Large Coronary Vessels Research Articles

Long term clinical outcome of sirolimus drug coated balloons in large coronary vessels.

Studies evaluating the safety and efficacy of drug coating balloons (DCB) for the treatment of lesions in large coronary vessel are limited. Our study aimed to evaluate the performance of a sirolimus DCB in large coronary arteries. We analyzed all the procedures included in the EASTBOURNE Registry (NCT03085823) enrolling patients with a clinical indication to percutaneous coronary intervention performed by a sirolimus DCB according to investigator judgment. In the present analysis, a cut-off of 2.75 mm was used to define large coronary arteries. Primary endpoint of the study was clinically driven target lesion revascularization (TLR) at 24 months whereas secondary endpoint included procedural success, myocardial infarction (MI), cardiac death and total mortality. Among the 2123 patients and 2440 lesions enrolled in the EASTBOURNE study between 2016 and 2020, 757 patients/810 lesions fulfilled the criteria for the present analysis. Mean reference vessel diameter was 3.2 ± 0.3 mm with mean lesion length of 22 ± 7 mm. Procedural success was high (96%) and at 2-year follow up the device showed a good efficacy with a TLR rate of 9%. There were 34 deaths (4.5%), 30 MIs (4%) and 8 BARC type 3-5 bleedings (1.1%). In-stent restenosis (629 lesions) and de novo lesions (181) were associated with 11% and 4% rates of TLR at 2 years, respectively (p = 0.003). Clinical performance of a sirolimus DCB in large coronary artery vessels shows promising signals at 2-year follow up, both in de novo and in-stent restenosis lesions.

Two-year outcomes of drug-coated balloon only strategy for de novo lesions in large coronary vessels

Abstract Background Drug-coated balloons (DCB) are effective for the treatment of in-stent restenosis and de novo lesions in small coronary vessels (reference vessel diameter: RVD < 3.0 mm). Recently, several studies have reported acceptable results of DCB for de novo lesions in large coronary vessels (RVD ≧ 3.0 mm). However, previous studies were limited, we investigated the clinical outcomes of the DCB only strategy for de novo lesions in large coronary vessels. Methods We retrospectively analyzed 97 patients with 107 de novo lesions (RVD ≧ 3.0 mm) who underwent DCB only angioplasty from January 2016 to December 2021. We scheduled angiographic follow-up at 6 months after procedure and analyzed quantitative coronary angiography (QCA) data. Results The mean duration of follow-up was 737.8 ± 512.6 days. Patients who met the high bleeding risk (HBR) criteria was 56 (57.7%). Procedure success rate was 97.2% (3 lesions needed bailout drug eluting stent implantation) and acute coronary occlusion was not observed. The 2-year cumulative incidences of all-cause death was 7.1%, cardiac death was 1.6%. Target vessel revascularization was 9.2%, target lesion revascularization was 4.2%, respectively. Two patients had major bleeding events (BARC type 3 or 5) within 3 months after treatment and during the DAPT period. No major bleeding events were observed during the SAPT period. Conclusion The clinical outcomes of the DCB only strategy for de novo lesions in large coronary vessels were safe and acceptable. Especially in HBR patients, DCB only strategy could be an alternative treatment option.

Primary Clinical Outcomes of the Bioabsorbable Polymer-Coated, Everolimus-Eluting Synergy Megatron Stent in the Treatment of Large Coronary Vessels

Primary Clinical Outcomes of the Bioabsorbable Polymer-Coated, Everolimus-Eluting Synergy Megatron Stent in the Treatment of Large Coronary Vessels

Clinical and Angiographic Outcomes of Elective Paclitaxel-Coated Balloon Angioplasty in Comparison with Drug-Eluting Stents for De Novo Coronary Lesions in Large Vessels.

We retrospectively examined the feasibility of paclitaxel-coated balloon (PCB) angioplasty for de novo stenosis in large coronary vessels (LV; pre- or postprocedural reference vessel diameter ≥ 2.75 mm) in comparison with placement of drug-eluting stents (DESs).Consecutive de novo stenotic lesions in the LV electively and successfully treated with either PCB (n = 73) or DESs (n = 81) from January 2016 to December 2018 at our center were included. The primary endpoint was the incidence of target lesion failure (TLF), including cardiac death, nonfatal myocardial infarction, and target vessel revascularization. The impact of PCB on TLF was examined using Cox proportional hazards models by including 39 variables. The secondary endpoint, angiographic restenosis, defined as a follow-up percent diameter stenosis > 50, was examined in angiographic follow-up lesions after PCB angioplasty (n = 56) and DES placement (n = 53). This retrospective investigation was conducted in July 2022.The mean PCB size and length were 3.23 ± 0.42 and 18.4 ± 4.3 mm, respectively. The TLF frequency in the PCB group (6.8% during the mean observational interval of 1536 ± 538 days) was not significantly different from that in the DES group (14.6%, 1344 ± 606 days, P = 0.097). PCB was not a significant predictor of TLF in the univariate analysis (hazard ratio: 0.424; 95%CI: 0.15-1.21; P = 0.108). There was no angiographic restenosis after PCB angioplasty.The present observational single-center study showed that PCB for de novo stenosis in the LV had no significant adverse impact on TLF and had favorable angiographic outcomes.

Coronary stent failure: role of a blended approach with drug-coated balloons for complex lesions.

The management of coronary artery disease by means of percutaneous approach have been focused initially to overcome the recoil and acute occlusion after vessel ballooning; therefore, to develop and improve metallic stent platforms, and later drug-eluting technologies. Contemporarily, the necessity emerged to optimize interventional procedures using functional physiologic tests and intravascular imaging guidance, but still stent failures, especially in the complex lesion setting, continue to be not negligible. This comprehensive review is focused on the technology of drug-coated balloons as a tool to treat coronary artery disease without the need for metal implantation but still eluting antirestenotic drugs such as paclitaxel or sirolimus. We delve into these technologies, the drugs, the technical aspects of the deployment and the most updated evidence also proposing a dedicated interventional algorithm. There is solid data to support the use of drug-coated balloons in patients with in-stent restenosis and de-novo small coronary artery disease but also new evidence with promising results from recent studies indicate the feasibility of this approach in complex coronary interventions, bifurcation lesions and larger coronary vessels. In this state-of-the-art review, we also propose a blended approach based on the combination of drug-eluting stents and drug-coated balloons, keeping in mind the necessity to reduce the total stent length in order to reduce the long-term risk of complications.

CRT-100.52 Primary Clinical Outcomes of the Bioabsorbable Polymer-Coated, Everolimus-Eluting Synergy Megatron Stent in the Treatment of Large Coronary Vessels

CRT-100.52 Primary Clinical Outcomes of the Bioabsorbable Polymer-Coated, Everolimus-Eluting Synergy Megatron Stent in the Treatment of Large Coronary Vessels

Anatomy of the heart with the highest heart rate.

Shrews occupy the lower extreme of the seven orders of magnitude mammals range in size. Their hearts are large relative to body weight and heart rate can exceed a thousand beats a minute. It is not known whether traits typical of mammal hearts scale to these extremes. We assessed the heart of three species of shrew (genus Sorex) following the sequential segmental analysis developed for human hearts. Using micro‐computed tomography, we describe the overall structure and find, in agreement with previous studies, a large and elongate ventricle. The atrial and ventricular septums and the atrioventricular (AV) and arterial valves are typically mammalian. The ventricular walls comprise mostly compact myocardium and especially the right ventricle has few trabeculations on the luminal side. A developmental process of compaction is thought to reduce trabeculations in mammals, but in embryonic shrews the volume of trabeculations increase for every gestational stage, only slower than the compact volume. By expression of Hcn4, we identify a sinus node and an AV conduction axis which is continuous with the ventricular septal crest. Outstanding traits include pulmonary venous sleeve myocardium that reaches farther into the lungs than in any other mammals. Typical proportions of coronary arteries‐to‐aorta do not scale and the shrew coronary arteries are proportionally enormous, presumably to avoid the high resistance to blood flow of narrow vessels. In conclusion, most cardiac traits do scale to the miniscule shrews. The shrew heart, nevertheless, stands out by its relative size, elongation, proportionally large coronary vessels, and extent of pulmonary venous myocardium.

Numerical evaluation of the effectiveness of coronary revascularization

Abstract In the present paper we construct the model of coronary flow which utilizes the patient’s CT data on both large CA and perfusion. We reconstruct large coronary vessels based on the CT data and extrude possibly invisible vessels from the branches of the left coronary artery so that every terminal point supply every of standardized zone of myocardium. We apply a previously developed and validated 1D model of haemodynamics. Utilizing the patient-specific CTP data for modifying outflow terminal resistance at rest and under stress conditions is the major novelty of the present work. From our results it follows that acceptable values of fractional flow reserve (FFR) after the stenotic treatment may produce false negative output. Therefore healthy FFR values may be observed after ineffective revascularization. We also conclude that microvascular perfusion impairment plays significant role in correct computational estimation of haemodynamic indices before stenotic treatment. The advantage of the presented approach is the availability of transmural perfusion ratio assessment in everyday practice.

Cardiac tissue remodeling in healthy aging: the road to pathology.

This review aims to highlight the normal physiological remodeling that occurs in healthy aging hearts, including changes that occur in contractility, conduction, valve function, large and small coronary vessels, and the extracellular matrix. These "normal" age-related changes serve as the foundation that supports decreased plasticity and limited ability for tissue remodeling during pathophysiological states such as myocardial ischemia and heart failure. This review will identify populations at greater risk for poor tissue remodeling in advanced age along with present and future therapeutic strategies that may ameliorate dysfunctional tissue remodeling in aging hearts.

Device profile of the Resolute Onyx Zotarolimus eluting coronary stent system for the treatment of coronary artery disease: overview of its safety and efficacy

ABSTRACT Introduction: The increasing complexity of patients undergoing percutaneous coronary intervention (PCI) regarding both coronary anatomy and comorbidities requires dedicated devices. The Resolute Onyx (R-Onyx, Medtronic, CA, USA) stent is a novel durable polymer zotarolimus-eluting stent (ZES) promising better deliverability, increased radiopacity and lower thrombogenicity. Areas covered: In this review, we discuss device features, preclinical evidence, and clinical studies including patients treated with R-Onyx. The BIONYX and Onyx ONE studies were two major landmark trials demonstrating non-inferiority of R-Onyx as compared to other latest generation devices. We also elaborate on alternative innovations in drug-eluting stent (DES) technology and how R-Onyx fits into this field. Expert opinion: R-Onyx is designed to address the challenges of contemporary PCI, but evidence on its clinical performance is largely derived from studies on older generation devices from the ZES family. Nonetheless, all clinical studies on R-Onyx consistently show excellent outcomes, with particularly low rates of stent thrombosis, making it a promising candidate for short dual antiplatelet regimens. In addition, R-Onyx is available with a wide range of stent diameters allowing accurate sizing for both very small and very large coronary vessels.

Outcomes of patients treated with drug-coated balloons for de novo large coronary vessels

Objective: To evaluate the efficacy and safety of drug-coated balloons (DCB) for de novo large coronary vessels. Methods: One hundred and two patients were retrospectively enrolled in this study, there were 104 lesions with the reference lumen diameter of target vessel more than 2.8 mm and patients were treated with DCB in de novo lesions during May 2015 and July 2017 in our center. Coronary artery angiography and quantitative coronary angiography were performed in 82 (80.4%) patients at follow up period ((8.1±1.7) months post procedure). The endpoints were late lumen loss (LLL) at follow up,and major adverse cardiac events (MACE) including cardiac death, myocardial infarction (MI), target lesion revascularization (TLR) and stent or target lesion thrombosis at 12 months post procedure. Results: Ninety-eight lesions were treated with DCB only, 6 (5.9%) bailout drug-eluting stent (DES) were used because of severe coronary dissection, 2 patients (2.0%) received revascularization driven by acute ischemic events during hospitalization. Cutting balloons and NSE balloons were used in 65.4% (68/104) and 26.0% (27/104) lesions. The lesion length was (12.57±3.58) mm and the DCB length was (19.87±4.55) mm. The late lumen loss was (0.01±0.52) mm during angiographic follow up. The TLR rate and overall MACE rate was 3.9% (4/102) and 3.9% (4/102) and there was no death,MI and target lesion thrombosis at 12 months follow up. Conclusion: DCB treatment for de novo large coronary vessels is effective and safe.

Drug-eluting stents in large coronary vessels improve both safety and efficacy compared with bare-metal stents in women: a pooled analysis of the BASKET-PROVE I and II trials

BackgroundDrug-eluting stents (DES) have proven superior to bare-metal stents (BMS) in terms of safety and efficacy. However, inference to the female subgroup has been limited by low enrolment rates of...

Structural and Functional Characterization of the Adult Giant Danio Heart

Cardiovascular diseases remain that number one cause of death in the northern hemisphere and are increasing globally in developing economies. In spite of evolutionary separation between fishes and mammalian, the use of non‐mammalian model species has significantly increased our understanding of cardiac diseases. We have recently described the growth and cardiovascular development of the Devario malabaricus, a giant danio (GD) species closely related to the zebrafish. We hypothesize that the adult GD heart can serve as a robust non‐mammalian model for in vivo studies of cardiac biology. Using immunostaining, transmission electron microscopy, scanning block‐face electron microscopy, and Doppler, we have characterized the anatomical and functional characteristics of the adult GD heart. First, we found that the adult giant danio possesses a thick and highly vascularized compact heart. Second, the GD heart possesses a junctional region populated with a fibroblasts network similar to that observed in zebrafish. Third, multiple large coronary vessels investing the compact myocardium are connected to and continuous with atrioventricular (AV) canal lumen. In addition, the AV canal and bulbus are highly innervated, suggesting complex regulation in heart function. Moreover, we demonstrate that their cardiac function can be measured using Doppler flow velocity. These studies along with previous findings support the GD as a robust model for the study of cardiac biology.Support or Funding Information1R15HD084262‐01, Buehler Family FoundationThis abstract is from the Experimental Biology 2019 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.

Drug Coated Balloon-Only Strategy in De Novo Lesions of Large Coronary Vessels.

Objectives We analyzed the efficacy of drug coated balloons (DCB) as a stand-alone-therapy in de novo lesions of large coronary arteries. DCBs seem to be an attractive alternative for the stent-free interventional treatment of de novo coronary artery disease (CAD). However, data regarding a DCB-only approach in de novo CAD are currently limited to vessels of small caliber. Methods By means of propensity score (PS) matching 234 individuals with de novo CAD were identified with similar demographic characteristics. This patient population was stratified in a 1:1 fashion according to a reference vessel diameter cut-off of 2.75 mm in small and large vessel disease. The primary endpoint was the rate of clinically driven target lesion revascularization (TLR) at 9 months. Results Patients with small vessel disease had an average reference diameter of 2.45 ± 0.23 mm, while the large vessel group averaged 3.16 ± 0.27 mm. Regarding 9-month major adverse cardiac event (MACE), 5.7% of the patients with small and 6.1% of the patients with large vessels had MACE (p=0.903). Analysis of the individual MACE components revealed a TLR rate of 3.8% in small and 1.0% in large vessels (p=0.200). Of note, no thrombotic events in the DCB treated coronary segments occurred in either group during the 9-month follow-up. Conclusions Our data demonstrate for the first time that DCB-only PCI of de novo lesions in large coronary arteries (>2.75 mm) is safe and as effective. Interventional treatment for CAD without permanent or temporary scaffolding, demonstrated a similar efficacy for large and small vessels.

Adaptive Spatiotemporal Filtering for Coronary Ultrafast Doppler Angiography.

The heart's supply of oxygen and nutrients relies on the coronary vasculature, which branches from millimeter-sized arteries down to micrometer-sized capillaries. To date, imaging technologies can only detect large epicardial coronary vessels, whereas the intramural coronary vasculature remains invisible due to cardiac motion. We recently introduced coronary ultrafast Doppler angiography, a noninvasive vascular imaging technology based on ultrafast ultrasound that enables the visualization of epicardial and intramural coronary vasculature in humans. In this letter we describe, using an open-chest swine data set, the adaptive spatiotemporal filtering method that was developed for the detection of slow blood flows embedded in rapid myocardial motion.

Drug-Eluting vs. Bare-Metal Stents: Is it a Matter of Vessel Size?

Background: Although drug-eluting stents (DES) for percutaneous coronary intervention have dramatically reduced the incidence of in-stent restenosis, their deployment for large-size coronary lesions is still controversial because of problems such as prolonged dual antiplatelet therapy, late in-stent thrombosis and costs. Aim: This study sought to evaluate the safety and effectiveness of drug-eluting stents (DES) compared to baremetal stents (BMS) for patients with large coronary vessels ≥ 3.5 mm. Methods: This is a retrospective case-control comparative study conducted in the cardiology A department of the university hospital Fattouma Bourguiba in Monastir. A total of 77 consecutive patients (80 lesions) who underwent, between October 2003 and March 2014, successfully DES implantation were compared to 73 consecutive patients (84 lesions) who were treated with BMS in large coronary vessels ≥ 3.5 mm. Results: The average age in our population was 59.7 ± 11.3 years with a male majority without any significant difference between the two groups. The DES group contained significantly more patients with diabetes (67.5% vs. 38.1%; p<0.0001) and a history of coronary heart disease (40% vs. 16.7%; p=0.001). The BMS group had significantly more procedures in the aftermath of MI (18.8% vs. 40.5%; p=0.002) including more primary angioplasty (6.7% against 47.1%; p=0.006). About two-thirds of the study patients had multi-vessel disease with equal distribution in both groups. The average duration of dual antiplatelet therapy was significantly prolonged in the DES group: 13.01 ± 8.31 months vs. 7.59 ± 8.19 months; p<0.0001. A mean follow of 27.87 ± 14.82 months was obtained. At 12 months, DES led to a significant reduction in the combined rate of major cardiac events by about 70% (OR=0.32; 95% CI: 0.119 to 0.858; p=0.019) without allowing a significant reduction in the rates of in-stent restenosis, in-stent thrombosis, target vessel revascularization or non-combined major cardiac events. During longterm follow-up, the benefit of DES in terms of MACE was maintained by allowing a 60% reduction in the combined rate of major cardiac events (OR=0.406; 95% CI: 0.172 to 0.955; p=0.035). Multivariate analysis identified the BMS as an independent predictor of major cardiac events and death. However, the type of stent does not appear as a factor influencing the ISR and target lesion revascularization rates. Conclusion: The results of our study demonstrate a clear clinical benefit of drug-eluting stents during angioplasty of large coronary arteries in reducing major cardiac events and death without having any effect on in-stent restenosis, in-stent thrombosis nor target lesion revascularization.

Nine-year clinical outcomes of drug-eluting stents vs. bare metal stents for large coronary vessel lesions.

ObjectivesTo evaluate the very long-term safety and effectiveness of drug-eluting stents (DES) compared to bare-metal stents (BMS) for patients with large coronary vessels.MethodsFrom April 2004 to October 2006, 2407 consecutive patients undergoing de novo lesion percutaneous coronary intervention with reference vessel diameter greater than or equal to 3.5 mm at Fu Wai Hospital in Beijing, China, were prospectively enrolled into this study. We obtained 9-year clinical outcomes including death, myocardial infarction (MI), thrombosis, target lesion revascularization (TLR), target vessel revascularization (TVR), and major adverse cardiac events (MACE, the composite of death, MI, and TVR). We performed Cox's proportional-hazards models to assess relative risks of all the outcome measures after propensity match.ResultsAfter propensity scoring, 514 DES-treated patients were matched to 514 BMS-treated patients. The patients treated with BMS were associated with higher risk of TLR (HR: 2.55, 95%CI: 1.520–4.277, P = 0.0004) and TVR (HR: 1.889, 95%CI: 1.185–3.011, P = 0.0075), but the rates of death/MI and MACE were not statistically different. All Academic Research Consortium definition stent thrombosis at 9-year were comparable in the two groups.ConclusionsDuring long-term follow-up through nine years, use of DES in patients with large coronary arteries was still associated with significant reductions in the risks of TLR and TVR.

TCT-46 Coronary artery aneurysms: incididence, etiology, management and outcomes in a long-term follow up.

Coronary artery aneurysm (CAA) is defined as coronary dilatation which exceeds the normal adjacent segments or the diameter of the patient's largest coronary vessel by 1.5 times. The aim of this study was to evaluate the incidence, etiology, clinical features, management and long term outcomes of

0342 : Cardiac histo-physiological disorders by methionine nutritional overload

Methionine is the only endogenous precursor of homocysteine, sulfur-containing amino acid and well known as risk factor of cardiovascular disease, The aim of this study is to determinate the histological and biochemical modification in cardiac tissue, induced by methionine nutritional overload. Twenty adult male rabbits were randomly divided into control and experimental group fed for 3 month with standard or methionine- enriched diet (500 mg of L-Met D / kg / day), respectively. Gomori's argentic impregnation and Van Gieson staining were performed to observe pathologic changes of left heart ventricle. The levels of total protein, thiobarbituric acid reactive substances (TBARS), alanine aminotransferase (ALT) and aspartate transaminase (AST), alkaline phosphatase (ALP), lactate dehydrogenase (LDH) were measured, in plasma and cardiac tissue, by enzymatic methods. The results obtained, in our conditions, shows that Met supplementation increases the plasmatic TBARS in the first month (p<0.05) of the experimentation comparing to the control group, however, in the end of the experimentation (3 rd month) both plasmatic and cardiac TBARS shows no variation compared to control group. A plasmatic increase in both AST (32.13±3,5U /L vs 21.37±2.42 U /L) and peculiarly ALT (26.65±8 55 U /L vs 50.05±12.86 U /L); PAL activity increases gradually until the 3rd month. No significant variation is observed in LDH, transaminase and PAL in cardiac tissue. Cardiac histology reveals a reduction in the connective tissue content with the appearance of chronic local inflammation and apoptosis, structural abnormalities in large coronary vessels with Hyperplasia of smooth muscular cells. Methionine overload causes biochemical disorders and structural alterations in the heart tissue. The author hereby declares no conflict of interest

First-generation paclitaxel- vs. second-generation zotarolimus-eluting stents in small coronary arteries: the BASKET-SMALL Pilot Study.

IntroductionEvent rates after percutaneous coronary interventions (PCI) are higher in small than large coronary vessels but may vary between different drug-eluting stent (DES) types.AimTo assess the efficacy of two different DES in small vessel disease.Material and methodsPatients with small vessel PCI were randomised 1 : 1 to a first-generation paclitaxel- vs. a second-generation zotarolimus-eluting stent. The primary endpoint was a composite of cardiac death, non-fatal myocardial infarction, and target vessel revascularisation after 2 years.ResultsOverall, 191 patients were enrolled: 100 with a paclitaxel- and 91 with a zotarolimus-eluting stent. Baseline characteristics were similar in both groups. After 2 years, rates of the primary endpoint were numerically higher for zotarolimus- than paclitaxel-eluting stents (9.9% vs. 5.0%, hazard ratio 2.09, 95% confidence interval (CI) 0.7–6.2, p = 0.19), which was mainly driven by higher rates of target vessel revascularisation (6.6% vs. 2.0%, hazard ratio 3.39, 95% CI: 0.68–16.78, p = 0.14). Based on this, a total of 1,019 patients would be necessary to demonstrate at least non-inferiority between the DES used.ConclusionsIn this pilot study, paclitaxel-eluting stents had a favourable efficacy profile in small vessel disease, although the numbers were too small to draw final conclusions. Based on the prohibitively high sample size for a randomized controlled trial between DES, other treatment options should be considered.