Intravascular Ultrasound Assessment and Correlation With Angiographic Findings of Arterial Dissections Following Auryon Laser Atherectomy and Adjunctive Balloon Angioplasty: Results of the iDissection Auryon Laser Study

2021 ◽  
pp. 152660282110282
Author(s):  
Nicolas W. Shammas ◽  
James T. Torey ◽  
W. John Shammas ◽  
Susan Jones-Miller ◽  
Gail A. Shammas
Keyword(s):  
Intravascular Ultrasound ◽  
Complex Disease ◽  
Vessel Diameter ◽  
Transluminal Angioplasty ◽  
Primary Objective ◽  
Distal Embolization ◽  
Total Occlusion ◽  
Blood Institute ◽  
Minimal Rate ◽  
Laser Atherectomy

Background Femoropopliteal arterial angiographic dissections with the use of the Auryon laser atherectomy system (previously the B-laser) have been infrequent and non–flow limiting. However, the pattern of these dissections (depth and arc) using intravascular ultrasound remains unknown. Materials and Methods We prospectively enrolled 29 patients in the iDissection Auryon study. The primary objective was to define the occurrence of new adventitial injury with intravascular ultrasound (IVUS). Secondary objectives included distal embolization and bailout stenting as judged by the operator because of 30% or more residual narrowing and/or NHLBI (National Heart, Lung, and Blood Institute) angiographic dissection C and higher. Core laboratory analysis was carried on all cases except for 1 patient (that crossed over to Jetstream atherectomy). Dissections were classified according to the iDissection classification as involving the intima (A), media (B), and adventitia (C) and ≤ 180-° arc (1) or >180-° arc (2). Overall, 22 of 29 patients had an embolic filter (per protocol). Results Median lesion and treated lengths were 100.0 and 150.0 mm, respectively. Vessel diameter by IVUS was 6.5 ± 1.5 mm. Chronic total occlusion (CTO) was present in 24.1% of cases. The arc of calcium was: no calcium in 27.6%, <90° in 13.8%, 90° to 180° in 20.7%, and >180° in 34.4%. Lesion severity was reduced to a median of 14% post laser and adjunctive percutaneous transluminal angioplasty (PTA) from a baseline of 76%. Bailout stenting occurred in 6 of 28 (21.4%) patients (3 for dissections, 2 for residual >30%, and 1 for both) and primary stenting in 1 of 28 (3.6%). By IVUS, there were 9 new dissections post laser (1 adventitial; 3≥180°) and 21 new dissections post laser and PTA (3 adventitial; 1≥180°). No distal embolization requiring treatment was seen and no macrodebris ≥2 mm was recovered in the filters. Conclusion The Auryon laser atherectomy system had minimal rate of adventitial injury despite complex disease with relatively low bailout stent rate and no clinically significant macrodebris.

Vessel Diameter Evaluated by Intravascular Ultrasound Versus Angiography

2021 ◽  
pp. 152660282110479
Author(s):  
Osamu Iida ◽  
Mitsuyoshi Takahara ◽  
Yoshimitsu Soga ◽  
Masahiko Fujihara ◽  
Daizo Kawasaki ◽  
...  
Keyword(s):  
Intravascular Ultrasound ◽  
Stent Implantation ◽  
Vessel Diameter ◽  
Total Occlusion ◽  
Small Vessels ◽  
Clinically Important Difference ◽  
History Of ◽  
Increasing Risk ◽  
The Difference ◽  
Artery Disease

Purpose: Although reference vessel diameter (RVD) is conveniently measured by angiography during femoropopliteal (FP) endovascular therapy (EVT) in clinical practice, angiography will potentially underestimate RVD. On the other hand, intravascular ultrasound (IVUS) can measure RVD precisely. The aim of this study was to reveal the difference between angiography- and IVUS-assessed RVD in patients undergoing FP-EVT for symptomatic peripheral artery disease (PAD). Methods: We analyzed a prospective and multicenter database including 1967 limbs of 1725 patients with symptomatic PAD undergoing IVUS-supported FP-EVT. The study outcome measure was the difference between IVUS- and angiography-assessed distal RVD ( ΔRVD), calculated as angiography-assessed RVD subtracted from IVUS-assessed RVD. The clinically important difference was defined as 1 mm or larger. Results: IVUS-assessed RVD was significantly larger than angiography-assessed RVD (6.0±1.0 mm vs 5.0±1.0 mm; p<0.001). Mean ΔRVD (IVUS- minus angiography-assessed RVD) was 0.98 mm (95% CI, 0.94–1.03 mm). ΔRVD was 1 mm or larger in 48.8% (46.5%–51.0%) of the whole population. Multivariate analysis demonstrated that small angiography-assessed RVD, angiography-assessed bilateral calcification, and history of stent implantation were significantly associated with an increasing risk of ΔRVD ≥1mm, whereas presence of chronic total occlusion (CTO) was significantly associated with a decreasing risk of ΔRVD ≥1 mm. Conclusion: The current study revealed the difference between angiography-assessed reference lumen diameter and IVUS-assessed reference EEM diameter of FP lesions. About half of population had ΔRVD ≥1 mm. IVUS-assessed RVD was more likely to be different by angiography in cases with small vessels, CTO, bilateral calcification, and history of stent implantation.

Optimal Vessel Sizing and Understanding Dissections in Infrapopliteal Interventions: Data From the iDissection Below the Knee Study

2020 ◽  
Vol 27 (4) ◽  
pp. 575-580 ◽  
Author(s):  
Nicolas W. Shammas ◽  
W. John Shammas ◽  
Susan Jones-Miller ◽  
James T. Torey ◽  
Ehrin J. Armstrong ◽  
...  
Keyword(s):  
Vessel Diameter ◽  
Accurate Estimate ◽  
Transluminal Angioplasty ◽  
Lesion Length ◽  
Internal Elastic Lamina ◽  
Post Intervention ◽  
Blood Institute ◽  
Below The Knee ◽  
Orbital Atherectomy ◽  
Vascular Angiography

Purpose: To investigate if imaging with intravascular ultrasound (IVUS) yields a more accurate estimate of vessel diameter and the presence of dissections than angiography after intervention in the infrapopliteal arteries. Materials and Methods: A prospective, single-center study enrolled 20 consecutive patients (mean age 74.1±12.4 years; 12 women) with infrapopliteal disease who were treated with percutaneous transluminal angioplasty (PTA; n=10) or orbital atherectomy (OA) followed by PTA (n=10). The majority of patients were hypertensive and half were diabetic. The overall lesion length was 7.3±6.3 cm, and the diameter stenosis was 80.3%±22.1%. The baseline characteristics did not differ between the groups. Vessel diameters were measured using IVUS from the internal elastic lamina (IEL) to the IEL. IVUS was performed at baseline, post PTA or OA, and post OA+PTA. Quantitative vascular angiography (QVA) and IVUS were analyzed by a core laboratory. Dissections on cine images were categorized based on the National Heart Lung and Blood Institute (NHLBI) classification, while the arc and depth were used to characterize dissections on IVUS images. Results: Mean vessel diameter by QVA was 2.9±0.6 vs 4.0±1.0 mm by IVUS according to the core laboratory (mean difference 1.1±0.9, p<0.001). On angiography, there were 7 dissections after PTA (6 C, 1 D), 1 dissection after OA (1 B), and 2 dissections after OA+PTA (1 A, 1 B; p=0.028 vs post PTA). IVUS uncovered 3.8 times more dissections than seen on angiography. There were 23 dissections after PTA (18 intima, 3 media, 2 adventitia), 12 dissections after OA (8 intima, 1 media, 3 adventitia), and 11 dissections following OA+PTA (7 intima, 1 media, 3 adventitia; p=0.425 vs PTA). Bailout stenting (all due to angiographic dissections ≥C) was necessary in 6 of the PTA cohort and none of the OA+PTA group. Conclusion: In addition to underestimating the infrapopliteal vessel diameter by ~25%, angiography underappreciated the presence and severity of post-intervention dissections vs IVUS, particularly in the OA+PTA group.

Choice of Intracoronary Imaging: When to Use Intravascular Ultrasound or Optical Coherence Tomography

2016 ◽  
Vol 11 (1) ◽  
pp. 11
Author(s):  
Sudheer Koganti ◽  
◽  
◽  
◽  
Tushar Kotecha ◽  
...  
Keyword(s):  
Optical Coherence Tomography ◽  
Coronary Angiography ◽  
Intravascular Ultrasound ◽  
Coronary Stenosis ◽  
Coronary Intervention ◽  
Vessel Diameter ◽  
Drug Eluting Stent ◽  
Optical Coherence ◽  
Disease Extent ◽  
Intracoronary Imaging

Intracoronary imaging has the capability of accurately measuring vessel and stenosis dimensions, assessing vessel integrity, characterising lesion morphology and guiding optimal percutaneous coronary intervention (PCI). Coronary angiography used to detect and assess coronary stenosis severity has limitations. The 2D nature of fluoroscopic imaging provides lumen profile only and the assessment of coronary stenosis by visual estimation is subjective and prone to error. Performing PCI based on coronary angiography alone is inadequate for determining key metrics of the vessel such as dimension, extent of disease, and plaque distribution and composition. The advent of intracoronary imaging has offset the limitations of angiography and has shifted the paradigm to allow a detailed, objective appreciation of disease extent and morphology, vessel diameter, stent size and deployment and healing after PCI. It has become an essential tool in complex PCI, including rotational atherectomy, in follow-up of novel drug-eluting stent platforms and understanding the pathophysiology of stent failure after PCI (e.g. following stent thrombosis or in-stent restenosis). In this review we look at the two currently available and commonly used intracoronary imaging tools – intravascular ultrasound and optical coherence tomography – and the merits of each.

scholarly journals Efficacy of navigating through the intraplaque route using AnteOwl WR intravascular ultrasound in femoropopliteal chronic total occlusion

2021 ◽  
Vol 4 (1) ◽  
Author(s):  
Naoki Hayakawa ◽  
Satoshi Kodera ◽  
Keisuke Takanashi ◽  
Shuichi Sahashi ◽  
Sandeep Shakya ◽  
...  
Keyword(s):  
Intravascular Ultrasound ◽  
Popliteal Artery ◽  
Chronic Total Occlusion ◽  
Asymmetric Structure ◽  
Stent Deployment ◽  
Total Occlusion ◽  
Antegrade Approach ◽  
Angiographic Image ◽  
Good Expansion ◽  
Drug Coated Balloon

Abstract Background There is no consensus on the optimal guidewire passage route for femoropopliteal (FP) chronic total occlusion (CTO). If intraplaque wiring can be performed, a stent-less strategy using a drug-coated balloon can be realized even with FP CTO, and there is a high possibility that good expansion can be obtained even when stent deployment is performed. AnteOwl WR (AnteOwl) is a novel intravascular ultrasound (IVUS) device useful for navigating the second guidewire into the intraplaque route under IVUS observation from the subintimal space. Here, we describe representative cases of FP CTO in which CTO-specific IVUS was extremely useful. Case presentation Case 1 involved a 79-year-old man with total occlusion of the left superficial femoral artery (SFA). We used a contralateral antegrade approach, but the guidewire was advanced into the subintimal space. We advanced AnteOwl into the CTO. By utilizing the asymmetric structure of the transducer and the IVUS wire, we were able to reflect the positional relationship among the IVUS transducer, IVUS wire, and target plaque onto the angiographic image. By aiming the wiring in that direction, we succeeded in traversing the center of the plaque and finally succeeded in obtaining good expansion using the drug-coated balloon. Case 2 involved a 76-year-old woman with total occlusion from the SFA to the popliteal artery. We used an ipsilateral antegrade approach. When AnteOwl was placed on the wire and advanced to the popliteal artery, the subintimal space in the middle of the SFA could be visualized. We employed an IVUS-guided parallel wiring technique and succeeded in passing through all intraplaque routes. Although the CTO was long, we could easily advance through the intraplaque route by reflecting the information obtained from AnteOwl in angiography. Conclusions AnteOwl is an effective IVUS for FP CTO and facilitates a complex IVUS-guided procedure.

P3587Tip detection method using the new short-tip IVUS with pull-back system which facilitates the 3D wiring technique in percutaneous coronary intervention for chronic total occlusion

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
K Tanaka ◽  
A Okamura ◽  
M Iwakura ◽  
H Nagai ◽  
A Sumiyoshi ◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Intravascular Ultrasound ◽  
Chronic Total Occlusion ◽  
Distal Part ◽  
Detection Method ◽  
Coronary Intervention ◽  
Procedure Time ◽  
True Lumen ◽  
Total Occlusion ◽  
Percutaneous Coronary

Abstract Background The strategy of intravascular ultrasound (IVUS)-guided wiring for CTO PCI, that is, leading the second guidewire into the true lumen under observing by IVUS from subintimal space, is the last resort. We developed the angiography-based 3D wiring method. During establishment of the angiography-based 3D wiring method, we deduced that observation of the guidewire tip as well as the shaft named “The tip detection method” simplifies and facilitates 3D wiring under IVUS-guided wiring. Therefore, we produced New CTO IVUS which is the upgraded version of Navifocus WR IVUS by adding the pull-back transducer system. This pull-back system enables us to detect the tip as well as the shaft of the second guidewire in real time (tip detection method), which facilitates the 3D wiring technique under IVUS-guided wiring. Objective We evaluated the efficacy of the tip detection method during 3D wiring for CTO PCI with New CTO IVUS. Method We created a target pinpoint penetration model and performed the procedures using an experimental heartbeat model. The target (a tube with a lumen 0.6 mm in diameter) was placed in the distal part of a CTO 20 mm in length made of 2.5% agar. After the second guidewire (Conquest-12g) was advanced into the CTO lesion to within 5mm of the target using the angiography-based wiring, IVUS-guided wiring was performed by using Navifocus WR or New CTO IVUS each five times. Result The frequency of the puncture time was reduced using the new CTO IVUS compared to the Navifocus WR (1.7±0.8 vs. 28.8±23.2, p=0.17). The procedure time was significantly shorter using the new CTO IVUS compared to the Navifocus WR (103±61 vs. 459±373 seconds, p=0.04). Conclusion The tip detection method during 3D wiring with the new short tip IVUS with the pull-back system enables us to easily perform 3D wiring and will change the CTO PCI strategy.

Association between Preoperative Monocyte-to-Lymphocyte Ratio and Late Arteriovenous Fistula Dysfunction in Hemodialysis Patients: A Cohort Study

2021 ◽  
pp. 1-7
Author(s):  
Shouliang Hu ◽  
Dan Wang ◽  
Tean Ma ◽  
Fanli Yuan ◽  
Yong Zhang ◽  
...  
Keyword(s):  
Cohort Study ◽  
Arteriovenous Fistula ◽  
Vessel Diameter ◽  
Transluminal Angioplasty ◽  
Proportional Hazard ◽  
Clinical Value ◽  
Hazard Regression ◽  
Lymphocyte Ratio ◽  
Cox Proportional Hazard ◽  
Cox Proportional Hazard Regression

<b><i>Background:</i></b> Inflammation appears to be at the biological core of arteriovenous fistula (AVF) dysfunction, and the occurrence of AVF dysfunction is related to high death and disability in hemodialysis (HD) patients. Despite several studies on the correlations between AVF dysfunction and inflammatory indicators, how AVF dysfunction is related to the monocyte-to-lymphocyte ratio (MLR) is much unclear. We hypothesize that preoperative MLR is associated with AVF dysfunction in Chinese HD patients. <b><i>Methods:</i></b> In this single-center retrospective cohort study, totally 769 adult HD patients with a new AVF created between 2011 and 2019 were included. Association of preoperative MLR with AVF dysfunction (thrombosis or decrease of normal vessel diameter by &#x3e;50%, requiring either surgical revision or percutaneous transluminal angioplasty) was assessed by multivariable Cox proportional hazard regression. <b><i>Results:</i></b> The patients were aged 55.8 ± 12.2 years and were mostly males (55%). During the average 32-month follow-up (maximum 119 months), 223 (29.0%) patients had permanent vascular access dysfunction. In adjusted multivariable Cox proportional hazard regression analyses, the risk of AVF dysfunction was 4.32 times higher with 1 unit increase in MLR (hazard ratio [HR]: 5.32; 95% confidence interval [CI]: 3.1–9.11). Compared with patients with MLR &#x3c;0.28, HRs associated with an MLR of 0.28–0.41 and ≥0.41 are 1.54 (95% CI: 1.02–2.32) and 3.17 (2.18–4.62), respectively. <b><i>Conclusions:</i></b> A higher preoperative MLR is independently connected with a severer risk of AVF dysfunction in HD patients. Its clinical value should be determined in the future.

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