Title: Feasibility of FDG Imaging of the Coronary Arteries: Comparison Between Acute Coronary Syndrome and Stable Angina
Topic: Noninvasive Cardiology
Date Posted: 4/12/2010 5:00:00 PM
Author(s): Rogers IS, Nasir K, Figueroa AL, et al.
Citation: JACC Cardiovasc Imaging 2010;3:388-397.
Clinical Trial: No
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JACC Cardiovasc Img Article: Feasibility of FDG Imaging of the Coronary Arteries: Comparison Between Acute Coronary Syndrome and Stable Angina
Study Question: Is the presence of fluorodeoxyglucose (FDG) uptake within the ascending aorta and left main coronary artery (LM), measured using positron emission tomography (PET) a measure of plaque inflammation?
Methods: Twenty-five patients (10 acute coronary syndrome [ACS] and 15 stable coronary artery disease (CAD; STABLE) underwent cardiac computed tomographic angiography and PET imaging with 18-FDG after invasive angiography. Images were co-registered, and FDG uptake was measured at locations of interest for calculation of target-to-background ratios (TBRs). Additionally, FDG uptake was measured at the site of the lesion deemed clinically responsible for the presenting syndrome (culprit) by virtue of locating the stent deployed to treat the syndrome.
Results: Mean age was 57.9 ± 9.8 years and 72% were male; 20% of the ACS and 68% of the STABLE group had a history of CAD. The FDG uptake was higher in the ACS versus the STABLE groups in the ascending aorta (median TBR 3.30 vs. 2.43, p = 0.02), as well as the LM (2.48 vs. 2.00, p = 0.03). The TBR was greater for culprit lesions associated with ACS than for lesions stented for stable coronary syndromes (2.61 vs. 1.74, p = 0.02). Furthermore, the TBR in the stented lesions (in ACS and STABLE groups) correlated with C-reactive protein (r = 0.58, p = 0.04).
Conclusions: In patients with recent ACS, FDG accumulation is increased both within the culprit lesion as well as in the ascending aorta and LM. This observation provides evidence of up-regulation of activity within atherosclerotic plaques in ACS and supports intensification of efforts to refine PET methods to image coronary plaque inflammation.
Perspective: FDG PET imaging provides a measure of glycolysis, which is increased in inflamed tissues including atherosclerotic plaques. The finding of increased uptake in the left main and aorta in persons with ACS is consistent with pathologic studies and clinical observations that the presence of one or more unstable plaques probably identifies the ‘vulnerable patient.’ Melvyn Rubenfire, M.D., F.A.C.C.
Title: Proximal Endovascular Occlusion for Carotid Artery Stenting: Results From a Prospective Registry of 1,300 Patients
Topic: Interventional Cardiology
Date Posted: 4/12/2010 5:00:00 PM
Author(s): Stabile E, Salemme L, Sorropago G, et al.
Citation: J Am Coll Cardiol 2010;55:1661-1667.
Clinical Trial: No
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JACC Article: Proximal Endovascular Occlusion for Carotid Artery Stenting: Results From a Prospective Registry of 1,300 Patients
Study Question: What is the outcome of unselected patients undergoing carotid artery stenting (CAS) using proximal endovascular occlusion (PEO)?
Methods: The authors reported the outcome of 1,300 patients who underwent CAS at a single Italian center using PEO. An independent neurological assessment was performed before the procedure and at 1 hour, 24 hours, and 30 days after the procedure.
Results: PEO was achieved using the MOMA device. The procedure was successful in all but four patients (procedural success 99.7%). The in-hospital complication rate was low and included five deaths (0.38%), six major strokes (0.46%), and five minor strokes (0.38%). There was no acute myocardial infarction. By 30 days of follow-up, there were two additional deaths and one patient had a minor stroke. The overall 30-day stroke and death incidence was 1.38% (n = 19) and was higher in the symptomatic patients compared with asymptomatic patients (30-day stroke and death 3.04% vs. 0.82%; p < 0.01). There was no significant difference in outcome of those at high surgical risk compared with those at average surgical risk. Independent predictors of adverse events were symptomatic status, operator experience, and hypertension.
Conclusions: CAS performed using PEO is safe and effective in an unselected patient population.
Perspective: CAS provides a similar long-term efficacy compared with CEA, but multiple studies have demonstrated a higher rate of procedural stroke with CAS. This study had one of the lowest rates of stroke described with CAS, and it would be important to evaluate if similar results can be reproduced across multiple centers. This study provides strong support for using PEO in patients undergoing CAS. Hitinder S. Gurm, M.B.B.S., F.A.C.C.
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