1
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Yang Q, Ma X, Wang Y. Long-term outcomes of IVUS-guided and angiography-guided drug-eluting stent implantation for left main coronary artery disease: a retrospective consort study. J Cardiothorac Surg 2024; 19:407. [PMID: 38951893 PMCID: PMC11218326 DOI: 10.1186/s13019-024-02800-0] [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: 12/13/2023] [Accepted: 05/25/2024] [Indexed: 07/03/2024] Open
Abstract
BACKGROUND In patients with unprotected left main coronary artery disease (ULMCAD), this study compared the long-term prognosis of drug-eluting stent insertion guided by intravascular ultrasonography (IVUS) vs. angiography. PATIENTS AND METHODS This retrospective consort investigation was performed in December 2021. This analysis included 199 patients who underwent IVUS-guided (IVUS group, n = 81) or angiography-guided (angiography group, n = 118) drug-eluting stent implantation at the Affiliated Hospital of Inner Mongolia Medical University between September 2013 and September 2018. Major adverse cardiac events (MACE) were defined as cardiovascular death, sudden cardiac death, myocardial infarction. RESULTS The IVUS group had considerably lower proportions of MACE within 1 year postoperatively (P = 0.002) and cardiac mortality within 3 years postoperatively (P = 0.018) compared to the angiography group. However, after adjusting for confounding variables, the hazard ratio for 3-year cardiac mortality was similar between the two groups (P = 0.28). In the IVUS group, there was considerably greater minimum lumen diameter (MLD) (P = 0.046), and reduced frequencies of target vessel restenosis (P < 0.050) and myocardial infarction (MI) (P = 0.024) compared to the angiography group. Cox regression analysis for 3-year cardiac mortality found that MSD was independently associated with low cardiac mortality (HR = 0.1, 95% CI: 0.01-14.92, P = 0.030). CONCLUSION IVUS-guided drug-eluting stent implantation may lead to better long-term prognosis in patients with ULMCAD, and MSD may be a predictor for lower cardiac mortality.
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Affiliation(s)
- Qing Yang
- Department of Emergency Cardiovascular Medicine, Inner Mongolian People Hospital, Hohhot, 010000, China
| | - Xiaoyi Ma
- Department of cardiovascular medicine, Dalat people's Hospital, Erdos, 014300, China
| | - Yuexi Wang
- Department of cardiovascular medicine, Affiliated Hospital of Inner Mongolia Medical University, No. 1, Tongdao North Road, Hohhot, 010000, Inner Mongolia Autonomous Region, China.
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2
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Wu XQ, Li LB, You W, Wu ZM, Zhao L, Wang ZH, Meng PN, Liu B, Ye F. Clinical Value of the Quantitative Flow Ratio to Predict Long-term Target Vessel Failure in Patients with In-stent Restenosis after Drug-coated Balloon Angioplasty. Curr Med Sci 2024; 44:561-567. [PMID: 38809380 DOI: 10.1007/s11596-024-2876-0] [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: 10/11/2021] [Accepted: 01/15/2023] [Indexed: 05/30/2024]
Abstract
OBJECTIVE The study sought to investigate the clinical predictive value of quantitative flow ratio (QFR) for the long-term target vessel failure (TVF) outcome in patients with in-stent restenosis (ISR) by using drug-coated balloon (DCB) treatment after a long-term follow-up. METHODS This was a retrospective study. A total of 186 patients who underwent DCB angioplasty for ISR in two hospitals from March 2014 to September 2019 were enrolled. The QFR of the entire target vessel was measured offline. The primary endpoint was TVF, including target vessel-cardiac death (TV-CD), target vessel-myocardial infarction (TV-MI), and clinically driven-target vessel revascularization (CD-TVR). RESULTS The follow-up time was 3.09±1.53 years, and 50 patients had TVF. The QFR immediately after percutaneous coronary intervention (PCI) was significantly lower in the TVF group than in the no-TVF group. Multivariable Cox regression analysis indicated that the QFR immediately after PCI was an excellent predictor for TVF after the long-term follow-up [hazard ratio (HR): 5.15×10-5 (6.13×10-8-0.043); P<0.01]. Receiver-operating characteristic (ROC) curve analysis demonstrated that the optimal cut-off value of the QFR immediately after PCI for predicting the long-term TVF was 0.925 (area under the curve: 0.886, 95% confidence interval: 0.834-0.938; sensitivity: 83.40%, specificity: 88.00; P<0.01). In addition, QFR≤0.925 post-PCI was strongly correlated with the TVF, including TV-MI and CD-TVR (P<0.01). CONCLUSION The QFR immediately after PCI showed a high predictive value of TVF after a long-term follow-up in ISR patients who underwent DCB angioplasty. A lower QFR immediately after PCI was associated with a worse TVF outcome.
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Affiliation(s)
- Xiang-Qi Wu
- Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, 210006, China
| | - Long-Bo Li
- Department of Cardiology, The Second Hospital of Jilin University, Jilin, 130000, China
| | - Wei You
- Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, 210006, China
| | - Zhi-Ming Wu
- Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, 210006, China
| | - Lei Zhao
- Department of Cardiology, The Second Hospital of Jilin University, Jilin, 130000, China
| | - Zhi-Hui Wang
- Department of Cardiology, The Second Hospital of Jilin University, Jilin, 130000, China
| | - Pei-Na Meng
- Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, 210006, China
| | - Bin Liu
- Department of Cardiology, The Second Hospital of Jilin University, Jilin, 130000, China.
| | - Fei Ye
- Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, 210006, China.
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3
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Sibbald M, Cioffi GM, Shenouda M, McGrath B, Elbarouni B, Har B, Akl E, Schampaert E, Bishop H, Minhas KK, Elkhateeb O, Pinilla-Echeverri N, Sheth T, Bainey K, Cantor WJ, Cohen E, Hubacek J, Kalra S, Lavoie AJ, Mansour S, Wijeysundera HC. Intravascular Imaging in the Diagnosis and Management of Patients With Suspected Intracoronary Pathologies: A CJC White Paper. Can J Cardiol 2024:S0828-282X(24)00412-4. [PMID: 38823632 DOI: 10.1016/j.cjca.2024.05.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Revised: 05/24/2024] [Accepted: 05/27/2024] [Indexed: 06/03/2024] Open
Abstract
Intravascular imaging has become an integral part of the diagnostic and management strategies for intracoronary pathologies. In this White Paper we summarize current evidence and its implications on the use of intravascular imaging in interventional cardiology practice. The areas addressed are planning and optimization of percutaneous coronary intervention, management of stent failure, and evaluation of ambiguous coronary lesions and myocardial infarction with nonobstructive coronary disease. The findings presented followed the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system in an expert consensus process that involved a diverse writing group vetted by a review group. Expert consensus was achieved around 9 statements. Use of intravascular imaging in guiding percutaneous revascularization is supported by high-quality evidence, particularly for lesions with increased risk of recurrent events or stent failure. Specific considerations for intravascular imaging guidance of intervention in left main lesions, chronic occlusion lesions, and in patients at high risk of contrast nephropathy are explored. Use of intravascular imaging to identify pathologies associated with stent failure and guide repeat intervention, resolve ambiguities in lesion assessment, and establish diagnoses in patients who present with myocardial infarction with nonobstructive coronary disease is supported by moderate- to low-quality evidence. Each topic is accompanied by clinical pointers to aid the practicing interventional cardiologist in implementation of the White Paper findings. The findings presented in this White Paper will help to guide the use of intravascular imaging toward situations in which the balance of efficacy, safety, and cost are most optimal.
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Affiliation(s)
- Matthew Sibbald
- Division of Cardiology, McMaster University, Hamilton, Ontario, Canada.
| | - Giacomo M Cioffi
- Cardiology Division, Heart Center, Luzerner Kantonsspital, Lucerne, Switzerland
| | | | - Brent McGrath
- New Brunswick Heart Centre, Saint John, New Brunswick, Canada; Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Basem Elbarouni
- Cardiac Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Bryan Har
- Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary Alberta, Canada
| | - Elie Akl
- McGill University Health Centre, McGill University, Montreal, Quebec, Canada
| | - Erick Schampaert
- Hôpital du Sacré-Cœur de Montreal, CIUSSS NIM, University of Montreal, Montreal, Quebec, Canada
| | - Helen Bishop
- Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Kunal K Minhas
- Cardiac Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Osama Elkhateeb
- Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Natalia Pinilla-Echeverri
- Population Health Research Institute, Division of Cardiology, McMaster University, Hamilton, Ontario, Canada
| | - Tej Sheth
- Population Health Research Institute, Division of Cardiology, McMaster University, Hamilton, Ontario, Canada
| | - Kevin Bainey
- Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Alberta, Canada
| | - Warren J Cantor
- Southlake Regional Health Centre, Newmarket, Ontario, Canada; Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Eric Cohen
- Schulich Heart Program, Division of Cardiology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Jaroslav Hubacek
- New Brunswick Heart Centre, Saint John, New Brunswick, Canada; Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Sanjog Kalra
- University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Andrea J Lavoie
- Division of Cardiology, University of Saskatchewan, Regina, Saskatchewan, Canada
| | - Samer Mansour
- Centre hospitalier de l'Université de Montréal, University of Montreal, Montreal, Quebec, Canada
| | - Harindra C Wijeysundera
- Schulich Heart Program, Division of Cardiology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
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4
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Shafi I, Patel DA, Osman H, Patel N, Ramaseshan K, Goel M, Alraies MC. Outcomes of Intravascular Ultrasound-Guided Percutaneous Coronary Intervention Among Patients With Acute Coronary Syndrome. Am J Cardiol 2023; 204:115-121. [PMID: 37541147 DOI: 10.1016/j.amjcard.2023.07.014] [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: 04/02/2023] [Revised: 05/16/2023] [Accepted: 07/05/2023] [Indexed: 08/06/2023]
Abstract
Intravascular ultrasound (IVUS) use in percutaneous coronary intervention (PCI) improves outcomes. However, data on outcomes of IVUS-guided PCI in patients presenting with acute coronary syndrome (ACS) is scarce. Therefore, we sought to study the utilization rate and outcomes of IVUS-guided PCI in patients with ACS. Using the National Readmission database, we identified all patients with ACS who underwent PCI from 2016 to 2019. We used a 1:1 propensity-matched analysis to compare the outcome of patients with ACS who underwent PCI with and without IVUS. In 1,263,997 patients with ACS, 563,521 (44.6%) underwent PCI without IVUS and 40,095 (3.17%) underwent IVUS-guided PCI. A Propensity scored matched comparison of PCI with and without IVUS showed IVUS-guided PCI was associated with a lower risk of in-hospital mortality (odds ratio 0.74, 95% confidence interval 0.64 to 0.85, p <0.01) compared with PCI without IVUS. The utilization of IVUS increased from 2.64% in 2016 to 4.10% in 2019, p <0.001. In conclusion, IVUS-guided PCI is associated with lower in-hospital mortality in patients with ACS, yet the current utilization of IVUS-guided PCI remains low across the United States.
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Affiliation(s)
| | | | - Heba Osman
- Department of Internal Medicine - Pediatrics
| | - Neel Patel
- Department of Internal Medicine, Wayne State University School of Medicine, Detroit, Michigan; Department of Internal Medicine, New York Medical College/Landmark Medical Center, Woonsocket, Rhode Island
| | - Karthik Ramaseshan
- Department of Internal Medicine, Wayne State University/Detroit Medical Center, Detroit, Michigan
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5
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Shlofmitz E, Busch J. Intravascular Imaging for Restenosis: The Importance of Performing a Root Cause Analysis. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2023; 52:47-48. [PMID: 37029042 DOI: 10.1016/j.carrev.2023.03.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 03/28/2023] [Indexed: 04/03/2023]
Affiliation(s)
- Evan Shlofmitz
- St. Francis Hospital - The Heart Center, Roslyn, NY, United States of America.
| | - Jordan Busch
- St. Francis Hospital - The Heart Center, Roslyn, NY, United States of America
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6
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Ren XY, Li YF, Liu HQ, Lin H, Lin Q, Wu Y, Wan J, Lu JJ, Liu J, Cui XY. Anti-inflammatory Therapy Progress in Major Adverse Cardiac Events after PCI: Chinese and Western Medicine. Chin J Integr Med 2023:10.1007/s11655-023-3638-8. [PMID: 37198377 DOI: 10.1007/s11655-023-3638-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/03/2023] [Indexed: 05/19/2023]
Abstract
Acute coronary syndrome (ACS) is one of the leading causes of death in cardiovascular disease. Percutaneous coronary intervention (PCI) is an important method for the treatment of coronary heart disease (CHD), and it has greatly reduced the mortality of ACS patients since its application. However, a series of new problems may occur after PCI, such as in-stent restenosis, no-reflow phenomenon, in-stent neoatherosclerosis, late stent thrombosis, myocardial ischemia-reperfusion injury, and malignant ventricular arrhythmias, which result in the occurrence of major adverse cardiac events (MACE) that seriously reduce the postoperative benefit for patients. The inflammatory response is a key mechanism of MACE after PCI. Therefore, examining effective anti-inflammatory therapies after PCI in patients with ACS is a current research focus to reduce the incidence of MACE. The pharmacological mechanism and clinical efficacy of routine Western medicine treatment for the anti-inflammatory treatment of CHD have been verified. Many Chinese medicine (CM) preparations have been widely used in the treatment of CHD. Basic and clinical studies showed that effectiveness of the combination of CM and Western medicine treatments in reducing incidence of MACE after PCI was better than Western medicine treatment alone. The current paper reviewed the potential mechanism of the inflammatory response and occurrence of MACE after PCI in patients with ACS and the research progress of combined Chinese and Western medicine treatments in reducing incidence of MACE. The results provide a theoretical basis for further research and clinical treatment.
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Affiliation(s)
- Xue-Yu Ren
- Graduate School of Beijing University of Chinese Medicine, Beijing, 100029, China
| | - Ying-Fei Li
- Graduate School of Beijing University of Chinese Medicine, Beijing, 100029, China
| | - Hui-Qing Liu
- Graduate School of Beijing University of Chinese Medicine, Beijing, 100029, China
| | - Hui Lin
- Graduate School of Beijing University of Chinese Medicine, Beijing, 100029, China
| | - Qian Lin
- Department of Cardiology, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, 100700, China
| | - Yang Wu
- Department of Cardiology, Dong Fang Hospital, Beijing University of Chinese Medicine, Beijing, 100078, China
| | - Jie Wan
- Department of Cardiology, Dong Fang Hospital, Beijing University of Chinese Medicine, Beijing, 100078, China
| | - Jin-Jin Lu
- Department of Cardiology, Dong Fang Hospital, Beijing University of Chinese Medicine, Beijing, 100078, China
| | - Jing Liu
- Department of Cardiology, Dong Fang Hospital, Beijing University of Chinese Medicine, Beijing, 100078, China
| | - Xiao-Yun Cui
- Department of Cardiology, Dong Fang Hospital, Beijing University of Chinese Medicine, Beijing, 100078, China.
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7
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Ren L, Han Y, Long M, Yan L, Wang Q, Fei X, Luo Y. Association with carotid plaque parameters detected on contrast-enhanced ultrasound and coronary artery plaque progression in non-culprit lesions: A retrospective study. Int J Cardiol 2023; 377:115-122. [PMID: 36682688 DOI: 10.1016/j.ijcard.2023.01.059] [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: 10/30/2022] [Revised: 01/06/2023] [Accepted: 01/17/2023] [Indexed: 01/22/2023]
Abstract
AIM To investigate the correlation between carotid plaque parameters detected on contrast-enhanced ultrasound(CEUS) and the plaque progression in non-culprit coronary lesions (NCCLs) after percutaneous coronary intervention (PCI). METHODS In this retrospective cross-sectional study, we analyzed 173 patients who underwent PCI. Patients were stratified into two groups (progression and non-progression groups) by comparing the coronary angiography (CAG) results at baseline and follow-up. The correlation between carotid plaque parameters and plaque progression in NCCLs was analyzed by multivariate logistic regression analysis. A logistic regression model was established to predict NCCLs progression. RESULTS Overall, 55 of 173 patients exhibited NCCLs progression (31.79%). Univariate comparisons showed that plaque thickness, plaque length, and IPN score were significantly higher in the progressive group than in the non-progressive group (P < 0.01). Multivariate logistic regression analysis revealed that carotid plaque length (OR = 3.418, 95% CI =1.101-10.610) and IPN score (OR = 7.395, 95% CI =3.154-17.342) were strongly associated with plaque progression in NCCLs. After adjusting for confounders, the history of previous PCI, plaque length, and IPN score were independent predictors of the NCCLs progression (P < 0.05). The sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of the logistic regression model in predicting the NCCLs progression were 62.50%, 90.53%, 81.12%, 76.92%, and 82.69%, respectively, and the area under the receiver operating characteristic (ROC) curve was 0.882 (95% CI: 0.826-0.939). CONCLUSIONS Carotid plaque length and IPN score were strongly correlated with plaque progression in NCCLs. Combining the history of previous PCI can reasonably predict the NCCLs progression.
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Affiliation(s)
- Ling Ren
- The Second Medical College of Lanzhou University, No. 222 Tianshui South Road, Chengguan District, Lanzhou, Gansu 730030, China; Department of Ultrasound, First Medical Center, Chinese PLA General Hospital, No. 28 Fuxing Road, Haidian District, Beijing 100853, China
| | - Yanyan Han
- Cardiology Department, First Medical Center, Chinese PLA General Hospital, No. 28 Fuxing Road, Haidian District, Beijing 100853, China; Medical School of PLA, No. 28 Fuxing Road, Haidian District, Beijing 100853, China
| | - Mei Long
- Department of Cardiology, Zibo Central Hospital, No. 54 Gongqingtuanxi Road, Zhangdian District, Zibo, Shandong 255000, China
| | - Lin Yan
- Department of Ultrasound, First Medical Center, Chinese PLA General Hospital, No. 28 Fuxing Road, Haidian District, Beijing 100853, China
| | - Qi Wang
- Cardiology Department, First Medical Center, Chinese PLA General Hospital, No. 28 Fuxing Road, Haidian District, Beijing 100853, China; Medical School of PLA, No. 28 Fuxing Road, Haidian District, Beijing 100853, China
| | - Xiang Fei
- Department of Ultrasound, First Medical Center, Chinese PLA General Hospital, No. 28 Fuxing Road, Haidian District, Beijing 100853, China.
| | - Yukun Luo
- The Second Medical College of Lanzhou University, No. 222 Tianshui South Road, Chengguan District, Lanzhou, Gansu 730030, China; Department of Ultrasound, First Medical Center, Chinese PLA General Hospital, No. 28 Fuxing Road, Haidian District, Beijing 100853, China.
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8
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Moroni A, Marin F, Venturi G, Scarsini R, Ribichini F, De Maria GL, Banning AP. Management of failed stenting of the unprotected left main coronary artery. Catheter Cardiovasc Interv 2023; 101:1001-1013. [PMID: 37002949 DOI: 10.1002/ccd.30636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 02/16/2023] [Accepted: 03/03/2023] [Indexed: 04/03/2023]
Abstract
Percutaneous coronary intervention (PCI) is increasingly accepted as treatment for unprotected left main coronary artery (ULMCA) disease especially in those patients who are unsuitable for cardiac surgery. Treatment of any stent failure is associated with increased complexity and worse clinical outcomes when compared with de novo lesion revascularization. Intracoronary imaging has provided new insight into mechanisms of stent failure and treatment options have developed considerably over the last decade. There is paucity of evidence on the management strategy for stent failure in the specific setting of ULMCA. Treating any left main with PCI requires careful consideration and consequently treatment of failed stents in ULMCA is complex and provides unique challenges. Consequently, we provide an overview of ULMCA stent failure, proposing a tailored algorithm to guide best management and decision in daily clinical practice, with a special focus on intracoronary imaging characterization of causal mechanisms and specific technical and procedural considerations.
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Affiliation(s)
- Alice Moroni
- Clinical and Interventional Cardiology Department, IRCCS Policlinico San Donato, University of Milan, San Donato Milanese, Italy
| | - Federico Marin
- Deparment of Cardiology, Oxford Heart Centre, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Gabriele Venturi
- Division of Cardiology, Department of Medicine, University of Verona, Verona, Italy
| | - Roberto Scarsini
- Division of Cardiology, Department of Medicine, University of Verona, Verona, Italy
| | - Flavio Ribichini
- Division of Cardiology, Department of Medicine, University of Verona, Verona, Italy
| | - Giovanni Luigi De Maria
- Deparment of Cardiology, Oxford Heart Centre, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Adrian P Banning
- Deparment of Cardiology, Oxford Heart Centre, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
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9
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Arora P, Singh P, Girdhar A, Vijayvergiya R. A State-Of-The-Art Review on Coronary Artery Border Segmentation Algorithms for Intravascular Ultrasound (IVUS) Images. Cardiovasc Eng Technol 2023; 14:264-295. [PMID: 36650320 DOI: 10.1007/s13239-023-00654-6] [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: 02/11/2022] [Revised: 11/28/2022] [Accepted: 01/02/2023] [Indexed: 01/19/2023]
Abstract
Intravascular Ultrasound images (IVUS) is a useful guide for medical practitioners to identify the vascular status of coronary arteries in human beings. IVUS is a unique intracoronary imaging modality that is used as an adjunct to angioplasty to view vessel structures using a catheter with high resolutions. Segmentation of IVUS images has always remained a challenging task due to various impediments, for example, similar tissue components, vessel structures, and artifacts imposed during the acquisition process. Many researchers have applied various techniques to develop standard methods of image interpretation, however, the ultimate goal is still elusive to most researchers. This challenge was presented at the MICCAI- Computing and Visualization for (Intra)Vascular Imaging (CVII) workshop in 2011. This paper presents a major review of recently reported work in the field, with a detailed analysis of various segmentation techniques applied in IVUS, and highlights the directions for future research. The findings recommend a reference database with a larger number of samples acquired at varied transducer frequencies with special consideration towards complex lesions, suitable validation metrics, and ground-truth definition as a standard against which to compare new and current algorithms.
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Affiliation(s)
- Priyanka Arora
- Research Scholar, IKG Punjab Technical University, Punjab, India. .,Department of Computer Science and Engineering, Guru Nanak Dev Engineering College, Ludhiana, Punjab, India.
| | - Parminder Singh
- Department of Computer Science and Engineering, Guru Nanak Dev Engineering College, Ludhiana, Punjab, India
| | - Akshay Girdhar
- Department of Information Technology, Guru Nanak Dev Engineering College, Ludhiana, Punjab, India
| | - Rajesh Vijayvergiya
- Department of Cardiology, Advanced Cardiac Centre, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
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10
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Erdogan E, Bajaj R, Lansky A, Mathur A, Baumbach A, Bourantas CV. Intravascular Imaging for Guiding In-Stent Restenosis and Stent Thrombosis Therapy. J Am Heart Assoc 2022; 11:e026492. [PMID: 36326067 PMCID: PMC9750080 DOI: 10.1161/jaha.122.026492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Advances in stent technology and the design of endovascular devices with thinner struts, anti-inflammatory and antithrombotic polymers, and better drug kinetics have enhanced the safety and efficacy of the second-generation drug-eluting stents and broadened their use in the therapy of high-risk patients and complex anatomies. However, despite these developments, in-stent restenosis and stent thrombosis remain the Achilles' heel of percutaneous coronary intervention, with their cumulative incidence reaching up to 10% at 5 years following percutaneous coronary intervention. The treatment of stent failure poses challenges and is associated with a worse prognosis than conventional percutaneous coronary intervention. Several studies have recently highlighted the value of intravascular imaging in identifying causes of stent failure, underscored its role in treatment planning, and registries have shown that its use may be associated with better clinical outcomes. The present review aims to summarize the evidence in the field; it discusses the value of intravascular imaging in identifying the mechanisms of in-stent restenosis and stent thrombosis in assessing the morphological characteristics of neointima tissue that appears to determine long-term outcomes in evaluating procedural results, and presents the findings of studies supporting its value in guiding therapy in stent failure.
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Affiliation(s)
- Emrah Erdogan
- Department of Cardiology, Barts Heart CentreBarts Health NHS TrustLondonUnited Kingdom
- Centre for Cardiovascular Medicine and DevicesWilliam Harvey Research Institute, Queen Mary University of LondonUnited Kingdom
- Department of Cardiology, Faculty of MedicineYuzuncu Yil UniversityVanTurkey
| | - Retesh Bajaj
- Department of Cardiology, Barts Heart CentreBarts Health NHS TrustLondonUnited Kingdom
- Centre for Cardiovascular Medicine and DevicesWilliam Harvey Research Institute, Queen Mary University of LondonUnited Kingdom
| | - Alexandra Lansky
- Centre for Cardiovascular Medicine and DevicesWilliam Harvey Research Institute, Queen Mary University of LondonUnited Kingdom
- Yale University School of MedicineNew HavenCT
| | - Anthony Mathur
- Department of Cardiology, Barts Heart CentreBarts Health NHS TrustLondonUnited Kingdom
- Centre for Cardiovascular Medicine and DevicesWilliam Harvey Research Institute, Queen Mary University of LondonUnited Kingdom
| | - Andreas Baumbach
- Department of Cardiology, Barts Heart CentreBarts Health NHS TrustLondonUnited Kingdom
- Centre for Cardiovascular Medicine and DevicesWilliam Harvey Research Institute, Queen Mary University of LondonUnited Kingdom
- Yale University School of MedicineNew HavenCT
| | - Christos V. Bourantas
- Department of Cardiology, Barts Heart CentreBarts Health NHS TrustLondonUnited Kingdom
- Centre for Cardiovascular Medicine and DevicesWilliam Harvey Research Institute, Queen Mary University of LondonUnited Kingdom
- Institute of Cardiovascular SciencesUniversity College LondonLondonUnited Kingdom
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11
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Mintz GS, Bourantas CV, Chamié D. Intravascular Imaging for Percutaneous Coronary Intervention Guidance and Optimization: The Evidence for Improved Patient Outcomes. JOURNAL OF THE SOCIETY FOR CARDIOVASCULAR ANGIOGRAPHY & INTERVENTIONS 2022; 1:100413. [PMID: 39132365 PMCID: PMC11307675 DOI: 10.1016/j.jscai.2022.100413] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 06/27/2022] [Accepted: 06/30/2022] [Indexed: 08/13/2024]
Abstract
As of this writing, there have been approximately 24 randomized controlled trial publications, 32 meta-analyses, and 85 registries comparing intravascular ultrasound (IVUS) or optical coherence tomography (OCT) versus angiography-guided drug-eluting stent implantation (or IVUS versus OCT guidance). Although in specific clinical scenarios IVUS or OCT may be preferred, in most drug-eluting stent implantation procedures, either intravascular ultrasound or OCT can be used safely, efficiently, effectively, and interchangeably and will improve patient outcomes compared with stent implantation procedures performed just with angiography guidance.
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Affiliation(s)
- Gary S Mintz
- Cardiovascular Research Foundation, New York, New York
| | - Christos V Bourantas
- Department, of Cardiology, Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom
- Institute of Cardiovascular Sciences, University College London, London, United Kingdom
| | - Daniel Chamié
- Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, Connecticut
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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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Archilletti F, Zimarino M. Intravascular ultrasound for in-stent restenosis: A problem well stated is half-solved. Int J Cardiol 2021; 340:22-23. [PMID: 34454963 DOI: 10.1016/j.ijcard.2021.08.029] [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: 08/16/2021] [Accepted: 08/18/2021] [Indexed: 11/16/2022]
Affiliation(s)
| | - Marco Zimarino
- Institute of Cardiology, "G. d'Annunzio" University, 66100 Chieti, Italy; Cath Lab, Ospedale SS. Annunziata, ASL 2 Abruzzo, 66100 Chieti, Italy.
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Gai MT, Zhu B, Chen XC, Liu F, Xie X, Gao XM, Ma X, Fu ZY, Ma YT, Chen BD. A prediction model based on platelet parameters, lipid levels, and angiographic characteristics to predict in-stent restenosis in coronary artery disease patients implanted with drug-eluting stents. Lipids Health Dis 2021; 20:118. [PMID: 34587955 PMCID: PMC8480001 DOI: 10.1186/s12944-021-01553-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 09/10/2021] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND The present study was aimed to establish a prediction model for in-stent restenosis (ISR) in subjects who had undergone percutaneous coronary intervention (PCI) with drug-eluting stents (DESs). MATERIALS AND METHODS A retrospective cohort study was conducted. From September 2010 to September 2013, we included 968 subjects who had received coronary follow-up angiography after primary PCI. The logistic regression analysis, receiver operator characteristic (ROC) analysis, nomogram analysis, Hosmer-Lemeshow χ2 statistic, and calibration curve were applied to build and evaluate the prediction model. RESULTS Fifty-six patients (5.79%) occurred ISR. The platelet distribution width (PDW), total cholesterol (TC), systolic blood pressure (SBP), low-density lipoprotein cholesterol (LDL-C), and lesion vessels had significant differences between ISR and non-ISR groups (all P < 0.05). And these variables were independently associated with ISR (all P < 0.05). Furthermore, they were identified as predictors (all AUC > 0.5 and P < 0.05) to establish a prediction model. The prediction model showed a good value of area under curve (AUC) (95%CI): 0.72 (0.64-0.80), and its optimized cut-off was 6.39 with 71% sensitivity and 65% specificity to predict ISR. CONCLUSION The incidence of ISR is 5.79% in CAD patients with DES implantation in the Xinjiang population, China. The prediction model based on PDW, SBP, TC, LDL-C, and lesion vessels was an effective model to predict ISR in CAD patients with DESs implantation.
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Affiliation(s)
- Min-Tao Gai
- State Key Laboratory of Pathogenesis, Prevention and Treatment of High Incidence Diseases in Central Asia, Clinical Medical Research Institute, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Bing Zhu
- Department of Cardiology, First Affiliated Hospital of Xinjiang Medical University, No. 137, Liyushan Road, Urumqi, China
| | - Xiao-Cui Chen
- State Key Laboratory of Pathogenesis, Prevention and Treatment of High Incidence Diseases in Central Asia, Clinical Medical Research Institute, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Fen Liu
- State Key Laboratory of Pathogenesis, Prevention and Treatment of High Incidence Diseases in Central Asia, Clinical Medical Research Institute, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Xiang Xie
- Department of Cardiology, First Affiliated Hospital of Xinjiang Medical University, No. 137, Liyushan Road, Urumqi, China
| | - Xiao-Ming Gao
- Department of Cardiology, First Affiliated Hospital of Xinjiang Medical University, No. 137, Liyushan Road, Urumqi, China
| | - Xiang Ma
- Department of Cardiology, First Affiliated Hospital of Xinjiang Medical University, No. 137, Liyushan Road, Urumqi, China
| | - Zhen-Yan Fu
- Department of Cardiology, First Affiliated Hospital of Xinjiang Medical University, No. 137, Liyushan Road, Urumqi, China
| | - Yi-Tong Ma
- State Key Laboratory of Pathogenesis, Prevention and Treatment of High Incidence Diseases in Central Asia, Clinical Medical Research Institute, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China.
- Department of Cardiology, First Affiliated Hospital of Xinjiang Medical University, No. 137, Liyushan Road, Urumqi, China.
| | - Bang-Dang Chen
- State Key Laboratory of Pathogenesis, Prevention and Treatment of High Incidence Diseases in Central Asia, Clinical Medical Research Institute, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China.
- College of Basic Medicine of Xinjiang Medical University, No. 137, Liyushan Road, Urumqi, China.
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