- Email: [email protected]
National Heart Institute Registry of Coronary Catheter Interventions
APRIL 23e26, 2013 polymer, but different platform. Occlusion of small side branch (SB) jailed by stent is considered to be a cause of myocardial infarction after percutaneous coronary intervention. We compared the frequency of jailed small SB occlusion after stenting and clinical outcomes treated with TE and TL. Methods: From January 2011 to January 2012, 51 patients (68 year-old, 35% of female) were treated with TE (21 pts with 33 stents) or TL (30 pts with 46 stents) at our hospital. The total of 85 non-protected small SB (>0.5 and <1.5mm in diameter by visual estimation) were evaluated (34 in TE and 51 in TL). SB occlusion was defined as Thrombolysis in Myocardial Infarction flow grade 0 or 1. Results: Baseline characteristics and angiographic findings were similar between 2 groups. Small SB occlusion occurred in 0 patients in TE (0%) and 4 patients in TL (7.8%) after stenting (p¼0.15). None of patients have had cardiac death in hospital. Conclusion: TE tends to have lower incidence of SB occlusion than PL. The difference of platform, such as metal components, structures and strut thickness may be able to influence initial angiographic outcomes especially in small side branch occlusions.
- AS-057 Longitudinal Drug Eluting Stent Elongation Phenomenon after High Pressure Additional Dilatation; Insights from Bench Testing. Takenori Domei, Kisaki Amemiyaa, Tomoaki Ito, Hiroyoshi Yokoi, Masashi Iwabuchi, Masakiyo Nobuyoshi. Kokura Memorial Hospital, Kitakyusyu, Japan. Background: Stent longitudinal deformation was one of the clinical issue in percutaneous coronary intervention. The aim of this study was to evaluate how post stent dilatation with large balloon has impact on stent elongation. Methods: Four types of drug eluting stents were deployed into the model as shown Fig 1. Then, post stent dilatation was performed with four different kinds of 3.5mm balloon at nominal and rated pressure. A total of 16 stents were tested to evaluate stent elongation. Results: The stent length post stent dilatation at nominal and rated pressure was 0.40◇0.2mm and 1.04◇0.4mm, respectively. Significant difference of stent length between the three types of post stent balloons were found (Shown in Fig.2).
- AS-058 Impact of Longitudinal Stent Elongation During Percutaneous Coronary Intervention. Akihiko Matsumura. Kameda Medical Centerl, Kamogwa, Japan. Background: Longitudinal stent deformation is one of the hottest topics these days. We met stent elongation during percutaneous coronary intervention (PCI). The bench test was done to clarify the stent elongation during PCI. Methods: Case1. A 65 y/o male with history of stent implantation in the left anterior descending artery underwent PCI for in-stent restenosis. After the predilatation using 3.5 x 20 mm balloon, a 3.0 x33 mm Xience PRIME stent was deployed at 14 atm with the full coverage of previously implanted stent. Intravasucular ultrasound (IVUS) disclosed stent malapposition at the proximal part of the stent and postdilatation was performed using predilated balloon catheter at 14 atm. After postdilatation, stent got longer toward the proximal site and IVUS examinations detected stent elongation from 33.7mm to 37mm. Case2. A 71 male with significant stenosis in the right coronary artery underwent PCI. After the predilataion, a 3.5 x 24 mm TAXUS Element stent was deployed at 14 atm. IVUS examination detected stent malapposition at the proximal part of the stent and postdilatation was performed using 4.5 x 8 mm high pressure balloon at 18 atm. Final IVUS showed stent elongation 1.5mm toward the proximal site. Results: A bench test was performed to confirm the stent elongation. A 3 x 28 mm stent was deployed in a silicone phantom at 16 atm and postdilation was performed using semi-compliant balloon at 16 atm. Stent got longer more than 2 mm after postdilatation. Conclusion: Coronary stent elongation is observed in a certain situation during PCI.
- AS-154 National Heart Institute Registry of Coronary Catheter Interventions. Basem Enany1, Sameh Shaheen1, Wael Abdelshafee2, Hamdy Soliman2. 1Ainshams Univesity, Cairo, Egypt; 2National Heart Institute, Cairo, Egypt.
Conclusion: Stent elongation after post dilatation was observed in this study. Degree of stent elongation after post stent dilatation mainly depends on balloon types and pressure.
Background: Besides being tools of epidemiological research, registries have encountered new tasks in quality management as medical practice could be measured. Methods: We established an electronic database for diagnostic and interventional coronary artery procedures in National Heart Institute
The American Journal of Cardiologyâ APRIL 23e26, 2013 ANGIOPLASTY SUMMIT ABSTRACTS/Oral
25B
O R A L A B S T R A C T S
APRIL 23e26, 2013
O R A L A B S T R A C T S
cath lab in Cairo, Egypt to allow assessment of adherence to current international guidelines and comparing our patient’s outcomes with those of other national and international registries. Results: During the period from March 2008 to October 2009, 9059 Coronary artery procedures had been registered (72.8% of all coronary procedures were diagnostic coronary angiographies and 27.2% were percutaneous coronary interventions). Mean age was 51y and females were 39.9%. Femoral approach was 99% of all cases. About 15.2% of all coronary angiographies showed normal coronaries. Among PCI population, 35.3% of patients were females. Prior myocardial infarction was registered in 12.3% of patients, whereas prior stroke was registered in 0.5% of them (0.2% in non-diabetics vs. 1.2% in diabetics). The most frequently registered risk factor was smoking (63%). Hypertension was next common (57.7%). Diabetic patients had significantly higher percentage of hypertension (65.4% in diabetics vs. 50.5% in non-diabetics). About 25.3% of patients were diabetics. Hypertension and DM were more common among females. Elective procedures were 89.7% of coronary intervention procedures. The most frequently tackled native coronary artery was LAD. During this period 3109 stents were used in our cath lab. Post-Intervention stenosis had been less than 50% in 93% of intervened lesions. Post-intervention TIMI flow was three in 91.2% of intervened lesions (90.2% of intervened lesions in Diabetics vs. 92.4% in non-diabetics). Most frequently registered in-cath coronary artery complication was coronary artery dissection (2.1% of tackled lesions). No Reflow was registered in 0.7% of tackled lesions. Conclusion: It is not luxury for a cardiac cath lab to register cardiac intervention procedures especially coronary procedures being the most frequent procedures.
- AS-155 Off-hour Primary Percutaneous Coronary Angioplasty Does Not Affect Door to Balloon Time and Outcome. Mohammad Saifur Rohman, Doni Firman, Sunarya Soerianata, Nur Haryono. Harapan Kita Cardiovascular Hospital, Jakarta, Indonesia. Background: Conflicting results exist on the door to balloon and outcome of off-hour primary percutaneous coronary angioplasty (pPCI). This study therefore aims to evaluate the results of off-hours and regular-hour pPCI in Harapan Kita Cardiovascular Hospital. Methods: This study included 238 consecutive ST Elevation Myocardial Infarction (STEMI) patients treated with pPCI from January 2011 for 13 months. We examines differences in hospital events including heart failure, bleeding, arrhytmyas, contrast induced nephropathy, cerebrovascular complication and mortality among STEMI patients undergoing pPCI during regular-hour (weekdays 8:00 AM to 4.00 PM) and off-hour (weekdays 16:01 PM to 7:59 AM, weekend, holidays). Results: Overall, 185 (75.9%) patients underwent pPCI during offhour. Baseline characteristics were comparable, no difference observed between off-hour and regular-hour pPCI in door to balloon (114.3 64.4 vs. 100.5 45.3 minutes, p¼0.15) and procedure duration (41 20 vs. 45 24 minutes, p¼0.32). No statistically significant difference also observed in-hospital cardiovascular events, length of stay as well as in hospital mortality of patients treated with pPCI during off-hour or regular-hour. Conclusion: Comparable door to balloon and outcomes were observed among STEMI patients underwent pPCI during off-hour and regular-hours.
26B
- AS-217 Flexibility and Stent Fracture Potentials Against Cyclically Bending Coronary Artery Motions: Comparison Between 2-Link and 3-Link DESs. Kiyotaka Iwasaki, Sho Kishigami, Jun Arai, Takafumi Ohba, Xiaodong Zhu, Tadashi Yamamoto, Yutaka Hikichi, Mitsuo Umezu. Waseda University, Tokyo, Japan. Background: Deployment of coronary stents in cyclically bending coronary artery often provokes changes in bending angles during cardiac contraction and relaxation. Relationship between flexibility against bending motions and stent fracture has not been well understood yet. We investigated flexibility of 2-link and 3-link DESs in cyclically bending coronary artery model. Moreover, stent fracture potentials by cyclically bending angulation ranges were investigated using a novel accelerated durability tester capable of applying in-vivo simulated cyclically bending angulations. Methods: 1. Stent flexibility against bending motions Based on angiographic data of bending angles of proximal right coronary artery in end-systole and end-diastole of 63 patients, the angle data classified in type-B according to ACC/AHA guideline were used for stent flexibility tests. Based on the data that the average angles in endsystole and end-diastole were 105 and 125 , elastic coronary artery models with an angulation of 125 and an inner diameter of 3mm were manufactured. Mechanical stiffness of the coronary artery model was adjusted to that of referenced human coronary artery. The coronary artery models were cyclically bended between 105 and 125 . Promus Element PtCr stents (2-link) (30 20mm) and Xience Prime L605 CoCr stents (3-link) (30 18mm) were deployed in the transparent bending coronary artery models at each nominal balloon inflation pressure (n¼6 each). Angles at end-diastole, end-systole, and differences in the angles were analyzed using a digital microscope. 2. Stent fracture potentials by cyclically bending angulation ranges Stent fracture potentials under cyclically bending environments were investigated using the accelerated durability tester. The bending motions were exerted 1200 times per minute to the stents deployed in the coronary artery models filled with 37 C-controlled phosphate buffered saline. The durability tests were conducted under several angulation ranges. For the fracture-resistance tests, 2-link Promus Element PtCr stens and 3-link Xience L605 CoCr stents were assessed. Results: 1. Stent flexibility against bending motionsThere were distinct differences in stent flexibility against cyclic bending motions between the two DES platforms. The angles at enddiastole, end-systole, differences in end-systole and end-diastole were 116 1 , 132 1 , 16 for PtCr stent, and 136 3, 148 4 , 12 for L605 CoCr stents. Both the angles at endsystole, end-diastole, and the differences in the angles of PtCr stent were closer to those of the pre-set bending artery model. These data suggested that PtCr 2-link stents had higher flexibility at the bending lesion as compared with L605 CoCr stents. 2. Stent fracture potentials by cyclically bending angulation ranges In severer angulation ranges, 2-link PtCr stents had higher fractureresistance as compared with 3-link CoCr stents. In mild angulation ranges, both the stents had no fracture for one-year equivalent duration. Conclusion: Stent flexibility against cyclically bending motions was different between 2-link stent and 3-link stent. Angulation range was an influential factor for stent fracture. The results indicated that the 2-link stent having higher flexibility against cyclic bending motions had higher fracture-resistance against severer angulation ranges as compared with the 3-link stent.
The American Journal of Cardiologyâ APRIL 23e26, 2013 ANGIOPLASTY SUMMIT ABSTRACTS/Oral
- AS-057 Longitudinal Drug Eluting Stent Elongation Phenomenon after High Pressure Additional Dilatation; Insights from Bench Testing. Takenori Domei, Kisaki Amemiyaa, Tomoaki Ito, Hiroyoshi Yokoi, Masashi Iwabuchi, Masakiyo Nobuyoshi. Kokura Memorial Hospital, Kitakyusyu, Japan. Background: Stent longitudinal deformation was one of the clinical issue in percutaneous coronary intervention. The aim of this study was to evaluate how post stent dilatation with large balloon has impact on stent elongation. Methods: Four types of drug eluting stents were deployed into the model as shown Fig 1. Then, post stent dilatation was performed with four different kinds of 3.5mm balloon at nominal and rated pressure. A total of 16 stents were tested to evaluate stent elongation. Results: The stent length post stent dilatation at nominal and rated pressure was 0.40◇0.2mm and 1.04◇0.4mm, respectively. Significant difference of stent length between the three types of post stent balloons were found (Shown in Fig.2).
- AS-058 Impact of Longitudinal Stent Elongation During Percutaneous Coronary Intervention. Akihiko Matsumura. Kameda Medical Centerl, Kamogwa, Japan. Background: Longitudinal stent deformation is one of the hottest topics these days. We met stent elongation during percutaneous coronary intervention (PCI). The bench test was done to clarify the stent elongation during PCI. Methods: Case1. A 65 y/o male with history of stent implantation in the left anterior descending artery underwent PCI for in-stent restenosis. After the predilatation using 3.5 x 20 mm balloon, a 3.0 x33 mm Xience PRIME stent was deployed at 14 atm with the full coverage of previously implanted stent. Intravasucular ultrasound (IVUS) disclosed stent malapposition at the proximal part of the stent and postdilatation was performed using predilated balloon catheter at 14 atm. After postdilatation, stent got longer toward the proximal site and IVUS examinations detected stent elongation from 33.7mm to 37mm. Case2. A 71 male with significant stenosis in the right coronary artery underwent PCI. After the predilataion, a 3.5 x 24 mm TAXUS Element stent was deployed at 14 atm. IVUS examination detected stent malapposition at the proximal part of the stent and postdilatation was performed using 4.5 x 8 mm high pressure balloon at 18 atm. Final IVUS showed stent elongation 1.5mm toward the proximal site. Results: A bench test was performed to confirm the stent elongation. A 3 x 28 mm stent was deployed in a silicone phantom at 16 atm and postdilation was performed using semi-compliant balloon at 16 atm. Stent got longer more than 2 mm after postdilatation. Conclusion: Coronary stent elongation is observed in a certain situation during PCI.
- AS-154 National Heart Institute Registry of Coronary Catheter Interventions. Basem Enany1, Sameh Shaheen1, Wael Abdelshafee2, Hamdy Soliman2. 1Ainshams Univesity, Cairo, Egypt; 2National Heart Institute, Cairo, Egypt.
Conclusion: Stent elongation after post dilatation was observed in this study. Degree of stent elongation after post stent dilatation mainly depends on balloon types and pressure.
Background: Besides being tools of epidemiological research, registries have encountered new tasks in quality management as medical practice could be measured. Methods: We established an electronic database for diagnostic and interventional coronary artery procedures in National Heart Institute
The American Journal of Cardiologyâ APRIL 23e26, 2013 ANGIOPLASTY SUMMIT ABSTRACTS/Oral
25B
O R A L A B S T R A C T S
APRIL 23e26, 2013
O R A L A B S T R A C T S
cath lab in Cairo, Egypt to allow assessment of adherence to current international guidelines and comparing our patient’s outcomes with those of other national and international registries. Results: During the period from March 2008 to October 2009, 9059 Coronary artery procedures had been registered (72.8% of all coronary procedures were diagnostic coronary angiographies and 27.2% were percutaneous coronary interventions). Mean age was 51y and females were 39.9%. Femoral approach was 99% of all cases. About 15.2% of all coronary angiographies showed normal coronaries. Among PCI population, 35.3% of patients were females. Prior myocardial infarction was registered in 12.3% of patients, whereas prior stroke was registered in 0.5% of them (0.2% in non-diabetics vs. 1.2% in diabetics). The most frequently registered risk factor was smoking (63%). Hypertension was next common (57.7%). Diabetic patients had significantly higher percentage of hypertension (65.4% in diabetics vs. 50.5% in non-diabetics). About 25.3% of patients were diabetics. Hypertension and DM were more common among females. Elective procedures were 89.7% of coronary intervention procedures. The most frequently tackled native coronary artery was LAD. During this period 3109 stents were used in our cath lab. Post-Intervention stenosis had been less than 50% in 93% of intervened lesions. Post-intervention TIMI flow was three in 91.2% of intervened lesions (90.2% of intervened lesions in Diabetics vs. 92.4% in non-diabetics). Most frequently registered in-cath coronary artery complication was coronary artery dissection (2.1% of tackled lesions). No Reflow was registered in 0.7% of tackled lesions. Conclusion: It is not luxury for a cardiac cath lab to register cardiac intervention procedures especially coronary procedures being the most frequent procedures.
- AS-155 Off-hour Primary Percutaneous Coronary Angioplasty Does Not Affect Door to Balloon Time and Outcome. Mohammad Saifur Rohman, Doni Firman, Sunarya Soerianata, Nur Haryono. Harapan Kita Cardiovascular Hospital, Jakarta, Indonesia. Background: Conflicting results exist on the door to balloon and outcome of off-hour primary percutaneous coronary angioplasty (pPCI). This study therefore aims to evaluate the results of off-hours and regular-hour pPCI in Harapan Kita Cardiovascular Hospital. Methods: This study included 238 consecutive ST Elevation Myocardial Infarction (STEMI) patients treated with pPCI from January 2011 for 13 months. We examines differences in hospital events including heart failure, bleeding, arrhytmyas, contrast induced nephropathy, cerebrovascular complication and mortality among STEMI patients undergoing pPCI during regular-hour (weekdays 8:00 AM to 4.00 PM) and off-hour (weekdays 16:01 PM to 7:59 AM, weekend, holidays). Results: Overall, 185 (75.9%) patients underwent pPCI during offhour. Baseline characteristics were comparable, no difference observed between off-hour and regular-hour pPCI in door to balloon (114.3 64.4 vs. 100.5 45.3 minutes, p¼0.15) and procedure duration (41 20 vs. 45 24 minutes, p¼0.32). No statistically significant difference also observed in-hospital cardiovascular events, length of stay as well as in hospital mortality of patients treated with pPCI during off-hour or regular-hour. Conclusion: Comparable door to balloon and outcomes were observed among STEMI patients underwent pPCI during off-hour and regular-hours.
26B
- AS-217 Flexibility and Stent Fracture Potentials Against Cyclically Bending Coronary Artery Motions: Comparison Between 2-Link and 3-Link DESs. Kiyotaka Iwasaki, Sho Kishigami, Jun Arai, Takafumi Ohba, Xiaodong Zhu, Tadashi Yamamoto, Yutaka Hikichi, Mitsuo Umezu. Waseda University, Tokyo, Japan. Background: Deployment of coronary stents in cyclically bending coronary artery often provokes changes in bending angles during cardiac contraction and relaxation. Relationship between flexibility against bending motions and stent fracture has not been well understood yet. We investigated flexibility of 2-link and 3-link DESs in cyclically bending coronary artery model. Moreover, stent fracture potentials by cyclically bending angulation ranges were investigated using a novel accelerated durability tester capable of applying in-vivo simulated cyclically bending angulations. Methods: 1. Stent flexibility against bending motions Based on angiographic data of bending angles of proximal right coronary artery in end-systole and end-diastole of 63 patients, the angle data classified in type-B according to ACC/AHA guideline were used for stent flexibility tests. Based on the data that the average angles in endsystole and end-diastole were 105 and 125 , elastic coronary artery models with an angulation of 125 and an inner diameter of 3mm were manufactured. Mechanical stiffness of the coronary artery model was adjusted to that of referenced human coronary artery. The coronary artery models were cyclically bended between 105 and 125 . Promus Element PtCr stents (2-link) (30 20mm) and Xience Prime L605 CoCr stents (3-link) (30 18mm) were deployed in the transparent bending coronary artery models at each nominal balloon inflation pressure (n¼6 each). Angles at end-diastole, end-systole, and differences in the angles were analyzed using a digital microscope. 2. Stent fracture potentials by cyclically bending angulation ranges Stent fracture potentials under cyclically bending environments were investigated using the accelerated durability tester. The bending motions were exerted 1200 times per minute to the stents deployed in the coronary artery models filled with 37 C-controlled phosphate buffered saline. The durability tests were conducted under several angulation ranges. For the fracture-resistance tests, 2-link Promus Element PtCr stens and 3-link Xience L605 CoCr stents were assessed. Results: 1. Stent flexibility against bending motionsThere were distinct differences in stent flexibility against cyclic bending motions between the two DES platforms. The angles at enddiastole, end-systole, differences in end-systole and end-diastole were 116 1 , 132 1 , 16 for PtCr stent, and 136 3, 148 4 , 12 for L605 CoCr stents. Both the angles at endsystole, end-diastole, and the differences in the angles of PtCr stent were closer to those of the pre-set bending artery model. These data suggested that PtCr 2-link stents had higher flexibility at the bending lesion as compared with L605 CoCr stents. 2. Stent fracture potentials by cyclically bending angulation ranges In severer angulation ranges, 2-link PtCr stents had higher fractureresistance as compared with 3-link CoCr stents. In mild angulation ranges, both the stents had no fracture for one-year equivalent duration. Conclusion: Stent flexibility against cyclically bending motions was different between 2-link stent and 3-link stent. Angulation range was an influential factor for stent fracture. The results indicated that the 2-link stent having higher flexibility against cyclic bending motions had higher fracture-resistance against severer angulation ranges as compared with the 3-link stent.
The American Journal of Cardiologyâ APRIL 23e26, 2013 ANGIOPLASTY SUMMIT ABSTRACTS/Oral