1. Articles from Filippo Crea

    1-24 of 77 1 2 3 4 »
    1. Coronary artery plaque rupture and erosion: Role of wall shear stress profiling and biological patterns in acute coronary syndromes

      Coronary artery plaque rupture and erosion: Role of wall shear stress profiling and biological patterns in acute coronary syndromes

      Aims Wall shear stress (WSS) is involved in coronary artery plaque pathological mechanisms and modulation of gene expression. This study aims to provide a comprehensive haemodynamic and biological description of unstable (intact-fibrous-cap, IFC, and ruptured-fibrous-cap, RFC) and stable (chronic coronary syndrome, CCS) plaques and investigate any correlation between WSS and molecular pathways. Methods and results We enrolled 24 CCS and 25 Non-ST Elevation Myocardial Infarction-ACS patients with IFC ( n = 11) and RFC ( n = 14) culprit lesions according to optical coherence tomography analysis. A real-time PCR primer array was performed on peripheral blood mononuclear cells for 17 different molecules whose expression ...

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    2. Definition of Optimal Optical Coherence Tomography–Based Stent Expansion Criteria: In-Stent Minimum Lumen Area Versus Residual Stent Underexpansion

      Definition of Optimal Optical Coherence Tomography–Based Stent Expansion Criteria: In-Stent Minimum Lumen Area Versus Residual Stent Underexpansion

      Background: The mismatch between in-stent minimum lumen area (sMLA) and reference vessel lumen area, defined as stent underexpansion (SU), could be an important determinant of stent failure. We tested the clinical predictive value of absolute sMLA in comparison to relative SU in the context of the CLI-OPCI (Centro Per La Lotta Contro L'Infarto-Optimisation of Percutaneous Coronary Intervention) project registry. Methods: We retrospectively analyzed end procedural optical coherence tomography findings in 1211 patients (1422 lesions) undergoing percutaneous coronary intervention, assessing the prevalence and magnitude of residual SU and exploring correlation with outcome in comparison with sMLA. Results: In our series ...

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    3. Optical coherence tomography-derived lipid core burden index and clinical outcomes: results from the CLIMA registry

      Optical coherence tomography-derived lipid core burden index and clinical outcomes: results from the CLIMA registry

      Aims: The aim of this study was to assess the morphological characteristics and prognostic implications of the optical coherence tomography (OCT)-derived lipid core burden index (LCBI). Methods and results: OCT-LCBI was assessed in 1003 patients with 1-year follow-up from the CLIMA multicentre registry using a validated software able to automatically obtain a maximum OCT-LCBI in 4 mm (maxOCT-LCBI4mm). Primary composite clinical endpoint included cardiac death, myocardial infarction, and target-vessel revascularization. A secondary analysis using clinical outcomes of CLIMA study was performed. Patients with a maxOCT-LCBI4mm ≥ 400 showed higher prevalence of fibrous cap thickness (FCT) <75 μm [odds ratio (OR ...

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    4. The fingerprints of plaque rupture healing as detected by serial optical coherence tomography imaging

      The fingerprints of plaque rupture healing as detected by serial optical coherence tomography imaging

      Plaque rupture healing detected by serial optical coherence tomography imaging. A-B) RCA angiogram showing a focal, complex lesion at the crux (red arrow in magnification). C-D) 3D and 2D longitudinal OCT views showing a plaque rupture (red arrows) with a large empty cavity (asterisks). E) Thin-cap fibroatheroma (white arrowheads). F-G) Ruptured plaque, with a fibrous cap discontinuity (red arrows) and a cavity (asterisks). H) Layered pattern (white arrowheads). A’-B’) Follow-up RCA angiogram showing a resolution of the ulceration and a smooth vessel profile (red arrow in magnification). C’-D’) Follow-up 3D and 2D 

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    5. Optical coherence tomography in coronary atherosclerosis assessment and intervention

      Optical coherence tomography in coronary atherosclerosis assessment and intervention

      Since optical coherence tomography (OCT) was first performed in humans two decades ago, this imaging modality has been widely adopted in research on coronary atherosclerosis and adopted clinically for the optimization of percutaneous coronary intervention. In the past 10 years, substantial advances have been made in the understanding of in vivo vascular biology using OCT. Identification by OCT of culprit plaque pathology could potentially lead to a major shift in the management of patients with acute coronary syndromes. Detection by OCT of healed coronary plaque has been important in our understanding of the mechanisms involved in plaque destabilization and healing ...

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    6. Have I lost my large rupture cavity? The fingerprint of atherosclerotic plaque healing detected by serial optical coherence tomography imaging

      Have I lost my large rupture cavity? The fingerprint of atherosclerotic plaque healing detected by serial optical coherence tomography imaging

      A 64-year-old man, prior smoker, with a history of paroxysmal atrial fibrillation was referred to our hospital due to worsening dyspnoea, progressively worsening angina, and a positive stress EKG testing. Coronary angiography (CAG) showed an angiographically intermediate stenosis of the mid left anterior descending (LAD) artery and a focal, complex lesion of the distal right coronary artery (RCA) (Figure 1A and B, red arrow). Treatment of the LAD stenosis was deferred based on a negative fractional flow reserve value (i.e. 0.85). Optical coherence tomography (OCT) imaging (ILUMIEN OPTIS, Abbott Vascular, Santa Clara, CA) was performed to better characterize ...

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      Mentions: Abbott
    7. Coronary plaque healing and diabetes: insights from optical coherence tomography imaging

      Coronary plaque healing and diabetes: insights from optical coherence tomography imaging

      Aims Atherosclerotic plaque healing is a dynamic process developing after plaque rupture or erosion, which aims to prevent lasting occlusive thrombus formation and to promote plaque repair. We hypothesized that diabetes mellitus, one of the major conventional cardiovascular risk factors, may influence the healing capacity after plaque destabilization. Methods and results In this single-centre observational cohort study, patients with acute coronary syndrome (ACS) or chronic coronary syndrome (CCS) who underwent optical coherence tomography (OCT) imaging at Fondazione Policlinico A. Gemelli–IRCCS, Rome, were included. Patients were divided into two groups (i.e. diabetes vs. no diabetes), and stratified based on ...

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    8. Relationship between the amount and location of macrophages and clinical outcome: subanalysis of the clima-study

      Relationship between the amount and location of macrophages and clinical outcome: subanalysis of the clima-study

      Background The ability of optical coherence tomography (OCT) to recognize intraplaque macrophage infiltration is now well acknowledged. This post-hoc analysis of the CLIMA study aimed to address the clinical impact of the circumferential extension of OCT-defined macrophages and their location at one year follow-up. Methods The multicentre CLIMA study enrolled 1003 patients undergoing OCT evaluation of the untreated proximal left anterior descending (LAD) coronary artery. Measurements of circumferential extension of macrophages and measurements of the distance from intima-lumen contour to macrophages string were performed at the plaque cross-section judged as containing the greatest amount of macrophages. The main study endpoint ...

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    9. Optical coherence tomography and coronary revascularization: from indication to procedural optimization

      Optical coherence tomography and coronary revascularization: from indication to procedural optimization

      Angiography alone is the most commonly used imaging modality for guidance of percutaneous coronary interventions. Angiography is limited, however, by several factors, including that it only portrays a low resolution, two-dimensional outline of the lumen and does not inform on plaque composition and functional stenosis severity. Optical coherence tomography (OCT) is an intracoronary imaging technique that has superior spatial resolution compared to all other imaging modalities. High-resolution imaging of the vascular wall enables precise measurement of vessel wall and luminal dimensions, more accurately informing about the anatomic severity of epicardial stenoses, and also provides input for computational models to assess ...

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    10. Air Pollution and Coronary Plaque Vulnerability and Instability: An Optical Coherence Tomography Study

      Air Pollution and Coronary Plaque Vulnerability and Instability: An Optical Coherence Tomography Study

      Objectives: We assessed the relationship between exposure to air pollutants and mechanisms of coronary instability evaluated by optical coherence tomography (OCT) in patients with acute coronary syndrome (ACS). Background: Air pollution is an emerging key player in determining the residual risk of coronary events. However, pathophysiological mechanisms linking air pollution and coronary events have been not adequately investigated. Methods: Patients with ACS undergoing OCT imaging were retrospectively selected. Mechanism of culprit lesion instability was classified as plaque rupture (PR) or intact fibrous cap (IFC) by OCT, and the presence of macrophage infiltrates (MØI) and thin-cap fibroatheroma (TCFA) at the ...

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    11. Coronary Plaque Rupture in Stable Coronary Artery Disease and Non-ST Segment Elevation Myocardial Infarction: An Optical Coherence Tomography Study

      Coronary Plaque Rupture in Stable Coronary Artery Disease and Non-ST Segment Elevation Myocardial Infarction: An Optical Coherence Tomography Study

      Background. Plaque rupture (PR) is the main cause of coronary thrombosis in non-ST segment elevation myocardial infarction (NSTEMI), but can be found in stable coronary artery disease (CAD). Our study compared the morphology and local inflammatory activity of ruptured plaques between stable CAD and NSTEMI patients using frequency-domain optical coherence tomography (FD-OCT). Methods. We retrospectively evaluated 70 plaques with PR at the FD-OCT (25 in stable CAD patients and 45 in NSTEMI patients). Main clinical, angiographic, and morphological features were compared. Results. Besides an overall equivalence in clinical and angiographic features (except for more smokers among NSTEMI patients), some important ...

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    12. Coronary plaque and clinical characteristics of South Asian (Indian) patients with acute coronary syndromes: An optical coherence tomography study

      Coronary plaque and clinical characteristics of South Asian (Indian) patients with acute coronary syndromes: An optical coherence tomography study

      Background South Asians, and Indians in particular, are known to have a higher incidence of premature atherosclerosis and acute coronary syndromes (ACS) with worse clinical outcomes, compared to populations with different ethnic backgrounds. However, the underlying pathobiology accounting for these differences has not been fully elucidated. Methods ACS patients who had culprit lesion optical coherence tomography (OCT) imaging were enrolled. Culprit plaque characteristics were evaluated using OCT. Results Among 1315 patients, 100 were South Asian, 1009 were East Asian, and 206 were White. South Asian patients were younger (South Asians vs. East Asians vs. Whites: 51.6 ± 13.4 vs ...

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    13. Netrin-1 in Atherosclerosis: Relationship between Human Macrophage Intracellular Levels and In Vivo Plaque Morphology

      Netrin-1 in Atherosclerosis: Relationship between Human Macrophage Intracellular Levels and In Vivo Plaque Morphology

      Netrin-1 is a laminin-like protein that plays a pivotal role in cell migration and, according to the site of its release, exerts both pro and anti-atherosclerotic functions. Macrophages, key cells in atherosclerosis, are heterogeneous in morphology and function and different subpopulations may support plaque progression, stabilization, and/or regression. Netrin-1 was evaluated in plasma and, together with its receptor UNC5b, in both spindle and round monocyte-derived macrophages (MDMs) morphotypes from coronary artery disease (CAD) patients and control subjects. In CAD patients, plaque features were detected in vivo by optical coherence tomography. CAD patients had lower plasma Netrin-1 levels and a ...

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    14. Atherosclerotic Plaque Disruption and Healing

      Atherosclerotic Plaque Disruption and Healing

      According to the United States Geologic Survey, there are approximately 1500 active volcanoes around the world. 1 By simplicity, volcanoes are considered as mountains where materials from within the earth come out. Yet each volcano is different. Their explosive force can create mountains as well as craters. Some volcanoes burst into life in explosive eruptions, while others slowly burp rivers of lava causing an effusive eruption. These differences can be explained by the physics and chemistry driving the molten activity. Effusive eruptions more frequently happen when the magma is less viscous, enabling gas to escape and the magma to flow ...

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    15. New prediction tools and treatment for ACS patients with plaque erosion

      New prediction tools and treatment for ACS patients with plaque erosion

      For decades, we have known from autopsy observations that the proximate cause of the majority of acute coronary syndromes (ACS) is occlusive thrombosis generated by plaque rupture or, less frequently, superficial erosion.1-3 Mounting evidence supports the concept that these two substrates are separate entities, with distinct pathogenesis, clinical presentation, and prognosis.4-9 Yet, when ACS patients present to the emergency department with ischemic symptoms, we still triage them exclusively based on the presence or absence of ST-segment elevation on electrocardiogram and/or on troponin levels, assess them using coronary angiography, and manage them almost invariably with percutaneous coronary intervention ...

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    16. Clinical outcomes of calcified nodules detected by optical coherence tomography

      Clinical outcomes of calcified nodules detected by optical coherence tomography

      Aims: The goal of the present post hoc analysis of the CLIMA registry was to establish the relationship between calcified nodules (CNs) with (CND) or without (CNWD) disruption of the superficial intimal fibrous layer and one-year occurrence of target lesion myocardial infarction (MI) and/or cardiac death. Methods and results: CND and CNWD were identified based on the presence or absence of superficial irregularities indicative of disruption of the intimal fibrous layer, with possible overlying local thrombus. In total, 222 CNs were found in the 1,776 non-culprit LAD plaques. CND had larger maximum calcific arc and smaller lumen area ...

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    17. Circadian variations in pathogenesis of ST-segment elevation myocardial infarction: an optical coherence tomography study

      Circadian variations in pathogenesis of ST-segment elevation myocardial infarction: an optical coherence tomography study

      Previous studies have reported a circadian variation in the onset of ST-segment elevation myocardial infarction (STEMI). However, underlying mechanisms for the circadian variation have not been fully elucidated. We investigated the relationship between onset of STEMI and the underlying pathology using optical coherence tomography (OCT). Patients with a diagnosis of STEMI were selected from a multicenter OCT registry. Patients were divided into 4 groups based on the estimated time of onset (00:00–05:59, 06:00–11:59, 12:00–17:59, or 18:00–23:59). Underlying pathologies of MI (plaque rupture, plaque erosion, and calcified plaque) were ...

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    18. COMPARISON OF POST STENT OPTICAL COHERENCE TOMOGRAPHY FINDINGS AMONG THREE SUBTYPES OF CALCIFIED CULPRIT PLAQUES IN PATIENTS WITH ACUTE CORONARY SYNDROME

      COMPARISON OF POST STENT OPTICAL COHERENCE TOMOGRAPHY FINDINGS AMONG THREE SUBTYPES OF CALCIFIED CULPRIT PLAQUES IN PATIENTS WITH ACUTE CORONARY SYNDROME

      Background Recently, three subtypes of calcified plaques at the culprit lesion were reported in patients with acute coronary syndrome (ACS): eruptive calcified nodule, superficial calcific sheet, and calcified protrusion. Methods A total of 157 patients with ACS and calcified plaque at the culprit lesion were selected from our database. Optical coherence tomography (OCT) findings at index procedure and after stent implantation were compared among the three subgroups. Results In the final analysis, 92 cases were included. Pre-procedural OCT showed eruptive calcified nodules in 20 (21.7%) cases, superficial calcific sheets in 66 (71.7%), and calcified protrusion in 6 (6 ...

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    19. Comparison of post‐stent optical coherence tomography findings among three subtypes of calcified culprit plaques in patients with acute coronary syndrome

      Comparison of post‐stent optical coherence tomography findings among three subtypes of calcified culprit plaques in patients with acute coronary syndrome

      Objectives To compare the postprocedural optical coherence tomography (OCT) findings and in‐hospital outcomes among the three subtypes of calcified plaques: eruptive calcified nodules, superficial calcific sheet, and calcified protrusion. Background Recently, three subtypes of calcified culprit plaques were reported in patients with acute coronary syndrome (ACS). How these subtypes respond to stenting is unknown. Methods ACS patients with calcified plaque at the culprit lesion were selected from our database. OCT findings at baseline and after stent implantation were compared. Results In the final analysis, 87 cases were included. Preprocedural OCT showed eruptive calcified nodules in 19 (21.8%) cases ...

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    20. The year in cardiology: acute coronary syndromes: The year in cardiology 2019

      The year in cardiology: acute coronary syndromes: The year in cardiology 2019

      The mechanisms and the pathologic substrate of plaque erosion and plaque fissure are different. Indeed, plaques complicated by erosion tend to be matrix-rich, lipid-poor, and usually lack prominent macrophage collections, unlike plaques that rupture, which characteristically have thin fibrous caps, large lipid pools, and abundant foam cells. 9 In a prospective study in 211 patients with STEMI who underwent pre-intervention optical coherence tomography (OCT) examination for the culprit lesion, Tan et al . 10 found that trimethylamine N-oxide (TMAO) levels, a gut microbiota-dependent metabolite derived from dietary phosphatidylcholine and choline, were significantly and independently higher in patients with plaque fissure than ...

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    21. The year in cardiology 2019: Acute Coronary Syndromes

      The year in cardiology 2019: Acute Coronary Syndromes

      The management of acute coronary syndromes (ACS) has made enormous progress over the last five decades due to the introduction of defibrillation, beta blockers, thrombolytics, aspirin, primary percutaneous transluminal intervention (PCI), P 2 Y 12 inhibitors, statins, radial access, and eventually PCSK9 inhibitors, among others. 1 However, in spite of all these remedies, there is a remaining acute mortality risk, in particular, in those presenting in cardiogenic shock or after resuscitation and an accruing number of major cardiovascular events (MACE) over the following years. 2 Thus, there is an unmet need in the management of ACS. In 2019, there were ...

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    22. Characteristics of non-culprit plaques in acute coronary syndrome patients with layered culprit plaque

      Characteristics of non-culprit plaques in acute coronary syndrome patients with layered culprit plaque

      Aims  Layered plaques represent signs of previous plaque destabilization. A recent study showed that acute coronary syndrome (ACS) patients with layered culprit plaque have more vulnerability at the culprit lesion and systemic inflammation. We aimed to compare the characteristics of non-culprit plaques between patients with or without layered plaque at the culprit lesion. We also evaluated the characteristics of layered non-culprit plaques, irrespective of culprit plaque phenotype. Methods and results We studied ACS patients who had undergone pre-intervention optical coherence tomography (OCT) imaging. The number of non-culprit lesions was evaluated on coronary angiogram and morphological characteristics of plaques were studied ...

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    23. Fractional Flow Reserve or Optical Coherence Tomography to Guide Management of Angiographically-Intermediate Coronary Stenosis: A Single-Center Trial

      Fractional Flow Reserve or Optical Coherence Tomography to Guide Management of Angiographically-Intermediate Coronary Stenosis: A Single-Center Trial

      Background Fractional flow reserve (FFR) and optical coherence tomography (OCT) may help both in assessment of angiographically-intermediate coronary lesions (AICL) and in percutaneous coronary interventions (PCI) optimization. Objectives: To compare OCT-guidance and FFR-guidance in patients with AICL in a single-center, prospective, 1:1 randomized trial (acronym: FORZA, NCT01824030 ). Methods Patients with AICL were randomized to FFR or OCT. In the FFR arm, PCI was performed if FFR was ≤0.80. In the OCT arm, PCI was performed if area stenosis was ≥75% or 50%-75% with minimal lumen area <2.5 mm 2 or plaque rupture. Angina (evaluated by Seattle ...

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    1-24 of 77 1 2 3 4 »
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