Publications

New advances in image and signal processing have allowed the development of numerous invasive and noninvasive imaging modalities that have revealed details of plaque pathology and allowed us to study in vivo the atherosclerotic evolution. Recent natural history of atherosclerosis studies permitted us to evaluate changes in the compositional and morphological characteristics of the plaque and identify predictors of future events. The idea of being able to identify future culprit lesions and passivate these plaques has gradually matured, and small scale studies have provided proofs about the feasibility of this concept. This review article summarizes the recent advances in the study of atherosclerosis, cites the current evidence, highlights our limitations in understanding the evolution of the plaque and in predicting plaque destabilization, and discusses the potentiality of an early invasive sealing of future culprit lesions.

Objectives The purpose of this study was to investigate the long-term clinical and angiographic profile of sirolimus-eluting stent (SES) versus paclitaxel-eluting stent (PES) in patients undergoing percutaneous intervention for left main (LM) coronary disease. Background The long-term clinical and angiographic impact of SES as opposed to PES implantation in this subset of patients is unknown. Methods From April 2002 to March 2004, 110 patients underwent percutaneous intervention for LM stenosis at our institution; 55 patients were treated with SES and 55 with PES. The two groups were well balanced for all baseline characteristics. Results At a median follow-up of 660 days (range 428 to 885), the cumulative incidence of major adverse cardiovascular events was similar (25% in the SES group vs. 29%, in the PES group; hazard ratio 0.88 [95% confidence interval 0.43 to 1.82]; p = 0.74), reflecting similarities in both the composite death/myocardial infarction (16% in the SES group and 18% in the PES group) and target vessel revascularization (9% in the SES group and 11% in the PES group). Angiographic in-stent late loss (mm), evaluated in 73% of the SES group and in 77% of the PES group, was 0.32 ± 74 in the main and 0.36 ± 0.59 in the side branch in the SES group vs. 0.46 ± 0.57 (p = 0.36) and 0.52 ± 0.42 (p = 0.41) in the PES group, respectively. Conclusions In consecutive patients undergoing percutaneous LM intervention, PES may perform closely to SES both in terms of angiographic and long-term clinical outcome.

BM COPD accounts for a substantially large proportion of COPD especially in developing countries. However, little is known whether this COPD is different from TS COPD radiologically. Aims: To study and compare the radiological changes in the lung parenchyma between BM COPD and TS COPD. Method : 20 stable BM COPD (M:F 1:19) and 34 stable TS COPD (M:F 34:0) underwent HRCT thorax. Helical HRCT sections were taken from apex to domes of diaphragm at 1mm thickness and 10mm intervals during deep inspiration maneuver. Emphysema was quantified using “ Quantification of Emphysema” software and depicted as area less then -950HU, while bronchial wall thickness was defined as presence of >1.5mm thickness. Independent sample t -test was used to compare the two groups of COPD. Results: BM COPD \[age: 65yrs (8.5)] subjects showed significantly lesser mean lung volumes (cc) compared to TS COPD [age:63 yrs (5)\] \[2916 ± 2589 vs 4347 ±4507; p<0.0001\] TS COPD subjects had more mean % emphysema compare to BM COPD [13%±11.5% vs 6.42%±6.3%; p=0.022]. 80% of subjects with BM COPD showed presence of pure form of emphysema pattern {either centrilobular (40%) or panlobular (40%)}, whereas there was no distinct pattern seen with TS COPD. There was no significant difference in bronchial wall thickness between the two COPD phenotypes, although TS COPD trended to show greater wall thickness (p=0.09). Conclusions: The BM COPD has lesser lung volumes and emphysema compared to TS COPD. There is predominance of either centriacinar or panacinar in BM COPD. Biomass smoke-induced COPD subjects showed lower lung volumes and lesser mean % emphysema than TS COPD on HRCT imaging.

No abstract is provided for this article.

Objectives : To reassess the reproducibility of the SYNTAX score. Background : The SYNTAX score appears to have an important role to play in the evaluation of patients with complex coronary artery disease undergoing revascularisation. However, the calculation of the SYNTAX score relies on the subjective assessment of lesions using coronary angiography, and therefore is subject to intra‐and inter‐observer variability. Methods : The SYNTAX score was calculated in 100 patients randomly selected from the SYNTAX trial, on two occasions 8 weeks apart, by a team made up of three interventional cardiologists. The weighted kappa values were compared with values obtained 1 year previously, when core lab analysts assessed the intra‐observer reproducibility amongst the same patient cohort. Results : The mean ± standard deviation difference in SYNTAX score was 2.1 ± 7.6. The respective weighted kappa values for the number of lesions, bifurcation lesions, ostial lesions, and total occlusions were 0.62, 0.36, 0.66, and 0.91 compared with 0.59, 0.41, 0.63, and 0.82 in the previous core lab assessment. The weighted kappa for the intra‐observer reproducibility of the SYNTAX score grouped into deciles was 0.54, and according to the terciles ≤22, &gt;22–≤32, &gt;32 was 0.51 both indicating a moderate level of agreement beyond the level of chance. In the previous assessment, the comparative kappa values were 0.45 and 0.53. Conclusions : The SYNTAX score has moderate intra‐observer reproducibility when assessed by a team of three interventional cardiologists, which is consistent with a prior evaluation performed by core lab analysts. The scoring of bifurcation lesions remains the main source of inconsistency. © 2009 Wiley‐Liss, Inc.

The Absorb BVSs (Abbott Vascular, Santa Clara, CA; hereafter referred to as BVSs) is a 150 µm thick bioresorbable poly(l-lactide) scaffold with a conformal bioresorbable poly(d, l-lactide) coating (total thickness 7 µm) that elutes everolimus. Randomized trials comparing this device to the XIENCE cobalt-chromium everolimus-eluting stent (CoCr-EESs; Abbott Vascular) were done to support regulatory approval in Europe, Asia, and the United States, and have only recently been reported. These studies were designed to show the noninferiority of the BVSs compared with the CoCr-EESs for 1-year clinical and angiographic outcomes, since improved results with the BVSs compared with drug-eluting stents are not expected to become evident until 3-5 years after implantation. However, none of these trials were powered to exclude small differences in composite adverse event rates between devices, or to detect differences in rarely occurring safety endpoints, and their outcomes according to specific patient and lesion characteristics. Currently, several meta-analyses have been published [1-7]. In this chapter, we present the summary of what we have learned from these meta-analyses.

No abstract is provided for this article.

We evaluated a novel motion-compensating 3D reconstruction technique applied to rotational angiography (R-angio) which produces MSCT-like images for evaluation of implanted TAVI prostheses without requiring rapid pacing.Fifty-one consecutive patients were retrospectively identified who were evaluated with rotational angiography (R-angio) using the Siemens Artis zee angiographic C-arm system after TAVI with a Medtronic CoreValve prosthesis. A novel 3D image reconstruction technique was applied which corrects for cardiac motion. CoreValve frame geometry was evaluated according to the same protocol for MSCT and R-angio at the level of: 1) the inflow, 2) the nadirs, 3) central coaptation, and 4) the commissures. The native aortic annulus dimensions were measured at the nadirs of the three leaflets. Sizing ratio, prosthesis expansion and frame ellipticity were assessed. Good quality 3D reconstructions were obtained in 43 patients (84%) and failure was predictable prior to reconstruction in six of the other seven patients (superposition of radiographically dense object n=4, obesity n=2). Prosthesis inflow ellipticity and expansion were correlated with implantation depth (respectively r=-0.46, p<0.01, and r=0.61, p<0.001). Aortic regurgitation grade ≥2 was associated with greater prosthesis ellipticity at the level of central coaptation (median [25th-75th percentile]: 1.15 [1.10-1.20] vs. 1.08 [1.06-1.12], p=0.009). The inter-observer, inter-modality (MSCT, R-angio) variability in measurement at the level of coaptation for minimum diameter, maximum diameter and area were all low (respectively, mean ±SD:1.2% ±1.2; 1.7% ±1.8 and 2.0% ±1.3).R-angio with motion-compensated reconstruction offers new possibilities for evaluation of the post-implantation geometry of percutaneous structural heart prostheses and the potential clinical effects.

Recurrent restenosis following vascular brachytherapy (VBT) has been reported in up to one-third of the patients enrolled in clinical trials. The long-term outcome of repeat percutaneous intervention (PCI) after failed beta-brachytherapy is currently unknown.We retrospectively analyzed 97 consecutive patients undergoing percutaneous coronary reintervention after failed beta-brachytherapy at our institution (80.8% of all brachytherapy failures). Long-term incidence of major adverse cardiac events (MACE, death, myocardial infarction, target lesion revascularization) was assessed.The procedure was successful in 90 patients (92.8%). A new stent was implanted in 72% of the procedures (sirolimus-eluting stent in 16.5%). After 3 years, survival was 94.3%, survival-free from myocardial infarction was 86.7% and MACE-free survival was 66.1%. No difference was observed in MACE-free survival between patients originally treated with brachytherapy for recurrent in-stent restenosis and patients receiving irradiation for de novo lesions (68.2% de novo group versus 61.2% ISR group; p=0.6 by log rank test). Overall, a second target lesion revascularization was performed in 27 patients (27.8%) after an average of 11.2 11.2 months; 21 patients (21.6%) had restenosis, and 6 (6.2%) developed late total vessel occlusion (related to acute myocardial infarction in 2 cases).Repeat PCI is the most common choice after failed brachytherapy. This strategy appears to be a reasonable therapeutic option for this complex iterative pathology.

Objectives This study sought to investigate the effect of post-dilatation on angiographic and intracoronary imaging parameters in the setting of primary percutaneous coronary intervention comparing the everolimus-eluting bioresorbable scaffold (BRS) with the everolimus-eluting metallic stent (EES). Background Routine post-dilatation of BRS has been suggested to improve post-procedural angiographic and subsequent device-related clinical outcomes. Methods In the ABSORB STEMI TROFI II trial, 191 patients with ST-segment elevation myocardial infarction were randomly assigned to treatment with BRS (n = 95) or EES (n = 96). Minimal lumen area and healing score as assessed by optical coherence tomography at 6 months were compared between BRS- and EES-treated patients stratified according to post-dilatation status. Results Primary percutaneous coronary intervention with post-dilatation was performed in 48 (50.5%) BRS- and 25 (25.5%) EES-treated lesions. There were no differences in baseline characteristics and post-procedural minimal lumen diameter between groups. In the BRS group, lesions with post-dilatation were associated with a trend toward a smaller minimal lumen area at 6 months (5.07 ± 1.68 mm2 vs. 5.72 ± 1.77 mm2; p = 0.09) and significantly larger angiographic late lumen loss (0.28 ± 0.34 mm vs. 0.12 ± 0.25 mm; p = 0.02), whereas no difference was observed in the EES arm (5.46 ± 2.18 mm2 vs. 5.55 ± 1.77 mm2; p = 0.85). The neointimal healing score was low and comparable between groups with and without post-dilation (BRS: 1.55 ± 2.61 vs. 1.92 ± 2.17; p = 0.48; EES: 2.50 ± 3.33 vs. 2.90 ± 4.80; p = 0.72). Conclusions In the setting of selected patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention with BRS or EES, post-dilatation did not translate into larger lumen area or improved arterial healing at follow-up. (ABSORB STEMI: The TROFI II; NCT01986803)