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Zhang J, Fang J, Xu Y, Si G. How AI and Robotics Will Advance Interventional Radiology: Narrative Review and Future Perspectives. Diagnostics (Basel) 2024; 14:1393. [PMID: 39001283 PMCID: PMC11241154 DOI: 10.3390/diagnostics14131393] [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: 04/28/2024] [Revised: 06/20/2024] [Accepted: 06/26/2024] [Indexed: 07/16/2024] Open
Abstract
The rapid advancement of artificial intelligence (AI) and robotics has led to significant progress in various medical fields including interventional radiology (IR). This review focuses on the research progress and applications of AI and robotics in IR, including deep learning (DL), machine learning (ML), and convolutional neural networks (CNNs) across specialties such as oncology, neurology, and cardiology, aiming to explore potential directions in future interventional treatments. To ensure the breadth and depth of this review, we implemented a systematic literature search strategy, selecting research published within the last five years. We conducted searches in databases such as PubMed and Google Scholar to find relevant literature. Special emphasis was placed on selecting large-scale studies to ensure the comprehensiveness and reliability of the results. This review summarizes the latest research directions and developments, ultimately analyzing their corresponding potential and limitations. It furnishes essential information and insights for researchers, clinicians, and policymakers, potentially propelling advancements and innovations within the domains of AI and IR. Finally, our findings indicate that although AI and robotics technologies are not yet widely applied in clinical settings, they are evolving across multiple aspects and are expected to significantly improve the processes and efficacy of interventional treatments.
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Affiliation(s)
- Jiaming Zhang
- Department of Radiology, Clinical Medical College, Southwest Medical University, Luzhou 646699, China; (J.Z.); (J.F.)
| | - Jiayi Fang
- Department of Radiology, Clinical Medical College, Southwest Medical University, Luzhou 646699, China; (J.Z.); (J.F.)
| | - Yanneng Xu
- Department of Radiology, Affiliated Traditional Chinese Medicine Hospital, Southwest Medical University, Luzhou 646699, China;
| | - Guangyan Si
- Department of Radiology, Affiliated Traditional Chinese Medicine Hospital, Southwest Medical University, Luzhou 646699, China;
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Ahmed M, Javaid H, Talha Maniya M, Shafiq A, Shahbaz H, Singh P, Jain H, Basit J, Hamza M, Nashwan AJ, Ali S, Vadamalai K. Optical coherence tomography-guided versus angiography-guided percutaneous coronary intervention: A meta-analysis of randomized controlled trials. IJC HEART & VASCULATURE 2024; 52:101405. [PMID: 38854743 PMCID: PMC11156695 DOI: 10.1016/j.ijcha.2024.101405] [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: 01/16/2024] [Revised: 02/10/2024] [Accepted: 02/22/2024] [Indexed: 06/11/2024]
Abstract
Background Optical Coherence Tomography (OCT), a high-resolution imaging modality, guides stent implantation during percutaneous coronary intervention (PCI). However, OCT-guided PCI safety and efficacy data is limited. Methods MEDLINE, Embase, and Cochrane Central were searched for randomized controlled trials (RCTs) comparing OCT-guided PCI to Angiography-guided PCI from inception to August 2023. A random-effects model was used to pool risk ratios (RRs), mean differences (MDs), and 95% confidence intervals (CIs) for clinical endpoints. Results Our analysis included 5,139 patients from 11 studies. OCT-guided PCI resulted in a higher minimum stent area (MD = 0.35 [95 % CI, 0.21-0.49]; p < 0.00001), significantly reduced risk of cardiovascular mortality (RR = 0.56 [95 % CI, = 0.32-0.99]; p = 0.04), stent thrombosis (RR = 0.56 [95 % CI, 0.32-0.96]; p = 0.04), stent malapposition RR = 0.79 [95 % CI, 0.71-0.88]; p = < 0.0001) and major edge dissection (RR = 0.47 [95 % CI, 0.34-0.65]; p = <0.00001). However, no statistically significant difference was observed for all-cause mortality (RR = 0.71; p = 0.06), major adverse cardiovascular events (MACE) [RR = 0.80; p = 0.10], myocardial infarction (MI) [RR = 0.84; p = 0.16], target lesion revascularization (TLR) [RR = 0.94; p = 0.68], and target vessel revascularization (TVR) [RR = 0.91; p = 0.52]. Conclusion OCT-guided PCI led to an increased MSA and decreased cardiovascular mortality, stent thrombosis, stent malapposition, and major edge dissection. The incidence of all-cause mortality, MACE, MI, TLR, and TVR remained comparable across the two groups.
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Affiliation(s)
- Mushood Ahmed
- Department of Medicine, Rawalpindi Medical University, Rawalpindi, Pakistan
| | - Hira Javaid
- Department of Medicine, Allama Iqbal Medical College, Lahore, Pakistan
| | | | - Aimen Shafiq
- Department of Medicine, Dow University of Health Sciences, Karachi, Pakistan
| | - Haania Shahbaz
- Department of Medicine, Dow University of Health Sciences, Karachi, Pakistan
| | - Priyansha Singh
- Smt. Nathiba Hargovandas Lakhmichand Municipal Medical College, Ahmedabad, Gujarat, India
| | - Hritvik Jain
- Department of Internal Medicine, All India Institute of Medical Sciences (AIIMS), Jodhpur, India
| | - Jawad Basit
- Department of Medicine, Rawalpindi Medical University, Rawalpindi, Pakistan
- Cardiovascular Analytics Group, Canterbury, UK
| | | | | | - Shafaqat Ali
- Department of Medicine, Louisiana State University, Shreveport, LA USA
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Baruś P, Hunia J, Kaczorowski R, Bednarek A, Ochijewicz D, Gumiężna K, Kołtowski Ł, Kochman J, Grabowski M, Tomaniak M. Renal Dysfunction Increases Risk of Adverse Cardiovascular Events in 5-Year Follow-Up Study of Intermediate Coronary Artery Lesions. Med Sci Monit 2024; 30:e943956. [PMID: 38720443 DOI: 10.12659/msm.943956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2024] Open
Abstract
BACKGROUND Progression of chronic coronary syndrome (CCS) is influenced by chronic kidney disease (CKD). This 5-year follow-up study aimed to assess 100 patients with 118 intermediate coronary artery lesions evaluated by fractional flow reserve (FFR) and intravascular imaging stratified according to renal function. MATERIAL AND METHODS This prospective study enrolled patients with intermediate coronary stenosis identified by coronary angiogram. Patients with severe renal dysfunction (estimated glomerular filtration rate (eGFR) <45 ml/min/1.73 m²) were excluded from the study. The remaining were divided into 2 groups according to eGFR: 45-60 ml/min/1.73 m² for mild-to-moderate renal dysfunction and >60 ml/min/1.73 m² for no renal dysfunction. We analyzed intermediate-grade stenoses (40-80% as assessed in coronary angiography) with the use of optical coherence tomography (OCT), FFR, and intravascular ultrasound (IVUS). RESULTS Renal dysfunction patients were older (67.7±8.1 vs 63.6±9.7 years, P=0.044). Lesion characteristics, including plaque type and minimal lumen area in OCT, showed no significant differences between the renal dysfunction and no renal dysfunction groups. Thin-cap fibroatheroma, calcific plaques, lipidic plaques, and fibrous plaques had similar prevalence. FFR values and IVUS parameters did not significantly differ between the groups. Over a 5-year follow-up, individuals with mild-to-moderate renal dysfunction had an elevated risk of all-cause mortality and major adverse cardiovascular events in multivariate analyses adjusted for age and sex. CONCLUSIONS Mild-to-moderate renal dysfunction was not associated with significant differences in OCT- and IVUS-derived plaque morphology nor with functional indices characterizing intermediate-grade coronary stenoses. Renal dysfunction was related to a higher risk of all-cause mortality and major adverse cardiovascular events prevalence in 5-year follow-up.
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Affiliation(s)
- Piotr Baruś
- First Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Jaromir Hunia
- First Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Rafał Kaczorowski
- First Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Adrian Bednarek
- First Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Dorota Ochijewicz
- First Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Karolina Gumiężna
- First Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Łukasz Kołtowski
- First Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Janusz Kochman
- First Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Marcin Grabowski
- First Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Mariusz Tomaniak
- First Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
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He W, Fang T, Fu X, Lao M, Xiao X. Risk factors and the CCTA application in patients with vulnerable coronary plaque in type 2 diabetes: a retrospective study. BMC Cardiovasc Disord 2024; 24:89. [PMID: 38311736 PMCID: PMC10840286 DOI: 10.1186/s12872-024-03717-1] [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: 07/26/2023] [Accepted: 01/06/2024] [Indexed: 02/06/2024] Open
Abstract
BACKGROUND Diabetes is an independent risk factor for cardiovascular disease. The purpose of this study was to identify the risk factors for vulnerable coronary plaques (VCPs), which are associated with adverse cardiovascular events, and to determine the value of coronary CT angiography (CCTA) in patients with type 2 diabetes mellitus (T2DM) and VCPs. METHODS Ninety-eight T2DM patients who underwent CCTA and intravascular ultrasound (IVUS) were retrospectively included and analyzed. The patients were grouped and analyzed according to the presence or absence of VCPs. RESULTS Among the patients with T2DM, time in range [TIR {the percentage of time blood glucose levels were in the target range}] (OR = 0.93, 95% CI = 0.89-0.96; P < 0.001) and the high-density lipoprotein-cholesterol (HDL-C) concentration (OR = 0.24, 95% CI = 0.09-0.63; P = 0.04) were correlated with a lower risk of VCP, but the triglycerides (TG) concentration was correlated with a higher risk of VCP (OR = 1.79, 95% CI = 1.01-3.18; P = 0.045). The area under the receiver operator characteristic curve (AUC) of TIR, and HDL-C and TG concentrations were 0.76, 0.73, and 0.65, respectively. The combined predicted AUC of TIR, and HDL-C and TG concentrations was 0.83 (P < 0.05). The CCTA sensitivity, specificity, false-negative, and false-positive values for the diagnosis of VCP were 95.74%, 94.12%, 4.26%, and 5.88%, respectively. The identification of VCP by CCTA was positively correlated with IVUS (intraclass correlation coefficient [ICC] = 0.90). CONCLUSIONS The TIR and HDL-C concentration are related with lower risk of VCP and the TG concentration was related with higher risk of VCP in patients with T2DM. In clinical practice, TIR, HDL-C and TG need special attention in patients with T2DM. The ability of CCTA to identify VCP is highly related to IVUS findings.
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Affiliation(s)
- Weihong He
- Department of Radiology, Foshan Hospital of Traditional Chinese Medicine, Guangzhou University of Traditional Chinese Medicine, Foshan, China.
| | - Tingsong Fang
- Department of Radiology, Foshan Hospital of Traditional Chinese Medicine, Guangzhou University of Traditional Chinese Medicine, Foshan, China
| | - Xi Fu
- Department of Radiology, Foshan Hospital of Traditional Chinese Medicine, Guangzhou University of Traditional Chinese Medicine, Foshan, China
| | - Meiling Lao
- Department of Endocrinology, Foshan Hospital of Traditional Chinese Medicine, Guangzhou University of Traditional Chinese Medicine, Foshan, China
| | - Xiuyun Xiao
- Department of Radiology, Foshan Hospital of Traditional Chinese Medicine, Guangzhou University of Traditional Chinese Medicine, Foshan, China
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Fishman M, Matt A, Wang F, Gracheva E, Zhu J, Ouyang X, Komarov A, Wang Y, Liang H, Zhou C. A Drosophila heart optical coherence microscopy dataset for automatic video segmentation. Sci Data 2023; 10:886. [PMID: 38071220 PMCID: PMC10710430 DOI: 10.1038/s41597-023-02802-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 11/30/2023] [Indexed: 12/18/2023] Open
Abstract
The heart of the fruit fly, Drosophila melanogaster, is a particularly suitable model for cardiac studies. Optical coherence microscopy (OCM) captures in vivo cross-sectional videos of the beating Drosophila heart for cardiac function quantification. To analyze those large-size multi-frame OCM recordings, human labelling has been employed, leading to low efficiency and poor reproducibility. Here, we introduce a robust and accurate automated Drosophila heart segmentation algorithm, called FlyNet 2.0+, which utilizes a long short-term memory (LSTM) convolutional neural network to leverage time series information in the videos, ensuring consistent, high-quality segmentation. We present a dataset of 213 Drosophila heart videos, equivalent to 604,000 cross-sectional images, containing all developmental stages and a wide range of beating patterns, including faster and slower than normal beating, arrhythmic beating, and periods of heart stop to capture these heart dynamics. Each video contains a corresponding ground truth mask. We expect this unique large dataset of the beating Drosophila heart in vivo will enable new deep learning approaches to efficiently characterize heart function to advance cardiac research.
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Affiliation(s)
- Matthew Fishman
- Washington University in St. Louis, Department of Computer Science and Engineering, St. Louis, MO, 63130, USA
| | - Abigail Matt
- Washington University in St. Louis, Department of Biomedical Engineering, St. Louis, MO, 63130, USA
| | - Fei Wang
- Washington University in St. Louis, Department of Biomedical Engineering, St. Louis, MO, 63130, USA
| | - Elena Gracheva
- Washington University in St. Louis, Department of Biomedical Engineering, St. Louis, MO, 63130, USA
| | - Jiantao Zhu
- Washington University in St. Louis, Department of Biomedical Engineering, St. Louis, MO, 63130, USA
| | - Xiangping Ouyang
- Washington University in St. Louis, Department of Computer Science and Engineering, St. Louis, MO, 63130, USA
| | - Andrey Komarov
- Washington University in St. Louis, Department of Biomedical Engineering, St. Louis, MO, 63130, USA
| | - Yuxuan Wang
- Washington University in St. Louis, Department of Biomedical Engineering, St. Louis, MO, 63130, USA
| | - Hongwu Liang
- Washington University in St. Louis, Department of Biomedical Engineering, St. Louis, MO, 63130, USA
| | - Chao Zhou
- Washington University in St. Louis, Department of Biomedical Engineering, St. Louis, MO, 63130, USA.
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Zhao M, Nie H, Wang H, Fang J, Wang F, Wang H, Yu H, Bai X, Zhang Y, Xiong Q, Cai H, Zhao Q. Novel oviduct endoscope combining optical coherence tomography with intratubal ultrasonography for fallopian tube exploration: An in vivo rabbit pilot study. Photodiagnosis Photodyn Ther 2023; 43:103650. [PMID: 37302641 DOI: 10.1016/j.pdpdt.2023.103650] [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: 03/04/2023] [Revised: 05/26/2023] [Accepted: 06/05/2023] [Indexed: 06/13/2023]
Abstract
BACKGROUND AND STUDY AIM Currently, several limitations exist in the examination of the oviduct. In this study, the usefulness and feasibility of a novel ultrafine dual-modality oviduct endoscopy device for in vivo assessment of the oviduct were evaluated. METHODS Five Japanese white rabbits were selected to undergo oviduct probing using a combination of optical coherence tomography (OCT) and intratubal ultrasonography. The feasibility of the procedure was evaluated through 152 pairs of clear, clinically interpretable images obtained using spiral scanning via the pull-back method. OCT images were compared with the oviduct histopathology sections. RESULTS Visualization of the oviduct using both OCT and ultrasound revealed a differentiated three-layer tissue; however, ultrasound showed a poorer clarity than OCT. By comparing OCT images with the histological morphology of the oviduct, the inner low-reflective layer of the oviduct corresponds to the mucosal layer, the middle high-reflective layer corresponds to the fibrous muscle layer, and the outer low-reflective layer corresponds to the connective tissue layer. Postoperatively, the general condition of the animals was good. CONCLUSION This study demonstrated the feasibility and potential clinical value of the novel ultrafine dual-modality oviduct endoscope. Dual-modality imaging of OCT and intratubal ultrasonography can provide clearer microstructure of the oviduct wall.
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Affiliation(s)
- Mengya Zhao
- Department of Gynecologic Oncology, Zhongnan Hospital of Wuhan University, Wuhan 430071, China; Reproductive Medicine Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Haihang Nie
- Department of Gastroenterology, Zhongnan Hospital of Wuhan University, Wuhan 430071, China; Clinical Center and Key Lab of Intestinal and Colorectal Diseases of Hubei Province, Wuhan 430071, China
| | - Hongling Wang
- Department of Gastroenterology, Zhongnan Hospital of Wuhan University, Wuhan 430071, China; Clinical Center and Key Lab of Intestinal and Colorectal Diseases of Hubei Province, Wuhan 430071, China
| | - Jun Fang
- Department of Gastroenterology, Zhongnan Hospital of Wuhan University, Wuhan 430071, China; Clinical Center and Key Lab of Intestinal and Colorectal Diseases of Hubei Province, Wuhan 430071, China
| | - Fan Wang
- Department of Gastroenterology, Zhongnan Hospital of Wuhan University, Wuhan 430071, China; Clinical Center and Key Lab of Intestinal and Colorectal Diseases of Hubei Province, Wuhan 430071, China
| | - Haizhou Wang
- Department of Gastroenterology, Zhongnan Hospital of Wuhan University, Wuhan 430071, China; Clinical Center and Key Lab of Intestinal and Colorectal Diseases of Hubei Province, Wuhan 430071, China
| | - Hualiang Yu
- InnerMedical Co. Ltd, Shenzhen 518000, China
| | | | - Yafei Zhang
- Department of Gastroenterology, Zhongnan Hospital of Wuhan University, Wuhan 430071, China; Clinical Center and Key Lab of Intestinal and Colorectal Diseases of Hubei Province, Wuhan 430071, China
| | | | - Hongbing Cai
- Reproductive Medicine Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China.
| | - Qiu Zhao
- Department of Gastroenterology, Zhongnan Hospital of Wuhan University, Wuhan 430071, China; Clinical Center and Key Lab of Intestinal and Colorectal Diseases of Hubei Province, Wuhan 430071, China.
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Baruś P, Piasecki A, Gumiężna K, Bednarek A, Dunaj P, Głód M, Sadowski K, Ochijewicz D, Rdzanek A, Pietrasik A, Grabowski M, Kochman J, Tomaniak M. Multimodality OCT, IVUS and FFR evaluation of coronary intermediate grade lesions in women vs. men. Front Cardiovasc Med 2023; 10:1021023. [PMID: 37424919 PMCID: PMC10325624 DOI: 10.3389/fcvm.2023.1021023] [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: 08/16/2022] [Accepted: 05/31/2023] [Indexed: 07/11/2023] Open
Abstract
Background The pathophysiology of atherosclerotic plaque formation and its vulnerability seem to differ between genders due to contrasting risk profiles and sex hormones, however this process is still insufficiently understood. The aim of the study was to compare the differences between sexes regarding the optical coherence tomography (OCT), intravascular ultrasound (IVUS) and fractional flow reserve (FFR)-derived coronary plaque indices. Methods In this single-center multimodality imaging study patients with intermediate grade coronary stenoses identified in coronary angiogram (CAG) were evaluated using OCT, IVUS and FFR. Stenoses were considered significant when the FFR value was ≤0.8. Minimal lumen area (MLA), was analyzed by OCT in addition to plaque stratification into fibrotic, calcific, lipidic and thin-cap fibroatheroma (TCFA). IVUS was used for evaluation of lumen-, plaque- and vessel volume, as well as plaque burden. Results A total of 112 patients (88 men and 24 women) with chronic coronary syndromes (CCS), who underwent CAG were enrolled. No significant differences in baseline characteristics were present between the study groups. The mean FFR was 0.76 (0.73-0.86) in women and 0.78 ± 0.12 in men (p = 0.695). OCT evaluation showed a higher prevalence of calcific plaques among women than men p = 0.002 whereas lipid plaques were more frequent in men (p = 0.04). No significant differences regarding minimal lumen diameter and minimal lumen area were found between the sexes. In IVUS analysis women presented with significantly smaller vessel area, plaque area, plaque volume, vessel volume (11.1 ± 3.3 mm2 vs. 15.0 ± 4.6 mm2 p = 0.001, 6.04 ± 1.7 mm2 vs. 9.24 ± 2.89 mm2 p < 0.001, 59.8 ± 35.2 mm3 vs. 96.3 (52.5-159.1) mm3 p = 0.005, 106.9 ± 59.8 mm3 vs. 153.3 (103-253.4) mm3 p = 0.015 respectively). At MLA site plaque burden was significantly greater for men than women (61.50 ± 7.7% vs. 55.5 ± 8.0% p = 0.005). Survival did not differ significantly between women and men (94.6 ± 41.9 months and 103.51 ± 36.7 months respectively; p = 0.187). Conclusion The presented study did not demonstrate significant differences in FFR values between women and men, yet a higher prevalence of calcific plaques by OCT and lower plaque burden at the MLA site by IVUS was found in women vs. men.
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Siddiqi TJ, Khan MS, Karimi Galougahi K, Shlofmitz E, Moses JW, Rao S, West NEJ, Wolff E, Hochler J, Chau K, Khalique O, Shlofmitz RA, Jeremias A, Ali ZA. Optical coherence tomography versus angiography and intravascular ultrasound to guide coronary stent implantation: A systematic review and meta-analysis. Catheter Cardiovasc Interv 2022; 100 Suppl 1:S44-S56. [PMID: 36251325 DOI: 10.1002/ccd.30416] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Accepted: 09/02/2022] [Indexed: 01/24/2023]
Abstract
BACKGROUND Optical coherence tomography (OCT) is an adjunct to angiography-guided coronary stent placement. However, in the absence of dedicated, appropriately powered randomized controlled trials, the impact of OCT on clinical outcomes is unclear. OBJECTIVE To conduct a systematic review and meta-analysis of all available studies comparing OCT-guided versus angiography-guided and intravascular ultrasound (IVUS)-guided coronary stent implantation. METHODS MEDLINE and Cochrane Central were queried from their inception through July 2022 for all studies that sought to compare OCT-guided percutaneous coronary intervention (PCI) to angiography-guided and IVUS-guided PCI. The primary endpoint was minimal stent area (MSA) compared between modalities. Clinical endpoints of interest were all-cause and cardiovascular mortality, major adverse cardiovascular events (MACE), myocardial infarction (MI), target lesion revascularization (TLR), target vessel revascularization (TVR), and stent thrombosis (ST). Risk ratios (RRs) and mean differences (MDs) with their corresponding 95% confidence intervals (CIs) were pooled using a random-effects model. RESULTS Thirteen studies (8 randomized control trials and 5 observational studies) enrolling 6312 participants were included. OCT was associated with a strong trend toward increased MSA compared to angiography (MD = 0.36, p = 0.06). OCT-guided PCI was also associated with a reduction in the incidence of all-cause mortality [RR = 0.59, 95% CI (0.35, 0.97), p = 0.04] and cardiovascular mortality [RR = 0.41, 95% CI (0.21, 0.80), p = 0.009] compared with angiography-guided PCI. Point estimates favored OCT relative to angiography in MACE [RR = 0.75, 95% CI (0.47, 1.20), p = 0.22] and MI [RR = 0.75, 95% CI (0.53, 1.07), p = 0.12]. No differences were detected in ST [RR = 0.71, 95% CI (0.21, 2.44), p = 0.58], TLR [RR = 0.71, 95% CI (0.17, 3.05), p = 0.65], or TVR rates [RR = 0.89, 95% CI (0.46, 1.73), p = 0.73]. Compared with IVUS guidance, OCT guidance was associated with a nonsignificant reduction in the MSA (MD = -0.16, p = 0.27). The rates of all-cause and cardiovascular mortality, MACE, MI, TLR, TVR, or ST were similar between OCT-guided and IVUS-guided PCI. CONCLUSIONS OCT-guided PCI was associated with reduced all-cause and cardiovascular mortality compared to angiography-guided PCI. These results should be considered hypothesis generating as the mechanisms for the improved outcomes were unclear as no differences were detected in the rates of TLR, TVR, or ST. OCT- and IVUS-guided PCI resulted in similar post-PCI outcomes.
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Affiliation(s)
- Tariq Jamal Siddiqi
- Department of Medicine, University of Mississippi Medical Center, Jackson, USA
| | - Muhammad Shahzeb Khan
- Department of Medicine, Division of Cardiology, Duke University Medical Center, Raleigh-Durham, North Carolina, USA
| | - Keyvan Karimi Galougahi
- St. Francis Hospital, Roslyn, New York, USA.,Department of Medicine, Clinical Trials Center, Cardiovascular Research Foundation, New York, New York, USA
| | | | - Jeffrey W Moses
- St. Francis Hospital, Roslyn, New York, USA.,Department of Medicine, Division of Cardiology, Columbia University Medical Center, New York, New York, USA
| | - Sunil Rao
- Department of Medicine, Division of Cardiology, Duke University Medical Center, Raleigh-Durham, North Carolina, USA
| | | | - Eric Wolff
- St. Francis Hospital, Roslyn, New York, USA
| | | | - Karen Chau
- St. Francis Hospital, Roslyn, New York, USA
| | | | | | - Allen Jeremias
- St. Francis Hospital, Roslyn, New York, USA.,Department of Medicine, Clinical Trials Center, Cardiovascular Research Foundation, New York, New York, USA
| | - Ziad A Ali
- St. Francis Hospital, Roslyn, New York, USA.,Department of Medicine, Clinical Trials Center, Cardiovascular Research Foundation, New York, New York, USA
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Serial Changes in Coronary Plaque Formation Using CT Angiography in Patients Undergoing PCSK9-Inhibitor Therapy With 1-year Follow-up. J Thorac Imaging 2022; 37:285-291. [PMID: 35797638 DOI: 10.1097/rti.0000000000000666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
PURPOSE Previous studies have shown positive effects of intensive low-density lipoprotein (LDL)-lowering therapy on atheroma volume using invasive intravascular ultrasound. This study describes the changes in coronary plaque composition on coronary computed tomography angiography in patients treated with proprotein convertase subtilisin kexin type 9 (PCSK9) inhibitors. MATERIALS AND METHODS In this prospective study, coronary plaques were analyzed using third-generation dual-source computed tomography before and after 1 year of PCSK9-inhibitor treatment. Plaque markers included total plaque volume (TPV), calcified plaque volume (CPV), noncalcified plaque volume (NCPV), lumen volume and vessel volume (VV), minimal luminal area (MLA), minimal lumen diameter (MLD), corrected coronary opacification, eccentricity, remodeling index, and functional plaque parameters. Primary endpoint was defined as change in TPV; the secondary endpoint was TPV or CPV regression or nominal change in plaque parameters. RESULTS We analyzed 74 coronary plaques in 23 patients (60±9 y, 65% male). After 1 year of PCSK9-inhibitor treatment, LDL was reduced from 148 to 66 mg/dL ( P <0.0001). Significant changes were found for VV (196 to 215 mm 3 , P =0.0340), MLA (3.1 to 2.6 mm 2 , P =0.0413), and MLD (1.7 to 1.4 mm, P =0.0048). TPV, CPV, NCPV, lumen volume, and functional plaque parameters did not change significantly ( P >0.05). CONCLUSIONS Coronary artery plaque analysis by coronary computed tomography angiography highlights that LDL lowering therapy affects plaque composition. The primary endpoint of TPV change was not reached; however, VV, MLA, and MLD changed significantly.
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Optical coherence tomography in the diagnosis of myocardial infarction with non-obstructive coronary arteries. Adv Cardiol 2022; 18:192-200. [PMID: 36751279 PMCID: PMC9885232 DOI: 10.5114/aic.2022.121233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2022] [Accepted: 10/23/2022] [Indexed: 11/24/2022]
Abstract
Myocardial infarction with non-obstructive coronary arteries (MINOCA) is a working diagnosis and requires identification of the underlying causes to optimize treatment, improve prognosis, and prevent the recurrence of myocardial infarction. According to the literature, the prognosis of patients diagnosed with MINOCA is comparable to the group of patients with myocardial infarction (MI) and significant stenosis of the coronary arteries. Intracoronary imaging is a crucial diagnostic tool used in identifying epicardial causes of MINOCA that are not visible in coronary angiography. Optical coherence tomography (OCT) provides the highest spatial resolution, simultaneously allowing detailed visualization of plaque pathology in individuals with MINOCA and identifying the cause of MI in up to 80% of patients. Common causes of a MINOCA may include plaque disruption, spontaneous coronary artery dissection (SCAD), coronary artery spasm, and coronary thromboembolism. The optimization of pharmacological treatment in this group of patients, especially dual antiplatelet therapy and statins, improves the prognosis. Data on the indications for invasive treatment of patients with MINOCA based on OCT findings are insufficient. There is a strong need for research comparing treatment strategies, especially in high-risk lesions visualized in OCT. The main aim of this review is to demonstrate the usefulness of OCT in determining the mechanism of MINOCA.
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Baruś P, Modrzewski J, Gumiężna K, Dunaj P, Głód M, Bednarek A, Wańha W, Roleder T, Kochman J, Tomaniak M. Comparative Appraisal of Intravascular Ultrasound and Optical Coherence Tomography in Invasive Coronary Imaging: 2022 Update. J Clin Med 2022; 11:jcm11144055. [PMID: 35887819 PMCID: PMC9324054 DOI: 10.3390/jcm11144055] [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: 05/13/2022] [Revised: 07/09/2022] [Accepted: 07/11/2022] [Indexed: 02/04/2023] Open
Abstract
Although coronary angiography has been well established as a standard modality for percutaneous coronary intervention guidance, recent developments in intravascular imaging techniques, such as intravascular ultrasound and optical coherence tomography, have become increasingly adopted, enabling direct detailed lesion visualization, including lesions beyond the scope of assessment using exclusively angiography. Intravascular imaging modalities have been reported to potentially improve both short- and long-term percutaneous intervention outcomes. This review aims to provide a comparative summary of recent advancements in research regarding the clinical applications and outcomes of intravascular ultrasound and optical coherence tomography.
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Affiliation(s)
- Piotr Baruś
- First Department of Cardiology, Medical University of Warsaw, 02-091 Warsaw, Poland; (P.B.); (J.M.); (K.G.); (P.D.); (M.G.); (A.B.); (J.K.)
| | - Jakub Modrzewski
- First Department of Cardiology, Medical University of Warsaw, 02-091 Warsaw, Poland; (P.B.); (J.M.); (K.G.); (P.D.); (M.G.); (A.B.); (J.K.)
| | - Karolina Gumiężna
- First Department of Cardiology, Medical University of Warsaw, 02-091 Warsaw, Poland; (P.B.); (J.M.); (K.G.); (P.D.); (M.G.); (A.B.); (J.K.)
| | - Piotr Dunaj
- First Department of Cardiology, Medical University of Warsaw, 02-091 Warsaw, Poland; (P.B.); (J.M.); (K.G.); (P.D.); (M.G.); (A.B.); (J.K.)
| | - Marcin Głód
- First Department of Cardiology, Medical University of Warsaw, 02-091 Warsaw, Poland; (P.B.); (J.M.); (K.G.); (P.D.); (M.G.); (A.B.); (J.K.)
| | - Adrian Bednarek
- First Department of Cardiology, Medical University of Warsaw, 02-091 Warsaw, Poland; (P.B.); (J.M.); (K.G.); (P.D.); (M.G.); (A.B.); (J.K.)
| | - Wojciech Wańha
- Department of Cardiology and Structural Heart Diseases, Medical University of Silesia, 40-055 Katowice, Poland;
| | - Tomasz Roleder
- Department of Cardiology, Regional Specialist Hospital in Wrocław, 51-124 Wroclaw, Poland;
| | - Janusz Kochman
- First Department of Cardiology, Medical University of Warsaw, 02-091 Warsaw, Poland; (P.B.); (J.M.); (K.G.); (P.D.); (M.G.); (A.B.); (J.K.)
| | - Mariusz Tomaniak
- First Department of Cardiology, Medical University of Warsaw, 02-091 Warsaw, Poland; (P.B.); (J.M.); (K.G.); (P.D.); (M.G.); (A.B.); (J.K.)
- Correspondence: ; Tel.: +48-599-19-51
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Li X, Sun S, Luo D, Yang X, Ye J, Guo X, Xu S, Sun B, Zhang Y, Luo J, Zhou Y, Tu S, Dong H. Microvascular and Prognostic Effect in Lesions With Different Stent Expansion During Primary PCI for STEMI: Insights From Coronary Physiology and Intravascular Ultrasound. Front Cardiovasc Med 2022; 9:816387. [PMID: 35355977 PMCID: PMC8959302 DOI: 10.3389/fcvm.2022.816387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 02/07/2022] [Indexed: 12/05/2022] Open
Abstract
Background While coronary stent implantation in ST-elevation myocardial infarction (STEMI) can mechanically revascularize culprit epicardial vessels, it might also cause distal embolization. The relationship between geometrical and functional results of stent expansion during the primary percutaneous coronary intervention (pPCI) is unclear. Objective We sought to determine the optimal stent expansion strategy in pPCI using novel angiography-based approaches including angiography-derived quantitative flow ratio (QFR)/microcirculatory resistance (MR) and intravascular ultrasound (IVUS). Methods Post-hoc analysis was performed in patients with acute STEMI and high thrombus burden from our prior multicenter, prospective cohort study (ChiCTR1800019923). Patients aged 18 years or older with STEMI were eligible. IVUS imaging, QFR, and MR were performed during pPCI, while stent expansion was quantified on IVUS images. The patients were divided into three subgroups depending on the degree of stent expansion as follows: overexpansion (>100%), optimal expansion (80%−100%), and underexpansion (<80%). The patients were followed up for 12 months after PCI. The primary endpoint included sudden cardiac death, myocardial infarction, stroke, unexpected hospitalization or unplanned revascularization, and all-cause death. Results A total of 87 patients were enrolled. The average stent expansion degree was 82% (in all patients), 117% (in overexpansion group), 88% (in optimal expansion), and 75% (in under-expansion). QFR, MR, and flow speed increased in all groups after stenting. The overall stent expansion did not affect the final QFR (p = 0.08) or MR (p = 0.09), but it reduced the final flow speed (−0.14 cm/s per 1%, p = 0.02). Under- and overexpansion did not affect final QFR (p = 0.17), MR (p = 0.16), and flow speed (p = 0.10). Multivariable Cox analysis showed that stent expansion was not the risk factor for MACE (hazard ratio, HR = 0.97, p = 0.13); however, stent expansion reduced the risk of MACE (HR = 0.95, p = 0.03) after excluding overexpansion patients. Overexpansion was an independent risk factor for no-reflow (HR = 1.27, p = 0.02) and MACE (HR = 1.45, p = 0.007). Subgroup analysis shows that mild underexpansion of 70%−80% was not a risk factor for MACE (HR = 1.11, p = 0.08) and no-reflow (HR = 1.4, p = 0.08); however, stent expansion <70% increased the risk of MACE (HR = 1.36, p = 0.04). Conclusions Stent expansion does not affect final QFR and MR, but it reduces flow speed in STEMI. Appropriate stent underexpansion of 70–80% does not seem to be associated with short-term prognosis, so it may be tolerable as noninferior compared with optimal expansion. Meanwhile, overexpansion and underexpansion of <70% should be avoided due to the independent risk of MACEs and no-reflow events.
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Affiliation(s)
- Xida Li
- Guangdong Provincial People's Hospital Zhuhai Hospital (Zhuhai Golden Bay Hospital), Zhuhai, China
- Department of Cardiology, Southern Medical University, Guangzhou, China
| | - Shuo Sun
- Guangdong Provincial People's Hospital, Guangdong Cardiovascular Institute, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Demou Luo
- The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Xing Yang
- Guangdong Provincial People's Hospital Zhuhai Hospital (Zhuhai Golden Bay Hospital), Zhuhai, China
| | - Jingguang Ye
- Guangdong Provincial People's Hospital Zhuhai Hospital (Zhuhai Golden Bay Hospital), Zhuhai, China
| | - Xiaosheng Guo
- Guangdong Provincial People's Hospital Zhuhai Hospital (Zhuhai Golden Bay Hospital), Zhuhai, China
| | - Shenghui Xu
- Guangdong Provincial People's Hospital Zhuhai Hospital (Zhuhai Golden Bay Hospital), Zhuhai, China
| | - Boyu Sun
- Guangdong Provincial People's Hospital Zhuhai Hospital (Zhuhai Golden Bay Hospital), Zhuhai, China
| | - Youti Zhang
- Department of Cardiology, Guangdong Provincial Jiexi People's Hospital, Jiexi, China
| | - Jianfang Luo
- Department of Cardiology, Southern Medical University, Guangzhou, China
- Guangdong Provincial People's Hospital, Guangdong Cardiovascular Institute, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Yingling Zhou
- Guangdong Provincial People's Hospital, Guangdong Cardiovascular Institute, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Shengxian Tu
- Med-X Research Institute, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
- Shengxian Tu
| | - Haojian Dong
- Guangdong Provincial People's Hospital, Guangdong Cardiovascular Institute, Guangdong Academy of Medical Sciences, Guangzhou, China
- *Correspondence: Haojian Dong
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Ma W, Wang Q, Wang B, Wang C, Niu X, Zhang D, Liu H, Niu X, Liu Y, Guo W, Lu S, Chu Y, Li Y. Novel predictors of stent under-expansion regarding calcified coronary lesions assessed by optical coherence tomography. Catheter Cardiovasc Interv 2022; 99 Suppl 1:1473-1481. [PMID: 35199934 DOI: 10.1002/ccd.30118] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Accepted: 01/02/2022] [Indexed: 01/16/2023]
Abstract
A previous calcium scoring system using circumferential angle, thickness, and length of coronary calcium by OCT could assist in predicting stent under-expansion. However, this scoring system only reflects the calcification distribution within a single cross-section and fails to consider the lumen's original size. The current study aims to investigate whether novel parameters to quantify calcium lesions, including calcium burden, area, and volume assessed by optical coherence tomography (OCT), could predict stent under-expansion related to calcium lesions. Consecutive patients admitted between March 10th to October 19th 2021 with calcified coronary lesions undergoing percutaneous coronary intervention (PCI) with OCT guidance were screened for inclusion. The calcium burden, area, and volume of the target lesions were measured using OCT at pre-PCI. After successful stent implantation, stent expansion at the corresponding lesions was also measured by OCT. A total of 125 patients who underwent OCT-guided PCI were included in this study. While the calcium grades by angiography failed to show a significant correlation with stent expansion, maximum and average calcium burden, maximum calcium area, and calcium volume exhibited a moderate correlation with stent expansion. According to the receiver operating characteristic curves, the optimal cutoffs of calcium volume and area for predicting stent under-expansion were 4.37 mm3 and 2.48 mm2 , respectively. Calcium burden, area, and volume by OCT are more favorable predictors of stent under-expansion given its better performance than calcium grades by angiography. Using cutoffs of calcium area and volume could identify high-risk patients of under-expansion and might guide future clinical practice.
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Affiliation(s)
- Wenshuai Ma
- Department of Cardiology, Tangdu Hospital, Air Force Military Medical University, Xi'an, China
| | - Qiuhe Wang
- Department of Cardiology, Tangdu Hospital, Air Force Military Medical University, Xi'an, China
| | - Bin Wang
- Department of Cardiology, Tangdu Hospital, Air Force Military Medical University, Xi'an, China
| | - Chiyao Wang
- Department of Cardiology, Tangdu Hospital, Air Force Military Medical University, Xi'an, China
| | - Xiaona Niu
- Department of Cardiology, Tangdu Hospital, Air Force Military Medical University, Xi'an, China
| | - Dongwei Zhang
- Department of Cardiology, Tangdu Hospital, Air Force Military Medical University, Xi'an, China
| | - Hui Liu
- Department of Cardiology, Tangdu Hospital, Air Force Military Medical University, Xi'an, China
| | - Xiaolin Niu
- Department of Cardiology, Tangdu Hospital, Air Force Military Medical University, Xi'an, China
| | - Yin Liu
- Department of Cardiology, Tangdu Hospital, Air Force Military Medical University, Xi'an, China
| | - Wangang Guo
- Department of Cardiology, Tangdu Hospital, Air Force Military Medical University, Xi'an, China
| | - Shaoping Lu
- Department of Cardiology, Tangdu Hospital, Air Force Military Medical University, Xi'an, China
| | - Yi Chu
- Department of Cardiology, Tangdu Hospital, Air Force Military Medical University, Xi'an, China
| | - Yan Li
- Department of Cardiology, Tangdu Hospital, Air Force Military Medical University, Xi'an, China
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Nie H, Wang F, Xiong Q, Dong L, Fang J, Wang H, Zhao Q. Novel biliopancreatic duct endoscope combining optical coherence tomography with intraductal US for exploring the bile duct: a diagnostic study in a porcine model. Gastrointest Endosc 2021; 94:1136-1142. [PMID: 34274345 DOI: 10.1016/j.gie.2021.07.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 07/05/2021] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS Existing biliopancreatic duct endoscopy is deficient in the examination of early biliary and pancreatic tumors. This study aimed to evaluate the usefulness and feasibility of a novel ultrafine, separable, biliopancreatic duct endoscopy device with dual modalities of intraductal US (IDUS) and optical coherence tomography (OCT) for the in vivo assessment of the biliopancreatic duct system during ERCP. METHODS Five Bama miniature pigs were selected to probe their common bile duct and branches by using this novel equipment during ERCP. The feasibility of the procedure was evaluated by clear, clinically interpretable images obtained by using spiral scanning with the pull-back method. The clinical usefulness of the novel product was evaluated by postoperative choledochoscopy and assessment of the animal's general condition. RESULTS One hundred forty-one pairs of images from 5 Bama miniature pigs were acquired. Visualization of the bile duct using both OCT and IDUS was characterized by a differentiated 3-layer architecture, whereas IDUS had poor clarity when compared with OCT. Postoperative choledochoscopy showed no local lesion in the bile duct wall, and the general condition of animals was normal. CONCLUSIONS This prospective evaluation indicated the feasibility and potential clinical value of the novel, ultrafine, separable biliopancreatic duct endoscopy device. The fusion of the 2 imaging modalities can shed light on the early diagnosis of biliary and pancreatic tumors. Further studies will be carried out to establish diagnosis criteria with the dual-modality imaging using an animal pathologic model and a human clinical study.
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Affiliation(s)
- Haihang Nie
- Department of Gastroenterology, Zhongnan Hospital of Wuhan University, Wuhan, China; Clinical Center and Key Lab of Intestinal and Colorectal Diseases of Hubei Province, Wuhan, China
| | - Fan Wang
- Department of Gastroenterology, Zhongnan Hospital of Wuhan University, Wuhan, China; Clinical Center and Key Lab of Intestinal and Colorectal Diseases of Hubei Province, Wuhan, China
| | | | - Li Dong
- Department of Gastroenterology, Zhongnan Hospital of Wuhan University, Wuhan, China; Clinical Center and Key Lab of Intestinal and Colorectal Diseases of Hubei Province, Wuhan, China
| | - Jun Fang
- Department of Gastroenterology, Zhongnan Hospital of Wuhan University, Wuhan, China; Clinical Center and Key Lab of Intestinal and Colorectal Diseases of Hubei Province, Wuhan, China
| | - Hongling Wang
- Department of Gastroenterology, Zhongnan Hospital of Wuhan University, Wuhan, China; Clinical Center and Key Lab of Intestinal and Colorectal Diseases of Hubei Province, Wuhan, China
| | - Qiu Zhao
- Department of Gastroenterology, Zhongnan Hospital of Wuhan University, Wuhan, China; Clinical Center and Key Lab of Intestinal and Colorectal Diseases of Hubei Province, Wuhan, China
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Staessens S, François O, Brinjikji W, Doyle KM, Vanacker P, Andersson T, De Meyer SF. Studying Stroke Thrombus Composition After Thrombectomy: What Can We Learn? Stroke 2021; 52:3718-3727. [PMID: 34517770 PMCID: PMC8545837 DOI: 10.1161/strokeaha.121.034289] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
The composition of ischemic stroke thrombi has gained an increasing amount of interest in recent years. The implementation of endovascular procedures in standard stroke care has granted researchers the unique opportunity to examine patient thrombus material. Increasing evidence indicates that stroke thrombi are complex and heterogenous, consisting of various biochemical (eg, fibrin, von Willebrand Factor, and neutrophil extracellular traps) and cellular (eg, red blood cells, platelets, leukocytes, and bacteria) components. This complex composition may explain therapeutic limitations and also offer novel insights in several aspects of stroke management. Better understanding of thrombus characteristics could, therefore, potentially lead to improvements in the management of patients with stroke. In this review, we provide a comprehensive overview of the lessons learned by examining stroke thrombus composition after endovascular thrombectomy and its potential relevance for thrombectomy success rates, thrombolysis, clinical outcomes, stroke etiology, and radiological imaging.
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Affiliation(s)
- Senna Staessens
- Laboratory for Thrombosis Research, KU Leuven Campus Kulak Kortrijk, Kortrijk, Belgium
| | | | | | - Karen M. Doyle
- CÚRAM-Centre for Research in Medical Devices, National University of Ireland Galway, Galway, Ireland
| | - Peter Vanacker
- Department of Neurology, AZ Groeninge, Kortrijk, Belgium
- Department of Neurology, University Hospitals Antwerp, Antwerp, Belgium
- Department of Translational Neuroscience, University of Antwerp, Antwerp, Belgium
| | - Tommy Andersson
- Department of Medical Imaging, AZ Groeninge, Kortrijk, Belgium
- Department of Neuroradiology, Karolinska University Hospital and Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Simon F. De Meyer
- Laboratory for Thrombosis Research, KU Leuven Campus Kulak Kortrijk, Kortrijk, Belgium
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Bryniarski K, Gasior P, Legutko J, Makowicz D, Kedziora A, Szolc P, Bryniarski L, Kleczynski P, Jang IK. OCT Findings in MINOCA. J Clin Med 2021; 10:2759. [PMID: 34201727 PMCID: PMC8269308 DOI: 10.3390/jcm10132759] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 06/16/2021] [Accepted: 06/17/2021] [Indexed: 11/24/2022] Open
Abstract
Myocardial infarction with non-obstructive coronary artery disease (MINOCA) is a working diagnosis for patients presenting with acute myocardial infarction without obstructive coronary artery disease on coronary angiography. It is a heterogenous entity with a number of possible etiologies that can be determined through the use of appropriate diagnostic algorithms. Common causes of a MINOCA may include plaque disruption, spontaneous coronary artery dissection, coronary artery spasm, and coronary thromboembolism. Optical coherence tomography (OCT) is an intravascular imaging modality which allows the differentiation of coronary tissue morphological characteristics including the identification of thin cap fibroatheroma and the differentiation between plaque rupture or erosion, due to its high resolution. In this narrative review we will discuss the role of OCT in patients presenting with MINOCA. In this group of patients OCT has been shown to reveal abnormal findings in almost half of the cases. Moreover, combining OCT with cardiac magnetic resonance (CMR) was shown to allow the identification of most of the underlying mechanisms of MINOCA. Hence, it is recommended that both OCT and CMR can be used in patients with a working diagnosis of MINOCA. Well-designed prospective studies are needed in order to gain a better understanding of this condition and to provide optimal management while reducing morbidity and mortality in that subset patients.
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Affiliation(s)
- Krzysztof Bryniarski
- Jagiellonian University Medical College, Institute of Cardiology, Department of Interventional Cardiology, John Paul II Hospital, 31-202 Krakow, Poland; (K.B.); (J.L.); (P.S.); (P.K.)
| | - Pawel Gasior
- Division of Cardiology and Structural Heart Diseases, Medical University of Silesia, 40-635 Katowice, Poland;
| | - Jacek Legutko
- Jagiellonian University Medical College, Institute of Cardiology, Department of Interventional Cardiology, John Paul II Hospital, 31-202 Krakow, Poland; (K.B.); (J.L.); (P.S.); (P.K.)
| | - Dawid Makowicz
- Interventional Cardiology, Electrotherapy and Angiology Department, John Paul II Hospital, 38-400 Krosno, Poland;
| | - Anna Kedziora
- Department of Cardiovascular Surgery and Transplantation, John Paul II Hospital, 31-202 Krakow, Poland;
| | - Piotr Szolc
- Jagiellonian University Medical College, Institute of Cardiology, Department of Interventional Cardiology, John Paul II Hospital, 31-202 Krakow, Poland; (K.B.); (J.L.); (P.S.); (P.K.)
| | - Leszek Bryniarski
- 2nd Department of Cardiology and Cardiovascular Interventions, University Hospital, Institute of Cardiology, Jagiellonian University Medical College, 31-501 Krakow, Poland;
| | - Pawel Kleczynski
- Jagiellonian University Medical College, Institute of Cardiology, Department of Interventional Cardiology, John Paul II Hospital, 31-202 Krakow, Poland; (K.B.); (J.L.); (P.S.); (P.K.)
| | - Ik-Kyung Jang
- Cardiology Division, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street|GRB 800, Boston, MA 02114, USA
- Department of Cardiology, School of Medicine, Kyung Hee University, Dongdaemoon-gu, Seoul 130-701, Korea
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Bays HE, Khera A, Blaha MJ, Budoff MJ, Toth PP. Ten things to know about ten imaging studies: A preventive cardiology perspective ("ASPC top ten imaging"). Am J Prev Cardiol 2021; 6:100176. [PMID: 34327499 PMCID: PMC8315431 DOI: 10.1016/j.ajpc.2021.100176] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 03/16/2021] [Accepted: 03/19/2021] [Indexed: 02/07/2023] Open
Abstract
Knowing the patient's current cardiovascular disease (CVD) status, as well as the patient's current and future CVD risk, helps the clinician make more informed patient-centered management recommendations towards the goal of preventing future CVD events. Imaging tests that can assist the clinician with the diagnosis and prognosis of CVD include imaging studies of the heart and vascular system, as well as imaging studies of other body organs applicable to CVD risk. The American Society for Preventive Cardiology (ASPC) has published "Ten Things to Know About Ten Cardiovascular Disease Risk Factors." Similarly, this "ASPC Top Ten Imaging" summarizes ten things to know about ten imaging studies related to assessing CVD and CVD risk, listed in tabular form. The ten imaging studies herein include: (1) coronary artery calcium imaging (CAC), (2) coronary computed tomography angiography (CCTA), (3) cardiac ultrasound (echocardiography), (4) nuclear myocardial perfusion imaging (MPI), (5) cardiac magnetic resonance (CMR), (6) cardiac catheterization [with or without intravascular ultrasound (IVUS) or coronary optical coherence tomography (OCT)], (7) dual x-ray absorptiometry (DXA) body composition, (8) hepatic imaging [ultrasound of liver, vibration-controlled transient elastography (VCTE), CT, MRI proton density fat fraction (PDFF), magnetic resonance spectroscopy (MRS)], (9) peripheral artery / endothelial function imaging (e.g., carotid ultrasound, peripheral doppler imaging, ultrasound flow-mediated dilation, other tests of endothelial function and peripheral vascular imaging) and (10) images of other body organs applicable to preventive cardiology (brain, kidney, ovary). Many cardiologists perform cardiovascular-related imaging. Many non-cardiologists perform applicable non-cardiovascular imaging. Cardiologists and non-cardiologists alike may benefit from a working knowledge of imaging studies applicable to the diagnosis and prognosis of CVD and CVD risk - both important in preventive cardiology.
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Affiliation(s)
- Harold E. Bays
- Louisville Metabolic and Atherosclerosis Research Center, 3288 Illinois Avenue, Louisville KY 40213 USA
| | - Amit Khera
- UT Southwestern Medical Center, Dallas, TX USA
| | - Michael J. Blaha
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Baltimore MD USA
| | - Matthew J Budoff
- Department of Medicine, Lundquist Institute at Harbor-UCLA, Torrance CA USA
| | - Peter P. Toth
- CGH Medical Cener, Sterling, IL 61081 USA
- Cicarrone center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, MD USA
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Alsagaff MY, Hidayat DFO, Daida H. Simultaneous kissing stents in acute left main total occlusion complicated with cardiogenic shock. BMJ Case Rep 2021; 14:14/4/e241245. [PMID: 33875505 PMCID: PMC8057574 DOI: 10.1136/bcr-2020-241245] [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: 11/03/2022] Open
Abstract
We present a case of acute left main bifurcation lesion presenting as very high-risk non-ST elevation acute coronary syndrome. Consequently, an immediate invasive strategy for this complex anatomical lesion in an unstable patient requires an emergent bailout strategy to restore the haemodynamic condition.Our case shows the simultaneous kissing stents technique in a patient with a true left main bifurcation lesion (Medina 1-1-1) as a strategy to overcome the compromised haemodynamics. This protocol would be an alternative life-saving strategy in an acute setting.
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Affiliation(s)
- Mochamad Yusuf Alsagaff
- Department of Cardiology and Vascular Medicine, Airlangga University, Surabaya, East Java, Indonesia
| | | | - Hiroyuki Daida
- Cardiology, Juntendo University School of Medicine, Bunkyo-ku, Tokyo, Japan
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Gupta A, Chhikara S, Singh N, Prasad K. Optical coherence tomography-guided management of underexpanded stent in calcified coronary lesion. BMJ Case Rep 2021; 14:14/1/e239143. [PMID: 33495188 PMCID: PMC7839892 DOI: 10.1136/bcr-2020-239143] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
Calcified lesions often result in undilatable lesions, balloon dog-boning, poor device delivery as well as underexpanded stents (UES). This leads to an increased risk of acute and chronic stent failure. A 49-year-old man was admitted with anterior wall myocardial infarction and angiogram showed a diffuse calcific left anterior descending artery/diagonal lesion, which was stented with two overlapping drug-eluting stents. Angiogram after post-dilatation showed UES. Optical coherence tomography (OCT) confirmed UES with 58% expansion, minimum stent area (MSA) of 2.91 mm2 and 360° calcium arc around the stent. This UES was dilated with a ultra high-pressure balloon (UHPB) at 40 atmosphere, that led to calcium fracture and increased MSA to 7.42 mm2 and stent expansion to 97%. While OCT-guided lesion modification prior to stenting is ideal, OCT-guided assessment and management is also invaluable post-percutaneous coronary intervention. In the event of stent underexpansion, UHPB may be used as an initial management strategy.
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Affiliation(s)
- Ankush Gupta
- Department of Cardiology, Military Hospital Jaipur, Jaipur, India
| | - Sanya Chhikara
- Department of Cardiology, Base Hospital Delhi Cantt, New Delhi, India
| | - Navreet Singh
- Cardiology, Air Force Central Medical Establishment, New Delhi, Delhi, India
| | - Krishna Prasad
- Cardiology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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