Successful use of the five‐in‐six system with IVUS guided transradial renal artery stenting

In transradial renal intervention, the long distance between the vascular access and the target lesion represents a major issue. The 100 cm guiding catheter (GC) may be too short to engage the renal artery particularly in tall patients or with excessive aortic turtousity. On the other hand, with the use of 125 cm long GC, only few premounted dedicated renal stents can be used. The shaft of the stent delivery system must be 140 cm or more to be compatible with the 125 GC. However, in many renal interventions, only few more centimeters are required to give the GC the sufficient working length needed for proper engagement and back up support. For this purpose, we used the Terumo “five‐in‐six” system to provide the necessary extra length through the protruding part of the 5 Fr GC out of the tip of the 6 Fr GC. With the super soft distal segment of the 5 FR GC deeply intubated into the right renal artery, we had the sufficient backup support to do renal stenting with IVUS guidance. This case illustrates that the “five‐in‐six” system can be an alternative strategy whenever extra length or strong backup support is needed during transradial renal artery intervention. © 2011 Wiley‐Liss, Inc.     

Novel Method for Real Time Co‐Registration of IVUS and Coronary Angiography

Objectives

We present our experience with a novel method for real time co‐registration of intravascular ultrasound (IVUS) and coronary angiography.

Background

A major limitation of the current practice of concomitant use of coronary angiography and IVUS is that the locations of the acquired IVUS images are not correlated with their exact locations on the vessel roadmap obtained by coronary angiography.

Methods

Phantoms simulating the coronary tree were used to test the accuracy and potential of co‐registration. Subsequently we examined patients who underwent IVUS during cardiac catheterization. Analysis and feasibility were performed in 42 arteries of 36 patients.

Results

The statistical validation in phantoms resulted in a co‐registration accuracy of 1.12 mm. The length measurement on an angiogram resulted in an accuracy of 0.38 mm. Co‐registration in patients was successful in all cases and four categories were assisted by 1(bad) to 5 (good) grading. Accuracy (the co‐registration precision in pointing at the exact corresponding location): 4.8±0.41; Ease of use and workflow: 4.74±0.44; Stent landing zone detection and evaluation: 4.58±0.5; Stent landing zone length and diameter measurement: 4.94±0.23. The co‐registration error was estimated as no more than 1 mm.

Conclusion

In this pilot study, we found that the novel IVUS and coronary angiography co‐registration method is accurate, easy to use, fast and user‐friendly. This method precludes the need to use motorized automated pull back device. (J Interven Cardiol 2016;29:225–231)

     

Long‐term health outcome and mortality evaluation after invasive coronary treatment using drug eluting stents with or without the IVUS guidance. Randomized control trial. HOME DES IVUS

Objective : To assess the role of the intravascular ultrasound (IVUS) during implantation of Drug‐eluting stents (DES) on long‐term outcome in patients with complex coronary artery disease and high clinical risk profile with special attention to the development of late stent thrombosis (LST). Methods : Two hunderd and ten patients were randomly assigned to receive DES either with (N = 105) or without (N = 105) the IVUS guidance. Dual antiplatelet treatment was administered for 6 months in all patients. At 18‐month follow‐up, the rates of Major adverse cardiac events (MACEs) (death, myocardial infarction, and reintervention) were assessed in both groups with special attention to possible LST. Stent thrombosis was classified according to Academic Research Consortium (ARC). Results : At the 18‐month follow‐up, there was no significant difference between both groups regarding MACE (11% vs. 12%; P = NS). Stent thrombosis has occurred in four patients (3.8%) in the group with and in 6 patients (5.7%; P = NS) in the group without the IVUS guidance. Conclusions : In our randomized trial we failed to demonstrate the superiority of the IVUS guidance during DES implantation over standard high‐pressure postdilatation. However we confirmed worrisome results concerning DES thrombosis after discontinuation of dual antiplatelet‐treatment with documented stent thrombosis related events in almost 5% of patients with 50% of mortality in this high‐risk clinical scenario. © 2009 Wiley‐Liss, Inc.     

Randomized comparison of endothelial progenitor cells capture stent versus cobalt‐chromium stent for treatment of ST‐elevation myocardial infarction. Six‐month clinical,angiographic, and IVUS follow‐up

Purpose : The aim of this trial was to assess the feasibility and safety of endothelial progenitor cells capture (EPC) stent in the treatment of acute ST‐elevation myocardial infarction (STEMI) when compared with cobalt‐chromium stents (CoCr). Methods : Between July 2006 and May 2008, 100 patients with single vessel disease undergoing primary PCI for STEMI were randomly assigned to receive either EPC stent (N = 50) or CoCr stent (N = 50). High‐pressure stent implantation was carried out in both groups. Dual antiplatelet treatment was administered for 30 days in both groups. All patients underwent 6‐month clinical, angiographic, and IVUS follow‐up. Results : The rate of major adverse cardiovascular events (MACEs) at 30 days was comparable in both groups. At 6‐month follow‐up, the rates of MACEs and TLR in the EPC stent group when compared with CoCr stent were 24% vs.10%; P = 0.06 and 14% vs. 4%; P = 0.08, respectively. There were three cases (6%) of stent thrombosis (ST) in the EPC stent group versus none in CoCr group. Conclusion : The use of EPC capture stents in the setting of STEMI is feasible and safe in terms of 30‐days outcome. However, at the 6‐month follow‐up, we found a trend of higher rates of MACE and TLR in the EPC stent capture group compared to CoCr stents. The study does not support the use of EPC capture stents with short duration dual antiplatelet therapy in patients with STEMI. Future randomized studies with large sample sizes would be necessary to demonstrate the safety of such approach. © 2010 Wiley‐Liss, Inc.     

Quantitative measurements in IVUS images

IntraVascular UltraSound (IVUS) is a catheter-based technique which provides real-time high resolution tomographic images of both the lumen and arterial wall of a coronary segment, this in contrast to X-ray arteriography that provides a shadow image (luminogram) of the entire lumen. Nowadays the lumen and vessel parameters are measured manually, which is very time consuming and suffers from high inter- and intra-obser variability. With the continuing improvement in IVUS imaging, it is now feasible to develop and clinically apply automated methods of three-dimensional quantitative analysis of the coronary vessel morphology in an objective and reproducible way with automated contour detection techniques (QCU). Quantification, in 2D and 3D, as well as volume rendering for visualization of the IVUS images requires segmentation of the images (contour detection). The 3D contour detection system described in this article is based on the combination of contour detection in the transversal and sagital view. This article provides some of the basic principles of IVUS, the IVUS image quantification, the three-dimensional reconstruction and the contour detection and quantification in three-dimensional IVUS images.     

First nine‐month complete invasive assessment (angiography,IVUS, and OCT) of the novel NEVO™ sirolimus‐eluting stent with biodegradable polymer

At present, percutaneous coronary intervention with drug‐eluting stent (DES) implantation represents the default strategy to treat coronary artery disease in many institutions around the world. However, concerns regarding long‐term safety of first‐generation DES have prompted the development of novel DES systems such as the NEVO? (Cordis Corporation, Johnson & Johnson, Warren, NJ) sirolimus‐eluting stent with biodegradable polymer and reservoir technology. In the current report, we present, for the first time, a complete midterm invasive assessment of a patient treated with this novel device in the Res‐Elution I study. © 2010 Wiley‐Liss, Inc.     

Epidemiology of parasitic co‐infections during pregnancy in Lambaréné, Gabon

Objectives To evaluate the epidemiologic data of parasitic infections and co‐infections in pregnant women in Lambaréné, Gabon. Methods In Lambaréné, Gabon – a region of high endemicity for Plasmodium falciparum and helminths – we conducted a longitudinal survey of malaria and helminth infections during pregnancy. Results Of 388 pregnant women included in the study, 98 (25%) experienced at least one episode of P. falciparum infection (incidence of 2.6 infections per year of pregnancy). One hundred and seventy pregnant women (49%) were infected with intestinal helminths, and 41 (12%) harboured Shistosoma haematobium. In total, 230 (65%) pregnant women carried at least one parasitic infection are 74 (22%) harboured at least two or more parasite species. Ascaris lumbricoides and primiparity were independently associated with Plasmodium infection during pregnancy [odds ratio (95% confidence intervals) 2.4, (1.4–3.8); 2.1, (1.3–3.5), respectively]. Conclusion This study shows a high burden of parasitic infections with substantial degree of parasitic co‐infections in pregnant women in a Central African region. This may have implications for immunological studies and operational research involving pregnant women.