Complex Lesion Characteristics Research Articles

A conditional generative adversarial networks and Yolov5 Darknet -based skin lesion localization and classification using independent component analysis model

Automated diagnosis systems significantly improve the early detection of skin cancer, thereby contributing to its successful treatment. Skin lesion segmentation represents a crucial yet challenging issue within the realm of computer-assisted dermoscopy image analysis. Numerous segmentation techniques reliant on convolutional neural networks falter in achieving precise lesion boundaries due to the diminishing spatial scale of feature maps as they traverse through network layers. Nonetheless, neural networks demand a substantial amount of data, which presents a notable obstacle in the medical field. More data, and possibly a pre-trained model tailored to medical images, are imperative. Researchers have resorted to extensive augmentation and preprocessing methods, as well as fine-tuning the network using pre-trained models on unrelated images, in order to address the challenge of lesion segmentation as the initial step in skin cancer analysis. This arises from the fact that datasets are limited in size and encompass a diverse array of images, varying in terms of lighting, color, scale, and markings. The proposed method addresses the issue of precisely locating and classifying skin lesions in dermatological images. The architecture of Conditional Generative Adversarial Networks (cGAN) enables the generation of high-resolution, contextually pertinent images, thereby enhancing the discriminative properties of skin lesions. YOLOv5 Darknet has an effective object detection mechanism that aids in precise lesion localization. Independent component analysis (ICA), a signal processing technique that identifies statistically separate components from diverse data sources, is employed to improve the model's robustness and interpretability further. This facilitates extracting latent features from the combined dermatological images and data collection, thereby enhancing the model's understanding of complex lesion characteristics. According to experimental results on an extensive dermatological data set, the proposed cGAN-YOLOv5 technique is effective. In pinpointing and classifying lesion locations, the hybrid model outperforms the competition. The synergistic integration of cGANs, YOLOv5 Darknet, and ICA demonstrates the effectiveness of multifaceted integration in enhancing medical image analysis. Using high-resolution feature blocks and a noise-suppressing attention method, cGAN-YOLOv5 is proposed. Therefore, the proposed strategy segments skin lesions effectively.

Dynamic feature splicing for few-shot rare disease diagnosis.

Annotated images for rare disease diagnosis are extremely hard to collect. Therefore, identifying rare diseases under a few-shot learning (FSL) setting is significant. Existing FSL methods transfer useful and global knowledge from base classes with abundant training samples to enrich features of novel classes with few training samples, but still face difficulties when being applied to medical images due to the complex lesion characteristics and large intra-class variance. In this paper, we propose a dynamic feature splicing (DNFS) framework for few-shot rare disease diagnosis. Under DNFS, both low-level features (i.e., the output of three convolutional blocks) and high-level features (i.e., the output of the last fully connected layer) of novel classes are dynamically enriched. We construct the position coherent DNFS (P-DNFS) module to perform low-level feature splicing, where a lesion-oriented Transformer is designed to detect lesion regions. Thus, novel-class channels are replaced by similar base-class channels within the detected lesion regions to achieve disease-related feature enrichment. We also devise a semantic coherent DNFS (S-DNFS) module to perform high-level feature splicing. It explores cross-image channel relations and selects base-class channels with semantic consistency for explicit knowledge transfer. Both low-level and high-level feature splicings are performed dynamically and iteratively. Consequently, abundant spliced features are generated for disease diagnosis, leading to more accurate decision boundary and improved diagnosis performance. Extensive experiments have been conducted on three medical image classification datasets. Our results suggest that the proposed DNFS achieves superior performance against state-of-the-art approaches.

Treatment of In-Stent Restenosis Using a Dedicated Super High-Pressure Balloon

BackgroundTreatment of in-stent restenosis (ISR) is challenging and treatment failure rate remains high. Correction of stent under-expansion and neointimal compression using the twin-layer OPN™ highly non-compliant balloon (NCB) at high pressure (>30 atm) may lead to increased luminal gain and thus better clinical outcomes. We evaluated periprocedural safety and clinical long-term outcomes after ISR treatment using the OPN™ NCB in a real-world population. MethodsFrom an ongoing registry, consecutive ISR patients treated with the OPN™ NCB at a tertiary cardiology center in Switzerland were analyzed. We evaluated procedural efficacy, periprocedural complications, target lesion/vessel failure (TLF/TVF), and major adverse cardiovascular events (MACE). ResultsTotally, 208 ISR lesions were treated in 188 patients (mean age 68 ± 13 years, 78 % males). Most lesions were moderately to heavily calcified (89 %), the majority (70.2 %) had complex lesion characteristics (AHA Type B2/C lesions) and 50.5 % were non-focal ISR lesions. After ISR treatment using high pressure pre- and post-dilatation (mean pressure 33 ± 6 atm) with the OPN™ NCB device, the rate of major complications was low (0.96 % coronary perforation, 4 % major dissections, 1.9 % no-reflow and 0.5 % acute vessel closure). At 1-year follow-up, MACE occurred in 19.7 %; 15.4 % patients had TVF; MI and stent thrombosis was found in 5.9 % and 2.1 % of all patients, respectively; and 5 patients died. ConclusionsFor ISR treatment, using the super non-compliant OPN™ balloon at very high pressures is safe. Moreover, its use might lead to a low rate of TLF/TVF during long-term follow-up, but this requires further evaluation in dedicated comparative trials.

Lesion characteristics and procedural complications of chronic total occlusion percutaneous coronary intervention in patients with prior bypass surgery: A meta‐analysis

Coronary artery bypass graft (CABG) accelerates the prevalence of native coronary chronic total occlusion (CTO), and this kind of CTO shows extensive challenging and complex atherosclerotic pathology. As a result, the procedural success rate of percutaneous coronary intervention (PCI) is inferior to another kind of lesions. The present meta‐analysis aims to compare the lesion characteristics and procedural complications of CTO‐PCI in patients with or without prior CABG. A total of 8 studies, comprising of 13439 patients, published from inception to August 2021 were included in this meta‐analysis. Results were pooled using random effects model and are presented as odds ratio (OR) with 95% confidence intervals (95% CIs). From the 13439 patients enrolled, 3349 (24.9%) patients had previous CABG and 10090 (75.1%) formed the control group in our analysis. For the clinical characteristic, compared to the non‐CABG patients, prior CABG patients were older (OR, 3.98; 95% CI, 3.19–4.78; p < .001; I 2 = 72%), had more male (OR, 1.30; 95% CI, 1.14–1.49; p < .001; I 2 = 6%), diabetes mellitus (OR, 1.54; 95% CI, 1.36–1.73; p < .001; I 2 = 37%), dyslipidemia (OR, 1.89; 95% CI, 1.33–2.69; p < .001; I 2 = 81%), hypertension (OR, 1.88; 95% CI, 1.46–2.41; p < .001; I 2 = 71%), previous myocardial infarction (OR, 1.94; 95% CI, 1.48–2.56; p < .001; I 2 = 85%), and previous PCI (OR, 1.74; 95% CI, 1.52–1.98; p < .001; I 2 = 22%). Non‐CABG patents had more current smoker (OR, .45; 95% CI, 0.27–0.74; p < .001; I 2 = 91%). BMI (OR, −0.01; 95% CI, −0.07–0.06; p = .85; I 2 = 36%) were similar in both groups. For lesions location, the right coronary artery (RCA) was predominant target vessel in both groups (50.5% vs 48.7%; p＝.49), although, the left circumflex (LCX) was more frequently CTO in the prior CABG group (27.3% vs 18.9%; p＜.01), while left anterior descending artery (LAD) in non‐CABG ones (16.0% vs 29.1%; p＜0.01). For lesions characteristics, prior CABG patients had more blunt stump (OR, 1.71; 95% CI, 1.46–2.00; p < .001; I 2 = 40%), proximal cap ambiguity (OR, 1.45; 95% CI, 1.28–1.64; p < .001; I 2 = 0.0%), severe calcifications (OR, 2.91; 95% CI, 2.19–3.86; p < .001; I 2 = 83%), more bending (OR, 3.07; 95% CI, 2.61–3.62; p < .001; I 2 = 0%), lesion length > 20 mm (OR, 1.59; 95% CI, 1.10–2.29; p = .01; I 2 = 83%), inadequate distal landing zone (OR, 1.95; 95% CI, 1.75–2.18; p＜.001; I 2 = 0.0%), distal cap at bifurcation (OR, 1.65; 95% CI, 1.46–1.88; p < .001; I 2 = 0.0%), and higher J‐CTO score (SMD, 0.52; 95% CI, 0.42–0.63; p < .001; I 2 = 65%). But side branch at proximal entry (OR, 0.88; 95% CI, 0.72–1.07; p = .21; I 2 = 45%), in‐stent CTO (OR, 0.99; 95% CI, 0.86–1.14; p = .88; I 2 = 0.0%), lack of interventional collaterals (OR, 0.80; 95% CI, 0.55–1.15; p = .23; I 2 = 78%), and previously failed attempt (OR, 0.73; 95% CI, 0.48–1.11; p = .14; I 2 = 89%) were similar in both groups. For complication, prior CABG patients had more perforation with need for intervention (OR, 1.91; 95% CI, 1.36–2.69; p < 0.001; I 2 = 34%), contrast‐induced nephropathy (OR, 3.40; 95% CI, 1.31–8.78; p = .01; I 2 = 0.0%). Non‐CABG patents had more tamponade (OR, 0.25; 95% CI, 0.09–0.72; p = .01; I 2 = 0.0%), and the major bleeding complication (OR, 1.18; 95% CI, 0.57–2.44; p = .65; I 2 = 0%) were no significant difference in both groups. In conclusion, Patients with prior CABG undergoing CTO‐PCI have more complex lesion characteristics, though procedural complication rates were comparable.

Abstract 10326: Do Veterans Having Superficial Femoral Artery Revascularization Have Worse Disease and Poorer Long-Term Outcomes Than Non-Veterans?

Introduction: Veteran Affairs (VA) patients may have higher risk factors and worse outcomes after peripheral revascularization compared to patients treated in non-VA facilities. Hypothesis: Compared to non-VA patients, VA patients have higher rates of risk factors and poorer outcomes after superficial femoral artery (SFA) endovascular revascularization. Methods: We assessed long-term outcomes in all patients having SFA endovascular revascularization between 2003-2010 in 2 regional referral institutions in Boston, one a VA hospital (VA Boston) and the other a non-VA hospital (Brigham and Women’s Hospital). Atherosclerosis risk factors, lesion characteristics, and outcomes of death, repeat revascularization, and limb amputation were assessed by review of the chart and national death indices. The hazard ratio and 95% confidence interval (HR, 95%CI) of death and adverse limb events for VA versus non-VA patients were assessed by Cox proportional hazard models. Results: Of the 203 subjects, 88 were VA patients and 115 were non-VA patients and 254 limbs were revascularized. VA and non-VA patients had a similar mean age (68 vs 68 years, p=0.74), and aspirin and statin use were over 90% in both groups. VA patients had a higher prevalence of diabetes (59% vs 41%, p=0.011) and current smoking (36% vs 18%, p=0.006). The prevalence of limbs with critical limb ischemia was similar (VA: 20% vs Non-VA: 17%, p=0.51), but limbs in VA patients were more likely to have TASC C or D lesions (57% vs 43%, p=0.028), and lesions &gt; 200mm in length (44% vs 31%, p=0.044). Over an average 5.1 years follow-up, 96 patients died and 82 limbs required repeat revascularization. Compared to non-VA patients, VA patients had similar risks of death (HR=0.91, 95%CI=0.55, 1.49) and repeat revascularization (HR=1.1, 95%CI=0.67, 1.75). 17 limbs required subsequent surgical revascularization and 16 limbs had minor or major amputation with similar rates in both groups. Multivariable models showed similar results. Conclusion: In this comparison, VA patients having SFA endovascular revascularization had a higher prevalence of some atherosclerosis risk factors and more complex lesion characteristics, but similar long-term outcomes over an average 5 years.

IVUS-Guided Zero-Contrast PCI in CKD Patients: Safety and Short-Term Outcome in Patients with Complex Demographics and/or Lesion Characteristics

Background. Percutaneous coronary intervention (PCI) in patients with significant renal dysfunction is challenging because of the lesion characteristics and the risk of contrast-induced acute kidney injury (CI-AKI). With the advent of intravascular ultrasound- (IVUS-) guided zero-contrast PCI, outcomes have improved considerably. Objective. To assess the safety and short-term outcomes of IVUS-guided zero-contrast PCI in chronic kidney disease (CKD) patients with complex demographics or lesion morphology. Methods. Patients who underwent IVUS-guided zero-contrast PCI at a tertiary center, from November 2019 to May 2020, were included in this prospective analysis. Clinical characteristics, procedural data, and follow-up data were collected and analyzed. Results. A total of 15 patients (27 vessels), all men (mean age, 70.0 ± 11.0 years), underwent zero-contrast PCI. The mean estimated glomerular filtration rate (eGFR) and serum creatinine were 30.8 ± 7.3 mL/min/1.73 m2 and 2.6 ± 1.3 mg/dL, respectively. The mean BMC2 risk for dialysis was 2.1 ± 1.1%, mean SYNTAX score was 20.3 ± 10.3, and mean left ventricular ejection fraction (LVEF) was 42.4 ± 11.6%. Four patients (26.6%) underwent left main coronary artery (LMCA) PCI including one LMCA bifurcation. One patient underwent chronic total occlusion PCI. Technical and procedural success were 100% without any periprocedural complications. No major adverse cardiovascular events (MACE) were reported, and no patient required dialysis within three months of follow-up. Conclusion. Zero-contrast PCI guided by IVUS is safe in coronary artery disease (CAD) patients with moderate-to-severe CKD. High procedural success without complications can be achieved even in cases with complex clinical characteristics and lesion morphology.

Determinants of Periprocedural Myocardial Infarction in Current Elective Percutaneous Coronary Interventions.

Periprocedural myocardial infarction (PMI) is closely associated with long-term cardiovascular events. The factors associated with PMI are not fully understood. The purpose of this study was to investigate the determinants of PMI in contemporary elective percutaneous coronary intervention (PCI). Overall, 731 elective PCI was divided into the PMI (n = 27) and non-PMI (n = 704) groups. Univariate and multivariate logistic regression analysis was used to find factors associated with PMI. In the univariate analysis, PMI was associated with complex lesion characteristics, such as the lesion length, lesion angle, calcification, and Medina classification. In the multivariate logistic regression analysis, the lesion length (per 10-mm increase: odds ratio (OR), 1.477; 95% confidence interval (CI), 1.161‒1.879; P = 0.002), lesion angle ≥ 45° (versus lesion angle < 45°: OR, 4.244; 95% CI, 1.187‒15.171; P = 0.026), and Medina classification (0,1,1) / (1,1,1) (versus other lesions: OR, 14.843; 95% CI, 6.235‒35.334; P < 0.001) were significantly associated with PMI. Of the 24 lesions with lesion angle ≥ 45° in the PMI group, 14 had final TIMI flow grade ≤ 2 in side branches and 9 had transient slow flow in main branches/transient ST elevation during PCI. Of the 87 lesions with Medina classification (1,1,1) / (0,1,1), 19 had final TIMI grade ≤ 2 in side branches. In conclusion, the lesion length, lesion angle ≥ 45°, and Medina classification (0,1,1) / (1,1,1) were significantly associated with PMI in contemporary elective PCI. Preventing flow limitation in both side branches and main vessels in elective PCI for the diffuse long, angulated, or true bifurcation lesions is important.

Association of the long fluoroscopy time with factors in contemporary primary percutaneous coronary interventions.

BackgroundSince the long fluoroscopy time in primary PCI for ST-segment elevation myocardial infarction (STEMI) could be an indicator of delayed reperfusion, it should be important to recognize which types of lesions require longer fluoroscopy-time in primary PCI. The purpose of this study was to investigate the association of the long fluoroscopy-time with clinical factors in primary percutaneous coronary interventions (PCI).MethodsA total of 539 patients who underwent primary PCI were divided into the conventional fluoroscopy-time group (Q1-Q4: n = 434) and the long fluoroscopy-time group (Q5: n = 105) according to the quintile of the total fluoroscopy time in primary PCI. Univariate and multivariate logistic regression analyses were performed to find associations between clinical variables and the long fluoroscopy-time.ResultsIn univariate logistic regression analysis, prevalence of diabetes mellitus, hemodialysis, and previous CABG were significantly associated with the long fluoroscopy-time. In addition, complex lesion characteristics such as lesion length, lesion angle, tortuosity, and calcification were associated with the long fluoroscopy-time. In multivariable logistic regression analysis, lesion length [per 10 mm incremental: odds ratio (OR) 1.751, 95% confidence interval (CI) 1.397–2.195, P<0.001], moderate-excessive tortuosity (vs. mild tortuosity: OR 4.006, 95% CI 1.498–10.715, P = 0.006), and moderate to severe calcification (vs. none-mild calcification: OR 1.865, 95% CI 1.107–3.140, P = 0.019) were significantly associated with the long fluoroscopy-time.ConclusionsIn primary PCI for STEMI, diffuse long lesion, tortuosity, and moderate-severe calcification were associated with the long fluoroscopy-time. These complex features require special attention to reduce reperfusion time in primary PCI.

Impact of prior coronary artery bypass grafting in patients undergoing chronic total occlusion-percutaneous coronary intervention: Procedural and clinical outcomes from the REgistry of Crossboss and Hybrid procedures in FrAnce, the NetheRlands, BelGium, and UnitEd Kingdom (RECHARGE).

Chronic total occlusions (CTO) in patients with history of coronary artery bypass graft (CABG) show more advanced and complex atherosclerotic pathology. Aim of our study is to compare outcomes in patients undergoing CTO percutaneous coronary intervention (PCI) with previous CABG versus those without in the REgistry of Crossboss and Hybrid procedures in FrAnce the NetheRlands, BelGium and UnitEd Kingdom (RECHARGE). The RECHARGE cohort (1,252 patients) was divided in two groups according to the presence of previous CABG (217) or not. We also focused, in the post-CABG group, on a comparison between CTO in previously grafted vessels versus non-grafted vessels. The CTO complexity scores were higher and the success rate (71.9% vs. 88.7%, p < .001) was lower in the CABG group, this difference was driven by higher failure rates in high-complexity-score CTO. The rate of in-hospital complications was similar. In the post-CABG group, the procedural success of CTO located in previously grafted vessels versus those in vessels not previously grafted, was comparably suboptimal (73.1% vs. 68%, p = .47). Patients undergoing CTO PCI with prior CABG have a higher prevalence of comorbidities and more complex lesion characteristics. In the post-CABG population the success rate was significantly lower, particularly in high CTO complexity scores, though complication rates were comparable. In the post-CABG population, the CTO success rate was independent of the presence of a previous graft on the CTO vessel.

Association of less-contrast media with clinical factors in elective percutaneous coronary intervention

Since the amount of contrast media during percutaneous coronary intervention (PCI) is closely related to the exacerbation of renal function, it should be important to reduce the dose of contrast media during PCI. The purpose of this retrospective study was to evaluate the association of less-contrast media with clinical factors in elective PCI. A total of 709 patients were divided into the less-contrast media group (n = 142) and the conventional-contrast media group (n = 567) according to the quintile of total contrast volume. Univariate and multivariate logistic regression analyses were performed to find associations between the clinical variables and the less-contrast media group. The intravascular ultrasound (IVUS) use rate in the study population was considerably high (94.9%). In multivariable logistic regression analysis, an eGFR < 30mL/min/1.73m2 without hemodialysis was significantly associated with the less-contrast media group [odds ratio (OR) 43.73, 95% confidence interval (CI) 14.05-136.09, P < 0.001]. Left main-left anterior descending artery lesion (OR 0.28, 95% CI 0.17-0.48, P < 0.001), bifurcation lesion (OR 0.39, 95% CI 0.16-0.92, P = 0.03), chronic total occlusion (OR 0.22, 95% CI 0.06-0.90, P = 0.03) were inversely associated with the less-contrast media group. In conclusion, complex lesion characteristics were inversely associated with the less-contrast media in elective PCI. Since operators could access patients' renal function before elective procedure, an eGFR < 30mL/min/1.73m2 was most significantly associated with the less-contrast media. Our results suggest the possibility that the amount of contrast media is controllable in current PCI under IVUS-guidance.

Highlights From the Circulation Family of Journals

Highlights From the <i>Circulation</i> Family of Journals

Twelve-month comparative analysis of clinical outcomes using biodegradable polymer–coated everolimus-eluting stents versus durable polymer–coated everolimus-eluting stents in all-comer patients

AimThe purpose of the present study was to examine whether clinical differences exist between the biodegradable polymer (BDP)–coated Tetrilimus everolimus-eluting stent (EES) and the durable polymer (DP)–coated Xience EES by comparing the major adverse cardiac event (MACE) rate at 12 months in all-comer patients. MethodsThis study was designed as a multicentre, observational, retrospective, investigator-initiated study between January 2016 and October 2016. Two hundred thirteen patients who underwent percutaneous coronary intervention (PCI) with the BDP-EES were compared with 204 patients who underwent PCI with the DP-EES, irrespective of lesion complexity, comorbidities and acute presentation. The primary end point was MACE defined as a composite of cardiac death, myocardial infarction and target lesion revascularization. ResultsBaseline clinical and lesion characteristics of both the groups were similar, although the BDP-EES group had a significantly higher number of patients with diabetes mellitus (39.9% vs. 30.4%; p = 0.042) and type C lesion (67.4% vs. 48.1%; p < 0.001) than the DP-EES group. The 12-month MACE rate was 4.2% for the BDP-EES group versus 4.9% for the DP-EES group (p = 0.740). Mortality was lower in the BDP-EES group than in the DP-EES group (0.9% vs. 2.0%; p = 0.441). ConclusionThe present comparative analysis shows that the BDP-coated Tetrilimus EES was as safe and effective as the DP-coated Xience EES during the 12-month follow-up period despite complex lesion characteristics.

Routine Fractional Flow Reserve Measurement After Percutaneous Coronary Intervention.

Fractional flow reserve (FFR) is the current gold standard to determine hemodynamic severity of angiographically intermediate coronary lesions. Much less is known about the prognostic effects of FFR measured directly after percutaneous coronary intervention (PCI). The aims of this study were to evaluate post-PCI FFR values, identify predictors for a low post-PCI FFR, and to investigate whether a relationship between postprocedural FFR and outcome during 30-day follow-up exists. The FFR-SEARCH (Fractional Flow Reserve-Stent Evaluated at Rotterdam Cardiology Hospital) is a prospective registry in which FFR measurements were performed after PCI in 1000 consecutive patients. All FFR measurements were performed under maximum hyperemia with intravenous adenosine with the Navvus RXi system (ACIST Medical Systems, Eden Prairie, MN). The clinical end point was defined as a composite of death, target vessel revascularization, or nonfatal myocardial infarction at 30-day follow-up. Measurement of post-PCI FFR was successful in 959 patients (96%), and a total of 1165 lesions were assessed. There were no complications related to the microcatheter. A total of 322 ST-segment-elevation myocardial infarction patients with 371 measured lesions were excluded leaving 637 patients with 794 measured lesions for the final analysis. Overall post-PCI FFR was 0.90±0.07. In 396 lesions (50%), post-PCI FFR was >0.90. A total of 357 patients (56%) had ≥1 lesion(s) with a post-PCI FFR ≤0.90, and 73 patients (11%) had ≥1 lesion(s) with a post-PCI FFR ≤0.80 with post-PCI FFR ≤0.80 in 78 lesions (9.8%). Complex lesion characteristics, use of multiple stents and smaller reference vessel diameter was associated with post-PCI FFR ≤0.90. During follow-up, 11 patients (1.8%) reached the clinical end point. There was no significant relationship between post-PCI FFR and the clinical end point at 30-day follow-up ( P=0.636). Routine measurement of post-PCI FFR using a monorail microcatheter is safe and feasible. Several lesion and patient characteristics were associated with a low post-PCI FFR. Post-PCI FFR did not correlate with clinical events at 30 days.

Bioresorbable Everolimus-Eluting Vascular Scaffold for Long Coronary Lesions: A Subanalysis of the International, Multicenter GHOST-EU Registry

ObjectivesThe authors sought to investigate 1-year outcomes in patients treated with bioresorbable everolimus-eluting vascular scaffolds (BVS) for “long coronary lesions.” BackgroundThe present substudy derived from the GHOST-EU registry included 1,722 lesions in 1,468 consecutive patients, enrolled between November 2011 and September 2014 at 11 European centers. MethodsThe lesions were divided into 3 groups according to continuous BVS length: 1) shorter than 30 mm; 2) between 30 and 60 mm; and 3) longer than 60 mm. Primary device-oriented endpoint (target lesion failure [TLF]) was defined as a combination of cardiovascular death, target vessel myocardial infarction, or clinically driven target lesion revascularization. ResultsPatients with lesions ≥60 mm had more comorbidities and more complex lesion characteristics, including chronic total occlusions (37%), bifurcation lesions (40.3%), higher Syntax score (16.4 ± 7.8), and higher number of scaffolds implanted per lesion (3.3 ± 0.9 mm). The main target vessel was the left anterior coronary artery in all groups. Median follow-up was 384 (interquartile range: 359 to 459) days. One-year follow-up was completed in 70.3% of patients. TLF at 1 year was significantly higher in group C (group A 4.8%, group B 4.5%, group C 14.3%; overall p = 0.001), whereas there were no significant differences between groups A and B. Finally, a numerically higher (but not statistically significant) number of scaffold thromboses were observed in group C when compared with shorter lesions (group A 2.1%, group B 1.1%, group C 3.8%; overall p = 0.29). ConclusionsIn a real-world setting, treatment of long coronary lesions with BVS ≥60 mm was associated with a higher TLF rate, driven by myocardial infarction and clinically driven target lesion revascularization.

Spectral CT imaging of intranodular hemorrhage in cases with challenging benign thyroid nodules.

While conventional ultrasound and laboratory testing can differentiate most thyroid conditions and malignancies, spectral dual-energy computed tomography (DECT) provides molecular data potentially useful in differential diagnosis of small, complex, and partially obscured hemorrhaged nodules with recent bleeding. To demonstrate that Gemstone Spectral Imaging (GSI) analysis of DECT data differentiates challenging benign thyroid nodule conditions in patients with intranodular hemorrhages. A retrospective study was conducted of 30 intranodular hemorrhage patients from 2010 to 2013, including 18 that underwent surgery and provided thyroid tissues for prospective histological analysis. Iodine and water content were determined in patient CT scans and ex vivo tissue specimen scans by reconstruction of raw CT data at 65keV (optimal contrast). Slope of spectral curve (λ HU), effective atomic number (Z eff), and final pathological diagnosis were recorded. Iodine content, water content, Z eff, and λ HU significantly varied by region (intranodular hemorrhage, solid thyroid nodule, and adjacent margins) in patients and tissue specimens (P<0.05). Intranodular hemorrhage exhibited elevated water concentrations (~1100mg/mL), suggesting a practical threshold of 1075mg/mL for differentiating intra-plaque hemorrhage and solid nodular regions. Spectral CT provided diagnostic information in 14 thyroid adenomas and four goiters (histologically confirmed in donor specimens), and eight thyroid adenomas and four nodular goiters based on clinical diagnosis. Diagnostically useful regional characteristic of intranodular hemorrhage in the thyroid was visualized via spectral CT employing material decomposition, potentially yielding additional molecular data about complex lesion characteristics no apparent in conventional imaging or laboratory methods.

Abstract 12850: Complex Lesion Characteristics Would be the Potential Risk Factors for Ventricular Fibrillation With Acute Coronary Syndrome

Background: In the setting of acute coronary syndrome (ACS), ventricular fibrillation (VF) was serious and fatal complication. However, even though ischemia was well known as the risk for occurrence of VF, what influential factors of ACS patients related to VF were still unclear. We performed extracorporeal cardiopulmonary resuscitation for VF with ACS patients taken to our institute and performed coronary angiography to make definite diagnosis. Accordingly, We sought to the risk factors for VF with ACS. Methods: Consecutive 246 ACS patients hospitalized and underwent emergent coronary revascularization from September 2010 to September 2014 were enrolled. In these, patients with VF were categorized into VF group, and patients without VF were into non-VF group. We reviewed patients’ characteristics, including medications, past histories and laboratory findings, and CAG findings (lesion characteristics with ACC/AHA classification, number of disease vessels, existence of chronic total occlusion (CTO) and left-main coronary artery (LMCA) lesion) retrospectively. Results: Fifty-seven patients developed ACS with VF (VF group), and 189 patients were without VF (non-VF group). Comparing between the groups, the morbidity of previous angina pectoris or coronary artery bypass grafting were significantly higher in VF groups (32.1%-16.0%, p=0.01, 14.3%-1.1%, p&lt;0.001, respectively). The prevalence of Complex lesion characteristics, such as multi vessel disease, CTO and LMCA lesion, was also higher in VF group (71.9%-42.8%, 43.9%-13.9%, 15.8%-6.3%, all p &lt; 0.025, retrospectively). Moreover, multiple logistic regression analysis revealed multi vessel disease and existence of CTO lesion were independent factors for VF. Conclusion: VF group had more complex characteristics of coronary artery disease. Complex lesion characteristics, such as multi vessel disease, CTO and LMCA lesion, would be potential risk factors of VF with ACS patients.

Training Standards and Recommendations for Intervention on Chronic Total Occlusions.

Despite major advances in coronary intervention, the recanalization of a chronic total occlusion (CTO) remains a challenge for many interventional cardiologists. Complex anatomy and lesion characteristics demand a special set of skills for procedural success. Provided patient selection is appropriate, CTO intervention can confer a variety of benefits including relief of angina, improvement in left ventricular function and reduction in ischemic burden. The chances of procedural success are enhanced by having a dedicated CTO program. This involves adequate training of staff, quality control and availability of equipment. A diverse toolkit allows variation in strategy and increases procedural success. Further, skills and equipment are required to manage complications like vessel dissection, perforation and the resultant ischemic or mechanical complications. These procedures can often be lengthy and giving careful consideration to peri-procedural issues like radiation exposure and contrast dose plays a vital role in ensuring optimal patient outcomes and radiation hygiene. In this article we review the evidence behind indications for CTO intervention and discuss the development of a CTO program.

TCT-244 Real World 1-year Clinical Outcomes of Bioresorbable Vascular Scaffold Implanted in Diabetic Patients

Aim of the present study is to investigate 1-year clinical outcomes after implantation of BVS vs. EES in all-comer diabetic patients, including those with complex lesion characteristics. Consecutive diabetic patients treated with BVS between May 2007 and April 2014 and those treated with EES

Clinical outcomes in real‐world patients with small vessel disease treated with XIENCE V® everolimus‐eluting stents: One year results from the XIENCE V® USA condition of approval post‐market study

The purpose of this study was to evaluate the 1-year clinical outcomes of more complex XIENCE V USA real-world patients with small versus nonsmall vessel lesions. Patients with small vessel lesions undergoing coronary stent placement are at higher risk of major adverse cardiac events. Improved safety and efficacy of XIENCE V everolimus eluting stents (EES) have been previously demonstrated in selected low-risk small vessel populations in randomized clinical trials. The XIENCE V USA study was a condition of approval, single-arm study in unselected real-world patients. Baseline and 1-year clinical outcomes were compared between XIENCE V USA patients who received a single 2.5 mm stent (small vessel group, N = 838) and patients implanted with a single >2.5 mm stent (non-small vessel group, N = 2,015). Mean reference vessel diameter was 2.55 ± 0.36 and 3.25 ± 0.46 mm in the small and non-small vessel groups, respectively (P < 0.001). Small vessel group had more females, presented with a higher rate of diabetes, and had more complex lesion characteristics. The definite or probable ST rates analyzed using Kaplan-Meier method were low and not significantly different between the groups at 0.37 and 0.40% for the small and nonsmall vessel group (P = 0.88), respectively. The composite rate of cardiac death or MI was comparable at 4.5% for the small and 5.1% for the non-small vessel 1 groups (P = 0.57). The 1-year target lesion revascularization rate was also comparable in the small vessel group (3.8% vs. 3.0%, P = 0.35). Despite gender difference, higher prevalence of diabetes and more complex lesions in the small vessel groups, the 1-year clinical outcomes were similar in both small and nonsmall vessel groups. These results demonstrate the therapeutic benefit of XIENCE V EES in a real-world all inclusive patient population with small vessel disease.

Zotarolimus- and Paclitaxel-Eluting Stents in an All-Comer Population in China: The RESOLUTE China Randomized Controlled Trial

This study sought to compare clinical outcomes and angiographic findings using the Resolute zotarolimus-eluting stent (R-ZES) (Medtronic, Santa Rosa, California) versus the Taxus Liberte paclitaxel-eluting stent (PES) (Boston Scientific, Natick, Massachusetts) in an all-comer Chinese population. Concerns regarding restenosis risk led to new-generation drug-eluting stents (DES) designed for use in patients with complex clinical or lesion characteristics. In-stent late lumen loss (LLL) is a measure of restenosis risk. Patients with an indication for treatment with a DES were randomized in a 1:1 ratio to placement of at least 1 R-ZES or PES with minimal exclusions. The primary endpoint was angiographic in-stent LLL at 9 months post-procedure. Clinical endpoints at 12 months are compared between the 2 stents. A total of 198 patients received a R-ZES, and 202 patients received a PES. Most patients were male; 25.8% and 29.2% of R-ZES and PES patients, respectively, had diabetes. Over 70% of lesions in both cohorts were American College of Cardiology/American Heart Association lesion classification Type B2 and C (B2/C). In-stent LLL was 0.16 ± 0.38 mm for R-ZES and 0.33 ± 0.52 mm for PES at 9 months (p < 0.001; 95% confidence interval [CI]: -0.26 to -0.08). The rates of clinically driven target lesion revascularization were 1.5% for R-ZES and 7.0% for PES (p = 0.011). The rate of target lesion failure was 5.6% for R-ZES and 11% for PES (p = 0.068). In an all-comers Chinese population, 9-month in-stent LLL was significantly less with R-ZES compared with PES, which was reflected in lower revascularization rates at 12 months for the R-ZES patients. Results are consistent with previous clinical trials of the R-ZES in all-comer populations. (Resolute Zotarolimus-Eluting Stent Versus the Taxus Liberte Paclitaxel-Eluting Stent for Percutaneous Coronary Intervention in China [R-China RCT]; NCT01334268).