1. Articles from Gregg W. Stone

    1-23 of 23
    1. Algorithmic Approach for Optical Coherence Tomography–Guided Stent Implantation During Percutaneous Coronary Intervention

      Algorithmic Approach for Optical Coherence Tomography–Guided Stent Implantation During Percutaneous Coronary Intervention

      Intravascular imaging plays a key role in optimizing outcomes for percutaneous coronary intervention (PCI). Optical coherence tomography (OCT) utilizes a user-friendly interface and provides high-resolution images. OCT can be used as part of daily practice in all stages of a coronary intervention: baseline lesion assessment, stent selection, and stent optimization. Incorporating a standardized, algorithmic approach when using OCT allows for precision PCI.

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    2. Bifurcation and Ostial Optical Coherence Tomography Mapping (BOOM) – Case Description of a Novel Bifurcation Stent Technique

      Bifurcation and Ostial Optical Coherence Tomography Mapping (BOOM) – Case Description of a Novel Bifurcation Stent Technique

      Stent placement guided by angiography alone is often inexact, but of increased importance with bifurcation percutaneous coronary intervention (PCI). We describe a novel technique using optical coherence tomography (OCT)-guided angiographic co-registration termed “Bifurcation and Ostial OCT Mapping” (BOOM). The technique is based on the precise identification and mapping of the side-branch ostium using co-registration to minimize protrusion of stent struts into the main branch while ensuring full coverage of the ostium in the side-branch.

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    3. Intracoronary Optical Coherence Tomography 2018 : Current Status and Future Directions

      Intracoronary Optical Coherence Tomography 2018 : Current Status and Future Directions

      The advent of intravascular imaging has been a significant advancement in visualization of coronary arteries, particularly with optical coherence tomography (OCT) that allows for high-resolution imaging of intraluminal and transmural coronary structures. Accumulating data support a clinical role for OCT in a multitude of clinical scenarios, including assessing the natural history of atherosclerosis and modulating effects of therapies, mechanisms of acute coronary syndromes, mechanistic insights into the effects of novel interventional devices, and optimization of percutaneous coronary intervention. In this state-of-the-art review, we provide an overview of the published data on the clinical utility of OCT, highlighting the areas that ...

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    4. IVUS-Guided Versus OCT-Guided Coronary Stent Implantation: A Critical Appraisal

      IVUS-Guided Versus OCT-Guided Coronary Stent Implantation: A Critical Appraisal

      Procedural guidance with intravascular ultrasound (IVUS) imaging improves the clinical outcomes of patients undergoing percutaneous coronary intervention (PCI) by: 1) informing the necessity for lesion preparation; 2) directing appropriate stent sizing to maximize the final stent area and minimize geographic miss; 3) selecting the optimal stent length to cover residual disease adjacent to the lesion, thus minimizing geographic miss; 4) guiding optimal stent expansion; 5) identifying acute complications (edge dissection, stent malapposition, tissue protrusion); and 6) clarifying the mechanism of late stent failure (stent thrombosis, neointimal hyperplasia, stent underexpansion or fracture, or neoatherosclerosis). Optical coherence tomography (OCT) provides similar information ...

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    5. Optical coherence tomography-guided PCI – Authors' reply

      Optical coherence tomography-guided PCI – Authors' reply

      We read with interest the Correspondence by Rahman Shah regarding our 2016 ILUMIEN III: OPTIMIZE PCI trial. 1 In nearly all previous studies of percutaneous coronary intervention (PCI) guided by intravascular ultrasound (IVUS) or optical coherence tomography (OCT), the most important predictor of follow-up events was the minimum stent area, followed by edge dissections and untreated disease. 2 , 3 Nine randomised trials 4 have compared IVUS guidance versus angiography guidance for PCI with drug-eluting stents (DES). IVUS guidance improved event-free survival by achieving larger acute stent dimensions than angiography guidance. 4 Therefore, before embarking on a definitive trial comparing OCT-guided ...

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    6. Is quantitative coronary angiography reliable in assessing the late lumen loss of the everolimus eluting bioresorbable polylactide scaffold in comparison with the cobalt chromium metallic stent?

      Is quantitative coronary angiography reliable in assessing the late lumen loss of the everolimus eluting bioresorbable polylactide scaffold in comparison with the cobalt chromium metallic stent?

      Aims: Immediately after stent/scaffold implantation, quantitative coronary angiography (QCA) with respect to optical coherence tomography (OCT) more severely underestimates the lumen diameter (LD) in Absorb than in XIENCE. This OCT-QCA discrepancy has not been evaluated at long-term follow-up. The present study aimed to assess the accuracy of QCA with reference to OCT in Absorb as compared to XIENCE.

       

       

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    7. Coronary Plaque Characteristics in Hemodialysis-Dependent Patients as Assessed by Optical Coherence Tomography

      Coronary Plaque Characteristics in Hemodialysis-Dependent Patients as Assessed by Optical Coherence Tomography

      Coronary arteries in patients with chronic kidney disease (CKD) have been shown to exhibit more extensive atherosclerosis and calcium. We aimed to assess characteristics of coronary plaque in hemodialysis (HD)-dependent patients using optical coherence tomography (OCT). This was a multicenter, retrospective study of 124 patients with stable angina who underwent OCT imaging. Sixty-two HD-dependent patients who underwent pre-intervention OCT for coronary artery disease (CAD) were compared 1:1 with a cohort of patients without CKD, matched for age, diabetes mellitus, sex, and culprit vessel. Baseline characteristics were comparable. Pre-intervention OCT imaging identified 62 paired culprit, 53 paired non-culprit, and ...

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    8. Intraluminal bioresorbable vascular scaffold dismantling with aneurysm formation leading to very late thrombosis

      Intraluminal bioresorbable vascular scaffold dismantling with aneurysm formation leading to very late thrombosis

      Coronary artery aneurysm formation has been described in patients after the placement of first-generation drug-eluting stents (DES), but is less common with newer generation metallic stents. In contrast, coronary artery aneurysm formation may be more common with the use of bioresorbable vascular scaffolds (BVS) due to the frequent formation of evaginations in the arterial wall seen with BVS. In this article, we describe a unique case of BVS dismantling and thrombus formation leading to an acute coronary syndrome thirty-two months after initial BVS placement. We also discuss existing literature and the pathophysiology of BVS degradation, in addition to the utility ...

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      Mentions: Gregg W. Stone
    9. Guiding Light: Insights Into Atherectomy by Optical Coherence Tomography

      Guiding Light: Insights Into Atherectomy by Optical Coherence Tomography

      Coronary calcification presents multiple technical challenges in percutaneous coronary intervention (PCI) and is associated with suboptimal procedural results and an increase in subsequent adverse clinical events (1) . Currently, there is no standardized evidence-based strategy for PCI of calcified coronary lesions. Decisions for the use of adjunctive atheroablation—shown to increase the acute procedural success rates (2) —are based on visual estimation of calcification severity on angiography (with its inherent limitations [3] ) or when delivery of devices is impeded by calcified deposits in the vessel wall. Although the so-called “rota-regret” remains common following suboptimal acute procedural results in calcified plaques not ...

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    10. Optical coherence tomography compared with intravascular ultrasound and with angiography to guide coronary stent implantation (ILUMIEN III: OPTIMIZE PCI): a randomised controlled trial

      Optical coherence tomography compared with intravascular ultrasound and with angiography to guide coronary stent implantation (ILUMIEN III: OPTIMIZE PCI): a randomised controlled trial

      Background Percutaneous coronary intervention (PCI) is most commonly guided by angiography alone. Intravascular ultrasound (IVUS) guidance has been shown to reduce major adverse cardiovascular events (MACE) after PCI, principally by resulting in a larger postprocedure lumen than with angiographic guidance. Optical coherence tomography (OCT) provides higher resolution imaging than does IVUS, although findings from some studies suggest that it might lead to smaller luminal diameters after stent implantation. We sought to establish whether or not a novel OCT-based stent sizing strategy would result in a minimum stent area similar to or better than that achieved with IVUS guidance and better ...

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    11. Utility of near-infrared spectroscopy for detection of thin-cap neoatherosclerosis

      Utility of near-infrared spectroscopy for detection of thin-cap neoatherosclerosis

      Aims Near-infrared spectroscopy (NIRS) has been employed to assess the composition of the atherosclerotic plaques in native coronary arteries. However, little is known about the detection of neoatherosclerosis by NIRS in in-stent restenosis (ISR). The aim of the study was to assess the relationship between the distribution of lipid determined by NIRS and morphology of ISR on optical coherence tomography (OCT). Methods and results We performed both NIRS and OCT in 39 drug-eluting stents with ISR. Values of lipid-core burden index (LCBI) derived by NIRS were compared with the OCT-derived thickness of the fibrous cap covering neoatherosclerotic lesions. A total ...

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    12. Two-year clinical, angiographic, and serial optical coherence tomographic follow-up after implantation of an everolimus-eluting bioresorbable scaffold and an everolimus-eluting metallic stent: insights from the randomised ABSORB Japan trial

      Two-year clinical, angiographic, and serial optical coherence tomographic follow-up after implantation of an everolimus-eluting bioresorbable scaffold and an everolimus-eluting metallic stent: insights from the randomised ABSORB Japan trial

      Aims: We sought to investigate two-year clinical and serial optical coherence tomography (OCT) outcomes after implantation of a fully bioresorbable vascular scaffold (BVS) or a cobalt-chromium everolimus-eluting stent (CoCr-EES). Methods and results: In the ABSORB Japan trial, 400 patients were randomised in a 2:1 ratio to BVS (N=266) or CoCr-EES (N=134). A pre-specified OCT subgroup (N=125, OCT-1 group) underwent angiography and OCT post procedure and at two years. Overall, the two-year TLF rates were 7.3% and 3.8% in the BVS and CoCr-EES arms (p=0.18), respectively. Very late scaffold thrombosis (VLST) beyond one ...

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    13. Update on Intracoronary Optical Coherence Tomography: a Review of Current Concepts

      Update on Intracoronary Optical Coherence Tomography: a Review of Current Concepts

      Purpose of review The advent of intracoronary optical coherence tomography (OCT) has been a significant leap forward in the ability to visualize coronary structures with unprecedented resolution. However, the clinical application of this imaging modality has lagged behind rapid technological advances. One of the main reasons for the lack of wider clinical uptake has been the paucity of appropriately designed prospective randomized studies to demonstrate the impact of OCT on outcome measures after percutaneous coronary intervention (PCI). Recent findings Over the last couple of years, studies from large registries have shown the impact of OCT in decision-making in PCI, with ...

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    14. Optical coherence tomography evaluation of intermediate-term healing of different stent types: systemic review and meta-analysis

      Optical coherence tomography evaluation of intermediate-term healing of different stent types: systemic review and meta-analysis

      Aims The intermediate-term incidence of strut malapposition (SM) and uncovered struts (US), and the degree of neointimal thickness (NIT) according to stent type have not been characterized. Methods and results All studies of >50 patients in which optical coherence tomography was performed between 6 and 12 months after stent implantation were included. The incidences of SM and US were the co-primary end points, while NIT was the secondary end point. A total of 458 citations were initially appraised at the abstract level, and 11 full-text studies (280 652 analysed struts, 921 patients) were assessed. The 6–12 months incidences of ...

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    15. Comparison of Stent Expansion Guided by Optical Coherence Tomography Versus Intravascular Ultrasound : The ILUMIEN II Study (Observational Study of Optical Coherence Tomography [OCT] in Patients Undergoing Fractional Flow Reserve [FFR] and Percutaneous Co

      Comparison of Stent Expansion Guided by Optical Coherence Tomography Versus Intravascular Ultrasound : The ILUMIEN II Study (Observational Study of Optical Coherence Tomography [OCT] in Patients Undergoing Fractional Flow Reserve [FFR] and Percutaneous Co

      Background The most important predictor of adverse outcomes (thrombosis and restenosis) after stent implantation with IVUS guidance is the degree of stent expansion achieved. Methods We compared the relative degree of stent expansion (defined as the minimal stent area divided by the mean of the proximal and distal reference lumen areas) after OCT-guided stenting in patients in the ILUMIEN (Observational Study of Optical Coherence Tomography [OCT] in Patients Undergoing Fractional Flow Reserve [FFR] and Percutaneous Coronary Intervention) (N = 354) and IVUS-guided stenting in patients in the ADAPT-DES (Assessment of Dual Antiplatelet Therapy With Drug-Eluting Stents) study (N = 586). Stent expansion ...

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    16. OCT Versus IVUS: Accuracy Versus Clinical Utility

      OCT Versus IVUS: Accuracy Versus Clinical Utility

      The technology of optical coherence tomography (OCT) has evolved from time-domain to frequency-domain imaging. Time-domain OCT is most often performed using proximal balloon occlusion; as such, dimensions are smaller than measured using intravascular ultrasound (IVUS), presumably due to diminished perfusion pressure. Conversely, frequency-domain OCT does not require proximal balloon occlusion, theoretically resulting in more accurate measurements. With this background, Kubo et al. ( 1 ) in this issue of iJACC , conducted a multicenter study to compare pre-intervention quantitative analysis and post-intervention qualitative analysis among frequency-domain OCT, IVUS, and quantitative coronary angiography (QCA). The mean minimum lumen diameter measured by QCA was smaller ...

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    17. In Search of Vulnerable Plaque

      In Search of Vulnerable Plaque

      Between 1970 and 2010, the number of cardiovascular deaths per 100 000 persons in the United States has fallen from ≈450 to ≈125, a reduction >70%.1 This marked decline in cardiovascular mortality represents one of the true success stories of modern medicine. The improving lifespan of both men and women can be attributed principally to prevention of death first from coronary artery disease (CAD) and second from stroke, with a much smaller contribution from other disease states.2 The decrease in coronary heart disease deaths may be ascribed to both treatment of acute coronary syndromes (ACS) and chronic CAD ...

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    18. Examination of the In Vivo Mechanisms of Late Drug-Eluting Stent Thrombosis: Findings From Optical Coherence Tomography and Intravascular Ultrasound Imaging

      Examination of the In Vivo Mechanisms of Late Drug-Eluting Stent Thrombosis: Findings From Optical Coherence Tomography and Intravascular Ultrasound Imaging
      Objectives: This study investigated the role of uncovered stent struts on late stent thrombosis (LST) after drug-eluting stent (DES) implantation with optical coherence tomography (OCT). Background: Autopsy studies have identified delayed healing and lack of endothelialization of DES struts as the hallmarks of LST. DES strut coverage has not previously been examined in vivo in patients with LST. Methods: We studied 54 patients, including 18 with DES LST (median 615 days after implant) undergoing emergent percutaneous coronary interventions and 36 matched DES control subjects undergoing routine repeat OCT and intravascular ultrasound (IVUS) who did not experience LST for 3 years ...
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    19. Correlation of Angiographic Late Loss With Neointimal Proliferation in Stents Evaluated by OCT and Histology in Porcine Coronary Arteries

      Correlation of Angiographic Late Loss With Neointimal Proliferation in Stents Evaluated by OCT and Histology in Porcine Coronary Arteries
      Objectives We aimed to evaluate the correlation of angiographic late loss (LL) with the degree of in-stent neointimal proliferation assessed by optical coherence tomography (OCT) and histology. Background Angiographic LL is the most common endpoint used in clinical trials for the evaluation of the efficacy of drug-eluting stents (DES). However, there are few data in regards to the accuracy of angiographic LL in the evaluation of DES displaying lower degrees of neointimal proliferation. Methods A total of 49 stents (36 DES and 13 bare-metal stents) were deployed in coronary arteries of 23 domestic swine and followed up for 28 or ...
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    20. A Prospective Natural-History Study of Coronary Atherosclerosis

      A Prospective Natural-History Study of Coronary Atherosclerosis
      Background Atherosclerotic plaques that lead to acute coronary syndromes often occur at sites of angiographically mild coronary-artery stenosis. Lesion-related risk factors for such events are poorly understood. Full Text of Background... Methods In a prospective study, 697 patients with acute coronary syndromes underwent three-vessel coronary angiography and gray-scale and radiofrequency intravascular ultrasonographic imaging after percutaneous coronary intervention. Subsequent major adverse cardiovascular events (death from cardiac causes, cardiac arrest, myocardial infarction, or rehospitalization due to unstable or progressive angina) were adjudicated to be related to either originally treated (culprit) lesions or untreated (nonculprit) lesions. The median follow-up period was 3.4 ...
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    21. Strut Coverage and Late Malapposition With Paclitaxel-Eluting Stents Compared With Bare Metal Stents in Acute Myocardial Infarction: OCT Substudy of the Harmonizing Outcomes With Revascularization and Stents in Acute Myocardial Infarction (HORIZONS-AMI)

      Strut Coverage and Late Malapposition With Paclitaxel-Eluting Stents Compared With Bare Metal Stents in Acute Myocardial Infarction: OCT Substudy of the Harmonizing Outcomes With Revascularization and Stents in Acute Myocardial Infarction (HORIZONS-AMI)
      Background— The safety of drug-eluting stents in ST-segment elevation myocardial infarction (STEMI) continues to be debated. Pathological studies have demonstrated an association between uncovered struts and subsequent stent thrombosis. Optical coherence tomography can detect stent strut coverage in vivo on a micron-scale level. We therefore used optical coherence tomography to examine strut coverage in patients with STEMI treated with paclitaxel-eluting stents (PES) and bare metal stents (BMS). Methods and Results— In the Harmonizing Outcomes With Revascularization and Stents in Acute Myocardial Infarction (HORIZONS-AMI) trial, patients with STEMI were randomized 3:1 to PES or BMS implantation. In a formal substudy ...
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    22. Unhealed Plaque Ruptures After Stenting in Acute Myocardial Infarction Assessed by Intracoronary Optical Coherence Tomography: Incidence, Predictors, and Clinical Implication

      Backgrounds: Non healing after stenting a ruptured thin capped fibroatheroma in acute myocardial infarction (AMI) has been suggested to be a possible cause of late stent thrombosis. Optical coherence tomography (OCT) provides detailed information of ruptured plaques and stent strut coverage. We used OCT to assess the incidence, predictors, and implications of residual plaque rupture after stenting in AMI. Methods: The HORIZONS-AMI trial was a prospective, multicenter, dual arm factorial trial in which pts with AMI were randomized to different antithrombotic regimens and paclitaxel-eluting TAXUS stents vs. bare metal EXPRESS stents (3:1). Clinical follow-up was performed at 12 months ...
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    1-23 of 23
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    Strut Coverage and Late Malapposition With Paclitaxel-Eluting Stents Compared With Bare Metal Stents in Acute Myocardial Infarction: OCT Substudy of the Harmonizing Outcomes With Revascularization and Stents in Acute Myocardial Infarction (HORIZONS-AMI) A Prospective Natural-History Study of Coronary Atherosclerosis The Reality of Vulnerable Plaque Detection Correlation of Angiographic Late Loss With Neointimal Proliferation in Stents Evaluated by OCT and Histology in Porcine Coronary Arteries Examination of the In Vivo Mechanisms of Late Drug-Eluting Stent Thrombosis: Findings From Optical Coherence Tomography and Intravascular Ultrasound Imaging In Search of Vulnerable Plaque OCT Versus IVUS: Accuracy Versus Clinical Utility Optical coherence tomography compared with intravascular ultrasound and with angiography to guide coronary stent implantation (ILUMIEN III: OPTIMIZE PCI): a randomised controlled trial IVUS-Guided Versus OCT-Guided Coronary Stent Implantation: A Critical Appraisal Measurement of the Shrinkage of Natural and Simulated Lesions on Root Surfaces using CP-OCT Optic-Net: A Novel Convolutional Neural Network for Diagnosis of Retinal Diseases from Optical Tomography Images Double layer sign: A new optical coherence tomography finding in active tubercular serpiginous-like choroiditis to monitor activity