Stented Segment Research Articles

Pathological migrating intramural hematoma in stenting for carotid artery dissection: A ten-year consecutive cohort study

ObjectiveTo study the phenomenon, incidence and management of pathological migrating intramural hematoma in stenting for carotid artery dissection. MethodsWe consecutively enrolled CAD patients with stenting treatment over 10-year period, and retrospectively analyzed the pathological migrating intramural hematoma (PMIH) incidence of these CAD patients. Besides, we also explored the related factors with PMIH and provided an appropriate management strategy. ResultsA total of 67 CAD underwent stenting. PMIH occurred in 7 cases (10.4%). The median time from onset of symptoms to stenting was 5 days (3 to 11 days). There were 4 cases of PMIH in the proximal segment of stent and 3 cases of PMIH in the distal segment of stent. All the patients presented with new stenosis and no patient presented with dissecting aneurysm. Through proper management, none of the patients had occurred clinical complications. ConclusionPathological migrating intramural hematoma phenomenon exists in the stenting for carotid artery dissection, rescue angioplasty or stenting is needed for early treatment of moderate and severe stenosis due to migrating intramural hematoma on preventing further ischemic events.

Nitric oxide transport in carotid bifurcation after different stent interventions: a numerical study

Stent restenosis and late thrombosis compromise endovascular stent implantation clinical benefit, and the mechanism is unclear. Since nitric oxide (NO) plays a pivotal role in maintaining vascular homeostasis, we believe that stenting can affect NO concentration in the host artery, thereby contributing to postoperative adverse events. We numerically investigated NO concentration after stenting based on the patient-specific carotid to verify this hypothesis. The simulation revealed that stent implantation caused blood flow disturbance, a low wall shear stress, and a significant decrease in NO on the luminal surface, especially in the region of the stented segment. Moreover, severe damage to the artery wall or low blood flow, leading to a low NO generation rate, would induce relatively low NO level in the stented segment. Additionally, we demonstrated that NO distribution might be affected by the combination of stent struts and carotid bifurcation geometry, while the host arterial configuration might play a leading role in the distribution of NO concentration. In conclusion, the carotid artery had a relatively low NO concentration level near stent struts, especially at the severely injured artery, low blood flow, long stenting, and complex host artery which might lead to a genesis/development of adverse events after that intervention.

Impact of lower limb movements on iliac vein stenting in iliac vein compression syndrome patients: insights from computational modeling.

Purpose: Iliac vein stenting is the primary treatment for patients with iliac vein compression syndrome (IVCS). However, post-stent placement, patients often experience in-stent restenosis and thrombosis. Despite this, the role of lower limb movements in the functioning of stents and veins in IVCS patients remains unclear. This study aimed to address this knowledge gap by developing a computational model using medical imaging techniques to simulate IVCS after stent placement. Methods: This research used a patient-specific model to analyze the effects of lower extremity exercises on hemodynamics post-stent placement. We conducted a comprehensive analysis to evaluate the impact of specific lower limb movements, including hip flexion, ankle movement and pneumatic compression on the hemo-dynamic characteristics within the treated vein. The analysis assessed parameters such as wall shear stress (WSS), oscillatory shear index (OSI), and residence time (RRT). Results: The results demonstrated that hip flexion significantly disrupts blood flow dynamics at the iliac vein bifurcation after stenting. Bilateral and left hip flexion were associated with pronounced regions of low WSS and high OSI at the iliac-vena junction and the stent segment. Additionally, active ankle exercise (AAE) and intermittent pump compression (IPC) therapy were found to enhance the occurrence of low WSS regions along the venous wall, potentially reducing the risk of thrombosis post-stent placement. Consequently, both active joint movements (hip and ankle) and passive movements have the potential to influence the local blood flow environment within the iliac vein after stenting. Conclusions: The exploration of the impact of lower limb movements on hemodynamics provides valuable insights for mitigating adverse effects associated with lower limb movements post iliac-stenting. Bilateral and left hip flexions negatively impacted blood flow, increasing thrombosis risk. However, active ankle exercise and intermittent pump compression therapies effectively improve the patency.

A method for detecting ureteral stent encrustations in medical CT images based on Mask-RCNN and 3D morphological analysis.

To develop and validate a method for detecting ureteral stent encrustations in medical CT images based on Mask-RCNN and 3D morphological analysis. All 222 cases of ureteral stent data were obtained from the Fifth Affiliated Hospital of Sun Yat-sen University. Firstly, a neural network was used to detect the region of the ureteral stent, and the results of the coarse detection were completed and connected domain filtered based on the continuity of the ureteral stent in 3D space to obtain a 3D segmentation result. Secondly, the segmentation results were analyzed and detected based on the 3D morphology, and the centerline was obtained through thinning the 3D image, fitting and deriving the ureteral stent, and obtaining radial sections. Finally, the abnormal areas of the radial section were detected through polar coordinate transformation to detect the encrustation area of the ureteral stent. For the detection of ureteral stent encrustations in the ureter, the algorithm's confusion matrix achieved an accuracy of 79.6% in the validation of residual stones/ureteral stent encrustations at 186 locations. Ultimately, the algorithm was validated in 222 cases, achieving a ureteral stent segmentation accuracy of 94.4% and a positive and negative judgment accuracy of 87.3%. The average detection time per case was 12s. The proposed medical CT image ureteral stent wall stone detection method based on Mask-RCNN and 3D morphological analysis can effectively assist clinical doctors in diagnosing ureteral stent encrustations.

Virtual stenting and coregistration of instantaneous wave-free ratio to predict the physiological effect of percutaneous coronary intervention in patients with multilevel coronary artery disease

Aim. To evaluate the accuracy of virtual stenting in predicting the physiological effect of percutaneous coronary intervention (PCI) for multilevel coronary artery disease (CAD).Material and methods. In order to define PCI strategy, 34 patients with multilevel CAD underwent assessment of instantaneous wave-free ratio (iFR) with mapping. Using the virtual stenting, predicted iFR (priFR) was assessed. After stent implantation, the factual iFR (fiFR) was re-assessed. A discrepancy between the priFR and fiFR by 0,03 was considered the threshold level of a significant difference and "poor agreement" criterion between measurements.Results. Mean iFR before PCI was 0,77±0,11; after PCI, this indicator increased significantly and amounted to 0,94±0,04 (p<0,001). Comparison of the predicted and factual iFR revealed that the difference did not significantly depend on the value (rxy=-0,183; p=0,300), and mean difference between measurements was 0,013 (standard deviation, ±0,019), which indicates no systematic discrepancy and good comparability of the studied methods. In addition, correlation analysis of priFR and fiFR revealed a significant strong (Chaddock scale) direct relationship (r=0,854; p<0,001). Independent predictors of "poor agreement" were heart rate and systolic blood pressure before surgery. Discrepancy in decisions on the choice of stented lesions and the required number of stents based on coronary angiography (CAG) and MRI occurred in 21 patients (62%) and 16 patients (47%), respectively. After iFR measurement, there was a significant decrease in the mean length of affected segment (from 61,82±19,68 mm (CAG) and 49,15±19,19 mm (iFR)), which made it possible to significantly reduce the number of implanted stents from 1,91±0,57 (CAG) to 1,50±0,56 (p=0,001).Conclusion. Mapping the iFR and virtual stenting technology makes it possible to revise the classification of coronary lesions by length, which leads to a significant reduction in the number of implanted stents and the length of stented segment. High correlation between priFR and fiFR achieved in our study indicates the high accuracy of virtual stenting in predicting the physiological effect of stenting.

Effect of co-trimoxazole and N-acetylcysteine alone and in combination on bacterial adherence on ureteral stent surface

To assess the effect of co-trimoxazole and N-acetylcysteine (NAC), alone and in combination, on bacterial adherence to biofilm formed on ureteral stent surfaces. This prospective randomized study was conducted on 636 patients who underwent double J ureteral stent insertion after variable urological procedures. Patients were randomized into four groups: A (n = 165), no antibiotics or mucolytics during stent indwelling; B (n = 153), oral NAC (200 mg/day for children aged < 12 years old and 600 mg/day for adults) during stent indwelling; C (n = 162), oral co-trimoxazole (2 mg TMP/kg/day) during stent indwelling; and D (n = 156), both oral NAC and co-trimoxazole during stent indwelling. Two weeks following double J stent (JJ stent) insertion, urinalysis was performed on all patients and urine culture was done for all the patients at the day of double J stent removal. The stent was removed 2 weeks postoperatively, and a stent segment sized 3–5 cm from the bladder segment of the stent was sent for culture. Positive stent cultures were found in 63.6% (105/165), 43.1% (66/153), 37% (60/162), and 19.2% (30/156) patients of groups A, B, C, and D, respectively. E. coli was the organism most commonly isolated from the stent culture in all groups. The combination of co-trimoxazole and NAC was more effective in reducing bacterial adherence on ureteral stent surfaces than either alone.

Preprocedural physiological assessment of coronary disease patterns to predict haemodynamic outcomes post-PCI.

Even with intracoronary imaging-guided stent optimisation, suboptimal haemodynamic outcomes post-percutaneous coronary intervention (PCI) can be related to residual lesions in non-stented segments. Preprocedural assessment of pathophysiological coronary artery disease (CAD) patterns could help predict the physiological response to PCI. The aim of this study was to assess the relationship between preprocedural pathophysiological haemodynamic patterns and intracoronary imaging findings, as well as their association with physiological outcomes immediately post-PCI. Data from 206 patients with chronic coronary syndrome enrolled in the ASET-JAPAN study were analysed. Pathophysiological CAD patterns were characterised using Murray law-based quantitative flow ratio (μQFR)-derived indices acquired from pre-PCI angiograms. The diffuseness of CAD was defined by the pullback pressure gradient (PPG) index. Intracoronary imaging in stented segments after stent optimisation was also analysed. In the multivariable analysis, diffuse disease - defined by the pre-PCI μQFR-PPG index - was an independent factor for predicting a post-PCI μQFR <0.91 (per 0.1 decrease of PPG index, odds ratio 1.57, 95% confidence interval: 1.07-2.34; p=0.022), whereas the stent expansion index (EI) was not associated with a suboptimal post-PCI μQFR. Among vessels with an EI ≥80% and post-PCI μQFR <0.91, 84.0% of those vessels had a diffuse pattern preprocedure. There was no significant difference in EI between vessels with diffuse disease and those with focal disease. The average plaque burden in the stented segment was significantly larger in vessels with a preprocedural diffuse CAD pattern. A physiological diffuse pattern preprocedure was an independent factor in predicting unfavourable immediate haemodynamic outcomes post-PCI, even after stent optimisation using intracoronary imaging. Preprocedural assessment of CAD patterns could identify patients who are likely to exhibit superior immediate haemodynamic outcomes following PCI.

Comparison of endothelial shear stress between ultrathin strut bioresorbable polymer drug-eluting stent vs durable-polymer drug-eluting stent post-stent implantation: An optical coherence tomography substudy from BIOFLOW II

BackgroundRecent clinical data indicate a different performance of biodegradable polymer (BP)-drug eluting stent (DES) compared to durable polymer (DP)-DES. Whether this can be explained by a beneficial impact of BP-DES stent design on the local hemodynamic forces distribution remains unclear. ObjectivesTo compare endothelial shear stress (ESS) distribution after implantation of ultrathin (us) BP-DES and DP-DES and examine the association between ESS and neointimal thickness (NIT) distribution in the two devices at 9 months follow up. Methods and resultsWe retrospectively identified patients from the BIOFLOW II trial that had undergone OCT imaging. OCT data were utilized to reconstruct the surface of the stented segment at baseline and 9 months follow-up, simulate blood flow, and measure ESS and NIT in the stented segment. The patients were divided into 3 groups depending on whether DP-DES (N = 8, n = 56,160 sectors), BP-DES with a stent diameter of >3 mm (strut thickness of 80 μm, N = 6, n = 36,504 sectors), or BP-DES with a stent diameter of ≤3 mm (strut thickness of 60 μm, N = 8, n = 50,040 sectors) were used for treatment. The ESS, and NIT distribution and the association of these two variables were estimated and compared among the 3 groups. ResultsIn the DP-DES group mean NIT was 0.18 ± 0.17 mm and ESS 1.68 ± 1.66 Pa; for the BP-DES ≤3 mm group the NIT was 0.17 ± 0.11 mm and ESS 1.49 ± 1.24 Pa and for the BP-DES >3 mm group 0.20 ± 0.23 mm and 1.42 ± 1.24 Pa respectively (p < 0.001 for both NIT and ESS comparisons across groups). A negative correlation between NIT and baseline ESS was found, the correlation coefficient for all the stented segments was −0.33, p < 0.001. ConclusionIn this OCT sub-study of the BIOFLOW II trial, the NIT was statistically different between groups of patients treated with BP-DES and DP-DES. In addition, regions of low ESS were associated with increased NIT in all studied devices.

Long-term association of post stent fractional flow reserve with clinical events

Abstract Background Low fractional flow reserve (FFR) after percutaneous coronary intervention (PCI) is associated with procedural factors in the stented segment and residual disease in the non-stented segment. Even the prognostic value of post-PCI FFR has been reported, its long-term clinical relevance has not been thoroughly investigated. Purpose We sought to investigate the long-term prognostic value of post-PCI FFR and its relative significance on future events in stented and non-stented segments. Methods The International Post-PCI FFR extended registry (NCT04684043) followed the 2,200 patients who underwent PCI and measured post-PCI FFR between June 2011 and May 2018. The primary outcome was target vessel failure (TVF), a composite of cardiac death, target vessel myocardial infarction (TVMI), and target vessel revascularization (TVR) at 5 years. The secondary outcomes were a composite of cardiac death or TVMI at 5 years. Results The median value of post-PCI FFR of target vessels was 0.89 (IQR 0.84-0.93). The optimal cut-off value of post-PCI FFR for predicting TVF was 0.81, and that for predicting cardiac death or TVMI was 0.76, respectively. The cumulative incidence of TVF was significantly higher in the low post-PCI group (20.5%) than in the high post-PCI FFR group (10.3%) (adjusted hazard ratio [HR] 2.11, 95% confidence interval [CI] 1.56-2.86, p&amp;lt;0.001). The cumulative incidence of cardiac death or TVMI was also significantly higher in the low post-PCI FFR group (7.3%) than in the high post-PCI FFR group (3.2%) (adjusted HR 2.34, 95% CI 1.12-4.91, p=0.024). Landmark analysis at 2 years showed that the impact of post-PCI FFR on TVF was consistently found during the first 2 years (adjusted HR of low post-PCI FFR 2.22, 95% CI 1.54-3.21, p&amp;lt;0.001) and thereafter (adjusted HR of low post-PCI FFR 1.96, 95% CI 1.14-3.36, p&amp;lt;0.001). However, the impact of post-PCI FFR on cardiac death or TVMI was more significant after 2 years of follow-up (adjusted HR of low post-PCI FFR 2.01, 95% CI 0.66-6.11, p=0.217 for the first 2 years and adjusted HR of low-post PCI FFR 2.81, 95% CI 1.04-7.60, p=0.042). The cumulative incidence of TVR was 9.5% for 5 years, and 61.0% of TVRs occurred in the stented segment. However, the proportion of TVRs in the non-stented segment increased along with the decrease of post-PCI FFR (35.3% in post-PCI FFR more than 0.90, 34.1% in post-PCI FFR 0.81-0.90, 43.8% in post-PCI FFR 0.71-0.80, and 66.7% in post-PCI FFR 0.70 and less than 0.70, p-for trend&amp;lt;0.001). Conclusions The long-term outcome results of the Internation Post-PCI FFR Extended registry showed that the prognostic impact of post-PCI FFR on TVF was consistently found along with the follow-up. However, that of post-PCI FFR on cardiac death or TVMI was more prominent during the late period of follow-up. In addition, clinical event distribution was different according to post-PCI FFR values.

Vascular healing of Combo plus stents in patients with acute coronary syndrome

Abstract Background The Combo stent has an abluminal sirolimus-eluting coating composed of a biodegradable polymer to form a drug-eluting stent platform. Sirolimus release is completed in 30 days, and the biodegradable polymer disappears within 90 days. This dual therapy approach aims for neointimal suppression while retaining the endothelial progenitor cell–capturing prohealing benefits enabling rapid endothelialization. However, in patients with acute coronary syndrome (ACS), early vascular healing after COMBO stent implantation remains unknown. Purpose The aim of this study is to elucidate the early phase vascular responses in patients with ACS after COMBO stent implantation at 1 month and 6 months follow-up by using optical coherence tomography (OCT). Methods Twenty-eight patients who underwent primary percutaneous coronary intervention (PCI) for AMI with COMBO stent between March 2020 and July 2020 were examined. All patients received follow-up OCT at 1 and 6 months after primary PCI. For assessment of each strut, OCT images were analyzed at 1.0-mm intervals throughout the stented segment. The degree of strut coverage by OCT were measured both 1 month and 6 months. Results The neointimal thickness were 0.110 ± 0.036 mm at 1 months and 0.217 ±0.083 mm at 6 months (P&amp;lt; 0.001). The median rate of any covered struts was 40.2% at 1 month and 89.5% at 6 months (P&amp;lt; 0.001). The median rate of definite uncovered struts was 14.4% at 1 month and 0.7% at 6 months (P&amp;lt; 0.001). Major adverse cardiac events (MACE) were limited to two target vessel failure without target lesion revascularization. No definite or probable stent thrombosis was noted. Conclusions In patients with MI, the COMBO stent is associated with a high degree of neointimal strut coverage at 1 monthfs. Furthermore, almost complete vascular healing at 6 months is observed. These findings may have impact on the duration of dual anti-platelet therapy in patients with MI who underwent PCI using COMBO stent.

The effect of antibody-mediated PCSK9 inhibitor on bare-metal stent implantation outcome

Abstract Introduction Percutaneous coronary intervention (PCI) is the gold standard for the management of acute coronary syndrome, and has been benefited from advances in pharmacotherapy and device innovation. Nevertheless, in-stent restenosis and stent thrombosis remain serious complications following PCI procedure with stent implantation. Proprotein convertase subtilisin kexin type 9 (PCSK9) is an enzyme known for its role in plasma cholesterol homeostasis. Efficiently reducing plasma cholesterol, PCSK9 inhibition recently became a pivotal treatment strategy for hypercholesterolemia. However, the effect of PCSK9 inhibition on stent implantation outcomes remains uninvestigated. Methods Carotid artery bare-metal stent (BMS) implantation was performed on C57Bl/6 mice, which then a parallel assessment of various inflammatory mediators was performed. To inhibit PCSK9, alirocumab was administered weekly to antiplatelet-treated mice started before stent implantation. Six weeks after the stent implantation procedure, animals were harvested and histomorphometric analysis was performed on stented arteries. In vitro cell migration and cellular senescence were also assessed on alirocumab-treated primary human aortic endothelial (EC) and vascular smooth muscle cells (VSMC). Results Compared to sham intervention, stent implantation was associated with increased expression of several inflammatory mediators, including PCSK9. Interestingly, the increase in PCSK9 level was confirmed in the stented vascular tissue, but not in plasma (Fig 1A). Following alirocumab treatment, PCSK9 inhibition results in an increased intimal hyperplasia in the stented vascular segment of alirocumab-treated animals compared to controls (Fig 1B). In vitro, alirocumab promoted migration and inhibited the onset of senescence in primary human VSMC, while blunted the migration and increased the senescence of EC. Conclusion The results of this study demonstrated that antibody-based PCSK9 inhibition worsen bare-metal stent implantation outcome in mice. This observed effect is mediated, in part, by the differential effect on VSMC and EC senescence, thus promoting in-stent intimal hyperplasia while blunting vascular healing. The herein-reported data warrant additional investigations concerning the use of PCSK9 inhibitors in patients undergoing PCI with stent implantation.

Evaluation of the residual myocardial ischemia after PCI to long diffuse left anterior descending artery lesions: comparison of IVUS vs FFR

Abstract Background Up to 30% of coronary artery lesions continue to induce myocardial ischemia (FFR ≤ 0.8) despite angiographically successful PCI. This proportion is even larger after PCI to the left anterior descending (LAD) artery as it supplies blood to the largest myocardial territory and often has diffuse disease. Post PCI FFR is an important tool to risk stratify patients, as lower values are associated with a worse prognosis. Therefore, achieving a good functional PCI result after LAD treatment is crucial. PCI optimization tools such as intravascular ultrasound (IVUS) and FFR were both proven to be superior to angiography-guided PCI, however, there is a lack of studies comparing these two modalities head-to-head, especially in the long LAD lesions. Purpose To compare functional PCI result assessed with FFR measured immediately post PCI and at 9-12 months follow-up between IVUS optimization and FFR optimization strategies after percutaneous treatment of long LAD lesions. Methods This was a single center observational study, which enrolled 127 patients. 61 patients underwent PCI optimized with FFR (historical FFR optimization group) and for 66 patients PCI was optimized with IVUS. FFR measurement was performed using intravenous adenosine with a pullback before and after PCI for all patients. Post PCI FFR was recorded in both groups when the PCI result was considered to be final and no more optimization was performed afterwards. Patients also underwent invasive follow-up at 9-12 months post PCI with FFR measurement at the same location (Figure 1). A case example of IVUS optimization strategy is demonstrated in Figure 2. Results The average patients age (66.5 ± 9.5) and baseline clinical characteristics (males 70.1%, diabetes 20.5%, hypertension 92.1%, dyslipidemia 91.3%, smoking 23.0%, chronic kidney disease 21.3%) did not differ between IVUS and FFR optimization groups. IVUS strategy resulted in the longer stented segment compared to FFR group (62 [48-75] mm vs 52 [36-63] mm, p=0.03). The proportion of patients with optimal functional PCI result (FFR &amp;gt; 0.9) did not differ significantly between two groups (16.7% in IVUS group vs 15% in FFR group), however, there was a lower incidence of residual myocardial ischemia in the IVUS optimization group: 0% of patients with post-PCI FFR ≤ 0.8 in the IVUS group vs 13.3% in the FFR group (p=0.002). The trend for smaller ischemia prevalence in IVUS optimization strategy continued during follow-up: there were 4.5% of patients with target vessel related myocardial ischemia in IVUS group and 18.0% in FFR group (p=0.015). Conclusion(s) In the treatment of long LAD lesions IVUS PCI optimization strategy was associated with lower incidence of poor functional PCI result and smaller ischemia burden at follow-up compared to FFR optimization strategy. The implementation of intravascular imaging should be mandatory in the treatment of long diffuse coronary disease.Figure 1Figure 2

Predictors of residual lipid content detected by near-infrared spectroscopy after elective stenting in patients with chronic coronary syndrome

Abstract Backgrounds Residual lipid-rich plaque (LRP) in stented segments assessed by near-infrared spectroscopy (NIRS) immediately after percutaneous coronary intervention (PCI) is reportedly associated with target lesion failure. However, morphological determinants of residual LRP after elective PCI remains unknown. Purpose This single-center observational study aimed to explore morphological and procedural predictors of residual LRP after electing PCI. Methods We investigated 340 consecutive patients who underwent elective NIRS-intravascular ultrasound-guided PCI for de novo coronary lesions. Lesions requiring balloon dilatation or debulking before NIRS imaging, requiring ≥2 remote stent deployment in the vessel, being treated with drug-coated balloon, and having insufficient NIRS imaging were excluded. Maximum lipid core burden index in 4mm (maxLCBI4mm) in culprit segment both before and after PCI was assessed by NIRS. Residual LRP was defined as post-PCI maxLCBI4mm in stented lesions &amp;gt;200. Baseline clinical and morphological findings were compared between lesions with versus without residual LRP. Multivariable logistic regression analysis was performed to determine predictors of residual LRP. Results A total of 236 de novo lesions in 223 patients were included in the final dataset. After PCI, residual LRP was observed in 69 (29%) lesions. Patients with residual LRP tended to be older than those without residual LRP. Pre-PCI maxLCBI4mm in culprit lesions, plaque burden, and remodeling index were greater in lesions with residual LRP. Post-PCI minimum stent area and expansion index tended to be smaller in lesions with residual LRP. In a multivariable analysis, pre-PCI maxLCBI4mm (per 10, adjusted odds ratio [OR]:1.04; 95% confidence interval [CI]: 1.02 to 1.05; p&amp;lt;0.01) and stent expansion index (per 10%, adjusted OR: 0.80; 95%CI: 0.64 to 0.99; p=0.047) were independently predictive of residual LRP. Conclusions In patients undergoing elective PCI, greater pre-PCI maxLCBI4mm and smaller stent expansion were associated with post-PCI residual LRP.

Abstract 17285: Impact of Baseline Yellow Plaque Assessed by Coronary Angioscopy on 11-month Vascular Response After Stent Implantation

Background: In-stent yellow plaque (YP) evaluated by coronary angioscopy (CAS) 1 year after stent implantation is associated with the future adverse cardiac event. However, the impact of baseline YP on vascular response has not been fully investigated. Methods: This was a sub-analysis of the Collaboraiton-1 study (multicenter, retrospective, observational study). A total of 88 lesions from 80 patients with chronic coronary syndrome who underwent percutaneous coronary intervention with polymer-free biolimus A9-coated stent or durable-polymer everolimus-eluting stent implantation were analyzed. Optical coherence tomography (OCT) and CAS were serially performed immediately and 11 months after stent implantation. YP was defined as the stented segment with yellow or intensive yellow color assessed by CAS. Neoatherosclerosis was defined as a lipid or calcified neointima assessed by OCT. Neointimal coverage (NIC) over the stent was classified into 4 grades by CAS: grade 0, stent struts fully visible; grade 1, stent struts bulging into the lumen, although covered; grade 2, stent struts embedded in the neointima, but translucently visible; and grade 3, stent struts fully embedded and invisible. OCT and CAS findings at 11 months were compared between the lesions with baseline YP (YP group) and those without YP (Non-YP group). Results: Baseline YP was detected in 37 lesions (42%). OCT findings at 11 months showed that the incidence of neoatherosclerosis was significantly higher in YP than Non-YP groups (11% versus 0%, P=0.028) and mean neointimal thickness tended to be lower (104±43 μm versus 120±48 μm, P=0.098). CAS finding at 11 months demonstrated that dominant and minimum NIC grades were significantly lower (Figure) and maximum yellow color grade was significantly higher in YP than Non-YP groups. Conclusions: Baseline YP affected the incidence of neoatherosclerosis as well as poor neointimal coverage at 11 months after stent implantation.

Abstract 18897: Safety and Efficacy of Coronary Intravascular Lithotripsy for Percutaneous Coronary Intervention of Severely Calcified Left Main Stenosis

Introduction: Coronary Intravascular Lithotripsy has been shown to be a safe and effective modality for the modification of non-left main calcific stenosis. This study was done to evaluate the safety and efficacy of IVL during percutaneous coronary intervention (PCI) of severely calcified left main (LM) bifurcation disease. Methods: This was a prospective, single-arm observational study in which 22 patients with significant calcific LM bifurcation disease undergoing angioplasty were enrolled. Pre and Post-IVL Optical coherence tomography (OCT) was done in all patients as an imaging modality. The primary safety end-point was peri-procedure complications and freedom from major adverse cardiovascular events (MACE) defined as cardiac death, non-fatal MI, and target vessel revascularization at 30 days, and the primary efficacy endpoint was stent expansion of more than 80% in stratified stented segment. The secondary efficacy endpoint was mean stent area more than the accepted target value of 5.0 mm 2 , 6.3 mm 2 , and 8.2 mm 2 for the ostial LCX, ostial LAD, and distal LM, respectively. Results: 15 (68.2%) patients underwent LM bifurcation angioplasty using provisional strategy and 7(31.81%) using upfront two stent strategy (DKC 22.7% &amp; TAP 9.1%). A total of 55 Ca lesions were modified using one IVL per patient with a mean size of 3.38 ± 0.40mm. Stent expansion at LM was 95.64±5.89%, left anterior descending (LAD) was 87.20±6.81% and left circumflex (LCx) was 85.56±5.89%. The primary efficacy endpoint of more than 80% stent expansion was noticed in all LM segments (22/22), 18/20 (90%) LAD segments, and 9/9 LCX segments. The primary safety endpoints were met in 21 (95.45%) patients undergoing IVL-assisted distal LM bifurcation angioplasty. Target MSAs were achieved in all 22 (100%) of all IVL-treated segments, and stent apposition was achieved in 21 (95%) of all stented segments. No perforation (0%) or slow/no flow (0%) were observed, while minor 3 (13.6%) and major dissections 3 (13.6%) were seen. None of the major dissections were flow-limiting. Conclusions: IVL appears to be a safe and effective device for percutaneous coronary intervention of severely calcific LM disease with a high success rate.

Bifurcation stenting on the background of an aneurysm of the anterior descending artery

A case report of a combination of an aneurysm of the anterior descending artery in the area of the departure of the diagonal branch and two coronary-ventricular fistulas has been described. The patient was stented earlier (in 2019 – the anterior descending artery and diagonal branch and in 2020 – the circumflex artery) for stable angina pectoris. However, in 2022, she was admitted to the hospital with a diagnosis of “ST-segment elevation myocardial infarction” and a coronary angiography revealed thrombosis of both the aneurysm cavity of the anterior descending artery and previously stented segments of the anterior descending artery. As an emergency, the patient underwent provisional stenting with final kissing balloon dilation, as a result of which the lumens of the anterior descending artery and the diagonal branch were completely restored, and the aneurysm cavity was not contrasted due to its embolization by thrombotic masses.

Coronary computed tomography angiography analysis using artificial intelligence for stenosis quantification and stent segmentation: a multicenter study.

Accurate interpretation of coronary computed tomography angiography (CCTA) is a labor-intensive and expertise-driven endeavor, as inexperienced readers may inadvertently overestimate stenosis severity. Recent artificial intelligence (AI) advances in medical imaging present compelling prospects for auxiliary diagnostic tools in CCTA. This study aimed to externally validate an AI-assisted analysis system capable of rapidly evaluating stenosis severity, exploring its potential integration into routine clinical workflows. This multicenter study consisted of an internal and external cohort of patients who underwent CCTA scans between April 2017 and February 2023. CCTA scans were evaluated using Coronary Artery Disease Reporting and Data System (CAD-RADS) scores to determine stenosis severity, while ground-truth stents were manually annotated by expert readers. The InferRead CT Heart (version 1.6; Infervision Medical Technology Co., Ltd., Beijing, China), which incorporates AI-assisted coronary artery stenosis quantification and automatic stent segmentation, was employed for CCTA scan analysis. AI-based stenosis assessment performance was determined using sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV), while the AI-based stent segmentation overlap was assessed using the Dice similarity coefficient (DSC). For ≥50% stenosis diagnoses, the AI system attained per-patient sensitivity, specificity, PPV, and NPV surpassing 90.0% for the internal dataset; for the external dataset, the per-patient values were 88.0% [95% confidence interval (CI): 81.0-94.4%], 94.5% (95% CI: 90.7-97.6%), 90.0% (95% CI: 83.3-95.6%), and 93.4% (95% CI: 89.2-96.8%), respectively. For ≥70% stenosis diagnoses, the per-patient values on the internal dataset were 94.2% (95% CI: 89.2-98.1%), 95.8% (95% CI: 94.1-97.4%), 80.8% (95% CI: 73.5-87.7%), and 98.9% (95% CI: 97.9-99.6%), respectively; for the external dataset, the per-patient values were 91.9% (95% CI: 82.6-100.0%), 97.3% (95% CI: 94.9-99.1%), 85.0% (95% CI: 72.5-94.6%), and 98.6% (95% CI: 96.8-100.0%), respectively. Regarding CAD-RADS categorization, the Cohen kappa was 0.75 and 0.81 for the internal per-patient and per-vessel basis, respectively, and 0.72 and 0.76 for the external per-patient and per-vessel basis, respectively. The DSC for stent segmentation was 0.96±0.06. The AI-assisted analysis system for CCTA interpretation exhibited exceptional proficiency in stenosis quantification and stent segmentation, indicating that AI holds considerable potential in advancing CCTA postprocessing techniques.

Safety and efficacy of the Low-Profile Visualized Intraluminal Support stent in treating intracranial atherosclerotic stenosis

PurposeThe performance of the Low-Profile Visualized Intraluminal Support (LVIS) stent deployed following balloon angioplasty is unknown in treating intracranial atherosclerotic stenosis, and this study was to investigate the safety and efficacy of the LVIS stent in treating intracranial atherosclerotic stenosis in the middle cerebral artery M1 segment. MethodsThirty-five patients were enrolled with 35 atherosclerotic stenoses at the M1 segment. The stenosis was about 75% in 16 patients, 80% in 15, and 90% in the rest four. The LVIS stent was used to treat these patients. ResultsThe success rate of stenting was 97.1%. The stenting procedure was failed in one patient because of intraprocedural dissection of the stenotic (75%) segment, resulting in a 30-day periprocedural complication rate of 2.9% (1/35). Before stenting, the stenosis rate ranged 75%–90% (mean 78.9%±4.7%), and after stenting, the diameter of the stented segment was significantly (P<0.0001) increased to 1.5–3.4mm (mean 2.1±0.32mm) ranging 68.2%–100% (mean 94.0%±5.8%) of the normal arterial diameter, with the residual stenosis ranging 0–31.8% (median 4.8%, IQR 2.4%–7.3%). Follow-up was performed at 6–20 months (mean 8.5) after stenting. One patient (2.9%) had occlusion of the stented M1 segment with no symptoms, and two patients (5.7%) had slight asymptomatic instent stenosis (40%) at the M1 segment, with the instent restenosis and occlusion rate of 8.6% (3/35). ConclusionThe braided LVIS stent can be safely applied for treatment of intracranial atherosclerotic stenosis in the middle cerebral artery with good safety and efficacy immediately after stenting and at follow-up.

Intravascular Ultrasound vs. Fractional Flow Reserve for Percutaneous Coronary Intervention Optimization in Long Coronary Artery Lesions.

intravascular ultrasound (IVUS) and fractional flow reserve (FFR) have both been shown to be superior to angiography in optimizing percutaneous coronary intervention (PCI). However, there is still a lack of comparative studies between PCI optimization using physiology and intravascular imaging head-to-head. The aim of this study was to compare the effectiveness of FFR and IVUS PCI optimization strategies on the functional PCI result (assessed with FFR) immediately post-PCI and at 9-12 months after the treatment of long coronary lesions. This was a single-center study comparing post-PCI FFR between two different PCI optimization strategies (FFR and IVUS). The study included 154 patients who had hemodynamically significant long lesions, necessitating a stent length of 30 mm or more. The procedural outcomes were functional PCI result immediately post-PCI and at 9-12 months after treatment. Clinical outcomes included target vessel failure (TVF) and functional target vessel restenosis rate during follow-up. Baseline clinical characteristics and FFR (0.65 [0.55-0.71]) did not differ significantly between the two groups and the left anterior descending artery was treated in 82% of cases. The FFR optimization strategy resulted in a significantly shorter stented segment (49 mm vs. 63 mm, p = 0.001) compared to the IVUS optimization strategy. Although the rates of optimal functional PCI result (FFR > 0.9) did not significantly differ between the FFR and IVUS optimization strategies, a proportion of patients in the FFR group (12%) experienced poor post-PCI functional outcome with FFR values ≤ 0.8, which was not observed in the IVUS group. At the 9-12 month follow-up, 20% of patients in the FFR group had target-vessel-related myocardial ischemia, compared to 6% in the IVUS group. The rates of TVF and functional target vessel restenosis during follow-up were also numerically higher in the FFR optimization group. The use of FFR PCI optimization strategy in the treatment of long coronary artery lesions is associated with a higher incidence of poor functional PCI result and larger myocardial ischemia burden at follow-up compared to the IVUS optimization strategy. However, this discrepancy did not translate into a statistically significant difference in clinical outcomes. This study highlights the importance of using IVUS to optimize long lesions functional PCI outcomes.

Antibody-mediated PCSK9 neutralization worsens outcome after bare-metal stent implantation in mice

AimsDespite advances in pharmacotherapy and device innovation, in-stent restenosis (ISR) and stent thrombosis (ST) remain serious complications following percutaneous coronary intervention (PCI) procedure with stent implantation. Proprotein convertase subtilisin/kexin type 9 (PCSK9) is an enzyme involved in plasma cholesterol homeostasis and recently emerged as a therapeutic target for hypercholesterolemia. Antibody-based PCSK9 inhibition is increasingly used in different subsets of patients, including those undergoing PCI. However, whether PCSK9 inhibition affects outcome after stent implantation remains unknown. Methods and results12 to 14 weeks old C57Bl/6 mice underwent carotid artery bare-metal stent implantation. Compared to sham intervention, stent implantation was associated with increased expression of several inflammatory mediators, including PCSK9. The increase in PCSK9 protein expression was confirmed in the stented vascular tissue, but not in plasma. To inhibit PCSK9, alirocumab was administered weekly to mice before stent implantation. After 6 weeks, histological examination revealed increased intimal hyperplasia in the stented segment of alirocumab-treated animals compared to controls. In vitro, alirocumab promoted migration and inhibited the onset of senescence in primary human vascular smooth muscle cells (VSMC). Conversely, it blunted the migration and increased the senescence of endothelial cells (EC). ConclusionAntibody-based PCSK9 inhibition promotes in-stent intimal hyperplasia and blunts vascular healing by increasing VSMC migration, while reducing that of EC. This effect is likely mediated, at least in part, by a differential effect on VSMC and EC senescence. The herein-reported data warrant additional investigations concerning the use of PCSK9 inhibitors in patients undergoing PCI with stent implantation.