1. Articles from Nicolas Foin

    1-24 of 44 1 2 »
    1. Very late scaffold thrombosis: insights from optical coherence tomography and histopathology

      Very late scaffold thrombosis: insights from optical coherence tomography and histopathology

      A 79-year-old male patient had a 2.5×12 mm bioresorbable vascular scaffold (Absorb™ BVS; Abbott Vascular, Santa Clara, CA, USA) implanted in the setting of the RIBS VI study protocol for in-stent restenosis of a 3×9 mm bare metal stent (AVE S670; Medtronic, Minneapolis, MN, USA) in January 2015, at which time point the patient presented with stable angina and positive exercise stress test (index procedure). The Absorb BVS was implanted with predilatation at 20 atmospheres (atm) accompanied by post-dilatation with a non-compliant balloon (2.5×10 mm) at 26 atm. The patient was maintained on dual antiplatelet ...

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    2. Very Late Scaffold Thrombosis: Insights from Optical Coherence Tomography and Histopathology

      Very Late Scaffold Thrombosis: Insights from Optical Coherence Tomography and Histopathology

      Aims: to investigate and understand the mechanisms of very late scaffold thrombosis 13 months following implantation in the setting of bare metal in-stent restenosis. Methods and results: we collected consecutive angiography, optical coherence tomography and full autopsy evaluation in a 79-year old patients presenting with cardiogenic shock and undergoing rescue PCI after suffering very late scaffold thrombosis. Combined assessment of angiography, optical coherence tomography and histopathology revealed heterogenous vascular healing 13 months following implantation of a bioresorbable vascular scaffold with presence of scaffold struts fully integrated into neointimal tissue while others remained uncovered and malapposed. Furthermore, plaque rupture within the ...

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    3. Serial 5-Year Evaluation of Side Branches Jailed by Bioresorbable Vascular Scaffolds Using 3-Dimensional Optical Coherence Tomography

      Serial 5-Year Evaluation of Side Branches Jailed by Bioresorbable Vascular Scaffolds Using 3-Dimensional Optical Coherence Tomography

      Background— The long-term fate of Absorb bioresorbable vascular scaffold (Abbott Vascular, Santa Clara, CA) struts jailing side branch ostia has not been clarified. We therefore evaluate serially (post-procedure and at 6 months, 1, 2, 3, and 5 years) the appearance and fate of jailed Absorb bioresorbable vascular scaffold struts. Methods and Results— We performed 3-dimensional optical coherence tomographic analysis of the ABSORB Cohort B trial (A Clinical Evaluation of the Bioabsorbable Everolimus Eluting Coronary Stent System in the Treatment of Patients With De Novo Native Coronary Artery Lesions) up to 5 years using a novel, validated cut-plane analysis method. We ...

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    4. Automatic Fibroatheroma Identification from Intravascular Optical Coherence Tomography Images

      Automatic Fibroatheroma Identification from Intravascular Optical Coherence Tomography Images

      Vulnerable plaque identification is important in coronary heart disease diagnosis. Intravascular Optical Coherence Tomography (IVOCT) is an imaging modality which can characterize the appearance of vulnerable plaques. However, current used manual reading of the images is time consuming and subjective. Therefore, an automated and objective assessment of the plaque is necessary. This paper proposes a method for automatic identification of potential vulnerable plaque such as fibroatheroma in IVOCT images. In the proposed method, a graph search based method is applied to detect the region of interest (ROI) including the inner lumen border and outer border. Then various appearance features including ...

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    5. Early coverage of drug-eluting stents analysed by optical coherence tomography: evidence of the impact of stent apposition and strut characteristics on the neointimal healing process

      Early coverage of drug-eluting stents analysed by optical coherence tomography: evidence of the impact of stent apposition and strut characteristics on the neointimal healing process

      Aims: Previous studies have associated issues such as incomplete stent apposition with delayed healing and adverse events (stent thrombosis). The aim of this study was to evaluate the impact of strut apposition and stent type on the progression of stent strut coverage. Methods and results: We evaluated in vivo in porcine models the follow-up response and coverage characteristics of well-apposed and malapposed segments of drug-eluting stents (DES) (CYPHER, PROMUS Element and Orsiro) and the Absorb bioresorbable vascular scaffold (BVS) by optical coherence tomography (OCT) sequentially, at baseline, and at one week and four weeks of follow-up. Supporting results were provided ...

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    6. Absorb vs. DESolve: an optical coherence tomography comparison of acute mechanical performances

      Absorb vs. DESolve: an optical coherence tomography comparison of acute mechanical performances

      Aims: The aim of the study was to compare retrospectively the acute mechanical performance of the Absorb vs. DESolve scaffolds in terms of appropriate deployment with OCT. Methods and results: Final post-deployment OCT pullbacks of consecutive patients treated with either Absorb or DESolve were reviewed. The following parameters were calculated and compared: mean and minimal lumen area (MLA), residual in-scaffold area stenosis (RAS), incomplete strut apposition (ISA), tissue prolapse area, eccentricity index, asymmetry index, strut fracture and edge dissection. A total of 72 patients were included. The Absorb group consisted of 35 patients treated with 63 Absorb scaffolds and was ...

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    7. 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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    8. Left main artery compression by haematoma following acute aortic root dissection: identification by optical coherence tomography

      Left main artery compression by haematoma following acute aortic root dissection: identification by optical coherence tomography

      A 42-year-old woman with no previous history of cardiovascular disease was referred to our institution for a type A aortic dissection (A1), compressing the left main artery (LMA) ostium (arrow/ A2) and causing anterior ST elevation myocardial infarction with cardiogenic shock. The patient underwent emergent cardiac surgery: the ascending aorta was replaced, and a haematoma was removed from LMA …

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      Mentions: Nicolas Foin
    9. Optical coherence tomography guidance for percutaneous coronary intervention with bioresorbable scaffolds

      Optical coherence tomography guidance for percutaneous coronary intervention with bioresorbable scaffolds

      Background The effect of optical coherence tomography (OCT) guidance on the implantation strategy during all phases of percutaneous coronary intervention (PCI) with bioresorbable vascular scaffolds (BVSs) in a real-world scenario has been poorly investigated. Methods Consecutive patients undergoing BVS implantation at our institution were included in this registry. Frequency-domain OCT pullbacks were performed at the operator's discretion during all phases of BVS implantation procedures to optimize preparation of lesions, confirm BVS size, and optimize expansion and apposition of scaffolds. Results Between September 2012 and July 2015, 203 BVSs were implanted in 101 consecutive patients at our institution (2.01 ...

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    10. Biomechanical stress in coronary atherosclerosis: emerging insights from computational modelling

      Biomechanical stress in coronary atherosclerosis: emerging insights from computational modelling

      Coronary plaque rupture is the most common cause of vessel thrombosis and acute coronary syndrome. The accurate early detection of plaques prone to rupture may allow prospective, preventative treatment; however, current diagnostic methods remain inadequate to detect these lesions. Established imaging features indicating vulnerability do not confer adequate specificity for symptomatic rupture. Similarly, even though experimental and computational studies have underscored the importance of endothelial shear stress in progressive atherosclerosis, the ability of shear stress to predict plaque progression remains incremental. This review examines recent advances in image-based computational modelling that have elucidated possible mechanisms of plaque progression and rupture ...

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    11. Coronary evaginations and peri-scaffold aneurysms following implantation of bioresorbable scaffolds: incidence, outcome, and optical coherence tomography analysis of possible mechanisms

      Coronary evaginations and peri-scaffold aneurysms following implantation of bioresorbable scaffolds: incidence, outcome, and optical coherence tomography analysis of possible mechanisms

      Background Peri-stent coronary evaginations may disturb flow and have been proposed as possible risk factor for late stent thrombosis. We describe incidence, predictors, and possible mechanisms of coronary evaginations 12 months after implantation of bioresorbable vascular scaffolds (BVS). Methods and results One hundred and two BVS implanted in 90 patients (age 63 ± 13 years, 71 males, 14 diabetics) were analysed with angiography and optical coherence tomography (OCT) 12 months after implantation. Evaginations were identified as any hollow in the luminal vessel contour between well-apposed struts and were classified as major when extending ≥3 mm with a depth ≥10% of the ...

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      Mentions: Nicolas Foin
    12. Is high pressure postdilation safe in bioresorbable vascular scaffolds? Optical coherence tomography observations after noncompliant balloons inflated at more than 24 atmospheres

      Is high pressure postdilation safe in bioresorbable vascular scaffolds? Optical coherence tomography observations after noncompliant balloons inflated at more than 24 atmospheres

      Objectives Optical coherence tomography (OCT) was used to investigate integrity and expansion of bioresorbable drug-eluting scaffolds (BVS) after high-pressure postdilation (HPPD). Background Because of concerns about the risk of BVS damage, postdilation was not recommended and applied in the existing randomized studies and most registries. Recent real world data suggest incomplete BVS expansion cause higher rates of thrombosis. In vivo confirmation of the safety of high pressure postdilation is of paramount importance. Methods Data from final OCT examination of consecutive implanted BVS, postdilated with noncompliant (NC) balloons at pressure ≥24 atm were analyzed. The following stent performance indices were assessed ...

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    13. Inducing Persistent Flow Disturbances Accelerates Atherogenesis and Promotes Thin Cap Fibroatheroma Development in D374Y-PCSK9 Hypercholesterolemic Minipigs

      Inducing Persistent Flow Disturbances Accelerates Atherogenesis and Promotes Thin Cap Fibroatheroma Development in D374Y-PCSK9 Hypercholesterolemic Minipigs

      Background— Although disturbed flow is thought to play a central role in the development of advanced coronary atherosclerotic plaques, no causal relationship has been established. We evaluated whether inducing disturbed flow would cause the development of advanced coronary plaques, including thin cap fibroatheroma. Methods and Results— D374Y -PCSK9 hypercholesterolemic minipigs (n=5) were instrumented with an intracoronary shear-modifying stent (SMS). Frequency-domain optical coherence tomography was obtained at baseline, immediately poststent, 19 weeks, and 34 weeks, and used to compute shear stress metrics of disturbed flow. At 34 weeks, plaque type was assessed within serially collected histological sections and coregistered to ...

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    14. Advances in three-dimensional coronary imaging and computational fluid dynamics: is virtual fractional flow reserve more than just a pretty picture?

      Advances in three-dimensional coronary imaging and computational fluid dynamics: is virtual fractional flow reserve more than just a pretty picture?

      Percutaneous coronary intervention (PCI) has shown a high success rate in the treatment of coronary artery disease. The decision to perform PCI often relies on the cardiologist’s visual interpretation of coronary lesions during angiography. This has inherent limitations, particularly due to the low resolution and two-dimensional nature of angiography. State-of-the-art modalities such as three-dimensional quantitative coronary angiography, optical coherence tomography and invasive fractional flow reserve (FFR) may improve clinicians’ understanding of both the anatomical and physiological importance of coronary lesions. While invasive FFR is the gold standard technique for assessment of the haemodynamic significance of coronary lesions, recent studies ...

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    15. Optical coherence tomography to evaluate coronary stent implantation and complications

      Optical coherence tomography to evaluate coronary stent implantation and complications

      Coronary optical coherence tomography (OCT) is now an established imaging technique in many catheterization laboratories worldwide. With its near-histological view of the vessel wall and lumen interface, it offers unprecedented imaging quality to improve our understanding of the pathophysiology of atherosclerosis, plaque vulnerability, and vascular biology. Not only is OCT used to accurately detect atherosclerotic plaque and optimize stent position, but it can further characterize plaque composition, quantify stent apposition, and assess stent tissue coverage. Given that its resolution of 15 μm is well above that of angiography and intravascular ultrasound, OCT has become the invasive imaging method of choice ...

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    16. First Optical Coherence Tomography Follow-up of Coronary Bifurcation Lesions Treated by Drug-Eluting Balloons

      First Optical Coherence Tomography Follow-up of Coronary Bifurcation Lesions Treated by Drug-Eluting Balloons

      Background. A strategy of percutaneous bifurcation intervention with provisional bare-metal stent (BMS) implantation followed by drug-eluting balloon (DEB) treatment represents a valuable opportunity in patients not compliant with long-duration dual-antiplatelet therapy. We used optical coherence tomography (OCT) to assess coronary bifurcation lesions treated by BMS and DEB, and secondarily, to better explore the association between stent geometry and tissue coverage. Methods. Twelve patients underwent frequency-domain OCT 6 months after undergoing percutaneous bifurcation intervention with BMS implantation followed by kissing DEB. The same type of BMS was correspondingly implanted in silicone bifurcation models and scanned by microcomputed tomography. Results. Overall, a ...

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    17. ABSORB Biodegradable Stents Versus Second-Generation Metal Stents : A Comparison Study of 100 Complex Lesions Treated Under OCT Guidance

      ABSORB Biodegradable Stents Versus Second-Generation Metal Stents : A Comparison Study of 100 Complex Lesions Treated Under OCT Guidance

      Objectives The aim of this study was to compare the acute performance of the PLLA ABSORB bioresorbable vascular scaffold (BVS) (Abbott Vascular, Santa Clara, California) with second-generation metal drug-eluting stents (DES) in complex coronary artery lesions. Background Thick polymer-based BVS have different mechanical properties than thin second-generation DES. Data on the acute performance of BVS are limited to simple coronary lesions treated in trials with strict inclusion criteria. Methods Fifty complex coronary lesions (all type American College of Cardiology/American Heart Association B2-C) treated with a BVS undergoing a final optical coherence tomography (OCT) examination were compared with an equal ...

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    18. Intracoronary optical coherence tomography: a review of clinical applications

      Intracoronary optical coherence tomography: a review of clinical applications

      Optical coherence tomography (OCT) is a light-based technology that provides very high spatial resolution images. OCT has been initially employed as a research tool to investigate plaque morphology and stent strut coverage. The introduction of frequency domain OCT allowing fast image acquisition during a prolonged contrast injection via the guiding catheter has made OCT applicable for guidance of coronary interventions. In this manuscript, the various applications of OCT are reviewed, from assessment of plaque vulnerability and severity to characteristics of unstable lesions and thrombus burden to stent optimization and evaluation of late results.

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    19. Bifurcated Lesions and Optical Coherence Tomography

      Bifurcated Lesions and Optical Coherence Tomography

      Coronary artery bifurcation lesions constitute a complex subgroup that are encountered in 15–20 % of all percutaneous coronary interventions (PCI). 1–5 Compared with simple lesions, bifurcations have been associated with lower procedural success rates, higher adverse event rates, longer procedures, and worse angiographic and clinical outcomes. 1,3,5–12 The less favourable outcomes associated with bifurcation treatment compared with non-bifurcation lesions may in part result from the inability of current devices and techniques to adequately scaffold and preserve the side branch (SB) ostium, which is a common location of restenosis. 1,3,5–13

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    20. Optical coherence tomography characteristics of in-stent restenosis are different between first and second generation drug eluting stents ☆

      Optical coherence tomography characteristics of in-stent restenosis are different between first and second generation drug eluting stents ☆

      Aims Characterization of neointimal tissue is essential to understand the pathophysiology of in-stent restenosis (ISR) after drug eluting stent (DES) implantation. Using optical coherence tomography (OCT), we compared the morphologic characteristics of ISR between first and second generation DES. Methods and Results OCT was performed in 66 DES-ISR, defined as > 50% angiographic diameter stenosis within the stented segment. Patients with ISR of first generation sirolimus-eluting stents (SES), paclitaxel eluting stents (PES) and second generation zotarolimus-eluting stents (ZES), everolimus-eluting stents (EES) and biolimus-eluting stents (BES) were enrolled. Quantitative and qualitative ISR tissue analysis was performed at 1-mm intervals along the entire ...

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    21. Incomplete Stent Apposition Causes High Shear Flow Disturbances and Delay in Neointimal Coverage as a Function of Strut to Wall Detachment Distance: Implications for the Management of Incomplete Stent Apposition

      Incomplete Stent Apposition Causes High Shear Flow Disturbances and Delay in Neointimal Coverage as a Function of Strut to Wall Detachment Distance: Implications for the Management of Incomplete Stent Apposition

      BACKGROUND: Lack of re-endothelialization and neointimal coverage on stent struts has been put forward as the main underlying mechanism leading to late stent thrombosis. Incomplete stent apposition (ISA) has been observed frequently in patients with very late stent thrombosis after drug eluting stent implantation, suggesting a role of ISA in the pathogenesis of this adverse event. The aim of this study was to evaluate the impact of different degrees of ISA severity on abnormal shear rate and healing response with coverage, because of its potential implications for stent optimization in clinical practice. METHODS AND RESULTS: We characterized flow profile and ...

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    22. Coronary artery aneurysm following stent implantation: insights from serial multiple intravascular imaging modalities

      Coronary artery aneurysm following stent implantation: insights from serial multiple intravascular imaging modalities

      Coronary artery aneurysms after coronary intervention are rare and most ‘aneurysms’ are, in fact, pseudoaneurysms rather than true aneurysms. A correct diagnosis is mandatory for optimal management of this rare coronary complication. Intravascular ultrasound (IVUS) has become the gold standard for providing crucial information on the anatomical composition of the vessel wall, necessary to achieve the diagnosis. On the other hand, optical coherence tomography (OCT) is the most accurate diagnostic tool for providing luminal coronary measurement,

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    1-24 of 44 1 2 »
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