bluuebunny/crossref_metadata_2025_split huggingface dataset:
The effect of doxycycline on abdominal aortic aneurysm growth: a meta-analysis
Authors: Patel M M 
Published: October 2021

Abstract

Introduction
There have been many studies on the benefits of chronic doxycycline therapy on slowing down the rate of abdominal aortic aneurysm (AAA) expansion by decreasing matrix metalloproteinase (MMPs) levels in AAA, known contributors to AAA growth. However, there have been few studies performed on the clinical effect of doxycycline on reducing the rate of AAA expansion.

Purpose
The objective of this meta-analysis was to evaluate the effect of doxycycline on the expansion of AAA.

Methods
We performed a comprehensive literature search using PubMed, Embase, and Cochrane Libraries from inception to October 2020 for all studies evaluating the effect of chronic doxycycline therapy on AAA growth. The primary outcome was the effect doxycycline therapy on AAA growth rate compared to the placebo. The mean difference and 95% confidence intervals (CI) were obtained by the Inverse Variance method within a random effect model.

Results
A total of three randomized control trials (485 total patients) were included in the final analysis. The analysis showed that there was no significant benefit of chronic doxycycline therapy in reducing AAA dilation rate compared to placebo [Mean difference of 0.03; 95% CI −0.05 to 0.11, P=0.43, I2=90%].

Conclusion
This is the first meta-analysis evaluating the effects of chronic doxycycline therapy on the growth rate of AAAs. The current data suggests that there is no significant decrease in rate of expansion of AAA diameter in patients treated with chronic doxycycline vs. placebo.

Funding Acknowledgement
Type of funding sources: None.
Hybrid vascular interventin for multilevel peripheral arterial disease
Authors: Puzdriak P D , Ivanov M A , Gusinskiy A V , Shlomin V V , Bondarenko P B , Chizhova K A , Novikova N Y U , Shvarts E Y U 
Published: October 2021

Abstract

Objective
To increase the effectiveness of intervention for the lower limb arteries multilevel lesion (MPAD) in patients with type C and D lesions by TASC II classification.

Materials and methods
87 hybrid vascular reconstructions (74 male and 13 female, 59% (n=52) smokers) for MPAD were performed from 2017 to 2020. The average age was 64,6±8,1y. CLI was diagnosed in 47% (n=41) by Fontaine- Pokrovsky classification. Following concomitant disease were diagnosed: stage 2–3 of CHF by HYHA classification 33% (n=29), COPD 23% (n=20), arterial hypertension stage 2–3 54% (n=47), CAD 66% (n=58), postinfarction cardiosclerosis 29% (n=26). Registered lesion of iliac-femoral segment type A/B=44 (51%) and C/D=43 (49%); registered lesion of femoro-tibial segment A/B=14 (16%), C/D=73 (84%) by TASC-II classification. Common femoral artery (CFA) bifurcation was most important to perform hybrid intervention. Through CFA with patented method (RU 2621395C) we performed remote endartherectomy from external iliac or superficial femoral arteries, that allowed us to remove a total prolonged occlusion (&gt;15–20 cm), reducing the time and complexity of the endovascular stage. The key note is that we perform CFA plasty with using an autovenous patch with a “trunk” through which we provide endovascular stage of hybrid intervention on natural blood flow, restored after open endartherectomy. This technique allows you to change the direction of introducer in both distal and proximal direction without the need for extra punctures or temporary clamping of the arteries.

Results
Technical success rate was 98%. Local aneurysm of EIA was found in one case that restricted to provide the loop endarterectomy. The average duration of hybrid operation was 223,7±88,2 min (134,2±72,3 min for open and 89,9±52,9 for endovascular stages). Average blood loss was 225,3±130,7 ml. ICU staying duration was 20,6±2,8 hours. 30-days patency was 98,8%, 12 and 36 months primary patency was 98% and 88,5% respectively. There were no deaths within 30 days after hybrid operation. The following complications occurred: bleeding n=2 (2,3%), acute thrombosis n=1 (1,2%), surgical site infection n=1 (1,2%) but cured safely. Limb salvage in critical ischemia was in 100% of patients for 20 months.

Conclusion
Hybrid surgery of MPAD is highly effective, reduces operation trauma, improves its results and limb salvage. By reducing trauma of surgical intervention reduces admition in ICU, postoperative risks, especially in patients with severe concomitant pathology.

Funding Acknowledgement
Type of funding sources: None.
Elevated lipoprotein(a) level predicts repeated peripheral revascularization
Authors: Tmoyan N , Ezhov M , Afanasieva O , Chubykina U , Klesareva E , Tyurina A , Afanasieva M , Pokrovsky S 
Published: October 2021

Abstract

Background
Despite high-intensity lipid-lowering therapy, there is a residual risk of cardiovascular events that could be associated with lipoprotein(a) [Lp(a)]. Data about the role of Lp(a) in the development of significant stenosis after carotid and lower extremity artery revascularization are lacking.

Purpose
To evaluate the relationship of Lp(a) level with repeated revascularization due to restenosis or de novo stenosis after endovascular or surgery repair of carotid and lower limb arteries.

Methods
The study included 258 patients (209 men and 49 women, mean age 67 years) who underwent revascularization of carotid and/or arteries of lower extremities for symptomatic stenotic atherosclerosis. Restenosis or de novo stenosis has been assessed by ultrasonography or angiography. History and physical examination have been performed to identify atherosclerosis risk factors. Lipids, C-reactive protein, Lp(a) concentrations were measured in blood serum.

Results
During 3 years follow-up, repeated revascularization due to restenosis or de novo stenosis was registered in 111 patients. Hyperlipoproteinemia(a) [Lp(a) ≥30 mg/dL] was associated with an increased risk of repeated revascularization with hazard ratio 2.9; 95% confidence interval 2.0–4.2, p&lt;0.01 (figure). C-reactive protein and other clinical and laboratory variables did not differ in patients with and without repeated peripheral revascularization. According to Cox regression analysis adjusted for all risk factors, hyperlipoproteinemia(a) remained an independent predictor of severe restenosis or de novo stenosis of carotid and lower extremity arteries and was associated with a threefold increased risk of repeated revascularization.

Conclusions
In a three-year prospective study of patients after peripheral revascularization, Lp(a) level ≥30 mg/dL was shown as an independent risk factor for repeated revascularization.

Funding Acknowledgement
Type of funding sources: None. Survival analysis
Intravascular lithotripsy in calcified peripheral lesions: the real-world single-center JEN-experience
Authors: Kretzschmar D , Aftanski P , Thieme M , Schulze P C , Moebius-Winkler S 
Published: October 2021

Abstract

Objective
Peripheral vascular disease (PVD) is a major cause of morbidity and mortality with increasing need for interventional therapies. Vascular calcification increases risk of complications and may impair the effect of antiproliferative therapy. Intravascular lithotripsy (IVL) using pulsatile sonic pressure waves to modify intimal and medial calcium is a promising approach for those patients to overcome the drawbacks of vascular calcification.

Purpose
A single-center, prospective registry of patients undergoing peripheral lithotripsy was established. Periprocedural safety events as well as short and long term follow-up clinical data were evaluated.

Methods
A prospective review of cases using IVL was performed for the period from December 2018 to January 2021 at our center. Angiographic images were quantified by using the QVA 8.0 module, Medis Suite Version 3.2.60.4 developed by Medis Imaging Systems.

Results
61 cases of IVL were performed in 51 patients with Rutherford class 3. Mean age was 71 years with 78% (28) of the patients being men. Diabetes was present in 80% and renal insufficiency in 47% of the cases. The median calcified lesion length treated was 82 mm (10; 390 mm) with a PACCS sore of 3 (1; 3), indicating a highly calcified status. In 41% (n=25), predilation was necessary. We treated 8 iliac-, 19 common femoral-, 52 superficial femoral-, 5 deep femoral-, 29 popliteal- and 2 crural- lesions with balloon sizes ranging from 4.0 to 7.0 mm. In 35 (57%) cases IVL was used as a stand-alone therapy, in the remaining 26 an adjunctive therapy (DCB and/or stent) was used. We were able to reach an acute luminal gain of 2.5 mm. A ballon rupture occurred in 6 (10%) cases. There were no other complications. Mean ABI improved from 0.6 to 0.8 (p&lt;0.0001) immediate after the intervention. Follow-up after 6 months again demonstrated an improved ABI of 0.8 (p&lt;0.0001 vs. baseline).

Conclusion
This first real-world data of IVL reports compelling safety of IVL in a complex, difficult-to-treat patient cohort. For the first time, clinical follow-up data were presented and demonstrated a sustained improved ABI after 6 months. This innovative approach will gain more interest in the future, especially since long term effects of paclitaxel eluting devices are controversially discussed.

Funding Acknowledgement
Type of funding sources: None. ABI initial follow-up
Temporal course of vascular response after fluoropolymer paclitaxel-eluting stent implantation for femoropopliteal artery lesions
Authors: Tomoi Y , Kuramitsu S , Hiramori S , Soga Y , Ando K 
Published: October 2021

Abstract

Background
Limited data is available regarding the vascular response after fluoropolymer paclitaxel-eluting stent (FP-PES) implantation. We sought to assess the vascular response at 6- and 12-month after FP-PES implantation for femoropopliteal artery lesions using serial optical coherence tomography (OCT) examination.

Methods and results
From the IMPERIAL trial, this study evaluated 10 de novo femoropopliteal lesions treated with FP-PES. The primary study endpoint was neointimal tissue coverage at 6- and 12-month follow-up as assessed by serial OCT examination. The incidence of peri-strut low-intensity area (PLIA) and extra-stent lumen (ESL) was also assessed. A total of 203 matched cross-sectional images were evaluated at 6- and 12-month (5,615 and 5,763 struts, respectively). From 6 to 12 months, the mean neointimal thickness tended to increase from 198 μm to 233 μm with a significant reduction in the incidence of malapposed struts (0.59% vs. 0.28%, p=0.039). Conversely, uncovered struts and PLIA were more frequently observed at 12 months (4.4% vs. 7.8%, p=0.01; 12.7% vs. 21.0%, p&lt;0.001, respectively). The ESL area significantly increased over time without any difference in its incidence (0.24±0.32 mm2 vs. 0.38±0.36 mm2, p=0.009).

Conclusions
Neointimal proliferation was markedly inhibited from 6 to 12 months after FP-PES implantation, whereas the incidence of uncovered struts and PLIA significantly increased over time with the enlargement of ESL.

Funding Acknowledgement
Type of funding sources: None.
Quantitative flow ratio for the functional assessment of extracranial internal carotid artery stenosis
Authors: Franzese M , Di Serafino L , Stabile E , Giugliano G , Leone A , Ilardi F , Strisciuglio T , Esposito G 
Published: October 2021

Abstract

Background
In asymptomatic patients at high surgical risk presenting with significant extracranial internal carotid artery stenoses, a selective invasive angiography is performed before carotid artery stenting (CAS). Sometimes, the angiographic findings of the stenosis could be discordant from those observed at the non-invasive imaging evaluation and the use of a pressure-wire to evaluate the hemodynamic potential of the stenosis, might be dangerous for the higher risk of cerebrovascular events.

Purpose
The Quantitative Flow Ratio (QFR), by estimating the contrast flow velocity and based on a 3-dimensional quantitative angiography, might be of value as an online angiography-based functional assessment of internal carotid stenoses, in order to guide the physicians in the decision-making process to proceed or not to revascularization.

Methods
We prospectively enrolled 14 asymptomatic patients with an indication for invasive treatment of internal carotid artery stenosis. The echo-colour-Doppler was performed in 28 vessels and the Peak Systolic Velocity (PSV, cm/sec) was used to identify functionally significant stenoses (PSV &gt;120cm/sec). At the angiography, internal carotid artery stenosis degree was obtained according to NASCET criteria (%DSNASCET) and the lesion considered angiographically significant if &gt;60%. After the exclusion of 4 vessels, QFR, Area Stenosis (AS, %) and Minimal Lumen Area (MLA, mm2) were obtained in the remaining 24 vessels (Figure 1, Panel A and B).

Results
At the linear regression analysis, QFR values significantly correlated with PSV (r2=0.71, p&lt;0.001) as well as with %DSNASCET (r2=0.81, p&lt;0.001). In addition, using the PSV as reference, QFR showed good accuracy to predict the presence of a functionally significant stenosis (AUC=1.00, p&lt;0.001) with a cut-off value of 0.90. Similarly, the MLA significantly correlated with both the PSV and %DSNASCET (respectively, r2=0.61 and r2=0.60, p&lt;0.001) as well as the AS (respectively, r2=0.68 and r2=0.87, p&lt;0.001) (Figure 2).

Conclusion
This study suggests the possibility to adopt QFR for the functional assessment of extracranial internal carotid artery stenoses and should be considered as hypothesis generating to design a larger validation trial.

Funding Acknowledgement
Type of funding sources: None.
Comparison of outcomes between imaging guided versus angiography guided percutaneous coronary intervention in patients with acute coronary syndrome: insights from the national inpatient sample
Authors: Akuna E A , Asemota I A , Elbermawy M E , Almani U A , Soon-Shiong R S , Kang C K , Bharosa B S , Usman M U , Li L L , Vij A V 
Published: October 2021

Abstract

Objective
Coronary intravascular imaging allows visualization and characterization of vessel wall. Percutaneous coronary intervention (PCI) using intravascular ultrasound or optical coherence tomography has optimized stent deployment techniques, reduced periprocedural outcomes and reduced long-term major cardiovascular events. We sought to investigate the outcomes of imaging guided to conventional angiography guided PCI with reference to in-hospital mortality, hospital length of stay (LOS) and total hospital charge.

Methods
We performed a retrospective cohort study using data from the 2016–2017 Nationwide Inpatient Sample (NIS) which is the largest collection of inpatient hospitalization data in the United States. Patients admitted with a principal diagnosis of acute coronary syndrome (ACS) who underwent PCI with and without intravascular imaging was determined using the International Classification of Diseases, Tenth revision codes. The primary outcome was inpatient mortality while secondary outcomes are showed in table 1. STATA software was used for the analysis. Multivariate logistic and linear regression models were used to adjust for confounders.

Results
There were over 71 million hospital discharges in the combined 2016 and 2017 NIS database. Admission for ACS in adult patients (aged ≥18 years) who underwent PCI yielded 622,855 results. Among this group, 27, 520 (4.4%) had imaging guided PCI while 595,335 (95.6%) had PCI without imaging.
Patients with imaging guided PCI had lower inpatient mortality (3.2% vs 2.3%, AOR: 0.74, 95% CI 0.60–0.90, p=0.004) compared to PCI with angiographic data alone. Imaging guided PCI had an adjusted increased mean LOS of 0.16 days (3.8 vs 3.7 days, CI: 006–0.26, p=0.002) with an adjusted increased mean total hospital charge of $13, 206 ($120,203 vs $104,916, p= &lt;0.0001).

Conclusion
Patients hospitalized for ACS who had imaging guided PCI had reduced inpatient hospital mortality compared to those who had PCI without imaging guidance. Overall utilization of imaging was less than 5% in 2016–2017, however it is expected to be higher in recent years with improvements in clinical practice, training and available scientific evidence.

Funding Acknowledgement
Type of funding sources: None.
Impact of wire sensor location on coronary physiological measurement
Authors: Lotfi A L , Haider A H , Pervaiz A P , Kadado A J K , Bachman M B , Rodriguez Arciniega J R A , Visintainer P V 
Published: October 2021

Abstract

Background
The location of the wire sensor to measure FFR and dPR has not been systemically studied. Therefore, we hypothesize that the coronary physiological measurements will vary with the location of the sensor. This exploratory study is to assess whole cycle pressure distal/pressure aorta (Pd/Pa) ratio, FFR, and dPR at different sensor position within the vessel to evaluate the impact of pressure drop and measurements based on sensor position.

Methods
54 patients who had an indication for coronary angiography were screened and 30 consecutive patients were enrolled. The OptoWire 2 or 3 generation fiberoptic pressure wire was used to assess Pd/Pa, dPR, and FFR. Our primary goal is to test if those measurements vary with the FFR wire sensor placed at 10mm (proximal), 35–45mm (mid), and greater than or equal 60–70mm (distal) distal to the target lesion respectively. We used a multilevel linear regression approach.

Results
Of 30 patients enrolled, 23 (76.6%) were males, mean age was 64.7 years (± 11.0 yrs), and mean stenosis was 61.6% (±13.4%). Adjusting for age, gender, and severity of stenosis, results showed that for all three measures (Pd/Pa, DPR, and FFR) (Figure 1), pressure decreased in a linear fashion the further the sensor was from the target lesion (p values &lt;0.001). Further, pairwise comparisons of the measurements at adjacent locations similarly showed significant declines in pressure (p values &lt;0.001).

Conclusions
This is first study to demonstrate that the location of the pressure wire can impact the results of both resting and hyperemic pressures which can cause a false negative result. This is especially important where the values are near the cut-off.

Funding Acknowledgement
Type of funding sources: None.
CHA2DS2 -VASc score as a predictor for contrast-induced nephropathy in patients with acute coronary syndrome undergoing percutaneous coronary intervention
Authors: Hamdy Elkholy M O N , Shehata H , Abu Arab T 
Published: October 2021

Abstract

Background
Contrast induced nephropathy (CIN) is one of the most important complications of PCI, resulting in increased medical resources, longer hospital stay and higher mortality so it is important to detect early high risk patients for CIN and provide them with preventive measures. In recent years, several studies have demonstrated an association of CHA2DS2-VASc score with cardiovascular prognosis and adverse outcomes in different populations including heart failure, SCAD and ACS beyond the original AF field. The predictive value of the CHA2DS2-VASc score on CIN still remains unclear although all of the components of the CHA2DS2-VASc score are important risk factors for CIN. For this reason, the present study was designed to evaluate the predictive value of preprocedural CHA2DS2-VASc score on the development of CIN in patients with ACS who underwent PCI.

Objective
To assess the predictive value of the CHA2DS2-VASc Score for contrast induced nephropathy among acute coronary syndrome patients who underwent percutaneous coronary intervention.

Material and methods
This study is a prospective study conducted over 300 patients with myocardial infarction underwent primary coronary intervention. It took place from February 2020 till September 2020. We analyzed patient's demographic data, clinical data, laboratory data, angiographic data and CHADSVASC score and followed up patients daily for 72 hour after PCI for development of CIN then compared these data in CIN versus non CIN patients trying to find out which of these factors can predict occurrence of CIN and find CHADSVASC score cutoff value for prediction of CIN.

Results
CIN was developed in 89 patients. A significant relationship existed between CIN and female gender, DM, HTN, door to needle time, killip class above one, contrast volume (p&lt;0.000), previous intervention using contrast (p&lt;0.001), anemia (p&lt;0.014), duration of procedure (p&lt;0.074) and number of coronary vessels affected (p&lt;0.031). However, non-significant relationship existed between CIN and Stroke, TIA, previous thromboembolism (p&lt;0.446), ejection fraction (p&lt;0.155), culprit vessel (p&lt;0.317), TIMI grade (p&lt;0.278) and antiplatelet type (p&lt;0.934). Receiver operating characteristic curve analysis showed good predictive value of CHA2DS2-VASc score for CIN (area under the curve 0.801, sensitivity 69.66% and specificity 80.75%). Patients with a CHA2DS2-VASc score cutoff value ≥4 had a higher liability for CIN (p&lt;0.000).

Conclusion
CHA2DS2-VASc score is a simple bedside risk score for preprocedure CIN risk stratification among ACS patients who underwent primary PCI.

Funding Acknowledgement
Type of funding sources: None.
Identifying predictive risk factors for permanent pacemaker implantation up to 30 days post-TAVI
Authors: Li J , Christodoulidou A , Cranley J , Ara F , Costopoulos C.H.A.R.I.S , Costanzo P , Osullivan M , Davies W , Densem C , Martin C A 
Published: October 2021

Abstract

Background
Conduction system abnormalities, including AV block, are amongst the most common complications of transcatheter aortic valve implantation (TAVI). Post-TAVI high degree AV block necessitates permanent pacemaker (PPM) implantation.

Purpose
To assess the ability of standardly available pre-, intra- and post-TAVI factors to predict PPM implantation within 30-days post procedure.

Methods
Demographic and clinical (pre-, intra-, and post-procedural) data including ECG parameters were collected from all patients who underwent TAVI at our centre from August 2017 to November 2020. Patients with pre-existing PPM were excluded from the study. Predictive factors were selected through univariate analysis, and selected characteristics were incorporated into a multivariate binomial logistic regression model, in order to create a 30-day PPM risk-prediction model. The Akaike information criterion (AIC) and area under receiver operating curve (AUC/C-statistic) were used to assess discriminative performance.

Results
In total, data from a total of 446 patients were analysed. Of these, 40 (8.97%) received PPM implantation within 30 days of the procedure. The mean age of the patients was 81.5 (±7.3 SD) years; 99 (22.2%) had pre-existing first degree AV block, 55 (12.3%) had pre-existing left bundle branch block (LBBB) and 50 (11.2%) had pre-existing right bundle branch block (RBBB). Intra-procedurally 40 (9.0%) developed LBBB, 21 (4.7%) developed 3rd degree AV block, and 95 (21.3%) patients required temporary pacing wire (TPW) pacing. Post-procedurally, 138 (30.9%) exhibited AV block, 107 (24.0%) LBBB and 50 (11.2%) RBBB.
The following factors met significance at multivariate logistic regression analysis: pre-TAVI RBBB (OR 6.62 [95% CI, 1.37–36.51]), intra-TAVI 3rd degree AV block (OR 12.80 [95% CI, 3.44–53.34]), intra-TAVI LBBB (OR 4.02 [95% CI, 1.28–12.53]), use of TPW pacing (OR 8.58 [95% CI, 3.19–25.12]) and post-TAVI LBBB (OR 7.84 [95% CI, 2.75–24.46]) (Table).
Finally, variables were incorporated into a multivariate logistic regression model with the outcome variable of 30-day PPM implantation (Figure 1a). A model incorporating five factors (pre-TAVI RBBB, intra-TAVI 3rd degree AV block, intra-TAVI LBBB, use of TPW pacing and post-TAVI LBBB) demonstrated excellent discriminative ability (accuracy 0.925 and an AUC of 0.952) at predicting PPM implantation (Figure 1b).

Conclusions
Following variable selection, the best performing model incorporated five factors including pre-TAVI RBBB, intra-TAVI AV block (3rd degree), intra-TAVI LBBB, use of TPW pacing and post-TAVI LBBB. We aim to validate this model using an external cohort.

Funding Acknowledgement
Type of funding sources: None. Table 1Figure 1