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| 1 | Importance of bifurcation angle in bifurcation stenting显示文摘Bifurcation coronary lesions are relatively frequent in today's interventional cardiology practice,averaging between 10%-15% of all percutaneous coronary interventions(PCIs).1 Several problems inherent in the treatment of bifurcation lesions are periprocedural side branch(SB)compromise(composite of SB closure or appearance of significant ostial stenosis after main vessel(MV)stenting causing ischemia)frequently related to periprocedural myonecrosis,relatively higher restenosis rates especially in two-stent techniques,and higher rates of stent thrombosis in different time frames.1-4 The lead author and other investigators demonstrated that both periprocedural result and long-term results could be influenced by bifurcation angulations.The purpose of this study is to show why and how bifurcation angulations are important for bifurcation stenting. | Dobrin Vassilev Alexander Alexandrov Dan Le Katrina Nguyen James Nguyen Hung Phan Robert J. Gil | 2012 | Chinese Medical Journal2012，，22： | 7 |
| 2 | Prolonged high-pressure balloon angioplasty of femoropopliteal lesions:Impact on stent implantation rate and mid-term outcome显示文摘ObjectivesTo 在 stent 培植率和回顾地注册的 femoropopliteal lesions.MethodsWe 的延长高压力 angioplasty 的中间的结果上估计影响从 2011 年 1 月的 620 个连续病人到 2011 年 12 月(75.6 ±12.3 年, 355 男性, 76.5% 在卢班 5-6 ) ,为批评手足局部缺血参考了并且提交了到 femoropopliteal 损害的延长高压的 angioplasty。延长高压的 angioplasty 的定义为至少 120 s 包括膨胀到至少 18 atm。程序的数据,和临床、仪器的后续被分析估计比较喜欢的培植率和中间的 outcomes.ResultsThe 接近的 stent 是 ipsilateral 在 433/620 病人(69.7%) 和在 164/620 (26.4%) 的 contralateral 转线路的大腿骨的 antegrade 并且腿弯部后退 +在 23/620 (3.7%)的大腿骨的 antegrade 。技术在 193/620 病人(31.2%) 在 427/620 病人(68.8%) 和 endoluminal angioplasty 包括了 subintimal angioplasty。延长高压力汽球 angioplasty 过程在 86.2% 是成功的(次要的 intra 程序的复杂并发症率 15.7 %) , stent 培植在 74 个病人(11.9%) 被执行,与脚关节臂的索引的重要改进(0.29 ±0.6 对 0.88 ±0.3, P <00.1 ) 并且卢班(5.3 ±0.8 对 0.7 ±1.9, P <0.01 ) , 86.7% 的主要明显率, Doppler 超声和在 18.1 ± 的吝啬的后续的 14.8% 的目标损害 revascularization 上的 18.6 % 的狭窄;6.4 个月(范围 1-24 月) 。第二等的明显率高是 87.7%.ConclusionsProlonged femoropopliteal 损害的压力 angioplasty 看起来安全、有效允许可接受的明显和狭窄在期中考试上评价。 | Gianluca Rigatelli Mariano Palena Paolo Cardaioli Fabio dell'Avvocata Massimo Giordan Dobrin Vassilev Marco Manzi | 2014 | Journal of Geriatric Cardiology2014，11，2： | 2 |
| 3 | Impact of number of run-off vessels on interwoven nitinol mesh stents patency in the femoropopliteal segment显示文摘Objective To evaluate the impact of run-off vessels number on the outcomes of Supera stent(Abbott Vascular,Santa Clara,Calif,USA)for treatment of femoropopliteal occlusive disease.Methods We retrospectively evaluated the medical records of 188 consecutive patients(mean age 68.2±9.6 years,100 males)undergone angiography and woven mesh stent implantation in femoral or popliteal arteries or both arterial segments,in our institution between January 12014 and January 12018.Target lesion revascularization and major adverse limb events at 12-month were evaluated comparing patients with 1-,2-or 3-run-off vessels in the foot.Results Interventional success was achieved in 100%.Stent implantation involved in the femoral site in 56 patients(30.3%),the femoropopliteal in 92 patients(48.9%)and the popliteal site in 40 patients(21.3%).A significant improvement of ankle-brachial index(0.29±0.6 vs.0.88±0.3,P<0.001)and Rutherford class(5.3±0.8 vs.0.7±1.9,P<0.01)were observed before discharge.The median follow-up duration was 12.3 months(inter quartile range:11.0 to 13.9).During the follow-up period,52 patients(27.6%)had clinical events.Primary patency at 12 months was 72.4%.The primary patency significantly increased when the runoff status.Comparing the number of events among patients with different number of run-off vessels,a significant difference(P<0.001)was observed for patients having one(24.0%)and two run-off vessels(15.0%).Conclusions The outcomes of Supera stent in femoropopliteal occlusive disease depend strictly on the number of run-off vessels. | Gianluca Rigatelli Marco Zuin Fabio Dell’Avvocata Dobrin Vassilev Stefano Barison Sabrina Osti Alberto Mazza Alberto Sacco | 2020 | Journal of Geriatric Cardiology2020，17，9： | 2 |
| 4 | Changes in coronary bifurcations after stent placement in the main vessel and balloon opening of stent cells:theory and practical verification on a bench-test model显示文摘Objective To describe changes that occur in stent morphology and structure after its implantation in coronary bifurcation.Side branch (SB) compromise after stenting of main vessel in coronary bifurcation is a major intraprocedural problem and for the long term,as a place of restenosis.Methods We created an elastic wall model (parent vessel diameter 3.5mm,daughter branches 3.5mm and 2.75mm)with 30,45 and 60 degree distal angulation between branches.After stent implantation,struts to the side branch were opened with 2.0mm and consequently 3.0mm diameter balloons.Subsequent balloon redilatations and kissing balloon inflations (KBI) were performed.All stages of the procedure were photographed with magnification up to 100 times.Results We found that the leading mechanism for side branch compromise was carina displacement,and discovered theoretical description for expected ostial stenosis severity.Based on our model we found that displacement of bifurcation flow divider cause SB stenosis with almost perfect coincidence with our theoretical predictions.Opening of stent cells through the proximal and distal stent struts always increased interslrut distance,but never achieved good apposition to the wall.Balloon diameter increase didn't give proportional enlargement in stent cell diameters.KBI leads to some small better stent positioning,correcting main vessel strut dislodgment from wall,but never gave full strut-wall contact.Distance between struts and wall was minimal only when the stent cell perfectly faced ostium of SB.This was also our observation that the shape of ostium of SB becomed eUiptically-bean shaped after stent implantation and generally kept that shape during consequent stages of experiment.Measured diameter and area stenosis were perfectly fitted and theoretically predicted from our concept Conclusion We have described stent-wall deformations in stent-balloon technique for treatment of coronary bifurcation demonstrating carina displacement as possibly main mechanism of side branch compromise after main vessel stenting.We have shown that KBI could not give full strut-wall contact if there is no perfect facing of stem cell and SB ostium.(J Geroatr Cardool 2008;5(1):43-49) | Dobrin Vassilev Robert Gil | 2008 | Journal of Geriatric Cardiology2008，5，1： | 1 |
| 5 | Misdiagnosed Aortic Intramural Hematoma and the Role of Intravascular Ultrasound Imaging in Detection of Acute Aortic Syndrome:A Case Report显示文摘Acute aortic syndrome includes classic aortic dissection,aortic intramural hematoma,and penetrating atherosclerotic ulcer– a group of conditions that are defined by their dynamic evolution and similar clinical manifestation.Accurate diagnosis and prompt treatment are essential as all the aforementioned conditions are a signifi cant threat to a patient’s life.However,acute aortic syndrome and especially aortic intramural hematoma may be challenging diagnostic problems.Intravascular ultrasound imaging is a diagnostic method that can be useful for more thorough evaluation of the aortic lesion and can particularly aid in discerning the different forms of acute aortic syndrome.We present a case of a patient with aortic intramural hematoma that was missed by conventional imaging studies but was successfully visualized with intravascular ultrasound imaging. | Niya Mileva Dobrin Vassilev Robert Gil Gianluca Rigatelli | 2018 | Cardiovascular Innovations and Applications2018，，B01： | 1 |
| 6 | Theoretical prediction of side branch compromise after main branch stenting in coronary bifurcation显示文摘One of the main problems of treatment of bifurcation lesions is side branch (SB) stenosis appearing after stent placement in the main vessel. The aim of this study was to create quantitative method for prediction of side branch compromise extent. We accepted that the main mechanism for SB ostial stenosis is flow divider (FD) displacement from stent struts after stent implantation in the main vessel. Using easily measurable parameters from coronary angiography, as SB diameter, angle á (initial angle between axes of parent vessel and SB axis) and angle á' (angle between above mentioned axes after stent placement) we can calculate percentage diameter stenosis at branch ostium (%DS): %DS = sin (á - á')/(tan á). In boundary condition of full FD displacement %DS = cos á. We tested our theoretical predictions with fluoroscopic observation of elastic wall model of bifurcation (45o distal angle between branches) permitting wall deformations with stent. There is full coincidence of values of %DS and percentage area stenosis (%AS). The regular formulas for calculations of %DS and %AS overestimate stenosis severity between 10% and 25%. Our model tests have shown full coincidence between predicted values for %DS and observed values. We demonstrate that part of the SB ostium is not visible in regular angiography and contributes to ostial lumen area. This is a method that permits quantitative prediction of side branch compromise. | Dobrin Vassilev Robert Gil | 2008 | Journal of Geriatric Cardiology2008，5，2： | 0 |
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