The Virtual histology in CaroTids Observational RegistrY (VICTORY) study: A European prospective registry to assess the feasibility and safety of intravascular ultrasound and virtual histology during carotid interventions
Sangiorgi G.,University of Rome Tor Vergata |
Bedogni F.,Istituto Clinico santAmbrogio |
Sganzerla P.,Clinica Humanitas Gavazzeni |
Binetti G.,Ospedale S. Salvatore |
And 8 more authors.
International Journal of Cardiology | Year: 2013
Background Carotid occlusive disease is the most common determinant of thromboembolic stroke. However, limited insights in vivo into the pathophysiology and pathology of carotid plaques are available. We designed a prospective multicenter registry to appraise the safety and feasibility of intravascular ultrasound (IVUS) and IVUS-virtual histology (IVUS-VH) imaging before and immediately after carotid stenting. Methods Symptomatic and asymptomatic patients scheduled for carotid stenting were included. IVUS-VH pullbacks were performed before and after stenting. Angiographic, IVUS and IVUS-VH analyses were performed. The primary objective was to appraise feasibility and safety of IVUS-VH, and secondary objectives were to correlate plaque composition and plaque type derived from IVUS-VH with acute and 30-day complications. Results A total of 119 patients were enrolled. IVUS-VH could be performed in all cases (100%), with additional runs after completion of the stenting procedure in 85%. Most plaques were stable by IVUS-VH, with vulnerable ones at minimum lumen area in 7%. Conversely, vulnerable plaques were significantly more common elsewhere in the internal carotid artery (ICA, 24% of patients, p < 0.001). Acute and 30-day adverse events were uncommon (2 strokes, 1 transient ischemic attack), with no significant association between these and IVUS-VH features. Conclusions IVUS and IVUS-VH examinations during carotid interventions are feasible and safe, and provide important insights on qualitative and quantitative compositions of carotid plaques. Whether carotid IVUS-VH can predict clinical events remains uncertain, awaiting long-term follow-up of the VICTORY study and additional clinical trials. © 2013 Elsevier Ireland Ltd. All rights reserved.
Virtual histology-intravascular ultrasound assessment of lesion coverage after angiographically-guided stent implantation in patients with ST elevation myocardial infarction undergoing primary percutaneous coronary intervention
Legutko J.,Jagiellonian University |
Jakala J.,Jagiellonian University |
Mintz G.S.,Cardiovascular Research Foundation |
Wizimirski M.,Jagiellonian University |
And 8 more authors.
American Journal of Cardiology | Year: 2012
An occlusion or severe stenosis (angiographic culprit lesion) of the infarct-related artery is frequently located at the site of the maximum thrombus burden, whereas the origin of the plaque rupture (the true culprit) can be situated proximal or distal to it. The aim of this study was to examine stent coverage of true culprit lesions in 20 patients who underwent primary percutaneous coronary intervention and had Thrombolysis In Myocardial Infarction (TIMI) grade 3 flow restored in the infarct-related artery by angiographically guided direct stenting. Images of lesions were obtained using virtual histology-intravascular ultrasound before and after intervention (blinded to the operator). Plaque rupture sites were identified by intravascular ultrasound in 12 lesions (60%), 11 proximal and 1 distal to the minimum luminal area (MLA). Maximum necrotic core sites were found proximal to the MLA in 16 lesions, at the MLA in 3 lesions, and distal to the MLA in 1 lesion. Plaque rupture sites were fully covered by stents in 11 lesions. Virtual histology-intravascular ultrasound-derived thin-cap fibroatheroma longitudinal geographic misses were found in 10 lesions, 7 in the proximal reference segment and in 3 patients in the proximal and distal reference segments. In conclusion, in about 50% of patients who undergo primary percutaneous coronary intervention for ST-segment elevation myocardial infarction with optimal angiographic results, the stent does not fully cover the maximum necrotic core site related to the culprit lesion. © 2012 Elsevier Inc.
Siudak Z.,Jagiellonian University |
Mielecki W.,Jagiellonian University |
Dziewierz A.,Jagiellonian University |
Rakowski T.,Jagiellonian University |
And 5 more authors.
Catheterization and Cardiovascular Interventions | Year: 2015
Background: Current STEMI guidelines recommend thrombectomy should be considered during primary PCI. Multiple data from randomized clinical trials, registries, and metanalysis have confirmed the efficacy of thrombectomy in terms of surrogate endpoints like better myocardial perfusion, less pronounced distal embolization, and conflicting results on lower all-cause mortality. Our aim was to analyze long-term outcome of STEMI patients treated with manual thrombectomy during primary PCI in a contemporary national registry. Methods: There were 13 catheterization laboratories in Poland that enrolled patients in NRDES Registry. Patients were divided into two groups: those that were treated with manual thrombectomy for their primary PCI vs. those who were not. Results: There were altogether 2,686 patients enrolled in the NRDES Registry of whom 1,763 were diagnosed with STEMI (66%). Aspiration thrombectomy was used in 673 of these cases (38%) and 1,090 (62%) patients were treated without thrombectomy during the index primary PCI. Overall mortality at 1 year was 11.03% in thrombectomy and 7.46% in no thrombectomy group respectively (P = 0.0292 which became insignificant after propensity score matching adjustment P = 0.613). Specific subgroup analyses revealed that there was no benefit from aspiration thrombectomy in neither subgroup. Conclusions: Manual aspiration thrombectomy in patients undergoing primary PCI for STEMI was not associated with improved long-term 1-year clinical outcome. Subgroup analysis did not reveal any specific setting in which thrombectomy would be clinically superior. © 2014 Wiley Periodicals, Inc.
Siudut J.,Cracow Center for Medical Research and Technologies |
Grela M.,Jagiellonian University |
Wypasek E.,Jagiellonian University |
Wypasek E.,Innovative Laboratory Diagnostic Center |
And 3 more authors.
Journal of Thrombosis and Haemostasis | Year: 2016
Background: The postthrombotic syndrome (PTS) is a severe complication of deep vein thrombosis (DVT). Reduced plasma clot permeability and lysability have been linked to DVT and residual vein obstruction. Objectives: We investigated whether altered fibrin clot properties are associated with the occurrence of PTS. Patients and Methods: Plasma fibrin clot permeability (Ks) and lysability were investigated in a cohort of 197 consecutive patients aged 18 to 65 years recruited 3 months following the first-ever DVT. Patients with severe thrombophilia or comorbidities known to adversely affect clot phenotype were ineligible. Results: During a 1-year follow-up PTS developed in 48 (24%) patients, who were characterized by lower Ks, prolonged fibrin clot lysis time (CLT) and slower release of D-dimer from clots (D-Drate), together with higher plasma D-dimer, C-reactive protein and thrombin-activatable fibrinolysis inhibitor (TAFI). No PTS-associated differences in fibrinogen, thrombin generation, factor VIII, other fibrinolysis proteins and the quality of anticoagulation were observed. Ks (r = -0.71), CLT (r = 0.45), D-Drate (r = -0.30) and TAFI activity (r = 0.38) were associated with the Villalta scale (all P < 0.05). Recurrent VTE occurred also more commonly in PTS patients during follow-up and the 26 (13.2%) patients had lower Ks, longer CLT and lower D-Drate (all P < 0.05). A multivariate model adjusted for age, body mass index, fibrinogen and glucose showed that independent predictors of PTS were idiopathic DVT, plasma D-dimer, Ks, D-Drate, tissue plasminogen activator and TAFI activity. Conclusions: This study demonstrates that formation of more compact fibrin clots displaying impaired susceptibility to lysis predisposes to PTS. © 2016 International Society on Thrombosis and Haemostasis.
Rzeszutko L.,Jagiellonian University |
Siudak Z.,Jagiellonian University |
Wlodarczak A.,Miedziowe Centrum Zdrowia S.A. |
Lekston A.,University of Silesia |
And 9 more authors.
Kardiologia Polska | Year: 2014
Background: Current revascularisation guidelines recommend coronary stenting with either a bare metal stent or a drug eluting stent. The results of bioresorbable vascular scaffold (BVS) implantation in the setting of both stable angina and acute coronary syndrome (ACS) have proven to be both safe and efficacious. Aim: To describe current use and real life experience among Polish percutaneous coronary intervention (PCI) operators in using BVS since they were made commercially available on our market. Methods: We performed a one-arm retrospective observational registry study which enrolled patients in 30 invasive cardiology centres in Poland who had their PCI procedure performed between October 2012 and November 2013. All patients who received at least one BVS stent during index PCI were included in the registry. There were no additional inclusion or exclusion criteria. Results: There were 591 patients enrolled in the registry in 30 centres in Poland. Of these, 48% were with stable angina (CCS I-III) and 52% with ACS (23% unstable angina, 18% NSTEMI and 11% STEMI). Radial access for PCI was used in 70% of cases. Left anterior descending was the target lesion in 48% of patients and predilatation used in 90%. PCI complications occurred very rarely with dissection in 2.9% of patients, slow-flow in 0.5%, no-reflow in 0.17%, and side branch occlusion in 0.33%. Technical success, defined as successful BVS delivery to the lesion, was achieved in all cases (100%). There were no periprocedural deaths. Conclusions: The early in-hospital results of this large scale national registry of 'real world' utilisation of BVS in Poland present excellent device performance in a properly selected group of patients with appropriate lesion preparation. Copyright © Polskie Towarzystwo Kardiologiczne.