scholarly journals Role of IVUS in the rectification of angiographically judged ramus intermedius and its clinical significance

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Xue Gong ◽  
Zheyong Huang ◽  
Zhonghan Sun ◽  
Qibing Wang ◽  
Juying Qian ◽  
...  
Keyword(s):  
Intravascular Ultrasonography ◽  
Left Main ◽  
Severe Stenosis ◽  
Diagonal Branch ◽  
Coronary Artery Angiography ◽  
Group 12 ◽  
Obtuse Marginal Branch ◽  
Obtuse Marginal ◽  
The Impact

Abstract Background Due to the technical limitations of coronary artery angiography (CAG), ramus intermedius (RI) is sometimes difficult to distinguish from a high-origin obtuse marginal branch or a high-origin diagonal branch. This study sought to investigate the role of intravascular ultrasonography (IVUS) in the rectification of angiographically judged RI. Methods This study retrospectively analyzed 165 patients who were reported to have an RI based on CAG and underwent IVUS implementation from 02/01/2009 to 31/12/2019 in Zhongshan Hospital, Fudan University. Taking IVUS as the gold standard, we calculated the accuracy of RI identification by CAG and evaluated the impact of RI on revascularization strategy. Results Among the 165 patients, 89 patients (54%) were demonstrated to have an RI on IVUS (IVUS-RI), 32 patients (19%) were identified to have a high-origin diagonal branch on IVUS (IVUS-h-D), and 44 patients (27%) had an actual high-origin obtuse marginal artery on IVUS (IVUS-h-OM). Among 84 patients who underwent one-stent crossover stenting because of left main furcation lesions (48 patients in the IVUS-RI group, 12 patients in the IVUS-h-D group, and 24 in the IVUS-h-OM group), 14.6% of patients in the IVUS-RI group, 33.3% in the IVUS-h-D group and 0% in the IVUS-h-OM group had CAG-RI compromise (P = 0.02), which was defined as severe stenosis of the RI ostium (> 75%) or significant RI flow impairment (TIMI < 3). Conclusions Only 54% of CAG-RIs were confirmed by IVUS, which indicates the necessity of preintervention IVUS to distinguish real RIs from other branches in LM furcation lesions.

Grafts for Left Main Trunk Lesion Using “MIDCAB Doughnut” on Beating Heart

2000 ◽  
Vol 8 (2) ◽  
pp. 114-117 ◽  
Author(s):  
Masao Takahashi ◽  
Go Watanabe ◽  
Hidetoshi Furuta ◽  
Toshio Doi ◽  
Nobuyuki Tanaka ◽  
...  
Keyword(s):  
Blood Flow ◽  
Internal Thoracic Artery ◽  
Axillary Artery ◽  
Beating Heart ◽  
Left Main ◽  
Main Trunk ◽  
Left Main Trunk ◽  
Hemodynamic Deterioration ◽  
Obtuse Marginal Branch ◽  
Obtuse Marginal

Successful beating heart multiple bypass grafting to the left anterior descending and circumflex artery for a left main trunk lesion was performed in 5 patients through a left thoracotomy using the “MIDCAB doughnut” for immobilization and hemostasis. After completion of left internal thoracic artery-to-left anterior descending artery grafting, a radial artery or saphenous vein graft was anastomosed safely to the obtuse marginal branch, without hemodynamic deterioration. Extending the left anterior small thoracotomy 3 or 4 cm laterally, the obtuse marginal branch could be approached easily without rotating the beating heart. The device achieved a still and stable operative field even for circumflex grafting. An inflow of the graft to the circumflex was placed at the left axillary artery to prevent blood flow shortage to the left coronary system. Mean perioperative blood flow was 29.5 ± 7.1 mL·min−1 in the internal thoracic artery grafts and 43 ± 8 mL·min−1 in the circumflex grafts. Postoperative angiography revealed patency of all grafts. The technique may extend the surgical indications for beating heart bypass surgery without cardiopulmonary bypass.

Spontaneous Left Main Coronary Artery Dissection and the Role of Intravascular Ultrasonography

2010 ◽  
Vol 29 (6) ◽  
pp. 981-988 ◽  
Author(s):  
Andrew J. Klein ◽  
Paul A. Hudson ◽  
Michael S. Kim ◽  
Joseph C. Cleveland ◽  
John C. Messenger
Keyword(s):  
Coronary Artery ◽  
Left Main Coronary Artery ◽  
Artery Dissection ◽  
Intravascular Ultrasonography ◽  
Left Main ◽  
Coronary Artery Dissection

scholarly journals Revascularization of Coronary Artery Chronic Total Occlusion by Active Antegrade Reverse Wire Technique

2021 ◽  
Vol 2021 ◽  
pp. 1-6
Author(s):  
Xiao-jiao Zhang ◽  
Zhan-xiu Zhang ◽  
Yong Wang ◽  
Pei-pei Hou ◽  
Da-ming Mu ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Chronic Total Occlusion ◽  
Coronary Intervention ◽  
Total Occlusion ◽  
Diagonal Branch ◽  
Percutaneous Coronary ◽  
Obtuse Marginal Branch ◽  
Branch Vessel ◽  
Obtuse Marginal ◽  
Occluded Segment

Objectives. To assess the effectiveness and safety of ARW for vascular recanalization in CTO patients. Background. Chronic total occlusion (CTO) of coronary artery accompanied with large branch distal to the occluded segment (<2 mm) is one of the challenges physicians are facing during the coronary intervention. In cases where the antegrade wire passed the occluded segment reaching the branch vessel, but could not access the main vessel through various adjustments, application of active antegrade reverse wire technique (ARW) could be considered. Patients and Methods. A total of 301 consecutive CTO patients who received the antegrade percutaneous coronary intervention (PCI) between December 2015 and December 2019 at our institution were included, of whom 11 were treated with ARW (10 successfully) for vascular recanalization. The applicability and safety of ARW were assessed. Results. Among the 301 CTO patients who received antegrade vascular recanalization, 11 were treated with ARW. ARW was successful in 10 patients as follows: from the diagonal branch (D) to anterior descending branch (LAD) in 4 patients; from the septal branch (S) to LAD in 1 patient; from D to S and LAD in 1 patient; from the circumflex branch (LCX) to obtuse marginal branch (OM) in 1 patient; from OM to LCX in 1 patient; from a posterior descending artery (PDA) to the posterior lateral vein (PLV) in 2 patients. Yet, ARW in patient with RCAm CTO failed, while the consequent retrograde PCI succeeded. The mean J-CTO score of the 11 patients was 2.7 ± 0.65, among whom eight were accompanied with calcifications. Sion Black and Fielder XTR reverse wires were used in 9 and 2 patients, respectively. No loss of side branches or severe procedure-related complications occurred in 11 patients. Conclusion. Therefore, ARW can improve procedural efficiency and should be popularized for further application.

scholarly journals Percutaneous Intervention for Quadrifurcation Lesion of the Left Main Coronary Artery

2019 ◽  
Vol 1 (4) ◽  
pp. 5-19
Author(s):  
Murman Kantaria ◽  
Murman Kantaria ◽  
Murman Kantaria ◽  
Vazha Agladze ◽  
Pavle Machavariani ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Left Main Coronary Artery ◽  
Optimization Technique ◽  
Bare Metal Stents ◽  
Functional Class ◽  
Metal Stents ◽  
Left Main ◽  
Circumflex Artery ◽  
Obtuse Marginal Branch ◽  
Obtuse Marginal

To demonstrate that percutaneous coronary intervention (PCI) may in some cases be a safe option for patients with a high-risk surgical category, we report a complex clinical case of revascularization of multivessel coronary artery disease including left main coronary artery (LMCA) quadrifurcation. Methods For safety reasons, PCI was done in 2 separate sessions (staged PCI). Stenting of the LMCA quadrifurcation was performed using different stenting techniques in combination: modified balloon mini crush stenting technique was used - for LMCA and intermediate artery (IMA) stenting; modified balloon crush stenting technique was used for LMCA, circumflex artery (CX) and first obtuse marginal branch (OM1) stenting; provisional stenting technique was used for CX stenting, followed by sequential kissing balloon post-dilatation technique between LMCA and every branch; proximal optimization technique (POT) was performed in the LMCA. Left anterior descending artery (LAD), intermediate artery, circumflex artery, first obtuse marginal branch, left main coronary artery and its quadrifurcation were stented with 5 drug-eluting stents (DES) (Resolute Integrity, Medtronic); right coronary artery (RCA) was stented with 3 bare-metal stents (BMS) (Rebel, Boston Scientific). Results The interventions ended without complications, the ejection fraction increased from 35% to 48%, congestive heart failure functional class decreased to class I. Subsequent coronary angiography, eight months after the last PCI, revealed patent stents with mild, nonsignificant restenosis. More than three years after the intervention, the patient has no complaints (according to MACE). Conclusions It should be considered that in case of the selection of suitable patients and the use of the appropriate revascularization technique, LMCA quadrifurcation lesion can be successfully treated with PCI.

Intergroup Threat and Outgroup Attitudes

2013 ◽  
Vol 44 (5) ◽  
pp. 311-319 ◽  
Author(s):  
Marco Brambilla ◽  
David A. Butz
Keyword(s):  
Gay Men ◽  
Social Group ◽  
Welfare Recipients ◽  
Intergroup Attitudes ◽  
Social Policies ◽  
Intergroup Threat ◽  
Economic Threat ◽  
The Impact ◽  
General Climate

Two studies examined the impact of macrolevel symbolic threat on intergroup attitudes. In Study 1 (N = 71), participants exposed to a macrosymbolic threat (vs. nonsymbolic threat and neutral topic) reported less support toward social policies concerning gay men, an outgroup whose stereotypes implies a threat to values, but not toward welfare recipients, a social group whose stereotypes do not imply a threat to values. Study 2 (N = 78) showed that, whereas macrolevel symbolic threat led to less favorable attitudes toward gay men, macroeconomic threat led to less favorable attitudes toward Asians, an outgroup whose stereotypes imply an economic threat. These findings are discussed in terms of their implications for understanding the role of a general climate of threat in shaping intergroup attitudes.

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