Abstract:

Introduction: one of directions in development of intravascular diagnostic methods is creation of stations or development of methods that allow combining or uniting possibilities of different modalities. This approach makes it possible to overcome limitations inherent in each method of invasive vascular diagnostics, including angiography. This work is devoted to the analysis of possibilities and first results of using the SyncVision station (Philips Volcano), which allows, in various combinations, to carry out joint registration of angiography data, intravascular ultrasound (IVUS) and instantaneous blood flow reserve (iFR) in various combinations - a non-hyperemic version of fractional flow reserve study.

Aim: was to describe possibilities provided by the use of joint recording of data from angiography, IVUS and real-time instantaneous blood flow reserve, the technique for performing these procedures, as well as to analyze the application of these methods in a department with a large volume of intravascular studies.

Material and methods: the first experience in Russian Federation of the clinical use of the SyncVision station, which is an addition to the s5i intravascular ultrasound system (Philips Volcano), is presented. The station allows you to implement five options that expand the operator's ability to analyze study data and develop a treatment strategy directly at the operating table: co-registration of angiography and intravascular ultrasound (IVUS) data; co-registration of angiography data and instantaneous flow reserve (iFR); triple co-registration - angiography, IVUS and iFR; modification of the program for the quantitative calculation of coronary artery stenosis (QCA); real-time image enhancement software for interventional devices.

Results: studies using co-registration with angiography accounted for 21% of all IVUS procedures and 62,4% of iFR procedures. In 67,3% of all studies with angio-IVUS co-registration, the indication for this diagnostic variant was an extended lesion of artery, which required clarification of length of stenotic area, localization of reference segments, and diameter of artery at different levels. In 30 of these patients, triple co-registration was performed. To clarify the hemodynamic significance of lesion with an angiographically indeterminate or borderline picture, co-registration was performed in 13,2% of all cases, to study a bifurcation lesion with a significant difference in the reference segments and angiographically difficult to determine the entry of lateral branch - in 7,3%.

Based on results of triple co-registration, the decision to perform surgical treatment was made in 30 out of 42 patients (71,4%).

Conclusion: joint registration of IVUS data, coronary angiography, and instantaneous flow reserve (iFR) in real time, forms a new diagnostic modality that significantly expands possibilities of intraoperative examination and affects the planning or analysis of intervention results.

Abstract:

Introduction: the importance of intravascular diagnostic methods and the frequency of their use in clinical practice is steadily increasing. However, in the Russian Federation, studies on the analysis of possibilities of intravascular imaging or physiology are sporadic, and statistical data are presented only in very generalized form. This makes it relevant to create a specialized register dedicated to these diagnostic methods.

Aim: was to present the structure, tasks and possibilities of the Russian registry for the use of intravascular imaging and physiology based on results of the first year of its operation.

Material and methods: In total, in 2021, forms were filled out for 2632 studies in 1356 patients.

Studies included all types of intravascular imaging and physiology - intravascular ultrasound, optical coherence tomography, measurement of fractional flow reserve and non-hyperemic indices.

The registry's web-based data platform includes 14 sections and 184 parameters to describe all possible scenarios for applying these methodologies. Data entry is possible both from a stationary computer and from mobile devices, and takes no more than one minute per study. Received material is converted into Excel format for further statistical processing.

Results: 13 departments participated in the register, while the share of the eight most active ones accounted for 97,5% of all entered forms. On average, 1.9 studies per patient were performed, with fluctuations between clinics from 1,6 to 2,9. Studies of the fractional flow reserve accounted for 40% of total data array, intravascular ultrasound - 37%, optical coherence tomography - 23%. Of all studies, 80% were performed on coronary arteries for chronic coronary artery disease, 18% - for acute coronary syndrome, 2% were studies for non-coronary pathology. In 41% of cases, studies were performed at the diagnostic stage, without subsequent surgery. In 89,6% of cases, this was due to the detection of hemodynamically insignificant lesions, mainly by means of physiological assessment. In 72% of cases, the use of intravascular imaging or physiology methods directly influenced the tactics or treatment strategy - from deciding whether to perform surgery or not to choose the optimal size of instruments or additional manipulations to optimize the outcome of the intervention. In the clinics participating in the register, the equipment of all major manufacturers represented on the Russian market was used.

Conclusions: the design of the online registry database is convenient for data entry. Participation in the registry of most departments that actively and systematically use methods of intravascular imaging and physiology ensured the representativeness of obtained data for analysis in interests of both practical medicine and industry, as well as for scientific research in the field of intravascular imaging and physiology. The register has great potential for both quantitative and qualitative improvement.

Abstract:

Aim: was to analyze long-term resuts of true lumen reconstruction in complicated aortic dissections type В with help of balloon-expandable stents under intravascular ultrasonic (IVUS) guidance as a preoperative evaluation of anatomy and morphology of lesion.

Materials and methods: 47 patients witn type В aortiс dissections underwent endovascular treatment in our departmert n 20 cases - IVUS was used for irtraoperative anatomy and morphology verification. Complications developed n 16 patients, and true lumen was reconstructed by stent-graft implantation (to cover proximal fenestration) followed by balloon-expandable stents implantation at the level of visceral arteries under IVUS control at every stage. 87,5% of patents were man, mean ago 51 8—16,2 years.

Results: Technical success was 100% True lumen total reconstruction was reached in every case under precise IVUS control. Visceral arteries malperfusion was not observed at hospital period or follow-up. З0-day mortality rate was 6,25% (1 case due to aortic rupture in uncovered part of aorta - 7 days after procedure). All 15 discharged patients survived for 1st year. Mean follow-up period is 3,3±1,6 years. One patient died due to aortobronchial fistula, 1 due to repeated stroke and 1 due to cancer. At CT-scan 2 years after implantation (10 cases) fractures of balloon-expandable stents were observed, without аnу influence on intraluminal size or stenotic lesion. True lumen size stayed stable for 1 year.

Conclusion: true lumen reconstruction under IVUS control seems to be feasible and effective in complicated Type B dissections, even with the use of balloon-expandable stents. The usage of additional intraoperative visualization - intraaortic IVUS is the key point in the development of advanced endovascular methods.

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Abstract:

The article presents a literature review of the use of optical coherence tomography in interventional cardiology. The method of optical coherence tomography is described in details, as well as its comparison with other methods of intravascular imaging. Direct results of the use of optical coherence tomography in clinical practice in the performance of percutaneous coronary intervention have been analyzed. Article describes possibilities of assessment of long-term results after interventional procedures using optical coherence tomography in patients with coronary heart disease. Article notes possibilities of using optical coherence tomography to assess the effectiveness of treatment of patients with atherosclerotic coronary pathology using biodegradable stents.

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