BRENO DE ALENCAR ARARIPE FALCAO
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conferenceObject Head-to-head comparison between coronary computed tomography angiography (CCTA) and intravascular ultrasound (IVUS) tridimensional models: a geometric point of view(2016) BEZERRA, Cristiano G.; TALOU, Gonzalo Maso; BULANT, Carlos A.; MARIANI JR., Jose; PINTON, Fabio A.; FALCAO, Breno A. A.; FILHO, Antonio E.; FEIJOO, Raul A.; LEMOS, Pedro A.; BLANCO, Pablo J.- Remoção Precoce do Introdutor Arterial Após Intervenção Coronária Percutânea por Via Femoral: Estudo de Segurança e Eficácia(2014) ZAGO, Gabriel; TRENTIN, Fabio; PRADO JR., Guy F. A.; SPADARO, Andre Gasparini; SILVA, Expedito Eustáquio Ribeiro da; CAMPOS, Carlos Magalhães; PERIN, Marco Antonio; FALCÃO, Breno de Alencar Araripe; ESTEVES-FILHO, Antonio; KAJITA, Luiz Junya; GAMA, Marcus Nogueira da; MARCHIORI, Gilberto; HORTA, Pedro Eduardo; TAKIMURA, Celso Kiyochi; MARIANI JR., Jose; GALON, Micheli Zanotti; SOARES, Paulo Rogerio; ZALC, Silvio; KALIL-FILHO, Roberto; LEMOS NETO, Pedro AlvesIntroduction: We evaluated the safety and efficacy of protamine administration, guided by activated clotting time, for the immediate femoral arterial sheath removal in patients undergoing percutaneous coronary intervention with unfractionated heparin in order to propose an algorithm for clinical practice. Methods: Prospective study with consecutive patients with stable angina or low-to-moderate risk acute coronary syndrome. We compared patients with an early removal of the arterial sheath to those whose sheath removal was based on a standard protocol. Results: The early removal group (n = 149) had lower access manipulation time than the conventional group (58.3 ± 21.4 minutes vs. 355.0 ± 62.9 minutes; p < 0.01), mainly due to a reduced time to sheath removal (42.3 ± 21.1 minutes vs. 338.6 ± 61.5 minutes; p < 0.01), with no impact on the duration of femoral compression (16.0 ± 3.6 minutes vs. 16.4 ± 5.1 minutes; p = 0.49). There was no stent thrombosis during hospitalization and no significant differences in the incidence of major vascular or bleeding events. The incidence of other bleeding events leading to a prolonged in-hospital length of stay was lower in the early removal group (1.3% vs. 5.1%; p = 0.05). Conclusions: The selective use of an approach for immediate femoral sheath removal, based on activated clotting time guidance and protamine administration, is a safe and effective option in patients undergoing percutaneous coronary intervention by femoral access.
conferenceObject Full Hemodynamic Characterization of Intracoronary Physiology: Merging Advanced Grayscale Intravascular Ultrasound With Fractional Flow Reserve(2019) BEZERRA, Cristiano; PINTON, Fabio; FALCAO, Breno; MARIANI JR., Jose; HIDEO-KAJITA, Alexandre; BULANT, Carlos; BLANCO, Pablo; LEMOS, Pedro A.- Validation of coronary computed tomography angiography scores for non-invasive assessment of atherosclerotic burden through a comparison with multivessel intravascular ultrasound(2016) CAVALCANTE, Rafael; BITTENCOURT, Marcio S.; PINHEIRO, Thais L.; FALCAO, Breno A. A.; MORAIS, Gustavo R.; SOARES, Paulo; MARIANI JR., Jose; RIBEIRO, Expedito; KALIL-FILHO, Roberto; ROCHITTE, Carlos E.; LEMOS, Pedro A.Aims: While the atherosclerotic plaque volume can be manually quantified in coronary computed tomography angiography (CTA) it is impractical for clinical routine use. Several anatomical scores have been developed as surrogates for overall atherosclerotic burden in coronary CTA and even proven to be highly predictive for future adverse events. However, they have not been validated against the gold standard for atherosclerotic burden, intra-vascular ultrasound (IVUS). In the present study we have compared several coronary CTA scores with the coronary IVUS. Methods and results: A total of 62 patients with diagnosed coronary disease scheduled for percutaneous intervention were prospectively enrolled. For all patients, coronary CTA and multivessel IVUS were obtained. Calcium score and 6 previously reported scores were calculated from coronary CTA imaging and compared to average IVUS-derived percent atheroma volume (PAV). On average, 3.8 +/- 0.7 vessels, comprising 123.8 +/- 31.3 mm in length, were imaged with IVUS per patient. All but one previously described scoring systems showed a significant association with IVUS-derived PAV. Among them, the SSS score demonstrated the strongest correlation with IVUS-PAV (r = 0.61, p < 0.001) and the greatest area under the ROC curve (C-statistic = 0.87), to predict a high PAV. Conclusions: Most frequently used coronary CTA scores have a good correlation with global coronary atherosclerotic burden measured by multivessel IVUS derived atheroma volume. Among them, the SSS score shows the best performance being a good non-invasive alternative to IVUS for global coronary atherosclerotic burden assessment.
conferenceObject Computational fractional flow reserve derived from three-dimensional intravascular ultrasound: a new algorithm of fusion between anatomy and physiology(2017) BEZERRA, Cristiano; PINTON, Fabio A.; FALCAO, Breno; MARIANI JR., Jose; BULANT, Carlos A.; TALOU, Gonzalo; ESTEVES, Antonio Esteves Filh; BLANCO, Pablo; LEMOS, Pedro A.- Comparison between fractional flow reserve (FFR) and Computational fractional flow reserve derived from three-dimensional intravascular ultrasound (FFR-IVUS), percentage of diameter stenosis by visual estimation and bi-dimensional quantitative coronary angiography.(2018) HIDEO-KAJITA, Alexandre; GARCIA-GARCIA, Hector; BEZERRA, Cristiano; PINTON, Fabio A.; FALCAO, Breno; MARIANI JR., Jose; BULANT, Carlos; TALOU, Gonzalo Maso; ESTEVES, Antonio Esteves Filh; BLANCO, Pablo; LEMOS, Pedro A.
conferenceObject Coronary computed tomography angiography (CCTA) blood flow model, how we can improve it? Insights based on comparison with intravascular ultrasound (IVUS) tridimensional model.(2016) BEZERRA, Cristiano G.; BULANT, Carlos A.; TALOU, Gonzalo Maso; MARIANI JR., Jose; FALCAO, Breno A. A.; PINTON, Fabio A.; FEIJOO, Raul A.; FILHO, Antonio E.; BLANCO, Pablo J.; LEMOS, Pedro A.- Coronary fractional flow reserve derived from intravascular ultrasound imaging: Validation of a new computational method of fusion between anatomy and physiology(2019) BEZERRA, Cristiano G.; HIDEO-KAJITA, Alexandre; BULANT, Carlos A.; MASO-TALOU, Gonzalo D.; MARIANI JR., Jose; PINTON, Fabio A.; FALCAO, Breno A. A.; ESTEVES-FILHO, Antonio; FRANKEN, Marcelo; FEIJOO, Raul A.; KALIL-FILHO, Roberto; GARCIA-GARCIA, Hector M.; BLANCO, Pablo J.; LEMOS, Pedro A.Objectives: To evaluate the diagnostic performance of a novel computational algorithm based on three-dimensional intravascular ultrasound (IVUS) imaging in estimating fractional flow reserve (IVUSFR), compared to gold-standard invasive measurements (FFRINVAS). Background: IVUS provides accurate anatomical evaluation of the lumen and vessel wall and has been validated as a useful tool to guide percutaneous coronary intervention. However, IVUS poorly represents the functional status (i.e., flow-related information) of the imaged vessel. Methods: Patients with known or suspected stable coronary disease scheduled for elective cardiac catheterization underwent FFRINVAS measurement and IVUS imaging in the same procedure to evaluate intermediate lesions. A processing methodology was applied on IVUS to generate a computational mesh condensing the geometric characteristics of the vessel. Computation of IVUSFR was obtained from patient-level morphological definition of arterial districts and from territory-specific boundary conditions. FFRINVAS measurements were dichotomized at the 0.80 threshold to define hemodynamically significant lesions. Results: A total of 24 patients with 34 vessels were analyzed. IVUSFR significantly correlated (r = 0.79; P < 0.001) and showed good agreement with FFRINVAS, with a mean difference of -0.008 +/- 0.067 (P = 0.47). IVUSFR presented an overall accuracy, sensitivity, specificity, positive predictive value, and negative predictive value of 91%, 89%, 92%, 80%, and 96%, respectively, to detect significant stenosis. Conclusion: The computational processing of IVUSFR is a new method that allows the evaluation of the functional significance of coronary stenosis in an accurate way, enriching the anatomical information of grayscale IVUS.
- A Novel Algorithm to Quantify Coronary Remodeling Using Inferred Normal Dimensions(2015) FALCAO, Breno A. A.; FALCAO, Joao Luiz A. A.; MORAIS, Gustavo R.; SILVA, Rafael C.; LOPES, Augusto C.; SOARES, Paulo R.; MARIANI JR., Jose; KALIL-FILHO, Roberto; EDELMAN, Elazer R.; LEMOS, Pedro A.Background: Vascular remodeling, the dynamic dimensional change in face of stress, can assume different directions as well as magnitudes in atherosclerotic disease. Classical measurements rely on reference to segments at a distance, risking inappropriate comparison between dislike vessel portions. Objective: to explore a new method for quantifying vessel remodeling, based on the comparison between a given target segment and its inferred normal dimensions. Methods: Geometric parameters and plaque composition were determined in 67 patients using three-vessel intravascular ultrasound with virtual histology (IVUS-VH). Coronary vessel remodeling at cross-section (n = 27.639) and lesion (n = 618) levels was assessed using classical metrics and a novel analytic algorithm based on the fractional vessel remodeling index (FVRI), which quantifies the total change in arterial wall dimensions related to the estimated normal dimension of the vessel. A prediction model was built to estimate the normal dimension of the vessel for calculation of FVRI. Results: According to the new algorithm, ""Ectatic"" remodeling pattern was least common, ""Complete compensatory"" remodeling was present in approximately half of the instances, and ""Negative"" and ""Incomplete compensatory"" remodeling types were detected in the remaining. Compared to a traditional diagnostic scheme, FVRI-based classification seemed to better discriminate plaque composition by IVUS-VH. Conclusions: Quantitative assessment of coronary remodeling using target segment dimensions offers a promising approach to evaluate the vessel response to plaque growth/regression.
conferenceObject Quantifying Total Atherosclerotic Burden Non-Invasively Through Coronary Computed Tomography Angiography: A Comparison With Multivessel Intravascular Ultrasound Data(2014) SILVA, Rafael C.; FALCAO, Breno A.; LIMA, Thais P.; MORAIS, Gustavo R.; ROCHITTE, Carlos E.; SPADARO, Andre G.; MARIANI JR., Jose; RIBEIRO, Expedito; KALIL-FILHO, Roberto; LEMOS, Pedro A.