1. Articles from Jagat Narula

    1-24 of 31 1 2 »
    1. Optical coherence tomography-verified morphological correlates of high-intensity coronary plaques on non-contrast T1-weighted magnetic resonance imaging in patients with stable coronary artery disease

      Optical coherence tomography-verified morphological correlates of high-intensity coronary plaques on non-contrast T1-weighted magnetic resonance imaging in patients with stable coronary artery disease

      Aims Coronary high-intensity plaques (HIPs) with a high plaque-to-myocardial signal intensity ratio (PMR) on non-contrast T1-weighted imaging in patients with stable coronary artery disease (CAD) are associated with future coronary events. To characterize the morphological substrate of HIP, we performed a correlative optical coherence tomography (OCT) study. Methods and results We examined 137 lesions in 105 patients with stable angina pectoris or silent myocardial ischaemia scheduled for percutaneous coronary intervention (PCI) using a 3 T magnetic resonance scanner. Pre-interventional OCT was performed for PCI target lesions. HIP was defined as PMR ≥ 1.4. Of the 137 lesions, 34% were HIP ...

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      Mentions: Jagat Narula
    2. Atlas of Coronary Intravascular Optical Coherence Tomography (Textbook)

      Atlas of Coronary Intravascular Optical Coherence Tomography (Textbook)

      This atlas is a practical and fully illustrated guide to the use of intravascular OCT in diagnosis and treatment of coronary artery disease. It consists of two parts. The first part of the book provides a systematic introduction to coronary imaging with OCT. It describes how to interpret images and describes abnormal findings seen in atherosclerosis, complications after intervention, and stent assessment. The second part of the book presents real-life case studies that show how OCT is used in clinical practice in Mount Sinai to assess the disease, select appropriate treatment, and evaluate complications and results. Each case includes a ...

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    3. Histopathological Differential Diagnosis of Optical Coherence Tomographic Image Interpretation After Stenting

      Histopathological Differential Diagnosis of Optical Coherence Tomographic Image Interpretation After Stenting

      Objectives The aim of this study was to identify histological features that correlate with terms commonly used to describe optical coherence tomographic (OCT) and optical frequency-domain imaging (OFDI) images of stented vessels, by means of a histopathological validation study using stented human coronary arteries. Background OCT imaging and OFDI are used to evaluate vascular responses to stent implantation. Descriptive terms such as “peristrut low attenuation” and “heterogeneous” have been used to describe neointimal characteristics that may have clinical relevance. However, only limited histopathological correlations are available. Methods Using the CVPath stent registry, 19 cases were identified in whom implantation duration ...

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    4. Plaque Morphology Predictors of Side Branch Occlusion After Main Vessel Stenting in Coronary Bifurcation Lesions Optical Coherence Tomography Imaging Study

      Plaque Morphology Predictors of Side Branch Occlusion After Main Vessel Stenting in Coronary Bifurcation Lesions Optical Coherence Tomography Imaging Study

      Side branch (SB) occlusion remains a major complication of bifurcation lesion treatment. Although plaque and carina shift are suggested as mechanisms of SB occlusion (1) , little is known about underlying plaque morphology and composition of the main vessel (MV) and its potential impact on SB occlusion after MV stenting. Optical coherence tomography (OCT) allows precise evaluation of plaque characteristics, and dedicated bifurcation 3-dimensional (3D) quantitative coronary angiography (QCA) software permits highly accurate lesion assessment (2) . The primary aim of this study was to identify the predictors of SB occlusion after MV stenting by OCT and dedicated bifurcation 3D-QCA.

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    5. Multimodality Intravascular Imaging to Evaluate Sex Differences in Plaque Morphology in Stable CAD

      Multimodality Intravascular Imaging to Evaluate Sex Differences in Plaque Morphology in Stable CAD

      Objectives The aim of this study was to evaluate sex differences in plaque morphology in stable coronary artery disease (CAD) patients using a multimodality intravascular imaging approach. Background Differences in atherosclerotic burden and plaque morphology between men and women is a focus of treatment and preventative measures. Methods We retrospectively analyzed data from 383 patients with stable CAD who were referred for angiography and underwent optical coherence tomography. Among them, 128 also underwent intravascular ultrasound (IVUS)/near infrared spectroscopy. Results Of the 383 patients included in the study, 268 were men and 115 were women. Women tended to be older ...

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      Mentions: Jagat Narula
    6. Multimodality Intravascular Imaging to Evaluate Sex Differences in Plaque Morphology in Stable CAD

      Multimodality Intravascular Imaging to Evaluate Sex Differences in Plaque Morphology in Stable CAD

      OBJECTIVES: The aim of this study was to evaluate sex differences in plaque morphology in stable coronary artery disease (CAD) patients using a multimodality intravascular imaging approach. BACKGROUND: Differences in atherosclerotic burden and plaque morphology between men and women is a focus of treatment and preventative measures. METHODS: We retrospectively analyzed data from 383 patients with stable CAD who were referred for angiography and underwent optical coherence tomography. Among them, 128 also underwent intravascular ultrasound (IVUS)/near infrared spectroscopy. RESULTS: Of the 383 patients included in the study, 268 were men and 115 were women. Women tended to be older ...

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    7. Plaque morphology predictors of side branch occlusion after provisional stenting in coronary bifurcation lesion: Results of optical coherence tomography bifurcation study (ORBID)

      Plaque morphology predictors of side branch occlusion after provisional stenting in coronary bifurcation lesion: Results of optical coherence tomography bifurcation study (ORBID)

      Objectives The aim of this study was to identify the predictors of side branch (SB) ostial stenosis developed after provisional stenting of the main vessel (MV) using optical coherence tomography (OCT). Background Provisional stenting remains the main approach to treatment of bifurcation lesions; however, it may result in the narrowing of SB ostium. There is little information about underlying plaque morphology of the MV lesion and its potential impact on the SB after provisional stenting. Methods Patients with stable coronary disease with angiographic MV lesion not involving SB were included in a prospective single center study. The primary outcome was ...

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    8. Serial optical coherence tomography imaging of ACS-causing culprit plaques

      Serial optical coherence tomography imaging of ACS-causing culprit plaques

      Aims: The aim of this study was to understand better the mechanisms of repair of plaque complications causing acute coronary syndrome. Methods and results: We used OCT in the acute phase and at follow-up (one to seven months) to investigate the plaque healing in 10 culprit plaques: five ruptured fibrous cap (RFC) and five intact fibrous cap (IFC) which were not treated with stent deployment and caused ST-segment elevation myocardial infarction (n=8) and non-STEMI (n=2). At follow-up OCT, the margins of the evacuated cavity in RFC plaques showed a smooth surface and a morphology similar to that of ...

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    9. Multimodality Intravascular Imaging to Predict Periprocedural Myocardial Infarction During Percutaneous Coronary Intervention

      Multimodality Intravascular Imaging to Predict Periprocedural Myocardial Infarction During Percutaneous Coronary Intervention

      Objectives The aim of this study is to compare the relative merits of optical coherence tomography (OCT), intravascular ultrasound (IVUS), and near infrared spectroscopy (NIRS) in patients with coronary artery disease for the prediction of periprocedural myocardial infarction (MI). Background Although several individual intravascular imaging modalities have been employed to predict periprocedural MI, it is unclear which of the imaging tools would best allow prediction of this complication. Methods We retrospectively analyzed 110 patients who underwent OCT, IVUS, and NIRS. Periprocedural MI was defined as a post-procedural cardiac troponin I (cTnI) elevation above 3× the upper limit of normal; analysis ...

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    10. In Search of the Vulnerable Plaque Is There Any Light at the End of the Catheter?

      In Search of the Vulnerable Plaque Is There Any Light at the End of the Catheter?

      Plaque destabilization with consequent rupture (or erosion) and superimposed thrombosis is the proximate cause of acute coronary syndromes (ACS). Although ACS treatment has advanced considerably in the past decade, the ability to detect, predict, and prevent plaque vulnerability remains elusive. Several imaging tools have been developed to characterize morphological determinants of plaque vulnerability 1 . Among these, intravascular ultrasound (IVUS) is useful for characterizing stenosis severity, plaque burden (PB), remodeling, and calcification but has low resolution and limited ability to detect plaque erosion, rupture, and thrombus. Optical coherence tomography (OCT) can characterize plaques but possesses poor penetration, thereby limiting assessment of ...

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      Mentions: Jagat Narula
    11. Matching human pathology is essential for validating OCT imaging to detect high-risk plaques

      Matching human pathology is essential for validating OCT imaging to detect high-risk plaques

      We thank Mark Brezinski for his Correspondence ( Capabilities, limitations, and misconceptions of using OCT to assess vulnerable plaques . Nat. Rev. Cardiol. doi:10.1038/nrcardio.2014.62-c1 ) 1 on our Review ( Clinical classification of plaque morphology in coronary disease . Nat. Rev. Cardiol. 11 , 379 – 389 ; 2014 ), 2 and for his comments and clarifications. We agree that the phenomenon

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    12. Imaging Plaques to Predict and Better Manage Patients With Acute Coronary Events

      Imaging Plaques to Predict and Better Manage Patients With Acute Coronary Events

      Culprit lesions of patients, who have had an acute coronary syndrome commonly, are ruptured coronary plaques with superimposed thrombus. The precursor of such lesions is an inflamed thin-capped fibroatheroma. These plaques can be imaged by means of invasive techniques, such as intravascular ultrasound (and derived techniques), optical coherence tomography, and near-infrared spectroscopy. Often these patients exhibit similar (multiple) plaques beyond the culprit lesion. These remote plaques can be assessed noninvasively by computed tomographic angiography and MRI and also using invasive imaging. The detection of these remote plaques is not only feasible but also in natural history studies have been associated ...

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    13. Clinical classification of plaque morphology in coronary disease

      Clinical classification of plaque morphology in coronary disease

      In published post-mortem pathological studies, more than two-thirds of acute coronary events are associated with the rupture of lipid-rich, voluminous, and outwardly remodelled plaques covered by attenuated and inflamed fibrous caps in the proximal part of coronary arteries. Superficial erosion of the plaques is responsible for most of the remaining events; the eroded plaques usually do not demonstrate much lipid burden, do not have thin fibrous caps, are not positively remodelled, and are not critically occlusive. Both noninvasive and invasive imaging studies have been performed to clinically define the plaque characteristics in acute coronary syndromes in an attempt to identify ...

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    14. Advances in the Understanding of Plaque Composition and Treatment Options - Year in Review

      Advances in the Understanding of Plaque Composition and Treatment Options - Year in Review

      Atherosclerosis research has classically followed 2 intertwining lines of investigation concerning atherosclerosis as a local process (the “high-risk plaque”) and as a systemic disease (the “high-risk patient”). Over time, the weight of attention has swung, like a pendulum, between these 2 related foci. With optimal medical therapy and attention to risk factors firmly established as fundamental aspects of management, in the past year, we have nevertheless perceived a shift in the pendulum toward renewed focus on the local plaque. We contend that this shift results from a convergence of major advances in understanding the biology of plaque progression, novel sophisticated ...

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    15. Integrated IVUS-OCT for Real-Time Imaging of Coronary Atherosclerosis

      Integrated IVUS-OCT for Real-Time Imaging of Coronary Atherosclerosis

      Accurate assessment of atherosclerotic plaque characteristics and the subsequent tailoring of optimal therapy holds great promise for preventing acute coronary syndromes (ACS) and life-threatening sequelae 1 . Combined use of optical coherence tomography (OCT) and intravascular ultrasound (IVUS) was proposed as a potential method for accurate assessment of plaque characteristics and vulnerability ( 2 , ). However, significant challenges remain in trying to adapt an integrated OCT-IVUS system for clinical applications. We report here a fully integrated intracoronary OCT-IVUS imaging technique to visualize atherosclerotic plaque in living animals and human coronary arteries from cadavers with high resolution and deep penetration capability simultaneously.

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    16. Comprehensive overview of definitions for optical coherence tomography-based plaque and stent analyses

      Comprehensive overview of definitions for optical coherence tomography-based plaque and stent analyses

      Optical coherence tomography (OCT) is the current state-of-the-art intracoronary imaging modality that allows visualization of detailed morphological characteristics of both atherosclerotic plaque and stent. So far, three expert review documents have been released for standardization of OCT image analysis. In the real world, a variety of definitions are being used by different groups and by different core laboratories to analyze OCT findings because of different clinical/procedural contexts in which OCT research has been carried out. This comprehensive overview is aimed to summarize different applicable definitions used by different research groups in plaque and stent analysis using OCT. In addition ...

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    17. Increased Thin-Cap Neoatheroma and Periprocedural Myocardial Infarction in Drug-Eluting Stent Restenosis Multimodality Intravascular Imaging of Drug-Eluting and Bare-Metal Stents

      Increased Thin-Cap Neoatheroma and Periprocedural Myocardial Infarction in Drug-Eluting Stent Restenosis  Multimodality Intravascular Imaging of Drug-Eluting and Bare-Metal Stents

      Background— Re-endothelialization is delayed after drug-eluting stent (DES) implantation. In this setting, neointima is more prone to become lipid laden and develop neoatherosclerosis (NA), potentially increasing plaque vulnerability. Methods and Results— Optical coherence tomography and near-infrared spectroscopy with intravascular ultrasound were used to characterize NA in 65 (51 DES and 14 bare-metal stents) consecutive symptomatic patients with in-stent restenosis. Median duration poststent implantation was 33 months. Optical coherence tomography–verified NA was observed in 40 stents with in-stent restenosis (62%), was more prevalent in DES than bare-metal stents (68% versus 36%; P =0.02), and demonstrated significantly higher prevalence of ...

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    18. Feature Of The Week 8/4/13: MGH OCT Registry Reports on In Vivo OCT Studies of Plaque Erosion and Calcified Nodule In Acute Coronary Syndrome

      Feature Of The Week 8/4/13: MGH OCT Registry Reports on In Vivo OCT Studies of Plaque Erosion and Calcified Nodule In Acute Coronary Syndrome

      Pathology studies reported that three most common causes of acute coronary syndrome (ACS) or sudden cardiac death are plaque rupture, plaque erosion and calcified nodules. The morphological and clinical characteristics of the underlying pathology of ACS, especially plaque erosion and calcified nodule, have never been well studied in vivo. Using optical coherence tomography, we found that plaque erosions are the substrate for ACS in 31% of patients and calcified nodules in 8% of patients, which are consistent with pathological findings. Erosions are more likely to cause non-ST-segment elevation ACS than ST-segment elevation myocardial infarction. Compared to plaque rupture, plaque erosion ...

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    19. In Vivo Diagnosis of Plaque Erosion and Calcified Nodule in Patients with Acute Coronary Syndrome by Intravascular Optical Coherence Tomography

      In Vivo Diagnosis of Plaque Erosion and Calcified Nodule in Patients with Acute Coronary Syndrome by Intravascular Optical Coherence Tomography

      Objectives To characterize the morphological features of plaque erosion and calcified nodule in patients with acute coronary syndrome (ACS) by optical coherence tomography (OCT). Background Plaque erosion and calcified nodule have not been systematically investigated in vivo . Methods One hundred and twenty-six patients with ACS who had undergone pre-intervention OCT imaging were included. The culprit lesions were classified as plaque rupture (PR), erosion (OCT-erosion), calcified nodule (OCT-CN), or others using a new set of diagnostic criteria for OCT. Results The incidences of PR, OCT-erosion, and OCT-CN were 43.7%, 31.0%, and 7.9%, respectively. Patients with OCT-erosion were the ...

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    20. OCT-Based Diagnosis and Management of STEMI Associated With Intact Fibrous Cap

      OCT-Based Diagnosis and Management of STEMI Associated With Intact Fibrous Cap

      In autopsy studies, at least 25% of thrombotic coronary occlusions are caused by plaque erosion in which thrombus often overlies atherosclerotic plaque without evident disruption of the fibrous cap. We performed optical coherence tomography imaging after aspiration thrombectomy and identified plaque erosion as the cause in 31 patients presenting with ST-segment elevation myocardial infarction. Plaque erosion was identified when the fibrous cap of the culprit lesion was intact. Based on clinical criteria, 40% of patients with subcritically occlusive plaque were treated with dual antiplatelet therapy without percutaneous revascularization (group 1), and the remaining 60% of patients underwent angioplasty and stenting ...

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    21. Plaques with high lipid burden: keeping the fat out of the fire

      Plaques with high lipid burden: keeping the fat out of the fire

      Two recent papers published in Heart have evaluated the utility of advanced imaging modalities for the morphological detection and evaluation of high-risk atherosclerotic plaques. 1 , 2 While these studies employed differing methodologies (CT angiography (CTA), optical coherence tomography (OCT) and optic angioscopy), the results are broadly concordant and of major potential clinical significance. Notably, when subjected to percutaneous coronary intervention (PCI), such high-risk plaques may embolise and release a slurry of lipid-rich necrotic debris to the distal circulation, with consequent myocardial damage. In addition, it has been proposed that PCI of lipid-rich plaques (LRP) with thin fibrous caps (<65 μm ...

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    22. Intravascular atherosclerotic imaging with combined fluorescence and optical coherence tomography probe based on a double-clad fiber combiner

      Intravascular atherosclerotic imaging with combined fluorescence and optical coherence tomography probe based on a double-clad fiber combiner

      We developed a multimodality fluorescence and optical coherence tomography probe based on a double-clad fiber (DCF) combiner. The probe is composed of a DCF combiner, grin lens, and micromotor in the distal end. An integrated swept-source optical coherence tomography and fluorescence intensity imaging system was developed based on the combined probe for the early diagnoses of atherosclerosis. This system is capable of real-time data acquisition and processing as well as image display. For fluorescence imaging, the inflammation of atherosclerosis and necrotic core formed with the annexin V–conjugated Cy5.5 were imaged. Ex vivo imaging of New Zealand white rabbit ...

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    23. Impact of Statin Therapy on Plaque Characteristics as Assessed by Serial OCT, Grayscale and Integrated Backscatter–IVUS

      Impact of Statin Therapy on Plaque Characteristics as Assessed by Serial OCT, Grayscale and Integrated Backscatter–IVUS

      Objectives: The purpose of this study was to evaluate the effect of statin treatment on coronary plaque composition and morphology by optical coherence tomography (OCT), grayscale and integrated backscatter (IB) intravascular ultrasound (IVUS) imaging. Background: Although previous studies have demonstrated that statins substantially improve cardiac mortality, their precise effect on the lipid content and fibrous cap thickness of atherosclerotic coronary lesions is less clear. While IVUS lacks the spatial resolution to accurately assess fibrous cap thickness, OCT lacks the penetration of IVUS. We used a combination of OCT, grayscale and IB-IVUS to comprehensively assess the impact of pitavastatin on plaque ...

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    24. Intracoronary Optical Diagnostics: Current Status, Limitations, and Potential

      Intracoronary Optical Diagnostics: Current Status, Limitations, and Potential

      Optical coherence tomography (OCT), is a novel intravascular imaging modality analogous to intravascular ultrasound but uses light instead of sound. This review details the background, development, and status of current investigation using OCT, and discusses advantages, limitations, and likely future developments. It provides indications for possible future clinical use, and places OCT in the context of current intravascular imaging in what is a rapidly changing field of investigation.

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    1-24 of 31 1 2 »
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