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Current Status of Intra-Vascular Imaging during Coronary Interventions

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World Journal of Cardiovascular Diseases 2021年第8期11卷 389-419页

作者： sridhar kasturi Sunshine Heart Institute Secunderabad India

Most important interventional application of IVUS is plaque assessment, vessel sizing and stent implantation guidance. Image guided PCI is associated with decreased incidence of stent thrombosis and MACE rate as evident in recently published meta-analysis of IVUS guided PCI studies. Many imaging studies have shown very clearly under-expansion, edge-dissection, tissue-prolapse, mal apposition, and geographical miss are associated with adverse events following DES implantation, and IVI guides in optimization of stent implantation by identifying and rectifying these predictors of DES outcomes.

关键词： Left-Main Coronary Artery Imaging Intra-Vascular Ultra-Sound Optical Co-herence Tomography

Coronary Physiology in the Management of CAD Patients: Position Paper Regarding the Current Scenario in India

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World Journal of Cardiovascular Diseases 2023年第11期13卷 795-810页

作者： sridhar kasturi Ramneek Kaur Manish Narang Surinder Kher Department of Cardiology Sunshine Heart Institute Secunderabad Hyderabad India Department of Medical Affairs Abbott Vascular Abbott Healthcare Pvt Ltd. Delhi India Asia Pacific & Japan Department of Medical Affairs Abbott Vascular Abbott Healthcare Pvt Ltd. Delhi India Independent Clinical Research Professional Bangalore India

Fractional flow reserve (FFR), a physiology-based diagnostic method, has emerged as an important decision-making tool in determining the borderline or intermediate coronary lesions requiring revascularization. As per the guidelines recommended by European and American cardiology associations, functional assessment of indeterminate lesions is to be considered strongly prior to PCI. However, in India, FFR continues to be a much-underutilized tool due to limited facilities, and many times, physicians are reluctant to advise FFR because of its time-consuming nature with additional cost implications of simple diagnostic tests. Notably, for stenoses ranging between 50% - 70% where the choice between revascularization and medication becomes ambiguous, FFR provides invaluable insight. Without such guidance, there is a risk of improper decisions and strategies while planning revascularization procedures, which might adversely influence clinical outcomes, escalation of the cost due to unnecessary procedures, and prolonged hospitalization as a result of simple vs complex procedures. Landmark studies have validated the efficacy of FFR in enhancing outcomes in coronary artery disease (CAD) patients, especially when paired with a coronary angiogram. This combination provides robust evidence of the functional significance of stenosis in stable CAD. Additionally, non-hyperemic pressure ratio indices correlate well with conventional FFR. Hence, adopting FFR-guided management can have transformative effects on the clinical and economic facets of treating severe CAD with intermediary lesions in Indian settings.

关键词： Coronary Physiology Fractional Flow Reserve Percutaneous Coronary Intervention Revascularization

Usefulness of Fractional Flow Reserve during Routine Clinical Procedures in All-Comer Coronary Artery Disease Patients

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World Journal of Cardiovascular Diseases 2021年第11期11卷 509-522页

作者： sridhar kasturi Shailender Singh Vijay Kumar Reddy Shanivaram Manikandhar Pendyala Chandrashekar Challa Department of Cardiology Sunshine Heart Institute Secunderabad Hyderabad Telangana

Background: Fractional flow reserve (FFR)-guided interventions, though proved to be safe, continue to be a much-underutilized modality in determining treatment strategy, and data is lacking in Indian population. Objective: We aimed to determine the use of FFR-guided PCI and assess the overall impact on treatment decisions and clinical outcomes in patients with acute coronary syndrome (ACS) or chronic coronary syndromes (CCS). Methods: In this single-center retrospective and prospective observational study, FFR had been performed for the evaluation of treatment reclassification and clinical outcomes, as per physician’s clinical practice. Results: Data was obtained for 250 subjects (mean age 60.45 ± 9.6 years) with 324 lesions. The treatment plan based on angiography alone changed in 28% of lesions post-hyperemic FFR. The initial treatment plan based on angiography vs. the final treatment plan post-FFR (>0.80) was medical management 56.5% vs. 66.0%;CABG 11.1% vs. 7.7%;and PCI 32.4% vs. 26.2%. In subjects initially assigned to medical management, 14% had changed to PCI, and for subjects initially assigned to PCI, 44% had changed to medical therapy. Receiver operating characteristics (ROC) curve analysis revealed a good correlation between a resting FFR value of <0.87 and hyperemic FFR value of <0.80. T

关键词： Angiogram Fractional Flow Reserve Percutaneous Coronary Intervention Coronary Physiology

A Real World Experience of Guidewire-Induced Perforations during Percutaneous Intervention and Their Successful Management

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International Journal of Clinical Medicine 2014年第8期5卷 475-481页

作者： sridhar kasturi Vinothkumar Vilvanathan Srinivas Polasa Shiva Kumar Bandimida Kripa Patel Ashok Thakkar Department of Clinical Trials Sahajanand Medical Tech. Pvt. Ltd. Surat India Department of Pharmacology Ramanbhai Patel College of Pharmacy Charotar University of Science and Technology Campus Changa India Sunshine Heart Institute Hyderabad India

Complication rates following percutaneous interventions have decreased over the past decade due to advancement in both interventional equipment and procedure technique. Despite these advances, the risk of iatrogenic perforations still exists with associated high morbidity and mortality. We are presenting three cases of guidewire-induced perforations including coronary artery and renal artery perforation with their complications and successful management in these case-series.

关键词： Percutaneous Intervention Guidewire Coronary Artery Perforation Renal Artery Perforation

All-Comers Study of Percutaneous Coronary Interventions with Ultrathin Strut Biodegradable-Polymer Sirolimus-Eluting Stents—ORSHINE Registry

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World Journal of Cardiovascular Diseases 2021年第7期11卷 319-331页

作者： sridhar kasturi Shailender Singh S. Vijay Kumar Reddy Kondalrao Gollamandala Ganesh Mathan Manikandhar Pendyala Chandrashekar Challa Sunshine Heart Institute Secunderabad Telangana Hyderabad India

Current new generation stent technology has made remarkable progress in stent design, structure, and component material to improve its performance in reducing stent thrombosis, and restenosis compared to earlier DES and BMS. Orsiro-Sirolimus eluting stent is new generation ultra-thin strut stent with biodegradable abluminal coating that leaves a polymer free stent after drug release enhances coverage of stent struts and prevents excess neo intimal proliferation. A retrospective data analysis was done to see safety and efficacy of Orsiro in patients treated with ultra-thin DES with Orsiro stents at Sunshine Hospitals, Hyderabad. A total of 331 patients with 525 lesions were treated with 506 Orsiro stents and the major adverse cardiac events (MACE) rate and stent thrombosis (ST) at 2 years’ follow-up were analysed. MACE rate was 1.6% for an average follow-up at 2 years. Out of 2 patients who developed ST, one presented with definite acute stent thrombosis and one with possible, late stent thrombosis and 1.8% non-cardiac death reported during the follow-up. Despite many patients with complex PCI in the ACS subset, Orsiro reduced significant reduction in MACE rate in all spectrum of coronary artery disease patients with excellent acute and long-term results similar to other established FDA-approved current generations stents.

关键词： Ultra-Thin Struts Biodegradable Polymer Sirolimus-Eluting Stent

Safety and Efficacy of a Novel Everolimus-Eluting Stent System in “Real-World” Patients with Coronary Artery Disease: A Report of Preliminary Outcomes

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World Journal of Cardiovascular Diseases 2016年第12期6卷 458-467页

作者： sridhar kasturi Srinivas Polasa Shailender Singh Vijay Kumar Reddy Kondal Rao Ganesh Mathan Shiva Kumar Bandimida Manikandhar Pendyala Chandrashekar Challa Sunshine Heart Institute Secunderabad India Chalmeda Anandrao Institute of Medical Sciences Karimnagar India

Introduction: Tetrilimus (Sahajanand Medical Technologies Pvt. Ltd., Surat, India) is a recently-introduced biodegradable-polymer coated everolimus-eluting cobalt-chromium coronary stent system with an ultra-thin strut thickness. We aimed to evaluate the clinical outcomes with Tetrilimus coronary stents in “real-world” patients with coronary artery disease. Methods: In this retrospective, single-arm, open-label, multi-center registry, all consecutive patients who received Tetrilimus stents between July-2015 and April-2016 at two tertiary-care centers in India were analyzed. Primary endpoint was 30-day incidence of major adverse cardiac events (MACE), defined as a composite of cardiac death, myocardial infarction, target lesion revascularization, and target vessel revascularization. The Academic Research Consortium (ARC)-defined stent thrombosis was assessed as additional safety endpoint. Results: During the study period, 280 Tetrilimus stents (1.4 ± 0.5 stent/patient) were implanted to treat 252 coronary lesions (1.1 ± 0.3 stent/lesion) in 208 patients (age: 57.5 ± 11.9 years). Of study population, 65.9% were males, 46.6% were hypertensives, 25% were diabetics, 36.5% were alcoholics, 29.3% were smokers, 13.9% were tobacco chewers, 5.3% had previous revascularization, and 45.2% displayed multi-vessel disease. Of treated lesions, 67.5% were complex and 18.7% had total occlusion. Average length and diameter of implanted stents were 25.5 ± 8.8 mm and 2.9 ± 0.3 mm respectively. Subsequently, 30-day MACE were reported in 2 (0.96%) patients;both cases owing to in-hospital cardiac deaths. Events of stent thrombosis or noncardiac death were not reported in any patient. Conclusion: Low MACE rates and absence of stent thrombosis at early 30-day follow-up indicates that Tetrilimus everolimus-eluting stents may have encouraging safety and efficacy in unselected “real-world” patients with coronary artery disease.

关键词： Biodegradable Polymer Percutaneous Coronary Intervention Everolimus-Eluting

One-Year Clinical Outcomes of Biodegradable Polymer-Coated Sirolimus-Eluting Coronary Stent System in Patients with Coronary Artery Disease

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World Journal of Cardiovascular Diseases 2017年第8期7卷 233-242页

作者： sridhar kasturi Shailender Singh Vijay Kumar Shanivaram Kondal Rao Gollamandala Ganesh Mathan Shiva Kumar Bandimida Manikandhar Pendyala Chandrashekar Challa Sunshine Heart Institute Hyderabad India

Background: The biodegradable polymer-coated sirolimus-eluting coro-nary stent (SES) system for the treatment of coronary artery disease (CAD) has been implanted in a real-world patient population. Aim: The present study was designed to evaluate the safety and performance of MetaforTM sirolimus- eluting coronary stent (SES) system in consecutive patients with CAD in a real-world patient population. Methods: All the consecutive 251 patients who underwent percutaneous coronary interventions with the use of Metafor sirolimus-eluting stents were included in this study. Patients were clinically/tele- phonically followed-up at one-year from August 2015 to August 2016. We observed and analyzed major adverse cardiac event (MACE) defined as the aggregate of cardiac death, myocardial infarction (MI), and any target lesion revascularization (TLR) at one-year. Also, stent thrombosis (ST) was observed at one-year patients follow-up. Results: We collected and analyzed the data for 251 patients. Out of 251 participants, 191 (76.1%) were males, 95 (37.8%) patients had diabetes, 117 (46.6%) had ST-segment-elevation myocardial infarction (STEMI), and 134 (53.4%) had hypertension. Mean patient age was 56.35 ± 11.23 years. A total of 295 lesions were treated, out of which 13.6% of the lesions were the long lesion of ≥40 mm. At one-year, MACE occurred in 4 (1.6%) of 251 patients, consisting of 2 (0.8%) cardiac deaths, 2 (0.8%) MI, and 0 (0%) TLR. Stent thrombosis was reported in one patient (0.4%). Conclusions: This retrospective data demonstrated excellent safety and performance of Metafor SES in a “real-world” consecutive CAD patient, indicating low rates of MACE and ST at one-year follow-up.

关键词： Drug-Eluting Stents Cobalt-Chromium Hybrid Cell Design Percutaneous Coronary Intervention

Evidences for Incipient Hydrothermal Event(s) in the Central Indian Basin: A Review

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Acta Geologica Sinica(English Edition) 2005年第1期79卷 77-86页

作者： sridhar D. IYER National Institute of Oceanography Dona Paula Goa 403 004 India

The Central Indian Basin (CIB, 10°-19°S) encompasses morphotectonic features such as seamounts, abyssal hills, faults, fracture zones and lineations and basic to silicic volcanics that were derived from different sources. Instances of incipient hydrothermal event (s) occurred as evident from: (1) spilites that probably formed due to low-temperature hydrothermal action on the precursory basalts, (2) slabs and fragments of zeolitites which are the consequent products of palagonitization of the basaltic glasses, (3) chemical variations in the ferromanganese crusts, and (4) abundance of volcanogenic-hydrothermal material (vhm) that includes ochrous sediments and magnetite spherules. The vhm suggests its origin by interaction of Fe-rich hydrothermal solutions with surrounding sediments. The CIB spherules occur in sediments of~10 ka and ~425 to 650 ka age and are orders of magnitude younger than the 50 to 60 Ma age of the basin. Incidentally, to the north of the basin at ODP Site 717-719(1 °S/81 °E) hydrothermal precipitates of inorganic calcite and deposition of sulphide minerals (~7.5 to 9 Ma and 0.5 Ma) occur as a result of the on-going intraplate deformation. This paper reviews the above evidences that possibly indicate episodes of localized hydrothermal events in the CIB.

关键词： Central Indian Basin morphotectonics volcanics hydrothermal events synopsis

Defected Ground Structure Multiple Input-Output Antenna For Wireless Applications

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Computer Systems Science & Engineering 2023年第8期46卷 2109-2122页

作者： Ramya sridhar Vijayalakshimi Patteeswaran Department of Electronics and Communication Engineering RF Microwave&Wireless Communication LaboratoryHindusthan Institute of TechnologyCoimbatore641028Tamil NaduIndia Department of Electronics and Communication Engineering Hindusthan College of Engineering&TechnologyCoimbatore641050Tamil NaduIndia

In this paper,the investigation of a novel compact 2×2,2×1,and 1×1 Ultra-Wide Band(UWB)based Multiple-Input Multiple-Output(MIMO)antenna with Defected Ground Structure(DGS)is *** proposed Electromagnetic Radiation Structures(ERS)is composed of multiple radiating *** MIMO antennas are designed and analyzed with and without *** feeding is introduced by a microstrip-fed line to significantly moderate the radiating structure’s overall size,which is 60×40×1 *** high directivity and divergence characteristics are attained by introducing the microstripfed lines perpendicular to each *** the projected MIMO antenna structures are compared with others by using parameters like Return Loss(RL),Voltage Standing Wave Ratio(VSWR),Radiation Pattern(RP),radiation efficiency,and *** same MIMO set-up is redesigned with DGS,and the resultant parameters are ***,the Multiple Input and Multiple Output Radiating Structures with and without DGS are compared for result considerations like RL,VSWR,RP,radiation efficiency,and *** projected antenna displays an omnidirectional RP with moderate gain,which is highly recommended for human healthcare *** introducing the defected ground structure in bottom layer the lower cut-off frequencies of 2.3,4.5 and 6.0 GHz are achieved with few biological effects on radio propagation in human body *** proposed design covers numerous well-known wireless standards,along with dual-function DGS slots,and it can be easily integrated into Wireless Body Area Networks(WBAN)in medical *** WBAN links the autonomous nodes that may be situated either in the clothes,on-body or beneath the skin of a *** system typically advances the complete human body and the inter-connected nodes through a wireless communication channel.

关键词： MIMO-multiple input multiple output defected ground structure WBAN-wireless body area networks ultra-wideband voltage standing wave ratio