1. Articles from Ziad A. Ali

    1-24 of 43 1 2 »
    1. Lesion Preparation with Orbital Atherectomy

      Lesion Preparation with Orbital Atherectomy

      Abstract Despite significant improvements in stent design, severe coronary calcification continues to impede adequate stent expansion and is associated with worse clinical outcomes. Angiography is limited in its ability to detect and comprehensively characterise calcified plaque. Intravascular imaging provides information on lesion morphology guiding appropriate treatment strategies. Orbital atherectomy allows for lesion preparation of severely calcified plaque prior to stent implantation. Utilising a unique mechanism of action incorporating centrifugal forces, a standard 1.25 mm eccentrically mounted and diamond-coated burr orbits bi-directionally to ablate calcified plaque. Lesion preparation with orbital atherectomy allows for modification of calcified plaque to facilitate stent ...

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    2. Artificial intelligence and optical coherence tomography for the automatic characterisation of human atherosclerotic plaques

      Artificial intelligence and optical coherence tomography for the automatic characterisation of human atherosclerotic plaques

      Background: Intravascular optical coherence tomography (IVOCT) enables detailed plaque characterisation in vivo , but visual assessment is time-consuming and subjective. Aims: This study aimed to develop and validate an automatic framework for IVOCT plaque characterisation using artificial intelligence (AI). Methods: IVOCT pullbacks from five international centres were analysed in a core lab, annotating basic plaque components, inflammatory markers and other structures. A deep convolutional network with encoding-decoding architecture and pseudo-3D input was developed and trained using hybrid loss. The proposed network was integrated into commercial software to be externally validated on additional IVOCT pullbacks from three international core labs, taking the ...

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    3. Double-kissing nano-crush for bifurcation PCI guided by live OCT imaging: Shedding light on stent positioning

      Double-kissing nano-crush for bifurcation PCI guided by live OCT imaging: Shedding light on stent positioning

      Percutaneous coronary intervention (PCI) of bifurcation lesions poses unique challenges and carries a high risk of adverse events on follow-up, mainly driven by repeat revascularization and stent thrombosis . Several techniques exist to tackle bifurcation lesions. Among those, double kissing (DK) crush has emerged in recent years as a safe and effective approach for complex bifurcations requiring a two-stent strategy. In its most recent iteration, the DK nano-crush, minimal (ideally less than 3 mm) side branch stent protrusion into the main branch is recommended, to reduce the number of layers of stent struts at the ostium. Angiographic guidance of stent placement ...

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    4. Lesion Preparation with Orbital Atherectomy

      Lesion Preparation with Orbital Atherectomy

      Despite significant improvements in stent design, severe coronary calcification continues to impede adequate stent expansion and is associated with worse clinical outcomes. Angiography is limited in its ability to detect and comprehensively characterise calcified plaque. Intravascular imaging provides information on lesion morphology guiding appropriate treatment strategies. Orbital atherectomy allows for lesion preparation of severely calcified plaque prior to stent implantation. Utilising a unique mechanism of action incorporating centrifugal forces, a standard 1.25 mm eccentrically mounted and diamond-coated burr orbits bi-directionally to ablate calcified plaque. Lesion preparation with orbital atherectomy allows for modification of calcified plaque to facilitate stent expansion.

      Read Full Article
    5. Lesion Preparation with Orbital Atherectomy

      Lesion Preparation with Orbital Atherectomy

      Despite significant improvements in stent design, severe coronary calcification continues to impede adequate stent expansion and is associated with worse clinical outcomes. Angiography is limited in its ability to detect and comprehensively characterise calcified plaque. Intravascular imaging provides information on lesion morphology guiding appropriate treatment strategies. Orbital atherectomy allows for lesion preparation of severely calcified plaque prior to stent implantation. Utilising a unique mechanism of action incorporating centrifugal forces, a standard 1.25 mm eccentrically mounted and diamond-coated burr orbits bi-directionally to ablate calcified plaque. Lesion preparation with orbital atherectomy allows for modification of calcified plaque to facilitate stent expansio

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    6. Intracoronary optical coherence tomography: state of the art and future directions

      Intracoronary optical coherence tomography: state of the art and future directions

      Optical coherence tomography (OCT) has been increasingly utilised to guide percutaneous coronary intervention (PCI). Despite the diagnostic utility of OCT, facilitated by its high resolution, the impact of intracoronary OCT on clinical practice has thus far been limited. Difficulty in transitioning from intravascular ultrasound (IVUS), complex image interpretation, lack of a standardised algorithm for PCI guidance, and paucity of data from prospective clinical trials have contributed to the modest adoption. Herein, we provide a comprehensive up-do-date overview on the utility of OCT in coronary artery disease, including technical details, device set-up, simplified OCT image interpretation, recognition of the imaging artefacts ...

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    7. Optical Coherence Tomography in Acute Coronary Syndromes

      Optical Coherence Tomography in Acute Coronary Syndromes

      Advances in intravascular imaging have enabled assessment of the underlying plaque morphology in acute coronary syndromes, which allows for the initiation of individualized therapy. The atherothrombotic substrates for acute coronary syndromes consist of plaque rupture, erosion, and calcified nodule, whereas spontaneous coronary artery dissection, coronary artery spasm, and coronary embolism constitute rarer nonatherothrombotic etiologies. This review provides a brief overview of the data from clinical studies that have used intravascular optical coherence tomography to assess the culprit plaque morphology. We discuss the usefulness of intravascular imaging for effective treatment of patients presenting with acute coronary syndromes by percutaneous coronary intervention.

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    8. Automatic Characterisation of Human Atherosclerotic Plaque Composition from Intravascular Optical Coherence Tomography Using Artificial Intelligence

      Automatic Characterisation of Human Atherosclerotic Plaque Composition from Intravascular Optical Coherence Tomography Using Artificial Intelligence

      Background Intravascular optical coherence tomography (IVOCT) enables detailed plaque characterisation in-vivo, but visual assessment is time-consuming and subjective. Aims This study aims to develop and validate an automatic framework for IVOCT plaque characterisation using artificial intelligence (AI). Methods IVOCT pullbacks from 5 international centres were analysed in a corelab, annotating basic plaque components, inflammatory markers and other structures. A deep convolutional network with encoding-decoding architecture and pseudo-3D input was developed and trained using hybrid loss. The proposed network was integrated into commercial software to be externally validated on additional IVOCT pullbacks from three international corelabs, taking the consensus among corelabs ...

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    9. Intravascular Imaging-Guided Percutaneous Coronary Intervention: A Universal Approach for Optimization of Stent Implantation

      Intravascular Imaging-Guided Percutaneous Coronary Intervention: A Universal Approach for Optimization of Stent Implantation

      Despite consistent clinical data supporting the use of intravascular imaging with percutaneous coronary intervention, utilization remains low. A practical and standardized approach to incorporating intravascular imaging with percutaneous coronary intervention may overcome the barriers to utilization. This review focuses on basic image interpretation with intravascular ultrasound and optical coherence tomography and proposes an algorithmic approach to stent sizing and optimization. Incorporation of this strategic method for percutaneous coronary intervention may aid in the greater adoption of intravascular imaging for percutaneous coronary intervention.

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    10. Coronary Optical Coherence Tomography and Cardiac Magnetic Resonance Imaging to Determine Underlying Causes of MINOCA in Women

      Coronary Optical Coherence Tomography and Cardiac Magnetic Resonance Imaging to Determine Underlying Causes of MINOCA in Women

      Background: Myocardial infarction with non-obstructive coronary arteries (MINOCA) occurs in 6-15% of MI and disproportionately affects women. Scientific statements recommend multi-modality imaging in MINOCA to define the underlying cause. We performed coronary optical coherence tomography (OCT) and cardiac magnetic resonance imaging (CMR) to assess mechanisms of MINOCA. Methods: In this prospective, multicenter, international, observational study, we enrolled women with a clinical diagnosis of MI. If invasive coronary angiography revealed <50% stenosis in all major arteries, multi-vessel OCT was performed, followed by CMR (cine imaging, late gadolinium enhancement, and T2-weighted imaging and/or T1 mapping). Angiography, OCT, and CMR were evaluated ...

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    11. External elastic lamina vs. luminal diameter measurement for determining stent diameter by optical coherence tomography: an ILUMIEN III substudy

      External elastic lamina vs. luminal diameter measurement for determining stent diameter by optical coherence tomography: an ILUMIEN III substudy

      Aims Optical coherence tomography (OCT)-guided external elastic lamina (EEL)-based stent sizing is safe and as effective as intravascular ultrasound in achieving post-procedural lumen dimensions. However, when compared with automated lumen diameter (LD) measurements, this approach is time-consuming. We aimed to compare vessel diameter measurements and stent diameter selection using either of these approaches and examined whether applying a correction factor to automated LD measurements could result in selecting similar stent diameters to the EEL-based approach. Methods and results We retrospectively compared EEL-based measurements vs. automated LD in reference segments in 154 OCT acquisitions and derived a correction factor ...

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    12. A case report of a coronary myocardial bridge with impaired full-cycle ratio during dobutamine challenge

      A case report of a coronary myocardial bridge with impaired full-cycle ratio during dobutamine challenge

      Background A myocardial bridge (MB) is a coronary variant in which an epicardial coronary artery tunnels through the myocardial band. Although MBs have been reported to cause ischaemia, physiological assessment of an MB has not been fully established. Case summary We encountered a case with exertional chest pain who underwent coronary angiography showing an MB at the mid-left anterior descending artery with systolic compression. Optical coherence tomography showed an MB defined as a homogeneous intermediate intensity surrounding the epicardial artery. The full-cycle ratio, defined as the lowest ratio of distal coronary pressure ( P d ) to aortic pressure ( P a ) during ...

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    13. Competency-Based Assessment of Interventional Cardiology Fellows’ Abilities in Intracoronary Physiology and Imaging

      Competency-Based Assessment of Interventional Cardiology Fellows’ Abilities in Intracoronary Physiology and Imaging

      Although coronary angiography remains necessary for percutaneous coronary intervention, it provides limited information about lesion morphology, functional significance, and percutaneous coronary intervention results-limitations that are addressed by intravascular imaging and invasive physiology with demonstrated improve procedural and clinical outcomes.

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    14. In-Stent Restenosis Lesion Morphology Related to Repeat Stenting Underexpansion as Evaluated by Optical Coherence Tomography

      In-Stent Restenosis Lesion Morphology Related to Repeat Stenting Underexpansion as Evaluated by Optical Coherence Tomography

      Aims: To use optical coherence tomography (OCT) to predict newly implanted stent expansion for treatment of in-stent restenosis (ISR). Methods and results: With OCT-guidance, 143 ISR lesions were treated with a new stent. Stent underexpansion was defined as minimum stent area (MSA) <4.5mm 2 and MSA/average of reference lumen area <70%. New stent underexpansion was found in 33 lesions (23%), had a smaller old stent MSA (4.13 [3.32-4.62] versus 5.18 [4.01-6.38] mm 2 , p=0.001), and had a higher prevalence of multiple old stent layers (51.5% versus 10.9%, p ...

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    15. The “Oculo‐Appositional Reflex”: Should Optical Coherence Tomography–Detected Stent Malapposition Be Corrected?

      The “Oculo‐Appositional Reflex”: Should Optical Coherence Tomography–Detected Stent Malapposition Be Corrected?

      Stent malposition, recognized as an entity with the advent of intravascular imaging, refers to the lack of full contact between stent struts and the vessel wall after percutaneous coronary intervention ( Figure ). Malapposition may be present immediately after placement of stents (acute stent malapposition), or it may develop later (late stent malapposition), which can, in turn, be categorized as late persistent malapposition (ongoing since the time of implantation) or late acquired malapposition (developing de novo during follow‐up). 1

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    16. Covering our tracks – optical coherence tomography to assess vascular healing

      Covering our tracks – optical coherence tomography to assess vascular healing

      Over the better part of two decades, lessons learned from stent failure have led to technical advances that have resulted in current-generation metallic drug-eluting stents (DES) with very low rates of target lesion failure (TLF) and stent thrombosis 1 . Continued efforts have been directed at achieving iterative improvements in the design of DES to enhance adaptive vascular healing following vascular injury. By promoting early strut coverage with minimal neointimal hyperplasia but a functioning endothelial layer, stent thrombosis may be minimised and, by reducing the inflammatory response to the foreign

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    17. A prospective, single‐center, randomized study to assess whether automated coregistration of optical coherence tomography with angiography can reduce geographic miss

      A prospective, single‐center, randomized study to assess whether automated coregistration of optical coherence tomography with angiography can reduce geographic miss

      Objective We sought to evaluate whether automated coregistration of optical coherence tomography (OCT) with angiography reduces geographic miss (GM) during coronary stenting. Background Previous intravascular ultrasound or OCT studies have showed that residual disease at the stent edge or stent edge dissection was associated with stent thrombosis or edge restenosis. This has been termed GM. Methods Two hundred de novo coronary lesions were randomized in a 1:1 ratio to OCT‐guided percutaneous coronary intervention (PCI) with versus without automated coregistration of OCT with angiography. GM, the primary endpoint, was defined as angiographic ≥type B dissection or diameter stenosis >50 ...

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    18. Effect of orbital atherectomy in calcified coronary artery lesions as assessed by optical coherence tomography

      Effect of orbital atherectomy in calcified coronary artery lesions as assessed by optical coherence tomography

      Objectives We sought to assess plaque modification and stent expansion following orbital atherectomy (OA) for calcified lesions using optical coherence tomography (OCT). Background The efficacy of OA for treating calcified lesions is not well studied, especially using intravascular imaging in vivo. Methods OCT was performed preprocedure, post‐OA, and post‐stent ( n  = 58). Calcium modification after OA was defined as a round, concave, polished calcium surface. Calcium fracture was complete discontinuity of calcium. Results Comparing pre‐ vs post‐OA OCT ( n  = 29), calcium area was significantly decreased post‐OA (from 3.4 mm 2 [2.4–4.7] to 2 ...

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    19. Algorithmic Approach for Optical Coherence Tomography–Guided Stent Implantation During Percutaneous Coronary Intervention

      Algorithmic Approach for Optical Coherence Tomography–Guided Stent Implantation During Percutaneous Coronary Intervention

      Intravascular imaging plays a key role in optimizing outcomes for percutaneous coronary intervention (PCI). Optical coherence tomography (OCT) utilizes a user-friendly interface and provides high-resolution images. OCT can be used as part of daily practice in all stages of a coronary intervention: baseline lesion assessment, stent selection, and stent optimization. Incorporating a standardized, algorithmic approach when using OCT allows for precision PCI.

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    20. Bifurcation and Ostial Optical Coherence Tomography Mapping (BOOM) – Case Description of a Novel Bifurcation Stent Technique

      Bifurcation and Ostial Optical Coherence Tomography Mapping (BOOM) – Case Description of a Novel Bifurcation Stent Technique

      Stent placement guided by angiography alone is often inexact, but of increased importance with bifurcation percutaneous coronary intervention (PCI). We describe a novel technique using optical coherence tomography (OCT)-guided angiographic co-registration termed “Bifurcation and Ostial OCT Mapping” (BOOM). The technique is based on the precise identification and mapping of the side-branch ostium using co-registration to minimize protrusion of stent struts into the main branch while ensuring full coverage of the ostium in the side-branch.

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    21. Utility of intracoronary imaging in the cardiac catheterization laboratory: comprehensive evaluation with intravascular ultrasound and optical coherence tomography

      Utility of intracoronary imaging in the cardiac catheterization laboratory: comprehensive evaluation with intravascular ultrasound and optical coherence tomography

      Background Intracoronary imaging is an important tool for guiding decision making in the cardiac catheterization laboratory. Sources of data We have reviewed the latest available evidence in the field to highlight the various potential benefits of intravascular imaging. Areas of agreement Coronary angiography has been considered the gold standard test to appropriately diagnose and manage patients with coronary artery disease, but it has the inherent limitation of being a 2-dimensional x-ray lumenogram of a complex 3-dimensional vascular structure. Areas of controversy There is well-established inter- and intra-observer variability in reporting coronary angiograms leading to potential variability in various management strategies ...

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    22. IVUS-Guided Versus OCT-Guided Coronary Stent Implantation: A Critical Appraisal

      IVUS-Guided Versus OCT-Guided Coronary Stent Implantation: A Critical Appraisal

      Procedural guidance with intravascular ultrasound (IVUS) imaging improves the clinical outcomes of patients undergoing percutaneous coronary intervention (PCI) by: 1) informing the necessity for lesion preparation; 2) directing appropriate stent sizing to maximize the final stent area and minimize geographic miss; 3) selecting the optimal stent length to cover residual disease adjacent to the lesion, thus minimizing geographic miss; 4) guiding optimal stent expansion; 5) identifying acute complications (edge dissection, stent malapposition, tissue protrusion); and 6) clarifying the mechanism of late stent failure (stent thrombosis, neointimal hyperplasia, stent underexpansion or fracture, or neoatherosclerosis). Optical coherence tomography (OCT) provides similar information ...

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    1-24 of 43 1 2 »
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