Objectives: The purpose of this studywas to evaluate predictors of an adverse outcome after “crush”bifurcation stenting. Background: The “crush”technique is a recently introduced strategy with limited data regardi...Objectives: The purpose of this studywas to evaluate predictors of an adverse outcome after “crush”bifurcation stenting. Background: The “crush”technique is a recently introduced strategy with limited data regarding long-term outcomes. Methods: We identified 231 consecutive patients treated with drug-eluting stent implantation with the “crush”technique for 241 de novo bifurcation lesions. Clinical follow-up was obtained in 99.6%. Results: The in-hospital major adverse cardiac event(MACE) rate was 5.2%. At 9 months, 10(4.3%) patients had an event consistent with possible post-procedural stent thrombosis. Survival free of target lesion revascularization(TLR) was 90.3%; the only independent predictor of TLR was left main stem(LMS) therapy(odds ratio[OR] 4.97; 95%confidence interval[CI] 2.00 to 12.37, p=0.001). Survival free of MACE was 83.5%and independent predictors of MACE were LMS therapy(OR 3.79; 95%CI 1.76 to 8.14, p=0.001) and treatment of patients with multivessel disease(OR 4.21; 95%CI 0.95 to 18.56, p=0.058). Angiographic follow-up was obtained in 77%of lesions at 8.3±3.7 months. The mean late loss of the main vessel and side branch were 0.30±0.64 mm and 0.41±0.67 mm, respectively, with binary restenosis rates of 9.1%and 25.3%. Kissing balloon post-dilation significantly reduced the side branch late lumen loss(0.24±0.50 mm vs. 0.58±0.77 mm, p< 0.001). Conclusions: The crush technique of bifurcation stenting with drug-eluting stents is associated with favorable outcomes for most lesions; however, efficacy appears significantly reduced in LMS bifurcations, and further research is needed before the technique can be routinely recommended in this group. Furthermore, the incidence of possible stent thrombosis is of concern and requires further investigation. Kissing balloon post-dilatation is mandatory to reduce side branch restenosis.展开更多
Objective: To assess the effectiveness of routine sirolimus eluting stent (SES) implantation for unselected patients with instent restenosis and to provide preliminary information about the angiographic outcome for le...Objective: To assess the effectiveness of routine sirolimus eluting stent (SES) implantation for unselected patients with instent restenosis and to provide preliminary information about the angiographic outcome for lesion subgroups and for different in-stent restenosis patterns. Design: Prospective, single centre registry. Setting: Tertiary referral centre. Patients: 44 consecutive patients(53 lesions) without previous brachytherapy who were treated with SES for in-stent restenosis were evaluated. Routine angiographic follow up was obtained at six months and the incidence of major adverse cardiovascular events was evaluated. Results: At baseline, 42%of the lesions were focal, 21%diffuse, 26%proliferative, and 11%total occlusions. Small vessel size (reference diameter ≤2.5 mm) was present in 49%, long lesions( > 20 mm) in 30%, treatment of bypass grafts in 13%, and bifurcation stenting in 18%. At follow up, post-SES restenosis was observed in 14.6%. No restenosis was observed in focal lesions. For more complex lesions, restenosis rates ranged from 20-25%. At the one year follow up, the incidence of death was 0, myocardial infarction 4.7%(n=2), and target lesion revascularisation 16.3%(n=7). The target lesion was revascularised because of restenosis in 11.6%(n=5). Conclusions: Routine SES implantation is highly effective for focal in-stent restenosis and appears to be a promising strategy for more complex patterns of restenosis.展开更多
Aims: Relative plaque composition, more than its morphology alone, is thought to play a pivotal role in determining propensity to vulnerability. Thus, we investigated in vivo whether the distance from coronary ostium ...Aims: Relative plaque composition, more than its morphology alone, is thought to play a pivotal role in determining propensity to vulnerability. Thus, we investigated in vivo whether the distance from coronary ostium to plaque location independently affects plaque composition in humans. This may help explaining the recently reported non-uniform distribution of culprit lesions along the vessel in acute coronary syndromes. Methods and results: In 51 consecutive patients(45 men), aged 38-76 years(mean age: 58± 10), a non-culprit vessel was investigated through spectral analysis of IVUS radiofrequency data(IVUS Virtual HistologyTM). The study vessel was the left anterior descending artery in 23(45% ) patients; the circumflex artery in nine(18% ), and right coronary artery in 19(37% ). The overall length of the region of interest, subsequently divided into 10 mm segments, was 41.5± 13 mm long(range: 30.2-78.4). No significant change was observed in terms of relative plaque composition along the vessel with respect to fibrous, fibrolipidic, and calcified tissue, whereas the percentage of lipid core resulted to be increased in the first(median: 8.75% ; IQR: 5.7-18) vs. the third(median: 6.1% ; IQR: 3.2-12)(P=0.036) and fourth(median: 4.5% ; IQR: 2.4-7.9)(P=0.006) segment. At multivariable regression analysis, distance from the ostium resulted to be an independent predictor of relative lipid content [β =-0.28(95% CI:-0.15,-0.41)], together with older age, unstable presentation, no use of statin, and presence of diabetes mellitus. Conclusion: Plaque distance from the coronary ostium, as an independent determinant of relative lipid content, is potentially associated to plaque vulnerability in humans.展开更多
Background: Identification of subclinical high-risk plaques is potentially important because they may have greater likelihood of rupture and subsequent thrombosis. The purpose of this study was to assess the relations...Background: Identification of subclinical high-risk plaques is potentially important because they may have greater likelihood of rupture and subsequent thrombosis. The purpose of this study was to assess the relationship between plaque composition determined by intravascular ultrasound(IVUS) radio frequency(RF) data analysis and clinical presentation. Methods: In 55 patients, a nonculprit vessel with< 50%diameter stenosis was studied with IVUS. Tissue maps were reconstructed from RF data using IVUS-Virtual Histology software. Results: Mean percentage of the different plaque components were 0.99%±0.9%, calcium; 68.04%±9.8%, fibrous; 19.31%±7.3%, fibrolipidic; and 9.43%±6.6%, lipid core. Mean lipid core percentage was significantly larger in patients with acute coronary syndrome(ACS) when compared with stable patients(12.26%±7.0%vs 7.40%±5.5%, P=.006). In addition, stable patients showed more fibrotic vessels(70.97%±9.3%vs 63.96%±9.1%, P=.007). There was no significant difference for either mean calcium(1.20%±1.1%vs 0.83%±0.7%, P=.124) or fibrolipidic(20.57%±6.9%vs 18.40%±7.6%, P=.281) percentages in ACS and stable patients, respectively. Vessel area obstruction did not differ between groups(46.49%±10.9%vs 42.83%±11.8%, P=.221). There was a significant, albeit weak, positive correlation between lipid core percentage and stenosis severity as determined by vessel area obstruction(r=0.34, P=.015). Conclusions: In this study, plaque characterization of nonculprit vessels using spectral analysis of IVUS RF data analysis was significantly related to clinical presentation. Percentage of lipid core, a feature related to acute coronary events and worse prognosis, was significantly larger in patients with ACS. Conversely, stable patients showed more fibrotic content.展开更多
文摘Objectives: The purpose of this studywas to evaluate predictors of an adverse outcome after “crush”bifurcation stenting. Background: The “crush”technique is a recently introduced strategy with limited data regarding long-term outcomes. Methods: We identified 231 consecutive patients treated with drug-eluting stent implantation with the “crush”technique for 241 de novo bifurcation lesions. Clinical follow-up was obtained in 99.6%. Results: The in-hospital major adverse cardiac event(MACE) rate was 5.2%. At 9 months, 10(4.3%) patients had an event consistent with possible post-procedural stent thrombosis. Survival free of target lesion revascularization(TLR) was 90.3%; the only independent predictor of TLR was left main stem(LMS) therapy(odds ratio[OR] 4.97; 95%confidence interval[CI] 2.00 to 12.37, p=0.001). Survival free of MACE was 83.5%and independent predictors of MACE were LMS therapy(OR 3.79; 95%CI 1.76 to 8.14, p=0.001) and treatment of patients with multivessel disease(OR 4.21; 95%CI 0.95 to 18.56, p=0.058). Angiographic follow-up was obtained in 77%of lesions at 8.3±3.7 months. The mean late loss of the main vessel and side branch were 0.30±0.64 mm and 0.41±0.67 mm, respectively, with binary restenosis rates of 9.1%and 25.3%. Kissing balloon post-dilation significantly reduced the side branch late lumen loss(0.24±0.50 mm vs. 0.58±0.77 mm, p< 0.001). Conclusions: The crush technique of bifurcation stenting with drug-eluting stents is associated with favorable outcomes for most lesions; however, efficacy appears significantly reduced in LMS bifurcations, and further research is needed before the technique can be routinely recommended in this group. Furthermore, the incidence of possible stent thrombosis is of concern and requires further investigation. Kissing balloon post-dilatation is mandatory to reduce side branch restenosis.
文摘Objective: To assess the effectiveness of routine sirolimus eluting stent (SES) implantation for unselected patients with instent restenosis and to provide preliminary information about the angiographic outcome for lesion subgroups and for different in-stent restenosis patterns. Design: Prospective, single centre registry. Setting: Tertiary referral centre. Patients: 44 consecutive patients(53 lesions) without previous brachytherapy who were treated with SES for in-stent restenosis were evaluated. Routine angiographic follow up was obtained at six months and the incidence of major adverse cardiovascular events was evaluated. Results: At baseline, 42%of the lesions were focal, 21%diffuse, 26%proliferative, and 11%total occlusions. Small vessel size (reference diameter ≤2.5 mm) was present in 49%, long lesions( > 20 mm) in 30%, treatment of bypass grafts in 13%, and bifurcation stenting in 18%. At follow up, post-SES restenosis was observed in 14.6%. No restenosis was observed in focal lesions. For more complex lesions, restenosis rates ranged from 20-25%. At the one year follow up, the incidence of death was 0, myocardial infarction 4.7%(n=2), and target lesion revascularisation 16.3%(n=7). The target lesion was revascularised because of restenosis in 11.6%(n=5). Conclusions: Routine SES implantation is highly effective for focal in-stent restenosis and appears to be a promising strategy for more complex patterns of restenosis.
文摘Aims: Relative plaque composition, more than its morphology alone, is thought to play a pivotal role in determining propensity to vulnerability. Thus, we investigated in vivo whether the distance from coronary ostium to plaque location independently affects plaque composition in humans. This may help explaining the recently reported non-uniform distribution of culprit lesions along the vessel in acute coronary syndromes. Methods and results: In 51 consecutive patients(45 men), aged 38-76 years(mean age: 58± 10), a non-culprit vessel was investigated through spectral analysis of IVUS radiofrequency data(IVUS Virtual HistologyTM). The study vessel was the left anterior descending artery in 23(45% ) patients; the circumflex artery in nine(18% ), and right coronary artery in 19(37% ). The overall length of the region of interest, subsequently divided into 10 mm segments, was 41.5± 13 mm long(range: 30.2-78.4). No significant change was observed in terms of relative plaque composition along the vessel with respect to fibrous, fibrolipidic, and calcified tissue, whereas the percentage of lipid core resulted to be increased in the first(median: 8.75% ; IQR: 5.7-18) vs. the third(median: 6.1% ; IQR: 3.2-12)(P=0.036) and fourth(median: 4.5% ; IQR: 2.4-7.9)(P=0.006) segment. At multivariable regression analysis, distance from the ostium resulted to be an independent predictor of relative lipid content [β =-0.28(95% CI:-0.15,-0.41)], together with older age, unstable presentation, no use of statin, and presence of diabetes mellitus. Conclusion: Plaque distance from the coronary ostium, as an independent determinant of relative lipid content, is potentially associated to plaque vulnerability in humans.
文摘Background: Identification of subclinical high-risk plaques is potentially important because they may have greater likelihood of rupture and subsequent thrombosis. The purpose of this study was to assess the relationship between plaque composition determined by intravascular ultrasound(IVUS) radio frequency(RF) data analysis and clinical presentation. Methods: In 55 patients, a nonculprit vessel with< 50%diameter stenosis was studied with IVUS. Tissue maps were reconstructed from RF data using IVUS-Virtual Histology software. Results: Mean percentage of the different plaque components were 0.99%±0.9%, calcium; 68.04%±9.8%, fibrous; 19.31%±7.3%, fibrolipidic; and 9.43%±6.6%, lipid core. Mean lipid core percentage was significantly larger in patients with acute coronary syndrome(ACS) when compared with stable patients(12.26%±7.0%vs 7.40%±5.5%, P=.006). In addition, stable patients showed more fibrotic vessels(70.97%±9.3%vs 63.96%±9.1%, P=.007). There was no significant difference for either mean calcium(1.20%±1.1%vs 0.83%±0.7%, P=.124) or fibrolipidic(20.57%±6.9%vs 18.40%±7.6%, P=.281) percentages in ACS and stable patients, respectively. Vessel area obstruction did not differ between groups(46.49%±10.9%vs 42.83%±11.8%, P=.221). There was a significant, albeit weak, positive correlation between lipid core percentage and stenosis severity as determined by vessel area obstruction(r=0.34, P=.015). Conclusions: In this study, plaque characterization of nonculprit vessels using spectral analysis of IVUS RF data analysis was significantly related to clinical presentation. Percentage of lipid core, a feature related to acute coronary events and worse prognosis, was significantly larger in patients with ACS. Conversely, stable patients showed more fibrotic content.
