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Chandramohan N, Hinton J, O'Kane P, Johnson TW. Artificial Intelligence for the Interventional Cardiologist: Powering and Enabling OCT Image Interpretation. Interv Cardiol 2024; 19:e03. [PMID: 38532946 PMCID: PMC10964291 DOI: 10.15420/icr.2023.13] [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: 04/25/2023] [Accepted: 12/11/2023] [Indexed: 03/28/2024] Open
Abstract
Intravascular optical coherence tomography (IVOCT) is a form of intra-coronary imaging that uses near-infrared light to generate high-resolution, cross-sectional, and 3D volumetric images of the vessel. Given its high spatial resolution, IVOCT is well-placed to characterise coronary plaques and aid with decision-making during percutaneous coronary intervention. IVOCT requires significant interpretation skills, which themselves require extensive education and training for effective utilisation, and this would appear to be the biggest barrier to its widespread adoption. Various artificial intelligence-based tools have been utilised in the most contemporary clinical IVOCT systems to facilitate better human interaction, interpretation and decision-making. The purpose of this article is to review the existing and future technological developments in IVOCT and demonstrate how they could aid the operator.
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Affiliation(s)
| | | | - Peter O'Kane
- University Hospitals Dorset NHS Foundation TrustPoole, UK
- Dorset Heart Centre, Royal Bournemouth HospitalBournemouth, UK
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Poon EKW, Wu X, Dijkstra J, O'Leary N, Torii R, Reiber JHC, Bourantas CV, Barlis P, Onuma Y, Serruys PW. Angiography and optical coherence tomography derived shear stress: are they equivalent in my opinion? THE INTERNATIONAL JOURNAL OF CARDIOVASCULAR IMAGING 2023; 39:1953-1961. [PMID: 37733283 DOI: 10.1007/s10554-023-02949-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 08/31/2023] [Indexed: 09/22/2023]
Abstract
Advances in image reconstruction using either single or multimodality imaging data provide increasingly accurate three-dimensional (3D) patient's arterial models for shear stress evaluation using computational fluid dynamics (CFD). We aim to evaluate the impacts on endothelial shear stress (ESS) derived from a simple image reconstruction using 3D-quantitative coronary angiography (3D-QCA) versus a multimodality reconstruction method using optical coherence tomography (OCT) in patients' vessels treated with bioresorbable scaffolds. Seven vessels at baseline and five-year follow-up of seven patients from a previous CFD investigation were retrospectively selected for a head-to-head comparison of angiography-derived versus OCT-derived ESS. 3D-QCA significantly underestimated the minimum stent area [MSA] (-2.38mm2) and the stent length (-1.46 mm) compared to OCT-fusion method reconstructions. After carefully co-registering the region of interest for all cases with a sophisticated statistical method, the difference in MSA measurements as well as the inability of angiography to visualise the strut footprint in the lumen surface have translated to higher angiography-derived ESS than OCT-derived ESS (1.76 Pa or 1.52 times for the overlapping segment). The difference in ESS widened with a more restricted region of interest (1.97 Pa or 1.63 times within the scaffold segment). Angiography and OCT offer two distinctive methods of ESS calculation. Angiography-derived ESS tends to overestimate the ESS compared to OCT-derived ESS. Further investigations into ESS analysis resolution play a vital role in adopting OCT-derived ESS.
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Affiliation(s)
- Eric K W Poon
- Department of Medicine, St Vincent's Hospital, Melbourne Medical School, University of Melbourne, Victoria, Australia
| | - Xinlei Wu
- Department of Cardiology, University of Galway, Galway, Ireland
- Department of Cardiology, The Second Affiliated Hospital, Yuying Children's Hospital of Wenzhou Medical University, Zhejiang, China
| | - Jouke Dijkstra
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Neil O'Leary
- Department of Cardiology, University of Galway, Galway, Ireland
| | - Ryo Torii
- Department of Mechanical Engineering, University College London, London, UK
| | - Johan H C Reiber
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Christos V Bourantas
- Device and Innovation Centre, William Harvey Research Institute, Queen Mary University of London, London, UK
- Department of Cardiology, Barts Heart Centre, London, UK
| | - Peter Barlis
- Department of Medicine, St Vincent's Hospital, Melbourne Medical School, University of Melbourne, Victoria, Australia
| | - Yoshinobu Onuma
- Department of Cardiology, University of Galway, Galway, Ireland
| | - Patrick W Serruys
- Department of Cardiology, University of Galway, Galway, Ireland.
- Emeritus Professor of Medicine, Erasmus University, Rotterdam, The Netherlands.
- CÚRAM, SFI Research Centre for Medical Devices, Galway, Ireland.
- School of Engineering, University of Melbourne, Melbourne, Australia.
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Xu K, Jiang Y, Yang W, Zhang W, Wang D, Zhao Y, Zheng S, Hao Z, Shen L, Jiang L, Qiu X, Escaned J, Tu S, Shen L, He B. Post-procedural and long-term functional outcomes of jailed side branches in stented coronary bifurcation lesions assessed with side branch Murray law-based quantitative flow ratio. Front Cardiovasc Med 2023; 10:1217069. [PMID: 37600052 PMCID: PMC10435891 DOI: 10.3389/fcvm.2023.1217069] [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: 05/04/2023] [Accepted: 07/19/2023] [Indexed: 08/22/2023] Open
Abstract
Introduction In coronary bifurcation lesions treated with percutaneous coronary intervention (PCI) using a 1-stent strategy, the occurrence of side branch (SB) compromise may lead to long-term myocardial ischemia in the SB territory. Murray law-based quantitative flow ratio (μQFR) is a novel angiography-based approach estimating fractional flow reserve from a single angiographic view, and thus is more feasible to assess SB compromise in routine practice. However, its association with long-term SB coronary blood flow remains unknown. Methods A total of 146 patients with 313 non-left main bifurcation lesions receiving 1-stent strategy with drug-eluting stents was included in this retrospective study. These lesions had post-procedural Thrombolysis in Myocardial Infarction (TIMI) flow grade 3 in SBs, and documented angiographic images of index procedure and 6- to 24-month angiographic follow-up. Post-procedural SB μQFR was calculated. Long-term SB coronary blood flow was quantified with the TIMI grading system using angiograms acquired at angiographic follow-up. Results At follow-up, 8 (2.6%), 16 (5.1%), 61 (19.5%), and 228 (72.8%) SBs had a TIMI flow grade of 0, 1, 2, and 3, respectively. The incidences of long-term SB TIMI flow grade ≤1 and ≤2 both tended to decrease across the tertiles of post-procedural SB μQFR. The receiver operating characteristic curve analyses indicated the post-procedural SB μQFR ≤0.77 was the optimal cut-off value to identify long-term SB TIMI flow grade ≤1 (specificity, 37.50%; sensitivity, 87.20%; area under the curve, 0.6673; P = 0.0064), and it was independently associated with 2.57-fold increased risk (adjusted OR, 2.57; 95% CI, 1.02-7.25; P = 0.045) in long-term SB TIMI flow grade ≤1 after adjustment. Discussion Post-procedural SB μQFR was independently associated with increased risk in impaired SB TIMI flow at long-term follow-up. Further investigations should focus on whether PCI optimization based on μQFR may contribute to improve SB flow in the long term.
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Affiliation(s)
- Ke Xu
- Department of Cardiology, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yue Jiang
- Department of Cardiology, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Wentao Yang
- Department of Cardiology, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Weifeng Zhang
- Department of Cardiology, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Dong Wang
- Department of Cardiology, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yu Zhao
- Department of Cardiology, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Shunwen Zheng
- Department of Cardiology, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ziyong Hao
- Department of Cardiology, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Lan Shen
- Department of Cardiology, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Lisheng Jiang
- Department of Cardiology, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xingbiao Qiu
- Department of Cardiology, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Javier Escaned
- Department of Cardiology, Hospital Clínico San Carlos IDISSC, Universidad Complutense de Madrid, Madrid, Spain
| | - Shengxian Tu
- Biomedical Instrument Institute, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Linghong Shen
- Department of Cardiology, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ben He
- Department of Cardiology, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Chen H, Li B, Xiao Y, Wang H, Kuang M, Sun H, Yang L. Diagnostic efficacy of the optical flow ratio in patients with coronary heart disease: A meta-analysis. PLoS One 2023; 18:e0285508. [PMID: 37163524 PMCID: PMC10171614 DOI: 10.1371/journal.pone.0285508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 04/25/2023] [Indexed: 05/12/2023] Open
Abstract
BACKGROUND Coronary atherosclerotic heart disease (CAD) remains one of the most serious diseases threatening human health and life. PCI (Percutaneous Coronary Intervention) is the most common treatment for patients with CAD. A rigorous and comprehensive assessment of coronary artery lesions is now needed before PCI, however, there is no consensus on how best evaluate the combination of various intracavitary imaging techniques. By merging the benefits of physiological assessment and high-definition imaging, the optical flow ratio (OFR) has emerged as a novel technology with promising prospects for application. METHODS A systematic review of the literature was conducted. Studies that met the criteria of the meta-analysis were considered to assess OFR and FFR (fractional flow reserve). And the summary values of sensitivity and specificity of diagnostic tests and summary receiver operating curves (SROC) were calculated. RESULTS A total of 5 studies were included. The sensitivity and specificity of OFR in the diagnosis of coronary artery lesions were 0.83 (95% CI: 0.75-0.88) and 0.94 (95% CI: 0.91-0.96), respectively; the positive likelihood ratio and the negative likelihood ratio were 14 (95% CI: 9.3, 21.3) and 0.18 (95% CI:0.13, 0.27), respectively. OFR showed good correlation and consistency with FFR. CONCLUSION The new OFR technique achieve an encouraging diagnostic performance, which also showed good correlation and consistency with FFR.
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Affiliation(s)
- Huaigang Chen
- Medical College of Nanchang University, Nanchang, Jiangxi Province, China
- Department of Cardiology, Jiangxi Provincial People's Hospital, The First Affiliated Hospital of Nanchang Medical College, Nanchang, Jiangxi Province, China
| | - Bin Li
- Department of Cardiology, Jiangxi Provincial People's Hospital, The First Affiliated Hospital of Nanchang Medical College, Nanchang, Jiangxi Province, China
| | - Yanyan Xiao
- Postgraduate School of Jiangxi University of Traditional Chinese Medicine, Jiangxi University of Traditional Chinese Medicine, Nanchang, Jiangxi Province, China
| | - Hong Wang
- Department of Cardiology, Jiangxi Provincial People's Hospital, The First Affiliated Hospital of Nanchang Medical College, Nanchang, Jiangxi Province, China
| | - Maobin Kuang
- Medical College of Nanchang University, Nanchang, Jiangxi Province, China
- Department of Cardiology, Jiangxi Provincial People's Hospital, The First Affiliated Hospital of Nanchang Medical College, Nanchang, Jiangxi Province, China
| | - Hanjin Sun
- Department of Cardiology, Jiangxi Provincial People's Hospital, The First Affiliated Hospital of Nanchang Medical College, Nanchang, Jiangxi Province, China
| | - Liu Yang
- Department of Cardiology, Jiangxi Provincial People's Hospital, The First Affiliated Hospital of Nanchang Medical College, Nanchang, Jiangxi Province, China
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Vassilev D, Mileva N, Panayotov P, Georgieva D, Koleva G, Collet C, Rigatelli G, Gil RJ. A novel technique of proximal optimization with kissing balloon inflation in bifurcation lesions. Cardiol J 2022; 29:899-905. [PMID: 35997048 PMCID: PMC9788753 DOI: 10.5603/cj.a2022.0078] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 06/10/2022] [Accepted: 06/14/2022] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Percutaneous coronary interventions (PCI) of bifurcation lesions poses a technical challenge with a high complication rate. Kissing balloon inflation (KBI) and proximal optimization technique (POT) are used to correct bifurcation carina after stenting. However, both may still lead to uncomplete strut apposition to the side branch (SB) lateral wall. Proposed herein, is a new stent-optimization technique following bifurcation stenting consisting of a combination of POT and KBI called proximal optimization with kissing balloon inflation (POKI). METHODS Bench and in-vivo evaluations were performed. For the bench visualization bifurcated silicone mock vessel was used. The POKI technique was simulated using a 3.5 mm POT balloon. For the in-vivo evaluation patients with angiographic bifurcation lesions in a native coronary artery with diameter ≥ 2.5 mm and ≤ 4.5 mm, SB diameter ≥ 2.0 mm, and percentage diameter stenosis (%DS) more than 50% in the main vessel (MV) were included. Provisional stenting was the default strategy. RESULTS In total 41 vessels were evaluated. The target vessel was left main in 9 (22.0%) patients, left anterior descending artery - in 26 (63.4%), left circumflex artery - in 4 (9.8%) and right coronary artery - in 2 (4.9%). The predominant type of bifurcation was Medina 1-1-1 (61.8%). Baseline proximal MV DS% was 60.0 ± 23.7%, distal MV DS% - 58.8 ± 28.9% and SB DS% 53.0 ± 32.0%. The application of POKI was feasible in 41 (100%) of the vessels. Post-PCI residual DS at proximal MV was 11.5 ± 15.4%, distal MV - 6.6 ± 9.3%, and SB - 22.9 ± 28.5%. Both procedural and angiographic success was 100%. CONCLUSIONS POKI is a novel stent-optimization technique for bifurcation lesions. It showed excellent feasibility and success rate both in bench and in-vivo evaluation.
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Affiliation(s)
- Dobrin Vassilev
- Medica Cor Hospital, Ruse, Bulgaria,University of Ruse, “Angel Kanchev”, Ruse, Bulgaria
| | - Niya Mileva
- Medica Cor Hospital, Ruse, Bulgaria,“Alexandrovska” University Hospital, Cardiology Department, Medical University Sofia, Bulgaria
| | | | | | - Greta Koleva
- University of Ruse, “Angel Kanchev”, Ruse, Bulgaria
| | | | - Gianluca Rigatelli
- Cardiovascular Diagnosis and Endoluminal Interventions, Rovigo General Hospital, Rovigo, Italy
| | - Robert J. Gil
- Department of Invasive Cardiology, Central Clinical Hospital of the Ministry of Interior, Warsaw, Poland
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Pan L, Lu W, Han Z, Pan S, Wang X, Shan Y, Peng M, Qin X, Sun G, Zhang P, Dong J, Qiu C. Drug-coated balloon in the treatment of coronary left main true bifurcation lesion: A patient-level propensity-matched analysis. Front Cardiovasc Med 2022; 9:1028007. [PMID: 36407423 PMCID: PMC9669294 DOI: 10.3389/fcvm.2022.1028007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 10/20/2022] [Indexed: 11/06/2022] Open
Abstract
Aims An increasing body of evidence suggests that drug-coated balloon (DCB) angioplasty represents a valuable option for revascularization in selected patients with coronary bifurcation disease. However, there remains a paucity of real-world observational evidence on the efficacy of DCB in left main (LM) true bifurcation lesion. We compared clinical and angiographic outcomes of hybrid [DCB + drug-eluting stent (DES)] versus DES-only strategy (provisional stenting or two-stent strategies) in de novo LM true bifurcated lesions. Methods The primary endpoint was the 2-year composite rate of target lesion failure (TLF): cardiac death, target vessel myocardial infarction (TVMI), or clinically driven target lesion revascularization (CD-TLR). A routine 1-year angiographic follow-up was scheduled. Propensity-score matching was utilized to assemble a cohort of patients with similar baseline characteristics. Results Among 1077 eligible patients, 199 who received DCB treatment and 398 who were assigned to DES therapy had similar propensity scores and were included in the analysis. TLF within 2 years occurred in 13 patients (7.56%) assigned to DCB group, and 52 patients (14.36%) assigned to DES group (odds ratio: 0.487; 95% confidence interval: 0.258–0.922; P = 0.025; Log-rank P = 0.024). Compared with the DES group, the DCB group resulted in a lower rate of CD-TLR (2.91% vs. 9.42%; P = 0.007). Cardiac death, TVMI, all-cause mortality, and stent thrombosis were comparable between both groups. Patients treated with DES-only were associated with a higher late lumen loss (0.42 ± 0.62 mm vs. 0.13 ± 0.42 mm, P < 0.001) compared with the DCB group at 1 year. In sensitivity analysis, the DCB group also presented a lower incidence of TLF, CD-TLR and stent thrombosis both compared to the two-stent strategy and compared to provisional stenting (Ps < 0.05). Conclusion The 2-year results of PCI utilizing DCB for LM true bifurcation lesions are superior to employing DES alone in terms of safety and effectiveness.
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Affiliation(s)
- Liang Pan
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Wenjie Lu
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Zhanying Han
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Sancong Pan
- Department of Cardiology, Jincheng People’s Hospital, Jincheng, China
| | - Xi Wang
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yingguang Shan
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Meng Peng
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Xiaofei Qin
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Guoju Sun
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Peisheng Zhang
- Department of Cardiology, The Fifth Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Jianzeng Dong
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- *Correspondence: Chunguang Qiu, ,
| | - Chunguang Qiu
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Jianzeng Dong,
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Wang J, Li C, Ding D, Zhang M, Wu Y, Xu R, Lu H, Chen Z, Chang S, Dai Y, Qian J, Zhang F, Tu S, Ge J. Functional comparison of different jailed balloon techniques in treating non-left main coronary bifurcation lesions. Int J Cardiol 2022; 364:20-26. [PMID: 35597490 DOI: 10.1016/j.ijcard.2022.05.036] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 05/06/2022] [Accepted: 05/16/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND There is a paucity of data comparing functional difference between active jailed balloon technique (A-JBT) and conventional jailed balloon technique (C-JBT) in treating non-left main coronary bifurcation lesions (CBLs). METHODS In this retrospective cohort study, we consecutively enrolled 232 patients with non-left main CBLs who underwent percutaneous coronary intervention (PCI) using JBTs between January 2018 and March 2019. Among them, 191 patients entered the final analysis with 12-months angiographic follow-up. We stratified patients into A-JBT group (130 patients) and C-JBT group (61 patients). The functional analysis by Murray law-based quantitative flow ratio (μQFR) and Seattleanginaquestionnaire (SAQ) were performed to compare the two techniques. RESULTS Compared with C-JBT group, A-JBT group observed a lower abrupt (0.8% vs. 11.1%, p = 0.002) and final SB occlusion (0 vs. 7.9%, p = 0.005). Meanwhile, A-JBT group had a significantly higher μQFR of side branch (SB) both post-PCI and 12-months follow-up (median [interquartile range (IQR)]: 0.91 (0.86-0.96) vs. 0.82 (0.69-0.92), p < 0.001; median [IQR]: 0.95 (0.89-0.98) vs. 0.85 (0.74-0.93), p < 0.001) than C-JBT group. Besides, A-JBT group gained a μQFR improvement at follow-up period compared with post-PCI data (median [IQR]: 0.95 [0.89-0.98] vs. 0.91[0.86-0.96] of SB, p < 0.001) and a higher SAQ scores at 12-months follow-up compared with C-JBT group (p < 0.001). CONCLUSIONS Compared with C-JBT, A-JBT provided excellent SB protection during MV stenting and improved the SB functional blood flow as well as the angina relief even after 12 months.
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Affiliation(s)
- Jingpu Wang
- Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai, China; National Clinical Research Center for Interventional Medicine, Shanghai, China
| | - Chenguang Li
- Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai, China; National Clinical Research Center for Interventional Medicine, Shanghai, China
| | - Daixin Ding
- The Lambe Institute for Translational Medicine and Curam, National University of Ireland, Galway, Ireland
| | - Mingyou Zhang
- Department of Cardiology, The first hospital of Jilin university, Changchun, China
| | - Yizhe Wu
- Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai, China; National Clinical Research Center for Interventional Medicine, Shanghai, China
| | - Rende Xu
- Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai, China; National Clinical Research Center for Interventional Medicine, Shanghai, China
| | - Hao Lu
- Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai, China; National Clinical Research Center for Interventional Medicine, Shanghai, China
| | - Zhangwei Chen
- Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai, China; National Clinical Research Center for Interventional Medicine, Shanghai, China
| | - Shufu Chang
- Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai, China; National Clinical Research Center for Interventional Medicine, Shanghai, China
| | - Yuxiang Dai
- Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai, China; National Clinical Research Center for Interventional Medicine, Shanghai, China
| | - Juying Qian
- Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai, China; National Clinical Research Center for Interventional Medicine, Shanghai, China
| | - Feng Zhang
- Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai, China; National Clinical Research Center for Interventional Medicine, Shanghai, China.
| | - Shengxian Tu
- Med-X Research Institute, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China..
| | - Junbo Ge
- Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai, China; National Clinical Research Center for Interventional Medicine, Shanghai, China.
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Vassilev D, Mileva N, Collet C, Nikolov P, Karamfiloff K, Naunov V, Sonck J, Hristova I, Georgieva D, Rigatelli G, Kassab GS, Gil RJ. Determinants of functional significance of coronary bifurcation lesions and clinical outcomes after physiology-guided treatment. IJC HEART & VASCULATURE 2022; 38:100929. [PMID: 35024426 PMCID: PMC8728425 DOI: 10.1016/j.ijcha.2021.100929] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 12/11/2021] [Accepted: 12/14/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To determine the rate of functionally significant (fractional flow reserve, FFR ≤ 0.80) coronary bifurcation stenoses that are considered anatomically significant based on angiographic estimation and to define predictors of functional significance of stenoses in main vessel and side branch. BACKGROUND To date, the rate of functionally significant stenoses in angiographic significant coronary bifurcation stenoses has not been specifically determined. METHODS Patients with significant angiographic bifurcation lesions defined as diameter stenosis >50% in main vessel and/or side branch were included. FFR was performed in main vessel (MV) and side branch (SB) before and after percutaneous coronary intervention (PCI). The protocol was approved by the local ethics committee. RESULTS Overall, 171 patients with bifurcation lesions were included. Mean FFR in MV was 0.80 ± 0.01 and 0.84 ± 0.09 in SB. 46% (n = 78) of bifurcation lesions were functionally significant when assessed with FFR. Diameter stenosis in main vessel, lesion length, side branch territory and SYNTAX score (SS) were found as predictors for lesion functional severity (main vessel FFR ≤ 0.80). At the time of follow-up, there were no differences between the treated and deferred group regarding rates of all-cause death, cardio-vascular death, MACEs and POCE. CONCLUSION Less than half of all angiographic significant bifurcation lesions were functionally significant when assessed with FFR. There was no difference in clinical outcomes at mean time of three years follow-up in treated and deferred lesion.
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Affiliation(s)
- Dobrin Vassilev
- “Alexandrovska” University Hospital, Cardiology Department, Medical University Sofia, Bulgaria
- Ruse University “Angel Kanchev”, Department of Healthcare, Studentska-8 Street, Ruse, Bulgaria
| | - Niya Mileva
- “Alexandrovska” University Hospital, Cardiology Department, Medical University Sofia, Bulgaria
- Cardiovascular Center OLV Ziekenhuis, Aalst, Belgium
| | - Carlos Collet
- Cardiovascular Center OLV Ziekenhuis, Aalst, Belgium
| | - Pavel Nikolov
- “Alexandrovska” University Hospital, Cardiology Department, Medical University Sofia, Bulgaria
| | - Kiril Karamfiloff
- “Alexandrovska” University Hospital, Cardiology Department, Medical University Sofia, Bulgaria
| | - Vladimir Naunov
- “Alexandrovska” University Hospital, Cardiology Department, Medical University Sofia, Bulgaria
| | - Jeroen Sonck
- Cardiovascular Center OLV Ziekenhuis, Aalst, Belgium
| | - Irinka Hristova
- Ruse University “Angel Kanchev”, Department of Healthcare, Studentska-8 Street, Ruse, Bulgaria
| | - Despina Georgieva
- Ruse University “Angel Kanchev”, Department of Healthcare, Studentska-8 Street, Ruse, Bulgaria
| | - Gianluca Rigatelli
- Section of Cardiovascular Diagnosis and Endoluminal Interventions, Rovigo General Hospital, Rovigo, Italy
| | | | - Robert J. Gil
- Mossakowski Medical Research Institute, Polish Academy of Science, Warsaw, Poland
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Vassilev D, Mileva N, Collet C, Nikolov P, Sokolova K, Karamfiloff K, Naunov V, Sonck J, Rigatelli G, Kassab GS, Gil RJ. Bifurcation functional significance score as predictor of mortality: a validating study. Sci Rep 2021; 11:24308. [PMID: 34934122 PMCID: PMC8692595 DOI: 10.1038/s41598-021-03815-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Accepted: 10/26/2021] [Indexed: 11/10/2022] Open
Abstract
Considerable progress has been made in the treatment of coronary bifurcation stenosis. Anatomical characteristics of the vessel and lesion, however, fail to give information about the functional significance of the bifurcation stenosis. To the best of our knowledge, there is no study that systematically establishes the baseline functional significance of coronary stenosis and its effect on procedural and clinical outcomes. Patients with significant angiographic bifurcation lesions defined as diameter stenosis > 50% in main vessel and/or side branch were included. FFR was performed in main vessel (MV) and side branch (SB) before and after percutaneous coronary intervention (PCI). 169 patients from Fiesta study (derivation cohort) and 555 patients from prospective bifurcation registry (clinical effect cohort) were analyzed to validate angiographic prediction score (BFSS) used to determine the potentially functional significance of coronary bifurcation stenosis. Bifurcation functional significance score (including the following parameters-SYNTAX ≥ 11, SB/MB BARI score, MV %DS ≥ 55%, main branch (MB) %DS ≥ 65%, lesion length ≥ 25 mm) with a maximum value of 11 was developed. A cut-off value of 6.0 was shown to give the best discriminatory ability-with accuracy 87% (sensitivity 77%, specificity 96%, p < 0.001). There was also a significant difference in all-cause mortality between patients with BFSS ≥ 6.0 vs. BFSS < 6.0-25.5% vs. 18.4%, log-rank p = 0.001 as well as cardiac mortality: BFSS ≥ 6.0 vs. BFSS < 6.0-17.7% vs. 14.5%, log-rank (p = 0.016). The cardiac mortality was significantly lower in patients with smaller absolute SB territory, p = 0.023. An angiographic score (BFSS) with good discriminatory ability to determine the functional significance of coronary bifurcation stenosis was developed. The value for BFSS ≥ 6.0 can be used as a discriminator to define groups with higher risk for all-cause and cardiac mortality. Also, we found that the smaller side branches pose greater mortality risk.
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Affiliation(s)
- Dobrin Vassilev
- Cardiology Department, Medical University Sofia, "Alexandrovska" University Hospital, Sofia, Bulgaria.
| | - Niya Mileva
- Cardiology Department, Medical University Sofia, "Alexandrovska" University Hospital, Sofia, Bulgaria.
- Cardiovascular Center OLV Ziekenhuis, Moorselbaan 164, 9300, Aalst, Belgium.
| | - Carlos Collet
- Cardiovascular Center OLV Ziekenhuis, Moorselbaan 164, 9300, Aalst, Belgium
| | - Pavel Nikolov
- Cardiology Department, Medical University Sofia, "Alexandrovska" University Hospital, Sofia, Bulgaria
| | - Katerina Sokolova
- Cardiology Department, Medical University Sofia, "Alexandrovska" University Hospital, Sofia, Bulgaria
| | - Kiril Karamfiloff
- Cardiology Department, Medical University Sofia, "Alexandrovska" University Hospital, Sofia, Bulgaria
| | - Vladimir Naunov
- Cardiology Department, Medical University Sofia, "Alexandrovska" University Hospital, Sofia, Bulgaria
| | - Jeroen Sonck
- Cardiovascular Center OLV Ziekenhuis, Moorselbaan 164, 9300, Aalst, Belgium
- Department of Advanced Biomedical Sciences, University of Naples, Federico II, Naples, Italy
| | - Gianluca Rigatelli
- Section of Cardiovascular Diagnosis and Endoluminal Interventions, Rovigo General Hospital, Rovigo, Italy
| | | | - Robert J Gil
- Mossakowski Medical Research Institute, Polish Academy of Science, Warsaw, Poland
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10
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Computerized technologies informing cardiac catheterization and guiding coronary intervention. Am Heart J 2021; 240:28-45. [PMID: 34077744 DOI: 10.1016/j.ahj.2021.05.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Accepted: 05/22/2021] [Indexed: 11/21/2022]
Abstract
Advances in image processing and computer hardware have enabled the development of user-friendly software which operate in real-time and can be used in the catheterization laboratory to facilitate percutaneous coronary intervention (PCI). The two dimensional-(2D) quantitative coronary angiography (QCA) systems that have traditionally been used to assess lesion severity have been replaced by 3D-QCA systems, enabling more reliable evaluation of vessel geometry and lesion dimensions. This also allows 3D reconstruction of coronary bifurcation anatomy and generation of models that can be processed by computational fluid dynamic techniques to reliably detect flow-limiting lesions. More recently, software has been introduced that has the capability of generating a digital silhouette of the coronary arteries superimposed onto X-ray angiography to facilitate wire crossing and stent placement, and potentially reduce contrast use. In parallel, methodologies have been developed that operate with an accessible interface and can process intravascular imaging data, reliably quantify lesion severity and co-register intravascular and X-ray angiographic data to comprehensively assess plaque distribution and guide PCI. The above advances are used in daily practice to improve procedural results and outcomes. This review aims to provide an overview of the developments in the field - it presents the computer-based technologies that have been designed to accurately assess lesion severity, summarizes the advantages and limitations of the systems introduced to co-register imaging data and discusses the potential value of the existing and emerging software in the catheterization laboratory.
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11
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Implementing Coronary Computed Tomography Angiography in the Catheterization Laboratory. JACC Cardiovasc Imaging 2021; 14:1846-1855. [DOI: 10.1016/j.jcmg.2020.07.048] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 07/10/2020] [Accepted: 07/14/2020] [Indexed: 01/05/2023]
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12
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Tu S, Ding D, Chang Y, Li C, Wijns W, Xu B. Diagnostic accuracy of quantitative flow ratio for assessment of coronary stenosis significance from a single angiographic view: A novel method based on bifurcation fractal law. Catheter Cardiovasc Interv 2021; 97 Suppl 2:1040-1047. [DOI: 10.1002/ccd.29592] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 02/16/2021] [Accepted: 02/19/2021] [Indexed: 12/29/2022]
Affiliation(s)
- Shengxian Tu
- Biomedical Instrument Institute, School of Biomedical Engineering Shanghai Jiao Tong University Shanghai China
- Shanghai Med‐X Engineering Research Center Shanghai Jiao Tong University Shanghai China
| | - Daixin Ding
- Biomedical Instrument Institute, School of Biomedical Engineering Shanghai Jiao Tong University Shanghai China
- The Lambe Institute for Translational Medicine and Curam National University of Ireland Galway Galway Ireland
| | - Yunxiao Chang
- Division of Scientific Research Pulse Medical Imaging Technology Co., Ltd. Shanghai China
| | - Chunming Li
- Biomedical Instrument Institute, School of Biomedical Engineering Shanghai Jiao Tong University Shanghai China
| | - William Wijns
- The Lambe Institute for Translational Medicine and Curam National University of Ireland Galway Galway Ireland
| | - Bo Xu
- Catheterization Laboratories, Fu Wai Hospital, National Center for Cardiovascular Diseases Chinese Academy of Medical Sciences and Peking Union Medical College Beijing China
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13
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Nagumo S, Collet C, Norgaard BL, Otake H, Ko B, Koo BK, Leipsic J, Andreini D, Heggermont W, Jensen JM, Takahashi Y, Ihdayhid A, Zhang Z, Barbato E, Maeng M, Mizukami T, Bartunek J, Updegrove A, Penicka M, Rogers C, Taylor C, De Bruyne B, Sonck J. Rationale and design of the precise percutaneous coronary intervention plan (P3) study: Prospective evaluation of a virtual computed tomography-based percutaneous intervention planner. Clin Cardiol 2021; 44:446-454. [PMID: 33656754 PMCID: PMC8027584 DOI: 10.1002/clc.23551] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 01/13/2021] [Accepted: 01/16/2021] [Indexed: 01/08/2023] Open
Abstract
Introduction Fractional flow reserve (FFR) measured after percutaneous coronary intervention (PCI) has been identified as a surrogate marker for vessel related adverse events. FFR can be derived from standard coronary computed tomography angiography (CTA). Moreover, the FFR derived from coronary CTA (FFRCT) Planner is a tool that simulates PCI providing modeled FFRCT values after stenosis opening. Aim To validate the accuracy of the FFRCT Planner in predicting FFR after PCI with invasive FFR as a reference standard. Methods Prospective, international and multicenter study of patients with chronic coronary syndromes undergoing PCI. Patients will undergo coronary CTA with FFRCT prior to PCI. Combined morphological and functional evaluations with motorized FFR hyperemic pullbacks, and optical coherence tomography (OCT) will be performed before and after PCI. The FFRCT Planner will be applied by an independent core laboratory blinded to invasive data, replicating the invasive procedure. The primary objective is to assess the agreement between the predicted FFRCT post‐PCI derived from the Planner and invasive FFR. A total of 127 patients will be included in the study. Results Patient enrollment started in February 2019. Until December 2020, 100 patients have been included. Mean age was 64.1 ± 9.03, 76% were males and 24% diabetics. The target vessels for PCI were LAD 83%, LCX 6%, and RCA 11%. The final results are expected in 2021. Conclusion This study will determine the accuracy and precision of the FFRCT Planner to predict post‐PCI FFR in patients with chronic coronary syndromes undergoing percutaneous revascularization.
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Affiliation(s)
- Sakura Nagumo
- Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium.,Department of Cardiology, Showa University Fujigaoka Hospital, Yokohama, Kanagawa, Japan
| | - Carlos Collet
- Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium
| | - Bjarne L Norgaard
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Hiromasa Otake
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Brian Ko
- Monash Cardiovascular Research Centre, Monash University and Monash Heart, Monash Health, Clayton, Victoria, Australia
| | - Bon-Kwon Koo
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, South Korea
| | - Jonathon Leipsic
- Department of Medicine and Radiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Daniele Andreini
- Centro Cardiologico Monzino, IRCCS, Milano - Dipartimento di Scienze Cliniche e di Comunità, Università degli Studi, Milan, Italy
| | | | - Jesper M Jensen
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Yu Takahashi
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Abdul Ihdayhid
- Monash Cardiovascular Research Centre, Monash University and Monash Heart, Monash Health, Clayton, Victoria, Australia
| | - Zinlong Zhang
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, South Korea
| | - Emanuele Barbato
- Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium.,Department of Advanced Biomedical Sciences, University Federico II, Naples, Italy
| | - Michael Maeng
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Takuya Mizukami
- Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium.,Clinical Research Institute for Clinical Pharmacology and Therapeutics, Showa University, Tokyo, Japan
| | | | | | | | | | | | - Bernard De Bruyne
- Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium.,Department of Cardiology, University Hospital of Lausanne, Lausanne, Switzerland
| | - Jeroen Sonck
- Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium.,Department of Advanced Biomedical Sciences, University Federico II, Naples, Italy
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14
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Three-dimensional optical coherence tomography versus intravascular ultrasound in percutaneous coronary intervention for the left main coronary artery. Heart Vessels 2021; 36:630-637. [PMID: 33389063 DOI: 10.1007/s00380-020-01742-6] [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] [Received: 07/02/2020] [Accepted: 11/27/2020] [Indexed: 10/22/2022]
Abstract
We aimed to compare the intravascular imaging findings, and clinical outcomes between three-dimensional optical coherence tomography (OCT)- and intravascular ultrasound (IVUS)-guided percutaneous coronary intervention (PCI) for the left main coronary artery (LMCA). We enrolled 331 patients underwent OCT- or IVUS-guide single crossover stenting across the side branch (SB) and subsequent kissing balloon inflation (KBT) for LMCA bifurcation. Primary endpoint was defined as a composite of cardiac death, myocardial infarction, and target lesion revascularization. Of 331 patients, 58 patients (17.5%) underwent OCT-guide PCI. OCT-guide PCI associated with higher frequency of proximal optimization technique (POT) (98.3% vs 85.3%, P = 0.013) and smaller balloon size of POT (4.29 ± 0.44 mm vs 4.43 ± 0.42, P = 0.02) than IVUS-guide PCI. Although maximal stent area at LMCA and minimal stent area at main vessel were significantly smaller in OCT-guide PCI in intravascular imaging (P = 0.01, and P = 0.002, respectively), the restenosis rate at follow-up angiography was comparable in both groups (15.2% vs. 9.4%, P = 0.387). Cumulative rate of primary endpoint was not significantly different between 2 groups both before and after propensity score adjustment (7.0% vs. 7.4%, P = 0.98 and 2.6% vs. 7.3%, P = 0.18). In conclusion, the clinical outcomes at 1 year were comparable, suggesting OCT- and IVUS-guided PCI for LMCA were similarly feasible. The balloon size of POT in OCT-guide PCI might be influenced by the limited visibility in the proximal LMCA.
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15
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Asano T, Kogame N, Onuma Y, Modolo R, Chichareon P, Lefèvre T, Legutko J, Digne F, Morel MA, Serruys PW, Gil RJ. Treatment with a dedicated bifurcation sirolimus-eluting cobalt-chromium stent for distal left main coronary artery disease: rationale and design of the POLBOS LM study. EUROINTERVENTION 2020; 16:654-662. [PMID: 31543500 DOI: 10.4244/eij-d-19-00361] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS The aim of this study is to demonstrate the non-inferiority of the BiOSS LIM C sirolimus-eluting cobalt-chromium bifurcation dedicated stent against the XIENCE stent regarding the patient-oriented composite endpoint (POCE) at 12 months among patients with left main coronary artery disease (LMCA). METHODS AND RESULTS The POLBOS LM study is a single-arm, prospective, multicentre study enrolling 260 patients (SYNTAX score ≤32) with a pre-specified performance goal based on the results of the EXCEL trial with contemporary percutaneous coronary intervention (PCI) for LMCA disease. Patient enrolment will comply with objective inclusion criteria of diameter stenosis ≥50% in the LMCA based on off-line quantitative coronary angiography (QCA) analysed by an independent core laboratory using dedicated bifurcation QCA software. The BiOSS LIM C is used for the treatment of LMCA disease with the same specific technical classification as for the BiOSS LIM (modified MADS classification) and the stent implantation is optimised by using pre-specified intravascular ultrasound criteria. The primary endpoint is POCE (a composite of all-cause death, stroke, any myocardial infarction, and any revascularisation) at 12 months. CONCLUSIONS The POLBOS LM study will indicate the efficacy of the BiOSS LIM C stent with contemporary PCI for distal left main bifurcation lesions in comparison with the XIENCE stent from the recent EXCEL trial, as a performance index.
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Affiliation(s)
- Taku Asano
- Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
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16
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Stephan T, Keßler M, Goldberger N, Rottbauer W, Markovic S. Angiographic Results After Percutaneous Coronary Interventions in Ostial Versus Distal Left Main Lesions. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2020; 23:22-27. [PMID: 32952077 DOI: 10.1016/j.carrev.2020.08.025] [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: 04/19/2020] [Revised: 08/02/2020] [Accepted: 08/12/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE We sought to evaluate angiographic outcomes in ostial and distal LM lesions. METHODS 176 patients with LM disease undergoing PCI were retrospectively included in this study. 9 months of angiographic and 12 months of clinical follow-up was obtained. Quantitative coronary analysis (QCA) was performed for all lesions, using an 11-segment model. Clinical endpoint measure was a composite endpoint of cardiac death, myocardial infarction and target lesion revascularization (TLR). RESULTS During 12 months follow up after successful PCI, the composite endpoint occurred more frequently in distal LM bifurcation lesions mainly driven by elevated TLR rates (14.1% in distal LM disease vs. 5.6% in ostial/midshaft LM disease, P = 0.20). Concordantly angiographic binary restenosis (8.2% compared to 0.0%) and late lumen loss (LLL, 0.42 ± 0.97 vs. 0.28 ± 0.34 mm) were increased in distal LM bifurcation lesions compared to ostial LM lesions. In distal lesions highest values for LLL were observed in segments adjacent to the bifurcation (0.37 ± 1.13 mm and 0.37 ± 0.73 mm). On cox proportional regression analysis the angiographic parameter LLL in a bifurcation segment (P = 0.03, HR 1.68 [1.1-2.7]) as well as presence of diabetes mellitus as a clinical parameter (P = 0.046, HR 2.77 [1.0-7.5]) were independent correlates for occurrence of MACE in distal LM bifurcations lesions. CONCLUSION PCI of ostial LM in accomplished with low LLL (0.28 ± 0.34 mm) and binary restenosis rates. In distal left main lesions highest rates for LLL and binary restenosis were observed in segments nearest to the bifurcation and rather focused on the main vessel (0.42 ± 0.97 mm).
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Affiliation(s)
- Tilman Stephan
- Department of Cardiology, Angiology and Pneumology, University Hospital Ulm, Ulm, Germany
| | - Mirjam Keßler
- Department of Cardiology, Angiology and Pneumology, University Hospital Ulm, Ulm, Germany
| | - Nadine Goldberger
- Department of Cardiology, Angiology and Pneumology, University Hospital Ulm, Ulm, Germany
| | - Wolfgang Rottbauer
- Department of Cardiology, Angiology and Pneumology, University Hospital Ulm, Ulm, Germany
| | - Sinisa Markovic
- Department of Cardiology, Angiology and Pneumology, University Hospital Ulm, Ulm, Germany.
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17
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Burzotta F, Lassen JF, Louvard Y, Lefèvre T, Banning AP, Daremont O, Pan M, Hildick‐Smith D, Chieffo A, Chatzizisis YS, Džavík V, Gwon H, Hikichi Y, Murasato Y, Koo BK, Chen S, Serruys P, Stankovic G. European Bifurcation Club white paper on stenting techniques for patients with bifurcated coronary artery lesions. Catheter Cardiovasc Interv 2020; 96:1067-1079. [DOI: 10.1002/ccd.29071] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2020] [Accepted: 05/26/2020] [Indexed: 01/29/2023]
Affiliation(s)
- Francesco Burzotta
- Institute of Cardiology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore Rome Italy
| | - Jens Flensted Lassen
- Department of Cardiology B Odense Universitetshospital and University of Southern Denmark Odense Denmark
| | - Yves Louvard
- Ramsay Générale de Santé—Institut cardiovasculaire Paris Sud Hopital Privé Jacques Cartier Massy France
| | - Thierry Lefèvre
- Ramsay Générale de Santé—Institut cardiovasculaire Paris Sud Hopital Privé Jacques Cartier Massy France
| | - Adrian P. Banning
- Cardiovascular Medicine Division, Radcliffe Department of Medicine John Radcliffe Hospital Oxford UK
| | | | - Manuel Pan
- Department of Cardiology Reina Sofia Hospital, University of Cordoba (IMIBIC) Cordoba Spain
| | | | - Alaide Chieffo
- Interventional Cardiology Unit San Raffaele Scientific Institute Milan Italy
| | | | - Vladimír Džavík
- Interventional Cardiology Program, Division of Cardiology Toronto General Hospital Toronto Ontario Canada
| | - Hyeon‐Cheol Gwon
- Division of Cardiology, Department of Medicine, Samsung Medical Center Sungkyunkwan University School of Medicine Seoul South Korea
| | - Yutaka Hikichi
- Department of Cardiovascular Medicine Saga University Saga Japan
| | - Yoshinobu Murasato
- Department of Cardiology and Clinical Research Institute National Hospital Organization Kyushu Medical Center Fukuoka Japan
| | - Bon Kwon Koo
- Department of Internal Medicine and Cardiovascular Center Seoul National University Hospital Seoul South Korea
| | - Shao‐Liang Chen
- Division of Cardiology, Nanjing First Hospital and Key Laboratory of Targeted Intervention of Cardiovascular Disease Collaboratory Innovation Center for Cardiovascular Disease Translational Medicine, Nanjing Medical University Nanjing China
| | - Patrick Serruys
- National Heart and Lung Institute, Imperial College London London UK
| | - Goran Stankovic
- Medical Faculty, Department of Cardiology Clinical Center of Serbia, University of Belgrade Belgrade Serbia
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18
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Di Gioia G, Sonck J, Ferenc M, Chen SL, Colaiori I, Gallinoro E, Mizukami T, Kodeboina M, Nagumo S, Franco D, Bartunek J, Vanderheyden M, Wyffels E, De Bruyne B, Lassen JF, Bennett J, Vassilev D, Serruys PW, Stankovic G, Louvard Y, Barbato E, Collet C. Clinical Outcomes Following Coronary Bifurcation PCI Techniques. JACC Cardiovasc Interv 2020; 13:1432-1444. [DOI: 10.1016/j.jcin.2020.03.054] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 03/25/2020] [Accepted: 03/31/2020] [Indexed: 01/01/2023]
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Zimarino M, Barbato E, Nakamura S, Radico F, Di Nicola M, Briguori C, Gil RJ, Kanic V, Perfetti M, Pellicano M, Mairic K, Stankovic G. The impact of the extent of side branch disease on outcomes following bifurcation stenting. Catheter Cardiovasc Interv 2020; 96:E84-E92. [PMID: 32150341 DOI: 10.1002/ccd.28842] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2019] [Revised: 01/25/2020] [Accepted: 02/25/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVES To define the impact of side branch (SB) lesion length on clinical outcomes after percutaneous coronary intervention (PCI) on bifurcation lesions. BACKGROUND The role of the SB lesion length remains questionable in PCI planning and its implication on clinical outcome is controversial. METHODS Data from the retrospective multicenter EBC-P2BiTO registry were analyzed. The primary endpoint was the occurrence of major adverse cardiac events (MACE), defined as the composite of cardiac death, myocardial infarction excluding periprocedural, or stent thrombosis at 13 months median follow-up (IQR 11-28). By using propensity scores for inverse probability of treatment weighting (IPTW), the comparison of treatment groups was adjusted to correct for potential confounding. RESULTS Among 1,252 patients, SB was normal in 489 (39%), diseased in 763 (61%) cases. MACE occurred in 68 patients (5.4%). The optimal discriminant SB lesion length for MACE was ≥10 mm, with an area under the curve of 0.71 (p < .01). The incidence of MACE was higher among patients with SB lesions ≥10 mm (8%) than with normal SB (4.1%) (hazard ratio [HR], 2.8; 95% confidence interval [CI], 1.5-5.3; p = .001, IPTW-adjusted) or SB lesions <10 mm (5.1%) (HR, 1.5; 95% CI, 1.1-3.3; p = .048, IPTW-adjusted), being similar between these last two groups. CONCLUSIONS In bifurcation PCI, SB lesion length ≥ 10 mm identifies patients at higher risk of MACE than those with <10 mm SB lesions and those without SB disease, considering that no differences were observed among these last two groups. Careful planning is mandatory when approaching bifurcations with long SB lesions.
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Affiliation(s)
- Marco Zimarino
- Institute of Cardiology "G. d'Annunzio" University Chieti-Pescara, Chieti, Italy.,Interventional Cath Lab, ASL 2 Abruzzo, Chieti, Italy
| | - Emanuele Barbato
- Division of Cardiology, Department of Advanced Biomedical Sciences, Federico II University of Naples, Naples, Italy
| | - Sunao Nakamura
- Department of Cardiology, New Tokyo Hospital, Chiba, Japan
| | - Francesco Radico
- Institute of Cardiology "G. d'Annunzio" University Chieti-Pescara, Chieti, Italy
| | - Marta Di Nicola
- Department of Medical, Oral and Biotechnological Sciences, Laboratory of Biostatistics "G. d'Annunzio", Chieti, Italy
| | - Carlo Briguori
- Interventional Cardiology Unit, Mediterranea Cardiocentro, Naples, Italy
| | - Robert J Gil
- Department of Invasive Cardiology, Central Clinical Hospital of the Ministry of Interior, Warsaw, Poland
| | - Vojko Kanic
- Department of Cardiology and Angiology, University Medical Centre, Maribor, Slovenia
| | | | - Mariano Pellicano
- Division of Cardiology, Department of Advanced Biomedical Sciences, Federico II University of Naples, Naples, Italy.,Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium
| | - Kristina Mairic
- Department of Cardiovascular Medicine, University Hospital Centre, Zagreb, Croatia
| | - Goran Stankovic
- Department of Cardiology, Clinical Center of Serbia, University of Belgrade, Belgrade, Serbia
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20
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Ding D, Yang J, Westra J, Chen Y, Chang Y, Sejr-Hansen M, Zhang S, Christiansen EH, Holm NR, Xu B, Tu S. Accuracy of 3-dimensional and 2-dimensional quantitative coronary angiography for predicting physiological significance of coronary stenosis: a FAVOR II substudy. Cardiovasc Diagn Ther 2019; 9:481-491. [PMID: 31737519 DOI: 10.21037/cdt.2019.09.07] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Three-dimensional quantitative coronary angiography (3D-QCA) enables reconstruction of a coronary artery in 3D from two angiographic image projections. This study compared the diagnostic accuracy of 3D-QCA vs. 2-dimensional (2D) QCA in predicting physiologically significant coronary stenosis, using fractional flow reserve (FFR) as the reference standard. Methods All interrogated vessels in the FAVOR II China study and the FAVOR II Europe-Japan study were assessed by 2D-QCA and 3D-QCA according to standard operating procedures in core laboratories. QCA analysts were blinded to the corresponding FFR values. Results A total of 645 vessels from 576 patients with 3D-QCA, 2D-QCA, and FFR were analyzed. Using the conventional cut-off value of 50% for percent diameter stenosis (DS%), 3D-QCA was more accurate in predicting FFR ≤0.80 than 2D-QCA [accuracy 74.0% (95% CI: 69.9-77.7%) vs. 64.9% (95% CI: 61.3-68.7%), difference: 9.1%, P<0.001]. Sensitivity was higher by 3D-QCA compared with 2D-QCA [69.1% (95% CI: 63.0-75.1%) vs. 47.1% (95% CI: 40.5-53.6%), difference: 22.0%, P<0.001] and specificity was similar [76.5% (95% CI: 72.5-80.6%) vs. 74.4% (95% CI: 70.2-78.6%), difference: 2.1%, P=0.40]. Area under the receiver operating characteristic curve was significantly higher for 3D-QCA than for 2D-QCA [0.81 (95% CI: 0.77-0.84) vs. 0.66 (95% CI: 0.62-0.71), P<0.001]. Conclusions 3D-QCA demonstrated better diagnostic performance in predicting physiologically significant coronary stenosis compared with 2D-QCA, when FFR was used as the reference standard.
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Affiliation(s)
- Daixin Ding
- Biomedical Instrument Institute, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai 200030, China.,Shanghai Med-X Engineering Research Center, Shanghai Jiao Tong University, Shanghai 200030, China
| | - Junqing Yang
- Department of Cardiology, Guangdong Provincial People's Hospital, Guangzhou 510055, China
| | - Jelmer Westra
- Department of Cardiology, Aarhus University Hospital, Skejby, Denmark
| | - Yundai Chen
- Department of Cardiology, PLA General Hospital, Beijing 100853, China
| | - Yunxiao Chang
- Biomedical Instrument Institute, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai 200030, China.,Shanghai Med-X Engineering Research Center, Shanghai Jiao Tong University, Shanghai 200030, China
| | | | - Su Zhang
- Biomedical Instrument Institute, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai 200030, China.,Shanghai Med-X Engineering Research Center, Shanghai Jiao Tong University, Shanghai 200030, China
| | | | - Niels R Holm
- Department of Cardiology, Aarhus University Hospital, Skejby, Denmark
| | - Bo Xu
- Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Beijing 100037, China
| | - Shengxian Tu
- Biomedical Instrument Institute, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai 200030, China.,Shanghai Med-X Engineering Research Center, Shanghai Jiao Tong University, Shanghai 200030, China
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21
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Banning AP, Lassen JF, Burzotta F, Lefèvre T, Darremont O, Hildick-Smith D, Louvard Y, Stankovic G. Percutaneous coronary intervention for obstructive bifurcation lesions: the 14th consensus document from the European Bifurcation Club. EUROINTERVENTION 2019; 15:90-98. [PMID: 31105066 DOI: 10.4244/eij-d-19-00144] [Citation(s) in RCA: 82] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
The European Bifurcation Club recommends an approach to a bifurcation stenosis which involves careful assessment, planning and a sequential provisional approach. In the minority of lesions where two stents are required, careful deployment and optimal expansion are essential to achieve a long-term result.
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Affiliation(s)
- Adrian P Banning
- Department of Cardiology, Radcliffe Department of Medicine, John Radcliffe Hospital, Oxford University Hospitals, Oxford, United Kingdom
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22
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Yu W, Huang J, Jia D, Chen S, Raffel OC, Ding D, Tian F, Kan J, Zhang S, Yan F, Chen Y, Bezerra HG, Wijns W, Tu S. Diagnostic accuracy of intracoronary optical coherence tomography-derived fractional flow reserve for assessment of coronary stenosis severity. EUROINTERVENTION 2019; 15:189-197. [PMID: 31147309 DOI: 10.4244/eij-d-19-00182] [Citation(s) in RCA: 71] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
AIMS A novel method for computation of fractional flow reserve (FFR) from optical coherence tomography (OCT) was developed recently. This study aimed to evaluate the diagnostic accuracy of a new OCT-based FFR (OFR) computational approach, using wire-based FFR as the reference standard. METHODS AND RESULTS Patients who underwent both OCT and FFR prior to intervention were analysed. The lumen of the interrogated vessel and the ostia of the side branches were automatically delineated and used to compute OFR. Bifurcation fractal laws were applied to correct the change in reference lumen size due to the step-down phenomenon. OFR was compared with FFR, both using a cut-off value of 0.80 to define ischaemia. Computational analysis was performed in 125 vessels from 118 patients. Average FFR was 0.80±0.09. Accuracy, sensitivity, specificity, positive predictive value, and negative predictive value for OFR to identify FFR ≤0.80 was 90% (95% CI: 84-95), 87% (95% CI: 77-94), 92% (95% CI: 82-97), 92% (95% CI: 82-97), and 88% (95% CI: 77-95), respectively. The AUC was higher for OFR than minimal lumen area (0.93 [95% CI: 0.87-0.97] versus 0.80 [95% CI: 0.72-0.86], p=0.002). Average OFR analysis time was 55±23 seconds for each OCT pullback. Intra- and inter-observer variability in OFR analysis was 0.00±0.02 and 0.00±0.03, respectively. CONCLUSIONS OFR is a novel and fast method allowing assessment of flow-limiting coronary stenosis without pressure wire and induced hyperaemia. The good diagnostic accuracy and low observer variability bear the potential of improved integration of intracoronary imaging and physiological assessment.
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Affiliation(s)
- Wei Yu
- Med-X Research Institute, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
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23
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Kawarada O, Hozawa K, Zen K, Huang HL, Kim SH, Choi D, Park K, Kato K, Kato T, Tsubakimoto Y, Ichihashi S, Fujimura N, Higashimori A, Sato T, Yan BPY, Pang SYC, Wongwanit C, Leong YP, Chua B, George RK, Chen IC, Lee JK, Hsu CH, Pua U, Iwata Y, Miki K, Okada K, Obara H. Peak systolic velocity ratio derived from quantitative vessel analysis for restenosis after femoropopliteal intervention: a multidisciplinary review from Endovascular Asia. Cardiovasc Interv Ther 2019; 35:52-61. [PMID: 31292931 PMCID: PMC6942011 DOI: 10.1007/s12928-019-00602-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2019] [Accepted: 06/24/2019] [Indexed: 01/08/2023]
Abstract
With technological improvements in the endovascular armamentarium, there have been tremendous advances in catheter-based femoropopliteal artery intervention during the last decade. However, standardization of the methodology for assessing outcomes has been underappreciated, and unvalidated peak systolic velocity ratios (PSVRs) of 2.0, 2.4, and 2.5 on duplex ultrasonography have been arbitrarily but routinely used for assessing restenosis. Quantitative vessel analysis (QVA) is a widely accepted method to identify restenosis in a broad spectrum of cardiovascular interventions, and PSVR needs to be validated by QVA. This multidisciplinary review is intended to disseminate the importance of QVA and a validated PSVR based on QVA for binary restenosis in contemporary femoropopliteal intervention.
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Affiliation(s)
- Osami Kawarada
- Department of Cardiovascular Medicine, Ikuwakai Memorial Hospital, 3-20-29 Tatsumikita, Ikunoku, Osaka, Osaka, 544-0004, Japan.
| | - Koji Hozawa
- Department of Cardiology, New Tokyo Hospital, Matsudo, Japan
| | - Kan Zen
- Department of Cardiovascular Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Hsuan-Li Huang
- Division of Cardiology, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei, Taiwan
| | - Su Hong Kim
- Department of Cardiology, Busan Veterans Hospital, Busan, Korea
| | - Donghoon Choi
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Kihyuk Park
- Department of Vascular Surgery, Daegu Catholic University Hospital, Daegu, Korea
| | - Kenichi Kato
- Department of Vascular Laboratory, Ikuwakai Memorial Hospital, Osaka, Japan
| | - Taku Kato
- Department of Cardiology, Rakuwakai Otowa Hospital, Kyoto, Japan
| | | | - Shigeo Ichihashi
- Department of Radiology, Nara Medical University, Kashihara, Japan
| | - Naoki Fujimura
- Division of Vascular Surgery, Tokyo Saiseikai Central Hospital, Tokyo, Japan
| | | | - Tomoyasu Sato
- Department of Radiology, Tsuchiya General Hospital, Hiroshima, Japan
| | - Bryan Ping-Yen Yan
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Sha Tin, Hong Kong, China
| | - Skyi Yin-Chun Pang
- Department of Surgery, Pamela Youde Nethersole Eastern Hospital, Chai Wan, Hong Kong, China
| | - Chumpol Wongwanit
- Department of Vascular Surgery, Siriraj Hospital, Bangkok, Thailand
| | - Yew Pung Leong
- Department of Vascular Surgery, Cardiac Vascular Sentral Kuala Lumpur, Kuala Lumpur, Malaysia
| | - Benjamin Chua
- Department of Vascular Surgery, Vascular and Interventional Centre Singapore, Mount Elizabeth Novena Specialist Centre, The Farrer Park Hospital, Singapore, Singapore
| | - Robbie K George
- Department of Vascular Surgery, Narayana Hrudayalaya and Mazumdar Shaw Medical Centre, Bengaluru, India
| | - I-Chih Chen
- Division of Cardiology, Department of Internal Medicine, Tainan Municipal Hospital, Tainan, Taiwan
| | - Jen-Kuang Lee
- Department of Cardiology, National Taiwan University, Taipei, Taiwan
| | - Chung-Ho Hsu
- Department of Cardiology, China Medical University Hospital, Taichung, Taiwan
| | - Uei Pua
- Department of Radiology, Tan Tock Seng Hospital, Singapore, Singapore
| | - Yo Iwata
- Department of Cardiology, Funabashi Municipal Medical Center, Funabashi, Japan
| | - Kojiro Miki
- Department of Cardiology, Hyogo College of Medicine, Nishinomiya, Japan
| | - Kozo Okada
- Department of Cardiology, Yokohama City University Medical Center, Yokohama, Japan
| | - Hideaki Obara
- Department of Surgery, Keio University School of Medicine, Tokyo, Japan
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24
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Onuma Y, Katagiri Y, Burzotta F, Holm NR, Amabile N, Okamura T, Mintz GS, Darremont O, Lassen JF, Lefèvre T, Louvard Y, Stankovic G, Serruys PW. Joint consensus on the use of OCT in coronary bifurcation lesions by the European and Japanese bifurcation clubs. EUROINTERVENTION 2019; 14:e1568-e1577. [DOI: 10.4244/eij-d-18-00391] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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25
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Byrne RA, Capodanno D, Mylotte D, Serruys PW. State of the art: 40 years of percutaneous cardiac intervention. EUROINTERVENTION 2018; 13:621-624. [PMID: 28844023 DOI: 10.4244/eijv13i6a98] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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26
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Collet C, Mizukami T, Grundeken MJ. Contemporary techniques in percutaneous coronary intervention for bifurcation lesions. Expert Rev Cardiovasc Ther 2018; 16:725-734. [PMID: 30221565 DOI: 10.1080/14779072.2018.1523717] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
INTRODUCTION Treatment of coronary bifurcation lesions with contemporary state-of-the-art percutaneous coronary intervention (PCI) is still associated with higher rate of adverse cardiovascular events compared to non-bifurcation lesions. Bench testing and virtual computer modeling have increased our understanding of bifurcation PCI guiding refinement in bifurcation techniques. New insights on bifurcation PCI have the potential to further improve clinical outcomes in patients presenting with bifurcation lesions. Areas covered: The present manuscript aims to review the methods for bifurcation lesion assessment and treatment strategy step by step supported on bench and clinical evidence. Expert commentary: Invasive pressure-wire evaluation is essential to determine the appropriateness of bifurcation PCI, particularly in intermediate coronary stenosis. Treatment strategy relies on four parameters: diameters of the three segments of the bifurcation; lesion length and plaque distribution; and bifurcation angle. The optimal technique for bifurcation PCI is still debated, an individualized approach with an initial provisional side branch stenting strategy seems to be suitable in the 75 to 95% of patients. For more complex bifurcations, two-stent techniques may be required with increasing evidence supporting the usefulness of the double kissing balloon crush (DK-crush) technique.
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Affiliation(s)
- Carlos Collet
- a Amsterdam Heart Center, Department of Cardiology , Academic Medical Center, University of Amsterdam , Amsterdam , The Netherlands.,b Universitair Ziekenhuis Brussels , University of Brussels , Brussel , Belgium
| | - Takuya Mizukami
- b Universitair Ziekenhuis Brussels , University of Brussels , Brussel , Belgium
| | - Maik J Grundeken
- a Amsterdam Heart Center, Department of Cardiology , Academic Medical Center, University of Amsterdam , Amsterdam , The Netherlands.,c Department of Cardiology , Academic Medical Center , Amsterdam , The Netherlands
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27
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Collet C, Onuma Y, Sonck J, Asano T, Vandeloo B, Kornowski R, Tu S, Westra J, Holm NR, Xu B, de Winter RJ, Tijssen JG, Miyazaki Y, Katagiri Y, Tenekecioglu E, Modolo R, Chichareon P, Cosyns B, Schoors D, Roosens B, Lochy S, Argacha JF, van Rosendael A, Bax J, Reiber JHC, Escaned J, De Bruyne B, Wijns W, Serruys PW. Diagnostic performance of angiography-derived fractional flow reserve: a systematic review and Bayesian meta-analysis. Eur Heart J 2018; 39:3314-3321. [DOI: 10.1093/eurheartj/ehy445] [Citation(s) in RCA: 90] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Accepted: 07/31/2018] [Indexed: 01/09/2023] Open
Affiliation(s)
- Carlos Collet
- Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
- Department of Cardiology, Universitair Ziekenhuis Brussel, Brussel, Belgium
| | - Yoshinobu Onuma
- Cardialysis BV, Rotterdam, The Netherlands
- Thoraxcenter, Erasmus MC, Rotterdam, The Netherlands
| | - Jeroen Sonck
- Department of Cardiology, Universitair Ziekenhuis Brussel, Brussel, Belgium
| | - Taku Asano
- Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - Bert Vandeloo
- Department of Cardiology, Universitair Ziekenhuis Brussel, Brussel, Belgium
| | - Ran Kornowski
- Cardiology Department, Rabin Medical Center, Belinson Hospital Affiliated to the “Sackler” Faculty of Medicine, Tel Aviv University, Petah Tikva, Israel
| | - Shengxian Tu
- Biomedical Instrument Institute, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Jelmer Westra
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Niels R Holm
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Bo Xu
- Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Beijing, China
| | - Robbert J de Winter
- Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - Jan G Tijssen
- Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | | | - Yuki Katagiri
- Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | | | - Rodrigo Modolo
- Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - Ply Chichareon
- Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - Bernard Cosyns
- Department of Cardiology, Universitair Ziekenhuis Brussel, Brussel, Belgium
| | - Daniel Schoors
- Department of Cardiology, Universitair Ziekenhuis Brussel, Brussel, Belgium
| | - Bram Roosens
- Department of Cardiology, Universitair Ziekenhuis Brussel, Brussel, Belgium
| | - Stijn Lochy
- Department of Cardiology, Universitair Ziekenhuis Brussel, Brussel, Belgium
| | | | | | - Jeroen Bax
- Department of Cardiology, Leiden University Medical Center, The Netherlands
| | - Johan H C Reiber
- Division of Image Processing (LKEB), Department of Radiology, Leiden University Medical Center (LUMC), Leiden, The Netherlands
- Medis Medical Imaging Systems, Leiden, The Netherlands
| | - Javier Escaned
- Hospital Clinico San Carlos IDISSC and Universidad Complutense de Madrid, Madrid, Spain
| | | | - William Wijns
- The Lambe Institute for Translational Medicine and Curam, National University of Ireland, Galway, Saolta University Healthcare Group, Galway, Ireland
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28
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Vassilev D, Dosev L, Collet C, Karamfiloff K, Stoikova J, Pancheva R, Shumkova M, Zlatancheva G, Naunov V, Rigatelli G, Kassab GS, Gil RJ, Serruys PW. Intracoronary electrocardiogram to guide percutaneous interventions in coronary bifurcations - a proof of concept: the FIESTA (Ffr vs. IcEcgSTA) study. EUROINTERVENTION 2018; 14:e530-e537. [PMID: 28829743 DOI: 10.4244/eij-d-17-00189] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS The aim of this study was to determine the accuracy of the intracoronary electrocardiogram (icECG) to detect ischaemia during bifurcation lesion percutaneous coronary intervention (PCI) with fractional flow reserve (FFR) as a reference. METHODS AND RESULTS Patients with significant bifurcation lesions defined as FFR ≤0.80 were included. FFR and icECG were performed in the main vessel (MV) and side branch (SB) before and after provisional stenting. icECG was recorded with an uninsulated proximal wire end connected to a unipolar lead. The diagnostic accuracy of the icECG for the detection of ischaemia in the SB after MV stenting was determined with FFR as a reference. Overall, 37 patients were included. Seventeen bifurcations had an SB FFR ≤0.80 after MV stenting and 20 patients had an ST-segment elevation on the icECG. There was significant correlation between SB FFR and ST-segment elevation on the icECG (r=-0.533, p<0.001). The diagnostic accuracy of icECG ST-elevation to detect functionally significant SB stenosis revealed an AUC of 0.71 (95% CI: 0.64-0.80) with a sensitivity of 88% and specificity of 75% with a positive predictive value of 75% and negative predictive value of 88%. Neither SB FFR nor icECG correlated with SB percent diameter stenosis after MV stenting. CONCLUSIONS Intracoronary ECG has a good ability to predict functionally significant stenosis at the SB after MV stenting during bifurcation PCI. This method provides a novel strategy to assess the significance of an SB lesion without the need of a pressure wire.
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Affiliation(s)
- Dobrin Vassilev
- "Alexandrovska" University Hospital, Cardiology Department, Medical University, Sofia, Bulgaria
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29
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Collet C, Grundeken MJ, Asano T, Onuma Y, Wijns W, Serruys PW. State of the art: coronary angiography. EUROINTERVENTION 2018; 13:634-643. [PMID: 28844026 DOI: 10.4244/eij-d-17-00465] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
In the early days of coronary angiography, the precise quantification of luminal narrowing was challenging. The introduction of balloon angioplasty (percutaneous transluminal coronary angioplasty [PTCA]) by Andreas Grüntzig in 1977 was perhaps the greatest incentive to the development of quantitative coronary angiography (QCA). QCA has played a crucial role in evaluating interventional techniques and assessing the results of new technologies. With the advent of drug-eluting stents (DES), QCA metrics such as late lumen loss and diameter stenosis (restenosis) proved to be instrumental in assessing new technologies. Refinements in QCA with the advent of dedicated bifurcation analysis and three-dimensional (3D) QCA have broadened the application of QCA. Beyond angiographic metrics, new developments in the field of QCA have introduced the functional component in the assessment of coronary lesions. Angiography-derived fractional flow reserve (FFR) may be a good tool for diagnosing ischaemia-producing lesions in patients with non-complex coronary artery disease. Furthermore, the incremental functional information can be used to expand the traditional late lumen loss (LLL) and restenosis concepts.
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Affiliation(s)
- Carlos Collet
- Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
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30
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Biomechanical Impact of Wrong Positioning of a Dedicated Stent for Coronary Bifurcations: A Virtual Bench Testing Study. Cardiovasc Eng Technol 2018; 9:415-426. [DOI: 10.1007/s13239-018-0359-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Accepted: 05/01/2018] [Indexed: 10/16/2022]
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31
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Collet C, Onuma Y, Grundeken MJ, Miyazaki Y, Bittercourt M, Kitslaar P, Motoyama S, Ozaki Y, Asano T, Wentzel JJ, Streekstra GJ, Serruys PW, de Winter RJ, Planken RN. In vitro validation of coronary CT angiography for the evaluation of complex lesions. EUROINTERVENTION 2018. [PMID: 28649954 DOI: 10.4244/eij-d-17-00326] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS The aim of this study was to assess in vitro the diagnostic accuracy of computed tomography angiography (CTA) for the evaluation of complex coronary lesions. METHODS AND RESULTS Five Plexiglas phantoms with three bifurcation lesions each were designed to mimic the anatomic variations and fractal phenomena of the coronary tree. In addition, luminal stenoses were scaled up with increases of 10% from 40% to 80%, corresponding to luminal areas ranging from 3.0 mm2 to 0.22 mm2. Third-generation dual-source computed tomography was used. Automated quantitative CTA analysis was performed according to the bifurcation segment model. The primary objective was to determine the diagnostic accuracy of quantitative CTA in assessing bifurcation lesions with the phantoms as a reference. The accuracy of CTA for the assessment of minimal luminal diameter was -0.07 mm (limits of agreement -0.75 to 0.61), for reference vessel diameter 0.19 mm (limits of agreement -0.25 to 0.63) and diameter stenosis 8.2% (limits of agreement -13.2 to 29.5) with no difference regarding the location within the bifurcation (i.e., proximal and distal main vessel and side branch). In stenosis with minimal luminal diameter ≥1 mm, CTA overestimated the lesion severity (bias 0.19 mm, limits of agreement -0.09 to 0.47), whereas in lesions with severe stenosis and minimal luminal diameter ≤1 mm, CTA underestimated the lesion severity (bias -0.48 mm, limits of agreement -0.55 to -0.41). CTA was able to identify the contrast-filled lumen in all degrees of lesion severity. CONCLUSIONS In vitro, CTA is accurate for the evaluation of bifurcation lesions. CTA was able to distinguish contrast-filled lumen even in severe obstructive lesions. These findings require further validation in the clinical setting.
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Affiliation(s)
- Carlos Collet
- Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
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32
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Lassen J, Burzotta F, Banning A, Lefèvre T, Darremont O, Hildick-Smith D, Chieffo A, Pan M, Holm N, Louvard Y, Stankovic G. Percutaneous coronary intervention for the left main stem and other bifurcation lesions: 12th consensus document from the European Bifurcation Club. EUROINTERVENTION 2018; 13:1540-1553. [DOI: 10.4244/eij-d-17-00622] [Citation(s) in RCA: 152] [Impact Index Per Article: 25.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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33
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Grundeken MJ, de Winter RJ, Wykrzykowska JJ. Safety and efficacy of the Tryton Side Branch Stent™ for the treatment of coronary bifurcation lesions: an update. Expert Rev Med Devices 2017; 14:545-555. [DOI: 10.1080/17434440.2017.1338135] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Maik J. Grundeken
- Department of Cardiology, Academic Medical Center – University of Amsterdam, Amsterdam, The Netherlands
| | - Robbert J. de Winter
- Department of Cardiology, Academic Medical Center – University of Amsterdam, Amsterdam, The Netherlands
| | - Joanna J. Wykrzykowska
- Department of Cardiology, Academic Medical Center – University of Amsterdam, Amsterdam, The Netherlands
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