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Hyunjae Kang - One of the best experts on this subject based on the ideXlab platform.
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a novel noninvasive technology for treatment planning using virtual Coronary Stenting and computed tomography derived computed fractional flow reserve
Jacc-cardiovascular Interventions, 2014Co-Authors: Andrejs Erglis, Han Mo Yang, Kyung Woo Park, Hyunjae KangAbstract:Objectives This study sought to determine whether computational modeling can be used to predict the functional outcome of Coronary Stenting by virtual Stenting of ischemia-causing stenoses identified on the pre-treatment model. Background Computed tomography (CT)-derived fractional flow reserve (FFR) is a novel noninvasive technology that can provide computed (FFRct) using standard Coronary CT angiography protocols. Methods We prospectively enrolled 44 patients (48 lesions) who had Coronary CT angiography before angiography and Stenting, and invasively measured FFR before and after Stenting. FFRct was computed in blinded fashion using Coronary CT angiography and computational fluid dynamics before and after virtual Coronary Stenting. Virtual Stenting was performed by modification of the computational model to restore the area of the target lesion according to the proximal and distal reference areas. Results Before intervention, invasive FFR was 0.70 ± 0.14 and noninvasive FFRct was 0.70 ± 0.15. FFR after Stenting and FFRct after virtual Stenting were 0.90 ± 0.05 and 0.88 ± 0.05, respectively (R = 0.55, p Conclusions Virtual Coronary Stenting of CT-derived computational models is feasible, and this novel noninvasive technology may be useful in predicting functional outcome after Coronary Stenting. (Virtual Coronary Intervention and Noninvasive Fractional Flow Reserve [FFR]; NCT01478100)
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a novel noninvasive technology for treatment planning using virtual Coronary Stenting and computed tomography derived computed fractional flow reserve
Jacc-cardiovascular Interventions, 2014Co-Authors: Andrejs Erglis, Han Mo Yang, Kyung Woo Park, Hyunjae KangAbstract:Objectives This study sought to determine whether computational modeling can be used to predict the functional outcome of Coronary Stenting by virtual Stenting of ischemia-causing stenoses identified on the pre-treatment model. Background Computed tomography (CT)-derived fractional flow reserve (FFR) is a novel noninvasive technology that can provide computed (FFR ct ) using standard Coronary CT angiography protocols. Methods We prospectively enrolled 44 patients (48 lesions) who had Coronary CT angiography before angiography and Stenting, and invasively measured FFR before and after Stenting. FFR ct was computed in blinded fashion using Coronary CT angiography and computational fluid dynamics before and after virtual Coronary Stenting. Virtual Stenting was performed by modification of the computational model to restore the area of the target lesion according to the proximal and distal reference areas. Results Before intervention, invasive FFR was 0.70 ± 0.14 and noninvasive FFR ct was 0.70 ± 0.15. FFR after Stenting and FFR ct after virtual Stenting were 0.90 ± 0.05 and 0.88 ± 0.05, respectively (R = 0.55, p ct and FFR was 0.006 for pre-intervention (95% limit of agreement: –0.27 to 0.28) and 0.024 for post-intervention (95% limit of agreement: –0.08 to 0.13). Diagnostic accuracy of FFR ct to predict ischemia (FFR ≤0.8) prior to Stenting was 77% (sensitivity: 85.3%, specificity: 57.1%, positive predictive value: 83%, and negative predictive value: 62%) and after Stenting was 96% (sensitivity: 100%, specificity: 96% positive predictive value: 50%, and negative predictive value: 100%). Conclusions Virtual Coronary Stenting of CT-derived computational models is feasible, and this novel noninvasive technology may be useful in predicting functional outcome after Coronary Stenting. (Virtual Coronary Intervention and Noninvasive Fractional Flow Reserve [FFR]; NCT01478100 )
Donald E. Cutlip - One of the best experts on this subject based on the ideXlab platform.
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Extended Duration Dual Antiplatelet Therapy After Coronary Stenting Among Patients With Peripheral Arterial Disease: A Subanalysis of the Dual Antiplatelet Therapy Study
JACC. Cardiovascular interventions, 2017Co-Authors: Eric A. Secemsky, Laura Mauri, Dean J Kereiakes, Donald E. Cutlip, Robert W. Yeh, P. Gabriel Steg, Joseph M. Massaro, Patricia Apruzzese, Dual Antiplatelet Therapy Study InvestigatorsAbstract:Abstract Objectives This study sought to determine whether patients with peripheral arterial disease (PAD) experience different reductions in ischemic event and increases in bleeding events with extended duration dual antiplatelet therapy versus those without PAD. Background Patients with PAD have increased ischemic and bleeding risks after Coronary Stenting. Methods The DAPT (Dual Antiplatelet Therapy) study randomized 11,648 patients free from ischemic and bleeding events 12 months after Coronary Stenting to continued thienopyridine plus aspirin therapy for an additional 18 months versus aspirin therapy alone. The effects of continued thienopyridine on myocardial infarction (MI) or stent thrombosis, major adverse cardiovascular and cerebrovascular events (death, MI, or stroke) and bleeding (GUSTO [Global Utilization of t-PA and Streptokinase for Occluded Coronary Arteries] moderate or severe) were assessed among those with versus without PAD. Results Among 11,648 randomized patients, 649 (5.57%) had PAD. Between 12 and 30 months, randomized patients with PAD had higher rates of MI/stent thrombosis (6.03% vs. 2.92%; p Conclusions Among patients undergoing Coronary Stenting, those with PAD have more ischemic and bleeding events versus those without PAD. Extended duration dual antiplatelet therapy is associated with consistent ischemic benefit and bleeding harm among patients with and without PAD.
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Adapting DAPT to Improve Outcomes After Coronary Stenting.
JACC. Cardiovascular interventions, 2016Co-Authors: Donald E. CutlipAbstract:Dual antiplatelet therapy (DAPT) after Coronary Stenting reduces risk for stent thrombosis (ST) and ischemic events unrelated to the stented Coronary segment [(1–3)][1]. Current evidence for optimal duration of DAPT after Coronary Stenting is limited because of conflicting reports regarding the
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Risk of target lesion revascularization after Coronary Stenting in patients with and without chronic kidney disease
Nephrology dialysis transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association, 2007Co-Authors: David M. Charytan, John P. Forman, Donald E. CutlipAbstract:Background. Rates of restenosis following percutaneous Coronary intervention with stent placement are high in patients with advanced renal failure. Whether mild to moderate chronic kidney disease (CKD) is associated with a similarly increased need for short or long-term target lesion revascularization (TLR) following Coronary Stenting is uncertain. Methods. We analysed results from 1228 patients enrolled in four separate, randomized, controlled clinical trials who underwent elective Coronary angioplasty with Stenting and were prospectively followed for 5 years after the index procedure. Cox proportional hazards regression was used to correct for confounding and to estimate the short and long-terms risks of target lesion revascularization in patients with vs without mild to moderate CKD. Results. During a median follow-up of 5 years, 205 patients (16.7%) required TLR with 59 (4.8%) requiring TLR after the first year. Mild (HR 1.07, 95% CI 0.74–1.53) and moderate (HR 0.95, 95% CI 0.552–1.64) CKD were not associated with an increase in the adjusted, overall-risk of TLR. However, mild to moderate CKD was associated with a non-significantly increased risk of late TLR (HR 1.40, 95% CI 0.73–2.69). Conclusions. Coronary Stenting appears to be similarly effective in patients with mild to moderate CKD and patients with normal renal function. While target lesion revascularization is rarely needed beyond the first year after revascularization, long-term results of Coronary Stenting may be less-favourable in patients with CKD.
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clinical restenosis after Coronary Stenting perspectives from multicenter clinical trials
Journal of the American College of Cardiology, 2002Co-Authors: Donald E. Cutlip, Jeffrey J. Popma, Manish S Chauhan, Donald S Baim, Joseph P Carrozza, David J Cohen, Richard E KuntzAbstract:Abstract Objectives We sought to evaluate clinical restenosis in a large population of patients who had undergone Coronary stent placement. Background One-year success after Coronary Stenting is limited mainly by restenosis of and requirement for repeat revascularization of the treated lesion. Methods We studied 6,186 patients (6,219 lesions) pooled from several recently completed Coronary stent trials. Clinical restenosis was defined using three different definitions: target lesion revascularization (TLR) beyond 30 days, target vessel revascularization (TVR) beyond 30 days, and target vessel failure (TVF), defined as TVR, any death, or myocardial infarction (MI) of the target vessel territory after hospital discharge. Results By one year, 638 (12.2%) patients had TLR, 748 (14.3%) had TVR, and 848 (16.0%) had TVF, more than two-thirds higher than the rate of these end points at six months. The severity of angiographic restenosis (≥50% follow-up diameter stenosis [DS]) in 419 of 1,437 (29%) patients undergoing routine angiographic follow-up correlated directly with the likelihood of TLR (73% vs. 26% for >70% DS compared with Conclusions At one year after Stenting, most clinical restenosis reflected TLR, which was predicted by the same variables previously associated with an increased risk of angiographic restenosis. The lower absolute rate of clinical restenosis relative to angiographic restenosis was due to infrequent TLR in lesions with less severe (
Andrejs Erglis - One of the best experts on this subject based on the ideXlab platform.
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a novel noninvasive technology for treatment planning using virtual Coronary Stenting and computed tomography derived computed fractional flow reserve
Jacc-cardiovascular Interventions, 2014Co-Authors: Andrejs Erglis, Han Mo Yang, Kyung Woo Park, Hyunjae KangAbstract:Objectives This study sought to determine whether computational modeling can be used to predict the functional outcome of Coronary Stenting by virtual Stenting of ischemia-causing stenoses identified on the pre-treatment model. Background Computed tomography (CT)-derived fractional flow reserve (FFR) is a novel noninvasive technology that can provide computed (FFRct) using standard Coronary CT angiography protocols. Methods We prospectively enrolled 44 patients (48 lesions) who had Coronary CT angiography before angiography and Stenting, and invasively measured FFR before and after Stenting. FFRct was computed in blinded fashion using Coronary CT angiography and computational fluid dynamics before and after virtual Coronary Stenting. Virtual Stenting was performed by modification of the computational model to restore the area of the target lesion according to the proximal and distal reference areas. Results Before intervention, invasive FFR was 0.70 ± 0.14 and noninvasive FFRct was 0.70 ± 0.15. FFR after Stenting and FFRct after virtual Stenting were 0.90 ± 0.05 and 0.88 ± 0.05, respectively (R = 0.55, p Conclusions Virtual Coronary Stenting of CT-derived computational models is feasible, and this novel noninvasive technology may be useful in predicting functional outcome after Coronary Stenting. (Virtual Coronary Intervention and Noninvasive Fractional Flow Reserve [FFR]; NCT01478100)
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a novel noninvasive technology for treatment planning using virtual Coronary Stenting and computed tomography derived computed fractional flow reserve
Jacc-cardiovascular Interventions, 2014Co-Authors: Andrejs Erglis, Han Mo Yang, Kyung Woo Park, Hyunjae KangAbstract:Objectives This study sought to determine whether computational modeling can be used to predict the functional outcome of Coronary Stenting by virtual Stenting of ischemia-causing stenoses identified on the pre-treatment model. Background Computed tomography (CT)-derived fractional flow reserve (FFR) is a novel noninvasive technology that can provide computed (FFR ct ) using standard Coronary CT angiography protocols. Methods We prospectively enrolled 44 patients (48 lesions) who had Coronary CT angiography before angiography and Stenting, and invasively measured FFR before and after Stenting. FFR ct was computed in blinded fashion using Coronary CT angiography and computational fluid dynamics before and after virtual Coronary Stenting. Virtual Stenting was performed by modification of the computational model to restore the area of the target lesion according to the proximal and distal reference areas. Results Before intervention, invasive FFR was 0.70 ± 0.14 and noninvasive FFR ct was 0.70 ± 0.15. FFR after Stenting and FFR ct after virtual Stenting were 0.90 ± 0.05 and 0.88 ± 0.05, respectively (R = 0.55, p ct and FFR was 0.006 for pre-intervention (95% limit of agreement: –0.27 to 0.28) and 0.024 for post-intervention (95% limit of agreement: –0.08 to 0.13). Diagnostic accuracy of FFR ct to predict ischemia (FFR ≤0.8) prior to Stenting was 77% (sensitivity: 85.3%, specificity: 57.1%, positive predictive value: 83%, and negative predictive value: 62%) and after Stenting was 96% (sensitivity: 100%, specificity: 96% positive predictive value: 50%, and negative predictive value: 100%). Conclusions Virtual Coronary Stenting of CT-derived computational models is feasible, and this novel noninvasive technology may be useful in predicting functional outcome after Coronary Stenting. (Virtual Coronary Intervention and Noninvasive Fractional Flow Reserve [FFR]; NCT01478100 )
Albert Schomig - One of the best experts on this subject based on the ideXlab platform.
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antiplatelet effects of abciximab tirofiban and eptifibatide in patients undergoing Coronary Stenting
Journal of the American College of Cardiology, 2001Co-Authors: Franzjosef Neumann, Albert Schomig, Willibald Hochholzer, Gisela Pogatsamurray, Meinrad GawazAbstract:Abstract OBJECTIVES We sought to investigate whether abciximab, tirofiban and eptifibatide achieve comparable antiplatelet effects with Coronary Stenting. BACKGROUND The glycoprotein (GP) IIb/IIIa antagonists abciximab, tirofiban and eptifibatide differ in chemical structure, binding site and pharmacokinetics. METHODS Sixty patients undergoing Coronary Stenting were randomly assigned to abciximab (bolus 0.25 mg/kg body weight, infusion 10 μg per min for 12 h), tirofiban (bolus 10 μg/kg, infusion 0.15 μg/kg per min for 72 h) or eptifibatide (bolus 180 μg/kg, infusion 2 μg/kg per min for 72 h). We took serial blood samples to analyze platelet function by using flow cytometry, turbidimetric aggregometry and the rapid platelet-function assay (RPFA). RESULTS As assessed by RPFA, platelet aggregation after 2 h of infusion was reduced to 5.9 ± 7.8% (mean ± SD) of baseline by abciximab, to 5.0 ± 5.4% by tirofiban and to 7.8 ± 7.1% by eptifibatide (p = 0.42). Turbidimetric aggregometry with adenosine diphosphate stimulation yielded similar results, whereas percent inhibition of platelet aggregation after thrombin receptor stimulation was 45.8 ± 16.8% with abciximab, 51.3 ± 17.6% with tirofiban and 52.9 ± 14.8% with eptifibatide (p = 0.37). Tirofiban and eptifibatide maintained their level of platelet inhibition during infusion. Flow cytometry revealed that the reduction in the monocyte-platelet interaction by abciximab, tirofiban and eptifibatide was not significantly different (20.0 ± 21.9%, 23.8 ± 18.2% and 21.0 ± 19.8%, respectively; p = 0.87). CONCLUSIONS Abciximab, tirofiban and eptifibatide, at currently recommended doses, achieved similar levels of inhibition of platelet aggregation and a similar reduction in the platelet–monocyte interaction.
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Coronary Stenting plus platelet glycoprotein iib iiia blockade compared with tissue plasminogen activator in acute myocardial infarction
The New England Journal of Medicine, 2000Co-Authors: Albert Schomig, Franzjosef Neumann, Adnan Kastrati, Josef Dirschinger, Julinda Mehilli, Ullrich Schricke, Jurgen Pache, Stefan Martinoff, Markus SchwaigerAbstract:Background Prevention of myocardial damage is the main goal of all reperfusion therapies in patients with acute myocardial infarction. The relative efficacy of various reperfusion strategies is under intensive investigation. We assessed whether Coronary Stenting combined with the blockade of platelet glycoprotein IIb/IIIa receptors produces a greater degree of myocardial salvage than fibrinolysis with an accelerated infusion of alteplase, a tissue plasminogen activator. Methods A total of 140 patients were enrolled in the randomized trial; 71 were assigned to receive a stent plus abciximab, and 69 to receive intravenous alteplase. The primary end point was the degree of myocardial salvage, determined by means of serial scintigraphic studies with technetium Tc 99m sestamibi. The secondary end point was a composite of death, reinfarction, and stroke within six months after randomization. Results In the group that received a stent plus abciximab, the median size of the final infarct was 14.3 percent of the l...
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Long-term outcome after Coronary Stenting
Trials, 2000Co-Authors: Adnan Kastrati, Donald Hall, Albert SchomigAbstract:The present review assesses the data on long-term outcome after Coronary Stenting. Histological, angiographical and intravascular imaging data have shown that the insertion of stents constitutes only a transient stimulus to lumen renarrowing, that this process is almost complete at 6 months and that a certain degree of neointima regression is also possible after this time. Clinical data have confirmed the sustained benefit of Stenting in the long term. Careful selection of optimal stent designs and application of the recent advances in adjunctive pharmacological therapy are currently effective strategies to improve both short-and long-term results with Coronary Stenting. However, further efforts are needed and are ongoing to combat restenosis, a process that counters the excellent short-term results of Stenting in the long term.
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antiplatelet effect of ticlopidine after Coronary Stenting
Journal of the American College of Cardiology, 1997Co-Authors: Franzjosef Neumann, Timm Dickfeld, Anne Wehinger, Hanna Walter, Rudolf Blasini, Meinrad Gawaz, Albert SchomigAbstract:Abstract Objectives. This study sought to investigate the contribution of ticlopidine to the inhibition of platelet activation after Coronary stent placement. Background. After Coronary Stenting, antiplatelet therapy with aspirin and ticlopidine improves stent patency compared with anticoagulation. However, the specific role of ticlopidine has not been elucidated. Methods. After successful Coronary stent placement, we randomized 22 patients to receive ticlopidine and aspirin (ticlopidine group) and 25 to receive aspirin alone (aspirin group). Surface expression on platelets of the activated fibrinogen receptor and of P-selectin was assessed by flow cytometry. Results. In the aspirin group the percent of platelets with activated fibrinogen receptors increased between days 1 and 5 (p = 0.001), whereas there were no substantial changes in the ticlopidine group. The percent of P-selectin–positive platelets did not change significantly in the aspirin group but decreased in the ticlopidine group (p = 0.019). At day 5 after the intervention, the percent of platelets with activated fibrinogen receptors in the ticlopidine group was significantly lower (median [interquartile range]: 8.5 [3.1 to 17.8] vs. 18.1 [8.5 to 35.5], p = 0.025), and there was a trend to fewer P-selectin–positive platelets than in the aspirin group (5.8 [3.4 to 9.5] vs. 8.8 [4.0 to 15.8], p = 0.073). Conclusions. Combined antiplatelet therapy with ticlopidine plus aspirin is superior to treatment with aspirin alone in suppressing platelet activation after Coronary Stenting. (J Am Coll Cardiol 1997;29:1515–9)
D. Barry O'keeffe - One of the best experts on this subject based on the ideXlab platform.
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Coronary Stenting in the setting of spontaneous Coronary artery dissection.
International journal of cardiology, 1998Co-Authors: Colm G. Hanratty, Pascal P. Mckeown, D. Barry O'keeffeAbstract:Spontaneous Coronary artery dissection is a rare cause of myocardial ischaemia. Typically it affects young, apparently healthy females, and may result in significant myocardial loss or even death. Due to the rarity of the condition there are no clear guidelines for its management. We describe two cases of spontaneous Coronary artery dissection and report successful Coronary Stenting of the affected artery in one patient. We believe that this interventional technique may be the treatment of choice in selected patients with this condition.