bluuebunny/crossref_metadata_2025_split huggingface dataset:
Left-sided valvular heart disease associated with poor functional outcomes in patients with acute ischaemic stroke undergoing endovascular thrombectomy
Authors: Ngiam N , Tan B.Y.Q , Sia C.H , Chan B.P.L , Anil G , Yang C.L , Poh K.K , Yeo L.L.L , Sharma V.K 
Published: November 2020

Abstract

Background
Valvular heart disease (VHD) may be an important comorbidity acute ischemic stroke (AIS), adversely affecting cerebral haemodynamics and consequently limiting functional recovery after endovascular thrombectomy (EVT). We examined the clinical profile and outcomes in patients with or without VHD who underwent EVT for AIS.

Methods
Consecutive patients (n=224) who underwent EVT for AIS were examined. All patients underwent transthoracic echocardiography within 6 months of AIS. The patients were divided into those with left-sided VHD (at least moderate severity of aortic valve or mitral valve stenosis or regurgitation) and those without. Univariate and multivariate analyses were employed to compare clinical profile and outcomes.

Results
There were 47 (20.9%) patients with VHD. Of these, 31 (66.0%) had mitral regurgitation, 15 (31.9%) had aortic stenosis, 8 (17.0%) had aortic regurgitation and 6 (12.8%) had mitral stenosis. VHD patients had a higher prevalence of atrial fibrillation (68.1% vs 43.5%, p=0.003) compared to those without, but stroke severity was similar. They had higher prevalence of pathological left ventricular (LV) remodelling, with larger end-diastolic volume index (77.9±34.5 vs 61.1±19.9ml/m2, p&lt;0.001) and LV mass index (116.4±32.7 vs 99.8±32.2g/m2, p=0.002). Despite similar rates of recanalisation, VHD patients had poorer functional outcomes (mRS&gt;2) at 3 months (68.1% vs 50.3%, p=0.029). On multivariable analyses, VHD remained independently associated with poor functional outcomes (adjusted OR 2.42, 95% CI 1.08–5.43), after adjusting for age, stroke severity and recanalisation rates.

Conclusion
VHD may be associated with poorer functional outcomes in patients with AIS undergoing EVT, despite similar rates of successful recanalisation.
Ordinal shift analyses

Funding Acknowledgement
Type of funding source: None
Utility of transcranial color flow imaging for detecting high risk morphology of patent foramen ovale in patients with cerebral infarction
Authors: Chino S , Mochizuki Y , Toyosaki E , Ota M , Mizuma K , Nohara T , Sawai A , Shinke T 
Published: November 2020

Abstract

Background
Micro-bubble test by using transcranial color flow imaging (TCCFI) is important as a screening evaluation for diagnosis of paradoxical cerebral embolism which requires the proof of right to left shunt at atrial septum. In addition, high risk features of patent foramen ovale (PFO) that may allow thrombus to easily pass through the PFO itself were previously reported. However, little is known about the association between the degrees on micro-bubble test by TCCFI and the features of high risk PFO.

Purpose
Our aim is to clarify the relationship between the degree of micro-bubble test in TCCFI and the morphology of PFO from transesophageal echocardiography (TEE).

Methods
Seventy-seven patients in whom cardiogenic embolism was strongly suspected by neurologists in Showa University from April to December in 2019 were retrospectively studied. 55 patients underwent both TCCFI and TEE with sufficient Valsalva stress. TCCFI grade of micro-bubble test was classified into 3 groups (A: none, B: small, and C: massive), in which signified “none” is no sign of micro-embolic signals (MES) within 30 seconds, “small” is 1 or more MES, and “massive” is so much MES look like a curtain (Figure). Evaluated high risk characteristics of PFO for cerebral embolism as previously reported were as follows; (1) tunnel height, (2) tunnel length, (3) total excursion distance into right and left atrium, (4) existence of Eustachian valve or Chiari network, (6) angle of PFO from inferior vena cava (7) large shunt (20 or more micro-bubbles).

Results
Of all TCCFI-positive patients (n=32; Group B=19, Group C=13) with cerebral embolism, PFOs were detected in 23 patients in TEE. Therefore, the sensitivity and specificity of TCCFI to PFO were 87% and 63% (AUC=0.75, p&lt;0.001, respectively). Interestingly, all 13 patients (Group C) had manifest PFOs. Moreover, group C include 2 patients with platypnea orthodeoxia syndrome in which hypoxia in the sitting position becomes apparent. Among PFO-positive patients, tunnel height, length, total excursion distance into right and left atrium, and large shunt in TEE were significantly larger in Group C than Group B (p&lt;0.05).

Conclusions
Micro-bubble test by using TCCFI may have screening advantages in predicting paradoxical cerebral embolism, high-risk morphology of PFO, and platypnea orthodeoxia syndrome.
Figure 1

Funding Acknowledgement
Type of funding source: None
Practice patterns, feasibility and efficacy of coronary artery angiography using distal radial approach
Authors: Kajiya T , Takaoka J , Mukai R , Inoue T , Ninomiya T , Kitazono K , Miyamura A , Atsuchi Y , Atsuchi N , Ohishi M 
Published: November 2020

Abstract

Background
Most patients undergo coronary angiography by transradial approach. However, recently distal radial approach has been introduced as a novel approach for coronary angiography and intervention. There is uncertainty on the feasibility and safety of distal radial approach for coronary angiography.

Methods
All consecutive 1450 coronary angiography cases (distal radial approach 237 cases, conventional transradial approach 1213 cases) between October 2018 and December 2019 were included in this study. Emergency coronary angiography cases and ad hoc coronary intervention cases were excluded. Patients were stratified into distal radial approach and conventional radial approach subgroups. Baseline characteristics, contrast amount, procedure time, radiation amount, fluoroscopy time, and complications in catheterization laboratory were statistically analyzed.

Results
There were no significant differences in age and gender between distal radial vs transradial groups: mean age, 70.8±10.5 vs 70.8±11.0 years; % of males, 77.2% vs 66.9%. Procedure time was significantly shorter in distal radial approach group (28.7±13.3 min vs 32.3±14.2 min, p&lt;0.05) and total radiation amount during procedure was significantly less in distal radial approach group (366.4±189.5 ml vs 412.9±220.3 mGy, p&lt;0.05).

Conclusions
Coronary angiography with distal radial approach decreases the procedure time and total radiation amount. It is feasible and safe in most stable patients.

Funding Acknowledgement
Type of funding source: None
The comparison of the chronic-phase vascular healing between bioabsorbable and durable polymer drug eluting stent by using optical coherence tomography
Authors: Yamakami Y , Kimura S , Hara K , Ohmori M , Tateishi R , Kaneda T , Shimada H , Manno T , Isshiki A , Shimizu M , Fujii H , Suzuki M , Sasano T 
Published: November 2020

Abstract

Background
Bioabsorbable polymer drug eluting stents (BP-DESs) were designed to reduce a vascular inflammatory reaction compared to durable polymer drug eluting stents (DP-DESs). However, few studies have compared vascular responses to BP-DESs and DP-DESs.

Methods
We enrolled 88 consecutive patients with single culprit coronary artery lesions (31 lesions with acute coronary syndrome) undergoing a single stent-implantation. BP-DESs and DP-DESs were implanted in 50 (57%) and 38 patients (43%), respectively. All lesions underwent optical coherence tomography examination at chronic phase and intrastent OCT findings at the follow-up were evaluated in every 1-mm cross-sections (CSs).

Results
A total of 1887 CSs (BP-DES: 1096, DP-DES: 791) were analyzed. The median period of follow-up OCT was 293 (250–374) days. There were no differences in the patient, lesion, and initial clinical presentation of acute coronary syndrome (ACS). BP-DESs had significantly higher percent neointimal hyperplasia area, defined as neointimal hyperplasia area divided by stent area x 100 (18.4±9.0% vs. 16.1±9.9%, p&lt;0.001), fewer malapposed struts (1.7% vs. 3.9%, p=0.005), fewer uncovered struts (3.6% vs. 5.8%, p=0.02) but higher frequency of superficial low intensity neointima (LIN) (7.7% vs. 3.4%, p&lt;0.001). Multivariate logistic analysis showed that BP-DES (OR: 2.5, 95% CI: 1.49–4.08, p&lt;0.001) and the initial clinical presentation of ACS (OR: 2.31, 95% CI: 1.47–3.62, p&lt;0.001) are independent predictive factors for LIN.

Conclusion
BP-DESs showed homogenous neointimal growth and complete stent coverage quantitatively. Meanwhile, the significant relationships of BP-DES with LIN may suggest that the neointimal quality remains immature in BP-DESs in this period.

Funding Acknowledgement
Type of funding source: None
Intravascular imaging to guide lithotripsy in concentric and eccentric calcific coronary lesions
Authors: Nardi G , Mattesini A , Martellini A , Sorini Dini C , Meucci F , Stolcova M , Hamiti B , Di Mario C 
Published: November 2020

Abstract

Background
Calcified coronary lesions still represent a challenge for coronary angioplasty, with sub-optimal acute PCI results causing more frequent late stent failure.

Purpose
The study aimed at the evaluation of the immediate procedural outcome of a novel treatment algorithm based on IVUS and/or OCT and including lithotripsy into a real-world consecutive based on intravascular imaging assessment by IVUS or OCT.

Methods and results
Thirty-one calcified stenoses (28 patients) out of a total of 455 lesions in 370 patients treated between November 2018 and May 2019 met the clinical and angiographic criteria for treatment with IVL under intravascular imaging guidance. Patients were divided into two subgroups depending on the calcium arc measured with intravascular imaging. Twenty lesions showed a calcium arc greater than 180 degrees (289±53 degrees) and 11 lesions smaller than 180 (140±24 degrees). The following parameters were assessed with OCT and/or IVUS: post stent minimal lumen area (MLA) and area stenosis (AS), incomplete strut apposition (ISA), eccentricity index, strut fracture, and edge dissection. After optimization a satisfactory lumen enlargement (acute gain 1.28±0.46 mm; minimal stent area 7.09±2.77 mm2) was observed with good stent expansion (residual area stenosis &lt;20% in 29 lesions, 93.5%) and OCT calcium fractures in 71% of cases. Peri-procedural complications were limited to one dissection at the distal edge requiring an additional stent and 3 peri-procedural myocardial infarctions. There were no in-hospital coronary perforations, no pericardial effusions, no stent failure or thrombosis, no deaths.

Conclusions
A standardized algorithm applying multimodality imaging to guide selection and application of IVL facilitated second generation DES implantation with final post-dilatation delivers excellent immediate procedural results and patient outcome, both in concentric or eccentric calcifications.

Funding Acknowledgement
Type of funding source: None
Impact of SYNTAX score 2 on 7-year clinical outcomes in patients treated with cobalt-chromium everolimus-eluting stent
Authors: Hiromasa T , Kuramitsu S , Yamaji K , Domei T , Hyodo M , Soga Y , Shirai S , Ando K 
Published: November 2020

Abstract

Background
Impact of SYNTAX score II (SSII) on long-term clinical outcomes after cobalt-chromium everolimus-eluting stent (CoCr-EES) implantation remains unclear.

Methods
Between February 2010 and May 2011, 1064 consecutive patients with 1440 lesions were treated only with CoCr-EES implantation. Of these, the SSII was calculated in 1013 patients with 1345 lesions. Patients were divided into the tertile group: Tertiles for SSII (low SSII [12–28.9], n=334; intermediate SSII [29–39.1], n=339; and high SSII [39.2–80.8], n=340). We assessed the cumulative 7-year incidences of major adverse cardiac events (MACE), defined as a composite of cardiac death, myocardial infarction, definite stent thrombosis, and clinically driven target lesion revascularization (CDTLR) based on SSII groupings.

Results
Cumulative 7-year incidence of MACE was significantly higher in the high SSII group than in the other groups (34.1% vs. 18.6% vs. 17.2%, p&lt;0.001). The cumulative incidence of cardiac death, myocardial infarction and stent thrombosis were significantly higher in the high SSII group than in the other groups (22.1% vs. 2.0% vs. 5.3%, p&lt;0.001; 6.6% vs. 4.9% vs. 1.7%, p=0.01; 2.9% vs. 1.7% vs. 0.3%, p=0.03, respectively). The cumulative incidence of CDTLR was similar between the groups (15.2% vs. 12.8% vs. 15.7%, p=0.57). High SSII group (hazard ratio [HR] 2.18 [vs. low SS], 95% confidence intervals [CI]: 1.56–3.06, p&lt;0.001) and diabetes mellitus (HR 1.37, 95% CI: 1.04–1.81, p=0.03) were predictors of 7-year MACE.

Conclusions
SSII has significantly impact on 7 years clinical outcomes after CoCr-EES implantation.
Cumulative incidence of MACE

Funding Acknowledgement
Type of funding source: None
Impact of diabetes mellitus on the early phase arterial healing after drug-eluting stent implantation: a multicenter coronary angioscopic study
Authors: Ishihara T , Sotomi Y , Tsujimura T , Okuno S , Iida O , Kobayashi T , Hamanaka Y , Omatsu T , Higuchi Y , Mano T 
Published: November 2020

Abstract

Background
Diabetes mellitus (DM) is a strong risk factor for major cardiac and cerebrovascular events. In particular, coronary artery disease with DM is often complicated with complex lesions. Drug-eluting stents (DES) are mainly used for these lesions, and dual-antiplatelet therapy (DAPT) has been used to prevent stent thrombosis. Early arterial healing after DES implantation may enable short DAPT strategy. However, the impact of DM on the arterial healing in the early phase has not been elucidated to date.

Purpose
We evaluated the arterial healing in the early phase after DES implantation using coronary angioscopy (CAS) and compared the findings between DM and non-DM patients.

Methods
This study was a multicenter retrospective observational study. We analyzed CAS findings of 337 lesions from 270 patients which were evaluated 3 to 5 months after DES implantation. Patients were divided into two groups: DM (149 lesions in 118 patients) versus non-DM groups (188 lesions in 152 patients). We assessed neointimal coverage (NIC) grades (maximum, minimum and dominant), thrombus adhesion and maximum yellow color of plaque underneath the stent. NIC was graded as follows: grade 0, stent struts were not covered; grade 1, stent struts were covered by thin layer; grade 2, stent struts were buried under neointima. Yellow color was graded as follows: grade 0, white; grade 1, light yellow; grade 2, yellow; grade 3, intensive yellow.

Results
Minimum NIC coverage grade was lower in DM group than in non-DM group (P=0.002, Figure), while maximum and dominant NIC coverage grades were similar between them (P=0.94 and P=0.59, respectively). Thrombus adhesion (44.3% versus 38.8%, P=0.32) and maximum yellow color grade (P=0.78) were also similar between DM and non-DM groups. Even after the adjustment by the confounding factors such as follow-up duration and primary disease of acute coronary syndrome, DM was an independent factor predicting grade 0 of minimum NIC (odds ratio [OR] 1.83 [95% confidence interval 1.11–3.03], P=0.019).

Conclusion
DM patients showed less covered struts than non-DM patients 3 to 5 months after DES implantation, suggesting that the recent ultra-short DAPT strategy might not be easily applicable to DM patients.
Minimum neointimal coverage grade

Funding Acknowledgement
Type of funding source: None
Percutaneous vs. surgical revascularization for patients with unprotected left main stenosis: a meta-analysis of 5 years follow-up RCTs
Authors: De Filippo O , D'Ascenzo F , Elia E , Doronzo M.P , Montefusco A , Pennone M , Angelini F , Franchin L , Bruno F , Salizzoni S , Gaudino M , Rinaldi M , De Ferrari G.M 
Published: November 2020

Abstract

Introduction
5-year survival of patients with ULM (Unprotected Left Main) stenosis according to the choice of revascularization (percutaneous vs. surgical) remains to be defined.

Methods and results
Randomized Controlled Trials (RTCs) comparing Percutaneous Coronary Intervention (PCI) vs. Coronary Artery Bypass Graft (CABG) with a follow-up of at least 5 years were included. All-cause death was the primary endpoint. MACCE (a composite endpoint of all-cause mortality, myocardial infarction [MI], stroke and repeat revascularization) along with its single components and cardiovascular (CV) death were the secondary ones. Analyses were stratified according to use of first vs. last generation coronary stents. Subgroup comparisons were performed according to Syntax Score (below or above 33) and to age (using cutoffs of each trial's subgroup analysis). 4 RCTs with 4394 patients were identified: 2197 were treated with CABG, 657 with first generation and 1540 with last generation stents. At 5 years rates of all-cause death did not differ (OR 0.93: 0.71–1.21), as those of CV death and stroke. CABG reduced rates of MACCE (OR 0.69: 0.60–0.79), mainly driven by MI (OR 0.48: 0.36–0.65) and revascularization (OR 0.53: 0.45–0.64). Benefit of CABG for MACCE was consistent, although with different extent, across values of Syntax Score (OR 0.76: 0.59–0.97 for values &lt;32 and OR 0.63: 0.47–0.84 for values ≥33) while was not evident for “younger” patients (OR 0.83: 0.65–1.07 vs. OR 0.65: 0.51–0.84 for “older” patients, all CI 95%).

Conclusion
For patients with ULM disease, PCI and CABG yielded same survival benefit at 5 years. CABG reduced risk of MI, revascularization and MACCE especially in older patients and in those with diffuse coronary disease.

Funding Acknowledgement
Type of funding source: None
Comparison of coronary bifurcation lesions stenting techniques- a network meta-analysis
Authors: Barrett O , Hadad L , Abramowitz Y , Cafri C , Rosenstein G , Merkin M , Zahger D , Koifman E 
Published: November 2020

Abstract

Background
Coronary bifurcations lesions (CBL) are account for 15–20% of all percutaneous coronary interventions (PCI) and constitute a major challenge for interventionists in terms of procedural success rate and long-term cardiac events. Based on data from multiple randomized trials and registries, current guidelines advocate the use of provisional side branch (SB) stenting strategy for the majority of CBL's. However, for true or complex CBL's (long side branches lesions, difficult side branches access or high risk of side branches compromise), which account for up to 25% of CBL's, this strategy may by unsafe and ineffective due to a potential risk of intraprocedural or long-term occlusion of a significant side branch and a two-stenting technique may be needed in order to achieve optimal results. Up to date, the optimal two- stenting technic for CBL remains in debate. Accordingly, our aim was to compare different stenting techniques in coronary bifurcation lesions.

Methods
We performed a MEDLINE search for randomized controlled trials (RCT) and observational studies comparing stenting techniques in CBL's with reported clinical outcomes. Mixed treatment comparison model generation was performed to directly and indirectly compare culotte, T and protrusion (TAP), crush and provisional techniques

Results
A total of 13 RCT and 12 observational studies were identified including 6806 patients, among whom 1,201 were treated with cullotte, 2,731 with crush, 797 with TAP and 2077 with provisional stenting. The Bayesian hierarchical random-effects model demonstrated a significant reduction in target lesion revascularization (TLR) rate with crush techniques compared with provisional technique (OR 0.64 95% CI 0.42–0.97) along with a trend for reduction in major adverse cardiovascular (MACE) events (OR 0.75, 95% CI 0.55–1.02). TAP and culotte techniques did not show similar results. Equality of other endpoints, including mortality, myocardial infarction and re-stenosis was found between all CBL's techniques (Figure 1).

Discussion
Our findings suggest improved outcomes with crush technique compared to other double stenting techniques in terms of TLR with a trend towards MACE reduction. Further research is required to determine the optimal stenting technique for coronary bifurcations lesions along with the utility of imaging and physiology in this complex subset.
Figure 1. Comparison of double stentin techniques

Funding Acknowledgement
Type of funding source: None
Late survival benefit of percutaneous coronary intervention compared with medical therapy in patients with coronary chronic total occlusion: a 10-year follow-up study
Authors: Park T.K , Choi S.H , Lee J.M , Yang J.H , Song Y.B , Hahn J.Y , Gwon H.C , Lee S.H 
Published: November 2020

Abstract

Background
As an initial treatment strategy, percutaneous coronary intervention (PCI) for coronary chronic total occlusion (CTO) did not show mid-term survival benefits compared with optimal medical therapy (OMT).

Purpose
To compare 10-year clinical outcomes between OMT and PCI in CTO patients.

Methods
Between March 2003 and February 2012, 2,024 patients with CTO were enrolled in a single center registry and followed for about 10 years. We excluded CTO patients who underwent coronary artery bypass grafting, and classified patients into the OMT group (n=664) or PCI group (n=883) according to initial treatment strategy. Propensity-score matching was performed to minimize potential selection bias. The primary outcome was cardiac death.

Results
In the PCI group, 699 patients (79.2%) underwent successful revascularization. Clinical and angiographic characteristics revealed more comorbidities and more complex lesions in the OMT group than in the PCI group. At 10 years, the PCI group had lower risks of cardiac death (10.4% versus 22.3%; HR 0.43; 95% CI 0.32 to 0.57; p&lt;0.001) than the OMT group. After the propensity-score matching analyses, the PCI group had lower risks of cardiac death (13.6% versus 20.8%; HR 0.62; 95% CI 0.44 to 0.88; p=0.007), acute myocardial infarction (6.3% versus 11.2%; HR 0.55; 95% CI 0.34 to 0.91; p=0.02), any revascularization (23.9% versus 32.2%; HR 0.67; 95% CI 0.51 to 0.88; p=0.004) than the OMT group. The beneficial effects of CTO PCI were consistent across various subgroups (all p-values for interaction: non-significant).

Conclusions
As an initial treatment strategy, PCI reduced late cardiac death compared with OMT in CTO patients.
Cardiac death in matched population

Funding Acknowledgement
Type of funding source: None