1. Articles from Pascal Motreff

    1-26 of 26
    1. 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
    2. Coronary Stent Thrombosis (Book Chapter)

      Coronary Stent Thrombosis (Book Chapter)

      Stent thrombosis is a rare complication of percutaneous coronary intervention and carries a poor prognosis. Recent improvements in stent technology and new antiplatelet therapies have reduced the incidence of stent thrombosis. Coronary stent thrombosis has been defined by the Academic Research Consortium criteria. Four types of thrombosis are defined according to the time of occurrence from stent implantation: acute (<24 h), subacute (<30 days), late (between 1 month and 1 year), and very late (>1 year). Management consists primarily of urgent restoration of antegrade coronary flow. The concurrent management of platelet aggregation is of paramount importance; compliance with the regimen ...

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    3. Optical Coherence Tomography to Optimize Results of Percutaneous Coronary Intervention in Patients with Non–ST-Elevation Acute Coronary Syndrome

      Optical Coherence Tomography to Optimize Results of Percutaneous Coronary Intervention in Patients with Non–ST-Elevation Acute Coronary Syndrome

      Background: No randomized study has investigated the value of optical coherence tomography (OCT) in optimizing the results of percutaneous coronary intervention (PCI) for non–ST-segment elevation acute coronary syndromes. Methods: We conducted a multicenter, randomized study involving 240 patients with non–ST-segment elevation acute coronary syndromes to compare OCT-guided PCI (use of OCT pre- and post-PCI; OCT-guided group) to fluoroscopy-guided PCI (angiography-guided group). The primary end point was the functional result of PCI assessed by the measure of post PCI fractional flow reserve. Secondary end points included procedural complications and type 4a periprocedural myocardial infarction. Safety was assessed by the ...

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    4. Characteristics of stent thrombosis in bifurcation lesions analyzed by optical coherence tomography

      Characteristics of stent thrombosis in bifurcation lesions analyzed by optical coherence tomography

      Aims: This work aimed to investigate a cohort of patients presenting with stent thrombosis (ST) explored by optical coherence tomography (OCT) to identify the underlying mechanical abnormalities in case of bifurcation lesions. Methods and results: The PESTO study was a prospective national registry involving 29 French catheterization facilities. Patients with acute coronary syndromes were prospectively screened for presence of definite ST and analyzed by OCT after culprit lesion reopening.The cohort involved n=120 subjects, including n=21 patients (17.5% of the global PESTO group; median age: 62.6 y; 76% male) with bifurcation lesions. The clinical presentation was ...

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    5. Culprit plaque characteristics in younger versus older patients with acute coronary syndromes: An optical coherence tomography study from the FORMIDABLE registry

      Culprit plaque characteristics in younger versus older patients with acute coronary syndromes: An optical coherence tomography study from the FORMIDABLE registry

      Objectives Culprit plaque characteristics in young patients who experience an Acute Coronary Syndrome (ACS) evaluated by OCT (Optical Coherence Tomography) have to be defined. The OCT-FORMIDABLE is a multicentre retrospective registry enrolling consecutive patients with ACS who performed OCT in 9 European centres. Methods Patients were divided in two groups according to age at presentation: juvenile-ACS (age ≤ 50 years) and not juvenile-ACS (age > 50 years). Primary end-point was the prevalence of plaque rupture (PR). Secondary end point was the prevalence of thin cap fibro atheroma (TCFA), fibrocalcific and fibrotic plaque. Results 285 patients were included, 71 (24.9%) in juvenile-ACS ...

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    6. Effects of statins on plaque rupture assessed by optical coherence tomography in patients presenting with acute coronary syndromes: insights from the optical coherence tomography (OCT)-FORMIDABLE registry

      Effects of statins on plaque rupture assessed by optical coherence tomography in patients presenting with acute coronary syndromes: insights from the optical coherence tomography (OCT)-FORMIDABLE registry

      Aims Chronic pre-treatment with statins may reduce mortality and morbidity in patients experiencing acute coronary syndromes (ACS), but mechanisms accounting for these findings are not completely understood. Methods and results The optical coherence tomography (OCT)-Formidable registry retrospectively enrolled 285 consecutive patients with ACS undergoing OCT in 9 European centres. Mean age was 60.4 ± 12.8 years, 148 (51.9%) patients had hyperlipemia, 45 (15.8%) diabetes mellitus and 142 (49.8%) presented with ST Segment Elevation Myocardial Infarction (STEMI). Patients were stratified according to statin prescription: 150 (52.6%) were on chronic pre-treatment with statins before ACS and ...

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    7. Optical coherence tomography compared with fractional flow reserve guided approach in acute coronary syndromes: A propensity matched analysis

      Optical coherence tomography compared with fractional flow reserve guided approach in acute coronary syndromes: A propensity matched analysis

      Aim To compare in patients with ACS (Acute Coronary Syndromes) a PCI (Percutaneous Coronary Intervention) approach based on FFR (Fractional Flow Reserve) vs. one based on OCT (Optical Coherence Tomography). Methods and Results Consecutive patients admitted for ACS and treated with a PCI approach based on OCT or on FFR (recruited in two different studies) were compared and matched with propensity score analysis. Target Lesion revascularization (TLR) was the primary end point, while major adverse cardiovascular events [MACEs defined as the composite of death from cardiac causes, non- fatal MI, clinically driven target vessel revascularization (TVR), or re-hospitalization due to ...

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    8. Impact of an optical coherence tomography guided approach in acute coronary syndromes: A propensity matched analysis from the international FORMIDABLE-CARDIOGROUP IV and USZ registry

      Impact of an optical coherence tomography guided approach in acute coronary syndromes: A propensity matched analysis from the international FORMIDABLE-CARDIOGROUP IV and USZ registry

      Aim. To determine the potential clinical impact of OCT (Optical Coherence Tomography) during primary percutaneous coronary intervention in patients presenting with ACS (Acute Coronary Syndrome). Methods and Results. FORMIDABLE is a multicentre retrospective registry enrolling all patients presenting with ACS and treated with an OCT-guided approach, while the USZ registry enrolled patients treated with a standard angiography guided approach. Multivariate adjustment was performed via a propensity score matching. The number stents useds was the primary outcome, while the incidence of MACE (a composite of death, myocardial infarction, target vessel revascularization, and stent thrombosis) was the secondary endpoint. A total of ...

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    9. Mechanical abnormalities associated with first and second-generation drug eluting stent thrombosis analyzed by optical coherence tomography in the national PESTO French registry

      Mechanical abnormalities associated with first and second-generation drug eluting stent thrombosis analyzed by optical coherence tomography in the national PESTO French registry

      Background and objectives DES thrombosis may be triggered by different mechanisms that are difficult to identify by angiography alone. This work aimed to investigate and compare the characteristics of stent thrombosis (ST) between 1 st and 2 nd generation drug eluting stents (DES) among a large cohort of patients explored by optical coherence tomography (OCT). Methods and results The PESTO study was a prospective national registry involving 29 French catheterization facilities. Patients with acute coronary syndromes were prospectively screened for presence of definite ST and analyzed by OCT after culprit lesion deocclusion The analysis involved 71 subjects including 34 patients ...

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    10. Optical Coherence Tomography to Optimize Results of Percutaneous Coronary Intervention in Patients with Non-ST-Elevation Acute Coronary Syndrome: Results of the Multicenter, Randomized DOCTORS (Does Optical Coherence Tomography Optimize Results of Stentin

      Optical Coherence Tomography to Optimize Results of Percutaneous Coronary Intervention in Patients with Non-ST-Elevation Acute Coronary Syndrome: Results of the Multicenter, Randomized DOCTORS (Does Optical Coherence Tomography Optimize Results of Stentin

      BACKGROUND: No randomized study has investigated the value of optical coherence tomography (OCT) in optimizing the results of percutaneous coronary intervention (PCI) for non-ST-segment elevation acute coronary syndromes. METHODS: We conducted a multicenter, randomized study involving 240 patients with non-ST-segment elevation acute coronary syndromes to compare OCT-guided PCI (use of OCT pre- and post-PCI; OCT-guided group) to fluoroscopy-guided PCI (angiography-guided group). The primary end point was the functional result of PCI assessed by the measure of post PCI fractional flow reserve. Secondary end points included procedural complications and type 4a periprocedural myocardial infarction. Safety was assessed by the rate of ...

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    11. Contribution of optical coherence tomography imaging in management of iatrogenic coronary dissection

      Contribution of optical coherence tomography imaging in management of iatrogenic coronary dissection

      Iatrogenic coronary dissection is a rare but potentially serious complication of coronary angiography and angioplasty. Treatment with angioplasty guided only by angiography is often difficult. Optical coherence tomography imaging seems to be an interesting technique to lead the management of iatrogenic coronary dissection. Diagnosis can be made by optical coherence tomography; it can also eliminate differential diagnosis. Furthermore, this technique can guide safely the endovascular treatment.

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    12. Mechanisms of stent thrombosis analysed by optical coherence tomography: insights from the national PESTO French registr

      Mechanisms of stent thrombosis analysed by optical coherence tomography: insights from the national PESTO French registr

      Aims Angiography has limited value for identifying the causes of stent thrombosis (ST). We studied a large cohort of patients by optical coherence tomography (OCT) to explore ST characteristics and mechanisms. Methods and results A prospective multicentre registry was screened for patients with confirmed ST. Optical coherence tomography was performed after initial intervention to the culprit lesion (in 69% of cases in a deferred procedure). Stent thrombosis was classified as acute (AST), sub-acute (SAST), late (LST), and very late (VLST). Optical coherence tomography records were analysed in a central core lab. The analysis included 120 subjects aged 61.7 [51 ...

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    13. 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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    14. OCT for bifurcation stenting: what have we learned?

      OCT for bifurcation stenting: what have we learned?

      Treatment of bifurcation lesions by percutaneous coronary intervention (PCI) shows major variation in complexity. Intravascular optical coherence tomography (OCT) provides high-resolution images of the pathoanatomy, thrombus, wires and stent positions during the procedure. This information may prove crucial in optimising PCI results and clinical outcomes after complex bifurcation treatment. Mounting evidence confirms the feasibility of OCT in bifurcations, and specific steps where OCT may be advantageous in guiding bifurcation PCI have been identified. Awaiting major clinical outcome trials, OCT has already entered the European guidelines for myocardial revascularisation. This paper aims to provide an overview of the potential clinical use ...

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    15. Automated peroperative assessment of stents apposition from OCT pullbacks

      Automated peroperative assessment of stents apposition from OCT pullbacks

      This study׳s aim was to control the stents apposition by automatically analyzing endovascular optical coherence tomography (OCT) sequences. Lumen is detected using threshold, morphological and gradient operators to run a Dijkstra algorithm. Wrong detection tagged by the user and caused by bifurcation, struts’presence, thrombotic lesions or dissections can be corrected using a morphing algorithm. Struts are also segmented by computing symmetrical and morphological operators. Euclidian distance between detected struts and wall artery initializes a stent׳s complete distance map and missing data are interpolated with thin-plate spline functions. Rejection of detected outliers, regularization of parameters by generalized cross-validation ...

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    16. Invasive management without stents in selected acute coronary syndrome patients with a large thrombus burden: a prospective study of optical coherence tomography guided treatment decisions

      Invasive management without stents in selected acute coronary syndrome patients with a large thrombus burden: a prospective study of optical coherence tomography guided treatment decisions

      Aims: To assess whether a strategy of invasive management without stents in selected acute coronary syndrome (ACS) patients with a large thrombus burden (LTB) might be feasible and safe. Methods and results: We performed a prospective non-randomised observational cohort study of invasive treatment decisions guided by optical coherence tomography (OCT) in selected ACS patients with LTB. Among 852 ACS patients who had undergone invasive coronary angiography, 101 (11.8%) patients with large thrombus burden on initial angiography underwent thrombectomy to restore TIMI 3 flow without stenting. All of these patients then had repeat angiography with OCT (days 0-2 [Group 1 ...

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      Mentions: Francesco Prati
    17. Does optical coherence tomography optimize results of stenting? Rationale and study design.

      Does optical coherence tomography optimize results of stenting? Rationale and study design.

      Background To date, no randomized study has investigated the value of optical coherence tomography (OCT) in optimizing the results of coronary angioplasty for non-ST elevation acute coronary syndromes (NSTE-ACS). Methods DOCTORS is a randomized, prospective, multicentre, open-label clinical trial to evaluate the utility of OCT to optimize results of angioplasty of a lesion responsible for NSTE-ACS. Patients (n = 250) will be randomized to undergo OCT-guided angioplasty (use of OCT to optimise procedural result, including change to strategy with the possibility of additional interventions); or angioplasty under fluoroscopy alone. The primary endpoint is the functional result of the angioplasty procedure as ...

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    18. Very late stent thrombosis related to incomplete neointimal coverage or neoatherosclerotic plaque rupture identified by optical coherence tomography imaging

      Very late stent thrombosis related to incomplete neointimal coverage or neoatherosclerotic plaque rupture identified by optical coherence tomography imaging

      Aims Recent data have reported that neoatherosclerosis could develop long after stent implantation and lead to subsequent rupture and acute coronary syndrome (ACS). We sought to identify the presence of in-stent neoatheroma (ISNA) in patients with very late stent thrombosis (VLST) using optical coherence tomography (OCT). Methods and results All patients from two catheterization centres who presented with ACS related to VLST underwent a standard coronary angiography and intra-coronary OCT. ISNA was defined as the combination of diffuse neointimal proliferation, lipid-laden intima with plaque organization, and fibrous cap rupture with no evidence of an uncovered strut. Out of 2139 ACS ...

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    19. Very late active stent thrombosis: Contribution of optical coherence tomography

      Very late active stent thrombosis: Contribution of optical coherence tomography

      Angiographic imaging of left anterior descending artery. A. Intrastent proximal LAD occlusion. B. TIMI-3 flow after LAD thrombus aspiration: 50% residual diameter stenosis of LAD, thrombus in first diagonal. C. Angiographic result after repeated thrombus aspiration in LAD. D. Angiographic follow-up at day 2: residual diameter stenosis < 10%. E. Optimal angiographic result at day 30.

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    20. OCT-Based Diagnosis and Management of STEMI Associated With Intact Fibrous Cap

      OCT-Based Diagnosis and Management of STEMI Associated With Intact Fibrous Cap

      In autopsy studies, at least 25% of thrombotic coronary occlusions are caused by plaque erosion in which thrombus often overlies atherosclerotic plaque without evident disruption of the fibrous cap. We performed optical coherence tomography imaging after aspiration thrombectomy and identified plaque erosion as the cause in 31 patients presenting with ST-segment elevation myocardial infarction. Plaque erosion was identified when the fibrous cap of the culprit lesion was intact. Based on clinical criteria, 40% of patients with subcritically occlusive plaque were treated with dual antiplatelet therapy without percutaneous revascularization (group 1), and the remaining 60% of patients underwent angioplasty and stenting ...

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    21. Contribution of guidance by optical coherence tomography (OCT) in rescue management of spontaneous coronary artery dissection

      Contribution of guidance by optical coherence tomography (OCT) in rescue management of spontaneous coronary artery dissection

      Spontaneous coronary artery dissection (SCAD) is a rare pathology with a poor prognosis, affecting young patients, often peripartum women, without cardiovascular risk factors. 1 The SCAD management remains controversial. In the case of haemodynamic instability with coronary occlusion, rescue percutaneous intervention may be required but still challenging. 2 A 43-year-old nurse was admitted for acute myocardial infarction complicated by cardiogenic shock. Emergent angiography revealed a total occlusion

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    22. Spatial distribution of neo-intimal hyperplasia 6 months after zotarolimus-eluting stent implantation, analysed by optical coherence tomography

      Spatial distribution of neo-intimal hyperplasia 6 months after zotarolimus-eluting stent implantation, analysed by optical coherence tomography
      Background Optical coherence tomography is a high-resolution imaging technology that allows in vivo assessment of neointimal hyperplasia and strut coverage after coronary stenting. Aim Assessment of spatial distribution of healing, 6 months after zotarolimus-eluting stent implantation. Methods Forty-two zotarolimus-eluting stents were monitored by optical coherence tomography 6 months after implantation. Mean neointimal strut coverage thickness and percentage of neointimal hyperplasia were measured every millimetre. Non-covered strut ratios were assessed on each slice. In addition, the spatial distribution of neointimal hyperplasia and strut coverage were analysed longitudinally on five stent segments and axially on each slice. Results There were no clinical ...
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      Mentions: Abbot
    23. In Vivo Supervised Analysis of Stent Reendothelialization From Optical Coherence Tomography

      In Vivo Supervised Analysis of Stent Reendothelialization From Optical Coherence Tomography
      The aim of this study is to interactively assess reendothelialization of stents at an accuracy of down to a few micrometer by analyzing endovascular optical coherence tomography (OCT) sequences. Vessel wall and stent struts are automatically detected by using morphological, gradient, and symmetry operators coupled with active contour models; alerts are issued to ask for user supervision over some extreme irregular geometries caused by thrombotic lesions or dissections. A complete distance map is then computed from sparse distances measured between wall and struts. Missing values are interpolated by thin-plate spline (TPS) functions. Accuracy and robustness are increased by taking into ...
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    24. Comparative analysis of neointimal coverage with paclitaxel and zotarolimus drug-eluting stents, using optical coherence tomography 6 months after implantation

      Background Intrastent thrombosis, while rare, has a poor prognosis. Strut non-coverage is one causal factor, especially in cases of resistance to or premature discontinuation of dual antiplatelet therapy. Aim To compare neointimal coverage with paclitaxel and zotarolimus drug-eluting stents, using optical coherence tomography (OCT). Methods Twenty-two drug-eluting stents (11 paclitaxel-eluting stents and 11 zotarolimus-eluting stents) were examined by OCT, 6 months after implantation. Mean neointimal strut-coverage thickness and percentage neointimal hyperplasia were measured every millimetre. On each OCT image, struts were classified into one of four categories: well-apposed to vessel wall with apparent neointimal coverage; well-apposed to vessel wall without ...
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    1-26 of 26
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    In Vivo Supervised Analysis of Stent Reendothelialization From Optical Coherence Tomography Spatial distribution of neo-intimal hyperplasia 6 months after zotarolimus-eluting stent implantation, analysed by optical coherence tomography OCT-Based Diagnosis and Management of STEMI Associated With Intact Fibrous Cap Very late stent thrombosis related to incomplete neointimal coverage or neoatherosclerotic plaque rupture identified by optical coherence tomography imaging Does optical coherence tomography optimize results of stenting? Rationale and study design. Invasive management without stents in selected acute coronary syndrome patients with a large thrombus burden: a prospective study of optical coherence tomography guided treatment decisions OCT for bifurcation stenting: what have we learned? Optical coherence tomography compared with fractional flow reserve guided approach in acute coronary syndromes: A propensity matched analysis Effects of statins on plaque rupture assessed by optical coherence tomography in patients presenting with acute coronary syndromes: insights from the optical coherence tomography (OCT)-FORMIDABLE registry The effect of software versions on the measurement of retinal vascular densities using optical coherence tomography angiography Peripapillary and Macular Microcirculation in Glaucoma Patients of African and European Descent Using Optical Coherence Tomography Angiography Comparison of two swept-source optical coherence tomography-based biometry devices