1. Articles from Luca Di Vito

    1-24 of 36 1 2 »
    1. A patient with multiple Swiss cheese aspect coronary lesions: optical coherence tomography to guide coronary angioplasty

      A patient with multiple Swiss cheese aspect coronary lesions: optical coherence tomography to guide coronary angioplasty

      Although spontaneous recanalization of coronary thrombi has been reported pathologically, it is rarely recognized in clinical practice. We presented a rare case of recanalized thrombi of the right coronary artery and distal left anterior descending artery in a patient with an anterior ST segment elevation myocardial infarction treated with primary percutaneous intervention of the proximal left anterior descending artery. Optical coherence tomography aspect of right coronary artery was consistent with a ‘Swiss cheese’ appearance that represented recanalization of organized thrombi. Optical coherence tomography has been essential to discriminate the underlying mechanism and may provide useful information for an appropriate treatment ...

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    2. A comparison of intracoronary treatment strategies for thrombus burden removal during primary percutaneous coronary intervention: a COCTAIL II substudy

      A comparison of intracoronary treatment strategies for thrombus burden removal during primary percutaneous coronary intervention: a COCTAIL II substudy

      Background: Manual thrombus aspiration and local drug delivery of abciximab have been proposed as a strategy to reduce thrombus burden during percutaneous coronary intervention in patients with ST elevation myocardial infarction; however, the effectiveness of these approaches, is uncertain. In this COCTAIL II substudy, we compared the effect of these strategies on prestenting and poststenting thrombus burden assessed by optical coherence tomography. Patients and methods: COCTAIL II trial enrolled patients with ST elevation myocardial infarction randomized to intralesion (IL, by the ClearWay catheter) versus intracoronary (IC, by the guide catheter) abciximab bolus with or without aspiration thrombectomy (AT). The following ...

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      Mentions: Francesco Prati
    3. The role of residual intrastent thrombus during primary angioplasty: insights from the COCTAIL II study

      The role of residual intrastent thrombus during primary angioplasty: insights from the COCTAIL II study

      Aims: Recent frequency-domain optical coherence tomography studies showed that a complete removal of thrombotic materials is rarely achieved after percutaneous coronary interventions for ST segment elevation myocardial infarction. Residual intrastent thrombus can embolize distally leading to microcirculatory injury. The aim was to find a possible correlation between residual intrastent thrombus and angiographic indexes of myocardial reperfusion. Methods: The population consisted of 128 ST segment elevation myocardial infarction patients enrolled in the COCTAIL II trial. Intrastent thrombus at optical coherence tomography was defined as the maximum percentage value of thrombus area (thrombus area/stent area × 100 in the cross-section with largest ...

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      Mentions: Francesco Prati
    4. Reproducibility of serial optical coherence tomography measurements for lumen area and plaque components in humans (The CLI-VAR [Centro per la Lotta Contro l’Infarto-variability] II study)

      Reproducibility of serial optical coherence tomography measurements for lumen area and plaque components in humans (The CLI-VAR [Centro per la Lotta Contro l’Infarto-variability] II study)

      Frequency-domain optical coherence tomography (FD-OCT) is a promising intracoronary imaging technique to study atherosclerosis. Indeed, its unprecedented spatial resolution allows the assessment of fibrous cap thickness, lipid pool and features of plaque vulnerability. Aim of this study was to determine the reproducibility of the in vivo FD-OCT measurements of lumen area and plaque components in serial studies. Twenty-six patients undergoing FD-OCT assessment of intermediate lesion during coronary angiography were included in this study. FD-OCT pullbacks were acquired twice from the same coronary segment at interval of 5 min without additional intervention and analyzed off-line at an independent imaging core laboratory ...

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      Mentions: Francesco Prati
    5. Clinical Impact of OCT Findings During PCI: The CLI-OPCI II Study

      Clinical Impact of OCT Findings During PCI: The CLI-OPCI II Study

      Objectives The goal of this study was to assess the clinical impact of optical coherence tomography (OCT) findings during percutaneous coronary intervention (PCI). Background OCT provides unprecedented high-definition visualization of plaque/stent structures during PCI; however, the impact of OCT findings on outcome remains undefined. Methods In the context of the multicenter CLI-OPCI (Centro per la Lotta contro l’Infarto–Optimisation of Percutaneous Coronary Intervention) registry, we retrospectively analyzed patients undergoing end-procedural OCT assessment and compared the findings with clinical outcomes. Results A total of 1,002 lesions (832 patients) were assessed. Appropriate OCT assessment was obtained in 98.2 ...

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    6. Optical Coherence Tomography for Characterization of Cardiac Allograft Vasculopathy in Late Survivors of Pediatric Heart Transplantation

      Optical Coherence Tomography for Characterization of Cardiac Allograft Vasculopathy in Late Survivors of Pediatric Heart Transplantation

      Background Optical coherence tomography (OCT) has been shown to reliably detect cardiac allograft vasculopathy (CAV). In recent studies performed in adult heart transplant (HTx) recipients, OCT revealed the presence of vulnerable plaques and complicated coronary artery lesions, thus challenging the current concept that CAV disease is a diffuse concentric and fibrosing vasculopathy. The aim of our study was to characterize CAV by OCT in a young population of HTx recipients. Methods We prospectively enrolled 21 young HTx recipients (mean age 27; range 22–38 years) to undergo OCT of the left anterior descending coronary artery (LAD) in addition to annual ...

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      Mentions: Francesco Prati
    7. Comparison between intermediate and severe coronary stenoses and clinical outcomes of an OCT-guided PCI strategy

      Comparison between intermediate and severe coronary stenoses and clinical outcomes of an OCT-guided PCI strategy

      Aims: We compared optical coherence tomography (OCT) features of intermediate and severe coronary stenoses in patients with stable angina and acute coronary syndrome (ACS), and tested the clinical impact of an OCT-based strategy for treating intermediate stenoses. Methods: The study enrolled 135 consecutive patients with either ACS or stable angina and a single de-novo coronary stenosis. Patients were divided into two groups: intermediate stenosis defined as quantitative coronary angiography percentage narrowing less than 70%, or presence of angiographic vessel haziness and severe stenosis with percentage narrowing more than 70%. OCT was performed to assess features of plaque vulnerability and to ...

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      Mentions: Francesco Prati
    8. Serial optical coherence tomography imaging of ACS-causing culprit plaques

      Serial optical coherence tomography imaging of ACS-causing culprit plaques

      Aims: The aim of this study was to understand better the mechanisms of repair of plaque complications causing acute coronary syndrome. Methods and results: We used OCT in the acute phase and at follow-up (one to seven months) to investigate the plaque healing in 10 culprit plaques: five ruptured fibrous cap (RFC) and five intact fibrous cap (IFC) which were not treated with stent deployment and caused ST-segment elevation myocardial infarction (n=8) and non-STEMI (n=2). At follow-up OCT, the margins of the evacuated cavity in RFC plaques showed a smooth surface and a morphology similar to that of ...

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    9. Optical Coherence Tomography for the Assessment of Coronary Artery Disease

      Optical Coherence Tomography for the Assessment of Coronary Artery Disease

      Angiography remains the gold standard for assessment of atherosclerotic impairment of coronary arteries and for guidance of coronary intervention. Angiography, as a main limitation, only depicts the luminal narrowings caused by coronary plaques, without showing the structures located beneath, such as the atherosclerotic lesions or the vessel wall. Intravascular imaging modalities are currently adopted to circumvent angiographic limitations. Optical coherence tomography (OCT)) is a novel imaging technique that uses infrared lights and can study atherosclerotic plaques and stented segments with extreme accuracy. Compared to intravascular ultrasound (IVUS) , OCT has a much higher resolution; this is at the expense of the ...

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      Mentions: Francesco Prati
    10. New techniques of intravessel imaging in coronary atherosclerosis

      New techniques of intravessel imaging in coronary atherosclerosis

      Intravascular imaging modalities are currently adopted to circumvent angiographic limitations. The present overview is aimed at describing the principal techniques used by an interventional cardiologist to assess both coronary atherosclerotic plaques and stent deployment results. Optical coherence tomography (OCT), intravascular ultrasound (IVUS), and near-infrared spectroscopy are currently available to address these issues. These techniques are characterized by specific advantages and limitations, making each of those applicable for specific purposes. Offline software programmes have been developed to further characterize plaque tissue, highlighting the macrophage presence or unfold coronary stent in a three-dimensional view by a carpet view. Although IVUS and OCT ...

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      Mentions: Francesco Prati
    11. Plaque rupture and intact fibrous cap assessed by optical coherence tomography portend different outcomes in patients with acute coronary syndrome

      Plaque rupture and intact fibrous cap assessed by optical coherence tomography portend different outcomes in patients with acute coronary syndrome

      Aims Patients presenting with acute coronary syndrome (ACS) may have different plaque morphologies at the culprit lesion. In particular, plaque rupture (PR) has been shown as the more frequent culprit plaque morphology in ACS. However, its prognostic value is still unknown. In this study, we evaluated the prognostic value of PR, compared with intact fibrous cap (IFC), in patients with ACS. Methods and results We enrolled consecutive patients admitted to our Coronary Care Unit for ACS and undergoing coronary angiography followed by interpretable optical coherence tomography (OCT) imaging. Culprit lesion was classified as PR and IFC by OCT criteria. Prognosis ...

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      Mentions: Francesco Prati
    12. Identification and quantification of macrophage presence in coronary atherosclerotic plaques by optical coherence tomography

      Identification and quantification of macrophage presence in coronary atherosclerotic plaques by optical coherence tomography

      Aims Vulnerable plaques are characterized by a high macrophage content. We investigated the optical coherence tomography (OCT) capability of identifying coronary plaque macrophage presence using tissue property indexes. Methods and results Fifteen epicardial coronary arteries were imaged by OCT and subsequently analysed by histology. Correlating OCT–histological sections were identified and regions of interest (ROIs) were selected on both atherosclerotic plaques and normal appearing vessel tracts. OCT-derived tissue property indexes named normalized standard deviation (NSD), signal attenuation, and granulometry index were applied on ROIs to identify inflamed ROIs defined as a macrophage percentage >10 by histology. Forty-three paired samples (OCT ...

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      Mentions: Francesco Prati
    13. Suboptimal stent deployment is associated with subacute stent thrombosis: Optical Coherence Tomography insights from a multicenter matched study. From the CLI Foundation investigators: the CLI-THRO study

      Suboptimal stent deployment is associated with subacute stent thrombosis: Optical Coherence Tomography insights from a multicenter matched study. From the CLI Foundation investigators: the CLI-THRO study

      Background Acute or sub-acute stent thrombosis (ST) is a well described complication usually causing acute coronary syndromes (ACS) and in the worst case scenario sudden cardiac death. In this study we aimed at exploring the potential role of optical coherence tomography (OCT) in the understanding of the mechanism of ST. Methods Twenty-one consecutive patients, after ACS due to a definite sub-acute ST, were assessed with OCT and matched 1:2 with 42 patients undergoing OCT for scheduled follow-up. OCT assessment was focused on features indicative of non-optimal stent deployment: under-expansion, malapposition, edge dissection and reference lumen narrowing. Results OCT revealed ...

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    14. Quantification of manual thrombus removal in patients with acute coronary syndromes: a study exploiting serial frequency domain-optical coherence tomography

      Quantification of manual thrombus removal in patients with acute coronary syndromes: a study exploiting serial frequency domain-optical coherence tomography

      Aims: Thrombus aspiration is useful in improving myocardial reperfusion in comparison to conventional percutaneous coronary intervention in patients with acute myocardial infarction. Nonetheless, assessment of thrombus aspiration efficacy is lacking. Aim of this study was to quantify by frequency domain optical coherence tomography (OCT) the amount of thrombus removal in patients with acute coronary syndromes undergoing manual thrombus aspiration, correlating it with the actual size of the retrieved material. Methods: Twenty-five consecutive patients with acute coronary syndrome were enrolled. OCT assessment of thrombotic lesions was performed before and after thrombus aspiration and repeated after stent deployment. OCT thrombus assessment was ...

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      Mentions: Francesco Prati
    15. Reproducibility of the Carpet View system: a novel technical solution for display and off line analysis of OCT images

      Reproducibility of the Carpet View system: a novel technical solution for display and off line analysis of OCT images

      The optical coherence tomography (OCT) evaluation of the stent anatomy requires the inspection of sequential cross section (CS). However stent coils cannot be appreciated in the conventional format as the OCT CS simply display stent struts, that are poorly representative of the stent architecture. The aim of the present study was to validate a new software ( Carpet View ), which unfolds the stented segment, reconstructing it as an open structure and displaying the stent meshwork. 21 patients were studied with frequency domain OCT after the deployment of different stents: seven bio-absorbable scaffolds (Dream), seven bare metal stent (Vision/Multilink8), seven drug ...

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      Mentions: Francesco Prati
    16. Stent-related defects in patients presenting with stent thrombosis: differences at optical coherence tomography between subacute and late/very late thrombosis in the Mechanism Of Stent Thrombosis (MOST) study

      Stent-related defects in patients presenting with stent thrombosis: differences at optical coherence tomography between subacute and late/very late thrombosis in the Mechanism Of Stent Thrombosis (MOST) study

      Aims: Subacute, late, and very late stent thrombosis (ST) may occur after stent implantation, but they are characterised by different underlying pathophysiological mechanisms. We sought to appraise differences between subacute and late/very late ST at the thrombus site by optical coherence tomography (OCT). The Mechanism Of Stent Thrombosis (MOST) study was a prospective multicentre non-randomised registry which enrolled six subacute ST and six controls (subacute ST study), and 17 late/very late ST and 17 controls (late/very late ST study). Methods and results: Patients with subacute ST had a minimum stent area at the thrombus site of 2 ...

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    17. Comprehensive overview of definitions for optical coherence tomography-based plaque and stent analyses

      Comprehensive overview of definitions for optical coherence tomography-based plaque and stent analyses

      Optical coherence tomography (OCT) is the current state-of-the-art intracoronary imaging modality that allows visualization of detailed morphological characteristics of both atherosclerotic plaque and stent. So far, three expert review documents have been released for standardization of OCT image analysis. In the real world, a variety of definitions are being used by different groups and by different core laboratories to analyze OCT findings because of different clinical/procedural contexts in which OCT research has been carried out. This comprehensive overview is aimed to summarize different applicable definitions used by different research groups in plaque and stent analysis using OCT. In addition ...

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    18. Serial Observation of Drug-Eluting Absorbable Metal Scaffold Multi-Imaging Modality Assessment

      Serial Observation of Drug-Eluting Absorbable Metal Scaffold Multi-Imaging Modality Assessment

      Background— The drug-eluting absorbable metal scaffold has demonstrated feasibility, safety, and promising clinical and angiographic outcomes at 12 months in human coronary arteries. This study aimed to evaluate the degradation rate and long-term vascular responses to drug-eluting absorbable metal scaffold. Methods and Results— BIOSOLVE-I was a multicenter, single-arm, first-in-man trial assessing the safety and performance of drug-eluting absorbable metal scaffold in 46 patients with coronary artery disease. Patients who underwent serial invasive imaging, such as quantitative coronary angiography, intravascular ultrasound, and optical coherence tomography, at 6 and 12 months were included in this study. From postimplantation to follow-up, arterial curvature ...

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    19. Radial artery complications occurring after transradial coronary procedures using long hydrophilic-coated introducer sheath: a frequency domain-optical coherence tomography study

      Radial artery complications occurring after transradial coronary procedures using long hydrophilic-coated introducer sheath: a frequency domain-optical coherence tomography study

      This study was performed to analyze the impact of transradial intervention (TRI), performed by long (25-cm) hydrophilic-coated radial introducer sheath (HRS), on radial artery (RA). Both acute damages and chronic intimal modifications, occurring in RA, were assessed using frequency domain-optical coherence tomography (FD-OCT). FD-OCT evaluation of RA was performed in 51 consecutive patients, undergoing TRI by long (25-cm) HRS. FD-OCT was performed from RA ostium to the puncture site. Acute damages such as intimal tears and medial dissections together with chronic intimal modifications, assessed as intimal hyperplasia indexes, were observed and compared between proximal and distal RA segments. Intimal tears ...

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    20. OCT Guidance to Improve Clinical Outcome of Coronary Interventions: What Have We Learnt?

      OCT Guidance to Improve Clinical Outcome of Coronary Interventions: What Have We Learnt?

      Optical coherence tomography (OCT) is the current state-of-the-art intravascular imaging technique which so far has been mainly used for research purpose. The clinical impact of an OCT-guided percutaneous coronary intervention is a field of controversy, although recent non randomized data has shown its potential clinical benefit. Many features that are clearly visualized by OCT are missed by both angiography and other intravascular imaging techniques due to their limited resolution. On the contrary, OCT allows visualization of detailed morphological characteristics of both atherosclerotic plaque and stent. This may translate in an improved clinical outcome of OCT-guided procedures. This article reviews the ...

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      Mentions: Francesco Prati
    21. Excimer laser for a highly stenotic saphenous vein graft: evidence of debulking by optical coherence tomography

      Excimer laser for a highly stenotic saphenous vein graft: evidence of debulking by optical coherence tomography

      A 73-year-old woman with a history of coronary artery bypass (saphenous vein graft [SVG] for left anterior descending artery [LAD] and right coronary artery) was admitted for non-ST-elevation acute coronary syndrome. Coronary angiography showed a proximal severe stenosis of the SVG for LAD that was the culprit lesion of the acute coronary syndrome (Figure 1A). Frequency-domain optical coherence tomography (FD-OCT) was performed using a non-occlusive technique and showed a highly fibrous stenosis of the SVG (MLA 0.7 mm) (Figure 1B-E) that was debulked with excimer laser coronary atherectomy (ELCA) (Figure 1-A’,B’). However, a thrombus occurred at the lesion ...

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    22. Long-term Morphofunctional Remodeling of Internal Thoracic Artery Grafts: A Frequency-Domain Optical Coherence Tomography Study

      Long-term Morphofunctional Remodeling of Internal Thoracic Artery Grafts: A Frequency-Domain Optical Coherence Tomography Study

      Background— Internal thoracic arteries (ITAs) are frequently anastomosed to the coronary circulation for bypass grafting. The purpose of this research was to investigate in vivo the long-term morphofunctional changes of ITAs after their use as coronary artery bypass conduits, by comparing the morphological features and vasoreactivity of the grafted left ITA (LITA) with the native, nonharvested right ITA (RITA) in the same patient. Methods and Results— At least 10 years after surgery, in 10 patients, LITA graft and nonharvested RITA were assessed by quantitative angiography and frequency-domain optical tomography. Endothelium-dependent and independent vasodilation was tested by selective infusion of acetylcholine ...

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    23. A “Stable” Coronary Plaque Rupture Documented by Repeated OCT Studies

      A “Stable” Coronary Plaque Rupture Documented by Repeated OCT Studies

      Letter to the Editor. Angiographic and OCT Findings at Baseline and 6 Months Later Coronary angiography of the left anterior descending (LAD) coronary artery and frequency domain-optical coherence tomography (FD-OCT) of the ruptured plaque at the first assessment (A, B, C) and second assessment (D, E, F) . (A) Angiography shows a de novo coronary stenosis (red arrow) located distally compared with the previous stented segment (blue line) . (B) FD-OCT cross-section shows the mid portion of the ruptured plaque (asterisk) characterized by a smooth floor and ruptured fibrous cap (arrows) . Arrowheads indicate side branches. (C) FD-OCT cross-section shows the distal portion ...

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      Mentions: Francesco Prati
    24. Randomized trial of standard versus ClearWay-infused abciximab and thrombectomy in myocardial infarction: rationale and design of the COCTAIL II study

      Randomized trial of standard versus ClearWay-infused abciximab and thrombectomy in myocardial infarction: rationale and design of the COCTAIL II study

      Background: Patients with ST-elevation myocardial infarction (STEMI) are at substantial risk of suboptimal procedural results and late adverse events. Angiography and optical coherence tomography (OCT) studies have identified residual coronary thrombus and microcirculatory injury as potential culprits for these adverse outcomes. We hypothesized that coronary thrombectomy and local infusion of glycoprotein IIb/IIIa inhibitors by means of a dedicated infusion device can synergistically improve results of percutaneous coronary intervention (PCI) for STEMI, as appraised by OCT. Methods: A total of 128 patients with STEMI will be randomized, to one of the following: abciximab infusion with the ClearWay coronary catheter (C ...

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