Background The association between vulnerability of plaque assessed with intravascular ultrasound （IVUS） and plasma levels of fibrinolytic biomarkers was determined in patients with acute coronary syndrome （ACS）. ...Background The association between vulnerability of plaque assessed with intravascular ultrasound （IVUS） and plasma levels of fibrinolytic biomarkers was determined in patients with acute coronary syndrome （ACS）. However, few data are available on the relationship between the levels of tissue type plasminogen activator （t-PA） and virtual histological intravascular ultrasound （VH-IVUS） signs of plaque instability. Methods Eighty-nine patients with ACS were enrolled in the study. Blood was collected to measure t-PA levels by liquid phase bead flow cytometry. Eighty-nine nonbifurcate lesions （identified by coronary angiography and ECG） were investigated using IVUS before catheterization. IVUS radiofrequency data obtained with a 20 MHz catheter were analyzed with IVUS virtual histological software. The areas of plaque and media were calculated and lesions were classified into two groups： VH-IVUS derived thin cap fibroatheroma （VH-TCFA） and non-VH-TCFA plaque. Results Plasma t-PA level in the patients with TCFA was significantly lower than that with non-TCFA （（1489 ± 715） pg/ml vs （2163 ± 1004） pg/ml）. Decreased plasma levels of t-PA were associated with plaque vulnerability. Plasma levels of t-PA correlated negatively with plaque plus media and necrotic core in plaque in patients with ACS. Conclusions t-PA is an independent risk factor and a powerful predictor of vulnerable plaques. Decreased levels of t-PA may reflect instability of atherosclerotic plaques and might therefore serve as noninvasive determinants of those at high risk for consequent adverse events.展开更多
Background The double kissing （DK） crush technique is a modified version of the crush technique. It is specifically designed to increase the success rate of the final kissing balloon post-dilatation, but its efficac...Background The double kissing （DK） crush technique is a modified version of the crush technique. It is specifically designed to increase the success rate of the final kissing balloon post-dilatation, but its efficacy and safety remain unclear. Methods Data were obtained from the DKCRUSH-I trial, a prospective, randomized, multi-center study to evaluate safety and efficacy. Post-procedural and eight-month follow-up intravascular ultrasound （IVUS） analysis was available in 61 cases. Volumetric analysis using Simpson＇s method within the Taxus stent, and cross-sectional analysis at the five sites of the main vessel （MV） and three sites of the side branch （SB） were performed. Impact of the bifurcation angle on stent expansion at the carina was also evaluated. Results Stent expansion in the SB ostium was significantly less the DK crush group （（72.27±11.46）%） （P=0.04）. For the MV, the n the classical crush group （（53.81±13.51）%） than in ncidence of incomplete crush was 41.9% in the DK group and 70.0% in the classical group （P=0.03）. The percentage of neointimal area at the ostium had a tendency to be smaller in the DK group compared with the classical group （（16.4±19.2）% vs. （22.8±27.1）%, P=0.06）. The optimal threshold of post-procedural minimum stent area （MSA） to predict follow-up minimum lumen area （MLA） 〈4.0 mm2 at the SB ostium was 4.55 mm2, yielding an area under the curve of 0.80 （95% confidence interval： 0.61 to 0.92）. Conclusion Our data suggest that the DK crush technique is associated with improved quality of the final kissing balloon inflation （FKBI） and had smaller optimal cutoff value of post-procedural MSA at the SB ostium.展开更多
BACKGROUND： Cerebrovascular intervention is a medical strategy to diagnose and treat cerehrovascular disease by intravascular intervention techniques. With the continual developments of computer technology, imageolog...BACKGROUND： Cerebrovascular intervention is a medical strategy to diagnose and treat cerehrovascular disease by intravascular intervention techniques. With the continual developments of computer technology, imageology, and angiography, cerebrovascular intervention techniques have developed rapidly. OBJECTIVE： To summarize and to evaluate vascular imaging diagnostic techniques, vascular intra-arterial thrombolysis, vascular intra-arterial angioplasty, and vascular embolization in clinical applications. RETRIEVAL STRATEGY： An online search was conducted in PubMed for English language reports, published from January 2002 to January 2008, containing the key words： intervention therapy, cerebral vascular disease, endovascular intervention and angioplasty. A total of 57 publications were identified. Inclusion criteria： articles about cerebrovascular intervention for cerebrovascular disease; articles published either in high impact factor journals or in recent years. Exclusion criteria： duplicated articles. LITERATURE EVALUATION; 30 articles were identified concerning intravascular intervention techniques and arterial angioplasty. Of those, 7 articles were reviews and 23 were clinical or basic studies. DATA SYNTHESIS： Carotid artery and basilar artery stenosis were important etiological factors for ischemic cerebrovascular disease. The mechanism of stenosis induction included atherosclerotic plaque exfoliation and stenosis could cause hemodynamic changes to induce cerebral infarction. Therefore, the treatment of carotid artery and basilar artery stenosis played a key role in preventing ischemic cerebral infarction. The international organization for subarachnoid hemorrhage aneurysm has conclusively shown that both relative and absolute risk factors of intravascular embolotherapy were reduced compared to those of surgical occlusion, demonstrating the important role of vascular embolization for the treatment of intracranial aneurysm. Endovascular stents were placed into the intracavities of affected vessels 展开更多
Percutaneous coronary intervention (PCI) of chronic total occlusion (CTO) represents the most technically challenging procedure in contemporary interventional cardiology.[1] Blunt lesions and presence of proximal side...Percutaneous coronary intervention (PCI) of chronic total occlusion (CTO) represents the most technically challenging procedure in contemporary interventional cardiology.[1] Blunt lesions and presence of proximal side branch are considered to be strong predictors of reduced technical success.[ 2,3] For such lesions, the antegrade approach may not be feasible or desirable, and the retrograde approach can be used as the initial crossing strategy. However, when treating the blunt CTO with a large side branch proximal to the occlusion, the side branch might be occluded after stent implantation if the retrograde guidewire passed the occluded segment through the subintimal space and re-entered into the true lumen at the opposite side of the side branch.[4] We reported a useful method to solve the above issue which utilizes intravascular ultrasound (IVUS) to guide “extended” reverse controlled antegrade and retrograde subintimal tracking (CART) technique with a cutting balloon.展开更多
文摘Background The association between vulnerability of plaque assessed with intravascular ultrasound （IVUS） and plasma levels of fibrinolytic biomarkers was determined in patients with acute coronary syndrome （ACS）. However, few data are available on the relationship between the levels of tissue type plasminogen activator （t-PA） and virtual histological intravascular ultrasound （VH-IVUS） signs of plaque instability. Methods Eighty-nine patients with ACS were enrolled in the study. Blood was collected to measure t-PA levels by liquid phase bead flow cytometry. Eighty-nine nonbifurcate lesions （identified by coronary angiography and ECG） were investigated using IVUS before catheterization. IVUS radiofrequency data obtained with a 20 MHz catheter were analyzed with IVUS virtual histological software. The areas of plaque and media were calculated and lesions were classified into two groups： VH-IVUS derived thin cap fibroatheroma （VH-TCFA） and non-VH-TCFA plaque. Results Plasma t-PA level in the patients with TCFA was significantly lower than that with non-TCFA （（1489 ± 715） pg/ml vs （2163 ± 1004） pg/ml）. Decreased plasma levels of t-PA were associated with plaque vulnerability. Plasma levels of t-PA correlated negatively with plaque plus media and necrotic core in plaque in patients with ACS. Conclusions t-PA is an independent risk factor and a powerful predictor of vulnerable plaques. Decreased levels of t-PA may reflect instability of atherosclerotic plaques and might therefore serve as noninvasive determinants of those at high risk for consequent adverse events.
文摘Background The double kissing （DK） crush technique is a modified version of the crush technique. It is specifically designed to increase the success rate of the final kissing balloon post-dilatation, but its efficacy and safety remain unclear. Methods Data were obtained from the DKCRUSH-I trial, a prospective, randomized, multi-center study to evaluate safety and efficacy. Post-procedural and eight-month follow-up intravascular ultrasound （IVUS） analysis was available in 61 cases. Volumetric analysis using Simpson＇s method within the Taxus stent, and cross-sectional analysis at the five sites of the main vessel （MV） and three sites of the side branch （SB） were performed. Impact of the bifurcation angle on stent expansion at the carina was also evaluated. Results Stent expansion in the SB ostium was significantly less the DK crush group （（72.27±11.46）%） （P=0.04）. For the MV, the n the classical crush group （（53.81±13.51）%） than in ncidence of incomplete crush was 41.9% in the DK group and 70.0% in the classical group （P=0.03）. The percentage of neointimal area at the ostium had a tendency to be smaller in the DK group compared with the classical group （（16.4±19.2）% vs. （22.8±27.1）%, P=0.06）. The optimal threshold of post-procedural minimum stent area （MSA） to predict follow-up minimum lumen area （MLA） 〈4.0 mm2 at the SB ostium was 4.55 mm2, yielding an area under the curve of 0.80 （95% confidence interval： 0.61 to 0.92）. Conclusion Our data suggest that the DK crush technique is associated with improved quality of the final kissing balloon inflation （FKBI） and had smaller optimal cutoff value of post-procedural MSA at the SB ostium.
文摘BACKGROUND： Cerebrovascular intervention is a medical strategy to diagnose and treat cerehrovascular disease by intravascular intervention techniques. With the continual developments of computer technology, imageology, and angiography, cerebrovascular intervention techniques have developed rapidly. OBJECTIVE： To summarize and to evaluate vascular imaging diagnostic techniques, vascular intra-arterial thrombolysis, vascular intra-arterial angioplasty, and vascular embolization in clinical applications. RETRIEVAL STRATEGY： An online search was conducted in PubMed for English language reports, published from January 2002 to January 2008, containing the key words： intervention therapy, cerebral vascular disease, endovascular intervention and angioplasty. A total of 57 publications were identified. Inclusion criteria： articles about cerebrovascular intervention for cerebrovascular disease; articles published either in high impact factor journals or in recent years. Exclusion criteria： duplicated articles. LITERATURE EVALUATION; 30 articles were identified concerning intravascular intervention techniques and arterial angioplasty. Of those, 7 articles were reviews and 23 were clinical or basic studies. DATA SYNTHESIS： Carotid artery and basilar artery stenosis were important etiological factors for ischemic cerebrovascular disease. The mechanism of stenosis induction included atherosclerotic plaque exfoliation and stenosis could cause hemodynamic changes to induce cerebral infarction. Therefore, the treatment of carotid artery and basilar artery stenosis played a key role in preventing ischemic cerebral infarction. The international organization for subarachnoid hemorrhage aneurysm has conclusively shown that both relative and absolute risk factors of intravascular embolotherapy were reduced compared to those of surgical occlusion, demonstrating the important role of vascular embolization for the treatment of intracranial aneurysm. Endovascular stents were placed into the intracavities of affected vessels
文摘Percutaneous coronary intervention (PCI) of chronic total occlusion (CTO) represents the most technically challenging procedure in contemporary interventional cardiology.[1] Blunt lesions and presence of proximal side branch are considered to be strong predictors of reduced technical success.[ 2,3] For such lesions, the antegrade approach may not be feasible or desirable, and the retrograde approach can be used as the initial crossing strategy. However, when treating the blunt CTO with a large side branch proximal to the occlusion, the side branch might be occluded after stent implantation if the retrograde guidewire passed the occluded segment through the subintimal space and re-entered into the true lumen at the opposite side of the side branch.[4] We reported a useful method to solve the above issue which utilizes intravascular ultrasound (IVUS) to guide “extended” reverse controlled antegrade and retrograde subintimal tracking (CART) technique with a cutting balloon.
