Submitted by Fabio Sobreira Campos da Costa (fabio.sobreira@ufpe.br) on 2016-04-07T13:45:11Z No. of bitstreams: 3 license_rdf: 1232 bytes, checksum: 66e71c371cc565284e70f40736c94386 (MD5) tese_completa_BIBLIOTECA_10_11_2015.pdf: 1137406 bytes, checksum: 99ca45ce4b42d3ca289fb6979849607a (MD5) tese_completa_BIBLIOTECA_10_11_2015.pdf: 1137406 bytes, checksum: 99ca45ce4b42d3ca289fb6979849607a (MD5) / Made available in DSpace on 2016-04-07T13:45:11Z (GMT). No. of bitstreams: 3 license_rdf: 1232 bytes, checksum: 66e71c371cc565284e70f40736c94386 (MD5) tese_completa_BIBLIOTECA_10_11_2015.pdf: 1137406 bytes, checksum: 99ca45ce4b42d3ca289fb6979849607a (MD5) tese_completa_BIBLIOTECA_10_11_2015.pdf: 1137406 bytes, checksum: 99ca45ce4b42d3ca289fb6979849607a (MD5) Previous issue date: 2015-05-26 / Introdução: O advento dos stents convencionais e daqueles liberadores de fármacos aboliu o recolhimento elástico provocado pela angioplastia por balão, porém, estes dispositivos apresentaram como consequência a hiperplasia neointimal, que é responsável pela reestenose angiográfica. O metotrexato, antagonista do folato, inibe a fase S do ciclo de mitose celular, reduzindo a produção de citocinas e outros mediadores inflamatórios que podem estar envolvidos na hiperplasia neointimal. Objetivo: Avaliar a segurança do Metotrexato (MTX) em pacientes com Doença Arterial Coronariana submetidos à Intervenção Coronariana Percutânea (ICP) com stents convencionais e o impacto da droga na reestenose clínica e angiográfica. Método: Estudo clínico de fase II aberto, prospectivo, não randomizado, realizado de setembro de 2011 a maio de 2014. Resultados: Foram recrutados 16 pacientes com indicação de implante de stent, sendo que estes tomaram 5 mg de MTX 15 dias antes e 30 após a ICP. Todos os pacientes foram submetidos à nova angiografia coronariana após 9 meses. A artéria coronária descendente anterior apresentou o maior número de lesões 16 (34%). O diâmetro médio dos stents foi de 3,0 ± 0,4 mm e o comprimento médio foi de 18,1 ± 5,9 mm. Não houve complicações relacionadas à ICP. As complicações do MTX foram menores e com prevalência de 18,7%. Nenhum paciente necessitou de interrupção no uso do medicamento e os sintomas desapareceram ao final do tratamento. A reestenose angiográfica foi 6,2% e a clínica foi zero (ausência de sintoma e de isquemia em cintilografia do miocárdio). Conclusão: O MTX foi seguro e gerou a hipótese de possível efeito benéfico na reestenose após implante de stent convencional. / Introduction: Bare metal stents (BMS) and those releasing drug abolished the elastic recoil caused by Plain Old Balloon Angioplasty (POBA), however, these devices showed the consequence of neointimal hyperplasia, which is responsible for angiographic restenosis. The methotrexate, folate antagonist inhibits S phase of mitotic cell cycle by reducing the production of cytokines and the other inflammatory mediators that may be involved in the neointimal hyperplasia. Objective: To evaluate the safety of Methotrexate (MTX) in patients with coronary artery disease undergoing Percutaneous Coronary Intervention (PCI) with BMS and the impact of drugs in clinical and angiographic restenosis. Methods: Clinical phase II open, prospective, nonrandomized, held from September 2011 to May 2014. Results: We recruited 16 patients with stent implantation indication, and these took 5 mg of MTX 15 days before and 30 after PCI. All patients underwent coronary angiography after nine months. The anterior descending coronary artery had the highest number of lesions 16 (34%). The average diameter of the stents was 3.0 ± 0.4 mm and the average length was 18.1 ± 5.9 mm. There were no complications related to PCI. The MTX complications were minor and with a prevalence of 18.7%. No patient required interruption in the use of the drug, and the symptoms disappeared after the treatment. Angiographic restenosis was 6.2% and the clinic was zero (no symptoms and ischemia on myocardial scintigraphy). Conclusion: MTX was safe and led the hypothesis of possible beneficial effect on restenosis after conventional stent implantation.

M.Cur. (Intensive General Nursing) / The incidence of coronary heart disease is still rising due to man's stressful way of life. Angioplasty is a relatively new procedure used to dilate coronary arteries which have been narrowed by sclerosis. This is seen as the 'instant solution' for a select group of patients with coronary artery sclerosis. It fits in well in the fast paced society. Angioplasty is painful and causes anxiety as the patient is awake during the whole procedure. The goal of the study is to determine the patient's experience during angioplasty and to set guidelines for nurses for the preparation of other patients for angioplasty. The Phenomenological method of interviewing was used for data-collection. Interviews were conducted with 9 participants who had had their first experience of angioplasty. Data was subjected to Phenomenological analysis and verified with suitable literature. The conclusions that were reached were used to set guidelines and make suggestions for the counselling of patients for angioplasty.

Angioplasty, or the use of rapidly deploying stents, is a common treatment for reopening narrowed vasculature often caused by atherosclerotic plaque. However, in-stent restenosis (ISR) induced by intimal hyperplasia is a common challenge to angioplasty. High impact stresses from current stent deployment processes have been linked to intimal hyperplasia; thus a stent that is gradually deployed over a longer period of time holds potential to mitigate these stresses. This work hypothesizes that resorbable polymeric links can be used as a triggering mechanism to enable repeatably controlled deployment of a compliant nitinol stent design with the eventual goal of reducing intimal hyperplasia. The aims of this work include the structured design process and design validation of a stent intended to meet this challenge. A structured design process was used to develop a multi-stage, gradually deploying nitinol stent in which PDLG (DL-lactide/Glycolide copolymer) bioresorbable links constrained specific mechanical cells within the stent geometry, thus limiting initial deployment to an intermediate diameter and allowing for secondary gradual deployment as the PDLG degraded via a combination of bioresorption and creep. A finite element analysis was carried out to design the link geometry to hold the stent at an intermediate stage (90% of final diameter) upon initial deployment, and enable a gradual secondary deployment phase lasting several minutes. Prototypes were then manufactured and the design was validated in a flow chamber mimicking the conditions of human blood flow and temperature. Using a camera and image processing methods, the diameter increase of the stents was tracked over time to characterize the secondary gradual deployment process of the stents. Results showed the links constrained the stents to an initial ~90% diameter upon initial deployment, followed by a gradual, secondary deployment with an average 63.2% rise time of 16.2 minutes. Creep was observed to be the primary driver of the gradual deployment, followed by subsequent bioresorption of the material. All prototypes exhibited gradual secondary deployment without any visible delamination of the bioresorbable links from the stent struts. Based on these findings it can be concluded our hypothesis has been demonstrated, and that a feasible gradually deploying stent design has been mechanically validated, preparatory to pre-clinical studies of its efficacy. Prior to clinical application, future in vivo work is needed to compare actual ISR rates with this stent design to other commonly used stent designs in preclinical trials. In addition, further preclinical work is needed to compare ISR rates through several stent design parameters such as initial deployment diameter, gradual deployment rate, final deployment diameter, and stent sizes to give insights into the optimal stent design. We anticipate that this gradually expanding stent design could reduce in-stent restenosis and improve clinical outcomes.

京都大学 / 0048 / 新制・課程博士 / 博士(医学) / 甲第20797号 / 医博第4297号 / 新制||医||1025(附属図書館) / 京都大学大学院医学研究科医学専攻 / (主査)教授 湊谷 謙司, 教授 齊藤 博英, 教授 Shohab YOUSSEFIAN / 学位規則第4条第1項該当 / Doctor of Medical Science / Kyoto University / DFAM

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Thesis (M. Phil.)--University of Hong Kong, 1999. / Includes bibliographical references (leaves 118-146).

Thesis (M. N.)--Memorial University of Newfoundland, School of Nursing, 1997. / Bibliography: leaves 103-116.

The purpose of this study was to determine if a written patient education booklet would produce an increase in knowledge of adult participants. Thirty subjects were admitted to this quasi-experimental, post-test only study. Subjects in the experimental group (n = 16) were given a patient education booklet, "PTCA--A Patients' Guide," before angioplasty and an Evaluation Questionnaire after angioplasty. Both groups were given a Knowledge Questionnaire after angioplasty. The Student's t-test of independent group means resulted in a non-significant t-value. No difference in knowledge test scores was found between patients who received the booklet and patients who did not receive the booklet. Results from the evaluation questionnaire suggest that subjects perceived the booklet and pictures to be helpful as preparation for angioplasty. Therefore, revision of the PTCA Knowledge Questionnaire and refinement of the study design is suggested.