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Low-viscosity contrast media result in higher flow rates and shorter injection times compared to high-viscosity contrast media in diagnostic coronary catheters
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Abstracts / Cardiovascular Revascularization Medicine 9 (2008) 192–216
Conclusions: Deferring revascularisation of moderate coronary lesions on the basis of an FFR threshold of 0.75 appears to be a safe strategy. FFR can be used to further classify multi-vessel disease and tailor revascularisation strategies. doi:10.1016/j.carrev.2008.03.030
Preclinical evaluation of a second generation intravascular magnetic resonance imaging catheter for lipid assessment in human atherosclerotic plaques A Weiss a, E Ladach b, R Wilensky c, G Mizsei a, R Virmani b a TopSpin Medical, Lod, Israel b CVPath, Gaithersburg, MD c Hospital of the University of Pennsylvania, Philadelphia, PA, USA Objective: An intravascular magnetic imaging (IVMRI) system has been developed to assess the lipid content of atherosclerotic plaques. A secondgeneration 6-Fr compatible IVMRI catheter was designed with dual sensors for bidirectional measurement of lipid within 100 μm of the vessel lumen. We compared the IVMRI lipid fraction index (LFI—the normalized MR signal) to quantitative and gross histopathology assessments in a human ex vivo plaque model. Methods: Test samples consisted of 100 aortic lesions from 48 human cadavers. LFI was determined in each sample and results were correlated with histopathology. Samples were sectioned at 200-μm increments and stained with Oil Red O and Movat's Pentachrome. Normal smooth muscle cells, adaptive intimal thickening, and fibrous-rich lesions were identified as “nonlipidic,” while foam cells/lipid pool-rich lesions and necrotic cores were identified as “lipidic.” Results: Of the 59 lipidic lesions identified by histopathology, 49 were similarly identified by a LFI ≥0.35. Fig. 1 shows the comparison of LFI level to the histology. Based on the prospectively defined LFI cutoff of 0.35, the sensitivity, specificity, and positive predictive values for distinguishing between “nonlipidic” and “lipidic” lesions were 83%, 88%, and 91%, respectively. Conclusions: The IVMRI LFI is an effective parameter for assessing the lipid content of the vessel wall. IVMRI may provide valuable information on plaque lipid characteristics for lesion assessment and risk profiling.
Fig. 1. Comparison of LFI level to the histology. doi:10.1016/j.carrev.2008.03.031
Experience with a novel system of covering in situ Yukon Choice system in a nonselected sample JM Nogales-Asensio Sr., JR López-Mínguez, Sr., R González-Fernández, C Palanco, J Doncel, F Giménez-Saez, A Vaello-Paños, A Merchán-Herrera Sr. Hospital Infanta Cristina, Badajoz, Spain Introduction: In situ coating system developed by Translumina of the premounted Yukon stent is a novel approach in the drug-eluting stent world. It is a polymer-free stent with a micro-porous surface which enables its coating in a stent coating machine directly in the catheterization lab with the application of different drugs at individual dosages.
Objective: To analyze the clinical and angiographic behavior of this system in the real world. Methods: We analyzed the first 50 patients revascularized by this system in our catheterization lab. Two percent rapamycin was the coating drug. Results: Mean age was 65.8±8.5. Forty percent were diabetics. Seventy-six percent had acute coronary syndrome. In 10%, abciximab was used and in 68% revascularization was complete. 1.7 lesions per patient were treated (84 lesions). Seventy-eight Yukon Choice stents were implanted on 65 lesions. During follow-up (mean time: 18.7±7.4 months), two patients died (1 patient due to sudden death). Subacute occlusion occurred in one patient. Angiographic follow-up was performed in 30 patients with 41 lesions (mean time: 8.1±2.5 months after procedure). Target lesion revascularization was required in six patients (12%). Minimum diameter
Maximal length
Yukon/lesion
Late loss
2.89±0.39 mm
25.5±11.9 mm
1.2±0.56
0.35±0.59 mm
Conclusion: Although it is an unselected sample, with a superior risk profile compared to patients enlisted in habitual clinical trials, the exposed results suggest a more unfavorable behavior of this novel system with respect to classic pharmacoactive stents. doi:10.1016/j.carrev.2008.03.032
Low-viscosity contrast media result in higher flow rates and shorter injection times compared to high-viscosity contrast media in diagnostic coronary catheters MC McDaniel a, MA Nelson b, MD Voeltz a, R Fazel a, CM Devireddy a, HA Liberman a, K Mavromatis a, SV Manoukian a a Emory University, Atlanta, GA, USA b Beth Israel Deaconess Medical Center, Boston, MA, USA Background: The ability to achieve adequate flow rates of contrast media (CM) during coronary angiography is critical for vessel opacification. CM viscosity is a major determinant of flow rate. Although CM viscosities differ substantially, the impact of these differences on flow rate is unknown. We hypothesized that a low-viscosity contrast medium (LVCM) would result in higher flow rates compared to a high-viscosity contrast medium (HVCM). Methods: LVCM, ioxilan 350 mgI/ml (16.3 cPs @ 20°C), and HVCM, iodixanol 320 mgI/ml (26.6 cPs @ 20°C), were injected through diagnostic coronary catheters using a power injector set to deliver 10 ml with a pressure limit of 200 PSI. Student t test and one-way ANOVA were used to compare groups. Results: LVCM resulted in higher flow rates compared to HVCM for all catheter sizes (Pb.0001 for all). Flow rates were also higher with increasing catheter size for both CM (Pb.001 for both). Comparison of flow rates between catheter sizes revealed that HVCM required the use of a 1-Fr-size larger catheter vs. LVCM to achieve similar flow rates. See Table 1. Injection times were shorter for LVCM vs. HVCM for 4-Fr (2.35 vs. 3.80 s), 5-Fr (1.77 vs. 2.66 s), and 6-Fr (1.45 vs. 1.93 s) catheters (all Pb.0001). Conclusions: LVCM achieves up to 61% higher flow rates and shorter injection times vs. HVCM. HVCM requires the use of a larger catheter vs. LVCM to produce similar flow rates. The increase in flow rate associated with LVCM may facilitate the use of smaller catheters in coronary angiography. doi:10.1016/j.carrev.2008.03.033
Acoustic radiation force impulse ultrasound for monitoring hemostasis at femoral artery puncture, in vivo RH Behler, TC Nichols, MC Caughey, CM Gallippi University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
Abstracts / Cardiovascular Revascularization Medicine 9 (2008) 192–216
Conclusions: Deferring revascularisation of moderate coronary lesions on the basis of an FFR threshold of 0.75 appears to be a safe strategy. FFR can be used to further classify multi-vessel disease and tailor revascularisation strategies. doi:10.1016/j.carrev.2008.03.030
Preclinical evaluation of a second generation intravascular magnetic resonance imaging catheter for lipid assessment in human atherosclerotic plaques A Weiss a, E Ladach b, R Wilensky c, G Mizsei a, R Virmani b a TopSpin Medical, Lod, Israel b CVPath, Gaithersburg, MD c Hospital of the University of Pennsylvania, Philadelphia, PA, USA Objective: An intravascular magnetic imaging (IVMRI) system has been developed to assess the lipid content of atherosclerotic plaques. A secondgeneration 6-Fr compatible IVMRI catheter was designed with dual sensors for bidirectional measurement of lipid within 100 μm of the vessel lumen. We compared the IVMRI lipid fraction index (LFI—the normalized MR signal) to quantitative and gross histopathology assessments in a human ex vivo plaque model. Methods: Test samples consisted of 100 aortic lesions from 48 human cadavers. LFI was determined in each sample and results were correlated with histopathology. Samples were sectioned at 200-μm increments and stained with Oil Red O and Movat's Pentachrome. Normal smooth muscle cells, adaptive intimal thickening, and fibrous-rich lesions were identified as “nonlipidic,” while foam cells/lipid pool-rich lesions and necrotic cores were identified as “lipidic.” Results: Of the 59 lipidic lesions identified by histopathology, 49 were similarly identified by a LFI ≥0.35. Fig. 1 shows the comparison of LFI level to the histology. Based on the prospectively defined LFI cutoff of 0.35, the sensitivity, specificity, and positive predictive values for distinguishing between “nonlipidic” and “lipidic” lesions were 83%, 88%, and 91%, respectively. Conclusions: The IVMRI LFI is an effective parameter for assessing the lipid content of the vessel wall. IVMRI may provide valuable information on plaque lipid characteristics for lesion assessment and risk profiling.
Fig. 1. Comparison of LFI level to the histology. doi:10.1016/j.carrev.2008.03.031
Experience with a novel system of covering in situ Yukon Choice system in a nonselected sample JM Nogales-Asensio Sr., JR López-Mínguez, Sr., R González-Fernández, C Palanco, J Doncel, F Giménez-Saez, A Vaello-Paños, A Merchán-Herrera Sr. Hospital Infanta Cristina, Badajoz, Spain Introduction: In situ coating system developed by Translumina of the premounted Yukon stent is a novel approach in the drug-eluting stent world. It is a polymer-free stent with a micro-porous surface which enables its coating in a stent coating machine directly in the catheterization lab with the application of different drugs at individual dosages.
Objective: To analyze the clinical and angiographic behavior of this system in the real world. Methods: We analyzed the first 50 patients revascularized by this system in our catheterization lab. Two percent rapamycin was the coating drug. Results: Mean age was 65.8±8.5. Forty percent were diabetics. Seventy-six percent had acute coronary syndrome. In 10%, abciximab was used and in 68% revascularization was complete. 1.7 lesions per patient were treated (84 lesions). Seventy-eight Yukon Choice stents were implanted on 65 lesions. During follow-up (mean time: 18.7±7.4 months), two patients died (1 patient due to sudden death). Subacute occlusion occurred in one patient. Angiographic follow-up was performed in 30 patients with 41 lesions (mean time: 8.1±2.5 months after procedure). Target lesion revascularization was required in six patients (12%). Minimum diameter
Maximal length
Yukon/lesion
Late loss
2.89±0.39 mm
25.5±11.9 mm
1.2±0.56
0.35±0.59 mm
Conclusion: Although it is an unselected sample, with a superior risk profile compared to patients enlisted in habitual clinical trials, the exposed results suggest a more unfavorable behavior of this novel system with respect to classic pharmacoactive stents. doi:10.1016/j.carrev.2008.03.032
Low-viscosity contrast media result in higher flow rates and shorter injection times compared to high-viscosity contrast media in diagnostic coronary catheters MC McDaniel a, MA Nelson b, MD Voeltz a, R Fazel a, CM Devireddy a, HA Liberman a, K Mavromatis a, SV Manoukian a a Emory University, Atlanta, GA, USA b Beth Israel Deaconess Medical Center, Boston, MA, USA Background: The ability to achieve adequate flow rates of contrast media (CM) during coronary angiography is critical for vessel opacification. CM viscosity is a major determinant of flow rate. Although CM viscosities differ substantially, the impact of these differences on flow rate is unknown. We hypothesized that a low-viscosity contrast medium (LVCM) would result in higher flow rates compared to a high-viscosity contrast medium (HVCM). Methods: LVCM, ioxilan 350 mgI/ml (16.3 cPs @ 20°C), and HVCM, iodixanol 320 mgI/ml (26.6 cPs @ 20°C), were injected through diagnostic coronary catheters using a power injector set to deliver 10 ml with a pressure limit of 200 PSI. Student t test and one-way ANOVA were used to compare groups. Results: LVCM resulted in higher flow rates compared to HVCM for all catheter sizes (Pb.0001 for all). Flow rates were also higher with increasing catheter size for both CM (Pb.001 for both). Comparison of flow rates between catheter sizes revealed that HVCM required the use of a 1-Fr-size larger catheter vs. LVCM to achieve similar flow rates. See Table 1. Injection times were shorter for LVCM vs. HVCM for 4-Fr (2.35 vs. 3.80 s), 5-Fr (1.77 vs. 2.66 s), and 6-Fr (1.45 vs. 1.93 s) catheters (all Pb.0001). Conclusions: LVCM achieves up to 61% higher flow rates and shorter injection times vs. HVCM. HVCM requires the use of a larger catheter vs. LVCM to produce similar flow rates. The increase in flow rate associated with LVCM may facilitate the use of smaller catheters in coronary angiography. doi:10.1016/j.carrev.2008.03.033
Acoustic radiation force impulse ultrasound for monitoring hemostasis at femoral artery puncture, in vivo RH Behler, TC Nichols, MC Caughey, CM Gallippi University of North Carolina at Chapel Hill, Chapel Hill, NC, USA