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Articles from Yoshinobu Onuma
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Randomized Comparison Between Everolimus-Eluting Bioresorbable Scaffold and Metallic Stent Multimodality Imaging Through 3 Years
Read Full ArticleObjectives The aim of this study was to investigate the vascular responses and fates of the scaffold after bioresorbable vascular scaffold (BVS) implantation using multimodality imaging. Background Serial comprehensive image assessments after BVS implantation in the context of a randomized trial have not yet been reported. Methods In the ABSORB Japan trial, 400 patients were randomized to a BVS (n = 266) or a cobalt-chromium everolimus-eluting stent (n = 134). Through 3 years, patients underwent serial angiography and intravascular ultrasound or optical coherence tomography (OCT). Results Luminal dimension at 3 years was consistently smaller with the BVS than with the cobalt-chromium everolimus-eluting ...
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Cracking (the code of) coronary artery calcification to win the last battle of percutaneous coronary intervention: still in the middle of a rocky road
Read Full ArticleThis editorial refers to ‘Vascular responses to coronary calcification following implantation of newer-generation drug-eluting stents in humans: impact on healing’, by S. Torii et al ., doi: 10.1093/eurheartj/ehz850 . Vascular calcification is classified into two categories according to its location. Calcification in the medial layer is called Monckeberg’s atherosclerosis and is seen mainly in the peripheral arteries. Intimal calcification is the dominant type of calcification seen in the coronary arteries. Coronary artery calcification (CAC) pathologically begins as microcalcification (0.5–15 μm) resulting from apoptosis of foam cells and/or smooth muscle cells. 1 Microcalcification may become calcified ...
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Neointimal characteristics comparison between biodegradable-polymer and durable-polymer drug-eluting stents: 3-month follow-up optical coherence tomography light property analysis from the RESTORE registry
Read Full ArticleWe aimed to quantitatively assess a possible difference of the neointimal quality between biodegradable polymer- (BP-) and durable polymer drug-eluting stents (DP-DESs). We conducted a single-center all-comer prospective cohort study: the RESTORE registry (UMIN000033009). All patients who received successful OCT examination at planned 3-month follow-up after DES implantation were analyzed. Study population was divided into 2 groups, BP-DES versus DP-DES groups. We evaluated standard OCT variables, coverage percent, and the quantitative light property values including light intensity, attenuation, and backscatter. We performed OCT analyses of 121 lesions in 98 patients (BP-DES 55 lesions in 51 patients vs. DP-DES 66 lesions ...
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Optical coherence tomography enables more accurate detection of functionally significant intermediate non-left main coronary artery stenoses than intravascular ultrasound: A meta-analysis of 6919 patients and 7537 lesions
Read Full ArticleObjective Fractional flow reserve (FFR) is regarded as the gold standard for the physiological assessment of intermediate coronary artery stenoses. However, FFR does not allow assessment of plaque morphology and lesion geometry. Intracoronary imaging techniques such as intravascular ultrasound (IVUS) and optical coherence tomography (OCT) can help treatment planning by optimising stent implantation, which can improve patient outcomes. The aim of this meta-analysis is to compare the efficacy of IVUS and OCT-derived metrics in detecting flow limiting stenoses in non-left main stem lesions. Methods A systematic review of PubMed, Medline, and Cochrane databases was performed and identified studies examining the ...
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Optical coherence tomography substudy of a prospective multicentre randomised post-market trial to assess the safety and effectiveness of the Firehawk cobalt-chromium coronary stent (rapamycin target-eluting) system for the treatment of atherosclerotic le
Read Full ArticleAims: Durable polymer drug-eluting stents (DP-DES) may contribute to persistent inflammation, delayed endothelial healing and subsequent late DES thrombosis. The aim of this optical coherence tomography (OCT) substudy was to compare healing and neointimal coverage of a novel bioabsorbable polymer sirolimus-eluting stent (Firehawk ® ) (BP-DES) versus the DP-DES (XIENCE) at 90 days in an all-comers patient population. Methods and results: The TARGET All Comers study is a prospective multicentre randomised post-market trial of 1,656 patients randomised 1:1 to Firehawk or XIENCE at 21 centres in 10 European countries. The TARGET OCT substudy enrolled 36 consecutive patients with 52 lesions ...
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Multimodality Imaging to Detect Vulnerable Plaque in Coronary Arteries and Its Clinical Application (Book Chapter)
Read Full ArticlePostmortem studies have described the association between the thin-cap fibroatheroma (TCFA) and the occurrence of acute coronary syndrome (ACS). Both noninvasive and invasive techniques have been refined and used as a research tool to visualize the plaque at a high risk of disruption. There has been a considerable effort to develop the imaging modalities that offer detailed visualization of coronary pathology and accurately predict the adverse cardiac outcomes. This chapter provides an overview of the current and experimental coronary imaging methods to detect vulnerable plaque and discuss the potential implication of multimodality imaging in clinical practice.
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Quality difference of neointima following the implantation of bioresorbable scaffold and metallic stent in patients with ST elevation myocardial infarction: quantitative assessments by light intensity, light attenuation, and backscatter on optical coheren
Read Full ArticleAims: We aimed to assess possible difference of the neointimal quality after everolimus-eluting bioresorbable scaffold (BVS) implantation in comparison with cobalt chromium everolimus-eluting scaffold (CoCr-EES) by optical frequency domain imaging (OFDI). Methods and results: This study is a post-hoc analysis of TROFI II trial assessing neointimal quality 6-month after the implantation of BVS(N=82) and CoCr-EES(N=87) in STEMI patients. Neointimal light property analysis by OFDI full-automatically computed light attenuation, backscatter and light intensity for superficial and deep neointima. High light attenuation/backscatter and high light intensity are reportedly associated with lipidic change and tissue maturation, respectively. Superficial ...
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Coronary calcification as a mechanism of plaque/media shrinkage in vessels treated with bioresorbable vascular scaffold: A multimodality intracoronary imaging study
Read Full ArticleBackground and aims Whether coronary calcification is correlated with plaque/media shrinkage (PS) remains unclear. The aim of this study was to assess the relationship between the calcification process and PS, combining serial optical coherence tomography (OCT) and intravascular ultrasound (IVUS) in vessels treated with bioresorbable vascular scaffolds (BVS). Methods In 15 patients (16 vessels), OCT and IVUS images were matched using anatomic landmarks at post-procedure and five years. PS was defined as relative decrease in plaque/media area >5%. The association between the calcification process and PS was investigated. Mixed effects model was used to assess correlations and changes ...
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Serial Assessment of Tissue Precursors and Progression of Coronary Calcification Analyzed by Fusion of IVUS and OCT
Read Full ArticleObjectives The aim of this study was to assess calcium growth with fused grayscale intravascular ultrasound (IVUS), IVUS–virtual histology, and optical coherence tomography (OCT) from baseline to 5-year follow-up in patients treated with bioresorbable vascular scaffolds. Background IVUS and OCT have individual strengths in assessing plaque composition and volume. Fusion of images obtained using these methods could potentially aid in coronary plaque assessment. Methods Anatomic landmarks and endoluminal radiopaque markers were used to fuse OCT and IVUS images and match baseline and follow-up. Results Seventy-two IVUS–virtual histology and OCT paired matched cross-sectional in- and out-scaffold segments were fused ...
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Effect of Post-Dilatation Following Primary PCI With Everolimus-Eluting Bioresorbable Scaffold Versus Everolimus-Eluting Metallic Stent Implantation: An Angiographic and Optical Coherence Tomography TROFI II Substudy
Read Full ArticleObjectives This study sought to investigate the effect of post-dilatation on angiographic and intracoronary imaging parameters in the setting of primary percutaneous coronary intervention comparing the everolimus-eluting bioresorbable scaffold (BRS) with the everolimus-eluting metallic stent (EES). Background Routine post-dilatation of BRS has been suggested to improve post-procedural angiographic and subsequent device-related clinical outcomes. Methods In the ABSORB STEMI TROFI II trial, 191 patients with ST-segment elevation myocardial infarction were randomly assigned to treatment with BRS (n = 95) or EES (n = 96). Minimal lumen area and healing score as assessed by optical coherence tomography at 6 months were compared between BRS- ...
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Tissue characterization with depth-resolved attenuation coefficient and backscatter term in intravascular optical coherence tomography images
Read Full ArticleAn important application of intravascular optical coherence tomography (IVOCT) for atherosclerotic tissue analysis is using it to estimate attenuation and backscatter coefficients. This work aims at exploring the potential of the attenuation coefficient, a proposed backscatter term, and image intensities in distinguishing different atherosclerotic tissue types with a robust implementation of depth-resolved (DR) approach. Therefore, the DR model is introduced to estimate the attenuation coefficient and further extended to estimate the backscatter-related term in IVOCT images, such that values can be estimated per pixel without predefining any delineation for the estimation. In order to exclude noisy regions with a weak ...
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Serial 5-Year Evaluation of Side Branches Jailed by Bioresorbable Vascular Scaffolds Using 3-Dimensional Optical Coherence Tomography
Read Full ArticleBackground— The long-term fate of Absorb bioresorbable vascular scaffold (Abbott Vascular, Santa Clara, CA) struts jailing side branch ostia has not been clarified. We therefore evaluate serially (post-procedure and at 6 months, 1, 2, 3, and 5 years) the appearance and fate of jailed Absorb bioresorbable vascular scaffold struts. Methods and Results— We performed 3-dimensional optical coherence tomographic analysis of the ABSORB Cohort B trial (A Clinical Evaluation of the Bioabsorbable Everolimus Eluting Coronary Stent System in the Treatment of Patients With De Novo Native Coronary Artery Lesions) up to 5 years using a novel, validated cut-plane analysis method. We ...
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Report of an ESC-EAPCI Task Force on the evaluation and use of bioresorbable scaffolds for percutaneous coronary intervention: executive summary
Read Full ArticleBRS require careful lesion assessment, to determine the need and extent of lesion preparation, as well as to select the appropriate size and length of the device. The use of pre-and post-procedural intracoronary imaging (Intravascular ultrasound, optical coherence tomography), as well as online quantitative coronary angiography, is encouraged to optimize device implantation. The use of BRS in heavily calcified vessels is strongly discouraged. Bioresorbable scaffolds should be avoided in stenoses with reference diameter smaller than 2.5 mm and in ostial lesions.
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Hemodynamic analysis of a novel bioresorbable scaffold in porcine coronary artery model
Read Full ArticleBackground The shear stress distribution assessment can provide useful insights for the hemodynamic performance of the implanted stent/scaffold. Our aim was to investigate the effect of a novel bioresorbable scaffold, Mirage on local hemodynamics in animal models. Method The main epicardial coronary arteries of 7 healthy mini-pigs were implanted with 11 Mirage Microfiber sirolimus-eluting Bioresorbable Scaffolds (MMSES). Optical coherence tomography (OCT) was performed post scaffold implantation and the obtained images were fused with angiographic data to reconstruct the coronary artery anatomy. Blood flow simulation was performed and Endothelial Shear Stress(ESS) distribution was estimated for each of the 11 ...
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Imaging outcomes of bioresorbable scaffold overlap: an optical coherence tomography analysis from the ABSORB EXTEND trial
Read Full ArticleAims: The purpose of this study was to assess the vascular response and vessel healing of overlapped Absorb scaffolds (Abbott Vascular, Santa Clara, CA, USA) compared to non-overlapped devices in human coronary arteries as assessed by optical coherence tomography (OCT) in the same treated segment. Methods and results: The ABSORB EXTEND (NCT01023789) trial is a prospective, single-arm, openlabel clinical study which enrolled 800 patients. The planned overlap OCT subgroup in the ABSORB EXTEND trial was analysed and two-year OCT follow-up was performed in seven patients. In cross-section level analysis at baseline, lumen and abluminal scaffold areas were larger in overlap ...
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Is quantitative coronary angiography reliable in assessing the late lumen loss of the everolimus eluting bioresorbable polylactide scaffold in comparison with the cobalt chromium metallic stent?
Read Full ArticleAims: Immediately after stent/scaffold implantation, quantitative coronary angiography (QCA) with respect to optical coherence tomography (OCT) more severely underestimates the lumen diameter (LD) in Absorb than in XIENCE. This OCT-QCA discrepancy has not been evaluated at long-term follow-up. The present study aimed to assess the accuracy of QCA with reference to OCT in Absorb as compared to XIENCE.
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Fate of post-procedural malapposition of everolimus-eluting polymeric bioresorbable scaffold and everolimus-eluting cobalt chromium metallic stent in human coronary arteries: sequential assessment with optical coherence tomography in ABSORB Japan trial
Read Full ArticleAims The natural course of post-procedural incomplete strut apposition (ISA) after the implantation of bioresorbable scaffolds (BVS) remains unknown. The purpose of the present study was to evaluate the fate of post-procedural ISA after everolimus-eluting Absorb BVS in comparison with the second-generation everolimus-eluting cobalt chromium stent (CoCr-EES). Methods and results Fate of post-procedural ISA was evaluated by serial optical coherence tomography (OCT) in the ABSORB Japan randomized trial [OCT-1 subgroup: 110 paired lesions of post-procedure and 2-year follow-up (BVS 73 lesions vs. CoCr-EES 37 lesions)] with respect to ISA distance. Post-procedure ISA struts were categorized into either ‘resolved’ or ‘persistent ...
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Intracoronary optical coherence tomography: Clinical and research applications and intravascular imaging software overview
Read Full ArticleBy providing valuable information about the coronary artery wall and lumen, intravascular imaging may aid in optimizing interventional procedure results and thereby could improve clinical outcomes following percutaneous coronary intervention (PCI). Intravascular optical coherence tomography (OCT) is a light-based technology with a tissue penetration of approximately 1 to 3 mm and provides near histological resolution. It has emerged as a technological breakthrough in intravascular imaging with multiple clinical and research applications. OCT provides detailed visualization of the vessel following PCI and provides accurate assessment of post-procedural stent performance including detection of edge dissection, stent struts apposition, tissue prolapse, and healing ...
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Accuracy of coronary computed tomography angiography for bioresorbable scaffold luminal investigation: a comparison with optical coherence tomography
Read Full ArticleTo establish the accuracy of coronary computed tomography angiography (CTA) for in-scaffold quantitative evaluation with optical coherence tomography (OCT) as a reference. The translucent backbone of the bioresorbable scaffold allow us to evaluate non-invasively the coronary lumen with coronary CTA. In the ABSORB first-in-man studies, coronary CTA was shown to be feasible for quantitative luminal assessment. Nevertheless, a comparison with an intravascular modality with higher resolution has never been performed. In the ABSORB Cohort B trial, 101 patient with non-complex lesions were treated with the fully biodegradable vascular scaffold. For this analysis, all patients who underwent coronary CTA at 18 ...
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Two-year clinical, angiographic, and serial optical coherence tomographic follow-up after implantation of an everolimus-eluting bioresorbable scaffold and an everolimus-eluting metallic stent: insights from the randomised ABSORB Japan trial
Read Full ArticleAims: We sought to investigate two-year clinical and serial optical coherence tomography (OCT) outcomes after implantation of a fully bioresorbable vascular scaffold (BVS) or a cobalt-chromium everolimus-eluting stent (CoCr-EES). Methods and results: In the ABSORB Japan trial, 400 patients were randomised in a 2:1 ratio to BVS (N=266) or CoCr-EES (N=134). A pre-specified OCT subgroup (N=125, OCT-1 group) underwent angiography and OCT post procedure and at two years. Overall, the two-year TLF rates were 7.3% and 3.8% in the BVS and CoCr-EES arms (p=0.18), respectively. Very late scaffold thrombosis (VLST) beyond one ...
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Evaluation of vascular healing of polymer-free sirolimus-eluting stents in native coronary artery stenosis: a serial follow-up at three and six months with optical coherence tomography imaging
Read Full ArticleAims: Our aim was to assess vascular response after polymer-free sirolimus-eluting stent (SES) implantation by using an optical coherence tomography (OCT)-derived vascular healing score (HS), quantifying the deficiency of healing. Methods and results: In a prospective, multicentre, single-arm, open-label study, OCT examinations were performed at three months in 45 patients (47 lesions). Per protocol, 24 lesions which had not reached adequate vascular healing according to study criteria were scheduled for OCT examination at six months. The HS was calculated at two time points. Serial OCT imaging demonstrated that the proportion of covered stent struts increased from a median of ...
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Bioresorption and Vessel Wall Integration of a Fully Bioresorbable Polymeric Everolimus-Eluting Scaffold Optical Coherence Tomography, Intravascular Ultrasound, and Histological Study in a Porcine Model With 4-Year Follow-Up
Read Full ArticleObjectives The aim of the present study was to investigate the relationship between the integration process and luminal enlargement with the support of light intensity (LI) analysis on optical coherence tomography (OCT), echogenicity analysis on intravascular ultrasound, and histology up to 4 years in a porcine model. Background In pre-clinical and clinical studies, late luminal enlargement has been demonstrated at long-term follow-up after everolimus-eluting poly-l-lactic acid coronary scaffold implantation. However, the time relationship and the mechanistic association with the integration process are still unclear. Methods Seventy-three nonatherosclerotic swine that received 112 Absorb scaffolds were evaluated in vivo by OCT, intravascular ...
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Edge Vascular Response After Resorption of the Everolimus-Eluting Bioresorbable Vascular Scaffold – A 5-Year Serial Optical Coherence Tomography Study –
Read Full ArticleBackground: The edge vascular response (EVR) has been linked to important prognostic implications in patients treated with permanent metallic stents. We aimed to investigate the relationship of EVR with the geometric changes in the everolimus-eluting bioresorbable scaffold using serial optical coherence tomography (OCT) analysis. Methods and Results: In the first-in-man ABSORB trial, 28 patients (29 lesions) underwent serial OCT at 4 different time points (Cohort B1: post-procedure, 6, 24, and 60 months [n=13]; Cohort B2: post-procedure, 12, 36, and 60 months [n=15]) following implantation of the scaffold. In Cohort B1, there was no significant luminal change at the ...
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