105 results on '"Dougal McClean"'
Search Results
2. DynamX Bioadaptor, a Novel Uncaging Platform for Percutaneous Coronary Artery Revascularisation: 6 Month Clinical and Imaging Results
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Madhav Menon, Gerard T. Wilkins, Jack S El, Mark Webster, Scott A. Harding, Dougal McClean, Douglas Scott, and V. Pera
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Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,medicine.anatomical_structure ,Percutaneous ,business.industry ,medicine ,Radiology ,Cardiology and Cardiovascular Medicine ,business ,Artery - Published
- 2021
3. Serial Assessment of Tissue Precursors and Progression of Coronary Calcification Analyzed by Fusion of IVUS and OCT
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Yaping Zeng, Jouke Dijkstra, Patrick W. Serruys, Shaoping Nie, Hans Jonker, Therese Fahrni, Nico Bruining, Rafael Cavalcante, Dougal McClean, Carlos Collet, Yoshinobu Onuma, Erhan Tenekecioglu, Lorenz Räber, Yohei Sotomi, Jacques J. Koolen, Hiroki Tateishi, Robert-Jan van Geuns, Pannipa Suwannasom, Evald Høj Christiansen, and Maria D. Radu
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medicine.medical_specialty ,5 year follow up ,medicine.diagnostic_test ,business.industry ,030204 cardiovascular system & hematology ,equipment and supplies ,medicine.disease ,eye diseases ,03 medical and health sciences ,surgical procedures, operative ,0302 clinical medicine ,Optical coherence tomography ,Coronary artery calcification ,Intravascular ultrasound ,cardiovascular system ,medicine ,Radiology, Nuclear Medicine and imaging ,cardiovascular diseases ,030212 general & internal medicine ,Radiology ,Cardiology and Cardiovascular Medicine ,business ,Bioresorbable vascular scaffold ,Calcification - Abstract
Objectives: The aim of this study was to assess calcium growth with fused grayscale intravascular ultrasound (IVUS), IVUS–virtual histology, and optical coherence tomography (OCT) from base...
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- 2017
4. Current practices of Asia-Pacific cardiologists in the utilization of bioresorbable scaffolds
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Sudheer Saxena, Ashok Seth, Jack Jun Cheng, Hyeon Cheol Gwon, S. Mathew, Teguh Santoso, G. Sengottuvelu, On Hing Kwok, Chee Siong Soo, Cheng Ting Tsai, Tiemin Jiang, Shubin Qiao, Krishnankutty Sudhir, Dougal McClean, Praveen Chandra, Adrian F. Low, Carl Schultz, Yee Guan Yap, Rony Mathew, Anuruck Jeamanukoolkit, Christopher X. Wong, Charles A. Simonton, B. B. Chanana, Michael Nguyen, Sunao Nakamura, M.S. Hiremath, Do Quang Huan, Michael C L Lim, Ronald Dick, Udayachalerm Wasan, and Alan Whelan
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medicine.medical_specialty ,Asia ,Cardiology ,Context (language use) ,Coronary Artery Disease ,030204 cardiovascular system & hematology ,Prosthesis Design ,03 medical and health sciences ,Cardiologists ,0302 clinical medicine ,Asia pacific ,Blood vessel prosthesis ,Absorbable Implants ,medicine ,Humans ,030212 general & internal medicine ,Statistics & numerical data ,Tissue Scaffolds ,business.industry ,medicine.disease ,Blood Vessel Prosthesis ,Patient management ,Surgery ,Software deployment ,Learning curve ,Medical emergency ,Cardiology and Cardiovascular Medicine ,business ,Bioresorbable scaffold - Abstract
Background & aims Although Absorb Bioresorbable Vascular Scaffolds (A-BVS) are routinely used in the Asia-Pacific, there is little information on patient selection or deployment technique here. This document investigates the experiences of leading interventional cardiologists from the Asia-Pacific region with a focus on patient characteristics, deployment techniques and management. Methods and results A detailed questionnaire was distributed to 28 highly-experienced interventional cardiologists (‘Authors') from 13 Asia-Pacific countries. The results were discussed at a meeting on patient selection, technical consideration, deployment practices and patient management. Potential patient benefits of Absorb compared to metallic DES, the learning curve for patient selection and preparation, device deployment, and subsequent patient management approaches are presented. Conclusions Current practices are derived from guidelines optimized for European patients. Differences in approach exist in the Asia-Pacific context, including limited access to imaging and frequency of occurrence of complex lesions. Nevertheless, the use of the Absorb BVS (‘Absorb') in certain Asia-Pacific countries has flourished and practices here are continuing to mature.
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- 2016
5. Comparison of an everolimus-eluting bioresorbable scaffold with an everolimus-eluting metallic stent for the treatment of coronary artery stenosis (ABSORB II): a 3 year, randomised, controlled, single-blind, multicentre clinical trial
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Andrés Iñiguez, Sebastian Reith, Manel Sabaté, Angel Cequier, Yoshinobu Onuma, Manuel de Sousa Almeida, Jan J. Piek, Gianluca Campo, Stephan Windecker, Bernard Chevalier, Yohei Sotomi, Dougal McClean, Ad J. van Boven, Dariusz Dudek, Steffen Helqvist, Michael Haude, Marcello Dominici, Patrick W. Serruys, Didier Carrié, Cardiology, Graduate School, and ACS - Amsterdam Cardiovascular Sciences
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medicine.medical_specialty ,medicine.medical_treatment ,Myocardial Ischemia ,Self Expandable Metallic Stents ,Lumen (anatomy) ,Biocompatible Materials ,030204 cardiovascular system & hematology ,NO ,law.invention ,03 medical and health sciences ,0302 clinical medicine ,Randomized controlled trial ,law ,Internal medicine ,Absorbable Implants ,Intravascular ultrasound ,medicine ,Clinical endpoint ,Humans ,Single-Blind Method ,Everolimus ,030212 general & internal medicine ,Myocardial infarction ,610 Medicine & health ,Ultrasonography, Interventional ,medicine.diagnostic_test ,business.industry ,Medicine (all) ,Hazard ratio ,Coronary Stenosis ,Stent ,Drug-Eluting Stents ,General Medicine ,medicine.disease ,Surgery ,Treatment Outcome ,Cardiology ,business ,Immunosuppressive Agents ,medicine.drug - Abstract
BACKGROUND No medium-term data are available on the random comparison between everolimus-eluting bioresorbable vascular scaffolds and everolimus-eluting metallic stents. The study aims to demonstrate two mechanistic properties of the bioresorbable scaffold: increase in luminal dimensions as a result of recovered vasomotion of the scaffolded vessel. METHODS The ABSORB II trial is a prospective, randomised, active-controlled, single-blind, parallel two-group, multicentre clinical trial. We enrolled eligible patients aged 18-85 years with evidence of myocardial ischaemia and one or two de-novo native lesions in different epicardial vessels. We randomly assigned patients (2:1) to receive treatment with an everolimus-eluting bioresorbable scaffold (Absorb; Abbott Vascular, Santa Clara, CA, USA) or treatment with an everolimus-eluting metallic stent (Xience; Abbott Vascular, Santa Clara, CA, USA). Randomisation was stratified by diabetes status and number of planned target lesions. At 3 year follow-up, the primary endpoint was superiority of the Absorb bioresorbable scaffold versus the Xience metallic stent in angiographic vasomotor reactivity after administration of intracoronary nitrate. The co-primary endpoint is the non-inferiority of angiographic late luminal loss. For the endpoint of vasomotion, the comparison was tested using a two-sided t test. For the endpoint of late luminal loss, non-inferiority was tested using a one-sided asymptotic test, against a non-inferiority margin of 0·14 mm. The trial is registered at ClinicalTrials.gov, number NCT01425281. FINDINGS Between Nov 28, 2011, and June 4, 2013, we enrolled 501 patients and randomly assigned them to the Absorb group (335 patients, 364 lesions) or the Xience group (166 patients, 182 lesions). The vasomotor reactivity at 3 years was not statistically different (Absorb group 0·047 mm [SD 0·109] vs Xience group 0·056 mm [0·117]; psuperiority=0·49), whereas the late luminal loss was larger in the Absorb group than in the Xience group (0·37 mm [0·45] vs 0·25 mm [0·25]; pnon-inferiority=0·78). This difference in luminal dimension was confirmed by intravascular ultrasound assessment of the minimum lumen area (4·32 mm(2) [SD 1·48] vs 5·38 mm(2) [1·51]; p
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- 2016
6. A027 Coronary Intravascular Lithotripsy; Early Experiences at a Single Centre
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Dougal McClean, C. McAlister, A. Puri, T. Clendon, Philip D Adamson, J. Blake, David Smyth, and John Elliott
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Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,Single centre ,business.industry ,medicine.medical_treatment ,General surgery ,medicine ,Lithotripsy ,Cardiology and Cardiovascular Medicine ,business - Published
- 2020
7. Diagnostic Accuracy of Coronary CT Angiography for the Evaluation of Bioresorbable Vascular Scaffolds
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Dougal McClean, Jean Fajadet, Antonio L. Bartorelli, Angel Cequier, Dariusz Dudek, Yoshinobu Onuma, Jan J. Piek, Erhan Tenekecioglu, Carlos Collet, Steffen Helqvist, Marcello Dominici, Bernard Chevalier, Manuel de Sousa Almeida, Ad J. van Boven, Patrick W. Serruys, Stephan Windecker, ACS - Heart failure & arrhythmias, Graduate School, ACS - Amsterdam Cardiovascular Sciences, Cardiology, ACS - Microcirculation, and ACS - Atherosclerosis & ischemic syndromes
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Male ,medicine.medical_specialty ,Computed Tomography Angiography ,medicine.medical_treatment ,Lumen (anatomy) ,Coronary Artery Disease ,030204 cardiovascular system & hematology ,Coronary Angiography ,Prosthesis Design ,Coronary Restenosis ,Coronary artery disease ,03 medical and health sciences ,Percutaneous Coronary Intervention ,0302 clinical medicine ,Predictive Value of Tests ,Absorbable Implants ,Multidetector Computed Tomography ,Intravascular ultrasound ,medicine ,Humans ,Single-Blind Method ,Radiology, Nuclear Medicine and imaging ,Prospective Studies ,030212 general & internal medicine ,cardiovascular diseases ,610 Medicine & health ,Prospective cohort study ,Ultrasonography, Interventional ,Aged ,Computed tomography angiography ,medicine.diagnostic_test ,business.industry ,Reproducibility of Results ,Stent ,Middle Aged ,medicine.disease ,Coronary Vessels ,Stenosis ,Treatment Outcome ,Predictive value of tests ,Female ,Radiology ,Cardiology and Cardiovascular Medicine ,business - Abstract
Objectives: The purpose of this study was to assess the diagnostic accuracy of coronary computed tomography angiography (CTA) for bioresorbable vascular scaffold (BVS) evaluation. Background: Coronary CTA has emerged as a noninvasive method to evaluate patients with suspected or established coronary artery disease. The diagnostic accuracy of coronary CTA to evaluate angiographic outcomes after BVS implantation has not been well established. Methods: In the ABSORB II (A Bioresorbable Everolimus-Eluting Scaffold Versus a Metallic Everolimus-Eluting Stent II) study, patients were randomized either to receive treatment with the BVS or everolimus-eluting metallic stent. At the 3-year follow-up, 238 patients (258 lesions) treated with BVS underwent coronary angiography with intravascular ultrasound (IVUS) evaluation and coronary CTA. The diagnostic accuracy of coronary CTA was assessed by the area under the receiver-operating characteristic curve with coronary angiography and IVUS as references. Results: The mean difference in coronary CTA-derived minimal luminal diameter was −0.14 mm (limits of agreement −0.88 to 0.60) with quantitative coronary angiography as reference, whereas the mean difference in minimal lumen area was 0.73 mm2 (limits of agreement −1.85 to 3.30) with IVUS as reference. The per-scaffold diagnostic accuracy of coronary CTA for detecting stenosis based on coronary angiography diameter stenosis of ≥50% revealed an area under the receiver-operating characteristic curve of 0.88 (95% confidence interval [CI]: 0.82 to 0.92) with a sensitivity of 80% (95% CI: 28% to 99%) and a specificity of 100% (95% CI: 98% to 100%), whereas diagnostic accuracy based on IVUS minimal lumen area ≤2.5 mm2 showed an area under the receiver-operating characteristic curve of 0.83 (95% CI: 0.77 to 0.88) with a sensitivity of 71% (95% CI: 44% to 90%) and a specificity of 82% (95% CI: 75% to 87%). The diagnostic accuracy of coronary CTA was similar to coronary angiography in its ability to identify patients with a significant lesion based on the IVUS criteria (p = 0.75). Conclusions: Coronary CTA has good diagnostic accuracy to detect in-scaffold luminal obstruction and to assess luminal dimensions after BVS implantation. Coronary angiography and coronary CTA yielded similar diagnostic accuracy to identify the presence and severity of obstructive disease. Coronary CTA might become the method of choice for the evaluation of patients treated with BVS.
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- 2018
8. Borderline Coronary Physiology: Outcomes of Patients With Negative Instantaneous Wave-Free Ratio
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Charlotte Greer, Aniket Puri, Jacalin Sutherland, Dougal McClean, John Elliott, James Blake, and David Smyth
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Pulmonary and Respiratory Medicine ,Cardiology and Cardiovascular Medicine - Published
- 2019
9. Are Instantaneous Wave-Free Ratio Measurements Influenced by Vessel Position?
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Charlotte Greer, Aniket Puri, Jacalin Sutherland, Dougal McClean, James Blake, John Elliott, and David Smyth
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Pulmonary and Respiratory Medicine ,Cardiology and Cardiovascular Medicine - Published
- 2019
10. Outcomes in Patients Presenting with Symptoms Suggestive of Acute Coronary Syndrome with Elevated Cardiac Troponin but Non-obstructive Coronary Disease on Angiography
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A. Mark Richards, Dougal McClean, A. Puri, John Elliott, and Sally Aldous
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Adult ,Male ,Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,Acute coronary syndrome ,Coronary Disease ,Coronary disease ,Coronary Angiography ,Disease-Free Survival ,Internal medicine ,medicine ,Humans ,cardiovascular diseases ,Myocardial infarction ,Acute Coronary Syndrome ,Aged ,biology ,medicine.diagnostic_test ,business.industry ,Middle Aged ,medicine.disease ,Troponin ,Coronary arteries ,Stenosis ,medicine.anatomical_structure ,Angiography ,biology.protein ,Cardiology ,Female ,Cardiology and Cardiovascular Medicine ,business ,Psychosocial ,Follow-Up Studies ,New Zealand - Abstract
Many patients provisionally diagnosed with acute myocardial infarction (AMI) have angiographically unobstructed coronary arteries. Despite other potential causes, patients are often diagnosed as AMI with psychosocial implications and medication burden. The aim of this audit was to review such patients at our centre.All patients investigated for possible AMI with coronary angiography from 2007 until 2011 at Christchurch Hospital, New Zealand, in whom cardiac troponin was elevated (with no other cause found for that elevation) but coronary angiography showed diameter stenosis50% were reviewed. Primary outcome was two-year cardiac death and AMI (by universal definition).Of the 351/6493 (5.4%) who met the inclusion criteria, 180 had normal angiograms and 171 had non-obstructive coronary disease (stenosis0% and50%). By two years there were two cardiac deaths (0.6%) and five AMIs (1.4%). The primary outcome rate was therefore 2.0% (2.2% for those with normal angiograms and 1.8% with non-flow limiting coronary disease, p=1.000).Patients who have presented with AMI symptoms, elevated cardiac troponin, and unobstructed coronary arteries on angiography are at very low risk of cardiac death (0.6%), AMI (1.4%) or either (2.0%) at two-year follow-up.
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- 2015
11. Circumferential distribution of the neointima at six-month and two-year follow-up after a bioresorbable vascular scaffold implantation: a substudy of the ABSORB Cohort Clinical Trial
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Dougal McClean, Cecile Dorange, Yao-Jun Zhang, Yoshinobu Onuma, Richard Rapoza, Takashi Muramatsu, Patrick W. Serruys, Leif Thuesen, Christos V. Bourantas, Vasim Farooq, Hector M. Garcia-Garcia, Bernard Chevalier, John A. Ormiston, Bill D. Gogas, Stephan Windecker, Robert Whitbourn, Jacques J. Koolen, and Cardiology
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Adult ,Male ,Neointima ,medicine.medical_specialty ,medicine.medical_treatment ,Lumen (anatomy) ,Antineoplastic Agents ,medicine.disease_cause ,Cohort Studies ,Percutaneous Coronary Intervention ,Tissue scaffolds ,Absorbable Implants ,medicine ,Humans ,Prospective Studies ,Aged ,Bioresorbable vascular scaffold ,Sirolimus ,Tissue Scaffolds ,business.industry ,Coronary Stenosis ,Percutaneous coronary intervention ,Drug-Eluting Stents ,Middle Aged ,Vulnerable plaque ,Current analysis ,Female ,Radiology ,Cardiology and Cardiovascular Medicine ,business ,Tomography, Optical Coherence ,Symmetry index - Abstract
Aims: To investigate the extent and the circumferential distribution of the neointima tissue developed following an Absorb bioresorbable vascular scaffold (BVS) implantation. Methods and results: Twenty-three patients who were treated with the Absorb BVS and had optical coherence tomographic examination after scaffold implantation, at six-month and at two-year follow-up, were included in the current analysis. The lumen and the scaffold borders were detected and the circumferential thickness of the neointima was measured at one degree intervals. The symmetry of the neointima was defined as: minimum/maximum thickness. The lumen area was decreased at six months compared to baseline but it did not change between six-month and two-year follow-up (baseline: 7.49 [6.13-8.00] mm(2), six months: 6.31 (4.75-7.06) mm(2), two years: 6.01 [4.67-7.11] mm(2), p=0.373). However, the mean neointima thickness (six months: 189 [173-229] mu m, two years: 258 [222-283] mu m, p
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- 2015
12. Incidence and Imaging Outcomes of Acute Scaffold Disruption and Late Structural Discontinuity After Implantation of the Absorb Everolimus-Eluting Fully Bioresorbable Vascular Scaffold
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Dariusz Dudek, Takashi Muramatsu, Pieter C. Smits, Yoshinobu Onuma, Dougal McClean, Shimpei Nakatani, Hector M. Garcia-Garcia, Bernard Chevalier, Susan Veldhof, Ian T Meredith, Robert Whitbourn, Richard Rapoza, Jacques J. Koolen, Stephan Windecker, Patrick W. Serruys, John A. Ormiston, Bernard De Bruyne, Robert-Jan van Geuns, and Evald Høj Christiansen
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Scaffold ,medicine.medical_specialty ,Everolimus ,medicine.diagnostic_test ,business.industry ,medicine.medical_treatment ,Stent ,medicine.anatomical_structure ,Optical coherence tomography ,Cohort ,Coronary stent ,medicine ,Radiology ,Cardiology and Cardiovascular Medicine ,business ,Clinical evaluation ,medicine.drug ,Artery - Abstract
Objectives This study sought to describe the frequency and clinical impact of acute scaffold disruption and late strut discontinuity of the second-generation Absorb bioresorbable polymeric vascular scaffolds (Absorb BVS, Abbott Vascular, Santa Clara, California) in the ABSORB (A Clinical Evaluation of the Bioabsorbable Everolimus Eluting Coronary Stent System in the Treatment of Patients With De Novo Native Coronary Artery Lesions) cohort B study by optical coherence tomography (OCT) post-procedure and at 6, 12, 24, and 36 months. Background Fully bioresorbable scaffolds are a novel approach to treatment for coronary narrowing that provides transient vessel support with drug delivery capability without the long-term limitations of metallic drug-eluting stents. However, a potential drawback of the bioresorbable scaffold is the potential for disruption of the strut network when overexpanded. Conversely, the structural discontinuity of the polymeric struts at a late stage is a biologically programmed fate of the scaffold during the course of bioresorption. Methods The ABSORB cohort B trial is a multicenter single-arm trial assessing the safety and performance of the Absorb BVS in the treatment of 101 patients with de novo native coronary artery lesions. The current analysis included 51 patients with 143 OCT pullbacks who underwent OCT at baseline and follow-up. The presence of acute disruption or late discontinuities was diagnosed by the presence on OCT of stacked, overhung struts or isolated intraluminal struts disconnected from the expected circularity of the device. Results Of 51 patients with OCT imaging post-procedure, acute scaffold disruption was observed in 2 patients (3.9%), which could be related to overexpansion of the scaffold at the time of implantation. One patient had a target lesion revascularization that was presumably related to the disruption. Of 49 patients without acute disruption, late discontinuities were observed in 21 patients. There were no major adverse cardiac events associated with this finding except for 1 patient who had a non-ischemia-driven target lesion revascularization. Conclusions Acute scaffold disruption is a rare iatrogenic phenomenon that has been anecdotally associated with anginal symptoms, whereas late strut discontinuity is observed in approximately 40% of patients and could be viewed as a serendipitous OCT finding of a normal bioresorption process without clinical implications. (ABSORB Clinical Investigation, Cohort B [ABSORB B]; NCT00856856)
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- 2014
13. Comparison of everolimus-eluting bioresorbable scaffolds with everolimus-eluting metallic stents for treatment of coronary artery stenosis: Three-year follow-up of the ABSORB II randomized trial
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Carlos Collet, Yohei Sotomi, Bernard Chevalier, Angel Ramón Cequier Fillat, Didier Carrié, Jan Piek, A.J. van Boven, Marcello Dominici, Dariusz Dudek, Dougal McClean, Steffen Helqvist, Michael Haude, Sebastian Reith, Manuel de Sousa Almeida, Gianluca Campo, Andrés Iñiguez, Robert-Jan M. van Geuns, Pieter Smits, Manel Sabaté, Stephan Windecker, Yoshinobu Onuma, and Patrick W.J.C. Serruys
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- 2017
14. Long-term serial non-invasive multislice computed tomography angiography with functional evaluation after coronary implantation of a bioresorbable everolimus-eluting scaffold: the ABSORB cohort B MSCT substudy
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Bernard De Bruyne, Robert-Jan van Geuns, Carlos Collet, Patrick W. Serruys, Pieter C. Smits, Evald Høj Christiansen, Jacques J. Koolen, Ian T. Meredith, Dougal McClean, Susan Veldhof, Stephan Windecker, Bernard Chevalier, John A. Ormiston, Koen Nieman, Dariusz Dudek, Yoshinobu Onuma, Cardiology, ACS - Heart failure & arrhythmias, and Graduate School
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Male ,Time Factors ,Computed Tomography Angiography ,Vascular damage Radboud Institute for Health Sciences [Radboudumc 16] ,Fractional flow reserve ,scaffold ,030204 cardiovascular system & hematology ,GUIDELINES ,IMAGING MODALITY ,VASCULAR SCAFFOLD ,0302 clinical medicine ,Interquartile range ,Absorbable Implants ,ARTERY-DISEASE ,Prospective Studies ,030212 general & internal medicine ,610 Medicine & health ,Tissue Scaffolds ,medicine.diagnostic_test ,Drug-Eluting Stents ,General Medicine ,Middle Aged ,Fractional Flow Reserve, Myocardial ,Treatment Outcome ,Cohort ,fractional flow reserve derived from computed tomography ,REVASCULARIZATION ,TRIAL ,Female ,STENT SYSTEM ,Radiology ,Cardiology and Cardiovascular Medicine ,medicine.drug ,medicine.medical_specialty ,Risk Assessment ,Statistics, Nonparametric ,03 medical and health sciences ,Percutaneous Coronary Intervention ,Multidetector Computed Tomography ,Medical imaging ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Everolimus ,Aged ,LESIONS ,business.industry ,Coronary Stenosis ,CT ANGIOGRAPHY ,medicine.disease ,Stenosis ,Angiography ,coronary computed tomography angiography ,business ,Mace ,Follow-Up Studies - Abstract
Item does not contain fulltext Aims: Multimodality invasive imaging of the first-in-man cohort demonstrated at 5 years stable lumen dimensions and a low rate of major adverse cardiac events (MACE). However, the long-term non-invasive assessment of this device remains to be documented. The objective was to describe the 72-month multislice computed tomography (MSCT) angiographic and functional findings after the implantation of the second iteration of the fully resorbable everolimus-eluting polymeric scaffold. Methods and results: In the ABSORB Cohort B trial patients with non-complex de novo lesions were treated with second iteration bioresobable vascular scaffold (BVS). MSCT angiography was performed as an optional investigation at 18 months; patients were reconsented for a second investigation at 72 months. MSCT data were analysed at independent core laboratories for quantitative analysis of lumen dimensions and for calculation of fractional flow reserve derived from computed tomography (FFRCT). From the overall Cohort B (101 patients), 53 patients underwent MSCT imaging at 72 months. The MACE rate was 1.9% (1/53). At 72 months, the median minimal lumen area (MLA) was 4.05 mm2 (interquartile range [IQR]: 3.15-4.90) and the mean percentage area stenosis was 18% (IQR: 4.75-31.25), one scaffold was totally occluded. In 39 patients with paired MSCT analysis, the MLA significantly increased from the first to the second follow-up (Delta = 0.80 mm2, P = 0.002). The change in the median FFRCT scaffold gradient between time points was zero. Conclusion: The long-term serial non-invasive MSCT evaluation with FFRCT assessment after bioresorbable scaffold implantation confirmed in-scaffold late lumen enlargement with the persistence of normalization of the FFRCT. Clinical trial registration: URL: http://www.clinicaltrials.gov. Unique identifier: NCT00856856.
- Published
- 2017
15. Borderline Coronary Physiology – Are All Vessels Equal?
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Dougal McClean, C. Greer, David Smyth, J. Sutherland, John Elliott, J. Blake, and A. Puri
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Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,business.industry ,Internal medicine ,medicine ,Cardiology ,Cardiology and Cardiovascular Medicine ,business ,Coronary physiology - Published
- 2019
16. Increasing Incidence of Spontaneous Coronary Artery Dissection (SCAD) in Christchurch
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C. McAlister, Ma Yi, A. Puri, David Smyth, John Elliott, Philip D Adamson, Dougal McClean, and J. Blake
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Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,business.industry ,Internal medicine ,Incidence (epidemiology) ,medicine ,Cardiology ,Spontaneous coronary artery dissection (SCAD) ,Cardiology and Cardiovascular Medicine ,medicine.disease ,business - Published
- 2019
17. Management and Outcomes of Spontaneous Coronary Artery Dissection in Christchurch
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A. Puri, John Elliott, J. Blake, Dougal McClean, David Smyth, C. McAlister, and Philip D Adamson
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Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,business.industry ,medicine ,Cardiology and Cardiovascular Medicine ,Artery dissection ,business ,Surgery - Published
- 2019
18. First-in-human evaluation of a sirolimus-eluting coronary stent on an integrated delivery system: the DIRECT study
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Mark Webster, John A. Ormiston, Dougal McClean, Scott A. Harding, Timothy J. N. Watson, Andrew Aitken, and Warwick M. Jaffe
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Male ,Target lesion ,medicine.medical_specialty ,Time Factors ,medicine.medical_treatment ,Coronary Artery Disease ,Coronary Angiography ,Prosthesis Design ,Coronary artery disease ,Percutaneous Coronary Intervention ,Intravascular ultrasound ,Coronary stent ,Humans ,Medicine ,Prospective Studies ,cardiovascular diseases ,Aged ,Sirolimus ,medicine.diagnostic_test ,business.industry ,Percutaneous coronary intervention ,Stent ,Cardiovascular Agents ,Drug-Eluting Stents ,Middle Aged ,equipment and supplies ,medicine.disease ,Surgery ,Treatment Outcome ,surgical procedures, operative ,medicine.anatomical_structure ,Cardiovascular agent ,Female ,Chromium Alloys ,Radiology ,Cardiology and Cardiovascular Medicine ,business ,Tomography, Optical Coherence ,New Zealand ,Artery - Abstract
AIMS: The DIRECT study is a first-in-human evaluation of the safety and efficacy of the Svelte sirolimus-eluting coronary stent mounted on a fixed-wire, "all-in-one" integrated delivery system (IDS) in patients with de novo coronary artery lesions. The system permits easy delivery, deployment and post-dilatation of a cobalt-chromium stent eluting sirolimus from a fully bioabsorbable amino acid coating. The stent on its IDS has a very low profile, and is designed specifically to facilitate direct stenting. METHODS AND RESULTS: Patients with symptomatic ischaemic heart disease and a single de novo native coronary lesion suitable for percutaneous coronary intervention were prospectively enrolled at four New Zealand sites. The lesion length had to be
- Published
- 2013
19. The Utility of Contrast Medium Fractional Flow Reserve in Functional Assessment Of Coronary Disease in Daily Practice
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Aniket Puri, Tina Bailey, Olivia Thacker, John Michael Elliott, Muhammad Arshad, Pieter Van Wyk, Dougal McClean, Jacalin Sutherland, James Blake, David Smyth, and Ma Yi
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Pulmonary and Respiratory Medicine ,Male ,medicine.medical_specialty ,Computed Tomography Angiography ,medicine.medical_treatment ,Contrast Media ,Fractional flow reserve ,Coronary Artery Disease ,030204 cardiovascular system & hematology ,Coronary Angiography ,Coronary artery disease ,03 medical and health sciences ,Coronary artery bypass surgery ,0302 clinical medicine ,Predictive Value of Tests ,Internal medicine ,medicine ,Humans ,030212 general & internal medicine ,Myocardial infarction ,Prospective Studies ,Instantaneous wave-free ratio ,Aged ,business.industry ,Percutaneous coronary intervention ,medicine.disease ,Coronary Vessels ,Fractional Flow Reserve, Myocardial ,Contrast medium ,ROC Curve ,Predictive value of tests ,Cardiology ,Female ,Radiology ,Cardiology and Cardiovascular Medicine ,business ,Follow-Up Studies - Abstract
Background Adenosine induced hyperaemic fractional flow reserve (aFFR) is a validated predictor of clinical outcome and part of routine interventional practice. Protocol issues associated with the adenosine infusion limit the use of aFFR in clinical practice. Contrast medium induced hyperaemic FFR (cFFR) is a simpler procedure from a practical standpoint. We compared the two in a real world setting. Methods We analysed 76 patients that had both cFFR and aFFR assessment of 100 angiographically indeterminate coronary stenosis. cFFR was performed with intracoronary contrast medium injections (10 ml for left coronary lesions and 8 ml for right coronary lesions). The diagnostic performance of cFFR was analysed and compared to the gold standard aFFR. Results Mean cFFR was 0.87 (±0.07) and mean aFFR was 0.84 (±0.08). Bland-Altman analysis revealed a close agreement between cFFR and aFFR (0.035 ± 0.032; 95% CI: −0.028 to 0.098) and good linear correlation (r = 0.92, r2 = 0.86; p 0.80 yielded a sensitivity of 100%, specificity of 96.1%, positive predictive value of 92.3%, negative predictive value of 100% and diagnostic accuracy of 96%. Only 24% of cFFR values were in the 0.84 to 0.87 range. Conclusion Contrast medium induced hyperaemic FFR as an initial assessment may limit the need for adenosine to when cFFR falls in the 0.84 to 0.87 range. The use of adenosine infusion potentially could have been avoided in the majority of patients in this study.
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- 2016
20. Serial 5-Year Evaluation of Side Branches Jailed by Bioresorbable Vascular Scaffolds Using 3-Dimensional Optical Coherence Tomography: Insights From the ABSORB Cohort B Trial (A Clinical Evaluation of the Bioabsorbable Everolimus Eluting Coronary Stent System in the Treatment of Patients With De Novo Native Coronary Artery Lesions)
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Joanna J. Wykrzykowska, Shimpei Nakatani, Robbert J. de Winter, Evald Høj Christiansen, Robert Whitbourn, Maik J. Grundeken, John A. Ormiston, Jacques J. Koolen, Patrick W. Serruys, Takayuki Okamura, Robert-Jan van Geuns, Yoshinobu Onuma, Nicolas Foin, Yohei Sotomi, Dougal McClean, Pieter G Smits, Taku Asano, Jaryl Ng, Stephan Windecker, Cardiology, Graduate School, Amsterdam Cardiovascular Sciences, ACS - Atherosclerosis & ischemic syndromes, ACS - Heart failure & arrhythmias, and ACS - Microcirculation
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medicine.medical_specialty ,Time Factors ,medicine.medical_treatment ,Vascular damage Radboud Institute for Health Sciences [Radboudumc 16] ,Coronary Artery Disease ,030204 cardiovascular system & hematology ,Prosthesis Design ,Percutaneous coronary intervention ,Coronary artery disease ,03 medical and health sciences ,0302 clinical medicine ,Percutaneous Coronary Intervention ,Optical coherence tomography ,Predictive Value of Tests ,Coronary stent ,Absorbable Implants ,medicine ,Humans ,030212 general & internal medicine ,Everolimus ,Bifurcation Lesion ,610 Medicine & health ,absorbable implants ,medicine.diagnostic_test ,business.industry ,Reproducibility of Results ,Cardiovascular Agents ,Drug-Eluting Stents ,medicine.disease ,Coronary Vessels ,Surgery ,Ostium ,medicine.anatomical_structure ,Treatment Outcome ,Cohort ,cardiovascular system ,Cardiology and Cardiovascular Medicine ,business ,Tomography, Optical Coherence ,Artery ,medicine.drug - Abstract
Background— The long-term fate of Absorb bioresorbable vascular scaffold (Abbott Vascular, Santa Clara, CA) struts jailing side branch ostia has not been clarified. We therefore evaluate serially (post-procedure and at 6 months, 1, 2, 3, and 5 years) the appearance and fate of jailed Absorb bioresorbable vascular scaffold struts. Methods and Results— We performed 3-dimensional optical coherence tomographic analysis of the ABSORB Cohort B trial (A Clinical Evaluation of the Bioabsorbable Everolimus Eluting Coronary Stent System in the Treatment of Patients With De Novo Native Coronary Artery Lesions) up to 5 years using a novel, validated cut-plane analysis method. We included 29 patients with a total of 85 side branch ostia. From the 12 ostia which could be assessed in true serial fashion, 7 showed a pattern of initial decrease in the ostial area free from struts, followed by an increase in strut-free ostial area toward the end of the 5 years of follow-up. In a repeated-measures analysis with time as fixed variable and ostial area free from struts as dependent variable, we showed a numeric decrease in the estimated ostial area free from struts from 0.75 mm 2 (baseline) to 0.68 mm 2 (first follow-up visit at 6 months or 1 year) and 0.63 mm 2 (second follow-up visit at 2 or 3 years). However, from the second visit to the 5-year follow-up visit, there was a statistically significant increase from 0.63 to 0.89 mm 2 ( P =0.001). Struts overlying an ostium divided the ostium into compartments, and the number of these compartments decreased over time. Conclusions— This study showed that in most cases, the side branch ostial area free from struts initially decreased. However, with full scaffold bioresorption, the ostial area free from scaffold increased between 2 to 3 years and 5 years in the vast majority of patients. Clinical Trial Registration— URL: http://www.clinicaltrials.gov . Unique identifier: NCT00856856.
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- 2016
21. Clinical and intravascular imaging outcomes at 1 and 2 years after implantation of absorb everolimus eluting bioresorbable vascular scaffolds in small vessels. Late lumen enlargement: does bioresorption matter with small vessel size? Insight from the ABSORB cohort B trial
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Susan Veldhof, Vasim Farooq, Robert Whitbourn, Jacques J. Koolen, Robert-Jan van Geuns, Pieter C. Smits, Patrick W. Serruys, Jung Ho Heo, Evelyn Regar, Dougal McClean, Hector M. Garcia-Garcia, Karine Miquel-Hebert, Dariusz Dudek, Ian T Meredith, Bill D. Gogas, Roberto Diletti, Yoshinobu Onuma, Christos V. Bourantas, Xiaolin Li, Leif Thuesen, Bernard De Bruyne, Chrysafios Girasis, John A. Ormiston, Bernard Chevalier, Stephan Windecker, Cardiology, and Radiology & Nuclear Medicine
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Adult ,Male ,Target lesion ,medicine.medical_specialty ,Time Factors ,Adolescent ,Lumen (anatomy) ,Coronary Artery Disease ,Coronary Angiography ,Prosthesis Design ,Young Adult ,Restenosis ,Internal medicine ,Absorbable Implants ,Intravascular ultrasound ,medicine ,Humans ,Everolimus ,Prospective Studies ,Myocardial infarction ,Prospective cohort study ,Ultrasonography, Interventional ,Aged ,Sirolimus ,Tissue Scaffolds ,medicine.diagnostic_test ,business.industry ,digestive, oral, and skin physiology ,Drug-Eluting Stents ,Middle Aged ,medicine.disease ,Coronary Vessels ,Thrombosis ,Treatment Outcome ,Cardiology ,Female ,Cardiology and Cardiovascular Medicine ,business ,Immunosuppressive Agents ,Follow-Up Studies ,medicine.drug - Abstract
The long-term results after second generation everolimus eluting bioresorbable vascular scaffold (Absorb BVS) placement in small vessels are unknown. Therefore, we investigated the impact of vessel size on long-term outcomes, after Absorb BVS implantation.In ABSORB Cohort B Trial, out of the total study population (101 patients), 45 patients were assigned to undergo 6-month and 2-year angiographic follow-up (Cohort B1) and 56 patients to have angiographic follow-up at 1-year (Cohort B2). The pre-reference vessel diameter (RVD) was2.5 mm (small-vessel group) in 41 patients (41 lesions) and ≥2.5 mm (large-vessel group) in 60 patients (61 lesions). Outcomes were compared according to pre-RVD.At 2-year angiographic follow-up no differences in late lumen loss (0.29±0.16 mm vs 0.25±0.22 mm, p=0.4391), and in-segment binary restenosis (5.3% vs 5.3% p=1.0000) were demonstrated between groups. In the small-vessel group, intravascular ultrasound analysis showed a significant increase in vessel area (12.25±3.47 mm(2) vs 13.09±3.38 mm(2) p=0.0015), scaffold area (5.76±0.96 mm(2) vs 6.41±1.30 mm(2) p=0.0008) and lumen area (5.71±0.98 mm(2) vs 6.20±1.27 mm(2) p=0.0155) between 6-months and 2-year follow-up. No differences in plaque composition were reported between groups at either time point. At 2-year clinical follow-up, no differences in ischaemia-driven major adverse cardiac events (7.3% vs 10.2%, p=0.7335), myocardial infarction (4.9% vs 1.7%, p=0.5662) or ischaemia-driven target lesion revascularisation (2.4% vs 8.5%, p=0.3962) were reported between small and large vessels. No deaths or scaffold thrombosis were observed.Similar clinical and angiographic outcomes at 2-year follow-up were reported in small and large vessel groups. A significant late lumen enlargement and positive vessel remodelling were observed in small vessels.
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- 2012
22. Vascular Response of the Segments Adjacent to the Proximal and Distal Edges of the ABSORB Everolimus-Eluting Bioresorbable Vascular Scaffold: 6-Month and 1-Year Follow-Up Assessment
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Bill D. Gogas, Evelyn Regar, Vasim Farooq, Bernard De Bruyne, Jung Ho Heo, Hector M. Garcia-Garcia, Yoshinobu Onuma, Robert Whitbourn, Karine Miquel-Hebert, Jacques J. Koolen, Richard Rapoza, Cecile Dorange, Patrick W. Serruys, Robert-Jan van Geuns, Maria D. Radu, Leif Thuesen, Pieter C. Smits, John A. Ormiston, Salvatore Brugaletta, Dariusz Dudek, Bernard Chevalier, Dougal McClean, Stefan Windecker, and Roberto Diletti
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medicine.medical_specialty ,Everolimus ,business.industry ,medicine.medical_treatment ,Balloon ,medicine.disease ,Coronary artery disease ,Fibrosis ,Sirolimus ,Angioplasty ,Cardiovascular agent ,medicine ,Radiology ,Prospective cohort study ,business ,Cardiology and Cardiovascular Medicine ,medicine.drug - Abstract
Objectives This study sought to investigate in vivo the vascular response at the proximal and distal edges of the second-generation ABSORB everolimus-eluting bioresorbable vascular scaffold (BVS). Background The edge vascular response after implantation of the BVS has not been previously investigated. Methods The ABSORB Cohort B trial enrolled 101 patients and was divided into B 1 (n = 45) and B 2 (n = 56) subgroups. The adjacent (5-mm) proximal and distal vessel segments to the implanted ABSORB BVS were investigated at either 6 months (B 1 ) or 1 year (B 2 ) with virtual histology intravascular ultrasound (VH-IVUS) imaging. Results At the 5-mm proximal edge, the only significant change was modest constrictive remodeling at 6 months (Δ vessel cross-sectional area: −1.80% [−3.18; 1.30], p Conclusions The vascular response up to 1 year after implantation of the ABSORB BVS demonstrated some degree of proximal edge constrictive remodeling and distal edge increase in FF tissue resulting in nonsignificant plaque progression with adaptive expansive remodeling. This morphological and tissue composition behavior appears to not significantly differ from the behavior of metallic drug-eluting stents at the same observational time points.
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- 2012
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23. Differences in Neointimal Thickness Between the Adluminal and the Abluminal Sides of Malapposed and Side-Branch Struts in a Polylactide Bioresorbable Scaffold
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Jolanda J. Wentzel, Dariusz Dudek, John A. Ormiston, Evelyn Regar, Leif Thuesen, Stephan Windecker, Bernard De Bruyne, Bernard Chevalier, Yoshinobu Onuma, Salvatore Brugaletta, Robert Whitbourn, Dougal McClean, Frank J. H. Gijsen, Juan Luis Gutiérrez-Chico, and Patrick W. Serruys
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medicine.medical_specialty ,business.industry ,In vivo ,Clinical investigation ,Side branch ,Medicine ,business ,Nuclear medicine ,Cardiology and Cardiovascular Medicine ,Poly(lactide) ,Bioresorbable scaffold ,Surgery ,Bioresorbable vascular scaffold - Abstract
Objectives The goal of this study was to describe the neointimal healing on the abluminal side (ABL) of malapposed (ISA) struts and nonapposed side-branch (NASB) struts in terms of coverage by optical coherence tomography (OCT) and in comparison with the adluminal side (ADL). Background The neointimal healing on the ABL of ISA and NASB struts has never to our knowledge been explored in vivo and could be involved in the correction of acute malapposition. The bioresorbable vascular scaffold (BVS) is made of a translucent polymer that enables imaging of the ABL with OCT. Methods Patients enrolled in the ABSORB B (ABSORB Clinical Investigation Cohort B) study were treated with implantation of a BVS and imaged with OCT at 6 months. Thickness of coverage on the ADL and ABL of ISA and NASB struts was measured by OCT. Results Twenty-eight patients were analyzed; 114 (2.4%) struts were malapposed or at side branches. In 76 ISA struts (89.4%) and 29 NASB struts (100%), the thickness of ABL coverage was >30 μm. Coverage was thicker on the ABL than on the ADL side (101 vs. 71 μm; 95% confidence interval [CI] of the difference: 20 to 40 μm). In 70 struts (60.7%, 95% CI: 50.6% to 70.0%), the neointimal coverage was thicker on the ABL, versus only 20 struts (18.5%, 95% CI: 11.6% to 28.1%) with thicker neointimal coverage on the ADL side (odds ratio: 3.35, 95% CI: 2.22 to 5.07). Conclusions Most of the malapposed and side-branch struts are covered on the ABL side 6 months after BVS implantation, with thicker neointimal coverage than on the ADL side. The physiological correction of acute malapposition involves neointimal growth from the strut to the vessel wall or bidirectional. (ABSORB Clinical Investigation, Cohort B [ABSORB B]; NCT00856856 )
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- 2012
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24. Angiographic maximal luminal diameter and appropriate deployment of the everolimus-eluting bioresorbable vascular scaffold as assessed by optical coherence tomography: an ABSORB cohort B trial sub-study
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Vasim Farooq, Cecile Dorange, Susan Veldhof, Patrick W. Serruys, Yoshinobu Onuma, Salvatore Brugaletta, Josep Gomez-Lara, Evelyn Regar, Hector M. Garcia-Garcia, Richard Rapoza, Robert Whitbourn, Roberto Diletti, Jacques J. Koolen, Dariusz Dudek, Dougal McClean, Stefan Windecker, John A. Ormiston, Leif Thuesen, and Cardiology
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Male ,medicine.medical_specialty ,Optimal deployment ,Coronary Angiography ,Cohort Studies ,Optical coherence tomography ,medicine ,Humans ,Everolimus ,Angioplasty, Balloon, Coronary ,Bioresorbable vascular scaffold ,Aged ,Sirolimus ,medicine.diagnostic_test ,business.industry ,Luminal diameter ,Drug-Eluting Stents ,Middle Aged ,Angiography ,Female ,Radiology ,Cardiology and Cardiovascular Medicine ,business ,Bioresorbable scaffold ,Tomography, Optical Coherence ,medicine.drug ,Biomedical engineering - Abstract
Bioresorbable vascular scaffolds (BVS) present different mechanical properties as compared to metallic platform stents. Therefore, the standard procedural technique to achieve appropriate deployment may differ.Fifty-two lesions treated with a 3 x 18 mm BVS were imaged with optical coherence tomography (OCT) post-implantation and screened for parameters suggesting non-optimal deployment. These included minimal scaffold area (minSA)5 mm², residual area stenosis (RAS)20%, edge dissections, incomplete scaffold/strut apposition (ISA)5% and scaffold pattern irregularities. The angiographic proximal and distal maximal lumen diameters (DMAX) were measured by quantitative coronary angiography. Based on the DMAX values, the population was divided into three groups: DMAX2.5 mm (n=13), DMAX between 2.5-3.3 mm (n=30) and DMAX3.3 mm (n=9). All three groups presented with similar pre-implantation angiographic characteristics except for the vessel size and were treated with similar balloon/artery ratios. The group with a DMAX2.5 mm presented with a higher percentage of lesions with minSA5 mm² (30.8% vs. 10.0% vs. 0%; p=0.08) and edge dissections (61.5% vs. 33.3% vs. 11.1%; p=0.05). Lesions with5% of ISA were significantly higher in the group with DMAX3.3 mm (7.7% vs. 36.7% vs. 66.7%; p=0.02). RAS20% was similar between all groups (46.2 vs. 53.3 vs. 77.8%; p=0.47) and scaffold pattern irregularities were only documented in three cases.BVS implantation guided with quantitative angiography may improve the OCT findings of optimal deployment. The clinical significance of these angiographic and OCT findings warranted long term follow-up of larger cohort of patients.
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- 2012
25. Endothelial-dependent vasomotion in a coronary segment treated by ABSORB everolimus-eluting bioresorbable vascular scaffold system is related to plaque composition at the time of bioresorption of the polymer: indirect finding of vascular reparative therapy?
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Hector M. Garcia-Garcia, Robert-Jan van Geuns, Richard Rapoza, Susan Veldhof, Yoshinobu Onuma, Vasim Farooq, Dougal McClean, Cecile Dorange, John A. Ormiston, Jacques J. Koolen, Jung Ho Heo, Salvatore Brugaletta, Pieter C. Smits, Dariusz Dudek, Bernard De Bruyne, Patrick W. Serruys, Nico Bruining, Cardiology, and Radiology & Nuclear Medicine
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Male ,medicine.medical_specialty ,Vasodilator Agents ,Myocardial Ischemia ,echogenicity ,Vasomotion ,Vasodilation ,Nitroglycerin ,Internal medicine ,Absorbable Implants ,vasomotion ,Medicine ,Humans ,Everolimus ,Aged ,Sirolimus ,Tissue Scaffolds ,business.industry ,ABSORB BVS ,Echogenicity ,Drug-Eluting Stents ,Anatomy ,Middle Aged ,Coronary Vessels ,Acetylcholine ,Plaque, Atherosclerotic ,Intracoronary Device ,Vasomotor System ,medicine.anatomical_structure ,Cardiology ,Female ,Endothelium, Vascular ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business ,Vasoconstriction ,Immunosuppressive Agents ,VH ,medicine.drug ,Artery - Abstract
Aims To analyse the vasoreactivity of a coronary segment, previously scaffolded by the ABSORB bioresorbable vascular scaffold (BVS) device, in relationship to its intravascular ultrasound–virtual histology (IVUS–VH) composition and reduction in greyscale echogenicity of the struts. Coronary segments, transiently scaffolded by a polymeric device, may in the long-term recover a normal vasomotor tone. Recovery of a normal endothelial-dependent vasomotion may be enabled by scaffold bioresorption, composition of the underlying tissue, or a combination of both mechanisms. Methods and results All patients from the ABSORB Cohort A and B trials, who underwent a vasomotion test and IVUS–VH investigation at 12 and 24 months, were included. Acetylcholine (Ach) and nitroglycerin were used to test either the endothelial-dependent or -independent vasomotion of the treated segment. Changes in polymeric strut echogenicity—a surrogate for bioresorption—IVUS–VH composition of the tissue underneath the scaffold and their relationship with the pharmacologically induced vasomotion were all evaluated. Overall, 26 patients underwent the vasomotion test (18 at 12 and 8 at 24 months). Vasodilatory response to Ach was quantitatively associated with larger reductions over time in polymeric strut echogenicity ( y = −0.159 x − 6.85; r = −0.781, P < 0.001). Scaffolded segments with vasoconstriction to Ach had larger vessel areas (14.37 ± 2.50 vs. 11.85 ± 2.54 mm2, P = 0.030), larger plaque burden (57.31 ± 5.96 vs. 49.09 ± 9.10%, P = 0.018), and larger necrotic core (NC) areas [1.39 (+1.14, +1.74) vs. 0.78 mm2 (+0.20, +0.98), P = 0.006] compared with those with vasodilation. Conclusion Vasodilatory response to Ach, in coronary segments scaffolded by the ABSORB BVS device, is associated with a reduction in echogenicity of the scaffold over time, and a low amount of NC. In particular, the latter finding resembles the behaviour of a native coronary artery not caged by an intracoronary device.
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- 2012
26. Evaluation of the Second Generation of a Bioresorbable Everolimus-Eluting Vascular Scaffold for the Treatment of De Novo Coronary Artery Stenosis
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Dougal McClean, Pieter C. Smits, John A. Ormiston, Hector M. Garcia-Garcia, Leif Thuesen, Cecile Dorange, Stephan Windecker, Krishnankutty Sudhir, Susan Veldhof, Bernard De Bruyne, Karine Miquel Hebert, Robert Whitbourn, Jacques J. Koolen, Dariusz Dudek, Ian T Meredith, Yoshinobu Onuma, Robert-Jan van Geuns, Bernard Chevalier, and Patrick W. Serruys
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medicine.medical_specialty ,Everolimus ,medicine.diagnostic_test ,Vascular disease ,business.industry ,medicine.medical_treatment ,Stent ,medicine.disease ,Surgery ,Coronary artery disease ,Sirolimus ,Intravascular ultrasound ,Angiography ,medicine ,Radiology ,Cardiology and Cardiovascular Medicine ,business ,Mace ,medicine.drug - Abstract
Background—The first generation of the bioresorbable everolimus drug-eluting vascular scaffold showed signs of shrinkage at 6 months, which largely contributed to late luminal loss. Nevertheless, late luminal loss was less than that observed with bare metal stents. To maintain the mechanical integrity of the device up to 6 months, the scaffold design and manufacturing process of its polymer were modified. Methods and Results—Quantitative coronary angiography, intravascular ultrasound with analysis of radiofrequency backscattering, and as an optional assessment, optical coherence tomography (OCT) were performed at baseline and at a 6-month follow-up. Forty-five patients successfully received a single bioresorbable everolimus drug-eluting vascular scaffold. One patient had postprocedural release of myocardial enzyme without Q-wave occurrence; 1 patient with OCT-diagnosed disruption of the scaffold caused by excessive postdilatation was treated 1 month later with a metallic drug-eluting stent. At follow-up, ...
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- 2011
27. The Real World Experience of the Everolimus-Eluting Coronary Stent System: Audit of Everolimus-Eluting Coronary Stents
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Dougal McClean, Sally Aldous, David Smyth, J. Blake, and John Elliott
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education.field_of_study ,medicine.medical_specialty ,Acute coronary syndrome ,Everolimus ,business.industry ,medicine.medical_treatment ,Population ,medicine.disease ,Thrombosis ,Surgery ,Restenosis ,Internal medicine ,Coronary stent ,medicine ,Cardiology ,Radiology, Nuclear Medicine and imaging ,Myocardial infarction ,Cardiology and Cardiovascular Medicine ,business ,education ,Adverse effect ,medicine.drug - Abstract
Aims: To investigate the safety and efficacy of everolimus-eluting stents (EES) in a real world population, including those with high-risk characteristics and complex lesions. Methods: In this report, we analyze 2-year outcomes in 500 consecutive unselected patients treated with EES between April 2007 and March 2008. All patients were followed for 2 years for adverse events. Results: There were 995 EES deployed in 792 lesions. The indication for the coronary procedure was acute coronary syndrome in 94.2% of patients. Bifurcations were involved in 21% of lesions, 3.5% degenerated vein grafts, 2.7% left main stem stenoses, 33% multivessel disease, 4.5% in-stent restenosis, and 79.1% AHA/ACC classification B2/C lesions. The major adverse cardiac event rate (composite of cardiovascular death, acute myocardial infarction, target lesion revascularization) was 10.6%. Target lesion revascularization was required in 4.0% patients, 1.4% for in-stent thrombosis. These event rates are comparable with studies involving lower risk patients and less complex coronary lesions. Conclusion: The use of EES, even in this real world, high-risk population, continues to demonstrate safety and efficacy rates comparable with current studies in more selected patient groups and, therefore, may justify current practice to utilize EES in “off label” situations. (J Interven Cardiol 2011;24:241–246)
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- 2011
28. Comparison of in vivo acute stent recoil between the bioresorbable everolimus-eluting coronary scaffolds (revision 1.0 and 1.1) and the metallic everolimus-eluting stent
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Stephan Windecker, Dariusz Dudek, Leif Thuesen, Bernard Chevalier, Yoshinobu Onuma, John A. Ormiston, Patrick W. Serruys, Ian T Meredith, Dougal McClean, Josep Gomez, Robert Whitbourn, Jacques J. Koolen, Peter Smits, Bernard De Bruyne, Hector M. Garcia-Garcia, and Cardiology
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Male ,medicine.medical_specialty ,medicine.medical_treatment ,Everolimus eluting stent ,Biocompatible Materials ,Coronary Angiography ,Prosthesis Design ,Mechanical strength ,Odds Ratio ,Pressure ,Humans ,Medicine ,Radiology, Nuclear Medicine and imaging ,Everolimus ,Angioplasty, Balloon, Coronary ,Aged ,Sirolimus ,business.industry ,Australia ,Coronary Stenosis ,Percutaneous coronary intervention ,Stent ,Cardiovascular Agents ,Drug-Eluting Stents ,General Medicine ,Middle Aged ,Surgery ,Europe ,Logistic Models ,Treatment Outcome ,Metals ,Female ,Stress, Mechanical ,Cardiology and Cardiovascular Medicine ,business ,New Zealand ,medicine.drug - Abstract
Objectives: The ABSORB cohort A trial using the bioresorbable everolimus-eluting scaffold (BVS revision 1.0, Abbott Vascular) demonstrated a slightly higher acute recoil with BVS than with metallic stents. To reinforce the mechanical strength of the scaffold, the new BVS scaffold (revision 1.1) with modified strut design was developed and tested in the ABSORB cohort B trial. This study sought to evaluate and compare the in vivo acute scaffold recoil of the BVS revision 1.0 in ABSORB cohort A and the BVS revision 1.1 in ABSORB cohort B with the historical recoil of the XIENCE V (R) everolimuseluting metal stent (EES, SPIRIT I and II). Methods: In the ABSORB cohort B trial, 101 patients with one or two de-novo lesions were enrolled at 10 sites. In ABSORB cohort A, 27 patients treated with a BVS 1.0 were analyzed and compared with EES. Acute absolute recoil, assessed by quantitative coronary angiography, was defined as the difference between mean diameter of the last inflated balloon at the highest pressure (X) and mean lumen diameter of the stent immediately after the last balloon deflation (Y). Acute percent recoil was defined as (X - Y)/X and expressed as a percentage. Results: Out of 101 patients enrolled in the ABSORB cohort B trial, 88 patients are available for complete analysis of acute recoil. Absolute recoil of BVS 1.1 (0.19 +/- 0.18 mm) was numerically higher than metallic EES (vs. 0.13 +/- 0.21 mm) and similar to BVS 1.0 (0.20 +/- 0.21 mm) but the differences did not reach statistical significance (P = 0.40). The acute percent recoil demonstrated the same trend (EES: 4.3% +/- 7.1%, BVS 1.0: 6.9% +/- 7.0%, BVS 1.1: 6.7% +/- 6.4%, P = 0.22). In the multivariate regression model, high balloon/artery ratio (>1.1) (OR 1.91 [1.34-2.71]) was the predictive for high absolute recoil (>0.27 mm) while (larger) preprocedural MLD was protective (OR 0.84 [0.72-0.99]). The stent/scaffold type was not a predictor of acute recoil. Conclusions: The average in vivo acute scaffold recoil of the BVS 1.1 is slightly higher than the metallic EES. However, the scaffold/stent type was not predictive of high acute recoil, while implantation in undersized vessels or usage of oversized devices might confound the results. (C) 2011 Wiley-Liss, Inc.
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- 2011
29. Evaluation of the Second Generation of a Bioresorbable Everolimus Drug-Eluting Vascular Scaffold for Treatment of De Novo Coronary Artery Stenosis
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Ian T. Meredith, Karine Miquel-Hebert, Evelyn Regar, Richard Rapoza, Pieter C. Smits, Stephan Windecker, Susan Veldhof, Hector M. Garcia-Garcia, Bernard De Bruyne, John A. Ormiston, Leif Thuesen, Yoshinobu Onuma, Dariusz Dudek, Dougal McClean, Cecile Dorange, Robert Whitbourn, Jacques J. Koolen, Bernard Chevalier, Patrick W. Serruys, and Cardiology
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Male ,medicine.medical_specialty ,Scaffold ,optical coherence ,Time Factors ,Polymers ,medicine.medical_treatment ,tomography ,coronary disease ,Coronary Angiography ,Restenosis ,Physiology (medical) ,Absorbable Implants ,Intravascular ultrasound ,Humans ,Medicine ,angiography ,Everolimus ,Aged ,Retrospective Studies ,Ultrasonography ,Bioresorbable vascular scaffold ,Sirolimus ,Tissue Scaffolds ,medicine.diagnostic_test ,ultrasound ,business.industry ,Coronary Stenosis ,Late Lumen Loss ,Stent ,Drug-Eluting Stents ,Middle Aged ,medicine.disease ,Coronary Vessels ,Treatment Outcome ,medicine.anatomical_structure ,Female ,Radiology ,Cardiology and Cardiovascular Medicine ,business ,Tomography, Optical Coherence ,Follow-Up Studies ,medicine.drug ,Artery - Abstract
Background— The first generation of the bioresorbable everolimus drug-eluting vascular scaffold showed signs of shrinkage at 6 months, which largely contributed to late luminal loss. Nevertheless, late luminal loss was less than that observed with bare metal stents. To maintain the mechanical integrity of the device up to 6 months, the scaffold design and manufacturing process of its polymer were modified. Methods and Results— Quantitative coronary angiography, intravascular ultrasound with analysis of radiofrequency backscattering, and as an optional assessment, optical coherence tomography (OCT) were performed at baseline and at a 6-month follow-up. Forty-five patients successfully received a single bioresorbable everolimus drug-eluting vascular scaffold. One patient had postprocedural release of myocardial enzyme without Q-wave occurrence; 1 patient with OCT-diagnosed disruption of the scaffold caused by excessive postdilatation was treated 1 month later with a metallic drug-eluting stent. At follow-up, 3 patients declined recatheterization, 42 patients had quantitative coronary angiography, 37 had quantitative intravascular ultrasound, and 25 had OCT. Quantitative coronary angiography disclosed 1 edge restenosis (1 of 42; in-segment binary restenosis, 2.4%). At variance with the ultrasonic changes seen with the first generation of bioresorbable everolimus drug-eluting vascular scaffold at 6 months, the backscattering of the polymeric struts did not decrease over time, the scaffold area was reduced by only 2.0% with intravascular ultrasound, and no change was noted with OCT. On an intention-to-treat basis, the late lumen loss amounted to 0.19±0.18 mm with a limited relative decrease in minimal luminal area of 5.4% on intravascular ultrasound. OCT showed at follow-up that 96.8% of the struts were covered and that malapposition of at least 1 strut, initially observed in 12 scaffolds, was detected at follow-up in only 3 scaffolds. Mean neointimal growth measured by OCT between and on top of the polymeric struts equaled 1.25 mm 2 , or 16.6% of the scaffold area. Conclusion— Modified manufacturing process of the polymer and geometric changes in the polymeric platform have substantially improved the medium-term performance of this new generation of drug-eluting scaffold to become comparable to those of current drug eluting stents. Clinical Trial Registration— URL: http://clinicaltrials.gov . Unique identifier: NCT00856856.
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- 2010
30. 3-Dimensional Optical Coherence Tomography Assessment of Jailed Side Branches by Bioresorbable Vascular Scaffolds
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Dougal McClean, Stefan Windecker, Robert Whitbourn, Yoshinobu Onuma, John A. Ormiston, Jacques J. Koolen, Absorb Cohort B Study Investigators, Evelyn Regar, Hector M. Garcia-Garcia, Patrick W. Serruys, Takayuki Okamura, Joanna J. Wykrzykowska, and Leif Thuesen
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medicine.medical_specialty ,medicine.diagnostic_test ,business.industry ,medicine.medical_treatment ,Stent ,Balloon ,Surgery ,Optical coherence tomography ,Drug-eluting stent ,Angioplasty ,Coronary stent ,Cardiovascular agent ,medicine ,Tomography ,business ,Nuclear medicine ,Cardiology and Cardiovascular Medicine - Abstract
OBJECTIVES: The purpose of this study is to assess jailing of side branches (SB) by the everolimus-eluting, bioresorbable vascular scaffold (BVS) with 3-dimensional (3D) optical coherence tomography (OCT) reconstruction. BACKGROUND: Because BVS struts at the SB orifice are suspected of being bioresorbed and/or forming a neointimal bridge, OCT has been used to evaluate the struts in detail at that particular site. Our understanding of the 3D relationship of the strut and the SB orifice is limited by the use of 2-dimensional OCT images. Fourier-domain OCT enables reliable 3D reconstruction of coronary vessels. METHODS: The ABSORB Cohort B (A Clinical Evaluation of the Bioabsorbable Everolimus Eluting Coronary Stent System in the Treatment of Patients With de Novo Native Coronary Artery Lesions) trial is a multicenter single-arm trial to assess the safety and performance of the BVS. Fourier-domain OCT pullbacks (C7-XR system, LightLab Imaging Inc., Westford, Massachusetts) are obtained at pullback speed of 20 mm/s and 3D renderings are performed. The orifices of the SB are assessed visually. The area of SB orifice and the number of strut-free compartments delineated by the BVS struts are evaluated. RESULTS: Fifty-one OCT pullbacks were acquired: 33 pullbacks were imaged with Fourier-domain OCT and 27 treated segments had 46 side branches. Three-dimensional assessment was feasible in 87% (40 of 46) of pullbacks. The mean area of the SB orifice was 1.16 +/- 1.02 mm(2). The mean number of strut-free compartments was 2.0 +/- 1.1. The classification of the overhanging struts is proposed. CONCLUSIONS: This study demonstrates that 3D OCT reconstruction is feasible to evaluate the orifices of SB jailed with BVS. (ABSORB Clinical Investigation, Cohort B; NCT00856856).
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- 2010
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31. Factors Influencing Local and Systemic Levels of Plasma Myeloperoxidase in ST-Segment Elevation Acute Myocardial Infarction
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Christine C. Winterbourn, Mark Nallaratnam, Tessa J. Mocatta, Dougal McClean, John Elliott, Catriona J. Marshall, Anthony J. Kettle, J. Blake, David Smyth, and Mark Richards
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Adult ,Male ,medicine.medical_specialty ,Neutrophils ,medicine.medical_treatment ,Myocardial Infarction ,Enzyme-Linked Immunosorbent Assay ,Femoral artery ,Statistics, Nonparametric ,Coronary circulation ,Coronary Circulation ,Internal medicine ,medicine.artery ,medicine ,Humans ,ST segment ,cardiovascular diseases ,Myocardial infarction ,Angioplasty, Balloon, Coronary ,Aged ,Peroxidase ,Aged, 80 and over ,biology ,Heparin ,business.industry ,ST elevation ,Anticoagulants ,Percutaneous coronary intervention ,Middle Aged ,medicine.disease ,surgical procedures, operative ,medicine.anatomical_structure ,Myeloperoxidase ,Circulatory system ,Linear Models ,Cardiology ,biology.protein ,Female ,Endothelium, Vascular ,Cardiology and Cardiovascular Medicine ,business - Abstract
Myeloperoxidase (MPO) is associated with risk in acute coronary syndromes. However, the precise role it plays in ST-elevation myocardial infarction (STEMI) remains unclear. In this study we tested the hypothesis that levels of MPO in plasma after a myocardial infarction are affected by its ability to bind to the endothelium and there is local release of the enzyme at the culprit lesion. We measured plasma MPO in systemic circulation and throughout the coronary circulation in patients with STEMI undergoing primary percutaneous coronary intervention (PCI). MPO levels at the femoral artery were higher (p0.001) in patients with STEMI (n = 67, median 45 ng/ml, interquartile range 34 to 83) compared to control patients (n = 12, 25 ng/ml, 19 to 30) with chronic stable angina undergoing elective PCI. After administration of the anticoagulant bivalirudin in 13 patients with STEMI, plasma MPO was increased only at the culprit coronary artery lesion before PCI (178 ng/ml, 91 to 245) versus all other sites (femoral artery 86 ng/ml, 54 to 139, p = 0.019). Administration of heparin caused a marked increase of plasma MPO. Even so, it was still possible to detect an increase of plasma MPO at culprit lesion in patients with STEMI (n = 54, 171 ng/ml, 122 to 230) versus controls (n = 12, 136 ng/ml, 109 to 151, p0.05) after heparin and before PCI. MPO levels were higher at the culprit lesion in patients with STEMI who presented early and in those with restricted flow (p0.05). In conclusion, our results demonstrate that, in addition to a systemic increase of MPO in patients presenting early with STEMI, levels of this leukocyte enzyme are increased at the culprit coronary lesion before PCI.
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- 2010
32. A myeloperoxidase precursor, pro-myeloperoxidase, is present in human plasma and elevated in cardiovascular disease patients
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Anthony J. Kettle, Christian Obinger, Tessa J. Mocatta, Dougal McClean, Irada Khalilova, Nina Dickerhof, and Catriona J. Bhagra
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0301 basic medicine ,Halogenation ,Physiology ,Neutrophils ,animal diseases ,Myocardial Infarction ,lcsh:Medicine ,Cardiovascular Medicine ,White Blood Cells ,0302 clinical medicine ,Animal Cells ,Cricetinae ,Blood plasma ,Medicine and Health Sciences ,Myocardial infarction ,lcsh:Science ,Enzyme Precursors ,Multidisciplinary ,biology ,Chinese hamster ovary cell ,Body Fluids ,Precipitation Techniques ,Immunoblot Analysis ,Leukemia ,Blood ,medicine.anatomical_structure ,Cardiovascular Diseases ,030220 oncology & carcinogenesis ,Myeloperoxidase ,Rabbits ,Anatomy ,Cellular Types ,Oxidation-Reduction ,Research Article ,medicine.medical_specialty ,Immunoprecipitation ,Immune Cells ,Immunoblotting ,Immunology ,Cardiology ,Molecular Probe Techniques ,HL-60 Cells ,CHO Cells ,Oxidative phosphorylation ,Research and Analysis Methods ,Blood Plasma ,03 medical and health sciences ,Cricetulus ,Affinity Purification ,Internal medicine ,medicine ,Animals ,Humans ,Amino Acid Sequence ,Molecular Biology Techniques ,Molecular Biology ,Peroxidase ,Blood Cells ,business.industry ,Macrophages ,lcsh:R ,Biology and Life Sciences ,Cell Biology ,medicine.disease ,030104 developmental biology ,Endocrinology ,biology.protein ,lcsh:Q ,Bone marrow ,business ,Purification Techniques - Abstract
Myeloperoxidase (MPO)-derived oxidants have emerged as a key contributor to tissue damage in inflammatory conditions such as cardiovascular disease. Pro-myeloperoxidase (pro-MPO), an enzymatically active precursor of myeloperoxidase (MPO), is known to be secreted from cultured bone marrow and promyelocytic leukemia cells, but evidence for the presence of pro-MPO in circulation is lacking. In the present study, we used a LC-MS/MS in addition to immunoblot analyses to show that pro-MPO is present in human blood plasma. Furthermore, we found that pro-MPO was more frequently detected in plasma from patients with myocardial infarction compared to plasma from control donors. Our study suggests that in addition to mature MPO, circulating pro-MPO may cause oxidative modifications of proteins thereby contributing to cardiovascular disease.
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- 2018
33. Cut-off Values in Coronary Physiology: Does One Size Fit All Vessels?
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C. McAlister, A. Puri, C. Greer, Dougal McClean, Toby Verryt, Bijan Jahangiri, John Elliott, J. Blake, David Smyth, and J. Sutherland
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Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,business.industry ,Internal medicine ,medicine ,Cardiology ,business ,Coronary physiology ,Cardiology and Cardiovascular Medicine - Published
- 2018
34. Instantaneous Wave-Free Ratio Guided Management of Coronary Lesions - A Single Centre Experience
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Jackie Sutherland, Aniket Puri, Bijan Jahangiri, Charlotte Greer, James Blake, Dougal McClean, David Smyth, Toby Verryt, C. McAlister, and John Elliott
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Pulmonary and Respiratory Medicine ,Single centre ,business.industry ,Acoustics ,Medicine ,Instantaneous wave-free ratio ,Cardiology and Cardiovascular Medicine ,business - Published
- 2018
35. PCI Following Bypass Graft Failure is Associated with Poor Clinical Outcomes
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Aniket Puri, David Smyth, Dougal McClean, James Blake, John Elliott, and C. McAlister
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010309 optics ,Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,Graft failure ,business.industry ,0103 physical sciences ,Conventional PCI ,medicine ,Cardiology and Cardiovascular Medicine ,business ,01 natural sciences ,Surgery - Published
- 2018
36. Angiographic Characteristics of Spontaneous Coronary Artery Dissection
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David Smyth, Dougal McClean, A. Puri, J. Blake, C. McAlister, C. Greer, B. Jahingiri, and John Elliott
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Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,business.industry ,Internal medicine ,Cardiology ,Medicine ,Cardiology and Cardiovascular Medicine ,business ,Artery dissection - Published
- 2018
37. Instantaneous Wave-Free Ratio Guided Management of Angiographically Intermediate Coronary Lesions: A Single-Centre Experience
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John Elliott, Dougal McClean, C. Greer, Toby Verryt, C. McAlister, David Smyth, Bijan Jahangiri, J. Sutherland, J. Blake, and A. Puri
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Pulmonary and Respiratory Medicine ,Single centre ,business.industry ,Medicine ,Instantaneous wave-free ratio ,Cardiology and Cardiovascular Medicine ,Nuclear medicine ,business - Published
- 2018
38. Clinical and Angiographic Results With the Next-Generation Resolute Stent System
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Mark Horrigan, Robert Whitbourn, Darren L. Walters, Resolute Us Investigators, Dougal McClean, Ann DePaoli, Peter J. Fitzgerald, Stephen G. Worthley, Manuela Negoita, Donald E. Cutlip, Jeffrey J. Popma, and Ian T Meredith
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medicine.medical_specialty ,business.industry ,medicine.medical_treatment ,Stent ,medicine.disease ,Revascularization ,Surgery ,Coronary artery disease ,Internal medicine ,Angioplasty ,Cardiovascular agent ,Coronary stent ,medicine ,Cardiology ,Zotarolimus ,Cardiology and Cardiovascular Medicine ,business ,Mace ,medicine.drug - Abstract
Objectives The RESOLUTE trial examined the safety and efficacy of a next-generation zotarolimus-eluting coronary stent, Resolute (Medtronic CardioVascular Inc., Santa Rosa, California). Background Revascularization benefits associated with current drug-eluting stents are often diminished in the presence of complex coronary lesions and in certain patient cohorts. Resolute uses a new proprietary polymer coating that extends the duration of drug delivery to match the longer healing duration often experienced in more complex cases. Methods The RESOLUTE trial was a prospective, nonrandomized, multicenter study of the Resolute stent in 139 patients with de novo coronary lesions with reference vessel diameters ≥2.5 and ≤3.5 mm and lesion length ≥14 and ≤27 mm. The primary end point was 9-month in-stent late lumen loss by quantitative coronary angiography. Secondary end points included major adverse cardiac events (MACE) at 30 days, 6, 9, and 12 months; acute device, lesion, and procedure success; and 9-month target vessel failure (TVF), target lesion revascularization (TLR), stent thrombosis, neointimal hyperplastic (NIH) volume, and percent NIH volume obstruction. Results The 9-month in-stent late lumen loss was 0.22 ± 0.27 mm. Cumulative MACE were 4.3%, 4.3%, 7.2%, and 8.7% at 30 days, 6, 9, and 12 months, respectively. Acute lesion, procedure, and device success rates were 100.0%, 95.7%, and 99.3%, respectively. At 9 months, TLR was 0.0%, TVF was 6.5%, stent thrombosis was 0.0%, NIH volume was 6.55 ± 7.83 mm 3 , and percent NIH volume obstruction was 3.73 ± 4.05%. Conclusions In this feasibility study, the Resolute stent demonstrated low in-stent late lumen loss, minimal neointimal hyperplastic ingrowth, low TLR, no stent thrombosis, and acceptable TVF and MACE. (The RESOLUTE Clinical Trial; NCT00248079 )
- Published
- 2009
39. Direct Stenting With the TAXUS Liberté Drug-Eluting Stent
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Louis Cannon, John A. Ormiston, Ehtisham Mahmud, Lazar Mandinov, Dougal McClean, Tift Mann, Neil J. Weissman, Soo-Teik Lim, Jack J. Hall, Michael J. Lucca, David Dobies, Mark Turco, Donald S. Baim, and Jeffrey J. Popma
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medicine.medical_specialty ,biology ,business.industry ,medicine.medical_treatment ,Stent ,equipment and supplies ,biology.organism_classification ,medicine.disease ,Confidence interval ,Surgery ,Taxus ,Restenosis ,Drug-eluting stent ,Inclusion and exclusion criteria ,Coronary stent ,medicine ,Radiology ,business ,Cardiology and Cardiovascular Medicine ,Mace - Abstract
Objectives This study was conducted to determine whether direct stenting with TAXUS Liberte is noninferior to stenting after pre-dilation. Background Direct stenting is performed in approximately 30% of patients, but data on clinical and angiographic outcomes with drug-eluting stents are limited. Methods The TAXUS ATLAS DIRECT STENT is a single-arm, multicenter study that enrolled patients with de novo coronary lesions visually estimated to be 10 to 28 mm in length in vessels 2.5 to 4.0 mm in diameter. The control group is the quantitative coronary angiography (QCA) subset of the TAXUS ATLAS trial, which used identical inclusion and exclusion criteria but mandated pre-dilation. The primary end point is 9-month analysis-segment percent diameter stenosis (%DS). Results Baseline patient characteristics were similar between the groups. On QCA analysis, significantly shorter lesions with larger lumen diameter and less calcification were observed in the direct stent group. Direct stenting was successful in 97.6% of patients and was associated with a shorter procedure time and fewer complications. Follow-up %DS was noninferior for direct stent (26.41%) versus pre-dilation (29.14%) with a 1-sided 95% confidence interval of the difference between the groups (−0.34%) well below the pre-specified noninferiority margin (6.75%). Additionally, significantly lower restenosis (5.9% vs. 11.4%, p = 0.0229) and target lesion revascularization (TLR) 2.9% vs. 7.8%, p = 0.0087) rates were seen for direct stent versus pre-dilation. Conclusions Direct stenting of TAXUS Liberte is feasible and highly successful in carefully selected lesions. Direct stenting is noninferior to stenting after pre-dilation on the basis of %DS and can significantly reduce procedural time, procedural complications, and possibly angiographic restenosis and TLR. (TAXUS Liberte-SR Paclitaxel-Eluting Coronary Stent System; NCT00371423).
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- 2008
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40. A Polylactide Bioresorbable Scaffold Eluting Everolimus for Treatment of Coronary Stenosis: 5-Year Follow-Up
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Patrick W, Serruys, John, Ormiston, Robert-Jan, van Geuns, Bernard, de Bruyne, Dariusz, Dudek, Evald, Christiansen, Bernard, Chevalier, Pieter, Smits, Dougal, McClean, Jacques, Koolen, Stephan, Windecker, Robert, Whitbourn, Ian, Meredith, Luc, Wasungu, Divine, Ediebah, Susan, Veldhof, and Yoshinobu, Onuma
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Male ,Time Factors ,Tissue Scaffolds ,Incidence ,Polyesters ,Coronary Stenosis ,Drug-Eluting Stents ,Middle Aged ,Coronary Angiography ,Prosthesis Design ,Coronary Vessels ,Europe ,Survival Rate ,Postoperative Complications ,Treatment Outcome ,Cause of Death ,Absorbable Implants ,Humans ,Female ,Everolimus ,Immunosuppressive Agents ,Tomography, Optical Coherence ,Ultrasonography, Interventional ,Aged ,Follow-Up Studies - Abstract
Long-term benefits of coronary stenosis treatment with an everolimus-eluting bioresorbable scaffold are unknown.This study sought to evaluate clinical and imaging outcomes 5 years after bioresorbable scaffold implantation.In the ABSORB multicenter, single-arm trial, 45 (B1) and 56 patients (B2) underwent coronary angiography, intravascular ultrasound (IVUS), and optical coherence tomography (OCT) at different times. At 5 years, 53 patients without target lesion revascularization underwent final imaging.Between 6 months/1 year and 5 years, angiographic luminal late loss remained unchanged (B1: 0.14 ± 19 mm vs. 0.13 ± 0.33 mm; p = 0.7953; B2: 0.23 ± 0.28 mm vs. 0.18 ± 0.32 mm; p = 0.5685). When patients with a target lesion revascularization were included, luminal late loss was 0.15 ± 0.20 mm versus 0.15 ± 0.24 mm (p = 0.8275) for B1 and 0.30 ± 0.37 mm versus 0.32 ± 0.48 mm (p = 0.8204) for B2. At 5 years, in-scaffold and -segment binary restenosis was 7.8% (5 of 64) and 12.5% (8 of 64). On IVUS, the minimum lumen area of B1 decreased from 5.23 ± 0.97 mm(2) at 6 months to 4.89 ± 1.81 mm(2) at 5 years (p = 0.04), but remained unchanged in B2 (4.95 ± 0.91 mm(2) at 1 year to 4.84 ± 1.28 mm(2) at 5 years; p = 0.5). At 5 years, struts were no longer discernable by OCT and IVUS. On OCT, the minimum lumen area in B1 decreased from 4.51 ± 1.28 mm(2) at 6 months to 3.65 ± 1.39 mm(2) at 5 years (p = 0.01), but remained unchanged in B2, 4.35 ± 1.09 mm(2) at 1 year and 4.12 ± 1.38 mm(2) at 5 years (p = 0.24). Overall, the 5-year major adverse cardiac event rate was 11.0%, without any scaffold thrombosis.At 5 years, bioresorbable scaffold implantation in a simple stenotic lesion resulted in stable lumen dimensions and low restenosis and major adverse cardiac event rates. (ABSORB Clinical Investigation, Cohort B [ABSORB B]; NCT00856856).
- Published
- 2015
41. Evaluation of a crystalline sirolimus-eluting coronary stent with a bioabsorbable polymer designed for rapid dissolution: two-year outcomes from the DESSOLVE I and II trials
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Pieter R. Stella, John A. Ormiston, Leszek Zagozdzon, Charlene Knape, William Wijns, Marie-Claude Morice, Dougal McClean, Maarten J. Suttorp, and Dennis Donohoe
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Target lesion ,Male ,medicine.medical_specialty ,Polymers ,medicine.medical_treatment ,Target vessel ,030204 cardiovascular system & hematology ,Bioabsorbable polymer ,Time ,03 medical and health sciences ,0302 clinical medicine ,Percutaneous Coronary Intervention ,Internal medicine ,Coronary stent ,Absorbable Implants ,medicine ,Humans ,cardiovascular diseases ,030212 general & internal medicine ,Aged ,Sirolimus ,business.industry ,Stent ,Drug-Eluting Stents ,Middle Aged ,Clinical trial ,Treatment Outcome ,Solubility ,Cardiology ,Female ,Cardiology and Cardiovascular Medicine ,business ,Mace ,medicine.drug - Abstract
Aims Our aim was to evaluate the two-year clinical results of a new sirolimus-eluting stent (MiStent SES) with a bioabsorbable coating designed for rapid polymer dissolution but sustained drug delivery. Methods and results Major adverse cardiac events (MACE), target lesion failure (TLF), target vessel failure (TVF), and stent thrombosis (ST) at two-year follow-up are reported for the DESSOLVE I and II trials. In DESSOLVE I, the MiStent SES (n=29) demonstrated a 3.4% two-year MACE rate without TLF or TVF. In DESSOLVE II, the MiStent group had a 6.7% (8/120) two-year MACE rate compared to 13.3% (8/60) for Endeavor (p=0.167). TLF was 5.0% in the MiStent and Endeavor groups (p=1.00). TVF was 5.0% for MiStent versus 11.7% for Endeavor (p=0.129). No probable or definite ST was reported with the MiStent up to two years. The median duration of dual antiplatelet therapy (DAPT) in DESSOLVE I and II was 364 and 366 days, respectively. Conclusions The MiStent SES demonstrated good long-term safety and effectiveness with low two-year MACE, TLF, and TVF rates.
- Published
- 2015
42. NINE-MONTH PRIMARY ENDPOINT RESULTS OF THE EVOLVE II QCA STUDY: A PROSPECTIVE, MULTICENTER TRIAL ASSESSING CLINICAL, ANGIOGRAPHIC, AND INTRAVASCULAR ULTRASOUND OUTCOMES WITH THE NOVEL PLATINUM-CHROMIUM ABLUMINALLY-COATED BIOABSORBABLE POLYMER SYNERGY EVEROLIMUS-ELUTING STENT IN DE NOVO CORONARY STENOSES
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Dominic J. Allocco, Ian T. Meredith, Darren L. Walters, Douglas Scott, Huay-Cheem Tan, Warwick M. Jaffe, John A. Ormiston, Seif El-Jack, Alan Whelan, Keith D. Dawkins, Shigeru Saito, Aaron K. Wong, Dougal McClean, and Mark Webster
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medicine.medical_specialty ,medicine.diagnostic_test ,business.industry ,Everolimus eluting stent ,Multicenter trial ,Intravascular ultrasound ,medicine ,Clinical endpoint ,Radiology ,business ,Bioabsorbable polymer ,Cardiology and Cardiovascular Medicine - Published
- 2015
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43. Incidence and Potential Mechanism(s) of Post-Procedural Rise of Cardiac Biomarker in Patients With Coronary Artery Narrowing After Implantation of an Everolimus-Eluting Bioresorbable Vascular Scaffold or Everolimus-Eluting Metallic Stent
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Luc Wasungu, Takashi Muramatsu, Bernard Chevalier, Dariusz Dudek, Ad J. van Boven, Shimpei Nakatani, Yohei Sotomi, Yun Kyeong Cho, Manel Sabaté, Karine Miquel-Hebert, Pannipa Suwannasom, Hector M. Garcia-Garcia, Patrick W. Serruys, Jan J. Piek, Andreas Baumbach, Maik J. Grundeken, Dougal McClean, Yuki Ishibashi, Yoshinobu Onuma, Steffen Helqvist, Manuel de Sousa Almeida, Cardiology, Graduate School, and Amsterdam Cardiovascular Sciences
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Male ,Time Factors ,medicine.medical_treatment ,Myocardial Infarction ,Infarction ,Coronary Artery Disease ,Coronary Angiography ,Risk Factors ,Absorbable Implants ,Odds Ratio ,Creatine Kinase, MB Form ,Single-Blind Method ,Myocardial infarction ,Prospective Studies ,biology ,Incidence ,Drug-Eluting Stents ,bioresorbable scaffold ,Middle Aged ,cardiac biomarker ,Troponin ,Up-Regulation ,Europe ,Treatment Outcome ,Metals ,Cardiology ,Female ,Cardiology and Cardiovascular Medicine ,TIMI ,medicine.drug ,medicine.medical_specialty ,periprocedural myocardial infarction ,Prosthesis Design ,device overlap ,Percutaneous Coronary Intervention ,Internal medicine ,Coronary stent ,medicine ,Humans ,Everolimus ,Aged ,business.industry ,Unstable angina ,Stent ,Cardiovascular Agents ,medicine.disease ,Logistic Models ,Multivariate Analysis ,biology.protein ,Creatine kinase ,business ,Biomarkers ,New Zealand - Abstract
OBJECTIVES This study sought to evaluate the mechanism of post-procedural cardiac biomarker (CB) rise following device implantation. BACKGROUND A fully bioresorbable Absorb scaffold, compared with everolimus-eluting metallic stents (EES), might be associated with a higher incidence of periprocedural myocardial injury. METHODS In 501 patients with stable or unstable angina randomized to either Absorb (335 patients) or EES (n = 166) in the ABSORB II trial, 3 types of CB (creatine kinase, creatine kinase-myocardial band, and troponin) were obtained before and after procedure. Per protocol, periprocedural myocardial infarction (PMI) was defined as creatine kinase rise >2x the upper limit of normal with creatine kinase-myocardial band rise. RESULTS Incidence of side branch occlusion and any anatomic complications assessed by angiography was similar between the 2 treatment arms (side branch occlusion: Absorb: 5.3% vs. Xience: 7.6%, p = 0.07; any anatomic complication: Absorb: 16.4% vs. EES: 19.9%, p = 0.39). Fourteen patients who presented with recent myocardial infarction at entry with normalized creatine kinase-myocardial band according to the protocol were excluded for post-CB analysis. The overall compliance for CB was 97.8%. The CB rise subcategorized in 7 different ranges was comparable between the 2 treatment arms. PMI rate was numerically higher in the Absorb arm according to the per-protocol definitions, and treatment with overlapping devices was the only independent determinant of per-protocol PMI (odds ratio: 5.07, 95% confidence interval: 1.78 to 14.41, p = 0.002). CONCLUSIONS There were no differences in the incidence of CB rise and PMI between Absorb and EES. Device overlap might be a precipitating factor of myocardial injury. (ABSORB II Randomized Clinical Trial: A Clinical Evaluation to Compare the Safety, Efficacy, and Performance of Absorb Everolimus Eluting Bioresorbable Vascular Scaffold System Against Xience Everolimus Eluting Coronary Stent System in the Treatment of Subjects With Ischemic Heart Disease Caused by De Novo Native Coronary Artery Lesions [ABSORB II]; NCT01425281). (C) 2015 by the American College of Cardiology Foundation.
- Published
- 2015
44. Bioresorbable vascular scaffold treatment induces the formation of neointimal cap that seals the underlying plaque without compromising the luminal dimensions: a concept based on serial optical coherence tomography data
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Robert Whitbourn, Jacques J. Koolen, Hector M. Garcia-Garcia, John A. Ormiston, Yoshinobu Onuma, Roberto Diletti, Susan Veldhof, Stephan Windecker, Vasim Farooq, Richard Rapoza, Jurgen Ligthart, Bernard Chevalier, Robert-Jan van Geuns, Alexander Sheehy, Dougal McClean, Yao-Jun Zhang, Shimpei Nakatani, Patrick W. Serruys, Christos V. Bourantas, and Cardiology
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Male ,Neointima ,medicine.medical_specialty ,Time Factors ,medicine.medical_treatment ,Lumen (anatomy) ,Coronary Artery Disease ,Coronary Angiography ,Prosthesis Design ,Coronary artery disease ,Percutaneous Coronary Intervention ,Optical coherence tomography ,Predictive Value of Tests ,Absorbable Implants ,medicine ,Humans ,Bare metal ,Aged ,Bioresorbable vascular scaffold ,Clinical Trials as Topic ,medicine.diagnostic_test ,business.industry ,digestive, oral, and skin physiology ,Follow up studies ,Percutaneous coronary intervention ,Middle Aged ,medicine.disease ,Coronary Vessels ,Fibrosis ,Plaque, Atherosclerotic ,Surgery ,Phenotype ,Treatment Outcome ,Metals ,Female ,Stents ,Cardiology and Cardiovascular Medicine ,business ,Nuclear medicine ,Tomography, Optical Coherence ,Follow-Up Studies - Abstract
Aims: To evaluate the implications of an Absorb bioresorbable vascular scaffold (Absorb BVS) on the morphology of the superficial plaques. Methods and results: Forty-six patients who underwent Absorb BVS implantation and 20 patients implanted with bare metal stents (BMS) who had serial optical coherence tomographic examination at baseline and follow-up were included in this analysis. The thin-capped fibroatheromas (TCFA) were identified in the device implantation regions and in the adjacent native coronary segments. Within all regions, circumferential locations of TCFA and calcific tissues were identified, and the neointimal thickness was measured at follow-up. At six to 12-month follow-up, only 8% of the TCFA detected at baseline were still present in the Absorb BVS and 27% in the BMS implantation segment (p=0.231). Sixty percent of the TCFA in native segments did not change their phenotype at follow-up. At short-term follow-up, significant reduction in the lumen area of the BMS was noted, which was higher compared to that reported in the Absorb BVS group (-2.11 +/- 1.97 mm(2) vs. -1.34 +/- 0.99 mm(2), p=0.026). In Absorb BVS, neointima tissue continued to develop at midterm follow-up (2.17 +/- 0.48 mm(2) vs. 1.38 +/- 0.52 mm(2), p
- Published
- 2015
45. Noninvasive Calibration of Cardiac Pressure Transducers in Patients With Heart Failure: An Aid to Implantable Hemodynamic Monitoring and Therapeutic Guidance
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Henry Krum, Robert N. Doughty, Jay Ritzema-Carter, Aamer H. Jamali, Joseph Aragon, Saibal Kar, Dougal McClean, Richard W. Troughton, William T. Abraham, Neal L. Eigler, and James S. Whiting
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Male ,medicine.medical_specialty ,Valsalva Maneuver ,medicine.medical_treatment ,Respiratory System ,Diastole ,Hemodynamics ,Blood Pressure ,Intracardiac pressure ,Ventricular Function, Left ,Coronary Circulation ,Internal medicine ,Pressure ,Transducers, Pressure ,Valsalva maneuver ,Humans ,Medicine ,Pulmonary Wedge Pressure ,Pulmonary wedge pressure ,Aged ,Monitoring, Physiologic ,Heart Failure ,business.industry ,Heart ,Stroke Volume ,Prostheses and Implants ,Middle Aged ,medicine.disease ,Blood pressure ,Heart failure ,Calibration ,Ventricular pressure ,Cardiology ,Female ,Cardiology and Cardiovascular Medicine ,business - Abstract
Background Implantable cardiac pressure monitors require assurance of calibration. This study evaluated if airway pressure responses during Valsalva maneuver (VM) can be used for calibrating intracardiac pressure transducers. Methods and Results Thirty-eight heart failure patients performed VMs while cardiac and airway pressures were recorded. Patients were designated as Lower (L) if baseline PCW was
- Published
- 2006
46. The Effect of Variable Dose and Release Kinetics on Neointimal Hyperplasia Using a Novel Paclitaxel-Eluting Stent Platform
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Frank Litvack, Dougal McClean, Patrick W. Serruys, Louise Gambone, Janette Symons, Jiro Aoki, Alexandre Abizaid, Eduardo Sousa, Georgios Sianos, Peter den Heijer, Stefan Verheye, Jorge A. Belardi, Marco Bressers, Jose F. Condado, Michel Pieper, Hans Bonnier, and Pieter C. Smits
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Neointimal hyperplasia ,medicine.medical_specialty ,medicine.diagnostic_test ,business.industry ,medicine.medical_treatment ,Urology ,Stent ,equipment and supplies ,medicine.disease ,Surgery ,chemistry.chemical_compound ,Pharmacokinetics ,Paclitaxel ,chemistry ,Drug-eluting stent ,Drug delivery ,Intravascular ultrasound ,medicine ,cardiovascular diseases ,business ,Cardiology and Cardiovascular Medicine ,Mace - Abstract
Objectives The aim of this study was to evaluate the effect of variable dose and release kinetics of paclitaxel on neointimal hyperplasia. Background Conventional paclitaxel-eluting stents use a durable polymer coating as a vehicle for drug delivery. The Conor stent (Conor Medsystems, Menlo Park, California) with intra-strut wells and erodable polymer is specifically designed for drug delivery with programmable pharmacokinetics. Methods Two hundred and forty-four patients with single vessel disease received either a bare metal Conor stent (n = 53) or one of six different release formulations that varied in dose (10 or 30 μg) and elution release kinetics (first order, zero order), direction (abluminal, luminal), and duration (5, 10, and 30 days). End points at six months (bare stent group) and at four months (eluting stent groups) were angiographic late loss and neointimal tissue volume by intravascular ultrasound and the rate of major adverse cardiac events (MACE). Results The lowest in-stent late loss (0.38 mm, p Conclusions This novel eluting stent platform, using an erodable polymer with complete elution of low doses of paclitaxel, is safe. The inhibition of the in-stent neointimal hyperplasia was best in the long release groups.
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- 2005
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47. Local Drug Delivery via a Coronary Stent With Programmable Release Pharmacokinetics
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Namjin Baek, Saibal Kar, Kiron Varghese, Ariel Finkelstein, Raj Makkar, Neal L. Eigler, Kinam Park, Kaname Takizawa, Frank Litvack, Dougal McClean, and Michael C. Fishbein
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Paclitaxel ,Swine ,medicine.medical_treatment ,Coronary Restenosis ,chemistry.chemical_compound ,Coated Materials, Biocompatible ,Restenosis ,Pharmacokinetics ,Physiology (medical) ,Angioplasty ,Coronary stent ,Animals ,Medicine ,Ultrasonography, Interventional ,Vascular Patency ,Drug Implants ,business.industry ,Stent ,Equipment Design ,medicine.disease ,Coronary Vessels ,Biodegradable polymer ,Treatment Outcome ,chemistry ,Delayed-Action Preparations ,Anesthesia ,Models, Animal ,Drug delivery ,Stents ,Tunica Intima ,Cardiology and Cardiovascular Medicine ,business ,Cell Division ,Biomedical engineering - Abstract
Background— Fixed drug release kinetics and vessel wall partitioning may limit the effectiveness of drug-eluting stents. We report preliminary experience using a new coronary stent with programmable pharmacokinetics. Methods and Results— A newly designed metallic stent contains honeycombed strut elements with inlaid stacked layers of drug and polymer. In vitro studies evaluated recipes for loading paclitaxel to establish the parameters for controlling drug release. Manipulation of the layers of biodegradable polymer and drug allowed varying of the initial 24-hour burst release of paclitaxel from 69% to 8.6% ( P P =0.04), a 28% increase in luminal volume (132±12 versus 103±21 mm 3 , P =0.02), and a 50% decrease in histological neointimal area (2.0±0.5 versus 4.0±1.6 mm 2 ; P Conclusions— Layered polymer/drug inlay stent technology permits flexible and controllable pharmacokinetic profiles. Programmable, complex chemotherapy using this approach may be feasible for the treatment of cardiovascular disease.
- Published
- 2003
48. Vasopeptidase inhibition with omapatrilat in chronic heart failure: acute and long-term hemodynamic and neurohumoral effects
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Catherine C Bryson, Sukh Mehta, Hamid Ikram, Rafael F. Sequeira, Eckart Fleck, Dougal McClean, Alan Niederman, Benoit Coutu, Chunlin Qian, Steven N. Singh, James J. Hanyok, Michel Komajda, Peter Hanrath, Michel F. Rousseau, and J.Thomas Heywood
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medicine.medical_specialty ,Time Factors ,Heart disease ,medicine.drug_class ,Pyridines ,Thiazepines ,Hemodynamics ,Double-Blind Method ,Internal medicine ,Natriuretic Peptide, Brain ,Natriuretic peptide ,Medicine ,Humans ,Protease Inhibitors ,Pulmonary Wedge Pressure ,Pulmonary wedge pressure ,Aged ,Heart Failure ,Neurotransmitter Agents ,business.industry ,Middle Aged ,medicine.disease ,medicine.anatomical_structure ,Endocrinology ,Blood pressure ,Heart failure ,Vascular resistance ,Cardiology ,Vascular Resistance ,Omapatrilat ,business ,Cardiology and Cardiovascular Medicine ,Atrial Natriuretic Factor ,medicine.drug - Abstract
OBJECTIVES We investigated the acute and long-term hemodynamic and neurohumoral effects of the vasopeptidase inhibitor omapatrilat in human heart failure. BACKGROUND Angiotensin-converting enzyme (ACE) inhibition constitutes a major advance in the treatment of chronic heart failure (CHF). Simultaneous inhibition of both neutral endopeptidase and ACE with omapatrilat may represent a new treatment strategy in CHF. METHODS Three hundred and sixty-nine patients with symptomatic heart failure were randomized to double-blind treatment with omapatrilat (first 190 patients: 2.5 mg, 5 mg or 10 mg; last 179 patients: 2.5 mg, 20 mg or 40 mg once daily) for 12 weeks. RESULTS Acutely, the 10 mg, 20 mg and 40 rug doses of omapatrilat produced greater reductions in pulmonary capillary, wedge pressure (PCWP), systolic blood pressure (SBP) and systemic vascular resistance compared with 2.5 mg. Higher doses were associated with greater increases in vasodilator and natriuretic peptides, in addition to ACE inhibition. After 12 weeks, omapatrilat 20 mg and 40 mg showed greater fills from baseline in PCWP (40 mg: 0 h to 12 h average change -7.3 +/- 0.8 mm Hg) and SBP (40 mg: -11.7 +/- 1.7 min Hg) than 2.5 mg (both p < 0.01 vs. 2.5 mg). The incidence of adverse experiences and patient withdrawal were similar in all groups. CONCLUSIONS In CHF, the acute hemodynamic benefit seen with higher doses of omapatrilat was associated with increases in plasma vasodilator and natriuretic peptide levels in addition to ACE inhibition. After 12 weeks, the hemodynamic benefit was maintained. Omapatrilat may be a promising new agent in CHF.
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- 2002
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49. TCT-176 Diagnostic Accuracy of Coronary Computed Tomography Angiography for the Evaluation of Bioresorbable Vascular Scaffolds
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Angel Cequier, Patrick W. Serruys, Bernard Chevalier, Jan J. Piek, Yoshinobu Onuma, Ad J. van Boven, Jean Fajadet, Carlos Collet, Antonio L. Bartorelli, Dougal McClean, and Stephan Windecker
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medicine.medical_specialty ,business.industry ,Coronary computed tomography angiography ,Medicine ,Diagnostic accuracy ,Radiology ,Cardiology and Cardiovascular Medicine ,business - Published
- 2017
50. SEQUENTIAL OPTICAL COHERENCE TOMOGRAPHY IMAGING POST PROCEDURE, AT 6, 12, 24 AND 36 MONTHS IN THE ABSORB COHORT B TRIAL: A LIGHT INTENSITY ANALYSIS TO ASSESS THE BIORESORPTION PROCESS OF EVEROLIMUS-ELUTING PLLA SCAFFOLD
- Author
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Dariusz Dudek, Bernard De Bruyne, B Chevalier, Shimpei Nakatani, Pieter C. Smits, John Ormiston, Hector Garcia Garcia, Ian Meredith, Evald Høj Christiansen, Dougal McClean, Jacques Koolen, Robert J. van Geuns, Yuki Ishibashi, Yoshinobu Onuma, Laura Perkins, Patrick W. Serruys, Richard Rapoza, and Stephan Windecker
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medicine.medical_specialty ,Everolimus ,medicine.diagnostic_test ,business.industry ,Post-Procedure ,Plla scaffold ,Surgery ,Light intensity ,Optical coherence tomography ,Cohort ,Medicine ,business ,Cardiology and Cardiovascular Medicine ,Biomedical engineering ,medicine.drug - Published
- 2014
- Full Text
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