1. Articles from francesco prati

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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. Relationship between coronary plaque morphology of the left anterior descending artery and 12 months clinical outcome: the CLIMA study

      Relationship between coronary plaque morphology of the left anterior descending artery and 12 months clinical outcome: the CLIMA study

      Aims The CLIMA study, on the relationship between c oronary p l aque morphology of the left anter i or descending artery and twelve m onths clinic a l outcome, was designed to explore the predictive value of multiple high-risk plaque features in the same coronary lesion [minimum lumen area (MLA), fibrous cap thickness (FCT), lipid arc circumferential extension, and presence of optical coherence tomography (OCT)-defined macrophages] as detected by OCT. Composite of cardiac death and target segment myocardial infarction was the primary clinical endpoint. Methods and results From January 2013 to December 2016, 1003 patients undergoing OCT evaluation ...

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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. Coronary Atherosclerotic Phenotype and Plaque Healing in Patients With Recurrent Acute Coronary Syndromes Compared With Patients With Long-term Clinical Stability An In Vivo Optical Coherence Tomography Study

      Coronary Atherosclerotic Phenotype and Plaque Healing in Patients With Recurrent Acute Coronary Syndromes Compared With Patients With Long-term Clinical Stability An In Vivo Optical Coherence Tomography Study

      Importance At one end of the coronary artery disease (CAD) spectrum, there are patients with multiple recurrent acute coronary syndromes (rACS), and at the other end there are those with long-standing clinical stability. Predicting the natural history of these patients is challenging because unstable plaques often heal without resulting in ACS. Objective To assess in vivo the coronary atherosclerotic phenotype as well as the prevalence and characteristics of healed coronary plaques by optical coherence tomography (OCT) imaging in patients at the extremes of the CAD spectrum. Design, Setting, and Participants This is an observational, single-center cohort study with prospective clinical ...

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    5. Flying through the coronary easily

      Flying through the coronary easily

      Optical coherence tomography (OCT) has been waived as a breakthrough in coronary imaging. With its superb resolution in the range of 10–20 µm, OCT has proven to be a valuable technique in guiding coronary interventions [1–3]. Apart from this, among other intracoronary technical solutions, OCT certainly has the greatest potential in studying atherosclerosis in vivo, and identifying subjects with vulnerable lesions which leave patients prone to developing hard coronary events. Among the steps that enabled OCT to gain such credibility, the adoption of the non-occlusive techniques to acquire images has certainly played an instrumental role [4, 5]. Subsequently ...

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      Mentions: Francesco Prati
    6. 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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    7. Innovative invasive management without stent implantation guided by optical coherence tomography in acute coronary syndrome

      Innovative invasive management without stent implantation guided by optical coherence tomography in acute coronary syndrome

      Background A two-step strategy of invasive management without stenting, guided by optical coherence tomography (OCT), in selected patients with acute coronary syndrome (ACS), might avoid systematic stent implantation and allow medical therapy alone. Aims To assess the feasibility and safety of such a procedure, and to define coronary imaging characteristics in a specific population. Methods This single-centre proof-of-concept study included all patients with ACS who benefited from a two-step revascularization procedure with optimal reperfusion during primary percutaneous coronary intervention followed by delayed angiography and OCT. OCT imaging determined medical therapy treatment alone without stenting in case of absence of vulnerable ...

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      Mentions: Francesco Prati
    8. Role of optical coherence tomography in identifying sub-optimal stent positioning and predicting major adverse cardiac events in a comparative study with angiography: a CLIO-OPCI II sub-study

      Role of optical coherence tomography in identifying sub-optimal stent positioning and predicting major adverse cardiac events in a comparative study with angiography: a CLIO-OPCI II sub-study

      Background Quantitative coronary angiography (QCA) is the gold standard for evaluating correct stenting, despite its limitation in recognizing features indicative of suboptimal deployment. This subanalysis of the CLI-OPCI II registry addressed the role of optical coherence tomography (OCT) to verify whether suboptimal OCT deployment occurs in the presence of an optimal angiographic result. Patients and methods We retrospectively analyzed 125 lesions in the 105 patients with major adverse cardiac events of the CLI-OPCI II . Every lesion was evaluated with OCT and angiography , including visual and QCA assessment. Optimal angiographic result was defined as residual stenosis of less than 30% at ...

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    9. Long-term consequences of optical coherence tomography findings during percutaneous coronary intervention: the centro per la lotta contro l\'infarto - optimization of percutaneous coronary intervention (cli-opci) late study

      Long-term consequences of optical coherence tomography findings during percutaneous coronary intervention: the centro per la lotta contro l\'infarto - optimization of percutaneous coronary intervention (cli-opci) late study

      Aims: The role of intra-procedural Optical Coherence Tomography (OCT) on long-term clinical outcome of percutaneous coronary interventions (PCI) remains undefined. Methods and results: In the context of the multicenter Centro per la Lotta contro l’Infarto-Optimisation of Percutaneous Coronary Intervention (CLI-OPCI) registry, we compared long-term PCI outcome of 1211 patients from 13 independent OCT-experienced centers according to end-procedural OCT findings. OCT assessment revealed suboptimal stent implantation in 30.9% of lesions, with increased prevalence in patients experiencing device-oriented cardiovascular events (DoCE) (52.8% vs. 28.0%, p<0.001). At median follow-up of 833 (quartiles 415-1447) days, in-stent minimum lumen ...

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    10. Long-tem consequences of optical coherence tomography findings during percutaneous coronary intervention: the centro per la lotta contro l\'infarto - optimization of percutaneous coronary intervention (cli-opci) late study

      Long-tem consequences of optical coherence tomography findings during percutaneous coronary intervention: the centro per la lotta contro l\'infarto - optimization of percutaneous coronary intervention (cli-opci) late study

      Aims: The role of intra-procedural Optical Coherence Tomography (OCT) on long-term clinical outcome of percutaneous coronary interventions (PCI) remains undefined. Methods and results: In the context of the multicenter Centro per la Lotta contro l’Infarto-Optimisation of Percutaneous Coronary Intervention (CLI-OPCI) registry, we compared long-term PCI outcome of 1211 patients from 13 independent OCT-experienced centers according to end-procedural OCT findings. OCT assessment revealed suboptimal stent implantation in 30.9% of lesions, with increased prevalence in patients experiencing device-oriented cardiovascular events (DoCE) (52.8% vs. 28.0%, p<0.001). At median follow-up of 833 (quartiles 415-1447) days, in-stent minimum lumen ...

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    11. A comparison of intracoronary treatment strategies for thrombus burden removal during primary percutaneous coronary intervention: a COCTAIL II substudy

      A comparison of intracoronary treatment strategies for thrombus burden removal during primary percutaneous coronary intervention: a COCTAIL II substudy

      Background: Manual thrombus aspiration and local drug delivery of abciximab have been proposed as a strategy to reduce thrombus burden during percutaneous coronary intervention in patients with ST elevation myocardial infarction; however, the effectiveness of these approaches, is uncertain. In this COCTAIL II substudy, we compared the effect of these strategies on prestenting and poststenting thrombus burden assessed by optical coherence tomography. Patients and methods: COCTAIL II trial enrolled patients with ST elevation myocardial infarction randomized to intralesion (IL, by the ClearWay catheter) versus intracoronary (IC, by the guide catheter) abciximab bolus with or without aspiration thrombectomy (AT). The following ...

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      Mentions: Francesco Prati
    12. Optical coherence tomography or intravascular ultrasound to optimize coronary stent implantation

      Optical coherence tomography or intravascular ultrasound to optimize coronary stent implantation

      Optical coherence tomography (OCT) provides high-resolution tomographic images of the coronary arteries. 1 , 2 Spatial resolution of OCT (∼15 μm) is 10 times better than that of intravascular ultrasound (IVUS) (∼150 μm). 1 , 2 However, OCT needs complete blood clearance from the coronary lumen and, therefore, requires the use of contrast media. 1 , 2 OCT is unable to penetrate and see throughout red thrombus (that casts major dorsal shadowing) whereas IVUS is unable to see through heavily calcified plaques. IVUS has a deeper penetration on the vessel wall and, therefore, is better suited to detect...

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    13. The role of residual intrastent thrombus during primary angioplasty: insights from the COCTAIL II study

      The role of residual intrastent thrombus during primary angioplasty: insights from the COCTAIL II study

      Aims: Recent frequency-domain optical coherence tomography studies showed that a complete removal of thrombotic materials is rarely achieved after percutaneous coronary interventions for ST segment elevation myocardial infarction. Residual intrastent thrombus can embolize distally leading to microcirculatory injury. The aim was to find a possible correlation between residual intrastent thrombus and angiographic indexes of myocardial reperfusion. Methods: The population consisted of 128 ST segment elevation myocardial infarction patients enrolled in the COCTAIL II trial. Intrastent thrombus at optical coherence tomography was defined as the maximum percentage value of thrombus area (thrombus area/stent area × 100 in the cross-section with largest ...

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      Mentions: Francesco Prati
    14. Reproducibility of serial optical coherence tomography measurements for lumen area and plaque components in humans (The CLI-VAR [Centro per la Lotta Contro l’Infarto-variability] II study)

      Reproducibility of serial optical coherence tomography measurements for lumen area and plaque components in humans (The CLI-VAR [Centro per la Lotta Contro l’Infarto-variability] II study)

      Frequency-domain optical coherence tomography (FD-OCT) is a promising intracoronary imaging technique to study atherosclerosis. Indeed, its unprecedented spatial resolution allows the assessment of fibrous cap thickness, lipid pool and features of plaque vulnerability. Aim of this study was to determine the reproducibility of the in vivo FD-OCT measurements of lumen area and plaque components in serial studies. Twenty-six patients undergoing FD-OCT assessment of intermediate lesion during coronary angiography were included in this study. FD-OCT pullbacks were acquired twice from the same coronary segment at interval of 5 min without additional intervention and analyzed off-line at an independent imaging core laboratory ...

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      Mentions: Francesco Prati
    15. Clinical Impact of OCT Findings During PCI: The CLI-OPCI II Study

      Clinical Impact of OCT Findings During PCI: The CLI-OPCI II Study

      Objectives The goal of this study was to assess the clinical impact of optical coherence tomography (OCT) findings during percutaneous coronary intervention (PCI). Background OCT provides unprecedented high-definition visualization of plaque/stent structures during PCI; however, the impact of OCT findings on outcome remains undefined. Methods In the context of the multicenter CLI-OPCI (Centro per la Lotta contro l’Infarto–Optimisation of Percutaneous Coronary Intervention) registry, we retrospectively analyzed patients undergoing end-procedural OCT assessment and compared the findings with clinical outcomes. Results A total of 1,002 lesions (832 patients) were assessed. Appropriate OCT assessment was obtained in 98.2 ...

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    16. 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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    17. Optical Coherence Tomography for Characterization of Cardiac Allograft Vasculopathy in Late Survivors of Pediatric Heart Transplantation

      Optical Coherence Tomography for Characterization of Cardiac Allograft Vasculopathy in Late Survivors of Pediatric Heart Transplantation

      Background Optical coherence tomography (OCT) has been shown to reliably detect cardiac allograft vasculopathy (CAV). In recent studies performed in adult heart transplant (HTx) recipients, OCT revealed the presence of vulnerable plaques and complicated coronary artery lesions, thus challenging the current concept that CAV disease is a diffuse concentric and fibrosing vasculopathy. The aim of our study was to characterize CAV by OCT in a young population of HTx recipients. Methods We prospectively enrolled 21 young HTx recipients (mean age 27; range 22–38 years) to undergo OCT of the left anterior descending coronary artery (LAD) in addition to annual ...

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      Mentions: Francesco Prati
    18. Comparison between intermediate and severe coronary stenoses and clinical outcomes of an OCT-guided PCI strategy

      Comparison between intermediate and severe coronary stenoses and clinical outcomes of an OCT-guided PCI strategy

      Aims: We compared optical coherence tomography (OCT) features of intermediate and severe coronary stenoses in patients with stable angina and acute coronary syndrome (ACS), and tested the clinical impact of an OCT-based strategy for treating intermediate stenoses. Methods: The study enrolled 135 consecutive patients with either ACS or stable angina and a single de-novo coronary stenosis. Patients were divided into two groups: intermediate stenosis defined as quantitative coronary angiography percentage narrowing less than 70%, or presence of angiographic vessel haziness and severe stenosis with percentage narrowing more than 70%. OCT was performed to assess features of plaque vulnerability and to ...

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      Mentions: Francesco Prati
    19. 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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    20. Error propagation in the characterization of atheromatic plaque types based on imaging

      Error propagation in the characterization of atheromatic plaque types based on imaging

      Imaging systems transmit and acquire signals and are subject to errors including: error sources, signal variations or possible calibration errors. These errors are included in all imaging systems for atherosclerosis and are propagated to methodologies implemented for the segmentation and characterization of atherosclerotic plaque. In this paper, we present a study for the propagation of imaging errors and image segmentation errors in plaque characterization methods applied to 2D vascular images. More specifically, the maximum error that can be propagated to the plaque characterization results is estimated, assuming worst-case scenarios. The proposed error propagation methodology is validated using methods applied to ...

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    21. Optical Coherence Tomography for the Assessment of Coronary Artery Disease

      Optical Coherence Tomography for the Assessment of Coronary Artery Disease

      Angiography remains the gold standard for assessment of atherosclerotic impairment of coronary arteries and for guidance of coronary intervention. Angiography, as a main limitation, only depicts the luminal narrowings caused by coronary plaques, without showing the structures located beneath, such as the atherosclerotic lesions or the vessel wall. Intravascular imaging modalities are currently adopted to circumvent angiographic limitations. Optical coherence tomography (OCT)) is a novel imaging technique that uses infrared lights and can study atherosclerotic plaques and stented segments with extreme accuracy. Compared to intravascular ultrasound (IVUS) , OCT has a much higher resolution; this is at the expense of the ...

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      Mentions: Francesco Prati
    22. Impact of drug-eluting balloon (pre- or post-) dilation on neointima formation in de novo lesions treated by bare-metal stent: the IN-PACT CORO trial

      Impact of drug-eluting balloon (pre- or post-) dilation on neointima formation in de novo lesions treated by bare-metal stent: the IN-PACT CORO trial

      The efficacy of DEB in modifying the high restenosis risk associated with BMS implantation is doubtful. Optical coherence tomography (OCT) may allow precise assessment of neointimal formation after stent implantation. We performed a single-center, prospective, 1:2 randomized trial comparing BMS implantation alone (BMS group) vs. additional DEB (DEB group). DEB patients were further randomized 1:1 to DEB before stenting (pre-DEB group), or after stenting (post-DEB group). Primary endpoint was OCT-assessed neointimal hyperplasia (expressed both as mean in-stent neointimal area and as percentage obstruction of the mean stent area) at 6 months. Secondary endpoints were the percentage of uncovered ...

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      Mentions: Francesco Prati
    23. New techniques of intravessel imaging in coronary atherosclerosis

      New techniques of intravessel imaging in coronary atherosclerosis

      Intravascular imaging modalities are currently adopted to circumvent angiographic limitations. The present overview is aimed at describing the principal techniques used by an interventional cardiologist to assess both coronary atherosclerotic plaques and stent deployment results. Optical coherence tomography (OCT), intravascular ultrasound (IVUS), and near-infrared spectroscopy are currently available to address these issues. These techniques are characterized by specific advantages and limitations, making each of those applicable for specific purposes. Offline software programmes have been developed to further characterize plaque tissue, highlighting the macrophage presence or unfold coronary stent in a three-dimensional view by a carpet view. Although IVUS and OCT ...

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      Mentions: Francesco Prati
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