Stent Expansion Indexes to Predict Clinical Outcomes

Fujimura, Tatsuhiro; Matsumura, Mitsuaki; Witzenbichler, Bernhard; Metzger, D. Christopher; Rinaldi, Michael; Duffy, Peter L.; Weisz, Giora; Stuckey, Thomas; Ali, Ziad A.; Zhou, Zhipeng; Mintz, Gary S.; Stone, Gregg W.; Maehara, Akiko

doi:10.1016/j.jcin.2021.05.019

Cited by 36 publications

(27 citation statements)

References 24 publications

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“…Percutaneous treatment of severely calcified coronary lesions remains a challenge and may be associated with early complications (perforation, dissection) as well as inadequate lesion preparation leading to stent underexpansion and suboptimal MSAs 9,22 which are powerful predictors of long-term adverse clinical outcomes including ST, angiographic, and clinical restenosis. 9,[23][24][25] As a result, prior studies have demonstrated that adverse clinical events accrue over time following treatment with either firstor second-generation DES implantation in moderately or severely calcified lesions. 7,9 In the largest and longest (5-year follow-up) patient-level meta-analysis to date evaluating the impact of target lesion calcification on clinical outcomes following DES implantation, severe lesion calcification was associated with a 44% relative increase in cardiac death, a 23% relative increase in target vessel MI, and a 21% increase in TLF compared with noncalcified lesions.…”

Section: Discussionmentioning

confidence: 99%

Intravascular Lithotripsy for Treatment of Severely Calcified Coronary Lesions: 1-Year Results From the Disrupt CAD III Study

Kereiakes

Hill

Shlofmitz

et al. 2022

Journal of the Society for Cardiovascular Angiography & Int

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Section: Discussionmentioning

confidence: 99%

Intravascular Lithotripsy for Treatment of Severely Calcified Coronary Lesions: 1-Year Results From the Disrupt CAD III Study

Kereiakes

Hill

Shlofmitz

et al. 2022

Journal of the Society for Cardiovascular Angiography & Int

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“…Contrary to this, a recent ADAPT-DES IVUS sub-study undertook a detailed analysis of 10 different stent expansion criteria including the criteria used in the ULTIMATE, ILUMIEN-IV and IVUS-XPL studies. Only the ratio of MSA/vessel area at the MSA site was associated with clinical outcomes (target lesion revascularization or stent thrombosis) at 2 years (25). The cut-off value was > 38.9% but still had only a modest c-statistic of 0.60.…”

Section: Utility Of Intracoronary Imaging During Revascularization (S...mentioning

confidence: 92%

Optimising PCI by Intracoronary Image-guidance

Alasnag

Ahmed

Al-Bawardy

et al. 2022

Front. Cardiovasc. Med.

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Evidence to support the use of intracoronary imaging (ICI) in guiding percutaneous coronary intervention (PCI) is growing, with observational and randomized controlled trials demonstrating a benefit in acute procedural and clinical outcomes. ICI provides an opportunity to guide PCI, detailing the nature of the coronary disease, potentially influencing lesion preparation and stent selection. Following stent deployment, ICI offers a detailed assessment of lesion coverage, associated vessel trauma and stent expansion. Consensus statements have emphasized the role of ICI and detailed the parameters of stent optimization. However, intracoronary imaging is not adopted widely yet. Significant global differences in the uptake of ICI have been reported, with the vast majority of PCI being angiographically-guided. The three major barriers to the implementation of ICI include, in order of impact, prohibitive cost, prolongation of procedure time and local regulatory issues for use. However, it is our belief that a lack of education and the associated challenges of ICI interpretation provide the greatest barrier to adoption. We hope that this review of the role of ICI in PCI optimization will provide a platform for PCI operators to gain confidence in the utilization of ICI to enhance outcomes for their patients.

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“…Interestingly, only MSA/vessel area at the MSA site (best cutoff was 38.9%) was independently associated with the study endpoint, after adjusting for morphologic and procedural parameters. In other words, stent/vessel area at the MSA site was superior to absolute MSA (and other expansion indices) in predicting the study endpoint, driven mainly by the difference in TLR rather than stent thrombosis ( 45 ).…”

Section: Prevention Of Restenosismentioning

confidence: 99%

Intravascular imaging in coronary stent restenosis: Prevention, characterization, and management

Abouelnour

Gori²

2022

Front. Cardiovasc. Med.

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Despite the introduction of drug-eluting stents to combat the neointimal hyperplasia that occurred after BMS implantation, in-stent restenosis is still encountered in a significant number of patients, particularly as increasingly complex lesions are tackled by percutaneous coronary intervention. Many biological and mechanical factors interplay to produce restenosis, some of which are avoidable. Intravascular imaging provided unique insights into various forms of stent-related mechanical issues that contribute to this phenomenon. From a practical perspective, intravascular imaging can therefore help to optimize the stenting procedure to avert these issues. Moreover, once the problem of restenosis eventuates, imaging can guide the management by tackling the underlying identified mechanism. Finally, it can be used to evaluate the re-intervention results. Nevertheless, with the emergence of different treatment options, more evidence is needed to define patient/lesion-specific characteristics that may help to tailor treatment selection in a way that improves clinical outcomes.

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Stent Expansion Indexes to Predict Clinical Outcomes

Cited by 36 publications

References 24 publications

Intravascular Lithotripsy for Treatment of Severely Calcified Coronary Lesions: 1-Year Results From the Disrupt CAD III Study

Intravascular Lithotripsy for Treatment of Severely Calcified Coronary Lesions: 1-Year Results From the Disrupt CAD III Study

Optimising PCI by Intracoronary Image-guidance

Intravascular imaging in coronary stent restenosis: Prevention, characterization, and management

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