Publications

This study reports the results from 3 European centers using rotary ablation with RotablatorTM, a device that is inserted into the coronary artery and removes atheroma by grinding it into millions of tiny fragments. Rotary ablation was performed in 129 patients. Primary success (reduction in percent luminal narrowing >20%, residual stenosis <50%, without complications) was achieved by rotary angioplasty alone in 73 patients (57%). An additional 38 patients (29%) had successful adjunctive balloon angioplasty. Thus primary success was achieved in 111 patients (86%) at the end of the procedure. Acute occlusion occurred in 10 patients (7.7%). Recanalization was achieved by balloon angioplasty in 7: urgent bypass grafting was undertaken in 2. Q-wave and non-Q-wave myocardial infarction occurred in 3 and 7 patients, respectively. No deaths occurred. Follow-up angiography was performed in 74 patients (60%). Restenosis, defined as the recurrence of significant luminal narrowing (>50%) occurred in 17 of 37 patients (46%) who underwent rotary ablation alone, and 11 of 37 patients (30%) who had adjunctive balloon angioplasty. The overall angiographic restenosis rate was 37.8%. In conclusion, rotary ablation is technically feasible, and relatively safe in the coronary circulation. The low primary success rate reflects the limited size of the device, which can be introduced through available guiding catheters, and limits the use of rotary ablation as a stand-alone procedure to lesions in small arteries or in distal locations. No reduction in restenosis was seen, but the role of this device combined with balloon angioplasty in larger arteries needs to be further defined.

Rupture, with subsequent thrombosis, of thin-cap fibroatheromas (TCFAs) is a major cause of myocardial infarction. A TCFA has two main components: these are a large, soft lipid pool and a thin, stiff fibrous cap covering it. Quantification of their morphology and stiffness is essential for monitoring atherosclerosis and quantifying the effect of plaque-stabilizing pharmaceutical treatment. To accomplish this, we have developed a model-based Young’s modulus reconstruction method. From a plaque strain elastogram, measured with an intravascular ultrasound catheter, it reconstructs a Young’s modulus image of the plaque. To this end, a minimization algorithm automatically varies the morphology and stiffness parameters of a TCFA computer model, until the corresponding computer-simulated strain elastogram resembles the measured strain elastogram. The morphology parameters of the model are the control-points of two deformable Bézier curves; one curve delineates the distal border of the lipid pool region, the other the distal border of the cap region. These component regions are assumed to be homogeneous and their stiffness is characterized by a Young’s modulus. Reconstructions from strain elastograms that were 1. simulated using a histology-derived computer TCFA, 2. measured from a physical phantom with a soft lipid pool, and 3. simulated with a computer TCFA, where the complexity of its plaque component borders was increased, demonstrated the superior reconstruction/delineation behavior of this method, compared with a previously developed circular reconstruction method that used only circles for border delineation. Consequently, this method may become a valuable tool for the quantification of both the morphology and stiffness of vulnerable atherosclerotic plaque components. (E-mail: r.baldewsing@erasmusmc.nl)

Background Few data are available about safety of second generation drug eluting stents in an all-comer ST elevation myocardial infarction (STEMI) population. We sought to investigate the predictors and clinical implications of 1-year stent thrombosis (ST) in patients with STEMI, included in the EXAMINATION trial. Methods and results The EXAMINATION trial is an all-comer prospective, randomized 1:1 controlled trial, testing everolimus-eluting stent (EES) vs. cobalt chromium bare metal stent (BMS) in STEMI patients. It included 1498 patients, randomized to EES (n=751) or BMS (n=747). At 1year, definite/probable stent thrombosis, defined according to ARC criteria, occurred in 26 patients (1.73%), including 18 definite and 8 probable events. The incidence of ST was lower in patients treated with EES than in those treated with BMS (HR 0.16, 95% CI 0.03–0.29, p=0.017). Patients with ST have higher 1-year rates of cardiac death (30.8% vs. 2.5%, p<0.001), myocardial infarction (30.8% vs. 0.5%, p<0.001) and target vessel revascularization (65.4% vs. 4.2%, p<0.001) compared with those without. Independent predictors of 1-year definite/probable ST were BMS implantation at the index procedure (HR 3.41, 95% CI 1.35–8.60), ST segment resolution of at least 70% in the EKG post-PCI (HR 0.30, 95% CI 0.13–0.70) and Killip class on admission (HR 2.57, 95% CI 1.70–3.90). Conclusions ST had low frequency in the first year after implantation of EES/BMS in STEMI patients, but it is associated with adverse events. BMS implantation, lack of ST-segment resolution and high Killip class on admission were independent predictors of 1-year ST.

Objectives : Due to the limited distensibility of the everolimus‐eluting bioresorbable vascular scaffold (ABSORB) compared to metallic platform stents, quantitative coronary arteriography (QCA) is a mandatory requirement for ABSORB deployment in the on‐going ABSORB EXTEND Single‐Arm Study. Visual assessment of vessel size in the ABSORB Cohort B study often lead to under and over‐sizing of the 3 mm ABSORB in coronary vessels (recommended range of the vessel diameter ≥2.5 mm and ≤3.3 mm), with an increased risk of spontaneous incomplete scaffold apposition post ABSORB deployment. We report whether mandatory QCA assessment of vessel size pre‐implantation, utilizing the maximal luminal diameter (Dmax) and established interpolated reference vessel diameter (RVD) measurements, has improved device/vessel sizing. Methods : Pre‐implantation post‐hoc QCA analyses of all 101 patients from ABSORB Cohort B (102 lesions) and first consecutive 101 patients (108 lesions) from ABSORB EXTEND were undertaken by an independent core‐laboratory; all patients had a 3 mm ABSORB implanted. Comparative analyses were performed. Results : Within ABSORB Cohort B, a greater number of over‐sized vessels (&gt;3.3 mm) were identified utilizing the Dmax compared to the interpolated RVD (17 vessels, 16.7% vs. 3 vessels, 2.9%; P = 0.002). Comparative analyses demonstrated a greater number of appropriate vessel‐size selection (75 vessels, 69.4% vs. 48 vessels, 47.1%; P = 0.001), a trend towards a reduction in implantation in small (&lt;2.5 mm) vessels (29 vessels, 26.9% vs. 40 vessels, 39.2%; P = 0.057) and a significant decrease in the implantation in large (&gt;3.3 mm) vessels (4 vessels, 3.7% vs. 17 vessels, 16.7%; P = 0.002) in ABSORB EXTEND. Bland–Altman plots suggested a good agreement between operator and core‐laboratory calculated Dmax measurements. Conclusions : The introduction of mandatory Dmax measurements of vessel size prior to ABSORB implantation significantly reduced the under‐sizing of the 3.0 mm scaffold in large vessels validating the use of this technique in vessel sizing prior to ABSORB implantation. © 2011 Wiley Periodicals, Inc.

No abstract is provided for this article.