1. Articles from Richard A. Shlofmitz

    1-17 of 17
    1. In-Stent Restenosis Lesion Morphology Related to Repeat Stenting Underexpansion as Evaluated by Optical Coherence Tomography

      In-Stent Restenosis Lesion Morphology Related to Repeat Stenting Underexpansion as Evaluated by Optical Coherence Tomography

      Aims: To use optical coherence tomography (OCT) to predict newly implanted stent expansion for treatment of in-stent restenosis (ISR). Methods and results: With OCT-guidance, 143 ISR lesions were treated with a new stent. Stent underexpansion was defined as minimum stent area (MSA) <4.5mm 2 and MSA/average of reference lumen area <70%. New stent underexpansion was found in 33 lesions (23%), had a smaller old stent MSA (4.13 [3.32-4.62] versus 5.18 [4.01-6.38] mm 2 , p=0.001), and had a higher prevalence of multiple old stent layers (51.5% versus 10.9%, p ...

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    2. The “Oculo‐Appositional Reflex”: Should Optical Coherence Tomography–Detected Stent Malapposition Be Corrected?

      The “Oculo‐Appositional Reflex”: Should Optical Coherence Tomography–Detected Stent Malapposition Be Corrected?

      Stent malposition, recognized as an entity with the advent of intravascular imaging, refers to the lack of full contact between stent struts and the vessel wall after percutaneous coronary intervention ( Figure ). Malapposition may be present immediately after placement of stents (acute stent malapposition), or it may develop later (late stent malapposition), which can, in turn, be categorized as late persistent malapposition (ongoing since the time of implantation) or late acquired malapposition (developing de novo during follow‐up). 1

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    3. A prospective, single‐center, randomized study to assess whether automated coregistration of optical coherence tomography with angiography can reduce geographic miss

      A prospective, single‐center, randomized study to assess whether automated coregistration of optical coherence tomography with angiography can reduce geographic miss

      Objective We sought to evaluate whether automated coregistration of optical coherence tomography (OCT) with angiography reduces geographic miss (GM) during coronary stenting. Background Previous intravascular ultrasound or OCT studies have showed that residual disease at the stent edge or stent edge dissection was associated with stent thrombosis or edge restenosis. This has been termed GM. Methods Two hundred de novo coronary lesions were randomized in a 1:1 ratio to OCT‐guided percutaneous coronary intervention (PCI) with versus without automated coregistration of OCT with angiography. GM, the primary endpoint, was defined as angiographic ≥type B dissection or diameter stenosis >50 ...

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    4. Effect of orbital atherectomy in calcified coronary artery lesions as assessed by optical coherence tomography

      Effect of orbital atherectomy in calcified coronary artery lesions as assessed by optical coherence tomography

      Objectives We sought to assess plaque modification and stent expansion following orbital atherectomy (OA) for calcified lesions using optical coherence tomography (OCT). Background The efficacy of OA for treating calcified lesions is not well studied, especially using intravascular imaging in vivo. Methods OCT was performed preprocedure, post‐OA, and post‐stent ( n  = 58). Calcium modification after OA was defined as a round, concave, polished calcium surface. Calcium fracture was complete discontinuity of calcium. Results Comparing pre‐ vs post‐OA OCT ( n  = 29), calcium area was significantly decreased post‐OA (from 3.4 mm 2 [2.4–4.7] to 2 ...

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      Mentions: Gary S. Mintz
    5. Algorithmic Approach for Optical Coherence Tomography–Guided Stent Implantation During Percutaneous Coronary Intervention

      Algorithmic Approach for Optical Coherence Tomography–Guided Stent Implantation During Percutaneous Coronary Intervention

      Intravascular imaging plays a key role in optimizing outcomes for percutaneous coronary intervention (PCI). Optical coherence tomography (OCT) utilizes a user-friendly interface and provides high-resolution images. OCT can be used as part of daily practice in all stages of a coronary intervention: baseline lesion assessment, stent selection, and stent optimization. Incorporating a standardized, algorithmic approach when using OCT allows for precision PCI.

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    6. Bifurcation and Ostial Optical Coherence Tomography Mapping (BOOM) – Case Description of a Novel Bifurcation Stent Technique

      Bifurcation and Ostial Optical Coherence Tomography Mapping (BOOM) – Case Description of a Novel Bifurcation Stent Technique

      Stent placement guided by angiography alone is often inexact, but of increased importance with bifurcation percutaneous coronary intervention (PCI). We describe a novel technique using optical coherence tomography (OCT)-guided angiographic co-registration termed “Bifurcation and Ostial OCT Mapping” (BOOM). The technique is based on the precise identification and mapping of the side-branch ostium using co-registration to minimize protrusion of stent struts into the main branch while ensuring full coverage of the ostium in the side-branch.

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    7. Utility of intracoronary imaging in the cardiac catheterization laboratory: comprehensive evaluation with intravascular ultrasound and optical coherence tomography

      Utility of intracoronary imaging in the cardiac catheterization laboratory: comprehensive evaluation with intravascular ultrasound and optical coherence tomography

      Background Intracoronary imaging is an important tool for guiding decision making in the cardiac catheterization laboratory. Sources of data We have reviewed the latest available evidence in the field to highlight the various potential benefits of intravascular imaging. Areas of agreement Coronary angiography has been considered the gold standard test to appropriately diagnose and manage patients with coronary artery disease, but it has the inherent limitation of being a 2-dimensional x-ray lumenogram of a complex 3-dimensional vascular structure. Areas of controversy There is well-established inter- and intra-observer variability in reporting coronary angiograms leading to potential variability in various management strategies ...

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    8. Intracoronary Optical Coherence Tomography 2018 : Current Status and Future Directions

      Intracoronary Optical Coherence Tomography 2018 : Current Status and Future Directions

      The advent of intravascular imaging has been a significant advancement in visualization of coronary arteries, particularly with optical coherence tomography (OCT) that allows for high-resolution imaging of intraluminal and transmural coronary structures. Accumulating data support a clinical role for OCT in a multitude of clinical scenarios, including assessing the natural history of atherosclerosis and modulating effects of therapies, mechanisms of acute coronary syndromes, mechanistic insights into the effects of novel interventional devices, and optimization of percutaneous coronary intervention. In this state-of-the-art review, we provide an overview of the published data on the clinical utility of OCT, highlighting the areas that ...

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    9. EuroIntervention Characteristics of early versus late in-stent restenosis in second-generation drug-eluting stents: an optical coherence tomography study

      EuroIntervention Characteristics of early versus late in-stent restenosis in second-generation drug-eluting stents: an optical coherence tomography study

      Aims: In-stent restenosis (ISR) is an important cause of drug-eluting stent (DES) failure and target vessel revascularisation. In this study we aimed to evaluate differences between early and late-presenting restenosis in second-generation DES using optical coherence tomography (OCT). Methods and results: Overall, 171 cases of second-generation DES ISR with a follow-up OCT minimum lumen area <3.0 mm 2 were included: 33.3% of patients (n=57) had early ISR, and 66.7% (n=114) had late ISR (duration from stent implantation >1 year). Minimum stent area (MSA) <4.0 mm 2 , neointimal thickness <100 µm, and heterogeneous neointimal hyperplasia ...

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    10. Characteristics of Early Versus Late In-Stent Restenosis in Second- Generation Drug-Eluting Stents: An Optical Coherence Tomography Study

      Characteristics of Early Versus Late In-Stent Restenosis in Second- Generation Drug-Eluting Stents: An Optical Coherence Tomography Study

      Aims: In-stent restenosis (ISR) is an important cause of DES failure and target vessel revascularization. We evaluated differences between early and late-presenting restenosis in second-generation drug-eluting stents (DES) using optical coherence tomography (OCT). Methods and results: Overall, 171 cases of second-generation DES ISR with a follow-up OCT minimum lumen area <3.0mm2 were included; 33.3% of patients (n=57) had early ISR; and 67.7% (n=114) had late ISR (duration from stent implantation >1 year). Minimum stent area (MSA) <4.0mm2, neointimal thickness <100µm, and heterogeneous neointimal hyperplasia (NIH) were more prevalent in early ISR, whereas NIH ...

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    11. Neoatherosclerosis assessed with optical coherence tomography in restenotic bare metal and first- and second-generation drug-eluting stents

      Neoatherosclerosis assessed with optical coherence tomography in restenotic bare metal and first- and second-generation drug-eluting stents

      Although reported in bare metal stents (BMS) and first-generation drug-eluting stents (DES), little is known about neoatherosclerosis in second-generation DES. We used optical coherence tomography to evaluate neoatherosclerosis among different stent generations. Overall, 274 in-stent restenosis (ISR) lesions (duration from implantation 56.9 ± 47.2 months) in 274 patients were assessed for the presence of neoatherosclerosis. Neoatherosclerosis was identified in 38.7% of lesions (106/274): 23.0% second-generation DES (38/165), 65.1% first-generation DES (54/83), and 53.8% BMS (14/26). In the neoatherosclerosis cohort (n = 106), more stent underexpansion or fracture/deformation was observed in second-generation ...

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      Mentions: Gary S. Mintz
    12. Coronary Plaque Characteristics in Hemodialysis-Dependent Patients as Assessed by Optical Coherence Tomography

      Coronary Plaque Characteristics in Hemodialysis-Dependent Patients as Assessed by Optical Coherence Tomography

      Coronary arteries in patients with chronic kidney disease (CKD) have been shown to exhibit more extensive atherosclerosis and calcium. We aimed to assess characteristics of coronary plaque in hemodialysis (HD)-dependent patients using optical coherence tomography (OCT). This was a multicenter, retrospective study of 124 patients with stable angina who underwent OCT imaging. Sixty-two HD-dependent patients who underwent pre-intervention OCT for coronary artery disease (CAD) were compared 1:1 with a cohort of patients without CKD, matched for age, diabetes mellitus, sex, and culprit vessel. Baseline characteristics were comparable. Pre-intervention OCT imaging identified 62 paired culprit, 53 paired non-culprit, and ...

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    13. Guiding Light: Insights Into Atherectomy by Optical Coherence Tomography

      Guiding Light: Insights Into Atherectomy by Optical Coherence Tomography

      Coronary calcification presents multiple technical challenges in percutaneous coronary intervention (PCI) and is associated with suboptimal procedural results and an increase in subsequent adverse clinical events (1) . Currently, there is no standardized evidence-based strategy for PCI of calcified coronary lesions. Decisions for the use of adjunctive atheroablation—shown to increase the acute procedural success rates (2) —are based on visual estimation of calcification severity on angiography (with its inherent limitations [3] ) or when delivery of devices is impeded by calcified deposits in the vessel wall. Although the so-called “rota-regret” remains common following suboptimal acute procedural results in calcified plaques not ...

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    14. Optical coherence tomography compared with intravascular ultrasound and with angiography to guide coronary stent implantation (ILUMIEN III: OPTIMIZE PCI): a randomised controlled trial

      Optical coherence tomography compared with intravascular ultrasound and with angiography to guide coronary stent implantation (ILUMIEN III: OPTIMIZE PCI): a randomised controlled trial

      Background Percutaneous coronary intervention (PCI) is most commonly guided by angiography alone. Intravascular ultrasound (IVUS) guidance has been shown to reduce major adverse cardiovascular events (MACE) after PCI, principally by resulting in a larger postprocedure lumen than with angiographic guidance. Optical coherence tomography (OCT) provides higher resolution imaging than does IVUS, although findings from some studies suggest that it might lead to smaller luminal diameters after stent implantation. We sought to establish whether or not a novel OCT-based stent sizing strategy would result in a minimum stent area similar to or better than that achieved with IVUS guidance and better ...

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    15. Update on Intracoronary Optical Coherence Tomography: a Review of Current Concepts

      Update on Intracoronary Optical Coherence Tomography: a Review of Current Concepts

      Purpose of review The advent of intracoronary optical coherence tomography (OCT) has been a significant leap forward in the ability to visualize coronary structures with unprecedented resolution. However, the clinical application of this imaging modality has lagged behind rapid technological advances. One of the main reasons for the lack of wider clinical uptake has been the paucity of appropriately designed prospective randomized studies to demonstrate the impact of OCT on outcome measures after percutaneous coronary intervention (PCI). Recent findings Over the last couple of years, studies from large registries have shown the impact of OCT in decision-making in PCI, with ...

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    16. Impact of the orbital atherectomy system on a coronary calcified lesion: quantitative analysis by light attenuation in optical coherence tomography

      Impact of the orbital atherectomy system on a coronary calcified lesion: quantitative analysis by light attenuation in optical coherence tomography

      A 64-year-old female with chronic kidney disease was scheduled to undergo stenting of a severely calcified lesion in the left anterior descending coronary artery following “preparation” of the lesion by orbital atherectomy performed with the Diamondback 360 Coronary Orbital Atherectomy System (OAS), 1.25 mm Classic Crown (Cardiovascular Systems, Inc., St. Paul, MN, USA) (Figure 1A) (pre- and post-OAS angiography: Figure 1B-1C and Figure 1B’-1C’ , respectively). The first run was performed at 80,000 rpm for 25 s followed by the second run at 120,000 rpm for 25 s. A 2.75×38 mm everolimus-eluting stent (XIENCE; Abbott ...

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    17. Excimer Laser Angioplasty–Facilitated Fracturing of Napkin-Ring Peri-Stent Calcium in a Chronically Underexpanded Stent Documentation by Optical Coherence Tomography

      Excimer Laser Angioplasty–Facilitated Fracturing of Napkin-Ring Peri-Stent Calcium in a Chronically Underexpanded Stent Documentation by Optical Coherence Tomography

      A 79-year-old man underwent stent implantation into a severely calcified proximal left anterior descending coronary lesion ( Figure 1 ) in December 2012 followed by restenting in March 2014 to treat in-stent restenosis ( Figure 2 ), both without full balloon expansion. Optical coherence tomography (OCT) documented thick, peri-stent napkin-ring calcium. He was admitted for recurrent unstable angina in April 2014. After initial treatment with excimer laser coronary angioplasty (ELCA; 1.4 mm, Spectranetics Corporation, Colorado Springs, Colorado) using saline injection, fluence of 60 mJ/mm 2 , and frequency of 80 Hz, a balloon was fully expanded. OCT showed fracturing of peri-stent calcium and ...

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    1-17 of 17
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    Excimer Laser Angioplasty–Facilitated Fracturing of Napkin-Ring Peri-Stent Calcium in a Chronically Underexpanded Stent Documentation by Optical Coherence Tomography Impact of the orbital atherectomy system on a coronary calcified lesion: quantitative analysis by light attenuation in optical coherence tomography Update on Intracoronary Optical Coherence Tomography: a Review of Current Concepts Optical coherence tomography compared with intravascular ultrasound and with angiography to guide coronary stent implantation (ILUMIEN III: OPTIMIZE PCI): a randomised controlled trial Guiding Light: Insights Into Atherectomy by Optical Coherence Tomography Coronary Plaque Characteristics in Hemodialysis-Dependent Patients as Assessed by Optical Coherence Tomography Neoatherosclerosis assessed with optical coherence tomography in restenotic bare metal and first- and second-generation drug-eluting stents EuroIntervention Characteristics of early versus late in-stent restenosis in second-generation drug-eluting stents: an optical coherence tomography study Intracoronary Optical Coherence Tomography 2018 : Current Status and Future Directions Bifurcation and Ostial Optical Coherence Tomography Mapping (BOOM) – Case Description of a Novel Bifurcation Stent Technique Optical coherence tomography angiography of foveal neovascularisation in proliferative diabetic retinopathy Treating port wine stain birthmarks using dynamic optical coherence tomography-guided setting