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Yang Q, Ma X, Wang Y. Long-term outcomes of IVUS-guided and angiography-guided drug-eluting stent implantation for left main coronary artery disease: a retrospective consort study. J Cardiothorac Surg 2024; 19:407. [PMID: 38951893 PMCID: PMC11218326 DOI: 10.1186/s13019-024-02800-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 05/25/2024] [Indexed: 07/03/2024] Open
Abstract
BACKGROUND In patients with unprotected left main coronary artery disease (ULMCAD), this study compared the long-term prognosis of drug-eluting stent insertion guided by intravascular ultrasonography (IVUS) vs. angiography. PATIENTS AND METHODS This retrospective consort investigation was performed in December 2021. This analysis included 199 patients who underwent IVUS-guided (IVUS group, n = 81) or angiography-guided (angiography group, n = 118) drug-eluting stent implantation at the Affiliated Hospital of Inner Mongolia Medical University between September 2013 and September 2018. Major adverse cardiac events (MACE) were defined as cardiovascular death, sudden cardiac death, myocardial infarction. RESULTS The IVUS group had considerably lower proportions of MACE within 1 year postoperatively (P = 0.002) and cardiac mortality within 3 years postoperatively (P = 0.018) compared to the angiography group. However, after adjusting for confounding variables, the hazard ratio for 3-year cardiac mortality was similar between the two groups (P = 0.28). In the IVUS group, there was considerably greater minimum lumen diameter (MLD) (P = 0.046), and reduced frequencies of target vessel restenosis (P < 0.050) and myocardial infarction (MI) (P = 0.024) compared to the angiography group. Cox regression analysis for 3-year cardiac mortality found that MSD was independently associated with low cardiac mortality (HR = 0.1, 95% CI: 0.01-14.92, P = 0.030). CONCLUSION IVUS-guided drug-eluting stent implantation may lead to better long-term prognosis in patients with ULMCAD, and MSD may be a predictor for lower cardiac mortality.
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Affiliation(s)
- Qing Yang
- Department of Emergency Cardiovascular Medicine, Inner Mongolian People Hospital, Hohhot, 010000, China
| | - Xiaoyi Ma
- Department of cardiovascular medicine, Dalat people's Hospital, Erdos, 014300, China
| | - Yuexi Wang
- Department of cardiovascular medicine, Affiliated Hospital of Inner Mongolia Medical University, No. 1, Tongdao North Road, Hohhot, 010000, Inner Mongolia Autonomous Region, China.
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2
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Goldberg LA, Zomer HD, McFetridge C, McFetridge PS. Silica nanoparticles enhance interfacial self-adherence of a multi-layered extracellular matrix scaffold for vascular tissue regeneration. Biotechnol Lett 2024; 46:469-481. [PMID: 38368285 DOI: 10.1007/s10529-024-03469-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Revised: 12/03/2023] [Accepted: 01/10/2024] [Indexed: 02/19/2024]
Abstract
PURPOSE Based on the clinical need for grafts for vascular tissue regeneration, our group developed a customizable scaffold derived from the human amniotic membrane. Our approach consists of rolling the decellularized amniotic membrane around a mandrel to form a multilayered tubular scaffold with tunable diameter and wall thickness. Herein, we aimed to investigate if silica nanoparticles (SiNP) could enhance the adhesion of the amnion layers within these rolled grafts. METHODS To test this, we assessed the structural integrity and mechanical properties of SiNP-treated scaffolds. Mechanical tests were repeated after six months to evaluate adhesion stability in aqueous environments. RESULTS Our results showed that the rolled SiNP-treated scaffolds maintained their tubular shape upon hydration, while non-treated scaffolds collapsed. By scanning electron microscopy, SiNP-treated scaffolds presented more densely packed layers than untreated controls. Mechanical analysis showed that SiNP treatment increased the scaffold's tensile strength up to tenfold in relation to non-treated controls and changed the mechanism of failure from interfacial slipping to single-point fracture. The nanoparticles reinforced the scaffolds both at the interface between two distinct layers and within each layer of the extracellular matrix. Finally, SiNP-treated scaffolds significantly increased the suture pullout force in comparison to untreated controls. CONCLUSION Our study demonstrated that SiNP prevents the unraveling of a multilayered extracellular matrix graft while improving the scaffolds' overall mechanical properties. In addition to the generation of a robust biomaterial for vascular tissue regeneration, this novel layering technology is a promising strategy for a number of bioengineering applications.
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Affiliation(s)
- Leslie A Goldberg
- J. Crayton Pruitt Family Department of Biomedical Engineering, University of Florida, Biomedical Sciences Building JG-56, 1275 Center Drive, Gainesville, FL, 32611-6131, USA
| | - Helena D Zomer
- Department of Physiological Sciences, University of Florida, Gainesville, FL, USA
| | - Calum McFetridge
- J. Crayton Pruitt Family Department of Biomedical Engineering, University of Florida, Biomedical Sciences Building JG-56, 1275 Center Drive, Gainesville, FL, 32611-6131, USA
| | - Peter S McFetridge
- J. Crayton Pruitt Family Department of Biomedical Engineering, University of Florida, Biomedical Sciences Building JG-56, 1275 Center Drive, Gainesville, FL, 32611-6131, USA.
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3
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Marulanda K, Genovese EA. Adjunctive Utilization of Intravascular Ultrasound in Peripheral Arterial Disease Treatment. Ann Vasc Surg 2024:S0890-5096(24)00163-8. [PMID: 38582216 DOI: 10.1016/j.avsg.2024.01.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2023] [Accepted: 01/17/2024] [Indexed: 04/08/2024]
Abstract
BACKGROUND The utility and benefit of intravascular ultrasound (IVUS) has been well established in coronary interventions, however widespread adoption for peripheral interventions has lagged. The objectives of this review article were to discuss the technical components of IVUS, describe key learning pearls for IVUS utilization, and review the literature describing the clinical outcomes of endovascular peripheral arterial interventions using IVUS. METHODS A scoping review of the current literature utilizing Pubmed. Terms used to search the literature included "intravascular ultrasound (IVUS)" in conjunction with "peripheral arterial disease (PAD)," "endovascular interventions," "chronic limb threatening ischemia," "balloon angioplasty" "stenting," "percutaneous coronary intervention," and "outcomes." All types of articles were reviewed including review articles, retrospective reviews, meta-analyses, and prospective observational and randomized studies. RESULTS Published literature regarding IVUS use in peripheral arterial interventions is heterogeneous and limited to mainly retrospective studies, registry analyses and metanalyses. Outcomes are generally favorable with the adjunct of IVUS compared to traditional angiography-driven peripheral interventions. The addition of IVUS improves stent expansion, stent patency, and reduces reintervention rates, particularly in infrainguinal arterial lesions. Long-term costs may also be lower with IVUS-guided procedures. CONCLUSIONS Expert consensus largely supports the implementation of IVUS in endovascular interventions for peripheral arterial disease. However, more robust high-quality data evaluating the efficacy, durability, and cost of IVUS in peripheral arterial disease are still needed.
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Lin H, Zhang M, Hu M, Zhang Y, Jiang W, Tang W, Ouyang Y, Jiang L, Mi Y, Chen Z, He P, Zhao G, Ouyang X. Emerging applications of single-cell profiling in precision medicine of atherosclerosis. J Transl Med 2024; 22:97. [PMID: 38263066 PMCID: PMC10804726 DOI: 10.1186/s12967-023-04629-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 10/14/2023] [Indexed: 01/25/2024] Open
Abstract
Atherosclerosis is a chronic, progressive, inflammatory disease that occurs in the arterial wall. Despite recent advancements in treatment aimed at improving efficacy and prolonging survival, atherosclerosis remains largely incurable. In this review, we discuss emerging single-cell sequencing techniques and their novel insights into atherosclerosis. We provide examples of single-cell profiling studies that reveal phenotypic characteristics of atherosclerosis plaques, blood, liver, and the intestinal tract. Additionally, we highlight the potential clinical applications of single-cell analysis and propose that combining this approach with other techniques can facilitate early diagnosis and treatment, leading to more accurate medical interventions.
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Affiliation(s)
- Huiling Lin
- Department of Physiology, Medical College, Institute of Neuroscience Research, Hengyang Key Laboratory of Neurodegeneration and Cognitive Impairment, University of South China, Hengyang, 421001, Hunan, China
- Department of Physiology, School of Medicine, Hunan Normal University, Changsha, 410081, Hunan, China
| | - Ming Zhang
- Affiliated Qingyuan Hospital, Guangzhou Medical University (Qingyuan People's Hospital), Qingyuan, 511518, Guangdong, China
| | - Mi Hu
- Department of Physiology, Medical College, Institute of Neuroscience Research, Hengyang Key Laboratory of Neurodegeneration and Cognitive Impairment, University of South China, Hengyang, 421001, Hunan, China
| | - Yangkai Zhang
- Department of Physiology, Medical College, Institute of Neuroscience Research, Hengyang Key Laboratory of Neurodegeneration and Cognitive Impairment, University of South China, Hengyang, 421001, Hunan, China
| | - WeiWei Jiang
- Department of Organ Transplantation, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong, China
| | - Wanying Tang
- Department of Physiology, Medical College, Institute of Neuroscience Research, Hengyang Key Laboratory of Neurodegeneration and Cognitive Impairment, University of South China, Hengyang, 421001, Hunan, China
| | - Yuxin Ouyang
- Department of Physiology, Medical College, Institute of Neuroscience Research, Hengyang Key Laboratory of Neurodegeneration and Cognitive Impairment, University of South China, Hengyang, 421001, Hunan, China
| | - Liping Jiang
- Department of Clinical Pharmacology, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Yali Mi
- Affiliated Qingyuan Hospital, Guangzhou Medical University (Qingyuan People's Hospital), Qingyuan, 511518, Guangdong, China
| | - Zhi Chen
- College of Physics and Optoelectronic Engineering, Shenzhen University, Shenzhen, China
| | - Pingping He
- Department of Nursing, School of Medicine, Hunan Normal University, Changsha, 410081, Hunan, China.
| | - Guojun Zhao
- Affiliated Qingyuan Hospital, Guangzhou Medical University (Qingyuan People's Hospital), Qingyuan, 511518, Guangdong, China.
| | - Xinping Ouyang
- Department of Physiology, Medical College, Institute of Neuroscience Research, Hengyang Key Laboratory of Neurodegeneration and Cognitive Impairment, University of South China, Hengyang, 421001, Hunan, China.
- Department of Physiology, School of Medicine, Hunan Normal University, Changsha, 410081, Hunan, China.
- The Key Laboratory of Model Animals and Stem Cell Biology in Hunan Province, School of Medicine, Hunan Normal University, 410081, Hunan, Changsha, China.
- The Engineering Research Center of Reproduction and Translational Medicine of Hunan Province, School of Medicine, Hunan Normal University, 410081, Hunan, Changsha, China.
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Yasmin F, Jawed K, Moeed A, Ali SH. Efficacy of Intravascular Imaging-Guided Drug-Eluting Stent Implantation: A Systematic Review and Meta-Analysis of Randomized Clinical Trials. Curr Probl Cardiol 2024; 49:102002. [PMID: 37544623 DOI: 10.1016/j.cpcardiol.2023.102002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 07/24/2023] [Indexed: 08/08/2023]
Abstract
Intravascular imaging (IVI) namely intravascular ultrasound (IVUS) and optical coherence tomography (OCT), presents as a promising imaging modality for drug-eluting stent (DES) implantation compared to the gold-standard conventional two-dimensional angiography. IVI provides detailed information on vessel lumen, lesion length, and degree of calcification. For this purpose, we conducted a meta-analysis by pooling recently conducted randomized control trials (RCTs) to compare IVI with angiography for DES implantation. Scopus and MEDLINE were searched till May 2023 for RCTs comparing IVI with traditional angiography-guided stent implantation in coronary artery disease patients undergoing percutaneous coronary intervention. The primary outcome of interest was target-lesion revascularization (TLR). Secondary outcomes included target vessel revascularization (TVR), all-cause mortality, and major adverse cardiovascular events (MACE). A random-effects meta-analysis with metaregression was performed to derive risk ratios with corresponding 95% CIs from dichotomous data. Fourteen RCTs with a total of 8946 CAD patients (IVI 4751 vs angiography 4195; mean age 61.7 years) and a median follow-up of 15 months (12-24.3) were included. IVI was associated with significantly reduced TLR (RR 0.63 [0.49, 0.79]) vs conventional angiography. Similarly, TVR incidence (RR 0.66 [0.53, 0.83]), and MACE (RR 0.69 [0.58, 0.78]) were also significantly decreased with IVI vs conventional angiography for PCI. However, no significant difference was observed in all-cause mortality between the 2 imaging modalities (RR 0.85 [0.63, 1.15]). Metaregression analysis showed no significant impact of follow-up duration, baseline comorbidities such as hypertension, smoking status, previous MI, and stent length on TLR incidence. IVI was associated with improved clinical outcomes in terms of reduced TLR, TVR, and MACE incidence when compared with traditional angiography in CAD patients for stent implantation.
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Affiliation(s)
- Farah Yasmin
- Department of Internal Medicine, Yale School of Medicine, New Haven CT 06510, USA.
| | - Kinza Jawed
- Department of Internal Medicine, Aga Khan Medical University, Karachi 74800, Pakistan
| | - Abdul Moeed
- Department of Internal Medicine, Dow University of Health Sciences, Karachi 74200 Pakistan
| | - Syed Hasan Ali
- Department of Internal Medicine, Dow University of Health Sciences, Karachi 74200 Pakistan
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Zhou Y, Yue T, Ding Y, Tan H, Weng J, Luo S, Zheng X. Nanotechnology translation in vascular diseases: From design to the bench. WILEY INTERDISCIPLINARY REVIEWS. NANOMEDICINE AND NANOBIOTECHNOLOGY 2024; 16:e1919. [PMID: 37548140 DOI: 10.1002/wnan.1919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 07/02/2023] [Accepted: 07/03/2023] [Indexed: 08/08/2023]
Abstract
Atherosclerosis is a systemic pathophysiological condition contributing to the development of majority of polyvascular diseases. Nanomedicine is a novel and rapidly developing science. Due to their small size, nanoparticles are freely transported in vasculature, and have been widely employed as tools in analytical imaging techniques. Furthermore, the application of nanoparticles also allows target intervention, such as drug delivery and tissue engineering regenerative methods, in the management of major vascular diseases. Therefore, by summarizing the physical and chemical characteristics of common nanoparticles used in diagnosis and treatment of vascular diseases, we discuss the details of these applications from cellular, molecular, and in vivo perspectives in this review. Furthermore, we also summarize the status and challenges of the application of nanoparticles in clinical translation. This article is categorized under: Therapeutic Approaches and Drug Discovery > Nanomedicine for Cardiovascular Disease Implantable Materials and Surgical Technologies > Nanomaterials and Implants Therapeutic Approaches and Drug Discovery > Emerging Technologies.
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Affiliation(s)
- Yongwen Zhou
- Department of Endocrinology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
| | - Tong Yue
- Department of Endocrinology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
| | - Yu Ding
- Department of Endocrinology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
| | - Huiling Tan
- Department of Endocrinology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
| | - Jianping Weng
- Department of Endocrinology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
| | - Sihui Luo
- Department of Endocrinology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
| | - Xueying Zheng
- Department of Endocrinology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
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Shafi I, Patel DA, Osman H, Patel N, Ramaseshan K, Goel M, Alraies MC. Outcomes of Intravascular Ultrasound-Guided Percutaneous Coronary Intervention Among Patients With Acute Coronary Syndrome. Am J Cardiol 2023; 204:115-121. [PMID: 37541147 DOI: 10.1016/j.amjcard.2023.07.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Revised: 05/16/2023] [Accepted: 07/05/2023] [Indexed: 08/06/2023]
Abstract
Intravascular ultrasound (IVUS) use in percutaneous coronary intervention (PCI) improves outcomes. However, data on outcomes of IVUS-guided PCI in patients presenting with acute coronary syndrome (ACS) is scarce. Therefore, we sought to study the utilization rate and outcomes of IVUS-guided PCI in patients with ACS. Using the National Readmission database, we identified all patients with ACS who underwent PCI from 2016 to 2019. We used a 1:1 propensity-matched analysis to compare the outcome of patients with ACS who underwent PCI with and without IVUS. In 1,263,997 patients with ACS, 563,521 (44.6%) underwent PCI without IVUS and 40,095 (3.17%) underwent IVUS-guided PCI. A Propensity scored matched comparison of PCI with and without IVUS showed IVUS-guided PCI was associated with a lower risk of in-hospital mortality (odds ratio 0.74, 95% confidence interval 0.64 to 0.85, p <0.01) compared with PCI without IVUS. The utilization of IVUS increased from 2.64% in 2016 to 4.10% in 2019, p <0.001. In conclusion, IVUS-guided PCI is associated with lower in-hospital mortality in patients with ACS, yet the current utilization of IVUS-guided PCI remains low across the United States.
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Affiliation(s)
| | | | - Heba Osman
- Department of Internal Medicine - Pediatrics
| | - Neel Patel
- Department of Internal Medicine, Wayne State University School of Medicine, Detroit, Michigan; Department of Internal Medicine, New York Medical College/Landmark Medical Center, Woonsocket, Rhode Island
| | - Karthik Ramaseshan
- Department of Internal Medicine, Wayne State University/Detroit Medical Center, Detroit, Michigan
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Setogawa N, Ohbe H, Matsui H, Yasunaga H. Amputation After Endovascular Therapy With and Without Intravascular Ultrasound Guidance: A Nationwide Propensity Score-Matched Study. Circ Cardiovasc Interv 2023; 16:e012451. [PMID: 37071721 DOI: 10.1161/circinterventions.122.012451] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/20/2023]
Abstract
BACKGROUND Intravascular ultrasound (IVUS) provides precise intravascular information during endovascular therapy (EVT). However, the clinical efficacy of IVUS in patients who undergo EVT remains unknown. The present study aimed to determine whether the use of IVUS-guided EVT is associated with better clinical outcomes in a real-world setting. METHODS Using the Japanese Diagnosis Procedure Combination administrative inpatient database from April 2014 to March 2019, we identified patients diagnosed with atherosclerosis of arteries of extremities and underwent EVT (percutaneous endovascular transluminal angioplasty and thrombectomy for extremities or percutaneous endovascular removal). Propensity score matching analysis was performed to compare outcomes between the patients who underwent IVUS on the same day as the first EVT intervention (IVUS group) and the others (non-IVUS group). The primary outcome was major and minor amputation for extremities within 12 months of the first EVT procedure. Secondary outcomes were bypass surgery, stent grafting, reintervention, all-cause death, readmission, and total hospitalization costs within 12 months of the first EVT procedure. RESULTS Among 85 649 eligible patients, 50 925 (59.5%) were IVUS group. After propensity score matching, the IVUS group had significantly lower incidence of 12-month amputation compared with the non-IVUS group (6.9% in the IVUS group versus 9.3% in the non-IVUS group; hazard ratio, 0.80 [95% CI, 0.72-0.89]). Compared with the non-IVUS group, the IVUS group showed a lower risk of bypass surgery and stent grafting and decreased total hospitalization costs, while a higher risk of reintervention and readmission. No significant differences in all-cause death were found between the 2 groups. CONCLUSIONS In this retrospective study, IVUS-guided EVT was associated with a lower amputation risk than non-IVUS-guided EVT. Our findings should be interpreted carefully because of the limitations of an observational study using administrative data. Further studies are warranted to confirm whether IVUS-guided EVT leads to decreased amputations.
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Affiliation(s)
- Nao Setogawa
- Department of Clinical Epidemiology and Health Economics, School of Public Health, University of Tokyo, Japan
| | - Hiroyuki Ohbe
- Department of Clinical Epidemiology and Health Economics, School of Public Health, University of Tokyo, Japan
| | - Hiroki Matsui
- Department of Clinical Epidemiology and Health Economics, School of Public Health, University of Tokyo, Japan
| | - Hideo Yasunaga
- Department of Clinical Epidemiology and Health Economics, School of Public Health, University of Tokyo, Japan
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Taalab MA, Kamal AM, Mohammad AF, Zaki MM. Intravascular Ultrasound Versus Computed Tomography Angiography in Sizing and Operative Management of Endovascular Aortic Aneurysm Repair. J Endovasc Ther 2023:15266028231158964. [PMID: 36927269 DOI: 10.1177/15266028231158964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2023]
Abstract
OBJECTIVES An abdominal aortic aneurysm (AAA) is a potentially life-threatening condition, the management of which has dramatically evolved over the past 2 decades with an increasing tendency toward endovascular repair (EVAR) rather than open surgical repair. Classically, contrast-enhanced multislice computed tomography (CT) angiography (CTA) is performed preoperatively for procedure sizing and EVAR planning. This entails voluminous contrast injection with risk of allergic reaction, nephropathy, and radiation exposure. Intra-vascular ultrasound (IVUS) has been increasingly used to guide EVAR procedures intraoperatively. The aim of this study is to investigate the accuracy of IVUS in sizing AAAs, device selection, and EVAR planning compared to the gold standard CTA. DESIGN This is a prospective observational study enrolling 10 patients who underwent standard infrarenal EVAR procedures performed for unruptured infrarenal AAAs over the course of 1 year. All patients had a preoperative CTA done upon which aneurysm sizing and device planning were performed, and the measurements obtained were compared to those obtained from intraoperative IVUS. METHODS All participating patients had unruptured infrarenal AAA, had no renal impairment, and had anatomical suitability for EVAR according to the instructions for use (IFU) of the device manufacturer. Primary endpoint was comparing anatomical measurements recorded by IVUS with those obtained from the preoperative CTA. RESULTS Mean age was 65.6 (±6.19), all patients were males and hypertensives and 4 (40%) had a positive family history for AAA. On comparing mean measurements taken by CTA and IVUS, there was no statistically significant differences with exception of maximal aortic diameter and aortic diameter at site of bifurcation (both p-values <.001). There were no statistically significant differences in length measurements between the 2 imaging modalities. Computed tomography angiography was more associated with neck thrombus detection, and IVUS was more associated with calcification detection. CONCLUSION Although CT angiography is still the gold standard imaging modality for AAA, IVUS use is very beneficial in EVAR sizing and planning, in addition to intra-operative guidance of the procedure, saving the patient significant time, contrast administration, and radiation exposure, especially in patients with renal impairment and contrast allergy. CLINICAL IMPACT A preoperative CT angiogram is the gold standard required investigation for planning and sizing EVARs, with subsequent contrast injection entailing a risk of contrast induced nephropathy and allergic reactions. IVUS has been used as an adjuvant technique to guide EVAR stent graft deployment. However, our study concluded that it can also be reliably used in sizing and planning of the EVAR stent graft along with complementary non contrast imaging, especially in patients with high risk for contrast induced nephropathy and contrast allergy.
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Affiliation(s)
- Mohammad A Taalab
- Vascular Surgery Department, Nasr City Hospital for Health Insurance, Cairo, Egypt
| | - Ahmed M Kamal
- General Surgery Department, El Demerdash University Hospital, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Ahmed F Mohammad
- Vascular Surgery Department, El Demerdash University Hospital, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Mohamed M Zaki
- Vascular Surgery Department, El Demerdash University Hospital, Faculty of Medicine, Ain Shams University, Cairo, Egypt
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10
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Kumar AP, Valakkada J, Ayappan A, Kannath S. Management of Acute Complications during Endovascular Procedures in Peripheral Arterial Disease: A Review. JOURNAL OF CLINICAL INTERVENTIONAL RADIOLOGY ISVIR 2022. [DOI: 10.1055/s-0042-1760246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
AbstractEndovascular therapy, as opposed to surgical bypass, has become the mainstay for peripheral arterial disease even in long segment occlusions. Complications can occur during the arterial access, catheter manipulation, balloon dilation, and/or stent placement. Given the high prevalence of comorbidities such as diabetes, hypertension, renal dysfunction, and coronary artery disease in these patients, early identification of procedural complications and initiation of treatment are of paramount importance. This review aims to provide comprehensive data on the identification and management of commonly encountered endovascular complications during endovascular interventions in peripheral arterial disease.
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Affiliation(s)
- Ajay Pawan Kumar
- Department of Imaging Sciences and Interventional Radiology, Sreechitra Institute of Medical Sciences and Technology, Trivandrum, Kerala, India
| | - Jineesh Valakkada
- Department of Imaging Sciences and Interventional Radiology, Sreechitra Institute of Medical Sciences and Technology, Trivandrum, Kerala, India
| | - Anoop Ayappan
- Department of Imaging Sciences and Interventional Radiology, Sreechitra Institute of Medical Sciences and Technology, Trivandrum, Kerala, India
| | - Santhosh Kannath
- Department of Imaging Sciences and Interventional Radiology, Sreechitra Institute of Medical Sciences and Technology, Trivandrum, Kerala, India
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Kager RL, Vacek TP. A case of percutaneous coronary intervention of the right coronary artery in a situs inversus patient with foreshortening of lesion revealed by intravenous ultrasound imaging technology. Oxf Med Case Reports 2022; 2022:omac141. [PMID: 36540834 PMCID: PMC9759951 DOI: 10.1093/omcr/omac141] [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: 06/08/2022] [Revised: 10/02/2022] [Accepted: 11/06/2022] [Indexed: 12/23/2022] Open
Abstract
Situs inversus totalis is a rare anomaly in which the internal organs are transposed oppositely as mirror images. Due to its rarity, interventionalists are less likely to be acquainted with angiography in this unique population. In the case of lesion ambiguity, different invasive diagnostic tools can be used to further evaluate lesion severity, including fractional flow reserve, instantaneous wave-free ratio and intravenous ultrasound (IVUS). In this case, we discuss the usefulness of IVUS as a beneficial tool in evaluation of angiographically ambiguous lesions due to foreshortening. Dextrocardia presents unique challenges to the interventional cardiologist secondary to difficulty in acquiring adequate views and unfamiliarity with mirroring of anatomy, and thus angiography can result in inaccurately assessed lesions. We demonstrate how IVUS can be used in evaluation of such lesions for more accurate evaluation, precision in stent placement and in turn better patient outcomes.
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Affiliation(s)
- Rebecca L Kager
- Corresponding address. VCOM, Virginia, Blacksburg 24060, USA. Fax: Fax: 540-961-0218; E-mail:
| | - Thomas P Vacek
- Interventional Cardiology, LewisGale Montgomery Hospital, Blacksburg, USA
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12
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Long-term prognostic impact of paravalvular leakage on coronary artery disease requires patient-specific quantification of hemodynamics. Sci Rep 2022; 12:21357. [PMID: 36494362 PMCID: PMC9734172 DOI: 10.1038/s41598-022-21104-8] [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: 05/17/2022] [Accepted: 09/22/2022] [Indexed: 12/13/2022] Open
Abstract
Transcatheter aortic valve replacement (TAVR) is a frequently used minimally invasive intervention for patient with aortic stenosis across a broad risk spectrum. While coronary artery disease (CAD) is present in approximately half of TAVR candidates, correlation of post-TAVR complications such as paravalvular leakage (PVL) or misalignment with CAD are not fully understood. For this purpose, we developed a multiscale computational framework based on a patient-specific lumped-parameter algorithm and a 3-D strongly-coupled fluid-structure interaction model to quantify metrics of global circulatory function, metrics of global cardiac function and local cardiac fluid dynamics in 6 patients. Based on our findings, PVL limits the benefits of TAVR and restricts coronary perfusion due to the lack of sufficient coronary blood flow during diastole phase (e.g., maximum coronary flow rate reduced by 21.73%, 21.43% and 21.43% in the left anterior descending (LAD), left circumflex (LCX) and right coronary artery (RCA) respectively (N = 6)). Moreover, PVL may increase the LV load (e.g., LV load increased by 17.57% (N = 6)) and decrease the coronary wall shear stress (e.g., maximum wall shear stress reduced by 20.62%, 21.92%, 22.28% and 25.66% in the left main coronary artery (LMCA), left anterior descending (LAD), left circumflex (LCX) and right coronary artery (RCA) respectively (N = 6)), which could promote atherosclerosis development through loss of the physiological flow-oriented alignment of endothelial cells. This study demonstrated that a rigorously developed personalized image-based computational framework can provide vital insights into underlying mechanics of TAVR and CAD interactions and assist in treatment planning and patient risk stratification in patients.
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Niu Y, Bai N, Ma Y, Zhong PY, Shang YS, Wang ZL. Efficacy of intravascular imaging-guided drug-eluting stent implantation: a systematic review and meta-analysis of randomized clinical trials. BMC Cardiovasc Disord 2022; 22:327. [PMID: 35870904 PMCID: PMC9308935 DOI: 10.1186/s12872-022-02772-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 07/13/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Traditional angiography only displays two-dimensional images of the coronary arteries during stent implantation. However, intravascular imaging can show the structure of the vascular wall, plaque characteristics. This article aims to evaluate the efficacy of intravascular imaging-guided drug-eluting stent (DES) implantation.
Method
We conducted a systematic review and meta-analysis of randomized controlled trials of intravascular imaging-guided, including patients with DES implantation guided by intravascular ultrasound or optical coherence tomography and traditional angiography. The databases of PubMed, EMBASE, web of science, and Cochrane Library were searched. The primary outcome was target lesion revascularization (TLR). The secondary outcomes included the target vessel revascularization (TVR), myocardial infarction (MI), stent thrombosis (ST), cardiac death, all-cause death, and the major adverse cardiac events (MACE) during the 6–24 months follow-up. The fixed-effects model was used to calculate the relative risk (RR) and 95% confidence interval of the outcome event. Meanwhile, the trial sequence analysis was employed to evaluate the results.
Result
This meta-analysis included fourteen randomized controlled trials with 7307 patients. Compared with angiography-guided, intravascular imaging-guided DES implantation can significantly reduce the risk of TLR (RR 0.63, 0.49–0.82, P = 0.0004), TVR (RR 0.66, 0.52–0.85, P = 0.001), cardiac death (RR 0.58; 0.38–0.89; P = 0.01), MACE (RR 0.67, 0.57–0.79; P < 0.00001) and ST (RR 0.43, 0.24–0.78; P = 0.005). While there was no significant difference regarding MI (RR 0.77, 0.57–1.05, P = 0.10) and all-cause death (RR 0.87, 0.58–1.30, P = 0.50).
Conclusions
Compared with angiography, intravascular imaging-guided DES implantation is associated with better clinical outcomes in patients with coronary artery disease, especially complex lesions (Registered by PROSPERO, CRD 42021289205).
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Yazu Y, Fujihara M, Takahara M, Kurata N, Nakata A, Yoshimura H, Ito T, Fukunaga M, Kozuki A, Tomoi Y. Intravascular ultrasound-based decision tree model for the optimal endovascular treatment strategy selection of femoropopliteal artery disease-results from the ONION Study. CVIR Endovasc 2022; 5:52. [PMID: 36201066 PMCID: PMC9537399 DOI: 10.1186/s42155-022-00328-9] [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: 05/03/2022] [Accepted: 09/10/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The role of catheter-based imaging in peripheral interventions for lower extremity artery disease (LEAD) has increased with percutaneous interventions. To clarify the relation between intravascular ultrasound (IVUS) information and procedure selection strategy for endovascular treatment therapy (EVT) of the femoropopliteal artery in the real-world clinical settings wherein new endovascular technologies (NETs), including drug-coated balloon (DCB), drug-eluting stent (DES), and covered stent-graft (CS). Our retrospective multicenter analysis examined symptomatic 970 patients treated by EVT for de novo femoropopliteal lesions with IVUS guidance. The decision tree analysis was performed retrospectively to determine the association of IVUS and angiography parameters with the strategy selection of endovascular procedures. We divided the study population according to the developed tree, and identified the most popular strategy selection in each subgroup. We finally examined whether the restenosis risk would be different among respective subgroups of the tree. RESULTS During the study periods, plain old balloon angioplasty, DCB, and bare nitinol stent were most frequently selected (25.3%, 23.9%, and 23.8%, respectively). The drug-eluting stent (DES), covered stent (CS), and spot stent strategies were used in 7.3%, 11.5%, and 8.1%. NETs had the lowest restenosis risk in the overall population. The decision tree had a depth of six branches and divided the patients into 11 subgroups by IVUS and angiography parameters. The restenosis rate was similarly low among these 11 subgroups when the most popular NET in each subgroup was selected (P = 0.94). CONCLUSIONS The use of IVUS data along with angiography data would standardize the selection of endovascular procedures and can improve patency outcomes if NETs are used properly.
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Affiliation(s)
- Yuko Yazu
- grid.415384.f0000 0004 0377 9910Department of Medical Engineering, Kishiwada Tokushukai Hospital, Kishiwada, Japan
| | - Masahiko Fujihara
- grid.415384.f0000 0004 0377 9910Department of Cardiology, Kishiwada Tokushukai Hospital, Kishiwada-City Osaka, 4-27-1, Kamoricho, 596-8522 Japan ,grid.177174.30000 0001 2242 4849Department of Medicine and Biosystemic Science, Kyushu University Graduate School of Medical Sciences, Fukuoka, Japan
| | - Mitsuyoshi Takahara
- grid.136593.b0000 0004 0373 3971Department of Diabetes Care Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Naoya Kurata
- grid.414976.90000 0004 0546 3696Department of Medical Engineering, Kansai Rosai Hospital, Amagasaki, Japan
| | - Aya Nakata
- grid.416110.30000 0004 0607 2793Department of Medical Engineering, Morinomiya Hospital, Osaka, Japan
| | - Hitoshi Yoshimura
- grid.416618.c0000 0004 0471 596XDepartment of Medical Engineering, Saiseikai Nakatsu Hospital, Osaka, Japan
| | - Tomoaki Ito
- grid.415432.50000 0004 0377 9814Department of Medical Engineering, Kokura Memorial Hospital, Kitakyushu, Fukuoka Japan
| | - Masashi Fukunaga
- grid.416110.30000 0004 0607 2793Cardiovascular Division, Morinomiya Hospital, Osaka, Japan
| | - Amane Kozuki
- grid.416618.c0000 0004 0471 596XDepartment of Cardiology, Saiseikai Nakatsu Hospital, Osaka, Japan
| | - Yusuke Tomoi
- grid.415432.50000 0004 0377 9814Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Fukuoka Japan
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Secemsky EA, Parikh SA, Kohi M, Lichtenberg M, Meissner M, Varcoe R, Holden A, Jaff M, Chalyan D, Clair D, Hawkins B, Rosenfield K. Intravascular ultrasound guidance for lower extremity arterial and venous interventions. EUROINTERVENTION 2022; 18:598-608. [PMID: 35438078 PMCID: PMC10331977 DOI: 10.4244/eij-d-21-00898] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 03/28/2022] [Indexed: 11/23/2022]
Abstract
This review details the utility of intravascular ultrasound (IVUS) for the management of peripheral artery and venous disease. The purpose of this document is to provide an update in the use of IVUS in peripheral arterial and venous pathology and demonstrate the use of IVUS as a practical diagnostic imaging procedure to evaluate and treat peripheral vascular disorders. IVUS, a diagnostic tool that relies on sound waves to produce precise images of the vessel being evaluated, was originally introduced to the medical community for the purposes of peripheral artery imaging, though it was quickly adapted for coronary interventions with positive outcomes. The utility of IVUS includes vessel measurement, pre- and post-procedural planning, treatment optimisation, and detection of thrombus, dissection or calcium severity. While angiography remains the standard imaging approach during peripheral intervention, multiple observational studies and small prospective trials have shown that in comparison, IVUS provides more accurate imaging detail, which may improve procedural outcomes. IVUS can also address limitations of angiography, including the need to administer contrast medium and eliminate the ambiguity associated with other forms of imaging. This review provides contemporary examples of where IVUS is being used during peripheral intervention as well as representative imaging to serve as a resource for the practising clinician.
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Affiliation(s)
- Eric A Secemsky
- Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
- Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Sahil A Parikh
- Center for Interventional Vascular Therapy and Division of Cardiology, Department of Medicine, Columbia University Medical Center, New York, NY, USA
| | - Maureen Kohi
- Department of Radiology, University of North Carolina, Chapel Hill, NC, USA
| | | | - Mark Meissner
- Department of Surgery, University of Washington School of Medicine, Seattle, WA, USA
| | - Ramon Varcoe
- Department of Surgery, Prince of Wales Hospital, Sydney, New South Wales, Australia
- Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
- The Vascular Institute, Prince of Wales Hospital, Sydney, New South Wales, Australia
| | - Andrew Holden
- Department of Interventional Radiology, Auckland City Hospital, Auckland, New Zealand
| | | | - David Chalyan
- Department of Radiological Sciences, University of California-Irvine, Irvine, CA, USA
- Philips Healthcare, Amsterdam, the Netherlands
| | - Daniel Clair
- Department of Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Beau Hawkins
- Division of Cardiology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
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16
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Nisar H, Groves L, Cardarelli-Leite L, Peters TM, Chen ECS. Toward Fluoro-Free Interventions: Using Radial Intracardiac Ultrasound for Vascular Navigation. ULTRASOUND IN MEDICINE & BIOLOGY 2022; 48:1290-1298. [PMID: 35487839 DOI: 10.1016/j.ultrasmedbio.2022.02.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 12/23/2021] [Accepted: 02/28/2022] [Indexed: 06/14/2023]
Abstract
Transcatheter cardiovascular interventions have the advantage of patient safety, reduced surgery time and minimal trauma to the patient's body. Transcathether interventions, which are performed percutaneously, are limited by the lack of direct line of sight with the procedural tools and the patient anatomy. Therefore, such interventional procedures rely heavily on image guidance for navigating toward and delivering therapy at the target site. Vascular navigation via the inferior vena cava, from the groin to the heart, is an imperative part of most transcatheter cardiovascular interventions including heart valve repair surgeries and ablation therapy. Traditionally, the inferior vena cava is navigated using fluoroscopic techniques such as venography and computed tomography venography. These X-ray-based techniques can have detrimental effects on the patient as well as the surgical team, causing increased radiation exposure, leading to risk of cancer, fetal defects and eye cataracts. The use of a heavy lead apron has also been reported to cause back pain and spine issues, thus leading to interventionalist's disc disease. We propose the use of a catheter-based ultrasound augmented with electromagnetic tracking technology to generate a vascular roadmap in real time and perform navigation without harmful radiation. In this pilot study, we used spatially tracked intracardiac echocardiography to reconstruct a vessel from a phantom in a 3-D virtual environment. We illustrate how the proposed ultrasound-based navigation will appear in a virtual environment, by navigating a tracked guidewire within the vessels in the phantom without any radiation-based imaging. The geometric accuracy is assessed using a computed tomography scan of the phantom, with a Dice coefficient of 0.79. The average distance between the surfaces of the two models comes out to be 1.7 ± 1.12 mm.
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Affiliation(s)
- Hareem Nisar
- Robarts Research Institute, Western University, London, Ontario, Canada; Department of Biomedical Engineering, Western University, London, Ontario, Canada.
| | - Leah Groves
- Robarts Research Institute, Western University, London, Ontario, Canada; Department of Biomedical Engineering, Western University, London, Ontario, Canada
| | | | - Terry M Peters
- Robarts Research Institute, Western University, London, Ontario, Canada; Department of Biomedical Engineering, Western University, London, Ontario, Canada; Department of Medical Biophysics, Western University, London, Ontario, Canada
| | - Elvis C S Chen
- Robarts Research Institute, Western University, London, Ontario, Canada; Department of Biomedical Engineering, Western University, London, Ontario, Canada; Department of Medical Biophysics, Western University, London, Ontario, Canada; Lawson Health Research Institute, London, Ontario, Canada
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17
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Optical coherence tomography: evaluating the effects of stent boost subtract imaging on stent underexpansion in STEMI patients. BMC Cardiovasc Disord 2022; 22:62. [PMID: 35184740 PMCID: PMC8859886 DOI: 10.1186/s12872-022-02498-9] [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: 08/05/2021] [Accepted: 01/31/2022] [Indexed: 11/23/2022] Open
Abstract
Background To evaluate the effect of stent boost subtract (SBS) imaging on stent underexpansion during percutaneous coronary intervention (PCI) in patients with acute ST-segment elevation myocardial infarction (STEMI) by optical coherence tomography (OCT). Methods One hundred thirty-eight STEMI patients who underwent drug-eluting stent (DES) implantation were prospectively recruited and divided into the SBS group (69 cases) and the CAG group (69 cases) according to whether SBS was used to guide PCI. Finally, OCT was performed on all enrolled patients, and the OCT results were used as the gold standard to evaluate the impact of standard SBS technology on stent underexpansion immediately after DES implantation. Results SBS identified 51 patients (24%) with stent underexpansion while OCT identified 56 patients (27.2%). SBS has a sensitivity of 80%, a specificity of 96%, a positive predictive value of 88%, and a negative predictive value of 93% for identifying stent underexpansion. Conclusion Compared with OCT, SBS technology is a rapid stent imaging evaluation method that can accurately quantify the stent expansion level and is time-saving and economical. Supplementary Information The online version contains supplementary material available at 10.1186/s12872-022-02498-9.
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18
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Hassanin A, Ahmad H, Leesar M, Hakim D. The role of far-field intravascular ultrasound in transcatheter aortic valve replacement. Egypt Heart J 2021; 73:102. [PMID: 34783920 PMCID: PMC8595449 DOI: 10.1186/s43044-021-00227-9] [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: 06/08/2021] [Accepted: 11/02/2021] [Indexed: 11/10/2022] Open
Abstract
Precise and accurate characterization of the aortic valve complex is a vital step in the procedure planning for transcatheter aortic valve replacement (TAVR). Far-field intravascular ultrasound (IVUS) is a novel technology that can be utilized to assess aortic valve annulus and predict paravalvular leak, with comparable results to multi-detector computed tomography-the current gold standard in the preprocedural planning in TAVR. Far-field IVUS carries the advantage of minimal contrast use and lower radiation exposure. In this commentary, we describe two cases of far-field IVUS use during TAVR procedures and review its role as a complementary tool to current the imaging modalities used in TAVR.
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Affiliation(s)
- Ahmed Hassanin
- Department of Cardiology, Westchester Medical Center and New York Medical College, Valhalla, NY, USA.
| | - Hasan Ahmad
- Department of Cardiology, Westchester Medical Center and New York Medical College, Valhalla, NY, USA
| | - Massoud Leesar
- Department of Cardiology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Diaa Hakim
- Intravascular and Cardiac Imaging Core Laboratory, Brigham and Women's/Harvard School of Medicine, Boston, MA, USA.,Department of Cardiology, Suez Canal University, Ismailia, Egypt
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19
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Dissecting Femoropopliteal Dissections: Time to FLIPI the Script? JACC Cardiovasc Interv 2021; 14:2402-2404. [PMID: 34736740 DOI: 10.1016/j.jcin.2021.08.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 08/17/2021] [Indexed: 11/20/2022]
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20
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Kozuki A, Takahara M, Shimizu M, Kijima Y, Nagoshi R, Fujiwara R, Shibata H, Suzuki A, Soga F, Miyata T, Sakamoto Y, Seo H, Asada H, Isawa K, Higuchi K, Shite J. Outcomes of Dissection Angles as Predictor of Restenosis after Drug-Coated Balloon Treatment. J Atheroscler Thromb 2021; 28:954-962. [PMID: 33100279 PMCID: PMC8532059 DOI: 10.5551/jat.59774] [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] [Indexed: 12/18/2022] Open
Abstract
AIM The predictors of restenosis after endovascular therapy (EVT) with paclitaxel drug-coated balloons (DCBs) have not been clearly established. The present study aimed to investigate the association of post-procedural dissection, as evaluated using intravascular ultrasound (IVUS), with the risk of restenosis following femoropopliteal EVT with paclitaxel DCBs. METHODS In the present single-center retrospective study, 60 de novo femoropopliteal lesions (44 patients) that underwent EVT with DCBs, without bail-out stenting, were enrolled. The primary outcome was 1-year primary patency. Risk factors for restenosis were evaluated using a Cox proportional hazards regression model and random survival forest analysis. RESULTS The 1-year primary patency rate was 57.2% [95% confidence interval, 45%-72%]. IVUS-evaluated post-procedural dissection was significantly associated with the risk of restenosis (P=0.002), with the best cutoff point of 64º [range, 39º-83º]. The random survival forest analysis showed that the variable importance measure of IVUS-evaluated dissection was significantly lower than that of the reference vessel diameter (P<0.001), not different from that of the lesion length (P=0.41), and significantly higher than that of any other clinical feature (all P<0.05). CONCLUSION IVUS-evaluated post-procedural dissection was associated with 1-year restenosis following femoropopliteal EVT with DCB.
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Affiliation(s)
- Amane Kozuki
- Osaka Saiseikai Nakatsu Hospital, Division of Cardiology
| | - Mitsuyoshi Takahara
- Department of Diabetes Care Medicine, Osaka University Graduate School of Medicine
| | | | - Yoichi Kijima
- Osaka Saiseikai Nakatsu Hospital, Division of Cardiology
| | - Ryoji Nagoshi
- Osaka Saiseikai Nakatsu Hospital, Division of Cardiology
| | - Ryudo Fujiwara
- Osaka Saiseikai Nakatsu Hospital, Division of Cardiology
| | | | - Atsushi Suzuki
- Osaka Saiseikai Nakatsu Hospital, Division of Cardiology
| | - Fumitaka Soga
- Osaka Saiseikai Nakatsu Hospital, Division of Cardiology
| | | | - Yuki Sakamoto
- Osaka Saiseikai Nakatsu Hospital, Division of Cardiology
| | - Hidenobu Seo
- Osaka Saiseikai Nakatsu Hospital, Division of Cardiology
| | - Hiroyuki Asada
- Osaka Saiseikai Nakatsu Hospital, Division of Cardiology
| | - Kouhei Isawa
- Osaka Saiseikai Nakatsu Hospital, Division of Cardiology
| | - Kotaro Higuchi
- Osaka Saiseikai Nakatsu Hospital, Division of Cardiology
| | - Junya Shite
- Osaka Saiseikai Nakatsu Hospital, Division of Cardiology
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21
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Zhong L, Chong TT. Editorial for "Quiescent-Interval Slice-Selective (QISS) MRI Accurately Estimates Intravascular Stent Dimensions Prior to Intervention in Patients with Peripheral Artery Disease". J Magn Reson Imaging 2021; 55:1810-1811. [PMID: 34378277 DOI: 10.1002/jmri.27886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 08/04/2021] [Indexed: 11/09/2022] Open
Affiliation(s)
- Liang Zhong
- National Heart Research Institute Singapore, National Heart Centre Singapore; Duke NUS Medical School, Singapore
| | - Tze Tec Chong
- Singapore General Hospital; Duke-NUS Medical School, Singapore
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22
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Hammes M, Moya-Rodriguez A, Bernstein C, Nathan S, Navuluri R, Basu A. Computational modeling of the cephalic arch predicts hemodynamic profiles in patients with brachiocephalic fistula access receiving hemodialysis. PLoS One 2021; 16:e0254016. [PMID: 34260609 PMCID: PMC8279323 DOI: 10.1371/journal.pone.0254016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 06/17/2021] [Indexed: 11/25/2022] Open
Abstract
Background The most common configuration for arteriovenous fistula is brachiocephalic which often develop cephalic arch stenosis leading to the need for numerous procedures to maintain access patency. The hemodynamics that contributes to the development of cephalic arch stenosis is incompletely understood given the inability to accurately determine shear stress in the cephalic arch. In the current investigation our aim was to determine pressure, velocity and wall shear stress profiles in the cephalic arch in 3D using computational modeling as tools to understand stenosis. Methods Five subjects with brachiocephalic fistula access had protocol labs, Doppler, venogram and intravascular ultrasound imaging performed at 3 and 12 months. 3D reconstructions of the cephalic arch were generated by combining intravascular ultrasounds and venograms. Standard finite element analysis software was used to simulate time dependent blood flow in the cephalic arch with velocity, pressure and wall shear stress profiles generated. Results Our models generated from imaging and flow measurements at 3 and 12 months offer snapshots of the patient’s cephalic arch at a precise time point, although the remodeling of the vessel downstream of an arteriovenous fistula in patients undergoing regular dialysis is a dynamic process that persists over long periods of time (~ 5 years). The velocity and pressure increase at the cephalic bend cause abnormal hemodynamics most prominent along the inner wall of the terminal cephalic arch. The topology of the cephalic arch is highly variable between subjects and predictive of pathologic stenosis at later time points. Conclusions Low flow velocity and wall pressure along the inner wall of the bend may provide possible nidus of endothelial activation that leads to stenosis and thrombosis. In addition, 3D modelling of the arch can indicate areas of stenosis that may be missed by venograms alone. Computational modeling reconstructed from 3D radiologic imaging and Doppler flow provides important insights into the hemodynamics of blood flow in arteriovenous fistula. This technique could be used in future studies to determine optimal flow to prevent endothelial damage for patients with arteriovenous fistula access.
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Affiliation(s)
- Mary Hammes
- Department of Medicine, Section of Nephrology, University of Chicago, Chicago, IL, United States of America
- * E-mail: (MH); (AB)
| | - Andres Moya-Rodriguez
- Department of Medicine, Section on Genetic Medicine, University of Chicago, Chicago, IL, United States of America
- Biophysical Sciences Graduate Program, University of Chicago, Chicago, IL, United States of America
| | - Cameron Bernstein
- College, University of Chicago, Chicago, IL, United States of America
| | - Sandeep Nathan
- Department of Medicine, Section of Cardiology, University of Chicago, Chicago, IL, United States of America
| | - Rakesh Navuluri
- Department of Radiology, University of Chicago, Chicago, IL, United States of America
| | - Anindita Basu
- Department of Medicine, Section on Genetic Medicine, University of Chicago, Chicago, IL, United States of America
- * E-mail: (MH); (AB)
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Peng C, Wu H, Kim S, Dai X, Jiang X. Recent Advances in Transducers for Intravascular Ultrasound (IVUS) Imaging. SENSORS (BASEL, SWITZERLAND) 2021; 21:3540. [PMID: 34069613 PMCID: PMC8160965 DOI: 10.3390/s21103540] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 05/11/2021] [Accepted: 05/17/2021] [Indexed: 12/16/2022]
Abstract
As a well-known medical imaging methodology, intravascular ultrasound (IVUS) imaging plays a critical role in diagnosis, treatment guidance and post-treatment assessment of coronary artery diseases. By cannulating a miniature ultrasound transducer mounted catheter into an artery, the vessel lumen opening, vessel wall morphology and other associated blood and vessel properties can be precisely assessed in IVUS imaging. Ultrasound transducer, as the key component of an IVUS system, is critical in determining the IVUS imaging performance. In recent years, a wide range of achievements in ultrasound transducers have been reported for IVUS imaging applications. Herein, a comprehensive review is given on recent advances in ultrasound transducers for IVUS imaging. Firstly, a fundamental understanding of IVUS imaging principle, evaluation parameters and IVUS catheter are summarized. Secondly, three different types of ultrasound transducers (piezoelectric ultrasound transducer, piezoelectric micromachined ultrasound transducer and capacitive micromachined ultrasound transducer) for IVUS imaging are presented. Particularly, the recent advances in piezoelectric ultrasound transducer for IVUS imaging are extensively examined according to their different working mechanisms, configurations and materials adopted. Thirdly, IVUS-based multimodality intravascular imaging of atherosclerotic plaque is discussed. Finally, summary and perspectives on the future studies are highlighted for IVUS imaging applications.
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Affiliation(s)
- Chang Peng
- Department of Mechanical and Aerospace Engineering, North Carolina State University, Raleigh, NC 27695, USA; (C.P.); (H.W.)
| | - Huaiyu Wu
- Department of Mechanical and Aerospace Engineering, North Carolina State University, Raleigh, NC 27695, USA; (C.P.); (H.W.)
| | | | - Xuming Dai
- Department of Cardiology, New York-Presbyterian Queens Hospital, Flushing, NY 11355, USA;
| | - Xiaoning Jiang
- Department of Mechanical and Aerospace Engineering, North Carolina State University, Raleigh, NC 27695, USA; (C.P.); (H.W.)
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McHugh S, Noory A, Mishra S, Vanchiere C, Lakhter V. Vascular Access for Large Bore Access. Interv Cardiol Clin 2021; 10:157-167. [PMID: 33745666 DOI: 10.1016/j.iccl.2020.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Recent advances in the field of interventional cardiology have allowed for more complex procedures to be performed percutaneously. Ability to obtain safe large bore vascular access is frequently the key factor to procedural success. Meticulous technique for successful vascular access incorporates the understanding of anatomic landmarks, ultrasound, fluoroscopy, and micropuncture. Adequate hemostasis at the end of the case can be achieved through careful use of commercially available vascular closure devices. Although access-related vascular complications are uncommon, early recognition is key to successful management. Arterial tortuosity and calcification can present a significant challenge to successful common femoral artery access.
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Affiliation(s)
- Stephen McHugh
- Department of Medicine, Temple University Hospital, Lewis Katz School of Medicine, 3401 North Broad Street, Philadelphia, PA 19140, USA
| | - Ali Noory
- Department of Medicine, Temple University Hospital, Lewis Katz School of Medicine, 3401 North Broad Street, Philadelphia, PA 19140, USA
| | - Suraj Mishra
- Department of Medicine, Temple University Hospital, Lewis Katz School of Medicine, 3401 North Broad Street, Philadelphia, PA 19140, USA
| | - Catherine Vanchiere
- Department of Medicine, Temple University Hospital, Lewis Katz School of Medicine, 3401 North Broad Street, Philadelphia, PA 19140, USA
| | - Vladimir Lakhter
- Division of Cardiovascular Diseases, Department of Medicine, Temple University Hospital, Lewis Katz School of Medicine, 3401 North Broad Street (9PP), Philadelphia, PA 19140, USA.
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Kawamori H, Konishi A, Shinke T, Akahori H, Ishihara M, Tsujita H, Otake H, Toba T, Nakano S, Tanimura K, Tsukiyama Y, Nanba I, Kakei Y, Yasuda T, Omori T, Kubo T, Kozuki A, Shite J, Hirata KI. Efficacy of optical frequency domain imaging in detecting peripheral artery disease: the result of a multi-center, open-label, single-arm study. Heart Vessels 2021; 36:818-826. [PMID: 33481085 DOI: 10.1007/s00380-020-01758-y] [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: 08/28/2020] [Accepted: 12/11/2020] [Indexed: 12/31/2022]
Abstract
Optical frequency domain imaging (OFDI) is a high-resolution intracoronary imaging modality with fast automated longitudinal pullback. We aimed to evaluate the ability of performing OFDI from the superficial femoral artery (SFA) to the below-knee (BK) artery. This clinical trial was a multi-center, single-arm, open-label study. The primary endpoint was to obtain a clear image of the intra-vascular lumen from the SFA to the BK artery, specifically > 270° visualization of the blood vessel lumen with > 16/21 cross sections. The proportion of the clear image (≥ 85%) was regarded as confirmatory of the ability of OFDI to visualize the vessel lumen. Overall, 20 patients were enrolled. The proportion of the primary endpoint was 90% (18/20), and the pre-specified criterion was successfully attained. The proportion of the clear image assessed by the operator was 100% (20/20), and an additional statistical analysis for the proportion of the visualization, > 270°, of the blood vessel lumen revealed a significantly higher cut-off value than that for the pre-specified criterion, 85% (p = 0.0315). There were three adverse events not related to OFDI. OFDI achieved acceptable visualization of the vessel lumen without any adverse event related to it. After regulatory approval based on the present study, OFDI will be available as a new option of endovascular imaging for peripheral artery diseases in daily practiceTrial registration: This study was registered in the Japanese Registry of Clinical Trials (jRCT 2052190025, https://jrct.niph.go.jp/latest-detail/jRCT2052190025 ).
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Affiliation(s)
- Hiroyuki Kawamori
- Division of Cardiovascular Medicine, Department of Internal Medicine, Graduate School of Medicine, Kobe University, Kobe, Japan
| | - Akihide Konishi
- Division of Cardiovascular Medicine, Department of Internal Medicine, Graduate School of Medicine, Kobe University, Kobe, Japan. .,Clinical and Translational Research Center, Kobe University Hospital, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, Hyogo, 650-0017, Japan.
| | - Toshiro Shinke
- Division of Cardiovascular Medicine, Department of Internal Medicine, Graduate School of Medicine, Kobe University, Kobe, Japan.,Division of Cardiovascular Medicine, School of Medicine, Showa University, Shinagawa, Japan
| | - Hirokuni Akahori
- Department of Cardiovascular and Renal Medicine, Hyogo College of Medicine, Nishinomiya, Japan
| | - Masaharu Ishihara
- Department of Cardiovascular and Renal Medicine, Hyogo College of Medicine, Nishinomiya, Japan
| | - Hiroaki Tsujita
- Division of Cardiovascular Medicine, School of Medicine, Showa University, Shinagawa, Japan
| | - Hiromasa Otake
- Division of Cardiovascular Medicine, Department of Internal Medicine, Graduate School of Medicine, Kobe University, Kobe, Japan
| | - Takayoshi Toba
- Division of Cardiovascular Medicine, Department of Internal Medicine, Graduate School of Medicine, Kobe University, Kobe, Japan
| | - Shinsuke Nakano
- Division of Cardiovascular Medicine, Department of Internal Medicine, Graduate School of Medicine, Kobe University, Kobe, Japan
| | - Kosuke Tanimura
- Division of Cardiovascular Medicine, Department of Internal Medicine, Graduate School of Medicine, Kobe University, Kobe, Japan
| | | | - Isao Nanba
- Clinical and Translational Research Center, Kobe University Hospital, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, Hyogo, 650-0017, Japan
| | - Yasumasa Kakei
- Clinical and Translational Research Center, Kobe University Hospital, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, Hyogo, 650-0017, Japan
| | - Takahiro Yasuda
- Advanced Medical-Engineering Development Center, Kobe University, Kobe, Japan
| | - Takashi Omori
- Clinical and Translational Research Center, Kobe University Hospital, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, Hyogo, 650-0017, Japan
| | - Takashi Kubo
- Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan
| | - Amane Kozuki
- Division of Cardiology, Osaka Saiseikai Nakatsu Hospital, Osaka, Japan
| | - Junya Shite
- Division of Cardiology, Osaka Saiseikai Nakatsu Hospital, Osaka, Japan
| | - Ken-Ichi Hirata
- Division of Cardiovascular Medicine, Department of Internal Medicine, Graduate School of Medicine, Kobe University, Kobe, Japan
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26
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Loffroy R, Falvo N, Galland C, Fréchier L, Ledan F, Midulla M, Chevallier O. Intravascular Ultrasound in the Endovascular Treatment of Patients With Peripheral Arterial Disease: Current Role and Future Perspectives. Front Cardiovasc Med 2020; 7:551861. [PMID: 33344512 PMCID: PMC7738328 DOI: 10.3389/fcvm.2020.551861] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 11/16/2020] [Indexed: 11/13/2022] Open
Abstract
Over the last decade, intravascular ultrasound (IVUS) has emerged as a useful adjunctive tool to angiography in an increasing number of catheter-based procedures for peripheral arterial disease (PAD). IVUS catheters offer accurate cross-sectional imaging of arterial vessels with high dimensional accuracy and provide accurate information about lesion morphology. IVUS enables assessment of the plaque morphology, vessel diameter, and the presence of arterial dissections. Furthermore, IVUS is able to properly guide the best choice of appropriate percutaneous transluminal angioplasty (PTA) technique, guide the delivery of different devices, and assess the immediate result of any endovascular intervention. In the present review, the role of IVUS for PAD will be discussed, specifically the applications of IVUS technology during interventional procedures including PTA, stent sizing, crossing total occlusion, assessing residual narrowing and stent apposition and expansion, and atherectomy. Future perspectives of IVUS-guided treatments and cost-effectiveness of the systematic use of IVUS during endovascular interventions will be also discussed.
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Affiliation(s)
- Romaric Loffroy
- Department of Vascular Medicine and Interventional Radiology, François-Mitterrand University Hospital, Dijon, France
| | - Nicolas Falvo
- Department of Vascular Medicine and Interventional Radiology, François-Mitterrand University Hospital, Dijon, France
| | - Christophe Galland
- Department of Vascular Medicine and Interventional Radiology, François-Mitterrand University Hospital, Dijon, France
| | - Léo Fréchier
- Department of Vascular Medicine and Interventional Radiology, François-Mitterrand University Hospital, Dijon, France
| | - Frédérik Ledan
- Department of Vascular Medicine and Interventional Radiology, François-Mitterrand University Hospital, Dijon, France
| | - Marco Midulla
- Department of Vascular Medicine and Interventional Radiology, François-Mitterrand University Hospital, Dijon, France
| | - Olivier Chevallier
- Department of Vascular Medicine and Interventional Radiology, François-Mitterrand University Hospital, Dijon, France
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27
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Dake MD, Fanelli F, Lottes AE, O'Leary EE, Reichert H, Jiang X, Fu W, Iida O, Zen K, Schermerhorn M, Zeller T, Ansel GM. Prediction Model for Freedom from TLR from a Multi-study Analysis of Long-Term Results with the Zilver PTX Drug-Eluting Peripheral Stent. Cardiovasc Intervent Radiol 2020; 44:196-206. [PMID: 33025243 PMCID: PMC7806559 DOI: 10.1007/s00270-020-02648-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Accepted: 09/08/2020] [Indexed: 01/20/2023]
Abstract
Purpose Develop a prediction model to determine the impact of patient and lesion factors on freedom from target lesion revascularization (ffTLR) for patients who are candidates for Zilver PTX drug-eluting stent (DES) treatment for femoropopliteal lesions. Methods Patient factors, lesion characteristics, and TLR results from five global studies were utilized for model development. Factors potentially associated with TLR (sex, age, diabetes, hypertension, hypercholesterolemia, renal disease, smoking status, Rutherford classification, lesion length, reference vessel diameter (RVD), popliteal involvement, total occlusion, calcification severity, prior interventions, and number of runoff vessels) were analyzed in a Cox proportional hazards model. Probability of ffTLR was generated for three example patient profiles via combinations of patient and lesion factors. TLR was defined as reintervention performed for ≥ 50% diameter stenosis after recurrent clinical symptoms. Results The model used records from 2227 patients. The median follow-up time was 23.9 months (range: 0.03–60.8). The Kaplan–Meier estimates for ffTLR were 90.5% through 1 year and 75.2% through 5 years. In a multivariate analysis, sex, age, Rutherford classification, lesion length, RVD, total occlusion, and prior interventions were significant factors. The example patient profiles have predicted 1-year ffTLRs of 97.4, 92.3, and 86.0% and 5-year predicted ffTLRs of 92.8, 79.5, and 64.8%. The prediction model is available as an interactive web-based tool (https://cooksfa.z13.web.core.windows.net). Conclusions This is the first prediction model that uses an extensive dataset to determine the impact of patient and lesion factors on ffTLR through 5 years and provides an interactive web-based tool for expected patient outcomes with the Zilver PTX DES. Clinical Trial Registrations Zilver PTX RCT unique identifier: NCT00120406; Zilver PTX single-arm study unique identifier: NCT01094678; Zilver PTX China study unique identifier: NCT02171962; Zilver PTX US post-approval study unique identifier: NCT01901289; Zilver PTX Japan post-market surveillance study unique identifier: NCT02254837. Levels of Evidence Zilver PTX RCT: Level 2, randomized controlled trial; Single-arm study: Level 4, large case series; China study: Level 4, case series; US post-approval study: Level 4, case series Japan PMS study: Level 4, large case series. Electronic supplementary material The online version of this article (10.1007/s00270-020-02648-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Michael D Dake
- The University of Arizona, Health Sciences Innovation Building, 1670 East Drachman Street, 9th Floor SVP Suite, P.O. Box 210216, Tucson, AZ, 85721-0216, USA.
| | - Fabrizio Fanelli
- Department of Vascular and Interventional Radiology, "Careggi" University Hospital, Florence, Italy
| | | | | | | | | | - Weiguo Fu
- Department of Vascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Osamu Iida
- Cardiovascular Center, Kansai Rosai Hospital, Amagasaki, Japan
| | - Kan Zen
- Department of Cardiovascular Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Marc Schermerhorn
- Division of Vascular Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Thomas Zeller
- Universitaets-Herz-Zentrum Freiburg - Bad Krozingen, Bad Krozingen, Germany
| | - Gary M Ansel
- Department of Medicine, Ohio Health/Riverside Methodist Hospital, Columbus, OH, USA
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28
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Nogic J, Prosser H, O’Brien J, Thakur U, Soon K, Proimos G, Brown AJ. The assessment of intermediate coronary lesions using intracoronary imaging. Cardiovasc Diagn Ther 2020; 10:1445-1460. [PMID: 33224767 PMCID: PMC7666953 DOI: 10.21037/cdt-20-226] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2020] [Accepted: 06/23/2020] [Indexed: 02/05/2023]
Abstract
Intermediate coronary artery stenosis, defined as visual angiographic stenosis severity of between 30-70%, is present in up to one quarter of patients undergoing coronary angiography. Patients with this particular lesion subset represent a distinct clinical challenge, with operators often uncertain on the need for revascularization. Although international guidelines appropriately recommend physiological pressure-based assessment of these lesions utilizing either fractional flow reserve (FFR) or quantitative flow ratio (QFR), there are specific clinical scenarios and lesion subsets where the use of such indices may not be reliable. Intravascular imaging, mainly utilizing intravascular ultrasound (IVUS) and optical coherence tomography (OCT) represents an alternate and at times complementary diagnostic modality for the evaluation of intermediate coronary stenoses. Studies have attempted to validate these specific imaging measures with physiological markers of lesion-specific ischaemia with varied results. Intravascular imaging however also provides additional benefits that include portrayal of plaque morphology, guidance on stent implantation and sizing and may portend improved clinical outcomes. Looking forward, research in computational fluid dynamics now seeks to integrate both lesion-based physiology and anatomical assessment using intravascular imaging. This review will discuss the rationale and indications for the use of intravascular imaging assessment of intermediate lesions, while highlighting the current limitations and benefits to this approach.
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Affiliation(s)
- Jason Nogic
- Monash Cardiovascular Research Centre, Monash University and MonashHeart, Monash Health, Melbourne, Victoria, Australia
- Department of Cardiology, Eastern Health, Melbourne, Victoria, Australia
| | - Hamish Prosser
- Department of Cardiology, Eastern Health, Melbourne, Victoria, Australia
| | - Joseph O’Brien
- Department of Cardiology, Eastern Health, Melbourne, Victoria, Australia
| | - Udit Thakur
- Monash Cardiovascular Research Centre, Monash University and MonashHeart, Monash Health, Melbourne, Victoria, Australia
| | - Kean Soon
- Department of Cardiology, Eastern Health, Melbourne, Victoria, Australia
| | - George Proimos
- Department of Cardiology, Eastern Health, Melbourne, Victoria, Australia
| | - Adam J. Brown
- Monash Cardiovascular Research Centre, Monash University and MonashHeart, Monash Health, Melbourne, Victoria, Australia
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29
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Wang J, Zheng Z, Chan J, Yeow JTW. Capacitive micromachined ultrasound transducers for intravascular ultrasound imaging. MICROSYSTEMS & NANOENGINEERING 2020; 6:73. [PMID: 34567683 PMCID: PMC8433336 DOI: 10.1038/s41378-020-0181-z] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/02/2020] [Revised: 04/28/2020] [Accepted: 05/23/2020] [Indexed: 05/27/2023]
Abstract
Intravascular ultrasound (IVUS) is a burgeoning imaging technology that provides vital information for the diagnosis of coronary arterial diseases. A significant constituent that enables the IVUS system to attain high-resolution images is the ultrasound transducer, which acts as both a transmitter that sends acoustic waves and a detector that receives the returning signals. Being the most mature form of ultrasound transducer available in the market, piezoelectric transducers have dominated the field of biomedical imaging. However, there are some drawbacks associated with using the traditional piezoelectric ultrasound transducers such as difficulties in the fabrication of high-density arrays, which would aid in the acceleration of the imaging speed and alleviate motion artifact. The advent of microelectromechanical system (MEMS) technology has brought about the development of micromachined ultrasound transducers that would help to address this issue. Apart from the advantage of being able to be fabricated into arrays with lesser complications, the image quality of IVUS can be further enhanced with the easy integration of micromachined ultrasound transducers with complementary metal-oxide-semiconductor (CMOS). This would aid in the mitigation of parasitic capacitance, thereby improving the signal-to-noise. Currently, there are two commonly investigated micromachined ultrasound transducers, piezoelectric micromachined ultrasound transducers (PMUTs) and capacitive micromachined ultrasound transducers (CMUTs). Currently, PMUTs face a significant challenge where the fabricated PMUTs do not function as per their design. Thus, CMUTs with different array configurations have been developed for IVUS. In this paper, the different ultrasound transducers, including conventional-piezoelectric transducers, PMUTs and CMUTs, are reviewed, and a summary of the recent progress of CMUTs for IVUS is presented.
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Affiliation(s)
- Jiaqi Wang
- Department of Systems Design Engineering, Faculty of Engineering, University of Waterloo, Waterloo, ON N2L 3G1 Canada
| | - Zhou Zheng
- Department of Systems Design Engineering, Faculty of Engineering, University of Waterloo, Waterloo, ON N2L 3G1 Canada
| | - Jasmine Chan
- Department of Systems Design Engineering, Faculty of Engineering, University of Waterloo, Waterloo, ON N2L 3G1 Canada
| | - John T. W. Yeow
- Department of Systems Design Engineering, Faculty of Engineering, University of Waterloo, Waterloo, ON N2L 3G1 Canada
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30
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Fujihara M, Yazu Y, Takahara M. Intravascular Ultrasound–Guided Interventions for Below-the-Knee Disease in Patients With Chronic Limb-Threatening Ischemia. J Endovasc Ther 2020; 27:565-574. [DOI: 10.1177/1526602820935606] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Purpose: To assess the utility of intravascular ultrasound (IVUS) during below-the-knee (BTK) interventions for patients with chronic limb-threatening ischemia (CLTI). Materials and Methods: This retrospective single-center study included 216 symptomatic patients (mean age 74.2±9.5 years; 167 men) with CLTI and BTK steno-occlusive disease who underwent successful balloon angioplasty between January 2016 and August 2018. Data from 88 vessels (58 patients) treated with IVUS-guided procedures were compared with corresponding values from 242 vessels (158 patients) treated with angiography-guided procedures. The primary outcomes included procedure-related variables of balloon size, contrast dose, and complication rates, as well as changes in ankle-brachial index (ABI) and skin perfusion pressure (SPP). Secondary outcomes included IVUS determination of vessel size, wire route, and calcification severity, as well as technical success and clinically-driven target lesion revascularization (TLR), limb salvage, and wound healing rates in the Rutherford category 5/6 patients as evaluated by propensity score matching analysis. Results: The patient and lesion characteristics were similar in both groups. The mean balloon size for IVUS-guided procedures was significantly larger (2.45±0.4 mm) compared with that for angiography-guided procedures (2.23±0.4 mm; p<0.001). The technical success (p=0.56) and complication rates (p=0.16) were similar between the groups. The postprocedure dorsal and plantar SPP and change in dorsal SPP improved more in the IVUS-guided group (p<0.001, p=0.015, and p=0.02, respectively). The IVUS-guided group had a significantly better wound healing rate than the angiography-guided group (p=0.006), although the freedom from TLR and limb salvage rates were similar between the groups (p=0.16 and p>0.99, respectively). Conclusion: IVUS-guided interventions for BTK lesions were safe and effective in accurately assessing the lesions. The results suggest that IVUS guidance of endovascular procedures has the potential to influence better clinical outcomes than angiography-guided angioplasty.
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Affiliation(s)
- Masahiko Fujihara
- Department of Cardiology, Kishiwada Tokushukai Hospital, Kishiwada, Japan
- Department of Medicine and Biosystemic Science, Kyushu University Graduate School of Medical Sciences, Fukuoka, Japan
| | - Yuko Yazu
- Department of Medical Engineering, Kishiwada Tokushukai Hospital, Kishiwada, Japan
| | - Mitsuyoshi Takahara
- Department of Diabetes Care Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
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Faggioli G, Abualhin M, Vacirca A, Gargiulo M. Commentary: Investigating and Predicting the Fate of Infrapopliteal Arterial Disease After Endovascular Treatment. J Endovasc Ther 2020; 27:581-583. [PMID: 32469295 DOI: 10.1177/1526602820928087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Shammas NW, Shammas WJ, Jones-Miller S, Torey JT, Armstrong EJ, Radaideh Q, Shammas GA. Optimal Vessel Sizing and Understanding Dissections in Infrapopliteal Interventions: Data From the iDissection Below the Knee Study. J Endovasc Ther 2020; 27:575-580. [DOI: 10.1177/1526602820924815] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Purpose: To investigate if imaging with intravascular ultrasound (IVUS) yields a more accurate estimate of vessel diameter and the presence of dissections than angiography after intervention in the infrapopliteal arteries. Materials and Methods: A prospective, single-center study enrolled 20 consecutive patients (mean age 74.1±12.4 years; 12 women) with infrapopliteal disease who were treated with percutaneous transluminal angioplasty (PTA; n=10) or orbital atherectomy (OA) followed by PTA (n=10). The majority of patients were hypertensive and half were diabetic. The overall lesion length was 7.3±6.3 cm, and the diameter stenosis was 80.3%±22.1%. The baseline characteristics did not differ between the groups. Vessel diameters were measured using IVUS from the internal elastic lamina (IEL) to the IEL. IVUS was performed at baseline, post PTA or OA, and post OA+PTA. Quantitative vascular angiography (QVA) and IVUS were analyzed by a core laboratory. Dissections on cine images were categorized based on the National Heart Lung and Blood Institute (NHLBI) classification, while the arc and depth were used to characterize dissections on IVUS images. Results: Mean vessel diameter by QVA was 2.9±0.6 vs 4.0±1.0 mm by IVUS according to the core laboratory (mean difference 1.1±0.9, p<0.001). On angiography, there were 7 dissections after PTA (6 C, 1 D), 1 dissection after OA (1 B), and 2 dissections after OA+PTA (1 A, 1 B; p=0.028 vs post PTA). IVUS uncovered 3.8 times more dissections than seen on angiography. There were 23 dissections after PTA (18 intima, 3 media, 2 adventitia), 12 dissections after OA (8 intima, 1 media, 3 adventitia), and 11 dissections following OA+PTA (7 intima, 1 media, 3 adventitia; p=0.425 vs PTA). Bailout stenting (all due to angiographic dissections ≥C) was necessary in 6 of the PTA cohort and none of the OA+PTA group. Conclusion: In addition to underestimating the infrapopliteal vessel diameter by ~25%, angiography underappreciated the presence and severity of post-intervention dissections vs IVUS, particularly in the OA+PTA group.
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Affiliation(s)
| | - W. John Shammas
- Midwest Cardiovascular Research Foundation, Davenport, IA, USA
| | | | | | | | - Qais Radaideh
- Midwest Cardiovascular Research Foundation, Davenport, IA, USA
| | - Gail A. Shammas
- Midwest Cardiovascular Research Foundation, Davenport, IA, USA
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