Angioscopic observation of an atherosclerotic coronary aneurysm without yellow plaque

Intravenous immunoglobulin (IVIG) reduces coronary aneurysms in patients with Kawasaki disease (KD), but additional management options remain challenging, with no generalisable evidence-based recommendations. We performed a survey of 724 physicians from 73 countries to assess variation in practice. IVIG was the preferred initial treatment by 659 (91%) of respondents. Criteria for adjunctive primary treatment varied considerably and definitions of IVIG resistance varied markedly by geographical continent, Human Development Index tiers and medical specialty. A second dose of IVIG was used most often for patients with coronary aneurysm non-responsive to initial treatment (572, 79%), but corticosteroids (379, 52%) and tumour necrosis factor alpha inhibitors (208, 29%) were also frequently used. Our findings highlight the need for international collaborative efforts to optimise management of patients with KD worldwide.

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IgG4-Related Coronary Aneurysm in a Child

The Indian Journal of Pediatrics ◽

10.1007/s12098-021-03743-3 ◽

2021 ◽

Author(s):

Anu K. Vasudevan ◽

G. Asok Kumar ◽

S. Rajesh ◽

M. Zulfikar Ahamed

Keyword(s):

Coronary Aneurysm

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Predictive value of brachial artery flow-mediated dilation on coronary artery abnormality in acute stage of Kawasaki disease

Scientific Reports ◽

10.1038/s41598-021-87704-y ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Yizhou Wen ◽

Xianmin Wang ◽

Yonghong Guo ◽

Mei Jin ◽

Jimei Xi ◽

...

Keyword(s):

Coronary Artery ◽

Kawasaki Disease ◽

Brachial Artery ◽

Characteristic Curve ◽

Coronary Aneurysm ◽

Acute Stage ◽

Flow Mediated Dilation ◽

Strong Negative Correlation ◽

Coronary Artery Abnormality ◽

Artery Flow

AbstractCoronary artery abnormalities (CAAs) are a severe complication of Kawasaki disease (KD) that may lead to cardiovascular events. Given the evidence that brachial artery flow-mediated dilation (FMD) decreases in children after the onset of KD, we hypothesized that it could be an early marker of CAA development in the acute stage and investigated its relationship with variation in the coronary artery diameter. A total of 326 sex- and age-matched children were enrolled, including 120 with KD, 109 febrile children and 97 healthy controls. In this study, FMD was significantly decreased in the KD group compared with the febrile and healthy groups. FMD was lower in the CAA group than in the no coronary artery abnormality group. The comparison of FMD showed an obvious difference among the CAA subgroups. The FMD in the coronary aneurysm (CA) group showed a strong negative correlation with the pretreatment maximum coronary artery Z-score (preZmax). While preZmax was 2.5, the receiver operating characteristic curve indicated an optimal cutoff point of 3.44% for FMD. FMD ≤ 3.44% could be considered as a signal of coronary lesions in acute stage of KD.

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Optical coherence tomography and coronary angioscopy assessment of healed vulnerable plaque components in patients with coronary artery lesions undergoing elective percutaneous coronary intervention

European Heart Journal ◽

10.1093/ehjci/ehaa946.2444 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

S Kimura ◽

K Hara ◽

M Ohmori ◽

R Tateishi ◽

T Kaneda ◽

...

Keyword(s):

Optical Coherence Tomography ◽

Coronary Artery ◽

Vulnerable Plaque ◽

Multivariate Logistic Regression Analysis ◽

Low Grade ◽

Optical Coherence ◽

Coronary Artery Lesions ◽

Coronary Syndrome ◽

Yellow Plaque ◽

Coronary Angioscopy

Abstract Background Many vulnerable plaques would progress without clinical events and might result in healed plaques (HPs). Histopathological or intracoronary image assessment of HPs has been reported. However, the morphological characteristics of HPs remain unclear yet. Purpose We sought to assess the healed vulnerable plaque components in patients with coronary artery lesions using optical coherence tomography (OCT) and coronary angioscopy (CAS). Methods We enrolled 47 patients with 50 native coronary artery lesions with angiographical severe stenosis (>90% diameter-stenosis) and without severe calcification (36 lesions with stable angina pectoris (SAP) and 14 acute coronary syndrome (ACS)) undergoing pre-intervention OCT and CAS. HPs was defined as layered phenotype on OCT. Lesion morphologies and plaque characteristics in lesions with HPs were assessed using OCT and CAS images. Results HPs were observed in 27 lesions (54.0%) and their prevalence were similar among each clinical status (SAP 52.8%, ACS 57.1%, p=1.00). Lesions with HPs had higher prevalence of OCT-macrophage (88.0% vs. 52.0%, p=0.01), CAS-red thrombus (88.8% vs. 52.2%, p=0.004) and CAS-low grade-yellow plaque (grade 1) (55.6% vs. 21.7%, p=0.02) than those without. SAP lesions with HPs had higher prevalence of CAS-yellow plaque (35.3% vs. 5.9%, p=0.09) and OCT-thin-cap fibroatheroma (42.1% vs. 5.9%, p=0.04) than SAP without HPs. ACS lesions with HPs had less CAS-red thrombus (0.0% vs. 50.0%, p=0.03) and OCT-plaque rupture (12.5% vs. 66.7%, p=0.04) than ACS without HPs. Multivariate logistic regression analysis revealed that OCT-macrophages (odds ratio (OR): 6.65, 95%-confidence intervals: 1.07–41.5, p=0.043), CAS-red thrombus (OR 8.77, 95% CI 1.33–57.8, p=0.02), and low grade-yellow plaque (OR 13.05, 95% CI 1.97–86.5, p=0.008) were independently related with the existence of HPs lesions. Combination of these 3 factors showed a high predictive value of OCT-HPs lesions (90.9%). Conclusions HPs lesions showed the lower lesion vulnerability than common ACS lesions but had more intraplaque inflammatory condition compared with common SAP lesions. Combined CAS and OCT examination might be useful to clarify the plaque components of HPs lesions in vivo, leading to help us understand the clinical significance of HPs. Funding Acknowledgement Type of funding source: None

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Acquired coronary aneurysm after stent implantation at a bifurcation excluded with a Papyrus covered stent subsequently fenestrated

Cardiovascular Intervention and Therapeutics ◽

10.1007/s12928-021-00760-z ◽

2021 ◽

Author(s):

Emilio Arbas-Redondo ◽

Alfonso Jurado-Román ◽

Santiago Jiménez-Valero ◽

Guillermo Galeote-García ◽

Ariana Gonzálvez-García ◽

...

Keyword(s):

Stent Implantation ◽

Coronary Aneurysm ◽

Covered Stent

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P3386Angioscopic comparison between polymer-free biolimus A9-coated stent and durable polymer drug-eluting stent 10 months after the implantation

European Heart Journal ◽

10.1093/eurheartj/ehz745.0262 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

T Tsujimura ◽

T Ishihara ◽

O Iida ◽

M Asai ◽

M Masuda ◽

...

Keyword(s):

De Novo ◽

Drug Eluting Stent ◽

Light Yellow ◽

Yellow Color ◽

Yellow Plaque ◽

Durable Polymer ◽

Biolimus A9 ◽

Drug Eluting ◽

Neointimal Coverage ◽

Grade 3

Abstract Background Polymer-free biolimus A9-coated stent (DCS) has currently emerged as expected better arterial healing compared to durable polymer drug-eluting stent (DP-DES). However, superiority of DCS on arterial healing over DP-DES has not been well elucidated using intracoronary images. Methods This study examined 288 stents in 224 patients with de novo coronary artery lesions. We angioscopically compared 55 DCS from 35 patients with 233 DP-DES from 189 patients 10±2 months after the implantation. We assessed thrombus adhesion, which is a marker of incomplete re-endothelialization. Dominant neointimal coverage (NIC) grade, heterogeneity of NIC and maximum yellow color of plaque underneath the stent were also evaluated. Neointimal coverage was graded as follows: grade 0, stent struts exposed; grade 1, struts bulged into the lumen, although covered; grade 2, struts embedded by the neointima, but translucent; grade 3, struts fully embedded and invisible. NIC was judged as heterogeneous when differences in the NIC grade became apparent. Yellow plaque was graded as follows: grade 0, white; grade 1, light yellow; grade 2, yellow; grade 3, intensive yellow. Results Thrombus adhesion was similar between DCS and DP-DES (29% versus 23%, P=0.32). Dominant NIC was greater in DCS than in BP-DES (P<0.001), while NIC was more heterogeneous in DCS than in BP-DES (P=0.001, Figure). Maximum yellow color of stented segment was similar between DCS and DP-DES (P=0.09). Conclusion DCS provided similar thrombus adhesion to DP-DES, which suggested similar re-endothelialization 10 months after implantation. However, DCS showed thick and heterogeneous NIC compared to DP-DES. The specific feature of polymer-free and Biolimus A9 would cause the difference, and further investigation is necessary to evaluate the longer-term safety and efficacy. Acknowledgement/Funding None

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