scholarly journals Vascular Response after Directional Coronary Atherectomy for Left Main Bifurcation Lesion

2021 ◽  
Vol 2021 ◽  
pp. 1-8
Author(s):  
Norihiro Kobayashi ◽  
Masahiro Yamawaki ◽  
Mana Hiraishi ◽  
Shinsuke Mori ◽  
Masakazu Tsutsumi ◽  
...  
Keyword(s):  
Large Vessel ◽  
Vascular Response ◽  
Left Main ◽  
Vessel Area ◽  
Plaque Area ◽  
Bifurcation Lesion ◽  
Single Center Study ◽  
Before And After ◽  
Directional Coronary Atherectomy ◽  
Drug Coated Balloon

Aims. To evaluate the vascular response after directional coronary atherectomy (DCA) for left main (LM) bifurcation lesion. Methods. This study was a retrospective, single-center study enrolling 31 patients who underwent stentless therapy using DCA followed by drug-coated balloon (DCB) angioplasty for LM bifurcation lesion. We compared intravascular ultrasound (IVUS) findings before and after DCA. Results. After DCA, the lumen and vessel areas significantly increased, whereas the plaque area (PA) and %PA were significantly reduced. When the lesions were divided into small vessel and large vessel groups using the median value of the vessel area, the maximum balloon pressure of the DCA catheter was greater in the large vessel group. Changes in the lumen and vessel areas were also significantly greater in the large vessel group. On the other hand, the changes in PA and %PA were similar between groups. Conclusions. The main vascular responses associated with lumen enlargement after DCA were plaque reduction and vessel expansion. Contribution of vessel expansion to lumen enlargement was larger than the effect of plaque reduction in large vessel lesions.

scholarly journals Vascular Response after Directional Coronary Atherectomy for Left Main Bifurcation Lesion

2021 ◽  
Author(s):  
Norihiro Kobayashi ◽  
Masahiro Yamawaki ◽  
Mana Hiraishi ◽  
Shinsuke Mori ◽  
Masakazu Tsutsumi ◽  
...  
Keyword(s):  
Small Vessel ◽  
Vascular Response ◽  
Left Main ◽  
Vascular Responses ◽  
Vessel Area ◽  
Plaque Area ◽  
Bifurcation Lesion ◽  
Single Center Study ◽  
Directional Coronary Atherectomy ◽  
Drug Coated Balloon

Abstract Purpose: To evaluate the vascular response after directional coronary atherectomy (DCA) for left main (LM) bifurcation lesion.Methods: This study was a retrospective, single-center study enrolling 31 patients who underwent stent-less therapy using DCA followed by drug-coated balloon angioplasty for LM bifurcation lesion. We compared the intravascular ultrasound (IVUS) findings pre- and post DCA. Results: After DCA, the lumen and vessel areas significantly increased whereas the plaque area (PA) and %PA significantly decreased. When the lesions were divided into small and large vessel groups using the median vessel area value, the maximum balloon pressure of the DCA catheter was greater in the large than in the small vessel group. Changes in the lumen and vessel areas were also significantly greater in the large than in the small vessel group. Conversely, the PA and %PA changes were similar between the groups. Conclusion: The main vascular responses associated with lumen enlargement after DCA were plaque reduction and vessel expansion. Contribution of vessel expansion to lumen enlargement was larger than the effect of plaque reduction in large than in small-vessel lesions.

scholarly journals Stentless Strategy by Drug-Coated Balloon Angioplasty following Directional Coronary Atherectomy for Left Main Bifurcation Lesion

2021 ◽  
Vol 2021 ◽  
pp. 1-7
Author(s):  
Norihiro Kobayashi ◽  
Masahiro Yamawaki ◽  
Shinsuke Mori ◽  
Masakazu Tsutsumi ◽  
Yohsuke Honda ◽  
...  
Keyword(s):  
De Novo ◽  
Artery Bypass ◽  
The Other ◽  
Bleeding Complications ◽  
Left Main ◽  
Other Hand ◽  
Bifurcation Lesion ◽  
Bifurcation Lesions ◽  
Directional Coronary Atherectomy ◽  
Drug Coated Balloon

Aims. We aimed to evaluate the efficacy of stentless strategy by drug-coated balloon (DCB) angioplasty following directional coronary atherectomy (DCA) for left main (LM) bifurcation lesions. Methods. A total of 38 patients who underwent DCB angioplasty following DCA for LM bifurcation lesions were retrospectively enrolled. The primary endpoint was target vessel failure (TVF) at 12 months. Secondary endpoints included procedure-related major events during the hospitalization, major adverse cardiac events at 12 months, ischemia-driven target lesion revascularization (TLR) at 12 months, and bleeding complications defined as the Bleeding Academic Research Consortium criteria ≥2 at 12 months. Results. Among these 38 lesions, 31 lesions were de novo LM bifurcation lesions and 7 lesions were stent edge restenosis at the left anterior descending (LAD) ostium. The mean % plaque area (%PA) after DCA was 44.0 ± 7.4%. TVF at 12 months occurred in 1 lesion (3.2%) of de novo LM bifurcation lesion and in 3 lesions (42.9%) of stent edge restenosis at the LAD ostium. All events of TVF were ischemia-driven TLR by percutaneous coronary intervention. Among 4 TLR cases, %PA after DCA was high (55.9%) in the de novo LM bifurcation lesions; on the other hand, %PA after DCA was low (42.4%, 38.7%, and 25.7% in the 3 cases) in stent edge restenosis at the LAD ostium. No procedure-related major events were observed during hospitalization. There was no cardiac death, no myocardial infarction, no coronary artery bypass grafting, and no bleeding complications at 12 months. Conclusions. Stentless strategy by DCB angioplasty following DCA for de novo LM bifurcation lesions resulted in acceptable outcomes. On the other hand, its efficacy was limited for stent edge restenosis at the LAD ostium even after aggressive debulking by DCA.

scholarly journals TCTAP C-061 Drug-coated Balloon Usage in Left Main Bifurcation Lesion

2019 ◽  
Vol 73 (15) ◽  
pp. S131
Author(s):  
Tanveer Iqbal Penwala ◽  
Rubenthiran Navaratnam ◽  
Al Fazir Omar ◽  
Yau Piow Ng
Keyword(s):  
Left Main ◽  
Bifurcation Lesion ◽  
Drug Coated Balloon

scholarly journals A case of drug-coated balloon treatment for three-vessel stenosis with left main bifurcation lesion

2020 ◽  
Vol 27 (1) ◽  
pp. 85-86
Author(s):  
Tae-Hyun Kim ◽  
Ju-Hyun Chung ◽  
Eun-Seok Shin
Keyword(s):  
Left Main ◽  
Bifurcation Lesion ◽  
Vessel Stenosis ◽  
Drug Coated Balloon

scholarly journals Progression of cerebral infarction before and after thrombectomy is modified by prehospital pathways

2021 ◽  
pp. neurintsurg-2020-017155
Author(s):  
Alexander M Kollikowski ◽  
Franziska Cattus ◽  
Julia Haag ◽  
Jörn Feick ◽  
Alexander G März ◽  
...  
Keyword(s):  
Patient Characteristics ◽  
Large Vessel ◽  
Stroke Severity ◽  
Large Vessel Occlusion ◽  
Time Intervals ◽  
Vessel Occlusion ◽  
Before And After ◽  
Transferred Patients ◽  
Stroke Center

BackgroundEvidence of the consequences of different prehospital pathways before mechanical thrombectomy (MT) in large vessel occlusion stroke is inconclusive. The aim of this study was to investigate the infarct extent and progression before and after MT in directly admitted (mothership) versus transferred (drip and ship) patients using the Alberta Stroke Program Early CT Score (ASPECTS).MethodsASPECTS of 535 consecutive large vessel occlusion stroke patients eligible for MT between 2015 to 2019 were retrospectively analyzed for differences in the extent of baseline, post-referral, and post-recanalization infarction between the mothership and drip and ship pathways. Time intervals and transport distances of both pathways were analyzed. Multiple linear regression was used to examine the association between infarct progression (baseline to post-recanalization ASPECTS decline), patient characteristics, and logistic key figures.ResultsASPECTS declined during transfer (9 (8–10) vs 7 (6-9), p<0.0001), resulting in lower ASPECTS at stroke center presentation (mothership 9 (7–10) vs drip and ship 7 (6–9), p<0.0001) and on follow-up imaging (mothership 7 (4–8) vs drip and ship 6 (3–7), p=0.001) compared with mothership patients. Infarct progression was significantly higher in transferred patients (points lost, mothership 2 (0–3) vs drip and ship 3 (2–6), p<0.0001). After multivariable adjustment, only interfacility transfer, preinterventional clinical stroke severity, the degree of angiographic recanalization, and the duration of the thrombectomy procedure remained predictors of infarct progression (R2=0.209, p<0.0001).ConclusionsInfarct progression and postinterventional infarct extent, as assessed by ASPECTS, varied between the drip and ship and mothership pathway, leading to more pronounced infarction in transferred patients. ASPECTS may serve as a radiological measure to monitor the benefit or harm of different prehospital pathways for MT.

Intraoperative transesophageal assessment of coronary artery flow can predict 5 type myocardial infarction

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
A Zagatina ◽  
M Novikov ◽  
N Zhuravskaya ◽  
V Balakhonov ◽  
S Efremov ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Cardiac Surgery ◽  
Coronary Artery ◽  
Flow Velocity ◽  
Coronary Flow ◽  
Index Number ◽  
Left Main ◽  
Coronary Flow Velocity ◽  
Before And After ◽  
Flow Velocities

Abstract Background Stenosis of a coronary artery results in an increase in flow velocity in the pathologic segment. Effective grafting should decrease the stenotic native coronary velocity according to hemodynamic law. The range of decreased velocity before and after cardiac surgery can hypothetically reflect the effectiveness of a graft. The aim of the study is to determine if measuring coronary flow velocity changes during coronary artery bypass grafting (CABG) can predict intraoperative myocardial infarction. Methods One hundred sixty-six (166) consecutive patients (121 men, 64±9 years old) referred for cardiac surgery, were prospectively included in the study. A standard basic perioperative transesophageal echocardiography (TEE) examination was performed with additional scans of the left main, left anterior descending (LAD), and circumflex (LCx) arteries' proximal segments. Measurements of coronary flow velocities were performed before and after grafting in the same sites of the arteries. The maximal value of cardiac troponin I (cTnI) after CABG and the additive criteria were accounted for in the analysis as it is described in the expert consensus document for Type 5 myocardial infarction (MI) definition. Results One hundred sixty-three patients (98%) had arterial hypertension, 28 patients (17%) had diabetes mellitus, 35 patients (21%) were currently smokers. The feasibility of coronary flow assessment during cardiac operations was 95%. Before grafting, the mean velocity in the left main artery was 91±49 cm/s, in LAD 101±35 cm/s, and in LCx 117±49 cm/s. There was a significant correlation between changes in coronary flow velocities during operation and the value of cTnI (R=0.34, p&lt;0.0001). Ten patients met the criteria for Type 5 MI. There were no differences in age, body mass index, number of coronary arteries with stenoses, frequency of prior MI, ejection fraction or coronary flow velocity before surgery in patients with and without Type 5 MI. The group of patients with Type 5 MI had an increase in native artery velocities during surgery in comparison with patients without MI, who had a significant decrease in coronary flow velocity after grafting (30±48 vs. −10±30 cm/s; p&lt;0.0006). Increases in native coronary velocities greater than 3 cm/s predicted Type 5 MI with 81% accuracy (sensitivity 88%, specificity 70%). Conclusion Coronary flow velocity assessment during cardiac surgery could predict an elevation of cardiac troponins and Type 5 MI. Funding Acknowledgement Type of funding source: None

scholarly journals Intracoronary ultrasound imaging before and after directional coronary atherectomy: In vitro and clinical observations

1995 ◽  
Vol 129 (5) ◽  
pp. 841-851 ◽  
Author(s):  
Shigeru Nakamura ◽  
Donald J. Mahon ◽  
Cyril Y. Leung ◽  
Bavani Maheswaran ◽  
Dan E. Gutfinger ◽  
...  
Keyword(s):  
Ultrasound Imaging ◽  
Intracoronary Ultrasound ◽  
Clinical Observations ◽  
Before And After ◽  
Directional Coronary Atherectomy

Left coronary artery stenosis with post-stenotic aneurysm after arterial switch operation before and after coronary revascularisation surgery

2011 ◽  
Vol 21 (4) ◽  
pp. 456-457 ◽  
Author(s):  
Davide Marini ◽  
Claudio Defilippi ◽  
Gabriella Agnoletti
Keyword(s):  
Coronary Artery ◽  
Left Coronary Artery ◽  
Left Main Coronary Artery ◽  
Coronary Artery Stenosis ◽  
Arterial Switch Operation ◽  
Cardiac Computed Tomography ◽  
Left Main ◽  
Arterial Switch ◽  
Switch Operation ◽  
Before And After

AbstractWe report the case of a child with severe and atypical stenosis of the left main coronary artery, which occurred late after arterial switch operation for transposition of the great arteries. Cardiac computed tomography accurately defined the lesion, showing the presence of post-stenotic dilation, guided the surgical approach and assessed coronary patency after revascularisation surgery.

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