scholarly journals Treatment Procedures for Calcified Coronary Artery Lesions: A Juxtaposing Review of Intravascular Lithotripsy and Rotational Atherectomy

2021 ◽  
Author(s):  
Prima Hapsari Wulandari
Keyword(s):  
Coronary Artery ◽  
Coronary Arteries ◽  
Mechanical Energy ◽  
Coronary Vessels ◽  
Calcium Content ◽  
Electrical Energy ◽  
Rotational Atherectomy ◽  
Vascular Lesions ◽  
Major Adverse Cardiovascular Events ◽  
High Calcium

Abstract The calcium content in the coronary artery is one of the most important factors that influence coronary events. High calcium levels lead to excessive calcification in coronary vessels and are more difficult to treat with percutaneous intervention (PCI). Treatment for complex lesions is performed by intravascular lithotripsy (IVL) system consisting of balloon catheters within which electrical energy is being transformed into mechanical energy. IVL technology discharges soundwaves that transmit to the neighbouring tissue leading to improvement in vascular compliance and the destruction of both superficial and visceral calcium deposits. Consequently, coronary artery calcification (CAC) treatment becomes more effective, more practical, and plays a role in reducing lesion complexity. Types of lesions studied for the IVL system comprise of calcified coronary arteries and peripheral vascular lesions. This article evaluates the role of the IVL system in treating coronary arteries calcification, its benefits, and drawbacks compared to other techniques. According to clinical trials in intravascular lithotripsy and rotational atherectomy, the former was deemed more secure, primarily by reducing the risk of embolization by atheroma. Interpreting the studies included in this review, IVL appears to have superior results in acute lumen gain, success rate, and improvement in stenosis residue, while rotational atherectomy (RA) delivers lesser in-hospital major adverse cardiovascular events (MACE) and provides better approach in the presence of lesion crossings. Additional extensive researches and clinical data are needed to substantiate the efficiency and safety of IVL technology.

A CADAVERIC STUDY ON CORONARY ARTERY VARIATIONS AND ITS CLINICAL `SIGNIFICANCE

2021 ◽  
pp. 20-22
Author(s):  
Sony Jhansi Priya ◽  
Sangeetha A ◽  
M. Sai Krishna
Keyword(s):  
Coronary Artery ◽  
Coronary Arteries ◽  
Left Coronary Artery ◽  
Coronary Vessels ◽  
Average Diameter ◽  
Cadaveric Study ◽  
Aortic Sinus ◽  
Clinical Procedures ◽  
Human Cadavers ◽  
The Right

Coronary artery variations are one of the commonest variations observed during clinical procedures. Normally, there are two main coronary arteries, the right coronary artery (RCA), left coronary artery (LCA).Left coronary artery gives two important branches left circumex artery (LCX) and left anterior descending (LAD) arteries. Knowledge about the coronary vessels and its variations are essential to clinicians to prevent untoward injury of vessels during any procedures. To study the morphology and variations of coronar Aim: y arteries by dissection. Materials and Methods: The present study was a cadaveric study which was conducted on 50 hearts obtained from adult human cadavers. Coronary arteries were dissected to see the origin, course and variations. The data was entered in Microsoft excel sheet and expressed in percentage. The Right Results: coronary artery branched out from the right aortic sinus and had an average diameter of 3.5mm. The left coronary artery arouse from left aortic sinus and had an average diameter of 4mm. LMCA divided into two branches in 60 percent, three branches in 30 percent and four branches in 06 percent of the hearts and direct branches from left aortic sinuus in 4 percent hearts.Based on the origin of Posterior descending or interventricular artery, Right dominance was observed in 68 percent, left dominance in 26 percent, and equal dominance in 06 percent of the hearts. Conclusion: Knowledge about the variations of coronary vessels is a prerequisite for clinicians to perform interventions of coronary vessels.

P873Plasma PCSK9 levels and atherosclerosis burden in the coronary arteries of patients undergoing coronary angiography

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
Y Panahi ◽  
M S Ghahrodi ◽  
M S Jamshir ◽  
M A Safarpour ◽  
M Pirro ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Coronary Angiography ◽  
Coronary Arteries ◽  
Coronary Stenosis ◽  
Coronary Vessels ◽  
Cross Sectional Study ◽  
Cross Sectional ◽  
Vessel Disease ◽  
Coronary Calcifications ◽  
Triple Vessel Disease

Abstract Background Plasma PCSK9 levels, a novel and effective therapeutic target for CVD prevention, have been associated with CVD events irrespective of traditional risk factors. Whether PCSK9 levels predict coronary artery disease (CAD) burden and severity is a matter of dispute. Purpose To investigate the association between plasma PCSK9 levels and CAD characteristics, including number of major diseased vessels, severity of coronary stenosis, and the burden of coronary calcifications. Methods One hundred and one patients undergoing coronary angiography were recruited for this cross-sectional study. The number of major coronary diseased vessels was defined as the presence of ≥1 stenoses ≥50% in diameter of at least one major coronary artery. CAD severity was defined as either the absence of coronary stenosis (no-CAD), CAD<50% or CAD≥50% in one or more coronary arteries. The burden of coronary calcifications was estimated by angiography visual inspection and classified as absent, mild, moderate or severe. Results Coronary angiography showed single, double and triple vessel disease in 26 (25.7%), 23 (22.8%) and 21 (20.8%) patients, respectively; 20 (19.8%) and 11 (10.9%) pts had either minimal CAD (<50%) or normal angiographic findings. Also, calcifications were absent in 65 patients (64.4%), and mild, moderate and severe in 23 (22.8%), 11 (10.9%) and 2 (2%) patients, respectively. Plasma PCSK9 levels were significantly associated with age (rho=0.22, p=0.025) and SBP (rho=0.21, p=0.034), and were almost doubled in patients with chronic kidney disease (CKD) as compared to those without CKD [164.6 ng/mL (104.6–187.0) vs 94.8 ng/mL (86.8–114.9), p=0.006]. Among patients without CKD, those with CAD≥50% had higher plasma PCSK9 levels than those without [97.1 ng/mL (87.8–143.0) vs 83.2 ng/mL (73.4–102.6), p=0.04]. In the overall population, higher plasma PCSK9 levels were found in pts with triple vessel disease [165.7 ng/mL (121.3–180.5)] than in those with double/single vessel involvement [97.9 ng/mL (87.6–99.8) and 88.4 ng/mL (87.3–97.4), p<0.001 for both comparisons] or without CAD [87.5 ng/mL (74.3–114.9), p<0.001]. Also, a trend toward an increase of plasma PCSK9 levels was found with higher CAD severity [no-CAD: 87.5 ng/mL (74.3–114.9), CAD<50%: 89.1 ng/mL (78.9–105.3), CAD≥50%: 97.6 ng/mL (87.9–155.3), p=0.051], which turned significant after exclusion of CKD patients (p=0.042). Adjustment for age, sex, plasma LDL-cholesterol levels, statin use and CKD abolished the association between PCSK9 and CAD severity but not with the number of significantly diseased vessels and the burden of coronary calcifications. Conclusions Circulating PCSK9, whose plasma levels are significantly influenced by the presence of CKD, discriminates patients with significant coronary artery stenosis from those without CAD. In addition, both the number of diseased coronary vessels and total coronary calcifications are independently predicted by an elevated plasma PCSK9 level. Acknowledgement/Funding None

scholarly journals Intimal Estrogen Receptor (ER)β, But Not ERα Expression, Is Correlated with Coronary Calcification and Atherosclerosis in Pre- and Postmenopausal Women

2006 ◽  
Vol 91 (7) ◽  
pp. 2713-2720 ◽  
Author(s):  
Rose C. Christian ◽  
Peter Y. Liu ◽  
Sean Harrington ◽  
Ming Ruan ◽  
Virginia M. Miller ◽  
...  
Keyword(s):  
Smooth Muscle ◽  
Coronary Artery ◽  
Postmenopausal Women ◽  
Coronary Arteries ◽  
Smooth Muscle Actin ◽  
Premenopausal Women ◽  
Calcium Content ◽  
Coronary Calcification ◽  
Calcium Deposition ◽  
Plaque Area

Abstract Background: Controversy exists over the association of estrogen and cardiovascular disease. Estrogen receptors (ERs) α and β are expressed in the endothelial cells and vascular smooth muscle cells (VSMCs) of many arteries, but the relative importance of ERα or ERβ in mediating the vascular response to estrogens is not well defined, particularly in humans. We have shown previously that postmenopausal women receiving hormone therapy (HT) had lower mean coronary artery calcium, plaque area, and calcium-to-plaque ratio compared with untreated women. In this study, we examined coronary artery ERα and ERβ expression in pre- and postmenopausal women as a function of plaque area, calcium area, calcium-to-plaque ratio, and estrogen status. Methods: Coronary arteries were obtained at autopsy from a total of 55 women: nine premenopausal women, 13 postmenopausal women on HT and 33 untreated postmenopausal women (non-HT). Coronary calcification was quantified by contact microradiography, and atherosclerotic plaque area was measured histologically. Coronary artery cross-sections were immunostained for ERα and ERβ, and the amount of receptors was estimated semiquantitatively in each arterial wall layer (intima, adventitia, and media). Double immunofluorescence was used to colocalize ERα and ERβ with smooth muscle actin, a marker of VSMCs. Results: ERβ and ERα were expressed in all artery wall layers, but most avidly in the media (P = 0.001), and colocalized with VSMCs. ERβ expression exceeded ERα expression in all wall layers (P &lt; 0.001) and was adjacent to areas of calcium deposition. ERβ expression in the intimal layer correlated with calcium content, plaque area, and calcium-to-plaque ratio (all P &lt; 0.01) and tended to be greater in non-HT than in HT women (P = 0.06). ERα expression did not vary significantly among groups, nor did it correlate with calcium content, plaque area or calcium-to-plaque ratio. Expression of ERα but not ERβ declined with age (P &lt; 0.01) in HT women only. Age had no effect on ERα or ERβ expression in non-HT or premenopausal women. Conclusions: ERβ is the predominant ER in human coronary arteries and correlates with coronary calcification, a marker of severe atherosclerosis. Increased ERβ expression is linked to advanced atherosclerosis and calcification independent of age or hormone status. Future pharmacogenetic studies that target this receptor are needed to confirm causality.

scholarly journals VOLUMETRIC DYNAMIC 640-SLICE CT OF CORONARY ARTERIES

2018 ◽  
pp. 32-39
Author(s):  
N. S. Serova ◽  
O. S. Kondrashina ◽  
S. A. Kondrashin
Keyword(s):  
Heart Disease ◽  
Coronary Artery ◽  
Ct Angiography ◽  
Coronary Arteries ◽  
Prognostic Value ◽  
Selection Criterion ◽  
Coronary Vessels ◽  
Rank Correlation ◽  
Diagnostic Efficiency ◽  
Coronary Syndrome

Purpose. Evaluation of diagnostic efficiency and safety of volumetric dynamic 640-slice CT in the detection of stenotic lesions of the coronary arteries.Materials and methods. In University clinic N1 in 2016–2017 years we investigated 86 patients with ischemic heart disease or valvular heart disease. All patients were fulfilled volumetric dynamic 640-slice CT-coronarography with retrospective ECG-synchronization and subsequent multiparametric reconstruction and evaluation of the coronary vessels. We determinate the degree of stenosis of the coronary arteries. The results are compared with data of the standard coronarography. 22 patients previously had stenting coronary arteries. In 12 cases, patients have atrial fibrillation. The selection criterion for the study was the absence of progression of the disease for at least 6 weeks and a minimum period of 3 months of optimal medical therapy. The study did not include patients with acute coronary syndrome and patients with aortic-coronary bypass surgery in history. All patients were performed CT-angiography on 640-slice CT Aquilion One (Toshiba, Japan). Contrast agent (Ultravist-370) of room temperature was injected into the cubital vein via catheter 18G at a speed of 4.5 ml/s.Results. Statistical criteria in the detection of coronary artery stenosis at MSCT-coronarography were as follows: sensitivity – 94.3%, specificity – 93.5%, accuracy – 92.8%, positive prognostic value – 96.4%, negative prognostic value – 87.3%. Spearman rank correlation coefficient in the evaluation of coronary artery lesions according to these methods was 0.68.Conclusion. Volumetric dynamic 640-slice CT-angiography is a highly sensitive safe non-invasive method of examination of patients with different cardiovascular diseases, which is characterized by low radiation dose and high security.

scholarly journals Spontaneous Extramural Coronary Arteritis in Dogs,

1989 ◽  
Vol 17 (1_part_2) ◽  
pp. 138-144 ◽  
Author(s):  
Howard A. Hartman
Keyword(s):  
Coronary Arteries ◽  
Inflammatory Cell ◽  
Mononuclear Cells ◽  
Coronary Vessels ◽  
Inflammatory Lesion ◽  
Vascular Lesions ◽  
Coronary Arteritis ◽  
Random Source ◽  
The Media ◽  
The Right

Control and treated beagle and random-source dog hearts obtained from 119 toxicological experiments were evaluated histologically to study the incidence and characteristics of a microscopic inflammatory lesion specific to the extramural coronary arteries. The lesion occurred in 23% of the experiments. The incidence was 2.3% of the control and treated beagle hearts examined. In the control begales, it was present in 3.1% of males and 1.3% of females and in the treated beagles, in 1.8% males and 2.8% females. It occurred in 4.7% of the random-source animals. While not visible grossly, histologically, the solitary lesions were characterized by adventitial infiltrates of mononuclear cells, occasional areas of necrosis with inflammatory cell infiltrates occurring in the mural and subendothelial regions. The latter resulted in prominent separation of the intima from the media. The lesions occurred in the right and left coronary arteries and in the dorsal, circumflex and ventral descending branches of the left coronary artery. Similar vascular lesions were not found in the intramural coronary vessels or in other organs in the affected animals. Expanded sampling of the extramural coronary arteries revealed an incidence of 5–9%. This lesion of focal extramural coronary arteritis was considered idiopathic, and not a manifestation of recently reported polyarteritis syndromes in dogs.

scholarly journals CORONARY ARTERY FISTULA, WHERE ARE WE NOW?''

2021 ◽  
Author(s):  
Federico Benetti ◽  
Jessica González ◽  
Gustavo Abuin
Keyword(s):  
Coronary Artery ◽  
Coronary Arteries ◽  
Surgical Repair ◽  
Coronary Vessels ◽  
Rare Condition ◽  
Coronary Artery Fistula ◽  
Myocardial Scintigraphy ◽  
Coronary Ct ◽  
Cardiac Procedures ◽  
Coronary Artery Fistulas

In the study “Long-term outcomes following surgical repair of coronary artery fistula in adults”, Wada and associates, retrospectively evaluated 13 consecutive patients that underwent surgical repair of CAF No deaths, significant ST-T changes or CAF-related events were reported in a follow-up period of 66.2 months, and 1 patient showed poor contrast RCA#2 on postoperative coronary CT with a myocardial scintigraphy showing no significant change compared to the preoperative state Coronary artery fistulas (CAF) are rare congenital or acquired malformations in the connection of the coronary vessels, first described by Krause in 1865 (2). They can be classified as coronary-cameral fistulas, which connect coronary arteries with any of the heart chambers, or coronary artery malformations, which connect coronary arteries with systemic or pulmonary vessels. Congenital CAFs are normally a result of abnormal embryological development, acquired CAFs are commonly a result of cardiac traumatic injuries, and iatrogenic CAFs are usually a result of interventional cardiac procedures. This condition is still highly undiagnosed, as around 75% of incidentally-found CAFs are small and clinically silent, but it is estimated that CAFs are present in about 0.9% of the general population In our experience, we have a CAF incidence of 0.05% in 10,000 cardiac surgeries, which have demonstrated beneficial outcomes of the surgical repair of CAFs in adults . Authors of this article must be congratulated for the successful development of the study and for the contributions to the literature on this rare condition

scholarly journals Coronary Microvascular Vasodilatory Function: Related Clinical Features and Differences According to the Different Coronary Arteries and Types of Coronary Spasm

2021 ◽  
Vol 11 (1) ◽  
pp. 130
Author(s):  
Hiroki Teragawa ◽  
Chikage Oshita ◽  
Yuko Uchimura ◽  
Ryota Akazawa ◽  
Yuichi Orita
Keyword(s):  
Coronary Artery ◽  
Coronary Arteries ◽  
Smoking Status ◽  
Coronary Spasm ◽  
Coronary Vessels ◽  
Clinical Parameters ◽  
Microvascular Angina ◽  
Flow Reserve ◽  
Diffuse Spasm ◽  
Vasodilatory Function

Background: In the clinical setting; the microvascular vasodilatory function test (MVFT) with a pressure wire has been used in ischaemia patients with non-obstructive coronary arteries (INOCA), including vasospastic angina (VSA) and microvascular angina (MVA). The exact factors that affect the microvascular vasodilatory function (MVF) in such patients are still unknown. We aimed to identify the factors, including clinical parameters and lesion characteristics, affecting the MVF in such patients. Methods: A total of 53 patients who underwent coronary angiography, spasm provocation tests (SPTs) and MVFTs were enrolled. In the MVFT, the coronary flow reserve (CFR) and index of microcirculatory resistance (IMR) were measured. Of the 53 patients, MVFT data in the left anterior descending coronary artery (LAD) were obtained from 49 patients, and the clinical parameters were checked in all of them. Based on the results of the SPT, coronary spasms were divided into focal spasm, diffuse spasm, and microvascular spasm (MVS). To assess the lesion characteristics influencing MVF, MVFT data were compared according to the types of coronary spasm and coronary vessels in 73 vessels of the 53 patients. Results: In 49 patients who underwent the MVFT in the LAD, the IMR was higher in active smokers (n = 7) than in former smokers (n = 15) and never smokers (n = 27, p < 0.01). In the 73 coronary arteries in this study, the type of coronary spasm did not correlate with the CFR or IMR, whereas a higher IMR were more frequently observed in cases of focal spasm than in cases of diffuse spasm (p = 0.03). In addition, the IMR was higher in the right coronary artery (RCA) than in the LAD (p = 0.02). Conclusion: These results indicate that the smoking status affected the MVF in patients with INOCA, suggesting the possibility of improvement in the MVF by smoking cessation in such patients. In addition, in the assessment of MVF, it may be important to take into account which coronary artery or types of coronary spasm are being evaluated.

scholarly journals Idiopathic Extramural Coronary Arteritis in Beagle and Mongrel Dogs

1987 ◽  
Vol 24 (6) ◽  
pp. 537-544 ◽  
Author(s):  
H. A. Hartman
Keyword(s):  
Coronary Arteries ◽  
Left Coronary Artery ◽  
Inflammatory Cell ◽  
Mononuclear Cells ◽  
Coronary Vessels ◽  
Vascular Lesions ◽  
Elastic Membrane ◽  
Inflammatory Lesions ◽  
Coronary Arteritis ◽  
The Right

Hearts obtained from 119 toxicological experiments on dogs during a 21-year period (1965–1986) were evaluated histologically to determine the incidence and characteristics of focal microscopic inflammatory lesions of the extramural coronary arteries. Lesions were encountered in 23% of 119 experiments. The average overall incidence was 2.3% of 1,905 control and chemically treated male and female beagle hearts (3.1% of male and 1.3% of female control beagles, and 1.8% of male and 2.8% of female treated beagles). Lesions were seen in 4.7% of 127 random-source mongrel dogs. Histologically, lesions were characterized by adventitial infiltrates of mononuclear cells, areas of mural necrosis, and inflammatory cell infiltrates in both mural and subendothelial regions. In the latter region, fibrosis developed separating the intima from the internal elastic membrane. Lesions occurred in the right and left coronary arteries and in the dorsal, circumflex, and ventral descending branches of the left coronary artery. Vascular lesions were not present in the intramural coronary vessels or in vessels of other organs in affected animals. More extensive sampling of the extramural coronary arteries revealed an incidence of 5–9%. The lesion of focal extramural coronary arteritis was idiopathic, and not a manifestation of the polyarteritis syndrome of dogs.

Sign in / Sign up

Export Citation Format

Share Document