In-stent restenosis characteristics and repeat stenting underexpansion: insights from optical coherence tomography.
- 作者列表："Yin D","Mintz GS","Song L","Chen Z","Lee T","Kirtane AJ","Parikh MA","Moses JW","Fall KN","Jeremias A","Ali ZA","Shlofmitz RA","Maehara A","Collaborators.
AIMS:The aim of this study was to use optical coherence tomography (OCT) to predict newly implanted stent expansion for treatment of in-stent restenosis (ISR). METHODS AND RESULTS:With OCT guidance, 143 ISR lesions were treated with a new stent. Stent underexpansion was defined as minimum stent area (MSA) <4.5 mm2 and MSA/average of reference lumen area <70%. New stent underexpansion was found in 33 lesions (23%). These had a smaller old stent MSA (4.13 [3.32-4.62] versus 5.18 [4.01-6.38] mm2, p=0.001), and had a higher prevalence of multiple old stent layers (51.5% versus 10.9%, p<0.001) and neointimal or peri-stent calcium (69.7% versus 37.3%, p=0.001) compared to those without new stent underexpansion. Old stent underexpansion, multiple layers of old stent, maximum calcium angle >180°, and maximum calcium thickness >0.5 mm were independently associated with new stent underexpansion. Patients with new stent underexpansion had a higher prevalence of major adverse cardiac events (35.5% vs 14.3%, p=0.009), mainly driven by a higher rate of myocardial infarction and target vessel revascularisation at two years. CONCLUSIONS:When re-stenting an ISR lesion, old stent underexpansion, the amount of neointimal or peri-stent calcium, and multiple old stent strut layers are important determinants of new stent underexpansion which is then associated with adverse long-term outcomes.
目的: 本研究的目的是使用光学相干断层扫描 (OCT) 预测新植入的支架扩张治疗支架内再狭窄 (ISR)。 方法和结果: 在OCT引导下，143个ISR病灶用新的支架治疗。支架扩张不足定义为最小支架面积 (MSA) <4.5平方毫米和MSA/参考腔面积的平均值 <70%。33个病灶 (23%) 发现新的支架扩张不足。这些患者具有较小的旧支架MSA (4.13 [3.32-4.62] 对5.18 [4.01-6.38] mm2，p = 0.001)，并且具有较高的多个旧支架层 (51.5% 对10.9%，p<0.001) 和新生内膜或支架周围钙 (69.7% 对37.3%，p = 0.001) 相比那些没有新的支架欠扩张。旧支架扩张不足、多层旧支架、最大钙角> 180 ° 和最大钙厚度> 0.5毫米与新支架扩张不足独立相关。新支架扩张不足的患者主要不良心脏事件的发生率较高 (35.5% vs 14.3%，p = 0.009)，主要是由于两年时心肌梗死和靶血管再血管化的发生率较高。 结论: 当重新植入ISR病变支架时，旧支架扩张不足、新内膜或支架周围钙的量以及多个旧支架支撑层是新支架扩张不足的重要决定因素，这与不良的长期结果相关。
METHODS::We present the case of a 61-year-old woman with a large tumoral infiltration extending from the pelvis throughout the inferior vena cava inferior to the right atrium, protruding into the right ventricle and right ventricular outflow tract. She had been treated 10 years before for low-grade endometrial stromal sarcoma by hysterectomy and adnexectomy followed by hormone- and radio-therapy. Due to cancer recurrence, she underwent peritonectomy, appendectomy, and resection of terminal ileum.
METHODS:AIMS:Significant platelet activation after long stented coronary segments has been associated with periprocedural microvascular impairment and myonecrosis. In long lesions treated either with an everolimus-eluting bioresorbable vascular scaffold (BVS) or an everolimus-eluting stent (EES), we aimed to investigate (a) procedure-related microvascular impairment, and (b) the relationship of platelet activation with microvascular function and related myonecrosis. METHODS AND RESULTS:Patients (n=66) undergoing elective percutaneous coronary intervention (PCI) in long lesions were randomised 1:1 to either BVS or EES. The primary endpoint was the difference between groups in changes of pressure-derived corrected index of microvascular resistance (cIMR) after PCI. Periprocedural myonecrosis was assessed by high-sensitivity cardiac troponin T (hs-cTnT), platelet reactivity by high-sensitivity adenosine diphosphate (hs-ADP)-induced platelet reactivity with the Multiplate Analyzer. Post-dilatation was more frequent in the BVS group, with consequent longer procedure time. A significant difference was observed between the two groups in the primary endpoint of ΔcIMR (p=0.04). hs-ADP was not different between the groups at different time points. hs-cTnT significantly increased after PCI, without difference between the groups. CONCLUSIONS:In long lesions, BVS implantation is associated with significant acute reduction in IMR as compared with EES, with no significant interaction with platelet reactivity or periprocedural myonecrosis.
METHODS:BACKGROUND:Aortopulmonary window is an uncommon congenital heart disease, with untreated cases not surviving beyond childhood. However, very rarely it can present in adult patients with features of pulmonary hypertension. Clinically these patients cannot be differentiated from other more common conditions with left to right shunt. Transthoracic echocardiography if performed meticulously, can depict the defect in aortopulmonary septum. RESULTS:We report a case of large unrepaired aortopulmonary window in a 23 years old patient, diagnosed on transthoracic echocardiography.