1. Articles from Lorenz Räber

    1-24 of 39 1 2 »
    1. Optical Coherence Tomography Findings After Atherectomy Devices | Icr Journal

      Optical Coherence Tomography Findings After Atherectomy Devices | Icr Journal

      Heavily calcified coronary artery lesions hinder the delivery of devices and limit stent expansion, resulting in low procedural success and poor clinical outcomes driven by an increase in restenosis and stent thrombosis. Intracoronary imaging provides a more precise assessment of lesions and is a critical step when deciding whether the lesion needs to be prepared with atherectomy devices. Physiological assessment of lesion significance is an important consideration to avoid unnecessary stenting. This article summarises the current data on the value of intracoronary imaging and functional assessment for coronary calcified lesions and suggests a treatment strategy based on the findings of ...

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    2. Effects of the PCSK9 Antibody Alirocumab on Coronary Atherosclerosis in Patients with Acute Myocardial Infarction: A Serial, Multivessel, Intravascular Ultrasound, Near-Infrared Spectroscopy and Optical Coherence Tomography Imaging Study Rationale and Des

      Effects of the PCSK9 Antibody Alirocumab on Coronary Atherosclerosis in Patients with Acute Myocardial Infarction: A Serial, Multivessel, Intravascular Ultrasound, Near-Infrared Spectroscopy and Optical Coherence Tomography Imaging Study Rationale and Des

      Background: The risk for cardiovascular adverse events after acute myocardial infarction (AMI) remains high despite potent medical treatment including low-density lipoprotein cholesterol (LDL-C) lowering with statins. Proprotein convertase subtilisin/kexin type 9 (PCSK9) antibodies substantially reduce LDL-C when added to statin. Alirocumab, a momoclonal antibody to PCSK9, reduces major adverse cardiovascular events after AMI. The effects of alirocumab on coronary atherosclerosis including plaque burden, plaque composition and fibrous cap thickness in patients presenting with AMI remains unknown. Aims: To determine the effect of LDL-C lowering with alirocumab on top of high-intensitv statin therapy on intravascular ultrasound (IVUS)-derived percent atheroma ...

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    3. Peri-procedural stent thrombosis following bifurcational PCI of lipid-rich plaque: serial optical coherence tomography insights

      Peri-procedural stent thrombosis following bifurcational PCI of lipid-rich plaque: serial optical coherence tomography insights

      Pre-procedural optical coherence tomography (OCT) of the left anterior descending artery (LAD) in a 58-year-old man with unstable angina due to a stenosis involving LAD and first diagonal branch detected underlying mixed plaque, partially containing lipid in a circumferential distribution distal to the first diagonal branch (Figures A1-3). Bifurcational percutaneous coronary intervention with side-branch-stenting (double-kissing mini-crush: 2.0x18mm zotarolimus-eluting-stent (ZES) in diagonal branch, 2.25x38mm-ZES in LAD with post-dilation using 3.0x20mm and 3.5x8mm non-compliant balloons) was performed after loading with ticagrelor (180mg) and cumulative administration of 15’000 IU of heparin to achieve an activated clotting time >250 ...

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    4. Coronary Artery Occlusion Caused by Intramural Hematoma Due to In-Stent Dissection

      Coronary Artery Occlusion Caused by Intramural Hematoma Due to In-Stent Dissection

      A 54-year-old man developed ST-segment elevation myocardial infarction 1 week after percutaneous coronary intervention of the left anterior descending artery. Optical coherence tomography at the emergent percutaneous coronary intervention revealed an intramural hematoma extending from the in-stent dissection. We highlight that in-stent dissection, although generally considered a benign finding, can extend and cause intramural hematoma, resulting in coronary artery occlusion.

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    5. ST-elevation myocardial infarction and pulmonary embolism in a patient with COVID-19 acute respiratory distress syndrome

      ST-elevation myocardial infarction and pulmonary embolism in a patient with COVID-19 acute respiratory distress syndrome

      The clinical course of an 82-year-old patient with acute respiratory distress syndrome due to SARS-CoV-2 infection was complicated by concomitant ST-elevation myocardial infarction and pulmonary embolism. An 82-year-old man was diagnosed with COVID-19 following a positive test for SARS-CoV-2 in the presence of symptoms of fever and mild dyspnoea. Following self-isolation at home for 1 week, the patient was hospitalized due to severe respiratory distress. Physical examination revealed a body temperature of 39.0°C, blood pressure of 152/113 mmHg, heart rate of 160 b.p.m., and an oxygen saturation of 78% on 10 L of oxygen. Laboratory ...

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    6. Utility of Multimodality Intravascular Imaging and the Local Hemodynamic Forces to Predict Atherosclerotic Disease Progression

      Utility of Multimodality Intravascular Imaging and the Local Hemodynamic Forces to Predict Atherosclerotic Disease Progression

      Objectives This study sought to examine the utility of multimodality intravascular imaging and of the endothelial shear stress (ESS) distribution to predict atherosclerotic evolution. Background There is robust evidence that intravascular ultrasound (IVUS)-derived plaque characteristics and ESS distribution can predict, with however limited accuracy, atherosclerotic evolution; nevertheless, it is yet unclear whether multimodality imaging and ESS mapping enable more accurate prediction of coronary plaque progression. Methods A total of 44 patients admitted with a myocardial infarction that had successful revascularization and 3-vessel IVUS and optical coherence tomography (OCT) imaging at baseline and 13-month follow-up were included in the study ...

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    7. Randomized comparison of optical coherence tomography versus angiography to guide Bioresorbable vascular scaffold implantation: The OPTICO BVS stud

      Randomized comparison of optical coherence tomography versus angiography to guide Bioresorbable vascular scaffold implantation: The OPTICO BVS stud

      Purpose We investigated whether optical coherence tomography (OCT)-guided bioresorbable vascular scaffolds (BVS) implantation can improve in-scaffold minimal lumen area (MLA) at 6-month compared with angiography guidance. Methods The OPTICO BVS was a randomized, international multicenter, assessor blind, superiority trial comparing OCT- versus angiography-guided percutaneous coronary intervention (PCI) (1:1 allocation) in patients with coronary artery disease undergoing Absorb BVS 1.1 implantation. The primary endpoint was in-scaffold MLA at 6-month. Results The trial was prematurely stopped on May 31, 2017 after enrollment of 38 of 270 planned patients (14%) following the retraction of the device in Europe. Patients were ...

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    8. Mechanism of Drug-Eluting Absorbable Metal Scaffold Restenosis: A Serial Optical Coherence Tomography Study

      Mechanism of Drug-Eluting Absorbable Metal Scaffold Restenosis: A Serial Optical Coherence Tomography Study

      Background: The pathomechanisms underlying restenosis of the bioabsorbable sirolimus-eluting metallic scaffold (Magmaris) remain unknown. Using serial optical coherence tomography, we investigated causes of restenosis, including the contribution of late scaffold recoil versus neointimal hyperplasia. Methods: Patients enrolled in BIOSOLVE-II undergoing serial angiography and optical coherence tomography (post-intervention and follow-up: 6 months and/or 1 year) were analyzed. Patients were divided into 2 groups according to angiographic in-scaffold late lumen loss (LLL) <0.5 or ≥0.5 mm. End points were late absolute scaffold recoil and neointimal hyperplasia area as assessed by optical coherence tomography. Results: Serial data were available for ...

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    9. In vivo relationship between near-infrared spectroscopy-detected lipid-rich plaques and morphological plaque characteristics by optical coherence tomography and intravascular ultrasound: a multimodality intravascular imaging study

      In vivo relationship between near-infrared spectroscopy-detected lipid-rich plaques and morphological plaque characteristics by optical coherence tomography and intravascular ultrasound: a multimodality intravascular imaging study

      Aims We assessed morphological features of near-infrared spectroscopy (NIRS)-detected lipid-rich plaques (LRPs) by using optical coherence tomography (OCT) and intravascular ultrasound (IVUS). Methods and results IVUS-NIRS and OCT were performed in the two non-infarct-related arteries (non-IRAs) in patients undergoing percutaneous coronary intervention for treatment of an acute coronary syndrome. A lesion was defined as the 4 mm segment with the maximum amount of lipid core burden index (maxLCBI 4mm ) of each LRP detected by NIRS. We divided the lesions into three groups based on the maxLCBI 4mm value: <250, 250–399, and ≥400. OCT analysis and IVUS analysis were ...

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    10. Efficacy and Reproducibility of Attenuation-Compensated Optical Coherence Tomography for Assessing External Elastic Membrane Border and Plaque Composition in Native and Stented Segments ― An In Vivo and Histology-Based Study ―

      Efficacy and Reproducibility of Attenuation-Compensated Optical Coherence Tomography for Assessing External Elastic Membrane Border and Plaque Composition in Native and Stented Segments ― An In Vivo and Histology-Based Study ―

      Background: Attenuation-compensated (AC) technique was recently introduced to improve the plaque characterization of optical coherence tomography (OCT). Histological validation demonstrated promising results but the efficacy and reproducibility of this technique for assessing in-vivo tissue composition remains unclear. Methods and Results: OCT images portraying native (n=200) and stented (n=200) segments and 31 histological cross-sections were analyzed. AC-OCT appeared superior to conventional (C)-OCT in detecting the external elastic lamina (EEM) borders (76% vs. 65.5%); AC-OCT enabled larger EEM arc detection compared with C-OCT (174.2±58.7° vs. 137.5±57.9°; P<0.001). There was poor ...

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    11. Correlation between in vivo near-infrared spectroscopy and optical coherence tomography detected lipid-rich plaques with post-mortem histology

      Correlation between in vivo near-infrared spectroscopy and optical coherence tomography detected lipid-rich plaques with post-mortem histology

      A 67-year-old female presented with an acute anterior STEMI and underwent percutaneous coronary intervention of the mid-left anterior descending (LAD) coronary artery. Following successful implantation of two drug-eluting stents with TIMI III flow, multimodality imaging using near-infrared spectroscopy with intravascular ultrasound (NIRS-IVUS) and optical coherence tomography (OCT) was performed in the LAD and right coronary artery (RCA) in the setting of an imaging study (A1 and B1).

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    12. Diagnosis of malignant coronary vasospasm by 12-lead Holter electrocardiogram and optical coherence tomography

      Diagnosis of malignant coronary vasospasm by 12-lead Holter electrocardiogram and optical coherence tomography

      A 73-year-old man presented with recurrent syncopes preceded by angina. Three years earlier, the patient had a pacemaker implanted due to symptomatic sick sinus syndrome. Device interrogation showed several torsade-like ventricular tachycardias (VTs) corresponding with the symptoms. Left ventricular ejection fraction was normal. Coronary angiography revealed diffuse coronary sclerosis and a hazy 50% lesion in the mid left anterior descending artery (LAD), which was treated with a drug-eluting stent. Three days later, the patient experienced another syncope with documentation of ventricular fibrillation by the provided life-vest ( Panel A ). The pacemaker was upgraded to an implantable cardioverter-defibrillator. During subsequent workup, a ...

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    13. Clinical use of intracoronary imaging. Part 2: acute coronary syndromes, ambiguous coronary angiography findings, and guiding interventional decision-making: an expert consensus document of the European Association of Percutaneous Cardiovascular Intervent

      Clinical use of intracoronary imaging. Part 2: acute coronary syndromes, ambiguous coronary angiography findings, and guiding interventional decision-making: an expert consensus document of the European Association of Percutaneous Cardiovascular Intervent

      This consensus document is the second of two reports summarizing the views of an expert panel organized by the European Association of Percutaneous Cardiovascular Interventions (EAPCI) on the clinical use of intracoronary imaging including intravascular ultrasound (IVUS), optical coherence tomography (OCT), and near infrared spectroscopy (NIRS)-IVUS. Beyond guidance of stent selection and optimization of deployment, invasive imaging facilitates angiographic interpretation and may guide treatment in acute coronary syndrome. Intravascular imaging can provide additional important diagnostic information when confronted with angiographically ambiguous lesions and allows assessment of plaque morphology enabling identification of vulnerability characteristics. This second document focuses on useful ...

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    14. Clinical use of intracoronary imaging. Part 2: acute coronary syndromes, ambiguous coronary angiography findings, and guiding interventional decision-making: an expert consensus document of the European Association of Percutaneous Cardiovascular Intervent

      Clinical use of intracoronary imaging. Part 2: acute coronary syndromes, ambiguous coronary angiography findings, and guiding interventional decision-making: an expert consensus document of the European Association of Percutaneous Cardiovascular Intervent

      This consensus document is the second of two reports summarizing the views of an expert panel organized by the European Association of Percutaneous Cardiovascular Interventions (EAPCI) on the clinical use of intracoronary imaging including intravascular ultrasound (IVUS), optical coherence tomography (OCT), and near infrared spectroscopy (NIRS)-IVUS. Beyond guidance of stent selection and optimization of deployment, invasive imaging facilitates angiographic interpretation and may guide treatment in acute coronary syndrome. Intravascular imaging can provide additional important diagnostic information when confronted with angiographically ambiguous lesions and allows assessment of plaque morphology enabling identification of vulnerability characteristics. This second document focuses on useful ...

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    15. Changes in Coronary Plaque Composition in Patients With Acute Myocardial Infarction Treated With High-Intensity Statin Therapy (IBIS-4): A Serial Optical Coherence Tomography Study

      Changes in Coronary Plaque Composition in Patients With Acute Myocardial Infarction Treated With High-Intensity Statin Therapy (IBIS-4): A Serial Optical Coherence Tomography Study

      Objectives This study assessed changes in optical coherence tomography (OCT)-defined plaque composition in patients with ST-elevation myocardial infarction (STEMI) receiving high-intensity statin treatment. Background OCT is a high-resolution modality capable of measuring plaque characteristics including fibrous cap thickness (FCT) and macrophage infiltration. There is limited in vivo evidence regarding the effects of statins on OCT-defined coronary atheroma composition and no evidence in the context of STEMI. Methods In the IBIS-4 (Integrated Biomarker Imaging Study-4), 103 patients underwent intravascular ultrasonography and OCT of 2 noninfarct-related coronary arteries in the acute phase of STEMI. Patients were treated with high-dose rosuvastatin for ...

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    16. Clinical use of intracoronary imaging. Part 1: guidance and optimization of coronary interventions. An expert consensus document of the European Association of Percutaneous Cardiovascular Interventions

      Clinical use of intracoronary imaging. Part 1: guidance and optimization of coronary interventions. An expert consensus document of the European Association of Percutaneous Cardiovascular Interventions

      his Consensus Document is the first of two reports summarizing the views of an expert panel organized by the European Association of Percutaneous Cardiovascular Interventions (EAPCI) on the clinical use of intracoronary imaging including intravascular ultrasound (IVUS) and optical coherence tomography (OCT). The first document appraises the role of intracoronary imaging to guide percutaneous coronary interventions (PCIs) in clinical practice. Current evidence regarding the impact of intracoronary imaging guidance on cardiovascular outcomes is summarized, and patients or lesions most likely to derive clinical benefit from an imaging-guided intervention are identified. The relevance of the use of IVUS or OCT prior ...

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    17. Quality difference of neointima following the implantation of bioresorbable scaffold and metallic stent in patients with ST elevation myocardial infarction: quantitative assessments by light intensity, light attenuation, and backscatter on optical coheren

      Quality difference of neointima following the implantation of bioresorbable scaffold and metallic stent in patients with ST elevation myocardial infarction: quantitative assessments by light intensity, light attenuation, and backscatter on optical coheren

      Aims: We aimed to assess possible difference of the neointimal quality after everolimus-eluting bioresorbable scaffold (BVS) implantation in comparison with cobalt chromium everolimus-eluting scaffold (CoCr-EES) by optical frequency domain imaging (OFDI). Methods and results: This study is a post-hoc analysis of TROFI II trial assessing neointimal quality 6-month after the implantation of BVS(N=82) and CoCr-EES(N=87) in STEMI patients. Neointimal light property analysis by OFDI full-automatically computed light attenuation, backscatter and light intensity for superficial and deep neointima. High light attenuation/backscatter and high light intensity are reportedly associated with lipidic change and tissue maturation, respectively. Superficial ...

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    18. Serial Assessment of Tissue Precursors and Progression of Coronary Calcification Analyzed by Fusion of IVUS and OCT

      Serial Assessment of Tissue Precursors and Progression of Coronary Calcification Analyzed by Fusion of IVUS and OCT

      Objectives The aim of this study was to assess calcium growth with fused grayscale intravascular ultrasound (IVUS), IVUS–virtual histology, and optical coherence tomography (OCT) from baseline to 5-year follow-up in patients treated with bioresorbable vascular scaffolds. Background IVUS and OCT have individual strengths in assessing plaque composition and volume. Fusion of images obtained using these methods could potentially aid in coronary plaque assessment. Methods Anatomic landmarks and endoluminal radiopaque markers were used to fuse OCT and IVUS images and match baseline and follow-up. Results Seventy-two IVUS–virtual histology and OCT paired matched cross-sectional in- and out-scaffold segments were fused ...

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    19. Effect of Post-Dilatation Following Primary PCI With Everolimus-Eluting Bioresorbable Scaffold Versus Everolimus-Eluting Metallic Stent Implantation: An Angiographic and Optical Coherence Tomography TROFI II Substudy

      Effect of Post-Dilatation Following Primary PCI With Everolimus-Eluting Bioresorbable Scaffold Versus Everolimus-Eluting Metallic Stent Implantation: An Angiographic and Optical Coherence Tomography TROFI II Substudy

      Objectives This study sought to investigate the effect of post-dilatation on angiographic and intracoronary imaging parameters in the setting of primary percutaneous coronary intervention comparing the everolimus-eluting bioresorbable scaffold (BRS) with the everolimus-eluting metallic stent (EES). Background Routine post-dilatation of BRS has been suggested to improve post-procedural angiographic and subsequent device-related clinical outcomes. Methods In the ABSORB STEMI TROFI II trial, 191 patients with ST-segment elevation myocardial infarction were randomly assigned to treatment with BRS (n = 95) or EES (n = 96). Minimal lumen area and healing score as assessed by optical coherence tomography at 6 months were compared between BRS- ...

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    20. Optical coherence tomography- vs. intravascular ultrasound-guided percutaneous coronary intervention (Editorial)

      Optical coherence tomography- vs. intravascular ultrasound-guided percutaneous coronary intervention (Editorial)

      Coronary angiography is routinely used to guide percutaneous coronary interventions (PCI) despite obvious limitations of this lumen based approach. Intravascular imaging including intravascular ultrasound (IVUS) and optical coherence tomography (OCT) represent two techniques that provide essential information on pre-procedural lesion characteristics (i.e., lesion severity, landing zone, and plaque composition) and the result after stent implantation (i.e., stent expansion and eccentricity, strut apposition, lesion coverage, tissue protrusion, and dissections). A total of 11 randomized controlled trials investigated the effect of IVUS-guided PCI with mixed results ( 1 - 11 ). Of note, studies including patients with an increased complexity [i.e., chronic ...

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    21. Intracoronary optical coherence tomography: Clinical and research applications and intravascular imaging software overview

      Intracoronary optical coherence tomography: Clinical and research applications and intravascular imaging software overview

      By providing valuable information about the coronary artery wall and lumen, intravascular imaging may aid in optimizing interventional procedure results and thereby could improve clinical outcomes following percutaneous coronary intervention (PCI). Intravascular optical coherence tomography (OCT) is a light-based technology with a tissue penetration of approximately 1 to 3 mm and provides near histological resolution. It has emerged as a technological breakthrough in intravascular imaging with multiple clinical and research applications. OCT provides detailed visualization of the vessel following PCI and provides accurate assessment of post-procedural stent performance including detection of edge dissection, stent struts apposition, tissue prolapse, and healing ...

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    22. Variability in the measurement of minimum fibrous cap thickness and reproducibility of fibroatheroma classification by optical coherence tomography using manual versus semi-automatic assessment

      Variability in the measurement of minimum fibrous cap thickness and reproducibility of fibroatheroma classification by optical coherence tomography using manual versus semi-automatic assessment

      Aims: The minimum fibrous cap thickness (FCT) is considered a major criterion of coronary plaque vulnerability according to autopsy studies. We aimed to assess the reproducibility in the measurement of the optical coherence tomography (OCT)-detected minimum FCT and the agreement in the classification of thin-cap fibroatheroma (TCFA), by a software-based semi-automatic method compared with the manual method. Methods and results: A total of 50 frames with fibroatheromas (FA) were randomly selected from the Integrated Biomarker Imaging Study-4 (IBIS-4). Two experienced OCT analysts independently measured the minimum FCT at two different time points, manually and by three different semi-automatic software-based ...

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    23. Optical Coherence Tomography to Improve Outcome for Coronary Revascularisation Using Bioresorbable Vascular Scaffolds (OPTICO-BVS)

      Optical Coherence Tomography to Improve Outcome for Coronary Revascularisation Using Bioresorbable Vascular Scaffolds (OPTICO-BVS)

      Fully Bioresorbable Vascular Scaffolds (BVS) have been introduced with the objective to preserve native vessel geometry, allow for adaptive vessel remodeling with late lumen gain, restore physiological vasomotion, and avoid late adverse events including restenosis and scaffold thrombosis. Although randomized clinical trials in low risk patients to date suggest non-inferiority in terms of safety and efficacy compared with metallic DES, several reports have raised concerns regarding the scaffold thrombosis highlighting the importance of technical considerations regarding lesion preparation and scaffold expansion. OCT offers the opportunity to plan the procedure and optimize the implantation of BVS. The hypothesis of the present ...

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    24. Mechanisms of Very Late Drug-Eluting Stent Thrombosis Assessed by Optical Coherence Tomography

      Mechanisms of Very Late Drug-Eluting Stent Thrombosis Assessed by Optical Coherence Tomography

      Background —The pathomechanisms underlying very late stent thrombosis (VLST) after implantation of drug-eluting stents (DES) are incompletely understood. Using optical coherence tomography (OCT), we investigated potential causes of this adverse event. Methods and Results —Between August 2010 and December 2014, 64 patients were investigated at the time-point of VLST as part of an international OCT registry. OCT pullbacks were performed after restoration of flow and analyzed at 0.4mm. A total of 38 early- and 20 newer-generation DES were suitable for analysis. VLST occurred at a median time of 4.7 years (IQR 3.1 to 7.5). An underlying ...

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    1-24 of 39 1 2 »
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