bluuebunny/crossref_metadata_2025_split huggingface dataset:
Microvascular Resistance Reserve assessed by bolus and continuous thermodilution
Authors: Gallinoro E , Bertolone D T , Belmonte M , Paolisso P , Mizukami T , Bermpeis K , Storozhenko T , Esposito G , Sakai K , Munhoz D , Seki R , Ohashi H , Sonck J , Collet C , De Bruyne B 
Published: November 2023

Abstract

Aim
The main limitation of Coronary flow reserve (CFR) as an index to assess coronary microvascular function, is that it is influenced by epicardial resistance. Microvascular Resistance Reserve (MRR) has been recently introduced as a metric that is truly specific for the coronary microcirculation. MRR can, in principle, be derived from any tool that measure flow and pressure. The aim of the present study was to compare CFR and MRR as derived by bolus (CFRbolus and MRRbolus, respectively) and continuous thermodilution (CFRcont and MRRcont, respectively).

Methods and Results
A total of 175 patients were studied. Bolus and continuous thermodilution measurements were performed in the LAD in all patients. The MRR was derived as a function of the coronary flow reserve (CFR) divided by the fractional flow reserve (FFR) and corrected for driving pressures. Coefficient of variation was calculated to assess the precision of both methods. Mean CFRbolus was higher than the corresponding value of CFRcont (3.47±1.42 and 2.67±0.81, respectively, p&lt;0.001, mean bias 0.80). Also mean MRRbolus was higher than the corresponding value of MRRcont (4.40±1.99 vs 3.22±1.02, respectively p&lt;0.001, mean bias 1.2) The correlation between CFR and MRR values obtained by both approaches was weak (R= 0.28 (0.14 to 0.41) for CFR; R=0.26 (0.16 to 0.39) for MRR; p&lt;0.001 for both). Continuous thermodilution had a smaller dispersion of data for both CFR (CoV= 30.2% vs 46.6% respectively, p&lt;0.001) and MRR (CoV= 31.7 % vs 45.2% vs, respectively, p&lt;0.001).

Conclusion
Bolus thermodilution significantly overestimates continuous thermodilution-derived CFR and MRR and shows a larger scatter of the data. Therefore, bolus thermodilution seems a less appropriate method to assess microvascular function than is continuous thermodilution.
Two-year outcomes of drug-coated balloon only strategy for de novo lesions in large coronary vessels
Authors: Bando R , Wakatsuki T , Yamaguchi K , Kawabata Y , Takahashi T , Saijo Y , Kadota M , Matsuura T , Ise T , Kusunose K , Yagi S , Yamada H , Soeki T , Akaike M , Sata M 
Published: November 2023

Abstract

Background
Drug-coated balloons (DCB) are effective for the treatment of in-stent restenosis and de novo lesions in small coronary vessels (reference vessel diameter: RVD &lt; 3.0 mm). Recently, several studies have reported acceptable results of DCB for de novo lesions in large coronary vessels (RVD ≧ 3.0 mm). However, previous studies were limited, we investigated the clinical outcomes of the DCB only strategy for de novo lesions in large coronary vessels.

Methods
We retrospectively analyzed 97 patients with 107 de novo lesions (RVD ≧ 3.0 mm) who underwent DCB only angioplasty from January 2016 to December 2021. We scheduled angiographic follow-up at 6 months after procedure and analyzed quantitative coronary angiography (QCA) data.

Results
The mean duration of follow-up was 737.8 ± 512.6 days. Patients who met the high bleeding risk (HBR) criteria was 56 (57.7%). Procedure success rate was 97.2% (3 lesions needed bailout drug eluting stent implantation) and acute coronary occlusion was not observed. The 2-year cumulative incidences of all-cause death was 7.1%, cardiac death was 1.6%. Target vessel revascularization was 9.2%, target lesion revascularization was 4.2%, respectively. Two patients had major bleeding events (BARC type 3 or 5) within 3 months after treatment and during the DAPT period. No major bleeding events were observed during the SAPT period.

Conclusion
The clinical outcomes of the DCB only strategy for de novo lesions in large coronary vessels were safe and acceptable. Especially in HBR patients, DCB only strategy could be an alternative treatment option.
Drug coated balloon treatment with or without long inflation time in patients undergoing percutaneous coronary intervention: a propensity score matching analysis
Authors: Fujiwara Y , Ueda H , Nishida Y , Maenaka M , Yoshimura K , Oshida Y , Natsuyama K , Matsuhisa S , Yoshida N , Yoshitani H , Yamaguti K , Kuga Y , Ueda K , Nishida Y 
Published: November 2023

Abstract

Aim
Although drug coated balloon (DCB) treatment for coronary de novo or in-stent restenosis lesions is a widespread strategy, consensus is lacking regarding appropriate DCB inflation time during percutaneous coronary intervention (PCI). We sought to evaluate the effect of long inflation time of DCB on procedural results and clinical outcomes after PCI.

Methods
Between January 2019 and August 2020, 314 consecutive patients with 445 lesions underwent intravascular imaging-guided PCI with paclitaxel DCB using different inflation time. In the entire cohort, the median follow-up duration was 966 days. We classified patients into DCB inflation time of ≥180 sec (prolonged group, n = 101) or &lt;180 sec (standard group, n = 212). The primary clinical endpoint was a composite of death, myocardial infarction (MI), stroke, and target lesion revascularization. One-to-one propensity score matching was performed for potential bias. A total of 92 pairs were matched.

Results
In the matched population, the median age was 73 years, 82.1% was male, and 35.8% was treated for in-stent restenosis. The median duration of DCB inflation was 300 sec in the prolonged group and 60 sec in the standard group during PCI. After PCI, angiographic acute lumen gain was similar between the groups, but diameter stenosis was smaller in the prolonged group than in the standard group (30.0% vs. 33.5%, p = 0.042). Intravascular ultrasound (IVUS) analysis revealed that the prolonged group resulted in smaller plaque burden at the MLA (61.9% vs. 66.7%, p = 0.002), smaller area stenosis (66.6% vs. 69.4%, p = 0.044), and less mean increase in percent atheroma volume (-11.2 ± 7.1% vs. -7.4 ± 5.9%, p = 0.004). The rate of the primary clinical endpoint was lower in the prolonged group compared with the standard group (log-rank p = 0.025). The rate of IVUS dissection and hematoma and the incidence of periprocedural MI were not different among the 2 groups.

Conclusions
Despite comparable acute lumen gain, long DCB inflation time was associated with favorable angiographic and IVUS results and reduced adverse events compared with standard DCB treatment in patients with coronary artery disease.
High bleeding risk mainly predicts non-access site bleeding events in the first month after percutaneous coronary intervention
Authors: Woelders E C I , Peeters D A M , Luijkx J J P , Winkler P J C , Damman P , Remkes W S , Van 'T Hof A W J , Van Geuns R J M 
Published: November 2023

Abstract

Background/Introduction
The majority of bleeding events after percutaneous coronary intervention (PCI) occur in the first month after PCI. To predict and anticipate on events during hospitalisation and in the first month, the CRUSADE- and ACUITY scores have been developed. In order to enhance the use of bleeding risk stratification, a consortium of PCI centres in the South East of the Netherlands has created and implemented a simple binary variant of the existing models. High bleeding risk (HBR) is defined by one of the following: eGFR&lt; 30; anaemia (Hb &lt; 7mmol/L); a spontaneous bleeding within one year before PCI; a history of intracranial haemorrhage.

Purpose
We evaluated the predictive value of our risk model and other risk factors for bleeding events in the first month after PCI and discriminated between access site- non-access site bleedings.

Methods
In an ongoing multicentre prospective PCI registry in the South East of the Netherlands collects baseline and follow-up data of all patients undergoing PCI. We compared access site- and non- access site bleedings between HBR and non HBR using the Kaplan Meier method and Cox regression. Also, we performed multivariate analysis of the separate factors of the model and other probable risk factors.

Results
We collected baseline and 30 day follow-up data in 3996 patients of which 357 with HBR (9%). Access site bleedings occurred in 3% of patients with HBR vs 2% without (sens. 0.13; spec. 0.98). Patients with HBR showed 5% non-access site bleedings versus 1% in non HBR (sens. 0.21; spec. 0.99). Survival curves and hazard ratios presented in figure 1 show that these differences are significant only for non-access site bleedings (HR: 4.2, 95% CI: 2.47-7.30). The multivariate analysis is presented in table 1. All bleeding events were predicted by age ≥ 60 and peripheral arterial disease. Furthermore, non-access site bleedings were predicted by anaemia and bleeding events in the previous year. Additional risk factors for access site bleedings were female sex and double access site punction.

Conclusion
The simplified risk model showed to be conservative in the determination of HBR as depicted by the sensitivity and specificity. However, it showed good discriminative value for non-access site bleedings which was driven by anemia and a history of bleedings. Furthermore, these results suggest that age ≥60 and peripheral arterial disease should be taken into consideration. Extra precaution for access site bleedings should also be taken in female patients and in the case of double access site punction.Figure 1Table 1
Distal radial approach using a transdermal nitroglycerin patch : double-blinded randomized trial
Authors: Murai K , Fujino M , Iwai T , Sawada K , Matama H , Miura H , Honda S , Yoneda S , Nakao K , Takagi K , Otsuka F , Kataoka Y , Asaumi Y , Tahara Y , Noguchi T 
Published: November 2023

Abstract

Background
The distal radial approach (DRA) provides a lower risk of radial artery occlusion than the conventional transradial approach (TRA) and has recently been used worldwide as an alternative access route for coronary catheterization. However, the small diameter of the distal radial artery causes difficulty in puncture and leads to DRA failure.

Purpose
The aim of this study is to elucidate whether a transdermal nitroglycerin patch improves the rate of successful DRA cannulation.

Methods
A total of 92 patients with angina pectoris scheduled for elective coronary angiography via DRA randomly received (1:1) a transdermal nitroglycerin patch pre-integrated with the covering material or only the covering material on their upper arm on the side of the puncture. The diameter of the distal radial artery was evaluated with ultrasound at baseline and after application. DRA procedures were performed in a double-blinded fashion. The primary outcome was the rate of successful palpation-guided distal radial artery cannulation with the first puncture.

Results
The nitroglycerin group had larger distal radial artery diameter after patch application than the no-treatment group (3.21 ± 0.68 mm vs. 2.71 ± 0.52 mm, P&lt;0.001), but not at baseline (2.64 ± 0.48 mm vs. 2.64 ± 0.45 mm, P = 0.965, Figure 1).The nitroglycerin group had a significantly higher success rate of palpation-guided DRA cannulation with the first puncture than the no-treatment group (58.7% vs. 23.9%; P = 0.001; odds ratio, 4.5; 95% confidence interval, 1.9–11.0, Figure 2). Fewer punctures were required for successful sheath insertion in the nitroglycerin group compared with the no-treatment group (1 [1–5] vs. 3 [2–6]; P=0.019). Procedure time from puncture to sheath insertion was shorter in the nitroglycerin group, but the difference was not significant (142 [112–287] seconds vs. 202 [142–411] seconds; P=0.058). The incidence of vasospasm, hypotension (systolic blood pressure &lt; 90 mmHg) before and during CAG, and puncture site hematoma was similar in the two groups. No patients experienced distal radial arterial occlusion.

Conclusions
The use of a transdermal nitroglycerin patch was associated with an increase in the diameter of the distal radial artery, higher success rate of DRA cannulation with the palpation-guided first puncture. The transdermal nitroglycerin patch has a potential to be an effective pretreatment for DRA.Changes in distal radial artery diameterResults of primary outcome
Double kissing inflation outside the stent versus jailed balloon technique for coronary bifurcation lesions
Authors: Yang H , Huang Z , Zhang F , Qian J , Ge J 
Published: November 2023

Abstract

Background
Side branch (SB) occlusion remains challenging in percutaneous coronary intervention (PCI) for bifurcation lesions even in the era of jailed balloon technique (JBT). Our previous single-arm study introduced a novel method to protect SB named double kissing inflation outside the stent (DKo), which features twice inflation of the protective balloon kissing with the stent balloon and post-dilation balloon.

Objective
To confirm whether DKo can protect SB better than JBT in a large sample of bifurcation lesions.

Methods
This retrospective, single-center cohort study enrolled 875 consecutive patients underwent bifurcation PCI either in DKo (n=209) or JBT group (n=666). The primary endpoint was transient SB loss after removal of the protective balloon. The secondary endpoints included rates of SB rewiring, final kissing balloon inflation (FKBI), SB stenting, final SB loss, and peri-procedural myocardial infarction (PMI).

Results
Transient SB loss occurred in only 1 patient (0.5%) in DKo but 32 patients (4.8%) in JBT (p&lt;0.005). Transient loss in JBT group was triggered by rewiring (n=21), post-dilation (n=8) and severe dissection (n=3). DKo caused lower rates of rewiring (0.5% vs. 13.8%, p&lt;0.001), FKBI (0.5% vs. 7.7%, p&lt;0.001) and PMI (0.5% vs. 2.9%, p=0.045). SB stenting and final SB loss showed a lower tendency in DKo [0% vs. 0.8%, p=0.21; 0% vs. 1.2%, p=0.11]. DKo was the only protector against transient SB loss [odds ratio=0.08, 95% confidence interval (0.01-0.59), p=0.013].

Conclusion
DKo protects SB better than JBT in PCI for bifurcation lesions. Randomized controlled studies are required to confirm the long-term benefit.
Outcomes of drug eluting stents vs. drug eluting balloons. A single center experience
Authors: Kheifets M , Rahat O , Bental T , Levi A , Samara A , Greenberg G , Codner P , Witberg G , Vaknin-Assa H , Kornowski R , Perl L 
Published: November 2023

Abstract

Introduction
Drug eluting stents (DES) are considered the default treatment option in the current era of percutaneous coronary interventions (PCI). Nevertheless, the use of drug eluting balloons (DEB) remains highly relevant, especially in the setting of in stent restenosis (ISR), and de-novo small vessel disease or bifurcation lesions.

Material and method
Among 17,630 consecutive PCI procedures performed in our tertiary medical center between 2010 and 2021, we identified 16,435 procedures performed using DES and 1,195 using DEB. Endpoints included mortality and major adverse cardiac events [MACE: death, myocardial infarction (MI), target vessel revascularization (TVR), and coronary artery bypass surgery (CABG)] at 1 year. Propensity score matching was used to create a well-balanced cohort. Results and discussion: Mean age was similar (65.7±12.1 vs. 65.8±11.1, p=0.85), but less female patients (16.7% vs. 21.2%, p&lt;0.01) were observed in the DEB group. DEB patients presented with higher rates of diabetes, hypertension, and prior CABG (62.1% vs. 48.1%, 84.9% vs. 73.2% and 18.3% vs. 10.1% respectively, p&lt;0.01 for all), as compared to DES patients. There were also higher rates of PCI for bifurcation lesions and in-stent restenosis (18.3% vs. 15.1% and 56.0% vs. 7.8% respectively, p&lt;0.01 for both) in the DEB group. After propensity and adjustment for confounders, 370 matched pairs were compared. 1-year MACE rates were significantly higher (HR-1.51, 95%CI 1.04-2.18, p=0.03) in the DEB group, as compared to the DES group. This was driven by higher MI (6.8% vs. 1.9%, p&lt;0.01), TVR (20.5% vs. 11.4%, p&lt;0.01) and CABG (12.2% vs. 7.3%, p=0.02) rates in the DEB group. Adjusted rates of 1-year mortality (HR-1.20, 95%CI 0.75-1.67, p=0.45) did not differ between the two groups.

Conclusions
Treatment with DEB was associated with increased MACE at 1-year, driven by higher rates of MI, TVR and CABG, as compared to DES.Freedom from MACE
Efficacy of intravascular lithotripsy (IVL) in coronary stenosis with severe calcification: a systematic review and meta-analysis of 38 studies
Authors: Sagris M , Ktenopoulos N , Dimitriadis K , Papanikolaou A , Beneki E , Tzoumas A , Soulaidopoulos S , Lichtenberg M , Korosoglou G , Toutouzas K , Tousoulis D , Honton B , Tsiamis E , Tsioufis K 
Published: November 2023

Abstract

Introduction
Heavily calcified coronary lesions impede appropriate stent deployment and expansion, increasing the risk of complications. Intravascular Lithotripsy (IVL) technology disrupts subendothelial calcification by using localized pulsative sonic pressure waves and is a promising technique for patients with severe coronary calcification.

Purpose
Our aim was to systematically review and summarize available data regarding the safety and efficacy of IVL in preparing severely calcified plaques in coronary before stenting.

Methods
This study was conducted according to the PRISMA guidelines. We systematically searched PubMed, SCOPUS, and Cochrane databases from their inception to February 23, 2023, for studies assessing the characteristics and outcomes of patients undergoing IVL before stent implantation. The diameter of the vessel lumen before and after IVL as well as stent implantation were analyzed. The occurrence of peri-procedural complications and major adverse cardiovascular events (MACE) in a 30-day period were assessed using a random-effects model.

Results
This meta-analysis comprised 38 studies including 2,977 patients with heavily calcified coronary lesions. The mean age was 72.2 ± 9.1 years, with an overall IVL procedural success rate of 98% (95% CI: 96%-99%, I2=69.2%) and clinical success of 96% (95% CI: 93%-98%, I2=72.2%), while the in-hospital and 30-days incidence of MACE, myocardial infarction (MI) and death were 8% (95% CI: 6%-11%, I2=84.5%), 5% (95% CI: 2%-8%, I2=85.6%) and 2% (95% CI: 1%-3%, I2=69.3%), respectively. There was a significant increase in the vessel diameter (SMD: 2.47, 95% CI: 1.77-3.17, I2=96%) and a decrease in diameter stenosis (SMD: -3.44, 95% CI: -4.36 to -2.52, I2=97.5%) immediately after IVL application, while it was observed further reduction in diameter stenosis (SMD: -6.57, 95% CI: -7.43 to -5.72, I2=95.8%) and increase in the vessel diameter (SMD: 4.37, 95% CI: 3.63-5.12, I2=96.7%) and the calculated lumen area (SMD: 3.23, 95% CI: 2.10-4.37, I2=98%), after stent implantation. The mean acute luminal gain following IVL and stent implantation was estimated to be 1.27 ± 0.6 mm and 1.94 ± 1.1 mm, respectively. Peri-procedural complications were rare, with just a few cases of perforations, dissection, or no-reflow phenomena recorded.

Conclusions
The present meta-analysis shows that IVL constitutes an effective and safe technique for preparing severely calcified lesions before stent implantation in coronary arteries. These results support the use of IVL in the high procedural risk setting of severe coronary calcification.
Coronary rotational atherectomy in patients with severe aortic stenosis
Authors: Alotaibi S , Heyer H , Mankerious N , Landt M , Abdel-Wahab M , Geist V , Toelg R , Allali A , Richardt G , Elbasha K 
Published: November 2023

Abstract

Introduction
Rotational atherectomy (RA) has been shown to be safe and effective in patients with severe calcified coronary arteries lesions. However, clinical data on the use of RA in patients with concomitant severe aortic stenosis (AS patients) are lacking. Escalation to RA for coronary lesion preparation in patients undergoing transcatheter aortic valve implantation (TAVI) is still controversial, given their impaired haemodynamic status and possible higher risk of complications. We reported the clinical outcomes of AS patients undergoing RA and TAVI from a prospective clinical registry and compared their outcome with patients undergoing RA with no severe aortic valve stenosis (non-AS patients).

Methods
We retrieved data of all consecutively enrolled patients in a single centre registry from January 2016 up to October 2021. All AS patients who underwent RA prior to TAVI within a six-month period were included for our analysis. We compared the AS patients with all patients without severe aortic stenosis (non-AS patients) who underwent RA during the same period. Data were analysed to assess rates of in-hospital major adverse cardiovascular event (MACE) in AS vs non-AS patients. MACE was defined as composite of cardiac death, myocardial infarction, and target lesion revascularisation. Procedural characteristics as well as in-hospital outcomes and complications were also examined to detect differences between both patient groups. We then performed univariate and multivariate analyses using binary logistic regression with the presence of severe aortic stenosis as a dependent variable for MACE.

Results
A total of 472 patients underwent RA. Of those, 38 (8.05%) had severe AS and received TAVI within six months after index RA. Compared with the AS-patients, more non-AS patients presented with acute coronary syndrome (2.6% vs 19.8 %; p&lt;0.009). Left main coronary artery intervention was documented in 36.8% of the AS-patients and in 25.1% of the non-AS patients. Mechanical circulatory support during the procedures was low (10 %) in both groups and was used only in two patients from the AS group. The procedural success was 97% and did not differ between both patients’ groups. There was no difference of in-hospital MACE between the AS and non-AS patients (7.9% vs 8.8%; p=0.418). Procedural rates of complications related to RA such as slow flow, coronary dissection, coronary perforation, or trapped burr did not differ between both patient groups. Adverse outcomes of RA were not affected by the presence of severe AS in the univariate analysis (OR 1.12; 95% CI [0.33-3.91]; p=0.857).

Conclusion
RA in patients with severe AS undergoing TAVI is feasible, and in-hospital adverse events were comparable to non-AS patients. Adequate lesion preparation of calcified coronary arteries should be implemented regardless of the presence of severe AS.