1. Articles from hector m. garcia-garcia

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    1. 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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    2. Impact of optical coherence tomography findings on clinical outcomes in ST-segment elevation myocardial infarction patients: a MATRIX (Minimizing Adverse Hemorrhagic Events by Trans-radial Access Site and angioX) OCT sub-study

      Impact of optical coherence tomography findings on clinical outcomes in ST-segment elevation myocardial infarction patients: a MATRIX (Minimizing Adverse Hemorrhagic Events by Trans-radial Access Site and angioX) OCT sub-study

      Purpose: To investigate the association of the degree of stent expansion, as assessed by optical coherence tomography (OCT), following stent implantation, and clinical outcomes in ST-segment elevation myocardial infarction (STEMI) patients. Methods: STEMI patients from the MATRIX (Minimizing Adverse Haemorrhagic Events by TRansradial Access Site and angioX) OCT study were selected; Clinical outcomes were collected through 1 year. Stent expansion index is a minimum stent area (MSA) divided by average lumen area (average of proximal and distal reference lumen area). The following variables were measured: MSA (< 4.5mm 2 ), dissection (> 200 µm in width and < 5 mm from stent segment ...

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    3. Comparison of plaque distribution and wire-free functional assessment in patients with stable angina and non-ST elevation myocardial infarction: an optical coherence tomography and quantitative flow ratio study

      Comparison of plaque distribution and wire-free functional assessment in patients with stable angina and non-ST elevation myocardial infarction: an optical coherence tomography and quantitative flow ratio study

      Background Data comparing plaque characteristics and wire-free physiological assessment in the target vessel in patients with stable angina versus acute coronary syndrome are sparse. Therefore, we investigated the difference in plaque distribution between stable angina and non-ST-elevation myocardial infarction (NSTEMI) and explored the relationship between target vessel vulnerability by optical coherence tomography (OCT) and wire-free functional assessment with quantitative flow ratio (QFR). Methods Patients with stable angina ( n  = 25) and NSTEMI ( n  = 24) were in the final prospective study cohort from the DECODE study (ClinicalTrials.gov, NCT02335086). All 5480 OCT frames in the region of interest were analyzed to study ...

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    4. Supporting evidence from optical coherence tomography for shortening dual antiplatelet therapy after drug-eluting stents implantation

      Supporting evidence from optical coherence tomography for shortening dual antiplatelet therapy after drug-eluting stents implantation

      Introduction : Dual antiplatelet therapy (DAPT) is required for coronary artery disease treated with drug-eluting stents (DES) implantation. Shortening DAPT duration would be beneficial for patients with high bleeding risk. Areas covered : Early healing patterns, especially stent strut coverage, assessed by optical coherence tomography (OCT) as a surrogate of neointima have been investigated to make decisions on whether short DAPT would be a safe alternative. This review evaluates the OCT evidence (i.e., neointimal coverage of stent struts within 3 months) for shortening DAPT duration after DES implantation. Expert commentary : Shortening DAPT (i.e., within 3 months) duration after DES implantation ...

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    5. Utility of Multimodality Intravascular Imaging and the Local Hemodynamic Forces to Predict Atherosclerotic Disease Progression

      Utility of Multimodality Intravascular Imaging and the Local Hemodynamic Forces to Predict Atherosclerotic Disease Progression

      Objectives This study sought to examine the utility of multimodality intravascular imaging and of the endothelial shear stress (ESS) distribution to predict atherosclerotic evolution. Background There is robust evidence that intravascular ultrasound (IVUS)-derived plaque characteristics and ESS distribution can predict, with however limited accuracy, atherosclerotic evolution; nevertheless, it is yet unclear whether multimodality imaging and ESS mapping enable more accurate prediction of coronary plaque progression. Methods A total of 44 patients admitted with a myocardial infarction that had successful revascularization and 3-vessel IVUS and optical coherence tomography (OCT) imaging at baseline and 13-month follow-up were included in the study ...

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    6. Mechanism of Drug-Eluting Absorbable Metal Scaffold Restenosis: A Serial Optical Coherence Tomography Study

      Mechanism of Drug-Eluting Absorbable Metal Scaffold Restenosis: A Serial Optical Coherence Tomography Study

      Background: The pathomechanisms underlying restenosis of the bioabsorbable sirolimus-eluting metallic scaffold (Magmaris) remain unknown. Using serial optical coherence tomography, we investigated causes of restenosis, including the contribution of late scaffold recoil versus neointimal hyperplasia. Methods: Patients enrolled in BIOSOLVE-II undergoing serial angiography and optical coherence tomography (post-intervention and follow-up: 6 months and/or 1 year) were analyzed. Patients were divided into 2 groups according to angiographic in-scaffold late lumen loss (LLL) <0.5 or ≥0.5 mm. End points were late absolute scaffold recoil and neointimal hyperplasia area as assessed by optical coherence tomography. Results: Serial data were available for ...

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    7. Second-generation drug-eluting absorbable metal scaffold target-lesion revascularization: an optical coherence tomography case series study and literature review

      Second-generation drug-eluting absorbable metal scaffold target-lesion revascularization: an optical coherence tomography case series study and literature review

      Bioresorbable scaffolds (BRS) were introduced into clinical practice to overcome long-term limitations of drug-eluting stents (DES), but they were instead associated with a high rate of target lesion revascularization (TLR) and thrombosis. Whereas scaffold discontinuity was the most frequent mechanism for polymeric-BRS TLR1, there are no studies on the causes of second-generation drug-eluting absorbable metal scaffold (MgBRS) TLR (Magmaris, BIOTRONIK, Bulach, Switzerland). We sought to determine the optical coherence tomography (OCT) findings in patients who experienced a MgBRS TLR. Moreover, we performed a systematic review of the reported cases. 

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    8. Deoxyribonucleic Acid Repair Activity Is Associated with Healed Coronary Plaque Rupture by Optical Coherence Tomography

      Deoxyribonucleic Acid Repair Activity Is Associated with Healed Coronary Plaque Rupture by Optical Coherence Tomography

      Deoxyribonucleic acid (DNA) damage and repair signaling cascades are related to the development of atherosclerosis. Pathological studies have demonstrated that healed coronary plaque rupture (HCPR) contributes to plaque progression and predisposes to sudden ischemic cardiac death. The objective of this study is to investigate the relationship between HCPR detected by optical coherence tomography (OCT) and DNA ligase. Forty-two patients with both OCT and DNA ligase were prospectively enrolled. The population included patients with stable angina pectoris (SA) and non-ST-elevation myocardial infarction (NSTEMI). It was found that the prevalence of HCPR was greater in subjects with higher DNA ligase activity (correlation ...

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    9. The impact of blood pressure variability on coronary arterial lumen dimensions as assessed by optical coherence tomography in patients with ST-elevation myocardial infarction

      The impact of blood pressure variability on coronary arterial lumen dimensions as assessed by optical coherence tomography in patients with ST-elevation myocardial infarction

      Background Patients with ST-elevation Myocardial Infarction treated by primary percutaneous coronary intervention (PPCI) experience drastic hemodynamic systemic changes (i.e., blood pressure) during the different phases of the procedure. Optical coherence tomography is often used to unveil the underlying cause of STEMI (pre-PCI) and to optimize stent implantation (post-PCI). The impact of blood pressure variability on coronary lumen remains uncertain. This study aimed to investigate the relationship between blood pressure variability, before and after PCI, and coronary arterial lumen dimensions of the infarct-related artery. Methods We measured systolic, diastolic and mean arterial blood pressure (SBP, DBP, and MAP; respectively) at ...

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    10. DNA Damage and Repair in Patients with Coronary Artery Disease: Correlation with Plaque Morphology Using Optical Coherence Tomography (DECODE Study)

      DNA Damage and Repair in Patients with Coronary Artery Disease: Correlation with Plaque Morphology Using Optical Coherence Tomography (DECODE Study)

      Objective The aim of this study was to examine DNA ligase activity and expression of DNA damage response pathway (DDR) genes in patients with stable angina (SA) and non-ST elevation myocardial infarction (NSTEMI) and determine whether they correlate with plaque morphology. Background Patients with coronary artery disease (CAD) have evidence of deoxyribonucleic acid (DNA) damage in peripheral blood mononuclear cells (PBMCs). It is unclear whether this represents excess damage or defective DNA repair activity. Methods DNA ligase activity and the expression of 22 DDR genes were measured in PBMCs of patients (both SA ( n = 47) and NSTEMI ( n = 42)) and ...

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    11. First Report of Edge Vascular Response at 12 Months of Magmaris, A Second-Generation Drug-Eluting Resorbable Magnesium Scaffold, Assessed by Grayscale Intravascular Ultrasound, Virtual Histology, and Optical Coherence Tomography. A Biosolve-II Trial Sub-S

      First Report of Edge Vascular Response at 12 Months of Magmaris, A Second-Generation Drug-Eluting Resorbable Magnesium Scaffold, Assessed by Grayscale Intravascular Ultrasound, Virtual Histology, and Optical Coherence Tomography. A Biosolve-II Trial Sub-S

      Introduction and objective The edge vascular response (EVR) remains unknown in second generation drug-eluting Resorbable Magnesium Scaffold (RMS), such as Magmaris. The aim of the study was to evaluate tissue modifications in the RMS edges over time, assessed by different invasive imaging modalities. Methods The patients treated with the device were assessed by optical coherence tomography (OCT), grayscale intravascular ultrasound (IVUS), and virtual histology IVUS at baseline and 12 months. The EVR study performed a segment- and frame-level analysis of the 5 mm segments proximal and distal of the actual RMS. Results The segment-level grayscale IVUS (n = 10), virtual histology ...

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    12. 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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    13. 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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    14. Serial 3-Dimensional Optical Coherence Tomography Assessment of Jailed Side-Branch by Second-Generation Drug-Eluting Absorbable Metal Scaffold (From the BIOSOLVE-II Trial)

      Serial 3-Dimensional Optical Coherence Tomography Assessment of Jailed Side-Branch by Second-Generation Drug-Eluting Absorbable Metal Scaffold (From the BIOSOLVE-II Trial)

      Second-generation drug-eluting absorbable metal scaffold (DREAMS 2G) is used for treating coronary lesions. However, the natural history of the jailed side-branch (SB) after DREAMS 2G implantation remains to be elucidated. The aim of this study is to investigate the effect of scaffold struts on jailed SBs as assessed by 3-dimensional (3D) optical coherence tomography (OCT) after implantation of DREAMS 2G. We enrolled the patients who received a DREAMS 2G implantation and where OCT was performed at post-procedure and 12-month follow-up in the BIOSOLVE-II trial. The area of the ostium of jailed SBs and number of compartments divided by scaffold struts ...

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    15. Impact of procedural characteristics on coronary vessel wall healing following implantation of second-generation drug-eluting absorbable metal scaffold in patients with de novo coronary artery lesions: an optical coherence tomography analysis

      Impact of procedural characteristics on coronary vessel wall healing following implantation of second-generation drug-eluting absorbable metal scaffold in patients with de novo coronary artery lesions: an optical coherence tomography analysis

      Aims Second-generation drug-eluting absorbable metal scaffold (DREAMS 2G) is an alternative novel device for treating coronary lesions. However, the relationship between in-scaffold dimensions after implantation of DREAMS 2G and vessel healing and luminal results at follow-up is unknown. The aim of this study is, therefore, to investigate whether the expansion index after implantation of DREAMS 2G as assessed by optical coherence tomography (OCT) impacts late luminal status and healing of the vessel wall. Methods and results This study comprises of a total 65 out of 123 patients who were enrolled in the BIOSOLVE-II trial. We assessed both qualitative and quantitative ...

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    16. Changes in Coronary Plaque Composition in Patients With Acute Myocardial Infarction Treated With High-Intensity Statin Therapy (IBIS-4): A Serial Optical Coherence Tomography Study

      Changes in Coronary Plaque Composition in Patients With Acute Myocardial Infarction Treated With High-Intensity Statin Therapy (IBIS-4): A Serial Optical Coherence Tomography Study

      Objectives This study assessed changes in optical coherence tomography (OCT)-defined plaque composition in patients with ST-elevation myocardial infarction (STEMI) receiving high-intensity statin treatment. Background OCT is a high-resolution modality capable of measuring plaque characteristics including fibrous cap thickness (FCT) and macrophage infiltration. There is limited in vivo evidence regarding the effects of statins on OCT-defined coronary atheroma composition and no evidence in the context of STEMI. Methods In the IBIS-4 (Integrated Biomarker Imaging Study-4), 103 patients underwent intravascular ultrasonography and OCT of 2 noninfarct-related coronary arteries in the acute phase of STEMI. Patients were treated with high-dose rosuvastatin for ...

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    17. Scaffold thrombosis following implantation of the Absorb Bvs in routine clinical practice: Insight into possible mechanisms from optical coherence tomography

      Scaffold thrombosis following implantation of the Absorb Bvs in routine clinical practice: Insight into possible mechanisms from optical coherence tomography

      Objectives To identify potential underlying mechanisms of early and (very) late scaffold thrombosis (ScT) by optical coherence tomography (OCT), in a frame-by-frame analysis. Background The absorb scaffold is associated with an increased risk of ScT compared with metallic stents. Several potential causes of bioresorbable ScT have been identified, however the precise etiology still remains unclear. Methods Between February 2013 and February 2016, 13 patients presenting with definite ScT underwent OCT imaging. After guidewire passage or balloon inflations, OCT images were acquired. Pullbacks were assessed offline at each 1 mm longitudinal interval within the treated segment and the 5 mm segments ...

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    18. The influence of coronary plaque morphology assessed by optical coherence tomography on final microvascular function after stenting in patients with ST-elevation myocardial infarction

      The influence of coronary plaque morphology assessed by optical coherence tomography on final microvascular function after stenting in patients with ST-elevation myocardial infarction

      Objectives: The index of microcirculatory resistance (IMR) provides a reproducible assessment of the status of coronary microvasculature in patients with ST-elevation myocardial infarction (STEMI). Frequency-domain optical coherence tomography (FD-OCT) enables detailed assessment of the morphology of coronary plaque. We sought to determine the influence of the initial culprit coronary plaque anatomy within the infarct-related artery on IMR after stenting in STEMI. Patients and methods: In 25 STEMI patients IMR was measured immediately before and after stent implantation. FD-OCT imaging was performed at the same time points and atherothrombotic volume (ATV) before stenting, prolapsed+floating ATV after stenting and [DELTA]ATV ...

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    19. Variability in the measurement of minimum fibrous cap thickness and reproducibility of fibroatheroma classification by optical coherence tomography using manual versus semi-automatic assessment

      Variability in the measurement of minimum fibrous cap thickness and reproducibility of fibroatheroma classification by optical coherence tomography using manual versus semi-automatic assessment

      Aims: The minimum fibrous cap thickness (FCT) is considered a major criterion of coronary plaque vulnerability according to autopsy studies. We aimed to assess the reproducibility in the measurement of the optical coherence tomography (OCT)-detected minimum FCT and the agreement in the classification of thin-cap fibroatheroma (TCFA), by a software-based semi-automatic method compared with the manual method. Methods and results: A total of 50 frames with fibroatheromas (FA) were randomly selected from the Integrated Biomarker Imaging Study-4 (IBIS-4). Two experienced OCT analysts independently measured the minimum FCT at two different time points, manually and by three different semi-automatic software-based ...

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    20. Letter by Garcia-Garcia and Brugaletta Regarding Article, “Optical Coherence Tomography–Guided Percutaneous Coronary Intervention in ST-Segment–Elevation Myocardial Infarction: A Prospective Propensity-Matched Cohort of the Thrombectomy Versus Percutaneou

      Letter by Garcia-Garcia and Brugaletta Regarding Article, “Optical Coherence Tomography–Guided Percutaneous Coronary Intervention in ST-Segment–Elevation Myocardial Infarction: A Prospective Propensity-Matched Cohort of the Thrombectomy Versus Percutaneou

      Sheth et al 1 compared optical coherence tomography (OCT)–guided versus angiography-guided primary percutaneous coronary intervention for ST-segment–elevation myocardial infarction among patients in the TOTAL trial (Thrombectomy Versus Percutaneous Coronary Intervention Alone). Patients (n=214) were imaged with OCT and were propensity-matched with 428 patients who had angio-guided percutaneous coronary intervention. There were clear OCT guidelines for stent optimization; however, operator compliance to follow those guidelines and whether optimal results were achieved are not reported. This makes us wonder whether the investigator’s good intentions were actually executed and were effective. Hence, it is uncertain whether the OCT group ...

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    21. Letter by Garcia-Garcia and Brugaletta Regarding Article, "Optical Coherence Tomography-Guided Percutaneous Coronary Intervention in ST-Segment-Elevation Myocardial Infarction: A Prospective Propensity-Matched Cohort of the Thrombectomy Versus Percutaneou

      Letter by Garcia-Garcia and Brugaletta Regarding Article, "Optical Coherence Tomography-Guided Percutaneous Coronary Intervention in ST-Segment-Elevation Myocardial Infarction: A Prospective Propensity-Matched Cohort of the Thrombectomy Versus Percutaneou

      Sheth et al 1 compared optical coherence tomography (OCT)–guided versus angiography-guided primary percutaneous coronary intervention for ST-segment–elevation myocardial infarction among patients in the TOTAL trial (Thrombectomy Versus Percutaneous Coronary Intervention Alone). Patients (n=214) were imaged with OCT and were propensity-matched with 428 patients who had angio-guided percutaneous coronary intervention. There were clear OCT guidelines for stent optimization; however, operator compliance to follow those guidelines and whether optimal results were achieved are not reported. This makes us wonder whether the investigator’s good intentions were actually executed and were effective. Hence, it is uncertain whether the OCT group ...

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    22. 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

      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

      Aims: 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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    1. (98 articles) Hector M. Garcia-Garcia
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