Stent implantation for the treatment of coronary artery disease can cause unintended tearing at of vessel wall adjacent to the stent struts resulting in a stent edge dissection (SED)...
Background Optical coherence tomography (OCT) can detect detailed plaque features in native coronary arteries. Stent struts cause shadows that partially obscure the vessel wall, but plaque features can still be seen. We investigated the impact of stent artefact on plaque quantification and whether the plaque behind struts is associated with microvascular dysfunction. Methods Patients retrospectively recruited from two centres, underwent OCT pre- and post-stenting on the same vessel segment. Lipid (LA) and calcium (CA) were measured as arcs. Macrophages, microchannels and cholesterol crystals were counted. Subsequently, we determined whether stented plaque features were associated with reduced TIMI flow grade in ...
Aims: Qualitative criteria for plaque tissue characterisation by OCT are well established, but quantitative methods lack systematic validation in vivo . High optical attenuation coefficient µ t has been associated with unstable plaque features, such as lipid core. The purpose of this study was to validate optical coherence tomography (OCT) attenuation imaging for tissue characterisation in vivo , specifically to detect lipid core in coronary atherosclerotic plaques, and to evaluate quantitatively the ability of OCT attenuation imaging to differentiate thin-cap (TCFA) and thick-cap fibroatheroma (FA). Methods and results: We prospectively enrolled 85 patients undergoing imaging of a native coronary segment by both OCT ...
Aims: To evaluate the implications of an Absorb bioresorbable vascular scaffold (Absorb BVS) on the morphology of the superficial plaques. Methods and results: Forty-six patients who underwent Absorb BVS implantation and 20 patients implanted with bare metal stents (BMS) who had serial optical coherence tomographic examination at baseline and follow-up were included in this analysis. The thin-capped fibroatheromas (TCFA) were identified in the device implantation regions and in the adjacent native coronary segments. Within all regions, circumferential locations of TCFA and calcific tissues were identified, and the neointimal thickness was measured at follow-up. At six to 12-month follow-up, only 8 ...
A 68-year-old man was treated in our catheterization laboratory for ST-segment elevation myocardial infarction. He had undergone 3.5 × 18-mm bioresorbable vascular scaffold (BVS) implantation in the proximal left anterior descending coronary artery for stable angina in another institution 2 days before. At presentation, angiography showed a filling defect located >5 mm distally to the scaffolded segment ( Figure 1A ). An attempt at thrombus aspiration was performed, without retrieving any aspiration material, and the angiographic image remained unchanged ( Figure 1B ). Optical coherence tomography (OCT) was performed and revealed the absence of intraluminal thrombus, but the presence of an occlusive intramural hematoma ...
Intracoronary optical coherence tomography (OCT) is a light-based imaging modality able to visualise with high resolution (~10 μm) the vascular morphology and the acute and chronic effects of intervention with intracoronary devices. 1,2 OCT could therefore find application in the guidance of percutaneous coronary intervention (PCI), allowing a thorough preprocedural lesion assessment, which enables accurate device sizing, selection of the vessel segment requiring treatment, and, thus, efficient planning of the implantation strategy (see Table 1 ). 3 Moreover, it can be used for the assessment of the acute procedural result, allowing the estimation of stent expansion and vessel injury. Consequently ...
Background— Renal denervation is a new treatment considered for several possible indications. As new systems are introduced, the incidence of acute renal artery wall injury with relation to the denervation method is unknown. We investigated the acute repercussion of renal denervation on the renal arteries of patients treated with balloon-based and nonballoon-based denervation systems by quantitative angiography, intravascular ultrasound, and optical coherence tomography (OCT). Methods and Results— Twenty-five patients (50 renal arteries) underwent bilateral renal denervation with 5 different systems, 3 of which balloon-based (Paradise [n=5], Oneshot [n=6], and Vessix V2 [n=5)]) and 2 nonballoon-based (Symplicity [n ...
Aims: To evaluate the implications of an Absorb bioresorbable vascular scaffold (Absorb BVS) on the morphology of the superficial plaques. Methods and results: Forty-six patients who underwent Absorb BVS implantation and 20 patients implanted with bare metal stents (BMS) who had serial optical coherence tomographic examination at baseline and follow-up were included in this analysis. The thin-capped fibroatheromas (TCFA) were identified in the device implantation regions and in the adjacent native coronary segments. Within all regions, circumferential locations of TCFA and calcific tissues were identified, and the neointimal thickness was measured at follow-up. At six to 12-month follow-up, only 8 ...
Periprocedural guide-wire induced coronary artery dissection is a rare but potentially serious complication of PCI. Immediate stenting of the entry point is one of the therapeutic options but engaging the guide-wire in the true lumen may be challenging. We report a case of a 55-year-old woman with a guide-wire induced coronary dissection that occurred during treatment of a bifurcation lesion. Optical coherence tomography was instrumental to distinguish true form false lumen and thereby guide correct positioning of the guide-wire to successfully treat the lesion using a dedicated bifurcation stent.
Purpose: Neoatherosclerosis within a stent has been recently described as a culprit of late stent failure. We investigated by optical coherence tomography (OCT) the association of neoatherosclerotic plaque morphology with neointimal rupture (NR) and clinical presentation in patients late after coronary stent implantation. Methods: From 1/1/2007 to 31/1/2012, 74 patients from two institutions underwent OCT assessment of a coronary stent implanted at least 18 months prior to OCT study. Native atherosclerosis criteria were used for neointimal characterization. Results: Neoatherosclerosis was observed in 59.5% of the stents (n=44). Stents with neoatherosclerosis were more often associated ...
Purpose: In-stent neoatherosclerosis has been recognised in pathologic specimens of bare metal stents (BMS), and recently in first generation drug eluting stents (1st-DES), as well. However, in vivo data are scarce. By optical coherence tomography, we investigated the incidence and morphological characteristics of neoatherosclerosis (NA) very late after BMS or 1st-DES implantation. Methods: From 1/1/2007 to 31/1/2012, 52 patients from two institutions underwent >24 months follow-up OCT assessment of a BMS or a 1st-DES (13 BMS – 39 1st-DES). NA was characterized using criteria for native atherosclerosis. Results: BMS had longer follow-up interval but no differences in ...
A 33-year-old male soccer player started to experience chest discomfort briefly after taking a blow from an opponent’s knee into his chest during a dribbling maneuver on the pitch. He completed the game but then consulted a referring hospital because of waxing and waning chest complaints irradiating to his left arm. The ECG demonstrated ST-T–segment changes compatible with inferoposterior ischemia (Figure 1). Cardiac enzyme markers were elevated. Echocardiography confirmed inferior wall hypokinesis. The patient was loaded with aspirin and clopidogrel. He subsequently underwent transradial invasive coronary angiography, which demonstrated Thrombolysis In Myocardial Infarction (TIMI) 2 flow in the ...
Correct characterization of coronary bifurcations by optical coherence tomography (OCT) is critical in the evaluation of lesions, dedicated bifurcation stents and stent techniques. Assessment is limited by the need for acquiring images in both the main branch (MB) and the dissection prone side branch (SB). Analysis poses the significant risk of OCT cross sections not being perpendicular to the true vessel centerline due to imaging wires being non-parallel to the centerline. Correct measurements in tortuous vessels and ostia are particularly sensitive to the non-parallel wire problem and to the actual measurement plane, independent of whether a MB or a SB ...
This study sought to compare lumen dimensions as assessed by 3D quantitative coronary angiography (QCA) and by intravascular ultrasound (IVUS) or optical coherence tomography (OCT), and to assess the association of the discrepancy with vessel curvature. Coronary lumen dimensions often show discrepancies when assessed by X-ray angiography and by IVUS or OCT. One source of error concerns a possible mismatch in the selection of corresponding regions for the comparison. Therefore, we developed a novel, real-time co-registration approach to guarantee the point-to-point correspondence between the X-ray, IVUS and OCT images. A total of 74 patients with indication for cardiac catheterization were ...
A 58-year-old man, included in cohort A of the Bioabsorbable Vascular Solutions First in Man Clinical Investigation: A Clinical Evaluation of the Bioabsorbable Vascular Solutions Everolimus Eluting Coronary Stent System in the Treatment of Patients With Single de Novo Native Coronary Artery Lesions (ABSORB) trial,1 had undergone implantation of a bioresorbable everolimus-eluting scaffold (BVS; Abbott Vascular, Santa Clara, CA) in June 2006 because of stable angina class III with a positive exercise test (Figure 1). He had a positive family history for coronary artery disease. At implantation, his total cholesterol was 207 mg/dL, his low-density lipoprotein level was ...
Three-dimensional optical coherence tomography rendering has been suggested as a method providing additive information for the assessment of the result of percutaneous coronary intervention. However, rendering of such models is very time-consuming and cannot be performed online during the intervention. We present a case in which a new method for 3-dimensional rendering of optical coherence tomography images helped visualize the stent–vessel wall interaction, providing useful information that discouraged further intervention.
Abstract Optical coherence tomography (OCT) is a novel intravascular imaging modality using near-infrared light. By OCT it is possible to obtain high-resolution cross-sectional images of the vascular wall structure and assess the acute and long-term effects of percutaneous coronary intervention. For the time being OCT has been mainly used in research providing new insights into the pathophysiology of the atheromatic plaque and of the vascular response to stenting, however, it seems that there is potential for clinical application of OCT in various fields, such as pre-interventional evaluation of coronary arteries, procedural guidance in coronary interventions, and follow-up assessment of vascular ...
A 59-year old male with a history of controlled hyperlipidaemia, hypertension and diabetes mellitus presented with a recurrence of angina pectoris. Previously, in August 2000, two overlapping 4 mm by 12 mm igaki-Tamai stents had been implanted in his proximal right coronary artery...
Aims: The objective of this study is to evaluate the feasibility and safety of imaging human coronary arteries in vivo by optical frequency domain imaging (OFDI) in comparison to intravascular ultrasound (IVUS). OFDI has been recently developed to overcome the limitations of conventional time-domain optical coherence tomography (OCT), namely the need for proximal balloon occlusion. The Terumo-OFDI system is capable of acquiring images with high-speed automated pullback (up to 40 mm/sec) and requires only a short injection (3-4 sec) of small amount of x-ray contrast (9-16 ml). Methods and results: Nineteen patients who underwent stent implantation were enrolled. IVUS ...
