Browsing by Author "Tufaro, Vincenzo"

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An Automated Software for Real-Time Quantification of Wall Shear Stress Distribution in Quantitative Coronary Angiography Data
(Elsevier Ireland Ltd, 2022) Tufaro, Vincenzo; Torii, Ryo; Erdogan, Emrah; Kitslaar, Pieter; Koo, Bon-Kwon; Rakhit, Roby; Bourantas, Christos, V
Background: Wall shear stress (WSS) estimated in 3D-quantitative coronary angiography (QCA) models appears to provide useful prognostic information and identifies high-risk patients and lesions. However, conventional computational fluid dynamics (CFD) analysis is cumbersome limiting its application in the clinical arena. This report introduces a user-friendly software that allows real-time WSS computation and examines its reproducibility and accuracy in assessing WSS distribution against conventional CFD analysis. Methods: From a registry of 414 patients with borderline negative fractional flow reserve (0.81-0.85), 100 lesions were randomly selected. 3D-QCA and CFD analysis were performed using the conventional approach and the novel CAAS Workstation WSS software, and QCA as well as WSS estimations of the two approaches were compared. The reproducibility of the two methodologies was evaluated in a subgroup of 50 lesions.Results: A good agreement was noted between the conventional approach and the novel software for 3D-QCA metrics (ICC range: 0.73-0-93) and maximum WSS at the lesion site (ICC: 0.88). Both methodologies had a high reproducibility in assessing lesion severity (ICC range: 0.83-0.97 for the conventional approach; 0.84-0.96 for the CAAS Workstation WSS software) and WSS distribution (ICC: 0.85-0.89 and 0.83-0.87, respectively). Simulation time was significantly shorter using the CAAS Workstation WSS software compared to the conventional approach (4.13 +/- 0.59 min vs 23.14 +/- 2.56 min, p < 0.001).Conclusion: CAAS Workstation WSS software is fast, reproducible, and accurate in assessing WSS distribution. Therefore, this software is expected to enable the broad use of WSS metrics in the clinical arena to identify highrisk lesions and vulnerable patients.
Dcb Combined With Provisional Des Implantation in the Treatment of De Novo Medina 0,1,0 or 0,0,1 Left Main Coronary Bifurcation Lesions: a Proof-Of Study
(Aves, 2022) Erdogan, Emrah; Li, Zheng; Zhu, Yong-Xiang; Tufaro, Vincenzo; Feng, Si-Li; Li, Qian; Zhang, Yao-Jun
Objective: To investigate the safety and efficacy of a percutaneous revascularization strategy that is based on the use of drug-coated balloon for the treatment of patients with acute coronary syndrome and de novo Medina type 0,1,0 or 0,0,1Ieft main stem bifurcation lesions. Methods: In this multicenter, prospective, proof-of-concept study, patients fulfilling the above criteria were enrolled and received treatment with drug-coated balloon combined with provisional drug-eluting stent implantation in the proximal major branches of the left main stem. Patients who declined this revascularization approach were treated with drug-eluting stent implantation 1-2 mm distally to the left anterior descending or left circumflex artery ostium followed by drug-coated balloon therapy for the ostial disease. The primary endpoint of the study was the calculation of percent diameter stenosis on quantitative coronary angiography post-procedure as well as event rate at 8 months follow-up. Results: A total of 30 patients were enrolled in the study; their mean age was 60.3 +/- 7.8 years, while 22 (73.3%) were male. Twenty-two patients were treated only with drug-coated balloon and provisional drug-eluting stent implantation and 8 had drug-eluting stent implantation followed by drug-coated balloon therapy of the ostium of the left main stem major branch. All the procedures were successful with no immediate complications. The percent diameter stenosis of lesion decreased significantly post-procedure from 87.5% (80.0-90.0) to 20% (17.5-30.0), P < .001. During the follow-up period, no major adverse cardiac events were reported. Conclusions: This proof-of-concept study indicates that ostial drug-coated balloon therapy of the left main stem major branches is safe and effective. Larger clinical data and longer follow-up are needed before advocating its regular use in clinical practice.
Reply To Letter To the Editor: "management of Coronary Ostial Stenosis With Drug Coated Balloons: Technical and Clinical Aspects
(Aves, 2022) Erdogan, Emrah; Li, Zheng; Zhu, Yong-Xiang; Tufaro, Vincenzo; Feng, Si-Li; Li, Qian; Zhang, Yao-Jun
Wall Shear Stress Estimated by 3d-Qca Can Predict Cardiovascular Events in Lesions With Borderline Negative Fractional Flow Reserve
(Elsevier Ireland Ltd, 2021) Tufaro, Vincenzo; Safi, Hannah; Torii, Ryo; Koo, Bon-Kwon; Kitslaar, Pieter; Ramasamy, Anantharaman; Bourantas, Christos, V
Background and aims: There is some evidence of the implications of wall shear stress (WSS) derived from three-dimensional quantitative coronary angiography (3D-QCA) models in predicting adverse cardiovascular events. This study investigates the efficacy of 3D-QCA-derived WSS in detecting lesions with a borderline negative fractional flow reserve (FFR: 0.81-0.85) that progressed and caused events. Methods: In this retrospective cohort study, we identified 548 patients who had at least one lesion with an FFR 0.81-0.85 and complete follow-up data; 293 lesions (286 patients) with suitable angiographic characteristics were reconstructed using a dedicated 3D-QCA software and included in the analysis. In the reconstructed models blood flow simulation was performed and the value of 3D-QCA variables and WSS distribution in predicting events was examined. The primary endpoint of the study was the composite of cardiac death, target lesion related myocardial infarction or clinically indicated target lesion revascularization. Results: During a median follow-up of 49.4 months, 37 events were reported. Culprit lesions had a greater area stenosis [(AS), 66.1% (59.5-72.3) vs 54.8% (46.5-63.2), p<0.001], smaller minimum lumen area [(MLA), 1.66 mm(2) (1.45-2.30) vs 2.10 mm(2) (1.69-2.70), p=0.011] and higher maximum WSS [9.0 Pa (5.10-12.46) vs 5.0 Pa (3.37-7.54), p < 0.001] than those that remained quiescent. In multivariable analysis, AS [hazard ratio (HR): 1.06, 95% confidence interval (CI): 1.03-1.10, p=0.001] and maximum WSS (HR: 1.08, 95% CI: 1.02-1.14, p=0.012) were the only independent predictors of the primary endpoint. Lesions with an increased AS (>= 58.6%) that were exposed to high WSS (>= 7.69Pa) were more likely to progress and cause events (27.8%) than those with a low AS exposed to high WSS (7.4%) or those exposed to low WSS that had increased (12.8%) or low AS (2.7%, p<0.001). Conclusions: This study for the first time highlights the potential value of 3D-QCA-derived WSS in detecting, among lesions with a borderline negative FFR, those that cause cardiovascular events.