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Martin B. Leon - One of the best experts on this subject based on the ideXlab platform.
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TCT-166 Predictors of Target Lesion Revascularization After Implantation of Second-Generation Drug-Eluting Stents in Randomized Trials and the “Real-World”: Analysis From Two Large Datasets
Journal of the American College of Cardiology, 2018Co-Authors: Behnood Bikdeli, Martin B. Leon, Ajay J. Kirtane, Shmuel Chen, Patrick W. Serruys, Pieter C. Smits, Clemens Von Birgelen, Bernhard Witzenbichler, Giora Weisz, Michael J. RinaldiAbstract:Despite progress made in stent technologies, Target Lesion revascularization (TLR) still occurs after PCI with DES. Identification of predisposing factors is important not only for prognostication, but also to test strategies that mitigate this risk. We performed an individual patient pooled
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impact of Target Lesion and nonTarget Lesion cardiac events on 5 year clinical outcomes after sirolimus eluting or bare metal stenting
Jacc-cardiovascular Interventions, 2009Co-Authors: Riya Chacko, Martin B. Leon, Laura Mauri, Meredith Mulhearn, Victor Novack, Lena Novack, Sidney Cohen, Jeffrey W Moses, Donald E. CutlipAbstract:Objectives We sought to compare patient-oriented outcomes related to Target vessel or nonTarget vessel events for sirolimus-eluting stents (SES) versus bare-metal stents. Background SES significantly reduce restenosis but the influence of reduced restenosis on overall patient-oriented outcome has not been reported. Methods The study population included 1,057 patients randomized in the SIRIUS (Sirolimus-Eluting Stent in De Novo Native Coronary Lesions) study and followed clinically for 5 years. The primary end point was a composite of all-cause mortality, any myocardial infarction, or any repeat revascularization. In secondary analyses, myocardial infarction and repeat revascularization events attributed to the Target vessel or a nonTarget vessel were compared by stent type. Results Patients with an SES were more likely to be free from the primary composite end point at 5 years (60.4% vs. 47.8%, p Conclusions The benefit of SES over bare-metal stents for reduced Target Lesion revascularization is maintained for 5 years. Remote coronary segments of the Target vessel and nonTarget vessel remain an important cause of future adverse events despite sustained restenosis benefit.
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Stent implantation neutralizes the impact of preintervention arterial remodeling on subsequent Target Lesion revascularization.
The American journal of cardiology, 2000Co-Authors: George Dangas, Gary S. Mintz, Augusto D. Pichard, Kenneth M. Kent, Lowell F. Satler, Roxana Mehran, Alexandra J. Lansky, Gregg W. Stone, Javed Ahmed, Martin B. LeonAbstract:Positive remodeling of the atherosclerotic arterial wall occurs to compensate for plaque accumulation. However, more recent studies, primarily using intravascular ultrasound (IVUS) in vivo, have emphasized that in certain Lesions, inadequate or negative arterial remodeling contributes to lumen compromise. Possible explanatory mechanisms include failure of positive adaptive remodeling, initial positive remodeling followed by late arterial shrinkage, and restriction of the extent of positive remodeling due to certain plaque elements (i.e., calcium or dense fibrous tissue). A number of studies have documented that positive remodeling Lesions may be associated with unstable coronary syndromes and, therefore, may be more biologically active. In this regard, we recently reported that the preintervention pattern of remodeling is an independent predictor of clinical restenosis after non-stent coronary intervention: positive remodeling Lesions had more frequent Target Lesion revascularization events than negative remodeling Lesions. In the present study, we evaluated the interaction of baseline remodeling characteristics and clinical restenosis in native coronary Lesions treated with stent implantation. It was our hypothesis that stent implantation would equalize the event rate between positive and negative remodeling Lesions.
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Comparison of time course of Target Lesion revascularization following successful saphenous vein graft angioplasty versus successful native coronary angioplasty.
The American journal of cardiology, 2000Co-Authors: Mun K. Hong, Gary S. Mintz, Augusto D. Pichard, Kenneth M. Kent, Lowell F. Satler, Roxana Mehran, George Dangas, Alexandra J. Lansky, Gregg W. Stone, Martin B. LeonAbstract:We studied 1,267 patients with 2,186 saphenous vein graft (SVG) Lesions to determine the time course of Target Lesion revascularization (TLR) after successful SVG angioplasty. We found that the time course of TLR in SVG appears prolonged, with only 54% occurring within the first 6 months and continued TLR even after 1 year.
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intravascular ultrasound predictors of Target Lesion revascularization after stenting of protected left main coronary artery stenoses
American Journal of Cardiology, 1999Co-Authors: M K Hong, Gary S. Mintz, Augusto D. Pichard, Kenneth M. Kent, Lowell F. Satler, Jeffrey J. Popma, Mun K. Hong, Martin B. LeonAbstract:We evaluated the predictors of late clinical outcomes after stenting of protected left main coronary artery (LMCA) stenoses. Intravascular ultrasound (IVUS) guided stenting of protected LMCA stenoses was performed in 87 consecutive patients between January 1994 and December 1996. Results were evaluated using conventional (clinical, angiographic, and IVUS) methodology. Late (12 month) clinical follow-up information was obtained in all patients. Initial procedural success was achieved in 86 patients (99%). There was 1 in-hospital death (in the 1 patient with a procedural failure). There were no other in-hospital complications, including Q-wave myocardial infarction, emergency bypass surgery, or repeat coronary angioplasty. The overall Target Lesion revascularization (TLR) rate was 13%. Using multivariate logistic regression analysis, the only independent predictor of TLR was the postintervention lumen area by IVUS. A final lumen area ≥7.0 mm2 was obtained in 74 patients (86%); the TLR rate for these patients was 7%. This was compared with patients with a final lumen area <7.0 mm2 in whom the TLR rate was 50% (p = 0.0011). Stenting of protected LMCA stenoses is safe and effective with acceptable long-term clinical outcomes. The most important factor determining long-term success was the postintervention lumen area by IVUS.
Gary S. Mintz - One of the best experts on this subject based on the ideXlab platform.
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late Target Lesion revascularization after implantation of sirolimus eluting stent
Catheterization and Cardiovascular Interventions, 2007Co-Authors: Myeongki Hong, Gary S. Mintz, Cheol Whan Lee, Dukwoo Park, Seungwhan Lee, Younghak Kim, Inhyun Jung, Sanghyun Kim, Sangsig Cheong, Jaejoong KimAbstract:Objectives: We evaluated the incidence, clinical presentation, and angiographic in-stent restenosis (ISR) pattern of late Target Lesion revascularization (TLR) after sirolimus-eluting stent (SES) implantation. Background: Late TLR is an unusual finding beyond 6–9 months after bare-metal stent implantation. However, late TLR after SES implantation has not been sufficiently evaluated. Methods: The study population consisted of 804 patients with 1,020 native Lesions that were patent at 6-month follow-up angiogram after SES implantation. Results: Late TLR was performed in 18 patients with 18 Lesions (1.8%) at 24.1 ± 2.6 months (range; 18–30 months) after SES implantation. Clinical presentation of late TLR patients was silent ischemia in eight patients and recurrent angina in 10 patients, but none had an acute coronary syndrome. Angiographic ISR pattern of late TLR Lesions were focal ISR in 12 Lesions (67%) and diffuse ISR in six Lesions (33%). Serial quantitative coronary angiographic analysis of these Lesions showed a minimal lumen diameter of 2.6 ± 0.5 mm immediately after SES implantation, 2.4 ± 0.4 mm at 6-month follow-up and 0.7 ± 0.6 mm at 24-month follow-up (ANOVA P < 0.001). By stepwise multiple logistic regression analysis, the only independent predictor of late TLR was stent length (P < 0.001, OR = 1.040, 95% CI = 1.019–1.061). Conclusions: Late TLR was performed in 1.8% of 1,020 native Lesions that were patent at 6-month follow-up angiogram. Clinical presentations of late TLR was either silent ischemia or recurrent angina, but not acute coronary syndrome. Two-thirds of late TLR Lesions had a focal angiographic ISR pattern. © 2007 Wiley-Liss, Inc.
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optimal final lumen area and predictors of Target Lesion revascularization after stent implantation in small coronary arteries
American Journal of Cardiology, 2003Co-Authors: Ioannis Iakovou, Gary S. Mintz, Roxana Mehran, George Dangas, Alexandra J. Lansky, Yoshio Kobayashi, Alexandre Abizaid, Makoto Hirose, Dale T Ashby, Gregg W. StoneAbstract:Abstract Despite similar early clinical events, patients who undergo treatment of small vessels are at an increased risk for Target Lesion revascularization (TLR) after coronary artery stenting. We sought to determine predictors of TLR after stent implantation in small coronary arteries. We identified 423 consecutive patients who underwent intravascular ultrasound (IVUS)-guided small vessel stenting procedures in 465 coronary Lesions with an angiographic reference vessel diameter of 2 (n = 345 Lesions, group I) and >6.0 mm 2 (n = 115, group II). Baseline patient characteristics and in-hospital outcomes were similar between the 2 groups, except for a higher rate of restenotic Lesions in group I and bifurcation Lesions in group II. Group I had higher TLR rates at 1 year compared with group II patients (39% vs 26%, p = 0.02). The TLR rate appeared to decrease with greater stent expansion, especially at >90% of the reference vessel area, as assessed by IVUS. By multivariate analysis, an IVUS final stent area of ≤6 mm 2 , diabetes, absence of prior myocardial infarction, and history of intervention were independent predictors of 1-year TLR in this population. Final stent area of >6.0 mm 2 and greater stent expansion were associated with a decrease in TLR. Therefore, there does not appear to be any “downside” to aggressive stent implantation strategies in small vessels. In contrast, IVUS allows maximization of final lumen dimensions to minimize clinical restenosis.
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Stent implantation neutralizes the impact of preintervention arterial remodeling on subsequent Target Lesion revascularization.
The American journal of cardiology, 2000Co-Authors: George Dangas, Gary S. Mintz, Augusto D. Pichard, Kenneth M. Kent, Lowell F. Satler, Roxana Mehran, Alexandra J. Lansky, Gregg W. Stone, Javed Ahmed, Martin B. LeonAbstract:Positive remodeling of the atherosclerotic arterial wall occurs to compensate for plaque accumulation. However, more recent studies, primarily using intravascular ultrasound (IVUS) in vivo, have emphasized that in certain Lesions, inadequate or negative arterial remodeling contributes to lumen compromise. Possible explanatory mechanisms include failure of positive adaptive remodeling, initial positive remodeling followed by late arterial shrinkage, and restriction of the extent of positive remodeling due to certain plaque elements (i.e., calcium or dense fibrous tissue). A number of studies have documented that positive remodeling Lesions may be associated with unstable coronary syndromes and, therefore, may be more biologically active. In this regard, we recently reported that the preintervention pattern of remodeling is an independent predictor of clinical restenosis after non-stent coronary intervention: positive remodeling Lesions had more frequent Target Lesion revascularization events than negative remodeling Lesions. In the present study, we evaluated the interaction of baseline remodeling characteristics and clinical restenosis in native coronary Lesions treated with stent implantation. It was our hypothesis that stent implantation would equalize the event rate between positive and negative remodeling Lesions.
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Comparison of time course of Target Lesion revascularization following successful saphenous vein graft angioplasty versus successful native coronary angioplasty.
The American journal of cardiology, 2000Co-Authors: Mun K. Hong, Gary S. Mintz, Augusto D. Pichard, Kenneth M. Kent, Lowell F. Satler, Roxana Mehran, George Dangas, Alexandra J. Lansky, Gregg W. Stone, Martin B. LeonAbstract:We studied 1,267 patients with 2,186 saphenous vein graft (SVG) Lesions to determine the time course of Target Lesion revascularization (TLR) after successful SVG angioplasty. We found that the time course of TLR in SVG appears prolonged, with only 54% occurring within the first 6 months and continued TLR even after 1 year.
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intravascular ultrasound predictors of Target Lesion revascularization after stenting of protected left main coronary artery stenoses
American Journal of Cardiology, 1999Co-Authors: M K Hong, Gary S. Mintz, Augusto D. Pichard, Kenneth M. Kent, Lowell F. Satler, Jeffrey J. Popma, Mun K. Hong, Martin B. LeonAbstract:We evaluated the predictors of late clinical outcomes after stenting of protected left main coronary artery (LMCA) stenoses. Intravascular ultrasound (IVUS) guided stenting of protected LMCA stenoses was performed in 87 consecutive patients between January 1994 and December 1996. Results were evaluated using conventional (clinical, angiographic, and IVUS) methodology. Late (12 month) clinical follow-up information was obtained in all patients. Initial procedural success was achieved in 86 patients (99%). There was 1 in-hospital death (in the 1 patient with a procedural failure). There were no other in-hospital complications, including Q-wave myocardial infarction, emergency bypass surgery, or repeat coronary angioplasty. The overall Target Lesion revascularization (TLR) rate was 13%. Using multivariate logistic regression analysis, the only independent predictor of TLR was the postintervention lumen area by IVUS. A final lumen area ≥7.0 mm2 was obtained in 74 patients (86%); the TLR rate for these patients was 7%. This was compared with patients with a final lumen area <7.0 mm2 in whom the TLR rate was 50% (p = 0.0011). Stenting of protected LMCA stenoses is safe and effective with acceptable long-term clinical outcomes. The most important factor determining long-term success was the postintervention lumen area by IVUS.
Lowell F. Satler - One of the best experts on this subject based on the ideXlab platform.
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Stent implantation neutralizes the impact of preintervention arterial remodeling on subsequent Target Lesion revascularization.
The American journal of cardiology, 2000Co-Authors: George Dangas, Gary S. Mintz, Augusto D. Pichard, Kenneth M. Kent, Lowell F. Satler, Roxana Mehran, Alexandra J. Lansky, Gregg W. Stone, Javed Ahmed, Martin B. LeonAbstract:Positive remodeling of the atherosclerotic arterial wall occurs to compensate for plaque accumulation. However, more recent studies, primarily using intravascular ultrasound (IVUS) in vivo, have emphasized that in certain Lesions, inadequate or negative arterial remodeling contributes to lumen compromise. Possible explanatory mechanisms include failure of positive adaptive remodeling, initial positive remodeling followed by late arterial shrinkage, and restriction of the extent of positive remodeling due to certain plaque elements (i.e., calcium or dense fibrous tissue). A number of studies have documented that positive remodeling Lesions may be associated with unstable coronary syndromes and, therefore, may be more biologically active. In this regard, we recently reported that the preintervention pattern of remodeling is an independent predictor of clinical restenosis after non-stent coronary intervention: positive remodeling Lesions had more frequent Target Lesion revascularization events than negative remodeling Lesions. In the present study, we evaluated the interaction of baseline remodeling characteristics and clinical restenosis in native coronary Lesions treated with stent implantation. It was our hypothesis that stent implantation would equalize the event rate between positive and negative remodeling Lesions.
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Comparison of time course of Target Lesion revascularization following successful saphenous vein graft angioplasty versus successful native coronary angioplasty.
The American journal of cardiology, 2000Co-Authors: Mun K. Hong, Gary S. Mintz, Augusto D. Pichard, Kenneth M. Kent, Lowell F. Satler, Roxana Mehran, George Dangas, Alexandra J. Lansky, Gregg W. Stone, Martin B. LeonAbstract:We studied 1,267 patients with 2,186 saphenous vein graft (SVG) Lesions to determine the time course of Target Lesion revascularization (TLR) after successful SVG angioplasty. We found that the time course of TLR in SVG appears prolonged, with only 54% occurring within the first 6 months and continued TLR even after 1 year.
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intravascular ultrasound predictors of Target Lesion revascularization after stenting of protected left main coronary artery stenoses
American Journal of Cardiology, 1999Co-Authors: M K Hong, Gary S. Mintz, Augusto D. Pichard, Kenneth M. Kent, Lowell F. Satler, Jeffrey J. Popma, Mun K. Hong, Martin B. LeonAbstract:We evaluated the predictors of late clinical outcomes after stenting of protected left main coronary artery (LMCA) stenoses. Intravascular ultrasound (IVUS) guided stenting of protected LMCA stenoses was performed in 87 consecutive patients between January 1994 and December 1996. Results were evaluated using conventional (clinical, angiographic, and IVUS) methodology. Late (12 month) clinical follow-up information was obtained in all patients. Initial procedural success was achieved in 86 patients (99%). There was 1 in-hospital death (in the 1 patient with a procedural failure). There were no other in-hospital complications, including Q-wave myocardial infarction, emergency bypass surgery, or repeat coronary angioplasty. The overall Target Lesion revascularization (TLR) rate was 13%. Using multivariate logistic regression analysis, the only independent predictor of TLR was the postintervention lumen area by IVUS. A final lumen area ≥7.0 mm2 was obtained in 74 patients (86%); the TLR rate for these patients was 7%. This was compared with patients with a final lumen area <7.0 mm2 in whom the TLR rate was 50% (p = 0.0011). Stenting of protected LMCA stenoses is safe and effective with acceptable long-term clinical outcomes. The most important factor determining long-term success was the postintervention lumen area by IVUS.
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Interrelation of Coronary Angiographic Reference Lumen Size and Intravascular Ultrasound Target Lesion Calcium
The American journal of cardiology, 1998Co-Authors: Gary S. Mintz, Augusto D. Pichard, Kenneth M. Kent, Lowell F. Satler, Jeffrey J. Popma, Martin B. LeonAbstract:Abstract Intravascular ultrasound (IVUS) detects Target Lesion calcium twice as often as does coronary angiography. Target Lesions in smaller vessels are thought to be more calcified than Target Lesions in large vessels. This study determined whether the presence and magnitude of Target Lesion calcium is related to angiographic reference lumen size. Preintervention IVUS imaging and coronary angiography were performed to study 1,454 non-aortoostial native vessel Lesions in 1,342 patients. Target Lesions and reference segments were evaluated according to previously published methods and are presented as mean ± 1 SD. By angiography, 37% of Lesions contained calcium, and 68% of calcium-containing Lesions were classified as moderately calcified, and 32% as severely calcified. There was no relation between angiographic reference lumen size and angiographic calcium detection (p = 0.7066) or classification (none/mild vs moderate vs severe, p = 0.8135). By IVUS, 73% of Lesions contained calcium. There was a consistent relation between decreasing angiographic reference lumen size and increasing IVUS Lesion-associated calcium: the presence of any calcium (p = 0.0122), arc of calcium (p = 0.002), percent of Lesions with an arc of calcium >180° (p = 0.0018), length of calcium (p 180° (p = 0.0021), and length of superificial calcium (p
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Determinants and Correlates of Target Lesion Calcium in Coronary Artery Disease: A Clinical, Angiographic and Intravascular Ultrasound Study
Journal of the American College of Cardiology, 1997Co-Authors: Gary S. Mintz, Augusto D. Pichard, Kenneth M. Kent, Lowell F. Satler, Jeffrey J. Popma, Theresa A. Bucher, Martin B. LeonAbstract:Objectives. This report used intravascular ultrasound and quantitative coronary angiography to explore the relation between Lesion-associated calcium and risk factors, clinical presentation and angiographic severity of coronary artery stenoses. Background. Coronary artery calcium is a marker for significant coronary atherosclerosis. Noninvasive procedures are being proposed as screening tests for coronary artery disease. Intravascular ultrasound identification of tissue calcium has been validated in vitro. Methods. Independent chart review, preintervention intravascular ultrasound imaging and coronary angiography were used to study primary native vessel Lesions in 1,442 patients. Target Lesions and reference segments were evaluated according to previously published quantitative and qualitative methods. Results are presented as mean value ± SD. Results. Overall, 1,043 Lesions contained Target Lesion calcium (72%); the arc of Target Lesion calcium was 110 ± 109°. Lesions with an ultrasound plaque burden >0.75 or an angiographic diameter stenosis >0.25 had a prevalence of calcium of at least 65%, with a mean arc >100°. Intermediate Lesions had as much Target Lesion calcium as did angiographically severe Lesions. Using multivariate linear regression analysis, patient age, stable (vs. unstable) angina and the intravascular ultrasound Lesion site and reference segment plaque burden (but not the angiographic diameter stenosis) were the independent predictors of the arc of Target Lesion calcium (all p < 0.0001). Conclusions. Intravascular ultrasound analysis shows that coronary calcification correlates with plaque burden but not with degree of lumen compromise. Thus, the noninvasive detection of coronary calcium is predictive of future cardiac events, presumably because coronary calcification is a marker for overall atherosclerotic plaque burden. Coronary calcium increases with increasing patient age and is less common in unstable Lesion subsets. (J Am Coll Cardiol 1997;29:268–74)
Augusto D. Pichard - One of the best experts on this subject based on the ideXlab platform.
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Stent implantation neutralizes the impact of preintervention arterial remodeling on subsequent Target Lesion revascularization.
The American journal of cardiology, 2000Co-Authors: George Dangas, Gary S. Mintz, Augusto D. Pichard, Kenneth M. Kent, Lowell F. Satler, Roxana Mehran, Alexandra J. Lansky, Gregg W. Stone, Javed Ahmed, Martin B. LeonAbstract:Positive remodeling of the atherosclerotic arterial wall occurs to compensate for plaque accumulation. However, more recent studies, primarily using intravascular ultrasound (IVUS) in vivo, have emphasized that in certain Lesions, inadequate or negative arterial remodeling contributes to lumen compromise. Possible explanatory mechanisms include failure of positive adaptive remodeling, initial positive remodeling followed by late arterial shrinkage, and restriction of the extent of positive remodeling due to certain plaque elements (i.e., calcium or dense fibrous tissue). A number of studies have documented that positive remodeling Lesions may be associated with unstable coronary syndromes and, therefore, may be more biologically active. In this regard, we recently reported that the preintervention pattern of remodeling is an independent predictor of clinical restenosis after non-stent coronary intervention: positive remodeling Lesions had more frequent Target Lesion revascularization events than negative remodeling Lesions. In the present study, we evaluated the interaction of baseline remodeling characteristics and clinical restenosis in native coronary Lesions treated with stent implantation. It was our hypothesis that stent implantation would equalize the event rate between positive and negative remodeling Lesions.
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Comparison of time course of Target Lesion revascularization following successful saphenous vein graft angioplasty versus successful native coronary angioplasty.
The American journal of cardiology, 2000Co-Authors: Mun K. Hong, Gary S. Mintz, Augusto D. Pichard, Kenneth M. Kent, Lowell F. Satler, Roxana Mehran, George Dangas, Alexandra J. Lansky, Gregg W. Stone, Martin B. LeonAbstract:We studied 1,267 patients with 2,186 saphenous vein graft (SVG) Lesions to determine the time course of Target Lesion revascularization (TLR) after successful SVG angioplasty. We found that the time course of TLR in SVG appears prolonged, with only 54% occurring within the first 6 months and continued TLR even after 1 year.
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intravascular ultrasound predictors of Target Lesion revascularization after stenting of protected left main coronary artery stenoses
American Journal of Cardiology, 1999Co-Authors: M K Hong, Gary S. Mintz, Augusto D. Pichard, Kenneth M. Kent, Lowell F. Satler, Jeffrey J. Popma, Mun K. Hong, Martin B. LeonAbstract:We evaluated the predictors of late clinical outcomes after stenting of protected left main coronary artery (LMCA) stenoses. Intravascular ultrasound (IVUS) guided stenting of protected LMCA stenoses was performed in 87 consecutive patients between January 1994 and December 1996. Results were evaluated using conventional (clinical, angiographic, and IVUS) methodology. Late (12 month) clinical follow-up information was obtained in all patients. Initial procedural success was achieved in 86 patients (99%). There was 1 in-hospital death (in the 1 patient with a procedural failure). There were no other in-hospital complications, including Q-wave myocardial infarction, emergency bypass surgery, or repeat coronary angioplasty. The overall Target Lesion revascularization (TLR) rate was 13%. Using multivariate logistic regression analysis, the only independent predictor of TLR was the postintervention lumen area by IVUS. A final lumen area ≥7.0 mm2 was obtained in 74 patients (86%); the TLR rate for these patients was 7%. This was compared with patients with a final lumen area <7.0 mm2 in whom the TLR rate was 50% (p = 0.0011). Stenting of protected LMCA stenoses is safe and effective with acceptable long-term clinical outcomes. The most important factor determining long-term success was the postintervention lumen area by IVUS.
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Interrelation of Coronary Angiographic Reference Lumen Size and Intravascular Ultrasound Target Lesion Calcium
The American journal of cardiology, 1998Co-Authors: Gary S. Mintz, Augusto D. Pichard, Kenneth M. Kent, Lowell F. Satler, Jeffrey J. Popma, Martin B. LeonAbstract:Abstract Intravascular ultrasound (IVUS) detects Target Lesion calcium twice as often as does coronary angiography. Target Lesions in smaller vessels are thought to be more calcified than Target Lesions in large vessels. This study determined whether the presence and magnitude of Target Lesion calcium is related to angiographic reference lumen size. Preintervention IVUS imaging and coronary angiography were performed to study 1,454 non-aortoostial native vessel Lesions in 1,342 patients. Target Lesions and reference segments were evaluated according to previously published methods and are presented as mean ± 1 SD. By angiography, 37% of Lesions contained calcium, and 68% of calcium-containing Lesions were classified as moderately calcified, and 32% as severely calcified. There was no relation between angiographic reference lumen size and angiographic calcium detection (p = 0.7066) or classification (none/mild vs moderate vs severe, p = 0.8135). By IVUS, 73% of Lesions contained calcium. There was a consistent relation between decreasing angiographic reference lumen size and increasing IVUS Lesion-associated calcium: the presence of any calcium (p = 0.0122), arc of calcium (p = 0.002), percent of Lesions with an arc of calcium >180° (p = 0.0018), length of calcium (p 180° (p = 0.0021), and length of superificial calcium (p
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Determinants and Correlates of Target Lesion Calcium in Coronary Artery Disease: A Clinical, Angiographic and Intravascular Ultrasound Study
Journal of the American College of Cardiology, 1997Co-Authors: Gary S. Mintz, Augusto D. Pichard, Kenneth M. Kent, Lowell F. Satler, Jeffrey J. Popma, Theresa A. Bucher, Martin B. LeonAbstract:Objectives. This report used intravascular ultrasound and quantitative coronary angiography to explore the relation between Lesion-associated calcium and risk factors, clinical presentation and angiographic severity of coronary artery stenoses. Background. Coronary artery calcium is a marker for significant coronary atherosclerosis. Noninvasive procedures are being proposed as screening tests for coronary artery disease. Intravascular ultrasound identification of tissue calcium has been validated in vitro. Methods. Independent chart review, preintervention intravascular ultrasound imaging and coronary angiography were used to study primary native vessel Lesions in 1,442 patients. Target Lesions and reference segments were evaluated according to previously published quantitative and qualitative methods. Results are presented as mean value ± SD. Results. Overall, 1,043 Lesions contained Target Lesion calcium (72%); the arc of Target Lesion calcium was 110 ± 109°. Lesions with an ultrasound plaque burden >0.75 or an angiographic diameter stenosis >0.25 had a prevalence of calcium of at least 65%, with a mean arc >100°. Intermediate Lesions had as much Target Lesion calcium as did angiographically severe Lesions. Using multivariate linear regression analysis, patient age, stable (vs. unstable) angina and the intravascular ultrasound Lesion site and reference segment plaque burden (but not the angiographic diameter stenosis) were the independent predictors of the arc of Target Lesion calcium (all p < 0.0001). Conclusions. Intravascular ultrasound analysis shows that coronary calcification correlates with plaque burden but not with degree of lumen compromise. Thus, the noninvasive detection of coronary calcium is predictive of future cardiac events, presumably because coronary calcification is a marker for overall atherosclerotic plaque burden. Coronary calcium increases with increasing patient age and is less common in unstable Lesion subsets. (J Am Coll Cardiol 1997;29:268–74)
Kenneth M. Kent - One of the best experts on this subject based on the ideXlab platform.
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Stent implantation neutralizes the impact of preintervention arterial remodeling on subsequent Target Lesion revascularization.
The American journal of cardiology, 2000Co-Authors: George Dangas, Gary S. Mintz, Augusto D. Pichard, Kenneth M. Kent, Lowell F. Satler, Roxana Mehran, Alexandra J. Lansky, Gregg W. Stone, Javed Ahmed, Martin B. LeonAbstract:Positive remodeling of the atherosclerotic arterial wall occurs to compensate for plaque accumulation. However, more recent studies, primarily using intravascular ultrasound (IVUS) in vivo, have emphasized that in certain Lesions, inadequate or negative arterial remodeling contributes to lumen compromise. Possible explanatory mechanisms include failure of positive adaptive remodeling, initial positive remodeling followed by late arterial shrinkage, and restriction of the extent of positive remodeling due to certain plaque elements (i.e., calcium or dense fibrous tissue). A number of studies have documented that positive remodeling Lesions may be associated with unstable coronary syndromes and, therefore, may be more biologically active. In this regard, we recently reported that the preintervention pattern of remodeling is an independent predictor of clinical restenosis after non-stent coronary intervention: positive remodeling Lesions had more frequent Target Lesion revascularization events than negative remodeling Lesions. In the present study, we evaluated the interaction of baseline remodeling characteristics and clinical restenosis in native coronary Lesions treated with stent implantation. It was our hypothesis that stent implantation would equalize the event rate between positive and negative remodeling Lesions.
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Comparison of time course of Target Lesion revascularization following successful saphenous vein graft angioplasty versus successful native coronary angioplasty.
The American journal of cardiology, 2000Co-Authors: Mun K. Hong, Gary S. Mintz, Augusto D. Pichard, Kenneth M. Kent, Lowell F. Satler, Roxana Mehran, George Dangas, Alexandra J. Lansky, Gregg W. Stone, Martin B. LeonAbstract:We studied 1,267 patients with 2,186 saphenous vein graft (SVG) Lesions to determine the time course of Target Lesion revascularization (TLR) after successful SVG angioplasty. We found that the time course of TLR in SVG appears prolonged, with only 54% occurring within the first 6 months and continued TLR even after 1 year.
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intravascular ultrasound predictors of Target Lesion revascularization after stenting of protected left main coronary artery stenoses
American Journal of Cardiology, 1999Co-Authors: M K Hong, Gary S. Mintz, Augusto D. Pichard, Kenneth M. Kent, Lowell F. Satler, Jeffrey J. Popma, Mun K. Hong, Martin B. LeonAbstract:We evaluated the predictors of late clinical outcomes after stenting of protected left main coronary artery (LMCA) stenoses. Intravascular ultrasound (IVUS) guided stenting of protected LMCA stenoses was performed in 87 consecutive patients between January 1994 and December 1996. Results were evaluated using conventional (clinical, angiographic, and IVUS) methodology. Late (12 month) clinical follow-up information was obtained in all patients. Initial procedural success was achieved in 86 patients (99%). There was 1 in-hospital death (in the 1 patient with a procedural failure). There were no other in-hospital complications, including Q-wave myocardial infarction, emergency bypass surgery, or repeat coronary angioplasty. The overall Target Lesion revascularization (TLR) rate was 13%. Using multivariate logistic regression analysis, the only independent predictor of TLR was the postintervention lumen area by IVUS. A final lumen area ≥7.0 mm2 was obtained in 74 patients (86%); the TLR rate for these patients was 7%. This was compared with patients with a final lumen area <7.0 mm2 in whom the TLR rate was 50% (p = 0.0011). Stenting of protected LMCA stenoses is safe and effective with acceptable long-term clinical outcomes. The most important factor determining long-term success was the postintervention lumen area by IVUS.
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Interrelation of Coronary Angiographic Reference Lumen Size and Intravascular Ultrasound Target Lesion Calcium
The American journal of cardiology, 1998Co-Authors: Gary S. Mintz, Augusto D. Pichard, Kenneth M. Kent, Lowell F. Satler, Jeffrey J. Popma, Martin B. LeonAbstract:Abstract Intravascular ultrasound (IVUS) detects Target Lesion calcium twice as often as does coronary angiography. Target Lesions in smaller vessels are thought to be more calcified than Target Lesions in large vessels. This study determined whether the presence and magnitude of Target Lesion calcium is related to angiographic reference lumen size. Preintervention IVUS imaging and coronary angiography were performed to study 1,454 non-aortoostial native vessel Lesions in 1,342 patients. Target Lesions and reference segments were evaluated according to previously published methods and are presented as mean ± 1 SD. By angiography, 37% of Lesions contained calcium, and 68% of calcium-containing Lesions were classified as moderately calcified, and 32% as severely calcified. There was no relation between angiographic reference lumen size and angiographic calcium detection (p = 0.7066) or classification (none/mild vs moderate vs severe, p = 0.8135). By IVUS, 73% of Lesions contained calcium. There was a consistent relation between decreasing angiographic reference lumen size and increasing IVUS Lesion-associated calcium: the presence of any calcium (p = 0.0122), arc of calcium (p = 0.002), percent of Lesions with an arc of calcium >180° (p = 0.0018), length of calcium (p 180° (p = 0.0021), and length of superificial calcium (p
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Determinants and Correlates of Target Lesion Calcium in Coronary Artery Disease: A Clinical, Angiographic and Intravascular Ultrasound Study
Journal of the American College of Cardiology, 1997Co-Authors: Gary S. Mintz, Augusto D. Pichard, Kenneth M. Kent, Lowell F. Satler, Jeffrey J. Popma, Theresa A. Bucher, Martin B. LeonAbstract:Objectives. This report used intravascular ultrasound and quantitative coronary angiography to explore the relation between Lesion-associated calcium and risk factors, clinical presentation and angiographic severity of coronary artery stenoses. Background. Coronary artery calcium is a marker for significant coronary atherosclerosis. Noninvasive procedures are being proposed as screening tests for coronary artery disease. Intravascular ultrasound identification of tissue calcium has been validated in vitro. Methods. Independent chart review, preintervention intravascular ultrasound imaging and coronary angiography were used to study primary native vessel Lesions in 1,442 patients. Target Lesions and reference segments were evaluated according to previously published quantitative and qualitative methods. Results are presented as mean value ± SD. Results. Overall, 1,043 Lesions contained Target Lesion calcium (72%); the arc of Target Lesion calcium was 110 ± 109°. Lesions with an ultrasound plaque burden >0.75 or an angiographic diameter stenosis >0.25 had a prevalence of calcium of at least 65%, with a mean arc >100°. Intermediate Lesions had as much Target Lesion calcium as did angiographically severe Lesions. Using multivariate linear regression analysis, patient age, stable (vs. unstable) angina and the intravascular ultrasound Lesion site and reference segment plaque burden (but not the angiographic diameter stenosis) were the independent predictors of the arc of Target Lesion calcium (all p < 0.0001). Conclusions. Intravascular ultrasound analysis shows that coronary calcification correlates with plaque burden but not with degree of lumen compromise. Thus, the noninvasive detection of coronary calcium is predictive of future cardiac events, presumably because coronary calcification is a marker for overall atherosclerotic plaque burden. Coronary calcium increases with increasing patient age and is less common in unstable Lesion subsets. (J Am Coll Cardiol 1997;29:268–74)