Comparison of BARD®LIFESTREAM™ Covered Balloon-Expandable Stent Versus GORE® VIABAHN™ Covered Self-Expandable Stent in Treatment of Aortoiliac Obstructive Disease: Study Protocol for a Prospective Randomized Controlled Trial(NEONATAL Trial)

Background Covered stent has become one of the mainstream therapies for aortoiliac obstructive disease (AIOD), with higher patency rate compared to bare metal stent. Covered balloon-expandable (CBE) stent can be placed more accurately with higher radial support force, while covered self-expanding (CSE) stent has greater elasticity and higher trackability. However, there is no level I evidence regarding the comparison safety and efficacy between the CSE stent and CBE stent in AIOD up to date. Therefore, this study aims to compare the efficacy and safety of CBE stent (BARD®LIFESTR`EAM™) and CSE stent (GORE® VIABAHN™) in AIOD. Methods This trial is a prospective, single center, paralleled, non-inferiority, randomized controlled trial. A total of 106 patients will be enrolled and these patients will be randomized to either the CBE stent group or CSE stent group. The primary end point of the study is occurrence of Target Lesion Revascularization (TLR) at 12 months after the intervention. Discussion To our knowledge, the NEONATAL trial is the first RCT to compare CBE and CSE stent in AIOD patients. The results of clinical trials may contribute to establishing a strategic guideline for choosing the optimal type of covered stent in treatment of AIOD patients. Trial registration: ChiCTR2100046734; Registered on 27 May, 2021 in Chinese Clinical Trials Registry.

Endovascular Treatment of Acquired Atheromatous Postsubclavian Aortic Coarctation

Coral reef aorta is a rare calcifying obstructive disease that involves the thoracoabdominal aorta. Similar presentations in the postsubclavian aorta may result in acquired atheromatous aortic coarctation leading to systemic hypertension and heart failure. The associated calcification makes surgical anatomic or extraanatomic bypass and thromboendarterectomy challenging. Extensive circumferential calcification often precludes endovascular intervention. We present the case of a 25-year-old man with an acquired atheromatous coarctation of the postsubclavian aorta who underwent successful endovascular treatment with use of a balloon-expandable covered stent.

Association of coronary artery calcium score groups with qualitative and quantitatively assessed adverse plaque

Introduction Coronary artery calcification is a marker of cardiovascular risk, but its association with qualitatively and quantitatively assessed plaque subtypes on coronary computed tomography (CT) angiography (CCTA) is unknown. Methods In this post-hoc analysis, CT images and clinical outcomes were assessed in SCOT-HEART trial participants. Agatston coronary artery calcium score (CACS) was measured on non-contrast CT and was stratified as zero (0 Agatston units, AU), minimal (1 to 9AU), low (10 to 99AU), moderate (100 to 399AU), high (400 to 999AU) and very high (≥1000AU). Adverse plaques were investigated with qualitative (visual categorisation of positive remodelling, low-attenuation plaque, spotty calcification, napkin ring sign) and quantitative (calcified, non-calcified, low-attenuation and total plaque burden) methods. Results Images of 1769 patients were assessed (mean age 58±9 years, 56% male, median Agatston score 21 [interquartile range 0 to 230] AU). Of these 36% had a zero, 9% minimal, 20% low, 17% moderate, 10% high and 8% very high CACS. Amongst patients with a zero CACS, 14% had nonobstructive disease, 2% had obstructive disease, 2% had visually assessed adverse plaques and 13% had quantitative low-attenuation plaque (LAP) burden >4% (Figure 1). Non-calcified and low-attenuation plaque burden increased between patients with zero, minimal and low CACS (p<0.001), but there was no difference between those with medium, high and very high CACS. Over a median follow-up of 4.8 [4.1 to 5.7] years, fatal or non-fatal myocardial infarction occurred in 41 patients, 10% of whom had zero CACS. CACS ≥1000AU (Hazard ratio (HR) 4.55 [1.20 to 17.3], p=0.026) and low-attenuation plaque burden (HR 1.74 [1.19 to 2.54], p=0.004) were the only predictors of myocardial infarction, independent of obstructive disease and cardiovascular risk score. Figure 2 shows example CCTA images in a patient with zero CACS, non-calcified plaque (red), low attenuation plaque (orange) burden >4% and obstructive disease in the left anterior descending coronary artery. Conclusions In patients with stable chest pain, a zero CACS is associated with a good prognosis, but 1 in 6 have coronary artery disease, including the presence of adverse plaques. FUNDunding Acknowledgement Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): British Heart Foundation, National Institute of Health/National Heart, Lung, and Blood Institute