Intravascular Ultrasound Findings Research Articles

Risk factors and the CCTA application in patients with vulnerable coronary plaque in type 2 diabetes: a retrospective study

BackgroundDiabetes is an independent risk factor for cardiovascular disease. The purpose of this study was to identify the risk factors for vulnerable coronary plaques (VCPs), which are associated with adverse cardiovascular events, and to determine the value of coronary CT angiography (CCTA) in patients with type 2 diabetes mellitus (T2DM) and VCPs.MethodsNinety-eight T2DM patients who underwent CCTA and intravascular ultrasound (IVUS) were retrospectively included and analyzed. The patients were grouped and analyzed according to the presence or absence of VCPs.ResultsAmong the patients with T2DM, time in range [TIR {the percentage of time blood glucose levels were in the target range}] (OR = 0.93, 95% CI = 0.89–0.96; P < 0.001) and the high-density lipoprotein-cholesterol (HDL-C) concentration (OR = 0.24, 95% CI = 0.09–0.63; P = 0.04) were correlated with a lower risk of VCP, but the triglycerides (TG) concentration was correlated with a higher risk of VCP (OR = 1.79, 95% CI = 1.01–3.18; P = 0.045). The area under the receiver operator characteristic curve (AUC) of TIR, and HDL-C and TG concentrations were 0.76, 0.73, and 0.65, respectively. The combined predicted AUC of TIR, and HDL-C and TG concentrations was 0.83 (P < 0.05). The CCTA sensitivity, specificity, false-negative, and false-positive values for the diagnosis of VCP were 95.74%, 94.12%, 4.26%, and 5.88%, respectively. The identification of VCP by CCTA was positively correlated with IVUS (intraclass correlation coefficient [ICC] = 0.90).ConclusionsThe TIR and HDL-C concentration are related with lower risk of VCP and the TG concentration was related with higher risk of VCP in patients with T2DM. In clinical practice, TIR, HDL-C and TG need special attention in patients with T2DM. The ability of CCTA to identify VCP is highly related to IVUS findings.

Clinical Outcomes of Deferred Lesions by IVUS Versus FFR-Guided Treatment Decision.

There are limited data regarding the safety of deferral of percutaneous coronary intervention based on intravascular ultrasound (IVUS) findings. The current study sought to compare the prognosis between deferred lesions based on IVUS and fractional flow reserve (FFR)-guided treatment decision. This study is a post hoc analysis of the FLAVOUR randomized trial (Fractional Flow Reserve and Intravascular Ultrasound for Clinical Outcomes in Patients With Intermediate Stenosis) that compared 2-year clinical outcomes between IVUS- and FFR-guided treatment decision on intermediate coronary artery lesions using predefined criteria. In both IVUS and FFR groups, vessels were classified into deferred or revascularized vessels, and patients were classified as those with or without deferred lesions. Vessel-oriented composite outcomes (cardiac death, target vessel myocardial infarction, or target vessel revascularization) in deferred vessels and patient-oriented composite outcomes (death, myocardial infarction, or any revascularization) in patients with deferred lesions were compared between the IVUS and FFR groups. A total of 1682 patients and 1820 vessels were analyzed, of which 922 patients and 989 vessels were deferred. At 2 years, there was no difference in the cumulative incidence of vessel-oriented composite outcomes in deferred vessels between IVUS (n=375) and FFR (n=614) groups (3.8% versus 4.1%; hazard ratio, 0.91 [95% CI, 0.47-1.75]; P=0.77). The risk of vessel-oriented composite outcomes was comparable between deferred and revascularized vessels following treatment decision by IVUS (3.8% versus 3.5%; hazard ratio, 1.09 [95% CI, 0.54-2.19]; P=0.81) and FFR (4.1% versus 3.6%; hazard ratio, 1.14 [95% CI, 0.56-2.32]; P=0.72). In comparison of patient-oriented composite outcomes in patients with deferred lesions, there was no significant difference between the IVUS (n=357) and FFR (n=565) groups (6.2% versus 5.9%; hazard ratio, 1.05 [95% CI, 0.61-1.80]; P=0.86). In patients with intermediate coronary artery stenosis, deferral of percutaneous coronary intervention based on IVUS-guided treatment decision showed comparable risk of clinical events with FFR-guided treatment decision. URL: https://www.clinicaltrials.gov; Unique identifier: NCT02673424.

Clinical outcomes of deferred lesions by IVUS versus FFR-guided treatment decision: the FLAVOUR trial substudy

Abstract Background There is limited data regarding the safety of deferral of percutaneous coronary intervention (PCI) based on intravascular ultrasound (IVUS) findings. Current study sought to compare the prognosis between deferred lesions based on IVUS and FFR (fractional flow reserve)-guided treatment decision. Methods Study population was derived from FLAVOUR trial which is a multinational, open-label, randomized, and non-inferiority trial that compared 2-year clinical outcomes between IVUS and FFR-guided treatment decision using predefined criteria. In both IVUS and FFR groups, vessels were classified into deferred or revascularized vessels, and patients into those with or without deferred lesion. Vessel-oriented composite outcomes (VOCO) (cardiac death, target-vessel myocardial infarction, or target-vessel revascularization) in deferred vessels and patient-oriented composite outcomes (POCO) (death, myocardial infarction, or any revascularization) in patients with deferred lesion were compared between IVUS and FFR group. Results A total of 1682 patients and 1820 vessels were analyzed. At 2 years, there is no difference in cumulative incidence of VOCO in deferred vessels between IVUS and FFR groups (3.8% vs. 4.1%; hazard ratio [HR] 0.91; 95% confidence interval [CI] 0.47-1.75; P=0.771). The risk of VOCO was comparable between deferred and revascularized vessels following both IVUS (3.8% vs. 3.5%; HR 1.09; 95% CI 0.54-2.19; P=0.813) and FFR-guided treatment decision (4.1% vs. 3.6%; HR 1.14; 95% CI 0.56-2.32; P=0.715). In comparison of POCO in patients with deferred lesion, there was no significant difference between IVUS and FFR groups (6.2% vs. 5.9%; HR 1.05; 95% CI 0.61-1.80; P=0.856). Conclusion In patients with intermediate coronary artery stenosis, deferral of PCI based on IVUS-guided treatment decision showed comparable risk of clinical events with FFR-guided treatment decision.

Intravascular Ultrasound in the Detection of Bridging Stent Graft Instability During Fenestrated and Branched Endovascular Aneurysm Repair Procedures: A Multicentre Study on 274 Target Vessels

The use of intravascular ultrasound (IVUS) reduces contrast medium use and radiation exposure during conventional endovascular aneurysm repair (EVAR). The aim of this study was to evaluate the safety and efficacy of IVUS in detecting bridging stent graft (bSG) instability during fenestrated and branched EVAR (F/B-EVAR). This was a prospective observational multicentre study. The following outcomes were evaluated: (1) technical success of the IVUS in each bSG, (2) IVUS findings compared with intra-operative angiography, (3) incidence of post-operative computed tomography angiography (CTA) findings not detected with IVUS, and (4) absence of IVUS related adverse events. Target visceral vessel (TVV) instability was defined as any branch or fenestration issues requiring an additional manoeuvre or re-intervention. Any IVUS assessment that detected stenosis, kinking, or any geometric TVV issue was considered to be branch instability. All procedures were performed in ad hoc hybrid rooms. Eighty patients (69% males; median age 72 years; interquartile range 59, 77 years) from four aortic centres treated with F/B-EVAR between January 2019 and September 2021 were included: 70 BEVAR (21 off the shelf; 49 custom made), eight FEVAR (custom made), and two F/B-EVAR (custom made), for a total of 300 potential TVVs. Two TVVs (0.7%) were left unstented and excluded from the analysis. The TVVs could not be accessed with the IVUS catheter in seven cases (2.3%). Furthermore, 17 (5.7%) TVVs could not be examined due to a malfunction of the IVUS catheter. The technical success of the IVUS assessment was 91.9% (274/298), with no IVUS related adverse events. Seven TVVs (2.5%) showed signs of bSG instability by means of IVUS, leading to immediate revisions. The first post-operative CTA at least 30 days after the index procedure was available in 268 of the 274 TVVs originally assessed by IVUS. In seven of the 268 TVVs (2.6%) a re-intervention became necessary due to bSG instability. This study suggests that IVUS is a safe and potentially valuable adjunctive imaging technology for intra-operative detection of TVV instability. Further long term investigations on larger cohorts are required to validate these promising results and to compare IVUS with alternative technologies in terms of efficiency, radiation exposure, procedure time, and costs.

Predictors of recurrence based on intravascular ultrasound findings after Eluvia placement in symptomatic peripheral arterial disease: A retrospective study.

Polymer-coated drug-eluting stents (Eluvia) have shown favorable clinical outcomes in real-world registries. There are no reports on recurrent predictors after Eluvia placement based on intravascular ultrasound (IVUS) findings. We analyzed clinical data from the ASIGARU PAD registry, a retrospective, multicenter, observational study that enrolled patients who underwent endovascular therapy for superficial femoral and proximal popliteal arteries lesions using Eluvia or drug-coated balloon. The primary outcome was the identification of recurrent predictors, including IVUS parameters at 12 months. The rate of target lesion recurrence was also assessed. IVUS images were obtained in 54 of 65 cases. Seven recurrent cases (13.0%) were observed within 12 months. The random survival forest method presented eight predictive variables of recurrence: Clinical Frailty Scale (CFS), distal stent edge area, distal plaque burden, age, sex, distal external elastic membrane (EEM) area, minimum stent area (MSA), and distal lumen area. Furthermore, the partial dependence plot showed that frailty (CFS ≥ 6), smaller distal stent edge area, higher and lower distal plaque burden, older and younger age, female sex, smaller distal EEM area, smaller MSA, and smaller and larger distal lumen area predicted recurrence after Eluvia placement within 12 months. CFS, distal stent edge area, distal plaque burden, age, sex, distal EEM area, MSA, and distal lumen area were significant recurrent predictors after Eluvia placement.

Bifurcation left main stenting with or without intracoronary imaging: Outcomes from the EBC MAIN trial.

The impact of intracoronary imaging on outcomes, after provisional versus dual-stenting for bifurcation left main (LM) lesions, is unknown. We investigated the effect of intracoronary imaging in the EBC MAIN trial (European Bifurcation Club LM Coronary Stent study). Four hundred and sixty-sevenpatients were randomized to dual-stenting or a stepwise provisional strategy. Four hundred and fifty-fivepatients were included. Intravascular ultrasound (IVUS) or optical coherence tomography (OCT) was undertaken at the operator's discretion. The primary endpoint was death, myocardial infarction or target vessel revascularization at 1-year. Intracoronary imaging was undertaken in 179 patients (39%; IVUS = 151, OCT = 28). As a result of IVUS findings, operators reintervened in 42 procedures. The primary outcome did not differ with intracoronary imaging versus angiographic-guidance (17% vs. 16%; odds ratio [OR]: 0.92 (95% confidence interval [CI]: 0.51-1.63) p = 0.767), nor for reintervention based on IVUS versus none (14% vs. 16%; OR: 0.88 [95% CI: 0.32-2.43] p = 0.803), adjusted for syntax score, lesion calcification and ischemic symptoms. With angiographic-guidance, primary outcome events were more frequent with dual versus provisional stenting (21% vs. 10%; adjusted OR: 2.11 [95% CI: 1.04-4.30] p = 0.039). With intracoronary imaging, there were numerically fewer primary outcome events with dual versus provisional stenting (13% vs. 21%; adjusted OR: 0.56 [95% CI: 0.22-1.46] p = 0.220). In EBC MAIN, the primary outcome did not differ with intracoronary imaging versus none. However, in patients with angiographic-guidance, outcomes were worse with a dual-stent than provisional strategy When intracoronary imaging was used, there was a trend toward better outcomes with the dual-stent than provisional strategy.

Contrast Venography Versus Intravenous Ultrasound in Hemodialysis Arteriovenous Access Dysfunction

Contrast Venography Versus Intravenous Ultrasound in Hemodialysis Arteriovenous Access Dysfunction

Safe and effective profile of the VSTENT bioresorbable polymer sirolimus-eluting stent in the treatment of patients with de novo coronary artery lesions: a prospective, cohort, multicenter study.

The drug-eluting stent was a significant stride forward in the development of enhanced therapeutic therapy for coronary intervention, with three generations of increased advancement. VSTENT is a newly developed stent manufactured in Vietnam that aims to provide coronary artery patients with a safe, effective, and cost-efficient option. The purpose of this trial was to determine the efficacy and safety of a new bioresorbable polymer sirolimus-eluting stent called VSTENT. This is a prospective, cohort, multicenter research in 5 centers of Vietnam. A prespecified subgroup received intravascular ultrasound (IVUS) or optical coherence tomography (OCT) imaging. We determined procedure success and complications during index hospitalization. We monitored all participants for a year. Six-month and 12-month rates of major cardiovascular events were reported. All patients had coronary angiography after 6 months to detect late lumen loss (LLL). Prespecified patients also had IVUS or OCT performed. The rate of device success was 100% (95% CI: 98.3-100%; P<0.001). Major cardiovascular events were 4.7% (95% CI: 1.9-9.4%; P<0.001). The LLL over quantitative coronary angiography (QCA) was 0.08±0.19 mm (95% CI: 0.05-0.10; P<0.001) in the in-stent segment and 0.07±0.31 mm (95% CI: 0.03-0.11; P=0.002) in 5 mm within the two ends of the stent segment. The LLL recorded by IVUS and OCT at 6 months was 0.12±0.35 mm (95% CI: 0.01-0.22; P=0.028) and 0.15±0.24 mm (95% CI: 0.02-0.28; P=0.024), respectively. This study's device success rates were perfect. IVUS and OCT findings on LLL were favorable at 6-month follow-up. One-year follow-up showed low in-stent restenosis (ISR) and target lesion revascularization (TLR) rates, reflecting few significant cardiovascular events. VSTENT's safety and efficacy make it a promising percutaneous intervention option in developing nations.

Intravascular ultrasound imaging for diagnosis and characterization of the popliteal compression syndrome.

Functional popliteal artery entrapment syndrome (fPAES) is a rare form of nonatherosclerotic claudication most often seen in young athletic patients. Diagnosis remains challenging, with various imaging modalities showing equivocal or subtle findings that may be missed. We sought to critically examine and quantitate the utility of intravascular ultrasound (IVUS) imaging, a common diagnostic tool for vascular compression syndromes, in diagnosis and characterization of fPAES. Patients presenting to a single tertiary care center between 2019 and 2022 with symptoms of PAES but without an anatomic etiology or equivocal workup were selected. Angiogram and IVUS with maneuvers were performed on affected extremities at rest, active plantarflexion/dorsiflexion, and plantarflexion/dorsiflexion against resistance. IVUS examination was recorded using a pull-back technique from the tibial vessels to the superficial femoral artery. The degree, length, and anatomic location of compression using the two imaging modalities were compared. Angiogram and IVUS with maneuvers were performed on 17 lower extremities (9 left, 8 right) in 15 patients (88% female; mean age, 21.2years). Evidence of arterial compression on angiography was noted in 88.2% (n= 15) of limbs (66.7% complete contrast cessation and 20% popliteal artery tapering); 13.3% (n= 2) only demonstrated sluggish flow as possible evidence of compression. Arterial compression was seen on IVUS imaging in 15 of 17 limbs, and all completely compressed around the IVUS catheter. The IVUS-measured mean length of compression was 10.5cm± 4.2 (median, 11cm; range, 4-23cm). Compression involved only the popliteal vessels in 86.7% (n= 13); one patient had both popliteal and tibioperoneal trunk compression, whereas another had tibioperoneal trunk and peroneal artery compression. Popliteal vein compression was 100%. The contrast cessation point on angiography and the proximal point of compression on IVUS imaging differed in 80% of cases (P< .05). The distal extent of compression was unable to be determined by angiogram findings but was clearly delineated by IVUS imaging in all cases. IVUS imaging is a more sensitive diagnostic and descriptive imaging modality compared with angiogram in patients with possible fPAES. IVUS and angiogram findings are greatly discordant; moreover, IVUS imaging can provide detailed information such as the precise extent and anatomic location of the arterial compression, which may be useful in aiding surgical planning. IVUS imaging should be considered the gold standard for diagnosing and characterizing fPAES before intervention planning.

Abstract 10602: The Relationship Between Layered Plaque and Plaque Volume in Patients With Acute Coronary Syndromes

Introduction: Layered plaque is a signature of previous subclinical plaque destabilization and healing, which can be identified by optical coherence tomography (OCT). Silent plaque rupture or erosion with formation of a layer might contribute to rapid step-wise progression of plaque. We examined the relationship between layered plaques detected by OCT and plaque burden detected by intravascular ultrasound (IVUS) in patients with acute coronary syndromes (ACS). Methods: Patients presented with ACS who underwent preintervention OCT and IVUS were included in the analysis. Layered plaque was identified by OCT, and plaque burden was measured by IVUS around the culprit lesion. IVUS findings were compared between patients with layered plaque versus those without layered plaque. Results: Among 150 patients, total atheroma volume (TAV) (183.27 mm 3 [114.2 mm 3 to 275.0 mm 3 ] vs. 119.27 mm 3 [68.9 mm 3 to 185.5 mm 3 ], p=0.004), percent atheroma volume (PAV) (60.06 % [54.7 % to 60.1 %] vs. 53.69 % [46.8 % to 60.6 %], p=0.001), and plaque burden (PB) (86.51 % [81.7 % to 85.7 %] vs. 82.58 % [77.9 % to 85.4 %], p=0.001) were significantly higher in patients with layered plaques than non-layered plaques (Figure). When multi, single, and non-layered plaques were compared, TAV (188.69 mm 3 [122.1 mm 3 to 293.6 mm 3 ] vs. 137.85 mm 3 [100.1 mm 3 to 208.4 mm 3 ] vs. 119.27 mm 3 [68.9 mm 3 to 185.5 mm 3 ], p=0.021), PAV (62.12 % [56.8 % to 67.8 %] vs. 57.52 % [48.9 % to 60.1 %] vs. 53.69 % [46.8 % to 60.6 %] p&lt;0.001), and PB (87.44 % [81.8 % to 89.3 %] vs. 84.7 % [77.9 % to 88.0 %] vs. 82.58 % [77.9 % to 85.4 %], p=0.018) were significantly greater in multi-layered plaques than others. Conclusions: This study demonstrates that layered plaques, compared to non-layered plaques, have significantly greater plaque burden in patients with ACS, indicating plaque disruption and healing process, rather than gradual smooth muscle proliferation, significantly contributes to plaque progression at the culprit lesion in patients with ACS.

Abstract 10001: Relationship Between Coronary HIPs on Non-Contrast T1-WI by CMR and Vulnerable Plaque Features by NIRS-IVUS

Introduction: Although high-intensity plaques (HIPs) on cardiac magnetic resonance (CMR) have been reported to be associated with vulnerable plaque features, there is little evidence in comparison with near-infrared spectroscopy (NIRS)-intravascular ultrasound (IVUS) findings, which have recently been shown to positively identify vulnerable plaques and predict peri-procedural myocardial infarction (pMI). Hypothesis: We assumed that the coronary plaque characterization of CMR and NIRS-IVUS may have a significant relationship, and determined whether pre-percutaneous coronary intervention (PCI) evaluation using CMR identifies HIPs at risk of pMI. Methods: In total, 52 patients with stable coronary artery disease who underwent CMR with non-contrast T1-weighted imaging and PCI using NIRS-IVUS were studied. HIP was defined as a signal intensity of the coronary plaque-to-myocardial signal intensity ratio (PMR) ≥1.4. We evaluated the association between the NIRS-derived maximum 4-mm lipid-core burden index (maxLCBI 4mm ) and plaque morphology on IVUS, and assessed the incidence of pMI. Results: Of 62 lesions, HIPs were observed in 30 lesions (48%). HIPs had a significantly higher maxLCBI 4mm (500±170 versus [vs.] 288±218, p &lt;0.001) and plaque burden (69±8% vs. 63±10%, p =0.011) than the non-HIPs. The correlation between the maxLCBI 4mm and PMR was significantly positive (r=0.51). In multivariable analysis, HIP independently predicted a maxLCBI 4mm ≥400 (odds ratio [OR]=3.93; 95% confidence intervals [CIs]: 1.21-13.6, p =0.023). Furthermore, pMI occurred in 14 of 30 lesions (47%) with HIP, compared to 5 of 32 lesions (16%) without HIP ( p =0.005). Conclusions: We found an important relationship between coronary HIPs on CMR and NIRS-derived maxLCBI 4mm . We also confirmed that non-contrast T1-weighted imaging in CMR can be useful not only for the characterization of vulnerable plaque features, but also for pre-PCI risk stratification.

Venous stent patency is independent of total stented length in nonthrombotic iliac vein and post-thrombotic venous stenoses

ObjectiveVenous stenting has become the preferred treatment of symptomatic outflow obstruction due to nonthrombotic iliac vein lesions (NIVLs) and post-thrombotic venous stenoses (PTs). A paucity of data exists regarding the effect of stent length on patency rates after intervention. We evaluated the association between stent length and patency in patients treated for iliofemoral venous outflow obstruction. MethodsThe institutional review board approved the present study. A total of 161 patients had undergone venous stenting for NIVLs and thrombotic disease from January 2016 to April 2021. For thrombotic disease, patients with PTs and those with acute deep vein thrombosis (DVT) with underlying outflow obstruction were included. The patient characteristics evaluated included gender, age, body mass index, diagnosed thrombophilia, a history of venous thromboembolism, and CEAP (clinical, etiologic, anatomic, pathophysiologic) score. All the patients had undergone multiplanar venography and intravascular ultrasound during the index procedure. The intravascular ultrasound findings were used to determine the diameter and length of the implanted stents. The patients were placed into two groups, those with stented lengths ≤100 mm and those with stented lengths >100 mm. The primary end point was stent patency between the two groups using duplex ultrasound at 6 months. ResultsA total of 108 patients (58.3% female) had had 6-month duplex ultrasound scans available for review. Their mean age was 55.6 ± 17.2 years. The mean body mass index was 31.7 ± 6.9 kg/m2. Overall, the 6-month patency was 89.9%. Of the 108 patients, 56 (51.9%) had had a total stented length of ≤100 mm with a 6-month patency of 92.9%. The remaining 52 patients (48.1%) had had a total stented length >100 mm with a 6-month patency of 86.5%. The rate of patency did not differ significantly between the two groups (P = .222). Stent patency at 6 months for patients with NIVLs was 98% (40 of 41). Stent patency for patients with PTs was 84% (32 of 38). Patency for patients with acute DVT who had undergone stenting after thrombectomy was 86% (25 of 29). Overall, 10 patients with thrombotic disease, including PT and acute DVT, had developed stent thrombosis. The total stented length was not predictive of the loss of patency. ConclusionsThese findings suggest that the length of stent coverage does not confer an increased likelihood of stent thrombosis for patients with iliofemoral venous obstruction. Interventionalists should treat the affected venous segments identified on intravascular ultrasound and effectively stent from normal to normal venous areas, regardless of the stent length required. These results suggest that the total stented length is not a risk factor for stent thrombosis for both NIVL and thrombotic iliofemoral venous lesions.

A novel initial wiring technique for chronic total occlusion of the superficial femoral artery using the structural features of a polymer jacket guidewire

BackgroundTo evaluate the efficacy of the GLadIus MG drilLINg technique (GLIMGLIN), a novel initial wiring technique using the Gladius MG™ structural features, for crossing the superficial femoral artery (SFA) with chronic total occlusion (CTO).MethodsThis retrospective, single-center study enrolled 27 symptomatic patients (mean age 77.4 ± 8.5 years; 20 men) with de novo SFA CTO (mean CTO length 16.1 ± 8.9 cm) who underwent GLIMGLIN as the initial wiring between January 2020 and December 2021. The success of GLIMGLIN was defined when the wire crossing was completed using a Gladius MG™ and a microcatheter without any additional devices and techniques.ResultsThe success rate of GLIMGLIN was 48.1%. Intravascular ultrasound findings showed complete true lumen passage in the GLIMGLIN success group. Compared to the failure group, the proximal (6.3 ± 0.8 vs. 5.5 ± 0.9 mm, p = 0.02) and distal (5.9 ± 0.5 vs. 5.4 ± 0.6 mm, p = 0.02) reference vessel diameters were significantly larger, and the rate of calcium angle > 180° was significantly lower (30.8 vs. 71.4%, p = 0.04) in the success group. No significant difference was shown in the CTO length between two groups. Total wiring time, total procedure time, and fluoroscopic time were significantly shorter in the success group.ConclusionsGLIMGLIN may enable operators to perform CTO wiring easily and efficiently in selected cases.

Intravascular ultrasound correlation of unenhanced magnetic resonance venography in the context of pelvic deep venous disease

ObjectiveIn the present retrospective, assessor-blinded cross-sectional study, we compared the diagnostic efficacy of the relaxation-enhanced angiography without contrast and triggering (REACT) protocol for magnetic resonance venography (MRV) and intravascular ultrasound (IVUS). MethodsAll patients without prior lower limb vascular stenting who had undergone MRV with the REACT protocol and IVUS at our institution from January 2018 to May 2020 were included. The REACT protocol for MRV comprises three main phases: the adiabatic-based T2-preparation module, the non–volume-selective short tau inversion recovery pulse sequence, and the three-dimensional, modified two-point chemical-shift water-fat separated turbo-field echo pulse sequence. The IVUS findings served as the reference standard for stenosis and were used in the diagnostic efficacy analysis of the REACT protocol for MRV. The REACT protocol MRV images were reviewed by three board-certified interventional radiologists, and an interrater analysis was performed. ResultsA total of 33 patients (110 segments with IVUS correlation; 18 men [54.5%] and 15 women [45.5%]) were included. Most patients were Chinese (63.6%), and 24 had had bilateral deep venous disease (72.7%). The mean patient age was 59.0 years (range, 26.0-79.5 years). Moderate agreement was found between the three radiologists’ diagnoses of iliac vein pathology using the REACT protocol for MRV (κ = 0.524; 95% confidence interval [CI], 0.426-0.623; P < .001). Compared with IVUS, REACT protocol MRV achieved a sensitivity of 96.10% (95% CI, 89.03%-99.19%), specificity of 78.79% (95% CI, 61.09%-91.02%), positive predictive value of 91.36% (95% CI, 84.54%-95.33%), and negative predictive value of 89.66% (95% CI, 73.81%-96.38%). Overall, 78.5% agreement was noted between the REACT protocol MRV and IVUS findings. Good agreement between the index test and reference standard was noted (κ = 0.779; 95% CI, 0.645-0.907; P ≤ .05). ConclusionsREACT protocol MRV has the potential to be a highly sensitive and specific screening tool to diagnose deep venous disease.

Intravascular ultrasound-factors associated with slow flow following rotational atherectomy in heavily calcified coronary artery

Intravascular ultrasound (IVUS) can provide useful information in patients undergoing complex percutaneous coronary intervention with rotational atherectomy (RA). The association between IVUS findings and slow flow following rotational atherectomy (RA) has not been investigated, although slow flow has been shown to be an unfavorable sign with worse outcomes. The aim of this study was to determine the IVUS-factors associated with slow flow just after RA. We retrospectively enrolled 290 lesions (5316 IVUS-frames) with RA, which were divided into the slow flow group (n = 43 with 1029 IVUS-frames) and the non-slow flow group (n = 247 with 4287 IVUS-frames) based on the presence of slow flow. Multivariate regression analysis assessed the IVUS-factors associated with slow flow. Slow flow was significantly associated with long lesion length, the maximum number of reverberations [odds ratio (OR) 1.49; 95% confidence interval (CI) 1.07–2.07, p = 0.02] and nearly circumferential calcification at minimal lumen area (MLA) (≥ 300°) (OR, 2.21; 95% CI 1.13–4.32; p = 0.02). According to the maximum number of reverberations, the incidence of slow flow was 2.2% (n = 0), 11.9% (n = 1), 19.5% (n = 2), 22.5% (n = 3), and 44.4% (n = 4). In conclusion, IVUS findings such as longer lesion length, the maximum number of reverberations, and the greater arc of calcification at MLA may predict slow flow after RA. The operators need to pay more attention to the presence of reverberations to enhance the procedure safety.

Vascular Response after Directional Coronary Atherectomy for Left Main Bifurcation Lesion.

Aims To evaluate the vascular response after directional coronary atherectomy (DCA) for left main (LM) bifurcation lesion. Methods This study was a retrospective, single-center study enrolling 31 patients who underwent stentless therapy using DCA followed by drug-coated balloon (DCB) angioplasty for LM bifurcation lesion. We compared intravascular ultrasound (IVUS) findings before and after DCA. Results After DCA, the lumen and vessel areas significantly increased, whereas the plaque area (PA) and %PA were significantly reduced. When the lesions were divided into small vessel and large vessel groups using the median value of the vessel area, the maximum balloon pressure of the DCA catheter was greater in the large vessel group. Changes in the lumen and vessel areas were also significantly greater in the large vessel group. On the other hand, the changes in PA and %PA were similar between groups. Conclusions The main vascular responses associated with lumen enlargement after DCA were plaque reduction and vessel expansion. Contribution of vessel expansion to lumen enlargement was larger than the effect of plaque reduction in large vessel lesions.

Refractory hypertension secondary to renal artery stenosis with a honeycomb-like structure

BackgroundA honeycomb-like structure (HLS) is a rare abnormality characterized by a braid-like appearance. Angiograph and intravascular examination, including coherence tomography and intravascular ultrasound (IVUS), can further confirm the multiple intraluminal channels or honeycomb structure, which can also be described as looking like ‘swiss cheese’, a ‘spider web’ or a ‘lotus root’. Previous studies have mostly reported this abnormality in coronary arteries, with a few cases in renal arteries. More information about the characteristics and development of HLS is needed.Case presentationA 69-year-old Han man with resistant hypertension received abdominal enhanced computerised tomography and was revealed to have left renal artery stenosis with the possibility of left renal infarction. Renal artery angiography confirmed a 95% stenosis located in the proximal segment of the left renal artery, and the middle segment was blurred with multi-channel-like blood flow. Further IVUS was performed and identified multiple channels surrounded by fibrous tissue. It was a rare case of HLS in the renal artery secondary to the thrombus, with organisation and recanalisation. Balloon dilatation and stent implantation at the proximal segment of the left renal artery were performed successfully. Blood pressure was well controlled after the procedure.ConclusionsThe IVUS findings are helpful for forming interventional therapeutic strategies for HLS lesions in the renal artery.

Impact of Baseline and Postprocedural Intravascular Ultrasound Findings on 1-Year Primary Patency After Drug-Coated Balloon Treatment of Femoropopliteal Lesions

Purpose: Drug-coated balloons (DCBs) are commonly used for endovascular treatment of femoropopliteal lesions. Here, we employed intravascular ultrasound (IVUS) to investigate the predictors of restenosis after DCB treatment. Methods: This retrospective and single-center study was performed to examine 1-year primary patency after DCB treatment and to identify the risk factors for restenosis by analyzing clinical characteristics, angiographic findings, and IVUS measurements. We included 111 consecutive patients undergoing DCB treatment for de novo femoropopliteal lesions at our hospital from July 2018 to March 2020. Results: The primary patency rate was found to be 80.0% at 1 year. The Cox proportional hazard multivariate analysis revealed that restenosis was independently associated with chronic total occlusion (CTO; p < 0.001), circumferential calcification (p = 0.023), and smaller postprocedural minimum lumen area (MLA; p = 0.036). Furthermore, receiver operating characteristic curve analysis showed that the cutoff value of postprocedural MLA to prevent restenosis was 12.7 mm2, with an area under the curve of 0.774 (p< 0.001). The multivariate analysis indicated that patients with a postprocedural MLA below 12.7 mm2 (n = 44) had a significantly smaller distal reference vessel size (p < 0.001) compared to those with a postprocedural MLA over 12.7 mm2 (n = 67). Conclusions: Restenosis after DCB treatment was shown to correlate with CTO, circumferential calcification, and postprocedural MLA as evaluated by IVUS. Moreover, smaller vessel sizes might represent a particular challenge to the DCB strategy due to the difficulty of restoring a sufficient postprocedural lumen area by balloon dilatation.

Comparison of Angiographic Dissection Classification Systems in the Femoropopliteal Arteries Using IVUS Validation and Reliability Testing

Purpose: Objective assessment of dissection severity is difficult. Recognition of this has led to the creation of classification systems. This study investigated the performance of the National Heart Lung and Blood Institute (NHLBI) and Kobayashi systems at differentiating severity of femoropopliteal dissection using intravascular ultrasound (IVUS) as the reference standard. Comparison between the 2 systems and the inter- and intra-observer reliability were also investigated. Materials and Methods: Angiographic and IVUS imaging was assessed in 51 cases sourced from a RCT investigating the use of IVUS in femoropopliteal disease. A total of 2 readers independently scored the angiography images according to NHLBI and Kobayashi dissection classification systems and a consensus score was obtained for each system in each case. The NHLBI classification was condensed into 3 grades of dissection to allow comparison between systems. Dissection length, dissection arc, minimum lumen area, and lumen area stenosis were obtained from the IVUS imaging. IVUS parameters were compared between grades of severity for both systems. Agreement in grading between the systems was assessed and IVUS parameters for each level of dissection severity were compared between systems. Inter and intra-observer agreement tested for each system. Results: Dissection was present on IVUS in 92.2% (47/51) of cases and angiography identified 78.7% (37/47) of these. No difference was present in any IVUS parameters between mild and severe dissections with either classification system. No difference in IVUS findings was present for the same grades of dissection between systems. The 2 systems agreed on severity grade in 47 of 51 cases. The inter-observer agreement was for NHLBI was k=0.549 and k=0.627 for Kobayashi. Intra-observer agreement for NHLBI was k=0.633 and k=0.633 and for Kobayashi was k=0.657 and k=0.297. Conclusion: The lack of difference in IVUS parameters between mild and severe dissection for the NHLBI and Kobayashi systems raises doubts about their ability to effectively differentiate dissection severity. Weak to moderate reliability suggests that variability in interpreting dissection may be higher than acceptable. IVUS imaging is more sensitive for detecting dissection than angiography and research is required to establish the value of adding IVUS to dissection classification systems.

Rapid Progression of Coronary Atherosclerosis in Patients Taking an Oral Antitumor, Multikinase Receptor Inhibitor.

Rapid Progression of Coronary Atherosclerosis in Patients Taking an Oral Antitumor, Multikinase Receptor Inhibitor.