bluuebunny/crossref_metadata_2025_split huggingface dataset:
Stroke etiology by occlusion site – data from the PRAGUE 16 study
Authors: Vavrova J , Koznar B , Peisker T , Vasko P , Rohac F , Sulzenko J , Kroupa J , Stetkarova I , Mengozzi L , Widimsky P 
Published: November 2020

Abstract

Background
Catheter-based thrombectomy (CBT) is the most effective treatment for acute ischemic stroke. Endovascular treatment program - Prague 16 was established in tertiary university hospital in 2012 as result of close cooperation among cardiologists, neurologists and radiologists. The aim of this substudy is to analyze relationship between stroke localization and its etiology.

Methods
Single center, prospective registry of consecutive patients (pts) treated by CBT for acute ischemic stroke. Total of 214 pts (median 70 ys, range 21–92 ys, men 53.3%) were enrolled between 2012 and 2018. During hospitalization and subsequent 3-months follow-up, all pts were carefully examined (at least 48 hours ECG monitoring, CT angiography, carotid arteries sonography, transthoracal/ transoesofageal echocardiography) to determine the most likely stroke etiology.

Results
Relative frequency of strokes based on occlusion site and their etiology is shown in table below. In half of all strokes (50.9%), stroke etiology was assumed to be cardioembolic, mostly due to atrial fibrillation (89.0%). Isolated middle cerebral artery (MCA) occlusion and T-type strokes were mostly caused by cardioembolism (66.3% and 58.9%), unlike vertebrobasilar (VB) strokes, isolated internal carotid artery (ICA) occlusion/tight stenosis and tandem occlusion strokes were mostly atherotrombogenic (53.8%, 44.8% and 55.6%).

Conclusions
The majority of strokes with MCA and T-type occlusion was caused by cardioembolization, mostly due to atrial fibrillation. ICA occlusion, tandem occlusion and VB occlusion strokes were mostly caused by atherotrombosis.

Funding Acknowledgement
Type of funding source: Public grant(s) – National budget only. Main funding source(s): Charles University Research Project Progress Q35
Safety of early anticoagulation in patients treated with urgent reperfusion for acute ischemic stroke related to non-valvular atrial fibrillation
Authors: Giustozzi M 
Published: November 2020

Abstract

Background
The optimal timing for starting anticoagulation after an acute ischemic stroke related to non-valvular atrial fibrillation (AF) remains a challenge, especially in patients treated with systemic thrombolysis or mechanical thrombectomy.

Purpose
We aimed to assess the rates of early recurrence and major bleeding in patients with acute ischemic stroke and AF treated with thrombolytic therapy and/or thrombectomy who received oral anticoagulants for secondary prevention.

Methods
We combined the dataset of the RAF and the RAF-NOACs studies, which were prospective observational studies carried out from January 2012 to March 2014 and April 2014 to June 2016, respectively. We included consecutive patients with acute ischemic stroke and AF treated with either vitamin K antagonists (VKAs) or new oral anticoagulants (NOACs). Primary outcome was the composite of stroke, transient ischemic attack, symptomatic systemic embolism, symptomatic cerebral bleeding, and major extracerebral bleeding within 90 days from the inclusion.

Results
A total of 2,159 patients were included in the RAF and RAF-NOACs trials, of which 564 patients (26%) were treated with urgent reperfusion therapy. After acute stroke, 505 (90%) patients treated with reperfusion and 1,287 out of the 1,595 (81%) patients not treated with reperfusion started oral anticoagulation. Timing of starting oral anticoagulation was similar in reperfusion-treated and untreated patients (13.5±23.3 vs 12.3±18.3 days, respectively, p=0.287). At 90 days, the composite rate of recurrence and major bleeding occurred in 37 (7%) of patients treated with reperfusion treatment and in 139 (9%) of untreated patients (p=0.127). Twenty-four (4%) reperfusion-treated patients and 82 (5%) untreated patients had early recurrence while major bleeding occurred in 13 (2%) treated and in 64 (4%) untreated patients, respectively. Seven patients in the untreated group experienced both an ischemic and hemorrhagic event. Figure 1 shows the risk of early recurrence and major bleeding over time in patients treated and not treated with reperfusion treatments. The use of NOACs was associated with a favorable rate of the primary outcome compared to VKAs (Odd ratio 0.4, 95% Confidence Interval 0.3–0.7).

Conclusions
Reperfusion treatment did not influence the risk of early recurrence and major bleeding in patients with AF-related acute ischemic stroke who started anticoagulant treatment.
Figure 1

Funding Acknowledgement
Type of funding source: None
Angioscopic findings one year after percutaneous coronary intervention for chronic total occlusion
Authors: Fukuizumi I.F , Tokita Y.T , Mozawa K.M , Sasamoto N.S , Seki T.S , Wakita M.W , Shiomura R.S , Noma S.N , Matsuda J.M , Kubota Y.K , Nakata J.N , Tara S.T , Yamamoto T.Y , Takano H.T , Shimizu W.S 
Published: November 2020

Abstract

Background
Chronic total occlusion (CTO) is thought as a high-risk feature of stent thrombosis, but little is known about the difference in neointimal healing of stents implanted for CTO lesions compared to that of non-CTO lesions.

Methods and results
A total of 62 stents in consecutive 47 patients (69±11 years, 41 male) who underwent follow-up angiography and angioscopy one year after percutaneous coronary intervention (PCI) between March 2016 and July 2019 were evaluated. The examined stents were divided into 3 groups according to the lesion status at previous PCI: CTO group (n=12), stable coronary artery disease without CTO (non-CTO group, n=30) and acute coronary syndrome (ACS group, n=20). The grade of neointimal stent coverage in CTO group was significantly lower than that of non-CTO group (0.5±0.5 vs 1.4±0.9, p=0.001). The frequency of presence of thrombus was significantly higher in CTO group and ACS group compared to non-CTO group (67%, 50%, and 13%, respectively, p=0.001). The yellow grade in CTO group was equivalent (p=1.00) to that in ACS group and was tented to be higher (p=0.051) compared to non-CTO group (1.3±0.8, 1.5±0.6, and 0.8±0.7, respectively).

Conclusion
The present study suggested a delayed healing in stents implanted for CTO lesions. Longer dual-antithrombotic therapy maybe beneficial for these patients.

Funding Acknowledgement
Type of funding source: None
Association between pre-infarction angina and culprit-lesion morphology in patients with ST-segment elevation myocardial infarction: an optical coherence tomography study
Authors: Wang Y , Sheng Z , Li J , Tan Y , Zhou P , Liu C , Zhao X , Zhou J , Chen R , Song L , Zhao H , Yan H 
Published: November 2020

Abstract

Background
Previous studies reported the cardiac protection effect of pre-infarction angina (PIA) in patients with acute myocardial infarction (AMI). However, the association between PIA and culprit plaques characteristics in AMI patients through optical coherence tomography (OCT)assessment remains unclear.

Purpose
We sought to identify culprit-plaque morphology associated with PIA in patients with ST-segment elevation myocardial infarction (STEMI) using OCT.

Methods
A total of 279 STEMI patients who underwent intravascular OCT of culprit-lesion were included. Baseline clinical data and culprit-plaque characteristics were compared between the PIA group the non-PIA group.

Results
Patients with PIA represented 54.8% of the study population (153 patients). No differences were observed in clinical and angiographic data between two groups, except STEMI onset with exertion was significantly less common in PIA group (24.2% versus 40.5%, P=0.004). Patients with PIA exhibited a significantly lower incidence of plaque rupture (40.5% versus 61.9%, P&lt;0.001) and lipid-rich plaques (48.4% versus 69.0%, P=0.001). The thin-cap fibroatheroma (TCFA) prevalence was lower in PIA group, presenting a thicker fibrous cap thickness, although statistically significant differences were not observed (20.3% versus 30.2%, P=0.070; 129.1±92.0μm versus 111.4±78.1μm, P=0.088; respectively). Multivariate logistic regression analysis indicated that PIA was an independent negative predictor for plaque rupture (odds ratio: 0.44, 95% confidence interval: 0.268–0.725, P=0.001).

Conclusion
STEMI patients with PIA showed a significantly lower prevalence of plaque rupture and lipid-rich plaques in culprit-lesion than non-PIA group, implying different mechanisms of STEMI attack.
Flow chart + Bar graphs of OCT findings

Funding Acknowledgement
Type of funding source: Public Institution(s). Main funding source(s): Association between pre-infarction angina and culprit-lesion morphology in patients with ST-segment elevation myocardial infarction: An optical coherence tomography study
The accuracy and interobserver variability in the assessment of coronary atherosclerotic plaques by optical frequency domain imaging: involving five observers with different levels of coronary imaging
Authors: Shibutani H , Fujii K , Kawakami R , Imanaka T , Kawai K , Hashimoto K , Morishita S , Otagaki M , Matsumura K , Tsujimoto S , Hirota S , Shiojima I 
Published: November 2020

Abstract

Background
Whether optical frequency domain imaging (OFDI) images can realize pathological diagnosis of coronary atherosclerotic plaques, and whether its diagnostic accuracy of lesion types varies depending on the personal experience of the clinician caring for coronary intervention have not been elucidated.

Purpose
This study investigated the interobserver variability in characterizing atherosclerotic plaque types by OFDI for multiple OFDI observers with levels of different experience.

Methods
Three-hundred-thirty-three histological cross-sections from 21 autopsy hearts were co-registered with the corresponding OFDI images. Histological cross-sections were classified into the following 7 lesion types according to the modified AHA atherosclerosis classification by a single experienced pathologist blinded for OCT findings: adaptive intimal thickening (AIT), intimal xanthoma (IX), pathological intimal thickening (PIT), fibrous cap atheroma (FA), fibrocalcific plaque (FC), calcified nodule (CN), and healed erosion/rupture (HER). The five OFDI observers, unaware of the histological diagnosis, provided a single diagnosis for each corresponding OFDI image. The OFDI observer 1 was an expert interventional cardiologist with sufficient experience in OFDI imaging, followed by the OFDI observer 2, 3, and 4 as middle career interventional cardiologists who had completed training ten, seven, and four years. The OFDI observer 5 was a young career interventional cardiologist. The diagnostic accuracy of lesion types for each OFDI observer was determined taking histology as a gold standard.

Results
On histological analysis, 13% of histological cross-sections were diagnosed as AIT, 5% as IX, 23% as PIT, 25% as FA, 27% as FC, 2% as CN, and 5% as HER. The overall agreement between OFDI diagnosis and histopathologic diagnosis for OFDI observer 1 to 5 was 77%, 62%, 61%, 56%, and 46% (k values of 0.71, 0.54, 0.54, 0.45, and 0.33), respectively. Although the performance for characterizing AIT and FC was excellent and comparable among all OFDI observers, the sensitivity and positive predictive value for characterizing IX, PIT and FA varied depending on the OFDI observers' years of experience (Table). The main causes of false-positive or -negative diagnosis of FA were IX and PIT for all OFDI observers.

Conclusion
The diagnostic accuracy of atherosclerotic tissue properties from OFDI images correlated with the observers' years of experience, subspecialty training in coronary imaging, which suggests that the interpretation of OFDI images requires expertise and can be challenging to a less experienced reader.
Table 1

Funding Acknowledgement
Type of funding source: None
Coronary plaque characteristics associated with reduced thrombolysis in myocardial infarction flow in st-segment elevation myocardial infarction patients with plaque erosion
Authors: Wang J , Dai J , Fang C , Yu B 
Published: November 2020

Abstract

Background
It has been reported that the lumen factors of the culprit lesions are related to Thrombolysis in Myocardial Infarction (TIMI) flow grade in ST-Segment–Elevation Myocardial Infarction (STEMI) patients, but the factors of reduced TIMI flow in plaque erosion have not been studied.

Methods
329 STEMI patients with plaque erosion who underwent pre-intervention optical coherence tomography after thrombectomy were included and divided into 2 groups according to preprocedural TIMI flow grade [TIMI 0–1 (n=219) and TIMI 2–3 (n=110)].

Results
The patients with older age (55.7±11.1yrs vs. 51.8±10.6yrs, P=0.003) and diabetes patients (18.3% vs. 8.2%, P=0.015) had poorer TIMI flow, and the patients with reduced TIMI flow grade have lower initial cTnI (1.2ng/mL vs. 2.1ng/mL, P=0.023). The lesion in the LAD had better blood flow than the lesion in RCA (P=0.003), and the patients in TIMI 0–1 grade had more lipid plaques (53.9% vs. 41.8%, P=0.039), more macrophage (59.8% vs. 41.8%, P=0.002), and more calcification (34.2% vs. 21.8%, P=0.020). There was no statistically significant difference in the descriptive indicators of lipid or lumen between the two groups. And In a multivariate logistic regression model, the independent correlation factors of reduced TIMI flow grade in erosion patients were age, diabetes mellitus, lesion vessel, and macrophage.

Conclusions
In STEMI patients with plaque erosion non-lumen factors greatly affect flow, which suggests that systemic treatment is as important as local treatment for plaque erosion.
Flow Chart

Funding Acknowledgement
Type of funding source: Foundation. Main funding source(s): National Natural Science Foundation of China (81827806, 81801861), National Key R&D Program of China (2016YFC1301100)
Real-world clinical impact of external elastic lamina-based stent sizing criteria using optical coherence tomography
Authors: Okamoto N , Shutta R , Yanagawa K , Matsuhiro Y , Nakamura H , Yasumoto K , Tsuda M , Tanaka A , Matsunaga Y , Yano M , Yamato M , Egami Y , Tanouchi J , Nishino M 
Published: November 2020

Abstract

Introduction
ILUMIEN III trial has reported that non-inferiority of optical coherence tomography (OCT)-guided percutaneous coronary intervention (PCI) to intravascular ultrasound-guided PCI for postprocedural minimum stent area. In the trial, external elastic lamina (EEL)-based stent sizing criteria was introduced, however OCT has limitations including incomplete visualization of EEL in severale lesions.

Purpose
The aim of the study is to investigate real-world clinical impact of EEL-based stent sizing criteria.

Methods
The study included consecutive patients who underwent OCT-guided percutaneous coronary intervention (PCI) for de novo lesions in our institution between September 2016 and April 2018. EEL visibility, mean EEL diameter, mean lumen diameter and plaque morphology were assessed at proximal and distal references. The plaque morphology at references was categorized according to its most prevalent component as follows: normal, fibrous plaque, lipid plaque, and calcified plaque. Both references were divided into 3 groups according to visibility of EEL.

Results
Among 205 lesions, 31 lesions had artifacts at references (16 proximal and 17 distal references). EEL visibility was summarized in a table. Out of 174 lesions with both analyzable references, 111 lesions (63.8%) had &gt;180-degree EEL visibility at both references. Proportion of plaque morphology were significantly different among 3 groups at proximal and distal references as shown in a figure.

Conclusions
EEL-based stent sizing criteria was usable for 63.8% of all the lesions. Vessel size and plaque morphology were significantly associated with EEL visibility.
Proportion of plaque morphology

Funding Acknowledgement
Type of funding source: None
Ex Vivo assessment of competent strut coverage after coronary stenting by optical coherence tomography
Authors: Bhoite R , Jinnouchi H , Otsuka F , Sato Y , Sakamoto A , Kolodgie F , Virmani R , Finn A 
Published: November 2020

Abstract

Background
In many studies, struts coverage is defined as &gt;0 mm of tissue overlying the stent struts by optical coherence tomography (OCT). However, this definition has never been validated using histology as the “gold standard”. The present study sought to assess the appropriate cut-off value of neointimal thickness of stent strut coverage by OCT using histology.

Methods
OCT imaging was performed on 39 human coronary arteries with stents from 25 patients at autopsy. A total of 165 cross-sectional images from 46 stents were co-registered with histology. The optimal cut-off value of strut coverage by OCT was determined. Strut coverage by histology was defined as endothelial cells with at least underlying two layers of smooth muscle cells. Considering the resolution of OCT is 10–20 μm, 3 different cut-off values (i.e. at ≥20, ≥40, and ≥60 μm) were assessed.

Results
A total of 2235 struts were evaluated by histology. Eventually, 1216 struts which were well-matched struts were analyzed in this study. By histology, uncovered struts were observed in 160 struts and covered struts were observed in 1056 struts. The broadly used definition of OCT-coverage which does not consider neointimal thickness yielded a poor specificity of 37.5% and high sensitivity 100%. Of 3 cut-off values, the cut-off value of &gt;40 μm was more accurate as compared to &gt;20 and &gt;60 mm [sensitivity (99.3%), specificity (91.0%), positive predictive value (98.6%), and negative predictive value (95.6%)]

Conclusion
The most accurate cut-off value was ≥40 μm neointimal thickness by OCT in order to identify stent strut coverage validated by histology.

Funding Acknowledgement
Type of funding source: None
Discordance predictor between fractional flow reserve and resting full-cycle ratio in clinical characteristics
Authors: Ohashi H , Takashima H , Ando H , Suzuki A , Sakurai S , Nakano Y , Sawada H , Fujimoto M , Suzuki W , Waseda K , Amano T 
Published: November 2020

Abstract

Introduction
Fractional flow reserve (FFR) is a gold standard method to evaluate functional lesion severity in daily clinical practice. Recently, the resting full-cycle ratio (RFR) which was newly developed resting indices was launched. Unlike other resting indices evaluated in diastolic phase, RFR is evaluated during entire cardiac phase. Previous studies showed discordance predictors between FFR and instantaneous wave-free ratio. However, it is previously unreported what predictor cause discordant outcome between FFR and RFR.

Purpose
The purpose of this study was to evaluate clinical predictors of discordance between FFR and RFR.

Methods
A total of 156 patients with 220 lesions were prospectively enrolled in this study. RFR was evaluated before inducing hyperemia. FFR was measured after intravenous adenosine triphosphate administration (180 mcg/kg/min). According to FFR and RFR values, the patients and lesions were classified into 4 groups: Concordant negative (Group-1 [n=114]: FFR &gt;0.80, RFR &gt;0.89); negative FFR and positive RFR (Group-2 [n=18]: FFR &gt;0.80, RFR ≤0.89); positive FFR and negative RFR (Group-3 [n=25]: FFR ≤0.80, RFR &gt;0.89); Concordant positive (Group-4 [n=63]: FFR ≤0.80, RFR ≤0.89). Among them, discordance predictors with clinical characteristics between RFR and FFR were compared using by two separate logistic regression analyses. (Group-1 vs. Group-2, Group-3 vs. Group-4, respectively). Age, sex and those predictors with a p value ≤0.10 were included in a multivariate regression analysis using by forward stepwise selection to identify independent predictors of discordance.

Results
On multiple regression analysis, hemodialysis (HD) (OR:6.072 [1.090–33.836]), peripheral artery disease (PAD) (OR:9.053 [1.776–46.162]) and left anterior descending artery (LAD) (OR:9.264 [2.092–41.031]) were significantly associated with positive RFR among negative FFR groups (Groupe 2 discordance). Conversely, diabetes mellitus (DM) (OR:0.212 [0.062–0.721]) and Hb (OR:1.480 [1.102–1.987]) were significantly associated with negative RFR among positive FFR groups (Groupe 3 discordance)

Conclusions
Since the clinical characteristics with HD, PAD, LAD, DM and Hb may influence concordant with FFR during RFR evaluation, it should be considered when interpreting RFR.
Distribution and independent predictors

Funding Acknowledgement
Type of funding source: None
Predictors of fractional flow reserve/instantaneous wave-free ratio discordance documented during functional coronary stenosis assessment: impact of tailored diagnostic cut-offs on long-term outcomes
Authors: De Filippo O , Gallone G , D'Ascenzo F , Peirone A , Castelli C , Leone A.M , Mancone M , Cerrato E , Niccoli G , Rognoni A , Varbella F , Omede P , Conrotto F , Escaned J , De Ferrari G.M 
Published: November 2020

Abstract

Background
Patient- and lesion-related factors may influence concordance between instantaneous wave-free ratio (iFR) and fractional flow reserve (FFR), potentially affecting safety of revascularization deferral.

Methods
Consecutive patients with at least an intermediate coronary stenosis evaluated by both iFR and FFR were retrospectively enrolled. Revascularization was at physician's discretion. The agreement between IFR and FFR at their diagnostic cut-offs (FFR 0.80, iFR 0.89) according to patient- and lesion-level characteristics was assessed. Multivariate analyses were carried to identify the independent predictors of discordance. Tailored iFR cut-offs according to predictors of discordance best matching an FFR of 0.80 were identified by receiver-operating characteristic (ROC) curves. The impact of reclassification according to tailored iFR cut-offs on major cardiovascular events (MACE: cardiovascular death, myocardial infarction or target lesion revascularization) among deferred lesions was investigated.

Results
299 coronary stenosis (diameter stenosis 54±14%, FFR 0.84 [0.78–0.89], iFR 0.91 [0.87–0.95], left main/left anterior descending [LM/LAD] vessel 67.6%) of 260 patients were studied, and 46.5% were revascularized. Discordance rate was 23.4% (10.7% iFR-negative discordant, 12.7% iFR-positive discordant). Independent predictors of discordance were LM/LAD disease, multivessel disease, non-ST-elevation myocardial infarction presentation, smoking, reduced glomerular filtration rate and hypertension. Lesion reclassification with tailored iFR-cut-offs based on patient-level predictors carried no prognostic value among deferred lesions. Reclassification according to lesion location, which was entirely driven by LM/LAD lesions (iFR-cut-offs: 0.93 for LM/LAD, 0.89 for non-LM/LAD), identified increased MACE among lesions deferred based on a negative FFR, between patients with a positive as compared to a negative iFR (19.4% vs. 6.1%, p=0.044), while the same association was not observed with the conventional 0.89 iFR cut-off (15.0% vs 8.6%, p=0.303).

Conclusion
Tailored vessel-based iFR cut-offs carry prognostic value among FFR negative lesions, suggesting that iFR may more safely defer revascularization of LM/LAD lesions than FFR and that a single iFR cut-off might be clinically unsatisfactory.

Funding Acknowledgement
Type of funding source: None