Treatment of coronary artery stenosis and coronary arteriovenous fistula by interventional cardiology techniques

Abstract Objective This article investigates the relationship of fractional flow reserve (FFR) with whole blood viscosity (WBV) in patients who were diagnosed with chronic coronary syndrome and significant stenosis in the major coronary arteries and underwent the measurement of FFR. Material and Method In the FFR measurements performed to evaluate the severity of coronary artery stenosis, 160 patients were included in the study and divided into two groups as follows: 80 with significant stenosis and 80 with nonsignificant stenosis. WBVs at low shear rate (LSR) and high shear rate (HSR) were compared between the patients in the significant and nonsignificant coronary artery stenosis groups. Results In the group with FFR < 0.80 and significant coronary artery stenosis, WBV was significantly higher compared with the group with nonsignificant coronary artery stenosis in terms of both HSR (19.33 ± 0.84) and LSR (81.19 ± 14.20) (p < 0.001). In the multivariate logistic regression analysis, HSR and LSR were independent predictors of significant coronary artery stenosis (HSR: odds ratio: 1.67, 95% confidence interval: 1.17–2.64; LSR: odds ratio: 2.46, 95% confidence interval: 2.19–2.78). In the receiver operating characteristic (ROC) curve analysis, when the cutoff value of WBV at LSR was taken as 79.23, it had 58.42% sensitivity and 62.13% specificity for the prediction of significant coronary artery stenosis (area under the ROC curve: 0.628, p < 0.001). Conclusion WBV, an inexpensive biomarker that can be easily calculated prior to coronary angiography, was higher in patients with functionally severe coronary artery stenosis, and thus could be a useful marker in predicting the hemodynamic severity of coronary artery stenosis in patients with chronic coronary syndrome.

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HOW FAST CAN IT GO - RAPIDLY PROGRESSIVE ATHEROSCLEROSIS LEADING TO CATASTROPHIC LEFT MAIN CORONARY ARTERY STENOSIS

Journal of the American College of Cardiology ◽

10.1016/s0735-1097(21)03798-0 ◽

2021 ◽

Vol 77 (18) ◽

pp. 2443

Author(s):

Bilal Saqi ◽

Rahul Gupta ◽

Mario Caruso ◽

Sagar Vadhar ◽

Nikhil Mehta ◽

...

Keyword(s):

Coronary Artery ◽

Left Main Coronary Artery ◽

Coronary Artery Stenosis ◽

Artery Stenosis ◽

Left Main ◽

Main Coronary Artery Stenosis

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Prevalence of pathological FFRCT values without coronary artery stenosis in an asymptomatic marathon runner cohort

European Radiology ◽

10.1007/s00330-021-08027-0 ◽

2021 ◽

Author(s):

Sebastian Gassenmaier ◽

Ilias Tsiflikas ◽

Simon Greulich ◽

Jens Kuebler ◽

Florian Hagen ◽

...

Keyword(s):

Computed Tomography ◽

Coronary Artery ◽

Coronary Artery Stenosis ◽

Artery Stenosis ◽

Fractional Flow ◽

Marathon Runners ◽

Coronary Artery Segment ◽

Relevance Evaluation ◽

Artery Segment ◽

Distal Vessel

Abstract Objectives To evaluate computed tomography fractional flow reserve (FFRCT) values in distal parts of the coronaries in an asymptomatic cohort of marathon runners without any coronary stenosis for potentially false-positive values. Methods Ninety-eight asymptomatic male marathon runners (age 53 ± 7 years) were enrolled in a prospective monocentric study and underwent coronary computed tomography angiography (CCTA). CCTA data were analyzed for visual coronary artery stenosis. FFRCT was evaluated in 59 participants without coronary artery stenosis in proximal, mid, and distal coronary sections using an on-site software prototype. Results In participants without coronary artery stenosis, abnormal FFRCT values ≤ 0.8 in distal segments were found in 22 participants (37%); in 19 participants in the LAD; in 5 participants in the LCX; and in 4 participants in the RCA. Vessel diameters in participants with FFRCT values > 0.80 compared to ≤ 0.80 were 1.6 ± 0.3 mm versus 1.5 ± 0.3 mm for distal LAD (p = 0.025), 1.8 ± 0.3 mm versus 1.6 ± 0.5 mm for distal LCX (p = 0.183), and 2.0 ± 0.4 mm versus 1.5 ± 0.2 mm for distal RCA (p < 0.001). Conclusions Abnormal FFRCT values of ≤ 0.8 frequently occurred in distal coronary segments in subjects without any anatomical coronary artery stenosis. This effect is only to some degree explainable by small distal vessel diameters. Therefore, the validity of hemodynamic relevance evaluation using FFRCT in distal coronary artery segment stenosis is reduced. Key Points • Abnormal FFRCT values (≤ 0.8) occurred in over a third of the subjects in the distal LAD despite the absence of coronary artery stenosis.. • Therefore, the validity of hemodynamic relevance evaluation in distal coronary artery segment stenosis is reduced. • Decision-making based on abnormal FFRCT values in distal vessel sections should be performed with caution and only in combination with visual assessment of the grade of stenosis..

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Effect of Significant Coronary Artery Stenosis on Prognosis in Patients with Vasospastic Angina: A Propensity Score-Matched Analysis

Journal of Clinical Medicine ◽

10.3390/jcm10153341 ◽

2021 ◽

Vol 10 (15) ◽

pp. 3341

Author(s):

Hyun-Jin Kim ◽

Min-Ho Lee ◽

Sang-Ho Jo ◽

Won-Woo Seo ◽

Hack-Lyoung Kim ◽

...

Keyword(s):

Coronary Artery ◽

Propensity Score ◽

Clinical Outcomes ◽

Coronary Artery Stenosis ◽

Study Data ◽

Artery Stenosis ◽

Vasospastic Angina ◽

Significant Stenosis ◽

Significant Coronary Artery Stenosis ◽

Increased Risk

Vasospastic angina (VA) is a functional disease of the coronary artery and occurs in an angiographically normal coronary artery. However, it may also occur with coronary artery stenosis. We investigated the effect of coronary artery stenosis on clinical outcomes in VA patients. Study data were obtained from a prospective multicenter registry that included patients who had symptoms of VA. Patients were classified into two groups according to presence of significant coronary artery stenosis. Among 1920 patients with VA, 189 patients were classified in the “significant stenosis” group. The one-year composite clinical events rate was significantly higher in the significant stenosis group than in the “no significant stenosis” group (5.8% vs. 1.4%, respectively; p < 0.001). Additionally, the prevalence of ACS was significantly greater in the "significant stenosis" group (4.8% vs. 0.9%, respectively; p < 0.001). After propensity score matching, the adverse effects of significant stenosis remained. In addition, significant stenosis was independently associated with a 6.67-fold increased risk of ACS in VA patients. In conclusion, significant coronary artery stenosis can increase the adverse clinical outcomes in VA patients at long-term follow-up. Clinicians should manage traditional risk factors associated with atherosclerosis and control vasospasm as well as reduce the burden of atherosclerosis.

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