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Gary S Mintz - One of the best experts on this subject based on the ideXlab platform.

  • effect of Intravascular Ultrasound guided drug eluting stent implantation 5 year follow up of the ivus xpl randomized trial
    Jacc-cardiovascular Interventions, 2020
    Co-Authors: Sung Jin Hong, Gary S Mintz, Chul Min Ahn, Jung Sun Kim, Byeong Keuk Kim, Taesoo Kang, Woongchol Kang, Yong Hoon Kim, Seung Ho Hur, Bumkee Hong
    Abstract:

    Abstract Objectives The goal of this study was to evaluate whether the beneficial effect of use of Intravascular Ultrasound (IVUS) is sustained for long-term follow-up. Background The use of IVUS promoted favorable 1-year clinical outcome in the IVUS-XPL (Impact of Intravascular Ultrasound Guidance on the Outcomes of Xience Prime Stents in Long Lesions) trial. It is not known, however, whether this effect is sustained for long-term follow-up. Methods The IVUS-XPL trial randomized 1,400 patients with long coronary lesions (implanted stent length ≥28 mm) to receive IVUS-guided (n = 700) or angiography-guided (n = 700) everolimus-eluting stent implantation. Five-year clinical outcomes were investigated in patients who completed the original trial. The primary outcome was the composite of major adverse cardiac events, including cardiac death, target lesion–related myocardial infarction, or ischemia-driven target lesion revascularization at 5 years, analyzed by intention-to-treat. Results Five-year follow-up was completed in 1,183 patients (85%). Major adverse cardiac events at 5 years occurred in 36 patients (5.6%) receiving IVUS guidance and in 70 patients (10.7%) receiving angiographic guidance (hazard ratio: 0.50; 95% confidence interval: 0.34 to 0.75; p = 0.001). The difference was driven mainly by a lower risk for target lesion revascularization (31 [4.8%] vs. 55 [8.4%]; hazard ratio: 0.54; 95% confidence interval: 0.33 to 0.89; p = 0.007). By landmark analysis, major adverse cardiac events between 1 and 5 years occurred in 17 patients (2.8%) receiving IVUS guidance and in 31 patients (5.2%) receiving angiographic guidance (hazard ratio: 0.53; 95% confidence interval: 0.29 to 0.95; p = 0.031). Conclusions Compared with angiography-guided stent implantation, IVUS-guided stent implantation resulted in a significantly lower rate of major adverse cardiac events up to 5 years. Sustained 5-year clinical benefits resulted from both within 1 year and from 1 to 5 years post-implantation. (Impact of Intravascular Ultrasound Guidance on the Outcomes of Xience Prime Stents in Long Lesions [IVUS-XPL Study]: Retrospective and Prospective Follow-Up Study; NCT03866486)

  • comparison of optical coherence tomography versus Intravascular Ultrasound detection of tissue protrusion and acute stent vessel wall malapposition in 498 patients after drug eluting stent implantation
    Journal of the American College of Cardiology, 2017
    Co-Authors: Yongqing Lin, Gary S Mintz, Mitsuaki Matsumura, Xiao Wang, Cheolmin Lee, Tsunekazu Kakuta, Akiko Maehara
    Abstract:

    Background: Optical coherence tomography (OCT) has higher resolution and improved tissue characterization compared to Intravascular Ultrasound (IVUS). Methods: We retrospectively analyzed 498 pts (44.1% acute coronary syndrome) who underwent stent implantation with final IVUS and OCT. Tissue

  • tissue characterization of in stent neointima using Intravascular Ultrasound radiofrequency data analysis
    American Journal of Cardiology, 2010
    Co-Authors: Soojin Kang, Gary S Mintz, Seongwook Park, Dukwoo Park, Seungjung Park
    Abstract:

    Using virtual histology and Intravascular Ultrasound (VH-IVUS), tissue characterization of restenotic in-stent neointima after drug-eluting stent (DES) and bare metal stent (BMS) implantation was assessed. VH-IVUS was performed in 117 lesions (70 treated with DESs and 47 treated with BMSs) with angiographic in-stent restenosis and intimal hyperplasia (IH) >50% of the stent area. The region of interest was placed between the luminal border and the inner border of the struts and tissue composition was reported as percentages of IH area (percent fibrous, percent fibrofatty, percent necrotic core, percent dense calcium) at the 2 sites of maximal percent IH and maximal percent necrotic core. Mean follow-up times between stent implantation and VH-IVUS study were 43.5 ± 33.8 months for BMS-treated lesions and 11.1 ± 7.8 months for DES-treated lesions (p

  • Intravascular Ultrasound findings in patients with very late stent thrombosis after either drug eluting or bare metal stent implantation
    Journal of the American College of Cardiology, 2010
    Co-Authors: Cheol Whan Lee, Seongwook Park, Gary S Mintz, Sujin Kang, Dukwoo Park, Seunghwan Lee, Younghak Kim, Jaejoong Kim, Seungjung Park
    Abstract:

    Objectives: This study compared Intravascular Ultrasound (IVUS) findings at drug-eluting stent (DES) and bare-metal stent (BMS) sites in patients with very late stent thrombosis (VLST).Background: ...

  • a volumetric Intravascular Ultrasound comparison of early drug eluting stent thrombosis versus restenosis
    Jacc-cardiovascular Interventions, 2009
    Co-Authors: Xuebo Liu, George Dangas, Gary S Mintz, Akiko Maehara, Giora Weisz, Hiroshi Doi, Jose De Ribamar Costa, Koichi Sano, Alexandra J Lansky, Edward M Kreps
    Abstract:

    Objectives We compared Intravascular Ultrasound findings of drug-eluting stent (DES)–treated lesions that developed thrombosis versus in-stent restenosis (ISR). Background Stent underexpansion is a predictor of both DES thrombosis and ISR. However, all underexpanded DES may not be equal. Methods Intravascular Ultrasound findings from 20 definite DES thrombosis patients (representing all definite thromboses from 1,407 consecutive DES patients undergoing Intravascular Ultrasound imaging) were compared with 50 risk-factor-balanced ISR patients with no evidence of stent thrombosis and 50 risk-factor-balanced “no-event” patients with neither thrombosis nor ISR. Results Minimum stent area (3.9 ± 1.0 mm2 vs. 5.0 ± 1.7 mm2, p = 0.008), mean stent area (5.3 ± 1.0 mm2 vs. 7.2 ± 2.0 mm2, p = 0.001), and both focal (55.4 ± 13.2% vs. 74.9 ± 19.9%, p Conclusions The DES-treated lesions that develop thrombosis or restenosis are often underexpanded, but underexpansion associated with thrombosis is more severe, diffuse, and proximal in location.

Akiko Maehara - One of the best experts on this subject based on the ideXlab platform.

Martin B Leon - One of the best experts on this subject based on the ideXlab platform.

  • a randomized controlled trial of angiography versus Intravascular Ultrasound directed bare metal coronary stent placement the avid trial
    Circulation-cardiovascular Interventions, 2009
    Co-Authors: Robert J Russo, Peter J. Fitzgerald, Charles J Davidson, Patricia D Silva, Paul S Teirstein, Michael J Attubato, Anthony C Defranco, Steven L Goldberg, James B Hermiller, Martin B Leon
    Abstract:

    Background— AVID (Angiography Versus Intravascular Ultrasound-Directed stent placement) is a multicenter, randomized controlled trial designed to assess the effect of Intravascular Ultrasound (IVUS)-directed stent placement on the 12-month rate of target lesion revascularization (TLR). Methods and Results— After elective coronary stent placement and an optimal angiographic result (<10% stenosis), 800 patients were randomized to Angiography- or IVUS-directed therapy. Blinded IVUS was performed in the Angiography group without further therapy. In the IVUS group, IVUS criteria for optimal stent placement (<10% area stenosis, apposition, and absence of dissection) were applied. Final minimum stent area was 6.90�2.43 mm2 in the Angiography group and 7.55�2.82 mm2 in the IVUS group (P=0.001). In the IVUS group, only 37% with inadequate expansion (<90%) received further therapy. The 12-month TLR rate was 12.0% in the Angiography group and 8.1% in the IVUS group (P=0.08, 95% confidence level [CI], [−8.3% to 0.5%]...

  • contribution of inadequate arterial remodeling to the development of focal coronary artery stenoses an Intravascular Ultrasound study
    Circulation, 1997
    Co-Authors: Gary S Mintz, Jeffrey J Popma, Augusto D Pichard, Kenneth M Kent, Lowell F Satler, Martin B Leon
    Abstract:

    Background Adaptive remodeling occurs to compensate for the accumulation of atherosclerotic plaque. Lumen reduction depends on the relative rates of plaque deposition and adaptive remodeling responses. Intravascular Ultrasound permits detailed, high-quality, cross-sectional imaging of the coronary arteries in vivo. Methods and Results Preintervention Intravascular Ultrasound was used to study 603 focal, new, nonostial significant coronary artery stenoses in patients with chronic stable angina. Measurements of the target lesion of the external elastic membrane (EEM), lumen, and plaque plus media (PM P&M=EEM−Lumen) cross-sectional areas (CSAs) were compared with a proximal reference segment (most normal-looking cross section within 10 mm proximal to the lesion but distal to any side branch). Inadequate remodeling was defined as lesion/reference EEM CSA that exceeded the upper limits of normal arterial tapering (lesion/reference EEM CSA ratio ≤0.78 or a 21% reduction in EEM CSA per 10-mm length). Overall, ...

  • arterial remodeling after coronary angioplasty a serial Intravascular Ultrasound study
    Circulation, 1996
    Co-Authors: Gary S Mintz, Jeffrey J Popma, Augusto D Pichard, Kenneth M Kent, Lowell F Satler, Mun K. Hong, Chiu S Wong, Julie A Kovach, Martin B Leon
    Abstract:

    Background Restenosis occurs after 30% to 50% of transcatheter coronary procedures; however, the natural history and pathophysiology of restenosis are still incompletely understood. Methods and Results Serial (postintervention and follow-up) Intravascular Ultrasound imaging was used to study 212 native coronary lesions in 209 patients after percutaneous transluminal coronary angioplasty, directional coronary atherectomy, rotational atherectomy, or excimer laser angioplasty. The external elastic membrane (EEM) and lumen cross-sectional areas (CSA) were measured; plaque plus media (P+M) CSA was calculated as EEM minus lumen CSA. The anatomic slice selected for serial analysis had an axial location within the target lesion at the smallest follow-up lumen CSA. At follow-up, 73% of the decrease in lumen (from 6.6±2.5 to 4.0±3.7 mm2, P<.0001) was due to a decrease in EEM (from 20.1±6.4 to 18.2±6.4 mm2, P<.0001); 27% was due to an increase in P+M (from 13.5±5.5 to 14.2±5.4 mm2, P<.0001). ΔLumen CSA correlated mo...

  • in vivo validation of Intravascular Ultrasound length measurements using a motorized transducer pullback system
    American Journal of Cardiology, 1996
    Co-Authors: Rolf T Fuessl, Gary S Mintz, Jeffrey J Popma, Augusto D Pichard, Kenneth M Kent, Lowell F Satler, Martin B Leon
    Abstract:

    Abstract With use of endovascular targets of known length, IVUS lesion length measurements have been validated in vivo. Intravascular Ultrasound imaging using motorized pullback of the transducer and imaging core through a stationary imaging sheath may prove to be a useful clinical and experimental adjunct to conventional cross-sectional image analysis.

  • small stent size and intimal hyperplasia contribute to restenosis a volumetric Intravascular Ultrasound analysis
    Journal of the American College of Cardiology, 1995
    Co-Authors: Gaston R Dussaillant, Augusto D Pichard, Kenneth M Kent, Lowell F Satler, Chiu S Wong, Martin B Leon
    Abstract:

    Objectives The purpose of this study was to use volumetric Intravascular Ultrasound analysis of Palmaz-Schatz stents to assess the in-stent restenotic process. Background By reducing lesion elastic recoil and chronic arterial remodeling, stents improve the long-term results of coronary angioplasty. However, stents are prone to the development of neointimal hyperplasia. Angiographic studies of stent restenosis have suggested that these hyperplastic responses are the cause of in-stent restenosis; however, it is difficult to visualize the radiolucent Palmaz-Schatz stent by angiography. Intravascular Ultrasound provides detailed cross-sectional imaging of the coronary arteries, especially the intense metallic reflection of endovascular stents. Methods Forty-four patients with 60 Palmaz-Schatz stents underwent Intravascular Ultrasound imaging at follow-up ([mean ± SD] 8.8 ± 7.2 months after implantation). Thirty-four stents were placed in saphenous vein grafts and 26 in native coronary arteries; 30 were placed in restenotic lesions. Intravascular Ultrasound with automatic transducer pullback at 0.5 mm/s allowed measurement of stent, lumen and intimal hyperplasia crosssectional areas at 1-mm axial increments within the stents. Using Simpson's rule, stent, lumen and intimal hyperplasia volumes were calculated. Patterns of in-stent restenosis were then identified. Results Restenotic stents had smaller stent volumes (120 ± 41 vs. 147 ± 43 mm 3 , p = 0.016) and lumen volumes (62 ± 28 vs. 118 ± 42 mm 3 , p 3 , p 3 , respectively, p = NS); however, stents with diffuse restenosis had larger intimal hyperplasia volumes (84 ± 30 vs. 50 ± 34 mm 3 , p Conclusions Stent volume and magnitude and distribution of intimai hyperplasia are important in the development of in-stent restenosis. Stent volume was smaller and intimai hyperplasia volume greater in restenotic stents. Stent restenosis is more commonly focal in nature and located at the central articulation.

Paul G. Yock - One of the best experts on this subject based on the ideXlab platform.

  • functional versus anatomic assessment of myocardial bridging by Intravascular Ultrasound impact of arterial compression on proximal atherosclerotic plaque
    Journal of the American Heart Association, 2016
    Co-Authors: Ryotaro Yamada, Peter J. Fitzgerald, Paul G. Yock, Jennifer A Tremmel, Shigemitsu Tanaka, Shin Lin, Yuhei Kobayashi, Brooke M Hollak, Ingela Schnittger, Yasuhiro Honda
    Abstract:

    Background The presence of a myocardial bridge (MB) has been shown to promote atherosclerotic plaque formation proximal to the MB, presumably because of hemodynamic disturbances provoked by retrograde blood flow toward this segment in cardiac systole. We aimed to determine the anatomic and functional properties of an MB related to the extent of atherosclerosis assessed by Intravascular Ultrasound. Methods and Results We enrolled 100 patients with angina but no significant obstructive coronary artery disease who had an Intravascular Ultrasound–detected MB in the left anterior descending artery (median age 54 years, 36% male). The MB was identified with Intravascular Ultrasound by the presence of an echolucent band (halo). Anatomically, the MB length was 22±13 mm, and halo thickness was 0.7±0.6 mm. Functionally, systolic arterial compression was 23±12%. The maximum plaque burden up to 20 mm proximal to the MB entrance was significantly greater than the maximum plaque burden within the MB segment. Among the Intravascular Ultrasound–defined MB properties, arterial compression was the sole MB parameter that demonstrated a significant positive correlation with maximum plaque burden up to 20 mm proximal to the MB entrance ( r =0.254, P =0.011 overall; r =0.545, P <0.001 low coronary risk). In multivariate analysis, adjusting for clinical characteristics and coronary risk factors, arterial compression was independently associated with maximum plaque burden up to 20 mm proximal to the MB entrance. Conclusions In patients with an MB in the left anterior descending artery, the percentage of arterial compression is related directly to the burden of atherosclerotic plaque located proximally to the MB, particularly in patients who otherwise have low coronary risk. This may prove helpful in identifying high‐risk MB patients.

  • Abstract 17597: Intravascular Ultrasound and Angiographic Predictors of 5-Year Target Lesion Revascularization: Very Long-Term Clinical Follow-Up of the SPIRIT III Trial
    Circulation, 2012
    Co-Authors: Kenji Sakamoto, Katsuhisa Waseda, Gregg W. Stone, Takao Shimohama, Masao Yamasaki, Ichizo Tsujino, Paul G. Yock, Shigeru Saito, Manejeh Yaqub, Sherry Cao
    Abstract:

    BACKGROUND: This study aimed to assess the hypothesis that Intravascular Ultrasound (IVUS) or angiographic parameters can predict very long-term target lesion revascularization (TLR) in de novo cor...

  • in vivo comparison between optical coherence tomography and Intravascular Ultrasound for detecting small degrees of in stent neointima after stent implantation
    Jacc-cardiovascular Interventions, 2008
    Co-Authors: Yoriyasu Suzuki, Peter J. Fitzgerald, Paul G. Yock, Fermin O Tio, Alan C Yeung, Fumiaki Ikeno, Tomomi Koizumi, William F Fearon
    Abstract:

    Objectives The purpose of this study was to evaluate optical coherence tomography (OCT) for detecting small degrees of in-stent neointima (ISN) after stent implantation compared with Intravascular Ultrasound (IVUS). Background The importance of detecting neointimal coverage of stent struts has grown with the appreciation of the increased risk for late stent thrombosis after drug-eluting stent (DES) implantation. Intravascular Ultrasound, the current standard for evaluating the status of DES, lacks the resolution to detect the initial neointimal coverage. Optical coherence tomography has greater resolution but has not yet been compared with IVUS in vivo with histological correlation for validation. Methods Intravascular Ultrasound and OCT were performed with motorized pullback imaging in 6 pigs across 33 stents, 1 month after implantation. Each pig was euthanized, and histological measurements of vessel, stent, and lumen dimensions were performed in 3 sections of each stent. A small degree of ISN was defined as occupying l30% of the stent area measured with histology. The IVUS, OCT, and histological assessment of ISN were compared in matched cross-sections of the stents with a small degree of ISN. Results Eleven stents had a small degree of ISN (average ISN area: 1.26 ± 0.46 mm 2 , and percent area obstruction: 21.4 ± 5.2%). Compared with histology, the diagnostic accuracy of OCT (area under the receiver operating characteristic curve [AUC] = 0.967, 95% confidence interval [CI] 0.914 to 1.019) was higher than that of IVUS (AUC = 0.781, 95% CI 0.621 to 0.838). Conclusions Optical coherence tomography detects smaller degrees of ISN more accurately than IVUS and might be a useful method for identifying neointimal coverage of stent struts after DES implantation.

  • detailed Intravascular Ultrasound analysis of zotarolimus eluting phosphorylcholine coated cobalt chromium alloy stent in de novo coronary lesions results from the endeavor ii trial
    American Journal of Cardiology, 2007
    Co-Authors: Ryota Sakurai, Donald E Cutlip, Jeffrey J Popma, Masao Yamasaki, Paul G. Yock, Yasuhiro Honda, Yoichiro Hongo, Heidi N Bonneau, Peter Zimetbaum, Jean Fajadet
    Abstract:

    Zotarolimus-eluting phosphorylcholine-coated cobalt-chromium alloy Driver stents (ZES) demonstrated significant reductions in target lesion revascularization rate with few apparent adverse events compared with bare metal stents (BMS; uncoated Driver stents) in a prospective, multicenter, double-blind, randomized controlled trial in de novo coronary lesions. The aim of this study was to examine detailed vascular responses to ZES compared with BMS using serial Intravascular Ultrasound analysis. A total of 343 patients (ZES n=178, BMS n=165) were enrolled in this formal, prespecified Intravascular Ultrasound substudy of the Randomized Controlled Trial to Evaluate the Safety and Efficacy of the Medtronic AVE Zotarolimus-Eluting Driver Coronary Stent in de Novo Native Coronary Artery Lesions (ENDEAVOR II), a prospective, multicenter, double-blind, randomized controlled trial to compare ZES and BMS in de novo native coronary artery lesions. Quantitative and qualitative Intravascular Ultrasound analyses were performed postprocedurally and at 8-month follow-up in stented and reference segments. ZES showed significantly less neointima, with a larger lumen than BMS at 8 months (percentage neointimal volume 17.6 ± 10.1% vs 29.4 ± 17.2%, p 2 , p

  • predictors and outcomes of stent thrombosis an Intravascular Ultrasound registry
    European Heart Journal, 2002
    Co-Authors: Neal G Uren, Peter J. Fitzgerald, Yasuhiro Honda, Severin P Schwarzacher, Jonas A Metz, David P Lee, Alan C Yeung, Paul G. Yock
    Abstract:

    Aims To investigate whether Intravascular Ultrasound provides additional information regarding the prediction of stent thrombosis, a retrospective multicentre registry was designed to enrol patients with stent thrombosis following stent deployment under Ultrasound guidance. Methods and Results A total of 53 patients were enrolled (mean age 61±9 years) with stable angina (43%), unstable angina (36%), and post-infarct angina (21%) who underwent intracoronary stenting. The majority had balloon angioplasty alone prior to stenting (94%) with 6% also undergoing rotational atherectomy. The indication for stenting was elective (53%), suboptimal result (32%) and bailout (15%). There were 1·6±0·8 stents/artery with 87% undergoing high-pressure dilatation (≥14 atmospheres). The minimum stent area was 7·7±2·8mm2with a mean stent expansion of 81·5±21·9%. Overall, 94% of cases demonstrated one abnormal Ultrasound finding (stent under-expansion, malapposition, inflow/outflow disease, dissection, or thrombus). Angiography demonstrated an abnormality in only 32% of cases (chi-square=30·0, P <0·001). Stent thrombosis occurred at 132±125h after deployment. Myocardial infarction occurred in 67% and there was an overall mortality of 15%. Conclusion On comparison with angiography, the vast majority of stents associated with subsequent thrombosis have at least one abnormal feature by Intravascular Ultrasound at the time of stent deployment.

Peter J. Fitzgerald - One of the best experts on this subject based on the ideXlab platform.

  • functional versus anatomic assessment of myocardial bridging by Intravascular Ultrasound impact of arterial compression on proximal atherosclerotic plaque
    Journal of the American Heart Association, 2016
    Co-Authors: Ryotaro Yamada, Peter J. Fitzgerald, Paul G. Yock, Jennifer A Tremmel, Shigemitsu Tanaka, Shin Lin, Yuhei Kobayashi, Brooke M Hollak, Ingela Schnittger, Yasuhiro Honda
    Abstract:

    Background The presence of a myocardial bridge (MB) has been shown to promote atherosclerotic plaque formation proximal to the MB, presumably because of hemodynamic disturbances provoked by retrograde blood flow toward this segment in cardiac systole. We aimed to determine the anatomic and functional properties of an MB related to the extent of atherosclerosis assessed by Intravascular Ultrasound. Methods and Results We enrolled 100 patients with angina but no significant obstructive coronary artery disease who had an Intravascular Ultrasound–detected MB in the left anterior descending artery (median age 54 years, 36% male). The MB was identified with Intravascular Ultrasound by the presence of an echolucent band (halo). Anatomically, the MB length was 22±13 mm, and halo thickness was 0.7±0.6 mm. Functionally, systolic arterial compression was 23±12%. The maximum plaque burden up to 20 mm proximal to the MB entrance was significantly greater than the maximum plaque burden within the MB segment. Among the Intravascular Ultrasound–defined MB properties, arterial compression was the sole MB parameter that demonstrated a significant positive correlation with maximum plaque burden up to 20 mm proximal to the MB entrance ( r =0.254, P =0.011 overall; r =0.545, P <0.001 low coronary risk). In multivariate analysis, adjusting for clinical characteristics and coronary risk factors, arterial compression was independently associated with maximum plaque burden up to 20 mm proximal to the MB entrance. Conclusions In patients with an MB in the left anterior descending artery, the percentage of arterial compression is related directly to the burden of atherosclerotic plaque located proximally to the MB, particularly in patients who otherwise have low coronary risk. This may prove helpful in identifying high‐risk MB patients.

  • a randomized controlled trial of angiography versus Intravascular Ultrasound directed bare metal coronary stent placement the avid trial
    Circulation-cardiovascular Interventions, 2009
    Co-Authors: Robert J Russo, Peter J. Fitzgerald, Charles J Davidson, Patricia D Silva, Paul S Teirstein, Michael J Attubato, Anthony C Defranco, Steven L Goldberg, James B Hermiller, Martin B Leon
    Abstract:

    Background— AVID (Angiography Versus Intravascular Ultrasound-Directed stent placement) is a multicenter, randomized controlled trial designed to assess the effect of Intravascular Ultrasound (IVUS)-directed stent placement on the 12-month rate of target lesion revascularization (TLR). Methods and Results— After elective coronary stent placement and an optimal angiographic result (<10% stenosis), 800 patients were randomized to Angiography- or IVUS-directed therapy. Blinded IVUS was performed in the Angiography group without further therapy. In the IVUS group, IVUS criteria for optimal stent placement (<10% area stenosis, apposition, and absence of dissection) were applied. Final minimum stent area was 6.90�2.43 mm2 in the Angiography group and 7.55�2.82 mm2 in the IVUS group (P=0.001). In the IVUS group, only 37% with inadequate expansion (<90%) received further therapy. The 12-month TLR rate was 12.0% in the Angiography group and 8.1% in the IVUS group (P=0.08, 95% confidence level [CI], [−8.3% to 0.5%]...

  • in vivo comparison between optical coherence tomography and Intravascular Ultrasound for detecting small degrees of in stent neointima after stent implantation
    Jacc-cardiovascular Interventions, 2008
    Co-Authors: Yoriyasu Suzuki, Peter J. Fitzgerald, Paul G. Yock, Fermin O Tio, Alan C Yeung, Fumiaki Ikeno, Tomomi Koizumi, William F Fearon
    Abstract:

    Objectives The purpose of this study was to evaluate optical coherence tomography (OCT) for detecting small degrees of in-stent neointima (ISN) after stent implantation compared with Intravascular Ultrasound (IVUS). Background The importance of detecting neointimal coverage of stent struts has grown with the appreciation of the increased risk for late stent thrombosis after drug-eluting stent (DES) implantation. Intravascular Ultrasound, the current standard for evaluating the status of DES, lacks the resolution to detect the initial neointimal coverage. Optical coherence tomography has greater resolution but has not yet been compared with IVUS in vivo with histological correlation for validation. Methods Intravascular Ultrasound and OCT were performed with motorized pullback imaging in 6 pigs across 33 stents, 1 month after implantation. Each pig was euthanized, and histological measurements of vessel, stent, and lumen dimensions were performed in 3 sections of each stent. A small degree of ISN was defined as occupying l30% of the stent area measured with histology. The IVUS, OCT, and histological assessment of ISN were compared in matched cross-sections of the stents with a small degree of ISN. Results Eleven stents had a small degree of ISN (average ISN area: 1.26 ± 0.46 mm 2 , and percent area obstruction: 21.4 ± 5.2%). Compared with histology, the diagnostic accuracy of OCT (area under the receiver operating characteristic curve [AUC] = 0.967, 95% confidence interval [CI] 0.914 to 1.019) was higher than that of IVUS (AUC = 0.781, 95% CI 0.621 to 0.838). Conclusions Optical coherence tomography detects smaller degrees of ISN more accurately than IVUS and might be a useful method for identifying neointimal coverage of stent struts after DES implantation.

  • predictors and outcomes of stent thrombosis an Intravascular Ultrasound registry
    European Heart Journal, 2002
    Co-Authors: Neal G Uren, Peter J. Fitzgerald, Yasuhiro Honda, Severin P Schwarzacher, Jonas A Metz, David P Lee, Alan C Yeung, Paul G. Yock
    Abstract:

    Aims To investigate whether Intravascular Ultrasound provides additional information regarding the prediction of stent thrombosis, a retrospective multicentre registry was designed to enrol patients with stent thrombosis following stent deployment under Ultrasound guidance. Methods and Results A total of 53 patients were enrolled (mean age 61±9 years) with stable angina (43%), unstable angina (36%), and post-infarct angina (21%) who underwent intracoronary stenting. The majority had balloon angioplasty alone prior to stenting (94%) with 6% also undergoing rotational atherectomy. The indication for stenting was elective (53%), suboptimal result (32%) and bailout (15%). There were 1·6±0·8 stents/artery with 87% undergoing high-pressure dilatation (≥14 atmospheres). The minimum stent area was 7·7±2·8mm2with a mean stent expansion of 81·5±21·9%. Overall, 94% of cases demonstrated one abnormal Ultrasound finding (stent under-expansion, malapposition, inflow/outflow disease, dissection, or thrombus). Angiography demonstrated an abnormality in only 32% of cases (chi-square=30·0, P <0·001). Stent thrombosis occurred at 132±125h after deployment. Myocardial infarction occurred in 67% and there was an overall mortality of 15%. Conclusion On comparison with angiography, the vast majority of stents associated with subsequent thrombosis have at least one abnormal feature by Intravascular Ultrasound at the time of stent deployment.

  • Intravascular Ultrasound imaging of angiographically normal coronary arteries an in vivo comparison with quantitative angiography
    Journal of the American College of Cardiology, 1991
    Co-Authors: Frederick G St Goar, Peter J. Fitzgerald, Fausto J Pinto, Edwin L Alderman, Michael L Stadius, Richard L Popp
    Abstract:

    Abstract Intravascular Ultrasound, a new technique for real-time twodimensional visualization of arteries and veins, delineates vessel wall morphology and measures luminal dimensions. This imaging method has been validated with in vitro systems and in peripheral vessels, but there are few in vivo coronary artery studies. Twenty cardiac transplant recipients with no angiographic coronary artery disease were scanned with a 30-MHz Intravascular Ultrasound catheter from the left main coronary ostium to the mid-left anterior descending coronary artery. Simultaneous angiographic measurements were performed at 76 sites. Ultrasound end-diastolic diameters in two perpendicular axes were 3.8 ± 0.9 and 3.9 ± 0.6 mm, respectively, and mean diameter derived from an area determined by planimetry was 3.9 ± 0.9 mm. Angiographic coronary artery diameters measured with a computer-assisted edge detection system perpendicular to the long axis of the vessel and to the long axis of the catheter were 3.4 ± 0.8 and 3.6 ± 0.8 mm, respectively. Luminal diameters measured with the two imaging systems correlated closely, with an r value of 0.86 when Ultrasound was compared with the angiographic diameter measured perpendicular to the vessel and 0.88 when compared with the angiographic diameter measured perpendicular to the imaging catheter. Eighty-three percent of the Ultrasound-measured diameters were above the line of identity when compared with the simultaneous angiographic measurement. The more the imaging catheter deviated from the long axis of the vessel, the greater was the discrepancy between the Ultrasound and angiographic measurements. In summary, in vivo intracoronary Ultrasound measurements correlate closely with quantitative angiography, although Ultrasound measurements tend to be slightly larger. Correlation is improved when the Ultrasound catheter is parallel to the vessel long axis. Eccentric Ultrasound catheter placement does not have a significant effect on measurements in coronary vessels. Intravascular Ultrasound provides an accurate method to assess coronary dimensions as an alternative to quantitative angiography.