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 study properties of nanostructured carbon coating stents in coronary arteries with the help of intravascular ultrasonic visualization.

Materials and Methods: experimental implantation of stents in coronary artery was performed on 8 yearling sheep. Estimation of bioinertness properties of stents was made by intravascular ultrasonic method on the 14, 28, 180 day. Bioinertness properties were estimated in comparison with analogical bare-metal stents.

Results: The analysis of results showed that in early stages (up to 28 days) experimental samples of stents cause less formation of trombus than simple balloon-extendable stents. In the period of late outcomes, coronary nanostructured carbon coating stents have lower level of «in-stent stenosis».

Conclusion: stent implantation with nanostructured carbon coating does not prevent the natural reparative processes taking place in the artery wall, does not cause the formation of thrombotic masses under standard doses of antiaggregants. Experimental stents significantly less affected in-stent stenosis, than stents without surface modification, indicating their higher bioinertness. 

References

1.     Libby P., Ganz P. Restenosis revisited.- new tsrgets, new therapies. - N. Egl.S.Med. 1997; 37: 418-419.

2.     Aref'eva T.I. et. al. Uvelichenie jekspressii monocitarnyh molekul adgezii i obrazovanija monocitotrombocitarnyh agregatov v krovi pri koronarnom restenoze [Increased expression of monocyte adhesion molecules and the formation of aggregates monotsitotrombotsitarnyh blood in coronary restenosis]. Terapevticheskijarhiv. 2002; 4:46-49 [In Russ].

3.     Morice M.C. A randomized comparison of sirolimus-eluting stent with a standard stent for coronary revesculazation. N. Engl. J. Med. 2002; 346:1773-1780.

4.     Topol E.J. Artery size, neointima and remodeling time for some standards. J. Am. Coll Cardiol. 1998; 32:2087-2094.

5.     Kremneva L.V. Vospalenie kak faktor riska restenoza i serdechno-sosudistyh oslozhnenij posle chreskozhnyh intrakoronarnyh vmeshatel'stv [Inflammation as a risk factor for restenosis and cardiovascular events after percutaneous intracoronary intervention]. Terapevticheskij arhiv. 2006; 3: 89-95 [In Russ].

6.     Lazarenko O.N. Vlijanie pokrytij stentov na tromboobrazovanie i razvitie restenozov [Tekst] [Influence of coatings on the stent thrombosis and restenosis. [Text]. Prakticheskaja angiologija. 2007; 2 (7): 10-13 [In Russ].

7.     Demin V.V. Klinicheskoe rukovodstvo po vnutrisosudistomu ul'trazvukovomu issledovaniju [Clinical guidelines for intravascular ultrasound]. O. IPK JuzhnyjUral. 2005; 400 s. [In Russ].

8.     Fedorchenko AN., Osiev A.G., Kochkina T.A., Protopopov A.V. Prognozirovanie klinicheskih rezul'tatov jendovaskuljarnogo vosstanovlenija prosveta stentirovannyh koronarnyh arterij. Diagnosticheskaja i intervencionnaja radiologija [Prediction of clinical results of endovascular stented recovery lumen of the coronary arteries. Diagnostic and intewentional Radiology. 2007; 3(1): 54-65 [In Russ].

9.     Vlodaver Z., French R., Van tassel R.A. et. al. Corellation of the atamortem coronary arteriogram and the postmortem specimen. Circulation. 1973; 47:162-9.

10.   Grondin C.M., dyrda I., Pasternac A. et al. Discrepancies between cineangiographic and postmortem findings in partients with coronary artery disease and recent myocardial revascularheart diseases: comparison of ciuneangiographic and necropsy findings. Ann. Intern. Med. 1979; 91:350-6.

12.   Isner J.M., Kishel J., Kent K.M. et. al. Accuracy of angiographic determination of left main coronary arterial narrowing. Angiographic - histologic correlative analisys in 28 patients. Circulation. 1981; 63: 1056-64.

13.   Ivanov V.A., Movsesjanc M.Ju., Trunin I.V. Vnutrisosudistye metody issledovanija v intervencionnoj kardiologii [Intravascular methods of research in interventional cardiology]. Medpraktika. M. 2008; 112S. [In Russ].

14.   Nakamura S., Colombo A., Gaglione A. et al. Intracoronary ultrasound observations during stent implantations. Circulation. 1994; 89; 2026-34.

15.   Colombo A., Hall P., Nakamura S. et al. Intracoronary stenting without anticoagulation accomplished with intravascular ultrasound guidance. Circulation. 1995; 91: 1676-88.

16.   Goldberg S.L., Colombo A., Nakamura S. et al. Benefit of intracoronary ultrasound in the deployment of Palmaz - Schatz stents. J. Am. Coll. Cardiol. 1994; 24:996-1003.