- Email: [email protected]
Clinical Profile of Coronary Slow Flow Phenomenon
APRIL 23e26, 2013 percent necrotic core (22.87.7% vs. 15.411.1%, p¼0.01) and dense calcium volume (3.42.5 mm3 vs. 1.72.8 mm3, p¼0.03) were greater in the ED group than in the non-ED group by IVUS-VH. One patient had implantation of an additional stent to treat the ED during the index PCI.
Angiography Edge dissection Edge dissection IVUS Edge dissection Edge dissection
Edge Dissection by OCT (n¼19)
Non-Edge Dissection by OCT (n¼38)
(+) (-)
1 (1.8%) 18
2 36
(+) (-)
3 (5.3%) 16
0 38
Conclusion: OCT is superior to conventional coronary angiography and IVUS in the identification of stent ED. The risk of ED may be reduced if underlying plaque composition is considered when assessing stent length thereby ensuring that stent landing zones are free of calcium and necrotic core.
- AS-171 Efficacy of Using Non Slip Element Balloon (Lacrosse NSE) to Treatment for In-stent Restenosis Lesion. Optical Coherence Tomography Analysis. Nobuyuki Miyai, Keisuke Oota, Reo Nakamura, Takayoshi Sawanishi, Noriyuki Kinoshita, Katsushige Matsumoto. Kouseikai Takeda Hospital, Kyoto, Japan.
P O S T E R A B S T R A C T S
Background: Drug-eluting stents (DES) have been shown to reduce restenosis rates. However, restenosis after DES implantation is still observed. In this study, we evaluated the efficacy of non slip element balloon (NSE) for target lesion revascularization (TLR) of in-stent restenosis (ISR). Methods: We enrolled 71 patients who underwent TLR for ISR using NSE. We succeeded in performing angiographic follow-up in 58 patients. We classified these patients into a re-restenosis group and a non re-restenosis group. We compared OCT images of pre-procedure with images of post-procedure. Results: Recurrent restenosis was angiographically documented in 18 patients (31%), and TLR was in 17patients (29%). There were no difference in gender, age, and coronary risk factor between a re-restenosis group and a non re-restenosis group. QCA data before and after procedure were not difference between two groups. Tissue coverage structures in stent, for example homogeneous, heterogeneous, and layered, were not difference between two groups. However, peri-stent low signal area had a tendency to be more detected in re-restenosis group compared with non re-restenosis group (73% vs. 32%, p¼0.072). After NSE angioplasty, we detected fissures in 73% of patients. Irregular lumen shape had tendency to be more detected in re-resteosis group (55% vs. 16%, p¼0.069). Stent area change after using NSE was bigger in non re-restenosis group than re-restenosis group (1.67◇ 0.66mm2 vs. 0.52◇ 0.38mm2, p¼0.0039). Conclusion: A treatment with NSE for ISR lesion may be more effective compared with plain old balloon angioplasty.
- AS-172 Clinical Profile of Spontaneous Coronary Dissection in a Community Hospital. Mathew Ravi Cherian, Balasubramaniyan Amirtha Ganesh, Palamalai Arun Prasath. Mahatma Gandhi Medical College and Research Institute, Puducherry, India.
84B
Background: Spontaneous Coronary Artery Dissection (SCAD) is a rare, infrequent cause of Acute Coronary Syndrome which has been reported frequently in young female with free of atheromatous risk factors. Recent reports highlights the varying trend in the incidence of SCAD different from which was predicted. Methods: A total of 300 patients were analysed over a period of 1 year out of which 10 patients had Spontaneous Coronary Artery Dissection (SCAD) who presented to us with Acute Coronary Syndrome (ACS). Presence of SCAD was confirmed by different orthogonal views during Coronary Angiogram which is usually seen as longitudinal ill filling defects. 70% of the cases were non flow limiting lesions which were medically managed and other 30% cases under went Revascularization. Results: The mean age of presentation was 55 years of which all were males. All the patients were smokers and diabetic, with 4% having Hypertension grade II. 70% (7) of the patients presented with Myocardial Infarction, 30% (3) Unstable Angina. Out of 70% of cases of Myocardial Infarction 57% (4) had Anterior Wall Myocardial Infarction of which 75% (3) had involvement of the Left Anterior Descending Artery Territory and 25% (1) had involvement of the Right Coronary Artery. 43% (3) of the cases had Inferior Wall Myocardial Infarction out of which 33% (1) had involvement of Right Coronary Artery and 67% (2) had Left Anterior Descending artery involvement. 43% (3) of SCAD was seen in non culprit arteries. The mean follow up was for 1 year and all the patients are doing well. Conclusion: SCAD is a rare disease which usually involves the young women, but ours were all middle aged males. Left Anterior Coronary artery dissection is the most common location. SCAD can be seen in non culprit arteries also which are incidentally detected during Coronary Angiogram needing revascularization. Intravascular Ultrasonography is an extremely useful tool to evaluate SCAD, which was not done in our setup for economical reasons. This study emphasis the varying clinical profile of SCAD and its prompt identification.
- AS-173 Clinical Profile of Coronary Slow Flow Phenomenon. Mathew Ravi Cherian, Palamalai Arun Prasath, Balasubramaniyan Amirtha Ganesh. Mahatma Gandhi Medical College and Research Institute, Puducherry, India. Background: Coronary slow flow phenomenon (CSFP) is characterized by delayed progression of the contrast medium injected through the coronary tree during Coronary Angiogram (CAG). CSFP is usually observed in patient with various spectrum of Coronary Artery Disease including Acute Coronary Syndrome and Chronic Stable Angina (CSA). The exact pathogenesis of CSFP is unknown, but 80% of patients experience recurrent episodes of typical anginal pain which results in impairment of quality of the life. Methods: We analysed a total of 20 patients over a period of 6 months with Non Obstructive coronaries below the age group of 60 yrs who presented with Ischemic Heart Disease. Coronary Slow Flow was identified using thrombolysis in myocardial infarction frame count (TFC) method introduced by Gibson. Risk factors and profiles of all the patients were studied in detail. Those patients who had Coronary Artery ectasia and coronary aneurysm were excluded. Results: Out of 20 patients presented with CSFP 95% were males and 5% females with a mean age of 49 years. CSA with Positive Stress Test were 70%, 10% had Unstable Angina and 20% presented with Myocardial Infarction with Positive Troponin. Dynamic ECG changes were present in 30% of the cases. Analysing the risk factors, most of the patients had uncontrolled hypertension (80%) and also were smokers (55%). Diabetes was prevalent in 55% of cases and dyslipidemia in 30% of cases. There were no mortalities noted in hospitalised patients.
The American Journal of Cardiologyâ APRIL 23e26, 2013 ANGIOPLASTY SUMMIT ABSTRACTS/Poster
APRIL 23e26, 2013 Conclusion: CSFP was prevalent in wide spectrum of Ischemic Heart Disease presenting as CSA and Acute Coronary Syndrome. Most of the patients presented with CSFP were smokers and had uncontrolled Hypertension. Endothelial Dysfunction, Inflammation and diffuse atherosclerosis are various proposed pathogenesis of CSFP. CSFP causes significant cardiovascular morbidity due to dynamic ECG changes and symptom worsening necessitating recurrent hospitalization and they tend to undergo repeated investigations like Coronary Angiogram.
- AS-174 Very Long-term Evaluation by Coronary Angioscopy after Sirolimus-eluting Stent Implantation. Yusuke Katayama, Keiji Yamada, Kota Okabe, Takashi Fujiwara, Takashi Miki, Hiroaki Ootsuka, Shinpei Fujita, Kazuhiko Yamamoto, Kenji Kawamoto, Satoru Sakuragi. Iwakuni Clinical Center, Iwakuni, Japan. Background: Very late stent thrombosis after sirolimus-eluting stent (SES) implantation may be one of the most serious problem and be believed to be related to sustained inflammation around the SES polymer. Several reports indicated that yellowish plaque, delayed stent coverage and thrombus is observed in the medium-term evaluation of the SES sites (3 months-2 years). In the present study, we evaluated angioscopic findings more over 2 years after SES implantation. Methods: Angioscopic observations in the SES impanted site were performed in 13 patients with PCI for SES restenosis (n¼8) or de novo lesion (n¼5) more than 2 years after SES implantation. Average duration after SES implantation was 55.7◇ 16.8 months. NISC grade (G0-3), YP grade (G0-3) and existence of thrombi was evaluated. Results: The minimum NISC grade was not significantly different between the SES-ISR group and the non-ISR group (1.2◇ 0.5 vs 0.5◇ 0.5, respectively). YP grades among the SES-ISR group were mostly G0/1 and higher than the non-ISR group (2.7◇ 0.5 vs 0.7◇ 0.8, respectively). Thrombi existed only in the SES-ISR group. Conclusion: The angioscopic findings indicates that intra-stent plaque at the SES site with restenosis may be relatively unstable, in comparison with that at the non-ISR site.
- AS-175 Spontaneous Coronary Dissection - A Rare but Serious Illness Hitting Clean Artery. Ping Tim Tsui. Princess Margaret Hospital, Hong Kong, Hong Kong, China. Background: Spontaneous coronary dissection (SCD) is rare. The incidence is around one to two cases out of 1000 coronary angiography. It predominantly affects otherwise healthy pre-menopausal woman with few conventional cardiovascular risk factors. SCD risk factors are female sex, pregnancy and estrogen therapy. It can be fatal with diagnosis only at post-mortem. Proximal or distal extension of dissection and thus procedural complication is common during percutaneous coronary intervention (PCI). Methods: This was a retrospective case series study conducted in cardiac intervention center of Princess Margaret Hospital. Results: Eleven patients (11 female, 1 male) of age 48+/-7 (37 to 62) were identified. Nine females were pre-menopausal. The only male patient had congenital absence of one upper limb. All of them presented with acute coronary syndrome. Right coronary, left circumflex and left anterior descending artery was the culprit vessel in 8, 1 and 3 patients respectively. Two patients presented with cardiac arrest as a result of ventricular fibrillation. Diagnosis was made by angiography and 7 cases were confirmed by intravascular ultrasonography and one by optical coherence tomography. Presence of dissection flap, normal looking uninvolved segments and containment of dissection by branching points were tell-tale signs. Underlying conventional cardiovascular risk factors except hypertension were uncommon: diabetes (0%), hypertension (50%), dyslipidemia (17%), current or history of smoking (25%). PCI was attempted in 9 and extension of dissection was noted in 8. PCI was abandoned in 2 but was successful in remaining 7. Two patients had complete spontaneous healing of SCD without PCI. All patients survived without acute clinical complication. One patient suffered from sequelae of hypoxic brain damage related to cardiac arrest at presentation. Conclusion: SCD is a serious illness and early recognition is critical before PCI. Extension of dissection is very common and it makes intervention much more difficult. Spontaneous complete recovery without intervention is possible.
P O S T E R A B S T R A C T S
The American Journal of Cardiologyâ APRIL 23e26, 2013 ANGIOPLASTY SUMMIT ABSTRACTS/Poster
85B
Angiography Edge dissection Edge dissection IVUS Edge dissection Edge dissection
Edge Dissection by OCT (n¼19)
Non-Edge Dissection by OCT (n¼38)
(+) (-)
1 (1.8%) 18
2 36
(+) (-)
3 (5.3%) 16
0 38
Conclusion: OCT is superior to conventional coronary angiography and IVUS in the identification of stent ED. The risk of ED may be reduced if underlying plaque composition is considered when assessing stent length thereby ensuring that stent landing zones are free of calcium and necrotic core.
- AS-171 Efficacy of Using Non Slip Element Balloon (Lacrosse NSE) to Treatment for In-stent Restenosis Lesion. Optical Coherence Tomography Analysis. Nobuyuki Miyai, Keisuke Oota, Reo Nakamura, Takayoshi Sawanishi, Noriyuki Kinoshita, Katsushige Matsumoto. Kouseikai Takeda Hospital, Kyoto, Japan.
P O S T E R A B S T R A C T S
Background: Drug-eluting stents (DES) have been shown to reduce restenosis rates. However, restenosis after DES implantation is still observed. In this study, we evaluated the efficacy of non slip element balloon (NSE) for target lesion revascularization (TLR) of in-stent restenosis (ISR). Methods: We enrolled 71 patients who underwent TLR for ISR using NSE. We succeeded in performing angiographic follow-up in 58 patients. We classified these patients into a re-restenosis group and a non re-restenosis group. We compared OCT images of pre-procedure with images of post-procedure. Results: Recurrent restenosis was angiographically documented in 18 patients (31%), and TLR was in 17patients (29%). There were no difference in gender, age, and coronary risk factor between a re-restenosis group and a non re-restenosis group. QCA data before and after procedure were not difference between two groups. Tissue coverage structures in stent, for example homogeneous, heterogeneous, and layered, were not difference between two groups. However, peri-stent low signal area had a tendency to be more detected in re-restenosis group compared with non re-restenosis group (73% vs. 32%, p¼0.072). After NSE angioplasty, we detected fissures in 73% of patients. Irregular lumen shape had tendency to be more detected in re-resteosis group (55% vs. 16%, p¼0.069). Stent area change after using NSE was bigger in non re-restenosis group than re-restenosis group (1.67◇ 0.66mm2 vs. 0.52◇ 0.38mm2, p¼0.0039). Conclusion: A treatment with NSE for ISR lesion may be more effective compared with plain old balloon angioplasty.
- AS-172 Clinical Profile of Spontaneous Coronary Dissection in a Community Hospital. Mathew Ravi Cherian, Balasubramaniyan Amirtha Ganesh, Palamalai Arun Prasath. Mahatma Gandhi Medical College and Research Institute, Puducherry, India.
84B
Background: Spontaneous Coronary Artery Dissection (SCAD) is a rare, infrequent cause of Acute Coronary Syndrome which has been reported frequently in young female with free of atheromatous risk factors. Recent reports highlights the varying trend in the incidence of SCAD different from which was predicted. Methods: A total of 300 patients were analysed over a period of 1 year out of which 10 patients had Spontaneous Coronary Artery Dissection (SCAD) who presented to us with Acute Coronary Syndrome (ACS). Presence of SCAD was confirmed by different orthogonal views during Coronary Angiogram which is usually seen as longitudinal ill filling defects. 70% of the cases were non flow limiting lesions which were medically managed and other 30% cases under went Revascularization. Results: The mean age of presentation was 55 years of which all were males. All the patients were smokers and diabetic, with 4% having Hypertension grade II. 70% (7) of the patients presented with Myocardial Infarction, 30% (3) Unstable Angina. Out of 70% of cases of Myocardial Infarction 57% (4) had Anterior Wall Myocardial Infarction of which 75% (3) had involvement of the Left Anterior Descending Artery Territory and 25% (1) had involvement of the Right Coronary Artery. 43% (3) of the cases had Inferior Wall Myocardial Infarction out of which 33% (1) had involvement of Right Coronary Artery and 67% (2) had Left Anterior Descending artery involvement. 43% (3) of SCAD was seen in non culprit arteries. The mean follow up was for 1 year and all the patients are doing well. Conclusion: SCAD is a rare disease which usually involves the young women, but ours were all middle aged males. Left Anterior Coronary artery dissection is the most common location. SCAD can be seen in non culprit arteries also which are incidentally detected during Coronary Angiogram needing revascularization. Intravascular Ultrasonography is an extremely useful tool to evaluate SCAD, which was not done in our setup for economical reasons. This study emphasis the varying clinical profile of SCAD and its prompt identification.
- AS-173 Clinical Profile of Coronary Slow Flow Phenomenon. Mathew Ravi Cherian, Palamalai Arun Prasath, Balasubramaniyan Amirtha Ganesh. Mahatma Gandhi Medical College and Research Institute, Puducherry, India. Background: Coronary slow flow phenomenon (CSFP) is characterized by delayed progression of the contrast medium injected through the coronary tree during Coronary Angiogram (CAG). CSFP is usually observed in patient with various spectrum of Coronary Artery Disease including Acute Coronary Syndrome and Chronic Stable Angina (CSA). The exact pathogenesis of CSFP is unknown, but 80% of patients experience recurrent episodes of typical anginal pain which results in impairment of quality of the life. Methods: We analysed a total of 20 patients over a period of 6 months with Non Obstructive coronaries below the age group of 60 yrs who presented with Ischemic Heart Disease. Coronary Slow Flow was identified using thrombolysis in myocardial infarction frame count (TFC) method introduced by Gibson. Risk factors and profiles of all the patients were studied in detail. Those patients who had Coronary Artery ectasia and coronary aneurysm were excluded. Results: Out of 20 patients presented with CSFP 95% were males and 5% females with a mean age of 49 years. CSA with Positive Stress Test were 70%, 10% had Unstable Angina and 20% presented with Myocardial Infarction with Positive Troponin. Dynamic ECG changes were present in 30% of the cases. Analysing the risk factors, most of the patients had uncontrolled hypertension (80%) and also were smokers (55%). Diabetes was prevalent in 55% of cases and dyslipidemia in 30% of cases. There were no mortalities noted in hospitalised patients.
The American Journal of Cardiologyâ APRIL 23e26, 2013 ANGIOPLASTY SUMMIT ABSTRACTS/Poster
APRIL 23e26, 2013 Conclusion: CSFP was prevalent in wide spectrum of Ischemic Heart Disease presenting as CSA and Acute Coronary Syndrome. Most of the patients presented with CSFP were smokers and had uncontrolled Hypertension. Endothelial Dysfunction, Inflammation and diffuse atherosclerosis are various proposed pathogenesis of CSFP. CSFP causes significant cardiovascular morbidity due to dynamic ECG changes and symptom worsening necessitating recurrent hospitalization and they tend to undergo repeated investigations like Coronary Angiogram.
- AS-174 Very Long-term Evaluation by Coronary Angioscopy after Sirolimus-eluting Stent Implantation. Yusuke Katayama, Keiji Yamada, Kota Okabe, Takashi Fujiwara, Takashi Miki, Hiroaki Ootsuka, Shinpei Fujita, Kazuhiko Yamamoto, Kenji Kawamoto, Satoru Sakuragi. Iwakuni Clinical Center, Iwakuni, Japan. Background: Very late stent thrombosis after sirolimus-eluting stent (SES) implantation may be one of the most serious problem and be believed to be related to sustained inflammation around the SES polymer. Several reports indicated that yellowish plaque, delayed stent coverage and thrombus is observed in the medium-term evaluation of the SES sites (3 months-2 years). In the present study, we evaluated angioscopic findings more over 2 years after SES implantation. Methods: Angioscopic observations in the SES impanted site were performed in 13 patients with PCI for SES restenosis (n¼8) or de novo lesion (n¼5) more than 2 years after SES implantation. Average duration after SES implantation was 55.7◇ 16.8 months. NISC grade (G0-3), YP grade (G0-3) and existence of thrombi was evaluated. Results: The minimum NISC grade was not significantly different between the SES-ISR group and the non-ISR group (1.2◇ 0.5 vs 0.5◇ 0.5, respectively). YP grades among the SES-ISR group were mostly G0/1 and higher than the non-ISR group (2.7◇ 0.5 vs 0.7◇ 0.8, respectively). Thrombi existed only in the SES-ISR group. Conclusion: The angioscopic findings indicates that intra-stent plaque at the SES site with restenosis may be relatively unstable, in comparison with that at the non-ISR site.
- AS-175 Spontaneous Coronary Dissection - A Rare but Serious Illness Hitting Clean Artery. Ping Tim Tsui. Princess Margaret Hospital, Hong Kong, Hong Kong, China. Background: Spontaneous coronary dissection (SCD) is rare. The incidence is around one to two cases out of 1000 coronary angiography. It predominantly affects otherwise healthy pre-menopausal woman with few conventional cardiovascular risk factors. SCD risk factors are female sex, pregnancy and estrogen therapy. It can be fatal with diagnosis only at post-mortem. Proximal or distal extension of dissection and thus procedural complication is common during percutaneous coronary intervention (PCI). Methods: This was a retrospective case series study conducted in cardiac intervention center of Princess Margaret Hospital. Results: Eleven patients (11 female, 1 male) of age 48+/-7 (37 to 62) were identified. Nine females were pre-menopausal. The only male patient had congenital absence of one upper limb. All of them presented with acute coronary syndrome. Right coronary, left circumflex and left anterior descending artery was the culprit vessel in 8, 1 and 3 patients respectively. Two patients presented with cardiac arrest as a result of ventricular fibrillation. Diagnosis was made by angiography and 7 cases were confirmed by intravascular ultrasonography and one by optical coherence tomography. Presence of dissection flap, normal looking uninvolved segments and containment of dissection by branching points were tell-tale signs. Underlying conventional cardiovascular risk factors except hypertension were uncommon: diabetes (0%), hypertension (50%), dyslipidemia (17%), current or history of smoking (25%). PCI was attempted in 9 and extension of dissection was noted in 8. PCI was abandoned in 2 but was successful in remaining 7. Two patients had complete spontaneous healing of SCD without PCI. All patients survived without acute clinical complication. One patient suffered from sequelae of hypoxic brain damage related to cardiac arrest at presentation. Conclusion: SCD is a serious illness and early recognition is critical before PCI. Extension of dissection is very common and it makes intervention much more difficult. Spontaneous complete recovery without intervention is possible.
P O S T E R A B S T R A C T S
The American Journal of Cardiologyâ APRIL 23e26, 2013 ANGIOPLASTY SUMMIT ABSTRACTS/Poster
85B