Angiographic Factors Research Articles

Prediction of cerebral infarction after bypass surgery in adult moyamoya disease: combing parameters on 4D perfusion CT with clinical related factors

ObjectiveThis study aimed to identify predictive factors for cerebral infarction after bypass surgery in adult patients with moyamoya disease (MMD) using quantitative parameters in 4D-CT perfusion software.MethodsA total of 108 patients who underwent combined revascularization, including superficial temporal artery-middle cerebral artery (STA-MCA) anastomosis and encephalo-duro-myo-synangiosis (EDMS), in our hospital between September 2019 and August 2023 were analyzed retrospectively. Preoperative relative cerebral blood flow (rCBF), relative cerebral blood volume (rCBV), relative mean transit time (rMTT), and relative time to maximum residual function (rTmax) perfusion parameters were obtained using 4D-CT perfusion software. These quantitative parameters, combined with related clinical and angiographic factors, were statistically analyzed using univariate and multivariate regression analyses to determine the significant predictors of cerebral infarction after bypass surgery.ResultsAcute cerebral infarction occurred in 12 patients postoperatively. Univariate analysis showed that a history of previous ischemic events (P = 0.024), higher Suzuki stage (P = 0.006), higher modified Rankin score (mRS) (P = 0.013), rCBV (P = 0.026), rMTT (P = 0.001), and rTmax (P < 0.001) were associated with postoperative cerebral infarction. Further multivariate regression analysis showed that a history of previous ischemic events (OR = 12.830, 95%CI = 1.854–875.672, P = 0.031) and higher rTmax (OR = 16.968, 95%CI = 2.035–141.451, P = 0.009) were independently associated with new postoperative cerebral infarction. The cutoff value for rTmax was 2.025 (AUC = 0.935).ConclusionsPrevious ischemic event history and rTmax greater than 2.025 are independent risk factors for predicting cerebral infarction after combined revascularization with high sensitivity in adult patients with MMD. These patients should be more cautious when deciding on combined revascularization.

Angiographic features and progression risk factors in children with asymptomatic moyamoya disease.

This study aims to explore the potential contribution of angiographic characteristics in the increased stroke risk among pediatric patients. This study retrospectively enrolled pediatric patients with ischemic, hemorrhagic, and asymptomatic moyamoya disease. Their hemispheres were categorized into five groups for the analysis of angiographic characteristics, which included Suzuki's stage, moyamoya vessels, lenticulostriate artery, thalamotuberal artery, thalamoperforating artery, anterior choroidal arteries, posterior choroidal arteries, and posterior cerebral artery involvement. Two hundred and nineteen pediatric patients with four hundred and thirty-eight hemispheres were enrolled. There was no significant difference in collateral dilatation between asymptomatic and hemorrhagic hemispheres. However, asymptomatic hemispheres had significantly lower incidence of posterior cerebral artery involvement and Suzuki's stage compared to hemorrhagic (p = 0.008, p = 0.004) and ischemic hemispheres (p = 0.026, p < 0.001). Multivariate analysis revealed that Suzuki's stage (p = 0.002, 95% CI 1.261-2.867) is a risk factor for ischemia, while age (p < 0.001, 95% CI 0.712-2.014) and posterior cerebral artery involvement (p = 0.037, 95% CI 0.087-13.377) are risk factors for hemorrhage. Angiographic features in children with asymptomatic moyamoya disease resemble those observed in the hemorrhagic pediatric patients, indicating that greater attention should be focused on the risk of future hemorrhage in these patients, rather than on ischemia. Additionally, studies have demonstrated a correlation between posterior cerebral artery involvement and age with the incidence of hemorrhage. Monitoring angiographic characteristics may assist in tracking the transition from asymptomatic to symptomatic hemispheres.

UNVEILING CLINICAL AND ANGIOGRAPHIC PREDICTORS OF RESTENOSIS FOLLOWING PERCUTANEOUS CORONARY INTERVENTION (PCI) IN LEFT ANTERIOR DESCENDING (LAD) ARTERY LESIONS: INSIGHTS FROM A RETROSPECTIVE COHORT STUDY

Restenosis, the re-narrowing of coronary arteries post-stenting, continues to be a significant clinical issue, particularly in Left Anterior Descending (LAD) artery lesions. Despite advances in stent technology, including drug-eluting stents (DES), restenosis remains a significant contributor to adverse cardiovascular events such as myocardial infarction and repeat revascularisation. Understanding the clinical and angiographic factors that predict restenosis is crucial for improving patient outcomes. Objective: This study aims to identify clinical and angiographic predictors of restenosis in patients undergoing Percutaneous Coronary Intervention (PCI) for LAD artery lesions. Methods: A retrospective cohort study was conducted at MTI-Hayatabad Medical Complex from January 1, 2023, to December 31, 2023. A total of 162 patients who underwent PCI for de-novo LAD lesions were included. Data regarding patient demographics, comorbidities, lesion characteristics, and stent types were extracted from hospital records. Angiographic follow-up was performed at 12 months post-PCI to assess restenosis, defined as ≥50% luminal narrowing. Multivariate logistic regression analysis was used to identify independent predictors of restenosis. Results: Among the 162 patients, 15.4% (n=25) developed restenosis within 12 months. Diabetes mellitus (OR: 2.74; 95% CI: 1.21–6.24; p=0.014), lesion length (OR: 1.08 per mm; 95% CI: 1.01–1.15; p=0.025), and stent type (DES vs. BMS; OR: 0.42; 95% CI: 0.18–0.98; p=0.046) were identified as significant predictors. Smoking and hypertension were not found to be statistically significant. Conclusion: Diabetes mellitus, lesion length, and the use of drug-eluting stents are independent predictors of restenosis in LAD artery lesions. These findings underscore the need for tailored stenting strategies and enhanced post-PCI management in high-risk patients to reduce restenosis rates and improve long-term outcomes.

Tandem lesions associate with angiographic progression of coronary artery stenoses

BackgroundAlthough the clinical factors associated with progression of coronary artery disease have been well studied, the angiographic predictors are less defined. ObjectivesOur objective was to study the clinical and angiographic factors that associate with progression of coronary artery stenoses. MethodsWe conducted a retrospective analysis of consecutive patients undergoing multiple, clinically indicated invasive coronary angiograms with an interval greater than 6 months, between January 2013 and December 2016. Lesion segments were analysed using Quantitative Coronary Angiography (QCA) if a stenosis ≥ 20 % was identified on either angiogram. Stenosis progression was defined as an increase ≥ 10 % in stenosis severity, with progressor groups analysed on both patient and lesion levels. Mixed-effects regression analyses were performed to evaluate factors associated with progression of individual stenoses. Results199 patients were included with 881 lesions analysed. 108 (54.3 %) patients and 186 (21.1 %) stenoses were classified as progressors. The median age was 65 years (IQR 56–73) and the median interval between angiograms was 2.1 years (IQR 1.2–3.0). On a patient level, age, number of lesions and presence of multivessel disease at baseline were each associated with progressor status. On a lesion level, presence of a stenosis downstream (OR 3.07, 95 % CI 2.04–4.63, p < 0.001) and circumflex artery stenosis location (OR 1.81, 95 % CI 1.21–2.7, p = 0.004) were associated with progressor status. Other lesion characteristics did not significantly impact progressor status or change in stenosis severity. ConclusionCoronary lesions which have a downstream stenosis may be at increased risk of stenosis progression. Further research into the mechanistic basis of this finding is required, along with its implications for plaque vulnerability and clinical outcomes.

The changes in health-related quality of life in stable coronary artery disease patients and intermediante coronary lesions after elective percutaneous coronary intervention

The aim – to analyze the factors, associated with the change in health-related quality of life (HRQoL) in stable coronary artery disease (SCAD) patients with intermediate coronary lesions at 3-months follow-up after elective percutaneous coronary intervention (PCI).Materials and methods. A prospective single-center study enrolled 84 SCAD patients (mean age 64±8 years; males – 73 %) with intermediate coronary lesions (stenosis 50-90 %) (by invasive coronary angiography [ICA]), consecutively enrolled and hospitalized with the aim of elective PCI to be performed. HRQoL was evaluated by SF-36 (physical health summary [PHsum] and mental health summary [МНsum]) and SAQ (Seattle Angina Questionnaire»; the domains «physical limitation» [PL], «angina stability» [AS], «angina frequency» [AF], «treatment satisfaction» [TS] and «disease perception» [DP]), – at baseline and 3-months follow-up. The enrolled sample was subdivided in a dichotomous manner into the HRQoL «improvement» or «non-improvement» patterns, based on the cut-off-values (COVs) of clinically meaningful change of the certain HRQoL parameter score at 3-months follow-up after PCI.Results and discussion. We revealed an improvement of average (median) HRQoL parameters at 3-months follow-up after PCI, namely PHsum (score increase from 38.8 to 43.1; р &lt; 0.001), SAQ-AS (25 to 75; р &lt; 0.001), SAQ-AF (70 to 80; р &lt; 0.001), SAQ-TS (58.8 to 70.6; р &lt; 0.001) and SAQ-DP (45.8 to 66.7; р &lt; 0.001). The clinically meaningful HRQoL improvement ranged from 14 % to 71 % cases, depending on the certain HRQoL parameter and the COVs of its change at follow-up after PCI. The worse baseline HRQoL, older age and higher baseline total cholesterol level were the factors, associated with the increased probability of HRQoL to be meaningfully improved after revascularization. In addition, a presence of diabetes mellitus, a history of acute cerebrovascular accident, and the ICA data on multivessel disease and in-stent restenosis after previous PCI, – all were associated with the lower odds of HRQoL «improvement» status to be achieved.Conclusions. A PCI favored the HRQoL improvement in SCAD patients at 3-months follow-up. The clinical and angiographic factors, associated with the post-procedure change in HRQoL, should be considered for a better selection of SCAD patients with intermediate coronary lesions for PCI.

Prediction of postoperative cerebral infarction after combined bypass surgery in adult moyamoya disease: combining quantitative parameters on RAPID perfusion CT with clinically related factors.

The aim of this study was to identify predictive factors of postoperative cerebral infarction (PostCI) following combined bypass (CB) surgery in adult patients with moyamoya disease (MMD) using quantitative parameters from the rapid processing of perfusion and diffusion (RAPID) perfusion CT (PCT) software. The authors retrospectively reviewed 276 total hemispheres in patients with MMD who underwent CB. Preoperative volumes of time-to-maximum (Tmax) > 4 sec and > 6 sec were obtained from the RAPID analysis of PCT. These quantitative parameters, along with other clinical and angiographic factors, were statistically analyzed to determine the significant predictors for PostCI following CB. PostCI occurred in 17 hemispheres (6.16%). PCA involvement (p = 0.016), and the volume of Tmax > 6 sec (p < 0.001) and Tmax > 4 sec (p < 0.001), were identified as variables related to PostCI in the univariable analysis. In the multivariable analysis, the volume of Tmax > 6 sec (OR 1.013, 95% confidence interval 1.007-1.019, p < 0.001) was determined to be an independent predictive factor significantly associated with PostCI after CB in adult patients with MMD. In the receiver operating characteristic (ROC) curve, the cutoff value of the preoperative volume of Tmax > 6 sec was determined to be 59.5 ml (sensitivity 82.4%, specificity 71.9%, area under the ROC curve 0.811). For adult patients with MMD and a large volume of Tmax > 6 sec over 59.5 ml, more caution is required when deciding to undergo bypass surgery and in postoperative management.

Pattern of Coronary Angiography in Young Adults versus Older Adults Presented by Coronary Artery Disease in Correlation to Their Risk Factors with 1-year Follow-up of Their Clinical Outcome

Abstract Background: Coronary artery disease (CAD) is a leading cause of mortality worldwide, with varying patterns and risk factors across different age groups. While CAD is common in older adults, data on young adults are limited, with traditional risk factors and familial history playing a significant role in early disease development. The purpose of this study was to compare the coronary angiographic patterns in young adults (&lt;40 years) and older adults (≥40 years) presented with CAD, assess the correlation with risk factors, and monitor clinical outcomes after 1 year. Patients and Methods: This retrospective cohort study was conducted at the National Heart Institute, including 2204 consecutive patients undergoing coronary angiography and/or percutaneous coronary intervention for CAD from January 2019 to January 2020. Patients were divided into two groups based on age: group A (&lt;40 years) and Group B (≥40 years). Angiographic findings, risk factors, and clinical outcomes were assessed and compared. Results: Group B had significantly higher rates of hypertension (63.6% vs. 22.2%, P &lt; 0.001), diabetes (53.5% vs. 24.1%, P &lt; 0.001), and female gender (29% vs. 11.1%, P &lt; 0.001) compared to Group A. Group A showed higher smoking rates (70.4% vs. 46.5%, P &lt; 0.001) and positive family history (42.6% vs. 4.4%, P &lt; 0.001). Angiographic findings revealed higher rates of single-vessel affection, coronary ectasia, aneurysm, and slow flow phenomenon in Group A, whereas Group B demonstrated more bifurcation lesions, chronic total occlusion, and calcification. Conclusions: This study highlights the need for age-specific approaches in managing CAD, with younger patients showing early disease onset and older patients exhibiting more complex disease. Tailored cardiovascular care is essential, focusing on lifestyle modifications in younger adults and managing metabolic conditions in older adults.

The unexpected silent manifestation of myocardial infarctions in ischemic heart failure patients: Insights from a case-control study

BackgroundRecent studies show Silent Myocardial Infarction (SMI) as a quite frequent event. However, regarding severe tertiary care patients that frequently present consequences of Coronary Artery Disease (CAD) and Left Ventricular Dysfunction (LVD), the occurrence of this manifestation is unexpected and its associated factors aren't clear in the literature. AimTo compare clinical, laboratorial, ventricular and angiographic factors between silent and classical presentation of MI in patients with CAD and LVD. MethodsPatients with multivessel CAD with over 70 % obstructive lesions and LVD with EF less than 35 % were evaluated for MASS VI trial and later included in the present study. The ventricular function and coronary assessment were measured by echocardiography and SYNTAX score, respectively. The population was stratified in a SMI group and Clinically Manifested Myocardial Infarction (CMMI) group based on MI presentation for a comparison of medical parameters. ResultsFrom 132 patients, 47 (35.6 %) were classified as SMI and 85 (64.4 %) as CMMI. No differences were observed between groups regarding age, sex, diabetes mellitus, SYNTAX score, or collateral circulation. Higher proportion of NYHA II classification, inferior wall MI and lower creatinine clearance were found in SMI group. After multivariate analysis, peripheral diabetic neuropathy (OR = 4.6 [1.1‒12.7] p = 0.032) and inferior wall MI (OR = 4.1 [1.5‒11.4] p = 0.007) were significantly associated with SMI. ConclusionPeripheral diabetic neuropathy and inferior wall MI were associated with SMI presentation. Overall, associated factors tend to be similar comparing SMI and CMMI, but in the specific population of diabetic patients with chronic neuropathy a special care should be taken.

Radial artery spasms - angiographic morphology, risk factors and management.

Radial artery is the preferred access for coronary interventions. However, the procedure is sometimes interrupted by a spasm which causes pain, prolongs the procedure, and can force the access crossover. To observe factors contributing to a symptomatic radial artery spasm. In this prospective study, we present results of 103 consecutive patients regarding radial artery spasm and angiographic image of the punctured artery. Angiography of the radial artery was performed in 70 (68.0%) patients. Potential risk factors for radial artery spasm were evaluated. The overall incidence of the radial artery spasm was high - 25 (24.3%). Signs of spasm were present in 37.1% of radial artery angiographies before the procedure and 60.1% after, however, it did not always indicate a symptomatic spasm. Risk factors related to radial artery spasm included female sex (OR = 2.94, p = 0.02), failure of the first puncture attempt (OR = 3.12, p = 0.014) and use of non-hydrophilic sheath (OR = 9.56, p = 0.036). Radial artery narrowing at the tip of the sheath was also a risk factor for spasm (p = 0.022). No spasms were observed after hydrophilic sheath application (n = 13). The administration of a radial cocktail was not observed to significantly decrease the spasm odds. Risk factors for radial artery spasm include female sex and multiple puncture attempts. Hydrophilic sheath coating protects against radial artery spasm. Overall signs of a spasm in the angiography are common and do not imply a symptomatic spasm, which can be predicted by a tight narrowing at the tip of the sheath.

In-stent restenosis in acute coronary syndrome-a classic and a machine learning approach.

In acute coronary syndrome (ACS), a number of previous studies tried to identify the risk factors that are most likely to influence the rate of in-stent restenosis (ISR), but the contribution of these factors to ISR is not clearly defined. Thus, the need for a better way of identifying the independent predictors of ISR, which comes in the form of Machine Learning (ML). The aim of this study is to evaluate the relationship between ISR and risk factors associated with ACS and to develop and validate a nomogram to predict the probability of ISR through the use of ML in patients undergoing percutaneous coronary intervention (PCI). Consecutive patients presenting with ACS who were successfully treated with PCI and who had an angiographic follow-up after at least 3 months were included in the study. ISR risk factors considered into the study were demographic, clinical and peri-procedural angiographic lesion risk factors. We explored four ML techniques (Random Forest (RF), support vector machines (SVM), simple linear logistic regression (LLR) and deep neural network (DNN)) to predict the risk of ISR. Overall, 21 features were selected as input variables for the ML algorithms, including continuous, categorical and binary variables. The total cohort of subjects included 340 subjects, in which the incidence of ISR observed was 17.68% (n = 87). The most performant model in terms of ISR prediction out of the four explored was RF, with an area under the receiver operating characteristic (ROC) curve of 0.726. Across the predictors herein considered, only three predictors were statistically significant, precisely, the number of affected arteries (≥2), stent generation and diameter. ML models applied in patients after PCI can contribute to a better differentiation of the future risk of ISR.

A novel scoring system devised by an international large-scale coronary bifurcation registry to guide the optimal choice between the 1- and 2-stent strategy: the BIFURCAT Two-Stent (BTS) score

Abstract Background and Aims Previous studies used predefined criteria to evaluate the outcomes of two stents over one stent. We sought to devise a scoring system based on data-driven criteria for the guiding the optimal choice between two approaches. Methods We analyzed an international coronary bifurcation cohort with 2nd-generation drug-eluting stents, the combined insights from the unified RAIN and COBIS bifurcation registries (BIFURCAT) registry. The primary endpoint was major adverse cardiac events (MACE), a composite of death, myocardial infarction, and target lesion failure. Results We analyzed 5333 patients (mean age: 66.2 years; male: 76%; 1-stent: 82%). We found one clinical and five angiographic factors associated with lower MACE risk when two stents were implanted compared with one. We assigned one point per each component the patient was positive for and defined this as the BIFURCAT Two-Stent (BTS) score. The 2-stent strategy was associated with significantly higher MACE rate in the total patient cohort (HR: 1.49; 95% CI: 1.19-1.87; P&amp;lt;0.001) and BTS score&amp;lt;4 (HR: 2.04; 95% CI: 1.64-2.56; P&amp;lt;0.001). However, the two stents had a lower chance of MACE in BTS score≥4 (HR: 0.56; 95% CI: 0.35-0.89; P=0.014) with or without adjustment for baseline and procedural characteristics and antiplatelet therapy. Conclusions Approximately 80% of the patients had low (&amp;lt;4) BTS score that showed favorable outcomes with the 1-stent strategy. However, those with high BTS scores (≥4) proved favorable outcomes with the 2-stent strategy. The BTS score may be able to guide interventionists to select an optimal stenting strategy in bifurcation lesions.

Abstract 17479: Angiographic Factors Influencing Treatment Decisions in Pediatric Brain Arteriovenous Malformation (pAVM): Insights From Cart Analysis

Introduction: Pediatric cerebral AVM (pAVM) are the most common cause of hemorrhagic stroke in children. Their optimal management approach remains controversial. Determining the angiographic factors that impact outcomes for the various treatment strategies is crucial. Hypothesis: To identify angiographic factors for modality-treatment decision-making Methods: Cross-sectional study of patients diagnosed with pAVM at a pediatric stroke center between 2016 and 2021. Patients’ demographics, angiographic characteristics (volume, location, nidal aneurysms, non-plexiform rapid fistulas, venous drainage, and nidus diffuseness), treatment, and clinical outcomes were collected. Classification and Regression Tree Analysis (CART) was used to identify impactful angiographic factors, multivariate regression was applied to evaluate their significance in treatment decision-making. Results: Thirty-seven consecutive patients were included, 25 were male, with a median age of 10.3 years (IQR 7.9-13.3). Median follow-up was 30.3 months (IQR 8.6-53.8). Twenty patients presented with a ruptured pAVM. Endovascular embolization was the most common treatment (19, 51.4%), followed by radiosurgery (14, 37.8%), and observation (8, 21.6%). Twenty-seven patients (81.8%) had improved or stable functional neurologic status at last follow-up, and six (18.2%) declined (none of them by more than one point on the mRS). Only one patient had post-treatment hemorrhage during follow-up.The angiographic features associated with specific treatments were: the presence of non-plexiform rapid fistulas (endovascular in 94.0% of patients p=0.01), basal ganglia or pons location (excluded from endovascular in 86% of patients p=0.30), absence of a nidal aneurysm (radiation in 98% p=0.03). CART did not identify other potentially impactful angiographic factors. Conclusions: Our study shows generally favorable outcomes and low complication rates in pAVM patients who underwent multimodal treatment. The presence of non-plexiform rapid fistulas and nidal aneurysms should be considered when determining the appropriate treatment approach. Further prospective confirmatory analyses are warranted.

Characteristics of patients with recurrent acute myocardial infarction after MINOCA

BackgroundMyocardial infarction (MI) with non-obstructed coronary arteries (MINOCA) is an increasingly recognized condition with challenging management. Some MINOCA patients ultimately experience recurrent acute MI (re-AMI) during follow-up; however, clinical and angiographic factors predisposing to re-AMI are still poorly defined. MethodsIn this retrospective multicenter cohort study we enrolled consecutive patients fulfilling diagnostic criteria of MINOCA according to the IV universal definition of myocardial infarction; characteristics of patients experiencing re-AMI during the follow-up were compared to a group of MINOCA patients without re-AMI. Results54 patients (mean age 66 ± 13) experienced a subsequent re-AMI after MINOCA and follow-up was available in 44 (81%). Compared to MINOCA patients without re-AMI (n = 695), on first invasive coronary angiography (ICA) MINOCA patients with re-AMI showed less frequent angiographically normal coronaries (37 versus 53%, p = 0.032) and had a higher prevalence of atherosclerosis involving 3 vessels or left main stem (17% versus 8%, p = 0.049).Twenty-four patients (44%) with re-AMI underwent a new ICA: 25% had normal coronary arteries, 12.5% had mild luminal irregularities (<30%), 20.8% had moderate coronary atherosclerosis (30–49%), and 41.7% showed obstructive coronary atherosclerosis (≥50% stenosis).Among patients undergoing new ICA, atherosclerosis progression was observed in 11 (45.8%), 37.5% received revascularization, only 4.5% had low-density lipoprotein cholesterol (LDL_C) under 55 mg/dL and 33% experienced a new cardiovascular disease (CVD) event (death, AMI, heart failure, stroke) at subsequent follow-up. ConclusionsIn the present study, only a minority of MINOCA patients with re-AMI underwent a repeated ICA, nearly one out of two showed atherosclerosis progression, often requiring revascularization. Recommended LDL-C levels were achieved only in a minority of the cases, indicating a possible underestimation of CVD risk in this population.

Ischemic patterns and their angiographic risk factors in adult patients with moyamoya disease.

The present study aims to determine whether angiographic differences increase the risk of ischemic pattern among adult patients with moyamoya disease (MMD). From January 2020 to December 2021, we retrospectively enrolled 123 ischemic or asymptomatic adult patients diagnosed as MMD. Angiographic changes including Suzuki stage, moyamoya vessels, anterior choroidal artery (AChoA) dilatation, lenticulostriate artery (LSA) dilatation, posterior communicating artery (PcomA) dilatation, and posterior cerebral artery (PCA) involvement were evaluated for all patients. Among the 123 participants, 35 ischemic patients and 88 asymptomatic patients were analyzed. There was no significant difference of Suzuki stage, AChoA dilatation, LSA dilatation, and PcomA dilatation between ischemic group and asymptomatic group. The grading of moyamoya vessels differed significantly but was not a factor associated with ischemic pattern after adjusting multiple related confounders. However, the frequency of PCA steno-occlusive changes in ischemic patients was statistically higher than that in asymptomatic patients (54.3% vs 34.1%, p = 0.039). Furthermore, PCA involvement was a risk factor associated with ischemic form and remained statistically significant after the multivariate adjustment (p = 0.033, 95% CI 1.092-8.310). PCA involvement is closely related to the presentation of ischemic stroke but other angiographic features had no association with ischemic pattern in adult MMD.

Clinical and hemodynamic characteristics of patients with intermediate coronary lesions selected for elective percutaneous coronary intervention

The aim – to identify clinical, angiographic and hemodynamic factors, having impact upon the decision on percutaneous coronary intervention (PCI) in stable coronary artery disease (SCAD) patients with intermediate subepicardial coronary lesions, in clinical settings. Materials and methods. The cross-sectional single-center study analyzed clinical and instrumental data from 123 SCAD patients (mean age 62 ± 9 years; 90 (73.2 %) males) and intermediate (50–90 %) stenotic subepicardial coronary lesions (by invasive coronary angiography [ICA]). The enrolled sample included 74 (60.2 %) patients with an assessment of ICA-derived fractional flow reserve (FFR). The studied parameters were analyzed in the groups of decision not to perform (PCI(–); n = 30 [24.4 %]) and to perform PCI (PCI(+); n = 93 [75.6 %]). Results. The positive decision on PCI was more frequent in patients with stable angina ІII and ІI CCS class, as compared to those without angina (93 %, 79 % і 46 %, respectively; рtrend &lt; 0.001). PCI was considered to be appropriate in all patients with FFR &lt; 0.8 (46 of 74 (62 %) cases). The more advanced hemodynamic compromise of coronary lesions was associated with the higher maximum degree of coronary artery stenosis. Multivariable logistic regression analysis revealed a more pronounced coronary stenosis (at least, in one subepicardial coronary artery territory) was independently associated with the PCI(+) decision (stenosis 80–90 % vs. 70–79 %; 70–79 % vs. 60–69 %; 60–69 % vs. 50–59 %: odds ratio 26 (95 % confidence interval 8–87); р &lt; 0.001). Conclusions. A degree of coronary artery stenosis was a key factor impacting upon a positive decision on PCI in SCAD patients with intermediate (50–90 %) coronary lesions. There is a need for the broader implementation of non-invasive diagnostic tests and the tools for a quantitative assessment of myocardial ischemia in patients with intermediate pretest probability of coronary stenosis, including those with previous PCI.

Impact of Radial Wall Strain on Serial Changes in Vascular Physiology in Patients with Intermediate Coronary Stenosis.

Coronary biomechanical stress contributes to the plaque rupture and subsequent events. This study aimed to investigate the impact of plaque biomechanical stability on the physiological progression of intermediate lesions, as assessed by the radial wall strain (RWS) derived from coronary angiography. Patients with at least one medically treated intermediate lesion at baseline who underwent follow-up coronary angiography over 6 months were included. The maximal RWS ( ) of the interrogated lesion was calculated from the baseline angiogram. The primary endpoint was to determine the association between baseline and the functional progression of coronary lesions, defined as an increase in the lesion-specific quantitative flow ratio (L- QFR, calculated as the absolute change in QFR across the lesion) on serial angiograms. Among 175 lesions in 156 patients, 63 lesions showed an increase in L- QFR during a median follow-up period of 12.4 months. Baseline values were significantly higher in lesions with increased L- QFR than in those with stabilized or decreased L- QFR (11.8 [10.7, 13.7] vs.10.8 [9.7, 11.7]; p 0.001). Baseline presented an area under the curve of 0.658 (95% confidence interval [CI]: 0.572-0.743, p 0.001) for the prediction of increased L- QFR. After full adjustment for clinical and angiographic factors, a high ( 12) was found to be an independent predictor of functional lesion progression (odds ratio: 2.871, 95% CI: 1.343-6.138, p = 0.007). A high calculated from baseline angiograms was independently associated with the subsequent physiological progression in patients with intermediate coronary lesions.

Unprotected Left Main Bifurcation Stenting in Acute Coronary Syndromes: Two-Stent Technique versus One-Stent Technique.

There is little evidence guiding the choice between a one-stent and a two-stent approach in unprotected distal left main coronary artery disease (UDLMCAD) presenting as acute coronary syndrome (ACS). We aim to compare these two techniques in an unselected ACS group. We conducted a single center retrospective observational study, that included all patients with UDLMCAD and ACS undergoing PCI between 2014 and 2018. Group A underwent PCI with a one-stent technique (n = 41, 58.6%), Group B with a two-stent technique (n = 29, 41.4%). A total of 70 patients were included, with a median age of 63 years, including n = 12 (17.1%) with cardiogenic shock. There were no differences between Group A and B in terms of patient characteristics, including SYNTAX score (median 23). The 30-day mortality was 15.7% overall, and was lower in Group B (3.5% vs. 24.4%, p = 0.02). Mortality rate at 4 years was significantly lower in Group B (21.4% vs. 44%), also when adjusted in a multivariable regression model (HR 0.26, p = 0.01). In our study, patients with UDLMCAD and ACS undergoing PCI using a two-stent technique had lower early and midterm mortality compared to one-stent approach, even after adjusting for patient-related or angiographic factors.

Angiographic factors leading to hemorrhage in AVMs: A systematic review and meta-analysis.

For patients with unruptured intracranial arteriovenous malformations (AVMs), the risk of a hemorrhagic event is approximately 2% to 4% annually. These events have an associated 20-50% morbidity and 10% mortality rate. An understanding of risk factors that predispose these lesions to rupture is important for optimal management. We aimed to pool a large cohort of both ruptured and unruptured AVMs from the literature with the goal of identifying angiographic risk factors that contribute to rupture. A systematic review of the literature was conducted in accordance with the PRISMA guidelines using Pubmed, Embase, Scopus, and Web of Science databases. Studies that presented patient-level data from ruptured AVMs from January 1990 to January 2022 were considered for inclusion. The initial screening of 8,304 papers resulted in a quantitative analysis of 25 papers, which identified six angiographic risk factors for AVM rupture. Characteristics that significantly increase the odds of rupture include the presence of aneurysm (OR = 1.45 [1.19, 1.77], p < 0.001, deep location (OR = 3.08 [2.56, 3.70], p < 0.001), infratentorial location (OR = 2.79 [2.08, 3.75], p < 0.001), exclusive deep venous drainage (OR = 2.50 [1.73, 3.61], p < 0.001), single venous drainage (OR = 2.97 [1.93, 4.56], p < 0.001), and nidus size less than 3cm (OR = 2.54 [1.41, 4.57], p = 0.002). Although previous literature has provided insight into AVM rupture risk factors, obscurity still exists regarding which risk factors pose the greatest risk. We have identified six major angiographic risk factors (presence of an aneurysm, deep location, infratentorial location, exclusive deep venous drainage, single venous drainage, and nidus size less than 3cm) that, when identified by a clinician, may help to tailor patient-specific approaches and guide clinical decisions.

Prediction of hemorrhagic cerebral hyperperfusion syndrome after direct bypass surgery in adult nonhemorrhagic moyamoya disease: combining quantitative parameters on RAPID perfusion CT with clinically related factors.

The aim of this study was to identify predictive factors for hemorrhagic cerebral hyperperfusion syndrome (hCHS) after direct bypass surgery in adult nonhemorrhagic moyamoya disease (non-hMMD) using quantitative parameters on rapid processing of perfusion and diffusion (RAPID) perfusion CT software. A total of 277 hemispheres in 223 patients with non-hMMD who underwent combined bypass were retrospectively reviewed. Preoperative volumes of time to maximum (Tmax) > 4 seconds and > 6 seconds were obtained from RAPID analysis of perfusion CT. These quantitative parameters, along with other clinical and angiographic factors, were statistically analyzed to determine the significant predictors for hCHS after bypass surgery. Intra- or postoperative hCHS occurred in 13 hemispheres (4.7%). In 7 hemispheres, subarachnoid hemorrhage occurred intraoperatively, and in 6 hemispheres, intracerebral hemorrhage was detected postoperatively. All hCHS occurred within the 4 days after bypass. Advanced age (OR 1.096, 95% CI 1.039-1.163, p = 0.001) and a large volume of Tmax > 6 seconds (OR 1.011, 95% CI 1.004-1.018, p = 0.002) were statistically significant factors in predicting the risk of hCHS after surgery. The cutoff values of patient age and volume of Tmax > 6 seconds were 43.5 years old (area under the curve [AUC] 0.761) and 80.5 ml (AUC 0.762), respectively. In adult patients with non-hMMD older than 43.5 years or with a large volume of Tmax > 6 seconds over 80.5 ml, more prudence is required in the decision to undergo bypass surgery and in postoperative management.

Factors affecting the availability of hybrid cerebral and myocardial revascularization

Aim. To analyze factors affecting the availability of hybrid cerebral and myocardial revascularization by synchronous percutaneous coronary intervention (PCI) and carotid endarterectomy (CEA).Material and methods. This retrospective study included 263 patients with coronary and internal carotid artery involvement undergoing PCI and CEA during the period from 2011 to 2017.Results. The study revealed the following factors increasing the availability of revascularization: hybrid cerebral and myocardial revascularization, successful PCI using drug-eluting stents, postPCI TIMI flow grade 3, and radial access for PCI. The following factors reduced the availability: polyvascular disease &gt;50% in three beds, prior PCI, left ventricular ejection fraction &lt;50%, left coronary artery involvement, living without a family, staged revascularization, CEA before PCI, unsuccessful/complicated PCI with post-PCI TIMI flow grades of 0-1, residual SYNTAX score &gt;9, emergency hospitalization and multiple emergency PCI of the coronary arteries in the long-term follow-up period.Conclusion. Comprehensive analysis of clinical, demographic, anatomical, angiographic, and perioperative factors made it possible to identify predictors that affect the availability of hybrid revascularization.