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Fu PC, Wang JY, Su Y, Liao YQ, Li SL, Xu GL, Huang YJ, Hu MH, Cao LM. Intravascular ultrasonography assisted carotid artery stenting for treatment of carotid stenosis: Two case reports. World J Clin Cases 2023; 11:7127-7135. [PMID: 37946762 PMCID: PMC10631408 DOI: 10.12998/wjcc.v11.i29.7127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 09/09/2023] [Accepted: 09/25/2023] [Indexed: 10/13/2023] Open
Abstract
BACKGROUND Digital subtraction angiography (DSA), the gold standard of cerebrovascular disease diagnosis, is limited in its diagnostic ability to evaluate arterial diameter. Intravascular ultrasonography (IVUS) has advantages in assessing stenosis and plaque nature and improves the evaluation and effectiveness of carotid artery stenting (CAS). CASE SUMMARY Case 1: A 65-year-old man presented with a five-year history of bilateral lower limb weakness due to stroke. Physical examination showed decreased strength (5-/5) in both lower limbs. Carotid artery ultrasound, magnetic resonance angiography, and computed tomography angiography (CTA) showed a right proximal internal carotid artery (ICA) stenosis (70%-99%), acute cerebral infarction, and severe right ICA stenosis, respectively. We performed IVUS-assisted CAS to measure the stenosis and detected a low-risk plaque at the site of stenosis prior to stent implantation. Post-stent balloon dilatation was performed and postoperative IVUS demonstrated successful expansion and adherence. CTA six months postoperatively showed no significant increase in in-stent stenosis. Case 2: A 36-year-old man was admitted with a right common carotid artery (CCA) dissection detected by ultrasound. Physical examination showed no positive neurological signs. Carotid ultrasound and CTA showed lumen dilation in the proximal CCA with an intima-like structure and bulging in the proximal segment of the right CCA with strip-like low-density shadow (dissection or carotid web). IVUS-assisted DSA confirmed right CCA dissection. CAS was performed and intraoperative IVUS suggested a large residual false lumen. Post-stent balloon dilatation was performed reducing the false lumen. DSA three months postoperatively indicated good stent expansion with mild stenosis. CONCLUSION IVUS aids decision-making during CAS by accurately assessing carotid artery wall lesions and plaque nature preoperatively, dissection and stenosis morphology intraoperatively, and visualizing and confirming CAS postoperatively.
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Affiliation(s)
- Peng-Cheng Fu
- Department of Neurology, The First Affiliated Hospital of Shenzhen University, Shenzhen 518000, Guangdong Province, China
| | - Jing-Yi Wang
- Faculty of Chinese Medicine, Macau University of Science and Technology, Macau 999078, China
| | - Ying Su
- Graduate School, Guangzhou Medical University, Guangzhou 511495, Guangdong Province, China
| | - Yu-Qi Liao
- School of Medicine, Shenzhen University, Shenzhen 518000, Guangdong Province, China
| | - Shao-Ling Li
- School of Medicine, Shenzhen University, Shenzhen 518000, Guangdong Province, China
| | - Ge-Lin Xu
- Department of Neurology, The First Affiliated Hospital of Shenzhen University, Shenzhen 518000, Guangdong Province, China
| | - Yan-Jiao Huang
- Medical Department, Baise People’s Hospital, Baise 533000, Guangxi Zhuang Autonomous Region, China
| | - Ming-Hua Hu
- Hunan Provincial Key Laboratory of the Research and Development of Novel Pharmaceutical Preparations, Changsha Medical University, Changsha 410219, Hunan Province, China
| | - Li-Ming Cao
- Clinical College of the Shenzhen Second People’s Hospital, Anhui Medical University, Shenzhen 518000, Guangdong Province, China
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McConkey HZR, De Maria GL. Juxtaposition of urgent angioplasty results in spontaneous coronary artery dissection: a case report of fresh vs. organized intramural haematoma. Eur Heart J Case Rep 2023; 7:ytad210. [PMID: 37323527 PMCID: PMC10266167 DOI: 10.1093/ehjcr/ytad210] [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: 06/03/2022] [Revised: 09/15/2022] [Accepted: 04/21/2023] [Indexed: 06/17/2023]
Abstract
Background Coronary intramural haematoma from spontaneous coronary artery dissection (SCAD) presents as an acute coronary syndrome, usually in young or middle-aged female patients. Conservative management in the absence of ongoing symptoms is best practice, and the artery eventually heals fully. Case summary A 49-year-old female presented with a non-ST elevation myocardial infarction. Initial angiography and intravascular ultrasound (IVUS) demonstrated typical intramural haematoma of the ostial to mid left circumflex artery. Initial conservative management was selected, but the patient developed further chest pain 5 days later and with worsening electrocardiogram changes. Further angiography was carried out demonstrating near-occlusive disease with organized thrombus in the false lumen. The angioplasty result from this is juxtaposed with another acute SCAD case on the same day with fresh intramural haematoma. Discussion Reinfarction is a common occurrence in SCAD, and little is known about how to predict it. These cases demonstrate the appearance on IVUS of fresh vs. organized thrombus and the relative angioplasty result in each case. Follow-up IVUS due to ongoing symptoms in one patient demonstrated significant stent malapposition, not apparent at the index intervention, in all likeliness due to intramural haematoma regression.
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Affiliation(s)
- Hannah Z R McConkey
- The Heart Centre, John Radcliffe Hospital, Headley Way, Headington, Oxford OX3 9DU, UK
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3
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Suwannasom P, Chichareon P, Roongsangmanoon W, Thongtanomkul A, Wongpen A, Muenkaew M, Kanoksilp A, Chandavimol M, Kuanprasert S, Thakkinstian A, Srimahachota S, Sansanayudh N. Impact of the adjunctive use criteria for intravascular ultrasound-guided percutaneous coronary intervention and clinical outcomes. Sci Rep 2023; 13:711. [PMID: 36639405 PMCID: PMC9839682 DOI: 10.1038/s41598-022-27250-3] [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: 10/11/2022] [Accepted: 12/28/2022] [Indexed: 01/14/2023] Open
Abstract
The impact of the adherence to the adjunctive use criteria (AUC) for intravascular ultrasound (IVUS) guided percutaneous coronary intervention (PCI) and clinical outcomes in low IVUS volume countries are limited. The current study compared the procedural success and complication rates between used and not used IVUS catheter in the patients who were met (C +) and were not met (C-) the AUC for IVUS-guided PCI. From June 2018 through June 2019, a total of 21,066 patients were included in the Thai PCI registry. Among the study population, 15,966 patients (75.8%) have met the IVUS-AUC. The IVUS-guided PCI rates were 14.5% and 11.3% in the C + and C - groups, respectively. After adjusting for covariables by propensity model, IVUS-guided PCI was identified as an independent predictor of the procedural success rate regardless of whether the AUC were met with the relative risk [RR (95% confidence interval (CI)] of 1.033(1.026-1.040) and 1.012(1.002-1.021) in C + and C- groups, respectively. IVUS-guided PCI increased the procedural complication risks in both groups but were not significant with corresponding RRs of 1.171(0.915-1.426) and 1.693(0.959-2.426). Procedural success was achieved with IVUS-guided PCI regardless of whether the AUC were met. IVUS-guided PCI did not lead to an increase in procedural complications.
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Affiliation(s)
- Pannipa Suwannasom
- Division of Cardiology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Ply Chichareon
- Faculty of Medicine, Songklanakarind Hospital, Prince of Songkla University, Songkla, Thailand
| | - Worawut Roongsangmanoon
- Faculty of Medicine, HRH Princess MahaChakri Sirindhorn Medical Center, Srinakharinwirot University, Nakhon Nayok, Thailand
| | | | | | - Muenpetch Muenkaew
- Faculty of Medicine, Thammasat University Hospital, Thammasat University, Bangkok, Thailand
| | - Anek Kanoksilp
- Central Chest Institute of Thailand, Nonthaburi, Thailand
| | - Mann Chandavimol
- Division of Cardiology, Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Srun Kuanprasert
- Division of Cardiology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Ammarin Thakkinstian
- Department of Clinical Epidemiology and Biostatistics, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Suphot Srimahachota
- Division of Cardiovascular Diseases, Department of Medicine, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Nakarin Sansanayudh
- Phramongkutklao College of Medicine, 315 Ratchawithi Rd, Khwaeng Thung Phaya Thai, Bangkok, 10400, Thailand.
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Usefulness of intravascular ultrasound assessment after development of the slow flow phenomenon during percutaneous coronary intervention. Coron Artery Dis 2022; 33:302-310. [DOI: 10.1097/mca.0000000000001126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Improving PCI Outcomes Using Postprocedural Physiology and Intravascular Imaging. JACC Cardiovasc Interv 2021; 14:2415-2430. [PMID: 34794649 DOI: 10.1016/j.jcin.2021.08.069] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 07/07/2021] [Accepted: 08/03/2021] [Indexed: 11/24/2022]
Abstract
Although clinical outcomes after percutaneous coronary intervention (PCI) are improving, the long-term risk for target vessel failure remains concerning. Although the application of intravascular imaging and physiological indexes significantly improves outcomes, their routine use in practice remains limited. Nevertheless, merely using these modalities is not enough, and to truly improve patient outcomes, optimal intravascular dimensions with minimal vascular injury should be targeted. When assessing post-PCI results using either type of physiological or imaging technology, a broad spectrum of stent- and vessel-related anomalies can be expected. As not all of these issues warrant treatment, a profound knowledge of what to expect and how to recognize and when to treat these intraluminal problems is needed. Additionally, promising new modalities such as angiography-derived coronary physiology and hybrid imaging catheters are becoming available. The authors provide an overview of the currently available tools and techniques to define suboptimal PCI and when to apply these technologies to improve outcomes.
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Impact of stent edge dissection detected by optical coherence tomography after current-generation drug-eluting stent implantation. PLoS One 2021; 16:e0259693. [PMID: 34735528 PMCID: PMC8568188 DOI: 10.1371/journal.pone.0259693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Accepted: 10/22/2021] [Indexed: 11/19/2022] Open
Abstract
Background Stent edge dissection (SED) is a well-known predictor of worse clinical outcomes. However, impact of SED after current-generation drug-eluting stent (DES) implantation remains unknown since there was no study using only current-generation DES to assess impact of SED. This study aimed to investigate a relationship between SED detected by optical coherence tomography (OCT) and clinical outcomes after current-generation DES implantation. Methods This study enrolled 175 patients receiving OCT after current-generation DES implantation. The SED group was compared with the non-SED group in terms of the primary study endpoints which was the cumulative incidence of major adverse cardiac event (MACE) composed of cardiac death, target vessel myocardial infarction (TV-MI), and clinically-driven target lesion revascularization (CD-TLR). Results Of 175 patients, SED detected by OCT was observed in 32 patients, while 143 patients did not show SED. In the crude population, the SED group showed a significantly higher incidence of CD-TLR, definite stent thrombosis, TV-MI and cardiac death relative to the non-SED group. After adjustment by an inverse probability weighted methods, the SED group showed a significantly higher incidence of MACE compared with the non-SED group (hazard ratio 3.43, 95% confidence interval 1.09–10.81, p = 0.035). Fibrocalcific or lipidic plaques, greater lumen eccentricity, and stent-oversizing were the predictors of SED. Conclusions SED detected by OCT after the current-generation DES implantation led to unfavorable outcomes. Aggressive post-dilatation around the stent edge might worse clinical outcomes due to SED, although achievement of optimal stent expansion is strongly encouraged to improve clinical outcomes.
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Ramasamy A, Bajaj R, Jones DA, Amersey R, Mathur A, Baumbach A, Bourantas CV, O'Mahony C. Iatrogenic catheter-induced ostial coronary artery dissections: Prevalence, management, and mortality from a cohort of 55,968 patients over 10 years. Catheter Cardiovasc Interv 2020; 98:649-655. [PMID: 33241605 PMCID: PMC8518823 DOI: 10.1002/ccd.29382] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Revised: 08/17/2020] [Accepted: 10/26/2020] [Indexed: 11/21/2022]
Abstract
Objective We sought to describe the prevalence, management strategies and evaluate the prognosis of patients with iatrogenic catheter‐induced ostial coronary artery dissection (ICOCAD). Background ICOCAD is a rare but potentially devastating complication of cardiac catheterisation. The clinical manifestations of ICOCAD vary from asymptomatic angiographic findings to abrupt vessel closure leading to myocardial infarction and death. Methods 55,968 patients who underwent coronary angiography over a 10‐year period were screened for ICOCAD as defined by the National Heart, Lung, and Blood Institute. The management and all‐cause mortality were retrieved from local and national databases. Results The overall prevalence of ICOCAD was 0.09% (51/55,968 patients). Guide catheters accounted for 75% (n = 37) of cases. Half of the ICOCAD cases involved the right coronary artery while the remaining were related to left main stem (23/51; 45%) and left internal mammary artery (2/51; 4%). Two‐thirds of ICOCAD were high grade (type D, E, and F). The majority of cases were type F dissections (n = 18; 66%), of which two third occurred in females in their 60s. The majority of ICOCAD patients (42/51; 82%) were treated with percutaneous coronary intervention while the remaining underwent coronary artery bypass grafting (3/51; 6%) or managed conservatively (6/51; 12%). Three deaths occurred during the index admission while 48/51 patients (94.1%) were safely discharged without further mortality over a median follow‐up of 3.6 years. Conclusions ICOCAD is a rare but life‐threatening complication of coronary angiography. Timely recognition and prompt bailout PCI is a safe option for majority of patients with good clinical outcomes.
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Affiliation(s)
- Anantharaman Ramasamy
- Department of Cardiology, Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK.,Centre for Cardiovascular Medicine and Device Innovation, William Harvey Research Institute, Queen Mary University London, London, UK
| | - Retesh Bajaj
- Department of Cardiology, Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK.,Centre for Cardiovascular Medicine and Device Innovation, William Harvey Research Institute, Queen Mary University London, London, UK
| | - Daniel A Jones
- Department of Cardiology, Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK.,Centre for Cardiovascular Medicine and Device Innovation, William Harvey Research Institute, Queen Mary University London, London, UK
| | - Rajiv Amersey
- Department of Cardiology, Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK
| | - Anthony Mathur
- Department of Cardiology, Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK.,Centre for Cardiovascular Medicine and Device Innovation, William Harvey Research Institute, Queen Mary University London, London, UK
| | - Andreas Baumbach
- Department of Cardiology, Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK.,Centre for Cardiovascular Medicine and Device Innovation, William Harvey Research Institute, Queen Mary University London, London, UK
| | - Christos V Bourantas
- Department of Cardiology, Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK.,Centre for Cardiovascular Medicine and Device Innovation, William Harvey Research Institute, Queen Mary University London, London, UK.,Institute of Cardiovascular Sciences, University College London, London, UK
| | - Constantinos O'Mahony
- Department of Cardiology, Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK.,Institute of Cardiovascular Sciences, University College London, London, UK
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Palaparti R, Koduru G, Palaparti S, S. Chowdary PS, Kondru P, Ghanta S, Mannuva B, Maganti P, Yendapalli S. Real time 3D-OCT predicts restenosis by identifying geographic miss between overlapping stents after complex multivessel percutaneous coronary intervention. HEART INDIA 2020. [DOI: 10.4103/heartindia.heartindia_51_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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9
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Shlofmitz E, Shlofmitz R, Lee MS. The Role of Novel Oral Anticoagulants and Antiplatelet Therapy after Percutaneous Coronary Intervention: Individualizing Therapy to Optimize Outcomes. Korean Circ J 2019; 49:645-656. [PMID: 31347321 PMCID: PMC6675700 DOI: 10.4070/kcj.2019.0185] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Accepted: 06/24/2019] [Indexed: 11/23/2022] Open
Abstract
The number of patients undergoing percutaneous coronary intervention (PCI) who mandate additional oral anticoagulant therapy has been increasing. Dual antiplatelet therapy (DAPT) is associated with reduced ischemic events including stent thrombosis, myocardial infarction and stroke following PCI. However, the tradeoff is an increased risk for bleeding while on DAPT. The addition of a novel oral anticoagulant (NOAC) further increases the likelihood of bleeding while on antiplatelet therapy. Thus, the overall risks and benefits for each patient undergoing PCI on NOAC must be assessed and therapy individualized to ensure optimal therapy for each unique situation. Patients on NOAC undergoing PCI should undergo routine assessment with intravascular imaging as the role of high-risk lesion-related features have increased importance prior to determining optimal duration of treatment with DAPT. We review the best practices for the pharmacologic management of patients requiring anticoagulation with NOAC who are treated with PCI and require antiplatelet therapy.
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Affiliation(s)
- Evan Shlofmitz
- MedStar Washington Hospital Center, Washington, D.C., USA
| | | | - Michael S Lee
- Ronald Reagan UCLA Medical Center, Los Angeles, CA, USA.
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Mechanisms of Stent Failure: Lessons from IVUS and OCT. CURRENT CARDIOVASCULAR IMAGING REPORTS 2019. [DOI: 10.1007/s12410-019-9513-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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11
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Medina López LA, Balestrini CS, Gorgadze T, Saaibi Solano JF. Utilidad de otras técnicas de imagen en la valoración de la enfermedad coronaria: Ultrasonido intravascular (IVUS). REVISTA COLOMBIANA DE CARDIOLOGÍA 2019. [DOI: 10.1016/j.rccar.2018.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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12
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Kuno T, Numasawa Y, Sawano M, Abe T, Ueda I, Kodaira M, Suzuki M, Noma S, Nakamura I, Negishi K, Ishikawa S, Fukuda K, Kohsaka S. Real-world use of intravascular ultrasound in Japan: a report from contemporary multicenter PCI registry. Heart Vessels 2019; 34:1728-1739. [DOI: 10.1007/s00380-019-01427-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Accepted: 05/15/2019] [Indexed: 01/30/2023]
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14
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Song HG, Kang SJ, Mintz GS. Value of intravascular ultrasound in guiding coronary interventions. Echocardiography 2018; 35:520-533. [DOI: 10.1111/echo.13837] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Affiliation(s)
- Hae Geun Song
- Department of Cardiology; DeltaHealth Hospital; Shanghai China
| | - Soo-Jin Kang
- Department of Cardiology; Asan Medical Center; University of Ulsan College of Medicine; Seoul South Korea
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Tan M, Urasawa K, Koshida R, Haraguchi T, Kitani S, Igarashi Y, Sato K. Comparison of Angiographic Dissection Patterns Caused by Long vs Short Balloons During Balloon Angioplasty of Chronic Femoropopliteal Occlusions. J Endovasc Ther 2018; 25:192-200. [DOI: 10.1177/1526602818756610] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Michinao Tan
- Cardiovascular Center Tokeidai Memorial Hospital, Sapporo, Hokkaido, Japan
| | - Kazushi Urasawa
- Cardiovascular Center Tokeidai Memorial Hospital, Sapporo, Hokkaido, Japan
| | - Ryoji Koshida
- Cardiovascular Center Tokeidai Memorial Hospital, Sapporo, Hokkaido, Japan
| | - Takuya Haraguchi
- Cardiovascular Center Tokeidai Memorial Hospital, Sapporo, Hokkaido, Japan
| | - Shunsuke Kitani
- Cardiovascular Center Tokeidai Memorial Hospital, Sapporo, Hokkaido, Japan
| | - Yasumi Igarashi
- Cardiovascular Center Tokeidai Memorial Hospital, Sapporo, Hokkaido, Japan
| | - Katsuhiko Sato
- Cardiovascular Center Tokeidai Memorial Hospital, Sapporo, Hokkaido, Japan
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Lu H, Kalkman DN, Grundeken MJ, Tijssen JGP, Wykrzykowska JJ, de Winter RJ, Koch KT. Does the novel delivery system for the STENTYS self-apposing coronary stent increase the risk of stent edge dissections? Optical coherence tomography post stent findings. Expert Rev Med Devices 2017; 15:157-165. [PMID: 29284310 DOI: 10.1080/17434440.2018.1421942] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND With optical coherence tomography (OCT), details of arterial injuries during percutaneous coronary intervention can be assessed accurately. There might be an increased risk of stent edge dissections with the novel delivery system for the STENTYS stent. We evaluated the prevalence of stent edge dissections using the novel Xposition delivery device as compared with the conventional delivery device. METHODS A total of 38 patients who were treated with the self-apposing STENTYS stent and with OCT assessment at our center were retrospectively analysed. Twenty patients were treated using the Xposition- and 18 using the conventional delivery device. OCT was performed according to study protocol. Frames with poor quality were excluded. RESULTS A total of 12(18%) dissections were detected, 7(20%) in the Xposition delivery device group, and 5(15%) in the conventional group (p = 1). Using the Xposition delivery device 4(33%) dissections were found proximally, using the conventional delivery device 3(25%) (p = ns). Mean longitudinal dissection length was 2.07 ± 1.80mm, 8(67%) appeared as flaps, 4(33%) as cavities. Morphometric parameters were comparable in both groups. CONCLUSIONS Detailed OCT assessment of stent edge dissections was possible, which revealed no large differences using the Xposition delivery device as compared with conventional delivery device, however large studies are warranted.
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Affiliation(s)
- Huangling Lu
- a Academic Medical Center , University of Amsterdam , Amsterdam , The Netherlands
| | - Deborah N Kalkman
- a Academic Medical Center , University of Amsterdam , Amsterdam , The Netherlands
| | - Maik J Grundeken
- a Academic Medical Center , University of Amsterdam , Amsterdam , The Netherlands
| | - Jan G P Tijssen
- a Academic Medical Center , University of Amsterdam , Amsterdam , The Netherlands
| | | | - Robbert J de Winter
- a Academic Medical Center , University of Amsterdam , Amsterdam , The Netherlands
| | - Karel T Koch
- a Academic Medical Center , University of Amsterdam , Amsterdam , The Netherlands
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Optical Coherence Tomography Guided Percutaneous Coronary Intervention. Heart Lung Circ 2017; 26:1267-1276. [DOI: 10.1016/j.hlc.2017.07.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Revised: 06/05/2017] [Accepted: 07/10/2017] [Indexed: 11/23/2022]
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Coronary Artery Hematoma Treated with Fenestration Using a Novel NSE Alpha® Scoring Balloon. Case Rep Cardiol 2017; 2017:8189530. [PMID: 29098092 PMCID: PMC5643103 DOI: 10.1155/2017/8189530] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2017] [Revised: 08/04/2017] [Accepted: 08/27/2017] [Indexed: 12/04/2022] Open
Abstract
The optimal management of coronary intramural hematoma has not been defined. We described a case in which coronary occlusion developed due to an intramural hematoma after percutaneous coronary intervention for mid left circumflex artery (LCX). Intravascular ultrasound (IVUS) demonstrated the progression of the intramural hematoma and a totally compressed true lumen. Our approach was based on fenestration with a scoring balloon (NSE Alpha, Goodman, Japan), which allowed the deployment of an additional stent to be avoided. In conclusion, this management can be effectively and safely performed.
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Optical Frequency Domain Imaging Versus Intravascular Ultrasound in Percutaneous Coronary Intervention (OPINION Trial): Results From the OPINION Imaging Study. JACC Cardiovasc Imaging 2017; 11:111-123. [PMID: 28917678 DOI: 10.1016/j.jcmg.2017.06.021] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Revised: 06/02/2017] [Accepted: 06/08/2017] [Indexed: 12/19/2022]
Abstract
OBJECTIVES The authors sought to clarify how intravascular ultrasound (IVUS) and optical coherence tomography affect percutaneous coronary intervention (PCI) with current-generation drug-eluting stents in a pre-specified substudy of the OPINION (OPtical frequency domain imaging versus INtravascular ultrasound in percutaneous coronary interventiON) trial, a multicenter, prospective, randomized, noninferiority trial comparing optical frequency domain imaging (OFDI)-guided PCI with IVUS-guided PCI. BACKGROUND The impact of these 2 imaging modalities in guiding PCI remains unknown. METHODS Of 829 patients enrolled in the OPINION trial, 106 were included in the present imaging substudy. Their PCI was guided by either IVUS or OFDI, but all patients were imaged by both modalities after PCI and by OFDI at 8 months. Angiographic, OFDI, and IVUS images were analyzed by independent core laboratories, and statistical analysis was done independently by a dedicated institution. RESULTS A total of 103 patients underwent either OFDI-guided (n = 54) or IVUS-guided (n = 49) PCI. Immediately after PCI, OFDI-guided PCI was associated with a smaller trend of minimum stent area (5.28 ± 1.65 mm2 vs. 6.12 ± 2.34 mm2; p = 0.088), fewer proximal stent-edge hematomas (p = 0.04), and fewer irregular protrusions (p = 0.014) than IVUS-guided PCI. At 8 months, the neointima area tended to be smaller in the OFDI-guided PCI group than in the IVUS-guided PCI group (0.56 ± 0.30 mm2 vs. 0.80 ± 0.65 mm2; p = 0.057), although the percentage of uncovered struts was significantly higher in the OFDI-guided PCI group than in the IVUS-guided PCI group (6.97 ± 7.03% vs. 4.67 ± 6.43%; p = 0.039). The minimum lumen area was comparable in both groups (p = 0.18). CONCLUSIONS There were several differences in local findings between OFDI- and IVUS-guided PCI as expected given the different protocols for stent sizing in the 2 groups. The minimum lumen area at the 8-month follow-up was comparable, suggesting that OFDI- and IVUS-guided PCI are similarly feasible using the current-generation drug-eluting stents. (OPtical frequency domain imaging versus INtravascular ultrasound in percutaneous coronary interventiON; NCT01873222).
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Song HG, Kang SJ. Current Clinical Applications of Intravascular Ultrasound in Coronary Artery Disease. CURRENT CARDIOVASCULAR IMAGING REPORTS 2017. [DOI: 10.1007/s12410-017-9424-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Optical coherence tomography assessment of incidence, morphological characteristics, and spontaneous healing course of edge dissections following percutaneous coronary intervention with stent implantation in patients with non-ST segment elevation myocardial infarction. Int J Cardiol 2016; 223:466-474. [PMID: 27544607 DOI: 10.1016/j.ijcard.2016.08.245] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2016] [Revised: 08/10/2016] [Accepted: 08/12/2016] [Indexed: 11/22/2022]
Abstract
BACKGROUND Stenting-induced edge dissections (ED) can be assessed in detail by optical coherence tomography (OCT). This study sought to investigate the incidence, morphological characteristics, and spontaneous healing course of OCT-identified EDs following drug-eluting stent (DES) implantation in a non-ST segment elevation myocardial infarction (NSTEMI) patient-population. METHODS Acute vessel wall injury at the 5-mm stent adjacent distal and proximal reference segments was assessed by post-procedure OCT and intravascular ultrasound (IVUS) in n=97 NSTEMI-patients (n=97 lesions). Six months OCT follow-up was available in 82 patients (including 35 untreated post-procedure EDs). RESULTS The overall incidence of post-procedure OCT-detected ED was 38 per 97 patients (39.2%), and 47 per 182 stent edges (25.8%). None of the EDs were angiographically visualizable, while 10 (21.3%) were visible on concomitant IVUS-analysis. Morphologically, there was a significant difference in plaque type present at ED-edges vs. non-ED-edges when assessed with OCT; (1) lipid-rich and calcified plaques: 80.9% vs. 57.0%, (2) fibrous plaques: 17.0% vs. 26.7%, and (3) normal coronary vessels: 2.1% vs. 16.3%, p<0.01. Plaqueburden, assessed by IVUS, was substantially larger at ED-containing borders: 54.5±10.0% vs. 43.7±11.6%, p=0.01. Three dissections (8.6%) were incompletely healed at 6-month OCT follow-up. None of the EDs caused cardiac events during the 6-month follow-up, however, 1 ED-patient had target lesion revascularization with PCI and DES-implantation in extension of the scheduled OCT-control. CONCLUSIONS OCT-detected EDs were frequent after stent implantation due to NSTEMI, and the majority of these EDs healed without leading to an adverse prognosis at 6months.
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Intravascular ultrasound-guided drug-eluting stent implantation. Cardiovasc Interv Ther 2016; 32:1-11. [DOI: 10.1007/s12928-016-0438-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2016] [Accepted: 10/30/2016] [Indexed: 10/20/2022]
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The effect of statin treatment on the prevention of stent mediated flow limited edge dissections during PCI in patients with stable angina. Int J Cardiol 2016; 220:365-70. [PMID: 27390956 DOI: 10.1016/j.ijcard.2016.06.214] [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: 04/30/2016] [Accepted: 06/25/2016] [Indexed: 11/22/2022]
Abstract
OBJECTIVES The effect of statin therapy before PCI with direct stenting may reduce the development of flow limited edge dissections (ED) in patients with stable angina. BACKGROUND Flow limited ED after PCI is associated with an increased risk of major adverse cardiovascular events. Statin therapy induces important changes in the plaque composition which have been previously identified as strong predictors of ED. MATERIAL AND METHODS 100 patients complicated with flow limited ED and 100 control patients with successful procedure were enrolled into the study. EDs were described as the 5-mm regions that were immediately adjacent to the stent borders, both distally and proximally on the coronary angiography. RESULTS Rate of statin use and duration of statin use were significantly higher in patients with non-ED group (63%) versus ED group (25%) (p<0.001). In addition, patients in ED group had significantly higher levels of C-reactive protein (CRP) at admission (9.9mg/dL (5.89-16.45) vs. 4.40mg/dL (3.5-7.09), respectively, p=0.014). CONCLUSIONS Our findings suggested that maintenance statin treatment before PCI with direct stenting may reduce the development of flow limited ED in patients with stable angina.
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Prevalence, Features, and Prognostic Importance of Edge Dissection After Drug-Eluting Stent Implantation. Circ Cardiovasc Interv 2016; 9:e003553. [DOI: 10.1161/circinterventions.115.003553] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2015] [Accepted: 05/25/2016] [Indexed: 01/24/2023]
Abstract
Background—
Intravascular ultrasound detects stent edge dissections after percutaneous coronary intervention that are not seen angiographically. This study investigated the association between stent edge dissections and clinical outcomes.
Methods and Results—
ADAPT-DES (Assessment of Dual Antiplatelet Therapy With Drug-Eluting Stents) was a large-scale, prospective, multicenter study of patients undergoing drug-eluting stent implantation. In this prospective substudy, 2062 patients (2433 lesions) were evaluated with intravascular ultrasound to characterize the morphological features and clinical outcomes of stent edge dissection after percutaneous coronary intervention. The prevalence of post–percutaneous coronary intervention stent edge dissection was 6.6% per lesion (161 of 2433). Calcified plaque at the proximal stent edge (relative risk [RR]=1.72;
P
=0.04) and proximal stent edge expansion (RR=1.18;
P
=0.004) were predictors for proximal dissection; attenuated plaque at the distal stent edge (RR=3.52;
P
=0.004), distal reference plaque burden (RR=1.56;
P
<0.0001), and distal edge stent expansion (RR=1.11;
P
=0.02) were predictors for distal dissection. At 1-year follow-up, target lesion revascularization was more common in lesions with versus without dissection (5.2% versus 2.7%;
P
=0.04). Multivariable analysis indicated that residual dissection was associated with target lesion revascularization at 1-year follow-up (RR=2.67;
P
=0.02). Among lesions with dissection, smaller effective lumen area increased the risk of target lesion revascularization at 1-year follow-up (cutoff value of 5.1 mm
2
;
P
=0.05).
Conclusions—
Greater stent expansion and the presence of large, calcified, and/or attenuated plaques were independent predictors of stent edge dissection. Residual stent edge dissection, especially with a smaller effective lumen area, was associated with target lesion revascularization during 1-year follow-up after drug-eluting stent implantation.
Clinical Trial Registration—
URL:
http://www.clinicaltrials.gov
. Unique identifier: NCT00638794.
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Abstract
Coronary optical coherence tomography (OCT) is now an established imaging technique in many catheterization laboratories worldwide. With its near-histological view of the vessel wall and lumen interface, it offers unprecedented imaging quality to improve our understanding of the pathophysiology of atherosclerosis, plaque vulnerability, and vascular biology. Not only is OCT used to accurately detect atherosclerotic plaque and optimize stent position, but it can further characterize plaque composition, quantify stent apposition, and assess stent tissue coverage. Given that its resolution of 15 μm is well above that of angiography and intravascular ultrasound, OCT has become the invasive imaging method of choice to examine the interaction between stents and the vessel wall. This review focuses on the application of OCT to examine coronary stents, the mechanisms of stent complications, and future directions of OCT-guided intervention.
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Kim IC, Yoon HJ, Shin ES, Kim MS, Park J, Cho YK, Park HS, Kim H, Nam CW, Han SW, Kim YN, Kim KB, Hur SH. Usefulness of Frequency Domain Optical Coherence Tomography Compared with Intravascular Ultrasound as a Guidance for Percutaneous Coronary Intervention. J Interv Cardiol 2016; 29:216-24. [PMID: 26927366 DOI: 10.1111/joic.12276] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVES To compare outcomes and rates of optimal stent placement between optical coherence tomography (OCT) and intravascular ultrasound (IVUS) guided percutaneous coronary intervention (PCI). BACKGROUND Unlike IVUS-guided PCI, rates of clinical outcomes and optimal stent placement have not been well characterized for OCT-guided PCI. METHODS The study enrolled 290 patients who underwent implantation of a second generation drug eluting stent under OCT (122 patients) or IVUS (168 patients) guidance. The two groups were compared after adjusting for baseline differences using 1:1 propensity score matching (PSM) (114 patients in each group). Optimal stent placement was defined as achieving an adequate lumen (optimal minimum stent area [MSA > 4.85 mm(2) for OCT, >5 mm(2) for IVUS] or a final MSA ≥ 90% of the distal reference lumen area, without edge dissection, incomplete stent apposition, or tissue prolapse), or otherwise performing additional interventions to address suboptimal post-stenting OCT or IVUS findings. The primary endpoint was one-year cumulative incidence of major adverse cardiac events (MACE; cardiac death, myocardial infarction and target lesion revascularization). Definite or probable stent thrombosis (ST) rates were evaluated. RESULTS In adjusted comparisons between OCT and IVUS groups, there was no significant difference in rates of MACE (3.5% vs. 3.5%, P = 1.000) and ST (0% vs. 0.9%, P = 1.000) at 1 year, optimal stent placement (89.5% vs. 92.1%, P = 0.492), and further intervention (7.9% vs.13.2%, P = 0.234), despite OCT significantly more frequently detecting tissue prolapse (97.4% vs. 47.4%, P < 0.001), and numerically more edge dissection (10.5% vs. 4.4%, P = 0.078) or incomplete stent apposition (48.2% vs. 36.8%, P = 0.082). CONCLUSIONS OCT guidance showed comparable results to IVUS in mid-term clinical outcomes, suggesting that OCT can be an alternative tool for stent placement optimization.
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Affiliation(s)
- In-Cheol Kim
- Division of Cardiology, Department of Internal Medicine, Keimyung University Dongsan Medical Center, Daegu, Korea
| | - Hyuck-Jun Yoon
- Division of Cardiology, Department of Internal Medicine, Keimyung University Dongsan Medical Center, Daegu, Korea
| | - Eun-Seok Shin
- Division of Cardiology, Department of Internal Medicine, Ulsan University Hospital, Ulsan, Korea
| | - Min-Seok Kim
- Department of Statistics, Keimyung University, Daegu, Korea
| | - Jincheol Park
- Department of Statistics, Keimyung University, Daegu, Korea
| | - Yun-Kyeong Cho
- Division of Cardiology, Department of Internal Medicine, Keimyung University Dongsan Medical Center, Daegu, Korea
| | - Hyoung-Seob Park
- Division of Cardiology, Department of Internal Medicine, Keimyung University Dongsan Medical Center, Daegu, Korea
| | - Hyungseop Kim
- Division of Cardiology, Department of Internal Medicine, Keimyung University Dongsan Medical Center, Daegu, Korea
| | - Chang-Wook Nam
- Division of Cardiology, Department of Internal Medicine, Keimyung University Dongsan Medical Center, Daegu, Korea
| | - Seong-Wook Han
- Division of Cardiology, Department of Internal Medicine, Keimyung University Dongsan Medical Center, Daegu, Korea
| | - Yoon-Nyun Kim
- Division of Cardiology, Department of Internal Medicine, Keimyung University Dongsan Medical Center, Daegu, Korea
| | - Kwon-Bae Kim
- Division of Cardiology, Department of Internal Medicine, Keimyung University Dongsan Medical Center, Daegu, Korea
| | - Seung-Ho Hur
- Division of Cardiology, Department of Internal Medicine, Keimyung University Dongsan Medical Center, Daegu, Korea
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Contribution of optical coherence tomography imaging in management of iatrogenic coronary dissection. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2016; 17:138-42. [PMID: 26994747 DOI: 10.1016/j.carrev.2016.01.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Revised: 01/18/2016] [Accepted: 01/25/2016] [Indexed: 11/22/2022]
Abstract
Iatrogenic coronary dissection is a rare but potentially serious complication of coronary angiography and angioplasty. Treatment with angioplasty guided only by angiography is often difficult. Optical coherence tomography imaging seems to be an interesting technique to lead the management of iatrogenic coronary dissection. Diagnosis can be made by optical coherence tomography; it can also eliminate differential diagnosis. Furthermore, this technique can guide safely the endovascular treatment.
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Mintz GS. Intravascular imaging of coronary calcification and its clinical implications. JACC Cardiovasc Imaging 2016; 8:461-471. [PMID: 25882575 DOI: 10.1016/j.jcmg.2015.02.003] [Citation(s) in RCA: 133] [Impact Index Per Article: 16.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2014] [Revised: 01/21/2015] [Accepted: 02/12/2015] [Indexed: 12/21/2022]
Abstract
Calcium impacts the natural history and treatment of coronary artery disease in many ways. Intravascular imaging studies, mostly intravascular ultrasound, but more recently studies using optical coherence tomography, have been instrumental in increasing our understanding of the relationship between calcium and coronary atherosclerosis, the predictors, the natural history of this relationship, and the impact on treatment. On one hand, stable coronary lesions are associated with more calcium than unstable lesions; and the amount of calcium may affect the success of percutaneous coronary intervention. On the other hand, calcium correlates with plaque burden; unstable lesions are associated with focal calcium deposits; and calcific nodules are one of the morphologies of vulnerable plaque. This review focuses on more than 20 years of intravascular imaging studies of the relationship between calcium and coronary atherosclerosis.
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Affiliation(s)
- Gary S Mintz
- Cardiovascular Research Foundation, New York, New York.
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29
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Su JL, Grainger SJ, Greiner CA, Madden SP, Sum ST, Muller JE, Madder RD. Detection and structural characterization of lipid-core plaques with intravascular NIRS-IVUS imaging. Interv Cardiol 2015. [DOI: 10.2217/ica.15.41] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Intravascular Ultrasound for the Assessment of Coronary Lesion Severity and Optimization of Percutaneous Coronary Interventions. Interv Cardiol Clin 2015; 4:383-395. [PMID: 28581952 DOI: 10.1016/j.iccl.2015.02.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Intravascular ultrasound (IVUS) has provided valuable information on cross-sectional coronary vascular structure and has played a key role in contemporary stent-based percutaneous coronary interventions (PCI). It accurately assesses coronary anatomy, assists in the selection of treatment strategy, and helps to optimize stenting outcomes. IVUS-guided PCI for drug-eluting stent implantation seems to be associated with a significantly reduced risk of death, myocardial infarction, target lesion revascularization, and stent thrombosis.
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32
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Present Status and Future Direction of NIRS-IVUS Multimodality Direct Coronary Imaging. CURRENT CARDIOVASCULAR IMAGING REPORTS 2015. [DOI: 10.1007/s12410-015-9342-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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33
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Chung JH, Ann SH, Koo BK, Nam CW, Doh JH, Singh GB, Kim HI, Shin ES. Assessment of stent edge dissections by fractional flow reserve. Int J Cardiol 2015; 185:29-33. [DOI: 10.1016/j.ijcard.2015.03.043] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2014] [Revised: 02/23/2015] [Accepted: 03/03/2015] [Indexed: 11/24/2022]
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Impact of the distance from the stent edge to the residual plaque on edge restenosis following everolimus-eluting stent implantation. PLoS One 2015; 10:e0121079. [PMID: 25775115 PMCID: PMC4361545 DOI: 10.1371/journal.pone.0121079] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2014] [Accepted: 01/28/2015] [Indexed: 11/22/2022] Open
Abstract
Objectives This study aimed to assess the relation between stent edge restenosis (SER) and the distance from the stent edge to the residual plaque using quantitative intravascular ultrasound. Background Although percutaneous coronary intervention with drug-eluting stents has improved SER rates, determining an appropriate stent edge landing zone can be challenging in cases of diffuse plaque lesions. It is known that edge vascular response can occur within 2 mm from the edge of a bare metal stent, but the distance to the adjacent plaque has not been evaluated for drug-eluting stents. Methods A total of 97 proximal residual plaque lesions (plaque burden [PB] >40%) treated with everolimus-eluting stents were retrospectively evaluated to determine the distance from the stent edge to the residual plaque. Results The SER group had significantly higher PB (59.1 ± 6.1% vs. 51.9 ± 9.1% for non-SER; P = 0.04). Higher PB was associated with SER, with the cutoff value of 54.74% determined using receiver operating characteristic (ROC) curve analysis. At this cutoff value of PB, the distance from the stent edge to the lesion was significantly associated with SER (odds ratio = 2.05, P = 0.035). The corresponding area under the ROC curve was 0.725, and the cutoff distance value for predicting SER was 1.0 mm. Conclusion An interval less than 1 mm from the proximal stent edge to the nearest point with the determined PB cutoff value of 54.74% was significantly associated with SER in patients with residual plaque lesions.
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Antonsen L, Thayssen P, Jensen LO. Large coronary intramural hematomas: a case series and focused literature review. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2015; 16:116-23. [DOI: 10.1016/j.carrev.2014.10.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2014] [Revised: 10/22/2014] [Accepted: 10/23/2014] [Indexed: 11/15/2022]
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36
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Intracoronary Optical Coherence Tomography: Insights from Clinical Research—What Do We Need to Learn? CURRENT CARDIOVASCULAR IMAGING REPORTS 2014. [DOI: 10.1007/s12410-014-9286-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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37
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The influence of vascular anatomy on carotid artery stenting: A parametric study for damage assessment. J Biomech 2014; 47:890-8. [DOI: 10.1016/j.jbiomech.2014.01.008] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/13/2014] [Indexed: 11/24/2022]
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38
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Jang JS, Song YJ, Kang W, Jin HY, Seo JS, Yang TH, Kim DK, Cho KI, Kim BH, Park YH, Je HG, Kim DS. Intravascular Ultrasound-Guided Implantation of Drug-Eluting Stents to Improve Outcome. JACC Cardiovasc Interv 2014; 7:233-43. [DOI: 10.1016/j.jcin.2013.09.013] [Citation(s) in RCA: 121] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2013] [Revised: 09/11/2013] [Accepted: 09/26/2013] [Indexed: 01/29/2023]
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39
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Hanson I, Dixon S, Goldstein J. Assessing coronary target lesion length: the Goldilocks approach. Future Cardiol 2014; 10:179-82. [PMID: 24762245 DOI: 10.2217/fca.13.105] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Affiliation(s)
- Ivan Hanson
- Beaumont Health System, 1301 West 13 Mile Road, Royal Oak, MI 48073, USA
| | - Simon Dixon
- Beaumont Health System, 1301 West 13 Mile Road, Royal Oak, MI 48073, USA
| | - James Goldstein
- Beaumont Health System, 1301 West 13 Mile Road, Royal Oak, MI 48073, USA
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40
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Ann SH, Lim KH, De Jin C, Shin ES. Multi-modality imaging for stent edge assessment. Heart Vessels 2014; 30:162-8. [PMID: 24481539 DOI: 10.1007/s00380-014-0467-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2013] [Accepted: 01/10/2014] [Indexed: 10/25/2022]
Abstract
Optical coherence tomography (OCT) has a sufficiently high resolution to allow assessment of stent edge dissection (ED). The aims of the present study were as follows: (1) evaluation of the frequency of stent ED using OCT; (2) comparison of stent ED detection rates obtained using angiography, intravascular ultrasound (IVUS), and OCT; and (3) IVUS-Virtual Histology (IVUS-VH) evaluation of plaque composition at the site of stent EDs detected by OCT after percutaneous coronary intervention (PCI). Fifty-eight consecutive patients (59 lesions, 100 stent edges) who underwent balloon-expandable stent implantation and post-stent assessment with OCT and IVUS-VH were included. OCT revealed stent ED in 24.0 % (24 of 100) of stent edges after PCI with a balloon-expandable stent. In contrast, ED was detected in only 3.0 % (3 of 100) of stent edges using angiography and 4.0 % (4 of 100) of stent edges using IVUS. Plaque evaluation using IVUS-VH showed that the percent necrotic core (21.2 ± 8.3 vs. 13.4 ± 10.7 %, p = 0.001) and absolute dense calcium (2.9 ± 2.4 vs. 1.3 ± 2.2 mm(3), p = 0.0104) and dense calcium (13.8 ± 9.3 vs. 5.4 ± 5.8 %, p < 0.001) volumes were greater in the ED group than in the non-ED group. Thus, OCT is superior to conventional coronary angiography and IVUS in the identification of stent ED. In addition, the plaque composition at the ED site is characterized by a necrotic core and greater dense calcium levels than those observed at the non-ED site.
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Affiliation(s)
- Soe Hee Ann
- Department of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine, 290-3 Jeonha-dong, Dong-gu, Ulsan, 682-714, South Korea
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41
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Mortier P, Verdonck PR. Stent design matters: insights from virtual bench testing. Expert Rev Cardiovasc Ther 2014; 8:613-5. [DOI: 10.1586/erc.10.32] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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42
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Radu MD, Räber L, Heo J, Gogas BD, Jørgensen E, Kelbæk H, Muramatsu T, Farooq V, Helqvist S, Garcia-Garcia HM, Windecker S, Saunamäki K, Serruys PW. Natural history of optical coherence tomography-detected non-flow-limiting edge dissections following drug-eluting stent implantation. EUROINTERVENTION 2014; 9:1085-94. [DOI: 10.4244/eijv9i9a183] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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43
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Burzotta F, Talarico GP, Trani C, De Maria GL, Pirozzolo G, Niccoli G, Leone AM, Saffioti S, Porto I, Crea F. Frequency-domain optical coherence tomography findings in patients with bifurcated lesions undergoing provisional stenting. Eur Heart J Cardiovasc Imaging 2013; 15:547-55. [PMID: 24255135 DOI: 10.1093/ehjci/jet231] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
AIMS Bifurcations represent challenging lesions which may benefit from improved understanding of stent-related vessel complications. Since optical coherence tomography (OCT) allows us to detect post-stenting vessel injuries, we sought to assess the geographic pattern of stent-related complications occurring during provisional stenting of bifurcated lesions. METHODS AND RESULTS Fifty-one patients with bifurcated lesions treated by provisional stenting and undergoing intra-procedural OCT assessment were enrolled. OCT images were acquired with the aim of guiding the percutaneous coronary intervention but were re-analysed off-line for the present study. The stented bifurcation was divided into four segments [three in the main vessel (MV) and one in the side branch (SB)]. The following acute post-stenting vessel injuries/complications at the different bifurcation segments were evaluated: (i) stent under-expansion, (ii) stent malapposition, (iii) stent edge dissection, (iv) side-branch ostium dissection, (v) tissue prolapse, (vi) intracoronary thrombus, and (vii) in-stent dissection. A total of 55 bifurcation lesions undergoing provisional stenting were analysed. At least one OCT complication was detectable in all cases. Across different bifurcation sites, significant differences in the occurrence of stent complications were observed. In particular, stent malapposition was more common at the proximal MV segment (P < 0.001), while tissue prolapse was more common at the distal MV segment (P < 0.001). CONCLUSION In bifurcated interventions, OCT often detects vessel injuries/stent complications, which tend to have a specific geographical distribution. In particular, stent malapposition is more common at the proximal MV and tissue prolapse at the distal MV segment.
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Affiliation(s)
- Francesco Burzotta
- Institute of Cardiology, Catholic University of the Sacred Heart, L.go Gemelli 8, Rome 00168, Italy
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Baquero GA, Gilchrist IC. Acute thrombotic occlusion or intramural hematoma: only IVUS can tell for sure. Catheter Cardiovasc Interv 2013; 82:768-9. [PMID: 24167051 DOI: 10.1002/ccd.25199] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2013] [Accepted: 09/08/2013] [Indexed: 11/10/2022]
Affiliation(s)
- Giselle A Baquero
- College of Medicine, Heart & Vascular Institute, MS Hershey Medical Center, Penn State University, Hershey, Pennsylvania
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45
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Park S, Lee DG, Shim JH, Lee DH, Suh DC. Recanalization of symptomatic vertebral ostial occlusion in patients with acute or subacute stroke. AJNR Am J Neuroradiol 2013; 35:367-72. [PMID: 23907242 DOI: 10.3174/ajnr.a3681] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
SUMMARY Vertebral artery recanalization in symptomatic stenosis/occlusion remains controversial, as no definite evidence exists regarding this topic. There are only a few reports regarding the feasibility and safety of recanalization in the first segment of the vertebral artery with atherosclerotic vertebral ostial occlusion. We report our experience treating first segment occlusion in 8 patients and present a balloon protection technique used to reduce the thromboembolic burden during the stent placement procedure. The outcome at 3 months showed an mRS ≤2 except for a patient with a poor initial status with basilar artery occlusion. Revascularization of a rather long first segment occlusion is technically feasible and can be safely performed by use of embolic protection methods.
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Affiliation(s)
- S Park
- From the Department of Radiology and Research Institute of Radiology (S.P., D.-G.L., J.H.S., D.H.L., D.C.S.), University of Ulsan, College of Medicine, Asan Medical Center, Seoul, Korea
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Incidence, Predictors, Morphological Characteristics, and Clinical Outcomes of Stent Edge Dissections Detected by Optical Coherence Tomography. JACC Cardiovasc Interv 2013; 6:800-13. [DOI: 10.1016/j.jcin.2013.03.019] [Citation(s) in RCA: 118] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2013] [Revised: 03/18/2013] [Accepted: 03/22/2013] [Indexed: 11/18/2022]
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Zhang Y, Farooq V, Garcia-Garcia HM, Bourantas CV, Tian N, Dong S, Li M, Yang S, Serruys PW, Chen SL. Comparison of intravascular ultrasound versus angiography-guided drug-eluting stent implantation: a meta-analysis of one randomised trial and ten observational studies involving 19,619 patients. EUROINTERVENTION 2013; 8:855-65. [PMID: 23171805 DOI: 10.4244/eijv8i7a129] [Citation(s) in RCA: 133] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS The impact of intravascular ultrasound (IVUS) guided coronary drug-eluting stent (DES) implantation on clinical outcomes remains controversial. A meta-analysis of the currently available clinical trials investigating IVUS-guided DES implantation was undertaken. METHODS AND RESULTS We searched Medline, the Cochrane Library and other internet sources, without language or date restrictions, for published articles comparing clinical outcomes between IVUS-guided and angiography-guided DES implantation. Clinical studies with both adjusted and unadjusted data were included. Eleven studies were identified (one randomised controlled trial and 10 registries) and included in the meta-analysis with a weighted follow-up time of 20.7±11.5 months. Compared with angiography guidance, IVUS-guided DES implantation was associated with a reduced incidence of death (hazard ratio [HR]: 0.59, 95% confidence interval [CI]: 0.48-0.73, p<0.001), major adverse cardiac events (HR: 0.87, 95% CI: 0.78-0.96, p=0.008) and stent thrombosis (HR: 0.58, 95% CI: 0.44-0.77, p<0.001). The incidence of myocardial infarction (HR: 0.82, 95% CI: 0.63-1.06, p=0.126), target lesion (HR: 0.90, 95% CI: 0.73-1.11, p=0.316) and target vessel (HR: 0.90, 95% CI: 0.77-1.05, p=0.195) revascularisation was comparable between the angiography and IVUS-guided arms. A repeat meta-analysis of propensity-matched studies only (six studies, n=5,300) yielded broadly similar results in terms of clinical outcomes. CONCLUSIONS IVUS-guided coronary DES implantation is associated with a significant reduction in death, MACE and stent thrombosis compared to angiography guidance. Appropriately powered randomised trials are necessary to confirm the findings from this meta-analysis.
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Affiliation(s)
- Yaojun Zhang
- Division of Cardiovascular Diseases, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
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Reith S, Battermann S, Jaskolka A, Lehmacher W, Hoffmann R, Marx N, Burgmaier M. Predictors and incidence of stent edge dissections in patients with type 2 diabetes as determined by optical coherence tomography. Int J Cardiovasc Imaging 2013; 29:1237-47. [PMID: 23558468 DOI: 10.1007/s10554-013-0213-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2012] [Accepted: 03/28/2013] [Indexed: 11/28/2022]
Abstract
Patients with type 2 diabetes are at increased risk for post-PCI complications including stent thrombosis and restenosis. Stent edge dissections (SEDs) have been associated with these complications. This study assessed incidence and predictors of SEDs in patients with type 2 diabetes using optical coherence tomography (OCT). Intravascular lesion parameters and plaque morphology were investigated pre- and post-PCI using OCT in 73 type 2 diabetic patients with 90 lesions and 166 visible stent edges. We detected 42 (25.3 %) SEDs in 166 stent edges and 37 (41.1 %) SEDs in 90 lesions. More SEDs occurred if the border of the stent had been placed within diseased vessel segments with predominantly fibrous (42.9 %) and fibrocalcific (40.5 %) plaques compared to healthy vessel wall morphology (p < 0.001). Furthermore, the lumen eccentricity of the stent at its edges (SAE) (16.00 ± 6.07 vs. 13.11 ± 5.22 %, p < 0.003) and the stent-edge-to-lumen-area-ratio (1.26 ± 0.27 vs. 0.99 ± 0.20, p < 0.001) were both significantly larger in the presence of SEDs. All of the above parameters were significant predictors for SEDs on uni- and multivariate logistic regression analysis (all p < 0.01), suggesting that the lumen eccentricity of the SAE, the stent-edge-to-lumen-area-ratio and diseased vessel wall morphology of the reference segment adjacent to the stent edge are independent risk factors for the presence of SEDs. These results suggest that diseased vessel wall morphology at the stent edges may promote the occurrence of SEDs and that avoidance of longitudinal and transverse mismatch between stent and vessel could be important to reduce SEDs in cardiovascular high-risk patients with type 2 diabetes.
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Affiliation(s)
- Sebastian Reith
- Department of Internal Medicine I, University Hospital of the RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Germany.
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Patel VG, Banerjee S, Brilakis ES. Treatment of inadvertent subintimal stenting during intervention of a coronary chronic total occlusion. Interv Cardiol 2013. [DOI: 10.2217/ica.13.9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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