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Chandra P, Sethuraman S, Roy S, Mohanty A, Parikh K, Charantharalyil Gopalan B, Sahoo PK, Kasturi S, Shah VT, Kumar V, Pinto B, Rath PC, Yerramareddy VR, Davidson D, Navasundi GB, Subban V, Livingston N, Rajaraman DP, Narang M, West NEJ, Mullasari A. Effectiveness and safety of optical coherence tomography-guided PCI in Indian patients with complex lesions: A multicenter, prospective registry. Indian Heart J 2023; 75:236-242. [PMID: 37244397 PMCID: PMC10421993 DOI: 10.1016/j.ihj.2023.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 04/30/2023] [Accepted: 05/21/2023] [Indexed: 05/29/2023] Open
Abstract
BACKGROUND Optical coherence tomography (OCT) is reported to be a feasible and safe imaging modality for the guidance of percutaneous coronary intervention (PCI) of complex lesions. METHODS This multicenter, prospective registry assessed the minimum stent area (MSA) achieved under OCT guidance. A performance goal of 24% improvement in MSA over and above the recommendation set by the European Association of Percutaneous Cardiovascular Interventions Consensus 2018 (4.5 mm2 MSA for non-left main and 3.5 mm2 for small vessels). The incidence of contrast-induced nephropathy was also assessed. Core lab analysis was conducted. RESULTS Five hundred patients (average age: 59.4 ± 10.1 years; 83% males) with unstable angina (36.8%), NSTEMI (26.4%), and STEMI (22%) were enrolled. The primary endpoint was achieved in 93% of lesions with stent diameter ≥2.75 mm (average MSA: 6.44 mm2) and 87% of lesions with stent diameter ≤2.5 mm (average MSA: 4.56 mm2). The average MSA (with expansion ≥80% cutoff) was 6.63 mm2 and 4.74 mm2 with a stent diameter ≥2.75 mm and ≤2.5 mm, respectively. According to the core lab analysis, the average MSA achieved with a stent diameter ≥2.75 mm and ≤2.5 mm was 6.23 mm2 and 3.95 mm2, respectively (with expansion ≥80% cutoff). Clinically significant serum creatinine was noted in two patients (0.45%). Major adverse cardiac events at 1 year were noted in 1.2% (n = 6) of the patients; all were cardiac deaths. CONCLUSION PCI under OCT guidance improves procedural and long-term clinical outcomes in patients with complex lesions not just in a controlled trial environment but also in routine clinical practice.
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Affiliation(s)
- Praveen Chandra
- Interventional and Structural Heart Cardiology, Interventional Cardiology Heart Institute, Medanta-The Medicity, Gurgaon, Haryana, India.
| | - Selvamani Sethuraman
- Department of Cardiology, Meenakshi Mission Hospital and Research Centre, Madurai, Tamil Nadu, India
| | - Sanjeeb Roy
- Interventional Cardiology, Intervention Cardiology, Fortis Escorts Hospital, Jaipur, Rajasthan, India
| | - Arun Mohanty
- Department of Cardiology, Sir Ganga Ram Hospital, New Delhi, Delhi, India
| | - Keyur Parikh
- Intervention Cardiology, Marengo CIMS Hospital, Ahmedabad, Gujarat, India
| | | | - Prasant Kumar Sahoo
- Interventional Cardiology, Department of Cardiology, Apollo Hospital, Bhubaneshwar, Odisha, India
| | - Sridhar Kasturi
- Department of Cardiology, Sunshine Hospital, Hyderabad, Telangana, India
| | | | - Viveka Kumar
- Cardiac Sciences, Department of Cardiology, Max Super Specialty Hospital, Saket, New Delhi, Delhi, India
| | - Brian Pinto
- Department of Cardiology, Holy Family Hospital, Mumbai, Maharashtra, India
| | | | | | - Deepak Davidson
- Intervention Cardiology, Caritas Hospital, Kottayam, Kerala, India
| | - Girish B Navasundi
- Interventional Cardiology, Department of Cardiology, Apollo Hospital, Bangalore, Karnataka, India
| | - Vijayakumar Subban
- Indian Cardiology Research Foundation, Core Lab, Chennai, Tamil Nadu, India
| | | | | | | | | | - Ajit Mullasari
- Institute of Cardiovascular Diseases, Madras Medical Mission, Chennai, Tamil Nadu, India
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Refaat H, Tantawy A. Low Plasma Adiponectin Levels Are Associated With Vulnerable Plaque Features in Patients With Acute Coronary Syndrome: An Optical Coherence Tomography Study. Cardiovasc Revasc Med 2020; 25:63-71. [PMID: 33097459 DOI: 10.1016/j.carrev.2020.10.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 10/03/2020] [Accepted: 10/12/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Vulnerable plaques are the primary cause of acute coronary syndrome (ACS). The association between in-vivo plaque vulnerability and adiponectin levels in ACS still remains to be determined. OBJECTIVE The purpose of this study was to investigate the correlation between adiponectin levels and vulnerable plaque features in ACS patients. METHODS We enrolled 107 ACS patients admitted to our institution; 83 with Non-ST elevation ACS (NSTE-ACS) and 24 with ST-elevation myocardial infarction (STEMI). Adiponectin levels were measured in these patients. Coronary angiography and subsequent optical coherence tomography (OCT) analysis of culprit lesions were performed. RESULTS Adiponectin level was lower in patients with complex angiographic lesions, compared to those with non-complex lesions (7.13 ± 3.04 vs. 8.94 ± 2.84 μg/ml, P = 0.002). Adiponectin level was lower in patients with plaque rupture (PR), micro-thrombi, and thin cap fibroatheroma (TCFA), compared to those with non-vulnerable features (7.19 ± 2.95 vs 8.79 ± 3.02 μg/ml, P = 0.007 & 7.29 ± 2.97 vs 8.44 ± 3.09 μg/ml, P = 0.04 and 4.76 ± 0.65 vs 9.74 ± 2.35 μg/ml, P < 0.001 μg/ml respectively). There was a significant negative correlation between adiponectin levels and lipid rich plaque extent and maximum lipid arc (r = -0.05, P < 0.001 & r = -0.03, P = 0.03, respectively). However, a significant positive correlation was observed between adiponectin levels and fibrous cap thickness (r = 0.95, P < 0.001). CONCLUSION Low adiponectin levels were associated with complex angiographic lesions and vulnerable plaque features in ACS patients, where there was a significant correlation between it and PR, TCFA, and lipid rich plaque.
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Affiliation(s)
- Hesham Refaat
- Cardiology Department, Zagazig University, Zagazig, Egypt; Institute of Cardiology, Catholic University of the Sacred Heart, Rome, Italy.
| | - Ayman Tantawy
- Cardiology Department, Zagazig University, Zagazig, Egypt
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Priola SM, Ku JC, Pasarikovski CR, Yang VXD, da Costa L. Angio-architecture of complex cranial dural arteriovenous fistulas: A single centre retrospective review of treatment modalities and outcomes. J Clin Neurosci 2020; 76:87-99. [PMID: 32284290 DOI: 10.1016/j.jocn.2020.04.037] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Accepted: 04/04/2020] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Cranial dural arteriovenous fistulas (DAVFs) are rare vascular lesions that often harbour complex angio-architectural features. This subtype of DAVF may require multiple, multimodality, or hybrid treatments. In this paper we aim to identify specific angio-architectural features that are present in complex cranial DAVFs and we report our series with respect to treatment modalities and outcomes. METHODS Twenty-five cranial Borden type II and III cranial DAVFs were treated at our Institution from 2013 to 2017. We classified nine (36%) as complex based on specific angio-architectural features. Treatment strategies were based on fistula location, angiographic features and patient's presenting condition. Phone interviews were used to confirm outcome at 6 and 12 months. RESULTS Four patients (45%) presented with acute hydrocephalus, and 3 (33%) with intracranial hemorrhage. Multiple and combined treatment sessions were needed for all complex DAVFs. Five patients required 2 endovascular procedures each. One patient had 2 surgeries. The first line of treatment was endovascular in 6 cases (67%) and surgery in 3 (33%). Two treatment-related (22%) complications occurred. Complete disconnection was achieved in 5 out of 9 patients (55%). Two patients with an incomplete disconnection refused further treatment and were well at last follow up, with a partially treated fistula and persistent CVR. The other 3 patients concluded treatment after the end of our data collection period. At 1 year, 7/9 patients had stable or improved clinical symptoms, and 8/9 patients had GOS of 4 or 5. CONCLUSIONS Complex cranial DAVF often require a multidisciplinary approach and multiple treatment sessions should be expected. Specific angio-architectural features that increase DAVF complexity include multiple arterial feeders, especially transosseous or pial, reflux into multiple cortical veins, sinus occlusion/entrapment, venous aneurysms, segmental stenosis, medial or deep location, and association with the deep venous system.
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Affiliation(s)
- Stefano M Priola
- Health Sciences North, Department of Surgery, Division of Neurosurgery, Northern Ontario School of Medicine, Sudbury (ON), Canada; Sunnybrook Health Sciences Centre, Division of Neurosurgery, University of Toronto, Toronto (ON), Canada.
| | - Jerry C Ku
- Sunnybrook Health Sciences Centre, Division of Neurosurgery, University of Toronto, Toronto (ON), Canada.
| | - Christopher R Pasarikovski
- Sunnybrook Health Sciences Centre, Division of Neurosurgery, University of Toronto, Toronto (ON), Canada.
| | - Victor X D Yang
- Sunnybrook Health Sciences Centre, Division of Neurosurgery, University of Toronto, Toronto (ON), Canada.
| | - Leodante da Costa
- Sunnybrook Health Sciences Centre, Division of Neurosurgery, University of Toronto, Toronto (ON), Canada; Department of Medical Imaging, Sunnybrook Health Sciences Centre, University of Toronto, Toronto (ON), Canada.
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Zhang YQ, Qiu HC, Tao YF, Liu ML, Ye X, Chen XL, Jiang WJ. [Hybrid surgery for complex symptomatic intracranial fistulas: a technical note]. Zhonghua Yi Xue Za Zhi 2017; 97:822-826. [PMID: 28355736 DOI: 10.3760/cma.j.issn.0376-2491.2017.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective: To explore the efficacy of hybrid management of complex symptomatic intracranial fistulas in neurovascular hybrid operating room. Methods: From March 2014 to January 2015, 2 complex dural arteriovenous fistulas and 1 carotid cavernous fistulas were managed by hybrid surgeries in the PLA Rocket Force General Hospital.With first attempts with endovascular treatment failed, all cases were finally managed by hybrid surgery.Dural arteriovenous fistulas were approached via meningeal artery followed craniotomy.The carotid cavernous fistulas were treated by direct puncture into the left cavernous sinus after craniotomy. Results: Post-operative angiography demonstrated complete occlusion for 2 cases and nearly complete occlusion for 1 case.All 3 cases had no complications.On discharge 2 patients presented no symptoms and 1 greatly improved.Within the follow-up (1-33 months), 1 patient had recurrence after 21 months and received re-embolization with complete occlusion. Conclusion: Hybrid surgery is a promising method to manage complex intracranial fistulas.
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Affiliation(s)
- Y Q Zhang
- Department of Neurovascular Surgery, New Era Stroke Care & Research Center, PLA Rocket Force General Hospital, Beijing 100088, China
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Roth C, Berger R, Scherzer S, Krenn L, Gangl C, Dalos D, Delle-Karth G, Neunteufl T. Comparison of magnetic wire navigation with the conventional wire technique for percutaneous coronary intervention of chronic total occlusions: a randomised, controlled study. Heart Vessels 2015; 31:1266-76. [PMID: 26369660 DOI: 10.1007/s00380-015-0739-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2015] [Accepted: 08/28/2015] [Indexed: 12/21/2022]
Abstract
Wire crossing of a chronic total coronary occlusion (CTO) is time consuming and limited by the amount of contrast agent and time of radiation exposure. Magnetic wire navigation (MWN) might accelerate wire crossing by maintaining a coaxial vessel orientation. This study compares MWN with the conventional approach for recanalization of CTOs. Forty symptomatic patients with CTO were randomised to MWN (n = 20) or conventional approach (n = 20) for antegrade crossing of the occlusion. In the intention-to-treat analysis, MWN showed a shorter crossing time (412 versus 1131 s; p = 0.001), and, consequently, lower usage of contrast agent (primary endpoint 42 versus 116 ml; p = 0.01), and lower radiation exposure (dose-area product: 29 versus 80 Gy*cm(2); p = 0.002) during wire crossing compared to the conventional approach. Accordingly, in the per-protocol analysis, the wire-crossing rate was, in trend, higher using the conventional approach (17 of 31) compared to MWN (9 of 28; p = 0.08). The use of MWN for revascularisation of CTOs is feasible and reduces crossing time, use of contrast agent, and radiation exposure. However, due to a broader selection of wires, the conventional approach enables wire crossing in cases failed by MWN and seems to be the more successful choice.
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Affiliation(s)
- Christian Roth
- Department of Internal Medicine II, Cardiology, Medical University of Vienna, Vienna, Austria
| | - Rudolf Berger
- Department of Internal Medicine II, Cardiology, Medical University of Vienna, Vienna, Austria.
- Department of Internal Medicine I, Cardiology and Nephrology, Hospital of St. John of God, Eisenstadt, Austria.
| | - Sabine Scherzer
- Department of Internal Medicine II, Cardiology, Medical University of Vienna, Vienna, Austria
| | - Lisa Krenn
- Department of Internal Medicine II, Cardiology, Medical University of Vienna, Vienna, Austria
| | - Clemens Gangl
- Department of Internal Medicine II, Cardiology, Medical University of Vienna, Vienna, Austria
| | - Daniel Dalos
- Department of Internal Medicine II, Cardiology, Medical University of Vienna, Vienna, Austria
| | - Georg Delle-Karth
- Department of Internal Medicine II, Cardiology, Medical University of Vienna, Vienna, Austria
- Department of Internal Medicine IV, Cardiology, Hospital of Hietzing, Vienna, Austria
| | - Thomas Neunteufl
- Department of Internal Medicine II, Cardiology, Medical University of Vienna, Vienna, Austria
- Department of Internal Medicine I, Cardiology, University Hospital of Krems, Krems an der Donau, Austria
- Karl Landsteiner Private University for Health Sciences, Krems an der Donau, Austria
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Fujihara M, Utsunomiya M, Higashimori A, Yokoi Y, Nakamura M. Outcomes of Zilver PTX stent implantation for the treatment of complex femoropopliteal artery disease. Heart Vessels 2016; 31:152-7. [PMID: 25351136 DOI: 10.1007/s00380-014-0596-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2014] [Accepted: 10/17/2014] [Indexed: 10/24/2022]
Abstract
The purpose of this study was to evaluate the efficacy of Zilver PTX, the first drug-eluting stent, in patients with complex femoropopliteal (FP) artery disease. Between July 2012 and March 2013, 60 consecutive patients (39 males; mean age: 72.5 ± 8.6 years) with complex risk factors including TASC II C/D lesions, in-stent restenosis (ISR) and/or on haemodialysis underwent successful Zilver PTX implantation for symptomatic FP artery disease. The primary outcome was primary patency, which was defined as freedom from restenosis at 12 months, as verified by duplex ultrasound. Secondary outcomes included the technical success rate, the freedom from target lesion revascularisation (TLR) rate and the amputation-free survival (AFS) rate. The average follow-up period was 13.2 ± 5.3 months. 62 % of the patients had TASC II C/D lesions, 35.0 % experienced ISR, and 41.6 % were on haemodialysis. The mean lesion length was 188 ± 96 mm. The technical success rate was 98.3 %. The primary patency rate was 50.2 %, the freedom from clinically driven TLR rate was 68.6 %, and the AFS rate was 83.2 % at 12 months. In conclusion, Zilver PTX stent implantation for complex FP artery disease did not affect long-term durability.
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