Objective:The goal of this study was to examine the prognostic performance of optical flow ratio(OFR)among patients with coronary artery disease(CAD)after percutaneous coronary intervention(PCI).Methods:We recruited p...Objective:The goal of this study was to examine the prognostic performance of optical flow ratio(OFR)among patients with coronary artery disease(CAD)after percutaneous coronary intervention(PCI).Methods:We recruited patients with CAD undergoing optical coherence tomography(OCT)-directed PCI between January 2019 and June 2021 for our single-center,hospital-based,retrospective cohort investigation.We assessed the link between post-PCI OFR and major adverse cardiovascular events(MACE)via multivariate Cox regression analy-sis.Results:Receiver operating characteristic analysis revealed that the best post-PCI OFR threshold for MACE was 0.91,and introduction of OFR into the baseline profile and OCT results markedly enhanced MACE identification after PCI.On the basis of survival curves,patients with OFR≤0.91(P<0.001)and thin-cap fibroatheroma(TCFA)(P=0.007)exhibited higher MACE incidence,and myocardial infarction(MI)incidence was considerably greater among patients with OFR≤0.91(P<0.001),compared with OFR>0.91.Multivariate Cox regression analysis suggested that OFR≤0.91(hazard ratio[HR]:3.60;95%confidence interval[CI]:1.24–10.44;P=0.019),and TCFA(HR:3.63;95%CI:1.42–9.20;P=0.007)were independent risk factors for MACE,and OFR≤0.91 was independently associated with MI(HR:14.64;95%CI:3.27–65.54;P<0.001).Conclusion:OFR after PCI is an independent MACE bio-indicator among patients with CAD.Adding OFR to post-PCI OCT results may potentially enhance MACE prediction.展开更多
Background Optical coherence tomography （OCT） is increasingly used in the process of percutaneous coronary intervention （PCI）, but there is still lack of data about the significance of OCT in the process of PCI. T...Background Optical coherence tomography （OCT） is increasingly used in the process of percutaneous coronary intervention （PCI）, but there is still lack of data about the significance of OCT in the process of PCI. The study aimed to investigate the long term value of OCT in the procedure of PCI. Methods One hundred sixty-five patients with coronary artery disease and implanted drug eluting stents were enrolled in the retrospective study. OCT was performed after stent implantation to detect the complications in 82 patients, who were named as OCT group. And the other 83 patients without OCT application served the control group. Incidence of the angina pectoris, acute myocardial infarction, revascularization and cardiac sudden death was observed in the two groups during one year follow-up. Results At one year clinical follow-up, the incidences of angina and revascularization in OCT group were significantly lower than those in control group （angina： 3.66% vs. 18.07%, P 〈 0.05; revascularization： 2.44% vs. 12.04%, P 〈 0.05）, the incidence of acute myocardial infarction was not significantly different （2.44% vs. 4.82%, P 〉 0.05）. Conclusions OCT is a feasible technique for guidance of coronary interventions, and its application during PCI procedure can improve the clinical outcome.展开更多
Woven coronary artery (WCA) is a rare and underdiagnosed anomaly characterized by epicardial coronary artery dividing into multiple twisted single channels then anastomosing at distal segment. The malformation is usua...Woven coronary artery (WCA) is a rare and underdiagnosed anomaly characterized by epicardial coronary artery dividing into multiple twisted single channels then anastomosing at distal segment. The malformation is usually believed as a benign condition without traces of thrombosis or dissection flaps, and merely diagnosed incidentally. However, coincidence of WCA with atherosclerosis or tachycardia may incur myocardium ischemia,[1] and even caused acute coronary syndrome (ACS) or sudden cardiac death (SCD) in reported cases.[2–4] Since the absence of evidence, the guideline for management of the coronary malformation is still lacking. Notably, as an intravascular image modality with high resolution,[5] optical coherence tomography (OCT) may shed lights on diagnosis and management of WCA.[2] Herein, we reported three cases of optimizing WCA management through performing OCT.展开更多
Objective To evaluate the feasibility and efficacy of intravascular optical coherence tomography(OCT)in the assessment of plaque characteristics and drug eluting stent deployment quality in the elderly patients with u...Objective To evaluate the feasibility and efficacy of intravascular optical coherence tomography(OCT)in the assessment of plaque characteristics and drug eluting stent deployment quality in the elderly patients with unstable angina(UA)and non-ST segment elevation myocardial infarction(NSTEMI).Methods OCT was used in elderly patients undergoing percutaneous coronary interventions.Fifteen patients,9 males and 6 females with mean age of 72.6±5.3 years(range 67-92 years)were enrolled in the study.Images were obtained before initial balloon dilatation and following stent deployment.The plaque characteristics before dilation,vessel dissection,tissue prolapse,stent apposition and strut distribution after stent implantation were evaluated.Results Fifteen lesions were selected from 32 angiographic lesions as study lesions for OCT imaging after diagnostic coronary angiography.There were 7 lesions in the left anterior descending artery,5 lesions in the right coronary artery and 3 lesions in the left circumflex coronary artery.Among them,12(80.0%)were lipid-rich plaques,and 10(66.7%)were vulnerable plaques with fibrous cap thickness 54.2±7.3μm.Seven ruptured culprit plaques(46.7%)were found;4 in UA patients and 3 in NSTEMI patients.Tissue prolapse was observed in 11 lesions(73.3%).Irregular stent strut distribution was detected in 8 lesions(53.3%).Vessel dissections were found in 5 lesions(33.3%).Incomplete stent apposition was observed in 3 stents(20%)with mean spacing between the struts and the vessel wall 172±96 mm(range 117-436 mm).Conclusions 1)It is safe and feasible to perform intravascular OCT to differentiate vulnerable coronary plaque and monitor stent deployment in elderly patients with UA and USTEMI.2)Coronary plaques in elderly patients with UA and USTEMI could be divided into acute ruptured plaque,vulnerable plaque,lipid-rich plaque,and stable plaque.3)Minor or critical plaque rupture is one of the mechanisms of UA in elderly patients.4)Present drug eluting stent implantation is complicated with multiple tissue prolapses which are associated with irregular strut distributions.5)The action and significance of tissue prolapse on acute vessel flow and in-stent thrombus and restenosis need to be further studied.展开更多
AIM To establish whether frequency-domain optical coherence tomography(FD-OCT) is safe and effective in the evaluation and treatment of angiographicallyintermediate coronary lesions(ICL) METHODS Sixty-four patients wi...AIM To establish whether frequency-domain optical coherence tomography(FD-OCT) is safe and effective in the evaluation and treatment of angiographicallyintermediate coronary lesions(ICL) METHODS Sixty-four patients with 2-dimensional quantitativecoronary angiography(2D-QCA) demonstrating ICL were included. OCT imaging was performed. According to predetermined OCT criteria, patients were assigned to either of 2 groups: OCT-guided percutaneous coronary intervention(PCI) or OCT-guided optimal medical therapy(OMT). The primary efficacy endpoint was to demonstrate the superiority and higher accuracy of FD-OCT compared to 2D-QCA in evaluating stenosis severity in patients with ICL. The primary safety endpoint was the incidence of 30-d major adverse cardiac events(MACE). Secondary endpoints included MACE at 12 mo and other clinical events.RESULTS Analysis of the primary efficacy endpoint demonstrates that 2D-QCA overestimates the stenosis severity of ICL in both the OCT-guided PCI and OMT groups, proving FD-OCT to be superior to and more precise than 2D-QCA in treating this subset of lesions. The primary safety endpoint was fully met with the incidence of 30-d MACE being nil in both the OCT-guided PCI and OCTguided OMT groups. Incidences of secondary endpoints were found to be low in both arms, the only exception being the relatively high incidence of recurrent episodes of angina which was, however, very similar in the 2 groups.CONCLUSION FD-OCT is safe and effective in the evaluation and treatment of ICL. Larger studies are needed to firmly establish the efficacy and safety of FD-OCT in treating ICL across all coronary artery disease population subgroups.展开更多
BACKGROUND Increasing attention has been paid to acute myocardial infarction(AMI)in young female patients for whom secondary factors should be considered during the diagnostic process.Anti-phospholipid syndrome(APS),a...BACKGROUND Increasing attention has been paid to acute myocardial infarction(AMI)in young female patients for whom secondary factors should be considered during the diagnostic process.Anti-phospholipid syndrome(APS),a rare autoimmune disease that is most common in young female patients,is reportedly related to AMI.To date,coronary interventions,particularly stenting,remains controversial in this special clinical scenario.CASE SUMMARY A 26-year-old female patient was admitted to hospital for acute chest pain,palpitations,and dyspnea.She had a past medical history of APS and pulmonary embolism.Coronary angiography showed acute occlusion of the proximal left anterior descending artery.After repeated thrombus aspirations,residual thrombus and mild stenosis were found in the proximal left anterior descending artery.Optical coherence tomography(OCT)was done,which confirmed the non-atherosclerosis coronary thrombosis and an intact intima in this patient.Deferring or avoiding stenting based on follow-up intracoronary findings with intensified antithrombotic treatment was chosen.One week later,coronary angiography and OCT confirmed an intact intima with no injury and no residual thrombus.The 3-mo telephone follow-up reported a good prognosis.CONCLUSION APS can cause acute non-atherosclerosis coronary thrombosis which presents as an AMI in young female patients.Intracoronary OCT findings can guide interventional strategies in this special clinical scenario.展开更多
Evaluation of acute percutaneous coronary intervention(PCI)results and longterm follow-up remains challenging with ongoing stent designs.Several imaging tools have been developed to assess native vessel atherosclerosi...Evaluation of acute percutaneous coronary intervention(PCI)results and longterm follow-up remains challenging with ongoing stent designs.Several imaging tools have been developed to assess native vessel atherosclerosis and stent expansion,improving overall PCI results and reducing adverse cardiac events.Quantitative coronary analysis has played a crucial role in quantifying the extent of coronary artery disease and stent results.Digital stent enhancement methods have been well validated and improved stent strut visualization.Intravascular imaging remains the gold standard in PCI guidance but adds costs and time to the procedure.With a recent shift towards non-invasive imaging assessment and coronary computed tomography angiography imaging have shown promising results.We hereby review novel stent visualization techniques used to guide PCI and assess stent patency in the modern PCI era.展开更多
Ostial lesions present unique challenges for percutaneous coronary intervention(PCI). These lesions are often more calcified,fibrotic,rigid,and more prone to elastic recoil. Intervention on these lesions is associated...Ostial lesions present unique challenges for percutaneous coronary intervention(PCI). These lesions are often more calcified,fibrotic,rigid,and more prone to elastic recoil. Intervention on these lesions is associated with higher procedural complications and higher rates of restenosis. Ostial lesions require precise stent placement in the ostium with the absence of side branch compromise. Accurate stent placement in the ostium without side branch compromise is difficult to accomplish with angiography alone. The Szabo technique uses two coronary guidewires for the correct placement in the aorto-ostial or bifurcation lesion. One guidewire is passed through the final cell of the stent strut and acts as the anchor wire. It helps to prevent migration of the stent beyond the ostium and facilitates the precise stenting at the ostium. This technique has several advantages including less reliance on angiography,lower rates of stent malposition and lower rates of incomplete stent coverage. Potential disadvantages include stent distortion and dislodgement from stent manipulation. We describe two cases of successful PCI to bifurcation lesions using the Szabo technique and confirmation of correct placement in the ostium with optical coherence tomography.展开更多
In this letter,we comment on a recent case report by Sun et al in the World Journal of Cardiology.The report describes the successful management of a rare complication:The unloading or detachment of a bioresorbable st...In this letter,we comment on a recent case report by Sun et al in the World Journal of Cardiology.The report describes the successful management of a rare complication:The unloading or detachment of a bioresorbable stent(BRS)during percutaneous coronary intervention(PCI)in a male patient.The unloading of BRS was detected via angiography and intravascular ultrasound(IVUS)imaging of the left coronary artery and left anterior descending artery.Although this case is interesting,the authors’report lacked crucial details.Specifically,insufficient information about the type of BRS used,potential causes of BRS unloading,or whether optical coherence tomography(OCT)imaging for coronary arteries was performed before,during,or after PCI.The OCT imaging of coronary arteries before PCI can potentially prevent BRS unloading due to its higher resolution compared to IVUS.In addition,despite detecting myocardial bridging during the PCI,the authors did not provide any details regarding this variation.Here we discuss the various types of BRS,the importance of OCT in PCI,and the clinical relevance of myocardial bridging.展开更多
BACKGROUND Optical coherence tomography(OCT)offers detailed cross-sectional imaging during percutaneous coronary intervention(PCI),aiding in anatomically complex coronary lesions.Despite its advantages,evidence on the...BACKGROUND Optical coherence tomography(OCT)offers detailed cross-sectional imaging during percutaneous coronary intervention(PCI),aiding in anatomically complex coronary lesions.Despite its advantages,evidence on the clinical effectiveness of OCT-guided PCI remains limited.Major databases were systematically searched for randomized controlled trials(RCTs)comparing OCT-guided and angiography-guided PCI in complex lesions.Primary outcomes included major adverse cardiovascular events(MACE)and target vessel failure(TVF);secondary outcomes included mortality,myocardial infarction(MI),and other procedural outcomes.A random-effects model was used to pool risk ratio(RR),with 95%CI.Statistical analysis was conducted in R software(v4.4.1),with significance set at P<0.05.RESULTS Five RCTs(5737 patients)showed OCT-guided PCI significantly reduced MACE(RR:0.63,95%CI:0.52-0.77,P<0.01),TVF(RR:0.68,95%CI:0.56-0.83,P<0.01),all-cause(RR:0.58,95%CI:0.38-0.87,P<0.01)and cardiac mortality(RR:0.43,95%CI:0.24-0.76,P<0.01),target-lesion revascularization(RR:0.53,95%CI:0.33-0.84,P<0.01),stent thrombosis(RR:0.52,95%CI:0.31-0.86,P=0.01),and target-vessel MI(RR:0.64,95%CI:0.42-0.97,P=0.04)vs angiography-guided PCI.Periprocedural MI,any revascularization,target-vessel revascularization,and contrast-associated kidney injury were similar between groups.CONCLUSION OCT-guided PCI improves outcomes in complex lesions by reducing MACE,TVF,mortality,stent thrombosis,and target-vessel MI.These findings highlight the need for further large-scale RCTs to confirm its benefits.展开更多
Optic nerve health is essential for proper function of the visual system.However,the pathophysiology of certain neurodegenerative disease processes affecting the optic nerve,such as glaucoma,is not fully understood.Re...Optic nerve health is essential for proper function of the visual system.However,the pathophysiology of certain neurodegenerative disease processes affecting the optic nerve,such as glaucoma,is not fully understood.Recently,it was hypothesized that a lack of proper clearance of neurotoxins contributes to neurodegenerative diseases.The ability to clear metabolic waste is essential for tissue homeostasis in mammals,including humans.While the brain lacks the traditional lymphatic drainage system identified in other anatomical regions,there is growing evidence of a glymphatic system in the central nervous system,which structurally includes the optic nerve.Named to acknowledge the supportive role of astroglial cells,this perivascular fluid drainage system is essential to remove toxic metabolites from the central nervous system.Herein,we review existing literature describing the physiology and dysfunction of the glymphatic system specifically as it relates to the optic nerve.We summarize key imaging studies demonstrating the existence of a glymphatic system in the optic nerves of wild-type rodents,aquaporin 4-null rodents,and humans;glymphatic imaging studies in diseases where the optic nerve is impaired;and current evidence regarding pharmacological and lifestyle interventions that may help promote glymphatic function to improve optic nerve health.We conclude by highlighting future research directions that could be applied to improve imaging detection and guide therapeutic interventions for diseases affecting the optic nerve.展开更多
基金supported by the Outstanding Young Talent Program of Guangdong Provincial People’s Hospital(grant number KJ012019084)the High-level Hospital Construction Project(grant number DFJH2020021).
文摘Objective:The goal of this study was to examine the prognostic performance of optical flow ratio(OFR)among patients with coronary artery disease(CAD)after percutaneous coronary intervention(PCI).Methods:We recruited patients with CAD undergoing optical coherence tomography(OCT)-directed PCI between January 2019 and June 2021 for our single-center,hospital-based,retrospective cohort investigation.We assessed the link between post-PCI OFR and major adverse cardiovascular events(MACE)via multivariate Cox regression analy-sis.Results:Receiver operating characteristic analysis revealed that the best post-PCI OFR threshold for MACE was 0.91,and introduction of OFR into the baseline profile and OCT results markedly enhanced MACE identification after PCI.On the basis of survival curves,patients with OFR≤0.91(P<0.001)and thin-cap fibroatheroma(TCFA)(P=0.007)exhibited higher MACE incidence,and myocardial infarction(MI)incidence was considerably greater among patients with OFR≤0.91(P<0.001),compared with OFR>0.91.Multivariate Cox regression analysis suggested that OFR≤0.91(hazard ratio[HR]:3.60;95%confidence interval[CI]:1.24–10.44;P=0.019),and TCFA(HR:3.63;95%CI:1.42–9.20;P=0.007)were independent risk factors for MACE,and OFR≤0.91 was independently associated with MI(HR:14.64;95%CI:3.27–65.54;P<0.001).Conclusion:OFR after PCI is an independent MACE bio-indicator among patients with CAD.Adding OFR to post-PCI OCT results may potentially enhance MACE prediction.
文摘Background Optical coherence tomography （OCT） is increasingly used in the process of percutaneous coronary intervention （PCI）, but there is still lack of data about the significance of OCT in the process of PCI. The study aimed to investigate the long term value of OCT in the procedure of PCI. Methods One hundred sixty-five patients with coronary artery disease and implanted drug eluting stents were enrolled in the retrospective study. OCT was performed after stent implantation to detect the complications in 82 patients, who were named as OCT group. And the other 83 patients without OCT application served the control group. Incidence of the angina pectoris, acute myocardial infarction, revascularization and cardiac sudden death was observed in the two groups during one year follow-up. Results At one year clinical follow-up, the incidences of angina and revascularization in OCT group were significantly lower than those in control group （angina： 3.66% vs. 18.07%, P 〈 0.05; revascularization： 2.44% vs. 12.04%, P 〈 0.05）, the incidence of acute myocardial infarction was not significantly different （2.44% vs. 4.82%, P 〉 0.05）. Conclusions OCT is a feasible technique for guidance of coronary interventions, and its application during PCI procedure can improve the clinical outcome.
基金supported by grants from National Key R&D Program of China (2016YFC1300304)
文摘Woven coronary artery (WCA) is a rare and underdiagnosed anomaly characterized by epicardial coronary artery dividing into multiple twisted single channels then anastomosing at distal segment. The malformation is usually believed as a benign condition without traces of thrombosis or dissection flaps, and merely diagnosed incidentally. However, coincidence of WCA with atherosclerosis or tachycardia may incur myocardium ischemia,[1] and even caused acute coronary syndrome (ACS) or sudden cardiac death (SCD) in reported cases.[2–4] Since the absence of evidence, the guideline for management of the coronary malformation is still lacking. Notably, as an intravascular image modality with high resolution,[5] optical coherence tomography (OCT) may shed lights on diagnosis and management of WCA.[2] Herein, we reported three cases of optimizing WCA management through performing OCT.
基金This work is supported by China Capital Medical Development Fund(C03030201).
文摘Objective To evaluate the feasibility and efficacy of intravascular optical coherence tomography(OCT)in the assessment of plaque characteristics and drug eluting stent deployment quality in the elderly patients with unstable angina(UA)and non-ST segment elevation myocardial infarction(NSTEMI).Methods OCT was used in elderly patients undergoing percutaneous coronary interventions.Fifteen patients,9 males and 6 females with mean age of 72.6±5.3 years(range 67-92 years)were enrolled in the study.Images were obtained before initial balloon dilatation and following stent deployment.The plaque characteristics before dilation,vessel dissection,tissue prolapse,stent apposition and strut distribution after stent implantation were evaluated.Results Fifteen lesions were selected from 32 angiographic lesions as study lesions for OCT imaging after diagnostic coronary angiography.There were 7 lesions in the left anterior descending artery,5 lesions in the right coronary artery and 3 lesions in the left circumflex coronary artery.Among them,12(80.0%)were lipid-rich plaques,and 10(66.7%)were vulnerable plaques with fibrous cap thickness 54.2±7.3μm.Seven ruptured culprit plaques(46.7%)were found;4 in UA patients and 3 in NSTEMI patients.Tissue prolapse was observed in 11 lesions(73.3%).Irregular stent strut distribution was detected in 8 lesions(53.3%).Vessel dissections were found in 5 lesions(33.3%).Incomplete stent apposition was observed in 3 stents(20%)with mean spacing between the struts and the vessel wall 172±96 mm(range 117-436 mm).Conclusions 1)It is safe and feasible to perform intravascular OCT to differentiate vulnerable coronary plaque and monitor stent deployment in elderly patients with UA and USTEMI.2)Coronary plaques in elderly patients with UA and USTEMI could be divided into acute ruptured plaque,vulnerable plaque,lipid-rich plaque,and stable plaque.3)Minor or critical plaque rupture is one of the mechanisms of UA in elderly patients.4)Present drug eluting stent implantation is complicated with multiple tissue prolapses which are associated with irregular strut distributions.5)The action and significance of tissue prolapse on acute vessel flow and in-stent thrombus and restenosis need to be further studied.
基金Supported by the National Natural Science Foundation of China,No.81570363the National Key Research and Development Program of China,No.2016YFA0201304the Priority Academic Program Development of Jiangsu Higher Education Institutions,No.KYZZ15_0263
文摘AIM To establish whether frequency-domain optical coherence tomography(FD-OCT) is safe and effective in the evaluation and treatment of angiographicallyintermediate coronary lesions(ICL) METHODS Sixty-four patients with 2-dimensional quantitativecoronary angiography(2D-QCA) demonstrating ICL were included. OCT imaging was performed. According to predetermined OCT criteria, patients were assigned to either of 2 groups: OCT-guided percutaneous coronary intervention(PCI) or OCT-guided optimal medical therapy(OMT). The primary efficacy endpoint was to demonstrate the superiority and higher accuracy of FD-OCT compared to 2D-QCA in evaluating stenosis severity in patients with ICL. The primary safety endpoint was the incidence of 30-d major adverse cardiac events(MACE). Secondary endpoints included MACE at 12 mo and other clinical events.RESULTS Analysis of the primary efficacy endpoint demonstrates that 2D-QCA overestimates the stenosis severity of ICL in both the OCT-guided PCI and OMT groups, proving FD-OCT to be superior to and more precise than 2D-QCA in treating this subset of lesions. The primary safety endpoint was fully met with the incidence of 30-d MACE being nil in both the OCT-guided PCI and OCTguided OMT groups. Incidences of secondary endpoints were found to be low in both arms, the only exception being the relatively high incidence of recurrent episodes of angina which was, however, very similar in the 2 groups.CONCLUSION FD-OCT is safe and effective in the evaluation and treatment of ICL. Larger studies are needed to firmly establish the efficacy and safety of FD-OCT in treating ICL across all coronary artery disease population subgroups.
文摘BACKGROUND Increasing attention has been paid to acute myocardial infarction(AMI)in young female patients for whom secondary factors should be considered during the diagnostic process.Anti-phospholipid syndrome(APS),a rare autoimmune disease that is most common in young female patients,is reportedly related to AMI.To date,coronary interventions,particularly stenting,remains controversial in this special clinical scenario.CASE SUMMARY A 26-year-old female patient was admitted to hospital for acute chest pain,palpitations,and dyspnea.She had a past medical history of APS and pulmonary embolism.Coronary angiography showed acute occlusion of the proximal left anterior descending artery.After repeated thrombus aspirations,residual thrombus and mild stenosis were found in the proximal left anterior descending artery.Optical coherence tomography(OCT)was done,which confirmed the non-atherosclerosis coronary thrombosis and an intact intima in this patient.Deferring or avoiding stenting based on follow-up intracoronary findings with intensified antithrombotic treatment was chosen.One week later,coronary angiography and OCT confirmed an intact intima with no injury and no residual thrombus.The 3-mo telephone follow-up reported a good prognosis.CONCLUSION APS can cause acute non-atherosclerosis coronary thrombosis which presents as an AMI in young female patients.Intracoronary OCT findings can guide interventional strategies in this special clinical scenario.
文摘Evaluation of acute percutaneous coronary intervention(PCI)results and longterm follow-up remains challenging with ongoing stent designs.Several imaging tools have been developed to assess native vessel atherosclerosis and stent expansion,improving overall PCI results and reducing adverse cardiac events.Quantitative coronary analysis has played a crucial role in quantifying the extent of coronary artery disease and stent results.Digital stent enhancement methods have been well validated and improved stent strut visualization.Intravascular imaging remains the gold standard in PCI guidance but adds costs and time to the procedure.With a recent shift towards non-invasive imaging assessment and coronary computed tomography angiography imaging have shown promising results.We hereby review novel stent visualization techniques used to guide PCI and assess stent patency in the modern PCI era.
文摘Ostial lesions present unique challenges for percutaneous coronary intervention(PCI). These lesions are often more calcified,fibrotic,rigid,and more prone to elastic recoil. Intervention on these lesions is associated with higher procedural complications and higher rates of restenosis. Ostial lesions require precise stent placement in the ostium with the absence of side branch compromise. Accurate stent placement in the ostium without side branch compromise is difficult to accomplish with angiography alone. The Szabo technique uses two coronary guidewires for the correct placement in the aorto-ostial or bifurcation lesion. One guidewire is passed through the final cell of the stent strut and acts as the anchor wire. It helps to prevent migration of the stent beyond the ostium and facilitates the precise stenting at the ostium. This technique has several advantages including less reliance on angiography,lower rates of stent malposition and lower rates of incomplete stent coverage. Potential disadvantages include stent distortion and dislodgement from stent manipulation. We describe two cases of successful PCI to bifurcation lesions using the Szabo technique and confirmation of correct placement in the ostium with optical coherence tomography.
文摘In this letter,we comment on a recent case report by Sun et al in the World Journal of Cardiology.The report describes the successful management of a rare complication:The unloading or detachment of a bioresorbable stent(BRS)during percutaneous coronary intervention(PCI)in a male patient.The unloading of BRS was detected via angiography and intravascular ultrasound(IVUS)imaging of the left coronary artery and left anterior descending artery.Although this case is interesting,the authors’report lacked crucial details.Specifically,insufficient information about the type of BRS used,potential causes of BRS unloading,or whether optical coherence tomography(OCT)imaging for coronary arteries was performed before,during,or after PCI.The OCT imaging of coronary arteries before PCI can potentially prevent BRS unloading due to its higher resolution compared to IVUS.In addition,despite detecting myocardial bridging during the PCI,the authors did not provide any details regarding this variation.Here we discuss the various types of BRS,the importance of OCT in PCI,and the clinical relevance of myocardial bridging.
文摘BACKGROUND Optical coherence tomography(OCT)offers detailed cross-sectional imaging during percutaneous coronary intervention(PCI),aiding in anatomically complex coronary lesions.Despite its advantages,evidence on the clinical effectiveness of OCT-guided PCI remains limited.Major databases were systematically searched for randomized controlled trials(RCTs)comparing OCT-guided and angiography-guided PCI in complex lesions.Primary outcomes included major adverse cardiovascular events(MACE)and target vessel failure(TVF);secondary outcomes included mortality,myocardial infarction(MI),and other procedural outcomes.A random-effects model was used to pool risk ratio(RR),with 95%CI.Statistical analysis was conducted in R software(v4.4.1),with significance set at P<0.05.RESULTS Five RCTs(5737 patients)showed OCT-guided PCI significantly reduced MACE(RR:0.63,95%CI:0.52-0.77,P<0.01),TVF(RR:0.68,95%CI:0.56-0.83,P<0.01),all-cause(RR:0.58,95%CI:0.38-0.87,P<0.01)and cardiac mortality(RR:0.43,95%CI:0.24-0.76,P<0.01),target-lesion revascularization(RR:0.53,95%CI:0.33-0.84,P<0.01),stent thrombosis(RR:0.52,95%CI:0.31-0.86,P=0.01),and target-vessel MI(RR:0.64,95%CI:0.42-0.97,P=0.04)vs angiography-guided PCI.Periprocedural MI,any revascularization,target-vessel revascularization,and contrast-associated kidney injury were similar between groups.CONCLUSION OCT-guided PCI improves outcomes in complex lesions by reducing MACE,TVF,mortality,stent thrombosis,and target-vessel MI.These findings highlight the need for further large-scale RCTs to confirm its benefits.
基金supported by National Institutes of Health,No.R01-EY028125Bright Focus Foundation,No.G2019103+2 种基金Feldstein Medical FoundationResearch to Prevent Blindness/Stavros Niarchos Foundation International Research Collaborators Awardan unrestricted grant from Research to Prevent Blindness to NYU Langone Health Department of Ophthalmology(to KCC)。
文摘Optic nerve health is essential for proper function of the visual system.However,the pathophysiology of certain neurodegenerative disease processes affecting the optic nerve,such as glaucoma,is not fully understood.Recently,it was hypothesized that a lack of proper clearance of neurotoxins contributes to neurodegenerative diseases.The ability to clear metabolic waste is essential for tissue homeostasis in mammals,including humans.While the brain lacks the traditional lymphatic drainage system identified in other anatomical regions,there is growing evidence of a glymphatic system in the central nervous system,which structurally includes the optic nerve.Named to acknowledge the supportive role of astroglial cells,this perivascular fluid drainage system is essential to remove toxic metabolites from the central nervous system.Herein,we review existing literature describing the physiology and dysfunction of the glymphatic system specifically as it relates to the optic nerve.We summarize key imaging studies demonstrating the existence of a glymphatic system in the optic nerves of wild-type rodents,aquaporin 4-null rodents,and humans;glymphatic imaging studies in diseases where the optic nerve is impaired;and current evidence regarding pharmacological and lifestyle interventions that may help promote glymphatic function to improve optic nerve health.We conclude by highlighting future research directions that could be applied to improve imaging detection and guide therapeutic interventions for diseases affecting the optic nerve.
