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Murasato Y, Watanabe Y, Yamawaki M, Kinoshita Y, Okubo M, Yumoto K, Masuda N, Otake H, Aoki J, Nakazawa G, Numasawa Y, Ito T, Shite J, Okamura T, Takagi K, Kozuma K, Lefèvre T, Chevalier B, Louvard Y, Suzuki N, Kozuma K. Effect of proximal optimization technique on coronary bifurcation stent failure: Insights from the multicenter randomized PROPOT trial. Catheter Cardiovasc Interv 2022; 99:1047-1058. [PMID: 35170843 DOI: 10.1002/ccd.30120] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 12/24/2021] [Accepted: 01/26/2022] [Indexed: 12/13/2022]
Abstract
OBJECTIVE We investigated the effect of proximal optimization technique (POT) on coronary bifurcation stent failure (BSF) in cross-over stenting by comparing with the kissing balloon technique (KBT) in a multicenter randomized PROPOT trial. BACKGROUND POT is recommended due to increased certainty for optimal stent expansion and side branch (SB) wiring. METHODS We randomized 120 patients treated with crossover stenting into the POT group, which was followed by SB dilation (SBD), and the KBT group. Finally, 52 and 57 patients were analyzed by optical coherence tomography before SBD and at the final procedure, respectively. Composite BSF was defined as a maximal malapposition distance of >400 μm, or malapposed and SB-jailed strut rates of >5.95% and >21.4%, respectively. RESULTS Composite BSF before SBD in the POT and KBT groups was observed in 29% and 26% of patients, respectively. In the POT group, differences in stent volumetric index between the proximal and distal bifurcation (odds ratio [OR] 60.35, 95% confidential interval [CI] 0.13-0.93, p = 0.036) and between the proximal bifurcation and bifurcation core (OR: 3.68, 95% CI: 1.01-13.40, p = 0.048) were identified as independent risk factors. Composite BSF at final in 27% and 32%, and unplanned additional procedures in 38% and 25% were observed, respectively. Composite BSF before SBD was a risk factor for the former (OR: 6.33, 95% CI: 1.10-36.50, p = 0.039) and the latter (OR: 6.43, 95% CI: 1.25-33.10, p = 0.026) in the POT group. CONCLUSION POT did not result in a favorable trend in BSF. Insufficient expansion of the bifurcation core after POT was associated with BSF.
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Affiliation(s)
- Yoshinobu Murasato
- Department of Cardiology and Clinical Research Center, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan
| | - Yusuke Watanabe
- Department of Medicine, Teikyo University School of Medicine, Tokyo, Japan
| | - Masahiro Yamawaki
- Department of Cardiology, Saiseikai Yokohama City Eastern Hospital, Yokohama, Japan
| | | | - Munenori Okubo
- Department of Cardiology, Gifu Heart Center, Gifu, Japan
| | - Kazuhiko Yumoto
- Department of Cardiology, Yokohama Rosai Hospital, Yokohama, Japan
| | - Naoki Masuda
- Department of Cardiology, Ageo Central General Hospital, Ageo, Japan
| | - Hiromasa Otake
- Department of Cardiology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Jiro Aoki
- Department of Cardiology, Mitsui Memorial Hospital, Tokyo, Japan
| | - Gaku Nakazawa
- Department of Cardiology, Tokai University School of Medicine, Isehara, Japan
| | - Yohei Numasawa
- Department of Cardiology, Japanese Red Cross Ashikaga Hospital, Ashikaga, Japan
| | - Tatsuya Ito
- Department of Cardiology, Nagoya Heart Center, Nagoya, Japan
| | - Junya Shite
- Department of Cardiology, Osaka Saiseikai Nakatsu Hospital, Osaka, Japan
| | - Takayuki Okamura
- Department of Medicine and Clinical Science, Yamaguchi University Graduate School of Medicine, Ube, Japan
| | - Kensuke Takagi
- Department of Cardiology, Ogaki Municipal Hospital, Ogaki, Japan
| | - Kayoko Kozuma
- Department of Biostatistics, The University of Tokyo, Tokyo, Japan
| | - Thierry Lefèvre
- Department of Cardiology, Ramsay Générale de Santé, Institut Cardiovasculaire Paris Sud, Hopital Privé Jacques Cartier, Massy, France
| | - Bernard Chevalier
- Department of Cardiology, Ramsay Générale de Santé, Institut Cardiovasculaire Paris Sud, Hopital Privé Jacques Cartier, Massy, France
| | - Yves Louvard
- Department of Cardiology, Ramsay Générale de Santé, Institut Cardiovasculaire Paris Sud, Hopital Privé Jacques Cartier, Massy, France
| | - Nobuaki Suzuki
- Division of Cardiology, Teikyo University Mizonokuchi Hospital, Kawasaki, Japan
| | - Ken Kozuma
- Department of Medicine, Teikyo University School of Medicine, Tokyo, Japan
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Comparable neointimal healing in patients with stable coronary lesions and acute coronary syndrome: 3-month optical coherence tomography analysis. Int J Cardiovasc Imaging 2021; 37:2095-2105. [PMID: 33591475 DOI: 10.1007/s10554-021-02189-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Accepted: 02/05/2021] [Indexed: 10/22/2022]
Abstract
We aimed to assess a possible difference of the neointimal coverage status and its quality after implantation of the current-generation metallic stents in patients with acute coronary syndrome (ACS) vs. stable coronary lesions (non-ACS). We comprehensively analyzed three prospective single-center observational studies RESTORE (UMIN000033009), HEAL-BioFreedom (UMIN000029692), and HEAL-BioFreedom ACS (UMIN000034769). All patients who received successful optical coherence tomography (OCT) examination at planned 3-month follow-up after stent implantation were analyzed. Study population was divided into two groups, ACS vs. non-ACS groups. We evaluated standard OCT variables, coverage percent, and the quantitative light property values including light intensity, attenuation, and backscatter of neointima. A total of 177 lesions from 154 patients (ACS 44 lesions vs. non-ACS 133 lesions) were analyzed. At 3-month follow-up, coverage percent (ACS 91.5 ± 9.5% vs. non-ACS 91.8 ± 9.0%, P = 0.722) and neointimal thickness (ACS 59.5 ± 32.3 µm vs. non-ACS 58.2 ± 32.3 µm, P = 0.760) did not significantly differ. Light property values were similar between both groups (light intensity 159.29 ± 72.20 vs. 159.45 ± 63.78, P = 0.654; light attenuation 0.88 ± 0.26 vs. 0.87 ± 0.24 m-1, P = 0.988; backscatter 4.86 ± 0.58 vs. 4.83 ± 0.57, P = 0.812). The similarity of the neointimal quality in ACS and non-ACS patients was consistent across the 6 different types of current-generation metallic stents (P for interaction > 0.05). Our findings suggested the comparable neointimal characteristics 3 months after implantation of the current-generation metallic stents in patients with ACS and stable coronary lesions by quantitative OCT methodology.
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Omatsu T, Sotomi Y, Kobayashi T, Hamanaka Y, Hirata A, Hirayama A, Ueda Y, Sakata Y, Higuchi Y. Quantitative Validation of the Coronary Angioscopic Yellow Plaque with Lipid Core Burden Index Assessed by Intracoronary Near-Infrared Spectroscopy. J Atheroscler Thromb 2021; 29:362-369. [PMID: 33487618 PMCID: PMC8894116 DOI: 10.5551/jat.60566] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Aim:
We aimed to validate the subjective and qualitative angioscopic findings by the objective and quantitative near-infrared spectroscopic (NIRS) assessment to compensate each other’s drawbacks.
Methods:
This is a single-center prospective observational study. Patients undergoing a planned follow-up coronary angiography after percutaneous coronary intervention were prospectively enrolled from January 2018 to April 2019. The major three vessels were examined by NIRS-intravascular ultrasound, followed by coronary angioscopic evaluation. Yellow color grade on angioscopy was classified into four grades (0, white; 1, slight yellow; 2, yellow; and 3, intensive yellow) at a location of maximal lipid core burden index over 4 mm [LCBI (4)] on NIRS in each vessel.
Results:
A total of 95 lesions in 44 patients (72.6±6.7 years, 75% male) were analyzed. LCBI (4) was significantly different among different yellow color grades by coronary angioscopy (ANOVA,
p
<0.001). Positive correlation was found between angioscopic yellow color grade and LCBI (4) (beta coefficient 164.8, 95% confidence interval 122.9–206.7;
p
<0.001). The best cutoff value of LCBI (4) to predict the presence of yellow plaque (yellow color grade ≥ 2) was 448 (sensitivity 79.3%, specificity 69.7%, C-statistic 0.800, 95% confidence interval 0.713–0.887,
p
<0.001).
Conclusion:
The qualitative angioscopic assessment was objectively validated by the quantitative NIRS evaluation, which would be helpful for the reinterpretation of the existing evidences of both imaging modalities.
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Affiliation(s)
| | - Yohei Sotomi
- Cardiovascular Division, Osaka Police Hospital.,Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine
| | | | | | - Akio Hirata
- Cardiovascular Division, Osaka Police Hospital
| | | | - Yasunori Ueda
- Cardiovascular Division, National Hospital Organization Osaka National Hospital
| | - Yasushi Sakata
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine
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Ahuja R, Kumari N, Srivastava A, Bhati P, Vashisth P, Yadav PK, Jacob T, Narang R, Bhatnagar N. Biocompatibility analysis of PLA based candidate materials for cardiovascular stents in a rat subcutaneous implant model. Acta Histochem 2020; 122:151615. [PMID: 33066837 DOI: 10.1016/j.acthis.2020.151615] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 08/08/2020] [Accepted: 08/11/2020] [Indexed: 01/18/2023]
Abstract
Modification of Polylactic acid (PLA), a biopolymer, is a strategy still to be fully explored for the next generation of bioresorbable vascular stent (BVS) biomaterials. With this focus, inclusions upto 5% of Polycaprolactone (PCL) and Magnesium in PLA were tested in the rat subcutaneous model and their cellular and tissue interactions characterized, specifically with respect to inflammatory response, angiogenesis and capsularization. The cytokines IL6, TNF Alpha and IL-1Beta were estimated in the peri-implant tissue, all of which showed a non-significant difference between the non-implanted animals and those containing PLA by 8 weeks, speaking to the benign nature of PLA as an implant biomaterial. Both modified materials, had increased macrophage counts and cytokine levels, except IL6 at 8 weeks. Vascularization only at 8 weeks in PLA PCL containing tissue was significantly higher than pure PLA, which may be more carefully controlled along with the material hydrophobicity for possible efforts towards therapeutic angiogenesis. Capsule thickness, measured by staining with both Hematoxylin & Eosin and Masson's Trichome did not show any differences between materials, including PLA.
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Affiliation(s)
- Ramya Ahuja
- Department of Mechanical Engineering, Indian Institute of Technology, Delhi, India
| | - Nisha Kumari
- Department of Mechanical Engineering, Indian Institute of Technology, Delhi, India
| | - Alok Srivastava
- Department of Mechanical Engineering, Indian Institute of Technology, Delhi, India
| | - Pooja Bhati
- Department of Mechanical & Automation Engineering, Indira Gandhi Delhi Technical University for Women, India
| | - Priya Vashisth
- Department of Mechanical Engineering, Indian Institute of Technology, Delhi, India
| | - P K Yadav
- Central Animal Facility, All India Institute of Medical Sciences, Delhi, India
| | - Tony Jacob
- Department of Anatomy, All India Institute of Medical Sciences, Delhi, India
| | - Rajiv Narang
- Department of Cardiology, All India Institute of Medical Sciences, Delhi, India
| | - Naresh Bhatnagar
- Department of Mechanical Engineering, Indian Institute of Technology, Delhi, India.
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Sotomi Y, Suzuki S, Kobayashi T, Hamanaka Y, Nakatani S, Hirata A, Takeda Y, Ueda Y, Sakata Y, Higuchi Y. Impact of the one-year angioscopic findings on long-term clinical events in 504 patients treated with first-generation or second-generation drug-eluting stents: the DESNOTE-X study. EUROINTERVENTION 2019; 15:631-639. [DOI: 10.4244/eij-d-18-00660] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Suzuki S, Nakatani S, Sotomi Y, Shiojima I, Sakata Y, Higuchi Y. Serial optical coherence tomography and angioscopic assessments of 10-year in-stent restenosis of Cypher sirolimus-eluting stent treated with drug-coated balloon angioplasty. J Int Med Res 2019; 48:300060519837445. [PMID: 30938569 PMCID: PMC7140181 DOI: 10.1177/0300060519837445] [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] [Indexed: 11/17/2022] Open
Abstract
The drug-coated balloon (DCB) angioplasty is considered a standard therapeutic
option for in-stent restenosis. In the present case, we observed high-intensity
spots on optical coherence tomography (OCT) and bright spots on coronary
angioplasty (CAS) immediately after DCB angioplasty. The superficial
high-intensity area on OCT presumably corresponded with the bright spots on CAS.
The high-intensity superficial regions were thought to represent an
iopromide/paclitaxel mixture. The present serial observation demonstrated that
the eluted drugs remained for at least 2 months but disappeared within 6 months.
At the site where we observed the drugs, neointimal growth was successfully
inhibited and stabilized at the 6-month follow-up. The association of eluted
drugs after DCB angioplasty with consequent neointimal growth is of scientific
interest. Further prospective imaging studies with a large sample size are
warranted to clarify this association.
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Affiliation(s)
- Satoshi Suzuki
- Department of Cardiology, Osaka Police Hospital, Osaka, Japan
| | | | - Yohei Sotomi
- Department of Cardiology, Osaka Police Hospital, Osaka, Japan
| | - Ichiro Shiojima
- Department of Medicine II, Kansai Medical University, Hirakata, Japan
| | - Yasushi Sakata
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
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Suzuki S, Sotomi Y, Kobayashi T, Hamanaka Y, Nakatani S, Shiojima I, Sakata Y, Hirayama A, Higuchi Y. Early vessel healing after implantation of biodegradable-polymer and durable-polymer drug-eluting stent: 3-month angioscopic evaluation of the RESTORE registry. Int J Cardiovasc Imaging 2019; 35:973-980. [PMID: 30874980 DOI: 10.1007/s10554-019-01580-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2018] [Accepted: 03/07/2019] [Indexed: 10/27/2022]
Abstract
The purpose of this study was to evaluate the vessel healing status 3 months after stent implantation of bioresorbable-polymer drug-eluting stents (BP-DESs) in comparison with durable-polymer DESs (DP-DESs) by angioscopy. Study design was a single-center all-comer prospective cohort study: the RESTORE registry (UMIN000033009). All patients who received successful angioscopic examination at planned 3-month follow-up after the DES implantation in the native coronary artery were enrolled. We evaluated main, maximum, minimum strut coverage grades and coverage heterogeneity score defined as a difference between maximum and minimum coverage grades. All lesions were divided into three segments: proximal, mid, and distal segments. A total of 108 patients (66.6 ± 10 years) with 124 lesions were analyzed (BP-DES 57 patients 61 lesions 226 segments vs. DP-DES 57 patients 63 lesions 203 segments; six patients had both BP-DES and DP-DES). Patient and lesion demographics, procedural characteristics were well balanced. Main coverage grade (mean ± standard error; 1.08 ± 0.02 vs. 1.05 ± 0.03, p = 0.354) and minimum coverage grade (1.00 ± 0.00 vs. 1.00 ± 0.00, p > 0.999) were not significantly different between BP-DES and DP-DES groups. Maximum coverage grade was significantly higher in the BP-DES than in the DP-DES (1.45 ± 0.04 vs. 1.35 ± 0.04, p = 0.049). Coverage heterogeneity score did not differ between BP-DES and DP-DES groups (1.05 ± 0.07 vs. 0.90 ± 0.07, p = 0.162). At 3-month follow-up, the current BP-DES had higher maximum stent coverage than the contemporary DP-DES, while main and minimum coverage grades and heterogeneity of the neointimal coverage were comparable. Further prospective randomized trials should be conducted to evaluate the clinical significance of the present imaging results.
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Affiliation(s)
- Satoshi Suzuki
- Department of Cardiology, Osaka Police Hospital, 10-31, Kitayama, Tennoji, 543-0035, Osaka, Japan
| | - Yohei Sotomi
- Department of Cardiology, Osaka Police Hospital, 10-31, Kitayama, Tennoji, 543-0035, Osaka, Japan.
| | - Tomoaki Kobayashi
- Department of Cardiology, Osaka Police Hospital, 10-31, Kitayama, Tennoji, 543-0035, Osaka, Japan
| | - Yuma Hamanaka
- Department of Cardiology, Osaka Police Hospital, 10-31, Kitayama, Tennoji, 543-0035, Osaka, Japan
| | - Shimpei Nakatani
- Department of Cardiology, Osaka Police Hospital, 10-31, Kitayama, Tennoji, 543-0035, Osaka, Japan
| | - Ichiro Shiojima
- Department of Medicine II, Kansai Medical University, Hirakata, Japan
| | - Yasushi Sakata
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Atsushi Hirayama
- Department of Cardiology, Osaka Police Hospital, 10-31, Kitayama, Tennoji, 543-0035, Osaka, Japan
| | - Yoshiharu Higuchi
- Department of Cardiology, Osaka Police Hospital, 10-31, Kitayama, Tennoji, 543-0035, Osaka, Japan
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