1. Articles from Shiro Uemura

    1-24 of 48 1 2 »
    1. Predictors of Rapid Plaque Progression: An Optical Coherence Tomography Study

      Predictors of Rapid Plaque Progression: An Optical Coherence Tomography Study

      Objectives This study sought to identify morphological predictors of rapid plaque progression. Background Two patterns of plaque progression have been described: slow linear progression and rapid step-wise progression. The former pattern will cause stable angina when the narrowing reaches a critical threshold, whereas the latter pattern may lead to acute coronary syndromes or sudden cardiac death. Methods Patients who underwent optical coherence tomography (OCT) imaging during the index procedure and follow-up angiography with a minimum interval of 6 months were selected. Nonculprit lesions with a diameter stenosis of ≥30% on index angiography were assessed. Lesion progression was defined as a ...

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    2. Effects of Fatty Acid Therapy in Addition to Strong Statin on Coronary Plaques in Acute Coronary Syndrome: An Optical Coherence Tomography Study

      Effects of Fatty Acid Therapy in Addition to Strong Statin on Coronary Plaques in Acute Coronary Syndrome: An Optical Coherence Tomography Study

      ACKGROUND Vascular healing response associated with adjunctive n‐3 polyunsaturated fatty acid therapy therapy in patients receiving strong statin therapy remains unclear. The aim of this study was to evaluate the effect of polyunsaturated fatty acid therapy with eicosapentaenoic acid (EPA) or docosahexaenoic acid (DHA) in addition to strong statin therapy on coronary atherosclerotic plaques using optical coherence tomography. METHODS AND RESULTS This prospective multicenter randomized controlled trial included 130 patients with acute coronary syndrome treated with strong statins. They were assigned to either statin only (control group, n=42), statin+high‐dose EPA (1800 mg/day) (EPA group, n ...

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    3. Prevalence and Clinical Significance of Layered Plaque in Patients With Stable Angina Pectoris ― Evaluation With Histopathology and Optical Coherence Tomography ―

      Prevalence and Clinical Significance of Layered Plaque in Patients With Stable Angina Pectoris ― Evaluation With Histopathology and Optical Coherence Tomography ―

      Background: Healed plaques are identified as a layered pattern with optical coherence tomography (OCT) imaging, but the exact relationship between healed plaques and the development of significant coronary stenosis in stable angina pectoris (SAP) is not fully understood. Methods and Results: A retrospective clinincal study investigated the OCT characteristics of culprit lesions of SAP patients (n=205), and a prospective study examined the histopathological characteristics of layered plaque in directional coronary atherectomy (DCA) samples (42 samples from 18 SAP patients). In the retrospective study, layered plaque was observed in 36.6% of the SAP culprit lesions. Compared with patients with ...

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    4. Healed Culprit Plaques in Patients With Acute Coronary Syndrome

      Healed Culprit Plaques in Patients With Acute Coronary Syndrome

      ackground Healed plaques, morphologically characterized by a layered phenotype, are frequently found in subjects with sudden cardiac death. However, in vivo data are lacking. Objectives The purpose of this study was to determine the prevalence, morphological characteristics, and clinical significance of healed culprit plaques in patients with acute coronary syndromes (ACS) using optical coherence tomography (OCT). Methods A total of 376 ACS patients (252 ST-segment elevation myocardial infarction [MI] and 124 non–ST-segment elevation acute coronary syndrome) who had undergone pre-intervention OCT imaging of the culprit lesion were enrolled. Patients were stratified according to the presence of layered phenotype, defined ...

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    5. Clinical Predictors for Lack of Favorable Vascular Response to Statin Therapy in Patients With Coronary Artery Disease: A Serial Optical Coherence Tomography Study

      Clinical Predictors for Lack of Favorable Vascular Response to Statin Therapy in Patients With Coronary Artery Disease: A Serial Optical Coherence Tomography Study

      Background Previous studies have demonstrated that statin therapy improves cardiac outcomes, probably by stabilizing thin‐cap fibroatheroma in patients with coronary artery disease. However, major adverse cardiac events still occur in some patients, despite statin therapy. The aim of this study is to identify clinical predictors for the lack of a favorable vascular response to statin therapy in patients with coronary artery disease. Methods and Results A total of 140 nonculprit plaques from 84 patients with coronary artery disease who were treated with a statin and had serial optical coherence tomography imaging (median interval, 6.3 months) were included. Thin ...

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    6. Neointimal coverage of jailed side branches in coronary bifurcation lesions: an optical coherence tomography analysis

      Neointimal coverage of jailed side branches in coronary bifurcation lesions: an optical coherence tomography analysis

      Objectives: The jailed strut at the side-branch (SB) orifice may be a cause of delayed neointimal coverage and SB flow disturbance after single stenting to bifurcation. The aim of this study was to characterize the exact relationship between the jailed strut pattern at the SB orifice immediately after stent implantation and neointimal coverage of the jailed SB orifice in the chronic phase. Patients and methods: A total of 29 bifurcation (left anterior descending coronary artery and diagonal branch) lesions treated by optical coherence tomography-guide single-stent implantation and followed at 18 months after a percutaneous coronary intervention were included in this ...

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    7. Current clinical applications of coronary optical coherence tomography

      Current clinical applications of coronary optical coherence tomography

      Optical coherence tomography (OCT) is an intra-coronary diagnostic technique that provides detailed imagings of blood vessels in the current cardiac catheterization laboratory. The higher resolution of OCT often provides superior delineation of each structure compared with intravascular ultrasound (IVUS), and it can reliably visualize the microstructure of normal and diseased arteries. The capabilities of OCT are well suited for the identification of calcified plaque and neointima formation after stent implantation. It has been reported that OCT-guided percutaneous coronary intervention (PCI) resulted in equivalent clinical and angiographic outcomes in comparison with IVUS-guided PCI. Recently, the three-dimensional reconstruction of OCT and a ...

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    8. Clinical Significance of Lipid-Rich Plaque Detected by Optical Coherence Tomography : A 4-Year Follow-Up Study

      Clinical Significance of Lipid-Rich Plaque Detected by Optical Coherence Tomography : A 4-Year Follow-Up Study

      Background Lipid-rich plaque (LRP) is thought to be a precursor to cardiac events. However, its clinical significance in coronary arteries has never been systematically investigated. Objectives This study investigated the prevalence and clinical significance of LRP in the nonculprit region of the target vessel in patients undergoing percutaneous coronary intervention (PCI). Methods The study included 1,474 patients from 20 sites across 6 countries undergoing PCI, who had optical coherence tomography (OCT) imaging of the target vessel. Major adverse cardiac events (MACE) were defined as a composite of cardiac death, acute myocardial infarction, and ischemia-driven revascularization. Patients were followed for ...

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    9. Impact of branching angle on neointimal coverage of drug-eluting stents implanted in bifurcation lesions

      Impact of branching angle on neointimal coverage of drug-eluting stents implanted in bifurcation lesions

      Objectives: To investigate the impact of branching angle (BA) on neointimal coverage of drug-eluting stents (DESs) in bifurcation lesions. Background: Previous experimental studies indicated that BA influences the local flow turbulence and wall shear stress, which are associated with neointimal coverage of DESs. Methods: Fifty-five bifurcation lesions in 47 patients were evaluated by serial optical coherence tomography (OCT) before DES implantation and at follow-up. Neointimal coverage was assessed in cross-sectional OCT images containing the side branch; regions including the side branch ostium (SO) and vessel wall (VW) were assessed separately. BA was measured using angiography (Angio-BA) and longitudinal OCT imaging ...

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    10. Prevalence and Predictors of Multiple Coronary Plaque Ruptures In Vivo 3-Vessel Optical Coherence Tomography Imaging Study

      Prevalence and Predictors of Multiple Coronary Plaque Ruptures In Vivo 3-Vessel Optical Coherence Tomography Imaging Study

      Objective— Plaque rupture may be the local expression of a widespread coronary instability. This study aimed to investigate: (1) the prevalence and characteristics of nonculprit plaque rupture; (2) the pancoronary atherosclerotic phenotype in patients with and without nonculprit plaque rupture; and (3) the prevalence and predictors of multiple plaque ruptures. Approach and Results— Six hundred and seventy-five nonculprit plaques from 261 patients (34 acute myocardial infarction, 73 unstable angina pectoris, and 154 stable angina pectoris) were analyzed by 3-vessel optical coherence tomography. Nonculprit plaque ruptures were identified in 51 patients (20%). Patients with nonculprit plaque ruptures had higher prevalence of ...

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    11. Impact of stent platform on longitudinal stent deformation: an in vivo frequency domain optical coherence tomography study

      Impact of stent platform on longitudinal stent deformation: an in vivo frequency domain optical coherence tomography study

      Recently, longitudinal coronary stent deformation has been highlighted as a possible cause of drug-eluting stent failure. Although bench tests and in vivo studies have demonstrated difference in longitudinal stent strength among the stents with different platforms, its clinical impact is still unknown. Furthermore, it is unknown if modified stent platform favorably affect the incidence of stent deformation. The aim of this study was to investigate the longitudinal deformation of the everolimus-eluting stents (EES) with different stent platforms by using frequency domain optical coherence tomography (FD-OCT). Seventy-eight lesions treated with EES (Xience Prime: n = 26, Promus element: n = 29, Promus premier ...

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    12. Associations between the Framingham Risk Score and coronary plaque characteristics as assessed by three-vessel optical coherence tomography

      Associations between the Framingham Risk Score and coronary plaque characteristics as assessed by three-vessel optical coherence tomography

      Objectives: This study sought to explore the association between the Framingham Risk Score (FRS) and coronary plaque characteristics assessed by optical coherence tomography (OCT) imaging. Background: Clinical prediction models are useful for identifying high-risk patients. However, coronary events often occur in individuals estimated to be at low risk. Methods: A total of 254 patients with coronary artery disease who underwent three-vessel OCT were divided into tertiles according to FRS. Nonculprit plaque characteristics were compared among the three groups. Results: A total of 663 plaques were analyzed. FRS was significantly associated with calcification [37% (low FRS) vs. 46% (intermediate FRS) vs ...

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    13. Thin-cap fibroatheroma and large calcification at the proximal stent edge correlate with a high proportion of uncovered stent struts in the chronic phase

      Thin-cap fibroatheroma and large calcification at the proximal stent edge correlate with a high proportion of uncovered stent struts in the chronic phase

      Objective: A high proportion of uncovered stent struts is associated with late stent thrombosis after drug-eluting stent (DES) implantation, which frequently results in myocardial infarction or death. However, the predictors of uncovered stent struts remain unknown. Here, using optical coherence tomography (OCT), we studied the baseline tissue characteristics of the target coronary segment and evaluated their influence on the neointimal coverage of the strut in the chronic phase. Methods: We analyzed 118 coronary lesions treated with OCT-guided DES implantation. OCT examinations of target lesions were performed before and after DES implantation, and tissue characteristics were evaluated within 5 mm outer ...

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    14. High Platelet Reactivity and Intrastent Thrombi Assessed by OCT After DES

      High Platelet Reactivity and Intrastent Thrombi Assessed by OCT After DES

      High platelet reactivity (HPR) on clopidogrel may be related to stent thrombosis after drug-eluting stent (DES) implantation (1) . To investigate the relationship between HPR and intrastent thrombi following DES implantation, 202 lesions treated with DES from 109 patients were studied. Coronary angiography and optical coherence tomography (OCT) examination were performed as parts of routine follow-up examination at our institution except for the presence of renal dysfunction or congestive heart failure. OCT imaging and platelet function test were performed at 6 to 9 months (median 202 days). Dual antiplatelet therapy with aspirin and clopidogrel was started before stent implantation and continued ...

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    15. Detection of Plaque Neovascularization by Optical Coherence Tomography: Ex Vivo Feasibility Study and In Vivo Observation in Patients With Angina Pectoris

      Detection of Plaque Neovascularization by Optical Coherence Tomography: Ex Vivo Feasibility Study and In Vivo Observation in Patients With Angina Pectoris

      Abstract: Objectives. The purposes of this study were: (1) to assess the feasibility of optical coherence tomography (OCT) for detecting neovascularization; and (2) to clarify the impact of plaque neovascularization on coronary vessel behavior over time. Background. Plaque neovascularization may be related to plaque vulnerability. Methods. In an ex vivo study, a total of 55 coronary plaques from 31 human cadavers were examined by OCT. Plaque neovascularization was diagnosed based on the presence or absence of microchannels (MCs) by OCT. In an in vivo study, we explored 83 major coronary arteries from 42 patients with angina pectoris. A total of ...

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    16. Quantitative analysis of the side-branch orifice after bifurcation stenting using en-face processing of OCT images: a comparison between Xience V and Resolute Integrity stents

      Quantitative analysis of the side-branch orifice after bifurcation stenting using en-face processing of OCT images: a comparison between Xience V and Resolute Integrity stents

      Objective: Methods for intravascular assessment of the side-branch (SB) orifice after stenting are not readily available. The aim of this study was to assess the utility of an en-face projection processing for optical coherence tomography (OCT) images for SB evaluation. Methods: Measurements of the SB orifice obtained using en-face OCT images were validated using a phantom model. Linear regression modeling was applied to estimated area measurements made on the en-face images. The SB orifice was then analyzed in 88 patients with bifurcation lesions treated with either Xience V (everolimus-eluting stent) or Resolute Integrity [zotarolimus-eluting stent (ZES)]. The SB orifice area ...

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    17. Incidence and Clinical Significance of Poststent Optical Coherence Tomography Findings: One-Year Follow-Up Study From a Multicenter Registry

      Incidence and Clinical Significance of Poststent Optical Coherence Tomography Findings: One-Year Follow-Up Study From a Multicenter Registry

      Background— Optical coherence tomography (OCT) was recently introduced to optimize percutaneous coronary intervention. However, the exact incidence and significance of poststent OCT findings are unknown. Methods and Results— A total of 900 lesions treated with 1001 stents in 786 patients who had postprocedure OCT imaging were analyzed to evaluate the incidence of poststent OCT findings and to identify the OCT predictors for device-oriented clinical end points, including cardiac death, target vessel–related myocardial infarction, target lesion revascularization, and stent thrombosis. Patients were followed up to 1 year. Stent edge dissection was detected in 28.7% of lesions, and incomplete stent ...

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    18. In-stent neointimal characteristics and late neointimal response after drug-eluting stent implantation: A preliminary observation

      In-stent neointimal characteristics and late neointimal response after drug-eluting stent implantation: A preliminary observation

      Background Progressive neointimal proliferation may lead to late restenosis and/or neoatherosclerosis after drug-eluting stent (DES) implantation. Late neointimal response may be different among different tissue characteristics. The aim of this study was to assess impact of in-stent neointimal characteristics on late neointimal response following DES implantation. Methods Serial (median 270 days and median 551 days after stent implantation) optical coherence tomography (OCT) examinations were performed in 42 stented lesions from 26 patients. In-stent neointimal tissue was categorized as either homogeneous or heterogeneous neointima based on the OCT appearance at 1st follow-up. Serial changes in neointimal area (NIA) were compared ...

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    19. Incidence and Clinical Significance of Post-Stent OCT Findings: One Year Follow-Up Study From a Multicenter Registry

      Incidence and Clinical Significance of Post-Stent OCT Findings: One Year Follow-Up Study From a Multicenter Registry

      Background —Optical coherence tomography (OCT) was recently introduced to optimize percutaneous coronary intervention. However, the exact incidence and significance of post-stent OCT findings are unknown. Methods and Results —A total of 900 lesions treated with 1001 stents in 786 patients who had post-procedure OCT imaging were analyzed to evaluate the incidence of post-stent OCT findings and to identify the OCT predictors for device-oriented clinical endpoints (DoCE), including cardiac death, target vessel-related myocardial infarction, target lesion revascularization (TLR) and stent thrombosis. Patients were followed up to 1 year. Stent edge dissection was detected in 28.7% of lesions and incomplete stent ...

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    20. Comparison of Neoatherosclerosis and Neovascularization Between Patients With and Without Diabetes : An Optical Coherence Tomography Study

      Comparison of Neoatherosclerosis and Neovascularization Between Patients With and Without Diabetes : An Optical Coherence Tomography Study

      Objectives This study aimed to investigate the characteristics of neoatherosclerosis (NA) in patients with diabetes mellitus (DM) after drug-eluting stent (DES) implantation using optical coherence tomography. Background NA is an important substrate for stent failure. In vivo NA characteristics in DM patients have not been investigated. Methods A total of 397 patients with 452 DES who underwent follow-up optical coherence tomography examination after DES implantation were enrolled. Characteristics of NA were compared between DM and non-DM patients. Neovascularization was defined as signal-poor holes or tubular structures with a diameter of 50 to 300 μm. Results A total of 123 DES ...

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    21. New implication of three-dimensional optical coherence tomography in optimising bifurcation PCI

      New implication of three-dimensional optical coherence tomography in optimising bifurcation PCI

      With the advance of optical coherence tomography (OCT) technology, three-dimensional (3D) reconstruction based on the optical coherence tomography has become feasible. In bifurcation lesions, 3D OCT may guide positioning of the wire through the appropriate (distal) cells. The early studies suggested that such a guidance strategy could reduce the incidence of malapposition in bifurcation lesions. The pre-installed “real-time” 3D OCT on the console will promote the utilisation of 3D assessment in bifurcation treatment and possibly establish the clinical benefit of such guidance in the near future when investigated in a prospective study.

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    22. Impacts of lesion angle on incidence and distribution of acute vessel wall injuries and strut malapposition after drug-eluting stent implantation assessed by optical coherence tomography

      Impacts of lesion angle on incidence and distribution of acute vessel wall injuries and strut malapposition after drug-eluting stent implantation assessed by optical coherence tomography

      Aims To investigate the impact of lesion angle on the incidence and distribution of acute vessel wall injuries and incomplete stent apposition (ISA) following second-generation drug-eluting stent (DES) implantation using optical coherence tomography (OCT). Several ex vivo studies demonstrated that angled arterial walls are exposed to imbalanced mechanical stress from deployed stents. Methods and results We included 243 lesions treated with a single DES (148 everolimus-eluting stent and 95 zotarolimus-eluting stent). Angled lesions were defined as lesions with angle ≥45° on an angiogram ( n = 58). The vessel wall injuries and ISA were evaluated by OCT. The results were compared with ...

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    23. Optical Coherence Tomographic Evaluation of the Effect of Cigarette Smoking on Vascular Healing after Sirolimus-Eluting Stent Implantation

      Optical Coherence Tomographic Evaluation of the Effect of Cigarette Smoking on Vascular Healing after Sirolimus-Eluting Stent Implantation

      Cigarette smoking is known to be deleterious to patients with coronary artery disease, however the effect of smoking on vascular responses after coronary drug-eluting stent implantation is unknown. We sought to examine vascular response after sirolimus-eluting stent (SES) implantation in patients with ongoing smoking using optical coherence tomography (OCT), compared with former smokers and nonsmokers. We identified 181 SESs in 140 subjects who underwent follow-up OCT imaging. Subjects were divided into 3 groups: current smokers (n = 28), former smokers (n = 35), and nonsmokers (n = 77). Stent strut coverage, neointimal characteristics, and strut malapposition were evaluated. The incidence of uncovered stent ...

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    24. Insights into the spatial distribution of lipid-rich plaques in relation to coronary artery bifurcations: an in-vivo optical coherence tomography study

      Insights into the spatial distribution of lipid-rich plaques in relation to coronary artery bifurcations: an in-vivo optical coherence tomography study

      Objectives: The aim of this study was to investigate the spatial location of vulnerable plaques at coronary artery bifurcations using frequency domain-optical coherence tomography. Background: In-vivo data on geometric location of vulnerable plaques in relation to coronary bifurcation are limited. Materials and methods: A total of 40 patients with left anterior descending artery bifurcation were studied. Plaque characteristics in five regions in relation to a side branch were compared: opposite flow divider (OFD); bifurcation site (BF); main branch side proximal (MBP); side branch side proximal (SBP); and flow divider (FD). Frequency domain-optical coherence tomography was used for plaque characterization. Results ...

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    1-24 of 48 1 2 »
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