1. Articles from Kenichi Komukai

    1-24 of 33 1 2 »
    1. Optical Coherence Tomography Findings in Patients with Coronary Stent Thrombosis: A Report of the PREvention of Late Stent Thrombosis by an Interdisciplinary Global European Effort (PRESTIGE) Consortium

      Optical Coherence Tomography Findings in Patients with Coronary Stent Thrombosis: A Report of the PREvention of Late Stent Thrombosis by an Interdisciplinary Global European Effort (PRESTIGE) Consortium

      Background —Stent thrombosis (ST) is a serious complication following coronary stenting. Intravascular optical coherence tomography (OCT) may provide insights into mechanistic processes leading to ST. We performed a prospective, multicenter study to evaluate OCT findings in patients with ST. Methods —Consecutive patients presenting with ST were prospectively enrolled in a registry using a centralized telephone registration system. After angiographic confirmation of ST, OCT imaging of the culprit vessel was performed with frequency domain OCT. Clinical data were collected according to a standardized protocol. OCT acquisitions were analyzed at a core laboratory. Dominant and contributing findings were adjudicated by an imaging ...

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    2. Impact of Culprit Plaque and Atherothrombotic Components on Incomplete Stent Apposition in Patients With ST-Elevation Myocardial Infarction Treated With Everolimus-Eluting Stents – An OCTAVIA Substudy –

      Impact of Culprit Plaque and Atherothrombotic Components on Incomplete Stent Apposition in Patients With ST-Elevation Myocardial Infarction Treated With Everolimus-Eluting Stents – An OCTAVIA Substudy –

      Background: The role of culprit plaque and related atherothrombotic components on incomplete stent apposition (ISA) occurrence after primary percutaneous coronary intervention (p-PCI) is unknown. Methods and Results: ST-segment elevation myocardial infarction (STEMI) patients undergoing p-PCI with an everolimus-eluting stent were prospectively investigated with optical coherence tomography (OCT) of the infarct-related artery before, after stenting and at 9 months. OCT data, aspirated thrombus and serum inflammatory biomarkers were analyzed. 114 patients with 114 lesions were evaluated. Acute ISA occurred in 82 lesions (71.9%), preferentially in larger vessels with a median area of 0.2 mm 2 . The presence of thrombus ...

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    3. Comparison of vascular response between everolimus-eluting stent and bare metal stent implantation in ST-segment elevation myocardial infarction assessed by optical coherence tomography

      Comparison of vascular response between everolimus-eluting stent and bare metal stent implantation in ST-segment elevation myocardial infarction assessed by optical coherence tomography

      Aims The long-term safety of second-generation everolimus-eluting stents (EESs) in ST-segment elevation myocardial infarction (STEMI) remains unclear. The aim of this study was to evaluate the late vascular response after stent implantation in STEMI between EES and bare-metal stent (BMS) by using optical coherence tomography (OCT). Methods and results A prospective OCT examination was performed in 102 patients at 10 months after stent implantation for treatment of STEMI. A total of 1253 frames with 12 772 struts in 61 EESs and 776 frames with 8594 struts in 41 BMSs were analysed. There were no significant differences in the percentage of ...

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    4. Effect of Atorvastatin Therapy on Fibrous Cap Thickness in Coronary Atherosclerotic Plaque as Assessed by Optical Coherence Tomography The EASY-FIT Study

      Effect of Atorvastatin Therapy on Fibrous Cap Thickness in Coronary Atherosclerotic Plaque as Assessed by Optical Coherence Tomography The EASY-FIT Study

      Background The detailed mechanism of plaque stabilization by statin therapy is not fully understood. Objectives The aim of this study was to assess the effect of lipid-lowering therapy with 20 mg/day of atorvastatin versus 5 mg/day of atorvastatin on fibrous cap thickness in coronary atherosclerotic plaques by using optical coherence tomography (OCT). Methods Seventy patients with unstable angina pectoris and untreated dyslipidemia were randomized to either 20 mg/day or 5 mg/day of atorvastatin therapy. OCT was performed to assess intermediate nonculprit lesions at baseline and 12-month follow-up. Results Serum low-density lipoprotein cholesterol level was significantly lower ...

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    5. Difference of Ruptured Plaque Morphology between Asymptomatic Coronary Artery Disease and Non-ST Elevation Acute Coronary Syndrome Patients: an Optical Coherence Tomography Study

      Difference of Ruptured Plaque Morphology between Asymptomatic Coronary Artery Disease and Non-ST Elevation Acute Coronary Syndrome Patients: an Optical Coherence Tomography Study

      Background Autopsy studies have reported that rupture of a thin-cap fibroatheroma and subsequent thrombus formation is the major mechanism leading to acute coronary syndrome (ACS). However, it is not clear why only some plaque ruptures lead to ACS. Optical coherence tomography (OCT) is a high-resolution imaging modality which is capable of investigating detailed coronary plaque morphology in vivo. The objective of this study was to determine whether ruptured plaque morphology assessed by OCT differs between asymptomatic coronary artery disease (CAD) and non-ST elevation acute coronary syndrome (NSTEACS). Methods We examined ruptured plaque morphology using OCT in 80 patients, 33 with ...

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    6. Coronary artery disease in systemic sclerosis not clinically apparent: findings from optical coherence tomography

      Coronary artery disease in systemic sclerosis not clinically apparent: findings from optical coherence tomography

      A 42-year-old female was referred for intermittent effort angina. She had low body mass index, no coronary risk factors and an unremarkable past medical history except for a Raynaud's phenomenon. Owing to a normal exercise stress test ( Panel A ), symptoms were initially attributed to anxiety. However, a 24h-EKG monitoring revealed diffuse ST-segment depression during …

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    7. Comparison of diagnostic accuracy between multidetector computed tomography and virtual histology intravascular ultrasound for detecting optical coherence tomography-derived fibroatheroma

      Comparison of diagnostic accuracy between multidetector computed tomography and virtual histology intravascular ultrasound for detecting optical coherence tomography-derived fibroatheroma

      Histopathological studies have reported that optical coherence tomography (OCT) can accurately detect fibroatheroma that is involved in not only culprit lesion of acute coronary syndrome but also no-reflow phenomenon after percutaneous coronary intervention. Studies have demonstrated superiority of OCT in plaque characterization and interruption of arterial wall component. At current, multidetector computed tomography (MDCT) and virtual histology intravascular ultrasound (VH-IVUS) are considered as alternative imaging devices for coronary plaque characterization. This study aimed to compare the diagnostic accuracy for detecting fibroatheroma between MDCT and VH-IVUS using OCT as the reference standard. Forty-three lesions from 27 patients assessed by MDCT, VH-IVUS ...

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    8. Coronary Superficial and Spotty Calcium Deposits in Culprit Coronary Lesions of Acute Coronary Syndrome as Determined by Optical Coherence Tomography

      Coronary Superficial and Spotty Calcium Deposits in Culprit Coronary Lesions of Acute Coronary Syndrome as Determined by Optical Coherence Tomography

      The characteristics of coronary artery calcium responsible for vulnerable plaque remain incompletely elucidated. We used optical coherence tomography to investigate the characteristics of coronary calcium in acute myocardial infarction (AMI), unstable angina pectoris (UAP), and stable angina pectoris (SAP). We evaluated calcium deposits in the culprit lesions (30-mm segment) using optical coherence tomography in 187 patients with AMI (n = 44), UAP (n = 73), or SAP (n = 70). The arc, area, and length of calcium were significantly smaller in those with AMI and UAP than in those with SAP (p <0.001). The number of spotty calcium deposits (with an arc ...

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    9. Clinical Significance of Low Signal Intensity Area Surrounding Stent Struts Identified by Optical Coherence Tomography

      Clinical Significance of Low Signal Intensity Area Surrounding Stent Struts Identified by Optical Coherence Tomography

      Previous intravascular ultrasound studies have shown that echolucent neointimal hyperplasia occasionally appears after bare-metal stent (BMS) or sirolimus-eluting stent (SES) implantation. Optical coherence tomography (OCT) studies have also demonstrated that paclitaxel-eluting stent (PES) restenosis exhibited similar images showing low signal intensity areas (LSIA) surrounding stent struts and three-layer appearance (TLA). The aim of the present study was to investigate the clinical significance of LSIA on OCT images in various types of stents. Fifty nine consecutive patients who underwent scheduled follow-up coronary angiography and OCT were enrolled. There was no significant difference in the prevalence of LSIA among the 3 stent ...

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    10. Difference in neointimal appearance between early and late restenosis after sirolimus-eluting stent implantation assessed by optical coherence tomography

      Difference in neointimal appearance between early and late restenosis after sirolimus-eluting stent implantation assessed by optical coherence tomography

      Objectives: Late in-stent restenosis (ISR) is an important clinical issue in the drug-eluting stent era. Autopsy studies have reported different underlying mechanisms between early ISR and late ISR. The aim of the present study was to compare the neointimal tissue appearance between early ISR (<1 year) and late ISR (>1 year) after sirolimus-eluting stent (SES) implantation using optical coherence tomography (OCT). Materials and methods: We examined the neointimal tissue appearance in 48 ISR lesions after SES implantation [30 early ISR lesions (8±1 months after stenting) and 18 late ISR lesions (34±14 months after stenting)] by OCT. ISR was ...

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    11. Optical Coherence Tomography-Derived Anatomical Criteria for Functionally Significant Coronary Stenosis Assessed by Fractional Flow Reserve

      Optical Coherence Tomography-Derived Anatomical Criteria for Functionally Significant Coronary Stenosis Assessed by Fractional Flow Reserve

      Background: For the identification of functionally significant coronary artery disease, there have not been any dedicated optical coherence tomography (OCT) studies reported previously, although OCT can clearly detect coronary vessel lumina at higher resolution than intravascular ultrasound (IVUS). Methods and Results: OCT and fractional flow reserve (FFR) measurements were performed in 62 intermediate coronary lesions in 59 patients. FFR was calculated as the ratio of distal coronary pressure divided by proximal coronary pressure during maximal hyperemia. FFR <0.75 was used as the threshold for diagnosing functionally significant stenosis. Minimal lumen area (MLA), minimal lumen diameter (MLD) and percent lumen ...

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    12. Circulating malondialdehyde-modified low-density lipoprotein levels are associated with the presence of thin-cap fibroatheromas determined by optical coherence tomography in coronary artery disease

      Circulating malondialdehyde-modified low-density lipoprotein levels are associated with the presence of thin-cap fibroatheromas determined by optical coherence tomography in coronary artery disease

      Aims The importance of oxidized low-density lipoprotein (oxLDL) has been implicated in the process of plaque rupture. However, few previous studies demonstrated the relationship between plaque morphology and oxLDL. We evaluated the relationship between coronary plaque vulnerability assessed by optical coherence tomography (OCT) and circulating malondialdehyde-modified low-density lipoprotein (MDA-LDL). Methods and results OCT was used to determine plaque vulnerability in 102 patients with acute coronary syndrome (ACS; n = 53) and stable angina pectoris (SAP; n = 49). Circulating levels of MDA-LDL were measured by using enzyme-linked immunosorbent assay. Thin-cap fibroatheromas (TCFAs; defined as lipid-rich with plaque cap thickness

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    13. Effect of strut thickness on neointimal atherosclerotic change over an extended follow-up period (≥4 years) after bare-metal stent implantation: Intracoronary optical coherence tomography examination

      Effect of strut thickness on neointimal atherosclerotic change over an extended follow-up period (≥4 years) after bare-metal stent implantation: Intracoronary optical coherence tomography examination

      Background Neointima inside the bare-metal stents (BMSs) can transform into atherosclerotic tissue during an extended follow-up because of a persistent inflammatory reaction to the metal. We sought to investigate whether strut thickness may impact on the atherosclerotic change in neointima 4 years or more after BMS implantation using optical coherence tomography. Methods Forty-six stented lesions of 41 patients with BMS ≥4 years after implantation who underwent optical coherence tomography were enrolled in the study. The strut was defined as thin when less than 100 μm and thick when ≥100 μm. According to these criteria, stents were divided into 2 groups ...

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    14. Comparison of Contrast Media and Low-Molecular-Weight Dextran for Frequency-Domain Optical Coherence Tomography

      Comparison of Contrast Media and Low-Molecular-Weight Dextran for Frequency-Domain Optical Coherence Tomography

      Although an intracoronary frequency-domain optical coherence tomography (FD-OCT) system overcomes several limitations of the time-domain OCT (TD-OCT) system, the former requires injection of contrast media for image acquisition. The increased total amount of contrast media for FD-OCT image acquisition may lead to the impairment of renal function. The safety and usefulness of the non-occlusion method with low-molecular-weight dextran L (LMD-L) via a guiding catheter for TD-OCT image acquisition have been reported previously. The aim of the present study was to compare the image quality and quantitative measurements between contrast media and LMD-L for FD-OCT image acquisition in coronary stented lesions ...

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    15. Thin-Cap Fibroatheroma as High Risk Plaque for Microvascular Obstruction in Patients With Acute Coronary Syndrome

      Thin-Cap Fibroatheroma as High Risk Plaque for Microvascular Obstruction in Patients With Acute Coronary Syndrome
      Background—Plaque contents can cause microvascular impairment, which is an important determinant of clinical outcomes in patients with acute coronary syndrome (ACS). We hypothesized that percutaneous coronary intervention (PCI) for thin-cap fibroatheroma (TCFA) could easily disrupt the fibrous cap and expose the contents of plaque to coronary flow, possibly resulting in microvascular obstruction (MVO). The purpose of this study was to investigate whether TCFA was associated with MVO following PCI in patients with ACS. Methods and Results—We enrolled 115 patients with ACS who were successfully recanalized with PCI. The patients were divided into a ruptured plaque group (n=59 ...
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    16. Optical Coherence Tomography Analysis of Attenuated Plaques Detected by Intravascular Ultrasound in Patients with Acute Coronary Syndromes

      Optical Coherence Tomography Analysis of Attenuated Plaques Detected by Intravascular Ultrasound in Patients with Acute Coronary Syndromes

      Recent intravascular ultrasound (IVUS) studies have demonstrated that hypoechoic plaque with deep ultrasound attenuation despite absence of bright calcium is common in acute coronary syndrome. Such “attenuated plaque” may be an IVUS characteristic of unstable lesion. Methods. We used optical coherence tomography (OCT) in 104 patients with unstable angina to compare lesion characteristics between IVUS-detected attenuated plaque and nonattenuated plaque. Results. IVUS-detected attenuated plaque was observed in 41 (39%) patients. OCT-detected lipidic plaque (88% versus 49%,

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    17. Virtual Histology Intravascular Ultrasound Compared With Optical Coherence Tomography for Identification of Thin-Cap Fibroatheroma

      Virtual Histology Intravascular Ultrasound Compared With Optical Coherence Tomography for Identification of Thin-Cap Fibroatheroma

      Virtual histology intravascular ultrasound (VH-IVUS) allows detailed assessment of plaque composition in the clinical setting. Optical coherence tomography (OCT) has been developed as a high-resolution imaging method, which might be a promising technique to identify thin-cap fibroatheroma (TCFA) in vivo. The purpose of the present study was to evaluate the diagnostic accuracy of VH-IVUS to identify TCFA as determined by OCT.We examined 96 target lesions in patients with stable angina pectoris by using VH-IVUS and OCT. VH-IVUS derived TCFA was defined as a focal necrotic core-rich lesion without evident overlying fibrous tissue. OCT derived TCFA was defined as a ...

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    18. Difference of Culprit Lesion Morphologies Between ST-Segment Elevation Myocardial Infarction and Non-ST-Segment Elevation Acute Coronary Syndrome: An Optical Coherence Tomography Study

      Difference of Culprit Lesion Morphologies Between ST-Segment Elevation Myocardial Infarction and Non-ST-Segment Elevation Acute Coronary Syndrome: An Optical Coherence Tomography Study
      Objectives The aim of this study was to investigate the difference of culprit lesion morphologies assessed by optical coherence tomography (OCT) between ST-segment elevation myocardial infarction (STEMI) and non–ST-segment elevation acute coronary syndrome (NSTEACS). Background Autopsy studies have reported that rupture of a thin-cap fibroatheroma and subsequent thrombus formation is the most important mechanism leading to acute coronary syndrome (ACS). Optical coherence tomography is a high-resolution imaging modality that is capable of investigating detailed coronary plaque morphology in vivo. Methods We examined the culprit lesion morphologies by OCT in 89 consecutive patients with acute coronary syndrome (STEMI = 40; NSTEACS ...
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    19. Assessment by Optical Coherence Tomography of Stent Struts Across Side Branch – Comparison of Bare-Metal Stents and Drug-Eluting Stents –

      Assessment by Optical Coherence Tomography of Stent Struts Across Side Branch – Comparison of Bare-Metal Stents and Drug-Eluting Stents –
      Late stent thrombosis (LST) after drug-eluting stent (DES) implantation is a major clinical problem that has not been fully explained. Incomplete neointimal coverage of stent struts is an important morphometric predictor of LST, which may be associated with impaired healing and the absence of full coverage of struts at branch-point ostia. Optical coherence tomography (OCT) was performed to compare 3 types of stents placed across side branches. Methods and Results: At 9-month follow-up, the neointimal coverage of the struts of 58 stents across a side branch was measured by OCT (bare metal (BMS), n=20; sirolimus-eluting (SES), n=23; paclitaxel-eluting ...
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    20. Clinical Classification and Plaque Morphology Determined by Optical Coherence Tomography in Unstable Angina Pectoris

      Clinical Classification and Plaque Morphology Determined by Optical Coherence Tomography in Unstable Angina Pectoris
      Unstable angina pectoris (UAP) is categorized with the Braunwald classification. However, the association of clinical presentation and plaque structure/function has not yet been elucidated in relation to cause. We used optical coherence tomography to investigate this relation. One hundred fifteen patients with primary UAP were categorized according to the Braunwald classification. Patients with class I UAP had the highest frequency of ulcers without fibrous cap disruption (p = 0.003) and the smallest minimum lumen area (class I, median 0.70 mm2, quartiles 1 to 3 0.42 to 1.00; class II, 1.80 mm2, 1.50 to 2 ...
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    21. The Effect of Lipid and Inflammatory Profiles on the Morphological Changes of Lipid-Rich Plaques in Patients With Non-ST-Segment Elevated Acute Coronary Syndrome: Follow-Up Study by Optical Coherence Tomography and Intravascular Ultrasound

      The Effect of Lipid and Inflammatory Profiles on the Morphological Changes of Lipid-Rich Plaques in Patients With Non-ST-Segment Elevated Acute Coronary Syndrome: Follow-Up Study by Optical Coherence Tomography and Intravascular Ultrasound
      Objectives The aim of this study was to determine the relationship between the morphological changes of nonculprit lipid-rich plaques and several clinical profiles in patients with non–ST-segment elevated acute coronary syndrome (NSTEACS). Background Identification of coronary lesion with morphological characteristics of rupture-prone plaques is still difficult. Methods Eighty-two consecutive patients with NSTEACS who underwent percutaneous coronary intervention were enrolled. The changes in total atheroma volume (TAV) of residual nonculprit lipid-rich plaques and the changes in the corresponding fibrous cap thickness (FCT) were assessed by intravascular ultrasound and optical coherence tomography, respectively, at baseline and after 9 months. Results The ...
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    22. Association of monocyte subset counts with coronary fibrous cap thickness in patients with unstable angina pectoris

      Association of monocyte subset counts with coronary fibrous cap thickness in patients with unstable angina pectoris
      Abstract: Objectives: We examined whether distinct monocyte subsets relate in specific ways to coronary fibrous cap thickness (FCT) in patients with unstable angina pectoris (UAP).Methods: Forty patients with UAP who underwent percutaneous coronary intervention were enrolled in this study. The changes in the non-culprit FCT were assessed by optical coherence tomography (OCT) at baseline and after 9 months. The distinct monocyte subsets (CD14+CD16−CCR2+ and CD14+CD16+CX3CR1+) were measured by flow cytometry.Results: The percent change in FCT showed significantly negative correlation with the percent changes in CD14+CD16+CX3CR1+ monocytes, but not CD14+CD16−CCR2+ monocytes ...
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