Project 19

Intravascular imaging and interventional cardiology

The potentials of interventional cardiology are constantly increasing by the introduction of new technologies. In 2017 major changes in treatment strategies for obstructive coronary arteries have occurred where previous paradigm have been overthrown. Our research in optimal treatment of left main disease demonstrated that percutaneous coronary intervention (PCI) results in similar outcome compared to coronary artery bypass surgery in well selected patients offering a much less invasive option to our patients. Current research investigates the effect of different types of drug-eluting stents and optimal concomitant medication for this indication. For multivessel disease we demonstrated the improvement of functional guided PCI by fractional flow reserve (FFR)  with intravascular imaging optimization versus pure anatomy guided PCI in the SYNTAX 2 study. The next step in this research line is the assessment of the value of post PCI FFR to improve outcomes in these patients with complex coronary artery disease. Developments in intravascular imaging technologies by the researchers of the biomedical engineering group within COEUR explore the possible early identification of high risk lesions before events occur. In the setting of multivessel disease during acute coronary syndromes the CULPRIT-SHOCK trial on patients presenting with cardiogenic shock at the moment of publication in the NEJM unveiled a revolution in the approach to these patients.
Data on the new developed fully bioresorbable stents (BRS) became widely available. Our research demonstrated that outcomes in daily practice are less compared to earlier highly selected patient series or current thin strut metallic DES in complex disease. Detailed analysis identified multiple parameters to optimize implantation and future BRS design. Current research with optimal patient selection and implantation strategy will reveal outcome in 2018.

Principal InvestigatorsRJM van Geuns
Co-InvestigatorsH Boersma, J Daemen, RT van Domburg, R Diletti, G van Soest,
PPT de Jaegere, ES Regar, AFW van der Steen, F Zijlstra
PhD candidatesR Cavalcante, FC Costa, JMF Fam, CM Felix, L Feyz, Y Miyazaki, E Tenekecioglu, CHD Girasis