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International Journal of Cardiology Jun 2019Bioresorbable-polymer drug-eluting stent (BP-DES) demonstrates comparable clinical outcomes compared to durable-polymer drug-eluting stent (DP-DES). However, early- and... (Observational Study)
Observational Study
BACKGROUND
Bioresorbable-polymer drug-eluting stent (BP-DES) demonstrates comparable clinical outcomes compared to durable-polymer drug-eluting stent (DP-DES). However, early- and middle-phase arterial repair following deployment of BP-DES and DP-DES has not been elucidated to date.
METHODS
We extracted coronary angioscopy (CAS) findings covering early phase (4 ± 1 months) or middle phase (10 ± 2 months) between January 2010 and February 2018 from the database of Kansai Rosai Hospital. Neointimal coverage (NIC), yellow color intensity of the stented segment and incidence of thrombus adhesion were compared between BP-DES (Synergy or Ultimaster) and DP-DES (Promus or Resolute or Xience) in early (39 BP-DES of 33 lesions from 24 patients and 83 DP-DES of 74 lesions from 56 patients) and middle (198 BP-DES of 175 lesions from 135 patients and 204 DP-DES of 184 lesions from 149 patients) phases.
RESULTS
In early phase, while NIC was similar in both groups (P = 0.84), the incidence of thrombus adhesion was significantly higher in BP-DES than in DP-DES (67% versus 34%, P = 0.001) even though maximum yellow color was less intense in BP-DES (P = 0.004). In middle phase, while NIC was better in BP-DES (P < 0.001), thrombus adhesion (23% versus 22%, P = 0.81) and maximum yellow color (P = 0.72) were similar in both groups.
CONCLUSIONS
Although NIC was similar in the early phase, the incidence of thrombus adhesion was significantly higher in BP-DES than in DP-DES. The incidence of thrombus adhesion reached similar values and NIC improved in BP-DES over that in DP-DES in the middle phase.
Topics: Absorbable Implants; Aged; Angioscopy; Coronary Artery Disease; Coronary Vessels; Drug-Eluting Stents; Female; Follow-Up Studies; Humans; Male; Percutaneous Coronary Intervention; Polymers; Prosthesis Design; Retrospective Studies; Time Factors; Treatment Outcome
PubMed: 30857848
DOI: 10.1016/j.ijcard.2019.02.059 -
JACC. Cardiovascular Interventions Jan 2018
Topics: Aged; Angioscopy; Cineangiography; Coronary Angiography; Coronary Artery Disease; Coronary Circulation; Coronary Vessels; Drug-Eluting Stents; Female; Humans; Percutaneous Coronary Intervention; Plaque, Atherosclerotic; Predictive Value of Tests; Time Factors; Tomography, Optical Coherence; Treatment Outcome
PubMed: 29248411
DOI: 10.1016/j.jcin.2017.10.012 -
JACC. Case Reports May 2020Aortogenic embolization is among the major mechanisms of cryptogenic stroke. Angioscopic surveillance of the aortic wall clearly visualized the existence of thrombi and...
Aortogenic embolization is among the major mechanisms of cryptogenic stroke. Angioscopic surveillance of the aortic wall clearly visualized the existence of thrombi and spontaneously ruptured plaques, which dynamically liberated embolic materials. ().
PubMed: 34317329
DOI: 10.1016/j.jaccas.2020.02.023 -
Journal of Cardiology Sep 2018Coronary artery vasospasm (CS) can be identified as either a diffuse type or focal type; however, the difference in endothelial characteristics between these spasm types... (Observational Study)
Observational Study
BACKGROUND
Coronary artery vasospasm (CS) can be identified as either a diffuse type or focal type; however, the difference in endothelial characteristics between these spasm types remains unclear. The features of coronary intima associated with diffuse spasm and focal spasm using coronary angioscopy (CAS) were evaluated and the optical coherence tomography (OCT) findings were compared.
METHODS
CAS and/or OCT observational analysis was performed in 55 patients (mean age: 61.4 years, 31 men) who had acetylcholine-provoked CS (diffuse CS, 31 patients; focal CS, 24 patients). The yellowness of the intima, presence of thrombus in CAS, and intimal characteristics based on the OCT results were evaluated.
RESULTS
CAS showed more atherosclerotic yellow plaques at the focal spasm segment than at the diffuse spasm segment (p=0.032). Moreover, there were more thrombi at the focal spasm segment (p=0.039). In addition, OCT results revealed that the intima area, maximum intima thickness, and lipid content in the focal CS group were larger than the diffuse CS group (4.22±1.67mm vs. 3.45±2.36mm; 0.71±0.29mm vs. 0.53±0.30mm; 55.9% vs. 32.0%, p<0.001, respectively).
CONCLUSIONS
These results indicate that the presence of atherosclerotic plaques at the spasm site is likely to be related to the occurrence of a focal vasospasm. This may support the difference of features between focal CS and diffuse CS and contribute to precise treatment for each spasm type.
Topics: Acetylcholine; Aged; Angioscopy; Coronary Vasospasm; Coronary Vessels; Female; Humans; Male; Middle Aged; Plaque, Atherosclerotic; Thrombosis; Tomography, Optical Coherence; Tunica Intima; Vasodilator Agents
PubMed: 29898865
DOI: 10.1016/j.jjcc.2018.04.013 -
The International Journal of... Jun 2016The yellow plaque has been considered to be a vulnerable and high risk for acute coronary syndrome events but not fully evaluated. The aim of this study was to evaluate... (Comparative Study)
Comparative Study
The yellow plaque has been considered to be a vulnerable and high risk for acute coronary syndrome events but not fully evaluated. The aim of this study was to evaluate the relationship between angioscopic color grade and histological features in coronary autopsy specimens. We longitudinally sectioned 110 coronary arteries from 40 autopsy hearts with non-cardiovascular death. Harvested arteries were imaged with intravascular ultrasound to identify the focal plaque (plaque burden >50 %). An angioscopic examination of each focal plaque evaluated its color intensity as follows: 0 (white), 1 (light yellow), 2 (yellow), or 3 (dark yellow). The corresponding histological assessment was classified according to a modified version of the American Heart Association classification of atherosclerosis. Two hundred six plaques were matched to the histological analysis. Of these, 82 (40 %) were categorized as yellow (≥grade 1). Although, yellow plaque often includes thin-cap fibroatheroma (TCFA), the sensitivity, specificity, positive predictive value, negative predictive value, and overall diagnostic accuracy for histological TCFA were 83, 91, 22, 99 and 91 %, respectively. The false-positive coronary angioscopic diagnoses for TCFA that contributed to the low positive predictive value consisted of the following plaques: thick FA (>65 μm), accumulations of large quantities of foam cells on the luminal surface, or dense calcified plates at the surface of the intima. Vulnerable coronary plaques were detected with high sensitivity and low positive predictive value from their yellow color on angioscopy. Not only fibroatheroma but also various types of plaques and their components, such as immature lipidic components and superficial calcium plates, appeared yellow on coronary angioscopy.
Topics: Angioscopy; Autopsy; Biopsy; Coronary Artery Disease; Coronary Vessels; False Positive Reactions; Fibrosis; Humans; Lipids; Plaque, Atherosclerotic; Predictive Value of Tests; Reproducibility of Results; Rupture, Spontaneous; Severity of Illness Index; Ultrasonography, Interventional
PubMed: 26873010
DOI: 10.1007/s10554-016-0855-7 -
Heart and Vessels Jun 2021The significance of microvessels within atherosclerotic plaques is not yet fully clarified. Associated with plaque vulnerability. The aim of this study is to examine... (Observational Study)
Observational Study
Clinical significance of microvessels detected by in vivo optical coherence tomography within human atherosclerotic coronary arterial intima: a study with multimodality intravascular imagings.
The significance of microvessels within atherosclerotic plaques is not yet fully clarified. Associated with plaque vulnerability. The aim of this study is to examine tissue characteristics of plaque with microvessels detected by optical coherence tomography (OCT) by use of a commercially available color-coded intravascular ultrasound (IVUS) and coronary angioscopy (CAS). The subjects examined comprised of 44 patients with stable angina pectoris who underwent percutaneous coronary intervention. Microvessels were defined as a tiny tubule with a diameter of 50-300 µm detected over three or more frames in OCT. We compared the total volume of microvessels with tissue component such as fibrotic, lipidic, necrotic, and calcified volume and the number of yellow plaque. In IVUS analysis, % necrotic volume and % lipidic volume were significantly correlated and % fibrotic volume was inversely significantly correlated with the total volume of microvessel (r = 0.485, p = 0.0009; r = 0.401, p = 0.007; r = - 0.432, p = 0.003, respectively). The number of plaque with an angioscopic yellow grade of two or more was significantly correlated with the total volume of microvessel (r = 0.461, p = 0.002). The greater the luminal volume of microvessels, the more the percent content of necrotic/lipidic tissue volume within plaque and the more the number of yellow plaques. These data suggested that microvessels within coronary plaque might be related to plaque vulnerability.
Topics: Aged; Angioscopy; Atherosclerosis; Cardiac Catheterization; Coronary Artery Disease; Coronary Vessels; Female; Follow-Up Studies; Humans; Male; Microvessels; Multimodal Imaging; Retrospective Studies; Tomography, Optical Coherence; Tunica Intima; Ultrasonography, Interventional
PubMed: 33403471
DOI: 10.1007/s00380-020-01756-0 -
The International Journal of... Oct 2019The aim of this study was to elucidate the vascular responses to paclitaxel-eluting stent (Zilver PTX stent) in superficial femoral artery lesion at different elapsed... (Observational Study)
Observational Study
Vascular response to paclitaxel-eluting nitinol self-expanding stent in superficial femoral artery lesions: post-implantation angioscopic findings from the SHIMEJI trial (Suppression of vascular wall Healing after IMplantation of drug Eluting peripheral stent in Japanese patients with the Infra...
The aim of this study was to elucidate the vascular responses to paclitaxel-eluting stent (Zilver PTX stent) in superficial femoral artery lesion at different elapsed times using angioscopy. Patients who received Zilver PTX stent implantation from five centers were enrolled. We performed angioscopic examinations at 2, 6, and 12 months after implantation and evaluated neointimal coverage (NIC) grade, intra-stent thrombus (IS-Th) grade, and presence of yellow plaque. NIC grade 0 was defined as stent struts exposed; grade 1, struts transparently visible although covered; grade 2, struts embedded in the neointima, but translucent; and grade 3, struts fully embedded and invisible. IS-Th was graded as follows: grade 0 (none), 1 (focal), and 2 (diffusely spread). Angioscopic follow-up evaluation was performed at 2 months (25 patients, 42 lesions), 6 months (18 patients, 23 stents), and 12 months (14 patients, 24 stents) after stent implantation. Dominant NIC grade significantly increased over time; however, 16.3% of the cases had NIC grade 1 or 2 at 12 months. IS-Th grade decreased; however IS-Th and yellow plaque were persistently observed in 62.5% and 83.3% cases, respectively, at 12 months. An ongoing healing response was observed at 12 months after implantation; however, thrombogenic findings were noted. Prolonged dual antiplatelet therapy could potentially enhance the clinical utility of Zilver PTX.
Topics: Aged; Aged, 80 and over; Alloys; Angioscopy; Cardiovascular Agents; Cell Proliferation; Drug-Eluting Stents; Endovascular Procedures; Female; Femoral Artery; Humans; Japan; Male; Middle Aged; Neointima; Paclitaxel; Peripheral Arterial Disease; Platelet Aggregation Inhibitors; Predictive Value of Tests; Prospective Studies; Prosthesis Design; Registries; Risk Factors; Self Expandable Metallic Stents; Time Factors; Treatment Outcome; Wound Healing
PubMed: 31201589
DOI: 10.1007/s10554-019-01638-1 -
Cardiovascular Intervention and... Jul 2015Drug-eluting stent (DES) failure and conditions thereafter remain issues of concern despite generational advancements in DES technology. Registry data and pathological...
Drug-eluting stent (DES) failure and conditions thereafter remain issues of concern despite generational advancements in DES technology. Registry data and pathological investigations have shown a variety of causes of late stent thrombosis and very late stent thrombosis. On the other hand, clinical imaging including serial studies can provide information on the conditions during the event, the previous status of the lesion, and the healing process after stent implantation. Therefore we investigated thrombus-related DES failure using coronary angioscopy (CAS), which is a robust tool for thrombus assessment. Five out of 8 thrombotic DES failures were documented during urgent repeat percutaneous coronary intervention (repeat PCI). Four patients underwent CAS before the event, and 5 patients were followed using CAS after repeat PCI for DES failure. Among these cases, there were data before and after the event in 4 patients, which highlighted various patterns of healing after repeat PCI for thrombus-related DES failure, including erosion and yellow plaque underneath the DES. The cause of thrombus formation in this series was delayed healing process, but other possible triggers included restenosis, insufficient DAPT duration, neoatherosclerosis, and vasospasm. In addition to these findings being consistent with previous segmental postmortem studies, invasive imaging modalities can provide data on more than just the event itself, such as sequential comparison and lesion features of the survivor. Accumulation of this knowledge would contribute to generating new hypothesis in the future.
Topics: Adult; Aged; Angioscopy; Coronary Vessels; Drug-Eluting Stents; Humans; Male; Middle Aged; Thrombosis; Treatment Failure
PubMed: 25666526
DOI: 10.1007/s12928-014-0301-5 -
Cardiovascular Intervention and... Jan 2019The ultrathin strut biodegradable polymer sirolimus-eluting stent (Orsiro, O-SES) exhibits satisfactory clinical outcomes. However, no report to date has documented the...
The ultrathin strut biodegradable polymer sirolimus-eluting stent (Orsiro, O-SES) exhibits satisfactory clinical outcomes. However, no report to date has documented the intravascular status of artery repair after O-SES implantation. We examined 5 O-SES placed in 4 patients (age 65 ± 12 years, male 75%) presenting with stable angina pectoris due to de novo lesions in native coronary arteries. Coronary angioscopy was performed immediately after percutaneous coronary intervention and 1 year later. Angioscopic images were analyzed to determine the following: (1) dominant grade of neointimal coverage (NIC) over the stent; (2) maximum yellow plaque grade; and (3) existence of thrombus. Yellow plaque grade was evaluated both immediately after stent implantation and at the time of follow-up observation. The other parameters were evaluated at the time of follow-up examination. NIC was graded as: grade 0, stent struts exposed; grade 1, struts bulging into the lumen, although covered; grade 2, struts embedded in the neointima, but translucent; grade 3, struts fully embedded and invisible. Yellow plaque severity was graded as: grade 0, white; grade 1, light yellow; grade 2, yellow; and grade 3, intensive yellow. Angioscopic findings at 1 year demonstrated the following: dominant NIC grade 1, grade 2, and grade 3 in 1, 2, and 2 stents, respectively; all stents were covered to some extent; focal thrombus adhesion was observed in only 1 stent. Yellow plaque grade did not change from immediately after stent implantation to follow-up. O-SES demonstrated satisfactory arterial repair 1 year after implantation.
Topics: Absorbable Implants; Aged; Angina, Stable; Angioscopy; Cardiovascular Agents; Coronary Angiography; Coronary Vessels; Drug-Eluting Stents; Female; Humans; Male; Middle Aged; Percutaneous Coronary Intervention; Prospective Studies; Sirolimus
PubMed: 29335827
DOI: 10.1007/s12928-018-0510-4 -
The International Journal of... Oct 2017Coronary calcification is a risk factor for ischemic heart disease. Hydroxyapatite that is formed by polymerization from calcium phosphate tribasic (CPT) is the major...
Coronary calcification is a risk factor for ischemic heart disease. Hydroxyapatite that is formed by polymerization from calcium phosphate tribasic (CPT) is the major constituent of coronary calcium deposits. If CPT could be visualized, coronary calcification could be predicted and prevented. We discovered that when CPT and collagen I, the main constituent of collagen fibers, are mixed with lac dye (LD) and then exposed to fluorescent light excited at 345 ± 15 nm and emitted at 420 nm, a purple fluorescence that is characteristic of CPT only is elicited. So, we examined localization of CPT and its relation to plaque morphology by color fluorescent angioscopy (CFA) or microscopy (CFM) in 24 coronary arteries obtained from 12 autopsy subjects. By CFA, the incidence (%) of CPT as confirmed by purple fluorescence in 15 normal segments, 25 white plaques, 14 yellow plaques without necrotic core (NC) and 8 yellow plaques with NC was 20, 36, 64 and 100 (p < 0.05 vs. normal segments), respectively. By CFM, the CPT was either deposited alone amorphously or surrounded hydroxyapatite that was identified by Oil Red O, methylene blue and von Kossa's stain. The results suggested that CFA using LD is feasible for imaging CPT, that is a precursor of hydroxyapatite, in human coronary plaques, and this technique would help prediction and discovery of a preventive method of coronary calcification.
Topics: Aged; Angioscopy; Autopsy; Azo Compounds; Biomarkers; Calcium Phosphates; Collagen Type I; Coronary Artery Disease; Coronary Vessels; Durapatite; Female; Fluorescent Dyes; Humans; Luminescent Measurements; Male; Middle Aged; Necrosis; Optical Imaging; Plaque, Atherosclerotic; Predictive Value of Tests; Vascular Calcification
PubMed: 28432452
DOI: 10.1007/s10554-017-1142-y