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Background: The impact of a non-dominant right coronary artery (NDRCA), on single photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI)has not been clarified., Methods and Results: We compared SPECT-MPI results of consecutive patients without significant (diameter stenosis ≥50%)coronary artery disease (CAD) and a NDRCA (Group-1), with those of patients from our database without CAD and a dominant RCA (Group-2). All patients were subjected to SPECT-MPI with I.V. infusion of adenosine, and TC 99 -tetrofosmin. Group-1 included 69 patients (55 men, 79.7%), mean age 66.8 ± 9.8 years. Group-2 consisted of 79 patients (56 men, 70.9%), mean age 62.7 ± 11.5. There was no difference in demographics and CAD risk factors between the two groups. The SPECT-MPI revealed inferior wall ischemia, in 35 patients (50.7%), in Group-1 and 27 patients (34.1%), in Group-2 (P = 0.041)., Conclusions: A relatively high rate of reversible SPECT-MPI perfusion defects may be anticipated in patients with an unobstructed NDRCA compared to patients with a dominant RCA., (Copyright © 2022 Elsevier B.V. All rights reserved.)

Background: Radial artery occlusion (RAO) remains the Achilles' heel of transradial coronary procedures. Standard over lower systemic anticoagulation levels are believed to reduce RAO rates but this is ill-supported by scientific evidence. We compared whether standard in comparison with less intensive anticoagulation was superior in preventing vessel closure., Methods and Results: The two arms of this analysis included 731 pooled patients with the same inclusion and exclusion criteria. We assessed forearm arterial access site occlusion rate by unfractionated heparin (UFH) dose in an individual participant data meta-analysis of this randomized study and of consecutive eligible patients from our previous trial. We randomized 308 consecutive patients undergoing transradial coronary angiography with 5 French (5 Fr) catheters without need to crossover to receive 2500 or 5000 UFH units. The primary end-point was the ultrasonographically determined vessel occlusion rate. Incident RAOs in the randomized arm were 15.9% vs. 14%, in the low and standard UFH dose, respectively (p=0.7). Corresponding figures for forearm arterial occlusion rates in the pooled population were 13.0% vs. 9.9% (relative risk: 1.3, 95% confidence interval - CI: 0.88-1.98; p=0.2). Procedural and fluoroscopy duration was less than 15 and 3 min, respectively. The mean UFH dose difference was 3.52 (95% CI: -0.45 to 7.49) units per kilo body weight between occluded (n=84) and patent forearm arteries (n=647); (p=0.053)., Conclusions: Incident forearm arterial occlusions were high despite using 5 Fr catheters for a short-lasting procedure. Systemic anticoagulation with standard over lower UFH dose did not reduce the frequency of RAOs after coronary angiography., (Copyright © 2015. Published by Elsevier Ireland Ltd.)

Background: The diagnostic accuracy of flat panel digital detector (FPDD) cinefluoroscopy for coronary artery calcium (CAC) detection, compared to multiple detector computed tomography (MDCT), is not known., Methods: CAC was assessed by FPDD cinefluoroscopy (graded as 0,1, 2 and 3) and calcium score (CACS) was determined by MDCT in 151 asymptomatic individuals of low to intermediate cardiovascular risk, 40-60 years old (mean age 53.1 ± 7.4, men 76.5%)., Results: CAC was detected by MDCT and cinefluoroscopy in 79 (52.3%) and 69 (45.7%) of cases respectively. Agreement between MDCT and cinefluoroscopy was 77.5% (weighted kappa coefficient 0.75). Cinefluoroscopy was able to detect CAC in 50% of subjects with minimal CACS (<10). For CACS=0, area under the curve (AUC) was 0.89 (95% CI 0.83-0.93, p=0.0001) with sensitivity 82.3% and specificity 94.4%. For CACS=10, AUC was 0.91 (95% CI 0.86-0.95, p=0.0001) with sensitivity 91.8% and specificity 85.6%. For CACS=400, AUC was 0.97 (95% CI 0.94-0.99, p=0.0001) with sensitivity 100% and specificity 88.7%. The effective radiation dose was 1.8 ± 0.09 mSv for CT and 0.26 ± 0.13 mSv for cinefluoroscopy., Conclusions: Cinefluoroscopy performed with 'state-of-the art' FPDD technology has an excellent diagnostic accuracy compared to the 'gold standard' MDCT for CAC detection in middle aged, low to intermediate cardiovascular risk, asymptomatic individuals, with the advantage of lower radiation exposure., (Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.)

Background: Tissue coverage and strut apposition of drug eluting stents (DES), which can be assessed with optical coherence tomography (OCT), may be associated with late stent thrombosis (LST)., Methods: Prospective observational angiographic and OCT follow-up at 6 months post-implantation of a biolimus-A9 eluting stent (BES) vs. a paclitaxel eluting stent (PES), with biodegradable polymer carriers. The primary outcome was the percent difference of uncovered struts between BESs and PESs., Results: A maximum likelihood model was used for analysis, to account for data clustering. Sixteen patients were treated with BES (28 lesions/4530 struts) and 16 with PES (23 lesions/4450 struts). Overall, BESs compared to PESs had more uncovered [0.41% vs. 0.21%, difference estimate (DE) 0.2 (95% CI, 0.06-0.34), p=0.006], malapposed [0.18% vs. 0.04%, DE 0.14 (95% CI 0.05-0.23), p=0.003], uncovered and malapposed [0.08% vs. 0.026%, DE 0.057 (95% CI 0.015-0.1), p=0.01] and protruding struts [0.23% vs. 0.04%, DE 0.185 (95% CI 0.1-0.27), p<0.001], and significantly lower neointimal thickness (59.3 ± 28.2 μm vs. 201.7 ± 97.5, p<0.001). None of the BESs was totally covered with neointima, in contrast to 5 (21.7%) PESs (p=0.01). Thrombus was detected in 1 (3.6%) BES and 5 (21.7%) PESs (p=0.05); however, no patient experienced clinical stent thrombosis., Conclusion: Between two stents with biodegradable polymer, OCT demonstrated that BESs had more uncovered and malapposed struts compared to PESs at 6 months. This difference might be partly attributed to the more potent antiproliferative properties of biolimus-A9; however, its impact on clinical outcome and on the risk of LST is yet to be determined., (Copyright © 2010 Elsevier Ireland Ltd. All rights reserved.)

Background: Coronary stent fracture (SF), is rare and confined mainly in patients treated with sirolimus eluting stents (SES). The role of flat panel digital detector (FPDD) fluoroscopy in detecting SF has not been investigated., Methods: Assessment with FPDD fluoroscopy of asymptomatic patients, with 200 SES (Cypher, Cordis, J&J, Miami, Florida, US), and 200 bare metal stents (BMS), at 45.5 ± 15.7 and 38.4 ± 3.9 months post-stenting respectively. SF was defined as discontinuity of stent struts on fluoroscopy. Coronary angiography was reserved for patients with documented SF., Results: Effective radiation dose was 0.26 ± 0.14 mSv. SF was depicted in 6 (3%) SES, and 1 BMS (0.5%). Stent length was an independent predictor of SF (OR 1.19, 95% CI 1.03-1.4, p=0.024). RCA location and vessel angulation were marginally significant (OR 7.7, 95% CI 0.8-74.2, p=0.077 and OR 5.1, 95% CI 0.8-34, p=0.089). Significant angiographic restenosis was detected in 4 SES (66.6%), and 1 BMS (0.5%). Re-intervention was needed in 3 (42.8%) cases, (2 SES and 1 BMS)., Conclusion: Detection of SF with FPDD cinefluoroscopy late following coronary stenting is feasible, involves low radiation and is confined mainly to SES compared to BMS. Application of cinefluoroscopy as part of a routine stent surveillance programme in asymptomatic patients may be more appropriate in "high risk" settings (SES, long stents and adverse angiographic characteristics). The role of invasive imaging and subsequent management of such patients need further studying., (Copyright © 2010 Elsevier Ireland Ltd. All rights reserved.)

Objectives: Prospective optical coherence tomography (OCT) study of strut apposition and neointimal hyperplasia thickness (NIH) of a paclitaxel eluting stent (PES), (Infinium, Sahajanand Medical Technologies Pvt Ltd.)., Background: Few data exist concerning neointimal coverage of PES. Uncovered and malapposed struts are more common following stenting in acute coronary syndromes (ACS) than in non-ACS lesions., Methods: All consecutive patients with ACS, treated with the above PES for single native coronary lesions between August 2008 and January 2009, who consented to invasive follow-up with OCT at six months (N=13), were included., Results: At 6 months no patient demonstrated angiographic restenosis. 3180 struts from 20 stents were analyzed, and 91.3% were covered with neointima (NIH 204.8 ± 159.5 μm). Standard statistics and least squares estimates (LSE) derived from a hierarchical ANCOVA model to take into account clustering effects are presented. Rate of uncovered struts was 8.6%, LSE 7.39 (95% CI 3.05-11.73), malapposed struts 2.2%, LSE 1.76 (95% CI 0.05-3.58), and protruding struts 2.9%, LSE 2.8 (95% CI 1.35-4.65). The proportion of uncovered malapposed struts was significantly higher compared to uncovered embedded struts (55.7% vs. 6.8%, p<0.01). In total, 5 (25%) PES were fully covered by neointima. No intracoronary thrombus or clinical events were detected., Conclusions: Six months after implantation of a specific PES in patients with ACS, most of the stents were only partially covered with neointima, especially at sites of strut malapposition or protrusion. These findings emphasize the need for optimal stent apposition during implantation and for prolonged dual antiplatelet therapy., (Copyright © 2010 Elsevier Ireland Ltd. All rights reserved.)