1. Articles from Hiram G. Bezerra

    25-48 of 76 « 1 2 3 4 »
    1. Proximal optimization technique and kissing balloon inflations with the bioresorbable vascular scaffold for coronary bifurcation percutaneous coronary intervention

      Proximal optimization technique and kissing balloon inflations with the bioresorbable vascular scaffold for coronary bifurcation percutaneous coronary intervention

      Proximal optimization technique and final kissing balloon inflations with noncompliant balloons facilitate success with coronary bifurcation intervention. The use of bioresorbable vascular scaffolds has been postulated to reduce the risk of in-stent restenosis, a particular problem with bifurcation intervention. We present a case of bifurcation intervention in a 49-year-old woman, using for the first time, proximal optimization and kissing balloon inflation within bioresorbable vascular scaffolds, using optical coherence tomography guidance.

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    2. 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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    3. 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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    4. 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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    5. 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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    6. Feasibility of Optical Coherence Tomography in Children with Kawasaki Disease and Pediatric Heart Transplant Recipients

      Feasibility of Optical Coherence Tomography in Children with Kawasaki Disease and Pediatric Heart Transplant Recipients

      Background —Optical Coherence Tomography (OCT) is a high-resolution intravascular imaging technique used in adults. We tested the hypothesis that OCT could identify coronary abnormalities not seen by angiography in children with a history of Kawasaki Disease (KD) and pediatric heart transplant (TX) recipients. Methods and Results —KD patients and TX recipients were evaluated between December 2012 and October 2013 with angiography and OCT (Ilumien System, LightLabs, St Jude Medical, Westford, MA). Modifications were made to the adult OCT protocol to adapt this technique for children. Serial cross sectional area (CSA) measurements of the lumen, intima and media were made. Entire ...

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    7. Optical coherence tomography and intravascular ultrasound of double kissing crush coronary bifurcation stenting

      Optical coherence tomography and intravascular ultrasound of double kissing crush coronary bifurcation stenting

      A 55-year-old male underwent percutaneous coronary intervention (PCI) of a Medina 1,1,1 circumflex (LCx) and a first obtuse marginal (OM1) bifurcation lesion. A double kissing crush technique was performed, utilising a 2.75×12 mm everolimus-eluting stent (EES) in OM1 and a XIENCE V 4.0×15 mm EES (Abbott Vascular, Santa Clara, CA, USA) in the LCx (Online Figure 1). Intravascular ultrasound (IVUS) and optical coherence tomography (OCT) runs were performed (Online Figure 2, Online Figure 3, Moving image 1). 3D reconstruction of the OCT further clarified the reconstruction of the bifurcation carina and paving, in particular ...

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    8. Optical coherence tomography of the intracranial vasculature and Wingspan stent in a patient

      Optical coherence tomography of the intracranial vasculature and Wingspan stent in a patient

      A 67-year-old man with medically refractory vertebrobasilar insufficiency and short segment occlusions of the intracranial vertebral arteries was treated with angioplasty and stent placement. Fifteen hours after the procedure the patient developed symptoms of posterior fossa ischemia and repeat angiography showed thrombus formation within the stent which was treated with thrombolytic and aggressive antiplatelet therapy. Angiography revealed lysis of the clot, but concerns regarding the mechanism of the thrombotic phenomenon prompted frequency-domain optical coherence tomography (FDOCT) assessment. FDOCT provided excellent visualization of the stent and vessel wall interactions, as well as excluding residual flow-limiting stenosis, obviating the need for further ...

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    9. 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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    10. Comprehensive overview of definitions for optical coherence tomography-based plaque and stent analyses

      Comprehensive overview of definitions for optical coherence tomography-based plaque and stent analyses

      Optical coherence tomography (OCT) is the current state-of-the-art intracoronary imaging modality that allows visualization of detailed morphological characteristics of both atherosclerotic plaque and stent. So far, three expert review documents have been released for standardization of OCT image analysis. In the real world, a variety of definitions are being used by different groups and by different core laboratories to analyze OCT findings because of different clinical/procedural contexts in which OCT research has been carried out. This comprehensive overview is aimed to summarize different applicable definitions used by different research groups in plaque and stent analysis using OCT. In addition ...

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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. The use of dextran and carbon dioxide for optical coherence tomography in the superficial femoral artery

      The use of dextran and carbon dioxide for optical coherence tomography in the superficial femoral artery

      The following case report describes using carbon dioxide (CO 2 ) as contrast media for intravascular optical coherence tomography (OCT) imaging in the superficial femoral artery. For initial OCT imaging, 20 mL of iodinated contrast was used during automated pullback. This was followed by 20 mL of hand-injected dextran 40 in normal saline, and finally hand-injected 50 mL of CO 2 . CO 2 gave comparable erythrocyte clearance and imaging quality compared with dextran and iodinated contrast. To our knowledge, this is the first reported case using both dextran and CO 2 with OCT imaging of the superficial femoral artery. Using CO ...

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    18. 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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    19. 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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    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. Volumetric assessment of lesion severity with optical coherence tomography: relationship with fractional flow reserve

      Volumetric assessment of lesion severity with optical coherence tomography: relationship with fractional flow reserve

      Aims: Frequency-domain optical coherence tomography (FD-OCT) provides a rapid tomographic scan of a coronary vessel, with an accurate reconstruction of its lumen profile. An FD-OCT-based metric that corresponds more closely with physiological significance of lesions may enable more precise guidance of interventional procedures. The aim of this feasibility study was to evaluate a new method for quantifying coronary lesion severity that estimates hyperaemic flow resistance of branched vessel segments imaged by FD-OCT. Methods and results: An analytical flow model was developed that relates fractional flow reserve (FFR) to the vascular resistance ratio (VRR), a measure of blood flow resistance derived ...

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    22. 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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    23. 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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    24. 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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    25-48 of 76 « 1 2 3 4 »
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