Intravascular ultrasound assessment of distal left main bifurcation disease: the importance of the polygon of confluence of the left main, left anterior descending, and left circumflex arteries.

Background: The polygon of confluence (POC) represents the zone of confluence of the distal left main (LM), ostial left anterior descending (LAD), and ostial left circumflex (LCX) arteries.

Methods: We used intravascular ultrasound (IVUS) to assess the POC pre and post-drug-eluting stent implantation for unprotected distal LM disease. Four segments within 82 LM bifurcation lesions were defined by longitudinal IVUS reconstruction: (1) ostial LAD, (2) POC, and (3) distal LM (DLM)--from LAD-pullback, and (4) ostial LCX from LCX-pullback.

Comparison of differential expression of P2Y₁₂ receptor in culprit coronary plaques in patients with acute myocardial infarction versus stable angina pectoris.

P2Y₁₂ receptor antagonists may have pleiotropic benefits. Little is known, however, about the expression of P2Y₁₂ receptors in coronary atherosclerotic plaques. We investigated the expression of P2Y₁₂ receptor in coronary atherectomy tissues retrieved from patients with acute myocardial infarction (AMI) or stable angina pectoris (SAP).

Changes in left main bifurcation geometry after a single-stent crossover technique: an intravascular ultrasound study using direct imaging of both the left anterior descending and the left circumflex coronary arteries before and after intervention.

Background: We assessed geometric changes responsible for acute lumen loss at the left circumflex coronary artery (LCX) ostium after crossover stenting from the left anterior descending coronary artery (LAD) to the left main artery.

Methods And Results: Twenty-three left main artery bifurcation lesions with a preprocedural angiographic diameter stenosis <50% at the LCX ostium were evaluated using prestenting and poststenting intravascular ultrasound pullbacks from both the LAD and the LCX. At the minimal lumen area (MLA) sites within the LCX ostium and at the LCX carina, the lumen, stent, plaque+media (P+M), and external elastic membrane (EEM) areas were measured; the EEM eccentricity was calculated at the LCX carina.

Validation of minimal luminal area measured by intravascular ultrasound for assessment of functionally significant coronary stenosis comparison with myocardial perfusion imaging.

Objectives: This study sought to evaluate the ability of minimal luminal area (MLA) measured by intravascular ultrasound (IVUS) to assess the functional significance of coronary artery disease.

Background: The use of IVUS to determine the functional significance of coronary artery lesions remains a matter for debate.

Methods: From our prospective IVUS imaging database, between July 2009 and April 2010, 170 coronary lesions in 150 patients who underwent stress myocardial single-photon emission computed tomography (SPECT) performed within 1 month of IVUS evaluation were identified and analyzed.

Optical coherence tomographic analysis of in-stent neoatherosclerosis after drug-eluting stent implantation.

Background: We report findings from optical coherence tomography (OCT) of in-stent neoatherosclerosis as a cause of drug-eluting stent (DES) failure.

Methods And Results: Optical coherence tomography and grayscale and virtual histology intravascular ultrasound were performed in 50 patients (30 stable, 20 unstable angina) with 50 DES in-stent restenosis lesions and intimal hyperplasia >50% of stent area. Median follow-up time was 32.

Complexity of atherosclerotic coronary artery disease and long-term outcomes in patients with unprotected left main disease treated with drug-eluting stents or coronary artery bypass grafting.

Objectives: The aim of this study was to compare treatment effects of drug-eluting stents (DES) or coronary artery bypass grafting (CABG) for left main coronary artery (LMCA) disease according to the complexity of atherosclerotic disease burden.

Background: Limited information is available on the relationships between the extent of coronary atherosclerosis and very long-term outcomes of surgical or percutaneous LMCA revascularization.

Methods: A total of 1,146 patients with unprotected LMCA disease who received DES (n = 645) or underwent CABG (n = 501) were evaluated.

Impact of angiographic complete revascularization after drug-eluting stent implantation or coronary artery bypass graft surgery for multivessel coronary artery disease.

Background: This study sought to evaluate the clinical impact of angiographic complete revascularization (CR) after drug-eluting stent implantation or coronary artery bypass graft surgery for multivessel coronary disease.

Methods And Results: A total of 1914 consecutive patients with multivessel coronary disease undergoing drug-eluting stent implantation (1400 patients) or coronary artery bypass graft surgery (514 patients) were enrolled. Angiographic CR was defined as revascularization in all diseased segments according to the Synergy Between PCI With Taxus and Cardiac Surgery classification.

Stroke risk after coronary artery bypass graft surgery and extent of cerebral artery atherosclerosis.

Objectives: We aimed to define the relationship between cerebral atherosclerosis and stroke after coronary artery bypass grafting (CABG).

Background: Although cerebral atherosclerosis may play a crucial role in the advent of post-CABG stroke, only extracranial carotid artery disease has been extensively studied, and the effects of atherosclerosis on the mechanisms underlying post-CABG stroke remain unclear.

Methods: Pre-operative magnetic resonance angiography was performed on 1,367 consecutive CABG patients to assess intracranial and extracranial cerebral atherosclerosis.

Comparison of single- versus two-stent techniques in treatment of unprotected left main coronary bifurcation disease.

Background: This study sought to compare 3-year outcomes of single- versus two-stent techniques in patients with distal unprotected left main coronary artery (LMCA) disease treated with drug-eluting stents (DES).

Methods And Results: A total of 392 patients with distal unprotected LMCA disease who underwent DES implantation with single- (n = 234) or two- (n = 158) stent techniques were evaluated. The primary end point was major adverse cardiac events (MACE), defined as the composite of death, myocardial infarction (MI), and target lesion revascularization (TLR).

Impact of bleeding on subsequent early and late mortality after drug-eluting stent implantation.

Objectives: The aim of this study was to assess the impact of early and late bleeding on subsequent mortality after drug-eluting stent (DES) implantation.

Background: Little is known about the impact of late bleeding after DES implantation.

Methods: With a time-updated Cox model, the impact of bleeding and myocardial infarction (MI) on 3-year mortality was analyzed in 3,148 consecutive patients who underwent DES implantation for coronary disease.

Preintervention angiographic and intravascular ultrasound predictors for side branch compromise after a single-stent crossover technique.

A single stent crossover technique is the most common approach to treating bifurcation lesions. In 90 bifurcation lesions with side branch (SB) angiographic diameter stenosis <75%, we assessed preintervention intravascular ultrasound (IVUS; of main branch [MB] and SB) predictors for SB compromise (fractional flow reserve [FFR] <0.80) after a single stent crossover.

Comparison of ruptured coronary plaques in patients with unstable and stable clinical presentation.

It remains uncertain why some plaque ruptures trigger acute coronary syndrome (ACS), whereas others do not. We investigated the anatomic features and tissue factor (TF) expression at the sites of plaque rupture in 42 patients presenting with ACS (n = 23) or stable angina (n = 19). Intravascular ultrasound examination was performed before directional coronary atherectomy.

Randomized trial of stents versus bypass surgery for left main coronary artery disease.

Background: Percutaneous coronary intervention (PCI) is increasingly used to treat unprotected left main coronary artery stenosis, although coronary-artery bypass grafting (CABG) has been considered to be the treatment of choice.

Methods: We randomly assigned patients with unprotected left main coronary artery stenosis to undergo CABG (300 patients) or PCI with sirolimus-eluting stents (300 patients). Using a wide margin for noninferiority, we compared the groups with respect to the primary composite end point of major adverse cardiac or cerebrovascular events (death from any cause, myocardial infarction, stroke, or ischemia-driven target-vessel revascularization) at 1 year.

Long-term clinical outcomes of successful versus unsuccessful revascularization with drug-eluting stents for true chronic total occlusion.

Objectives: The aims of this study were to investigate the long-term clinical outcomes of patients with successful versus unsuccessful revascularization with drug-eluting stents (DES) for chronic total occlusion (CTO).

Background: The benefits of successful revascularization of CTO remain unclear.

Methods: Consecutive patients (n = 333) with "true" CTO, defined as Thrombolysis In Myocardial Infarction (TIMI) flow grade 0 on angiography and duration ≥3 months, were divided into two groups, those with successful (CTO success group, n = 251) and unsuccessful (CTO failure group, n = 82) revascularization with DES for CTO lesions.

A randomized comparison of sirolimus- versus paclitaxel-eluting stent implantation in patients with diabetes mellitus: 4-year clinical outcomes of DES-DIABETES (drug-eluting stent in patients with DIABETES mellitus) trial.

Objectives: We compared 4-year efficacy and safety of sirolimus-eluting stents (SES) and paclitaxel-eluting stents (PES) in patients with diabetes mellitus (DM).

Background: Four-year comparison of SES with PES in diabetic patients has not been evaluated in a randomized manner.

Methods: This prospective, multicenter, randomized study compared SES (n = 200) and PES (n = 200) implantation in diabetic patients.

Preventive strategies of renal insufficiency in patients with diabetes undergoing intervention or arteriography (the PREVENT Trial).

Few studies have compared the ability of sodium bicarbonate plus N-acetylcysteine (NAC) and sodium chloride plus NAC to prevent contrast-induced nephropathy (CIN) in diabetic patients with impaired renal function undergoing coronary or endovascular angiography or intervention. Diabetic patients (n = 382) with renal disease (serum creatinine ≥1.1 mg/dl and estimated glomerular filtration rate <60 ml/min/1.

Incidence, predictors, treatment, and long-term prognosis of patients with restenosis after drug-eluting stent implantation for unprotected left main coronary artery disease.

Objectives: The aim of this study was to evaluate the incidence, predictors, and long-term outcomes of patients with in-stent restenosis (ISR) after percutaneous coronary intervention (PCI) with drug-eluting stents (DES) for unprotected left main coronary artery (LMCA) disease.

Background: Few data on the clinical course and management of patients experiencing restenosis after DES treatment for unprotected LMCA disease have appeared.

Methods: Between February 2003 and November 2007, 509 consecutive patients with unprotected LMCA disease underwent DES implantation, with 402 (80.

A randomized, double-blind, multicenter comparison study of triple antiplatelet therapy with dual antiplatelet therapy to reduce restenosis after drug-eluting stent implantation in long coronary lesions: results from the DECLARE-LONG II (Drug-Eluting Stenting Followed by Cilostazol Treatment Reduces Late Restenosis in Patients with Long Coronary Lesions) trial.

Objectives: The purpose of this study was to determine whether cilostazol reduces intimal hyperplasia in patients undergoing long zotarolimus-eluting stent implantation (stent length: ≥ 30 mm) for native long coronary lesions (length: ≥ 25 mm).

Background: Restenosis after drug-eluting stent implantation remains a significant clinical problem in long coronary lesions.

Methods: Patients (n = 499) were assigned randomly to triple (aspirin, clopidogrel, and cilostazol, triple group: n = 250) or dual antiplatelet therapy (aspirin and clopidogrel and placebo, dual group: n = 249) for 8 months after long zotarolimus-eluting stent implantation.

Comparison of zotarolimus-eluting stents with sirolimus-eluting and paclitaxel-eluting stents: intimal hyperplasia and vascular changes assessed by volumetric intravascular ultrasound analysis.

Background: As a substudy of the large, randomized ZEST (Comparison of the Efficacy and Safety of Zotarolimus-Eluting Stent with Sirolimus-Eluting and PacliTaxel-Eluting Stent for Coronary Lesions) trial comparing first- and second-generation drug-eluting stents, we evaluated intimal hyperplasia (IH) and vascular changes using volumetric intravascular ultrasound analysis.

Methods And Results: Complete angiographic and volumetric intravascular ultrasound data immediately after stenting and at 9-month follow-up were available in 162 patients with 183 lesions: 61 sirolimus-eluting stents (SES), 64 paclitaxel-eluting stents (PES), and 58 zotarolimus-eluting stents (ZES). External elastic membrane, stent, lumen, and peristent plaque volumes (external elastic membrane minus stent) were normalized by stent length.

Comparison of ADAMTS-1, -4 and -5 expression in culprit plaques between acute myocardial infarction and stable angina.

Background: ADAMTS (a disintegrin and metalloproteinase with thrombospondin type 1 motifs) proteases might contribute to plaque destabilisation by weakening the fibrous cap. However, little is known about the expression of ADAMTS proteases in coronary atherosclerotic plaques.

Objective: To examine the expression of ADAMTS proteases in coronary atherectomy samples obtained from patients with acute myocardial infarction (AMI) or stable angina.

Comparison of dual drug-eluting Cilotax stent and paclitaxel-eluting Taxus Liberte stent in native coronary artery lesions.

Cilotax stent is a new type of drug-eluting stent (DES) designed to increase the antirestenotic performance of the paclitaxel-eluting stent and decrease the risk of stent thrombosis by the incorporation of cilostazol. Therefore, we investigated the safety and efficacy of Cilotax dual DESs and compared their performance to that of paclitaxel-eluting Taxus Liberte. Patients undergoing percutaneous coronary intervention for de novo coronary artery lesions at 2 centers in Korea were randomized to receive Cilotax (n = 55) or Taxus Liberte (n = 56) stents.

Validation of intravascular ultrasound-derived parameters with fractional flow reserve for assessment of coronary stenosis severity.

Background: We assessed optimal intravascular ultrasound (IVUS) criteria for predicting functional significance of intermediate coronary lesions.

Methods And Results: Overall, 201 patients with 236 coronary lesions underwent IVUS and invasive physiological assessment before intervention. Fractional flow reserve (FFR) was measured at maximal hyperemia induced by intravenous adenosine infusion.

Mechanisms of in-stent restenosis after drug-eluting stent implantation: intravascular ultrasound analysis.

Background: We used intravascular ultrasound (IVUS) to (1) clarify the mechanisms of luminal loss after drug-eluting stent (DES) implantation and (2) classify morphological patterns of in-stent restenosis (ISR).

Methods And Results: On the basis of IVUS-identified luminal narrowing (in-stent minimum lumen area <4 mm(2)), IVUS-defined ISR was classified as focal (luminal narrowing ≤10 mm in length), multifocal (≥1 focal lesions), and diffuse (luminal narrowing >10 mm in length) with or without stent edge involvement. Significant intimal hyperplasia (IH) was defined as IH area >50% of stent.

Effect of intravascular ultrasound findings on long-term repeat revascularization in patients undergoing drug-eluting stent implantation for severe unprotected left main bifurcation narrowing.

We studied the effect of the preprocedural intravascular ultrasound findings on stent expansion and the pre- and postprocedural findings on the long-term clinical outcomes in patients undergoing drug-eluting stent implantation for unprotected left main (LM) bifurcation disease. Using a left anterior descending (LAD) pullback, we evaluated the ostial LAD artery (3 mm distal to the carina), the polygon of confluence (POC; the confluent zone of the LAD artery and left circumflex artery), and the distal LM artery (3 mm just proximal to the POC). The measurements included the minimum lumen area (MLA) and minimum stent area within each segment.

Long-term comparison of drug-eluting stents and coronary artery bypass grafting for multivessel coronary revascularization: 5-year outcomes from the Asan Medical Center-Multivessel Revascularization Registry.

Objectives: We performed the long-term (5-year) follow-up of a large cohort of patients who underwent drug-eluting stent (DES) or coronary artery bypass graft (CABG) surgery for multivessel revascularization.

Background: Limited information is available on very long-term outcomes after multivessel DES treatment relative to CABG.

Methods: We evaluated 3,042 patients with multivessel disease who received DES (n = 1,547) or underwent CABG (n = 1,495) between January 2003 and December 2005, and for whom complete follow-up data were available for a median 5.