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Ozaki Y, Kitabata H, Takahata M, Katayama Y, Wada T, Hikida R, Taruya A, Shiono Y, Kuroi A, Yamano T, Tanimoto T, Tanaka A. Intracoronary Near-Infrared Spectroscopy to Predict No-Reflow Phenomenon During Percutaneous Coronary Intervention in Acute Coronary Syndrome. Am J Cardiol 2024; 219:17-24. [PMID: 38490338 DOI: 10.1016/j.amjcard.2024.03.009] [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] [Received: 12/18/2023] [Revised: 02/05/2024] [Accepted: 03/03/2024] [Indexed: 03/17/2024]
Abstract
Near-infrared spectroscopy-intravascular ultrasound (NIRS-IVUS) can identify the lipid-rich lesions, described as high lipid-core burden index (LCBI). The aim of this study was to investigate the relation between lipid-core plaque (LCP) in the infarct-related lesion detected using NIRS-IVUS and no-reflow phenomenon during percutaneous coronary intervention (PCI) in patients with acute coronary syndrome (ACS). We investigated 371 patients with ACS who underwent NIRS-IVUS in the infarct-related lesions before PCI. The extent of LCP in the infarct-related lesion was calculated as the maximum LCBI for each of the 4-mm longitudinal segments (maxLCBI4mm) measured by NIRS-IVUS. The patients were divided into 2 groups using a maxLCBI4mm cut-off value of 400. The overall incidence of no-reflow phenomenon was 53 of 371 (14.3%). No-reflow phenomenon more frequently occurred in patients with maxLCBI4mm ≥400 compared with those with maxLCBI4mm<400 (17.5% vs 2.5%, p <0.001). After propensity score matching, multivariable logistic regression analysis demonstrated that maxLCBI4mm (odds ratio: 1.008; 95% confidence interval: 1.005 to 1.012, p <0.001) was independently associated with the no-reflow phenomenon. The maxLCBI4mm of 719 in the infarct-related lesion had the highest combined sensitivity (69.8%) and specificity (72.1%) for the identification of no-reflow phenomenon. In conclusion, in patients with ACS, maxLCBI4mm in the infarct-related lesion assessed by NIRS-IVUS was independently associated with the no-reflow phenomenon during PCI.
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Affiliation(s)
- Yuichi Ozaki
- Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan.
| | - Hironori Kitabata
- Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan
| | - Masahiro Takahata
- Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan
| | - Yosuke Katayama
- Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan; Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Teruaki Wada
- Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan
| | - Ryo Hikida
- Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan
| | - Akira Taruya
- Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan
| | - Yasutsugu Shiono
- Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan
| | - Akio Kuroi
- Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan
| | - Takashi Yamano
- Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan
| | - Takashi Tanimoto
- Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan
| | - Atsushi Tanaka
- Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan
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No-reflow phenomenon and in vivo cholesterol crystals combined with lipid core in acute myocardial infarction. IJC HEART & VASCULATURE 2022; 38:100953. [PMID: 35059493 PMCID: PMC8760498 DOI: 10.1016/j.ijcha.2022.100953] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 12/24/2021] [Accepted: 01/01/2022] [Indexed: 12/17/2022]
Abstract
The number of in vivo cholesterol crystals at the culprit plaque is increased in patients with the no-reflow phenomenon. The number of cholesterol crystals, lipid arch, and ostium lesion are independent predictors for the no-reflow phenomenon after PCI. The combination of the number of cholesterol crystals and lipid arc can improve the prediction ability for the no-reflow phenomenon.
Background The release of lipid-laden plaque material subsequent to ST-segment elevation myocardial infarction (STEMI) may contribute to the no-reflow phenomenon. The aim of this study was to investigate the association between in vivo cholesterol crystals (CCs) detected by optical coherence tomography (OCT) and the no-reflow phenomenon after successful percutaneous coronary intervention (PCI) in patients with acute STEMI. Methods We investigated 182 patients with STEMI. Based on the thrombolysis in myocardial infarction (TIMI) flow grade after PCI, patients were divided into a no-reflow group (n = 31) and a reflow group (n = 151). On OCT, CCs were defined as thin, high-signal intensity regions within a plaque. A multivariable logistic regression analysis was performed to determine predictors for the no-reflow phenomenon. Results The prevalence of CCs was higher in the no-reflow group than the reflow group (no-reflow group, 77% vs. reflow group, 53%; p = 0.012). The multivariable logistic model showed that the CC number, lipid arc and ostial lesions were positive independent predictors of no-reflow. The combination of a lipid arc ≥ 139°and CC number ≥ 12 showed good predictive performance for the no-reflow phenomenon (sensitivity, 48%; specificity, 93%; and accuracy, 86%). Conclusion In vivo CCs at the culprit plaque are associated with the no-reflow phenomenon after PCI in patients with STEMI. The combination of the number of CCs and lipid arc can predict the no-reflow phenomenon after PCI with a high accuracy of 86%.
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Watanabe Y, Sakakura K, Taniguchi Y, Yamamoto K, Seguchi M, Tsukui T, Jinnouchi H, Wada H, Fujita H. Long-term outcomes of the modest stent expansion strategy for the culprit lesion of acute myocardial infarction. Cardiovasc Interv Ther 2022; 37:660-669. [PMID: 35107749 DOI: 10.1007/s12928-022-00841-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 01/24/2022] [Indexed: 12/22/2022]
Abstract
Slow flow during primary percutaneous coronary intervention (PCI) is a common complication. Our group showed that the stent (or post-balloon) diameter-to-vessel diameter ratio was inversely associated with slow flow phenomenon. We advocated the utility of modest stent expansion strategy, which was defined as the stent (or post-balloon) diameter-to-culprit vessel diameter ratio < 0.71, for prevention of slow flow phenomenon. This study aimed to compare the long-term outcomes in patients with acute myocardial infarction (AMI) between the modest stent expansion strategy and the aggressive stent expansion strategy (the stent diameter-to-culprit vessel diameter ratio ≥ 0.71). We included 584 AMI patients, which were divided 177 patients in the modest stent expansion group and 146 patients in the aggressive stent expansion group. The primary endpoint was major adverse cardiac events (MACE), which was defined as a composite of cardiac death, ischemia driven target vessel revascularization, and stent thrombosis. The slow flow after stent deployment was more frequently observed in the aggressive stent expansion group (24.0%) than in the modest stent expansion group (4.0%) (P < 0.001). The Kaplan-Meier curves revealed that MACE was comparable between the two groups (P = 0.64). The multivariate COX hazard model showed the non-significant association between the modest stent expansion strategy and MACE (vs. aggressive stent expansion: hazard ratio 1.005, 95% confidence interval 0.619-3.242, P = 0.41). In conclusion, the modest stent expansion strategy was not associated with long-term MACE. Therefore, the modest stent expansion strategy may be a good choice for the culprit lesion of AMI.
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Affiliation(s)
- Yusuke Watanabe
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma, Omiya, Saitama City, 330-8503, Japan
| | - Kenichi Sakakura
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma, Omiya, Saitama City, 330-8503, Japan.
| | - Yousuke Taniguchi
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma, Omiya, Saitama City, 330-8503, Japan
| | - Kei Yamamoto
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma, Omiya, Saitama City, 330-8503, Japan
| | - Masaru Seguchi
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma, Omiya, Saitama City, 330-8503, Japan
| | - Takunori Tsukui
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma, Omiya, Saitama City, 330-8503, Japan
| | - Hiroyuki Jinnouchi
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma, Omiya, Saitama City, 330-8503, Japan
| | - Hiroshi Wada
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma, Omiya, Saitama City, 330-8503, Japan
| | - Hideo Fujita
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma, Omiya, Saitama City, 330-8503, Japan
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Small lipid core burden index in patients with stable angina pectoris is also associated with microvascular dysfunction: Insights from intracoronary electrocardiogram. J Thromb Thrombolysis 2021; 52:1-8. [PMID: 33528755 DOI: 10.1007/s11239-021-02380-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/10/2021] [Indexed: 12/22/2022]
Abstract
Near-infrared spectroscopy with intravascular ultrasound (NIRS)-IVUS enables precise detection of lipid core burden. Intracoronary electrocardiography (ECG) can detect slight ischemia during percutaneous coronary intervention (PCI), indicating microvascular dysfunction (MD) by distal embolization, etc. Thus, this study aimed to investigate whether plaques with a low max-lipid core burden index (LCBI) at 4 mm (LCBI4mm) influence MD, using intracoronary ECG. We enrolled 40 consecutive patients who underwent PCI for stable angina pectoris (SAP) due to stenosis of the proximal segment of the left anterior descending artery in this study. Max-LCBI4mm was measured for each culprit lesion. Gray-scale IVUS data including plaque burden were measured. Intracoronary ECG was performed to measure the time from the initiation of ST-segment elevation from the isoelectric baseline after stent balloon inflation to the return of the ST-segment to the isoelectric baseline after the deflation of the stent balloon, which was defined as the severity of the MD. The patients were divided into two groups according to median max-LCBI4mm of 120 as follows: low- [n = 20] and high- [n = 20] LCBI groups. The overall mean Max-LCBI4mm was 120 ± 86. No differences in baseline characteristics, including prevalence of dyslipidemia, were found between both groups, as well as in the gray-scale IVUS parameters. The severity of the MD was greater in the high-LCBI group than in the low-LCBI group (16.6 ± 9.1 vs 4.7 ± 4.8 s, P < 0.01). The no-reflow and slow-flow phenomena were not observed. Even max-LCBI4mm value <400 on NIRS-IVUS was associated with MD during PCI in patients with SAP.
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Plaque characteristics and slow flow during percutaneous coronary intervention of irregular protrusion by optical coherence tomography. Heart Vessels 2019; 34:1076-1085. [DOI: 10.1007/s00380-018-01335-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Accepted: 12/28/2018] [Indexed: 10/27/2022]
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Watanabe Y, Sakakura K, Taniguchi Y, Yamamoto K, Wada H, Momomura SI, Fujita H. Determinants of Slow Flow in Percutaneous Coronary Intervention to the Culprit Lesion of Non-ST Elevation Myocardial Infarction. Int Heart J 2018; 59:1237-1245. [PMID: 30305588 DOI: 10.1536/ihj.18-050] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Slow flow is a serious complication in percutaneous coronary intervention (PCI) and is associated with poor clinical outcomes. Our previous study revealed that the ratio of stent diameter to vessel diameter was the determinant of slow flow in intravascular ultrasound (IVUS)-guided PCI to the culprit lesion of ST elevation myocardial infarction (STEMI). The purpose of this study was to verify whether the ratio of stent diameter to vessel diameter is the determinant of slow flow in IVUS-guided PCI to the culprit lesion of non-STEMI (NSTEMI). We included 150 NSTEMI patients and divided into the slow flow group (n = 17) and the non-slow flow group (n = 133). The ratio of stent diameter to vessel diameter was significantly larger in the slow flow group (0.77 ± 0.11) than the non-slow flow group (0.71 ± 0.11) (P = 0.03). Multivariate logistic regression analysis revealed that the ratio of stent diameter to vessel diameter (per 0.1 increase: OR 2.06, 95% CI 1.23-3.46, P = 0.006) was the determinant of slow flow after controlling covariates. In conclusion, the ratio of stent diameter to vessel diameter was the determinant of slow flow in IVUS-guided PCI to the culprit lesion of NSTEMI. Unlike other parameters, the ratio of stent diameter to vessel diameter is the modifiable parameters. We may consider the modest stent expansion strategy rather than the aggressive stent expansion strategy in IVUS-guided PCI to the culprit lesion of NSTEMI.
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Affiliation(s)
- Yusuke Watanabe
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University
| | - Kenichi Sakakura
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University
| | - Yousuke Taniguchi
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University
| | - Kei Yamamoto
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University
| | - Hiroshi Wada
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University
| | - Shin-Ichi Momomura
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University
| | - Hideo Fujita
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University
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Sato T, Aizawa Y, Suzuki N, Taya Y, Yuasa S, Kishi S, Koshikawa T, Fuse K, Fujita S, Ikeda Y, Kitazawa H, Takahashi M, Okabe M. The utility of total lipid core burden index/maximal lipid core burden index ratio within the culprit plaque to predict filter-no reflow: insight from near-infrared spectroscopy with intravascular ultrasound. J Thromb Thrombolysis 2018; 46:203-210. [PMID: 29915959 DOI: 10.1007/s11239-018-1697-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
Filter-no reflow (FNR) is a phenomenon wherein flow improves after the retrieve of distal protection. Near-infrared spectroscopy with intravascular ultrasound (NIRS-IVUS) enables lipid detection. We evaluated the predictors of FNR during PCI using NIRS-IVUS. Thirty-two patients who underwent PCI using the Filtrap® for acute coronary syndrome (ACS) were enrolled. The culprit plaque (CP) was observed using NIRS-IVUS. Total lipid-core burden index (T-LCBI) and maximal LCBI over any 4-mm segment (max-LCBI4mm) within CP were evaluated. T-LCBI/max-LCBI4mm ratio within CP was calculated as an index of the extent of longitudinal lipid expansion. The attenuation grade (AG) and remodeling index (RI) in CP were analyzed. AG was scored based on the extent of attenuation occupying the number of quadrants. The patients were divided into FNR group (N = 8) and no-FNR group (N = 24). AG was significantly higher in FNR group than in no-FNR group (1.6 ± 0.6 vs. 0.9 ± 0.42, p = 0.01). RI in FNR group tended to be greater than in no-FNR group. T-LCBI/max-LCBI4mm ratio within the culprit plaque was significantly higher in FNR group than in no-FNR group (0.50 ± 0.10 vs. 0.33 ± 0.13, p < 0.01). In multivariate logistic regression analysis, AG > 1.04 (odds ratio [OR] 18.4, 95% confidence interval [CI] 1.5-215.7, p = 0.02) and T-LCBI/max-LCBI4mm ratio > 0.42 (OR 14.4, 95% CI 1.2-176.8, p = 0.03) were independent predictors for the occurrence of FNR. The use of T-LCBI/max-LCBI4mm ratio within CP might be an effective marker to predict FNR during PCI in patients with ACS.
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Affiliation(s)
- Takao Sato
- Cardiology, Tachikawa General Hospital, 561-1 Jyojyomachi Aza Yauchi, Nagaoka, Japan.
| | - Yoshifusa Aizawa
- Cardiology, Tachikawa General Hospital, 561-1 Jyojyomachi Aza Yauchi, Nagaoka, Japan
| | - Naomasa Suzuki
- Cardiology, Tachikawa General Hospital, 561-1 Jyojyomachi Aza Yauchi, Nagaoka, Japan
| | - Yuji Taya
- Cardiology, Tachikawa General Hospital, 561-1 Jyojyomachi Aza Yauchi, Nagaoka, Japan
| | - Sho Yuasa
- Cardiology, Tachikawa General Hospital, 561-1 Jyojyomachi Aza Yauchi, Nagaoka, Japan
| | - Shohei Kishi
- Cardiology, Tachikawa General Hospital, 561-1 Jyojyomachi Aza Yauchi, Nagaoka, Japan
| | - Tomoyasu Koshikawa
- Cardiology, Tachikawa General Hospital, 561-1 Jyojyomachi Aza Yauchi, Nagaoka, Japan
| | - Koichi Fuse
- Cardiology, Tachikawa General Hospital, 561-1 Jyojyomachi Aza Yauchi, Nagaoka, Japan
| | - Satoshi Fujita
- Cardiology, Tachikawa General Hospital, 561-1 Jyojyomachi Aza Yauchi, Nagaoka, Japan
| | - Yoshio Ikeda
- Cardiology, Tachikawa General Hospital, 561-1 Jyojyomachi Aza Yauchi, Nagaoka, Japan
| | - Hitoshi Kitazawa
- Cardiology, Tachikawa General Hospital, 561-1 Jyojyomachi Aza Yauchi, Nagaoka, Japan
| | - Minoru Takahashi
- Cardiology, Tachikawa General Hospital, 561-1 Jyojyomachi Aza Yauchi, Nagaoka, Japan
| | - Masaaki Okabe
- Cardiology, Tachikawa General Hospital, 561-1 Jyojyomachi Aza Yauchi, Nagaoka, Japan
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Han X, Jeong MH, Sim DS, Kim MC, Kim Y, Kim JH, Hong YJ, Ahn Y. Successful Treatment of Coronary Spasm with Atherosclerosis Rapidly Progressing to Acute Myocardial Infarction in a Young Woman. J Lipid Atheroscler 2018. [DOI: 10.12997/jla.2018.7.1.68] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Affiliation(s)
- Xiongyi Han
- The Heart Center and Cardiovascular Convergence Research Center Nominated by Korea Ministry of Health and Welfare, Chonnam National University Hospital, Gwangju, Korea
| | - Myung Ho Jeong
- The Heart Center and Cardiovascular Convergence Research Center Nominated by Korea Ministry of Health and Welfare, Chonnam National University Hospital, Gwangju, Korea
| | - Doo Sun Sim
- The Heart Center and Cardiovascular Convergence Research Center Nominated by Korea Ministry of Health and Welfare, Chonnam National University Hospital, Gwangju, Korea
| | - Min Chul Kim
- The Heart Center and Cardiovascular Convergence Research Center Nominated by Korea Ministry of Health and Welfare, Chonnam National University Hospital, Gwangju, Korea
| | - Yongcheol Kim
- The Heart Center and Cardiovascular Convergence Research Center Nominated by Korea Ministry of Health and Welfare, Chonnam National University Hospital, Gwangju, Korea
| | - Ju Han Kim
- The Heart Center and Cardiovascular Convergence Research Center Nominated by Korea Ministry of Health and Welfare, Chonnam National University Hospital, Gwangju, Korea
| | - Young Joon Hong
- The Heart Center and Cardiovascular Convergence Research Center Nominated by Korea Ministry of Health and Welfare, Chonnam National University Hospital, Gwangju, Korea
| | - Youngkeun Ahn
- The Heart Center and Cardiovascular Convergence Research Center Nominated by Korea Ministry of Health and Welfare, Chonnam National University Hospital, Gwangju, Korea
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Determinants of slow flow following stent implantation in intravascular ultrasound-guided primary percutaneous coronary intervention. Heart Vessels 2017; 33:226-238. [PMID: 28887713 DOI: 10.1007/s00380-017-1050-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Accepted: 09/06/2017] [Indexed: 12/13/2022]
Abstract
Slow flow is a serious complication in primary percutaneous coronary intervention (PCI) and is associated with poor clinical outcomes. Intravascular ultrasound (IVUS)-guided PCI may improve clinical outcomes after drug-eluting stent implantation. The purpose of this study was to seek the factors of slow flow following stent implantation, including factors related to IVUS-guided primary PCI. The study population consisted of 339 ST-elevation myocardial infarction patients, who underwent stent deployment with IVUS. During PCI, 56 patients (16.5%) had transient or permanent slow flow. Multivariate logistic regression analysis showed age (OR 1.04, 95% CI 1.01-1.07, P = 0.01), low attenuation plaque on IVUS (OR 3.38, 95% CI 1.70-6.72, P = 0.001), initial Thrombolysis In Myocardial Infarction (TIMI) flow grade 2 (vs. TIMI 0: OR 0.44, 95% CI 0.20-0.99, P = 0.046), and the ratio of stent diameter to vessel diameter (per 0.1 increase: OR 2.63, 95% CI 1.84-3.77, P < 0.001) were significantly associated with slow flow. A ratio of stent diameter to vessel diameter of 0.71 had an 80.4% sensitivity and 56.9% specificity to predict slow flow. There was no significant difference in ischemic-driven target vessel revascularization between the modest stent expansion (ratio of stent diameter to vessel diameter <0.71) and aggressive stent expansion (ratio of stent diameter to vessel diameter ≥0.71) strategies. Unlike other variables, the ratio of stent diameter to vessel diameter was the only modifiable factor. The modest stent expansion strategy should be considered to prevent slow flow following stent implantation in IVUS-guided primary PCI.
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Lipid-core burden response to stent implantation assessed with near-infrared spectroscopy and intravascular ultrasound evaluation in patients with myocardial infarction. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2017; 18:182-189. [DOI: 10.1016/j.carrev.2016.12.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2016] [Revised: 12/15/2016] [Accepted: 12/22/2016] [Indexed: 11/17/2022]
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Leibundgut G, Lee JH, Strauss BH, Segev A, Tsimikas S. Acute and long-term effect of percutaneous coronary intervention on serially-measured oxidative, inflammatory, and coagulation biomarkers in patients with stable angina. J Thromb Thrombolysis 2016; 41:569-80. [PMID: 26964999 DOI: 10.1007/s11239-016-1351-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
To derive insights into the temporal changes in oxidative, inflammatory and coagulation biomarkers in patients with stable angina undergoing percutaneous coronary intervention (PCI). PCI is associated with a variety of biochemical and mechanical stresses to the vessel wall. Oxidized phospholipids are present on plasminogen (OxPL-PLG) and potentiate fibrinolysis in vitro. We recently showed that OxPL-PLG increase following acute myocardial infarction, suggesting that they are involved in atherothrombosis. Plasma samples were collected before, immediately after, 6 and 24 h, 3 and 7 days, and 1, 3, and 6 months after PCI in 125 patients with stable angina undergoing uncomplicated PCI. Plasminogen levels, OxPL-PLG, and an array of 16 oxidative, inflammatory and coagulation biomarkers were measured with established assays. OxPL-PLG and plasminogen declined significantly immediately post-PCI, rebounded to baseline, peaked at 3 days and slowly returned to baseline by 6 months (p < 0.0001 by ANOVA). The temporal trends to maximal peak in biomarkers were as follows: immediately post PCI: OxPL-apoB and lipoprotein (a); Day 1-the inflammatory biomarker IL-6; Day 3-CRP and coagulation biomarkers OxPL-PLG, plasminogen and tissue plasminogen activity; Day 3 to 7-plasminogen activator inhibitor activity, and complement factor H binding to malondialdehyde-LDL and MDA-LDL IgG; Day 7-30 MDA-LDL IgM, CuOxLDL IgM, and ApoB-IC IgM and IgG; >30 days uPA activity, uPA antigen, CuOxLDL IgG and peptide mimotope to MDA-LDL. Most of the biomarkers trended to baseline by 6 months. PCI results in a specific, temporal sequence of changes in plasma biomarkers. These observations provide insights into the effects of iatrogenic barotrauma and plaque disruption during PCI and suggest avenues of investigation to explain complications of PCI and development of targeted therapies to enhance procedural success.
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Affiliation(s)
- Gregor Leibundgut
- Division of Cardiology, University of Basel, Basel, Switzerland.,Vascular Medicine Program, Department of Medicine, University of California San Diego, 9500 Gilman Drive, La Jolla, CA, 92993-0682, USA
| | - Jun-Hee Lee
- Division of Cardiology, Kang-Dong Sacred Heart Hospital, Hallym University Medical Center, Seoul, Korea
| | - Bradley H Strauss
- Division of Cardiology, St. Michael's Hospital, Toronto, ON, Canada.,Schulich Heart Center, Sunnybrook Health Sciences Center, University of Toronto, Toronto, ON, Canada
| | - Amit Segev
- The Heart Centre, Chaim Sheba Medical Centre, Tel Hashomer, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Sotirios Tsimikas
- Vascular Medicine Program, Department of Medicine, University of California San Diego, 9500 Gilman Drive, La Jolla, CA, 92993-0682, USA.
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Hong YJ, Ahn Y, Jeong MH. Role of Intravascular Ultrasound in Patients with Acute Myocardial Infarction. Korean Circ J 2015; 45:259-65. [PMID: 26240578 PMCID: PMC4521102 DOI: 10.4070/kcj.2015.45.4.259] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2015] [Revised: 04/09/2015] [Accepted: 04/14/2015] [Indexed: 11/11/2022] Open
Abstract
Rupture of a vulnerable plaque and subsequent thrombus formation are important mechanisms leading to the development of an acute myocardial infarction (AMI). Typical intravascular ultrasound (IVUS) features of AMI include plaque rupture, thrombus, positive remodeling, attenuated plaque, spotty calcification, and thin-cap fibroatheroma. No-reflow phenomenon was attributable to the embolization of thrombus and plaque debris that results from mechanical fragmentation of the vulnerable plaque by percutaneous coronary intervention (PCI). Several grayscale IVUS features including plaque rupture, thrombus, positive remodeling, greater plaque burden, decreased post-PCI plaque volume, and tissue prolapse, and virtual histology-IVUS features such as large necrotic corecontaining lesion and thin-cap fibroatheroma were the independent predictors of no-reflow phenomenon in AMI patients. Non-culprit lesions associated with recurrent events were more likely than those not associated with recurrent events to be characterized by a plaque burden of ≥70%, a minimal luminal area of ≤4.0 mm(2), or to be classified as thin-cap fibroatheromas.
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Affiliation(s)
- Young Joon Hong
- Division of Cardiology of Chonnam National University Hospital, Heart Convergence Research Center Nominated by Korea Ministry of Health and Welfare, Gwangju, Korea
| | - Youngkeun Ahn
- Division of Cardiology of Chonnam National University Hospital, Heart Convergence Research Center Nominated by Korea Ministry of Health and Welfare, Gwangju, Korea
| | - Myung Ho Jeong
- Division of Cardiology of Chonnam National University Hospital, Heart Convergence Research Center Nominated by Korea Ministry of Health and Welfare, Gwangju, Korea
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Ohshima K, Ikeda S, Kadota H, Yamane K, Izumi N, Ohshima K, Hamada M. Impact of culprit plaque volume and composition on myocardial microcirculation following primary angioplasty in patients with ST-segment elevation myocardial infarction: Virtual histology intravascular ultrasound analysis. Int J Cardiol 2013; 167:1000-5. [DOI: 10.1016/j.ijcard.2012.03.079] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2011] [Revised: 12/13/2011] [Accepted: 03/03/2012] [Indexed: 11/15/2022]
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Wu X, Maehara A, He Y, Xu K, Oviedo C, Witzenbichler B, Lansky AJ, Dressler O, Parise H, Stone GW, Mintz GS. Plaque shift and distal embolism in patients with acute myocardial infarction. Catheter Cardiovasc Interv 2013; 82:203-9. [DOI: 10.1002/ccd.24644] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2012] [Accepted: 08/26/2012] [Indexed: 11/06/2022]
Affiliation(s)
- Xiaofan Wu
- Columbia University Medical Center; New York
- The Cardiovascular Research Foundation; New York
| | - Akiko Maehara
- Columbia University Medical Center; New York
- The Cardiovascular Research Foundation; New York
| | - Yong He
- Columbia University Medical Center; New York
- The Cardiovascular Research Foundation; New York
| | - Kai Xu
- Columbia University Medical Center; New York
- The Cardiovascular Research Foundation; New York
| | - Carlos Oviedo
- Columbia University Medical Center; New York
- The Cardiovascular Research Foundation; New York
| | | | | | | | - Helen Parise
- The Cardiovascular Research Foundation; New York
| | - Gregg W. Stone
- Columbia University Medical Center; New York
- The Cardiovascular Research Foundation; New York
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15
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Hong YJ, Jeong MH, Ahn Y, Mintz GS, Kim SW, Lee SY, Kim SY, Cho JG, Park JC, Kang JC, Weissman NJ. Intravascular ultrasound analysis of plaque characteristics and postpercutaneous coronary intervention catheterization outcomes according to the remodeling pattern in narrowed saphenous vein grafts. Am J Cardiol 2012; 110:1290-5. [PMID: 22835407 DOI: 10.1016/j.amjcard.2012.06.031] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2012] [Revised: 06/20/2012] [Accepted: 06/20/2012] [Indexed: 11/16/2022]
Abstract
We assessed the plaque characteristics and postpercutaneous coronary intervention (PCI) outcome according to the remodeling pattern (positive remodeling [PR], n = 113; and intermediate/negative remodeling [IR/NR], n = 198) in 311 saphenous vein graft lesions using intravascular ultrasound. The remodeling index was the ratio of the lesion site saphenous vein graft area to the mean of the proximal and distal references (PR/remodeling index >1.05, IR 0.95 to 1.05, and NR <0.95). Tissue prolapse was defined as tissue extrusion through the stent strut after PCI, and the tissue prolapse volume was calculated by subtracting the lumen volume from the stent volume. The presence of hypoechoic plaque (59% vs 36%, p = 0.001), plaque rupture (26% vs 16%, p = 0.042), multiple plaque rupture (12% vs 5%, p = 0.020), and an intraluminal mass (59% vs 41%, p = 0.002) were more common in the PR lesions than in the IR/NR lesions. The plaque cavity area was significantly greater in the PR lesions than in the IR/NR lesions (0.83 ± 1.43 mm(2) vs 0.42 ± 1.07 mm(2), p = 0.009). Post-PCI no-reflow (19% vs 9%, p = 0.019) and post-PCI tissue prolapse (53% vs 27%, p <0.001) were observed more frequently, and the tissue prolapse volume was significantly greater after PCI for PR lesions than for IR/NR lesions (0.86 ± 1.30 mm(3) vs 0.34 ± 0.74 mm(3), p <0.001). PR was the independent predictor of post-PCI no-reflow (odds ratio 2.58, 95% confidence interval 1.25 to 5.64, p = 0.040) and post-PCI tissue prolapse (odds ratio 2.45, 95% confidence interval 1.46 to 5.41, p = 0.045). In conclusion, saphenous vein graft lesions with PR have vulnerable plaque and are associated with no-reflow and tissue prolapse after PCI.
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MESH Headings
- Aged
- Aged, 80 and over
- Angioplasty, Balloon, Coronary/adverse effects
- Angioplasty, Balloon, Coronary/methods
- Cohort Studies
- Confidence Intervals
- Coronary Angiography/methods
- Coronary Circulation/physiology
- Coronary Restenosis/diagnostic imaging
- Coronary Restenosis/mortality
- Coronary Restenosis/therapy
- Coronary Stenosis/diagnostic imaging
- Coronary Stenosis/mortality
- Coronary Stenosis/therapy
- Female
- Follow-Up Studies
- Graft Occlusion, Vascular/diagnostic imaging
- Graft Occlusion, Vascular/physiopathology
- Graft Occlusion, Vascular/therapy
- Humans
- Logistic Models
- Male
- Middle Aged
- Multivariate Analysis
- No-Reflow Phenomenon/diagnostic imaging
- Odds Ratio
- Plaque, Atherosclerotic/diagnostic imaging
- Retrospective Studies
- Risk Assessment
- Saphenous Vein/diagnostic imaging
- Saphenous Vein/transplantation
- Survival Rate
- Time Factors
- Treatment Outcome
- Ultrasonography, Interventional
- Vascular Patency/physiology
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Affiliation(s)
- Young Joon Hong
- Heart Center of Chonnam National University Hospital, Gwangju, South Korea
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16
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17
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Shibuya M, Okamura A, Hao H, Date M, Higuchi Y, Nagai H, Ozawa M, Masuyama T, Iwakura K, Fujii K. Prediction of distal embolization during percutaneous coronary intervention for unstable plaques with grayscale and integrated backscatter intravascular ultrasound. Catheter Cardiovasc Interv 2012; 81:E165-72. [PMID: 22777882 DOI: 10.1002/ccd.24559] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2011] [Revised: 04/05/2012] [Accepted: 06/30/2012] [Indexed: 11/06/2022]
Abstract
OBJECTIVES We performed microscopic examination of the debris collected by a distal protection device and investigated the usefulness of grayscale and integrated backscatter intravascular ultrasound (IB-IVUS) for the prediction of distal embolization during percutaneous coronary intervention (PCI) in cases of unstable angina. BACKGROUND The prediction of distal embolization during PCI has not been studied in depth because assessment of distal embolization is difficult. METHODS We prospectively studied 39 consecutive patients with unstable angina who underwent PCI with a filter distal protection device. The preprocedural plaque volume at target lesions was measured with grayscale IVUS and plaque characteristics were assessed with IB-IVUS. We performed microscopic examination of the particles collected by the distal protection device. RESULTS There was a significant correlation between the plaque volume and the number of the collected particles >100 μm in diameter (r = 0.48, P = 0.0034). Filter no-reflow (FNR) phenomenon was found in nine patients. The plaque volume was significantly greater (355 ± 133 mm(3) vs. 199 ± 90 mm(3) , P = 0.0004), and the lipid ratio was significantly higher (29.3 ± 4.3% vs. 26.1 ± 4.3 P = 0.045) in the FNR group compared with the non-FNR group. Multivariate logistic regression analysis showed that the plaque volume was an independent predictor of FNR phenomenon. CONCLUSIONS Although tissue characterization of IB-IVUS may provide additional information for distal embolization, plaque volume is the only significant predictor of distal embolization during PCI.
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Affiliation(s)
- Masahiko Shibuya
- Cardiovascular Division, Hyogo College of Medicine, Nishinomiya, Japan
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18
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Hong YJ, Jeong MH, Ahn Y, Kang JC, Mintz GS, Kim SW, Lee SY, Kim SY, Pichard AD, Satler LF, Waksman R, Weissman NJ. Intravascular ultrasound findings that are predictive of no reflow after percutaneous coronary intervention for saphenous vein graft disease. Am J Cardiol 2012; 109:1576-81. [PMID: 22440118 DOI: 10.1016/j.amjcard.2012.01.383] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2011] [Revised: 01/24/2012] [Accepted: 01/24/2012] [Indexed: 11/17/2022]
Abstract
The aim of this study was to investigate the relation between intravascular ultrasound (IVUS) findings and the no-reflow phenomenon and long-term outcome after percutaneous coronary intervention (PCI) of saphenous vein graft (SVG) lesions. No reflow was defined as Thrombolysis In Myocardial Infarction grade 0, 1, or 2 flow after PCI. Of 311 patients who underwent IVUS before and after stenting, no reflow was observed in 39 patients (13%). Degenerated SVG (62% vs 36%, p = 0.002), IVUS-detected intraluminal mass (82% vs 43%, p <0.001), culprit lesion multiple plaque ruptures (23% vs 6%, p <0.001), and tissue prolapse (51% vs 35%, p = 0.043) were observed more frequently in patients with no reflow. In multivariate logistic regression analysis, an intraluminal mass (odds ratio [OR] 4.84, 95% confidence interval [CI] 1.98 to 10.49, p = 0.001), culprit lesion multiple plaque ruptures (OR 3.46, 95% CI 1.46 to 8.41, p = 0.014), and degenerated SVGs (OR 3.17, 95% CI 1.17 to 6.56, p = 0.024) were the independent predictors of no reflow after PCI. At 5-year clinical follow-up, rates of death (14, 36%, vs 55, 20%, p = 0.036) and myocardial infarction (13, 33%, vs 52, 19%, p = 0.039) were significantly higher in the no-reflow group. However, rate of target vessel revascularization was not significantly different between the 2 groups (15, 38%, vs 90, 33%, p = 0.3). IVUS-detected intraluminal mass, multiple plaque ruptures, and degenerated SVGs were associated with no reflow in SVG lesions after PCI. In conclusion, no reflow was associated with poor long-term clinical outcomes after PCI for SVG lesions.
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Affiliation(s)
- Young Joon Hong
- Heart Center of Chonnam National University Hospital, Seoul, Korea
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19
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Niccoli G, Spaziani C, Cosentino N, Lombardo A, Fracassi F, Cataneo L, Loria V, Trani C, Burzotta F, Porto I, Leone AM, Crea F. Predictors of myocardial microvascular obstruction in patients treated by primary percutaneous coronary intervention and a short ischemic time. Int J Cardiol 2011; 153:113-5. [DOI: 10.1016/j.ijcard.2011.09.035] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2011] [Accepted: 09/11/2011] [Indexed: 11/30/2022]
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20
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Goldstein JA, Maini B, Dixon SR, Brilakis ES, Grines CL, Rizik DG, Powers ER, Steinberg DH, Shunk KA, Weisz G, Moreno PR, Kini A, Sharma SK, Hendricks MJ, Sum ST, Madden SP, Muller JE, Stone GW, Kern MJ. Detection of Lipid-Core Plaques by Intracoronary Near-Infrared Spectroscopy Identifies High Risk of Periprocedural Myocardial Infarction. Circ Cardiovasc Interv 2011; 4:429-37. [DOI: 10.1161/circinterventions.111.963264] [Citation(s) in RCA: 172] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- James A. Goldstein
- From the Department of Cardiovascular Medicine, William Beaumont Hospital, Royal Oak, MI (J.A.G., S.R.D., C.L.G.); Pinnacle Health, Moffitt Heart and Vascular Group, Wormleysburg, PA (B.M.); Veterans Affairs North Texas Healthcare System and University of Texas Southwestern Medical Center at Dallas, Dallas, TX (E.B.); Scottsdale Heart Group, Scottsdale Healthcare Hospital, Scottsdale, AZ (D.G.R.); Heart and Vascular Center, Medical University of South Carolina, Charleston, SC (E.R.P., D.H.S.); the
| | - Brijeshwar Maini
- From the Department of Cardiovascular Medicine, William Beaumont Hospital, Royal Oak, MI (J.A.G., S.R.D., C.L.G.); Pinnacle Health, Moffitt Heart and Vascular Group, Wormleysburg, PA (B.M.); Veterans Affairs North Texas Healthcare System and University of Texas Southwestern Medical Center at Dallas, Dallas, TX (E.B.); Scottsdale Heart Group, Scottsdale Healthcare Hospital, Scottsdale, AZ (D.G.R.); Heart and Vascular Center, Medical University of South Carolina, Charleston, SC (E.R.P., D.H.S.); the
| | - Simon R. Dixon
- From the Department of Cardiovascular Medicine, William Beaumont Hospital, Royal Oak, MI (J.A.G., S.R.D., C.L.G.); Pinnacle Health, Moffitt Heart and Vascular Group, Wormleysburg, PA (B.M.); Veterans Affairs North Texas Healthcare System and University of Texas Southwestern Medical Center at Dallas, Dallas, TX (E.B.); Scottsdale Heart Group, Scottsdale Healthcare Hospital, Scottsdale, AZ (D.G.R.); Heart and Vascular Center, Medical University of South Carolina, Charleston, SC (E.R.P., D.H.S.); the
| | - Emmanouil S. Brilakis
- From the Department of Cardiovascular Medicine, William Beaumont Hospital, Royal Oak, MI (J.A.G., S.R.D., C.L.G.); Pinnacle Health, Moffitt Heart and Vascular Group, Wormleysburg, PA (B.M.); Veterans Affairs North Texas Healthcare System and University of Texas Southwestern Medical Center at Dallas, Dallas, TX (E.B.); Scottsdale Heart Group, Scottsdale Healthcare Hospital, Scottsdale, AZ (D.G.R.); Heart and Vascular Center, Medical University of South Carolina, Charleston, SC (E.R.P., D.H.S.); the
| | - Cindy L. Grines
- From the Department of Cardiovascular Medicine, William Beaumont Hospital, Royal Oak, MI (J.A.G., S.R.D., C.L.G.); Pinnacle Health, Moffitt Heart and Vascular Group, Wormleysburg, PA (B.M.); Veterans Affairs North Texas Healthcare System and University of Texas Southwestern Medical Center at Dallas, Dallas, TX (E.B.); Scottsdale Heart Group, Scottsdale Healthcare Hospital, Scottsdale, AZ (D.G.R.); Heart and Vascular Center, Medical University of South Carolina, Charleston, SC (E.R.P., D.H.S.); the
| | - David G. Rizik
- From the Department of Cardiovascular Medicine, William Beaumont Hospital, Royal Oak, MI (J.A.G., S.R.D., C.L.G.); Pinnacle Health, Moffitt Heart and Vascular Group, Wormleysburg, PA (B.M.); Veterans Affairs North Texas Healthcare System and University of Texas Southwestern Medical Center at Dallas, Dallas, TX (E.B.); Scottsdale Heart Group, Scottsdale Healthcare Hospital, Scottsdale, AZ (D.G.R.); Heart and Vascular Center, Medical University of South Carolina, Charleston, SC (E.R.P., D.H.S.); the
| | - Eric R. Powers
- From the Department of Cardiovascular Medicine, William Beaumont Hospital, Royal Oak, MI (J.A.G., S.R.D., C.L.G.); Pinnacle Health, Moffitt Heart and Vascular Group, Wormleysburg, PA (B.M.); Veterans Affairs North Texas Healthcare System and University of Texas Southwestern Medical Center at Dallas, Dallas, TX (E.B.); Scottsdale Heart Group, Scottsdale Healthcare Hospital, Scottsdale, AZ (D.G.R.); Heart and Vascular Center, Medical University of South Carolina, Charleston, SC (E.R.P., D.H.S.); the
| | - Daniel H. Steinberg
- From the Department of Cardiovascular Medicine, William Beaumont Hospital, Royal Oak, MI (J.A.G., S.R.D., C.L.G.); Pinnacle Health, Moffitt Heart and Vascular Group, Wormleysburg, PA (B.M.); Veterans Affairs North Texas Healthcare System and University of Texas Southwestern Medical Center at Dallas, Dallas, TX (E.B.); Scottsdale Heart Group, Scottsdale Healthcare Hospital, Scottsdale, AZ (D.G.R.); Heart and Vascular Center, Medical University of South Carolina, Charleston, SC (E.R.P., D.H.S.); the
| | - Kendrick A. Shunk
- From the Department of Cardiovascular Medicine, William Beaumont Hospital, Royal Oak, MI (J.A.G., S.R.D., C.L.G.); Pinnacle Health, Moffitt Heart and Vascular Group, Wormleysburg, PA (B.M.); Veterans Affairs North Texas Healthcare System and University of Texas Southwestern Medical Center at Dallas, Dallas, TX (E.B.); Scottsdale Heart Group, Scottsdale Healthcare Hospital, Scottsdale, AZ (D.G.R.); Heart and Vascular Center, Medical University of South Carolina, Charleston, SC (E.R.P., D.H.S.); the
| | - Giora Weisz
- From the Department of Cardiovascular Medicine, William Beaumont Hospital, Royal Oak, MI (J.A.G., S.R.D., C.L.G.); Pinnacle Health, Moffitt Heart and Vascular Group, Wormleysburg, PA (B.M.); Veterans Affairs North Texas Healthcare System and University of Texas Southwestern Medical Center at Dallas, Dallas, TX (E.B.); Scottsdale Heart Group, Scottsdale Healthcare Hospital, Scottsdale, AZ (D.G.R.); Heart and Vascular Center, Medical University of South Carolina, Charleston, SC (E.R.P., D.H.S.); the
| | - Pedro R. Moreno
- From the Department of Cardiovascular Medicine, William Beaumont Hospital, Royal Oak, MI (J.A.G., S.R.D., C.L.G.); Pinnacle Health, Moffitt Heart and Vascular Group, Wormleysburg, PA (B.M.); Veterans Affairs North Texas Healthcare System and University of Texas Southwestern Medical Center at Dallas, Dallas, TX (E.B.); Scottsdale Heart Group, Scottsdale Healthcare Hospital, Scottsdale, AZ (D.G.R.); Heart and Vascular Center, Medical University of South Carolina, Charleston, SC (E.R.P., D.H.S.); the
| | - Annapoorna Kini
- From the Department of Cardiovascular Medicine, William Beaumont Hospital, Royal Oak, MI (J.A.G., S.R.D., C.L.G.); Pinnacle Health, Moffitt Heart and Vascular Group, Wormleysburg, PA (B.M.); Veterans Affairs North Texas Healthcare System and University of Texas Southwestern Medical Center at Dallas, Dallas, TX (E.B.); Scottsdale Heart Group, Scottsdale Healthcare Hospital, Scottsdale, AZ (D.G.R.); Heart and Vascular Center, Medical University of South Carolina, Charleston, SC (E.R.P., D.H.S.); the
| | - Samin K. Sharma
- From the Department of Cardiovascular Medicine, William Beaumont Hospital, Royal Oak, MI (J.A.G., S.R.D., C.L.G.); Pinnacle Health, Moffitt Heart and Vascular Group, Wormleysburg, PA (B.M.); Veterans Affairs North Texas Healthcare System and University of Texas Southwestern Medical Center at Dallas, Dallas, TX (E.B.); Scottsdale Heart Group, Scottsdale Healthcare Hospital, Scottsdale, AZ (D.G.R.); Heart and Vascular Center, Medical University of South Carolina, Charleston, SC (E.R.P., D.H.S.); the
| | - Michael J. Hendricks
- From the Department of Cardiovascular Medicine, William Beaumont Hospital, Royal Oak, MI (J.A.G., S.R.D., C.L.G.); Pinnacle Health, Moffitt Heart and Vascular Group, Wormleysburg, PA (B.M.); Veterans Affairs North Texas Healthcare System and University of Texas Southwestern Medical Center at Dallas, Dallas, TX (E.B.); Scottsdale Heart Group, Scottsdale Healthcare Hospital, Scottsdale, AZ (D.G.R.); Heart and Vascular Center, Medical University of South Carolina, Charleston, SC (E.R.P., D.H.S.); the
| | - Steve T. Sum
- From the Department of Cardiovascular Medicine, William Beaumont Hospital, Royal Oak, MI (J.A.G., S.R.D., C.L.G.); Pinnacle Health, Moffitt Heart and Vascular Group, Wormleysburg, PA (B.M.); Veterans Affairs North Texas Healthcare System and University of Texas Southwestern Medical Center at Dallas, Dallas, TX (E.B.); Scottsdale Heart Group, Scottsdale Healthcare Hospital, Scottsdale, AZ (D.G.R.); Heart and Vascular Center, Medical University of South Carolina, Charleston, SC (E.R.P., D.H.S.); the
| | - Sean P. Madden
- From the Department of Cardiovascular Medicine, William Beaumont Hospital, Royal Oak, MI (J.A.G., S.R.D., C.L.G.); Pinnacle Health, Moffitt Heart and Vascular Group, Wormleysburg, PA (B.M.); Veterans Affairs North Texas Healthcare System and University of Texas Southwestern Medical Center at Dallas, Dallas, TX (E.B.); Scottsdale Heart Group, Scottsdale Healthcare Hospital, Scottsdale, AZ (D.G.R.); Heart and Vascular Center, Medical University of South Carolina, Charleston, SC (E.R.P., D.H.S.); the
| | - James E. Muller
- From the Department of Cardiovascular Medicine, William Beaumont Hospital, Royal Oak, MI (J.A.G., S.R.D., C.L.G.); Pinnacle Health, Moffitt Heart and Vascular Group, Wormleysburg, PA (B.M.); Veterans Affairs North Texas Healthcare System and University of Texas Southwestern Medical Center at Dallas, Dallas, TX (E.B.); Scottsdale Heart Group, Scottsdale Healthcare Hospital, Scottsdale, AZ (D.G.R.); Heart and Vascular Center, Medical University of South Carolina, Charleston, SC (E.R.P., D.H.S.); the
| | - Gregg W. Stone
- From the Department of Cardiovascular Medicine, William Beaumont Hospital, Royal Oak, MI (J.A.G., S.R.D., C.L.G.); Pinnacle Health, Moffitt Heart and Vascular Group, Wormleysburg, PA (B.M.); Veterans Affairs North Texas Healthcare System and University of Texas Southwestern Medical Center at Dallas, Dallas, TX (E.B.); Scottsdale Heart Group, Scottsdale Healthcare Hospital, Scottsdale, AZ (D.G.R.); Heart and Vascular Center, Medical University of South Carolina, Charleston, SC (E.R.P., D.H.S.); the
| | - Morton J. Kern
- From the Department of Cardiovascular Medicine, William Beaumont Hospital, Royal Oak, MI (J.A.G., S.R.D., C.L.G.); Pinnacle Health, Moffitt Heart and Vascular Group, Wormleysburg, PA (B.M.); Veterans Affairs North Texas Healthcare System and University of Texas Southwestern Medical Center at Dallas, Dallas, TX (E.B.); Scottsdale Heart Group, Scottsdale Healthcare Hospital, Scottsdale, AZ (D.G.R.); Heart and Vascular Center, Medical University of South Carolina, Charleston, SC (E.R.P., D.H.S.); the
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Gregorini L, Marco J, Heusch G. Peri-interventional coronary vasomotion. J Mol Cell Cardiol 2011; 52:883-9. [PMID: 21971073 DOI: 10.1016/j.yjmcc.2011.09.017] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2011] [Revised: 09/05/2011] [Accepted: 09/14/2011] [Indexed: 12/21/2022]
Abstract
A percutaneous coronary intervention (PCI) is a unique condition to study the effects of ischemia and reperfusion in patients with severe coronary atherosclerosis when coronary vasomotor function is compromised by loss of endothelial and autoregulatory vasodilation. We studied the effects of intracoronary non-selective α-, as well as selective α(1)- and α(2)-blockade in counteracting the observed vasoconstriction in patients with stable and unstable angina and in patients with acute myocardial infarction. Coronary vasoconstriction in our studies was a diffuse phenomenon and involved not only the culprit lesion but also vessels with angiographically not visible plaques. Post-PCI vasoconstriction was reflected by increased coronary vascular resistance and associated with decreased LV-function. α (1)-Blockade with urapidil dilated epicardial coronary arteries, improved coronary flow reserve and counteracted LV dysfunction. Non-selective α-blockade with phentolamine induced epicardial and microvascular dilation, while selective α(2)-blockade with yohimbine had only minor vasodilator and functional effects. Intracoronary α-blockade also attenuated the no-reflow phenomenon following primary PCI. This article is part of a Special Issue entitled "Coronary Blood Flow".
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Affiliation(s)
- Luisa Gregorini
- Centro Cardiologico Monzino, IRCCS, Department of Cardiovascular Sciences, University of Milan, Via Parea 4, Milan, Italy.
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22
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Ozaki Y, Tanaka A, Tanimoto T, Kitabata H, Kashiwagi M, Kubo T, Takarada S, Ishibashi K, Komukai K, Ino Y, Hirata K, Mizukoshi M, Imanishi T, Akasaka T. Thin-cap fibroatheroma as high-risk plaque for microvascular obstruction in patients with acute coronary syndrome. Circ Cardiovasc Imaging 2011; 4:620-7. [PMID: 21946700 DOI: 10.1161/circimaging.111.965616] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
BACKGROUND Plaque contents can cause microvascular impairment, which is an important determinant of clinical outcomes in patients with acute coronary syndrome (ACS). We hypothesized that percutaneous coronary intervention (PCI) for thin-cap fibroatheroma (TCFA) could easily disrupt the fibrous cap and expose the contents of plaque to coronary flow, possibly resulting in microvascular obstruction (MVO). The purpose of this study was to investigate whether TCFA was associated with MVO after PCI in patients with ACS. METHODS AND RESULTS We enrolled 115 patients with ACS who were successfully recanalized with PCI. The patients were divided into a ruptured plaque group (n=59), a nonrupture with TCFA group (n=21), and a nonrupture and non-TCFA group (n=35), according to optical coherence tomography findings of the culprit lesion. Using contrast-enhanced MRI, we assessed MVO. There were no statistically significant differences in patient characteristics. The nonrupture with TCFA group more frequently presented MVO (ruptured plaque, 27%; versus nonrupture with TCFA, 43%; versus non-TCFA and nonrupture, 9%; P=0.012). The prevalence of MVO increases as cap thickness decreases. CONCLUSIONS TCFA is more frequently associated with MVO after PCI. TCFA is a high-risk plaque for MVO after PCI in patients with ACS.
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Affiliation(s)
- Yuichi Ozaki
- Department of Cardiovascular Medicine, Wakayama Medical University, Kimiidera, Wakayama, Japan
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23
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Kubo T, Matsuo Y, Ino Y, Tanimoto T, Ishibashi K, Komukai K, Kitabata H, Tanaka A, Kimura K, Imanishi T, Akasaka T. Optical coherence tomography analysis of attenuated plaques detected by intravascular ultrasound in patients with acute coronary syndromes. Cardiol Res Pract 2011; 2011:687515. [PMID: 21941667 PMCID: PMC3173965 DOI: 10.4061/2011/687515] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2011] [Accepted: 07/14/2011] [Indexed: 11/20/2022] Open
Abstract
Background. Recent intravascular ultrasound (IVUS) studies have demonstrated that hypoechoic plaque with deep ultrasound attenuation despite absence of bright calcium is common in acute coronary syndrome. Such “attenuated plaque” may be an IVUS characteristic of unstable lesion.
Methods. We used optical coherence tomography (OCT) in 104 patients with unstable angina to compare lesion characteristics between IVUS-detected attenuated plaque and nonattenuated plaque.
Results. IVUS-detected attenuated plaque was observed in 41 (39%) patients. OCT-detected lipidic plaque (88% versus 49%, P < 0.001), thin-cap fibroatheroma (48% versus 16%, P < 0.001), plaque rupture (44% versus 11%, P < 0.001), and intracoronary thrombus (54% versus 17%, P < 0.001) were more often seen in IVUS-detected attenuated plaques compared with nonattenuated plaques.
Conclusions. IVUS-detected attenuated plaque has many characteristics of unstable coronary lesion. The presence of attended plaque might be an important marker of lesion instability.
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Affiliation(s)
- Takashi Kubo
- Department of Cardiovascular Medicine, Wakayama Medical University, 811-1, Kimiidera, Wakayama 641-8510, Japan
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Medvegy M, Simonyi G, Medvegy N, Pécsvárady Z. Non-ST elevation myocardial infarction: a new pathophysiological concept could solve the contradiction between accepted cause and clinical observations. ACTA PHYSIOLOGICA HUNGARICA 2011; 98:252-261. [PMID: 21893464 DOI: 10.1556/aphysiol.98.2011.3.2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
UNLABELLED Non-ST elevation myocardial infarction (NSTEMI) and ST elevation infarction have many differences in their appearance and prognosis. A comprehensive search made us form a new hypothesis that a further cause also existsin NSTEMI: an acute, critical increase in the already existing high microvascular resistance in addition to the subtotal coronary artery occlusion. Various findings and studies can be interpreted only by our hypothesis: hemodynamic findings, ECG changes, autopsy reports and clinical observations (different long-time prognosis and different result of acute revascularization therapy in NSTEMI, similarities of NSTEMI with other clinical symptoms where increased microvascular resistance can be supposed without coronary artery disease). OBJECTIVE Despite similarities in the underlying pathologic mechanism non-ST elevation myocardial infarction(NSTEMI) and ST elevation infarction (STEMI) have many differences in their clinical presentation and prognosis. METHOD A systematic review of the literature about NSTEMI and the blood supply of the myocardium made us form a hypothesis that a further cause also exists in addition to the accepted cause of NSTEMI (subtotal coronaryartery occlusion): an acute, critical increase in an already existing high intramyocardial microvascular resistance. EVIDENCE Knowledge about microcirculation disturbances in ischemic heart disease and development of microcirculation damage can be fitted in our hypothesis. Various findings and studies can be interpreted only by our hypothesis: hemodynamic findings, ECG changes, autopsy reports and clinical observations about NSTEMI. The latest ones involve the different long-time prognosis and different result of acute revascularization therapy in STEMI and NSTEMI. Regarding the repolarization changes on the ECG NSTEMI shows similarities with other clinical symptoms where increased intramyocardial microvascular resistance can be supposed without coronary artery disease: false positive exercise stress test, supraventricular tachycardia, left ventricular strain and conduction disturbances. CONCLUSION The acute treatment of NSTEMI should aim to improve the blood inflow to the stiff myocardiumand/or impaired microvascular system and decrease the high microvascular resistance.
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Nakata T, Fujii K, Fukunaga M, Kawasaki D, Kawabata-Lee M, Masutani M, Ohyanagi M, Masuyama T. The impact of plaque characterization assessed by intravascular ultrasound on myocardial perfusion after primary angioplasty in patients With ST-segment elevation myocardial infarction. Circ J 2011; 75:2642-7. [PMID: 21836367 DOI: 10.1253/circj.cj-11-0011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Previous studies described that inadequate tissue perfusion after primary angioplasty in ST-elevation myocardial infarction (STEMI) patients is associated with adverse cardiac events. This study evaluated whether plaque morphological intravascular ultrasound (IVUS) characteristics affects tissue perfusion after stent implantation in STEMI patients. METHODS AND RESULTS A total of consecutive 306 STEMI patients who underwent primary angioplasty with IVUS were analyzed. Maximum ST-segment elevation before angioplasty was compared with ST-segment levels 60min after angioplasty. Percent ST-segment resolution (STR) was calculated and categorized as complete (>70%), partial (30-70%), and absent (<30%). Qualitative and quantitative IVUS analyses were performed using standard methods. Plaque with ultrasound attenuation was defined as IVUS finding with backward signal attenuation behind plaque >180° without dense calcium. One-hundred-fifty patients had complete, 101 had partial, and 55 had absent STR. The incidence of in-hospital death tended to be higher in absent STR than in partial and complete STR groups. Multivariate analysis indicated that remodeling index (P=0.004), the presence of ultrasound attenuation (P=0.02), percentage stent expansion (P=0.03), and the presence of deep calcium (P=0.049) were the independent predictors related to the occurrence of absent STR after angioplasty. CONCLUSIONS Positive vessel remodeling, plaque with ultrasound attenuation >180°, deep calcium, and stent overexpansion as assessed by IVUS are associated with the absence of STR after primary angioplasty in patients with STEMI.
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Affiliation(s)
- Tsuyoshi Nakata
- Cardiovascular Division, Hyogo College of Medicine, Nishinomiya, Japan
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Sakata K, Kawashiri MA, Ino H, Matsubara T, Uno Y, Yasuda T, Miwa K, Kanaya H, Yamagishi M. Intravascular ultrasound appearance of scattered necrotic core as an index for deterioration of coronary flow during intervention in acute coronary syndrome. Heart Vessels 2011; 27:443-52. [PMID: 21837498 DOI: 10.1007/s00380-011-0175-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2010] [Accepted: 07/08/2011] [Indexed: 12/22/2022]
Abstract
In acute coronary syndrome (ACS) patients with deterioration of coronary flow during percutaneous coronary intervention (PCI), a scattered necrotic core pattern (SNC) is observed by intravascular ultrasound virtual histology (VH-IVUS). The purpose of this study was to evaluate the impact of SNC on deterioration of coronary flow during PCI in ACS. A total of 38 ACS patients were imaged using VH-IVUS before PCI. In addition to conventional definitions of thin-cap fibroatheroma by VH-IVUS (ID-TCFA), the SNC was defined as necrotic core foci with a maximum diameter of <14 pixels on a 400 × 400 VH-IVUS image in the presence of >50% plaque burden except in the ID-TCFA frame. Patients were divided into deterioration of coronary flow group (n = 15) and normal-reflow group (n = 23). The incidence of residual thrombus and plaque rupture, the external elastic membrane, plaque and fibrous volumes, the incidence of ID-TCFA and the average number of SNC per frame was significantly greater in deterioration of coronary flow group than in normal-reflow group (all parameters P < 0.05). Multivariate analysis revealed that the average number of SNC per frame was independently associated with deterioration of coronary flow in ACS patients (odds ratio 1.18, P < 0.05). In conclusion, an increased number of SNC is associated with deterioration of coronary flow during PCI in ACS patients.
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Affiliation(s)
- Kenji Sakata
- Division of Cardiovascular Medicine, Kanazawa University Graduate School of Medicine, 13-1 Takara-machi, Kanazawa, Ishikawa 920-8640, Japan.
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Utsunomiya M, Hara H, Sugi K, Nakamura M. Relationship between tissue characterisations with 40 MHz intravascular ultrasound imaging and slow flow during coronary intervention. EUROINTERVENTION 2011; 7:340-6. [DOI: 10.4244/eijv7i3a58] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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The Relationship Between Attenuated Plaque Identified by Intravascular Ultrasound and No-Reflow After Stenting in Acute Myocardial Infarction. JACC Cardiovasc Interv 2011; 4:495-502. [DOI: 10.1016/j.jcin.2010.12.012] [Citation(s) in RCA: 92] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2010] [Accepted: 12/26/2010] [Indexed: 11/22/2022]
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Assessment of Echo-Attenuated Plaque by Optical Coherence Tomography and its Impact on Post-Procedural Creatine Kinase-Myocardial Band Elevation in Elective Stent Implantation. JACC Cardiovasc Interv 2011; 4:483-91. [DOI: 10.1016/j.jcin.2010.12.013] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2010] [Revised: 11/29/2010] [Accepted: 12/09/2010] [Indexed: 11/22/2022]
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Endo M, Hibi K, Shimizu T, Komura N, Kusama I, Otsuka F, Mitsuhashi T, Iwahashi N, Okuda J, Tsukahara K, Kosuge M, Ebina T, Umemura S, Kimura K. Impact of Ultrasound Attenuation and Plaque Rupture as Detected by Intravascular Ultrasound on the Incidence of No-Reflow Phenomenon After Percutaneous Coronary Intervention in ST-Segment Elevation Myocardial Infarction. JACC Cardiovasc Interv 2010; 3:540-9. [DOI: 10.1016/j.jcin.2010.01.015] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2009] [Revised: 12/22/2009] [Accepted: 01/08/2010] [Indexed: 11/16/2022]
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Funayama H, Ishikawa SE, Sugawara Y, Kubo N, Momomura SI, Kawakami M. Myeloperoxidase may contribute to the no-reflow phenomenon in patients with acute myocardial infarction. Int J Cardiol 2010; 139:187-92. [DOI: 10.1016/j.ijcard.2008.10.018] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2008] [Revised: 07/29/2008] [Accepted: 10/12/2008] [Indexed: 10/21/2022]
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Yamada R, Okura H, Kume T, Neishi Y, Kawamoto T, Miyamoto Y, Imai K, Saito K, Tsuchiya T, Hayashida A, Yoshida K. Target Lesion Thin-Cap Fibroatheroma Defined by Virtual Histology Intravascular Ultrasound Affects Microvascular Injury During Percutaneous Coronary Intervention in Patients With Angina Pectoris. Circ J 2010; 74:1658-62. [DOI: 10.1253/circj.cj-09-0992] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
| | | | - Teruyoshi Kume
- Division of Cardiovascular Medicine, Stanford University
| | - Yoji Neishi
- Division of Cardiology, Kawasaki Medical School
| | | | | | | | - Ken Saito
- Division of Cardiology, Kawasaki Medical School
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Kimura S, Kakuta T, Yonetsu T, Suzuki A, Iesaka Y, Fujiwara H, Isobe M. Clinical significance of echo signal attenuation on intravascular ultrasound in patients with coronary artery disease. Circ Cardiovasc Interv 2009; 2:444-54. [PMID: 20031755 DOI: 10.1161/circinterventions.108.821124] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
BACKGROUND Atherosclerotic plaque that shows echo signal attenuation (EA) without associated bright echoes is sometimes observed by intravascular ultrasound but its clinical significance remains unclear. We investigated the impact of EA on coronary perfusion and evaluated the pathological features of plaque with EA. METHODS AND RESULTS We studied 687 native coronary lesions in 687 consecutive patients (336 with acute coronary syndrome and 351 with stable angina pectoris) who underwent intravascular ultrasound before percutaneous coronary intervention. By subgroup analysis, 60 lesions (30 lesions with EA) treated with directional coronary atherectomy underwent pathological examination. The Thrombolysis in Myocardial Infarction (TIMI) flow grade and myocardial blush grade after percutaneous coronary intervention were compared between lesions with and without EA in 627 lesions except directional coronary atherectomy subgroup. EA was observed in 245 lesions (35.7%), and coronary flow after percutaneous coronary intervention was worse for lesions with EA than without (final TIMI grade of 0 to 2: 15.4% versus 2.4%, P<0.001; final myocardial blush grade of 0 to 2: 45.6% versus 21.4%, P<0.001). Multivariate analysis revealed a significant association between no reflow (TIMI grade 0 to 2) and EA (odds ratio, 5.59; 95% CI, 2.64 to 11.85; P<0.001), a baseline TIMI grade of 0 to 2 (odds ratio, 5.91; 95% CI, 2.79 to 12.5; P<0.001), and a large reference area (odds ratio, 3.08; 95% CI, 1.40 to 6.76; P=0.005) after controlling for other associated factors. Pathological examination revealed a significantly higher frequency of lipid-rich plaque with microcalcification in lesions with EA. CONCLUSIONS Atherosclerotic plaque with EA showed a significant association with no reflow after percutaneous coronary intervention, suggesting the existence of fragile components susceptible to distal embolization.
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Affiliation(s)
- Shigeki Kimura
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan
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Hong YJ, Jeong MH, Choi YH, Ko JS, Lee MG, Kang WY, Lee SE, Kim SH, Park KH, Sim DS, Yoon NS, Youn HJ, Kim KH, Park HW, Kim JH, Ahn Y, Cho JG, Park JC, Kang JC. Predictors of no-reflow after percutaneous coronary intervention for culprit lesion with plaque rupture in infarct-related artery in patients with acute myocardial infarction. J Cardiol 2009; 54:36-44. [DOI: 10.1016/j.jjcc.2009.03.003] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2009] [Revised: 02/11/2009] [Accepted: 03/11/2009] [Indexed: 10/20/2022]
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Sattler KJ, Herrmann J, Yun S, Lehmann N, Wang Z, Heusch G, Sack S, Erbel R, Levkau B. High high-density lipoprotein-cholesterol reduces risk and extent of percutaneous coronary intervention-related myocardial infarction and improves long-term outcome in patients undergoing elective percutaneous coronary intervention. Eur Heart J 2009; 30:1894-902. [DOI: 10.1093/eurheartj/ehp183] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Tanaka A, Imanishi T, Kitabata H, Kubo T, Takarada S, Tanimoto T, Kuroi A, Tsujioka H, Ikejima H, Komukai K, Kataiwa H, Okouchi K, Kashiwaghi M, Ishibashi K, Matsumoto H, Takemoto K, Nakamura N, Hirata K, Mizukoshi M, Akasaka T. Lipid-rich plaque and myocardial perfusion after successful stenting in patients with non-ST-segment elevation acute coronary syndrome: an optical coherence tomography study. Eur Heart J 2009; 30:1348-55. [DOI: 10.1093/eurheartj/ehp122] [Citation(s) in RCA: 141] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Hong YJ, Jeong MH, Choi YH, Ko JS, Lee MG, Kang WY, Lee SE, Kim SH, Park KH, Sim DS, Yoon NS, Youn HJ, Kim KH, Park HW, Kim JH, Ahn Y, Cho JG, Park JC, Kang JC. Impact of plaque components on no-reflow phenomenon after stent deployment in patients with acute coronary syndrome: a virtual histology-intravascular ultrasound analysis. Eur Heart J 2009; 32:2059-66. [PMID: 19228713 PMCID: PMC3155758 DOI: 10.1093/eurheartj/ehp034] [Citation(s) in RCA: 76] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Aims We used virtual histology-intravascular ultrasound (VH-IVUS) to evaluate the relation between coronary plaque characteristics and no-reflow in acute coronary syndrome (ACS) patients. Methods and results A total of 190 consecutive ACS patients were imaged using VH-IVUS and analysed retrospectively. Angiographic no-reflow was defined as TIMI flow grade 0, 1, and 2 after stenting. Virtual histology-intravascular ultrasound classified the colour-coded tissue into four major components: fibrotic, fibro-fatty, dense calcium, and necrotic core (NC). Thin-cap fibroatheroma (TCFA) was defined as focal, NC-rich (≥10% of the cross-sectional area) plaques being in contact with the lumen in a plaque burden ≥40%. Of the 190 patients studied at pre-stenting, no-reflow was observed in 24 patients (12.6%) at post-stenting. The absolute and %NC areas at the minimum lumen sites (1.6 ± 1.2 vs. 0.9 ± 0.8 mm2, P < 0.001, and 24.5 ± 14.3 vs. 16.1 ± 10.6%, P = 0.001, respectively) and the absolute and %NC volumes (30 ± 24 vs. 16 ± 17 mm3, P = 0.001, and 22 ± 11 vs. 14 ± 8%, P < 0.001, respectively) were significantly greater, and the presence of at least one TCFA and multiple TCFAs within culprit lesions (71 vs. 36%, P = 0.001, and 38 vs. 15%, P = 0.005, respectively) was significantly more common in the no-reflow group compared with the normal-reflow group. In the multivariable analysis, %NC volume was the only independent predictor of no-reflow (odds ratio = 1.126; 95% CI 1.045–1.214, P = 0.002). Conclusion In ACS patients, post-stenting no-reflow is associated with plaque components defined by VH-IVUS analysis with larger NC and more TCFAs.
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Affiliation(s)
- Young Joon Hong
- Heart Center of Chonnam National University Hospital, Chonnam National University Research Institute of Medical Sciences, 671 Jaebongro, Dong-gu, Gwangju 501-757, Republic of Korea
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Carlsson M, Wilson M, Martin AJ, Saeed M. Myocardial microinfarction after coronary microembolization in swine: MR imaging characterization. Radiology 2009; 250:703-13. [PMID: 19164123 DOI: 10.1148/radiol.2503081000] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
PURPOSE To use first-pass perfusion and delayed-enhanced (DE) magnetic resonance (MR) imaging for the detection of the early effects of coronary microembolization on myocardial perfusion and viability. MATERIALS AND METHODS Approval was obtained from the institutional committee on animal research. A hybrid x-ray and MR imaging system was used to guide the endovascular catheter and quantify the left anterior descending coronary artery (LAD) perfusion territory before microembolization and ischemic myocardium and microinfarction after microembolization. The embolic agent was selectively delivered in the LAD in six pigs. First-pass perfusion MR imaging was performed 1 hour and 1 week after microembolization. Microinfarction was measured on DE MR images in beating and nonbeating hearts (high-spatial-resolution sequence) by using extracellular and blood pool MR contrast media and after death. The Wilcoxon signed rank test and correlation analysis were used. RESULTS The LAD perfusion territory was 35% of left ventricular (LV) mass +/- 2 (standard error of the mean). Microembolization caused perfusion deficit in 15.7% of LV mass +/- 2.6 compared with that of LAD territory (P = .03). At 1 week, perfusion parameters improved and the extent of hypoperfused territory declined (4.6% of LV mass +/- 1.4, P = .03). Microinfarction size expanded from 1.4% of LV mass +/- 0.2 at 1 hour to 7.5% of LV mass +/- 1.2 at 1 week. In nonbeating hearts and at triphenyltetrazolium chloride staining at 1 week, microinfarction size was 7.6% of LV mass +/- 1.4 and 7.2% of LV mass +/- 1.5, respectively. There was no correlation between the ejection fraction and the extents of microinfarction or hypoperfused territory. Histopathologic findings confirmed the presence of patchy microinfarction. CONCLUSION Coronary microembolization caused persistent decline in myocardial perfusion at first-pass perfusion imaging. DE MR imaging has the potential to help reliably quantify subacute microinfarction. The magnitude of LV dysfunction is not related to the extents of microinfarction or hypoperfused territory.
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Affiliation(s)
- Marcus Carlsson
- Department of Radiology and Biomedical Imaging, University of California San Francisco, 513 Parnassus Ave, HSW 207B, San Francisco, CA 94134, USA
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Attenuated Plaque Detected by Intravascular Ultrasound. JACC Cardiovasc Interv 2009; 2:65-72. [DOI: 10.1016/j.jcin.2008.08.022] [Citation(s) in RCA: 108] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2008] [Accepted: 08/30/2008] [Indexed: 12/13/2022]
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Kawai Y, Hisamatsu K, Matsubara H, Dan K, Akagi S, Miyaji K, Munemasa M, Fujimoto Y, Kusano KF, Ohe T. Intravenous administration of nicorandil immediately before percutaneous coronary intervention can prevent slow coronary flow phenomenon. Eur Heart J 2008; 30:765-72. [DOI: 10.1093/eurheartj/ehp077] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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De Carlo M, Wood DA, Webb JG, Gerckens U, Cortese B, Grube E, Mancini GJ, Krucoff MW, Rn CM, Goff T, Petronio AS, Hamburger JN. Adjunctive use of the Rinspiration system for fluidic thrombectomy during primary angioplasty: The Rinspiration international registry. Catheter Cardiovasc Interv 2008; 72:196-203. [DOI: 10.1002/ccd.21596] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Higashikuni Y, Tanabe K, Tanimoto S, Aoki J, Yamamoto H, Nakazawa G, Chihara R, Onuma Y, Ohtsuki S, Yagishita A, Yachi S, Nakajima H, Hara K. Impact of Culprit Plaque Composition on the No-Reflow Phenomenon in Patients With Acute Coronary Syndrome An Intravascular Ultrasound Radiofrequency Analysis. Circ J 2008; 72:1235-41. [DOI: 10.1253/circj.72.1235] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
| | - Kengo Tanabe
- Division of Cardiology, Mitsui Memorial Hospital
| | | | - Jiro Aoki
- Division of Cardiology, Mitsui Memorial Hospital
| | | | | | - Ruri Chihara
- Division of Cardiology, Mitsui Memorial Hospital
| | | | | | | | - Sen Yachi
- Division of Cardiology, Mitsui Memorial Hospital
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Kawamoto T, Okura H, Koyama Y, Toda I, Taguchi H, Tamita K, Yamamuro A, Yoshimura Y, Neishi Y, Toyota E, Yoshida K. The Relationship Between Coronary Plaque Characteristics and Small Embolic Particles During Coronary Stent Implantation. J Am Coll Cardiol 2007; 50:1635-40. [DOI: 10.1016/j.jacc.2007.05.050] [Citation(s) in RCA: 107] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2007] [Revised: 05/16/2007] [Accepted: 05/21/2007] [Indexed: 11/16/2022]
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Nakamura T, Kubo N, Ako J, Momomura SI. Angiographic No-Reflow Phenomenon and Plaque Characteristics by Virtual Histology Intravascular Ultrasound in Patients with Acute Myocardial Infarction. J Interv Cardiol 2007; 20:335-9. [PMID: 17880329 DOI: 10.1111/j.1540-8183.2007.00282.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE This study aimed to evaluate the relationship between the occurrence of the angiographic no-reflow phenomenon in patients with acute myocardial infarction (AMI) and the preintervention plaque composition as assessed by virtual histology intravascular ultrasound (VH-IVUS). BACKGROUND The angiographic no-reflow phenomenon is an adverse prognostic factor in patients with AMI. METHOD We enrolled consecutive 50 patients with ST-elevation AMI was treated by primary stent implantation. All culprit lesions were imaged by VH-IVUS before stent implantation. The angiographic no-reflow phenomenon was defined as a decrease in final TIMI flow grade compared with TIMI flow grade before stent implantation. RESULTS Eight of 50 patients developed angiographic no-reflow after stent implantation. Gray-scale intravascular ultrasound (IVUS) showed significantly larger external elastic membrane volume and plaque burden in the no-reflow group. VH-IVUS showed a trend toward larger percentage of fibro-fatty plaque volume in the no-reflow group than in the reflow group (23.1 +/- 3.5 vs. 17.0 +/- 1.1%, P = 0.05). The presence of "marble"-like image, mainly consisting of fibro-fatty and fibrous plaque (plaque volume of fibro-fatty + fibrous >80% and containing fibro-fatty plaque volume >10%) was associated with angiographic no-reflow (P = 0.02). Corrected TIMI frame counts of the cases with "marble"-like image were significantly larger than the cases without it (46.8 +/- 5.6 vs. 27.4 +/- 2.3, P = 0.01). CONCLUSION The culprit lesions with large plaque burden, or with "marble"-like image by VH-IVUS, are associated with the angiographic no-reflow phenomenon in patients with AMI.
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Affiliation(s)
- Tomohiro Nakamura
- Cardiovascular Division, Jichi Medical University, Omiya Medical Center, Saitama, Japan.
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Böse D, Leineweber K, Konorza T, Zahn A, Bröcker-Preuss M, Mann K, Haude M, Erbel R, Heusch G. Release of TNF-α during stent implantation into saphenous vein aortocoronary bypass grafts and its relation to plaque extrusion and restenosis. Am J Physiol Heart Circ Physiol 2007; 292:H2295-9. [PMID: 17208993 DOI: 10.1152/ajpheart.01116.2006] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The reduction in plaque volume during stent implantation is associated with the release of particulate debris and plaque-derived soluble substances. We studied the potential release of the proinflammatory cytokine TNF-α into the coronary circulation and whether such release is related to the reduction in plaque volume and, possibly, a predictor for restenosis. In 18 male patients ( n = 24 stents) with severe stenosis in a saphenous vein aortocoronary bypass graft (SVG), we used a distal balloon occlusion-aspiration device during stent implantation. The aspirate TNF-α levels were determined before and after stent implantation and related to the angiographic and intravascular ultrasound-assessed severity of stenosis and restenosis. We found that TNF-α is, indeed, released into the aspirate of stented SVG (9 ± 1 and 28 ± 3 pg/ml before and after stent implantation, respectively, P < 0.0001) and that such release is related to the reduction in plaque volume ( r = 0.88, P < 0.0001) and associated with restenosis after 5 mo ( r = 0.71, P = 0.001). The periprocedural release of plaque-derived TNF-α possibly represents the amount and activity of the atherosclerotic process and might be a predictor for restenosis.
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Affiliation(s)
- Dirk Böse
- Department of Cardiology, University of Essen Medical School, Hufelandstrasse 55, 45147 Essen, Germany
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Okura H, Taguchi H, Kubo T, Toda I, Yoshida K, Yoshiyama M, Yoshikawa J. Atherosclerotic Plaque With Ultrasonic Attenuation Affects Coronary Reflow and Infarct Size in Patients With Acute Coronary Syndrome An Intravascular Ultrasound Study. Circ J 2007; 71:648-53. [PMID: 17456986 DOI: 10.1253/circj.71.648] [Citation(s) in RCA: 70] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND No reflow following percutaneous coronary intervention (PCI) is a major concern in patients with acute coronary syndrome (ACS) and it may be influenced by the preexisting plaque type. METHODS AND RESULTS To evaluate the impact of plaque characteristics on coronary reflow following PCI in patients with ACS, a total of 110 patients (89 acute myocardial infarction, 21 unstable angina) were assessed by intravascular ultrasound. Plaque type was categorized as either atherosclerotic plaque without ultrasonic attenuation (group 1) or atherosclerotic plaque with attenuation (group 2). External elastic membrane, plaque plus media, and lumen area were measured. Coronary flow was assessed by Thrombolysis in Myocardial Infarction (TIMI) grade and TIMI frame count. Although the final TIMI frame count was similar between the 2 groups, TIMI frame count immediately after the first balloon inflation was significantly higher in group 2 (p=0.03). Despite the similar final TIMI grade and TIMI frame count, peak creatine kinase level was significantly higher (3,035+/-2,553 vs 1,950+/-1,958 IU/L, p=0.04) and fatal arrhythmia more frequently observed (16.4% vs 2.7%, p=0.04) in group 2 than in group 1. CONCLUSIONS Atherosclerotic plaque with ultrasonic attenuation may be related to a transient deterioration in coronary flow and as a result larger infarct size and higher incidence of fatal arrhythmia following PCI in patients with ACS. These results may help in selecting lesions suitable for distal protection devices.
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Affiliation(s)
- Hiroyuki Okura
- Division of Cardiology, Bell Land General Hospital, Sakai, Japan.
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Porto I, Selvanayagam JB, Van Gaal WJ, Prati F, Cheng A, Channon K, Neubauer S, Banning AP. Plaque volume and occurrence and location of periprocedural myocardial necrosis after percutaneous coronary intervention: insights from delayed-enhancement magnetic resonance imaging, thrombolysis in myocardial infarction myocardial perfusion grade analysis, and intravascular ultrasound. Circulation 2006; 114:662-9. [PMID: 16894040 DOI: 10.1161/circulationaha.105.593210] [Citation(s) in RCA: 150] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Myocardial necrosis can occur during percutaneous coronary intervention (PCI) despite optimal adjunctive pharmacology and careful technique. We investigated the mechanisms of procedural infarction using angiographic analysis, intravascular ultrasound, and delayed-enhancement magnetic resonance imaging. METHODS AND RESULTS Fifty-two patients (64 vessels) who underwent complex PCI were studied. All patients were preloaded with clopidogrel and received glycoprotein IIb/IIIa inhibitors. "Adjacent" myonecrosis was defined as the presence of an area of new gadolinium hyperenhancement close to the stent. "Distal" myonecrosis was defined as situated at least 10 mm downstream from the stent. Fifteen vessels (23%) had evidence of new hyperenhancement after PCI. Of these, 8 (12%) had the distal type, and 7 (11%) had the adjacent type. Intravascular ultrasound showed a significantly greater reduction in plaque volume (91.6+/-51.5 versus 8+/-14 versus 20+/-35 mm3; P < 0.001) in the group with distal hyperenhancement compared with patients without new hyperenhancement or adjacent hyperenhancement. In the entire sample, a significant correlation was seen between changes in plaque volume (rho = 0.58, P < 0.001) after PCI and the mass of new necrosis measured by magnetic resonance imaging. Thrombolysis in Myocardial Infarction perfusion grade assessment of a closed microvasculature after PCI carried an odds ratio of 8.0 (95% confidence interval, 1.4 to 46.1; P = 0.02) for the occurrence of hyperenhancement, whereas side-branch occlusion was associated with an odds ratio of 16.2 (95% confidence interval, 2.6 to 102.5; P = 0.03). However, a closed microvasculature was associated with distal hyperenhancement (P = 0.02), and side-branch occlusion was associated with adjacent hyperenhancement (P < 0.001). CONCLUSIONS These data suggest that distal embolization of plaque material occurs in contemporary PCI of native coronary arteries. Efforts to minimize procedural necrosis may require careful review of side branch anatomy and/or use of distal protection during extensive coronary stenting.
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Affiliation(s)
- Italo Porto
- Department of Cardiology, John Radcliffe Hospital, Oxford, OX3 9DU, UK
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Fujii K, Ochiai M, Mintz GS, Kan Y, Awano K, Masutani M, Ashida K, Ohyanagi M, Ichikawa S, Ura S, Araki H, Stone GW, Moses JW, Leon MB, Carlier SG. Procedural implications of intravascular ultrasound morphologic features of chronic total coronary occlusions. Am J Cardiol 2006; 97:1455-62. [PMID: 16679083 DOI: 10.1016/j.amjcard.2005.11.079] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2005] [Revised: 11/21/2005] [Accepted: 11/21/2005] [Indexed: 10/24/2022]
Abstract
Although the success rates of percutaneous coronary intervention of chronic total occlusions (CTOs) have improved, morphologic features are not well known. We analyzed experience at 4 centers where intravascular ultrasound (IVUS) was performed in 67 native artery CTO lesions (mean CTO duration 6.3 months) just after the lesion was crossed with a guidewire (n = 7) or after dilatation with a 1.5-mm (n = 46) or 2.0-mm (n = 14) balloon. IVUS detected calcium somewhere in the CTO in 96%; however, only 68% had mild calcium. IVUS identified a proximal end of the CTO in all lesions, but a distal end of the CTO in only 50%. An intramural hematoma was observed in 34% of CTOs, suggesting that the guidewire frequently entered the medial space during successful recanalization. CTOs were longer, vessel area was smaller, and total calcium index was greater in lesions with hematomas (p = 0.003, 0.05, and 0.03, respectively). Inadequate reflow after the procedure was observed in 9% and was associated with longer lesions and intralesional calcium. CTO length as measured with angiography was shorter than the length as measured with IVUS (p = 0.02). Calcium was detected on the angiogram in 61% (p = 0.054 vs IVUS). Most typical angiographic findings associated with a low rate of procedural success were not associated with different IVUS morphologies. In conclusion, CTO lesions had multiple small calcium deposits, intramural hematomas were common and were indicative of guidewire penetration into the medial space during the CTO procedure, especially in long calcified lesions in smaller vessels, and inadequate reflow after the procedure was correlated with more complex CTO morphology.
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Affiliation(s)
- Kenichi Fujii
- Columbia University Medical Center and Cardiovascular Research Foundation, New York, New York, USA
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Katayama T, Kubo N, Takagi Y, Funayama H, Ikeda N, Ishida T, Hirahara T, Sugawara Y, Yasu T, Kawakami M, Saito M. Relation of atherothrombosis burden and volume detected by intravascular ultrasound to angiographic no-reflow phenomenon during stent implantation in patients with acute myocardial infarction. Am J Cardiol 2006; 97:301-4. [PMID: 16442385 DOI: 10.1016/j.amjcard.2005.08.043] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2005] [Revised: 08/22/2005] [Accepted: 08/22/2005] [Indexed: 11/15/2022]
Abstract
This study investigated the mechanism of occurrence of the no-reflow phenomenon during stent implantation in patients with acute myocardial infarction (AMI) using intravascular ultrasound (IVUS) with volumetric analysis. Of 70 patients with AMI who underwent IVUS-guided stent implantation within 24 hours of symptom onset, 12 developed decreased Thrombolysis In Myocardial Infarction flow grade during stent implantation and without subsequent restoration to Thrombolysis In Myocardial Infarction flow grade before stenting. External elastic membrane cross-sectional area and maximum diameter at the culprit lesion as measured by IVUS before stent implantation were significantly larger in the no-reflow group (n = 12) than in the normal reflow group (n = 58; 20.1 +/- 6.5 vs 16.4 +/- 4.3 mm2, p = 0.015 for cross-sectional area and 5.2 +/- 0.9 vs 4.8 +/- 0.6 mm, p = 0.049 for maximum diameter). Plaque volume, volumetric plaque burden (plaque volume/external elastic membrane volume), and change in plaque volume during stent implantation (plaque volume after vs before) were significantly greater in the no-reflow group than in the normal reflow group (239 +/- 142 vs 178 +/- 72 mm3, p = 0.030; 0.76 +/- 0.07 vs 0.71 +/- 0.06, p = 0.010; and -46 +/- 63 vs -11 +/- 37 mm3, p = 0.013, respectively). In conclusion, high atherothrombotic burden and decreased plaque volume as detected by IVUS may be risk factors for development of the no-reflow phenomenon during stent implantation in patients with AMI.
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Affiliation(s)
- Takuji Katayama
- The Cardiovascular Division, First Department of Integrated Medicine, Omiya Medical Center, Jichi Medical School, Saitama, Japan
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Gibson CM, Kirtane AJ, Boundy K, Ly H, Karmpaliotis D, Murphy SA, Giugliano RP, Cannon CP, Antman EM, Braunwald E. Association of a negative residual stenosis following rescue/adjunctive percutaneous coronary intervention with impaired myocardial perfusion and adverse outcomes among ST-segment elevation myocardial infarction patients. J Am Coll Cardiol 2005; 45:357-62. [PMID: 15680712 DOI: 10.1016/j.jacc.2004.10.047] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2004] [Revised: 10/14/2004] [Accepted: 10/18/2004] [Indexed: 11/22/2022]
Abstract
OBJECTIVES We hypothesized that <0% residual stenosis (RS) after rescue/adjunctive percutaneous coronary intervention (PCI) following fibrinolytic administration in ST-segment elevation myocardial infarction (STEMI) would be associated with improved outcomes. BACKGROUND Prior studies have associated larger lumen diameters after PCI with reduced rates of restenosis and target vessel revascularization. METHODS Data were drawn from 748 patients with open epicardial arteries and with optimal luminal results (RS <20%) following rescue/adjunctive PCI after fibrinolytic administration in six STEMI trials. Patients were divided into two groups: 1) <0% RS and 2) 0% to 20% RS. RESULTS A RS <0% was associated with greater gains in lumen diameter and smaller reference diameters after PCI (p < 0.001 for each), with a trend toward less frequent Thrombolysis In Myocardial Infarction flow grade (TFG) 3. A RS <0% was associated with a greater incidence of abnormal post-PCI Thrombolysis In Myocardial Infarction myocardial perfusion grades (TMPGs) (odds ratio 2.6 [1.2 to 5.9] for TMPG 0/1/2, p = 0.02), even when the analysis was restricted to patients with post-PCI TFG 3. CONCLUSIONS A RS <0% following rescue/adjunctive PCI after fibrinolytic therapy for STEMI was independently associated with a reduction in the frequency of normal myocardial perfusion. Potential mechanisms of this finding include greater downstream embolization, increased stimulation of arterial stretch receptors with resultant coronary vasoconstriction, and increased vessel-wall injury after PCI. These findings suggest that additional prospective studies are needed to assess optimal RS that minimizes long-term restenosis without adverse effects.
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Affiliation(s)
- C Michael Gibson
- Cardiovascular Division, Beth Israel Deaconess Medical Center, Harvard Medical School, 350 Longwood Avenue, Boston, MA 02115, USA.
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