1. Articles from Akiko Maehara

    1-24 of 91 1 2 3 4 »
    1. Intravascular Imaging to Guide Percutaneous Coronary Intervention Will Be Mandatory Soon

      Intravascular Imaging to Guide Percutaneous Coronary Intervention Will Be Mandatory Soon

      Intravascular ultrasound (IVUS) or optical coherence tomography provides superior information to coronary angiography, including cross-sectional true vessel size, amount of calcification, distribution of plaque to inform stent landing zone, stent expansion, and stent edge dissection or uncovered disease, which have been well known as key metrics in percutaneous coronary intervention avoiding future stent failure. 1 Complex lesion morphology is typically defined as an unprotected left main lesion, severely calcified lesion, long lesion, bifurcation lesion, chronic total occlusion, or in-stent restenosis in which optimal percutaneous coronary intervention is far more difficult than other lesions. 2-4 Thus, they have a greater chance ...

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    2. Optical coherence tomography in coronary atherosclerosis assessment and intervention

      Optical coherence tomography in coronary atherosclerosis assessment and intervention

      Since optical coherence tomography (OCT) was first performed in humans two decades ago, this imaging modality has been widely adopted in research on coronary atherosclerosis and adopted clinically for the optimization of percutaneous coronary intervention. In the past 10 years, substantial advances have been made in the understanding of in vivo vascular biology using OCT. Identification by OCT of culprit plaque pathology could potentially lead to a major shift in the management of patients with acute coronary syndromes. Detection by OCT of healed coronary plaque has been important in our understanding of the mechanisms involved in plaque destabilization and healing ...

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    3. Diagnostic performance of fractional flow reserve derived from coronary angiography, intravascular ultrasound, and optical coherence tomography; a meta-analysis

      Diagnostic performance of fractional flow reserve derived from coronary angiography, intravascular ultrasound, and optical coherence tomography; a meta-analysis

      Background: Little is known about the overall diagnostic performance of computational fractional flow reserve (FFR) derived from angiography (Angio-FFR), intravascular ultrasound (IVUS-FFR), and optical coherence tomography (OCT-FFR) to detect hemodynamically significant coronary artery disease. The present study aimed to evaluate the diagnostic performance of those novel physiologic indices using conventional FFR as the gold standard. Methods: PubMed and Embase were searched in September 2021 for a systematic review and meta-analysis of studies assessing the diagnostic performance of invasive imaging-derived FFR. The primary outcomes were the summary sensitivity, specificity, correlation coefficients of each index. Results: A total of 6572 records were ...

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    4. Image-based biomechanical modeling for coronary atherosclerotic plaque progression and vulnerability prediction

      Image-based biomechanical modeling for coronary atherosclerotic plaque progression and vulnerability prediction

      Atherosclerotic plaque progression and rupture play an important role in cardiovascular disease development and the final drastic events such as heart attack and stroke. Medical imaging and image-based computational modeling methods advanced considerably in recent years to quantify plaque morphology and biomechanical conditions and gain a better understanding of plaque evolution and rupture process. This article first briefly reviewed clinical imaging techniques for coronary thin-cap fibroatheroma (TCFA) plaques used in image-based computational modeling. This was followed by a summary of different types of biomechanical models for coronary plaques. Plaque progression and vulnerability prediction studies based on image-based computational modeling were ...

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    5. Optical coherence tomography versus angiography guided magnesium bioresorbable scaffold implantation in NSTEMI patients

      Optical coherence tomography versus angiography guided magnesium bioresorbable scaffold implantation in NSTEMI patients

      Background: The purpose of a bioresorbable scaffold (BRS) is to provide radial support during coronary healing. In this study, coronary artery healing after optical coherence tomography (OCT)- versus angiography-guided magnesium BRS (MBRS) implantation in patients with non-ST-segment-elevation myocardial infarction (NSTEMI) is compared. Methods: 75 patients were randomized 1:1 to OCT- or angiography-guided implantation of a MBRS with protocolled pre- and post-dilation. In the OCT-guided group, prespecified criteria indicating additional intervention were (1) scaffold under-expansion, (2) strut malapposition, (3) edge dissection, and (4) residual stenosis at distal or proximal reference segments. The primary endpoint was OCT-derived healing stage at 6 ...

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    6. Artificial intelligence and optical coherence tomography for the automatic characterisation of human atherosclerotic plaques

      Artificial intelligence and optical coherence tomography for the automatic characterisation of human atherosclerotic plaques

      Background: Intravascular optical coherence tomography (IVOCT) enables detailed plaque characterisation in vivo , but visual assessment is time-consuming and subjective. Aims: This study aimed to develop and validate an automatic framework for IVOCT plaque characterisation using artificial intelligence (AI). Methods: IVOCT pullbacks from five international centres were analysed in a core lab, annotating basic plaque components, inflammatory markers and other structures. A deep convolutional network with encoding-decoding architecture and pseudo-3D input was developed and trained using hybrid loss. The proposed network was integrated into commercial software to be externally validated on additional IVOCT pullbacks from three international core labs, taking the ...

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    7. Intravascular Ultrasound–Derived Calcium Score to Predict Stent Expansion in Severely Calcified Lesions | Circulation: Cardiovascular Interventions

      Intravascular Ultrasound–Derived Calcium Score to Predict Stent Expansion in Severely Calcified Lesions | Circulation: Cardiovascular Interventions

      Background: Coronary calcification inhibits stent expansion. We sought to establish an intravascular ultrasound–derived calcium score to predict stent underexpansion. Methods: This is a retrospective observational study including de novo lesions that underwent intravascular ultrasound–guided stenting and had maximum superficial calcium angle >270°. Lesions with angiographic calcium not treated with atherectomy or scoring/cutting balloon before stent implantation were randomly divided into derivation and validation cohorts. The end point was stent expansion (minimum stent area/average of reference lumen area) at the maximum calcium site, and stent expansion <70% was considered underexpansion. Results: The morphological characteristics associated with stent ...

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    8. Using Optical Coherence Tomography and Intravascular Ultrasound Imaging to Quantify Coronary Plaque Cap Stress/Strain and Progression: A Follow-Up Study Using 3D Thin-Layer Models

      Using Optical Coherence Tomography and Intravascular Ultrasound Imaging to Quantify Coronary Plaque Cap Stress/Strain and Progression: A Follow-Up Study Using 3D Thin-Layer Models

      Accurate plaque cap thickness quantification and cap stress/strain calculations are of fundamental importance for vulnerable plaque research. To overcome uncertainties due to intravascular ultrasound (IVUS) resolution limitation, IVUS and optical coherence tomography (OCT) coronary plaque image data were combined together to obtain accurate and reliable cap thickness data, stress/strain calculations, and reliable plaque progression predictions. IVUS, OCT, and angiography baseline and follow-up data were collected from nine patients (mean age: 69; m: 5) at Cardiovascular Research Foundation with informed consent obtained. IVUS and OCT slices were coregistered and merged to form IVUS + OCT (IO) slices. A total of ...

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    9. Clinical determinants of coronary artery disease burden and vulnerability using optical coherence tomography co-registered with intravascular ultrasound

      Clinical determinants of coronary artery disease burden and vulnerability using optical coherence tomography co-registered with intravascular ultrasound

      Objectives: We investigated clinical determinants of disease burden and vulnerability using optical coherence tomography (OCT) co-registered with intravascular ultrasound (IVUS) in a large cohort of patients. Methods: A total of 704 patients [44.5% with acute coronary syndromes (ACS)] underwent coronary intervention. IVUS plaque burden and OCT lipid, macrophage and calcium indices and the presence of thrombus, plaque rupture and thin-cap fibroatheroma (TCFA) were analyzed. Results: Median patient age was 66 years with 81.8% men, 34.4% with diabetes mellitus and 15.5% with preadmission statins. Median lesion length was 25.7 mm, and 33.0% had a TCFA ...

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    10. Clinical outcomes of low-intensity area without attenuation and cholesterol crystals in non-culprit lesions assessed by optical coherence tomography

      Clinical outcomes of low-intensity area without attenuation and cholesterol crystals in non-culprit lesions assessed by optical coherence tomography

      Background and aims Pathologists have shown that intraplaque hemorrhage contributes to plaque destabilization and is frequently co-located with cholesterol crystals (CC). Optical coherence tomography (OCT)-detected low-intensity area without attenuation (LIA) may represent intraplaque hemorrhage. We aimed to examine the prevalence and impact of OCT-detected LIA + CC in untreated non-culprit lesions (NCLs) on subsequent major adverse cardiac events (MACE). Methods OCT imaged NCLs in the culprit vessel in the patients who underwent OCT-guided percutaneous coronary intervention were included. An NCL was a lesion with >90° of diseased arc (≥0.5 mm intimal thickness), length ≥2 mm, and >5 mm away ...

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    11. Intracoronary optical coherence tomography: state of the art and future directions

      Intracoronary optical coherence tomography: state of the art and future directions

      Optical coherence tomography (OCT) has been increasingly utilised to guide percutaneous coronary intervention (PCI). Despite the diagnostic utility of OCT, facilitated by its high resolution, the impact of intracoronary OCT on clinical practice has thus far been limited. Difficulty in transitioning from intravascular ultrasound (IVUS), complex image interpretation, lack of a standardised algorithm for PCI guidance, and paucity of data from prospective clinical trials have contributed to the modest adoption. Herein, we provide a comprehensive up-do-date overview on the utility of OCT in coronary artery disease, including technical details, device set-up, simplified OCT image interpretation, recognition of the imaging artefacts ...

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    12. 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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    13. Optical Coherence Tomography-Based Patient-Specific Residual Multi-Thrombus Coronary Plaque Models with Fluid-Structure Interaction for Better Treatment Decisions: A Biomechanical Modeling Case Study

      Optical Coherence Tomography-Based Patient-Specific Residual Multi-Thrombus Coronary Plaque Models with Fluid-Structure Interaction for Better Treatment Decisions: A Biomechanical Modeling Case Study

      Intracoronary thrombus from plaque erosion could cause fatal acute coronary syndrome (ACS). A conservative anti-thrombotic therapy has been proposed to treat ACS patients in lieu of stenting. It is speculated that the residual thrombus after aspiration thrombectomy would influence the prognosis of this treatment. However, biomechanical mechanisms affecting intracoronary thrombus remodeling and clinical outcome remain largely unknown. In vivo optical coherence tomography (OCT) data of a coronary plaque with two residual thrombi after anti-thrombotic therapy were acquired from an ACS patient with consent obtained. Three OCT-based FSI models with different thrombus volumes, fluid-only and structure-only models were constructed to simulate ...

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    14. Predicting plaque vulnerability change using intravascular ultrasound + optical coherence tomography image-based fluid–structure interaction models and machine learning methods with patient follow-up data: a feasibility study

      Predicting plaque vulnerability change using intravascular ultrasound + optical coherence tomography image-based fluid–structure interaction models and machine learning methods with patient follow-up data: a feasibility study

      Background Coronary plaque vulnerability prediction is difficult because plaque vulnerability is non-trivial to quantify, clinically available medical image modality is not enough to quantify thin cap thickness, prediction methods with high accuracies still need to be developed, and gold-standard data to validate vulnerability prediction are often not available. Patient follow-up intravascular ultrasound (IVUS), optical coherence tomography (OCT) and angiography data were acquired to construct 3D fluid–structure interaction (FSI) coronary models and four machine-learning methods were compared to identify optimal method to predict future plaque vulnerability. Methods Baseline and 10-month follow-up in vivo IVUS and OCT coronary plaque data were ...

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    15. Automatic Characterisation of Human Atherosclerotic Plaque Composition from Intravascular Optical Coherence Tomography Using Artificial Intelligence

      Automatic Characterisation of Human Atherosclerotic Plaque Composition from Intravascular Optical Coherence Tomography Using Artificial Intelligence

      Background Intravascular optical coherence tomography (IVOCT) enables detailed plaque characterisation in-vivo, but visual assessment is time-consuming and subjective. Aims This study aims to develop and validate an automatic framework for IVOCT plaque characterisation using artificial intelligence (AI). Methods IVOCT pullbacks from 5 international centres were analysed in a corelab, annotating basic plaque components, inflammatory markers and other structures. A deep convolutional network with encoding-decoding architecture and pseudo-3D input was developed and trained using hybrid loss. The proposed network was integrated into commercial software to be externally validated on additional IVOCT pullbacks from three international corelabs, taking the consensus among corelabs ...

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    16. Using optical coherence tomography and intravascular ultrasound imaging to quantify coronary plaque cap thickness and vulnerability: a pilot study

      Using optical coherence tomography and intravascular ultrasound imaging to quantify coronary plaque cap thickness and vulnerability: a pilot study

      Background: Detecting coronary vulnerable plaques in vivo and assessing their vulnerability have been great challenges for clinicians and the research community. Intravascular ultrasound (IVUS) is commonly used in clinical practice for diagnosis and treatment decisions. However, due to IVUS limited resolution (about 150-200 µm), it is not sufficient to detect vulnerable plaques with a threshold cap thickness of 65 µm. Optical Coherence Tomography (OCT) has a resolution of 15-20 µm and can measure fibrous cap thickness more accurately. The aim of this study was to use OCT as the benchmark to obtain patient-specific coronary plaque cap thickness and evaluate the ...

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    17. 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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    18. Coronary Optical Coherence Tomography and Cardiac Magnetic Resonance Imaging to Determine Underlying Causes of MINOCA in Women

      Coronary Optical Coherence Tomography and Cardiac Magnetic Resonance Imaging to Determine Underlying Causes of MINOCA in Women

      Background: Myocardial infarction with non-obstructive coronary arteries (MINOCA) occurs in 6-15% of MI and disproportionately affects women. Scientific statements recommend multi-modality imaging in MINOCA to define the underlying cause. We performed coronary optical coherence tomography (OCT) and cardiac magnetic resonance imaging (CMR) to assess mechanisms of MINOCA. Methods: In this prospective, multicenter, international, observational study, we enrolled women with a clinical diagnosis of MI. If invasive coronary angiography revealed <50% stenosis in all major arteries, multi-vessel OCT was performed, followed by CMR (cine imaging, late gadolinium enhancement, and T2-weighted imaging and/or T1 mapping). Angiography, OCT, and CMR were evaluated ...

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    19. 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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    20. 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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    21. OPtical Coherence Tomography Guided Coronary Stent IMplantation Compared to Angiography: A Multicenter Randomized TriaL in PCI

      OPtical Coherence Tomography Guided Coronary Stent IMplantation Compared to Angiography: A Multicenter Randomized TriaL in PCI

      AIMS: Randomized trials have demonstrated improvement in clinical outcomes with intravascular ultrasound (IVUS)-guided percutaneous coronary intervention (PCI) compared with angiography-guided PCI. The ILUMIEN III trial demonstrated non-inferiority of an optical coherence tomography (OCT)- versus IVUS-guided PCI strategy in achieving similar post-PCI lumen dimensions. ILUMIEN IV is a large-scale, multicenter, randomized trial designed to demonstrate the superiority of OCT- versus angiography-guided stent implantation in patients with high-risk clinical characteristics (diabetes) and/or complex angiographic lesions in achieving larger post-PCI lumen dimensions and improving clinical outcomes. METHODS AND RESULTS: ILUMIEN IV is a prospective, single-blind clinical investigation that will randomize between ...

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    22. Culprit lesion morphology in patients with ST-segment elevation myocardial infarction assessed by optical coherence tomography

      Culprit lesion morphology in patients with ST-segment elevation myocardial infarction assessed by optical coherence tomography

      Aims This study sought to evaluate the incidence of ruptured plaques and nonruptured plaques (NRP) and to compare patient characteristics and detailed plaque morphology features between the two culprit types in ST-segment elevation myocardial infarction (STEMI) patients, using optical coherence tomography (OCT). Methods and results Using OCT, the culprit lesions in patients with STEMI were assessed prior to stent implantation. The culprit lesion was categorized as ruptured plaques or NRP, and the plaque components were evaluated. Fifty-two patients (69.3%) presented with ruptured plaques and 23 (30.7%) with NRP. Patients with NRP were younger (58.0 ± 10.4 vs ...

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    23. The relationship between coronary artery calcium density and optical coherence tomography-derived plaque characteristics

      The relationship between coronary artery calcium density and optical coherence tomography-derived plaque characteristics

      Background and aims Although coronary artery calcium (CAC) density has been associated with plaque stability, pathological evidence is lacking. We investigated the relationship between coronary computed tomography (CCT)-derived CAC density and multiple calcified and high-risk plaque (HRP) characteristics using optical coherence tomography (OCT). Methods We analyzed 83 plaques from 33 stable angina patients who underwent both CCT and OCT. CAC density was measured at calcium plaques with >90 Hounsfield units (HU) and >130 HU using custom CT software. The correlation between median CAC density and OCT-derived calcium size (thickness and area) was assessed. To investigate whether median CAC densities ...

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