Distal Target Vessel Research Articles

Intra-arterial Pressure-Enabled Drug Delivery Significantly Increases Penetration of Glass Microspheres in a Porcine Liver Tumor Model

PurposeTo test the hypothesis that Pressure-Enabled Drug Delivery (PEDD) would improve the delivery of surrogate therapeutic glass microspheres (GMs) via hepatic artery infusion to liver tumors when compared with a conventional endhole microcatheter. Materials and MethodsThe study was conducted in transgenic pigs (Oncopigs) with induced liver tumors. Tumors were infused intra-arterially with fluorescently labeled GM. PEDD with a specialized infusion device (TriNav; TriSalus Life Sciences, Westminster, Colorado) was compared with conventional endhole microcatheter delivery in both lobar and selective infusions. Near-infrared imaging was used to detect GM fluorescent signal in tumors. Image analysis with a custom deep learning algorithm (Visiopharm A/S) was used to quantitate signal intensity in relation to the tumor border. ResultsWith lobar infusions, significant increases in GM signal intensity were observed in and around tumors after PEDD (n = 10) when compared with those after conventional delivery (n = 7), with PEDD increasing penetration into the tumor by 117% (P = .004). In selective infusions, PEDD (n = 9) increased penetration into the tumor by 39% relative to conventional delivery (n = 8, P = .032). Lobar PEDD of GMs to the tumor was statistically equivalent to conventional selective delivery (P = .497). ConclusionsPEDD with a TriNav device significantly improved GM uptake in liver tumors relative to conventional infusion in both lobar and selective procedures. Lobar GM delivery with PEDD was equivalent to conventional selective delivery with an endhole device, suggesting that proximal PEDD infusions may enable effective delivery without selection of distal target vessels.

Physician Modification of a Custom-Made Fenestrated Endograft By Closure of a Fenestration With Bovine Patch.

Ruptured mycotic pararenal aortic aneurysms are rare and serious condition that requires prompt treatment. Open surgery with aortic resection and in-situ or extra-anatomic reconstruction is the standard treatment. The aim of this technical note is to report urgent endovascular treatment using a readily available custom-made device (created for another patient), with a back-table modification using pericardium patch and a new fenestration. In preoperative measurements on centerline-based workstation, aortic diameter in proximal and distal landing zone and target vessel position matched the measurements of graft plan of custom-made device (CMD) besides left renal artery. To address current patient`s anatomy, closure of the nonsuitable fenestration with pericardial patch and creation of new fenestration (1 cm above and 1:15 hours posterior to original fenestration) for the respective target vessel have been performed. Postoperative computed tomography angiography (CTA) scan showed complete exclusion of aneurysm, perfused target vessels, and no endoleak. Under resistance-based antibiotic therapy, the patient was asymptomatic and showed normal infection parameters in blood samples postoperatively. In the hands of an experienced endovascular aortic surgeon modification of a custom-made device is a quick and feasible technique in this emergency situation. Long-term follow-up must confirm the durability and reliability of this new technique. The described technique of modification of a custom-made endograft can provide an alternative endovascular treatment option for urgent complex abdominal aortic pathologies. Compared to the current available treatment modalities, like physician modified endografts, off-the-shelf branched devices, parallel grafts and in-situ fenestration, it can save considerable time and provides reasonable sealing in ruptured cases. The technique offers a valuable add-on to the armamentarium of experienced endovascular physicians.

Distal Target Vessel Quality and Outcomes of Chronic Total Occlusion Percutaneous Coronary Intervention

BackgroundDistal vessel quality is a key parameter in the global chronic total occlusion (CTO) crossing algorithm. ObjectivesThe study sought to evaluate the association of distal vessel quality with the outcomes of CTO percutaneous coronary intervention. MethodsWe examined the clinical and angiographic characteristics and procedural outcomes of 10,028 CTO percutaneous coronary interventions performed at 39 U.S. and non-U.S. centers between 2012 and 2022. A poor-quality distal vessel was defined as <2 mm diameter or with significant diffuse atherosclerotic disease. In-hospital major adverse cardiac events (MACE) included death, myocardial infarction, urgent repeat target vessel revascularization, tamponade requiring pericardiocentesis or surgery, and stroke. ResultsA total of 33% of all CTO lesions had poor-quality distal vessel. When compared with good-quality distal vessels, CTO lesions with a poor-quality distal vessel had higher J-CTO (Japanese chronic total occlusion) scores (2.7 ± 1.1 vs 2.2 ± 1.3; P < 0.01), lower technical (79.9% vs 86.9%; P < 0.01) and procedural (78.0% vs 86.8%; P < 0.01) success, and higher incidence of MACE (2.5% vs 1.7%; P < 0.01) and perforation (6.4% vs 3.7%; P < 0.01). A poor-quality distal vessel was independently associated with technical failure and MACE. Poor-quality distal vessels were associated with higher use of the retrograde approach (25.2% vs 14.9%; P < 0.01) and higher air kerma radiation dose (2.4 [IQR: 1.3-4.0] Gy vs 2.0 [IQR: 1.1-3.5] Gy; P < 0.01). ConclusionsA poor-quality distal vessel in CTO lesions is associated with higher lesion complexity, higher need for retrograde crossing, lower technical and procedural success, higher incidence of MACE and coronary perforation, and higher radiation dose.

Long-term outcomes after fenestrated endovascular aortic repair for juxtarenal aortic aneurysms

ObjectiveFenestrated endovascular aortic aneurysm repair (FEVAR) for juxtarenal aortic aneurysm (jAAA) disease is safe and effective with good short- and mid-term outcomes. The durability issues have mainly focused on the proximal and distal seal and target vessel (TV) instability, and long-term data are scarce. In previous studies, we have reported the short-term outcomes after FEVAR and compared our early and late experience and the long-term results for the early cohort. In the present report, we have provided the long-term outcomes for our late experience cohort who had undergone FEVAR at the Vascular Center (Skåne University Hospital, Malmö, Sweden). MethodsConsecutive patients who had undergone FEVAR for jAAAs from 2007 to 2011 were included in the present study. Data were collected retrospectively from the medical and imaging records. The follow-up protocol consisted of a clinical examination 1 month postoperatively and computed tomography angiography combined with plain abdominal radiography at 1 and 12 months and annually thereafter. The primary endpoints were TV instability, reinterventions, and survival. Changes in the aneurysm diameter and renal function and the incidence and type of endoleaks were also analyzed. ResultsA total of 94 patients were included in the present study. The median follow-up time was 89 months (range, 0-152 months). A total of 280 fenestrations or scallops were used, of which 205 were stented. Technical success was 89.4%. Primary TV patency was 94% ± 1% at 1 year, 90% ± 2% at 3 years, and 89% ± 2% at 5 years. Of the 94 patients, 37 (39.4%) had required a total of 70 reinterventions. The mean time to the first reintervention was 21 ± 3.97 months. Five patients (5.3%) had died of aneurysm-related causes. Overall survival was 95.7% ± 2.1% at 1 year, 87.1% ± 3.5% at 3 years, and 71.0% ± 4.7% at 5 years. A stable or decreasing aortic diameter after treatment was seen in 91% of the cases. The mean glomerular filtration rate had decreased from 59.2 ± 14.9 mL/min/1.73 m2 preoperatively to 50.0 ± 18.6 mL/min/1.73 m2 at the end of follow-up. ConclusionsThe results of the present study have shown that the long-term results after treatment of jAAAs with FEVAR remain good and the treatment is safe and effective. Although the need for reintervention remained high, long-term renal function and survival support the use of FEVAR as a valid treatment option for jAAA disease.

Renovisceral Stents in Complex Aortic Grafts: Assessing Endoleaks, Patency, and Reintervention

Endovascular techniques for complex aortic aneurysm repair include fenestrated endovascular aortic repair, branched aortic grafts, and parallel stent-grafts. These require durable stent-grafts to maintain renovisceral perfusion and limit endoleak and gutter leaks, specifically the occurrence of type Ic endoleaks between stent-graft and distal target vessel attachment and the occurrence of type IIIc endoleaks between renovisceral stent placement and fenestration of the main aortic graft. Others have anecdotally reported an increase in type IIIc endoleaks with VBX stents (W.

Patterns of arterial involvement and feasibility of revascularization in thromboangiitis obliterans: a tertiary care centre experience.

Arterial revascularization is seldom considered as a treatment option in thromboangiitis obliterans (TAO) due to diffuse segmental involvement of medium- and small-sized extremity vessels. Although typical angiographic features include bilaterally symmetrical involvement of infrapopliteal vessels, larger vessels too can be affected. Similarly, there could be distal target vessels feasible for revascularization. This study was conducted to describe the patterns of arterial involvement in TAO and assess the feasibility of revascularization. The study was approved by the Institutional Review Board and research ethics committee of Christian Medical College, Vellore (IRB no: 12034). A retrospective study was conducted in the Department of Vascular Surgery, Christian Medical College, Vellore, India, between January 2009 and December 2018. There were 329 patients who fulfilled the clinical criteria for TAO of whom 83 had an angiogram done. These 83 patients formed the study cohort. Large vessel involvement was seen in 56.6% of patients and 79.5% of patients had at least one or more distal target artery feasible for revascularization. The anterior tibial artery and peroneal artery were the most common target vessels that were patent for revascularization. Of the 22 patients who underwent revascularization (16 bypasses and six angioplasties), the patency rate was 64.8% and the limb salvage rate was 80.9% at the end of 6 months. The study shows that one-third of our patients with TAO have a distal target artery feasible for revascularization. As most of the affected patients are in the economically productive age group, every attempt should be made to salvage the limb with revascularization for which the use of angiography should be more liberal.

Cryopreserved Allografts for Treatment of Chronic Limb-Threatening Ischemia in Patients Without Autologous Saphenous Veins

Revascularization is the best alternative to reduce symptoms and to improve the limb salvage rate in patients with chronic limb-threatening ischemia (CLI). Alternative grafts as synthetic prostheses and allografts must be considered for patients without a suitable autologous graft. Our aim was to evaluate outcomes of cryopreserved allografts used as a vascular conduit for bypass surgery in the infrainguinal territory. A retrospective analysis (January 1995 to January 2014) of the Registry of vascular and valvular allografts transplant in the autonomous community of Catalonia, Spain was performed for identifying patients with CLI who required infrainguinal bypass with cryopreserved arterial allografts. Statistical analysis was performed using SPSS, ver. 20, for Mac (Chicago). A total of 149 patients with CLI (mean age of 70.1years) were analyzed. One hundred two patients (68.5%) had a grade IV lesion (Fontaine classification). In the overall follow-up, 24.8% of patients required a reintervention. Overall graft occlusion, infection, and dilation rate were 52.3%, 6%, and 5.4% respectively. Overall 30-day mortality was 0.7%. Five-year primary patency rate and limb salvage rate were 38.6% and 50.2%, respectively. Survival rate at 5years was 54.2%. Major adverse limb event (MALE)-free rate was 21.5% at 5years. Revascularization to a distal target vessel was an independent positive predictive risk factor for a lower limb salvage rate and lower primary patency rate. Dyslipidemia was related to a lower limb salvage rate and represents a risk factor involved in MALEs. Although arterial allografts seem to represent a suboptimal alternative, some selected patients could beneficiate from them. Five-year results are disappointing, and more studies are required to know other predictive factors for better selection of patients.

The Compression of a Plantar Lejars Pump Can Produce Arterial Flows in Acute Limb Ischemia

A maneuver is explained to show arterial flow and its runoff in patients with acute limb ischemia in whom neither the angiography nor the baseline Doppler can obtain a diagnosis of permeability. During the maneuver, the Doppler color scale should be set to the lowest speed. Plantar compression may result in an inverted flow in the artery because the arteriovenous precapillary communications are open. During the plantar decompress, the negative venous pressure created allows a transient arterial flow by aspiration. This maneuver can produce flux in distal tibial arteries without Doppler signal in the supine rest position and can help locate the distal target vessels for revascularization.

Use of Thrombolysis in Acute Lower Extremity Ischemia with Known Distal Target Vessel for Revascularization

Use of Thrombolysis in Acute Lower Extremity Ischemia with Known Distal Target Vessel for Revascularization

LEA26. Use of Thrombolysis in Acute Lower Extremity Ischemia With Known Distal Target Vessel for Revascularization Stenting

LEA26. Use of Thrombolysis in Acute Lower Extremity Ischemia With Known Distal Target Vessel for Revascularization Stenting

Outcomes of endovascular treatment versus bypass surgery for critical limb ischemia in patients with thromboangiitis obliterans.

We aimed to compare the clinical outcomes between endovascular treatment and inframalleolar bypass surgery for critical limb ischemia (CLI) in patients with thromboangiitis obliterans (TAO) and to assess the role of bypass surgery in the era of innovative endovascular treatment. Between January 2007 and December 2017, a total of 33 consecutive patients with the diagnosis of TAO presenting with CLI who underwent endovascular treatment (endovascular group, n = 22) or bypass surgery to the pedal or plantar vessels (bypass group, n = 11) were included and analyzed retrospectively. The primary endpoint was defined as a major amputation of the index limb, and the secondary endpoint was defined as graft occlusion, regardless of the number of subsequent procedures. In the bypass group, six patients (55%) had undergone previous failed endovascular procedures and/or arterial bypass surgery to the index limb before inframalleolar bypass, and two patients (18%) received microvascular flap reconstruction after bypass surgery. During the median follow-up period of 32 months (range 1–115 months), there were no significant differences in primary and secondary endpoints between the two groups although the bypass group had a higher Rutherford class than the endovascular group. Kaplan–Meier survival analysis showed that there were similar limb salvage (P = 0.95) and graft patency rates (P = 0.39). In conclusion, endovascular treatment is a valid strategy leading to an acceptable limb salvage rate for TAO patients, and surgical bypass to distal target vessels could play a vital role in cases of previous failed endovascular treatment or extensive soft tissue loss of the foot.

Complete revascularization for multi-vessel coronary diseases through lower ministernotomy on beating heart off-pump surgery

Objective: To discuss a novel method of complete revascularization for multi-vessel coronary diseases on beating heart off-pump surgery through lower ministernotomy. Methods: Clinical data of 79 patients underwent ministernotomy off-pump coronary artery bypass from January 2015 to May 2016 at Department of Cardiac Surgery, Heart Center, Beijing Friendship Hospital, Capital Medical University were analyzed retrospectively. There were 62 male and 17 female patients, with an average age of (65±9) years. All the patients were multi-vessel coronary diseases and planned to receive coronary artery bypass grafting. Left internal mammary artery, radial artery and great saphenous veins were harvested and prepared, respectively. The perioperative clinical data was observed and collected. Postoperative ventilator-assisted time, intensive care time, and 24-hour thoracic mediastinal drainage volume were recorded. Postoperative cardiac function was evaluated by echocardiography. The data were compared between pre- and post-operative using paired t test. Results: Cardiopulmonary bypass was used in 2 patients during operation because of unstable hemodynamic status, but the incision was not needed to extend for those 2 patients. The lower ministernotomy was converted to traditional full sternotomy in 2 patients due to limited space for proximal anastomosis. In total, 79 patients had an average of (2.8±0.6) grafts. One proximal anastomosis was performed in 75 patients and 2 anastomoses in 4 patients. Distal target vessels consisted of left descending arteries for 79 patients, posterior descending artery for 60 patients, obtuse marginal branch and intermediate branch for 56 patients and diagonal branches for 25 patients, respectively. Average postoperative ventilation time was (19.0±2.2) hours and ICU stay was (60±20) hours. One patient developed postoperative myocardial infarction and needed temporary intra-aortic balloon pump support. One patient was subjected to incision infection. None of patient died in this study. There were no significant differences in left ventricular end-diastolic diameter and left ventricular end-systolic diameter between pre- and post-operative. The post-operative ejection fraction was significantly higher than that pre-operative (66.5%±1.6% vs. 61.2%±2.3%, t=4.30, P=0.00). Conclusion: With lower ministernotomy, the various sites of distal target vessels could be reached and complete revascularization could be achieved for selected patients with triple vessel diseases, although the procedure is technical demanding.

IP219. When Antegrade Access Fails: Utilization of Retrograde Arterial Access in the Management of Infrainguinal Occlusive Disease Is a Safe and Feasible Strategy

The objective of this review is to describe technical success and short-term outcomes after a retrograde approach for infrainguinal therapeutic revascularization. Retrograde access techniques allow entry into the distal target vessel to aid in recanalization of occlusions when endovascular antegrade access fails. A lower extremity intervention vascular registry was queried to identify patients in whom a retrograde access was performed when a tibial, popliteal, or superficial femoral artery (SFA) occlusion could not be managed through an antegrade approach. Demographics, surgical indication, comorbidities, rates of procedural success, limb salvage rates, periprocedural complications, and mortality were collected. Access of the tibial, peroneal, pedal, or popliteal artery was obtained after anesthetizing the skin with a micropuncture sheath under ultrasound. Lesions successfully crossed were then treated either directly via the retrograde access or via subintimal arterial flossing with antegrade-retrograde intervention. From February 2012 to August 2015, 51 cases were identified (19 office and 32 hospital) in which a retrograde access was performed. Preoperative indications included Rutherford 3 (6), Rutherford 4 (12), and Rutherford 5 (33). Technical success rate was 86% (44 of 51). Technical failures were due to inability to cross the lesion or to connect with the antegrade access. Of these failures, two required below-knee amputation (BKA), four remained chronic Rutherford 5, but with healing wounds, and one died. A variety of tibial (23) and SFA/popliteal (56) lesions were treated via percutaneous angioplasty (PTA) alone (29), atherectomy (27), or with PTA/stent (26). At follow-up, there was a 73% overall improvement rate in clinical status as measured by Rutherford score. Three intraoperative crossing complications occurred. All complications were repaired successfully with stents, except one posterior tibial perforation that did not lead to limb compromise. At 60 days postprocedure, five major amputations (three below- and two above-knee amputations) had occurred. One BKA was the result of wet gangrene. The patient later developed a stump infection, underwent a knee disarticulation, and ultimately died secondary to sepsis for a 2% mortality rate. Retrograde approach for extensive infrainguinal occlusive disease in high-risk patients for limb salvage is a safe and feasible strategy with excellent limb-salvage and complication rates at follow-up. This technique can be expanded to both office and hospital locations offering an endovascular option for revascularization to patients who are not otherwise bypass candidates for limb salvage.

Subintimal Arterial Flossing With Antegrade-Retrograde Intervention (SAFARI) and Rertograde Access for Critical Limb Ischemia

Retrograde access techniques involve the addition of a retrograde access into the distal target vessel to aid in recanalization of chronic total occlusions. Many patients with critical limb ischemia are also poor surgical candidates because of comorbidities or lack of suitable landing zone for bypass procedures. This approach may be helpful in the setting of chronic occlusions that cannot be crossed via conventional antegrade true-lumen approaches. Subintimal arterial flossing with antegrade-retrograde intervention technique can be used when the occlusion was crossed in the subintimal plane and antegrade re-entry techniques failed. It may also be useful for flush superficial femoral artery occlusions or those lesions that extend into the trifurcation vessels. Proficiency in these techniques allows limb salvage in patients who lack surgical options and would otherwise undergo amputation.

Endovascular recanalization of failed distal bypass in Buerger’s disease

In the treatment of Buerger's disease, bypass surgery with the use of an autologous vein has served as a treatment option in cases in which distal target vessel has been available. However, failed bypass occlusion can result in a devastating clinical scenario. Herein, we report a successful endovascular revascularization of failed distal bypass graft as a last resort for a patient with Burger's disease with ischemic rest pain and extensive tissue loss.

Evaluation of Superficial Femoral Artery Remote Endarterectomy for Treatment of Critical Limb Ischemia in Patients with Limited Autogenous Conduit

Many patients with critical limb ischemia require infrageniculate bypass with a prosthetic graft due to the limited availability of autogenous vein. Prosthetic grafts have been shown to have inferior patency and subject the patient to increased infection rates when compared to bypass with autogenous conduit for lower extremity revascularization. In an effort to avoid the use of prosthetic material, we evaluated the use of remote superficial femoral artery endarterectomy (RSFAE) with distal autogenous revascularization in patients with critical limb ischemia and limited conduit. This study is a retrospective review of a prospectively maintained database from January 2009 to September 2011. All patients undergoing RSFAE for critical limb ischemia were identified. Patients undergoing RSFAE with simultaneous distal revascularization constituted the study group. Outcome variables, including patency, time to healing, limb salvage, ambulatory status, and survival, were analyzed. Twenty-one patients underwent RSFAE at our institution. The study group was comprised of 5 patients undergoing RSFAE and adjunct distal revascularization for critical limb ischemia during the study period. Four patients (80%) presented with tissue loss, and 1(20%) presented with ischemic rest pain. Three (60%) required simultaneous outflow sequential vein bypass and 2 (40%) required distal endovascular revascularization. The distal target vessels for bypass included the infrageniculate popliteal artery, posterior tibial artery, and peroneal artery. The mean operative time was 5.3 hours. The mean length of hospital stay was 8days. Technical success was 100%, and there were no early reconstruction failures. There was 1 popliteal wound complication, and no groin wound complications during the study follow-up. At 6 months postoperatively, 4 of 5 reconstructions were patent. Two of 5 patients (40%) required percutaneous reintervention for restenosis at 10 and 11 months, respectively. Primary assisted patency was 80% with a mean follow-up of 12.6 months (range 8-22 months). The 4 patients with tissue loss achieved initial wound healing at a mean time of 4.8 months. The limb salvage rate was 80% and there have been no deaths. Remote superficial femoral artery endarterectomy with distal revascularization allows for autogenous reconstruction in patients with critical limb ischemia and compromised conduit by shortening bypass length. This procedure constitutes an appealing alternative to the use of synthetic material for lower extremity revascularization. Further study is needed to determine whether the long-term results are superior to distal composite bypass or polytetrafluoroethylene bypass alone.

4:10 PM Abstract No. 221 - Quantitative endpoints for embolization utilizing real-time pressure measurements: anti-reflux infusion system versus end-hole catheter

Purpose Embolization procedures are currently performed using end-hole catheters; contrast agent flow dynamics provide a qualitative indicator of the degree of embolization. This research investigates the feasibility of monitoring real-time pressures as a quantitative endpoint for embolization. Results from an anti-reflux infusion system are compared to those of an end-hole catheter. Materials and Methods A benchtop model of the hepatic anatomy was constructed from 3D CT imaging. This model included left and right hepatic arteries and 16 distal target vessels (1mm ID). To simulate hepatic flow, the model was perfused with distilled water at a constant pressure of 120 mmHg and an initial flow rate of 400 mL/min. Real-time pressures were acquired at 100 Hz from multiple arterial locations: Proper Hepatic (PH), Right Hepatic (RH), Left Hepatic (LH), and three distal RH and LH branches. Embolization was modeled and controlled by occluding distal vessels with pinch valves. Degree of Embolization (DE) was used to quantify the amount of flow occluded by the pinch valves; at baseline DE was 0% and at full stasis DE was 100%. Recovery of Pressure (RP) was defined to be the normalized pressure difference from baseline (or DE=0) to the pressure at a specific DE. Least squares regression and paired t-tests were used to quantify dependence of RP on PE. Results After deployment of the anti-reflux catheter, average tip pressure decreased by 38.4 +/- 8.2 mmHg, which was significantly more than the pressure drop of an end-hole catheter (0.5 +/- 0.4 mmHg, p=.00004). For the anti-reflux catheter, RP correlated with DE, such that at complete embolization RP was 100%. Least squares regression quantified this relationship for locations in the PH (R2=0.9956), LH (R2=0.9996) and RH (R2=0.9998). End-hole catheter data was also fit for the PH (R2=0.9307) and the RH (R2=0.9572), but RP did not equal 100% when DE was 100%. Conclusion Standard end-hole catheters cannot accurately quantify degree of embolization. However, after deployment of an anti-reflux catheter, recovery of pressure gradients from baseline can be used to accurately quantify degree of embolization.

Treatment of digit ulcers in a patient with Buerger's disease by using cervical spinal cord stimulation -a case report-

Buerger's disease (thromboangiitis obliterans) is known as a segmental inflammatory vasculitis that involves the small-sized and medium-sized arteries, veins, and nerves. Most effective treatment for Buerger's disease is smoking cessation. Except for the cessation of tobacco use, surgical revascularization is available in severe ischemia and a distal target vessel. Amputation has been used as the last treatment option of the disease up to the present. Increasing limb survival and decreasing amputation rate is important. This case describes the use of spinal cord stimulation (SCS) in patient with Buerger's disease and its effect is not only the complete healing of ulcers but also amputation is not performed.

Can metabolic syndrome predict the vulnerable plaque in patients with stable angina pectoris? Virtual histology-intravascular ultrasound analysis

Vulnerable plaque in coronary artery can progress to plaque rupture and thrombosis, and have a strong potential to induce acute coronary syndrome. Many studies have demonstrated that metabolic syndrome (MetS) is associated with increased risk for cardiovascular diseases and related mortalities. From September 2007 to June 2010, a total of 239 patients with stable angina pectoris (SAP) who underwent coronary angiogram and intravascular ultrasound (IVUS) were categorized into two groups: MetS group (n=100, 56 men, 64.7±9.5years) and non-MetS group (n=139, 98 men, 60.2±8.4 years). MetS group showed more frequent multivessel involvement (p=0.026) and had more distal target vessel in coronary artery (p=0.005) than non-MetS group, but IVUS findings showed no significant difference between the two groups. In addition, low high-density lipoprotein (HDL) cholesterol level as the criteria of MetS was observed in virtual histology (VH)-derived thin cap fibroatheroma (TCFA) group more than stable plaque group (p=0.020), but the prevalence of MetS and other components of MetS were not different between the two groups. Multivariate analysis using logistic regression for the presence of VH-derived TCFA showed that the independent predictor is the low HDL cholesterol level (odds ratio=3.563, 95% confidence interval=1.370-9.269, p=0.009). The presence of MetS was not associated with VH-derived TCFA in patients with SAP.

Abstract 18045: Can Metabolic Syndrome Predict the Vulnerable Plaque in Patients with Stable Angina Pectoris?: Virtual Histology-Intravascular Ultrasound Analysis

Background- Vulnerable plaque (VP) in coronary artery can progress to plaque rupture and thrombosis, and have a strong potential to induce acute coronary syndrome. Many studies have demonstrated that metabolic syndrome (MS) is associated with increased risk for cardiovascular diseases and related mortalities. This study aimed to determine the predictive value of MS on VP in the patients with stable angina pectoris (SAP). Methods and Results- From September 2007 to June 2010, a total of 239 patients with SAP who underwent coronary angiogram and intravascular ultrasound were categorized into two groups: MS group (n = 100, 56 men, 64.7 ± 9.5 years) and non-MS group (n = 139, 98 men, 60.2 ± 8.4 years). National Cholesterol Education Program-Adult Treatment Panel III guideline was used to determine the presence of MS and diverse variables containing IVUS findings were compared between two groups. MS group were older age and more likely to be women than non-MS group (p &lt;0.001, p = 0.021, respectively). MS group showed more frequent multivessel involvement (p = 0.026) and had more distal target vessel in coronary artery (p = 0.005) than non-MS group, but IVUS finding containing the plaque burden showed no significant difference between two groups. In addition, low high density lipoprotein (HDL) cholesterol level as the criteria of MS (male &lt;40 mg/dl, female &lt;50 mg/dl) was observed in VP group more than stable plaque group (p = 0.020), but the prevalence of MS and other components of MS were not different between two groups. Multivariate analysis using logistic regression for the presence of VP showed that the independent predictor is the low HDL cholesterol level (odds ratio = 3.563, 95% confidence interval = 1.370-9.269, p = 0.009). Conclusions- Low HDL cholesterol level, but not MS, is the independent predictor of VP as a culprit lesion in SAP patients.