Intravascular Ultrasound and Optical Coherence Tomography in the Procedural Planning and Execution of Left Main Coronary Artery Percutaneous Coronary Intervention

AbstractPurpose of ReviewLeft main coronary artery disease (LMCAD) is a frequently encountered, high-risk presentation of atherosclerosis, traditionally managed with surgical bypass grafting. Percutaneous coronary intervention (PCI) for LMCAD is an increasingly attractive option for patients with low to intermediate complexity disease or patients at extremely high or prohibitive surgical risk. The goal of this review is to outline the current indications and guideline recommendations regarding PCI for LMCAD and the role of intracoronary imaging in optimizing these cases.Recent FindingsSeveral recent randomized controlled trials have demonstrated the non-inferiority of PCI in LMCAD compared with CABG. Further, the use of intracoronary imaging techniques (i.e., intravascular ultrasound (IVUS) and optical coherence tomography (OCT)) has an advanced understanding of the features, both pre- and post-intervention, responsible for poor procedural outcomes and the metrics of successful PCI.SummaryPCI for LMCAD should be considered a viable option for those patients at increased surgical risk with low to intermediate lesion complexity. While not directly evaluated in LMCAD intervention, routine intracoronary imaging use and PCI optimization metrics can help to improve outcomes in LMCAD PCI procedures. Further exploration of intracoronary imaging techniques in LMCAD PCI procedures, as well as the long-term follow-up data comparing patients with LMCAD treated with PCI versus CABG, will ...
Source: Current Cardiovascular Imaging Reports - Category: Radiology Source Type: research

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CONCLUSIONS: In degenerative SVG lesions, VH-IVUS found that plaque composition was associated with clinical features, future studies need to explore the relationship between VH-IVUS defined atherosclerotic plaque components and clinical outcomes in SVGD patients undergoing PCI, an innovative prediction tool of clinical outcomes can be created. PMID: 30958438 [PubMed - in process]
Source: Chinese Medical Journal - Category: General Medicine Authors: Tags: Chin Med J (Engl) Source Type: research
We report our experience with RA for severely calcified LM-CAD. METHODS: From January 2008 to January 2017, all patients who underwent RA-assisted LM-PCI were evaluated. The study population included both protected and unprotected LM-CAD patients. Clinical characteristics and in-hospital outcomes were collected retrospectively. In-hospital outcomes included post-PCI myocardial infarction, stroke, death, emergency coronary artery bypass graft surgery, and urgent repeat PCI. Angiographic success was defined by residual stenosis
Source: The Journal of Invasive Cardiology - Category: Cardiology Tags: J Invasive Cardiol Source Type: research
CONCLUSION: Orbital atherectomy guided by intravascular imaging is feasible and safe. A large prospective randomized trial is needed to determine the clinical benefit of IVUS/OCT during PCI with orbital atherectomy. PMID: 29378972 [PubMed - in process]
Source: The Journal of Invasive Cardiology - Category: Cardiology Tags: J Invasive Cardiol Source Type: research
AbstractPurpose of ReviewWhile coronary artery bypass grafting (CABG) remains the standard of care, advances in stenting technology and procedural technique are changing the role of percutaneous coronary intervention (PCI) in the treatment of severe left main coronary artery (LMCA) disease. We review contemporary evidence comparing PCI and CABG for the treatment of severe LMCA disease, discuss optimal techniques during left main PCI, and provide guidance on studied revascularization strategies within specific patient subgroups.Recent FindingsResults from randomized control trials of patients treated with PCI or CABG for se...
Source: Current Atherosclerosis Reports - Category: Cardiology Source Type: research
Time limit: 0 Quiz-summary 0 of 20 questions completed Questions: 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 Information This test series requires login for attempting. You can login easily with your Facebook account (Use the CONNECT WITH icon on the upper part of right sidebar displaying t...
Source: Cardiophile MD - Category: Cardiology Authors: Tags: General Cardiology Source Type: blogs
ConclusionAt one year, clinical outcomes with the SYNTAX-II strategy were associated with improved clinical results compared to the PCI performed in comparable patients from the original SYNTAX-I trial. Longer term follow-up is awaited and a randomized clinical trial with contemporary CABG is IdentifierNCT02015832
Source: European Heart Journal - Category: Cardiology Source Type: research
Authors: Koide M, Kato M, Usui K, Mera K, Tsubakimoto Y, Isodono K, Sakatani T, Matsuo A, Inoue K, Fujita H Abstract The most important factor for preventing contrast-induced nephropathy (CIN) during percutaneous coronary intervention (PCI) in patients with severe renal dysfunction is to minimize the contrast volume. Herein, we report a successful case of complete revascularization after 3 separate PCI procedures using a super-low volume of contrast medium in a patient with 3-vessel disease, including two chronic total occlusions (CTOs). A 70-year-old man having exertional angina despite maximal medical therapy was...
Source: International Heart Journal - Category: Cardiology Tags: Int Heart J Source Type: research
Revascularization of significant Left Main Stem (LMS) disease improves clinical outcomes. This can be achieved through either Coronary Artery Bypass Grafting or Percutaneous coronary intervention. Defining a significant stenosis of the LMS can be challenging and debatable, as most data have been derived using angiographic assessment alone, with a threshold of 50% luminal stenosis used as a marker of functional significance. The use of adjunctive technologies like Intravascular Ultrasound and Fractional Flow Reserve has improved our ability to accurately assess the anatomical severity and physiological significance of coron...
Source: Cardiovascular Revascularization Medicine - Category: Cardiology Authors: Source Type: research
A 79-year-old male who had a history of coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) received coronary angiography (CAG), because of angina pectoris. CAG showed in-stent restenosis of the paclitaxel-eluting stent (PES). Since the devices could not pass the lesion, we performed rotational atherectomy. Although we could not identify the calcified lesion by the optical frequency domain imaging (OFDI) findings because of strong attenuation, the intravascular ultrasound (IVUS) image showed the superficial calcification.
Source: Cardiovascular Revascularization Medicine - Category: Cardiology Authors: Source Type: research
Spontaneous coronary artery pseudoaneurysm (PSA, false aneurysm) is an extremely rare occurrence with the precise incidence unknown. It is defined as an outwardly bulging monolayer or double layer within the coronary artery that lacks all 3 layers (intima, media, and adventitia) of the arterial wall. Coronary PSA commonly occurs from arterial dissection or perforation induced by catheter intervention, infection, pregnancy, or trauma. Traumatic dissection or perforation of the coronary artery after a percutaneous coronary intervention (PCI) remains the most common cause. Such cases may progress to myocardial ischemia, acute...
Source: Catheterization and Cardiovascular Interventions - Category: Cardiovascular & Thoracic Surgery Authors: Tags: Coronary Artery Disease Source Type: research
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