1. Articles from Evan Shlofmitz

    1-19 of 19
    1. 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 ...

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    2. 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.

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    3. Comparison of quantitative calcium parameters between optical coherence tomography and invasive coronary angiography

      Comparison of quantitative calcium parameters between optical coherence tomography and invasive coronary angiography

      Introduction and objectives: Former studies have associated the severity of calcified plaques (CP) on the invasive coronary angiography (ICA) with a limited number of optical coherence tomography (OCT) measurements. The objective of this study was to describe the correlation between an extended and comprehensive set of OCT measurements and the severity of calcifications as seen on the ICA. Methods: We retrospectively studied 75 patients (75 lesions) who underwent ICA and, concurrently, OCT imaging at a single institution. The OCT was performed before the percutaneous coronary intervention and after the administration of intracoronary nitroglycerine. The coronary artery calcium was scored using ...

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    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

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    5. Optical Coherence Tomography in Acute Coronary Syndromes

      Optical Coherence Tomography in Acute Coronary Syndromes

      Advances in intravascular imaging have enabled assessment of the underlying plaque morphology in acute coronary syndromes, which allows for the initiation of individualized therapy. The atherothrombotic substrates for acute coronary syndromes consist of plaque rupture, erosion, and calcified nodule, whereas spontaneous coronary artery dissection, coronary artery spasm, and coronary embolism constitute rarer nonatherothrombotic etiologies. This review provides a brief overview of the data from clinical studies that have used intravascular optical coherence tomography to assess the culprit plaque morphology. We discuss the usefulness of intravascular imaging for effective treatment of patients presenting with acute coronary syndromes by percutaneous coronary intervention.

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    6. Optical Coherence Tomography based treatment approach for patients with Acute Coronary Syndrome

      Optical Coherence Tomography based treatment approach for patients with Acute Coronary Syndrome

      Areas covered: In this review, we outline the underlying causes of acute coronary syndrome (ACS) as evaluated by optical coherence tomography (OCT). We report both the definitions of each mechanism and its frequency as reported in the literature to date. Finally, we present an algorithm based on the findings in the review that gives an outlined approach to perform intervention on ACS patients. Expert opinion: Although the most common and most accepted intervention in ACS cases is stent implantation, data suggest a stentless approach in cases of plaque erosion, which generally occurs in younger patients presenting with an acute coronary ...

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    7. Intravascular Imaging-Guided Percutaneous Coronary Intervention: A Universal Approach for Optimization of Stent Implantation

      Intravascular Imaging-Guided Percutaneous Coronary Intervention: A Universal Approach for Optimization of Stent Implantation

      Despite consistent clinical data supporting the use of intravascular imaging with percutaneous coronary intervention, utilization remains low. A practical and standardized approach to incorporating intravascular imaging with percutaneous coronary intervention may overcome the barriers to utilization. This review focuses on basic image interpretation with intravascular ultrasound and optical coherence tomography and proposes an algorithmic approach to stent sizing and optimization. Incorporation of this strategic method for percutaneous coronary intervention may aid in the greater adoption of intravascular imaging for percutaneous coronary intervention.

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    8. 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 ...

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    9. 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 ...

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    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.

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    11. Techniques to Optimize the Use of Optical Coherence Tomography: Insights From the Manufacturer and User Facility Device Experience (MAUDE) Database

      Techniques to Optimize the Use of Optical Coherence Tomography: Insights From the Manufacturer and User Facility Device Experience (MAUDE) Database

      Background/Purpose Optical coherence tomography (OCT) is a high-resolution intravascular imaging modality used to assess coronary arteries and as an adjunctive tool for optimization of percutaneous coronary interventions. Overall, the rate of complications and adverse events related to intravascular imaging is low. Limited data exist on the most commonly reported complications and modes of failure related to the use of OCT. Therefore, we analyzed the post-marketing surveillance data from the Food and Drug Administration Manufacturer and User Facility Device Experience (MAUDE) database to assess the reported complications and failure modes for OCT and reviewed techniques to optimize device use. Methods ...

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    12. Feasibility of a porcine arteriovenous shunt model for assessment of acute thrombogenicity in bifurcation stenting technique by optical coherence tomography

      Feasibility of a porcine arteriovenous shunt model for assessment of acute thrombogenicity in bifurcation stenting technique by optical coherence tomography

      Background Double kissing (DK) crush stenting has been reported as a superior bifurcation stenting strategy compared to culotte stenting. However, the mechanism associated with the reduction of clinical events by DK crush stenting remains unclear. We therefore investigated the thrombogenicity of DK crush stenting and culotte stenting with both bare-metal stents (BMS) and drug-eluting stents (DES) and the feasibility of a novel porcine arteriovenous shunt model. Methods High-resolution intracoronary imaging with optical coherence tomography (OCT) evaluated the bifurcation stenting models for thrombogenicity. Results All porcine models retained continuous circulation without blood leakage. Thrombus was macroscopically demonstrated around the bifurcation in ...

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    13. Precision percutaneous coronary intervention: Is optical coherence tomography co‐registration the future?

      Precision percutaneous coronary intervention: Is optical coherence tomography co‐registration the future?

      Integration of angiographic co‐registration (ACR) with optical coherence tomography (OCT) leads to significant changes in PCI strategy. ACR with OCT allows complete integration of all available data‐points to aid decision making. Randomized clinical trials comprehensively evaluating the impact of OCT with ACR to improve clinical outcomes are ongoing.

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

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

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

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

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

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

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

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

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

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    1-19 of 19
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    Utility of intracoronary imaging in the cardiac catheterization laboratory: comprehensive evaluation with intravascular ultrasound and optical coherence tomography 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 Precision percutaneous coronary intervention: Is optical coherence tomography co‐registration the future? Feasibility of a porcine arteriovenous shunt model for assessment of acute thrombogenicity in bifurcation stenting technique by optical coherence tomography Avoiding Patient-Stent Mismatch: Incorporating Optical Coherence Tomography Into Routine Practice Competency-Based Assessment of Interventional Cardiology Fellows’ Abilities in Intracoronary Physiology and Imaging Prospective Comparison Between Saline and Radiocontrast for Intracoronary Imaging With Optical Coherence Tomography Left coronary artery calcification patterns after coronary bypass graft surgery: An in‐vivo optical coherence tomography study Optical Coherence Tomography in Acute Coronary Syndromes Editorial – Optical Coherence Tomography Angiography: Considerations Regarding Diagnostic Parameters Imaging of the optic nerve: technological advances and future prospects