Plaque morphology predictors of side branch occlusion after provisional stenting in coronary bifurcation lesion: Results of optical coherence tomography bifurcation study (ORBID).

OBJECTIVES: The aim of this study was to identify the predictors of side branch (SB) ostial stenosis developed after provisional stenting of the main vessel (MV) using optical coherence tomography (OCT). BACKGROUND: Provisional stenting remains the main approach to treatment of bifurcation lesions; however, it may result in the narrowing of SB ostium. There is little information about underlying plaque morphology of the MV lesion and its potential impact on the SB after provisional stenting. METHODS: Patients with stable coronary disease with angiographic MV lesion not involving SB were included in a prospective single center study. The primary outcome was significant SB ostium stenosis (SBOS), defined as residual stenosis of >50% after MV stenting. RESULTS: Thirty bifurcation lesions in 30 patients were analyzed in the study. Poststenting significant SBOS was observed in 30% of patients. The MV lesions with SBOS > 50% were characterized by a higher prevalence of lipid rich plaques (100 vs. 64%, p = 0.040) and spotty calcifications (60 vs. 0%, p = 0.005). Maximal lipid arcs were greater (257° vs. 132°, p = 0.001) and lipid volume index was higher (1380 vs. 574, p = 0.012) in the SBOS >50% group. Multivariate logistic regression analysis identified maximal lipid arc (odds ratio (OR): 1.014, p = 0.038) and the presence of lipid plaque contralateral to SB ostium (OR: 8.14, p = 0.046) before stenting as independent predictors of significant SBOS after PCI. CONCLUSIONS: High lipid content of the MV lesion and a contralateral location of lipid in the bifurcation area may contribute to SBOS after provisional stenting. © 2016 Wiley Periodicals, Inc.

Meta-Analysis of Radial Versus Femoral Access for Percutaneous Coronary Interventions in Non-ST-Segment Elevation Acute Coronary Syndrome.

Radial access for percutaneous coronary intervention (PCI) has been shown to reduce mortality and vascular complications compared to femoral access in patients with ST-segment elevation myocardial infarction. However, efficacy and safety of radial access PCI in non-ST-segment elevation acute coronary syndrome (NSTE ACS) is not well understood. A systematic search of electronic databases was performed through July 2015 to search and identify relevant studies. We evaluated the following short-term outcomes: all-cause mortality, major bleeding, access site bleeding, and need for blood transfusions. In addition, we evaluated 1-year mortality. Studies were pooled using random effects model. Nine studies including a total of 220,126 patients (radial approach: 94,663 patients [43%], femoral approach: 125,463 patients [57%]) were included in the analysis. On pooled analysis, no significant difference in incidence of short-term all-cause mortality was found between radial and femoral access (odds ratio [OR] 0.78, 95% CI 0.57 to 1.07, p = 0.12). Radial access was associated with significant reduction in major bleeding (OR 0.52, 95% CI 0.36 to 0.73, p = 0.0002), access-site bleeding (OR 0.41, 95% CI 0.22 to 0.78, p = 0.007), and need for blood transfusions (OR 0.61, 95% CI 0.41 to 0.91, p = 0.02). Furthermore, the 1-year mortality was significantly lower in radial approach (OR 0.72, 95% CI 0.55 to 0.95, p = 0.02). In conclusion, in patients with non-ST-segment elevation acute coronary syndrome undergoing PCI, radial access is associated with decreased bleeding and access-site complications.

Live/real time three-dimensional transthoracic echocardiographic assessment of transposition of the great arteries in the adult.

We studied 11 adult patients with dextro-transposition and 5 adult patients with levo-transposition (corrected transposition) of the great arteries with real time two-dimensional (2DTTE) and live/real time three-dimensional transthoracic echocardiography (3DTTE). All patients with dextro-transposition underwent a Mustard or Senning procedure during infancy. Incremental findings provided by 3DTTE and not delineated by 2DTTE were (a) comprehensive examination of all three leaflets of the tricuspid valve including the detection and measurement of anatomic defects in the leaflets and the assessment of systolic noncoaptation and segmental prolapse; (b) en face viewing and measurement of vena contracta areas of the valvular regurgitation jets and the assessment of regurgitant volumes; (c) en face viewing of the intra-atrial baffle and localization and measurement of baffle defects as well as the measurement of vena contractas of the baffle leaks; (d) recognition of a bicuspid pulmonary valve; and (e) the quantitative assessment of left ventricular outflow tract obstruction. 3DTTE appears to be a useful noninvasive modality which could supplement 2DTTE in the comprehensive assessment of adult patients with transposition of the great arteries.

Real time/three-dimensional transthoracic echocardiographic visualization of the valve of foramen ovale.

We describe an adult patient in whom the valve of foramen ovale and its opening and closing movements were well visualized by live/real time three-dimensional transthoracic echocardiography.

Superior vena cava, right pulmonary artery or both: real time two- and three-dimensional transthoracic contrast echocardiographic identification of the echo-free space posterior to the ascending aorta.

We describe the usefulness of contrast echocardiography and live/real time three-dimensional transthoracic echocardiography in characterizing the normal structures imaged posterior to the proximal ascending aorta as superior vena cava, right pulmonary artery, or both.

Live/real time three-dimensional transthoracic echocardiographic visualization of Chiari network.

We report the usefulness of live/real time three-dimensional transthoracic echocardiography in the visualization of Chiari network.

Live/real time three-dimensional transthoracic echocardiographic identification of quadricuspid aortic valve.

We describe an adult in whom live/real time three-dimensional echocardiography was able to make a definite diagnosis of a quadricuspid aortic valve which was misdiagnosed as bicuspid by live two-dimensional transthoracic echocardiography (2DTTE).

Live/real time three-dimensional transthoracic echocardiographic assessment of tricuspid valve pathology: incremental value over the two-dimensional technique.

Twenty-nine patients with different tricuspid valve (TV) pathologies were studied by both two-dimensional transthoracic (2DTTE) and live/real time three-dimensional transthoracic echocardiography (3DTTE). A major contribution of 3DTTE over 2DTTE was the en face visualization of all three leaflets of the TV in all patients. This allowed accurate assessment of TV orifice area in patients with TV stenosis and carcinoid disease. Loss of TV leaflet tissue, defects in TV leaflets and size of TV systolic non-coaptation could also be delineated and resulted in identifying the mechanism of tricuspid regurgitation (TR) in patients with Ebstein's anomaly and rheumatic heart disease. Prolapse of TV leaflets could also be well visualized and enabled us to develop a schema for systematic assessment of individual segment prolapse which could help in surgical planning. The exact sites of chordae rupture in patients with flail TV as well as right ventricular papillary muscle rupture could be well seen by 3DTTE. 3DTTE also permitted sectioning of various TV masses for more specific diagnosis of their nature. In addition, color Doppler 3DTTE provided an estimate of quantitative evaluation of TR severity, since the exact shape and size of the vena contracta could be accurately assessed. In conclusion, our preliminary experience with 3DTTE has demonstrated substantial incremental value over 2DTTE in the assessment of various TV pathologies.

Identification of tricuspid valve vegetation by computed tomography scan.

We report a patient with disseminated sepsis in whom a large vegetation involving the tricuspid valve was seen on a routine nongated computed tomography (CT) study emphasizing the potential role of CT scan in endocarditis.