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Mansour HM, Mohamed AM, Ibrahim SG, Ibrahim AM, Mohamed RG. Value of stent boost imaging in decision making after coronary stenting. Int J Cardiovasc Imaging 2023; 39:2557-2566. [PMID: 37845408 PMCID: PMC10692007 DOI: 10.1007/s10554-023-02961-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 09/16/2023] [Indexed: 10/18/2023]
Abstract
BACKGROUND Several studies reported the comparability of digital stent enhancement techniques (including stent boost imaging) in detecting suboptimal results of coronary stenting with Intra Vascular Ultrasound and optical coherence tomography. AIMS to assess results of stent deployment and determine the incidence of suboptimal results requiring changing final decision using stent boost imaging. METHODS This cross-sectional study included 120 patients eligible for PCI were recruited during a period of one year (January 2021 to 2022) using DES. RESULTS Suboptimal results were found in 38% of the PCI cases with stents (angiography guided). Importantly it was found that improper lesion preparation in our practice could not help improving stent optimization. Also, angiography guided PCI has significant incidence of suboptimal results. Digital stent enhancement techniques like stent boost have significant and important value in better decision making. After adjusting for age and sex, six factors were identified as independent predictors for final decision change (stent length, LAD/RCA affection, proximal segment affection, calcification, and optical coherence tomography. CONCLUSION This study has confirmed the utility of stent boost for the optimization of PCI in daily practice. Stent Boost is a simple and costless technique that provides an accurate assessment of a deployed stent without extending the procedure time and without more risk. It appears to be useful for the immediate evaluation of stent expansion and optimization of PCI by additional post-dilatation, when appropriate. Future studies are needed to determine whether Stent Boost data will correlate with adverse long-term clinical outcomes in patients undergoing PCI.
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Affiliation(s)
- Hossam M Mansour
- Department of Cardiology, Faculty of Medicine, Aswan University, Aswan, 81528, Egypt
| | - Ahmed M Mohamed
- Department of Cardiology, Faculty of Medicine, Aswan University, Aswan, 81528, Egypt.
| | - Soliman G Ibrahim
- Department of Cardiology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Ayman M Ibrahim
- Department of Cardiology, Faculty of Medicine, Aswan University, Aswan, 81528, Egypt
| | - Ramadan G Mohamed
- Department of Cardiology, Faculty of Medicine, Aswan University, Aswan, 81528, Egypt
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2
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Ninno F, Tsui J, Balabani S, Díaz-Zuccarini V. A systematic review of clinical and biomechanical engineering perspectives on the prediction of restenosis in coronary and peripheral arteries. JVS Vasc Sci 2023; 4:100128. [PMID: 38023962 PMCID: PMC10663814 DOI: 10.1016/j.jvssci.2023.100128] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 09/10/2023] [Indexed: 12/01/2023] Open
Abstract
Objective Restenosis is a significant complication of revascularization treatments in coronary and peripheral arteries, sometimes necessitating repeated intervention. Establishing when restenosis will happen is extremely difficult due to the interplay of multiple variables and factors. Standard clinical and Doppler ultrasound scans surveillance follow-ups are the only tools clinicians can rely on to monitor intervention outcomes. However, implementing efficient surveillance programs is hindered by health care system limitations, patients' comorbidities, and compliance. Predictive models classifying patients according to their risk of developing restenosis over a specific period will allow the development of tailored surveillance, prevention programs, and efficient clinical workflows. This review aims to: (1) summarize the state-of-the-art in predictive models for restenosis in coronary and peripheral arteries; (2) compare their performance in terms of predictive power; and (3) provide an outlook for potentially improved predictive models. Methods We carried out a comprehensive literature review by accessing the PubMed/MEDLINE database according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The search strategy consisted of a combination of keywords and included studies focusing on predictive models of restenosis published between January 1993 and April 2023. One author independently screened titles and abstracts and checked for eligibility. The rest of the authors independently confirmed and discussed in case of any disagreement. The search of published literature identified 22 studies providing two perspectives-clinical and biomechanical engineering-on restenosis and comprising distinct methodologies, predictors, and study designs. We compared predictive models' performance on discrimination and calibration aspects. We reported the performance of models simulating reocclusion progression, evaluated by comparison with clinical images. Results Clinical perspective studies consider only routinely collected patient information as restenosis predictors. Our review reveals that clinical models adopting traditional statistics (n = 14) exhibit only modest predictive power. The latter improves when machine learning algorithms (n = 4) are employed. The logistic regression models of the biomechanical engineering perspective (n = 2) show enhanced predictive power when hemodynamic descriptors linked to restenosis are fused with a limited set of clinical risk factors. Biomechanical engineering studies simulating restenosis progression (n = 2) are able to capture its evolution but are computationally expensive and lack risk scoring for individual patients at specific follow-ups. Conclusions Restenosis predictive models, based solely on routine clinical risk factors and using classical statistics, inadequately predict the occurrence of restenosis. Risk stratification models with increased predictive power can be potentially built by adopting machine learning techniques and incorporating critical information regarding vessel hemodynamics arising from biomechanical engineering analyses.
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Affiliation(s)
- Federica Ninno
- Department of Medical Physics and Biomedical Engineering, University College London, London, United Kingdom
- Wellcome-EPSRC Centre for Interventional Surgical Sciences, London, United Kingdom
| | - Janice Tsui
- Department of Vascular Surgery, Royal Free Hospital NHS Foundation Trust, London, United Kingdom
- Division of Surgery & Interventional Science, Department of Surgical Biotechnology, Faculty of Medical Sciences, University College London, Royal Free Campus, London, United Kingdom
| | - Stavroula Balabani
- Wellcome-EPSRC Centre for Interventional Surgical Sciences, London, United Kingdom
- Department of Mechanical Engineering, University College London, London, United Kingdom
| | - Vanessa Díaz-Zuccarini
- Wellcome-EPSRC Centre for Interventional Surgical Sciences, London, United Kingdom
- Department of Mechanical Engineering, University College London, London, United Kingdom
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Predictors and outcomes of acute recoil after ultrathin bioresorbable polymer sirolimus-eluting stents implantation: an intravascular ultrasound in native coronary arteries. Coron Artery Dis 2021; 31:18-24. [PMID: 34086612 DOI: 10.1097/mca.0000000000001067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Ultrathin bioresorbable polymer sirolimus-eluting stents (BP-SESs) may easily lead to acute recoil. This study investigated acute recoil after BP-SES implantation on the basis of intravascular ultrasound (IVUS). METHODS We enrolled 40 consecutive stents. Absolute acute recoil by quantitative coronary angiography was defined as the difference between the mean diameter of the last inflated balloon (X) and mean lumen diameter of the BP-SES immediately after balloon deflation (Y). Percent (%) acute recoil was defined as (X-Y)×100/X. IVUS was performed within the culprit lesion. Plaque eccentricity, % plaque burden and calcification grade score were assessed using IVUS. Calcification grade was scored on the basis of quadrants. On the basis of the median acute recoil value of 5.0%, the stents were divided into two groups: low (LAR, n = 20) and high % acute recoil (HAR, n = 20). RESULTS Mean % acute recoil was 5.8 ± 5.3%. Plaque eccentricity, % plaque burden and stent/artery ratio were significantly higher in the HAR group than in the LAR group. Significant differences in % acute recoil were not observed regarding the types of stent diameter. In multivariate logistic regression and multiple linear regression analysis, plaque eccentricity and % plaque burden in the culprit plaque were significant positive predictors for the occurrence of % acute recoil. No significant differences, including clinical outcomes, were found between both groups at follow-up. CONCLUSION Acute recoil of BP-SESs may be influenced by an eccentric plaque with a large burden, which did not affect long-term outcomes. However, the present study might suggest the proper strategy (e.g. a more exhaustive plaque preparation) before BP-SES implantation in a case with these IVUS characteristics.
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4
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Post-intervention minimal stent area as a predictor of target lesion revascularization after everolimus-eluting stent implantation for in-stent restenosis. Coron Artery Dis 2019; 30:432-439. [DOI: 10.1097/mca.0000000000000731] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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5
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Mechanisms of Stent Failure: Lessons from IVUS and OCT. CURRENT CARDIOVASCULAR IMAGING REPORTS 2019. [DOI: 10.1007/s12410-019-9513-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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6
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Optimization of Coronary Bifurcation Intervention Using Intravascular Imaging. CURRENT CARDIOVASCULAR IMAGING REPORTS 2019. [DOI: 10.1007/s12410-019-9504-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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7
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Rencuzogullari I, Karabağ Y, Çağdaş M, Karakoyun S, Seyis S, Gürsoy MO, Yesin M, Artaç İ, İliş D, Tanboğa İH. Assessment of the relationship between preprocedural C-reactive protein/albumin ratio and stent restenosis in patients with ST-segment elevation myocardial infarction. REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2019. [DOI: 10.1016/j.repce.2019.05.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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8
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Rencuzogullari I, Karabağ Y, Çağdaş M, Karakoyun S, Seyis S, Gürsoy MO, Yesin M, Artaç İ, İliş D, Tanboğa İH. Assessment of the relationship between preprocedural C-reactive protein/albumin ratio and stent restenosis in patients with ST-segment elevation myocardial infarction. Rev Port Cardiol 2019; 38:269-277. [DOI: 10.1016/j.repc.2018.08.008] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Revised: 05/27/2018] [Accepted: 08/24/2018] [Indexed: 01/28/2023] Open
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Safety of Same-Day Discharge after Percutaneous Coronary Intervention with Orbital Atherectomy. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2018; 20:573-576. [PMID: 30224311 DOI: 10.1016/j.carrev.2018.09.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Revised: 08/31/2018] [Accepted: 09/04/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Severely calcified lesions present many challenges to percutaneous coronary intervention (PCI). Orbital atherectomy (OA) aids vessel preparation and treatment of severely calcified coronary lesions. Same-day discharge (SDD) after PCI has numerous advantages including cost savings and improved patient satisfaction. The aim of this study is to evaluate the safety of SDD among patients treated with OA in a real-world setting. METHODS This was a single-center retrospective analysis of patients undergoing OA. In-hospital and 30-day outcomes were assessed for major adverse cardiac events (MACE), device-related events and hospital readmissions. RESULTS There were 309 patients treated with OA of whom 94 had SDD (30.4%). Among SDD patients, there were no acute procedural complications and all patients were safely discharged on the day of the procedure. MACE at 30 days occurred in 1 patient (1.06%) due to major bleeding in the setting of a gastric arteriovenous malformation. There were 8 patients with unplanned 30-day readmissions (8.5%). CONCLUSION SDD after OA in patients with heavily calcified lesions appears to be safe, with low rates of adverse events and readmissions in select patients. In patients with SDD treated with OA, unplanned readmission occurred at a similar rate to the statewide average 30-day PCI readmission rate. Larger studies are needed to confirm the safety of this treatment paradigm and the potential cost savings.
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10
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Yagi S, Kondo D, Ise T, Fukuda D, Yamaguchi K, Wakatsuki T, Kawabata Y, Ito H, Saijo Y, Seno H, Sutou K, Ueno R, Todoroki T, Kusunose K, Matsuura T, Tobiume T, Yamada H, Soeki T, Shimabukuro M, Aihara KI, Akaike M, Sata M. Association of Decreased Docosahexaenoic Acid Level After Statin Therapy and Low Eicosapentaenoic Acid Level with In-Stent Restenosis in Patients with Acute Coronary Syndrome. J Atheroscler Thromb 2018; 26:272-281. [PMID: 30135329 PMCID: PMC6402885 DOI: 10.5551/jat.44735] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Aim: It is speculated that statin therapy modulates the synthesis of polyunsaturated fatty acids (PUFA), including eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA). However, the data available on the effects of statin therapy on the serum levels of PUFA and the subsequent impact on in-stent restenosis (ISR) in patients with acute coronary syndrome (ACS) are limited. Methods: A total of 120 ACS patients who received emergent coronary stent implantation, follow-up coronary angiography to evaluate ISR, and new statin therapy were enrolled. We measured the serum levels of the PUFA and lipids at the onset of ACS and at the follow-up coronary angiography. Results: The follow-up coronary angiography revealed 38 ISR cases. New statin therapy significantly reduced the serum levels of DHA and low-density lipoprotein cholesterol (LDL-C), while it did not affect EPA level. Single regression analysis revealed that a decreased serum level of LDL-C was associated with decreased DHA level. The multiple logistic regression analysis revealed that the decreased DHA level after statin therapy and low serum level of EPA on admission were determinants of prevalence of ISR. Conclusion: Statin therapy decreased the serum level of DHA with a parallel reduction in LDL-C level in patients with ACS. Decreased DHA level after statin therapy and low EPA level on admission are risk factors for ISR, indicating that in patients with ACS, decreased serum levels of DHA may be a residual target for the prevention of ISR.
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Affiliation(s)
- Shusuke Yagi
- Department of Cardiovascular Medicine, Tokushima University Graduate School of Biomedical Sciences.,Department of Community Medicine and Human Resource Development, Tokushima University Graduate School of Biomedical Sciences
| | - Daisuke Kondo
- Student Laboratory, Faculty of Medicine, Tokushima University
| | - Takayuki Ise
- Department of Cardiovascular Medicine, Tokushima University Graduate School of Biomedical Sciences
| | - Daiju Fukuda
- Department of Cardio-Diabetes Medicine, Tokushima University Graduate School of Biomedical Sciences
| | - Koji Yamaguchi
- Department of Cardiovascular Medicine, Tokushima University Graduate School of Biomedical Sciences
| | - Tetsuzo Wakatsuki
- Department of Cardiovascular Medicine, Tokushima University Graduate School of Biomedical Sciences
| | - Yutaka Kawabata
- Department of Cardiovascular Medicine, Tokushima University Graduate School of Biomedical Sciences
| | - Hiroyuki Ito
- Department of Cardiovascular Medicine, Tokushima University Graduate School of Biomedical Sciences
| | - Yoshihito Saijo
- Department of Cardiovascular Medicine, Tokushima University Graduate School of Biomedical Sciences
| | - Hiromitsu Seno
- Department of Cardiovascular Medicine, Tokushima University Graduate School of Biomedical Sciences
| | - Kumiko Sutou
- Department of Cardiovascular Medicine, Tokushima University Graduate School of Biomedical Sciences
| | - Rie Ueno
- Department of Cardiovascular Medicine, Tokushima University Graduate School of Biomedical Sciences
| | - Takafumi Todoroki
- Department of Cardiovascular Medicine, Tokushima University Graduate School of Biomedical Sciences
| | - Kenya Kusunose
- Department of Cardiovascular Medicine, Tokushima University Graduate School of Biomedical Sciences
| | - Tomomi Matsuura
- Department of Cardiovascular Medicine, Tokushima University Graduate School of Biomedical Sciences
| | - Takeshi Tobiume
- Department of Cardiovascular Medicine, Tokushima University Graduate School of Biomedical Sciences
| | - Hirotsugu Yamada
- Department of Cardiovascular Medicine, Tokushima University Graduate School of Biomedical Sciences
| | - Takeshi Soeki
- Department of Cardiovascular Medicine, Tokushima University Graduate School of Biomedical Sciences
| | - Michio Shimabukuro
- Department of Cardio-Diabetes Medicine, Tokushima University Graduate School of Biomedical Sciences.,Department of Diabetes, Endocrinology and Metabolism, School of Medicine, Fukushima Medical University
| | - Ken-Ichi Aihara
- Department of Community Medicine for Diabetes and Metabolic Disorders, Tokushima University Graduate School of Biomedical Sciences
| | - Masashi Akaike
- Department of Medical Education, Tokushima University Graduate School of Biomedical Sciences
| | - Masataka Sata
- Department of Cardiovascular Medicine, Tokushima University Graduate School of Biomedical Sciences
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11
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Soylu K, Ataş AE, Yenerçağ M, Akçay M, Şeker O, Aksan G, Gülel O, Şahin M. Effect of routine postdilatation on final coronary blood flow in primary percutaneous coronary intervention patients without angiographic stent expansion problems. J Investig Med 2018; 66:1096-1101. [PMID: 29997147 DOI: 10.1136/jim-2018-000725] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/08/2018] [Indexed: 11/04/2022]
Abstract
Inadequate expansion of coronary stents is associated with stent thrombosis in early stage and with stent restenosis in later stages. Postdilatation (postD) performed using non-compliant balloons improves stent expansion. However, use of this ballooning strategy in primary percutaneous coronary intervention (PPCI) has not been evaluated adequately. Patients who presented with ST segment elevation myocardial infarction (STEMI) and underwent PPCI were included in the present study. Patients were randomized into two groups as those for whom postD was performed (n=62) and those for whom postD was not performed (n=62). Coronary blood flow was evaluated using the thrombolysis in myocardial infarction (TIMI) flow and TIMI frame count (TFC). Total of 124 patients with STEMI were included in the study. There was no difference with respect to baseline TIMI flow, culprit coronary artery and MI localization. However, slow-reflow rate (14.5% vs 35.5%, p=0.007) and final corrected TFC (28.9±16.9 vs 37.0±23.1, p=0.028) were significantly higher in the postD group. Multivariate regression analysis showed postD as an independent variable for slow reflow (OR 11.566, 95% CI 1.633 to 81.908, p=0.014). In our study, routine postD during PPCI was found to be associated with an increased risk of slow reflow in patients without angiographic stent expansion problems.
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Affiliation(s)
- Korhan Soylu
- Department of Cardiology, Faculty of Medicine, Ondokuz Mayis University, Samsun, Turkey
| | - Ali Ekber Ataş
- Department of Cardiology, Samsun Medical Park Private Hospital, Samsun, Turkey
| | - Mustafa Yenerçağ
- Department of Cardiology, Samsung Training and Research Hospital, Samsun, Turkey
| | - Murat Akçay
- Department of Cardiology, Faculty of Medicine, Ondokuz Mayis University, Samsun, Turkey
| | - Onur Şeker
- Department of Cardiology, Faculty of Medicine, Ondokuz Mayis University, Samsun, Turkey
| | - Gökhan Aksan
- Department of Cardiology, Şişli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey
| | - Okan Gülel
- Department of Cardiology, Faculty of Medicine, Ondokuz Mayis University, Samsun, Turkey
| | - Mahmut Şahin
- Department of Cardiology, Faculty of Medicine, Ondokuz Mayis University, Samsun, Turkey
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Shlofmitz E, Shlofmitz RA, Galougahi KK, Rahim HM, Virmani R, Hill JM, Matsumura M, Mintz GS, Maehara A, Landmesser U, Stone GW, Ali ZA. Algorithmic Approach for Optical Coherence Tomography-Guided Stent Implantation During Percutaneous Coronary Intervention. Interv Cardiol Clin 2018; 7:329-344. [PMID: 29983145 DOI: 10.1016/j.iccl.2018.03.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Intravascular imaging plays a key role in optimizing outcomes for percutaneous coronary intervention (PCI). Optical coherence tomography (OCT) utilizes a user-friendly interface and provides high-resolution images. OCT can be used as part of daily practice in all stages of a coronary intervention: baseline lesion assessment, stent selection, and stent optimization. Incorporating a standardized, algorithmic approach when using OCT allows for precision PCI.
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Affiliation(s)
- Evan Shlofmitz
- Center for Interventional Vascular Therapy, Division of Cardiology, NewYork-Presbyterian Hospital, Columbia University Medical Center, 161 Fort Washington Avenue, New York, NY 10032, USA; Department of Cardiology, St. Francis Hospital, 100 Port Washington Boulevard, Suite 105, Roslyn, NY 11576, USA; Clinical Trials Center, Cardiovascular Research Foundation, 1700 Broadway 9th Floor, New York, NY 10019, USA
| | - Richard A Shlofmitz
- Department of Cardiology, St. Francis Hospital, 100 Port Washington Boulevard, Suite 105, Roslyn, NY 11576, USA
| | - Keyvan Karimi Galougahi
- Center for Interventional Vascular Therapy, Division of Cardiology, NewYork-Presbyterian Hospital, Columbia University Medical Center, 161 Fort Washington Avenue, New York, NY 10032, USA
| | - Hussein M Rahim
- Center for Interventional Vascular Therapy, Division of Cardiology, NewYork-Presbyterian Hospital, Columbia University Medical Center, 161 Fort Washington Avenue, New York, NY 10032, USA
| | - Renu Virmani
- CVPath Institute, 19 Firstfield Road, Gaithersburg, MD 20878, USA
| | - Jonathan M Hill
- London Bridge Hospital, 2nd Floor, St Olaf House, London SE1 2PR, UK; Department of Cardiology, King's College Hospital, Denmark Hill, London, SE5 9RS, UK
| | - Mitsuaki Matsumura
- Clinical Trials Center, Cardiovascular Research Foundation, 1700 Broadway 9th Floor, New York, NY 10019, USA
| | - Gary S Mintz
- Clinical Trials Center, Cardiovascular Research Foundation, 1700 Broadway 9th Floor, New York, NY 10019, USA
| | - Akiko Maehara
- Center for Interventional Vascular Therapy, Division of Cardiology, NewYork-Presbyterian Hospital, Columbia University Medical Center, 161 Fort Washington Avenue, New York, NY 10032, USA; Clinical Trials Center, Cardiovascular Research Foundation, 1700 Broadway 9th Floor, New York, NY 10019, USA
| | - Ulf Landmesser
- Department of Cardiology, Charité - Universitätsmedizin Berlin, Hindenburgdamm 30, Berlin 12200, Germany
| | - Gregg W Stone
- Center for Interventional Vascular Therapy, Division of Cardiology, NewYork-Presbyterian Hospital, Columbia University Medical Center, 161 Fort Washington Avenue, New York, NY 10032, USA; Clinical Trials Center, Cardiovascular Research Foundation, 1700 Broadway 9th Floor, New York, NY 10019, USA
| | - Ziad A Ali
- Center for Interventional Vascular Therapy, Division of Cardiology, NewYork-Presbyterian Hospital, Columbia University Medical Center, 161 Fort Washington Avenue, New York, NY 10032, USA; Department of Cardiology, St. Francis Hospital, 100 Port Washington Boulevard, Suite 105, Roslyn, NY 11576, USA; Clinical Trials Center, Cardiovascular Research Foundation, 1700 Broadway 9th Floor, New York, NY 10019, USA.
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Watanabe H, Morimoto T, Shiomi H, Natsuaki M, Kawai K, Kozuma K, Igarashi K, Kadota K, Tanabe K, Morino Y, Hibi K, Akasaka T, Abe M, Suwa S, Muramatsu T, Kobayashi M, Dai K, Nakao K, Tarutani Y, Fujii K, Kimura T. Impact of Angiographic Residual Stenosis on Clinical Outcomes After New-Generation Drug-Eluting Stents Implantation: Insights From a Pooled Analysis of the RESET and NEXT Trials. J Am Heart Assoc 2018; 7:e008718. [PMID: 29960987 PMCID: PMC6064905 DOI: 10.1161/jaha.118.008718] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Accepted: 05/28/2018] [Indexed: 11/16/2022]
Abstract
BACKGROUND Previous intravascular ultrasound studies suggested the association of stent underexpansion with increased risk of stent thrombosis and restenosis. However, no previous study has addressed the association of the suboptimal angiographic result with target-lesion revascularization (TLR) in patients receiving new-generation drug-eluting stents (DES). METHODS AND RESULTS RESET (Randomized evaluation of sirolimus-eluting versus everolimus-eluting stent trial) and NEXT (NOBORI biolimus-eluting versus XIENCE/PROMUS everolimus-eluting stent trial) are prospective, multicenter, randomized "DES versus DES" trials; 3196 patients and 3235 patients were enrolled in the RESET and NEXT, respectively. Using the pooled individual patient-level data, the current study population consisted of 3679 patients who received single-lesion treatment using new-generation DES such as everolimus-eluting stent and biolimus-eluting stent. The study population was divided into 3 groups according to the residual in-stent % diameter stenosis (%DS) after stent implantation by offline quantitative coronary angiography assessed in a core angiographic laboratory (optimal group: %DS <10%, intermediate group: %DS=10% to 20%, suboptimal group: %DS ≧20%). The cumulative 3-year incidence of TLR was significantly higher in the suboptimal group than in the intermediate and optimal groups (9.8% versus 5.8% versus 5.7%, log-rank P=0.004). Even after adjusting for the clinical, angiographic, and procedural characteristics, the excess TLR risk of the suboptimal group relative to the optimal group remained significant (hazard ratio: 1.65, 95% confidence interval, 1.14-2.41, P=0.009). The excess TLR risk of the suboptimal group relative to the optimal group was consistently seen across all the subgroups including heavy calcification. CONCLUSIONS The residual angiographic in-stent %DS ≥20% was associated with increased risk for TLR in patients treated with the new-generation DES.
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Affiliation(s)
- Hiroki Watanabe
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Takeshi Morimoto
- Division of General Medicine, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Japan
| | - Hiroki Shiomi
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | | | - Kazuya Kawai
- Division of Cardiology, Chikamori Hospital, Kochi, Japan
| | - Ken Kozuma
- Department of Cardiology, Teikyo University Hospital, Tokyo, Japan
| | - Keiichi Igarashi
- Department of Cardiology, Hokkaido Social Insurance Hospital, Sapporo, Japan
| | - Kazushige Kadota
- Department of Cardiology, Kurashiki Central Hospital, Kurashiki, Japan
| | - Kengo Tanabe
- Department of Cardiology, Mitsui Memorial Hospital, Tokyo, Japan
| | - Yoshihiro Morino
- Department of Cardiology, Iwate University Hospital, Morioka, Japan
| | - Kiyoshi Hibi
- Department of Cardiology, Yokohama City University Medical Center, Yokohama, Japan
| | - Takashi Akasaka
- Department of Cardiovascular Medicine, Wakayama Medical University Hospital, Wakayama, Japan
| | - Mitsuru Abe
- Department of Cardiology, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
| | - Satoru Suwa
- Department of Cardiology, Juntendo University Shizuoka Hospital, Nagaoka, Japan
| | - Toshiya Muramatsu
- Department of Cardiology, Saiseikai Yokohama-City Eastern Hospital, Yokohama, Japan
| | | | - Kazuoki Dai
- Department of Cardiology, Hiroshima City Hospital, Hiroshima, Japan
| | - Koichi Nakao
- Division of Cardiology, Chikamori Hospital, Kochi, Japan
- Department of Cardiology, Saiseikai Kumamoto Hospital Cardiovascular Center, Kumamoto, Japan
| | - Yasuhiro Tarutani
- Department of Cardiology, Okamura Memorial Hospital, Shizuoka, Japan
| | - Kenshi Fujii
- Department of Cardiology, Sakurabashi Watanabe Hospital, Osaka, Japan
| | - Takeshi Kimura
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
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14
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Vásquez SH, Vesga BE, Hernández HJ. Imagenología coronaria: ultrasonido intravascular (IVUS). REVISTA COLOMBIANA DE CARDIOLOGÍA 2017. [DOI: 10.1016/j.rccar.2017.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Laimoud M, Nassar Y, Omar W, Abdelbarry A, Elghawaby H. Stent boost enhancement compared to intravascular ultrasound in the evaluation of stent expansion in elective percutaneous coronary interventions. Egypt Heart J 2017; 70:21-26. [PMID: 29622993 PMCID: PMC5883512 DOI: 10.1016/j.ehj.2017.09.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Accepted: 09/26/2017] [Indexed: 12/16/2022] Open
Abstract
Background Stent underexpansion is a major risk factor for in-stent restenosis and acute in-stent thrombosis1Intravascular ultrasound (IVUS) is one of the standards for detection of stent underexpansion (de Feyter et al. 1999; Mintz et al., 2001). StentBoost (SB) enhancement allows an improved angiographic visualization of the stent (Koolen et al., 2005). Aim of work Comparison of stent expansion by IVUS and SB enhancement and detection of value of SB to guide dilatation post stent deployment. Methodology IVUS, SB enhancement and QCA were done in 30 patients admitted for elective stenting procedures .We compared measurements of mean ±standard deviations of (Max SD, Min SD, Mean SD, stent symmetry index) using IVUS, SB and QCA after stent deployment and after postdilatation whenever necessary to optimize stent deployment. The Stent symmetry index was calculated [(maximum stent diameter minus minimum stent diameter) divided by maximum stent diameter]. Results The Max SD was (3.45 ± 0.62 vs 3.55 ± 0.56 vs 2.97 ± 0.59) by IVUS vs SB vs QCA respectively. Max SD was significantly higher by IVUS vs QCA (p .009) and between SB vs QCA (p .001) while there was nonsignificant difference between IVUS vs SB (p .53). The Min SD was (2.77 ± 0.53 vs 2.58 ± 0.56 vs 1.88 ± 0.60) by IVUS vs SB vs QCA respectively. Min SD was significantly higher by IVUS vs QCA (p .001) and between SB vs QCA (p .001) while there was nonsignificant difference between IVUS vs SB (p .07). The stent symmetry index was (0.24 ±0.09 vs 0.34 ± 0.09 vs 0.14 ±0.27) by IVUS vs SB vs QCA respectively. It was significantly higher by IVUS vs QCA (p .001) and between SB vs QCA (p .001) while there was nonsignificant difference between IVUS vs SB (p .32). SB was positively correlated with IVUS measurements of Max SD (p < .0001 & r 0.74) and Min SD (p < .0001 & r 0.68). QCA was positively correlated with IVUS measurements of Max SD correlation (p < .0001 & r 0.69) and Min SD (p < .0001 & r 0.63). QCA was positively correlated with SB measurements of Max SD (p < .0001 & r 0.61) and Min SD (p .003 & r 0.49). Conclusions StentBoost enhancement has superior correlations for stent expansion measured by IVUS when compared with QCA. SB enhancement improved stent visualization and identification of stent underexpansion to guide stent postdilatation.
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Affiliation(s)
| | - Yasser Nassar
- Critical Care Medicine Department-Cairo University, Egypt
| | - Walid Omar
- Critical Care Medicine Department-Cairo University, Egypt
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16
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Kim YH, Her AY, Rha SW, Choi BG, Shim M, Choi SY, Byun JK, Li H, Kim W, Kang JH, Choi JY, Park EJ, Park SH, Lee S, Na JO, Choi CU, Lim HE, Kim EJ, Park CG, Seo HS, Oh DJ. Three-Year Major Clinical Outcomes of Angiography-Guided Single Stenting Technique in Non-Complex Left Main Coronary Artery Diseases. Int Heart J 2017; 58:704-713. [PMID: 28966331 DOI: 10.1536/ihj.17-115] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
There is limited long-term comparative clinical outcome data concerning angiography- versus intravascular ultrasound (IVUS)-guided percutaneous coronary intervention (PCI) in non-complex left main coronary artery (LMCA) disease treated with the single stenting technique in the drug-eluting stent (DES) era.The aim of this study was to investigate whether angiography-guided stenting is comparable to IVUS-guided stenting during 3-year clinical follow-up periods in patients with non-complex LM disease treated with the single stenting technique.A total of 196 patients treated with either angiography-guided (n = 74) or IVUS-guided (n = 122) PCI were included. The primary outcome was the occurrence of major adverse cardiac events (MACE) defined as total death, non-fatal myocardial infarction (MI), target lesion revascularization (TLR), target vessel revascularization (TVR), and non-target vessel revascularization (Non-TVR). To adjust for any potential confounders, propensity score (PS) adjusted analysis was performed.During 3-year follow-up, the PS adjusted Cox-proportional hazard ratio (HR) was not significantly different between the two groups for total death, cardiac death, and MI. Also, TLR and the combined rates of TVR and non-TVR were not significantly different. Finally, MACE was not significantly different between the two groups (HR: 0.63, 95% Confidence interval (CI): 0.33-1.17; P = 0.149).Angiography-guided PCI for non-complex LMCA diseases treated with the single stenting technique showed comparable results compared with IVUS-guided PCI in reducing clinical events during 3-year clinical follow-up in the DES era. Although IVUS guided PCI is the ideal strategy, angiography-guided PCI can be an option for LMCA PCI in some selected cases.
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Affiliation(s)
- Yong Hoon Kim
- Division of Cardiology, Department of Internal Medicine, Kangwon National University School of Medicine
| | - Ae-Young Her
- Division of Cardiology, Department of Internal Medicine, Kangwon National University School of Medicine
| | - Seung-Woon Rha
- Department of Medicine, Korea University Graduate School.,Cardiovascular Center, Korea University Guro Hospital
| | | | - Minsuk Shim
- Department of Medicine, Korea University Graduate School
| | - Se Yeon Choi
- Department of Medicine, Korea University Graduate School
| | | | - Hu Li
- Department of Medicine, Korea University Graduate School
| | - Woohyeun Kim
- Department of Medicine, Korea University Graduate School.,Cardiovascular Center, Korea University Guro Hospital
| | - Jun Hyuk Kang
- Department of Medicine, Korea University Graduate School.,Cardiovascular Center, Korea University Guro Hospital
| | - Jah Yeon Choi
- Department of Medicine, Korea University Graduate School.,Cardiovascular Center, Korea University Guro Hospital
| | - Eun Jin Park
- Department of Medicine, Korea University Graduate School.,Cardiovascular Center, Korea University Guro Hospital
| | - Sung Hun Park
- Department of Medicine, Korea University Graduate School.,Cardiovascular Center, Korea University Guro Hospital
| | - Sunki Lee
- Department of Medicine, Korea University Graduate School.,Cardiovascular Center, Korea University Guro Hospital
| | - Jin Oh Na
- Department of Medicine, Korea University Graduate School.,Cardiovascular Center, Korea University Guro Hospital
| | - Cheol Ung Choi
- Department of Medicine, Korea University Graduate School.,Cardiovascular Center, Korea University Guro Hospital
| | - Hong Euy Lim
- Department of Medicine, Korea University Graduate School.,Cardiovascular Center, Korea University Guro Hospital
| | - Eung Ju Kim
- Department of Medicine, Korea University Graduate School.,Cardiovascular Center, Korea University Guro Hospital
| | - Chang Gyu Park
- Department of Medicine, Korea University Graduate School.,Cardiovascular Center, Korea University Guro Hospital
| | - Hong Seog Seo
- Department of Medicine, Korea University Graduate School.,Cardiovascular Center, Korea University Guro Hospital
| | - Dong Joo Oh
- Department of Medicine, Korea University Graduate School.,Cardiovascular Center, Korea University Guro Hospital
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17
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Adnan Y, Noor L, Dar MH, Ali U, Hafizullah M. Impact of stent length and diameter on short term clinical outcomes of drug eluting stents in patients with stable coronary artery disease. Pak J Med Sci 2017; 33:959-962. [PMID: 29067073 PMCID: PMC5648972 DOI: 10.12669/pjms.334.13068] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Background & Objective: The risk of restenosis and other adverse cardiovascular events with bare-metal stents have increased with smaller stent diameters and longer stent lengths. However, the exact impact of stent size on the short-term outcomes of drug-eluting stent (DES) implantations has not been much classified in Pakistani population. This study was designed to evaluate the impact of size (length and diameter) of Drug Eluting Stents on Clinical outcomes in patient with stable coronary artery disease at three months of implantation in Pakistani Population. Methods: This is a prospective study which was carried out in the Department of Cardiology, Lady Reading Hospital Peshawar from April 2011 and July 2012. All consecutive patients with stable coronary disease undergoing Percutaneous Intervention (PCI) with DES implantation at Cardiology Unit Lady Reading Hospital, were included prospectively. Clinical outcomes (Myocardial infarction [MI], unstable angina[UA], and positive ETT) at three months stratified by 3 tertiles of stent length and diameter each, were measured in patients who underwent PCI with DES for coronary artery lesions. All patients were followed and reassessed after three months from the index procedure. Exercise Tolerance Test(ETT) was performed on every patient and recorded on proforma. Data analysis was done using SPSS software version 16. Results: A total of 376 patients were included prospectively in this study. The mean age was 57±9.313 years. Male patients were 271(72.1%). Mean length of drug eluting stent was 27.313±7.235 mm while mean diameter of stent was 2.90±0.2483mm. There were slightly higher rates of MI, U.A and positive ETT in the longest stent length tertile(>28mm) compared with the shortest stent length tertile (<22mm) at three months, but they were statistically not significant. We also observed that for DES, there was no clear relationship between stent diameter and outcome for any of the clinical outcome variables. Conclusion: In our single-center prospective study, stent length and diameter defined in tertiles, had no impact on the short-term clinical outcomes of DES in patients with stable coronary artery disease.
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Affiliation(s)
- Yasir Adnan
- Dr. Yasir Adnan, FCPS Cardiology, Department of Cardiology, Police and Services Hospital, Peshawar, Pakistan
| | - Lubna Noor
- Dr. Lubna Noor, FCPS Cardiology, Department of Cardiology, Lady Reading Hospital, Peshawar, Pakistan
| | - Muhammad Habeel Dar
- Dr. Muhammad Habeel Dar, FCPS Cardiology, Department of Cardiology, Lady Reading Hospital, Peshawar, Pakistan
| | - Umair Ali
- Dr. Umair Ali, FCPS Cardiology, Department of Cardiology, Lady Reading Hospital, Peshawar, Pakistan
| | - Muhammad Hafizullah
- Dr. Muhammad Hafizullah, FRCP, Department of Cardiology, Lady Reading Hospital, Peshawar, Pakistan
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18
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Abstract
Restenosis is a pathologic response to vascular injury, characterized by neointimal hyperplasia and progressive narrowing of a stented vessel segment. Although advances in stent design have led to a dramatic reduction in the incidence of restenosis, it continues to represent the most common cause of target lesion failure following percutaneous coronary intervention. Efforts to maximize restenosis prevention, through careful consideration of modifiable risk factors and an individualized approach, are critical, as restenosis, once established, can be particularly difficult to treat. Novel approaches are on the horizon that have the potential to alter the natural history of this stubborn disease.
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19
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Morofuji T, Inaba S, Aisu H, Takahashi K, Saito M, Higashi H, Yoshii T, Sumimoto T. Heterogeneous Intravascular Ultrasound Findings of Stent Thrombosis. Intern Med 2017; 56:259-268. [PMID: 28154268 PMCID: PMC5348448 DOI: 10.2169/internalmedicine.56.7093] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Objective The underlying mechanisms of stent thrombosis are not completely understood. Methods We experienced 12 definite stent thrombosis cases (1 early, 1 late, and 10 very late) at our hospital from July 2011 to April 2016 and evaluated the possible causes of stent thrombosis by intravascular ultrasound (IVUS). Results Five different potential morphological causes of stent thrombosis (neoatherosclerosis, stent malapposition, stent fracture, edge dissection, and stent underexpansion) were detected by IVUS in 10 cases (83.3%); in 1 of the remaining 2 cases, the discontinuation of antithrombotic drugs resulted in early stent thrombosis without abnormal IVUS findings. Of the 12 stent thrombosis cases, 4 occurred at a bare-metal stent (average time from stent implantation, 106 months); in all 12, significant neointimal hyperplasia was observed on IVUS, and 2 had plaque ruptures at an in-stent or proximal reference. Malapposed stent struts were observed in three very-late stent thromboses, and all of these underwent sirolimus-eluting stent implantation. Stent thrombosis due to mechanical (stent fracture) or procedure-related complications (edge dissection and stent underexpansion) was observed in three cases. Conclusion In patients with stent thrombosis, heterogeneous findings were observed in IVUS. This IVUS case series illustrates the possible mechanisms of stent thrombosis.
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Affiliation(s)
- Toru Morofuji
- Department of Cardiology, Kitaishikai Hospital, Japan
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20
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Caixeta A, Maehara A, Mintz GS. Intravascular Ultrasound and Virtual Histology. Interv Cardiol 2016. [DOI: 10.1002/9781118983652.ch7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Affiliation(s)
- Adriano Caixeta
- Hospital Israelita Albert Einstein; Universidade Federal de São Paulo; São Paulo Brazil
| | - Akiko Maehara
- Columbia University Medical Center and the Cardiovascular Research Foundation; New York NY USA
| | - Gary S. Mintz
- Columbia University Medical Center and the Cardiovascular Research Foundation; New York NY USA
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21
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Predictors of acute scaffold recoil after implantation of the everolimus-eluting bioresorbable scaffold: an optical coherence tomography assessment in native coronary arteries. Int J Cardiovasc Imaging 2016; 33:145-152. [PMID: 27761749 DOI: 10.1007/s10554-016-0997-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Accepted: 10/03/2016] [Indexed: 01/16/2023]
Abstract
This study investigated the predictors of acute recoil after implantation of everolimus-eluting BRS based on optical coherence tomography (OCT). Thirty-nine patients (56 scaffolds) were enrolled. Acute absolute recoil by quantitative coronary angiography was defined as the difference between the mean diameter of the last inflated balloon (X) and the mean lumen diameter of BRS immediately after balloon deflation (Y). Acute percent recoil was defined as (X - Y) × 100/X. Plaque eccentricity (PE) and plaque composition (PC) were assessed by OCT. PC was classified into two different types: calcific (score = 1), fibrous and lipid (score = 0). Based on the mean acute scaffold recoil value of the present study, scaffolds were divided into two groups: the low acute recoil group (LAR, n = 34) and the high acute recoil group (HAR, n = 22). Acute percent and absolute recoil were 6.4 ± 3.0 % and 0.19 ± 0.11 mm. PE, PC score and scaffold/artery ratio were significantly higher in HAR than in LAR. In multivariate logistic regression analysis, PE > 1.49, PC score (score 1) and scaffold/artery ratio >1.07 were significant positive predictors for the occurrence of acute scaffold recoil (OR 10.7, 95 % CI 2.2-51.4, p < 0.01; OR 5.6, 95 % CI 1.9-22.0, p = 0.04; OR 12.4, 95 % CI 2.6-65.4, p < 0.01, respectively). Acute recoil of BRS is influenced by BRS sizing as well as OCT-derived plaque characteristics.
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22
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Falcone C, Emanuele E, Buzzi M, Ballerini L, Repetto A, Canosi U, Mazzucchelli I, Schirinzi S, Sbarsi I, Boiocchi C, Cuccia M. The-374T/A Variant of the Rage Gene Promoter is Associated with Clinical Restenosis after Coronary Stent Placement. Int J Immunopathol Pharmacol 2016; 20:771-7. [DOI: 10.1177/039463200702000413] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Upregulation of the receptor for advanced glycation end products (RAGE) may play a crucial role in neointimal formation upon vessel injury. The −374T/A variant of the RAGE gene promoter, which has been associated with an altered expression of the cell-surface receptor, could exert a protective effect toward the development of vascular disease. The aim of this study is to determine the impact of this common genetic variant in the occurrence of clinical in-stent restenosis after coronary stent implantation. The −374T/A polymorphism of the RAGE gene promoter was evaluated by PCR-RFLPs in 267 patients with coronary artery disease who underwent coronary stent implantation and a subsequent coronary angiography 6–9 months later for suspected restenosis. In-stent restenosis was assessed by means of quantitative angiography. Carriers of the-374AA genotype showed a significantly reduced risk of developing restenosis after percutaneous transluminal intervention than non-carriers. To determine whether the protective effect of the homozygous AA genotype toward clinical restenosis was independent of potential confounders, we performed multivariable logistic regression analysis. After allowance for clinical and biochemical risk factors and stent length, the AA genotype remained significantly associated with a reduced prevalence of in-stent restenosis. No relation was evident between the RAGE genotype and established cardiovascular risk factors. In conclusion, the −374AA genotype of the RAGE gene promoter could be associated with a reduced risk of in-stent restenosis after coronary stent implantation.
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Affiliation(s)
- C. Falcone
- Department of Cardiology, University Hospital Foundation IRCCS San Matteo, Pavia
- Interdepartmental Center for Research in Prevention of Cardiovascular and Metabolic Diseases (CIRMC), University of Pavia, Pavia, Italy
| | - E. Emanuele
- Interdepartmental Center for Research in Prevention of Cardiovascular and Metabolic Diseases (CIRMC), University of Pavia, Pavia, Italy
| | - M.P. Buzzi
- Department of Cardiology, University Hospital Foundation IRCCS San Matteo, Pavia
| | - L. Ballerini
- Department of Cardiology, University Hospital Foundation IRCCS San Matteo, Pavia
| | - A. Repetto
- Department of Cardiology, University Hospital Foundation IRCCS San Matteo, Pavia
| | - U. Canosi
- Department of Cardiology, University Hospital Foundation IRCCS San Matteo, Pavia
| | - I. Mazzucchelli
- Interdepartmental Center for Research in Prevention of Cardiovascular and Metabolic Diseases (CIRMC), University of Pavia, Pavia, Italy
| | - S. Schirinzi
- Department of Cardiology, University Hospital Foundation IRCCS San Matteo, Pavia
| | - I. Sbarsi
- Department of Genetics and Microbiology, University of Pavia, Pavia, Italy
| | - C. Boiocchi
- Department of Genetics and Microbiology, University of Pavia, Pavia, Italy
| | - M. Cuccia
- Department of Genetics and Microbiology, University of Pavia, Pavia, Italy
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23
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Goto K, Zhao Z, Matsumura M, Dohi T, Kobayashi N, Kirtane AJ, Rabbani LE, Collins MB, Parikh MA, Kodali SK, Leon MB, Moses JW, Mintz GS, Maehara A. Mechanisms and Patterns of Intravascular Ultrasound In-Stent Restenosis Among Bare Metal Stents and First- and Second-Generation Drug-Eluting Stents. Am J Cardiol 2015; 116:1351-7. [PMID: 26341188 DOI: 10.1016/j.amjcard.2015.07.058] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2015] [Revised: 07/30/2015] [Accepted: 07/30/2015] [Indexed: 11/17/2022]
Abstract
The most common causes of in-stent restenosis (ISR) are intimal hyperplasia and stent under expansion. The purpose of this study was to use intravascular ultrasound (IVUS) to compare the ISR mechanisms of bare metal stents (BMS), first-generation drug-eluting stents (DES), and second-generation DES. There were 298 ISR lesions including 52 BMS, 73 sirolimus-eluting stents, 52 paclitaxel-eluting stents, 16 zotarolimus-eluting stents, and 105 everolimus-eluting stent. Mean patient age was 66.6 ± 1.1 years, 74.2% were men, and 48.3% had diabetes mellitus. BMS restenosis presented later (70.0 ± 66.7 months) with more intimal hyperplasia compared with DES (BMS 58.6 ± 15.5%, first-generation DES 52.6 ± 20.9%, second-generation DES 48.2 ± 22.2%, p = 0.02). Although reference lumen areas were similar in BMS and first- and second-generation DES, restenotic DES were longer (BMS 21.8 ± 13.5 mm, first-generation DES 29.4 ± 16.1 mm, second-generation DES 32.1 ± 18.7 mm, p = 0.003), and stent areas were smaller (BMS 7.2 ± 2.4 mm(2), first-generation DES 6.1 ± 2.1 mm(2), second-generation DES 5.7 ± 2.0 mm(2), p <0.001). Stent fracture was seen only in DES (first-generation DES 7 [5.0%], second-generation DES 8 [7.4%], p = 0.13). In conclusion, restenotic first- and second-generation DES were characterized by less neointimal hyperplasia, smaller stent areas, longer stent lengths, and more stent fractures than restenotic BMS.
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Affiliation(s)
- Kosaku Goto
- Cardiovascular Research Foundation, New York, New York; Columbia University Medical Center, New York, New York
| | - Zhijing Zhao
- Cardiovascular Research Foundation, New York, New York; Columbia University Medical Center, New York, New York
| | | | - Tomotaka Dohi
- Cardiovascular Research Foundation, New York, New York; Columbia University Medical Center, New York, New York
| | | | - Ajay J Kirtane
- Cardiovascular Research Foundation, New York, New York; Columbia University Medical Center, New York, New York
| | | | | | - Manish A Parikh
- Cardiovascular Research Foundation, New York, New York; Columbia University Medical Center, New York, New York
| | - Susheel K Kodali
- Cardiovascular Research Foundation, New York, New York; Columbia University Medical Center, New York, New York
| | - Martin B Leon
- Cardiovascular Research Foundation, New York, New York; Columbia University Medical Center, New York, New York
| | | | - Gary S Mintz
- Cardiovascular Research Foundation, New York, New York
| | - Akiko Maehara
- Cardiovascular Research Foundation, New York, New York; Columbia University Medical Center, New York, New York.
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Miki K, Fujii K, Fukunaga M, Nishimura M, Horimatsu T, Saita T, Tamaru H, Imanaka T, Shibuya M, Naito Y, Masuyama T. Impact of intravascular ultrasound findings on long-term patency after self-expanding nitinol stent implantation in the iliac artery lesion. Heart Vessels 2015; 31:519-27. [DOI: 10.1007/s00380-014-0625-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2014] [Accepted: 12/26/2014] [Indexed: 10/24/2022]
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25
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Zhang M, Cresswell N, Tavora F, Mont E, Zhao Z, Burke A. In-stent restenosis is associated with neointimal angiogenesis and macrophage infiltrates. Pathol Res Pract 2014; 210:1026-30. [DOI: 10.1016/j.prp.2014.04.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2012] [Revised: 08/26/2013] [Accepted: 04/09/2014] [Indexed: 10/25/2022]
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26
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Panoulas VF, Colombo A. Is "the bigger the better" still valid for drug-eluting stents? Catheter Cardiovasc Interv 2014; 83:879-80. [PMID: 24753167 DOI: 10.1002/ccd.25478] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2014] [Accepted: 03/10/2014] [Indexed: 11/07/2022]
Affiliation(s)
- Vasileios F Panoulas
- Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy; Interventional Cardiology Unit, EMO-GVM Centro Cuore Columbus, Milan, Italy; National Heart and Lung Institute (Division of ICL), Imperial College London, London, United Kingdom
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27
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From Histology and Imaging Data to Models for In-Stent Restenosis. Int J Artif Organs 2014; 37:786-800. [DOI: 10.5301/ijao.5000336] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/29/2014] [Indexed: 11/20/2022]
Abstract
The implantation of stents has been used to treat coronary artery stenosis for several decades. Although stenting is successful in restoring the vessel lumen and is a minimally invasive approach, the long-term outcomes are often compromised by in-stent restenosis (ISR). Animal models have provided insights into the pathophysiology of ISR and are widely used to evaluate candidate drug inhibitors of ISR. Such biological models allow the response of the vessel to stent implantation to be studied without the variation of lesion characteristics encountered in patient studies. This paper describes the development of complementary in silico models employed to improve the understanding of the biological response to stenting using a porcine model of restenosis. This includes experimental quantification using microCT imaging and histology and the use of this data to establish numerical models of restenosis. Comparison of in silico results with histology is used to examine the relationship between spatial localization of fluid and solid mechanics stimuli immediately post-stenting. Multi-scale simulation methods are employed to study the evolution of neointimal growth over time and the variation in the extent of neointimal hyperplasia within the stented region. Interpretation of model results through direct comparison with the biological response contributes to more detailed understanding of the pathophysiology of ISR, and suggests the focus for follow-up studies. In conclusion we outline the challenges which remain to both complete our understanding of the mechanisms responsible for restenosis and translate these models to applications in stent design and treatment planning at both population-based and patient-specific levels.
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28
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Mintz GS. Clinical utility of intravascular imaging and physiology in coronary artery disease. J Am Coll Cardiol 2014; 64:207-22. [PMID: 24530669 DOI: 10.1016/j.jacc.2014.01.015] [Citation(s) in RCA: 91] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2013] [Revised: 01/02/2014] [Accepted: 01/14/2014] [Indexed: 12/26/2022]
Abstract
Intravascular imaging and physiology techniques and technologies are moving beyond the framework of research to inform clinical decision making. Currently available technologies and techniques include fractional flow reserve; grayscale intravascular ultrasound (IVUS); IVUS radiofrequency tissue characterization; optical coherence tomography, the light analogue of IVUS; and near-infrared spectroscopy that detects lipid within the vessel wall and that has recently been combined with grayscale IVUS in a single catheter as the first combined imaging device. These tools can be used to answer questions that occur during daily practice, including: Is this stenosis significant? Where is the culprit lesion? Is this a vulnerable plaque? What is the likelihood of distal embolization or periprocedural myocardial infarction during stent implantation? How do I optimize acute stent results? Why did thrombosis or restenosis occur in this stent? One of the legacies of coronary angiography is to presume that one technique will answer all of these questions; however, that often has been proved inaccurate in contemporary practice.
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Affiliation(s)
- Gary S Mintz
- Cardiovascular Research Foundation, New York, New York.
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29
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Hynes BG, Kennedy KF, Ruggiero NJ, Kiernan TJ, Margey RJ, Rosenfield K, Garasic JM. Carotid Artery Stenting for Recurrent Carotid Artery Restenosis After Previous Ipsilateral Carotid Artery Endarterectomy or Stenting. JACC Cardiovasc Interv 2014; 7:180-186. [DOI: 10.1016/j.jcin.2013.11.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2013] [Revised: 11/01/2013] [Accepted: 11/07/2013] [Indexed: 11/30/2022]
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30
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Nakatani S, Proniewska K, Pociask E, Paoletti G, de Winter S, Muramatsu T, Bruining N. How clinically effective is intravascular ultrasound in interventional cardiology? Present and future perspectives. Expert Rev Med Devices 2014; 10:735-49. [DOI: 10.1586/17434440.2013.841353] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Vasquez A, Mistry N, Singh J. Impact of Intravascular Ultrasound in Clinical Practice. Interv Cardiol 2014; 9:156-163. [PMID: 29588795 DOI: 10.15420/icr.2014.9.3.156] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Intravascular ultrasound (IVUS) has expanded our understanding of atherosclerotic plaque morphology, and provides an opportunity to guide cardiovascular interventions and evaluate results. Use of this technique requires understanding of ultrasound physics, catheter differences, skills in vessel, plaque and stent quantification and knowledge of artifacts and various physiologic and pathologic findings. Optimal cardiovascular interventions should result in absence of inflow or outflow obstruction, precise geographic landing, while attaining the largest feasible luminal gain without plaque protrusion, vessel dissection or perforation and, if deployed, with complete stent expansion and apposition to the vessel wall. IVUS is safe, cost efficient and effectively optimises cardiovascular interventions. In addition, IVUS improves outcomes when used to guide coronary interventions using bare metal stents (BMS) and drug eluting stents (DES). The role of IVUS in endovascular therapy is rapidly expanding. This review will focus on the impact of IVUS in clinical practice.
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Affiliation(s)
- Andres Vasquez
- Cardiovascular Division, Washington University School of Medicine, St. Louis, Missouri, US
| | - Neville Mistry
- Cardiovascular Division, Washington University School of Medicine, St. Louis, Missouri, US
| | - Jasvindar Singh
- Cardiovascular Division, Washington University School of Medicine, St. Louis, Missouri, US
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Klersy C, Ferlini M, Raisaro A, Scotti V, Balduini A, Curti M, Bramucci E, De Silvestri A. Use of IVUS guided coronary stenting with drug eluting stent. Int J Cardiol 2013; 170:54-63. [DOI: 10.1016/j.ijcard.2013.10.002] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Park CB, Park HK. Identification of independent risk factors for restenosis following bare-metal stent implantation: Role of bare-metal stents in the era of drug-eluting stents. Exp Ther Med 2013; 6:840-846. [PMID: 24137276 PMCID: PMC3786962 DOI: 10.3892/etm.2013.1212] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2013] [Accepted: 06/28/2013] [Indexed: 02/02/2023] Open
Abstract
In the era of drug-eluting stents (DESs), the ability of clinicians to predict which patients have a low risk of coronary restenosis following bare-metal stent (BMS) implantion is likely to be of benefit. The study population consisted of 2,711 patients who underwent BMS implantation in 3,770 lesions between 1995 and 2004. With clinical and 6 month follow-up angiographic data, we retrospectively sought to identify the independent risk predictors of restenosis, applied a previously proposed prediction model and assessed the characteristics of patients with a low likelihood of coronary restenosis within 6 months of BMS implantation. A 6-month follow-up coronary angiography was performed in 65.0% of the patients who had undergone the BMS implantation and the rate of restenosis was 26.6%. Using multivariate analysis, diabetes [odds ratio (OR), 1.294; 95% confidence interval (CI), 1.094–1.483; P=0.005], current smoking (OR, 1.294; 95% CI, 1.094–1.483; P=0.002), a reference vessel diameter of <3.25 mm (OR, 1.238; 95% CI, 1.021–1.501; P<0.001), a lesion length of >30 mm (OR, 1.645; 95% CI, 1.336–2.026; P<0.001), ostial lesion (OR, 1.858; 95% CI, 1.437–2.402; P<0.001), post-stenting minimal luminal diameter (OR, 0.576; 95% CI, 0.484–0.685; P<0.001) and bifurcation lesion (OR, 1.353; 95% CI, 1.070–1.711; P=0.012) were identified as significant independent predictors of restenosis. However, the accuracy of the prediction obtained with the current model, which used the clinical and angiographic variables correlated with the risk of restenosis, was poor. Various clinical and angiographic independent risk variables were revealed to be correlated with the risk of restenosis following BMS implantation in the present large dataset. Certain groups of patients with a relatively low risk of restenosis may be considered for BMS implantation as an alternative to DESs. However, the prediction models used at present are incomplete and further studies are required.
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Affiliation(s)
- Chang-Bum Park
- Department of Internal Medicine, Graduate School of Medicine, Kyung Hee University Hospital at Gangdong, Kyung Hee University, Seoul 134-727, Republic of Korea
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Chacko Y, Haladyn JK, Smith DM, Lim R. Compliance charts to guide non-complex small artery stenting: validation by quantitative coronary angiography. HEART ASIA 2013; 5:76-9. [PMID: 27326085 DOI: 10.1136/heartasia-2013-010312] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/07/2013] [Accepted: 05/05/2013] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To determine whether stent sizing derived from manufacturers' compliance charts provides a reasonable in vivo estimate of final minimum lumen diameter (MLD) when compared with quantitative coronary angiography (QCA). DESIGN Single-centre measurement comparison study. SETTING Tertiary referral university hospital. PATIENTS Fifty cases receiving a single stent for non-complex de novo stenosis were randomly selected from the percutaneous coronary intervention database of our high-volume centre. Restenosis, stent thrombosis, bifurcational disease, rotablation, left main or graft stenting, intravascular ultrasound or kissing balloon inflations were exclusion criteria. MAIN OUTCOME MEASURES Equality and limits of agreement (LOA) between compliance chart and QCA measurements of final MLD, especially focusing on patients with small stents<3 mm. The paired t test and Bland-Altman plots were used to compare measurements. RESULTS There was no significant difference between compliance chart-derived and QCA final MLD (n=50; mean -0.034 mm, SD 0.35, 95% CI -0.132 to +0.064; p=0.49), with reasonable Bland-Altman LOA between the two methods of assessing final MLD in the overall group (LOA -0.72 to +0.66 mm), as well as in the group of particular interest with Derived final MLD <3 mm (n=30; mean 0.019 mm, SD 0.27, 95% CI -0.082 to +0.119; p=0.71; LOA -0.52 to +0.56 mm). CONCLUSIONS Compliance charts provide an acceptable estimate of final MLD and are a reasonable guide to sizing during non-complex stenting, especially in small vessels <3 mm.
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Affiliation(s)
- Yohan Chacko
- Department of Medicine, The University of Queensland, Brisbane, Queensland, Australia; Department of Cardiology, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - J Kimberly Haladyn
- Department of Medicine , The University of Queensland , Brisbane, Queensland , Australia
| | - Debbie M Smith
- Department of Cardiology , Princess Alexandra Hospital , Brisbane, Queensland , Australia
| | - Richard Lim
- Department of Medicine, The University of Queensland, Brisbane, Queensland, Australia; Department of Cardiology, Princess Alexandra Hospital, Brisbane, Queensland, Australia
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Roura G, Gomez-Lara J, Ferreiro JL, Gomez-Hospital JA, Romaguera R, Teruel LM, Carreño E, Esplugas E, Alfonso F, Cequier A. Multislice CT for assessing in-stent dimensions after left main coronary artery stenting: a comparison with three dimensional intravascular ultrasound. Heart 2013; 99:1106-12. [DOI: 10.1136/heartjnl-2013-303679] [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] [Indexed: 11/03/2022] Open
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Cook JR, Mhatre A, Wang FW, Uretsky BF. Prolonged high-pressure is required for optimal stent deployment as assessed by optical coherence tomography. Catheter Cardiovasc Interv 2013; 83:521-7. [PMID: 23436559 DOI: 10.1002/ccd.24724] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2012] [Accepted: 10/12/2012] [Indexed: 12/21/2022]
Abstract
AIMS Optimizing stent deployment is important for both acute- and long-term outcomes. High-pressure balloon inflation is the standard for coronary stent implantation. However, there is no standardized inflation protocol. We hypothesized that prolonged high-pressure balloon inflation until stabilization of inflation pressure is superior to a rapid inflation/deflation sequence for both stent expansion and strut apposition. METHODS AND RESULTS A high-pressure rapid inflation/deflation sequence was deployed followed by angiography to assure no residual stenosis. Optical coherence tomography (OCT) was then performed followed by prolonged inflation until balloon pressure was stabilized for 30 sec using the same balloon at the same pressure as the rapid sequence. A second OCT run was then done. Thirteen thousand nine hundred thirteen stent struts were evaluated by OCT in 12 patients undergoing successful stenting. Stent expansion improved with prolonged (206 ± 115 sec) vs. rapid (28 ± 17 sec) inflation for both minimal stent diameter (3.0 ± 0.5 vs. 2.75 ± 0.44 mm, P < 0.0001) and area (7.83 ± 2.45 vs. 6.63 ± 1.85 mm(2) , P = 0.0003). The number of malapposed struts decreased (45 ± 41 vs. 88 ± 75, P = 0.005) as did the maximal malapposed strut distance (0.31 ± 0.2 vs. 0.43 ± 0.2 mm, P = 0.0001). Factors related to strut malapposition after rapid inflation included localized asymmetry in 67%, stent underexpansion in 75%, and stent undersizing in 67%. CONCLUSIONS These data demonstrate that prolonged inflation is superior to a rapid inflation/deflation technique for both stent expansion and strut apposition. We recommend for routine stent deployment a prolonged inflation protocol as described above to optimize stent deployment.
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Affiliation(s)
- Jeffrey R Cook
- Central Arkansas Veterans Health System, Division of Cardiology, University of Arkansas for Medical Sciences, Little Rock, Arkansas
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Chang SH, Chen CC, Hsieh MJ, Wang CY, Lee CH, Hsieh IC. Lesion length impacts long term outcomes of drug-eluting stents and bare metal stents differently. PLoS One 2013; 8:e53207. [PMID: 23326399 PMCID: PMC3543456 DOI: 10.1371/journal.pone.0053207] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2012] [Accepted: 11/27/2012] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Long lesions have been associated with adverse outcomes in percutaneous coronary interventions with bare metal stents (BMS). However, the exact impact of lesion length on the short- and long-term outcomes of drug-eluting stent (DES) implantations is not as clear. METHODS AND RESULTS This study compared the impact of lesion length on angiographic and clinical outcomes of BMS and DES in a single-center prospective registry. Lesion length was divided into tertiles. The primary endpoints were angiographically defined binary in-stent restenosis (ISR) rate and major adverse cardiac event (MACE). Of the 4,312 de novo lesions in 3,447 consecutive patients in the CAPTAIN registry, 2,791 lesions (of 2,246 patients) received BMS, and the remaining 1,521 lesions (of 1,201 patients) received DES. The mean follow-up duration was 4.5 years. The longer the lesion, the higher the ISR rate (14%, 18%, and 29%, p<0.001) and the lower the MACE-free survivals (p = 0.007) in the BMS group. However, lesion length showed no such correlation with ISR rates (4.7%, 3.3%, and 7.8%, p = 0.67) or MACE-free survivals (p = 0.19) in the DES group. CONCLUSIONS In our single-center prospective registry, lesion length defined in tertiles has no impact on the short-term (ISR) or long-term (MACE) outcomes of patients implanted with DES. In contrast, longer lesion correlates with higher ISR and MACE rates in BMS group.
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Affiliation(s)
- Shang-Hung Chang
- Second Section of Cardiology and Percutaneous Coronary Intervention Center Department of Medicine, Chang Gung Memorial Hospital and Chang Gung University, Taipei, Taiwan
| | - Chun-Chi Chen
- Second Section of Cardiology and Percutaneous Coronary Intervention Center Department of Medicine, Chang Gung Memorial Hospital and Chang Gung University, Taipei, Taiwan
| | - Ming-Jer Hsieh
- Second Section of Cardiology and Percutaneous Coronary Intervention Center Department of Medicine, Chang Gung Memorial Hospital and Chang Gung University, Taipei, Taiwan
| | - Chao-Yung Wang
- Second Section of Cardiology and Percutaneous Coronary Intervention Center Department of Medicine, Chang Gung Memorial Hospital and Chang Gung University, Taipei, Taiwan
| | - Cheng-Hung Lee
- Second Section of Cardiology and Percutaneous Coronary Intervention Center Department of Medicine, Chang Gung Memorial Hospital and Chang Gung University, Taipei, Taiwan
| | - I-Chang Hsieh
- Second Section of Cardiology and Percutaneous Coronary Intervention Center Department of Medicine, Chang Gung Memorial Hospital and Chang Gung University, Taipei, Taiwan
- * E-mail:
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Caputo RP, Goel A, Pencina M, Cohen DJ, Kleiman NS, Yen CH, Waksman R, Tolerico P, Dhar G, Gordon P, Bach RG, Lopez JJ. Impact of drug eluting stent length on outcomes of percutaneous coronary intervention (from the EVENT registry). Am J Cardiol 2012; 110:350-5. [PMID: 22560770 DOI: 10.1016/j.amjcard.2012.03.031] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2012] [Revised: 03/17/2012] [Accepted: 03/17/2012] [Indexed: 11/19/2022]
Abstract
In randomized trials, longer drug-eluting stent (DES) length has been associated with adverse clinical events. We used data from the EVENT registry to examine the impact of DES length on outcomes in routine clinical practice. We identified 5,425 unselected consecutive patients from the EVENT registry who had a single vessel treated with DES for nonemergency indications from 2004 through 2007. The association between stented length and short- and long-term outcomes was analyzed in ordinal categories (<15, 15 to 19, 20 to 24, and >24 mm) and as a continuous variable. There were few differences in baseline characteristics across categories. At 1 year, there was a stepwise increase in major adverse cardiac events (composite of death, myocardial infarction [MI], and target lesion revascularization [TLR]) with increasing stent length (8.0%, 10.1%, 11.8%, and 14.8%, p <0.001) and a similar relation with TLR (3.0%, 3.1%, 3.3%, and 5.0%, p = 0.02). After adjusting for demographic, clinical, angiographic, and treatment characteristics, longer stent length remained associated with 1-year major adverse cardiac events (adjusted hazard ratio 1.17 per 10-mm increase stent length) and TLR (hazard ratio 1.20 per 10 mm), but not with stent thrombosis. In conclusion, longer DES length is associated with increased adverse events, predominantly periprocedural MI, but also an increased rate of TLR.
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WAKABAYASHI KOHEI, LINDSAY JOSEPH, LAYNEZ-CARNICERO ANA, BEN-DOR ITSIK, SARDI GABRIEL, TORGUSON REBECCA, XUE ZHENYI, SATLER LOWELLF, PICHARD AUGUSTOD, WAKSMAN RON. Utility of Intravascular Ultrasound Guidance in Patients Undergoing Percutaneous Coronary Intervention for Type C Lesions. J Interv Cardiol 2012; 25:452-9. [DOI: 10.1111/j.1540-8183.2012.00744.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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40
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Shand JA, Ramsewak A, Hanratty CG, Spence MS, Walsh SJ. The ‘concertina effect’ and the limitations of current drug-eluting stents: is it time to revisit and prioritize stent design over efficacy? Interv Cardiol 2012. [DOI: 10.2217/ica.12.27] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Hovasse T, Mylotte D, Garot P, Salvatella N, Morice MC, Chevalier B, Pichard A, Lefèvre T. Duration of balloon inflation for optimal stent deployment: five seconds is not enough. Catheter Cardiovasc Interv 2011; 81:446-53. [PMID: 22109977 DOI: 10.1002/ccd.23343] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2011] [Accepted: 08/08/2011] [Indexed: 11/12/2022]
Abstract
OBJECTIVES To assess the effect of the duration of stent inflation on stent expansion using digital stent enhancement (DSE). BACKGROUND Optimal stent expansion and apposition to the vessel wall are of critical importance to optimize the results of percutaneous coronary intervention (PCI). However, it is not known if stent inflation duration impacts on stent expansion. METHODS We performed a prospective cohort study in patients undergoing PCI. Quantitative coronary angiography and DSE data were analyzed. DSE was performed at 5, 15, and 25 sec during stent implantation, after target balloon inflation pressure was achieved. RESULTS One hundred and four consecutive patients (150 lesions) were enrolled. The mean age was 66.9 ± 11.1 years. Complex lesions (ACC/AHA B2/C) occurred in 26.9%. Stents used: Cypher Select (54.1%), Xience V (30.6%), and Taxus Liberté (15.3%). The minimal stent diameter increased significantly with the duration of stent inflation: 2.60 ± 0.51, 2.76 ± 0.51, and 2.82 ± 0.52 mm at 5, 15, and 25 sec (P < 0.0001). Similarly, maximal stent diameter increased with the duration of stent inflation: 3.21 ± 0.51, 3.32 ± 0.52, and 3.36 ± 0.54 mm (P < 0.0001). The average stent diameter also increased with longer stent inflation (P < 0.0001). Using MUSIC criteria 24.0, 53.3, and 68.0% of stents were appropriately expanded at 5, 15, and 25 sec (P < 0.0001). CONCLUSIONS The duration of stent balloon inflation has a significant impact on stent expansion. Stent deployment for >25 sec is recommended.
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Affiliation(s)
- Thomas Hovasse
- Department of Interventional Cardiology, Institut Hospitalier Jacques Cartier, Massy, France
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Contemporary Clinical Applications of Coronary Intravascular Ultrasound. JACC Cardiovasc Interv 2011; 4:1155-67. [DOI: 10.1016/j.jcin.2011.07.013] [Citation(s) in RCA: 89] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2010] [Revised: 07/27/2011] [Accepted: 07/28/2011] [Indexed: 11/20/2022]
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Kim U, Lee SH, Hong GR, Park JS, Shin DG, Kim YJ, Jang JS, Yang TH, Kim DK, Kim DS, Kim DK, Seol SH, Kim DI, Cho YK, Kim HS, Nam CW, Hur SH, Kim KB. Two-year clinical outcomes of patients with long segments drug-eluting stents: comparison of sirolimus-eluting stent with paclitaxel-eluting stent. J Korean Med Sci 2011; 26:1299-304. [PMID: 22022181 PMCID: PMC3192340 DOI: 10.3346/jkms.2011.26.10.1299] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2011] [Accepted: 08/02/2011] [Indexed: 11/20/2022] Open
Abstract
Limited data are available on the long-term clinical efficacy of drug-eluting stent (DES) in diffuse long lesions. From May 2006 to May 2007, a total of 335 consecutive patients (374 lesions) were underwent percutaneous coronary intervention with implantation of long DES (≥ 30 mm) in real world practice. Eight-month angiographic outcomes and 2-yr clinical outcomes were compared between SES (n = 218) and PES (n = 117). Study endpoints were major adverse cardiac events including cardiac death, myocardial infarction, target-lesion revascularization, target-vessel revascularization and stent thrombosis. Baseline characteristics were similar in the two groups as were mean stent length (44.9 ± 15.2 mm in SES and 47.4 ± 15.9 in PES, P = 0.121). Late loss at 8 months follow-up was significantly lower in SES than in PES group (0.4 ± 0.6 mm in SES vs 0.7 ± 0.8 mm in PES, P = 0.007). Mean follow-up duration was 849 ± 256 days, and 2-yr cumulative major adverse cardiac events were significantly lower in the SES than in the PES group (5.5% in SES vs 15.4% in PES, P = 0.003). In conclusion, long-term DES use in diffuse long coronary lesions is associated with favorable results, with SES being more effective and safer than PES in this real-world clinical experience.
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Affiliation(s)
- Ung Kim
- Division of Cardiology, Department of Internal Medicine, Yeungnam University Medical Center, Daegu, Korea
| | - Sang-Hee Lee
- Division of Cardiology, Department of Internal Medicine, Yeungnam University Medical Center, Daegu, Korea
| | - Geu-Ru Hong
- Division of Cardiology, Department of Internal Medicine, Yeungnam University Medical Center, Daegu, Korea
| | - Jong-Seon Park
- Division of Cardiology, Department of Internal Medicine, Yeungnam University Medical Center, Daegu, Korea
| | - Dong-Gu Shin
- Division of Cardiology, Department of Internal Medicine, Yeungnam University Medical Center, Daegu, Korea
| | - Young-Jo Kim
- Division of Cardiology, Department of Internal Medicine, Yeungnam University Medical Center, Daegu, Korea
| | - Jae-Sik Jang
- Division of Cardiology, Department of Internal Medicine, Inje University Busan Paik Hospital, Busan, Korea
| | - Tae-Hyun Yang
- Division of Cardiology, Department of Internal Medicine, Inje University Busan Paik Hospital, Busan, Korea
| | - Dae-Kyeong Kim
- Division of Cardiology, Department of Internal Medicine, Inje University Busan Paik Hospital, Busan, Korea
| | - Dong-Soo Kim
- Division of Cardiology, Department of Internal Medicine, Inje University Busan Paik Hospital, Busan, Korea
| | - Dong-Kie Kim
- Division of Cardiology, Department of Internal Medicine, Inje University Haeundae Paik Hospital, Busan, Korea
| | - Sang-Hoon Seol
- Division of Cardiology, Department of Internal Medicine, Inje University Haeundae Paik Hospital, Busan, Korea
| | - Doo-Il Kim
- Division of Cardiology, Department of Internal Medicine, Inje University Haeundae Paik Hospital, Busan, Korea
| | - Yoon-Kyung Cho
- Division of Cardiology, Department of Internal Medicine, Keimyung University Dongsan Hospital, Daegu, Korea
| | - Hyung-Seop Kim
- Division of Cardiology, Department of Internal Medicine, Keimyung University Dongsan Hospital, Daegu, Korea
| | - Chang-Wook Nam
- Division of Cardiology, Department of Internal Medicine, Keimyung University Dongsan Hospital, Daegu, Korea
| | - Seung-Ho Hur
- Division of Cardiology, Department of Internal Medicine, Keimyung University Dongsan Hospital, Daegu, Korea
| | - Kwon-Bae Kim
- Division of Cardiology, Department of Internal Medicine, Keimyung University Dongsan Hospital, Daegu, Korea
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Rogacka R, Latib A, Colombo A. IVUS-Guided Stent Implantation to Improve Outcome: A Promise Waiting to be Fulfilled. Curr Cardiol Rev 2011; 5:78-86. [PMID: 20436848 PMCID: PMC2805818 DOI: 10.2174/157340309788166697] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2008] [Revised: 11/10/2008] [Accepted: 11/10/2008] [Indexed: 02/04/2023] Open
Abstract
The use of intravascular ultrasound (IVUS) to improve acute angiographic results was already shown in the prestent era. Various studies demonstrated the efficacy of IVUS in balloon sizing and estimating the extent of positive remodeling. With the introduction of drug-eluting stents (DES) the rate of restenosis has been significantly reduced but a new concern, the risk of stent thrombosis, has emerged. The association of stent underexpansion with stent thrombosis was observed for bare metal stents (BMS) and DES. Until now, the criteria for IVUS optimization used in different studies have relied on distal reference or on mean reference vessel for stent or postdilatation balloon sizing. Furthermore, an important recent innovation not available in previous studies is the use of noncompliant balloons to perform high pressure post-dilatation. Universal and easily applicable IVUS criteria for optimization of stent implantation as well as randomized studies on IVUS-guided DES implantation are necessary to minimize stent malapposition and underexpansion, which in turn can positively influence the rates of stent restenosis and thrombosis.
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Affiliation(s)
- Renata Rogacka
- Interventional Cardiology Unit, Desio Hospital, Milan, Italy
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Brugaletta S, Gomez-Lara J, Diletti R, Farooq V, van Geuns RJ, de Bruyne B, Dudek D, Garcia-Garcia HM, Ormiston JA, Serruys PW. Comparison of in vivo eccentricity and symmetry indices between metallic stents and bioresorbable vascular scaffolds: insights from the ABSORB and SPIRIT trials. Catheter Cardiovasc Interv 2011; 79:219-28. [PMID: 21563288 DOI: 10.1002/ccd.22996] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2011] [Accepted: 01/16/2011] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To compare the geometrical parameters of a bioresorbable vascular scaffold (BVS) with a standard metallic stent. BACKGROUND The introduction of polymeric bioresorbable materials in the design of novel coronary scaffolds may affect some geometrical parameters, such as eccentricity and symmetry indices, previously introduced as IVUS criteria for optimal metallic stent deployment. METHODS From ABSORB Cohort A, ABSORB Cohort B, SPIRIT I, and SPIRIT II, all patients implanted with BVS 1.0, BVS 1.1, or XIENCE V, respectively and intravascular ultrasound analyses post-implantation were selected. The eccentricity index was calculated frame by frame and expressed as an average per device (minimum diameter/maximum diameter). The symmetry index of the device was reported as ([maximum diameter - minimum diameter]/maximum diameter). Six months major adverse cardiac events (MACE) were analyzed. RESULTS A total of 242 patients were selected (BVS 1.0: n = 28, BVS 1.1: n = 94, XIENCE V: n = 120). The BVS exhibited a significantly lower eccentricity index (BVS 1.0: 0.83 ± 0.09; BVS 1.1: 0.85 ± 0.08; XIENCE V: 0.90 ± 0.06; P < 0.01) and a significantly higher symmetry index (BVS 1.0: 0.30 ± 0.07; BVS 1.1: 0.31 ± 0.06, XIENCE V 0.26 ± 0.07; P < 0.01) as compared to the XIENCE V. An inverse correlation was found between the symmetry and eccentricity indices for both (BVS r = -0.69, P < 0.01; XIENCE V r = -0.61, P < 0.01). No differences in MACE were detected between the groups according to their geometrical parameters. CONCLUSIONS The introduction of a new polymeric material in the design of BVS resulted in a lower eccentricity index and a higher symmetry index as compared to metallic stents, without detectable impact in MACE, at 6 months.
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Caixeta A, Maehara A, Mintz GS. Intravascular Ultrasound: Principles, Image Interpretation, and Clinical Applications. Interv Cardiol 2011. [DOI: 10.1002/9781444319446.ch10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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Angiographic late lumen loss at the site of overlap of multiple Cypher™ sirolimus-eluting stents: ALSOCE study. J Cardiol 2011; 57:187-93. [DOI: 10.1016/j.jjcc.2010.11.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2010] [Revised: 11/10/2010] [Accepted: 11/15/2010] [Indexed: 11/19/2022]
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Williams P, Appleby C, Chowdhary S, Fraser D. Double stenting: a method for treating acute stent recoil and luminal filling defects. EUROINTERVENTION 2011; 6:846-53. [DOI: 10.4244/eijv6i7a145] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Parise H, Maehara A, Stone GW, Leon MB, Mintz GS. Meta-analysis of randomized studies comparing intravascular ultrasound versus angiographic guidance of percutaneous coronary intervention in pre-drug-eluting stent era. Am J Cardiol 2011; 107:374-82. [PMID: 21257001 DOI: 10.1016/j.amjcard.2010.09.030] [Citation(s) in RCA: 130] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2010] [Revised: 09/15/2010] [Accepted: 09/18/2010] [Indexed: 12/11/2022]
Abstract
We conducted a formal meta-analysis of peer-reviewed, published, randomized studies comparing intravascular ultrasound (IVUS)-guidance and angiographic-guided bare metal stent implantation. A total of 8 studies were identified. Because the Balloon Equivalent to Stent (BEST) study was a noninferiority trial designed to compare 2 very different percutaneous coronary intervention strategies-IVUS-guided aggressive balloon angioplasty (with bail-out stenting) and angiographic-guided deliberate bare metal stent implantation-it was eliminated. An unadjusted random-effects meta-analysis was used to compare the IVUS-guided and non-IVUS-guided stenting in the 7 remaining studies. A total of 2,193 patients were randomized in 5 multicenter and 2 single-center studies. IVUS guidance was associated with a significantly larger postprocedure angiographic minimum lumen diameter. The mean difference was 0.12 mm (95% confidence interval [CI] 0.06 to 0.18, p <0.0001). IVUS guidance was also associated with a significantly lower rate of 6-month angiographic restenosis (22% vs 29%, odds ratio 0.64, 95% CI 0.42 to 0.96, p = 0.02), a significant reduction in the revascularization rate (13% vs 18%, odds ratio 0.66, 95% CI 0.48 to 0.91, p = 0.004), and overall major adverse cardiac events (19% vs. 23%, odds ratio 0.69, 95% CI 0.49 to 0.97, p = 0.03). However, no significant effect was seen for myocardial infarction (p = 0.51) or mortality (p = 0.18). In conclusion, IVUS guidance for bare metal stent implantation improved the acute procedural results (angiographic minimum lumen diameter) and thereby reduced angiographic restenosis and repeat revascularization and major adverse cardiac events, with a neutral effect on death and myocardial infarction during a follow-up period of 6 months to 2.5 years.
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Park SM, Kim JS, Ko YG, Choi D, Hong MK, Jang Y, Kang WC, Ahn T, Kim BK, Oh SJ, Jeon DW, Yang JY. Angiographic and intravascular ultrasound follow up of paclitaxel- and sirolimus-eluting stent after poststent high-pressure balloon dilation: From the poststent optimal stent expansion trial. Catheter Cardiovasc Interv 2010; 77:15-21. [DOI: 10.1002/ccd.22635] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2010] [Accepted: 04/22/2010] [Indexed: 11/09/2022]
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