Статті в журналах: "Restenose intrastent"

1

Seabra Gomes, Ricardo, Pedro de Araújo Gonçalves, Rui Campante Teles, and Manuel de Sousa Almeida. "Avaliação tardia (> 10 anos) da braquiterapia intracoronária com radiação beta para restenose difusa intrastent." Revista Portuguesa de Cardiologia 33, no. 10 (October 2014): 609–16. http://dx.doi.org/10.1016/j.repc.2014.02.027.

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2

Setacci, Carlo, Emiliano Chisci, Francesco Setacci, Francesca Iacoponi, and Gianmarco de Donato. "Grading Carotid Intrastent Restenosis." Stroke 39, no. 4 (April 2008): 1189–96. http://dx.doi.org/10.1161/strokeaha.107.497487.

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3

Bajeu, Ioan-Teodor, Adelina-Gabriela Niculescu, Alexandru Scafa-Udriște, and Ecaterina Andronescu. "Intrastent Restenosis: A Comprehensive Review." International Journal of Molecular Sciences 25, no. 3 (January 30, 2024): 1715. http://dx.doi.org/10.3390/ijms25031715.

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The primary objective of this paper is to delineate and elucidate the contemporary advancements, developments, and prevailing trajectories concerning intrastent restenosis (ISR). We aim to provide a thorough overview of the most recent developments in this area, covering various aspects such as pathophysiological insights, therapeutic approaches, and new strategies for tackling the complex challenges of ISR in modern clinical settings. The authors have undertaken a study to address a relatively new medical challenge, recognizing its significant impact on the morbidity and mortality of individuals with cardiovascular diseases. This effort is driven by the need to fully understand, analyze, and possibly improve the outcomes of this emerging medical issue within the cardiovascular disease field. We acknowledge its considerable clinical implications and the necessity for innovative methods to mitigate its effects on patient outcomes. Therefore, our emphasis was directed towards elucidating the principal facets of the condition’s prevalence, expounding upon the foundational mechanisms underscoring conspicuous restenosis, and delineating the risk factors relevant in shaping the contemporary landscape of diagnostic and therapeutic modalities. This thorough examination aims to provide a comprehensive understanding of the various dimensions of the condition, including epidemiological data, pathophysiological complexities, and clinical considerations critical for evaluating and enhancing current diagnostic and treatment approaches.

4

Freitas Jr, João Orávio de, Sérgio Luis Berti, José Geraldo Bonfá, Maria Sílvia Martins Speranza, Pércio Primo Gandolphi, and Hércules Lisboa Bongiovani. "Cutting balloon angioplasty for intrastent restenosis treatment." Arquivos Brasileiros de Cardiologia 72, no. 5 (May 1999): 618–20. http://dx.doi.org/10.1590/s0066-782x1999000500009.

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5

Chow, Wing-Hing, and T. F. Chan. "Pullback atherectomy for the treatment of intrastent restenosis." Catheterization and Cardiovascular Diagnosis 41, no. 1 (May 1997): 94–95. http://dx.doi.org/10.1002/(sici)1097-0304(199705)41:1<94::aid-ccd21>3.0.co;2-p.

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6

Setacci, C., E. Chisci, and F. Setacci. "Grading Carotid Intrastent Restenosis: A Six-Year Follow-Up Study." Journal of Vascular Surgery 48, no. 1 (July 2008): 247. http://dx.doi.org/10.1016/j.jvs.2008.05.052.

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7

Moneta, G. L. "Grading Carotid Intrastent Restenosis: A 6-Year Follow-Up Study." Yearbook of Vascular Surgery 2009 (January 2009): 55–56. http://dx.doi.org/10.1016/s0749-4041(08)79015-8.

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8

Choho, Zakaria, Tanae El Ghali, Walid Ben Brahim, Fatima Azzahra Benmessaoud, and Latifa Oukerraj. "CORONARY IN-STENT RESTENOSIS: A LITERATURE REVIEW." International Journal of Advanced Research 11, no. 09 (September 30, 2023): 1440–48. http://dx.doi.org/10.21474/ijar01/17667.

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Intrastent restenosis is a narrowing of the lumen of a coronary vessel previously treated with angioplasty It is the result of two histopathological processes: vascular remodeling and neointimal hyperplasia due to smooth muscle migration and proliferation, with the latter mechanism predominating. It manifests clinically with symptoms of ischemia and angiographic findings showing at least a 50% reduction in the lumen of a vessel previously treated with balloon angioplasty or a stent. Second generation drug eluting stents or drug eluting balloons are recommended for treatment, depending on the type of restenosis being treated. We present a review of the literature about of the various aspects of this topic which remains a clinical challenge for interventional cardiologists, starting from its origin its historical background.to various treatment options.

9

Schiele, F. "Assessment of Balloon Angioplasty in Intrastent Restenosis With Intra Coronary Ultrasound." Journal of the American College of Cardiology 31, no. 2 (February 1998): 495A—496A. http://dx.doi.org/10.1016/s0735-1097(97)88158-2.

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10

Schiele, F., N. Meneveau, A. Vuillemenot, S. Gupta, D. D. Zhang, C. Xu, and J. P. Bassand. "Assessment of balloon angioplasty in intrastent restenosis with intra coronary ultrasound." Journal of the American College of Cardiology 31 (February 1998): 495–96. http://dx.doi.org/10.1016/s0735-1097(98)80509-3.

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11

Montelione, Nunzio, Francesco Stilo, Pasqualino Sirignano, Laura Capoccia, Wassim Mansour, Francesco Spinelli, and Francesco Speziale. "IP117. Symptomatic Intrastent Carotid Restenosis: A Double-Center Experience With Carotid Bypass." Journal of Vascular Surgery 65, no. 6 (June 2017): 86S—87S. http://dx.doi.org/10.1016/j.jvs.2017.03.162.

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12

Robertson, Cameron, Ramon L. Varcoe, Stephen Black, and Shannon D. Thomas. "Histopathology of Iliocaval Venous In-Stent Restenosis Treated With Directional Atherectomy." Journal of Endovascular Therapy 26, no. 5 (June 20, 2019): 742–46. http://dx.doi.org/10.1177/1526602819857240.

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Purpose: To report the use of directional atherectomy to treat venous in-stent restenosis (ISR) and subsequent histopathological analysis of retrieved intrastent tissue. Case Report: A 55-year-old man presented with recurrent symptoms of venous congestion following iliofemoral stenting. The stents were found to be occluded on imaging. Directional atherectomy was used to recanalize the iliofemoral venous stents, which provided significant symptom relief. Tissue retrieved from within the stent demonstrated patterns of cellular components similar to arterial ISR. At 6-month follow-up, the stents remain patent, with no evidence of further ISR. Conclusion: Directional atherectomy is a potential treatment option for iliofemoral venous ISR. The pathological process of venous ISR demonstrates cellular changes similar to arterial ISR.

13

Albuquerque, Felipe C., Elad I. Levy, Aquilla S. Turk, David B. Niemann, Beverly Aagaard-Kienitz, G. Lee Pride, Phillip D. Purdy, et al. "ANGIOGRAPHIC PATTERNS OF WINGSPAN IN-STENT RESTENOSIS." Neurosurgery 63, no. 1 (July 1, 2008): 23–28. http://dx.doi.org/10.1227/01.neu.0000335067.53190.a2.

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ABSTRACT OBJECTIVE A classification system developed to characterize in-stent restenosis (ISR) after coronary percutaneous transluminal angioplasty with stenting was modified and applied to describe the appearance and distribution of ISR occurring after Wingspan (Boston Scientific, Fremont, CA) intracranial percutaneous transluminal angioplasty with stenting. METHODS A prospective, intention-to-treat, multicenter registry of Wingspan treatment for symptomatic intracranial atherosclerotic disease was maintained. Clinical and angiographic follow-up results were recorded. ISR was defined as greater than 50% stenosis within or immediately adjacent (within 5 mm) to the implanted stent(s) and greater than 20% absolute luminal loss. ISR lesions were classified by angiographic pattern, location, and severity in comparison with the original lesion treated. RESULTS Imaging follow-up (3–15.5 months) was available for 127 intracranial stenotic lesions treated with Wingspan percutaneous transluminal angioplasty with stenting. Forty-one lesions (32.3%) developed either ISR (n = 36 [28.3%]) or complete stent occlusion (n = 5 [3.9%]) after treatment. When restenotic lesions were characterized using the modified classification system, 25 of 41 (61.0%) were focal lesions involving less than 50% of the length of the stented segment: three were Type IA (focal stenosis involving one end of the stent), 21 were Type IB (focal intrastent stenosis involving a segment completely contained within the stent), and one was Type IC (multiple noncontiguous focal stenoses). Eleven lesions (26.8%) demonstrated diffuse stenosis (>50% of the length of the stented segment): nine were Type II with diffuse intrastent stenosis (completely contained within the stent) and two were Type III with proliferative ISR (extending beyond the stented segment). Five stents were completely occluded at follow-up (Type IV). Of the 36 ISR lesions, 16 were less severe or no worse than the original lesion with respect to severity of stenosis or length of the segment involved; 20 lesions were more severe than the original lesion with respect to the segment length involved (n = 5), actual stenosis severity (n = 6), or both (n = 9). Nine of 10 supraclinoid internal carotid artery ISR lesions and nine of 13 middle cerebral artery ISR lesions were more severe than the original lesion. CONCLUSION Wingspan ISR typically occurs as a focal lesion. In more than half of ISR cases, the ISR lesion was more extensive than the original lesion treated in terms of lesion length or stenosis severity. Supraclinoid internal carotid artery and middle cerebral artery lesions have a propensity to develop more severe posttreatment stenosis.

14

Garriboli, Luca, Tommaso Miccoli, Gianguido Pruner, and Antonio Maria Jannello. "PTA and Stenting of Femoropopliteal Trunk With Cordis Smartflex Stent System: A Single-Center Experience." Vascular and Endovascular Surgery 54, no. 1 (September 16, 2019): 17–24. http://dx.doi.org/10.1177/1538574419875551.

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Introduction: The aim of this study is to describe our experience in the treatment of femoropopliteal occlusive disease with percutaneous transluminal angioplasty (PTA) followed by stenting with S.M.A.R.T. Flex vascular stent system. Materials and Methods: From June 2014 to October 2018, 80 patients were treated at our Institution for intermittent claudication, critical, or acute limb ischemia due to total occlusion or long diffused lesions of the femoropopliteal segment. Main study end points are primary patency, target lesion revascularization, and stent fractures; secondary end points are major amputation rate, procedure-related bleeding, incidence of intrastent restenosis, and primary assisted patency after reintervention. Results: Mean follow-up time was 21 months (range 2-48 months). Primary patency rate was 80% (64 patients of 80), with mean covered lesion length of 8.2 cm. The deployment of a single stent was obtained for 57 (89%) patients, with a mean stent length of 9.86 cm. Of 80 patients, 2 (2.5%) had early stent occlusion within first 48 hours after the procedure, while 4 (5%) of 80 patients experienced stent occlusion within first 6 months. Of 80 patients, 6 (7.5%) had an intrastent restenosis detected at duplex ultrasound with a primary-assisted patency after simple re-PTA procedures of 83.3% at 12 months. Discussion: In the literature, primary patency after PTA and stenting of the femoropopliteal trunk seems to be related to several variables, such as number of stents used, specific stent length, diameters, type and length of lesions, type of pathology (if acute or chronic), and number of preoperatory patent below-the-knee vessels. In this study, we try to analyze each single factor in order to understand their role in predisposing specific stent restenosis. Conclusions: S.M.A.R.T. Flex vascular stent system has shown good results in terms of primary patency in the treatment of calcified lesions both at SFA and at popliteal level. However, in our experience, stent patency seems to be significantly poorer in patients presenting with acute limb ischemia associated with chronic atherosclerotic disease as well as for lesions located in the mid-distal part of the popliteal artery and both when number of stents increases or number of runoff vessel decreases.

15

McMahon, C. J. "Intrastent sonotherapy in pulmonary vein restenosis: a new treatment for a recalcitrant problem." Heart 89, no. 2 (February 1, 2003): 6e—6. http://dx.doi.org/10.1136/heart.89.2.e6.

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16

Mitomo, Satoru, Francesco Giannini, Luciano Candilio, Antonio Mangieri, Daisuke Hachinohe, Azeem Latib, and Antonio Colombo. "Intrastent Hematoma After Pre-Dilatation for 17-Month Restenosis of Polytetrafluoroethylene-Covered Stent." JACC: Cardiovascular Interventions 10, no. 23 (December 2017): e213-e215. http://dx.doi.org/10.1016/j.jcin.2017.08.046.

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17

Pascual Andréu, Juan Carlos. "Prevención secundaria de restenosis Intrastent: Transición de cuidados de enfermería al alta hospitalaria." Publicación Científica de la Asociación Española en Enfermería en Cardiología XXX, no. 90 (September 1, 2023): 40–49. http://dx.doi.org/10.59322//90.4049.lc5.

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A pesar de los avances en el diseño de stent para el tratamiento percutáneo de la enfermedad coronarias severa, aún no se ha logrado la combinación de fármacos, plataformas y recubrimientos que permitan eliminar por completo la reestenosis del stent a largo plazo, precisando un tratamiento de doble antiagregante plaquetario como medida preventiva en la aparición de un nuevo evento coronario, que no es tan infrecuente, ni tan benigno. Junto con el desarrollo de medidas como elección del stent, emplear técnicas minuciosas adaptadas al tipo de lesión y tratamiento antitrombótico ajustado a las circunstancias de cada paciente para evitar situaciones indeseables, es necesario identificar a los pacientes coronarios más vulnerables y realizar acciones dirigidas a un cambio de estilo de vida y una buena adherencia terapéutica, con el fin de reducir factores de riesgos cardiovasculares y promover bienestar. Para ello, la intervención de enfermería desde la atención secundaria es fundamental. Palabras clave: angioplastia, reestenosis coronaria, atención secundaria de salud, factores de riesgo de enfermedad cardiaca, cumplimiento y adherencia al tratamiento.

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Pascual Andréu, Juan Carlos. "Prevención secundaria de restenosis Intrastent: Transición de cuidados de enfermería al alta hospitalaria." Publicación Científica de la Asociación Española en Enfermería en Cardiología XXX, no. 90 (September 1, 2023): 40–49. http://dx.doi.org/10.59322/90.4049.lc5.

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A pesar de los avances en el diseño de stent para el tratamiento percutáneo de la enfermedad coronarias severa, aún no se ha logrado la combinación de fármacos, plataformas y recubrimientos que permitan eliminar por completo la reestenosis del stent a largo plazo, precisando un tratamiento de doble antiagregante plaquetario como medida preventiva en la aparición de un nuevo evento coronario, que no es tan infrecuente, ni tan benigno. Junto con el desarrollo de medidas como elección del stent, emplear técnicas minuciosas adaptadas al tipo de lesión y tratamiento antitrombótico ajustado a las circunstancias de cada paciente para evitar situaciones indeseables, es necesario identificar a los pacientes coronarios más vulnerables y realizar acciones dirigidas a un cambio de estilo de vida y una buena adherencia terapéutica, con el fin de reducir factores de riesgos cardiovasculares y promover bienestar. Para ello, la intervención de enfermería desde la atención secundaria es fundamental. Palabras clave: angioplastia, reestenosis coronaria, atención secundaria de salud, factores de riesgo de enfermedad cardiaca, cumplimiento y adherencia al tratamiento.

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Carpinella, G., D. D‘Andrea, F. Furbatto, R. Moscato, F. Serino, and C. Mauro. "P305 MULTIVESSEL SUBACUTE STENT THROMBOSIS." European Heart Journal Supplements 25, Supplement_D (May 2023): D160—D161. http://dx.doi.org/10.1093/eurheartjsupp/suad111.379.

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Abstract The presence of comorbidities such as psychiatric pathologies negatively influences the prognosis of patients with acute cardiovascular events. A 62–year–old male patient suffering from arterial hypertension, dyslipidemia, ischemic heart disease, treated 3 years earlier with PCI of LAD, Cx e RCA (EF 45%), and schizophrenia, is hospitalized with a diagnosis of NSTEMI. Coronary angiography shows: eccentric stenosis 70% proximal to the pre–existing stent in the middle LAD; Intrastent occlusion of the middle circumflex branch with omocoronary rehabilitation and ulcerated critical plaque in the proximal segment of the right coronary artery with mild intrastent restenosis in the middle. The patient refuses cardiac surgery, so angioplasty with ultra–thin drug–eluting stents is performed. The patient starts DAPT with clopidogrel, choosing a combination formulation to promote compliance, with discharge on the fourth day. Three days after discharge, the patient returns with anterior STEMI, with multivessel intrastent thrombotic closure (LAD, Cx, RCA), so angioplasty with paclitaxel–releasing balloon is performed on LAD and with NC balloons on the right coronary artery; impossibility to obtain total recanalization of the circumflex branch due to the non–transit of guides, even hydrophilic and of different weights. During angioplasty and for the following 12 hours, bolus and infusion of tirofiban is administered due to the high thrombotic burden. The choice of the second antiplatelet agent in this second procedure fell on prasugrel. The patient is discharged on the sixth day and a long conversation is held with his wife regarding the correct management of the home therapy. One year later, the patient a dual–chamber ICD was implanted at another centre, with correct and regular assumption of home therapy. Our case demonstrates an infrequent form of multivessel thrombosis during STEMI. The presence of schizophrenia influences negatively the evolution of the natural history of ischemic cardiopaty. The psychiatric substrate exposes to a greater number of cardiovascular events, given the reduced therapeutic compliance, also as regards the choice of appropriate therapeutic strategies. A joint path between the hospital, local medicine and the family environment would be desirable in order to correctly manage this type of patient.

20

Napoli, M., R. Prudenzano, E. Sozzo, D. Mangione, V. Martella, C. Montagna, A. M. Montinaro, C. Pati, and G. Sandri. "Lo stenting nelle stenosi delle fistole arterovenose distali: esperienze preliminari." Giornale di Clinica Nefrologica e Dialisi 24, no. 1 (January 24, 2018): 40–45. http://dx.doi.org/10.33393/gcnd.2012.1114.

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L'angioplastica percutanea transluminale (PTA) è un efficace trattamento per la correzione delle stenosi delle fistole arterovenose (AFV). Un limite della PTA è l'alta frequenza di recidiva. In teoria lo stenting, prevenendo la restenosi, potrebbe rappresentare la risposta al problema. In letteratura sono limitate tuttavia le esperienze con lo stenting nelle AVF. In questo studio riportiamo la nostra esperienza preliminare in proposito che ha interessato 6 pazienti. Dall'aprile 2008 al dicembre 2011 sono stati posizionati 6 stent su 122 PTA eseguite. Sono stati utilizzati stent me-tallici auto-espandibili. I criteri di selezione dei pazienti per lo stenting erano rappresentati da: a) stenosi interessanti il tratto di vena post-anastomotico; b) seconda recidiva dopo PTA; c) resistenza della stenosi alla PTA pur con pressioni elevate (fino a 21 atm). Dei 6 pazienti, 5 erano alla seconda recidiva dopo PTA, 1 era alla prima recidiva ma la stenosi era resistente alla PTA Risultati: in tutti i casi lo stenting ha prodotto la risoluzione della stenosi. In nessun caso si è verificata la trombosi dello stent. Il follow-up medio è stato di 21+10 mesi (3–33) con un periodo di osservazione totale di 124 mesi. Due pazienti sono deceduti rispettivamente dopo 13 e 26 mesi dallo stenting con la AVF ben funzionante. Due pazienti, a 3 e 30 mesi dallo stenting, hanno presentato una trombosi pre-anastomotica dell'arteria radiale, mentre lo stent era pervio e la AVF funzionante rifornita dall'arteria ulnare attraverso l'arcata palmare. Degli altri 3 casi, 1 non ha presentato alcun problema dopo un follow-up rispettivamente di 21 mesi. Gli ultimi 2 pazienti, rispettivamente dopo 11 e 12 mesi hanno presentato una stenosi da iperplasia neo-intimale intrastent Entrambi sono stati trattati con PTA con risoluzione totale della stenosi. A distanza rispettivamente di 12 e 13 mesi si è ripresentata la stenosi intrastent da iperplasia neo-intimale. Entrambi sono stati trattati con successo con PTA I due pazienti con la recidiva intrastent, hanno presentato un intervallo libero da stenosi in media di 15.1+0.9 mesi. Conclusioni: la nostra esperienza, anche se limitata per numero di casi, ha dimostrato l'efficacia dello stenting nella risoluzione delle stenosi (100%). La possibile iperplasia neo-intimale impone un monitoraggio ultrasonografico dello stent, indirizzando i pazienti al trattamento con PTA La risoluzione con PTA della stenosi indotta da iperplasia intimale rende tuttavia questa complicanza di importanza relativa. I risultati ci inducono a continuare la nostra esperienza con lo stenting nei casi opportunamente selezionati.

21

Alfonso, Fernando, José M. Augé, Javier Zueco, Armando Bethencourt, José R. López-Mínguez, José M. Hernández, Juan A. Bullones, et al. "Long-Term Results (Three to Five Years) of the Restenosis Intrastent: Balloon Angioplasty Versus Elective Stenting (RIBS) Randomized Study." Journal of the American College of Cardiology 46, no. 5 (September 2005): 756–60. http://dx.doi.org/10.1016/j.jacc.2005.05.050.

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Alfonso, F., J. M. Augé, and J. Zueco. "Long-Term Results (Three to Five Years) of the Restenosis Intrastent: Balloon Angioplasty Versus Elective Stenting (RIBS) Randomized Study." ACC Current Journal Review 14, no. 12 (December 2005): 29–30. http://dx.doi.org/10.1016/j.accreview.2005.11.051.

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23

De Filippo, Ovidio, Matteo Bianco, Matteo Tebaldi, Mario Iannaccone, Luca Gaido, Vincenzo Guiducci, Andrea Santarelli, et al. "Angiographic control versus ischaemia-driven management of patients undergoing percutaneous revascularisation of the unprotected left main coronary artery with second-generation drug-eluting stents: rationale and design of the PULSE trial." Open Heart 7, no. 2 (October 2020): e001253. http://dx.doi.org/10.1136/openhrt-2020-001253.

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BackgroundThe role of planned angiographic control (PAC) over a conservative management driven by symptoms and ischaemia following percutaneous coronary intervention (PCI) of the unprotected left main (ULM) with second-generation drug-eluting stents remains controversial. PAC may timely detect intrastent restenosis, but it is still unclear if this translated into improved prognosis.Methods and analysisPULSE is a prospective, multicentre, open-label, randomised controlled trial. Consecutive patients treated with PCI on ULM will be included, and after the index revascularisation patients will be randomised to PAC strategy performed with CT coronary after 6 months versus a conservative symptoms and ischaemia-driven follow-up management. Follow-up will be for at least 18 months from randomisation. Major adverse cardiovascular events at 18 months (a composite endpoint including death, cardiovascular death, myocardial infarction (MI) (excluding periprocedural MI), unstable angina, stent thrombosis) will be the primary efficacy outcome. Secondary outcomes will include any unplanned target lesion revascularisation (TLR) and TLR driven by PAC. Safety endpoints embrace worsening of renal failure and bleeding events. A sample size of 550 patients (275 per group) is required to have a 80% chance of detecting, as significant at the 5% level, a 7.5% relative reduction in the primary outcome.Trial registration numberNCT04144881

24

Hikita, Hiroyuki, Shunsuke Kuroda, Naohiko Kawaguchi, Emiko Nakashima, Tatsuya Fujinami, Tomoyo Sugiyama, Tetsuo Kamiishi, et al. "Differential Characteristics of Inflammatory Responses to Stent Implantation Between De Novo and Intrastent Restenosis Lesion in Patients With Stable Angina." Angiology 63, no. 2 (May 11, 2011): 92–95. http://dx.doi.org/10.1177/0003319711408284.

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25

Gomez-Recio, Manuel, Cesar Moris, Luis Insa, Isabel Calvo, Jose M. Hernández, Jose A. Bullones, Vasco Gama-Ribeiro, et al. "1121-54 Implications of the “watermelon seeding” phenomenon during coronary interventions for in-stent restenosis insights from the restenosis intrastent balloon angioplasty versus elective stenting (RIBS) randomized trial." Journal of the American College of Cardiology 43, no. 5 (March 2004): A78. http://dx.doi.org/10.1016/s0735-1097(04)90325-7.

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26

Tocci, G., R. Coluccia, A. Modestino, S. Sciarretta, F. Paneni, D. M. Zardi, B. A. Pace, et al. "12.24 Coronary Intrastent Restenosis and Blood Pressure Levels: Retrospective Analysis of a Large Cohort of Patients with Coronary Single Vessel Disease." High Blood Pressure & Cardiovascular Prevention 15, no. 3 (July 2008): 333. http://dx.doi.org/10.1007/bf03263745.

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Gherasie, Flavius-Alexandru, Chioncel Valentin, and Stefan-Sebastian Busnatu. "Is There an Advantage of Ultrathin-Strut Drug-Eluting Stents over Second- and Third-Generation Drug-Eluting Stents?" Journal of Personalized Medicine 13, no. 5 (April 28, 2023): 753. http://dx.doi.org/10.3390/jpm13050753.

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In patients undergoing percutaneous coronary intervention, the second-generation drug-eluting stents (DES) are considered the gold standard of care for revascularization. By reducing neointimal hyperplasia, drug-eluting coronary stents decrease the need for repeat revascularizations compared with conventional coronary stents without an antiproliferative drug coating. It is important to note that early-generation DESs were associated with an increased risk of very late stent thrombosis, most likely due to delayed endothelialization or a delayed hypersensitivity reaction to the polymer. Studies have shown a lower risk of very late stent thrombosis with developing second-generation DESs with biocompatible and biodegradable polymers or without polymers altogether. In addition, research has indicated that thinner struts are associated with a reduced risk of intrastent restenosis and angiographic and clinical results. A DES with ultrathin struts (strut thickness of 70 µm) is more flexible, facilitates better tracking, and is more crossable than a conventional second-generation DES. The question is whether ultrathin eluting drug stents suit all kinds of lesions. Several authors have reported that improved coverage with less thrombus protrusion reduced the risk of distal embolization in patients with ST-elevation myocardial infarction (STEMI). Others have described that an ultrathin stent might recoil due to low radial strength. This could lead to residual stenosis and repeated revascularization of the artery. In CTO patients, the ultrathin stent failed to prove non-inferiority regarding in-segment late lumen loss and showed statistically higher rates of restenosis. Ultrathin-strut DESs with biodegradable polymers have limitations when treating calcified (or ostial) lesions and CTOs. However, they also possess certain advantages regarding deliverability (tight stenosis, tortuous lesions, high angulation, etc.), ease of use in bifurcation lesions, better endothelialization and vascular healing, and reducing stent thrombosis risk. In light of this, ultrathin-strut stents present a promising alternative to existing DESs of the second and third generation. The aims of the study are to compare ultrathin eluting stents with second- and third-generation conventional stents regarding procedural performance and outcomes based on different lesion types and specific populations.

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Facci, G., A. Bottardi, G. Venturi, A. Mugnolo, A. Zamboni, F. Bacchion, and G. Morando. "TO CUT OR NOT TO CUT: CUTTING BALLOON FOR LESION PREPARATION BEFORE DRUG COATED BALLOON ANGIOPLASTY." European Heart Journal Supplements 26, Supplement_2 (April 2024): ii45. http://dx.doi.org/10.1093/eurheartjsupp/suae036.102.

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Abstract Background There are limited data on the use of DCB in calcified lesions. In particular, evidence regarding the use of cutting balloon before DCB angioplasty is scarce. Methods We retrospectively analyzed our internal registry between May 2017 and May 2023 to retrieve intrastent restenosis angioplasty performed with DCB. We divided our population according to the use of cutting balloon as debulking technique before DCB. The objective of the study was to compare the two population in term of procedural success (primary endpoint defined as absence of flow–limiting dissection or residual stenosis>30% or bail–out to stent strategy) and 6 months target lesion revascularization (secondary endpoint). Results Between May 2017 and May 2023 one hundred and six (106) ISR were treated with DCB–angioplasty at our center: twenty–four were prepared with cutting–balloon, mostly because of high calcification burden, while eighty–two only with conventional NC balloon before DCB strategy. Procedural success was achieved in all patients analyzed (100%). Therefore, there were no differences in procedural success between the two groups. In the cutting balloon group, mainly for unstable angina, a new angiography was performed for 4 patients: one underwent target vessel revascularization (4.1%) while three target lesion revascularizations (12.5%). In the second group, seven out of 82 presented stable angina and needed new angiography resulting in target lesion revascularization (9,1%) due to severe ISR (two underwent surgical revascularization, five percutaneous with DCB). Therefore, cutting balloon was not associated with increased TLR (HR 2.7; 95% CI 0.70–10.52; p 0.147). Conclusion Lesion preparation with cutting balloon represent a valid strategy in the setting of in stent restenosis before DCB angioplasty in term of procedural success and 6 months risk for target lesion revascularization. Our monocentric registry presents the limitation of a small number which did not allow for any adjustment and a short follow up period but provides an overview of a real–world experience.

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Tocci, G., A. Modestino, R. Coluccia, A. Saponaro, DM Zardi, BA Pace, C. Nannini, et al. "CORONARY INTRASTENT RESTENOSIS AND BLOOD PRESSURE LEVELS: RETROSPECTIVE ANALYSIS OF A LARGE COHORT OF PATIENTS WITH CORONARY SINGLE VESSEL DISEASE: 1C.06." Journal of Hypertension 28 (June 2010): e8. http://dx.doi.org/10.1097/01.hjh.0000378255.81414.b5.

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LaDisa, John F., Lars E. Olson, Ismail Guler, Douglas A. Hettrick, Judy R. Kersten, David C. Warltier, and Paul S. Pagel. "Circumferential vascular deformation after stent implantation alters wall shear stress evaluated with time-dependent 3D computational fluid dynamics models." Journal of Applied Physiology 98, no. 3 (March 2005): 947–57. http://dx.doi.org/10.1152/japplphysiol.00872.2004.

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The success of vascular stents in the restoration of blood flow is limited by restenosis. Recent data generated from computational fluid dynamics (CFD) models suggest that stent geometry may cause local alterations in wall shear stress (WSS) that have been associated with neointimal hyperplasia and subsequent restenosis. However, previous CFD studies have ignored histological evidence of vascular straightening between circumferential stent struts. We tested the hypothesis that consideration of stent-induced vascular deformation may more accurately predict alterations in indexes of WSS that may subsequently account for histological findings after stenting. We further tested the hypothesis that the severity of these alterations in WSS varies with the degree of vascular deformation after implantation. Steady-state and time-dependent simulations of three-dimensional CFD arteries based on canine coronary artery measurements of diameter and blood flow were conducted, and WSS and WSS gradients were calculated. Circumferential straightening introduced areas of high WSS between stent struts that were absent in stented vessels of circular cross section. The area of vessel exposed to low WSS was dependent on the degree of circumferential vascular deformation and axial location within the stent. Stents with four vs. eight struts increased the intrastrut area of low WSS in vessels, regardless of cross-sectional geometry. Elevated WSS gradients were also observed between struts in vessels with polygonal cross sections. The results obtained using three-dimensional CFD models suggest that changes in vascular geometry after stent implantation are important determinants of WSS distributions that may be associated with subsequent neointimal hyperplasia.

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Hong, Xu-Lin, Guo-Sheng Fu, Zhan-Lu Li, and Wen-Bin Zhang. "Intrastent haematoma after treatment with a drug-eluting balloon for in-stent restenosis: a case report." European Heart Journal - Case Reports 5, no. 8 (August 1, 2021). http://dx.doi.org/10.1093/ehjcr/ytab295.

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Abstract Background Intrastent haematoma after dilatation of in-stent restenosis (ISR) is rarely reported and the optimal treatment for this condition remains unclear. Case summary We present the case of an 87-year-old man with in-stent subtotal occlusion of left circumflex. He experienced chest pain after drug-eluting balloon was released in the stent. Intravascular ultrasound revealed intrastent haematoma, which was not relieved with a cutting balloon but completely sealed by an Endeavor Resolute stent. Discussion Intrastent haematoma after dilatation of ISR is rare. Reimplantation of stent seems the best method to solve this problem. Intravascular ultrasound imaging may provide insight into the cause of ISR and guide the treatment.

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Basso, P., N. Locuratolo, F. Carrata, D. De Laura, D. Cavallari, S. Rutigliano, F. Trotta, et al. "C56 THE IMPACT OF STATIN THERAPY ON THE PROGNOSIS OF PATIENTS DISCHARGED AFTER ACUTE CORONARY SYNDROME: A SUBANALYSIS OF THE APULIA PONTE ACS STUDY." European Heart Journal Supplements 24, Supplement_C (May 1, 2022). http://dx.doi.org/10.1093/eurheartj/suac011.055.

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Abstract Background The administration of statin therapy in patients who suffered from acute coronary syndrome (ACS) is fundamental in order to avoid recurrences and adverse cardiovascular events. The long–term adherence and persistence on statin therapy is challenging. The aim of this study was to evaluate the prognostic impact of a dedicated follow–up outpatient program for patients who were discharged with the diagnosis of ACS on adherence and persistence on statin therapy. Methods This was a subanalysis of the PONTE ACS study. The PONTE ACS study is a prospective, longitudinal, cohort study which enrolled patients who were discharged from HUB centres of ASL BARI after coronary revascularization and/or ACS. They underwent clinical evaluation at 30 days, 3, 6 and 1 year–follow–up. The data were collected after including the data in the electronic medical record of the PONTE ACS study. Anthropometric, clinical and pharmacological parameters, instrumental and laboratory examinations were included. The following endpoints were considered: all cause death, ACS recurrence/cardiac ischemia/angina, restenosis/intrastent thrombosis, stroke/transient ischemic attack (TIA), heart failure, all–cause bleeding. Results We enrolled 2476 patients (mean age: 67.2±12.0 years). At 1–year follow–up optimal medical therapy was reached in most of patients: 84.1% were on beta–blockers, 63.1% on ACEi/sartans, 92.1% on dual antiplatelet therapy, 99.5% on statins, 16.1% on ezetimibe, and 9.9% on PCSK9 inhibitors. At multivariate regression analysis, heart rate, baseline creatinine values, and statin therapy were independent predictors of the composite endpoint all cause death, ACS recurrence/cardiac ischemia/angina, restenosis/intrastent thrombosis, while heart rate and statin therapy remained predictors of the composite endpoint death, ACS recurrence/cardiac ischemia/angina, restenosis/intrastent thrombosis, stroke/transient ischemic attack (TIA), heart failure (Figure 1). Conclusions Statin therapy confirmed their therapeutic role in secondary cardiovascular prevention protocols. The need for continuing long–term statin therapy after ACS is fundamental in order to ameliorate the prognosis of patients.

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Nobile, Edoardo, Aurelio De Filippis, Simone Circhetta, Federico Bernardini, Michele Viscusi, Paolo Gallo, and Gian Paolo Ussia. "526 ALAGILLE SYNDROME, A CASE REPORT." European Heart Journal Supplements 24, Supplement_K (December 14, 2022). http://dx.doi.org/10.1093/eurheartjsupp/suac121.353.

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Abstract Alagille syndrome (AGS) is a dominantly inherited multisystem disorder caused by heterozygous mutations of genes that are components of the Notch signaling pathway. The main clinical manifestations of AGS are intrahepatic bile duct paucity, congenital heart defects involving primarily the pulmonary arteries, butterfly vertebrae, anterior chamber defects of the eye and facial dysmorphism. A male patient of 39 years old came to our observation due to the worsening of dyspnea, cyanosis, dizziness, heartbeat and asthenia for about two years. His cardiological history includes percutaneous pulmonary artery angioplasty in both left and right main pulmonary artery in 1994. In 2012, finding of pulmonary hypertension and diagnosis of Alagille syndrome confirmed by genetic analysis (JAG1 gene), and vasoreactivity testing of the pulmonary circulation was positive. Intrastent restenosis of the right lobar pulmonary artery treated with POBA in 2016. Patient therapy includes, diltiazem 60 mg OD, macitentan 10 mg OD, sildenafil 40 mg TID. Echocardiogram showed: preserved global and segmental systolic function. Minimal mitral valve insufficiency. Dilated right ventricle (RV / LV> 1), ipokinetic. Right atrium of increased size. Mild tricuspid valve insufficiency (VD-AD 20 mmHg). reduced systolic flow acceleration time (80 msec). Inferior vena cava of normal caliber with preserved inspiratory collapse. Indirect signs of pulmonary hypertension. The six minutes walking test showed severe desaturation after only one hundred meters. Right catheterization showed severe pulmonary hypertension (PAPm 63 mmHg). blood gas analysis showed oxygen saturation of 83% in the pulmonary artery. Angiography of the pulmonary arteries showed intrastent restenosis on the left pulmonary artery and fracture of the stent on the right pulmonary artery. For which was performed angioplasty with stent intrastent implantation in the right pulmonary artery. After the procedure there was immediate reduction in pulmonary mean arterial pressure (53 mmHg), a progressive improvement in 02 saturation (88% at discharge) while the echocardiogram after the procedure results unchanged except for the increasing of the systolic flow acceleration time (100 msec). Right catheterization showed a gradient trans-stenosis of 96 mmHg. We performed angioplasty with stent intrastent implantation in the right pulmonary artery. After that we saw a drop in the gradient trans-stenosis (63 mmHg) and a raise in the systolic pressure of the left pulmonary artery. In Conclusion, in this particular population of patients with pulmonary hypertension even if on maximal therapy, the worsening of symptoms should in our opinion be an indication for right cardiac catheterization and angiography of the pulmonary arteries.

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Gundert, Timothy J., Alison L. Marsden, Weiguang Yang, and John F. LaDisa. "Optimization of Cardiovascular Stent Design Using Computational Fluid Dynamics." Journal of Biomechanical Engineering 134, no. 1 (January 1, 2012). http://dx.doi.org/10.1115/1.4005542.

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Coronary stent design affects the spatial distribution of wall shear stress (WSS), which can influence the progression of endothelialization, neointimal hyperplasia, and restenosis. Previous computational fluid dynamics (CFD) studies have only examined a small number of possible geometries to identify stent designs that reduce alterations in near-wall hemodynamics. Based on a previously described framework for optimizing cardiovascular geometries, we developed a methodology that couples CFD and three-dimensional shape-optimization for use in stent design. The optimization procedure was fully-automated, such that solid model construction, anisotropic mesh generation, CFD simulation, and WSS quantification did not require user intervention. We applied the method to determine the optimal number of circumferentially repeating stent cells (NC) for slotted-tube stents with various diameters and intrastrut areas. Optimal stent designs were defined as those minimizing the area of low intrastrut time-averaged WSS. Interestingly, we determined that the optimal value of NC was dependent on the intrastrut angle with respect to the primary flow direction. Further investigation indicated that stent designs with an intrastrut angle of approximately 40 deg minimized the area of low time-averaged WSS regardless of vessel size or intrastrut area. Future application of this optimization method to commercially available stent designs may lead to stents with superior hemodynamic performance and the potential for improved clinical outcomes.

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Scicchitano, P., N. Locuratolo, A. Lillo, L. Sublimi Saponetti, V. Palumbo, S. Lanzone, C. Campanella, et al. "P209 THE FOLLOW–UP OF PATIENTS AFTER ACUTE CORONARY SYNDROME: THE APULIAN PONTE–ACS PROJECT." European Heart Journal Supplements 24, Supplement_C (May 1, 2022). http://dx.doi.org/10.1093/eurheartj/suac012.201.

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Abstract Background Patients discharged after acute coronary syndrome (ACS) deserve a tight follow–up in order to optimize long–term pharmacological treatments and prevent the occurrence of adverse events. The aim of the PONTE–ACS Project was to evaluate the impact of a dedicated cooperative program between hospital and outpatient structures on the persistance on recommended therapies and long–term outcome occurrence in patients discharged after ACS. Materials and Methods This was a prospective, longitudina, cohort study. We enrolled patients who were discharged after ACS and/or after coronary revascularization in the HUB centres of ASL Bari. Patients underwent cardiologic evaluation and laboratory examination at 30 days, 3–, 6–, and 12–months from the index event. The following endpoint were considered: all–cause mortality, ACS recurrence/cardiac ischemia/angina, restenosis/intrastent thrombosis, stroke/transient ischemic attack (TIA), heart failure, any bleeding. Adherence and persistence to therapies were evalauted as well as the percentage of patients who reached the recommended goals. Results We enrolled 2476 patients (77.4% male, mean age: 67.2±12.0 yrs). After one–year follow–up, 99.5% (p < 0.05) were on statin–therapy, 16.1% with ezetimibe (p < 0.01) and 9.9% (p < 0.01) with proprotein convertase subtilisin/kexin type 9 inhibitors. The overall mortality at one–year follow–up was 3.1%, while ACS recurrence/cardiac ischemia/angina and restenosis/intrastent thrombosis were 3% e 1.3%, respectively. Any bleeding rate was 2.2%. Conclusions The PONTE–ACS Project was able to improve the management of patients after ACS, to manage a structured follow–up protocol for patients discharged after ACS and/or coronary revascularization, thus improving adhesion to recommended therapies and keeping lower the incidence of major cardiovascular and bleeding events.

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Bai, Chaobo, Zhiying Chen, Xiaoqin Wu, Roxanne Ilagan, Yuchuan Ding, Xunming Ji, and Ran Meng. "Safety and efficacy comparison between OACs plus single antiplatelet and dual antiplatelet therapy in patients with cerebral venous sinus stenosis poststenting." BMC Neurology 22, no. 1 (June 6, 2022). http://dx.doi.org/10.1186/s12883-022-02731-0.

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Abstract Background and purpose The present strategies regarding poststent management for cerebral venous sinus stenosis (CVSS) are inconsistent. Herein, we compared the safety and efficacy of oral anticoagulants (OACs) plus single antiplatelet therapy and dual antiplatelet therapy for CVSS poststenting. Methods A real-world observational study conducted from January 2009 through October 2019 enrolled patients who were diagnosed with CVSS and received stenting. Patients were divided into two groups according to the management they received poststenting. Group 1: OACs plus a single antiplatelet agent (clopidogrel 75 mg or aspirin 100 mg) and Group 2: dual antiplatelet therapy (clopidogrel 75 mg plus aspirin 100 mg). The safety (such as major or minor bleeding or venous thrombosis) and efficacy (the incidences of cerebral venous sinus restenosis, intrastent thrombosis, or stent displacement) of the two groups were compared. Results There were a total of 110 eligible patients in the final analysis, including 79 females and 31 males with a mean age of 43.42 ± 13.23 years. No major bleeding or venous thrombosis occurred in either of the two groups. Two minor bleeding events occurred in group 2 (one with subcutaneous bleeding points in both lower limbs, another with submucosal bleeding in the mouth), whereas no bleeding events occurred in Group 1. In addition, at the 1-year follow-up, one case of intraluminal restenosis and two cases of in-stent thrombi occurred in Group 2, while none occurred in Group 1. Neither stenosis at stent-adjacent segments nor stent migration was detected in either group during the 1-year following stent placement. Conclusion OACs plus single antiplatelet therapy and dual antiplatelet therapy alone are both safe and efficacious management strategies after CVSS stent placement. The former may have more advantages than the latter for inhibiting intrastent thrombosis. However, further research by larger, multicenter clinical trials is needed.

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Boccuto, Fabiola, Laura Tammè, Claudio Iaconetti, Jolanda Sabatino, Alberto Polimeni, Sabato Sorrentino, Andrea Carbone, et al. "738 Role of non-coding RNA uc.194 and uc.443+A in the intrastent restenosis." European Heart Journal Supplements 23, Supplement_G (December 1, 2021). http://dx.doi.org/10.1093/eurheartj/suab138.

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Abstract Aims Vascular smooth muscle cells (VSMCs) play a key role in the vessel wall, being active partaker in vascular remodelling and influencing multiple pathophysiological phenomena, such as progression of atherosclerosis, in-stent restenosis and vascular reactivity. Recently antisense oligonucleotides have shown promising results as a therapeutic option. The aim of this study was to analyse the expression profile and function of T-UCRs in vascular smooth muscle cells (VSMCs)—both in vitro and in vivo—and to evaluate the effects of their inhibition by the use of specific antisense oligonucleotides. Methods After obtaining cell cultures of vascular smooth muscle cells, we modified their phenotype varying growth conditions. A microarray and qRT-PCR expression profile analysis and a cell cycle analysis with cell proliferation/apoptosis/migration assay were performed. In vivo studies were performed on rat carotids after cell damage and administration of specific antisense oligonucleotides. Results There were significant differences in the expression of T-UCRs in VSMCs with a proliferating and quiescent phenotype. In particular, 5 T-UCRs were found to be upregulated in VSMCs. These types of cells were subsequently transfected with specific antisense oligonucleotides obtaining a reduction in their proliferative activity in particular with the inhibition of the T-UCRs uc.194 and uc.443 + A. MiR-10A and miR-34b-5p were identified with complementary sequences respectively to uc.194 and uc.443 + A. The increase of these miRs following the inhibition of the T-UCRs were closely related to the inhibition of the proliferative signals of VSMCs. Similarly, the same results were obtained in vivo. Conclusions The expression levels of non-coding RNAs uc.194 and uc. 443 + A increase in proliferating smooth muscle cells in vitro and in the vascular wall following damage, suggesting an important role of these molecules in the phenomenon of intra-stent restenosis. Through the inhibition of uc.194 and uc.443 + A using an antisense strategy, we demonstrated a reduction in cell proliferation and migration processes and, consequently, in the formation of neointima. A possible relationship was also highlighted between the aforementioned non-coding RNAs and some micro-RNAs (miR-10A and miR-34b-5p), negative regulators of the proliferative phenotype of VSMCs. The inhibition of the analysed T-UCRs would allow the maintenance of the contractile phenotype thanks to the activity of the miRs analysed in this study. Our results might pave the way for the identification of new therapeutic targets in order to prevent and reduce the incidence of intra-stent restenosis.

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Oana, Stoia, Catrina Bianca, Puia Andreea, and Bitea Ioan Cornel. "Poster No. 030 Young patient with hyperhomocysteinemia and multiple atherosclerotic vascular lesions." Cardiovascular Research 118, Supplement_2 (October 1, 2022). http://dx.doi.org/10.1093/cvr/cvac157.043.

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Abstract Background Hyperhomocysteinemia is usually defined as an elevation of plasma tHcy > 15 μmol/L with a prevalence ranging around 5–10% in the adult general population. In the last years, studies have demonstrated that moderate hyperhomocysteinemia is a frequent and independent risk factor for premature vascular disease in the coronary, cerebral, and peripheral arteries by impairing endothelium-dependent vasomotor responses in a way that increases risk for complications of atherosclerosis. Material and methods We present the case of a 45 years old man, without significant pathological history, who has a marked weight loss and diffuse abdominal pain. The patient is investigated, and following a CT scan of the abdomen, the diagnosis of mesenteric ischemia was made with severe stenosis of the superior mesenteric artery and celiac trunk in the proximal segments. Two drug-active stents were implanted at the level of both the celiac trunk and the superior mesenteric artery. Following the investigations, coronary heart disease is established by monovascular damage and significant carotid atheromatosis. After one year the abdominal pain returns, and the control angiography reveals severe intrastent restenosis in the superior mesenteric artery and occlusive restenosis and fracture of the stent implanted in the celiac trunk (modifications in context of cessation of threatment and abdominal traumatism). More detailed investigation revealed moderate hyperhomocysteinemia. Afther succesful treatment he returns one year later with the same simptoms and ocluzions of mesenteric artery. Conclusion In young patients presenting with multiple vascular damage hiperhomocysteinemia must be thought as it is an independent cardiovascular risk factor.

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Kimura, Shigeki, Yosuke Yamakami, Keisuke Kojima, Yuichiro Sagawa, Hirofumi Ohtani, Keiichi Hishikari, Tomoyo Sugiyama, Hiroyuki Hikita, Atsushi Takahashi, and Mitsuaki Isobe. "Abstract 13746: Relationships between Neointimal Tissue Characteristics and Occurrence of Periprocedural Myocardial Infarction in Lesions with In-Stent Restenosis." Circulation 130, suppl_2 (November 25, 2014). http://dx.doi.org/10.1161/circ.130.suppl_2.13746.

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Background: Recent studies have reported several types of neointimal tissues including neoatherosclerotic progression in stent restenosis. However, the influence of neointimal tissue characteristics on outcomes after percutaneous coronary intervention (PCI) for in-stent restenosis (ISR) remains unclear. Periprocedural myocardial infarction (PMI) is related to poor outcomes after PCI. We assessed relationships neointimal tissue characteristics and occurrence of PMI after PCI in ISR lesions. Methods: We investigated 45 ISR lesions in 45 stable angina pectoris (SAP) patients who underwent pre- and post-PCI coronary angioscopy (CAS) and optical coherence tomography (OCT) examination. We excluded patients with hemodialysis. All lesions were divided into lesions with PMI, defined as high-sensitivity cardiac troponin-T (hs-cTnT) values after PCI ≥5 times of the upper reference limit in patients with normal baseline values or ≥5 times of baseline values if hs-cTnT values were elevated before PCI, and those without. Clinical and lesion characteristics including intrastent neointimal tissues were compared between two groups. Results: PMI was observed in 15 (33.3%) lesions. Clinical characteristics including stent types and terms after stenting were similar between lesions with and without PMI. CAS analysis showed higher frequency of white neointimal proliferation with irregular surface or yellow neointima at the culprit site before PCI (86.7% vs. 43.3%, p=0.009) and atheromatous appearance (CAS-AP), defined as yellow plaque including complex thrombi underneath disrupted neointimal coverage after ballooning (66.7% vs. 16.7%, p=0.003) in lesions with PMI than those without. OCT analysis demonstrated higher frequency of heterogeneous neointima or neointimal thin-cap fibroatheroma in lesions with PMI (73.3% vs. 33.3%, p=0.02). Multivariate analysis including clinical and lesion characteristics and procedural results showed CAS-AP as an independent predictor for occurrence of PMI (odds ratio:6.90, 95% CI:1.68-28.41, p=0.008). Conclusions: In ISR lesions with SAP patients, the assessment of neointimal tissue characteristics by using CAS and OCT images may be useful for the prediction of occurrence of PMI.

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Bettella, N., M. Previtero, A. Ruocco, D. Muraru, S. Iliceto, and L. P. Badano. "P167 The burden of post-actinic heart disease: a case of severe valvular and coronary artery disease in a cancer survivor." European Heart Journal - Cardiovascular Imaging 21, Supplement_1 (January 1, 2020). http://dx.doi.org/10.1093/ehjci/jez319.041.

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Abstract Background A 47-year old female complaining of exertional dyspnoea (NYHA class III) was admitted at our Cardiology department. She had a history of nodular sclerosis Hodgkin lymphoma (HL), treated with chemo- and radiotherapy, and complicated by post-actinic pneumopathy and cardiopathy. At the age of 39, she had undergone coronary artery bypass grafting with left internal mammal artery (LIMA) to left anterior descendent artery and saphenous vein to obtuse marginal branch, and aortic valve replacement with a mechanical prosthesis due to severe aortic stenosis. Some years later, she had undergone percutaneous stenting of the left main (LM) due to occlusion of the LIMA bypass graft. At admission, the patient was hemodynamically stable, with signs of right-sided congestive heart failure. Both 2D and 3D transthoracic echocardiogram (TTE) showed preserved biventricular function, normal function of the aortic prosthesis, and diffuse calcification of the whole mitral valve apparatus, involving the leaflets, the annulus, the tendinous chords and the anterolateral papillary muscle (Figure Panels A-B), causing severe mitral stenosis (mean gradient 10 mmHg, 3D planimetric area 0.9 cm2, Wilkins score 12) and moderate organic insufficiency (Panel C). The tricuspid valve was also affected, with thickened, hypomobile leaflets, causing mild stenosis (mean gradient 4 mmHg, 3D planimetric area 3.8 cm2) and severe insufficiency (Panel D). Transesophageal echocardiogram (TOE) couldn"t be performed because of actinic oesophagitis. Percutaneous valvuloplasty was contraindicated due to moderate mitral insufficiency, high Wilkins score and a huge amount of calcium affecting the whole valve apparatus but sparing the commissures. The patient was scheduled to PCI on the LM due to intrastent restenosis, but died during the procedure as a consequence of an intrastent massive thrombosis leading to cardiac arrest. Learning points Hodgkin lymphoma survivors are at increased cardiovascular and intraoperative risk. Old radiotherapy protocols for HL may cause severe post-actinic valvular and coronary disease. Post-actinic valvular heart disease often affects aortic and mitral valve more than a decade after irradiation, and may manifest as stenosis, insufficiency or both. Organic regurgitation and stenosis of tricuspid valve are uncommon, but may also occur and lead to worse patient outcome. Despite TOE may bring additional valuable informations in challenging cases, the coexistence of oesophageal sequelae from post-actinic oesophagitis may limit its applicability. TTE is the first line and often the only diagnostic tool available for identifying the characteristic valvular lesions in cancer survivors exposed to radiotherapy. 3D TTE may be particularly useful to identify subtle signs of primary involvement of tricuspid apparatus and quantify the anatomical area of a stenotic tricuspid valve, when severe regurgitation coexists and transvalvular gradients may be unreliable. Abstract P167 Figure

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Micillo, M., M. Cocco, A. Cossu, M. De Raffele, A. Boccadoro, G. Campo, G. Guardigli, and E. Tonet. "P417 ASSESSMENT OF RESIDUAL CARDIOVASCULAR RISK AFTER STENTING: THE ROLE OF IMAGING." European Heart Journal Supplements 24, Supplement_C (May 1, 2022). http://dx.doi.org/10.1093/eurheartj/suac012.402.

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Abstract Background Reduction of residual risk after myocardial infarction (MI) represents the main goal in secondary prevention. Imaging may provide additional evidence beyond the monitoring of risk factors. Clinical Case In June 2019 a 29–year old man, Pakistani ethnicity, former smoker with family history of cardiovascular disease experienced a myocardial infarction without ST–segment elevation. Coronary angiography revealed a severe disease of circumflex branch (LCx) and of second obtuse marginal branch (OM2) treated with drug eluting stent (DES) implantation. A strong medical therapy was planned including dual antiplatelet therapy, high–potency statin and ACE inhibitor. The year after, a new coronary angio was performed because of effort angina: intrastent restenosis of LCx–OM2 was highlighted and treated with balloon, associated with a critical disease of right coronary artery (RCA), treated with DES. In the following months, the patient experienced three hospitalization for unstable angina related to critical intra–stent restenosis of LCx and intermediate stenosis of left anterior descendent (LAD). In order to better understand the subtle mechanism of patient’s symptoms, an invasive assessment of microvascular disease was performed, showing microvascular dysfunction (IMR 30; CFR 2.2; RRR 2.7). Additionally, coronary angio images raised the suspicion of positive remodeling on mid tract of RCA and LCx, expression of a progressive and high risk atherosclerosis (Figure 1). A close follow up was planned: a coronary computed tomography angiography (CCTA) 4 months after the last angio was performed aiming the assessment of atherosclerosis progression. CT images showed patency of the previously placed stents. A severe amount of positive plaque remodeling of RCA and LCx was documented: it was characterized by hypodense eccentric plaque (<30 HU) with some little calcific spot near to the lipid core. These features underlined the presence of high–risk coronary plaque (Figure 2, Figure 3). Taking into account clinical history, instrumental and laboratory data, the patient was a candidate for therapy with PCSK9 inhibitors, which previously demonstrated an effect on reduction of plaque’s lipid core. Conclusions CT coronary represents an excellent method for the assessment of residual risk in ischemic patients thanks to its ability to detect not only stenotic plaques, but also high–risk features of atherosclerosis, thus allowing therapeutic optimization.

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Rochira, Carla. "673 A CRACK AND A CLOT." European Heart Journal Supplements 24, Supplement_K (December 14, 2022). http://dx.doi.org/10.1093/eurheartjsupp/suac121.539.

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Abstract A 74-year-old man with a history of ischaemic heart disease (multiple percutaneous coronary interventions (PCI)), broke his ankle. Therefore, he discontinued dual antiplatelet therapy (DAPT) -acetylsalicylic acid plus clopidogrel- and started enoxaparin sodium 4000 UI/day on medical advice. A few days later, he was admitted to the emergency department for refractory chest pain, vomit and syncope. Twelve-lead electrocardiogram (ECG) showed a sinus rhythm interrupted by frequent premature ventricular contractions in a pattern of trigeminy. The transthoracic echocardiogram revealed a mildly dilated LV with normal wall thickness and marked hypokinesis/ akinesis in apical, infero-lateral and antero-lateral walls, with a 33% ejection fraction. High sensitivity cardiac troponin was increased, and a second ECG showed a diffuse ST segment depression. The patient was loaded with aspirin and emergently taken to the cardiac catheterization lab. Coronary angiography showed a very late stent thrombosis of the left circumflex artery (LCx), with occlusion of the extreme distality of the second obtuse marginal artery and a 50-60% intrastent restenosis of the ostium-proximal tract of the left anterior descending artery (LAD). Given the non-obstructive nature of the thrombus, risk of peripheral embolization, TIMI flow grade 3 and improvement of symptoms, the decision was made to adopt a conservative strategy with loading dose of ticagrelor, heparin and tirofiban infusion. Besides, an optical coherence tomography (OCT) control was scheduled for the next day. OCT of the LCx revealed a well apposed and well expanded stent with a non-obstructive residual thrombus, nevertheless not visible on angiography. Thus, the tirofiban infusion was prolonged up to 48 hours. OCT of the LAD detected a fibro-calcific disease determining a significant restenosis of the distal left main (LM)-LAD ostium. OCT-guided provisional stenting with two drug eluting stents on LM-LAD-LCx was performed successfully. The patient was discharged home on acetylsalicylic acid (lifelong), ticagrelor (for 12 months) and enoxaparin sodium 4000 UI/day (according to specialist indication). DAPT is superior to anticoagulant therapy in preventing stent thrombosis in patients undergoing PCI, and a more informed inter-specialist communication is needed. Intracoronary imaging can help in the management of stent failure and in the guidance of complex PCI, allowing a patient-tailored treatment.

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Koszegi, Zsolt, Tibor Szuk, Gusztav Vajda, Frederick Marty, and Csaba Jenei. "Optical coherence tomography imaging of intrastent neointimal bridge caused by semicircumferencial dissection after drug eluting balloon dilatation of instent restenosis of sapheneous venous graft." Anadolu Kardiyoloji Dergisi/The Anatolian Journal of Cardiology 14, no. 2 (April 4, 2014). http://dx.doi.org/10.5152/akd.2014.5200.

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Caminiti, Rodolfo, Giampaolo Vetta, Antonio Parlavecchio, Paolo Mazzone, Giuseppe Giacchi, Giorgio Sacchetta, Domenico Giovanni Della Rocca, et al. "773 CONTRAST-ENHANCED EXCIMER LASER CORONARY ANGIOPLASTY IN THE TREATMENT OF HEAVILY CALCIFIED LESIONS: A STEPWISE APPROACH." European Heart Journal Supplements 24, Supplement_K (December 14, 2022). http://dx.doi.org/10.1093/eurheartjsupp/suac121.305.

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Abstract Introduction The treatment of heavily calcified lesions is a challenge for the interventional cardiologist. The Excimer laser coronary atherectomy (ELCA) is a plaque modification tool and the main mechanism of action seems to be the photomechanical delivering acoustic pressure with a mechanical disruption of the plaque in front of the catheter tip. Objective To evaluate the effectiveness of the contrast-enhanced ELCA by a stepwise approach, with incremental frequency/fluency in the treatment of calcified lesions in different contexts. Methods We retrospectively enrolled consecutively all patients undergoing contrast-enhanced ELCA-assisted PCIs between 2018 and 2021 at the Cardiology Unit of “Umberto I” Hospital of Syracuse (Italy). The frequency/fluency ELCA profile used with a stepwise approach were 50/50, 60/60, 70/70 and 80/80. ELCA technical success was defined as the laser catheter crossing the entire length of the target lesion established by angiographic evidence of the catheter tip in the artery distal to the stenosis. Procedural success was defined as <30% residual stenosis after laser and adjunctive therapy. Clinical success requested procedural success with absence of major adverse cardiac events at hospital discharge. Major adverse cardiac events included death of all causes, myocardial infarction, need for target lesion revascularization, tamponade, and life-threatening arrhythmias. Results We enrolled 114 patients who underwent contrast-enhanced ELCA-assisted PCI. 58% of the patients had acute coronary syndrome and 42% had chronic coronary syndrome. The left anterior descending artery was the target vessel in 42.1% of cases, the right coronary artery in 26.3%, the circumflex in 10.5%, and the left main artery in 2.3%. The main indication for ELCA was intrastent restenosis (56.2%). The median stenosis was 90% (80% – 90%). The ELCA catheter tip was 0.9 mm and 1.4 mm was employed in the 89.5% and 10.5% of cases respectively. The most used frequency/fluency profile was 70/70 (39.5%) followed by 60/60 (31.6%), 50/50 (15.8%) and 80/80 (13.2%). Use of contrast-enhanced ELCA was associated with high technical success rate (97.4%), procedural success rate (93.7%), and clinical success rate (97.1%). Conclusions In Conclusion, the contrast-enhanced ELCA seems to be a safe and effective treatment for management of calcified lesions.

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Buonpane, Angela, Rocco Vergallo, Emiliano Bianchini, Marco Lombardi, Alessandro Maino, Alfredo Ricchiuto, Antonio Maria Leone, et al. "698 Acute coronary syndrome in neoatherosclerosis with major stent malapposition and OCT-guided PCI." European Heart Journal Supplements 23, Supplement_G (December 1, 2021). http://dx.doi.org/10.1093/eurheartj/suab140.010.

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Abstract Aims Due to its bidimensional nature, angiography is not always sufficient to accurately define coronary lesions, in particular when they are ambiguous or indeterminate. Intracoronary imaging, such as intravascular ultrasound or optical coherence tomography (OCT), is often useful in these cases to better characterize the ambiguous angiographic images, to identify the culprit lesion during acute coronary syndrome (ACS) and to guide percutaneous coronary intervention (PCI). Methods and results We report a case of a 61-year-old male with multiple cardiovascular risk factors and a previous ST-segment elevation myocardial infarction treated by PCI of the right coronary artery (RCA) about 7 years before, wo was admitted to our emergency department after acute onset chest pain. At the time of admission, his ECG was normal and cardiac troponin was below the upper reference limit of normality with positive molecular SARS-CoV-2 diagnostic test. Echocardiogram disclosed a mild left ventricular dysfunction with inferior wall hypokinesia. Coronary angiography showed a moderate in-stent restenosis at mid RCA and a hazy, undetermined image at the proximal edge of the previously implanted stent. Left coronary artery angiography showed only diffuse atherosclerotic disease without significant stenoses and a myocardial bridge at the mid tract of left anterior descending artery. OCT pullback of RCA to better characterize the undetermined lesions shown by angiography. OCT revealed significant neointima hyperplasia and a focal area of neoatherosclerosis with unstable features (fissure/microthrombi) at mid RCA. Severe stent strut malapposition embedded neointimal hyperplasia was observed at the proximal stent edge, resulting in ‘dual’ lumen appearance. The two lesions were treated with a single 3.5/48 mm everolimus-eluting stent (stent-in-stent), which was post-dilated with a 3.5/20 mm non-compliant balloon (18 atm) in the mid-to-distal segments, and 4.5/15 mm (16 atm) and 5.0/8 mm (14 atm) semi-compliant balloons in the proximal stent segment. Post-PCI OCT imaging confirmed good stent expansion and apposition. Our case demonstrates the utility of OCT in clarifying the aetiology of ambiguous angiographic lesions and as a guide for PCI. Indeed, the ‘hazy’ appearance on the angiograms corresponded to the major stent malapposition covered by neointima disclosed by OCT as a ‘dual-lumen’. Of note, OCT allowed to confirm the correct guidewire position in the ‘true’ lumen preventing a crush of the previously implanted stent. OCT was also useful as a diagnostic modality for the identification and characterization of the mechanism underlying the ACS (neoatherosclerosis instability). Conclusions Due to its unprecedented spatial resolution, OCT enables an ‘optical biopsy’ of the coronary artery wall and intrastent tissue. Therefore, OCT imaging should be considered when lesions are ambiguous or indetermined by coronary angiography to guide the diagnosis and treatments of ACS patients. OCT imaging is also useful to guide stenting and to optimize PCI result, and its impact on clinical outcome is under investigation in large randomized clinical trials.

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