Drug-coated balloons for treating de novo lesions in large coronary vessels:A case report

BACKGROUND Percutaneous transluminal coronary angioplasty,while an effective intervention,can frequently lead to acute occlusion with severe consequences.Although clinical trials have demonstrated the efficacy of drug-coated balloons(DCB)in treating acute coronary artery occlusion and in preventing restenosis,there has been limited exploration on the use of DCB in treating de novo lesions in large vessels.Currently,DCB are only recommended for patients with small vessel lesions and in-stent restenosis lesions,those at high risk of bleeding,and other special groups of patients.CASE SUMMARY This report presents a case of successful drug-coated balloon treatment of de novo lesions in large coronary vessels.Postoperatively,the patient demonstrated favorable recovery,with subsequent examination results revealing no significant differences from the previous examination.CONCLUSION The successful treatment of the patient in our case highlights the potential of DCB in the treatment of de novo lesions in large coronary vessels.

Challenging situation of coronary artery anomaly associated with ischemia and/or risk of sudden death

Coronary artery anomaly is known as one of the causes of angina pectoris and sudden death and is an important clinical entity that cannot be overlooked.The incidence of coronary artery anomalies is as low as 1%-2%of the general population,even when the various types are combined.Coronary anomalies are practically challenging when the left and right coronary ostium are not found around their normal positions during coronary angiography with a catheter.If there is atherosclerotic stenosis of the coronary artery with an anomaly and percutaneous coronary intervention(PCI)is required,the suitability of the guiding catheter at the entrance and the adequate back up force of the guiding catheter are issues.The level of PCI risk itself should also be considered on a caseby-case basis.In this case,emission computed tomography in the R-1 subtype single coronary artery proved that ischemia occurred in an area where the coronary artery was not visible to the naked eye.Meticulous follow-up would be crucial,because sudden death may occur in single coronary arteries.To prevent atherosclerosis with full efforts is also important,as the authors indicated admirably.

Correlation of neutrophil to lymphocyte ratio to severity of coronary artery disease and in-hospital clinical outcomes in patients with acute coronary syndrome: A prospective observational study

Objective:To explore correlation of neutrophil-to-lymphocyte ratio(NLR)to severity of coronary artery disease(CAD)and in-hospital clinical outcomes in patients with acute coronary syndrome(ACS).Methods:In this prospective and observational study,we recruited 500 patients with ACS.For all the eligible patients,demographic details were collected,and laboratory parameters were evaluated.The CAD severity was evaluated in terms of the number of involved vessels.The NLR was calculated based on neutrophils and lymphocytes and the correlation of various risk factors and severity and outcome of CAD was performed.Results:77.2%of Patients was male,and 52%of the patients aged between 55-70 years.Based on the type of ACS,396 out of 500 patients had ST-elevation myocardial infarction.An ascending trend in the white blood cell levels and NLR value was noted as the severity of the ACS increased and the highest white blood cell levels and NLR was noted among classⅣpatients.The mean NLR value among the non-survivors were higher compared to the survivors(9.52±5.72 vs.4.76±2.36;P<0.01).Receiver operating curve showed that the cut-off NLR value was 5.76 with a sensitivity of 75.0%and a specificity of 77.3%.Conclusions:The NLR can be used as an independent prognostic marker in ACS.An elevated NLR value serves as a reliable predictor for short-term complications,notably in-hospital mortality.

Evaluation of Clinical Outcomes of ses Stent in Patients with Coronary Artery Disease After Intracoronary Stenting in Small Vessels

Background:Limited data are available for sirolimus-eluting stent(SES,Cypher)implantation in patients with coronary artery disease in small vessels.The clinical longtermoutcomes of SES in patients with coronary artery disease after intracoronary stenting in small vessels has not been yet evaluated.

Fast interactive volume rendering method for adjustable vessel segmentation visualization

Medical diagnosis software and computer-assisted surgical systems often use segmented image data to help clinicians make decisions. The segmentation extracts the region of interest from the background, which makes the visualization clearer. However, no segmentation method can guarantee accurate results under all circumstances. As a result, the clinicians need a solution that enables them to check and validate the segmentation accuracy as well as displaying the segmented area without ambiguities. With the method presented in this paper, the real CT or MR image is displayed within the segmented region and the segmented boundaries can be expanded or contracted interactively. By this way, the clinicians are able to check and validate the segmentation visually and make more reliable decisions. After experiments with real data from a hospital, the presented method is proved to be suitable for efficiently detecting segmentation errors. The new algorithm uses new graphic processing uint （GPU） shading functions recently introduced in graphic cards and is fast enough to interact oil the segmented area, which was not possible with previous methods.

Congenital coronary artery fistulas： dual-source CT findings from consecutive 6624 patients with suspected or confirmed coronary artery disease

Background Coronary artery fistulas （CAFs） are rare congenital abnormality often unintentionally found in patients with coronary artery disease. Clinical diagnosis of CAFs is difficult due to symptomless or lack of specific symptoms. Dual-source computed tomography （DSCT） might be a useful diagnostic tool for CAFs. The study aimed to retrospectively summarize the imaging features of CAFs delineated at DSCT in 48 CAF patients detected from consecutive 6624 patients with suspected or confirmed coronary artery disease in our institution. Methods Forty-eight patients underwent DSCT angiography by using retrospective electrocardiographic （ECG） gating after infusion of 70 ml of intravenous contrast material during breath hold. Maximum intensity projection （MIP）, curved planar reconstruction （CPR）, and volume rendering technique （VR） were obtained. Anomalous termination of coronary artery in each subject was evaluated by two radiologists （with more than 10 years experience with cardiovascular imaging）, and disagreement between diagnosis readers was settled by a consensus reading. Ten of 48 patients also underwent traditional coronary angiography （CAG） simultaneously. Results In each CAF case, DSCT angiography clearly demonstrated the origin, the termination, the size of abnormal vessel and its course in relation to surrounding great vessels. CAF arising from right coronary artery was the most common type, left circumflex was the least one involved among three coronaries, and pulmonary artery was the most common drainage site. Aneurismal fistulous tract, coronary atherosclerosis, myocardial bridging and anomalous origin of coronary artery were also detected in this group. The demonstration of drainage sites in CAG was consistent with DSCT angiography in 9 patients, and judgment on one anomalous connection in CAG was inconsistent with that in DSCT angiography. Conclusions DSCT angiography could provide accurate delineation of anomalous communications, size and numbers of fistulas in patients with CAFs. It suggested that DSCT is a useful tool for the assessment of CAFs and may be considered as the first-choice imaging modality, especially for patients with coronary artery disease.

Sixty-four-multi-detector computed tomography diagnosis of coronary artery anomalies in 66 patients

Background The abnormalities of coronary arteries, though rare and sometimes benign, may first present clinically as myocardial infarction or sudden death. Multi-detector computed tomography （MDCT） is a non-invasive test that is highly suitable for detecting these anomalies. The study aimed to review the 64-MDCT appearance of the coronary artery anomalies in 66 patients and to discuss the clinical importance of these anomalies.Methods In 6014 consecutive patients examined over 12 months by 64-MDCT for the study of coronary artery disease, 66 were diagnosed for coronary artery anomalies. All patients were symptomatic for one or more of the following diseases： chest pain, dyspnoea, palpitations, arrhythmia and myocardial infarction. Nine patients had undergone a coronary angiography. All the CT images were evaluated by two radiologists and one cardiologist. The right coronary artery （RCA） and the conus branch arising separately, myocardial bridging and duplication of arteries were not analysed in our study.Results The incidence of coronary artery anomalies found in our study group was 1.097%. In the selected patients, seven different types of coronary anomalies were found by 64-MDCT examination. The high takeoff, origin of the coronary artery from the opposite or noncoronary sinus with an anomalous course, and coronary artery fistula were the three common forms of anomalies （n=16, 18 and 16, respectively）. Compared with the results of the coronary angiography, the number of the drainage sites of two coronary artery fistula was less in MDCT images （3 small sites in total）. In all cases, coronary artery computed tomography angiography （CTA） technique was able to recognize the origin of the coronary artery, its three-dimensional course and its spatial relationship with the adjacent structures. Conventional coronary angiography in two cases, however, was unable to provide sufficient information for correct and complete diagnosis.Conclusions In conclusion, the study showed that 64-MDCT, especially the volume rendering technique （VRT）, may be useful for the assessment of complex variations, even if the conventional angiography may not be sufficient. It may be considered as the first-choice imaging modality when an anomalous coronary artery is suspected.

Percutaneous extraction of leads from coronary sinus vein and branch by modified techniques

Background Cardiac resynchronization therapy （CRT） device and coronary sinus （CS） lead extraction are required due to the occurrence of systemic infection, malfunction, or upgrade. Relevant research of CS lead extraction is rare, especially in developing countries because of the high cost and lack of specialized tools. We aimed to evaluate percutaneous extraction of CS leads by modified conventional techniques. Methods Of 200 patients referred for lead extraction from January 2007 to June 2011, 24 （12.0%） involved CS leads （24 CS leads）. We prospectively analyzed clinical characteristics, optimized extraction techniques and feasibility of extraction. Results Complete procedural success was achieved in 23 patients （95.8%）, and the clinical success in 24 patients （100.0%）. The leading indication for CS lead extraction was infection （66.7%）. Mean implant duration was （29.5±20.2） months （range, 3-78 months）. Sixteen CS leads （66.6%） were removed with locking stylets plus manual traction by superior transvenous approach. Mechanical dilatation and counter-traction was required to free fibrotic adhesions and extract 4 CS leads （16.7%）, which had longer implant duration than other leads （（62.5±12.3） vs. （22.9±14.1） months, P〈0.05）. Another 4 CS （16.7%） leads were removed by modified and innovative snare techniques from femoral vein approach. Median extraction time was 11 minutes （range, 3-61 minutes） per CS lead, which had significant correlation with implant duration （r = 0.8, P 〈0.001）. Sixteen patients （66.6%） were reimplanted with new devices at a median of 7.5 days after extraction. Median followed-up was 23.5 months （range, 8-61 months）, three patients died due to sudden cardiac death （26 months）, heart failure （45 and 57 months, respectively）. Conclusion The modified procedure was proved to be practical for percutaneous extraction of CS leads, especially in developing countries lacking expensive powered sheaths.