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Hatfaludi CA, Tache IA, Ciusdel CF, Puiu A, Stoian D, Calmac L, Popa-Fotea NM, Bataila V, Scafa-Udriste A, Itu LM. Co-registered optical coherence tomography and X-ray angiography for the prediction of fractional flow reserve. THE INTERNATIONAL JOURNAL OF CARDIOVASCULAR IMAGING 2024; 40:1029-1039. [PMID: 38376719 DOI: 10.1007/s10554-024-03069-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 02/13/2024] [Indexed: 02/21/2024]
Abstract
Cardiovascular disease (CVD) stands as the leading global cause of mortality, and coronary artery disease (CAD) has the highest prevalence, contributing to 42% of these fatalities. Recognizing the constraints inherent in the anatomical assessment of CAD, Fractional Flow Reserve (FFR) has emerged as a pivotal functional diagnostic metric. Herein, we assess the potential of employing an ensemble approach with deep neural networks (DNN) to predict invasively measured Fractional Flow Reserve (FFR) using raw anatomical data extracted from both optical coherence tomography (OCT) and X-ray coronary angiography (XA). In this study, we used a challenging dataset, with 46% of the lesions falling within the FFR range of 0.75 to 0.85. Despite this complexity, our model achieved an accuracy of 84.3%, demonstrating a sensitivity of 87.5% and a specificity of 81.4%. Our results demonstrate that incorporating both OCT and XA signals, co-registered, as inputs for the DNN model leads to an important increase in overall accuracy.
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Affiliation(s)
- Cosmin-Andrei Hatfaludi
- Advanta, Siemens SRL, 15 Noiembrie Bvd, Brasov, 500097, Romania.
- Automation and Information Technology, Transilvania University of Brasov, Mihai Viteazu nr. 5, Brasov, 5000174, Romania.
| | - Irina-Andra Tache
- Advanta, Siemens SRL, 15 Noiembrie Bvd, Brasov, 500097, Romania
- Department of Automatic Control and Systems Engineering, University Politehnica of Bucharest, Bucharest, 014461, Romania
| | - Costin-Florian Ciusdel
- Advanta, Siemens SRL, 15 Noiembrie Bvd, Brasov, 500097, Romania
- Automation and Information Technology, Transilvania University of Brasov, Mihai Viteazu nr. 5, Brasov, 5000174, Romania
| | - Andrei Puiu
- Advanta, Siemens SRL, 15 Noiembrie Bvd, Brasov, 500097, Romania
- Automation and Information Technology, Transilvania University of Brasov, Mihai Viteazu nr. 5, Brasov, 5000174, Romania
| | - Diana Stoian
- Advanta, Siemens SRL, 15 Noiembrie Bvd, Brasov, 500097, Romania
- Automation and Information Technology, Transilvania University of Brasov, Mihai Viteazu nr. 5, Brasov, 5000174, Romania
| | - Lucian Calmac
- Department of Cardiology, Emergency Clinical Hospital, 8 Calea Floreasca, Bucharest, 014461, Romania
- Department Cardio-Thoracic, University of Medicine and Pharmacy "Carol Davila", 8 Eroii Sanitari, Bucharest, 050474, Romania
| | - Nicoleta-Monica Popa-Fotea
- Department of Cardiology, Emergency Clinical Hospital, 8 Calea Floreasca, Bucharest, 014461, Romania
- Department Cardio-Thoracic, University of Medicine and Pharmacy "Carol Davila", 8 Eroii Sanitari, Bucharest, 050474, Romania
| | - Vlad Bataila
- Department of Cardiology, Emergency Clinical Hospital, 8 Calea Floreasca, Bucharest, 014461, Romania
| | - Alexandru Scafa-Udriste
- Department of Cardiology, Emergency Clinical Hospital, 8 Calea Floreasca, Bucharest, 014461, Romania
- Department Cardio-Thoracic, University of Medicine and Pharmacy "Carol Davila", 8 Eroii Sanitari, Bucharest, 050474, Romania
| | - Lucian Mihai Itu
- Advanta, Siemens SRL, 15 Noiembrie Bvd, Brasov, 500097, Romania
- Automation and Information Technology, Transilvania University of Brasov, Mihai Viteazu nr. 5, Brasov, 5000174, Romania
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Kume T, Nishi T, Murasato Y, Koto S, Sasahira Y, Okamoto H, Yamada R, Koyama T, Tamada T, Imai K, Neishi Y, Uemura S. Impact of stent strut link location in proximal balloon edge dilation technique for bifurcation percutaneous coronary intervention. Cardiovasc Interv Ther 2024; 39:137-144. [PMID: 38294663 PMCID: PMC10940397 DOI: 10.1007/s12928-023-00981-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 12/21/2023] [Indexed: 02/01/2024]
Abstract
The single-stent strategy has generally been accepted as the default approach to bifurcation percutaneous coronary intervention. We have proposed the proximal balloon edge dilation (PBED) technique to prevent stent deformation during side branch (SB) dilation. This bench study aimed to evaluate the impact of stent link location and stent design on stent deformation, obstruction by stent struts at a jailed SB ostium, and incomplete stent apposition in the proximal optimization technique (POT)-PBED procedure. A coronary bifurcation model was used. We intentionally set the absence or presence of stent link on the carina (link-free or link-connect) under videoscope observation and compared stent parameters between 3- and 2-link stents (n = 5 each, n = 20 total). In the link-free group, the SB jailing rate of 3-link stents was significantly higher than that of 2-link stents (15.5 ± 5.1% vs. 6.6 ± 1.2%, p = 0.009). In the link-connect group, the SB jailing rate of 3-link stents was significantly lower than that of 2-link stents (30.0 ± 4.5% vs. 39.0 ± 2.6%, p = 0.009). In the bifurcation segment, the rate of incomplete stent apposition was significantly lower for 3-link stents of the link-connect group than for 2-link stents of the link-connect group (3.3 ± 4.2% vs. 19.0 ± 7.8%, p = 0.009). For both stent designs, ellipticity ratio was higher for link-connect group than link-free group. Link location as well as stent cell design greatly impacted stent deformation during the POT-PBED procedure.
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Affiliation(s)
- Teruyoshi Kume
- Department of Cardiology, Kawasaki Medical School, Kurashi, Japan.
| | - Takeshi Nishi
- Department of Cardiology, Kawasaki Medical School, Kurashi, Japan
| | - Yoshinobu Murasato
- Department of Cardiology and Clinical Research Institute, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan
| | - Satoshi Koto
- Department of Cardiology, Kawasaki Medical School, Kurashi, Japan
| | | | - Hiroshi Okamoto
- Department of Cardiology, Kawasaki Medical School, Kurashi, Japan
| | - Ryotaro Yamada
- Department of Cardiology, Kawasaki Medical School, Kurashi, Japan
| | - Terumasa Koyama
- Department of Cardiology, Kawasaki Medical School, Kurashi, Japan
| | - Tomoko Tamada
- Department of Cardiology, Kawasaki Medical School, Kurashi, Japan
| | - Koichiro Imai
- Department of Cardiology, Kawasaki Medical School, Kurashi, Japan
| | - Yoji Neishi
- Department of Cardiology, Kawasaki Medical School, Kurashi, Japan
| | - Shiro Uemura
- Department of Cardiology, Kawasaki Medical School, Kurashi, Japan
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Wu P, Qiao Y, Chu M, Zhang S, Bai J, Gutierrez-Chico JL, Tu S. Reciprocal assistance of intravascular imaging in three-dimensional stent reconstruction: Using cross-modal translation based on disentanglement representation. Comput Med Imaging Graph 2023; 104:102166. [PMID: 36586195 DOI: 10.1016/j.compmedimag.2022.102166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 12/21/2022] [Accepted: 12/21/2022] [Indexed: 12/27/2022]
Abstract
BACKGROUND Accurate and efficient 3-dimension (3D) reconstruction of coronary stents in intravascular imaging of optical coherence tomography (OCT) or intravascular ultrasound (IVUS) is important for optimization of complex percutaneous coronary interventions (PCI). Deep learning has been used to address this technical challenge. However, manual annotation of stent is strenuous, especially for IVUS images. To this end, we aim to explore whether the OCT and IVUS images can assist each other in stent 3D reconstruction when one of them is lack of labeled dataset. METHODS We firstly performed cross-modal translation between OCT and IVUS images, where disentangled representation was employed to generate synthetic images with good stent consistency. The reciprocal assistance of OCT and IVUS in stent 3D reconstruction was then conducted by applying unsupervised and semi-supervised learning with the aid of synthetic images. Stent consistency in synthetic images and reciprocal effectiveness in stent 3D reconstruction were quantitatively assessed by F1-Score (FS) on two datasets: OCT-High Definition IVUS (HD IVUS) and OCT-Conventional IVUS (IVUS). RESULTS The employment of disentangled representation achieved higher stent consistency in synthetic images (OCT to HD IVUS: FS=0.789 vs 0.684; HD IVUS to OCT: FS=0.766 vs 0.682; OCT to IVUS: FS=0.806 vs 0.664; IVUS to OCT: FS=0.724 vs 0.673). For stent 3D reconstruction, the assistance from synthetic images significantly promoted unsupervised adaptation across modalities (OCT to HD IVUS: FS=0.776 vs 0.109; HD IVUS to OCT: FS=0.826 vs 0.125; OCT to IVUS: FS=0.782 vs 0.068; IVUS to OCT: FS=0.815 vs 0.123), and improved performance in semi-supervised learning, especially when only limited labeled data was available. CONCLUSION The intravascular images of OCT and IVUS can provide reciprocal assistance to each other in stent 3D reconstruction by cross-modal translation, where the stent consistency in synthetic images was maintained by disentangled representation.
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Affiliation(s)
- Peng Wu
- Biomedical Instrument Institute, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Yuchuan Qiao
- Institute of Science and Technology for Brain-Inspired Intelligence, Fudan University, Shanghai, China
| | - Miao Chu
- Biomedical Instrument Institute, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Su Zhang
- Biomedical Instrument Institute, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Jingfeng Bai
- Biomedical Instrument Institute, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China.
| | | | - Shengxian Tu
- Biomedical Instrument Institute, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China.
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Identification of post-procedural optical coherence tomography findings associated with the 1-year vascular response evaluated by coronary angioscopy. Cardiovasc Interv Ther 2023; 38:86-95. [PMID: 35917060 DOI: 10.1007/s12928-022-00880-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Accepted: 07/18/2022] [Indexed: 01/06/2023]
Abstract
Optical coherence tomography (OCT) provides higher resolution intravascular imaging and allows detailed evaluations of stent implantation sites post-percutaneous coronary intervention (PCI). Coronary angioscopy (CAS) can evaluate the vascular response after drug-eluting stent (DES) implantation. The post-PCI OCT findings that are associated with the CAS 1-year vascular response have not been known. We enrolled 168 lesions from 119 patients who underwent OCT-guided PCI using DES and follow-up CAS observation at 1 ± 0.5 year from August 2012 to December 2019. Outcome measures were sufficient neointimal coverage (NIC) defined as stent struts embedded in the neointima, subclinical intrastent thrombus, and vulnerable stented segments defined as those with angioscopic yellow or intensive yellow color 1 year after PCI. We identified the post-PCI OCT findings associated with these CAS findings. Sufficient NIC, subclinical intrastent thrombus, and vulnerable stented segment were detected in 85 lesions (51%), 47 lesions (28%), and 54 lesions (32%), respectively. A multivariate analysis demonstrated that malapposed struts were negatively associated with sufficient NIC (odds ratio 0.87; 95% CI 0.76-0.99; p = 0.029). However, no specific OCT findings immediately after PCI were associated with subclinical intrastent thrombus or vulnerable stented segment. Malapposition immediately after PCI was negatively associated with sufficient NIC at 1 year even without associations between post-PCI OCT findings and subclinical intrastent thrombus or vulnerable stented segment.
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Ding Y, Fu R, Collins CP, Yoda SF, Sun C, Ameer GA. 3D-Printed Radiopaque Bioresorbable Stents to Improve Device Visualization. Adv Healthc Mater 2022; 11:e2201955. [PMID: 36168854 PMCID: PMC9742307 DOI: 10.1002/adhm.202201955] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 09/06/2022] [Indexed: 12/14/2022]
Abstract
Bioresorbable stents (BRS) hold great promise for the treatment of many life-threatening luminal diseases. Tracking and monitoring of stents in vivo is critical for avoiding their malposition and inadequate expansion, which often leads to complications and stent failure. However, obtaining high X-ray visibility of polymeric BRS has been challenging because of their intrinsic radiolucency. This study demonstrates the use of photopolymerization-based 3D printing technique to fabricate radiopaque BRS by incorporating iodixanol, a clinical contrast agent, into a bioresorbable citrate-based polymer ink. The successful volumetric dispersion of the iodixanol through the 3D-printing process confers strong X-ray visibility of the produced BRS. Following in vitro degradation, the 3D-printed BRS embedded in chicken muscle maintains high X-ray visibility for at least 4 weeks. Importantly, the 3D-printed radiopaque BRS demonstrates good cytocompatibility and strong mechanical competence in crimping and expansion, which is essential for minimally invasive stent deployment. In addition, it is found that higher loading concentrations of iodixanol, e.g. 10 wt.%, results in more strut fractures in stent crimping and expansion. To conclude, this study introduces a facile strategy to fabricate radiopaque BRS through the incorporation of iodixanol in the 3D printing process, which could potentially increase the clinical success of BRS.
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Affiliation(s)
- Yonghui Ding
- Center for Advanced Regenerative Engineering (CARE), Northwestern University, Evanston, IL, 60208, USA
- Department of Biomedical Engineering, Northwestern University, Evanston, IL, 60208, USA
| | - Rao Fu
- Center for Advanced Regenerative Engineering (CARE), Northwestern University, Evanston, IL, 60208, USA
- Department of Mechanical Engineering, Northwestern University, Evanston, IL, 60208, USA
| | - Caralyn Paige Collins
- Center for Advanced Regenerative Engineering (CARE), Northwestern University, Evanston, IL, 60208, USA
- Department of Mechanical Engineering, Northwestern University, Evanston, IL, 60208, USA
| | - Sarah-Fatime Yoda
- Center for Advanced Regenerative Engineering (CARE), Northwestern University, Evanston, IL, 60208, USA
| | - Cheng Sun
- Center for Advanced Regenerative Engineering (CARE), Northwestern University, Evanston, IL, 60208, USA
- Department of Mechanical Engineering, Northwestern University, Evanston, IL, 60208, USA
| | - Guillermo A Ameer
- Center for Advanced Regenerative Engineering (CARE), Northwestern University, Evanston, IL, 60208, USA
- Department of Biomedical Engineering, Northwestern University, Evanston, IL, 60208, USA
- Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL, 60611, USA
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Towards a Deep-Learning Approach for Prediction of Fractional Flow Reserve from Optical Coherence Tomography. APPLIED SCIENCES-BASEL 2022. [DOI: 10.3390/app12146964] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Cardiovascular disease (CVD) is the number one cause of death worldwide, and coronary artery disease (CAD) is the most prevalent CVD, accounting for 42% of these deaths. In view of the limitations of the anatomical evaluation of CAD, Fractional Flow Reserve (FFR) has been introduced as a functional diagnostic index. Herein, we evaluate the feasibility of using deep neural networks (DNN) in an ensemble approach to predict the invasively measured FFR from raw anatomical information that is extracted from optical coherence tomography (OCT). We evaluate the performance of various DNN architectures under different formulations: regression, classification—standard, and few-shot learning (FSL) on a dataset containing 102 intermediate lesions from 80 patients. The FSL approach that is based on a convolutional neural network leads to slightly better results compared to the standard classification: the per-lesion accuracy, sensitivity, and specificity were 77.5%, 72.9%, and 81.5%, respectively. However, since the 95% confidence intervals overlap, the differences are statistically not significant. The main findings of this study can be summarized as follows: (1) Deep-learning (DL)-based FFR prediction from reduced-order raw anatomical data is feasible in intermediate coronary artery lesions; (2) DL-based FFR prediction provides superior diagnostic performance compared to baseline approaches that are based on minimal lumen diameter and percentage diameter stenosis; and (3) the FFR prediction performance increases quasi-linearly with the dataset size, indicating that a larger train dataset will likely lead to superior diagnostic performance.
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Kitabata H. Vascular response following drug-eluting stent implantation in calcified coronary lesions: 2 major clinical questions emerged. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2022; 41:61-62. [PMID: 35624013 DOI: 10.1016/j.carrev.2022.05.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Accepted: 05/16/2022] [Indexed: 11/03/2022]
Affiliation(s)
- Hironori Kitabata
- Department of Cardiovascular Medicine, Wakayama Medical University, 811 Kimiidera, Wakayama 641-8509, Japan.
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Nishimura T, Okamura T, Fujimura T, Miyazaki Y, Takenaka H, Akase H, Tateishi H, Mochizuki M, Uchinoumi H, Oda T, Yano M. Feasibility, reproducibility and characteristics of coronary bifurcation type assessment by three-dimensional optical coherence tomography. PLoS One 2022; 17:e0263246. [PMID: 35104282 PMCID: PMC8806074 DOI: 10.1371/journal.pone.0263246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Accepted: 01/17/2022] [Indexed: 11/18/2022] Open
Abstract
Aim To investigate the characteristics of coronary artery bifurcation type (parallel or perpendicular type) using three-dimensional (3D) optical coherence tomography (OCT), and determine the feasibility, reproducibility, assessment time and correlation with bifurcation angles measured by 3D quantitative coronary angiography (QCA). Methods and results We evaluated 60 lesions at the coronary bifurcation that were treated by main vessel (MV) stenting with kissing balloon inflation (KBI) under OCT/optical frequency domain imaging (OFDI) guidance. Inter- and intra-observer agreement regarding the assessment of 3D bifurcation types were 0.88 and 0.94, respectively. The assessment times of 3D-OCT bifurcation type with OCT and OFDI were within about 30 seconds. 3D-OCT bifurcation types showed the greatest correlation with the distal bifurcation angle assessed by 3D-QCA among the three bifurcation angles (distal bifurcation angle, proximal bifurcation angle and main vessel angle), and the optimal cut-off distal bifurcation angle to predict a perpendicular type bifurcation, as determined by ROC analysis, was 51.0° (AUC 0.773, sensitivity 0.80, specificity 0.67). Based on this cut-off value for the distal bifurcation angle (51°), the diagnostic accuracy for perpendicular type bifurcation in cases with a BA ≥ 51° (n = 34) was 70.6% (24/34) and that of the parallel type bifurcation in cases of BA < 51° (n = 26) was 76.9% (20/26). Conclusion Performing 3D-OCT for assessment of coronary artery bifurcation type is feasible and simple, and can be done in a short time with high reproducibility.
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Affiliation(s)
- Takashi Nishimura
- Division of Cardiology, Department of Medicine and Clinical Science, Yamaguchi University Graduate School of Medicine, Ube, Japan
| | - Takayuki Okamura
- Division of Cardiology, Department of Medicine and Clinical Science, Yamaguchi University Graduate School of Medicine, Ube, Japan
- * E-mail:
| | - Tatsuhiro Fujimura
- Division of Cardiology, Department of Medicine and Clinical Science, Yamaguchi University Graduate School of Medicine, Ube, Japan
| | - Yosuke Miyazaki
- Division of Cardiology, Department of Medicine and Clinical Science, Yamaguchi University Graduate School of Medicine, Ube, Japan
| | - Hitoshi Takenaka
- Division of Cardiology, Department of Medicine and Clinical Science, Yamaguchi University Graduate School of Medicine, Ube, Japan
| | - Hideaki Akase
- Division of Cardiology, Department of Medicine and Clinical Science, Yamaguchi University Graduate School of Medicine, Ube, Japan
| | - Hiroki Tateishi
- Division of Cardiology, Department of Medicine and Clinical Science, Yamaguchi University Graduate School of Medicine, Ube, Japan
| | - Mamoru Mochizuki
- Division of Cardiology, Department of Medicine and Clinical Science, Yamaguchi University Graduate School of Medicine, Ube, Japan
| | - Hitoshi Uchinoumi
- Division of Cardiology, Department of Medicine and Clinical Science, Yamaguchi University Graduate School of Medicine, Ube, Japan
| | - Tetsuro Oda
- Division of Cardiology, Department of Medicine and Clinical Science, Yamaguchi University Graduate School of Medicine, Ube, Japan
| | - Masafumi Yano
- Division of Cardiology, Department of Medicine and Clinical Science, Yamaguchi University Graduate School of Medicine, Ube, Japan
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Wu H, Li M, Lin C. Influence of balloon location during proximal optimization technique (POT): A finite element analysis. J Biomech 2021; 127:110703. [PMID: 34481186 DOI: 10.1016/j.jbiomech.2021.110703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 08/14/2021] [Accepted: 08/16/2021] [Indexed: 11/17/2022]
Abstract
Proximal Optimization Technique (POT)is a post-expansion technique that must be completed after single-stent implantation for the coronary bifurcation. The optimal location for the distal balloon shoulder during POT remains debatable. In the present study, the finite element method is applied to simulate POT after single-stent implantation in the coronary bifurcation. Three different balloon locations based on the distal shoulder relative to the carina cut plane were analyzed: 1) "proximal":1mm before carina cut plane; 2) "standard": at the carina cut plane; and 3) "distal": 1 mm after the carina cut plane. The computational results showed differences in stent, vessel morphology, and vessel wall stress due to the different balloon locations. However, when distal balloon shoulder was located between two adjacent stent rings, it formed the distal cell of the stent, the best stent apposition, least stent structs obstruction at SB ostial. Moreover, best opening effect of distal cell of the stent can be achieved, with the least damage to the vessel wall.
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Affiliation(s)
- Heng Wu
- Beijing Anzhen Hospital, Capital Medical University, No.2 Anzhen Road, Chaoyang District, Beijing, China
| | - Meng Li
- Beijing Anzhen Hospital, Capital Medical University, No.2 Anzhen Road, Chaoyang District, Beijing, China
| | - Changyan Lin
- Beijing Anzhen Hospital, Capital Medical University, No.2 Anzhen Road, Chaoyang District, Beijing, China.
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Okabe K, Ohya M, Ikuta A, Takamatsu M, Osakada K, Shimada T, Miura K, Kubo S, Tada T, Tanaka H, Fuku Y, Katoh H, Kadota K. Outcomes at 1 Year of Non-Left Main Trunk Bifurcation Lesions Treated With a 2-Stent Strategy Using Newer-Generation Everolimus-Eluting Stents. Circ J 2021; 85:1972-1980. [PMID: 34349075 DOI: 10.1253/circj.cj-20-1281] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Percutaneous coronary intervention (PCI) for coronary bifurcation lesions using the 2-stent strategy remains a challenging procedure for interventionalists because of the higher incidence of in-stent restenosis (ISR) and adverse events. ISR predictors in patients treated with newer-generation everolimus-eluting stents (EES) and the 2-stent strategy remain unknown. Hence, we aimed to evaluate the 1-year clinical and angiographic outcomes of non-left main trunk (LMT) bifurcation lesions treated with the 2-stent strategy using newer-generation EES.Methods and Results:The study sample consisted of 262 non-LMT bifurcation lesions treated using culotte or T-stenting with EES between 2010 and 2018. One-year post-procedural angiographic and clinical examinations were conducted in 208 (79.4%) and 260 (99.2%) lesions, respectively. The primary outcome measure was the 1-year post-procedural ISR rate, which was found to be 15.9%. Independent predictors of 1-year post-procedural ISR were long side branch lesions (adjusted odds ratio [aOR] 2.31; 95% confidence interval [CI] 1.02-5.23; P=0.04) and 3-link EES implantation (aOR 2.45; 95% CI 1.07-5.61; P=0.03). The 1-year cumulative incidence of target lesion revascularization was 3.5%. CONCLUSIONS The 1-year clinical outcomes of non-LMT bifurcation lesions treated with the 2-stent strategy using EES were acceptable. Long side branch lesions and lesions treated with 3-link EES were independent predictors of 1-year post-procedural ISR.
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Affiliation(s)
- Koya Okabe
- Department of Cardiovascular Medicine, Kurashiki Central Hospital
| | - Masanobu Ohya
- Department of Cardiovascular Medicine, Kurashiki Central Hospital
| | - Akihiro Ikuta
- Department of Cardiovascular Medicine, Kurashiki Central Hospital
| | - Makoto Takamatsu
- Department of Cardiovascular Medicine, Kurashiki Central Hospital
| | - Kohei Osakada
- Department of Cardiovascular Medicine, Kurashiki Central Hospital
| | - Takenobu Shimada
- Department of Cardiovascular Medicine, Kurashiki Central Hospital
| | - Katsuya Miura
- Department of Cardiovascular Medicine, Kurashiki Central Hospital
| | - Shunsuke Kubo
- Department of Cardiovascular Medicine, Kurashiki Central Hospital
| | - Takeshi Tada
- Department of Cardiovascular Medicine, Kurashiki Central Hospital
| | - Hiroyuki Tanaka
- Department of Cardiovascular Medicine, Kurashiki Central Hospital
| | - Yasushi Fuku
- Department of Cardiovascular Medicine, Kurashiki Central Hospital
| | - Harumi Katoh
- Department of Cardiovascular Medicine, Kurashiki Central Hospital
| | - Kazushige Kadota
- Department of Cardiovascular Medicine, Kurashiki Central Hospital
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11
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Cortes C, Chu M, Schincariol M, Martínez-Hervás Alonso M, Reisbeck B, Zhang R, Murasato Y, Chen SL, Lavarra F, Tu S, Silber S, Gutiérrez-Chico JL. Identification of the type of stent with three-dimensional optical coherence tomography: the SPQR study. EUROINTERVENTION 2021; 17:e140-e148. [PMID: 32928714 PMCID: PMC9724971 DOI: 10.4244/eij-d-20-00598] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND The ability of optical coherence tomography (OCT) to identify specific types of stent has never been systematically studied. AIMS The aim of this study was to test the accuracy of OCT imaging to identify patterns of stent platform and subsequently identify the type of stent implanted. METHODS Consecutive patients from six international centres were retrospectively screened, searching for OCT studies with metallic stents or scaffolds. The sample was analysed by two blinded operators, applying a dedicated protocol in four steps to identify the type of stent: 1) 3D and automatic strut detection (ASD), 2) 3D tissue view, 3) longitudinal view with ASD, 4) mode "stent only" and ASD. RESULTS A series of 212 patients underwent OCT in the study centres, finding 294 metallic stents or scaffolds in 146 patients. The protocol correctly identified 285 stents (96.9%, kappa 0.965), with excellent interobserver agreement (kappa 0.988). The performance tended to be better in recently implanted stents (kappa 0.993) than in stents implanted ≥3 months before (kappa 0.915), and in pullback speed 18 mm/s as compared with 36 mm/s (kappa 0.969 vs 0.940, respectively). CONCLUSIONS The type of stent platform can be accurately identified in OCT by trained analysts following a dedicated protocol, combining 3D-OCT, ASD and longitudinal view. This might be clinically helpful in scenarios of device failure and for the quantification of apposition. The blinding of analysts in OCT studies should be revisited.
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Affiliation(s)
- Carlos Cortes
- Klinikum Frankfurt (Oder), Frankfurt, Germany,San Pedro Hospital, Logroño, Spain
| | - Miao Chu
- Cardiology Department, Campo de Gibraltar Health Trust, Algeciras, Spain,Med-X Research Institute, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | | | | | - Bernd Reisbeck
- Cardiology Department, Campo de Gibraltar Health Trust, Algeciras, Spain
| | - Ruiyan Zhang
- Ruijin Hospital, Shanghai, China,Medical University, Shanghai Jiao Tong University, Shanghai, China
| | | | | | | | - Shengxian Tu
- Med-X Research Institute, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
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Fajadet J, Mennuni MG, Carrié D, Barragan P, Coste P, Vert M, Lafont A. First-in-Man trial of a drug-free bioresorbable stent designed to minimize the duration of coronary artery scaffolding. JOURNAL OF BIOMATERIALS SCIENCE-POLYMER EDITION 2021; 32:1251-1266. [PMID: 33792525 DOI: 10.1080/09205063.2021.1910919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
For the last two decades, various degradable stents have been proposed to treat coronary artery diseases and replace metallic stents to avoid residual foreign material after healing. To date, the right balance between suitable scaffolding and loss of radial strength soon after endothelium restoration is still an unmet need. The present article reports on the First-in-Man trial of a drug-free bioresorbable stent based on a lactic acid stereocopolymer composed of 98% l-lactyl units selected to release stress shielding earlier than in the case of homopoly(l-lactic acid). Thirty patients with single de novo coronary lesions were included in the trial. The fate of scaffolds was monitored by clinical and imaging follow-ups to assess rate of adverse events, acute recoil, late luminal loss, and late lumen recovery. There was no death, no myocardial infarction, and no stent thrombosis observed over the 36 months trial. Dismantling occurred about 3 months after implantation. Bioresorption was almost completed at 2 years. The late lumen loss observed at the end of the first year was partly compensated one year later by enlarging remodeling. At one year, a neointimal hyperplasia slightly greater than for drug-eluting metallic and bioresorbable stents was shown using optical coherence tomography. The excess of hyperplasia was discussed relative to struts thickness, absence of anti-proliferative drug, and release of degradation by-products.
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Affiliation(s)
| | - Marco G Mennuni
- Hôpital Européen Georges Pompidou, Centre Hospitalier Universitaire Paris-Descartes, APHP, Paris, France
| | - Didier Carrié
- Centre Hospitalier Universitaire Rangueil, Toulouse, France
| | | | - Pierre Coste
- Centre Hospitalier Universitaire Bordeaux Pessac, Bordeaux University, Bordeaux, France
| | - Michel Vert
- UMR CNRS 5247, Faculty of Pharmacy, University-ENSCM, Montpellier, France
| | - Antoine Lafont
- Hôpital Européen Georges Pompidou, Centre Hospitalier Universitaire Paris-Descartes, APHP, Paris, France
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13
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Kume T, Murasato Y, Yamada R, Koyama T, Tamada T, Imai K, Okamoto H, Enzan A, Neishi Y, Uemura S. Effect of proximal balloon edge dilation technique for opening a side branch ostium in repetitive-proximal optimizing technique sequence. Catheter Cardiovasc Interv 2021; 97:E12-E18. [PMID: 32329140 PMCID: PMC7891658 DOI: 10.1002/ccd.28926] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 02/12/2020] [Accepted: 04/10/2020] [Indexed: 11/08/2022]
Abstract
OBJECTIVE The purpose of this experimental bench test was to compare stent deformation, obstruction of stent struts at a jailed side branch (SB) ostium, and stent strut malapposition between SB inflation using proximal balloon edge dilation (PBED) technique and SB inflation using conventional balloon dilation in repetitive-proximal optimizing technique (re-POT) sequence. BACKGROUND The second proximal optimizing technique (POT) procedure in the re-POT sequence might increase obstruction of stent struts at a jailed SB ostium, because deformation of stent cells at the main branch (MB) occurred during SB inflation for opening the SB ostium. METHODS A fractal coronary bifurcation bench model made of flexible urethane was used, and crossover single-stent implantation (Xience Sierra, Abbott Vascular, Santa Clara, CA, n = 12) was performed from the MB with the re-POT sequence. During the re-POT sequence, the jailing rate at the SB ostium assessed by videoscopy was compared between SB inflation using PBED technique (PBED group, n = 6) and SB inflation using conventional balloon dilation (conventional group, n = 6). RESULTS The jailing rate after the second POT procedure tended to be lower in the PBED group than in the conventional group (26 ± 12% vs. 34 ± 8%, p = .211), and the change in the jailing rate during the second POT procedure was significantly smaller in the PBED group than in the conventional group (4.8 ± 5.3% vs. 11.6 ± 3.5%, p = .026). CONCLUSIONS In the re-POT sequence, the PBED technique with a short balloon for SB inflation might minimize worsening of the jailing rate at the SB ostium during the second POT procedure.
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Affiliation(s)
- Teruyoshi Kume
- Department of Cardiology, Kawasaki Medical School, Kurashiki, Japan
| | - Yoshinobu Murasato
- Department of Cardiology and Clinical Research Institute, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan
| | - Ryotaro Yamada
- Department of Cardiology, Kawasaki Medical School, Kurashiki, Japan
| | - Terumasa Koyama
- Department of Cardiology, Kawasaki Medical School, Kurashiki, Japan
| | - Tomoko Tamada
- Department of Cardiology, Kawasaki Medical School, Kurashiki, Japan
| | - Koichiro Imai
- Department of Cardiology, Kawasaki Medical School, Kurashiki, Japan
| | - Hiroshi Okamoto
- Department of Cardiology, Kawasaki Medical School, Kurashiki, Japan
| | - Ayano Enzan
- Department of Cardiology, Kawasaki Medical School, Kurashiki, Japan
| | - Yoji Neishi
- Department of Cardiology, Kawasaki Medical School, Kurashiki, Japan
| | - Shiro Uemura
- Department of Cardiology, Kawasaki Medical School, Kurashiki, Japan
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14
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Montarello NJ, Nelson AJ, Verjans J, Nicholls SJ, Psaltis PJ. The role of intracoronary imaging in translational research. Cardiovasc Diagn Ther 2020; 10:1480-1507. [PMID: 33224769 DOI: 10.21037/cdt-20-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Atherosclerotic cardiovascular disease is a key public health concern worldwide and leading cause of morbidity, mortality and health economic costs. Understanding atherosclerotic plaque microstructure in relation to molecular mechanisms that underpin its initiation and progression is needed to provide the best chance of combating this disease. Evolving vessel wall-based, endovascular coronary imaging modalities, including intravascular ultrasound (IVUS), optical coherence tomography (OCT) and near-infrared spectroscopy (NIRS), used in isolation or as hybrid modalities, have been advanced to allow comprehensive visualization of the pathological substrate of coronary atherosclerosis and accurately measure temporal changes in both the vessel wall and plaque characteristics. This has helped further our appreciation of the natural history of coronary artery disease (CAD) and the risk for major adverse cardiovascular events (MACE), evaluate the responsiveness to conventional and experimental therapeutic interventions, and assist in guiding percutaneous coronary intervention (PCI). Here we review the use of different imaging modalities for these purposes and the lessons they have provided thus far.
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Affiliation(s)
- Nicholas J Montarello
- Department of Cardiology, Central Adelaide Local Health Network, Adelaide, Australia
| | - Adam J Nelson
- Adelaide Medical School, University of Adelaide, Adelaide, Australia.,Duke Clinical Research Institute, Durham, NC, USA
| | - Johan Verjans
- Department of Cardiology, Central Adelaide Local Health Network, Adelaide, Australia.,Adelaide Medical School, University of Adelaide, Adelaide, Australia.,Vascular Research Centre, Heart and Vascular Program, Lifelong Health Theme, South Australian Health and Medical Research Institute, Adelaide, Australia
| | - Stephen J Nicholls
- Monash Cardiovascular Research Centre, Monash University, Clayton, Australia
| | - Peter J Psaltis
- Department of Cardiology, Central Adelaide Local Health Network, Adelaide, Australia.,Adelaide Medical School, University of Adelaide, Adelaide, Australia.,Vascular Research Centre, Heart and Vascular Program, Lifelong Health Theme, South Australian Health and Medical Research Institute, Adelaide, Australia
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15
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Golino M, Nuzzo S, Briguori C. STENTYS coronary system: current status and future direction. Minerva Cardiol Angiol 2020; 69:201-214. [PMID: 32989961 DOI: 10.23736/s2724-5683.20.05167-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Stentys self-apposing stent was designed to face complex lesions in the precincts of percutaneous coronary interventions. Nitinol platform and disconnectable struts were designed to provide a complete apposition on the vessel wall in challenging lesions such as significant tapering, primary angioplasty in ST segment elevation myocardial infarction and bifurcation. Stentys X-position S is a sirolimus eluting stent with a novel delivery system aiming to improve positioning. Clinical trials showed good results in terms of procedural success rate, clinical outcome and short-term strut apposition. Nevertheless, Stentys stent did not show superiority over the conventional balloon-expandable stents in the clinical outcomes. Authors underlined the importance of a learning curve and an adequate training period to get familiar with the device's features. Future trials in an all-comer population using the novel X-Position S stent will confirm the preliminary findings and strengthen evidence in clinical practice.
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Affiliation(s)
- Marco Golino
- Interventional Cardiology Unit, Mediterranea Cardiocentro, Naples, Italy
| | | | - Carlo Briguori
- Interventional Cardiology Unit, Mediterranea Cardiocentro, Naples, Italy -
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16
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Wu P, Gutiérrez-Chico JL, Tauzin H, Yang W, Li Y, Yu W, Chu M, Guillon B, Bai J, Meneveau N, Wijns W, Tu S. Automatic stent reconstruction in optical coherence tomography based on a deep convolutional model. BIOMEDICAL OPTICS EXPRESS 2020; 11:3374-3394. [PMID: 32637261 PMCID: PMC7316028 DOI: 10.1364/boe.390113] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 04/17/2020] [Accepted: 05/17/2020] [Indexed: 05/23/2023]
Abstract
Intravascular optical coherence tomography (IVOCT) can accurately assess stent apposition and expansion, thus enabling the optimisation of a stenting procedure to minimize the risk of device failure. This paper presents a deep convolutional based model for automatic detection and segmentation of stent struts. The input of pseudo-3D images aggregated the information from adjacent frames to refine the probability of strut detection. In addition, multi-scale shortcut connections were implemented to minimize the loss of spatial resolution and refine the segmentation of strut contours. After training, the model was independently tested in 21,363 cross-sectional images from 170 IVOCT image pullbacks. The proposed model obtained excellent segmentation (0.907 Dice and 0.838 Jaccard) and detection metrics (0.943 precision, 0.940 recall and 0.936 F1-score), significantly better than conventional features-based algorithms. This performance was robust and homogenous among IVOCT pullbacks with different sources of acquisition (clinical centres, imaging operators, type of stent, time of acquisition and challenging scenarios). In addition, excellent agreement between the model and a commercialized software was observed in the quantification of clinically relevant parameters. In conclusion, the deep-convolutional model can accurately detect stent struts in IVOCT images, thus enabling the fully-automatic quantification of stent parameters in an extremely short time. It might facilitate the application of quantitative IVOCT analysis in real-world clinical scenarios.
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Affiliation(s)
- Peng Wu
- Biomedical Instrument Institute, School of Biomedical Engineering, Shanghai Jiao Tong University, No. 1954 Hua Shan Road, 200030 Shanghai, China
| | | | - Hélène Tauzin
- Department of Cardiology, University Hospital Jean Minjoz, EA3920, Boulevard Fleming, 25000 Besançon, France
| | - Wei Yang
- School of Biomedical Engineering, Southern Medical University, 510515 Guangzhou, China
| | - Yingguang Li
- Kunshan Industrial Technology Research Institute Co.,Ltd., 215347 Kunshan, China
| | - Wei Yu
- Biomedical Instrument Institute, School of Biomedical Engineering, Shanghai Jiao Tong University, No. 1954 Hua Shan Road, 200030 Shanghai, China
| | - Miao Chu
- Biomedical Instrument Institute, School of Biomedical Engineering, Shanghai Jiao Tong University, No. 1954 Hua Shan Road, 200030 Shanghai, China
| | - Benoît Guillon
- Department of Cardiology, University Hospital Jean Minjoz, EA3920, Boulevard Fleming, 25000 Besançon, France
| | - Jingfeng Bai
- Biomedical Instrument Institute, School of Biomedical Engineering, Shanghai Jiao Tong University, No. 1954 Hua Shan Road, 200030 Shanghai, China
| | - Nicolas Meneveau
- Department of Cardiology, University Hospital Jean Minjoz, EA3920, Boulevard Fleming, 25000 Besançon, France
| | - William Wijns
- The Lambe Institute for Translational Medicine and Curam, National University of Ireland Galway, University Road, H91 TK3 Galway, Ireland
| | - Shengxian Tu
- Biomedical Instrument Institute, School of Biomedical Engineering, Shanghai Jiao Tong University, No. 1954 Hua Shan Road, 200030 Shanghai, China
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17
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Gutiérrez-Chico JL, Chen Y, Yu W, Ding D, Huang J, Huang P, Jing J, Chu M, Wu P, Tian F, Xu B, Tu S. Diagnostic accuracy and reproducibility of optical flow ratio for functional evaluation of coronary stenosis in a prospective series. Cardiol J 2020; 27:350-361. [PMID: 32436590 DOI: 10.5603/cj.a2020.0071] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 05/16/2020] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Evaluating prospectively the feasibility, accuracy and reproducibility of optical flow ratio (OFR), a novel method of computational physiology based on optical coherence tomography (OCT). METHODS AND RESULTS Sixty consecutive patients (76 vessels) underwent prospectively OCT, angiography- based quantitative flow ratio (QFR) and fractional flow ratio (FFR). OFR was computed offline in a central core-lab by analysts blinded to FFR. OFR was feasible in 98.7% of the lesions and showed excellent agreement with FFR (ICCa = 0.83, r = 0.83, slope = 0.80, intercept = 0.17, kappa = 0.84). The area under curve to predict an FFR ≤ 0.80 was 0.95, higher than for QFR (0.91, p = 0.115) and for minimal lumen area (0.64, p < 0.001). Diagnostic accuracy, sensitivity, specificity, positive predictive value, negative predictive value, positive likelihood ratio and negative likelihood ratio were 93%, 92%, 93%, 88%, 96%, 13.8, 0.1, respectively. Median time to obtain OFR was 1.07 (IQR: 0.98-1.16) min, with excellent intraobserver and interobserver reproducibility (0.97 and 0.95, respectively). Pullback speed had negligible impact on OFR, provided the same coronary segment were imaged (ICCa = 0.90, kappa = 0.697). CONCLUSIONS The prospective computation of OFR is feasible and reproducible in a real-world series, resulting in excellent agreement with FFR, superior to other image-based methods.
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Affiliation(s)
| | - Yundai Chen
- Department of Cardiology, PLA General Hospital, Beijing, China
| | - Wei Yu
- Med-X Research Institute Shanghai Jiao Tong University, No. 1954, Hua Shan Road, 200030 Shanghai, China
| | - Daixin Ding
- Med-X Research Institute Shanghai Jiao Tong University, No. 1954, Hua Shan Road, 200030 Shanghai, China
| | - Jiayue Huang
- Med-X Research Institute Shanghai Jiao Tong University, No. 1954, Hua Shan Road, 200030 Shanghai, China
| | - Peng Huang
- Med-X Research Institute Shanghai Jiao Tong University, No. 1954, Hua Shan Road, 200030 Shanghai, China
| | - Jing Jing
- Department of Cardiology, PLA General Hospital, Beijing, China
| | - Miao Chu
- Cardio Care Heart Centre, Ventura del Mar 11, 29660 Marbella, Spain.,Med-X Research Institute Shanghai Jiao Tong University, No. 1954, Hua Shan Road, 200030 Shanghai, China
| | - Peng Wu
- Med-X Research Institute Shanghai Jiao Tong University, No. 1954, Hua Shan Road, 200030 Shanghai, China
| | - Feng Tian
- Department of Cardiology, PLA General Hospital, Beijing, China
| | - Bo Xu
- Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Beijing, China
| | - Shengxian Tu
- Med-X Research Institute Shanghai Jiao Tong University, No. 1954, Hua Shan Road, 200030 Shanghai, China.
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18
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Drug-eluting coronary stents: insights from preclinical and pathology studies. Nat Rev Cardiol 2019; 17:37-51. [DOI: 10.1038/s41569-019-0234-x] [Citation(s) in RCA: 104] [Impact Index Per Article: 20.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/25/2019] [Indexed: 01/02/2023]
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19
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Li B, Jin QH, Chen YD, Wang CQ, Shi B, Su X, Fu GS, Wu YQ, Zhou XC, Yuan ZY. A prospective, multicenter, randomized OCT study of early neointimal condition at first and second months after BuMA Supreme stent versus XIENCE stent implantation in high-bleeding-risk coronary artery disease patients: study protocol for a randomized controlled trial. Trials 2019; 20:335. [PMID: 31174600 PMCID: PMC6555937 DOI: 10.1186/s13063-019-3361-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Accepted: 04/15/2019] [Indexed: 11/21/2022] Open
Abstract
Background Earlier vascular healing after drug-eluting stent (DES) implantation may reduce the incidence of late stent thrombosis and provide theoretical evidence to shorten dual antiplatelet therapy duration in patients with high bleeding risks. The BuMA supreme stent is a newly developed DES-coated with the sirolimus by using the international patent electronic grafted eG™ technology. Previous randomized trials showed that BuMA stents had better stent-strut coverage at 3-month follow-ups, which were evaluated by optical coherence tomography (OCT). However, there have been a limited number of studies that are directly evaluating the extent of neointima formation at the first and second months after stent implantation in high-bleeding-risk patients with coronary artery disease. This clinical trial is designed to demonstrate the non-inferiority of the BuMA supreme stent compared to the XIENCE stent in early neointimal formation. Methods/design This is a prospective, multicenter, randomized trial. Forty patients will be assigned into the first-month OCT group, and another 40 patients into the second-month OCT group. The patients in each cohort will be randomized again into two groups in a 1:1 ratio, either being implanted with the BuMA Supreme stent or the Xience V/Prime/Xpedition stent. The primary endpoint is stent-strut neointimal coverage rate (%) at the first and second months, respectively. Secondary endpoints include neointimal hyperplasia area/volume, neointimal hyperplasia thickness, stent-strut malapposition rate, late lumen loss (LLL), restenosis rate, device/lesion/clinical success rate, device-oriented composite endpoints at the first and second months, stent thrombosis and other serious adverse events and bleeding events at follow-up. Discussion The results will provide the first accurate imaging evidence on neointimal formation of the BuMA Supreme stent and the Xience stent at 1–2 months post PCI. The result should inspire further exploration and adjustment of DAPT treatments. Trial registration ClinicalTrials.gov, ID: NCT02747329. Registered on 21 April 2016. Last updated 17 May 2018. Electronic supplementary material The online version of this article (10.1186/s13063-019-3361-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Bo Li
- Department of Cardiology, Chinese Hainan hospital of PLA General Hospital, Jianglin Road, Haitangwan District, Sanya, China
| | - Qin Hua Jin
- Department of Cardiology, Chinese PLA General Hospital 28#, Fuxing Road, Haidian District, Beijing, 100853, China
| | - Yun Dai Chen
- Department of Cardiology, Chinese PLA General Hospital 28#, Fuxing Road, Haidian District, Beijing, 100853, China.
| | - Chang Qian Wang
- Department of Cardiology, Shanghai 9th People's Hospital, Shanghai, China
| | - Bei Shi
- Department of Cardiology, Affiliated Hospital of Zunyi Medical College, Zunyi, China
| | - Xi Su
- Department of Cardiology, Wuhan Asia Heart Hospital, Wuhan, China
| | - Guo Sheng Fu
- Department of Cardiology, Sir Run Run Shaw Hospital, Zhejiang U. School of Medicine, Hangzhou, China
| | - Yan Qing Wu
- Department of Cardiology, 2nd Affiliated Hospital of Nanchang University, Nancang, China
| | - Xu Chen Zhou
- Department of Cardiology, 1st Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Zu Yi Yuan
- Department of Cardiology, 1st Affiliated Hospital of Xi'An Jiaotong University, Xi'An, China
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20
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Pellegrini D, Cortese B. Focus on STENTYS ® Xposition S Self-Apposing ® stent: a review of available literature. Future Cardiol 2019; 15:145-159. [PMID: 31023079 DOI: 10.2217/fca-2018-0087] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Percutaneous coronary interventions are the primary revascularization strategy for the vast majority of patients with coronary artery disease. Nevertheless, challenging settings still limit optimal results, especially in case of significant tapering, bifurcations or primary angioplasty in ST-segment elevation myocardial infarction. Stentys® Self-Apposing® stent was designed to improve strut apposition to the vessel wall and to adapt to difficult targets. The Xposition S is a sirolimus-eluting stent with a novel delivery system, to improve accurate positioning. Several studies compared the device with traditional balloon-expandable stents, showing better results in terms of malapposition reduction and a noninferiority in relation to procedural outcomes. Available data show good clinical results, but a direct comparison with balloon-expandable stents from large randomized trials is still lacking. Thus, the Stentys Xposition S can be an alternative to traditional stents in dedicated scenarios, but strong evidence from large randomized trials is needed to derive stronger recommendations.
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Affiliation(s)
- Dario Pellegrini
- Department of Medicine and Surgery, Università degli Studi di Milano-Bicocca, Milan, Italy
| | - Bernardo Cortese
- Department of Cardiac, San Carlo Clinic, Via Leonardo da Vinci, Paderno Dugnano, Milano, Italy
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21
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Ozaki Y, Garcia-Garcia HM, Hideo-Kajita A, Kuku KO, Haude M, Ince H, Abizaid A, Tölg R, Lemos PA, von Birgelen C, Christiansen EH, Wijns W, Escaned J, Waksman R. Serial 3-Dimensional Optical Coherence Tomography Assessment of Jailed Side-Branch by Second-Generation Drug-Eluting Absorbable Metal Scaffold (from the BIOSOLVE-II Trial). Am J Cardiol 2019; 123:1044-1051. [PMID: 30683424 DOI: 10.1016/j.amjcard.2018.12.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Revised: 12/19/2018] [Accepted: 12/20/2018] [Indexed: 11/25/2022]
Abstract
Second-generation drug-eluting absorbable metal scaffold (DREAMS 2G) is used for treating coronary lesions. However, the natural history of the jailed side-branch (SB) after DREAMS 2G implantation remains to be elucidated. The aim of this study is to investigate the effect of scaffold struts on jailed SBs as assessed by 3-dimensional (3D) optical coherence tomography (OCT) after implantation of DREAMS 2G. We enrolled the patients who received a DREAMS 2G implantation and where OCT was performed at postprocedure and 12-month follow-up in the BIOSOLVE-II trial. The area of the ostium of jailed SBs and number of compartments divided by scaffold struts were assessed by cut-plane analysis using 3D OCT. A total of 24 patients with 61 jailed SBs were analyzed in this study. The number of compartments was significantly decreased (postprocedure; 1.98 ± 0.84 vs 12 months; 1.10 ± 0.30, p <0.001) during the 12 months. Since most of the struts disappeared, the ostium area was increased in 62% of jailed SBs at 12 months, however, not significantly different from postprocedure (postprocedure; 0.74 [0.34 to 1.46] mm2 vs 12 months; 0.78 [0.41 to 1.68] mm2, p = 0.055). The number of compartments created by scaffold struts and branching angle at postprocedure had no effect on the changes of SB ostium area. DREAMS 2G has a favorable absorption process in the jailed SBs up to 12 months and may be considered as an optional therapy for treating lesions that involve SBs.
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22
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Jiang B, Thondapu V, Poon E, Barlis P, Ooi A. Numerical study of incomplete stent apposition caused by deploying undersized stent in arteries with elliptical cross-sections. J Biomech Eng 2019; 141:2725823. [PMID: 30778567 DOI: 10.1115/1.4042899] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Indexed: 12/26/2022]
Abstract
Incomplete stent apposition (ISA) is one of the causes leading to post-stent complications, which can be found when an undersized or under-expanded stent is deployed at lesions. Previous research efforts have focused on ISA in idealized coronary arterial geometry with circular cross-sections. However, arterial cross-section eccentricity plays an important role in both location and severity of ISA. Computational fluid dynamics (CFD) simulations are carried out to systematically study the effects of ISA in arteries with elliptical cross-sections, as such stents are partially embedded on the minor axis sides of the ellipse and malapposed elsewhere. Overall, ISA leads to high time-averaged WSS (TAWSS) at the proximal end of the stent and low TAWSS at the ISA transition region and the distal end. Shear rate depends on both malapposition distance and blood stream locations, which is found to be significantly higher at the inner stent surface than the outer surface. The proximal high shear rate signifies increasing possibility in platelet activation, when coupled with low TAWSS at the transition and distal region which may indicate a nidus for in-stent thrombosis.
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Affiliation(s)
- Bo Jiang
- Department of Mechanical Engineering, The University of Melbourne, Department of Mechanical Engineering, Melbourne School of Engineering, The University of Melbourne, Victoria 3010, Australia
| | - Vikas Thondapu
- Department of Mechanical Engineering, The University of Melbourne, Department of Medicine, Faculty of Medicine, Dentistry & Health Sciences, The University of Melbourne, Department of Mechanical Engineering, Melbourne School of Engineering, The University of Melbourne, Victoria 3010, Australia
| | - Eric Poon
- Department of Mechanical Engineering, The University of Melbourne, Department of Mechanical Engineering, Melbourne School of Engineering, The University of Melbourne, Victoria 3010, Australia
| | - Peter Barlis
- Department of Medicine, Faculty of Medicine, Dentistry & Health Sciences, The University of Melbourne, Department of Medicine, Faculty of Medicine, Dentistry & Health Sciences, The University of Melbourne, Victoria 3010, Australia
| | - Andrew Ooi
- Department of Mechanical Engineering, The University of Melbourne, Department of Mechanical Engineering, Melbourne School of Engineering, The University of Melbourne, Victoria 3010, Australia
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23
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Kume T, Yamada R, Koyama T, Tamada T, Imai K, Fukuhara K, Goryo Y, Kawamura A, Okamoto H, Neishi Y, Uemura S. Coronary bifurcation bench test using multimodality imaging: Impact of stent strut link location on stent deformity and jailed side-branch orifices during re-proximal optimizing technique. Catheter Cardiovasc Interv 2019; 93:E17-E23. [PMID: 30244506 DOI: 10.1002/ccd.27719] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Revised: 05/30/2018] [Accepted: 06/10/2018] [Indexed: 11/08/2022]
Abstract
OBJECTIVES The purpose of this study was to compare the stent deformation, obstruction of stent struts at a jailed side branch (SB) ostium, and stent strut malapposition after a repetitive proximal optimizing technique (re-POT) sequence between bifurcation lesions with and without stent links at SB ostia in ex vivo experimental setting. METHODS A flexible urethane coronary bifurcation bench model was used, and crossover single stent implantation was performed from main branch (MB) with re-POT sequence. Under videoscope observation, presence (link group, n = 12) or absence (no-link group, n = 12) of stent link at distal semicircle of SB ostium was intentionally set, and rewiring was performed through distal cell in four different stent platforms. RESULTS There were no significant differences in the rate of malapposed struts and in SB jailing ratio after the re-POT sequence between the link and no-link groups. SB jailing ratio increased significantly from 8.0% to 9.6% during the second POT procedure (P < 0.001). SB jailing ratio after the second POT procedure differed among stent platforms. CONCLUSIONS The presence of a stent link at an SB ostium was not associated with a rate of malapposed struts and SB jailing ratio after the re-POT sequence. SB jailing ratio was significantly increased after second POT procedure, but was different among stent platforms. The Xience stent might minimize the change of SB jailing ratio and be suitable for coronary bifurcation stenting using re-POT sequence.
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Affiliation(s)
- Teruyoshi Kume
- Department of Cardiology, Kawasaki Medical School, Kurashiki, Japan
| | - Ryotaro Yamada
- Department of Cardiology, Kawasaki Medical School, Kurashiki, Japan
| | - Terumasa Koyama
- Department of Cardiology, Kawasaki Medical School, Kurashiki, Japan
| | - Tomoko Tamada
- Department of Cardiology, Kawasaki Medical School, Kurashiki, Japan
| | - Koichiro Imai
- Department of Cardiology, Kawasaki Medical School, Kurashiki, Japan
| | - Kenzo Fukuhara
- Department of Cardiology, Kawasaki Medical School, Kurashiki, Japan
| | - Yutaka Goryo
- Department of Cardiology, Kawasaki Medical School, Kurashiki, Japan
| | - Ai Kawamura
- Department of Cardiology, Kawasaki Medical School, Kurashiki, Japan
| | - Hiroshi Okamoto
- Department of Cardiology, Kawasaki Medical School, Kurashiki, Japan
| | - Yoji Neishi
- Department of Cardiology, Kawasaki Medical School, Kurashiki, Japan
| | - Shiro Uemura
- Department of Cardiology, Kawasaki Medical School, Kurashiki, Japan
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Impact of underlying plaque type on strut coverage in the early phase after drug-eluting stent implantation. Coron Artery Dis 2018; 29:624-631. [DOI: 10.1097/mca.0000000000000654] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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25
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Holm NR, Andreasen LN, Walsh S, Kajander OA, Witt N, Eek C, Knaapen P, Koltowski L, Gutiérrez-Chico JL, Burzotta F, Kockman J, Ormiston J, Santos-Pardo I, Laanmets P, Mylotte D, Madsen M, Hjort J, Kumsars I, Råmunddal T, Christiansen EH. Rational and design of the European randomized Optical Coherence Tomography Optimized Bifurcation Event Reduction Trial (OCTOBER). Am Heart J 2018; 205:97-109. [PMID: 30205242 DOI: 10.1016/j.ahj.2018.08.003] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Accepted: 08/09/2018] [Indexed: 12/16/2022]
Abstract
Background Percutaneous coronary intervention in complex bifurcation lesions is prone to suboptimal implantation results and is associated with increased risk of subsequent clinical events. Angiographic ambiguity is high during bifurcation stenting, but it is unknown if procedural guidance by intravascular optical coherence tomography (OCT) improves clinical outcome. Methods and Design OCTOBER is a randomized, investigator-initiated, multicenter trial aimed to show superiority of OCT-guided stent implantation compared to standard angiographic-guided implantation in bifurcation lesions. The primary outcome measure is a 2-year composite end point of cardiac death, target lesion myocardial infarction, and ischemia-driven target lesion revascularization. The calculated sample size is 1,200 patients in total, and allocation is 1:1. Eligible patients have stable or unstable angina pectoris or stabilized non–ST elevation myocardial infarction, and a coronary bifurcation lesion with significant main vessel stenosis and more than 50 % stenosis in a side branch with a reference diameter ≥2.5mm. Treatment is performed by the provisional side branch stenting technique or 2-stent techniques, and the systematic OCT guiding protocol is aimed to evaluate (1) plaque preparation, (2) lesion length, (3) segmental reference sizes, (4) lesion coverage, (5) stent expansion, (6) malapposition, (7) wire positions, and (8) ostial results. Implications A positive outcome of the OCTOBER trial may establish OCT as a routine tool for optimization of complex percutaneous coronary intervention, whereas a negative result would indicate that OCT remains a tool for ad hoc evaluation in selected cases.
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Takahashi T, Okayama H, Hiasa G, Kazatani Y. A unique case of ST-elevation myocardial infarction related to very late stent thrombosis. J Cardiol Cases 2018; 17:63-67. [PMID: 30279857 DOI: 10.1016/j.jccase.2017.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Revised: 09/21/2017] [Accepted: 09/24/2017] [Indexed: 11/19/2022] Open
Abstract
A 67-year-old man was transferred to our hospital because of anterior ST elevation myocardial infarction (STEMI). He had a history of a sirolimus-eluting stent implantation from the left main to the left anterior descending coronary artery (LAD) 9 years before and had undergone laparoscopic prostatectomy 8 days before in the setting of discontinuation of dual antiplatelet therapy. Emergent coronary angiography showed total occlusion in the distal LAD that was successfully treated by aspiration alone. Optical coherence tomography (OCT) showed no vulnerable lesion from the occluded lesion to the proximal LAD. OCT demonstrated that the thrombus attached to floating struts at the left main bifurcation and non-apposed struts at the left coronary ostium partly protruding to aorta, while the other struts were covered and well-apposed. Based on OCT findings, this case of STEMI was thought to be caused by distal embolism of a thrombus that formed at the stent site before it evolved into total occlusion. <Learning objective: We demonstrated how optical coherence tomography can be essential in revealing the underlying pathology. The patient showed an unusual manifestation of ST-elevation myocardial infarction caused by distal embolism of a thrombus that formed at the sirolimus-eluting stent due to dual antiplatelet therapy discontinuation during perioperative period. Optical coherence tomography revealed very late stent thrombosis at the left coronary ostium and could elucidate the underlying mechanism.>.
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Affiliation(s)
| | - Hideki Okayama
- Department of Cardiology, Ehime Prefectural Central Hospital, Ehime, Japan
| | - Go Hiasa
- Department of Cardiology, Ehime Prefectural Central Hospital, Ehime, Japan
| | - Yukio Kazatani
- Department of Cardiology, Ehime Prefectural Central Hospital, Ehime, Japan
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Lu H, De Winter RJ, Koch KT. The STENTYS self-apposing stent technology in coronary artery disease: literature review and future directions. Expert Rev Med Devices 2018; 15:479-487. [DOI: 10.1080/17434440.2018.1491305] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Huangling Lu
- Department of Cardiology, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Robbert J. De Winter
- Department of Cardiology, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Karel T. Koch
- Department of Cardiology, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
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Lu H, Bekker RJ, Grundeken MJ, Woudstra P, Wykrzykowska JJ, Tijssen JGP, de Winter RJ, Koch KT. Five-year clinical follow-up of the STENTYS self-apposing stent in complex coronary anatomy: a single-centre experience with report of specific angiographic indications. Neth Heart J 2018; 26:263-271. [PMID: 29654515 PMCID: PMC5910317 DOI: 10.1007/s12471-018-1111-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Objectives We sought to investigate angiographic indications for the use of the STENTYS technique and evaluated the long-term safety and clinical efficacy of the stent. Background Coronary lesions involving complex anatomy, including aneurysmatic, ectatic, or tapered vessel segments often carry a substantial risk of stent malapposition. The self-apposing stent technique may reduce the risk of stent malapposition and therefore improve clinical outcomes. Methods A total of 120 consecutive patients treated with the STENTYS stent were included (drug-eluting stent (DES) n = 101, bare-metal stent (BMS) n = 19). All lesions were scored for angiographic indications for the STENTYS stent, including aneurysms, ectasias, tapering, absolute diameters, bifurcation lesions, and saphenous vein grafts. Off-line quantitative coronary angiography analyses were performed pre-procedure and post-procedure. Five years follow-up was obtained including cardiac death, target vessel myocardial infarction (TV-MI), target vessel revascularisation, stent thrombosis, and the composite endpoint target vessel failure (cardiac death, TV-MI and target vessel revascularisation). Results Angiographic indications for STENTYS use were aneurysm (30%), ectasia (19%), tapering (27%), bifurcation lesions (8%), and saphenous vein graft lesions (16%) and absolute diameters (22%). Mean maximal diameter was 4.51 ± 0.99 mm. At 5‑year follow-up target vessel failure rates were 24.1% in the total cohort (DES 22.8% vs. BMS 33%, p = 0.26). Definite stent thrombosis rate was 3.8% at 5‑year follow-up in this cohort with complex and high-risk lesions (DES 4.5% vs. BMS 0%, p = 0.39). Conclusions Angiographic indications for the use of the self-apposing stent were complex lesions with atypical coronary anatomy. Our data showed reasonable stent thrombosis rates at 5‑year follow-up, considering the high-risk lesion characteristics. Electronic supplementary material The online version of this article (10.1007/s12471-018-1111-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- H Lu
- Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - R J Bekker
- Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - M J Grundeken
- Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - P Woudstra
- Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - J J Wykrzykowska
- Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - J G P Tijssen
- Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - R J de Winter
- Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - K T Koch
- Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
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Early Strut Coverage in Patients Receiving Drug-Eluting Stents and its Implications for Dual Antiplatelet Therapy: A Randomized Trial. JACC Cardiovasc Imaging 2018; 11:1810-1819. [PMID: 29454763 DOI: 10.1016/j.jcmg.2017.12.014] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Revised: 11/01/2017] [Accepted: 12/22/2017] [Indexed: 12/17/2022]
Abstract
OBJECTIVES This study sought to measure early strut coverage in patients receiving drug-eluting stents (DESs) and to explore the feasibility of short-term dual antiplatelet therapy (DAPT) based on the degree of early strut coverage. BACKGROUND Data for early strut coverage in patients receiving new-generation DESs, and its implications for DAPT continuation were limited. METHODS A randomized, multicenter trial was conducted in 894 patients treated with DESs. Patients were randomly assigned to everolimus-eluting stent (EES) (n = 444) or biolimus-eluting stent (BES) (n = 450) groups and optical coherence tomography (OCT)-guided (n = 445) or angiography-guided (n = 449) implantation groups using a 2-by-2 factorial design. Early strut coverage was measured as the percentage of uncovered struts on 3-month follow-up OCT examination. The primary outcome was the difference in early strut coverage between EES and BES groups and between OCT- and angiography-guided implantation groups. The secondary outcome was a composite of cardiac death, myocardial infarction, stent thrombosis, and major bleeding during the first 12 months post-procedure in patients receiving 3-month DAPT based on the presence of early strut coverage (≤6% uncovered) on 3-month follow-up OCT. RESULTS Three-month follow-up OCT data were acquired for 779 patients (87.1%). The median percentage of uncovered struts at 3 months was 8.9% and 8.2% in the EES and BES groups, respectively (p = 0.69) and was lower in the OCT-guided group (7.5%) than in the angiography-guided group (9.9%; p = 0.009). Favorable early strut coverage (≤6% uncovered strut) was observed in 320 of 779 patients (41.1%). At 12 months, the composite event rarely occurred in the 3-month (0.3%) or 12-month (0.2%) DAPT groups (p = 0.80). CONCLUSIONS OCT-guided DES implantation improved early strut coverage compared with angiography-guided DES implantation, with no difference in strut coverage between EES and BES groups. Short-term DAPT may be feasible in selected patients with favorable early strut coverage (Determination of the Duration of the Dual Antiplatelet Therapy by the Degree of the Coverage of The Struts on Optical Coherence Tomography From the Randomized Comparison Between Everolimus-eluting Stents Versus Biolimus A9-eluting Stents [DETECT-OCT]; NCT01752894).
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Okamura T, Nagoshi R, Fujimura T, Murasato Y, Yamawaki M, Ono S, Serikawa T, Hikichi Y, Norita H, Nakao F, Sakamoto T, Shinke T, Shite J. Impact of guidewire recrossing point into stent jailed side branch for optimal kissing balloon dilatation: core lab 3D optical coherence tomography analysis. EUROINTERVENTION 2018; 13:e1785-e1793. [PMID: 29131806 DOI: 10.4244/eij-d-17-00591] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS We aimed to investigate the influence of the guidewire recrossing point on the incidence of incomplete stent apposition (ISA) after kissing balloon dilatation (KBD), and also clinical and angiographic outcome at nine months in a prospective multicentre registry. METHODS AND RESULTS One hundred and five patients underwent single crossover stenting across the side branch (SB) and subsequent KBD. The jailing configuration of the SB orifice and the guidewire recrossing position were assessed by off-line 3D-OCT in the core lab. We defined the cases that achieved both link-free carina configuration and distal recrossing as the LFD group (54 cases), and the other cases as the non-LFD group (51 cases). ISA in the LFD group was significantly smaller than that in the non-LFD group (6.7±5.9% vs. 17.0±10.5%, p<0.0001). The distal recrossing rate was 83%. Proximal recrossing increased ISA compared with distal recrossing, particularly in parallel bifurcations (17.1±10.1% vs. 6.3±6.0%, p<0.0001). At follow-up, though event rates did not differ, SB restenosis in the non-LFD group tended to be higher than in the LFD group (20.5% vs. 8.3%, p=0.1254). CONCLUSIONS The guidewire recrossing point and the location of a stent link at the SB orifice had an influence on the ISA. KBD with optimal conditions under 3D-OCT guidance may reduce SB restenosis.
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Affiliation(s)
- Takayuki Okamura
- Department of Medicine and Clinical Science, Yamaguchi University Graduate School of Medicine, Ube, Japan
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Xiao H, Chen S, Wang G, Du R, Song Y, Jin J, Huang L, Jabbour R, Azzalini L, Zhao X. A "Jail Escape Technique" (JET) for distal side branch wiring during provisional stenting: Feasibility and first-in-man study. J Interv Cardiol 2017; 30:527-534. [PMID: 29094411 DOI: 10.1111/joic.12456] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2017] [Revised: 07/28/2017] [Accepted: 08/01/2017] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE To evaluate the feasibility of a novel technique for achieving distal SB access and improve strut apposition during provisional stenting. BACKGROUND While distal rewiring and stent expansion toward the side branch (SB) are associated with better results during provisional stenting of coronary artery bifurcation lesions, these techniques are technically challenging and often leave unopposed struts near the carina. METHODS The "Jail Escape Technique" (JET) is performed by passing the proximal tip of the SB wire between the main vessel (MV) stent struts and balloon before implantation, allowing the MV stent to push the SB wire against the distal part of the carina. The MV stent can then be deployed without jailing the SB wire. Distal SB access and strut distribution at the carina were tested in phantom and swine models. Stent distortion, dislodgement forces, and material damage were evaluated with tensile testing. Human feasibility was then tested on 32 patients. RESULTS Preclinical testing demonstrated that the SB wire was located at the most distal part of the carina and no strut malapposition at the carina was present after balloon inflation. Stent distortion, dislodgement forces, or material damage were not affected. JET was successfully performed in 30 of 32 patients. No major adverse cardiovascular events occurred in any patient at 6-month follow-up. CONCLUSION The "JET" enables distal SB access and eliminates strut malapposition at the carina. Further studies with larger numbers of patients are needed to further investigate this technique.
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Affiliation(s)
- Han Xiao
- Institution of Cardiovascular Research, Xinqiao Hospital, Third Military Medical University, Chongqing, China
| | - Shengda Chen
- State and Local Joint Engineering Laboratory for Vascular Implants, Bioengineering College of Chongqing University, Chongqing, China.,IBiTech-bioMMeda, Ghent University-IMinds Medical IT, Ghent, Belgium
| | - Guixue Wang
- State and Local Joint Engineering Laboratory for Vascular Implants, Bioengineering College of Chongqing University, Chongqing, China
| | - Ruolin Du
- State and Local Joint Engineering Laboratory for Vascular Implants, Bioengineering College of Chongqing University, Chongqing, China
| | - Yaoming Song
- Institution of Cardiovascular Research, Xinqiao Hospital, Third Military Medical University, Chongqing, China
| | - Jun Jin
- Institution of Cardiovascular Research, Xinqiao Hospital, Third Military Medical University, Chongqing, China
| | - Lan Huang
- Institution of Cardiovascular Research, Xinqiao Hospital, Third Military Medical University, Chongqing, China
| | - Richard Jabbour
- Interventional Cardiology, San Raffaele Scientific Institute, Milan, Italy
| | - Lorenzo Azzalini
- Interventional Cardiology, San Raffaele Scientific Institute, Milan, Italy
| | - Xiaohui Zhao
- Institution of Cardiovascular Research, Xinqiao Hospital, Third Military Medical University, Chongqing, China
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Nagoshi R, Okamura T, Murasato Y, Fujimura T, Yamawaki M, Ono S, Serikawa T, Hikichi Y, Nakao F, Sakamoto T, Shinke T, Kijima Y, Kozuki A, Shibata H, Shite J. Feasibility and usefulness of three-dimensional optical coherence tomography guidance for optimal side branch treatment in coronary bifurcation stenting. Int J Cardiol 2017; 250:270-274. [PMID: 29030141 DOI: 10.1016/j.ijcard.2017.09.197] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Revised: 09/10/2017] [Accepted: 09/25/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND For the treatment of coronary bifurcation lesions, optimal guidewire (GW) recrossing after main vessel stenting is important for good stent apposition at the side branch (SB) orifice in kissing balloon inflation (KBI). METHODS We analyzed 150 bifurcation lesions treated with single stenting following KBI in the three-dimensional optical coherence tomography (3D-OCT) bifurcation registry study (2015-16) and a single center experience (2012-16). OCT examination was performed after GW recrossing to the SB and after KBI. Patients were divided into two-dimensional (2D, n=78) and 3D groups (n=72) according to 2D- or 3D-OCT guidance. GW recrossing position, jailing configuration of the stent over the SB (divided into Link-connecting type: stent link connecting to the carina and Link-free type: no stent link at the carina) and stent apposition were compared between the groups. RESULTS Distal GW recrossing was achieved in 75.6% and 91.7% in the 2D and 3D groups, respectively (P=0.004). Compared with the 2D group, the incidence of incomplete stent apposition (ISA) toward the SB in the 3D group tended to be lower in the whole cohort (14.5±13.6% vs 10.0±9.0%, P=0.077), and was significantly lower in left main trunk bifurcations (18.7±12.8% vs 10.3±8.9%, P=0.014). Independent contributors to ISA were the Link-connecting type (β 0.089, P<0.001), distal GW recrossing (β -0.078, P=0.001), and age (β -0.0020, P=0.012). CONCLUSION Optimal GW recrossing under 3D-OCT guidance is feasible and improves stent apposition, which may lead to a better clinical outcome in the treatment of bifurcation lesions.
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Affiliation(s)
- Ryoji Nagoshi
- Department of Cardiology, Osaka Saiseikai Nakatsu Hospital, Japan
| | - Takayuki Okamura
- Department of Medicine and Clinical Science, Yamaguchi University Graduate School of Medicine, Japan
| | | | - Tatsuhiro Fujimura
- Department of Medicine and Clinical Science, Yamaguchi University Graduate School of Medicine, Japan
| | - Masahiro Yamawaki
- Department of Cardiology, Saiseikai Yokohama Eastern Hospital, Japan
| | - Shiro Ono
- Department of Cardiology, Saiseikai Yamaguchi General Hospital, Japan
| | - Takeshi Serikawa
- Department of Cardiology, Saiseikai Fukuoka General Hospital, Japan
| | | | - Fumiaki Nakao
- Department of Cardiology, Yamaguchi Central General Hospital, Japan
| | - Tomohiro Sakamoto
- Department of Cardiology, Saiseikai Kumamoto General Hospital, Japan
| | - Toshiro Shinke
- Department of Cardiology, Kobe University Graduate School of Medicine, Japan
| | - Yoichi Kijima
- Department of Cardiology, Osaka Saiseikai Nakatsu Hospital, Japan
| | - Amane Kozuki
- Department of Cardiology, Osaka Saiseikai Nakatsu Hospital, Japan
| | - Hiroyuki Shibata
- Department of Cardiology, Osaka Saiseikai Nakatsu Hospital, Japan
| | - Junya Shite
- Department of Cardiology, Osaka Saiseikai Nakatsu Hospital, Japan.
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Romagnoli E, Gatto L, La Manna A, Burzotta F, Taglieri N, Saia F, Amico F, Marco V, Ramazzotti V, Di Giorgio A, Di Vito L, Boi A, Contarini M, Castriota F, Mintz GS, Prati F. Role of residual acute stent malapposition in percutaneous coronary interventions. Catheter Cardiovasc Interv 2017; 90:566-575. [DOI: 10.1002/ccd.26974] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
Affiliation(s)
- Enrico Romagnoli
- Centro per la Lotta Contro L'Infarto - CLI Foundation; Rome Italy
| | - Laura Gatto
- Centro per la Lotta Contro L'Infarto - CLI Foundation; Rome Italy
- San Giovanni Addolorata Hospital; Rome Italy
| | | | | | | | | | | | - Valeria Marco
- Centro per la Lotta Contro L'Infarto - CLI Foundation; Rome Italy
| | | | | | | | | | | | - Fausto Castriota
- GVM Care and Research, E. S. Health Science Foundation; Cotignola Italy
| | - Gary S. Mintz
- Cardiovascular Research Foundation; New York, New York
| | - Francesco Prati
- Centro per la Lotta Contro L'Infarto - CLI Foundation; Rome Italy
- San Giovanni Addolorata Hospital; Rome Italy
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Kikuchi T, Ishii A, Chihara H, Arai D, Ando M, Takenobu Y, Okada T, Takagi Y, Miyamoto S. Occlusion Status on Magnetic Resonance Angiography Is Associated with Risk of Delayed Ischemic Events in Cerebral Aneurysms Treated with Stent-Assisted Coiling. World Neurosurg 2017; 107:226-232. [PMID: 28826708 DOI: 10.1016/j.wneu.2017.07.161] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Revised: 07/25/2017] [Accepted: 07/27/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Management after stent-assisted coiling (SAC) for unruptured intracranial aneurysm is sometimes difficult because close monitoring for ischemic events for a long period of time after the procedure is necessary. The purpose of this study was to clarify the usefulness of magnetic resonance angiography (MRA) at follow-up after SAC. METHODS Sixty-six consecutive cases of SAC for unruptured intracranial aneurysm in our institute and affiliated hospitals were retrospectively reviewed for a delayed ischemic event. Occlusion status of the aneurysm and stent apposition on time-of-flight (TOF)-MRA, patient demographics, and characteristics of the aneurysms were analyzed for a possible relationship to delayed ischemic events. RESULTS Over a median follow-up of 755 days, 14 patients had delayed ischemic events after a median follow-up of 230.5 days. All of the ischemic events were transient or asymptomatic. Univariate analysis revealed that the history of hypertension (P = 0.042) and the occlusion status of the aneurysm (P = 0.006) were significantly associated with delayed ischemic events. Multivariate analysis indicated that dome filling had a hazard ratio of 4.96 (95% confidence interval [CI], 1.30-23.60) and 3.74 (95% CI, 1.10-13.34), compared with neck remnant and complete obliteration, respectively. Six of 7 patients who had persistent dome filling during follow-up developed a delayed ischemic event. CONCLUSIONS In this preliminary study, dome filling on follow-up TOF-MRA is a possible risk factor for delayed ischemic events. TOF-MRA could be a modality for tailored management after SAC.
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Affiliation(s)
- Takayuki Kikuchi
- Department of Neurosurgery, Kyoto University Graduate School of Medicine, Kyoto, Japan.
| | - Akira Ishii
- Department of Neurosurgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Hideo Chihara
- Department of Neurosurgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Daisuke Arai
- Department of Neurosurgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Mitsushige Ando
- Department of Neurosurgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Yohei Takenobu
- Department of Neurosurgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Tomohisa Okada
- Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Yasushi Takagi
- Department of Neurosurgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Susumu Miyamoto
- Department of Neurosurgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
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Sethi A, Singbal Y, Rastogi U, Prasad VS. Late Incomplete stent apposition is associated with late/very late stent thrombosis: A meta-analysis. Catheter Cardiovasc Interv 2017; 91:365-375. [DOI: 10.1002/ccd.27102] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Revised: 03/02/2017] [Accepted: 03/29/2017] [Indexed: 11/07/2022]
Affiliation(s)
- Ankur Sethi
- Department of Interventional Cardiology; Icahn School of Medicine at Mount Sinai; New York
| | - Yash Singbal
- Department of Cardiology; University of Queensland; Brisbane Australia
| | - Ujjwal Rastogi
- Department of Interventional Cardiology; Icahn School of Medicine at Mount Sinai; New York
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Lee SY, Ahn JM, Mintz GS, Hur SH, Choi SY, Kim SW, Cho JM, Hong SJ, Kim JW, Hong YJ, Lee SG, Shin DH, Kim JS, Kim BK, Ko YG, Choi D, Jang Y, Park SJ, Hong MK. Characteristics of Earlier Versus Delayed Presentation of Very Late Drug-Eluting Stent Thrombosis: An Optical Coherence Tomographic Study. J Am Heart Assoc 2017; 6:JAHA.116.005386. [PMID: 28411245 PMCID: PMC5533030 DOI: 10.1161/jaha.116.005386] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Background The pathophysiology underlying very late drug‐eluting stent (DES) thrombosis is not sufficiently understood. Using optical coherence tomography, we investigated characteristics of very late stent thrombosis (VLST) according to different onset times. Methods and Results A total of 98 patients from 10 South Korean hospitals who underwent optical coherence tomography for evaluation of very late DES thrombosis were retrospectively included in analyses. VLST occurred at a median of 55.1 months after DES implantation. All patients were divided into 2 equal groups of earlier versus delayed presentation of VLST, according to median onset time. In total, 27 patients were treated with next‐generation DES and 71 with first‐generation DES. Based on optical coherence tomography findings at thrombotic sites, main VLST mechanisms were as follows, in descending order: neoatherosclerosis (34.7%), stent malapposition (33.7%), and uncovered struts without stent malapposition or evagination (24.5%). Compared with patients with earlier VLST, patients with delayed VLST had lower frequency of uncovered struts without stent malapposition or evagination (34.7% versus 14.3%, respectively; P=0.019). Conversely, the frequency of neoatherosclerosis was higher in patients with delayed versus earlier VLST (44.9% versus 24.5%, respectively; P=0.034). The frequency of stent malapposition was not different between patients with earlier and delayed VLST (34.7% versus 32.7%, respectively; P=0.831). The frequency of stent malapposition, evagination, and uncovered struts was still half of delayed VLST. Conclusions The pathological mechanisms of very late DES thrombosis changed over time. Delayed neointimal healing remained a substantial substrate for VLST, even long after DES implantation.
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Affiliation(s)
- Seung-Yul Lee
- Department of Internal Medicine, Sanbon Hospital, Wonkwang University College of Medicine, Gunpo, Korea
| | - Jung-Min Ahn
- Department of Cardiology, Heart Institute, Asan Medical Center, University of Ulsan, Seoul, Korea
| | - Gary S Mintz
- Cardiovascular Research Foundation, New York, NY
| | - Seung-Ho Hur
- Department of Cardiology, Keimyung University College of Medicine, Daegu, Korea
| | - So-Yeon Choi
- Division of Cardiology, Ajou University Hospital, Suwon, Korea
| | - Sang-Wook Kim
- Department of Cardiology, Chung-Ang University Medical Center, Seoul, Korea
| | - Jin Man Cho
- Division of Cardiology, Kyung Hee University School of Medicine, Seoul, Korea
| | - Soon Jun Hong
- Department of Cardiology, Korea University Anam Hospital, Seoul, Korea
| | - Jin Won Kim
- Department of Cardiology, Korea University Guro Hospital, Seoul, Korea
| | - Young Joon Hong
- Departments of Cardiology, Chonnam National University Medical School, Gwangju, Korea
| | - Sang-Gon Lee
- Department of Cardiology, Ulsan University College of Medicine, Ulsan, Korea
| | - Dong-Ho Shin
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University Health System, Seoul, Korea
- Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Jung-Sun Kim
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University Health System, Seoul, Korea
- Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Byeong-Keuk Kim
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University Health System, Seoul, Korea
- Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Young-Guk Ko
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University Health System, Seoul, Korea
- Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Donghoon Choi
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University Health System, Seoul, Korea
- Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Yangsoo Jang
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University Health System, Seoul, Korea
- Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul, Korea
- Severance Biomedical Science Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Seung-Jung Park
- Department of Cardiology, Heart Institute, Asan Medical Center, University of Ulsan, Seoul, Korea
| | - Myeong-Ki Hong
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University Health System, Seoul, Korea
- Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul, Korea
- Severance Biomedical Science Institute, Yonsei University College of Medicine, Seoul, Korea
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Serial changes in the three-dimensional aspect of the side-branch ostium jailed by a drug-eluting stent assessed by optical coherence tomography. Int J Cardiovasc Imaging 2017; 33:797-806. [PMID: 28168562 DOI: 10.1007/s10554-017-1080-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Accepted: 01/20/2017] [Indexed: 01/03/2023]
Abstract
The present study investigated serial changes in the three-dimensional (3D) aspect of the jailed side-branch (SB) ostium. We evaluated 32 patients who underwent examination with optical coherence tomography (OCT) both at baseline and at follow-up. After reconstruction of the 3D images, we classified the configuration of overhanging struts at the SB orifice into three groups according to the 3D aspect of the jailing configuration. The number of compartments divided by the stent strut was counted. The side-branch flow area (SBFA), i.e., the area of the SB ostium except for jailing struts, was measured by cut-plane analysis. Forty-eight SBs of 25 patients were analyzed. Thirteen SBs were classified as the No-jail type (N-type), 19 as the Simple-jail type (S-type; no longitudinal link at the carina), and 16 as the Complex-jail type (C-type; had a link at the carina). In the N-type, the SBFA was significantly increased at follow-up (P = 0.018). In the C-type, the SBFA was significantly decreased at follow-up (P = 0.002). Percent reduction of SBFA in the C-type group was significantly greater than that in the N-type or S-type groups (S-type vs. C-type P = 0.002, N-type vs. C-type P < 0.001). 3D-OCT images showed that some of the compartments were filled with tissue. The number of compartments was significantly decreased at follow-up (P < 0.001). In the C-type group, the SBFA was significantly decreased and small compartments were filled with tissue. These findings suggest that stent jail complexity is associated with the progression of SB ostial stenosis.
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First-in-Human Evaluation of a Novel Polymer-Free Drug-Filled Stent. JACC Cardiovasc Interv 2017; 10:147-156. [DOI: 10.1016/j.jcin.2016.10.020] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2016] [Revised: 10/18/2016] [Accepted: 10/19/2016] [Indexed: 11/20/2022]
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Lee R, Foin N, Ng J, Allen J, Soh N, Ang I, Shim W, Torii R, Wong P. Early coverage of drug-eluting stents analysed by optical coherence tomography: evidence of the impact of stent apposition and strut characteristics on the neointimal healing process. EUROINTERVENTION 2016; 12:e605-14. [DOI: 10.4244/eijv12i5a100] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Radu MD, Engstrøm T. Casting light on coronary evaginations: different mechanisms in different coronary devices? Eur Heart J 2016; 37:2050-4. [PMID: 26612580 DOI: 10.1093/eurheartj/ehv623] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Affiliation(s)
- Maria D Radu
- Department of Cardiology, Herlev Hospital, Copenhagen University Hospital, Herlev, Denmark Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Thomas Engstrøm
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
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Antonsen L, Thayssen P, Maehara A, Hansen HS, Junker A, Veien KT, Hansen KN, Hougaard M, Mintz GS, Jensen LO. Optical Coherence Tomography Guided Percutaneous Coronary Intervention With Nobori Stent Implantation in Patients With Non-ST-Segment-Elevation Myocardial Infarction (OCTACS) Trial: Difference in Strut Coverage and Dynamic Malapposition Patterns at 6 Months. Circ Cardiovasc Interv 2016; 8:e002446. [PMID: 26253735 DOI: 10.1161/circinterventions.114.002446] [Citation(s) in RCA: 60] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
BACKGROUND Incomplete strut coverage has been documented an important histopathologic morphometric predictor for later thrombotic events. This study sought to investigate whether optical coherence tomography (OCT)-guided percutaneous coronary intervention with Nobori biolimus-eluting stent implantation in patients with non-ST-segment-elevation myocardial infarction would provide improved strut coverage at 6 months in comparison with angiographic guidance only. METHODS AND RESULTS One hundred patients were randomized 1:1 to either OCT-guided or angio-guided Nobori biolimus-eluting stent implantation. Postprocedure OCT was performed in all patients. In the OCT-guided group, prespecified criteria indicating additional intervention were related to (1) stent underexpansion, (2) strut malapposition, (3) edge dissection(s), and (4) residual stenosis at the distal or proximal reference segment(s). A final OCT was performed in case of reintervention. Six-month OCT follow-up was available in 85 patients. Twenty-three (46%) OCT-guided patients had additional postdilation or stenting. The percentage of acutely malapposed struts was substantially lower in the OCT-guided group (3.4% [interquartile range, 0.3-7.6] versus 7.8% [interquartile range, 2.3-19.4]; P<0.01). At 6-month follow-up, the OCT-guided group had a significantly lower proportion of uncovered struts; 4.3% [interquartile range, 1.2-9.8] versus 9.0% [interquartile range, 5.5-14.5], P<0.01. Furthermore, OCT-guided patients had significantly more completely covered stents: 17.5% versus 2.2%, P=0.02. The percentages of malapposed struts and struts being both uncovered and malapposed at follow-up were comparable between groups. CONCLUSIONS OCT-guided optimization of Nobori biolimus-eluting stent implantation improves strut coverage at 6-month follow-up in comparison with angiographic guidance alone. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT02272283.
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Affiliation(s)
- Lisbeth Antonsen
- From the Department of Cardiology, Odense University Hospital, Odense, Denmark (L.A., P.T., H.S.H., A.J., K.T.V., K.N.H., M.H., L.O.J.); and Departments of Cardiology, Columbia University Medical Center and Cardiovascular Research Foundation, New York, NY (A.M., G.S.M.).
| | - Per Thayssen
- From the Department of Cardiology, Odense University Hospital, Odense, Denmark (L.A., P.T., H.S.H., A.J., K.T.V., K.N.H., M.H., L.O.J.); and Departments of Cardiology, Columbia University Medical Center and Cardiovascular Research Foundation, New York, NY (A.M., G.S.M.)
| | - Akiko Maehara
- From the Department of Cardiology, Odense University Hospital, Odense, Denmark (L.A., P.T., H.S.H., A.J., K.T.V., K.N.H., M.H., L.O.J.); and Departments of Cardiology, Columbia University Medical Center and Cardiovascular Research Foundation, New York, NY (A.M., G.S.M.)
| | - Henrik Steen Hansen
- From the Department of Cardiology, Odense University Hospital, Odense, Denmark (L.A., P.T., H.S.H., A.J., K.T.V., K.N.H., M.H., L.O.J.); and Departments of Cardiology, Columbia University Medical Center and Cardiovascular Research Foundation, New York, NY (A.M., G.S.M.)
| | - Anders Junker
- From the Department of Cardiology, Odense University Hospital, Odense, Denmark (L.A., P.T., H.S.H., A.J., K.T.V., K.N.H., M.H., L.O.J.); and Departments of Cardiology, Columbia University Medical Center and Cardiovascular Research Foundation, New York, NY (A.M., G.S.M.)
| | - Karsten Tange Veien
- From the Department of Cardiology, Odense University Hospital, Odense, Denmark (L.A., P.T., H.S.H., A.J., K.T.V., K.N.H., M.H., L.O.J.); and Departments of Cardiology, Columbia University Medical Center and Cardiovascular Research Foundation, New York, NY (A.M., G.S.M.)
| | - Knud Nørregaard Hansen
- From the Department of Cardiology, Odense University Hospital, Odense, Denmark (L.A., P.T., H.S.H., A.J., K.T.V., K.N.H., M.H., L.O.J.); and Departments of Cardiology, Columbia University Medical Center and Cardiovascular Research Foundation, New York, NY (A.M., G.S.M.)
| | - Mikkel Hougaard
- From the Department of Cardiology, Odense University Hospital, Odense, Denmark (L.A., P.T., H.S.H., A.J., K.T.V., K.N.H., M.H., L.O.J.); and Departments of Cardiology, Columbia University Medical Center and Cardiovascular Research Foundation, New York, NY (A.M., G.S.M.)
| | - Gary S Mintz
- From the Department of Cardiology, Odense University Hospital, Odense, Denmark (L.A., P.T., H.S.H., A.J., K.T.V., K.N.H., M.H., L.O.J.); and Departments of Cardiology, Columbia University Medical Center and Cardiovascular Research Foundation, New York, NY (A.M., G.S.M.)
| | - Lisette Okkels Jensen
- From the Department of Cardiology, Odense University Hospital, Odense, Denmark (L.A., P.T., H.S.H., A.J., K.T.V., K.N.H., M.H., L.O.J.); and Departments of Cardiology, Columbia University Medical Center and Cardiovascular Research Foundation, New York, NY (A.M., G.S.M.)
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Mechanical properties of the everolimus-eluting bioresorbable vascular scaffold compared to the metallic everolimus-eluting stent. BMC Cardiovasc Disord 2016; 16:104. [PMID: 27225486 PMCID: PMC4880814 DOI: 10.1186/s12872-016-0296-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Accepted: 05/21/2016] [Indexed: 11/25/2022] Open
Abstract
Background Everolimus-eluting bioresorbable vascular scaffolds (BVS) represent an innovative treatment option for coronary artery disease. Clinical and angiographic results seem promising, however, data on its immediate procedural performance are still scarce. The aim of our study was to assess the mechanical properties of BVS by Optical Coherence Tomography (OCT) in clinical routine. Methods Post-implantation OCT images of 40 BVS were retrospectively compared to those of 40 metallic everolimus-eluting stents (EES). Post-procedural device related morphological features were assessed. This included incidences of gross underexpansion and the stent eccentricity index (SEI, minimum/maximum diameter) as a measure for focal radial strength. Results Patients receiving BVS were younger than those with EES (54.0 ± 11.2 years versus 61.7 ± 11.4 years, p = 0.012), the remaining baseline, vessel and lesion characteristics were comparable between groups. Lesion pre-dilatation was more frequently performed and inflation time was longer in the BVS than in the EES group (n = 34 versus n = 23, p = 0.006 and 44.2 ± 12.8 versus 25.6 ± 8.4 seconds, p < 0.001, respectively). There were no significant differences in maximal inflation pressures and post-dilatation frequencies with non-compliant balloons between groups. Whereas gross device underexpansion was not significantly different, SEI was significantly lower in the BVS group (n = 12 (30 %) versus n = 14 (35 %), p = 0.812 and 0.69 ± 0.08 versus 0.76 ± 0.09, p < 0.001, respectively). There was no difference in major adverse cardiac event-rate at six months. Conclusion Our data show that focal radial expansion was significantly reduced in BVS compared to EES in a clinical routine setting using no routine post-dilatation protocol. Whether these findings have impact on scaffold mid-term results as well as on clinical outcome has to be investigated in larger, randomized trials.
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Abstract
Coronary optical coherence tomography (OCT) is now an established imaging technique in many catheterization laboratories worldwide. With its near-histological view of the vessel wall and lumen interface, it offers unprecedented imaging quality to improve our understanding of the pathophysiology of atherosclerosis, plaque vulnerability, and vascular biology. Not only is OCT used to accurately detect atherosclerotic plaque and optimize stent position, but it can further characterize plaque composition, quantify stent apposition, and assess stent tissue coverage. Given that its resolution of 15 μm is well above that of angiography and intravascular ultrasound, OCT has become the invasive imaging method of choice to examine the interaction between stents and the vessel wall. This review focuses on the application of OCT to examine coronary stents, the mechanisms of stent complications, and future directions of OCT-guided intervention.
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Hikichi Y, Umezu M, Node K, Iwasaki K. Reduction in incomplete stent apposition area caused by jailed struts after single stenting at left main bifurcation lesions: micro-CT analysis using a three-dimensional elastic bifurcated coronary artery model. Cardiovasc Interv Ther 2016; 32:12-17. [PMID: 26968169 PMCID: PMC5214711 DOI: 10.1007/s12928-016-0380-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2015] [Accepted: 01/25/2016] [Indexed: 12/27/2022]
Abstract
Stent struts protruding into ostial side branch called “jailed strut” at bifurcation lesions is a likely cause of thrombus formation. We aimed to investigate the influences of multiple kissing balloon inflation (KBI) for stent expansion, and stent platform design, respectively, on the reduction of incomplete stent apposition area (ISA area) caused by jailed struts at a side-branch ostium, using a three-dimensional elastic left main (LM) bifurcated coronary artery model. The referenced LM bifurcation angle data of 209 patients were stratified by tertiles focusing on the angle between the LM trunk (LMT) and left anterior descending artery (LAD). A bifurcation model was fabricated with angles of 129°, 122.2°, and 76.4° for LMT–LAD, LMT–left circumflex (LCx), and LAD–LCx, respectively, and with diameters of 5, 3.75, and 3.5 mm for LMT, LAD, and LCx, respectively; these diameters fulfill Murray’s law. A 75 % stenosis was included along the LMT. One-time and three-time KBIs were conducted using two-link Nobori and three-link Xience Xpedition (n = 6 each). The ISA area was quantified using micro-CT. Three-time KBI was effective in reducing the ISA area compared with one-time KBI for both the Nobori (p = 0.05) and Xience Xpedition (p = 0.07). The ISA area was smaller in the Nobori than in the Xience Xpedition, both in one-time and three-time KBI (one-time KBI: p = 0.003; three-time KBI: p = 0.001). Our findings of this study on reducing the ISA area by focusing on an interventional technique and stent design may help to improve coronary bifurcation intervention for a possibly better long-term clinical outcome.
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Affiliation(s)
- Yutaka Hikichi
- Cooperative Major in Advanced Biomedical Sciences, Joint Graduate School of Tokyo Women's Medical University and Waseda University, Waseda University, 2-2 Wakamatsucho, Shinjuku, Tokyo, Japan.,Department of Cardiovascular Medicine, Saga University, Saga, Japan
| | - Mitsuo Umezu
- Cooperative Major in Advanced Biomedical Sciences, Joint Graduate School of Tokyo Women's Medical University and Waseda University, Waseda University, 2-2 Wakamatsucho, Shinjuku, Tokyo, Japan.,Faculty of Science and Engineering, Waseda University, Shinjuku, Japan
| | - Koichi Node
- Department of Cardiovascular Medicine, Saga University, Saga, Japan
| | - Kiyotaka Iwasaki
- Cooperative Major in Advanced Biomedical Sciences, Joint Graduate School of Tokyo Women's Medical University and Waseda University, Waseda University, 2-2 Wakamatsucho, Shinjuku, Tokyo, Japan. .,Faculty of Science and Engineering, Waseda University, Shinjuku, Japan.
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Takahashi H, Otake H, Shinke T, Murasato Y, Kinoshita Y, Yamawaki M, Takeda Y, Fujii K, Yamada SI, Shimada Y, Yamashita T, Yumoto K, Hirata KI. Impact of final kissing balloon inflation on vessel healing following drug-eluting stent implantation: Insight from the optical coherence tomography sub-study of the J-REVERSE trial. J Cardiol 2016; 68:504-511. [PMID: 26899277 DOI: 10.1016/j.jjcc.2015.12.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2015] [Revised: 12/15/2015] [Accepted: 12/18/2015] [Indexed: 10/22/2022]
Abstract
BACKGROUND We sought to clarify the impact of final kissing inflation (FKI) after single stenting of bifurcation lesions on vessel healing. METHODS From the J-REVERSE registry enrolling 303 bifurcation lesions treated with provisional single stenting using sirolimus- (SES) or everolimus-eluting stent (EES), 65 lesions treated with (n=30) and without (n=35) FKI underwent 9-month follow-up optical coherence tomography. Average stent eccentricity index (SEI: minimum/maximum stent diameter) and neointimal unevenness score (NUS: maximum/average neointimal thickness of the same cross-section) for the proximal, bifurcation, and distal segments were compared between FKI and non-FKI groups. RESULTS At the proximal segment, the FKI group demonstrated significantly larger average stent area with greater asymmetric stent expansion, and average lumen area remained significantly larger at 9-month follow-up despite a tendency toward greater neointimal proliferation. Jailed strut and thrombus incidence were also significantly lower at the side branch orifice, and NUS was significantly smaller at the bifurcation and proximal segments in the FKI group. CONCLUSIONS Nine months after SES and EES treatment of bifurcation lesions, FKI reduced proximal-segment luminal narrowing. Considering its homogeneous neointimal distribution and fewer jailed struts, FKI may be beneficial for treating bifurcation lesions.
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Affiliation(s)
| | - Hiromasa Otake
- Department of Cardiovascular Medicine, Kobe University, Kobe, Japan
| | - Toshiro Shinke
- Department of Cardiovascular Medicine, Kobe University, Kobe, Japan.
| | - Yoshinobu Murasato
- Department of Cardiology, Cardiovascular Center, Kyushu Medical Center, Fukuoka, Japan
| | - Yoshihisa Kinoshita
- Department of Cardiovascular Medicine, Toyohashi Heart Center, Toyohashi, Japan
| | - Masahiro Yamawaki
- Department of Cardiovascular Medicine, Saiseikai Yokohama-Eastern Hospital, Yokohama, Japan
| | - Yoshihiro Takeda
- Department of Cardiovascular Medicine, Rinku General Medical Center, Izumi-Sano, Japan
| | - Kenichi Fujii
- Department of Cardiovascular Medicine, Hyogo Medical College, Nishinomiya, Japan
| | - Shin-Ichiro Yamada
- Department of Cardiovascular Medicine, Himeji Cardiovascular Center, Himeji, Japan
| | - Yoshihisa Shimada
- Department of Cardiovascular Medicine, Shiroyama Hospital, Habikino, Japan
| | - Takehiro Yamashita
- Department of Cardiovascular Medicine, Cardiovascular Center Hokkaido Ono Hospital, Sapporo, Japan
| | - Kazuhiko Yumoto
- Department of Cardiovascular Medicine, Yokohama Rosai Hospital, Yokohama, Japan
| | - Ken-Ichi Hirata
- Department of Cardiovascular Medicine, Kobe University, Kobe, Japan
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Differences of side branch jailing between left main–left anterior descending artery stenting and left main–left circumflex artery stenting with Nobori biolimus-eluting stent. Heart Vessels 2016; 31:1895-1903. [DOI: 10.1007/s00380-016-0812-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2015] [Accepted: 02/05/2016] [Indexed: 01/10/2023]
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Quantitative analysis of the side-branch orifice after bifurcation stenting using en-face processing of OCT images: a comparison between Xience V and Resolute Integrity stents. Coron Artery Dis 2015; 27:19-28. [PMID: 26554662 DOI: 10.1097/mca.0000000000000319] [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: 11/25/2022]
Abstract
OBJECTIVE Methods for intravascular assessment of the side-branch (SB) orifice after stenting are not readily available. The aim of this study was to assess the utility of an en-face projection processing for optical coherence tomography (OCT) images for SB evaluation. METHODS Measurements of the SB orifice obtained using en-face OCT images were validated using a phantom model. Linear regression modeling was applied to estimated area measurements made on the en-face images. The SB orifice was then analyzed in 88 patients with bifurcation lesions treated with either Xience V (everolimus-eluting stent) or Resolute Integrity [zotarolimus-eluting stent (ZES)]. The SB orifice area (A) and the area obstructed by struts (B) were calculated, and the %open area was evaluated as (A-B)/A*100. RESULTS Linear regression modeling demonstrated that the observed departures of the intercept and slope were not significantly different from 0 (-0.12 ± 0.22, P=0.59) and 1 (1.01 ± 0.06, R(2)=0.88, P=0.87), respectively. In cases without SB dilatation, the %open area was significantly larger in the everolimus-eluting stent group (n=25) than in the ZES group [n=32; 89.2% (83.7-91.3) vs. 84.3% (78.9-87.8), P=0.04]. A significant difference in %open area between cases with and those without SB dilatation was demonstrated in the ZES group [91.4% (86.1-94.0) vs. 84.3% (78.9-87.8), P=0.04]. CONCLUSION The accuracy of SB orifice measurement on an en-face OCT image was validated using a phantom model. This novel approach enables quantitative evaluation of the differences in SB orifice area free from struts among different stent types and different treatment strategies in vivo.
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Impact of Side Branch Modeling on Computation of Endothelial Shear Stress in Coronary Artery Disease: Coronary Tree Reconstruction by Fusion of 3D Angiography and OCT. J Am Coll Cardiol 2015; 66:125-35. [PMID: 26160628 DOI: 10.1016/j.jacc.2015.05.008] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2015] [Revised: 04/06/2015] [Accepted: 05/04/2015] [Indexed: 11/22/2022]
Abstract
BACKGROUND Computational fluid dynamics allow virtual evaluation of coronary physiology and shear stress (SS). Most studies hitherto assumed the vessel as a single conduit without accounting for the flow through side branches. OBJECTIVES This study sought to develop a new approach to reconstruct coronary geometry that also computes outgoing flow through side branches in hemodynamic and biomechanical calculations, using fusion of optical coherence tomography (OCT) and 3-dimensional (3D) angiography. METHODS Twenty-one patients enrolled in the DOCTOR (Does Optical Coherence Tomography Optimize Revascularization) fusion study underwent OCT and 3D-angiography of the target vessel (9 left anterior descending, 2 left circumflex, 10 right coronary artery). Coronary 3D reconstruction was performed by fusion of OCT and angiography, creating a true anatomical tree model (TM) including the side branches, and a traditional single-conduit model (SCM) disregarding the side branches. RESULTS The distal coronary pressure to aortic pressure (Pd/Pa) ratio was significantly higher in TMs than in SCMs (0.904 vs. 0.842; p < 0.0001). Agreement between TM and SCM in identifying patients with a Pd/Pa ratio ≤0.80 under basal flow conditions was only k = 0.417 (p = 0.019). Average SS was 4.64 Pascal lower in TMs than in SCMs (p < 0.0001), with marked differences in the point-per-point comparison, ranging from -60.71 to 7.47 Pascal. CONCLUSIONS True anatomical TMs that take into account the flow through side branches are feasible for accurate hemodynamic and biomechanical calculations. Traditional SCMs underestimate Pd/Pa and are inaccurate for regional SS estimation. Implementation of TMs might improve the accuracy of SS and virtual fractional flow reserve calculations, thus improving the consistency of biomechanical studies.
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Okamura T, Onuma Y, Yamada J, Iqbal J, Tateishi H, Nao T, Oda T, Maeda T, Nakamura T, Miura T, Yano M, Serruys PW. 3D optical coherence tomography: new insights into the process of optimal rewiring of side branches during bifurcational stenting. EUROINTERVENTION 2015; 10:907-15. [PMID: 24531393 DOI: 10.4244/eijv10i8a157] [Citation(s) in RCA: 66] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS We describe three-dimensional optical coherence tomography (3D-OCT) guided bifurcation stenting and the clinical utility of 3D-OCT. METHODS AND RESULTS Twenty-two consecutive patients who underwent OCT examination to confirm the recrossing position after stent implantation in a bifurcation lesion were enrolled. Frequency domain OCT images were obtained to check the recrossing position and 3D reconstructions were performed off-line. The recrossing position was clearly visualised in 18/22 (81.8%) cases. In 13 cases, serial 3D-OCT could be assessed both before and after final kissing balloon post-dilation (FKBD). We divided these cases into two groups according to the presence of the link between hoops at the carina: free carina type (n=7) and connecting to carina type (n=6). All free carina types complied with the distal rewiring. The percentage of incomplete stent apposition (%ISA) of free carina type at the bifurcation segment after FKBD was significantly smaller than that of the connecting to carina type (0.7±0.9% vs. 12.2±6.5%, p=0.0074). CONCLUSIONS 3D-OCT confirmation of the recrossing into the jailed side branch is feasible during PCI and may help to achieve distal rewiring and favourable stent positioning against the side branch ostium, leading to reduction in ISA and potentially better clinical outcomes.
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Affiliation(s)
- Takayuki Okamura
- Division of Cardiology, Department of Medicine and Clinical Science, Yamaguchi University Graduate School of Medicine, Ube, Japan
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Lee SY, Hong MK. Neointimal Coverage After Drug-Eluting Stent Implantation: Insights from Optical Coherence Tomography. Interv Cardiol Clin 2015; 4:321-331. [PMID: 28581948 DOI: 10.1016/j.iccl.2015.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Optical coherence tomography (OCT), which provides high-resolution imaging of the coronary vasculature, has provided novel insights into the pathophysiology of neointimal growth after drug-eluting stent (DES) implantation. The natural history, time course, and characteristics of strut coverage with neointima have been well defined by OCT. Pathology studies have identified strut coverage as a risk factor for stent thrombosis, and OCT studies have shown that next-generation DES have better strut coverage than first-generation DES. By reducing the incidence of stent thrombosis, improved strut coverage should lead to favorable clinical safety and the feasibility of shorter-duration dual antiplatelet therapy after DES implantation.
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Affiliation(s)
- Seung-Yul Lee
- Division of Cardiology, Sanbon Hospital, Wonkwang University College of Medicine, 321 Sabbonno, Gunpo, Gyeonggido 435-040, Korea
| | - Myeong-Ki Hong
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Yonsei University Health System, 250 Seongsanno, Seodaemun-gu, Seoul 120-752, Korea; Cardiovascular Institute, Yonsei University College of Medicine, 250 Seongsanno, Seodaemun-gu, Seoul 120-752, Korea; Severance Biomedical Science Institute, Yonsei University College of Medicine, 250 Seongsanno, Seodaemun-gu, Seoul 120-752, Korea.
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