Eccentric Morphology Research Articles

The FLASHES Survey. I. Integral Field Spectroscopy of the CGM around 48 z ≃ 2.3–3.1 QSOs

Abstract We present the pilot study of the Fluorescent Lyman-Alpha Structures in High-z Environments Survey; the largest integral field spectroscopy survey to date of the circumgalactic medium at z = 2.3–3.1. We observed 48 quasar fields with the Palomar Cosmic Web Imager to an average (2σ) limiting surface brightness of 6 × 10−18 erg s−1 cm−2 arcsec−2 (in a 1″ aperture and ∼20 Å bandwidth). Extended H i Lyα emission is discovered around 37/48 of the observed quasars, ranging in projected radius from 14 to 55 proper kiloparsecs (pkpc), with one nebula exceeding 100 pkpc in effective diameter. The dimming-adjusted circularly averaged surface brightness profile peaks at 1 × 10−15 erg s−1 cm−2 arcsec−2 at R ⊥ ∼ 20 pkpc and integrated luminosities range from 0.4 to 9.4 × 1043 erg s−1. The emission appears to have an eccentric morphology and an average covering factor of ∼30%–40% at small radii. On average, the nebular spectra are redshifted with respect to both the systemic redshift and Lyα peak of the quasar spectrum. The integrated spectra of the nebulae mostly have single- or double-peaked profiles with global dispersions ranging from 143 to 708 km s−1, though the individual Gaussian components of lines with complex shapes mostly have dispersions ≤400 km s−1, and the flux-weighted velocity centroids of the lines vary by thousands of km s−1 with respect to the QSO redshifts. Finally, the root-mean-square velocities of the nebulae are found to be consistent with those expected from gravitational motions in dark matter halos of mass Log 10 ( M h [ M ⊙ ] ) ≃ 12.2 − 1.2 + 0.7 . We compare these results to existing surveys at higher and lower redshift.

Three-dimensional black blood contrast enhanced magnetic resonance imaging in patients with acute ischemic stroke and negative susceptibility vessel sign

PurposeThe purpose of this study was to evaluate the enhancement patterns of three-dimensional (3D) black blood (BB) contrast enhanced magnetic resonance (MR) imaging in acute stroke patients with negative susceptibility vessel sign (SVS). Materials and methodsFrom January 2014 to August 2016 we retrospectively reviewed MR imaging and MR angiography findings of patients who presented with acute stroke symptoms of less than 24 h duration. For the 394 patients enrolled, we assessed the frequency of patients who exhibited negative SVS on susceptibility weighted MR imaging (SWI) and positive enhancement in 3D BB contrast enhanced MR imaging. We subdivided the enrolled group according to whether the MR angiography findings suggested stenosis (stenosis group) or occlusion (occlusion group). Enhancement patterns on BB contrast enhanced MR imaging were compared between the two groups according to several qualitative parameters: intensity (weak or strong), morphology (linear/eccentric or round/concentric), length (focal or segmental) and multiplicity (single or multiple). ResultsSixty-two of 394 patients (15.7%) showed positive findings on BB contrast-enhanced MR imaging with negative SVS. Forty-two patients were classified into the stenosis group, and 20 patients were assigned to the occlusion group. Enhancement patterns of the stenosis group showed weak intensity, linear or eccentric morphology and focal lesion length on BB contrast enhanced MR imaging, compared to the occlusion group (P < 0.001). In contrast, enhancement patterns of the occlusion group showed strong intensity, round or concentric morphology and longer segmental lesion length, compared to the stenosis group (P < 0.001). ConclusionThree-dimensional BB contrast enhanced MR imaging in acute stroke patients with stenotic lesions and negative SVS shows enhancement patterns of linear or eccentric morphology and shorter, more focal lesions.

P1.03-028 Wolf in Sheep's Clothing - Primary Lung Cancer Mimicking Benign Diseases

Lung cancer is the biggest cancer killer and typically presents as mass or nodule, round or oval in shape. Recognition and diagnosis of these typical cases is often straightforward, whereas diagnosis of uncommon manifestations of primary lung cancer certainly is far more challenging. The aim of this pictorial essay is to illustrate the Computed Tomography (CT) and histopathology findings of uncommon manifestations of primary lung cancer with focus on these entities that mimic benign diseases. Cases presented were collected during the Multidisciplinary Thoracic Oncology Tumor Board between January 2014 and May 2016 and have histopathologic proof. Lung cancer can mimic a variety of benign diseases, including infection, granulomatous disease, lung abscess, postinfectious scarring, mediastinal mass, emphysema, atelectasis and pleural disease. Previous history, clinical and biochemical parameters are certainly helpful and necessary in the assessment of these cases, but often aspecific and inconclusive. Whereas 18FDG-PET is the cornerstone in diagnosis and staging of lung cancer, it’s role in these uncommon manifestations is less straightforward since benign diseases, such as granulomatous and infectious diseases may also present with increased FDG-uptake. Chest CT is the imaging modality of choice and plays a central role in these cases. ‘Irregular air bronchogram sign’ in pneumonia-like lung cancer, ‘drowned lung sign’ in obstructive atelectasis and cortical bone erosion in lung cancer mimicking pleural disease are important signs that point to a malignant etiology. The stippled and eccentric morphology of calcifications in apical lesions aids in differentiating these lesions from postinfectious scarring. Mucinous tumors can mimic a pulmonary abscess and small cell lung cancer can typically present as mediastinal mass without parenchymal abnormalities. Lung cancer presenting with a miliary pattern or cavitating nodules can mimic granulomatous disease. Lung cancer presenting with cystic airspaces and ‘emphysema-like’ morphology is an uncommon entity in which early recognition is crucial since these tumors have an aggressive nature. Key imaging findings and tips and tricks for recognizing these uncommon faces of primary lung cancer will be discussed and illustrated. Primary lung cancer can mimic a wide variety of benign entities. Knowledge of these uncommon and atypical manifestations is crucial to avoid delay in diagnosis and treatment. A multidisciplinary approach in these cases is mandatory.

The Impact of Post-Procedural Asymmetry, Expansion, and Eccentricity of Bioresorbable Everolimus-Eluting Scaffold and Metallic Everolimus-Eluting Stent on Clinical Outcomes in the ABSORB II Trial

The study sought to investigate the relationship between post-procedural asymmetry, expansion, and eccentricity indices of metallic everolimus-eluting stent (EES) and bioresorbable vascular scaffold (BVS) and their respective impact on clinical events at 1-year follow-up. Mechanical properties of a fully BVS are inherently different from those of permanent metallic stent. The ABSORB II (A bioresorbable everolimus-eluting scaffold versus a metallic everolimus-eluting stent for ischaemic heart disease caused by de-novo native coronary artery lesions) trial compared the BVS and metallic EES in the treatment of a de novo coronary artery stenosis. Protocol-mandated intravascular ultrasound imaging was performed pre- and post-procedure in 470 patients (162 metallic EES and 308 BVS). Asymmetry index (AI) was calculated per lesion as: (1- minimum scaffold/stent diameter/maximum scaffold/stent diameter). Expansion index and optimal scaffold/stent expansion followed the definition of the MUSIC (Multicenter Ultrasound Stenting in Coronaries) study. Eccentricity index (EI) was calculated as the ratio of minimum and maximum scaffold/stent diameter per cross section. The incidence of device-oriented composite endpoint (DoCE) was collected. Post-procedure, the metallic EES group was more symmetric and concentric than the BVS group. Only 8.0% of the BVS arm and 20.0% of the metallic EES arm achieved optimal scaffold/stent expansion (p< 0.001). At 1 year, there was no difference in the DoCE between both devices (BVS 5.2% vs. EES 3.1%; p= 0.29). Post-procedural devices asymmetry and eccentricity were related to higher event rates while there was no relevance to the expansion status. Subsequent multivariate analysis identified that post-procedural AI >0.30 is an independent predictor of DoCE (hazardratio: 3.43; 95% confidence interval: 1.08 to 10.92; p= 0.037). BVS implantation is more frequently associated with post-procedural asymmetric and eccentric morphology compared to metallic EES. Post-procedural devices asymmetry were independently associated with DoCE following percutaneous coronary intervention. However, this approach should be viewed as hypothesis generating duetolow event rates. (ABSORB II Randomized Controlled Trial [ABSORB II]; NCT01425281).

Abstract 9908: Three-dimensional Optical Coherence Tomographic Analysis of Eccentric Morphology of the Jailed Side-branch Ostium in Coronary Bifurcation Lesions

Introduction: Using the 3D-OCT, morphologic changes in the jailed side- branch ostium were evaluated before and after a single stent crossover at coronary bifurcation lesions. Hypothesis: The severity of angiographic diameter stenosis of the jailed side-branch ostium is usually overestimated over the three-dimensional (3D) optical coherence tomography (OCT)-measured actual stenosis. Methods: In 109 patients who received a single stent crossover at coronary bifurcation lesions, the pre- and post-intervention minimal lumen area (MLA) and the eccentricity of the jailed side-branch ostium were measured with 3D-OCT. The eccentricity index was defined as the ratio of maximal diameter/minimal diameter of the jailed side-branch ostium. When the eccentricity index was &lt;1.5, the shape of the jailed side-branch ostium was defined as circular. The MLA of the jailed side-branch ostium was also calculated from the quantitative coronary angiography (QCA) minimal lumen diameter assuming a circular lumen. Results: The 3D-OCT-measured MLA of the jailed side-branch ostium decreased from 2.91±1.65 mm2 pre-intervention to 2.37±1.48 mm2 post-intervention (p&lt;0.01). The QCA- derived MLA also decreased from 2.35±1.71 mm2 pre-intervention to 1.68±1.56 mm2 post- intervention (p&lt;0.01). However, the 3D-OCT-measured MLA was significantly larger than the QCA-derived MLA (p&lt;0.01). The shape of the jailed side-branch ostium changed from circular to elliptical after the stent implantation (eccentricity index: 1.40±0.33 pre- intervention; 1.71±0.60 post-intervention, p&lt;0.01). Conclusions: Compared to QCA measurements, 3D-OCT analysis could be useful to guide decision for additional intervention or not after stent implantation across coronary bifurcation lesions.

Eccentric morphology of jailed side-branch ostium after stent crossover in coronary bifurcation lesions: A three-dimensional optical coherence tomographic analysis

BackgroundAngiographic stenosis of a jailed side-branch ostium is usually observed after a single-stent crossover at coronary bifurcation lesions. However, the stenosis severity is typically overestimated due to the limited information obtained from two-dimensional morphology by angiography. We evaluated the actual stenosis of jailed side-branch ostium using three-dimensional (3D) optical coherence tomography (OCT). MethodsUsing 3D reconstructions of OCT data, we analyzed minimal lumen area (MLA) and eccentricity of the jailed side-branch ostium in 41 patients who were treated with single stent crossover at coronary bifurcation lesions and subsequently underwent serial OCT follow-up. ResultsThe MLA of jailed side-branch ostium calculated from quantitative coronary angiography (QCA) assuming a circular lumen markedly decreased after stent implantation (1.73±1.22mm2 pre-intervention to 0.84±0.91mm2 post-intervention, p<0.001). However, the MLA of jailed side-branch ostium measured at post-intervention by 3D-OCT (2.67±1.75mm2) was significantly larger than that measured by QCA (p<0.001). There were no statistically significant changes in MLA of jailed side-branch ostium based on 3D-OCT measurements during the follow-up (2.35±1.50mm2 at 3–6 months post-intervention; 2.44±1.27mm2 at 1–2 years post-intervention, p=0.098). The shapes of the jailed side-branch ostium were nearly elliptical (mean eccentricity index: 2.97±1.27 post-intervention; 2.79±1.17 at 3–6 months post-intervention; 2.59±1.02 at 1–2 years post-intervention). ConclusionsCompared to 3D-OCT measurements, QCA measurements overestimated the jailed side-branch ostial stenosis after single stent crossover due to eccentric morphology from orthogonal projection in coronary angiography. Significant changes in the MLA of jailed side-branch ostium by 3D-OCT were not observed during the follow-up.

A Vertex Model of Drosophila Ventral Furrow Formation

Ventral furrow formation in Drosophila is an outstanding model system to study the mechanisms involved in large-scale tissue rearrangements. Ventral cells accumulate myosin at their apical sides and, while being tightly coupled to each other via apical adherens junctions, execute actomyosin contractions that lead to reduction of their apical cell surface. Thereby, a band of constricted cells along the ventral epithelium emerges which will form a tissue indentation along the ventral midline (the ventral furrow). Here we adopt a 2D vertex model to simulate ventral furrow formation in a surface view allowing easy comparison with confocal live-recordings. We show that in order to reproduce furrow morphology seen in vivo, a gradient of contractility must be assumed in the ventral epithelium which renders cells more contractile the closer they lie to the ventral midline. The model predicts previous experimental findings, such as the gain of eccentric morphology of constricting cells and an incremental fashion of apical cell area reduction. Analysis of the model suggests that this incremental area reduction is caused by the dynamical interplay of cell elasticity and stochastic contractility as well as by the opposing forces from contracting neighbour cells. We underpin results from the model through in vivo analysis of ventral furrow formation in wildtype and twi mutant embryos. Our results show that ventral furrow formation can be accomplished as a “tug-of-war” between stochastically contracting, mechanically coupled cells and may require less rigorous regulation than previously thought.SummaryFor the developmental biologist it is a fascinating question how cells can coordinate major tissue movements during embryonic development. The so-called ventral furrow of the Drosophila embryo is a well-studied example of such a process when cells from a ventral band, spanning nearly the entire length of the embryo, undergo dramatic shape change by contracting their tips and then fold inwards into the interior of the embryo. Although numerous genes have been identified that are critical for ventral furrow formation, it is an open question how cells work together to elicit this tissue rearrangement. We use a computational model to mimic the physical properties of cells in the ventral epithelium and simulate the formation of the furrow. We find that the ventral furrow can form through stochastic self-organisation and that previous experimental observations can be readily explained in our model by considering forces that arise when cells execute contractions while being coupled to each other in a mechanically coherent epithelium. The model highlights the importance of a physical perspective when studying tissue morphogenesis and shows that only a minimal genetic regulation may be required to drive complex processes in embryonic development.

Peculiar calcite speleothems filling fissures in calcareous sandstones and their palaeohydrological and palaeoclimatic significance: an example from the Polish Carpathians

Peculiar calcite speleothems developed in fissures in the Cergowa Sandstones were found in the Klęczany Quarry (Polish Western Carpathians). They represent flowstone and stalactites, rafts and various sparry crusts. Such speleothems, especially phreatic ones, are uncommon in the Outer Carpathians that are composed mainly of siliciclastic rocks of flysch type, with only limited calcium carbonate content. The speleothems analysed grew in vadose and phreatic conditions as well as at the air-water interface. Phreatic speleothems and thin rafts comprise calcite crystals of eccentric morphology. Based on their stable isotope composition the majority of the speleothems form two clusters. The first is characterized by d 18 O values between &ndash;9.8 and &ndash;8.5&permil; and of d 13 C values between &ndash;5.7 and &ndash;0.6&permil; whereas the second cluster of samples yields d 18 O values between &ndash;9.4 and &ndash;7.3&permil; and d 13 C values from &ndash;11.5 to &ndash;9.7&permil;. Speleothems grew between 230 +14 &ndash;13 &nbsp; &nbsp; ka and Holocene time. Phreatic speleothems, including massive rafts, precipitated from ascending water of deep circulation whereas vadose and water table speleothems crystallized from local infiltration water charged with soil CO 2 . Mixing of both waters in the shallow phreatic zone is plausible.

Abstract 4485: Clinical, Procedural and Angiographic Predictors of Stent Thrombosis Following Drug-Eluting Stent Implantation in Unselected Patients from the Real-World Clinical Practice with Clinical Follow-up (FU) up to 6 Years

DES has demonstrated marked efficacy on reducing restenosis, and therefore TLR, in previous randomized clinical trials compared to bare metal stents. Thus, a widespread use of DES has been observed since their introduction into clinical practice, including treatment of high-risk subgroups. However, recent studies including pts from the “real-world” have raised questions regarding the long-term safety of DES, especially in more complex subsets. Between May/02-Jan/08, 2,365 unselected pts all comers for PCI with DES were prospective enrolled in this single center study. Lesion criteria included ≥1 lesion ≥50% stenosis. Clinical FU was assigned at 1, 6 and 12 months, and yearly up to 6 years (median time: 3.6 yrs). Stent thrombosis (ST) was defined according to the Academic Research Consortium. Overall, 29% of pts had diabetes, 60% multivessel disease, 40% presented with ACS (including 15% AMI). LAD was treated in 43%; 67% of lesions had complex morphology (type B2/C), including 29% mod./severe calcification, 32% eccentric, 5% ostial lesion location, and 5% in-stent restenosis. A total of 3,634 DES were implanted, and 40% had multiple stenting procedure. At late FU (98.3%), overall ST rate was 1.6% (N=38); of that, 61% were definitive (angiographic confirmation), 42% occurred between 1–12 months (late ST), and a fatal event was reported in 47%. By multivariate analysis, ST was associated to: current smoking (HR 2.59; 95%CI 1.18 –5.67; P=0.018), PCI in AMI (HR 3.50; 95%CI 1.31–9.40; P=0.013), multiple steting procedure (HR 1.81; 95%CI 1.09 –3.02; P=0.023), lesion postdilatation (HR 0.50; 95%CI 0.29 – 0.90; P=0.020), eccentric morphology (HR 1.86; 95%CI 1.03–3.34; P=0.039), mod./severe calcium (HR 2.38; 95%CI 1.34 – 4.23; P=0.003), and final residual stenosis by QCA (HR 1.04 per % unit increase; 95%CI 1.01–1.06; P=0.003). In this study, the cumulative incidence of ST up to 6 years clinical FU was very low (1.6%); however, it was associated with a fatal event in half of cases. In this analysis, ST occurred mostly between 1–12 months, and was associated with current smoking, PCI in AMI, multiple stenting, postdilatation, complex lesion morphology including eccentric and significant calcium, and stent underexpansion.

Subcolumnar Dendritic and Axonal Organization of Spiny Stellate and Star Pyramid Neurons within a Barrel in Rat Somatosensory Cortex

Excitatory neurons at the level of cortical layer 4 in the rodent somatosensory barrel field often display a strong eccentricity in comparison with layer 4 neurons in other cortical regions. In rat, dendritic symmetry of the 2 main excitatory neuronal classes, spiny stellate and star pyramid neurons (SSNs and SPNs), was quantified by an asymmetry index, the dendrite-free angle. We carefully measured shrinkage and analyzed its influence on morphological parameters. SSNs had mostly eccentric morphology, whereas SPNs were nearly radially symmetric. Most asymmetric neurons were located near the barrel border. The axonal projections, analyzed at the level of layer 4, were mostly restricted to a single barrel except for those of 3 interbarrel projection neurons. Comparing voxel representations of dendrites and axon collaterals of the same neuron revealed a close overlap of dendritic and axonal fields, more pronounced in SSNs versus SPNs and considerably stronger in spiny L4 neurons versus extragranular pyramidal cells. These observations suggest that within a barrel dendrites and axons of individual excitatory cells are organized in subcolumns that may confer receptive field properties such as directional selectivity to higher layers, whereas the interbarrel projections challenge our view of barrels as completely independent processors of thalamic input.

Atheroma morphology and distribution in proximal left anterior descending coronary artery: In vivo observations

Objectives. This study sought to examine, in vivo, the shape and position of atheroma in the proximal left anterior descending coronary artery.Background. The prevalence, shape and location of atheromas involving the proximal left anterior descending artery have implications regarding the role of disturbed shear forces in the genesis of atherosclerosis. However, no data are available regarding in vivo findings or advanced disease.Methods. Forty-two consecutive high quality intravascular ultrasound images were examined from patients with atherosclerotic disease in the proximal left anterior descending artery just distal to the left main bifurcation. Lesion percent area stenosis and maximal, minimal and flow divider intimal-medial thickness were measured at the region immediately after the circumflex takeoff. The angle formed by the midpoint of the flow divider, the lumen center of gravity and the maximal plaque thickness were determined.Results. Eccentricity of vessel wall atheroma was observed such that the maximal wall thickness (1.42 ± 0.50 mm [mean ± SD]) differed significantly from minimal wall thickness (0.17 ± 0.098 mm). Further, the region of vessel wall manifesting maximal thickness was greater than the flow divider thickness (0.26 ± 0.17 mm). Maximal plaque thickness spared the region of the flow divider in 100% of cases and was positioned at a mean angle of 193 ± 49° from the center of the flow divider. Eccentric morphology was maintained across the 24% to 80% range of area stenosis.Conclusions. Atheromas in the very proximal left anterior descending artery are located opposite the circumflex takeoff, spare the flow divider and maintain eccentricity across a wide range of vessel stenoses. These in vivo morphologic data support the potential role of fluid dynamic mechanical factors in atherogenesis and have implications regarding the success of catheter-based interventional procedures at the site.

Can restenosis after coronary angioplasty be predicted from clinical variables?

Objectives. The purpose of this study was to determine whether variables shown to correlate with restenosis in one group (learning group) could be shown to predict recurrent stenosis in a second group (validation group).Background. Restenosis remains a critical limitation after percutaneous transluminal coronary angioplasty. Although several clinical variables have been shown to correlate with restenosis, there are few data concerning attempts to predict recurrent stenosis.Methods. The source of data was the clinical data bese at Emory University. Patients who had had previous coronary surgery and patients who underwent coronary angioplasty in the setting of acute myocardial Infarction were excluded. A total of 4,006 patients with angiographic restudy after successful angioplisty were identified. They were classified into a learning group of 2,500 patients and a validation group of 1,506 patients. The correlates of restenosis in the learning group were determined by stepwise logistic regression, and a model was developed to predict the probability of restenosis and was tested in the validation group. By using various cut points for the predicted probability of restenosis, a receiver operating characteristic curve was created. Goodness of fit of the model was evaluated by comparing average predicted probabilities with average observed probabilities within subgroups on the basis of risk level determined by linear regression analysis.Results. In the learning group 1,145 patients had restenosis and 1,355 did not. Correlates of restenosis were severe angina, severe diameter stenosis before angioplasty, left anterior descending coronary artery dilation, diabetes, greater diameter stenosis after angioplasty, hypertension, absence of an intimal tear, eccentric morphology and older patient age. The model derived from the learing group was used to predict restenosis in the validation group. By varying the cut point for the predicted probability of restenosis above which restenosis is diagnosed and below which it is not, a receiver operating characteristic curve was created. The curve was close to the line of identity, reflecting a poor predictive ability. However, the model was shown to fit well with the predicted probability of restenosis correlating well with the observed probability (r = 0.98, p = 0.0001).Conclusions. Clinical variables provide limited ability to predict definitively whether a particular patient will have restenosis. However, the current model may be used to predict the probability of restenosis, with some uncertainty, at least in well characterized patients who have already had angioplasy.

Coronary angiographic findings and in-hospital outcome of aggressive treatment in impending myocardial infarction.

The influence of coronary angiographic findings and treatment on clinical outcome was determined in 104 patients with impending myocardial infarction (unstable angina with prolonged chest pain and persistent electrocardiographic changes on admission). Coronary arteriography was performed on day one (aggressive strategy) in 50 patients and following medical treatment (conservative strategy) in 48 patients, of whom 40 were unstable. Six elderly patients were treated medically without angiography. A complex eccentric morphology of the coronary vessels was the most common finding in both groups, but the incidence of intracoronary thrombus was significantly higher in the aggressive strategy group (78%) and in unstable patients (77%) compared with patients controlled medically (24%). Severe multivessel disease was also common in refractory patients without thrombus. Percutaneous transluminal coronary angioplasty was less successful and produced more distal emboli in patients with thrombus. Emergency intervention was applied to 90% of the aggressive strategy group-it failed to improve the in-hospital outcome, but shortened hospitalization significantly. Elderly patients treated medically without angiography had the highest mortality. We concluded that intracoronary thrombus plays a major role in the pathogenesis of impending infarction, and that the majority of such patients cannot be stabilized medically. An aggressive strategy can be applied safely to impending infarction and will shorten hospitalization.

The effect of predilatation on coronary angioplasty-induced vessel wall injury

Fifty-four patients presenting with stenotic lesions in a major coronary artery visually estimated by diagnostic angiography to be > 90% but < 100% were randomized to one of two angioplasty regimens, predilation (group 1) or no predilation (group 2). In group 1, the artery was initially dilated with a 2 mm balloon followed by a balloon that was considered by the operator to be the definitive size to fully dilate the target vessel. In group 2, the artery was dilated with a balloon deemed the definitive size to complete the angioplasty procedure. There were no statistical differences between groups with respect to age, sex, history of unstable angina, or prior acute myocardial infarction. There were also no significant differences in the angiographic characteristics of the coronary lesions including artery location, lesion length, concentric or eccentric morphology, tubular versus discrete stenosis, calcium in lesions, or lesions on a bend. Following angioplasty, luminal filling defects were present in 5% of the predilated group and in 9% of the nonpredilated group ( p = NS). The incidence of luminal border haziness at the dilatation site did not differ between groups, seven (35%) in group 1 versus eight (24%) in group 2. Angiographic evidence of a linear dissection at the angioplasty site was also similar between groups, one (5%) in group 1 versus five (15%) in group 2. Occlusive complications were witnessed in 10% of the predilated group and 12% of the nonpredilated group ( p = NS). Dissection accompanied by a dye stain and dissection beyond the angioplasty site accompanied by a stain each occurred in one patient in the predilated group but not in the nonpredilated group ( p = NS). No patients required emergency coronary artery bypass surgery and there were no deaths. In conclusion, there is no evidence to support the routine predilatation of coronary stenoses in an effort to decrease the acute complication rate as a consequence of major artery injury.

Clinical and angiographic determinants of primary coronary angioplasty success

Clinical and anatomic determinants of the initial success of percutaneous transluminal coronary angioplasty were prospectively evaluated in 826 patients enrolled in the Multi-Hospital Eastern Atlantic Restenosis Trial (M-HEART). The 639 men and 187 women ranged in age from 31 to 85 years. Successful angioptasty (residual stenosis <50% and no major complications) wss achieved in 886 (88.6%) of 1,000 lesions. Success rates were uniform among the eight individual centers. Outcome was not influenced by gender, age or other clinical features, including severity and duration of angina, prior myocardial infarction, rest pain, transient ST segment elevation, history of smoking or diabetes.In contrast, procedural outcome was significantly associated with lesion-specific angiographic factors. Stenoses 60% to 74%, 75% to 89%, 90% to 99% and 100% were associated with success rates of 96%, 90%, 84% and 69%, respectively (p < 0.001). Angioplasty was less successful in calcified than in noncalcified lesions (82% versus 90%, p < 0.01), in thrombotic than in nonthrombotic lesions (82% versus 90%, p < 0.05) and in lesions in the right coronary artery than in other vessels (84% versus 90%, p < 0.01). Outcome was not related to other anatomic variables, including lesion location (proximal versus distal), vessel size, eccentricity, stenosis length or translesional gradient. By multivariate logistic regression, preangioplasty percent stenosis, right coronary artery location and lesion calcification were demonstrated to be significant independent predictors of angioplasty success. Alternative clinical and angiographic variables did not contribute to this regression model.These results suggest that attempted coronary angioplasty is no longer adversely influenced by previously important clinical features (female gender) or anatomic factors (circumflex artery or distal locations or eccentric morphology). Although patientrelated variables had no predictive value, primary angioplasty success was significantly affected by specific angiographic factors. Stenosis severity, calcification, thrombus and right coronary artery location were the principal determinants of coronary angioplasty outcome.