1. Articles from Konstantinos Toutouzas

    1-24 of 24
    1. Culprit plaque characteristics in younger versus older patients with acute coronary syndromes: An optical coherence tomography study from the FORMIDABLE registry

      Culprit plaque characteristics in younger versus older patients with acute coronary syndromes: An optical coherence tomography study from the FORMIDABLE registry

      Objectives Culprit plaque characteristics in young patients who experience an Acute Coronary Syndrome (ACS) evaluated by OCT (Optical Coherence Tomography) have to be defined. The OCT-FORMIDABLE is a multicentre retrospective registry enrolling consecutive patients with ACS who performed OCT in 9 European centres. Methods Patients were divided in two groups according to age at presentation: juvenile-ACS (age ≤ 50 years) and not juvenile-ACS (age > 50 years). Primary end-point was the prevalence of plaque rupture (PR). Secondary end point was the prevalence of thin cap fibro atheroma (TCFA), fibrocalcific and fibrotic plaque. Results 285 patients were included, 71 (24.9%) in juvenile-ACS ...

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    2. Effects of statins on plaque rupture assessed by optical coherence tomography in patients presenting with acute coronary syndromes: insights from the optical coherence tomography (OCT)-FORMIDABLE registry

      Effects of statins on plaque rupture assessed by optical coherence tomography in patients presenting with acute coronary syndromes: insights from the optical coherence tomography (OCT)-FORMIDABLE registry

      Aims Chronic pre-treatment with statins may reduce mortality and morbidity in patients experiencing acute coronary syndromes (ACS), but mechanisms accounting for these findings are not completely understood. Methods and results The optical coherence tomography (OCT)-Formidable registry retrospectively enrolled 285 consecutive patients with ACS undergoing OCT in 9 European centres. Mean age was 60.4 ± 12.8 years, 148 (51.9%) patients had hyperlipemia, 45 (15.8%) diabetes mellitus and 142 (49.8%) presented with ST Segment Elevation Myocardial Infarction (STEMI). Patients were stratified according to statin prescription: 150 (52.6%) were on chronic pre-treatment with statins before ACS and ...

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    3. Optical Coherence Tomography For the Detection of the Vulnerable Plaque

      Optical Coherence Tomography For the Detection of the Vulnerable Plaque

      Morphological characteristics of the atheromatous plaque have been associated with the development of plaque rupture and the pathogenesis of acute coronary syndromes (ACS). Plaques with a specific morphological phenotype that are at high risk of causing ACS are called vulnerable plaques, and can be identified in vivo through the use of intracoronary imaging. Optical coherence tomography (OCT) is a high-resolution intravascular imaging modality that enables detailed visualization of atheromatous plaques. Consequently, OCT is a valuable research tool for examining the role of morphological characteristics of atheromatous plaques in the progression of coronary artery disease and plaque destabilisation, which leads to ...

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    4. Optical Coherence Tomography For the Detection of the Vulnerable Plaque

      Optical Coherence Tomography For the Detection of the Vulnerable Plaque

      Morphological characteristics of the atheromatous plaque have been associated with the development of plaque rupture and the pathogenesis of acute coronary syndromes (ACS). Plaques with a specific morphological phenotype that are at high risk of causing ACS are called vulnerable plaques, and can be identified in vivo through the use of intracoronary imaging. Optical coherence tomography (OCT) is a high-resolution intravascular imaging modality that enables detailed visualization of atheromatous plaques. Consequently, OCT is a valuable research tool for examining the role of morphological characteristics of atheromatous plaques in the progression of coronary artery disease and plaque destabilisation, which leads to ...

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    5. Impact of an optical coherence tomography guided approach in acute coronary syndromes: A propensity matched analysis from the international FORMIDABLE-CARDIOGROUP IV and USZ registry

      Impact of an optical coherence tomography guided approach in acute coronary syndromes: A propensity matched analysis from the international FORMIDABLE-CARDIOGROUP IV and USZ registry

      Aim. To determine the potential clinical impact of OCT (Optical Coherence Tomography) during primary percutaneous coronary intervention in patients presenting with ACS (Acute Coronary Syndrome). Methods and Results. FORMIDABLE is a multicentre retrospective registry enrolling all patients presenting with ACS and treated with an OCT-guided approach, while the USZ registry enrolled patients treated with a standard angiography guided approach. Multivariate adjustment was performed via a propensity score matching. The number stents useds was the primary outcome, while the incidence of MACE (a composite of death, myocardial infarction, target vessel revascularization, and stent thrombosis) was the secondary endpoint. A total of ...

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    6. Association of global and local low endothelial shear stress with high-risk plaque using intracoronary 3D optical coherence tomography: Introduction of ‘shear stress score’

      Association of global and local low endothelial shear stress with high-risk plaque using intracoronary 3D optical coherence tomography: Introduction of ‘shear stress score’

      Aims The association of low endothelial shear stress (ESS) with high-risk plaque (HRP) has not been thoroughly investigated in humans. We investigated the local ESS and lumen remodelling patterns in HRPs using optical coherence tomography (OCT), developed the shear stress score , and explored its association with the prevalence of HRPs and clinical outcomes. Methods and results A total of 35 coronary arteries from 30 patients with stable angina or acute coronary syndrome (ACS) were reconstructed with three dimensional (3D) OCT. ESS was calculated using computational fluid dynamics and classified into low, moderate, and high in 3-mm-long subsegments. In each subsegment ...

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    7. Optical Coherence Tomography guided treatment of recurrent drug-eluting stent failure using drug-eluting balloon

      Optical Coherence Tomography guided treatment of recurrent drug-eluting stent failure using drug-eluting balloon

      A 52-year old gentleman was admitted to our department to undergo catheterization due to recent onset stable angina in minimal effort. He had a history of myocardial infarction 10 years ago, with coronary artery bypass graft surgery 8 years ago. A left internal mammary artery (LIMA) graft had been anastomosed in the mid left anterior descending (LAD) artery and two saphenous vein grafts (SVGs) in the left circumflex (LCx) and the right coronary artery (RCA), respectively. Six years ago, he underwent percutaneous coronary intervention (PCI) of the native LCx, with implantation of two overlapping second generation drug-eluting stents (DES), due ...

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    8. Metabolic syndrome predicts plaque rupture in patients with acute myocardial infarction. An optical coherence study

      Metabolic syndrome predicts plaque rupture in patients with acute myocardial infarction. An optical coherence study

      The metabolic syndrome (MS) is conceptualized as a clustering of risk factors-including insulin resistance, dyslipidemia, central adiposity, and elevated blood pressure (BP)-that increase the risk for cardiovascular disease and type 2 diabetes mellitus (DM) [1]. Metabolic syndrome is known to be a low-grade systemic inflammatory condition with its origins in the perinatal period and childhood, while recent evidence suggests that markers of systemic inflammation may be included in the definition of the syndrome and play some role in its pathogenesis

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    9. Prevalence and predictors of culprit plaque rupture at OCT in patients with coronary artery disease: a meta-analysis

      Prevalence and predictors of culprit plaque rupture at OCT in patients with coronary artery disease: a meta-analysis

      Aims The prevalence of plaque rupture at the culprit lesion identified by optical coherence tomography (OCT) in different clinical subset of patients undergoing coronary angiography and its clinical predictors remain to be defined. Methods All studies including patients with OCT evaluation of the culprit coronary plaque were included. The prevalence of culprit plaque rupture (CPR) and thin-cap fibro-atheroma (TCFA) were the primary endpoints. The factors associated with these findings were studied in a subset of patients with different clinical presentations [ST-elevation myocardial (STEMI) vs. nonST-elevation myocardial infarction (NSTEMI) vs. unstable angina (UA) vs. stable angina pectoris (SAP)]. Results One hundred ...

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    10. Vulnerable plaque imaging: updates on new pathobiological mechanisms

      Vulnerable plaque imaging: updates on new pathobiological mechanisms

      Early identification of vulnerable, rupture-prone atherosclerotic plaques with the optimal goal of cardiovascular event prevention is a field of vigorous research. Despite the advances in imaging modalities and the in vivo identification of many characteristics of vulnerability, few of these plaques actually rupture and even fewer lead to clinical events, questioning the predictive value of the above techniques in clinical practice. Factors causing the higher local vulnerability of the culprit plaque within a prothrombotic environment of widespread inflammation are generally unknown. Newly recognized local features, including microcalcifications and biomechanical factors, seem to contribute. In this review article, we target on ...

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    11. Impact of coronary artery stent edge dissections on long-term clinical outcome in patients with acute coronary syndrome: An Optical Coherence Tomography Study

      Impact of coronary artery stent edge dissections on long-term clinical outcome in patients with acute coronary syndrome: An Optical Coherence Tomography Study

      Aims: The purpose of the present study was to assess the incidence, predictors and long term prognosis of stent edge dissections identified by (OCT) after the implantation of bare metal (BMS) and drug eluting stents (DES). Methods and results: We studied 74 patients who underwent percutaneous coronary intervention (PCI) because of an acute coronary syndrome. Edge dissections were found in 29 of 74 patients (39.1%). Independent predictors of edge dissections were: the presence of ST-elevation myocardial infarction (STEMI) (p=0.005, odds ratio 11.78; 95% Cl 2.06-67.10), the small reference lumen diameter ( p= 0.009, odds ...

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    12. Clinical Validation of an Algorithm for Rapid and Accurate Automated Segmentation of Intracoronary Optical Coherence Tomography Image

      Clinical Validation of an Algorithm for Rapid and Accurate Automated Segmentation of Intracoronary Optical Coherence Tomography Image

      Objectives The analysis of intracoronary optical coherence tomography (OCT) images is based on manual identification of the lumen contours and relevant structures. However, manual image segmentation is a cumbersome and time-consuming process, subject to significant intra- and inter-observer variability. This study aims to present and validate a fully-automated method for segmentation of intracoronary OCT images. Methods We studied 20 coronary arteries (mean length = 39.7 ± 10.0 mm) from 20 patients who underwent a clinically indicated cardiac catheterization. The OCT images (n = 1812) were segmented manually, as well as with a fully-automated approach. A semi-automated variation of the fully-automated algorithm ...

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    13. Association of neointimal morphology by optical coherence tomography with rupture of neoatherosclerotic plaque very late after coronary stent implantation.

      Association of neointimal morphology by optical coherence tomography with rupture of neoatherosclerotic plaque very late after coronary stent implantation.

      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 ...

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    14. In-stent neoatherosclerosis: are first generation drug eluting stents different than bare metal stents? an optical coherence tomography study

      In-stent neoatherosclerosis: are first generation drug eluting stents different than bare metal stents? an optical coherence tomography study

      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 ...

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    15. Optical coherence tomography assessment of the spatial distribution of culprit ruptured plaques and thin-cap fibroatheromas in acute coronary syndrome

      Optical coherence tomography assessment of the spatial distribution of culprit ruptured plaques and thin-cap fibroatheromas in acute coronary syndrome

      Aims: Plaque rupture and subsequent thrombosis is known to be the most important pathology leading to acute coronary syndrome (ACS). We investigated by optical coherence tomography (OCT) whether in ACS there is an association of the location of the culprit plaque in the coronary tree with plaque rupture and/or thin cap fibroatheroma (TCFA). Methods and results: We included 74 patients presenting with ACS that underwent OCT study of the culprit lesion. The distance of the culprit lesion from the ostium was measured angiographically, and the presence of rupture and/or TCFA was assessed by OCT. Sixty-seven patients were analysed ...

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    16. Pitfalls of Angiography in the Assessment of Atherosclerosis: The Role of Optical Coherence Tomography

      Pitfalls of Angiography in the Assessment of Atherosclerosis: The Role of Optical Coherence Tomography

      We report the case of a patient presenting with unstable angina, in whom information obtained by coronary angiography was inconclusive for the existence of a culprit lesion in the ostium of the right coronary artery. The use of optical coherence tomography was required for proper lesion assessment.

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    17. Mechanisms of Non-Fatal Stent-Related Myocardial Infarction Late Following Coronary Stenting With Drug-Eluting Stents and Bare Metal Stents – Insights From Optical Coherence Tomography –

      Mechanisms of Non-Fatal Stent-Related Myocardial Infarction Late Following Coronary Stenting With Drug-Eluting Stents and Bare Metal Stents – Insights From Optical Coherence Tomography –

      A prospective observational study using optical coherence tomography (OCT) of patients with myocardial infarction (MI), late following drug-eluting (DES) or bare metal stent (BMS) implantation, when the stented segment was considered culprit. Methods and Results: Seventeen patients (58.9±8.3 years; 7 DES, 10 BMS) with MI at 50 (3-180) months post-stenting. Patients with BMS sustained a MI later than patients with DES (95 (3-180) vs. 8 (3-62) months, P=0.01]; 5 (71.4%) of the DES patients demonstrated binary angiographic restenosis, in contrast to 8 (80%) with BMS (P=1.0). DES had significantly less thickness of ...

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    18. New insights by optical coherence tomography into the differences and similarities of culprit ruptured plaque morphology in non–ST-elevation myocardial infarction and ST-elevation myocardial infarction

      New insights by optical coherence tomography into the differences and similarities of culprit ruptured plaque morphology in non–ST-elevation myocardial infarction and ST-elevation myocardial infarction

      BackgroundPlaque rupture is the most common pathology associated with non–ST-elevation myocardial infarction (NSTEMI) and ST-elevation myocardial infarction (STEMI). However, limited data are available regarding ruptured plaque morphology and its relationship with the clinical syndrome. This study aimed (1) to provide a morphologic description of ruptured culprit lesions by optical coherence tomography (OCT) and (2) to investigate whether ruptured plaque morphology differs between NSTEMI and STEMI.MethodsWe included 84 consecutive patients with NSTEMI and STEMI undergoing OCT study of the culprit lesion. We identified patients with plaque rupture in the OCT study and used them as the study population. Qualitative ...

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    19. Morphological Characteristics of Culprit Atheromatic Plaque Are Associated With Coronary Flow After Thrombolytic Therapy

      Morphological Characteristics of Culprit Atheromatic Plaque Are Associated With Coronary Flow After Thrombolytic Therapy

      ObjectivesThis study investigated the association between morphological characteristics of culprit atheromatic lesions as assessed by optical coherence tomography and Thrombolysis In Myocardial Infarction (TIMI) flow grade after thrombolysis in patients with ST-segment elevation myocardial infarction (STEMI).BackgroundAlthough several variables have been found to predict coronary flow after thrombolysis in patients with STEMI, the impact of culprit lesion morphology has not been studied.MethodsFifty-five patients with STEMI from 3 tertiary centers that were treated with thrombolysis and underwent optical coherence tomography examination in the culprit lesion between 24 and 48 h after thrombolysis were included in the study. Patients were categorized ...

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    20. Assessment of a New Biodegradable Drug Eluting Stent for the Inhibition of Neovascularisation and Neointimal Hyperplasia: An Experimental Study With Optical Coherence Tomography

      Background: Vascular endothelial growth factor (VEGF) appears to be the most important mediator of neovascularisation. We assumed that inhibition of VEGF, using local delivery of bevacizumab, a monoclonal antibody specific for VEGF, could affect neovascularization and intimal hyperplasia in hypercholesterolemic rabbits. Methods: We used 10 New Zealand white rabbits under atherogenic diet for 3 weeks. Eleven biodegradable bevacizumab-eluting stents (BES) were implanted in the distal aorta. The control group consisted of 7 New Zealand white rabbits that were treated with 7 bare metal stents covered by biodegradable polymer. All animals were treated with aspirin and clopidogrel for 4 weeks. Follow-up ...

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    21. Morphological Characteristics of the Culprit Lesion Correlate With the Angiographic Flow Grade Following Thrombolysis in Myocardial Infarction. An Optical Coherence Tomography Study

      Background: Intravenous thrombolysis fails to restore blood flow in a significant percentage of patients with ST-elevation myocardial infarction (STEMI). It remains unknown, whether certain morphological characteristics of the culprit lesion (CL) can predict the success of thrombolysis. We hypothesized that the thickness of the fibrous cap and the incidence of plaque rupture at the CL, as measured by Optical Coherence Tomography (OCT), may correlate with the outcome of thrombolysis. Methods: We prospectively enrolled 55 consecutive patients with STEMI that were treated with thrombolysis 6 hours from symptom onset. All patients underwent coronary angiography within 24 hours from thrombolysis. We estimated ...

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    22. Fibrous Caps with Excessive Macrophage Infiltration in Culprit Lesions of Patients with Acute Coronary Syndromes are Associated with Increased Local Temperature

      Fibrous Caps with Excessive Macrophage Infiltration in Culprit Lesions of Patients with Acute Coronary Syndromes are Associated with Increased Local Temperature

      Background: Optical coherence tomography (OCT) provides detailed analysis of the morphological characteristics of the culprit lesion (CL) and determines macrophage density within fibrous caps. Intracoronary thermography (ICT) detects the local inflammatory activation of the CL. We investigated the correlation between morphological and functional characteristics of the CL as analysed by OCT and ICT in patients with acute coronary syndromes (ACS). Methods: We studied 31 CL of 31 pts (mean age 61±14 years) with ACS. We measured by ICT the temperature difference between the lesion and the healthy proximal vessel wall (T). Thereafter, we measured the minimal thickness of the ...

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    1-24 of 24
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    Fibrous Caps with Excessive Macrophage Infiltration in Culprit Lesions of Patients with Acute Coronary Syndromes are Associated with Increased Local Temperature Morphological Characteristics of Culprit Atheromatic Plaque Are Associated With Coronary Flow After Thrombolytic Therapy New insights by optical coherence tomography into the differences and similarities of culprit ruptured plaque morphology in non–ST-elevation myocardial infarction and ST-elevation myocardial infarction Mechanisms of Non-Fatal Stent-Related Myocardial Infarction Late Following Coronary Stenting With Drug-Eluting Stents and Bare Metal Stents – Insights From Optical Coherence Tomography – Pitfalls of Angiography in the Assessment of Atherosclerosis: The Role of Optical Coherence Tomography Optical coherence tomography assessment of the spatial distribution of culprit ruptured plaques and thin-cap fibroatheromas in acute coronary syndrome In-stent neoatherosclerosis: are first generation drug eluting stents different than bare metal stents? an optical coherence tomography study Clinical Validation of an Algorithm for Rapid and Accurate Automated Segmentation of Intracoronary Optical Coherence Tomography Image Assessment of Anatomical and Functional Macular Changes with Optical Coherence Tomography Angiography After Macula-Off Rhegmatogenous Retinal Detachment Repair Comparison of Spectralis and Cirrus optical coherence tomography for the detection of incomplete and complete retinal pigment epithelium and outer retinal atrophy Wide-Field Swept-Source Optical Coherence Tomography Analysis of Interocular Symmetry of Choroidal Thickness in Healthy Young Individuals Impact of cardiometabolic factors on retinal vasculature: A 3x3, 6x6 and 8x8-mm optical coherence tomography angiography study