{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,21]],"date-time":"2026-07-21T05:04:35Z","timestamp":1784610275327,"version":"3.55.0"},"reference-count":18,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,7,21]],"date-time":"2026-07-21T00:00:00Z","timestamp":1784592000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Cardiovasc. Med."],"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>This study aims to preliminarily explore the feasibility and safety of intravascular ultrasound (IVUS)-guided percutaneous coronary intervention (PCI) for syphilitic coronary artery ostial lesions (SCAOL), providing hypothesis-generating insights for optimal stenting strategies in this distinct pathological entity.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Cardiovascular syphilis, a severe manifestation of tertiary syphilis, frequently leads to coronary ostial stenosis. While coronary artery bypass grafting (CABG) is the traditional revascularization modality, PCI has emerged as a minimally invasive alternative. Given the \u201cborderless\u201d inflammatory nature of syphilitic aortitis, the efficacy of the conventional \u201cflush-alignment\u201d stenting strategy lacks specific evidence.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We retrospectively analyzed seven consecutive patients with confirmed SCAOL who underwent PCI at our center between January 2019 and February 2026 (follow-up through March 2026). All cases were diagnosed via syphilis serology, and IVUS was utilized for pre-procedural assessment and post-stenting optimization. The IVUS characteristics of SCAOL and PCI-related outcomes were analyzed to explore the potential impact of stent positioning strategies. The study received institutional ethical approval and written informed consent from all patients.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The cohort included four males and three females (mean age: 54.3\u2009\u00b1\u20093.4 years). Pre-procedural IVUS consistently revealed concentric fibrous hyperplasia and significant negative remodeling, lacking typical atherosclerotic plaque features. Second-generation drug-eluting stents (DES) were successfully implanted in all seven patients. Six patients, whose stents protruded variably into the aortic sinus (ranging from approximately 2\u20134\u2005mm in most cases), remained free of major adverse cardiovascular events (MACE) over a median follow-up of 4 years (IQR: 3\u20136 years). Conversely, one patient (Case 6), who received a \u201cflush-alignment\u201d LM stent (protrusion &amp;lt;1\u2005mm) and lacked standardized anti-syphilitic therapy, developed NSTEMI due to severe in-stent restenosis (ISR) 8 months post-procedure. A bailout PCI utilizing a protrusion of approximately 4\u20135\u2005mm was performed, and the stent remained patent at the 13-month follow-up.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>IVUS-guided PCI was technically feasible in this small retrospective series of patients with suspected syphilitic coronary ostial lesions. Moderate aortic protrusion may help ensure ostial coverage, but the optimal protrusion length and its effect on restenosis require confirmation in larger multicenter studies. Furthermore, mechanical revascularization must be coupled with standardized systemic anti-syphilitic therapy and careful control of residual inflammatory activity to optimize long-term prognosis.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fcvm.2026.1849354","type":"journal-article","created":{"date-parts":[[2026,7,21]],"date-time":"2026-07-21T04:20:21Z","timestamp":1784607621000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Intravascular ultrasound-guided percutaneous coronary intervention for syphilitic coronary ostial lesions: a single-center case series"],"prefix":"10.3389","volume":"13","author":[{"given":"Yize","family":"Qi","sequence":"first","affiliation":[{"name":"Department of Nuclear Medicine, China-Japan Union Hospital of Jilin University","place":["Changchun, Jilin, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhiyuan","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Ultrasound, China-Japan Union Hospital of Jilin University","place":["Changchun, Jilin, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Junzhi","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of Nuclear Medicine, China-Japan Union Hospital of Jilin University","place":["Changchun, Jilin, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiangdong","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Cardiology, China-Japan Union Hospital of Jilin University","place":["Changchun, Jilin, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,7,21]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1097\/CRD.0000000000001115","article-title":"Syphilitic cardiac and vascular disease: a comprehensive review","author":"Maheta","year":"2025","journal-title":"Cardiol Rev"},{"key":"B2","doi-asserted-by":"publisher","first-page":"8392542","DOI":"10.1155\/2020\/8392542","article-title":"A review of primary vasculitis mimickers based on the Chapel Hill consensus classification","volume":"2020","author":"Zarka","year":"2020","journal-title":"Int J Rheumatol"},{"key":"B3","doi-asserted-by":"publisher","first-page":"100337","DOI":"10.1016\/j.ahjo.2023.100337","article-title":"Syphilitic ostial coronary artery occlusion treated with percutaneous coronary intervention: case series and literature review","volume":"36","author":"Baydoun","year":"2023","journal-title":"Am Heart J Plus Cardiovasc Res Pract"},{"key":"B4","doi-asserted-by":"publisher","first-page":"15","DOI":"10.21037\/acr-22-32","article-title":"Syphilitic aortitis and ostial coronary stenosis treated by endarterectomy, bypass grafting and aortic valve replacement: a case report","volume":"7","author":"Ip","year":"2023","journal-title":"AME Case Rep"},{"key":"B5","doi-asserted-by":"publisher","first-page":"1","DOI":"10.15585\/mmwr.rr7004a1","article-title":"Sexually transmitted infections treatment guidelines, 2021","volume":"70","author":"Workowski","year":"2021","journal-title":"MMWR Recomm Rep"},{"key":"B6","doi-asserted-by":"publisher","first-page":"1314","DOI":"10.1016\/j.jacc.2011.01.011","article-title":"The pathology of neoatherosclerosis in human coronary implants","volume":"57","author":"Nakazawa","year":"2011","journal-title":"J Am Coll Cardiol"},{"key":"B7","doi-asserted-by":"publisher","first-page":"3126","DOI":"10.1016\/j.jacc.2018.09.013","article-title":"Intravascular ultrasound versus angiography-guided drug-eluting stent implantation","volume":"72","author":"Zhang","year":"2018","journal-title":"J Am Coll Cardiol"},{"key":"B8","doi-asserted-by":"publisher","first-page":"3281","DOI":"10.1093\/eurheartj\/ehy285","article-title":"Clinical use of intracoronary imaging. 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