Loading [MathJax]/jax/element/mml/optable/Arrows.js
Review Special Issues

Challenges and risks associated with coronary calcified lesions in cardiovascular interventions: What makes calcified lesions more challenging and dangerous?

  • Received: 06 July 2024 Revised: 25 December 2024 Accepted: 30 December 2024 Published: 05 March 2025
  • Calcified lesions pose significant challenges in cardiovascular interventions due to their complex nature and associated risks. These challenges range from accurate diagnosis to the modification of calcified areas using various techniques. Failing to adequately treat calcification can lead to suboptimal outcomes in coronary angioplasty, increasing the risk of complications such as stent thrombosis and in-stent restenosis. While various calcium modification techniques are available, they come with inherent risks, including vessel perforations and dissections. In this review article, we explored the difficulties associated with calcified lesions, categorizing them into access site issues, acute complications, and long-term complications. Understanding these challenges is important in improving patient outcomes.

    Citation: Sophia Khattak, Farhan Shahid, Sohail Q. Khan. Challenges and risks associated with coronary calcified lesions in cardiovascular interventions: What makes calcified lesions more challenging and dangerous?[J]. AIMS Medical Science, 2025, 12(1): 69-89. doi: 10.3934/medsci.2025006

    Related Papers:

    [1] Xiao Qing Huang, Jia Feng Liao . Existence and asymptotic behavior for ground state sign-changing solutions of fractional Schrödinger-Poisson system with steep potential well. Communications in Analysis and Mechanics, 2024, 16(2): 307-333. doi: 10.3934/cam.2024015
    [2] Fangyuan Dong . Multiple positive solutions for the logarithmic Schrödinger equation with a Coulomb potential. Communications in Analysis and Mechanics, 2024, 16(3): 487-508. doi: 10.3934/cam.2024023
    [3] Wenqian Lv . Ground states of a Kirchhoff equation with the potential on the lattice graphs. Communications in Analysis and Mechanics, 2023, 15(4): 792-810. doi: 10.3934/cam.2023038
    [4] Xin Qiu, Zeng Qi Ou, Ying Lv . Normalized solutions to nonautonomous Kirchhoff equation. Communications in Analysis and Mechanics, 2024, 16(3): 457-486. doi: 10.3934/cam.2024022
    [5] Yangyu Ni, Jijiang Sun, Jianhua Chen . Multiplicity and concentration of normalized solutions for a Kirchhoff type problem with $ L^2 $-subcritical nonlinearities. Communications in Analysis and Mechanics, 2024, 16(3): 633-654. doi: 10.3934/cam.2024029
    [6] Rui Sun, Weihua Deng . A generalized time fractional Schrödinger equation with signed potential. Communications in Analysis and Mechanics, 2024, 16(2): 262-277. doi: 10.3934/cam.2024012
    [7] Chen Yang, Chun-Lei Tang . Sign-changing solutions for the Schrödinger-Poisson system with concave-convex nonlinearities in $ \mathbb{R}^{3} $. Communications in Analysis and Mechanics, 2023, 15(4): 638-657. doi: 10.3934/cam.2023032
    [8] Xiao Han, Hui Wei . Multiplicity of the large periodic solutions to a super-linear wave equation with general variable coefficient. Communications in Analysis and Mechanics, 2024, 16(2): 278-292. doi: 10.3934/cam.2024013
    [9] Henryk Żoła̧dek . An example in Hamiltonian dynamics. Communications in Analysis and Mechanics, 2024, 16(2): 431-447. doi: 10.3934/cam.2024020
    [10] Qi Li, Yuzhu Han, Bin Guo . A critical Kirchhoff problem with a logarithmic type perturbation in high dimension. Communications in Analysis and Mechanics, 2024, 16(3): 578-598. doi: 10.3934/cam.2024027
  • Calcified lesions pose significant challenges in cardiovascular interventions due to their complex nature and associated risks. These challenges range from accurate diagnosis to the modification of calcified areas using various techniques. Failing to adequately treat calcification can lead to suboptimal outcomes in coronary angioplasty, increasing the risk of complications such as stent thrombosis and in-stent restenosis. While various calcium modification techniques are available, they come with inherent risks, including vessel perforations and dissections. In this review article, we explored the difficulties associated with calcified lesions, categorizing them into access site issues, acute complications, and long-term complications. Understanding these challenges is important in improving patient outcomes.



    In the past decades, the following Kirchhoff problem

    (a+bR3|u|2dx)Δu+V(x)u=f(x,u),    xR3 (1.1)

    has attracted considerable attention. As we know, the following Dirichlet problem is one of the important deformations of Equation (1.1), which can be degenerated from (1.1). That is, if V(x)=0 and Ω is a bounded subset of R3, then Equation (1.1) will become

    {(a+bΩ|u|2dx)Δu=f(x,u)inΩ,u=0onΩ. (1.2)

    Problem (1.2) corresponds to

    utt(a+bΩ|u|2dx)Δu=f(x,u),

    which was advanced by Kirchhoff in [1]. As a generalization of the classical D'Alembert wave equation of the free vibration of elastic strings, the Kirchhoff model considers the changes of string length caused by lateral vibrations, which has important practical significance. For more mathematical and physical background about the Kirchhoff equations, we direct readers to [2,3] and the references quoted within them.

    When b=0, Equation (1.1) degenerates to the Schrödinger problem

    aΔu+V(x)u=f(x,u),    xRN, (1.3)

    which has been studied in the past few decades; see, for instance, [4,5,6,7,8,9] and the references therein. One interesting characteristic is the potential V change sign on RN. In [6], Bahrouni, Ounaies, and Radulescu showed the existence of infinitely many solutions for Equation (1.3) with f(x,u)=a(x)|u|q1u and 0<q<1. Further, Furtado, Maia, and Medeiros [10] investigated the Schrödinger equation (1.3) with a=1 and f(x,u)=f(u). Concretely, the nonlinearity fC1(R,R) is superlinear with subcritical growth. In addition, it verifies the Ambrosetti-Rabinowitz condition: for some θ>2, there is

    (ˆf)0<θF(t)tf(t)  for all t0,  where F(t)=t0f(s)ds.

    Besides, V satisfies the following assumptions:

    (V0) VLtloc(R3) for some t>32;

    (V1) 0<V:=lim|x|V(x)<+;

    (V2) R3|V(x)|32dx<S32, where V:=max{V,0} and S is the best constant for the Sobolev embedding, given by

    S:=infuD1,2(R3){0}R3|u|2dx(R3|u|6dx)13;

    (V3) V(x)V for all xR3 and VV;

    (V4) there exist γ>0 and CV>0 such that

    V(x)VCVeγ|x|,for all xR3.

    By using variational methods and the concentration-compactness principle, they obtained a positive ground state solution, and also a nodal solution. Therefore, we know that Equation (1.3) has a least energy sign-changing solution v0M0 such that I0(v0)=c0,2:=infuM0I0(u), where M0:={uX:u±0, I0(u),u+=I0(u),u=0} with I0(u)=12R3(a|u|2+V(x)u2)dxR3F(u)dx. For more results about problem (1.3) with indefinite potential, see [10,11,12,13] and the references therein.

    When b0, due to the presence of R3|u|2dxΔu, problem (1.1) becomes a nonlocal problem, which also brings some essential difficulties for our study. In the past, problems similar to (1.1) have attracted a lot of interest, and so there are many results. For instance, the existence of positive, ground state, and sign-changing solutions for problem (1.1) with various potential V and nonlinearity f has been extensively studied; see [14,15,16,17,18,19,20,21]. In a recent paper [22], Ni, Sun, and Chen also obtained the existence and multiplicity of normalized solutions for a Kirchhoff type problem by using minimization techniques and Lusternik-Schnirelmann theory.

    In what follows, we are particularly interested in the case when the potential V involved in problem (1.1) is indefinite. When V can change its sign and satisfies conditions (V0)(V2) and (V4), Batista and Furtado [23] studied problem (1.1) with f(x,u)=a(x)|u|p2u, that is,

    (a+bR3|u|2dx)Δu+V(x)u=a(x)|u|p2u,    xR3, (1.4)

    where 4<p<6 and a satisfies the following assumptions:

    (a0) aL(R3);

    (a1) there exist Ca, θ0>0 such that

    a(x)aCaeθ0|x|,for a.e. xR3,

    where

    a:=lim|x|+a(x)>0.

    Via the constraint variational methods and the quantitative deformation lemma, the authors not only obtained a non-negative ground state solution, but also a sign-changing solution of Equation (1.4). Here, we point out that the proof of the existence of sign-changing solutions depends on the radial symmetry of V in their paper. Indeed, once the potential V is radial, one can overcome the lack of compactness by considering in the radial subspace. However, if V is not radial, it makes no sense to restrict the problem to spaces of radial functions as the authors did in [23]. Besides, we know the embedding H1(R3)Lp(R3) is not compact for 2<p<6. Therefore, one may ask if there will be a sign-changing solution for problem (1.4) or problem (1.1) when the indefinite potential V is not radially symmetric and f is a general nonlinearity.

    Next, we will provide an answer to the questions raised above. Specifically, we are going to investigate the problem

    (a+bR3|u|2dx)Δu+V(x)u=f(u),    xR3, (1.5)

    where a,b>0 and V is a sign-changing potential.

    Moreover, we shall impose that fC(R,R) is odd. In addition, f also satisfies the following assumptions:

    (f0) limt0f(t)t=0;

    (f1) lim|t|f(t)|t|5=0;

    (f2) lim|t|F(t)|t|4=+, where F(t):=t0f(s)ds;

    (f3) f(t)|t|3 is a non-decreasing function for tR{0};

    (f4) F(t)0, for all tR.

    Through (f0) and (f1), it can be known that for any ε>0, there is a positive constant Cε which makes

    |f(t)|ε(|t|+|t|5)+Cε|t|q1,for any tR (1.6)

    where q(2,6). Then, let G(t):=14f(t)tF(t). By using (f3), we can easily obtain

    0G(t1)G(t2),for any 0t1t2. (1.7)

    In fact, for any t2t10, from (f3), one has f(t1)t31f(t)t3f(t2)t32 for all t1tt2. Then,

    G(t1)=14f(t1)t1+t2t1f(t)dtF(t2)=14f(t1)t1+t2t1f(t)t3t3dtF(t2)14f(t1)t1+t2t1f(t2)t32t3dtF(t2)14f(t1)t1+14f(t2)t32(t42t41)F(t2)14{f(t1)t1+f(t2)t2f(t1)t1}F(t2)=14f(t2)t2F(t2)=G(t2).

    Before presenting our main results, we first discussed the basic framework in the space

    X:={uH1(R3):R3V(x)u2dx<+}

    and the corresponding norm is given by

    uX:=(R3(a|u|2+V(x)u2)dx)12,for any uX.

    Next, we present the main results.

    Theorem 1.1. Assume that (V0)(V3) and (f0)(f3) are satisfied. Then, problem (1.5) has a positive ground state solution.

    In the proof, we need to overcome the problems stemming from the lack of compactness of Sobolev embedding in the whole space R3. To solve this problem, we first analyze the relationship between the energy functional's minimax level and that of the limit problem. Subsequently, we obtain a positive ground state solution by applying a more general global compactness lemma (see Lemma 3.1).

    In the second result, we mainly focused on researching the existence of least-energy sign-changing solutions. In order to obtain the result, we will use the method in [24].

    Theorem 1.2. Assume that f satisfies (f0)(f4). Assume also that V satisfies (V0)(V2), and there exist positive constants M,C, and γ such that, for |x|M,

    (V4)V(x)VC1+|x|γ.

    Then, there exists b>0 small enough such that Equation (1.5) possesses a least energy sign-changing solution for every b(0,b).

    Remark 1.3. Here, we would like to provide an example of nonlinearity f, which is odd and satisfies the conditions (f0)(f4), as shown below:

    f(t)=li=1ai|t|bit,for any tR,

    where ai>0 and 2<bi<4 for every i{1,2,,l}.

    In addition, we can find that a more obvious example that satisfies conditions (V0)(V2),(V4) is to take V(x)=VC1+|x|γ, where C and γ are positive given by (V4). Alternatively, we can give another example below that satisfies our hypothesis. That is, the potential function V is given by

    V(x)={α|x|β,if |x|<1;|x|21+|x|2,if |x|1,

    where β(0,2) and α>0 is a sufficiently small.

    Remark 1.4. Compared with [10], we apply weaker conditions (f2) and (f4) instead of the Ambrosetti-Rabinowitz condition to investigate the existence of sign-changing solutions. Moreover, condition (f4) can be used to construct a sign-changing (PS)cb,2; please refer to Section 5 for the detailed process. We note that condition (f4) is only used here. Besides, it is not necessary for f to be differentiable. By using the quantitative deformation lemma, we can prove that the minimizer on the Nehari manifold is a critical point of the energy functional Ib given in Section 2, please refer to Theorem 1.1 below.

    Remark 1.5. In this result, we apply the weaker condition (V4) instead of the condition (V4) given in [23], which makes our results applicable to a wider range of potential functions. Furthermore, the potential function V does not need to be radial in our paper, which is different from [23]. Moreover, for the proof of Theorem 1.2, compared to [10], the essential problem we face is that the existence of the nonlocal term poses some difficulties to energy estimates. Here, the condition (V4) and the restriction on the range of the parameter b are crucial for estimating energy (see Lemma 5.1). After that, we can restore the compactness of a bounded Palais–Smale sequence at a certain level with the help of a global compactness lemma, thereby obtaining the conclusion of Theorem 1.2.

    Theorem 1.6. Assume that ubn are the least energy sign-changing solutions of Equation (1.5) obtained in Theorem 1.2. Then, for any sequence {bn} with bn0 as n, there exists a subsequence, still denoted by {bn}, such that ubnu0 in X as n. Moreover, u0 is a least energy sign-changing solution of Equation (1.3) with f(x,u)=f(u).

    Remark 1.7. In this paper, we not only weaken the potential condition, but also increase asymptotic behavior, which is different from [23]. In particular, our result regarding asymptotic behavior is new. The asymptotic research enriches the results of our paper, and at the same time, the sign-changing solution is closely related to the results of the Schrödinger equation in [10]. In practical terms, we study their asymptotic behavior as b0 under assumptions (V0)(V2) and (V4), and we show that they converge to a least energy sign-changing solution of the Schrödinger equation (1.3) with f(x,u)=f(u), b0.

    Now, we introduce the organizational structure of this paper. We first provide the notations and some necessary lemmas in Section 2. Then, in Section 3, our main job is to establish a more general global compactness result, which will be well applied in the proof of our main theorems. In Section 4, we first give energy estimates, then Theorem 1.1 is verified. Finally, we prove Theorem 1.2. After that, Theorem 1.6 is verifed in Section 5.

    Next, we first give some notations and necessary lemmas, which are very helpful for us in proving the main theorems.

    "⇀" and "→" depict the weak and strong convergence, sequentially.

    |u|p=(R3|u|pdx)1p denotes the norm in Lp(R3) for p[1,+).

    ● Let H1(R3) be the Hilbert space with respect to the norm u2H1:=R3(|u|2+u2)dx.

    ● We use |Ω| to represent the Lebesgue measure of the set Ω.

    o(1) denotes a quantity which goes to zero as n.

    C, Ci (i=1,2,) represent different positive constants.

    ● We denote V=V+V with V±:=max{±V,0}.

    Lemma 2.1. Under the conditions of (V1) and (V2), the quadratic form

    uR3(a|u|2+V(x)u2)dx (2.1)

    defines a norm in H1(R3), which is equivalent to the usual one.

    Proof. Due to (V1), one has that there is R>0, which satisfies

    V2V+3V2,for any xR3BR(0), (2.2)

    where BR(0):={xR3:|x|<R}. In general, we take a=1. Then, using the Hölder inequality, the definition of S, and (2.2), one can ascertain

    R3(|u|2+Vu2)dx=R3(|u|2+V+u2)dxR3Vu2dxR3|u|2dx+BR(0)V+u2dx+|x|RV+u2dxR3|u|2dx+|V+|L3/2(BR(0))|u|26+3V2|x|Ru2dx(1+S1|V+|L3/2(BR(0)))R3|u|2dx+3V2R3u2dxmax{1+S1|V+|L3/2(BR(0)),3V2}R3(|u|2+u2)dx.

    Furthermore, from [10, Lemma 2.1], one deduces that there is C1>0, which holds the inequality R3(|u|2+V+u2)dxC1R3(|u|2+u2)dx. Moreover, from (V2), one has

    |R3Vu2dx|R3|V|u2dx|V|32|u|26S1|V|32R3|u|2dx.

    Hence, combining with V=V+V, it can be obtained that

    R3(|u|2+Vu2)dxR3|u|2dx+R3V+u2dxS1|V|32R3|u|2dxmin{1S1|V|32,1}R3(|u|2+V+u2)dxmin{1S1|V|32,1}C1R3(|u|2+u2)dx

    and the lemma is completed.

    Remark 2.2. From Lemma 2.1, it is obvious to see that the norm given by (2.1) is equivalent to the usual norm of H1(R3). Moreover, we know that the embeddings H1(R3)Lp(R3) (see [9, Theorem 1.8]) and H1(R3)Lqloc(R3) (see [9, Theorem 1.9]) are continuous and compact, respectively, where p[2,6] and q[1,6). Therefore, the embedding XLp(R3) is also continuous for all p[2,6]. Besides, one can see that the continuity of the embedding mentioned above can be represented by the following inequalities:

    |u|ppSppupX,for any p[2,6],

    in which Spp>0 is a constant.

    Define the energy functional Ib:XR by

    Ib(u)=12u2X+b4(R3|u|2dx)2R3F(u)dx.

    One can see that uF(u)dx is well defined on X, so Ib(u) is also well defined. Through discussions, one can deduce that IbC1(X,R). Moreover, for any vH1(R3),

    Ib(u),v=R3(auv+V(x)uv)dx+bR3|u|2dxR3uvdxR3f(u)vdx.

    The limit problem associated with (1.5) is the autonomous problem below:

    (a+bR3|u|2dx)Δu+Vu=f(u),    xR3. (P)

    The functional corresponding to Equation (P) is

    Ib,(u)=12R3(a|u|2+Vu2)dx+b4(R3|u|2dx)2R3F(u)dx.

    Let

    cb,1:=infuNbIb(u)andcb,:=infuNb,Ib,(u), (2.3)

    where

    Nb:={uX{0}:Ib(u),u=0}andNb,:={uX{0}:Ib,(u),u=0}.

    In addition, we define

    cb,2:=infuMbIb(u),

    where

    Mb:={uX:u±0, Ib(u),u+=Ib(u),u=0}.

    Next, we will provide some important lemmas to prove Theorem 1.1 and Theorem 1.2.

    Lemma 2.3. If {un}Mb is a minimizing sequence for Ib, then C1u±nXC2 for some C1, C2>0.

    Proof. Let {un}Mb and Ib(un)m as n. On one hand, due to (f0), (f1), and the Sobolev inequality, one has

    u±n2Xu±n2X+bR3|un|2dxR3|u±n|2dx=R3f(un)u±ndxR3(ε|un|+Cε|un|5)u±ndx=εR3|u±n|2dx+CεR3|u±n|6dxεS22u±n2X+CεS66u±n6X.

    When ε is sufficiently small to make (1εS22)>0, we can obtain that u±nXC1 for some C1>0. On the other hand, in light of {un}MbNb, we have Ib(un),un=0. In virtue of (1.7), one can arrive at

    m+o(1)=Ib(un)=Ib(un)14Ib(un),un=14un2X+R3(14f(un)unF(un))dx14un2X,

    which means that m>0, so one can deduce that {un} is bounded in X. Namely, u±nXC2 for some C2>0. Therefore, C1u±nXC2.

    Remark 2.4. If {un}X be a (PS)c sequence, then by using (1.7) and similar arguments to Lemma 2.3, one can get unXC2 for some C2>0.

    Similar to the discussion in [25], one can derive Lemma 2.5 and Lemma 2.6. Here, we omit the proof process.

    Lemma 2.5. Assume that (V0)(V2) and (f0)(f3) hold. If uX with u±0, then there exists a unique pair (su,tu)(0,+)×(0,+) such that suu++tuuMb. Moreover,

    Ib(suu++tuu)=maxs,t0Ib(su++tu).

    Lemma 2.6. Assume that (V0)(V2) and (f0)(f3) hold. If uX with u0, then there exists a unique su>0 such that suuNb. Moreover,

    Ib(suu)=maxs0Ib(su).

    Lemma 2.7. cb, can be obtained by some positive and radially symmetric function ˉuNb,, that corresponds to the ground state solution of (P) (see [26]). Furthermore, if f is odd, then for every 0<δ<V, there is C=C(δ)>0 that satisfies

    0<ˉu(x)Ceδα|x|,  for any xR3, (2.4)

    where α=(a+bR3|ˉu|2dx)12.

    Proof. The existence of the ground state solutions of (P) was proved in [26, Proposition 2.4]. For the properties of solutions of (P), see [27, Proposition 1.1].

    Now, we will give a more general global compactness lemma, which is very useful.

    Lemma 3.1. Let {un}X be a sequence such that

    Ib(un)c  and   Ib(un)0,as n.

    Then, there exist u0H1(R3) and AR+, such that JA(u0)=0, where

    JA(u)=a+bA2R3|u|2dx+12R3V(x)u2dxR3F(u)dx,

    and either

    (i) unu0 in X, or

    (ii) there exists a number kN+, k sequences of points {yjn}R3 with |yjn|+, 1jk, and k functions {u1,u2,,uk}H1(R3), which are nontrivial weak solutions to

    (a+bA)Δu+Vu=f(u) (3.1)

    and

    c+bA24=JA(u0)+kj=1JA(uj), (3.2)
    unu0kj=1uj(yjn)X0,
    A=|u0|22+kj=1|uj|22, (3.3)

    where

    JA(u)=a+bA2R3|u|2dx+12R3Vu2dxR3F(u)dx.

    Proof. In view of Remark 2.4, we know {un} is bounded in X. Then, there are u0X and AR+ that satisfy

    unu0  in X  and  R3|un|2dxA. (3.4)

    Due to (3.4) and Ib(un)0 as n, we arrive at

    R3(au0φ+V(x)u0φ)dx+bAR3u0φdxR3f(u0)φdx=0,φX.

    That is, JA(u0)=0. On the other hand, it is clear to see that

    JA(un)=a+bA2R3|un|2dx+12R3V(x)u2ndxR3F(un)dx=a2R3|un|2dx+12R3V(x)u2ndx+b4(R3|un|2dx)2R3F(un)dx+bA24+o(1)=Ib(un)+bA24+o(1). (3.5)

    Besides, for all φC0(R3), one has

    JA(un),φ=(a+bA)R3unφdx+R3V(x)unφdxR3f(un)φdx=R3(aunφ+V(x)unφ)dx+bR3|un|2dxR3unφdxR3f(un)φdx+o(1)=Ib(un),φ+o(1). (3.6)

    It follows from (3.5) and (3.6) that

    JA(un)c+bA24  and   JA(un)0,as n.

    Next, we will demonstrate in three steps and provide detailed proof process.

    Step 1. Letting u1n:=unu0, we can obtain

    (a1) JA(u1n)c+bA24JA(u0),

    (b1) (JA)(u1n),u1n=JA(un),unJA(u0),u0+o(1)=o(1).

    To prove (a1), we can use the weak convergence of {un} and [28, Lemma 3] to conclude that

    |u1n|22=|un|22|u0|22+o(1), (3.7)
    |u1n|22=|un|22|u0|22+o(1), (3.8)
    R3F(u1n)dx=R3F(un)dxR3F(u0)dx+o(1), (3.9)
    R3f(u1n)u1ndx=R3f(un)undxR3f(u0)u0dx+o(1). (3.10)

    Moreover, by virtue of (V1), we know ε>0, R>0 such that |VV(x)|<ε on R3BR(0). Hence, it holds that

    |R3(VV)(u2nu20)dx|BR(0)|VV||u2nu20|dx+εR3BBR(0)|u2nu20|dxC1|unu0|L2(BBR(0))+C2ε=C2ε+o(1).

    From the arbitrariness of ε, it can be concluded that

    limnR3(VV)(u2nu20)dx=0. (3.11)

    Using (3.7)-(3.9) and (3.11), we can show that

    JA(u1n)JA(un)+JA(u0)=a+bA2(|u1n|22|un|22+|u0|22)+12R3V(x)(u20u2n)dx+12R3V(u1n)2dx+R3(F(un)F(u0)F(u1n))dx=o(1).

    That is, (a1) is correct. As for (b1), by using a similar argument as before and (3.10), it is sufficient to get (b1). We omit the details here. Furthermore, by (a1), we can obtain that JA(u1n)0.

    Step 2. Define

    δ(1):=lim supn+supyR3B1(y)|u1n|2dx.

    Case 1 (Vanishing): δ(1)=0. That is, as n,

    supyR3B1(y)|u1n|2dx0.

    From the P.L. Lions lemma in [9], one has u1n0 in Lt(R3) for any t(2,6). Thus, we deduce that limn+R3f(u1n)u1ndx=0 by (1.6). Besides, it is easy to get R3(V(x)V)(u1n)2dx=o(1). Hence, by (b1), we can conclude u1nX0 as n.

    Case 2 (Non-vanishing): δ(1)>0. Assume that there exists {y1n}R3 such that

    B1(y1n)|u1n|2dx>δ(1)2>0.

    We now define a new sequence w1n:=u1n(+y1n). It is easy to get that {w1n} is bounded in X. Moreover, we suppose that w1nu1 in X. Since

    B1(0)|w1n|2dx=B1(y1n)|u1n|2dx>δ(1)2>0,

    it follows from the Sobolev embedding that u10. Moreover, u1n0 in X implies that {y1n} is unbounded. That is, |y1n| as n. Furthermore, we can show (JA)(u1)=0.

    Step 3. Setting u2n:=u1nu1(y1n), we can check that

    (a2) JA(u2n)c+bA24JA(u0)JA(u1),

    (b2) (JA)(u2n),u2n=JA(un),unJA(u0),u0(JA)(u1),u1+o(1)=o(1).

    Similar to Step 2, define

    δ(2):=lim supn+supyR3B1(y)|u2n|2dx.

    If δ(2)=0, we have u2nX0 as n. That is, unu0u1(y1n)X0 as n. By (3.7) and (a2), we have A=|u0|22+|u1|22 and c+bA24=JA(u0)+JA(u1). Furthermore, we know that JA(u2n)=o(1). If δ(2)>0, as the arguments as above, we know that there exists {y2n}R3 unbounded, and a sequence w2n:=u2n(+y2n) that satisfies w2nu2 in X and u20. Besides, we can obtain (JA)(u2)=0. Iterating the above process, we can show that

    ujn=uj1nuj1(yj1n)

    with |yjn| and

    wj1n=uj1n(+yj1n)uj1  in X,

    where uj is the nontrivial weak solution of Equation (3.1). Moreover, we can conclude that

    JA(ujn)=c+bA24JA(u0)j1i=1JA(ui)+o(1).

    Noticing that ui is the nontrivial weak solution of Equation (3.1), in view of (1.7), we can obtain JA(ui)>0. Besides, similar to the above discussion, we know that when δ(j)=0, JA(ujn)=o(1). Hence, there is some finite constant kN. Moreover, the above process will stop after k iterations. Namely, the proof is completed.

    Corollary 3.2. The functional Ib satisfies (PS)c condition for c(0,cb,).

    Proof. Let {un}X be a (PS)c sequence for c(0,cb,). Then,

    Ib(un)c(0,cb,)  and  Ib(un)0,as n.

    We only need to prove that {un} has a convergent subsequence in X next. From Remak 2.4, we first conclude that {un} is bounded in X. Hence, there is a subsequence of {un}, still denoted as {un}. Besides, there is also u0H1(R3) that satisfies unu0 in X. If it is strongly convergent, then the proof is completed. If unu0 in X, from Lemma 3.1, there exist A=|u0|22+kj=1|uj|22, kN and {yjn}R3 with |yjn|+ for j=1,2,,k and ujH1(R3) such that

    JA(u0)=0,unu0kj=1uj(yjn)X0,c+bA24=JA(u0)+kj=1JA(uj),

    where uj are nontrivial critical points of JA for j=1,2,,k.

    We first give the following two claims.

    Claim 1: If u00 and there exists t0>0 such that t0u0Nb, then we claim that t01.

    Since t0u0Nb and JA(u0)=0, we can obtain that

    t0u02X+b(R3|(t0u0)|2dx)2=R3f(t0u0)(t0u0)dx (3.12)

    and

    (a+bA)R3|u0|2dx+R3V(x)u20dx=R3f(u0)u0dx. (3.13)

    It follows from (3.3), (3.12), and (3.13) that

    (11t20)u02XR3(f(u0)(u0)3f(t0u0)(t0u0)3)|u0|4dx. (3.14)

    From (f3) and (3.14), it is easy to obtain t01. Therefore, the claim is proved.

    Claim 2: If u00, we claim that

    JA(u0)cb,1+bA4R3|u0|2dx. (3.15)

    Combining t01 and (1.7), we can arrive at

    R3(14f(t0u0)(t0u0)F(t0u0))dxR3(14f(u0)u0F(u0))dx.

    Hence, we can obtain

    JA(u0)=JA(u0)14JA(u0),u0=a+bA4R3|u0|2dx+14R3V(x)u20dx+R3(14f(u0)u0F(u0))dxt204R3(a|u0|2+V(x)u20)dx+bA4R3|u0|2dx+R3(14f(t0u0)(t0u0)F(t0u0))dx=Ib(t0u0)14Ib(t0u0),t0u0+bA4R3|u0|2dx=Ib(t0u0)+bA4R3|u0|2dxcb,1+bA4R3|u0|2dx.

    Therefore, the claim is proved. Similarly, since uj0 and (JA)(uj)=0, it is easy to see that

    JA(uj)cb,+bA4R3|uj|2dx. (3.16)

    Now, we return to our proof. If u00,k1, then A=kj=1|uj|22 and c+bA24=kj=1JA(uj)kcb,+bA24. Noticing that c<cb,, this is absurd. If u00,k1, then from (3.2), (3.15), and (3.16), we can obtain c+bA24cb,1+kcb,+bA24. By using (f0)(f3) and similar discussions to those in [9, Theorem 4.2], one ascertains cb,1>0. Combining c<cb,, we know this case cannot occur. Therefore, k=0 and the proof is completed.

    Now, we prove Theorem 1.1. First, due to conditions (f0)(f2), one can easily deduce that Ib satisfies the mountain pass geometry. Then, by conditions (f0)(f3) and similar discussions to those in [9, Theorem 4.2], we have

    cb,1=infγΓmaxt[0,1]Ib(γ(t))=infuX{0}maxt0Ib(tu)>0,

    where Γ:={γC([0,1],X):γ(0)=0, Ib(γ(1))<0}. Then, we show the relationship between cb,1 and cb,. Note that ˉu is a positive ground state solution of (P), so combined with Lemma 2.6, one can ascertain that there is tˉu>0, which makes tˉuˉuNb.

    Lemma 4.1. Assume that (V0)(V3) and (f0)(f3) hold. Then,

    0<cb,1<cb,.

    Proof. We first claim that tˉu<1.

    Since ˉuNb,, one has that

    R3(a|ˉu|2+Vˉu2)dx+b(R3|ˉu|2dx)2=R3f(ˉu)ˉudx. (4.1)

    Due to tˉuˉuNb, we ascertain that

    t2ˉuR3(a|ˉu|2+V(x)ˉu2)dx+t4ˉub(R3|ˉu|2dx)2=R3f(tˉuˉu)(tˉuˉu)dx. (4.2)

    Combining (4.1), (4.2), and (V3), we deduce that

    (1t2ˉu1)R3(a|ˉu|2+Vˉu2)dx>R3(f(tˉuˉu)(tˉuˉu)3f(ˉu)ˉu3)|ˉu|4dx.

    If tˉu1, the above equation does not hold by (f3). Thus, we can obtain that tˉu<1.

    It follows from (1.7), (V3), Lemma 2.6, and the above claim that

    cb,1maxt0Ib(tˉu)=Ib(tˉuˉu)<t2ˉu4R3(a|ˉu|2+Vˉu2)dx+R3(14f(tˉuˉu)(tˉuˉu)F(tˉuˉu))dx<14R3(a|ˉu|2+Vˉu2)dx+R3(14f(ˉu)ˉuF(ˉu))dx=Ib,(ˉu)=cb,.

    The proof is completed.

    Proof of Theorem 1.1. Through using [9, Theorem 1.15], one knows that there exists a sequence {un}X such that

    Ib(un)cb,1andIb(un)0,as n.

    In view of Corollary 3.2 and Lemma 4.1, the sequence {un} has a subsequence which strongly converges to uX. Besides, the function u satisfies Ib(u)=cb,1>0 and Ib(u)=0. We can easily get that u0. This indicates that u is a ground solution of Equation (1.5). Next, we prove that Equation (1.5) has a positive ground solution. First, based on f being an odd function, we can see Ib(|u|)=Ib(u)=cb,1 and |u|Nb. We can claim that Ib(|u|)=0 by using the deformation lemma, where f does not require differentiability. For convenience, let us note w=|u|. Then, we only need to prove Ib(w)=0.

    By contradiction, we assume Ib(w)0. Then, there are ϱ>0 and δ>0 that satisfy

    Ib(u)Xϱ,uX  with  uwX3δ.

    Let D:=(1σ,1+σ), where σ(0,min{12,δ2wX}). By using the fact that wNb and the condition (f3), we have

    Ib(tw),tw>0,if  t<1

    and

    Ib(tw),tw<0,if  t>1.

    Hence, we can take t1,t2D{1}, such that

    Ib(t1w),t1w>0, Ib(t2w),t2w<0. (4.3)

    It follows from Lemma 2.6 that

    ˉc:=max{Ib(t1w),Ib(t2w)}<Ib(w)=cb,1. (4.4)

    For ε:=min{(cb,1ˉc)/3,δϱ/8} and Sδ:={uX:uwXδ}, due to the deformation lemma in [9, Lemma 2.3], one deduces that there exists ηC([0,1]×X,X) that satisfies

    (a) η(1,u)=u if uI1b([cb,12ε,cb,1+2ε])S2δ;

    (b) η(1,Icb,1+εbSδ)Icb,1εb;

    (c) Ib(η(1,u))Ib(u), for any uX.

    From this deformation, with the help of Lemma 2.6, we can claim that

    maxtDIb(η(1,tw))<cb,1. (4.5)

    Indeed, on the one hand, from Lemma 2.6, we know tD,

    Ib(tw)Ib(w)=cb,1cb,1+ε.

    In addition, based on the definition of σ, it can be concluded that

    tww2Xσ2w2X12δ2<δ2,

    which means twSδ. Hence, twIcb,1+εbSδ. According to (b), it is easy to obtain (4.5).

    In what follows, we can first claim that η(1,tw)Nb for some tD. We define

    Φ(t):=Ib(η(1,tw)),η(1,tw),for t>0.

    From (4.4), the definition of ε and (a), we have η(1,t1w)=t1w and η(1,t2w)=t2w. From (4.3), one has

    Φ(t1)=Ib(t1w),t1w>0, Φ(t2)=Ib(t2w),t2w<0. (4.6)

    In view of (4.6) and the continuity of Φ, there exists t0[t1,t2]D such that Φ(t0)=0. From the definition of Φ, one has η(1,t0w)Nb. Namely, η(1,tw)Nb for some t[t1,t2]. Then, one gets cb,1Ib(η(1,t0w)), which is clearly contradictory to (4.5). Hence, the assumption is not valid and we ascertain that Ib(w)=0. Therefore, w is a non-negative solution of Equation (1.5). Finally, according to the maximum principle [29, Theorem 3.5], one can obtain w>0 in R3. Then, we say Equation (1.5) has a positive ground solution w. So far, the proof is completed.

    Remark 4.2. Let u1X be the solution obtained from Theorem 1.1. From the theory of classical Schrödinger equations (see [30, Theorem 3.1]), it is easy to conclude that u1 decays exponentially as |x|. Namely, for every δ>0, there exist C=C(δ)>0 and R>0 such that

    u1(x)Ceδ|x|,for any |x|R. (4.7)

    In this section, we will prove the existence and asymptotic behavior of least-energy sign-changing solutions of Eq. (1.5). We first give the relationship among cb,1, cb, and cb,2. Then, inspired by [24], we can construct a sign-changing (PS)cb,2 sequence for Ib. After that, we can use Lemma 3.1 to prove Theorem 1.2. Finally, we prove Theorem 1.6.

    Lemma 5.1. Assume that (V0)(V2), (V4), and (f0)(f3) hold. Then, there exists b>0 small enough such that for 0<b<b we have

    0<cb,2<cb,1+cb,<2cb,.

    Proof. Define ˉun(x):=ˉu(xne1) and e1:=(1,0,0), where ˉu is given in Lemma 2.7. In what follows, u1 represents the positive ground state solution of Equation (1.5), which is obtained from Theorem 1.1.

    Claim 1: There exist s0,t0>0 such that s0u1t0ˉun0Mb for some n0N large enough.

    In fact, denote χ(a)=1au1ˉun with a>0, and define a1,a2 by

    a1=sup{aR+:χ+(a)0}anda2=inf{aR+:χ(a)0}.

    By Lemma 2.5, there exists (s(χ(a)),t(χ(a))) such that s(χ(a))χ+(a)+t(χ(a))χ(a)Mb. Because u1 is positive and ˉu is radial, we can prove that a1=+. Indeed, we first notice that ˉu is radially symmetric, as the same arguments presented in [31, Lemma 3.1.2] (see also [32, Radial Lemma 1]), one has that there exists a constant C>0 such that

    |ˉu(x)|CˉuX|x|,for every |x|1. (5.1)

    We can obtain that for every xBR(0), there is |xne1|n|x|nR. By using (5.1), one can ascertain

    ˉun(x)=ˉu(xne1)C1ˉuXnRC2nR.

    Then, for fixed xBR(0), we will have

    χ(a)=1au1ˉun1au1C21nR. (5.2)

    Therefore, we can take ε=u12aC2>0 and n0N, such that 1nR<ε for every nn0. Combining with (5.2), we know that for all nn0 and a(0,+), there is

    χ(a)=1au1ˉun>12au1>0.

    Finally, we obtain that a1=+ by the definition of a1.

    If aa1=+, then 1au10 in X and χ+(a)0. Similar to [33, Lemma 2.2 (ii)], one concludes that s(χ(a))+ and {t(χ(a))} is bounded in R+. Hence, as aa1, one has

    s(χ(a))t(χ(a))+. (5.3)

    Similarly, if aa+2, χ(a)0, one has that t(χ(a))+ and {s(χ(a))} is bounded in R+. So, as aa+2, we have

    s(χ(a))t(χ(a)). (5.4)

    From [33, Lemma 2.2 (i)], we can ascertain the continuity of s and t. Combining (5.3) and (5.4), we obtain that there exists a0(a2,a1) such that s(χ(a0))=t(χ(a0)) for n0. Hence, let s0=1a0s(χ(a0)) and t0=t(χ(a0)), it is easy to show that

    s(χ(a0))χ(a0)=s0u1t0ˉun0Mb.

    Claim 2: There exist b>0 small enough and nN+ large enough such that for 0<b<b we have

    maxs,t>0Ib(s0u1t0ˉun)<cb,1+cb,. (5.5)

    Obviously, Ib(su1tˉun)<0 for s or t large enough. Next, we only need to consider this problem in a bounded interval. That is, we consider the case that s,t(0,C), where C>0. Moreover, one can check that there is tn>0 that satisfies tn1 as n and tnˉunNb. Then, by a direct calculation, we can obtain

    Ib(su1tˉun)=12R3(a|(su1tˉun)|2+V(x)(su1tˉun)2)dx+b4(R3|(su1tˉun)|2dx)2R3F(su1tˉun)dx=12R3(a|(su1)|2+V(x)(su1)2)dx+b4(R3|(su1)|2dx)2R3F(su1)dx+12R3(a|(tˉun)|2+V(x)(tˉun)2)dx+b4(R3|(tˉun)|2dx)2R3F(tˉun)dxR3asu1tˉundxR3V(x)(su1)(tˉun)dx+b4{4s2t2(R3u1ˉundx)24s3tR3|u1|2dxR3u1ˉundx+2s2t2R3|u1|2dxR3|ˉun|2dx4st3R3|ˉun|2dxR3u1ˉundx}R3(F(su1tˉun)F(su1)F(tˉun))dxIb(su1)+Ib(tnˉun)+Bn+Cn+Dn=Ib(su1)+Ib,(tnˉun)+An+Bn+Cn+Dn, (5.6)

    where

    An=12R3(V(x)V)(tnˉun)2dx,Bn=stR3(au1ˉun+V(x)u1ˉun)dx,Cn=b4{4s2t2(R3u1ˉundx)24s3tR3|u1|2dxR3u1ˉundx+2s2t2R3|u1|2dxR3|ˉun|2dx4st3R3|ˉun|2dxR3u1ˉundx},Dn=R3(F(su1)+F(tˉun)F(su1tˉun))dx.

    First, similar to the conclusion presented in [10], we can show that

    R3u1|ˉun|qdxC1eδα(q+1)n+C2eδq+1n, (5.7)
    R3|u1|qˉundxC3eδqα(q+1)n+C4eδqq+1nC5eδα(q+1)n+C6eδq+1n, (5.8)

    for any q[1,5].

    For An, in view of (V4), we can arrive at

    An14B1(0)(VV(x+ne1))ˉu2dx14CB1(0)ˉu21+|x+ne1|γdxC7nγ. (5.9)

    As for Dn, due to (1.6), one has

    Dn2R3(f(su1)tˉun+f(tˉun)su1)dx2R3(ε(|su1|+|su1|5)tˉun+Cε|su1|q1tˉun+ε(|tˉun|+|tˉun|5)su1+Cε|tˉun|q1su1)dxC8eδ6αn+C9eδ6n. (5.10)

    In what follows, we estimate Bn. Since Ib,(ˉun),u1=0, we deduce that

    R3(aˉunu1+Vˉunu1)dx+bR3|ˉun|2dxR3ˉunu1dx=R3f(ˉun)u1dx. (5.11)

    From (1.6), (5.7), and (5.11), we derive that

    R3ˉunu1dx=R3f(ˉun)u1dxR3Vˉunu1dxa+bR3|ˉun|2dxC10(R3f(ˉun)u1dx+R3Vˉunu1dx)C11eδ6αn+C12eδ6n. (5.12)

    Since Ib(u1),ˉun=0, we can get that

    R3(au1ˉun+V(x)u1ˉun)dx+bR3|u1|2dxR3u1ˉundx=R3f(u1)ˉundx.

    Let us go back to the term Bn now. Combining (1.6), (5.8), (5.12), and the above equation, we can obtain that

    Bn=st(bR3|u1|2dxR3u1ˉundxR3f(u1)ˉundx)st(bR3|u1|2dxR3u1ˉundx+R3|f(u1)|ˉundx)C13eδ6αn+C14eδ6n. (5.13)

    By (5.12), it is easy to conclude that

    CnC15eδ6αn+C16eδ6n+C42bR3|u1|2dxR3|ˉun|2dxC15eδ6αn+C16eδ6n+C17b. (5.14)

    Then, due to (5.9), (5.10), (5.13), and (5.14), we can ascertain that

    An+Bn+Cn+DnC7nγ+C18eδ6αn+C19eδ6n+C17b. (5.15)

    Therefore, choosing n0N+ large enough, we can obtain C7nγ0+C18eδ6αn0+C19eδ6n0<0. Hence, we can take b=C71nγ0C18eδ6αn0C19eδ6n02C17>0, and then, b(0,b), we have

    An+Bn+Cn+Dn<0,

    for all nn0. Noticing that (5.6), we deduce that

    maxs,t(0,C)Ib(su1tˉun)<maxs(0,C)Ib(su1)+Ib,(ˉun)Ib(u1)+Ib,(ˉun)=cb,1+cb,,

    for all nn0. Therefore, the claim is proved. Finally, combining Claim 1 and Claim 2, for any b(0,b), we can show that

    cb,2Ib(s0u1t0ˉun0)maxs,t>0Ib(su1tˉun0)<cb,1+cb,.

    The proof is completed.

    In order to construct a sign-changing (PS)cb,2 sequence of the functional Ib, we follow the method in [24]. Define

    g(u,v):={R3f(u)udxu2X+b(R3|u|2dx)2+bR3|u|2dxR3|v|2dx,ifu0;0,ifu=0. (5.16)

    First, since f being an odd function, we can obtain g(u,v)>0 if u0. Besides, we can see that uMb if and only if g(u+,u)=g(u,u+)=1. Moreover, we can construct the following set U, which is larger than the set Mb. Namely, we define

    U:={uX:|g(u+,u)1|<12,|g(u,u+)1|<12}.

    We know MbU. Furthermore, from Lemma 2.5, it can be concluded that Mb. That is, MbU. Now, we use P to represent the cone of the non-negative functions in X, D:=[0,1], E:=D×D, and Σ to represent the set of continuous maps σ, so that for all s,tD,

    (i) σC(E,X);

    (ii) σ(s,0)=0,σ(0,t)P and σ(1,t)P;

    (iii) (Ibσ)(s,1)0 and R3f(σ(s,1))σ(s,1)dxσ(s,1)2X+b(R3|(σ(s,1))|2dx)22.

    We can claim that Σ. In fact, for every uX and u±0, we can set σ(s,t)=μ(1s)tu++μstu, where μ>0 and s,tD. Then, through simple calculations, one can conclude σ(s,t)Σ for some μ>0. Moreover, we can also obtain the following lemmas.

    Lemma 5.2. Assume that (V0)(V2) and (f0)(f4) hold. Then,

    infσΣsupuσ(E)Ib(u)=infuMbIb(u)=cb,2.

    Proof. On one hand, for all uMb and s,tD, there is σ(s,t)=μ(1s)tu++μstu such that when μ>0 is sufficiently large, σ(s,t)Σ. In light of Lemma 2.5, one concludes that Ib(u)=maxs,t0Ib(su++tu). Hence, one obtains that

    Ib(u)supuσ(E)Ib(u)infσΣsupuσ(E)Ib(u),

    which implies that

    infuMbIb(u)infσΣsupuσ(E)Ib(u). (5.17)

    On the other hand, we can see that for every σΣ, there is uσσ(E)Mb. Therefore,

    supuσ(E)Ib(u)Ib(uσ)infuMbIb(u).

    Then, one can arrive at

    infσΣsupuσ(E)Ib(u)infuMbIb(u). (5.18)

    Hence, combining (5.17) and (5.18), we can conclude that

    infσΣsupuσ(E)Ib(u)=infuMbIb(u)=cb,2.

    Now it remains to prove the claim. Indeed, due to the definition of Σ, we can know σ(0,t)P and σ(1,t)P, which holds for every σΣ and tD. Moreover, by using conditions (f4) and (1.7), it is easy to ascertain that for every tR, there is 14f(t)tF(t)0. Next, for convenience, one can define . Then, one can deduce

    (5.19)

    and

    (5.20)

    Then, we can use property and the inequality , where , to obtain that

    Thus,

    (5.21)

    In addition, we can verify . Hence,

    (5.22)

    Therefore, using Miranda's theorem [34] and (5.19)-(5.22), there is that satisfies

    As a result, one has

    Namely, there exists for any . The proof is completed.

    Lemma 5.3. Assume that and hold, then there exists a sequence satisfying and as .

    Proof. Let be a minimizing sequence and , so

    (5.23)

    We can claim that there is a sequence , which satisfies, as ,

    (5.24)

    Suppose there is a contradiction, then, there exists such that for , which is sufficiently large, where

    Through using [35], due to Hofer [36], there is , which satisfies the following properties for some and every .

    , ;

    for any , where ;

    ;

    .

    By (5.23), select to be sufficiently large so that

    (5.25)

    Define for all . Then, it is clear to see that . From (5.25) and property , it can be inferred that . Therefore,

    which is absurd, so the claim is valid.

    Now, we begin to prove when is large enough. Indeed, in light of as , one can ascertain . After that, it is sufficient to prove , which means and . Therefore, one gets for large enough. Using (5.24), there is a sequence that satisfies

    (5.26)

    To get , we only need to show that and for large enough. It derives from Lemma 2.3 and the fact of that for some . Next, we only need to prove and as . By contradiction, if as , in light of (5.26) and being continuous, one can get

    Choosing such that

    leads to a contradiction. Then, the above assumption is not valid. Therefore, for large enough.

    Based on the previous lemma, we will now focus on the proof of Theorem 1.2.

    Proof of Theorem 1.2. First, there is a sequence by Lemma 2.3 and Lemma 5.3, which is bounded. Then, we assume that there exists a subsequence, which satisfies in . We can claim in , thus we deduce that

    From Lemma 2.3, by in , we get , namely . Hence, is a least energy sign-changing solution of Equation (1.5).

    It remains to verify the above claim. In fact, due to Lemma 3.1, if case occurs, the proof is completed. If case occurs, since , it follows from (3.2) that . Hence, or .

    If , in light of , one can deduce for and ,

    (5.27)

    Since and , (5.27) and Lemma 2.3 imply that . Besides, due to , we get . Hence, we have by (3.16). Therefore,

    which contradicts with . Thus, , combining , (3.2), (3.15), and (3.16), we can get that

    Therefore, we can show that and in . The proof is completed.

    From now on, we will study the asymptotic behavior of the above sign-changing solutions with respect to . In order to facilitate research, we set , and with , , and , where and respectively represent and with . Besides, from Theorem 1.2, we have obtained that Equation (1.5) has a least energy sign-changing solution for all under hypothesis and . Next, we denote it as and consider the problem with .

    Proof of Theorem 1.6. First of all, in virtue of Theorem 1.2 and Lemma 5.1, we immediately know that is achievable by some for all and satisfies . Hence, there is a sequence that satisfies and . Similar to the proof in [37], we can get that , where is a positive constant. Due to , we have that

    and we can easily infer that is bounded. Thus, there is a subsequence of and that satisfies in . Besides that, we can easily check that the sequence is bounded for all . Therefore, combining as , we can arrive at

    Through simple calculations, one has

    for all , which implies that .

    In the following, we deduce that . Because of , we know that there is large enough such that for all . Due to Lemma 2.5, we get that there is that satisfies , where satisfies . Hence, we have by , and then . Therefore, we can conclude that

    Hence,

    (5.28)

    In light of and Fatou's Lemma, one gets

    (5.29)

    Next, we show that and . First, combining the boundedness of and (5.28), one deduces that

    (5.30)

    Besides, it is easy to check that

    for all , which means that

    (5.31)

    Hence, owing to (5.30) and (5.31), we know that there is a subsequence of , still denoted by , which satisfies

    (5.32)

    In virtue of [10, Proposition 4.1], we get that . According to [10], we know that satisfies the condition, where . Hence, by (5.32), we get that the sequence has a convergent subsequence, still denoted by . Then, one has in . Moreover, in light of and Lemma 2.3, we can arrive at , and then . Noting that , we can show that . Therefore, we can obtain that . Combining with (5.29), we conclude that and . Namely, is a least energy sign-changing solution of Equation (1.3). The proof is completed.

    Yan-Fei Yang: Writing-original draft, Writing-review & editing; Chun-Lei Tang: Formal analysis, Methodology, Supervision, Writing-review & editing.

    The authors declare they have not used Artificial Intelligence (AI) tools in the creation of this article.

    This study was funded by the National Natural Science Foundation of China (No. 12371120).

    All authors declare no conflicts of interest in this paper.



    Conflict of interest



    The authors declare no conflict of interest.

    [1] Caiazzo G, Di Mario C, Kedhi E, et al. (2023) Current management of highly calcified coronary lesions: an overview of the current status. J Clin Med 12: 4844. https://doi.org/10.3390/jcm12144844
    [2] Bourantas CV, Zhang YJ, Garg S, et al. (2014) Prognostic implications of coronary calcification in patients with obstructive coronary artery disease treated by percutaneous coronary intervention: a patient-level pooled analysis of 7 contemporary stent trials. Heart 100: 1158-1164. https://doi.org/10.1136/heartjnl-2013-305180
    [3] Kedhi E, Berta B, Roleder T, et al. (2021) Thin-cap fibroatheroma predicts clinical events in diabetic patients with normal fractional flow reserve: the COMBINE OCT-FFR trial. Eur Heart J 42: 4671-4679. https://doi.org/10.1093/eurheartj/ehab433
    [4] Protty M, Sharp ASP, Gallagher S, et al. (2022) Defining percutaneous coronary intervention complexity and risk: an analysis of the United Kingdom BCIS database 2006–2016. JACC Cardiovasc Interv 15: 39-49. https://doi.org/10.1016/j.jcin.2021.09.039
    [5] Budoff MJ, Shaw LJ, Liu ST, et al. (2007) Long-term prognosis associated with coronary calcification. Observations from a registry of 25253 patients. J Am Coll Cardiol 49: 1860-1870. https://doi.org/10.1016/j.jacc.2006.10.079
    [6] Folsom AR, Kronmal RA, Detrano RC, et al. (2008) Coronary artery calcification compared with carotid intima-media thickness in the prediction of cardiovascular disease incidence: the Multi-Ethnic Study of Atherosclerosis (MESA). Arch Intern Med 168: 1333-1339. https://doi.org/10.1001/archinte.168.12.1333
    [7] Moussa I, Di Mario C, Moses J, et al. (1997) Coronary stenting after rotational atherectomy in calcified and complex lesions. Angiographic and clinical follow-up results. Circulation 96: 128-136. https://doi.org/10.1161/01.cir.96.1.128
    [8] Alfonso F, Kastrati A (2021) Clinical burden and implications of coronary interventions for in-stent restenosis. EuroIntervention 17: e355-e357. https://doi.org/10.4244/EIJV17I5A60
    [9] Giustino G, Mastoris I, Baber U, et al. (2016) Correlates and impact of coronary artery calcifications in women undergoing percutaneous coronary intervention with drug-eluting stents: from the Women in Innovation and Drug-Eluting Stents (WIN-DES) collaboration. JACC Cardiovasc Interv 9: 1890-1901. https://doi.org/10.1016/j.jcin.2016.06.022
    [10] Cialdella P, Sergi SC, Zimbardo G, et al. (2023) Calcified coronary lesions. Eur Heart J Suppl 25: C68-C73. https://doi.org/10.1093/eurheartjsupp/suad009
    [11] Guedeney P, Claessen BE, Mehran R, et al. (2020) Coronary calcification and long-term outcomes according to drug-eluting stent generation. JACC Cardiovasc Interv 13: 1417-1428. https://doi.org/10.1016/j.jcin.2020.03.053
    [12] Ellis SG, Ajluni S, Arnold AZ, et al. (1994) Increased coronary perforation in the new device era: incidence, classification, management, and outcome. Circulation 90: 2725-2730. https://doi.org/10.1161/01.cir.90.6.2725
    [13] Virmani R, Kolodgie FD, Burke AP, et al. (2005) Atherosclerotic plaque progression and vulnerability to rupture: angiogenesis as a source of intraplaque hemorrhage. Arterioscler Thromb Vasc Biol 25: 2054-2061. https://doi.org/10.1161/01.ATV.0000178991.71605.18
    [14] Aikawa E, Nahrendorf M, Figueiredo JL, et al. (2007) Osteogenesis associates with inflammation in early-stage atherosclerosis evaluated by molecular imaging in vivo. Circulation 116: 2841-2850. https://doi.org/10.1161/CIRCULATIONAHA.107.732867
    [15] Jadhav KP, Kavalipatu KNR, Kuchulakanti PK, et al. (2021) Coronary artery calcification: from cell to stent—a review. Indian J Clin Cardiol 2: 97-109. https://doi.org/10.1177/26324636211013156
    [16] Zaidan M, Alkhalil M, Alaswad K (2022) Calcium modification therapies in contemporary percutaneous coronary intervention. Curr Cardiol Rev 18: e281221199533. https://doi.org/10.2174/1573403X18666211228095457
    [17] Mintz GS, Popma JJ, Pichard AD, et al. (1995) Patterns of calcification in coronary artery disease: a statistical analysis of intravascular ultrasound and coronary angiography in 1155 lesions. Circulation 91: 1959-1965. https://doi.org/10.1161/01.cir.91.7.1959
    [18] Terashima M, Kaneda H, Suzuki T (2012) The role of optical coherence tomography in coronary intervention. Korean J Intern Med 27: 1-12. https://doi.org/10.3904/kjim.2012.27.1.1
    [19] Fujino A, Mintz GS, Matsumura M, et al. (2018) A new optical coherence tomography-based calcium scoring system to predict stent underexpansion. EuroIntervention 13: e2182-e2189. https://doi.org/10.4244/EIJ-D-17-00962
    [20] Zhang M, Matsumura M, Usui E, et al. (2021) Intravascular ultrasound-derived calcium score to predict stent expansion in severely calcified lesions. Circ Cardiovasc Interv 14: e010296. https://doi.org/10.1161/CIRCINTERVENTIONS.120.010296
    [21] Watanabe Y, Sakakura K, Taniguchi Y, et al. (2020) Comparison of clinical outcomes of intravascular ultrasound-calcified nodule between percutaneous coronary intervention with versus without rotational atherectomy in a propensity-score matched analysis. PLoS One 15: e0241836. https://doi.org/10.1371/journal.pone.0241836
    [22] Sato T, Matsumura M, Yamamoto K, et al. (2023) Impact of eruptive vs noneruptive calcified nodule morphology on acute and long-term outcomes after stenting. JACC Cardiovasc Interv 16: 1024-1035. https://doi.org/10.1016/j.jcin.2023.03.009
    [23] Komaki S, Ishii M, Ikebe S, et al. (2021) Association between coronary artery calcium score and stent expansion in percutaneous coronary intervention. Int J Cardiol 334: 31-36. https://doi.org/10.1016/j.ijcard.2021.04.021
    [24] Kang SJ (2021) Intravascular ultrasound-derived criteria for optimal stent expansion and preprocedural prediction of stent underexpansion. Circ Cardiovasc Interv 14: e011374. https://doi.org/10.1161/CIRCINTERVENTIONS.121.011374
    [25] Torngren K, Rylance R, Björk J, et al. (2020) Association of coronary calcium score with endothelial dysfunction and arterial stiffness. Atherosclerosis 313: 70-75. https://doi.org/10.1016/j.atherosclerosis.2020.09.022
    [26] Byrne RA, Joner M, Kastrati A (2015) Stent thrombosis and restenosis: What have we learned and where are we going? the Andreas Grüntzig Lecture ESC 2014. Eur Heart J 36: 3320-3331. https://doi.org/10.1093/eurheartj/ehv511
    [27] Mauri L, Bonan R, Weiner BH, et al. (2002) Cutting balloon angioplasty for the prevention of restenosis: results of the cutting balloon global randomized trial. Am J Cardiol 90: 1079-1083. https://doi.org/10.1016/s0002-9149(02)02773-x
    [28] Bonaventura K, Schwefer M, Yusof AKM, et al. (2020) Systematic scoring balloon lesion preparation for drug-coated balloon angioplasty in clinical routine: results of the PASSWORD observational study. Adv Ther 37: 2210-2223. https://doi.org/10.1007/s12325-020-01320-2
    [29] Leick J, Rheude T, Cassese S, et al. (2024) Comparison of angiographic result and long-term outcome in patients with in-stent restenosis treated with cutting balloon or with scoring balloon angioplasty. J Invasive Cardiol 36. https://doi.org/10.25270/jic/24.00070
    [30] Angsubhakorn N, Kang N, Fearon C, et al. (2022) Contemporary management of severely calcified coronary lesions. J Pers Med 12: 1638. https://doi.org/10.3390/jpm12101638
    [31] Secco GG, Ghione M, Mattesini A, et al. (2016) Very high-pressure dilatation for undilatable coronary lesions: indications and results with a new dedicated balloon. EuroIntervention 12: 359-365. https://doi.org/10.4244/EIJY15M06_04
    [32] Secco GG, Buettner A, Parisi R, et al. (2019) Clinical experience with very high-pressure dilatation for resistant coronary lesions. Cardiovasc Revasc Med 20: 1083-1087. https://doi.org/10.1016/j.carrev.2019.02.026
    [33] Hill JM, Kereiakes DJ, Shlofmitz RA, et al. (2020) Intravascular lithotripsy for treatment of severely calcified coronary artery disease. J Am Coll Cardiol 76: 2635-2646. https://doi.org/10.1016/j.jacc.2020.09.603
    [34] Mastrangelo A, Monizzi G, Galli S, et al. (2022) Intravascular lithotripsy in calcified coronary lesions: a single-center experience in “real-world” patients. Front Cardiovasc Med 9: 829117. https://doi.org/10.3389/fcvm.2022.829117
    [35] Ali ZA, Nef H, Escaned J, et al. (2019) Safety and effectiveness of coronary intravascular lithotripsy for treatment of severely calcified coronary stenoses: the disrupt CAD II study. Circ Cardiovasc Interv 12: e008434. https://doi.org/10.1161/CIRCINTERVENTIONS.119.008434
    [36] Riley RF, Patel MP, Abbott JD, et al. (2024) SCAI expert consensus statement on the management of calcified coronary lesions. J Soc Cardiovasc Angiogr Interv 3: 101259. https://doi.org/10.1016/j.jscai.2023.101259
    [37] Khattak S, Sharma H, Khan SQ (2024) Atherectomy techniques: rotablation, orbital and laser. Interv Cardiol 19: e21. https://doi.org/10.15420/icr.2024.16
    [38] Tomey MI, Kini AS, Sharma SK (2014) Current status of rotational atherectomy. JACC Cardiovasc Interv 7: 345-353. https://doi.org/10.1016/j.jcin.2013.12.196
    [39] Kobayashi N, Ito Y, Yamawaki M, et al. (2018) Distal embolization of coronary calcified nodule after rotational atherectomy. SAGE Open Med Case Rep 6. https://doi.org/10.1177/2050313X18799243
    [40] Kinnaird T, Gallagher S, Sharp A, et al. (2021) Operator volumes and in-hospital outcomes: an analysis of 7740 rotational atherectomy procedures from the BCIS national database. JACC Cardiovasc Interv 14: 1423-1430. https://doi.org/10.1016/j.jcin.2021.04.034
    [41] Jawad-Ul-Qamar M, Sharma H, Vetrugno V, et al. (2021) Contemporary use of excimer laser in percutaneous coronary intervention with indications, procedural characteristics, complications and outcomes in a university teaching hospital. Open Heart 8: e001522. https://doi.org/10.1136/openhrt-2020-001522
    [42] Tsutsui RS, Sammour Y, Kalra A, et al. (2021) Excimer laser atherectomy in percutaneous coronary intervention: a contemporary review. Cardiovasc Revasc Med 25: 75-85. https://doi.org/10.1016/j.carrev.2020.10.016
    [43] Egred M, Brilakis ES (2020) Excimer Laser Coronary Angioplasty (ELCA): fundamentals, mechanism of action, and clinical applications. J Invasive Cardiol 32: E27-E35. https://doi.org/10.25270/jic/19.00325
    [44] Ali ZA, Shin D, Barbato E (2024) Between a rock and a hard place: a consensus statement on the management of calcified coronary lesions. J Soc Cardiovasc Angiogr Interv 3: 101265. https://doi.org/10.1016/j.jscai.2023.101265
    [45] Achenbach S, Ropers D, Pohle K, et al. (2002) Influence of lipid-lowering therapy on the progression of coronary artery calcification: a prospective evaluation. Circulation 106: 1077-1082. https://doi.org/10.1161/01.cir.0000027567.49283.ff
    [46] Schwartz GG, Steg PG, Szarek M, et al. (2018) Alirocumab and cardiovascular outcomes after acute coronary syndrome. N Engl J Med 379: 2097-2107. https://doi.org/10.1056/NEJMoa1801174
    [47] Limpijankit T, Jongjirasiri S, Unwanatham N, et al. (2022) Causal relationship of coronary artery calcium on myocardial infarction and preventive effect of antiplatelet therapy. Front Cardiovasc Med 9: 871267. https://doi.org/10.3389/fcvm.2022.871267
    [48] Matheus ASDM, Tannus LRM, Cobas RA, et al. (2013) Impact of diabetes on cardiovascular disease: an update. Int J Hypertens 2013: 653789. https://doi.org/10.1155/2013/653789
    [49] Allali A, Abdel-Wahab M, Elbasha K, et al. (2023) Rotational atherectomy of calcified coronary lesions: current practice and insights from two randomized trials. Clin Res Cardiol 112: 1143-1163. https://doi.org/10.1007/s00392-022-02013-2
    [50] Achim A, Kákonyi K, Nagy F, et al. (2022) Radial artery calcification in predicting coronary calcification and atherosclerosis burden. Cardiol Res Pract 2022: 5108389. https://doi.org/10.1155/2022/5108389
    [51] Yin WH, Tseng CK, Tsao TP, et al. (2015) Transradial versus transfemoral rotablation for heavily calcified coronary lesions in contemporary drug-eluting stent era. J Geriatr Cardiol 12: 489-496. https://doi.org/10.11909/j.issn.1671-5411.2015.05.004
    [52] Khan AA, Panchal HB, Zaidi SIM, et al. (2019) Safety and efficacy of radial versus femoral access for rotational atherectomy: a systematic review and meta-analysis. Cardiovasc Revasc Med 20: 241-247. https://doi.org/10.1016/j.carrev.2018.06.006
    [53] Saleem T, Baril DT (2023) Vascular Access Closure Devices. StatPearls Publishing. Available from: https://www.ncbi.nlm.nih.gov/books/NBK470233/?report=reader. [cited January 16, 2025].
    [54] Mehta A, Bath A, Kalavakunta J (2020) Arteriovenous fistula: rare complication of radial artery access. BMJ Case Rep 13: e237278. https://doi.org/10.1136/bcr-2020-237278
    [55] Alomar ME, Michael TT, Patel VG, et al. (2013) Stent loss and retrieval during percutaneous coronary interventions: a systematic review and meta-analysis. J Invasive Cardiol 25: 637-641.
    [56] Khattak S, Upadhyaya S, Nolan J, et al. (2021) Manual extraction of a dislodged and migrated DES from radial artery puncture site. Eur Heart J Case Rep 5: ytab468. https://doi.org/10.1093/ehjcr/ytab468
    [57] Eggebrecht H, Haude M, Von Birgelen C, et al. (2000) Nonsurgical retrieval of embolized coronary stents. Catheter Cardiovasc Interv 51: 432-440. https://doi.org/10.1002/1522-726x(200012)51:4<432::aid-ccd12>3.0.co;2-1
    [58] Abdalwahab A, Farag M, Brilakis ES, et al. (2021) Management of coronary artery perforation. Cardiovasc Revasc Med 26: 55-60. https://doi.org/10.1016/j.carrev.2020.11.013
    [59] Umar H, Sharma H, Osheiba M, et al. (2022) Changing trends in the incidence, management and outcomes of coronary artery perforation over an 11-year period: single-centre experience. Open Heart 9: e001916. https://doi.org/10.1136/openhrt-2021-001916
    [60] Giannini F, Candilio L, Mitomo S, et al. (2018) A practical approach to the management of complications during percutaneous coronary intervention. JACC Cardiovasc Interv 11: 1797-1810. https://doi.org/10.1016/j.jcin.2018.05.052
    [61] Xenogiannis I, Brilakis ES (2019) Advances in the treatment of coronary perforations. Catheter Cardiovasc Interv 93: 921-922. https://doi.org/10.1002/ccd.28205
    [62] Muller O, Windecker S, Cuisset T, et al. (2008) Management of two major complications in the cardiac catheterisation laboratory: the no-reflow phenomenon and coronary perforations. EuroIntervention 4: 181-183. https://doi.org/10.4244/eijv4i2a32
    [63] Anghel L, Tudurachi BS, Tudurachi A, et al. (2023) Patient-related factors predicting stent thrombosis in percutaneous coronary interventions. J Clin Med 12: 7367. https://doi.org/10.3390/jcm12237367
    [64] Grove ECL, Kristensen SD (2007) Stent thrombosis: definitions, mechanisms and prevention. E J Cardiol Practice 5.
    [65] Cutlip DE, Windecker S, Mehran R, et al. (2007) Clinical end points in coronary stent trials: a case for standardized definitions. Circulation 115: 2344-2351. https://doi.org/10.1161/CIRCULATIONAHA.106.685313
    [66] Généreux P, Madhavan MV, Mintz GS, et al. (2014) Ischemic outcomes after coronary intervention of calcified vessels in acute coronary syndromes: pooled analysis from the HORIZONS-AMI (Harmonizing Outcomes with Revascularization and Stents in Acute Myocardial Infarction) and ACUITY (Acute Catheterization and Urgent Intervention Triage Strategy) trials. J Am Coll Cardiol 63: 1845-1854. https://doi.org/10.1016/j.jacc.2014.01.034
    [67] Abouelnour A, Gori T (2022) Intravascular imaging in coronary stent restenosis: prevention, characterization, and management. Front Cardiovasc Med 9: 843734. https://doi.org/10.3389/fcvm.2022.843734
    [68] Klein LW, Nathan S, Maehara A, et al. (2023) SCAI expert consensus statement on management of in-stent restenosis and stent thrombosis. J Soc Cardiovasc Angiogr Interv 2: 100971. https://doi.org/10.1016/j.jscai.2023.100971
    [69] Généreux P, Stone GW, Harrington RA, et al. (2014) Impact of intraprocedural stent thrombosis during percutaneous coronary intervention: insights from the champion phoenix trial (clinical trial comparing Cangrelor to Clopidogrel standard of care therapy in subjects who require Percutaneous coronary intervention). J Am Coll Cardiol 63: 619-629. https://doi.org/10.1016/j.jacc.2013.10.022
    [70] Dangas GD, Claessen BE, Mehran R, et al. (2013) Stent thrombosis after primary angioplasty for STEMI in relation to non-adherence to dual antiplatelet therapy over time: results of the HORIZONS-AMI trial. EuroIntervention 8: 1033-1039. https://doi.org/10.4244/EIJV8I9A159
    [71] Husted S, Boersma E (2016) Case study: ticagrelor in PLATO and Prasugrel in TRITON-TIMI 38 and TRILOGY-ACS trials in patients with acute coronary syndromes. Am J Ther 23: e1876-e1889. https://doi.org/10.1097/MJT.0000000000000237
    [72] Lee SY, Mintz GS, Kim JS, et al. (2020) Long-term clinical outcomes of drug-eluting stent malapposition. Korean Circ J 50: 880-889. https://doi.org/10.4070/kcj.2020.0198
    [73] Alfonso F, Coughlan JJ, Giacoppo D, et al. (2022) Management of in-stent restenosis. EuroIntervention 18: e103-e123. https://doi.org/10.4244/EIJ-D-21-01034
    [74] Omeh DJ, Shlofmitz E  (2023) Restenosis of Stented Coronary Arteries. Available from: https://www.ncbi.nlm.nih.gov/books/NBK545139/. (Updated Aug 8, 2023).
    [75] Halwani DO, Anderson PG, Brott BC, et al. (2012) The role of vascular calcification in inducing fatigue and fracture of coronary stents. J Biomed Mater Res B Appl Biomater 100: 292-304. https://doi.org/10.1002/jbm.b.31911
  • Reader Comments
  • © 2025 the Author(s), licensee AIMS Press. This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0)
通讯作者: 陈斌, bchen63@163.com
  • 1. 

    沈阳化工大学材料科学与工程学院 沈阳 110142

  1. 本站搜索
  2. 百度学术搜索
  3. 万方数据库搜索
  4. CNKI搜索

Metrics

Article views(159) PDF downloads(14) Cited by(0)

Figures and Tables

Figures(7)  /  Tables(3)

Other Articles By Authors

/

DownLoad:  Full-Size Img  PowerPoint
Return
Return

Catalog