Rotablation in complex ACS versus Non-ACS patients: Prospective follow up study from tertiary care centre in North India

The purpose of this study is to compare short term outcome of rotablation in ACS versus non-ACS patients. 60 Consecutive patients who underwent rotational atherectomy were followed prospectively. The mean duration of follow up was 13.05 ± 5.2 months. The mean ejection fraction was 52.41% ± 9.4%. 45% patients had diagnosis of CSA and 55% were ACS. The mean syntax score was 29.23 ± 7.99. LAD was the most common vessel treated by RA in 76.6%. Rotablation of LM was done in 30%. IVUS guided procedure was done in 66.7%. RA can be done with comparable safety and success in both non-ACS and ACS patients

Ultra-low CONtraSt PCI vs conVEntional PCI in patients of ACS with increased risk of CI-AKI (CONSaVE-AKI)

Objectives: This prospective, randomized study assessed short-term outcomes and safety of ultra-low contrast percutaneous coronary intervention(ULC-PCI) vs conventional PCI in high risk for contrast induced acute kidney injury(CI-AKI) patients presenting with acute coronary syndrome(ACS). Background: Patients at an increased risk of developing CI-AKI can be identified prior to PCI based on their pre-procedural risk scores. ULC-PCI is a novel contrast conservation strategy in such high risk patients for prevention of CI-AKI. Methods: 82 patients undergoing PCI for ACS were enrolled having estimated glomerular filtration rate(eGFR) < 60 ml/min/1.73 m2 and moderate to very high pre-procedural risk of developing CI-AKI as calculated by Maioli risk calculator. They were randomized into two groups of 41 patients each of ULCPCI (contrast volume patient's eGFR) and conventional PCI (contrast volume 3xpatient's eGFR). Primary end point was development of CI-AKI. Results: Baseline clinical and angiographic characteristics were similar between groups. Primary outcome of CI-AKI occurred more in patients of the conventional PCI group [7 (17.1%)] than in the ULC PCI group [(0 patients), p ¼ 0.012]. Contrast volume (41.02 (±9.8) ml vs 112.54 (±25.18) ml; P < 0.0001) was markedly lower in the ULC-PCI group. No significant difference in secondary safety outcomes between two study arms at 30 days. IVUS was used in 17% patients in ULC PCI. Conclusion: ULC-PCI in patients with increased risk of developing CI-AKI is feasible, appears safe, and has the potential to decrease the incidence of CI-AKI specially in resource limited setting such as ours where coronary imaging by IVUS is not possible in every patient.

The principles of ultra-low contrast percutaneous coronary intervention

Ultra-low contrast percutaneous coronary intervention (ULCPCI) can be performed electively in advanced chronic kidney disease. Engage guide catheter and advance guidewire into the coronary artery without using contrast. IVUS-guided PCI can reduce the contrast load. Perform co-registration of distal and proximal radio-opaque marker bands of intravascular ultrasound (IVUS) catheter. Deploy the stent at the target lesion under fluoroscopic guidance of these co-registered position of the IVUS-marking images. Complete the ULCPCI procedure with a final angiography using minimal contrast. Newer contrast sparing techniques and intravascular imaging technologies provide opportunities to perform ULCPCI efficiently with good results and the least complications

Cardiac allograft vasculopathy after heart transplantation: summary of a single-center long-term follow-up experience in Fuwai Hospital / 器官移植

Objective To summarize the incidence of cardiac allograft vasculopathy (CAV) after heart transplantation and the effect on the long-term survival of recipients. Methods Clinical data of 1 006 heart transplant recipients were retrospectively analyzed. Of 48 CAV patients, 4 cases were not included in this analysis due to lack of imaging evidence. A total of 1 002 recipients were divided into the CAV group (n=44) and non-CAV group (n=958) according to the incidence of CAV. The incidence of CAV was summarized. Clinical data of all patients were statistically compared between two groups. Imaging diagnosis, coronary artery disease, drug treatment and complications, postoperative survival and causes of death of CAV patients were analyzed. Results Among 1 006 heart transplant recipients, 48 cases (4.77%) developed CAV. Compared with the non-CAV group, the proportion of preoperative smoking history, preoperative hypertension history, coronary artery disease and perioperative infection was significantly higher in the CAV group (all P < 0.05). Among 44 patients diagnosed with CAV by imaging examination, 24 cases were diagnosed with CAV by coronary CT angiography (CTA), 4 cases by coronary angiography (CAG), and 16 cases by coronary CTA combined with CAG. Among 44 patients, the proportion of grade Ⅰ CAV was 45% (20/44), 30% (13/44) for grade Ⅱ CAV and 25% (11/44) for grade Ⅲ CAV, respectively. All patients received long-term use of statins after operation, and 20 patients were given with antiplatelet drugs. Among 44 CAV patients, 11 patients underwent percutaneous coronary intervention, 6 cases received repeated heart transplantation, and 8 patients died. Kaplan-Meier survival analysis demonstrated that there was no significant difference in the long-term survival rate between the CAV and non-CAV groups (P > 0.05), whereas the survival rate of patients tended to decline after the diagnosis of CAV (at postoperative 6-7 years). The long-term survival rates of patients with grade Ⅰ, grade Ⅱ and grade Ⅲ CAV showed no significant difference (P > 0.05). Even for patients with grade Ⅰ CAV, the long-term survival rate tended to decline. Conclusions CAV is a common and intractable complication following heart transplantation, and the long-term survival rate of patients after the diagnosis of CAV tended to decline. Deepening understanding of CAV, prompt prevention, diagnosis and treatment should be delivered to improve the long-term survival rate of patients after heart transplantation.

A Case of Surgical Removal of an Intravascular Ultrasonography Catheter Entrapped in a Coronary Stent after Percutaneous Coronary Intervention / 日本心臓血管外科学会雑誌

Entrapment of an intravascular ultrasonography (IVUS) catheter is an infrequent but serious complication associated with percutaneous coronary intervention (PCI). We report a case of successful surgical treatment of an IVUS catheter entrapped in a coronary stent after PCI. An-80-year-old man was admitted to a hospital with sudden anterior chest pain. He underwent PCI to left circumflex branch (Cx) and left anterior descending artery (LAD), followed by IVUS to ascertain stent expansion of the LAD stent. The IVUS catheter became entangled in the stent and could not be withdrawn from the outside. The patient was transferred to our hospital for its surgical removal. For the emergent surgery, we opened the stent region in the LAD and directly removed the IVUS catheter with the twisted stent. The opened place in the LAD was directly closed. Additional coronary bypass grafting involving two vessels was performed. The postoperative course was uneventful with no graft occlusion.

Clinical Value of Serum miRNA-21 and miRNA-126 Expression in Diagnosis of the Coronary Artery Restenosis after PCI / 现代检验医学杂志

Objective To study the clinical application of serum miRNA 21 and miRNA-126 in diagnosis of the coronary artery restenosis after percutaneous coronary intervention (PCI).Methods The serum and clinical data of 82 cases of acute coronary syndrome (ACS) patients treated with PCI from the Hospital of Jingyang Country and the Affiliated Hospital of Shaanxi University of Chinese Traditional Medicine (stenosis group consisted of 30 cases,non-stenosis group consisted of 52 cases),and healthy persons (control group consisted of 33 cases) were collected.The relative expression levels of serum miRNA-21 and miRNA 126 were detected using real-time qPCR technology in the comparative analysis for their changes in the groups.Intravascular ultrasound (IVUS) was used to evaluate the occurrence of restenosis after PCI.Results Serum miRNA-21 and miRNA 126 levels in the control group,the non-stenosis group and the stenosis group were,,(0.22 ± 0.03,0.43±0.08,0.92±0.17) and (0.87±0.15,0.49±0.10,0.23±0.04),respectively.Compared with the control group,the expression level of serum miRNA-21 in the stenosis group and the non stenosis group were significantly increased,while the miRNA-126 levels was significantly decreased (P=0.000),the differences were statistically significant.Compared with the non stenosis group,the level of miRNA-21 in the stenosis group was significantly increased,while the level of miRNA-126 was significantly decreased (P=0.000),the differences were statistically significant.The results of IVUS showed that the plaque area (PLA) of the patients in the stenosis group was significantly higher than that in the non stenosis group,while the minimal luman area (MLA) was significantly decreased,and the differences were statistically significant (P=0.000).There was a negative correlation between the expression of two markers in the stenosis group (r=-0.919,P＜0.01).The levels of miRNA-126 and miRNA 21 in the stenosis group were correlated with PLA and MLA (r=-0.945,0.926,P＜ 0.01) and (r=0.933,-0.917,P＜0.01).Conclusion The detection of serum miRNA-21 and miRNA-126 levels can be used in diagnosis and prediction for the coronary artary restenosis of ACS after PCI,as the gene detection index of the disease.

Statin Therapy with Coronary Plaque Imaging

If there is coronary plaque, do we need statin therapy? Many studies have been conducted to answer this question. According to global guidelines, there is a high-risk patient population who could benefit from statin therapy. According to the guidelines, patients with a history of previous cardiovascular disease are subject to statin therapy. In addition, several other studies have shown that asymptomatic coronary plaque could cause future cardiovascular events. Therefore, statin therapy could be considered in patients with coronary artery plaque. These coronary plaques can be quantified through invasive intra-coronary imaging equipment. Especially, vulnerable arteriosclerosis is the main cause of cardiovascular events. Use of statins in the presence of coronary plaques may help reduce atheroma volume and stabilize vulnerability. In conclusion, coronary artery imaging is very useful for the initiation and evaluation of statin therapy.

A Case Report on Percutaneous Coronary Intervention in Chronic Total Occlusion by Retrograde Visualization.

As bilateral approach is paramount in chronic total occlusions with retrograde flow, the use of two radial arteries,two femoral arteries or combination technique using one radial and one femoral artery will probably be increasingly reported in the near future. After puncture of opposite groin, a diagnostic 6 Fr catheter is used to intubate the ostium of the contralateral artery. By visualizing the distal vessel in multiple projections, contralateral injections help to direct the progression of the wire in the occluded segment towards the distal true lumen. and confirm the intraluminal position of the wire after the occluded segment. We are reporting a case with chronic total occlusion where we used bilateral femoral access and simultaneous contrast injection to visualize retrograde flow in LAD while opening CTO through ante-grade pathway.

Research Progress of Percutaneous Coronary Intervention of Left Main Coronary Artery Stenoses with Intravascular Ultrasound / 沈阳医学院学报

Intravascular ultrasound (IVUS) is an invasively tomograhpic techology. As a adjunct to angiography, IVUS has important application value for percutaneous coronary intervention (PCI) . IVUS allows to assess the degree of area stenosis, optimize PCI strategy and improve clinical outcomes. Although lacking randomized trials, the currently nonrandomized studies support that IVUS-guided PCI of the left main coronary artery stenoses reduce the rate of the major adverse cardiac events (MACE, including cardiac death,myocardial infarction,and target vessel revacularization) and improve long-term outcomes compared with angiography-guided PCI.

Atherosclerotic plaque characterization using plaque area variation in IVUS images during compression: a computational investigation

INTRODUCTION: The rupture of atherosclerotic plaques causes millions of death yearly. It is known that the kind of predominant tissue is associated with its dangerousness. In addition, the mechanical properties of plaques have been proved to be a good parameter to characterize the type of tissue, important information for therapeutic decisions. METHODS: Therefore, we present an alternative and simple way to discriminate tissues. The procedure relies on computing an index, the ratio of the plaque area variation of a suspecting plaque, using images acquired with vessel and plaques, pre and post-deformation, under different intraluminal pressure. Numerical phantoms of coronary cross-sections with different morphological aspects, and simulated with a range of properties, were used for evaluation. RESULTS: The outcomes provided by this index and a widely used one were compared, so as to measure their correspondence. As a result, correlations up to 99%, a strong agreement with Bland-Altman and very similar histograms between the two indices, have shown a good level of equivalence between the methods. CONCLUSION: The results demonstrated that the proposed index discriminates highly lipidic from fibro-lipidic and calcified tissues in many situations, as good as the widely used index, yet the proposed method is much simpler to be computed.

Spontaneous Renal Artery Dissection: An Important Differential Diagnosis for Sudden Onset of Back Pain / General Medicine

Spontaneous renal artery dissection (SRAD) is uncommon and hence diagnosis is often delayed when ideally a quick one is preferred. We report a case of a 53 year-old male, with a known history of nephrolithiasis, who was admitted into hospital complaining of sudden onset left-sided back pain. Ultrasound showed a right-sided calculus instead of the expected left. A subsequent contrast computed tomography (CT) scan was done showing an infarcted segment of the left kidney. Further investigation with angiography and intravascular ultrasound (IVUS) revealed the presence of two left renal arteries with the distal originating left renal artery having dissected.

Early Differential Changes in Coronary Plaque Composition According to Plaque Stability Following Statin Initiation in Acute Coronary Syndrome: Classification and Analysis by Intravascular Ultrasound-Virtual Histology

PURPOSE: The aim of this study was to demonstrate the early effects of statin treatment on plaque composition according to plaque stability on Intravascular Ultrasound-Virtual Histology at 6 months after a coronary event. Previous trials have demonstrated that lipid lowering therapy with statins decreases plaque volume and increases plaque echogenicity in patients with coronary artery disease. MATERIALS AND METHODS: Fifty-four patients (54 lesions) with acute coronary syndrome were prospectively enrolled. We classified and analyzed the target plaques into two types according to plaque stability: thin-cap fibroatheroma (TCFA, n=14) and non-TCFA (n=40). The primary end point was change in percent necrotic core in the 10-mm subsegment with the most disease. RESULTS: After 6 months of statin therapy, no change was demonstrated in the mean percentage of necrotic core (18.7+/-8.5% to 20.0+/-11.0%, p=0.38). There was a significant reduction in necrotic core percentage in patients with TCFA (21.3+/-7.2% to 14.4+/-8.9%, p=0.017), but not in patients with non-TCFA. Moreover, change in percent necrotic core was significantly correlated with change in high-sensitivity C-reactive protein levels (r=0.4, p=0.003). Changes in low-density lipoprotein cholesterol levels and lipid core percentage demonstrated no significant associations. CONCLUSION: A clear reduction of lipid core was observed only for the TCFA plaque type, suggesting that changes in plaque composition following statin therapy might occur earlier in vulnerable plaque than in stable plaque; the effect may be related to the anti-inflammatory effects of statins.

An approach to automatically segment the media-adventitia borders in IVUS / Uma associação de técnicas para segmentação automática da fronteira da média-adventícia em IVUS

Por ser capaz de mostrar aspectos morfológicos e patológicos de ateroscleroses, o Ultrassom Intravascular (IVUS) se tornou uma das modalidades de imagens médicas mais confiáveis e empregadas em intervenções cardíacas. As características de sua imagem aumentam as chances de um bom diagnóstico, resultando em terapias mais precisas. O estudo de segmentação da fronteira média-adventícia, dentre muitas aplicações, é importante para o aprendizado das propriedades mecânicas e determinação de algumas medidas específicas (raio, diâmetro, etc.) em vasos e placas. Neste trabalho, uma associação de técnicas de processamento de imagens está sendo proposta para atingir alta acurácia na segmentação da borda média-adventícia. Para tanto, foi feita uma combinação das seguintes técnicas: Redução do Speckle por Difusão Anisotrópica (SRAD), Wavelet, Otsu e Morfologia Matemática. Primeiramente, é usado SRAD para atenuar os ruídos speckle. Posteriormente, é executada Transformada Wavelet para extração das características dos vasos e placas. Uma versão binarizada dessas características é criada na qual o limiar ótimo é definido por Otsu. Finalmente, é usada Morfologia Matemática para obtenção do formato da adventícia. O método proposto é avaliado ao segmentar 100 imagens de alta complexidade, obtendo uma média de Verdadeiro Positivo (TP(%)) = 92,83 ± 4,91, Falso Positivo (FP(%)) = 3,43 ± 3,47, Falso Negativo (FN(%)) = 7,17 ± 4,91, Máximo Falso Positivo (MaxFP(mm)) = 0,27 ± 0,22, Máximo Falso Negativo (MaxFN(mm)) = 0,31 ± 0,2. A eficácia do nosso método é demonstrada, comparando este resultado com outro trabalho recente na literatura.

By being able to show morphological and pathological aspects of atherosclerosis, the Intravascular Ultrasound (IVUS) be¬came one of the most reliable and employed medical imaging modality in cardiac interventions. Its image characteristics in¬crease the chances of a good diagnostic, resulting in a precise therapy. The study of media-adventitia borders segmentation in IVUS, among many applications, is important for learning about the mechanical properties and determining some specific measurements (radius, diameter, etc.) in vases and plaques. An approach is proposed to achieve high accuracy in media-adventitia borders segmentation, by making a combination of different image processing operations: Speckle Reducing Anisotropic Diffusion (SRAD), Wavelet, Otsu and Mathematical Morphology. Firstly, SRAD is applied to attenuate the speckle noise. Next, the vessel and plaque features are extracted by performing Wavelet Transform. Optimal thresholding is car¬ried out by Otsu method to create a binarized version of these features. Then, Mathematical Morphology operations are used to obtain an adventitia shape. The proposed approach is evaluated by segmenting 100 challenging images, obtaining an average of True Positive (TP(%)) = 92.83 ± 4.91, False Positive (FP(%)) = 3.43 ± 3.47, False Negative (FN(%)) = 7.17 ± 4.91, Max False Positive (MaxFP(mm)) = 0.27 ± 0.22, Max False Negative (MaxFN(mm)) = 0.31 ± 0.2. The effectiveness of our approach is demonstrated by comparing this result with another recent work in the literature.

Relationship between interleukin-18 levels and characterization of atherosclerotic plaque and percutaneous coronary intervention / 老年心脏病学杂志（英文版）

Background lnterleuldn-18(IL- 18) plays a key role in the development,progression and outcome of coronary artery disease and its complications.However,its variability relation to the characterization of atherosclerotic plaque and percutaneous coronary intervention are still unknown.Methods Fifty four patients with coronary artery disease [22 patients with stable angina (SA) and 32 patients with acute coronary syndrome (ACS)] were enrolled in this study.All patients underwent percutaneous coronary intervention (PCI).The stability of the plaques at the criminal vessels was assessed with analogical IVUS.Serum IL-18 levels were measured at the time points of 5 rain before PCI,and Oh,6h,24h and lmonth after PCI in all patients.Results ACS group consisted mainly of lipidic unstable plaques while SA group of fibrous stable plaques.Moreover,compared with those in SA group,eccentricity index (EI) and remodeling index (RI) were significantly higher in ACS group.Positive remodeling was seen in ACS group while negative or no remodeling in SA group.Further,serum IL-18 levels were significantly elevated in patients with ACS than those in SA group before PCI,increased at Oh,6h,24h after PCI (P＜0.05)and were not significant different at 1 month after PCI from those before PCI.Conclusions There is significant difference in the composition and structural characteristics of atherosclerotic plaques between ACS and UA groups.PCI triggersd and enhances the inflammatory response in a short time.Serum levels of IL- 18 are the predictors of progression of unstable plaque in atherosclerosis.Post-operative complications of PCI might be reduced by inhibiting IL- 18.(J Geriatr Cardiol 2008;5:21-24)

The Establishment of Model on Aorta Abdominalis Atherosclerosis in Rabbits / 医学研究杂志

Objective Experimental Study of balloon catheter injury technique in establishment of atherosclerosis.Methods The healthy New Zealand rabbits were randomly divided into two groups.(ns=20,weight2.5～3kg,4month old) The two groups were fed a cholesterol-supplemented diet and one group were subject to balloon catheter injury of the abdominalaorta by femoral artery.And three New Zealand rabbits were fed ordinary diet.The abdominal aorta were observed by pathology in both groups in order to determined whether there was atherosclerosis of the rabbit model.The thickness was measured and the quality of plaque was identified.Results Comparing with cholesterol-supplemented diet group,balloon catheter injury group,the typical carotid atherosclerosis was observed.The neoiniimal thickening and plaque were signficant in two groups and the P/IM ratio reached 0.56?9.4 and 0.99?26.9.Conclusion The typical carotid atherosclerosis lesion can induced by cholesterol-diet plus balloon catheter injury of the abdominalaorta in rabbit.