1. Articles from Fumiyuki Otsuka

    1-22 of 22
    1. In vivo imaging of vulnerable plaque with intravascular modalities: its advantages and limitations

      In vivo imaging of vulnerable plaque with intravascular modalities: its advantages and limitations

      In vivo imaging of plaque instability has been considered to have a great potential to predict future coronary events and evaluate the stabilization effect of novel anti-atherosclerotic medical therapies. Currently, there are several intravascular imaging modalities which enable to visualize plaque components associated with its vulnerability. These include virtual histology intravascular ultrasound (VH-IVUS), integrated backscatter IVUS (IB-IVUS), optical coherence tomography (OCT), near-infrared spectroscopy and coronary angioscopy. Recent studies have shown that these tools are applicable for risk stratification of cardiovascular events as well as drug efficacy assessment. However, several limitation exists in each modality. The current review paper will outline ...

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    2. https://doi.org/10.1093/eurheartj/ehaa632

      https://doi.org/10.1093/eurheartj/ehaa632

      A 56-year-old man with stable angina pectoris underwent implantation of a 3.5 mm × 28-mm Absorb bioresorbable vascular scaffold (BVS; Abbott Vascular, Santa Clara, CA, USA) in the left anterior descending coronary artery ( Panels A and B ). Optical coherence tomography (OCT) before ( Panel E ) and after implantation ( Panel F ) showed significant signal attenuation at the culprit site suggesting lipid-rich plaque, and fully apposed BVS struts ( Panel F and Supplementary material online , Video S1 ). Dual antiplatelet therapy (DAPT) with aspirin and clopidogrel continued for a year, followed by aspirin monotherapy. Follow-up angiography after 2 years showed a patent, scaffolded segment...

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    3. In vivo tissue characterization of human atherosclerotic plaques by optical coherence tomography: A directional coronary atherectomy study with histopathologic confirmation

      In vivo tissue characterization of human atherosclerotic plaques by optical coherence tomography: A directional coronary atherectomy study with histopathologic confirmation

      Background The histopathological validation of optical coherence tomography (OCT) in visualizing atherosclerotic plaques has been reported only in ex vivo studies. We sought to evaluate the accuracy of OCT in tissue characterization in vivo . Methods and results A total of 25 patients with stable angina pectoris who underwent directional coronary atherectomy (DCA) were included in the investigation, whereby OCT was performed before and after a single debulking. The debulked region was determined on OCT and classified into fibrous tissue, lipid, calcification, thrombus, and macrophage accumulation, which were compared with histology. Changes in OCT signal intensity in the deeper intimal region ...

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    4. Optical coherence tomography-verified morphological correlates of high-intensity coronary plaques on non-contrast T1-weighted magnetic resonance imaging in patients with stable coronary artery disease

      Optical coherence tomography-verified morphological correlates of high-intensity coronary plaques on non-contrast T1-weighted magnetic resonance imaging in patients with stable coronary artery disease

      Aims Coronary high-intensity plaques (HIPs) with a high plaque-to-myocardial signal intensity ratio (PMR) on non-contrast T1-weighted imaging in patients with stable coronary artery disease (CAD) are associated with future coronary events. To characterize the morphological substrate of HIP, we performed a correlative optical coherence tomography (OCT) study. Methods and results We examined 137 lesions in 105 patients with stable angina pectoris or silent myocardial ischaemia scheduled for percutaneous coronary intervention (PCI) using a 3 T magnetic resonance scanner. Pre-interventional OCT was performed for PCI target lesions. HIP was defined as PMR ≥ 1.4. Of the 137 lesions, 34% were HIP ...

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      Mentions: Jagat Narula
    5. Neoatherosclerosis in the Iliac Artery Stent ― Insights From Optical Coherence Tomography and Intravascular Ultrasound ―

      Neoatherosclerosis in the Iliac Artery Stent ― Insights From Optical Coherence Tomography and Intravascular Ultrasound ―

      There has been increasing attention on neoatherosclerosis in coronary arteries following implantation of bare-metal and drug-eluting stents.1,2 Neoatherosclerosis might be a concern even in the field of peripheral artery disease (PAD). A 75-year-old man with hypertension, diabetes mellitus, dyslipidemia and a history of right iliac artery stenting with a Wallstent 12 years previously, was referred to hospital for treatment of recurrent/progressive intermittent claudication (Rutherford category 3) that had started 6 months earlier. Ankle brachial index (ABI) was 0.51 on the right. Diagnostic angiography showed significant in-stent restenosis in the right iliac artery stent (Figure A). Intravascular ...

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    6. Optimization of coronary optical coherence tomography imaging using the attenuation-compensated technique: a validation study

      Optimization of coronary optical coherence tomography imaging using the attenuation-compensated technique: a validation study

      Purpose To optimize conventional coronary optical coherence tomography (OCT) images using the attenuation-compensated technique to improve identification of plaques and the external elastic lamina (EEL) contour. Method The attenuation-compensated technique was optimized via manipulating contrast exponent C, and compression exponent N, to achieve an optimal contrast and signal-to-noise ratio (SNR). This was applied to 60 human coronary lesions (38 native and 22 stented) ex vivo conventional coronary OCT images acquired from heart autopsies of 10 patients and matching histology was available as reference. Three independent reviewers assessed the conventional and attenuation-compensated OCT images blindly for plaque characteristics and EEL detection ...

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    7. Neoatherosclerosis: mirage of an ancient illness or genuine disease condition?

      Neoatherosclerosis: mirage of an ancient illness or genuine disease condition?

      In-stent neoatherosclerosis has become the darling of the interventional cardiology community and is blamed for most stent thrombosis (ST) occurring late after drug-eluting stent (DES) implantation. Neoatherosclerosis accounted for only 33% of late and very late ST at autopsy following implantation of first-generation DES. 1 However, the clinical prevalence of neoatherosclerosis and its percentage of cases presenting with late and very late ST remains unknown. In the current issue of the journal, Taniwaki et al . propose a significant and biologically relevant association between the presence of in-stent neoatherosclerosis and the progression of native atherosclerosis in a cohort of 88 patients ...

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    8. Neoatherosclerosis: overview of histopathologic findings and implications for intravascular imaging assessment

      Neoatherosclerosis: overview of histopathologic findings and implications for intravascular imaging assessment

      Despite the reduction in late thrombotic events with newer-generation drug-eluting stents (DES), late stent failure remains a concern following stent placement. In-stent neoatherosclerosis has emerged as an important contributing factor to late vascular complications including very late stent thrombosis and late in-stent restenosis. Histologically, neoatherosclerosis is characterized by accumulation of lipid-laden foamy macrophages within the neointima with or without necrotic core formation and/or calcification. The development of neoatherosclerosis may occur in months to years following stent placement, whereas atherosclerosis in native coronary arteries develops over decades. Pathologic and clinical imaging studies have demonstrated that neoatherosclerosis occurs more frequently and ...

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    9. Hypersensitivity Reaction in the US Food and Drug Administration-Approved Second-Generation Drug-Eluting Stents: Histopathological Assessment With Ex Vivo Optical Coherence Tomography

      Hypersensitivity Reaction in the US Food and Drug Administration-Approved Second-Generation Drug-Eluting Stents: Histopathological Assessment With Ex Vivo Optical Coherence Tomography

      A 55-year-old white man received 4 coronary stents, 3 Resolute zotarolimus-eluting stents (R-ZES; Medtronic, Santa Rosa, CA) and 1 XIENCE Xpedition (CoCr-EES; Abbott Vascular, Santa Clara, CA), for unstable angina pectoris 238 days antemortem. The patient was found dead and had recently been seen without any complaints. The patient had a history of hypertension, hyperlipidemia, and smoking. At the time of stent placement, coronary angiography revealed diffuse disease in the left anterior descending artery (LAD) with severe stenosis of the proximal LAD and moderate to severe stenosis of the mid LAD. Percutaneous coronary intervention was carried out, and 4 overlapping ...

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    10. Multiple Simultaneous Plaque Erosion in 3 Coronary Arteries

      Multiple Simultaneous Plaque Erosion in 3 Coronary Arteries

      We performed optical coherence tomography (OCT) imaging with matched histology in a 34-year-old man with history of smoking and untreated hyperlipidemia who had suffered from epigastric pain and was found dead at home. Multiple plaque erosions in 3 major coronary arteries were discovered (Figure 1 )

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    11. Matching human pathology is essential for validating OCT imaging to detect high-risk plaques

      Matching human pathology is essential for validating OCT imaging to detect high-risk plaques

      We thank Mark Brezinski for his Correspondence ( Capabilities, limitations, and misconceptions of using OCT to assess vulnerable plaques . Nat. Rev. Cardiol. doi:10.1038/nrcardio.2014.62-c1 ) 1 on our Review ( Clinical classification of plaque morphology in coronary disease . Nat. Rev. Cardiol. 11 , 379 – 389 ; 2014 ), 2 and for his comments and clarifications. We agree that the phenomenon

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    12. Clinical classification of plaque morphology in coronary disease

      Clinical classification of plaque morphology in coronary disease

      In published post-mortem pathological studies, more than two-thirds of acute coronary events are associated with the rupture of lipid-rich, voluminous, and outwardly remodelled plaques covered by attenuated and inflamed fibrous caps in the proximal part of coronary arteries. Superficial erosion of the plaques is responsible for most of the remaining events; the eroded plaques usually do not demonstrate much lipid burden, do not have thin fibrous caps, are not positively remodelled, and are not critically occlusive. Both noninvasive and invasive imaging studies have been performed to clinically define the plaque characteristics in acute coronary syndromes in an attempt to identify ...

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    13. Expectations and limitations of contemporary intravascular imaging: lessons learned from pathology

      Expectations and limitations of contemporary intravascular imaging: lessons learned from pathology

      Acute coronary syndrome is the leading cause of death worldwide and plaque rupture is the most common underlying mechanism of coronary thrombosis. During the last 2 decades the understanding of atherosclerotic plaque progression advanced dramatically and pathology studies provided fundamental insights of underlying plaque morphology, which paved the way for invasive imaging modalities, which bring a new area of atherosclerotic plaque characterization in vivo. The development of intravascular ultrasound (IVUS) allowed the field to evaluate the principles of vascular anatomy, which is often underestimated by coronary angiography. Furthermore, IVUS image technologies were developed to obtain improved characterization of plaque composition ...

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    14. Clinical use of Optical Coherence Tomography to identify angiographic silent stent thrombosis

      Clinical use of Optical Coherence Tomography to identify angiographic silent stent thrombosis

      Objectives: Patients previously treated with coronary stents may suffer an acute coronary syndrome (ACS) without any evidence of thrombus formation on coronary angiography (CAG). This may be due to partial, non-occlusive stent thrombosis with microembolization. In this paper we illustrate possible mechanisms both with Optical coherence tomography (OCT) and histology. Design: We present two cases with ACS from very late stent thrombosis, both previously treated with first generation drug eluting stents (DES). Results: The first patient had ACS 15 months after DES implantation. The angiogram (CAG) was near normal with slight peri-stent contrast staining. OCT revealed abnormalities including thrombus not ...

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    15. Increased Thin-Cap Neoatheroma and Periprocedural Myocardial Infarction in Drug-Eluting Stent Restenosis Multimodality Intravascular Imaging of Drug-Eluting and Bare-Metal Stents

      Increased Thin-Cap Neoatheroma and Periprocedural Myocardial Infarction in Drug-Eluting Stent Restenosis  Multimodality Intravascular Imaging of Drug-Eluting and Bare-Metal Stents

      Background— Re-endothelialization is delayed after drug-eluting stent (DES) implantation. In this setting, neointima is more prone to become lipid laden and develop neoatherosclerosis (NA), potentially increasing plaque vulnerability. Methods and Results— Optical coherence tomography and near-infrared spectroscopy with intravascular ultrasound were used to characterize NA in 65 (51 DES and 14 bare-metal stents) consecutive symptomatic patients with in-stent restenosis. Median duration poststent implantation was 33 months. Optical coherence tomography–verified NA was observed in 40 stents with in-stent restenosis (62%), was more prevalent in DES than bare-metal stents (68% versus 36%; P =0.02), and demonstrated significantly higher prevalence of ...

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    16. How Do OCT and IVUS Compare to Histology in Coronary Atherosclerosis and Stenting?

      How Do OCT and IVUS Compare to Histology in Coronary Atherosclerosis and Stenting?

      Abstract  Recent advances in intra-coronary imaging modalities have enabled us to evaluate precise plaque morphologies and vascular response to coronary stents in vivo. Superior resolution of optical coherence tomography (OCT) allows the measurement of fibrous cap thickness and detection of macrophage accumulation, both of which are critical to identify vulnerable plaques. Poor penetration of OCT however limits the assessment of plaque volume and vessel remodeling, while intravascular ultrasound (IVUS) is capable of evaluating these parameters. Caution must be exercised when interpreting IVUS-based tissue characterization because this technology lacks sufficient resolution to evaluate plaque composition. In stented arteries, OCT has the ...

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    17. Ex Vivo Assessment of Vascular Response to Coronary Stents by Optical Frequency Domain Imaging

      Ex Vivo Assessment of Vascular Response to Coronary Stents by Optical Frequency Domain Imaging

      Objectives This study sought to examine the capability of optical frequency domain imaging (OFDI) to characterize various morphological and histological responses to stents implanted in human coronary arteries. Background A precise assessment of vascular responses to stents may help stratify the risk of future adverse events in patients who have been treated with coronary stents. Methods Fourteen human stented coronary segments with implant duration ≥1 month from 10 hearts acquired at autopsy were interrogated ex vivo by OFDI and intravascular ultrasound (IVUS). Comparison with histology was assessed in 134 pairs of images where the endpoints were to investigate: 1) accuracy ...

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    18. Microvascular Obstruction Is Caused by Atherothrombosis in Patients With Acute Coronary Syndrome Undergoing Percutaneous Coronary Intervention

      Microvascular Obstruction Is Caused by Atherothrombosis in Patients With Acute Coronary Syndrome Undergoing Percutaneous Coronary Intervention

      The diagnosis of acute coronary syndrome (ACS) is primarily based on the mode of clinical presentation and is a term used for any conditions suggesting the acute induction of myocardial ischemia. The precise molecular and cellular triggers that lead to ACS remain poorly understood; however, histopathologic studies have illustrated several mechanisms that may explain the sudden onset of symptoms in ACS patients. The most common substrate underlying ACS is thought to be rupture of a vulnerable plaque that contains a necrotic core covered by a fibrous cap. The term, thin-cap fibroatheroma (TCFA) is used to describe vulnerable plaque because histomorphometric ...

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    19. Assessment of Morphological Features of Non-culprit Plaques in Patients With Acute Coronary Syndrome Using Optical Coherence Tomography

      Background: Previous studies have shown that the culprit lesion in patients (pts) with acute coronary syndrome (ACS) had thinner fibrous cap and higher incidence of plaque rupture and thrombus formation. Although plaque instability might be expected to develop in a multifocal pattern, morphological features including fibrous cap thickness of non-culprit plaques have not been well established. Therefore, we assessed the morphological features of non-culprit plaques in pts with ACS using optical coherence tomography (OCT). Methods: A total of 48 culprit and non-culprit coronary plaques (non-culprit vessel) in pts with coronary artery disease were interrogated by OCT before PCI. Pts were ...
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    1-22 of 22
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    Microvascular Obstruction Is Caused by Atherothrombosis in Patients With Acute Coronary Syndrome Undergoing Percutaneous Coronary Intervention Ex Vivo Assessment of Vascular Response to Coronary Stents by Optical Frequency Domain Imaging How Do OCT and IVUS Compare to Histology in Coronary Atherosclerosis and Stenting? Increased Thin-Cap Neoatheroma and Periprocedural Myocardial Infarction in Drug-Eluting Stent Restenosis  Multimodality Intravascular Imaging of Drug-Eluting and Bare-Metal Stents Clinical use of Optical Coherence Tomography to identify angiographic silent stent thrombosis Clinical classification of plaque morphology in coronary disease Matching human pathology is essential for validating OCT imaging to detect high-risk plaques Multiple Simultaneous Plaque Erosion in 3 Coronary Arteries Neoatherosclerosis: overview of histopathologic findings and implications for intravascular imaging assessment Impact of cardiometabolic factors on retinal vasculature: A 3x3, 6x6 and 8x8-mm optical coherence tomography angiography study Quantitative research on the interaction between cerebral edema and peripheral cerebral blood perfusion using swept-source optical coherence tomography Optical coherence tomography angiography measures blood pulsatile waveforms at variable tissue depths