Value of intracoronary Doppler for guiding percutaneous interventions

Following the rapid developments in computer software directed towards the anatomical assessment of coronary arteries by quantitative coronary angiography (QCA), interventional cardiologist felt that the anatomical information obtained was sufficient for clinical decision-making. However, further down the line, it became clear that QCA presented some limitations especially in patients with diffuse coronary artery atherosclerosis. In addition, the presence of haziness at the dilated area precluded an accurate estimate of the acute angioplasty results. The latter was further supporter by a lack of correlation observed between the QCA and coronar

Improved regional wall motion 6 months after direct myocardial revascularization (DMR) with the NOGA DMR system

A60-year-old man was referred to our intervention laboratory for direct myocardial revascularization (DMR). He had received maximal medical therapy and had undergone coronary bypass surgery 10 years earlier, and his peripheral coronary anatomy was now found to be unsuited for surgical revascularization

Positive geometric vascular remodeling is seen after catheter-based radiation followed by conventional stent implantation but not after radioactive stent implantation

BACKGROUND: Recent reports demonstrate that intracoronary radiation affects not only neointimal formation but also vascular remodeling. Radioactive stents and catheter-based techniques deliver radiation in different ways, suggesting that different patterns of remodeling after each technique may be expected. METHODS AND RESULTS: We analyzed remodeling in 18 patients after conventional stent implantation, 16 patients after low-activity radioactive stent implantation, 16 patients after higher activity radioactive stent implantation, and, finally, 17 patients who underwent catheter-based radiation followed by conventional stent implantation. Intravascular ultrasound with 3D reconstruction was used after stent implantation and at the 6-month follow-up to assess remodeling within the stent margins and at its edges. Preprocedural characteristics were similar between groups. In-stent neointimal hyperplasia (NIH) was inhibited by high-activity radioactive stent implantation (NIH 9.0 mm(3)) and by catheter-based radiation followed by conventional stent implantation (NIH 6.9 mm(3)) compared with low-activity radioactive stent implantation (NIH 21.2 mm(3)) and conventional stent implantation (NIH 20.8 mm(3)) (P:=0.008). No difference in plaque or total vessel volume was seen behind the stent in the conventional, low-activity, or high-activity stent implantation groups. However, significant increases in plaque behind the stent (15%) and in total vessel volume (8%) were seen in the group that underwent catheter-based radiation followed by conventional stent implantation. All 4 groups demonstrated significant late lumen loss at the stent edges; however, edge restenosis was seen only in the group subjected to high-activity stent implantation and appeared to be due to an increase in plaque and, to a lesser degree, to negative remodeling. CONCLUSIONS: Distinct differences in the patterns of remodeling exist between conventional, radioactive, and catheter-based radiotherapy with stenting

Coronary hemodynamics of stent implantation after suboptimal and optimal balloon angioplasty

AbstractObjectivesThis study was performed to evaluate hemodynamic alterations of stent implantation after Doppler flow–guided balloon angioplasty (BA).BackgroundThere is controversy regarding the effect of stent implantation on coronary hemodynamics after suboptimal and optimal BA.MethodsA total of 523 of 620 patients underwent Doppler-guided BA in the setting of a multicenter study and were analyzed before and after additional stent implantation. Balloon angioplasty was considered optimal when the diameter stenosis (DS) was ≤35% and coronary flow reserve (CFR) was >2.5 and suboptimal if these two criteria were not met. Coronary flow reserve was also measured in an angiographically normal artery to determine relative CFR. Patients were followed for 12 months to document major adverse cardiac events (MACE).ResultsThe main difference between patients with suboptimal BA (n = 195 [51%]) and optimal BA (n = 184 [49%]) was a more pronounced increase in baseline blood flow velocity (15 ± 8 to 22 ± 11 vs. 14 ± 8 to 16 ± 10 cm/s, p < 0.01). Coronary flow reserve improved after stent implantation in both patient groups, owing to a reduction in residual lumen obstruction, as determined by angiographic (%DS) and Doppler flow criteria (hyperemic blood flow velocity, relative CFR), and was associated with a decrease in MACE (16% vs. 7% in optimal BA group, p = 0.08; and 27% vs. 11% in suboptimal BA group, p = 0.007).ConclusionsStent implantation enhances CFR after suboptimal and optimal Doppler-guided BA, owing to a reduction in residual lumen obstruction—determined by angiographical and Doppler flow criteria—as the underlying mechanism for an improved clinical outcome