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McInerney A, Travieso A, Jerónimo Baza A, Alfonso F, Del Val D, Cerrato E, Garcia de Lara J, Pinar E, Perez de Prado A, Jimenez Quevedo P, Tirado-Conte G, Nombela-Franco L, Brugaletta S, Cepas-Guillén P, Sabaté M, Cubero Gallego H, Vaquerizo B, Jurado A, Varbella F, Jimenez M, Garcia Escobar A, de la Torre JM, Amat Santos I, Jimenez Diaz VA, Escaned J, Gonzalo N. Impact of coronary calcium morphology on intravascular lithotripsy. EUROINTERVENTION 2024; 20:e656-e668. [PMID: 38776142 PMCID: PMC11100505 DOI: 10.4244/eij-d-23-00605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 12/20/2023] [Indexed: 05/24/2024]
Abstract
BACKGROUND Coronary calcification negatively impacts optimal stenting. Intravascular lithotripsy (IVL) is a new calcium modification technique. AIMS We aimed to assess the impact of different calcium morphologies on IVL efficacy. METHODS This was a prospective, multicentre study (13 tertiary referral centres). Optical coherence tomography (OCT) was performed before and after IVL, and after stenting. OCT-defined calcium morphologies were concentric (mean calcium arc >180°) and eccentric (mean calcium arc ≤180°). The primary outcomes were angiographic success (residual stenosis <20%) and the presence of fracture by OCT in concentric versus eccentric lesions. RESULTS Ninety patients were included with a total of 95 lesions: 47 concentric and 48 eccentric. The median number of pulses was 60 (p=1.00). Following IVL, the presence of fracture was not statistically different between groups (79.0% vs 66.0% for concentric vs eccentric; p=0.165). The number of fractures/lesion (4.2±4.4 vs 2.3±2.8; p=0.018) and ≥3 fractures/lesion (57.1% vs 34.0%; p=0.029) were more common in concentric lesions. Angiographic success was numerically but not statistically higher in the concentric group (87.0% vs 76.6%; p=0.196). By OCT, no differences were noted in final minimum lumen area (5.9±2.2 mm2 vs 6.2±2.1 mm2; p=0.570), minimum stent area (5.9±2.2 mm² vs 6.25±2.4 mm2; p=0.483), minimum stent expansion (80.9±16.7% vs 78.2±19.8%), or stent expansion at the maximum calcium site (100.6±24.2% vs 95.8±27.3%) (p>0.05 for all comparisons of concentric vs eccentric, respectively). Calcified nodules were found in 29.5% of lesions; these were predominantly non-eruptive (57%). At the nodule site, dissection was more common than fracture with stent expansion of 103.6±27.2%. CONCLUSIONS In this prospective, multicentre study, the effectiveness of IVL followed by stenting was not significantly affected by coronary calcium morphology.
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Affiliation(s)
- Angela McInerney
- Department of Interventional Cardiology, Hospital Clínico San Carlos, IdISSC, Universidad Complutense de Madrid, Madrid, Spain
| | - Alejandro Travieso
- Department of Interventional Cardiology, Hospital Clínico San Carlos, IdISSC, Universidad Complutense de Madrid, Madrid, Spain
| | - Adrián Jerónimo Baza
- Department of Interventional Cardiology, Hospital Clínico San Carlos, IdISSC, Universidad Complutense de Madrid, Madrid, Spain
| | - Fernando Alfonso
- Department of Cardiology, Hospital Universitario La Princesa, IIS-IP, CIBER-CV, Madrid, Spain
| | - David Del Val
- Department of Cardiology, Hospital Universitario La Princesa, IIS-IP, CIBER-CV, Madrid, Spain
| | - Enrico Cerrato
- Interventional Cardiology Unit, San Luigi Gonzaga University Hospital, Orbassano, Italy
- Rivoli Infermi Hospital, Rivoli, Turin, Italy
| | - Juan Garcia de Lara
- Department of Cardiology, Hospital Universitario Virgen de la Arrixaca, Murcia, Spai
| | - Eduardo Pinar
- Department of Cardiology, Hospital Universitario Virgen de la Arrixaca, Murcia, Spai
| | | | - Pilar Jimenez Quevedo
- Department of Interventional Cardiology, Hospital Clínico San Carlos, IdISSC, Universidad Complutense de Madrid, Madrid, Spain
| | - Gabriela Tirado-Conte
- Department of Interventional Cardiology, Hospital Clínico San Carlos, IdISSC, Universidad Complutense de Madrid, Madrid, Spain
| | - Luis Nombela-Franco
- Department of Interventional Cardiology, Hospital Clínico San Carlos, IdISSC, Universidad Complutense de Madrid, Madrid, Spain
| | - Salvatore Brugaletta
- Cardiology Department, Hospital Clínic Cardiovascular Institute, Hospital Clínic Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain
| | - Pedro Cepas-Guillén
- Cardiology Department, Hospital Clínic Cardiovascular Institute, Hospital Clínic Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain
| | - Manel Sabaté
- Cardiology Department, Hospital Clínic Cardiovascular Institute, Hospital Clínic Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain
| | - Héctor Cubero Gallego
- Departamento de Cardiología Intervencionista, Hospital del Mar, IMIM, Universidad Autónoma, Barcelona, Spain
| | - Beatriz Vaquerizo
- Departamento de Cardiología Intervencionista, Hospital del Mar, IMIM, Universidad Autónoma, Barcelona, Spain
| | - Alfonso Jurado
- Departamento de Cardiología Intervencionista, Servicio de Cardiología, Hospital Universitario la Paz, Madrid, Spain
| | - Ferdinando Varbella
- Interventional Cardiology Unit, San Luigi Gonzaga University Hospital, Orbassano, Italy
- Rivoli Infermi Hospital, Rivoli, Turin, Italy
| | - Marcelo Jimenez
- Cardiac Department, Hospital Santa Creu i Sant Pau, Barcelona, Spain
| | - Artemio Garcia Escobar
- Departamento de Cardiología Intervencionista, Servicio de Cardiología, Hospital Universitario la Paz, Madrid, Spain
| | | | - Ignacio Amat Santos
- CIBERCV, Instituto de Ciencias del Corazón (ICICOR), Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | | | - Javier Escaned
- Department of Interventional Cardiology, Hospital Clínico San Carlos, IdISSC, Universidad Complutense de Madrid, Madrid, Spain
| | - Nieves Gonzalo
- Department of Interventional Cardiology, Hospital Clínico San Carlos, IdISSC, Universidad Complutense de Madrid, Madrid, Spain
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Sato T, Matsumura M, Yamamoto K, Shlofmitz E, Moses JW, Khalique OK, Shin D, Dakroub A, Singh M, Malik S, Tsoulios A, Cohen DJ, Mintz GS, Shlofmitz RA, Jeremias A, Ali ZA, Maehara A. Prevalence and anatomical factors associated with stent under-expansion in non-severely calcified lesions. Catheter Cardiovasc Interv 2024. [PMID: 38639137 DOI: 10.1002/ccd.31035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 03/07/2024] [Accepted: 03/26/2024] [Indexed: 04/20/2024]
Abstract
BACKGROUND Stent underexpansion, typically related to lesion calcification, is the strongest predictor of adverse events after percutaneous coronary intervention (PCI). Although uncommon, underexpansion may also occur in non-severely calcified lesions. AIM We sought to identify the prevalence and anatomical characteristics of underexpansion in non-severely calcified lesions. METHODS We included 993 patients who underwent optical coherence tomography-guided PCI of 1051 de novo lesions with maximum calcium arc <180°. Negative remodeling (NR) was the smallest lesion site external elastic lamina diameter that was also smaller than the distal reference. Stent expansion was evaluated using a linear regression model accounting for vessel tapering; underexpansion required both stent expansion <70% and stent area <4.5mm2. RESULTS Underexpansion was observed in 3.6% of non-heavily calcified lesions (38/1051). Pre-stent maximum calcium arc and thickness were greater in lesions with versus without underexpansion (median 119° vs. 85°, p = 0.002; median 0.95 mm vs. 0.78 mm, p = 0.008). NR was also more common in lesions with underexpansion (44.7% vs. 24.5%, p = 0.007). In the multivariable logistic regression model, larger and thicker eccentric calcium, mid left anterior descending artery (LAD) location, and NR were associated with underexpansion in non-severely calcified lesions. The rate of underexpansion was especially high (30.7%) in lesions exhibiting all three morphologies. Two-year TLF tended to be higher in underexpanded versus non-underexpanded stents (9.7% vs. 3.7%, unadjusted hazard ratio [95% confidence interval] = 3.02 [0.92, 9.58], p = 0.06). CONCLUSION Although underexpansion in the absence of severe calcium (<180°) is uncommon, mid-LAD lesions with NR and large and thick eccentric calcium were associated with underexpansion.
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Affiliation(s)
- Takao Sato
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York, USA
- Department of Cardiology, St. Francis Hospital, Roslyn, New York, USA
- Division of Cardiology, Department of Medicine, Columbia University Medical Center/NewYork-Presbyterian Hospital, New York, New York, USA
| | - Mitsuaki Matsumura
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York, USA
| | - Kei Yamamoto
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York, USA
- Department of Cardiology, St. Francis Hospital, Roslyn, New York, USA
- Division of Cardiology, Department of Medicine, Columbia University Medical Center/NewYork-Presbyterian Hospital, New York, New York, USA
| | - Evan Shlofmitz
- Department of Cardiology, St. Francis Hospital, Roslyn, New York, USA
| | - Jeffrey W Moses
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York, USA
- Department of Cardiology, St. Francis Hospital, Roslyn, New York, USA
- Division of Cardiology, Department of Medicine, Columbia University Medical Center/NewYork-Presbyterian Hospital, New York, New York, USA
| | - Omar K Khalique
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York, USA
- Department of Cardiology, St. Francis Hospital, Roslyn, New York, USA
| | - Doosup Shin
- Department of Cardiology, St. Francis Hospital, Roslyn, New York, USA
| | - Ali Dakroub
- Department of Cardiology, St. Francis Hospital, Roslyn, New York, USA
| | - Mandeep Singh
- Department of Cardiology, St. Francis Hospital, Roslyn, New York, USA
| | - Sarah Malik
- Department of Cardiology, St. Francis Hospital, Roslyn, New York, USA
| | - Anna Tsoulios
- Department of Cardiology, St. Francis Hospital, Roslyn, New York, USA
| | - David J Cohen
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York, USA
- Department of Cardiology, St. Francis Hospital, Roslyn, New York, USA
| | - Gary S Mintz
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York, USA
| | | | - Allen Jeremias
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York, USA
- Department of Cardiology, St. Francis Hospital, Roslyn, New York, USA
| | - Ziad A Ali
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York, USA
- Department of Cardiology, St. Francis Hospital, Roslyn, New York, USA
| | - Akiko Maehara
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York, USA
- Division of Cardiology, Department of Medicine, Columbia University Medical Center/NewYork-Presbyterian Hospital, New York, New York, USA
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Tian X, Chen Y, Pan S, Lan H, Cheng L. Enhanced in-stent luminal visualization and restenosis diagnosis in coronary computed tomography angiography via coronary stent decomposition algorithm from dual-energy image. Comput Biol Med 2024; 171:108128. [PMID: 38342047 DOI: 10.1016/j.compbiomed.2024.108128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 01/17/2024] [Accepted: 02/06/2024] [Indexed: 02/13/2024]
Abstract
Stent implantation is a principal therapeutic approach for coronary artery diseases. Nonetheless, the presence of stents significantly interferes with in-stent luminal (ISL) visualization and complicates the diagnosis of in-stent restenosis (ISR), thereby increasing the risk of misdiagnoses and underdiagnoses in coronary computed tomography angiography (CCTA). Dual-energy (DE) CT could calculate the volume fraction for voxels from low- and high-energy images (LHEI) and provide information on specific three basic materials. In this study, the innovative coronary stent decomposition algorithm (CSDA) was developed from the DECT three materials decomposition (TMD), through spectral simulation to determine the scan and attenuation coefficient for the stent, and preliminary execution for an in vitro sophisticated polyether ether ketone (PEEK) 3D-printed right coronary artery (RCA) replica. Furthermore, the whole-coronary-artery replica with multi-stent implantation, the RCA replica with mimetic plaque embedded, and two patients with stent further validated the effectiveness of CSDA. Post-CSDA images manifested no weakened attenuation values, no elevated noise values, and maintained anatomical integrity in the coronary lumen. The stents were effectively removed, allowing for the ISL and ISR to be clearly visualized with a discrepancy in diameters within 10%. We believe that CSDA presents a promising solution for enhancing CCTA diagnostic accuracy post-stent implantation.
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Affiliation(s)
- Xin Tian
- Department of Medical Imaging, Jincheng People's Hospital, Jincheng, 048000, China.
| | - Yunbing Chen
- Department of Medical Imaging, Jincheng People's Hospital, Jincheng, 048000, China
| | - Sancong Pan
- Department of Cardiovascular Medicine, Jincheng People's Hospital, Jincheng, 048000, China
| | - Honglin Lan
- Department of Medical Imaging, Jincheng People's Hospital, Jincheng, 048000, China
| | - Lei Cheng
- The First Affiliated Hospital of Anhui Medical University, Hefei, 230022, China.
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Clinical Utility of Intravascular Imaging. JACC: CARDIOVASCULAR IMAGING 2022; 15:1799-1820. [DOI: 10.1016/j.jcmg.2022.04.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 04/01/2022] [Indexed: 12/28/2022]
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Jinnouchi H, Sakakura K, Taniguchi Y, Tsukui T, Watanabe Y, Yamamoto K, Seguchi M, Wada H, Fujita H. Clinical Outcomes and Unique Restenosis of Calcified Nodule in Heavily Calcified Coronary Artery. J Atheroscler Thromb 2022. [PMID: 36002255 DOI: 10.5551/jat.63667] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
AIMS Calcified nodule (CN) has been known as the advanced stage of coronary calcification. However, clinical outcomes following percutaneous coronary intervention (PCI) to CN remain unknown. This study aimed to compare clinical outcomes, including target lesion revascularization (TLR), between calcified coronary lesions with and without CN. METHODS Two hundred forty-nine lesions undergoing intravascular ultrasound-guided PCI with rotational atherectomy (RA) were enrolled and divided into the CN group (n=100) and the non-CN group (n=149) according to the presence of CN. The cumulative incidence of clinically driven TLR (CD-TLR) and the reasons for CD-TLR were compared between the CN and non-CN groups. RESULTS The incidence of CD-TLR was significantly higher in the CN group than in the non-CN group. In the landmark analysis at 1 year, the CN group showed a significantly higher incidence of CD-TLR within 1 year. However, the incidence of CD-TLR beyond 1 year was numerically lower in the CN group than in the non-CN group. In the multivariate Cox hazard model, CN was significantly associated with CD-TLR. In the CN group, in-stent CN was the major reason for CD-TLR (52%) and was observed mainly within 1 year (90%). CONCLUSIONS In the heavily calcified lesions requiring RA, CN was the factor associated with the higher rate of CD-TLR especially within 1 year. The timing of CD-TLR in lesions with CN may indicate that the process of CN protruding through the struts was progressed monthly.
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Affiliation(s)
- Hiroyuki Jinnouchi
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University
| | - Kenichi Sakakura
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University
| | - Yousuke Taniguchi
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University
| | - Takunori Tsukui
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University
| | - Yusuke Watanabe
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University
| | - Kei Yamamoto
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University
| | - Masaru Seguchi
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University
| | - Hiroshi Wada
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University
| | - Hideo Fujita
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University
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6
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Intravascular lithotripsy of underexpanded and recoiled freshly implanted internal carotid stents. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2022; 40S:200-204. [DOI: 10.1016/j.carrev.2022.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 01/18/2022] [Accepted: 02/08/2022] [Indexed: 11/17/2022]
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