DOCSLIB.ORG

Training a Team of Skilled Operators

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Training a Team of Skilled Operators Training a Team of Skilled Operators Jeffrey W. Moses, MD John and Myrna Daniels Professor of Cardiology Director, Interventional Cardiac Therapeutics Columbia University Medical Center Director Complex Coronary Interventions St. Francis Hospital, Roslyn, LI Disclosure Statement of Financial Interest I, Jeffrey W. Moses, DO NOT have a financial interest/arrangement or affiliation with one or more organizations that could be perceived as a real or apparent conflict of interest in the context of the subject of this presentation. Perspective on PCI in the Past Decade • Coronary population in the cath lab suffered precipitous decline • A philosophy of “watchful waiting” (i.e., let’s let things get really bad first) otherwise known as GDMT holds sway Algorithm for Guideline-Directed Medical Therapy for Patients With SIHD* (cont.) * Colors correspond to the ACCF/AHA Classification of Recommendations and Levels of Evidence Table. The Basic CHIP Premise • There is a large underserved patient population that can benefit from revascularization Rather than focusing on low-risk patients who may be “easy to treat”, we need to focus upon higher-risk patients who have the most to gain These patients will be more commonly seen as our field / the healthcare system evolves The development of comprehensive specialists trained with advanced technical and cognitive skills to assess and treat these patients is clearly needed Cardiogenic Shock or Arrest* *SCAI Shock Categories: B-E E Inpatient Hospital Complex Comorbidity** or Complex PCI*** **Complex comorbidity: ACS, low EF<30%, NYHA HF Class III-IV, CKD eGFR <45, severe anemia, severe contrast allergy, severe aortic stenosis, severe PAD, recent TIA/stroke, severe coagulopathy, severe pulmonary hypertension or severe lung C disease ACS Hospital ***Complex PCI: SVG, UPLM, bifurcation with severe side branch lesion, severe calcification CTO, MCS, coronary Ambulatory or thrombosis, three vessel PCI, last remaining conduit, or severe tortuosity Inpatient Non-ACS Hospital preferred Stable CAD without Complexity A Ambulatory Surgical Ambulatory Center or Hospital Patient Status Performance Center Riley et al. Catheter Cardiovasc Interv. 2020;1-17 Multivessel CAD Calcified Lesions Left Main Disease Bifurcation Lesions In-stent Restenosis Chronic Total Occlusions Saphenous Vein Graft Disease ANATOMY COMPLEX Diabetes Mellitus PCI Atherectomy CABG Ineligibilty Covered Stents Cardiogenic Shock Intravascular Imaging Valvular Heart Disease Specialty Coronary Wires Acute Coronary Syndrome Intracoronary Physiology Renal Insufficiency/Dialysis Guide Cathether Extensions Impaired Ventricular Function Embolic Protection Devices Mechanical Circulatory Support COMORBIDITIES EQUIPMENT Riley et al. Catheter Cardiovasc Interv. 2020;1-17 Cath Lab Population is Aging 100 80 60 40 Proportion (%) 20 0 2000-2002 2003-2005 2006-2008 Time <39 years 60-79 years 40-59 years >80 years Rajani et al. Br J Cardiol 2011; 18:73-76. Cath Lab Population is Getting Sicker: NCDR 2009-2014 Angina Severity 3-4 16% 38% High Risk 22% 33% Acute PCI 378K 375K Non-acute 90K 60K Desai et al, JAMA 2015;314:2045-53 Co-morbidity in the Cath Lab is Increasing 2004-2014 n=6,601, 526 PCI 100.00% 6.30% 6.40% 5.40% 6.40% 7.50% 7.50%10.10% 11.50% 11.90% 13.00% 14.20% 90.00% 13.50% 13.40% 13.80% 14.80% 15.40% 16.30% 16.60% 80.00% 17.60% 18.00% 18.50% 18.80% 70.00% 34.60% 34.50% 35.20% 60.00% 35.30% 35.30% 34.50% 34.00% 33.50% 33.50% 50.00% 32.90% 32.80% 40.00% 30.00% 46.60% 46.80% 20.00% 45.60% 43.50% 41.80% 39.80% 39.30% 37.30% 36.60% 35.60% 34.20% 10.00% 0.00% 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 CCI=0 CCI=1 CCI=2 CCI≥3 Rios et al, DOI:10.1016/j.amjcard.2018.07.011 Comorbidity and Increased Risk of Complications Charlson Comorbidity Index Score 1 v 0 2 v 0 ≥3 v 0 In-hospital mortality 1.19 (1.15, 1.25) 1.41 (1.34, 1.48) 1.96 (1.86, 2.07) Any complication 1.23 (1.21, 1.27) 1.66 (1.61, 1.70) 2.47 (2.38, 2.56) Bleeding complication 1.57 (1.52, 1.61) 2.47 (2.39, 2.56) 4.26 (4.09, 4.42) Vascular complication 1.06 (1.02, 1.10) 1.09 (1.03, 1.15) 1.12 (1.05, 1.20) Cardiac complication 0.94 (0.91, 0.97) 0.94 (0.90, 0.99) 1.00 (0.95, 1.04) Stroke 1.30 (1.26, 1.34) 1.72 (1.67, 1.79) 2.40 (2.30, 2.51) Rios et al, DOI:10.1016/j.amjcard.2018.07.011 Is It Worth the Effort? Survival in “No-option” Patients Based on Subsequent Revascularization and Type (a) 100 (b) 100 90 95 90 80 85 70 80 Log-rank test: p=0.50 Mortality (%) Mortality Log-rank test: p<0.01 75 60 (%) Mortality CABG 70 Existing Lesion No Revasc Performed Freedom from All-cause Freedom from New Lesion Freedom from All-cause Freedom from 65 50 Revasc Performed Restenosis 0 2 4 6 8 10 60 0 1 2 3 4 5 Time from No-option Designation (years) Time from No-option Designation (years) No. at Risk: No Revasc 1043 866 747 623 438 255 Revasc 342 320 286 260 197 99 Sharma et al. Catheter Cardiovasc Interv. 2018;00:1-5 “The CHIP Operators Creed” The indications for the case do not change just because the lesion is “harder to treat” The CHIP Message • The revascularization must be able to be done safely and with high quality and/or durability • The revascularization being performed has to be performed on lesions that are of prognostic or symptomatic importance Ischemia-based lesion assessment These Patients Present Complex Issues to the Interventional Cardiologist • Higher risk of complications • Less tolerance of imperfect outcomes • Need to be acquainted with advanced PCI techniques Underscores the Need for CHIP Specific Training And Skills With Increasing CHIP Experience and Tools, Outcomes are Improving 1.0 0.1 4 0.08 0.8 0.08 0.23 0.08 3 0.6 0.28 0.23 2 0.05 0.4 0.08 0.05 1 Proportion (%) 0.49 (%) MACCE Rate 0.2 0.42 0.29 0 0.0 2000-2002 2003-2005 2006-2008 2000-2002 2003-2005 2006-2008 Time Time CVA STEMI Overall MACCE <80 years Emergency CABG In-hospital Non-elective >80 years mortality Elective Rajani et al. Br J Cardiol 2011; 18:73-76. UK Central Audit: CTO and Mortality n=13,443 Patients Complete revascularization Partial revascularization – HR .72 p<.001 Failed revascularization – HR .61 p=0.002 10% 8% 6% 4% Cumulative Mortality 2% 0% 0 .5 1 1.5 2 2.5 3 3.5 4 Follow-up Time (Years) George et al, J Am Coll Cardiol 2014;64:235-43 COURAGE: Rates of Death or MI by Residual Ischemia on 6-18m MPS p=0.002 p=0.023 p=0.063 Death or MI Rate (%) MI Death or 0% 1%-4.9% 5%-9.9% >10% (n=23) (n=141) (n=88) (n=62) Shaw LA et al. Circulation 2008;117:1283-91 PROTECT II: MACCE Outcomes Based on the Extent of Revascularization (All Patients, N=413) IABP IMPELLA p=0.489 36% p=0.007 30% 28% ↓ 46% MACCE 90 day MACCE 15% N=54 N=65 N=145 N=133 Limited Revascularization Extensive Revascularization IZ [0-2] IZ [3-11] Extent of Revascularization So How Are We Performing With Complex Patients? Let’s Look at 2 Scenarios • Complete Revascularization • Left Main PCI Complete Revascularization Is a Key Objective Meta-analysis 38 Studies 156K Patients Death 0.69 (0.61-0.78) MI 0.64 (0.50-0.81) Revasc 0.60 (0.45-0.80) MACE 0.63 (0.50-0.79) CTO 0.65 (0.53-0.80) Conclusion: Mortality and Morbidity Increases with Degree of IR Nagaraja et al. J Am Heart Assoc. 2016; 5:e004598 Hazards of Incomplete Revascularization: New York, 2010-2012 Non-STEMI (N = 35,993) Observed Type of Revascularization No. (%) Mortality Rate, % Adjusted HRc (95%CI) P Value Complete revascularization 10 059 (31.71) 10.15 1 [Reference] NA Highest stenosis in incomplete lesion, %d 70-89 11 461 (36.13) 12.96 1.18 (1.09-1.28) <.001 >90 10 205 (32.17) 17.71 1.36 (1.25-1.47) <.001 >90 vs 70-89 NA NA 1.15 (1.07-1.24) <.001 Vessels incomplete, No. None 10 261 (28.51) 10.19 1 [Reference] NA 1 17 925 (49.50) 14.39 1.22 (1.13-1.31) <.001 2 or more 7807 (21.69) 20.10 1.42 (1.30-1.55) <.001 2 or more vs. 1 NA NA 1.17 (1.09-1.59) <.001 Location of incomplete vessel Complete revascularization 10 261 (28.51) 10.19 1 [Reference] NA Not PLAD 23 230 (64.54) 15.62 1.26 (1.17-1.35) <.001 PLAD 2502 (6.95) 20.78 1.40 (1.25-1.57) <.001 PLAD vs. not PLAD NA NA 1.11 (1.01-1.23) .03 Hannan et al. JAMA Cardiol. 2017; doi:10.1001 How Are We Doing? Incomplete Revascularization Is Increasing in NY! Operator and Hospital IR Rates n=27,860 70 68 66 64 62 60 58 IR Rate (%) 56 54 52 50 07/09-12/09 01/10-06/10 07/10-12/10 01/11-06/11 07/12-12/12 01/12-06/12 Time Period (P value for trend test = 0.04) Rate of IR for PCI: July 2009 to June 2012 Hannan et al.
Load more

Recommended publications
  • Miniature Integrated Optical Coherence Tomography (OCT) - Ultrasound (US) Probe for Intravascular Imaging
    Miniature integrated optical coherence tomography (OCT) - ultrasound (US) probe for intravascular imaging Jiawen Lia, Jiechen Yina, Xiang Lib, Joe Jingc, David Mukaic, Sari Mahonc, Ahmad Edrisd, Khiet Hoangd, K. Kirk Shungb, Matthew Brennerce, Jagat Narulad, Qifa Zhoub, Patel, Pranavd and Zhongping Chenac a Department of Biomedical Engineering, University of California, Irvine, Irvine, California 92697 b NIH Ultrasonic Transducer Resource Center and Department of Biomedical Engineering, University of Southern California, Los Angeles, California 90089 c Beckman Laser Institute, University of California, Irvine, 1002 Health Sciences Road East, Irvine, California 92612 d Division of Cardiology, University of California, Irvine Medical Center, Orange, California 92868 e Division of Pulmonary and Critical Care, University of California, Irvine Medical Center, Orange, California 92868 SUMMARY A miniature integrated optical coherence tomography (OCT) – ultrasound (US) probing system for real-time intravascular imaging has been developed. The outer diameter of the integrated probe is 0.69 mm, which is small enough for imaging in human coronary arteries. This probe, which has high resolution and deep tissue penetration, is designed to identify vulnerable atherosclerotic plaques in coronary arteries. The first in vivo images of a rabbit abdominal aorta obtained by the integrated OCT-US probe are presented. Keywords: atherosclerosis, vulnerable plaque, intravascular ultrasound, optical coherent tomography ABSTRACT Coronary artery atherosclerosis is a major public health problem associated with high clinical morbidity and mortality. For over 20 years, intravascular ultrasound (IVUS) imaging has been a standard diagnostic tool for atherosclerosis1. Recently, optical coherence tomography (OCT) with high resolution, has been applied to intravascular imaging because it enables direct imaging of thin fibrous cap2, one of the key feature of vulnerable atherosclerotic plaque, and tissue responses to stent implantation1.
    [Show full text]
  • Final Program
    FinalProgram:2007 2/15/07 11:54 AM Page 1 American Institute of Ultrasound in Medicine Final Program American Institute of Ultrasound in Medicine 14750 Sweitzer Ln, Suite 100 Laurel, MD 20707-5906 USA 301-498-4100 • 800-638-5352 Fax: 301-498-4450 www.aium.org FinalProgram:2007 2/15/07 11:55 AM Page 2 The new ACUSON Antares. Do it all. In creating the new ACUSON Antares™ ultrasound system, premium edition, we investigated your latest, most pressing clinical issues. The result — a system designed around you, enabling you to excel at virtually any ultrasound challenge. Across the full range of ultrasound examinations, including cardiac imaging, the new Antares system delivers the impressive combination of superior image quality, operator-friendly ErgoDynamic™ imaging system design, applications versatility, and the latest advancements in clinical workflow. So no matter what diagnostic challenge walks in the door, you’ll know you already have the answer. 1-888-826-9702 www.usa.siemens.com/medical A91112-61172-A1-4A00 © 2007 Siemens Medical Solutions USA, Inc. All rights reserved. FinalProgram:2007 2/15/07 11:55 AM Page 3 Table of Contents Schedule at a Glance.....................................1 General Information .....................................3 Educational Opportunities ...........................5 Committee Meeting Schedule .......................6 Professional Interest Section Meeting Schedule.......................................7 CME Credit Information...............................8 Faculty Disclosures.......................................9
    [Show full text]
  • Cardiovascular Research Scholarship Program
    2021 CARDIOVASCULAR RESEARCH SCHOLARSHIP PROGRAM - THE 24TH TRANS-PACIFIC RESEARCH OPPORTUNITY - Stanford University The Cardiovascular Medicine Division at Stanford University features diverse faculty and provides opportunities for research in many cardiovascular subspecialties. Stanford’s Center for Cardiovascular Technology (CCVT) facilities include animal laboratories, device development programs, and participation in multi-center cardiology trials, which are supported by Core Angiographic and Intravascular Ultrasound Laboratories. Visiting Scholars to Stanford’s CCVT represent many countries and a variety of research disciplines, resulting in a stimulating and productive research environment. URL: http://med.stanford.edu/ccvt Stanford Scholarship Program Oce c/o: Abbott Medical Japan LLC, VASCULAR Div. Attention: Stanford Scholarship Program TEL: 03-4560-0780 FAX: 03-4560-0781 E-mail: [email protected] Address: Sumitomo Fudosan Mita Twin Building West 3-5-27 Mita, Minato, Tokyo, 108-6304, Japan URL: www.cardiovascular.abbott/jp/ja/hcp/resources/ education-training/stanford.html * Abbott Medical Japan LLC, as a management representative, will jointly use the personal information disclosed in your application form with Stanford University Medical Center in the selection process for this study program and the enrollment procedures to Stanford University Medical Center. © 2020 Abbott. All rights reserved. (APJ00000928-JPN-Rev.A) MEDICINE Stanford Center for Cardiovascular Technology Stanford University School of Medicine Introduction Stanford Center for Cardiovascular Technology Stanford University School of Medicine The Stanford Center for Cardiovascular Technology, formally known as the Center for Research in Cardiovascular Interventions founded at Stanford in 1994, is a core facility for development and testing of new devices in cardiovascular medicine. The Center focuses on early-stage concepts for new technologies, providing a clearinghouse where these ideas can be refined and tested in animal models and clinical studies.
    [Show full text]
  • Clinical Use of Intracoronary Imaging. Part 2: Acute Coronary Syndromes
    CORONARY INTERVENTIONS Euro CLINICAL RESEARCH Intervention 2019;15: 434-451 434-451 published online online published Clinical use of intracoronary imaging. Part 2: acute coronary syndromes, ambiguous coronary angiography findings, and guiding interventional decision-making: an expert consensus document of the European Association of Percutaneous June 2019 Cardiovascular Interventions 3 Thomas W. Johnson/RUHQ]5lEHU, Carlo di Mario , Christos Bourantas+DLER-LD, Alessio Mattesini, Nieves Gonzalo-RVH0GHOD7RUUH+HUQDQGH], Francesco Prati8, Konstantinos Koskinas0LFKDHO-RQHU9, Maria D. Radu, David Erlinge, Evelyn Regar, Vijay Kunadian, Akiko Maehara, Robert A. Byrne9, Davide Capodanno, Takashi Akasaka, WilliamWijns, Gary S. Mintz, Giulio Guagliumi* The authors’ affiliations can be found in the Appendix paragraph. Endorsed by the Chinese Society of Cardiology, the Hong Kong Society of Transcatheter Endocardiovascular Therapeutics (HKSTENT) and the Cardiac Society of Australia and New Zealand This paper also includes supplementary data published online at: https://eurointervention.pcronline.com/doi/10.4244/EIJY19M06_02 This consensus document is the second of two reports summarizing the views of an expert panel organ- KEYWORDS ized by the European Association of Percutaneous Cardiovascular Interventions (EAPCI) on the clinical use of intracoronary imaging including intravascular ultrasound (IVUS), optical coherence tomography • percutaneous (OCT), and near infrared spectroscopy (NIRS)-IVUS. Beyond guidance of stent selection and optimization coronary
    [Show full text]
  • Intravascular Endoscopy Improvement Through Narrow-Band Imaging
    Int J CARS DOI 10.1007/s11548-017-1579-4 ORIGINAL ARTICLE Intravascular endoscopy improvement through narrow-band imaging Axel Boese1 · Akhil Karthasseril Sivankutty1 · Alfredo Illanes1 · Michael Friebe1 Received: 11 January 2017 / Accepted: 21 March 2017 © The Author(s) 2017. This article is an open access publication Abstract Purpose Purpose Recent advances in endoscopy have led to new technologies with significant optical imaging improvements. Through technology advancements and the introduction Since its development a few years ago, narrow-band imaging of complete new methodologies, endoscopic intravascu- (NBI) has already been proved useful in detecting malignant lar visualisation is becoming more and more interesting lesions and carcinoma in clinical settings of urology, gas- as a diagnostic tool. Intravascular imaging could be used troenterology and ENT. The potential of this technology for to identify conditions that lead to strokes, aneurysm and imaging applications of the arterial vessel wall has not been embolism. In vivo imaging of the arteries could addition- properly analysed yet, but with the observed benefits could ally help to find calcifications [1], plaques [2,3], thrombus prove valuable for this clinical use as well. [4] and also to assess the placement of stents [5]. Thus Methods In order to assess the efficacy of NBI, defects such intravascular imaging could play an important role in the as burns and mechanical tears were created on the walls of an clinical decision making process and provide therapy rele- arterial vessel sample. Ex vivo imaging using NBI and white vant information. Several studies have been conducted using light imaging (WLI) were performed with rigid and flexible X-ray-based angioscopic systems to illustrate and record fibre endoscopes.
    [Show full text]
  • Transplant Coronary Heart Disease: Challenges and Solutions
    Transplant Research and Risk Management Dovepress open access to scientific and medical research Open Access Full Text Article REVIEW Transplant coronary heart disease: challenges and solutions Jacob C Jentzer1 Abstract: Cardiac allograft vasculopathy (CAV) remains one of the leading causes of death and Gavin W Hickey1 graft failure after heart transplantation. A variety of causes, including donor heart characteristics, Sameer J Khandhar2,3 recipient risk factors, and immune-mediated influences, are associated with developing CAV. In this review, we will focus on the pathophysiology of developing CAV and various methods 1Heart and Vascular Institute, University of Pittsburgh Medical to screen for this condition. The pathogenesis of CAV likely involves repeated injuries to the Center, Pittsburgh, PA, USA; 2Perelman endothelium from a variety of factors such as cellular-mediated rejection, and alloimmune School of Medicine, University factors, including antibody-mediated injury, ischemia-reperfusion injury at time of transplant, of Pennsylvania, Philadelphia, PA, USA; 3Heart and Vascular Institute, cytomegalovirus infections, immunosuppression medications, systemic inflammation, and tra- Penn-Presbyterian Medical Center, ditional atherosclerosis risk factors. Patients with significant CAV are often asymptomatic, and Philadelphia, PA, USA therefore early detection by routine screening prior to graft dysfunction is crucial. There are a variety of invasive, noninvasive, and blood tests that have been studied as screening methods, and we will discuss the role of each of these in this review article. Although some treatment regimens have been established for CAV, this is an area where further studies and research are necessary. Keywords: cardiac allograft vasculopathy, orthotopic heart transplantation, intra-vascular imaging Introduction Cardiac allograft vasculopathy (CAV) is widely considered the “Achilles heel” of heart transplantation.1 Early posttransplant survival has improved, but median survival remains only 10.4 years.
    [Show full text]
  • Intravascular Ultrasound for Coronary Vessels Policy Number: MP-091 Last Review Date: 11/14/2019 Effective Date: 01/01/2020
    Intravascular Ultrasound for Coronary Vessels Policy Number: MP-091 Last Review Date: 11/14/2019 Effective Date: 01/01/2020 Policy Evolent Health considers Intravascular Ultrasound (IVUS) for Coronary Vessels medically necessary for either of the following indications: 1. IVUS of the coronary arteries (consistent with the 2011 ACCF/AHA Guidelines for Percutaneous Coronary Intervention (PCI) 5.4.2) is indicated for any of the following medical reasons: a. To confirm clinical suspicion of a significant left main coronary artery stenosis when standard angiography is indeterminate; b. To detect rapidly progressive cardiac allograft vasculopathy following heart transplant; c. To determine the mechanism of stent thrombosis or restenosis; d. To assess non-left main coronary arteries with angiographic intermediate stenosis (50-70%) to aid the decision whether or not to place a stent; or, e. To assist in guidance of complex coronary stent implementation, especially involving the L main coronary artery. 2. In lieu of coronary angiography when performed to minimize use of iodinated contrast material in an individual with compromised renal function, congestive heart failure or known contrast allergy. Limitations Coronary IVUS is not covered for any of the following (this is not an all-inclusive list): 1. Screening for coronary artery disease in asymptomatic individuals; 2. Routine lesion assessment is not recommended when revascularization with PCI or Coronary Artery Bypass Grafting (CABG) is not being considered; 3. Carotid stent placement; 4. Follow-up monitoring of medical therapies for atherosclerosis; 5. Peripheral vascular intervention; or, 6. Evaluation of chronic venous obstruction or to guide venous stenting. Background Ultrasound diagnostic procedures utilizing low energy sound waves are being widely employed to determine the composition and contours of nearly all body tissues except bone and air-filled spaces.
    [Show full text]
  • Intravascular Ultrasound Imaging: a New Method for Guiding Interventional Vascular Procedures
    UCLA UCLA Previously Published Works Title Intravascular ultrasound imaging: a new method for guiding interventional vascular procedures. Permalink https://escholarship.org/uc/item/43b8t0wq Journal Echocardiography (Mount Kisco, N.Y.), 7(4) ISSN 0742-2822 Authors Tobis, JM Mallery, JA Mahon, D et al. Publication Date 1990-07-01 DOI 10.1111/j.1540-8175.1990.tb00382.x License https://creativecommons.org/licenses/by/4.0/ 4.0 Peer reviewed eScholarship.org Powered by the California Digital Library University of California Intravascular Ultrasound Imaging: A New Method for Guiding Interventional Vascular Procedures JONATHAN M. TOBIS, M.D., JOHN A. MALLERY, M.D., DONALD MAHON, M.D., JAMES GRIFFITH, PH.D., JIM GESSERT, B.A., KENNETH LEHMANN, M.D., and WALTER L. HENRY, M.D. Cardiology Division, University of California, Irvine; Cardiology Division, Veterans Administration Hospital, Long Beach; and InterTherapy, Inc., Costa Mesa, California A wide variety of therapeutic procedures have terie~.~-~Such external ultrasound devices have been developed to intervene in patients with obvious limitations for evaluating human coro- coronary artery disease. Whether the interven- nary arteries in vivo. An intravascular ultra- tion is intended to increase lumen size by dilat- sound transducer placed on the end of a catheter ing the artery or to decrease atheroma mass by has been used in vitro and in vivo animal studies laser ablation, mechanical atherectomy, or by to image coronary and peripheral arteries.'-'' lowering serum cholesterol, it will be important This approach allows the arterial wall to be to quantitate atherosclerotic plaque volume be- imaged in cross section from inside the artery, fore and after treatment.
    [Show full text]
  • Current Use of Intracoronary Imaging in Interventional Practice
    CLINICAL RESEARCH Euro Intervention Current use of intracoronary imaging in interventional 2018;13-online publish-ahead-of-print March 2018 2018;13-online practice – Results of a European Association of Percutaneous Cardiovascular Interventions (EAPCI) and Japanese Association of Cardiovascular Interventions and Therapeutics (CVIT) Clinical Practice Survey Konstantinos C. Koskinas1*, MD; Masato Nakamura2, MD; Lorenz Räber1, MD, PhD; Roisin Colleran3, MD; Kazushige Kadota4, MD; Davide Capodanno5, MD, PhD; William Wijns6, MD, PhD; Takashi Akasaka7, MD; Marco Valgimigli1, MD, PhD; Giulio Guagliumi8, MD; Stephan Windecker1, MD; Robert A. Byrne3,9, MD, PhD 1. Department of Cardiology, Bern University Hospital, Switzerland; 2. Toho University, Ohashi Medical Center, Tokyo, Japan; 3. Deutsches Herzzentrum München, Technische Universität München, Munich, Germany; 4. Kurashiki Central Hospital, Kurashiki, Japan; 5. Ferrarotto Hospital, University of Catania, Catania, Italy; 6. The Lambe Institute for Translational Medicine and Curam Saolta University Healthcare Group, Galway, Ireland; 7. Wakayama Medical University, Wakayama, Japan; 8. Interventional Cardiology Unit, Azienda Ospedaliera Papa Giovanni XXIII, Bergamo, Italy; 9. DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, Munich, Germany This paper also includes supplementary data published online at: http://www.pcronline.com/eurointervention/ahead_of_print/20180227-01 KEYWORDS Abstract Aims: This study evaluated the views of the cardiology community on the clinical use of coronary intra- • coronary imaging vascular imaging (IVI). • intravascular Methods and results: ultrasound A web-based survey was distributed to 31,893 individuals, with 1,105 responses • optical coherence received (3.5% response rate); 1,010 of 1,097 respondents (92.1%) self-reported as interventional cardio- tomography logists, 754 (68.7%) with >10 years experience.
    [Show full text]
  • Automated Machine Learning Based Analysis Of
    AUTOMATED MACHINE LEARNING BASED ANALYSIS OF INTRAVASCULAR OPTICAL COHERENCE TOMOGRAPHY IMAGES by RONNY SHALEV Submitted in partial fulfillment of the requirements For the degree of Doctor of Philosophy Dissertation Adviser: Dr. David L. Wilson Department of Electrical Engineering and Computer Science CASE WESTERN RESERVE UNIVERSITY May, 2016 CASE WESTERN RESERVE UNIVERSITY SCHOOL OF GRADUATE STUDIES We hereby approve the dissertation of Ronny Y. Shalev Candidate for the degree of Ph.D*. Committee Chair M. Cenk ÇAVUŞOĞLU Committee Member David L. Wilson Committee Member Hiram G. Bezerra Committee Member Soumya Ray Committee member Francis Merat Date of Defense February 23rd, 2016 *We also certify that written approval has been obtained for any proprietary material contained therein 2 Contents Chapter 1 Background ............................................................................................... 19 1.1 Coronary Artery Disease ......................................................................... 19 1.2 Atherosclerotic Plaques ........................................................................... 20 1.3 Imaging Technologies for Assessing CAD .............................................. 23 1.4 Optical Coherence Tomography (OCT) ................................................. 23 1.5 IVOCT in Intravascular Imaging ........................................................... 29 1.6 Plaque Characterization Using IVOCT ................................................. 31 1.7 Machine Learning ...................................................................................
    [Show full text]
  • Improving Ovarian Cancer Imaging with LHRH-Nbs: an Experimental Study
    Arch Gynecol Obstet (2016) 294:631–638 DOI 10.1007/s00404-016-4092-z GYNECOLOGIC ONCOLOGY Improving ovarian cancer imaging with LHRH-NBs: an experimental study 1 2 2,3 3 Wenjuan Li • Lingping Zhang • Yuanfang Zhu • Jinyi Zhang • 3 3 3 Li Shen • Shuying Huang • Shanyu Fang Received: 6 November 2015 / Accepted: 30 March 2016 / Published online: 13 April 2016 Ó The Author(s) 2016. This article is published with open access at Springerlink.com Abstract Results The imaging intensity and duration were not Purpose Our previous study used freeze-drying and bio- significantly different between N-NBs and LHRH-NBs. tin–avidin binding methods and obtained nontargeted The imaging intensity in the N-NB and LHRH-NB groups nanobubbles (N-NBs) and ovarian cancer-targeting was not significantly different compared with the SonoVue nanobubbles (LHRH-NBs, luteinizing hormone-releasing group; however, the imaging duration in the N-NB and hormone nanobubbles). Our study also identified the LHRH-NB groups was significantly longer than in the physical and chemical properties of these two contrast SonoVue group (P \ 0.001). Both N-NBs and LHRH-NBs agents, and validated the targeting ability and underlying penetrated through the vascular endothelial gaps. After mechanisms of LHRH-NBs in vitro. The present study penetrating through the vascular endothelial gapes, LHRH- investigated the imaging of N-NBs and LHRH-NBs in NBs could target and bind to the tumor cells. nude mice and their binding with tissues. Conclusions N-NBs and LHRH-NBs are of good imaging Methods The nude mice models of xenografts were effectiveness and relatively long imaging duration.
    [Show full text]
  • Personalized Assessment of the Coronary Atherosclerotic Arteries by Intravascular Ultrasound Imaging: Hunting the Vulnerable Plaque
    Journal of Personalized Medicine Review Personalized Assessment of the Coronary Atherosclerotic Arteries by Intravascular Ultrasound Imaging: Hunting the Vulnerable Plaque Theodore G. Papaioannou 1,*,†,‡, Charalampos Kalantzis 1,†, Efstratios Katsianos 1, Despina Sanoudou 2, Manolis Vavuranakis 3 and Dimitrios Tousoulis 1 1 Biomedical Engineering Unit, First Department of Cardiology, Hippokration Hospital, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece; [email protected] (C.K.); [email protected] (E.K.); [email protected] (D.T.) 2 Fourth Department of Internal Medicine, “Attikon” Hospital, Medical School, National and Kapodistrian University of Athens, 12462 Athens, Greece; [email protected] 3 Third Department of Cardiology, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece; [email protected] * Correspondence: [email protected]; Tel.: +30-213-2088286; Fax: +30-213-2088676 † Equal first authorship. ‡ Current address: Biomedical Engineering Unit, First University Department of Cardiology, Hippokration Hospital, 114 Vas. Sophias ave., 11527 Athens, Greece. Received: 25 November 2018; Accepted: 21 January 2019; Published: 24 January 2019 Abstract: The term “vulnerable plaque” is commonly used to refer to an atherosclerotic plaque that is prone to rupture and the formation of thrombosis, which can lead to several cardiovascular and cerebrovascular events. Coronary artery atherosclerosis has a wide variety of different phenotypes among patients who may have a substantially variable risk for plaque rupture and cardiovascular events. Mounting evidence has proposed three distinctive histopathological mechanisms: plaque rupture, plaque erosion and calcified nodules. Studies have demonstrated the characteristics of plaques with high vulnerability such as the presence of a thin fibrous cap, a necrotic lipid-rich core, abundant infiltrating macrophages and neovascularization.
    [Show full text]