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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: Introduction: development of intravascular diagnostic methods has significantly increased the amount of information in the study of various vessels in comparison with standard angiography. Technological and software improvement of optical coherence tomography (OCT) allows expanding diagnostic capabilities and providing greater convenience for analyzing of results of this method of intravascular examination, which leads to an increase in its importance both for daily clinical practice and in scientific research. Aim: was to describe the methodology of performing a new modification of OCT and to analyze accumulated experience, advantages and possibilities provided by this method. Material and methods: the modern version of the complex for optical coherence tomography OPTIS allows to implement such new features as automatic indication of malapposition of stents, easy-to-perceive three-dimensional image of examination data in various versions, joint presentation (co-registration) of angiography and OCT data in real time. The first experience of clinical use of this system in the Russian Federation is presented, with an analysis of priority indications for the use of new possibilities. Using the angio-OCT-co-registration function, 309 studies of 205 arteries in 178 patients were performed, which accounted for 63,3% of all OCT procedures performed in our department. Results: priority indications for the use of the method were identified, which primarily include: cases of extended stenoses with an uncertainty in the hemodynamic significance of individual sections or the entire lesion as a whole; difficulties in constructing an optimal projection of the angiogram (without overlapping branches and significant shortening of the target area); bifurcation lesions; diagnostics of thrombus, dissections, plaque ruptures, severe calcification, including in acute coronary syndrome; selection of the optimal size of biodegradable scaffold and preparation of the artery for its implantation; intermediate or final control of results of coronary artery stenting. The use of co-registration of angiography and OCT contributes to a more accurate determination of the area of interest during repeated studies, which is especially important for the dynamic assessment of the patient's condition and for scientific research. Conclusions: the development and modernization of optical coherence tomography causes an increase in its importance both in daily clinical practice and in scientific research. The possibility of spatial co-registration of OCT data with angiographic images, as well as new options for automatic processing of resulting images, including stent apposition assessment, significantly increase the operator's ability to quickly and accurately analyze examination data directly at the operating table. References 1. Demin VV. Clinical guide to intravascular ultrasound. Orenburg. Yuzhnyj Ural. 2005: 400 [In Russ]. 2. Raber L, Mintz GS, Koskinas KC, et al. Clinical use of intracoronary imaging. Part 1: guidance and optimization of coronary interventions. An expert consensus document of the European Association of Percutaneous Cardiovascular Interventions. EuroIntervention. 2018; 14: 656-677. https://doi.org/10.4244/EIJY18M06_011 3. Johnson TW, Raber L, di Mario C, et al. Clinical use of intracoronary imaging. Part 2: guidance and optimization of coronary interventions. An expert consensus document of the European Association of Percutaneous Cardiovascular Interventions. EuroIntervention. 2019; 15: 434-451. https://doi.org/10.4244/EIJY19M06_02 4. Van der Sijde JN, Guagliumi G, Sirbu V, et al. The OPTIS Integrated System: real-time, co-registration of angiography and optical coherence tomography. EuroIntervention. 2016; 12: 855-860. https://doi.org/10.4244/EIJV12I7A140 5. Karanasos A, Van der Sijde JN, Ligthart J, et al. Utility of Optical Coherence Tomography Imaging with Angiographic Co-registration for the Guidance of Percutaneous Coronary Intervention. Radcliffe Cardiology.com. 2015. [Internet source] 6. Demin VV, Demin DV, Seroshtanov EV, et al. Clinical issues of optical coherence tomography for coronary diagnosis. International Journal of Interventional Cardioangilogy. 2016; 44: 34-48 [In Russ]. 7. Ermolaev PA, Khramykh TP, Vyaltsin AS. Use of optical coherence tomography for intermediate coronary artery lesions. Circulation Pathology and Cardiac Surgery. 2019; 23(3): 47-56 [In Russ]. https://doi.org/10.21688/1681-3472-2019-3-47-56 8. Onuma Y, Okamura T, Muramatsu T, et al. New implication of three-dimensional optical coherence tomography in optimising bifurcation PCI. EuroIntervention. 2015; 11: 71-74. https://doi.org/10.4244/EIJV11SVA15 9. Alegr?a-Barrero E, Foin N, Chan PH, et al. Optical coherence tomography for guidance of distal cell recrossing in bifurcation stenting: choosing the right cell matters. EuroIntervention. 2012; 8: 205-213. https://doi.org/10.4244/EIJV8I2A34 10. Tyczynski P, Ferrante G, Kukreja N, et al. Optical coherence tomography assessment of a new dedicated bifurcation stent. EuroIntervention. 2009; 5: 544-551. https://doi.org/10.4244/EIJV5I5A89 11. Souteyrand G, Amabile N, Combaret N, et al. Invasive management without stents in selected acute coronary syndrome patients with a large thrombus burden: a prospective study of optical coherence tomography guided treatment decisions. EuroIntervention. 2015; 11: 895-904. https://doi.org/10.4244/EIJY14M07_18 12. Souteyrand G, Arbustini E, Motreff P, et al. Serial optical coherence tomography imaging of ACS-causing culprit plaques. EuroIntervention. 2015; 11: 319-324. https://doi.org/10.4244/EIJV11I3A59 13. Mustafina IA, Pavlov VN, Ishmetov VSh, et al. Identification of plaque morphology in acute coronary syndrome by optical coherence tomography. Bashkortostan Medical Journal. 2017; 12; 4(70): 27-32 [In Russ]. 14. Allahwala UK, Cockburn JA, Shaw E, et al. Clinical utility of optical coherence tomography (OCT) in the optimisation of Absorb bioresorbable vascular scaffold deployment during percutaneous coronary intervention. EuroIntervention. 2015; 10: 1154-1159. https://doi.org/10.4244/EIJV10I10A190 15. Shugushev ZK, Maksimkin DA, Vorob'eva YuS, et al. Results of biodegradable vascular endoprotheses implantation in ischemic heart disease patients with type 2 diabetes. Russian Journal of Cardiology. 2016; 9(137): 19-24 [In Russ]. https://doi.org/10.15829/1560-4071-2016-9-19-24 16. R?ber L, Radu MD. Optimising cardiovascular outcomes using optical coherence tomography-guided percutaneous coronary interventions. EuroIntervention. 2012; 8: 765-771. https://doi.org/10.4244/EIJV8I7A118 17. Tanigawa J, Barlis P, Dimopoulos K, et al. Optical coherence tomography to assess malapposition in overlapping drug-eluting stents. EuroIntervention. 2008; 3(5): 580-583. https://doi.org/10.4244/EIJV3I5A104 18. Radu M, J?rgensen E, Kelb?k H, et al. Optical coherence tomography at follow-up after percutaneous coronary intervention: relationship between procedural dissections, stent strut malapposition and stent healing. EuroIntervention. 2011; 7: 353-361. https://doi.org/10.4244/EIJV7I3A60 19. Trusov IS, Nifontov EM, Biryukov AV, et al. The use of optical coherence tomography imaging of the vascular wall of the coronary arteries before and after stenting. Regional blood circulation and microcirculation. 2019; 18(1): 77-85 [In Russ]. https://doi.org/10.24884/1682-6655-2019-18-1-77-85 20. Demin VV, Galin PYu, Demin DV, et al. The comparison of intravascular ultrasound guided and angiography guided implantation of drug-eluting stents: The randomized trial ORENBURG. Part 1: Study design, direct clinical results. Diagnostic & Interventional Radiology. 2015; 9(3): 31-43 [In Russ]. 21. Demin VV, Murzajkina MM, Galin PYu, et al. Comparison between implantation of drug-eluting stents under control of intravascular ultrasound and angiography: The randomized trial ORENBURG. Part 2: The data of angiography and intravascular methods of visualization. Diagnostic & Interventional Radiology. 2016; 10(2): 31-47 [In Russ]. 22. Demin VV, Gusev SD, Murzaykina MM, et al. Immediate and early results of a clinical trial comparing different strategies of drug-eluting stents implantation under IVUS and angiographic guidance. International Journal of Interventional Cardioangilogy. 2016; 44: 49-59 [In Russ]. 23. Demin VV, Demin AV, Demin DV, et al. The drug-eluting balloons for coronary arterial restenosis: 7-year experience. International Journal of Interventional Cardioangilogy. 2016; 44: 59-71 [In Russ].
Abstract: Aim: was to optimize treatment of patients with acute myocardial infarction without significant stenotic lesions of coronary arteries. Materials and methods: authors present a clinical case of treatment of patient, who was admitted in few hours from onset of myocardial infarction. At first-stage, patient underwent manual vacuum thrombectomy, and it revealed the absence of significant stenotic lesions of coronary arteries. Patient underwent coronary angiography, left ventriculography, optical-coherence tomography of the infarct-dependent artery Results: in this clinical case the cause of myocardial infarction in patient without significant stenotic coronary lesions was the presence of intramural fibrecalcific plaque without signs of instability Conclusions: according to authors, in order to reduce the incidence of re-thrombosis of coronary arteries in patients with myocardial infarction without stenotic lesions of coronary arteries, it is recommended to perform optical-coherence tomography to reveal unstable atherosclerotic plaque; in such cases it may be warranted stenting of coronary artery. References 1. Sidel'nikov A.V., Chernysheva I.E., Koledinskij A.G.. Sravnitel'nyj analiz ehffektivnosti primeneniya tromboliticheskih preparatov: poisk prodolzhaetsya [Comparative analysis of efficacy of thrombolytic therapy: further search]. Mezhdunarodnyj zhurnal intervencionnoj kardioangiologii. 2014, 39:48-56 [In Russ]. 2. Chandrasekaran B., Kurbaan A. S. Myocardial infarction with angiographically normal coronary arteries. Journal of Royal Society of Medicine. 2002 Aug; 95(8): 398-400. 3. Reynolds H. R. Myocardial infarction without obstructive coronary artery disease. Current Opinion in Cardiology. 2012, 27:655-660. 4. Widimsky P., Stellova B., Groch L. et al. Prevalence of normal coronary angiography in the acute phase of suspected ST-elevation myocardial infarction: Experience from the PRAGUE studies; on behalf of the PRAGUE Study Group Investigators. Can J Cardiol. 2006; 22(13): 1147-1152. 5. Da Costa A., Isaaz K., Faure E. et al. Clinical characteristics, aetiological factors and long-term prognosis of myocardial infarction with an absolutely normal coronary angiogram; a 3-year follow-up study of 91 patients. Eur Heart J. 2001; 22(16): 1459-1465. 6. Jamil G., Jamil M., Abbas A. et al. «Lone aspiration thrombectomy» without stenting in young patients with ST elevation myocardial infarction - Am J Cardiovasc Dis. 2013; 3(2):71-78. 7. Escaned J, Echavarrna-Pinto M, Gorgadze T et al. Safety of lone thrombus aspiration without concomitant coronary stenting in selected patients with acute myocardial infarction. EuroIntervention. 2013;8: 1149-1156. 8. Talarico G. P., Burzotta F., Trani C. et al. Thrombus Aspiration without Additional Ballooning or Stenting to Treat Selected Patients with ST-Elevation Myocardial Infarction. J Invasive Cardiol. 2010; 22(10): 489-492. 9. Berger J.S., Elliott L., Gallup D. et al. Sex differences in mortality following acute coronary syndromes. JAMA. 2009; 302(8): 874-882. 10. Dey S., Flather M.D., Devlin G. et al. Sex-related differences in the presentation, treatment and outcomes among patients with acute coronary syndromes: the Global Registry of Acute Coronary Events. Heart. 2009; 95(1): 20-26. 11. Roger V.L., Go A.S., Lloyd-Jones D.M. et al. Heart disease and stroke statistics - 2012 update: a report from the American Heart Association. Circulation. 2012; 125:e2-e220. 12. Glagov S., Weisenberg E., Zarins C. et al. Compensatory enlargement of human atherosclerotic coronary arteries. N Engl J Med. 1987; 316: 1371-1375. 13. Bentzon J. F., Otsuka F., Virmani R., Falk E. Mechanisms of Plaque Formation and Rupture. Circ Res. 2014; 114: 1852-1866. 14. Shmatkov M.G., Morozova E.V. Opticheskaya kogerentnaya tomografiya: novye vozmozhnosti vnutrisosudistoj vizualizacii (obzor literatury) [Optical cpherence tomography: new possibilities of intravascular imaging (literature review)]. Diagnosticheskaya i intervencionnaya radiologiya, 2013, 7(4): 89-100 [In Russ] . 15. Virmani R., Burke A.P., Farb A., Kolodgie F.D. Pathology of the vulnerable plaque. J Am Coll Cardiol. 2006; 47: 13-18. 16. Dhume A.S., Soundararajan K., Hunter W.J. III, Agrawal D.K. Comparison of vascular smooth muscle cell apoptosis and fibrous cap morphology in symptomatic and asymptomatic carotid artery disease. Ann Vasc Surg 2003; 17:1-8. 17. Burke A.P, Farb A., Malcom G.T. et al. Coronary risk factors and plaque morphology in men with coronary disease who died suddenly. N Engl J Med. 1997; 336: 1276-1282. 18. Lam M. K., Sen H., Tandjung K. et al. Clinical Outcome of Patients With Implantation of Second-Generation Drug-Eluting Stents in the Right Coronary Ostium: Insights From 2-Year Follow-up of the TWENTE Trial/ Catheterization and Cardiovascular Interventions 2015; 85:524-531.
Abstract: Article describes a case report of successful treatment of coronary artery perforation using handmade stent-graft, ex tempore made of coronary balloon and two bare-metal stents. Article also reports results of follow-up, including control angiography and optical coherence tomography 3 months later. References 1. Ellis S.G., Ajluni S., Arnold A.Z., Popma J.J., Bittl J.A., Eigler N.L. et al. Increased coronary perforation in the new device era. Incidence, classification, management, and outcome. Circulation. 1994; 90(6):2725-30. 2. Shirakabe A., Takano H., Nakamura S., Kikuchi A., Sasaki A., Yamamoto E. et al. Coronary perforation during percutaneous coronary intervention. Int Heart J. 2007; 48(1):1-9. 3. Lansky A.J., Yang YM., Khan Y, Costa R.A., Pietras C., Tsuchiya Y et al. Treatment of coronary artery perforations complicating percutaneous coronary intervention with a polytetrafluoroethylene-covered stent graft. Am J Cardiol. 2006; 98(3): 370-4. 4. Sarli B., Baktir A.O., Saglam H., Kurtul S., Dogan Y., Aring H. Successful Treatment of Coronary Artery Perforation with Hand-Made Covered Stent. Erciyes Med J. 2013; 35(3):164-6 • DOI: 10.5152/etd.2013.20. 5. Copeland K.A., Hopkins J.T., Weintraub W.S., Rahman E. Long-term follow-up of polytetrafluoroethylene-covered stents implanted during percutaneous coronary intervention for management of acute coronary perforation. Catheter Cardiovasc Interv. 2012; 80(1):53-7.
Abstract: Aim: was to compare endothelialization of stents with permanent and biodegradable coatings at an early stage with help of optical coherence tomography (OCT). Materials and methods: this study is a prospective, randomized trial that includes a comparative analysis of OCT data in patients after implantation of coronary stents with biodegradable (study group) and permanent coatings (control group). 98 patients were randomized 1:1 into 2 groups. After 3 months, 10 patients from each group - were randomized to conduct OCT. Results: we analyzed OCT data of 10 studies in the biodegradable group (1,776 struts and 247 sections) and 10 studies in the permanent coating group (1562 struts and 226 sections). There were no differences in proportion of uncovered (8,9% vs. 8,5%, p=0,49) and non-exposed struts (1,6% vs. 1,3%, p=0,2). Thus, 98,4% of struts in study group and 98.7% in control group were endothelialized. Conclusions: according to OCT data, similar results were obtained in both groups. After 3 months of observation in two groups, the overwhelming number of struts were endothelialized. At the early stage of observation, none of groups, achievement of endpoints was detected. References 1. Mauri L., Kereiakes D., Yeh R. et al. Twelve or 30 Months of Dual Antiplatelet Therapy after Drug-Eluting Stents. N Engl J Med. 2014; 371:2155-2166. 2. Authors/Task Force members , Windecker S., Kolh P., et al. ESC/EACTS Guidelines on myocardial revascularization: The Task Force on Myocardial Revascularization of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS) Developed with the special contribution of the European Association of Percutaneous Cardiovascular Interventions (EAPCI). Eur Heart J. 2014;35:2541-619. 3. Kim S., Kim J.S., Shin D.H., et al. Comparison of early strut coverage between zotarolimus- and everolimus-eluting stents using optical coherence tomography. Am J Cardiol. 2013;111:1-5. 4. Izumi D., Miyahara M., Sakai M., Fukuoka S. OCT- based comparison of early strut coverage between zotarolimus- and everolimus-eluting stents with second stent designs. Eurointervention. 2014;5;20. 5. Ormiston J., Webster M., Stewart J. et al. First-inHuman Evaluation of a Bioabsorbable Polymer-Coated Sirolimus-Eluting Stent. JACC: Cardiovasc int 2013; 6(10): 1026-1034. 6. Karjalainen P, Varho V., Nammas W. et al. Early Neointimal Coverage and Vasodilator Response Following Biodegradable Polymer Sirolimus-Eluting vs. Durable Polymer Zotarolimus-Eluting Stents in Patients With Acute Coronary Syndrome. Circulation Journal .2015;79(2): 360-367.
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. References: 1. Hiram G. Bezerra., Marco A. Costa., Guagliuni G. et al. Intracoronary Optical Coherence Tomography: A Comprehencive Review: Clinical and Research Applications. J.Am.Col. Cardiol. 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Incomplete Stent Apposition And Delayed Tissue Coverage Are More Frequent In Drug Eluting Stents Implanted During Primary Percutaneous Coronary Intervention For ST Elevation Myocardial Infarction Than In Drug Eluting Stents Implanted For Stable/Unstable Angina. Insights from Optical Coherence Tomography. Cardiovasc Interv. 2009; 2(5): 445-52. 23. Gonzalo N., Serruys P.W. Optical coherence tomography (OCT) in secondary revascularisation: stent and graft assessment. Euro.Intervention. 2009; 5: D93-D100. 24. Tanigawa J., Barlis P., Dimopoulos K., Di Mario. Optical coherence tomography to assess malapposition in overlapping drug-eluting stents. EuroInterv. 2008; 3: 580-583. 25. Gonzalo N., Garcia-Garcia H.M., Serruys P.W. et al. Reproducibility of quantitative per strut stent analysis with OCT. EuroIntervention. 2009; 5(2): 224-32. 26. Gonzalo N., Serruys P.W., Okamura T. et al. Optical Coherence Tomography Assessment Of The Acute E?ects Of Stent Implantation On The Vessel Wall. 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