Drug-coated balloon (DCB) became a potential treatment option for patients with acute coronary syndrome (ACS); however, factors associated with target lesion failure (TLF) remain uncertain.
This ...retrospective, multicentre, observational study included consecutive ACS patients who underwent optical coherence tomography (OCT)-guided DCB treatment. Patients were divided into two groups according to the occurrence of TLF, a composite of cardiac death, target vessel-related myocardial infarction, and ischemia-driven target lesion revascularisation.
We enrolled 127 patients in this study. During the median follow-up period of 562 (IQR: 342–1164) days, 24 patients (18.9%) experienced TLF, and 103 patients (81.1%) did not. The cumulative 3-year incidence of TLF was 22.0%. The cumulative 3-year incidence of TLF was the lowest in patients with plaque erosion (PE) (7.5%), followed by those with rupture (PR) (26.1%) and calcified nodule (CN) (43.5%). Multivariable Cox regression analysis revealed that plaque morphology was independently associated with TLF on pre-PCI (percutaneous coronary intervention) OCT, and residual thrombus burden (TB) was positively associated with TLF on post-PCI OCT. Further stratification by post-PCI TB revealed a comparable incidence of TLF in patients with PR (4.2%) to that of PE if the culprit lesion had a smaller post-PCI TB than the cut-off value (8.4%). TLF incidence was high in patients with CN, regardless of TB size on post-PCI OCT.
Plaque morphology was strongly associated with TLF for ACS patients after DCB treatment. Residual TB post-PCI might be a key determinant for TLF, especially in patients with PR.
•DCB is an option for specific lesion subsets in patients with ACS.•Potential difficulties exist with angiography-based patient and lesion selection.•Plaque morphology and residual TB may enable risk stratification.•DCB could be considered an effective treatment for patients with PE.•Stent implantation may be preferred if the residual TB is large in lesions with PR.
This study determined the predictive accuracy of optical frequency domain imaging (OFDI) on debulking effects of rotational atherectomy (RA) and compared the predictive accuracy of OFDI ...catheter-based with Rota wire-based prediction methods. This prospective, single-center, observational study included 55 consecutive patients who underwent OFDI-guided RA. On pre-RA OFDI images, a circle, identical to the Rota burr was drawn at the center of the OFDI catheter (OFDI catheter-based prediction method) or wire (wire-based prediction method). The area overlapping the vessel wall was defined as the predicted ablation area (P-area). The actual ablated area (A-area) was measured by superimposing the OFDI images before and after RA. The overlapping P-area and A-area were defined as overlapped ablation area (O-area), and the predictive accuracy was evaluated by %Correct area (O-area/P-area) and %Error area (A-area − O-area/A-area). The median %Correct and %Error areas were 47.8% and 41.6%, respectively. Irrelevant ablation (low %Correct-/high % Error areas) and over ablation (high %Correct-/high % Error areas) were related to deep vessel injury and intimal flap outside the P-area. The predictive accuracy was better in the OFDI catheter-based prediction method than the wire-based prediction method in the cross sections where the OFDI catheter and wire came in contact. However, it was better in the latter than the former where the OFDI catheter and wire were not in contact. OFDI-based simulation of the RA effect is feasible though accuracy may be affected by the OFDI catheter and wire position. OFDI-based simulation of RA effect might reduce peri-procedural complications during RA.
Background:In persistent AF, the effect of adjunctive ablation in addition to PV isolation (PVI) is controversial. We considered a new modified PVI including complex fractionated atrial electrogram ...(CFAE) area.Methods and Results:In 57 patients with persistent AF undergoing first ablation, CFAE were mapped before ablation and CFAE-guided extensive encircling PVI (CFAE-guided EEPVI) was performed. The PVI line was designed to include the CFAE area near PV or to cross the minimum cycle length points of the CFAE area near PV (CFAE-guided EEPVI group). The outcome was compared with conventional PVI in 34 patients with persistent AF (conventional PVI group). During a mean follow-up of 365±230 days after the first procedure, AF in 13 and atrial tachycardia (AT) in 9 patients recurred in the CFAE-guided EEPVI group, while only AF in 17 patients recurred in the conventional PVI group. Eight of 9 AT in the CFAE-guided EEPVI group were successfully ablated at second procedure. After first and second procedures, the recurrence of atrial tachyarrhythmia in the CFAE-guided EEPVI group was significantly reduced compared with the conventional PVI group (8 patients, 14% vs. 11 patients, 32%, respectively; P<0.01, log-rank test).Conclusions:CFAE-guided EEPVI was more effective for persistent AF compared with conventional PVI after first and second procedures, because recurring AT as well as re-conduction of PV was successfully ablated.
Background:In persistent AF, the effect of adjunctive ablation in addition to PV isolation (PVI) is controversial. We considered a new modified PVI including complex fractionated atrial electrogram ...(CFAE) area.Methods and Results:In 57 patients with persistent AF undergoing first ablation, CFAE were mapped before ablation and CFAE-guided extensive encircling PVI (CFAE-guided EEPVI) was performed. The PVI line was designed to include the CFAE area near PV or to cross the minimum cycle length points of the CFAE area near PV (CFAE-guided EEPVI group). The outcome was compared with conventional PVI in 34 patients with persistent AF (conventional PVI group). During a mean follow-up of 365±230 days after the first procedure, AF in 13 and atrial tachycardia (AT) in 9 patients recurred in the CFAE-guided EEPVI group, while only AF in 17 patients recurred in the conventional PVI group. Eight of 9 AT in the CFAE-guided EEPVI group were successfully ablated at second procedure. After first and second procedures, the recurrence of atrial tachyarrhythmia in the CFAE-guided EEPVI group was significantly reduced compared with the conventional PVI group (8 patients, 14% vs. 11 patients, 32%, respectively; P<0.01, log-rank test).Conclusions:CFAE-guided EEPVI was more effective for persistent AF compared with conventional PVI after first and second procedures, because recurring AT as well as re-conduction of PV was successfully ablated.
In this study, we propose a novel power assist control method for a powered exoskeleton without binding its legs. The proposed method uses motion sensors on the wearer’s torso and legs to estimate ...his/her motion to enable the powered exoskeleton to assist with the estimated motion. It can detect the start of walking motion quickly because it does not prevent the motion of the wearer’s knees at the beginning of the walk. A nine-axis motion sensor on the wearer’s body is designed to work robustly in very hot and humid spaces, where an electromyograph is not reliable due to the wearer’s sweat. Moreover, the sensor avoids repeated impact during the walk because it is attached to the body of the wearer. Our powered exoskeleton recognizes the motion of the wearer based on a database and accordingly predicts the motion of the powered exoskeleton that supports the wearer. Experiments were conducted to prove the validity of the proposed method.
This paper proposes walk pattern modeling for powered exoskeleton based on complex-valued neural network and reports its validity through experiments. We have been developing a powered exoskeleton to ...support workers at a nuclear power plant in time of hazard. The objective of the powered exoskeleton is to support a worker wearing a heavy radiation protection suit. We believe that conventional reactive power assist control based on EMG sensors is not feasible because they fail to measure the worker muscle activity robustly in the radiation protection suit as the worker has a lot of sweat in the high temperature and the humidity in the suit. Therefore, we have developed feed-forward control to assist the worker's motion based on the recognition of the worker's motion. Our previous studies use a simple k-nearest neighbor algorithm to model the motion of the powered exoskeleton, however, the algorithm is not for online learning and the estimated trajectory is not as smooth as we expected. This paper proposes a new modeling of walk motion of the powered exoskeleton based on a complex-valued neural network. The complex-valued neural network generally has good properties on learning speed and stability. This paper shows its validity for the modeling of powered exoskeleton's walk through experiments.
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