Automatic characterization of neointimal tissue by intravascular optical coherence tomography

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Long-term outcomes after percutaneous revascularization of complex coronary bifurcation lesions using a dedicated self-expanding biolimus-eluting stent system

Background: To evaluate long-term clinical outcomes after treatment of complex bifurcation lesions with the AXXESS dedicated self-expanding biolimus A9-eluting bifurcation stent.Methods: Between 2004 and 2013, 123 patients with complex bifurcation lesions were treated in a single-center with the AXXESS stent in the proximal main vessel (MV) and additional drug-eluting stents in branches when required. Median follow-up was 5 years. Primary endpoint was the rate of major adverse cardiac events (MACE). Secondary endpoints included MACE components (cardiac death, non-periprocedural clinical myocardial infarction [MI], target lesion revascularization [TLR] and definite/probable stent thrombosis [ST]) as well as all-cause death, target vessel revascularization (TVR) and non-TVR.Results: During follow-up, 11 (8.9%) patients experienced a MACE, of whom 2 (1.6%) suffered cardiac death, 2 (1.6%) had a non-periprocedural clinical MI requiring TLR, and 7 (5.7%) underwent elective TLR. No definite/probable ST was observed. All-cause death occurred in 9 (7.3%) patients, TVR in 11 (8.9%) and non-TVR in 11 (8.9%). Patients treated for left main (LM) bifurcation lesions were more likely to experience MACE than non-LM bifurcation lesions (25% vs. 6.5%, p = 0.04).Conclusions: Percutaneous revascularization of complex bifurcation lesions with the AXXESS stent is safe and provides excellent long-term results, especially in non-LM lesions

Automatic 3D aortic annulus sizing by computed tomography in the planning of transcatheter aortic valve implantation

Background: Accurate imaging assessment of aortic annulus (AoA) dimension is paramount to decide on the correct transcatheter heart valve (THV) size for patients undergoing transcatheter aortic valve implantation (TAVI). We evaluated the feasibility and accuracy of a novel automatic framework for multi detector row computed tomography (MDCT)-based TAVI planning. Methods: Among 122 consecutive patients undergoing TAVI and retrospectively reviewed for this study, 104 patients with preoperative MDCT of sufficient quality were enrolled and analyzed with the proposed software. Fully automatic (FA) and semi-automatic (SA) AoA measurements were compared to manual measurements, with both automated and manual-based interobserver variability (IOV) being assessed. Finally, the effect of these measures on hypothetically selected THV size was evaluated against the implanted size, as well as with respect to manually-derived sizes. Results: FA analysis was feasible in 92.3% of the cases, increasing to 100% if using the SA approach. Automatically-extracted measurements showed excellent agreement with manually-derived ones, with small biases and narrow limits of agreement, and comparable to the interobserver agreement. The SA approach presented a statistically lower IOV than manual analysis, showing the potential to reduce interobserver sizing disagreements. Moreover, the automated approaches displayed close agreement with the implanted sizes, similar to the ones obtained by the experts. Conclusion: The proposed automatic framework provides an accurate and robust tool for AoA measurements and THV sizing in patients undergoing TAVI.FCT - Fundação para a Ciência e a Tecnologia, Portugal, and the European Social Found, European Union, through the Programa Operacional Capital Humano (POCH) in the scope of the PhD grants SFRH/BD/93443/2013 (S. Queirós) and SFRH/BD/95438/2013 (P. Morais), and the project ‘PersonalizedNOS (01-0145-FEDER-000013)’ co-funded by Programa Operacional Regional do Norte (QREN), through Fundo Europeu de Desenvolvimento Regional (FEDER)info:eu-repo/semantics/publishedVersio

Impact of ultra-thin struts on restenosis after chronic total occlusion recanalization: Insights from the randomized PRISON IV trial

The PRISON-IV trial showed inferior outcome in patients with chronic total occlusions (CTOs) treated with the ultrathin-struts (60\u2009\u3bcm for stent diameter 643\u2009mm, 81\u3bcm >3\u2009mm) hybrid-sirolimus eluting stents (SES) compared with everolimus eluting stents (EES, 81\u2009\u3bcm). The aim of this study is to investigate if the use of smaller stents ( 643\u2009mm) was responsible for the inferior outcome reported in the trial

"You're never making just one decision" : exploring the lived experiences of ambulance Emergency Operations Centre personnel

BACKGROUND: The aim of this study was to explore the experiences of ambulance dispatch personnel, identifying key stressors and their impact on staff well-being. METHODS: Qualitative methodology was used. Nine semistructured interviews were conducted with National Health Service (NHS) ambulance Emergency Operations Centre (EOC) dispatch personnel in the UK between July and August 2014. Participants were asked about their experiences of the role, stress experienced and current strategies they use to deal with stress. Transcripts were analysed using an inductive, bottom-up thematic analysis. RESULTS: Three key themes were identified: (1) 'How dispatch is perceived by others', (2) 'What dispatch really involves' and (3) 'Dealing with the stresses of dispatch'. All participants expressed pride in their work, but felt overloaded by the workload and undervalued by others. Several sources of additional stress, not directly related to the execution of their work, were identified, including the need to mentally unwind from work at the end of a shift. Participants were able to identify a number of ways in which they currently manage work-related stress, but they also suggested changes the organisation could put in place in order to reduce stress in the working environment. CONCLUSIONS: Building on existing theory on work stress and postwork recovery, it was concluded that EOC dispatch staff require greater support at work, including skills training to promote postshift recovery, in order to reduce the likelihood of sickness absence, and prevent work-related fatigue

New candidate genes to predict pregnancy outcome in single embryo transfer cycles when using cumulus cell gene expression

Objective: To relate the gene expression in cumulus cells surrounding an oocyte to the potential of the oocyte, as evaluated by the embryo morphology (days 3 and 5) and pregnancy obtained in single-embryo transfer cycles. Design: Retrospective analysis of individual human cumulus complexes using quantitative real-time polymerase chain reaction for 11 genes. Setting: University hospital IVF center. Patient(s): Thirty-three intracytoplasmic sperm injection patients, of which 16 were pregnant (4 biochemical and 12 live birth). Intervention(s): Gene expression analysis in human cumulus complexes collected individually at pickup, allowing a correlation with the outcome of the corresponding oocyte. Multiparametric models were built for embryo morphology parameters and pregnancy prediction to find the most predictive genes. Main Outcome Measure(s): Gene expression profile of 99 cumulus complexes for 11 genes. Result(s): For embryo morphology prediction, TRPM7, ITPKA, STC2, CYP11A1, and HSD3B1 were often retained as informative. Models for pregnancy-biochemical or live birth-complemented or not with patient and cycle characteristics, always retained EFNB2 and CAMK1D together with STC1 or STC2. Positive and negative predictive values of the live birth models were >85%. Conclusion(s): EFNB2 and CAMK1D are promising genes that could help to choose the embryo to transfer with the highest chance of a pregnancy. (Fertil Steril Ò 2012;98:432-9. Ó2012 by American Society for Reproductive Medicine.

Clinical and laboratory predictors for plaque erosion in patients with acute coronary syndromes

Background-—Plaque erosion is responsible for 25% to 40% of patients with acute coronary syndromes (ACS). Recent studies suggest that anti-thrombotic therapy without stenting may be an option for this subset of patients. Currently, however, an invasive procedure is required to make a diagnosis of plaque erosion. The aim of this study was to identify clinical or laboratory predictors of plaque erosion in patients with ACS to enable a diagnosis of erosion without additional invasive procedures. Methods and Results-—Patients with ACS who underwent optical coherence tomography imaging were selected from 11 institutions in 6 countries. The patients were classified into plaque rupture, plaque erosion, or calcified plaque, and predictors were identified using multivariable logistic modeling. Among 1241 patients with ACS, 477 (38.4%) patients were found to have plaque erosion. Plaque erosion was more frequent in non–ST-segment elevation-ACS than in ST-segment–elevation myocardial infarction (47.9% versus 29.8%, P=0.0002). Multivariable logistic regression models showed 5 independent parameters associated with plaque erosion: age 15.0 g/dL, and normal renal function. When all 5 parameters are present in a patient with non–ST-segment elevation-ACS, the probability of plaque erosion increased to 73.1%. Conclusions-—Clinical and laboratory parameters associatedwith plaque erosion are explored in this retrospective registry study. These parametersmay be useful to identify the subset ofACS patients with plaque erosion and guide themto conservativemanagement without invasive procedures. The results of this exploratory analysis need to be confirmed in large scale prospective clinical studiesDr. Jang has received an educational grant from Abbott Vascular and Medicure. Dr. Adriaenssens has received grants and consulting fees from Abbott Vascula

Assessment of vessel wall healing after percutaneous coronary intervention using optical coherence tomography

In the current research project, we studied with optical coherence tomography (OCT), in vivo and in humans, the healing response of the coronary vessel wall after percutaneous coronary intervention (PCI). Different intracoronary devices were studied in different patient and lesions subsets. In parallel, several novel and innovative research algorithms were developed by our imaging research group, which allowed automated assessment of OCT images in the core lab and offered the possibility to obtain high detail three dimensional reconstructions of the OCT images. We validated these algorithms versus manual assessment and versus histology in a rabbit iliac model and implemented 3D reconstruction of OCT images in our clinical practice in the cardiac catheterization laboratory.A substantial amount of the dataset of this project was acquired in the setting of two randomized clinical trials (the SEDUCE and the STACCATO study), conducted in our hospital. In the first trial, SEDUCE, we assessed the specific subset of patients that need repeated treatment with PCI for a problem of in-stent restenosis (renarrowing of a segment of the coronary artery that has been treated with a stent earlier). We compared two different treatment modalities, application of a drug-eluting stent (DES) vs. a drug-eluting balloon (DEB) and assessed healing of the coronary artery at follow-up with OCT. The results were indicative of an advantage in healing in the DEB group.In the second trial, STACCATO, we made a randomized comparison between drug-eluting stents with vs. without durable polymer in the treatment of coronary artery disease and again, assessed the healing of the vessel wall at long term follow-up with OCT. The results of our study could not support the many claims on improved healing with biodegradable polymer DES. To the contrary, significantly more uncovered struts at follow-up (a marker of delayed healing) were found in this treatment group. These observations are in agreement with the fact that these devices have failed to show superiority over the current generation of DES in larger trials with clinical endpoints. We formulate several hypotheses that could explain our observations.As an extension to this work, we also performed several comparative studies between OCT pullbacks acquired immediately after stent implantation and at long-term follow-up. Using the dedicated software that was developed and validated earlier by our research group, we were the first to be able to provide such a detailed frame by frame comparative analysis. In a first STACCATO substudy, we identified all regions of vessel injury in the baseline pullbacks and assessed the healing of the vessel wall at the same spot in the follow-up acquisitions. We were able to provide very detailed information on the healing course at these specific sites of acute vessel injury. In another substudy, we investigated all sites with signs of delayed healing in the follow-up images, and tried to define predictors of these events by detailed analysis of the corresponding sites in the baseline images.In a final chapter of the work, we illustrate the value of the detailed 3D OCT reconstruction software in the clinical setting in the catheterization laboratory, where in selected cases; it can be an indispensable tool for adequate diagnosis and guidance of percutaneous treatment.status: publishe

Direct oral anticoagulants for postoperative myocardial injury

status: publishe