1. Articles from Richard A. Shlofmitz

    1-24 of 28 1 2 »
    1. Visualizing Inside Conduits – Intraoperative Screening of Grafts by Optical Coherence Tomography

      Visualizing Inside Conduits – Intraoperative Screening of Grafts by Optical Coherence Tomography

      PURPOSE Saphenous vein graft (SVG) failure is a complex phenomenon, with technical, biological and local factors contributing to early-, medium- and long-term failure after coronary artery bypass graft (CABG). Both technical and conduit factors may have significant impact on the early SVG failure. DESCRIPTION We review the complex factors that play a pathogenic role in SVG failure followed by reviewing the existing literature on potential utility of high-definition optical coherence tomography (OCT) in comprehensive intraoperative assessment of SVGs. EVALUATION We describe a new technique for intraoperative acquisition of OCT images in the harvested SVGs, and introduce a classification system for ...

      Read Full Article
    2. Lesion Preparation with Orbital Atherectomy

      Lesion Preparation with Orbital Atherectomy

      Abstract Despite significant improvements in stent design, severe coronary calcification continues to impede adequate stent expansion and is associated with worse clinical outcomes. Angiography is limited in its ability to detect and comprehensively characterise calcified plaque. Intravascular imaging provides information on lesion morphology guiding appropriate treatment strategies. Orbital atherectomy allows for lesion preparation of severely calcified plaque prior to stent implantation. Utilising a unique mechanism of action incorporating centrifugal forces, a standard 1.25 mm eccentrically mounted and diamond-coated burr orbits bi-directionally to ablate calcified plaque. Lesion preparation with orbital atherectomy allows for modification of calcified plaque to facilitate stent ...

      Read Full Article
    3. Lesion Preparation with Orbital Atherectomy

      Lesion Preparation with Orbital Atherectomy

      Despite significant improvements in stent design, severe coronary calcification continues to impede adequate stent expansion and is associated with worse clinical outcomes. Angiography is limited in its ability to detect and comprehensively characterise calcified plaque. Intravascular imaging provides information on lesion morphology guiding appropriate treatment strategies. Orbital atherectomy allows for lesion preparation of severely calcified plaque prior to stent implantation. Utilising a unique mechanism of action incorporating centrifugal forces, a standard 1.25 mm eccentrically mounted and diamond-coated burr orbits bi-directionally to ablate calcified plaque. Lesion preparation with orbital atherectomy allows for modification of calcified plaque to facilitate stent expansion.

      Read Full Article
    4. Lesion Preparation with Orbital Atherectomy

      Lesion Preparation with Orbital Atherectomy

      Despite significant improvements in stent design, severe coronary calcification continues to impede adequate stent expansion and is associated with worse clinical outcomes. Angiography is limited in its ability to detect and comprehensively characterise calcified plaque. Intravascular imaging provides information on lesion morphology guiding appropriate treatment strategies. Orbital atherectomy allows for lesion preparation of severely calcified plaque prior to stent implantation. Utilising a unique mechanism of action incorporating centrifugal forces, a standard 1.25 mm eccentrically mounted and diamond-coated burr orbits bi-directionally to ablate calcified plaque. Lesion preparation with orbital atherectomy allows for modification of calcified plaque to facilitate stent expansio

      Read Full Article
    5. Intracoronary optical coherence tomography: state of the art and future directions

      Intracoronary optical coherence tomography: state of the art and future directions

      Optical coherence tomography (OCT) has been increasingly utilised to guide percutaneous coronary intervention (PCI). Despite the diagnostic utility of OCT, facilitated by its high resolution, the impact of intracoronary OCT on clinical practice has thus far been limited. Difficulty in transitioning from intravascular ultrasound (IVUS), complex image interpretation, lack of a standardised algorithm for PCI guidance, and paucity of data from prospective clinical trials have contributed to the modest adoption. Herein, we provide a comprehensive up-do-date overview on the utility of OCT in coronary artery disease, including technical details, device set-up, simplified OCT image interpretation, recognition of the imaging artefacts ...

      Read Full Article
    6. External elastic lamina vs. luminal diameter measurement for determining stent diameter by optical coherence tomography: an ILUMIEN III substudy

      External elastic lamina vs. luminal diameter measurement for determining stent diameter by optical coherence tomography: an ILUMIEN III substudy

      Aims Optical coherence tomography (OCT)-guided external elastic lamina (EEL)-based stent sizing is safe and as effective as intravascular ultrasound in achieving post-procedural lumen dimensions. However, when compared with automated lumen diameter (LD) measurements, this approach is time-consuming. We aimed to compare vessel diameter measurements and stent diameter selection using either of these approaches and examined whether applying a correction factor to automated LD measurements could result in selecting similar stent diameters to the EEL-based approach. Methods and results We retrospectively compared EEL-based measurements vs. automated LD in reference segments in 154 OCT acquisitions and derived a correction factor ...

      Read Full Article
    7. Left coronary artery calcification patterns after coronary bypass graft surgery: An in‐vivo optical coherence tomography study

      Left coronary artery calcification patterns after coronary bypass graft surgery: An in‐vivo optical coherence tomography study

      Objectives We sought to evaluate the severity and patterns of calcifications in the left main coronary artery (LMCA) and proximal segments of left anterior descending coronary artery (LAD) and left circumflex artery (LCX) using optical coherence tomography (OCT) in patients with and without prior coronary artery bypass grafting (CABG). Background CABG may accelerate upstream calcium development. Methods OCT images ( n = 76) of the LMCA bifurcation from either the LAD or LCX in 76 patients with at least one patent left coronary graft, on average 7.0 ± 5.6 years post‐CABG, were compared with 148 OCT images in propensity‐score ...

      Read Full Article
    8. OPtical Coherence Tomography Guided Coronary Stent IMplantation Compared to Angiography: A Multicenter Randomized TriaL in PCI

      OPtical Coherence Tomography Guided Coronary Stent IMplantation Compared to Angiography: A Multicenter Randomized TriaL in PCI

      AIMS: Randomized trials have demonstrated improvement in clinical outcomes with intravascular ultrasound (IVUS)-guided percutaneous coronary intervention (PCI) compared with angiography-guided PCI. The ILUMIEN III trial demonstrated non-inferiority of an optical coherence tomography (OCT)- versus IVUS-guided PCI strategy in achieving similar post-PCI lumen dimensions. ILUMIEN IV is a large-scale, multicenter, randomized trial designed to demonstrate the superiority of OCT- versus angiography-guided stent implantation in patients with high-risk clinical characteristics (diabetes) and/or complex angiographic lesions in achieving larger post-PCI lumen dimensions and improving clinical outcomes. METHODS AND RESULTS: ILUMIEN IV is a prospective, single-blind clinical investigation that will randomize between ...

      Read Full Article
    9. Outcomes of Optical Coherence Tomography Compared With Intravascular Ultrasound and With Angiography to Guide Coronary Stent Implantation: One-Year Results from the ILUMIEN III: OPTIMIZE PCI trial

      Outcomes of Optical Coherence Tomography Compared With Intravascular Ultrasound and With Angiography to Guide Coronary Stent Implantation: One-Year Results from the ILUMIEN III: OPTIMIZE PCI trial

      Aims: In the ILUMIEN III trial, among 450 randomised patients with non-complex lesions undergoing percutaneous coronary intervention (PCI), optical coherence tomography (OCT) guidance led to greater stent expansion than angiography guidance, similar minimal stent area compared to both intravascular ultrasound (IVUS) guidance and angiography guidance, and lower rates of uncorrected dissection and malapposition than both IVUS guidance and angiography guidance. Whether these differences impact clinical outcomes is unknown. Methods and results : OCT-guided PCI, using an external elastic lamina-based protocol, was compared to operator-directed IVUS-guided or angiography-guided PCI. Target lesion failure (TLF) and major adverse cardiovascular events (MACE) at 12 months ...

      Read Full Article
    10. Competency-Based Assessment of Interventional Cardiology Fellows’ Abilities in Intracoronary Physiology and Imaging

      Competency-Based Assessment of Interventional Cardiology Fellows’ Abilities in Intracoronary Physiology and Imaging

      Although coronary angiography remains necessary for percutaneous coronary intervention, it provides limited information about lesion morphology, functional significance, and percutaneous coronary intervention results-limitations that are addressed by intravascular imaging and invasive physiology with demonstrated improve procedural and clinical outcomes.

      Read Full Article
    11. 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 ...

      Read Full Article
    12. 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

      Read Full Article
    13. 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 ...

      Read Full Article
    14. 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 ...

      Read Full Article
    15. 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.

      Read Full Article
    16. 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.

      Read Full Article
    17. 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 ...

      Read Full Article
    18. 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 ...

      Read Full Article
    19. 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 ...

      Read Full Article
    20. 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 ...

      Read Full Article
    21. 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 ...

      Read Full Article
    22. 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 ...

      Read Full Article
    23. 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 ...

      Read Full Article
    1-24 of 28 1 2 »
  1. Categories

    1. Applications:

      Art, Cardiology, Dentistry, Dermatology, Developmental Biology, Gastroenterology, Gynecology, Microscopy, NDE/NDT, Neurology, Oncology, Ophthalmology, Other Non-Medical, Otolaryngology, Pulmonology, Urology
    2. Business News:

      Acquisition, Clinical Trials, Funding, Other Business News, Partnership, Patents
    3. Technology:

      Broadband Sources, Probes, Tunable Sources
    4. Miscellaneous:

      Jobs & Studentships, Student Theses, Textbooks
  2. Topics in the News

    1. (12 articles) Cardiovascular Research Foundation
    2. (11 articles) Columbia University
    3. (4 articles) Abbott
    4. (2 articles) Wakayama Medical University
    5. (2 articles) National Institutes of Health
    6. (1 articles) Erasmus University
    7. (1 articles) Mount Sinai School of Medicine
    8. (1 articles) Royal Brompton Hospital
    9. (1 articles) Cardiovascular Systems, Inc.
  3. Popular Articles

  4. Picture Gallery

    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 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 Algorithmic Approach for Optical Coherence Tomography–Guided Stent Implantation During Percutaneous Coronary Intervention Outcomes of Optical Coherence Tomography Compared With Intravascular Ultrasound and With Angiography to Guide Coronary Stent Implantation: One-Year Results from the ILUMIEN III: OPTIMIZE PCI trial OPtical Coherence Tomography Guided Coronary Stent IMplantation Compared to Angiography: A Multicenter Randomized TriaL in PCI The truth about invisible posterior vitreous structures Increased Macrophage-like Cell Density in Retinal Vein Occlusion as Characterized by en Face Optical Coherence Tomography