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Circulation Reports May 2021The Orsiro ultrathin-strut, biodegradable-polymer, sirolimus-eluting stent (O-SES) has specific characteristics regarding its components and has demonstrated comparable...
The Orsiro ultrathin-strut, biodegradable-polymer, sirolimus-eluting stent (O-SES) has specific characteristics regarding its components and has demonstrated comparable clinical outcomes compared with durable-polymer, drug-eluting stents (DES). However, arterial repair following deployment of the O-SES has not been elucidated to date. Using data from the Kansai Rosai Hospital database between November 2010 and September 2020, we analyzed coronary angioscopy (CAS) findings a mean (±SD) of 10±2 months after implantation of an O-SES, a durable-polymer everolimus-eluting stent (Xience; X-EES), or a biodegradable-polymer everolimus-eluting stent (Synergy; S-EES). Neointimal coverage (NIC), yellow color intensity of the stented segment, and the incidence of thrombus adhesion were compared between the O-SES (66 stents from 42 patients), X-EES (119 stents from 87 patients), and S-EES (132 stents from 88 patients). NIC was significantly thinner for the O-SES than S-EES (P<0.001), but was similar between the O-SES and X-EES (P=0.25). Yellow color intensity was significantly greater for the O-SES than X-EES (P<0.001), but similar between the O-SES and S-EES (P=0.51). The incidence of thrombus adhesions was similar in all 3 groups. O-SES and X-EES resulted in similar inhibition of NIC and both resulted in a thinner NIC than with S-EES. In addition, O-SES exhibited a similar degree of thrombus adhesion as the other DES, suggesting similar thrombogenicity.
PubMed: 34136706
DOI: 10.1253/circrep.CR-21-0053 -
Circulation Journal : Official Journal... Nov 2020The relationship between the characteristics of tissue protrusion detected by using optical coherence tomography (OCT) and the findings of coronary angioscopy (CAS)...
BACKGROUND
The relationship between the characteristics of tissue protrusion detected by using optical coherence tomography (OCT) and the findings of coronary angioscopy (CAS) immediately after stent implantation were evaluated.Methods and Results:A total of 186 patients (192 stents) underwent OCT before and after stenting and were observed by using CAS immediately after stenting and at the chronic phase. Patients were assigned to irregular protrusion, smooth protrusion, and disrupted fibrous tissue protrusion groups according to OCT findings. Serum high-sensitivity C-reactive protein (hs-CRP) levels were measured before and after stent implantation. The grade of yellow color (YC) and neointimal coverage (NC), and incidence of thrombus in the stented segment were evaluated by using CAS. After stent implantation, maximum YC grade (smooth, 0.64±0.80; disrupted fibrous tissue, 0.50±0.77; irregular, 1.50±1.09; P<0.0001), a prevalence of Max-YC grade of 2 or 3 (smooth, 17%; disrupted fibrous tissue, 17%; irregular, 50%; P<0.0001) and thrombus (smooth, 15%; disrupted fibrous tissue, 10%; irregular, 69%; P=0.0005), and elevated hs-CRP levels (smooth, 0.22±0.89; disrupted fibrous tissue, -0.05±0.29; irregular, 0.75±1.41; P=0.023) were significantly higher in irregular protrusion than in the other 2 groups. In the chronic phase, maximum- and minimum-NC grade and heterogeneity index, and thrombus did not differ significantly among the 3 groups.
CONCLUSIONS
Irregular protrusion was associated with atherosclerotic yellow plaque, incidence of thrombus, and vascular inflammation. The angioscopic findings in the chronic phase may endorse the clinical efficacy of second- and third-drug eluting stents, regardless of the tissue protrusion type.
Topics: Angioscopy; C-Reactive Protein; Coronary Angiography; Coronary Vessels; Humans; Neointima; Percutaneous Coronary Intervention; Plaque, Atherosclerotic; Stents; Thrombosis; Tomography, Optical Coherence
PubMed: 33055456
DOI: 10.1253/circj.CJ-20-0306 -
Journal of Atherosclerosis and... Mar 2022We aimed to validate the subjective and qualitative angioscopic findings by the objective and quantitative near-infrared spectroscopic (NIRS) assessment to compensate... (Observational Study)
Observational Study
AIM
We aimed to validate the subjective and qualitative angioscopic findings by the objective and quantitative near-infrared spectroscopic (NIRS) assessment to compensate each other's drawbacks.
METHODS
This is a single-center prospective observational study. Patients undergoing a planned follow-up coronary angiography after percutaneous coronary intervention were prospectively enrolled from January 2018 to April 2019. The major three vessels were examined by NIRS-intravascular ultrasound, followed by coronary angioscopic evaluation. Yellow color grade on angioscopy was classified into four grades (0, white; 1, slight yellow; 2, yellow; and 3, intensive yellow) at a location of maximal lipid core burden index over 4 mm [LCBI (4)] on NIRS in each vessel.
RESULTS
A total of 95 lesions in 44 patients (72.6±6.7 years, 75% male) were analyzed. LCBI (4) was significantly different among different yellow color grades by coronary angioscopy (ANOVA, p<0.001). Positive correlation was found between angioscopic yellow color grade and LCBI (4) (beta coefficient 164.8, 95% confidence interval 122.9-206.7; p<0.001). The best cutoff value of LCBI (4) to predict the presence of yellow plaque (yellow color grade ≥ 2) was 448 (sensitivity 79.3%, specificity 69.7%, C-statistic 0.800, 95% confidence interval 0.713-0.887, p<0.001).
CONCLUSION
The qualitative angioscopic assessment was objectively validated by the quantitative NIRS evaluation, which would be helpful for the reinterpretation of the existing evidences of both imaging modalities.
Topics: Aged; Angioscopy; Coronary Artery Disease; Coronary Vessels; Female; Follow-Up Studies; Humans; Lipids; Male; Plaque, Atherosclerotic; Predictive Value of Tests; Prospective Studies; Spectroscopy, Near-Infrared; Ultrasonography, Interventional
PubMed: 33487618
DOI: 10.5551/jat.60566 -
Circulation Journal : Official Journal... Apr 2023The vessel healing process after implantation of biodegradable polymer (BP) and durable polymer (DP) everolimus-eluting stent (EES) in ST-elevation myocardial infarction... (Randomized Controlled Trial)
Randomized Controlled Trial
Angioscopic Comparison of Early- and Mid-Term Vascular Responses Following Treatment of ST-Elevation Acute Myocardial Infarction With Biodegradable vs. Durable Polymer Everolimus-Eluting Stents - A Prespecified Subanalysis of the MECHANISM AMI RCT.
BACKGROUND
The vessel healing process after implantation of biodegradable polymer (BP) and durable polymer (DP) everolimus-eluting stent (EES) in ST-elevation myocardial infarction (STEMI) lesions remains unclear.Methods and Results: We conducted a multicenter prospective randomized controlled trial to compare early (2 weeks) and mid-term (12 months) vascular responses after implantation of BP-EES vs. DP-EES in STEMI patients. In this prespecified subanalysis, serial coronary angioscopy (CAS) analysis was performed in 15 stents in the BP-EES arm (n=10 patients) and 14 stents in the DP-EES arm (n=10 patients). At the 2-week follow-up, there was no significant difference in the estimated marginal means of the neointimal coverage grade (primary endpoint) between the 2 arms (mean [±SE] 0.00±0.00 in both arms; P>0.999). There were no significant differences between the BP-EES and DP-EES groups in the yellow color grade (1.046±0.106 vs. 0.844±0.114, respectively; P=0.201) or the presence of thrombus (77.8% vs. 88.8%, respectively; P=0.205). At 12 months, competent strut coverage, defined as yellow color grade ≤1, no thrombus, and a neointimal coverage grade ≥1 was achieved more frequently in the BP-EES than DP-EES arm (85.2% vs. 53.1%; adjusted odds ratio 2.11 [95% confidence interval 1.26-3.53]; P=0.023).
CONCLUSIONS
Neointimal coverage 2 weeks after implantation of BP-EES and DP-EES in STEMI lesions was comparable on CAS evaluation. However, at 1 year, BP-EES was independently associated with competent strut coverage.
Topics: Humans; Everolimus; ST Elevation Myocardial Infarction; Sirolimus; Coronary Artery Disease; Polymers; Angioscopy; Drug-Eluting Stents; Prospective Studies; Treatment Outcome; Percutaneous Coronary Intervention; Absorbable Implants
PubMed: 36418112
DOI: 10.1253/circj.CJ-22-0534 -
Surgical Case Reports Mar 2022Non-anastomotic thoracic aortic graft rupture is extremely rare and difficult to diagnose. Non-obstructive general angioscopy can help monitor the aortic intima and...
BACKGROUND
Non-anastomotic thoracic aortic graft rupture is extremely rare and difficult to diagnose. Non-obstructive general angioscopy can help monitor the aortic intima and detect the locations of abnormal findings, while aortic angioscopy can detect vulnerable plaques in the aorta, which are difficult to visualize using conventional diagnostic methods. Herein, we report the case of a patient with non-anastomotic thoracic aortic graft rupture diagnosed using non-obstructive aortic angioscopy.
CASE PRESENTATION
An 85-year-old man who had undergone total arch replacement 5 years prior complained of chest pain. Emergent contrast-enhanced computed tomography (CT) revealed an intra-mediastinal hematoma around the vascular graft of the ascending aorta and angiography revealed pooling of contrast medium on the dorsal side of the vascular graft. We suspected extravasation of the thoracic vascular graft. Aortic angioscopic examination revealed a red vascular graft defect that matched extravasation at the contralateral level of the prosthetic left common carotid artery branch. Subsequently, non-anastomotic thoracic aortic graft rupture was diagnosed. The patient underwent a two-debranching thoracic endovascular aortic repair (Zone 0) with a right subclavian artery-left common carotid artery-left subclavian artery bypass. Postoperative angiography revealed disappearance of the extravasation from the graft rupture site, patent grafted vessels with flow, and no endoleak. Follow-up CT at 6 months postoperatively showed no extravasation.
CONCLUSIONS
To our knowledge, this is the first report of non-anastomotic thoracic aortic graft rupture detected using non-obstructive aortic angioscopy. Aortic angioscopy can help establish a definitive diagnosis in patients with aortic graft rupture.
PubMed: 35286489
DOI: 10.1186/s40792-022-01394-w -
HeartRhythm Case Reports Nov 2022
PubMed: 36618593
DOI: 10.1016/j.hrcr.2022.07.020 -
The Journal of Invasive Cardiology Feb 2022The current guidelines recommend at least 6 months of antithrombotic and antibiotic prophylaxis following atrial septal occluding device placement using the phrase...
The current guidelines recommend at least 6 months of antithrombotic and antibiotic prophylaxis following atrial septal occluding device placement using the phrase "until endothelialization." However, neo-endothelialization has not been assessed in vivo in humans. Considering the atrial septal defect occluding device, several autopsy cases and device extraction cases only demonstrated insufficient endothelialization beyond 6 months after implantation caused endocarditis and thrombosis. Accordingly, we have successfully developed a method for determining device endothelialization using angioscopy. This method helped us evaluate the endothelialization of a 25 mm Amplatzer PFO occluder device (Abbott) in a 40-year-old man 12 months after implantation. This is the first report evaluating the PFO occluder device in vivo.
Topics: Adult; Angioscopy; Cardiac Catheterization; Foramen Ovale, Patent; Humans; Male; Septal Occluder Device; Treatment Outcome
PubMed: 35100559
DOI: No ID Found -
European Heart Journal. Case Reports Oct 2022Angioscopy plays an important role providing much information regarding vessel surfaces as macro-pathology in living patients. However, its viewing field is sometimes...
BACKGROUND
Angioscopy plays an important role providing much information regarding vessel surfaces as macro-pathology in living patients. However, its viewing field is sometimes limited due to insufficient removal of blood flow and a catheter that cannot be controlled to view the intended direction. Angioscopy from a retrograde approach was found to overcome these limitations.
CASE SUMMARY
A 68-year-old man was admitted to our hospital with acute intermittent claudication for 2 weeks. He was diagnosed with acute limb ischaemia (ALI) in his left superficial femoral artery, and revascularization by endovascular treatment was attempted. A bi-directional approach was needed for successful revascularization with thrombus aspiration and angioplasty. Subsequent angioscopic examination from the retrograde approach visualized a clear and adequate image of the vessel and helped identify the aetiology of the case as on-site thrombosis at an atherosclerotic lesion.
DISCUSSION
It is important to understand the aetiology of ALI in each case for the management of the patient. Angioscopy can be a useful modality to identify the aetiology. It was found that retrograde angioscopy has several advantages over antegrade angioscopy in clear visualization and intentional control of the angioscopy catheter. This methodology may help us identify the aetiology of ALI by evaluating the vessel walls of patients with peripheral artery disease more precisely.
PubMed: 36225806
DOI: 10.1093/ehjcr/ytac393 -
Circulation Journal : Official Journal... Oct 2020The detailed mechanism of early-phase arterial healing after novel fluoropolymer-based paclitaxel-eluting stent (PES) implantation in the femoropopliteal (FP) lesions...
BACKGROUND
The detailed mechanism of early-phase arterial healing after novel fluoropolymer-based paclitaxel-eluting stent (PES) implantation in the femoropopliteal (FP) lesions has not been elucidated.Methods and Results:We evaluated the intravascular status of 20 PES implanted in 11 FP lesions of 9 patients using angioscopy at approximately 3 months after implantation. Angioscopic images were analyzed to determine (1) the dominant degree of neointimal coverage (NIC) over the stent; (2) the extent of uncovered struts; and (3) the presence of intrastent thrombus. NIC was classified into 4 grades: grade 0, stent struts fully visible; grade 1, stent struts bulging into the lumen although covered; grade 2, stent struts embedded in neointima, but translucently visible; grade 3, stent struts fully embedded and invisible. The extent of uncovered struts was scored as follows: score 0, no uncovered struts of the entire stent; score 1, uncovered struts area approximately <30% of the stent; and score 2, uncovered struts area approximately ≥30% of the stent. In total, 90% of stents demonstrated grade 1 dominant NIC and 10% showed grade 2 dominant NIC; 85% of stents showed an uncovered stent score of 0, and the remainder had a score of 1. Thrombus was observed in all stents.
CONCLUSIONS
Widely uncovered stent struts were not observed by angioscopy at 3 months after PES implantation in these FP lesions, even with the detection of thrombus adhesion.
Topics: Angioscopy; Coronary Vessels; Drug-Eluting Stents; Femoral Artery; Humans; Neointima; Paclitaxel; Popliteal Artery; Treatment Outcome
PubMed: 32981923
DOI: 10.1253/circj.CJ-20-0551 -
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