PURPOSE: To evaluate the impact of pre-procedural coronary plaque composition assessed by virtual histology intravascular ultrasound (VH-IVUS) on late stent malapposition assessed by optical coherence tomography (OCT) following drug-eluting stent (DES) implantation. MATERIALS AND METHODS: The study population consisted of 121 patients (121 lesions) who underwent both pre-procedural VH-IVUS and follow-up OCT after DES implantation. The association between pre-procedural plaque composition [necrotic core (NC), dense calcium (DC), fibrotic (FT), and fibro-fatty (FF) volumes] assessed by VH-IVUS and late stent malapposition (percent malapposed struts) or strut coverage (percent uncovered struts) assessed by follow-up OCT was evaluated. RESULTS: Pre-procedural absolute total NC, DC, FT, and FF plaque volumes were 22.9+/-19.0, 7.9+/-9.6, 63.8+/-33.8, and 16.5+/-12.4 mm3, respectively. At 6.3+/-3.1 months post-intervention, percent malapposed and uncovered struts were 0.8+/-2.5% and 15.3+/-16.7%, respectively. Pre-procedural absolute total NC and DC plaque volumes were positively correlated with percent malapposed struts (r=0.44, p<0.001 and r=0.45, p<0.001, respectively), while pre-procedural absolute total FT plaque volume was weakly associated with percent malapposed struts (r=0.220, p=0.015). Pre-procedural absolute total DC plaque volume was the only independent predictor of late stent malapposition on multivariate analysis (beta=1.12, p=0.002). There were no significant correlations between pre-intervention plaque composition and percent uncovered struts. CONCLUSION: Pre-procedural plaque composition was associated with late stent malapposition but not strut coverage after DES implantation. Larger pre-procedural absolute total DC plaque volumes were associated with greater late stent malapposition.
Aged ; Coronary Artery Disease/*therapy/ultrasonography ; Coronary Vessels/*ultrasonography ; *Drug-Eluting Stents ; Female ; Humans ; Male ; Middle Aged ; *Prosthesis Failure ; Time Factors ; Tomography, Optical Coherence/*methods ; *Ultrasonography, Interventional

No abstract available.
*Angioplasty, Balloon, Coronary ; Coronary Artery Disease/*drug therapy ; Coronary Vessels/*drug effects/pathology ; Humans ; Hydroxymethylglutaryl-CoA Reductase Inhibitors/*pharmacology ; Metals ; Simvastatin/*pharmacology ; *Stents ; Ultrasonography, Interventional

OBJECTIVETo evaluate the efficacy of intravascular ultrasound guided tranradial rotational atherectomy (RA) followed by drug eluting stent (DES) implantation in treating patients with heavily calcified coronary lesions.

METHODSClinical characteristics, coronary angiogram, intravascular ultrasound images, peri-procedure and follow-up data (including death , myocardial infarction and target lesion revascularization) of 44 patients treated with RA and DES implantation under the guidance of IVUS in our department from March 2011 to March 2013 were retrospectively analyzed. IVUS examination was carried out before RA, after RA and stent implantation to guide whether further RA or post dilatation was needed. According to the arc of calcification, the patients were divided into group A (90°-270°, 18 cases) and group B (271°-360°, 26 cases).

RESULTSIn A and B group, the arc of calcification was (195 ± 71)° in group A and (345 ± 23)° in group B (P < 0.01) , length of calcification was (34.4 ± 11.8) mm in group A and (20.0 ± 6.6) mm in group B (P < 0.05). Number of burrs used and size of largest burr used were similar between 2 groups (both P > 0.05). Acute cross sectional area gain after RA was (0.43 ± 0.32) mm in group A and (0.53 ± 0.38) mm² in group B (P > 0.05). After RA, there was significant decrease in the arc of calcification in group B compared with baseline ((324 ± 52)° vs. (345 ± 23)°, P < 0.05). The minimal lumen area and diameter were significantly increased after RA resulting in significant decrease in the plaque burden in both groups (all P < 0.05). The final minimal lumen area after stenting were similar between 2 groups (P > 0.05). Procedure success rate was 100% (44/44) without any major complications such as death, acute myocardial infarction and coronary perforation. During the (16.6 ± 6.3) months follow-up, there was 1 death in group A, 1 target lesion revascularization in group B and there was no acute myocardial infarction in the 2 groups.

CONCLUSIONHeavily calcified coronary lesions can be effectively and safely treated by transradial RA under the guidance of IVUS.

Atherectomy, Coronary ; Coronary Angiography ; Coronary Artery Disease ; therapy ; Drug-Eluting Stents ; Humans ; Myocardial Infarction ; Retrospective Studies ; Stents ; Treatment Outcome ; Ultrasonography, Interventional ; Vascular Calcification ; therapy

BACKGROUNDThe durable presence of polymer coating on drug-eluting stent (DES) surface may be one of the principal reasons for stent thrombosis. The long-term coronary arterial response to biodegradable polymer-coated sirolimus-eluting stent (BSES) in vivo remained unclear.

METHODSForty-one patients were enrolled in this study and virtual histology intravascular ultrasound (VH-IVUS) was performed to assess the native artery vascular responses to BSES compared with durable polymer-coated SES (DSES) during long-term follow-up (median: 8 months). The incidence of necrotic core abutting to the lumen was evaluated at follow-up.

RESULTSWith similar in-stent late luminal loss (0.15 mm (0.06-0.30 mm) vs. 0.19 mm (0.03-0.30 mm), P = 0.772), the overall incidence of necrotic core abutting to the lumen was significantly less in BSES group than in DSES group (44% vs. 63%, P < 0.05) (proximal 18%, stented site 14% and distal 12% in BSES group, proximal 19%, stented site 28% and distal 16% in DSES group). The DSES-treated segments had a significant higher incidence of necrotic core abutting to the lumen through the stent struts (73% vs. 36%, P < 0.01). In addition, more multiple necrotic core abutting to the lumen was observed in DSES group (overall: 63% vs. 36%, P < 0.05). Furthermore, when the stented segments with necrotic core abutting to the lumen had been taken into account only, DSES-treated lesions tended to contain more multiple necrotic core abutting to the lumen through the stent struts than BSES-treated lesions (74% vs. 33%), although there was no statistically significant difference between them (P = 0.06).

CONCLUSIONSBy VH-IVUS analysis at follow-up, a greater frequency of stable lesion morphometry was shown in lesions treated with BSESs compared with lesions treated with DSESs. The major reason was BSES produced less toxicity to the arterial wall and facilitated neointimal healing as a result of polymer coating on DES surface biodegraded as time went by.

Coronary Angiography ; Coronary Artery Disease ; diagnostic imaging ; therapy ; Coronary Vessels ; diagnostic imaging ; Drug-Eluting Stents ; Female ; Humans ; Male ; Middle Aged ; Sirolimus ; therapeutic use ; Ultrasonography

Catheter-based techniques to treat coronary artery diseases have been developed rapidly during the past half a century. After the first performance in 1977, the percutaneous transluminal coronary angioplasty has attained clinical relevance and become a viable option for medical and surgical treatment in patients with a coronary artery disease. However, the high incidence of acute closure and restenosis following balloon angioplasty limits its widespread use. Among the various medical and technical efforts to prevent the untoward effects of balloon angioplasty, coronary artery stenting was most successful and has been the turning point in the management of coronary occlusive diseases in 1990's. Intravascular ultrasound and doppler pressure wire have facilitated the optimal procedure of coronary stenting. However, the stent restenosis and in-stent restenotic lesion present a new and an even more challenging dilemma due to the widespread use of coronary stent. With better understanding of pathophysiology of stent restenosis, new approaches and therapies are encouraged and provide unique insight in the treatment of restenosis. Intracoronary brachytherapy with beta- and gamma-radiation was successful in decreasing the occurrence of in-stent restenotic lesions. Drug-eluting stents using various antiproliferative drugs are the most exciting modality in preventing restenosis and are currently under clinical trials. Newer percutaneous coronary interventional techniques including gene therapy and targeted drug delivery are also under investigation. This article presents the review of the current practice of percutaneous coronary intervention in the treatment of coronary occlusive diseases.
Angioplasty, Balloon ; Angioplasty, Balloon, Coronary ; Arteries ; Brachytherapy ; Coronary Artery Disease ; Drug-Eluting Stents ; Genetic Therapy ; Humans ; Incidence ; Myocardial Ischemia* ; Percutaneous Coronary Intervention* ; Stents ; Ultrasonography

OBJECTIVETo evaluate the value of combined optical coherence tomography (OCT) and intravascular ultrasound (IVUS) examinations in detecting coronary artery plaque during percutaneous transluminal coronary intervention (PCI).

METHODSOCT and IVUS examinations were performed on 30 diseased coronary vessels from 27 patients underwent PCI from Feb. 2008 to July. 2008.

RESULTSSeventeen vulnerable plaques (4 intima tearing which were not detected by IVUS), 5 plaque rupture (1 out of 5 was detected by IVUS), 5 thrombus lesions (1 out of 5 was found by IVUS), 12 thin-cap lipid-rich lesions (2 detected by IVUS) were detected by OCT in 22 lesions (without 8 lesions post DES stents). Analysis result of plaque burden by IVUS was superior to that obtained by OCT. In 8 DES stents (implanted for 6 months to 4 years), OCT detected 2 had severe restenosis, 6 stents struts were completely covered with neointima without restenosis, 1 stent had aneurysm-like dilatation. IVUS results were similar except for limitations on exactly detecting neointima post stenting. In 19 newly implanted stents, the incidence of stent under-expansion detected by OCT was 26.0% (same as that by IVUS), stent malposition was 63.2% (10.5% by IVUS, P < 0.01), near stent tearing was 10.5% (not detected by IVUS), tissue prolapse between coronary stent struts was 52.6% (10.5% in IVUS, P < 0.05).

CONCLUSIONSOCT imaging is superior to IVUS on detecting vulnerable plaques and change of structure around stents while IVUS is superior to OCT on estimating plaque burden in patients underwent PCI.

Adult ; Aged ; Angioplasty, Balloon, Coronary ; methods ; Coronary Artery Disease ; diagnostic imaging ; therapy ; Drug-Eluting Stents ; Female ; Humans ; Male ; Middle Aged ; Radiography ; Tomography, Optical Coherence ; Ultrasonography, Interventional

Intravascular ultrasound (IVUS) is a useful diagnostic method that provides valuable information in addition to angiography regarding the coronary vessel lumen, dimensions, plaque burden, and characteristics. The major use of IVUS in coronary intervention is to guide interventional strategies and assess optimal stent deployment. Since the introduction of the drug-eluting stent (DES), concerns about restenosis have decreased. However, high-risk lesion subsets are being routinely treated with DESs, and the incidence of suboptimal results after stent deployment, such as stent underexpansion, incomplete stent apposition, edge dissection, geographic miss, and the risk of stent thrombosis, have correspondingly increased. Thus, optimization of stent deployment under IVUS guidance may be clinically important. In this review, we focus on the potential role of IVUS in stent optimization during percutaneous coronary intervention and its clinical benefits.
Angioplasty, Balloon, Coronary/adverse effects/*instrumentation/mortality ; Coronary Artery Disease/mortality/*therapy/*ultrasonography ; Coronary Restenosis/etiology ; Drug-Eluting Stents ; Evidence-Based Medicine ; Humans ; Myocardial Infarction/etiology ; Prosthesis Design ; *Stents ; Thrombosis/etiology ; Treatment Outcome ; *Ultrasonography, Interventional

OBJECTIVEIntravascular ultrasound (IVUS) was used to compare the effects on neointimal hyperplasia inhibition between national made Firebird stents and Cypher stents in patients with coronary artery disease.

METHODSFrom May 2003 to March 2007, 215 patients with 317 native lesions received either Firebird stent (147 lesions of 108 patients, Firebird group) or Cypher stent implantation (138 lesions of 107 patients, Cypher group). Quantitative coronary angiography (QCA) and IVUS were performed at one-year follow-up.

RESULTSThe baseline clinical and angiographic characteristics between the two groups were similar, but post procedural minimal lumen diameter was significantly larger in Firebird group than that in Cypher group [(2.88 +/- 0.43) mm vs. (2.78 +/- 0.33) mm, P < 0.05]. follow-up QCA results showed that in-stent late loss [(0.17 +/- 0.29) mm vs. (0.16 +/- 0.27) mm, P > 0.05] and in-segment late loss [(0.18 +/- 0.36) mm vs. (0.20 +/- 0.32) mm, P > 0.05] was similar between Firebird group and Cypher group, while stent cross sectional area (CSA) [(6.99 +/- 2.25) mm(2) vs. (6.46 +/- 1.71) mm(2), P < 0.05], lumen CSA [(6.89 +/- 2.30) mm(2) vs. (6.36 +/- 1.73) mm(2), P < 0.05], stent volume [(162.5 +/- 68.9) m(3) vs. (140.8 +/- 57.9) mm(3), P < 0.01], lumen volume [(160.4 +/- 69.5) mm(3) vs. (138.6 +/- 57.6) mm(3), P < 0.01] and minimal stent CSA [(5.40 +/- 1.85) mm(2) vs. (4.92 +/- 1.43) mm(2), P < 0.05] were larger in Firebird group than those in Cypher group. IVUS analysis showed that there was no significant difference in neointimal hyperplasia volume [(2.09 +/- 5.46) mm(3) vs. (2.23 +/- 6.50) mm(3), P > 0.05] and percentage of volume obstruction [(1.68 +/- 5.84)% vs. (1.59 +/- 4.10)%, P > 0.05] between the two groups.

CONCLUSIONImplantation of Firebird stent was associated with low restenosis rate and both Firebird and Cypher stents equally and effectively inhibited neointimal hyperplasia.

Aged ; Coronary Artery Disease ; diagnostic imaging ; therapy ; Drug-Eluting Stents ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Sirolimus ; administration & dosage ; therapeutic use ; Ultrasonography, Interventional

BACKGROUND/AIMS: Recent intravascular ultrasound (IVUS) studies of sirolimus-eluting stents (SES) and paclitaxel-eluting stents (PES) have demonstrated a significant reduction in neointimal hyperplasia (NIH) based on simple coronary lesions. In this study, we evaluated the efficacy of SES and PES using IVUS in complex coronary lesions. METHODS: Eighty-seven patients in whom 95 drug-eluting stents (66 SES and 29 PES) were implanted in complex coronary lesions were enrolled in this study. Case selection was based on the availability of IVUS and quantitative coronary angiographic (QCA) examinations at the index procedure and at follow-up. The neointimal volume index (volume/length: NIVI) and percent neointimal volume (% NIV) were calculated. The longitudinal length of stented segments without IVUS-detectable NIH was also evaluated. RESULTS: The baseline patient demographics were similar between the SES and PES groups. At follow-up, no significant differences were observed in the vessel, plaque, or stent volume indices between the two groups. However, the NIVI and % NIV were significantly lower in the SES group (p<0.01). The longitudinal length of stented segments without IVUS-detectable NIH was significantly higher in the SES group (p<0.01). The net gain was significantly larger in the SES group (2.3+/-0.7 vs. 2.0x0.6 mm, p=0.025), while the rate of major adverse cardiac events was similar between the two groups. CONCLUSIONS: Although SES showed significantly greater suppression of NIH at follow-up, both stents were highly effective at inhibiting NIH in complex coronary lesions.
Adult ; Aged ; Coronary Angiography ; Coronary Artery Disease/radiography/*therapy/ultrasonography ; *Drug-Eluting Stents/adverse effects ; Female ; Follow-Up Studies ; Humans ; Hyperplasia ; Male ; Middle Aged ; Paclitaxel/*administration & dosage ; Sirolimus/*administration & dosage ; Tunica Intima/pathology ; Ultrasonography, Interventional/*methods

OBJECTIVETo evaluate the effects of statins on coronary atherosclerotic plaque in patients with stable angina pectoris and type 2 diabetes with mild elevated low density lipoprotein-cholesterol (LDL-C).

METHODSSeventy-eight patients with stable angina pectoris and type 2 diabetes mellitus and mild elevated LDL-C were treated with (n=40) or without (n=38) statins for 12 months. Coronary artery angiography (CAG) and intravascular ultrasound (IVUS) were performed at baseline and after 12 months on lesion and reference segment to compare the plaque volume, lumen volume, vascular volume and remodeling index was calculated as vascular volume index (VVI) at lesion divided by VVI at reference segment One coronary lesion with 50%-70% stenosis was selected as target plaque in each patient.

RESULTSBaseline clinical and angiographic data were comparable between the two groups. After 12 months, LDL-C decreased 31.5% in statin group and remained unchanged in non-statin group. After 12 months, plaque volume was significantly increased [ (76.1 +/- 13.0) mm3 vs. (95.0 +/- 21.9) mm3 , P < 0.05], lumen volume was significantly decreased [(65.0 +/- 10.9) mm3 vs. (45.4 +/- 6.6) mm3, P < 0.05 ] and vascular volume remained unchanged in non-statins group; plaque volume was also significantly increased [(79.5 +/- 15.2) mm3 vs. (87.5 +/- 17.9) mm3 , P < 0.05] while lumen volume and vascular volume remained unchanged in statin group. Remodeling index (RI) remained unchanged in non-statin group but significantly increased in statin group (0.91 +/- 0.08 vs. 0.95 +/- 0.10, P < 0.05) after 12 months.

CONCLUSIONChronic statin therapy could retard the coronary atherosclerotic progression in patients with stable angina pectoris and type 2 diabetes with mild elevated LDL-C.

Aged ; Cholesterol, LDL ; blood ; Coronary Angiography ; Coronary Artery Disease ; diagnostic imaging ; drug therapy ; Diabetes Mellitus, Type 2 ; blood ; drug therapy ; Female ; Humans ; Hydroxymethylglutaryl-CoA Reductase Inhibitors ; therapeutic use ; Male ; Middle Aged ; Treatment Outcome ; Ultrasonography