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No abstract is provided for this article.

Aims: Our aim was to assess vascular response after polymer-free sirolimus-eluting stent (SES) implantation by using an optical coherence tomography (OCT)-derived vascular healing score (HS), quantifying the deficiency of healing. Methods and results:In a prospective, multicentre, single-arm, open-label study, OCT examinations were performed at three months in 45 patients (47 lesions).Per protocol, 24 lesions which had not reached adequate vascular healing according to study criteria were scheduled for OCT examination at six months.The HS was calculated at two time points.Serial OCT imaging demonstrated that the proportion of covered stent struts increased from a median of 87.1% at three months to 98.6% at six months (p<0.001).The neointimal thickness increased from a median of 82.8 µm to 112.2 µm (p<0.001),whereas the median percentages of malapposed struts were 0.2% and 0.0% at the two respective time points.Neointimal volume obstruction increased from 6.3% to 12.8%, and the HS decreased from a median of 28.1 at three months to 2.4 at six months. Conclusions:In patients who had inadequate vascular healing three months after polymer-free SES implantation, serial OCT showed almost complete vascular healing at six months.(ClinicalTrials.gov

We describe a new mm-wave molecular-line mapping survey of the southern Galactic Plane and its first data releases. The Three-mm Ultimate Mopra Milky Way Survey (ThrUMMS) maps a 60{\deg}x2{\deg} sector of our Galaxy's fourth quadrant, using a combination of fast mapping techniques with the Mopra radio telescope, simultaneously in the J=1-0 lines of $^{12}$CO, $^{13}$CO, C$^{18}$O, and CN near 112 GHz at ~arcminute and ~0.3 km s$^{-1}$ resolution, with ~2 K channel$^{-1}$ sensitivity for $^{12}$CO and ~1 K channel$^{-1}$ for the other transitions. The calibrated data cubes from these observations are made available to the community after processing through our pipeline. Here, we describe the motivation for ThrUMMS, the development of new observing techniques for Mopra, and how these techniques were optimised to the objectives of the survey. We showcase some sample data products and describe the first science results on CO-isotopologue line ratios. These vary dramatically across the Galactic Plane, indicating a very wide range of optical depth and excitation conditions, from warm and translucent to cold and opaque. The population of cold clouds in particular have optical depths for $^{12}$CO easily exceeding 100. We derive a new, nonlinear conversion law from $^{12}$CO integrated intensity to column density, which suggests that the molecular mass traced by CO in the Galactic disk may have been substantially underestimated. This further suggests that some global relationships in disk galaxies, such as star formation laws, may need to be recalibrated. The large ThrUMMS team is proceeding with several other science investigations.

Present day XeCI excimer laser coronary angioplasty (ELCA) with multifiber catheters is a safe and efficacious therapeutic modality. However, ELCA related complications, such as perforation, acute closure and arterial wall dissection, have been reported. These complications are at least partly attributed to vascular wall damage inflicted by fast expanding water vapor bubbles and insoluble gas induced by excimer laser pulses. It has been shown that the single pulse fluence threshold for the formation of a fast expanding bubble is about 20 mJ/mm2. Also, it has been observed that the gas yield increases sharply above 30 mJ/mm2. Therefore, it is conceivable that the vascular damage in ELCA caused by fast expanding bubbles and the accumulation of insoluble gas may be reduced by reducing the size and strength of the fast expanding bubbles and the gas yield by using fluences below 20 mJ/mm2.

Background Angiography-based technologies can evaluate the physiological phenotypes of coronary artery disease (CAD) and the functional results of percutaneous coronary intervention (PCI), however, few studies have combined these to assess CAD pre- and post-PCI. Purpose We investigated the impact of physiological phenotypes of CAD on immediate post-PCI angiography-derived functional indices. Methods We analyzed 1004 vessels from three ongoing trials. Pre-PCI physiological phenotypes were characterized according to the angiography-derived pullback pressure gradient index (PPGi) as focal (≥0.66) or diffuse (&amp;lt;0.66). Local disease severity was assessed by instantaneous quantitative flow reserve (QFR) gradient per unit length (dQFR/ds) with a dQFR/ds≥0.025/mm, a "major" gradient. Post-PCI, epicardial and microvasculature functions were assessed using QFR and the index of microcirculatory resistance (angio-IMR), respectively. Results Pre-PCI, 327(35.81%) vessels had a PPGi&amp;lt;0.66, whilst 121 (13.25%) had a dQFR/ds&amp;lt;0.025 (Figure1, panel A). Post-PCI, a QFR&amp;lt;0.91 and IMR≥25 occurred in 247 (24.6%) and 310 (30.9%) vessels, respectively (Figure2, panel B). A post-PCI QFR&amp;lt;0.91 was associated with a lower PPGi (Odds ratio [OR]:1.31[1.17-1.47], p&amp;lt;0.001, Figure 1, panel C) but not a dQFR/ds (OR:0.99[0.96-1.02], p=0.453). A post-PCI IMR&amp;lt;25 was not associated with PPGi or dQFR/ds. Worsening in the IMR post-PCI was significantly associated with lower PPGi (1.31[1.16-1.48], p&amp;lt;0.001, Figure 1, panel D) and higher dQFR/ds (1.08[1.02-1.14], p=0.008, Figure 1, panel E) pre-PCI. Higher PPGi was associated with a higher odds ratio of achieving the optimal result (OR per 0.1 increase 1.25, [1.13-1.38], p&amp;lt;0.001, Figure 1, panel F). Multivariable analysis identified PPGi as an independent predictor of a post-PCI QFR≥0.91 and an optimal outcome (QFR≥0.91 and IMR&amp;lt;25, Figure2). Conclusion the phenotype of CAD pre-PCI can help predict functional outcome post-PCI, and therefore angiography-derived assessment has an important role in determining treatment strategy and outcome.Figure 1Figure 2

Objectives The aim of this study was to determine whether high-risk patients with left main coronary artery disease (LMCAD) and prior cerebrovascular disease (CEVD) preferentially benefit from revascularization by percutaneous coronary intervention (PCI) compared with coronary artery bypass grafting (CABG). Background Patients with known CEVD requiring revascularization are often referred to PCI rather than CABG. There is a paucity of data regarding the impact of CEVD in patients with LMCAD undergoing revascularization. Methods In the EXCEL (Evaluation of XIENCE Versus Coronary Artery Bypass Surgery for Effectiveness of Left Main Revascularization) trial, patients with LMCAD and low or intermediate SYNTAX (Synergy Between PCI with Taxus and Cardiac Surgery) scores were randomized to PCI with everolimus-eluting stents versus CABG. The effects of prior CEVD, defined as prior stroke, transient ischemic attack, or carotid artery disease, on 30-day and 3-year event rates were assessed. Results Prior CEVD was present in 233 of 1,898 patients (12.3%). These patients were older and had higher rates of comorbidities, including hypertension, diabetes, peripheral vascular disease, anemia, chronic kidney disease, and prior PCI, compared with those without prior CEVD. Patients with prior CEVD had higher rates of stroke at 30 days (2.2% vs. 0.8%; p = 0.05) and 3 years (6.4% vs. 2.2%; p = 0.0003) and higher 3-year rates of the primary endpoint of all-cause death, stroke, or myocardial infarction (25.0% vs. 13.6%; p < 0.0001). The relative effects of PCI versus CABG on the 30-day and 3-year rates of stroke (pinteraction = 0.65 and 0.16, respectively) and the 3-year rates of the primary composite endpoint (pinteraction = 0.14) were consistent in patients with and those without prior CEVD. Conclusions Patients with LMCAD and prior CEVD compared with those without CEVD have higher rates of stroke and reduced event-free survival after revascularization. Data from the EXCEL trial do not a priori support a preferential role of PCI over CABG in patients with known CEVD.

AimsWe aimed to asses the generalizability of two 'all-comers' randomized clinical trials (AC-RCTs) in patients undergoing percutaneous coronary intervention (PCI).

Three-dimensional (3-D) vessel reconstruction using intravascular ultrasound (IVUS) is limited by the lack of information on the real vessel curvatures and the orientation of the IVUS catheter. To overcome these limitations a method was developed using data obtained from ANGiography and intravascular UltraSound (ANGUS). This technique provides real spatial geometry and orientation of coronary lumen and plaque. The artery is studied by IVUS during a pull-back (PB) of the IVUS catheter at a speed of 1mm/s. Start and end of the PB are recorded by biplane fluoroscopy (BF) and finally biplane coronary angiography (BA) is performed without changes in geometrical X-ray settings. Using a new computer program the contours of the lumen-plaque and plaque-adventitia boundaries are semi-automatically detected at 0.5mm intervals. BF allows geometrical reconstruction of the catheter trajectory, which is the path of the IVUS transducer during PB. Combined use of the IVUS data, the catheter trajectory and the lumen contours in the BA provides a unique 3-D reconstruction of coronary arteries without any evidence of an additional unknown geometric factor. Studying the trajectory in a vessel phantom of known dimensions a high accuracy was found (distance between reconstructed and real trajectory at any point&lt;2 mm). First application in a human right coronary artery in-vivo (length: 75mm) showed a difference of 2% between the length of the reconstructed trajectory and the PB distance. Checking the locations of the origin of side-branches in the 3-D reconstruction and BA differences of less than 2mm were found. Location and shape of stenoses in simulated projections of the reconstructed lumen matched well with BA. However, at the site of a previous PTCA luminal haziness in angiography and dissection observed by IVUS may slightly reduce the accuracy of this technique. Thus combining ANGiography and intravascular UltraSound (ANGUS) is promising and provides a unique reconstruction of 3-D coronary geometry.