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Yonetsu T, Jang IK. Cardiac Optical Coherence Tomography: History, Current Status, and Perspective. JACC. ASIA 2024; 4:89-107. [PMID: 38371282 PMCID: PMC10866736 DOI: 10.1016/j.jacasi.2023.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 09/05/2023] [Accepted: 10/02/2023] [Indexed: 02/20/2024]
Abstract
For more than 2 decades since the first imaging procedure was performed in a living patient, intravascular optical coherence tomography (OCT), with its unprecedented image resolution, has made significant contributions to cardiovascular medicine in the realms of vascular biology research and percutaneous coronary intervention. OCT has contributed to a better understanding of vascular biology by providing insights into the pathobiology of atherosclerosis, including plaque phenotypes and the underlying mechanisms of acute coronary syndromes such as plaque erosion, neoatherosclerosis, stent thrombosis, and myocardial infarction with nonobstructive coronary arteries. Moreover, OCT has been used as an adjunctive imaging tool to angiography for the guidance of percutaneous coronary intervention procedures to optimize outcomes. However, broader application of OCT has faced challenges, including subjective interpretation of the images and insufficient clinical outcome data. Future developments including artificial intelligence-assisted interpretation, multimodality catheters, and micro-OCT, as well as large prospective outcome studies could broaden the impact of OCT on cardiovascular medicine.
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Affiliation(s)
- Taishi Yonetsu
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Ik-Kyung Jang
- Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, USA
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2
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Hu T, Qiu Q, Xie N, Sun M, Jia Q, Huang M. Prognostic value of optical flow ratio for cardiovascular outcomes in patients after percutaneous coronary stent implantation. Front Cardiovasc Med 2023; 10:1247053. [PMID: 38155983 PMCID: PMC10753062 DOI: 10.3389/fcvm.2023.1247053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Accepted: 11/20/2023] [Indexed: 12/30/2023] Open
Abstract
Background The relationship between the optical flow ratio (OFR) and clinical outcomes in patients with coronary artery disease (CAD) after percutaneous coronary stent implantation (PCI) remains unknown. Objective To examine the correlation between post-PCI OFR and clinical outcomes in patients with CAD following PCI. Methods Patients who underwent optical coherence tomography (OCT) guided PCI at Guangdong Provincial People's Hospital were retrospectively and continuously enrolled. Clinical data, post-PCI OCT characteristics, and OFR measurements were collected and analyzed to identify predictors of target vessel failure (TVF) after PCI. Results Among 354 enrolled patients, 26 suffered TVF during a median follow-up of 484 (IQR: 400-774) days. Post-PCI OFR was significantly lower in the TVF group than in the non-TVF group (0.89 vs. 0.93; P = 0.001). In multivariable Cox regression analysis, post-PCI OFR (HR per 0.1 increase: 0.60; 95% CI: 0.41-0.89; P = 0.011), large stent edge dissection (HR: 3.85; 95% CI: 1.51-9.84; P = 0.005) and thin-cap fibroatheroma (TCFA) (HR: 2.95; 95% CI: 1.19-7.35; P = 0.020) in the non-stented segment were independently associated with TVF. In addition, the inclusion of post-PCI OFR to baseline characteristics and post-PCI OCT findings improved the predictive power of the model to distinguish subsequent TVF after PCI (0.838 vs. 0.796; P = 0.028). Conclusion The post-PCI OFR serves as an independent determinant of risk for TVF in individuals with CAD after PCI. The inclusion of post-PCI OFR assessments, alongside baseline characteristics and post-PCI OCT findings, substantially enhances the capacity to differentiate the subsequent manifestation of TVF in CAD patients following PCI.
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Affiliation(s)
- Tianyu Hu
- Department of Catheterization Lab, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
| | - Qinghua Qiu
- Department of Catheterization Lab, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
| | - Nianjin Xie
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
| | - Mingming Sun
- Department of Catheterization Lab, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
| | - Qianjun Jia
- Department of Catheterization Lab, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
| | - Meiping Huang
- Department of Catheterization Lab, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
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Delia VI, Emmanouil D, Theodora KA, Dimitra K, Athanasios K. Missed Coronary Artery Dissection Post-Blunt Chest Trauma. Cureus 2023; 15:e47630. [PMID: 38022221 PMCID: PMC10680047 DOI: 10.7759/cureus.47630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/25/2023] [Indexed: 12/01/2023] Open
Abstract
Cardiac contusion is rarely diagnosed in patients with blunt chest trauma in the emergency department, especially if patients are asymptomatic. We present a case of a 43-year-old man whose diagnosis of left anterior descending artery (LAD) dissection after blunt chest trauma was delayed. The patient presented to the emergency department of a remote district hospital after a motorcycle accident, asymptomatic with a mildly reduced level of consciousness due to a very small subdural hemorrhage. Ten days later, when he developed a syncopal attack due to a massive pulmonary embolism (PE), his first performed electrocardiogram (ECG) showed sinus rhythm with QS waves and slight ST elevation in leads V2-V6. The subsequent coronary angiography showed left anterior descending artery dissection, and the diagnosis was nicely depicted with optical coherence tomography (OCT). A drug-eluting stent was implanted with a good angiographic result. This case highlights the significance of early recognition of traumatic coronary dissection, which should be excluded even in asymptomatic patients with a plain ECG acquisition, for the appropriate management and prevention of unfavorable outcomes.
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Affiliation(s)
- Vlad I Delia
- 2nd Department of Cardiology, General Hospital of Nikea, Piraeus, GRC
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Yonetsu T, Wakabayashi K, Mizukami T, Yamamoto MH, Yasuhara S, Kondo S, Oishi Y, Okabe T, Sugiyama T, Araki M, Takano M, Kobayashi N, Kimura S, Yamakami Y, Suwa S, Nakamura S, Mitomo S, Kakuta T, Usui E, Higuma T, Ako J, Minami Y, Iwasaki M, Shite J, Kozuki A, Saito S, Shishido K, Okura H, Naruse G, Uemura S, Kume T, Nanasato M, Dohi T, Ashikaga T, Otake H, Mori H, Sekimoto T, Sugizaki Y, Shinke T. Optical Coherence Tomography-Guided Percutaneous Coronary Intervention for ST-Segment Elevation Myocardial Infarction: Rationale and Design of the ATLAS-OCT Study. Am J Cardiol 2023; 203:466-472. [PMID: 37562073 DOI: 10.1016/j.amjcard.2023.07.077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 07/13/2023] [Indexed: 08/12/2023]
Abstract
Even after successful revascularization with primary percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI), subsequent adverse events still occur. Previous studies have suggested potential benefits of intravascular imaging, including optical coherence tomography (OCT). However, the feasibility of OCT-guided primary PCI has not been systematically examined in these patients. The ATLAS-OCT (ST-elevation Acute myocardial infarcTion and cLinicAl outcomeS treated by Optical Coherence Tomography-guided percutaneous coronary intervention) trial was designed to investigate the feasibility of OCT guidance during primary PCI for STEMI in experienced centers with expertise on OCT-guided PCI as a prospective, multicenter registry of consecutive patients with STEMI who underwent a primary PCI. The sites' inclusion criteria are as follows: (1) acute care hospitals providing 24/7 emergency care for STEMI, and (2) institutions where OCT-guided PCI is the first choice for primary PCI in STEMI. All patients with STEMI who underwent primary PCI at participating sites will be consecutively enrolled, irrespective of OCT use during PCI. The primary end point will be the rate of successful OCT imaging during the primary PCI. As an ancillary imaging modality to angiography, OCT provides morphologic information during PCI for the assessment of plaque phenotypes, vessel sizing, and PCI optimization. Major adverse cardiac events, defined as a composite of all-cause death, myocardial infarction, and target vessel revascularization at 1 year, will also be recorded. The ATLAS-OCT study will clarify the feasibility of OCT-guided primary PCI for patients with STEMI and further identify a suitable patient group for OCT-guided primary PCI.
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Affiliation(s)
- Taishi Yonetsu
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | | | - Takuya Mizukami
- Division of Clinical Pharmacology, Department of Pharmacology, Showa University School of Medicine, Tokyo, Japan
| | - Myong Hwa Yamamoto
- Clinical Research Institute for Clinical Pharmacology & Therapeutics, Showa University, Tokyo, Japan
| | - Sakiko Yasuhara
- Division of Clinical Pharmacology, Department of Pharmacology, Showa University School of Medicine, Tokyo, Japan
| | - Seita Kondo
- Division of Cardiology, Department of Medicine, Showa University School of Medicine, Tokyo, Japan
| | - Yosuke Oishi
- Division of Cardiology, Department of Medicine, Showa University School of Medicine, Tokyo, Japan
| | - Toshitaka Okabe
- Division of Cardiology, Showa University Northern Yokohama Hospital, Kanagawa, Japan
| | - Tomoyo Sugiyama
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Makoto Araki
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Masamichi Takano
- Department of Cardiology, Nippon Medical School Chiba Hokusoh Hospital, Chiba, Japan
| | - Nobuaki Kobayashi
- Department of Cardiology, Nippon Medical School Chiba Hokusoh Hospital, Chiba, Japan
| | - Shigeki Kimura
- Department of Cardiology, Yokohama Minami Kyosai Hospital, Kanagawa, Japan
| | - Yosuke Yamakami
- Department of Cardiology, Yokohama Minami Kyosai Hospital, Kanagawa, Japan
| | - Satoru Suwa
- Department of Cardiology, Juntendo University Shizuoka Hospital, Izunokuni, Shizuoka, Japan
| | - Sunao Nakamura
- Department of Cardiovascular Medicine, New Tokyo Hospital, Chiba, Japan
| | - Satoru Mitomo
- Department of Cardiovascular Medicine, New Tokyo Hospital, Chiba, Japan
| | - Tsunekazu Kakuta
- Division of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Ibaraki, Japan
| | - Eisuke Usui
- Division of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Ibaraki, Japan
| | - Takumi Higuma
- Division of Cardiology, Department of Internal Medicine, Kawasaki Municipal Tama Hospital, Kanagawa, Japan
| | - Junya Ako
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, Kanagawa, Japan
| | - Yoshiyasu Minami
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, Kanagawa, Japan
| | - Masamichi Iwasaki
- Department of Cardiology, Hyogo Prefectural Awaji Medical Center, Hyogo, Japan
| | - Junya Shite
- Division of Cardiology, Osaka Saiseikai Nakatsu Hospital, Osaka, Japan
| | - Amane Kozuki
- Division of Cardiology, Osaka Saiseikai Nakatsu Hospital, Osaka, Japan
| | - Shigeru Saito
- Department of Cardiology, Shonan Kamakura General Hospital, Kanagawa, Japan
| | - Koki Shishido
- Department of Cardiology, Shonan Kamakura General Hospital, Kanagawa, Japan
| | - Hiroyuki Okura
- Department of Cardiology, Graduate School of Medicine, Gifu University, Gifu, Japan
| | - Genki Naruse
- Department of Cardiology, Graduate School of Medicine, Gifu University, Gifu, Japan
| | - Shiro Uemura
- Department of Cardiology, Kawasaki Medical School, Okayama, Japan
| | - Teruyoshi Kume
- Department of Cardiology, Kawasaki Medical School, Okayama, Japan
| | - Mamoru Nanasato
- Department of Cardiology, Sakakibara Heart Institute, Tokyo, Japan
| | - Tomotaka Dohi
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Takashi Ashikaga
- Department of Cardiology, Japanese Red Cross Musashino Hospital, Tokyo, Japan
| | - Hiromasa Otake
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Hiroyoshi Mori
- Division of Cardiology, Department of Internal Medicine, Showa University Fujigaoka Hospital, Kanagawa, Japan
| | - Teruo Sekimoto
- Division of Cardiology, Department of Internal Medicine, Showa University Fujigaoka Hospital, Kanagawa, Japan
| | - Yoichiro Sugizaki
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan; Clinical Trials Center, Cardiovascular Research Foundation, New York, New York
| | - Toshiro Shinke
- Division of Cardiology, Department of Medicine, Showa University School of Medicine, Tokyo, Japan.
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Phan QT, Nguyen HL, Lee WS, Won HY, Cho I, Shin SY, Hong JH, Lee JB, Kim SW. Impact of Reference Mismatch on Procedure Outcomes of Percutaneous Coronary Intervention. Angiology 2022; 74:417-426. [PMID: 36047931 DOI: 10.1177/00033197221123719] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
A significant mismatch between proximal and distal reference lumen diameters of the target lesion may pose challenges during percutaneous coronary intervention (PCI) and therefore influence the outcomes. We investigated total 1706 lesions underwent IVUS guided percutaneous coronary intervention, that were divided into 2 groups, including 411 lesions in Mismatch group and 1295 lesions in Non-Mismatch group. After propensity score matching, 397 lesions in each group were selected for final data set. The analysis showed that Mismatch group PCI required more frequently use of post-stenting optimization (79.6% vs 53.9%, P < .001) using higher max pressure (19.5 ± 3.9 vs 16.7 ± 3.7 atm, P < .001). Besides, Mismatch group also encountered more PCI major complications (7.8% vs 4.0%, P = .024) and lower procedure success rate (91.4% vs 95.5%, P = .022). On final angiogram, Mismatch group had smaller minimum lumen diameter (2.62 ± .45 vs 2.90 ± .57 mm, P < .001) and lower angiographic success rate (93.2% vs 96.7%, P = .023). On final IVUS, Mismatch group had higher rate of incomplete stent apposition and stent edge dissection (6.3% vs 3.0%, P = .029 and 2.5% vs .5%, P = .021, respectively). In conclusion, reference mismatch posed significant challenging during PCI that led to unfavorable procedural outcomes. These impacts may translate into long-term clinical implications that need to be addressed in future studies.
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Affiliation(s)
- Quang Tan Phan
- Intervention Center, Quang Nam Central National Hospital, Quang Nam, Vietnam.,Cardiovascular Research Center, 65542Chung-Ang University Hospital, Seoul, Korea
| | - Hieu Lan Nguyen
- Intervention Center, Vietnam National Heart Institute, Hanoi, Vietnam.,Intervention Center, Hanoi University Medical Center, Vietnam
| | - Wang Soo Lee
- Cardiovascular Research Center, 65542Chung-Ang University Hospital, Seoul, Korea
| | - Ho Youn Won
- Cardiovascular Research Center, 65542Chung-Ang University Hospital, Seoul, Korea
| | - Iksung Cho
- Cardiovascular Research Center, 65542Chung-Ang University Hospital, Seoul, Korea
| | - Seung Yong Shin
- Cardiovascular Research Center, 65542Chung-Ang University Hospital, Seoul, Korea
| | - Joon Hwa Hong
- Department of Cardiovascular Surgery, Chung-Ang University Hospital, Seoul, Korea
| | - Jin Bae Lee
- Intervention Center, 58931Daegu Catholic University Medical Center, Daegu, Korea
| | - Sang Wook Kim
- Cardiovascular Research Center, 65542Chung-Ang University Hospital, Seoul, Korea
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6
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Abouelnour A, Gori T. Intravascular imaging in coronary stent restenosis: Prevention, characterization, and management. Front Cardiovasc Med 2022; 9:843734. [PMID: 36017094 PMCID: PMC9395642 DOI: 10.3389/fcvm.2022.843734] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2021] [Accepted: 07/21/2022] [Indexed: 11/13/2022] Open
Abstract
Despite the introduction of drug-eluting stents to combat the neointimal hyperplasia that occurred after BMS implantation, in-stent restenosis is still encountered in a significant number of patients, particularly as increasingly complex lesions are tackled by percutaneous coronary intervention. Many biological and mechanical factors interplay to produce restenosis, some of which are avoidable. Intravascular imaging provided unique insights into various forms of stent-related mechanical issues that contribute to this phenomenon. From a practical perspective, intravascular imaging can therefore help to optimize the stenting procedure to avert these issues. Moreover, once the problem of restenosis eventuates, imaging can guide the management by tackling the underlying identified mechanism. Finally, it can be used to evaluate the re-intervention results. Nevertheless, with the emergence of different treatment options, more evidence is needed to define patient/lesion-specific characteristics that may help to tailor treatment selection in a way that improves clinical outcomes.
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Affiliation(s)
- Amr Abouelnour
- Zentrum für Kardiologie, Kardiologie I, Deutsches Zentrum für Herz und Kreislauf Forschung, University Medical Center Mainz, Mainz, Germany
- Department of Cardiovascular Medicine, Cardiovascular Institute, Assiut University, Assiut, Egypt
| | - Tommaso Gori
- Zentrum für Kardiologie, Kardiologie I, Deutsches Zentrum für Herz und Kreislauf Forschung, University Medical Center Mainz, Mainz, Germany
- *Correspondence: Tommaso Gori,
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Dissections after bioresorbable vascular scaffold implantation in the POLAR ACS Registry. Adv Cardiol 2022; 18:131-136. [PMID: 36051830 PMCID: PMC9421522 DOI: 10.5114/aic.2022.118530] [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: 05/18/2022] [Accepted: 06/04/2022] [Indexed: 11/17/2022]
Abstract
Introduction Percutaneous coronary intervention (PCI) is a common method of treatment for patients with coronary artery disease. One of the most common complications during the PCI procedure is coronary artery dissection. It usually requires an additional action to assure the patency of the treated vessel. Aim The aim of the publication is to describe the occurrence of coronary artery dissection after bioresorbable vascular scaffold (BVS) implantation. This selected type of PCI procedure is especially interesting because precise target vessel measurement before BVS implantation is required for optimal determination of scaffold size. Material and methods Based on angiographic data gathered in the POLAR ACS Registry, we assessed the frequency of dissections, their localization, and severity. Based on data regarding patients’ demographic, clinical status, and details regarding treatment strategy, the factors that could have an influence on the dissection occurrence were identified. Results A group of 100 patients included in the analyses. Group A consisted of 9 patients. This group was defined as patients in whom the significant dissection occurred after the BVS implantation. Group B comprised 91 patients. Both groups were very similar according to demographic data. The frequency of predilatation was similar; post-dilatation was performed more often in group A but without statistical significance. The presence of calcification in the target lesion was an independent factor of dissection during the index PCI procedure. Conclusions The occurrence of significant dissection can be effectively treated, and the good angiographic results of this treatment immediately after the initial procedure translate into good clinical results in longer follow-up.
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Ozaki Y, Hara H, Onuma Y, Katagiri Y, Amano T, Kobayashi Y, Muramatsu T, Ishii H, Kozuma K, Tanaka N, Matsuo H, Uemura S, Kadota K, Hikichi Y, Tsujita K, Ako J, Nakagawa Y, Morino Y, Hamanaka I, Shiode N, Shite J, Honye J, Matsubara T, Kawai K, Igarashi Y, Okamura A, Ogawa T, Shibata Y, Tsuji T, Yajima J, Iwabuchi K, Komatsu N, Sugano T, Yamaki M, Yamada S, Hirase H, Miyashita Y, Yoshimachi F, Kobayashi M, Aoki J, Oda H, Katahira Y, Ueda K, Nishino M, Nakao K, Michishita I, Ueno T, Inohara T, Kohsaka S, Ismail TF, Serruys PW, Nakamura M, Yokoi H, Ikari Y. CVIT expert consensus document on primary percutaneous coronary intervention (PCI) for acute myocardial infarction (AMI) update 2022. Cardiovasc Interv Ther 2022; 37:1-34. [PMID: 35018605 PMCID: PMC8789715 DOI: 10.1007/s12928-021-00829-9] [Citation(s) in RCA: 63] [Impact Index Per Article: 31.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 11/15/2021] [Indexed: 12/14/2022]
Abstract
Primary Percutaneous Coronary Intervention (PCI) has significantly contributed to reducing the mortality of patients with ST-segment elevation myocardial infarction (STEMI) even in cardiogenic shock and is now the standard of care in most of Japanese institutions. The Task Force on Primary PCI of the Japanese Association of Cardiovascular Interventional and Therapeutics (CVIT) society proposed an expert consensus document for the management of acute myocardial infarction (AMI) focusing on procedural aspects of primary PCI in 2018. Updated guidelines for the management of AMI were published by the European Society of Cardiology (ESC) in 2017 and 2020. Major changes in the guidelines for STEMI patients included: (1) radial access and drug-eluting stents (DES) over bare-metal stents (BMS) were recommended as a Class I indication, (2) complete revascularization before hospital discharge (either immediate or staged) is now considered as Class IIa recommendation. In 2020, updated guidelines for Non-ST-Elevation Myocardial Infarction (NSTEMI) patients, the followings were changed: (1) an early invasive strategy within 24 h is recommended in patients with NSTEMI as a Class I indication, (2) complete revascularization in NSTEMI patients without cardiogenic shock is considered as Class IIa recommendation, and (3) in patients with atrial fibrillation following a short period of triple antithrombotic therapy, dual antithrombotic therapy (e.g., DOAC and single oral antiplatelet agent preferably clopidogrel) is recommended, with discontinuation of the antiplatelet agent after 6 to 12 months. Furthermore, an aspirin-free strategy after PCI has been investigated in several trials those have started to show the safety and efficacy. The Task Force on Primary PCI of the CVIT group has now proposed the updated expert consensus document for the management of AMI focusing on procedural aspects of primary PCI in 2022 version.
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Affiliation(s)
- Yukio Ozaki
- Department of Cardiology, Fujita Health University School of Medicine, Aichi, Japan.
| | - Hironori Hara
- Department of Cardiology, National University of Ireland, Galway (NUIG), Galway, Ireland
- Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Yoshinobu Onuma
- Department of Cardiology, National University of Ireland, Galway (NUIG), Galway, Ireland
| | - Yuki Katagiri
- Department of Cardiology, Sapporo Higashi Tokushukai Hospital, Sapporo, Japan
| | - Tetsuya Amano
- Department of Cardiology, Aichi Medical University, Aichi, Japan
| | - Yoshio Kobayashi
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Takashi Muramatsu
- Department of Cardiology, Fujita Health University School of Medicine, Aichi, Japan
| | - Hideki Ishii
- Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine, Gunma, Japan
| | - Ken Kozuma
- Department of Cardiology, Teikyo University Hospital, Tokyo, Japan
| | - Nobuhiro Tanaka
- Division of Cardiology, Tokyo Medical University Hachioji Medical Center, Tokyo, Japan
| | | | - Shiro Uemura
- Cardiovascular Medicine, Kawasaki Medical School, Kurashiki, Japan
| | | | | | - Kenichi Tsujita
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Junya Ako
- Department of Cardiology, Kitasato University Hospital, Sagamihara, Japan
| | - Yoshihisa Nakagawa
- Division of Cardiovascular Medicine, Department of Internal Medicine, Shiga University of Medical Science, Otsu, Japan
| | - Yoshihiro Morino
- Department of Cardiology, Iwate Medical University Hospital, Morioka, Japan
| | - Ichiro Hamanaka
- Cardiovascular Intervention Center, Rakuwakai Marutamachi Hospital, Kyoto, Japan
| | - Nobuo Shiode
- Division of Cardiology, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan
| | - Junya Shite
- Cardiology Division, Osaka Saiseikai Nakatsu Hospital, Osaka, Japan
| | | | | | | | | | | | - Takayuki Ogawa
- Division of Cardiology, The Jikei University School of Medicine, Tokyo, Japan
| | | | | | | | | | | | | | | | | | | | | | | | - Masakazu Kobayashi
- Department of Cardiology, Fujita Health University School of Medicine, Aichi, Japan
| | - Jiro Aoki
- Division of Cardiology, Mitsui Memorial Hospital, Tokyo, Japan
| | | | | | | | - Masami Nishino
- Division of Cardiology, Osaka Rosai Hospital, Osaka, Japan
| | - Koichi Nakao
- Division of Cardiology, Saiseikai Kumamoto Hospital, Cardiovascular Center, Kumamoto, Japan
| | | | | | - Taku Inohara
- Keio University School of Medicine, Tokyo, Japan
| | - Shun Kohsaka
- Keio University School of Medicine, Tokyo, Japan
| | - Tevfik F Ismail
- Department of Cardiology, Fujita Health University School of Medicine, Aichi, Japan
- King's College London & Guy's and St Thomas' Hospital NHS Foundation Trust, London, UK
| | - Patrick W Serruys
- Department of Cardiology, National University of Ireland, Galway (NUIG), Galway, Ireland
- NHLI, Imperial College London, London, UK
| | - Masato Nakamura
- Division of Cardiovascular Medicine, Ohashi Medical Center, Toho University School of Medicine, Tokyo, Japan
| | - Hiroyoshi Yokoi
- Cardiovascular Center, Fukuoka Sanno Hospital, Fukuoka, Japan
| | - Yuji Ikari
- Department of Cardiology, Tokai University School of Medicine, Isehara, Japan
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9
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Improving PCI Outcomes Using Postprocedural Physiology and Intravascular Imaging. JACC Cardiovasc Interv 2021; 14:2415-2430. [PMID: 34794649 DOI: 10.1016/j.jcin.2021.08.069] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 07/07/2021] [Accepted: 08/03/2021] [Indexed: 11/24/2022]
Abstract
Although clinical outcomes after percutaneous coronary intervention (PCI) are improving, the long-term risk for target vessel failure remains concerning. Although the application of intravascular imaging and physiological indexes significantly improves outcomes, their routine use in practice remains limited. Nevertheless, merely using these modalities is not enough, and to truly improve patient outcomes, optimal intravascular dimensions with minimal vascular injury should be targeted. When assessing post-PCI results using either type of physiological or imaging technology, a broad spectrum of stent- and vessel-related anomalies can be expected. As not all of these issues warrant treatment, a profound knowledge of what to expect and how to recognize and when to treat these intraluminal problems is needed. Additionally, promising new modalities such as angiography-derived coronary physiology and hybrid imaging catheters are becoming available. The authors provide an overview of the currently available tools and techniques to define suboptimal PCI and when to apply these technologies to improve outcomes.
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10
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Impact of stent edge dissection detected by optical coherence tomography after current-generation drug-eluting stent implantation. PLoS One 2021; 16:e0259693. [PMID: 34735528 PMCID: PMC8568188 DOI: 10.1371/journal.pone.0259693] [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: 06/12/2021] [Accepted: 10/22/2021] [Indexed: 11/19/2022] Open
Abstract
Background Stent edge dissection (SED) is a well-known predictor of worse clinical outcomes. However, impact of SED after current-generation drug-eluting stent (DES) implantation remains unknown since there was no study using only current-generation DES to assess impact of SED. This study aimed to investigate a relationship between SED detected by optical coherence tomography (OCT) and clinical outcomes after current-generation DES implantation. Methods This study enrolled 175 patients receiving OCT after current-generation DES implantation. The SED group was compared with the non-SED group in terms of the primary study endpoints which was the cumulative incidence of major adverse cardiac event (MACE) composed of cardiac death, target vessel myocardial infarction (TV-MI), and clinically-driven target lesion revascularization (CD-TLR). Results Of 175 patients, SED detected by OCT was observed in 32 patients, while 143 patients did not show SED. In the crude population, the SED group showed a significantly higher incidence of CD-TLR, definite stent thrombosis, TV-MI and cardiac death relative to the non-SED group. After adjustment by an inverse probability weighted methods, the SED group showed a significantly higher incidence of MACE compared with the non-SED group (hazard ratio 3.43, 95% confidence interval 1.09–10.81, p = 0.035). Fibrocalcific or lipidic plaques, greater lumen eccentricity, and stent-oversizing were the predictors of SED. Conclusions SED detected by OCT after the current-generation DES implantation led to unfavorable outcomes. Aggressive post-dilatation around the stent edge might worse clinical outcomes due to SED, although achievement of optimal stent expansion is strongly encouraged to improve clinical outcomes.
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11
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Lv S, Ma X, Zhou Y, Zhao Y, Liu X, Liu Y, Shi D. Intracoronary Imaging Versus Coronary Angiography to Guide Drug-Coated Balloon Intervention in Coronary Artery Disease: A Propensity-Matched Pilot Study Analysis. Angiology 2021; 72:971-978. [PMID: 33957806 DOI: 10.1177/00033197211012518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Limited data exist about the effect of intracoronary imaging (ICI)-guided drug-coated balloon (DCB) intervention on clinical end points. In all, 1157 patients with coronary artery disease treated with DCB between December 2014 and December 2017 at Beijing Anzhen Hospital were included in the final analysis in this cohort study. The primary end point was the incidence of target lesion failure (TLF), a composite of cardiac death, target vessel myocardial infarction (MI), and target lesion revascularization, and the key secondary end point was the incidence of cardiac death or target vessel MI. The median follow-up for clinical events was 32.0 months (IQR 25.0-40.0). Intracoronary imaging was used in 90 (7.8%) patients. There was no statistically significant difference in TLF (12.2% vs 12.5%, P = .80) between ICI-guided and angiography-guided group. Cardiac death or target vessel MI rates (1.1% vs 3.7%, P = .17) were numerically lower for the ICI-guided cohort. In the propensity score-based analysis, TLF (10.5% vs 16.2%, P = .19) and cardiac death or target vessel MI rates (1.2% vs 2.3%, P = .51) tended to be lower for the ICI-guided cohort. In this observational study, TLF rate tended to decrease in the ICI-guided DCB treatment group compared with angiography-guided procedures. Larger studies are needed.
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Affiliation(s)
- Sai Lv
- Department of Cardiology, Beijing Institute of Heart Lung and Blood Vessel Disease, Beijing Anzhen Hospital, Capital Medical University, Beijing Key Laboratory of Precision Medicine of Coronary Atherosclerotic Disease, Clinical Center for Coronary Heart Disease, Beijing, People's Republic of China
| | - Xiaoteng Ma
- Department of Cardiology, Beijing Institute of Heart Lung and Blood Vessel Disease, Beijing Anzhen Hospital, Capital Medical University, Beijing Key Laboratory of Precision Medicine of Coronary Atherosclerotic Disease, Clinical Center for Coronary Heart Disease, Beijing, People's Republic of China
| | - Yujie Zhou
- Department of Cardiology, Beijing Institute of Heart Lung and Blood Vessel Disease, Beijing Anzhen Hospital, Capital Medical University, Beijing Key Laboratory of Precision Medicine of Coronary Atherosclerotic Disease, Clinical Center for Coronary Heart Disease, Beijing, People's Republic of China
| | - Yingxin Zhao
- Department of Cardiology, Beijing Institute of Heart Lung and Blood Vessel Disease, Beijing Anzhen Hospital, Capital Medical University, Beijing Key Laboratory of Precision Medicine of Coronary Atherosclerotic Disease, Clinical Center for Coronary Heart Disease, Beijing, People's Republic of China
| | - Xiaoli Liu
- Department of Cardiology, Beijing Institute of Heart Lung and Blood Vessel Disease, Beijing Anzhen Hospital, Capital Medical University, Beijing Key Laboratory of Precision Medicine of Coronary Atherosclerotic Disease, Clinical Center for Coronary Heart Disease, Beijing, People's Republic of China
| | - Yuyang Liu
- Department of Cardiology, Beijing Institute of Heart Lung and Blood Vessel Disease, Beijing Anzhen Hospital, Capital Medical University, Beijing Key Laboratory of Precision Medicine of Coronary Atherosclerotic Disease, Clinical Center for Coronary Heart Disease, Beijing, People's Republic of China
| | - Dongmei Shi
- Department of Cardiology, Beijing Institute of Heart Lung and Blood Vessel Disease, Beijing Anzhen Hospital, Capital Medical University, Beijing Key Laboratory of Precision Medicine of Coronary Atherosclerotic Disease, Clinical Center for Coronary Heart Disease, Beijing, People's Republic of China
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12
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Ali Z, Karimi Galougahi K, Maehara A, Shlofmitz R, Fabbiocchi F, Guagliumi G, Alfonso F, Akasaka T, Matsumura M, Mintz G, Ben-Yehuda O, Zhang Z, Rapoza R, West N, Stone G. Outcomes of optical coherence tomography compared with intravascular ultrasound and with angiography to guide coronary stent implantation: one-year results from the ILUMIEN III: OPTIMIZE PCI trial. EUROINTERVENTION 2021; 16:1085-1091. [PMID: 32540793 PMCID: PMC9724851 DOI: 10.4244/eij-d-20-00498] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS In the ILUMIEN III trial, among 450 randomised patients with non-complex lesions undergoing percutaneous coronary intervention (PCI), optical coherence tomography (OCT) guidance led to greater stent expansion than angiography guidance, similar minimal stent area compared to both intravascular ultrasound (IVUS) guidance and angiography guidance, and lower rates of uncorrected dissection and malapposition than both IVUS guidance and angiography guidance. Whether these differences impact on clinical outcomes is unknown. The aim of the present study was to report the 12-month clinical follow-up data from the ILUMIEN III study. METHODS AND RESULTS OCT-guided PCI, using an external elastic lamina-based protocol, was compared to operator-directed IVUS-guided or angiography-guided PCI. Target lesion failure (TLF) and major adverse cardiovascular events (MACE) at 12 months were adjudicated by a blinded clinical events committee. There were no significant differences in the rates of TLF (2.0% OCT, 3.7% IVUS, 1.4% angiography), MACE (9.8% OCT, 9.1% IVUS, 7.9% angiography), or any of the individual components of these outcomes among the groups. No independent predictors of 12-month stent-related clinical events were identified from final OCT. CONCLUSIONS In this underpowered study, OCT-guided PCI of non-complex lesions did not show a statistical difference in clinical outcomes at 12 months compared with IVUS or angiography guidance. An appropriately powered trial, including only complex patients and lesions, is underway to substantiate the potential clinical benefit of OCT-guided PCI. TRIAL REGISTRATION NCT02471586.
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Affiliation(s)
- Ziad Ali
- Cardiovascular Research Foundation, 1700 Broadway, 9th Floor, New York, NY 10019, USA. E-mail:
| | | | - Akiko Maehara
- Center for Interventional Vascular Therapy, Division of Cardiology, NewYork-Presbyterian Hospital/Columbia University Medical Center, New York, NY, USA,Clinical Trials Center, Cardiovascular Research Foundation, New York, NY, USA
| | | | | | - Giulio Guagliumi
- Cardiovascular Department, Ospedale Papa Giovanni XXIII, Bergamo, Italy
| | - Fernando Alfonso
- Hospital Universitario de La Princesa, IIS-IP, CIBERCV, Madrid, Spain
| | | | - Mitsuaki Matsumura
- Clinical Trials Center, Cardiovascular Research Foundation, New York, NY, USA
| | - Gary Mintz
- Clinical Trials Center, Cardiovascular Research Foundation, New York, NY, USA
| | - Ori Ben-Yehuda
- Center for Interventional Vascular Therapy, Division of Cardiology, NewYork-Presbyterian Hospital/Columbia University Medical Center, New York, NY, USA,Clinical Trials Center, Cardiovascular Research Foundation, New York, NY, USA
| | | | | | - Nick West
- Abbott Vascular, Santa Clara, CA, USA
| | - Gregg Stone
- Clinical Trials Center, Cardiovascular Research Foundation, New York, NY, USA,The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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13
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Muramatsu T, Ozaki Y, Nanasato M, Ishikawa M, Nagasaka R, Ohota M, Hashimoto Y, Yoshiki Y, Takatsu H, Ito K, Kamiya H, Yoshida Y, Murohara T, Izawa H. Comparison Between Optical Frequency Domain Imaging and Intravascular Ultrasound for Percutaneous Coronary Intervention Guidance in Biolimus A9-Eluting Stent Implantation: A Randomized MISTIC-1 Non-Inferiority Trial. Circ Cardiovasc Interv 2020; 13:e009314. [PMID: 33106049 PMCID: PMC7665240 DOI: 10.1161/circinterventions.120.009314] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Supplemental Digital Content is available in the text. Background: Given the characteristic differences between intravascular ultrasound (IVUS) and optical frequency domain imaging (OFDI), their approach to therapeutic guidance during percutaneous coronary interventions (PCIs) and arterial healing response after stenting may also vary. Methods: MISTIC-1 (The Multimodality Imaging Study in Cardiology cohort 1) is a multicenter, randomized-controlled, noninferiority trial that compared imaging end points between OFDI- and IVUS-guided PCI. Patients with stable coronary artery disease were randomly assigned to either OFDI- or IVUS-guided PCI using a Biolimus A9-eluting stent according to a prespecified protocol for imaging guidance. Stent sizing was based on external elastic lamina in IVUS-guided PCI while lumen up-size in OFDI-guided PCI. Postprocedural OFDI was investigated regardless of randomization, while operators in IVUS-guided PCI arm were blinded to the images. The primary end point was in-segment minimum lumen area assessed using OFDI at 8 months, while the secondary end point was a composite of cardiovascular mortality, target-vessel myocardial infarction, or target-lesion revascularization (device-oriented composite end point). Patients were followed up to 3 years after the index procedure. Results: A total of 109 patients (mean age 70 years, male 78%) with 126 lesions were enrolled. Postprocedural minimum stent area was 6.31±1.89 and 6.72±2.08 mm2 in OFDI and IVUS group, respectively (P=0.26). At the 8-month follow-up, in-segment minimum lumen area was 4.56±1.94 and 4.13±1.86 mm2 in OFDI and IVUS group, respectively (Pnon-inferiority <0.001). Both groups had comparable neointimal healing score (median 0.16 [interquartile range, 0.00–3.14] versus 0.90 [0.00–3.30], respectively; P=0.43). The incidence rate of device-oriented composite end point at 3 years was 7.4% and 7.3% in OFDI and IVUS group, respectively (hazard ratio, 1.05 [95% CI, 0.26–4.18]; P=0.95). Conclusions: OFDI-guided PCI was not inferior to IVUS-guided PCI in terms of in-segment minimum lumen area at 8 months. Although a small sample size was acknowledged, OFDI could be an alternative to IVUS when considering intracoronary imaging-guided PCI in selected populations with coronary artery diseases. Registration: URL: https://www.clinicaltrials.gov. Unique identifier: NCT03292081.
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Affiliation(s)
- Takashi Muramatsu
- Department of Cardiology, Cardiovascular Center (T. Muramatsu, M.I., R.N., M.O., H.T., H.I.), Fujita Health University Hospital, Toyoake, Japan
| | - Yukio Ozaki
- Department of Cardiology, Fujita Health University Okazaki Medical Center, Japan (Y.O., Y.H., Y. Yoshiki)
| | - Mamoru Nanasato
- Department of Cardiology, Sakakibara Heart Institute, Tokyo, Japan (M.N.)
| | - Masato Ishikawa
- Department of Cardiology, Cardiovascular Center (T. Muramatsu, M.I., R.N., M.O., H.T., H.I.), Fujita Health University Hospital, Toyoake, Japan
| | - Ryo Nagasaka
- Department of Cardiology, Cardiovascular Center (T. Muramatsu, M.I., R.N., M.O., H.T., H.I.), Fujita Health University Hospital, Toyoake, Japan
| | - Masaya Ohota
- Department of Cardiology, Cardiovascular Center (T. Muramatsu, M.I., R.N., M.O., H.T., H.I.), Fujita Health University Hospital, Toyoake, Japan
| | - Yosuke Hashimoto
- Department of Cardiology, Fujita Health University Okazaki Medical Center, Japan (Y.O., Y.H., Y. Yoshiki)
| | - Yu Yoshiki
- Department of Cardiology, Fujita Health University Okazaki Medical Center, Japan (Y.O., Y.H., Y. Yoshiki)
| | - Hidemaro Takatsu
- Department of Cardiology, Cardiovascular Center (T. Muramatsu, M.I., R.N., M.O., H.T., H.I.), Fujita Health University Hospital, Toyoake, Japan
| | - Katsuyoshi Ito
- Department of Radiology (K.I.), Fujita Health University Hospital, Toyoake, Japan
| | - Hiroki Kamiya
- Department of Cardiovascular Medicine, Gifu Heart Center, Japan (H.K.)
| | - Yukihiko Yoshida
- Department of Cardiology, Cardiovascular Center, Japanese Red Cross Nagoya Daini Hospital, Japan (Y. Yoshida)
| | - Toyoaki Murohara
- Department of Cardiology, Nagoya University Graduate School of Medicine, Japan (T.M.)
| | - Hideo Izawa
- Department of Cardiology, Cardiovascular Center (T. Muramatsu, M.I., R.N., M.O., H.T., H.I.), Fujita Health University Hospital, Toyoake, Japan
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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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15
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Yamamoto K, Sakakura K, Momomura SI, Fujita H. Conservative management of severe coronary artery hematoma and dissection following stent implantation. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2018; 20:347-350. [PMID: 29793897 DOI: 10.1016/j.carrev.2018.04.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Revised: 04/15/2018] [Accepted: 04/20/2018] [Indexed: 11/24/2022]
Abstract
Severe dissection and hematoma following stent implantation can cause acute vessel closure, which requires an immediate bailout procedure. However, bailout from such a situation may not be easy, especially when the hematoma extends to the distal segment of a coronary artery. We present a case of 73-year-old woman with effort angina who underwent PCI to the right coronary artery (RCA). Following stent implantation, there was a massive hematoma from the distal edge of the stent. We tried to create re-entry at the distal part of the hematoma, but were not successful. We managed her conservatively without additional stent placement or creating re-entry. Follow-up coronary angiography on day 68 showed excellent coronary flow. Intravascular ultrasound demonstrated complete healing of the hematoma. A hematoma caused by edge dissection is a challenging complication. Additional stent implantation to cover the entire length of the hematoma and/or cutting balloon dilatation to create re-entry are options; however, these procedures may worsen the situation. Our case clearly showed healing of dissection and hematoma without creating re-entry or additional stent implantation. Conservative management should be considered an option for severe edge dissection and hematoma following stent implantation.
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Affiliation(s)
- Kei Yamamoto
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Kenichi Sakakura
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan.
| | - Shin-Ichi Momomura
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Hideo Fujita
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan
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16
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Song HG, Kang SJ, Mintz GS. Value of intravascular ultrasound in guiding coronary interventions. Echocardiography 2018; 35:520-533. [DOI: 10.1111/echo.13837] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Affiliation(s)
- Hae Geun Song
- Department of Cardiology; DeltaHealth Hospital; Shanghai China
| | - Soo-Jin Kang
- Department of Cardiology; Asan Medical Center; University of Ulsan College of Medicine; Seoul South Korea
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17
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Ozaki Y, Katagiri Y, Onuma Y, Amano T, Muramatsu T, Kozuma K, Otsuji S, Ueno T, Shiode N, Kawai K, Tanaka N, Ueda K, Akasaka T, Hanaoka KI, Uemura S, Oda H, Katahira Y, Kadota K, Kyo E, Sato K, Sato T, Shite J, Nakao K, Nishino M, Hikichi Y, Honye J, Matsubara T, Mizuno S, Muramatsu T, Inohara T, Kohsaka S, Michishita I, Yokoi H, Serruys PW, Ikari Y, Nakamura M. CVIT expert consensus document on primary percutaneous coronary intervention (PCI) for acute myocardial infarction (AMI) in 2018. Cardiovasc Interv Ther 2018; 33:178-203. [PMID: 29594964 PMCID: PMC5880864 DOI: 10.1007/s12928-018-0516-y] [Citation(s) in RCA: 67] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Accepted: 02/27/2018] [Indexed: 12/28/2022]
Abstract
While primary percutaneous coronary intervention (PCI) has significantly contributed to improve the mortality in patients with ST segment elevation myocardial infarction even in cardiogenic shock, primary PCI is a standard of care in most of Japanese institutions. Whereas there are high numbers of available facilities providing primary PCI in Japan, there are no clear guidelines focusing on procedural aspect of the standardized care. Whilst updated guidelines for the management of acute myocardial infarction were recently published by European Society of Cardiology, the following major changes are indicated; (1) radial access and drug-eluting stent over bare metal stent were recommended as Class I indication, and (2) complete revascularization before hospital discharge (either immediate or staged) is now considered as Class IIa recommendation. Although the primary PCI is consistently recommended in recent and previous guidelines, the device lag from Europe, the frequent usage of coronary imaging modalities in Japan, and the difference in available medical therapy or mechanical support may prevent direct application of European guidelines to Japanese population. The Task Force on Primary Percutaneous Coronary Intervention of the Japanese Association of Cardiovascular Intervention and Therapeutics (CVIT) has now proposed the expert consensus document for the management of acute myocardial infarction focusing on procedural aspect of primary PCI.
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Affiliation(s)
- Yukio Ozaki
- Department of Cardiology, Fujita Health University School of Medicine, Toyoake, Japan.
| | - Yuki Katagiri
- Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Yoshinobu Onuma
- Department of Cardiology, Fujita Health University School of Medicine, Toyoake, Japan.,Thoraxcenter, Erasmus MC, Erasmus University, Rotterdam, The Netherlands
| | - Tetsuya Amano
- Department of Cardiology, Aichi Medical University, Nagakute, Japan
| | - Takashi Muramatsu
- Department of Cardiology, Fujita Health University School of Medicine, Toyoake, Japan
| | - Ken Kozuma
- Department of Cardiology, Teikyo University Hospital, Tokyo, Japan
| | - Satoru Otsuji
- Higashi Takarazuka Satoh Hospital, Takarazuka, Japan
| | - Takafumi Ueno
- Division of Cardio-vascular Medicine, Department of Internal Medicine, Kurume University School of Medicine, Kurume, Japan
| | - Nobuo Shiode
- Division of Cardiology, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan
| | - Kazuya Kawai
- Department of Cardiology, Chikamori Hospital, Kochi, Japan
| | - Nobuhiro Tanaka
- Division of Cardiology, Tokyo Medical University Hachioji Medical Center, Tokyo, Japan
| | - Kinzo Ueda
- Rakuwakai Kyoto Cardiovascular Intervention Center, Rakuwakai Marutamachi Hospital, Kyoto, Japan
| | - Takashi Akasaka
- Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan
| | | | - Shiro Uemura
- Cardiovascular Medicine, Kawasaki Medical School, Kurashiki, Japan
| | - Hirotaka Oda
- Department of Cardiology, Niigata City General Hospital, Niigata, Japan
| | | | | | - Eisho Kyo
- Kusatsu Heart Center, Kusatsu, Japan
| | | | | | - Junya Shite
- Cardiology Division, Osaka Saiseikai Nakatsu Hospital, Osaka, Japan
| | - Koichi Nakao
- Division of Cardiology, Saiseikai Kumamoto Hospital Cardiovascular Center, Kumamoto, Japan
| | - Masami Nishino
- Division of Cardiology, Osaka Rosai Hospital, Sakai, Japan
| | - Yutaka Hikichi
- Department of Cardiovascular Medicine, Saga University, Saga, Japan
| | | | | | | | | | - Taku Inohara
- Keio University School of Medicine, Tokyo, Japan
| | - Shun Kohsaka
- Keio University School of Medicine, Tokyo, Japan
| | - Ichiro Michishita
- Yokohama Sakae Kyosai Hospital, Federation of National Public Service Personnel Mutual Associations, Yokohama, Japan
| | - Hiroyoshi Yokoi
- Cardiovascular Center, Fukuoka Sanno Hospital, Fukuoka, Japan
| | | | - Yuji Ikari
- Department of Cardiology, Tokai University School of Medicine, Kanagawa, Japan
| | - Masato Nakamura
- Division of Cardiovascular Medicine, Ohashi Medical Center, Toho University School of Medicine, Tokyo, Japan
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Lu H, Kalkman DN, Grundeken MJ, Tijssen JGP, Wykrzykowska JJ, de Winter RJ, Koch KT. Does the novel delivery system for the STENTYS self-apposing coronary stent increase the risk of stent edge dissections? Optical coherence tomography post stent findings. Expert Rev Med Devices 2017; 15:157-165. [PMID: 29284310 DOI: 10.1080/17434440.2018.1421942] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND With optical coherence tomography (OCT), details of arterial injuries during percutaneous coronary intervention can be assessed accurately. There might be an increased risk of stent edge dissections with the novel delivery system for the STENTYS stent. We evaluated the prevalence of stent edge dissections using the novel Xposition delivery device as compared with the conventional delivery device. METHODS A total of 38 patients who were treated with the self-apposing STENTYS stent and with OCT assessment at our center were retrospectively analysed. Twenty patients were treated using the Xposition- and 18 using the conventional delivery device. OCT was performed according to study protocol. Frames with poor quality were excluded. RESULTS A total of 12(18%) dissections were detected, 7(20%) in the Xposition delivery device group, and 5(15%) in the conventional group (p = 1). Using the Xposition delivery device 4(33%) dissections were found proximally, using the conventional delivery device 3(25%) (p = ns). Mean longitudinal dissection length was 2.07 ± 1.80mm, 8(67%) appeared as flaps, 4(33%) as cavities. Morphometric parameters were comparable in both groups. CONCLUSIONS Detailed OCT assessment of stent edge dissections was possible, which revealed no large differences using the Xposition delivery device as compared with conventional delivery device, however large studies are warranted.
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Affiliation(s)
- Huangling Lu
- a Academic Medical Center , University of Amsterdam , Amsterdam , The Netherlands
| | - Deborah N Kalkman
- a Academic Medical Center , University of Amsterdam , Amsterdam , The Netherlands
| | - Maik J Grundeken
- a Academic Medical Center , University of Amsterdam , Amsterdam , The Netherlands
| | - Jan G P Tijssen
- a Academic Medical Center , University of Amsterdam , Amsterdam , The Netherlands
| | | | - Robbert J de Winter
- a Academic Medical Center , University of Amsterdam , Amsterdam , The Netherlands
| | - Karel T Koch
- a Academic Medical Center , University of Amsterdam , Amsterdam , The Netherlands
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Optical Coherence Tomography Guided Percutaneous Coronary Intervention. Heart Lung Circ 2017; 26:1267-1276. [DOI: 10.1016/j.hlc.2017.07.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Revised: 06/05/2017] [Accepted: 07/10/2017] [Indexed: 11/23/2022]
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[Coronary interventions : Current developments for improved long-term results]. Internist (Berl) 2016; 57:832-43. [PMID: 27506215 DOI: 10.1007/s00108-016-0111-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Based on solid scientific evidence, new generation drug-eluting stents (DES) have become established as the standard of care in interventional cardiology. With at least similar safety and superior efficacy over uncoated bare metal stents (BMS) in various scenarios and including patients with increased bleeding risk, there are probably no remaining indications favoring the use of BMS. Additional developments regarding the platform, drug elution characteristics and polymer design were aimed at optimizing DES with even better outcomes. Although there is no lack of new variations, none has proven to be superior and several non-inferiority trials lacked statistical power, which precludes the label third generation (over second generation or new generation DES). While it is recognized that potential long-term advantages of bioresorbable scaffolds cannot be expected at this stage from the current ABSORB III trial, the safety and efficacy are encouraging. Beyond procedural aspects, such as intracoronary imaging, variations in duration of antiplatelet therapy should help to improve outcomes but still require careful individual weighting of ischemic vs. bleeding risk.
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Bioresorbable vascular scaffold implantation and scaffold edge dissection, to treat or not to treat? The dilemma clarified by optical coherence tomography. Int J Cardiol 2016; 214:398-9. [PMID: 27085654 DOI: 10.1016/j.ijcard.2016.03.163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2016] [Accepted: 03/20/2016] [Indexed: 11/20/2022]
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Metabolic syndrome predicts plaque rupture in patients with acute myocardial infarction. An optical coherence study. Int J Cardiol 2016; 209:139-41. [DOI: 10.1016/j.ijcard.2016.02.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2015] [Revised: 01/27/2016] [Accepted: 02/01/2016] [Indexed: 11/20/2022]
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Matsuo Y, Kubo T, Akasaka T. The use of optical coherence tomography in acute coronary syndrome. Expert Rev Cardiovasc Ther 2016; 14:649-57. [DOI: 10.1586/14779072.2016.1145054] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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25
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Coronary optical coherence tomography: A practical overview of current clinical applications. Rev Port Cardiol 2016; 35:105-12. [DOI: 10.1016/j.repc.2015.09.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2015] [Accepted: 09/13/2015] [Indexed: 01/01/2023] Open
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Cruz Ferreira R, Pereira-da-Silva T, Patrício L, Bezerra H, Costa M. Coronary optical coherence tomography: A practical overview of current clinical applications. REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2016. [DOI: 10.1016/j.repce.2015.09.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Abstract
Deep stent edge dissection by OCT predicts adverse outcome. STEMI culprit lesions are most susceptible to edge dissection. Procedural performance influences edge dissection.
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Affiliation(s)
- James A Goldstein
- Department of Cardiovascular Medicine, Beaumont Health System, Royal Oak, Michigan
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