1. Articles from Carlo Di Mario

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    1. Clinical use of intracoronary imaging. Part 2: acute coronary syndromes, ambiguous coronary angiography findings, and guiding interventional decision-making: an expert consensus document of the European Association of Percutaneous Cardiovascular Intervent

      Clinical use of intracoronary imaging. Part 2: acute coronary syndromes, ambiguous coronary angiography findings, and guiding interventional decision-making: an expert consensus document of the European Association of Percutaneous Cardiovascular Intervent

      This consensus document is the second of two reports summarizing the views of an expert panel organized by the European Association of Percutaneous Cardiovascular Interventions (EAPCI) on the clinical use of intracoronary imaging including intravascular ultrasound (IVUS), optical coherence tomography (OCT), and near infrared spectroscopy (NIRS)-IVUS. Beyond guidance of stent selection and optimization of deployment, invasive imaging facilitates angiographic interpretation and may guide treatment in acute coronary syndrome. Intravascular imaging can provide additional important diagnostic information when confronted with angiographically ambiguous lesions and allows assessment of plaque morphology enabling identification of vulnerability characteristics. This second document focuses on useful ...

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    2. Comparison between functional and intravascular imaging approaches guiding percutaneous coronary intervention: A network meta‐analysis of randomized and propensity matching studies

      Comparison between functional and intravascular imaging approaches guiding percutaneous coronary intervention: A network meta‐analysis of randomized and propensity matching studies

      Background The optimal approach to guide percutaneous coronary intervention (PCI) has yet to be defined. The aim of this study was to compare functional driven (fractional flow reserve) versus intravascular imaging (intravascular ultrasound, IVUS, and/or optical coherence tomography, OCT) versus standard (coronary angiography only, CA)‐guided PCI. Methods Randomized controlled trials (RCTs) and propensity score weight‐matched studies (PSWMs) comparing FFR versus IVUS versus OCT versus CA‐guided PCI were included. Major adverse cardiovascular event (MACE; a composite end point of death or myocardial infarction [MI] or revascularization) was the primary endpoint, whereas definite stent thrombosis (ST) and single ...

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    3. Clinical use of intracoronary imaging. Part 2: acute coronary syndromes, ambiguous coronary angiography findings, and guiding interventional decision-making: an expert consensus document of the European Association of Percutaneous Cardiovascular Intervent

      Clinical use of intracoronary imaging. Part 2: acute coronary syndromes, ambiguous coronary angiography findings, and guiding interventional decision-making: an expert consensus document of the European Association of Percutaneous Cardiovascular Intervent

      This consensus document is the second of two reports summarizing the views of an expert panel organized by the European Association of Percutaneous Cardiovascular Interventions (EAPCI) on the clinical use of intracoronary imaging including intravascular ultrasound (IVUS), optical coherence tomography (OCT), and near infrared spectroscopy (NIRS)-IVUS. Beyond guidance of stent selection and optimization of deployment, invasive imaging facilitates angiographic interpretation and may guide treatment in acute coronary syndrome. Intravascular imaging can provide additional important diagnostic information when confronted with angiographically ambiguous lesions and allows assessment of plaque morphology enabling identification of vulnerability characteristics. This second document focuses on useful ...

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    4. OCT-Guided Percutaneous Coronary Intervention In Bifurcation Lesions

      OCT-Guided Percutaneous Coronary Intervention In Bifurcation Lesions

      Coronary artery bifurcation lesions remain challenging despite significant advancements in stent technology and development of specific bifurcation stenting approaches. Optical coherence tomography (OCT) is the intracoronary imaging technique with the highest resolution and can generate automatically contoured lumen areas across the variable geometry of bifurcation lesions. Knowledge of plaque severity and composition facilitates planning of the best strategy for percutaneous coronary intervention (PCI) and stenting. In particular, the provisional stent strategy preferred in this context can be modified when there is high risk of side-branch compromise at the ostium after main vessel stenting. OCT is unique because it allows the ...

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      Mentions: Carlo Di Mario
    5. Clinical use of intracoronary imaging. Part 1: guidance and optimization of coronary interventions. An expert consensus document of the European Association of Percutaneous Cardiovascular Interventions

      Clinical use of intracoronary imaging. Part 1: guidance and optimization of coronary interventions. An expert consensus document of the European Association of Percutaneous Cardiovascular Interventions

      his Consensus Document is the first of two reports summarizing the views of an expert panel organized by the European Association of Percutaneous Cardiovascular Interventions (EAPCI) on the clinical use of intracoronary imaging including intravascular ultrasound (IVUS) and optical coherence tomography (OCT). The first document appraises the role of intracoronary imaging to guide percutaneous coronary interventions (PCIs) in clinical practice. Current evidence regarding the impact of intracoronary imaging guidance on cardiovascular outcomes is summarized, and patients or lesions most likely to derive clinical benefit from an imaging-guided intervention are identified. The relevance of the use of IVUS or OCT prior ...

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    6. Will Optical Coherence Tomography Become the Standard Imaging Tool for Percutaneous Coronary Intervention Guidance?

      Will Optical Coherence Tomography Become the Standard Imaging Tool for Percutaneous Coronary Intervention Guidance?

      Editorial Comment: In the last 3 decades, intravascular ultrasound (IVUS) and, more recently, optical coherence tomography (OCT) have been increasingly used to guide percutaneous coronary intervention (PCI). Although there are randomized trials, registries, and meta-analyses suggesting better outcomes using IVUS to guide PCI (1–3), data on the clinical impact of OCT are still missing. In the United Kingdom, consecutive data of all PCI procedures must be prospectively entered in the registry organized by the British Cardiovascular Interventional Society, endorsed by the United Kingdom Department of Health, with tracking of events based on the complete and unquestionable national statistics. One ...

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      Mentions: Carlo Di Mario
    7. Intracoronary Imaging

      Intracoronary Imaging

      Two intracoronary imaging techniques are routinely available to complement angiography in the management of coronary artery disease, namely intravascular ultrasound (IVUS) and optical coherence tomography (OCT). The former has been in clinical use for >25 years and has directly informed the fundamentals of atherosclerotic plaque composition and arterial remodelling, as well as contemporary optimal stent implantation technique. 1 , 2 The latter, introduced 10 years ago, has only been more widely adopted with the development of the frequency domain (FD)-OCT imaging, which enables complete image acquisition over a 6–10 cm segment during a 3–5 s pullback period obtaining ...

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    8. Absorb vs. DESolve: an optical coherence tomography comparison of acute mechanical performances

      Absorb vs. DESolve: an optical coherence tomography comparison of acute mechanical performances

      Aims: The aim of the study was to compare retrospectively the acute mechanical performance of the Absorb vs. DESolve scaffolds in terms of appropriate deployment with OCT. Methods and results: Final post-deployment OCT pullbacks of consecutive patients treated with either Absorb or DESolve were reviewed. The following parameters were calculated and compared: mean and minimal lumen area (MLA), residual in-scaffold area stenosis (RAS), incomplete strut apposition (ISA), tissue prolapse area, eccentricity index, asymmetry index, strut fracture and edge dissection. A total of 72 patients were included. The Absorb group consisted of 35 patients treated with 63 Absorb scaffolds and was ...

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    9. Optical coherence tomography guidance for percutaneous coronary intervention with bioresorbable scaffolds

      Optical coherence tomography guidance for percutaneous coronary intervention with bioresorbable scaffolds

      Background The effect of optical coherence tomography (OCT) guidance on the implantation strategy during all phases of percutaneous coronary intervention (PCI) with bioresorbable vascular scaffolds (BVSs) in a real-world scenario has been poorly investigated. Methods Consecutive patients undergoing BVS implantation at our institution were included in this registry. Frequency-domain OCT pullbacks were performed at the operator's discretion during all phases of BVS implantation procedures to optimize preparation of lesions, confirm BVS size, and optimize expansion and apposition of scaffolds. Results Between September 2012 and July 2015, 203 BVSs were implanted in 101 consecutive patients at our institution (2.01 ...

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    10. Optical coherence tomography evaluation of intermediate-term healing of different stent types: systemic review and meta-analysis

      Optical coherence tomography evaluation of intermediate-term healing of different stent types: systemic review and meta-analysis

      Aims The intermediate-term incidence of strut malapposition (SM) and uncovered struts (US), and the degree of neointimal thickness (NIT) according to stent type have not been characterized. Methods and results All studies of >50 patients in which optical coherence tomography was performed between 6 and 12 months after stent implantation were included. The incidences of SM and US were the co-primary end points, while NIT was the secondary end point. A total of 458 citations were initially appraised at the abstract level, and 11 full-text studies (280 652 analysed struts, 921 patients) were assessed. The 6–12 months incidences of ...

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    11. Invasive coronary imaging: any role in primary and secondary prevention?

      Invasive coronary imaging: any role in primary and secondary prevention?

      This review discusses the possibilities offered by new modalities of non-invasive and invasive coronary imaging in an effort to optimize risk stratification for coronary artery disease, and identify subgroups at high risk that may benefit from an aggressive, personalized approach, with access to a growing number of novel drugs and interventions. Special emphasis is placed on the progress of novel invasive imaging techniques such as near infrared spectroscopy and optical coherence tomography that can reliably identify thin-capped fibroatheromas. Multiple trials are exploring the feasibility of these techniques to guide modulation of risk factor control and treatment of non-flow limiting lesions ...

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    12. Time-related changes in neointimal tissue coverage of a novel Sirolimus eluting stent: Serial observations with optical coherence tomography

      Time-related changes in neointimal tissue coverage of a novel Sirolimus eluting stent: Serial observations with optical coherence tomography

      Background DES has reduced rates of restenosis compared with BMS but it has been associated with delayed healing and increase of stent thrombosis. The aim of our study was to evaluate the vascular time-related changes following implantation of a new SES coated with an amorphous silicon carbide that allows faster re-endothelisation (Orsiro-Biotronik). Methods This prospective registry enrolled STEMI-patients with multi-vessel disease, thus candidates for a two-step procedure. PCI of the culprit lesion was performed with at least one Orsiro stent that was OCT-analysed during the second-step procedure (deferred to 30,90 and 180-days). Results 16 of the 95 patients with ...

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      Mentions: Carlo Di Mario
    13. OCT imaging of aorto-coronary vein graft pathology modified by external stenting: 1-year post-surgery

      OCT imaging of aorto-coronary vein graft pathology modified by external stenting: 1-year post-surgery

      Aims The Venous External Support Trial (VEST) evaluated whether a novel external stent attenuated saphenous vein graft (SVG) disease assessed with intravascular ultrasound 1 year following coronary artery bypass graft (CABG) surgery. This sub-study assessed SVGs with and without external stenting using optical coherence tomography (OCT). The aim of this study was to accurately compare quantitative and qualitative features of SVGs with and without a novel external stent using OCT. Methods and results Twenty-four of 30 patients (65 ± 8 years) enrolled in VEST underwent coronary angiography with OCT imaging using a non-occlusive technique. Quantitative analysis of lumen area was performed ...

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    14. Comparative analysis method of permanent metallic stents (XIENCE) and bioresorbable poly-L-lactic (PLLA) scaffolds (Absorb) on optical coherence tomography at baseline and follow-up

      Comparative analysis method of permanent metallic stents (XIENCE) and bioresorbable poly-L-lactic (PLLA) scaffolds (Absorb) on optical coherence tomography at baseline and follow-up

      Aims: Fully bioresorbable Absorb poly-L-lactic-acid (PLLA) scaffolds (Abbott Vascular, Santa Clara, CA, USA) are a novel approach for the treatment of coronary narrowing. Due to the translucency of the material (PLLA), the optical coherence tomography (OCT) measurement methods used in the ABSORB trials were unique but not applicable for permanent metallic stents. When the Absorb scaffold and metallic stents are compared in the context of randomised trials, it is challenging to compare the two devices using the conventional methods. The primary purpose of this report is to explain the biases in conventional methodologies applied for metallic stents and for PLLA ...

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    15. Is high pressure postdilation safe in bioresorbable vascular scaffolds? Optical coherence tomography observations after noncompliant balloons inflated at more than 24 atmospheres

      Is high pressure postdilation safe in bioresorbable vascular scaffolds? Optical coherence tomography observations after noncompliant balloons inflated at more than 24 atmospheres

      Objectives Optical coherence tomography (OCT) was used to investigate integrity and expansion of bioresorbable drug-eluting scaffolds (BVS) after high-pressure postdilation (HPPD). Background Because of concerns about the risk of BVS damage, postdilation was not recommended and applied in the existing randomized studies and most registries. Recent real world data suggest incomplete BVS expansion cause higher rates of thrombosis. In vivo confirmation of the safety of high pressure postdilation is of paramount importance. Methods Data from final OCT examination of consecutive implanted BVS, postdilated with noncompliant (NC) balloons at pressure ≥24 atm were analyzed. The following stent performance indices were assessed ...

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    16. Inducing Persistent Flow Disturbances Accelerates Atherogenesis and Promotes Thin Cap Fibroatheroma Development in D374Y-PCSK9 Hypercholesterolemic Minipigs

      Inducing Persistent Flow Disturbances Accelerates Atherogenesis and Promotes Thin Cap Fibroatheroma Development in D374Y-PCSK9 Hypercholesterolemic Minipigs

      Background— Although disturbed flow is thought to play a central role in the development of advanced coronary atherosclerotic plaques, no causal relationship has been established. We evaluated whether inducing disturbed flow would cause the development of advanced coronary plaques, including thin cap fibroatheroma. Methods and Results— D374Y -PCSK9 hypercholesterolemic minipigs (n=5) were instrumented with an intracoronary shear-modifying stent (SMS). Frequency-domain optical coherence tomography was obtained at baseline, immediately poststent, 19 weeks, and 34 weeks, and used to compute shear stress metrics of disturbed flow. At 34 weeks, plaque type was assessed within serially collected histological sections and coregistered to ...

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    17. Bioresorbable vascular scaffold overlap evaluation with optical coherence tomography after implantation with or without enhanced stent visualization system (WOLFIE study): a two-centre prospective comparison

      Bioresorbable vascular scaffold overlap evaluation with optical coherence tomography after implantation with or without enhanced stent visualization system (WOLFIE study): a two-centre prospective comparison

      To assess if enhanced stent visualization (ESV)-guided implantation of overlapping bioresorbable vascular scaffold (BVS) is superior to angiography alone-guided implantation in the reduction of overlap length. WOLFIE is a two-centre prospective open study enrolling 30 patients treated with implantation of at least two overlapping BVS. In the first centre (London), BVS implantation was guided by conventional angiography, while in the second centre (Ferrara), an ESV system was systematically employed. The primary endpoint of the study was overlap length. Secondary endpoints were: stacked struts number, area, thickness, and amount of clusters. In the ESV-guided group, overlap length was significantly lower ...

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    18. First Optical Coherence Tomography Follow-up of Coronary Bifurcation Lesions Treated by Drug-Eluting Balloons

      First Optical Coherence Tomography Follow-up of Coronary Bifurcation Lesions Treated by Drug-Eluting Balloons

      Background. A strategy of percutaneous bifurcation intervention with provisional bare-metal stent (BMS) implantation followed by drug-eluting balloon (DEB) treatment represents a valuable opportunity in patients not compliant with long-duration dual-antiplatelet therapy. We used optical coherence tomography (OCT) to assess coronary bifurcation lesions treated by BMS and DEB, and secondarily, to better explore the association between stent geometry and tissue coverage. Methods. Twelve patients underwent frequency-domain OCT 6 months after undergoing percutaneous bifurcation intervention with BMS implantation followed by kissing DEB. The same type of BMS was correspondingly implanted in silicone bifurcation models and scanned by microcomputed tomography. Results. Overall, a ...

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    19. Optical Coherence Tomography Evaluation of Overlapping Everolimus-Eluting Bioresorbable Vascular Scaffolds implantation guided by Enhanced Stent Visualization System

      Optical Coherence Tomography Evaluation of Overlapping Everolimus-Eluting Bioresorbable Vascular Scaffolds implantation guided by Enhanced Stent Visualization System

      In a porcine model, implantation of overlapping everolimus-eluting bioresorbable vascular scaffolds (BVS, Abbott Vascular, Santa Clara, California) resulted in delayed struts coverage and higher neointimal response [1] that might lead to important clinical consequences (scaffold thrombosis; in-scaffold restenosis). According to this, any effort to minimize BVS overlap area and the number of overlapping struts is desirable. A bench testing in an in vitro phantom model has shown how to minimize BVS overlap utilizing the platinum markers located at each BVS edge, where the ideal overlap should be achieved when BVS edge markers positioned at 90 degrees to each other, causing ...

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      Mentions: Carlo Di Mario
    20. Three-vessel coronary artery disease evaluation by multimodality imaging with Near-Infrared Spectroscopy (NIRS) plus Intravascular Ultrasound (IVUS) and Optical Coherence Tomography (OCT)

      Three-vessel coronary artery disease evaluation by multimodality imaging with Near-Infrared Spectroscopy (NIRS) plus Intravascular Ultrasound (IVUS) and Optical Coherence Tomography (OCT)

      There is a rapid evolution in hybrid intravascular imaging for identifying high-risk biological and structural coronary arterial plaques in vivo and searching the missing pieces of the complex puzzle that determine the pathophysiology of myocardial infarction [1].

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    21. ABSORB Biodegradable Stents Versus Second-Generation Metal Stents : A Comparison Study of 100 Complex Lesions Treated Under OCT Guidance

      ABSORB Biodegradable Stents Versus Second-Generation Metal Stents : A Comparison Study of 100 Complex Lesions Treated Under OCT Guidance

      Objectives The aim of this study was to compare the acute performance of the PLLA ABSORB bioresorbable vascular scaffold (BVS) (Abbott Vascular, Santa Clara, California) with second-generation metal drug-eluting stents (DES) in complex coronary artery lesions. Background Thick polymer-based BVS have different mechanical properties than thin second-generation DES. Data on the acute performance of BVS are limited to simple coronary lesions treated in trials with strict inclusion criteria. Methods Fifty complex coronary lesions (all type American College of Cardiology/American Heart Association B2-C) treated with a BVS undergoing a final optical coherence tomography (OCT) examination were compared with an equal ...

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    22. Intracoronary optical coherence tomography: a review of clinical applications

      Intracoronary optical coherence tomography: a review of clinical applications

      Optical coherence tomography (OCT) is a light-based technology that provides very high spatial resolution images. OCT has been initially employed as a research tool to investigate plaque morphology and stent strut coverage. The introduction of frequency domain OCT allowing fast image acquisition during a prolonged contrast injection via the guiding catheter has made OCT applicable for guidance of coronary interventions. In this manuscript, the various applications of OCT are reviewed, from assessment of plaque vulnerability and severity to characteristics of unstable lesions and thrombus burden to stent optimization and evaluation of late results.

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    23. Bifurcated Lesions and Optical Coherence Tomography

      Bifurcated Lesions and Optical Coherence Tomography

      Coronary artery bifurcation lesions constitute a complex subgroup that are encountered in 15–20 % of all percutaneous coronary interventions (PCI). 1–5 Compared with simple lesions, bifurcations have been associated with lower procedural success rates, higher adverse event rates, longer procedures, and worse angiographic and clinical outcomes. 1,3,5–12 The less favourable outcomes associated with bifurcation treatment compared with non-bifurcation lesions may in part result from the inability of current devices and techniques to adequately scaffold and preserve the side branch (SB) ostium, which is a common location of restenosis. 1,3,5–13

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