The impact of statin-ezetimibe combination therapy versus statin monotherapy on coronary plaque regression in patients with acute coronary syndrome: a meta-analysis.

OBJECTIVE: To investigate the effects of statin monotherapy and statin-ezetimibe combination therapy on coronary plaque regression in acute coronary syndrome patients. METHODS: The systematic review was conducted from July to September 2022 and comprised search on PubMed, ScienceDirect and Cochrane databases to identify studies from January 2010 to July 2022 assessing the effects of statin-ezetimibe combination therapy versus statin monotherapy on coronary plaque regression in patients with acute coronary syndrome. The outcomes of interest were total atheroma volume, plaque volume, and percent atheroma volume assessed by intravascular ultrasound. Meta-analyses were performed on the studies, and mean differences with 95% confidence interval were estimated using Review Manager v5.4. RESULTS: Of the 730 studies identified, 12(1.64%) were shortlisted, and, of them, 5(41.7%) were analysed in detail. There were a total of 557 patients with a mean follow-up of 9 ± 2.43 months. The difference between baseline and follow-up showed significant lowering in total atheroma volume, plaque volume, and percent atheroma volume (p<0.05) in the patients who were receiving statin-ezetimibe combination therapy. CONCLUSIONS: Adding ezetimibe to statin medication was found to be significantly more successful in reducing coronary plaque than statin monotherapy.

Discordance Between Angiographic Assessment and Fractional Flow Reserve or Intravascular Ultrasound in Intermediate Coronary Lesions: A Post-hoc Analysis of the FLAVOUR Trial.

BACKGROUND AND OBJECTIVES: Angiographic assessment of coronary stenosis severity using quantitative coronary angiography (QCA) is often inconsistent with that based on fractional flow reserve (FFR) or intravascular ultrasound (IVUS). We investigated the incidence of discrepancies between QCA and FFR or IVUS, and the outcomes of FFR- and IVUS-guided strategies in discordant coronary lesions. METHODS: This study was a post-hoc analysis of the FLAVOUR study. We used a QCA-derived diameter stenosis (DS) of 60% or greater, the highest tertile, to classify coronary lesions as concordant or discordant with FFR or IVUS criteria for percutaneous coronary intervention (PCI). The patient-oriented composite outcome (POCO) was defined as a composite of death, myocardial infarction, or revascularization at 24 months. RESULTS: The discordance rate between QCA and FFR or IVUS was 30.2% (n=551). The QCA-FFR discordance rate was numerically lower than the QCA-IVUS discordance rate (28.2% vs. 32.4%, p=0.050). In 200 patients with ≥60% DS, PCI was deferred according to negative FFR (n=141) and negative IVUS (n=59) (15.3% vs. 6.5%, p<0.001). The POCO incidence was comparable between the FFR- and IVUS-guided deferral strategies (5.9% vs. 3.4%, p=0.479). Conversely, 351 patients with DS <60% underwent PCI according to positive FFR (n=118) and positive IVUS (n=233) (12.8% vs. 25.9%, p<0.001). FFR- and IVUS-guided PCI did not differ in the incidence of POCO (9.5% vs. 6.5%, p=0.294). CONCLUSIONS: The proportion of QCA-FFR or IVUS discordance was approximately one third for intermediate coronary lesions. FFR- or IVUS-guided strategies for these lesions were comparable with respect to POCO at 24 months. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT02673424.

Use of Ultrasound-Assisted, Catheter-Directed Thrombolysis in a Patient With High-Risk Pulmonary Embolism.

High-risk pulmonary embolism (PE) is a complex clinical entity associated with high mortality rates. Ultrasound-assisted, catheter-directed thrombolysis, typically used for intermediate-risk PE, may be a viable treatment approach for high-risk PE, particularly in patients at increased risk for major bleeding. This report describes a case in which ultrasound-assisted, catheter-directed thrombolysis was successfully used to treat high-risk PE in a female patient with extensive peritoneal metastases from gastric adenocarcinoma. Other examples from the literature, in which ultrasound-assisted, catheter-directed thrombolysis was used to treat high-risk PE, are also provided.

Effect of statins combined with PCSK9 inhibitors on coronary atheromatous plaque assessed by intravascular imaging: a Meta-analysis / 中国基层医药

Objective:To evaluate the effect of statins combined with PCSK9 inhibitors on coronary artery atherosclerotic plaque, as well as to verify the lipid-lowering effect of the combined therapy.Methods:A computerized search of PubMed, Embase, Web of Science, Cochrane Library, Wanfang, and CNKI databases was conducted to retrieve published literature from inception to December 20, 2022. The English search terms utilized included "PCSK9 inhibitors," "Alirocumab," "Evolocumab," "plaque," "IVUS," and "OCT." The corresponding Chinese search terms were "PCSK9 inhibitors," "plateau," "intravascular ultrasound," and "optical coherence tomography." The literature that examined the effect of statins alone or in combination with PCSK9 inhibitors on coronary atherosclerotic plaques using intravascular ultrasound or optical coherence tomography was identified. The collected data were subsequently processed using Review Manager (Revman) version 5.4.Results:In the final analysis, nine studies involving 1912 patients were included. The analysis results revealed that compared with statins alone, statins combined with PCSK9 inhibitors significantly reduced the percentage of atherosclerotic volume ( MD: -2.08 mm 3, 95% CI: -2.94 to -1.23 mm 3, P < 0.001), accelerated the regression of atherosclerotic volume ( MD: -1.13 mm 3, 95% CI: -1.49 to -0.77 mm 3, P < 0.001), slightly, but not significantly, reduced the overall atherosclerotic volume ( MD: -6.42 mm 3, 95% CI: -14.34-1.51 mm 3, P = 0.110). Nevertheless, the combined therapy contributed to a significant reduction in atherosclerotic volume ( MD: -5.16 mm 3, 95% CI: -7.09 to -3.23 mm 3, P < 0.001) and significantly increased the fiber cap thickness of thin cap plaques ( MD: 8.46 μm, 95% CI: 5.13-11.79 μm, P < 0.001). Additionally, this combined therapy significantly lowered blood lipid levels. Conclusion:The combination of statins and PCSK9 inhibitors can significantly improve the characteristics and phenotype of atherosclerotic plaques and significantly reduce blood lipid levels. For patients with high cardiovascular risk, it is recommended to initiate treatment with statins combined with PCSK9 inhibitors as soon as possible and maintain it for a long time to ensure more benefits.

Laparoscopic ultrasound combined with CT three-dimensional reconstruction for guiding laparoscopic hepatectomy / 中国医学影像技术

Objective To observe the value of laparoscopic ultrasound(LUS)combined with CT three-dimensional reconstruction for guiding laparoscopic hepatectomy(LH).Methods Data of 78 hepatocellular carcinoma(HCC)patients who underwent LH were retrospectively analyzed.The patients were divided into observation group(n=46)or control group(n=32)based on whether underwent preoperative CT three-dimensional reconstruction and LUS.Clinical data,perioperative data and prognosis were compared between groups.Results No significant difference of clinical data was found(all P＞0.05),whereas significant differences of tumor body mainly location,resection method,tumor resection margin,surgical operation time,intraoperative blood loss,postoperative hospital stay,postoperative complication grading and incidence were found between groups(all P＜0.05).During follow-up period,15 patients died in observation group and 14 died in control group.Significant difference of disease-free survival rate was detected between groups(x2=4.210,P=0.040).Conclusion LUS combined with CT three-dimensional reconstruction for guiding LH could reduce intraoperative injury and complication incidence,improving disease-free survival rate of HCC patients.

Optical Coherence Tomography-Guided or Intravascular Ultrasound-Guided Percutaneous Coronary Intervention: The OCTIVUS Randomized Clinical Trial.

BACKGROUND: Intravascular imaging-guided percutaneous coronary intervention (PCI) with intravascular ultrasound (IVUS) or optical coherence tomography (OCT) showed superior clinical outcomes compared with angiography-guided PCI. However, the comparative effectiveness of OCT-guided and IVUS-guided PCI regarding clinical outcomes is unknown. METHODS: In this prospective, multicenter, open-label, pragmatic trial, we randomly assigned 2008 patients with significant coronary artery lesions undergoing PCI in a 1:1 ratio to undergo either an OCT-guided or IVUS-guided PCI. The primary end point was a composite of death from cardiac causes, target vessel-related myocardial infarction, or ischemia-driven target-vessel revascularization at 1 year, which was powered for noninferiority of the OCT group compared with the IVUS group. Safety outcomes were also assessed. RESULTS: At 1 year, primary end point events occurred in 25 of 1005 patients (Kaplan-Meier estimate, 2.5%) in the OCT group and in 31 of 1003 patients (Kaplan-Meier estimate, 3.1%) in the IVUS group (absolute difference, -0.6 percentage points; upper boundary of one-sided 97.5% CI, 0.97 percentage points; P<0.001 for noninferiority). The incidence of contrast-induced nephropathy was similar (14 patients [1.4%] in the OCT group versus 15 patients [1.5%] in the IVUS group; P=0.85). The incidence of major procedural complications was lower in the OCT group than in the IVUS group (22 [2.2%] versus 37 [3.7%]; P=0.047), although imaging procedure-related complications were not observed. CONCLUSIONS: In patients with significant coronary artery lesions, OCT-guided PCI was noninferior to IVUS-guided PCI with respect to the incidence of a composite of death from cardiac causes, target vessel-related myocardial infarction, or ischemia-driven target-vessel revascularization at 1 year. The selected study population and lower-than-expected event rates should be considered in interpreting the trial. REGISTRATION: URL: https://www. CLINICALTRIALS: gov; Unique number: NCT03394079.

Ultrasound-Guided WALANT Technique in Carpal Tunnel Decompression Surgery.

Carpal tunnel syndrome (CTS) is the most common compressive neuropathy in the human body. Its symptoms result from compression of the median nerve in the carpus. The treatment can be conservative, with medications and/or infiltrations that alleviate the symptoms, or surgical, which is more effective, with decompression of the median nerve by surgical section of the flexor retinaculum of the carpus. The anesthetic technique varies according to the anesthesia method: sedation, venous locoregional anesthesia and, more recently, wide-awake local anesthesia no tourniquet (WALANT), which can be performed by the surgeons themselves. The WALANT technique uses local anesthesia with a vasoconstrictor, and does not require the use of a tourniquet on the upper limb nor sedation. The median nerve block in ultrasound-guided WALANT provides better accuracy to the technique, with greater patient safety; in the present article, its use in the performance of carpal tunnel decompression is described, and the literature is reviewed.

Investigation of the existence of and a block technique for the inferior lateral genicular nerve: cadaveric study.

Background: Among the four genicular nerves innervating the anterior aspect of the knee, the inferior lateral genicular nerve has been omitted as a target of blocking. Some authors have suggested that the inferior lateral genicular nerve of the knee might pass beneath the lateral collateral ligament of knee. The authors aimed to study the location of the inferior lateral genicular nerve and the spread of injectate during the inferior lateral genicular nerve block. Methods: In ten knees from fresh frozen cadavers, the authors performed on each an ultrasound-guided block of the inferior lateral genicular nerve of the knee just below the lateral collateral ligament. The needle was inserted below the lateral collateral ligament, and 2 mL of blue dye was injected. A week later, the cadavers were dissected, and the existence of the inferior lateral genicular nerve and the spread of dye around it was investigated. Results: The proportion of inferior lateral genicular nerves branching from the common peroneal nerve was found in 8 of 10 (80.0%) cadavers. Of these eight cadavers with inferior lateral genicular nerve, five specimens (62.5%) were stained with blue dye. The common peroneal nerve was not infiltrated with dye in any specimens. Conclusions: When 2 mL of dye was inserted inferiorly to the lateral collateral ligament, the inferior lateral genicular nerve could be blocked in 62.5% of specimens. Because the common peroneal nerve was not involved in any specimen, motor weakness would be avoided with this method.

Ultrasound-Guided WALANT Technique in Carpal Tunnel Decompression Surgery* / Técnica WALANT guiada por ultrassom na cirurgia de descompressão do túnel do carpo

Abstract Carpal tunnel syndrome (CTS) is the most common compressive neuropathy in the human body. Its symptoms result from compression of the median nerve in the carpus. The treatment can be conservative, with medications and/or infiltrations that alleviate the symptoms, or surgical, which is more effective, with decompression of the median nerve by surgical section of the flexor retinaculum of the carpus. The anesthetic technique varies according to the anesthesia method: sedation, venous locoregional anesthesia and, more recently, wide-awake local anesthesia no tourniquet (WALANT), which can be performed by the surgeons themselves. The WALANT technique uses local anesthesia with a vasoconstrictor, and does not require the use of a tourniquet on the upper limb nor sedation. The median nerve block in ultrasound-guided WALANT provides better accuracy to the technique, with greater patient safety; in the present article, its use in the performance of carpal tunnel decompression is described, and the literature is reviewed.

Resumo A síndrome do túnel do carpo (STC) é a neuropatía compressiva mais comum do corpo humano. Seus sintomas decorrem da compressão do nervo mediano no carpo. O tratamento pode ser incruento, com medicações e/ou infiltrações que amenizam os sintomas, ou cruento, mais eficaz, com a descompressão do nervo mediano pela seção cirúrgicadoretináculodos flexores do carpo. A técnica anestésica varia de acordo com o serviço de anestesia: sedação, anestesia locorregional venosa e, mais recentemente, a anestesia local com o paciente acordado e sem torniquete (wide-awake local anesthesia no tourniquet, WALANT), que pode ser realizada pelo próprio cirurgião. Por utilizar anestesia local com vasoconstritor, essa técnica dispensa o uso de torniquete no membro superior e a necessidade de sedação. O bloqueio do nervo mediano na WALANT guiada por ultrassonografiaconfere melhor precisão àtécnica,e mais segurança ao paciente, e, neste artigo seu uso na realização da descompressão do túnel do carpo é descrito, e a literatura, revisada.

Use of point of care ultrasound (POCUS) by intensive care paramedics to achieve peripheral intravenous access in patients predicted to be difficult: An out-of-hospital pilot study.

INTRODUCTION: Intravenous cannulation is a common procedure for paramedics. Difficulty is often encountered and may result in escalation of care to an intensive care paramedic (ICP). Ultrasound-guided peripheral intravenous access (USGPIVA) is used in-hospital as an alternative approach. Historically limited to physicians, it is increasingly embraced by non-physicians, with point of care ultrasound (POCUS) devices more affordable, portable, and suited to the out of hospital environment. OBJECTIVE: To explore the utility of ICP-performed USGPIVA for patients who are predicted to be difficult according to a difficult intravenous access scoring tool. METHODS: This was a prospective observational pilot study of ICPs who used the adult difficult intravenous access (A-DIVA) scale to predict difficulty and perform USGPIVA using a contemporary POCUS device. RESULTS: For the 32 patients enroled, the overall success rate was 50% of which 87% were successful on the first attempt. Mean A-DIVA score was 4.1/5, and paradoxically, success improved with A-DIVA-predicted difficulty. CONCLUSION: ICPs can perform USGPIVA with moderate success. The A-DIVA score could be useful for paramedics to predict difficult cannulation. Future research should focus on increasing exposure, training time and enhancing feedback to paramedics performing USGPIVA.

Clinical application of water-filling with "four-eyes" sign under the guidance of ultrasound in nasal-jejunum intubation for critical patients / 中国实用护理杂志

Objective:To evaluate the clinical application of water-filling with "four-eyes" sign under the guidance of ultrasound in nasal-jejunum intubation for critical patients.Methods:This study was a randomized controlled trial. Eighty patients who needed indwelling nasobenteric tube were selected from June 2021 to April 2022 in the Department of Critical Care Medicine, Xiangya Hospital, Central South University. They were divided into control group ( n=40) and experimental group ( n=40) by systemic randomization. For the patients in the experimental group, the intubation was performed by water-filling with "four-eyes" sign under the guidance of ultrasound. For the control group, the traditional method was applicated under the guidance of ultrasound. Using abdominal X-ray as the gold standard of successful pylorus posterior catheterization, the result of catheterization, time of operation, efficiency of positioning in the two groups were analyzed and compared. Results:In the experimental group, 38 cases were successfully intubated, 2 were failed; in the control group, 27 cases were successfully intubated, 13 were failed, and all the failed cases in the control group were then successfully intubated again by using method of the experimental group. The success rate of tube placement in the experimental group was 95.0% (38/40), which was higher than 67.5% (27/40) in the control group ( χ2 = 9.93, P<0.05). The average time of operation in the experimental group was (45.2 ± 14.2) min, which was significantly lower than (70.2 ± 17.7) min in the control group, the difference was significantly different ( t=-5.51, P<0.05). The specificity, sensitivity, positive predictive value, negative predictive value and diagnostic rate of nasal-jejunum intubation positioning in the experimental group were 100.0% respectively, higher than 38.4%, 77.7%, 72.4%, 45.4%, 65.0% in the control group; the false positive rate, false negative rate in the experimental group were both 0, lower than 22.2%, 61.5% in the control group, with statistically significant differences( χ2 values were 4.69- 16.97, all P<0.05). Conclusions:Water-filling with "four-eyes" sign under the guidance of ultrasound in nasal-jejunum intubation was a new method which can shorten the operation time and increase the success rate for intubation. It has relatively high positioning accuracy and possess valuable clinical application.

Microvascular perfusion characteristics of breast cancer by contrast-enhanced ultrasound and its comparison with pathology / 中国医师进修杂志

Objective:To study the characteristics of tumor microvascular perfusion by contrast-enhanced ultrasound (CEUS) in patients with breast cancer, and to analyze its relationship with pathology.Methods:The clinical data of 180 breast cancer patients admitted to Tangshan People′s Hospital from February 2019 to March 2021 were retrospectively analyzed. They were examined by contrast-enhanced ultrasound before surgery, and the specimens were sent for pathological biopsy after surgery. The characteristics of tumor microvascular perfusion under CEUS were observed, and the correlation between the characteristics and pathological classification and grade were analyzed.Results:The results of the CEUS showed that the contrast agentrapid infusion was 47.78%(86/180), slowly filled was 60.00%(108/180), the mass showed hyperenhancement when the contrast agent reached its peak was 42.78%(77/180), the contrast agent slowly withdrew was 42.78% (77/180), and the contrast agent retention in clearance was 65.56% (118/180). Pathological biopsy revealed that among 180 patients, 16 patients (8.89%) were non-invasive carcinoma, 41 patients (22.78%) were invasive lobular carcinoma, 88 patients (48.89%) were invasive ductal carcinoma, 10 patients (5.56%) were mucinous adenocarcinoma, 11 patients (6.11%) were medullary carcinoma, 8 patients (4.44%) were squamous carcinoma, 6 patients (3.33%) were hard carcinoma (3.33%). There was no correlation between tumor microvascular perfusion characteristics and pathological classification under CEUS ( P>0.05). Pathological biopsy showed that 95 patients (52.78%) were grade Ⅰ, 49 patients (27.22%) were gradeⅡand 36 patients (20.00%) were grad Ⅲ. There was a certain correlation between tumor microvascular perfusion characteristics and pathological grade under CEUS ( P<0.05). Conclusions:There is a certain relationship between tumor microvascular perfusion characteristics detected by CEUS and pathological grading in patients with breast cancer. Analysis of the microvascular perfusion characteristics can provide an important basis for pathological grading.

Effect of ultrasound-guided stellate ganglion block on cerebral oxygen metabolism and S100B protein during carotid endarterectomy / 国际脑血管病杂志

Objective:To investigate the effect of ultrasound-guided stellate ganglion block (SGB) on cerebral oxygen metabolism and serum S100B protein during carotid endarterectomy (CEA).Methods:Patients aged 40-75 years old, classified as Grade Ⅱ-Ⅲ by the American Society of Anesthesiologists (ASA), and underwent elective CEA under general anesthesia at the Affiliated Suzhou Hospital of Nanjing Medical University from June 2021 to April 2023 were prospectively enrolled. They were randomly divided into an SGB group and a control group. Before anesthesia induction, the SGB group underwent ipsilateral SGB under the ultrasound guidance, while the control group did not undergo SGB. The right subclavian vein catheterization was performed under the ultrasound guidance during the general anesthesia. The mean arterial pressure (MAP) and heart rate (HR) were recorded before induction of general anesthesia (T0), during tracheal intubation (T1), before vascular occlusion (T2), after vascular opening (T3), and at the end of surgery (T4), as well as the pressure of the jugular vein bulb at each time point from T1 to T4. Arterial blood and jugular venous bulb blood were collected at various time points for blood gas analysis. Jugular venous bulb oxygen saturation (SjvO 2), arteriovenous oxygen content difference (AVDO 2), cerebral oxygen extraction rate (COER), lactate production rate (LPR) and lactate oxygen index (LOI) were calculated. The serum S100B concentration in the jugular vein bulb blood at various time points was detected with enzyme-linked immunosorbent assay. The incidence of postoperative hoarseness, hematoma, dizziness, diaphragmatic nerve block, nausea, and vomiting were recorded. Results:A total of 82 patients conducted CEA were included, with 41 patients in the SGB group and 41 in the control group. During anesthesia induction and surgery in the SGB group, HR was significantly lower than that in the control group, and the MAP and HR during tracheal intubation and at the beginning of surgery were also more stable than those in the control group (all P<0.05). In the SGB group, the changes in SjvO 2, AVDO 2, and COER were relatively smaller from T1 to T3, while SjvO 2 increased, and AVDO 2 and CEOR decreased at T4. In contrast, the control group showed a decrease in SjvO 2, AVDO 2, and COER at T3 and a slight increase at T4. At all time points, SjvO 2 in the SGB group was significantly higher than that in the control group ( P<0.05). AVDO 2 and COER in both groups gradually decreased over time, and the control group was significantly higher than the SGB group at all time points (all P<0.05). LPR and LOI increased at T1 to T4 in both groups, reaching their highest value at T3 and decreasing at T4. There was statistically significant difference at T4 and at T2 in the control group (all P<0.05). The LPR and LOI of the control group were significantly higher than those of the SGB group at all time points (all P<0.05). In addition, the serum S100B levels in both groups increased first and then decreased, but the T2-T4 levels in the SGB group were significantly lower than those in the control group at all time points (all P<0.05). The incidence of perioperative adverse events in the SGB group was significantly lower than that in the control group ( P<0.05). Conclusion:Performing ipsilateral SGB before CEA surgery can effectively inhibit stress response, maintain intraoperative hemodynamic stability, improve brain tissue oxygen supply, and have a certain neuroprotective effect.

Value of vascular ultrasound examination in the diagnosis of subclavian artery stenosis combined with vertebral artery stenosis / 中国基层医药

Objective:To investigate the effectiveness of vascular ultrasound examination in the diagnosis of subclavian artery stenosis (ASA) combined with vertebral artery stenosis (VSA) and its effects on different types of steal syndrome.Methods:Seventy patients with ASA combined with VSA who received treatment in Zhuji People's Hospital from February 2018 to May 2022 were included in this study. All patients underwent digital subtraction angiography (DSA) and a vascular ultrasound examination. Taking the DSA examination results as the reference standard, the accuracy of vascular ultrasound examination in the classification of ASA and VSA and its consistency with the DSA diagnosis results were evaluated. The detection rate of subclavian artery steal was compared between DSA and vascular ultrasound examination was compared. The correlation between the degree of ASA and the severity of subclavian artery steal was analyzed.Results:The accuracy of vascular ultrasound examination in the diagnosis of different degrees of ASA was 84.62% (11/13), 89.66% (26/29), 95.24% (20/21), and 100.00% (7/7), respectively. The Kappa value, indicating the consistency of vascular ultrasound examination and DSA restults in the diagnosis of ASA, was 0.858 ( P < 0.05). There was a significant difference in the type of subclavian artery steal among patients with different degrees of ASA ( χ2 = 50.71, P < 0.01). The severity of subclavian artery steal was highly positively correlated with the severity of ASA ( r = 0.71, P < 0.001). Conclusion:Vascular ultrasound examination has high diagnostic accuracy for different degrees of ASA and VSA, has high consistency with DSA results, and can increase the detection rate of subclavian artery steal. Vascular ultrasound examination has certain advantages in the early screening and condition monitoring of ASA, VSA, and subclavian artery steal.

Thermal Ablation Therapy for Breast Cancer / 中国医学影像学杂志

Breast cancer is the most common malignancy of women in China.It seriously affects the quality of life of patients.With the progress of medical technology,minimally invasive treatment has gradually become an important part of breast cancer management.Thermal ablation technology has been proved to have great potential in the treatment of breast cancer.Compared with surgery,it has similar therapeutic effect and more safer.Targeted ablation of breast cancer is expected to become a new treatment mode under the integration of diagnosis and treatment.This article reviews the current status and development trend of thermal ablation therapy for breast cancer.

Ultrassonografia intravascular para guiar a intervenção coronária percutânea: resultados do registro nacional português / Intravascular ultrasound in percutaneous coronary intervention guidance: results from Portuguese registry

Introdução: As diretrizes atuais recomendam o uso da ultrassonografia intravascular de coronárias como ferramenta adjuvante em situações difíceis. Objetivo: Caracterizar a utilização da ultrassonografia intravascular em Portugal e comparar os desfechos após intervenção coronária percutânea no tronco da coronária esquerda, guiada ou não por ultrassonografia intravascular. Métodos: Estudo observacional retrospectivo multicêntrico, que analisou pacientes submetidos à intervenção coronária percutânea entre janeiro de 2012 e dezembro de 2018, incluídos no Portuguese Registry on Interventional Cardiology da Sociedade Portuguesa de Cardiologia. Valor de p bicaudal <0,05 foi considerado estatisticamente significativo. Resultados: Este estudo demonstrou variação significativa na utilização da ultrassonografia intravascular em Portugal (valor de p qui-quadrado para tendência <0,001). O ano com maior utilização foi 2016 (2,4%). Houve aumento progressivo, nos últimos 7 anos, na utilização da ultrassonografia intravascular na intervenção coronária percutânea do tronco da coronária esquerda (valor de p qui-quadrado para tendência <0,001), com importantes diferenças regionais. A população submetida à intervenção coronária percutânea do tronco da coronária esquerda guiada por ultrassonografia intravascular era mais jovem, mas tinha maior prevalência de fatores de risco cardiovascular, disfunção sistólica ventricular e lesões coronárias complexas. Além disso, esse grupo de pacientes teve menor prevalência do desfecho primário intra-hospitalar (1,4% versus 3,9%; p=0,024). Porém, após análise multivariada ajustada para fatores de confusão, este estudo não demonstrou impacto significativo da utilização da ultrassonografia intravascular no desfecho intra-hospitalar. Conclusão: A utilização da ultrassonografia intravascular na intervenção coronária percutânea do tronco da coronária esquerda vem aumentando lentamente nos últimos 7 anos em Portugal. Neste estudo, a utilização desse método não teve impacto estatístico nos desfechos intra-hospitalares.

Background: Current guidelines recommend the use of coronary intravascular ultrasound as an adjunctive tool in challenging situations. Objective: To characterize the use of intravascular ultrasound in Portugal and compare outcomes after left main percutaneous coronary intervention, with or without intravascular ultrasound. Methods: A retrospective multicentric observational study analyzed patients who underwent percutaneous coronary intervention between January 2012 and December 2018 and were included in the Portuguese Registry on Interventional Cardiology of the Sociedade Portuguesa de Cardiologia. A two-sided p-value<0.05 was considered statistically significant. Results: This study revealed significant variation of intravascular ultrasound usage in Portugal over time (p-value Chi-squared for trend <0.001). The year with maximum use was 2016 (2.4%). Regarding left main percutaneous coronary intervention, there was a progressive increase in use of intravascular ultrasound (p-value Chi-squared for trend<0.001) in the last 7 years, with important regional differences. The population submitted to left main percutaneous coronary intervention with intravascular ultrasound was younger, but had a higher prevalence of some cardiovascular risk factors, ventricular systolic dysfunction, and complex coronary lesions. Moreover, this group of patients had lower prevalence of intrahospital primary endpoint (1.4% versus 3.9%; p=0.024). However, after multivariate analysis adjusted to confounding factors, this study did not demonstrate a significant impact of intravascular ultrasound on intrahospital endpoint. Conclusion: The overall use of intravascular ultrasound in left main percutaneous coronary intervention has been slowly increasing in the last seven years, in Portugal. In this study, the use of this method had no statistical impact in intrahospital endpoints.

Artery-first microwave ablation in the treatment of benign thyroid nodules.

BACKGROUND: Microwave ablation (MWA) is a safe and effective procedure for the treatment of benign thyroid nodules. The MWA causes progressive nodule shrinkage as well as the improvement of the symptoms and cosmesis. Some basic techniques have been described to further increase the efficacy and safety of this procedure. OBJECTIVES: To evaluate the efficacy of artery-first MWA as an advanced technique in the treatment of benign thyroid nodules. MATERIAL AND METHODS: A total of 40 patients treated with MWA were enrolled in the study. Nineteen patients who underwent artery-first MWA were selected for the study group and 21 patients who underwent MWA alone were included in the control group. Nodular vascularization was assessed using a new Doppler technique (Superb Microvascular Imaging (SMI)) and characterized using a 3-point scale. All patients were evaluated in terms of volume, symptoms, cosmetic scores, and laboratory findings before the procedure as well as 3 months (early-term follow-up) and 6 months (intermediate-term follow-up) after the procedure. RESULTS: Both groups were comparable with respect to the baseline volume (p = 0.135). Nevertheless, the nodular volume reduction rate was significantly different at 3-month follow-up (study group: 56.97 ±11.39%, control group: 47.07 ±7.93%; p = 0.003) and 6-month follow-up (study group: 78.38 ±8.91%, control group: 69.54 ±9.41%; p = 0.004). In both groups, cosmetic and symptom scores decreased progressively (p < 0.005) and there were no major complications. Thyroid hormones and antibodies were within normal limits before the procedure, and no significant change was observed during follow-up after the ablation. CONCLUSIONS: The artery-first MWA technique can be used in the treatment of benign thyroid nodules as a method of increasing the effectiveness of MWA.