Early Diagnosis Research Articles

Early detection and treatment of obstructive sleep apnoea in infants with Down syndrome: a prospective, non-randomised, controlled, interventional study

Infants with Down syndrome (DS) are at high risk of obstructive sleep apnoea (OSA) which is associated with neurocognitive dysfunction and behaviour problems. The aim of our study was to evaluate the effect of early OSA treatment in infants with DS on neurocognitive development and behaviour. In this prospective, interventional, non-randomised study, 40 infants with DS underwent polysomnography (PSG) every 6 months in room air between 6 and 36 months of age (Screened Group) and were compared to a control group of 40 infants with DS receiving standard of care and a single, systematic PSG in room air at 36 months of age (Standard Care Group). When present, OSA was treated. The primary endpoint was the total score of the Griffiths Scales of Child Development, Third Edition (Griffiths III) and its subscores at 36 months. Secondary endpoints included a battery of neurocognitive and behaviour questionnaires, and PSG outcomes. On the Griffiths III, the total score was significantly higher in the Screened Group compared to the Standard Care Group (difference: 4.1; 95%CI: 1.3; 7.6; p=0.009). Results in Griffiths III subscores and secondary endpoints were in support of better neurocognitive outcomes in the Screened Group compared with the Standard Care Group. At 36 months, median (Q1; Q3) apnoea-hypopnea index was higher in the Standard Care Group (4.0 [1.5; 9.0] events/hour) compared to the Screened Group (1.0 [1.0; 3.0] events/hour, p=0.006). Moderate and severe OSA were more frequent in the Standard Care Group as compared to the Screened Group (18.9% versus 3.7% for moderate OSA and 27.0% versus 7.4% for severe OSA). Early diagnosis and treatment of OSA in infants with DS may contribute to a significantly better neurocognitive outcome and behaviour at the age of 36 months. The study was funded by the Jérôme Lejeune Foundation.

Probable cutaneous-hemolytic loxoscelism

This study delves into loxoscelism, a condition arising from the bites of Loxosceles spiders. The case revolves around a 53-year-old woman who encountered systemic toxicity marked by dermal necrosis, hemolysis, and acute kidney injury. Timely medical intervention, incorporating surgical procedures and a meropenem regimen, resulted in nearly complete recovery. The report underscores the imperative for heightened awareness, early diagnosis, and appropriate treatment to alleviate complications linked to loxoscelism.

Descripción de un caso: ¿es factible realizar una biopsia selectiva de ganglio centinela en tumores de mama originados en el tejido ectópico axilar?

Breast cancer on axillary ectopic breast tissue is very rare, representing 0.3-0.6% of malignant breast cancers. Therefore, its early diagnosis is a real challenge. In this case, we describe a breast cancer on left axillary ectopic tissue in a 36-year-old female patient, who underwent local surgery with excision of the tissue. When approaching the nodal study of this patient, the possibility of selective study of the sentinel lymph node was considered. The absence of validated clinical guidelines in these cases and the exhaustive review of the literature led the multidisciplinary tumour committee of our hospital, the Hospital Clínico de Santiago de Compostela, to adopt the decision to attempt to perform this technique, adapting it, however, to this particular case. A double tracer was used, injecting technetium-99m in the periareolar area of the left breast and patent blue in the intratumoral area of the axillary ectopic tissue to determine whether both the breast and the tumour had the same lymphatic drainage pathways.Finally, 7 sentinel nodes and 1 palpable non-sentinel node were detected, of which the first was marked with both technetium-99m and patent blue, 4 with the radioisotope only, and 2 stained with patent blue. Two macrometastases were detected intraoperatively in the sentinel nodes, stained only with patent blue, while the rest were negative. The tumour committee took the decision to treat the axilla with radiotherapy. It is therefore concluded that in these cases the periareolar lymphatic drainage and that of the tumour itself may be different, so it would be advisable to use the double tracer injected in different areas to correctly identify the sentinel lymph node. The literature available for this type of situation is scanty and there are no approved clinical guidelines to support our therapeutic decisions, so it would be essential to study breast cancer in infrequent locations, in depth, in order to achieve protocols standardised by international societies that would serve as a benchmark for the management of these cases.

An Interdisciplinary Approach to Care of Veterans with Vision Impairment

This report describes the impact of vision impairment (VI) among veterans and how nurse practitioners (NPs) can assist patients with VI using an interdisciplinary approach. Evidence-based recommendations are presented. Early diagnosis and treatment of VI is critical. NPs can foster positive outcomes among veteran patients as they engage in interdisciplinary collaboration with vision care specialists and support patients in adjustment to blindness training. Current evidence supports the assessment of visual function among all veteran patients as part of routine evaluation. Suggestions are offered to assist NPs in identifying adjustment to blindness training and vision loss resources to improve care.

Harnessing Deep Learning for Early Breast Cancer Diagnosis: A Review of Datasets, Methods, Challenges, and Future Directions

Harnessing Deep Learning for Early Breast Cancer Diagnosis: A Review of Datasets, Methods, Challenges, and Future Directions

Genetic testing for pediatric sensorineural hearing loss in the era of gene therapy.

To summarize indications, methods, and diagnostic yields for genetic testing for pediatric hearing loss. Genetic testing has become a cornerstone of clinical care for children with sensorineural hearing loss. Recent studies have shown the efficacy of gene panels and exome sequencing for any child with sensorineural hearing loss. Recent findings have underscored the importance of a diagnosis in clinical care. Clinical trials for gene therapy for hearing loss have begun. Genetic testing has become critical for personalized care for children with hearing loss. Recent studies have shown a 43% overall diagnostic yield for genetic testing for pediatric hearing loss, though the diagnostic yield may range from 10 to 60% depending on clinical features. Syndromic diagnoses comprise 25% of positive genetic tests for pediatric sensorineural hearing loss. While diagnostic yield is lower for children with unilateral or asymmetric sensorineural hearing loss, the likelihood of syndromic hearing loss finding is higher. An early and accurate genetic diagnosis is required for participating in clinical trials for gene therapy for hearing loss.

Deciphering gene expression signatures in liver metastasized colorectal cancer in stage IV colorectal cancer patients

BackgroundColorectal cancer (CRC) liver metastasis (CRLM) is a clinical challenge, and optimizing treatment strategies is crucial for improving patient outcomes. This study aimed to identify gene expression signatures associated with CRLM for early diagnosis and improved treatment outcomes. MethodsWe obtained RNA-seq data of 34 samples (17 colorectal tumor samples from metastasized liver and 17 samples from normal surrounding colonic epithelia) from the Gene Expression Omnibus (GEO) with accession number GSE50760 and analysed them using next-generation knowledge discovery tools such as GEO2R and web based gene set enrichment analysis (WebGestalt). ResultsA total of 18808 genes were identified in the initial analysis which were further reduced to 2490 differentially expressed genes (DEGs) after applying different parameters using GEO2R tools. Furthermore, in the gene set enrichment analysis (GSEA), we analysed the biological processes, cellular components, and molecular functions. We analysed four pathways: KEGG, panther, reactome, and wikipathway cancer. In each analysis, we ascertained the most important top expressed and downregulated genes. ConclusionsWe identified various gene sets that could be used as important prognostic and therapeutic markers, particularly in patients with advanced CRLM. Future studies in larger cohorts may further our research findings to establish the best prognostic biomarkers for early diagnosis and improved overall survival.

Diagnostic and screening potential of plasma exosome miR‑99b‑5p and its combination with other miRNAs for colorectal cancer.

Extracellular vesicles (EVs) secreted by tumor cells have been documented to hold viable biomarker potential. Therefore, the present study evaluated the potential clinical value of EV-microRNAs (miRNAs or miRs) in the plasma exosomes of patients with colorectal cancer (CRC) for the early diagnosis and screening of CRC. In total, 95 plasma samples were collected at The Third Affiliated Hospital of Guangzhou Medical University (Guangzhou, China) between 2017 and 2019. Specifically, 68 samples were from patients with CRC and 27 were from healthy control (HC) donors. High-throughput sequencing was used to detect the expression of miRNAs in the isolated plasma EVs, which was subsequently verified by reverse transcription-quantitative PCR. Receiver operating characteristic (ROC) curves were used to analyze the diagnostic potential of single and combined miRNAs for CRC. Bioinformatics analysis was employed to predict the target genes of candidate miRNAs. Compared with those in the HC group, the CRC group expressed higher levels of miR-99b-5p and miR-409-3p, especially during the early stages of CRC. Clinicopathological analysis confirmed the higher expression levels of miR-99b-5p during the early stages, as well as higher expression levels in the colon compared with those in the rectum. ROC curve analysis revealed that the area under the curve (AUC) of miR-99b-5p for the diagnosis of early CRC was 73.5% (P=0.007). The early diagnostic capability of miR-99b-5p combined with miR-409-3p for CRC was evaluated, and the AUC was found to be 74.1% (P=0.006). In addition, the AUC of the combination of miR-99b-5p, miR-409-3p and carcinoembryonic antigen was 81.2% (P<0.001), indicating that this three-parameter combination displayed higher diagnostic power compared with any single miRNA for early CRC screening. The results from the present study suggest that the expression of miR-99b-5p in plasma exosomes is significantly upregulated in CRC, which holds potential for the early diagnosis of this cancer type. Such potential can be enhanced further by combining it with other miRNAs. Therefore, the present study provides a comprehensive but preliminary insight for the viability of miR-99b-5p (alone or combined with other miRNAs) for CRC diagnosis, which requires further exploration in the future.

Association of serum and synovial adipokines (chemerin and resistin) with inflammatory markers and ultrasonographic evaluation scores in patients with knee joint osteoarthritis- a pilot study.

Chemerin and resistin are adipokines studied as potential markers for early diagnosis and disease severity in patients with knee osteoarthritis (KOA) Therefore, we aimed to investigate the associations serum and synovial levels of chemerin and resistin with inflammatory parameters and ultrasonographic scores (US) in KOA individuals. Serum was collected from 28 patients with KOA and synovial fluid was obtained from 16 of them. Another 31 age and sex matched cases with no joint disease were included as healthy controls. Concentrations of chemerin, resistin, interleukin-6 (IL-6) and tumor necrosis factor alpha (TNF-alpha) were determined with ELISA. Erythrocyte sedimentation rate (ESR), C-reactive protein, serum uric acid (UA) were measured in the patients group. Participants with KOA underwent US assessment using the Outcome Measures in Rheumatology (OMERACT) scores. Patients with KOA had statistically significant higher level of serum resistin than healthy controls [11.05 (3.78-24.13) ng/mL and 7.23 (3.83-12.19) respectively, p < 0.001]. A strong correlation was found between serum chemerin and ESR (r = 0.434, p = 0.021), uric acid (r = 0.573, p = 0.001) as well as the US (r=-0.872, p < 0.001). Serum resistin demonstrated significant association with TNF-alpha (r = 0.398, p = 0.044). In conclusion, both chemerin and resistin might contribute to inflammatory changes associated with KOA. Further studies are needed to elucidate their potential role in the pathogenesis of the disease.

High efficacy and safety of direct-acting antivirals for the treatment of chronic hepatitis C: A cohort study conducted in Vietnam.

Direct-acting antivirals (DAAs) have revolutionized hepatitis C virus (HCV) treatment through their high cure rates and improved safety profiles. We aimed to evaluate the efficacy and safety, and identify the optimal combination, of DAAs for the treatment of chronic HCV. A retrospective study was conducted of 613 patients with chronic HCV who were treated with DAAs. Demographic, HCV genotype, treatment regimen, virological response, and adverse drug event (ADE) data were collected at the initial visit and 4, 8, 12, and 24 weeks later. The rapid virologic response (RVR) and sustained virologic response (SVR) rates were 90.4% and 97.8% for HCV genotype 1, 89.2% and 98.7% for genotype 6, 92.8% and 99% for genotype 2, and 90.9% and 100% for mixed genotype 2/6 or unspecified genotypes, respectively. There were no significant differences in the RVR and SVR rates for the various DAA regimens. The mean ALT, AST, and GGT activities decreased, and the PLT count increased during the treatments. ADEs occurred in 8% of the patients. The commonest ADEs were itching (3.1%), fatigue (1.8%), and dizziness (1.1%). None of the patients discontinued treatment because of an ADE. Posttreatment disease progression occurred in 7.7% of the patients, including liver fibrosis (3.6%), cirrhosis (1.1%), hepatocellular carcinoma (1.1%), and high alpha-fetoprotein (AFP) (1%). The factors associated with the achievement of RVR were low viral load, the use of sofosbuvir/ledipasvir or sofosbuvir/daclatasvir regimens, and a treatment duration of 12 weeks. No specific factors were found to be associated with the achievement of SVR. Posttreatment disease progression was associated with a high AFP and the use of sofosbuvir/ledipasvir. Thus, DAAs are highly effective and well-tolerated means of treating chronic HCV, and significantly improve patient outcomes. Their high efficacy and favorable safety profiles highlight the importance of early diagnosis and the use of personalized treatment strategies.

Esophageal stenosis as an initial presentation of Behçet’s disease: A case report and literature review

IntroductionBehçet’s disease (BD) is a multiorgan inflammatory vascular disease of unknown etiology, affecting vessels of any size and type. While, gastrointestinal involvement in BD is uncommon, esophageal Behçet’s disease (EBD) is rarely reported, especially in the Mediterranean region. Aim of the workTo report a case with esophageal stenosis as an initial presentation of BD and compare to reported cases worldwide. Case presentationA 30-year-old Syrian male presented with dysphagia, odynophagia with weight loss 20 kg. He had a history of recurrent oral ulcers and was otherwise healthy. On examination he appeared pale, dehydrated with normal systemic examination. Blood tests revealed anemia (hemoglobin 10.5 mg/dl), elevated erythrocyte sedimentation rate (ESR) (90 mm/1sthr) and C-reactive protein (CRP)(98 mg/dl)levels. Upper gastrointestinal endoscopy showed mild ulceration with edema and mucosal thickness at the upper sphincter of the esophagus, leading to stenosis. Biopsy showed nonspecific inflammation, without granulomas or signs of malignancy. Percutaneous endoscopic gastrostomy (PEG) tube was placed and during hospitalization he developed genital ulcers and hemoptysis, with chest computed tomography revealing pulmonary vasculitis. The patient was diagnosed with BD, and treated with methylprednisolone and cyclophosphamide, leading to significant improvement. After two months he could swallow normally, and the PEG tube was removed with no recurrence after one year follow-up. He was maintained on azathioprine 100 g/day and prednisolone 7.5 mg/day. ConclusionBD is a diagnostic challenge due to its diverse manifestations and geographic variations. EBD is rare and can cause disability. Early diagnosis of EBD and appropriate treatment are crucial for improving outcomes.

Experience in the diagnosis and treatment of non-invasive bilateral carotid cavernous sinus fistula based on CT image examination

Carotid cavernous fistula is a rare but clinically important vascular abnormality that is challenging to diagnose and treat. The clinical data of a patient with bilateral carotid cavernous fistula diagnosed by CT images were retrospectively analyzed. Through the analysis of CT images, the patient was accurately located and the diagnosis was confirmed. CT images can provide detailed anatomical information and accurately show the location, morphology and hemodynamic characteristics of carotid cavernous fistula. Through CT image examination, we successfully diagnosed bilateral carotid cavernous fistula patients, and can provide an important reference for surgical treatment. Therefore, CT image examination can provide accurate diagnosis and surgical planning information, and provide support for the formulation of individual treatment plans for patients. The application of this method is helpful to improve the early diagnosis rate and treatment effect of carotid cavernous fistula.

Heart Sound Abnormality Detection From Multi-Institutional Collaboration: Introducing a Federated Learning Framework.

Early diagnosis of cardiovascular diseases is a crucial task in medical practice. With the application of computer audition in the healthcare field, artificial intelligence (AI) has been applied to clinical non-invasive intelligent auscultation of heart sounds to provide rapid and effective pre-screening. However, AI models generally require large amounts of data which may cause privacy issues. Unfortunately, it is difficult to collect large amounts of healthcare data from a single centre. In this study, we propose federated learning (FL) optimisation strategies for the practical application in multi-centre institutional heart sound databases. The horizontal FL is mainly employed to tackle the privacy problem by aligning the feature spaces of FL participating institutions without information leakage. In addition, techniques based on deep learning have poor interpretability due to their "black-box" property, which limits the feasibility of AI in real medical data. To this end, vertical FL is utilised to address the issues of model interpretability and data scarcity. Experimental results demonstrate that, the proposed FL framework can achieve good performance for heart sound abnormality detection by taking the personal privacy protection into account. Moreover, using the federated feature space is beneficial to balance the interpretability of the vertical FL and the privacy of the data. This work realises the potential of FL from research to clinical practice, and is expected to have extensive application in the federated smart medical system.

PheW2P2V: a phenome-wide prediction framework with weighted patient representations using electronic health records.

Electronic health records (EHRs) provide opportunities for the development of computable predictive tools. Conventional machine learning methods and deep learning methods have been widely used for this task, with the approach of usually designing one tool for one clinical outcome. Here we developed PheW2P2V, a Phenome-Wide prediction framework using Weighted Patient Vectors. PheW2P2V conducts tailored predictions for phenome-wide phenotypes using numeric representations of patients' past medical records weighted based on their similarities with individual phenotypes. PheW2P2V defines clinical disease phenotypes using Phecode mapping based on International Classification of Disease codes, which reduces redundancy and case-control misclassification in real-life EHR datasets. Through upweighting medical records of patients that are more relevant to a phenotype of interest in calculating patient vectors, PheW2P2V achieves tailored incidence risk prediction of a phenotype. The calculation of weighted patient vectors is computationally efficient, and the weighting mechanism ensures tailored predictions across the phenome. We evaluated prediction performance of PheW2P2V and baseline methods with simulation studies and clinical applications using the MIMIC-III database. Across 942 phenome-wide predictions using the MIMIC-III database, PheW2P2V has median area under the receiver operating characteristic curve (AUC-ROC) 0.74 (baseline methods have values ≤0.72), median max F1-score 0.20 (baseline methods have values ≤0.19), and median area under the precision-recall curve (AUC-PR) 0.10 (baseline methods have values ≤0.10). PheW2P2V can predict phenotypes efficiently by using medical concept embeddings and upweighting relevant past medical histories. By leveraging both labeled and unlabeled data, PheW2P2V reduces overfitting and improves predictions for rare phenotypes, making it a useful screening tool for early diagnosis of high-risk conditions, though further research is needed to assess the transferability of embeddings across different databases. PheW2P2V is fast, flexible, and has superior prediction performance for many clinical disease phenotypes across the phenome of the MIMIC-III database compared to that of several popular baseline methods.

Nano-theranostics: A novel platform in drug therapy

A fundamental component of customized medicine, theranostics is a therapy approach that combines therapeutics and diagnostics with the goal of increasing drug efficacy and safety while also monitoring treatment response. It will require significant advancements in predictive medicine. Theranostics is linked to tailored drug administration based on test results as well as a diagnostic that screens patients for potential adverse drug reactions. Early diagnosis and treatment have benefited from the designed nanoparticles with unique physicochemical characteristics. This allows treatments to be delivered and the detection method to be employed concurrently, not just before or after treatment but throughout the entire regimen. The development of nanotechnology presents more opportunities for theranostics applications using nanoparticle engineering, and it has demonstrated encouraging outcomes, particularly in cancer therapy when compared with conventional treatments.

Enhancing breast cancer detection accuracy through transfer learning: A case study using efficient net

Breast cancer continues to pose a significant global health challenge, emphasizing the need for advancements in early detection methods. This study explores the application of transfer learning techniques, specifically utilizing EfficientNet, to enhance the accuracy of breast cancer detection through medical imaging. Leveraging a dataset of mammography images from the Digital Database for Screening Mammography (DDSM), the research implements various data preprocessing methods, including median filtering, contrast enhancement, and artifact removal, to ensure the quality of input data. The EfficientNet model, trained with these preprocessed images, is evaluated against other transfer learning architectures, such as DenseNet and ResNeXt50, using metrics like accuracy, AUC, precision, and F1-score. The results demonstrate that EfficientNet outperforms other models, achieving an accuracy of 95.23%, with a sensitivity of 96.67% and specificity of 93.82%. These findings suggest that transfer learning, particularly with EfficientNet, can significantly improve the predictive accuracy of breast cancer detection, offering a reliable tool for early diagnosis and personalized treatment planning. The study also discusses the potential integration of these models into clinical workflows, addressing challenges such as data privacy, model generalizability, and clinical applicability. Future research will focus on expanding the dataset and exploring the use of other advanced deep learning techniques to further enhance detection accuracy and robustness.

Radiation therapy systems using linear accelerator, importance of its components and their development

Given the importance of devices used in the field of medicine in terms of diagnosis and treatment, and the great importance of this topic in accelerating early diagnosis and saving the lives of the largest possible number of people, we decided to study one of these devices to better define its components and review some of the difficulties. Many linear accelerators for hybrid magnetic resonance imaging have been developed as a result of the need to profit from directed images of tissues and various body sections during radiation therapy (linear accelerators). There are now a number of linear accelerators for magnetic resonance imaging that cover both low and high magnetic field strengths as well as two directions of the beam field; these systems have the potential to be beneficial. This technology has only recently been used in clinical trials. However, its continued usage as a routine radiation therapy procedure is certain. The majority of the key elements and difficulties encountered in the creation of such technology as well as its present state are outlined in this review article.

Reconceptualization of immune checkpoint inhibitor-associated gastritis

In recent years, with the extensive application of immunotherapy in clinical practice, it has achieved encouraging therapeutic effects. While enhancing clinical efficacy, however, it can also cause autoimmune damage, triggering immune-related adverse events (irAEs). Reports of immunotherapy-induced gastritis have been increasing annually, but due to its atypical clinical symptoms, early diag-nosis poses a certain challenge. Furthermore, it can lead to severe complications such as gastric bleeding, elevating the risk of adverse outcomes for solid tumor patients if immunotherapy is interrupted. Therefore, gaining a thorough understanding of the pathogenesis, clinical manifestations, diagnostic criteria, and treatment of immune-related gastritis is of utmost importance for early identification, diagnosis, and treatment. Additionally, the treatment of immune-related gastritis should be personalized according to the specific condition of each patient. For patients with grade 2-3 irAEs, restarting immune checkpoint inhibitors (ICIs) therapy may be considered when symptoms subside to grade 0-1. When restarting ICIs therapy, it is often recommended to use different types of ICIs. For grade 4 irAEs, permanent discontinuation of the medication is necessary.

Diagnostic value of serum vascular endothelial growth factor and interleukin-17 in primary hepatocellular carcinoma

BACKGROUND Despite significant advancements in the medical treatment of primary hepatocellular carcinoma (PHC) in recent years, enhancing therapeutic effects and improving prognosis remain substantial challenges worldwide. AIM To investigate the expression levels of serum vascular endothelial growth factor (VEGF) and interleukin (IL)-17 in patients with PHC and evaluate their diagnostic value while exploring their relationship with patients’ clinical characteristics. METHODS The study included 50 patients with confirmed PHC who visited Wuhan Hanyang Hospital from January 2021 to January 2022, and 50 healthy individuals from the same period served as the control group. Serum VEGF and IL-17 levels in both groups were measured by Enzyme-Linked Immunosorbent Assay, and their diagnostic value was assessed using receiver operating characteristic (ROC) curves. Pearson correlation analysis was performed to examine the relationship between serum VEGF and IL-17 levels. Pathological data of the PHC patients were analyzed to determine the relationship between serum VEGF and IL-17 levels and pathological characteristics. RESULTS Serum VEGF and IL-17 levels were significantly higher in the study group compared to the control group (P &lt; 0.05). No significant association was observed between serum VEGF and IL-17 levels and gender, age, combined cirrhosis, tumor diameter, or degree of differentiation (P &gt; 0.05). However, there was a significant relationship between clinical TNM stage, tumor metastasis, and serum VEGF and IL-17 levels (P &lt; 0.05). Correlation analysis revealed a positive correlation between serum VEGF and IL-17 (P &lt; 0.05). ROC analysis demonstrated that both serum VEGF and IL-17 had good diagnostic efficacy for PHC. CONCLUSION Serum VEGF and IL-17 levels were significantly higher in PHC patients compared to healthy individuals. Their levels were closely related to pathological features such as tumor metastasis and clinical TNM stage, and there was a significant positive correlation between VEGF and IL-17. These biomarkers may serve as valuable reference indicators for the early diagnosis and treatment guidance of PHC.

Recognizing and preventing complications regarding bioresorbable scaffolds during coronary interventions

The evolution of coronary intervention techniques and equipment has led to more sophisticated procedures for the treatment of highly complex lesions. However, as a result, the risk of complications has increased, which are mostly iatrogenic and often include equipment failure. Stent dislodgement warrants vigilance for the early diagnosis and a stepwise management approach is required to either expand or retrieve the lost stent. In the era of bioresorbable scaffolds that are not radiopaque, increased caution is required. Intravascular imaging may assist in detecting the lost scaffold in cases of no visibility fluoroscopically. Adequate lesion preparation is the key to minimizing the possibility of equipment loss; however, in the case that it occurs, commercially available and improvised devices and techniques may be applied.