1. Articles from Marco A. Costa

    1-24 of 52 1 2 3 »
    1. OCT guidance during stent implantation in primary Pci: A randomized multicenter study with nine months of optical coherence tomography follow-up

      OCT guidance during stent implantation in primary Pci: A randomized multicenter study with nine months of optical coherence tomography follow-up

      Aims To assess the possible merits of optical coherence tomography (OCT) guidance in primary percutaneous coronary intervention (pPCI). Methods and results 201 patients with ST-elevation myocardial infarction (STEMI) were enrolled in this study. Patients were randomized either to pPCI alone (angio-guided group, n = 96) or to pPCI with OCT guidance (OCT-guided group, n = 105) and also either to biolimus A9 or to everolimus-eluting stent implantation. All patients were scheduled for nine months of follow-up angiography and OCT study. OCT guidance led to post-pPCI optimization in 29% of cases (59% malapposition and 41% dissections). No complications were found related to the ...

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    2. OCT Made Easy (Textbook)

      OCT Made Easy (Textbook)

      This book, written by premier authors in the field of OCT intravascular imaging, covers the best practices for using OCT to provide high resolution cross-sectional viewing for atherosclerotic plaque assessment, stent strut coverage and apposition, assessment in stent restenosis evaluation, and PCI guide and optimization. Fully illustrated thorughout in a handy, cath-lab side handbook supplemented by online movie clips, OCT Made Easy includes case studies, angiography, CT correlations, and simple techniques for getting the best image.

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    3. Failure Mechanisms and Neoatherosclerosis Patterns in Very Late Drug-Eluting and Bare-Metal Stent Thrombosis

      Failure Mechanisms and Neoatherosclerosis Patterns in Very Late Drug-Eluting and Bare-Metal Stent Thrombosis

      Background— There are few clinical studies on the pathophysiological mechanisms of very late stent thrombosis (VLST). We report optical coherence tomography findings in patients with VLST and compare the findings between bare-metal stents (BMS) and drug-eluting stents (DES). Methods and Results— We conducted a registry of stent thrombosis at 4 North American centers with optical coherence tomography imaging programs SAFE registry (The Study of Late Stent Failure Evaluated by OCT). Images were acquired in 61 patients (42 DES and 19 BMS) presenting with definite VLST. The median duration from implantation to VLST presentation was 51.4 months in the DES ...

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    4. Comparative analysis method of permanent metallic stents (XIENCE) and bioresorbable poly-L-lactic (PLLA) scaffolds (Absorb) on optical coherence tomography at baseline and follow-up

      Comparative analysis method of permanent metallic stents (XIENCE) and bioresorbable poly-L-lactic (PLLA) scaffolds (Absorb) on optical coherence tomography at baseline and follow-up

      Aims: Fully bioresorbable Absorb poly-L-lactic-acid (PLLA) scaffolds (Abbott Vascular, Santa Clara, CA, USA) are a novel approach for the treatment of coronary narrowing. Due to the translucency of the material (PLLA), the optical coherence tomography (OCT) measurement methods used in the ABSORB trials were unique but not applicable for permanent metallic stents. When the Absorb scaffold and metallic stents are compared in the context of randomised trials, it is challenging to compare the two devices using the conventional methods. The primary purpose of this report is to explain the biases in conventional methodologies applied for metallic stents and for PLLA ...

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    5. 3-D Stent Detection in Intravascular OCT Using a Bayesian Network and Graph Search

      3-D Stent Detection in Intravascular OCT Using a Bayesian Network and Graph Search

      Worldwide, many hundreds of thousands of stents are implanted each year to revascularize occlusions in coronary arteries. Intravascular optical coherence tomography (OCT) is an important emerging imaging technique, which has the resolution and contrast necessary to quantitatively analyze stent deployment and tissue coverage following stent implantation. Automation is needed, as current, it takes up to 16 hours to manually analyze hundreds of images and thousands of stent struts from a single pullback. For automated strut detection, we used image formation physics and machine learning via a Bayesian network, and 3-D knowledge of stent structure via graph search. Graph search was ...

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    6. Differences determined by optical coherence tomography volumetric analysis in non-culprit lesion morphology and inflammation in ST-segment elevation myocardial infarction and stable angina pectoris patients

      Differences determined by optical coherence tomography volumetric analysis in non-culprit lesion morphology and inflammation in ST-segment elevation myocardial infarction and stable angina pectoris patients

      Background: While the current methodology for determining fibrous cap (FC) thickness of lipid plaques is based on manual measurements of arbitrary points, which could lead to high variability and decreased accuracy, it ignores the three-dimensional (3-D) morphology of coronary artery disease. Objective: To compare, utilizing optical coherence tomography (OCT) assessments, volumetric quantification of FC and macrophage detection using both visual assessment and automated image processing algorithms in non-culprit lesions of STEMI and stable angina pectoris (SAP) patients. Methods: Lipid plaques were selected from 67 consecutive patients (1 artery/patient). FC was manually delineated by a computer-aided method and automatically classified ...

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    7. Impact of Main-Branch Calcified Plaque on Side-Branch Stenosis in Bifurcation Stenting: An Optical Coherence Tomography Study

      Impact of Main-Branch Calcified Plaque on Side-Branch Stenosis in Bifurcation Stenting: An Optical Coherence Tomography Study

      Percutaneous coronary intervention (PCI) in bifurcations is routinely performed, however this procedure is associated with higher rates of adverse events compared non-bifurcation PCI [1,2]. While bifurcation PCI per se leads to progressively higher rates of periprocedural myocardial infarction as its complexity increases (i.e., 1- vs. 2-stent technique) [3], side-branch (SB) stenosis (SBS) after main-branch (MB) stenting may further contribute to myocardial ischemia and necrosis; in addition, it might require additional intervention and resource utilization.

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    8. Comparison of scanning electron microscopy and optical coherence tomography (OCT) for imaging of coronary bifurcation stents

      Comparison of scanning electron microscopy and optical coherence tomography (OCT) for imaging of coronary bifurcation stents

      Background: Optical coherence tomography (OCT) is a new intracoronary imaging modality that has excellent resolution and image quality and has been used to image neointimal coverage after stent implantation. OCT has been compared to histologic, intravascular ultrasound, and scanning electron microscopy (SEM) studies. However, OCT has not been compared with SEM for imaging stent coverage over side branches. Objective: The aim of this study was to compare OCT with scanning electron microscopy (SEM) in imaging neointimal coverage over stent struts bridging coronary side-branch ostia. Methods: Using a balloon-overstretch in-stent restenosis model, we deployed 38 everolimus-eluting stents across coronary bifurcations in ...

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    9. Intravascular Frequency-Domain Optical Coherence Tomography Assessment of Carotid Artery Disease in Symptomatic and Asymptomatic Patients

      Intravascular Frequency-Domain Optical Coherence Tomography Assessment of Carotid Artery Disease in Symptomatic and Asymptomatic Patients

      Objectives The goal of this study was to investigate carotid plaque characteristics in symptomatic versus asymptomatic patients with the use of nonocclusive optical coherence tomography (OCT). Background The identification of asymptomatic patients with carotid disease who are at risk of stroke remains a challenge. There is an increasing awareness that plaque characteristics may best risk-stratify this population. We hypothesized that OCT, a new high-resolution (∼10 μm) imaging modality, might be useful for the identification of low-risk versus high-risk carotid plaque features and help us to understand the relationship between carotid diameter stenosis and plaque morphology to ischemic stroke. Methods Fifty-three ...

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    10. Frequency-domain optical coherence tomography evaluation of a patient with Kawasaki disease and severely calcified plaque

      Frequency-domain optical coherence tomography evaluation of a patient with Kawasaki disease and severely calcified plaque

      Patients with Kawasaki disease (KD) not treated with immunoglobulin therapy have a 25% risk of developing coronary aneurysms, which lead to adverse cardiovascular events such as myocardial infarction and death . In addition, these individuals frequently present significant calcium deposits in regions of previous inflammation in the coronaries . OCT assessment of stent-vessel interactions seems to be more accurate than IVUS' in patients with highly calcified plaques .

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    11. Frequency-Domain Optical Coherence Tomography Assessment of Unfavorable Kissing-Balloon Result in Unprotected Left Main Intervention

      Frequency-Domain Optical Coherence Tomography Assessment of Unfavorable Kissing-Balloon Result in Unprotected Left Main Intervention

      A 67-year-old man with a history of hypertension and dyslipidemia was admitted because of angina symptoms. Coronary angiography (CAG) showed an eccentric lesion of the distal unprotected left main coronary artery (ULMCA) involving the ostium of the left anterior descending coronary artery (LAD) (Figure 1 A). ULMCA/LAD crossover stent implantation was conducted with a 3.5 × 18-mm everolimus-eluting stent (EES) (XIENCE PRIME, Abbott Vascular, Santa Clara, California) at 12 atm, followed by the kissing-balloon technique (KBT). Despite a favorable CAG result (Figure 2 A), frequency-domain optical coherence tomography (FD-OCT) revealed stent strut deformation towards the LAD, leading to a ...

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    12. Serial assessment of vessel interactions after drug-eluting stent implantation in unprotected distal left main coronary artery disease using frequency-domain optical coherence tomography

      Serial assessment of vessel interactions after drug-eluting stent implantation in unprotected distal left main coronary artery disease using frequency-domain optical coherence tomography

      Objectives This study sought to assess stent-vessel interactions after drug-eluting stent (DES) implantation in unprotected left main coronary artery (ULM) by frequency-domain optical coherence tomography (FD-OCT). Background Percutaneous coronary intervention using DES in ULM has been increasingly performed in routine practice. Recently, FD-OCT assessments of DES-vessel interactions have been used as surrogates for DES safety; however, there are no FD-OCT studies in ULM. Methods We prospectively enrolled 33 consecutive patients with ULM disease treated with sirolimus- (n = 11) and everolimus-eluting stents (n = 22). FD-OCT assessments were performed post-percutaneous coronary intervention and at 9-month follow-up. Three different segments of ULM were ...

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    13. Novel use of optical coherence tomography

      Novel use of optical coherence tomography

      Currently in use by interventional cardiology for the intravascular evaluation of coronary arteries, optical coherence tomography (OCT) has proven to be effective in the evaluation of atherosclerotic disease and further therapeutic management. We report a novel use of OCT technology in the case of a 46-year-old man with sudden onset blurred vision and greater than 70% stenosis of his left vertebral artery. To date, no detailed descriptions or case reports have previously been reported regarding the use of neuroendovascular OCT in diseased arteries.

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    14. Serial Assessment by Optical Coherence Tomography of Early and Late Vascular Responses After Implantation of an Absorbable-Coating Sirolimus-Eluting Stent (from the First-in-Human DESSOLVE I Trial)

      Serial Assessment by Optical Coherence Tomography of Early and Late Vascular Responses After Implantation of an Absorbable-Coating Sirolimus-Eluting Stent (from the First-in-Human DESSOLVE I Trial)

      The initial enthusiasm caused by the potent antirestenotic effect of early generation drug-eluting stents was recently plagued by concerns regarding their safety profile. Investigators worldwide were stimulated, therefore, to seek for improvement in drug-eluting stent technology, such as eliminating their permanent polymer blamed for vascular inflammation and delayed healing. Optical coherence tomography (OCT) assessments of stent-vessel interactions are used as a surrogate for vessel healing after DES implantation. Herewith, we report serial OCT assessments of vascular reactions to the implantation of a novel absorbable polymer sirolimus-eluting stent (MiStent). In total, 30 patients were included. At 4-, 6-, and 8-month follow-up ...

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    15. Incidence, Predictors, Morphological Characteristics, and Clinical Outcomes of Stent Edge Dissections Detected by Optical Coherence Tomography

      Incidence, Predictors, Morphological Characteristics, and Clinical Outcomes of Stent Edge Dissections Detected by Optical Coherence Tomography

      Objectives This study sought to investigate the frequency, predictors, and detailed qualitative and quantitative assessment of optical coherence tomography (OCT)-detected stent edge dissections. Its impact on subsequent management and clinical outcomes were also investigated. Background OCT is a high-resolution imaging modality that can lead to more frequent recognition and accurate assessment of vascular injuries during percutaneous coronary intervention (PCI). Methods From September 2010 to June 2011, all patients with OCT post-PCI were enrolled. Edge dissections were defined as disruptions of the arterial lumen surface in both the 5-mm distal and proximal stent edges. Qualitative and quantitative analyses of all ...

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    16. Volumetric Characterization of Human Coronary Calcification by Frequency-Domain Optical Coherence Tomography.

      Volumetric Characterization of Human Coronary Calcification by Frequency-Domain Optical Coherence Tomography.

      Background: Coronary artery calcification (CAC) presents unique challenges for percutaneous coronary intervention. Calcium appears as a signal-poor region with well-defined borders by frequency-domain optical coherence tomography (FD-OCT). The objective of this study was to demonstrate the accuracy of intravascular FD-OCT to determine the distribution of CAC. Methods and Results: Cadaveric coronary arteries were imaged using FD-OCT at 100-μm frame interval. Arteries were subsequently frozen, sectioned and imaged at 20-μm intervals using the Case Cryo-Imaging automated system TM . Full volumetric co-registration between FD-OCT and cryo-imaging was performed. Calcium area, calcium-lumen distance (depth) and calcium angle were traced on every ...

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    17. Optical coherence tomography versus intravascular ultrasound to evaluate coronary artery disease and percutaneous coronary intervention

      Optical coherence tomography versus intravascular ultrasound to evaluate coronary artery disease and percutaneous coronary intervention

      We compared intravascular ultrasound (IVUS) and 2 different generations of optical coherence tomography (OCT)—time-domain OCT (TD-OCT) and frequency-domain OCT (FD-OCT)—for the assessment of coronary disease and percutaneous coronary intervention (PCI) using stents. Background OCT is a promising light-based intravascular imaging modality with higher resolution than IVUS. However, the paucity of data on OCT image quantification has limited its application in clinical practice. Methods A total of 227 matched OCT and IVUS pull backs were studied. One hundred FD-OCT and IVUS pull backs in nonstented (n = 56) and stented (n = 44) vessels were compared. Additionally, 127 matched TD-OCT and ...

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    18. Optical coherence tomography for characterization of cardiac allograft vasculopathy after heart transplantation (OCTCAV study)

      Optical coherence tomography for characterization of cardiac allograft vasculopathy after heart transplantation (OCTCAV study)

      BACKGROUND Optical coherence tomography (OCT) is a novel intravascular imaging modality with excellent spatial resolution. This study explored the utility of OCT in cardiac transplantation for the detection and characterization of early changes associated with coronary allograft vasculopathy (CAV). METHODS Fifteen consecutive patients, 1 to 4 years after transplant with no angiographic evidence of CAV, underwent successful OCT imaging using the Fourier-domain OCT system (C7-XR, St. Jude Medical, St. Paul, MN) in the left anterior descending artery. Analysis included measurements of the lumen, intima, and media layers, and characterization of atherosclerotic plaques. Patients were stratified by intima-to-media (I/M) ratio ...

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    19. Very long-term follow-up of strut apposition and tissue coverage with Biolimus A9 stents analyzed by optical coherence tomography

      Very long-term follow-up of strut apposition and tissue coverage with Biolimus A9 stents analyzed by optical coherence tomography

      First generation drug-eluting stents (DES) are associated with reduced in-stent restenosis but significant increased risk of very late stent thrombosis (VLST). The absence of polymer in DES systems may reduce the occurrence of VLST. Optic coherence tomography (OCT) has been used for stent analysis as a surrogate safety endpoint. This study aimed to assess the long-term follow up of strut apposition and tissue coverage of BioMatrix™ DES by OCT. 20 patients undergoing BioMatrix™ DES (n = 15) or S-Stent™ BMS (n = 5) implantation were followed for at least 5 years and evaluated by quantitative coronary angiography, intravascular ultrasound, and OCT. The ...

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    20. Frequency-Domain Optical Coherence Tomography Assessment of Stent Constriction 9 Months After Sirolimus-Eluting Stent Implantation in a Highly Calcified Plaque

      Frequency-Domain Optical Coherence Tomography Assessment of Stent Constriction 9 Months After Sirolimus-Eluting Stent Implantation in a Highly Calcified Plaque

      A 60-year-old man with a history of chronic renal failure in hemodialysis was admitted due to angina symptoms. Coronary angiography showed an eccentric lesion of distal unprotected left main coronary artery involving the ostium of left anterior descending artery (Figure 22_gr1 A). Frequency-domain optical coherence tomography (FD-OCT) revealed a calcified plaque protruding to the lumen (Figure 22_gr1 -a). Rotational atherectomy with a 2.0-mm burr (Figure 22_gr1 -b) was conducted before the implantation of a 3.5 × 18 mm sirolimus-eluting stent at 12 atm., which was followed by intra-stent post-dilation with a noncompliant 4.0 × 12 mm balloon at 18 ...

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    21. Frequency-domain optical coherence tomography assessment of unprotected left main coronary artery disease - a comparison with intravascular ultrasound

      Frequency-domain optical coherence tomography assessment of unprotected left main coronary artery disease - a comparison with intravascular ultrasound

      Objectives: To investigate safety and feasibility of imaging unprotected left main (ULM) using frequency-domain optical coherence tomography (FD-OCT) compared with intravascular ultrasound (IVUS). Background: IVUS has been used to assess and guide percutaneous coronary intervention (PCI) of ULM disease. FD-OCT offers 10-fold higher axial resolution than IVUS and its high-speed image acquisition obviates the need for proximal balloon occlusion. Methods: We prospectively enrolled 35 consecutive patients with ULM disease. FD-OCT and IVUS assessments were attempted pre- and post-PCI and compared in regards to safety, ability to image the region of interest (ROI), number of pullbacks, volume of contrast and ability ...

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    22. Frequency-domain optical coherence tomography assessment of very late vascular response after carotid stent implantation

      Frequency-domain optical coherence tomography assessment of very late vascular response after carotid stent implantation

      Intravascular optical coherence tomography is a high-resolution invasive imaging modality that allows the evaluation of vascular responses after stent implantation in a micron-scale level. We describe for the first time two patients with very late vascular response after carotid artery stenting that exhibit two different patterns of low-signal intensity (LSI), "ill-appearing" neointima: the first patient shows layered LSI neointima leading to stent restenosis, coupled with the presence of intraluminal thrombus, whereas the second patient demonstrates another pattern of non-restenotic LSI stent strut coverage, suggestive of lipid laden neointima (ie, "neoatherosclerosis"), recently associated with stent failure in coronary arteries.

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    23. Feature Of The Week 1/20/13: CWRU Demonstrates Automatic Stent Detection in Intravascular OCT Images Using Bagged Decision Trees

      Feature Of The Week 1/20/13: CWRU Demonstrates Automatic Stent Detection in Intravascular OCT Images Using Bagged Decision Trees

      Cardiovascular disease is the leading cause of death worldwide. Stent implantation by means of percutaneous coronary intervention is the most common coronary revascularization procedure. Intravascular Optical Coherence Tomography (iOCT) is the only imaging modality with the resolution and contrast necessary to enable accurate measurements of luminal architecture and neointima stent coverage. Manual analysis of intravascular OCT pullbacks is time consuming, limiting the size and number of studies that can be performed. We developed a highly automated method for detecting stent struts and measuring tissue coverage. Candidate struts were first identified using image processing techniques. We trained a bagged decision trees ...

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    24. Serial Evaluation of Vascular Response After Implantation of a New Sirolimus-Eluting Stent with Bioabsorbable Polymer (MISTENT): An Optical Coherence Tomography and Histopathological Study

      Serial Evaluation of Vascular Response After Implantation of a New Sirolimus-Eluting Stent with Bioabsorbable Polymer (MISTENT): An Optical Coherence Tomography and Histopathological Study

      Abstract: Background. Novel vascular scaffolds aim at equipoise between safety and efficacy. Intravascular optical coherence tomography (OCT) allows in-vivo serial assessment of stent-vessel interactions with high resolution and frequent sampling and may complement histology assessment. We investigated the vascular response to a novel absorbable coating sirolimus-eluting stent (AC-SES) by means of serial OCT and histology evaluation in a porcine model. Methods. One AC-SES and one bare-metal stent (BMS) were implanted in separate coronary arteries of three Yucatan mini-swine. Serial OCT was performed post procedure and at 3-, 28-, 90-, and 180-day follow-up. Normalized optical density (NOD) was used for the ...

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    1-24 of 52 1 2 3 »
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    1. (52 articles) Marco A. Costa
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    "Old" problems revisited; imaging the coronary in high resolution Use of optical coherence tomography for accurate characterization of atherosclerosis Optical coherence tomography (OCT) strut-level analysis of drug-eluting stents (DES) in human coronary bifurcations Semiautomatic segmentation and quantification of calcified plaques in intracoronary optical coherence tomography images 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) In vitro validation of new Fourier-domain optical coherence tomography Congratulations to Zhao Wang from CWRU a Winner of a 2012 Student Travel Grant Award 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 Feasibility and Safety of the Second-Generation, Frequency Domain Optical Coherence Tomography (FD-OCT): A Multicenter Study Feature Of The Week 05.26.2019: In vivo volumetric imaging by crosstalk-free full-field OCT Impact of Posterior Sclera on Glaucoma Progression in Treated Myopic Normal-Tension Glaucoma Using Reconstructed Optical Coherence Tomographic Images Intravascular Ultrasound and Optical Coherence Tomography in the Procedural Planning and Execution of Left Main Coronary Artery Percutaneous Coronary Intervention