Treatment Of Coronary Artery Lesions Research Articles

药物涂层球囊技术治疗冠脉病变研究进展

药物涂层球囊技术治疗冠脉病变研究进展

Surgical treatment of coronary artery lesions in children with Kawasaki disease.

This study aimed to explore the efficacy of different surgical treatment for coronary artery lesions (CALs) caused by Kawasaki disease (KD) in children. We retrospectively analyzed the records of children with KD who presented with CALs to our hospital between 2015 and 2022. The patients were aged 126 ± 44.3 months (range: 84-180 months), and their body weight was 37.1 ± 18.6 kg (range: 17-60 kg). All patients were diagnosed with KD and were treated with standard medications. The patients had CALs for an average of 78 months (range: 24-156 months). All children underwent surgical treatment. In addition, one patient underwent cardiac defibrillator implantation, two underwent coronary artery bypass grafting (CABG), and one underwent heart bypass transplantation. The internal thoracic artery was used as the source of the left anterior descending branch bridge tube. The no-touch technique was used to obtain the free right thigh great saphenous vein as the bridge tube of the right coronary artery. All four patients had good postoperative recovery and the cardiac ultrasonography showed improved cardiac function and smooth coronary artery blood flow. The preoperative left ventricular ejection fraction was 44 ± 23.4%, which was significantly improved to 61.4 ± 14.0% postoperatively (p > .05). The preoperative left ventricle size was 5.6 ± 1.6 cm, which was significantly improved to 4.0 ± 0.6 cm postoperatively (p > .05). The two patients who underwent CABG received oral aspirin (5 mg/kg) and clopidogrel (1 mg/kg) antiplatelet therapy. The patients received oral tacrolimus antirejection drugs after the heart transplantation. The postoperative cardiac function was above grade II, and there were no symptoms of cardiac insufficiency, such as syncope, chest tightness, and orthopnea. Patients with CALs due to KD should be treated in a timely manner. The selection of an appropriate surgical treatment leads to prolonged survival and improved quality of life of patients.

TCTAP A-043 Long-Term Safety and Efficacy Outcomes After Treatment of Coronary Artery Lesions Using Sirolimus Coated Balloons: Insights From Real-World All-Comer Patients

TCTAP A-043 Long-Term Safety and Efficacy Outcomes After Treatment of Coronary Artery Lesions Using Sirolimus Coated Balloons: Insights From Real-World All-Comer Patients

Impact of Early Treatment With High-Dose Intravenous Immunoglobulin on Incidence of Kawasaki Disease Complications in Iranian Children.

Objective: Kawasaki disease (KD) occurs in five-year-old or younger children. This study aimed to evaluate the impact of high-dose intravenous immunoglobulin plus acetylsalicylic acid therapy on the prevention and treatment of coronary artery lesions and to evaluate the impact of high-dose acetylsalicylic acid (ASA) on the hearing of the patients. Materials and methods: In this retrospective cohort study, 31 patients with KD were followed from January 2012 to December 2015. The clinical, para-clinical, color Doppler echocardiogram and audiometry results were evaluated. Results: Overall, seven cases (22.6%) developed coronary artery aneurysm (CAA) in the acute phase of the disease, of whom only two still had CAA at the end of the treatment (6%). One of the five children with CAA recovery had a delay in the onset of treatment and one of two patients with persistent CAA at the end of treatment was admitted within the first 10 days. There was no evidence-based abnormal liver biochemical test. None of the patients developed sensorineural hearing loss (SNHL) on audiometry tests conducted before and after treatment. Conclusion: Recovery of coronary artery lesions was 71.43% after 28 days of the onset of treatment. The distribution of coronary artery aneurysm was not different in terms of the time of the treatment initiation (P-Value = 0.371). None of the children had a sensorineural hearing loss (SNHL) 48 hours and 4 weeks after treatment.

TCT-447 Three-Year Follow-Up After Treatment of Coronary Artery Lesions Using Sirolimus-Coated Balloons: Insights From Real-World All-Comer Patients

TCT-447 Three-Year Follow-Up After Treatment of Coronary Artery Lesions Using Sirolimus-Coated Balloons: Insights From Real-World All-Comer Patients

Evaluation of Effectiveness and Safety of Everolimus Eluting Stent System (XIENCE V) in the Treatment of Coronary Artery Lesions

Evaluation of Effectiveness and Safety of Everolimus Eluting Stent System (XIENCE V) in the Treatment of Coronary Artery Lesions

Evaluation of Effectiveness and Safety of Everolimus Eluting Stent System (Xience V) in the Treatment of Coronary Artery Lesions

Evaluation of Effectiveness and Safety of Everolimus Eluting Stent System (Xience V) in the Treatment of Coronary Artery Lesions

SICI-GISE Position paper on the use of the magnesium bioresorbable scaffold Magmaris in clinical practice

Bioresorbable scaffolds have emerged as a potential breakthrough for the treatment of coronary artery lesions. The need for drug release and plaque scaffolding is temporary, and leaving a permanent stent once the process of plaque recoil and vessel healing has ended might be superfluous or even deleterious exposing the patient to the risk of very late thrombosis, eliminating vessel reactivity, impairing non-invasive imaging and precluding possible future surgical revascularization. This long-term potential limitation of permanent bare metal stents might be overcome by using a resorbable scaffold. The metallic and antithrombotic properties makes the resorbable magnesium scaffold an appealing technology for the treatment of coronary artery lesions. Notwithstanding this, its mechanical properties substantially differ from those of conventional bare metal stents, and previous experience using polymer-based scaffolds has shown that a standardized implantation technique and optimal patient and lesion selection are key factors for a successful implantation. A panel of expert cardiologists gathered to find a consensus on the best practices for Magmaris implantation in a selected patient population and to discuss the rationale for new potential future indications.

CRT-100.90 2-Years Follow-Up After Treatment of Coronary Artery Lesions Using Sirolimus-Coated Balloons: Insights From Real-World All-Comer Patients

We investigated the performance of MagicTouch sirolimus-coated balloon (SCB) (Concept Medical), on the immediate performance and the long-term clinical outcome, including target lesion revascularization (TLR) and major adverse cardiac event (MACE), in patients with a broad spectrum of coronary

Risk factors of intravenous immunoglobulin resistance and coronary arterial lesions in Turkish children with Kawasaki disease.

Kawasaki disease (KD) is the most common cause of childhood coronary artery disease. The incidence of coronary artery lesions (CALs) has declined with the routine use of intravenous immunoglobulin (IVIG) treatment, but there is still considerable risk for resistance to IVIG treatment and development of CALs. The present study was aimed to determine the risk factors in Turkish children with IVIG resistant KD and coronary artery involvement. Clinical, laboratory and echocardiographic data were retrospectively analyzed in 94 Kawasaki patients. IVIG resistant and responsive groups were compared. The IVIG resistant group had a higher rate of CALs compared to the IVIG responsive group (p < 0.05). Duration of fever ≥ 9.5 days, C-reactive protein (CRP) ≥ 88 mg/L and Neutrophil/lymphocyte ratio (NLR) ≥1.69 were the best cutoff values for predicting IVIG resistance before treatment. The criteria for at least two of these three predictors were considered to be statistically significant risk factors for detecting IVIG resistance in KD before treatment (76.47% sensitivity, 71.05% specificity and 95% CI were 50.1-93.19% and 59.51-80.89%, respectively). Based on the clinical and laboratory features, we established a new risk-scoring system for predicting IVIG resistance in a cohort of Turkish children with KD. This may be useful for choosing optimal treatment for KD to prevent coronary artery involvement.

Drug-coated Balloon Versus Drug-eluting Stent in the Treatment of Coronary Artery Lesions in STEMI Patients in De Novo Coronary Lesions

Drug-coated Balloon Versus Drug-eluting Stent in the Treatment of Coronary Artery Lesions in STEMI Patients in De Novo Coronary Lesions

Bioresorbable Scaffold for Treatment of Coronary Artery Lesions: Intravascular Ultrasound Results From the ABSORB Japan Trial

ObjectivesThe aim of this study was to characterize post-procedural intravascular ultrasound (IVUS) findings in the ABSORB Japan trial, specifically stratified by the size of target coronary arteries. BackgroundDespite overall noninferiority confirmed in recent randomized trials comparing bioresorbable vascular scaffolds (BVS) (Absorb BVS) and cobalt-chromium everolimus-eluting metallic stents (CoCr-EES), higher event rates of Absorb BVS have been reported with suboptimal deployment, especially in small coronary arteries. MethodsIn the ABSORB Japan trial, 150 patients (2:1 randomization) were scheduled in the IVUS cohort. Small vessel was defined as mean reference lumen diameter <2.75 mm. Tapered-vessel lesions were defined as tapering index (proximal/distal reference lumen diameter) ≥1.2. ResultsOverall, IVUS revealed that the Absorb BVS arm had smaller device expansion than the CoCr-EES arm did, which was particularly prominent in small- and tapered-vessel lesions. Higher tapering index was also associated with higher rates of incomplete strut apposition in Absorb BVS, but not in CoCr-EES. With respect to procedural techniques, small-vessel lesions were treated more frequently with noncompliant balloons at post-dilatation but using significantly lower pressure in the Absorb BVS arm. In contrast, tapered-vessel lesions were post-dilated at equivalent pressure but with significantly smaller balloon catheters in the Absorb BVS arm, compared with the CoCr-EES arm. ConclusionsThe significantly smaller device expansion especially in small vessels may account for the poorer outcomes of Absorb BVS in this lesion type. Appropriate optimization strategy, possibly different between polymeric and metallic devices, needs to be established for bioresorbable scaffold technology. (AVJ-301 Clinical Trial: A Clinical Evaluation of AVJ-301 Absorb™ BVS) in Japanese Population [ABSORB JAPAN]; NCT01844284)

CRT-100.79 Impact on Clinical Decision-making Process of Two Formulas to Calculate Diameter Stenosis of Coronary Lesions: From Benchmark to Real Cases

The 2016 American guidelines for percutaneous revascularization recommend treatment of coronary artery lesions based on diameter stenosis (DS). However, due to the high inter-operator variability in the visual assessment of DS, quantitative coronary analysis (QCA) is the gold standard to assess it.

TCT-436 Multi-Center, Post-marketing Evaluation of the Elixir DESolve® Novolimus Eluting Bioresorbable Coronary Stent System: 6-month Results from the DESolve PMCF Study

Bioresorbable scaffolds are an equivalent alternative to metallic drug-eluting stents for the treatment of coronary artery lesions, but experience with other than Everolimus-eluting PLLA-based scaffolds is limited. A post marketing clinical follow-up study was conducted evaluating the continued

Subacute thrombosis after primary percutaneous coronary intervention with bioresorbable vascular scaffold implantation

Everolimus-eluting bioresorbable vascular scaffold (BVS) is a promising new technology recently applied in the treatment of coronary artery lesions that might overcome the limitations of the currently used drug eluting stents. There were no scaffold thromboses reported in the first-in-human trials with BVS implantation. However, the current body of evidence on its safety and incidence of early thrombotic complications in the setting of acute coronary syndromes is still limited. We present the case of a 58-year-old male who was admitted to a coronary care unit due to typical (two-hour long) chest pain with electrocardiographic signs of anterior wall ST segment-elevation myocardial infarction. Coronary angiography revealed critical stenosis of the proximal left anterior descending artery (Fig. 1A). Subsequent primary angioplasty with manual aspiration thrombectomy, balloon predilatation, and implantation of BVS (ABSORB, 3.5/28 mm, 12 atm.) was performed, with good angiographic result (TIMI 3 flow) (Fig. 1B). Optical coherence tomography (OCT) confirmed good scaffold expansion and complete strut apposition (Fig. 1C–F). Further in-hospital course was uneventful and the patient was discharged after five days of hospitalisation. On the ninth day after BVS implantation he presented again with acute severe chest pain and anterior ST-segment elevation in electrocardiogram. The patient confirmed that he discontinued both antiplatelet drugs (aspirin and clopidogrel) after discharge. Repeat coronary angiography revealed a subacute scaffold thrombosis (Fig. 2A). Manual aspiration thrombectomy, abciximab infusion, and plain old balloon angioplasty was performed (Fig. 2B), with good final angiographic result (TIMI 3) (Fig. 2C). Echocardiography revealed an impaired left ventricular ejection fraction of 38%, compared to 50% directly after the primary index procedure. As there was appropriate scaffold expansion and strut apposition in OCT directly after the index procedure, the most likely cause of scaffold thrombosis was the cessation of antiplatelet therapy. Figure 2. A. Occlusion of the proximal left anterior descending artery in the place of bioresorbable vascular scaffold implantation (arrow); B. Plain old balloon angioplasty performed in the occluded left anterior descending artery; C. Good final angiographic result of the treatment of scaffold thrombosis (TIMI 3) Figure 1. A. Coronary angiography revealing critical stenosis of the proximal left anterior descending artery (arrow); B. Good angiographic result of primary angioplasty with bioresorbable vascular scaffold implantation (TIMI 3); C–F. Good scaffold expansion and complete strut apposition in optical coherence tomography A

OP-069 Evaluation of Effectiveness and Safety of Everolimus Eluting Stent System (XIENCE V) in the Treatment of Coronary Artery Lesions

OP-069 Evaluation of Effectiveness and Safety of Everolimus Eluting Stent System (XIENCE V) in the Treatment of Coronary Artery Lesions

Biodegradable polymer Biolimus-eluting stent (Nobori&amp;reg;) for the treatment of coronary artery lesions: review of concept and clinical results

First-generation drug-eluting stents have raised concerns regarding the risk of late and very late stent thrombosis compared with bare metal stents and require prolonged dual antiplatelet therapy. Despite extensive investigations, the physiopathology of these late events remains incompletely understood. Aside from patient- and lesion-related risk factors, stent polymer has been cited as one of the potential causes. In fact, the persistence of durable polymer after complete drug release has been shown to be responsible for local hypersensitivity and inflammatory reactions. Third-generation drug-eluting stents with more biocompatible or biodegradable polymers have subsequently been developed to address this problem. In this article, we evaluate and discuss the concept and clinical results (safety and efficacy) of a third-generation drug-eluting stent with biodegradable polymer: the Nobori® stent.

CRT-601 “Powerful” Bioresorbable Scaffolds Have Comparable Radial Strengths - Truth or Legend?

Bioresorbable vascular scaffolds (BVS) are a novel innovation in treatment of coronary artery lesions. Initial angiographic procedure results seem to be satisfying, but data concerning optimal scaffold expansion and its radial force are rare, so our aim was to assess intravascular conformability as

Percutaneous Coronary Interventional Treatment for Coronary Artery Disease and the Role of Antiplaplatelets Therapy: A Review of the Literature

Uses of balloon catheters or BMS for the treatment of coronary artery lesions shows good short-term results but long-term follow up revealed restenosis in up to 20%-30% of patients. Thus new improvements to balloons and stents are always necessary to achieve the best results from percutaneous coronary intervention (PCI). Drug-eluting stents (DES) improved the principles of bare metal stents (BMS) by local drug release to inhibit neointimal growth. DES reduced the incidence of in-stent restenosis. These benefits and lower costs compared to surgical treatment make the DES an attractive alternative for the treatment of coronary artery disease. Different components of DES which include the polymers, drugs and the stents underwent progressive evolution, and these led to development of new generations of DES with variable types of drugs and polymers to fully absorbable stents. The concern of stent thrombosis still an issue and dual antiplatlets therapy (DAPT) is mandatory for variable time ranging from one month to one year. This article discusses the main available clinical trials in the developments of BMS, DES and the comparison between both with a prospective look at future technologies in the field, in addition to reviewing the current guideline in the uses of DAPT after PCI.

Drug-eluting Stents: Will the transformation to bioabsorption make durable polymers obsolete?

It's been over a decade since drug-eluting stents (DES) were introduced into the clinical practice of percutaneous coronary intervention for the treatment of coronary artery lesions. With significant reductions in restenosis rates and the need for repeat revascularizations, the technology was disseminated globally at an unprecedented rate [1]. Soon after, reports of early and late stent thrombosis curbed the enthusiasm and mandated selective DES uses and prolonged dual antiplatelet therapy (DAPT) for at least 12months [2]. This strategy significantly reduced stent thrombosis rates, albeit at the price of bleeding, which has often led to premature DAPT discontinuation [3]. Additionally, first-generation DES, Cypher and Taxus, reported a stent thrombosis increasing hazard of 0.6 per year up to 5 years and even higher rates of target lesion failure [4]. Firstgeneration DES were then replaced with second-generation DES that utilize a thinner cobalt chromium or platinum chromium alloy, sirolimus analogue drugs, such as everolimus and zotarolimus, and a thinner and more biocompatible polymer layer. Despite these iterations, the requirement for prolonged DAPT did not change. At the same time, the hazard ratios for stent thrombosis and target vessel failure were attenuated, but not eliminated, especially in the more complex patient and lesion subsets [5,6]. The question remains, “What factors contribute to the development of the late events seen in second-generation DES?” Is it the metal? The polymer? Or is it the drug? For BMS, target vessel failure occurs within the first 6–12 months, and events beyond that are rare. With second-generation DES, the drug is gone within the first 6 months and complete healing is usually attained at 12 months. This suggests that the culprit for these late events (N12 months) is most likely the polymer, which continues to irritate the vessel wall causing low grade inflammation and subsequently neoatherosclerosis. The polymers used in first-generation DES were associated with a high degree of inflammation, which often resulted in vessel wall toxicity, target lesion failure, and late stent thrombosis. Nevertheless, the polymers used in the second-generation DES, such as BioLinx and fluoropolymer, are proven to be more biocompatible. More specifically, the fluoropolymer used in Xience V (Abbott Vascular) and Promus Element stents (Boston Scientific) have further claimed to have antithrombotic properties and protection from stent thrombosis when compared to BMS [7]. However, the data to support this claim are rather weak and did not result in a change in the recommended duration of DAPT for such stents. Further, in the Prospective, Randomized, Multicenter Trial to Assess