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Hartung V, Augustin AM, Gruschwitz P, Grunz JP, Knarr J, Kickuth R. Endovascular therapy in intermittent claudication: Impact of IVUS guidance on treatment decisions. ROFO-FORTSCHR RONTG 2024. [PMID: 39236739 DOI: 10.1055/a-2379-8857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/07/2024]
Abstract
Conservative therapy is favored over revascularization for patients with peripheral arterial disease (PAD) and intermittent claudication (IC) owing to the better long-term results. The adjunctive use of intravascular ultrasound (IVUS) significantly improves endovascular therapy. However, data on IVUS and IC is scarce. Therefore, the aim of this investigation was to determine the safety and efficacy of IVUS in patients with IC and to evaluate discrepancies compared to angiography and potential consequences for treatment.This was a single-center prospective cohort study. Twenty patients with IC and femoropopliteal disease eligible for endovascular therapy were enrolled. Procedural data and discrepancies between IVUS and angiography were recorded.In total, 30 lesions were treated. IVUS-based measurements yielded substantially higher reference vessel diameters (RVD) and lesion lengths compared to DSA alone (RVD: 5.37 ± 0.71 mm vs. 4.74 ± 0.63 mm, p<.001, lesion length: 62.4 ± 41.4 mm vs. 42.18 ± 30.2 mm, p<.001). In 24 of 30 lesions (80%), a significant discrepancy in RVD (defined as difference >0.5 mm) and lesion length (defined as >20 mm) was determined between IVUS and standard DSA. Subsequently, IVUS assessment led to upsizing in 14 of 30 lesions (47%) and downsizing in 3 of 30 lesions (10%). On average, IVUS led to the selection of considerably larger balloons (5.25 ± 0.62 vs. 4.74 ± 0.63, p<.004) and device length (78.97 ± 44.19 mm vs. 42.18 ± 30.2, p<.001). Serious adverse events did not occur. Technical success was achieved in all cases.IVUS is safe and provides advantages regarding the evaluation of IC by depicting RVD and lesion length more reliably than standard DSA. More precise assessment of lesions resulted in the use of significantly larger devices. · The safety and efficacy of IVUS are confirmed for the distinct cohort of patients with IC.. · IVUS provides advantages for the evaluation of IC by depicting RVD and lesion length more reliably than standard DSA.. · More precise assessment of stenoses resulted in the selection of significantly larger devices, hence suggesting substantial clinical impact.. Hartung V, Augustin AM, Gruschwitz P et al. Endovascular therapy in intermittent claudication: Impact of IVUS guidance on treatment decisions. Fortschr Röntgenstr 2024; DOI 10.1055/a-2379-8857.
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Affiliation(s)
- Viktor Hartung
- Department of Diagnostic and Interventional Radiology, University Hospital Wurzburg, Wurzburg, Germany
| | - Anne Marie Augustin
- Department of Interventional and Diagnostic Radiology, Klinikum Bayreuth GmbH, Bayreuth, Germany
| | - Philipp Gruschwitz
- Department of Diagnostic and Interventional Radiology, University Hospital Wurzburg, Wurzburg, Germany
| | - Jan-Peter Grunz
- Department of Radiology, University of Wisconsin-Madison, Madison, United States
| | - Jonas Knarr
- Institute of Diagnostic and Interventional Radiology, University Hospital Wurzburg, Wurzburg, Germany
| | - Ralph Kickuth
- Institute of Diagnostic and Interventional Radiology, University Hospital Wurzburg, Wurzburg, Germany
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Çamci S, Ari H, Sünbül A, Ari S, Melek M, Bozat T. Safety and efficacy results of percutaneous renal stent implantation in patients with acute coronary syndrome with ectatic and aneurysmatic coronary arteries. Postgrad Med 2024; 136:95-102. [PMID: 38299468 DOI: 10.1080/00325481.2024.2313447] [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: 10/30/2023] [Accepted: 01/30/2024] [Indexed: 02/02/2024]
Abstract
BACKGROUND For the treatment of stenotic lesions developing in dilated coronary arteries, it is difficult to find an appropriately sized coronary stent given that the vessel diameter is too large. This poses a greater problem, especially in patients who require urgent intervention, such as acute coronary syndrome. OBJECTIVE We aimed to evaluate the efficacy and safety of renal stents implanted in ectatic/aneurysmatic coronary arteries in such patients. METHODS In total, 18 patients (renal stent group) who underwent renal stent implantation in ectatic/aneurysmatic coronary arteries requiring percutaneous coronary intervention (PCI) and 45 patients who underwent large-sized bare-metal coronary stent (BMCS) implantation (BMCS group) at our center were included in the study. The primary endpoints were MACE (myocardial infarction and cardiovascular mortality), and the secondary endpoints were restenosis and all-cause mortality. RESULTS In the study patients with a mean follow-up of 25.3 ± 14.6 months (1-48 months), the control coronary angiography duration was 24.6 ± 14.8 months for the renal stent group and 22.8 ± 15.7 months for the BMCS group (p = 0.06). The MACE was observed in 2 (11.1%) patients in the renal stent group and 4 (8.9%) patients in the BMCS group (HR: 1.39 (0.24-7.82), p = 0.70). The secondary composite outcome was identified in 4 (22.2%) patients in the renal stent group and 6 (13.7%) patients in the BMCS group (HR: 1.93 (0.53-6.91), p = 0.31). No significant differences in primary and secondary outcomes were noted between the groups. CONCLUSION Renal stents used during PCI in patients with acute coronary syndrome with ectatic/aneurysmatic coronary arteries have similar efficacy, and mid-term follow-up results those noted for BMCS. These findings support that renal stents can be used in ectatic and aneurysmatic coronary arteries when necessary. CLINICAL TRIAL REGISTRATION This study has been registered on ClinicalTrials.gov (NCT05410678).
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Affiliation(s)
- Sencer Çamci
- Department of Cardiology, Giresun University Faculty of Medicine, Giresun, Turkey
| | - Hasan Ari
- Bursa Postgraduate Hospital, Department of Cardiology, Bursa, Turkey
| | - Ayşe Sünbül
- Unye State Hospital, Department of Cardiology, Ordu, Turkey
| | - Selma Ari
- Bursa Postgraduate Hospital, Department of Cardiology, Bursa, Turkey
| | - Mehmet Melek
- Bursa Postgraduate Hospital, Department of Cardiology, Bursa, Turkey
| | - Tahsin Bozat
- Bursa Postgraduate Hospital, Department of Cardiology, Bursa, Turkey
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Hwang D, Yang S, Zhang J, Koo BK. Physiologic Assessment after Coronary Stent Implantation. Korean Circ J 2021; 51:189-201. [PMID: 33655719 PMCID: PMC7925968 DOI: 10.4070/kcj.2020.0548] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 01/10/2021] [Indexed: 12/13/2022] Open
Abstract
The presence of myocardial ischemia is a prerequisite for the benefit of coronary revascularization. In the cardiac catheterization laboratory, fractional flow reserve and non-hyperemic pressure ratios are used to define the ischemia-causing coronary stenosis, and several randomized studies showed the benefit of physiology-guided coronary revascularization. However, physiology-guided revascularization does not necessarily guarantee the relief of ischemia. Recent studies reported that residual ischemia might exist in up to 15-20% of cases after angiographically successful percutaneous coronary intervention (PCI). Therefore, post-PCI physiologic assessment is necessary for judging the appropriateness of PCI, detecting the lesions that may benefit from additional PCI, and risk stratification after PCI. This review will focus on the current evidence for post-PCI physiologic assessment, how to interpret these findings, and the future perspectives of physiologic assessment after PCI.
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Affiliation(s)
- Doyeon Hwang
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, Korea
| | - Seokhun Yang
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, Korea
| | - Jinlong Zhang
- Department of Cardiology, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Bon Kwon Koo
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, Korea.
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ZHENG QINGLI, MOZAFARI HOZHABR, LI ZHIQIANG, GU LINXIA, AN MEIWEN, HAN XINWEI, YOU ZHONG. MECHANICAL CHARACTERIZATION OF BRAIDED SELF-EXPANDING STENTS: IMPACT OF DESIGN PARAMETERS. J MECH MED BIOL 2019. [DOI: 10.1142/s0219519419500386] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
In this paper, the mechanical performance of braided nitinol stents was systematically studied to provide guidelines for optimum stent designs. The influences of braiding patterns, braiding angles, wire diameters, and strand numbers on the mechanical behavior of the stent in terms of crimping strain, radial strength, longitudinal flexibility, and stability were characterized utilizing finite element method. Our results have shown that the two key design factors of braided stents are the braiding angle and wire diameter. A smaller braiding angle can increase radial stiffness and have better longitudinal flexibility and can maintain the stent stability. The wire diameter has less influence on the radial stiffness than the braiding angle, but the longitudinal flexibility is most sensitive to the wire diameter. The strand number is directly proportional to the radial stiffness and inversely proportional to the longitudinal flexibility. Compared to the classical crossing pattern, we have also proposed two patterns. These patterns have a minimal impact on the crimping and radial stiffness of stents, but the stent made from them are more flexible. Among three crossing patterns, it is interesting to see that the classical pattern is the most stable crossing pattern for stand numbers larger than 36, but it became the most unstable pattern at the strand number of 24. This work has shed light on the optimum design of braided stents.
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Affiliation(s)
- QINGLI ZHENG
- Institute of Biomedical Engineering, College of Biomedical Engineering, Taiyuan University of Technology, Taiyuan 030024, P. R. China
| | - HOZHABR MOZAFARI
- Department of Mechanical & Materials Engineering, University of Nebraska-Lincoln, Lincoln, NE 68588, USA
| | - ZHIQIANG LI
- Institute of Applied Mechanics, College of Mechanical and Vehicle Engineering, Taiyuan University of Technology, Taiyuan 030024, P. R. China
| | - LINXIA GU
- Department of Mechanical & Materials Engineering, University of Nebraska-Lincoln, Lincoln, NE 68588, USA
- Department of Biomedical and Chemical Engineering and Sciences, Florida Institute of Technology, Melbourne, FL 32901, USA
| | - MEIWEN AN
- Institute of Biomedical Engineering, College of Biomedical Engineering, Taiyuan University of Technology, Taiyuan 030024, P. R. China
| | - XINWEI HAN
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, Henan, P. R. China
| | - ZHONG YOU
- Department of Engineering Science, University of Oxford, Oxford OX1 3PJ, UK
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Hakeem A, Uretsky BF. Role of Postintervention Fractional Flow Reserve to Improve Procedural and Clinical Outcomes. Circulation 2019; 139:694-706. [DOI: 10.1161/circulationaha.118.035837] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Affiliation(s)
- Abdul Hakeem
- Robert Wood Johnson Medical School, Rutgers University, New Brunswick, NJ (A.H.)
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Holm NR, Andreasen LN, Walsh S, Kajander OA, Witt N, Eek C, Knaapen P, Koltowski L, Gutiérrez-Chico JL, Burzotta F, Kockman J, Ormiston J, Santos-Pardo I, Laanmets P, Mylotte D, Madsen M, Hjort J, Kumsars I, Råmunddal T, Christiansen EH. Rational and design of the European randomized Optical Coherence Tomography Optimized Bifurcation Event Reduction Trial (OCTOBER). Am Heart J 2018; 205:97-109. [PMID: 30205242 DOI: 10.1016/j.ahj.2018.08.003] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Accepted: 08/09/2018] [Indexed: 12/16/2022]
Abstract
Background Percutaneous coronary intervention in complex bifurcation lesions is prone to suboptimal implantation results and is associated with increased risk of subsequent clinical events. Angiographic ambiguity is high during bifurcation stenting, but it is unknown if procedural guidance by intravascular optical coherence tomography (OCT) improves clinical outcome. Methods and Design OCTOBER is a randomized, investigator-initiated, multicenter trial aimed to show superiority of OCT-guided stent implantation compared to standard angiographic-guided implantation in bifurcation lesions. The primary outcome measure is a 2-year composite end point of cardiac death, target lesion myocardial infarction, and ischemia-driven target lesion revascularization. The calculated sample size is 1,200 patients in total, and allocation is 1:1. Eligible patients have stable or unstable angina pectoris or stabilized non–ST elevation myocardial infarction, and a coronary bifurcation lesion with significant main vessel stenosis and more than 50 % stenosis in a side branch with a reference diameter ≥2.5mm. Treatment is performed by the provisional side branch stenting technique or 2-stent techniques, and the systematic OCT guiding protocol is aimed to evaluate (1) plaque preparation, (2) lesion length, (3) segmental reference sizes, (4) lesion coverage, (5) stent expansion, (6) malapposition, (7) wire positions, and (8) ostial results. Implications A positive outcome of the OCTOBER trial may establish OCT as a routine tool for optimization of complex percutaneous coronary intervention, whereas a negative result would indicate that OCT remains a tool for ad hoc evaluation in selected cases.
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Saad M, Bavineni M, Uretsky BF, Vallurupalli S. Improved stent expansion with prolonged compared with short balloon inflation: A meta-analysis. Catheter Cardiovasc Interv 2018; 92:873-880. [PMID: 29726622 DOI: 10.1002/ccd.27641] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2017] [Revised: 03/21/2018] [Accepted: 03/27/2018] [Indexed: 11/06/2022]
Abstract
BACKGROUND Despite evidence from individual studies suggesting that prolonged inflation improves coronary stent expansion, relatively shorter inflation times are commonly employed in clinical practice. METHODS We performed an electronic search of PubMed, Web of Science, Cochrane, and CINAHL databases to retrieve outcome studies comparing prolonged versus short inflation times during stent deployment. Outcomes studied included minimal stent diameter (MSD) and minimal stent area (MSA). Standardized mean difference (SMD) was used to estimate the effect sizes for these continuous variables. RESULTS Seven studies with a total of 341 patients (415 lesions; mean age 67.6 years; 82% male) were included. Drug-eluting stents were used in 89 ± 15% of coronary lesions. Prolonged stent inflation was associated with increased minimal stent diameter (2.93 ± 0.34 mm vs. 2.72 ± 0.28 mm; SMD = 0.42; 95% CI 0.25-0.59; P < 0.001) and minimal stent area (5.99 ± 1.21 mm2 vs. 5.17 ± 0.87 mm2 ; SMD = 0.46; 95% CI 0.19-0.73; P = 0.001) compared with shorter duration stent inflation. This difference remained significant in sensitivity analyses that excluded studies with very prolonged inflation duration or multiple stent balloon inflations. CONCLUSION Despite differences in duration and methodology, prolonged stent inflation is associated with improved expansion compared with shorter duration. The effect of this optimization recommends randomized trials to determine whether long-term outcomes can be improved by this simple technical modification.
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Affiliation(s)
- Marwan Saad
- Division of Cardiology, University of Arkansas for Medical Sciences, Little Rock, Arkansas.,Division of Cardiovascular Medicine, Ain Shams University, Cairo, Egypt
| | - Mahesh Bavineni
- Division of Hospital Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Barry F Uretsky
- Division of Cardiology, University of Arkansas for Medical Sciences, Little Rock, Arkansas.,Division of Cardiology, Central Arkansas Veterans Healthcare System, Little Rock, Arkansas
| | - Srikanth Vallurupalli
- Division of Cardiology, University of Arkansas for Medical Sciences, Little Rock, Arkansas.,Division of Cardiology, Central Arkansas Veterans Healthcare System, Little Rock, Arkansas
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Wolfrum M, De Maria GL, Banning AP. Optical coherence tomography to guide percutaneous treatment of coronary bifurcation disease. Expert Rev Cardiovasc Ther 2017; 15:705-713. [PMID: 28764604 DOI: 10.1080/14779072.2017.1362982] [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] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Cardiovascular disease remains the most common cause of death worldwide. Enormous progress in the technology and applicability of percutaneous techniques to treat obstructive coronary heart disease has been made, and the number of percutaneous coronary interventions (PCI) is increasing. Coronary bifurcations are involved in a substantial number of PCIs and despite recent advances, bifurcation PCI remains a challenge in terms of immediate success and long-term outcome. Angiography has a limited capacity for showing important features of the 3 dimensional coronary vessel anatomy, position of stent struts and exact wire positions and is therefore suboptimal for guiding bifurcation PCI. Intracoronary optical coherence tomography (OCT) provides high resolution and the information gained during PCI is unprecedented compared with angiography guidance and intravascular ultrasound. Areas covered: This review will provide an overview of the use of OCT to guide bifurcation-PCI. Expert commentary: OCT is a promising guide for bifurcation-PCI at each individual step: from planning the strategy (provisional versus two-stent strategy), to guidance during PCI, and finally checking the interventional result. Until dedicated randomized trails are complete, we recommend OCT guidance for interventions in complex coronary bifurcation disease and for imaging when unexpected procedural events occur.
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Affiliation(s)
- Mathias Wolfrum
- a Oxford Heart Centre , Oxford University Hospitals NHS Foundation Trust , Oxford , United Kingdom.,b Department of Internal Medicine , Cardiology and Angiology, Magdeburg University , Magdeburg , Germany
| | - Giovanni Luigi De Maria
- a Oxford Heart Centre , Oxford University Hospitals NHS Foundation Trust , Oxford , United Kingdom
| | - Adrian P Banning
- a Oxford Heart Centre , Oxford University Hospitals NHS Foundation Trust , Oxford , United Kingdom
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Song L, Mintz G, Yin D, Yamamoto MH, Chin CY, Matsumura M, Kirtane A, Parikh M, Moses J, Ali Z, Shlofmitz R, Maehara A. Characteristics of early versus late in-stent restenosis in second-generation drug-eluting stents: an optical coherence tomography study. EUROINTERVENTION 2017; 13:294-302. [DOI: 10.4244/eij-d-16-00787] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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10
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Vallurupalli S, Kasula S, Kumar Agarwal S, Pothineni NVK, Abualsuod A, Hakeem A, Ahmed Z, Uretsky BF. A novel stent inflation protocol improves long-term outcomes compared with rapid inflation/deflation deployment method. Catheter Cardiovasc Interv 2017; 90:233-240. [DOI: 10.1002/ccd.26930] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Accepted: 12/21/2016] [Indexed: 11/07/2022]
Affiliation(s)
- Srikanth Vallurupalli
- Central Arkansas Veterans Health Care System; Little Rock Arkansas
- University of Arkansas for Medical Sciences; Little Rock Arkansas
| | - Srikanth Kasula
- University of Arkansas for Medical Sciences; Little Rock Arkansas
| | | | | | - Amjad Abualsuod
- University of Arkansas for Medical Sciences; Little Rock Arkansas
| | - Abdul Hakeem
- Central Arkansas Veterans Health Care System; Little Rock Arkansas
- University of Arkansas for Medical Sciences; Little Rock Arkansas
| | - Zubair Ahmed
- Central Arkansas Veterans Health Care System; Little Rock Arkansas
- University of Arkansas for Medical Sciences; Little Rock Arkansas
| | - Barry F. Uretsky
- Central Arkansas Veterans Health Care System; Little Rock Arkansas
- University of Arkansas for Medical Sciences; Little Rock Arkansas
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Piraino D, Cimino G, Buccheri D, Dendramis G, Andolina G, Cortese B. Recurrent in-stent restenosis, certainty of its origin, uncertainty about treatment. Int J Cardiol 2016; 230:91-96. [PMID: 28038808 DOI: 10.1016/j.ijcard.2016.12.073] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2016] [Revised: 11/18/2016] [Accepted: 12/16/2016] [Indexed: 02/01/2023]
Abstract
Treatment of recurrent in-stent restenosis is a real brainteaser for the interventional cardiologist who cannot resort to the guidelines to have indications about the type of treatment to be preferred. The use of intracoronary imaging may provide insights into the underlying mechanisms of this complication and use of drug-coated balloons may be a valid alternative and especially a thoughtful treatment when the repeated and perseverant use of drug-eluting stents clearly fails. In this setting, we present a review of the literature about this interesting topic, going deep into the heart of the problem, its origin and possible treatment options.
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Affiliation(s)
- Davide Piraino
- Interventional Cardiology, "P. Giaccone" University Hospital of Palermo, Italy.
| | - Giuliana Cimino
- Interventional Cardiology, "P. Giaccone" University Hospital of Palermo, Italy
| | - Dario Buccheri
- Interventional Cardiology, "P. Giaccone" University Hospital of Palermo, Italy
| | - Gregory Dendramis
- Interventional Cardiology, "P. Giaccone" University Hospital of Palermo, Italy
| | - Giuseppe Andolina
- Interventional Cardiology, "P. Giaccone" University Hospital of Palermo, Italy
| | - Bernardo Cortese
- Interventional Cardiology, Fatebenefratelli Hospital, Milan, Italy
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12
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Vallurupalli S, Bahia A, Ruiz-Rodriguez E, Ahmed Z, Hakeem A, Uretsky BF. Optimization of stent implantation using a high pressure inflation protocol. Catheter Cardiovasc Interv 2015; 87:65-72. [DOI: 10.1002/ccd.26095] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2015] [Revised: 04/24/2015] [Accepted: 06/14/2015] [Indexed: 11/09/2022]
Affiliation(s)
- Srikanth Vallurupalli
- Division of Cardiology; University of Arkansas for Medical Sciences; Little Rock Arkansas
| | - Amit Bahia
- Division of Cardiology; University of Arkansas for Medical Sciences; Little Rock Arkansas
| | - Ernesto Ruiz-Rodriguez
- Division of Cardiology; University of Arkansas for Medical Sciences; Little Rock Arkansas
| | - Zubair Ahmed
- Division of Cardiology; University of Arkansas for Medical Sciences; Little Rock Arkansas
- Central Arkansas Veterans Healthcare System; Little Rock Arkansas
| | - Abdul Hakeem
- Division of Cardiology; University of Arkansas for Medical Sciences; Little Rock Arkansas
- Central Arkansas Veterans Healthcare System; Little Rock Arkansas
| | - Barry F. Uretsky
- Division of Cardiology; University of Arkansas for Medical Sciences; Little Rock Arkansas
- Central Arkansas Veterans Healthcare System; Little Rock Arkansas
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13
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Holm NR, Adriaenssens T, Motreff P, Shinke T, Dijkstra J, Christiansen EH. OCT for bifurcation stenting: what have we learned? EUROINTERVENTION 2015; 11 Suppl V:V64-70. [DOI: 10.4244/eijv11sva14] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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14
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Davies AG, Conway D, Reid S, Cowen AR, Sivananthan M. Assessment of coronary stent deployment using computer enhanced x-ray images-validation against intravascular ultrasound and best practice recommendations. Catheter Cardiovasc Interv 2012; 81:419-27. [PMID: 22262472 DOI: 10.1002/ccd.23366] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2011] [Accepted: 08/16/2011] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To investigate the accuracy of stent measurements using coronary x-ray angiograms with a computer based stent enhancement algorithm applied (StentBoost, SB). To derive recommendations for best practice when using such systems. BACKGROUND Computer enhancement algorithms allow better visualization of intracoronary stents to assist in ensuring adequate stent deployment. Factors that affect the accuracy of measurements taken on such systems are yet to be fully understood. METHODS We analysed stent deployment of 43 stents in 33 patients measuring minimum stent diameter and cross sectional area (CSA) using intravascular ultrasound (IVUS), SB enhanced x-ray images, and quantitative coronary angiography (QCA). We investigated if the use of two projections and method of calibration influenced correlation between IVUS and SB measurements. RESULTS Using two views and performing calibration via the guide catheter improved agreement between SB and IVUS measurements. For example, minimum stent diameter assessed with SB using one view and balloon markers for calibration produced a correlation coefficient, r, of 0.21, whereas using two views and the guide catheter for calibration increased agreement to r = 0.62. Relative measures of stent deployment, such as the ratio of minimum to maximum CSA, produced good correlation between IVUS and SB (r = 0.74). CONCLUSIONS When using the SB system, two projection angles should be used to image the stent. For absolute measurements, the guide catheter should be used for calibration purposes. Relative measures of stent size, which are probably sufficient for assessment of deployment, also give good agreement with similar measures on IVUS, and require no calibration.
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Affiliation(s)
- Andrew G Davies
- Department of Medical Physics, University of Leeds, Leeds, UK.
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Bismuth V, Vaillant R, Funck F, Guillard N, Najman L. A comprehensive study of stent visualization enhancement in X-ray images by image processing means. Med Image Anal 2011; 15:565-76. [DOI: 10.1016/j.media.2011.03.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2010] [Revised: 03/08/2011] [Accepted: 03/11/2011] [Indexed: 11/16/2022]
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16
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Drug release from coronary eluting stents: A multidomain approach. J Biomech 2010; 43:1580-9. [DOI: 10.1016/j.jbiomech.2010.01.033] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2009] [Revised: 11/17/2009] [Accepted: 01/03/2010] [Indexed: 11/23/2022]
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Bertrand OF. Inflation time and drug-eluting stent: the longer, the better... Catheter Cardiovasc Interv 2009; 73:212-3. [PMID: 19156881 DOI: 10.1002/ccd.21957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Olivier F Bertrand
- Interventional Cardiology Laboratories, Laval Hospital, Quebec Heart-Lung Institute, Quebec, Canada.
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Romagnoli E, Sangiorgi GM, Cosgrave J, Guillet E, Colombo A. Drug-Eluting Stenting. JACC Cardiovasc Interv 2008; 1:22-31. [DOI: 10.1016/j.jcin.2007.10.005] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2007] [Revised: 10/16/2007] [Accepted: 10/25/2007] [Indexed: 02/02/2023]
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Lee CY, Yim MB. Primary stent therapy for symptomatic intracranial atherosclerotic stenosis: 1-year follow-up angiographic and midterm clinical outcomes. J Neurosurg 2007; 105:235-41. [PMID: 17219828 DOI: 10.3171/jns.2006.105.2.235] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT The aim of this study was to report 1-year angiographic follow-up results and midterm clinical outcomes in patients with symptomatic intracranial atherosclerotic lesions treated with stent placement. METHODS Ten patients with ischemic symptoms referable to stenotic intracranial atherosclerotic arteries, with greater than 60% stenosis, underwent elective surgery in which a primary stent was placed. All patients underwent pretreatment (> or =1 week) combination oral antiplatelet (clopidogrel and aspirin) therapy and long-term (6-month) combination oral antiplatelet (clopidogrel and aspirin) therapy after stents were placed. The procedure involved selecting stents of the same size as the diameter of the target vessel and slowly inflating the balloon to its nominal pressure. One-year angiography and midterm clinical follow-up data were obtained. The stents were successfully placed in all patients without any perioperative complication. The mean preoperative stenosis rate of 81% decreased to 4% after the stent was placed. Nine patients who underwent follow-up angiography (one patient refused) at a mean of 12.3 months (range 10-19 months) had no changes in luminal diameter compared with the immediate postoperative luminal diameter. Luminal narrowing increased, from 15 to 38%, in one case in which there was comparatively greater residual stenosis (15%). No patient suffered new ischemic symptoms during a mean clinical follow-up period of 21 months (range 12-36 months). CONCLUSIONS Elective stent surgery can provide good angiographic and clinical midterm outcomes in patients with symptomatic intracranial atherosclerotic stenosis, and the procedure is associated with a high degree of technical success. Reassessment of these promising results is needed in a larger population and in a randomized prospective comparison study.
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Affiliation(s)
- Chang-Young Lee
- Department of Neurosurgery, Brain Research Institute, Keimyung University School of Medicine, Daegu, South Korea.
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Wijns W. Incidence of stent under-deployment as a cause of in-stent restenosis in long stents: take your lesson! Int J Cardiovasc Imaging 2005; 20:529-30. [PMID: 15856637 DOI: 10.1007/s10554-004-1631-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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