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Yamane H, Ueda Y, Ikeoka K, Kosugi S, Abe H, Mishima T, Inoue K, Matsumura Y. The observation of below-the-knee artery by optical frequency domain image and angioscopy: a case series. Eur Heart J Case Rep 2023; 7:ytad518. [PMID: 37942348 PMCID: PMC10630094 DOI: 10.1093/ehjcr/ytad518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 10/05/2023] [Accepted: 10/16/2023] [Indexed: 11/10/2023]
Abstract
Background Endovascular treatment (EVT) is a well-established treatment for patients with chronic limb-threatening ischaemia, and below-the-knee (BTK) artery is its main target, although the re-intervention rate is still high. Understanding of the characteristics of BTK artery atherosclerosis would be required to overcome this issue. In this case series, we elucidated the characteristics of non-stenotic BTK artery atherosclerosis in the patients who received EVT of the superficial femoral artery (SFA) using optical frequency domain imaging (OFDI) and angioscopy. Case summary We presented five patients who underwent EVT of SFA and subsequent observation of ipsilateral BTK artery using OFDI and angioscopy. Patients one and two had advanced atherosclerosis; however, patients three, four, and five had only mild atherosclerosis. Discussion All patients had multiple risk factors for atherosclerosis and stenosis/occlusion of the SFA and ipsilateral BTK arteries. Furthermore, some patients had several other atherosclerotic vascular diseases suggesting the presence of advanced systemic atherosclerosis. On the other hand, some patients with multiple BTK artery stenosis/occlusion did not have advanced atherosclerosis in the examined BTK artery. The absence of significant atherosclerosis in a BTK artery in patients with multiple stenoses or occlusion in other ipsilateral BTK arteries may suggest some mechanism of vessel occlusion other than atherosclerosis. Further investigations are needed to clarify the mechanism.
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Affiliation(s)
- Haruya Yamane
- Cardiovascular Division, NHO Osaka National Hospital, 2-1-14 Hoenzaka, Chuo-ku, Osaka, Osaka 540-0006, Japan
| | - Yasunori Ueda
- Cardiovascular Division, NHO Osaka National Hospital, 2-1-14 Hoenzaka, Chuo-ku, Osaka, Osaka 540-0006, Japan
| | - Kuniyasu Ikeoka
- Cardiovascular Division, NHO Osaka National Hospital, 2-1-14 Hoenzaka, Chuo-ku, Osaka, Osaka 540-0006, Japan
| | - Shumpei Kosugi
- Cardiovascular Division, NHO Osaka National Hospital, 2-1-14 Hoenzaka, Chuo-ku, Osaka, Osaka 540-0006, Japan
| | - Haruhiko Abe
- Cardiovascular Division, NHO Osaka National Hospital, 2-1-14 Hoenzaka, Chuo-ku, Osaka, Osaka 540-0006, Japan
| | - Tsuyoshi Mishima
- Cardiovascular Division, NHO Osaka National Hospital, 2-1-14 Hoenzaka, Chuo-ku, Osaka, Osaka 540-0006, Japan
| | - Koichi Inoue
- Cardiovascular Division, NHO Osaka National Hospital, 2-1-14 Hoenzaka, Chuo-ku, Osaka, Osaka 540-0006, Japan
| | - Yasushi Matsumura
- Cardiovascular Division, NHO Osaka National Hospital, 2-1-14 Hoenzaka, Chuo-ku, Osaka, Osaka 540-0006, Japan
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Kimura S, Isshiki A, Shimizu M, Fujii H, Suzuki M. Clinical Significance of Coronary Healed Plaques in Stable Angina Pectoris Patients Undergoing Percutaneous Coronary Intervention. Circ J 2023; 87:1643-1653. [PMID: 37183026 DOI: 10.1253/circj.cj-23-0031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
BACKGROUND Coronary healed plaques (HPs) reportedly have high vulnerability or show advanced atherosclerosis and a risk of rapid plaque progression. However, the prognosis of stable angina pectoris (SAP) patients with HPs undergoing percutaneous coronary intervention (PCI) remains under-investigated.Methods and Results: We analyzed 417 consecutive lesions from SAP patients undergoing pre- and post-intervention optical coherence tomography (OCT) for which HPs were defined as having a layered appearance. We investigated the differences in clinical and lesion characteristics, and post-PCI outcomes between HPs and non-HPs. To account for differences in clinical characteristics, propensity score matching was performed between the groups. HPs were observed in 216 lesions (51.8%) in the total cohort. In the propensity-matched cohort (n=294), HPs had higher rates of angiographic-B2/C lesions (77.6% vs. 59.2%, P<0.001), OCT-lipid-rich plaques (40.8% vs. 25.9%, P=0.007), macrophages (78.2% vs. 44.2%, P<0.001), greater luminal area stenosis (73.5±11.0% vs. 71.5±10.3%, P=0.002), and a higher prevalence of post-stenting irregular tissue protrusion (45.1% vs. 14.7%, P<0.001) than non-HPs. In the total cohort, target lesion revascularization (TLR)-free survival was poorer for HPs (log-rank test 7.66; P=0.006), and Cox proportional hazards analysis showed HP as an independent predictor of TLR (hazard ratio, 5.98; 95% confidence interval, 1.72-20.82; P=0.005). CONCLUSIONS In SAP patients, HPs had greater complexity of lesions and higher vulnerability, which may have contributed to the poorer post-PCI outcomes.
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Affiliation(s)
- Shigeki Kimura
- Department of Cardiology, Yokohama Minami Kyosai Hospital
| | - Ami Isshiki
- Department of Cardiology, Yokohama Minami Kyosai Hospital
| | - Masato Shimizu
- Department of Cardiology, Yokohama Minami Kyosai Hospital
| | - Hiroyuki Fujii
- Department of Cardiology, Yokohama Minami Kyosai Hospital
| | - Makoto Suzuki
- Department of Cardiology, Yokohama Minami Kyosai Hospital
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Kano K, Enomoto Y, Hori T, Funatsu N, Egashira Y, Nakayama N, Yoshimura S, Iwama T. The Height and Mobility of Protruding Plaque After Carotid Artery Stenting Are Associated with Postoperative Ischemic Lesions. World Neurosurg 2023; 172:e185-e193. [PMID: 36603647 DOI: 10.1016/j.wneu.2022.12.127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 12/28/2022] [Accepted: 12/29/2022] [Indexed: 01/04/2023]
Abstract
BACKGROUND Tissue protrusion (TP) is a possible cause of cerebral infarction after carotid artery stenting (CAS). Using optical frequency domain imaging (OFDI) and angioscopy, we investigated the relationship between the morphological features of TP and postoperative new ischemic lesions on magnetic resonance imaging (MRI)-diffusion weighted imaging (DWI) after CAS. METHODS Fifty patients who underwent CAS and subsequent poststenting intravascular evaluation using both OFDI and angioscopy were included. CAS was performed for proximal protection via the femoral artery approach, and intravascular evaluation with OFDI and angioscopy were performed after stent placement. We compared the background and poststenting intravascular findings between patients with and without postoperative new ischemic lesions on MRI-DWI. RESULTS TP was observed in 42 patients (84%), and postoperative new ischemic lesions on MRI-DWI were observed in 32 patients (64%). The frequency of TP did not differ between the 2 groups, but the height of TP was higher in the DWI-positive group (0.62 mm vs. 0.29 mm, P = 0.0028), and mobile TP was observed only in the DWI-positive group. The height of TP (P = 0.023) was an independent predictor of new periprocedural ischemic brain lesions after CAS, and its cut-off value for mobility was 0.55 mm on the receiver operating characteristic curve (area under the curve, 0.93). CONCLUSIONS The height of TP on OFDI and mobile-TP on angioscopy after CAS were associated with postoperative new ischemic lesions on MRI-DWI. The intravascular evaluation using OFDI and angioscopy could be helpful for a detailed evaluation of TP.
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Affiliation(s)
- Kiyomitsu Kano
- Department of Neurosurgery, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Yukiko Enomoto
- Department of Neurosurgery, Gifu University Graduate School of Medicine, Gifu, Japan.
| | - Takamitsu Hori
- Department of Neurosurgery, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Naoko Funatsu
- Department of Rehabilitation Therapy, Gifu Seiryu Hospital, Gifu, Japan
| | - Yusuke Egashira
- Department of Neurosurgery, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Noriyuki Nakayama
- Department of Neurosurgery, Gifu University Graduate School of Medicine, Gifu, Japan
| | | | - Toru Iwama
- Department of Neurosurgery, Gifu University Graduate School of Medicine, Gifu, Japan
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Roleder-Dylewska M, Gasior P, Hommels TM, Roleder T, Berta B, Ang HY, Ng JCK, Hermanides RS, Fabris E, IJsselmuiden AJJ, Kauer F, Alfonso F, von Birgelen C, Escaned J, Camaro C, Kennedy MW, Pereira B, Magro M, Nef H, Reith S, Malinowski K, De Luca G, Garcia Garcia HM, Granada JF, Wojakowski W, Kedhi E. Morphological characteristics of lesions with thin cap fibroatheroma—a substudy from the COMBINE (OCT-FFR) trial. Eur Heart J Cardiovasc Imaging 2022; 24:687-693. [PMID: 36342269 DOI: 10.1093/ehjci/jeac218] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 08/31/2022] [Accepted: 10/18/2022] [Indexed: 11/09/2022] Open
Abstract
Abstract
Aims
To study if any qualitative or quantitative optical coherence tomography (OCT) variables in combination with thin cap fibroatheroma (TCFA) patients could improve the identification of lesions at risk for future major adverse cardiac events (MACEs).
Methods and results
From the combined optical coherence tomography morphologic and fractional flow reserve hemodynamic assessment of non- culprit lesions to better predict adverse event outcomes in diabetes mellitus patients: COMBINE (OCT-FFR) trial database (NCT02989740), we performed a detailed assessment OCT qualitative and quantitative variables in TCFA carrying diabetes mellitus (DM) patients with vs. without MACE during follow-up. MACEs were defined as a composite of cardiac death, target vessel myocardial infarction, clinically driven target lesion revascularization, and hospitalization for unstable angina. From the 390 fractional flow reserve (FFR)-negative DM patients, 98 (25.2%) had ≥1 OCT-detected TCFA, of which 13 (13.3%) had MACE and 85 (86.7%) were event-free (non-MACE). The baseline characteristics were similar between both groups; however, a smaller minimal lumen area (MLA) and lower mean FFR value were observed in MACE group (1.80 vs. 2.50 mm2, P = 0.01, and 0.85 vs. 0.89, P = 0.02, respectively). Prevalence of healed plaque (HP) was higher in the MACE group (53.85 vs. 21.18%, P = 0.01). TCFA were predominantly located proximal to the MLA. TCFA area was smaller in the MACE group, while no difference was observed regarding the lesion area.
Conclusion
Within TCFA carrying patients, a smaller MLA, lower FFR values, and TCFA location adjacent to a HP were associated with future MACE. Carpet-like measured lesion area surface was similar, while the TCFA area was smaller in the MACE arm, and predominantly located proximal to the MLA.
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Affiliation(s)
- Magda Roleder-Dylewska
- Division of Cardiology and Structural Heart Diseases, Medical University of Silesia , ul.Ziołowa 45, Katowice, 40-635 , Poland
| | - Pawel Gasior
- Division of Cardiology and Structural Heart Diseases, Medical University of Silesia , ul.Ziołowa 45, Katowice, 40-635 , Poland
| | | | - Tomasz Roleder
- Division of Cardiology and Structural Heart Diseases, Medical University of Silesia , ul.Ziołowa 45, Katowice, 40-635 , Poland
- Department of Cardiology, Hospital Wroclaw , Wroclaw , Poland
| | - Balasz Berta
- Heart and Vascular Center, Semmelweis University , Budapest , Hungary
- Isala Hartcentrum , Zwolle , The Netherlands
| | - Hui Ying Ang
- National Heart Centre Singapore , 5 Hospital Drive, Singapore 169609 , Singapore
- Department of Biomedical Engineering , 4 Engineering Drive 3, Singapore 117583 , Singapore
| | - Jaryl Chen Koon Ng
- National Heart Centre Singapore , 5 Hospital Drive, Singapore 169609 , Singapore
- Department of Biomedical Engineering , 4 Engineering Drive 3, Singapore 117583 , Singapore
| | | | - Enrico Fabris
- Cardiovascular Department, University of Trieste , Trieste , Italy
| | | | - Floris Kauer
- Department of Cardiology, Albert Schweitzer Ziekenhuis , Dordrecht , The Netherlands
| | - Fernando Alfonso
- Department of Cardiology, Hospital Universitario La Princesa , Madrid , Spain
| | - Clemens von Birgelen
- Thoraxcentrum Twente, Medisch Spectrum Twente , Enschede , The Netherlands
- Technical Medical Centre, University of Twente , Enschede , The Netherlands
| | | | - Cyril Camaro
- University Medical Center Radboudumc , Nijmegen , The Netherlands
| | - Mark W Kennedy
- Beaumont Hospital , Dublin , Ireland
- Royal College of Surgeons in Ireland , Dublin , Ireland
| | | | | | - Holger Nef
- Department Cardiology and Angiology, University of Giessen; German Centre for Cardiovascular Research (DZHK) , Gießen , Germany
| | | | - Krzysztof Malinowski
- Department of Bioinformatics and Telemedicine, Faculty of Medicine, Jagiellonian University Medical College , Kraków , Poland
| | | | | | - Juan F Granada
- Cardiovascular Research Foundation , New York , USA
- Columbia University Medical Center NYC , NY , USA
| | - Wojciech Wojakowski
- Division of Cardiology and Structural Heart Diseases, Medical University of Silesia , ul.Ziołowa 45, Katowice, 40-635 , Poland
| | - Elvin Kedhi
- Division of Cardiology and Structural Heart Diseases, Medical University of Silesia , ul.Ziołowa 45, Katowice, 40-635 , Poland
- Erasmus Hospital, Université libre de Bruxelles (ULB) , Rte de Lennik 808, 1070 Bruxelles , Belgium
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Feng X, Liu Y, Yang J, Zhai G, Zhou Y, Guo Q. Prevalence of Healed Plaque and Factors Influencing Its Characteristics Under Optical Coherence Tomography in Patients With Coronary Artery Disease: A Systematic Review, Meta-Analysis, and Meta-Regression. Front Cardiovasc Med 2021; 8:761208. [PMID: 34881310 PMCID: PMC8645588 DOI: 10.3389/fcvm.2021.761208] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 10/15/2021] [Indexed: 01/02/2023] Open
Abstract
Aim: The purpose of this study was to determine the prevalence of healed plaque and its characteristics under optical coherence tomography (OCT) through a formal systematic review, meta-analysis, and meta-regression. Methods and Results: Thirteen studies were selected from MEDLINE, EMBASE, Cochrane, and online databases. The overall incidence of healed plaques was 40% (95% CI: 39-42), with 37% (95% CI: 35-39) in patients with acute coronary syndrome (ACS) and with 46% (95% CI: 43-49) in patients with stable angina pectoris (SAP). The incidence of healed plaque among culprit plaques (48%, 95% CI: 46-50) was nearly two times higher than that among non-culprit plaques (24%, 95% CI: 21-27). The incidence of thin cap fibroatheroma (TCFA), plaque rupture, microvessel, macrophage accumulation, and calcification was significantly higher in the healed plaque group. Meta-regression revealed an association between smoking (P = 0.033) and healed plaque rupture. Gender (P = 0.047) was independently associated with macrophage accumulation, and mean low-density lipoprotein cholesterol (LDL-C) was independently associated with microvessel. Conclusions: In summary, with a total incidence of 40%, the incidence of healed plaques under OCT was higher in SAP than in ACS, and higher in culprit plaques than in non-culprit plaques. Higher incidence of TCFA, plaque rupture, microvessel, macrophage accumulation, and calcification was found in the healed-plaque group. Smoking, gender, and mean LDL-C level were associated with healed-plaque characteristics.
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Affiliation(s)
- Xunxun Feng
- Beijing Key Laboratory of Precision Medicine of Coronary Atherosclerotic Disease, Department of Cardiology, Clinical Center for Coronary Heart Disease, Beijing Institute of Heart Lung and Blood Vessel Disease, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Yang Liu
- Beijing Key Laboratory of Precision Medicine of Coronary Atherosclerotic Disease, Department of Cardiology, Clinical Center for Coronary Heart Disease, Beijing Institute of Heart Lung and Blood Vessel Disease, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Jiaqi Yang
- Beijing Key Laboratory of Precision Medicine of Coronary Atherosclerotic Disease, Department of Cardiology, Clinical Center for Coronary Heart Disease, Beijing Institute of Heart Lung and Blood Vessel Disease, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Guangyao Zhai
- Beijing Key Laboratory of Precision Medicine of Coronary Atherosclerotic Disease, Department of Cardiology, Clinical Center for Coronary Heart Disease, Beijing Institute of Heart Lung and Blood Vessel Disease, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Yujie Zhou
- Beijing Key Laboratory of Precision Medicine of Coronary Atherosclerotic Disease, Department of Cardiology, Clinical Center for Coronary Heart Disease, Beijing Institute of Heart Lung and Blood Vessel Disease, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Qianyun Guo
- Beijing Key Laboratory of Precision Medicine of Coronary Atherosclerotic Disease, Department of Cardiology, Clinical Center for Coronary Heart Disease, Beijing Institute of Heart Lung and Blood Vessel Disease, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
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