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Fibrous cap thickness distribution in stable coronary artery lesions: An OCT study
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Abstracts / Annales de Cardiologie et d’Angéiologie 62 (2013) 372–381
Registre d’évaluation du système Femoseal© (REF) F. De Poli , P. Leddet , P. Couppié , J.-M. Daesslé , M. Hanssen Service de cardiologie, CH Haguenau, 67500 Haguenau, France Introduction.– L’objectif de notre étude était d’évaluer l’efficacité et la sécurité du système de fermeture artérielle mécanique Femoseal©, en vue d’obtenir l’hémostase au point de ponction après angioplastie coronaire par voie artérielle fémorale. Patients et méthode.– Nous avons réalisé une registre prospectif monocentrique de novembre 2010 à avril 2011, comparant les résultats de la compression manuelle (n : 111 patients), de la compression avec compresse hémostatique (n : 43 patients) et de la fermeture artérielle mécanique par un système Femoseal© (n : 100 patients). Le critère de jugement principal était l’obtention de l’hémostase immédiate. Les critères secondaires étaient les complications hémorragiques mineures et majeures immédiates et à 1 mois. Nous avons également évalué le confort du patient immédiat et à 1 mois. Résultats.– L’hémostase immédiate après mise en place du Femoseal© a été obtenue dans 93 % des cas (n : 93 patients). Sept patients ont nécessité une compression manuelle légère complémentaire ou un pansement compressif. L’utilisation du Femoseal© n’a été associée à aucune complication majeure, avec une réduction significative (P < 0,05) des complications en comparaison aux autres méthodes d’hémostase utilisées durant la même période. Une complication mineure a été observée après utilisation du Femoseal© (hématome de 15 mm, avec résorption spontanée, sans conséquence). Conclusion.– L’utilisation du système Femoseal© permet l’obtention de l’hémostase de fac¸on efficace et reproductible, après procédure interventionnelle par abord artériel fémoral, jusqu’à 7 French. Elle est associée à un très faible taux de complications. http://dx.doi.org/10.1016/j.ancard.2013.07.008
Fibrous cap thickness distribution in stable coronary artery lesions: An OCT study A. Veugeois , S. Fradi , C. Caussin , N. Amabile Department of Cardiology, Marie-Lannelongue Hospital, 92350 Le Plessis-Robinson, France Background.– Stable plaques with constrictive remodeling and significant hemodynamic outringing lead to stable angina. Thin cap fibro-atheroma lesions are suspected to be prone to rupture, with the shoulders zones presenting the highest risk for this evolution. Aim.– The aim of the study was to investigate the thickness repartition of the fibrous cap within stable plaque in human beings in vivo using frequency domain optical coherence tomography analysis (FD-OCT). Methods and results.– n = 10 stable fibro-lipid plaques were included in the study. FD-OCT methodology included serial cross sectional analysis with 1 mm intervals. The fibrous cap thickness was measured in longitudinal and transversal analysis all along the target lesion. In the longitudinal analysis, the plaque was divided in three equal parts (downstream, middle, upstream) according to their position within the vascular flow. In the transversal analysis, the thickness was quantified in five zones according to their quadratic position (from shoulders to zenith position) (Fig. 1). n = 620 thickness measures were performed. We observed that the shoulders were not, as usually suspected, the thinnest cap thickness zone. Hence, the fibrous cap was significantly thinner in the zenith zone than the shoulders (143.55 ± 0.10 m and 158.23 ± 0.11 m versus 227.02 ± 0.12 m, P < 0.01). Moreover, the middle part of the plaque presented a thinner fibrous cap comparing to the upstream and downstream parts. Conclusion.– Fibrous cap thickness distribution reveals high heterogeneity in stable coronary artery fibro-lipid plaques.
http://dx.doi.org/10.1016/j.ancard.2013.07.009
Intra-coronary thrombus evolution during acute coronary syndrome: Regression assessment by serial optical coherence tomography analyses N. Amabile a , S. Hammas a , S. Fradhi a , G. Souteyrand b , A. Veugeois a , P. Motreff b , L. Belle c , C. Caussin a a Department of Cardiology, Marie Lannelongue Hospital, 92350 Le Plessis-Robinson, France b Cardiology Department, CHU de Clermont-Ferrand, 63000 Clermont Ferrand, France c Cardiology Department, CHR Annecy, 74370 Pringy, France Aims.– Time-domain optical coherence tomography (TD-OCT) allows assessment of the anatomy and features of unstable coronary artery lesions, including discrimination between the thrombotic and atherosclerotic plaque components. We sought to investigate the feasibility of thrombus quantification and its monitoring in patients with high thrombotic burden acute coronary syndromes (ACS). Methods.– Patients were suitable for inclusion if they presented with an ACS that was successfully revascularized by manual thrombo-aspiration with a residual large thrombus burden on coronary angiography and initial TD-OCT analysis. These patients underwent a second procedure with TD-OCT analysis after several days of optimal anti-thrombotic therapy and benefited eventually from an intra-coronary stent. Coronary lesion stenosis degree was determined by quantitative coronary angiography (QCA). TD-OCT analysis included measurement of thrombus score (as defined by ESC consensus document), thrombus volume, length and minimal luminal area (MLA), which were quantified by serial area measurement within the athero-thrombotic culprit lesion. Results.– Seventeen patients fulfilled inclusion criteria. The OCT image quality was suitable for thrombus quantification in n = 14 subjects (86% men/age = 57.9 ± 4.5y/93% STEMI). Low molecular weight heparin anticoagulation and dual antiplatelet therapy were given to all patients between the two procedures (mean delay: 3.9 ± 0.3 days). No adverse events were observed during study time. The values of thrombus score and thrombus volume among individuals highly correlated together (rho = 0.8, P < 0.0001). We observed a progressive reduction of thrombus burden between the two analyses, as assessed by the significant reductions in thrombus score (22.1 ± 2.6 vs. 10.4 ± 1.4, P = 0.001), thrombus volume (9.6 ± 2.4 vs. 4.2 ± 1.2 mm3 , P = 0.003), length (11.1 ± 1.4 vs. 7.6 ± 0.9 mm, P = 0.03) and increase of MLA (2.5 ± 0.4 mm2 vs. 1.7 ± 0.2 mm2 , P = 0.01). However, the degree of stenosis analyzed by QCA didn’t significantly decrease over time. The thrombus burden reduction was time dependent, as the greatest reductions of thrombus score and volume were observed for the longer optimal medical therapy times. The percentages of thrombus score and volume reduction were highly correlated with the inter-OCT analyses delay (respectively r = 0.75 and
Abstracts / Annales de Cardiologie et d’Angéiologie 62 (2013) 372–381
Registre d’évaluation du système Femoseal© (REF) F. De Poli , P. Leddet , P. Couppié , J.-M. Daesslé , M. Hanssen Service de cardiologie, CH Haguenau, 67500 Haguenau, France Introduction.– L’objectif de notre étude était d’évaluer l’efficacité et la sécurité du système de fermeture artérielle mécanique Femoseal©, en vue d’obtenir l’hémostase au point de ponction après angioplastie coronaire par voie artérielle fémorale. Patients et méthode.– Nous avons réalisé une registre prospectif monocentrique de novembre 2010 à avril 2011, comparant les résultats de la compression manuelle (n : 111 patients), de la compression avec compresse hémostatique (n : 43 patients) et de la fermeture artérielle mécanique par un système Femoseal© (n : 100 patients). Le critère de jugement principal était l’obtention de l’hémostase immédiate. Les critères secondaires étaient les complications hémorragiques mineures et majeures immédiates et à 1 mois. Nous avons également évalué le confort du patient immédiat et à 1 mois. Résultats.– L’hémostase immédiate après mise en place du Femoseal© a été obtenue dans 93 % des cas (n : 93 patients). Sept patients ont nécessité une compression manuelle légère complémentaire ou un pansement compressif. L’utilisation du Femoseal© n’a été associée à aucune complication majeure, avec une réduction significative (P < 0,05) des complications en comparaison aux autres méthodes d’hémostase utilisées durant la même période. Une complication mineure a été observée après utilisation du Femoseal© (hématome de 15 mm, avec résorption spontanée, sans conséquence). Conclusion.– L’utilisation du système Femoseal© permet l’obtention de l’hémostase de fac¸on efficace et reproductible, après procédure interventionnelle par abord artériel fémoral, jusqu’à 7 French. Elle est associée à un très faible taux de complications. http://dx.doi.org/10.1016/j.ancard.2013.07.008
Fibrous cap thickness distribution in stable coronary artery lesions: An OCT study A. Veugeois , S. Fradi , C. Caussin , N. Amabile Department of Cardiology, Marie-Lannelongue Hospital, 92350 Le Plessis-Robinson, France Background.– Stable plaques with constrictive remodeling and significant hemodynamic outringing lead to stable angina. Thin cap fibro-atheroma lesions are suspected to be prone to rupture, with the shoulders zones presenting the highest risk for this evolution. Aim.– The aim of the study was to investigate the thickness repartition of the fibrous cap within stable plaque in human beings in vivo using frequency domain optical coherence tomography analysis (FD-OCT). Methods and results.– n = 10 stable fibro-lipid plaques were included in the study. FD-OCT methodology included serial cross sectional analysis with 1 mm intervals. The fibrous cap thickness was measured in longitudinal and transversal analysis all along the target lesion. In the longitudinal analysis, the plaque was divided in three equal parts (downstream, middle, upstream) according to their position within the vascular flow. In the transversal analysis, the thickness was quantified in five zones according to their quadratic position (from shoulders to zenith position) (Fig. 1). n = 620 thickness measures were performed. We observed that the shoulders were not, as usually suspected, the thinnest cap thickness zone. Hence, the fibrous cap was significantly thinner in the zenith zone than the shoulders (143.55 ± 0.10 m and 158.23 ± 0.11 m versus 227.02 ± 0.12 m, P < 0.01). Moreover, the middle part of the plaque presented a thinner fibrous cap comparing to the upstream and downstream parts. Conclusion.– Fibrous cap thickness distribution reveals high heterogeneity in stable coronary artery fibro-lipid plaques.
http://dx.doi.org/10.1016/j.ancard.2013.07.009
Intra-coronary thrombus evolution during acute coronary syndrome: Regression assessment by serial optical coherence tomography analyses N. Amabile a , S. Hammas a , S. Fradhi a , G. Souteyrand b , A. Veugeois a , P. Motreff b , L. Belle c , C. Caussin a a Department of Cardiology, Marie Lannelongue Hospital, 92350 Le Plessis-Robinson, France b Cardiology Department, CHU de Clermont-Ferrand, 63000 Clermont Ferrand, France c Cardiology Department, CHR Annecy, 74370 Pringy, France Aims.– Time-domain optical coherence tomography (TD-OCT) allows assessment of the anatomy and features of unstable coronary artery lesions, including discrimination between the thrombotic and atherosclerotic plaque components. We sought to investigate the feasibility of thrombus quantification and its monitoring in patients with high thrombotic burden acute coronary syndromes (ACS). Methods.– Patients were suitable for inclusion if they presented with an ACS that was successfully revascularized by manual thrombo-aspiration with a residual large thrombus burden on coronary angiography and initial TD-OCT analysis. These patients underwent a second procedure with TD-OCT analysis after several days of optimal anti-thrombotic therapy and benefited eventually from an intra-coronary stent. Coronary lesion stenosis degree was determined by quantitative coronary angiography (QCA). TD-OCT analysis included measurement of thrombus score (as defined by ESC consensus document), thrombus volume, length and minimal luminal area (MLA), which were quantified by serial area measurement within the athero-thrombotic culprit lesion. Results.– Seventeen patients fulfilled inclusion criteria. The OCT image quality was suitable for thrombus quantification in n = 14 subjects (86% men/age = 57.9 ± 4.5y/93% STEMI). Low molecular weight heparin anticoagulation and dual antiplatelet therapy were given to all patients between the two procedures (mean delay: 3.9 ± 0.3 days). No adverse events were observed during study time. The values of thrombus score and thrombus volume among individuals highly correlated together (rho = 0.8, P < 0.0001). We observed a progressive reduction of thrombus burden between the two analyses, as assessed by the significant reductions in thrombus score (22.1 ± 2.6 vs. 10.4 ± 1.4, P = 0.001), thrombus volume (9.6 ± 2.4 vs. 4.2 ± 1.2 mm3 , P = 0.003), length (11.1 ± 1.4 vs. 7.6 ± 0.9 mm, P = 0.03) and increase of MLA (2.5 ± 0.4 mm2 vs. 1.7 ± 0.2 mm2 , P = 0.01). However, the degree of stenosis analyzed by QCA didn’t significantly decrease over time. The thrombus burden reduction was time dependent, as the greatest reductions of thrombus score and volume were observed for the longer optimal medical therapy times. The percentages of thrombus score and volume reduction were highly correlated with the inter-OCT analyses delay (respectively r = 0.75 and