1. Articles from nieves gonzalo

    1-24 of 43 1 2 »
    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. 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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    3. Spontaneous Coronary Artery Dissection: Pathophysiological Insights From Optical Coherence Tomography

      Spontaneous Coronary Artery Dissection: Pathophysiological Insights From Optical Coherence Tomography

      Objectives This study used optical coherence tomography to investigate the mechanism of false lumen (FL) formation in spontaneous coronary artery dissection (SCAD) by studying: 1) differences between fenestrated and nonfenestrated SCAD; 2) vasa vasorum density; and 3) light attenuation characteristics of the FL. Background SCAD is an increasingly recognized cause of acute coronary syndromes , characterized by FL formation and compression of the true lumen (TL). The mechanisms underlying FL formation remain poorly understood. Methods A total of 65 SCAD patients (68 vessels) who underwent acute OCT imaging as part of routine clinical care were included. Images were classified by the ...

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    4. Qualitative and quantitative neointimal characterization by optical coherence tomography in patients presenting with in-stent restenosis

      Qualitative and quantitative neointimal characterization by optical coherence tomography in patients presenting with in-stent restenosis

      Aims To describe optical coherence tomography (OCT) findings in patients with in-stent restenosis (ISR) and determine predictors of neointimal patterns and neoatherosclerosis. Methods and results Patients undergoing OCT prior to PCI for ISR in three European centres were included. Analyses were performed in a core laboratory. Qualitative and quantitative [gray-scale signal intensity (GSI)] neointima analyses were performed on a per quadrant basis. A total of 107 patients were included. Predominantly homogeneous lesions included 4.5% (0.0–14.3) non-homogeneous quadrants, while predominantly non-homogeneous ones included 28.1% (20.3–37.5) homogeneous quadrants. Mean GSI values differed significantly between ...

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    5. Accuracy of intravascular ultrasound and optical coherence tomography in identifying functionally significant coronary stenosis according to vessel diameter: A meta-analysis of 2,581 patients and 2,807 lesions

      Accuracy of intravascular ultrasound and optical coherence tomography in identifying functionally significant coronary stenosis according to vessel diameter: A meta-analysis of 2,581 patients and 2,807 lesions

      Introduction Accuracy of intracoronary imaging to discriminate functionally significant coronary stenosis according to vessel diameter remains to be defined. Methods PubMed, Scopus, and Google Scholar were systematically searched for studies assessing diagnostic accuracy (area under the receiver operating characteristic curve [AUC], the primary end point) and sensitivity and specificity (the secondary end points) of minimal luminal area (MLA) or of minimal luminal diameter (MLD) derived from intravascular ultrasound (IVUS) or optical coherence tomography (OCT) to detect functionally significant stenosis as determined with fractional flow reserve (FFR). Results Fifteen studies were included, 2 with 110 patients analyzing only left main (LM ...

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    6. Treatment of Coronary In-Stent Restenosis With Bioabsorbable Vascular Scaffolds

      Treatment of Coronary In-Stent Restenosis With Bioabsorbable Vascular Scaffolds

      A 77-year-old woman was admitted for angina 13 years after receiving a bare-metal stent in the left anterior descending coronary artery. Angiography showed in-stent restenosis (ISR). Optical coherence tomography (OCT) revealed a well-expanded stent with focal ISR ( arrow in longitudinal display, A ) and heterogeneous tissue, including lipid pools (+) and and calcified segments (#) , suggesting neoatherosclerosis (B to D) (wire-artifact [*] ). Most underlying struts were not visible. A bioabsorbable vascular scaffold (BVS) was deployed and subsequently post-dilated at high pressures to remove a residual waist. Final OCT revealed a minimal lumen area of 8 mm 2 . The classic “ black box ” BVS appearance (without ...

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    7. New Insights on Plaque Erosion and Calcified Nodules “Seeing Is Believing”

      New Insights on Plaque Erosion and Calcified Nodules “Seeing Is Believing”

      Plaque erosion (PE) and calcified nodules (CN) have been classically described in pathological studies as causes of acute coronary syndromes (ACS) ( 1 ). However, until very recently, the diagnosis of these entities in the clinical setting has remained largely elusive ( 1 ). In this regard, the study of Jia et al. 2 , using optical coherence tomography (OCT) for the diagnosis of PE and CN, is of major clinical interest and raises several important issues. First, the investigators considered that OCT might provide a “definitive” diagnosis of PE when fibrous cap disruption is excluded and a thrombus overlying an “intact” plaque is visualized ...

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    8. Combined In Vivo Insights Unraveling the Underlying Substrate of an Acute Myocardial Infarction Treated With a Bioabsorbable Vascular Scaffold

      Combined In Vivo Insights Unraveling the Underlying Substrate of an Acute Myocardial Infarction Treated With a Bioabsorbable Vascular Scaffold

      An 86-year-old man presented with an ST-segment elevation inferior myocardial infarction. Coronary angiography revealed a large filling defect in the proximal right coronary artery (Figure 1 A) that was significantly reduced after thromboaspiration (Figure 1 B). On visual examination, the aspirated material appeared to be just a large red thrombus (Figure 1 D and Figure 1 E). Optical coherence tomography (OCT) disclosed the culprit lesion, which consisted of a red thrombus and a ruptured thin-cap fibroatheroma (Figure 2 A and Figure 2 A′). After thrombectomy, a large lumen was obtained, but a thin-cap fibroatheroma with some calcified areas and residual ...

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    9. Neoatherosclerosis After Paclitaxel-Coated Balloon Angioplasty for In-Stent Restenosis

      Neoatherosclerosis After Paclitaxel-Coated Balloon Angioplasty for In-Stent Restenosis

      In-stent neoatherosclerosis (NA) has been reported after drug-eluting stent (DES) and bare-metal stent implantation. 1 NA is not only more frequent but also occurs earlier in patients undergoing DES implantation compared with those treated with bare-metal stents. 1 This phenomenon has major potential implications because complicated NA (mainly from rupture of a thin-cap fibroatheroma) may result in very late stent thrombosis. 2 Although NA can be visualized using intravascular ultrasound (IVUS), optical coherence tomography (OCT), because of its unique resolution (15 μm), appears ideally suited to detect this phenomenon in vivo. 2 We report on a patient treated with a ...

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    10. Coronary Thrombosis From Large, Nonprotruding, Superficial Calcified Coronary Plaques

      Coronary Thrombosis From Large, Nonprotruding, Superficial Calcified Coronary Plaques

      A 76-year-old man admitted for an acute coronary syndrome showed on angiography diffuse coronary calcification and mild lumen irregularities in the proximal left anterior descending and mid left circumflex coronary arteries. Optical coherence tomography revealed preserved coronary lumen at all segments. No features consistent with thin- or thick-cap fibroatheromas, ruptured plaques, or erosions were detected. However, a massive calcification of the left anterior descending and left circumflex coronary artery was recognized. The pattern of calcification was rather unique, involving the entire vessel circumference (ranging from 120° to 360°) and strikingly superficial, with a characteristic “concave shaped” surface apparently devoid of ...

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    11. Optical Coherence Tomography Findings in an Acquired Coronary Fistula

      Optical Coherence Tomography Findings in an Acquired Coronary Fistula

      Introduction Most coronary artery fistulas (CAFs) have a congenital origin. Acquired CAF is a rare entity that may occur without an identifiable causative link. We present here the case of an acquired CAF in which optical coherence tomography was instrumental in outlining that its possible cause was a spontaneously ruptured, communicating, subadventitial coronary hematoma. Case Presentation A man aged 67 years was admitted for oppressive chest pain and sudden-onset dyspnea. He was a former smoker, had dyslipidemia and diabetes mellitus, and was in permanent atrial fibrillation. He also had had 2 mechanical valves implanted in the mitral and aortic positions ...

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    12. Combined use of optical coherence tomography and intravascular ultrasound imaging for the evaluation of stent thrombosis

      Combined use of optical coherence tomography and intravascular ultrasound imaging for the evaluation of stent thrombosis

      Stent thrombosis (ST) represents the most feared complication after the percutaneous treatment of a coronary stenosis, usually involving very serious or fatal consequences for the patient. The interest in ST was initiated after the first longitudinal follow-up of drug-eluting stents (DES), which dramatically decrease the rate of restenosis. Further investigation revealed that ST is not a class effect, also affecting bare metal stents, and that several factors are potentially implicated in the physiopathology of ST [1]. While subacute thrombosis seem to be more related to mechanical problems during deployment, late and very late ST described in DES have been associated ...

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    13. Late Drug-Eluting Stent Thrombosis: Optical Coherence Tomography and Intravascular Ultrasound Insights

      Late Drug-Eluting Stent Thrombosis: Optical Coherence Tomography and Intravascular Ultrasound Insights

      Late stent thrombosis (LST) after drug-eluting stent (DES) implantation remains a dreadful complication.1–4 Intravascular ultrasound (IVUS) and optical coherence tomography (OCT) provide unique insights on the results of DES implantation.1–3 We describe the value of a “combined” use of these intracoronary diagnostic techniques in a patient with DES LST. A 51-year-old man with unstable angina and a severe lesion in the proximal left anterior descending coronary artery was successfully treated with an everolimus-eluting stent. Despite excellent initial angiographic results, OCT disclosed malapposed struts and protrusion (2 mm) of the proximal edge of the DES across the ...

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    14. Combined use of optical coherence tomography and intravascular ultrasound imaging in patients undergoing coronary interventions for stent thrombosis

      Combined use of optical coherence tomography and intravascular ultrasound imaging in patients undergoing coronary interventions for stent thrombosis

      Objective This prospective study sought to assess the diagnostic value of optical coherence tomography (OCT) compared with intravascular ultrasound (IVUS) in patients presenting with stent thrombosis (ST). Design and setting Although the role of IVUS in this setting has been described, the potential diagnostic value of OCT in patients suffering ST remains poorly defined. Catheterization Laboratory, University Hospital. Patients and interventions Fifteen consecutive patients with ST undergoing rescue coronary interventions under combined IVUS/OCT imaging guidance were analysed. Mean outcome measures Analysis and comparison of OCT and IVUS findings before and after interventions. Results Before intervention, OCT visualised the responsible ...

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    15. Plaque sealing and passivation with a mechanical self-expanding low outward force nitinol VShield device for the treatment of intravascular ultrasound and optical coherence tomography-derived thin cap fibroatheromas (TCFAS) in native coronary arteries

      Plaque sealing and passivation with a mechanical self-expanding low outward force nitinol VShield device for the treatment of intravascular ultrasound and optical coherence tomography-derived thin cap fibroatheromas (TCFAS) in native coronary arteries

      Aims: The aim of the pilot SECRITT trial was to evaluate the safety and feasibility of sealing the high risk IVUS and optical coherence tomography-derived thin cap fibroatheroma (TCFA), with a dedicated nitinol self-expanding vShield device. Methods and results: After screening with angiography, fractional flow reserve (FFR), intravascular ultrasound virtual histology (IVUS-VH) and optical coherence tomography (OCT), 23 patients met enrolment criteria (presence of non-obstructive VH-derived TCFA lesion with thin cap on OCT) and were randomised to vShield (n=13) versus medical therapy (n=10). In the shielded group, baseline percent diameter stenosis was 33.2±13.5%, FFR was ...

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    16. Expert review document part 2: methodology, terminology and clinical applications of optical coherence tomography for the assessment of interventional procedures

      Expert review document part 2: methodology, terminology and clinical applications of optical coherence tomography for the assessment of interventional procedures

      Introduction This document is complementary to an Expert Review Document on Optical Coherence Tomography (OCT) for the study of coronary arteries and atherosclerosis.1 The goal of this companion manuscript is to provide a practical guide framework for the appropriate use and reporting of the novel frequency domain (FD) OCT imaging to guide interventional procedures, with a particular interest on the comparison with intravascular ultrasound (IVUS).1–4 Technique for optical coherence tomography imaging In the OCT Expert Review Document on Atherosclerosis, a comprehensive description of the physical principles for OCT imaging and time domain (TD) catheters (St Jude Medical ...

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    17. Consensus Standards for Acquisition, Measurement, and Reporting of Intravascular Optical Coherence Tomography Studies: A Report From the International Working Group for Intravascular Optical Coherence Tomography Standardization and Validation

      Consensus Standards for Acquisition, Measurement, and Reporting of Intravascular Optical Coherence Tomography Studies: A Report From the International Working Group for Intravascular Optical Coherence Tomography Standardization and Validation

      Objectives: The purpose of this document is to make the output of the International Working Group for Intravascular Optical Coherence Tomography (IWG-IVOCT) Standardization and Validation available to medical and scientific communities, through a peer-reviewed publication, in the interest of improving the diagnosis and treatment of patients with atherosclerosis, including coronary artery disease.Background: Intravascular optical coherence tomography (IVOCT) is a catheter-based modality that acquires images at a resolution of 10 μm, enabling visualization of blood vessel wall microstructure in vivo at an unprecedented level of detail. IVOCT devices are now commercially available worldwide, there is an active user base, and ...

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    18. Detection of very early stent healing after primary angioplasty: an optical coherence tomographic observational study of chromium cobaltum and first-generation drug-eluting stents. The DETECTIVE Study

      Detection of very early stent healing after primary angioplasty: an optical coherence tomographic observational study of chromium cobaltum and first-generation drug-eluting stents. The DETECTIVE Study

      Background Lack of stent coverage appears to be associated with stent thrombosis, a problem of particular concern in patients with ST elevation myocardial infarction (STEMI). Methods The DETECTIVE European Multicenter Registry was set up to address the early modality of stent healing in the setting of STEMI. The Registry compared, with an early optical coherence tomography (OCT) evaluation performed at 3–7 days, the patterns of coverage and apposition of the first generation of drug-eluting stents (DESs) and cobalt chromium non-drug-eluting stents (CCSs) that were deployed in culprit lesions and in non-culprit segments. The Registry included only patients with a ...

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    19. A Rare Cause of Late Drug-Eluting Stent Thrombosis Unraveled by Optical Coherence Tomography

      A Rare Cause of Late Drug-Eluting Stent Thrombosis Unraveled by Optical Coherence Tomography

      Drug-eluting stent (DES) thrombosis remains a rare but feared complication in patients undergoing coronary interventions. Mechanical factors (stent underexpansion, malapposition, inflow-outflow disease, residual dissections) have been suggested to play a potential role in this setting. 1,2 These predisposing problems can be readily identified with the use of intravascular ultrasound or optical coherence tomography (OCT). 1–4 Furthermore, lack of complete endothelialization appears to be implicated in cases with very late DES thrombosis, in which OCT might allow a more precise diagnosis. 3,4 We present a patient with very late DES thrombosis in whom OCT unraveled a unique, previously ...

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    20. Tissue coverage of a hydrophilic polymer-coated zotarolimus-eluting stent vs. a fluoropolymer-coated everolimus-eluting stent at 13-month follow-up: an optical coherence tomography substudy from the RESOLUTE All Comers trial

      Tissue coverage of a hydrophilic polymer-coated zotarolimus-eluting stent vs. a fluoropolymer-coated everolimus-eluting stent at 13-month follow-up: an optical coherence tomography substudy from the RESOLUTE All Comers trial

      Aims To compare the tissue coverage of a hydrophilic polymer-coated zotarolimus-eluting stent (ZES) vs. a fluoropolymer-coated everolimus-eluting stent (EES) at 13 months, using optical coherence tomography (OCT) in an ‘all-comers' population of patients, in order to clarify the mechanism of eventual differences in the biocompatibility and thrombogenicity of the devices. Methods and results Patients randomized to angiographic follow-up in the RESOLUTE All Comers trial (NCT00617084) at pre-specified OCT sites underwent OCT follow-up at 13 months. Tissue coverage and apposition were assessed strut by strut, and the results in both treatment groups were compared using multilevel logistic or linear regression, as ...

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    21. Treatment of a Giant Coronary Artery Aneurysm: Intravascular Ultrasound and Optical Coherence Tomography Findings

      Treatment of a Giant Coronary Artery Aneurysm: Intravascular Ultrasound and Optical Coherence Tomography Findings

      A giant coronary aneurysm (GCA) partially thrombosed was demonstrated in a 77-year-old patient evaluated for an inferior myocardial infarction. Primary angioplasty (balloon only) with suboptimal result was initially obtained. After triple antiplatelet and anticoagulation therapy (4 days), a new angiography was performed and a fusiform GCA was clearly delineated. A second percutaneous intervention was performed using a “scaffolding technique” with conventional stent and subsequent implantation of 2 polytetrafluoroethylene-covered stents to successfully exclude the aneurysm. This case demonstrates a novel technique to treat long GCA

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    22. Witnessed Coronary Plaque Rupture During Cardiac Catheterization

      Witnessed Coronary Plaque Rupture During Cardiac Catheterization
      Acute myocardial infarction is primarily caused by atherosclerotic plaque rupture within coronary arteries accompanied by intraluminal thrombus formation, sudden vessel occlusion, and impaired oxygen supply to the myocardium. However, study of plaque rupture has been previously limited to histological analysis of autopsy specimens and animal experiments. Using a high-resolution imaging technique, called intracoronary optical frequency domain imaging (OFDI), we have directly observed the microstructural detail of human coronary plaque rupture in vivo at multiple time points (1). This case of a dynamic observation in a patient provides evidence to support hypotheses about coronary plaque rupture and is illustrative of our ...
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