin degradation products. The effect of fibrin degradation products was blocked by the prior admixture of a specific antifragment E antiserum, but not by an antifragment D antiserum. Purified commercial fibrinogen E is inactive, but when treated with thrombin to resemble fibrin E it stimulated smooth muscle cell outgrowth, and this was not seen with comparable dosages of fragment D. We propose that fibrin degradation products, in particular fibrin fragment E, provide an abundant in situ early initiator of smooth muscle cell migration and proliferation in restenosis and atherogenesis.
During acute myocardial infarction, pre-hospital stage and the first hours after admission are crucial for initiating reperfusion therapy, which is determinant for short- and mid-term survival. Within 12 hours after onset of chest pain, either thrombolysis or primary angioplasty contribute to reduce mortality rate, the earlier being the better. Therapeutic advances, regarding either thrombolysis or angioplasty, are directed towards an earlier, more efficient and stable (without reocclusion) patency of the infarct-related artery. Most promising results so far have been obtained with platelet glycoprotein (GP) IIb/IIIa receptor blockers, in combination with thrombolysis or angioplasty.
Out-of-hospital cardiac arrest remains a clinical problem with a survival rate of less than 5%. Prompt initiation of cardiopulmonary resuscitation and rapid delivery of advanced cardiac-life procedures are required. Combined in-hospital management by experienced cardiologists and intensive care specialists is recommended. Acute coronary-artery occlusion is frequent and poorly predicted by clinical and electrocardiographic findings. Accurate diagnosis by immediate coronary angiography can be followed if necessary by coronary angioplasty. Survivors undergo extensive work-up to determine the indications of an implantable defibrillator or coronary revascularization.