0371: Bifurcation techniques with ABSORB® bioresorbable vascular scaffold: optical frequency-domain imaging and micro-computed tomography assessment

AimsWe aimed to determine the correlation between optical frequency-domain imaging (OFDI) and micro-computed tomography (mCT) in the quantitative and qualitative assessment of ABSORB® bioresorbable vascular scaffold (BVS) in a bench test of multiple bifurcation technique.MethodBVS were deployed in bifurcation silicon phantoms divided into two benches. Bench A is a LAD-diagonal bifurcation with a 40° angle and bench B, a left main bifurcation with a 70° angle. Finet’s law was respected. Different bifurcation techniques (provisional T stenting, kissing balloon, mini crush and culotte) were performed with a total of 16 procedures, 8 for each bench. All procedures were imaged by OFDI and mCT. BVS area, lumen area, number of struts, maximal stent thickness, disruption, lumen protrusion and deformation were the parameters collected. The analysis was performed in each segment, proximal, bifurcation and distal.ResultsIn bench A, we found no differences between OFDI and mCT for each proximal, bifurcation and distal segments concerning BVS area, lumen area, number of struts, maximal stent thickness, fractures, lumen protrusion, BVS deformation or BVS fragments. In the proximal segment, length was higher in mCT (13.2mm vs 10.4mm; p<0.0001) and there was more malapposition detected in mCT (75% vs 0%, p=0.007). In bench B, for the proximal segment, lumen area was higher (13.7mm2 vs 13.mm2, p=0.01) and we found more BVS malapposition in mCT (100% vs 0%, p=0.0002). All the other parameters were similar. In each bench, the apposition defect measured by mCT remained minimal.ConclusionWe demonstrated an excellent correlation between OFDI and mCT which is considered as the gold standard to evaluate stent in bench tests. In vitro techniques can now be validated in vivo using OFDI

0035 : Immediate percutaneous coronary intervention is associated with better survival after out-of-hospital cardiac arrest: experience of Clermont-Ferrand hospital

BackgroundThe out-of-hospital cardiac arrest represent the leading cause of death worldwide. Several therapeutic elements such as early reperfusion developed in recent years to reduce the high morbidity and mortality observed in this situation. The objective of this study was to evaluate the influence of emergency coronary angiography (CAG) and primary percutaneous coronary intervention (PCI) on the outcome of patients survivors after out-of-hospital cardiac arrest.MethodsBetween January 2012 and June 2013, a total of 54 consecutive patients survivors of out-of-hospital cardiac arrest underwent systematic emergency coronary angiography.ResultsThirty five of the 54 patients had clinically significant coronary disease on angiography, 23 of whom had coronary-artery occlusion (43%). Angioplasty was attempted in 20 patients and was technically successful in 18. The in-hospital survival rate was 48%. Multivariate logistic-regression analysis revealed that angioplasty was an independent predictor of survival (95 percent confidence interval, 3.1 to 750.1; P =0.006).ConclusionsAcute coronary-artery occlusion is frequent in survivors of out-of-hospital cardiac arrest. Accurate diagnosis by immediate coronary angiography can be followed in suitable candidates by coronary angioplasty, which seems to improve survival

0036 : Predictive value of clinical and electrocardiographic features in survivors of out-of-hospital cardiac arrest

BackgroundAcute coronary lesions are known to be the most common trigger of out of hospital cardiac arrest (OHCA). But the diagnosis of acute coronary artery disease in survivors of out-of-hospital cardiac arrest is difficult. The aim of the present study was to assess the predictive value clinical and electrpcardiographic features in diagnosing the presence of acute coronary lesions among out-of-hospital cardiac arrest patients.MethodsClinical and electrocardiographic data collected before coronary angiography were analyzed to determine whether they could be used to predict the presence of recent coronary – artery occlusion on angiography.Results54 patients underwent coronarography angiography after OHCA; 42% of patients had ST-segment elevation and 57% of patients had other ECG patterns on post-restoration of spontaneous circulation (ROSC) ECG. Acute coronary lesions was found in 66% of patients; Significant coronary artery disease was observed in 83% of patients with ST-segment elevation and in 55% of patients with other ECG patterns on post-ROSC ECG (p = 0.03).Significant coronary artery disease was observed in 100% of patients with chest pain before the arrest and in 55% of patients without chest pain (p=0.02). Chest pain has a good positive predictive value but a low negative predictive value in diagnosing the presence of acute or presumed recent coronary artery lesions (100% and 45%, respectively).ConclusionST-segment elevation and chest pain before arrest after OHCA should not be considered as strict selection criteria for performing emergent coronary angiography in patients resuscitated from OHCA; even in the absence of ST-segment elevation on post- return of spontaneous circulation ECG, acute culprit coronary lesions may be present and considered the trigger of cardiac arrest

Unprecedented incorporation of α-emitter radioisotope 213Bi into porphyrin chelates with reference to a daughter isotope mediated assistance mechanism.

International audienceFor the first time, α-emitter radioisotope (213)Bi has been incorporated into porphyrin chelates, with rates matching with the short period of the radionuclide. An in situ transmetalation mechanism involving the daughter isotope (209)Pb is expected to boost the (213)Bi radiolabeling process

Impact of intracoronary optical coherence tomography in routine clinical practice: A contemporary cohort study.

BACKGROUND/PURPOSE Guidelines recommend intracoronary optical coherence tomography (OCT) to assess stent failure and guide percutaneous coronary intervention (PCI) but OCT may be useful for other indications in routine clinical practice. METHODS/MATERIALS We conducted an international registry of OCT cases at two large tertiary care centers to assess clinical indications and the potential impact on decision making of OCT in clinical routine. Clinical indications, OCT findings, and their impact on interventional or medical treatment strategy were retrospectively assessed. RESULTS OCT was performed in 810 coronary angiography cases (1928 OCT-pullbacks). OCT was used for diagnostic purposes in 67% (N = 542) and OCT-guided percutaneous coronary intervention in 50% (N = 404, 136 cases with prior diagnostic indication). Most frequent indications for diagnostic OCT were culprit lesion identification in suspected ACS (29%) and stent failure assessment (28%). OCT findings in the diagnostic setting influenced patient management in 74%. OCT-guided PCIs concerned ACS patients in 45%. Among the 55% with chronic coronary syndrome, long lesions >28 mm (19%), left main PCI (16%), and bifurcation PCI with side-branch-stenting (5%) were the leading indications for PCI-guidance. Post-procedural OCT findings led to corrective measures in 52% (26% malapposition, 14% underexpansion, 6% edge dissection, 3% intrastent mass, 3% geographic plaque miss). CONCLUSIONS OCT was most frequently performed to identify culprit lesions in suspected ACS, for stent failure assessment, and PCI-guidance. OCT may impact subsequent treatment strategies in two out of three patients

Unprecedented Incorporation of alpha-Emitter Radioisotope 213Bi into Porphyrin Chelates with Reference to a Daughter Isotope Mediated Assistance Mechanism

For the first time, alphaemitter radioisotope 213Bi has been 10 incorporated into porphyrin chelates, with rates matching with the short period of the radionuclide. An in-situ transmetalation mechanism involving the daughter isotope 209Pb is expected to boost the 213Bi radiolabeling process.JRC.E.5-Nuclear chemistr

Association of the PHACTR1/EDN1 genetic locus with spontaneous coronary artery dissection

Background: Spontaneous coronary artery dissection (SCAD) is an increasingly recognized cause of acute coronary syndromes (ACS) afflicting predominantly younger to middle-aged women. Observational studies have reported a high prevalence of extracoronary vascular anomalies, especially fibromuscular dysplasia (FMD) and a low prevalence of coincidental cases of atherosclerosis. PHACTR1/EDN1 is a genetic risk locus for several vascular diseases, including FMD and coronary artery disease, with the putative causal noncoding variant at the rs9349379 locus acting as a potential enhancer for the endothelin-1 (EDN1) gene. Objectives: This study sought to test the association between the rs9349379 genotype and SCAD. Methods: Results from case control studies from France, United Kingdom, United States, and Australia were analyzed to test the association with SCAD risk, including age at first event, pregnancy-associated SCAD (P-SCAD), and recurrent SCAD. Results: The previously reported risk allele for FMD (rs9349379-A) was associated with a higher risk of SCAD in all studies. In a meta-analysis of 1,055 SCAD patients and 7,190 controls, the odds ratio (OR) was 1.67 (95% confidence interval [CI]: 1.50 to 1.86) per copy of rs9349379-A. In a subset of 491 SCAD patients, the OR estimate was found to be higher for the association with SCAD in patients without FMD (OR: 1.89; 95% CI: 1.53 to 2.33) than in SCAD cases with FMD (OR: 1.60; 95% CI: 1.28 to 1.99). There was no effect of genotype on age at first event, P-SCAD, or recurrence. Conclusions: The first genetic risk factor for SCAD was identified in the largest study conducted to date for this condition. This genetic link may contribute to the clinical overlap between SCAD and FMD

Faisabilité, innocuité et apport de la tomographie par cohérence optique dans la prise en charge des syndromes coronariens aigus avec sus-décalage du segment ST

La stratégie de prise en charge des SCA ST+ en deux temps de type MIMI (Minimalist Immediate Mechanical Intervention) avec optimisation de la thrombectomie et éventuel stenting différé pourrait permettre une meilleure analyse de la lésion coupable par une imagerie de haute résolution endoluminale : la tomographie par cohérence optique (OCT). 101 SCA ST+ avec forte charge thrombotique à l'angiographie initiale ont bénéficié d'une thrombectomie "agressive" (médicamenteuse et par thrombo-aspiration) avec pour objectif la restauration d'un flux TIMI 3. Après détersion du thrombus, une seconde angiographie était réalisée et complétée par un examen OCT afin d'évaluer la charge thrombotique résiduelle, d'étudier les lésions coupables et d'orienter la prise en charge thérapeutique. Suivi à 6 mois. L'angiographie et l'OCT post-thrombectomie sont réalisés entre J0 et J30 (médiane à J5). Aucun événement clinique avant le contrôle ou per procédure n'est survenu. Le contrôle angiographique montre une réduction importante du thrombus (100% initialement vs 20,8% lors du contrôle ; p<0,001), une réduction de longueur des lésions (15,9 +/- 9,1 mm vs 12,1 +/- 6,3mm ; p<0,001), de la sévérité des sténose en QCA (79,6 +/- 24,6% vs 47,5 +/- 22,5% ; p<0,001) et une augmentation du diamètre artériel de référence (3,22 +/- 0,59mm vs 3,36 +/- 0,64mm ; p=NS). L'OCT montre une sous estimation du thrombus en angiographie (20.8% vs 68.3% en OCT). On identifie 66 ruptures de plaque et un pourcentage d'obstruction de surface moyen de 60,4%. 63 patients ont été stentés et 38 ont été traités médicalement. 8,9% des patients ont bénéficié d'un traitement de bifurcation alors qu'une bifurcation a été impliquée à l'angiographie initiale dans 35,6% des cas. On retrouve une malapposition, une edge dissection et une protrusion importante dans respectivement 17,5%, 9,5% et 28,6% des cas sans aucun retentissement de flux (100% TIMI 3). A 6 mois, aucun évènement cardiaque aigu n'est à déplorer et un seul patient traité médicalement a finalement dû être stenté. La prise en charge du SCA ST+ en 2 temps avec réalisation d'OCT lors du contrôle est dans notre étude une procédure réalisable et sans risque. Cette stratégie permet d'observer une réduction importante de la charge thrombotique sous-estimée en angiographie. L'OCT, par une analyse du thrombus et des mécanismes à l'origine des SCA, pourrait aider à la décision thérapeutique en optimisant le stenting qui dans notre travail n'a été réalisé que dans 62,4% des cas.CLERMONT FD-BCIU-Santé (631132104) / SudocSudocFranceF

Simulation du déploiement de stents à partir d’éléments «poutres» élasto-plastiques

International audienc