Stent Implantation Research Articles

Development and Degradation Study of PLA-Based Medical Implant Markers for Magnetic Particle Imaging.

Magnetic particle imaging (MPI) is a promising imaging modality nearing clinical introduction. MPI's tracer-based principle allows for highly sensitive background-free imaging. Potential clinical applications include cardiovascular imaging and endovascular interventions. In principle, medical instruments are invisible in MPI due to the missing signal generation. Therefore, permanent marking technologies have been introduced. Additionally, temporary markers are of interest for follow-up examinations after stent implantation to prevent artifacts during postinterventional stent lumen quantification. Consequently, medical instrument markers for MPI, based on biodegradable polylactic acid (PLA) and superparamagnetic iron-oxide nanoparticles (SPIONs), are developed in this study. To investigate the markers, signal characteristics and degradation over time are studied for 28d in a water bath at 37°C. The samples are analyzed using a scale, micro-CT, microscopy, magnetic particle spectroscopy (MPS), MPI, and vibrating sample magnetometry (VSM). A continuous mass decrease is detected (≈90% after 28d), while MPS and MPI data show no loss of signal. VSM confirms that the markers' mass reduction can be accounted for the degradation of PLA, while the SPIONs hardly detach from the coating. The introduced marking technology, with its degradation characteristics and signal behavior, is the basis for a variety of anticipated medical application scenarios.

Clinical Outcomes of XEN45 Gel Stent Implantation (Ab Externo, Open Conjunctival Approach) versus Trabeculectomy: A Real-World Study

Purpose: To compare the clinical outcomes of XEN45 gel stent implantation surgery (<i>ab externo</i>, open conjunctiva) with those of trabeculectomy.Methods: We retrospectively reviewed electronic medical record of 57 patients (62 eyes) treated with XEN implantation surgery (<i>ab externo</i>, open conjunctival approach) between April 1, 2021, and July 31, 2023, by the same surgeon. Preoperative clinical data including intraocular pressure (IOP), the number of glaucoma medications, and visual acuity were collected from 1 day to 12 months postoperatively. These data were compared and analyzed with those of 67 patients (78 eyes) received trabeculectomy between February 1, 2017, and April 30, 2022, by the same surgeon. Statistical analyses were performed with <i>p</i> < 0.05 as significant.Results: Complete surgical success rate was 33.9% and 57.7% of the XEN and trabeculectomy groups, respectively (<i>p</i> = 0.005). The qualified success rate was 79.0% and 93.6%, respectively (<i>p</i> = 0.011). Postoperatively, the XEN group used more glaucoma medications than the trabeculectomy group (1.21 ± 1.05 vs. 0.69 ± 0.90, <i>p</i> = 0.003 at postoperative month 12). After postoperative month 1, the XEN group had a higher IOP (15.77 ± 5.07 mmHg vs. 13.17 ± 3.81 mmHg; at postoperative month 12, <i>p</i> = 0.001) and lower corneal astigmatism than the trabeculectomy group (1.32 ± 0.79 diopters vs. 1.88 ± 1.45 diopters, <i>p</i> = 0.020 at postoperative month 6). There was no significant difference in preoperative and postoperative best-corrected visual acuity (logMAR) between the groups at any of the follow-up period (favorable visual acuity subgroup; logMAR < 0.7). Postoperative complications were 0 cases of XEN group and 13 cases of trabeculectomy group (0% vs. 16.7%, <i>p</i> = 0.001). Also, XEN surgery (24 minutes 40 seconds ± 6 minutes 26 seconds) had a shorter operation time than the trabeculectomy (40 minutes 18 seconds ± 8 minutes 27 seconds, <i>p</i> < 0.001).Conclusions: Compared to trabeculectomy, XEN surgery (<i>ab externo</i>, open conjunctiva) showed relatively lower effectiveness (surgical success rate, IOP reduction). However, it demonstrated advantages as a minimally invasive glaucoma surgery, including a surgical success rate approaching about 80%, stability in inducing corneal astigmatism, fewer postoperative complications, and shorter operation times.

Riding a Vascular Time Train to Spatiotemporally Attenuate Thrombosis and Restenosis by Double Presentation of Therapeutic Gas and Biomacromolecules

ABSTRACTEndothelial injury is a common occurrence following stent implantation, often leading to complications such as restenosis and thrombosis. To address this issue, we have developed a multi‐functional stent coating that combines a dopamine‐copper (DA‐Cu) base with therapeutic biomolecule modification, including nitric oxide (NO) precursor L‐arginine, endothelial glycocalyx heparin, and endothelial cell (EC) catcher vascular endothelial growth factor (VEGF). In our stent coating, the incorporated Cu acts as a sustainable catalyst for converting endogenous NO donors into NO, and the immobilized arginine serves as a precursor for NO generation under the effect of endothelial nitric oxide synthase (eNOS). The presence of heparin endows the stent coating with anticoagulant ability and enhances eNOS activity, whilst rapid capture of EC by VEGF accelerates re‐endothelialization. After in vivo implantation, the antioxidant elements and produced NO alleviate the inflammatory response, establishing a favorable healing environment. The conjugated VEGF contributes to the formation of a new and intact endothelium on the stent surface to counteract inappropriate vascular cell behaviors. The long‐lasting NO flux inhibits smooth muscle cell (SMC) migration and prevents its excessive proliferation, reducing the risk of endothelial hyperplasia. This innovative coating enables the dual delivery of VEGF and NO to target procedural vascular repair phases: promoting rapid re‐endothelialization, effectively preventing thrombosis, and suppressing inflammation and restenosis. Ultimately, this innovative coating has the potential to improve therapeutic outcomes following stent implantation.

Lesion-specific coronary artery calcium score to predict stent underexpansion

BackgroundPrevious intracoronary imaging studies have shown that coronary artery calcium (CAC) is an independent risk factor of stent underexpansion; however, limited preintervention assessments of CAC have been performed using noninvasive methods. We aimed to determine the association between lesion-specific CAC score and stent underexpansion.MethodsIn this retrospective observational study, we included 416 lesions from 359 patients who underwent intravascular ultrasound (IVUS)-guided stent implantation. CAC of each lesion was quantified using the Agatston method derived from either nongated noncontrast chest CT (NCCT) or electrocardiogram-gated coronary CT angiography (CCTA). The primary endpoint was stent underexpansion defined as minimum stent area of <80% of the average reference lumen area.ResultsOverall, stent underexpansion occurred in 144 (34.6%) of 416 lesions. Lesion-specific CAC score was significantly negatively correlated with the stent expansion rate (in NCCT cohort, r = 0.8113, P < 0.05; in CCTA cohort, r = 0.8024, P < 0.05). The optimal cutoff values of lesion-specific CAC score to predict stent underexpansion were >200 in both NCCT (sensitivity, 91.4%; specificity, 66.8%) and CCTA (sensitivity, 84.6%; specificity, 64.3%) cohort, which were associated with 24.94-fold increased risk of stent underexpansion in NCCT cohort and 13.56-fold increased risk of stent underexpansion in CCTA cohort.ConclusionsIn this study, we found that lesion-specific CAC scores in both NCCT and CCTA cohorts were significantly independently associated with an increased risk of stent underexpansion, and the cutoff value to predict stent underexpansion was >200.

Serial Change and Clinical Impact of Irregular Protrusion in Lesions With Chronic Coronary Syndrome.

The changes over time and effects on long-term clinical outcomes beyond 1 year of irregular protrusion (IP) in chronic coronary syndrome (CCS) remains unclear. This study aimed to assess the time-dependent change and long-term clinical impact of IP in CCS lesions. This study was a post hoc analysis of COLLABORATION study, which was a multicenter, prospective, observational study conducted from July 2018 to February 2020, assessing 1- and 12-month serial vessel responses after stent implantation using OCT and coronary angioscopy. Time-dependent change in the presence of IP was evaluated using the serial OCT examinations. The cumulative 3-year incidence of TLR was compared between the lesions with and without IP, as well as between those with and without residual IP at 1 month. Among 107 lesions, IP was detected in post-OCT pullbacks in 38 (35.5%) lesions. Out of the 38 lesions, IP remained in 9 (23.7%) lesions at 1 month and existed in 2 (5.3%) lesions at 12 months. The cumulative 3-year incidence of TLR was significantly higher in IP group than in non-IP group (13.6% vs. 3.0%, p = 0.04). Similarly, it was significantly higher in lesions with residual IP at 1 month than those without (33.3% vs. 4.3%, p < 0.01). All residual IP at 1 month were composed of angioscopic yellow plaques and red thrombi. The presence of IP decreased over time, but approximately one-fourth of IP remained at 1 month. IP and residual IP at 1 month were important post-stent OCT findings leading to long-term TLR in patients with CCS.

The Role of IVUS in Coronary Complications.

Intravascular ultrasound (IVUS) is an essential tool in the diagnostic and therapeutic management of coronary artery disease. In daily practice, IVUS is particularly useful for plaque characterization, optimizing stent implantation, and identifying the cause of in-stent restenosis. In acute coronary syndromes, it helps to detect culprit lesions that are not clearly visible on angiography and plays a key role in the diagnostic algorithm for myocardial infarction with non-obstructive coronary arteries (MINOCA). Additionally, IVUS is frequently used in complex and calcified lesions to guide optimal plaque modification strategies and improve procedural and long term outcomes. Beyond these common applications, IVUS is crucial in managing coronary complications, such as coronary dissection, perforation, intramural hematoma, and side-branch occlusion. In these challenging cases, IVUS allows us to overcome some of the limitations of angiography. This review explores the role of IVUS in bail out situations, offering practical tips and techniques for navigating coronary complications and improving procedural success in a safer and more refined manner.

Diagnostic value of deep learning reconstruction-based subtraction CT-FFR in patients with calcified-related stenosis or stent implantation

Diagnostic value of deep learning reconstruction-based subtraction CT-FFR in patients with calcified-related stenosis or stent implantation

Transcatheter Stenting to Restore Cross-Sectional Area of Extracardiac Fontan Conduits.

Reduction in cross-sectional area (CSA) of extracardiac Fontan conduits (EFC) is a known complication of the Fontan operation. Relief of obstruction is crucial for optimal Fontan physiology. The aim of this study is to describe technical aspects and outcomes of EFC stenting and short-term follow-up. A retrospective study was performed of patients who underwent stent implantation in EFCs with reduced CSA from July 2011 to February 2024. The expected conduit CSA was calculated based on the implanted EFC diameter. The minimum CSA before and after stent implantation was calculated. The minimum EFC diameter and CSA were compared pre- and post-intervention. Data are presented as median [interquartile range]. Sixty-five patients with reduced EFC CSA underwent stent implantation (median age: 13.3 [12.5, 16.8] years, median weight: 49.5 [41.6, 65.4] kg). Forty-seven (72.3%) catheterizations were performed for routine surveillance. In the 63 patients with a known original EFC size, the median reduction in EFC CSA was 36.0 [29,46] %. The minimum CSA was significantly smaller than the expected CSA (157.2 [133.7, 180.1] mm2 vs. 254.5 [254.5, 254.5] mm2, p < 0.0001). Including all patients the minimum EFC diameter and CSA were 12.5 [11.6, 13.4] mm and 153.8 [133.7, 179.7] mm2, respectively. Following stent placement EFC diameter and CSA improved to 16.8 [16.2, 17.8] mm (p < 0.0001) and 234.8 [223.4, 269.2] mm2 (p < 0.0001), respectively. The EFC CSA was 96.8 [89.2, 108.4] % of the expected CSA based on the original EFC diameter. In 24 (36.9%) patients the EFC CSA following stent placement was greater than the expected CSA. There were nine complications in total, of which two were related to EFC stenting. Stent implantation can safely and effectively restore EFC CSA. In select cases, conduits can be expanded beyond the stated diameter.

Percutaneous permeabilisation with electrosurgery of intrahepatic inferior vena cava agenesis in a 12-year-old boy.

We describe a 12-year-old boy with agenesis of the intrahepatic segment of the inferior vena cava (a rare congenital anomaly) in whom an electrified coronary guidewire with electrocautery was used percutaneously to perforate and open the atretic segment, followed by stent implantation. This technique may be a safe and feasible option for paediatric patients, offering a therapeutic alternative for complex cardiac anatomies.

Three-Dimensional CT for Preprocedural Planning of PCI for Ostial Right Coronary Artery Lesions: A Randomized Controlled Pilot Trial.

Geographic stent-ostium mismatch is an important predictor of target lesion failure after percutaneous coronary intervention of an aorto-ostial right coronary artery lesion. Optimal visualization of the aorto-ostial plane is crucial for precise stent implantation at the level of the ostium. This study investigates whether preprocedural 3-dimensional computed tomography (3DCT), with determination of the optimal viewing angle, would allow for more precise stent implantation and reduce procedure time, contrast, and radiation dose. In this single-center, prospective, open-label, core-laboratory blinded trial, a total of 30 patients with an aorto-ostial right coronary artery lesion were randomly assigned to either percutaneous coronary intervention with a preprocedural 3DCT or angiography-guided percutaneous coronary intervention. The optimal working view angle was determined by 3DCT in the intervention group and by the operators' discretion in the control group. The primary end point was the percentage of patients without geographic mismatch, as determined by intravascular ultrasound. 3DCT-determined C-arm angles were heterogenous but, in general, more extreme left anterior oblique projections were used (P<0.0001). While stent implantation was in the optimal position in all patients randomized to the intervention group, geographic mismatch was present in 5 (33%) patients randomized to the control group (P=0.06). The mean amount of procedural contrast (P<0.0001), mean radiation (P=0.03), and median procedure time (P=0.03) were significantly lower in the intervention group. The 3DCT scan was able to predict the calcium arc (P<0.0001) and minimal lumen area by intravascular ultrasound (P=0.003). Preprocedural 3DCT planning for percutaneous coronary intervention of aorto-ostial right coronary artery lesions allows for optimal stent positioning while reducing procedure time, contrast, and radiation dose. URL: https://www.clinicaltrials.gov; Unique identifier: NCT05172323.

One-Year Real-World Outcomes of Ab-Externo Gel Stent Placement From the EXPAND Study.

In the real-world, retrospective, EXPAND study of consecutive adults with glaucoma, ab-externo gel stent implantation effectively lowered intraocular pressure (34%) and the medication burden (61%), with transient/self-resolving hypotony as the most frequent adverse event (28%). To assess effectiveness and safety of ab-externo gel stent (GS) implantation in glaucoma. Multicenter, real-world, retrospective study. Consecutive adults with glaucoma and ab-externo GS implantation (with/without phacoemulsification or open/closed conjunctiva) ≥12 months before study entry. Data were extracted between the baseline/preoperative and last follow-up visit or date of secondary surgical intervention (SSI). Primary effectiveness endpoint: proportion of primary eyes (first eye in bilaterally implanted patients) at Month 12 (M12) achieving ≥20% intraocular pressure (IOP) reduction from baseline without medication increase, clinical hypotony, vision loss to counting fingers, or SSI. Secondary effectiveness endpoints included complete success (IOP ≤18mmHg and ≥20% IOP reduction from medicated baseline without medication, clinical hypotony, or SSI); qualified success (same but without medication increase); and needling rate. Key safety endpoints (all eyes): intraoperative complications, postoperative adverse events (AEs), and SSIs. The safety population included 466 eyes; 80.7% received the GS alone and 85.0% were implanted with closed conjunctiva. At M12, 39.1% of all primary eyes (N=413) and 54.9% of primary eyes with IOP and medication data at baseline and M12 (N=213) achieved the primary endpoint. At M12 among all primary eyes, the complete success, qualified success, and needling rates were 33.5%, 56.5%, and 28.6%. Most eyes (97.9%) had no intraoperative complications. The most frequent postoperative AE was transient/self-resolving hypotony (IOP<6mmHg; 28.1%). Sixty-nine (14.8%) eyes required an SSI. Ab-externo GS placement effectively lowered IOP and the medication count without unexpected complications/AEs, expanding implantation options based on patients' needs and surgeons' preferences.

Parsimonious versus extensive bleeding score: can we simplify risk stratification after percutaneous coronary intervention and reduce bleeding events by de-escalation of the antiplatelet strategy?

Background and aimsDue to the multitude of risk factors outlined in the guidelines, personalised dual antiplatelet therapy (DAPT) guidance after percutaneous coronary intervention (PCI) is complex. A simplified method was...

Acute Kidney Injury Due to Ureter Compression Following Iliac Venous Stenting.

To report the occurrence of acute postrenal kidney failure caused by external ureteral obstruction after iliac venous stent placement. A 73-year-old male patient presented with a chronic swelling and feeling of heaviness of his right leg. The presence of venous thrombosis was excluded by duplex ultrasound (DUS). However, DUS revealed a high-grade non-thrombotic stenosis of the right external iliac vein which was confirmed by computed tomography venography. This stenosis was attributed to local scarring following prostatectomy, lymphadenectomy, and adjuvant radiation therapy for prostate cancer 7 years before. According to the clinical presentation, the patient underwent catheter-based revascularization by implantation of a dedicated venous stent in the external iliac vein. One day after this procedure, the patient experienced acute kidney failure, which was attributable to an incipient right-sided grade II hydronephrosis. Subsequent ureterorenoscopy demonstrated a stenotic lesion of the intermediate part of the ureter at the same level as the venous stent. Finally, ureteral stent placement resulted in the restoration of urinary drainage as well as resolution of acute kidney failure. This case report highlights the importance of considering nonvascular complications after venous stent placement and it stresses the importance of postprocedural clinical and laboratory surveillance and follow-up. In recent years the number of endovenous stent implantations has significantly increased. In patients with clinically relevant iliofemoral obstructions, endovenous stent placement potentially reduces related symptoms and improves quality of life. However, endovenous stent placement may have an impact on peri-vascular structures, such as the ureters. This case report highlights the awareness of potential nonvascular complications, which might be caused by iliofemoral stent implantation.

Effect of rapamycin-eluting stents on in-stent restenosis and early inflammatory response in coronary artery narrowing animal models

Objectiveit was to evaluate the efficacy and safety of rapamycin-eluting stents at different doses in the treatment of coronary artery narrowing in miniature pigs.Methodsa total of 20 miniature pigs were randomly assigned into four groups: S1 group (low-dose rapamycin-coated stent, 55 µg/mm2), S2 group (medium-dose rapamycin-coated stent, 120 µg/mm2), S3 group (high-dose rapamycin-coated stent, 415 µg/mm2), and D0 group (bare metal stent). The stent size was 3.0 mm × 18 mm, with an over-expansion ratio of 1.1. Each group consisted of five pigs. Stent implantation was followed by euthanasia and tissue collection after 1 month. Vascular measurements, inflammatory response scores, cardiovascular injury scores, endothelialization scores, liver and kidney function indices, and myocardial injury markers were compared among the groups.Resultsthe neointimal thickness in the S2 and S3 groups was significantly lower than that in the S1 and D0 groups (S1 group: 24.08 ± 3.95, S2 group: 1.86 ± 0.28, S3 group: 2.72 ± 0.74, D0 group: 22.85 ± 3.15, P < 0.05). The residual lumen area in the S2 and S3 groups was significantly larger than that in the S1 and D0 groups (S1 group: 2.73 ± 0.51, S2 group: 4.25 ± 0.78, S3 group: 3.91 ± 0.73, D0 group: 2.91 ± 0.44, P < 0.05). The neointimal area in the S2 and S3 groups was significantly smaller than that in the S1 and D0 groups (S1 group: 3.44 ± 0.84, S2 group: 1.78 ± 0.25, S3 group: 2.07 ± 0.41, D0 group: 3.43 ± 0.72, P < 0.05). The degree of lumen narrowing in the S2 and S3 groups was significantly lower than that in the S1 and D0 groups (S1 group: 44.25 ± 3.66%, S2 group: 14.19 ± 2.01%, S3 group: 15.29 ± 2.45%, D0 group: 21.79 ± 3.51%, P < 0.05). The inflammation scores of coronary artery walls in the S2 and S3 groups of miniature pigs were markedly lower than those in the S1 and D0 groups (P < 0.05). The cardiovascular injury scores (P = 0.072) and endothelialization scores (P = 0.085) differed slightly among the four groups (P > 0.05). Post-operative liver function indicators (alanine transaminase, aspartate transaminase), kidney function indicators (blood urea nitrogen, serum creatinine), and myocardial injury markers (creatine kinase, creatine kinase-MB) also showed neglectable differences among the four groups (P > 0.05).Conclusionmedium and high doses of rapamycin-eluting stents effectively inhibit neointimal hyperplasia and local vascular inflammatory response in miniature pigs without causing damage to liver and kidney functions or myocardial cells. These stents demonstrate high efficacy and safety. Rapamycin-coated coronary stents, as an effective treatment for coronary artery stenosis, may achieve further improvement in therapeutic efficacy through optimization of drug dosage and stent design.

Comparison of Vessel Responses Following Combined Sirolimus-Eluting and Endothelial Progenitor Cell Stent and Ultra-Thin Sirolimus-Eluting Stent Implantation by Serial Optical Coherence Tomography and Coronary Angioscopy: A Multicenter Observational Study.

A dual-therapy sirolimus-eluting and CD34+ antibody-coated Combo Stent (DTS) has been developed to enhance endothelization and capture endothelial progenitor cells; however, vessel responses following DTS implantation remain unclear. Therefore, we evaluated early- and mid-term intravascular characteristics of DTS using intravascular imaging modalities. This multicenter, prospective, observational study enrolled 88 patients (95 lesions) who underwent DTS (43 patients, 48 lesions) or sirolimus-eluting Orsiro stent (SES, 45 patients, 47 lesions) implantation. Serial optical coherence tomography (OCT) and coronary angioscopy (CAS) findings were compared between the groups at 1 and 12 months.The OCT findings were similar between the DTS and SES groups at 1 month, including the covered strut rate (84.21±9.50% versus 80.56±17.68%, P=0.27). CAS findings were also comparable despite a more severe yellow coloration observed in the DTS group (P=0.006). At 12 months, OCT findings revealed that the covered and adequate strut coverage (≥40 μm) rates were significantly higher (99.27±0.95% versus 95.46±5.56%, P<0.001 and 88.90±10.15% versus 72.96±16.48%, P<0.001) and neointimal thickness was significantly thicker (152.16±70.31 versus 84.39±29.80 μm, P<0.001) in DTS than in SES. The malapposed strut rate was significantly higher in SES than in DTS (0.04±0.18% versus 0.82±1.87%, P=0.018). CAS revealed that the yellow coloration (P=0.049) and subclinical intrastent thrombus (P=0.019) were less severe in DTS than in SES at 12 months. In conclusion, DTS provided better advantages regarding strut coverage and plaque stabilization compared to SES. However, given the observational nature of this study, further randomized controlled trials are needed to confirm these findings.

Impact of gratitude on posttraumatic growth in patients with coronary stent implantation: the mediating role of resilience and perceived social support

Impact of gratitude on posttraumatic growth in patients with coronary stent implantation: the mediating role of resilience and perceived social support

Endovascular therapy is effective in patients with post-thrombotic syndrome based on anatomical classification: a multi-center experience.

In this study, we aimed to retrospectively review patients with post-thrombotic syndrome (PTS) and investigate its long-term outcomes, and a novel classification were presented across multiple institutions. We retrospectively evaluated patients with PTS who underwent endovascular therapy at two institutions between January 2018 and September 2023. Baseline patient demographics, lesion characteristics, and in-hospital and follow-up outcomes were collected and analyzed retrospectively. 83 patients (86 limbs) patients suffered PTS received endovascular related surgery at the two institutions. The lesions were summarized into two categories: sufficient or insufficient inflow according to digital subtraction angiography(DSA). 77 limbs (89.53%) underwent successful endovascular treatment including 46 limbs receiving percutaneous transluminal angioplasty (PTA) and stent implantation ,and 31 limbs undergoing PTA without stent deployment was mainly contributed to insufficient inflow. The mean follow-up time was 23.44±16.91 months (range, 6-60 months) in stent implantation cohort. In-stent restenosis and an occlusive endograft edge were observed in two cases, respectively. No other stent-related complications, such as fractures or migration, were noted in any patient during the follow-up period. Endovascular technique was safe and effective for the treatment of PTS and showed promising long-term prognosis. The novel classification of PTS might be feasible for the strategy of endovascular treatment.

Percutaneous Revascularization of Thrombotic and Calcified Coronary Lesions

Percutaneous coronary intervention (PCI) for thrombotic and heavily calcified coronary artery lesions and occlusions is often hampered by difficulty in wiring the occlusions, restoring antegrade flow, and proceeding to successful stent implantation. Characterization of dynamic anatomical features such as thrombi and the calcium distribution is key to prevent periprocedural complications and long-term adverse events, which are mainly driven by stent underexpansion and malapposition and may prompt in-stent restenosis or stent thrombosis. Therefore, multimodal imaging is a critical step during PCI to better characterize these high-risk lesions and select those in which careful preparation with debulking devices is needed or to guide stent optimization with the aim of improving procedural and long-term clinical outcomes. Hence, obtaining a better understanding of the underlying cause of thrombus formation, imaging the calcium distribution, and thorough planning remain crucial steps in selecting the optimal revascularization strategy for an individual patient. In this review, we summarize current evidence about the prevalence, predictors, and clinical outcomes of “hard-rock” thrombotic lesions treated by PCI, focusing on the value of imaging and physiological assessments performed to guide interventions. Furthermore, we provide an overview of cutting-edge technologies with the aim of facilitating the use of such devices according to specific procedural features.

Relationship between stress hyperglycemia ratio and progression of non target coronary lesions: a retrospective cohort study

BackgroundStress hyperglycemia ratio is a novel indicator of acute coronary synthesis (ACS), which is closely related to the severity and complications of ACS and other cardiovascular diseases. However, its relationship with the progression of non target coronary lesions remains unclear. The purpose of this paper is to explore the relationship between stress hyperglycemia ratio and the progression of non target coronary lesions.MethodsThis study retrospectively enrolled patients diagnosed with acute coronary syndrome who underwent stent implantation and follow-up evaluations by coronary angiography at Zhongda Hospital between January 2019 and January 2024. Patients were classified into progression and non progression groups based on follow-up angiography findings. Logistic regression models, restricted cubic spline analysis, and machine learning algorithms (LightGBM, decision tree, and XGBoost) were utilized to analyse the relationship of stress hyperglycemia ratio and non target lesion progression.ResultsA total of 1,234 ACS patients were included; 29.1% experienced non target lesions progression. Logistic regression analysis showed that stress hyperglycemia ratio (SHR) was a risk factor for non target disease progression (P < 0.001), and after adjusting for other variables, SHR was still independently associated with non target disease progression (OR = 2.12, 95% CI: 1.30–3.44, p = 0.003). RCS analysis revealed a near-linear relationship between SHR and nontarget lesions progression (P = 0.14). With the increase of SHR, the risk of non target lesions progression continued to increase, and the risk was significant when the SHR was greater than 0.96, but tended to be stable when the SHR was greater than 1.36 (p = 0.0047). A hybrid model combining logistic regression and XGBoost yielded the best predictive performance, with an AUC of 0.78 (95% CI: 0.72–0.85), incorporating SHR, number and stenosis severity of non target lesions (NTLs), hypertension and high-density lipoprotein cholesterol (HDL-c). Subgroup analysis showed that elevated SHR was a stronger predictor of NTL progression in non-diabetic patients (OR = 3.76, p = 0.007) compared with diabetic patients (OR = 1.69, p = 0.083).ConclusionStress hyperglycemia ratio is closely related to the progression of non target lesions. This study provides a novel insight for optimizing the long-term management of non target lesions after PCI.

Huge pseudoaneurysm in severe calcified popliteal artery occlusion early after Supera stent implantation.

Huge pseudoaneurysm in severe calcified popliteal artery occlusion early after Supera stent implantation.