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BACKGROUND: Intermediate coronary lesions (ICLs) are highly prevalent but ported mixed prognosis. Radial strain has been associated with plaque vulnerability, yet its role in predicting lesion progression is largely unknown. The purpose of this study was to determine the predictive value of angiography-derived radial wall strain (RWS) for progression of untreated non-culprit ICLs. METHODS: Post-hoc analysis was conducted in a study cohort including 603 consecutive patients with 808 ICLs identified at index procedure with angiographic follow-up of up to two years. RWS analysis was performed on selected angiographic frames with minimal foreshortening and vessel overlap. Lesion progression was defined as ≥ 20% increase in percent diameter stenosis. RESULTS: Lesion progression occurred in 49 ICLs (6.1%) with a median follow-up period of 16.8 months. Maximal RWS (RWS(max)), frequently located at the proximal and throat plaque regions, distinguished progressive ICLs from silent ones. The largest area under the curve value of 0.75 (95% CI: 0.67–0.82, P < 0.001) was reached at the optimal RWS(max) cutoff value of > 12.6%. According to this threshold, 178 ICLs were classified as having a high strain pattern. Exposure to a high strain amplitude with RWS(max) > 12.6% was independently associated with an increased risk of lesion progression (adjusted HR = 6.82, 95% CI: 3.67–12.66, P < 0.001). CONCLUSIONS: Assessment of RWS from coronary angiography is feasible and provides independent prognostic value in patients with untreated ICLs.

Supplemental Digital Content is available in the text, Background: In patients with complex true coronary bifurcation lesions (CBLs), Crush or Culotte stenting has been the commonest approaches of percutaneous coronary intervention (PCI). However, the optimal one remains in debate. Methods: A systematic review and meta-analysis of cohort studies searched from PubMed, EMBASE, Cochrane Central Register of Controlled Trials (CENTRAL), Chinese National Knowledge Infrastructure (CNKI), VIP information database, and WangFang Data Information Site, to compare the long-term safety and efficacy of PCI with Crush versus Culotte in patients with CBLs. The primary end point was target lesion revascularization (TLR) and secondary end points were a composite of major adverse cardiac events (MACE) including cardiac death (CD), myocardial infarction (MI), stent thrombosis (ST), and target vessel revascularization (TVR) by PCI or bypass surgery, and each individual component at long-term follow-up. Furthermore, omitting each study in turn was used to sensitivity analysis for high heterogeneity of studies. Results: A total of 7 studies were included to perform a meta-analysis, 3 randomized trials and 4 observational studies with 2211 patients, 1281 treated with Crush and 930 with Culotte. There was no significant difference in TLR and MACE between Crush and Culotte [RR 0.76, 95% CI (0.48–1.23), I2 = 57%; RR 0.78, 95% CI (0.47–1.29), I2 = 83%, respectively]. ST tended to be lower in patients treated with Crush [RR 0.61, 95% CI (0.37–1.01), I2 = 23%]. CD and MI were comparable between the 2 groups [RR 0.80, 95% CI (0.43–1.49), I2 = 0%; RR 0.74, 95% CI (0.49–1.13), I2 = 32%, respectively]. TVR was also associated with the similar risk [RR 0.76, 95% CI (0.49–1.16), I2 = 60%]. However, high heterogeneity was detected for TLR, MACE, and TVR, and the source of heterogeneity was DKCRUSH-III study by Chen, SL. Conclusions: In the treatment of coronary bifurcation lesions, TLR and MACE were not significant difference between the Crush and Culotte groups, but TLR and MACE were also regarded as high heterogeneity mainly due to better outcomes achieved by DK Crush and there was a trend toward lower ST in the Crush group. Crush, particularly DK Crush, may be superior to conventional Culotte for treatment of CBLs. PROSPERO registration number: CRD42018111868.

Transfemoral and perventricular device occlusions are performed for doubly committed subarterial ventricular septal defect (dcVSD) to reduce the invasiveness of the conventional surgical repair through a median sternotomy. Few comparative studies have been conducted of these three procedures.Inpatients with isolated dcVSD who had undergone transfemoral and perventricular device occlusions or conventional surgical repair from January 2009 to June 2013 were reviewed to compare the three procedures.Procedure success was achieved in 33 transfemoral (66%), in 74 perventricular (94.9%), and in 205 repair (97.6%) procedures. The transfemoral group had the lowest success rate (p0.001), whereas the perventricular and repair groups had similar success rates (p = 0.418). Transfemoral patients were the oldest (p0.001) and had a dcVSD size similar to that of patients in other two groups (p = 0.518). The repair group required the longest hospitalization and longest stays in the intensive care unit (p0.001), required the longest operating room and mechanical ventilation times (p0.001), and had the highest rate of transfusion (p0.001). Major adverse events occurred in one transfemoral (3%), in two perventricular (2.7%), and in three repair (1.4%) procedures. Minor adverse events were absent in transfemoral (0%) and occurred in three perventricular (4%) and 14 repair (6.7%) procedures. No significant difference was noted in the rates of adverse events the three groups (p = 0.569). No grade 3 valvular regurgitation or complete atrioventricular block was observed in the studied patients.Device occlusion may be an alternative to surgical repair in selected patients with dcVSD. Perventricular occlusion was the preferred approach because it showed a higher success rate than transfemoral occlusion.

ObjectivesThe present study established criteria to differentiate simple from complex bifurcation lesions and compared 1-year outcomes stratified by lesion complexity after provisional stenting (PS) and 2-stent techniques using drug-eluting stents.BackgroundCurrently, no criterion can distinguish between simple and complex coronary bifurcation lesions. Comparisons of PS and 2-stent strategies stratified by lesion complexity have also not been reported previously.MethodsCriteria of bifurcation complexity in 1,500 patients were externally tested in another 3,660 true bifurcation lesions after placement of drug-eluting stents. The primary endpoint was the occurrence of a major adverse cardiac event (MACE) at 12 months. The secondary endpoint was the rate of stent thrombosis (ST).ResultsComplex (n = 1,108) bifurcation lesions were associated with a higher 1-year rate of MACE (16.8%) compared with simple (n = 2,552) bifurcation lesions (8.9%) (p < 0.001). The in-hospital ST and 1-year target lesion revascularization rates after 2-stent techniques in the simple group (1.0% and 5.6%, respectively) were significantly different from those after PS (0.2% [p = 0.007] and 3.2% [p = 0.009], respectively); however, 1-year MACE rates were not significantly different between the 2 groups. For complex bifurcation lesions, 2-stent techniques had lower rates of 1-year cardiac death (2.8%) and in-hospital MACE (5.0%) compared with PS (5.3%, p = 0.047; 8.4%, p = 0.031).ConclusionsComplex bifurcation lesions had higher rates of 1-year MACE and ST. The 2-stent and PS techniques were overall equivalent in 1-year MACE. However, 2-stent techniques for complex lesions elicited a lower rate of cardiac death and in-hospital MACE but higher rates of in-hospital ST and revascularization at 1 year for simple lesions.

Background and Objectives Pyrrole-Imidazole polyamide (PIP) is a novel gene silencer that can be readily designed and synthesised to target any gene. Contrary to traditional gene-silencing agents, PIP is resistant to nucleases and can enter into the nuclei of target cells without any particular delivery system. Moreover, PIP has a low molecular weight, a high efficiency of cellular uptake and bioavailability, and is hydrophobic and lipophilic, making it pharmacokinetically suitable for loading onto the metal stent. The present study was designed to evaluate the potential effects of PIP on in-stent restenosis and re-endothelialisation in rat abdominal aorta stenting models. Methods Rats were assigned to four groups (n=10 for each group): Control group, Bare-metal stent group, PIP-eluting stent group and Mismatch PIP-eluting stent group. In vitro pharmacological release kinetics was analysed by HPLC. The re-endothelialisation indices were determined by scanning electron microscopy (n=3). The expression of LOX-1, NADPH p22phox, NADPH p47phox will be determined by quantitative real-time PCR and Westernblot. The oxidative stress in the aorta will be determined by measuring aortic MDA levels. Sections in methylmethacrylate will be cut into 5-μm thickness and stained with hematoxylin-eosin. The area of neointimal hyperplasia (NIH), the rate of restenosis, and the injury and inflammation scores were measured. Results In vitro pharmacological release kinetics showed that PIP eluting stents showed almost complete release of the PIP with in 24h. In vivo pharmacological release kinetics demonstrated that trace amount of PIP was still remained in the local aorta tissues. Scanning electron microscopy showed that re-endothelialisation was nearly complete in all the three stents groups (n=3) at 14 days after stents implantation. The expression of LOX-1, NADPH p22phox, NADPH p47phox and the vascular MDA levels was significantly increased in BMS group compared with control group at 28 days after stents implantation (p 0.05). Conclusions PIP targeting LOX-1 eluting stents could decrease in-stent restenosis (ISR) without impairing re-endothelialisation by silencing LOX-1 and lowering oxidative stress. These results indicated that PIP targeting LOX-1 is considered to be a feasible gene silencing agent using the next generation of DES for the prevention of in-stent restenosis of the coronary artery.