Short-term outcome of complex coronary lesions treated by excimer laser coronary atherectomy / 中国介入心脏病学杂志

Objective To investigate the feasibility, safety and efficacy of excimer laser coronary atherectomy used in complex lesions, including in-stent restenosis, non-crossable or nonexpandable lesions, heavily calcified lesions without successful wire-exchange and saphenous vein grafts lesions. Methods From Jul 24, 2017 to Aug 24, 2018, 22 cases with 24 lesions were treated with excimer laser coronary atherectomy in Peking University People's Hospital, combined with or without IVUS/OCT, rotational atherectomy or other percutaneous coronary intervention instrument, and with or without stent implantation. Results The procedural success rate was 23/24. There was no complications in all cases. Drug-eluting stents were implanted in 19/24 of lesions. There were no major advent cardiovascular events, including death, acute ST-segment-elevation myocardia and pericardial tamponade recorded. Conclusions Excimer laser coronary atherectomy used in complex lesions is feasible, safe and efficient with satisfactory in-hospital short-term outcome.

Safety and efficacy of rotational atherectomy followed by drug-eluting stenting for treating patients with heavily calcified coronary lesions / 中华心血管病杂志

<p><b>OBJECTIVE</b>To investigate the safety and efficacy of rotational atherectomy followed by drug-eluting stent implantation for treating patients with heavily calcified coronary lesions.</p><p><b>METHODS</b>From March 1, 2010 to September 1, 2012, 65 cases with 78 heavily calcified coronary lesions which were treated with rotational atherectomy followed by drug-eluting stent implantation in Peking University People's Hospital were included, and 36 cases also underwent intravascular ultrasound to guide the rotational atherectomy procedure and drug-eluting stent implantation.All patients were followed up in hospital and post discharge. Procedure parameters, complications and major adverse cardiovascular events (cardiac death, non-fatal myocardial infarction, percutaneous coronary intervention related myocardial infarction, target vessel revascularization, recurrent angina, intra-stent restenosis and stent thrombosis) were analyzed.</p><p><b>RESULTS</b>Direct rotational atherectomy was performed in 64.6%(42/65) patients, rescued rotational atherectomy in 35.4%(23/65) patients, drug-eluting stents implantation was applied to all cases after rotational atherectomy. The immediate procedural success rate was 100% (78/78). The average burr/artery ratio was 0.50 ± 0.04, the average number of burr used per case was 1.15 ± 0.36. The average burr/artery ratio was 0.52 ± 0.03 and the average number of burr used per cases was 1.19 ± 0.40 in 36 cases guided with intravascular ultrasound. Five cases (7.7%) developed complications and were treated accordingly during procedure with satisfactory results. The incidence of major adverse cardiovascular events was 13.8% (9/65) during (17.6 ± 8.5) months follow-up.</p><p><b>CONCLUSION</b>Rotational atherectomy followed by drug-eluting stent implantation is a safe and efficient technique for treating heavily calcified coronary lesions.</p>

Elevated plasma lipoprotein-associated phospholipase A₂ activity is associated with plaque rupture in patients with coronary artery disease / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Lipoprotein-associated phospholipase A(2) (Lp-PLA(2)) has recently been shown to be positively related to coronary events in patients with coronary artery disease (CAD). However, direct evidence about the relationship between circulation Lp-PLA(2) activity and vulnerable plaque in patients with CAD remains lacking.</p><p><b>METHODS</b>Plasma Lp-PLA(2) activity was determined in 146 consecutive patients with CAD who underwent clinically-indicated coronary angiography and preinterventional intravascular ultrasound (IVUS).</p><p><b>RESULTS</b>Eighty-three patients were included in the final analysis after the initial screening. Sixty (72.3%) were acute coronary syndrome (ACS) patients and 23 (27.7%) were stable angina pectoris (SAP) patients. Plaque rupture occurred in 39 (47.0%) patients, and 34 (87.2%) were from ACS patients and 5 (12.8%) from SAP patients. There were no significant differences in clinical and angiographic characteristics between patients with plaque rupture and those without plaque rupture, except for smoking, high-sensitive C-reactive protein (hs-CRP) level and Lp-PLA(2) activity (all P < 0.05). IVUS measurement uncovered that patients with plaque rupture had more frequent positive remodeling (74.4% vs. 43.2%, P = 0.004), soft plaques (64.1% vs. 36.4%, P = 0.012) and higher remodeling index (1.13 ± 0.16 vs. 0.99 ± 0.11, P = 0.041) as compared with those without plaque rupture. Multivariate Logistic regression analysis showed that plasma Lp-PLA(2) activity was independently associated with plaque rupture after adjusting for smoking, positive remodeling and soft plaque (Model 1: odds ratio (OR) 1.13, 95% confidence interval (CI): 1.06 - 1.20) or adjusting for smoking, hs-CRP level, positive remodeling and soft plaque (Model 2: OR 1.11, 95%CI: 1.04 - 1.19).</p><p><b>CONCLUSIONS</b>Plasma Lp-PLA(2) activity is associated with plaque rupture in patients with CAD, independently of traditional CAD risk factors, hs-CRP level and IVUS parameters. Lp-PLA(2) may be a risk marker for vulnerable plaques.</p>

Assessment of culprit lesions by intravascular ultrasound in patients with acute myocardial infarction / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Intravascular ultrasound has become the standard invasive method for diagnosing coronary artery disease. The aim of the present study was to evaluate the ability of intravascular ultrasound for assessment of culprit lesion morphology during primary percutaneous coronary intervention (PCI) in patients with acute myocardial infarction (AMI).</p><p><b>METHODS</b>We performed 18 intravascular ultrasound assessments preintervention during the primary PCI for AMI. intravascular ultrasound analysis included qualitative and quantitative measurements of reference and lesion external elastic membrane (EEM), lumen, and plaque plus media (P&M) area. Positive remodeling was defined as lesion/mean reference EEM >1.0. Culprit lesions were identified by a combination of electrocardiogram (ECG) and coronary angiography.</p><p><b>RESULTS</b>There was an average of 1.44 infarct-related artery (IRA) plaques per patient. The incidences of thrombus and plaque ruptures were 28% (5) and 33% (6), respectively. Hypoechoic plaque was observed in 72% (13) of AMI patients. Calcified lesions could be found in 33% (6) of culprit lesions. Sixty percent of the culprit lesion sites presented with positive remodeling.</p><p><b>CONCLUSIONS</b>Intravascular ultrasound is a safe and feasible imaging modality in patients with AMI and can help identify plaque rupture, intracoronary thrombus or calcification. The culprit lesion site in AMI cases often presents with positive remodeling.</p>